Chinese clinical oncology最新文献

Background: Neuroendocrine tumors (NETs) often express somatostatin receptors, which makes Gallium-68 DOTATATE positron emission tomography/computed tomography (68Ga-DOTATATE PET/CT) scan an important diagnostic tool. However, incidental brain uptakes on 68Ga-DOTATATE PET/CT scan pose a significant diagnostic challenge, where these uptakes can represent meningiomas or tumor metastasis.

Case description: This case report presents two cases of patients with low-grade NETs that had incidental brain uptake on 68Ga-DOTATATE PET/CT. In the first case, a 48-year-old female with a history of bronchial carcinoid tumor and Cushing's syndrome had incidental uptake near the right skull, which magnetic resonance imaging (MRI) confirmed as a stable meningioma. In the second case, a 65-year-old female with a grade 1 gastric NET had incidental uptake in the right temporal and left occipital lobes; however, follow-up MRI was negative. Given the affinity of meningiomas for somatostatin analogues, such findings can complicate the interpretation of PET/CT results.

Conclusions: Previous studies reported a prevalence of Incidental brain uptake on 68Ga-DOTATATE PET/CT scan between 1.6% to 11%. The prevalence of meningioma was between 1.6% to 9%. In minor cases, the uptake revealed other causes such as varix abnormalities and metastasis. MRI is considered essential for differentiating meningioma from tumor metastasis, although some cases of meningioma can be missed while showing on PET/CT. Incidental brain uptake on 68Ga-DOTATATE PET/CT scan, while usually suggestive of meningioma, requires follow-up with MRI to confirm the diagnosis and prevent unwarranted aggressive treatments. Awareness of the diagnostic challenges is crucial for the appropriate management of patients with NETs.

Background: The rapid and accurate assessment of surgical margins in breast-conserving surgery (BCS) remains a pressing clinical challenge. This study aims to evaluate the effectiveness of the EndoSCellTM system, an innovative intraoperative cellular probing technology in assessing surgical margins during BCS and distinguishing between cancerous and normal breast tissue, to explore the feasibility of evaluating surgical margins during BCS.

Methods: Patients diagnosed with primary breast cancer by core needle biopsy and received BCS were consecutively enrolled from August 2022 to March 2023. Tissue samples from the primary lesion, peritumoral tissue, and normal breast tissue were obtained from consecutive cases undergoing BCS. A junior surgeon and a senior surgeon employed the EndoSCellTM system during routine breast-conserving or oncoplastic breast-conserving surgeries. Three pathologists were included to assess the accuracy of surgical margin determinations using the EndoSCellTM system postoperatively. The paraffin-embedded pathology remains the gold standard for diagnosis.

Results: A total of 53 breast cancer patients, including 43 (81.1%) cases of invasive carcinoma and 10 cases (18.9%) of ductal carcinoma in situ (DCIS) were enrolled in this study, with a total of 289 biopsy samples collected. Using the EndoSCellTM system, surgical oncologists achieved an area under the curve (AUC) of 0.909, demonstrating a sensitivity of 88.70% and a specificity of 93.01%. Pathologists, on the other hand, achieved a higher AUC of 0.937, with a sensitivity of 99.32% and a specificity of 88.11%. In the evaluation of diagnostic consistency using the EndoSCellTM system, the AUC for the comparison between pathologists and surgical oncologists was 0.880.

Conclusions: The application of the EndoSCellTM system has proven effective in assessing the pathological state of tissues in real-time, offering a feasible method for evaluating surgical margins during BCS. This technology not only supports the decision-making process in surgery but also provides a foundation for further prospective clinical validation.

