Interpretation of the 2020 American society of colon and rectal surgeons clinical practice guidelines for the management of rectal cancer / 中华胃肠外科杂志

Located in the pelvic cavity and contiguous to the anal sphincter complex and urogenital organs, the rectum has more intricate anatomical features compared with the colon. Consequently, the treatment of rectal cancer involves more consideration, including pelvic radiation, lateral lymph node dissection, transanal access, postoperative function, sphincter preservation, and nonoperative management. Based on the last set of American society of colon and rectal surgeons (ASCRS) practice parameters for the management of rectal cancer published in 2013, the 2020 guidelines present evidence-based updates for both long-existing and emerging controversies on surgical management of rectal cancer. These updates include the indication for local resection, lymph node dissection for radical proctectomy, minimally invasive surgery, the "watch and wait" strategy for patients with clinical complete response, and prevention of anastomotic leak. Meanwhile, the guidelines recommend a risk-stratified approach for perioperative therapies for non-metastatic disease, and an individualized multimodality treatment based on treatment intent for synchronous metastatic disease.

Curative efficacy of multimodality therapy for severe pulmonary infection in kidney transplantation patients (57 cases report) / 中华器官移植杂志

Objective To evaluate the curative efficacy of multimodality for severe pulmonary infection (SPI) following kidney transplantation (KT).Methods Fifty-seven cases of SPI following KT were treated with multimodality therapy in our hospital between Jan.2014 and Jan.2017.The outcome and data were analyzed and evaluated retrospectively.Results Of these 57 patients,45 cases were cured (41 cases were alive with functioning grafts,and 4 cases had grafts loss).The pulmonary lesions in 4 cases of pulmonary fungal infection were improved and oral anti-fungal drugs were continuously given after discharge.The symptoms in one case of tuberculosis were obviously improved and anti-tuberculosis treatment was given continuously after discharge.There were 5 deaths,including 2 deaths due to functioning grafts loss.Two cases abandoned treatment during therapy because of financial problem.Pathogens could be detected in only 29 cases.Conclusion SPI after KT is an acute important complication with rapid progression.Early and prompt treatment with combined antibiotics,antifungal drugs as well as antivirus is essential.The keys to successful rescue for SPI should also include immunosuppressant reduction,intravenous immunoglobulin and nutrition support.The combined therapy is successful and could reduce mortality of SPI obviously.

Câncer de ovário na prática clínica diária / Ovarian cancer daily practice

O câncer de ovário é a terceira neoplasia ginecológica mais incidente no Brasil com alta letalidade. Seu tratamento é sempre multidisciplinar envolvendo cirurgia e quimioterapia. No SEONC-HC-UFU realizamos quimioterapia baseada em platina e taxanos, tanto em neoadjuvância (pacientes com cirurgia não oncológica) como em adjuvância (pacientes com ressecção oncológica). Pacientes em tratamento sem intuito curativo recebem o mesmo esquema terapêutico caso nunca tenham sido tratados ou se foram há mais de seis meses. Pacientes resistentes a platina recebem, enquanto apresentarem performance, tratamento de segunda linha com gencitabina ou hormonioterapia (tamoxifeno). Após falha na segunda linha, pacientes recebem ?best supportive care? no ambulatório de cuidados paliativos. O seguimento e avaliação de respostas das pacientes são realizados através da dosagem periódica do marcador tumoral CA 125 e imagem quando indicada.

The historical evolution of diagnosis and radiotherapy for nasopharyngeal carcinoma / 中国癌症杂志

Radiation therapy is the mainstay treatment modality of nasopharyngeal carcinoma (NPC). The treatment outcome of NPC using external beam radiotherapy has been substantially improved over the past several decades. MRI has demonstrated remarkable advantage in detecting the extent of the primary tumor, and has replaced CT scan as the primary imaging modality for both diagnosis and staging for NPC. Functional imaging may further allow more precise staging of the disease and prediction of the treatment outcome. The introduction of Cobalt-60 has substantially improved the treatment outcome for NPC as compared to that in the era of Kilo-Voltage X-ray. And intensity-modulated radiation therapy (IMRT) not only improved the prognosis after treatment as compared to conventional radiotherapy, but also improved the quality of life. In addition, concurrent chemoradiation therapy has been extensively studied and become the standard treatment for locally and/or regionally advanced NPC. However,progress in radiation biology and its clinical application was not observed. This article presented a comprehensive review of the historical evolution of the diagnostic and therapeutic technologies and techniques for the management of NPC.

