ABSTRACT
Peritoneum is the third common metastatic site of colorectal cancer (CRC) following liver and lung. CRC peritoneal metastasis (PM) has been reckoned as an advanced disease with dismal prognosis. With the development of modern chemotherapeutic modalities, the prognosis of patients with metastatic CRC has been dramatically improved, yet patients with CRC PM achieved few survival benefits. It is the emergence and combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy that prolong the survival of PM cases. What's more, novel treatments, pressurized intraperitoneal aerosol chemotherapy, and intraperitoneal MOC31PE immunotoxin treatment, for instance, have been under investigation and preliminary results are promising. We aim to comprehensively review the literature focusing on the clinical treatment of PM.
ABSTRACT
Multi-disciplinary treatment (MDT) is an effective pattern to implement the standardized and individualized treatment for cancer. Under the pattern of MDT which integrates the surgery, chemotherapy, radiotherapy, interventional therapy, targeted therapy and immune therapy, there has been a landmark progress in the diagnosis and treatment of colorectal cancer. Curative resection followed by adjuvant chemotherapy has been established as a standard treatment for stage III( colon cancer, but it is still controversial about whether patients with stage II( colon cancer should receive adjuvant chemotherapy and which regimen is preferred. Decision making regarding the use of adjuvant therapy for stage II( patients should not only depend upon the clinicopathological features but also individualized discussion between patients and physicians about the biological behavior of the disease, evidence supporting the efficacy, and possible toxicity. Radical operation following neoadjuvant chemoradiotherapy is currently the standard modality for locally advanced rectal cancer, but the strategy of 'Wait and See' is proposed by some researchers for those achieving complete response after chemoradiotherapy, although there is no sufficient supportive data yet. Patients with metastatic colorectal cancer should undergo an upfront evaluation and discussion by a multidisciplinary team before the initial treatment. Achieving a negative surgical margin with adequate remanent liver reserve is the criteria for determining the resectability of liver metastasis. Both adjuvant and neoadjuvant chemotherapy are two alternatives for initially resectable liver metastasis. Concomitant with the progress of medicine, the MDT is moving toward a precise treatment system oriented by genes and being able to predict the prognosis, efficacy and side effects exactly.
Subject(s)
Humans , Chemoradiotherapy , Chemotherapy, Adjuvant , Colorectal Neoplasms , Pathology , Therapeutics , Liver Neoplasms , Neoadjuvant Therapy , PrognosisABSTRACT
Peritoneum is one of the common site of colorectal cancer metastasis. Traditionally, peritoneal carcinomatosis is associated with a poor prognosis without effective surgical treatment. Recently, the attitude towards the treatment strategies for colorectal peritoneal metastasis has changed significantly with advances in surgical techniques, hyperthermic intraperitoneal chemotherapy and multi-disciplinary treatment. As to the prognosis, colorectal peritoneal metastasis has an inferior outcome to non-peritoneal metastasis under the palliative systemic treatment. However, the complete peritoneal cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy can achieve a long-term survival in selective patients with colorectal peritoneal metastasas. The prognostic factors include peritoneal carcinomatosis index, completeness of cytoreduction, the presence of extra-peritoneal metastasis (liver etc), peritoneal surface disease severity score and Japanese peritoneal staging. In terms of the treatment, complete peritoneal cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy and systemic treatment (including chemotherapy and targeted therapy) may be the best modality of multi-disciplinary treatment for colorectal peritoneal metastasis.
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OBJECTIVE: The aims of this study were to observe the changes of a transplanted heart with cardiac computed tomography (CT) and to evaluate the clinical application of the examination. METHODS: Cardiac CT was performed on 12 heart transplant recipients, of which 4 cases were also examined by echocardiography. Coronary arteries, the cardiac chamber, and the wall were shown with three-dimensional imaging techniques, and their changes were analyzed and discussed. RESULTS: Twelve heart transplant recipients were successfully examined by CT. All transplanted hearts were found with good anastomosis at the great vessels and atria. Coronary allograft vasculopathy was found in 7 cases, of which 4 cases were found with ventricular dilation or ventricular septum thickening and 1 with tricuspid regurgitation. Ventricular dilation was found in other 3 cases, of which 1 was found with ventricular septum thickening and 1 with tricuspid regurgitation. No abnormality was found by cardiac CT in the rest 2 cases, which were found with mitral regurgitation by echocardiography. CONCLUSION: Cardiac CT can clearly and directly display the changes in the shape of a transplanted heart and coronary artery abnormalities. It will become an ideal noninvasive follow-up method for the heart transplant recipients.
