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*Only for medical professionals to read and refer to the grassroots special session of the 2021CSCO annual meeting and one hundred "cases" pick a classic case show SHOW digestive tract, hepatobiliary and pancreatic special show
.
One hundred "cases" and one case collection activity is sponsored by the Beijing Xisk Clinical Oncology Research Foundation, the Chinese Society of Clinical Oncology (CSCO), and co-organized by the medical community.
Through the model of case collection, it builds academic communication bridges and focuses on standardized tumor diagnosis and treatment.
, Collect standardized diagnosis and treatment cases from the majority of young and middle-aged doctors, especially primary doctors, to promote the process of standardized tumor diagnosis and treatment
.
The 24th National Oncology Conference and the 2021 Chinese Society of Clinical Oncology (CSCO) academic annual meeting was officially held yesterday
.
At the grassroots special session of the Beijing Xisk Clinical Oncology Research Foundation this afternoon, the final evaluation site of this year's "100 cases" selection item-the classic case show SHOW (digestive tract & hepatobiliary and pancreatic special session) was officially unveiled
.
The digestive tract special session invited Professor Li Jin from Dongfang Hospital of Tongji University, Professor Xu Ruihua from Sun Yat-sen University Cancer Center, Professor Shen Lin from Peking University Cancer Hospital, Professor Zhang Xiaotian from Peking University Cancer Hospital, Professor Chen Gong from Sun Yat-sen University Cancer Center, Professor Liu Jing from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Professor Huang Chen from the First People's Hospital Affiliated to Shanghai Jiaotong University, and Professor Cai Muyan from the Cancer Center of Sun Yat-sen University served as tutors to comment on selected cases and discuss hot topics
.
For the hepatobiliary and pancreatic special session, Professor Qin Shukui from the General Hospital of Eastern Theater Command, Professor Liang Jun from Peking University International Hospital, Professor Liang Houjie from Southwest Hospital of Army Military Medical University were invited as consultants, Professor Chen Xiaofeng from Jiangsu Provincial People's Hospital, Professor Fang Weijia from the First Affiliated Hospital of Zhejiang University School of Medicine, Shanghai Professor Shi Yan from Ruijin Hospital Affiliated to Jiaotong University School of Medicine, Professor Gong Xinlei from Nanjing Jinling Hospital, and Professor Xue Junli from Oriental Hospital Affiliated to Tongji University served as mentors to comment on selected cases and discuss hot topics
.
What kind of sparks will be produced by young doctors at the grassroots level on the same stage as academic experts? Let us find out! General View of the Cases of Gastrointestinal Tumor by Primary Doctors▌ Case 1: Discussion on the combined treatment plan of radiotherapy and immune and anti-angiogenesis therapy for recurrence of esophageal cancer after surgery A case of “posterior abdominal lymph node metastasis”
.
The patient completed palliative radiotherapy with a dose of 30 Gy/15 times (the original plan was 50 Gy/25 times, and the patient refused to continue radiotherapy due to gastrointestinal reactions) synchronously recombinant human endostatin 210mg (micro-pumping 72 hours) and Sindili Monoclonal antibody 200 mg, D1 treatment for 2 cycles
.
Then continue to complete 2 cycles of recombinant human endostatin 210 mg (micro-pumped 72 h) combined with Sintilizumab 200 mg, D1 treatment
.
After completing 2 cycles of treatment, she refused to be treated again because of her weakness, significant weight loss, and stomach nausea
.
▌ Case 2: Treatment experience of gastric emptying disorder after colon cancer surgery Cheng Jianbo, deputy chief physician of Fufeng County People's Hospital, shared a case of colon cancer
.
The patient had symptoms of incomplete intestinal obstruction again on the second day after admission, and was given laxative enema and other symptomatic treatments, and the symptoms were relieved
.
After multidisciplinary discussion, combined with the wishes of patients and family members, laparoscopic surgical exploration was performed to relieve the obstruction
.
The patient experienced repeated nausea and vomiting on the 5th day after surgery, without abdominal pain or bloating, and he could defecate on his own
.
Give patients continuous gastrointestinal decompression, nutritional support, intramuscular injection of metoclopramide, and traditional Chinese medicine physiotherapy and other symptomatic treatments
.
