ObjectiveTo summarize controversy and progress of multi-slice spiral CT in efficacy evaluation of transformation therapy for advanced gastric cancer.MethodThe recent studies published at home and abroad on the spiral CT in evaluating the therapeutic effect of transformation therapy for the advanced gastric cancer were reviewed and analyzed.ResultsIn recent years, though the energy spectrum and dual-energy CT examinations had appeared, the most common tool in evaluating of the efficacy of transformation therapy for the advanced gastric cancer was the spiral CT. The most common evaluation standard was still the RECIST standard.ConclusionsSpiral CT has its outstanding diagnostic significance in therapeutic evaluation of transformation therapy for advanced gastric cancer. Although there is some controversy, with advancements of a large number of studies, it will greatly help diagnosis and treatment of advanced gastric cancer.
ObjectiveTo explore feasibility and security of conversion chemotherapy of stage Ⅳ gastric cancer.MethodThe research progresses of conversion chemotherapy of stage Ⅳ gastric cancer were summarized by reading relevant literatures.ResultsThe prognosis of stage Ⅳ gastric cancer was poor, its correct treatment strategy was still controversial. At present, the palliative chemotherapy and targeted therapy were mainly used for it. In recent years, the development of chemotherapeutic drugs had improved the survival of some patients who showed the excellent chemotherapy response rate and subsequently undergone surgery, which promoted the derivation of the concept of conversion therapy. For the patients with initial unresectable stage Ⅳ gastric cancer, these patients could get better pathological reaction and then perform R0 operation through the comprehensive measures such as the preoperative chemotherapy, so that the patients could acquire relatively longer survival time. The previous studies indicated that the single unresectable factor, chemotherapy response rate, and whether R0 resection were the important predictors of prognosis for patients with stage Ⅳ gastric cancer.ConclusionsConversion therapy is still at initial stage. Different conversion chemotherapy regime has different response rate. Moreover, expert consensus on case selection, chemotherapy regimen are absent due to lack of high-quality, multi-center, large-sample data. So higher levels of clinical randomized controlled trials are needed to support and guide this practice. In a word, conversion therapy of stage Ⅳ gastric cancer requires multi-disciplinary efforts to carry out an optimal classification to select out suitable candidates, which may provide efficient guidance for comprehensive treatment for stage Ⅳ gastric cancer.
ObjectiveTo understand the latest progress of conversion therapies on increasing surgical resection rate of patients with liver metastasis from colorectal carcinoma, evaluate the clinical value of prognostic evaluation model in surgical resection of patients with liver metastasis from colorectal carcinoma, further offer guidance in comprehensive treatment to control disease and improve the quality of life. MethodsThe literatures about new progress in surgical treatment of liver metastasis from colorectal carcinoma at domestic and abroad were reviewed, including the indication of operation, prognostic evaluation model, and how to increase the resection rate for liver metastasis from colorectal carcinoma patients with conversion therapies. ResultsPart of patients with liver metastasis from colorectal carcinoma could get surgeries after accepting positive conversion therapies.For the patients with liver metastases from colorectal carcinoma did not accepted surgeries all the way, it was a safe and effective treatment method by different conversion therapies such as neoadjuvant chemotherapy, molecular targeted therapy, transcatheter arterial chemoembolization, radiofrequency ablation, and so on, and it could improve the quality of life and prolong the survival time. ConclusionsDoctors should pay attention to conversion therapies of patients with liver metastasis from colorectal carcinoma, and promote the usage of the prognostic evaluation model in liver metastasis from colorectal carcinoma.
ObjectiveTo explore the value of multi-slice spiral CT (MSCT) in the judgment of N stage and lymph node metastasis of patients with advanced gastric cancer who underwent surgery after transformation therapy.MethodsClinical data of 27 patients with advanced gastric cancer who underwent surgery after transformation therapy, form July 2017 to July 2019 in Affiliated Yantai Yuhuangding Hospital of Qingdao University were analyzed retrospectively, and all of patients underwent SOX regimen transformation therapy. The MSCT enhanced scan was performed before operation, and the postoperative pathology was used as the gold standard. The preoperative N stage and lymph node metastasis groups were evaluated by MSCT enhanced scan and compared with the pathological results.Results Before the operation, MSCT was used to evaluate the lymph node metastasis of the patients with advanced gastric cancer after transformation therapy, and compared with the lymph nodes metastasis of the corresponding pathological results, the accuracy rates of lymph node groups in No.1, No.3, No.5, No.6, No.7, No.8, and No.16 were 77.78% (21/27), 81.48% (22/27), 85.19% (23/27), 88.89% (24/27), 85.19% (23/27), 74.07% (20/27), and 96.30% (26/27), respectively. Compared with pathological results, the total accuracy of N stage after transformation therapy that evaluated by MSCT was 62.96% (17/27), with the Kappa coefficient was 0.419 (P=0.003).ConclusionsMSCT has high accuracy and consistency for the N stage of advanced gastric cancer after transformation therapy. Besides, MSCT has a certain diagnostic rate for lymph node metastasis in patients with advanced gastric cancer in lymph node groups of No.1, No.3, No.5, No.6, No.7, No.8, and No.16.
