BACKGROUND: Patients with gastro-oesophageal adenocarcinoma with tumour-positive lymph nodes (ypN+) or positive surgical margins (R1) following neoadjuvant chemotherapy and resection are at high risk of recurrence. Adjuvant nivolumab is effective in oesophageal/oesophagogastric junction cancer and residual pathological disease following chemoradiation and surgery. Immune checkpoint inhibition has shown efficacy in advanced gastro-oesophageal cancer. We hypothesised that nivolumab/ipilimumab would be more effective than adjuvant chemotherapy in high-risk (ypN+ and/or R1) patients with gastro-oesophageal adenocarcinoma following neoadjuvant chemotherapy and resection. PATIENTS AND METHODS: VESTIGE was an academic international, multicentre, open-label, randomised phase II trial evaluating the efficacy of adjuvant nivolumab/ipilimumab versus chemotherapy in gastro-oesophageal adenocarcinoma at high risk of recurrence. Patients were randomised 1 : 1 to receive standard adjuvant chemotherapy (same regimen as neoadjuvant) or nivolumab 3 mg/kg intravenously (i.v.) every 2 weeks plus ipilimumab 1 mg/kg i.v. every 6 weeks for 1 year. Key inclusion criteria included ypN+ and/or R1 status after neoadjuvant chemotherapy plus surgery. The primary endpoint was disease-free survival in the intent-to-treat population. Secondary endpoints included overall survival, locoregional and distant failure rates, and safety according to National Cancer Institute Common Terminology Criteria for Adverse Events v5.0. RESULTS: The independent Data Monitoring Committee reviewed data from 189 of the planned 240 patients in June 2022 and recommended stopping recruitment due to futility. At the time of final analysis, median follow-up was 25.3 months for 195 patients (98 nivolumab/ipilimumab and 97 chemotherapy). Median disease-free survival for the nivolumab/ipilimumab group was 11.4 months [95% confidence interval (CI) 8.4-16.8 months] versus 20.8 months (95% CI 15.0-29.9 months) for the chemotherapy group, hazard ratio 1.55 (95% CI 1.07-2.25, one-sided P = 0.99). The 12-month disease-free survival rates were 47.1% and 64.0%, respectively. There were no toxicity concerns or excess early discontinuations. CONCLUSION: Nivolumab/ipilimumab did not improve disease-free survival compared with chemotherapy in patients with ypN+ and/or R1 gastro-oesophageal adenocarcinoma following neoadjuvant chemotherapy and surgery.
- MeSH
- Adenocarcinoma * pathology drug therapy therapy MeSH
- Chemotherapy, Adjuvant methods MeSH
- Adult MeSH
- Gastrectomy MeSH
- Esophagogastric Junction * pathology MeSH
- Immunotherapy methods MeSH
- Ipilimumab administration & dosage therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Neoplasm Recurrence, Local * pathology prevention & control drug therapy epidemiology MeSH
- Esophageal Neoplasms * pathology drug therapy therapy MeSH
- Stomach Neoplasms * pathology drug therapy therapy surgery MeSH
- Neoadjuvant Therapy * methods adverse effects MeSH
- Nivolumab administration & dosage therapeutic use MeSH
- Disease-Free Survival MeSH
- Antineoplastic Combined Chemotherapy Protocols * therapeutic use MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase II MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
BACKGROUND/AIMS: The functional lumen imaging probe (FLIP) relies on the principle of impedance planimetry that enables direct measurement of intraluminal pressure, cross-sectional areas, and wall biomechanical properties. The aim of our pilot project was to introduce this method to assess function of the lower oesophageal sphincter and pyloric muscle in experimental pigs. METHODS: All measurements were accomplished in one session in six adult female pigs (mean weight 34.2 ± 3.6 kg), using the EndoFLIP 1.0 System with EndoFLIP catheters. Five major parameters were evaluated: balloon pressure (mm Hg), estimated diameter (mm), cross-sectional area (mm2), distensibility (mm2/mm Hg), and zone compliance (mm3/mm Hg). RESULTS: In total, 180 readings were successfully accomplished. Most of the measured values were nearing lower average figures for the lower oesophageal sphincter, and upper average figures for the pylorus in healthy humans. The porcine pyloric sphincter is composed of the Torus pyloricus. It serves as a study "gatekeeper" between the stomach and D1 duodenum, thus explaining higher pyloric readings. There was a clear trend for increasing values of CSA (cross-sectional area), diameter, and balloon pressure with increased filling balloon volumes. However, the sphincter distensibility did not change with increasing filling volumes, either for the lower oesophageal sphincter or pylorus. CONCLUSION: Endoscopic functional luminal planimetry in experimental pigs is feasible, both for the lower oesophageal sphincter and the pylorus. This is an important starting point for future experimental endoscopic trials and pharmacology studies.