The patient recovered and was discharged satisfactorily 32 days after the operation
.
▌ Case 3: Metastatic HER2-positive gastric cancer, targeted therapy combined with chemotherapy, liver metastases improved significantly, Fu Jingyi, attending physician at Shouguang City People’s Hospital, shared a case of advanced gastric cancer with multiple metastases
.
The patient received oxaliplatin 195 mg d1 + capecitabine 1.
5 g, twice a day, d1-14 regimen chemotherapy for 2 cycles, and combined trastuzumab targeted therapy for 2 cycles
.
There was no obvious gastrointestinal reaction during chemotherapy, and no bone marrow suppression after chemotherapy
.
After 2 cycles of treatment, the curative effect of intrahepatic metastases improved significantly
.
▌ Case 4: Comprehensive consideration of low rectal cancer ileal fistula surgery Lei Shaokui, deputy chief physician of Weng'an County People's Hospital in Guizhou Province, shared classic cases of clinical treatment of low rectal cancer
.
After admission, the patient was given complete blood routine, biochemical, coagulation function, virology, electrocardiogram, chest X-ray and other related examinations
.
Full-abdominal CT and whole-abdomen enhanced CT understand the surrounding conditions of the tumor and the presence or absence of liver metastasis, and exclude surgical contraindications
.
Later, laparoscopic radical resection of rectal cancer (Dixon operation) and ileal fistula were performed
.
After the operation, diet, somatostatin inhibits the secretion of digestive juice, nutrition, and supportive treatment are given
.
Hindgut function was restored, and the liquid diet was given without abnormalities and then gradually changed to a normal diet
.
▌ Case 5: A patient with advanced esophageal cancer undergoes surgery after neoadjuvant treatment, and Li Ruikai, deputy chief physician of the postoperative pathology pCR Chaozhou Central Hospital, shared a case of advanced esophageal cancer neoadjuvant treatment
.
The patient was treated with neoadjuvant therapy before the operation.
The treatment plan was: albumin paclitaxel 400mg + cisplatin 60mg d1 30mg d2+ tislelizumab 200mg, a total of 3 cycles of treatment
.
After 3 courses of neoadjuvant treatment, no obvious side effects were found.
The patient's swallowing obstruction and other symptoms were significantly improved.
The patient's various indicators were normal and the general condition was good.
The PS score was 0, and the mass was significantly reduced, which met the requirements of the operation.
, After radical resection of esophageal cancer, the pathology achieved pathological complete remission (pCR) after the operation
.
Gastrointestinal tumor tutor group focus on the issue.
For esophageal cancer, neoadjuvant immunization combined with chemotherapy after surgery, if R0 resection is performed, and pathology shows pCR, it is necessary to complete 4 to 6 courses of chemotherapy after surgery or just immunization Maintenance treatment? Professor Liu Jing shared his views: "According to the recommendations of relevant guidelines, the current standard treatment for locally advanced esophageal cancer is still concurrent radiotherapy and chemotherapy.
At this stage, treatment methods such as immunotherapy combined with chemotherapy are still being explored
.
Some patients are unable to tolerate problems.
Refusal to accept neoadjuvant radiotherapy, so clinicians may choose chemotherapy combined with immunotherapy
.
However, there is currently no large-scale phase III clinical study of neoadjuvant chemotherapy combined with immunotherapy.
In other words, there is no evidence-based medicine for this treatment.
Sufficient
.
If the patient achieves pCR after receiving this treatment, the follow-up treatment still needs to be individualized exploration
.
Personally, it is first necessary to judge whether the patient has a full course of treatment before surgery.
For the situation of the above case 5, it is recommended to give up chemotherapy after surgery.
The patient is given immune maintenance therapy alone, and we look forward to more follow-up related clinical studies
.
” For the patient of Case 5, Professor Zhang Xiaotian said: “In this case, the preoperative therapeutic effect of immunotherapy or chemotherapy plays a major role.
Still need to further judge
.
The
patient's postoperative treatment tolerance needs to be considered as a priority
.
It is worth noting that although the patient has reached pCR, there is still a risk of recurrence, so postoperative monitoring cannot be ignored either
.
