Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Where are we?

Peritoneal surface malignancies are generally associated with poor prognosis. In daily clinical routine, systemic chemotherapy is still considered the only reasonable therapy despite of encouraging results of cytoreductive surgery (CRS) along with intraperitoneal hyperthermic chemotherapy (HIPEC). The Achilles heel of CRS and HIPEC is appropriate patient selection and precise surgical technique preventing patients from excessive morbidity and mortality. Given these findings, new concepts of second look surgery for high risk patients allow detection of peritoneal spread ahead of clinical symptoms or presence of peritoneal masses reducing perioperative morbidity. In addition, personalized intraperitoneal chemotherapy might further improve outcome by appreciating individual tumor biology. These days, every physician should be aware of CRS and HIPEC for treatment of peritoneal surface malignancies. Since there is now sufficient data for the superiority of CRS and HIPEC to systemic chemotherapy in selected patients, our next goal should be providing this strategy with minimal morbidity and mortality even in the presence of higher tumor load.

Combined resection and multi-agent adjuvant chemotherapy for desmoplastic small round cell tumor arising in the abdominal cavity:Report of a case

Desmoplastic small round cell tumor （DSRCT） is a rare, highly aggressive malignancy with distinctive histological features： a nesting pattern of cellular growth within dense desmoplastic stroma, occurring in young population with male predominance. The mean survival period is only about 1.5-2.5 years. The tumor has co-expressed epithelial, muscle, and neural markers in immunohistochemical studies. This work reports a 27-year-old man presenting with hematemesis and chronic constipation. Serial studies including endoscopy, upper gastrointestinal series, abdominal computed tomography and barium enema study showed disseminated involvement of visceral organs. The patient underwent aggressive surgery and received postoperative adjuvant chemotherapy consisting of 5-fluorouracil, cyclophosphamide, etoposide, doxorubicin, and cisplatin. He survived without any disease for 20 mo after the surgery. No standard treatment protocol has been established. Aggressive surgery combined with postoperative multi-agent adjuvant chemotherapy is justified not only to relieve symptoms but also to try to improve the outcome in this advanced DSRCT young patient.

Primary hepatic leiomyosarcoma with liver metastasis of rectal cancer

Primary hepatic leiomyosarcoma is a particularly rare tumor with a poor prognosis. Curative resection is currently the only effective treatment, and the efficacy of chemotherapy is unclear. This represents the first case report of a patient with primary hepatic leiomyosarcoma co-existing with metastatic liver carcinoma. We present a 59-year-old man who was diagnosed preoperatively with rectal cancer with multiple liver metastases. He underwent a curative hepatectomy after a series of chemotherapy regimens with modified FOLFOX6 consisting of 5-fluorouracil, leucovorin and oxaliplatin plus bevacizumab, FOLFIRI consisting of 5-fluorouracil, leucovorin and irinotecan plus bevacizumab, and irinotecan plus cetuximab. One of the liver tumors showed a different response to chemotherapy and was diag-nosed as a leiomyosarcoma following histopathological examination. This case suggests that irinotecan has the potential to inhibit the growth of hepatic leiomyosarcomas. The possibility of comorbid different histological types of tumors should be suspected when considering the treatment of multiple liver tumors.

Comparison of neoadjuvant chemotherapy followed by surgery vs.surgery alone for locally advanced gastric cancer:a meta-analysis

