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Objective:To investigate the efficacy of different treatment modes for locoregional recurrence after nephrectomy in patients with renal cell carcinoma.Methods:A total of 106 patients with locoregional recurrence after nephrectomy without distant metastasis (77 males and 29 females) admitted to Sun Yat-sen University Cancer Center from October 2001 to July 2020 were retrospectively analyzed. The median age was 51 (40, 60) years old. Radical nephrectomy was performed in 90 patients with primary tumor and partial nephrectomy was performed in 16 patients. Pathological diagnosis showed that 54 cases were clear cell carcinoma and 52 cases were non-clear cell carcinoma. 53 cases were in stage T 1-2 and 53 cases in stage T 3-4. The median diameter of recurrent lesions was 3.2 (2.0, 6.3) cm, and the median number was 2 (1, 4). The recurrence sites were divided into renal fossa recurrence (33 cases), renal fossa±retroperitoneal lymph node recurrence (38 cases), and intra-abdominal spread (35 cases). The median duration from primary surgery to local recurrence was 14.8 (7.3, 35.8) months. Two treatment groups were identified as systemic therapy alone (Group A) and local therapy with or without systemic therapy (Group B). The Kaplan-Meier method was used to compare the progression free survival (PFS) and overall survival (OS) between Group A and Group B. The Cox model was used to perform univariate and multivariate analysis. Results:Of all the 106 patients, 33 patients were in Group A and 73 patients were in Group B. In Group A, 29 patients (87.9%) received targeted therapy, and 4 patients (12.1%) received targeted therapy combined with immunotherapy. In Group B, 34 patients (46.6%) received surgery or ablation and 39 patients (53.4%) received SBRT, of which 62 patients (84.9%) received concurrent systemic therapy. Among them, 58 patients (93.5%) received targeted therapy, and 4 patients (6.5%) received targeted therapy combined with immunotherapy. The median follow-up period was 29.0 (15.4, 45.9) months, 64 patients progressed on tumor including 28 patients died. The median PFS and OS were 15.6 (7.1, 35.2) months and 66.9 (37.8, not reached) months. The median PFS of Group A and Group B were 7.6(5.0, 17.2)months and 22.2(9.6, 63.9)months respectively ( P=0.001), median OS of Group A and Group B were 45.7 (23.4, 62.8)months and 71.0(50.6, not reached)months respectively, and the 2-year OS were 70.6% and 85.5% in Group A and Group B respectively ( P=0.023). The univariate analysis showed local therapy with or without systemic therapy was significantly reduced 56% risk of tumor progression ( HR=0.44, P=0.003) and reduced 60% risk of death ( HR=0.40, P=0.028). The multivariate analysis showed that the OS was associated with ECOG score( HR=10.20, 95% CI 4.13-25.30, P<0.001)and local therapy( HR=0.23, 95% CI 0.09-0.58, P=0.002). Conclusion:Compared with systemic therapy alone, local therapy with or without systemic therapy can effectively improve the PFS and OS of patients with locoregional recurrence after nephrectomy.
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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China, and when a single tumor is larger than 5 cm in diameter, it is defined as large HCC. Large HCC has the characteristics of high degree of tumor malignancy and high risk of tumor metastasis and vascular invasion, which increases the difficulty of treatment. Surgical resection is the preferred treatment regimen for large HCC, but only 20%-30% of patients are candidates for surgical treatment. Transarterial chemoembolization (TACE) is recommended as the treatment regimen for unresectable large HCC in Chinese and international guidelines. It can control tumor progression and prolong the survival time of patients; however, repeated TACE has limited efficacy and may cause serious damage to liver function, and TACE alone can no longer meet clinical needs. With the development of tumor ablation techniques such as radiofrequency ablation, microwave ablation, and cryoablation, TACE combined with tumor ablation has become an important treatment method for large HCC. However, there are still controversies over the effect of ablation on large HCC, and therefore, how to choose the appropriate ablation time, reduce tumor residue and recurrence after ablation, and finally bring survival benefits to patients remains a difficult problem to be solved in clinical and scientific research. This article reviews the current status, predicaments, and future development trends of ablation therapy for large HCC.
