Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Metastatic cancer to the esophagus is unusual. Breast cancer represents one of the most frequent solid tumors metastasizing to the esophagus. Less than 100 histologically confirmed cases were reported up to now. By suggestion of Laforet the entity of postmastectomy-dysphagia was inaugurated as a syndrome, characterized by dysphagia, occurring many years after mastectomy due to metastatic breast cancer. Surgical therapy by means of esophagectomy and esophagogastrostomy is a safe procedure and can provide a survival time of several years in combination with other therapies due to reliable palliation.
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PMID:[Postmastectomy dysphagia syndrome]. 811 92

Upper thoracic esophageal tumors adjacent to the trachea often require a preliminary thoracotomy to accomplish resection. Between January 1985 and July 1992, 49 consecutive patients (38 men and 11 women) underwent extended esophagectomy for esophageal cancer where the neoplasm was mobilized through an initial right thoracotomy and then resected and reconstructed through an abdomino-cervical approach. Ages ranged from 40 to 80 years (median 63.4 years). The tumor was located in the upper third of the thoracic esophagus in 44 patients and in the middle third in five. Thirty-three patients had squamous cell carcinoma, 14 had adenocarcinoma, and two had adenosquamous cell carcinoma. Complications occurred in 35 patients (71.4%) and included anastomotic leak in 15, vocal cord paralysis in 11, atrial arrhythmia in nine, pneumonia in six, wound infection in five, and postoperative bleeding in one. Three patients required tracheostomy. There was one postoperative death (2.0%). Median survival was 0.9 years (range 1 month to 5.1 years). Thirty-one patients were alive at the time this article was written, 28 without evidence of cancer. Cause of death was recurrent disease in 13 patients, unrelated to cancer in three, and unknown in one. Overall actuarial 3- and 5-year survivals were 48.6% and 18.2%, respectively. Four-year survival for stage II disease was 44.6% as compared to 24.9% for stage III (p < 0.02). The presence of lymph node metastases significantly affected survival. Three-year survival for patients with N0 disease was 77.9% compared with 20.9% for patients with N1 disease (p < 0.01). Age, sex, and cell type had no effect on survival. Ten patients had late dysphagia, four had gastroesophageal reflux, and one had dumping symptoms. Although associated with significant morbidity, we conclude that extended esophagectomy is an acceptable method of management for tumors of the upper thoracic esophagus. Mortality is low, and long-term results are reasonable.
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PMID:Extended esophagectomy in the management of carcinoma of the upper thoracic esophagus. 812 21

Despite obvious improvements in operative and postoperative management after esophageal resection, surgical treatment of esophageal cancer is still disappointing in terms of long term results. The purpose of the present study was to verify these poor results statistically and to discuss the value of a modified therapeutic approach. Our experience covers 349 esophageal resections performed between 1979 and 1992. These patients were predominantly males (93%) with squamous cell carcinoma (86%). The majority of the patients underwent either an Ivor-Lewis (52%) or an Akiyama procedure (36%). Survival was estimated according to the Kaplan-Meier model. Influence of parameters such as sex, histology, type of resection and TNM-staging was assessed with the "log-rank" test. The perioperative mortality was 10%. The non-fatal morbidity rate was 34%, and was most often related to anastomotic leaks. Pathological staging disclosed a majority of T3 tumors (71%). The overall survival rate was 54% at one year, 28% at 2 years and 9% at 5 years. This survival was not influenced by either histology (squamous cell or adenocarcinoma), the type of resection (Ivor-Lewis or Akiyama procedure). A slightly superior survival rate was observed after Ivor-Lewis procedure and is explained by a lower postoperative complication rate. In particular, diffuse N2 disease (abdominal and mediastinal) had a worse prognosis than localized N2. N1 disease was probably understaged, since survival was comparable to localized N2. The natural history was characterized by development of metastases (43%) rather than by local recurrence. We conclude that these results may justify surgery for palliation of dysphagia in so far as the post-operative morbidity is reduced, as we observed with Ivor-Lewis procedures. However, improvement of long-term survival requires a multimodality oncologic approach.
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PMID:[Result of surgery of esophageal cancer. Analysis of a series of 349 cases based on resection methods]. 831 12

