Peihong Wu

A new, preoperative, MRI-based scoring system for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer.

OBJECTIVEnMalignant axillary lymph nodes are an important predictor for breast cancer recurrence, but invasive dissection or biopsy is required for the diagnosis. We determined whether and how malignant nodes could be diagnosed preoperatively with magnetic resonance (MR) imaging.nnnMATERIALS AND METHODSnWe obtained MR images of all women evaluated for breast cancer at the Sun Yat-Sen University Cancer Center in 2010 and correlated the image characteristics of each axillary node with the pathologic diagnosis of the same node.nnnRESULTSnWe analyzed 251 nodes (117 benign; 134 malignant) from 136 women (mean age, 44 years; range, 20-67). Mean diameter of the nodes was 18 mm (range, 5-58 mm). With pathologic diagnosis as the reference standard, MRI-based interpretations were 66.4% sensitive, 94% specific, and 79% accurate. Diameter, pathologic type, apparent diffusion coefficient value (ADC, b=500 and 800), time-intensity curve (TIC) type of breast tumors correlated with node metastasis; ADC value (b=500 and 800), TIC type, early enhancement rate, long-axis, short-axis, shape, margin and the location of nodes correlated with node metastasis (P<0.001 for all). Tumor immunohistochemistry results for estrogen receptors, progesterone receptors, c-erbB-2, vascular endothelial growth factor, and Ki67 were not. An MRI-based lymph node scoring system based on these correlations had a specificity of 91%, a sensitivity of 93%, and an area under the ROC curve of 0.95 (P<0.001).nnnCONCLUSIONnMetastatic axillary lymph nodes can be accurately diagnosed by MR in women with early breast cancer preoperatively and non-invasively. The scoring system appears to be superior to current methods.

Subdividing the M1 stage of liver metastasis for nasopharyngeal carcinoma to better predict metastatic survival

In nasopharyngeal carcinoma (NPC), the M1 stage of the TNM classification does not differentiate between the site of metastasis or the number of metastatic lesions. However, NPC patients with lung or bone metastases survive longer than do those with liver metastasis (LM). We subdivided the M1 stage of LM to better predict survival in these patients. From the records of 305 NPC patients with LM treated at Sun Yat-sen University Cancer Center between January 2000 and December 2007, we determined the effects of clinical characteristics and the subclassifications of the M1 stage for LM characteristics [the number, size, timing (synchronous vs. metachronous), and distribution of metastases and metastases to other organs] on survival since the diagnosis of LM. Metastatic survival rates were 62% at 1xa0year, 31% at 2xa0years, and 21% at 3xa0years. Having 1–3 metastatic lesions, having lesions less than 5xa0cm in diameter, and having unilobular LM were better univariate predictors of metastatic survival. Better survival was independently predicted by having one to three (vs. more than three) metastatic lesions (hazards ratioxa0=xa00.52; 95% CIxa0=xa00.33–0.82) and unilobular (vs. bilobular) lesions (hazards ratioxa0=xa00.35; 95% CIxa0=xa00.22–0.57). The current report constitutes large samples of LM from NPC from our single institution with correlation between LM characteristics and metastatic survival. Patients with NPC and one to three liver metastases or unilobular metastases survive longer than their counterparts, and aggressive treatment should be considered.

CT-guided 125I brachytherapy for mediastinal metastatic lymph nodes recurrence from esophageal carcinoma: Effectiveness and safety in 16 patients

OBJECTIVESnTo retrospectively evaluate effectiveness and safety of CT-guided (125)I brachytherapy in 16 patients with mediastinal metastatic lymph nodes recurrence from esophageal carcinoma.nnnMATERIALS AND METHODSnSixteen metastatic lymph nodes in 16 patients were percutaneously treated in 19 (125)I brachytherapy sessions. Each metastatic lymph node was treated with computed tomographic (CT) guidance. Follow-up contrast material-enhanced CT or positron emission tomographic (PET) scans were reviewed and the treatments effectiveness was evaluated.nnnRESULTSnMonths are counted from the first time of (125)I brachytherapy and the median duration of follow-up was 11 months (range, 5-16 months). The local control rates after 3, 6, 10 and 15 months were 75.0, 50.0, 42.9 and 33.3% respectively. At the time of writing, four patients are alive without evidence of recurrence at 16, 9, 16 and 9 months. The 4 patients presented good control of local tumor and no systemic recurrence, and survived throughout the follow-up period. The other 12 patients died of multiple hematogenous metastases 5-15 months after brachytherapy. A small amount of local hematoma occurred in 2 patients that involved applicator insertion through the lung. Two patients presented pneumothorax with pulmonary compression of 30 and 40% after the procedure and recovered after drainage. One patient had minor displacement of radioactive seeds. Severe complications such as massive bleeding and radiation pneumonitis did not occur.nnnCONCLUSIONn(125)I radioactive seed implantation is effective and may be safely applied to mediastinal metastatic lymph nodes recurrence from esophageal carcinoma.

