PS02.035: CIRCUMFERENTIAL ENDOSCOPIC SUBMUCOSAL DISSECTION OF A LARGE SUPERFICIAL OESOPHAGUS SQUAMOUS CELL CANCER WITHOUT STRICTURES ON FOLLOW-UP

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 129-130
Author(s):  
Francisco Baldaque-Silva ◽  
Magnus Konradsson ◽  
Naning Wang ◽  
Masami Omae
Keyword(s):  
Hyaluronic Acid ◽  
Endoscopic Submucosal Dissection ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
High Volume ◽  
Stricture Formation ◽  
Submucosal Dissection ◽  
Oral Steroids

Abstract Description The optimal treatment for oesophageal superficial squamous cell cancer (SCC) is end bloc resection, that in large lesions is only possible with endoscopic submucosal dissection (ESD). Resections larger than 3cm, in the upper esophagus and encompassing more than 3/4 of the luminal circumference, are associated with high stricture rate. That risk is virtually 100% in cases of circumferential ESD. High focus had been given to preventive measurements such as steroids injection, oral steroids or cell sheet transplantation. Usually highly osmotic substances such as Glicerol ® are used for subepitelial lifting. Hyaluronic acid has high viscosity and anti-inflammatory proprieties, that due to its high cost is not widely used in ESD or is used in low concentration formulas and low volume. We report a case of a 7.5 cm long circumferential oesophageal ESD performed with injection of a high volume and concentration of hyaluronic acid that was not associated with stricture in the follow-up. A 73 years-old male patient was referred to our clinic due to the presence of a long superficial lesion and biopsies positive for SCC. We performed chromoendoscopy with lugol that revealed the presence of a ca 6cm long Paris IIa-b, circumferential SCC in the middle esophagus with ‘Tatami-no-me ‘and ‘pink-color’ signs, without ulcers or other endoscopic signs of deep invasion. The PET-CT was negative for metastasis. After multidisciplinary conference and patient's consent an ESD was performed under full narcosis using Dualknife ® and hyaluronic acid for subepitelial injection. A 7.5 cm circumferential ESD specimen was resected and the patient was discharged at day 3 without complications under proton pump Inhibitors and a step-down dose of 30mg/d of oral prednisolone. The pathological result revealed R0 resection of a SCC with invasion of the superficial muscularis mucosae (T1a) and no lymphovascular engagement. The follow-up at 2, 5, 8 weeks and 6, 9 and 12 months revealed the absence of stricture. There was no cancer recurrence in the last follow-up (1 year). Long circumferential ESD of oesophageal SCC is possible with curative intent. The combination of PPI, oral steroids and high volume/concentration of hyaluronic acid, avoided stricture formation in this case. Disclosure All authors have declared no conflicts of interest.

scholarly journals Endoscopic submucosal dissection of a large squamous cell cancer using the proximal mucosal bridge technique

Endoscopy ◽  
2019 ◽  
Vol 51 (08) ◽  
pp. E209-E210 ◽  
Author(s):  
Salmaan Jawaid ◽  
Dennis Yang ◽  
Peter V. Draganov
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Submucosal Dissection

Topical oro-dispersible budesonide tablets for stricture prevention after near circumferential ESD for esophageal squamous cell cancer – a case report

2021 ◽  
Author(s):  
Daniel Mathies ◽  
Tsuneo Oyama ◽  
Ingo Steinbrück ◽  
Franz Ludwig Dumoulin
Keyword(s):  
Case Report ◽  
High Risk ◽  
Endoscopic Resection ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Complete Healing ◽  
Esophageal Squamous Cell Cancer ◽  
Stricture Formation ◽  
Local Injections

Abstract Background Endoscopic resection is the treatment of choice for early esophageal cancers. However, resections comprising more than 70–80 % of the circumference are associated with a high risk of stricture formation. Currently, repetitive local injections and/or systemic steroids are given for prevention. Case report We present here the case of a 78-year-old male patient who had a near circumferential endoscopic submucosal dissection for a pT1a mm, L0, V0, R0, G2 esophageal squamous cell cancer. At the end of endoscopic resection, 80 mg of triamcinolone was injected locally. The patient was then treated with oro-dispersible budesonide tablets (2 × 1 mg/day) and nystatin (4 × 100 000 I.E.) for 8 weeks. This treatment resulted in complete healing without any stricture formation and did not result in any complications. Discussion Treatment with orodispersible budesonide tablets could help prevent strictures after large endoscopic resections in the esophagus.

