Objective To assess the efficacy of high-dose chemotherapy versus moderate-dose chemotherapy in the treatment of osteosarcoma. Methods We searched MEDLINE, EMbase, OVID database, CBMdisc, Cochrane CENTRAL Register of Controlled Trials in The Cochrane Library, and handsearched Journal of Chinese Oncology, Journal of Chinese Clinical Oncology and Tumor. The search time was updated to Feburary 2006.The quality of the included studies was evaluated by two reviewers and meta-analyses were performed on the results of homogenous studies. Results Four studies involving 937 participants with primary, high-grade and non-metastatic extremity osteosarcoma were included. All the included studies were judged to be inadequate at reporting randomization and blinding, only one reported allocation concealment. All included studies reported the number of withdrawals and the reasons for these. The meta-analyses showed that there were no significant differences in 5-year event free survival (EFS) (RR 1.10, 95% CI 0.96 to1.25), 5-year overall survival (OS) (RR 1.08, 95% CI 0.97 to1.20), local recurrence rate (RR 0.92, 95% CI 0.54 to 1.57), proportion of good histological response (RR 0.93, 95% CI 0.81 to 1.07), proportion of limb salvage [RR 0.97, 95% CI 0.92 to 1.02) between the high-dose group and the moderate-dose group. The 5-year EFS of the good histological response group was significantly higher than in the poor histological response group [OR 2.45, 95% CI 1.76 to 3.39,Plt;0.00001 ). Conclusions No advantage is shown for high-dose chemotherapy over moderate-dose chemotherapy in 5-year EFS, 5-year OS, local recurrence rate, proportion of good histological response and proportion of limb salvage. Histological response to preoperative chemotherapy is an independent prognosis factor for osteosarcoma. Due to the potential risk of selection bias, performance bias and publication bias, the evidence is not b enough to judge whether high-dose chemotherapy is better than moderate-dose chemotherapy in the treatment of osteosarcoma. Our conclusion suggests that large-scale randomized trials should be performed.
Objective To study the risk factors for contralateral breast cancer (CBC) in women after regular treatment of the primary breast cancer. Methods Between January 1997 to December 2002, the clinical data of 340 breast cancer patients at our institution were retrospectively analyzed. In all the patients a detailed analysis was carried out with respect to age, operation type, radiation therapy technique and dose, the use of chemotherapy or hormone therapy, and other clinicopathologic characteristics. The KaplanMeier method was used to estimate the actuarial rate of CBC. The Cox proportional hazard regression model was used to estimate the relative risk factors of CBC. Results Fourteen cases were diagnosed to be CBC, thus overall incidence of CBC was 4.1%. Ten-year CBC incidence (2.7%) was higher than 5-year incidence of CBC (1.4%). Univariate analysis showed that the risk factors of CBC at 5-year and 10-year included: ≤45 years old, medullary carcinoma, family history of breast cancer and being taken without endocrine therapy (P＜0.05), while chemotherapy and radiotherapy were not risk factors of CBC (P＞0.05). Mutivariate analysis showed that ≤ 45 years old and being internal breast radiotherapy were independent risk factors of CBC at 5-year and 10-year (P＜0.05). Conclusions CBC may occur in these primary breast cancer patients with age ≤45 years old, medullary carcinoma, family history of breast cancer. In order to reduce the incidence of CBC, endocrine therapy rather than internal breast radiotherapy should be performed in early breast cancer patients.
