Local chemotherapy of acute and chronic posttraumatic osteitis with Taurolin-Gel 4%

Posttraumatic osteitis is still the most important complication of bone surgery. In the last 30 years we have learned that antibiotics do not solve the problem. For 13 years Taurolin-Gel 4% has been used as a local bactericidal agent. Over 500 patients with acute or chronic osteitis have been treated. The overall results of the different studies show that in 86% infection free consolidation could be achieved.     

The best use of chemotherapy in the adjuvant setting

Currently, based on the results of large randomized clinical trials and the conclusions of the Oxford meta-analysis (EBCTCG. Lancet 1998; 352: 930; Peto R. Fifth Main Meeting of the Early Breast Cancer Trialist's Collaborative Group, Oxford, UK, September 2000) and following internationally accepted treatment guidelines (National Institutes of Health Consensus Development Panel. J Natl Cancer Inst 2001; 93(13): 979; Goldhirsch et al. J Clin Oncol 2001; 19: 3817), the vast majority of primary breast cancer patients is offered adjuvant medical therapy. Regarding adjuvant chemotherapy (CT), the two most important and challenging tasks of the medical oncologist today are (1) to identify who needs CT and (2) to select the CT regimen that will work best for the individual patient, while at the same time minimizing the risk of severe or permanent toxicities. The second question will be the focus of this paper.     

Over-using chemotherapy in the adjuvant setting

Avoidance of unnecessary or ineffective treatment should be one of the main goals in adjuvant breast oncology today. Unfortunately, both patients and doctors hunt for tiny statistical differences in survival curves. This search could not only lead to an oncological approach of unlimited addition that we will not be able to afford, but would also end inevitably in indeterminate overtreatment with substantial risks of unexpected toxic effects eating away whatever progress we might make. “Do not harm” remains the main principle in medicine. To be able to follow this rule, we need to better understand the biology of breast cancer. The mistake of “one treatment fits all” can only be changed when we critically review trial designs of adjuvant breast oncology. The risk of overtreatment is there and selection of precisely defined cohorts for phase 3 trials is necessary, despite pressure of scientific ambition, pragmatism, and demands of industry. The “add on” clinical trial design model accepts the inability to confirm that standard therapy is still necessary if a positive result from the addition of the new therapy is obtained. The same model can be applied to “extended” adjuvant treatments in breast cancer subtypes. Addition of “miraculin” to the standard of care should generate a new standard. Such trials that show a modest benefit on average at a population level take us a step away from refining care for the individual, and might support the use of multiple and costly interventions with potential short and long term side effects. It is essential to escalate treatment when necessary and to de-escalate when un-necessary.     

Location of pulmonary metastasis in pediatric osteosarcoma is predictive of outcome

Background

The 3-year survival after pulmonary metastasectomy for osteosarcoma (OS) is approximately 30%. Resection of metastatic disease can prolong life in pediatric patients with OS. Our objective is to assess the outcome of pediatric patients with pulmonary metastases located centrally as compared with peripheral lesions.

Methods

A retrospective review of patients 0 to 21 years old with a diagnosis of OS with pulmonary metastases on computed tomographic scan between 1985 and 2000 was completed. Demographics, metastasis location, survival, morbidity, and mortality were evaluated.

Results

Of 115 patients who had pulmonary metastasis secondary to OS, there were 96 wedge resections and 13 lobectomy/pneumonectomies in 84 patients. The morbidity of wedge resection was 9% and lobectomy/pneumonectomy was 8%. There were no deaths from surgery. The median survival for patients undergoing lobectomy compared with wedge resection was 0.61 and 1.14 years, respectively, but did not reach statistical significance. The median overall survival for the entire cohort was 0.75 years. The median overall survival after initial detection of metastatic disease was 1.06 years among the patients with peripheral disease, compared with 0.38 years in patients with central disease (P = .008).

