Surgery has remained the cornerstone of lung cancer therapy. Sleeve lobectomy, which is featured by not only the maximal resection of tumors but also the maximal preservation of functional lung parenchyma, has been proved to be a valid therapeutic option for the treatment of some centrally located lung cancer . Evidence points toward equivalent oncologic outcomes with improved survival and quality of life after sleeve resections compared with pneumonectomy. However, the postoperative morbidities and the long-term results after sleeve lobectomy remain controversial, especially in relation to nodal involvement and after induction therapy. With the development of technology, minimally invasive procedures have been performed more and more widely.
ObjectiveTo explore the treatment strategies of different types of pancreatic cancer.MethodsBy reading the relevant literatures on the treatment of pancreatic cancer at home and abroad in recent years, the classification of pancreatic cancer and the progress of treatment measures were summarized.ResultsAccording to preoperative imaging evaluation, pancreatic cancer was divided into resectable pancreatic cancer, borderline resectable pancreatic cancer, locally advanced pancreatic cancer, and pancreatic cancer with distant metastasis. Resection of pancreatic cancer should be radical resection, supplemented with chemotherapy after surgery; patients with resected pancreatic cancer in the junction, if the patient with venous invasion could be resected and reconstructed, it was recommended to undergo surgery and postoperative adjuvant chemotherapy. Patients with unresectable reconstruction and arterial invasion should undergo neoadjuvant therapy, and then re-evaluate the resectability of the tumor to determine whether surgery was feasible. Patients with locally advanced or combined metastatic pancreatic cancer had lost the opportunity for surgery, for this kind of patient, advocated neoadjuvant chemoradiotherapy or second-line combined targeted therapy.ConclusionsMost patients with pancreatic cancer have progressed to the stage of clinical diagnosis. They are familiar with the treatment of different types of pancreatic cancer and take targeted treatment measures to improve the survival time of patients.
ObjectiveTo analyze whether neoadjuvant chemoradiotherapy can impact patients’ anal function and quality of life after rectal cancer surgery.MethodThe domestic and international publications on the studies how the neoadjuvant chemoradiotherapy impacted patients’ anal function and quality of life were collected and reviewed.ResultsThe neoadjuvant chemoradiotherapy negatively impacted the patients’ anal function and quality of life, but which would be improved over time. The impact had no obvious difference between the long-course chemoradiotherapy and short-couse radiotherapy on the patients’ anal function and quality of life. Compared with the neoadjuvant chemoradiotherapy, the neoadjuvant chemotherapy might impact less on the anal function, but which still needed to evaluate the lower anterior resection syndrome (LARS) score. In present, it lacked evidence of a higher rate of anastomotic leakage caused by the neoadjuvant chemoradiotherapy, which might lead to the bowel dysfunction.ConclusionsNeoadjuvant chemoradiotherapy negatively impacts patients’ anal function and quality of life. Further studies are needed to figure out the best choice between long-course neoadjuvant chemoradiotherapy and short-couse radiotherapy. In long term, impact of neoadjuvant therapy can be improved over time and be accepted by patients. Some intervention treatments including medicine and operations are needed if major LARS occurs.
ObjectiveTo analyze the neoadjuvant therapy of colorectal cancer in this center in the background of real world data by studying Database from Colorectal Cancer (DACCA) in West China Hospital of Sichuan University.MethodsData was selected from DACCA who was updated on August 15, 2019. After deleting duplicate value, patients whose tumor location and tumor pathologic characteristic showed colon or rectum, as well as adenocarcinoma, mucinous adenocarcinoma, and signet ring cell carcinoma were enrolled.ResultsThere were 2 783, 2 789, 2 790, 2 811, 4 148,3 824, 4 191, 3 676, 4 090, and 499 valid data of T, N, and M stages, clinical stages, tumor site, distance from tumor to anal dentate line, tumor pathologic characteristics, degree of tumor differentiation, neoadjuvant therapy, and compliance, respectively. There were 1 839 lines that " nature of the tumor pathology” was not empty and neoadjuvant scheme for the pure chemotherapy, radiotherapy alone or radiation, and chemotherapy, including 50 lines of signet ring cell carcinoma (2.7%), 299 lines of mucous adenocarcinoma (16.3%), 1 490 lines of adenocarcinoma (81.0%), various kinds of pathology in selection of neoadjuvant therapy difference was statistically significant (χ2=9.138, P=0.041). Except for the data lines with null value in the column of " operation date”, there were 2 234 (82.1%) and 486 (17.9%) effective data lines of " recommended” and " not recommended” for the use of neoadjuvant therapy, respectively. In the years with a large amount of data, among the patients who completed neoadjuvant therapy, the proportion of patients meeting the recommended indications was 27.4%–67.6%, with an average of 47.4%. Patients who did not meet the recommended indications but were recommended (off-label use) accounted for 7.3%–70.0%, with an average of 39.8%. According to regression analysis, the proportion in line with the recommendation (\begin{document}$\hat y $\end{document}=–0.032 5x+66.003 2, P=0.020) varies with the year, and the overall trend shows a gradual decline. The proportion of the use of super indications (\begin{document}$\hat y $\end{document}=–0.054 5x+110.174 6, P=0.002) changed with the year, and the overall trend showed a decline. A total of 1 161 valid data with non-null values of " eoadjuvant therapy regimen” and " recommended or not recommended” showed statistically significant difference in the use rate of neoadjuvant therapy among patients with different recommendation groups (χ2=9.244, P=0.002). " Patient compliance” was shown as " active cooperation” and " passive acceptance”, and " neoadjuvant therapy” was shown as " radiotherapy alone”" chemotherapy alone”, and " chemoradiotherapy” were 470 lines. There was no statistically significant difference in neoadjuvant therapy between patients receiving active and passive treatment (χ2=0.537, P=0.841). The effective data of clinical remission degree meeting the research conditions were 388 lines, including 121 lines of complete response (31.2%), 180 lines of partial response (46.4%), 79 lines of stable disease (20.4%), and 8 lines of progressive disease (2.1%). There was no statistically significant difference in clinical response degree among patients with different neoadjuvant therapy (H=0.435, P=0.783). There were 346 lines with effective data of pathologic tumor regression grade (TRG) meeting the study conditions, including 47 lines with TRG0 (13.6%), 39 lines with TRG1 (11.3%), 180 lines with TRG2 (52.0%), and 80 lines with TRG3 (23.1%). There was no statistical difference in the degree of TRG among patients with different neoadjuvant therapy (H=1.816, P=0.518).ConclusionsThe real world study reflects that in the western regional medical center, the demand for neoadjuvant therapy among the patients with colorectal cancer covered is huge. Although the implementation of neoadjuvant therapy is greatly influenced by the doctor’s recommendation behavior, the selection and recommendation of neoadjuvant therapy according to some specific clinical application guidelines are not fully met. The impact of more behavioral factors requires further in-depth analysis and research.
Surgery remains as the primary definitive therapy for resectable non-small cell lung cancer (NSCLC) currently. However, quite a few NSCLC patients, especially in the later stage, suffered tumor recurrence after resection. Safer and more effective perioperative treatment is urgently needed to reduce the recurrence risk after NSCLC surgery. Immune checkpoint inhibitors can effectively prevent tumor immune evasion and have been shown to be a feasible, safe and effective neoadjuvant therapy for resectable NSCLC. Nevertheless, certain crucial problems, including the final effect on NSCLC recurrence, the selection of beneficial group and optimal treatment protocol are yet unsolved. Fortunately, several phase Ⅲ randomized controlled trials are ongoing to answer these questions and will hopefully provide stronger evidence.
ObjectiveTo summarize the value of imaging in the evaluation of non-surgical therapy for pancreatic cancer.MethodThe relevant literatures about imaging evaluation of non-surgical therapy for pancreatic cancer were collected to make an review.ResultsAt present, most of the imaging evaluation of non-surgical therapy for pancreatic cancer were based on the assessment of morphological characteristics of tumors, such as contrast-enhanced CT and MRI. However, only morphological changes of tumors could not accurately evaluate the response of pancreatic cancer after non-surgical treatment. A few studies had explored the value of functional imaging and artificial intelligence.ConclusionsNon-surgical therapy provides new treatment opportunities for unresectable pancreatic cancer, especially the proposed of neoadjuvant therapy, which provides the possibility of operation for patients with advanced pancreatic cancer. More imaging indicators with stronger objectivity, higher accuracy, and wider universality need to be improved and developed in the future.
ObjectiveTo analyze the details and efficacy of neoadjuvant therapy of colorectal cancer in the current version of Database from Colorectal Cancer (DACCA).MethodsThe DACCA version selected for this data analysis was the updated version on July 28th, 2020. The data items included “planned strategy of neoadjuvant therapy” “compliance of neoadjuvant therapy”, and “cycles of neoadjuvant therapy”. Item of “planned strategy of neoadjuvant therapy” included “accuracy of neoadjuvant therapy” and “once included in researches”. Item of “the intensity of neoadjuvant therapy” included “chemotherapy” “cycles of neoadjuvant therapy” “targeted drugs”, and “neoadjuvant radiotherapy”. Item of “effect of neoadjuvant therapy” included CEA value of “pre-neoadjuvant therapy” and “post-neoadjuvant therapy”“variation of tumor markers” “variation of symptom” “variation of gross” “variation of radiography”, and tumor regression grade (TRG). The selected data items were statistically analyzed.ResultsThe total number of medical records (data rows) that met the criteria was 7 513, including 2 539 (33.8%) valid data on the “accuracy of neoadjuvant therapy”, 498 (6.6%) valid data on “once included in researches”, 637 (8.5%) valid data on the “compliance of neoadjuvant therapy”, 2 077 (27.6%) valid data on “neoadjuvant chemotherapy”, 614 (8.2%) valid data on “cycles of neoadjuvant therapy”, 455 (6.1%) valid data on “targeted drugs”, 135 (1.8%) valid data on “neoadjuvant radiotherapy”, 5 022 (66.8%) valid data on “pre-neoadjuvant therapy CEA value”, 818 (10.9%) valid data on “post-neoadjuvant therapy CEA value ”, 614 (8.2%) valid data on “variation of tumor marker”, 464 (6.2%) valid data on “variation of symptom”, 478 (6.4%) valid data on “variation of gross”, 492 (6.5%) valid data on “variation of radiography”, and 459 (6.1%) valid data on TRG. During the correlation analysis, it appeared that “variation of tumor marker” and “variation of gross” (χ2=6.26, P=0.02), “variation of symptom” and “variation of gross”, “radiography” and TRG (χ2=53.71, P<0.01; χ2=38.41, P<0.01; χ2=8.68, P<0.01), “variation of gross” and “variation of radiography”, and TRG (χ2=44.41, P<0.01; χ2=100.37, P<0.01), “variation of radiography” and TRG (χ2=31.52, P<0.01) were related with each other.ConclusionsThe protocol choosing of neoadjuvant therapy has a room for further research and DACCA can provide data support for those who is willing to perform neoadjuvant therapy. The efficacy indicators of neoadjuvant therapy have association with each other, the better understand of it will provide more valuable information for the establishment of therapeutic prediction model.