Twenty eight patients with previously untreated oesophageal carcinoma without distant metastases were divided into two groups: Group A consisted of 18 pts. treated with conventional external radiotherapy only. Another group of 10 pts. (Group B) received treatment with external beam irradiation with further high dose rate intraluminal brachytherapy up to a dose of 4-12 Gy delivered in 2-3 sessions of 4 Gy (one session a week). All pts. were evaluated clinically, radiologically and endoscopically every 3 months. At the end of treatment there was a marked difference in relief of dysphagia (39% in Group A vs. 90% in Group B), local control (56.7% in Group A vs. 100% in Group B) and time to progression of dysphagia (20.8 weeks in Group A vs. 67.7 weeks in Group B). No marked difference was observed in overall survival. The complication rate was low in both groups and major complications were observed in pts. treated with external radiotherapy alone (two fistulas). The association of external beam and intraluminal radiotherapy can give a better local control of the disease, improving the quality of life.
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PMID:Intraluminal high dose rate brachytherapy combined with external radiotherapy in the treatment of oesophageal cancer. 841 29

From 1984 to 1989 the clinicopathological aspects of 21 patients with smooth muscle tumours of the stomach were reviewed. Ten patients had leiomyomas: 7 males, 3 females, average age 53 +/- 8 years. Four out of seven leiomyomas presenting with haematemesis were diagnosed correctly by an endoscopist but biopsy was positive in only two patients. Three leiomyomas were found incidently at laparotomy, and a total of nine leiomyomas were resected with a cuff of normal stomach. Their size ranged from 2 to 20 cm. All patients who underwent local resection are alive. Eight patients had leiomyosarcomata: 3 males, 5 females, average age 62 +/- 9 years. Six of these patients had an epigastric mass and four had haematemesis or melaena. The remaining patient in this group presented with dysphagia. Seven of these patients, who had no evidence of metastatic disease, underwent exploratory laparotomy. In four, palliative resections of the stomach and distal oesophagus were performed. In two, exogastric lesions involving colon and liver respectively were resected en bloc with a cuff of stomach. In one, biopsy alone was carried out. Two patients in this group are alive 1 and 2 years following surgery. Adjuvant treatment was not given to any of our patients. The remaining three tumours comprised a smooth muscle tumour of undetermined malignant potential whose clinical behaviour was unpredictable, and two leiomyoblastomas which mimicked malignant tumours in their presentation.
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PMID:Smooth muscle tumours of the stomach: clinicopathological aspects. 843 48

The treatment of choice for advanced inoperable non-small cell lung cancer (NSCLC) is radiation therapy. Palliative radiotherapy schedules vary considerably in different centers, but a 30-Gy dose given in ten fractions over two weeks is a typical standard schedule. Our study was aimed at investigating whether a shorter course of only one 10-Gy fraction allows good palliation in the treatment of inoperable NSCLC patients whose main symptoms are related to an intrathoracic lesion. Patients of both sexes and any age, untreated with radiotherapy, with inoperable and histologically or cytologically proved NSCLC were examined. Seventeen patients, too advanced for radical "curative" radiotherapy and whose main symptoms were related to primary intrathoracic lesions, entered the study even though they had metastases. On admission, 76% (13/17) of patients had cough 76% (13/17) dyspnea, 70.7% (12/17) chest pain and 23.6% (4/17) hemoptysis. They received a single dose of 10 Gy, delivered with an 18-Mv linear accelerator via anteroposteriorly opposing portals without spinal cord shielding. Treatment volume usually included the macroscopically detected lesion identified with a CT simulator. Palliation of symptoms was achieved in high rates of patients: 46% for cough, 69% for dyspnea, 83% for pain and 75% for hemoptysis. These results were obtained within one month of treatment. Unfortunately, palliation of symptoms did not last long, decreasing to 42% within two months of the end of treatment and to 32% at three months. Four patients were retreated, one patient three months and three patients two months after the end of radiotherapy. Ten Gy to the target volume were administered as retreatment with spinal cord shielding. Side-effects were mild: nausea in 3 patients (17%), vomiting in one patient (5%) and grade-II dysphagia in two patients were observed and classified according to WHO criteria. Pain increased 24 hours after radiotherapy in five patients. We can conclude that single dose radiotherapy yields good, but short, palliation of symptoms with acceptable side-effects.
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PMID:[Single-dose palliative radiotherapy in inoperable non-small-cell lung carcinoma]. 868 68

We experienced a case of small cell carcinoma of the esophagus treated by operation. A 57-year-old female was examined for a complaint of dysphagia. The radiologic and endoscopic examination revealed Borrmann III like tumor (8 cm long) at lower esophagus (EiEa). Endoscopic biopsy led to a diagnosis of poorly differentiated squamous cell carcinoma. Chest X-ray and chest CT showed no lung tumor, no swelling of lymph node and no invasion of esophageal tumor. Lower esophagectomy, proximal gastrectomy and esophago-gastrostomy through intrathoracic route was performed. Histopathologically, resected tumor was diagnosed as small cell carcinoma (Oat-cell type) with rosette formation. Grimerius stain revealed negative reaction and immunohistochemical stain by NSE monoclonal antibody revealed positive reaction in tumor cells. Histological staging was a0, n1(+), M0, P1(zero), stage II. Recurrence at paraaortic lymph node occurred in 2 months after the surgery. Chemotherapy (CDDP, 5-FU and Leucovorin) was performed, but not effective. She died from multiple metastases in 5 months after the surgery (6 months after the diagnosis).
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PMID:[A case of small cell carcinoma (oat-cell type) of the esophagus]. 874 55

