• Title, Summary, Keyword: unresectable

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Radiological Downstaging with Neoadjuvant Therapy in Unresectable Gall Bladder Cancer Cases

  • Agrawal, Sushma;Mohan, Lalit;Mourya, Chandan;Neyaz, Zafar;Saxena, Rajan
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.4
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    • pp.2137-2140
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    • 2016
  • Background: Gall bladder cancer (GBC) usually presents as unresectable or metastatic disease. We conducted a feasibility study to evaluate the effect of neoadjuvant therapy (NAT) on radiologic downstaging and resectability in unresectable GBC cases. Materials and Methods: Patients with locally advanced disease were treated with chemoradiotherapy [CTRT] ( external radiotherapy (45Gy) along with weekly concurrent cisplatin $35mg/m^2$ and 5-FU 500 mg) and those with positive paraaortic nodes were treated with neoadjuvant chemotherapy [NACT (cisplatin $25mg/m^2$ and gemcitabine $1gm/m^2$ day 1 and 8, 3 weekly for 3 cycles). Radiological assessment was according to RECIST criteria by evaluating downstaging of liver involvement and lymphadenopathy into complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Results: A total of 40 patients were evaluated from January 2012 to December 2014 (CTRT=25, NACT=15). Pretreatment CT scans revealed involvement of hilum (19), liver infiltration (38), duodenum involvement (n=22), colon involvement (n=11), N1 involvement (n=11), N2 disease (n=8), paraaortic LN (n=15), and no lymphadenopathy (n=6). After neoadjuvant therapy, liver involvement showed CR in 11(30%), PR in 4 (10.5%), SD in 15 (39.4%) and lymph node involvement showed CR in 17 (50%), PR in 6 (17.6%), SD in 4 (11.7 %). Six patients (CTRT=2, NACT=4) with 66.6 % and 83% downstaging of liver and lymphnodes respectively underwent extended cholecystectomy. There was 16.6 % and 83.3% rates of histopathological CR of liver and lymph nodes. All resections were R0. Conclusions: Neoadjuvant therapy in unresectable gall bladder cancer results in a 15% resectability rate. This approach has a strong potential in achieving R0 and node negative disease. Radiologic downstaging (CR+PR) of liver involvement is 40.5% and lymphadenopathy is 67.5%. Nodal regression could serve as a predictor of response to neoadjuvant therapy.

Surgical Management of Esophageal Carcinoma after Esophageal Prosthesis (인공 식도를 삽입한 식도암 환자의 수술치험 4례)

  • 박승훈
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.28 no.1
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    • pp.90-95
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    • 1995
  • Effective relief of dysphagia in unresectable esophageal cancer patients not only prolong survival but also is prerequisite for other treatment modalities.We tried surgical resection in 4 patients who had unresectable esophageal cancer,managed initially with esophageal prosthesis then followed by chemotherapy with good response. Curative resection was possible in 2 patients and palliative resection in one and exploration only in one case.Curatively resected patients are alive without recurrence for 57 months,8 months,each.Other non-curatively resected patients died after 10 months,7 months. Above results suggest that initial esophageal prosthesis to relieve dysphagia followed by chemotherapy in unresectable esophageal cancer may provide another chances for curative resection that promise better survival and need more clinical experience and trial.

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Treatment Outcome of Palliative Chemotherapy in Inoperable Cholangiocarcinoma in Thailand