"Accelerated Rehabilitation Surgery advocates early eating.
We encounter patients with gastrointestinal function not recovering in clinical work.
What aspects should we pay attention to? Professor Huang Chen said: "Before advancing accelerated rehabilitation surgery, we must accurately locate the path suitable for entering the clinical path.
Of patients, such as elderly or severely malnourished patients, are not suitable for accelerated rehabilitation surgical treatment concepts
.
In addition, for patients who adopt the concept of accelerated rehabilitation surgery, the gastrointestinal function cannot be recovered after the operation, the accelerated rehabilitation surgical treatment mode must be quickly reversed, and the routine perioperative treatment should be returned, such as fasting, intravenous nutritional support, Promote gastrointestinal motility and so on
.
"A basic view of the case of hepatobiliary and pancreatic tumors by primary doctors▌ Case 1: Immunization combined with chemotherapy for metastatic pancreatic ductal adenocarcinoma, with a median PFS of 8 months.
Han Chao, attending physician at Xintai City People’s Hospital in Shandong Province, shared a case of advanced pancreatic cancer with combined immunotherapy
.
the patients receiving natalizumab for Raleigh gemcitabine 200 mg + 1.
6 g d1,8 + oxaliplatin 150 mg d2 (every three weeks)
.
As of March this year, the patient has completed eight cycles of combination chemotherapy in immune, up Partial remission (PR)
.
The median progression-free survival (PFS) of this patient is as long as 8 months
.
Tirelizumab combined with chemotherapy provides clinicians with new treatment ideas and is expected to become a treatment for metastatic pancreatic catheters The first-line plan for adenocarcinoma
.
▌ Case 2: The treatment and thinking of immune pneumonia after lenvatinib combined with immunotherapy in the treatment of primary liver cancer Han Guangcheng, the attending physician of Jiaxiang County People’s Hospital in Shandong Province, shared the clinical treatment of primary liver cancer
.
The patient received lenvatinib combined immunotherapy (once every two weeks) for 13 cycles
.
The patient developed immune pneumonia after 6 cycles of PD-1 monoclonal antibody.
After treatment, the condition was relieved.
After 5 months, the immunotherapy was restarted
.
▌ Case 3: Practice and discussion of immunotherapy combined with chemotherapy in the treatment of advanced gallbladder cancer Huang Wulang, attending physician at Jinggangshan University Affiliated Hospital, shared a case of comprehensive treatment of advanced gallbladder cancer
.
The patient underwent a cycle of gemcitabine + cisplatin chemotherapy after surgery.
In the second cycle, the patient was unable to tolerate capecitabine single-agent oral chemotherapy due to bone marrow suppression and gastrointestinal symptoms
.
Relevant research results suggest that immune combined chemotherapy has broad application prospects in the treatment of gallbladder cancer
.
After discussion in the department, the patient was given a combined treatment plan of chemotherapy + radiotherapy + immunotherapy
.
The treatment plan is to continue capecitabine chemotherapy for 3 weeks; precise radiotherapy 12 times per cycle; tislelizumab 200 mg for 3 weeks
.
In the fourth course of chemotherapy and the second course of immunotherapy, the patient developed moderate anemia, leukopenia, and anorexia, and chemotherapy was stopped
.
Modification plan: tislelizumab 200mg, once every 3 weeks
.
At present, the patient has undergone 10 cycles of immunotherapy and 8 cycles of single-agent immunotherapy for nearly 10 months after surgery
.
The patient's general condition is normal, and the diet is normal; the weight has increased compared with the previous period, and the abdominal examination has no obvious positive signs; the tumor indicators are completely normal, and the reexamination of the abdominal CT indicates that the liver metastases are stable
.
▌ Case 4: Practice of clinical treatment of primary liver cancer Luo Jun, the attending physician of Dafang County People's Hospital in Guizhou Province, shared classic cases of clinical treatment of primary liver cancer
.
The patient underwent hepatic artery chemoembolization (TACE) for four cycles, and received sorafenib 0.
4 g orally twice a day.
Because of grade 3 hand-foot syndrome, the dose was adjusted to 0.
2 g orally twice a day , The maintenance treatment has been well tolerated by patients so far
.
