Available evidence on HIFU for focal treatment of prostate cancer: a systematic review

ABSTRACT Purpose: Prostate cancer (PCa) is the second most common oncologic disease among men. Radical treatment with curative intent provides good oncological results for PCa survivors, although definitive therapy is associated with significant number of serious side-effects. In modern-era of medicine tissue-sparing techniques, such as focal HIFU, have been proposed for PCa patients in order to provide cancer control equivalent to the standard-of-care procedures while reducing morbidities and complications. The aim of this systematic review was to summarise the available evidence about focal HIFU therapy as a primary treatment for localized PCa. Material and methods: We conducted a comprehensive literature review of focal HIFU therapy in the MEDLINE database (PROSPERO: CRD42021235581). Articles published in the English language between 2010 and 2020 with more than 50 patients were included. Results: Clinically significant in-field recurrence and out-of-field progression were detected to 22% and 29% PCa patients, respectively. Higher ISUP grade group, more positive cores at biopsy and bilateral disease were identified as the main risk factors for disease recurrence. The most common strategy for recurrence management was definitive therapy. Six months after focal HIFU therapy 98% of patients were totally continent and 80% of patients retained sufficient erections for sexual intercourse. The majority of complications presented in the early postoperative period and were classified as low-grade. Conclusions: This review highlights that focal HIFU therapy appears to be a safe procedure, while short-term cancer control rate is encouraging. Though, second-line treatment or active surveillance seems to be necessary in a significant number of patients.

68Ga-PSMA ligand PET/CT integrating indocyanine green-guided salvage lymph node dissection for lymph node metastasis after radical prostatectomy / 亚洲男科学杂志(英文版)

To efficiently remove all recurrent lymph nodes (rLNs) and minimize complications, we developed a combination approach that consisted of 68Gallium prostate-specific membrane antigen (PSMA) ligand positron emission tomography (PET)/computed tomography (CT) and integrated indocyanine green (ICG)-guided salvage lymph node dissection (sLND) for rLNs after radical prostatectomy (RP). Nineteen patients were enrolled to receive such treatment. 68Ga-PSMA ligand PET/CT was used to identify rLNs, and 5 mg of ICG was injected into the space between the rectum and bladder before surgery. Fluorescent laparoscopy was used to perform sLND. While extensive LN dissection was performed at level I, another 5 mg of ICG was injected via the intravenous route to intensify the fluorescent signal, and laparoscopy was introduced to intensively target stained LNs along levels I and II, specifically around suspicious LNs, with 68Ga-PSMA ligand PET/CT. Next, both lateral peritonea were exposed longitudinally to facilitate the removal of fluorescently stained LNs at levels III and IV. In total, pathological analysis confirmed that 42 nodes were rLNs. Among 145 positive LNs stained with ICG, 24 suspicious LNs identified with 68Ga-PSMA ligand PET/CT were included. The sensitivity and specificity of 68Ga-PSMA ligand PET/CT for detecting rLNs were 42.9% and 96.6%, respectively. For ICG, the sensitivity was 92.8% and the specificity was 39.1%. At a median follow-up of 15 (interquartile range [IQR]: 6-31) months, 15 patients experienced complete biochemical remission (BR, prostate-specific antigen [PSA] <0.2 ng ml-1), and 4 patients had a decline in the PSA level, but it remained >0.2 ng ml-1. Therefore, 68Ga-PSMA ligand PET/CT integrating ICG-guided sLND provides efficient sLND with few complications for patients with rLNs after RP.

