The Role of Adjuvant Chemotherapy after Neoadjuvant Chemoradiotherapy Followed by Surgery in Patients with Esophageal Squamous Cell Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study aimed to investigate the efficacy of adjuvant chemotherapy after neoadjuvant chemoradiotherapy (CCRTx) followed by surgery in patients with esophageal squamous cell carcinoma (ESCC). @*Materials and Methods@#We retrospectively analyzed the data from 382 patients who received neoadjuvant CCRTx and esophagectomy for ESCC between 2003 and 2018. @*Results@#This study included 357 (93.4%) men, and the years median patient age was 63 (range, 40 to 84 years). Overall, 69 patients (18.1%) received adjuvant chemotherapy, whereas 313 patients (81.9%) did not. The median follow-up period was 28.07 months (interquartile range, 15.50 to 62.59). The 5-year overall survival (OS) and disease-free survival were 47.1% and 42.6%, respectively. Adjuvant chemotherapy did not improve OS in all patients, but subgroup analysis revealed that adjuvant chemotherapy improved the 5-year OS in patients with ypT+N+ (24.8% vs. 29.9%, p=0.048), whereas the survival benefit of adjuvant chemotherapy was not observed in patients with ypT0N0, ypT+N0, or ypT0N+. Multivariable analysis revealed that ypStage and adjuvant chemotherapy (hazard ratio, 0.601; p=0.046) were associated with OS in patients with ypT+N+. Freedom from distant metastasis was marginally different according to the adjuvant chemotherapy (48.3% vs. 41.3%, p=0.141). @*Conclusion@#Adjuvant chemotherapy after neoadjuvant therapy followed by surgery reduces the distant metastasis in ypT+N+ ESCC patients, thereby improving the OS. The consideration could be given to administration of adjuvant chemotherapy to ypT+N+ ESCC patients with tolerable conditions.

Diagnostic Performance of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/CT for Chronic Empyema-Associated Malignancy

OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) for chronic empyema-associated malignancy (CEAM). MATERIALS AND METHODS: We retrospectively reviewed the ¹⁸F-FDG PET/CT images of 33 patients with chronic empyema, and analyzed the following findings: 1) shape of the empyema cavity, 2) presence of fistula, 3) maximum standardized uptake value (SUV) of the empyema cavity, 4) uptake pattern of the empyema cavity, 5) presence of a protruding soft tissue mass within the empyema cavity, and 6) involvement of adjacent structures. Final diagnosis was determined based on histopathology or clinical follow-up for at least 6 months. The abovementioned findings were compared between the ¹⁸F-FDG PET/CT images of CEAM and chronic empyema. A receiver operating characteristic (ROC) analysis was also performed. RESULTS: Six lesions were histopathologically proven as malignant; there were three cases of diffuse large B-cell lymphoma, two of squamous cell carcinoma, and one of poorly differentiated carcinoma. Maximum SUV within the empyema cavity (p < 0.001) presence of a protruding soft tissue mass (p = 0.002), and involvement of the adjacent structures (p < 0.001) were significantly different between the CEAM and chronic empyema images. The maximum SUV exhibited the highest diagnostic performance, with the highest specificity (96.3%, 26/27), positive predictive value (85.7%, 6/7), and accuracy (97.0%, 32/33) among all criteria. On ROC analysis, the area under the curve of maximum SUV was 0.994. CONCLUSION: ¹⁸F-FDG PET/CT can be useful for diagnosing CEAM in patients with chronic empyema. The maximum SUV within the empyema cavity is the most accurate ¹⁸F-FDG PET/CT diagnostic criterion for CEAM.

Prediction of Pathologic Grade and Prognosis in Mucoepidermoid Carcinoma of the Lung Using 18F-FDG PET/CT

