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 aγ-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.

Current landscape of preoperative neoadjuvant therapies for initial resectable colorectal cancer liver metastasis

Colorectal cancer liver metastasis(CRLM)presents a clinical challenge,and optimizing treatment strategies is crucial for improving patient outcomes.Surgical resection,a key element in achieving prolonged survival,is often linked to a heightened risk of recurrence.Acknowledging the potential benefits of preoperative neoadjuvant chemotherapy in managing resectable liver metastases,this approach has gained attention for its role in tumor downsizing,assessing biological behavior,and reducing the risk of postoperative recurrence.However,the use of neoadjuvant chemotherapy in initially resectable CRLM sparks ongoing debates.The balance between tumor reduction and the risk of hepatic injury,coupled with concerns about delaying surgery,necessitates a nuanced approach.This article explores recent research insights and draws upon the practical experiences at our center to address critical issues regarding considerations for initially resectable cases.Examining the criteria for patient selection and the judicious choice of neoadjuvant regimens are pivotal areas of discussion.Striking the right balance between maximizing treatment efficacy and minimizing adverse effects is imperative.The dynamic landscape of precision medicine is also reflected in the evolving role of gene testing,such as RAS/BRAF and PIK3CA,in tailoring neoadjuvant regimens.Furthermore,the review emphasizes the need for a multidisciplinary approach to navigate the comp-lexities of CRLM.Integrating technical expertise and biological insights is crucial in refining neoadjuvant strategies.The management of progression following neoadjuvant chemotherapy requires a tailored approach,acknowledging the diverse biological behaviors that may emerge.In conclusion,this review aims to provide a comprehensive perspective on the considerations,challenges,and advancements in the use of neoadjuvant chemotherapy for initially resectable CRLM.By combining evidencebased insights with practical experiences,we aspire to contribute to the ongoing discourse on refining treatment paradigms for improved outcomes in patients with CRLM.

Multidisciplinary comprehensive treatment of massive hepatocellular carcinoma with hemorrhage:A case report and review of literature

BACKGROUND Hepatocellular carcinoma(HCC),a major contributor to cancer-related deaths,is particularly prevalent in Asia,largely due to hepatitis B virus infection.Its prognosis is generally poor.This case report contributes to the medical literature by detailing a unique approach in treating a large HCC through multidisciplinary collaboration,particularly in patients with massive HCC complicated by ruptured bleeding,a scenario not extensively documented previously.CASE SUMMARY The patient presented with large HCC complicated by intratumoral bleeding.Treatment involved a multidisciplinary approach,providing individualized care.The strategy included drug-eluting bead transarterial chemoembolization,sorafenib-targeted therapy,laparoscopic partial hepatectomy,and standardized sintilimab monoclonal antibody therapy.Six months after treatment,the patient achieved complete radiological remission,with significant symptom relief.Imaging studies showed no lesions or recurrence,and clinical assessments confirmed complete remission.This report is notable as possibly the first docu-mented case of successfully treating such complex HCC conditions through integrated multidisciplinary efforts,offering new insights and a reference for future similar cases.CONCLUSION This study demonstrated effective multidisciplinary treatment for massive HCC with intratumoral bleeding,providing insights for future similar cases.

Multidisciplinary approaches in the management of advanced hepatocellular carcinoma:Exploring future directions

Recently,we read the article“Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy:A case report and review of the literature”published in the World Journal of Gastrointestinal Oncology.The prognosis of advanced hepatocellular carcinoma(HCC)is poor,and multidisciplinary comprehensive treatment is currently the main research direction.This case report demonstrated the efficacy of the combination therapy of transcatheter arterial chemoembolization,hepatic arterial infusion chemotherapy,epclusa,lenvatinib and sintilimab for a patient with advanced HCC,and the report can serve as a reference for clinical practice.We would also like to share some of our views.

Clinical application of multidisciplinary teams in tumor therapy

Multidisciplinary team （MDT） model is a diagnostic and treatment model characterized by interdisciplinarity, integration, centralism, individualization, and precision and is becoming more common in the management of complex malignancies. MDT emphasizes team spirit and a personalized treatment strategy according to the actual condition of each patient. A cooperative and effective multidisciplinary team is an important guarantee for delivering high-quality services to patients. Under the guidance of a medical humanistic concept, MDT provides reasonable, effective, convenient, and a full range of excellent quality medical service to patients. The MDT maximizes patient benefits, and it is the developmental direction for large-scale general hospitals. At the same time, the MDT is also an important measure to strengthen the core competitiveness of hospitals. Here, we introduce the clinical application of the model in tumor therapy as well as the current state and development in our hospital.

