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Objective:To investigate the long-term survival and safety in patients with muscle-invasive bladder cancer (MIBC) who experienced a noninvasive down-staging (≤pT 1)after transurethral resection of bladder tumor (TURBT) plus systemic chemotherapy and received bladder-sparing treatment. Methods:The records of patients with MIBC who underwent maximal TURBT plus systemic chemotherapy-guided bladder-sparing treatment were reviewed retrospectively from Dec 2013 to Dec 2020. Eventually, 22 patients who achieved noninvasive down-staging underwent conservative management. The total patient cohort contained 10 males and 12 females. A majority of patients had single lesion and stage T2 disease. The median age of the patients was 66 years and the median tumor size was 3.0 cm. All patients underwent maximal TURBT to resect all visible diseases and followed by 3-4 cycles platinum-based systemic chemotherapy. After achieving noninvasive down-staging, 14 patients received concurrent chemoradiotherapy, and the other 8 patients underwent surveillance. Overactive bladder symptom score (OABSS) was used to assess the bladder function after treatment.Results:Twelve patients achieved pT 0 and 10 patients were down-staged to cT a-T 1. At a median follow-up of 36.7 months, 90.9%(20/22) patients retained their bladder function successfully. Among the 14 patients who received concurrent chemoradiotherapy, 4 had grade 3 or 4 adverse events. Among the 8 patients who underwent surveillance, 3 had grade 3 or 4 adverse events after systemic chemotherapy.Nine patients experienced tumor recurrence in the bladder, and 2 patients died of bladder cancer. Seven (31.8%) patients experienced Ⅲ/Ⅳ grade complications. The 5-year recurrence-free survival (RFS) and overall survival (OS) in patients achieved pT0 were 66.7% and 100.0%, respectively. The 5-year RFS and OS in patients achieved cTa-T1 were 40% and 72%, respectively. The OABSS score of 20 patients who retained their bladder successfully was (1.00±1.03). Conclusions:MIBC patients who achieved noninvasive down-staging might be candidates for the bladder-sparing treatment with maximum TURBT followed by systemic chemotherapy.The patients who achieved pT 0 might have better prognosis with functional bladder.
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In order to suppress the geometrical artifacts caused by random jitter in ray source scanning, and to achieve flexible ray source scanning trajectory and meet the requirements of task-driven scanning imaging, a method of free trajectory cone-beam computed tomography (CBCT) reconstruction is proposed in this paper. This method proposed a geometric calibration method of two-dimensional plane. Based on this method, the geometric calibration phantom and the imaging object could be simultaneously imaged. Then, the geometric parameters could be obtained by online calibration method, and then combined with the geometric parameters, the alternating direction multiplier method (ADMM) was used for image iterative reconstruction. Experimental results showed that this method obtained high quality reconstruction image with high contrast and clear feature edge. The root mean square errors (RMSE) of the simulation results were rather small, and the structural similarity (SSIM) values were all above 0.99. The experimental results showed that it had lower image information entropy (IE) and higher contrast noise ratio (CNR). This method provides some practical value for CBCT to realize trajectory freedom and obtain high quality reconstructed image.
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Algorithms , Calibration , Cone-Beam Computed Tomography , Image Processing, Computer-Assisted , Phantoms, ImagingABSTRACT
Purpose@#Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. @*Materials and Methods@#Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. @*Results@#Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. @*Conclusion@#After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.
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At present, the application of artificial intelligence in the diagnosis of renal cell carcinoma (RCC) is still at an early stage. There were more reports of imaging diagnosis than pathology. Studies of imaging diagnosis mainly focused on using artificial intelligence to identify benign and malignant renal tumors and predict pathological types of RCC by computed tomography. However, there were no reports of artificial intelligence in diagnosing RCC by magnetic resonance imaging. Studies of pathological diagnosis were mainly about the classification of the nucleus. In the future, artificial intelligence has great development potential in the diagnosis of RCC, and further research is needed.
