The Clinical Observation Of Esophageal Carcinoma After Neoadjuvant Therapy

ObjectiveTo observe the changement of esophageal cancer cell after neoadjuvant therapy and evaluate the neoadjuvant therapy for the advanced esophageal cancer patients.Methods(1) To select 69 patients with locally advanced esophageal cancer patients,33 cases in neoadjuvant therapy group and 36 cases in only operation group. To make the families of patients clear about the pros and cons of the neoadjuvant therapy. To implement the new adjuvant therapy under the consent of their families.(2) The neoadjuvant therapy program:two cycles of preoperative chemotherapy, radiotherapy, and operation after two weeks.Chemotherapy program:fluorouracil (5-FU) 750mg/(m2·d), continuous intravenous infusion five days; cisplatinum (DDP) 15mg/(m2·d), five days;Radiotherapy program:total 40Gy, using sub-hyperfractionated accelerated radiotherapy 2Gy/time, two times a day, an interval of six hours or more;(3) Collecting data of two groups of patients with esophageal cancer, such as esophagoscopy, pathology, electron microscopy, digestive tract imaging and other morphological data.(4) Using TUNEL to label specimens, the calculation of apoptosis index, analysis of data using T test.(5) Using quality of life scale QLQ-C30 and QLQ-OES18 to conduct a questionnaire survey and analyse the quality of life of the patients on neoadjuvant therapy.(6) Comparing clinical stage of changement between before and after neoadjuvant therapy and complications between neoadjuvant therapy and only operation therapy groups.Rusults(1)The esophageal cancer after neoadjuvant therapy showed in the optical microscope, inflammatory cell infiltration, fibrous tissue hyperplasia, occlusion or becoming thin of tumor blood vessels, different degrees of cell degeneration and necrosis, the damage of cell. The colour of apoptotic cells vary after TUNEL staining, the number increased significantly. (2)Seeing from electron microscope, the nucleuses of tumor cells show different degrees of shrinkage, rupture, cytoplasmic coagulation and necrosis, membrane suddenly arise, desmosome connection is broken, irregular, apoptotic bodies.(3) From gastrointestinal radiography we can see that esophageal stenosis reduced, barium can pass the esophagus easier than the previous, esophageal mucosa becomes smooth, the length of cancer area shorter, no obvious wall stiffness.(4) Neoadjuvant therapy can decline the quality of life of patients with esophageal cancer in short-term, but does not affect the surgery and postoperative quality of life.(5) Neoadjuvant therapy can downgrade the pathological stage, does not increase the incidence of postoperative complications.ConclusionsThe esophageal cancer patients after neoadjuvant treatment showed good efficacy in microscopy, electron microscopy, image of the digestive tract. Although the quality of life of patients with esophageal cancer declined in short-term, it didn't affect the surgery and postoperative quality of life and enabled the patient's pathological stage reduction, didn't increase the incidence of postoperative complications. In short, locally advanced esophageal cancer patients will benefit from the neoadjuvant treatment.