Objective We searched and reviewed medical evidence to find the guide of treatment for local advanced nasopharyngeal carcinoma. Methods Firstly, we put forward clinical questions. Secondly, we searched medical evidence from Medline (1985-2002), Embase (1984-2000), Cochrane library (2002.1) and ACP. And then we reviewed the results. The key words we used were "nasopharyngeal carcinoma, chemotherapy and radiotherapy randomized" and "meta analysis or randomized control trial". Results Through searching, we got 17 papers including 1 systematic review and 16 randomized control trials, in which there were 8 prospective randomized phase Ⅲ trials. Most of these trials concluded that combination chemo-radiotherapy were better than radiotherapy alone. We think these results were suitable for our patient’treatment decision. Conclusion To treat our patients,we choosed the method of the mutimodality of squeitial neoadjuvant chemotherapy, concurrent chemo-radiotherapy and adjuvant chemotherapy with the drug doses down-adjusted.
Surgery is the preferred treatment for resectable esophageal cancer, but in locally advanced esophageal cancer, the effect of surgery alone is not ideal, so surgery-based comprehensive treatment is the best option. Neoadjuvant therapy has become a standard treatment in the treatment of locally advanced resectable esophageal cancer. Neoadjuvant therapy includes neoadjuvant chemotherapy, radiochemotherapy, immunotherapy, targeted therapy, etc. With the significant efficacy and acceptable toxicity of immunotherapy in the first-line and second-line treatment of advanced esophageal cancer, neoadjuvant immunotherapy has become a research hotspot of locally advanced resectable esophageal cancer. This article reviews the latest research progress and some limitations of neoadjuvant immunotherapy in locally advanced resectable esophageal cancer.
Lung cancer is the malignant tumor with the highest incidence and mortality rate in China, which seriously threatens the life and health of Chinese people. Locally advanced unresectable non-small cell lung cancer is characterized by high heterogeneity and poor prognosis, and durvalumab consolidation therapy after concurrent chemoradiotherapy is the main treatment modality. In recent years, advances in targeted therapies and immunotherapy have changed the treatment landscape of lung cancer. A portion of locally advanced or advanced non-small cell lung cancer that was initially unresectable is down-staged and converts to surgically operable radical resection after comprehensive treatment, and this surgical treatment strategy is called conversion surgery. With the progress of comprehensive treatment modalities, it may occupy an increasing proportion in thoracic surgery in the future. This article reviews the treatment modality and conversion surgery for locally advanced unresectable non-small cell lung cancer.
ObjectiveTo investigate the effect and predictive value of systemic inflammatory markers on pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) for locally advanced breast cancer (LABC). MethodsThe clinicopathologic data of female patients with LABC who received NACT and radical surgical resection in the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from February 2019 to February 2022 were retrospectively analyzed. The factors affecting pCR after NACT were analyzed by the multivariate logistic regression and the prediction model was established. The efficiency of the prediction model was evaluated by receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). ResultsA total of 98 patients were gathered, of which 29 obtained pCR, with a pCR rate of 29.6%. The multivariate analysis of binary logistic regression showed that the patients with non-menopausal status, negative estrogen receptor (ER), chemotherapy+targeted therapy, and systemic immune-inflammation index (SII) <532.70 (optimal critical value) were more likely to obtain pCR after NACT (P<0.05). The prediction model was established according to logistic regression analysis: Logit (P)=0.697–2.974×(menopausal status)–1.932×(ER status)+3.277×(chemotherapy regimen)–2.652×(SII). The AUC (95%CI) of the prediction model was 0.914 (0.840, 0.961), P<0.001. ConclusionsIt is not found that other inflammatory indicators such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio are associated with pCR after NACT. But SII is an important predictor of pCR after NACT for LABC and has a good predictive efficiency.
