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   2016| December  | Volume 12 | Issue 7  
    Online since February 21, 2017

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Current mechanism of acquired resistance to epidermal growth factor receptor-tyrosine kinase inhibitors and updated therapy strategies in human nonsmall cell lung cancer
Kaixian Zhang, Qianqian Yuan
December 2016, 12(7):131-137
DOI:10.4103/0973-1482.200613  PMID:28230005
Lung cancer continues to be a major health problem and the most common cancer-related mortality worldwide with about 80%–85% patients suffering from nonsmall cell lung cancer (NSCLC). More than 80% of NSCLC cases are often diagnosed as advanced stage and harbor epidermal growth factor receptor (EGFR) activating mutation. Although great success in initial response to EGFR-tyrosine kinase inhibitors (EGFR-TKIs) are found in EGFR-mutant NSCLC patients, acquired resistance usually occurs on the continuous treatment. Here, we provide an overview on the mechanism of acquired resistance to EGFR-TKIs in NSCLC therapy as well as current preclinical and clinical evidence of new therapy strategies and inhibitors in the treatment of NSCLC. Many studies have shown that original or induced T790M mutation, human EGFR 2 amplification, and activated secondary signaling such as MET amplification or phosphatidylinositol 3-kinase mutation can lead to acquired resistance to EGFR-TKIs. In addition, transformation from NSCLC to SCLC or conferred epithelial to mesenchymal transition has also been identified as mechanisms of acquired resistance to EGFR-TKIs. Increasing evidence has proven that non-coding RNA including long noncoding RNAs and microRNAs or new EGFR mutation is involved in acquired resistance. Preclinical and clinical Phase 1–3 evidence on combination drug therapy or new generation inhibitors with different tumor-targeting approaches have made those strategies the promising options for EGFR-TKI-resistant NSCLC therapy. This review aims to get deep insight into providing a state-of-the-art overview of the recent advances in the mechanisms of acquired resistance and new strategies for targeted cancer therapy in EGFR-TKI-resistant NSCLC.
  6,206 583 17
Evaluation of the safety and efficacy of percutaneous radiofrequency ablation for treating multiple breast fibroadenoma
Ping Li, Tang Xiao-yin, Dan Cui, Jia-chang Chi, Zhi Wang, Tao Wang, Xing-xing Qi, Bo Zhai
December 2016, 12(7):138-142
DOI:10.4103/jcrt.JCRT_966_16  PMID:28230006
Background: This study was conducted to evaluate the safety and efficacy of ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) for multiple breast fibroadenoma as an alternative to surgical resection. Patients and Methods: Sixty-five patients with multiple breast fibroadenoma accepted general anesthesia and US-guided percutaneous RFA in our hospital from September 2014 to January 2016. Contrast-enhanced US (CEUS) was used immediately after operation to determine whether the tumor was ablated completely. The complete ablation rate (CAR) and the change of focal volume were evaluated by CEUS at the 1st month and the 3rd month after operation. Results: All the patients were diagnosed by needle biopsy. Among all the patients, 256 nodules were found. Forty-six nodules (17.96%) were located <5 mm from epidermis; 26 nodules (10.15%) were located below areola. Complete ablation was achieved for 251 nodules (98.04%) after the 1st month of operation. The volume reduce rate was 39.06% and 75.99% at the 1st and the 3rd month after operation, respectively, of which 45 nodules were completely absorbed (17.58%). There was a statistically significant difference of the volume reduction rate (VRR) after operation (P < 0.01) compared with preoperative breast nodules volume. There were no complications such as skin burn, hemorrhage, and hematoma, nipple discharge in the process during and after RFA. Conclusion: Given advantages of high CAR, mild injury, rapid recovery, and cosmetic outcome desired by the patients, RFA has the potential to become the preferred method in the treatment of breast fibroadenoma.
