ABSTRACT
Objectives To explore the prognostic factors of patients with pancreatic ductal adenocarcinoma and synchronous liver metastases ( PALM ) receiving palliative treatment .Methods The clinical characteristics , therapeutic approaches and survival outcomes of 108 consecutive patients with PALM who were pathologically diagnosed and received only palliative treatment at Tianjin Medical University Cancer Hospital from January 2001 to December 2015 .were retrospectively analyzed .Survival rates were calculated by Kaplan-Meier method, and factors influencing the survival were analyzed by univariate and multivariate Cox proportional hazard regression model .Results Of these patients, 68 were male and 40 were female, with an average age of 58 years old.Seventy-seven (71.3%) cases or their relatives refused to receive anticancer therapies.Palliative treatments included choledochojejunostomy and /or gastrojejunostomy after exploratory laparotomy for 5 (4.6%) cases, percutaneous transhepatic biliary drainage (n=22, 19.4%), drug analgesia (n=79, 73.1%), drug analgesia combined with percutaneous neurolytic coeliac plexus block (n=17, 15.7%).The median survival time (MS)was 94 days in all patients.Karnofsky performance score (KPS)<80, lymph node metastases, ascites, fasting blood glucose ≥6.1 mmol/L and lactate dehydrogenase ( LDH ) ≥250 U/L were independent risk factors influencing prognosis of PALM . Three groups were categorized according to the number of the above 5 risk factors for 0~1 in low risk group, 2~3 in middle risk group and 4~5 in high risk group, and the MS of 3 groups was 137, 95 and 48 days, respectively, with an extremely statistical significance (P<0.0001).Conclusions KPS, lymph node metastases, ascites, fasting blood glucose and LDH were the risk factors for prognosis of PALM .Patient stratification according to the above factors is more advantageous for judging individualized prognosis and can provide reference for making clinical decision .
ABSTRACT
Objective:The implementation of a multidisciplinary team (MDT) approach for palliative treatment of patients with multi-ple primary carcinomas (MPCs) was evaluated in Tianjin Medical University Cancer Institute and Hospital. Methods:A total of 40 pa-tients with MPCs who attended the consultation by MDT in our hospital from January 1, 2014 to April 21, 2016 were analyzed retro-spectively. Clinical data of the 40 cancer patients were reviewed. The essential characteristics and results of MDT treatment decisions were summarized and expected outcomes were evaluated. Results:A total of 40 cases with MPCs were included in MDT assessment, accounting for 6.4%of the 629 patients who were handled by the MDT. A total of 39 MDT decisions were followed up successfully. Among these MDT decisions, 26 (65%) were fully implemented, 7 (17.5%) were partially implemented, and 6 (15.0%) were unimple-mented. Expected outcomes were achieved in 25 (96.2%) patients of the fully implemented concordant group, 4 (57.1%) patients of the partially concordant group, and 1 (16.7%) patient from the unimplemented group. Conclusion:MDT specializing on palliative treat-ment can provide recommendations for standardized individualized comprehensive treatment of patients with MPCs. MDT modality should be further improved and widely used for palliative treatment.
ABSTRACT
Objective To explore the therapeutic effect of lung cancer Ⅳ recipe combined with chemotherapy on treating middle and advanced stages of non-small cell lung cancer (NSCLC) in the elderly.Methods A total of 77 NSCLC patients in middle and advanced stages aged 70 years and over who had heat-toxin syndrome in traditional Chinese medicine (TCM) were selected from Apr.2013 to Oct.2014 in our hospital.Patients were randomly divided into chemotherapy group (n=39) and chemotherapy + herbs group (n=38).Karnofsky assessment scale (KPS),effective rate,symptom and sign in traditional Chinese medicine,changes in the levels of high-sensitivity c-reactive protein (hs-CRP),carcino embryonic antigen (CEA),neuron specific enolase (NSE),tumor special growth factor (TSGF) were observed before and 1 and 56 days after treatment.Results There was no significant difference in effective rate between the two groups (P＞0.05).The KPS and symptom and sign in TCM were improved significantly in chemotherapy + herbs group as compared with chemotherapy group (36.7 ％ vs.26.5 ％,80.0 ％ vs.58.8 ％,respectively (x2 =2.721,6.731,both P＜0.05).There were no significant differences in hs-CRP,NSE,CEA,TSGF levels between two groups before and after treatment (P＞0.05),but hs-CRP level in both groups was decreased after treatment as compared to pre-treatment and the decvease was more obvious in chemotherapy + herbs group (51.47％ vs.23.77％,x2 =19.713,P＜0.05).Conclusions Lung cancer Ⅳ recipe can improve the main clinical symptoms,quality of life and tolerance to chemotherapy in NSCLC patients with heat-toxin manifestation in TCM.There is a correlation between heat-toxin syndrome and hsCRP level in NSCLC patients,which shows that hs-CRP probably is the material basis of the heattoxin syndrome in TCM.
