crossing96/oncoscreening huggingface dataset:
Perigastric vascular abnormalities and the impact on esophagogastrectomy.	The surgeon's ability to recognize abnormal vascular anatomy has greater importance than ever in modern esophagogastric surgical procedures. Some aberrations of vascular vessels around the stomach found during extensive surgery due to primary cancer of the stomach, cardia and lower esophagus are presented in this paper. The purpose of the prospective study is to evaluate and classify these variations with respect to their impact in visceral surgery. A total of 426 patients who underwent total or extensive gastrectomy and esophagectomy combined with lymphadenectomy, have been analyzed prospectively. For the period of 10 years some vascular aberrations have been found in 54/426 (12.67%) of the patients in the operative field during lymphadenectomy as single or combined anomalies. An arterial perigastric anatomy considered normal in textbooks was found in 372 (87.32%) cases. An accessory left hepatic artery arising from the left gastric artery was found in 19/54 (35.18%), and replaced type in 7/54 (12.96%). The replaced right hepatic artery branching from the superior mesenteric artery was found in 5/54 (7.40%) cases. Replaced and accessory left gastric artery branching from the aorta was found in 8/54 (14.8%); accessory posterior gastric artery was found in 25/54 (44.4%), and abnormalities of the splenic, and subphrenic arteries were found in 6/54 (11.11%). Combined anomalies of both left and right hepatic arteries and variations of the celiac trunk were found in 2/54 (3.70%) cases. Forty-nine cases were classified according to established Michels' typology system. Six cases presented with extremely rare variations and remain unclassified. Possible intraoperative problems concerning postoperative complications are also emphasized.	esophagus
[Study of inhibitory effect of extracts from Actinidia arguta on human carcinoma of esophagus cells].	OBJECTIVE: To study the inhibitory effect of extracts from Actinidia arguta by n-butyl alcohol on human carcinoma of esophagus cells (Eca-109) and Its mechanism. METHODS: MTT colonmetric assay was used to examine the growth inhibitory of concentration-effect (1 microg/ml, 10 microg/ml,100 microg/ml) and time-effect (24 h, 48 h, 72 h) of extracts from Actinidia arguta by n-butyl alcohol on Eca-109 cells. TUNEL test were performed to observe the apoptosis induced by the extracts (1 microg/ml, 10 microg/ml, 100 microg/ml) on Eca-109 cells. RESULTS: The inhibitory effect of the extracts on Eca-109 cells increased in a dose-time Manner and the highest rate of inhibition was 87.2%. The extracts could significantly induce apoptosis of Eca-109 cells, but in control group, apoptosis wasn't observed. CONCLUSION: The extracts from Actinidia arguta by n-butyl alcohol have good inhibitory effect on Eca-109 cells.	esophagus
Potential and present limitation of endocytoscopy in the diagnosis of esophageal squamous-cell carcinoma: a multicenter ex vivo pilot study.	BACKGROUND: Endocytoscopy enables the in vivo observation of cellular nuclei in the GI tract. However, potential and present limitations of endocytoscopy have not been elucidated in detail. OBJECTIVE: To investigate whether endocytoscopic images of cancerous and normal squamous cells in the esophagus correspond with horizontal histology of the mucosal surface. DESIGN: An ex vivo pilot study. SETTING: Multiple academic institutions. MATERIALS: Endoscopically or surgically resected human esophagus obtained between May 2006 and July 2006. INTERVENTIONS: Endocytoscopic observation was performed on small areas of cancerous lesions and corresponding normal squamous cells. Biopsy specimens were then retrieved from the areas scanned to make horizontal histologic sections. MAIN OUTCOME MEASUREMENTS: Comparison of the images obtained by endocytoscopy and histology and comparison of the mean numbers of the total nuclei per endocytoscopic image obtained in cancerous and normal areas. RESULTS: Twenty-seven esophageal squamous-cell carcinomas were acquired and evaluable pairs of an endocytoscopic image and a histological picture were obtained at 12 cancerous and 14 normal areas that showed similar morphologies between them. The mean (+/-SD) numbers of the total nuclei per image were 129+/-14.8 at the normal area and 550+/-66.5 at the cancerous area, respectively, which were significantly different between groups (P<.0001). LIMITATIONS: Only a comparison of cancerous and normal squamous cells in the esophagus at the ex vivo setting. CONCLUSIONS: Although endocytoscopic images closely correlated with conventional histology in the esophagus, appropriate preconditioning to constantly obtain sufficient image quality and universal criteria for endocytoscopic diagnosis of various diseases are essential before clinical application.	esophagus
