AIM:To investigate the efficacy of neoadjuvant chemoradiotherapy(NACRT) for resectability of locally advanced gastric cancer(LAGC).METHODS:Between November 2007 and January 2014,29 patients with LAGC(clinically T3 wit...AIM:To investigate the efficacy of neoadjuvant chemoradiotherapy(NACRT) for resectability of locally advanced gastric cancer(LAGC).METHODS:Between November 2007 and January 2014,29 patients with LAGC(clinically T3 with distal esophagus invasion/T4 or bulky regional node metastasis) that were treated with NACRT followed by D2 gastrectomy were included in this study.Resectability was evaluated with radiologic and endoscopic exams before and after NACRT.Using threedimensional conformal radiotherapy,patients received 45 Gy,with a daily dose of 1.8 Gy.The entire tumor extent and the regional metastatic lymph nodes were included in the gross tumor volume.Patients presenting with a resectable tumor after NACRT received a total or subtotal gastrectomy with D2 dissection.The pathologic tumor response was evaluated using Japanese Gastric Cancer Association histologic evaluation criteria.Postoperative morbidity was evaluated using the National Cancer Institute-Common Terminology Criteria for Adverse Events version 4.0.Overall survival(OS) and progression-free survival(PFS) rates were estimated using a Kaplan-Meier analysis and compared using the log-rank test.RESULTS:All patients were assessed as unresectable cases.Twenty-four patients(24/29; 82.8%) showed LAGC on positron emission tomography-computed tomography(CT) and contrast-enhanced CT,whereas four patients(4/29; 13.8%) with vague invasion orabutment to an adjacent organ underwent diagnostic laparoscopy.One patient(1/29; 3.4%),initially assessed as a resectable case,underwent an "open and closure" after the tumor was found to be unresectable.Abutment to an adjacent organ(34.5%) was the most common reason for NACRT.The clinical response rate one month after NACRT was 44.8%.After NACRT,69%(20/29) of patients had a resectable tumor.Of the 20 patients with a resectable tumor,18 patients(62.1%) underwent a D2 gastrectomy.The R0 resection rate was 94.4% and two patients(2/18; 11.1%) showed a complete response.The median follow-up duration was 13.5 mo.The one-year OS and PFS rates were 72.4 and 48.9%,respectively.The one-year OS,PFS,local failure-free survival,and distant metastasis-free survival were higher in patients with a resectable tumor after NACRT(P < 0.001,P < 0.001,P < 0.001,and P =0.078,respectively).No grade 3-4 late treatment-related toxicities or postoperative mortalities were observed.CONCLUSION:NACRT with D2 gastrectomy showed a high rate of R0 resection and promising local control,which may increase the R0 resection opportunity resulting in survival benefit.展开更多
To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. ...To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. METHODSTwenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; n = 25), computed tomography (CT) enterography (n = 21), magnetic resonance (MR) enterography (n = 2), and abdominopelvic CT (n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during follow-up period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTSThe main symptoms were abdominal pain (n = 12) and anemia (n = 10). All patients showed small bowel strictures (n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum (n = 47) or jejunum (n = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement (n = 48) that were also noted on initial SBS (n = 36) with shallow ulcers (n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on follow-up SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures. CONCLUSIONUnder characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.展开更多
Objective:The aim of this study is to develop a nomogram for prediction of pathologic complete remission(p CR)after preoperative chemoradiotherapy(CRT)for rectal cancer.Methods:m RNA expression levels of seven molecul...Objective:The aim of this study is to develop a nomogram for prediction of pathologic complete remission(p CR)after preoperative chemoradiotherapy(CRT)for rectal cancer.Methods:m RNA expression levels of seven molecular markers[p53,p21,Ki-67,vascular endothelial growth factor(VEGF),CD133,CD24,CD44]were measured by reverse transcriptase polymerase chain reaction(RTPCR)in 120 rectal cancers.Endoscopic findings of clinical complete remission(c CR)and biologic variables were used to construct nomogram in the training group(n=80),which was validated in the validation group(n=40).Results:m RNA expression levels of four markers(p53,p21,Ki67,CD133)correlated with p CR(24/80,30.0%)in the training group.Low expression of p53 and/or high expression of p21,Ki67 and CD133 showed greater p CR rate.p CR was shown in 18(69.2%)of 26 cases showing endoscopic c CR in the training group.Higher p CR rate was demonstrated in lower tumor location than middle tumor(19/49,38.8%vs.5/31,16.1%).A nomogram for prediction of p CR was developed from the multivariate prediction model using these six variables,which showed good discrimination ability in the training group[area under the curve(AUC)=0.945]and validation group(AUC=0.922).The calibration plot showed good agreement between actual and predicted p CR in both patient groups.Conclusions:Nomogram for assessment of p CR can be useful for making treatment decisions after CRT according to predicted responses.展开更多
