Pancreatic cancer remains a major troublesome clinical problem, with conventional cancer treatments having little impact on disease course. The extent of disease is often classified as localized, locally advanced, and metastatic. Radical operation is the most effective method, but only 15%-20% of patients have resectable disease, and around 20% of them survive to 5 years. For locally advanced, unresectable, and metastatic diseases, palliative treatment is more appropriate, but the median survival in these patients is less than 6 months and the 5-year survival rates are even lower than 4%. Neoadjuvant therapy has been gradually accepted in breast cancer and gastroenterological cancer, and its value in pancreatic cancer has attracted increasing interests. This paper reviews recent advances of neoadjuvant therapy in pancreatic cancer.
Adenocarcinoma ; therapy ; Chemotherapy, Adjuvant ; adverse effects ; methods ; Combined Modality Therapy ; Humans ; Neoadjuvant Therapy ; adverse effects ; methods ; Pancreatic Neoplasms ; therapy ; Radiotherapy, Adjuvant ; adverse effects ; methods

Hepatocellular carcinoma (HCC) is one of the most critical global health issues. With frequent association of viral liver disease, HCC is highly complex, harboring both cancer and chronic liver disease. The tumor stage and underlying liver function are both major determinants of the treatment selection as well as prognosis in HCC patients, thus allowing no more than a 20% chance for potentially curative therapies. Radiotherapy technology has been evolved remarkably during the past decade, and radiation can be precisely delivered, thereby permitting higher doses to the tumour and reduced doses to surrounding normal tissues. There has been increasing interest in the merits of radiotherapy in HCC over the past few years, as indicated by a Pub Med search. Radiotherapy has been used as the definitive therapy with curative intent in early stage tumours. It has been used also in combination with TACE for intermediate stage tumours. In locally advanced tumours, radiotherapy has been combined with systemic agents. Despite its efficacy, radiotherapy has not yet been incorporated into the standard management guidelines of HCC. The lack of high evidence level data, especially randomized controlled trials, has posed an obstacle in including radiotherapy into the routine treatment schema of HCC. Therefore, well-designed prospective studies are strongly recommended using developing technology for radiotherapy alone or combination therapies. Also, many issues such as the optimal dose-fractionation, intra- or extrahepatic metastasis after radiotherapy, and radiation-induced hepatic dysfunction remain to be solved. In this review, current status of radiotherapy for HCC will be discussed with regard to technical consideration and combination strategy. The limitation and future perspectives will also be discussed.
Carcinoma, Hepatocellular/drug therapy/radiography/*radiotherapy ; Humans ; Liver/radiation effects ; Liver Neoplasms/drug therapy/radiography/*radiotherapy ; Neoplasm Metastasis ; Radiation Dosage ; Radiotherapy, Adjuvant/adverse effects/methods ; Treatment Outcome

OBJECTIVEThe aim of this study was to analyses the clinicopathologic features of the patient with myasthenia gravis (MG) occurring after resection of thymoma.

METHODSData of 15 patients were collected. The follow-up range from 8 to 178 (average 76.7) months. A retrospective analysis was performed through comparison with data of all 112 cases without MG, which had not occurred MG during our average 5.5 years follow-up, operated for thymoma in same period. The statistics analysis adopted chi(2) and t test.

RESULTS(1) According to Masaoka's classification of thymoma, stage I in 7 cases, stage II in 4, stage III in 4. Histologic Bernatz's classification: lymphocyte predominant type in 4, epithelial type in 3, mixed type in 7, unknown in 1. According to Osserman's classification of MG, grade I in 7, IIa in 4, IIb in 3, III in 1. The MG onset times was the postoperative narcotic waking duration-137 (average 33.9) months, and the average remission time was 30.9 (0.5 - 120) months. (2) 4 cases who occur MG as soon as pull up narcotic tube, all adopted nondepolarizing muscular relaxants. (3) MG was discovered in 3 cases (3/67) during postoperative radiotherapy until a average dosage of 36 Gy was received in average 24 days. (4) The tendency of occurring MG following resection was found in female patients with longer duration of disease, mixed type, larger and later stage thymoma as compared with the thymoma group.

