Choice of neoadjuvant therapy for rectal cancer: simple chemotherapy or synchronous chemoradiotherapy / 中华胃肠外科杂志

Rectal cancer is one of the most common malignancies in China. Total mesorectal excision (TME) plus neoadjuvant therapy is the standard treatment for locally advanced rectal cancer. After a development of over 20 years, neoadjuvant synchronous chemoradiotherapy has become the standard treatment and cornerstone of neoadjuvant therapy for rectal cancer. However, radiotherapy does not really increase the overall survival and is associated with long-term impact on the functions of anus, sex, urinary system and fertility, so the application of simple neoadjuvant chemotherapy rises gradually and becomes a potentially better treatment option. This paper elaborates the reason, present research status and future trend of the rising neoadjuvant chemotherapy.

Analysis on safety and preliminary efficacy of dose-modified regimen of 5-fluorouracil plus oxaliplatin and irinotecan (FOLFOXIRI) in advanced colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and preliminary efficacy of dose-modified regimen of 5-fluorouracil plus oxaliplatin and irinotecan (mFOLFOXIRI) for patients with advanced colorectal cancer (CRC).</p><p><b>METHODS</b>Data of 312 CRC patients confirmed by pathology receiving triplet drug alone or combined with target therapy between October 2012 and December 2016 at the Sixth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. CRC patients who had previously completed adjuvant therapy (or neoadjuvant therapy) within 6 months or palliative chemotherapy were excluded, meanwhile those with poor general condition (ECOG score > 2) or grade 2 neuropathy and allergy to oxaliplatin were excluded as well. Regimen of mFOLFOXIRI: oxaliplatin 85 mg/m² dissolved in 5% glucose solution 500 ml by intravenous infusion for 2 h; irinotecan 150 to 165 mg/m² dissolved in 0.9% sodium chloride 250 ml by intravenous infusion for 90 min; following intravenous infusion of leucovorin 400 mg/m² for 2 h, day 1; 5-FU 2800 mg/m², 48-h continuous intravenous infusion; once every 2 weeks. Therapy could be combined with a targeted drug, bevacizumab 5 mg/kg every two weeks; cetuximab 500 mg/m² every two weeks. Side effect was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE 4.0.3). The objective response rate was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) after administering at least four cycles of chemotherapy.</p><p><b>RESULTS</b>The median age was 52 years (range 16-73) in the whole group; 113 patients (36.2%) had locally advanced CRC, and 199 (63.8%) had metastatic CRC. Most patients (274/312, 87.8%) did not receive any treatment earlier. There were a total of 1651 chemotherapy cycles in the whole group, with a median of 6(1-19) cycles. Of these 1651 cycles, 124 cycles of chemotherapy(7.5%) were dose-adjusted; 176 cycles of chemotherapy(10.7%) were delayed for median 5(3-13) days; 124 cycles(7.5%) required dose decrease. The overall relative dose intensity was >90%; the specific drug dose intensity was 93.6%(2620 mg×m⁻²×d⁻¹) for fluorouracil, 97.8%(83 mg×m⁻²×d⁻¹) for oxaliplatin, and 94.2%(155 mg×m⁻²×d⁻¹) for irinotecan. Twenty-three patients (7 of intestinal perforation, 7 of intestinal obstruction, 1 of grade 4 hematologic toxicity, and 8 of grade 3 fatigue) refused subsequent chemotherapy due to intolerable toxicity. Main grade 3 or 4 adverse events in patients were neutropenia in 69 cases (22.1%), fatigue in 35 cases (11.2%), and anemia in 28 cases (8.9%). Twenty serious adverse events (6.4%) occurred, including 13 patients of febrile neutropenia (4.2%), 7 patients of intestinal perforation (2.2%, 4 patients in upper rectum, 2 in sigmoid colon, and 1 in transverse colon cancer), and 9 of them had subsequent sepsis (2.9%). All the patients with intestinal perforation underwent emergency operation. No treatment-related deaths occurred. In 199 patients with metastatic CRC, because 22 patients did not receive image evaluation, the preliminary efficacy of 177 patients was actually evaluated. A total of 113 objective response events were observed. The overall response rate was 63.8%(113/177), partial response rate was 61.6%(109/177), clinically complete response rate was 2.3%(4/177), stable disease was 29.9% (53/177), progressive disease was 6.2%(11/177), and the disease control rate was 93.8%(166/177). In 127 patients receiving triplet drug, objective response rate was 40.9% for those with less than four cycles and 81.1% for those with more than four cycles (P<0.001).</p><p><b>CONCLUSION</b>The mFOLFOXIRI regimen with reduced dose can be safely used in advanced CRC and has achieved promising results in terms of short-term efficacy.</p>

Comparison of the intrusion effects on the maxillary incisors between implants and conventional method：a Meta-analysis / 重庆医学

Objective To objectively evaluate the intrusion effects on the maxillary incisors of implants versus conventional method(J-hook headgear ,utility arch) .Methods Such online databases as Cochrane library ,PubMed ,EMbase ,VIP ,Wanfang and CNKI were searched by randomized control test and prospective case controlled study about implants vs conventional anchorage for the maxillary incisor intrusion .After study selection ,assessment and data extraction conducted ,meta-analyses were performed by u-sing the RevMan 5 .1 software .Results Totally 11 studies were included ,6 studies involving 154 patients were included in the J-hook headgear group ,5 studies involving 127 patients were included in the utility arch group .The results of meta-analyses showed that :(1)Compared with the J-hook headgear ,implants had more decrement in the distance of upper center incisior cutting to palatal plane(P0 .05) .(2)Compared with the utility arch ,implants had more decrement in the distance of the center of resistance of the upper incisor to palatal plane (P=0 .010) ,less increase in U6-PP angle (P0 .05) .Conclusion The implants anchorage intruded the maxillary incisor was better than conventional method (J-hook headgear ,utility arch) ,it has more incisor intrusion ,shorter treatment time and more comfortable for the patients ,there was no difference in root resorption between the two groups .