Clinicopathological characteristics and therapeutic effects of adult rhabdomyosarcoma patients / 中华肿瘤杂志

Objective@#This study aimed to investigate the clinicopathological characteristics and prognosis of adult rhabdomyosarcoma (RMS) patients.@*Methods@#The clinical data of 34 adult RMS patients were retrospectively analyzed. Based on their intervention and treatment, patients were divided into operation group (n=7), chemotherapy group (n=8) and operation plus chemotherapy group (n=19). The clinical characteristics and treatment outcomes of the three groups were compared.@*Results@#A statically significant difference was found in IRSG surgical-pathological stage among the three groups (P=0.026), while no significant difference existed in gender, age of disease onset, primary site, tumor size, pathological subtypes and IRSG risk group in the three groups (all P>0.05). In the operation group, three CR, one PR, one SD and two PD were achieved and one CR, one PR, one SD and five PD were obtained in the chemotherapy group. While in the chemotherapy plus operation group, four CR, twelve PR, one SD and two PD were achieved. A significant difference was found in response (P=0.043) and median overall survival (OS) (P=0.036) among the three groups, which were 44.7, 26.9 and 53.6 months, respectively.@*Conclusions@#Pleomorphic RMS was the main histological subtype for adult RMS patients, and the prognosis for adult RMS was usually poorer than that for pediatric RMS patients. Single therapeutic approach could not achieve satisfactory outcomes, while multimodal treatment consisted of surgery, chemotherapy and radiotherapy are helpful to improve the prognosis of adult patients with RMS.

Optimizing multimodality treatment for head and neck cancer in rural India.

Background: Multimodality treatment of head and neck cancer in rural India is not always feasible due to lack of infrastructure and logistics. Aim: To demonstrate the feasibility of multimodality treatment for head and neck cancer in a community setting in rural India. Setting and Design: Community cancer center, retrospective review. Materials and Methods: This article focuses on practice environment in a cancer clinic in rural India. We evaluated patient profile, treatment protocols, infrastructure availability, factors impacting treatment decisions, cost estimations, completion of treatment, and major treatment-related complications for the patient population treated in our clinic for a 2-year period. Results: A total of 230 head and neck cancer patients were treated with curative intent. Infrastructure support included basic operating room facility (cautery machine, suction, drill system, microscope, and anesthesia machine without ventilator support), blood bank, histopathology laboratory, and computerized tomography machine. Radiation therapy (RT) facility was available in a nearby city, about 75 km away. One hundred and fifty-four (67%) patients presented at an advanced stage, with 138 (60%) receiving multimodality treatment. One hundred and eighty-four (80%) patients underwent primary surgery and 167 (73%) received radiotherapy. Two hundred and twelve (92%) patients completed the treatment, 60 (26%) were lost to follow-up at 18-month median follow-up (range 12-26 months), with 112 patients (66%) being alive, disease free. Totally 142 were major head neck surgeries with 25 free flap reconstructions and 41 regional flaps. There were 15 (6%) major post-op complications and two perioperative mortalities. Average cost of treatment for single modality treatment was approximately 40,000 INR and for multimodality treatment was 80,000 INR. Conclusions: This study demonstrates that it is feasible to provide basic multimodality treatment to head and neck cancer patients in the community.

Progress of 18F-fluorodeoxyglucose PET-CT in multimodality treatment of colorectal cancer / 国际肿瘤学杂志

The efficacy of colorectal cancer treatment is not very satisfactory.Conventional morphologic imagings are limited in the diagnosis and in the applications of multimodality treatment for colorectal cancer.18 F-fluorodeoxyglucose PET-CT can play a pivotal role in detecting metabolism changes and in the localization of lesions concurrently.It is valuable in the assessment of responses to therapy,prediction of prognosis and selecting modality management and monitoring postoperative recurrence.The right-moment and proper application of PET-CT can increase the therapeutic efficacy of colorectal cancer.

Treatment of the Posterior Circulation Aneurysms / 대한뇌혈관외과학회지

OBJECTIVE: Endovascular treatment is now accepted as an initial treatment modality, especially in cases of posterior circulation aneurysms. The purpose of this study was to review the treatment outcomes and to emphasize the necessity of maintaining the surgical ability for posterior circulation aneurysms. METHODS: During the past 10 years, 570 patients have been treated for cerebral aneurysms at our institute. Among these patients, 34 harbored posterior circulation aneurysms. From January 2004 to June 2008, 13 of the 34 patients were treated by endovascular coiling. We retrospectively reviewed the clinical outcome, cerebral angiograms, and other radiological imagings through a comparative study of the pre- and post-endovascular treatment periods. RESULTS: Overall, 9 (69.2%) of the pre-endovascular treatment period group and 20 (95.2%) of the endovascular treatment period group had good outcomes. The mean post-operative hospital days for these groups were 38.6 and 21.1, respectively. Patients in the endovascular treatment period group had shorter post-operative hospital periods and better outcomes than those in the pre-endovascular treatment period group. CONCLUSION: It is recommended that multimodality treatment involving microsurgical clipping and endovascular coiling is used to obtain better results in the treatment of posterior circulation aneurysms. These results suggest that although the trend toward endovascular treatment as the initial aneurysm therapy for posterior circulation aneurysms is also enhancing, it might be necessary to maintain the surgical ability for posterior circulation aneurysm.

