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Objective:To investigate the safety and outcomes of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma (HCC).Methods:The clinical data of HCC patients who underwent hepatectomy at the University of Hongkong-Shenzhen Hospital from April 2014 to December 2020 were retrospectively analyzed. Of 57 HCC patients who were enrolled, there were 43 males and 14 females, aged (51±14) years old. According to the surgical method, the patients were divided into two groups: patients with pre-operative residual liver volume/standard liver volume <30% who underwent ALPPS procedure by anterior approach formed the study group ( n=20), and patients who underwent right hepatectomy with residual liver volume/standard liver volume ≥35% formed the control group ( n=37). Clinicopathological data and prognosis were reviewed and compared between the two groups. The patients were followed up via outpatient service and telephone. Results:There were more patients with well-moderately differentiated HCC in the study group than in the control group, and the difference was statistically significant ( P<0.05). All patients in the study group successfully completed two-step hepatectomy. Compared with the control group, the operative duration [644(535, 780) vs. 352 (269, 401) min], intraoperative blood loss [1 650 (1 338, 2 200) vs. 650 (500, 925) ml], and proportion of patients requiring blood transfusion (60.0% vs. 29.7%) were increased in the study group. The difference was statistically significant ( P<0.05). There was no significant difference in the incidence of grade III or higher complications between the study group and the control group [30.0% (6/20) vs. 18.9% (7/37), χ 2=0.91, P=0.341]. The 1-, 2- and 3-year overall survival rates were 90.0%, 63.8% and 46.4% respectively, and the corresponding tumor-free survival rates were 53.3%, 35.6%, and 35.6% respectively for the study group. The 1-, 2-, and 3-year overall survival rates were 71.4%, 63.4%, 51.7%, and tumor-free survival rates were 39.0%, 18.5%, 9.3% in the control group respectively. There was no significant difference in the postoperative survival rate and tumor-free survival rate between the two groups ( P>0.05). Conclusion:ALPPS was safe and feasible for treatment of right hepatocellular carcinoma with insufficient residual liver volume, and its survival outcomes was similar with one-stage right hepatectomy for HCC patients.
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Purpose To explore the optimal value of noise index (NI) of adaptive statistical iterative reconstruction (ASIR) in low-dose chest examination,so as to reduce the radiation dose of patients.Materials and Methods 1200 mid-age and elderly healthy individuals were randomly divided into 4 groups according to the NI difference,with 300 in each group,group A:NI=20;group B:NI=25;group C:NI=30;group D (the normal control group):NI=14.Combined with AS IR technology,the quality of the axial image was reviewed and evaluated,and the score of each subject was given and recorded based on the quality of the image and the matching degree with the disease it indicated.Results The subjective scores of images in each group were:group A (3.53±0.43),group B (3.28±0.32),group C (3.12±0.18) and group D (5.00±0),respectively.The scores of these 4 groups were all above 3,which could be used for diagnosis.The body mass index was (24.39 ± 3.09) kg/m2,(25.49 ± 2.45) kg/m2,(25.53 ± 3.21) kg/m2 and (25.55 ± 2.28) kg/m2,respectively.The number of layers was 60.64 ± 6.38,64.42 ± 5.71,61.77 ± 6.45 and 62.32±6.15,respectively,and there was no statistically significant difference between these 4 groups (P＞0.05).The effective dose (ED) was (1.66± 0.84) mSv,(1.11 ± 0.34) mSv,(0.88±0.30) mSv and (5.99± 1.37) mSv,respectively,and the differences between any two groups were all statistically significant (P＜0.05).ED of group C was the lowest,85％ lower than group D,47％ lower than group A,and 21％ lower than group B.Conclusion Using ASIR technology,setting NI=30 can ensure that the image quality meet the needs of diagnosis,and also effectively reduce the radiation dose,which is a preferable scanning scheme.
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Objective The results and side effects of nasopharyngeal carcinoma treated by combined external radiotherapy and Californium -252 neutron after loading intracavitary radiotherapy. Methods From November 2005 to March 2007, 30 nasopharyngeal carcinoma patients with staged T1 and T2 by 1992 Fuzhou staging system, were treated by external beam radiotherapy combined with Californium-252 neutron after loading intraeavitary radiotherapy. Results All patients were followed up for 2 years. 2 cases recurred in the nasopharynx. 4 cases developed distant metastases. 2 cases developed trismus. No perforations in hand and soft palate occurred. Conclusion External beam radiotherapy combined with Californian-252 neutron after loading intracavitary radiotherapy for nasopharyngeal carcinoma is indicated for boosting the dose to the nasopharyngeal cavity; reducing the dose for external irradiation. It can improve local control rate of nasopharyngeal carcinoma and reduce occur rate for the trismus.
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Objective To evaluated the treatment results of late-course accelerated hyperfractionated radiotherapy combined with chemotherapy for advanced esophageal carcinoma. Methods 72 patients with advanced esophageal cancer were randomized into two groups. The late-course accelerated hyperfractionated radiotherapy combined with chemotherapy(LCAF+CT)group received the induction chemotherapy for two cycles, followed by conventional fractionation radiotherapy to a dose of 36 Gy, then changed into accelerated hyperfractionated radiotherapy to a total dose of 60 ~ 66 Gy. The conventional fractionation radiotherapy combined with chemotherapy(CF+CT)group received the chemotherapy that it was similar to LCAF+CT group, and used the conventional fractionation radiotherapy to a total dose of 60 ~ 66 Gy. Results The 1-, 3- and 5-year survival rates were 82.3 %, 51.6 %, 38.2 % in the LCAF+CT group, and 73.8 %, 31.5 %, 18.6 % in the CF+CT group. The differences of 3- and 5-year survival rates were statistically significant (P 0.05). Conclusion Late-coures accelerated hyperfractionated radiotherapy combined with chemotherapy might improve the treatment efficacy of advanced esophageal cancer and lengthen the suvival time. The toxic and side effects of LCAF+CT group were more severe than those of CF+CT group, but they were well tolerable.
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Objective To evaluate the clinical curative effect and methods for recurring NPC with treatment of intracavitary radiotherapy after interventional chemotherapy. Methods 32 cases of recurring NPC were divided into two groups, each of which consisted of 16 cases. Group one was treated with intracavitary chemotherapy plus intracavitary radiotherapy. On the third day after interventional chemotherapy, the first intracavitary radiotherapy was performed (5 Gy) and the second treatment was done next day. Group two was only performed with intracavitary radiotherapy. The dose and interval were the same. The time of re examination was two weeks later. Results In the first group, clinical symptoms were improved, local swelling lymph nodes were shrunk, secretion on the nasopharyngeal surface was hardly left or disappeared. Tumours were shrunk and atrophy. On the intracavitary radiotherapy group, clinical symptoms changed a little, except the secretion on the mass surface was reduced. The white blood counts of the two groups showed no difference and there were no functional changes of liver, kidney and digestive system in the interventional group. Conclusions It is a new and effective therapy to treat recurring NPC with interventional chemotherapy plus intracavitary radiotherapy.