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This paper aims to develop folic acid-modified paclitaxel nanocrystals (PTX NC@FA) with good stability, high drug loading and tumor cell targeting for endoscopic injection for preoperative local chemotherapy of gastric cancer. PTX NC@FA was prepared by the "bottom-up" followed by ultrasonic to study its morphology, particle size, ζ-potential, drug loading, folic acid-modified phospholipid (FA-DSPE-PEG2000) content, crystalline characteristics, stability, in vitro release, cytotoxicity against human gastric cancer cell line SGC-7901, and anti-tumor effect in two different tumor sizes (tumor volume 100 mm3 or 300 mm3) after single peri-tumor injection in a murine subcutaneous SGC-7901 tumor model. Animal experiments were approved by the Experimental Animal Ethics Committee of the School of Pharmacy, Fudan University. The resulting PTX NC@FA was of short rod-like shape, average particle size 175.3 ± 2.5 nm (PDI 0.17 ± 0.02), ζ- potential -2.5 ± 0.2 mV, PTX loading (28.23 ± 0.74) % (w/w) and FA-DSPE-PEG2000 content (4.40 ± 0.60) % (w/w). The size of the PTX NC@FA remained unchanged for 4 days in phosphate buffer with or without serum. Cellular growth inhibition effect on SGC-7901 showed the superiority of PTX NC@FA over nanocrystals without FA modification. PTX NC@FA inhibited tumor growth more efficiently than both nanocrystals without FA modification and commercially available paclitaxel injection (Taxol) 12 days after peri-tumor injection. For model tumor with the volume of 100 mm3, tumors of all animals in the PTX NC@FA group disappeared completely. For model tumor with the volume of 300 mm3, tumors of 3 animals in the PTX NC@FA group completely disappeared and tumors of the rest 4 animals also became significantly smaller with a tumor volume inhibition rate of 90%. PTX NC@FA showed good potential for preoperative chemotherapy of increase the chances of function preserving gastrectomy and improve the quality of life of patients.
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@#[Abstract] Objective: To detect the expression of CD39 in head and neck squamous cell carcinoma (HNSCC) tisseus, and to analyze its correlation with patients’clinicopathological features and its prognostic significance. Methods: Tissue specimens and case data of 85 patients with HNSCC underwent surgery at Cancer Hospital of Tianjin from May 2012 to December 2013 were collected for this study. Gene chips were obtained from Oncomine database, and HNSCC cell lines SCC15, UM1, and Cal25 were selected for this study. Online analysis was performed to compare the differential expression of CD39 in buccal mucosa (BM) tissues and HNSCC tissues, Western blotting and Immunohistochemistry (IHC) were used to detect the protein expression of CD39 in HNSCC tissues. Spearman’ s correlation analysis was used to study the correlation between the expressions of CD39 and clinicopathological features of HNSCC patients. Both Kaplan-Meier curve analysis and Log rank test were used to analyze the association between the expression of CD39 in HNSCC tissues and the survival of patients, and Cox risk proportional regression model was used to evaluate the relationship between CD39 expression and the risk of relapse. Results: The transcription level of CD39 was obviously up-regulated in HNSCC tissues than in BM tissues (P<0.01), and CD39 expression was detected in HNSCC cell lines SCC15, UM1 and Cal25. Dexamethasone (DXM) could enhance the expression of CD39 in UM1 cells in dose-dependent manner. CD39 was highly expressed in 53 (62.4%) HNSCC patients, which was positively correlated with preoperative chemotherapy (r=0.234, P<0.05). The recurrence-free survival (RFS) of patients with high CD39 expression was significantly shortened (P<0.05), and high CD39 expression was an independent relapse risk factor (HR=2.328, 95%CI=1.091-4.967; P<0.05) for patients with HNSCC. Conclusion: CD39 is DXM-inducively and constitutively expressed in HNSCC. And over-expression of CD39 is an independent predictor of poor prognosis in HNSCC patients, indicating its important role in the progression of HNSCC.
