The role of adjuvant pelvic radiotherapy in rectal cancer with synchronous liver metastasis: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Synchronous liver metastases are detected in approximately 25% of colorectal cancer patients at diagnosis. The rates of local failure and distant metastasis are substantial in these patients, even after undergoing aggressive treatments including resection of primary and metastatic liver tumors. The purpose of this study was to determine whether adjuvant pelvic radiotherapy is beneficial for pelvic control and overall survival in rectal cancer patients with synchronous liver metastasis after primary tumor resection.</p> <p>Methods</p> <p>Among rectal cancer patients who received total mesorectal excision (TME) between 1997 and 2006 at Yonsei University Health System, eighty-nine patients diagnosed with synchronous liver metastasis were reviewed. Twenty-seven patients received adjuvant pelvic RT (group S + R), and sixty-two patients were managed without RT (group S). Thirty-six patients (58%) in group S and twenty patients (74%) in group S+R received local treatment for liver metastasis. Failure patterns and survival outcomes were analyzed.</p> <p>Results</p> <p>Pelvic failure was observed in twenty-five patients; twenty-one patients in group S (34%), and four patients in group S+R (15%) (<it>p </it>= 0.066). The two-year pelvic failure-free survival rates (PFFS) of group S and group S+R were 64.8% and 80.8% (<it>p </it>= 0.028), respectively, and the two-year overall survival rates (OS) were 49.1% and 70.4% (<it>p </it>= 0.116), respectively. In a subgroup analysis of fifty-six patients who received local treatment for liver metastasis, the two-year PFFS were 64.9% and 82.9% (<it>p </it>= 0.05), respectively; the two-year OS were 74.1% and 80.0% (<it>p </it>= 0.616) in group S (n = 36) and group S+R (n = 20), respectively.</p> <p>Conclusions</p> <p>Adjuvant pelvic RT significantly reduced the pelvic failure rate but its influence on overall survival was unclear. Rectal cancer patients with synchronous liver metastasis may benefit from adjuvant pelvic RT through an increased pelvic control rate and improved quality of life.</p

Assessment of the APCC Coupled MME Suite in Predicting the Distinctive Climate Impacts of Two Flavors of ENSO during Boreal Winter

Forecast skill of the APEC Climate Center (APCC) Multi-Model Ensemble (MME) seasonal forecast system in predicting two main types of El Nino-Southern Oscillation (ENSO), namely canonical (or cold tongue) and Modoki ENSO, and their regional climate impacts is assessed for boreal winter. The APCC MME is constructed by simple composite of ensemble forecasts from five independent coupled ocean-atmosphere climate models. Based on a hindcast set targeting boreal winter prediction for the period 19822004, we show that the MME can predict and discern the important differences in the patterns of tropical Pacific sea surface temperature anomaly between the canonical and Modoki ENSO one and four month ahead. Importantly, the four month lead MME beats the persistent forecast. The MME reasonably predicts the distinct impacts of the canonical ENSO, including the strong winter monsoon rainfall over East Asia, the below normal rainfall and above normal temperature over Australia, the anomalously wet conditions across the south and cold conditions over the whole area of USA, and the anomalously dry conditions over South America. However, there are some limitations in capturing its regional impacts, especially, over Australasia and tropical South America at a lead time of one and four months. Nonetheless, forecast skills for rainfall and temperature over East Asia and North America during ENSO Modoki are comparable to or slightly higher than those during canonical ENSO events

Benefits of Recurrent Colonic Stent Insertion in a Patient with Advanced Gastric Cancer with Carcinomatosis Causing Colonic Obstruction

Malignant obstruction develops frequently in advanced gastric cancer. Although it is primarily the gastric outlet that is obstructed, there are occasional reports of colonic obstruction. Treating intestinal obstruction usually requires emergency surgery or stent insertion. There are several kinds of complications with stent insertion, such as bowel perforation, stent migration, bleeding, abdominal pain and reobstruction. Nevertheless, endoscopic stent insertion could be a better treatment than emergency surgery in cases of malignant bowel obstruction in cancer patients with poor performance status. We report a case of advanced gastric cancer with carcinomatosis in which a recurrent colonic stent was inserted at the same site because of cancer growth into the stent. The patient maintained a good condition for chemotherapy, thus improving their chances for survival

