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neoadjuvant chemoradiotherapy for locally advanced gastric cancer with bulky lymph node metastasis:Five case reports

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World Journal of Clinical Cases 2020年第18期8卷 4177-4185页

作者： Eiji Nomura Hajime Kayano Takashi Machida Hideki Izumi Soichiro Yamamoto Akitomo Sugawara Masaya Mukai Terumitsu Hasebe Department of Gastroenterological and General Surgery Tokai University Hachioji HospitalHachioji 192-0032TokyoJapan Department of Radiology Tokai University Hachioji HospitalHachioji 192-0032TokyoJapan

BACKGROUND neoadjuvant chemoradiotherapy(NACRT)has not been accepted as a general therapy for gastric cancer because of its localized effect and toxicity for radiosensitive ***,if radiation therapy could compensate for the limited or inadequate treatment choices available for elderly patients and/or those at high risk,the available therapeutic options for advanced gastric cancer might *** this perspective,we present our experiences of five patients with advanced gastric cancer in whom we used NACRT therapy with interesting *** SUMMARY We admitted five patients with clinical Stage III gastric cancer and bulky lymph node metastasis or adjacent organ invasion at the time of diagnosis.A total of 50 Gy of preoperative intensity modulated radiation therapy was delivered to the patients in doses of 2.0 Gy/d,together with a regimen of concomitant chemotherapy comprising two courses of oral tegafur/gimeracil/oteracil(S-1;65 mg/m2 per day)for three consecutive weeks followed by two weeks of rest,starting at the same time as *** patients underwent no residual tumor resection and a pathological complete response of the primary tumors was achieved in two *** incidence of hematological toxicity was low,although the digestive toxicities of anorexia and diarrhea developed in three of the five patients,necessitating termination of radiation therapy at 30 Gy and S-1 at three ***,even 30 Gy of irradiation and half the dose of S-1 resulted in sufficient downstaging,indicating that even a reduced amount of NACRT could confer considerable *** Slightly reduced NACRT might be useful and safe for patients with locally advanced gastric cancer.

关键词： Advanced gastric cancer neoadjuvant chemoradiotherapy Intensity modulated radiation therapy Tegafur/gimeracil/oteracil Curative resection Case report Gastrectomy

neoadjuvant chemoradiotherapy followed by laparoscopic distal gastrectomy in advanced gastric cancer: A case report and review of literature

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World Journal of Clinical Cases 2021年第11期9卷 2542-2554页

作者： Zi-Ning Liu Yin-Kui Wang Zi-Yu Li Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Gastrointestinal Cancer CenterPeking University Cancer Hospital&InstituteBeijing 100142China

BACKGROUND The laparoscopic technique has been widely applied for early gastric cancer,with the advantages of minimal invasion and quick ***,there is no report about the safety and oncological outcome of laparoscopic gastrectomy with D2 lymph node dissection for patients after neoadjuvant *** SUMMARY A 60-year-old man was diagnosed with advanced distal gastric cancer,cT4aN1M0 stage *** neoadjuvant chemoradiotherapy was performed based on the regimen of gross tumor volume 50G y/25 f and clinical target volume 45 Gy/25 f,as well as concurrent S-160 mg *** laparoscopic distal gastrectomy with D2 lymph node dissection was undertaken successfully for him after achieving partial response evaluated by radiological *** patient recovered smoothly without moderate or severe postoperative *** postoperative pathological stage was ypT3N0M0 with American Joint Committee on Cancer tumor regression grade *** was still in good condition after 5 years of *** neoadjuvant chemoradiotherapy followed by laparoscopic technique could be applicable and may achieve satisfactory oncological *** finding requires further validation by cohort studies.