- MeSH
- Esophageal Sphincter, Lower * physiology diagnostic imaging MeSH
- Electric Impedance * MeSH
- Pilot Projects MeSH
- Swine MeSH
- Pylorus * MeSH
- Pressure MeSH
- Animals MeSH
- Check Tag
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Nádory gastroesophageální junkce (GEJ) a žaludku vzhledem k vysoké incidenci globálně představují závažný medicínský problém. Převážná část těchto onemocnění je diagnostikována v lokoregionálně pokročilém a/nebo metastatickém stadiu, které vyžaduje komplexní multidisciplinární přístup. Základem léčby lokoregionálně pokročilých stadií je systémová perioperační terapie, která prokazatelně zlepšuje prognózu pacientů. S cílem dalšího zlepšení je standardní perioperační chemoterapie kombinována s imunoterapií. Cílem tohoto sdělení je podat přehled současných doporučení a nových směrů léčby lokoregionálně pokročilých stadií nádorů GEJ a žaludku.
Given the high incidence of gastroesophageal junction (OGJ) and gastric tumours globally, they represent a major medical problem. The majority of these diseases are diagnosed at a locoregionally advanced and/or metastatic stage, which requires a comprehensive multidisciplinary approach. The mainstay of treatment of locoregionally advanced stages is systemic perioperative therapy, which has been shown to improve patient prognosis. With the aim of further improvement, standard perioperative chemotherapy is combined with immunotherapy. The aim of this review is to provide an overview of current recommendations and new treatment guidelines for locoregionally advanced stages of OGJ and gastric cancer.
- MeSH
- Chemoradiotherapy MeSH
- Drug Therapy methods MeSH
- Esophagogastric Junction pathology MeSH
- Gastrointestinal Neoplasms * surgery drug therapy therapy MeSH
- Immunotherapy methods MeSH
- Clinical Studies as Topic MeSH
- Clinical Trials, Phase II as Topic MeSH
- Drug Therapy, Combination methods MeSH
- Combined Modality Therapy methods MeSH
- Humans MeSH
- Stomach Neoplasms surgery drug therapy therapy MeSH
- Neoadjuvant Therapy MeSH
- Perioperative Care methods MeSH
- Antineoplastic Agents * administration & dosage MeSH
- Randomized Controlled Trials as Topic MeSH
- Check Tag
- Humans MeSH
Úvod: Endoskopická vakuová terapie (EVT) se stala důležitým nástrojem v léčbě defektů jícnu, jako jsou dehiscence anastomóz, píštěle a perforace. Studie prezentuje první zkušenosti s EVT v Ústřední vojenské nemocnici v Praze. Metody: Byla provedena retrospektivní analýza dat pacientů léčených EVT pro defekty jícnu v období od května 2020 do května 2024. Zahrnuti byli pacienti s dokončenou léčbou a 30denním sledováním. EVT byla zahájena v kombinaci s jinou endoskopickou/chirurgickou metodou, nebo bez nich. Primárním cílem byla úspěšnost uzávěru defektu, sekundárními cíli byly délka a charakteristika léčby, 30denní letalita a komplikace. Výsledky: Z celkem dvanácti léčených pacientů dokončilo deset pacientů (osm mužů, průměrný věk 65,2 let) 30denní sledování. V devíti z deseti případů byla příčinou defektu jícnu dehiscence po operaci jícnu, jeden pacient měl spontánní perforaci jícnu. Úspěšný uzávěr s použitím, nebo bez použití dalších endoskopických či chirurgických léčebných metod byl dosažen u osmi z deseti pacientů (80 %). Průměrná délka léčby byla 18,9 ± 11,1 dne a průměrný početEso-SPONGE na pacienta byl 5,1 ± 3,4. Léčbu pouze pomocí EVT měli dva pacienti z deseti, osm z deseti mělo kombinaci s jinou modalitou. Celková hospitalizační letalita byla 30 %, 30denní letalita 20 %. U dvou pacientů (20 %) se rozvinula stenóza v místě anastomózy a původního defektu, jiné komplikace léčby nebyly zaznamenány. Závěr: EVT se prokázala jako efektivní a bezpečná metoda v léčbě defektů jícnu, avšak její úspěšnost je často dosažena v kombinaci s jinými léčebnými modalitami, zejm. s chirurgickou přídatnou drenáží. Léčba je založena na multioborové spolupráci. Většina pacientů vyžadovala kombinovaný léčebný přístup.