Radiation therapy (RT) plays a critical role in the management of intracranial malignancies, offering a potent and targeted approach to tumor control. The benefits of RT have been recognized for decades, and it is commonly employed in the management of both primary brain tumors and, especially, brain metastases. Through the induction of DNA damage and disruption of cellular integrity, RT promotes apoptosis and inhibits the proliferative capacity of cancer cells. Advances in imaging, dose planning, and delivery techniques have significantly enhanced the precision of RT, allowing for effective tumor eradication while minimizing harm to surrounding healthy tissue. As a result, RT improves local disease control and contributes to prolonged survival in patients with brain tumors. Nonetheless, intracranial RT may inadvertently damage surrounding healthy brain structures. The effects of RT can manifest as both acute and delayed toxicities, potentially compromising patient quality of life and long-term outcomes. For treating clinicians, a thorough understanding of these complications is necessary to design radiation treatment plans that properly balance the therapeutic efficacy of therapy with the risks of adverse treatment-related outcomes. In this review, we explore the distinct pathophysiological mechanisms, symptoms, and management strategies associated with acute, early delayed (one to six months), and late delayed radiation-induced brain toxicities. In particular, we discuss the risks of somnolence syndrome, peri-ictal pseudoprogression, radiation necrosis, vascular disorders, cognitive impairment, cranial neuropathies, endocrine dysfunction, the development of secondary malignancies, stroke-like migraine attacks after radiation therapy (SMART) syndrome, and acute late-onset encephalopathy after radiation therapy (ALERT) syndrome after brain RT.

Background: Immunocompromised patients with B lymphocyte deficiency and hypogammaglobulinemia after anti-CD19 chimeric antigen receptor (CAR) T cell therapy for relapsed/refractory follicular lymphoma (FL) are at high risk of severe coronavirus disease 2019 (COVID-19) infection.

Case description: In our study, two patients with refractory FL had persistent COVID-19 infection after their anti-CD19 CAR T cell therapy. The patients were diagnosed with post-COVID-19 syndrome or COVID-19 with interstitial inflammation and persistent hypoxemia. The patients received molnupiravir and Paxlovid, along with methylprednisolone therapy when their interleukin (IL)-6 levels were high. No response was observed in interstitial inflammation, persistent hypoxemia, or persistent positive expression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, the level of IL-6 decreased after these therapies. These two patients subsequently received low-dose ruxolitinib (5 mg, twice daily) as salvage therapy in combination with a gradually reduced dosage of methylprednisolone. After 1-2 months of ruxolitinib therapy, persistent hypoxemia was relieved, and interstitial inflammation was significantly absorbed. At the same time, the SARS-CoV-2 detection was found to be negative.

Conclusions: Ruxolitinib might be a safe and effective alternative salvage therapy for patients with COVID-19 having interstitial inflammation and persistent hypoxemia without high cytokine levels and no response to corticosteroids.

Background: Primary hepatic angiosarcoma (PHA) is a rare but aggressive liver tumor, accounting for ~5% of all hemangiosarcomas and <2% of all primary hepatic malignancies. Oncological treatment data on PHA remain limited at present. The objective of this single-center study was to summarize the diagnosis and treatment of PHA, thereby contributing additional clinical data to improve understanding of the disease.

Methods: Eight patients were diagnosed with PHA in The First Affiliated Hospital, Zhejiang University School of Medicine from 2016 to 2022. Five patients were male and three were female with a mean age of 62.4 years (range, 38-74 years). We summarized the clinical characteristics, pathological parameters, and treatment based on the electronic medical record system.

Results: Among the 8 patients with PHA, four patients presented with abdominal distension and pain, and two with weakness. The diagnosis was confirmed by pathological findings. Four patients underwent surgery and four received conventional treatment. Seven patients died within 14 months due to tumor progression and the median survival time was 2 months.

Conclusions: PHA is a rare malignant liver tumor, and there are no specific symptoms or imaging methods for preoperative diagnosis. The diagnosis can only be confirmed by pathology and the prognosis is poor. Early diagnosis is crucial and further studies are needed to develop standardized diagnostic and treatment guidelines.

Background: Poliomyelitis is an acute infectious disease caused by poliovirus in childhood. After the onset of acute poliomyelitis, weakness of limbs occurs 15 to 30 years later, which is defined as post-polio syndrome. Poliomyelitis accompanying head and neck cancer is rare. Microvascular reconstruction is a well-established procedure following extensive tumor resection. Donor-site selection for flap harvest is a very important issue in paralyzed patients, particularly in patients with post-polio syndrome. To date, limited information is available regarding flap harvest in paralyzed patients.