Hypofractionated High-Dose Intensity-Modulated Radiotherapy (60 Gy at 2.5 Gy per Fraction) for Recurrent Renal Cell Carcinoma: A Case Report

A patient with renal cell carcinoma (RCC) developed synchronous bone metastasis with metachronous relapses to the bone and renal fossa. The primary lesion was initially removed surgically, and the metastatic bone lesions and locally recurrent tumours were treated by a high-fractional dose and high-total-dose intensity-modulated radiotherapy (IMRT, 60 Gy at 2.5 Gy per fraction) without significant side effects. All the grossly relapsed tumors underwent complete remission (CR) within a short time after IMRT. To date, CR has been maintained for more than two years. This case study reports the successful treatment of radioresistant RCC using a new scheme that involves a fractionation regimen with a high precision radiotherapy

Extracellular High-Mobility Group Box 1 is Increased in Patients with Behçet's Disease with Intestinal Involvement

High-mobility group box 1 (HMGB1) protein has been demonstrated to play an important role in chronic inflammatory diseases including rheumatoid arthritis, and systemic lupus erythematosus. This study investigated the association between extracellular HMGB1 expression and disease activity, and clinical features of Behçet's disease (BD). Extracellular HMGB1 expression in the sera of 42 BD patients was measured and was compared to that of 22 age- and sex-matched healthy controls. HMGB1 expression was significantly increased in BD patients compared to healthy controls (78.70 ± 20.22 vs 10.79 ± 1.90 ng/mL, P = 0.002). In addition, HMGB1 expression was significantly elevated in BD patients with intestinal involvement compared to those without (179.61 ± 67.95 vs 61.89 ± 19.81 ng/mL, P = 0.04). No significant association was observed between HMGB1 concentration and other clinical manifestations, or disease activity. It is suggested that extracellular HMGB1 may play an important role in the pathogenesis of BD

Two Dosages of Oral Fluoropyrimidine S-1 of 35 and 40 mg/m2 bid: Comparison of the Pharmacokinetic Profiles in Korean Patients with Advanced Gastric Cancer

Objective: In this study, we compared the pharmacokinetic profiles of 5-fluorouracil (5-FU), tegafur, 5-chloro-2,4-dihydroxypyridine (CDHP) and potassium oxonate (Oxo) after adminis-tration of S-1 at 35 or 40 mg/m2 bid for 28 consecutive days, in Cycles 1 and 3, in patients with advanced gastric cancer. Methods: Three patients were enrolled for each dosage. S-1 dosage was assigned based on body surface area (BSA), which is different from the Japanese dosing system. The median daily dose per BSA was 76 mg/m2, ranging from 70 to 88 mg/m2. Results: Plasma levels of 5-FU, tegafur, CDHP and Oxo at 4 h post-dose reached steady-state on day 8. The estimated steady-state level was dependent on S-1 dosage. There were no intercyclic differences of pre-dose and 4 h post-dose levels between Cycles 1 and 3, implying no cumulative effect of S-1 was shown probably due to 2-week drug-resting period. Pharmacokinetic profiles on day 28 were similar to previous Japanese report. Cmax and AUC0–48h values of each S-1 component increased depending on S-1 dosage. Pharmacokinetic parameters were not correlated with tumor response or toxicity. Conclusions: We suggest that these pharmacokinetic profiles of Asian population could provide a basis for schedule optimization and for additional studies on interaction with other antitumor drugs. Key words: S-1 – gastric cancer – pharmacokinetics – Asian populatio

Clinicopathologic Features of Metachronous or Synchronous Gastric Cancer Patients with Three or More Primary Sites