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"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions. .
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Objective@#To report the experience on the multi-disciplinary management of metastatic renal cell (mRCC) patients in a single center.@*Methods@#Data of 168 mRCC patients treated by multi-disciplinary team (MDT) at Sun Yat-sen University Cancer Center from December 2007 to February 2019 was retrospectively analyzed.Three treatment groups were identified, including 76 patients with 55 males and 21 females, received anti-angiogenic agents alone (Group A), 66 patients with 55 males and 11 males, received anti-angiogenic agents plus local therapy (Group B)and 26 patients, with 19 males and 7 females, received anti-angiogenic agents plus immunotherapy and local therapy (Group C). The Sunitinib, Sorafenib, Axitinib were chosen for the TKI. The Pembrolizumab was used for immunotherapy. The stereotactic body radiation therapy and surgical excision were considered as the local therapy. The study aims to compare the age, gender, IMDC score, pathology, nbephrectomy, adverse events, progression-free survival and overall survival (OS).@*Results@#Of all patients, the median follow-up duration was 23 months (ranging 6-117 cmonths). The PFS was 18.3 months and median OS was 33.5 months. The 2 years and 5 years survival rate was 66% and 35%, respectively. The median OS of Group A, B and C were 29.8 months, 44.6 months and not reached. 2y-OS was 58%, 67% and 89%, while 5y-OS 12%, 46% and 57%.There was no difference in age, gender, IMDC score, pathology, synchronous metastases or nephterectomy between the three groups. The prognostic result in TKI based combination therapy was superior to TKI therapy alone, which the 5y-OS was 51% and 11%, respectively. The prognostic result in group C's moderate-high risk mRCC patients was superior to group A and B. The median OS in TKI+ DC and CIK+ Pembrolizumab was 49.1 months and 53.1 months. On univariate analyses, IMDC score, nephrectomy and treatment group was associated with OS (P<0.05). On multivariate analyses, treatment group, nephrectomy was associated with OS (P<0.05). The risk of death of Group C decreased about 60% [HR 0.39 (0.17, 0.89), P=0.026]. 78 (46.4%) patients on TKI alone and 16 (61.5%) patients treated with TKI plus immunotherapy had Grade 3 or 4 adverse events. 16 (20.3%) patients had Clavien Ⅲ-Ⅳ toxicity after surgical procedures. 6 (5.7%) patients had Grade 3 toxiciy after SBRT.@*Conclusions@#Patients treated with combined therapy had better survival than those treated with anti-angiogenic agents alone. MDT approach could bring survival benefit to mRCC patients.
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Objective To report the experience on the multi-disciplinary management of metastatic renal cell (mRCC) patients in a single center.Methods Data of 168 mRCC patients treated by multidisciplinary team (MDT) at Sun Yat-sen University Cancer Center from December 2007 to February 2019 was retrospectively analyzed.Three treatment groups were identified,including 76 patients with 55 males and 21 females,received anti-angiogenic agents alone (Group A),66 patients with 55 males and 11 males,received anti-angiogenic agents plus local therapy (Group B)and 26 patients,with 19 males and 7 females,received anti-angiogenic agents plus immunotherapy and local therapy (Group C).The Sunitinib,Sorafenib,Axitinib were chosen for the TKI.The Pembrolizumab was used for immunotherapy.The stereotactic body radiation therapy and surgical excision were considered as the local therapy.The study aims to compare the age,gender,IMDC score,pathology,nbephrectomy,adverse events,progression-free survival and overall survival (OS).Results Of all patients,the median follow-up duration was 23 months (ranging 6-117 cmonths).The PFS was 18.3 months and median OS was 33.5 months.The 2 years and 5 years survival rate was 66％ and 35％,respectively.The median OS of Group A,B and C were 29.8 months,44.6 months and not reached.2y-OS was 58％,67％ and 89％,while 5y-OS 12％,46％ and 57％.There was no difference in age,gender,IMDC score,pathology,synchronous metastases or nephterectomy between the three groups.The prognostic result in TKI based combination therapy was superior to TKI therapy alone,which the 5y-OS was 51％ and 11％,respectively.The prognostic result in group C's moderate-high risk mRCC patients was superior to group A and B.The median OS in TKI + DC and CIK + Pembrolizumab was 49.1 months and 53.1 months.On univariate analyses,IMDC score,nephrectomy and treatment group was associated with OS (P ＜ O.05).On multivariate analyses,treatment group,nephrectomy was associated with OS (P ＜ O.05).The risk of death of Group C decreased about 60％ [HR O.39 (0.17,0.89),P =O.026].78 (46.4％)patients on TKI alone and 16 (61.5％) patients treated with TKI plus immunotherapy had Grade 3 or 4 adverse events.16 (20.3％) patients had Clavien IⅢ-V toxicity after surgical procedures.6 (5.7％) patients had Grade 3 toxiciy after SBRT.Conclusions Patients treated with combined therapy had better survival than those treated with anti-angiogenic agents alone.MDT approach could bring survival benefit to mRCC patients.