CONCLUSIONSThe factors including the operation, relatively using overdose relaxation control, choosing unfavorable muscle relaxant and postoperative radiotherapy could induce postoperative MG. An intensive care should be put on the cases with the tendency of occurring postoperative MG.

Adult ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Myasthenia Gravis ; etiology ; Neuromuscular Depolarizing Agents ; adverse effects ; Postoperative Period ; Radiotherapy, Adjuvant ; adverse effects ; Retrospective Studies ; Sex Factors ; Thymectomy ; adverse effects ; Thymoma ; radiotherapy ; surgery ; Thymus Neoplasms ; radiotherapy ; surgery

OBJECTIVETo explore efficacy of neoadjuvant radiochemotherapy in locally advanced low rectal cancer.

METHODSFrom May 2001 to August 2005, 105 patients with locally advanced low rectal cancer (T3, T4) were treated by preoperative radiotherapy to pelvis, 2.0 Gy daily up to 40-46 Gy in 4-5 weeks concomitantly with oral capecitabine at 1250 mg x m(-2) x d(-1) for 10 weeks up to surgery. In all patients surgery was carried out under the rule of total mesorectal excision technique.

RESULTSAll patients finished the course of neoadjuvant radiochemotherapy. Among them, 36 patients experienced adverse effects. Thirteen patients resulted in complete tumor response and spared the operation. Ninety-two patients were operated on with radical resection, among them 71 patients with low anterior resection, 17 with Parks' colo-anal anastomosis and 4 with abdomino-perineal resection, so sphincter preservation was achieved in 96.2%. In postoperative pathological studies, 11 cases showed complete tumor regression. According to the TNM staging system, 24 cases were ranged T0N0, and 23 cases T2N0, 43 cases T3N0, 2 cases T4N0, 5 cases T2N1, 8 cases T3N1; and according to Dworak's tumor regression grading, 5 cases were ranked TGR0, and 18 cases TGR1, 11 cases TGR2, 47 cases TGR3, 24 cases TGR4. Pathologic downstaging was achieved in 78.1%, including complete response (TGR4) and intermediate response (TGR2 + 3). No operative death occurred. Anastomotic leakage was found in 5 cases, including 3 rectovaginal fistula. All patients have been followed up for 16-67 months, and lung metastasis occurred in 4 cases, liver metastasis in 2 patients and local recurrence in 4 patients. Three patients died of distant metastasis. The 3-year disease-free survival was 82.8% and overall survival was 96.5%.

CONCLUSIONSNeoadjuvant radiochemotherapy brings tumor down-staging and increases resectability and sphincter preservation, decreases recurrence and improves survival in locally advanced low rectal cancer.

Chemotherapy, Adjuvant ; adverse effects ; methods ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoadjuvant Therapy ; adverse effects ; methods ; Preoperative Care ; methods ; Radiotherapy, Adjuvant ; adverse effects ; methods ; Rectal Neoplasms ; mortality ; surgery ; therapy ; Survival Rate ; Treatment Outcome