ObjectiveTo describe the constructive process of neoadjuvant therapy for colorectal cancer part in the West China Colorectal Cancer Database (DACCA).MethodWe used the form of text description.ResultsThe specific concept of neoadjuvant therapy for colorectal cancer including neoadjuvant treatment therapies, compliance of patients with neoadjuvant therapy, neoadjuvant therapy intensity scheme, the CEA value of patients during neoadjuvant therapy, changes of symptoms, changes of primary tumor size in colorectal cancer, and TRG grading of the DACCA in the West China Hospital were defined. Then the neoadjuvant therapies were detailed for their definition, label, structure, error correction, and update.ConclusionThrough detailed description and specification of neoadjuvant therapy for colorectal cancer in DACCA in West China Hospital, it can provide a reference for the standardized treatment of colorectal cancer and also provide experiences for the peers who wish to build a colorectal cancer database.
ObjectiveTo evaluate the efficacy and safety of programmed cell death receptor 1 (PD-1) inhibitor combined with chemotherapy in the preoperative neoadjuvant treatment of stage Ⅲ non-small cell lung cancer (NSCLC).MethodsThe clinical data of 68 patients with stage Ⅲ NSCLC who underwent preoperative neoadjuvant treatment in our hospital from June 2019 to October 2020 were analyzed and divided into two groups according to a random number table. There were 34 patients in the control group including 19 males and 15 females with an average age of 59.41±4.77 years. In the observation group, there were 34 patients including 21 males and 13 females with an average age of 61.15±6.24 years. The patients in the control group were treated with albumin-bound paclitaxel and cisplatin for injection, and the patients in the observation group were treated with carrelizumab on the basis of the control group, and both groups received 2 cycles of preoperative neoadjuvant therapy. We compared the clinical efficacy of imaging, T lymphocyte subsets, drug side effects, surgical resection rate, major pathological remission (MPR), complete pathological remission (pCR) and postoperative complications of the two groups of patients, and analyzed the influencing factors for MPR.ResultsThe objective response rate (ORR) of imaging in the observation group (70.6%) was higher than that in the control group (38.2%, P<0.05). The positive rate of CD3+ cells, the positive rate of CD4+ cells, the positive rate of CD8+ cells and the ratio of CD4+/CD8+ cells in the observation group after treatment were higher than those in the control group (P<0.05). The drug toxicity of the observation group was higher than that of the control group in the reactive cutaneouscapillary endothelial proliferation (RCCEP)/rash, abnormal thyroid function, and abnormal myocardial enzymes (P<0.05). The MPR (66.7%) and pCR (51.9%) of the surgical observation group were higher than those of the surgical control group (MPR: 19.2%, pCR: 7.7%, P<0.05). There was no statistical difference in surgical resection rate and postoperative complications between the two groups (P>0.05). Univariate analysis showed that ECOG score, pathological type, neoadjuvant treatment plan and surgical resection were related to MPR (P<0.05). The results of binary logistic regression analysis showed that Eastern Cooperative Oncology Group (ECOG) score and neoadjuvant treatment plan were independent risk factors for MPR (P<0.05).ConclusionThe clinical efficacy of PD-1 inhibitor combined with chemotherapy in the preoperative neoadjuvant treatment of stage Ⅲ NSCLC patients is definite, and it can significantly improve the patients' MPR, pCR and cellular immune function, but the side effects caused by immunotherapy drugs need to be concerned.
Objective To explore the clinical value, latest research progress, and clinical controversy of total neoadjuvant therapy (TNT) in locally advanced rectal cancer (LARC). Method We searched and reviewed on the latest literatures about studies of the clinical research of TNT in LARC. Results TNT could make the tumor downstage rapidly and improve the patients’ treatment compliance. In terms of organ preservation rate, 3-year disease-free survival and pathological complete remission rate, TNT had advantages and was a especial potential treatment strategy compared with traditional methods. Conclusions TNT decreases local recurrence rate and improves the long-term survival. For LARC patients with strong desire for organ preservation, TNT is a good treatment choice and has the value of clinical promotion.