Malignant ascites affects approximately 10% of patients with gastric cancer(gC), and poses significant difficulties for both patients and clinicians. In addition to the dismal general condition of affected patients an...Malignant ascites affects approximately 10% of patients with gastric cancer(gC), and poses significant difficulties for both patients and clinicians. In addition to the dismal general condition of affected patients and the diversity of associated complications such as jaundice and ileus, problems in assessing scattered tumors have hampered the expansion of clinical trials for this condition. However, the accumulation of reported studies is starting to indicate that the weak response to treatment in g C patients with malignant ascites is more relevant to their poor prognosis rather than to the ascites volume at diagnosis. Therefore, precise assessment of initial state of ascites, repetitive evaluation of treatment efficacy, selection of suitable treatment, and swift transition to other treatment options as needed are paramount to maximizing patient benefit. Accurately determining ascites volume is the crucial first step in clinically treating a patient with malignant ascites. Ultrasonography is commonly used to identify the existence of ascites, and several methods have been proposed to estimate ascites volume. Reportedly, the sum of the depth of ascites at five points(named "five-point method") on three panels of computed tomography images is well correlated to the actual ascites volume and/or abdominal girth. This method is already suited to repetitive assessment due to its convenience compared to the conventional volume rendering method. Meanwhile, a new concept, "Clinical Benefit Response in g C(CBR-GC)", was recently introduced to measure the efficacy of chemotherapy for malignant ascites of g C. CBR-GC is a simple and reliable patient-oriented evaluation system based on changes in performance status and ascites, and is expected to become an important clinical endpoint in future clinical trials. The principal of treatment for g C patients with ascites is palliation and prevention of ascites-related symptoms. The treatment options are various, including a standard treatment based on the available guidelines, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(HIPEC), laparoscopic HIPEC alone, intravenous chemotherapy, intraperitoneal chemotherapy, and molecular targetingtherapy. Although each treatment option is valid,further research is imperative to establish the optima choice for each patient.展开更多
The purpose of this article is to review the role of maintenance therapy in the treatment of advanced nonsmall cell lung cancer(NSCLC). A brief overview about induction chemotherapy and its primary function in NSCLC i...The purpose of this article is to review the role of maintenance therapy in the treatment of advanced nonsmall cell lung cancer(NSCLC). A brief overview about induction chemotherapy and its primary function in NSCLC is provided to address the basis of maintenance therapies foundation. The development of how maintenance therapy is utilized in this population is discussed and current guidelines for maintenance therapy are reviewed. Benefits and potential pitfalls of maintenance therapy are addressed, allowing a comprehensive review of the achieved clinical benefit that maintenance therapy may or may not have on NSCLC patient population. A review of current literature was conducted and a table is provided comparing the results of various maintenance therapy clinical trials. The table includes geographical location of each study, the number of patients enrolled, progression free survival and overall survival statistics, post-treatment regimens and if molecular testing was conducted. The role of molecular testing in relation to therapeutic treatment options foradvanced NSCLC patients is discussed. A treatment algorithm clearly depicts first line and second line treatment for management of NSCLC and includes molecular testing, maintenance therapy and the role clinical trials have in treatment of NSCLC. This treatment algorithm has been specifically tailored and developed to assist clinicians in the management of advanced NSCLC.展开更多
Monoclonal antibodies against epidermal growth factor receptor(EGFR) are used in the treatment of advanced colorectal cancer. However, these agents can induce severe dermatological side effects that discourage their a...Monoclonal antibodies against epidermal growth factor receptor(EGFR) are used in the treatment of advanced colorectal cancer. However, these agents can induce severe dermatological side effects that discourage their administration in patients with chronic dermatological disease. EGFR plays a key role in normal skin development and immunological function, and is expressed in various tissues and organs, although contrarily, it is overexpressed in psoriasis-related skin lesions. Thus, discussion is ongoing regarding the putative pathological role and therapeutic potential of this protein. We herein report on a patient with advanced colon cancer and concomitant long-standing psoriasis vulgaris who received antiEGFR antibody monotherapy as a third-line treatment for metastatic disease. One week after the initiation of treatment, the patient's skin lesions dramatically subsided and the improvement was sustained during therapy. Based on this case, we propose that anti-EGFR antibody therapy is not necessarily contraindicated in patients with psoriasis vulgaris. Moreover, the findings reaffirmed that EGFR is an important molecule in the pathology of psoriasis.展开更多
