Ai zheng = Aizheng = Chinese journal of cancer最新文献

Background and objective: Subcutaneous panniculitis T-cell lymphoma (SPTCL) is a rare subtype of primary cutaneous lymphoma. This study was to analyze the clinical characteristics, treatment and prognosis of SPTCL.

Methods: Clinical data of 19 SPTCL patients, treated at Cancer Center and the First Affiliated Hospital of Sun Yat-sen University from January 2001 to July 2007, were analyzed.

Results: The median age of the patients was 36 years. Seven patients had skin-excluded extra-nodal involvement; ten had lactate dehydragenase (LDH) elevation before treatment; one had hemophagocytic syndrome. Most of the parents received chemotherapy, including CHOP regimen, modified-alternative triple therapy (m-ATT), and Hyper-CVAD/HD-MA regimen. The median follow-up was 56 months. The median survival was 40 months, and the 2-year expected overall survival rate was 56%. Eight patients who received treatment of intensive chemotherapy had continous remission of 17-70 months; six of them underwent radiotherapy after chemotherapy. Univariate analysis (log-rank test) showed that sex, B symptoms, skin-excluded extra-nodal involvement, and pre-treatment blood cell count and LDH level affected the prognosis.

Conclusions: SPTCL might be cured by high dose chemotherapy combined with whole body irradiation. The regimens which are effective without crossing resistance or more intensive may improve the response rate and overall survival.

Background and objective: Bladder cancer is the most malignant cancer of the urinary system. However a noninvasive and sensitive method of the early diagnosis for bladder cancer has not been developed. This study was to explore the expression of survivin mRNA in urine exfoliated cells of preoperative and postoperative patients with bladder transitional cell carcinoma (BTCC), and to analyze its value in early diagnosis and postoperative monitoring.

Methods: Urine of 30 patients with initially diagnosed BTCC was collected before operation and one week, one month, six months and 15 months after operation. Urine of 10 healthy volunteers and 15 patients with cystitis was used as control. Expression of survivin mRNA in urine exfoliated cells was detected by real-time fluorescent quantitative polymerase chain reaction (real-time PCR).

Results: The relative copy number of survivin mRNA in the patients was (96.01+/-42.33) before operation, which was significantly higher than that of healthy volunteers and cystitis patients (P <0.05). The level of survivin mRNA was apparently declined one week after operation (25.30+/-1.51) compared with its preoperative level (P <0.05); and the level became as low as the control group after one month (13.20+/-1.49) and six months (13.90+/-1.36) (P>0.05). Patients were followed up for 15 months, and three patients recurred, whose survivin mRNA level (97.83+/-27.47) was significantly higher than that at six months after operation (P <0.05).

Conclusion: Detecting survivin mRNA in urine exfoliated cells is sensitive for the diagnosis of BTCC. Detection survivin mRNA after operation can monitor recurrence.

Vitamin E succinate (RRR-alpha-tocopheryl succinate, VES) is an ester derivative of vitamin E. Roles of vitamin E (alpha-tocopherol) family in cancer prevention and therapy have been investigated since 1960s'. Experimental evidences indicated that VES is one of the most effective anticancer compounds of the vitamin E family. VES can effectively inhibit many kinds of tumors without toxic effects on normal cells and tissues. This article reviewed the anticancer mechanisms of VES in the following four aspects: 1) the molecular structure, chemical property and carrier of VES. 2) the mechanisms of VES in inhibiting cancer cell proliferation. 3) the mechanisms of VES-induced apoptosis of cancer cells. 4) the mechanisms of VES in preventing tumor metastasis. Investigation on the anticancer mechanisms of VES would help find new targets and develop new effective and safe drugs for cancer prevention and treatment.

Background and objective: The 2008 staging system of nasopharyngeal carcinoma (NPC) was generated based on the NPC 92 and AJCC staging system. It remains open to be consummated. This study was to evaluate its rationality as well as compare the stage distribution among the 3 staging systems, by using of MRI imaging.

Methods: MRI data was collected from a cohort of 177 cases of untreated NPC for retrospective review. We accepted the nasal involvement criteria of 2008 staging system, in which the borderline between the nasal cavity and nasopharynx was a line linked between both posterior walls of the maxillary sinus, for all of the 3 systems.

Results: Involvement of oropharynx, nasopharynx, soft palatine, prevertebral muscles, post-styloid space, intracranial, orbit, 1st and/or 2nd cervical body are 100% accompanied with other same or more advanced T-stage classifications. The same situations happened in more than 95% of involvement of the medial pterygoid muscle or masticator space beyond it. Cervical lymph node metastasis (LNM) accounted for 76.3%. Proportion of metastatic lymph node extracapsular extension (ECE) and/or bilateral neck LNM elevated as maximum diameter of the node increased, no matter transverse or longitudinal. There were 11 cases of parotid LNM in this group. Advanced stage accounted for 81.4%, 78.5% and 75.7% in 2008, UICC and NPC 92 staging system, respectively, without statistic difference.