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Objective@#The study aimed to identify the pattern and clinicopathologic factors associated with locoregional failure (LRF) in locally-advanced breast cancer (LABC) patients who received neoadjuvant chemotherapy (NAC) and modified radical mastectomy (MRM) with or without adjuvant radiotherapy (RT).@*Methods@#Retrospective cohort analysis of LABC patients who developed LRF following NAC and MRM with or without RT in the Breast Care Center, Philippine General Hospital from 2007-2010 was done. Clinicopathologic and treatment factors were compared between patients who developed and did not develop recurrence using Student's t-tests and Chi-square tests and logistic regression analysis, with p values ≤0.05 considered significant.@*Results@#A total of 63 patients were included, 34 with locoregional recurrence (LR) and 29 without. Two-year locoregional recurrence rate (LRR) was 54% with mean time to recurrence at 263 days and chest wall as most common site. Simple logistic regression analysis showed age distribution, pathologic nodal status (pN), percentage positive pathologic lymph nodes, pathologic stage, lymphovascular invasion, and adjuvant RT to be predictors of LR. Furthermore, pN (OR 1.31, CI 1.07-1.59, p=0.01) and adjuvant RT (OR 0.14, CI 0.04-0.53, p=0.004) were independent predictors of LR on multiple logistic regression analysis. In the subset of patients without adjuvant RT, no independent predictor of LR was found on multiple logistic regression analysis.@*Conclusion@#Among patients with LABC who received NAC and MRM, locoregional recurrence occurred frequently, usually in the chest wall and within a year of treatment. The absence of adjuvant radiotherapy and increased number of positive pathologic lymph nodes were predictive of locoregional recurrence.
Subject(s)
Neoadjuvant Therapy , RecurrenceABSTRACT
OBJECTIVE: To determine the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and DCE ultrasound (DCE-US) for predicting response to neoadjuvant chemotherapy (NAC) in breast cancer patients. MATERIALS AND METHODS: This Institutional Review Board-approved prospective study was performed between 2014 and 2016. Thirty-nine women with breast cancer underwent DCE-US and DCE-MRI before the NAC, follow-up DCE-US after the first cycle of NAC, and follow-up DCE-MRI after the second cycle of NAC. DCE-MRI parameters (transfer constant [Ktrans], reverse constant [kep], and leakage space [Ve]) were assessed with histograms. From DCE-US, peak-enhancement, the area under the curve, wash-in rate, wash-out rate, time to peak, and rise time (RT) were obtained. After surgery, all the imaging parameters and their changes were compared with histopathologic response using the Miller-Payne Grading (MPG) system. Data from minor and good responders were compared using Wilcoxon rank sum test, chi-square test, or Fisher's exact test. Receiver operating characteristic curve analysis was used for assessing diagnostic performance to predict good response. RESULTS: Twelve patients (30.8%) showed a good response (MPG 4 or 5) and 27 (69.2%) showed a minor response (MPG 1–3). The mean, 25th, 50th, and 75th percentiles of Ktrans and Kep of post-NAC DCE-MRI differed between the two groups. These parameters showed fair to good diagnostic performance for the prediction of response to NAC (AUC 0.76–0.81, p ≤ 0.007). Among DCE-US parameters, the percentage change in RT showed fair prediction (AUC 0.71, p = 0.023). CONCLUSION: Quantitative analysis of DCE-MRI and DCE-US was helpful for early prediction of response to NAC.
Subject(s)
Female , Humans , Breast Neoplasms , Breast , Drug Therapy , Follow-Up Studies , Magnetic Resonance Imaging , Prospective Studies , ROC Curve , UltrasonographyABSTRACT
Objective To compare the therapeutic effects and side effects of cisplatin-S-1 (CS) program and docetaxel-cisplatin-S-1(DCS) program on patients with malignant gastric tumor who were treated by laparoscopic gastrectomy.MethodsA total of 67 patients in our hospital from January 2010 to June 2013 were included in this study,of which 33 cases accepted cisplatin-S-1 program (CS group),34 cases accepted DCS program (DCS group).The related side effects including diarrhea,nausea and acute upper respiratory infection,change of routine blood tests,blood biochemical index,and death caused by chemotherapy were analyzed.The related index of surgery including operation time,blood loss,recovery time of gastrointestinal function,pain incidence,hospital stay,lymph nodes resection success rate,postoperative infection,obstruction,intestinal emptying delays were recorded.Meanwhile,the 3-year survival rate after operation and postoperative 3-year recurrence rate between the two groups were compared.Results There was no significant difference in operation time,intraoperative blood loss,postoperative recovery time of gastrointestinal function,the lymph nodes resection success rate,the incidence of postoperative pain,as well as the length of hospital stay,postoperative infection rate,and complications such as obstruction and intestinal emptying delays between the two groups(P>0.05).And there was no significant difference in chemotherapy-related complications between the two groups(P>0.05).But the postoperative 3-year survival rate and postoperative 3-year recurrence rate of DCS group was better than those of the CS Group(P<0.05).Conclusion There is no significant difference in complications and surgery-related index between the two preoperative chemotherapy.However,the DCS programs have more advantages in therapeutic effects.