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OBJECTIVE:To observe therapeutic efficacy and safety of Duhuo jisheng decoction combined with glucosamine gulfate for genual osteoarthritis. METHODS:Totally 86 patients with genual osteoarthritis selected from our hospital during Dec. 2015-Apr. 2016 were divided into trial group and control group according to random number table,with 43 cases in each group. Control group was given Glucosamine sulfate tablets 1-2 tablet,po (at mealtime),tid. Trial group was additionally given Duhuo jisheng decoction,one dose a day,decocting 200 mL with water,morning and evening at twice,on the basis of control group. Both groups received treatment for 28 d. Clinical efficacies of 2 groups were observed as well as the levels of hs-CRP,TNF-α, IL-6,MMP-3,MMP-9 and MMP-13. The occurrence of ADR was recorded during treatment. RESULTS:Before treatment,there was no statistical significance in hs-CRP,TNF-α,IL-6,MMP-3,MMP-9 and MMP-13 between 2 groups(P>0.05). After treat-ment,total response rate of trial group(95.3%)was significantly higher than that of control group(76.7%),with statistical signif-icance (P<0.05). The level of hs-CRP in trial group was significantly lowered,and the levels of TNF-α and IL-6,MMP-3,MMP-9,MMP-13 in 2 groups were decreased significantly;above indexes of trial group were significantly lower than those of con-trol group,with statistcal significance(P<0.05). The incidence of ADR in trial group(7.0%)was significantly lower than control group (46.5%),with statistical significance (P<0.05). CONCLUSIONS:Duhuo jisheng decoction combined with glucosamine gulfate shows good therapeutic efficacy for genual osteoarthritis with good safety.
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Objective To observe the therapeutic effect of single lower limb traction plus massage for the lumbosacral tunnel syndrome.Methods The selected 80 candidate patients were divided into the observation group with 38 patients and treatment group with 39 patients. The observation group received single lower limb traction plus massage and the treatment group received pelvic traction plus massage. Both groups therapy last 5 days, The Japanese orthopaedic association scores (JOA) was evaluated for subjective symptoms, signs, functional activity and bladder function score. The therapeutic effect was evaluated.Results The total effective rate (94.7% vs. 82.1%;χ2=12.160,P=0.007) in the observation group was significantly higher than that in the control group. O, The scores of JOA at one week after treatment (20.2 ± 2.0 vs. 18.3 ± 2.8;t=3.419, P<0.01) and two weeks after treatment (24.4 ± 1. 4vs. 22.6 ± 3.0;t=3.359,P<0.01) in the observation group were significantly higher than those in the control group.Conclusions The single lower limb traction plus massage can improve the clinical symptoms of patients with lumbosacral tunnel syndrome, and be superior to the pelvic traction plus massage.
