The Efficacy and Toxicity of Lobaplatin-contained Chemotherapy in Extensive-stage Small-cell Lung Cancer.

To assess the efficacy and toxicity of Lobaplatin (LBP) -contained chemotherapy on extensive stage small-cell lung cancer (ES-SCLC), we conducted a prospective, single-arm, and multicenter Phase IV clinical trial on Lobaplatin (ChiCTR-ONC-13003471), and used the patient clinical data obtained from our cancer center to perform the analysis. Previously untreated patients with ES-SCLC were given LBP intravenously (IV) at 30 mg/m2 on day 1 and etoposide IV at 100 mg/m2 on day 1, 2, and 3. The treatment was cycled every 21 days, lasting for four to six cycles. The patients with second-line treatment or above were also included in the study, and they were treated with LBP-contained regimen: a single dose of LBP at 50 mg/m2 on day 1 through IV; combined application, LBP30 mg/m2 IV on day 1. From May 2015 to August 2016, 36 patients were enrolled in the study at our cancer center. For the 30 first-line patients, the median overall survival (OS) and the median progression-free survival (PFS) was 13.0 months (ranging from 11.2 to 14.7 months) and 4.7 months (ranging from 1.6 to 7.7 months) respectively, with overall response rate of 57 % and disease control rate of 85.7%. For the 6 patients with second-line treatment or above, one patient got a partial response (PR) and four patients got a stable disease (SD). The most frequent drug-related adverse effects were leukopenia and neutropenia, and no grade 3/4 hepatotoxicity or nephrotoxicity was observed. These results indicated that LBP-contained chemotherapy was effective and tolerable for extensive stage SCLC in terms of response and survival. However, due to the small sample size of this study, we need to wait for the OS data of phase Ⅲ clinical trial and the final data of this multicenter Phase IV study to draw the conclusion.

Multi-phasic CT arterial portography and CT hepatic arteriography improving the accuracy of liver cancer detection.

AIM: To evaluate the value of multi-phasic CT arterial portography (CTAP) and CT hepatic arteriography (CTHA) in differential diagnosis of liver diseases, and to improve the specificity of CTAP and CTHA for liver cancer detection. METHODS: From January 1999 to December 2002, multi-phasic CTAP and CTHA were performed in 20 patients with suspected liver disease. CT scanning was begun 25 s, 60 s and 120 s for the early-, late- and delayed-phase CTAP examinations, and 6 sec, 40 s and 120 s for the early-, late- and delayed-phase CTHA examinations respectively, after a transcatheter arterial injection of non-ionic contrast material. If a lesion was diagnosed as a liver cancer, transcatheter hepatic arterial chemoembolization (TACE) treatment was performed, and the follow-up CT was performed three or four weeks later. RESULTS: All eighteen HCCs in 12 cases were shown as nodular enhancement on early-phasic CTHA. The density of the whole tumor decreased rapidly on late and delayed phases, and the edge of 12 tumors (12/18) remained relatively hyperdense compared with the surrounding liver tissue, and demonstrated as rim enhancement. All HCCs were shown as perfusion defect nodules on multi-phasic CTAP. Five tumors (5/18) were shown as rim enhancement on delayed-phasic CTAP. Rim enhancement was shown as 1 to 2-mm-wide irregular, uneven and discontinuous circumferential enhancement at late-, and delayed-phase of CTHA or CTAP. Five pseudolesions and 4 hemoangiomas were found in multi-phasic CTAP and CTHA. No pseudolesions and hemoangiomas were shown as rim enhancement on late- or delayed-phasic CTHA and CTAP. CONCLUSION: Multi-phasic CTAP and CTHA could help to recognize the false-positive findings in CTAP and CTHA images, and improve the accuracy of CTAP and CTHA of liver cancer detection.

[Helical double-phase CT scan imaging features of hepatocellular carcinoma and pathology of false-positive lesions].

BACKGROUND & OBJECTIVE: The helical double-phase CT scan imaging features of hepatocellular carcinoma (HCC) overlap those of other hepatic lesions. This study was to investigate the helical double-phase CT scan imaging features of HCC to improve diagnosis accuracy. METHODS: Double-phase CT data and pathologic data of 52 HCC patients, received resection in Cancer Center of Sun Yat-sen University from Dec. 2000 to Dec. 2002, were analyzed. The double-phase CT features of HCC lesions were summarized. The pathology of false-positive lesions was analyzed. RESULTS: CT scan showed 56 lesions in the 52 patients: 51 were cancer lesions, including 49 HCC lesions and 2 mixed lesions of HCC and cholangioma, 5 were false-positive lesions. Arterial phase of these HCC lesions showed obvious heterogeneous enhancement, and the portal vein phase showed heterogeneous low dense. Necrosis was seen in all massive lesions, but was seldom seen in nodular and small lesions. Most lesions had clear borders and amicula. The pathologic diagnoses of the 5 false-positive lesions were hepatic cirrhosis with hepatocellular nodular hyperplasia, regenerative nodule, hepatic cirrhosis, bile duct calculus companied with inflammatory reaction, and fibrosis hyperplasia. CONCLUSIONS: Helical double-phase CT scan can be used to diagnose typical HCC lesions. There are no obvious differences in helical double-phase CT scan between HCC lesions and false-positive lesions. The diagnosis of HCC must be based on clinical information, follow-up or biopsy.

