Regional Spondylodiscitis Disparities: Impact on Pathogen Spectrum and Patients.

Background: Spondylodiscitis is an infectious disease affecting an intervertebral disc and the adjacent vertebral bodies and is often the complication of a distant focus of infection. This study aims to ascertain the regional and hospital-specific disparities in bacterial patterns and resistance profiles in spontaneous and iatrogenic spondylodiscitis and their implications for patient treatment. Methods: We enrolled patients from two German hospitals, specifically comparing a university hospital (UVH) with a peripheral non-university hospital (NUH). We documented patient demographics, laboratory results, and surgical interventions. Microbiological assessments, antibiotic regimens, treatment durations, and resistance profiles were recorded. Results: This study included 135 patients. Upon admission, 92.4% reported pain, with 16.2% also presenting neurological deficits. The primary microbial species identified in both the UVH and NUH cohorts were S. aureus (37.3% vs. 31.3%) and cog. neg. staphylococci (28.8% vs. 34.4%), respectively. Notably, a higher prevalence of resistant bacteria was noted in the UVH group (p < 0.001). Additionally, concomitant malignancies were significantly more prevalent in the UVH cohort. Conclusion: Significant regional variations exist in bacterial prevalence and resistance profiles. Consequently, treatment protocols need to consider these nuances and undergo regular critical evaluation. Moreover, patients with concurrent malignancies face an elevated risk of spondylodiscitis.

Clinical features and therapeutic outcomes of GH/TSH cosecreting pituitary adenomas: experience of a single pituitary center.

Background: Growth hormone (GH)/thyroid stimulating hormone (TSH) cosecreting pituitary adenoma (PA) is an exceedingly rare kind of bihormonal pituitary neuroendocrine tumors (PitNETs). Its clinical characteristics have rarely been reported. Objectives: This study aimed to summarize the clinical characteristics and experience of diagnosis and treatment among patients with mixed GH/TSH PAs from a single center. Methods: We retrospectively reviewed GH/TSH cosecreting PAs from 2063 patients diagnosed with GH-secreting PAs admitted to Peking Union Medical College Hospital between January 1st, 2010, and August 30th, 2022, to investigate the clinical characteristics, hormone detection, imaging findings, treatment patterns and outcomes of follow-up. We further compared these mixed adenomas with age- and sex-matched cases of GH mono-secreting PAs (GHPAs). The data of the included subjects were collected using electronic records from the hospital's information system. Results: Based on the inclusion and exclusion criteria, 21 GH/TSH cosecreting PAs were included. The average age of symptom onset was 41.6 ± 14.9 years old, and delayed diagnosis occurred in 57.1% (12/21) of patients. Thyrotoxicosis was the most common complaint (10/21, 47.6%). The median inhibition rates of GH and TSH in octreotide suppression tests were 79.1% [68.8%, 82.0%] and 94.7% [88.2%, 97.0%], respectively. All these mixed PAs were macroadenomas, and 23.8% (5/21) of them were giant adenomas. Comprehensive treatment strategies comprised of two or more therapy methods were applied in 66.7% (14/21) of patients. Complete remission of both GH and TSH was accomplished in one-third of cases. In the comparison with the matched GHPA subjects, the mixed GH/TSH group presented with a higher maximum diameter of the tumor (24.0 [15.0, 36.0] mm vs. 14.7 [10.8, 23.0] mm, P = 0.005), a greater incidence of cavernous sinus invasion (57.1% vs. 23.8%, P = 0.009) and a greater difficulty of long-term remission (28.6% vs. 71.4%, P <0.001). In addition, higher occurrence rates of arrhythmia (28.6% vs. 2.4%, P = 0.004), heart enlargement (33.3% vs. 4.8%, P = 0.005) and osteopenia/osteoporosis (33.3% vs. 2.4%, P = 0.001) were observed in the mixed PA group. Conclusion: There are great challenges in the treatment and management of GH/TSH cosecreting PA. Early diagnosis, multidisciplinary therapy and careful follow-up are required to improve the prognosis of this bihormonal PA.

Multidisciplinary treatment for locally advanced gastric cancer: A systematic review and network meta-analysis.

