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Pseudoprogression after Radiochemotherapy for High-grade Glioma

【摘要】　目的　探讨高级别胶质瘤患者放射、化学治疗后假性进展的临床特点、诊断与处理。　方法　分析2008年6月-2009年6月接受综合治疗的31例高级别胶质瘤患者临床资料，对假性进展的患者进行回顾分析，按照实体瘤疗效评判标准应用磁共振进行疗效评价。　结果　31例术后病理诊断为高级别胶质瘤的患者，替莫唑胺（TMZ）同期放射、化学治疗后维持TMZ辅助化学疗法，放射治疗后早期发生假性进展4例（14%)。　结论　对于TMZ同期放射、化学治疗后早期出现的影像学疑似进展，不要急于下结论，了解假性进展的临床特点，结合功能影像学检查可能会有助于临床医生的判断与处理。【Abstract】　Objective　To discuss the clinical feature, diagnosis, and management of pseudoprogression after radiochemotherapy of high-grade glioma patients. 　Methods　The clinical data of 31 high-grade glioma patients who underwent postoperative radiochemotherapy from June 2008 to June 2009 were reviewed. Pseudoprogression cases were analyzed. The treatment response was assessed through magnetic resonance imaging (MRI) according to the established response evaluation criteria in solid tumors.　Results　All the 31 high grade gioma patients received postoperative fractioned radiotherapy with concomitant TMZ chemotherapy, followed by TMZ maintenance chemotherapy. Four cases of pseudoprogression occurred after radiotherapy (14%).　Conclusion　Doctors should be careful in making early diagnosis for the suspected early progression after TMZ concomitant radiochemotherapy. It would be helpful for management to combine the clinical features of pseudoprogression with functional imaging technology.

Effect of Transanus Local Excision Combined with Radio-Chemotherapy in Gerontal Patients with Low Rectal Carcinoma

目的　 探讨老年低位直肠癌经肛门局部切除后加放、化疗的临床意义。方法　对18例年龄≥65岁，肿瘤距肛缘≤6 cm且经病理证实但拒绝Miles术的直肠癌患者行经肛门局部切除； 于术后1个月给予放疗（总剂量50 Gy）； 化疗： 亚叶酸钙200 mg、5-FU 400 mg/m2，第1次于术后第1~5 d，每3~4周重复1次，共3~6次。结果　全部病例无手术死亡，术后均有良好的肛门功能。16例获随访，随访5年，其中3例局部复发，拒绝再次手术，给予放、化疗。死亡12例，其中2例死于远处转移，10例死于其他因素。本组患者1年生存率为77.8%（14/18），5年生存率为38.9%（7/18）。结论　对老年低位直肠癌拒绝Miles术的患者行经肛门局部切除加放、化疗，疗效确切，可提高患者生活质量，延长生存期。

Neoadjuvant Chemoradiotherapy Combined with SphincterPreserving Surgery in Treatment of 34 Patients with Rectal Cancer

Objective To explore the safety of neoadjuvant chemoradiotherapy combined with sphincter-preserving operation in treatment of locally advanced low rectal cancer. Methods The clinical data of thirty-four patients admitted into our hospital between June 2007 and June 2009 with T3 and T4 low rectal cancer treated by neoadjuvant chemoradiotherapy and sphincter-preserving operation were collected and analyzed retrospectively. Routine fraction of radiation was given with total dose of 40 Gy, five times a week, 2 Gy per fraction. Patients received oxaliplatin （150 mg/d1）, plus folinic (100 mg/d1-3) and 5FU (750 mg/d1-3) for total 1 cycles started from the 4th week of irradiation. Operation was performed 4 weeks after neoadjuvant therapy. Results After neoadjuvant therapy, all patients underwent surgical resection with average tumor size decreased by 41.2%, tumor T stage decreased in 67.6% （23/34) patients, and lymph nodenegative change rate was 58.8% (10/17). One patient had liver metastasis and one had local recurrence, but without stomal leak. And 88.2% (30/34) patients showed good function of sphincter. Conclusions Neoadjuvant chemoradiotherapy in advanced lower rectal cancer patients has shown its efficacy in down-staging, which is safe without increasing operation complications when combined with sphincterpreserving surgery.

Preoperative Concurrent Chemoradiotherapy Combined with Total Mesorectal Excision in Treatment for Locally Advanced Lower Rectal Cancer

Objective　To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision （TME） in treatment for locally advanced lower rectal cancer. Methods　The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively. Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken. The efficacy was assessed by recording results of clinical and pathological examination. The function of sphincter was also recorded. Results　All 31 patients underwent TME operation. The complication morbidity and mortality was 12.9% （4/31） and 3.2% （1/31），respectively. As a result of the preoperative management，the tumor was reduced by an average of 21.9%， down-regulation of T stage was observed in 48.4% （15/31） patients，the frequency of lymph node metastasis decreased from 83.9% （26/31） to 38.7% （12/31）. Pathological complete response was observed in 5 patients （16.1%） and the total response rate was 74.2% （23/31），grade 3/4 toxicity was occurred in 2 （6.5%） patients. 84.6% （22/26） of patients underwent sphincter preservation surgery reserved good function of sphincter. Conclusions　Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe，which can lead to pathological complete response，decrease the tumor stage and the rate of lymph node metastasis，and can also increase the efficacy of operation.