ABSTRACT
Nasopharyngeal carcinoma (NPC) is one of the most common malignant tumor in China, Southeast Asia and North Africa region. The main treatment of NPC is radiation therapy, and concurrent chemoradiotherapy has become the standard treatment for locally advanced NPC Up to date, the targeted therapy in NPC has been gradually appreciated recently, in this paper, NPC biological targeted therapy in recent years as a progress of treatment were reviewed.
Subject(s)
Humans , Biological Therapy , Carcinoma , Chemoradiotherapy , China , Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms , Therapeutics , RadiotherapyABSTRACT
OBJECTIVE@#To evaluate the effects of NF-κB activation on the proliferation and apoptosis throughTLR4/MyD88 signaling pathway in human nasopharyngeal carcinoma (NPC) 5-8F cell lines.@*METHOD@#TLR4 induced by LPS is inhibited by PE anti-human. Real-Time Quantitative PCR and Western blot were employed to evaluate the efficacy of mRNA level and protein expression. The growth inhibition rate of 5-8F by Celecoxib was evaluated with MTT method. The cell cycle and apoptosis were measured with flow cytometric method (FCM).@*RESULT@#By using the specific inhibitor, the protein and gene expression of NF-κB and MyD88 were both significantly lower than the control group (P<. 05). Meanwhile, the down-rugulation of NF-κB could inhibit proliferation of NPC 5-8F cells and promote their apoptosis (P<0. 05).@*CONCLUSION@#By inhibiting TLR4 / MyD88 signaling pathway, the expression of NF-κB in NPC 5-8F cells could decrease, then the cell proliferation was inhibited and cell apoptosis was induced. The results showed that TLR4 / MyD88 / NF-κB induced by LPS is an important pathway in the genesis and development of NPC. This study provides evidence for targeting research of NPC.
Subject(s)
Humans , Apoptosis , Carcinoma , Cell Cycle , Cell Line, Tumor , Cell Proliferation , Gene Expression Regulation, Neoplastic , Myeloid Differentiation Factor 88 , Metabolism , NF-kappa B p50 Subunit , Metabolism , Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms , Pathology , Signal Transduction , Toll-Like Receptor 4 , MetabolismABSTRACT
Solitary brain metastasis in non-small cell lung cancer (NSCLC) patients was previously considered as Stage IV. Gen-erally, only chemotherapy or radiotherapy rather than surgery was considered the treatment for these patients;hence, achieving the de-sired effect was difficult. In recent years, the treatment benefit for these patients significantly increased. Several patients were even pro-vided the chance of being cured through standardized and individualized treatment by a multiple disciplinary team (MDT). This article introduces two solitary brain metastasis patients with NSCLC who were treated by MDT in Tianjin Medical University Cancer Institute and Hospital. This article aims to explore a complete set of diagnostic and treatment practices for the benefit of more patients.
ABSTRACT
Objective:To observe the effect of dexmedetomidine on sleep and anxiety in cancer patients who received chemothera-py. Methods: Sixty cancer patients suffering from sleep disorders or anxiety symptoms and receiving chemotherapy between March and June 2014 were randomly divided into treatment and control groups. The patients in the treatment group were treated with intrave-nous drip of 1.0μg/kg dexmedetomidine for more than 30 min, once a day for three days. The patients in the control group were given the same dose and drip time of normal saline. Athens Insomnia Scale (AIS) was used to assess the sleep quality of patients before and the 1st, 2nd, and 3rd days after the administration of dexmedetomidine. Self-Rating Anxiety Scale (SAS) was employed to assess anxi-ety before and the 3rd day after the administration of dexmedetomidine. Results:Compared with the control group and status before ad-ministration of dexmedetomidine, the AIS scores were significantly lower in the 1st, 2nd, and 3rd days after administration (P<0.01), and the SAS scores were also significantly lower in the 3rd day after administration (P<0.01). Conclusion:Dexmedetomidine may im-prove sleep quality and alleviate anxiety symptoms in cancer patients undergoing chemotherapy.