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Objective To investigate the clinical effect of preoperative XELOX chemotherapy combined with psychological intervention on patients with advanced gastric cancer.Methods The control group, advanced gastric cancer patients underwent surgical treatment, XELOX chemotherapy was given before the operation.The study group was treated with psychological intervention on the basis of the treatment of the control group.The clinical efficacy and adverse reactions of two patients with advanced gastric cancer were recorded.Results Study group five years survival rate(63.83%),disease-free survival(42.55%),no advanced end point event probability(46.81%)was significantly higher than the control group(five and 44.68%year survival rate, disease-free survival rate was 23.40%,no advanced end point event probability 27.66%),data comparison study group P<0.05;wound healing reaction indigestion, gastrointestinal reaction, infection, oral mucositis incidence was significantly lower than the control group(P<0.05).Conclusion In the preoperative XELOX chemotherapy combined with surgical treatment on the basis of advanced gastric cancer with the corresponding psychological intervention can effectively improve the curative effect and prognosis,has positive significance to guarantee the quality of life of patients, life safety.
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Objective To explore the effect of different doses of anthracycline on preoperative chemotherapy of breast cancer.Methods In 40 cases of breast cancer patients using small doses of anthracycline therapy, and classified as the control group, the other 40 patients using high-dose anthracycline therapy, and classified as observation group.Then observe two groups of patients were compared;the patients were in our hospital from January to December 2016 were treated.Results The total effective rate was 82.5% in the observation group and 62.5% in the control group, the difference between the two groups was statistically significant (P<0.05).The incidence of adverse reactions in the observation group was 0, the control group was 27.5%, and the incidence of adverse reactions in the two groups was statistically significant (P<0.05).Conclusion Different doses of anthracyclines on the clinical effect of chemotherapy before surgery for breast cancer research found that different the clinical effect of different doses produced by E100C and E75C, E100C can improve the treatment effect of the patients, and reduce the occurrence of toxicity, so it is worthy of reference.
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PURPOSE: Multidisciplinary approaches of surgical resection and chemotherapy have been widely used for the treatment of non-metastatic osteosarcomas. We aimed to assess the effect of neoadjuvant chemotherapy for metastasis and disease-specific survival. MATERIALS AND METHODS: Authors retrospectively reviewed 225 young (15 years) and large sized tumor (>8 cm) were meaningful risk factors of metastasis and disease-specific survival. Although, local recurrences were occurred in 13 patients, there was no significant difference. CONCLUSION: Neoadjuvant chemotherapy offers better disease-specific survival and metastasis-free survival.
