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Objective To investigate the consistency of mRECIST criterion and RECIST criterion in evaluating the curative effect of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) for primary hepatocellular carcinoma (PHC) which condition exceeds Milan liver transplantation standard in order to determine which criterion can evaluate the curative effect better.Methods A total of 78 PHC patients,whose lesion's extent exceeded Milan standard and who had received TACE combined with RFA therapy,were included in this study.The curative effect was separately evaluated by mRECIST criterion and RECIST criterion.KAPPA coefficient was calculated to determine the consistency of the evaluation results by the two criteria.By using Kaplan-Mier method,the median survival time (MST) of patients achieving different remission degree was calculated.Log-rank test was used to draw survival curve.The MST and the survival curve of patients with different remission degree were statistically compared between the two criteria.Results By using SPSS19.0 software,the KAPPA coefficient of the evaluation results of the two criteria was 0.243 (x2=5.250,P＜0.01).The MST of patients,which was calculated by Kaplan-Mier method,had multiple overlapping parts with SD and PR curves that were drawn by log-rank test based on RECIST criterion,the difference between the two was not statistically significant (P＞0.05).When mRECIST criterion was based on,the survival curve of patients with different remission degree was relatively balanced and showed no overlapping parts,the difference between the two was statistically significant (P＜0.01).Conclusion (1) The mRECIST criterion is not suitable for the evaluation of the curative effect of PHC patients whose lesion's extent exceeds Milan standard,and mRECIST criterion can not apply to make evaluation of the curative effect for PHC when the lesion's border is unclear and its enhancement is not obvious.(2) mRECIST criterion can more accurately evaluate the curative effect of TACE combined with PRA in treating PHC which extent exceeds Milan liver transplantation standard.
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Objective To discussion the efficacy and safety of single channel and double chinese -made biliary stent in high biliary malignant hilar obstructive jaundice .Methods We reviewed the clinical data of 24 malignant hilar obstructive jaundice patients treated with single channel and double chinese -made biliary stent from October 2012 to December 2013 retrospectively.Of which 9 cases(study group)were used for single channel and double stenttreatment,and 15 cases(control group)were treated by the bilateral channel;We compared the number of intraoperative percutaneous puncture hepatic duct , radiation exposure doses , operation time , drainage effectiveness and complication rates in the two groups .Results The average number of percutaneous puncture hepatic duct in the study group was 1.44 ±0.53 times,which was significantly lower than the control group (3.73 ±0.70 times).The fluoroscopy time and radiation exposure dose of study group was 1152.22 ±335.61 s and 653.22 ±207.02 mGy,which was slightly less than the control group (1236.93 ±463.43 s and 727.00 ±348.52 mGy),the difference was not statistically significant (P=0.638;P=0.572).Liver function was tested after 4 W, the drainage effectiveness of study group and the control group were 88.9%(eight-nineths),86.7%(thirteen-fifteenths),the difference was not statistically significant .One case occurred bile leakage in the study group ,2 pa-tients with hemobilia in control group ,both groups showed no serious complication .Conclusion The single chan-nel and double chinese -made biliary stent to treat high biliary malignant hilar obstructive jaundice is minimally injured and effective ,which can be selectively applied to treat patients with hepatic hilum malignant obstructive jaundice .
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Objective To evaluate whether dynamic contrast enhanced-MRI (DCE-MRI) can help clinicians in differentiating malignant tumors from benign lesions and in predicting and correlating the histologic grade for breast cancer patients.Methods DCE-MRI from 98 patients (with histopathological confirmation) in our department were retrospectively analyzed.In the first dynamic phase,the hot and cold spot ROIs were selected as the regions with maximum and minimum Slopein,respectively.The kinetic characteristics (including hot spot,cold spot,and heterogeneous characteristics) and morphologic features were evaluated.The ROC curve analysis was used to test the diagnostic power of all DCE-MRI parameters (inflow slope,Slopein ; washout slope; inflow slope ratio; washout slope ratio; time-signal intensity curve shape; rim enhancement; internal homogeneity) for differentiating malignant tumors from benign breast lesions.Joncheere-Terpstra test was adopted to analyze the kinetic data.Categorical data were analyzed by using the Fisher test.Results Hot spot Slopein might have the biggest area (0.620) under the ROC curve (but not significant) among all the different MRI parameters(P ＞ 0.05).Its sensitivity,specificity,positive predictive value,negative predictive value were 63.2％ (55/87) and 72.7％ (8/11),respectively.The cold spot parameter Slopein(P =0.025),heterogeneity parameter ratio-in (P =0.031),and internal homogeneity (P =0.032) showed a significant correlation with histologic grade.The median and quartile of cold spot Slopein in pathologic Ⅰ,Ⅱ,and Ⅲ were 6.1 × 10-3,5.4 × 10-3 and 1.4 × 10-3,respectively;inflow slope ratio:6.6,9.8 and 17.6 ; pathologic Ⅰ,Ⅱ,and Ⅲ showed 2,1,and 0 patients with homogeneity enhancement,respectively ; intermediate enhancement:5,12,and 2 patients,respectively;heterogeneity enhancement:2,6,and 8 patients.Conclusions The DCE-MRI is a potential tool in helping clinicians to predict the histologic grading in breast cancers.Parameter hot spot Slopein might help differentiae malignant tumors from the benign counterpart.
