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 study the curative effects of keloid by operation combined with postoperative β radiation and silicone gel sheeting. Methods From 1996 to 2002, 598 patients with keloid(243 males, 355 females, aging 15-55 years with an average of 28.6 years) were treated by integrated therapy. Their disease courses were from 6 months to 6 years. The keloid area ranged from 1.0 cm×1.5 cm~8.0 cm×15 cm. First, keloid was removed by operation, and then the wounds weresutured directly(group suture) or covered with skin graft(group graft). In groupsuture, the operational sites were managed by β ray radiotherapy 24-48 hours after operation. The total doses of radiation were 12-15 Gy, 5 times 1 week(group suture A) and 10 times 2 weeks (group suture B). Radiotherapy was not taken until stitches were taken out in group graft, and then the same methods were adopted as group suture B. After radiotherapy, silicone gel sheeting was used in 325 cases for 3-6 months. Results All patients were followed up for 12-18 months. (1) The overall efficacy was 91.3% in group suture A(n=196), and 95.8% in group suture B (n=383), respectively. There was significant difference between the two groups(Plt;0.01). (2) Radiotherapy was of no effect in 6 cases of group graft(n=19). (3) Silicone gel sheeting had effectivenessin 185 cases. Silicone gel sheeting had no obvious effect on the overall efficacy, but it could improve the quality of texture and color of skin. Conclusion By use of integrated methods to treat keloid, if the wound can be sutured directly, skin grafting should not be adopted. The results in group suture B are better than those in group suture A; silicone gel sheeting should be used as possible.
ObjectiveTo analyze the value of internal mammary lymph node biopsy via intercostal space in staging and adjuvant therapy of breast cancer. MethodsThe clinical data of 305 breast cancer patients received any kind of radical mastectomy from may 2003 to January 2014 in the Jinan Military General Hospital of PLA were analyzed retrospectively. The patient age, axillary lymph node, and internal mammary lymph node status were integrated to investigate the changing of staging and postoperative adjuvant therapy of the breast cancer. ResultsThese 305 patients were divided into neoadjuvant chemotherapy group and non-neoadjuvant therapy group. There were 67 patients in the neoadjuvant chemotherapy group, including 45(67.2%) patients with axillary lymph node positive, 23(34.3%) patients with internal mammary lymph node positive. There were 23(34.3%) patients who had a change of pathology lympy node (pN) staging and 8(11.9%) patients who had a change of the pTNM staging. Meanwhile, there were 238 patients in the non-neoadjuvant chemotherapy group, including 155(65.1%) patients with axillary lymph node positive, 30(12.6%) patients with internal mammary node positive. There were 30(12.6%) patients who had a change of the pN staging and 23(9.66%) patients who had a change of the pTNM staging. There was a significant difference in the metastasis rate of the internal mammary lymph node (χ2=15.7, P < 0.05) or the changing ratio of the pTNM staging (χ2=5.3, P < 0.05) in two groups. ConclusionsInternal mammary lymph node status could affect pN staging of breast cancer, so do the pTNM staging (TNM, pathology tumor, lymph node, metastasis). The internal mammary lymph node status could guide the postoperative adjuvant radiative therapy by reducing excessive treatment of the internal mammary lymph node area, also could enhance the individual accurate therapy.
Radiotherapy is the prior treatment for uveal melanoma, but a major problem confronted most of the patients is radiation retinopathy, which accompanied with severe visual loss and secondary enucleation potential. There is no optium choice and normative strategy so far, the intraocular melanoma society has focused on application of anti-vascular endothelial growth factor drugs injection and glucocorticoids. This article reviews a series of potential managements for radiation retinopathy and its further stage .
Four pigs underwent the hepatic arterial infusion with 32P glass microsphere (32PGM) and pigs were killed in 15th, 30th and 90th days separately. Pathological study showed that in early stage there were many small necrotic areas scattered along the hepatic arterioles. Three months later, these necrosis were gradually absorbed and replaced by regenerating hepatic cells. Tumor-inhibition experiment was performed in 40 Bal B/C mice bearing H22 hepatoma. Intratumoral injection of 0.2ml of 32PGM/glycerine suspension (group A, n=20) or 0.2ml of blank glass microsphere/glycerine suspension (group B, n=20) were performed. The average survival time in group A and group B was 24.8 and 11.8 days respectively. Five mice in group A were alive beyond 40 days after treatment, disappearance of tumor was found in two of them. This experiment demonstrates that 32PGM is effective for treatment of experiment hepatoma. The damage to hepatic tissue after infusion is associated with the irregular distribution of microsphere, and this lesion can completely recover within three months.
Objective To explore the clinical significance of internal mammary nodes in diagnosis and treatment of breast cancer. Methods The research papers on internal mammary nodes at home and abroad were analyzed in order to summarize the distribution, metastasis, detection and the effects of clinical treatment of the internal mammary nodes in breast cancer. Results The internal mammary nodes mainly locate near the sternum, along with the internal mammary artery and vein in the thorax. They were prone to metastasize at early stage and the metastasis rate also increased with the increased number of axillary lymph nodes in breast cancer. It could influence the recovery of the breast cancer patients by taking biopsy and treatment to the internal mammary nodes. Conclusion The biopsy and treatment of internal mammary nodes are useful for the patients with breast cancer to avoid the recurrence and helpful to stage, treatment and prognosis judgement of the breast cancer patients.