Introduction: This study aimed to evaluate the efficacy of multidisciplinary treatment for patients with locally advanced gastric cancer (LAGC) who underwent radical gastrectomy. Patients and Methods: Randomised controlled trials (RCTs) comparing the effectiveness of surgery alone, adjuvant chemotherapy (CT), adjuvant radiotherapy (RT), adjuvant chemoradiotherapy (CRT), neoadjuvant CT, neoadjuvant RT, neoadjuvant CRT, perioperative CT and hyperthermic intraperitoneal chemotherapy (HIPEC) for LAGC were searched. Overall survival (OS), disease-free survival (DFS), recurrence and metastasis, long-term mortality, adverse events (grade ≥3), operative complications and R0 resection rate were used as outcome indicators for meta-analysis. Results: Forty-five RCTs with 10077 participants were finally analysed. Adjuvant CT had higher OS (hazard ratio [HR] = 0.74, 95% credible interval [CI] = 0.66-0.82) and DFS (HR = 0.67, 95% CI = 0.60-0.74) than surgery-alone group. Perioperative CT (odds ratio [OR] = 2.56, 95% CI = 1.19-5.50) and adjuvant CT (OR = 0.48, 95% CI = 0.27-0.86) both had more recurrence and metastasis than HIPEC + adjuvant CT, while adjuvant CRT tended to have less recurrence and metastasis than adjuvant CT (OR = 1.76, 95% CI = 1.29-2.42) and even adjuvant RT (OR = 1.83, 95% CI = 0.98-3.40). Moreover, the incidence of mortality in HIPEC + adjuvant CT was lower than that in adjuvant RT (OR = 0.28, 95% CI = 0.11-0.72), adjuvant CT (OR = 0.45, 95% CI = 0.23-0.86) and perioperative CT (OR = 2.39, 95% CI = 1.05-5.41). Analysis of adverse events (grade ≥3) showed no statistically significant difference between any two adjuvant therapy groups. Conclusion: A combination of HIPEC with adjuvant CT seems to be the most effective adjuvant therapy, which contributes to reducing tumour recurrence, metastasis and mortality - without increasing surgical complications and adverse events related to toxicity. Compared with CT or RT alone, CRT can reduce recurrence, metastasis and mortality but increase adverse events. Moreover, neoadjuvant therapy can effectively improve the radical resection rate, but neoadjuvant CT tends to increase surgical complications.

Long-term survival with nivolumab followed by irinotecan after total gastrectomy in alpha-fetoprotein-producing gastric cancer: a case report and review of the literature.

BACKGROUND: Alpha-fetoprotein-producing gastric cancer (AFPGC) is a rare type of aggressive gastric cancer (GC) with a dismal prognosis. We present a patient with AFPGC who achieved long-term survival through a multidisciplinary approach. CASE PRESENTATION: A 67-year-old man with advanced GC was referred to our hospital for systemic chemotherapy. He was diagnosed with cStage IVB AFPGC. During 2nd-line treatment, we could not control bleeding from the GC itself. After complete resection, during chemotherapy, portal venous tumor thrombi (PVTTs) and liver metastases were identified. With nivolumab followed by irinotecan, the PVTTs and liver metastases disappeared. Without immunotherapy and chemotherapy for 23 months, the patient has survived for 48 months so far with no recurrence of GC. CONCLUSION: Long-term survival with AFPGC can be accomplished by using several different approaches, such as surgery, immunotherapy, and chemotherapy.

Centralized and Interdisciplinary Therapy Management in the Treatment of Sarcomas.

Sarcoma treatment requires a high level of expertise due to its rarity and heterogeneity. Sarcoma patients should, therefore, be referred to an expert centre as early as possible to ensure optimal treatment. Numerous studies have been carried out to provide evidence for this strategy. In compliance with the 2020 PRISMA guidelines, a systematic search was conducted in PubMed, EMBASE, Ovid Medline, ClinicalTrials.gov and Cochrane Library databases. The subject of these studies was the centralised treatment of adult sarcoma patients at expert centres and the use of interdisciplinary tumour boards. Uncertainty in therapy, delays in referral to expert centres, and limited access to therapeutic modalities continue to be a challenge in sarcoma therapy. At expert centres, diagnostic procedures were more frequently and adequately performed, and treatment was associated with an improvement in outcomes in the majority of studies: patients benefited from longer survival, lower local recurrence rates and a better postoperative outcome. The implementation of an interdisciplinary tumour board was associated with discrepant results. In a greater number of studies, it was associated with a lower local relapse rate, better overall survival and surgical outcome. In two studies, however, a shorter overall survival was observed. The establishment of expert centres and the consistent use of interdisciplinary tumour boards are important structures for ensuring multidisciplinary therapy approaches. There is growing evidence that this holds great potential for optimising sarcoma therapy.