  3,208 276 3
Screening of gene mutations associated with bone metastasis in nonsmall cell lung cancer
Kun Zhang, Min Zhang, Jinlong Zhu, Wang Hong
December 2016, 12(7):186-190
DOI:10.4103/0973-1482.200597  PMID:28230015
Objective: The objective of this study is to assess the gene mutation of advanced nonsmall cell lung cancer (NSCLC) patients with bone metastasis using next-generation sequencing (NGS), and screen for the driver genes which are associated with bone metastasis of lung cancer. Materials and Methods: Eight clinicopathologic samples from advanced NSCLC combined with bone metastasis patients were collected. Exome sequencing was conducted within 483 tumor-associated genes using Hiseq 2000_PE75 NGS platform. Results: Three thousand six hundred and twenty gene mutations were identified, including point mutation, insertion, and deletion. Among all genes associated with lung cancer signaling pathways, fibroblast growth factor receptor (FGFR), and cyclin-dependent kinase 12 (CDK12) were found to be mutated in all eight patients. The top three genes were FGFR, ataxia telangiectasia mutated, and CDK12, according to mutation frequency. In the meanwhile, hepatocyte nuclear factor 1 alpha, adenomatous polyposis coli, and CD22 were found to be mutated in all eight patients with an over 50% mutation frequency (75%, 62.5%, and 50%, respectively), which would be the most potential genes accounting for bone metastasis in lung cancer patients. Conclusion: Our findings shed light on several important signalling pathways involved in NSCLC, and suggest new potential molecular targets for treatment of NSCLC patients with bone metastasis.
  3,125 198 3
Effect of heat sink on the recurrence of small malignant hepatic tumors after radiofrequency ablation
Zheng-Yu Lin, Guo-Lin Li, Jin Chen, Zhong-Wu Chen, Yi-Ping Chen, Sun-Zhi Lin
December 2016, 12(7):153-158
DOI:10.4103/jcrt.JCRT_959_16  PMID:28230009
Aims: The aim of this study was to investigate the effect of heat sink on the recurrence of hepatic malignant tumors <3 cm after percutaneous radiofrequency ablation (RFA). Subjects and Methods: This study included 564 hepatic malignant tumors <3 cm in 381 patients. Preoperative images were used to determine whether these tumors were adjacent to vessels, and the diameter of adjacent vessels was measured. RFA was performed computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US) guidance, and postoperative imaging follow-up was then conducted. Statistical Analysis Used: SPSS software version 17.0 was used for data processing, and the χ2 test was used for comparative analysis. Two-sided P < 0.05 indicated statistical significance. Results: A total of 33 recurrences were found: 15 in the MR group (15/468), 12 in the US group (12/53), and 6 in the CT group (6/43). Of the 101 lesions adjacent to blood vessels larger than 3 mm, 20 showed recurrence: 10 in the MR group (10/77), 7 in the US group (7/17), and 3 in the CT group (3/7). The recurrence rate of perivascular lesions was higher than that of nonperivascular lesions, and the rate in the MR group was lower those in the US and CT groups. Conclusions: The curative effect of MRI-guided RFA is better than those of US- and CT-guided ablation. The heat sink effect is an important factor affecting recurrence of hepatic malignant tumors after RFA.
  2,972 128 9
Clinical study of transcatheter arterial chemoembolization combined with microwave ablation in the treatment of advanced hepatocellular carcinoma
Wei Li, Wenling Man, Huanqing Guo, Po Yang
December 2016, 12(7):217-220
DOI:10.4103/0973-1482.200598  PMID:28230020
Objective: To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with percutaneous microwave ablation (MWA) in the treatment of advanced hepatocellular carcinoma (HCC). Materials and Methods: Three thousand cases of advanced HCC patients were randomly divided into two groups: 1500 cases in the treatment group were treated with TACE combined with MWA and 1500 cases in the control group were treated with TACE. Results: The effective rate of the treatment group and control group was 71.4% and 42.8%, respectively, and the difference between the two groups was statistically significant (P < 0.05). During the follow-up period at 6, 12, 18, and 24 months postoperatively, the survival rates of the treatment group were 88.1%, 73.8%, 52.3%, and 33.3%, and the survival rates of the control group were 76.2%, 57.1%, 30.9%, and 9.5%, respectively. There was no significant difference in postoperative complications between the two groups. Conclusion: It is safe and effective to use TACE combined with MWA in the treatment of advanced HCC, and the effect of combined treatment is better than that of TACE alone.
