Objective To determine the oncological outcomes following the intersphincteric resection (ISR) for lower rectal cancer and influencing factors. Methods Reviewed the reports on ISR for lower rectal cancer, and summarized the oncological outcomes and influencing factors. The oncological outcomes included local and distant recurrence rates, postoperative survival, and mortality rates. Tumor indicators, surgical techniques, and perioperative radiochemotherapy were included in the influencing factors. Results The recurrence, survival, and mortality rates following ISR resemble traditional operations. Higher stages, metastasis, and non-standard operations affect the oncological outcomes significantly. Preoperative radiochemotherapy could improve the efficacy, but probably at the cost of postoperative anal function. Conclusions The oncological outcomes following ISR are acceptable. The careful case selection and rational arrangements of radiochemotherapy will allow better outcomes.
目的:比较常规放射治疗与放射治疗同期合并顺铂(PDD)加卡培他滨(CAP)治疗局部晚期鼻咽癌的有效性,同时评价此联合方式的安全性。方法:从2003年2月至2005年11月,78例局部晚期鼻咽癌患者(Ⅲ、Ⅳa,92分期)随机分为两组,放化疗组在放疗的第1、4、7周均用PDD+CAP各化疗一周期,PDD:20mg/m2,静脉滴注,连用5天;CAP:1000mg/m2,每天2次,连用14天,休7天;21天为一周期。两组放疗方法相同:鼻咽原发灶采用60Co外照射,颈部淋巴结引流区采用60Co前切线照射加深部X线垂直照射,鼻咽部剂量为65～70 Gy／6.5～7周,颈淋巴结转移灶剂量为65～70 Gy／6.5～7周。结果:放化疗组及单放组治疗结束后3个月鼻咽部肿瘤完全消退率分别为89.7%,69.2%(P﹤0.05)。3年生存率分别为76.9%,53.8%(P﹤0.05)。结论:顺铂加卡培他滨方案联合放化疗治疗局部晚期鼻咽癌可改善患者的生存,毒副反应可耐受。
【摘要】 目的 探讨颅内原发生殖细胞瘤的临床特征。方法 收集华西医院脑外科2000年1月—2009年3月119例颅内原发生殖细胞瘤的临床资料进行回顾性分析。结果 发病率约占同期颅内肿瘤的 1.1%。男〖DK〗∶女=1.64〖DK〗∶1,平均发病年龄15.4岁。临床表现主要为颅内高压症状及视力视野改变,分别为61、56例；肿瘤主要来源于松果体区及鞍区；64例患者行放疗或放疗加化疗,随访45例。55例患者行手术治疗(其中术后行单纯放疗19例,放疗加化疗5例),随访36例。随访时间3~94个月,平均29.7个月。行放疗和放化疗的患者3、5年生存率明显高于单纯行手术治疗的患者。结论 颅内原发生殖细胞瘤多见于儿童及青少年,男性多见,肿瘤大多位于松果体区及鞍区。临床表现位于松果体区者主要为颅内高压症状等,位于鞍区者主要为视力视野改变、尿崩等。放疗联合化疗是主要治疗手段。
Objective To explore the safety of neoadjuvant chemoradiotherapy combined with sphincter-preserving operation in treatment of locally advanced low rectal cancer. Methods The clinical data of thirty-four patients admitted into our hospital between June 2007 and June 2009 with T3 and T4 low rectal cancer treated by neoadjuvant chemoradiotherapy and sphincter-preserving operation were collected and analyzed retrospectively. Routine fraction of radiation was given with total dose of 40 Gy, five times a week, 2 Gy per fraction. Patients received oxaliplatin （150 mg/d1）, plus folinic (100 mg/d1-3) and 5FU (750 mg/d1-3) for total 1 cycles started from the 4th week of irradiation. Operation was performed 4 weeks after neoadjuvant therapy. Results After neoadjuvant therapy, all patients underwent surgical resection with average tumor size decreased by 41.2%, tumor T stage decreased in 67.6% （23/34) patients, and lymph nodenegative change rate was 58.8% (10/17). One patient had liver metastasis and one had local recurrence, but without stomal leak. And 88.2% (30/34) patients showed good function of sphincter. Conclusions Neoadjuvant chemoradiotherapy in advanced lower rectal cancer patients has shown its efficacy in down-staging, which is safe without increasing operation complications when combined with sphincterpreserving surgery.