Clinical analysis of 10 patients with pleural mesothelioma in surgical treatment / 中国癌症杂志

Purpose:To investigate the clinical features,diagnosis, surgical treament and prognosis of pleural mesothelioma. Methods:A retrospective study was conducted in a total of 10 cases of pleural mesothelioma hospitalized from January 1980 to June 2000. Results: None of the 10 patients had history of exposure to asbestos,and the clinical manifestation were chest pain and feeling of compression,cough,shortness of breath. Pleural thickening or nodules were found in radiography examaination with or without pleural effusion.Of 10 cases,4 cases were localized type and 6 cases were diffused type, 8 cases received surgery(5 cases received radical operation and 3 cases received palliative operation) Conclusions:Exposure to asbestos or not has no definite relations to pleural mesothelioma,cytology examination of pleural effusion is not very helpful in pathologic diagnosis due to low positive rate.CT scan and pleural needle biopsy are helpful preoperatively. Surgical operation is the optional treatment in localized type and the prognosis is good,but prognosis is poor in diffused type and multimodality therapy is emphasized.

Postoperative Radiation Therapy in the Soft-tissue Sarcoma / 대한방사선종양학회지

PURPOSE: The major goal of the therapy in the soft tissue sarcoma is to control both local and distant tumor. However, the technique of obtaining local control has changed significantly over the past few decades from more aggressive surgery to combined therapy including conservative surgery and radiation and/or chemotherapy. We retrospectively analyzed the treatment results of the postoperative radiation therapy of soft tissue sarcoma and its prognostic factor. MATERIAL AND METHODS: Between March 1983 and June 1994, 60 patients with soft tissue sarcoma were treated with surgery and postoperative radiation therapy at Kang-Nam St. Mary's hospital. Complete follow up was possible for all patints with median follow up duration 50 months (range 6- 162 months). There were 28 male and 32 female patients. Their age ranged from 6 to 83 with a median of 44 years. Extremity (58%) was the most frequent site of occurrence followed by trunk (20%) and head and neck (12 %). Histologically malignant fibrous histiocytoma (23%), liposarcoma (17%), malignant schwannoma (12%) constitute 52% of the patients. Daily radiation therapy designed to treat all areas at a risk for tumor spread upto dose of 4500-5000 cGy. A shrinking field technique was then used and total 55-65 Gy was delivered to tumor bed. Twenty-five patients (42%) received chemotherapy with various regimen in the postoperative period. RESULTS: Total 41 patients failed either with local recurrence or with distant metastasis. There were 29 patients (48%) of local recurrence. Four patients (7%) developed simultaneous local recurrence and distant metastasis and 8 patients (13%) developed only distant metastasis. Local recurrence rate was rather higher than of other reported series. This study included patients of gross residual, recurrent cases after previous operation, trunk and head andneck primary. This feature is likely explanation for the decreased local control rate. Five of 29 patients who failed only locally were salvaged by re-excision and/or re-irradiation and remained free of disease. Factors affecting local control include histologic type, grade, stage, extent of operation and surgical margin involvement, lymph node metastasis (p<0.05). All 21 patients who failed distantly are dead with progressive disease at the time of this report. Our overall survival results are similar to those of larger series. Actuarial 5 year overall survival and disease free survival were 60.4 %, 36.6% respectively. Grade, stage (being close association with grade), residual disease (negative margin, microscopic, gross) were significant as a predictor of survival in our series (p<0.05). CONCLUSION: Combined surgery and postoperative radiation therapy obtained 5 year survival rate comparable to that of radical surgery.