Staging of esophageal cancer by EUS: staging accuracy revisited.	BACKGROUND: EUS plays an important role in the preoperative staging of esophageal cancer. Recent data have called into question the staging accuracy of EUS, particularly in patients with early disease. OBJECTIVE: Our goals were to assess our institution's EUS staging accuracy by experienced endosonographers in a contemporary cohort of patients encompassing a wide range of disease stages and to assess staging accuracy after dilation of malignant strictures. DESIGN: Retrospective data review. SETTING: Single tertiary care center. PATIENTS AND INTERVENTIONS: A total of 42 patients with esophageal cancer undergoing preoperative EUS staging without neoadjuvant chemoradiotherapy between December 1999 and December 2004 were evaluated. MAIN OUTCOME MEASUREMENTS: EUS T and N stage sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: EUS accurately predicted T stage in 76% of cases and N stage in 89% of cases. Staging accuracy for T3 versus T1 and T2 disease and for N0 versus N1 disease was not significantly different. In 11 cases, malignant strictures required dilation, with 6 tumors being passable post dilation. Post dilation, T staging accuracy was 80% in impassable tumors and 100% in passable tumors, and N staging accuracy was 100% in the passable tumors. LIMITATIONS: Relatively small number of patients. CONCLUSIONS: EUS accurately predicts T and N stage in patients with a range of disease stages. EUS provides good staging accuracy after dilation of malignant strictures regardless of whether full tumor traversal post dilation is possible.	esophagus
Evaluation of respiratory-induced target motion for esophageal tumors at the gastroesophageal junction.	PURPOSE: To quantify the internal motion margin requirements for radiotherapy of tumors near the gastroesophageal junction (GEJ). METHODS AND MATERIALS: Four-dimensional computed tomography (4DCT) scans were obtained for 25 patients with primary tumors located near the GEJ. The gross tumor volume (GTV) was manually contoured on the exhale-phase image from the 4DCT image set. A deformable image registration method was used to automatically propagate the contours to other phases of the 4DCT images. To quantify target motion, we measured the displacement of the GTV centroid and the variations in the target boundary and volume. Internal margins were calculated in the lateral (RL), anterior-posterior (AP), and superior-inferior (SI) directions. RESULTS: The mean+/-standard deviation peak-to-peak GTV centroid motion was 0.39+/-0.27cm (range, 0.04-1.09cm) in the RL, 0.38+/-0.23cm (range, 0.10-0.94cm) in the AP, and 0.87+/-0.47cm (range, 0.43-2.63cm) in the SI directions, respectively. On average, the internal target volume was 72% (range, 9-172%) larger than the GTV defined on a single-phase CT image. Variations in tumor boundaries due to tissue motion and deformation suggested asymmetric margins: 1.0cm left [toward the stomach], 0.8cm right, 1.1cm anterior, 0.6cm posterior, 1.0cm superior (toward the distal esophagus), and 1.6cm inferior (toward the stomach). CONCLUSION: Because tumors near the GEJ are subject to a marked but asymmetric amount of respiratory-induced intrafractional tumor motion, the use of asymmetric internal margins may be beneficial.	esophagus
Effects of neoadjuvant therapy on perioperative morbidity in elderly patients undergoing esophagectomy for esophageal cancer.	BACKGROUND: The use of cytoreductive therapy followed by surgery is preferred by many centers dealing with locally advanced esophageal cancer. However, the potential for increase in mortality and morbidity rates has raised concerns on the use of chemoradiation therapy, especially in elderly patients. The aim of this study was to assess the effects of induction therapy on postoperative mortality and morbidity in elderly patients undergoing esophagectomy for locally advanced esophageal cancer at a single institution. METHODS: Postoperative mortality and morbidity of patients > or = 70 years old undergoing esophagectomy after neoadjuvant therapy, between January 1992 and October 2005 for cancer of the esophagus or esophagogastric junction, were compared with findings in younger patients also receiving preoperative cytoreductive treatments. RESULTS: 818 patients underwent esophagectomy during the study period. The study population included 238 patients < 70 years and 31 > or = 70 years old undergoing esophageal resection after neoadjuvant treatment. Despite a significant difference in comorbidities (pulmonary, cardiological and vascular), postoperative mortality and morbidity were similar irrespective of age. CONCLUSIONS: Elderly patients receiving neoadjuvant therapies for cancer of the esophagus or esophagogastric junction do not have a significantly increased prevalence of mortality and major postoperative complications, although cardiovascular complications are more likely to occur. Advanced age should no longer be considered a contraindication to preoperative chemoradiation therapy preceding esophageal resection in carefully selected fit patients.	esophagus
