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1رسالة جامعية
المؤلفون: Nakamura, Kenichi, 中村, 健一, ナカムラ, ケンイチ
المساهمون: 羽賀, 博典, 妹尾, 浩, 戸井, 雅和
مصطلحات موضوعية: gastric cancer, pathological response, response rate, Preoperative chemotherapy
وصف الملف: application/pdf; text/html
Degree: 博士(医学) -- Doctor of Medical Science -- 京都大学
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2رسالة جامعية
المؤلفون: Eriksson, Sam
المصدر: Lund University, Faculty of Medicine Doctoral Dissertation Series; (2021:106) (2021) ; ISSN: 1652-8220
مصطلحات موضوعية: Surgery, Colorectal liver metastases, Preoperative chemotherapy, Liver resection, Hepatic microcirculation, Sarcopenia
الوصف: Background Colorectal cancer is a leading cause of cancer related death worldwide. 20-30 % of patients will develop colorectal liver metastases (CRLMs). Surgical resection is the mainstay of treatment for CRLMs, and is often combined with perioperative chemotherapy, which can prolong progression-free survival after resection. Moreover, observation of CRLMs response to preoperative chemotherapy can help to identify patients with progressive disease, which allows for treatment adjustment. However, preoperative chemotherapy can induce liver parenchymal injury, which can negatively affect surgical outcome and be difficult to detect in the preoperative setting. In addition, a worse surgical outcome has also been reported in patients with low preoperative muscle mass. Little is known about whether preoperative chemotherapy worsens skeletal muscle depletion.AimsTo investigate effects of preoperative chemotherapy on the liver and preoperative muscle mass in patients undergoing liver resection for CRLMs, and to investigate whether diffusion-weighted magnetic resonance imaging (MRI) can be used to assess response in CRLMs to preoperative chemotherapy. Patients and methodsIn study I, liver volume measurements were conducted on pre- and postoperative computed tomography (CT) or MRI images in 74 patients who underwent major liver resections for CRLMs. In study II, intraoperative measurement of liver microcirculation was performed using sidestream dark-field imaging in 40 patients before and after liver resection. In study III, liver and spleen elastography was performed in 35 patients before and after liver resection. In study IV, measurement of skeletal muscle mass was carried out on pre- and posttreatment CT images in 97 patients undergoing neoadjuvant chemotherapy for CRLMs. In study V, measurements of the apparent diffusion coefficient (ADC) on pre- and postchemotherapy diffusion-weighted MRI in 49 CRLMs in 27 patients were conducted and compared to the metastases’ pathological chemotherapy response. Results and ...
وصف الملف: application/pdf
العلاقة: https://lup.lub.lu.se/record/8069af4b-0a02-45c9-9459-8807e118da45Test; urn:isbn:978-91-8021-113-0; https://portal.research.lu.se/files/103131770/Avhandling_Sam_Eriksson.pdfTest
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3رسالة جامعية
المؤلفون: Arredondo, J. (Jorge)
الملخص: Purpose Neoadjuvant chemotherapy is being actively tested as an emerging alternative for the treatment of locally advanced colon cancer (LACC) patients, resembling its use in other gastrointestinal tumors. This study assesses the mid-term oncologic outcome of LACC patients treated with oxaliplatin and fluoropyrimidines-based preoperative chemotherapy followed by surgery. Methods and patients Patients with radiologically resectable LACC treated with neoadjuvant therapy between 2009 and 2014 were retrospectively analyzed. Radiological, metabolic, and pathological tumor response was assessed. Both postoperative complications, relapse-free survival (RFS), and overall survival (OS) were studied. Results Sixty-five LACC patients who received treatment were included. Planned treatment was completed by 93.8 % of patients. All patients underwent surgery without delay. The median time between the start of chemotherapy and surgery was 71 days (65–82). No progressive disease was observed during preoperative treatment. A statistically significant tumor volume reduction of 62.5 % was achieved by CT scan (39.8–79.8) (p < 0.001). It was also observed a median reduction of 40.5 % (24.2–63.7 %) (p < 0.005) of SUVmax (Standard Uptake Value) by PET-CT scan. Complete pathologic response was achieved in 4.6 % of patients. Postoperative complications were observed in 15.4 % of patients, with no cases of mortality. After a median follow-up of 40.1 months, (p 25–p 75: 27.3–57.8) 3–5 year actuarial RFS was 88.9–85.6 %, respectively. Five-year actuarial OS was 95.3 %. Conclusion Preoperative chemotherapy in LACC patients is safe and able to induce major tumor regression. Survival times are encouraging, and further research seems warranted.