Introduction: Endoscopic vacuum therapy (EVT) has become an important tool in the treatment of esophageal defects such as anastomotic leaks, fistulas and perforations. The study presents the first experience with EVT at the Military University Hospital in Prague. Methods: A retrospective analysis of data from patients treated for esophageal defects using EVT from May 2020 to May 2024 was performed. Patients with completed treatment and 30-day fol low-up were included. EVT was initiated without or in combination with another endoscopic/surgical method. The primary endpoint of the analysis was the success rate of defect closure, the secondary objectives were the duration and characteristics of treatment, 30-day lethality and complications of EVT. Results: Overall, 12 patients have been treated during the study period, of which10 patients (8 men, mean age 65.2 years) completed a 30-day fol low-up and were included into the analysis. In 9/10 cases, the cause of the esophageal defect was anastomotic leak after esophageal surgery, 1 patient had spontaneous esophageal perforation. Successful closure with or without the use of other endoscopic or surgical treatment methods was achieved in 8/10 patients (80%). The mean duration of treatment was 18.9 ± 11.1 days, and the mean number of Eso-SPONGEs used per patient was 5.1 ± 3.4. Two patients (2/10) were treated with EVT alone, 8/10 in combination with another modality. The overall hospitalization lethality was 30%, the 30-day lethality was 20%. Two patients (20%) developed stricture at the site of anastomotic defect, but we have not experienced any ther complications of EVT treatment. Conclusion: EVT has proven to be an effective and safe method for the treatment of esophageal defects, but its success is often achieved in combination with other treatment modalities, especially surgical adjunctive drainage.The treatment is based on multidisciplinary approach and most patients required combination of treatment modalitites.
BACKGROUND: Dupilumab is a human monoclonal antibody that blocks interleukin-4 and interleukin-13 pathways and has shown efficacy in five different atopic diseases marked by type 2 inflammation, including eosinophilic esophagitis in adults and adolescents. METHODS: In this phase 3 trial, we randomly assigned, in a 2:2:1:1 ratio, patients 1 to 11 years of age with active eosinophilic esophagitis who had had no response to proton-pump inhibitors to 16 weeks of a higher-exposure or lower-exposure subcutaneous dupilumab regimen or to placebo (two groups) (Part A). At the end of Part A, eligible patients in each dupilumab group continued the same regimen and those in the placebo groups were assigned to higher-exposure or lower-exposure dupilumab for 36 weeks (Part B). At each level of exposure, dupilumab was administered in one of four doses tiered according to baseline body weight. The primary end point was histologic remission (peak esophageal intraepithelial eosinophil count, ≤6 per high-power field) at week 16. Key secondary end points were tested hierarchically. RESULTS: In Part A, histologic remission occurred in 25 of the 37 patients (68%) in the higher-exposure group, in 18 of the 31 patients (58%) in the lower-exposure group, and in 1 of the 34 patients (3%) in the placebo group (difference between the higher-exposure regimen and placebo, 65 percentage points [95% confidence interval {CI}, 48 to 81; P<0.001]; difference between the lower-exposure regimen and placebo, 55 percentage points [95% CI, 37 to 73; P<0.001]). The higher-exposure dupilumab regimen led to significant improvements in histologic, endoscopic, and transcriptomic measures as compared with placebo. The improvements in histologic, endoscopic, and transcriptomic measures between baseline and week 52 in all the patients were generally similar to the improvements between baseline and week 16 in the patients who received dupilumab in Part A. In Part A, the incidence of coronavirus disease 2019, nausea, injection-site pain, and headache was at least 10 percentage points higher among the patients who received dupilumab (at either dose) than among those who received placebo. Serious adverse events were reported in 3 patients who received dupilumab during Part A and in 6 patients overall during Part B. CONCLUSIONS: Dupilumab resulted in histologic remission in a significantly higher percentage of children with eosinophilic esophagitis than placebo. The higher-exposure dupilumab regimen also led to improvements in measures of key secondary end points as compared with placebo. (Funded by Sanofi and Regeneron Pharmaceuticals; EoE KIDS ClinicalTrials.gov number, NCT04394351.).
