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Benefit of Adjuvant Chemoradiotherapy for Gastric Adenocarcinoma: A SEER Population Analysis. 胃腺癌辅助放化疗的益处:一项SEER人群分析。
Steven Seyedin, Pin-Chieh Wang, Quan Zhang, Percy Lee

Background: Despite results of the Intergroup 0116 (INT-0116) study showing an overall survival benefit of adjuvant chemoradiotherapy in gastric adenocarcinoma, its use in the United States remains controversial. The Surveillance Epidemiology of End Results (SEER) database was used to compare cause-specific survival outcomes in resected gastric adenocarcinoma with various adjuvant therapies and patterns of care.

Methods: Individual data from 1988 to 2008 were selected for patients with resected, nonmetastatic gastric adenocarcinoma. These patients were stratified by stage (American Joint Committee on Cancer [AJCC], 6th edition), as well as treatment modalities (surgery alone, S; surgery followed by radiotherapy, SR; surgery with chemotherapy, SC; surgery followed by radiotherapy with chemotherapy, SRC; and radiotherapy followed by surgery with chemotherapy, RSC). Overall 21,472 patients (8335 stages IA and 1B; 5944 stage II, 4594 stage III, and 2599 stage IV) were included in this study.

Results: The median age of the cohort was 66 years, with 63.0% male and 66.4% white. The median number of lymph nodes examined was 17.6. Median survival by stage was 96 months for stage I, 30 months for stage II, 20 months for stage III, and 14 months for stage IV. Using the SRC group as the reference group, for stage I patients, S had the most favorable cause-specific survival (hazard ratio [HR], 0.67; confidence interval, [CI] 0.60-0.76). For patients with stage II, III, or IV, those treated with SRC had the best outcome compared with the other treatment modalities. After 1999, the number of patients treated with surgery alone decreased by at least 14%, whereas the number treated with SRC increased by approximately 12%.

Conclusions: This large SEER database analysis showed that stage I patients benefited most from surgery alone, whereas those at more advanced stages benefited most from adjuvant radiotherapy with chemotherapy. This result is consistent with INT-0116 for gastric adenocarcinoma in support of trimodality therapy and is reflected by the increased fraction of patients receiving chemotherapy and adjuvant radiation.

背景:尽管Intergroup 0116 (INT-0116)研究结果显示胃腺癌辅助放化疗的总体生存获益,但其在美国的使用仍存在争议。最终结果的监测流行病学(SEER)数据库用于比较各种辅助治疗和护理模式下切除胃腺癌的病因特异性生存结果。方法:选取1988年至2008年切除的非转移性胃腺癌患者的个体数据。这些患者按分期(美国癌症联合委员会[AJCC],第6版)和治疗方式(单独手术,S;手术后放疗,SR;化疗手术,SC;手术后放疗加化疗,SRC;放疗后手术加化疗(RSC)。总计21472例患者(8335例IA期和1B期;5944例II期,4594例III期,2599例IV期)纳入本研究。结果:队列的中位年龄为66岁,男性63.0%,白人66.4%。检查淋巴结的中位数为17.6个。分期的中位生存期为I期96个月,II期30个月,III期20个月,IV期14个月。以SRC组为参照组,对于I期患者,S组具有最有利的病因特异性生存(风险比[HR], 0.67;置信区间,[CI] 0.60-0.76)。对于II期、III期或IV期患者,与其他治疗方式相比,SRC治疗的结果最好。1999年以后,单独接受手术治疗的患者数量减少了至少14%,而接受SRC治疗的患者数量增加了约12%。结论:这项大型SEER数据库分析显示,I期患者从单纯手术中获益最多,而那些更晚期的患者从辅助放疗和化疗中获益最多。这一结果与胃腺癌的INT-0116一致,支持三段式治疗,并反映在接受化疗和辅助放疗的患者比例增加。
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引用次数: 0
Benign schwannoma masquerading as a malignant metastatic lesion in a patient with renal cell carcinoma. 肾细胞癌患者的良性神经鞘瘤伪装成恶性转移灶。
Santhosh Sadashiv, Georgios Deftereos, Eli Pakravan, Jan F Silverman, Shifeng Mao
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引用次数: 0
Quantitative perfusion- and diffusion-weighted magnetic resonance imaging of gastrointestinal cancers treated with multikinase inhibitors: a pilot study. 多激酶抑制剂治疗胃肠道癌症的定量灌注和扩散加权磁共振成像:一项初步研究。
Hyunki Kim, Kimberly S Keene, David B Sarver, S Kyle Lee, T Mark Beasley, Desiree E Morgan, James A Posey

Background: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) are often used to detect the early response of solid tumors to an effective therapy. The early changes in intratumoral physiological parameters measured by DCE-MRI/DWI have been evaluated as surrogate biomarkers allowing a tailored treatment for the individual patient.

