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Objective: To investigate the safety and efficacy of fluorouracil-based two-drug combination chemotherapy with apatinib, as a conversion therapy, in patients with unresectable gastric cancer (GC). Methods: A retrospective analysis of 33 patients with unresectable stage IV GC receiving conversion therapy at Tianjin Medical University Cancer Institute and Hospital between March 2017 and June 2018, was performed. Patients with peritoneal or ovarian metastasis received S1/paclitaxel (PTX)/apatinib (S1: 60 mg, bid, days 1-14; PTX: 50 mg/m2 iv, days 1 and 8; PTX: 20 mg/m2 ip, days 1 and 8; q3w; apatinib 500 mg po, qd). Patients with other non-curable factors were administered a regimen of SOX plus apatinib (oxaliplatin 130 mg/m2, S1: 60 mg, bid, days 1-14; apatinib 500 mg po, qd). Apatinib should be withdrawn from the last cycle before surgery. Surgery should be performed after MDT. Results: After at least three cycles chemotherapy, 21 patients achieved partial response (PRand 8 patients had progressive disease (PD), resulting in an objective response rate of 75.7%. Surgery was performed on 22 patients with PR, and 21 patients (63.6%) achieved R0 resection; the number of excised lymph nodes was 57.0±15.6, intraoperative hemorrhage was (164±46) mL, the operation time was (212.0±44.8) min, and the postoperative hospital stay was (13.0±2.7) days. Patients who had surgery had a median progression free survival (mPFS) of 10.5 months and an median overall survival (mOSof 16.5 months; for patients who did not undergo surgery, the median progression free survival (mPFSwas 2.5 months and mOS was 5.5 months. Conclusions: As a conversion therapy, fluorouracil-based two drug-combination chemotherapy with apatinib provided a high R0 resection rate for unresectable stage GC, with an acceptable safety profile. Keywords: apatinib, gastric cancer (GC), conversion therapy, safety, efficacy
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<p><b>OBJECTIVE</b>To evaluate the impact of primary site, NIH risk and imatinib treatment on the prognosis of patients with gastrointestinal stromal tumors(GIST).</p><p><b>METHODS</b>Clinicopathological data of 156 adult patients with GIST treated by imatinib in the Cancer Institute and Hospital of Tianjin Medical University from January 2006 to December 2010 were retrospectively analyzed. According to NIH risk classification, 30 patients were at moderate risk and 126 at high risk. Sixty-seven patients had advanced GIST. Prognosis of patients with different primary tumor site, different NIH risk and different treatment was compared respectively.</p><p><b>RESULTS</b>Imatinib therapy was well tolerated in all the patients. Eighty-nine cases received radical operation and adjuvant imatinib treatment. Among 67 advanced GIST cases, 26 received radical operation and adjuvant imatinib treatment, 27 received palliative operation and adjuvant imatinib treatment, and 14 received simple adjuvant imatinib treatment without operation. All the patients had routine follow-up, ranging from 9 to 56(median 27) months. The overall survival (OS) rate was 96% in 1-year, 86% in 2-year, and 71% in 3-year. The OS rate was 95% in 1-year, 77% in 2-year, and 65% in 3-year for patients at high risk, and all 100% in 1-, 2-, 3-year for patients at moderate risk, the differences was statistically significant (P=0.001). The OS rate was 97% in 1-year, 90% in 2-year, and 84% in 3-year for patients with gastric GIST, and 95% in 1-year, 69% in 2-year, and 52% in 3-year for patients with non-gastric GIST, the difference was significant(P=0.000). The OS rate was 98% in 1-year, 95% in 2-year, and 90% in 3-year for patients undergoing radical resection and adjuvant imatinib therapy. For 67 advanced GIST patients with imatinib therapy, none had complete remission, 41 had part remission, 15 had stable disease, indicating 56 advanced GIST cases(83.6%) obtaining clinical benefit. The OS rate was 91% in 1-year, 58% in 2-year, and 43% in 3-year.</p><p><b>CONCLUSIONS</b>The prognosis of high, and non-gastric and advanced GIST patients is poor. Radical resection combined with early imatinib treatment can improve the prognosis of GIST patients.</p>
Subject(s)
Humans , Antineoplastic Agents , Therapeutic Uses , Benzamides , Therapeutic Uses , Combined Modality Therapy , Follow-Up Studies , Gastrointestinal Neoplasms , Drug Therapy , Pathology , Gastrointestinal Stromal Tumors , Drug Therapy , Imatinib Mesylate , Piperazines , Therapeutic Uses , Prognosis , Pyrimidines , Therapeutic Uses , Retrospective Studies , Survival RateABSTRACT
OBJECTIVE:To prepare diclofenac sodium liposomes and establish a method for their quality control.METHODS:The diclofenac sodium liposomes were prepared by pH gradient method;the particle shape and size were measured by transmission electrical miscroscope;the concentration and encapsulation efficiency of diclofenac sodium in the liposomes were determined by HPLC.RESULTS:The prepared lipisomes were uniformly distributed with particle size of 150～175 nm.The linear range of diclofenac sodium was 0.01～1 mg?mL-1(r=0.999 0,n=6)at an average recovery of 100.05%(RSD=1.21%,n=6).The encapsulation efficiency ranged from 52.4% to 85.8%.CONCLUSION:High encapsulation efficiency of diclofenac sodium liposomes can be obtained from the established method.