Combination therapies improve the anticancer activities of retinoids in neuroblastoma

Most therapeutic protocols for child cancers use cytotoxic agents which have a narrow therapeutic index,and resulting in severe acute and chronic toxicities to normal tissues. Despite the fact that most child cancer patients achieve complete remission after chemotherapy,death still occurs due to relapse of persistent minimal residual disease(MRD) which remaining after initial cytotoxic chemotherapy. Advanced neuroblastoma(NB) is a leading cause of cancer deaths in young children. Retinoids are an important component of advanced NB therapy at the stage of MRD,yet half of all patients treated with 13-cis-retinoic acid still relapse and die. More effective combination therapies,with a lower side-effect profile,are required to improve outcomes for NB. Fenretinide or N-4-hydroxyphenyl retinamide is a synthetic derivative of retinoic acid which works on cancer cells through nuclear receptor-dependent and-independent signalling mechanisms. Moreover,several histone deacetylase inhibitors have entered early phase trials,and,suberoylanilide hydroxamic acid has been approved for use in adult cutaneous T cell lymphoma. A number of studies suggest that retinoid signal activation is necessary for histone deacetylase inhibitor activity. A better understanding of their mechanism of actions will lead to more evidence-based retinoid combination therapies.

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 surgicalcentered MDT mode in recent years.

Targeted molecular therapy (modified RIST regimen) in relapsed high risk stage Ⅳ neuroblastoma: two cases report

The prognosis for children with recurrent or refractory neuroblastoma remains a significant clinical challenge,and currently there are no known curative salvage regimens.In this paper we investigated the effect of imatinib with rapamycin and the chemotherapeutic agents temozolomide and irinotecan.We treated two children with recurrent neuroblastoma with this so called RIST protocol.Both patients,off therapy for 15 and 31 months,respectively are well,and developing normally,without any complications.These findings suggest that a combination regimen of RIST may provide a therapeutic benefit with a favorable toxicity profile to a unfortunate subset of patients with neuroblastoma.

A Pilot Trial Testing the Feasibility of Using Molecular-Guided Therapy in Patients with Recurrent Neuroblastoma

Background: Neuroblastoma is the most common extracranial solid tumor in children, and treatment options for recurrent neuroblastoma are limited. Using molecular profiling to target the molecular vulnerabilities of neuroblastoma with existing therapeutic agents may result in a rational, data-driven approach with potential to improve clinical outcomes. Methods: The primary objective of this pilot study was to evaluate the feasibility of supporting real-time treatment decisions through predictive modeling of genome-wide mRNA gene expression data from neuroblastoma tumor biopsies. Feasibility was defined as completion of tumor biopsy, histopathological evaluation, RNA extraction and quality control, gene expression profiling within a CLIA-certified laboratory, bioinformatic analysis, generation of a drug predicttion report, molecular tumor board review yielding a formulated treatment plan, and independent medical monitor review within a 2-week period. Results: Five patients with multiply relapsed or refractory neuroblastoma were enrolled between April and June 2010. All biopsies passed histopathology and RNA quality control. Generation of gene expression data and its analysis (3-7 days), reports which linked this data into medically actionable drug candidates (1-5 days), molecular tumor board (1-3 days) and independent medical monitor review (1 day) were all completed in real-time. The average time was 10.5 days for all patients. Conclusion: This study shows that it is feasible to create therapeutic treatment plans based on genomic profiling in less than 12 days. This warrants further testing in a Phase I study to determine safety of predicted treatments and evaluate whether the information obtained in these analyses would result in patient benefit.

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.

Neuroblastoma in Children: Intraoperative Goal Directed Therapy, Intraoperative and Postoperative Outcomes