The aim of the present study was to determine whether oncologic outcomes and adverse events associated with active on/off intermittent antiandrogen monotherapy (daily bicalutamide, 50 mg per day) are comparable with those of standard external beam radiation therapy (EBRT) or combined androgen blockade (CAB) therapy in prostate cancers with positive surgical margins after radical prostatectomy. Two hundred twenty-three patients with positive surgical margins post-radical prostatectomy who underwent active surveillance (AS, n = 32), EBRT without hormone therapy (n = 55), intermittent antiandrogen monotherapy without EBRT (IAAM, n = 50), or CAB without EBRT (n = 86), between 2007 and 2014, were reviewed retrospectively. Pathologic outcomes, biochemical recurrence rates, radiological disease progression, and adverse events were collected from medical records. Biochemical recurrence rates, biochemical recurrence-free survival rates, and radiological recurrence were not different between the groups (P = 0.225, 0.896, and 0.284, respectively). Adverse event rates and severities were lower for IAAM compared with EBRT or CAB (both P < 0.05), but were comparable to those for AS (P = 0.591 and 0.990, respectively). Grade ≥3 adverse events were not reported in the IAAM or AS groups. Erectile dysfunction and loss of libido rates were lower in the IAAM group compared with the EBRT and CAB groups (P = 0.032). Gastrointestinal complications were more frequently reported in the EBRT group (P = 0.008). Active on/off IAAM treatment might be an appropriate treatment option for patients with positive surgical margins after radical prostatectomy. Furthermore, regarding oncologic outcomes, IAAM was comparable to standard EBRT but had a milder adverse event profile.
Aged ; Aged, 80 and over ; Androgen Antagonists/adverse effects* ; Anilides/adverse effects* ; Antineoplastic Agents/adverse effects* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Chemotherapy, Adjuvant/adverse effects* ; Disease-Free Survival ; Humans ; Male ; Neoplasm Recurrence, Local/blood* ; Neoplasm, Residual ; Nitriles/adverse effects* ; Prostate-Specific Antigen/blood* ; Prostatectomy ; Prostatic Neoplasms/therapy* ; Radiotherapy, Adjuvant/adverse effects* ; Retrospective Studies ; Tosyl Compounds/adverse effects*

INTRODUCTIONThe majority of patients with gastric cancer relapse after definitive surgery and 5-year survival after surgery is very poor. The Intergroup 0116 study showed a modest survival benefit for postoperative bolus 5-fluorouracil-based chemoradiation with a high rate of toxicity. We hypothesised that treatment outcome could be further improved with feasible toxicity using a combination of bolus 5-fluorouracil, continuous 5-fluorouracil, and cisplatin followed by chemoradiation after 3 months of chemotherapy.

MATERIALS AND METHODSThirty-six patients with stages Ib through IV adenocarcinoma of the stomach or gastrooesophageal junction who had undergone gastric resection and negative margins were assigned to postoperative chemoradiation. The treatment consisted of 6 cycles of continuous 5-fluorouracil (600 mg/m2) for 24 hours, push 5-fluorouracil (400 mg/m2) and leucoverin (LCV) (200 mg/m2) on day 1 to 2 every 2 weeks, cisplatin (60 mg/m2) every 4 weeks followed by combined modality therapy using 45 Gy at 1.8 Gy per day concomitant with weekly bolus 5-fluorouracil (600 mg/m2) and LCV (50 mg).

RESULTSThe median age was 59 years (range, 29 to 75) and 25 patients were male. Thirty-five per cent had proximal tumour, T3 or T4 were diagnosed in 92% of the patients and lymph nodes metastases were confirmed in 83%. Grade 3 or 4 neutropaenia was documented in 25%, and gastrointestinal toxicity in 16%. There was no toxic death, but 1 patient had long-term complications. The median disease-free survival was 37.4 months and the overall survival was 40.3 months.

CONCLUSIONSPostoperative chemoradiation with combination of bolus 5-fluorouracil, continuous 5-fluorouracil and cisplatin is a feasible and well-tolerated approach. Larger clinical trials should be conducted to further evaluate the toxicity and the efficacy of this regimen.

Adenocarcinoma ; drug therapy ; radiotherapy ; surgery ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Chemotherapy, Adjuvant ; Cisplatin ; administration & dosage ; adverse effects ; Female ; Fluorouracil ; administration & dosage ; adverse effects ; Humans ; Infusions, Intravenous ; Injections, Intravenous ; Male ; Middle Aged ; Radiotherapy Dosage ; Radiotherapy, Adjuvant ; Stomach Neoplasms ; drug therapy ; radiotherapy ; surgery

OBJECTIVETo summarize the experiences in gallbladder cancer treatment, evaluate the efficacy of postoperative radiotherapy, and investigate the method of improving the survival of gallbladder cancer patients.

