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ACR Appropriateness Criteria®-Anal Cancer. ACR适宜性标准®-肛门癌。
Theodore S Hong, Jennifer L Pretz, Joseph M Herman, May Abdel-Wahab, Nilofer Azad, A William Blackstock, Prajnan Das, Karyn A Goodman, Salma K Jabbour, William E Jones, Andre A Konski, Albert C Koong, Miguel Rodriguez-Bigas, William Small, Charles R Thomas, Jennifer Zook, W Warren Suh

The management of anal cancer is driven by randomized and nonrandomized clinical trials. However, trials may present conflicting conclusions. Furthermore, different clinical situations may not be addressed in certain trials because of eligibility inclusion criteria. Although prospective studies point to the use of definitive 5-fluorouracil and mitomycin C-based chemoradiation as a standard, some areas remain that are not well defined. In particular, management of very early stage disease, radiation dose, and the use of intensity-modulated radiation therapy remain unaddressed by phase III studies. The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

肛门癌的治疗是由随机和非随机临床试验驱动的。然而,试验可能会得出相互矛盾的结论。此外,由于入选标准的不同,某些试验可能无法处理不同的临床情况。虽然前瞻性研究指出,使用明确的5-氟尿嘧啶和丝裂霉素c为基础的放化疗作为标准,但仍有一些领域没有得到很好的界定。特别是,非常早期疾病的管理、辐射剂量和调强放射治疗的使用仍未在III期研究中得到解决。美国放射学会(ACR)适当性标准®是针对特定临床条件的循证指南,每两年由多学科专家小组审查一次。指南的制定和审查包括对来自同行评议期刊的当前医学文献的广泛分析,并应用一种完善的共识方法(修正德尔菲法)来评估专家组对成像和治疗程序的适当性。在证据缺乏或不确定的情况下,专家意见可用于推荐成像或治疗。
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引用次数: 0
Upcoming articles. 即将到来的文章。
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引用次数: 0
A woman with metastatic pancreatic neuroendocrine tumor. 一位患有转移性胰腺神经内分泌肿瘤的女性。
Alexander N Shoushtari, Anne M Covey, Ghazi Zaatari, Ali Shamseddine, Andrew S Epstein, Ali Haydar, Mohamed Naghy, Deborah Mukherji, David P Kelsen, Ghassan K Abou-Alfa, Eileen M O'Reilly
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引用次数: 0
Tumor rupture as the initial manifestation of primary hepatic leiomyosarcoma. 肿瘤破裂为原发性肝平滑肌肉瘤的初始表现。
Shounak Majumder, Bhavtosh Dedania, Houman Rezaizadeh, Thomas Joyal, Michael Einstein
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引用次数: 0
Intrahepatic cholangiocarcinoma: are we doing the right thing? 肝内胆管癌:我们做的对吗?
Basile Njei
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引用次数: 0
KRAS G13D Mutation and Sensitivity to Cetuximab or Panitumumab in a Colorectal Cancer Cell Line Model. 结直肠癌细胞系模型中KRAS G13D突变和对西妥昔单抗或帕尼单抗的敏感性
Shalini Sree Kumar, Timothy J Price, Omar Mohyieldin, Matthew Borg, Amanda Townsend, Jennifer E Hardingham

Background: The treatment of metastatic colorectal cancer (mCRC) includes drugs targeting the epidermal growth factor receptor (EGFR). Mutation in codon 12 or 13 in the Kirsten rat sarcoma viral oncogene homolog (KRAS) gene, downstream of the EGFR, evokes constitutive activation of the RAS/RAF/MAPK signaling pathway and correlates with resistance to anti-EGFR monoclonal antibody (mAb) therapies. However, a retrospective study reported that a proportion of patients with the KRAS G13D mutation may respond to cetuximab. A similar analysis for panitumumab was not as conclusive. We sought to determine the sensitivity of CRC cell lines to cetuximab or panitumumab treatment and to investigate the correlation of the KRAS mutational status of the CRC cell lines to the responsiveness to cetuximab or panitumumab.

Methods: To determine the responsiveness of CRC cell lines to cetuximab or panitumumab, cell lines were treated with an optimized concentration of each mAb, and proliferation assays were conducted.

Results: After treatment with cetuximab or panitumumab, at the optimum concentration of 8 μg/well, the KRAS G13D mutant cell lines HCT-116, LoVo, and T84 showed intermediate sensitivity to both treatments, between the resistant KRAS G12V mutant cell line SW480 and the sensitive KRAS wild-type cell line LIM1215. One of the G13D cell lines was significantly more sensitive to panitumumab than to cetuximab (P = .02).

Conclusion: The specific KRAS mutation determines the responsiveness to anti-EGFR monoclonal antibody treatment, corresponding to reported clinical observations.

