Advances in treatment modalities, including systemic therapy, local therapy, and technical development, have substantially improved survival rates in patients with colorectal cancer [1]. In addition, the rate of colorectal cancer diagnosis before 50 years of age has been increasing over the past two decades [2]. The number of cancer survivors who suffer from chronic morbidities that impair their quality of life has also increased and will continue growing. Therefore, precision medicine in the era of rectal cancer management aims to provide curative-intent treatment based on tumor characteristics and preserve the quality of life, especially bowel function with sphincter preservation or rectum sparing. Functional derangement was considerably significant after radical resection of rectal cancer. Abdominoperineal resection results in a colossal lifestyle change, and surgeons have attempted to preserve the sphincter. However, several patients experience bowel dysfunction even after sphincter preservation, which constitutes a series of symptoms. Although researchers have suggested various methods for evaluating and managing bowel dysfunction after rectal cancer surgery, treatment strategies need to be established. Therefore, endoscopic removal or local excision has been widely accepted for early rectal cancer treatment, as oncologic outcomes are comparable to those after radical resection. Even in patients with advanced rectal cancer, neoadjuvant chemoradiotherapy resulted in complete tumor regression in a subset of patients, which led us to consider deferral surgery. Watch-andwait (WW) strategies have continuously gained approval in the Asia-Pacific region and Western countries [3]. Proper patient selection is critical for the organ-preserving strategies mentioned above. In this issue of Precision and Future Medicine, three review articles have been published on rectal cancer management, in which interest has increased. Park and Baik [4] reviewed functional assessment methods and various treatments for bowel dysfunction. A series of symptoms associated with postoperative bowel dysfunction was typically called “low anterior resection syndrome (LARS).” Although different scoring systems have been proposed, each affords advantages and drawbacks. The LARS score questionnaire is a widely used tool. Young age, low anastomosis level, anastomotic leakage, and radiotherapy were related to the occurrence of LARS. Medical management, pelvic floor rehabilitation, and sacral nerve stimulation have been suggested for treating LARS. The authors also documented urinary and sexual dysfunctions, as reported in 20% to 40% of patients who undergo rectal cancer surgery. The authors concluded that surgeons should carefully perform sphincter-preserving rectal cancer surgery to ensure functional recovery of the remnant bowel and improve urologic and sexual Received: December 22, 2021 Revised: December 24, 2021 Accepted: December 24, 2021
{"title":"Widening role of multidisciplinary treatment for rectal cancer: toward diversity of cancer care","authors":"Y. Cho","doi":"10.23838/pfm.2021.00191","DOIUrl":"https://doi.org/10.23838/pfm.2021.00191","url":null,"abstract":"Advances in treatment modalities, including systemic therapy, local therapy, and technical development, have substantially improved survival rates in patients with colorectal cancer [1]. In addition, the rate of colorectal cancer diagnosis before 50 years of age has been increasing over the past two decades [2]. The number of cancer survivors who suffer from chronic morbidities that impair their quality of life has also increased and will continue growing. Therefore, precision medicine in the era of rectal cancer management aims to provide curative-intent treatment based on tumor characteristics and preserve the quality of life, especially bowel function with sphincter preservation or rectum sparing. Functional derangement was considerably significant after radical resection of rectal cancer. Abdominoperineal resection results in a colossal lifestyle change, and surgeons have attempted to preserve the sphincter. However, several patients experience bowel dysfunction even after sphincter preservation, which constitutes a series of symptoms. Although researchers have suggested various methods for evaluating and managing bowel dysfunction after rectal cancer surgery, treatment strategies need to be established. Therefore, endoscopic removal or local excision has been widely accepted for early rectal cancer treatment, as oncologic outcomes are comparable to those after radical resection. Even in patients with advanced rectal cancer, neoadjuvant chemoradiotherapy resulted in complete tumor regression in a subset of patients, which led us to consider deferral surgery. Watch-andwait (WW) strategies have continuously gained approval in the Asia-Pacific region and Western countries [3]. Proper patient selection is critical for the organ-preserving strategies mentioned above. In this issue of Precision and Future Medicine, three review articles have been published on rectal cancer management, in which interest