Chinese clinical oncology最新文献

Background: Traumatic brachial plexus injury (BPI) is a debilitating injury that has a devastating impact. However, management of BPI remains a complex challenge, not only in diagnosis but also in treatment strategies for reconstructive microsurgeons. The aim of this study was to develop an additional assessment tool for root avulsion based on the volume of paraspinal muscle (PM) prior to surgical intervention, making the preoperative diagnosis more precise.

Methods: This retrospective study was centered on adult patients with BPI who underwent surgical exploration and treatment, postoperative follow-up at the Chang Gung Hospital. Labeling of PMs was aided by semi-automated segmentation using 3D Slicer 5.2.2. Slices spanning from the lower end of the upper vertebral body endplate to the upper end of the lower vertebral body. The ratio of muscle volume on the lesion side to that on the normal side (L/N ratio), indicating the volume proportion between the injured and healthy areas, serves as the primary parameter for assessing the relationship in root avulsion.

Results: The L/N ratio for the deepest layers of PMs consistently predicted the level of root injury across C4 to C7 levels, with all reaching statistical significance. In terms of partial and total root avulsion, the L/N ratio of layer 4th at 0.78 significantly outperforms other methods. Concerning the timing of MRI, both partial avulsion (PA) and total avulsion (TA) groups of merge roots showed a statistically significant decrease in the L/N ratio over time.

Conclusions: In conclusion, the L/N volume ratio of 4th layer in PMs reliably predicts the functional severity of avulsed roots and surpasses the performance of traditional diagnostic tools under specific conditions.

Background: Malignant neoplasms of the paranasal sinuses and nasal cavity are rare, comprising only 3% of all head and neck malignancies. Sinonasal undifferentiated carcinoma is a rare malignancy and an aggressive neoplasm that was clinic-pathologically distinct from other poorly differentiated malignancies of the nasal cavity and sinuses. The lesion is thought to originate from the epithelium, grows rapidly and invades nearby structures, often resulting in bony destruction while rapid progression of symptoms over weeks to months is characteristic.

Case description: A 75-year-old man initially presented to ophthalmologist due to blurry vision and diplopia for 2 months. There was also progressive right eye swelling and pain for the past 12 months. Further image study revealed a right superomedial orbital mass with frontal/ethmoid sinus and frontal base extension, causing significant right eye gaze limitation, visual loss, ptosis, chemosis and exophthalmos. He was then transferred to neurosurgical clinic for further treatment where combined surgery was advocated to relieve the mass effect and also for pathology proof. Orbital roof/medial wall and frontal skull base were invaded and destroyed by the tumor. A bicoronal craniotomy was performed and extensive tumor removal was achieved except the orbital fossa due to difficult separation from the ocular muscle and optic nerve. Frontal base was reconstructed in a layered fashion to avoid cerebrospinal fluid (CSF) leakage and infection. He was sent to intensive care unit (ICU) for overnight observation where no further neurologic deterioration occurred. Instant orbital pain relief was noted with significantly decreased proptosis and improving visual acuity. Detailed pathological staining and molecular tests revealed a sinonasal undifferentiated carcinoma, adjuvant chemotherapy was arranged, followed by 30 cycles of radiotherapy. Slight disease progression was noted 12 months after the surgery, chemotherapy regimen was adjusted according to clinical response and he is still currently under regular adjuvant treatment.

Conclusions: Sinonasal undifferentiated carcinoma typically carries a poor prognosis despite aggressive medical and surgical treatment, as it always presents at an advanced stage. Different combinations of chemotherapy, radiotherapy, radical surgical resection have been used to improve the outcome yet there is still not a universal treatment strategy. Early diagnosis, prompt treatment, and comprehensive medical care are crucial to achieve the best possible outcome for affected patients.

