Accurate preoperative assessment of pulmonary function is a valuable indicator of postoperative morbidity.
From January 1988 to June 1992, 66 patients with resectable squamous cell carcinoma of the thoracic esophagus underwent preoperative adjuvant therapy. These patients were prospectively divided into two treatment groups; 32 were treated with radiofrequency wave local hyperthermia combined with chemoradiotherapy (hyperthermochemoradiotherapy; HCR), while the remaining 34 patients were treated with chemoradiotherapy alone (CR). There were no procedural complications in either group and the postoperative mortality was zero. In the HCR group, no viable cancer cells were found within the entire 5 mm-width slices of the resected specimen in eight patients (25%), while only two (5.9%) in the CR group (P < 0.05) demonstrate no viable cancer cells. The cumulative 3-year survival rate was 50.4% in the HCR group and 24.2% in the CR group. The present prospective trial demonstrated that the addition of hyperthermia to chemoradiotherapy resulted in a better local control and an improved long-term survival when treating patients with advanced esophageal carcinoma.
Many women diagnosed with invasive breast cancer have undetected occult metastases at the time of their primary tumour diagnosis. The development and growth of these micro-metastases relies heavily on angiogenesis. Therefore, administering an angiogenesis-blocking treatment from the time of diagnosis could reduce the incidence of metastasis and, ultimately, increase patient survival. It is hypothesized that an antiangiogenesis strategy combining fever-range whole-body hyperthermia (FR-WBH) and metronomic chemotherapy could inhibit the development of metastatic disease with minimal toxicity. To test this theory, a low, daily dose of the topoisomerase-I inhibitor irinotecan hydrochloride (CPT-11) was administered over a prolonged period of time to rats bearing the highly metastatic MTLn3 mammary adenocarcinoma primary tumour surgically excised on day 12 after implantation. The metronomic CPT-11 was combined with long-duration, low-temperature, fever-range whole body hyperthermia (FR-WBH). This systemic hyperthermia enhances chemotherapy-induced cytotoxicity as well as immunological activity. Both the group treated with FR-WBH alone and the combined FR-WBH + CPT-11 group had delayed onset and reduced incidence of axillary lymph node metastases compared to control (p < 0.05). Combination therapy of FR-WBH + CPT-11 resulted in a significantly greater inhibition of axillary lymph node metastasis volume compared to both control and CPT-11 alone (p < 0.02) at day 16. Interestingly, none of the therapies significantly affected inguinal lymph node metastases. Lung metastases were decreased by 36% at the time of death in rats treated with FR-WBH + CPT-11, by 25% in the CPT-11 alone group and by 14% in the FR-WBH alone group. Rats treated with FR-WBH, + CPT-11 survived significantly longer (35%) than control animals (p < 0.04). Neither significant body weight loss nor gastrointestinal toxicity was observed in any group. These data suggest that, after excision of the primary tumour, FR-WBH and metronomic CPT-11 can be safely combined to reduce distant lymph node and lung metastases and, thus, to increase survival.
Dysplasia is one of the most important subjects regarding carcinogenesis of the esophagus, because there is continuing controversy as to whether esophageal dysplasia is a cancerous lesion or a noncancerous lesion. In this study, it is histopathologically shown that dysplasia has a close correlation with cancer itself and that there is no substantial difference in the cell proliferative activity of dysplasia and intraepithelial carcinoma. These findings thus show that dysplasia has as high a potential for malignancy, thus it should be treated as an extremely early cancerous lesion of the esophagus to substantially improve the long term results of this disease. Conversely, esophageal carcinoma with glandular and/or mucus‐secreting components is commonly found in addition to the ordinary component of squamous cell carcinoma, which indicates that this type of esophageal tumor originates not only from the squamous epithelium but also from the esophageal mucus gland or the ductal epithelium. These findings support the concept of field carcinogenesis in esophageal carcinoma. Cancer 1995;75:1440‐5.
Background and Objectives Although the relationship between angiogenesis and tumor proliferation or malignant potential has been previously demonstrated in several studies, early stage of cancer invasion and angiogenesis has seldom been investigated. Methods From the esophageal specimens of eight recently resected cases with esophageal squamous cell carcinoma, 25 areas of carcinoma‐in‐situ or microinvasive carcinoma were selected, and then a serial histologic investigation and immunohistochemical staining for the detection of Factor VIII‐related antigen to investigate microvessels in the lamina propria mucosae beneath the lesions as a measure of angiogeneses and staining for laminin to visualize basement membrane was performed. Lymphocyte infiltration below the lesions were also estimated. In view of early cancerous invasion, histologic patterns of the growth of the lesions were divided into “flat,” “expansive,” and “downgrowth” patterns. Results Although downgrowth patterns are thought to be more invasive, relationships between the histologic patterns, and basement membrane staining patterns, and lymphocyte infiltration patterns were not demonstrated. However, the angiogenetic ratio (the number of vessels/cm under the lesions divided by that under normal epithelium) was observed to be significantly and closely related to tumor invasion patterns (P < 0.01), although it was not related to the destruction of the basement membrane or lymphocyte infiltration below the lesions. Conclusions The angiogenesis of esophageal squamous cell carcinoma is closely correlated to the tumor invasion patterns in early esophageal cancerous lesions. J. Surg. Oncol. 1997;65:188–193. © 1997 Wiley‐Liss, Inc.
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