  • Butthongkomvong, Kritiya;Sirachainan, Ekaphop;Jhankumpha, Supattra;Kumdang, Surang;Sukhontharot, On-Usa
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.6
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    • pp.3565-3568
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    • 2013
  • Background: Cholangiocarcinoma is the most common cancer in males in Thailand. The outcome is poor although systemic chemotherapy has been used in attempts to improve disease control, quality of life and prolong survival in patient with unresectable and advanced disease. Materials and Methods: In this retrospective study the medical records of all patients diagnosed as having unresectable and metastatic cholangiocarcinoma and receiving systemic chemotherapy at Udonthani Cancer Hospital during January 2007 to December 2010 were reviewed. Results: Among the total of 105 patients, 21 received gemcitabine-based chemotherapy and 84 5FU-based chemotherapy. Most received platinum doublet regimens. 5FU-based regimens yielded an overall response rate (tumor control) of 23.8% and a median survival of 7.2 months while gemcitabine-based regimens yielded an overall response rate (tumor control) 19.1% and a median survival of 10.0 months. Conclusions: Tumor control and survival of patient with advanced cholangiocarcinoma treated with gemcitabine-based and 5FU-based chemotherapy do not markedly differ.

Improvement of Chronic Bleeding in the Patient with Unresectable Advanced Gastric Cancer Using the Decoction of Notoginseng Radix - a Case Report

  • Jeon, Hyeonjin;Park, Sora;Lee, Sookyung
    • The Journal of Korean Medicine
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    • v.37 no.2
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    • pp.104-109
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    • 2016
  • Objectives: A 74-year-old male patient with unresectable advanced gastric cancer (clinical initial stage T3N+, Borrmann type III) admitted due to gastric bleeding at tumor site. On first admission day, hemoglobin level was 5.7g/dl and performance status was grade 3 according to Eastern Cooperative Oncology Group Performance Status(ECOG-PS). After performing red blood cell transfusion as an emergency treatment, hemoglobin level was increased up to 9.5g/dl. However, bleeding of oozing site was continued. For hemostasis, decoction of notoginseng radix (30g/day) was administered since day 7 after admission. The dose was elevated to 40g/day after hemoglobin level was decreased to 6.5g/dl on day 11. Since then, melena was stopped and hemoglobin level was maintained over 9.1g/dl. This case shows the hemostasis effect of decoction of notoginseng radix on gastric bleeding in unresectable advanced gastric cancer.

Exceptional response to radiotherapy in unresectable pleuropulmonary blastoma of a child

  • Kim, Jae Sik;Lee, Joo Ho
    • Radiation Oncology Journal
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    • v.38 no.2
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    • pp.148-150
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    • 2020
  • Pleuropulmonary blastoma (PPB) is a rare intrathoracic neoplasm in children. Although surgery with or without chemotherapy mainly conducted, the response of radiotherapy (RT) has not been evaluated yet. For unresectable tumor, RT might be considered as one option to decrease tumor extent to relieve obstructing symptoms or to facilitate successive treatment. We report one child in whom PPB with DICER1 mutation recurred after surgery and lead to respiratory distress. She emergently received palliative RT with a relatively low dose (20 Gy), and symptoms sufficiently relieved. Even she showed an 84.3% reduction in diameter and maintained the remission status for 1 year. These might reflect possible radiosensitivity of PPB, and further investigations of RT might be necessary for unresectable PPB.

The Role of Radiation Therapy in the Unresectable Rectal Cancers (절제 불가능 직장암에서 방사선 치료의 역할)