- MeSH
- Child MeSH
- Double-Blind Method MeSH
- Eosinophilic Esophagitis * drug therapy MeSH
- Eosinophils drug effects MeSH
- Esophagus pathology MeSH
- Antibodies, Monoclonal, Humanized * therapeutic use adverse effects MeSH
- Remission Induction MeSH
- Injections, Subcutaneous MeSH
- Interleukin-13 antagonists & inhibitors MeSH
- Interleukin-4 antagonists & inhibitors MeSH
- Infant MeSH
- Humans MeSH
- Child, Preschool MeSH
- Dose-Response Relationship, Drug MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Humans MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase III MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
Introduction: Na experimentálnu verifikáciu vitality žalúdočného tubulu pred ezofagektómiou je nevyhnutná existencia jednoduchého modelu. Ischémia je hlavná príčina dehiscencie ezofagogastrickej anastomózy a následného leaku anastomózy. Ischemická príprava žalúdočného tubulu pred ezofagektómiou je potencionálna možnosť ako zamedziť rozvoju nežiaducich komplikácií. Avšak technika ako aj optimálne načasovanie ischemizácie ostávajú nejasné. Metody: Samce potkanov plemena Sprague-Dawley (n=24) boli náhodne rozdelené do štyroch skupín: ischemická skupina s odberom vzoriek po 1 hodine od ischémie (I1H), ischemická skupina s odberom vzoriek 1 deň od ischémie (I1D), ischemická skupina s odberom vzoriek 7 dní od ischémie (I7D) a kontrolná skupina (C). Ischémia bola navodená ligáciou a. gastrica sinistra a aa. gastricae breves. Vzorky boli histologicky a makroskopicky verifikované a stanovený bol počet a percentuálne zastúpenie jednotlivých imunokompetentných buniek. Výsledky: V skupine I1H bola pozorovaná ischemická denudácia s mukozálnymi eróziami a celkový počet eozinofilov bol signifikantne vyšší (p<0.05) v tejto skupine v porovnaní so skupinami I1D a I7D. V skupine I1D bola pozorovaná redukcia zápalu a parciálna regenerácia žalúdočnej mukózy. V skupine I7D bola pozorovaná takmer kompletná architektonická regenerácia žalúdočného epitelu a počet polymorfonukleárov bol signifikantne nižší (p<0,05) ako v skupine I1D. Záver: Ischemické poškodenie ligáciou žalúdočných tepien bolo predominantne pozorované v skupinách I1H a I1D avšak nie v skupine I7D. Táto práca prezentuje jednoduchú metódu verifikácie ischemických zmien žalúdočného tubulu.