Effects of body-resistance strengthening and tumor-suppressing granules on immune adhesion function of red blood cells and expression of metastasis protein CD44 in tumor cells of patients with esophageal carcinoma.	AIM: To investigate the effects of Fuzheng Yiliu granules (body-resistance strengthening and tumor-suppressing granules) in patients with esophageal carcinoma. METHODS: We compared the immune adherent properties of red blood cells (RBCs), the expression of metastasis protein CD44, and the metastasis inhibition factor nm23, in esophageal carcinoma tumor cells of patients before and after radiotherapy in the presence and absence of orally administered Fuzheng Yiliu granules. Sixty-three hospitalized patients with esophageal carcinoma were treated with standard radiotherapy and randomly divided into treatment group (n = 30) treated with both radiotherapy and Fuzheng Yiliu granules and control group (n = 33) given radiotherapy only. Blood samples and tumor tissue were obtained before and after 21 d of treatment. The rosette rates for complement receptor type 3b (C3bRR) and immune complex receptor (ICRR) on RBCs were measured by erythrocyte immunological methods. Expression of CD44 and nm23 in tumor tissue sections was determined by immunohistochemical staining with monoclonal antibodies CD44v6 ad nm23H-1, respectively. RESULTS: The positivity of RBC-C3bRR before and after 21 d of treatment increased from 7.78% +/- 1.59% to 10.03% +/- 2.01% in the double treatment group, while it changed only slightly from 7.18% +/- 1.29% to 7.46% +/- 1.12% in the radiotherapy group. The positive rate for RBC-ICRR decreased from 37.68% +/- 2.51% to 22.55% +/- 1.65% after the double treatment, and from 37.28% +/- 2.41% to 24.69% +/- 1.91% in radiotherapy group at the same time points. The difference in erythrocyte immune adherent function between the two groups was significant (P < 0.01, t-test). The CD44(+)-cases were reduced from 21 (70.00%) to 12 (40.00%) after treatment with Fuzheng Yiliu granules, whereas the CD44(+)-cases (69.70%) in the radiotherapy group remained unchanged. The difference between the treatment (40.00%) and control (69.70%) groups was significant (P < 0.05). Although the nm23(+)-cases were increased from 4 (13.33%) to 6 (20.00%) in the double treatment group and from 6 (18.18%) to 7 (21.21%) in the radiotherapy group, the difference was not significant (P > 0.05). CONCLUSION: Fuzheng Yiliu granules enhance the immune adhesion function of RBCs and reduce the number of CD44(+)-cells in esophageal carcinoma patients, suggesting a potential role of these Chinese herbals in suppression of invasion and metastasis of malignant cells. However, this anti-metastatic effect has yet to be validated in vivo.	esophagus
Helical tomotherapy for radiotherapy in esophageal cancer: a preferred plan with better conformal target coverage and more homogeneous dose distribution.	We compare different radiotherapy techniques-helical tomotherapy (tomotherapy), step-and-shoot IMRT (IMRT), and 3-dimensional conformal radiotherapy (3DCRT)-for patients with mid-distal esophageal carcinoma on the basis of dosimetric analysis. Six patients with locally advanced mid-distal esophageal carcinoma were treated with neoadjuvant chemoradiation followed by surgery. Radiotherapy included 50 Gy to gross planning target volume (PTV) and 45 Gy to elective PTV in 25 fractions. Tomotherapy, IMRT, and 3DCRT plans were generated. Dose-volume histograms (DVHs), homogeneity index (HI), volumes of lung receiving more than 10, 15, or 20 Gy (V(10), V(15), V(20)), and volumes of heart receiving more than 30 or 45 Gy (V(30), V(45)) were determined. Statistical analysis was performed by paired t-tests. By isodose distributions and DVHs, tomotherapy plans showed sharper dose gradients, more conformal coverage, and better HI for both gross and elective PTVs compared with IMRT or 3DCRT plans. Mean V(20) of lung was significantly reduced in tomotherapy plans. However, tomotherapy and IMRT plans resulted in larger V(10) of lung compared to 3DCRT plans. The heart was significantly spared in tomotherapy and IMRT plans compared to 3DCRT plans in terms of V(30) and V(45). We conclude that tomotherapy plans are superior in terms of target conformity, dose homogeneity, and V(20) of lung.	esophagus