Survival outcomes and prognostic factors of patients with salvage surgery for hypopharyngeal carcinoma after radiotherapy / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the survival outcomes and prognostic factors of patients with salvage surgery for hypopharyngeal carcinoma after radiotherapy. Methods: A retrospective analysis was performed, including 26 patients treated in Ningbo Medical Center Lihuili Hospital between January 2010 and December 2015. All patients were males, aged 48-83 years, of whom 8 cases were local residual after radiotherapy alone, 8 cases were local recurrence after postoperative radiotherapy, 2 cases were residual of cervical lymph nodes after radiotherapy alone, 2 cases were recurrence of cervical lymph nodes after radiotherapy alone, 2 cases were recurrence of cervical lymph nodes after postoperative radiotherapy and 4 cases were recurrence of tracheal stoma. The salvage operations included: local resection, local resection with neck dissection, simple neck dissection, tumor resection of tracheostomy, and additional repair according to the defect. Chi square test was used for recurrence and metastasis analysis, Kaplan-Meier method for survival analysis, Log-rank test for univariate analysis, and Cox regression model for multivariate analysis. Results: The complication rate of salvage surgery was 23.1% (6/26). The recurrence rate was 65.4% (17/26) and the distant metastasis rate was 42.3% (11/26) in the 5-year follow-up after salvage surgery. Patient's age and tumor invasion extent were correlated with recurrence. Initial treatment, tumor persistence or recurrence after radiotherapy, recurrence location and tumor invasion extent were correlated with distant metastasis (all P<0.05). Overall, 3 year and 5 year survival rates were 42.3% and 23.1% respectively. Age, recurrence location, surgical margin and tumor invasion extent were related to prognosis (χ²=6.56, 10.68, 9.32, and 7.90 respectively, all P<0.05). Multivariate analysis showed that surgical margin and tumor invasion extent were independent risk factors for prognosis (OR (95%CI) = 3.19 (1.03-9.84), 14.37 (2.46-84.08), both P<0.05). Conclusion: Salvage surgery is the first choice for patients with recurrence after radiotherapy for hypopharyngeal carcinoma. Safe surgical margin should be ensured, especially in tumors invading muscle, bone tissue or lymph node capsule.

Role of salvage lymph node dissection in patients previously treated for prostate cancer: systematic review

ABSTRACT Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.

Supervivencia de cirugía de rescate en carcinoma escamoso de orofaringe / Survival outcomes of salvage surgery in oropharyngeal squamous cell carcinoma

La recurrencia de carcinoma de células escamosas orofaríngeo (CCEOF) se asocia a mal pronóstico, particularmente en recurrencias en etapa avanzada. La cirugía en el contexto de rescate es más complicada por el tratamiento oncológico del tumor primario, por lo tanto, tiene un mayor riesgo de complicaciones y estadía hospitalaria. Sin embargo, la cirugía de rescate es la mejor oportunidad del paciente como tratamiento curativo y para supervivencia a largo plazo. La población de pacientes que reciben tratamiento para CCEOF ha cambiado en la última década, se ha reconocido que la incidencia de virus papiloma humano (VPH) asociado a CCEOF ha generado el gran aumento de CCEOF y el cambio asociado en las características de la población de pacientes, ahora los pacientes son más jóvenes y tienen menos comorbilidades. Con el aumento exponencial en la incidencia de CCEOF, la necesidad de cirugía de rescate en CCEOF podría verse en aumento. En vista del aumento de la incidencia de casos con carcinoma escamoso de orofaringe y su importante relación con el VPH, esta revisión se enfoca en la supervivencia tras cirugía de rescate con intención curativa y evaluar si con los avances en su tratamiento ha mejorado su pronóstico.

Recurrence of oropharyngeal squamous cell carcinoma (OPSCC) is associated with poor prognosis, particularly in advanced stage recurrences. Salvage surgery is complicated by previous oncological treatment of the primary tumor, therefore, it has a higher risk of complications and hospital stay. However, salvage surgery is the patient's best opportunity as a curative treatment and for long-term survival. The population of patients receiving treatment for OPSCC has changed in the last decade, it has been recognized that the incidence of human papilloma virus (HPV) associated OPSCC has generated an increase of OPSCC and changes in the epidemiology of the patient population, with younger patients and with less comorbidities. With the exponential increase in the incidence of OPSCC, the need for salvage surgery in OPSCC could increase in the future. In view of the increase in the incidence of cases with squamous oropharyngeal carcinoma and its relationship with HPV, this review focuses on survival after salvage surgery with curative intent and assessing whether the progress in its treatment has improved its prognosis.

