1994 Fiscal Year Final Research Report Summary
High-Dose-Rate Intracacvitary Irradiation in the Surgical Treatment of Cancer of the Tracic Esophagus
| Project/Area Number |
04454334
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| Research Category |
Grant-in-Aid for General Scientific Research (B)
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| Allocation Type | Single-year Grants |
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| Research Field |
Digestive surgery
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| Research Institution | Kochi Medical School |
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Principal Investigator |
OGOSHI Shohei Kochi Medical School Professor, 医学部, 教授 (60009587)
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| Co-Investigator(Kenkyū-buntansha) |
OGAWA Yasuhiro Kochi medical School Associate Professor, 医学部, 助教授 (90152397)
ONO Hiroto Kochi Medical School Research Associate, 医学部, 助手
TAKAHASHI Akira Kochi Medical School Research Associate, 医学部, 助手 (10243825)
TOKI Taiichi Kochi Medical School Research Associate, 医学部, 助手 (90217472)
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| Project Period (FY) |
1992 – 1994
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| Keywords | Esophageal Cancer / High-Dose-Rate Intracavitary Irradiation / RALS / Human Papillomavirus / HPV |
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| Research Abstract |
Although many kinds of adjuvant therapies are currently being emploied in combination with surgical operation, the prognosis of patients with esophageal cancer is still poor to improve the survival rate of these patients and there quality of life we recently developed a multidisciplinary treatment whicch was called the KOCHI system.
Fifty-two patients with thoracic esophageal cancer and confirmed with squamous cell cancer received this system. The patients ewre devided into two groups : those who were under went totl resection of the thoracic esopjagus (41 patients) and those who were noy resected (11 patients). The non-resected (bypass) cases included patients whose lesion was not radically resectable, patients preoperatively diagnosed as having extensive metastasis to the lymph nodes in the abdomen, and patients diagnosed as unable to receiveresection due to general condition, such as cardiac or pulmonary complications. The reconstruction of the esophagus was performed with the gastri
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c tube along to the greator curvature of 3cm width for almost all cases except the few cases with the colon substitute due to the previous gastrectomy. After the surgery, RALS (remote-controlled after roading system) was performed following the external irradiation to the local and cervical region as the definite regimen.
The 1-year survival rate of resected cases was 68.6% and the 5-year survival rate was 42.6%.The 1-year survival rate of non-resected cases was 45.5% and the 4-year survival rate was 9.1%.All patients including the bypass operation were able to consume a normal diet without the operative death. Our system suggest that RALS following external irradiatrion as a boost therapy is a new effective strategy for cancer of the esophagus with high quality of life.
Infection with high-risk HVP (human papillomvirus) types 16,18 has been detected in a high percentage of patients with esophageal cancer. And overexpression of p53 protein or mutation of the p53 gene has also been demonstrated in a high percentage of esophageal cancer in our study. The increased expression expression of H-ras p21 protein as well as p53 and/or HPV may be involved in the carcinogenesis of esophageal cancer and become apparent, when the function of p53 as a tumor suppressor gene is inhibited with overexpressed p53 prptein or HPV oncoprotein, resulting in a poor prognostic indicator. Less
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