PURPOSE: We investigated the clinicopathologic information of patients with gastric cancer with multiple primary cancers (GC-MPC) of three or more sites. MATERIALS AND METHODS: Between 1995 and 2009, 105,908 patients were diagnosed with malignancy at Severance Hospital, Yonsei University Health System. Of these, 113 (0.1%) patients with MPC of three or more sites were registered, and 41 (36.3%) of these were GC-MPC. We retrospectively reviewed the clinical data and overall survival using the medical records of these 41 GC-MPC patients. We defined synchronous cancers as those occurring within 6 months of the first primary cancer, while metachronous cancers were defined as those occurring more than 6 months later. RESULTS: Patients with metachronous GC-MPC were more likely to be female (p=0.003) and young than patients with synchronous GC-MPC (p=0.013). The most common cancer sites for metachronous GC-MPC patients were the colorectum, thyroid, lung, kidney and breast, while those for synchronous GC-MPC were the head and neck, esophagus, lung, and kidney. Metachronous GC-MPC demonstrated significantly better overall survival than synchronous GC-MPC, with median overall survival durations of 4.7 and 14.8 years, respectively, and 10-year overall survival rates of 48.2% and 80.7%, respectively (p<0.001). CONCLUSION: Multiplicity of primary malignancies itself does not seem to indicate a poor prognosis. The early detection of additional primary malignancies will enable proper management with curative intentope

Normative Values and Correlates of Mean Common Carotid Intima-Media Thickness in the Korean Rural Middle-aged Population: The Atherosclerosis RIsk of Rural Areas iN Korea General Population (ARIRANG) Study

Carotid intima-media thickness (CIMT) is considered as a surrogate marker for cardiovascular disease (CVD). We determined the normative value of CIMT and correlates of CVD risk factors and Framingham risk score (FRS) in Korean rural middle-aged population. We measured CIMT with a B-mode ultrasonography in 1,759 subjects, aged 40 to 70 yr, in a population-based cohort in Korea. A healthy reference sample (n = 433) without CVD, normal weight and normal metabolic parameters was selected to establish normative CIMT values. Correlates between CIMT and conventional CVD risk factors were assessed in the entire population. Mean values of CIMT (in mm) for healthy reference sample aged 40-49, 50-59, and 60-70 yr were 0.55, 0.59, and 0.66 for men and 0.48, 0.55, and 0.63 for women, respectively. In multivariate regression analysis, CIMT was correlated with older age, higher BMI, male gender, higher LDL-cholesterol level and history of diabetes mellitus. The mean CIMT was also correlated with FRS in both gender (r2 = 0.043, P < 0.01 for men; r2 = 0.142, P < 0.01 for women). We identified normative value of CIMT for the healthy Korean rural middle-aged population. The CIMT is associated with age, obesity, gender, LDL-cholesterol, diabetes mellitus and FRS

Climatic yield potential of Japonica???type rice in the Korean Peninsula under RCP scenarios using the ensemble of multi???GCM and multi???RCM chains

Rice production in the Korean Peninsula (KP) in the near future (2021-2050) is analysed in terms of the climatic yield potential (CYP) index for Japonica-type rice. Data obtained from the dynamically downscaled daily temperature and sunshine duration for the Historical period (1981-2010) and near future under two Representative Concentration Pathway (RCP4.5 and RCP8.5) scenarios are utilized. To reduce uncertainties that might be induced by using a Coupled General Circulation Model (CGCM)-a Regional Climate Model (RCM) chain in dynamical downscaling, two CGCM-three RCM chains are used to estimate the CYP index. The results show that the mean rice production decreases, mainly due to the increase of the temperature during the grain-filling period (40 days after the heading date). According to multi model ensemble, the optimum heading date in the near future will be approximately 12 days later and the maximum CYP will be even higher than in the Historical. This implies that the rice production is projected to decrease if the heading date is selected based on the optimum heading date of Historical, but to increase if based on that of near future. The mean rice production during the period of ripening is projected to decrease (to about 95% (RCP4.5) and 93% (RCP8.5) of the Historical) in the western and southern regions of the KP, but to increase (to about 104% (RCP4.5) and 106% (RCP8.5) of the Historical) in the northeastern coastal regions of the KP. However, if the optimum heading date is selected in the near future climate, the peak rice production is projected to increase (to about 105% (RCP4.5) and 104% (RCP8.5) of the Historical) in the western, southern and northeastern coastal regions of the KP, but to decrease (to about 98% (RCP4.5) and 96% (RCP8.5) of the Historical) in the southeastern coastal regions of the KP