A recent subgroup analysis of the TRIBE trial suggested that FOLFOXIRI plus bevacizumab may be a preferred option for the first-line treatment of only right-sided metastatic colorectal cancer(mCRC), regardless of RAS ...A recent subgroup analysis of the TRIBE trial suggested that FOLFOXIRI plus bevacizumab may be a preferred option for the first-line treatment of only right-sided metastatic colorectal cancer(mCRC), regardless of RAS or BRAF status. Our subanalysis of a phase Ⅱ trial of the FOLFOXIRI triplet regimen plus bevacizumab in patients with mCRC who had RAS mutant tumors showed that tumor shrinkage was better and the duration of treatment was longer in patients with leftsided tumors than in those with right-sided tumors, leading to a higher rate of conversion to surgery in mCRC patients with left-sided tumors. The early and deep responses to the triplet-regimen in patients with left-sided tumors might facilitate conversion treatment resulting in favorable survival. Our data suggest that the FOLFOXIRI plus bevacizumab might be a promising treatment for left-sided mCRC involving RAS mutant tumors.展开更多
目的系统评价腹腔镜下腹股沟疝修补术中腹膜前放置引流管的临床疗效。方法检索PubMed、Embase、Cochrane Library、Web of Science、万方、中国生物医学文献服务系统、中国知网、维普等数据库,收集腹腔镜下经腹膜前腹股沟疝修补术(TAPP...目的系统评价腹腔镜下腹股沟疝修补术中腹膜前放置引流管的临床疗效。方法检索PubMed、Embase、Cochrane Library、Web of Science、万方、中国生物医学文献服务系统、中国知网、维普等数据库,收集腹腔镜下经腹膜前腹股沟疝修补术(TAPP)或完全腹膜外腹股沟疝修补术(TEP)中腹膜前放置引流管减少血清肿形成的相关研究文献,检索时间为2000年9月至2022年9月,由2名研究人员严格按照纳入/排除标准独立完成文献筛选、资料提取及质量评价等,采用RevMan 5.3软件进行Meta分析。结果共纳入9篇文献,1944例患者。Meta分析显示:观察组(腹膜前放置引流管)术后血清肿形成率显著低于对照组(腹膜前未放置引流管)(P<0.00001,I~2=42%);TAPP(P<0.0001,I~2=0%)或TEP(P<0.00001,I~2=0%)中观察组较对照组术后血清肿形成率均更低。观察组手术时间较对照组更长(P<0.00001,I~2=17%)。2组术中出血量、术后24 h及1周疼痛评分比较差异均无统计学意义(P>0.05,I~2=0%)。结论腹腔镜下腹股沟疝修补术中腹膜前放置引流管能有效降低患者术后血清肿的形成率,且具有较好的安全性。展开更多
BACKGROUND Hemorrhagic chronic radiation proctitis(CRP) is a common late complication of irradiation of the pelvis and seriously impairs life quality. There is no standard treatment for hemorrhagic CRP. Medical treatm...BACKGROUND Hemorrhagic chronic radiation proctitis(CRP) is a common late complication of irradiation of the pelvis and seriously impairs life quality. There is no standard treatment for hemorrhagic CRP. Medical treatment, interventional treatment, and surgery are available, but they are limited in their applications due to nondefinite efficacy or side effects. Chinese herbal medicine(CHM), as a complementary or alternative therapy, may provide another option for hemorrhagic CRP treatment.CASE SUMMARY A 51-year-old woman with cervical cancer received intensity-modulated radiation therapy and brachytherapy with a total dose of 93 Gy fifteen days after hysterectomy and bilateral adnexectomy. She received six additional cycles of chemotherapy with carboplatin and paclitaxel. Nine months after radiotherapy treatment, she mainly complained of 5-6 times diarrhea daily and bloody purulent stools for over 10 d. After colonoscopy examinations, she was diagnosed with hemorrhagic CRP with a giant ulcer. After assessment, she received CHM treatment. The specific regimen was 150 mL of modified Gegen Qinlian decoction(GQD) used as a retention enema for 1 mo, followed by replacement with oral administration of 150 mL of modified GQD three times per day for 5 mo. After the whole treatment, her diarrhea reduced to 1-2 times a day. Her rectal tenesmus and mild pain in lower abdomen disappeared. Both colonoscopy and magnetic resonance imaging confirmed its significant improvement. During treatment,there were no side effects, such as liver and renal function damage.CONCLUSION Modified GQD may be another effective and safe option for hemorrhagic CRP patients with giant ulcers.展开更多