ABSTRACT
Pancreatic cancer with liver metastases (PCLM) is a refractory malignant tumor characterized by insidious onset, rap-id progress, and poor prognosis. Only a few patients had the opportunity of receiving surgical treatment. PCLM is primarily treated by systemic chemotherapy. The chemotherapeutic regimen of 5-fluorouracil, oxaliplatin, irinotecan, and leucovorin has become the first-line therapy for PCLM patients with good performance status. Gemcitabine-based chemotherapy is still very important in treating PCLM. Nab-paclitaxel plus gemcitabine, which has been found to increase survival, is recommended as a new standard for treating PCLM patients. However, still no breakthrough has been established in the study of gemcitabine plus molecular-targeted therapy. Sys-temic chemotherapy combined with trans-catheter arterial chemoembolization is valuable and may be effectual in prolonging survival. Further investigation of prospective and randomized controlled clinical trials is necessary. Radio frequency ablation and brachy-thera-peutic embolization with yttrium-90 microspheres are still in the exploratory stage. Multimodality treatment of PCLM using chemother-apy, radiation therapy, and Chinese herbal medicine is gaining wide acceptance. This article reviews the recent progress in the treatment of PCLM.
ABSTRACT
Objective To evaluate the diagnosis and treatment of primary breast lymphoma(PBL).Methods Clinical data of 49 PBL cases diagnosed in our center from 1997 to 2011 was retrospectively analyzed.Results 1 case was male,48 cases were female.Most patients were at the age of 35-55 years.Painless mass was the most common symptom which was most often seen on the upper-outer quadrant of the right breast,accounting for 61.11％ in this group.Preoperative misdiagnosis rate was high by mammography,B ultrasonic and hollow needle pathologic examination.Final diagnosis could only made by postoperative histopathologic examination.In this group 1 case was Hodgkin lymphoma and 48 cases were non-Hodgkin lymphoma(NHL) originating from B cells.46 patients underwent surgery and chemotherapy followed by radiotherapy in 16 cases.Median time of follow up was 40 months,5-year overall and disease free survival was 48％ and 28％ respectively,and bone marrow was the most common metastatic organ.Conclusions The prognosis of PBL is poor.The image diagnosis lacks specificity.Paraffin sections and immunohistochemistry were the main means to make a definite diagnosis.Chemotherapy-based comprehensive treatment is the strategy in the management of PBL instead of radical mastectomy.
ABSTRACT
Objective:This study aimed to determine the function of herbs in preventing diarrhea after irinotecan chemotherapy and analyze the efficacy of the herbs based on UGT1A1*28 gene polymorphism. Methods:A total of 200 patients admitted to the De-partment of Synergistic Chinese and Western Medicine, Tianjin Medical University Cancer Institute and Hospital between October 2011 and May 2013 were randomly divided into the control (chemotherapy alone) and herb (chemotherapy combined with herbs) groups. All patients consented to UGT1A1*28 gene polymorphism detection prior to chemotherapy. Herbs were administered from 2 d prior to chemotherapy to 5 d post chemotherapy, with or without the regimen of fluorouracil, folinic acid, and irinotecan. Adverse reac-tions were recorded, and short-term effect was evaluated regularly. Results:A total of 144 patients had TA6/6 wild genotype, and anoth-er 56 patients had non-wild genotype (12 of the 56 cases were TA7/7 homozygous, and the other 44 cases were TA6/7 hybrid). A total of 58 patients experienced grades 2 to 4 diarrhea. A 14%decrease in the incidence of diarrhea was observed in the herb group compared with that of the control group (22%vs. 36%, P=0.029). In addition to diarrhea, grades 2 to 4 vomiting was significantly lower in the herb group than in the control group (15% vs. 27%, P=0.037). The overall response rate was 37.5%. No significant difference was found between the two groups (40% vs. 35%, P=0.465). The incidences of grades 2 to 4 diarrhea (22.9% vs. 44.6%, P=0.002) and grades 2 to 4 vomiting (23.2%vs. 16.7%, P=0.016) were lower in patients with the UGT1A1*28 wild genotype than in those with the non-wild genotype. However, in the herb group, the incidences of grades 2 to 4 diarrhea (22.2% vs. 21.9%, P=0.974) and vomiting (18.5% vs. 13.7%, P=0.777) were not significant between the non-wild-and wild-type groups. Conclusion:Herbs can effectively pre-vent the late diarrhea caused by irinotecan, which is also applicable in UGT1A1*28 non-wild genotype patients. Incidence of diarrhea was obviously higher in the cases with UGT1A1*28 non-wild type than in those with wild genotype. Hence, the UGT1A1*28 gene type should be detected prior to chemotherapy with irinotecan.