has increased. Park and Baik [4] reviewed functional assessment methods and various treatments for bowel dysfunction. A series of symptoms associated with postoperative bowel dysfunction was typically called “low anterior resection syndrome (LARS).” Although different scoring systems have been proposed, each affords advantages and drawbacks. The LARS score questionnaire is a widely used tool. Young age, low anastomosis level, anastomotic leakage, and radiotherapy were related to the occurrence of LARS. Medical management, pelvic floor rehabilitation, and sacral nerve stimulation have been suggested for treating LARS. The authors also documented urinary and sexual dysfunctions, as reported in 20% to 40% of patients who undergo rectal cancer surgery. The authors concluded that surgeons should carefully perform sphincter-preserving rectal cancer surgery to ensure functional recovery of the remnant bowel and improve urologic and sexual Received: December 22, 2021 Revised: December 24, 2021 Accepted: December 24, 2021","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48000038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Watch and wait (WW) strategies have been suggested for patients with clinical complete regression (cCR). The WW approach was first introduced by Habr–Gama in patients with cCR after neoadjuvant treatment. Actually, it is not “no surgery” but “deferral of surgery;” therefore, the WW approach or non-operative management is a representative term currently. The number of publications regarding WW for rectal cancer has increased abruptly. We conducted a systematic review of PubMed for literature published on WW. It is now one of the most interesting issues in rectal cancer treatment. Many studies have reported comparable overall survival with WW and radical resection. However, a high local regrowth rate is a problem, and proper salvage management is the main concern in the WW approach. Adequate patient selection is necessary to achieve favorable oncologic outcomes. However, the appropriate definition and diagnostic method for cCR have not yet been clearly defined. Indeed, advances in local control have not translated into overall survival improvement, and many efforts have been made to improve distant metastasis control and overall survival and improve clinical response to preoperative chemoradiotherapy. In this review, oncologic outcomes, ongoing efforts to improve oncologic outcomes, and limitations for clinical practice were evaluated and described.
{"title":"Watch and wait strategies for rectal cancer A systematic review","authors":"I. Park","doi":"10.23838/pfm.2021.00177","DOIUrl":"https://doi.org/10.23838/pfm.2021.00177","url":null,"abstract":"Watch and wait (WW) strategies have been suggested for patients with clinical complete regression (cCR). The WW approach was first introduced by Habr–Gama in patients with cCR after neoadjuvant treatment. Actually, it is not “no surgery” but “deferral of surgery;” therefore, the WW approach or non-operative management is a representative term currently. The number of publications regarding WW for rectal cancer has increased abruptly. We conducted a systematic review of PubMed for literature published on WW. It is now one of the most interesting issues in rectal cancer treatment. Many studies have reported comparable overall survival with WW and radical resection. However, a high local regrowth rate is a problem, and proper salvage management is the main concern in the WW approach. Adequate patient selection is necessary to achieve favorable oncologic outcomes. However, the appropriate definition and diagnostic method for cCR have not yet been clearly defined. Indeed, advances in local control have not translated into overall survival improvement, and many efforts have been made to improve distant metastasis control and overall survival and improve clinical response to preoperative chemoradiotherapy. In this review, oncologic outcomes, ongoing efforts to improve oncologic outcomes, and limitations for clinical practice were evaluated and described.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44719440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eungu Kang, Lindsey Yoojin Chung, Yu Jin Kim, Kyung Eun Oh, Y. Rhie
Monogenic diabetes mellitus, which is diabetes caused by a defect in a single gene that is associated with β cell function or insulin action, accounts for 1% to 6% of all pediatric diabetes cases. Accurate diagnosis is important, as the effective treatment differs according to genetic etiology in some types of monogenic diabetes: high-dose sulfonylurea treatment in neonatal diabetes caused by activating mutations in KCNJ11 or ABCC8; low-dose sulfonylurea treatment in HNF1A/HNF4A-diabetes; and no treatment in GCK diabetes. Monogenic diabetes should be suspected by clinicians for certain combinations of clinical features and laboratory results, and approximately 80% of monogenic diabetes cases are misdiagnosed as type 1 diabetes or type 2 diabetes. Here, we outline the types of monogenic diabetes and the clinical implications of genetic diagnosis.
