Role of chemotherapy in breast cancer

Breast cancer represents a major health problem, with more than a million new cases and 370,000 deaths worldwide yearly. Options and understanding of how to use cytotoxic chemotherapy in both advanced and early stage breast cancer have made substantial progress in the past 10 years, with numerous landmark studies identifying clear survival benefits for newer approaches. Despite this research, the optimal approach for any individual patient cannot be determined from a literature review or decision-making algorithm alone. Treatment choices are still predominantly based on practice determined by individual or collective experience and the historic development of treatment within a locality. In many situations treatment decisions cannot be divorced from economic considerations. Blanket application of international, national or local guidelines is usually impractical or inappropriate and careful consideration of the detailed circumstances of each patient is required to make optimal use of available options. Recent research has allowed us to refine breast cancers further into prognostic groups based on a gene expression profile. Clinical trials to prove the value of this approach are currently being designed. This review discusses the evidence for various chemotherapy regimens in the adjuvant and metastatic settings, and examines the current evidence for the timing of radiotherapy in the adjuvant setting.     

Évaluation clinique des chimioradiothérapies concomitantes et recommandations pratiques

The efficacy of concurrent radiochemotherapy should be evaluated in term of therapeutic ratio. The aims of treatment are increasing local control and possibly overall survival. Acute toxicity should be reported using the WHO recommendations, while late toxicity is reported using the scales recommended by the EORTC and RTOC Radiotherapy Groups. Moreover, functional, esthetic and quality of life considerations should be introduced. The application of these treatments needs a well-designed multidisciplinary staff.     

CONCURRENT COLONIC ADENOCARCINOMA AND TWO ILEAL CARCINOIDS IN A 72-YEAR-OLD MALE

A case of synchronous rectal cancer and two small-bowel carcinoid tumours was recently encountered in a 72-year-old man. This will be presented and discussed with a literature review. It emphasizes the importance of the concept of synchronous malignancy within the gastrointestinal tract and that patients presenting with any gastrointestinal neoplasm, especially colonic cancer and carcinoids, should undergo thorough exploration of the peritoneal cavity and its organs at initial surgery.     

局部晚期鼻咽癌洛铂单周方案同期放疗初探

目的 探讨局部晚期鼻咽癌洛铂单药单周方案同期放疗中洛铂最大耐受剂量(MTD)。方法 选择18例Ⅲ-ⅣA期鼻咽癌初治患者,采用根治性IMRT同时进行洛铂剂量递增试验。洛铂初始剂量10 mg/m²,组间递增剂量为5 mg/m²,每个剂量组至少3位受试者。如无剂量限制性毒性反应则进入下一剂量组直至MTD,定期评价疗效及不良反应。结果 10、15 mg/m²剂量组各3例,20、25 mg/m²剂量组6例。25mg/m²组出现2例剂量限制性毒性反应,因此MTD确定为20 mg/m²。患者治疗结束后3个月,鼻咽部肿瘤和颈部阳性淋巴结临床缓解率为100%。主要毒性反应为骨髓抑制。结论 洛铂单药周方案同期放化疗治疗局部晚期鼻咽癌的MTD为20mg/m²,该方案疗效可靠安全性较好,值得开展进一步临床研究。     

Influence of concurrent exercise or nutrition countermeasures on thigh and calf muscle size and function during 60 days of bed rest in women

AIM: The goal of this investigation was to test specific exercise and nutrition countermeasures to lower limb skeletal muscle volume and strength losses during 60 days of simulated weightlessness (6 degrees head-down-tilt bed rest). METHODS: Twenty-four women underwent bed rest only (BR, n = 8), bed rest and a concurrent exercise training countermeasure (thigh and calf resistance training and aerobic treadmill training; BRE, n = 8), or bed rest and a nutrition countermeasure (a leucine-enriched high protein diet; BRN, n = 8). RESULTS: Thigh (quadriceps femoris) muscle volume was decreased (P < 0.05) in BR (-21 +/- 1%) and BRN (-24 +/- 2%), with BRN losing more (P < 0.05) than BR. BRE maintained (P > 0.05) thigh muscle volume. Calf (triceps surae) muscle volume was decreased (P < 0.05) to a similar extent (P > 0.05) in BR (-29 +/- 1%) and BRN (-28 +/- 1%), and this decrease was attenuated (P < 0.05) in BRE (-8 +/- 2%). BR and BRN experienced large (P < 0.05) and similar (P > 0.05) decreases in isometric and dynamic (concentric force, eccentric force, power and work) muscle strength for supine squat (-19 to -33%) and calf press (-26 to -46%). BRE maintained (P > 0.05) or increased (P < 0.05) all measures of muscle strength. CONCLUSION: The nutrition countermeasure was not effective in offsetting lower limb muscle volume or strength loss, and actually promoted thigh muscle volume loss. The concurrent aerobic and resistance exercise protocol was effective at preventing thigh muscle volume loss, and thigh and calf muscle strength loss. While the exercise protocol offset approximately 75% of the calf muscle volume loss, modification of this regimen is needed.     