OBJECTIVE: The maximum standardized uptake value (SUVmax) of pulmonary mucoepidermoid carcinoma (PMEC) in fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was evaluated as a preoperative predictor of pathologic grade and survival rate. MATERIALS AND METHODS: Twenty-three patients who underwent preoperative PET/CT and complete resection for PMEC were enrolled. The optimal cut-off SUVmax for tumor grade was calculated as 6.5 by receiver operating characteristic curve. The patients were divided into a high SUV group (n = 7) and a low SUV group (n = 16). Clinicopathologic features were compared between the groups by chi2 test and overall survival was determined by Kaplan-Meier analysis. RESULTS: The mean SUVmax was 15.4 +/- 11.5 in the high SUV group and 3.9 +/- 1.3 in the low SUV group. All patients except one from the low SUV group had low grade tumors and all had no nodal metastasis. The sensitivity and specificity of SUVmax from PET/CT for predicting tumor grade was 85.7% and 93.8%, respectively. During the follow-up period (mean, 48.6 +/- 38.7 months), four patients from the high SUV group experienced cancer recurrence, and one died of cancer. In contrast, none of the low SUV group had recurrence or mortality. Five-year overall survival rate was significantly higher in the low SUV group (100% vs. 71.4%, p = 0.031). CONCLUSION: Pulmonary mucoepidermoid carcinoma patients with high SUVmax in PET/CT had higher tumor grade, more frequent lymph node metastasis and worse long-term outcome. Therefore, PMEC patients with high uptake on PET/CT imaging might require aggressive mediastinal lymph node dissection and adjuvant therapies.

Endoscopic Cryotherapy of Lung and Bronchial Tumors: A Systematic Review

BACKGROUND/AIMS: We made a systematic review and evaluation of endoscopic cryotherapy of endobronchial tumors, investigating safety and efficacy. METHODS: Qualified studies regarding endoscopic cryotherapy of lung tumors were systemically evaluated using available databases according to predefined criteria. RESULTS: In total, 16 publications were included in the final assessment. A narrative synthesis was performed because a formal meta-analysis was not viable due to the lack of controlled studies and study heterogeneity. Overall success rates for significant recanalization of the obstruction were approximately 80%, although they varied, depending on disease status in the patient population. Complications from the procedure developed in 0-11.1% of cases, most of which were minor and controlled by conservative management. Although limited data were available on comprehensive functional assessment, some studies showed that respiratory symptoms, pulmonary function tests, and performance status were significantly improved. CONCLUSIONS: Endoscopic cryotherapy was found to be a safe and useful procedure in the management of endobronchial tumors although its efficacy and appropriate indications have yet to be determined in well-designed controlled studies.

Diagnosis of Superficial Esophageal Cancer: Comparative Study of Double Contrast Esophagography and Endoscopy

PURPOSE: To assess the diagnostic accuracy and limitations of double contrast esophagography in patients with superficial esophageal cancer, as compared with endoscopic, gross and microscopic findings. MATERIALS AND METHODS: In 43 patients with pathologically proven superficial esophageal cancer, the detection rate and diagnostic accuracy of double contrast esophagography and endoscopy were compared. The depth of invasion revealed by esophagography, and grossly and microscopically in resected specimens, was compared. RESULTS: The detection rate and diagnostic accuracy were, respectively, 86.0% and 76.7% for esophagography, and 100% and 95.3% for endoscopy. In addition, very different detection rates (54.6% and 100%, respectively) were noted for epithelial and mucosal lesions. In flat-type cases (0-IIb), esophagography showed limited ability to detect lesions, but the accuracy of this modality in predicting the depth of tumor invasion was relatively high (94.6%). CONCLUSION: In cases of superficial esophageal cancer, double contrast esophagography showed a lower detection rate and lower diagnostic accuracy than endoscopy, and this was especially so for epithelial and mucosal lesions. The modality was able, however, to reliably predict the depth of tumor invasion.

Trace element analysis by neutron activastion analysis in the human cancer tissue / 대한핵의학회잡지

No abstract available.

Thymic carcinoid tumor combined with thymoma--neuroendocrine differentiation in thymoma?

A carcinoid tumor of the thymus combined with thymoma in a 62-year-old man is described. The mediastinal tumor had been present for 13 years and was associated with pure red cell aplasia. Carcinoid tumor occupied the central two-thirds of the tumor, consisting of nests and trabeculae of monotonous round cells, which ultrastructurally showed many intracytoplasmic dense-core granules. Typical spindle cell type thymoma surrounded the carcinoid area. Clinico-pathologic findings of this unique case suggested that the carcinoid tumor developed within a preexisting thymoma, illustrating a possibility of neuroendocrine differentiation of thymic epithelial cells.

Surgical treatment of pulmonary aspergillosis / 대한흉부외과학회지

No abstract available.