文摘AIM:To investigate the efficacy of neoadjuvant chemoradiotherapy(NACRT) for resectability of locally advanced gastric cancer(LAGC).METHODS:Between November 2007 and January 2014,29 patients with LAGC(clinically T3 with distal esophagus invasion/T4 or bulky regional node metastasis) that were treated with NACRT followed by D2 gastrectomy were included in this study.Resectability was evaluated with radiologic and endoscopic exams before and after NACRT.Using threedimensional conformal radiotherapy,patients received 45 Gy,with a daily dose of 1.8 Gy.The entire tumor extent and the regional metastatic lymph nodes were included in the gross tumor volume.Patients presenting with a resectable tumor after NACRT received a total or subtotal gastrectomy with D2 dissection.The pathologic tumor response was evaluated using Japanese Gastric Cancer Association histologic evaluation criteria.Postoperative morbidity was evaluated using the National Cancer Institute-Common Terminology Criteria for Adverse Events version 4.0.Overall survival(OS) and progression-free survival(PFS) rates were estimated using a Kaplan-Meier analysis and compared using the log-rank test.RESULTS:All patients were assessed as unresectable cases.Twenty-four patients(24/29; 82.8%) showed LAGC on positron emission tomography-computed tomography(CT) and contrast-enhanced CT,whereas four patients(4/29; 13.8%) with vague invasion orabutment to an adjacent organ underwent diagnostic laparoscopy.One patient(1/29; 3.4%),initially assessed as a resectable case,underwent an "open and closure" after the tumor was found to be unresectable.Abutment to an adjacent organ(34.5%) was the most common reason for NACRT.The clinical response rate one month after NACRT was 44.8%.After NACRT,69%(20/29) of patients had a resectable tumor.Of the 20 patients with a resectable tumor,18 patients(62.1%) underwent a D2 gastrectomy.The R0 resection rate was 94.4% and two patients(2/18; 11.1%) showed a complete response.The median follow-up duration was 13.5 mo.The one-year OS and PFS rates were 72.4 and 48.9%,respectively.The one-year OS,PFS,local failure-free survival,and distant metastasis-free survival were higher in patients with a resectable tumor after NACRT(P < 0.001,P < 0.001,P < 0.001,and P =0.078,respectively).No grade 3-4 late treatment-related toxicities or postoperative mortalities were observed.CONCLUSION:NACRT with D2 gastrectomy showed a high rate of R0 resection and promising local control,which may increase the R0 resection opportunity resulting in survival benefit.
文摘To investigate the characteristic radiologic findings of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) which can be differentiated from other similar bowel disease and to assess their clinical behavior. METHODSTwenty pathologically and clinically confirmed CMUSE patients (males:females = 8:12; mean age: 40.4 years) between March 2002 and August 2015 from seven academic centers in South Korea were retrospectively reviewed. We evaluated small bowel series (SBS; n = 25), computed tomography (CT) enterography (n = 21), magnetic resonance (MR) enterography (n = 2), and abdominopelvic CT (n = 18) images, focusing on enteric and perienteric manifestations. Any change in radiologic features during follow-up period was recorded. We evaluated clinical data including presenting symptoms, laboratory finding and presence of relapse from electronic medical records. Histopathologic findings were also evaluated. RESULTSThe main symptoms were abdominal pain (n = 12) and anemia (n = 10). All patients showed small bowel strictures (n = 52, mean: 2.6 per patient) on initial CT/MR, located in the ileum (n = 47) or jejunum (n = 5). Strictures showed short-length (mean: 10.44 mm) and circumferential bowel wall thickening (mean: 5.56 mm) with layered enhancement (n = 48) that were also noted on initial SBS (n = 36) with shallow ulcers (n = 10). Some ulcerative lesions or wall thickening progressed into strictures on follow-up SBS/CT, and some strictures revealed recurrent ulceration on follow-up SBS. There were no penetrating disease features like fistula or abscess and no gastrointestinal tract involvement except the small bowel. Nine patients experienced disease recurrence (median relapse-free period: 32 mo) even post-operatively. Histopathologic features of surgically resected specimens were characterized as multiple superficial ulcerations confined to mucosa or submucosa and multiple strictures. CONCLUSIONUnder characteristic radiologic findings with multiple short-segmental strictures and/or shallow ulcers of the small intestine, CMUSE should be considered when assessing patients with recurrent abdominal pain and anemia.
基金supported by faculty research grant(No.62016-0060)from Yonsei University College of Medicine。
文摘Objective:The aim of this study is to develop a nomogram for prediction of pathologic complete remission(p CR)after preoperative chemoradiotherapy(CRT)for rectal cancer.Methods:m RNA expression levels of seven molecular markers[p53,p21,Ki-67,vascular endothelial growth factor(VEGF),CD133,CD24,CD44]were measured by reverse transcriptase polymerase chain reaction(RTPCR)in 120 rectal cancers.Endoscopic findings of clinical complete remission(c CR)and biologic variables were used to construct nomogram in the training group(n=80),which was validated in the validation group(n=40).Results:m RNA expression levels of four markers(p53,p21,Ki67,CD133)correlated with p CR(24/80,30.0%)in the training group.Low expression of p53 and/or high expression of p21,Ki67 and CD133 showed greater p CR rate.p CR was shown in 18(69.2%)of 26 cases showing endoscopic c CR in the training group.Higher p CR rate was demonstrated in lower tumor location than middle tumor(19/49,38.8%vs.5/31,16.1%).A nomogram for prediction of p CR was developed from the multivariate prediction model using these six variables,which showed good discrimination ability in the training group[area under the curve(AUC)=0.945]and validation group(AUC=0.922).The calibration plot showed good agreement between actual and predicted p CR in both patient groups.Conclusions:Nomogram for assessment of p CR can be useful for making treatment decisions after CRT according to predicted responses.