  • Kim, Woo-Cheol;Seong, Jin-Sil;Kim, Gwi-Eon
    • Radiation Oncology Journal
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    • v.13 no.2
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    • pp.173-180
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    • 1995
  • Purpose: Unresectable rectal cancer has a grave prognosis. regardless of the therapy used and median survival is less than 1 rear. Also, it is reported by many authors that $50-80\%$ of unresectable lesions were rendered resectable by radiation therapy and the median survival time for the completely resected patients were better than that of the unresected patients. So we analyzed retrospectively our data for the better treatment outcome in these patients. Materials and MEthods:From 1980 to 1992, 45 patients with initially unresectable tumors in the rectum were treated with radiation therapy with/without surgery in Department of Radiation Oncology, Yonsei Cancer Center 10 MV radiation and multiple field technique (box or AP/PA) were used. The total dose was 28-70 Gy and median dose was 48 Gy. We evaluated the lesion status at 45-50 Gy for operability. If the lesions appeared to be resectable, the Patients were operated on 4-6 weeks after radiation therapy. But if the lesions were still fixed, the radiation dose was increased to 60-65 Gy. Results: For all patients, the 2-year actuarial survival was $13.3\%$ and median survival was 9.5 months. Of 6 patients who had received less than 45 Gy, only $17\%$ of patients responded, but in the patients who had received more than 45 Gy, $60\%$ of response rate was achieved Six of the 24 patients$(25\%)$ underwent surgical resections following RT. For patients undergoing curative resection. the two-rear survival was $50\%,$ but that of the patients without resection was $9.5\%$ (p<0.01). Survival of patients with complete response following RT was $50\%$ at 2 years. Survival of patients with partial response, stable disease and progressive disease after RT was $13.4\%,\;15.4\%,\;0\%$ respectively (P<0.05). Conclision: Our data suffests that the efforts which can increase the response rate and aggressive surgical approach are needed to achieve the better local control and survival in unresectable rectal cancers.

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Residual, Unresectable and Recurrent Rectal Cancer : Role of External Radiation Therapy in 46 Patients (국소 재발성 또는 진행된 직장암의 방사선 치료 -46예의 치료 성적 분석-)

  • Gil, Hack-Joon;Oh, Yoon-Kyeong;Yoon, Sei-Chul;Shinn, Kyung-Sub;Bahk, Yong-Whee
    • Radiation Oncology Journal
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    • v.6 no.1
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    • pp.55-61
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    • 1988
  • Fifty patients with residual, unresectable or recurrent rectal cancer were treated with external irradiation using a 6-MV linear accelerator at the Division of Therapeutic Radiology, Department of Radiology, Kangnam St. Mary's Hospital, Catholic University Medical College during the period of April 1983 to December 1987. This paper describes the results of a retrospective analysis of the results of external irradiation for the residual, unresectable and recurrent rectal cancer in 46 patients. Four patients were lost to follow-up. Of the 46 patients, $18 (39\%)$ presented with unresectable primary lesions and $28 (61\%)$ with residual or recurrent rectal cancer. In $93\%$, the pathologic diagnosis was adenocarcinoma. Resonse to irradiation was observed in $22 (73\%)$ out of 30 patients who were treated for pain, $12 (86\%)$ out of 14 patients who were treated for mass, and $17 (77\%)$ out of 22 patients who were treated for bloody discharge. The actuarial postoperative 2-year and 3-year survival rates in recurrent and unresectable patients were $43\%$ and $22\%$, respectively. However, the post-RT 2-year survival rate was $13\% (6/46)$.

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The Clinical Analysis of Primary Malignant Hepatic Tumor in Childhood (소아의 원발성 악성 간종양에 대한 임상적 고찰)

  • Lim, Ki-Yun;Jeong, Yeon-Jun;Jung, Sung-Hoo;Kim, Jae-Chun
    • Advances in pediatric surgery
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    • v.9 no.1
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    • pp.12-18
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    • 2003
  • The purpose of this study is to evaluate children who underwent hepatic resection for primary malignant hepatic tumor in the period from January 1994 to December 2001. A total of 8 patients, seven with hepatoblastoma (HB) and one with hepatocellular carcinoma (HCC), were studied. One HCC was resectable at the initial diagnosis, but five cases of unresectable HB received two cycles of transarterial chemoembolization (TACE) before operation. One patient with an unresectable HB with bone marrow metastasis was operated after one cycle of TACE and one cycle of systemic chemotherapy based on CCG-823F protocol. Another unresectable HB patient received systemic chemotherapy instead of TACE before operation. Postoperative chemotherapy was administered to all of the patients after complete surgical resection on CCG-823F protocol. All 6 patients who underwent TACE and neoadjuvant chemotherapy showed marked reduction in tumor volume and a clear outline of the lesion. Major complication was not noticed. Mean alpha-fetoprotein (${\alpha}$-FP) level at diagnosis, after neoadjuvant chemotherapy and after postoperative chemotherapy was 9,818 (42-35,350), 664, and 10.1 ng/mL, respectively. Half life of the ${\alpha}$-FP after complete resection was 5.1 days (3.0-8.7 days). Median follow up period was 57.1 months (10-97 months) and all the patients are alive with NED. In conclusion, preoperative chemotherapy, especially TACE, is effective, safe, and useful to treat initially unresectable hepatoblastoma, and serial level of the serum ${\alpha}$-FP is a useful tumor marker for diagnosis and monitoring therapeutic responses.