Salvage treatment for refractory or relapsed acute myeloid leukemia: a 10-year single-center experience

OBJECTIVES: The outcomes of refractory and relapsed acute myeloid leukemia (AML) patients in developing countries are underreported, even though the similar classic regimens are widely used. METHODS: We conducted a retrospective comparison of "MEC" (mitoxantrone, etoposide, and cytarabine) and "FLAG-IDA" (fludarabine, cytarabine, idarubicin, and filgrastim) in adults with first relapse or refractory AML. RESULTS: In total, 60 patients were included, of which 28 patients received MEC and 32 received FLAG-IDA. A complete response (CR) rate of 48.3% was observed. Of the included patients, 16 (27%) died before undergoing bone marrow assessment. No statiscally significant difference in CR rate was found between the two protocols (p=0.447). The median survival in the total cohort was 4 months, with a 3-year overall survival (OS) rate of 9.7%. In a multivariable model including age, fms-like tyrosine kinase 3 (FLT3) status, and stem-cell transplantation (SCT), only the last two indicators remained significant: FLT3-ITD mutation (hazard ratio [HR]=4.6, p<0.001) and SCT (HR=0.43, p=0.01). CONCLUSION: In our analysis, there were no significant differences between the chosen regimens. High rates of early toxicity were found, emphasizing the role of supportive care and judicious selection of patients who are eligible for intensive salvage therapy in this setting. The FLT3-ITD mutation and SCT remained significant factors for survival in our study, in line with the results of previous studies.

Artroplastia de resección de hombro como salvamento para infecciones recalcitrantes: estado actual de la técnica a propósito de dos casos / Shoulder resection arthroplasty as a salvage procedure for recalcitrant infections: current state of the art regarding two cases

INTRODUCCIÓN Y OBJETIVOS La artroplastia de resección de hombro (ARH) se presenta como una técnica obsoleta y una opción no válida en la actualidad, debido a la evolución de las técnicas quirúrgicas y de los implantes. Pero, como consecuencia del aumento exponencial del uso de artroplastias de hombro, están aumentando en paralelo el número de fracasos e infecciones, con necesidad de revisión y rescate. Es por ello que, en determinadas situaciones y pacientes, esa técnica vuelve a ser una opción necesaria como salvataje, aunque tiene un alto coste funcional. El objetivo de nuestro trabajo, es presentar dos casos de artroplastia de resección de hombro como una opción válida de tratamiento en la actualidad y la revisión de la literatura. CASOS Se presentan dos casos de ARH como tratamiento de rescate, en un caso de osteomielitis crónica de cabeza humeral y un caso de infección de hemiartroplastia de hombro. Ambos pacientes se encontraban sin dolor y libres de infección con un seguimiento de más de 30 meses. En un caso la funcionalidad fue limitada con un Constant de 45 pero el otro caso la funcionalidad fue aceptable con un Constant de 67. CONCLUSIONES La ARH sigue siendo una técnica útil tras el fracaso de procedimientos de revisión, para resolver infecciones protésicas recalcitrantes u osteomielitis. Los resultados funcionales son pobres, por lo que debe reservarse para pacientes con baja demanda funcional y como salvataje, tras agotar otras opciones.

INTRODUCTION AND OBJECTIVES shoulder resection arthroplasty (SRA) is currently considered as an outdated technique, due to the advances in surgical techniques and new prosthesis designs. However, with the exponential increase in the use of shoulder arthroplasties, the number of failures and infections is equally increasing, as well as the revisions and salvage procedures. In certain situations, SRA is therefore a necessary solution, although it grossly compromise shoulder function. The aim of our study is to present two cases who underwent SRA as a valid treatment option nowadays and a literature review. CASES We present two cases of SRA as salvatage treatment. First case in a chronic humeral head osteomyelitis and second in a partial shoulder prosthesis recalcitrant infection. Both patients had complete pain relief and infection was solved with a follow-up over 30 months. In the first case, postoperative shoulder function was limited with a Constant­Murley score of 45. In the second case, function was fairly good with a Constant of 67. CONCLUSIONS SRA remains a valuable technique after the failure of revision procedures, as a salvage for recalcitrant prosthetic infections or osteomyelitis. The functional results are poor, so it should be reserved for patients with low functional demand and as salvatage procedure, after assess other options.