  2,757 161 9
Application of colon interposition among the esophageal cancer patients with partial gastrectomy
Qiuqiang Chen, Weimin Mao, Huanming Yu, Yixian Liang, Jiane Wang, Guoping Chen
December 2016, 12(7):212-216
DOI:10.4103/0973-1482.200602  PMID:28230019
Background: Esophageal reconstruction with colon interposition is an alternative solution for the esophageal cancer patients who have partial gastrectomy. The aim of this study was to investigate the therapeutic effects of colon interposition among the esophageal carcinoma patients with partial gastrectomy. Materials and Methods: Under institutional review board approval, 32 esophageal carcinoma patients with a history of partial gastrectomy were included in this study. All the patients had been diagnosed and confirmed squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma by histopathological examination. Surgical approaches, complications and therapeutic results were analyzed in the current study. Results: Thirty-two esophageal carcinoma patients (29 men, 3 women, median age 63.2 years) were included in this study. Isoperistaltic colon interposition was carried out on 14 patients; their 1-year and 2-year survival rate was 92.9% and 78.6%, respectively. Antiperistaltic colon interposition was carried out on 18 patients; their 1-year and 2-year survival rate was 88.9% and 77.8%, respectively. In which, cervical anastomotic leakage was observed on six patients. Conclusion: Colon interposition is an ideal surgical approach for the esophageal carcinoma patients who had partial gastrectomy. Isoperistaltic colon interposition is preferred, but antiperistaltic colon interposition has the advantage that a longer colon can be used.
  2,461 182 -
Iodine-125 radioactive seed tissue implantation as a remedy treatment for recurrent cervical cancer
Lei Han, Changlun Li, Junye Wang, Xueqi He, Xiao Zhang, Jundong Yang, Guofeng Liu
December 2016, 12(7):176-180
DOI:10.4103/0973-1482.200611  PMID:28230013
Purpose: This study was designed to discuss feasibility, short-term efficacy, and complications of iodine-125 radioactive seed tissue implantation for remedying recurrent cervical cancer. Materials and Methods: From June 2009 to December 2010, 17 patients with recurrent cervical cancer received radioactive seed implantation under computed tomography (CT) guidance. Matched peripheral dose was 145 Gy, while the number of implanted seeds was from 6 to 68 with a median of 20. Efficacy was determined based on the results of CT and 18 F-fluorodeoxyglucose positron emission tomography/CT. Results: Postoperative follow-ups were from 4 to 18 months with a median follow-up time of 9.5 months. Nine patients died during follow-up while remaining patients survived during the follow-up period. Evaluation of efficacy: six patients had a complete response, four patients had a partial response, and seven patients had progressive disease, clinical efficacy rate as 58% (10/17). No patients had complications of radiation injury. Rate of 6 months and 1-year survival period was 74.8% and 18.3%, respectively. Comparing to patients who responded ineffectively to radioactive seed implantation, patients who responded effectively to radioactive seed implantation had a longer survival period (median 7.2 vs. median 10.4), in which the difference was statistically significant (P = 0.038). Conclusion: Iodine-125 radioactive seed tissue implantation is a feasible, effective, and safe treatment method for remedying or palliative treatment of recurrent cervical cancer. Patients who have recurrent cervical cancer and responded effectively to radioactive seed implantation will have a longer survival period.
  2,478 136 3
Changes of CD4+ T-cell subsets after radiofrequency ablation in lung cancer and its significance
Wang Shaobin, Xiong Yu, Lin Jiatian, Chen Zaizhong, Dai Luping, Chen Junhui
December 2016, 12(7):166-170
DOI:10.4103/0973-1482.200609  PMID:28230011
Aims: To analyze the changes of CD4+ T-cell subsets following radiofrequency ablation (RFA) in lung cancer and the impact of RFA on the antitumor immunity. Subjects and Methods: Flow cytometry was employed to detect CD4+ T-cell subsets in the peripheral blood from 45 healthy controls and 45 lung cancer patients before and after RFA. The correlation between CD4+ T-cell subsets and the clinical characteristics was discussed by comparing the results between different groups. Results: Compared with the healthy controls, the lung cancer patients showed a decline in Th1 cells, but higher Th2, Th17, and Treg cells (P < 0.05). Th1 cell level and Th1/Th2 cell ratio were significantly lower for stage III/IV than Stage I/II and also lower for patients with Karnofsky Performance Status (KPS) score <60 than ≥ 60 (P < 0.05). The levels of Th2, Th17, and Treg cells were much higher for patients with Stage III/IV and KPS score <60 (P < 0.05). After 2 weeks of RFA, the level of Th1 cells and Th1/Th2 cell ratio increased, while the levels of Th2, Th17, and Treg cells declined (P < 0.05). For lesions with ablation volume ≥ 70%, the level of Th1 cells and Th1/Th2 cell ratio increased, whereas the levels of Th2, Th17, and Treg cells declined dramatically (P < 0.05). Conclusions: The level of Th1 cells declined in lung cancer patients, especially for patients with Stage III/IV and KPS score <60. After RFA, the level of Th1 cells and Th1/Th2 increased, whereas the levels of Th2, Th17, and Treg cells declined, indicating an improvement of antitumor immunity. The changes were more prominent for lesions with ablation volume ≥ 70%.