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Adult , Humans , Amputation, Surgical , Extremities , Follow-Up Studies , Neoplasm Metastasis , Osteosarcoma , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Hepatoblastoma is the most common primary malignant tumor of the liver in children. Complete surgical resection is the treatment of choice for cure. However, only 50% are eligible for resection at diagnosis. Recently combination of preoperative chemotherapy and surgery had led improved resectability and survival rate. METHODS: Between May, 2001 and November, 2010, 9 patients were diagnosed with initially unresectable hepatoblastoma at the department of pediatrics, Yeungnam University Hospital. Medical records were reviewed retrospectively. Initial evaluation included complete blood counts, liver function, serum AFP, cholesterol level and abdominal-CT scan. Preoperative chemotherapy was consisted of cisplatin and doxorubicin every 3-4 weeks. Second-line chemotherapy was cisplatin, vincristine and fluorouracil. The treatment response was analyzed by the Response Evaluation Criteria In Solid Tumors (RECIST) criteria. RESULTS: Among 9 patients, male:female was 4:5. Median age at diagnosis was 12 months (4-59 months). The most common presenting symptom was the abdominal mass. Laboratory findings revealed: median AFP 216,841 ng/dL (3,535-1,036,404 ng/dL), anemia: 4, thrombocytosis: 5, elevated AST/ALT: 8, hyperbilirubinemia: 1 and hypercholesterolemia: 5. The median tumor size was 11 cm (8-15 cm). No patient had metastasis. After median 4 (3-5) cycles of preoperative chemotherapy, all patients(100%) showed a partial response and underwent complete surgical resection. Postoperative chemotherapy was given for median 4 (3-5) cycles. The median follow up was 34 months (6-117 months) and all patients are surviving without events. CONCLUSION: Although this study includes limited number of cases, preoperative intensive chemotherapy and surgery for initially unresectable hepatoblastoma in children resulted in excellent outcomes.
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Child , Humans , Blood Cell Count , Cholesterol , Cisplatin , Doxorubicin , Fluorouracil , Follow-Up Studies , Hepatoblastoma , Liver , Medical Records , Neoplasm Metastasis , Pediatrics , Retrospective Studies , VincristineABSTRACT
BACKGROUND: Hepatoblastoma is the most common primary malignant tumor of the liver in children. Complete surgical resection is the treatment of choice for cure. However, only 50% are eligible for resection at diagnosis. Recently combination of preoperative chemotherapy and surgery had led improved resectability and survival rate.METHODS: Between May, 2001 and November, 2010, 9 patients were diagnosed with initially unresectable hepatoblastoma at the department of pediatrics, Yeungnam University Hospital. Medical records were reviewed retrospectively. Initial evaluation included complete blood counts, liver function, serum AFP, cholesterol level and abdominal-CT scan. Preoperative chemotherapy was consisted of cisplatin and doxorubicin every 3-4 weeks. Second-line chemotherapy was cisplatin, vincristine and fluorouracil. The treatment response was analyzed by the Response Evaluation Criteria In Solid Tumors (RECIST) criteria.RESULTS: Among 9 patients, male:female was 4:5. Median age at diagnosis was 12 months (4-59 months). The most common presenting symptom was the abdominal mass. Laboratory findings revealed: median AFP 216,841 ng/dL (3,535-1,036,404 ng/dL), anemia: 4, thrombocytosis: 5, elevated AST/ALT: 8, hyperbilirubinemia: 1 and hypercholesterolemia: 5. The median tumor size was 11 cm (8-15 cm). No patient had metastasis. After median 4 (3-5) cycles of preoperative chemotherapy, all patients(100%) showed a partial response and underwent complete surgical resection. Postoperative chemotherapy was given for median 4 (3-5) cycles. The median follow up was 34 months (6-117 months) and all patients are surviving without events.CONCLUSION: Although this study includes limited number of cases, preoperative intensive chemotherapy and surgery for initially unresectable hepatoblastoma in children resulted in excellent outcomes.
Subject(s)
Child , Humans , Blood Cell Count , Cholesterol , Cisplatin , Doxorubicin , Fluorouracil , Follow-Up Studies , Hepatoblastoma , Liver , Medical Records , Neoplasm Metastasis , Pediatrics , Retrospective Studies , VincristineABSTRACT
Objective To evaluate the efficacy of preoperative regional intra-arterial chemotherapy (RIAC) in the treatment of resectable pancreatic head carcinoma. Methods The clinical data of 50 patients with resectable pancreatic head carcinoma who had been admitted to the Research Institute of Pancreatic Diseases of Fudan University from December 2006 to July 2007 were retrospectively analyzed. Patients were randomly divided into2 groups (n =25 in each group): patients in group A were treated with preoperative RIAC followed by regional pancreaticoduodenectomy, and patients in group B were treated with surgical procedure routinely. The lymphatic metastases in the 50 specimens of pancreatic head carcinoma were detected by histological examination with hematoxylin and eosin (HE) staining, and lymphatic micrometastases were detected by immunohistochemical method with staining of cytokeratin AE1/AE3 in 10 specimens with negative HE staining of the lymph nodes in each group. Results There was no significant difference in the incidence of complications, the length of hospital stay and the 1-, 2-year survival rates between the 2 groups (χ2 = 0.12, 2.88, P > 0.05). The incidence of positive lymph node metastasis in group A was 7.1% (52/734), which was significantly higher than 22.1% (118/532) in group B (χ2 = 60.01, P < 0.05). The incidence of lymphatic micrometastasis was 9.4% (30/319) in group A, and 9.1% (23/252) in group B, with no statistical difference between the 2 groups (χ2= 0.01, P > 0.05). Conclusions Preoperative RIAC is helpful in improving the prognosis of patients with resectable pancreatic head carcinoma by reducing the incidence of lymphatic metastasis and decreasing tumor stage.