Advances in chemotherapy and radiofrequency ablation of colorectal cancer liver metastases / 中国癌症杂志

Colorectal cancer has the propensity to develop liver-dominant metastases.In some of these patients,the liver is the only site of metastatic disease.Thus,surgical resection is the mainstay of treatment for liver-only colorectal cancer metastases,which can produce long-term survival in selected patients,but only 10%-20% of patients are suitable for a surgical approach.In this paper we introduced how to transfer the inoperable colorectal liver metastases to operable colorectal liver metastases through improved chemotherapy with /without molecular target therapy and multidisciplinary treatment approaches,and the results of radiofrequency ablation(RFA),which can also produce long-term survival in a subset of patients with colorectal liver metastasis or prolong survival duration.

Recent Advances in the Diagnosis and Treatment for Rectal Cancer

Optimal surgical treatment of rectal cancer is important to control local disease and preserve voiding and sexual function with a good quality of life. Anal sphincter preservation is a challenging issue in distal rectal cancer. Preoperative combined multimodality treatment might increase the rate of anal sphincter preservation. Postoperative adjuvant therapy with chemoradiation in stage II and III seems to increase survical rates and decrease local failure. To achieve the best oncologic and functional outcomes, the extent and type of surgery must be chosen based upon accurate preoperative staging of rectal cancer. Early cancer can be managed with minimal invasive surgery, however, neoadjuvant chemoradiation therapy on patients with locally advanced rectal cancer can improve resectability and oncologic outcomes. The rate of local failure is markedly decreased with the development of sharp pelvic dissection and the concept of total mesorectal excision. Total mesorectal excision is to remove rectal cancer and surrounding mesorectum completely without interruption of the rectal proper fascia. Optimized surgical technique and adjuvant chemoradiation can guarantee a promising oncologic outcomes ; however, difficulties of management of patients with local or systemic failure still remain.

Clinical features and multimodality treatment of 11 cases with small-cell esophageal carcinoma / 中国癌症杂志

Purpose:To investigate the clinical feature of small-cell esophageal carcinoma,and try to find rational combined therapy modality.Methods:A retrospective study was conducted in a total of 11 cases of small cell esophageal carcinoma hospitalized from 1990 to 1999 and the literature of small cell esophageal carcinoma in recent years were re- viewed.Results:The median survival time of these patients is 11 months,five cases survived over 1 year,the 1 yr survival rate is 45.45%;only one patient survived over 3 years;nine cases received multimodality treatment,the median survival time was 12 months,and of which,the median survival time of the seven patients treated with combined regimens including surgical operation was 15 months,and the survival time was 10 months and 7 months respectively in two patients treated with combined regimens not including surgical operation.one patient underwent surgery alone,the survival time was 5 months;one patient received chemotherapy alone and survived 6 months.Conclusions:Small cell esophageal carcinoma has a poor prognosis.multimodality treatment including chemotherapy is an effective approach in improving survival;surgical operation play an important role which can not be replaced and preoperative chemotherapy combined with surgical resection and postoperative chemotherapy may be a better combined treatment modality in local regional small cell carcinoma of e- sophagus.

The current status and evaluation of comprehensive therapy of pancreatic carcinoma / 介入放射学杂志

The incidence of pancreatic carcinoma is increasing obviously in recent years with a serious threat to the people's life, and yet there is not a single treatment for obtaining satisfactory prognosis. At present, the radical resection is the primary method for resectable pancreatic carcinoma, together with radiotherapy can improve the surgical resection rate and reduce the dissemination of tumors. Intraoperative radiotherapy can alleviate the pain and increase the survival rate, but the role of postoperative radiotherapy and chemotherapy is still in controversial. There is a lot of advantages for regional chemotherapy theoretically, but lack of evidence in practice. Physical therapy and biological therapy in the treatment of pancreatic carcinoma have been recognized extensively. It is possible to change fundamentally the current status of treatment and to improve the long-term survival rates with the quality of life until establishing a comprehensive treatment system mainly depended on surgical resection with combination of radiotherapy, chemotherapy, physical and biological treatment. The interventional therapy has been significantly developed as an important palliative treatment during recent years.