{"title":"Monogenic diabetes mellitus and clinical implications of genetic diagnosis","authors":"Eungu Kang, Lindsey Yoojin Chung, Yu Jin Kim, Kyung Eun Oh, Y. Rhie","doi":"10.23838/pfm.2021.00100","DOIUrl":"https://doi.org/10.23838/pfm.2021.00100","url":null,"abstract":"Monogenic diabetes mellitus, which is diabetes caused by a defect in a single gene that is associated with β cell function or insulin action, accounts for 1% to 6% of all pediatric diabetes cases. Accurate diagnosis is important, as the effective treatment differs according to genetic etiology in some types of monogenic diabetes: high-dose sulfonylurea treatment in neonatal diabetes caused by activating mutations in KCNJ11 or ABCC8; low-dose sulfonylurea treatment in HNF1A/HNF4A-diabetes; and no treatment in GCK diabetes. Monogenic diabetes should be suspected by clinicians for certain combinations of clinical features and laboratory results, and approximately 80% of monogenic diabetes cases are misdiagnosed as type 1 diabetes or type 2 diabetes. Here, we outline the types of monogenic diabetes and the clinical implications of genetic diagnosis.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46219756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pubertal onset is a complex process, which is influenced by genetic and environmental factors, such as obesity and endocrine-disrupting chemicals. In addition, the timing of normal puberty varies between individuals and is a highly polygenic trait with both rare and common variants. Central precocious puberty (CPP) is defined as the early activation of the hypothalamic-pituitary-gonadal axis. Genetic factors are suggested to account for 50% to 80% of the variation in puberty initiation, as indicated by the greater concordance of pubertal timing observed in monozygotic twins than in dizygotic twins. Although genetic factors play a crucial role in CPP development, only few associated genes have been identified. To date, four monogenic genes have been identified: KISS1, KISS1R, MKRN3, and DLK1. Moreover, mutation prevalence in these genes varies considerably depending on the ethnicity of patients with CPP. This article reviews the current knowledge on the normal pubertal timing and physiology and discusses the CPP-causing genes.
{"title":"Genetic etiologies of central precocious puberty","authors":"Hae-sang Lee","doi":"10.23838/pfm.2021.00107","DOIUrl":"https://doi.org/10.23838/pfm.2021.00107","url":null,"abstract":"Pubertal onset is a complex process, which is influenced by genetic and environmental factors, such as obesity and endocrine-disrupting chemicals. In addition, the timing of normal puberty varies between individuals and is a highly polygenic trait with both rare and common variants. Central precocious puberty (CPP) is defined as the early activation of the hypothalamic-pituitary-gonadal axis. Genetic factors are suggested to account for 50% to 80% of the variation in puberty initiation, as indicated by the greater concordance of pubertal timing observed in monozygotic twins than in dizygotic twins. Although genetic factors play a crucial role in CPP development, only few associated genes have been identified. To date, four monogenic genes have been identified: KISS1, KISS1R, MKRN3, and DLK1. Moreover, mutation prevalence in these genes varies considerably depending on the ethnicity of patients with CPP. This article reviews the current knowledge on the normal pubertal timing and physiology and discusses the CPP-causing genes.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42657506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Do we need more genetic counselling in pediatric endocrine diseases?","authors":"E. Rhee","doi":"10.23838/pfm.2021.00121","DOIUrl":"https://doi.org/10.23838/pfm.2021.00121","url":null,"abstract":"","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41247554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder caused by a deficiency in gonadotropin-releasing hormone (GnRH). CHH is characterized by delayed puberty and/or infertility; this is because GnRH is the main component of the hypothalamic-pituitary-gonadal (HPG) axis, which is a key factor in pubertal development and reproductive function completion. However, since the development of sexual characteristics and reproduction begins in the prenatal period and is very complex and delicate, the clinical characteristics and involved genes are very diverse. In particular, the HPG axis is activated three times in a lifetime, and the symptoms and biochemical findings of CHH vary by period. In addition, related genes also vary according to the formation and activation process of the HPG axis. In this review, the clinical characteristics and treatment of CHH according to HPG axis activation and different developmental periods are reviewed, and the related genes are summarized according to their pathological mechanisms.
{"title":"Congenital hypogonadotropic hypogonadism: from clinical characteristics to genetic aspects","authors":"A. Kwon, Ho-Seong Kim","doi":"10.23838/pfm.2021.00093","DOIUrl":"https://doi.org/10.23838/pfm.2021.00093","url":null,"abstract":"Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder caused by a deficiency in gonadotropin-releasing hormone (GnRH). CHH is characterized by delayed puberty and/or infertility; this is because GnRH is the main component of the hypothalamic-pituitary-gonadal (HPG) axis, which is a key factor in pubertal development and reproductive function completion. However, since the development of sexual characteristics and reproduction begins in the prenatal period and is very complex and delicate, the clinical characteristics and involved genes are very diverse. In particular, the HPG axis is activated three times in a lifetime, and the symptoms and biochemical findings of CHH vary by period. In addition, related genes also vary according to the formation and activation process of the HPG axis. In this review, the clinical characteristics and treatment of CHH according to HPG axis activation and different developmental periods are reviewed, and the related genes are summarized according to their pathological mechanisms.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47652638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To report on infiltrative invasion of the diaphragm, an uncommon manifestation of recurrent hepatocellular carcinoma (HCC), and evaluate its clinical significance. Methods: Using the term “diaphragm” or “diaphragmatic” and “invasion” or “involvement,” we searched for patients in the database of radiologic reports of liver computed tomography or magnetic resonance imaging performed between 2012 and 2016 at our institution. Nine patients with infiltrative invasion of the diaphragm due to recurrent HCC were included. Their clinical and imaging findings were evaluated. Results: The median age of patients at the time of diagnosis was 68 years (range, 40 to 73). There were eight men and one woman. Imaging findings of infiltrative invasion of the diaphragm revealed diffuse thickening with enhancement involving a part of the diaphragm. The median interval between initial manifestation on imaging and radiologic diagnosis of infiltrative invasion of the diaphragm was 6.8 months (range, 3.4 to 18.6). In two of three patients who underwent surgical resection, tumors of the diaphragm were controlled without recurrence. In six patients except for one patient who was not followed up, tumors recurred at the resection site or diaphragm tumors showed a partial response or disease progression. Conclusion: Infiltrative invasion of the diaphragm by recurrent HCC manifested with diffuse thickening and diaphragm enhancement on radiologic imaging. A good prognosis can be expected only in patients who are diagnosed early and undergo surgical resection.
