Effect of Prophylactic Radiotherapy on Patients with Stage II-III Esophageal Cancer after Esophageal Cancer Radical Operation and Influencing Factors in Its Recurrence

Objective. To explore the effect of prophylactic radiotherapy on patients with stage II-III esophageal cancer (EC) after esophageal cancer radical operation (ECRO) and influencing factors on EC recurrence. Methods. Totally, 65 patients with EC in our hospital were enrolled. Among them, 30 patients were treated by routine ECRO as a control group (Con group) and 35 patients by prophylactic radiotherapy as a research group (Res group). Then, the following measures were taken: record the efficacy on both groups, quantify their C-reactive protein (CRP) and white blood cell count (WBC) before and after therapy, evaluate their mental state through the revised piper fatigue scale (PFS-R) before and after therapy, determine their changes in Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) before and after therapy, compare them in terms of lymph-node metastatic rate (LNMR), hematogenous metastasis rate (HMR), anastomotic recurrence rate (ARR), and 3-year survival rate, compare them in terms of life quality after therapy via the Quality of Life-Core Questionnaire (QLQ-C30), and analyze influencing factors on their recurrence. Results. The Res group showed a notably higher total effective rate (TER) than the Con group ( P = 0.037 ). After therapy, CRP and WBC in both groups increased, but their levels were not considerably different in both ( P > 0.05 ). Additionally, after therapy, in contrast to the Con group, the Res group got notably lower PFS-R, SDS, and SAS scores, showed notably lower LNMR and ARR and notably higher 3-year survival rate, and experienced notably higher life quality (all P < 0.05 ), and the HMR results were not considerably different in both groups ( P > 0.05 ). Moreover, carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), esophageal inflammation history, family medical history, postoperative complications, and lymphatic and vascular infiltration were risk factors for the disease recurrence, and treatment method was the protective factor for it. Conclusion. For patients with stage II-III EC after ECRO, prophylactic radiotherapy is highly effective and safe and can lower the recurrence rate, so it is worth popularizing in clinical practice.

Pattern of Locoregional Recurrence After Radical Surgery in Patients With Esophageal Squamous Cell Carcinoma and The Design of Target Volume of Postoperative Prophylactic Radiotherapy

Objective The study was undertaken to evaluate preferred sites for locoregional recurrence after radical surgery for patients with esophageal squamous cell carcinoma (ESCC) and to confirm the target volume of postoperative prophylactic radiotherapy.Methods 139 patients with locoregional recurrent ESCC after radical esophagectomy without postoperative radiotherapy were registered in this study. The sites of locoregional recurrence for these patients were collected and influence factors of locoregional recurrence were analyzed.Results The 1, 2, and 3-year progression-free survival rates were 48.2%, 18.0% and 8.6%, respectively. Mediastinum lymph node (LN) recurrence (74.2%) was the most frequent site of recurrence, following the anastomotic site (28.1%), supraclavicular LN (19.4%) and abdominal LN (15.1%) (P=0.000). The upper mediastinum (72.7%) was one of the most common recurrence occurred in mediastinal LN. Compared with upper and middle segment of ESCC, lower segment had the highest recurrence rate of upper abdominal LN (P=0.001). The predictive factors of anastomotic recurrence were the stage of pT3 or pT4, presence of nerve or vessel invasion, removed LN NO.≤ 17, presence of invasion or adhesion and without postoperative adjuvant chemotherapy. In addition, the risk factors of abdominal LN recurrence in patients with middle segment ESCC included the stage of pT3 or pT4, smoking history and without postoperative adjuvant chemotherapy.Conclusion For thoracic ESCC, supraclavicular, upper mediastinum, subcarinal LNs and anastomosis should be incorporated within target volume of postoperative prophylactic radiotherapy. Regarding to lower segment ESCC, target volume should include upper abdominal LNs. And it need cautious evaluated about upper abdominal LNs when presence of clinicopathologic factor in middle segment ESCC.