Subject(s)
Heart Failure/diagnostic imaging , Heart Failure/surgery , Heart Transplantation/diagnostic imaging , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Purpose:To explore the clinicopathologic features of sporadic colorectal cancer patients with microsatellite instability(MSI) and the correlation between the microsatellite instability and the DNA ploidy.Methods:Detecting microsatellite instability with two sites(BAT25 and BAT26),conduct flow cytometry to analyze the DNA ploidy among 71 sporadic colorectal cancer patients and probe into the relationship between the microsatellite instability phenotype and the clinicopathologic characteristics as well as the DNA ploidy.Results:The positive rate of the microsatellite instability among sporadic colorectal cancer patients was 9.86 percent.The microsatellite instability phenotype was correlated with the tumor site and the histopathologic type and the differentiation grade with the P value less than 0.05,while it was independent of the gender,age,lymph node metastasis and Dukes' stage.The proportion of right colon cancers and poorly-differentiated adenocarcinomas of sporadic colorectal cancers showing microsatellite instability was higher than that of microsatellite stable ones.18 and 50 cases showed diploidy and aneuploidy respectively.5 cases of MSI were diploid,There was statistically significant correlation between the microsatellite instability phenotype and the DNA ploidy(P=0.012).Conclusions:Sporadic colorectal cancers with microsatellite instability were prone to occur in the right colon and to be poorly-differentiated adenocarcinomas and inclined to be diploid.
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Objective To summarize the clinical and pathological characteristics of gastrointestinal stromal tumors with hepatic metastasis, and to analyze its survival and explore its principles of diagnosis and treatment. Methods Among 99 patients diagnosed as gastrointestinal stromal tumors who had a completely case history in our hospital, we retrospectively analyzed the clinical data of 26 patients with hepatic metastatic and the factors influencing survival. Results The average age at diagnosis of primary and hepatic metastatic gastrointestinal stromal tumors was 50.8 and 51.8 years old respectively. Five cases were confirmed by pathological examination, 12 cases were diagnosed by the exploration during the operation and 14 patients had an imaging diagnosis only. Synchronous and metachronous hepatic metastasis happened in 8 and 18 patients respectively. The median interval between the primary tumor and the metachronous hepatic metastasis was 12 months. The primary sites of 12 cases were in stomach, 5 in colorectum, 6 in small intestine and 3 in extra-gastrointestinal tract.Four cases of the hepatic metastatic tumors were treated with surgical resections, 2 with injections of anhydrous alcohol, 3 with interven-tional therapies, 7 with systemic chemotherapies, 8 with imatinib and 2 without treatment. The median survival was 21 months after hepatic metastasis. The administration of imatinib was an important factor prolonging the survival after hepatic metastasis. Conclusions The most frequent primary site of hepatic metastatic stromal tumor is the stomach while small intestinal stromal tumors are most inclined to metastasize to the liver. Treatment with imatinib for more than 3 months can prolong the survival.
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Objective To investigate the clinicopathologic features of sporadic colorectal cancers with CpG island methylator phenotype. Methods The methylation of the promotors of the five genes including p14, hMLH1, p16, MGMT and MINT1 were detected using methylation specific PCR in 71 patients to determine the clinicopathologic characteristics of sporadic colorectal cancers with CpG island methylator phenotype. Results Fifteen out of 71 (21. 1%) patients were positive for the CpG island methylator phenotype. The proportion of the right-sided colonic cancers(40. 0% vs. 12. 5% , P