Introduction: A reproducible and simple model is essential for verifying gastric conduit vitality before esophagectomy. Ischemia is a major cause of esophagogastric anastomotic dehiscence and leakage. Ischemic conditioning of the stomach prior to esophageal surgery has been shown to lower the incidence of postoperative complications, including anastomotic leakage. However, the optimal timing and technique of ischemization remain uncertain. Methods: Male Sprague-Dawley rats (n=24) were randomly divided into four groups: ischemic group – samples collected 1 hour after ischemia (I1H), ischemic group – samples collected 1 day after ischemia (I1D), ischemic group – samples collected 7 days after ischemia (I7D), and control group (C). Ischemia was induced by ligation of the left gastric (LGA) and short gastric arteries (SGA). The samples were verified using histological and macroscopic analysis, and the number and percentage of immunocompetent cells were determined. Results: One hour after ischemization (I1H), ischemic denudation with mucosal erosion was observed, and the total number of eosinophils was significantly higher (p<0.05) in the I1H group compared to the I1D and I7D groups. One day after ischemia (I1D), there was a reduction in the inflammatory response with partial regeneration of gastric mucosa. In the I7D group, nearly complete architectural regeneration of mucosal epithelium was documented. The total count of polymorphonuclears was significantly lower (p<0.05) compared to the I1D group. Conclusion: Ischemic mucosal injury after LGA and SGA ligation was observed dominantly in the I1H and I1D groups, but not in I7D group. In conclusion, this study presents a simple method for verifying gastric ischemic changes.
- MeSH
- Anastomosis, Surgical * MeSH
- Esophagectomy methods MeSH
- Esophagus surgery blood supply pathology MeSH
- Ischemic Postconditioning methods MeSH
- Rats MeSH
- Anastomotic Leak etiology prevention & control MeSH
- Rats, Sprague-Dawley MeSH
- Stomach surgery blood supply pathology MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Animals MeSH
INTRODUCTION: Long-term outcome data are limited for non-achalasia esophageal motility disorders treated by peroral endoscopy myotomy (POEM) as a separate group. We investigated a subset of symptomatic patients with hypercontractile esophagus (Jackhammer esophagus). METHODS: Forty two patients (mean age 60.9 years; 57% female, mean Eckardt score 6.2 ± 2.1) treated by primary peroral myotomy for symptomatic Jackhammer esophagus 2012-2018 in seven European centers were retrospectively analyzed; myotomy included the lower esophageal sphincter but did not extend more than 1 cm into the cardia in contrast to POEM for achalasia. Manometry data were re-reviewed by an independent expert. The main outcome was the failure rate defined by retreatment or an Eckardt score >3 after at least two years following POEM. RESULTS: Despite 100% technical success (mean intervention time 107 ± 48.9 min, mean myotomy length 16.2 ± 3.7 cm), the 2-year success rate was 64.3% in the entire group. In a subgroup analysis, POEM failure rates were significantly different between Jackhammer-patients without (n = 22), and with esophagogastric junction outflow obstruction (EGJOO, n = 20) (13.6% % vs. 60%, p = 0.003) at a follow-up of 46.5 ± 19.0 months. Adverse events occurred in nine cases (21.4%). 14 (33.3%) patients were retreated, two with surgical fundoplication due to reflux. Including retreatments, an improvement in symptom severity was found in 33 (78.6%) at the end of follow-up (Eckardt score ≤3, mean Eckardt change 4.34, p < 0.001). EGJOO (p = 0.01) and frequency of hypercontractile swallows (p = 0.02) were predictors of POEM failure. The development of a pseudodiverticulum was observed in four cases within the subgroup of EGJOO. CONCLUSIONS: Patients with symptomatic Jackhammer without EGJOO benefit from POEM in long-term follow-up. Treatment of Jackhammer with EGJOO, however, remains challenging and probably requires full sphincter myotomy and future studies which should address the pathogenesis of this variant and alternative strategies.
- MeSH
- Esophageal Achalasia surgery diagnosis physiopathology MeSH
- Esophageal Sphincter, Lower surgery physiopathology MeSH
- Adult MeSH
- Natural Orifice Endoscopic Surgery methods adverse effects MeSH
- Esophagoscopy methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Manometry * methods MeSH
- Myotomy * methods MeSH
- Follow-Up Studies MeSH
- Esophageal Motility Disorders * surgery diagnosis etiology MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
We present a case of a preterm neonate with a type IV laryngo-tracheo-oesophageal cleft, an uncommon congenital malformation, resulting from the failure of separation of the trachea and the oesophagus during fetal development, often associated with other deformities as well. Data in the literature shows that the long-term morbidity from the entity has declined over the last decades, even though prognosis remains unfavourable for types III and IV. This report emphasizes the complex issues neonatologists are faced with, when treating neonates with this rare disorder in the first days of life, what will raise suspicion of this rare medical entity, and that direct laryngoscopy/bronchoscopy finally depicts the exact extension of the medical condition. At the same time extensive evaluation for coexisting congenital anomalies should be performed. For all the above reasons, these neonates should be treated in specialized tertiary pediatric centers for multidisciplinary prompt management, which may improve, the outcome.