CT-guided radiofrequency ablation prolonged metastatic survival in patients with liver metastases from nasopharyngeal carcinoma

Purpose: The aim of this retrospective study was to evaluate the technical efficacy and survival following CT-guided radiofrequency ablation (RFA) of liver metastases (LM) from nasopharyngeal carcinoma (NPC) and to determine prognostic factors. Materials and methods: Between 2000 and 2008, 376 patients with LM from NPC were identified. Of these 17 patients with 31u2009LM from NPC underwent CT-guided percutaneous RFA. We assessed the technical effectiveness, complications and prognostic value of LM characteristics including timing (synchronous versus metachronous), number, size, presence of extra hepatic metastases and treatment regimen. Survival rates were calculated using the Kaplan–Meier method. Results: Technical success was achieved in 30/31 metastases (96.7%). The median overall survival was 16.5 months from the time of diagnosis of LM for all the 376 NPC patients with LM, and 48.1 months for the 17 NPC patients with LM who received RFA treatment. Of the 376 patients, 111 had 1–3u2009LM who did not receive RFA treatment, with a median survival of 25.9 months compared to 48.1 months for the 14 patients with 1–3 LM who received RFA. Conclusion: CT-guided RFA of LM from NPC can be performed with a high degree of technical effectiveness and offers the promise of improved survival in selected patients.

Safety and efficacy of transarterial chemoembolization plus sorafenib for hepatocellular carcinoma with portal venous tumour thrombus.

AIMnTo evaluate the safety and efficacy of combined therapy with transarterial chemoembolization (TACE) and sorafenib for hepatocellular carcinoma (HCC) with portal venous tumour thrombus (PVTT).nnnMATERIALS AND METHODSnThis study was approved by the institutional review board. From May 2009 to May 2012, 170 consecutive patients were newly diagnosed with advanced-stage HCC and treated with TACE plus sorafenib. Among them, 41 patients with PVTT were retrospectively enrolled in the study. The adverse events (AEs), overall survival (OS), time to progression (TTP), and prognostic factors were analysed. Statistical analysis was performed with the Kaplan-Meier method using the log-rank test and Cox regression models.nnnRESULTSnThe most common AEs were hand-foot skin reaction related to sorafenib and fever related to TACE. Procedure-related mortality and grade 4 AEs were not observed. Grade 3 AEs were observed in five patients. During the median follow-up period of 13.5 months (range 1.4-45 months), the 6-month and 1-year survival rates were 87.7% and 53.6%, respectively. The median OS was 13 months (range 1.4-44.8 months), and the median TTP was 7 months (range 1-18.6 months). The Child-Pugh class (p = 0.022), extrahepatic metastasis (p = 0.009), and gross morphological type (nodular type versus diffuse type; p = 0.008) were prognostic factors related to OS in the multivariate analysis.nnnCONCLUSIONnTACE plus sorafenib in an interrupted therapeutic scheme was well tolerated and might improve OS for HCC patients with PVTT, especially in those with Child-Pugh class A, no extrahepatic metastasis, or nodular-type HCC.

Percutaneous CT-Guided Radiofrequency Ablation as Supplemental Therapy After Systemic Chemotherapy for Selected Advanced Non–Small Cell Lung Cancers

OBJECTIVEnThe purpose of this study is to evaluate the safety and efficacy of percutaneous CT-guided radiofrequency ablation (RFA) as a supplemental therapy after systemic chemotherapy for selected patients with advanced non-small cell lung cancer (NSCLC).nnnMATERIALS AND METHODSnWe retrospectively reviewed the medical records of 220 patients with advanced NSCLC who were treated with platinum-doublet chemotherapy between January 2000 and January 2012. Among them, 49 patients underwent RFA as a supplemental therapy for tumors in partial response or stable diseases after first-line chemotherapy. The progression-free survival (PFS) was evaluated by Kaplan-Meier method.nnnRESULTSnThere were nine women and 40 men (median age, 60 years; range, 24-82 years), including 28 patients with stage IIIb cancer and 21 with stage IV cancer. All 49 patients (partial response, 23 patients; stable disease, 26 patients) underwent 67 RFA sessions for 61 targeted tumors after systemic chemotherapy. There were no procedure-related deaths. Pneumothorax requiring chest tubes developed in eight sessions (11.9%). Thirty-one patients (63.3%) had complete response, 12 patients (24.5%) had partial response, six patients (12.2%) had stable disease, and no patients had progressive disease. The median follow-up period was 19 months (range, 6-34), and the median PFS was 16 weeks (95% CI, 14.5-17.5).nnnCONCLUSIONnPercutaneous CT-guided RFA can be performed as a feasible minimally invasive supplemental therapy with satisfactory PFS after systemic chemotherapy for patients with advanced NSCLC.

Clinical value of whole-body F-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with carcinoma of unknown primary.

The purpose of the study is to investigate the clinical value of F‐18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in detecting the primary sites in patients with carcinoma of unknown primary (CUP).

