Objective To explore the safety and efficacy of lenvatinib in combination with transarterial chemoembolization (TACE) and programmed death receptor 1 (PD-1) antibody in the treatment of recurrent liver cancer. Method The clinical data of 22 patients with unresectable recurrent liver cancer admitted to Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University and received the conversion therapy of lenvatinib+TACE+PD-1 antibody between January 2019 and January 2022 were retrospectively analyzed. Results All 22 patients experienced some degree of adverse events, with a grade 3 adverse event rate of 18.2% (4/22) and no grade 4 or higher adverse events. At 4 months of treatment, according to the modified response evaluation criteria solid tumors (mRECIST), 2 cases were in complete response (CR), 5 cases were in partial response (PR), and 6 cases were in stable disease (SD), 9 cases were in progressive disease (PD), and the objective response (CR+PR) rate (ORR) was 31.8% (7/22). At the last follow-up, there was 1 case in CR, 5 cases in PR, 1 case in SD, and 15 cases in PD, with an ORR of 27.3% (6/22). The 1-year overall survival (OS) rate was 83.8% and the 1-year progression-free survival (PFS) rate was 38.2%. In the subgroup analysis, the 1-year OS rate for patients with recurrent liver cancer with intrahepatic lesions (n=16) only was 86.2% [95%CI (77.1%, 95.3%)], the 1-year PFS rate was 46.9% [95%CI (34.0%, 59.8%)], and the ORR based on mRECIST criteria was 43.8% (7/16). Patients with intrahepatic combined with extrahepatic lesions (n=6) had a 1-year OS rate of 75.0% [95%CI (53.3%, 96.7%)] and a 1-year PFS rate of 16.7% [95%CI (15.0%, 31.9%)], and the ORR based on mRECIST criteria was 0% (0/6). There were no significant differences in OS (P=0.864) and PFS (P=0.125) between the two subgroups. The ORR of intrahepatic combined with extrahepatic lesions group was worse compared to the intrahepatic lesion group (P=0.049). Conclusion Lenvatinib in combination with TACE and PD-1 antibody is safe and effective in the treatment of unresectable recurrent liver cancer, but there are still many issues that deserve further exploration.
摘要:目的: 评估手术、栓塞及γ刀综合治疗脑动静脉畸形的疗效。 方法 :回顾性分析了我科自2002年3月至2009年7月期间综合治疗的43例脑AVM患者,分析评估这43例脑AVM的临床特点及治疗效果,随访患者并对其进行GOS评分。 结果 :本组病例采取栓塞＋手术治疗3例、栓塞＋γ刀治疗26例、手术＋γ刀治疗11例、栓塞+手术＋γ刀治疗3例。术后随访28例,随访时间4月至7年6月,GOS评分5分者25例,患者均能重新回到工作或学校;GOS评分4分者2例,患者生活能够自理;GOS评分1分者1例,患者死亡。 结论 :对大型、功能区、有深部静脉引流的脑AVM综合治疗有一定的优越性,它不仅使脑AVM治愈率明显提高,而且与治疗相关的各种并发症和病死率也明显降低。Abstract: Objective: To evaluate the efficacy of multimodality treatment of cerebral arteriovenous malformations(AVMs) with surgery, embolization and γknife radiation. Methods : A retrospective analysis of 43 cases of cerebral AVMs applied with multimodality treatment in our department From March 2002 to July 2009 has been made, meanwhile we have analyzed and assessed the clinical characteristics and treatment outcome of these 43 patients with cerebral AVMs. Results : Patients received multimodality treatment with embolization followed by surgery(n=3), embolization followed by γknife radiation(n=26), surgery followed by γknife radiation(n=11), or embolization, surgery, and γknife radiation(n=3). Postoperative followup of 28 cases, the followup time is 4 months to 7 years and 6 months. GOS score 5 in 25 cases, who can be able to return to work or school. GOS score 4 in 2 cases, who can be able to live independently. GOS score 1 in 1 case, who is dead. Conclusion : In the cerebral AVMs which are large, or located within or immediately adjacent to eloquent regions of the brain, or have deep venous drainage, multimodality treatment has some superiority. It can not only improve the cure rate of cerebral AVMs significantly, but also reduce the treatmentrelated complications and mortality.
