SignificanceDetermining the extent of gastric cancer (GC) is necessary for evaluating the gastrectomy margin for GC. Additionally, determining the extent of the GC that is not exposed to the mucosal surface remains difficult. However, near-infrared (NIR) can penetrate mucosal tissues highly efficiently.AimWe investigated the ability of near-infrared hyperspectral imaging (NIR-HSI) to identify GC areas, including exposed and unexposed using surgical specimens, and explored the identifiable characteristics of the GC.ApproachOur study examined 10 patients with diagnosed GC who underwent surgery between 2020 and 2021. Specimen images were captured using NIR-HSI. For the specimens, the exposed area was defined as an area wherein the cancer was exposed on the surface, the unexposed area as an area wherein the cancer was present although the surface was covered by normal tissue, and the normal area as an area wherein the cancer was absent. We estimated the GC (including the exposed and unexposed areas) and normal areas using a support vector machine, which is a machine-learning method for classification. The prediction accuracy of the GC region in every area and normal region was evaluated. Additionally, the tumor thicknesses of the GC were pathologically measured, and their differences in identifiable and unidentifiable areas were compared using NIR-HSI.ResultsThe average prediction accuracy of the GC regions combined with both areas was 77.2%; with exposed and unexposed areas was 79.7% and 68.5%, respectively; and with normal regions was 79.7%. Additionally, the areas identified as cancerous had a tumor thickness of >2 mm.ConclusionsNIR-HSI identified the GC regions with high rates. As a feature, the exposed and unexposed areas with tumor thicknesses of >2 mm were identified using NIR-HSI.
As salvage surgery after failure of chemoradiotherapy (CRT) for esophageal cancer shows high morbidity and mortality, curative and less invasive salvage treatment has been needed. Photodynamic therapy (PDT) is a candidate for local failure after CRT. Taraporfin sodium (Leserphyrin) is the new generation photosensitizer which was made in Japan, and has an advantage of low skin toxicity because of rapid clearance.
We conducted multi-institutional trial to evaluate the safety and efficacy of PDT using taraporfin sodium for patients with histologically proven local failure limited within the muscularis propria after 50Gy or more CRT for esophageal cancer. The PDT procedure commenced with intravenous administration of a 40mg/m2 dose of talaporfin sodium followed by diode laser irradiation at a 664nm wavelength. We set the primary endpoint as local complete response (L-CR) per patients. In this study, 26 patients were enrolled and all were treated with PDT. Twenty three patients were assessed L-CR after PDT; the L-CR rate per patient was 88.5 % (95% CI: 69.8%-97.6%). No skin phototoxicity was observed only with two weeks’ sun shade, and no grade 3 or worse non-hematological toxicities related to PDT were observed. At the timing of all enrolled cases were followed 3 years or longer, the median local progression free and overall survival time were 3.1 and 4.2 years, respectively.
PDT using new generation photosensitizer and a diode laser is a safe and potentially curative salvage treatment for local failure after CRT for patients with esophageal cancer.
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