Background: Hemangioblastomas (HBLs) are uncommon tumors of the central nervous system (CNS), corresponding to 1% to 2.5% of all intracranial tumors. They can present sporadically or in patients with von Hippel-Lindau (VHL) disease along with a variety of benign and malignant tumors, and are most often located in the cerebellum, brainstem, and spinal cord. Although surgical resection is currently considered the main therapeutic option for symptomatic lesions, evidence supporting the application of microsurgery has not been systematically assessed. However, post-operative outcomes can vary depending on factors including disease location, number of lesions, and tumor characteristics that make complete resections difficult. The objective of this case report is to document a rare case of multiple HBL in a 45-year-old man, highlighting the need for further research, the absence of a standardized treatment protocol for appropriate management strategies.

Case description: A 45-year-old man presented to the outpatient neurology department with a chief complaint of gradual weakness of the left side of his body, walking unsteadily, and seizure. Neurological examination revealed a positive dysmetria sign. According to his medical records, he was diagnosed with multiple HBL since August 2022 and subsequently underwent two times partial tumor resections, and a ventriculoperitoneal (VP)-shunt due to hydrocephalus. The latest magnetic resonance imaging examination shows improvement in the original tumor. He is currently receiving symptomatic therapy with complaints have improved.

Conclusions: This case report highlights a rare occurrence of multiple HBL in a 45-year-old man. Surgical management of HBL was the most common modality and was suggested as an effective and optimal treatment, but the recurrence possibility of the cystic wall tumor must also be considered in the choice of treatment.

Background: Eighty percent of the global epilepsy burden is borne by developing countries, and 30% of these patients have drug-resistant epilepsy (DRE). Epilepsy surgery (ES) can significantly improve the cognition and quality of life in DRE. A comprehensive epilepsy center was established in Pakistan in 2010, the only facility for ES in a country of 231 million people. Hundreds of epilepsy patients are medically managed at the center each year. We aimed to study seizure control in all ES cases performed at the only comprehensive epilepsy center in the country during last 10 years.

Methods: It was a retrospective cohort study. Medical records of all cases of ES performed at our center from 2012 to 2021 were retrieved, through the Hospital's Information Management System. Patients were also contacted via phone calls where needed, to collect information about their seizure control as per Engel Classification. Data was analyzed using SPSSv21.

Results: Thirty-three surgeries including 10 temporal lobectomies with amygdalohippocampectomy, 11 selective amygdalohippocampectomies, 9 corpus callosotomies, 1 callosotomy with lesionectomy, 1 lesionectomy and 1 temporal lobectomy were performed. The median age of patients was 23: [18-31] years. Complex partial seizures were most common (14; 42.4%), followed by generalized seizures (10; 30.3%). The median duration of AEDs before surgery was 6 (IQR: 3.25-13.75) years. Eighteen (54.5%) patients had complete freedom from disabling seizures (Engel Class IA) at a median follow-up of 3.25 (IQR: 1.12-6) years. All patients continued to receive antiepileptic drugs after surgery, and all procedures had nearly 50% optimum seizure control outcomes.

Conclusions: The clinical outcomes of ES performed at our center are consistent with evidence. However, the small volume highlights the underutilization of this extremely important service. More studies are needed to identify the factors responsible for this disparity, so that all DRE patients have access to ES.

Background: Glioma is the second most common type of brain tumor, representing 24% of all brain tumor cases. The role of body mass index (BMI) on glioma remains unclear, with conflicting findings regarding the association between higher BMI and the risk of developing certain brain tumors. Glioblastoma, an aggressive and malignant form of glioma with limited treatment options and a poor prognosis, has been linked to BMI in some studies, suggesting that individuals with higher BMIs may have an elevated risk of glioblastoma development. However, a comprehensive understanding of the mechanisms underlying this relationship and its extent is still needed. The study aimed to investigate the correlation between BMI and the grading and survival of glioma patients.

Methods: A retrospective cross-sectional analysis was conducted on 117 histologically confirmed glioma patients at Dr. Sardjito General Hospital in Yogyakarta, Indonesia. Clinical data were collected from medical records. BMI was calculated by measuring weights (kg) and dividing it by squared heights (m2). The statistical analysis focused on assessing the association between BMI, tumor grade, and patient survival.