ObjectiveTo evaluate the effects of combined TACE and PVC regarding the survival and diseasefree survival rate in hepatocellular carcinoma (HCC) patients. MethodsThe relevant articles were searchd by a database search of PubMed, EMBASE, Cochrane Library (CENTRAL) Databases, Web of Science, Sciencedirect, National Institute of Health Clinical Trials Database, CNKI, WANFANG Database, and VIP Database. The analysis of the data was performed using Revman 5.1 Software. ResultsBy searching and selecting, a total of ten articles met the inclusion criteria, of which 6 were in the postoperative group, and 4 were in the no-operative group. There were no statistical significance of heterogeneity in each group through subgroup analyzed. The pooled OR showed that combined TACE and PVC could significantly increase the 1-, 2-, and/or 3-year survival and disease-free survival rates compared with TACE alone for HCC patients. The pooled OR and 95% CI of the 1-, 2-and/or 3-year survival and disease-free survival rate, respectively, were as follows:In operative group, 1-year disease-free survival rate 2.09, 1.21-3.61; 3-year disease-free survival rate 3.62, 1.88-6.97; 1-year survival rate 2.25, 1.30-3.87; 3-year survival rate 1.96, 1.20-3.21. In no-perative group:1-year survival rate 3.90, 2.33-6.54; 2-year survival rate 5.30, 1.87-15.06. Conlusions Compared with TACE alone, postoperative adjuvant combined TACE and PVC can significantly increase the 1-, and 3-year survival and disease-free survival rates. For no-perative group, adjuvant combined TACE and PVC can significantly increase the 1-, and 2-year survival rates. Based on the limitations of this meta-analysis (this article is included in the high quality literature less), clinicians should be cautious by using our findings.
Objective To summarize the blood supply to the sources and characteristics of advanced breast cancer，and explore the method，efficacy，and clinical applications of preoperative super-selective arterial catheterization chemoembolization under DSA for it. Methods Sixty patients with advanced breast cancer confirmed by the aspiration biopsy from February 2007 to October 2011 in this hospital were selected. Seldinger method was used，distributing of the tumor blood supply artery was identified and intubated the target artery by super-selective arterial catheterization via the femoral artery puncture under the DSA. Then，pirarubicin 60 mg plus paclitaxel 120 mg of two chemotherapy drugs was injected into slowly the target artery and the intervention infusion chemotherapy was performed，finally the tumor blood supply artery was embolizated by gelatin sponge particle. Results A total of 112 conclusive blood supply artery in 60 patients with DSA were found，including eight cases of single blood supply artery，52 cases of multiple blood supply arteries，mainly in the lateral thoracic artery and （or） internal thoracic artery-based. The complete remission rate was 25.0% （15/60），partial remission rate was 73.3% （44/60），stable disease rate was 1.7% （1/60），the total effective rate was 98.3% （59/60）. There was no progression disease. The median remission duration was 19 months，median survival time was 40 months. Conclusions The location of the original foci of breast cancer is closely related to blood supply arteries. The tumor in the lateral of the breast mainly dominates by the lateral thoracic artery blood supply. The tumor in the inner breast mainly dominates by the internal thoracic artery blood supply. The preoperative super-selective arterial catheterization chemoembolization under DSA can obviously improve the therapeutic effect，long-term survival，and the target of interventional chemoembolization.
ObjectiveTo explore the effect of hydroxyapatite nanoparticle (nHAP) on hepatocellular carcinoma (HCC) and its mechanisms. MethodsThe literatures about the effect of nHAP on HCC were reviewed and summarized. ResultsAs a new nanoparticle, nHAP could suppress the DNA synthesis and subsequent division and proliferation of HCC cells through the inhibition of proliferating cell nuclear antigen (PCNA) and telomerase gene expression and increase of intracellular Ca2+. Moreover, nHAP was able to suppress the differentiation and metastases of HCC cells through the effect on the expressions of Paxillin and P130cas and the decrease of expressions of multiple drug resistance gene protein, microvessel density, and vascular endothelial growth factor. Finally, nHAP induced the apoptosis of HCC tumor cells by the regulation of bcl-2 and bax protein expressions. The combined use of nHAP and chemoembolization drugs could enhance the efficacy, prolong drug duration and reduce toxicity. ConclusionnHAP can inhibit the division, proliferation, differentiation, and metastases, and promote the apoptosis of HCC cells and combined use with chemoembolization drugs can enhance the efficacy and reduce toxicity.
Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with transurethral resection of bladder tumor (TURBT) for muscle-invasive bladder cancer (MIBC). Methods China National Knowledge Infrastructure, Chongqing VIP, Wanfang, SinoMed, PubMed, Web of Science, and Cochrane Library were searched from the establishment of databases until December 2023. All randomized controlled trials of TACE combined with TURBT for MIBC were collected and subjected to meta-analysis using RevMan 5.4 software. Results A total of 7 studies were included, involving 490 patients, with 246 in the TACE+TURBT group and 244 in the TURBT group. The meta-analysis results showed that compared with TURBT, TACE+TURBT had certain advantages in reducing recurrence rate [relative risk (RR)=0.49, 95% confidence interval (CI) (0.35, 0.68)], improving survival rate [RR=1.16, 95%CI (1.07, 1.27)], shortening surgical time [standardized mean difference (SMD)=−4.97, 95%CI (−7.54, −2.40)], reducing intraoperative bleeding [SMD=−4.19, 95%CI (−5.78, −2.60)], and improving quality of life [SMD=4.51, 95%CI (2.15, 6.86)]. The adverse reactions of the two groups were similar. Conclusions Existing evidence suggests that TACE may reduce intraoperative bleeding and shorten surgical time to help achieve maximum TURBT. TACE combined with TURBT may be superior to simple TURBT in terms of tumor recurrence rate and survival rate. TACE combined with TURBT can benefit MIBC patients in bladder-preserving treatment plans.
