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 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 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.
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 explore the safety and effectiveness of transarterial chemoembolization (TACE) combined with lenvatinib and programmed cell death protein-1 (PD-1) antibody in the conversion resection for intermediate and advanced unresectable hepatocellular carcinoma (HCC), and to provide new treatment strategies for the treatment of intermediate and advanced unresectable HCC. MethodThirty-eight intermediate and advanced unresectable HCC patients treated at West China Hospital of Sichuan University from October 2020 to June 2021 were prospectively included in our study, all patients treated with TACE + lenvatinib + PD-1 antibody, and the clinical data of these 38 patients were summarized. ResultsThe last evaluation time for the 38 patients was October 20, 2021. According to the mRECIST standard for tumor efficacy evaluation, the objective response rate was 84.2% (32/38), the disease control rate was 94.7% (36/38); the conversion success rate based on imaging was 55.3% (21/38), the actual conversion resection rate was 52.6% (20/38). The incidence of adverse events was 100%, of which 22 patients had grade 3 adverse events, and there was no ≥ grade 4 adverse events. All patients were followed up, the follow-up time was 16–52 weeks, and the median follow-up time was 33.5 weeks. During the follow-up period, only two patients had tumor progression, of which one patient died due to disease progression, and there was no postoperative recurrence. ConclusionsLenvatinib combined with TACE and PD-1 antibody is safe for the treatment of intermediate and advanced unresectable HCC. Triple therapy can achieve satisfactory conversion resection rate of intermediate and advanced unresectable HCC, which will provide a new treatment strategy for it.
Objective To investigate the value of multidisciplinary team (MDT) diagnosis and treatment model in the conversion therapy of liver cancer. Method The clinical data of a patient with high-risk giant liver cancer of the right liver who was admitted to People’s Hospital of Leshan in April 2019, and who was successfully conversion therapy and safely underwent hepatectomy after MDT discussion was retrospectively analyzed. Results A 62 years old male patient was admitted to our hospital with “abdominal distension for more than 1 month, and liver mass was found for 10 days”. The relevant auxiliary examinations were perfected. The patient was diagnosed as huge primary hepatocellular carcinoma in the right liver. One-stage surgical resection cannot be performed safely due to the huge tumor. After MDT discussion, transcatheter arterial chemoembolization (TACE) combined with sorafenib targeted therapy was decided to reduce the lesions, and two-stage surgical resection was performed safely after conversion therapy. After two cycles of TACE combined with sorafenib targeted drug therapy, MDT discussed the feasibility of safe surgical resection, and underwent fluorescence-guided laparoscopic right posterior lobectomy. The postoperative pathological examination revealed moderately differentiated hepatocellular carcinoma. The patient recovered and was discharged from the hospital one week later. Outpatient followed-up for 32 months showed no obvious abnormality. Conclusions MDT discussion can formulate a more individualized treatment plan, improve the conversion rate and resectable rate of advanced liver cancer, and has important value in the diagnosis and treatment of advanced liver cancer.
Objective To evaluate the preliminary efficacy and safety of XELOX combined with trastuzumab in the transformation therapy of human epidermal growth factor receptor 2 (HER2) positive elderly patients with advanced gastric cancer. Methods The clinical and surgical data of 21 patients with HER2 positive elderly patients with advanced gastric cancer who were treated with XELOX combined with trastuzumab in our Hospital from February 2019 to February 2021 were retrospectively analyzed, and the remission of patients after conversion therapy and the relevant indicators during and after surgery were observed. Results After the conversion therapy, there were 2 cases (9.5%) of complete remission, 13 cases (61.9%) of partial remission, and 6 cases (28.6%) of stable disease, the remission rate of the conversion therapy was 71.4% (15/21). After conversion treatment, 21 patients underwent laparoscopic exploration, of which 20 patients (95.2%) underwent R0 resection, simple exploration 1 case. In all 21 cases, the operative time was 124–185 min, with a median of 152 min. The intraoperative blood loss was 100–210 mL, with a median of 120 mL. The number of lymph nodes cleared was 12–54, with a median of 32. The duration of indwelling gastrointestinal decompression was 51–134 h, with a median of 102 h. The recovery time of gastrointestinal function was 70–98 h, with a median of 78 h. The drainage time in the abdominal operation area was 4–9 days, with a median of 6 days. Postoperative hospital stay was 7–13 days, with a median of 8 days. There were 2 cases of Grade IIIA complications (1 case of incomplete intestinal obstruction and 1 case of pulmonary infection) and 2 cases of Grade II complications (1 case of incision fat liquefaction and 1 case of jugular catheter infection) after operation. All patients were followed up for 3–36 months, with a median of 16.8 months. The median progression-free survival time was 12.4 months and the median overall survival time was 20.5 months. Conclusion For HER2 positive elderly patients with advanced gastric cancer, XELOX combined with trastuzumab transformation therapy is effective and safe.