Prevention of cancer in the upper gastrointestinal tract with COX-inhibition. Still an option?	Epidemiological studies have shown that the regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a reduction of gastrointestinal cancer risk. Since up-regulation of COX-2 has been reported in different stages of the esophageal and gastric carcinogenic sequence, the cyclooxygenase-2 selective inhibitors (COXIBs) were considered a good alternative to traditional NSAIDs since they cause less injury to the gastrointestinal mucosa. However, recent chemoprevention trial data reporting an increased risk of cardiovascular events have raised serious concerns on the safety of COXIBs in chemoprevention strategies. Moreover, low expression of COX-2 has been reported in a subset of gastrointestinal cancers due to COX-2 methylation, indicating that these patients could be less responsive to treatment by specific COX-2 inhibitors. Furthermore, the COX-1 isoform may have a potential role in the angiogenic process associated with esophageal adenocarcinoma, which suggests that inhibition of COX-1 may be another effective therapeutic target in upper gastrointestinal cancer. Finally, lipoxygenase-derived products may be increased following COX-inhibition due to shunting of the arachidonic acid metabolism. Specifically, the 5-LOX pathway seems to be relevant in gastrointestinal cancer development. Taken together, these data indicate that a re-evaluation of potential chemoprevention strategies for cancers of the upper gastrointestinal tract needs to be considered.	esophagus
Prone position to treat bronchopleural fistula in post-operative acute lung injury.	OBJECTIVE: Prone position is used to treat patients with acute lung injury or acute respiratory distress syndrome because it improves gas exchange and respiratory mechanics. When broncho-pleural fistula occurring, the clinical impact of prone position is limited; however, its use could be tried when the fistula is small or other potential treatments are not possible. METHODS: A 45-year-old man with oesophageal cancer submitted to a total oesophagectomy with intrathoracic transposition of the stomach developed post-operatively respiratory failure and pneumothorax, which were worsened by unilateral pleural rupture and severe subcutaneous emphysema produced after an attempt to introduce through anterior chest wall a second drainage tube. RESULTS: Prone position associated with lung protective strategy was implemented during 16-18 h daily and after the change of position PaO2/FiO2 increased of 35% and PaCO2-PetCO2 decreased about 40%; at 4th day under treatment, the subcutaneous emphysema and pneumothorax could not be detected either clinically or radiologically. On the 6th day the lung lesion could not be observed under the CT-scan. CONCLUSIONS: In a patient that underwent a major thoracic surgery the addition of prone positioning to protective lung ventilation rendered possible not only the healing of the acute lung injury, but also the quick repair of a lung rupture owing to a thoracic drainage attempt.	esophagus
Role of serum angiopoietin-2 level in screening for esophageal squamous cell cancer and its precursors.	BACKGROUND: Angiopoietin-2 (Ang-2) is one of the critical regulators of tumor angiogenesis. Studies have shown a significant correlation of Ang-2 expression to tumor invasion and metastasis in various human cancers, but little is known about the serum Ang-2 (sAng-2) levels in esophageal squamous cell cancer (ESCC) and its precursors. In this study, we aimed to investigate its role in screening for ESCC and its precursors. METHODS: We carried out a free endoscopic screening in Feicheng City, a high ESCC incidence area in Shandong Province of China. Serum samples were collected as follows: 91 from normal subjects, 44 from patients with esophagitis, 85 from patients with hyperplasia, and 13 from patients with early ESCC. In addition, 28 serum samples were obtained from patients with invasive ESCC undergoing surgery in People's Hospital of Feicheng City. All the subjects of the five groups were diagnosed by histopathology. The sAng-2 levels were tested and compared, and the diagnostic power in early or/and invasive ESCC was calculated in terms of sensitivity and other parameters. RESULTS: The sAng-2 levels were (22.0 +/- 5.5), (21.3 +/- 3.2), (20.5 +/- 3.3), (24.0+/- 5.0), and (29.8 +/- 5.0) U/ml in normal, esophagitis, hyperplasia, early ESCC, and invasive ESCC groups respectively. It was significantly higher in early ESCC than inhyperplasia group (P = 0.009). The invasive ESCC group showed the highest Ang-2 level among all groups (all P = 0.000). The sensitivities of sAng-2 to early and invasive ESCC were 23.1% and 78.6% respectively. CONCLUSION: sAng-2 level is related to carcinogenesis and progression of ESCC, but it can not be used to screen for early ESCC.	esophagus
