Effectiveness of image-guided radiotherapy for locally advanced esophageal squamous cell carcinoma patients treated with definitive concurrent chemoradiotherapy.

BACKGROUND: Image-guided radiotherapy (IGRT) is an advanced radiotherapy technique to improve the accuracy of treatment delivery. However, a recent randomized controlled trial (RCT) for prostate cancer patients treated with radiotherapy either via IGRT or routine care (no daily IGRT) reported a statistically significant worse overall survival for those treated with IGRT. This raised the concern regarding the effectiveness of IGRT for definitive concurrent chemoradiotherapy (dCCRT) for locally advanced esophageal squamous cell carcinoma (LA-ESqCC). METHODS: Eligible LA-ESqCC patients diagnosed between 2011 and 2015 were identified via the Taiwan Cancer Registry. We estimated propensity scores to construct a 1:1 propensity-score-matched groups and balance observable potential confounders. The hazard ratio (HR) of death as well as other outcomes was compared between IGRT and non-IGRT matched groups during the entire follow-up period. The impact of additional covariables was considered in the sensitivity analysis. RESULTS: Our study population included 590 patients in the primary analysis. The HR for death when IGRT was compared with non-IGRT was 0.92 (95% confidence interval 0.77-1.10, P = 0.35). There were also no significant differences for other outcomes or sensitivity analyses. CONCLUSIONS: In this updated nonrandomized study using real world data, we found that the overall survival of LA-ESqCC patients treated with dCCRT was not statistically different between those treated with IGRT versus those without IGRT, although the hazard ratio was less than unity, ie, in favor of IGRT. The results should be interpreted with caution given the nonrandomized design and RCTs are needed to clarify our findings. KEY POINTS: Significant findings of the study: The OS of LA-ESqCC patients treated with dCCRT was not statistically different between those treated with IGRT versus those without IGRT, although the hazard ratio was less than unity, ie, in favor of IGRT. WHAT THIS STUDY ADDS: In this updated nonrandomized study using real world data with additional potential confounders, our study provided a reasonable tentative evidence of lack of RCT as suggested in the literature.

Small bowel volvulus among adults.

BACKGROUND: To elucidate clinical experience associated with rare cases of small bowel volvulus among adults, we conducted a retrospective study. METHODS: From January 1993 to March 2003 inclusively, we reviewed the presentation and management of 19 patients featuring small bowel volvulus. All study-included patients underwent surgical treatment to confirm their diagnosis. We also analyzed their signs, symptoms, radiological examination details, clinical course and surgical results. RESULTS: The mean age of the study-included 19 patients (13 males, six females) was 61.3 years (range = 16-83 years). All patients suffering from small bowel volvulus were categorized as displaying either primary (no obvious predisposing factors) or secondary volvulus (specific predisposing anatomical abnormalities present). Among them, nine patients were categorized as having primary volvulus, and the remaining 10 were patients with secondary volvulus; this comprised one pregnancy, two malignant stromal tumors of the jejunum, six jejunal diverticula, and one adhesion band. Nine examples of volvulus occurred in the jejunum, four in the ileum, and six in both jejunum and ileum. There were five examples of a counter clockwise rotation of small bowel volvulus. Two patients exhibited bowel wall gangrene, both of whom died subsequent to surgery. The overall mortality rate was 11%. CONCLUSIONS: Although small bowel volvulus is rarely seen among adults, when a patient presents with intestinal obstruction, the possibility of small bowel volvulus must be considered. Early surgical intervention should be undertaken in order to prevent vascular compromise.

Primary retroperitoneal teratoma in an adult.

Primary retroperitoneal teratoma is a rare entity in adults. It has a distinctive imaging appearance. We describe the case of a 26-year-old man who was referred to our hospital due to an abdominal tumor. Serial work-up disclosed a teratoma at the retroperitoneum. Laparotomy with tumor resection was performed. Pathological examination revealed a mature cystic teratoma. The postoperative course was smooth. This patient was doing well at one-year follow-up.

Ineffective esophageal motility is a primary motility disorder in gastroesophageal reflux disease.

The relationship between esophageal motor abnormalities and GERD has been widely studied. The purpose of this study was to identify the prevalence of ineffective esophageal motility (IEM) in patients with GERD. In addition, we also evaluated esophageal acid exposure, acid clearance, and endoscopic esophagitis in GERD patients with IEM. Of 89 patients enrolled in this study, 47 (52.8%) were found to have nonspecific esophageal motility disorder (NEMD). Forty-four of the 47 (93.6%) patients with NEMD met the diagnostic criteria for IEM. The overall incidence of IEM in GERD patients was 49.4%. Patients with IEM had significant increases in upright and recumbent mean fraction of time pH < 4 (6.70% and 4.38%) and mean recumbent esophageal acid clearance (12.45 min/reflux) when compared to those with other motility findings. Seventeen of the 44 (39%) IEM patients did not have endoscopic esophagitis. On the other hand, 26 of the 39 (67%) patients with normal manometry had endoscopic esophagitis. We concluded that not only is the prevalence of IEM high in GERD, but also that IEM patients have more recumbent gastroesophageal reflux and delayed acid clearance. Combined with endoscopic findings, we propose that IEM can be viewed as a specific entity of primary esophageal motility disorder in patients with GERD.