AIM:to determine whether fluoroscope time is a good predictor of patient radiation exposure during endoscopic retrograde cholangiopancreatography.METHODS:this is a prospective observational study of consecutive patien...AIM:to determine whether fluoroscope time is a good predictor of patient radiation exposure during endoscopic retrograde cholangiopancreatography.METHODS:this is a prospective observational study of consecutive patients undergoing endoscopic retrograde cholangiopancreatography in a tertiary care setting.Data related to radiation exposure were collected.The following measures were obtained:Fluoroscopy time(FT),dose area product(DAP)and dose at reference point(DOSERP).Coefficients of determination were calculated to analyze the correlation between FT,DAP and DOSRP.Agreement between FT and DAP/DOSRP was assessed using Bland Altman plots.RESULTS:Four hundred sixty-three data sets were obtained.Fluoroscopy time average was 7.3 min.Fluoroscopy related radiation accounted for 86%of the total DAP while acquisition films related radiation accounted for 14%of the DAP.For any given FT there are wide ranges of DAP and DOSERP and the variability in both increases as fluoroscopy time increases.The coefficient of determination(R2)on the non transformed data for DAP and DOSERP versus FT were respectively 0.416 and0.554.While fluoroscopy use was the largest contributor to patient radiation exposure during endoscopic retrograde cholangiography(ERCP),there is a wide variability in DAP and DOSERP that is not accounted for by FT.DAP and DOSERP increase in variability as FT increases.This translates into poor accuracy of FT in predicting DAP and DOSERP at higher radiation doses.CONCLUSION:DAP and DOSERP in addition to FT should be adopted as new ERCP quality measures to estimate patient radiation exposure.展开更多
基金Non-profit Epidemiological and Clinical Research Organization
文摘Malignant ascites affects approximately 10% of patients with gastric cancer(gC), and poses significant difficulties for both patients and clinicians. In addition to the dismal general condition of affected patients and the diversity of associated complications such as jaundice and ileus, problems in assessing scattered tumors have hampered the expansion of clinical trials for this condition. However, the accumulation of reported studies is starting to indicate that the weak response to treatment in g C patients with malignant ascites is more relevant to their poor prognosis rather than to the ascites volume at diagnosis. Therefore, precise assessment of initial state of ascites, repetitive evaluation of treatment efficacy, selection of suitable treatment, and swift transition to other treatment options as needed are paramount to maximizing patient benefit. Accurately determining ascites volume is the crucial first step in clinically treating a patient with malignant ascites. Ultrasonography is commonly used to identify the existence of ascites, and several methods have been proposed to estimate ascites volume. Reportedly, the sum of the depth of ascites at five points(named "five-point method") on three panels of computed tomography images is well correlated to the actual ascites volume and/or abdominal girth. This method is already suited to repetitive assessment due to its convenience compared to the conventional volume rendering method. Meanwhile, a new concept, "Clinical Benefit Response in g C(CBR-GC)", was recently introduced to measure the efficacy of chemotherapy for malignant ascites of g C. CBR-GC is a simple and reliable patient-oriented evaluation system based on changes in performance status and ascites, and is expected to become an important clinical endpoint in future clinical trials. The principal of treatment for g C patients with ascites is palliation and prevention of ascites-related symptoms. The treatment options are various, including a standard treatment based on the available guidelines, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(HIPEC), laparoscopic HIPEC alone, intravenous chemotherapy, intraperitoneal chemotherapy, and molecular targetingtherapy. Although each treatment option is valid,further research is imperative to establish the optima choice for each patient.
文摘The purpose of this article is to review the role of maintenance therapy in the treatment of advanced nonsmall cell lung cancer(NSCLC). A brief overview about induction chemotherapy and its primary function in NSCLC is provided to address the basis of maintenance therapies foundation. The development of how maintenance therapy is utilized in this population is discussed and current guidelines for maintenance therapy are reviewed. Benefits and potential pitfalls of maintenance therapy are addressed, allowing a comprehensive review of the achieved clinical benefit that maintenance therapy may or may not have on NSCLC patient population. A review of current literature was conducted and a table is provided comparing the results of various maintenance therapy clinical trials. The table includes geographical location of each study, the number of patients enrolled, progression free survival and overall survival statistics, post-treatment regimens and if molecular testing was conducted. The role of molecular testing in relation to therapeutic treatment options foradvanced NSCLC patients is discussed. A treatment algorithm clearly depicts first line and second line treatment for management of NSCLC and includes molecular testing, maintenance therapy and the role clinical trials have in treatment of NSCLC. This treatment algorithm has been specifically tailored and developed to assist clinicians in the management of advanced NSCLC.
