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Regional Pancreaticoduodenectomy with Superior Mesenteric Artery Resection for Pancreatic Carcinoma: Report of 2 Cases

Qiang LI ; Huikai LI ; Weidong MA ; Yunlong CUI ; Juan YU ; Xishan HAO

Chinese Journal of Clinical Oncology.2009;36(24):1424-1425,1429. doi:10.3969/j.issn.1000-8179.2009.24.013

Objective: To discuss the surgical treatment of carcinoma of the pancreas with superior mesenteric artery (SMA) invasion. Methods: Vascular resection and reconstruction of the portal vein and hepatic artery were performed in 2 cases. Results: The portal vein (PV), superior mesenteric vein (SMV) and superior mesenteric artery (SMA) were involved. During surgery, the invaded superior mesenteric vessels were localized. Case 1 underwent pancreaticoduodenectomy with vascular resection, SMA partial resection and reconstruction. Case 2 was submitted to total pancreatic resection with simultaneous vascular resection of spleen artery and SMA reconstruction. No perioperative mortality occurred. Conclusion: Regional pancreaticoduodenectomy with superior mesenteric artery resection is a safe and effective surgical treatment for pancreatic carcinoma.

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Research progress on the application of immune checkpoint inhibitors in malignant lymphomas

Tong QU ; Xuemeng ZHOU ; Haishi LIU ; Shu ZHAO ; Yue ZHANG ; Qingyuan ZHANG

Chinese Journal of Clinical Oncology.2016;43(20):922-926. doi:10.3969/j.issn.1000-8179.2016.20.869

Immune checkpoint inhibitors are members of a class of immune-suppressive molecules that regulate the strength and range of immune responses to avoid normal tissue damage. However, immune checkpoint activity can be stimulated by tumors to es-cape immune surveillance. To elicit anti-tumor effects, immune checkpoint inhibitors can promote the activation of T cells by blocking immune checkpoint proteins. Therefore, these inhibitors can be efficiently and safely used to treat solid tumors. Although the clinical usage of these inhibitors is in the initial stage, they have exhibited good efficacy and safety in lymphoma treatment. This review sum-marizes the biological activities of CTLA-4, PD-1, and PD-L1 and the application of antibodies as drugs for lymphoma treatment.

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Clinical observation of Capecitabine versus S-1 as maintenance therapy for advanced gastric cancer after the first-line inductive chemotherapy

Shubin WANG ; Xuan WU ; Xiaoqiu CHEN ; An PENG ; Donglan SHEN ; Gangling TONG

Chinese Journal of Clinical Oncology.2016;43(20):913-917. doi:10.3969/j.issn.1000-8179.2016.20.746

Objective:To evaluate the efficacy and adverse reaction caused by Capecitabine compared with S-1 as maintenance treat-ments for patients with advanced gastric cancer (AGC) after first-line induction chemotherapy. Methods:A total of 130 AGC patients who did not suffer disease progression after first-line chemotherapies, including XELOX (four to six cycles), SOX (four to six cycles), and mFOLFOX6 regimen (six to eight cycles), were randomized into three groups. The Capecitabine group (Cap) received maintenance che-motherapy with Capecitabine (1 000 mg/m2 twice daily for 14 days, 21 days/cycle), while the S-1 group (S1) received S-1 (40, 50, or 60 mg according to the body surface area and orally administered twice a day for 14 days, 21 days/cycle). The control group was consid-ered as the observation group. Patients with maintenance treatments received drugs until disease progression or observation of intol-erant toxicity. Results:A total of 44, 33, and 53 patients received XELOX, SOX, and mFOLFOX6 regimens, respectively. The overall DCR was 63.1%. Among the 82 patients, 35, 28, and 19 belonged to the Cap, S1, and observation groups, respectively. The comparison be-tween the efficacy of treatments in the Cap and S1 groups did not show statistically significant differences (P=0.678). The median time of progression was 8.5 months in the Cap group and 9.0 months in the S1 group (P>0.05). Both groups showed better responses than the observation group, which demonstrated a median progression of 6.0 months (P<0.001). The median overall survivals were 14.5, 15.0, and 14.0 months in the Cap, S-1, and observation groups, respectively (P=0.188). The most common adverse effects observed among the patients with maintenance treatments included myelo-suppression, gastrointestinal reaction, fatigue, hand-foot syndrome, and stomatitis. No death occurred in relation to the therapy. Conclusion:The effectiveness of Capecitabine and S-1 as maintenance chemotherapies in AGC patients after the first-line induction chemotherapy are similar, and both can prolong the time of disease pro-gression with low toxicity.