Performance and Impact of Prostate Specific Membrane Antigen-Based Diagnostics in the Management of Men with Biochemical Recurrence of Prostate Cancer and its Role in Salvage Lymph Node Dissection

Surgical treatment for limbs salvaged of diabetic foot ulcers / 中国骨伤

Diabetic foot ulcers (DFUs) is a severe complication of the diabetes mellitus, which is the first leading cause of non-traumatic lower limbs amputations. The pathogenesis of diabetic foot involves a variety of mechanisms, treatment involves the department of foot and ankle surgery, department of vascular surgery, endocrinology, and infection control. Treatment need multidisciplinary diagnosis and treatment. Debridement is the basis of treating diabetic foot ulcers, and the normal anatomical structure should be maintained during the process. Vacuum sealing drainage (VSD) and antibiotic-laden bone cement (ALBC) have more advantages of controlling infection and ulceration wound healing, which could receive good clinical effect. Tendon lengthening could alleviate the problem of ulcer occurrence and progression caused by stress concentration on the bottom of foot, which has widely application and has advantages of preventing formation of foot ulcers. Flap transplantation could solve the problem of wound healing, but it is necessary to consider whether the transplanted flap could bear the same function as plantar tissue. Tibial bone transverse distraction is a relatively new technique, and the mechanism is not clear, but it has certain application prospects from the perspective of clinical efficacy.

Salvage radiotherapy for biochemical recurrence after radical prostatectomy: does the outcome depend on the prostate cancer characteristics?

ABSTRACT Objective: To build a model to evaluate the impact of salvage radiotherapy (SRT) in men with PSA rise or persistent PSA after undergoing radical prostatectomy (RP). Materials and Methods: The study included 107 node-negative patients treated with SRT after RP at a single institution. Patients received SRT for either prostate-specific antigen (PSA) rising, or PSA persistence after RP. All patients received local radiation to the prostate / seminal vesicle bed. The primary measured outcome was the biochemical recurrence (BCR) free survival. Multivariable Cox regression analysis was used to develop a risk-stratification group to identify predictive factors associated with the probability of BCR at 5yr. Results: At a median follow-up of 52 months, the BCR free survival rate and overall survival in 5 years was 73% and 94%, respectively. At multivariable analysis, pre-SRT PSA level > 0.35ng / mL (p = 0.023), negative margins (p = 0.038), and seminal vesicles invasion (p = 0.001) were significantly associated with BCR free survival. Three risk groups using regression analysis for SRT administration was built. Low-, intermediate- and the high-risk groups had a BCR free survival in 5-years of 96%, 84%, and 44% (p = 0.0001), respectively. Conclusions: We developed a risk group stratification to show the impact of SRT based on prostate cancer characteristics. SRT showed to be extremely beneficial for patients with low- and intermediate-risk tumors. Moreover, the risk-group built could identify patients classified as high-risk who might benefit from more aggressive treatment for SRT.

Opciones terapéuticas en reconstrucción después de faringolaringectomía en cáncer de laringe e hipofaringe / Therapeutics options in reconstruction after of faringolaringectomy in larynx and hypopharyngeal cancer

RESUMEN El cáncer de laringe avanzado y el cáncer de hipofaringe pueden ser tratados con terapia de conservación de órganos con radioquimioterapia, sin embargo, cuando esta última fracasa, la cirugía es la última opción para esta patología. El cáncer de hipofaringe posee una pobre sobrevida en estados avanzados, y su tratamiento quirúrgico después de radioterapia siempre se transforma en un desafío quirúrgico por las condiciones del tejido irradiado. Este artículo realiza una revisión general de las opciones de reconstrucción para defectos faringolaríngeos tanto parciales como circunferenciales, ante el caso eventual de que por la extensión tumoral y su tratamiento ablativo no sea posible un cierre primario. Se revisan distintos resultados de los principales colgajos utilizados en reconstrucción en cabeza y cuello, como son los colgajos libres fasciocutáneos, colgajo pectoral mayor y colgajos viscerales como el yeyuno, comparando tasas de fistulas faringocutáneas, resultados en deglución y rehabilitación fonatoria posterior, intentando realizar una aproximación a una recomendación terapéutica. Por último cabe mencionar que todo servicio de cabeza y cuello debe conocer las opciones existentes para cada paciente en particular, ya que además de buscar resultados oncológicos, se debe intentar lograr buenos resultados funcionales que no empobrezcan la calidad de vida de nuestros pacientes.