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PURPOSE: There have been reported that preoperative chemotherapy for treating noncurative gastric cancer could increase the R0 resection rate by downstaging the gastric cancer. Yet there have been only rare reports about the effect of preoperative chemotherapy on performing surgery for noncurative gastric cancer. Our study was designed to analyze our experiences with these effects. MATERIALS AND METHODS: We retrospectively analyzed 46 patients who had undergone gastrectomy after chemotherapy between December 2001 and January 2009. The patients' preoperative condition, the operative findings and the postoperative clinical coursed were analyzed. RESULTS: Preoperative chemotherapy was performed for a mean of 4.4 cycles. Four patients showed a level of ANC below 1,500 (micron/L) and above a 10 percentile weight loss, respectively. For an operation, we found fibrosis or fixation between the tumor and the adjacent organs in 29 patients, and 4 of the 13 patients who underwent resection with another organ were documented to have invasion by tumor. Forty one patients underwent curative resection. Ten patients developed postoperative complications. There was no mortality at postoperative 60 days. CONCLUSION: We assumed that preoperative chemotherapy had little effect on the patient preoperatively, and it had some effect on down-staging pathologically. Preoperative chemotherapy didn't increase the postoperative complication rate.
Subject(s)
Humans , Benzeneacetamides , Fibrosis , Gastrectomy , Piperidones , Postoperative Complications , Retrospective Studies , Stomach Neoplasms , Weight LossABSTRACT
Surgery is the only curative modality for the treatment of gastric cancer. There has been no drastic improvement in the treatment of gastric cancer with chemotherapy. Clinical trials have attempted to demonstrate the benefit of the preoperative chemotherapy for gastric cancer. The benefit of the use of preoperative chemotherapy or chemoradiotherapy has been demonstrated for other solid cancers such as breast cancer, esophageal cancer and rectal cancer. Despite the rationale of the use of preoperative chemotherapy for patients with gastric cancer, the evidence of positive results with the use of preoperative chemotherapy has not been clear. Recently the British Medical Research Council Adjuvant Gastric Cancer Infusional Chemotherapy (MAGIC) study demonstrated the survival benefit of preoperative and postoperative chemotherapy. However, this study had several problems with the use of a heterogeneous population of patients, the method of surgery and the use of perioperative chemotherapy. Further studies with new drugs are warranted to determine the role of pre-operative chemotherapy for patients with gastric cancer.
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Humans , Breast Neoplasms , Chemoradiotherapy , Esophageal Neoplasms , Rectal Neoplasms , Stomach , Stomach NeoplasmsABSTRACT
Objective To summarize the current value of neoadjuvant chemotherapy(NAC) for potentially resectable gastric cancer.Methods The recent 5-year literatures searched through the PubMed with the key words:stomach neoplasm,gastric cancer/carcinoma,neoadjuvant therapy/chemotherapy and preoperative therapy/chemotherapy as well as the relevant reports presented in the ASCO Annual Meeting in 2007 and 2008 were analyzed.The present status of NAC for advanced gastric cancer was summarized,the necessity and feasibility were evaluated,and the patients features for selecting,the predictors for response,the mainly existing problems and development trend of NAC were analyzed.Results At present,there were 7 randomized control trails(RCT) published,and among them 3 were phase Ⅲ.It was safe,effective and feasible to most of trails in NAC for gastric cancer.However,it was still little to obtain survival benefit for NAC RCT,and short of randomized trial comparing strict preoperative chemotherapy to surgery alone or perioperative chemotherapy to surgery plus adjuvant chemotherapy.It remained lots of problems such as how to select the appropriate patients,the effective induced regimes and the predicted factors,the evaluated indices for response.Conclusion NAC is a safe,feasible and efficient method to potentially resectable gastric cancer,but strict phase Ⅲ randomized trials are needed.In the future,substantial improvements of treatment outcome will likely depend on the novel drugs and molecular biological targeted therapies.