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Objective To establish rabbit model of remnant carcinoma after RFA therapy, and to observe pathomorphological changes of remnant carcinoma in different time. Methods Forty-eight New Zealand white rabbits underwent ultrasound-guided percutaneous inoculation with VX2 carcinoma, then RFA therapy was performed to made models of remnant carcinoma. These models were averagely divided into 6 groups randomly (each n=8). Rabbits in each group was killed and pathologically observed before RFA and 1 d, 3 d, 1 week, 2 and 3 weeks after operation, respectively. Results The expression of MVD,VEGF and PCNA in remnant VX2 carcinomas tissues decreased significantly, but increased 2-3 weeks after RFA. The remnant VX2 carcinomas tissues were in inhibitory state 2 weeks after RFA. Conclusion The growth of remnant carcinoma could be inhibited in short term after RFA. Further therapy is necessary.
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Objective To compare the effects of hypertonic saline,acetic acid and acetic acid-hypertonic saline(AAHS) solution on the ablated volume produced by hepatic radiofrequency ablation(RFA) in rabbits in vivo,and to determine the optimal synergist for radiofrequency ablation.Methods Thirty big-ear white rabbits were equally divided into group A(RFA alone),group B(RFA with 36% NaCl injection),group C(RFA with 50% acetic acid injection),group D(RFA with 50% AAHS injection),group E(50% AAHS injection alone),and group F(36% NaCl injection alone),with five rabbits in each group.Follow-up exam with CT scanning was made.The experimental rabbits were sacrificed by stages.The livers were collected and fixed in 10% formalin.Both the longitudinal and transverse diameter of the necrosis lesion produced by radiofrequency ablation were measured,the results were compared among groups.Results The difference in the lowest impedance value between group A and other groups was statistically significant(P 0.997).The persistent time of group A was significantly shorter than that of both group B and group D(P
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Background and purpose:Medulloblastoma(MB),which is a primitive neuroectodermal tumor(PNET),is the most common malignant brain tumor of childhood.The mean age at diagnosis is 6 years.Due to the tremendous improvements in techniques of radiotherapy and chemotherapy,the 5-year overall survival(OS) is increased to 70% now,compared with 20% in the 1970s.Factors which include local relapse,whether or not there has occurred metastases before resection,residual tumor and age etc.are mostly considered to have significant effects on prognosis.We studied the effects and side effects of the three dimensional conformal radiation therapy(3D-CRT) for the children with medulloblastoma,and summarized the reasons of failure of the therapy.Methods:From August 2001 to August 2007,34 children with medulloblastoma were treated in our hospital.Among all the patients(3-16 years,mean age was 9.5 years) there were 16 cases in high-risk group,and 18 cases in low-risk group.All of them underwent total or subtotal resection before radiation therapy.Patients were not given radiotherapy and chemotherapy before surgery.The interval between surgery and radiotherapy was less than 3 weeks.The 3D-CRT was done for all the patients with the same techniques:30 Gy to the whole cranialspinal axis followed by a boost of 20-25 Gy to the posterior fossa,witha median fraction dose of 180 cGy.Chemotherapy was given according to the protocol which consisted of lomustine,cisplatinum and vincristine after radiotherapy,but the patients were not given intrathecal chemotherapy.Blood counts and chemistries and renal and hepatic evaluations were performed regularly before every course.Results:5-year OS and 5-year event free survival(EFS) were 71% and 62% respectively.The mean follow-up was 36.5 months.The 5-year OS of the high risk group and low risk group were 88.9% and 50.0% respectively.There was significant difference between them(P=0.01).13 patients were failures.Of all failure patients,3 had recurrence in the region of the cribriform plate.The complete remission was 70.5%,and the partial remission was 14%.If metastases were found before surgery,the 5-year OS was 12.5%(1/8),and if the residual tumor was more than 1.5 cm3,the 5-year OS was 0%(0/5).Whether or not the metastases were found before surgery,and the presence of residual tumor,both had significant impacts on the prognosis of the children with medulloblastoma(P