Methods: Patients with newly diagnosed, biopsy-proven, treatment-naïve gastrointestinal stromal tumor (GIST) or hepatocellular carcinoma (HCC) were enrolled prospectively after institutional review board (IRB)-approved informed consent (5 patients per tumor type). Patients with GIST were treated with sunitinib over 6 weeks. DCE-MRI/DWI was applied before therapy (baseline imaging) and at 2 and 6 weeks after therapy initiation. Patients with HCC were treated with radiation during the first 2 weeks and then with sorafenib for the next 6 weeks. DCE-MRI/DWI was applied in all patients with HCC before and after radiation therapy and at the end of sorafenib therapy. Tumor volume, perfusion parameters (K (trans), the forward volume-transfer constant, and k ep, the reverse reflux-rate constant) and the apparent diffusion coefficient (ADC) were measured.

Results: During 2 weeks of sunitinib therapy, GIST volume, K (trans), and k ep decreased 32 ± 13, 45 ± 24, and 42 ± 15%, respectively, whereas ADC increased 76 ± 24%. After 6 weeks of sunitinib therapy, GIST volume, K (trans), and k ep decreased 56 ± 7, 70 ± 7, and 50 ± 12%, respectively, whereas ADC increased 85 ± 33%. After completion of radiation therapy, HCC volume, K (trans), and k ep decreased 34 ± 14, 35 ± 12, and 4 ± 21%, respectively, but ADC increased 21 ± 9%. During the entire 10-week therapeutic period, HCC volume, K (trans), and k ep decreased 65 ± 15, 40 ± 9, and 26 ± 2%, respectively, whereas ADC increased 28 ± 10%.

Conclusion: DCE-MRI/DWI can measure the perfusion and diffusion changes in GISTs or HCCs treated with multikinase inhibitors.

背景:动态对比增强磁共振成像(DCE-MRI)和弥散加权成像(DWI)通常用于检测实体瘤对有效治疗的早期反应。通过DCE-MRI/DWI测量的肿瘤内生理参数的早期变化已被评估为替代生物标志物,允许针对个体患者进行定制治疗。方法:经机构审查委员会(IRB)批准的知情同意后,前瞻性纳入新诊断、活检证实的treatment-naïve胃肠道间质瘤(GIST)或肝细胞癌(HCC)患者(每种肿瘤类型5例)。GIST患者接受舒尼替尼治疗超过6周。在治疗前(基线成像)和治疗开始后2周和6周分别应用DCE-MRI/DWI。HCC患者在前2周接受放射治疗,然后在接下来的6周使用索拉非尼。所有HCC患者放疗前后及索拉非尼治疗结束时均行DCE-MRI/DWI检查。测定肿瘤体积、灌注参数(正向体积传递常数K (trans)、反向回流速率常数K ep)和表观扩散系数(ADC)。结果:舒尼替尼治疗2周,GIST体积、K (trans)和K - ep分别下降32±13%、45±24%和42±15%,而ADC增加76±24%。舒尼替尼治疗6周后,GIST体积、K(反式)和K - ep分别下降56±7%、70±7%和50±12%,而ADC增加85±33%。放疗结束后,HCC体积、K(反式)和K - ep分别下降34±14%、35±12%和4±21%,而ADC增加21±9%。在整个10周的治疗期间,HCC体积、K(反式)和K - ep分别下降65±15%、40±9%和26±2%,而ADC增加28±10%。结论:DCE-MRI/DWI可以测量多激酶抑制剂治疗后的gist或hcc灌注和弥散的变化。
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引用次数: 0
From the liver to the foot: a case of systemic embolism and acrometastasis in hepatocellular carcinoma. 从肝脏到足部:肝细胞癌的全身栓塞和肢端转移一例。
Ghaith Abu-Zeinah, Dwight Owen, Carlos Prieto-Granada, Natasha Rekhtman, David Klimstra, Dipti Gupta, James Harding, Ghassan K Abou-Alfa
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引用次数: 0
Metastatic breast cancer masquerading as primary gastric cancer: case report and review of the literature. 伪装成原发性胃癌的转移性乳腺癌:病例报告和文献回顾。
Alexander C Black, Danielle Lu, Susan Murakami
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引用次数: 0
A case of primary colonic small-cell carcinoma arising in a patient with long-standing ulcerative colitis. 一例长期溃疡性结肠炎患者的原发性结肠小细胞癌。
Renée M Marchioni Beery, Thomas J Devers, Jessica M Clement
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引用次数: 0
Pseudomyxoma peritonei metastatic to the bone: case report and review of systemic management. 腹膜假性黏液瘤骨转移:病例报告及系统治疗回顾。
Renata D'Alpino Peixoto, Sheridan Wilson, David F Schaeffer, Howard J Lim
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引用次数: 0
Hepatocellular Carcinoma With Intra-atrial Extension Responding to Transarterial Chemoembolization via the Right Hepatic and Right Inferior Phrenic Arteries. 经右肝动脉和右膈下动脉经动脉化疗栓塞治疗伴有心房内扩张的肝癌。
Maen W H Kamal, Maham Farshidpour, Andrew W Long, Saleem Farooqui, Steven C Cunningham
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引用次数: 0
Challenges in combining antiangiogenic therapy with transarterial chemoembolization for hepatocellular carcinoma. 抗血管生成治疗联合经动脉化疗栓塞治疗肝癌的挑战。
Ali A Haydar, Deborah Mukherji, Walid Faraj, Mohammad Khalifeh, Bedros Taslakian, Zeinab Abou Yehia, Sally Temraz, Karen T Brown, Ghassan K Abou-Alfa, Ali Shamseddine