ObjectiveTo compare the clinicopathological features of Luminal A breast cancer patients in early and middle stage, and locally advanced Luminal A breast cancer, then the influencing factors of disease-free survival (DFS) in locally advanced Luminal A breast cancer patients were further discussed.MethodsFrom January 2010 to December 2012, 295 Luminal A breast cancer patients who completed diagnosis, treatment, and follow-up in our hospital were retrospectively collected. According to TNM stage, 227 cases of early and middle breast cancer and 68 cases of locally advanced breast cancer were divided into two groups. Chi-square test or rank sum test was used to compare the clinicopathological characteristics of patients between the two groups, and log-rank test and Cox proportional risk regression model were used to explore the influencing factors of 5-year DFS situation in patients with locally advanced Luminal A breast cancer.ResultsT stage and N stage were later in locally advanced Luminal A breast cancer patients than that of the early and middle breast cancer patients (P<0.05), and the tumor grade was higher in locally advanced Luminal A breast cancer patients (P<0.05). The 5-year DFS rate was 87.8% (259/295). In this study, there were5 comprehensive treatment schemes as follows: neoadjuvant chemotherapy + surgery + radiotherapy + endocrine therapy, neoadjuvant chemotherapy + surgery + endocrine therapy, surgery + chemotherapy + radiotherapy + endocrine therapy, surgery + chemotherapy + endocrine therapy, and surgery + radiotherapy + endocrine therapy. The 5-year DFS rate of locally advanced Luminal A breast cancer patients was lower than that of the early and middle Luminal A breast cancer patients (76.5% vs. 91.2%, P=0.001). Univariate analysis showed that T stage (χ2=8.248, P=0.040), N stage (χ2=9.470, P=0.024), vascular invasion (χ2=4.211, P=0.031), and tumor grade (χ2=6.985, P=0.030) were the factors influencing the5-year DFS situation of locally advanced Luminal A breast cancer patients. Multivariate analysis showed that T staging (HR=5.062, P<0.001) and N staging (HR=7.075, P<0.001) were the influencing factors for 5-year DFS situation in locally advanced Luminal A breast cancer patients. The later the T stage and N stage, the worse the 5-year DFS situation.ConclusionsT stage and N stage are independent risk factors for prognosis of patients with locally advanced Luminal A breast cancer. Individualized comprehensive treatment program is an important guarantee for improving the 5-year DFS rate of this kind of patients.
ObjectiveTo systematically review the effectiveness and safety of taxanes combined with cisplatin and fluorouracil (TFP) versus cisplatin and fluorouracil (FP) for locally advanced head and neck squamous cell carcinoma.
MethodsDatabases such as The Cochrane Library (Issue 1, 2013), PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were electronically searched to collect randomized controlled trials (RCTs) about taxanes combined with cisplatin and fluorouracil in the treatment of locally advanced head and neck squamous cell carcinoma from the date of their establishment to April 1st, 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software.
ResultsA total of 7 RCTs involving 2 088 patients were included. The TFP group included 1 051 cases, while the FP group included 1 037 cases. The results of meta-analyses showed that, there were significant differences between the two groups in the 1-year, 2-year, and 3-year overall survival rates (RR=1.12, 95%CI 1.02 to 1.23, P=0.02; RR=1.20, 95%CI 1.11 to 1.29, P < 0.000 01; RR=1.18, 95%CI 1.07 to 1.31, P=0.000 7), the 1-year, 2-year, and 3 year of progressions free survival (RR=1.18, 95%CI 1.08 to 1.28, P=0.000 2; RR=1.20, 95%CI 1.06 to 1.36, P=0.003; RR=1.48, 95%CI 1.25 to 1.74, P < 0.000 01), the complete remission rate (RR=1.67, 95%CI 1.26 to 2.23, P=0.000 4), and the overall response to chemotherapy (RR=1.18, 95%CI 1.11 to 1.27, P < 0.000 01). As for the side effect, the FP group was superior to the TFP group in the neutropenia (RR=1.42, 95%CI 1.24 to 1.63, P < 0.000 01), alopecia (RR=16.09, 95%CI 4.59 to 56.38, P < 0.000 1), and febrile neutropenia (RR=2.21, 95%CI 1.29 to 3.80, P < 0.004).
ConclusionThe fluorouracil with cisplatin and fluorouracil for advanced head and neck squamous cell carcinoma might have better effects, but with higher side effects.