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Objective To improve the accuracy of preoperative diagnosis of renal vein tumor thrombus in renal cell carcinoma (RCC),the clinical characteristics of RCC with misdiagnosis of renal vein tumor thrombus (RVTT) were analyzed.Methods Clinical data of 128 patients with RCC accompanied with RVTT from January 2000 to September 2015 were studied retrospectively.According to whether RVTT failed to be detected preoperatively,all patients were divided into 39 cases of misdiagnosis group and 89 cases of no misdiagnosis group.Forty cases of RCC with pathologically confirmed no RVTT were selected as no tumor thrombus group from January 2015 to June 2015.Misdiagnosis group included 29 males and 10 females,with age of (61.4 ± 11.1) years old,body mass index of (26.74 ±3.12) kg/m2,KPS ＜80 in 2 cases,paraneoplastic syndrome and Mayo grade 0 in 1 case.No misdiagnosis group consisted of 74 males and 15 females,with age of (60.2 ± 9.7) years old,body mass index of (25.12 ± 1.93) kg/m2,KPS ＜ 80 in 5 cases,paraneoplastic syndrome and Mayo grade 0 in 7 cases.No tumor thrombus group comprised of 31 males and 9 females,with age of (59.5 ± 10.7) years old,body mass index of (24.48 ± 2.56) kg/m2,KPS ＜ 80 in 3 cases,and paraneoplastic syndrome in 3 cases.There was no significant difference in general clinical data between misdiagnosis group and no misdiagnosis group,and misdiagnosis group and no tumor thrombus group (P ＞ 0.05).The tumor location,tumor diameter and imaging data were compared between misdiagnosis group and no misdiagnosis group,and misdiagnosis group and no tumor thrombus group.Results There was no significant difference in term of tumor locating in the middle pole [56.4％ (22/39) vs.38.2％ (34/89)],tumor with collateral vessels [33.3％ (13/39) vs.31.5％ (28/89)] and renal vein contrast agents filling defect [42.9％ (9/21) vs.61.8％ (21/34)] between misdiagnosis group and no misdiagnosis group (P ＞ 0.05).The proportion of renal tumor locating in the middle pole,tumor with collateral vessels and renal vein contrast agents filling defect in misdiagnosis group was significantly higher than that of no tumor thrombus group [30.0％ (12/40),P =0.018;10.0％ (4/40),P =0.012;16.7％ (4/24),P =0.002].Conclusions RVTT is vulnerable of misdianosis in RCC.It should be alert to the possibility of complicating tumor thrombus in the presence of renal tumor locating in the middle pole,renal tumor with collateral vessels and renal vein contrast agents filling defect.The clinical understanding of these features should be improved.
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Objective@#Investigated the status quo of quality control of cancer chemotherapy in hospitals in Beijing to discover the main problems and provide the improvement measures.@*Methods@#One medical record of cancer chemotherapy was taken every month for examination of quality control, and a total of 10 medical records in each hospital were examined. A total of 756 medical records from 76 hospitals were examined.@*Results@#The results of analysis showed that the overall standardization and quality control of cancer chemotherapy was positively correlated with the grade of hospital. Only 36.8% of the hospitals were equipped with Pharmacy Intravenous Admixture Services (PIVAS). In terms of quality control of chemotherapy and medicine, the department of oncology had better performance than other departments (P<0.01). The scores of quality control of chemotherapy and medicine in the hospitals with clinical specialist pharmacists were 50.6 and 14.5, significantly higher than 47.2 and 12.7 of those without clinical specialist pharmacists (P<0.05).@*Conclusion@#We should focus on the quality control of cancer chemotherapy in secondary hospitals, reinforce the training of oncology specialists, establish the admission system of oncologists, enhance the training of oncology clinical pharmacists and promote the standardization of cancer chemotherapy.
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The tasks of artificial intelligence (AI) in tumor histopathology include image segmentation and classification. Currently, the specific contents including lymph node metastasis, pathological classification, grade and prognostic evaluation of malignant diseases, such as breast cancer, lung cancer and prostate cancer, have been studied by AI. Evaluation of sentinel lymph node metastasis of breast cancer has been the most mature application of AI technology, whose level can be analogous to the excellent pathologists. In the future, with the close cooperation of pathologists and engineers, the research of AI will be focus on improving the technology of simple and repetitive clinical diagnosis and differential diagnosis, such as the diagnosis of sentinel lymph node metastasis of breast cancer from biopsy frozen section and the judgment of incisal margin. Ultimately, AI will help us to precisely diagnose the tumor.