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Objective To investigate the therapeutic effect of arterial interventional chemotherapy on bulky cervical cancer. Methods One hundred and twenty-six patients with bulky cervical cancer were randomly divided into two groups. Arterial interventional chemotherapy group(n =74, C gronp), and radiotherapy group(n =52 R group). Patients in C group underwent internal iliac arterial infusion chemotherapy by using Seldinger technique. The chemotherapy regimens of cervical squamous cell carcinoma were prescribed including cisplatin and BLM, and cervical adenocarcinoma were prescribed including cisplatin and ADM and VCR. Patients in R group were only given radiotherapy Ir192 high-dose rate intracavitary radiotherapy was performed with A point dose at 24 Gy. Both groups of patients were followed up after two weeks. Results The tumor regression rate of C group was 93.24 %, significantly higher than 71.15 % in R group(P 0.05). The 3-year recurrence rate between the two groups had obvious difference(P 0.05). Conclusion Neoadjuvant chemotherapy can effectively reduce tumor volume, and postoperative 3-year recurrence rate, increases surgery rate on bulky cervical cancer. But the effect on long-term survival rate needs to be evaluated further through long-term follow-up.
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Gastric cancer is the most prevalent cancer in Korea and comprises the second cause of cancer death. Surgery only can provide chance of cure, but most locally advanced cancers recur after a curative resection, even though important advances in the surgical and nonsurgical treatments of gastric cancer have taken place. Preoperative chemotherapy theoretically can provide the advantages of reducing the bulk of tumor, which might improve the R0 resection rate, and of treating micrometastases early. Also, preoperative chemotherapy is expected to render unresectable tumors resectable without increasing postoperative morbidity and mortality. There are many new chemotherapeutic agents available for the treatment of advanced gastric cancer, but still the most effective agent, the optimal time and number of cycle for administration are still not known. The addition of postoperative chemotherapy through an intraperitoneal route and/or radiotherapy might affect the outcome of surgery favorably, but that hasn't been proved yet. A multicenter prospective randomized phase III trial should be performed to answer for those questions and to improve the curability of gastric cancer treatment.
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Drug Therapy , Korea , Mortality , Neoplasm Micrometastasis , Radiotherapy , Stomach NeoplasmsABSTRACT
We report a case of advanced gastric cancer with Virchow's node and lung metastasis that responded remarkably to preoperative chemotherapy. A 47-year-old female patient was diagnosed as having incurable advanced gastric cancer with Virchow's node and multiple lung metastasis. Preoperative chemotherapy with Taxotere, CDDP and 5FU was carried out. After four courses of the regimen, the Virchow's node and the lung metastasis had disappeared, and a marked reduction of the gastric lesion was observed on the CT scan. Consequently, the patient underwent a total gastrectomy with D2 lymph node dissection. On histopathological examination, cancer cells were found to have infiltrated up to the muscle layer of the gastric wall, and 42 out of 60 resected lymph nodes were found to be metastatic. The patient received another two courses of chemotherapy after the operation
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Female , Humans , Middle Aged , Drug Therapy , Fluorouracil , Gastrectomy , Lung , Lymph Node Excision , Lymph Nodes , Neoplasm Metastasis , Stomach Neoplasms , Tomography, X-Ray ComputedABSTRACT
PURPOSE: The purpose of this study was to evaluate the treatment result of surgical resection after preoperative chemotherapy in inoperable gastric cancer patients. MATERIALS AND METHODS: We analyzed 18 gastric cancer patients who underwent gastric resection after preoperative chemotherapy because they showed some clinical response to chemotherapy (15 with distant metastasis and 3 with locally advanced lesions). The mean postoperative follow-up period was 15.3+/-15.5 (1~56) months. RESULTS: In 15 patients with distant metastasis, 2 (13.3%) showed complete response (CR), 10 (66.7%) partial response (PR), 2 (13.3%) stable disease (SD), and 1 (6.7%) progressive disease (PD). The clinical response rate was 80.0%. Five subtotal gastrectomies, 4 total gastrectomies, and 6 extended total gastrectomies were performed. Two cases of CR were alive without recurrence for 4 and 26 months, respectively. Mean survival period in PR case was 37.7 months, but 2 cases of SD and 1 case of PD died after 11.7, 17.9, and 0.9 months, respectively. Postoperative survival was significantly associated with the response to chemotherapy (P<0.01). The mean survival period of the 10 patients with a complete resection was 44.1 months, which was significantly better than that of the 5 patients with an incomplete resection (9.8 months, P=0.03). Among 3 patients with locally advanced gastric cancer, 2 cases showed PR to chemotherapy, and complete resection was possible only by gastrectomy for those patients. CONCLUSION: In some selected cases, surgical resection was achievable after preoperative chemotherapy for patients with inoperable metastatic or locally advanced gastric cancer.
