High-grade gliomas are the most common malignant primary central nervous system tumors with poor prognosis. The operation based on the principle of maximum safe resection of tumors, combined with radiation therapy and chemotherapy, is the primary treatment method. This treatment only delays the progression of high-grade gliomas, and almost all patients eventually develop disease progression or relapse. With the development of molecular biology, immunology, and genomics, people have a deeper understanding of the pathogenesis of gliomas. Targeted therapy, immunotherapy, and other comprehensive treatments are expected to become potential treatments for high-grade gliomas. This article reviews the current status of medical treatment of primary and recurrent high-grade gliomas, and the research progress of high-grade gliomas in targeted therapy and immunotherapy.
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.
Ambulatory medicine is an important way to shorten the average length of hospital stay, reduce the cost of medical treatment, and enhance the efficient of diagnosis and treatment, providing patients with efficient, fast and convenient medical services. In combination with the developmental practice of ambulatory medicine of the First Medical Center of PLA General Hospital, this paper analyzes the operation and management mode and the innovative development process of ambulatory medicine. Through discussion, this paper gains a deeper understanding of ambulatory medicine, and confirms that in order to ensure the efficient and safe operation of ambulatory medicine, it is necessary to formulate specific norms and unified standards to promote the development of this new medical service mode.
Objective To evaluate the effect of the allied chemotherapy with 5-Fu、leucovorin (CF) and levamisole (LV) after resection of colorectal cancer. Methods 242 cases were divided randomly into three groups. 80 cases (group Ⅰ) were treated with 5-Fu and CF. 80 cases(groupⅡ) were treated with 5-Fu and LV. 82 cases (group Ⅲ) were treated with 5-Fu、CF and LV. Results The recurrence rates of group Ⅲ was 12.20%, which was significantly lower than that of group Ⅰ (26.25%) and group Ⅱ(27.50%). (P＜0.05). The 5-year survival rates in group Ⅰ, group Ⅱ and group Ⅲ were 37.50%, 35.00% and 58.54%, respectively, the highest one was in Group Ⅲ (P＜0.01). Conclusion The allied chemotherapy with 5-Fu、CF and LV is an effective therapy for petients of colorectal cancer after surgery, which can significantly decrease the recurrence and improve the 5-year survival rate.
【Abstract】Objective To analyze the function of BAG3 in antiapoptosis and chemotherapy resistance induction process of pancreatic cancer.Methods The expressions of BAG-3 in pancreatic cancerous tissues of patients with chemotherapy and those without chemotherapy before resection were determined by immunohistochemistry. The expression difference of BAG-3 protein 18 hours after cultured with chemotherapy drugs (concentration of drugs: 5-FU 50 μg/ml, MMC 0.5 μg/ml, EADM 1.5 μg/ml) of 3 pancreatic cancer cell lines （MIACaPa-2, PANC-1, SW1990） was measured through Western blotting method.Results The median positive rate of pancreatic cancer tissue from patients accepted chemotherapy before resection was higher than those not accepted chemotherapy, but there wasn’t significant difference. Eighteen hours after cultured with drugs, the level of BAG-3 of this three cell lines had significant increased compared with control group (P＜0.05). Conclusion Chemotherapy induces elevation of BAG-3 expression of pancreatic cancer. The upregulate of BAG-3 may associate with the chemotherapy resistance induced by drugs.
Objective To understand the latest research progress of chemotherapy, targeted therapy and immunotherapy drugs in the treatment of metastatic colorectal cancer. Method The literature on the efficacy of different treatment drugs for metastatic colorectal cancer in recent years both domestically and internationally was retrieved and reviewed. Results There had been many clinical research progress in the treatment of metastatic colorectal cancer, new drugs had emerged, targeted drugs were particularly prominent, and more trials of therapeutic drugs and drug combination treatment regimens were also being carried out. Different treatment methods were applied to patients according to the mutation status of RAS/RAF and the expression of mismatch repair protein, the survival benefit varied greatly. Conclusion Precision medicine is becoming increasingly important, screening patients to choose appropriate treatment modality can further improve survival benefit.