关键词： Gastric cancer neoadjuvant chemoradiotherapy Laparoscopic Distal gastrectomy S-1 Case report

neoadjuvant chemoradiotherapy plus surgery in the treatment of potentially resectable thoracic esophageal squamous cell carcinoma

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World Journal of Clinical Cases 2020年第24期8卷 6315-6321页

作者： Mao-Hui Yan Bo-Ning Cai Bao-Lin Qu Xiang-Kun Dai Fang Liu Xiao-Bin Hou Department of Radiotherapy The First Medical Center of the Chinese PLA General HospitalBeijing 100853China Department of Thoracic Surgery The First Medical Center of the Chinese PLA General HospitalBeijing 100853China

BACKGROUNDIn recent years, neoadjuvant chemoradiotherapy (NCRT) combined with surgeryhas been gradually applied in patients with locally advanced thoracic esophagealcancer, but its effectiveness and safety remains unclear. In this clinical trial, weprospectively investigated the efficacy and safety of NCRT plus surgery in thetreatment of thoracic esophageal squamous cell carcinoma (TESCC).AIMTo investigate the efficacy and safety of NCRT combined with surgery in thetreatment of potentially resectable *** patients with advanced TESCC hospitalized in our hospital from July2016 to June 2019 were prospectively studied. All patients received NCRT, whichincluded intensity modulated conformal radiotherapy (40-44 Gy/20-22f, 2 Gy/f)and chemotherapy (paclitaxel 150-175 mg/m2d1, 22 + lobaplatin 25-30 mg/m2d2,23 for two cycles). Surgery was performed after radiotherapy and *** effectiveness and safety of these treatments were *** these 30 patients, complete response was achieved in two cases (6.7%) andpartial response in 26 cases (86.7%), yielding an objective response rate of 100%.All patients underwent radical surgery successfully. The R0 resection rate was100%, and the pathologic complete response rate was 33.3%. The incidence ofgrade III- IV granulocytopenia was 10% during the NCRT, and anastomoticleakage occurred in one patient after *** patients with potentially resectable TESCC, NCRT can effectively reduce thetumor size, increase R0 resection rate, and achieve obvious pathologicaldegradation, with mild adverse reactions. Thus, it is worthy of wider clinicalapplication.

关键词： Esophageal cancer neoadjuvant chemoradiotherapy Surgical treatment Radiotherapy Chemotherapy Toxicity

neoadjuvant chemoradiotherapy Improving Survival Outcomes for Esophageal Carcinoma： An Updated Meta-analysis

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Chinese Medical Journal 2016年第24期129卷 2974-2982页

作者： Dong-Bin Wang Zhong-Yi Sun Li-Min Deng De-Qing Zhu Hong-Gang Xia Peng-Zhi Zhu Department of Cardiothoracic Surgery Tianjin Hospital Tianjin 300211 China

Background： The effectiveness of neoadjuvant chemoradiotherapy （NCRT） treatment for patients with esophageal carcinoma （EC） remains controversial. The aim of this study was to compare the effect of NCRT followed by surgery （NCRTS） with surgery alone （SA） for EC. Methods： The PubMed, EMBASE, and the Cochrane Library databases were electronically searched up to August 2015 for all the published studies that investigated EC patients receiving either NCRTS or SA, and the reference lists were also manually examined for the eligible studies. The risk ratio （RR） with 95% confidence intervals （CI s） as effective size was determined to assess the 1-, 3-, 5-year survival rates （SRs）, postoperative morbidity, and postoperative mortality. Heterogeneity was determined using the Q-test. The Begg＇s test and Egger＇s test were used for assessing any potential publication bias. Results： Of 1120 identified studies, 16 eligible studies were included in this analysis （involving 2549 patients）. Overall, the pooled results suggested that NCRTS was associated with significantly improved 1-year （RR： 1.07, 95% CI： 1.02–1.13）, 3-year （RR： 1.26, 95% CI： 1.14–1.39）, and 5-year （RR： 1.36, 95% CI： 1.18–1.56） SRs. However, the results also indicated that NCRTS had no or little effect on postoperative morbidity （RR： 0.93, 95% CI： 0.82–1.05） and postoperative mortality （RR： 1.17, 95% CI： 0.56–2.44）. Conclusions： Compared with SA, NCRTS can increase 1-, 3-, and 5-year SRs in patients with EC.

