All 62 patients underwent the SCRT, and each completed at least five cycles of ToriCAPOX; 52 of the 62 patients (83.9%) completed six cycles. Among the patient cohort, a complete clinical remission (cCR) was observed in 29 individuals (468%, 29 of 62), with 18 choosing to pursue a wait-and-watch strategy. A total of 32 patients experienced TME. Pathological review confirmed that 18 samples demonstrated pCR, 4 demonstrated TRG 1, and 10 demonstrated TRG 2-3. The complete clinical remission was observed in each of the three MSI-H patients. Post-surgery, one patient demonstrated pCR, contrasting with the two others who employed a W&W approach. Therefore, the pCR and CR rates were calculated as 562% (18 of 32 patients) and 581% (36 of 62 patients), respectively. The TRG 0-1 rate, representing 22 out of 32 instances, was 688%. Among the most frequent non-hematologic adverse events (AEs) were poor appetite (49/60, 817%), numbness (49/60, 817%), nausea (47/60, 783%), and asthenia (43/60, 717%); two participants were unable to complete this survey. The prevailing hematologic adverse events, found in a significant number of patients, included thrombocytopenia (77.4%, 48/62 patients), anemia (75.8%, 47/62 patients), leukopenia/neutropenia (71.0%, 44/62 patients), and high transaminase levels (62.9%, 39/62 patients). Thrombocytopenia, a Grade III-IV adverse event, was the most prevalent finding in 22 (35.5%) of the 62 patients evaluated. Critically, 3 (4.8%) of these patients exhibited Grade IV thrombocytopenia. No Grade 5 adverse events were recorded. The combined application of SCRT and toripalimab in neoadjuvant therapy for locally advanced rectal cancer (LARC) produces a surprisingly high complete response rate. This outcome holds the promise of innovative organ-preserving treatment options for patients with microsatellite stable (MSS) lower-rectal cancers. Concurrently, the preliminary findings from a single medical center display acceptable tolerability, with the most significant Grade III-IV adverse effect being thrombocytopenia. To ascertain the substantial efficacy and long-term prognostic benefits, further follow-up is required.
The study investigates the therapeutic impact of laparoscopic hyperthermic intraperitoneal perfusion chemotherapy, along with intraperitoneal and systemic chemotherapy (HIPEC-IP-IV), on peritoneal metastases arising from gastric cancer (GCPM). This investigation adopted a descriptive case series study design. For HIPEC-IP-IV treatment consideration, these factors must be present: (1) confirmed diagnosis of gastric or esophagogastric junction adenocarcinoma; (2) age within the range of 20 to 85 years; (3) solely peritoneal metastases as Stage IV disease evidence, verified by CT, laparoscopy, or ascites/peritoneal lavage fluid cytology analysis; and (4) Eastern Cooperative Oncology Group performance status of 0 to 1. Among the contraindications are: (1) normal results from routine blood tests, liver and kidney function tests, and electrocardiogram findings confirming no contraindications to chemotherapy; (2) absence of major cardiopulmonary dysfunction; and (3) no intestinal obstruction or peritoneal adhesions. Using the stated criteria, the Peking University Cancer Hospital Gastrointestinal Center conducted a data analysis on GCPM patients undergoing laparoscopic exploration and HIPEC between June 2015 and March 2021, excluding those who received prior antitumor medical or surgical interventions. Patients received intraperitoneal and systemic chemotherapy, two weeks after the laparoscopic exploration and HIPEC procedure was completed. Assessments of them took place every two to four cycles. protamine nanomedicine Considering the effectiveness of treatment, reflected by stable disease, partial or complete response, and negative cytology, surgery was a factor in the discussion. The key surgical metrics assessed were the conversion rate to an open procedure, the rate of complete tumor removal during the initial surgery (R0 resection), and the duration of patient survival. HIPEC-IP-IV was performed on 69 previously untreated gastrocolic peritoneal mesothelioma (GCPM) patients; the patient group included 43 men and 26 women, and had a median age of 59 years (24-83 years). Within the distribution of PCI values, the median was 10, with the values ranging from 1 to 39. Following the HIPEC-IP-IV procedure, surgical intervention was performed on 13 patients (representing 188%), resulting in R0 resection confirmation in 9 patients (130%). The middle value of overall survival times was 161 months. The median overall survival (OS) varied significantly (P < 0.0001) between patients with massive (66 months) or moderate/minimal ascites (179 months). Patients who underwent R0 surgery had a median overall survival time of 328 months, compared to 80 months for those who underwent non-R0 surgery and 149 months for those who had no surgery. These differences were statistically significant (P=0.0007). HIPEC-IP-IV is determined to be a suitable treatment approach, given the conclusions, for GCPM. Patients afflicted with pronounced or moderate ascites encounter a less-than-favorable outlook. Patients successfully treated prior to surgery should be carefully assessed as potential candidates, the primary goal being attaining R0.
