Résumé
T 3 rectal cancer patients are a heterogeneous group of populations. T 3 stage patients with good prognosis are similar to their T 2 stage counterparts, and T 3 stage patients with poor prognosis are similar to T 4 stage counterparts. Although small sample clinical trials, meta-analyses and retrospective analyses have been conducted, clinical guidelines are not completely consistent with the definition of risk factors and treatment recommendations for this group of populations. At present, the treatment strategy for T 3 rectal cancer is still controversial, especially the application of perioperative radiotherapy. In this article, current application status and research progress in perioperative chemoradiotherapy for T 3 rectal cancer were reviewed.
Résumé
The incidence of lateral lymph node metastases (LLN) of locally advanced middle-low rectal cancer (II-Ⅲ stage) is high and clinical prognosis is poor. At present, the treatment plan of LLN is controversial between the East and the West. Scholars from the East represented by Japan believe that LLN is a regional disease. Lateral pelvic lymph node dissection (LPLND) is recommended when the tumor is located under the peritoneal reflection and invades into the muscular layer, regardless of the presence or absence of LLN. However, European and American scholars believe that LLN is a systemic disease and recommend neoadjuvant chemoradiotherapy (nCRT) combined with total mesorectal excision (TME). Nevertheless, recent studies have found that neither nCRT nor LPLND can significantly reduce the locoregional recurrence (LR) rate in patients with LLN, while nCRT combined with LPLND yields better prognosis. Some studies have also demonstrated that increasing the radiotherapy dose of metastatic lymph nodes can improve the local control rate. In this article, current treatment status of this population was reviewed, aiming to provide a basis for clinical treatment.
Résumé
Objective Through the analysis of the clinicopathological features of triple-negative breast cancer(TNBC),the relationship between recurrence,metastasis,the location of metastatic lymph nodes and primary lesions in breast cancer patients with TNBC was investigated. Methods The clinical data of 763 patients with TNBC from December 2008 to December 2012 in our hospi-tal were retrospectively analyzed. Results The onset average age of TNBC breast cancer was 49 years old,and 84. 7% of patients with early stage. The recurrence and metastasis rates of lymph node-positive patients were significantly higher than those of lymph node-negative patients,and increased the number of lymph nodes(P<0. 001). In the patient with negative for lymph nodes,the pri-mary tumor recurred in the inner quadrant and the metastasis rates were the highest(9. 8% and 13. 7% )(P<0. 05). Univariate anal-ysis showed that lymph node status,surgical procedure,and radiation dose were factors influencing recurrence and metastasis in pa-tients with TNBC(P<0. 05). Multivariate analysis showed that clinical stage and lymph node status were independent risk factors for recurrence of TNBC. Clinical stage and surgical approach were independent risk factors for the metastasis of TNBC ( P <0. 05). Conclusion (1)The proportion of patients with TNBC at early stage is high. The main pathological type is invasive ductal carcino-ma,and the positive expression rate of ki67 is high. (2)The prognosis of patients with positive lymph nodes was related to the number of metastatic lymph nodes,and there was not significant correlated with the location of primary tumor. For patients with negative lymph nodes,the primary tumor was located in the inner quadrant with the highest recurrence and metastasis rates. (3)The recurrence rate of TNBC patients increased with the increase of BMI,but for obese patients,the recurrence rate decreased. (4)Lymph node status,clini-cal stage,surgical procedure,and radiotherapy dose all affect recurrence and metastasis of patients with TNBC. (5)Clinical stage and lymph node status are independent risk factors for the recurrence of TNBC. Clinical stage and surgical approach are independent risk factors for the metastasis of TNBC.
Résumé
The triple negative breast cancer is one of importance in clinical subtypes of breast cancer, which is easy to recur and metastasis, and its prognosis is very poor.Radiotherapy, as an effective method for breast cancer,can reduce the risk of local recurrence.This article elaborates its characteristics,the progress of ra-diotherapy in the breast conserving surgery and modified radical mastectomy in triple negative breast cancer,when is the appropriate time for radiotherapy and radiotherapy sensitization,and hope that it will be helpful to the treat-ments.
Résumé
Cancer malnutrition observed in 31%~87% patients with cancer can reduce the tolerance and compliance to radiotherapy ,interrupt or delay the treatment ,and significantly affect the prognosis .The malnu-trition may be aggravated when the duration of radiotherapy is prolonged and chemotherapy is applied concurrent -ly.PG-SGA is the most suitable method for nutritional risk screening in patients with malignant tumor .According to the result of nutrition assessment ,giving the adaptive nutrition support can improve the nutritional status of pa-tients and the curative effect in the early stage of radiotherapy ,as wells as post radiotherapy .