Multimodality Treatment of Malignant Nonfunctioning Islet Cell Tumor of the Pancreas: A Case Report / 한국간담췌외과학회지

Nonfunctioning islet cell tumor of the pancreas is mostly malignant and has a poor prognosis. But, even in case of hepatic metastasis, the multimodality treatment including surgical resection, transhepatic arterial chemoembolization(TACE), radiofrequency interstitial tissue ablation(RITA), and systemic chemotherapy provides a better prognosis. We report a case of the multimodality treatment for malignant nonfunctioning islet cell tumor of the pancreas. The patient was 38-year old male whose diagnosis was made by routine health check-up. Abdominal computed tomography revealed about 20cm sized hypervascular mass in the tail of the pancreas. After preoperative selective arterial embolization for the purpose of reducing surgical bleeding, we explored his abdomen and found the mass originating from the tail of the pancreas and expanding to the spleen and transverse colon. We performed distal pancreatectomy combined with total gastrectomy, splenectomy, and transverse colectomy. Also, we found multiple bilobar hepatic metastatic nodules and performed the wedge resection for the lesion of the left lateral segment. Postoperatively, we underwent the TACE and the RITA for the remaining right hepatic metastatic nodules, then performed the systemic chemotherapy with interferon-alpha. At postoperative 22 months, the patient was alive with regular follow up of viable right hepatic metastatic nodules.

Multimodality Treatment for Hepatolinthiasis

Hepatolithiasis is characterized by high treatment-failure and recurrence rates. In the past, surgery played a major role in the management of this disease, but the development of percutaneous transhepatic cholangioscopy and lithotripsy has played an important role in the treatment of this disease. Therefore, we undertook this prospective study to assess the effects of a systematic complementary approach of surgical and therapeutic endoscopic treatments for hepatolithiasis. We evaluated our results for 56 patients with intrahepatic stones treated by a percutaneous transhepatic cholangioscopic approach and by a surgical approach.The rate of complete stone removal was 94.4%(51/54). Twenty-five cases were treated with only a choledochoscopic approach, and 31 cases with a complementary approach(a definitive surgical approach after the choledochoscopic approach). There was no procedure or operative mortality. Because the improvement in the stone clearance rate was evident for the systematic complementary approach, this approach is recommended, when possible.

Cranial Chordoma ; Clinical Presentation and Multimodality Treatment

Cranial chordomas are rare and generally slow-growing malignant neoplasms of presumed notochordal origin. They seldom metastasize, but are difficult to manage because of their locally invasive nature and their proximity to critical structures. The clinical presentation and results of operative treatment, radiation therapy, and radiosurgery in a series of 10 patients with cranial chordomas seen at our hospital, between June 1989 and December 1994, are analysed. There were 4 men and 6 women with a mean age of 37.5 years. The most common presenting symptoms were visual loss, motor weakness and diplopia, and the most common presenting sign was visual field defect. The mean interval between symptom onset and initial treatment was 4.8(1-17) months. Three tumors classified as the chondroid type showed better clinical course. Extent of tumor resection included biopsy in 1 patient and subtotal or greater in 9. Four patients received postoperative radiation therapy and 4 patients stereotactic radiosurgery using Leksell gamma unit. Among them 1 patient showed tumor progression after radiation therapy but none after radiosurgery. One patient died due to tumor recurrence and two patients due to therapy but none after radiosurgery. One patient died due to tumor recurrence and two patients due to postoperative complications. At the time of analysis 7 patients were alive. The average length of follow-up for the alive patients was 34 months. The results of this study suggest that multimodality treatment using surgical debulking, radiation therapy and stereotactic radiosurgery is necessary for the optimal management of chordoma.

Treatment Results of Rhabdomyosarcoma / 대한치료방사선과학회지

Rhabdomyosarcoma is a highly malignant soft tissue sarcoma that car arise in any site of the body containing striated muscle or its mesenchymal analgae. It is the most common childhood sarcoma with two peak age frequencies, one at ages 2 to 6, and one in the adolescence. The site, stage and extent of disease, and pathologic characteristics of the tumor contribute to prognostic factors that influence therapeutic decisions. The results of treatment of 52 patients with rhabdomyosarcoma, who were treated at Department of Radiation Oncology. Yonsei University College of Medicine, Yonsei Cancer Center from 1976 to 1987 were retrospectively analyzed. The most frequent clinical group and primary sites were IRS group III(57.7%) and head and neck (42.3%) including orbit (11.5%) and parameningeal region(13.5%). The overall and disease free 5 year survival rate of eligible 41 patients were 31.7%, 29.3%, respectively. The complete remission(CR) rate was 50% in clinical group III and 0% in IV. Primary tumors of the orbit, clinical group I and embryonal subtype had the best prognosis. The survival rate was improved by addition of chemotherapy to operation and radiation therapy.