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冷冻消融术治疗针对性放化疗食管腺癌后存在的顽固性Barretts 食管上皮细胞

发布日期:2014-1-29 12:40:12 文章来源:GIE(July,2011) 作者次数:1248
    背景
    放化疗食管腺癌后Barretts食管上皮细胞异常增生仍然存在。这种现象表示有异时性腺癌发展的重大可能。
    目的
    分析內镜冷冻消融术治疗顽固性异常增生Barretts 上皮细胞的安全性和有效性,这种异常增生Barretts 上皮细胞在患者针对性放化疗食管腺癌后且临床完全缓解后仍存在。
     
    设计方案
    回顾性队列研究
    环境(Setting
     
    患者
    回顾分析2004年1月至2009年9月期间放射与內镜肿瘤治疗记录。14例食管腺癌患者入选,他们先接受针对性放化疗手术,然后接受冷冻消融术治疗。
     
    干预
    冷冻消融疗法
    主要评价指标
    冷冻消融术治疗后Prague等级参数与异常增生状况减少程度;经术后24h电话调查和随后內镜检查发现并报告的并发症。
    结果
    食管腺癌患者放射化疗且临床完全缓解后,顽固性BE平均长度用Prague 分类法表示为C1M4 (C为全周型化生黏膜长度,M为化生黏膜的最大长度)。冷冻消融治疗术后,它的平均长度减小为C0M1,其中BE全周型长度的置信区间P =0 .009,最大长度的置信区间P =0 .004。14例患者都有Barretts食管上皮细胞异常增生,且冷冻消融术后都出现了组织学降级。高度增生者中,20% (2/10)降为低度增生;60% (6/10)降为Barretts食管上皮细胞无异常增生;20% (2/10)降为无Barretts食管上皮细胞。低度增生者中,75% (3/4)降为Barretts食管上皮细胞无异常增生;25% (1/4) 降为无Barretts食管上皮细胞。实施给14例患者的冷冻消融治疗法的中位数被评估为1(平均数1.5,变化范围为1-5)。86%的患者术后24h内没有感到不适。术后內镜检查中没有出现穿孔和食管狭窄的报道。
     
    局限性
    研究中心单一,回顾性设计患者数量少。
    结论
     
    我们的观察研究结果表明:采用针对性放化疗术后会存在顽固性Barretts上皮细胞(BE),冷冻消融术是治疗这种顽固性细胞的安全有效的手段。
     
    缩写: BE为Barretts 食管上皮细胞,EAC为食管腺瘤,HGD为高度异常增生,IQR为内距 LGD为低度异常增生,PET为正电子发射计算机断层显像。
     
     
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    Cryoablation of persistent Barretts epithelium after definitive chemoradiation therapy for esophageal adenocarcinoma

    Abstract
     
    Background
    Dysplastic Barretts epithelium (BE) persists after chemoradiation therapy for esophageal adenocarcinoma (EAC) arising in Barretts esophagus. This phenomenon may present a significant risk for development of metachronous adenocarcinoma.
    Objective
    To analyze the safety and efficacy of endoscopic cryoablation therapy for persistent dysplastic BE in patients with complete clinical response after definitive chemoradiation therapy for EAC.
    Design
    Retrospective cohort study.
    Setting
    Single National Cancer Institute Comprehensive Cancer Center experience.
    Patients
    Radiation and endoscopic oncology treatment records were reviewed between January 2004 and September 2009. Fourteen patients with EAC who had been treated with definitive chemoradiation therapy followed by cryoablation were identified.
    Intervention
    Cryoablation therapy.
    Main Outcome Measurements
    Reduction in Prague Classification and dysplasia status following cryoablation therapy. Complications reported at 24 hour after the procedure telephone survey and at subsequent endoscopy.
    Results
    After complete clinical response of EAC to chemoradiation therapy, the median length of persistent BE was Prague classification C1M4 (C = circumferential extent, M = maximal extent). Cryoablation reduced the median length of persistent BE to Prague classification C0M1 (P = .009 with respect to circumferential extent and P = .004 with respect to maximal extent of BE). All 14 patients had dysplastic BE. Cryoablation resulted in histological downgrading in all 14 patients. Among patients with high-grade dysplasia, 20% (2/10) were reduced to low-grade dysplasia, 60% (6/10) to BE with no dysplasia, and 20% (2/10) to no BE. Among patients with low-grade dysplasia, 75% (3/4) were reduced to BE with no dysplasia, and 25% (1/4) to no BE. The median number of cryoablation treatments administered to the 14 patients evaluated was 1 (mean 1.5, range 1-5). Eighty-six percent (12/14) of patients reported no complaints during the 24 hours after cryoablation. No occurrences of perforation and no esophageal strictures were reported at surveillance endoscopy.
    Limitations
    Single-center, retrospective design involving a small number of patients.
    Conclusion
    Our observations suggest that cryoablation therapy is safe and effective for the treatment of persistent BE after definitive chemoradiation.
     
     
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