Conclusion

Patients with central pulmonary metastases in OS have a very poor prognosis, even after operative treatment, compared with those with peripheral disease. Patients with central lesions may benefit from other nonsurgical treatment options.     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

胰头十二指肠切除术联合替吉奥治疗胰腺癌的临床观察

目的：探讨胰头十二指肠切除术联合替吉奥治疗胰腺癌的疗效。方法：2008年2月—2011年6月间,58例I~II期胰腺癌患者行胰头十二指肠切除术后分别采取替吉奥（32例,观察组）和吉西他滨（26例,对照组）辅助化疗,比较两组患者的近、远期疗效及化疗期间不良反应的发生情况。结果：两组患者化疗后血清中各肿瘤标志物水平均明显较化疗前下降（均P<0.05）,但两组间差异无统计学意义（均P>0.05）;观察组患者总有效率明显高于对照组患者（37.50% vs. 30.77%,P<0.05）;生存分析显示,观察组患者1、1.5、2年的总生存率明显高于对照组患者（均P<0.05）;两组患者化疗期间不良反应均为I、II度,两组间不良反应发生率差异无统计学意义（P>0.05）。结论：胰头十二指肠切除术加术后替吉奥辅助化疗治疗胰腺癌疗效确切,可有效延长患者术后生存期,且不良反应较轻,患者耐受良好。

     

复方苦参注射液对术后胃癌DFC方案辅助治疗毒副反应的影响

目的观察复方苦参注射液对术后胃癌DFC方案辅助治疗的毒副反应的影响。方法将手术后经病理证实分期为Ⅱ、Ⅲ期的胃癌患者作为研究对象,随机分为复方苦参注射液联合DFC方案组（研究组）20例及单纯DFC方案组（对照组）20例。结果研究组白细胞减少、消化道反应及乏力的发生率显著少于对照组（P〈0.05）,肝毒性也显著少于对照组（P〈0.05）。结论复方苦参注射液能减少DFC方案化疗毒副作用,增加患者化疗耐受性。     

The significance of surgical resection for pulmonary metastasis from hepatocellular carcinoma

BACKGROUND: Pulmonary metastasis, which is the most common type of extrahepatic recurrence of hepatocellular carcinoma (HCC), has been considered unsuitable for surgical resection because most pulmonary metastases are multiple. Until now there have been few reports about surgical resection for pulmonary metastasis from HCC. The aim of the present study was to evaluate the significance of surgical resection for pulmonary metastasis from HCC. METHODS: Among 615 patients who underwent radical hepatic resection for HCC in our hospital over the past 15 years, 8 patients who had developed 1 or 2 pulmonary metastases underwent pulmonary resection for the pulmonary metastases (resection group), the other 6 patients who had developed 1 or 2 pulmonary metastases did not undergo pulmonary resection (nonresection group). The clinicopathologic features and long-term prognosis of the resection group were examined and compared with those of the nonresection group. RESULTS: In the resection group, although intrahepatic recurrences were present before the diagnosis of pulmonary metastasis in 4 patients, they were well controlled by repeated transarterial chemoembolization and/or further hepatic resections. The average survival periods after the pulmonary resection and after the initial hepatic resection were 29 months (range, 5-80 mo) and 61 months (range, 24-133 mo), respectively. No patients in the resection group showed pulmonary recurrence after the pulmonary resection, and the cause of death of the patients in the resection group was not pulmonary metastasis. The survival rate of patients in the resection group was significantly better than that in the nonresection group. CONCLUSIONS: It may be concluded that surgical resection for pulmonary metastasis from HCC might be beneficial in selected patients.     

