Clinical Cancer Bulletin

Expert Guidance on the Overall Management of Liver Cancer During the COVID-19 Pandemic

Huichuan SUN, Xinrong YANG, Zhiping YAN, Zhenggang REN, Rong LIU, Lan ZHANG, Yang XU, Yifeng HE, Zihan ZHANG, Jia FAN, Jian ZHOU

2022, 1(2): 49-55. doi: 10.11910/j.issn.2791-3937.2022.20220011

[Abstract](338) [FullText HTML] (160) [PDF 1286KB](39)

Abstract:
The COVID-19 pandemic remains complex, with concentrated and sporadic cases in multiple locations. During COVID-19 outbreaks, the routine diagnosis and treatment of liver cancer patients can be affected to a significant degree. For liver oncologists, it is important to identify strategies and protocols to reduce the risk of COVID-19 infection among patients and medical staff, use limited medical resources to maximally ensure access to anti-tumor treatment and related emergency treatment, and provide support for patients during the disruption caused by the pandemic. Given this requirement, eleven experts in liver cancer treatment-related disciplines from Zhongshan Hospital, Fudan University have written the Expert Guidance on the Overall Management of Liver Cancer During the COVID-19 Pandemic, which aims to provide a reference to assist liver oncologists in conducting clinical work safely and effectively while implementing COVID-19 prevention and control strategies and offer guidance on supporting liver cancer patients during the pandemic.

¹⁸F-FDG PET/MR Imaging for Evaluating of Obstructive Jaundice: Chinese Expert Consensus

Lifang PANG, Yushen GU, Zhi YANG, Zhifang WU, Wei FAN, Xiaohua ZHU, Jun ZHAO, Changjiu ZHAO, Xuemei WANG, Yongju GAO, Li HUO, Yi MO, Meiyun WANG, Jie LU, Lingzhi HU, Zheng ZHANG, Feng WANG, Xuemei DU, Yue CHEN, Jianjun LIU, Zhaoping CHENG, Yunlong LOU, Shuzhan YAO, Rong XU, Sijin LI, Hongcheng SHI

2022, 1(2): 56-65. doi: 10.11910/j.issn.2791-3937.2022.20220014

[Abstract](166) [FullText HTML] (22) [PDF 7197KB](38)

Abstract:
The cause of obstructive jaundice is usually complex which renders its differential diagnosis and lesion localization challenging in clinical practice. Integrated Positron Emission tomography/Magnetic Resonance (PET/MR) offers complementary information from PET and MR in the diagnosis of obstructive jaundice and is becoming widely adopted in clinical setting. While preserving its diagnostic accuracy, it is important to standardize and streamline the clinical scan protocol of PET/MR in evaluating obstructive jaundice. Based on literature review and experience of large number of clinical cases from the author group, this article reports an expert consensus on imaging protocol optimization and case interpretation template standardization.

Nomogram to Predict Prognosis of Patients with Gastric Cancer after Radical Gastrectomy

Zhaorui LIU, Xiaona LIU, Wei XIE, Zhe YAN, Lu ZHAN, Ying LIU, Jiangbo HAN, Mingming NIE, Lei LIU, Hui CAI, Kai YIN

2022, 1(2): 66-80. doi: 10.11910/j.issn.2791-3937.2022.20220017

[Abstract](215) [FullText HTML] (103) [PDF 1704KB](24)