ABSTRACT Advanced laryngeal cancer and hypopharyngeal cancer can be treated with organ preservation therapy with radiochemotherapy. However, when the latter fails, surgery is the last option for this pathology. Hypopharyngeal cancer has a poor survival in advanced stages, and its surgical treatment after radiotherapy always becomes a surgical challenge due to the conditions of the irradiated tissue. This article makes a general review of the reconstruction options for both partial and circumferential pharyngolaryngeal defects, in the case where tumor extensions and ablative treatments do not permit a primary closure. Different results of the main flaps used in head and neck reconstruction are reviewed, such as the fasciocutaneous free flaps, pectoralis major flap and visceral flaps such as the jejunum. We then compare the rates of pharyngocutaneous fistulas, swallowing results and posterior phonation rehabilitation, while trying to perform an approach to a therapeutic recommendation. Finally, it should be mentioned that all head and neck services must know the existing options for each patient in particular, since in addition to looking for oncological results, one should try to achieve good functional results that do not impoverish the quality of life of our patients.

Efficacy and Safety of Melphalan, Cyclophosphamide and Dexamethasone (MCD) as a Salvage Treatment for Patients with Relapsed/Refractory Multiple Myeloma / 전남의대학술지

This study investigated the efficacy and safety of melphalan, cyclophosphamide, and dexamethasone (MCD) as a salvage regimen for heavily treated relapsed or refractory multiple myeloma patients. We retrospectively analyzed a total of 27 patients who received the MCD regimen between April 2011 and November 2013. The MCD regimen consisted of oral melphalan 6.75 mg/m² on days 1–4, once-weekly dose of oral cyclophosphamide 300 mg/m2 and dexamethasone 20 mg/m² on days 1–4 and days 15–18. Each cycle was repeated every 28 days. The median age of the patients was 66 years and the MCD regimen was initiated at a median 37.7 months from diagnosis. Patients received a median of five regimens including autologous stem cell transplantation. The overall response rate was 25.9% (very good partial response 3.7%, partial response 22.2%) and 8 (29.6%) patients achieved a minor response. Median progression-free survival was 5.6 months (95% confidence interval [CI], 4.2–8.5) ; overall survival 11.7 months (95% CI, 5.4–16.6). Grade 3 or 4 neutropenia and thrombocytopenia were observed in 51.8% and 33.3%, respectively. Although the overall response rate is relatively low, the MCD regimen may have a role as a bridge to a novel regimen in heavily pretreated patients with MM.

Efficacy and dosimetry analysis of image-guided radioactive ¹²⁵I seed implantation as salvage treatment for pelvic recurrent cervical cancer after external beam radiotherapy / 부인종양

OBJECTIVE: To investigate the efficacy of image-guided radioactive 125I seed (IGRIS) implantation for pelvic recurrent cervical cancer (PRCC) after external beam radiotherapy (EBRT), and analyze the influence of clinical and dosimetric factors on efficacy. METHODS: From July 2005 to October 2015, 36 patients with PRCC received IGRIS. We evaluated local progression-free survival (LPFS) and overall survival (OS). RESULTS: The median follow up was 11.5 months. The 1- and 2-year LPFS rate was 34.9% and 20%, respectively. The multivariate analysis indicated recurrence site (central or pelvic wall) (hazard ratio [HR]=0.294; 95% confidence interval [CI]=0.121–0.718), lesion volume (HR=2.898; 95% CI=1.139–7.372), D 90 (HR=0.332; 95% CI=0.130–0.850) were the independent factors affecting LPFS. The 1- and 2-year OS rate was 52.0% and 19.6%, respectively. The multivariate analysis suggested pathological type (HR=9.713; 95% CI=2.136–44.176) and recurrence site (HR=0.358; 95% CI=0.136–0.940) were the independent factors affecting OS. The dosimetric parameters of 33 patients mainly included D 90 (128.5±47.4 Gy), D 100 (50.4±23.7 Gy) and V 100 (86.7%±12.9%). When D 90 ≥105 Gy or D 100 ≥55 Gy or V 100 ≥91%, LPFS was extended significantly, but no significant difference for OS. The 79.2% of 24 patients with local pain were suffering from pain downgraded after radioactive 125I seed implantation. CONCLUSION: IGRIS implantation could be a safe and effective salvage treatment for PRCC after EBRT, which could markedly release the pain. Recurrence site, tumor volume and dose were the main factors affected efficacy. Compared with central recurrence, it was more suitable for patients with pelvic wall recurrent cervical cancer after EBRT.