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Comparison study of efficacy evaluation based on RECIST 1.1 and mRECIST in hepato-cellular carcinoma treated with SBRT

Yufei ZHANG ; Jingbo KANG ; Juyi WEN ; Rui DU ; Xinhong ZHANG

Chinese Journal of Clinical Oncology.2016;43(20):902-906. doi:10.3969/j.issn.1000-8179.2016.20.689

Objective: To compare the difference of Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) and modified Re-sponse Evaluation Criteria in Solid Tumors (mRECIST) in the treatment of hepatocellular carcinoma (HCC) after stereotactic body radio-therapy (SBRT). Methods:From Janurary 2014 to August 2015, thirty-five patients with HCC treated with SBRT were included in De-partment of Radiation Oncology and Integrative Oncology of Navy General Hospital of PLA, and SBRT efficacy was evaluated based on RECIST 1.1 and mRECIST criteria. Results:Under RECIST 1.1, one patient had complete response (CR), 20 had partial response (PR), and 11 achieved stable disease (SD) at three months. Three patients had progressive disease (PD). The overall best response rate (CR+PR) was 60%. In comparison, under mRECIST, 10 patients had CR, 16 had PR, and 6 achieved SD at three months. Three patients had PD. The overall best response rate was 74.28%. The statistical analysis showed that Kappa=0.402 (χ2=43.3, P<0. 001) was less than 0.75 but greater than 0.4, indicating that it had not reached the two diagnostic criteria of consistency degree of satisfaction. According to the mRECIST criteria, the objective remission group (CR+PR) was superior to the nonobjective remission group (SD+PD) in progression-free survival (P<0.001). Conclusion:For unresectable HCC, mRECIST may be more useful than RECIST 1.1 in evaluating HCC response to SBRT.

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Intensity modulated radiation therapy for primary liver cancer with portal vein/inferi-or vena cava tumor thrombosis

Guangxin LI ; Haiying CHEN ; Jingzhe LI ; Jinyi LI ; Jianzhong ZHANG ; Lujuan ZHU ; Jie ZHOU

Chinese Journal of Clinical Oncology.2016;43(20):898-901. doi:10.3969/j.issn.1000-8179.2016.20.637

Objective:To evaluate the clinical outcomes of patients after intensity modulated radiation therapy (IMRT) for hepatocellu-lar carcinoma (HCC) with portal vein tumor thrombosis (PVTT) or inferior vena cava tumor thrombosis (IVTT). Methods:A registry data-base of 41 patients treated with IMRT for HCC with PVTT or IVTT in Radiotherapy Center of No.3 Hospital of Beijing Chinese People Armed Police Forces between January 2013 and May 2015 were analyzed retrospectively. The biological effective dose of radiation was ranged 48-94Gy. Short-term effects and prospective efficacy were observed. Log-rank test, Cox regression were used for survival analysis and prognostic factor identification. Results: Grade 2 or higher level gastrointestinal reaction was observed in 12 patients (29.3%). Hematological toxicity was observed in 11 patients (26.8%), and radiation-induced liver disease was observed in 6 patients (14.6%). We found that 29.3%of patients achieved a complete response and 31.7%of patients achieved a partial response. The stable and progressive disease rates were 39.0%and 0.0%, respectively. Median patient survival was 11 months, and the 1-year survival rate was 34.1%. The significant independent variables associated with the overall survival included Child-Pugh grade, AFP test, and CHE lev-el. Conclusion:IMRT is a safe and effective treatment for PVTT or IVTT in patients with HCC.

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Effects of XBP1 on glioma cell viability and glycolysis under hypoxia

Shuang CHAI ; Qilong BIAN ; Tao YU ; Zhongrui OUYANG ; Haiqi ZHAO ; Jiaqi LIU ; Xu HOU ; Shiguang ZHAO ; Yaohua LIU

Chinese Journal of Clinical Oncology.2016;43(20):892-897. doi:10.3969/j.issn.1000-8179.2016.20.588