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Objective@#To investigate the frequency of KRAS mutation in mucinous epithelial lesions of the endometrium, and analyze the correlation between KRAS mutation and the clinicopathologic features.@*Methods@#The cohort included forty-three cases of mucinous epithelial lesions of the endometrium selected from July 2015 to October 2017 from Beijing Obstetrics and Gynecology Hospital, and 22 control cases. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue sections. Polymerase chain reaction amplification for KRAS exons 2 and 3 was performed, followed by sequencing using capillary electrophoresis. The Fisher exact test was used to compare the prevalence of KRAS mutation among the different groups.@*Results@#The patients′age ranged from 33 to 77 years [mean (55.12±9.34) years, median 55 years]. None of the eight cases of endometrial hyperplasia with mucinous differentiation without atypia showed KRAS mutation. The frequency of KRAS mutations was 1/10 in endometrial atypical hyperplasia, 1/12 in endometrioid carcinoma, 4/11 in endometrial atypical hyperplasia with mucinous differentiation (EAHMD), 6/15 in endometrioid carcinoma with mucinous differentiation (ECMD) and 8/9 in mucinous carcinoma (MC), respectively. The differences were statistically significant between MC versus EC (P<0.01) and MC versus ECMD (P<0.05).@*Conclusion@#The high frequency of KRAS mutation in EAHMD, ECMD and MC indicates that KRAS mutational activation is implicated in the pathogenesis of endometrial mucinous carcinoma.
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Objective@#To investigate the value of short tandem repeat (STR) genotyping in the diagnostic workup of molar and non-molar gestations with correlation of histological characteristics.@*Methods@#Six hundred and fifty-six cases were selected based on clinically suspected hydropic abortion and/or molar pregnancy from July 2015 to September 2017 at Beijing Obstetrics and Gynecology Hospital. DNA was extracted from dissected chorionic villi and paired maternal endometrial FFPE tissue samples by Simplex OUP™ FFPE DNA Tissue Kit. STR genotyping was performed by PowerPlex 16 HS system.@*Results@#DNA genotyping was informative in 649 of 656 cases, leading to identification of 215 hydatidiform mole gestations and 434 non-molar gestations. Most of non-molar gestations (375 cases, 86.4%) were diploid hydropic abortion. Various trisomy syndromes were found (53 cases, 12.2%), including trisomy 2, 3, 4, 7, 8, 13, 16 and 21. Only 2(0.5%) digynic triploid gestations were detected. Moreover, 4 cases (0.9%) of uniparental disomies (homologous or heterologous) were found. There were 196 cases with histologic diagnostic suspicious of hydatidiform moles were accurate sub-classified. Among them, 59 cases hydatidiform moles were under-diagnosed as diploid hydropic abortions, and 28 cases diploid hydropic abortions were over-diagnosed as hydatidiform moles.Compared with partial moles(PHM), there were no specific histomorphological features between the various types of non-molar gestations and partial moles for definitive diagnostic separation. There was no significant difference in the expression of p57kip2 among PHM, trisomy and diploid hydropic abortions group (P=0.247).@*Conclusions@#STR genotyping can distinguish non-molar gestations from early hydatidiform moles, and efficiently avoid misdiagnosis based only on histological evaluation. Therefore, using STR genotyping, not only can the overdiagnosis of non-molar pregnancy be avoided, but also individualized management can be offered to patients including monitoring of serum hCG.
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Objective To evaluate the influence of cytochrome P450 (CYP2C9 and CYP4F2) polymorphisms on anticoagulant intensity of warfarin after cardiac valve replacement.Methods A total of 136 patients tak ing warfarin after cardiac valve replacement were identified and classified into 4 groups:CYP2C9 wild type group (CYP2C9*1*1),CYP2C9 mutated type group (CYP2C9*3),CYP4F2 rs2108622 wild type group (CC) and CYP4F2 rs2108622 mutated type group (CT or TT).The patients' baseline data,initial dose of warfarin and base INR measurement resuhs were recorded and then the follow-up was conducted.The initial administration of warfarin to INR standard time for the first time,total amount of warfarin and the average daily amount were recorded.Results Patients carrying CYP2C9* 1* 1 had increased time to reach INR target value for the first time (P ＜ 0.05);and the total warfarin doses and average daily dose when INR reached target value were higher than those carrying CYP2C9*3 (P ＜ 0.05).When compared with those in two wild type groups,patients carrying CYP2C9 and CYP4F2 rs2108622 mutated type needed the shortest time when INR reached target value for the first time,and the total warfarin doses and average daily dose when INR first reached target value was the lowest,which showed significant difference (P ＜ 0.05).And when compared with CYP2C9 mutated type group,the INR average time to reach the first target was shortened and the total warfarin dose of patients carrying CYP2C9 and CYP4F2 rs2108622 mutated type was lower (P ＜ 0.05).Conclusion The gene polymorphisms of CYP2C9 and CYP4F2 are significant hereditary factors influencing warfarin dose.Detection of CYP2C9 and CYP4F2 genotypes prior to medication and predicating warfarin dosage may result in lower incidence of over-anticoagulation and reduce the dosage-adjusting time of warfarin.