METHODSOne hundred and twenty-seven gallbladder cancer patients, treated in our center by radical resection (84 cases) and combined with postoperative radiotherapy (43 cases), between June 2003 to December 2009 were included in this study. Their clinical data and follow-up results were retrospectively analyzed. According to AJCC staging criteria, the survival time and 1-, 3- and 5-year survival rates of the surgery group and the postoperative radiotherapy group at the different pathological stages and resection margin status were compared.

RESULTSThe median survival time of postoperative radiotherapy patients in stage III was 16.9 months, and the 1-year, 3-year, and 5-year survival rates were 55.7%, 23.5% and 18.2%, respectively, significantly higher than that of the simple operation group ( median survival time 14.3 months, and 1-year, 3-year, 5-year survival rates 42.7%, 22.6% and 16.7%, respectively) (P<0.05). The median survival time of postoperative radiotherapy patients in stage IV, the median survival time was 9.7 months in the postoperative radiotherapy group and 6.3 months in the simple surgery group, and the 1-year survival rates were 14.2% and 9.8%, the 3-year survival rates were 7.2% and 3.9%, the 5-year survival rates were 7.2% and 1.9%, respectively, all showing a statistically significant difference (P<0.05). Among the stage III and IVpatients, all the 1-, 3- and 5-year survival rates of the postoperative radiotherapy group were higher than that of the simple R0 and R1 surgical resection group (all P<0.05), but with a non-significant difference between the stageIandIIpatients (P>0.05). The main side effects in postoperative radiotherapy patients including nausea, vomiting and abdominal pain, all were successfully alleviated by symptomatic and supportive therapy, and the radiotherapy was successfully completed.

CONCLUSIONSWith regard to the gallbladder cancer patients in stage III and IV, the survival rate can be obviously increased by postoperative radiotherapy. However, for patients in stageIand II, whether postoperative radiotherapy significantly improves the survival or not, needs to be further validated in larger scale studies.

Adult ; Aged ; Cholecystectomy ; methods ; Female ; Follow-Up Studies ; Gallbladder Neoplasms ; radiotherapy ; surgery ; Humans ; Male ; Middle Aged ; Nausea ; etiology ; Neoplasm Staging ; Radiotherapy, Adjuvant ; adverse effects ; Radiotherapy, Conformal ; adverse effects ; Retrospective Studies ; Survival Rate ; Vomiting ; etiology

OBJECTIVEThis phase I study is to determine the maximal tolerated dose and the dose-limiting toxicity of capecitabine combined with standard radiotherapy (RT) as postoperative adjuvant treatment for rectal cancer patients.

METHODSStage II/III rectal cancer patients 18 - 75 years of age had undergone curative surgery with Karnofsky score > or = 70% were eligible to be included in this study. Total dose of RT DT 50 Gy was delivered to the pelvic area in fraction of 2.0 Gy per day for 5 weeks. Capecitabine was orally administered concurrently with radiotherapy for a total of 2 cycles in escalating doses: twice daily at 12 hour interval for consecutive 14 days as one cycle, separated by a seven day rest, then followed by another cycle. From March 2004 to May 2005, 24 patients were included and treated at the following dose levels: daily 1000 mg/m(2) (3 patients), 1200 mg/m(2) (3 patients), 1400 mg/m(2) (3 patients), 1500 mg/m(2) (3 patients), 1600 mg/m(2) (6 patients), and 1700 mg/m(2) (6 patients). Dose-limiting toxicities (DLT) including grade 3 or grade 4 hematologic and nonhematologic toxicity were observed.

RESULTSDose-limiting toxicity was observed in one patient treated at dose of 1600 mg/m(2) with grade 3 diarrhea, and in 2 patients at dose of 1700 mg/m(2) with one grade 3 and one grade 4 diarrhea.