Abstract:
Objective To establish an effective prognostic nomogram for patients with gastric cancer after radical gastrectomy. Methods In the present study, we retrospectively analyzed the records of 1635 patients with gastric cancer treated at Changhai Hospital from January 2014 to December 2019. Final independent prognostic factors of overall survival to build a nomogram were screened using univariate and multivariate analyses. The predictive accuracy and discriminating ability of the nomogram were determined using the concordance index (C-index) and calibration curves. The results were validated using bootstrap resampling of 701 patients. The survival curves for low-, middle-, and high-risk patients were used to evaluate the accuracy of the nomogram. Results Multivariate analysis of the primary cohort revealed independent factors for survival as follows: age, sex, body mass index (BMI), depth of tumor invasion (T), lymph node metastasis (N), perineural invasion (PNI), tumor deposits, Alpha fetoprotein (AFP), and lactate dehydrogenase (LDH). Combining these predictors in the nomogram achieved powerful prognostic ability in the training and test sets. The C-index of the training set was 0.772 (95% CI, 0.748 to 0.796) compared with the C-index values of the AJCC 8^th (0.718), T (0.683), N (0.726) and that of the testing set (0.726 [95% CI, 0.684 to 0.767]), which were significant higher than the C-index values of the TNM system. The calibration curve for probability of survival showed good consistency between predictions made using nomogram compared with actual observations. The survival curves showed significant differences between- high, middle-, and low-risk groups. Conclusion We constructed a more accurate and comprehensive nomogram to predict the prognosis of gastric cancer after surgery, which may serve as a potential tool to guide personalized treatment.

Modern Radiotherapy in the Multidisciplinary Management of Common Cancers

Shisuo DU, Yixing CHEN, Qian ZHANG, Jing SUN, Guifen MA, Jian WANG, Xian ZHANG, Taiwei SUN, Yang ZHANG, Jianying ZHANG, Qiqiao WU, Zhaochong ZENG

2022, 1(2): 81-94. doi: 10.11910/j.issn.2791-3937.2022.20220006

[Abstract](590) [FullText HTML] (275) [PDF 1400KB](43)

Abstract:
Radiotherapy (RT) is an indispensable treatment for nearly all cancer types. Rapid evolution of technology has progressively increased the safely deliverable radiation dose, minimizing the exposure of uninvolved normal tissue and thus improving the efficacy, safety, and accessibility of radiation therapy. Meanwhile, multidisciplinary team management that aims to define personalized, optimal treatment strategies through shared decision-making between healthcare professionals and patients is a fundamental aspect of high-quality cancer diagnosis and treatment and often includes radiation oncology. How to combine this with other anti-tumor modalities, especially immunotherapy, in the era of modern RT has been increasingly emphasized. Here, in this review, we introduce the innovations in RT technology, and aim to provide an outline of the role of contemporary RT in the multidisciplinary treatment of most common cancers, including non-small cell lung cancer, esophageal cancer, breast cancer, hepatocellular carcinoma, gastric/esophageal-gastric junction cancer, and colorectal cancer, focusing on the main areas of innovation that are conducive to a change toward the personalized application of RT. We also discuss the future research directions for combination with modern RT.

Radiation-induced Oral Mucositis is a Critical Dilemma for Patients and Physicians During Radiotherapy for Nasopharyngeal Carcinoma

Zhifeng WU, Bingliang WANG, Xu ZHOU, Bei XU, Zhaochong ZENG

2022, 1(2): 95-99. doi: 10.11910/j.issn.2791-3937.2022.20220016

[Abstract](264) [FullText HTML] (128) [PDF 1271KB](35)

Abstract:
The combination of radiotherapy (RT) and chemotherapy is associated with a high cure rate but an increased risk of radiation-induced oral mucositis (RIOM) in patients with nasopharyngeal carcinoma (NPC). As a dose-limiting complication, RIOM remains a critical dilemma for patients and physicians, potentially leading to radiation interruptions and compromised tumor control. In this review, we discuss and analyze the pathological mechanisms and factors affecting prevention/treatment of RIOM. RT may induce RIOM via a positive feedback loop, consequently amplifying superoxide production, the immunoinflammatory response, dysbacteriosis, infection, and epithelial basal cell death. Routine interventions for RIOM focus on oral care, oral-pain relief, nutritional support, and infection control; however, recent novel and effective methods have been proposed according to the pathological mechanisms and influencing factors. Some patients with low-recurrence-risk NPCs may be treated with reduced-dose RT, reduced-dose chemotherapy, or RT alone (without chemotherapy) to prevent severe RIOM. Furthermore, traditional herbal medicine extracts, such as Kangfuxin and honey, may help to control RIOM. In addition to the routine application of antibiotics to treat oral dysbacteriosis and hormones to suppress immune inflammatory responses, edaravone and GC4419 can also be used to scavenge oxygen free radicals and reduce superoxide ions to protect the oral mucosa and limit the occurrence of RIOM.

