This retrospective study was conducted to evaluate the efficacy and safety of elective nodal irradiation (ENI) and involved-field irradiation (IFI) for esophageal squamous cell carcinoma (ESCC) patients treated with intensity-modulated radiotherapy (IMRT).From January 2006 to December 2012, 644 patients (ENI = 157, IFI = 487) with stage I to IVa ESCC (AJCC 2010) at our institution were analyzed. Propensity score matching (PSM) was used to identify 471 (ENI = 157, IFI = 314) well-balanced patients for comparison. Overall survival (OS) was the primary outcome of the study.After PSM, the median OS was 26.8 (95% confidence interval [CI], 17.9–35.7) for the ENI arm versus 21.5 (95% CI: 17.9–25.1) months in the IFI arm. The 1-, 3-, 5-year OS were 77.1%, 42.0%, and 26.1% for the ENI arm versus 73.2%, 32.2%, and 19.0% for the IFI arm (P = .020). ENI was a significant independent predictor of 5-year OS (1.301 [1.052–1.609]; P = .015). Furthermore, patients with stage I/II ESCC or lymph node (LN) positivity in the ENI arm had significantly better 5-year OS than their counterparts in the IFI arm. In addition, for LN positivity patients treated with definitive radiotherapy alone, ENI tended to prolong OS compared with IFI (P = .035). The 2 arms were comparable in toxicities.Using IMRT, ENI is superior to IFI in improving OS of ESCC patients, with acceptable toxicities that were comparable to those to IFI, especially for LN positivity ESCC patients treated with definitive irradiation alone. These results should be confirmed in a large randomized study comparing these 2 modalities.

Radiotherapy (RT) is a traditional and important treatment for carcinoma of the esophagus along with surgery and chemotherapy. High mobility group box 1 (HMGB1) plays a crucial part in inhibiting the apoptosis of cancer cells after irradiation treatment. The present study, was designed to analyze the function of HMGB1 in esophageal cancer progression and elucidate the effects of HMGB1 on the radiosensitivity of human esophageal cancer cell lines. In the present study, an immunohistochemical evaluation of HMGB1 was performed on 77 biopsies, and the results revealed that HMGB1 overexpression was positively correlated with gross tumor volume (GTV), tumor-node-metastasis (TNM) stage, T classification, distant metastasis, and relapse and negatively correlated with patient survival rates, suggesting that HMGB1 acts as a key factor in the development of esophageal cancer. An shRNA targeting HMGB1 was designed for the knockdown of HMGB1 in ECA109 and TE13 cells, and the transfection efficiency of the shRNA was assessed using quantitative real-time reverse transcription polymerase chain reaction and western blot analysis. CCK-8 and clonogenic assays were used to analyze the effect of HMGB1 on the proliferation and radiosensitivity, respectively, of esophageal cancer cells in vitro. The influence of HMGB1 on radiation-induced changes in the migration, invasion, and cell cycle as well as apoptosis of tumor cells was examined by wound-healing and Transwell assays and flow cytometry, respectively. In addition, xenograft tumor models were constructed to observe the effect of HMGB1 on tumor growth in vivo. The results of the study in vitro revealed that the proliferation of the HMGB1-shRNA group decreased after irradiation, and the radiation treatment reduced the tumor volume of the xenograft model which was more marked in HMGB1-shRNA group. Moreover, HMGB1 was involved in the phosphorylation of H2AX after irradiation, and HMGB1 knockdown blocked the cell cycle in the G0/G1 phase and increased apoptosis. HMGB1 deficiency was also correlated with the upregulation of p16, Bax and caspase-9 and the downregulation of MMP-2, MMP-9, cyclin D1, CDK4, γH2AX and Bcl-2. These data indicated that the overexpression of HMGB1 prior to treatment was correlated with poor clinical outcome in esophageal carcinoma and that knockdown HMGB1 expression in human esophageal cancer cell lines increased their radiosensitivity by allowing the induction of apoptosis and G0/G1 arrest after exposure to radiation.

The protein expression levels of Ring finger protein 2 (RNF2) and phosphor-protein kinase B (P-AKT) were determined in esophageal squamous cell carcinoma (ESCC) tissues, and the association between patient clinicopathological characteristics and survival time following definitive intensity-modulated radiotherapy was assessed. Cancerous biopsy tissues were collected from patients with ESCC at The Fourth Affiliated Hospital of Hebei Medical University between January 2010 and December 2013. Of these 99 cases, 83 were used to analyze the protein expression level of RNF2 (89.2% positive), 85 for P-AKT (65.9% positive) and 80 for RNF2+P-AKT protein expression levels (62.5% both positive). The expression levels of RNF2 protein in ESCC were associated with tumor volume (P=0.024), whilst those of P-AKT and RNF2+PAKT were associated with sex (P=0.041 and P=0.003, respectively). There were no significant differences in overall survival (OS) or progression-free survival (PFS) rate between the RNF2 − and the RNF2 +-+++ groups (P=0.134 and P=0.366, respectively), or between the P-AKT − group and P-AKT +-+++ group (P=0.468; P=0.580, respectively). The 1-, 3- and 5-year OS rates were 68.0, 28.0, and 20.0%, and 86.7, 53.3, and 31.1%, in the RNF2/P-AKT + group and Other group, respectively (χ 2 =4.205; P=0.040). Multivariate analysis revealed that age, T stage and RNF2+P-AKT expression were independent prognostic factors for ESCC (P=0.010, P=0.008 and P=0.010, respectively). The expression of RNF2+P-AKT combined was an independent prognostic factor affecting survival rate, and therefore presents a potential prognostic indicator for patients with ESCC, treated with definitive radiotherapy.

Background: Cardiac metastasis from small cell lung cancer (SCLC) origin is rare, whereas the incidence is anticipated to increase with the extended survival rates. Case: We here describe a case report of a 48-year-old male patient diagnosis with SCLC in 2020. In June 2021, he resorted to hospital due to shortness of breath, no obvious changes were found in repeated echocardiography, electrocardiogram and chest computer tomography from June 2021 to September 2021. Due to the persistence of the complaints, cardiac magnetic resonance (CMR) imaging was performed in September 30th, 2021, which showed a mass in the right atrioventricular groove. The patient underwent pericardiocentesis and small cell carcinoma cells were found in the pericardial effusion, confirming the diagnosis of cardiac metastasis. Conclusion:Patients with a history of SCLC who develop new cardiac symptoms of unknown etiology should undergo imaging studies such as CMR. The importance of CMR for patients with SCLC is highlighted. The literature regarding metastatic cardiac tumors is reviewed.