ObjectiveTo investigate effect of carbon nanoparticles on number of lymph nodes harvested in radical operation of rectal cancer after neoadjuvant chemoradiotherapy. MethodsOne hundred and five patients diagnosed with low and middle rectal cancer and received radical operation after neoadjuvant chemoradiotherapy in Cancer Hospital, Chinese Academy of Medical Sciences from March 1, 2014 to October 31, 2015 were included. Thirtysix patients were injected with carbon nanoparticles by colonoscopy before surgery and were classified as study group, and the rest patients were classified as control group. According to the same principle of surgery and procedure of pathological specimen handling, the effect of carbon nanoparticles on lymph node harvested in resected specimens was analyzed. ResultsThe total lymph nodes harvested were 764 in the study group and 1 242 in the control group. Among them, the metastatic lymph nodes were 19 in the study group, 58 in the control group. Although the average lymph nodes harvested in each patient had no significant difference between the study group and the control group (21.22±7.13 versus 18.00±9.84, t=1.739, P=0.085), the proportion of patients with 12 or more than 12 lymph nodes harvested in the study group was significantly higher than that in the control group [88.9% (32/36) versus 71.0% (49/69), χ2=4.287, P=0.038]. The ratio of patients with metastatic lymph nodes [27.8% (10/36) versus 33.3% (23/69), χ2=0.339, P=0.561] and the average metastatic lymph nodes harvested in each patient (1.90±1.29 versus 2.52±2.33, t=0.788, P=0.437) all had no significant differences between the study group and the control group. ConclusionThe injection of carbon nanoparticles by colonoscopy before surgery could increase detection rate of 12 or more than 12 lymph nodes in resected specimens of patients who were diagnosed with low and middle rectal cancer and received radical operation after neoadjuvant chemoradiotherapy.
ObjectiveTo construct a multimodal imaging radiomics model based on enhanced CT features to predict tumor regression grade (TRG) in patients with locally advanced rectal cancer (LARC) following neoadjuvant chemoradiotherapy (NCRT). MethodsA retrospective analysis was conducted on the Database from Colorectal Cancer (DACCA) at West China Hospital of Sichuan University, including 199 LARC patients treated from October 2016 to October 2023. All patients underwent total mesorectal excision after NCRT. Clinical pathological information was collected, and radiomics features were extracted from CT images prior to NCRT. Python 3.13.0 was used for feature dimension reduction, and univariate logistic regression (LR) along with Lasso regression with 5-fold cross-validation were applied to select radiomics features. Patients were randomly divided into training and testing sets at a ratio of 7∶3 for machine learning and joint model construction. The model’s performance was evaluated using accuracy, sensitivity, specificity, and the area under the curve (AUC). Receiver operating characteristic curve (ROC), confusion matrices, and clinical decision curves (DCA) were plotted to assess the model’s performance. ResultsAmong the 199 patients, 155 (77.89%) had poor therapeutic outcomes, while 44 (22.11%) had good outcomes. Univariate LR and Lasso regression identified 8 clinical pathological features and 5 radiomic features, including 1 shape feature, 2 first-order statistical features, and 2 texture features. LR, support vector machine (SVM), random forest (RF), and eXtreme gradient boosting (XGBoost) models were established. In the training set, the AUC values of LR, SVM, RF, XGBoost models were 0.99, 0.98, 1.00, and 1.00, respectively, with accuracy rates of 0.94, 0.93, 1.00, and 1.00, sensitivity rates of 0.98, 1.00, 1.00, and 1.00, and specificity rates of 0.80, 0.67, 1.00, and 1.00, respectively. In the testing set, the AUC values of 4 models were 0.97, 0.92, 0.96, and 0.95, with accuracy rates of 0.87, 0.87, 0.88, and 0.90, sensitivity rates of 1.00, 1.00, 1.00, and 0.95, and specificity rates of 0.50, 0.50, 0.56, and 0.75. Among the models, the XGBoost model had the best performance, with the highest accuracy and specificity rates. DCA indicated clinical benefits for all 4 models. ConclusionsThe multimodal imaging radiomics model based on enhanced CT has good clinical application value in predicting the efficacy of NCRT in LARC. It can accurately predict good and poor therapeutic outcomes, providing personalized clinical surgical interventions.