scholarly journals Low cardiac dose and neutrophil-to-lymphocyte ratio predict overall survival in inoperable esophageal squamous cell cancer patients after chemoradiotherapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yu-Chieh Ho ◽  
Yuan-Chun Lai ◽  
Hsuan-Yu Lin ◽  
Ming-Hui Ko ◽  
Sheng-Hung Wang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cancer Patients ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Performance Status ◽  
Cell Cancer ◽  
Esophageal Squamous Cell Cancer ◽  
Lymphocyte Ratio ◽  
Cardiac Dose

AbstractWe aimed to determine the prognostic significance of cardiac dose and hematological immunity parameters in esophageal cancer patients after concurrent chemoradiotherapy (CCRT). During 2010–2015, we identified 101 newly diagnosed esophageal squamous cell cancer patients who had completed definitive CCRT. Patients' clinical, dosimetric, and hematological data, including absolute neutrophil count, absolute lymphocyte count, and neutrophil-to-lymphocyte ratio (NLR), at baseline, during, and post-CCRT were analyzed. Cox proportional hazards were calculated to identify potential risk factors for overall survival (OS). Median OS was 13 months (95% confidence interval [CI]: 10.38–15.63). Univariate analysis revealed that male sex, poor performance status, advanced nodal stage, higher percentage of heart receiving 10 Gy (heart V10), and higher NLR (baseline and follow-up) were significantly associated with worse OS. In multivariate analysis, performance status (ECOG 0 & 1 vs. 2; hazard ratio [HR] 3.12, 95% CI 1.30–7.48), heart V10 (> 84% vs. ≤ 84%; HR 2.24, 95% CI 1.26–3.95), baseline NLR (> 3.56 vs. ≤ 3.56; HR 2.36, 95% CI 1.39–4.00), and follow-up NLR (> 7.4 vs. ≤ 7.4; HR 1.95, 95% CI 1.12–3.41) correlated with worse OS. Volume of low cardiac dose and NLR (baseline and follow-up) were associated with worse patient survival.

Pembrolizumab for previously treated advanced cervical squamous cell cancer: Preliminary results from the phase 2 KEYNOTE-158 study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5514-5514 ◽  
Author(s):  
Jan H.M. Schellens ◽  
Aurelien Marabelle ◽  
Susan Zeigenfuss ◽  
Jie Ding ◽  
Scott Knowles Pruitt ◽  
...  
Keyword(s):  
Antitumor Activity ◽  
Cancer Progression ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Tumor Biomarker ◽  
Phase 2 ◽  
Biomarker Analysis ◽  
Previously Treated

5514 Background: In the phase 1b KEYNOTE-028 study, pembrolizumab showed promising activity as monotherapy in patients with advanced cervical cancers that expressed PD-L1. As part of the ongoing, multicohort, phase 2 KEYNOTE-158 study (NCT02628067), we assessed the antitumor activity of pembrolizumab in a larger cohort of patients with previously treated, advanced cervical squamous cell cancer who were enrolled without regard to tumor PD-L1 or other tumor biomarker expression. Methods: Key eligibility criteria for this cohort included age ≥18 years, histologically or cytologically confirmed advanced cervical squamous cell cancer, progression on or intolerance to ≥1 line of standard therapy, ECOG PS 0 or 1, and provision of a tumor sample for biomarker analysis. Patients received pembrolizumab 200 mg Q3W for 2 years or until progression, intolerable toxicity, or physician or patient decision. Clinically stable patients with progression could remain on treatment until progression was confirmed on subsequent assessment. Tumor imaging was performed every 9 weeks for the first 12 months and every 12 weeks thereafter. PD-L1 positivity was evaluated retrospectively by IHC and was defined as a combined positive score ≥1%. Primary end point was ORR assessed per RECIST v1.1 by independent central radiologic review. Planned enrollment is ~100 patients. This efficacy analysis includes patients who had ≥18 weeks of follow-up as of Oct 19, 2016. Results: Among the first 47 patients with advanced cervical cancer who enrolled, ORR was 17% (95% CI, 8%-31%), with 3 confirmed and 5 unconfirmed responses. 41 (87%) patients had PD-L1–positive tumors, and ORR was independent of PD-L1 status. Among the 15 patients who had ≥27 weeks of follow-up, ORR was 27% (95% CI 8%-55%), with 3 confirmed responses and 1 unconfirmed response. Safety and updated efficacy data for 83 patients with ≥27 weeks of follow-up will be available for presentation. Conclusions: Preliminary data from KEYNOTE-158 suggest that pembrolizumab has promising antitumor activity in patients with previously treated advanced cervical squamous cell cancer. The observed ORR with pembrolizumab appears to increase with longer follow-up. Clinical trial information: NCT02628067.

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