Does Multidisciplinary Therapy at a Sarcoma Center Improve the Prognosis of Patients With Soft Tissue Sarcoma? A Retrospective Case Study at a Single Institute.

BACKGROUND/AIM: The effect of multidisciplinary therapy conducted at the sarcoma center of our hospital was examined to determine whether therapy undertaken here improved the prognosis of patients with soft-tissue sarcoma. PATIENTS AND METHODS: The clinical findings and prognoses of patients treated before the establishment of the sarcoma center (72 patients from April 2016 to March 2018) and those treated after (155 patients from April 2018 to March 2021) were compared. RESULTS: The mean number of patients increased from 36.0 to 51.7 per year after the establishment of the sarcoma center. The proportion of patients with stage IV disease also increased from 8.3% to 12.9% after establishment of the sarcoma center. The 3-year survival rate of patients, considering all stages, decreased from 80.0% to 78.3% after establishment of the sarcoma center rather than showing an increase. The 3-year survival rate of patients with stage II and III disease increased from 78.6% to 84.7%, and that of stage III patients with retroperitoneal sarcoma increased from 70.0% to 86.7% after establishment of the sarcoma center. However, no statistically significant difference was observed in the survival curves. CONCLUSION: The establishment of a sarcoma center has contributed to centralizing treatment for soft-tissue sarcoma. Multidisciplinary therapy at sarcoma centers may improve the prognosis of patients with soft-tissue sarcomas.

Recent Progress in Advanced Hydrogel-Based Embolic Agents: From Rational Design Strategies to Improved Endovascular Embolization.

Transcatheter arterial embolization, a minimally invasive treatment to deliberately occlude the blood vessels, has become a safe and effective procedure for the management of vascular diseases and benign/malignant tumors. Particularly, hydrogel-based embolic agents have garnered much attention because of their potential to address some of the limitations of clinically used embolic agents and can be rationally designed to impart more favorable characteristics or functions. In this review, the recent progress toward the development of polymer-based hydrogels for effective endovascular embolization, including the in situ gelling hydrogels mediated by physically or chemically crosslinking, imageable hydrogels for intraprocedural and postprocedural feedback, use of hydrogels as the drug depot for local delivery of therapeutic drugs, hemostatic hydrogels inducing extrinsic or intrinsic coagulation of blood, stimuli-responsive shape memory hydrogels as the smart embolization devices, and hydrogels incorporating external-stimuli functional materials for multidisciplinary therapy, is systemically summarized. Moreover, the potential considerations of hydrogel-based embolic agents confronted in therapeutic embolization are pointed out. Finally, the perspectives for the development of more effective embolic hydrogels are also highlighted.

Successful multidisciplinary therapy for a patient with liver metastasis from ascending colon adenocarcinoma: A case report and review of literature.

BACKGROUND: Liver metastasis is the most common form of distant metastasis in colorectal cancer, and the only possible curative treatment for patients with colorectal liver metastases (CRLM) is hepatectomy. However, approximately 25% of patients with CRLM have indications for liver resection at the initial diagnosis. Strategies aimed at downstaging large or multifocal tumors to enable curative resection are appealing. CASE SUMMARY: A 42-year-old man was diagnosed with ascending colon cancer and liver metastases. Due to the huge lesion size and compression of the right portal vein, the liver metastases were initially diagnosed as unresectable lesions. The patient was treated with preoperative transcatheter arterial chemoembolization (TACE) consisting of 5-fluorouracil/Leucovorin/oxaliplatin/Endostar®. After four courses, radical right-sided colectomy and ileum transverse colon anastomosis were performed. Postoperatively, the pathological analysis revealed moderately differentiated adenocarcinoma with necrosis and negative margins. Thereafter, S7/S8 partial hepatectomy was performed after two courses of neoadjuvant chemotherapy. Pathological examination of the resected specimen revealed a pathologically complete response (pCR). Intrahepatic recurrence was detected more than two months after the operation, and the patient was then treated with TACE consisting of irinotecan/Leucovorin/fluorouracil therapy plus Endostar®. Subsequently, the patient was treated with a γ-knife to enhance local control. Notably, a pCR was reached, and the patient's overall survival time was > 9 years. CONCLUSION: Multidisciplinary treatment can promote the conversion of initially unresectable colorectal liver metastasis and facilitate complete pathological remission of liver lesions.