[Diagnostic values of CT perfusion imaging in pulmonary masses].

BACKGROUND & OBJECTIVE: Blood flow patterns with CT perfusion imaging (CTPI) had been innovated to delineate abnormal hemodynamic lesions in the liver, brain, and kidney. This study was to evaluate the blood flow patterns of pulmonary masses by CTPI, and determine the value of CTPI in differential diagnosis among benign, malignant, and inflammatory masses. METHODS: Fifty-two patients with previously diagnosed pulmonary masses (37 with malignant masses, 7 with benign masses, and 8 with inflammatory masses) underwent dynamic CTPI. Time-density curves (TDC) of artery, vein, and pulmonary masses as well as mass perfusion images and parameters including perfusion volume (PV), peak height (PH), mean transit time (MTT) and blood volume (BV) were obtained by Phlips CT-perfusion software. RESULTS: The values of PV, PH, and BV were significantly higher in malignant masses and active inflammatory masses than in benign masses [(27.63+/-15.06) ml.min(-1).ml(-1) and (30.80+/-20.33) ml.min(-1).ml(-1) vs. (11.81+/-3.74) ml.min(-1).ml(-1), (28.46+/-12.07) Hu and (32.15+/-15.89) Hu vs. (10.41+/-3.77) Hu, (21.64+/-10.97) ml/100 g and (28.38+/-14.55) ml/100 g vs. (10.61+/-5.33) ml/100 g, P<0.01]. However, the differences of MTT among malignant, inflammatory, and benign masses were not significant [(28.39+/-21.66) s, (25.91+/-14.57) s, and (29.86+/-13.57) s, P=0.928]. No significant differences in the 4 parameters were found between malignant and inflammatory masses. When PV >20 ml.min(-1).ml(-1) and pH >15 Hu were set as a diagnostic threshold (excluded active inflammatory masses), the sensitivity, specificity, and accuracy were 91.9%, 100%, and 84.1%, respectively. CONCLUSION: CT perfusion imaging provides quantitative information about blood flow patterns of pulmonary masses and is an applicable diagnostic method for differentiating pulmonary masses.

[Typical and atypical features of focal nodular hyperplasia of the liver on helical CT images].

BACKGROUND & OBJECTIVE: Focal nodular hyperplasia (FNH) is a rare hepatic neoplastic lesion. This study was to evaluate the typical and atypical features of FNH of the liver on helical computed tomography (CT) images to improve the diagnosis accuracy. METHODS: Helical CT images of 32 patients with 37 lesions were reviewed in Cancer Center, Sun Yat-sen University retrospectively, who were confirmed as FNH by histopathologic or clinic examinations. The number, size, margin status, density, enhancing type, presence of a center scar, and presence of a pseudocapsule of FNH lesions were analyzed. RESULTS: The largest diameters of 14 lesions were < or = 3 cm, of 23 lesions were > 3 cm; 20 lesions were subcapsular; pseudocapsule was presented in 7 lesions with the largest diameters of > 3 cm; 22 lesions had center scars, among them, the largest diameters of 20 lesions was > 3 cm. All lesions were hyperattenuated to the liver in hepatic arterial phase; 31 lesions were enhanced homogeneously in hepatic arterial phase; abnormally thickened vessels were presented at the border of 17 lesions. CONCLUSIONS: Typical helical CT features of FNH include homogeneous enhancement in hepatic arterial phase, presence of central scar, and delayed enhancement. Atypical helical CT features of FNH include heterogeneous enhancement in hepatic arterial phase, absence of central scar, and presence of pseudocapsule. The various CT features are related to the pathologic type and the largest diameter of the lesion.

[Mediastinal lymph node staging in non-small cell lung cancer: comparison between spiral computed tomographic findings and pathology].

BACKGROUND & OBJECTIVE: Mediastinal lymph node staging in non-small cell lung cancer (NSCLC) is important to choose standard treatment plan and estimating prognosis. This study was to evaluate the clinical value of spiral CT in staging mediastinal lymph node in NSCLC through comparing spiral CT findings with corresponding pathology. METHODS: A total of 89 patients with pathologically proven NSCLC received spiral CT and mediastinoscopic biopsy. The spiral CT findings and corresponding pathologic findings in staging mediastinal lymph node were compared. The sensitivity, specificity, and accuracy of diagnosing mediastinal lymph node metastasis were calculated. RESULTS: Compared with corresponding pathologic results, the overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of mediastinal lymph node staging with spiral CT were 58.9%, 70.0%, 60.5%, 68.6%, and 65.2%, respectively. The accuracy and specificity of spiral CT was relatively low in staging 4R, 5, 6, 7 lymph node groups; the false negative and false positive rates were relatively high in staging 4R, 7 lymph node groups. CONCLUSIONS: Spiral CT is a non-invasive clinical examination which may be used in staging mediastinal lymph node in NSCLC; however, there exists false negative and false positive rates. It should be combined with other investigations, such as mediastinoscopy, to assess a more accurate mediastinal lymph node staging.