背景:转移性结直肠癌(mCRC)的治疗包括靶向表皮生长因子受体(EGFR)的药物。位于EGFR下游的Kirsten大鼠肉瘤病毒癌基因同系物(KRAS)基因的密码子12或13突变可引起RAS/RAF/MAPK信号通路的组成性激活,并与抗EGFR单克隆抗体(mAb)治疗的耐药性相关。然而,一项回顾性研究报道,一部分KRAS G13D突变患者可能对西妥昔单抗有反应。对帕尼珠单抗的类似分析并不是决定性的。我们试图确定CRC细胞系对西妥昔单抗或帕尼单抗治疗的敏感性,并研究CRC细胞系KRAS突变状态与对西妥昔单抗或帕尼单抗的反应性的相关性。方法:为确定结直肠癌细胞系对西妥昔单抗或帕尼单抗的反应性,分别用最佳浓度的单抗处理细胞系,并进行增殖试验。结果:经西妥昔单抗或帕尼单抗治疗后,在最佳浓度为8 μg/孔时,KRAS G13D突变细胞株HCT-116、LoVo和T84对两种治疗均表现出中等敏感性,介于耐药KRAS G12V突变细胞株SW480和敏感KRAS野生型细胞株LIM1215之间。其中一种G13D细胞系对帕尼单抗的敏感性明显高于西妥昔单抗(P = 0.02)。结论:特异性KRAS突变决定了抗egfr单克隆抗体治疗的反应性,与已有的临床观察结果相一致。
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引用次数: 0
Accelerated fraction radiotherapy with capecitabine as neoadjuvant therapy for borderline resectable pancreatic cancer. 卡培他滨加速分段放疗作为边缘性可切除胰腺癌的新辅助治疗。
Samhita Chakraborty, Monica M Morris, Todd W Bauer, Reid B Adams, Edward B Stelow, Gina Petroni, Hanna K Sanoff

Background: A standard neoadjuvant regimen has not been defined for borderline resectable (BR) pancreatic cancer. This phase II trial was designed to determine the safety of accelerated fraction radiotherapy (AFRT) with capecitabine in patients with BR pancreatic cancer.

Methods: The patients had newly diagnosed BR adenocarcinoma of the pancreas and normal organ function. Intensity-modulated (n = 11) or 3D conformal (n = 2) radiotherapy was given to a dose of 50 Gy in 2.5-Gy fractions with capecitabine 825 mg/m(2) twice on radiation days. The primary outcome was the frequency of severe treatment-related adverse events (AEs). The study was stopped before planned interim analysis because of 2 severe (grades 4 and 5) gastric ulcerations.

Results: Thirteen patients were enrolled with a median age of 66 years. All patients completed treatment. Seven (54%) experienced grade 3+ treatment-related AEs. Severe gastric ulceration occurred in 2 patients despite receipt of ≥43 Gy to only 1% (2-3 cm(3)) of the stomach. Lymphopenia (n = 7) was the only other severe AE that occurred in >1 patient. In 7 of the 13 patients, disease had progressed outside the pancreas at restaging. Five of the 13 underwent resection, and all had >10% viable tumor. Median progression-free survival (PFS) was 2.4 months (95% CI 1.9-5.9), and median survival was 9.1 months (95% CI 5.9-not reached). Among those who underwent resection, median PFS was 13.0 months (95% CI 4.4-not reached). Median survival was not reached.

Conclusions: Given the limited efficacy signal and severe gastric ulcerations, we do not recommend this regimen for pancreatic cancer. We also do not recommend the use of high doses per fraction outside a clinical trial.