{"title":"Infiltrative invasion of the diaphragm: an uncommon manifestation of recurrent hepatocellular carcinoma","authors":"C. Kim, K. D. Song, Jung Han Woo","doi":"10.23838/pfm.2021.00086","DOIUrl":"https://doi.org/10.23838/pfm.2021.00086","url":null,"abstract":"Purpose: To report on infiltrative invasion of the diaphragm, an uncommon manifestation of recurrent hepatocellular carcinoma (HCC), and evaluate its clinical significance. Methods: Using the term “diaphragm” or “diaphragmatic” and “invasion” or “involvement,” we searched for patients in the database of radiologic reports of liver computed tomography or magnetic resonance imaging performed between 2012 and 2016 at our institution. Nine patients with infiltrative invasion of the diaphragm due to recurrent HCC were included. Their clinical and imaging findings were evaluated. Results: The median age of patients at the time of diagnosis was 68 years (range, 40 to 73). There were eight men and one woman. Imaging findings of infiltrative invasion of the diaphragm revealed diffuse thickening with enhancement involving a part of the diaphragm. The median interval between initial manifestation on imaging and radiologic diagnosis of infiltrative invasion of the diaphragm was 6.8 months (range, 3.4 to 18.6). In two of three patients who underwent surgical resection, tumors of the diaphragm were controlled without recurrence. In six patients except for one patient who was not followed up, tumors recurred at the resection site or diaphragm tumors showed a partial response or disease progression. Conclusion: Infiltrative invasion of the diaphragm by recurrent HCC manifested with diffuse thickening and diaphragm enhancement on radiologic imaging. A good prognosis can be expected only in patients who are diagnosed early and undergo surgical resection.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45267629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A tic is a sudden, rapid, recurrent, and nonrhythmic motor movement and vocalization. In Tourette’s disorder (TD), the tics may wax and wane in frequency and severity but persist for more than one year since the first tic onset. TD may have a high spontaneous remission rate. However, in some patients, tic symptoms persist even after adulthood. Since tic symptoms develop from a very young age and have wax and wane patterns during the development period, uncontrolled symptoms can cause both subjective dis-tress and functional disability in activities of daily living. Even if psychoeducation and behavioral therapy are considered first, the treatment is determined by considering various factors such as severity of symptoms, subjective distress, physical pain, and functional impairment caused by symptoms. In addition to the antipsychotics that have been used so far, several drugs have recently been tried based on the pathogenesis hy-pothesis, and the evidence for treatment effects is increasing. This article reviewed pos-sible interventions with proven evidence of TD, including psychopharmacologic treatment.
{"title":"The therapeutic approaches in children and adolescent with Tourette’s disorder","authors":"Y. Joung, Moon-Soo Lee","doi":"10.23838/PFM.2020.00191","DOIUrl":"https://doi.org/10.23838/PFM.2020.00191","url":null,"abstract":"A tic is a sudden, rapid, recurrent, and nonrhythmic motor movement and vocalization. In Tourette’s disorder (TD), the tics may wax and wane in frequency and severity but persist for more than one year since the first tic onset. TD may have a high spontaneous remission rate. However, in some patients, tic symptoms persist even after adulthood. Since tic symptoms develop from a very young age and have wax and wane patterns during the development period, uncontrolled symptoms can cause both subjective dis-tress and functional disability in activities of daily living. Even if psychoeducation and behavioral therapy are considered first, the treatment is determined by considering various factors such as severity of symptoms, subjective distress, physical pain, and functional impairment caused by symptoms. In addition to the antipsychotics that have been used so far, several drugs have recently been tried based on the pathogenesis hy-pothesis, and the evidence for treatment effects is increasing. This article reviewed pos-sible interventions with proven evidence of TD, including psychopharmacologic treatment.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49103187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The targeted cancer therapies that have been introduced in recent years are directed against cancer-specific molecules and signaling pathways, and thus, they have limited nonspecific toxicities. However, major vascular events, including stroke, are common in patients receiving tyrosine kinase inhibitors (TKIs). Inhibition of vascular endothelial growth factor receptor by some TKIs probably explains such events. Moreover, venous and arterial thromboses, atherosclerosis, and bleeding have been reported. Ischemic lesions can also occur due to impaired angiogenesis or endothelial dysfunction. However, the exact mechanisms of arterial stroke in patients with cancer receiving TKIs are unknown. Here, we have report two cases of non-thrombotic ischemic cerebrovascular events related to TKIs and described the high-resolution magnetic resonance imaging findings.
