Percutaneous closure of gastrorenal shunt as adjunctive therapy for esophageal carcinoma

The embolization of gastric varices is an established technique for acute bleeding in patients with portal hypertension. Here, we report an attempt to embolize a gastrorenal shunt to facilitate esophagectomy in a patient with an esophageal malignancy. To our knowledge, this is the first case in the literature to highlight the role of interventional medicine in the treatment of patients with esophageal malignancy.

Revisiting oral fluoropyrimidine with cetuximab in metastatic colorectal cancer: Real-world data in Chinese population

BACKGROUND Cetuximab in combination with oral fluoropyrimidine(FP)remains controversial in metastatic colorectal cancer(mCRC).In view of the regional variation in the tolerability of FP,we conducted a retrospective analysis to compare oral FP with infusional FP in combination with cetuximab in Chinese population.AIM To compare the efficacy and safety profile of cetuximab in combination with oral FP and infusional FP in Chinese population in the real-world setting.METHODS A retrospective cohort study was done to analyse consecutive patients with Kras wild-type mCRC who received first-line treatment with cetuximab and FP-based chemotherapy in our unit from January 2010 to December 2015.Ninety-five eligible patients were included.The median follow-up of our cohort was 65.0 mo.RESULTS The median progression-free survival(mPFS)and median overall survival(mOS)of the entire cohort were 9.66 mo(95%CI:7.72–12.5)and 25.8 mo(95%CI:18.7–35.6),respectively.Between oral FP and infusional FP,there was no statistical significant difference in the mPFS[9.79 mo(95%CI:7.49–12.7)vs 9.63 mo(95%CI:6.34–13.4);P=0.72]and mOS[25.8 mo(95%CI:15.2–35.6)vs 26.3 mo(95%CI:18.7–41.2);P=0.63].Grade 3 or above adverse events were reported in 28.4%of patients,being similar with oral and infusional FP,and included 10.5%of neutropenia and 2.1%of diarrhoea events.CONCLUSION The current analysis demonstrates comparable efficacy and safety profiles of cetuximab in combination with oral and infusional FP in Chinese population.The results expand treatment options for Chinese patients and invite revision of existing treatment guidelines to incorporate oral FP-based chemotherapy plus cetuximab.

Intraperitoneal Chemotherapy for Gastric Cancer with Peritoneal Carcinomatosis: Is HIPEC the Only Answer?

Gastric cancer with peritoneal carcinomatosis is notorious for its dismal prognosis. While the pathophysiology of peritoneal dissemination is still controversial, the rapid downhill course is universal. Patients usually suffer abdominal distension, intestinal obstruction and various complications before they succumb after a median of 3 - 6 months. Although not adopted in most international treatment guidelines, intraperitoneal chemotherapy has growing evidence compared with conventional systemic chemotherapy for the treatment of peritoneal carcinomatosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is well-established for clinical benefit but is technically demanding with substantial treatment-related morbidities and mortality. On the other hand, normothermic intraperitoneal chemotherapy in the form of bidirectional neoadjuvant treatment is promising with various newer chemotherapeutic agents. Regardless of the treatment technique applied, the essential element of success is meticulous patient selection and availability of expertise. Future direction is along the line of personalized treatment with the application of translational science.

Metastatic Colorectal Cancer: Optimizing Treatment with Anti-EGFR Monoclonal Antibody

Colorectal cancer remains a major cause of morbidity and mortality worldwide despite substantial improvement in the standard of care. Although surgical resection in selected patients may potentially be curative, systemic therapy is the only choice of treatment for most patients with metastatic colorectal cancer. Anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibody has established its role in the systemic therapy of metastatic colorectal cancer through multiple well-designed clinical trials and yet, the optimal use of anti-EGFR monoclonal antibody is undefined. This article serves to review the available evidence for anti-EGFR monoclonal antibodies and to speculate optimal strategy for their uses.