Targeting Metabolism to Improve CAR-T Cell Immunotherapy

Xinlei HOU, Jian WANG

2022, 1(2): 100-106. doi: 10.11910/j.issn.2791-3937.2022.20220015

[Abstract](284) [FullText HTML] (133) [PDF 1813KB](24)

Abstract:
The transfer of genetically-engineered chimeric antigen receptor (CAR)-T cells has recently become one of the most promising approaches in the treatment of cancer. Like normal T cells, CAR-T cells are dependent on an adequate supply of nutrients and energy to be able to proliferate and mediate anti-tumor responses. However, CAR-T cell proliferation and cytotoxicity are limited by the elevated metabolic demands of actively dividing cancer cells, which deplete nutrients from the tumor microenvironment (TME). Thus, a variety of TME-imposed metabolic “barriers” must be overcome by artificially altering the metabolism of CAR-T cells to increase their clinical performance, especially in solid tumors. In this review, we summarize the metabolic interactions between T cells and the TME, discuss the metabolic reprogramming of T cells, present recent progress in the application of metabolic interventions in CAR-T cell therapy, and finally allude to future directions in this field.

Novel agents for multiple myeloma with extramedullary disease

Feifei CHEN, Aziguli MAIHEMAITI, Wenjing WANG, Peng LIU

2022, 1(2): 107-115. doi: 10.11910/j.issn.2791-3937.2022.20220013

[Abstract](298) [FullText HTML] (140) [PDF 1339KB](42)

Abstract:
Multiple myeloma (MM) is the second most common hematological malignancy. The introduction of proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs) greatly improved the outcomes for these patients. Extramedullary disease (EMD), an aggressive manifestation of MM, remains a significant treatment challenge. Recently, active clinical development of remarkable novel agents for MM with new mechanisms of action has begun. These agents show promising anti-MM effects and provide the opportunity to extend the survival of patients. They include next-generation PIs and IMiDs; monoclonal antibodies; chimeric antigen receptor T cells; antibody-drug conjugates; bispecific T cell engager antibodies; and small molecular inhibitors. However, few clinical trials have focused on patients with EMD, and the effectiveness of these agents has not been well evaluated and compared in these patients. In this review, we summarize the efficacy of these novel agents in MM patients with EMD.

Radiation-associated Angiosarcoma After Postoperative Adjuvant Radiotherapy for Cervical Cancer: A Case Report and Review of Published Reports

Yayu HUANG, Jing SUN, Genlai LIN, Guifen MA

2022, 1(2): 116-121. doi: 10.11910/j.issn.2791-3937.2022.20220009

[Abstract](218) [FullText HTML] (100) [PDF 5276KB](31)

Abstract:
Objective Radiation-associated angiosarcoma (RAAS) is rare. We present an unusual case of RAAS presenting only 1.5 years after radiotherapy for cervical cancer and review relevant published reports. Case report A 59-year-old woman with stage I B2 cervical cancer underwent radical hysterectomy and pelvic external beam radiation therapy. Seventeen months later, violaceous lesions began to appear, quickly covering her entire lower abdominal wall, perineum, and upper thighs. These lesions were accompanied by small nodules and ulceration. Immunohistochemistry revealed positive expression of CD31 and CD34. Genetic testing revealed MYC amplification. The patient was finally diagnosed with RAAS and treated with albumin-bound paclitaxel and bevacizumab. However, her condition deteriorated quickly and she died 7 months later. Conclusion This case illustrates the importance of extensive biopsy of skin lesions suspected of denoting RAAS as early as possible. Pathological examination for CD31, CD34, and MYC assists early establishment of the diagnosis.

September 25, 2022
2022 Vol. 1, No. 2

Contacts

September 25, 2022 2022 Vol. 1, No. 2

Contacts

September 25, 2022
2022 Vol. 1, No. 2