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Objective To evaluate the feasibility and advantages of gasless endoscopic thyroidectomy via the infraclavicular approach.Methods A single 2-to 4-cm infraclavicular incision was made at the ipsilateral side under local anesthesia.The subplastysmal plane was dissected up to the anterior neck to build a gasless space by mechanical method.Afterwards,by using ultrasonic scalpel,thyroidectomy was performed.Results The procedure was completed in 34 cases with a mean operation time of(120?30) min and mean blood loss of(20?12) ml.After the surgery,3 patients developed subcutaneous fluid and 1 patient had incisional infection,all of the 4 patients were cured by conservative therapy.The 34 cases were followed up for 1 to 30 months with a mean of 18.5 months,during the period,none of them had recurrence.Conclusions Gasless endoscopic thyroidectomy via the infraclavicular approach is a simple and safe method with good cosmetic outcomes.
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ObjectiveTo evaluate the treatment strategy for patients with abdominal aortic aneurysm (AAA) and concomitant digestive system diseases (DSD) necessitating a surgery.Method From Mar. 1999 to Oct. 2001, clinical result of 6 cases suffering from concomitant AAA and DSD was reviewed. The AAA ranged from 4 8 to 11?cm in diameter. Cholecystectomy (for acute cholecystitis) and sigmoidectomy (for colonic cancer) were performed synchronously with AAA repair in 2 cases and 1 case respectively. Right semicolonectomy, radical subtotal gastectomy and esophagogastrectomy (all for carcinoma) were performed heterochronously with AAA endovascular exclusive grafting in one each patient, ResultGastric paresis developed postoperatively and recovered spontaneously in one patient. Esophagogastroanastomosis leakage caused a death in 1 patient. With follow up of 6～42 months the remaining 5 patients were alive, with no graft infection, nor cancer recurrence. ConclusionThe concurrent presentation of AAA and digestive tract diseases necessitating surgical intervention could be successfully managed synchronously or heterochronously.Endovascular exclusive graft of AAA is an effective therapy in patiens suffering from concomitant AAA and DSD.
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Objective To study the surgical manipulation of major blood vessels invaded by retroperitoneal tumors in order to raise the resection rate. Method Clinical data were analyzed on 56 patients undergoing resection of retroperitoneal tumors along with reconstruction of major blood vessels in our hospitals from July 1994 to June 2002. Results There was no surgical mortality, and 51 patients were followed-up from 6 months to 8 years and 1 month (average of 4.8 years). Grafts were patent in 49 cases, thromboembolism developed in 2 cases. Forty-seven cases have survived more than 1 year, 38 cases more than 3 years, and 16 cases more than 5 years. Conclusion Combined resection of retroperitoneal neoplasm and reconstruction of major blood vessels is safe, effective and practical.
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Objective To evaluate surgical indications and method for regional pancreatoduodenectomy combined with blood vessel reconstruction. Methods Forty-four patients underwent pancreatoduodenectomy combined with superior mesenteric vein and portal vein(smv-pv) resection and reconstruction between April 1994 and March 2001.Among them superior mesenteric artery (SMA) and hepatic artery (HA) were reconstructed in 4 and 2 cases, respectively. Partial resection of the anterior wall of the inferior vena cava was performed in one case for tumor invasion. Results The overall mortality was 7.1%,with no complications. The resected endothelium or margins of the blood vessel and pancreas were microscopically tumor free in all cases. Histological specimen examinations demonstrated adenocarcinoma of pancreas head in 43 cases, neuroendocrine adenocarcinoma was diagnosed in one case. Patients were followed-up from 3～87 months with 2 cases lost after PV/SMV for pancreatoduodectomy. Six patients have survived more than 5 yearsand 21 cases more than 3 years. Conclusion Regional pancreatoduodenectomy combined with reconstructionof blood vessel could increase tumor resection rate in properly selected patients and could be performed safely without increased morbidity and mortality.