Results: Among 117 glioma patients, glioblastoma was the most prevalent tumor type (48.7%; n=57/117), followed by diffuse astrocytoma (22%; n=26/117). The remaining cases included anaplastic ependymoma, anaplastic oligodendroglioma, and pilocytic astrocytoma. Most patients were male (61%), with an average age of 47.5 years, age ranges between 20 and 79 years. The majority had grade IV of World Health Organization (WHO) classification (58%, n=68/117), while only two patients were classified as grade I. The average BMI was 23.5 kg/m2, indicating overweight status for the Asian population, with more than half of the patients being overweight or obese (54%, n=63/117). Additionally, ten patients were underweight. There was a trend of higher BMI being associated with higher grading and survival. However, no significant association between BMI and tumor grade (P=0.23) or survival (P=0.26) was found.

Conclusions: Although no significant associations were found between BMI, tumor grade, and survival in glioma patients, further studies are warranted. The high prevalence of overweight and obesity among patients should be further investigated to provide valuable insights for patient management and care.

Interleukins serve as communicating molecules between cells, mediating key interactions in the tumor microenvironment (TME) between immune cells and non-immune cells. Interleukin-10 (IL-10), a multifunctional cytokine with multiple properties, has been extensively studied in various aspects of immunology and cancer biology. IL-10 is pleiotropic, promotes cytotoxicity, yet inhibits antitumor-responses. In recent years, the role of IL-10 in ovarian cancer (OC) progression and treatment has gained significant scientific attention, elucidating the signaling pathways triggered by IL-10 action. OC, the leading cause of gynecologic cancer-related deaths, is characterized by ascites, which hosts an intricate TME that is not responsive to treatment by immune checkpoint inhibition. IL-10, known for its immunosuppressive and anti-inflammatory properties, plays a complex role in OC progression, immune modulation, and therapeutic response and has a potential therapeutic property as a target and as an effector. As the literature of basic science research studying the role of IL-10 in the TME of OC scopes a few decades and some data is contrasting, it is important to review the literature and provide concise input derived from it. This review aims to provide a comprehensive overview of the current understanding of IL-10 in OC, highlighting its influence on tumor growth, immune evasion, and potential as a therapeutic target.

Background and objective: Oncology is increasingly adopting three-dimensional (3D) printing, a method of creating objects through additive manufacturing using various techniques and materials. This technology, divided into conventional 3D printing (using non-biological materials like thermoplastics or titanium) and bioprinting (involving living cells and tissues), has shown potential in surgical planning, implant creation, and radiotherapy. However, despite promising preclinical and clinical applications, its clinical integration faces challenges such as a lack of strong evidence, standardized guidelines, and detailed data on costs and scalability. This study reviews the current use of 3D printing in oncology, aiming to differentiate between practical and experimental applications, thereby guiding clinicians interested in incorporating this technology.

Methods: A literature search was conducted to gather comments, reviews, and preclinical and clinical studies focusing on the use of 3D printing in oncology, with publications dated before December 1, 2023. The search for pertinent studies involved utilizing PubMed and Google Scholar Review. The selection process for articles was based on a unanimous consensus among all authors. We excluded topics related to bioprinting and the technical nuances of 3D printing.

Key content and findings: The review comprehensively describes the utilization of 3D printing in radiation oncology, surgical oncology, orthopedic oncology, medical oncology, hyperthermia, and patients' education. However, 3D printing faces several limitations that are related to unpredictable costs, difficult scalability, very complex regulations and lack of standardization.

Conclusions: 3D printing is increasingly useful in oncology for diagnostics and treatment, yet remains experimental and case-based. Despite growing literature, it focuses mostly on pre-clinical studies and case reports, with few clinical studies involving small samples. Thus, extensive research is needed to fully evaluate its efficacy and application in larger patient groups.