Prognostic significance of platelet-derived growth factor-BB expression in human esophageal squamous cell carcinomas.	BACKGROUND: Cancer metastases are commonly found in the lymphatic system and tumor lymphangiogenesis requires the interplay of several growth factors. The expression of platelet-derived growth factor (PDGF)-BB and vascular endothelial growth factor (VEGF)-C in esophageal cancer was investigated to define their clinicopathological significance. MATERIALS AND METHODS: Using immunohistochemistry, the expression of PDGF-BB and VEGF-C was examined, along with lymphatic vessel density (LVD) in 53 patients with esophageal cancer. RESULTS: PDGF-BB and VEGF-C expression was positive in 31 cases (58.5%) and 38 cases (71.7%), respectively, and expression correlated with lymph node metastasis and lymphatic invasion. Furthermore, PDGF-BB expression correlated with the depth of tumor invasion and the size of the tumor, and PDGF-BB-positive patients had a significantly poorer prognosis than PDGF-BB-negative patients. The LVD in positive PDGF-BB or VEGF-C tumors was higher than in negative tumors. CONCLUSION: PDGF-BB may play a pivotal role in lymphangiogenesis and tumor growth in esophageal cancer.	esophagus
Combinatory gene therapy with electrotransfer of midkine promoter-HSV-TK and interleukin-21.	We examined the effect of the combination of herpes simplex virus type1-thymidine kinase (HSV-TK)-suicide gene therapy and interleukin-21 (IL-21) immune gene therapy. MATERIALS AND METHODS: To improve tumor specificity and the safety of gene therapy, we designed the suicide gene (HSV-TK) to be driven by midkine (MK) minimal promoter (MKp-TK). Plasmid DNA containing HSV-TK-suicide gene or IL-21 gene was injected into TE2 and Colon26 tumors developed in nude mice and electric pulses were then delivered. RESULTS: Tumors transduced with the MKp-TK gene demonstrated increased sensitivity to ganciclovir (GCV) in vitro and in vivo. MK minimal promoter conferred efficient transcriptional activity to the HSV-TK-suicide gene and in vivo electroporation was an effective method for transducing the MKp-TK gene. IL-21-transduced tumors disappeared completely in syngeneic BALB/c mice. However, the tumors were not suppressed completely in T-cell-depleted nude mice, and antitumor effects were absent in NK-cell-depleted mice. These data suggest that IL-21 induces T- and NK-cell-dependent antitumor effects. Furthermore, the growth of IL-21-producing tumors subsequently transduced with MKp-TK by electroporation was significantly retarded compared with control groups. CONCLUSION: Using the minimal promoter region of MK to drive the HSV-TK gene and in vivo electroporation to transduce IL-21 DNA into the tumors produced an efficient gene therapy with improved safety. To our knowledge, this is the first report of a combination gene therapy using HSV-TK/GCVand IL-21.	esophagus
Phase I study of docetaxel (TXT) and 5-fluorouracil (5-FU) with concurrent radiotherapy in patients with advanced esophageal cancer.	This phase I study was designed to determine the maximum-tolerated dose (MTD) of docetaxel (TXT) and toxicities of combining weekly administration of TXT and continuous infusion of 5-fluorouracil (5-FU) with concomitant radiotherapy for advanced esophageal cancer. PATIENTS AND METHODS: Patients received TXT by i.v. infusion over 1 h on days 1, 8, 22 and 29. They were also given 5-FU 250 mg/m2/day by continuous infusion for 24 h on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40 and 43-45. Fractionated radiotherapy was performed on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40 and 43-45, and a total dose of 60 to 66 Gy was delivered. The starting dose level (Level 1) of TXT was set at 7.5 mg/m2. Dose escalation was conducted in increments of 25 mg/m2, until the dose reached Level 4 (15 mg/m2). At least three patients were enrolled at each level. RESULTS: Seven patients (median age, 64 years) were enrolled. Six patients had stage III (T4NIMO) and one had stage IVb (T4N1M1b) esophageal cancer; six had squamous cell carcinoma and one had carcinosarcoma. No patient had received prior chemotherapy or radiotherapy, and two patients had undergone esophageal bypass surgery using a whole stomach tube without resection of primary or metastatic lesions. In the 7patients, the regimen was well-tolerated, with esophagitis as the most common toxicity (grade 3: n=1; grade 4: n=3). In general, hematological toxicity was mild. Dose-limiting toxicity (DLT) was observed at Level 2 (TXT 10 mg/m2) when three patients developed grade 4 esophagitis and this dose was deemed the MTD for this regimen. In the 7 assessable patients, the overall clinical response rate was 85.7%. CONCLUSION: The MTD of TXT in this regimen was 10 mg/m2 and the recommended dose of TXT was 7.5 mg/m2. Although esophagitis was the dose-limiting and the most frequent toxicity, the regimen was safe and well-tolerated, and demonstrated the possibility of good efficacy in patients with advanced esophageal cancer.	esophagus