We intend to develop a nomogram to accurately predict the overall survival of patients with colorectal cancer and peritoneal metastases undergoing cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). This nomogram will be constructed to incorporate crucial prognostic factors pertinent to patient survival. check details The present study adopted a retrospective observational design. From January 2007 to December 2020, the Department of Peritoneal Cancer Surgery at Beijing Shijitan Hospital, Capital Medical University, gathered clinical and follow-up data on patients with colorectal cancer exhibiting peritoneal metastases, who received CRS + HIPEC treatment. This data was then analyzed using Cox proportional hazards regression. The research cohort was defined by patients presenting with peritoneal metastases from colorectal cancer, with no discernible distant spread to other bodily locations. Patients who had experienced emergency surgery due to obstruction or hemorrhage, or who suffered from other malignancies, or whose treatment was intolerable due to severe comorbidities affecting the heart, lungs, liver, or kidneys, or who were lost to follow-up, were excluded from the study. The study scrutinized (1) essential clinicopathological characteristics; (2) detailed CRS+HIPEC surgical approaches; (3) overall survival timelines; and (4) factors independently affecting overall survival; the objective being to identify independent prognostic elements and to use them in establishing and validating a nomogram. As follows, the evaluation criteria were applied in this study. The patients' well-being, as measured by their Karnofsky Performance Scale (KPS) scores, was assessed quantitatively in the study. The patient's condition is inversely related to the numerical score. In order to calculate a peritoneal cancer index (PCI), the abdominal cavity was divided into thirteen regions, each with a maximum score of three points. A smaller score signifies a greater benefit from the treatment. The cytoreduction score (CC) measures tumor cell eradication, with CC-0 and CC-1 signifying complete removal and CC-2 and CC-3 indicating incomplete tumor cell reduction. Employing a bootstrapping approach on the original data, the internal validation cohort was replicated 1000 times to assess and validate the nomogram model's generalizability. The nomogram's predictive accuracy was determined utilizing the consistency coefficient (C-index). A C-index value of 0.70 to 0.90 indicates accurate model predictions. The conformity of predicted risks was evaluated through calibration curves. The closer a predicted risk value aligns with the standard curve, the better the conformity. 240 patients with colorectal cancer peritoneal metastases, subjected to CRS+HIPEC, formed the basis of this study's cohort. Observed in the study group were 104 women and 136 men, with a median age of 52 years (aged 10 to 79 years) and a median preoperative KPS score of 90. Patients with PCI20 numbered 116 (483%), while those with PCI greater than 20 totaled 124 (517%). Preoperative analysis of tumor markers revealed abnormalities in 175 patients (729%), while 38 patients (158%) exhibited normal marker levels. The distribution of HIPEC procedure durations shows seven patients (29%) having 30-minute procedures, 190 (792%) having 60-minute procedures, 37 (154%) having 90-minute procedures, and 6 (25%) having 120-minute procedures. A total of 142 patients (representing 592 percent) had CC scores between 0 and 1, while 98 patients (comprising 408 percent) exhibited CC scores ranging from 2 to 3. In the dataset of 240 events, 52 (217%) demonstrated Grade III to V adverse events. After a median of 153 (04-1287) months, the follow-up concluded. The midpoint of overall survival duration was 187 months; this correlated with 1-, 3-, and 5-year survival rates of 658%, 372%, and 257%, respectively. Multivariate analysis demonstrated that the KPS score, preoperative tumor markers, CC score, and the duration of HIPEC served as independent prognostic indicators. Calibration curves within the nomogram derived from the four variables showed a satisfactory agreement between predicted and observed survival rates for 1-, 2-, and 3-year periods, with a C-index of 0.70 (95% confidence interval of 0.65-0.75). hyperimmune globulin A nomogram developed from KPS score, preoperative tumor markers, the CC score, and HIPEC duration accurately determines the survival probability for patients with colorectal peritoneal metastases treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.
A poor prognosis is often associated with colorectal cancer that has metastasized to the peritoneum. Currently, the treatment system that integrates cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has substantially improved the survival of these patients.