Objective To systematically review the efficacy and safety of tyrosine kinase inhibitors combined with chemotherapy versus chemotherapy in advanced non-small cell lung cancer(NSCLC). Methods An electronically search was conducted in The Cochrane Library, PubMed and EMbase databases from inception to December 2016 to collect randomized controlled trials (RCTs) about tyrosine kinase inhibitors combined with chemotherapy versus chemotherapy for NSCLC. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 RCTs involving 6 559 patients were finally included. The results of meta-analysis showed that: The median progression free survival (PFS) (HR=0.86, 95%CI 0.81 to 0.91, P<0.001) and objective response rate (ORR) (HR=1.43, 95%CI 1.20 to 1.70,P<0.001) of tyrosine kinase inhibitors combined with chemotherapy were significantly longer than those of the chemotherapy group. There were no significant differences between two groups in incidence of median overrall survival (OS) (HR=0.91, 95%CI 0.82 to 1.00,P=0.06), fatigue (RR=1.03, 95%CI 0.97 to 1.11, P=0.33), dyspnea (RR=1.01, 95%CI 0.91 to 1.13, P=0.82) and cough (RR=1.01, 95%CI 0.89 to 1.15, P=0.91). However, the incidence of neutrocytopenia (RR=1.16, 95%CI 1.05 to 1.28, P=0.003), thrombocytopenia (RR=1.46, 95%CI 1.23 to 1.73, P<0.001), diarrhea and hypertension (RR=2.91, 95%CI 2.28 to 3.71,P<0.001) of tyrosine kinase inhibitors combined with chemotherapy group were significantly higher than those of the chemotherapy group. The tyrosine kinase inhibitors combined with chemotherapy group had lower rate of anemia (RR=0.86, 95%CI 0.75 to 0.98,P=0.03). Conclusion Compared with chemotherapy alone, tyrosine kinase inhibitors combined with chemotherapy can improve the median PFS and ORR while it can be used as a treatment for advanced non-small cell lung cancer patients. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo observe the curative effect, survival rate, enucleation rate and pathological characteristics of retinoblastoma (RB) in children.MethodsRetrospective clinical study. From March 1999 to December 2018, a total of 313 patients (445 eyes) with RB diagnosed in Ophthalmology Department of Peking University People’s Hospital were enrolled in the study. Among them, 175 were male (55.9%), 138 were female (44.1%); 181 were monocular and 132 were binocular. The international standard of intraocular RB staging (IIRC) was 6, 13, 6, 52, 227 and 9 patients of A, B, C, D, E and extraocular stages respectively. Among the 313 patients, 245 patients were confirmed to the survivance, of which 22 cases (9.0%, 22/245) died. Among 445 eyes, 330 eyes definitely whether or not were enucleated; 184 eyes had definite IIRC stage, eye examination results, definite treatment plan and times before enucleation and definite pathological tumor node metastasis stage after operation. The basic information, demographic characteristics, clinical information, enucleation and treatment plan, pathological and immunohistochemical results were recorded. Binary logistic regression was used to analyze the risk factors of high risk pathological features (HRF) and prognosis in patients with RB.ResultsFrom 1999 to 2018, the survival rate of 245 patients was increased from 82.6% to 96.3% year by year; the enucleation rate of 330 eyes with final enucleation was reduced from 68.8% to 58.3% year by year. The rate of enucleation in stage D and stage E decreased from 83.3% and 100% before 2005 to 37.5% and 85.4% after 2014, respectively. Monocular disease (β=－1.551, P=0.005), stage D, stage E and extraocular stage in IIRC stage (P＜0.005) were the independent risk factors of RB enucleation, while the protective factors were Interventional chemotherapy of ophthalmic artery (IAC) (β=－0.877, P＜0.001). HRF was found in 51 eyes (27.7%). Age of onset (β=0.019, P=0.016) and glaucoma (β=0.816, P=0.050) were independent risk factors for HRF in RB pathology, while IAC treatment was the protective factor for enucleation (β=21.432, P＜0.001).ConclusionsAfter comprehensive treatment, the general trend of RB enucleation rate is gradually decreasing. IAC treatment can reduce the enucleation rate of stage D and E. The older age of onset and glaucoma stage are the independent risk factors of HRF, and IAC can reduce the risk factors of HRF.
We have performed guided chemoembolization on 84 patients of moderate and advanced carcinoma of liver using adriamycin lipiodol emulsion (A/L) since 1986. Result showed that the rate of improvement of symptoms was 86.1%, in 75% cases the AFP were decreased and in 79.2% the size of tumor were reduced. The mean survival time was 10.3 months which was much higher than that of the control group (5.6 months,Plt;0.001). THe survival rates of 1/2,1,2,3 year were 89.3%,43.4%,13.5% and 3.8% respctively that were significantly higher than those of the control group (51.2%, 11.5%,0) (Plt;0.01). Three patients underwent secondary resection after using A/L chemoembolization ans gelatin spinge central embolization with a longer survival rate. This may be a good method of treatment to the nonresectable liver cancers and may also be an easy way for postoperative observation.
Objective To introduce the research progress in the effect of chemotherapeutic resistance of metabolic enzymes of gemcitabine to pancreatic cancer.Methods Recent literatures about metabolic enzymes that played key roles in mediating gemcitabine chemotherapeutic resistance of pancreatic cancer were collected and reviewed. Results The metabolic enzymes of gemcitabine, such as hENT1, dCK, RRM1 and CDA, were closely related to chemotherapeutic resistance of pancreatic cancer. The relationship between the single nucleotide polymorphism of metabolic enzymes and the resistance to gemcitabine remained to be clarified. Conclusion Multiple factors are involved in the mechanism of chemotherapeutic resistance of pancreatic cancer to gemcitabine, which needs further research.