  2,449 135 2
Evaluation and identification of factors related to KRAS and BRAF gene mutations in colorectal cancer: A meta-analysis
Li Lin, Guang-yong Chen, Chun-wei Xu, Hai-yan Wang, Yong-fang Wu, Mei-yu Fang
December 2016, 12(7):191-198
DOI:10.4103/0973-1482.200601  PMID:28230016
Objective: The aim of this meta-analysis is to evaluate the distribution pattern of KRAS and BRAF mutations in colorectal cancer. Materials and Methods: The database was searched without language restrictions. Meta-analyses were conducted using the STATA software. We calculated the odds ratio (OR) and its 95% confidence interval (95% CI) to estimate the distribution of and correlation between KRAS and BRAF mutations, CpG island methylator phenotype (CIMP), and microsatellite instability (MSI) in left- and right-sided colorectal cancer. Results: The studies were divided into five groups: (1) distribution of KRAS/BRAF mutations in distal and proximal colorectal cancer, the summary OR value was 1.24 versus 4.03, (2) distribution of KRAS/BRAF mutations in CIMP-low/Neg and CIMP-high (CIMP-H) tumors, the summary OR value was 0.77 versus 10.49, (3) distribution of KRAS/BRAF mutations in MSI-low (MSI-L)/microsatellite stable (MSS) and MSI-high (MSI-H) tumors, the summary OR value was 0.51 versus 9.60, (4) proportion of CIMP-H/MSI-H tumors among distal and proximal colorectal tumors, the summary OR value was 3.66 versus 6.54, and (5) proportion of CIMP-H tumors among MSI-L/MSS and MSI-H tumors, the summary OR value was 5.87. Conclusion: The meta-analysis reveals that KRAS has a slightly higher mutation rate in MSI-L/MSS tumors. Moreover, BRAF mutations have higher detection rates in right-sided colorectal cancer, which suggests that BRAF mutations are likely in CIMP-H tumors. Therefore, based on these findings, the molecular diagnostic tests to be conducted in colorectal cancer patients can be determined according to the location/clinical features of the tumor.
  2,282 169 -
Laparoscopic combined with percutaneous ablation for hepatocellular carcinoma under liver capsule: A single Chinese center experience of thirty patients
Zhe Tang, Yi Zhu, Kezhong Tang, Linping Dong, Bin Yang, Heqin Fang, Yulian Wu, Bo Zhang
December 2016, 12(7):143-147
DOI:10.4103/0973-1482.200606  PMID:28230007
Aim of Study: For the tumor lesions close to capsule of the liver, traditional percutaneous radiofrequency ablation (PRFA) is limited due to high incidence of postoperative complications. The aim of the present study is to whether laparoscopic combined with PRFA (LCPR) could effectively ablate the tumor lesions close to capsule of the liver. Methods: A total of 119 patients with subcapsular hepatocellular carcinoma (HCC) were divided into two groups: PRFA group (89 patients) and LCPR group (30 patients). RFA was accomplished through cool-tip RFA system. For LCPR, PRFA was first carried out to destroy tumors deep inside the liver tissue. Then, laparoscopic RFA was performed under the guide of laparoscopic view and destroyed the superficial part of the tumor. Postoperative morbidity and technique effectiveness between two groups were evaluated. Results: In PRFA group, the rate of fever was 70.8% (63/89), and two patients had gallbladder damage. Five patients had ascites. Pain was found in 26 patients (29.2%). In LCPR group, the rate of fever was 22/30 (73.3%). Two patients had ascites and only two patients complained of pain. In PRFA group, 77.5% (69/89) of the tumors were totally ablated, and in LCPR, 93.3% (28/30) of the tumors were destroyed without any residuals. Conclusion: LCPR could significantly reduce the incidence of postoperative pain and the rate of regional tumor residuals compared to the PRFA, suggesting this method could potentially be useful for subcapsular HCC ablation treatment.