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Humans , Drug Therapy , Follow-Up Studies , Gastrectomy , Neoplasm Metastasis , Prognosis , Recurrence , Stomach NeoplasmsABSTRACT
PURPOSE: The current study was designed to evaluate the ability of thallium-201 scintigraphy to predict the response to preoperative chemotherapy in osteosarcoma, by comparing changes in thallium uptake ratio after chemotherapy to the tumor necrosis ratio. MATERIALS AND METHODS: Twelve osteosarcoma patients were included in this study. Thallium-201 scintigraphy was performed before and after preoperative chemotherapy, and the degree of tumor necrosis was estimated by histologic mapping postoperatively. To quantitatively determine thallium uptake, we drew a region of interest on the tumor side and on the contralateral normal side as a mirror image, and calculated the uptake ratio with dividing the gamma count in the tumor side by that of the normal side. We calculated these percent changes of thallium uptake ratio in the early and delayed phases, and compared these to the corresponding tumor necrosis ratio. RESULTS: Percent changes in the thallium uptake ratio were found to be correlated with the tumor necrosis ratio (p<0.03). This correlation was found in both the early (p<0.03) and delayed phase (p<0.03); moreover the correlation coefficient in early phase (0.79) was greater than that in the delayed phase (0.67). CONCLUSION: Thallium-201 scintigraphy could be effective at predicting the response to preoperative chemotherapy in osteosarcoma.
Subject(s)
Humans , Drug Therapy , Necrosis , Osteosarcoma , Radionuclide Imaging , ThalliumABSTRACT
Thallium-201 scintigraphy is used to discriminate the malignant bone tumor from the benign by qualitatively and quantitatively, and to predict the response of preoperative chemotherapy in osteosarcoma, by comparing the changes of thallium uptake ratio after chemotherapy to the tumor necrosis ratio. Thallium-201 scintigraphy scan should be done prior to surgical biopsy. PICKER Prism 2000 gamma camera with high resolution parallel hole collimator is usually used for scanning. The patient is injected with 2-3mCi of Tl-201 and the early phase is checked in 30 minutes and delayed phase in 3 hours. The scan images are visually evaluated by a blinded nuclear medicine physician. We could evaluate true positive, true negative, false positive and false negative by the comparison of results with those of biopsy, and calculate positive and negative predictive value(%), sensitivity(%), specificity(%) and diagnostic accuracy(%). For the quantitative analysis of thallium uptake, we drew the region of interest on the tumor side and contralateral normal side as mirror image, and calculated the uptake ratio with dividing the amount of gamma count in tumor side by normal side. We could calculate the percent changes of thallium uptake ratio in early and delayed phase, and compare them to the ratio of tumor necrosis. Thallium-201 scintigraphy proved as useful imaging study to discriminate malignant bone tumor from benign, but had exception in giant cell tumor and low grade malignant bone tumors. We can use T1-201 scan to differentiate the benign from the malignant tumor, and to evaluate the response of preoperative chemotherapy or radiotherapy, and to determine the residual tumor or local recurrence. For the better result, we need to have a more detail information about false positive cases and a more objective and quantitative reading technique.