Background: The combination of systemic antiangiogenic therapy and transarterial chemoembolization (TACE) for the treatment of unresectable hepatocellular carcinoma (HCC) is the subject of several ongoing clinical trials. We present a series of patients treated with sorafenib and TACE at our institution, highlighting the technical challenges of combining these two modalities of treatment.

Methods: We retrospectively identified patients with HCC treated with TACE and sorafenib at our institution.

Results: Five patients were treated with the combination of TACE and sorafenib given off-protocol based on preliminary reports in the literature. The first four patients started sorafenib 7 days prior to TACE resulting in intratumoral vascular pruning and poor visualization of lesions on angiography. This was managed by either superselective angiography or lobar TACE. The fifth patient stopped sorafenib 7 days prior to TACE with full visualization of multiple hypervascular lesions on angiography prior to embolization.

Conclusions: Our observations suggest that the biologically preferable strategy of continuous antiangiogenic therapy should be weighed against the possibility of suboptimal TACE due to poor visualization of lesions on angiography and safety.

背景:全身抗血管生成治疗和经动脉化疗栓塞(TACE)联合治疗不可切除的肝细胞癌(HCC)是几个正在进行的临床试验的主题。我们介绍了一系列在我们机构接受索拉非尼和TACE治疗的患者,强调了结合这两种治疗方式的技术挑战。方法:我们对我院接受TACE和索拉非尼治疗的HCC患者进行回顾性研究。结果:根据文献初步报道,5例患者采用非方案TACE联合索拉非尼治疗。前四名患者在TACE前7天开始使用索拉非尼,导致肿瘤内血管修剪和血管造影病变可视性差。这是由超选择性血管造影或大叶TACE处理。第五名患者在TACE前7天停用索拉非尼,栓塞前血管造影显示多个高血管病变。结论:我们的观察结果表明,持续抗血管生成治疗的生物学优选策略应与由于血管造影病变可视性差和安全性而导致TACE次优的可能性进行权衡。
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引用次数: 0
Multiorgan Streptococcus milleri Abscesses During FOLFIRINOX Chemotherapy in a Patient With Metastatic Pancreatic Cancer. 转移性胰腺癌患者在FOLFIRINOX化疗期间出现多器官米勒氏链球菌脓肿。
Evelyn Brosnan, Kabir Mody, Richard A Zuckerman, Kathryn L Ruoff, J Marc Pipas
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Gastrointestinal cancer research : GCR
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