Objective:To determine the effect of hypoxic stress on glioma cell XBP1 expression, the relationship between XBP1 expres-sion and sugar metabolism, the influence of XBP1 repression on the survival rate of glioma cells under normoxia and hypoxia, and the influence of XBP1 on glioma cell glycolysis. Methods:We tested XBP1 activation in human glioma cell lines cultured under normoxia and hypoxia. XBP1 expression was repressed with siRNA technology. Cells were treated with oxidative phosphorylation inhibitor. We then detected the variation in cell apoptosis, sugar metabolism mode, and cell apoptosis and glycolysis products under normoxia and hypoxia. Results:XBP1 activation increased under hypoxia. Silencing XBP1 expression reduced glioma cell survival level, ATP and lactic acid production, and glucose consumption under hypoxia. After inhibiting cell oxidative phosphorylation, XBP1 repression significantly reduced the survival level of glioma cells. Conclusion:Hypoxia can activate XBP1 in glioma cells. Under hypoxia, XBP1 silencing de-presses cell activity and glycolysis. Glycolysis of glioma cells under hypoxia depends on XBP1 activation.

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Research progress on patient-derived xenograft models of lung cancer

Shoubo CAO ; Shi JIN ; Yan YU

Chinese Journal of Clinical Oncology.2016;43(20):887-891. doi:10.3969/j.issn.1000-8179.2016.20.819

Patient-derived xenograft models (PDXs) of lung cancer are obtained by directly implanting lung cancer tissue fragments in-to immunocompromised mice. The implanted tumor fragments can be proliferated and passaged in these mice models. The PDXs maintain the tumor microenvironment, histological and pathological characteristics, and tumor biomarkers of the original tumor tis-sues. The PDX also offers an ideal mice model that mimics the human tumor microenvironment. These models have important roles in the pre-clinical evaluation of cancer, the assessment of anti-tumor drug responses, and the analysis of biomarkers. These models also present a new direction for the individualized therapy of lung cancer patients.

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Progress on the diagnosis, treatment, and family management of Lynch syndrome

Chenhan ZHONG ; Xiaofen LI ; Dong XU ; Ying YUAN

Chinese Journal of Clinical Oncology.2016;43(20):883-886. doi:10.3969/j.issn.1000-8179.2016.20.750

Lynch syndrome is the most common type of genetically determined colon-cancer predisposition syndrome, accounting for 5%of all colorectal cancer (CRC) cases. This hereditary syndrome is characterized by the germline mutation of human mismatch repair genes and microsatellite instability. Recent studies have shown that Lynch syndrome and sporadic CRC differ in diagnosis and treat-ment;these results are especially relevant for the clinical management of Lynch syndrome. In this review, we reverted to the original characterization of Lynch syndrome, and the developments in its screening and diagnosis were summarized. Furthermore, the manage-ment of families with this disorder was discussed.

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Hot issues in surgical treatment of early stage breast cancer patients in the era of preci-sion medicine

Jing SI ; Jiong WU

Chinese Journal of Clinical Oncology.2016;43(20):879-883. doi:10.3969/j.issn.1000-8179.2016.20.724

Breast cancer is the most common malignant tumor in women. For early stage breast cancer patients, surgical treatment is still the foundation of local treatment. With background from precision medicine, this article reviews recent hot issues in surgical treat-ment for early stage breast cancer patients. We summarized strategies in surgical treatment, selection of resection range, manage-ment of local lymph nodes, timing of breast reconstruction, and the application of minimally invasive surgery.

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Predictive value of continuous and significant reduction of serum CEA and CA153 for non-imaging progression in patients with advanced breast cancer

Long XU ; Guanzhong ZHANG ; Zhendong ZHENG ; Xiaodong XIE

Chinese Journal of Clinical Oncology.2016;43(19):865-868. doi:10.3969/j.issn.1000-8179.2016.19.665

Objective:This study evaluates the relationship between carcino-embryonic antigen (CEA) and carbohydrate antigen 153 (CA153) continuous and remarkable reduction after chemotherapy and no-imaging progression in patients with advanced breast can-cer. Methods: Medical records of 93 patients who received chemotherapy in the Oncology Department of the General Hospital of Shenyang Military Command were included in the retrospective analysis. A total of 188 CEA and CA153 serum data were collected from response evaluations that included 105 CEA cases and 139 CA153 cases. Predictive validity of serum CEA and CA153 was as-sessed for diagnosing no-imaging progression. Results:CEA was continuously reduced by 10%, with sensitivity of 54.1%and specificity of 95%. CA153 was continuously reduced by 40%, with sensitivity of 19.1%and specificity of 96.6%. Conclusion:Serum CEA and CA153 could be considered as response evaluation tools when they are continuously reduced by at least 10%and 40%, respectively.

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