背景:边缘性可切除(BR)胰腺癌的标准新辅助治疗方案尚未确定。这项II期试验旨在确定卡培他滨加速分段放疗(AFRT)在BR胰腺癌患者中的安全性。方法:新诊断的胰腺BR腺癌患者,脏器功能正常。调强放疗(n = 11)或三维适形放疗(n = 2),剂量为50 Gy,每组2.5 Gy,卡培他滨825 mg/m(2),放疗日两次。主要结局是严重治疗相关不良事件(ae)的发生频率。由于2例严重(4级和5级)胃溃疡,该研究在计划的中期分析之前停止。结果:13例患者入组,中位年龄66岁。所有患者均完成治疗。7例(54%)经历3+级治疗相关ae。2例患者在接受≥43 Gy照射后,仅1% (2-3 cm)的胃发生严重胃溃疡。淋巴细胞减少(n = 7)是发生在>1例患者中的唯一其他严重AE。13例患者中有7例在复发时疾病已进展到胰腺外。13例患者中有5例接受了手术切除,所有患者的肿瘤存活率均大于10%。中位无进展生存期(PFS)为2.4个月(95% CI 1.9-5.9),中位生存期为9.1个月(95% CI 5.9-未达到)。在接受切除术的患者中,中位PFS为13.0个月(95% CI 4.4-未达到)。中位生存期未达到。结论:鉴于有限的疗效信号和严重的胃溃疡,我们不推荐这种方案用于胰腺癌。我们也不建议在临床试验之外使用高剂量的每部分。
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引用次数: 0
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。
Pub Date : 2013-10-01 DOI: 10.1016/J.IJROBP.2013.06.782
S. Seyedin, Pin-Chieh Wang, Quan Zhang, Percy Lee
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引用次数: 34
Melanoma metastasis to the gastric mucosa preceded by guillain-barré as a paraneoplastic syndrome. 黑素瘤转移到胃粘膜前伴有格林-巴瑞综合征作为副肿瘤综合征。
Rodrigo Kraft Rovere, Maria Eduarda Pires de Souza, Sara Fernanda Hilgert, Yasmine Rodrigues Chamse Ddine, Adma Silva de Lima
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引用次数: 0
Predictors of acute gastrointestinal toxicity during pelvic chemoradiotherapy in patients with rectal cancer. 直肠癌患者盆腔化疗期间急性胃肠道毒性的预测因素。
T Jonathan Yang, Jung Hun Oh, Christina H Son, Aditya Apte, Joseph O Deasy, Abraham Wu, Karyn A Goodman

Background: This study was conducted to identify the factors associated with acute gastrointestinal (GI) toxicity during pelvic chemoradiotherapy (PCRT) in patients with rectal cancer.

Methods: We analyzed 177 patients with rectal cancer treated from 2007 through 2010. Clinical information, including weekly diarrhea and proctitis toxicity grade during PCRT, was recorded. GI structures including bowel and anal canal were contoured. The associations between toxicity and clinical and dosimetric predictors were tested.

Results: The median age was 60; 76 patients were women; 98 were treated with intensity-modulated radiotherapy (IMRT) and 79 with 3D conformal RT (3DCRT). A higher rate of grade 2+ diarrhea was observed in the women, starting at week 4 (24% women vs. 11% men, P = .01; week 5: 33% vs. 12%, P = .002), as well as in all the patients treated with 3DCRT (22% vs. 12% IMRT, P = .03; week 5: 32% vs. 11%, P = .001). On multivariate analysis, the normal tissue complication probability (NTCP) model including bowel V45 (bowel volume receiving ≥45 Gy) showed that being female, and use of 3DCRT, was most predictive of grade 2+ diarrhea (area under the curve [AUC] = 0.76; R S = 0.35; P < .001). A higher rate of grade 2+ proctitis was seen in patients <60 years of age starting at week 3 (21% vs. 9%, P = .02; week 4: 35% vs. 16%, P = .003). The NTCP model including anal canal V15 and younger age was most predictive of grade 2+ proctitis (AUC = 0.67; R S = 0.25; P < .001).

Conclusions: Women and all patients who were treated with 3DCRT had higher rates of grade 2+ diarrhea, and the younger patients had a higher rate of grade 2+ proctitis during PCRT. The use of more stringent dosimetric constraints in higher risk patients is a strategy for minimizing toxicity.

研究背景本研究旨在确定直肠癌患者盆腔放化疗(PCRT)期间急性胃肠道(GI)毒性的相关因素:我们对 2007 年至 2010 年接受治疗的 177 名直肠癌患者进行了分析。方法: 我们对 2007 年至 2010 年接受治疗的 177 例直肠癌患者进行了分析,记录了他们的临床信息,包括 PCRT 期间每周的腹泻和直肠炎毒性等级。对包括肠道和肛管在内的消化道结构进行了轮廓分析。测试了毒性与临床和剂量学预测因素之间的关联:中位年龄为 60 岁;76 名患者为女性;98 名患者接受了调强放射治疗(IMRT),79 名患者接受了三维适形放射治疗(3DCRT)。从第4周开始,女性患者出现2级以上腹泻的比例较高(女性24%,男性11%,P = .01;第5周:33%,男性12%,P = .002),所有接受3DCRT治疗的患者也是如此(IMRT 22%,IMRT 12%,P = .03;第5周:32%,IMRT 11%,P = .001)。在多变量分析中,正常组织并发症概率(NTCP)模型(包括肠道V45(接受≥45 Gy治疗的肠道体积))显示,女性和使用3DCRT最能预测2+级腹泻(曲线下面积[AUC] = 0.76;R S = 0.35;P < .001)。2级以上直肠炎发生率较高:女性和所有接受 3DCRT 治疗的患者发生 2 级以上腹泻的比例较高,年轻患者在 PCRT 期间发生 2 级以上直肠炎的比例较高。对高风险患者使用更严格的剂量限制是将毒性降至最低的一种策略。
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Gastrointestinal cancer research : GCR
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