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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. .
ABSTRACT
Esophageal cancer is one of the tumors with high morbidity rates in China, and surgery remains to be the preferred treatment. However, certain complications such as anastomotic fistula, lung infection, respiratory failure, and circulatory failure occur after surgery. Postoperative enteral nutritional support could not only maintain and improve the nutritional status of the body but also re-duce complications and maintain normal immune function. This review focuses on the progress in postoperative enteral nutrition in pa-tients with esophageal cancer.
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<p><b>BACKGROUND</b>Lung cancer invading left atrium or base of pulmonary vein belongs to locally advanced lung cancer (T4). The prognosis of treatment without surgery is poor. The aim of this study is to explore the feasibility and the value of surgical method in the treatment of this disease.</p><p><b>METHODS</b>From April, 1993 to April, 2005, lobectomy or pneumonectomy combined with extended resection of left atrium were carried out in 46 patients with locally advanced lung cancer. The operations included left low lobectomy in 20 cases, left pneumonectomy in 6 cases, right middle and low lobectomy in 12 cases, right low lobectomy in 3 cases and right pueumonectomy in 5 cases respectively. The base of the pulmonary vein was invaded by the tumor in 34 patients, while left atriums were invaded obviously in 12 patients. Two patients were operated using extracoporeal circulation because of main pulmonary artery and left atrium being invaded. The Kaplan-Meier method (Log rank test) and a COX model were used to analyse the survival and the prognosis.</p><p><b>RESULTS</b>There was no operative mortality in this series, 15 patients had operative complication, including arrhythmia in 13 cases, pneumonia in 8 cases and heart failure in 1 case. The median survival was 35 months. The 1-, 3-, 5-year survival rates were 84.2%, 43.7%, 30.5% respectively. The survival of patients with N0/1 was better than that of patients with N2 disease, the median survival of them were 38 months and 19 months respectively (P=0.002). Using a Cox model analysis, lymph node stage (N0/1 or N2) was independent prognostic factor, while preoperative chemotherapy, sex, age and the pathologic type were not independent prognostic factors.</p><p><b>CONCLUSIONS</b>Surgical treatment for lung cancer invading the left atrium or the base of pulmonary vein is feasible, especially for N0 patients.</p>
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<p><b>BACKGROUND</b>Neoadjuvant chemotheropy can improve the survival rate of patients with stage III non-small cell lung cancer (NSCLC), whose chemotherapy is valid. The value of P53 expression in stage III NSCLC has not been reported. This study is to investigate the value of P53 expression on neoadjuvant chemotherapy sensitivity and prognosis in stage III NSCLC and to investigate the relationship between P53 expression and the result from thoracic CT examination.</p><p><b>METHODS</b>By immunohistochemical technique, the expression of P53 in 51 patients with stage III NSCLC who received neoadjuvant chemotherapy was determined in contrast with 49 patients with stage III NSCLC without neoadjuvant chemotherapy. Every patient who received neoadjuvant chemotherapy was examined by thoracic CT before and after neoadjuvant chemotherapy.</p><p><b>RESULTS</b>(1) There was no significant difference in the positive rate of P53 and the median survival time between neoadjuvant group and control group (48.98% vs 49.02% and 18 months vs 19 months). In neoadjuvant chemotherapy group, the median survival time was significantly different between P53 positive patients and P53 negative ones (13 months vs 31 months). (2) The expression of P53 was related to the neoadjuvant chemotherapeutic response by the results from thoracic CT examination (r=0.537, P < 0.01).</p><p><b>CONCLUSIONS</b>(1)Detection of P53 expression might be helpful to predict the effect of neoadjuvant chemotherapy. (2)The expression of P53 and the neoadjuvant chemotherapeutic results from thoracic CT examination are correlated.</p>
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<p><b>BACKGROUND</b>To investigate the expression of vascular endothelial growth factor (VEGF) and CD44v6 in non-small cell lung cancer (NSCLC) and to explore their association with invasion, metastasis and prognosis of NSCLC.</p><p><b>METHODS</b>A rapid immunohistochemical method (streptoavidin-peroxidase, SP) was used to detect VEGF and CD44v6 proteins expression in 43 paraffin-embedded resected NSCLC tissues retrospectively. All the patients were initially treated.</p><p><b>RESULTS</b>The expression rates of VEGF in squamous cell carcinoma and adenocarcinoma were 62.5% (15/24) and 68.42% (13/19) respectively. The positive rates of CD44v6 expression in squamous cell carcinoma and adenocarcinoma were 58.33% (15/24) and 68.42% (13/19) respectively. The positive expressions of VEGF and CD44v6 were significantly correlated with lymph node metastasis and TNM stage (P < 0.05), and also significantly correlated with postoperative hematogenous metastasis (P < 0.05). The 3- and 5-year survival rates of patients with VEGF positive expression were 19.23% and 6.41% respectively, whereas those with negative expression were 67.41% and 58.82%, there was signi-ficant difference of survival rate between the two groups (P < 0.05). The 3- and 5-year survival rates of CD44v6 positive expression group and negative expression group were 18.67%, 10.67% and 67.83%, 53.50%, there was also significance difference of survival rate between two groups (P < 0.05). The positive expression of VEGF was significantly correated with the positive expression of CD44v6 (P < 0.05).</p><p><b>CONCLUSIONS</b>Detection of VEGF and CD44v6 expression in NSCLC is helpful to evaluate the lymph node metastasis, TNM stage and prognosis. It is also helpful to guide postoperative multiple modality therapy.</p>
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<p><b>BACKGROUND</b>To investigate the relationship between micrometastasis of bone marrow and neoadjuvant chemotherapy and prognosis in patients with stage III non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Sixty-five patients with stage III NSCLC were randomly divided into group A (32 patients treated with preoperative neoadjuvant chemotherapy plus operation) and group B (33 patients treated with operation and postoperative chemotherapy as control group). Expression of CK19 mRNA and CEA mRNA was detected in bone marrow samples from the rib segments of all patients obtained from operation by RT-PCR. The relationship between survival duration and CK19 and CEA expression was analyzed.</p><p><b>RESULTS</b>The positive rates of CK19 mRNA expression were 18.8%(6/32) and 45.5%(15/33) in group A and B, respectively (P=0.033), and the positive rates of CEA were 25.0%(8/32) and 51.5% (17/33) in group A and B, respectively (P= 0.041). A significant positive correlation was observed between CK19 and CEA expression (r s=0.671,P < 0.001). The response rates of neoadjuvant chemotherapy were 0%(0/5) and 56.5%(13/23) in patients with CK19(+)/CEA(+) and CK19(-)/CEA(-), respectively (P=0.044), and the median survival duration were 11 and 27 months, respectively (P=0.000 6). Cox's model showed that the response to neoadjuvant chemotherapy and the expression of CK19 or CEA were significantly prognostic factors in group A.</p><p><b>CONCLUSIONS</b>Neoadjuvant chemotherapy can reduce the possibility of bone marrow micrometastasis in stage III NSCLC patients. Bone marrow micrometastasis may indicate a poorer prognosis for NSCLC.</p>