The treatment of liver cancer is still a challenge in the world, and it is mainly refers to hepatocellular carcinoma (HCC). There are many factors affecting the overall survival rate of HCC; the recurrence of HCC is the main risk factor affecting the survival of patients, hence, it is urgent to explore the clinical treatment of recurrent HCC to obtain long-term survival of the patients. Up to now, surgical treatment is a radical treatment for HCC. Similarly, liver resection and liver transplantation are still the main therapy methods for recurrent HCC. In addition, radiofrequency ablation and transcatheter arterial chemoembolization and other local treatments still play an irresistible role. Therefore, emphasizing the postoperative follow-up of patients, diagnosing recurrent HCC in early stage, paying attention to the risk factors of HCC recurrence and selecting a suitable treatment plan for individuals are critical ways to prolong the survival of patients.
ObjectiveTo explore the plastic surgical treatment and the way to reduce hemorrhage for scalp and facial plexiform neurofibromas. MethodsBetween July 2004 and July 2013, 20 patients with scalp and facial plexiform neurofibromas (17 cases of neurofibromatosis type Ⅰ and 3 cases of plexiform neurofibroma) were treated, and the clinical data were retrospectively analyzed. There were 9 males and 11 females with an average age of 37 years (range, 18-56 years). The disease duration ranged from 8 to 56 years (mean, 19 years). The scalp was involved in 6 cases, the face in 7 cases, and both the scalp and face in 7 cases. The extent of involvement ranged from 4 cm×3 cm to 15 cm×13 cm. Obvious pigmentation was seen in 2 cases. Endovascular embolization was performed before surgical intervention in 4 cases. Preliminary sutures around the lesion were carried out in 18 cases having an involved range over 5 cm×5 cm. One-stage excision was performed in 17 cases, and two-stage excision in 3 cases. Wound repair and facial orthopedic treatment were performed after tumor excision. ResultsThe intraoperative blood loss was 100-500 mL (mean, 300 mL) for patients undergoing single operation. For 3 patients undergoing two-stage excision, the blood loss of the first operation was 500, 600, and 800 mL respectively, and the blood loss of the second operation was all 50 mL. Autologous blood transfusion of 200, 400, and 400 mL was performed in 3 cases respectively. The preliminary sutures were removed at 3-7 days (mean, 5 days) after operation. All the incisions healed primarily without secondary hemorrhage and hematoma, and the flap and skin graft survived totally. Fifteen patients were followed up 1 year to 7 years (mean, 2.5 years). All patients showed significant improvement in appearance. No significant progression, expanding, and sagging were observed. ConclusionEndovascular embolization and preliminary sutures around the lesion can be used to reduce hemorrhage in resection of plexiform neurofibroma in the scalp and face. Personalized surgical plan of benign neurofibromatosis should be made to reduce the tumor mass, to improve function and appearance.
Objective To investigate the growth of tumors and the natural life length of the rats after the adriamycinethylcellulose microspheres(ADM-EC mc) were injected in the rats bearing transplantable liver cancer through their hepatic arteries.Methods ADM-EC mc were infused into the proper hepatic arteries of the Wistar rats (W256). All of the rats were divided randomly into five groups, group 1: control, group 2: normal saline, group 3: conventional ADM, group 4: placebo ethylcellulose microspheres, and group 5: ADM-EC mc. Results As compared with other four groups, the ADM-EC mc (group 5) showed the best inhibition of the growth of tumors and the longest mean life length of the rats. Conclusion Hepatic arterial infusion of ADM-EC mc can inhibit the growth of the tumor, aggravate the necrosis, and improve the effects of the chemotherapy of liver cancer.
ObjectiveTo explore the application of the technique of liver venous deprivation (LVD) for two-stage radical hepatectomy in patient with liver cancer underlying hepatitis B virus infection.MethodsA 53 years old patient diagnosed with central primary liver cancer (Ⅴ/Ⅷ segment) could not receive standard right hepatectomy since his future liver remnant was insufficient, so the LVD was performed to induce FLR growth. The general condition and CT scan were repeated at 1-, 2- and 3-week after LVD, the FLR and FLR weigh/ body weight ratio were calculated.ResultsThe FLR and FLR weight/body weight ratio before LVD were 24.2% and 0.459%, the FLR at 1-, 2- and 3-week after LVD were 29.5%, 38.3% and 44.4% respectively, the FLR weight/body weight were 0.545%, 0.707% and 0.820% at 1-, 2- and 3-week after LVD. The standard right hepatectomy was undertaken successfully at 25 days after LVD and discharged safely.ConclusionThe LVD technique could induce a rapid and large FLR volume and offer opportunity for patients with insufficient FLR to receive two-stage radical hepatectomy, is a novel method to induce FLR growth effectively.