关键词： Esophageal Carcinoma Meta-analysis neoadjuvant chemoradiotherapy Survival Outcomes

Predictive factors for early distant metastasis after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

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World Journal of Gastrointestinal Oncology 2021年第4期13卷 252-264页

作者： Hyojung Park Departments of Radiation Oncology Dankook University HospitalDankook University College of MedicineCheonan 46115South Korea

BACKGROUND Distant relapse is the leading cause of cancer-related death in locally advanced rectal *** chemoradiation(NACRT)followed by surgery inevitably delays delivery of systemic *** patients show early distant metastasis before systemic *** To identify the most effective *** investigated prognostic factors for distant metastasis,especially early distant metastasis,using the standard treatment paradigm to identify the most effective treatments according to recurrence *** From January 2015 through December 2019,rectal cancer patients who underwent NACRT for having clinical T 3-4 or clinical N 1-2 disease according to the 8th American Joint Committee on Cancer staging system were *** was delivered to the whole pelvis with concomitant *** received surgery 6-8 wk after completion of *** chemotherapy was administered at the physician’s *** A total of 127 patients received ***-three patients(73.2%)underwent *** R0 resection rate was 89.2%in all *** tumor and node downstaging rates were 41.9%and 76.3%.Half the patients(n=69)received adjuvant chemotherapy after *** 3-year distant metastasis-free survival(DMFS)and overall survival(OS)rates were 81.7%and 83.5%.On univariate analyses,poorly differentiated tumors,>5 cm,involvement of mesorectal fascia(MRF),or presence of extramural involvement(EMVI)were associated with worse DMFS and *** patients showed distant metastasis at their first evaluation after *** with early distant metastasis were more likely to have poorly differentiated tumor(P=0.025),tumors with involved MRF(P=0.002),and EMVI(P=0.012)than those who did *** EMVI,the involvement of MRF,and poor histologic grade were associated with early distant *** order to control distant metastasis and improve treatment outcome,selective use of neoadjuvant treatment according to indivi

关键词： Rectal cancer neoadjuvant chemoradiotherapy Distant metastasis Extramural venous invasion

Endoscopic ultrasound-guided injection of carbon nanoparticles suspension to label rectal cancer before neoadjuvant chemoradiotherapy:a retrospective cohort study

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Gastroenterology Report 2023年第1期11卷 469-476页

作者： Nan Lin Yuanzhao Wang Changwei Yu Weihang Wu Yongchao Fang Jin Yang Wangwu Liu Rong Wang Yanyan Jiang Yu Wang Fuzong Clinical Medical College of Fujian Medical University Department of General Surgery900th Hospital of Joint Logistics Support ForceFuzhouP.R.China Department of General Surgery Dongfang Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityXiamenP.R.China Department of Breast Surgery Affiliated Fuzhou First Hospital of Fujian Medical UniversityFuzhouP.R.China Department of Gastroenterology 900th Hospital of Joint Logistics Support ForceFuzhouP.R.China Department of Ultrasonography 900th Hospital of Joint Logistics Support ForceFuzhouP.R.China

Background:Localization of the primary tumor and ensuring safe distal surgical margins(DSMs)following neoadjuvant chemoradiotherapy(nCRT)are challenging in locally advanced rectal cancers(LARCs).This study investigated the effectiveness of carbon nanoparticles suspension(CNS)for labeling the primary tumor and allowing precise tumor resection after ***:Clinicopathological data of LARC patients who underwent nCRT followed by laparoscopic radical anal preservation surgery at our center between January 2018 and February 2023 were prospectively *** patients were divided into the CNS tattooed(CNS)and non-tattooed(control)*** the CNS group,CNS was injected in four quadrants on the anal side 1 cm away from the lower tumor *** were determined through intraoperative distal rectal examination in the control group and observation of CNS tattoos in the CNS *** lengths and positive DSM rates were compared between the two groups to analyse the feasibility and effectiveness of CNS for labeling LARCs before ***:There was no statistically significant difference in the basic demographic data,effectiveness of nCRT,or post-operative recovery rates between the two groups(all P>0.05).In the CNS group,CNS tattoos were observed on the outside of the rectal wall,with an overall efficiency of 87.1%(27/31).The CNS group had fewer positive DSMs and safer DSM lengths(2.73±0.88 vs 2.12±1.15 cm,P=0.012)than the control group(P<0.05).Conclusions:Endoscopic ultrasound-guided injection of CNS tattoos before nCRT could effectively label the LARCs,ensuring safe DSMs during anus-preserving surgeries(*** No.:ChiCTR2300068991).