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OBJECTIVE:To observe the effectiveness and safety of Jin's three-needle combined with Jiawei wumei pill in the treatment of menopausal insomnia.METHODS:One hundred and sixty-five patients with perimenopausal insomnia were selected from our hospital during Jan.2015-Mar.2016,and then divided into group A (n=41),group B (n=41),group C (n=41) and group D (n=42) according to random number table.Group A was given Estazolam tablet 1 mg,qd;group B was given Jin's three-needle 30 min/time,qd;group C was given Jiawei wumei pill,one pill,after breakfast and supper warm taking;group D was given Jin's three-needle combined with Jiawei wumei pill with same usage as group C.Four groups were treated for 4 weeks.PSQI score,modified Kupperman score,life quality score,serum levels of E2 and FSH were observed in 4 groups before and after treatment,and the occurrence of ADR was recorded.RESULTS:Before treatment,there was no statistical significance in above score (P＞0.05).After treatment,PSQI score and modified Kupperman score of 4 groups were decreased significantly,compared to before treatment;the group B,C,D were significantly lower than the group A;the group D was significantly lower the group B,C,with statistical significance (P＜0.05).The life quality score of 4 groups were increased significantly,and the group B,C,D were significantly higher than the group A;the group D was significantly higher than the group B,C,with statistical signifi cance (P＜0.05).E2 level of group B,C,D were significantly increased,while FSH level was decreased significantly,the improvement of group D was significantly better than group B,C;the improvement of group D was significantly better than that of group B,C,with statistical significance (P＜0.05).The incidence of ADR in group A was significantly higher than group B,C,D,with statistical significance (P＜0.01),and there was no statistical significance in the incidence of ADR among group B,C,D,with statistical significance (P＞0.05).CONCLUSIONS:Jin's three needle combined with Jiawei wumei pill is effective in the treatment of perimenopausal insomnia with good safety.
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OBJECTIVE: To retrospectively evaluate the short-term outcomes and safety of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of solitary adrenal metastasis from lung cancer. MATERIALS AND METHODS: From May 2010 to April 2014, 31 patients with unilateral adrenal metastasis from lung cancer who were treated with CT-guided percutaneous MWA were enrolled. This study was conducted with approval from local Institutional Review Board. Clinical outcomes and complications of MWA were assessed. RESULTS: Their tumors ranged from 1.5 to 5.4 cm in diameter. After a median follow-up period of 11.1 months, primary efficacy rate was 90.3% (28/31). Local tumor progression was detected in 7 (22.6%) of 31 cases. Their median overall survival time was 12 months. The 1-year overall survival rate was 44.3%. Median local tumor progression-free survival time was 9 months. Local tumor progression-free survival rate was 77.4%. Of 36 MWA sessions, two (5.6%) had major complications (hypertensive crisis). CONCLUSION: CT-guided percutaneous MWA may be fairly safe and effective for treating solitary adrenal metastasis from lung cancer.
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Humans , Disease-Free Survival , Ethics Committees, Research , Follow-Up Studies , Lung Neoplasms , Lung , Microwaves , Neoplasm Metastasis , Retrospective Studies , Survival RateABSTRACT
Objective To study the construction of training bases for three tumor therapies. Methods Eight training bases in six third-level first-class hospitals with score of technology assessment higher than 90 were investigated. Results There were good hardware in all training bases and qualified teaching staff in six of them. Annual operative quantity of hyperthermia and radioactive particles implantation technology of all training bases were up to the standard , while the coincidence rate of ablation technology was 80%. Besides , quantity of ablation technology and radioactive particles implantation technology trainees participated in during training met the standard, but that of hyperthermia not. There were significant difference in theory and operational test results before and after training (P < 0.01). Conclusions Management system, operative quantity and teaching staff construction need to be improved. Clinical skills training and standardized training assessment should be strengthened in base construction.
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ObjectiveTo evaluate the correlation between ultrasound detected fetal heart abnormality and chromosomal abnormality.Methods The data of 3307 cases of prenatal fetal echocardiography and karyotype analysis results were retrospectively analyzed.The correlation between heart abnormality and chromsomal abnormality was analyzed.ResultsIn 3307 cases d pregnant women,194cases (5.87％) were found signs of fetal heart abnormality,and 3113 cases (94.13％) were not found any sign of fetal heart abnormality.And 124 cases(3.75％) were found chromosomal abnormality.The rate of chromosomal abnormality in fetus with heart abnormality was higher than that in fetus without heart abnormality[ 19.59％ (38/194) vs.2.76％ ( 86/3113 ),P ＜ 0.01 ],the relative risk ratio was 7.0903.One hundred and twenty-four cases of chromosomal abnormality in the 18-three-body(42 cases) and 21-three-body(36 cases) were the most common.ConclusionsFetal heart abnormality incidence of chromosomal abnormality is high relatively.When the signs of heart abnormality are found,it is suggested that the fetus should examine karyotype analysis.