Between September 1987 and September 1993, 88 patients with oesophageal cancer were treated by a single session of intraluminal brachytherapy of 15 Gy prescribed at 1 cm distance from the central axis, using MDR137Cs (n = 51) during the first part of the study and HDR192Ir (n = 37) during the second part of the study. All patients were regarded as inoperable. Improvement of dysphagia, assessed 4-6 weeks after treatment, was noted in 50 of 75 (67%) evaluable patients, whereas swallowing ability was completely restored in 47% of them. Relapse of dysphagia occurred in 28 (37%) patients during follow-up. Additional palliative treatment consisted of endoprosthesis in 14 (19%), a second course of brachytherapy in 13 (17%), one or more dilatations only in 11 (15%) and laser treatment in four (5%) patients. One non-fatal haemorrhage and five fistulae occurred, all in the presence of tumour. Two severe ulcerations without evidence of tumour were noted, both managed by combined curative treatment. The median survival of the group investigated was 5.5 months. An exophytic, non-circular growth pattern was associated with a better response. In a multivariate analysis the presence of distant metastases (p = 0.0028), weight loss (p = 0.0051) and an exophytic growth pattern (p = 0.0199) were associated with a worse survival. The present data indicate that a single session of ILB is appropriate in the palliation of dysphagia in patients with inoperable oesophagal cancer showing bad prognostic signs. Up to now there has been no clear evidence for benefit of addition of ERT.
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PMID:A single session of intraluminal brachytherapy in palliation of oesophageal cancer. 874 93

In patients with non-metastatic but inoperable non-small cell lung cancer that is locally too extensive for radical radiotherapy (RT), but who have good performance status, it is important to determine whether thoracic RT should be the minimum that is required to palliate thoracic symptoms or whether treatment should be more intensive, with the aim of prolonging survival. A total of 509 such patients from 11 centres in the UK between November 1989 and October 1992 were admitted to a trial comparing palliative versus more intensive RT with respect to survival and quality of life. They were allocated at random to receive thoracic RT with either 17 Gy in two fractions (F2) 1 week apart (255 patients) or 39 Gy in 13 fractions (F13) 5 days per week (254 patients). Survival was better in the F13 group, the median survival periods being 7 months in the F2 group compared with 9 months in the F13 group, and the survival rates 31% and 36% at one year and 9% and 12% at 2 years, respectively (hazard ratio = 0.82; 95% CI0.69-0.99). There was a suggestion of a trend towards greater benefit in fitter patients. Metastases appeared earlier in the F2 group. As recorded by patients using the Rotterdam Symptom Checklist, the commonest symptoms on admission were cough, shortness of breath, tiredness, lack of energy, worrying and chest pain. These were more rapidly palliated by the F2 regimen. Psychological distress was generally lower in the F13 group. Three patients (two F13, one F2) exhibited evidence of myelopathy. As recorded by patients using a diary card, 76% of the F2 compared with 81% of the F13 patients had dysphagia associated with their RT. This was transient, lasting for a median of 6.5 days in the F2 group compared with 14 days in the F13 group. In conclusion, the F2 regimen had a more rapid palliative effect. In the F13 group, although treatment-related dysphagia was worse, survival was longer.
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PMID:Randomized trial of palliative two-fraction versus more intensive 13-fraction radiotherapy for patients with inoperable non-small cell lung cancer and good performance status. Medical Research Council Lung Cancer Working Party. 897 64

The standard approaches of surgery or radiotherapy cure only a minority of patients with esophageal cancer. Because of these poor results and the frequent systemic pattern of recurrences, combined-modality therapy employing chemotherapy has been extensively studied. Preoperative chemotherapy, both alone and given concurrently with radiation, has not shown a significant impact on survival and remains investigational. Concurrent chemoradiation as definitive therapy is an alternative to surgery for localized disease. Paclitaxel and vinorelbine have significant activity as single agents in metastatic disease. Paclitaxel is currently under investigation in combination therapy for metastatic disease, as a radiosensitizer for locally advanced disease, and as preoperative therapy. For palliation of locally advanced esophageal cancer, a variety of endoscopic techniques are available to relieve dysphagia. Laboratory studies have identified growth factor pathways and tumor-suppressor genes as potential new pharmacologic targets.
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PMID:Management of esophageal cancer. 888 28


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