Conclusion: Nasal involvement criteria and T-stage classification of the medial pterygoid muscle defined by NPC 2008 staging system seems reasonable. Stage distribution is also similar to the other 2 systems. However, diameter of the LNM might not be a prognostic factor. Parameters such as how to classify a parotid LNM, or a node which occupies more than one region, require further clarify.

Background and objective: The efficacy of standard chemotherapy regimen on aggressive non-Hodgkin's lymphoma (NHL) of certain pathologic types is unsatisfied. This study was to evaluate the safety and efficacy of modified Hyper-CVAD regimen on Chinese patients with aggressive NHL.

Methods: Clinical records of 31 NHL patients who received modified Hyper-CVAD regimen in Cancer Hospital of Chinese Academy of Medical Sciences from June 2004 to June 2008 were analyzed in terms of toxicity and response.

Results: The 31 patients totally received 91 cycles of regimen A and 41 cycles of regimen B with a median of 4 cycles (ranged 1-7 cycles). The major toxicity was myelosuppresion: the occurrence rates of neutropenia of grades III-IV, thrombocytopenia and febrile neutropenia were 49.5%, 3.3% and 12.1% during treatment of regimen A, and were 80.5%, 82.9% and 46.3% during treatment of regimen B. No treatment-related death was observed. The responses were assessable in 26 patients. The total response rate was 80.8%, and 12 patients achieved complete response (46.2%).

Conclusion: Modified Hyper-CVAD regimen is a promising regimen for the patients with intermediate and high grade NHL.

Background and objective: Individual oral stent used in nasopharyngeal carcinoma (NPC) patients during radiotherapy can spare the oral mucosa and tongue. This study was to analyze the placement repeatability and feasibility of individual oral stent used in radiotherapy of NPC.

Methods: Individual oral stents were made for 17 naive NPC patients, and three lead markers of 2.0 mm diameter were embedded in each oral stent. The patients wearing individual oral stent were immobilized by thermoplast mask and underwent CT scan. Before and every week during radiotherapy, orthogonal (antero-posterior and lateral) X-ray films were taken in conventional simulator, respectively. Displacements of leader markers in medio-lateral (M-L),antero-posterior (A-P) and cranio-caudal (C-C) directions were respectively calculated and compared on each patient's X-ray films. At the dose of 40 Gy, a repeated CT scan was done with the same thermoplast mask and positioning markers. The displacements of co-ordinating gravity center of three lead markers and three selected bony structures between two sets of CT images for each patient were calculated and compared by ANOVA.

Results: A total of 240 X-ray films were taken. The displacements of lead markers were (0.69+/-0.54) mm in M-L direction, (0.49+/-0.62) mm in A-P direction, and (0.56+/-0.57) mm in C-C direction, and the overall vector displacement was (1.2+/-0.77) mm (range, 0-4.98 mm). In three-dimensional method, the displacements of co-ordinating gravity center of three lead markers were (0.75+/-0.68) mm in M-L direction, (1.25+/-1.12) mm in A-P direction, and (1.06+/-0.77) mm in C-C direction, and the overall vector displacement was (2.15+/-0.90) mm (range, 1-4.24 mm). The displacements between gravity center of three lead markers and three bony structures had no significant difference in M-L, A-P, and C-C directions (P>0.05). The overall vector displacements also had no significant difference (P=0.083).

Conclusion: The placement repeatability of individual oral dental stent in the mouth is very good during radiotherapy of NPC, and dental stent has a fixed position relationship with bony structures.

Background and objective: The Chinese 2008 staging system for nasopharyngeal carcinoma (NPC) was a common set of recommendations by initial revision of the previous'92 staging system. This study was to verify the Chinese 2008 staging system and to provide evidence for its further revision.

Methods: Between January 2003 and December 2004, 924 consecutive patients with newly diagnosed, nondisseminated biopsy-proven NPC, presented at the Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, were entered into our study. All patients received magnetic resonance imaging examination of the neck and nasopharynx before treatment. According to the principle of the staging system, the indices of hazard consistency, hazard discrimination, prognostic value, and distribution were used to evaluate the Chinese 2008 staging system.