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egrated interventional and minimally invasive therapy could improve the life and survival and it is an effective adjunctive therapy for primary hepatocellular carcinoma with metastasis outside the liver.
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Objective To describe the high-resolution CT(HRCT)findings of arc-welders with early pneumoconiosis and to evaluate manifestation in different course of disease.Methods Seventy-six arc-welders with a one to thirty-eight(mean,14)years history of exposure underwent CT and HRCT scanning.The extent of abnormalities were detected.The relations of age and year history of exposure were analysed in different groups.Results Thirty-eight welders(38/76,50%)showed positive characteristic findings with conventional CT.Predominant thin-section CT findings were poorly-defined centrilobular micronodules(18/76,23.7%),branching linear structure(20/76,26.3%).The mean age in group of branching linear structure[(39±9)years old]was elder than of poorly-defined centrilobular micronodules[(34±7)years old].There was no statistical difference between the two groups(t=-1.648,P＞0.05).The mean length of service at exposure in group of branching linear structure[(15±8)years]was longer than of poorlydefined centrilobular micronodules[(10±5)years].And the significant differences were showed between the two groups in the year history of exposure(t=-2.108,P＜0.05).Conclusions Poorly defined centrilobular micronodules and branching linear structures were the thin-section CT findings most frequently seen in patients with arc-welders'pneumoconiosis and the former may be one early stage characteristic finding of arc-welders'pneumoconiosis.HRCT is useful in achieving more accurate categorization of the parenchymal changes in arc-welders'pneumoconiosis.
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Objective To evaluate the value of MR spectroscopy (MRS) in the differential diagnosis between recurrence and radiation encephalopathy after radiotherapy for nasopharyngeal carcinoma (NPC). Methods Muhi-voxel proton MRS was performed on 50 patients with NPC, who were suspected of intracalvarium tumor recurrence or radiation encephalopathy after radiotherapy by conventional MRI,including 44 males and 6 females. Among the 50 patients, 26 cases were finally diagnosised as basicranial tumor recurrence and 24 cases as radiation encephalopathy by clinical and MRI follow-up. The following metabolites, such as Cho, NAA, Cr, lactate and lipid, were analyzed comparatively between basicranial tumor recurrence and radiation encephalopathy(RE), and between the lesions and the relative normal brain tissue. Wilcoxon's rank sum test was used to analyze the data. Results The median of Cho/Cr, Cho/NAA,LI/Cr in tumor recurrence group were 2. 22, 2. 13, and 1.77, respectively, and 1.40, 1.31, and 0. 57,respectively, in RE group. The difference of Cho/Cr, Cho/NAA, and LL/Cr between the two groups were statistically significant (P < 0. 01). Those in tumor recurrence group were higher than in RE group. The median of Cho, Cr, NAA in tumor recurrence group and in RE group were 3366. 00, 1023.00, 1930. 00 and 2469.50, 1864.50, 1734.00. There were no significant difference of Cho, Cr, and NAA between the two groups (P > 0. 05). In the 14 cases whose normal brain tissue were compared with the recurrent tumor tissue in tumor recurrence group, the median of Cr, NAA, LL, Cho/Cr, Cho/NAA, LL/Cr of recurrent tumor tissue and normal brain tissue were 1023.00, 1930.00, 2090.00, 3.76, 2. 13, 3.39 and 2370.00, 3012.00, 1680.00, 1.64, 1.17, 0.75,The difference of Cr, NAA, LL, Cho/Cr, Cho/NAA, LL/Cr between the normal tissue and recurrent tumor tissue were significant (P <0.05). LL, Cho/Cr, Cho/NAA, LL/Cr of recurrent tumors were higher than those of the normal brain tissue,while NAA and Cr of recurrent tumors were lower than those of the normal brain tissue. In the 12 cases whose normal brain tissue were compared with the RE tissue in RE group, the median of Cho, Cr, NAA, LL, Cho/Cr, IX,/Cr of RE tissue and normal brain tissue were 390.00, 217.50, 427.50, 39.00, 1.30, 0.40 and 680.00, 360.00, 610.00, 30.00, 1.54, 0. 09. The difference of above-mentioned parameters between RE tissue and normal tissue were significant. Cho, Cr, NAA, Cho/Cr of RE were lower than those of normal tissue (P <0. 05) ,while LL and LL/Cr of RE were higher than those of normal tissue (P < 0. 05). Conclusion The changes of the metabolites in recurrent lesions and RE lesions were different on MRS. Parameters such as Cho/Cr, Cho/NAA and LL/Cr, which were higher in recurrent lesions than those of RE, were valuable for the differential diagnosis between basicranial tumor recurrence and radiation encephalopathy after radiotherapy for NPC.