Percutaneous CT-guided radiofrequency ablation for unresectable hepatocellular carcinoma pulmonary metastases

Purpose: This study aimed to evaluate the safety and efficacy of percutaneous CT-guided radiofrequency ablation (RFA) for unresectable hepatocellular carcinoma pulmonary metastases (HCCPM) and to identify the prognostic factors for survival. Materials and methods: We reviewed the medical records of 320 patients with HCCPM treated between January 2005 and January 2012. Among them, 29 patients with 68 lesions of unresectable HCCPM underwent 56 RFA sessions. Safety, local efficacy, survival and prognostic factors were evaluated. Survival was analysed using the Kaplan-Meier method. Univariate analyses were evaluated by the log-rank test. Results: Pneumothorax requiring chest tube placement occurred in five (8.9%, 5/56) RFA sessions. During the median follow-up period of 23 months (range 6–70), 18 patients (62.1%, 18/29) died of tumour progression and 11 (37.9%, 11/29) were alive. The 1-, 2- and 3-year overall survival rates were 73.4%, 41.1% and 30%, respectively. The median progression-free survival was 18 months (95% confidence interval (CI) 9.8–26.2) and the median overall survival time was 21 months (95%CI, 9.7–32.3). The maximum tumour diameter ≤3u2009cm (pu2009=u20090.002), the number of pulmonary metastases ≤3 (pu2009=u20090.014), serum AFP level ≤400u2009ng/mL (pu2009=u20090.003), and the controlled status of intrahepatic tumour after lung RFA (pu2009=u20090.001) were favourable prognostic factors for overall survival. Conclusions: Our study indicates that percutaneous CT-guided RFA, as an alternative treatment procedure to pulmonary metastasectomy, can be a safe and effective therapeutic option for unresectable HCCPM.

Radiofrequency Ablation of Retroperitoneal Metastatic Lymph Nodes from Hepatocellular Carcinoma

RATIONALE AND OBJECTIVESnTo retrospectively evaluate effectiveness and safety of radiofrequency (RF) ablation with retroperitoneal metastatic lymph nodes from hepatocellular carcinoma (HCC).nnnMATERIALS AND METHODSnThirty-two patients with retroperitoneal metastatic lymph node recurrence from HCC were enrolled in our study and the patients stratified into two groups based on the treatment. Nineteen patients in Group A were percutaneously treated and each metastatic lymph node was ablated with computed tomographic (CT) guidance. Thirteen patients in Group B only underwent RF ablation for hematogenous metastases, but did not undergo RF ablation or any other treatment for metastatic lymph nodes. Follow-up contrast material-enhanced CT or positron emission tomographic scans were reviewed and Kaplan-Meier survival estimates were analyzed.nnnRESULTSnThere were no significant differences between characteristics of the two groups. Kaplan-Meier analysis indicated the patients of Group A had an overall survival of 26.3% at 1 year compared with 7.7% for those of Group B. Mantel-Cox log rank test showed the 1-year survival rate of Group A was significantly higher than that of Group B (P = .029). In Group A, the local control rate of 3, 6, 10, and 15 months was 78.9%, 73.3%, 41.7%, and 25.0%, respectively. Sixteen, 12, 6, and 2 patients showed no evidence of local progression for 3, 6, 10, and 15 months, respectively. There was no thermal injury of gastrointestinal tract or bile duct during RF ablation in all the 19 patients of Group A.nnnCONCLUSIONnRF ablation is effective and may be safely applied to retroperitoneal metastatic lymph nodes from HCC.

M1 Stage Subdivision and Treatment Outcome of Patients With Bone-Only Metastasis of Nasopharyngeal Carcinoma

BACKGROUNDnThe current M1 stage in nasopharyngeal carcinoma (NPC) does not differentiate patients based on metastatic site and number of metastases. This study aims to subdivide the M1 stage of NPC patients with bone-only metastases and to identify the patients who may benefit from combined chemoradiotherapy (CRT).nnnMETHODSnBetween 1998 and 2007, 312 patients diagnosed with bone-only metastasis at Sun Yat-sen University Cancer Center were enrolled. Various possible subdivisions of M1 stage were considered, including by the time order of metastasis (synchronous vs. metachronous), involvement of specific bone metastatic site, the number of metastatic sites, and the number of metastases. The correlation of the subdivisions of M1 stage with overall survival (OS) was determined by Cox regression.nnnRESULTSnThe median OS was 23.4 months. Patients with more than three metastatic sites had significantly poorer OS than patients with three or fewer metastatic sites (16.2 vs. 32.4 months; p < .001). Metastasis to the spine was significantly associated with unfavorable OS (20.4 vs. 37.9 months; p < .001). Multivariate analysis showed that number of metastatic sites (more than three vs. three or fewer), spine involvement (present vs. absent), and treatment modality (CRT vs. chemotherapy or radiotherapy only) were independent prognostic factors for OS. In stratified analysis, compared with chemotherapy or radiotherapy alone, combined chemoradiotherapy could significantly benefit the patients with single bone metastasis (hazard ratio: 0.21; 95% confidence interval: 0.09-0.50).nnnCONCLUSIONnMetastasis to the spine and having more than three bone metastatic sites are independent unfavorable predictors for OS in NPC patients with bone-only metastasis. Combined chemoradiotherapy should be considered for patients with single bone metastasis.