关键词： rectal cancer neoadjuvant chemoradiotherapy endoscopic ultrasound carbon nanoparticles suspension in situ resection

Predictive value of a serum tumor biomarkers scoring system for clinical stage Ⅱ/Ⅲ rectal cancer with neoadjuvant chemoradiotherapy

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World Journal of Gastrointestinal Oncology 2022年第10期14卷 2014-2024页

作者： Jie-Yi Zhao Qing-Qing Tang Yu-Ting Luo Shu-Min Wang Xiao-Rui Zhu Xiao-Yu Wang Department of Neurosurgery West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina Department of Ophthalmology West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina West China Medical School Sichuan UniversityChengdu 610041Sichuan ProvinceChina

BACKGROUND Multiple classes of molecular biomarkers have been studied as potential predictors for rectal cancer(RC)*** antigen(CEA)is the most widely used blood-based marker of RC and has proven to be an effective predictive *** antigen 19-9(CA19-9)is another tumor biomarker used for RC diagnosis and postoperative monitoring,as well as monitoring of the therapeutic *** a panel of tumor markers for RC outcome prediction is a practical *** To assess the predictive effect of pre-neoadjuvant chemoradiotherapy(NCRT)CEA and CA19-9 levels on the prognosis of stage II/III RC *** CEA and CA19-9 levels were evaluated 1 wk before *** to the receiver operating characteristic curve analysis,the optimal cut-off point of CEA and CA19-9 levels for the prognosis were 3.55 and 19.01,*** novel serum tumor biomarker(NSTB)scores were as follows:score 0:Pre-NCRT CEA3.55 and CA19-9>19.01;score 1:Other *** information was recorded according to histopathological reports after the *** In the univariate analysis,pre-NCRT CEA<3.55[P=0.025 for overall survival(OS),P=0.019 for disease-free survival(DFS)],pre-NCRT CA19-9<19.01(P=0.014 for OS,P=0.009 for DFS),a lower NSTB score(0-1 vs 2,P=0.009 for OS,P=0.005 for DFS)could predict a better ***,in the multivariate analysis,only a lower NSTB score(0-1 vs 2;for OS,HR=0.485,95%CI:0.251-0.940,P=0.032;for DFS,HR=0.453,95%CI:0.234-0.877,P=0.019)and higher pathological grade,node and metastasis stage(0-I vs II-III;for OS,HR=0.363,95%CI:0.158-0.837,P=0.017;for DFS,HR=0.342,95%CI:0.149-0.786,P=0.012)were independent predictive *** The combination of post-NCRT CEA and CA19-9 was a predictive factor for clinical stage II/III RC patients receiving NCRT,and the combined index had a stronger predictive effect.