Interferon-α salvage treatment is effective for patients with acute leukemia/myelodysplastic syndrome with unsatisfactory response to minimal residual disease-directed donor lymphocyte infusion after allogeneic hematopoietic stem cell transplantation / 医学前沿

The efficacy of salvage interferon-α (IFN-α) treatment was investigated in patients with unsatisfactory response to minimal residual disease (MRD)-directed donor lymphocyte infusion (DLI) (n = 24). Patients who did not become MRD-negative at 1 month after DLI were those with unsatisfactory response and were eligible to receive salvage IFN-α treatment within 3 months of DLI. Recombinant human IFN-α-2b injections were subcutaneously administered 2-3 times a week for 6 months. Nine (37.5%), 6 (25.0%), and 3 (12.5%) patients became MRD-negative at 1, 2, and > 2 months after the salvage IFN-α treatment, respectively. Two-year cumulative incidences of relapse and non-relapse mortality were 35.9% and 8.3%, respectively. Two-year probabilities of event-free survival, disease-free survival, and overall survival were 51.6%, 54.3%, and 68.0%, respectively. Outcomes of patients subjected to salvage IFN-α treatment after DLI were significantly better than those with persistent MRD without IFN-α treatment. Moreover, clinical outcomes were comparable between the salvage DLI and IFN-α treatment groups. Thus, salvage IFN-α treatment may help improve the outcome of patients with unsatisfactory responses to MRD-directed DLI and could be a potential salvage treatment for these patients after allogeneic hematopoietic stem cell transplantation.

Long-term response in refractory AML following azacitidine-failed MDS by salvage decitabine-bridged allogenic transplantation

No abstract available.

Clinical observation for NAPD regimen in the treatment of 67 cases of recurrent refractory non-Hodgkin's lymphoma / 中南大学学报(医学版)

To explore the clinical efficacy and toxicity of the NAPD regimen(vinorelbine, cytarabine, cisplatin, and dexamethasone) in the treatment of recurrent refractory non-Hodgkin' s lymphoma.
 Methods: A total of 67 patients identified with recurrent refractory non-Hodgkin's lymphoma were enrolled for this retrospective study. The curative efficacy of NAPD regimen was evaluated after 2 consecutive cycles. The toxicities and side effects were evaluated after 1 cycle. The objective response rate (ORR), overall survival (OS), progress free survival (PFS), 1, 2 or 4 years of OS and PFS rates were analyzed. The prognosis was evaluated with univariate and multivariate analysis.
 Results: The ORR was 53.8% after two cycles, including 5(7.5%) complete responses and 31(46.3%) partial responses. The clinical benefit rate (CBR) was 88.7% (59/67). The median OS was 22 (1.5-140.0) months. 1, 2 or 4 years of OS rates were 70.9%, 49.0%, and 35.0%, respectively. The median PFS was 14 (1.5-140.0) months; and 1, 2 or 4 years of PFS rates were 57.5%, 38.3%, and 29.8%, respectively. The main side effect was myelosuppression. The rates of Grade III/IV leukopenia and thrombocytopenia were 13.4% (9 cases) and 3.0% (2 cases), respectively. Gastrointestinal toxicity was at Grade I or II and 6% patients displayed gastrointestinal toxicity at Grade III/IV. No severe cardiac and hepatorenal functional toxicity was observed.
 Conclusion: The NAPD regimen for recurrent refractory non-Hodgkin's lymphoma is effective, and its toxicity is well tolerated. It is a salvage chemotherapy regimen and be of worth to be verified.