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Targeted treatment for tumors is based on the molecular biological aspects of a tumor. Identifying tumor-associated mole-cules as targets and then creating molecular preparations based on these targets is the goal of drug treatment and targeted therapy. Treatment for advanced renal carcinoma has evolved since the era of targeted therapy began eleven years ago when sorafenib was ap-proved in China in September, 2006. This article reviews the development of molecular targeted treatment for tumors, discuss the effi-cacy of vascular endothelial growth factor (VEGF) inhibitors for the treatment of advanced renal carcinoma, evaluate the problems aris-ing from clinical experiences, and put forward some suggestions for targeted treatment of advanced renal carcinoma.
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Radiotherapy(RT) is one of the principle treatment options for prostate cancer.Modern RT and surgery show similar progression-free survival in localized prostate cancer.Adjuvant RT compared to observation significantly diminishes the risk of prostate-specific antigen (PSA) progression and local failure for patients at the highest risk for recurrence after radical prostatectomy,including with seminal vesicle invasion,extraprostatic extension,extensive positive margins,and detectable postoperative PSA.Salvage RT is effective at controlling local recurrence and reduces the risk of distant metastasis and prostate cancerspecific mortality (PCSM) for patients with PSA or local recurrence after prostatectomy.Hypofractionated radiotherapy of recent years' reports shows similar cancer control rates without an increased risk of late toxicity in comparison to conventional regimens.The addition of androgen-deprivation therapy (ADT) to radiation improves the overall survival and biochemical progression-free survival(bPFS) for intermediate-risk and high-risk patients.
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Objective To investigate the incidence of renal dysfunction among patients received radical nephrectomy during 5-year follow-up and to discover the risk factors for chronic kidney dysfunction (CKD).Methods Data of 339 patients who underwent radical nephrectomy for renal cell carcinoma between Jan.2006 to Dec.2007 were investigated,and those who suffered renal dysfuntion before surgery or lost follow-up were excluded.Finally,148 patients were enrolled in this retrospective study.GFR after surgery were replaced by eGFR which were calculated with the abbreviated equation of MDRD.It will be defined as CKD when eGFR was less than 60 ml/(min · 1.73 m2).Postoperative occurence rate of CKD was estimated using the Kaplan-Meier methods.Rank sum test and chi-square test were used for the univariate analysis in term of CKD between groups.Multivariate Logistic regression analysis was used to judge the independent risk factors for CKD.Results Patients were followed up for 42-60 months.CKD occurred in 58 cases,and the 5 year cumulative incidence of CKD was 42.7％.As many as 17.4％ of the patients with a normal eGFR during the first 3 months follow-up would progress to CKD 5 years later.Clinical characteristics,including age at surgery,weight,body mass index,hypertension,preoperative total GFR and contralateral GFR,complications,size of tumor,pathologic type,eGFR calculated shortly after operation,were significantly different between the CKD group and the normal group (P＜0.05).Multivariate Logistic regression analysis shows that age at surgery (P =0.016,OR =1.106),size of tumor (P =0.048,OR =0.680) and eGFR calculated within one week postoperatively (P=0.002,OR=0.874) were the independent risk factors for postoperative CKD.Conclusions The incidence of CKD after radical nephrectomy in patients with renal cell carcinoma is not uncommon.The of age at surgery,size of tumor and eGFR value calculated within one week postroperatively have a close relation with the incidence of postoperative CKD.