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Retrospective Study of Gemcitabine Based Chemotherapy for Unresectable or Recurrent Esophagus Squamous Cell Carcinoma Refractory to First Line Chemotherapy

  • Wang, Mei;Gu, Jun;Wang, Hai-Xing;Wu, Mei-Hong;Li, Yong-Mei;Wang, Ya-Jie
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.8
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    • pp.4153-4156
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    • 2012
  • Purpose: To investigate the efficacy and toxicity of a combination of gemcitabine with nedaplatin (GN) or cisplatin (GC) for patients with unresectable or recurrent esophagus squamous cell carcinoma. Methods: Gemcitabine was administered at 1 g/m2 intravenously on days 1 and 8; and nedaplatin or cisplatin were administered at 80 mg/m2 intravenously on day 1. We analyzed the response rate, overall survival time, progression-free survival time, and toxicity in 21 patients treated with GN and 27 patients treated with GC. Results: In patients treated with gemcitabine plus nedaplatin, the ORR was 47.6%, the median progression-free survival time was 4.1 months, and the median survival time was 9.3 months. In patients treated with gemcitabine plus cisplatin, the ORR was 48.2%, the median progression-free survival time was 3.9 months, and the median survival time was 9.1 months, respectively. There were no statistically significant differences in ORR, PFS and OS between the two groups. In both, the most commonly observed toxicities were thrombocytopenia and fatigue. Nausea and vomiting was more frequent in the GC group than in the GN group. Conclusion: Gemcitabine based chemotherapy was effective and tolerable for patients with unresectable or recurrent esophagus squamous cell carcinoma refractory to first line chemotherapy.

Lobaplatin Combined Floxuridine/Pirarubicin-based Transcatheter Hepatic Arterial Chemoembolization for Unresectable Primary Hepatocellular Carcinoma

  • Zhao, Chang;Wang, Xu-Jie;Wang, Song;Feng, Wei-Hua;Shi, Lei;Yu, Chun-Peng
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.5
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    • pp.2057-2060
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    • 2014
  • Purpose: To assess the effect and safety of lobaplatin combinated floxuridine /pirarubicin in transcatheter hepatic arterial chemoembolization(TACE) of unresectable primary liver cancer. Patients and Methods: TACE combined with the chemotherapy regimen was used to treat 34 unresectable primary liver cancer patients. DSA/MRI/CT/blood routine examinations were used to evaluate short term activity and toxicity after 4-5 weeks, the process being repeated if necessary. Results: Among the 34 cases, 1 (2.9%) showed a complete response, 21 (61.7%) a partial response, 8 (23.5%) stable disease, and 4 progressive disease, with a total effective rate of 67.6%. The content of alpha fetoprotein dropped by over 50% in 20 cases (58.8%). The rate of recovery was hepatalgia (88.2%), ascites (47.1%), appetite (55.9%), Performance Status(30.4%). The median follow-up time (MFT) was 281 days (63-558 days), and median progression-free survival was 118.5 days (95%, CI:88.8-148.2days). Adverse reactions (III-IV grade) were not common, with only 4 cases of vomiting and 2 cases of thrombocytopenia (III grade). Conclusions: Lobaplatin-based TACE is an effective and safe treatment for primary liver cancer.