Multidisciplinary chronic pain management strategies in patients with Ehlers-Danlos syndromes.

Ehlers-Danlos syndromes (EDS) are a group of disorders characterized by abnormal connective tissue affecting several organ systems. Patients with the hypermobile type of EDS (hEDS) commonly experience chronic pain which can present as musculoskeletal pain, fibromyalgia, neuropathic pain or abdominal pain. The effective management of chronic pain in hEDS patients is a challenge. This study reviews two cases of chronic pain in hEDS patients and the multimodal treatment regimen used along with peripheral nerve stimulation for shoulder and knee pains, never before reported in hEDS patients. Since hEDS associated chronic pain is multifactorial in origin, treatment requires a multidisciplinary approach which includes physical therapy, psychotherapy, pharmacotherapy and interventional pain procedures such as trigger point injections, peripheral nerve block, radiofrequency ablation and peripheral nerve stimulation.

Ehlers­Danlos Syndromes (EDS) are a group of disorders that affects the connective tissues that supports skin, muscles and organs. Patients with the hypermobile subtype of EDS (hEDS) often experience chronic pain of multiple locations including the muscles, joints, nerves, abdomen, head or generalized pain. Treating chronic pain in patients with hEDS is challenging. In this study, we review the treatment of chronic pain in two patients with hEDS using multiple therapies including the novel use of peripheral nerve stimulation in this patient population. Chronic pain in hEDS patients is caused by multiple different mechanisms and therefore, the treatment of this pain requires multiple different therapeutic interventions such as medications, physical therapy, psychotherapy and minimally invasive procedures such as peripheral nerve stimulation.

Application prospect of minimally invasive surgical techniques in the treatment of biliary tract cancer / 中华消化外科杂志

Due to the inherent disease characteristics and surgical difficulties, the develop-ment of minimally invasive surgery in biliary tract cancer has encountered more difficulties and controversies. As one of the representative fields of modern precise surgery and an important part of multidisciplinary therapy, the value and application of minimally invasive surgery in the treatment of biliary tract cancer need to be further elaborated and standardized. Minimally invasive surgical techniques should be explored and studied under reasonable norms and supervision. More higher level evidence-based evidences should be obtained under the premise of ensuring the ethical prin-ciple of maximum benefit to patients, and ultimately promote the overall progress in the field.

Motor and non-motor improvements following short-term multidisciplinary day-clinic care in Parkinson´s disease.

BACKGROUND: Inpatient as well as outpatient care does often not meet PD-patients' individual needs. INTRODUCTION: Day-clinic concepts encompassing a multidisciplinary team as well as therapy adjustments accompanying everyday demands aim at filling this gap. METHODS: This is a retrospective study on short-term effects of a 3 week multidisciplinary rehabilitation program in patients with Parkinson´s disease (PD) embedded in a specialized movement disorder day-clinic. We analyzed short-term outcome of motor and non-motor symptoms (NMS) in 143 PD-patients (mean age 65.3 ± 11.9 years; Hoehn-and-Yahr-score 2.6 ± 0.7) after 3 weeks with 7.4 ± 1.8 active days of interdisciplinary day-care treatment. Participants attended the day-clinic in groups of five patients at a time. Improvements were evaluated by comparison of standardized physical therapy assessments, disease specific scores for motor symptoms (MDS-UPDRS III), mood (BDI), quality of life (PDQ39, SF36), sleep (PDSS, ESS), impulsiveness (QUIP), apathy (SAS), cognition (MMST), as well as change in medication before and directly after the intervention. RESULTS: MDS-UPDRS motor score improved significantly by 22.9 ± 21.5% (p < 0.001) and was accompanied by a significant reduction of imbalance, immobility, and weakness ranging between 6% and 17% in standardized physical therapy tests. In addition, all disease-specific non-motor scales improved significantly. CONCLUSIONS: A multidisciplinary day-clinic approach can support benefit on motor, non-motor symptoms and QoL in PD-patients. Given the increase in PD incidence and prevalence as well as the significant treatment effects shown here, more day-clinic treatment opportunities ought to be implemented to improve PD treatment adapted to everyday challenges while still reducing costs to the health care system.