序贯放化疗与同步放化疗对ⅢA-N2期非小细胞肺癌的疗效比较

目的比较序贯放化疗与同步放化疗对ⅢA-N2期非小细胞肺癌的治疗效果。方法将40例ⅢA-N2期非小细胞肺癌患者按照随机数字表法分为序贯组(接受化疗序贯纵隔淋巴结放疗)与同步组(接受化疗同步纵隔淋巴结放疗),每组20例。比较两组患者的临床疗效、治疗前后的血清肿瘤标志物[糖类抗原125(CA125)、鳞状上皮细胞癌抗原(SCC-Ag)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)]水平、治疗期间不良反应发生情况、无进展生存时间(PFS)和总生存时间(OS)。结果同步组患者的总有效率为75%(15/20),高于序贯组患者的35%(7/20),差异有统计学意义(P﹤0.05)。同步组患者的临床疗效优于序贯组患者,差异有统计学意义(P﹤0.05)。治疗后,同步组患者血清中的CEA、CYFRA21-1、SCC-Ag水平均低于序贯组患者,差异均有统计学意义(P﹤0.05)。两组患者的各不良反应发生率比较,差异均无统计学意义(P﹥0.05)。同步组患者的PFS、OS均长于序贯组患者,差异均有统计学意义(P﹤0.05)。结论与序贯放化疗相比,同步放化疗对于ⅢA-N2期非小细胞肺癌患者的临床疗效更优,能够有效延长患者的生存时间,且不会增加不良反应。     

Still proliferating CD44+/Ki67+ tumor cells after neoadjuvant radiochemotherapy identify rectal cancer patients with poor survival

IntroductionDistant recurrence, especially liver metastases, occurs in one-third of rectal cancer patients initially treated with curative therapy and is still an unsolved problem. The identification of patients at risk is crucial for enabling individualized treatment.Material and methodsAll patients undergoing curative resection for histologically confirmed rectal cancer after neoadjuvant radiochemotherapy between January 2001 and December 2015 were included. Sections were stained for Ki67, CD44, apoptosis and CD133. Patients were categorized based on whether they were found to have (CD44⁺/Ki67⁺) or not have (CD44⁺/Ki67⁺) still proliferating tumor cells.Results218 patients who underwent R0 resection for stage I-III rectal cancer were selected. In 37 (17%) of these patients, CD44⁺/Ki67⁺ tumor cells were found. In multivariable Cox regression analysis, patients with CD44⁺/Ki67⁺ cells had significantly impaired overall (hazard ratio (HR): 3.84, 95% CI: 1.77–8.31, p = 0.001) and relative survival (HR 3.44, 95% CI: 1.46–8.09). The previous results were confirmed after propensity-score matching. In mediation-analysis, the presence of CD44⁺/Ki67⁺ cells was associated with a substantial direct effect on overall (HR 1.92, 95% CI: 1.09–9.28) and relative survival (HR 1.63, 95% CI: 1.31–6.38).ConclusionsThe presence of still proliferating CD44⁺/Ki67⁺ tumor cells after neoadjuvant radiochemotherapy was associated with impaired oncological long-term outcomes. Characterization of these cells should be performed.     

初诊 ⅣB期胸段食管鳞癌综合放疗长期生存获益研究

目的 探讨综合放疗用于初诊 ⅣB期胸段食管鳞癌患者的价值。方法 选取2010—2016年间于河北医科大学第四医院初诊并经胃镜/食管镜或转移灶活检证实为 ⅣB的原发胸段食管鳞癌患者 199例。单纯远处淋巴结转移者 130例(65.3%),单纯实质脏器转移 51例(25.6%),实质脏器合并远处淋巴结转移者 18例(9.0%)。单纯化疗 16例(8.0%),单纯放疗 50例(25.1%),放化疗 133例(66.8%)(同期放化疗 81例、序贯放化疗 52例)。使用Kaplan-Meier法计算生存率并行log-rank检验差异,采用Cox模型行多因素预后分析。结果 全组中位总生存期为12.3个月(95%CI为 10.6~15.4个月),1、2、3、5年总生存率分别为52.1%、25.2%、19.1%、11.5%。多因素分析显示病变长度、转移器官数目、治疗模式是总生存的独立影响因素。同期放化疗对比序贯放化疗总生存相近(P=0.955)。放疗剂量≥6000 cGy组患者总生存明显高于 4500~5039 cGy组和 5040~6000 cGy组(均为 P<0.001)。结论 对于初诊 ⅣB期胸段食管鳞癌患者,原发病变长度≤3cm、单器官转移、放化疗模式有相对更长的总生存。对于体质较好的患者可考虑在全身化疗基础上将放疗参与到Ⅳ期食管癌的综合治疗中,个体化选择序贯或同期放化疗模式。在患者能够耐受基础上,建议给予原发灶或非区域转移淋巴结等部位进行放化疗,以达到延长患者生存的目的。     

局部晚期不可手术食管癌同步放化疗联合尼妥珠单抗的初步临床分析

目的 探讨局部晚期食管癌同步放化疗联合尼妥珠单抗治疗的不良反应及疗效。方法 回顾性分析北京大学肿瘤医院2015—2020 年间使用同步放化疗联合尼妥珠单抗治疗的 30例患者资料,采用Kaplan-Meier法生存分析。结果 中位随访时间22.5个月,总客观有效率为93%。1、2、3年总生存率分别为83%、57%、41%,无进展生存率分别为75%、47%、32%,无局部区域复发率分别为83%、53%、37%,无远处转移生存率分别为75%、51%、36%。≥3级血液学不良反应发生率为32%,3级放射性食管炎发生率为16%。结论 局部晚期食管癌同步放化疗联合尼妥珠单抗初步结果显示安全有效。