Background:The neoadjuvant chemotherapy is increasingly used in advanced gastric cancer,but the effects on safety and survival are still controversial.The objective of this meta-analysis was to compare the overall survival and short-term surgical outcomes between neoadjuvant chemotherapy followed by surgery(NACS)and surgery alone(SA)for locally advanced gastric cancer.Methods:Databases(PubMed,Embase,Web of Science,Cochrane Library,and Google Scholar)were explored for relative studies from January 2000 to January 2021.The quality of randomized controlled trials and cohort studies was evaluated using the modified Jadad scoring system and the Newcastle-Ottawa scale,respectively.The Review Manager software(version 5.3)was used to perform this meta-analysis.The overall survival was evaluated as the primary outcome,while perioperative indicators and post-operative complications were evaluated as the secondary outcomes.Results:Twenty studies,including 1420 NACS cases and 1942 SA cases,were enrolled.The results showed that there were no significant differences in overall survival(P=0.240),harvested lymph nodes(P=0.200),total complications(P=0.080),and 30-day post-operative mortality(P=0.490)between the NACS and SA groups.However,the NACS group was associated with a longer operation time(P<0.0001),a higher R0 resection rate(P=0.003),less reoperation(P=0.030),and less anastomotic leakage(P=0.007)compared with SA group.Conclusions:Compared with SA,NACS was considered safe and feasible for improved R0 resection rate as well as decreased reoperation and anastomotic leakage.While unbenefited overall survival indicated a less important effect of NACS on long-term oncological outcomes.

Adjuvant treatment in biliary tract cancer: To treat or not to treat?

Biliary tract cancer is a rare malignant tumor. There is limited knowledge about biology and natural history of this disease and considerable uncertainty remains regarding its optimal diagnostic and therapeutic man- agement. The role of adjuvant therapy is object of debate and controversy. Although resection is identified as the most effective and the only potentially curative treatment, there is no consensus on the impact of ad- juvant chemotherapy and/or radiotherapy on the high incidence of disease recurrence and on survival. This is mainly due to the rarity of this disease and the consequent difficulty in performing randomized trials. The only two prospectively controlled trials concluded that adjuvant chemotherapy did not improve survival. Most of the retrospective trials, which had limited sample size and included heterogeneous patients population and non-standardized therapies, suggested a marginal benefit of chemoradiotherapy in reducing locoregional recurrence and an uncertain impact on survival. Welldesigned multi-institutional randomized trials are necessary to clarify the role of adjuvant therapy. Two ongoing phase Ⅲ trials may provide relevant information.

Retrospective analysis of 67 consecutive cases of pure ovarian immature teratoma

To investigate the development regularity, treatment methods and prognosis of ovary immature teratoma (POIT) Methods Sixty seven patients with POIT, admitted from 1958 to 1998, were retrospectively analyzed There were 31 patients with stage Ⅰ, 4 with stage Ⅱ, 2 with stage Ⅲ and 1 with stage Ⅳ lesions Twenty seven patients had recurrences and 2 had distant metastases Unilateral adnexectomy was performed for stage Ⅰ lesions From the 1980s, this was followed by four cycles of combination chemotherapy (VAC, PVB or BEP×3 cycles) as post operative adjuvant therapy Combined chemotherapy and multiple operations were performed for advanced and recurrent lesions Results The overall survival rate was 75% (50/67) However, there was a remarkable difference in the results from the various periods From 1958 to 1983, the 5 year survival rate was 40% (6/15), and it was raised to 79% (26/33) from 1984 to 1993 In the period 1994 to 1998, 95% (18/19)of patients were rescued Thirty five patients who had early lesions (stage Ⅰ and Ⅱ) had a 5 year survival rate of 91 4% (32/35) Thirty two patients with recurrent or advanced lesions had a 5 years survival rate of 56% (18/32) There were 8 patients with grade Ⅲ tumors and their 5 year survival rate was only 25% (2/8) The chief prognostic factors for this disease are clinical stage, pathological grade and adequate treatment Conclusion POIT is a potentially curable disease in today’s practice It is characterized by the fact that recurrent tumors may be converted back to mature ones as time goes on With chemotherapy, these is a good opportunity to rescue those patients with recurrent tumors At present, treatment of POIT gives the most satisfactory results among all malignant ovarian germ cell tumor types Tests of serum specific tumor markers (CA19 9, AFP, CA125, CEA) performed preoperatively or before chemotherapy and during follow up have been found helpful in the evaluation of prognosis