关键词： Rectal cancer neoadjuvant chemoradiotherapy Scoring system Carcinoembryonic antigen Carbohydrate antigen 19-9 Predictive

Predictive value of indirect bilirubin before neoadjuvant chemoradiotherapy in evaluating prognosis of local advanced rectal cancer patients

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World Journal of Gastrointestinal Oncology 2022年第11期14卷 2224-2237页

作者： Shuo-Feng Li Ran Wei Guan-Hua Yu Zheng Jiang Department of Colorectal Surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

BACKGROUND Many biomarkers have predictive value for overall survival(OS)and disease-free survival(DFS)in tumor ***,the role of indirect bilirubin(IBIL)in local advanced rectal cancer(LARC)patients treated with neoadjuvant chemoradiotherapy(nCRT)has not been *** To explore the predictive value of IBIL before nCRT(pre-IBIL)for the OS and DFS of LARC patients treated with *** A total of 324 LARC patients undergoing nCRT with total mesorectal excision(TME)were *** clinical features and postoperative pathological characteristics were *** regression analysis was performed,and a Cox-based nomogram was developed to predict OS and *** also assessed the predictive performance of the nomogram with calibration plots and receiver operating characteristic(ROC)*** Among 324 patients,the median pre-IBIL was 6.2μmol/L(interquartile range:4.6μmol/L-8.4μmol/L).In the Cox multivariate regression analysis,we found that pre-IBIL,smoking history,tumor regression grade(TRG),vascular invasion,and carbohydrate antigen 19-9 before nCRT(pre-CA19-9)were predictors of ***,pre-IBIL,body mass index(BMI),nCRT with surgery interval,TRG,and vascular invasion were predictors of *** nomograms were developed to predict 5-year OS and 5-year DFS with area under the ROC curve values of 0.7518 and 0.7355,*** statistical performance on internal validation was shown by calibration plots and ROC *** This study demonstrated that pre-IBIL was an independent prognostic factor for OS and DFS in LARC patients treated with nCRT followed by *** incorporating pre-IBIL,BMI,smoking history,nCRT with surgery interval,TRG,vascular invasion,and pre-CA19-9 could be helpful to predict OS and DFS.

关键词： Indirect bilirubin Local advanced rectal cancer neoadjuvant chemoradiotherapy Prognostic factor Overall survival Disease-free survival

Application of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in curative surgery for esophageal cancer:A metaanalysis

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World Journal of Gastrointestinal Oncology 2024年第1期16卷 214-233页

作者： Mao-Xiu Yuan Qi-Gui Cai Zhen-Yang Zhang Jian-Zhong Zhou Cai-Yun Lan Jiang-Bo Lin The Graduate School Fujian Medical UniversityFuzhou 350000Fujian ProvinceChina Department of Thoracic Surgery Affiliated Hospital of Jinggangshan UniversityJi’an 343000Jiangxi ProvinceChina Department of Thoracic Surgery Fujian Medical University Union HospitalFuzhou 350000Fujian ProvinceChina

BACKGROUND The effectiveness of neoadjuvant therapy in esophageal cancer(EC)treatment is still a subject of *** To compare the clinical efficacy and toxic side effects between neoadjuvant chemoradiotherapy(nCRT)and neoadjuvant chemotherapy(nCT)for locally advanced EC(LAEC).METHODS A comprehensive search was conducted using multiple databases,including PubMed,EMBASE,MEDLINE,Science Direct,The Cochrane Library,China National Knowledge Infrastructure,Wanfang Database,Chinese Science and Technology Journal Database,and Chinese Biomedical Literature Database *** up to December 2022 comparing nCRT and nCT in patients with EC were *** The analysis revealed significant differences between nCRT and nCT in terms of disease-free *** results indicated that nCRT provided better outcomes in terms of the 3-year overall survival rate(OSR)[odds ratio(OR)=0.95],complete response rate(OR=3.15),and R0 clearance rate(CR)(OR=2.25).However,nCT demonstrated a better 5-year OSR(OR=1.02)than ***,when compared to nCRT,nCT showed reduced risks of cardiac complications(OR=1.15)and pulmonary complications(OR=1.30).CONCLUSION Overall,both nCRT and nCT were effective in terms of survival outcomes for ***,nCT exhibited better performance in terms of postoperative complications.

关键词： Esophageal cancer neoadjuvant chemoradiotherapy Radical resection for esophageal cancer neoadjuvant chemotherapy Meta-analysis