Objective To comprehend the concept， pathology， molecular mechanisms， diagnosis， and treatmentof aggressive fibromatosis （AF）， and to find a novel way to cure aggressive fibromatosis. Method The literatures about the definition， molecular mechanisms， and clinical research of AF were reviewed and analized. Results AF is rare and benign fibromatous lesion that is the result of abnormal proliferation of myofibroblasts. The pathologic features of AF isa benign disease， but it has “malignant” biological behavior. The tumor often involved the surrounding organs and bloodvessels， and caused death of patients. For patients with clinical symptoms or complications， complete excision of thetumor is the treatment of choice. Even if the operation to ensure the negative margin also has a higher recurrence rate， soits treatment requires multidisciplinary treatment. Conclusions The mechanism of AF is very complex， and it’s mecha-nism is still unclear. Clinical management of patients with AF is difficult and controversial， at present， the most effective treatment for AF is operation resection. The effects of adjuvant radiotherapy， chemotherapy， and other treatment after operation for AF still need further study.
Objective To investigate the effect of recombinant human growth hormone (hGH) on growth situation and bone marrow hematopoietic function in rats under chemotherapy. Methods A total of 136 10-week-old SD rats were included in the study. The rats were randomly assigned into five groups: normal control group (n=8), normal saline control group (NS group, n=32), human growth hormone group (hGH group, n=32), chemotherapeutic drug treated group (CT group, n=32), and chemotherapeutic drug plus hGH treated group (CT+hGH group, n=32). The body weight, bone marrow differential count, and the expression of proliferating cell nuclear antigen (PCNA) in bone marrow were measured before treatment and weekly in four weeks after treatment. Results Weight loss occurred in both CT group and CT+hGH group (P＜0.05), but the weight loss in CT+hGH group was significantly smaller (P＜0.05) on day 7 after treatment. In myeloid morphology, myeloid cell was hypoplastic excessively in CT group, and it was hypoplastic obviously in CT+hGH group on day 7 after treatment. Day 14, weight gain appeared in CT+hGH group, while weight loss remained in CT group; In myeloid morphology, myeloid cell was hyperplastic actively excessively in CT+hGH group, and myeloid karyote count was increased significantly in CT+hGH group (P＜0.05). Day 7, 14 and 21, PCNA positive cells count in CT group was lower than that in hGH group and CT+hGH group (P＜0.05). There was no significant different of every index among normal control group, NS group, and hGH group (Pgt;0.05), except weight between normal control group and hGH group on day 7 (P＜0.05). Conclusion hGH has a protective effect on myeloid hematopoietic function and growth situation in rats after intraperitoneal chemotherapy.
ObjectiveTo evaluate the clinical efficacy and safety of artieral infusion chemotherapy combined with 125I seed implantation in treatment of non-small cell lung cancer (NSCLC). MethodsBetween February 2012 to June 2014, 34 patients with unresectable NSCLC received 125I seed implantation, in which 16 patients also received artieral infusion chemotherapy. All the patients were followed up and two months after 125I seed implantation the thoracic CT scanning was carried out in all patients. The response to treatment was evaluated in accordance with Response Evaluation Criteria in Solid Tumors and the accumulated survival rate was analyzed by means of Kaplan-Meier. ResultsThe operation successful rate was 100% and no severe complications were observed. Two months later the thoracic CT scanning showed that patients who only received 125I seed implantation with a total effective rate of 72.2% and those received artieral infusion chemotherapy combined with 125I seed implantation with an effective rate of 87.5%, with no significant difference between two groups in the effective rate (χ2=1.122, P>0.05). Median survival time of two groups was 361 days and 470 days (χ2=2.985, P < 0.05), respectively. Survival rate of 1 year was 43.5% and 83.5%(χ2=4.101, P < 0.05), respectively. ConclusionArtieral infusion chemotherapy combined with 125I seed implantation is safe, reliable and effective in treatment of unresectable NSCLC, which can prolong the patient's survival time.
Objective To find individualized evidence-based treatments for a patient with lower rectal cancer. Methods Based on the clinical questions raised, evidence was collected and critically assessed. Patient preferences and physician clinical experience were also taken into consideration in the decision-making treatment. Results Twenty-four systematic reviews or meta analyses and 1 clinical guideline were included. The evidence showed that preoperative chemoradio- therapy reduces risk of local recurrence and death from rectal cancer compared to preoperative radiotherapy alone. Preoperative combined chemoradiotherapy, enhanced pathological response and improved local control in the resectable stage II and III rectal cancer. Preoperative chemoradiotherapy reduced the risk of local recurrence as compared with postoperative chemoradiotherapy. Postoperative radiotherapy alone did not improve survival for the patients with resected stage II and stage III rectal cancer, whereas either chemotherapy alone or combined chemotherapy and radiotherapy improved survival in comparison with observation. As compared with conventional radical surgery, total mesorectum excision (TME) resulted in lower postoperative local recurrence rate and higher survival rate. No significant differences in terms of disease-free survival rate, local recurrence rate, mortality, and morbidity were found between laparoscopic and open total mesorectal excision. Conclusion The patients with lower rectal cancer might benefit from preoperative chemoradiotherapy, postoperative chemotherapy, and chemoradiotherapy. TME is the standard rectal cancer surgery. However, long-term prognostic benefits need to be confirmed by further follow-up.