Oral vinorelbine-based concomitant chemoradiotherapy in unresectable stage III non-small cell lung cancer: a systematic review

Introduction: Cisplatin-based chemotherapy administered concomitantly to thoracic radiotherapy is the treatment recommended by the European guidelines for fit patients with unresectable stage III non-small cell lung cancer (NSCLC). Cisplatin may be combined with etoposide, vinorelbine or other vinca alkaloids, which act also as radiation sensitizers. Initially administered intravenously, vinorelbine is also available as oral formulation and is the only orally available microtubule-targeting agent. In addition, the oral formulation avoids the risk of extravasation and phlebitis.

Areas covered: A literature search has been performed for articles reporting phase II–III trials aimed to evaluate efficacy and safety of oral vinorelbine-based chemoradiotherapy in unresectable locally advanced NSCLC.

Expert commentary: In a series of trials with various protocols published from 2008 to 2018, mostly phase II studies, oral vinorelbine demonstrated a significant activity in concomitant chemoradiotherapy for unresectable locally advanced NSCLC typically as part of combination schedules with cisplatin. Main toxicities were hematologic (neutropenia and anemia); non-hematological toxicities included esophagitis and gastro-duodenal adverse events. Large prospective phase III trials are needed to confirm the role of vinorelbine-based chemotherapy associated to thoracic radiotherapy in unresectable stage III NSCLC and more particularly trials with metronomic oral vinorelbine.     

Role of structures in the masticator space in selecting patients with resectable T4b oral cancer: findings from a survival analysis

Oral squamous cell cancers involving the masticatory space are staged as unresectable cancers and their treatment is difficult. Curative treatment with extensive surgery followed by adjuvant therapy is one of the treatment options. In this retrospective study, the survival of 123 patients (93 with T4a cancers, 30 with T4b cancers), treated during the period August 2009 to August 2015, was evaluated. The majority had bucco-alveolar cancers (62.6%), were male (61.8%), and were tobacco users (76.4%). The select group of T4b oral cancer patients were treated with surgery, which included infratemporal fossa clearance in all 30 patients, followed by adjuvant therapy. The masseter was the most commonly involved masticatory muscle, and 24 patients had fewer than three involved structures. Free margins were obtained in 90.2% of cases; 41.5% of cases were node-positive. One hundred and four patients (84.6%) completed adjuvant treatment. The median follow-up was 42 months. For node-negative patients with T4a and T4b cancers, the 5-year overall survival was 59% and 50.2%, respectively (P =  0.62), and 5-year disease-free survival was 64.6% and 53.5%, respectively (P =  0.01). In conclusion, the select group of patients with T4b oral cancers and less than three masticatory space structures involved had comparable outcomes to those with T4a cancers after treatment with surgery and adjuvant radiotherapy.     

13例初始不可切除肝癌经转化治疗后行序贯手术切除的初步报告

目的 评估初始不可切除肝癌经转化治疗后行序贯手术切除的临床疗效和分析其临床特征。方法 回顾性收集并分析南方医科大学南方医院2020年1月至2021年12月期间收治的13例初始不可切除肝癌患者的临床数据。结果 13例患者中,12例为男性患者,1例为女性患者,年龄50.0±12.7岁（23~72岁）;Child-Pugh分级标准均为A级;CNLC Stage分级Ib期5例,Ⅱa期2例,Ⅱb期2例,Ⅲa期3例,Ⅲb期1例;ECOG ps评分均≤1分;肝硬化者有6例,无肝硬化者7例;有门脉癌栓者2例,无门脉癌栓者11例;治疗前最大肿瘤直径9.8±2.7 cm,治疗前中位AFP为848.1 ng/mL（IQR：20.0~4638.1 ng/mL）;有乙肝者12例,无乙肝者1例。转化治疗方案：TACE+免疫方案治疗的有2例、TACE+靶向+免疫方案治疗的有6例、HAIC+靶向+免疫方案3例及TACE+HAIC+靶向+免疫方案治疗的2例。中位转化时间为3.4月（IQR：2.7~5.5月）,转化治疗后术前的肿瘤最大直径为7.1±2.2 cm,转化治疗后术前的中位AFP水平17.2 ng/mL（IQR：4.0~121.6 ng/mL）,术前影像学评估（mRECIST）CR 2例,PR 5例,PD 1例,SD 5例,肿瘤学转化7例,外科学转化6例,术前PS评分均≤1分。转化后行手术切除：10例行肝部分切除,3例行半肝切除,经腹腔镜手术6例,开腹手术7例。中位手术时间295.0 min（IQR：230.5~418.0 min）,中位术中出血量300 mL（IQR：100~375 mL）,术后中位住院天数为10 d（IQR：7~13 d）,术后中位拔除引流管的时间为7 d（IQR：5.5~13 d）。术后病理结果pCR 6例,pPR有7例,MVI分级M0 10例,M1有3例,均为<5处脉管内癌栓,其中2例为1处脉管内癌栓,无一例切缘阳性病例。术后出现心衰1例,术后出现肺动脉栓塞1例,术后出现胆漏1例。术后中位随访时间11.9月（IQR：6.3~15.1月）,3位患者出现复发,随访期间无一例患者死亡。结论 转化后行序贯手术切除的临床疗效效果肯定,安全性尚可。     