Gallbladder carcinosarcoma with two heterologous components: a case report.

Carcinosarcoma of the gallbladder is a rare cancer characterized by presence of a carcinomatous and a sarcomatous component. In our work, we report the case of a 66-year-old male patient, presenting with isolated abdominal pain evolving for more than 6 months. contrast-enhanced computed tomography enabled identification of a gallbladder mass, invading liver, duodenum and abdominal wall. A cholecystectomy, extended to liver, duodenum and abdominal wall was performed. The final diagnosis of gallbladder carcinosarcoma was obtained by pathological assessment. Gallbladder carcinosarcoma has a poor prognosis. Since it is rare, no established chemotherapy or radiation protocols exist. Further studies about case series are needed to establish better therapeutic protocols. Gallbladder carcinosarcoma is a rare cancer with a rapid progression making therapeutic decisions difficult. All these factors contribute to the poor prognosis of this cancer.

Recent advances in multidisciplinary therapy for adenocarcinoma of the esophagus and esophagogastric junction.

Esophageal adenocarcinoma (EAC) and adenocarcinoma of the esophagogastric junction (EGJA) have long been associated with poor prognosis. With changes in the spectrum of the disease caused by economic development and demographic changes, the incidence of EAC and EGJA continues to increase, making them worthy of more attention from clinicians. For a long time, surgery has been the mainstay treatment for EAC and EGJA. With advanced techniques, endoscopic therapy, radiotherapy, chemotherapy, and other treatment methods have been developed, providing additional treatment options for patients with EAC and EGJA. In recent decades, the emergence of multidisciplinary therapy (MDT) has enabled the comprehensive treatment of tumors and made the treatment more flexible and diversified, which is conducive to achieving standardized and individualized treatment of EAC and EGJA to obtain a better prognosis. This review discusses recent advances in EAC and EGJA treatment in the surgical-centered MDT mode in recent years.

Guidelines for Diagnosis and Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus in China (2021 Edition).

Portal vein tumor thrombus (PVTT) is very common and it plays a major role in the prognosis and clinical staging of hepatocellular carcinoma (HCC). We have published the first version of the guideline in 2016 and revised in 2018. Over the past several years, many new evidences for the treatment of PVTT become available, especially for the advent of new targeted drugs and immune checkpoint inhibitors which have further improved the prognosis of PVTT. So, the Chinese Association of Liver Cancer and Chinese Medical Doctor Association revised the 2018 version of the guideline to adapt to the development of PVTT treatment. Future treatment strategies for HCC with PVTT in China would depend on new evidences from more future clinical trials.

Metástasis cutánea metacrónica de carcinoma escamoso de canal anal / Methachronical cutaneous metastasis of squamous carcinoma of the anal canal / Metástase cutânea metacronica de carcinoma escamoso do canal anal

El tratamiento correcto de carcinoma escamoso avanzado requiere de un manejo multidisciplinar entre cirujanos, anatomopatólogos, radioterapeutas y radiólogos. Los protocolos están claros cuando nos hallamos ante una enfermedad localizada, sin embargo, cuando la enfermedad es metastática no existe evidencia científica de los pasos a seguir. Presentamos una paciente con un carcinoma escamoso del ano con una única metástasis cutánea metacrónica que fue tratada con cirugía y radioterapia posterior con buena respuesta.