CONCLUSIONDiarrhea is the most common dose-limiting toxicity. In our study, the maximal tolerated dose (MTD) of capecitabine given concurrently with radiotherapy was daily 1600 mg/m(2), from D1 to D14 separated by 7-day rest for 2 cycles. Capecitabine given concurrently with standard radiotherapy is safe and tolerable for operated stage II/III rectal cancer patients.

Adolescent ; Adult ; Aged ; Antimetabolites, Antineoplastic ; administration & dosage ; adverse effects ; Capecitabine ; Chemotherapy, Adjuvant ; Deoxycytidine ; administration & dosage ; adverse effects ; analogs & derivatives ; Drug Administration Schedule ; Female ; Fluorouracil ; administration & dosage ; adverse effects ; analogs & derivatives ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Postoperative Care ; Radiotherapy, Adjuvant ; Radiotherapy, Conformal ; Rectal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Rectum ; surgery

OBJECTIVE: Lower extremity lymphedema adversely affects quality of life by causing discomfort, impaired mobility and increased risk of infection. The goal of this study is to investigate factors that influence the likelihood of lymphedema in patients with endometrial cancer who undergo adjuvant radiation with or without chemotherapy. METHODS: A retrospective chart review identified all stage I-III endometrial cancer patients who had a hysterectomy with or without complete staging lymphadenectomy and adjuvant radiation therapy between January 2006 and February 2013. Patients with new-onset lymphedema after treatment were identified. Logistic regression was used to find factors that influenced lymphedema risk. RESULTS: Of 212 patients who met inclusion criteria, 15 patients (7.1%) developed new-onset lymphedema. Lymphedema was associated with lymph-node dissection (odds ratio [OR], 5.6; 95% CI, 1.01 to 105.5; p=0.048) and with the presence of pathologically positive lymph nodes (OR, 4.1; 95% CI, 1.4 to 12.3; p=0.01). Multivariate logistic regression confirmed the association with lymph-node positivity (OR, 3.2; 95% CI, 1.0007 to 10.7; p=0.0499) when controlled for lymph-node dissection. Median time to lymphedema onset was 8 months (range, 1 to 58 months) with resolution or improvement in eight patients (53.3%) after a median of 10 months. CONCLUSION: Lymph-node positivity was associated with an increased risk of lymphedema in endometrial cancer patients who received adjuvant radiation. Future studies are needed to explore whether node-positive patients may benefit from early lymphedema-controlling interventions.
Adult ; Aged ; Aged, 80 and over ; Endometrial Neoplasms/*radiotherapy/surgery ; Female ; Humans ; Hysterectomy ; Lymph Node Excision/adverse effects ; Lymphatic Metastasis ; Lymphedema/*etiology/therapy ; Middle Aged ; Radiation Injuries/*etiology/therapy ; Radiotherapy, Adjuvant/adverse effects ; Retrospective Studies ; Risk Factors

OBJECTIVETo investigate the effect of enterostomy in treatment of locally advanced rectal carcinoma patients with combined chemoradiotherapy and operation.

METHODSClinical data from 51 cases of locally advanced rectal cancer patients treated with preoperative chemoradiotherapy and operation were analyzed.

RESULTSThirty-three patients (64.9%) got staging down of their cancer after preoperative chemoradiotherapy, and 21.6% of patients (11 cases) had complete pathologic response. Thirty-seven patients received enterostomy, including extraperitoneal sigmoidostomy (29 cases), defunctioning ileostomy (8 cases) and double colostomy (3 cases with colon obstruction during preoperative therapy). One case experienced parastomal hernia and one stomal stenosis and 2 cases parastomal infection after enterostomy. No death of enterostomy occurred.

CONCLUSIONColostomy can reduce the pressure of obstructed intestinal tract and contribute much to the preoperative chemoradiotherapy, ileostomy can protect the distal stoma from leakage in sphincter saving operation. Enterostomy could be selected when needed in the favor of locally advanced rectal cancer patients.

Adult ; Aged ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Enterostomy ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; pathology ; surgery ; therapy ; Rectum ; drug effects ; radiation effects ; surgery ; Treatment Outcome