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Objective To evaluate CT guided 125I seeds implantation for liver metastasis of colorectal cancer. Methods The retrospective analysis was undertaken in 15 colorectal cancer patients with 33 foci of hepatic metastases from Jul 2006 to Aug 2007, receiving CT guided 125I radioactive seeds implantation according to TPS or Halarism's experience function: mCi = Da × 5, Results All the patients were followed-up by CT scan after 3 months. There were 2 of complete remission (CR) , 10 of partial remission (PR), 3 of stable disease (SD). All patients are still alive now, the lougest follow-up time is 20 months, and the shortest is 6 months, the average followed span is 12 months. Conclusion CT guided 125I seeds implantation is a safe and effective method in the treatment of liver metastasis caused by colorectal cancer.
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Objective To evaluate the toxic effects and efficacy of the intra-arterial chrono-chemotherapy on patients with liver metastasis arised from colorectal cancer. Methods Chemotherapy of 42 patients were randomly divided into group A (n = 20) with continuously constant arterial infusion, and group B (n = 22) with arterial chrono-modulated infusion. And the toxic effects and efficacy of two groups were compared. Results A significant difference was found in the toxic effects of digestive system between the two groups. The treatment response was similar in the two groups. Conclusions Intra-arterial chrono-chemotherapy may decrease the toxic effects and improve the life quality of these patients.
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Objective To evaluate the size of the liver tissue necrosis at different power and energy, to search the size of liver tissue necrosis at ideal power and energy, and to provide dependable data for semiconductor laser-therapy in malignant hepatic tumor. Methods Ten rabbits were included, and the rabbit liver tissue was fired using semiconductor laser at 1 W, 2 W, and 3 W with the energy of 200 J, 400 J, 600 J, 800 J, and 1 000 J. The diameters of the necrosis and charring in the target area were measured. Results The diameter of the liver tissue necrosis and charring was from 4.3 mm and 7.8 mm at 1 W to 10.4 mm and 21.9 mm at 2 W in 1 000 J. From 2 W to 3 W, the diameter of the liver tissue necrosis and charring remained unchanged. At the power of 2 W, the diameter of liver tissue necrosis and charring was proportional to the energy, and the areas of necrosis were correlated with that of charring. Conclusion Semiconductor laser photocoagulation is safe and feasible. This experiment supplies valuable laboratorial data for further clinical study.
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Objective To investgate the value of interventional therapy in inferior vena cava stenosis or obstruction caused by tumor and management after the operation. Methods 53 patients with IVC stenosis caused by tumor had detailed information. After the guide wire passed through the stenosised part and then undergoing balloon expansion, Gianturco Z stents or wallstents were implanted to undergo venography and measuring pressure after that. Results Technical success was attained in 50 patients, 3 cases was failure because the guide wire couldn't pass through the obstructed region.The technical success rate is 94.3%. 2 patients with IVC stenosis over 10 cm length was placed two stents. In other 48 patients,everyone was placed one stent. The pressure of IVC dropped from (28.66?4.08)cm H 2O (1 cm H 2O =0.098 kPa) before operation to (17.65?4.18)cm H 2O after operation. Through t examination, the difference of IVC pressure before and after treatment has statistic significance( t =3.261, P