  2,302 128 1
Analysis of therapeutic effectiveness and prognostic factor on argon-helium cryoablation combined with transcatheter arterial chemoembolization for the treatment of advanced hepatocellular carcinoma
Chen Huang, Weizhao Zhuang, Huigang Feng, Huizhuang Guo, Yukuan Tang, Hanwei Chen, Yi Huang
December 2016, 12(7):148-152
DOI:10.4103/0973-1482.200605  PMID:28230008
Objective: The objective of this study was to evaluate the effectiveness on argon-helium cryoablation combined with transcatheter arterial chemoembolization (TACE) in treating advanced hepatocellular carcinoma (HCC) and its influence factor. Materials and Methods: This trial was approved by the Guangzhou Panyu Central Hospital Ethics Committee. This was a prospective, single-center study conducted in Guangzhou Panyu Central Hospital. After informed consent was obtained, the prospective randomized clinical data of 120 patients with advanced HCC were collected. Based on the therapeutic scheme, the patients were divided into control group (TACE + argon-helium cryoablation) and observed group (TACE group). All the patients were followed up for 60 months. The pre- and post-operative cancer situation, hepatic function situation, complete remission (CR) rate, total effective rate, and survival time were evaluated. The short-term and long-term effectiveness were compared between the two groups. Results: Both the CR rate and total effective rate of the combination group were significantly higher than those of TACE group (P < 0.05). Liver function damage of the combination group was lower than those of TACE group. The survival rate of the combination group was significantly longer than that of TACE group P < 0.05). The Cox regression model revealed that ages, tumor diameter, tumor periportal location, and liver function (Child-Pugh) were significant variables influencing survival time P < 0.05). Conclusion: For the treatment of advanced HCC, argon-helium cryoablation combined with TACE is obviously effective and safe. The ages, tumor diameter, tumor periportal location, and grade of liver function (Child-Pugh) have obvious impacted the treatment effectiveness.
  2,264 134 7
Postesophagectomy airway–gastric fistula successfully treated with subcutaneous fascia flap, tracheal reconstruction, and gastric fistula drainage: A case report and literature review
Changchun Wang, Xun Yang, Jianqiang Zhao, Qixun Chen
December 2016, 12(7):225-227
DOI:10.4103/0973-1482.200599  PMID:28230022
Airway–gastric fistula (AGF) is a dreaded complication of esophagectomy for esophageal cancer. Its presentations and treatment approaches differ from individual to individual. Herein, we report the case of a patient with postesophagectomy AGF that was successfully treated with a subcutaneous fascia flap twisting trachea, and gastric fistula drainage. On reviewing the related literature, we consider that protecting the airway with living soft tissues and draining the mediastinum are the key steps for the surgical treatment of AGF. Airway stenting may be used as a temporary solution, and conservative therapy can be successful in some carefully selected cases.
  2,252 97 -
Nimotuzumab treatment and outcome analysis in patients with leptomeningeal metastasis from nonsmall cell lung cancer
Yanfang Ju, Jinliang Wang, Shengjie Sun, Shunchang Jiao
December 2016, 12(7):181-185
DOI:10.4103/0973-1482.200596  PMID:28230014
Objective: Leptomeningeal metastasis (LM) leades a devastating consequence in patients with nonsmall cell lung cancer(NSCLC). Treatment is very limited for patients with LM. We introduced to use nimotuzumab (also known as h-R3) combined with methotrexate for treating LM in NSCLC patients. Patients and Methods: In the present report, twenty patients with LM of NSCLC were included, and the clinicopathology information and outcomes after treatment were analyzed. Results: All the twenty patients with LM were lung adenocarcinoma. Thirteen patients had poor Eastern Cooperative Oncology Group performance status (≥ 3) before treatment, fifteen patients received combined administration of h-R3 and methotrexate, and another five patients received h-R3 treatment alone. The median survival time after the diagnosis of LM was 5 months (range, 2.4–7.6 months) for these twenty patients. The mean cerebrospinal fluid opening pressure was 270mmH2O before treatment and decreased significantly after treatment (140 mmH2O) (P < 0.001). Associated symptoms were relieved quickly after one or two cycles of intrathecal therapy. Conclusion: These findings indicated that nimotuzumab might be a potential drug for treatment of LM in NSCLC patients.