Objective To investigate efficacy and toxicity of XELOX or FOLFOX4 regimen as neoadjuvant concurrent chemoradiotherapy for stage Ⅱ/Ⅲ middle and low rectal cancer. Methods From June 2011 to March 2014, 120 patients with stage Ⅱ/Ⅲ middle and low rectal cancer who underwent the surgical treatment were enrolled in The Fifth People’s Hospital of Qinghai Province, then were randomly divided into radiotherapy+FOLFOX4 regimen group and radiotherapy+XELOX regimen group. The radiotherapy and chemotherapy were performed simultaneously before the radical resection of rectal cancer. Three-dimensional conformal radiotherapy: 1.8–2.0 Gy/times, 5 times/week, a total of 25 times, the total dose was 45.0–50.0 Gy. At the same time, 2 cycles of chemotherapy were performed according to the FOLFOX4 program (oxaliplatin+leucovorin+5-fluorouracil) or XELOX regimen (capecitabine tablet+oxaliplatin). The radical surgery was performed on 4 to 8 weeks after the preoperative chemoradiotherapy, then 8 to 12 cycles of FOLFOX4 chemotherapy and 4 to 6 cycles of XELOX chemotherapy were completed in the radiotherapy+FOLFOX4 regimen group and the radiotherapy+XELOX regimen group respectively on 1 month after the radical surgery. The curative effect and the occurrence of acute toxicity were observed. Results ① There were no significant differences in thegeneral data such as the gender, age, cT stage, cN stage, TNM stage, histological type, differentiation degree, etc. between the two groups(P>0.05). ② The reduced staging rates of cT and cN in the radiotherapy+XELOX regimen group was 63.3% (38/60) and 86.7% (52/60), respectively, which was significantly higher than that in the radiotherapy+FOLFOX4 regimen group〔38.3% (23/60) and 53.3% (32/60), respectively〕 , the differences were statistically significant (P<0.05). ③ The complete response rate and the effective rate (complete response rate+partial response rate) in the radiotherapy+XELOX regimen group were significantly higher than those in the radiotherapy+FOLFOX4 regimen group (P<0.05). ④ The overall 3-year survival rate in the radiotherapy+XELOX regimen group was significantly higher than that in the radiotherapy+FOLFOX4 regimen group (P<0.05). There were no significant differences in the 3-year disease-free survival rate, distant metastasis rate, and local recurrence rate between the two groups (P>0.05). ⑤ All the patients suffered from 3 to 4 degrees toxicities, however, the incidence rates of the overall toxicity and the diarrhea toxicity in the radiotherapy+XELOX regimen group were significantly lower than those in the radiotherapy+FOLFOX4 regimen group (P<0.05). Conclusion Preliminary results of limited cases in this study show that XELOX regimen is more effective and less acute toxicity than FOLFOX4 regimen for preoperative concurrent chemoradiotherapy for patients with stage Ⅱ/Ⅲ middle and low rectal cancer.
Objective To summarize the application and advancement of neoadjuvant therapy combined with transanal resection in stage T2-3 rectal cancer. Methods Domestic and abroad publications on the studies of neoadjuvant therapy combined with transanal resection in stage T2-3 rectal cancer in recent years were collected and reviewed. Results In selected patients with stage T2-3 rectal cancer, neoadjuvant therapy combined with transanal resection was efficacious in sphincter preservation and complications prevention. Compared with modality without chemoradiation, the recurrence rate had decreased from 17%-62% to 0-20%. Conclusion Selected patients with stage T2-3 rectal cancer can benefit from neoadjuvant chemoradiation combined with transanal resection.