{"title":"Non-thrombotic ischemic cerebrovascular events related to the use of tyrosine kinase inhibitors in patients with cancer: high-resolution magnetic resonance imaging findings","authors":"J. Sim, J. Park, O. Bang","doi":"10.23838/pfm.2021.00072","DOIUrl":"https://doi.org/10.23838/pfm.2021.00072","url":null,"abstract":"The targeted cancer therapies that have been introduced in recent years are directed against cancer-specific molecules and signaling pathways, and thus, they have limited nonspecific toxicities. However, major vascular events, including stroke, are common in patients receiving tyrosine kinase inhibitors (TKIs). Inhibition of vascular endothelial growth factor receptor by some TKIs probably explains such events. Moreover, venous and arterial thromboses, atherosclerosis, and bleeding have been reported. Ischemic lesions can also occur due to impaired angiogenesis or endothelial dysfunction. However, the exact mechanisms of arterial stroke in patients with cancer receiving TKIs are unknown. Here, we have report two cases of non-thrombotic ischemic cerebrovascular events related to TKIs and described the high-resolution magnetic resonance imaging findings.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68884456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: This study aimed to evaluate the predictive value of preoperative chest computed tomography (CT) for axillary lymph node (ALN) metastasis in patients with breast cancer. Methods: CT features of ALNs were retrospectively reviewed in 212 patients with breast cancer who underwent preoperative chest CT examination and ALN dissection. Primary tumor size and CT characteristics of ALNs (cortical thickness, cortical shape, the presence or absence of contrast enhancement of ALNs, and the presence or absence of perinodal infiltration) were recorded and analyzed. A nomogram was developed to visualize the associations between the predictors and each ALN status endpoint. Results: Of 212 patients, 95 (44.8%) had ALN metastasis. Primary tumor size and CT characteristics of ALNs were identified as predictors of ALN metastasis. The nomogram comprising primary tumor size and cortical shape was a good validation model for predicting ALN metastasis. The sensitivity, specificity, and accuracy of the nomogram for predicting ALN metastasis were 88.4%, 79.5%, and 83.5%, respectively. Conclusion: Using preoperative chest CT scans, a nomogram combining the cortical shape of ALNs with the primary tumor size showed good performance in predicting ALN metastasis.
{"title":"Predictive value of chest computed tomography for axillary lymph node metastasis in patients with breast cancer","authors":"C. Kim, M. Chung, S. Chong","doi":"10.23838/pfm.2021.00079","DOIUrl":"https://doi.org/10.23838/pfm.2021.00079","url":null,"abstract":"Purpose: This study aimed to evaluate the predictive value of preoperative chest computed tomography (CT) for axillary lymph node (ALN) metastasis in patients with breast cancer. Methods: CT features of ALNs were retrospectively reviewed in 212 patients with breast cancer who underwent preoperative chest CT examination and ALN dissection. Primary tumor size and CT characteristics of ALNs (cortical thickness, cortical shape, the presence or absence of contrast enhancement of ALNs, and the presence or absence of perinodal infiltration) were recorded and analyzed. A nomogram was developed to visualize the associations between the predictors and each ALN status endpoint. Results: Of 212 patients, 95 (44.8%) had ALN metastasis. Primary tumor size and CT characteristics of ALNs were identified as predictors of ALN metastasis. The nomogram comprising primary tumor size and cortical shape was a good validation model for predicting ALN metastasis. The sensitivity, specificity, and accuracy of the nomogram for predicting ALN metastasis were 88.4%, 79.5%, and 83.5%, respectively. Conclusion: Using preoperative chest CT scans, a nomogram combining the cortical shape of ALNs with the primary tumor size showed good performance in predicting ALN metastasis.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68884468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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