Chest CT findings of recurrent esophageal cancer after transthoracic esophagectomy with esophagogastrostomy

Surgical resection of esophageal cance has played a prominent role in both cure and palliation. The radiologic evaluation of postesophagectomy patients is directed at the detection of normal and pathological appearances after surgical resection. Since early detection of recurrent tumor is important in the management of patients who have undergone esophagectomy, we undertook a retrospective study to evaluate the findings of recurrence on CT in postesophagectomy patients. Between January 1988 and July 1991, 26 patients who had undergone transthoracic esophagectomy with esophagogastrostomy for epidermoid carcinoma of the esophagus with following reoccurance were examined by chest CT. The group included 25 male and one female patients were aged 45-71 years(mean, 53). All patients had studies done immediate post operative 7-10 days. The CT were performed with a CT 9800 scanner (GE Medical System, Milwaukee) after administration of oral contrast media and intravenous injection of contrast media. The findings seen on CT were cnfirmed by biopsy in five cases and by clinical, radiological follow-up manifestation in 21 cases. The abnormalities that were demonstrated on follow-up CT were adenopathy-mediastinal node(ten cases) or abdominal node(five cases), local recurrence-previous tumor site (five case), anastomotic siteI(two cases) or thoracases), peicardial effusion(two cases). Our results indicate that serial chest CT play an important role in the evaluation of the patients after transthoracic esophagectomy with esophagogastrotomy.

Gastric pull-up vs. free jejunal graft for pharyngoesophagealreconstruction / 대한이비인후과학회지

No abstract available.

Chest CT findings after pneumonectomy for lung cancer

Evaluation of postpneumonectomy space (PPS) by CT in patients with lung cancer for operation-related complication or tumor recurrence is critical, but often difficult. We retrospectively analysed CT scans of 38 patients who underwent pneumonectomy for lung cancer. CT scans were obtained on 7-10th post-operative day for baseline image and at varying intervals of 2 to 24 months thereafter. Usual postoperative findings in patients without complication included mediastinal shifting, changes in subpleural space, changes in parietal pleura, and herniation of contralateral lung. Four patients had postoperative complications including empyema(n=3) and bronchopleural fistula(n=2). Twelve patients showed findings of tumor recurrence such as lymph node metastasis, local recurrence, and pericardial and contralateral pleural effusion. By comparing follow-up CT with baseline CT, we were able to detect early cancer recurrence and postoperative complications. Our results indicate that serial chest CT play an important role in the evaluation of the patients who underwent pneumonectomy for lung cancer.

A Case of Constrictive Pericarditis with Localized Pericardial Effusion Simulating a Cystic Mass

Chronic constrictive pericarditis is an uncommon disease, but an importanat one because of its potential curability. It usually begins with an initial episode of acute pericarditis often with a pericardial effusion which may not be detected clinically. This then progresses to resorption of the effusion followed by obliteration of pericardial abity with formation of fibrotic tissue, which results in symmetrical scarring that produce uniform restriction. In general, there are no specific problems due to remained pericardial effusion in the clinically manifestated case of constrictive pericarditis. We report a case of chronic constrictive pericarditis with localized pericardial effusion, which caused to hemodynamic compromise due to local compression of the right ventricle.

Fine Needle Aspiration Cytology of Myxodi Chondrsarcoma of Pleura: A Case Report / 대한세포병리학회지

A 70-year-old female who was diagnosed as myxoid chondrosarcoma by fine needle aspiration of a pleural mass is described. She presented with left chest discomfort of 4 months' duration and aggravating dyspnea and chest pain for 2 months. Chest X-ray and CT scan revealed a large lobulated low density mass invading chest wall at the left pleural cavity and massive pleural fluid. Fine needle aspiration was done under the impression of mesothelioma or metastatic cancer. The aspirates from the mass were very cellular and composed of isolated or clustered forms of large plump cells. Abundant cytoplasm was bluish opaque and the margin was rounded in the isolated cells, whereas clustered cells show ill-defined cell borders and aggregating tendency. The nuclei were eccentric, round to ovoid, and had fine chromatin pattern and multiple small nucleoli. Cellular pleomorphism or mitotic figure was not definite. These findings were consistent with cytologic features of chondrosarcoma. Final diagnosis was confirmed as myxoid chondrosarcoma by mediastinoscopic biopsy and the tumor showed strong positivity for S-100 protein.