Involved-field radiation therapy for selected cases of recurrent ovarian cancer / 부인종양

OBJECTIVES: In our institutional experience, involved-field radiation therapy (IFRT) yields favorable outcomes in patients with recurrent epithelial ovarian cancer (EOC). This retrospective study aimed to investigate the clinical benefits of IFRT in this patient population. METHODS: Among patients treated with IFRT for recurrent EOC between 2010 and 2017, 61 patients with 90 treatments were included. IFRT encompassed all treatable lesions identified via imaging studies with 10–15-mm margins. Prescribed doses were ≥45 Gy (equivalent dose in 2 Gy/fraction). RESULTS: Patients were followed up for a median of 19.0 (Interquartile range, 8.6–34.9) months after IFRT. The 2-year in-field control, progression-free survival, and overall survival (OS) rates were 42.7%, 24.2%, and 78.9%, respectively. Fifty-three IFRT sessions (58.9%) were followed by systemic chemotherapy, and the median chemotherapy-free interval (CFI) was 10.5 (95% confidence interval=7.3–13.7) months. A higher carbohydrate antigen-125 (CA-125) level correlated with a worse 2-year OS (69.2% vs. 91.0%; p=0.001) and shorter median CFI (4.7 vs. 11.9 months; p12 months. For patients with a normal CA-125 level and/or platinum-sensitive tumor, IFRT prolonged CFI regardless of pre-existing carcinomatosis, gross tumor volume, and number of treatment sites. CONCLUSION: Our early experience demonstrates the safety and feasibility of IFRT as an effective salvage therapy and enables a “chemotherapy holiday” in selected recurrent EOC settings. The CA-125 value before IFRT (within normal range) and/or platinum sensitivity could be used as selection criteria for IFRT.

Endoscopic Therapy and Radiologic Intervention of Acute Gastroesophageal Variceal Bleeding

Acute gastroesophageal variceal hemorrhage is a dreaded complication in patients with liver cirrhosis. Endoscopic therapy and radiologic intervention for gastroesophageal bleeding have rapidly developed in the recent decades. Endoscopic treatment is initially performed to stop variceal hemorrhage. For the treatment of esophageal variceal bleeding, endoscopic variceal ligation (EVL) is considered the endoscopic treatment of choice. In cases of gastric variceal hemorrhage, the type of gastric varices (GVs) is important in deciding the strategy of endoscopic treatment. Endoscopic variceal obturation (EVO) is recommended for fundal variceal bleeding. For the management of gastroesophageal varix type 1 bleeding, both EVO and EVL are available treatment options; however, EVO is preferred over EVL. If endoscopic management fails to control variceal hemorrhage, radiologic interventional modalities could be considered. Transjugular intrahepatic portosystemic shunt is a good option for rescue treatment in refractory variceal bleeding. In cases of refractory hemorrhage of GVs in patients with a gastrorenal shunt, balloon-occluded retrograde transvenous obliteration could be considered as a salvage treatment.

Clinical Outcomes of a 14-Day In-Hospital Stay Program in Patients Undergoing Head and Neck Cancer Surgery With Free Flap Reconstruction Under the National Health Insurance System

OBJECTIVES: Length of in-hospital stay (LOS) is often regarded as a surrogate marker of efficiency in medical care. A shorter stay can redistribute medical resources to more patients if patient outcomes would not be worsened. However, the adequate LOS remains largely understudied for a complex head and neck cancer (HNC) surgery and free flap reconstruction. METHODS: Active management of LOS (14-day LOS program) included detailed preoperative surgical planning, intensive wound care, postoperative early ambulation and positive psychological encouragement. It was applied to 43 patients undergoing HNC surgery and free flap reconstruction. Outcomes such as noninferior oncological results, rates of timely adjuvant treatments and complications were compared with those of 125 patients without active management of LOS. In addition, the medical costs of shortened LOS were compared with those of the control group. Cases undergoing HNC surgery as a salvage treatment were excluded from both groups for analyses. RESULTS: Active management of LOS resulted in less in-hospital period compared to the control group (15.0 vs. 21.0 days, P=0.001), and reduced medical costs significantly. Incidence of postoperative complications was comparable between the two groups. Oncological outcomes did not differ significantly according to LOS. In all patients in both groups, initial high T status (T3–4) and occurrence of postoperative complications were independent risk factors for long LOS (>30 days). CONCLUSION: In patients undergoing HNC surgery with free flap reconstruction as an initial treatment, a 14-day LOS could be safe in terms of comparable oncological outcomes and postoperative complications. To achieve this goal safely, careful management for T3–4 tumors and prevention of postoperative complications seem to be necessary.