文摘Monoclonal antibodies against epidermal growth factor receptor(EGFR) are used in the treatment of advanced colorectal cancer. However, these agents can induce severe dermatological side effects that discourage their administration in patients with chronic dermatological disease. EGFR plays a key role in normal skin development and immunological function, and is expressed in various tissues and organs, although contrarily, it is overexpressed in psoriasis-related skin lesions. Thus, discussion is ongoing regarding the putative pathological role and therapeutic potential of this protein. We herein report on a patient with advanced colon cancer and concomitant long-standing psoriasis vulgaris who received antiEGFR antibody monotherapy as a third-line treatment for metastatic disease. One week after the initiation of treatment, the patient's skin lesions dramatically subsided and the improvement was sustained during therapy. Based on this case, we propose that anti-EGFR antibody therapy is not necessarily contraindicated in patients with psoriasis vulgaris. Moreover, the findings reaffirmed that EGFR is an important molecule in the pathology of psoriasis.
文摘A recent subgroup analysis of the TRIBE trial suggested that FOLFOXIRI plus bevacizumab may be a preferred option for the first-line treatment of only right-sided metastatic colorectal cancer(mCRC), regardless of RAS or BRAF status. Our subanalysis of a phase Ⅱ trial of the FOLFOXIRI triplet regimen plus bevacizumab in patients with mCRC who had RAS mutant tumors showed that tumor shrinkage was better and the duration of treatment was longer in patients with leftsided tumors than in those with right-sided tumors, leading to a higher rate of conversion to surgery in mCRC patients with left-sided tumors. The early and deep responses to the triplet-regimen in patients with left-sided tumors might facilitate conversion treatment resulting in favorable survival. Our data suggest that the FOLFOXIRI plus bevacizumab might be a promising treatment for left-sided mCRC involving RAS mutant tumors.
基金Supported by The Chongqing Research Program of Basic Research and Frontier Technology,No. cstc2018jcyj AX0775The Open Foundation of The Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment。
文摘BACKGROUND Hemorrhagic chronic radiation proctitis(CRP) is a common late complication of irradiation of the pelvis and seriously impairs life quality. There is no standard treatment for hemorrhagic CRP. Medical treatment, interventional treatment, and surgery are available, but they are limited in their applications due to nondefinite efficacy or side effects. Chinese herbal medicine(CHM), as a complementary or alternative therapy, may provide another option for hemorrhagic CRP treatment.CASE SUMMARY A 51-year-old woman with cervical cancer received intensity-modulated radiation therapy and brachytherapy with a total dose of 93 Gy fifteen days after hysterectomy and bilateral adnexectomy. She received six additional cycles of chemotherapy with carboplatin and paclitaxel. Nine months after radiotherapy treatment, she mainly complained of 5-6 times diarrhea daily and bloody purulent stools for over 10 d. After colonoscopy examinations, she was diagnosed with hemorrhagic CRP with a giant ulcer. After assessment, she received CHM treatment. The specific regimen was 150 mL of modified Gegen Qinlian decoction(GQD) used as a retention enema for 1 mo, followed by replacement with oral administration of 150 mL of modified GQD three times per day for 5 mo. After the whole treatment, her diarrhea reduced to 1-2 times a day. Her rectal tenesmus and mild pain in lower abdomen disappeared. Both colonoscopy and magnetic resonance imaging confirmed its significant improvement. During treatment,there were no side effects, such as liver and renal function damage.CONCLUSION Modified GQD may be another effective and safe option for hemorrhagic CRP patients with giant ulcers.
文摘AIM:to determine whether fluoroscope time is a good predictor of patient radiation exposure during endoscopic retrograde cholangiopancreatography.METHODS:this is a prospective observational study of consecutive patients undergoing endoscopic retrograde cholangiopancreatography in a tertiary care setting.Data related to radiation exposure were collected.The following measures were obtained:Fluoroscopy time(FT),dose area product(DAP)and dose at reference point(DOSERP).Coefficients of determination were calculated to analyze the correlation between FT,DAP and DOSRP.Agreement between FT and DAP/DOSRP was assessed using Bland Altman plots.RESULTS:Four hundred sixty-three data sets were obtained.Fluoroscopy time average was 7.3 min.Fluoroscopy related radiation accounted for 86%of the total DAP while acquisition films related radiation accounted for 14%of the DAP.For any given FT there are wide ranges of DAP and DOSERP and the variability in both increases as fluoroscopy time increases.The coefficient of determination(R2)on the non transformed data for DAP and DOSERP versus FT were respectively 0.416 and0.554.While fluoroscopy use was the largest contributor to patient radiation exposure during endoscopic retrograde cholangiography(ERCP),there is a wide variability in DAP and DOSERP that is not accounted for by FT.DAP and DOSERP increase in variability as FT increases.This translates into poor accuracy of FT in predicting DAP and DOSERP at higher radiation doses.CONCLUSION:DAP and DOSERP in addition to FT should be adopted as new ERCP quality measures to estimate patient radiation exposure.