Results: According to the Chinese 2008 staging system, the distribution of stage group for the whole series was 4.9% for the stage I, 22.6% stage II, 38.0% stage III, and 34.5% stage IVA. As for hazard discrimination, the 4-year local relapse-free survival (LRFS) rates for T1-T4 patients were 95.4%, 93.7%, 90.5% and 79.1%, respectively. Although the separation of LRFS for all subclassifications of T-stage showed reasonable, the differences among the subgroups T1, T2, and T3 were still lack of significant statistically. The 4-year distant metastasis failure-free survival (DMFS) rates for N0-N3 patients were 89.4%, 84.3%, 73.6, and 59.2%, respectively. The 4-year overall survival (OS) rates for stage I-IV patients were 96.7%, 94.1%, 82.6% and 67.1%, respectively. As for hazard consistency, the distinctions between T3 with skull base involvement and T3 with medial pterygoid muscle in the hazard ratios of local failure (1.628 vs. 3.905) and disease failure (1.630 vs. 3.288) were large. Multivariate analyses showed that cervical nodal level, extranodal neoplastic spread, and laterality were independent prognostic factors for OS and DMFS, but maximal axial diameter was not.

Conclusion: Using the Chinese 2008 staging system for NPC produces an acceptable distribution of patient numbers. Stage group, T classification, and N classification represent independent prognosis factors for major endpoints. However, our study reveals several deficiencies in the current system yet.

Background and objective: Although anterolateral thigh (ALT) flap has the advantage of limited damage to the donor site, its clinical application is not common. This study was to study the clinical value of ALT flap in the reconstruction of head and neck soft tissue defects.

Methods: Twenty patients receiving reconstruction of head and neck soft tissue defects using ALT flap at Sun Yat-sen University Cancer Center between November 2004 and May 2008 were retrospectively reviewed. Surgical procedures in the harvest of ALT flap were described. The surgical anatomy and successful rate were reported.

Results: Twenty patients were all alive. The vessel pedicle length of ALT flap ranged from 5 cm to 14 cm, with an average of 9.9 cm. The harvested ALT flap was (4-9) cm X (6-16) cm. The skin perforator was classified into four cases of intermuscular septal branch (20%) and 16 cases of musculocutaneous branch (80%). The head and neck soft tissue defects included 14 cases (nine cases of tongue and oral floor, three cases of buccal mucosas, one case of hard palate, and one case of retromolar trigone mucosa) intraoral mucosa and six cases of facial-cervical skin defects. Except for one case, the donor sites were primarily sutured.

Conclusion: ALT flap is one of valuable and potential donor site for the reconstruction of head and neck soft tissue defects. It could achieve a high successful rate and causes little influence to the donor sites.

Experimental models that allow investigation of nasopharyngeal carcinoma(NPC) progression could provide valuable insights of the molecular mechanism of nasopharyngeal carcinogenesis as well as potential clinical intervention. Because Epstein-Barr virus only infects humans and a few species of monkeys, representative NPC animal models have not been available so far. Attempts to provide cell models for early nasopharyngeal carcinogenesis have involved in the studies of in vitro transformation of normal finite lifespan human nasopharyngeal epithelial cells (NPEC) to immortality. The first two immortalized NPECs were established by introduction of ectopic SV40T or HPV E6/E7. In order to avoid the unrelated molecular alterations caused by the viral oncogenes, we established and characterized two immortalized NPECs by introduction of Bmi-1, an oncogene which has been demonstrated to be overexpressed in NPC cells and specimens. In addition, human telomerase reverse transcriptase (hTERT) immortalized NPECs have been established in both Tsao's and our laboratory. Unlike the immortalized cells induced by viral oncogenes, these immortal NPECs maintain a normal p53 checkpoint, and are unlikely to have other undefined genetic lesions except presenting some molecular alterations which have been observed in NPC. Thus, the establishment of the immortalized NPECs can be used to further study the mechanism of NPC development using defined genetic elements, particularly in elucidating the role of EBV infection in NPC development.

With the rapid development in cytotoxic agents and molecular targeting drugs, some progress in palliative chemotherapy for advanced gastric cancer has been achieved and the median survival of advanced gastric cancer patients is prolonged to about one year. In this review, we summarized the application of new agents, such as docetaxel, paclitaxel, oxaliplatin, irinotecan, capecitabine, S1 and targeting drugs in the treatment of patients with advanced gastric cancer. We focused on the results of phase III clinical trials and concluded that till now no standard regimens for the treatment of advanced gastric cancer are available. New combination regimens such as docetaxel-cisplatin-fluorouracil (DCF), epirubicin-oxaliplatin-capecitabine (EOX), fluorouracil-leucovorine-oxaliplatin (FLO), irinotecan, leucovorin and 5-FU (ILF), cispaltin plus xeloda, S1 plus cisplatin are considered as new options for the first-line chemotherapy of advanced gastric cancer. Due to uncertain efficacy and safety concerns, the role of molecular targeting agents in the treatment of advanced gastric cancer needs further investigation. It is suggested that neoadjuvant chemotherapy is a suitable choice for locally advanced gastric cancer.