Selection of Adjuvant Radiochemotherapy in Treatment of Rectal Cancer

直肠癌围手术期辅助治疗的提出缘由是直肠癌发病率和死亡率仍不断上升。全球结、直肠癌发病率平均每年递增2%，在欧美国家其死亡率仍居癌症死亡第二位。我国情况亦相似，以上海为例，发病率每年递增4.2%，比全球平均递增速度还要高。1990～1992年我国十分之一人口的抽样调查显示，结、直肠癌平均调整死亡率为4.54/10万人口，居癌症死亡第五位。而直肠癌在美国占结、直肠癌的40%，在中国占50%以上。更甚的是，直肠癌治疗效果还不够理想，近30多年来提高并不显著。美国癌症协会Cutler统计分析25　000例结、直肠癌资料，其中外科治疗直肠癌5年生存率自1940～1960年由44%提高到50%。英国牛津大学临床试验研究中心收集1960～1987年世界各地所有结、直肠癌临床随机治疗资料共计97组154项研究，包含32　000余例，其中直肠癌3年和5年生存率分别为65.0%和45.1%。迄今，大宗直肠癌病例报告的术后5年生存率都徘徊在50%左右，扩大手术范围生存率提高不多，但随之而来的却是更大的手术损伤、合并症增加。术后远处转移，特别是局部复发是直肠癌治疗失败的原因，如何防止局部复发和肝转移，一直是困扰医学家们的临床课题。此外，随着社会进步和科学技术水平的提高，人们对生活质量要求也提高，更多直肠癌患者要求保留肛门。

Advances of Neoadjuvant Therapy Combined with Transanal Resection in Stage T 2-3 Rectal Cancer

Objective　To summarize the application and advancement of neoadjuvant therapy combined with transanal resection in stage T2-3 rectal cancer. Methods　Domestic and abroad publications on the studies of neoadjuvant therapy combined with transanal resection in stage T2-3 rectal cancer in recent years were collected and reviewed. Results　In selected patients with stage T2-3 rectal cancer, neoadjuvant therapy combined with transanal resection was efficacious in sphincter preservation and complications prevention. Compared with modality without chemoradiation, the recurrence rate had decreased from 17%-62% to 0-20%. Conclusion　Selected patients with stage T2-3 rectal cancer can benefit from neoadjuvant chemoradiation combined with transanal resection.

Risk factors of liver metastasis after preoperative total neoadjuvant chemoradiotherapy for middle and low rectal cancer of Ⅱ–Ⅲ stage

Objective To investigate the risk factors of liver metastasis in patients with middle and low rectal cancer of Ⅱ–Ⅲ stage after preoperative short course radiotherapy combined with chemotherapy. MethodsThe clinical data of 89 patients with middle and low rectal cancer of Ⅱ–Ⅲ stage admitted to the Dongnan Hospital of Xiamen University from January 2019 to June 2020 were retrospectively analyzed. All patients were treated with short-course radiotherapy combined with chemotherapy before operation. The risk factors of postoperative liver metastasis were analyzed by multivariate logistic regression. ResultsThe 89 patients were followed up for 7–53 months, with a median follow-up time of 33 months. During the follow-up period, 25 patients developed liver metastasis, the onset time was 7–35 months, and the median time of liver metastasis was 17 months. Among them, 5 patients (5.6%) developed liver metastasis in the first year after surgery, 15 patients (16.8%) developed liver metastasis at the second year after surgery, 5 patients (5.6%) developed liver metastasis at the 3rd year after surgery. Multivariate logistic regression results showed that lymph node metastasis [OR=3.550, 95%CI (1.425, 8.953), P=0.041], vascular invasion [OR=3.335, 95%CI (1.011, 11.001), P=0.048], maximum tumor diameter ≥5 cm [OR=4.477, 95%CI (1.273, 15.743), P=0.019], and peri-tumor diameter ≥1/2 [OR=4.633, 95%CI (1.387, 15.475), P=0.013] were risk factors for liver metastasis. ConclusionsLymph node metastasis, vascular invasion, maximum tumor diameter ≥5 cm, and circumferential tumor diameter ≥1/2 are risk factors for liver metastasis in patients with middle and low rectal cancer of Ⅱ–Ⅲ stage after preoperative short course radiotherapy combined with chemotherapy.

术前同步放化疗后胸腹腔镜联合食管癌根治术视频要点

Downstaging and Tumor Regression in Rectal Cancer Following Neo-Adjuvant Chemoradiotherapy

Neoadjuvant Therapy of Rectal Cancer

Objective To discuss the important role of preoperative chemoradiotherapy in the treatment of mid-low rectal cancer. Methods From the surgical point of view, the evidences from clinic trials in literatures of recent years and also from the results of our single institution were analyzed. Results Preoperative radiotherapy with total dosage of 50 Gy had showed more and more advantages in the past two decades. Preoperative radiotherapy with concomitant chemotherapy had definite effects in downing stage and improving local control, while its role in sphincter preserving kept in controversy. However, this combined preoperative therapies had not improved long-term survival in rectal cancer. By now, there were no proper indicators to predict the effects of therapies. Conclusion Preoperative chemoradiotherapy is still the only way to improve the rate of R0 resection and decrease the rate of local currence after surgery for patients with mid-low advanced rectal cancer.