- MeSH
- Child MeSH
- Esophagus diagnostic imaging surgery abnormalities MeSH
- Laryngoscopy MeSH
- Larynx * diagnostic imaging surgery abnormalities MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Trachea diagnostic imaging surgery abnormalities MeSH
- Congenital Abnormalities * MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Review MeSH
PURPOSE: Open-label phase II study (RELATIVITY-060) to investigate the efficacy and safety of first-line nivolumab, a PD-1-blocking antibody, plus relatlimab, a lymphocyte-activation gene 3 (LAG-3)-blocking antibody, plus chemotherapy in patients with previously untreated advanced gastric cancer (GC) or gastroesophageal junction cancer (GEJC). METHODS: Patients with unresectable, locally advanced or metastatic GC/GEJC were randomly assigned 1:1 to nivolumab + relatlimab (fixed-dose combination) + chemotherapy or nivolumab + chemotherapy. The primary end point was objective response rate (ORR; per RECIST v1.1 by blinded independent central review [BICR]) in patients whose tumors had LAG-3 expression ≥1%. RESULTS: Of 274 patients, 138 were randomly assigned to nivolumab + relatlimab + chemotherapy and 136 to nivolumab + chemotherapy. Median follow-up was 11.9 months. In patients with LAG-3 expression ≥1%, BICR-assessed ORR (95% CI) was 48% (38 to 59) in the nivolumab + relatlimab + chemotherapy arm and 61% (51 to 71) in the nivolumab + chemotherapy arm; median progression-free survival (95% CI) by BICR was 7.0 months (5.8 to 8.4) versus 8.3 months (6.9 to 12.1; hazard ratio [HR], 1.41 [95% CI, 0.97 to 2.05]), and median overall survival (95% CI) was 13.5 months (11.9 to 19.1) versus 16.0 months (10.9 to not estimable; HR, 1.04 [95% CI, 0.70 to 1.54]), respectively. Grade 3 or 4 treatment-related adverse events (TRAEs) occurred in 69% and 61% of all treated patients, and 42% and 36% of patients discontinued because of any-grade TRAEs in the nivolumab + relatlimab + chemotherapy and nivolumab + chemotherapy arms, respectively. CONCLUSION: RELATIVITY-060 did not meet its primary end point of improved ORR in patients with LAG-3 expression ≥1% when relatlimab was added to nivolumab + chemotherapy compared with nivolumab + chemotherapy. Further studies are needed to address whether adding anti-LAG-3 to anti-PD-1 plus chemotherapy can benefit specific GC/GEJC patient subgroups.
- MeSH
- Adenocarcinoma * drug therapy pathology mortality MeSH
- Progression-Free Survival MeSH
- Adult MeSH
- Esophagogastric Junction * pathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Esophageal Neoplasms * drug therapy pathology mortality MeSH
- Stomach Neoplasms * drug therapy pathology mortality MeSH
- Nivolumab * therapeutic use administration & dosage adverse effects MeSH
- Lymphocyte Activation Gene 3 Protein * MeSH
- Antineoplastic Combined Chemotherapy Protocols * therapeutic use adverse effects MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase II MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial MeSH
- MeSH
- Esophagogastric Junction pathology MeSH
- Humans MeSH
- Neoplasm Metastasis MeSH
- Esophageal Neoplasms * therapy MeSH
- Brain Neoplasms surgery radiotherapy secondary MeSH
- Paclitaxel pharmacology therapeutic use MeSH
- Antineoplastic Combined Chemotherapy Protocols MeSH
- Ramucirumab pharmacology therapeutic use MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
