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Objective To explore the clinical efficacy and safety of intraoperative radiotherapy (IORT) for the patients with unresectable locally advanced pancreatic cancer. Methods Cochrane library, PubMed, EMbase, CBM, CNKI, VIP database and WANFANG database were used to retrieve, in addition to manual retrieval important literature references and conference papers. The randomised controlled trials, cohort study, controlled clinical trials of the IORT in unresectable locally advanced pancreatic cancer were searched. According to the inclusion criteria and exclusion criteria, after the extraction of literature and data, RevMan 5.3 software was used for meta-analysis. Results The total of 1 401 articles were retrieved, 7 met the inclusion criteria, including 1 for randomized controlled trials, 4 for cohort study, 2 for case-control study. 313 cases in the IORT group, 362 cases in the control group, and meta-analysis showed that IORT group was better than control group in overall survival (OS) (Z=4.15, P<0.000 1, RR=2, 95%CI 1.05-2.94). Because lack of complete data in local control rate, pain remission rate, complications, descriptive analysis was done, rather than meta-analysis. Conclusions IORT may improve the OS of patients with unresectable locally advanced pancreatic cancer and the local control rate, and effectively alleviate pain with favorale safety but it still needs high quality randomized controlled trials to confirm.
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OBJECTIVE: To explore the effectiveness of stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation for the treatment of lumbosacral tuberculosis. METHODS: Seven cases of lumbosacral tuberculosis were treated by stage I anterior approach debridement, autologous iliac crest graft, and single self-locked titanium plate internal fixation between February 2010 and October 2014. There were 5 males and 2 females, aged 18-65 years (mean, 41.6 years). The disease duration was 5-21 months (mean, 8 months). The patients had signs and symptoms of pain in lumbosacral region, radiating pain in unilateral lower limb or bilateral lower limbs, decreased muscular strength and disorders of superficial sensation. According to Frankel classification for spinal injury, 1 case was rated as grade C, 3 cases as grade D, and 3 cases as grade E. Preoperative imaging examination suggested L5, S1 lesions in line with the manifestations of tuberculosis; the lumbosacral angle was 16.4-28.5° (mean, 18.6°). The erythrocyte sedimentation rate was 28-105 mm/1 hour (mean, 61 mm/1 hour). All patients received 4-drug antituberculosis therapy. RESULTS: All patients underwent the operation successfully and all incisions healed at stage I, without relevant complication. All patients were followed up 14-70 months (mean, 25.6 months). All symptoms of tuberculosis disappeared and the erythrocyte sedimentation rate returned to normal. At last follow-up, Frankel classification was returned to E from D in 3 cases, returned to D from C in 1 case. Two cases suffered from pains in the lumbosacral region and at the donor site, 1 case suffered from upper abdominal discomfort and poor appetite,but these symptoms disappeared after symptomatic treatment. At last follow-up, X-ray examination indicated that the lumbosacral angle was 23.4-34.2° (mean, 28.6°). According to Bridwell criteria, 5 cases gained grade I bone fusion, and 2 cases gained grade II bone fusion, without migration of bone graft, or loosening or breakage of titanium plate or bolt. CONCLUSIONS: Stage I anterior approach debridement and autologous iliac crest graft with single self-locked titanium plate internal fixation is safe and effective in treating lumbosacral tuberculosis. It can achieve good bone fusion and stable lumbosacral stability, and maintain good deformity correction.