Case description: We present a case of a 70-year-old male who presented with oral squamous cell carcinoma of the tongue, with both lower extremities paralyzed due to childhood poliomyelitis. Reconstruction was successfully performed with an anterolateral thigh flap despite extensive muscle atrophy. The sizes of the vascular pedicle and the cutaneous perforators were anatomically similar to the ones of healthy limbs. Both donor and recipient sites healed uneventfully; however, a postoperative complication due to pneumonia occurred.

Conclusions: The present case demonstrates that flap harvest from paralyzed limbs in post-polio syndrome is safe, which is in line with the sparse evidence from the literature. However, our attention should be drawn to postoperative respiratory complications and management. In order to avoid postoperative complications, it is essential to undertake a precise preoperative assessment.

Background: Atraumatic splenic rupture (ASR) is rare and typically attributed to underlying pathological conditions, with neoplastic diseases being the main etiologies. Traditionally, surgical intervention has been the standard approach for managing ASR in the majority of patients. However, reports on the outcomes of conservative management, especially for ASR related to myeloid neoplasms, are scarce.

Case description: Here, we present two case reports involving ASR associated with myeloid neoplasms. The first patient, suffering from chronic myelomonocytic leukemia (CMML) harboring CBL and ASXL1 mutations, developed ASR shortly after receiving treatment with the hypomethylating agent 5-azacytidine. The second patient, in the blast phase of myeloproliferative neoplasms (MPN), experienced ASR during the progression of their disease. In the initial case, despite experiencing intense abdominal pain and hypovolemic shock, the patient responded favorably to prompt fluid resuscitation and blood transfusion upon, thanks to a timely diagnosis. A non-operative management approach successfully averted the need for splenectomy or arterial embolism, leading to a favorable outcome. In the second case, the patient presented with progressive abdominal pain but remained hemodynamic stability throughout the ASR episode. We opted for a cautious approach, prioritizing resuscitation, close monitoring, and a watchful waiting strategy. Regrettably, the patient's condition deteriorated, marked by increasing splenomegaly, unchecked leukocytosis, and recurrent parenchymal hemorrhages.

Conclusions: Here, we report two cases of ASR in myeloid neoplasms, demonstrating that patients may achieve acceptable outcomes with conservative management.

Background: The current conventional treatment approach for newly diagnosed glioblastomas (GBMs) entails the complete removal of the tumor, followed by the implementation of Stupp's procedure. The main purpose of this study was to analyze the results of Stupp's treatment protocol in real-world practice and examine certain prognostic markers associated with survival, which could offer empirical evidence in the treatment of GBM.

Methods: A total of 64 patients diagnosed with newly developed GBM underwent treatment with irradiation and temozolomide (TMZ) at Vietnam National Cancer Hospital (VNCH) from January 2020 to September 2022. The study provided information on the demographic and clinical features of the patients, as well as their overall survival (OS) and progression-free survival (PFS) outcomes. The analysis of survival and related variables involved the utilization of Kaplan-Meier curves, Cox regression, and the log-rank test.

Results: The retrospective analysis comprised 64 participants. The vast majority of patients were in favorable performance status. The median OS and PFS were 21.91 and 9.39 months, respectively. Several factors, such as female patients, gross tumor resection/subtotal tumor resection (GTR/STR), time to start radiotherapy (RT) within 8 weeks postoperative, no progressive disease after concurrent chemoradiotherapy (CCRT), no dexamethasone required and Ki-67 level below 15%, were associated with increased OS. Regarding PFS, characteristics such as age <40 years old, GTR/STR and no disease progression following CCRT were substantially related to improved survival. Nearly half of patients received TMZ 50 mg/m2 in combination with bevacizumab following the initial progressive illness.

Conclusions: Multidisciplinary collaboration, as well as advancements in diagnosis and customized treatment strategies, are critical in the treatment of GBM patients. In actual life, completing the entire Stupp's protocol significantly improves GBM survival.