The right therapy of anal cancer needs a multidisciplinary management of surgeons, pathologists, radiotherapists and radiologist. The treatment of squamous cell carcinoma of the anal canal is well-known when the patient presents a locally disease, nevertheless, there is a lack of information with the advanced anal cancer. We report a case of a 74-year-old woman with a solitary methachronical cutaneous metastasis of anal cancer which responded perfectly to surgery and radiotherapy.

A correta terapêutica do câncer anal necessita de uma gestão multidisciplinar de cirurgiões, patologistas, radio terapeutas e radiologistas.O tratamento do carcinoma espinocelular do canal anal é bem conhecido quando o paciente apresenta uma doença local, porém, há uma falta de informação sobre o câncer anal avançado. Relatamos o caso de uma mulher de 74 anos com metástase cutânea metacrônica solitária de câncer anal que respondeu perfeitamente à cirurgia e à radioterapia.

Curative resection after chemotherapy and chemoradiotherapy for postoperative recurrence of pancreatic tail cancer in the abdominal wall: a case report.

BACKGROUND: Locoregional recurrence and metastasis to the liver, peritoneum, and lung are the most common recurrent patterns of pancreatic ductal adenocarcinoma (PDAC) after radical resection. Recurrence in the abdominal wall is extremely rare. Herein, we report our experience with a patient who had recurrent PDAC in the abdominal wall with long-term survival by means of multidisciplinary therapy. CASE PRESENTATION: A 76-year-old Japanese woman was diagnosed with resectable pancreatic tail cancer. She underwent distal pancreatectomy with regional lymphadenectomy after two cycles of gemcitabine plus S-1 as neoadjuvant therapy. She also received eight cycles of S-1 as adjuvant chemotherapy. Approximately 14 months after the initial surgery, imaging examinations identified a mass suggesting recurrence in the abdominal wall at the middle wound that involved the transverse colon. After two cycles of gemcitabine plus nab-paclitaxel, chemoradiotherapy (S-1 plus 45 Gy) and seven cycles of modified FOLFIRINOX (5-fluorouracil/leucovorin, irinotecan, and oxaliplatin) were administered. The patient did not develop any new recurrent lesions during chemotherapy and chemoradiotherapy. Therefore, the recurrent lesion in the abdominal wall and the involved transverse colon were resected. We confirmed the lack of peritoneal dissemination during surgery. Pathological examination revealed that the resected lesion was metastasis of primary PDAC, and the surgical margin was 1 mm. However, re-recurrence localized in the abdominal wall was detected 9 months later. The re-recurrent lesion was diagnosed as local recurrence of the first recurrent lesion. We performed a second resection of the abdominal wall using a femoral myocutaneous flap to achieve sufficient surgical margin. The pathological findings of the resected specimen were the same as those of the previous specimens, and the resection margin was negative. The patient's postoperative course was uneventful. Seven years after the initial surgery and 3 years and 7 months after the third surgery, the patient is alive with no signs of recurrence. CONCLUSIONS: Long-term survival could be achieved by radical resection with sufficient surgical margins for recurrence of PDAC in the abdominal wall if new other recurrent lesions, including peritoneal dissemination, are prevented through chemotherapy.

Two cases of resected gallbladder carcinosarcoma with a contrasting course.

INTRODUCTION: Carcinosarcoma of the gallbladder is a rare tumor with both carcinoma and sarcoma components. CASE PRESENTATION: In this paper, we report two cases. The first case is of a man in his 60s who was preoperatively diagnosed with gallbladder carcinosarcoma and has achieved 6 years and 6 months survival through aggressive surgical treatment. The second case is of a woman in her 70s who was diagnosed with locally advanced gallbladder cancer; she underwent multidisciplinary treatment for the same, but died 8 months after the surgery. While the primary disorder was the same in both cases, the clinical courses contrasted sharply. DISCUSSION: There is no established chemotherapy or radiation therapy for gallbladder carcinosarcoma, and the only curative treatment is surgery. However, it has a very poor prognosis. CONCLUSION: Carcinosarcoma of the gallbladder may progress very rapidly, and the treatment management should be carefully decided.

Fatigue and its management in cancer patients undergoing VEGFR-TKI therapy.