Objective To explore the application effect of a nursing management mode based on Swiss cheese model in safe medication for chemotherapy patients in daytime wards. Methods The study included chemotherapy patients in the Department of Day Care Ward of Tianjin Medical University Cancer Institute & Hospital between February and March 2023 (before improvement) and between June and July 2023 (after improvement). Before the improvement, a conventional nursing management mode was adopted, and after the improvement, a nursing management mode based on the Swiss cheese model was adopted. The medication safety ability of nurses, adverse drug events, and patients’ satisfaction of nursing before and after improvement were compared. Results Finally 150 patients were included before and after improvement, respectively. There was no statistically significant difference in age, gender, educational level, per capita monthly household income, tumor staging, and disease diagnosis between the two groups of patients (P>0.05). The total score of patients’ satisfaction of nursing after improvement was higher than before improvement (22.99±1.52 vs. 20.45±2.14, P<0.05), but there was no statistically significant difference in the dimensions of treatment environment and service attitude (P>0.05). There was no change in the nursing staff before and after the improvement, and a total of 34 nurses were included in the Department of Day Care Ward. The total score of the nurses’ medication safety ability was higher than before improvement [162.00 (160.75, 166.25) vs. 136.00 (135.00, 138.00), P<0.05], but there was no statistically significant difference in the dimensions of improving medication safety issues, multidisciplinary collaboration ability, and nursing professional responsibility (P>0.05). The incidences of adverse events during daytime chemotherapy after improvement were lower than before improvement (P<0.05). Conclusion The nursing management mode based on Swiss cheese model can improve the safety medication ability of nurses, reduce adverse events of chemotherapy medication in daytime wards, and improve patient satisfaction, which can be promoted in clinical practice.
Objective To systematically evaluate the efficacy and safety of dose-dense neoadjuvant chemotherapy (ddNACT) and conventional neoadjuvant chemotherapy (cNACT) for locally advanced breast cancer (LABC). Methods PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP databases were searched for randomized controlled trials (RCT) comparing ddNACT regimen with cNACT regimen for breast cancer. The time limit for retrieval was from establishment to March 1st, 2021. Two reviewers independently screened literatures, extracted data and assessed risk bias of included studies; then, meta-analysis was performed by using Stata 15.0 software. Results A total of 13 RCTs were included, including 3 258 patients, of which 1 625 patients received ddNACT and 1 633 patients received cNACT. The results of meta-analysis showed that the ddNACT regimen could improve the pathological complete response rate (pCR, P<0.001), objective response rate (ORR, P<0.001), and disease free survival (DFS, P=0.037) as compared with the cNACT regimen, there was no significant difference in the overall survival (OS) between the two groups (P=0.098). The incidences of grade 3 or 4 oral stomatitis (P=0.005) and neurotoxicity (P<0.001) were higher and the incidence of grade 3 or 4 neutropenia was lower (P=0.025) in the patients with ddNACT regimen, there were no significant differences in grade 3 or 4 thrombocytopenia (P=0.152), grade 3 or 4 anemia (P=0.123), chemotherapy completion rate (P=0.161) and breast conservative surgery rate (P=0.186) between the two groups. Patients with hormone receptor (HR) negative (HR–) were more likely to get pCR after neoadjuvant chemotherapy (P<0.001). ConclusionsCurrent evidence shows that the use of anthracycline/taxane-based ddNACT regimen in LABC patients can improve the pCR, ORR, and DFS as compared with cNACT regimen. The pCR after neoadjuvant chemotherapy in the patients with HR– is higher than that with HR+. Prophylactic use of granulocyte-colony stimulating factor could significantly reduce the incidence of neutropenia, and most patients are tolerant to ddNACT regimen, 2 regimens have similar chemotherapy completion rates.