A Case of Treatment of Serum EB Virus Antibody Positive Patient Presented with Evans Syndrome / 대한혈액학회지

Evans syndrome is defined as the simultaneous or sequential occurrence of Coombs- positive hemolytic anemia and idiopathic thrombocytopenia. The clinical course is characterized by periods of remission and exacerbation with variable, and often disappointing responses to therapy. We experienced a case of serum Epstein-Barr virus antibody positive patient presented with Evans syndrome in a 31-year-old woman whose chief complaints were dyspnea and general weakness and whose disease responded to the multimodality therapy including prednisolone, plasmapheresis, intravenous immunoglobulin (IVIG), and alternate-day cyclosporine A and prednisolone. This is the encouraging report of the use of multimodality treatment with prednisolone, plasmapheresis, IVIG, and cyclosporine A and prednisolone in a serum EV virus antibody positive patient presented with Evans syndrome.

Primary Rhabdomyosarcoma in Temporal Bone Invading Petrous Bone

The rhabdomyosarcoma(RMS), a leading malignant soft tissue tumor in the pediatric population, occurs most commonly in the craniocervical region. RMS has involved the temporal bone approximately 7% in the literature. Petrous bone invasion was very rare and the overall outcome was always fatal, in spite of the efficacy of multimodality therapy, until recent years. The authors report a case of primary RMS in the temporal bone invading petrous bone and the result of multimodality treatment.

Comparison of Single vs Combined Modality Treatment inLocally Advanced Non-Small Cell Lung Cancer / 결핵

BACKGROUND: One quarter to one third of patients with NSCLC present with primary tumors that although confined to the thorax are too extensive for surgical resection. Until resently standard treatment for these patients had been thoracic radiation, which produces tumor regression in most patients but few cures and dismal 5-year survival rate. The fact that death for most patients with stage III tumors is caused by distant metastases has promped a reevaluation of combined modality treatment approaches that include systemic chemotherapy. Therefore, we report the results observed in a study to evaluate the effect of multimodality treatment in locally advanced non-small cell lung cancer from 1/91 to 8/93 in CNUH. METHOD: We grouped the patients according to the treatment modalities and evaluated response rate, median survival and the effect of prognostic variables. Among 67 patients evaluated, twenty seven patients classified with group A, received cisplatin and etoposide containing combination chemotherapy alone, eighteen patients, classified with group B, received chemotherapy and radiotherapy, fifteen patients, group C, received neoadjuvant or adjuvant chemotherapy and surgery with/without radiation therapy, seven patients, group D, received only supportive care. RESULT: The major response rate for group A and B was 37% and 61% respectively. There was no statistically significant difference in response rate between A and B groups(p=0.97). The analysis of prognostic factors showed that differences of age, sex, pathology, blood type, smoking year, stage and ECOG performance did not related to improvement in survival. Median survival time was 8.6 months for group A, 13.4 months for group B, 19.2 months for group C, and 5.4 months for group D, respectively and there was statistically significant difference(p=0.003), suggesting that multimodality therapy was associated with signigicant improvement in survival. Subset survival analysis showed a significant therapeutic effect for earlier stage and good performance state(p=0.007, 0.009, respectively). A possible survival advantages were observed for major response groups. CONCLUSION: It was suggested that multimodality therapy for the management of patients who had stage III disease, has yielded good median survival and long survival for seleted patients. But, it is necessory to validate above result with further investigation in large scale and in prospective randomized trials.

Results of Treatment in 33 Patients with Neuroblastoma

Neuroblastoma is a malignant neoplasm which arises from primitive sympathetic neuroblasts. It is the second most common solid tumor in young children, exceeded in incidence only by brain tumors. This tumor shows immunological features and spontaneous regression. But, in spite of recent advances in multimodality therapy survival rate has not been improved much. We reviewed 33 patients with neuroblastoma who had been diagnosed and treated between 1974 and 1980, and calculated survival rate by life table method