  2,093 153 2
Safety and feasibility within 24 h of discharge in patents with inoperable malignant lung nodules after percutaneous microwave ablation
Bin Li, Zhiwei Wang, Kang Zhou, Qinzong Gao, Xiaoguang Li
December 2016, 12(7):171-175
DOI:10.4103/0973-1482.200608  PMID:28230012
Context: Minimally invasive interventional therapy is now the more effective treatment strategy for organ-confined malignancy in patients who are poor candidates for surgery. Microwave ablation (MWA) in lung malignancy has been receiving much attention as an effective minimally invasive approach. Aims: The aim of this study is to evaluate the safety and feasibility within 24 h of discharge of patients treated with percutaneous MWA for inoperable malignant lung nodules, and elucidate the factors predisposing to hospital readmission. Subjects and Methods: From September 2014 to April 2016, a total of eighty patients with inoperable malignant lung nodules who underwent 24 h of discharge following percutaneous MWA were consecutively enrolled in this retrospective study. Primary endpoints included the rate of short-term admission and procedure-related complications within 30 days of hospital discharge. The secondary outcomes included the rate of technical success and hospital readmission. Statistical Analysis Used: Student's t- test and Fisher exact test were used to analysis parametric and categorical variables accordingly. Results: The technical success was achieved in 94% of ablation sessions. Within 24 h of discharge was feasible in 73 cases (91.3%), and 7 (8.7%) required short-term admission. The complication rate was 27.5% (22/80), included the major 40.9% (9/22) and minor 59.1% (13/22) complications. Postoperative adverse event was 17.5% (14/80), these was managed conservatively. The lesion location and puncture technique were associated with an increased need for readmission. Conclusions: Routine 24 h discharge following percutaneous MWA for malignant lung nodules is safe and feasible, with relatively low complications and few requirements for short-term readmission.
  2,126 104 -
Dosimetry study of three-dimensional print template-guided precision 125I seed implantation
Zhang Hongtao, Di Xuemin, Yu Huimin, Wang Zeyang, Zhang Lijuan, Zhao Jinxin, Liu Zezhou, Sui Aixia, Wang Juan
December 2016, 12(7):159-165
DOI:10.4103/0973-1482.200607  PMID:28230010
Objective: This study aimed to compare the dose difference in 125 I seed implantation between three-dimensional (3D) print template-guided operation and traditional implantation. Materials and Methods: This study retrospectively analyzed 27 patients who underwent 125I seed implantation from August 2015 to December 2015 in Hebei General Hospital. Of these, 13 underwent seed implantation guided by a 3D print template, named the template group, and 14 underwent traditional implantation, named the traditional group. All patients underwent computed tomography (CT) scan. Then, 3D templates were printed in the template group. The implantation was guided by CT and 3D templates. The patients in the traditional group underwent implantation with free hands guided by CT scan. Postplan was performed after the operation. The dose-volume histogram, D90, and V90 were calculated. The D90 values pre- and post-operation were compared in each group. The postoperation V90 values of the two groups were also compared. Results: The mean D90 values pre- and post-operation in the template group were (87.09 ± 33.63) Gy and (85.31 ± 34.40) Gy, respectively, with no statistically significant difference. The mean D90 values pre- and post-operation in the traditional group were (86.04 ± 29.93) Gy and (74.96 ± 46.10) Gy, respectively, with a statistically significant difference. The mean V90 values postoperation in the template and traditional groups were (92.76% ± 1.89%) and (84.59% ± 7.56%), respectively, with a statistically significant difference. Conclusions: The postplan and preplan dose parameters of 3D print template-guided seed implantation were nearly consistent. The dose parameters of template group superior to the traditional group. The seeds can be implanted accurately with 3D print template.
