Radiotherapy and chemotherapy neoadjuvants in patients with squamous cell carcinoma of the esophagus offers benefits and increases survival.

RESUMO -Racional -A estenose esofágica secundária à ingestão de produtos cáusticos é freqüente no Brasil, principalmente como tentativa de suicídio. O esôfago de Barrett surge como conseqüência do refluxo gastroesofágico crônico. A literatura pesquisada mostrou que esta associação é muito rara. INTRODUÇÃOA ingestão acidental ou proposital de agentes corrosivos ainda é freqüente no país e significa um desafio tanto aos médicos, como à medicina preventiva em geral, tendo em vista as complicações agudas e crônicas dessa agressão ao esôfago, tais como hemorragia, broncopneumonia, perfuração, dor e estenose cicatricial. Após a fase aguda em que está presente o edema e a inflamação, segue-se a fibrose parcial ou total do órgão, acompanhada de estreitamentos, estenoses e encurtamento com danos não só na morfologia, como na sua fisiologia (2,8) .A ingestão de hidróxido de sódio, mais comumente conhecido como soda cáustica, prevalece na literatura como uma das principais causas de estenose benigna do esôfago, atingindo duas populações: as crianças que ingerem acidentalmente o cáustico e os adultos jovens que podem estar envolvidos em tentativas de suicídio (6,7,19) . TUCKER e YARINGTON (21) , revisando mais de 4.000 casos de ingestão de agentes corrosivos, relatam 2% de mortalidade após ingestão de soda cáustica e 20% após ingestão de vários tipos de ácidos. POSTLETHWAIT (12) , revisando várias publicações encontrou a incidência de 5% de estenose em 2.109 pacientes expostos a agentes corrosivos.A evolução para a estenose do esôfago depende de alguns fatores, tais como a quantidade de cáustico ingerida, o tempo de exposição à mucosa esofagiana, as camadas do órgão que foram envolvidas e a extensão do órgão envolvido. Além disso, acredita-se que o esôfago fibrosado possa produzir hérnia de hiato por deslizamento mais freqüentemente devido à retração cicatricial, portanto, é esperado ocorrer refluxo gastroesofágico com freqüência mais elevada nesses doentes, uma vez que a hérnia é um fator entre outros envolvidos no refluxo do conteúdo cloridropéptico agressivo à mucosa esofágica (2,6,19) . Sendo assim, não é surpreendente o achado endoscópico concomitante de esofagite por refluxo nos portadores de estenose cáustica.

Background:The treatment of advanced gastric cancer with curative intent is essentially surgical and chemoradiotherapy is indicated as neo or adjuvant to control the disease and prolong survival. Aim:To assess the survival of patients undergoing subtotal or total gastrectomy with D2 lymphadenectomy followed by adjuvant chemoradiotherapy. Methods:Were retrospectively analyzed 87 gastrectomized patients with advanced gastric adenocarcinoma, considered stages IB to IIIC and submitted to adjuvant chemoradiotherapy (protocol INT 0116). Tumors of the esophagogastric junction, with peritoneal implants, distant metastases, and those that had a compromised surgical margin or early death after surgery were excluded. They were separated according to the extention of the gastrectomy and analyzed for tumor site and histopathology, lymph node invasion, staging, morbidity and survival. Results: The total number of patients who successfully completed the adjuvant treatment was 45 (51.7%). Those who started treatment and discontinued due to toxicity, tumor-related worsening, or loss of follow-up were 10 (11.5%) and reported as incomplete adjuvant. The number of patients who refused or did not start adjuvant treatment was 33 (48.3%). Subtotal gastrectomy was indicated in 60 (68.9%) and total in 27 (31.1%) and this had a shorter survival. The mean resected lymph nodes was 30.8. Staging and number of lymph nodes affected were predictors of worse survival and the more advanced the tumor. Patients undergoing adjuvant therapy with complete chemoradiotherapy showed a longer survival when compared to those who did it incompletely or underwent exclusive surgery. On the other hand, comparing the T4b (IIIB + IIIC) staging patients who had complete adjuvance with those who underwent the exclusive operation or who did not complete the adjuvant, there was a significant difference in survival. Conclusion:Adjuvant chemoradiotherapy presents survival gain for T4b patients undergoing surgical treatment with curative intent.

Gastric adenocarcinoma after gastric bypass for morbid obesity is rare but has been described. The diet restriction, weight loss, and difficult assessment of the bypassed stomach, after this procedure, hinder and delay its diagnosis. We present a 52-year-old man who underwent Roux-en-Y gastric bypass 2 years ago and whose previous upper digestive endoscopy was considered normal. He presented with weight loss, attributed to the procedure, and progressive dysphagia. Upper digestive endoscopy revealed stenosing tumor in gastric pouch whose biopsy showed diffuse-type gastric adenocarcinoma. He underwent total gastrectomy, left lobectomy, distal pancreatectomy and splenectomy, segmental colectomy, and bowel resection with esophagojejunal anastomosis. The histopathological analysis confirmed the presence of gastric cancer. The pathogenesis of gastric pouch adenocarcinoma is discussed with a literature review.

HighlightsHe experienced a long gap without symptoms that were relieved following the surgery performed in his infancy. Nonetheless, no biopsy examination from the duodenum has been done preoperatively. It could explain the delay in reaching the definitive diagnosis.We submitted him to two surgeries.Every patient that comes from an endemic area for Strongyloides stercoralis the hypothesis of strongyloidiasis should be considered and biopsies on stomach and duodenum should be made.

Tumoral recurrence, lymphnode metastasis and broncopneumonia in the postoperative period were factors of bad prognosis and contributed significantly to increase morbimortality and decrease global survival.

We conducted a retrospective nonrandomized study including 97 patients distributed as follows: Group I -81 (83.5%) underwent neoadjuvant radiation therapy, and group II -16 (16.5%) underwent neoadjuvant radiotherapy and chemotherapy. A third group of 26 patients undergoing esophagectomy alone was used for comparison of postoperative complications. The characteristics of each patient (age, gender and race), tumor site, staging, and histological evaluation of treatment modalities were reviewed and analyzed. Tumor response to neoadjuvant therapy was evaluated by histopathology of the specimen. Results Results ResultsResults Results: There was no statistically significant differences regarding race, gender, age, staging and postoperative complications in patients in the three groups. Patients undergoing radiotherapy and neoadjuvant chemotherapy showed more satisfactory tumor reduction, with improved local efficacy when compared to the group only submitted to neoadjuvant radiotherapy. Conclusion Conclusion Conclusion Conclusion Conclusion: The study suggests that radiotherapy combined with chemotherapy was more efficient in reducing tumor site when compared to the group treated with radiotherapy. In addition, neoadjuvant therapy did not increase the postoperative complications when compared to patients undergoing surgery alone.