Pay attention to the rehabilitation of cancer patients--Excerpts of the 2013 NCCN Guidelines for Survivorship

For some survivors, the consequences of cancer are minimal; these patients can return to a normal life after the completion of treatment. In fact, a majority of cancer survivors report being in good general health and experience good to excellent quality of life. A recent review suggests that at least 50% of survivors suffer from some late effects of cancer treat ment. The most common problems in cancer survivors are depression, pain, and fatigue. The guidelines suggest the following standards for survivorship care： （1） prevention of new and recurrent cancers and other late effects; （2） surveillance for cancer spread, recurrence, or second cancers; （3） assessment of late psychosocial and medical effects; （4） intervention for consequences of cancer and treatment （eg, medical problems, symptoms, psychologic distress, financial and social concerns）; and （5） coordination of care between primary care providers and specialists to ensure that all of the survivor＇s health needs are met. The NCCN Survivorship Panel hopes that these guidelines can help both oncologic and primary health care profession als lessen the burden left on survivors by their cancer experience so they can transition back to a rewarding life.     

A dosimetric comparison between 3D-Conformal radiation therapy and intensity modulated radiation therapy plans in the treatment of posterior fossa boost in children with high risk medulloblastom

Objective： The work is a comparative study between two modalities of radiation therapy, the aim of which is to compare 3D conformal radiation therapy （3D-CRT） and intensity modulated radiation therapy （IMRT） in treating posterior fossa boost in children with high risk medulloblastorna; dosimetrically evaluating and comparing both techniques as regard target coverage and doses to organs at risk （OAR）. Methods： Twenty patients with high risk medulloblastoma were treated by 3D-CRT technique. A dosimetric comparison was done by performing two plans for the posterior fossa boost, 3D-CRT and IMRT plans, for the same patient using Eclipse planning system （version 8.6）. Results： IMRT had a better conformity index compared to 3D-CRT plans （P value of 0.000）. As for the dose homogeneity it was also better in the IMRT plans, yet it hasn＇t reached the statistical significant value. Also, doses received by the cochleae, brainstem and spinal cord were significantly less in the IMRT plans than those of 3D-CRT （P value 〈 0.05）. Conclusion： IMRT technique was clearly able to improve conformity and homogeneity index, spare the cochleae, reduce dose to the brainstem and spinal cord in comparison to 3D- CRT technique.     

Intravenous preemptive analgesia modifies the distribution of lymphocyte subsets after radical mastectomy

Objective： In this study, we evaluated the effect of preemptive analgesia of flurbiprofen axetil （FA） and tramadol on immune response in patients undergoing radical mastectomy. Methods： In this prospective randomized, double-blind, placebo-controlled study, 80 patients were randomly assigned to one of four groups （n = 20）. The FA group （group A） patients received FA before tracheal intubation and at the end of surgery. The tramadol group （group B） patients received tramadol before tracheal intubation and at the end of surgery. The control group （group C） patients received saline before tracheal intubation and at the end of surgery. The combination group （group D） patients received FA and tramadol before tracheal intubation and at the end of surgery. Cluster of differentiation and lymphocytes were measured. Results： The CD3, CD4, CD8 and lymphocytes decreased postoperatively of all groups except of group A and D at 0.5 h postoperatively （P 〈 0.05）. The CD3, CD4, CD8 and lymphocytes of group D were higher than those of group C at 0.5 h and 4 h postoperatively （P 〈 0.05）. Conclusion： Preemptive analgesia using flurbiprofen axetil （FA） and tramadol may protect the immune system. The immune protective effect of FA may be better than that of tramadol. The combination of FA and tramadol may be the most effective among all the strategies.     

The observation of single-agent gemcitabine maintenance therapy in patients with metastatic breast cancer

Objective： The aim of the study was to evaluate the efficacy and tolerability of single-agent gemcitabine in the maintenance treatment of histologically confirmed metastatic breast cancer cases. Methods： The 45 patients carried ef- ficacious chemotherapy were divided into maintenance therapy group （n = 23） and control group （n = 22） according to the different treatment methods. Patients in the maintenance therapy group received gemcitabine therapy until 6 cycles, disease progression or adverse effect intolerance. Within the control group, the patients were given best supportive care. Follow-up was made until disease progression, death or 2 years. The short-term clinical efficacy and adverse effects, progression-free survival （PFS） and median survival of recurrence （MSR） of these two groups were compared and analyzed. Results： Com- pared with the control group, the experiment group had higher response rate （RR; 73.9% vs 31.8%; P 〈 0.05）, and significantly progress of median PFS （13.1 vs 9.6 months; P 〈 0.05）. However, the progression of MSR had no statistically difference with the control group （23.3 vs 21.1 months; P 〉 0.05）. Most of the treatment-related adverse events were mild, and the most common adverse event was hematologic toxicity. The 3 cases occurred grades 3-4 neutropenia and 3 cases occurred grades 3-4 thrombocytopenia. The 1 patient stopped treatment because of grade 3 allergic reaction, and 4 patients required dose reduction for grade 4 adverse events. Other adverse effects were grades 1-2, and all were recovered after symptomatic treat- ment. There was no significant side effect which threatened the life. Conclusion： In the extension maintenance treatment, gemcitabine can consolidate the therapeutic effect in advance and significantly prolong median PFS of metastatic breast cancer patients. In conclusion, gemcitabine monotherapy with a favorable safety profile is an effective maintenance treatment in metastatic breast cancer patients.