骨肉瘤新辅助化疗的探讨

目的 评价新辅助化疗治疗骨肉瘤的临床疗效。方法 新辅助化疗保肢术治疗骨肉瘤38例。术前超大剂量化疗2个疗程，第12周手术，术后化疗3－5个疗程，根据肿瘤坏死率测定调整术后化疗方案。手术方法：关节置换17例，同种异体骨移植9例，自体骨移植7例，肿瘤骨灭活再植2例，肿瘤切除3例。结果 肿瘤坏死率测定：＞90％，32例，＜90％4例；未2例。3年无瘤生存率71．1％，5年无瘤生存率65．8％。结论 新辅助化疗配合保肢术是治疗骨肉瘤的理想方法。     

骨肉瘤辅助化疗方案的中远期疗效观察

目的 评估骨肉瘤辅助化疗方案的中远期疗效。方法 １９８９年１月－１９９５年１２月采用我们制定；的以国产铂类药物和阿霉素为主的文学发治疗ⅡＢ期肢体骨肉瘤体共６７例，其中男４７例，女２０例；年龄１０－５１岁，平均２０岁。股骨下端４５例，胫骨上端１４例，腓骨上端和肱骨上端各３例，股骨上端２例。成骨细胞型５１例，成软骨细胞型６例，成纤维细胞型５例和其他类型５例。根据化疗的具体上端２例。成骨细胞型５１例，成     

术后替加氟辅助化疗对Ro切除的食管鳞癌患者生存率的影响

目的探讨替加氟用于辅助化疗对Ro切除食管鳞癌患者生存率的影响。方法收集汕头市中心医院肿瘤外科1987年1月至1996年12月食管鳞癌RO手术病例411例,其中单纯手术组74例,术后口服替加氟化疗组337例。化疗方案：替加氟800～1200mg／d．连续服用3周后休息一周,总剂量达到40g以上。结果单纯手术组5年生存率50．1％,替加氟术后化疗组5年生存率44．3％,两组患者5年生存率相比未见显著性差异（P=0．853）。另外,从不同性别、年龄、肿瘤部位、大体类型、分化程度、浸润深度、有无淋巴结转移和分期等亚组人群分析来看,单纯手术组与替加氟术后化疗组的生存率皆无显著性差异。Cox回归模型分析结果显示,年龄、分化程度、淋巴结转移是影响生存率的独立因素,而术后替加氟化疗对预后没有产生明显影响。结论替加氟用于术后辅助化疗没有明显提高RO切除的食管鳞癌患者的生存率。食管癌术后辅助化疗缺乏有效方案,有待今后进一步深入研究。     

Physician practices in the diagnosis and management of patients with pulmonary embolism

To examine the diagnostic work-up and subsequent management of patients with pulmonary embolism, we retrospectively reviewed the medical records of 60 patients who had arteriographically proven pulmonary embolism. Ventilation-perfusion scans were utilized in 47 patients and were classified as showing a high (55.3%), moderate (14.9%), low (8.5%), or indeterminate (21.3%) probability of pulmonary embolism. Of the 33 patients treated with anticoagulation, complications occurred in 10 (30.3%). Of the 39 patients treated with inferior vena cava filters, complications occurred in 16 (41.0%) patients, with the most clinically significant complication being recurrent pulmonary embolism, found to occur in one (2.6%) patient. For patients treated with anticoagulation, heparin was started an average of 0.3 (±0.5) days following the initial suspicion of a pulmonary embolism. The average time to reach a therapeutic partial thromboplastin time level was 2.0 (±1.8) days, and warfarin was started an average of 6.2 (±4.1) days after heparin was begun. Among the 60 patients, five (8.3%) died from the pulmonary embolism, and two of these had at least a five day delay before diagnosis was made by pulmonary arteriography. Since the ventilationperfusion scan had a sensitivity of 70.2% and a false negative rate of 8.5%, it is not always sufficiently accurate in making final treatment decisions, so there should be less hesitation in attaining pulmonary arteriograms. Therapeutic partial thromboplastin time levels should be more aggressively sought. Warfarin should be started within the first few days of heparin therapy. Inferior vena cava filters should be utilized in patients who have a contraindication to anticoagulation therapy or a complication from anticoagulation therapy.     

