No abstract

We retrospectively investigated the efficacy and feasibility of concurrent chemoradiotherapy for patients with severe dysphagia caused by oesophageal squamous cell carcinoma. Concurrent chemoradiotherapy was performed in 57 patients with T3 or T4 disease containing M1 lymph node (LYM) disease. Chemotherapy consisted of protracted infusion of 5-fluorouracil (5-FU) 400 mg m À2 24 h À1 on days 1 -5 and 8 -12, combined with 2-h infusion of cisplatin (CDDP) 40 mg m À2 on days 1 and 8. Radiation treatment at a dose of 30 Gy in 15 fractions of the mediastinum was administered concomitantly with chemotherapy. A course schedule with 3-week treatment and a 1 to 2-week break was applied twice, with a total radiation dose of 60 Gy, followed by two or more courses of 5-FU and CDDP. In all, 24 patients (42%) achieved a complete response, and the 3-year survival rate was 19%. Major toxicities were leukocytopenia and oesophagitis, and there were two (4%) treatment-related deaths. In contrast, 22 patients with T3 disease survived longer than 35 patients with T4 disease (P ¼ 0.001); however, the survival rate in 15 patients with M1 LYM disease did not differ significantly from that in 42 patients without M1 LYM disease (P ¼ 0.3545). Our results indicate that definitive chemoradiotherapy is potentially curative for locally advanced oesophageal carcinoma with malignant stricture. The efficacy and survival of patients treated with this regimen are related to the T factor.

Scan the quick response (QR) code to the left with your mobile device to watch this article's video abstract and others. Don't have a QR code reader? Get one by searching 'QR Scanner' in your mobile device's app store. R ecently, the American Society of GastrointestinalEndoscopy established the Preservation and Incorporation of Valuable Endoscopic Innovations 1 for diminutive colorectal polyps. Preservation and Incorporation of Valuable Endoscopic Innovations suggests that, if an endoscopist diagnoses an agreement of >90% in determining postpolypectomy surveillance intervals and a negative predictive value of >90% with adenomatous histology, pathologic diagnosis might not be necessary. Although magnifying chromoendoscopy, 2 narrow-band imaging (NBI), 3 endocytoscopy (EC), 4 and confocal laser endomicroscopy 5 are highly accurate, interpretation of these modalities is difficult for novices. Furthermore, achieving a negative predictive value of >90% for adenoma is not easy using these modalities 3 and requires comprehensive experiments. 6 To achieve a breakthrough on this issue, we developed a computer-aided diagnosis (CAD) system for EC. This system automatically provides highly accurate diagnosis as expert endoscopists concurrently take EC images (Video Clip 1). 7 Our previous system, based on glandular structural and cellular atypia, required endoscopists to use dye for staining. In contrast, the endocytoscopic vascular pattern can effectively evaluate microvessel findings using EC with NBI (EC-NBI) without using any dye. We reported that EC-NBI has a highly accurate diagnostic ability, similar to other modalities. 8 Because dye staining complicates the procedure, our CAD system for EC-NBI represents a powerful tool for novices and experts who do not use dyes on a routine basis. Therefore, we developed a tentative CAD system model for EC-NBI image. Description of TechnologyWe developed custom software (EndoBRAIN, Cybernet Systems Co., Ltd., Tokyo, Japan) to analyze EC images. We collected a consecutive series of 1079 EC-NBI images (431 nonneoplasms and 648 neoplasms) from 85 lesions to form an image database. To validate the CAD system, we randomly extracted 100 images (50 nonneoplasms, 50 neoplasms) from the database. The remaining 979 images (381 nonneoplasms, 598 neoplasms) were used for machine learning. The inclusion criteria were colorectal lesions that had been detected during colonoscopy using EC and subsequently resected between December 2014 and April 2015. The exclusion criteria were inflammatory bowel disease; lesions for which no clear EC-NBI were available; sessile serrated adenomas/polyps (SSA/Ps); and nonepithelial Figure 1. Output image. (1) Computer diagnosis. (2) Input endocytoscopy with narrow band imaging. (3) Extracted vessel image, in which the green area denotes the extracted vessels. The light-green vessel has the maximum diameter. (4) Probability of computer diagnosis is calculated by the support vector machine classifier.Abbreviations used in this paper: CAD, computer-aided diagnosis; ...

SUMMARY BackgroundThe presence of abnormal microcapillaries detected by narrow band imaging (NBI) with magnifying colonoscopy has been reported to be a marker of colorectal neoplasia.

We reviewed the magnifying observation of the microvascular architecture of colorectal lesions and discuss the utility of the detailed observation of the microvascular architecture for differential diagnosis during narrow-band imaging (NBI) colonoscopy. Angiogenesis is critical to the transition of premalignant lesions in a hyperproliferative state to the malignant phenotype. Therefore, diagnosis based on angiogenic or vascular morphologic changes might be ideal for early detection or diagnosis of neoplasms. In this review, we propose the term 'meshed capillary' for the distinction between non-neoplastic and neoplastic lesions and the capillary classification 'capillary pattern' for the differential diagnosis of colorectal lesions. We believe that the combined use of NBI optical chromoendoscopy and real chromoendoscopy decreases the time and cost of screening colonoscopy. To assess the feasibility and efficacy of using the NBI system, further studies are required for colorectal lesions and other lesions of the gastrointestinal tract.