Objective To evaluate the effectiveness and safety of intraluminal brachytherapy (ILBT) in prolonging survival and the period free of symptoms for patients with unresectable bile duct cancer. Methods We searched MEDLINE (1977 to May 2007), CNKI (1979 to May 2007) and CBM Disk (1979 to May 2007). The qual ity of included studies was assessed according to the guidance in the Cochrane Handbook for Systematic Reviews of Interventions. Results One randomized controlled trial involving 42 patients with unresectable bile duct cancer fulfilled the inclusion criteria. This found that the median survival time was longer for patients treated with endoprostheses and ILBT compared to those treated with endoprostheses alone (387.9 days versus 298.0 days, Plt;0.05). The stent patency time in patients who were treated with endoprostheses and ILBT was longer than for those treated with endoprostheses alone (378.4 days versus 245.5 days, Plt;0.01). The reductions in bil irubin (mol/l) and alkal ine phosphatase (kat/l) before and after drainage in patients who were treated with endoprostheses and ILBT were similar to those treated with endoprostheses alone (Mean ±SD of bil irubin: before: 219.3 ± 40.5, after: 23.1 ± 37.1 versus before: 227.3 ± 39.8, after: 22.5 ± 44.2; Mean ± SD of alkal ine phosphatase: before: 10.3 ± 5.1. after: 3.6 ± 2.9 versus before: 11.7 ± 5.8, after: 3.7 ± 2.9). No severe adverse effects were observed in the trial. Conclusion Current evidence suggests that ILBT for unresectable bile duct cancer may improve the survival time of patients, prolong the time they spend symptom free, improve their quality of l ife and reduce the burden of treatment. However, it may increase toxicity in normal tissues, which can be managed by adjusting radiation dosage. No serious adverse effects were observed in the 42 patients in the trial in this review. More randomized controlled trials with large sample size are needed to provide rel iable results.
Objective To assess the effectiveness and safety of photodynamic therapy (PDT) for patients with nonresectable bile duct cancer. Methods Two reviewers independently searched The Cochrane Library (issue 4, 2006), MEDLINE (1966 to February 2007), CNKI (1994 to February 2007) and VIP (1989 to February 2007), respectively. The quality of included studies was assessed according to the guidance in the Cochrane Handbook of Systematic Reviews of Interventions. Results Two randomized controlled trials involving 71 patients with nonresectable bile duct cancer met the inclusion criteria and were included. Both of these trials reported that the median survival time in patients who were treated with endoprostheses and PDT was longer than for those treated with endoprostheses alone (493 days versus 98 days, and 21 months versus 7 months, in the two trials respectively) One trial reported that the global quality of life in patients in the PDT with endoprostheses group was significantly better than that for the endoprostheses alone group: the difference of Karnofshy index between the two groups was 25.4 (14.4-36.3). The other trial reported no difference between the two groups. No severe adverse effects were observed during either trial. Conclusion Current evidence demonstrates that PDT can improve the survival time of patients with nonresectable bile duct cancer, and reduce the burden of treatment. The treatment might increase biliary infectious rate, but this can be managed by antibiotics therapy. No severe adverse effects are observed. More randomized controlled trials, with large sample sizes, may lead to more accurate results.
Objective To explore application value of photodynamic therapy (PDT) in treatment of unresectable hilar cholangiocarcinoma. Method The literatures about PDT in the treatment of the unresectable hilar cholangiocarcinoma in the PubMed, MedLine, Embase, CNKI, and Wanfang databases were reviewed. Results The PDT combined with stent or chemotherapy was the main method in the treatment of the unresectable hilar cholangiocarcinoma, which could make the tumor down-staging, obviously reduce the jaundice, improve the quality of life, improve the survival rate, prolong the stent patency and be treated repeatedly. Especially, it was suitable for the patients with elderly, poor health, intolerance of surgery, could partly replace the R1 or R2 operation of hilar cholangiocarcinoma and avoid the risk of surgery and postoperative complications. The therapeutic effective of the PDT was related to the early therapy and times of therapy. However, the shortcomes of the PDT were that the depth of killing tumor was not enough and there was a certain incidence of adverse reaction. Conclusions Therapeutic effect of PDT combine with stent or chemotherapy for unresectable hilar cholangiocarcinoma is better than that of single therapy. It is expected to be a first-line scheme of palliative treatment for unresectable hilar cholangiocarcinoma.
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 systematically evaluate whether primary tumor resection (PTR) has a statistical survival benefit as compared with chemotherapy alone (CTA) for asymptomatic stage Ⅳ colorectal cancer patients with unresectable synchronous metastasis (ACRCUSR). MethodsThe PubMed, Embase, Web of Science, Cochrane Central, CNKI, Wanfang, and the other databases were searched systematically and the prospective or retrospective controlled studies of PTR versus CTA in treatment of ACRCUSR were collected. The outcomes included overall survival (OS) and overall 1–5-year survival rates. The Stata 12.0 and RevMan 5.3 softwares were used for the pooled-analysis of relative risk (RR) and hazard ratio (HR). The trial sequential analysis (TSA) software was used to analyze overall 5-year survival rate and calculate the sample size required to achieve stable results. ResultsA total of 35 studies involving 258 478 patients were included. The results of pooled-analysis showed that the OS of ACRCUSR with PTR was statistically better than that with CTA [HR=0.57, 95%CI (0.52, 0.61), P<0.001]; Meanwhile, it was found that the overall survival rates at 1-, 2-, 3-, 4-, and 5-year of ACRCUSR with PTR were statistically better than those with CTA [1-year: RR=1.30, 95%CI (1.21, 1.40), P<0.001; 2-year: RR=1.78, 95%CI (1.64, 1.93), P<0.001; 3-year: RR=2.10, 95%CI (1.65, 2.68), P<0.001; 4-year: RR=3.05, 95%CI (2.07, 3.44), P<0.001; 5-year: RR=3.43, 95%CI (3.00, 3.92), P<0.001]. The TSA showed the reliable outcome at overall 5-year survival rate and the sample size required to achieve stable result was 96 662 cases. ConclusionFrom analysis results of this study, for ACRCUSR with PTR can benefit survival as compared with CTA, which still needs to be verified by more randomized controlled trials.
Lung cancer is the malignant tumor with the highest incidence and mortality rate in China, which seriously threatens the life and health of Chinese people. Locally advanced unresectable non-small cell lung cancer is characterized by high heterogeneity and poor prognosis, and durvalumab consolidation therapy after concurrent chemoradiotherapy is the main treatment modality. In recent years, advances in targeted therapies and immunotherapy have changed the treatment landscape of lung cancer. A portion of locally advanced or advanced non-small cell lung cancer that was initially unresectable is down-staged and converts to surgically operable radical resection after comprehensive treatment, and this surgical treatment strategy is called conversion surgery. With the progress of comprehensive treatment modalities, it may occupy an increasing proportion in thoracic surgery in the future. This article reviews the treatment modality and conversion surgery for locally advanced unresectable non-small cell lung cancer.
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.