INTRODUCTION: Fatigue is the most common side effect of cancer and cancer treatment and is often called cancer fatigue or cancer-related fatigue. For cancer patients, cancer-related fatigue has a negative impact on participation in work and social activities, mood, and daily activities, significantly impairing quality of life. Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) sometimes cause fatigue, and early detection and appropriate management of fatigue in cancer patients treated with a VEGFR-TKI prevent fatigue from becoming more severe, thus maximizing the benefits of the treatment. AREAS COVERED: This paper focuses on fatigue and discusses its frequency, assessment, risk factors, and management methods. EXPERT OPINION: The drugs currently available for treating cancer-related fatigue are not effective enough, and their mechanisms of action are not fully understood. Some agents have demonstrated efficacy as treatments for fatigue due to pharmacotherapy, and further elucidation of their mechanisms is expected, together with the development of new drugs. Since fatigue has a range of causes, its treatment requires not only medication, but also exercise, nutrition, and other therapeutic approaches. The successful treatment of fatigue will therefore need multidisciplinary therapy involving the establishment of systems of cooperation across various specialties.

Recent advances in multidisciplinary therapy for sinonasal cancers / 中华放射肿瘤学杂志

Sinonasal cancers (SNCs) are rare and heterogeneous diseases. Most patients present with locally advanced stage due to the insidious symptoms. In the majority of cases, the treatment strategy relies on the combination of surgery and radiotherapy, supplemented with or without chemotherapy. However, postoperative organ preserving rate is low, quality of life and clinical prognosis are poor. With recent advancement of surgical techniques, radiotherapy and chemotherapy techniques, certain progress has been reached in the diagnosis and treatment of SNCs. Nevertheless, the specific treatment regimen remains controversial. In this article, advances and controversies in SNC were reviewed.

Outcomes of reduction hepatectomy combined with postoperative multidisciplinary therapy for advanced hepatocellular carcinoma.

BACKGROUND: The prognosis of advanced hepatocellular carcinoma (HCC) that is not indicated for curative hepatectomy remains poor, despite advances in the treatment of HCC, including the development of tyrosine kinase inhibitors (TKIs). The outcomes of reduction hepatectomy and multidisciplinary postoperative treatment for advanced HCC that is not indicated for curative hepatectomy, including those of recently treated cases, should be investigated. AIM: To examine the outcomes of combination treatment with reduction hepatectomy and multidisciplinary postoperative treatment for advanced HCC that is not indicated for curative hepatectomy. METHODS: Thirty cases of advanced HCC that were not indicated for curative hepatectomy, in which reduction hepatectomy was performed between 2000 and 2018 at the Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, were divided into postoperative complete remission (POCR) (+) and POCR (-) groups, depending on whether POCR of all evaluable lesions was achieved through postoperative treatment. The cases in the POCR (-) group were subdivided into POCR (-) TKI (+) and POCR (-) TKI (-) groups, depending on whether TKIs were administered postoperatively. RESULTS: The 5-year overall survival rate and mean survival time (MST) after reduction hepatectomy were 15.7% and 28.40 mo, respectively, for all cases; 37.5% and 56.55 mo, respectively, in the POCR (+) group; and 6.3% and 14.84 mo, respectively, in the POCR (-) group (P = 0.0041). Tumor size, major vascular invasion, and the number of tumors in the remnant liver after the reduction hepatectomy were also found to be related to survival outcomes. The number of tumors in the remnant liver was the only factor that differed significantly between the POCR (+) and POCR (-) groups, and POCR was achieved significantly more frequently when ≤ 3 tumors remained in the remnant liver (P = 0.0025). The MST was 33.52 mo in the POCR (-) TKI (+) group, which was superior to the MST of 10.74 mo seen in the POCR (-) TKI (-) group (P = 0.0473). CONCLUSION: Reduction hepatectomy combined with multidisciplinary postoperative treatment for unresectable advanced HCC that was not indicated for curative hepatectomy was effective when POCR was achieved via multidisciplinary postoperative therapy. To achieve POCR, reduction hepatectomy should aim to ensure that ≤ 3 tumors remain in the remnant liver. Even in cases in which POCR is not achieved, combined treatment with reduction hepatectomy and multidisciplinary therapy can improve survival outcomes when TKIs are administered.