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<p><b>OBJECTIVE</b>To investigate the causes and affecting factors of unplanned reoperations in cancer patients.</p><p><b>METHODS</b>All patients, who underwent surgery and unplanned surgical reoperations in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between November 1, 2012 and October 1, 2013, were included in this study. The causes and affecting factors of unplanned reoperations were retrospectively analyzed with logistic regression model.</p><p><b>RESULTS</b>A total of 16, 362 operations were performed in that period, in which 126 cases underwent unplanned reoperation. The incidence rate of unplanned reoperation was 0.77%. The top three causes for unplanned reoperation were bleeding or hematoma in 44 cases (34.92%), wound infection or split in 37 cases (29.37%), and anastomotic leak in 14 cases (11.11%). Logistic regression analysis showed that tumor classification, surgery grade and gender were independent factors for the unplanned reoperations.</p><p><b>CONCLUSIONS</b>The main causes of unplanned reoperation are bleeding or hematoma, wound infection or split and anastomotic leak. Tumor classification, surgery grade and gender are the independent factors for unplanned reoperations.</p>
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Humans , Anastomotic Leak , Hemorrhage , Logistic Models , Neoplasms , Postoperative Complications , Epidemiology , Reoperation , Retrospective StudiesABSTRACT
Objective To investigate the safety and feasibility of sorafenib in metastatic renal cell carcinoma (mRCC) patients with end-stage renal disease (ESRD) undergoing hemodialysis.Methods A case of 65-year-old female patient on hemodialysis and receiving sorafenib treatment for mRCC was reported.Literatures were searched through PubMed for such mRCC with ESRD.Results The patient underwent a left radical nephrectomy because of clear cell RCC.Hemodialysis was introduced because of ESRD four months after the nephrectomy.Lung metastases were found one year after the operation.With the failure of immunotherapy,the patient received sorafenib 800 mg daily.Hemodialysis was carried out three times weekly.The initial sizes of right and left lung metastases were 2.7 cm × 2.4 cm and 2.6 cm× 2.0 cm respectively.The patient achieved stable disease six months later (to 2.4 cm × 1.4 cm and 2.0 cm × 1.8 cm respectively) and partial remission one year later (to 1.8 cm × 1.0 cm and fibrosis respectively).Currently the patient has been under sorafenib treatment for 52 months.The pulmonary lesions were nearly replaced by fibrosis and calcification.Totally six case reports were found through PubMed including nine patients with ESRD and mRCC.The best objective response was partial response in three cases,stable disease in four cases and unknown in the other two cases.Sorafenib was generally well tolerated.Conclusion Treatment of patients with metastatic renal cell carcinoma undergoing hemodialysis with sorafenib appears to be feasible.
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Objective To investigate the pathologic features, diagnosis and differential diagnosis of inflammatory myofibroblastic tumor (IMT) in urinary bladder. Methods It was retrospectively reviewed for the characters of pathologic features and immunohistochemistry type in 3 patients diagnosed IMT in urinary bladder. Results 3 patients including 1 female and 2 male were 15, 36 and 60 years old (mean age 37),respectively. All patients underwent partial cystectomy. All cases presented single or multiple, polypoid or nodular mass(es), ranging in size from 1.8 to 5.5 cm. Microscopically, the tumor cell grew in invasive pattern, and were spindled with prominent nucleoli. The lesions varied from highly myxoid to highly cellular lesions. The mitotic rates were invisible. AE1/AE3, CK18 and ALK were positive in IMT. Follow-up was available for 3 patients (2, 18 and 18 months, respectively). None developed recurrences or metastasis. Conclusion IMT in urinary bladder are rare tumors. IMT grows in invasive pattern, and are spindled with prominent nucleoli.The main differential diagnosis of IMT includes embryonal rhabdomyosarcoma in juvenile, sarcomatoid urothelial carcinoma and leiomyosarcoma in adult.