Glucocorticoid receptor alpha expression in the intrahepatic biliary epithelium and adjuvant steroid therapy in infants with biliary atresia

Background/Purpose

In patients with cirrhosis, proinflammatory cytokines increase progressively in relation to the severity of liver dysfunction. Proinflammatory cytokines regulate the expression of glucocorticoid receptors (GcRs). On the other hand, GcRs mediate the effects of glucocorticoid steroids on bile excretion in the biliary epithelium. Glucocorticoid receptors have 2 isoforms: a cytoplasmic glucocorticoid receptor α (GcRα) mediates thier physiological effects, whereas a nuclear localized glucocorticoid receptor β (GcRβ) acts as a dominant negative inhibitor of GcRα activity. We examined the histology features of liver biopsy and the expression of GcRα in the intrahepatic biliary epithelium in infants with biliary atresia.

Patients/Methods

The patients were divided into 2 groups: patients in group 1 (n = 17) had a total bilirubin level below 1.0 mg/dL at least once after surgery, whereas patients in group 2 (n = 14) has never had bilirubin level below 1.0 mg/dL postoperatively. Liver biopsies taken from 31 infants with biliary atresia at the time of hepatic portoenterostomy between 1988 and 2002 were examined for immunohistochemistry and histology with H&E staining. The degree of GcRα expression in the biliary epithelium was semiquantitatively analyzed using staining scores. The histology features of the liver biopsy were also semiquantitatively analyzed by using the same scores to evaluate the liver injury. Intravenous prednisolone dosage was started with 4 mg/kg per day and tapered by a half dose every 2 days. The protocol was orally repeated during admission until the stool became constantly cholic. Statistical analysis was performed using Mann-Whitney U test and Spearman correlation coefficient by rank. Significance is set at a 95% confidence interval (P < .05).

Results

There was a significant positive correlation between the liver histology and the GcRα scores in all patients with biliary atresia (P = .0128; r = 0.429). In group 1, there was a significant positive correlation between the GcRα expression scores and the total dose of prednisolone administered (P = .0063; r = 0.767).

Conclusions

The increase and degree of GcRα expression were associated with the severity of liver injury and may correlate with the dose of prednisolone required to sustain bile flow after successful hepatic portoenterostomy.     

Bone metastases in osteosarcoma patients treated with neoadjuvant or adjuvant chemotherapy The Rizzoli experience in 52 patients

Introduction?There have been no large-scale studies reporting the outcome of patients with osteosarcoma who first relapse with bone metastases, but there have been several case reports describing a much poorer prognosis for these patients than for those who relapse with lung metastases.

Methods?We compared 52 patients with skeletal metastases as first relapse after neoadjuvant or adjuvant treatment for osteosarcoma of the extremity given at our institution between 1972 and 1999 with 371 contemporary patients treated with the same chemotherapy protocols, who first relapsed with lung metastases.

Results?We found that the 52 patients with bone metastases had a higher rate of local recurrences (36% vs. 6%), a lower rate of remission (35% vs. 77%), and lower rates of 5-year event-free survival (11% vs. 27%) and overall survival (13% vs. 31%) (p < 0.01 for all comparisons).

Interpretation?The prognosis of patients who relapse with bone metastases—unless they have a single lateappearing metastasis—is worse than the prognosis of patients who first relapse with lung metastases. There was no difference in outcome between patients with single, resectable and late-appearing skeletal metastases and patients relapsing in the lung.     

原发性肝癌合并肺转移的双重介入治疗的研究

目的探讨临床双重介入治疗原发性肝癌合并肺转移的临床效果。方法对40例晚期原发性肝癌合并肺转移的患者,采用经股动脉穿刺插管选择性经肝动脉分支和支气管动脉进行化疗栓塞术。结果原发性肝癌有效率为45%(18/40),肺转移灶有效率为40%(16/40)。原发性肝癌合并肺转移有效率为37.5%(15/40),半年和1年生存率分别为80%和37.5%。结论临床经肝动脉分支和支气管动脉双重联合介入治疗原发性肝癌合并肺转移是一种安全、有效的姑息性治疗方法。