Efficacy of capecitabine and oxaliplatin regimen for extrahepatic metastasis of hepatocellular carcinoma following local treatments

AIM: To investigate the efficacy and safety of capecitabine and oxaliplatin (CapeOx) for extrahepatic metastasis after local treatment of hepatocellular carcinoma (HCC). METHODS: Thirty-two patients with extrahepatic metastasis of HCC after local treatment were prospectively enrolled. The CapeOx regimen consisted of capecitabine 1000 mg/m 2 taken orally twice daily on days 1-14, and oxaliplatin was administered at a total dose of 100 mg/m 2 on day 1. The treatment was repeated every 3 wk until disease progression or unaccetablle toxicity. Efficacy and safety were assessable for all enrolled patients. The primary objective of this study was to assess the overall response rate. The secondary objectives were to evaluate the overall survival (OS), the time to tumor progression (TTP) and the toxicity profile of the combined strategy. TTP and OS were assessed by the Kaplan-Meier method and differences between the curves were analyzed using the log-rank test. The statistical software SPSS version 15.0 for Windows (SPSS Inc., Chicago, IL, United States) was used for statistical analysis. All P values were 2-tailed, with statistical significance defined byP ≤ 0.05. RESULTS: Thirty-two patients were assessable for efficacy and toxicity. The median follow-up duration was 15 mo (range, 12-20 mo). At the cut-off date of March 31, 2012, 27 patients died due to tumor progression and one patient died of myocardial infarction. Four patients were still alive (three patients with disease progression). OR was 21.9% (n = 7), the stabilization rate was 40.6% (n = 13), and the disease control rate was 62.5%. The responses lasted from 4 to 19 mo (median, 6 mo). Median TTP was 4.2 mo (95%CI: 2.5-7.4), and the median OS time was 9.2 mo (95%CI: 6.5-17.8). The 1-year survival rate was 43.6% (95%CI: 29.0-66.0). In a multivariate analysis, OS was significantly longer in patients with a Child-Pugh class A compared with class B patients (P = 0.014), with a median OS of 10.1 mo vs 5.4 mo, and there were trends towards longer OS (P = 0.065) in patients without portal vein tumor thrombosis. There were no significant effects of age, gender, performance status, cirrhosis, metastatic sites, and level of alpha fetoprotein (AFP) or hepatitis B virus-DNA on OS. Among the 22 patients with elevated AFP levels at baseline (≥ 400 ng/mL), the level fell by more than 50% during treatment in 6 patients (27.3%). The most frequent treatment-related grade 3 to 4 toxicities included leucopenia/neutropenia, transient elevation of aminotransferases, handfoot syndrome and fatigue. CONCLUSION: CapeOx showed modest anti-tumor activity in metastatic HCC. However, the manageable toxicity profile and the encouraging disease control rate deserve further study for these patients.

Percutaneous needle decompression in treatment of malignant small bowel obstruction

AIM:To investigate the efficacy and safety of percutaneous needle decompression in the treatment ofmalignant small bowel obstruction(MSBO).METHODS:A prospective analysis of the clinical data of 52 MSBO patients undergoing percutaneous needle decompression was performed.RESULTS:Percutaneous needle decompression was successful in all 52 patients.Statistically significant differences were observed in symptoms such as vomiting,abdominal distension and abdominal pain before and after treatment(81.6%vs 26.5%,100%vs 8.2%,and 85.7%vs 46.9%,respectively;all P<0.05).The overall significantly improved rate was 19.2%(11/52)and the response rate was 94.2%(49/52)using decompression combined with nasal tube placement,local arterial infusion of chemotherapy and nutritional support.During the one-month follow-up period,puncture-related complications were acceptable.CONCLUSION:Percutaneous needle intestinal decompression is a safe and effective palliative treatment for MSBO.

Combined radiochemotherapy in patients with locally advanced pancreatic cancer: A meta-analysis

AIM:To compare the long-term clinical efficacy of chemotherapy plus radiotherapy(CRT)with that of radiotherapy alone(RT)or chemotherapy alone(CT)for locally advanced pancreatic carcinoma(LAPC).METHODS:Using manual and computer-aided methods,we searched the data through the databases,including PubMed/EmBase/CNKI/CQVIP/China Journals Full Text Database and websites and proceedings of major annual meetings such as ASCO and CSCO.The methodological quality of the included studies was assessed using the Jadad scoring system.Both English and Chinese publications were searched.We collected data from controlled clinical trials on CRT vs RT or CT for LAPC,and conducted a meta-analysis of 15 included studies.Meta-analysis was performed using RevMan4.2Software according to the method recommended by Cochrane Collaboration.RESULTS:Fifteen eligible randomized controlled trials including a total of 1128 patients were screened.Jadad score was 2 in only one article,and 3-4 in the remaining 14 studies.The meta-analysis showed that CRT was superior in the 6-and 12-mo survivals to the RT alone group or CT alone group(P=0.0001 and P=0.02,respectively),whereas the 18-mo survival showed no significant difference(P=0.23).Subgroup analysis showed that the 6-,12-,and 18-mo survivals were not significantly different between the CRT group and CT group(P=0.07,P=0.23,and P=0.91,respectively).Notably,the CRT group had significantly better 6-,12-,and 18-mo survivals than the RT group(all P<0.01).CRT group had significantly more grade 3-4 treatmentrelated hematologic and non-hematologic toxicities than the CT group or RT group(all P<0.01).CONCLUSION:Compared with CT or RT,CRT can benefit the long-term survival of LAPC patients,although it may also increase treatment-related toxicities.