  2,099 99 4
The significance of transarterial chemoembolization combined with systemic chemotherapy for patients with KRAS wild-type unresectable metachronous colorectal carcinoma with liver metastases
Qiming Yu, Lusha Zhang, Sunfu Fan, Ling Huang, Xinbao Wang, Cai Xindun
December 2016, 12(7):205-211
DOI:10.4103/0973-1482.200603  PMID:28230018
Purpose: The purpose of this study was to assess the survival benefits of transarterial chemoembolization (TACE) combined with systemic chemotherapy as the first-line treatment for metachronous unresectable colorectal carcinoma with liver metastases (CLMs) and to identify prognostic determinants. Patients and Methods: One hundred and fifty-four patients with KRAS wild-type metachronous unresectable CLMs were retrospectively collected from January 2006 to December 2014. Patients were divided into four groups according to treatment modality: 43 patients with chemotherapy alone (Group A), 39 patients with chemotherapy plus TACE (Group B), 38 patients with chemotherapy plus cetuximab (Group C), and 34 patients with chemotherapy plus TACE and cetuximab (Group D). We compared the rate of patients converted to resection for liver metastases (LMs), overall survival among these groups, and assessed prognostic factors. Results: The median interval time from resection of primary tumor to the diagnosis of CMLs was 12.0 months. The 1-, 3-, and 5-year survival rates and median survival time (MST) for all patients were 83.1%, 24.7%, 5.8%, and 22.9 months, respectively. Survival rates were significantly different in four groups at 1 year, 3 years, and 5 years with the MST of 17.5, 28.4, 18.9, and 30.3 months, respectively (P < 0.0001). The R0 resection rates for LMs were 7.0% in Group A, 30.8% in Group B, 10.5% in Group C, and 32.4% in Group D, which were statistically significantly different (P = 0.004). Univariate analysis revealed that posttreatment carcinoembryonic antigen serum level, tumor node (TN) stage, resection of LMs, tumor response, and treatment group were the significant prognostic factors. After adjusting the covariates in multivariate analysis, TN stage (hazard ratio [HR] = 1.394, 95% confidence interval [CI] = 1.027–1.893,P = 0.033), tumor response (HR = 2.901, 95% CI = 2.105–3.999,P < 0.0001), and treatment group (HR = 0.726, 95% CI = 0.594–0.887,P= 0.002) remained independent prognostic determinants. Conclusion: For patients with initially unresectable KRAS wild-type CLMs, chemotherapy plus TACE improved the resectability of LMs and survival compared with chemotherapy alone or chemotherapy plus cetuximab.
  2,001 120 3
Percutaneous intraductal radiofrequency ablation combined with biliary stent placement for malignant biliary obstruction: A case report and review of the literature
Lijun Guan, Jianfeng Wang, Kun Gao, Renyou Zhai
December 2016, 12(7):221-224
DOI:10.4103/0973-1482.200604  PMID:28230021
Percutaneous management of unresectable malignant biliary obstruction remains challenging. Biliary radiofrequency ablation (RFA) using the Habib EndoHBP catheter is a new palliation therapy for malignant biliary obstruction. We report our initial experience of RFA for the management of malignant biliary obstruction. A 58-year-old male was diagnosed with gallbladder cancer. Intraductal bipolar RFA was delivered at power of 10 W for 120 s, followed by stent placement. The patient had immediate stricture improvements after RFA. No severe adverse event occurred. Percutaneous RFA seems to be safe and feasible for the treatment of malignant biliary obstruction. Further studies are warranted.
  1,953 161 1
Comparison of perioperative outcomes between laparoscopic and open surgery for mid-low rectal cancer with total mesorectal excision following neoadjuvant chemoradiotherapy
Weiping Chen, Qiken Li, Pengnian Qiu, Lai Jiang, Zhixuan Fu, Yongtian Fan, Dechuan Li, Peng Liu, Lilong Tang
December 2016, 12(7):199-204
DOI:10.4103/0973-1482.200600  PMID:28230017
Objective: The objective of our study was to determine the feasibility and safety of laparoscopic total mesorectal excision (TME) for mid-low rectal cancer following neoadjuvant chemoradiotherapy (nCRT). Methods: We retrospectively reviewed the records of 172 patients with locally advanced rectal cancer who underwent laparoscopic (n = 75) or conventional open (n = 97) surgery with TME following nCRT from June 2009 to October 2015. Perioperative outcomes and related clinical variables were collected and statistically analyzed. Results: Our results showed that patients who underwent laparoscopic surgery had significantly less blood loss and shorter time to pass first flatus and to start a liquid diet compared to those on open surgery. However, other perioperative outcomes, including operative times, postoperative morbidity rates, number of lymph nodes harvested, and sphincter preservation rates, were not significantly different between the two groups. After controlling for surgical approaches, we found that age, gender, tumor stages, and tumor distance to anal verge were significantly correlated with operative times in both groups. Likewise, age, body mass index, tumor T stages, and tumor distance to anal verge were predictors for postoperative morbidity in both groups. Conclusions: We concluded that laparoscopic TME following nCRT is feasible and safe for patients with mid-low rectal cancer. Furthermore, tumor distance to anal verge and age are two important determinants of both operative times and postoperative morbidity, regardless of surgical option.
  1,963 147 2