CT arterial portography and CT hepatic arteriography in detection of micro liver cancer.

AIM:To recognize the characteristic findings of micro-liver cancer (MLC) and to evaluate the effect of CT arterial portography (CTAP) and CT hepatic arteriography (CTHA) in diagnosis of MLC.METHODS:Between April 1996 to December 1998, CTAP and CTHA were performed in 12 patients with MLC, which were not detected by conventional CT examinations. After CTHA, 3mL-5mL mixture of lipiodol, doxorubicin and mitoycin C were injected into hepatic artery through the catheter, and the followed up by CT three or four weeks later (Lipiodol CT Lp-CT).RESULTS:A total of 22 micro-tumors (0.2cm-0.6cm in diameter) were detected in 12 patients, which manifested as small perfusion defects in CTAP and small round enhancement in CTHA. The rate of detectability of CTAP and CTHA was 68.2% (15/22) and 77.3% (17/22) respectively, and the rate of the simultaneous use of both procedures reached 86.4% (19/22).All micro-tumors were demonstrated as punctate lipiodol deposit foci in Lp-CT. After Lp-CT, the elevated serum level of alpha-fetoprotein (AFP) dropped to the normal level in all patients.CONCLUSION:The CTAP and CTHA are the most sensitive imaging methods for detecting micro-liver cancer.Confirmed by the change of the elevated serum AFP level and lipiodol deposit foci in Lp-CT, small perfusion defects in CTAP and puntuate enhancement in CTHA may suggest micro-liver cancer.

Findings of non-pathologic perfusion defects by CT arterial portography and non-pathologic enhancement of CT hepatic arteriography.

AIM:To recognize the characteristic findings of non-pathologic perfusion defects with CT arterial portography (CTAP) and nonpathologic enhancement found in CT hepatic arteriography (CTHA).METHONDS:The manifestations of nonpathologic perfusion defects with CTAP and non pathologic enhancement found in CTHA were analyzed in 50 patients with primary hepatocellular carcinoma.RESULTS:The false-positive rate of perfusion defects detected in CTAP was 15.1% The shapes of perfusion defects were peripheral wedge, small, round, and patchy. The occurrence rate of non-pathologic enhancement found in CTHA was 22.0%. The shapes of non-pathologic enhancement were small, round, irregular, and wedge.CONCLUSION:There was high frequency of non-pathologic perfusion defects detected with CTAP and non-pathologic enhancement found in CTHA. The simultaneous use of both procedures may help decrease the false-positive rate, and increase the veracity of diagnosis for hepatocellular carcinoma.

[Spiral computed tomography (CT) and magnetic resonance imaging (MRI) in assessment of the skull base encroachment in nasopharyngeal carcinoma].

BACKGROUND & OBJECTIVE: With the general using of computed tomography (CT) and magnetic resonance imaging (MRI), it is important to determine which method is more sensitive in detecting the skull base encroachment in clinic. This article was designed to investigate the diagnostic value of CT and MRI in detecting the skull base erosion in nasopharyngeal carcinoma patients. METHODS: Sixty-one cases pathologically proven as nasopharyngeal carcinoma were selected from August 1993 to September 2001. three-dimensional reconstruction with spiral CT thin slices scan were performed in 8 cases. CT scan was performed with Elscient CT Twin Flash; axial scan was parallel to the OM line routinely from soft palate to the suprasellar cistern. There were 13 cases with enhancement scan. MRI scan was performed by Philips T5-II super-conducting magnetic resonance imaging system (0.5T). The standard quadrature head coil was used. Routine axial, sagittal, and coronal image with SE sequences were obtained. Scanned field ranged from the soft palate to the suprasellar cistern. After plain scan, enhanced scan was performed in 55 of 61 cases. RESULTS: MRI discovered the skull base encroached more precisely than CT, 17 cases by CT and 26 cases by MRI, respectively. The early bone marrow infiltration was seen at clivus, basilar pterygoid, and basilar sphenoid in 6 cases by MRI scan while CT scan showed no abnormal lesion at these sites. In addition, MRI revealed nasopharyngeal carcinoma tissue infiltrated along the mandibular nerve (3 cases) while CT scan showed no change of these structures. CONCLUSION: Both CT and MRI can reveal that the tumor encroaches on the skull base by either destroying the bony structure or breaking through the natural foramen. MRI is more sensitive than CT in detecting the skull base encroachment. MRI could reveal the early infiltration of the bone marrow and tumor infiltration along the mandibular nerve. MRI confirms the dimension of nasopharyngeal carcinoma more precisely than CT. The three dimension reconstructional spiral CT was directer in discovering the dimension of the tumor.