Background: Neuroblastoma is the most common tumor in children. Anesthetic management can be challenging due to the localization and catecholamine-secreting characteristics of the tumor. We undertook a secondary analysis in a previous study to describe patients who underwent neuroblastoma resection. Objective: To describe intraoperative and postoperative outcomes in patients who underwent neuroblastoma resection and to propose optimal intraoperative management for postoperative outcome improvement. Methods: This was a secondary analysis of children who underwent neuroblastoma resection in the initial retrospective study. Results: There were 16 patients with a mean age of 39.3 ± 22.1 months. Seven (43.8%) patients presented with intraoperative or postoperative complications. One (6.3%) patient had intraoperative broncho-laryngospasm and difficult intubation. Two (12.5%) patients had intraoperative hemorrhagic shock. One patient (6.3%) had postoperative renal failure. Two patients (12.5%) had postoperative respiratory failure, and 3 (18.8%) patients had postoperative cardiocirculatory failure. One (6.3%) had postoperative pulmonary sepsis and septicemia. Thirteen (81.3%) patients were intraoperatively transfused. There was no in-hospital mortality. Conclusion: In this cohort, 43.8% of the patients had intraoperative and or postoperative complications in terms of organ dysfunction or sepsis. 81.3% of the patients received intraoperative transfusion. Neuroblastoma surgery can be a challenging situation where cardiovascular instability, high blood loss and transfusion requirements can be encountered. Consequently, preoperative preparation and optimal intraoperative management with validated tools in children could be necessary for a better postoperative outcome in this surgical setting.

Successful Treatment with 177Lutetium-Dotatate and Maintenance Octreotide in a Patient with Esthesioneuroblastoma with Central Nervous System Invasion: Case Report and Review of the Literature

This article presents a case of a patient with relapsed esthesioneuroblastoma (ENB), an aggressive rare tumor that arises from the specialized sensory epithelial olfactory cells in the skull base area, which was initially treated with endoscopic surgery, followed by adjuvant radiotherapy. After local relapse, new surgical approaches and subsequent lines of platin-based chemotherapy were performed. A PET-CT with 68GALIUM DOTATATOC (PET-DOTATOC) showed intense uptake of disease, compatible with the presence of somatostatin receptors, in the face, nodes, liver, bones, and meningeal area. Treatment with 4 cycles of 177Lutetium-Dotatate was performed, followed by maintenance octreotide, with a major radiological and clinical response that is lasting more than 1 year after treatment. This article describes a rare case of a skull-base tumor, with multiple recurrences, in which disease control was achieved with a targeted Peptide Receptor Radionuclide Therapy (PRRT) with 177Lutetium-Dotatate, and discusses factors that could influence the incorporation of this form of therapy. Previous case reports proved the potential efficacy of this therapy usually given for low-grade neuroendocrine tumors and will be carefully reviewed.

雾化吸入疗法合理用药专家共识(2024版)

雾化吸入疗法是一种以呼吸道和肺为靶器官的直接给药方法,是呼吸系统疾病的重要治疗手段。近年来中国呼吸道疾病高发,基层医疗机构雾化及居家雾化治疗普及率显著提高,雾化吸入疗法规范应用和合理用药面临的有关问题亟待解决。为此,由中华医学会临床药学分会牵头,与中国医药教育协会药事管理专业委员会、临床合理用药专业委员会共同组织编写了《雾化吸入疗法合理用药专家共识(2024版)》。该共识详细介绍了雾化吸入疗法的给药特点、安全性和有效性、用药指征、应用流程、药学监护,以及常用小容量雾化装置的选择、新上市的雾化吸入药物、常见呼吸系统疾病雾化吸入疗法推荐给药方案等,旨在为各级医疗机构医务工作者规范开展雾化吸入治疗和合理用药提供专业参考。

糖尿病足合并糖尿病肾病多学科联合治疗规范指标及流程的构建

目的构建糖尿病足(DF)合并糖尿病肾病(DN)的多学科联合治疗规范指标及流程。方法通过文献检索及小组讨论等方法,撰写DF合并DN多学科联合治疗规范指标及流程的初稿并形成专家函询问卷。利用德尔菲法进行3轮专家函询,确立DF合并DN多学科联合治疗规范指标,通过专家论证会最终确定DF合并DN多学科联合治疗流程。结果3轮专家函询问卷有效回收率均>90%,专家权威系数均>0.70;第三轮函询后一级、二级指标的肯德尔协调系数分别为0.268、0.314,变异系数分别为0.084~0.151、0.093~0.189。最终形成的DF合并DN多学科联合治疗规范指标及流程包括9个一级指标、61个二级指标,并在专家论证会讨论基础上形成流程图。结论本研究构建的DF合并DN多学科联合治疗规范指标及流程具有一定的科学性、可靠性和适用性,可为DF合并DN患者的综合管理提供框架。