ObjectivesTo explore the efficacy of simultaneous chemoradiotherapy combined with surgery for locally advanced cervical patients and perform multivariable analysis.MethodsA total of 130 cases of patients with locally advanced cervical cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from June 2012 to December 2016 were randomly divided into case group and control group. The patients in the control group were treated with platinum-based radical concurrent chemoradiation. In the case group, patients received both treatment in the control group with the addition of extensive hysterectomy and pelvic lymph node dissection. The short-term efficacy and survival outcomes of the two groups were compared.ResultsThe present study was the final report of this randomized controlled trial. 68 patients were randomly enrolled into the case group and 50 patients into control group. The non-microscopic residual tumor (non-MRT) rates were 83.8% (57/68) and microscopic residual tumor (MRT) rates were 2.9% (2/68) in the experimental group. There was no significant difference between two groups (χ2=0.008, P=0.928) in 3-year progression-free survival rate (65.6%vs. 59.6%) and 4-year progression-free survival rate (52.5% vs. 56.3%). And there was no significant difference between two groups (χ2=0.361, P=0.548) in 3-year overall survival rate (80.3%vs. 74.6%) and 4-year overall survival rate (77.6% vs. 64.9%). Multivariable analysis showed that only tumor size and parametrial invasion were significant prognostic factors of PFS (P<0.05). And only parametrial invasion was a potential prognostic indicator affecting OS (P=0.078).ConclusionParametrial invasion is an important prognostic factor. Radical concurrent chemoradiotherapy combined with surgical treatment of locally advanced cervical cancer has not significantly improved progression-free survival and overall survival. The treatment regimen should be applied with caution and selectivity.
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.
Objective To systematically evaluate the effectiveness and safety of zoledronic acid combined with radiotherapy in treating bone metastasis of malignant tumor. Methods Such databases as PubMed, EMbase, The Cochrane Library (Issue 10, 2012), CBM, CNKI, VIP and WanFang Data were searched to collect randomized clinical trials (RCTs) on bone metastasis of malignant tumor from inception to October, 2012. References of included studies were also retrieved. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results Twenty nine trials were included involving 2 021 patients. The results of meta-analysis showed that, compared with the radiotherapy alone group, zoledronic acid combined with radiotherapy improved the effectiveness rate of pain relieving at the end of treatment (OR=3.08, 95%CI 2.30 to 4.12, Plt;0.000 01), the effectiveness rate of pain relieving two weeks after treatment (OR=3.39, 95%CI 2.52 to 4.56, Plt;0.000 01), the quality of life (OR=2.74, 95%CI 1.66 to 4.52, Plt;0.000 01) and the ability of movement (OR=2.96, 95%CI 2.16 to 4.05, Plt;0.000 01). Zoledronic acid combined with radiotherapy also reduced the incidence of new bone metastasis (OR=0.21, 95%CI 0.10 to 0.45, Plt;0.000 1) and the incidence rate of bone-related events (OR=0.17, 95%CI 0.03 to 0.92, P=0.04). The adverse reactions of zoledronic acid combined with radiotherapy such as fever (OR=11.92, 95%CI 6.31 to 22.48, Plt;0.000 01) and hypocalcaemia (OR=8.82, 95%CI 1.61 to 48.36, P=0.01), significantly increased. Conclusion Compared with radiotherapy alone, zoledronic acid combined with radiotherapy can relieve bone metastatic pain, effectively enhance patients’ ability of movement, improve quality of life, and decrease new bone metastasis and the occurrence of bone-related events.
ObjectiveTo investigate the effect ofγ-ray irradiation on echinococcus protoscoleces before abdominal cavity implantation in mice. MethodsEchinococcus protoscoleces were cultured in vitro, and then divided into 5 groups, four groups receivedγ-ray irradiation with 10 Gy, 20 Gy, 40 Gy, and 80 Gy, respectively. The remaining control group was not irradiated. The protoscoleces were then implanted into the abdominal cavity of mice. Four months later, the incidence of echinococcosis was measured by detection of echinococcus antibody in the blood and then abdominal laparotomy was performed to isolate intraabdominal cysts, and the weight and structure of the echinococcus generated from the protoscoleces were measured and observed. ResultsAfter implantation of irradiated echinococcus protoscoleces in mice, the incidence of echinococcosis was 100% in the control group, 80.0% in the 10 Gy group, 33.3% in the 20 Gy group, 33.3% in the 40 Gy group, and 26.7% in the 80 Gy group. The echinococci had lower weight in the irradiated groups with 10 Gy (35.80 mg), with 20 Gy (0.00 mg), with 40 Gy (0.00 mg), and with 80 Gy (0.00 mg) as compared with the control group (157.80 mg). The echinococcus generated from the protoscoleces appeared calcification. Conclusionsγ-ray irradiation could inhibit the formation of echinococcus granulosus generated from protoscoleces, damage the structure of echinococcus generated from the protoscoleces. Irradiation might prevent echinococcosis recurrence after surgical removal of hydatid cysts.