Effect of different prophylactic therapies on the recurrence pattern of esophageal squamous cell carcinoma after radical surgery

Background To compared the patterns of lymph node recurrence after different prophylactic therapies to identify specific and effective target areas for prophylactic radiotherapy. Methods This retrospective study enrolled patients with recurrence from August 2011 to November 2015, who underwent different prophylactic therapies for esophageal squamous cell carcinoma after radical surgery previously. The patients were divided into unprotected, radiotherapy, chemotherapy, and radiochemotherapy groups. The recurrence patterns between these groups were compared. Results A total of 186 patients who met the above criteria were enrolled. The recurrence ratios of regional lymph nodes were 84.2%, 31.3%, 84.0%, and 48.0% in the unprotected, radiotherapy, chemotherapy, and radiochemotherapy groups, respectively. The recurrence ratio of regional lymph nodes in patients who received radiotherapy was significantly decreased ( P =0.009). The recurrence ratio of superior mediastinal lymph node was significantly lower than those of the chemotherapy and unprotected groups ( P =0.000). The recurrence ratios of the radiotherapy group with and without epigastrium coverage were 4/16 and 4/25, respectively, indicating no statistical difference with those of other groups ( P =0.259). The recurrence ratios with and without the coverage of anastomotic sites were 2/19 and 3/22, respectively, revealing no statistical difference with those of other groups ( P =0.712). Conclusion Prophylactic radiotherapy can significantly reduce the recurrence of regional lymph nodes, especially lymph node recurrence on the superior mediastinum.

Rhegmatogenous retinal detachment secondary to isolated retinal metastasis from small cell lung carcinoma: An uncommon complication

Purpose: To report a case of rhegmatogenous retinal detachment associated with isolated retinal metastasis from lung carcinoma. Methods: Multimodal imaging, including wide-field retinal imaging, ultrasonic imaging, and magnetic resonance imaging. Results: Systemic chemotherapy and cranial prophylactic radiotherapy resulted in shrinkage of these lesions and retinal breaks making them much smaller and preventing progression of retinal detachment transiently. Conclusion: This is the first reported case of rhegmatogenous retinal detachment secondary to retinal metastasis from a lung cancer.

Prophylactic Irradiation of Tracts in Patients With Malignant Pleural Mesothelioma: An Open-Label, Multicenter, Phase III Randomized Trial

PURPOSE Prophylactic irradiation to the chest wall after diagnostic or therapeutic procedures in patients with malignant pleural mesothelioma (MPM) has been a widespread practice across Europe, although the efficacy of this treatment is uncertain. In this study, we aimed to determine the efficacy of prophylactic radiotherapy in reducing the incidence of chest wall metastases (CWM) after a procedure in MPM. METHODS After undergoing a chest wall procedure, patients with MPM were randomly assigned to receive prophylactic radiotherapy (within 42 days of the procedure) or no radiotherapy. Open thoracotomies, needle biopsies, and indwelling pleural catheters were excluded. Prophylactic radiotherapy was delivered at a dose of 21 Gy in three fractions over three consecutive working days, using a single electron field adapted to maximize coverage of the tract from skin surface to pleura. The primary outcome was the incidence of CWM within 6 months from random assignment, assessed in the intention-to-treat population. Stratification factors included epithelioid histology and intention to give chemotherapy. RESULTS Between July 30, 2012, and December 12, 2015, 375 patients were recruited from 54 centers and randomly assigned to receive prophylactic radiotherapy (n = 186) or no prophylactic radiotherapy (n = 189). Participants were well matched at baseline. No significant difference was seen in the incidence of CWM at 6 months between the prophylactic radiotherapy and no radiotherapy groups (no. [%]: 6 [3.2] v 10 [5.3], respectively; odds ratio, 0.60; 95% CI, 0.17 to 1.86; P = .44). Skin toxicity was the most common radiotherapy-related adverse event in the prophylactic radiotherapy group, with 96 patients (51.6%) receiving grade 1; 19 (10.2%), grade 2; and 1 (0.5%) grade 3 radiation dermatitis (Common Terminology Criteria for Adverse Events, version 4.0). CONCLUSION There is no role for the routine use of prophylactic irradiation to chest wall procedure sites in patients with MPM.