高危神经母细胞瘤免疫治疗的研究进展

神经母细胞瘤(Neuroblastoma, NB)是儿童最常见的颅外实体肿瘤,因其恶性程度高、易发生早期转移及骨髓转移,严重威胁儿童生命健康。除了传统的手术、化疗、放疗、自体干细胞移植以及13-顺式维甲酸的治疗外,双唾液酸神经节苷脂(GD2)单抗治疗也被纳入国内外NB多模式治疗共识中。尽管如此,高危NB患儿5年生存率仍然低于50%。因此,越来越多的针对NB细胞及其免疫微环境的新免疫疗法正在积极研究中,有望给NB患儿的治疗提供新的思路和希望。本文对目前临床采用的抗GD2疗法和研究中的免疫治疗进行综述。

上颌第一磨牙遗漏MB2伴根尖囊肿的多学科联合治疗1例

由于上颌第一磨牙MB2遗漏导致根尖囊肿,本病例采用显微根管再治疗、根尖切除倒充填、囊肿摘除、骨再生术及冠修复等方法对患牙进行综合治疗。通过临床检查和锥束计算机断层扫描(cone-beam computed tomography,CBCT)观察,患牙临床症状消失,CBCT显示骨缺损区范围减小,密度增加。经多学科联合治疗成功保存了上颌第一磨牙的功能,消除了根尖囊肿,促进了骨缺损的再生修复。

双环醇防治肝脏炎性损伤多学科专家共识

肝脏炎性损伤是许多慢性肝病的始动因素。肝脏炎性损伤可累及全身,反之,全身疾病也会导致肝损伤。肝病的诊治既要考虑肝脏病变本身,又需了解全身各系统疾病与肝脏炎性损伤之间相互影响及其病理生理发生机制。因此,针对肝损伤的诊治,常需多学科讨论,共同决策。肝病治疗的重要环节之一是保护和维持肝功能的稳定,其中如何进行抗炎护肝是制定治疗策略的重要考量因素之一。双环醇是由我国自主研发、用于治疗肝脏炎性损伤的一类化学药物,对各种原因所致的肝脏炎性损伤均具有较好的防治作用,已于“一带一路”沿线九国注册并上市。为此,我们组织了国内相关学科专家,根据肝病诊疗相关指南/共识/临床路径和循证医学证据,结合我国临床实践,总结双环醇在防治肝脏炎性损伤多学科临床应用方面的进展,旨在形成共识,提高双环醇临床使用的科学性和规范性,提升各学科对肝脏炎性损伤的防治水平。

晚期胃癌的综合治疗进展

我国多数胃癌患者在确诊时已处于中晚期,针对晚期胃癌的综合治疗显得至关重要。全身药物治疗是晚期胃癌的主要治疗手段,在精准医疗的理念下,如HER2阳性患者的德曲妥珠单抗治疗,以及免疫治疗如纳武利尤单抗联合化疗,均显著改善了晚期胃癌患者的生存期。同时,局部治疗、营养和社会心理支持也提高了患者的生活质量。本文综合讨论了晚期胃癌围手术期治疗、缩小淋巴结清扫范围及去手术治疗的可行性,并强调多学科综合治疗模式的重要性,以期实现晚期胃癌患者的个体化、精准化治疗。

DNA损伤反应缺陷与高风险神经母细胞瘤

神经母细胞瘤(neuroblastoma,NB)是儿童最常见的颅外实体肿瘤。其中高风险患者进展快、预后差。分子遗传学上,高风险NB特征性表现为染色体不稳定性,以DNA损伤反应(DNA damage response,DDR)缺陷为主。目前已有靶向DDR的抑制剂(如ATR、ATM、PARP、CHK1和WEE1抑制剂)用于高风险NB的治疗。应用DDR缺陷及靶向抑制剂等方式可为高风险NB的精准诊断及治疗提供参考,有望成为治疗高风险NB的新策略。

先天性缺牙治疗的研究进展

先天性缺牙是人类最常见的牙发育异常,影响患者的咀嚼、发音、美观及颌面部发育。由于该疾病的特殊特点,其治疗历时久、花费高,给患者带来心理和经济的双重负担。治疗方法包括儿科、正畸、颌面外科、修复、种植等多学科协作的序列治疗,以及靶向分子治疗和组织工程技术等新兴手段。本文综述了先天性缺牙的疾病特点、传统治疗方式的新进展以及新兴的治疗方法,简述了不同治疗方法的治疗效果,旨在为先天性缺牙患者的临床治疗提供有意义的信息。