Primary liver cancer (hereinafter referred to as liver cancer) is the fourth most common cancer and second leading cause of cancer-related deaths of China. Hepatocellular carcinoma (HCC) accounts for 75% to 85% of liver cancers, more than half of patients with HCC present at an advanced stage where surgery is not suitable. Conversion therapy can provide the opportunity for some unresectable patients to realize surgical resection. With the progress of non-surgical treatments for liver cancer, increased emphasis on comprehensive treatment approaches, and continuous clinical research outcome, conversion therapy of liver cancer has become a common clinical pathway in treatment practice in our country. This paper summarizes the progress in research on conversion therapy for HCC, analyzing its methods, efficacy, safety, and timing of surgery, to provide insights for the clinical practice and research of conversion treatment in HCC.
Esophageal squamous cell carcinoma can easily penetrate into the esophageal wall and invade adjacent organs due to the lack of serosa. Stage cT4b tumors involving organs adjacent to the aorta, vertebral body, trachea, or bronchus were considered unresectable. For unresectable esophageal squamous cell carcinoma, radical chemoradiotherapy or chemotherapy is recommended. However, the therapeutic effect is poor. With the advent of conversion surgery, surgical resection is feasible after induction therapy for patients with esophageal tumors that are initially unresectable due to adjacent organ invasion or distant metastasis. This article reviews the research on conversion surgery for unresectable esophageal squamous cell carcinoma in recent years in order to explore the clinical application prospects of conversion surgery.
ObjectiveTo explore the value of multi-slice spiral CT (MSCT) in ycT stage and ycN stage evaluation of patients with locally advanced gastric cancer (cT4bN0-3M0) who underwent surgery after transformation therapy.MethodsClinical data of 32 patients with locally advanced gastric cancer (cT4bN0-3M0) in Affiliated Yantai Yuhuangding Hospital of Qingdao University form January 2017 to April 2019 were retrospective analyzed. All the patients underwent surgery after SOX regimen transformation therapy. Preoperative MSCT plain and enhanced scan were used to evaluate clinical T stage (ycT) and clinical N stage (ycN). The accuracy of MSCT scanning was evaluated by comparing with the gold standard for postoperative pathological ypT stage and ypN stage.ResultsThe accuracy of preoperative MSCT examination on ycT stage after transformation therapy was 78.1% (25/32), and that of ycN was 56.3% (18/32).ConclusionThe accuracy of MSCT in preoperative ycT stage and ycN stage after successful transformation therapy for locally advanced gastric cancer (cT4bN0-3M0) is relatively high.
ObjectiveTo investigate the value of multi-disciplinary team (MDT) for the diagnosis and treatment of postoperative recurrence of hepatocellular carcinoma (HCC). MethodThe clinicopathologic data of a patient with giant HCC (66 mm×60 mm×102 mm) who was multiple intrahepatic metastases with portal vein tumor thrombus after radical resection, admitted to the Department of Hepatobiliary Surgery of Sichuan Provincial People’s Hospital, were gathered. ResultsThe patient was a middle-aged male. The multiple recurrent intrahepatic metastases combined with portal vein right branch thrombosis was found at 1 month after radical hepatectomy. After MDT discussion and evaluation, the hepatic arterial infusion chemotherapy combined with immunotherapy and targeted therapy (chemical drugs regimen was FOLFOX, immunotherapy drug was sindilizumab, targeted therapy drug was lenvatinib) was administered. After 3 times conversion therapy, and most of the intrahepatic lesions liquefied and necrotic and shrunk markedly or disappeared. After further discussion and evaluation by MDT, radical surgical resection was performed. The postoperative pathological examination results showed granulomatous inflammation with necrosis, and no exact liver cancer cells were detected. At 6 months after surgery, no tumor recurrence was observed.ConclusionsFor early recurrence combined with portal vein thrombosis after radical resection for HCC, hepatic arterial infusion chemotherapy combined with immunotherapy and targeted therapy may still be effective and even has an opporunity of surgical therapy. MDT discussion can provide the best treatment plan for patient with recurrent liver cancer, leading to a better clinical outcome for them.