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Objective To discuss the characteristics of renal cell carcinoma with regional lymph node metastasis at diagnosis. Methods The data of 19 patients diagnosed with renal cell carcinoma with regional lymph node metastases at diagnosis from January 2004 to December 2008 were reviewed.The median age was 57 years (29-77).The study group included 15 males and four females.The primary tumor was located in the left kidney in 12 patients and fight in seven patients.The median maximam diameter of retroperitoneal lymph nodes was 2.8 cm(1.5-5.0).The lymph nodes in four patients were not detected by the preoperative image examination,but were confirmed by intraoperative exploration.Eleven cases had enlarged retroperitoneal lymph nodes resected and eight had regional lymph nodes dissected. Results The patients with regional lymph node metastases at diagnosis of renal celI carcinoma accounted for 1.6% (19/1213) of the total renal cell carcinoma cases.With a median follow-up of 34 months,six patients were survival without progression,and seven were survival with progression.giving a 5-year survival rate of 68.4%.The survival and recurrence rates after surgery were not significantly different by Fisher test(P=0.644 and 0.319 respectively) between the patients who underwent retroperitoneal regional lymph node dissection and those who underwent enlarged lymph node resection. Condmiom Renal cell carcinoma with regional lymph node metastasis at diagnosis is uncommon.Some patients may achieve long-term tumor-free survival through regional lymph node dissection or enlarged Iymph nodes resection.
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Objective To evaluate the efficacy and safety of sorafenib in combination with interferon-alpha(IFN-α)as the first-line treatment in patients with advanced renal cell carcinoma.Methods Since Dec 2007 to Jun 2008,137 legal patients with advanced renal cell carcinoma (RCC)were enrolled in the trail from 22 hospitals in China.All the patients continuously received the treatment of sorafenib plus IFN-α untill disease progressed or patients were unable to tolerate.The primary end points were objective response,disease control rate and adverse effects rate.Results This interim analysis was based on the data collected from the study initiation date to 2009/3/20.The overall response rate(ORR),including complete response (CR) and partial response(PR),was 32.8%(45/137).The median follow-up time was 11.9 months,only 25 patients progressed at the cut off time.The most common adverse events were hand-foot skin reaction(48.2%),alopecia(23.4%),rash (20.4%),diarrhea(19.7 0A),fever(16.8%),lassitude(10.2%),etc.The incidence of 3 or 4 grade hand-foot skin reaction was 8.8%.Conclusions Sorafenib in combination with IFN-α as the firstline treatment in patient with advanced RCC could be effective and safe.
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Objective To evaluate the safety and efficacy of sorafenib for patients with advanced stage renal cell carcinoma.Methods The clinical data of 85 patients with advanced renal cell carcinoma were reviewed.These patients were treated by sorafenib 400 mg Bid,dose escalation of sorafenib(400 mg Bid 1-4 weeks;600 mg Bid 5-8 weeks;800 mg Bid since then) or sorafenib 400 mg Bid+NF-α,respectively,until intolerance or disease progression occurred.The primary end points were objective response,disease control rate and adverse effects rate.Results The data of 80 patients can be evaluated.The median follow-up duration was 72 weeks (4-108 weeks).One patient (1.2%) reached complete remission(CR),17 cases(21.2%) reached partial remission(PR),50 cases (62.5%) maintained stable disease (SD),and 12 cases (15%) progressed.The objective response (CR+PR) was 22.5%,disease control rate (CR+PR-SD)was 85.0%.By May 2009,only 18 patients died,progression free survival and overall survival were not available.The common side effects included hand-foot skin reaction (55.0%),mucosa hemorrhage (52.5%),diarrhea(40.0%),lassitude (35.0%),anorexia(22.5%),mucosa ulcer(20.0%),hypertension(15.0%) and baldness(15.0%)etc.Most of these side effects could be released by symptomatic treatment.Conclusion Sorafenib has good short term effect for patients with advanced renal cell carcinoma and is well tolerated.
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Objective To evaluate the safety and efficacy of sorafenib as first line treatment in patients with metastatic renal cell carcinoma. Methods Eleven patients with metastatic renal cell carcinoma after radical nephrectomy and 1 patient with locally advanced renal cell carcinoma and unre-sectable primary renal tumor were eligible for this study. The regimen was oral intake of sorafenib (400 mg twice daily) until the disease progression or toxicity becoming intolerable. Results All pa-tients were evaluable for response and toxicity assessment. The overall objective response rate and dis-ease control rate were 25%(3/12) and 83%(10/12, 3 partial responses and 7 disease stabilizations). The actuarial 6-month progression-free survival was 83% (10/12), while the median survival time was 16 months. The most common adverse effects included hand-foot skin reaction, rash, alopecia and hy-pertension. Conclusion Sorafenib is effective and safe as first line treatment for patients with meta-static renal cell carcinoma.