Management of patients with advanced bladder cancer following major response to systemic chemotherapy

Chemotherapy continues to be the treatment of choice for advanced/metastatic bladder cancer. Although response rates as high as 70% have been achieved, there continue to be high progression rates and poor long-term survival. Surgical consolidation offers improved outcomes compared with chemotherapy alone, especially in patients who achieve complete clinical response to chemotherapy. The role of radiation and/or surveillance following major response to chemotherapy in patients with advanced disease remains unclear. Gross regional nodal involvement identified at the time of surgery does not preclude radical cystectomy with lymphadenectomy. Retroperitoneal lymph node dissection may be beneficial to select patients with nonregional retroperitoneal nodal metastasis who achieve good clinical response to chemotherapy. Visceral or lung metastasectomy may be offered to patients with solitary metastasis who achieve a good and durable response to chemotherapy. Nonresponders should be either offered a clinical trial (if available), second-line chemotherapy or best supportive care.     

Results of interval debulking surgery in advanced stage ovarian cancer: an exposed-non-exposed study.

BACKGROUND: To study the results of interval debulking surgery (IDS) in patients treated for 'unresectable' advanced stage ovarian cancer compared with primary debulking surgery (PDS) followed by chemotherapy. PATIENTS AND METHODS: An exposed-non-exposed study including a group of 34 patients who underwent an IDS and were matched to an historic control group of 34 patients treated with PDS. RESULTS: Optimal cytoreductive surgery was achieved in 94% (32 out of 34) of patients in both groups. The rates of post-operative morbidity, blood transfusion and median length of hospitalisation were significantly reduced in the study (IDS) group, but survival did not differ in both groups. CONCLUSIONS: IDS in patients with advanced stage ovarian cancer offers the same chance of survival as PDS, but it is better tolerated.     

Successful multidisciplinary therapy for a patient with liver metastasis from ascending colon adenocarcinoma: A case report and review of literature

BACKGROUND Liver metastasis is the most common form of distant metastasis in colorectal cancer,and the only possible curative treatment for patients with colorectal liver metastases(CRLM) is hepatectomy.However,approximately 25% of patients with CRLM have indications for liver resection at the initial diagnosis.Strategies aimed at downstaging large or multifocal tumors to enable curative resection are appealing.CASE SUMMARY A 42-year-old man was diagnosed with ascending colon cancer and liver me...     

Treatment patterns and survival in advanced unresectable esophageal squamous cell cancer: A population‐based study

Data on treatment and survival of patients with advanced unresectable esophageal squamous cell carcinoma (ESCC) from Western populations are limited. Here we describe treatment and survival in patients with advanced unresectable ESCC: patients with cT4b disease without metastases (cT4b), metastases limited to the supraclavicular lymph nodes (SCLNM) or distant metastatic ESCC at the population level. All patients with unresectable (cT4b) or synchronous metastatic ESCC at primary diagnosis (2015‐2018) or patients with metachronous metastases after primary non‐metastatic diagnosis in 2015‐2016 were selected from the Netherlands Cancer Registry. Fifteen percent of patients had cT4b disease (n = 146), 12% SCLNM (n = 118) and 72% distant metastases (n = 681). Median overall survival (OS) time was 6.3, 11.2, and 4.4 months in patients with cT4b, SCLNM, and distant metastases, respectively (P < .001). Multivariable Cox regression showed that patients with cT4b (hazard ratio 1.44, 95% CI 1.04‐1.99) and patients with distant metastases (hazard ratio 1.42, 95% CI 1.12‐1.80) had a worse survival time compared with patients with SCLNM. Among patients who received chemoradiotherapy and/or underwent resection (primary tumor and/or metastases), median OS was 11.9, 16.1, and 14.0 months in patients with cT4b, SCLNM, and distant metastases, respectively (P = .76). Patients with SCLNM had a better survival time compared with patients with cT4b and patients with distant metastases. Survival of patients with advanced unresectable ESCC in clinical practice was poor, even in patients treated with curative intent.