▌ Case 5: Immune therapy for primary liver cancer, with definite curative effect, Wang Wenzhong, attending physician at Suixian Traditional Chinese Medicine Hospital, Shangqiu City, Henan Province, shared the use of immunotherapy for primary liver cancer cases
.
In response to the patient’s condition, the clinician first launched a multidisciplinary diagnosis and treatment (MDT).
The patient was stage IIIa, with a tumor larger than 10 cm combined with portal embolism, liver function Child B stage, and color Doppler ultrasound showed intraportal blood flow signals.
The opportunity for surgical resection has been lost, and TACE+ system treatment can be considered
.
Two weeks after surgery, he was given apatinib 250 mg, once a day + carrelizumab 200 mg, once every two weeks
.
After 1 year of treatment with apatinib + carrelizumab, the patient has a definite effect
.
Due to economic reasons, carrelizumab treatment was stopped, and oral apatinib treatment was continued
.
Later, because carrelizumab was added to the medical insurance reimbursement scope, the patient continued to receive carrelizumab + apatinib oral treatment, and is still under treatment with this regimen
.
The focus of the hepatobiliary and pancreatic tumor tutors group broadcast.
For patients with multiple and huge liver lesions, which account for ≥70% of the whole liver, how is the interventional treatment relatively safe? Professor Fang Weijia said: "For this patient, superselective embolization can be considered
.
If the patient is in Child B stage, hepatic artery infusion chemotherapy (HAIC) is relatively safer
.
The choice of HAIC and TACE is based on liver function
.
"What is the future application prospects of the ctDNA project for early screening of liver cancer? How does its sensitivity and specificity compare with traditional AFP and abdominal ultrasound screening? Can it be included in liver cancer guidelines in the future? Professor Gong Xinlei said: "Professor Xu Ruihua published The results of a clinical study of ctDNA methylation status for early diagnosis of liver cancer in the Nature publication show that the sensitivity and specificity of ctDNA is higher than that of traditional serum AFP detection, which is of great value for distinguishing liver cancer patients from chronic hepatitis patients
.
Of course, the ctDNA project also has the problems of high cost and high technical requirements
.
Looking forward to a larger sample of research in the future to strengthen its evidence-based medical evidence
.
"Immune pneumonia after the application of immunotherapy is relieved, how to evaluate the conditions or timing of reactivation of immunity? Considering the tailing effect of immunotherapy, how to adjust the treatment cycle after reactivation of immunotherapy? Professor Xue Junli shared: "Target The issue of immune restart raised in Case 2 of the Hepatobiliary and Pancreatic Special Session.
I personally think that the level that needs to be considered is the severity of the patient's immune-related adverse reactions (irAE).
If the patient has severe irAEs during the course of immunotherapy, the immune restart may be more serious.
High risk
.
Secondly, it is necessary to consider the patient's response to irAE treatment.
If the patient's irAE still persists and cannot be relieved after receiving treatment, the time point for immune restart will be postponed indefinitely
.
In addition, the level that clinicians need to consider is the choice of drugs to control irAE.
Patients have not been able to effectively control irAE during previous treatment, which means that the choice of drugs within the range of available drugs will be greatly reduced
.
In this case, there is a higher risk of immune restart
.
"Finally, the level to be considered is the patient's personal wishes.
If the patient's personal wishes are not strong, the value of immune restart is not high
.
As for the tailing effect of immunotherapy, whether it is necessary to extend the treatment cycle after restarting immunotherapy is currently not supported by evidence-based medical evidence
.
"What are the common adverse reactions of PD-1 drugs and treatment methods? Professor Shi Yan analyzed: "Clinicians need to strengthen and broaden the management awareness of patients with irAE.
Secondly, clinicians need to establish a good communication relationship with patients before treatment.
.
Furthermore, evaluation and monitoring after medication is essential
.
It is worth mentioning that the patient's discomfort such as fatigue with no obvious cause may be a'signal' that prompts the patient to have irAE
.
"Which grassroots doctors are out of the two major sessions? First prize in the digestive tract tumor special session: Cheng Jianbo from Fufeng County People's Hospital-Colon cancer treatment case Second prize: Chaozhou Central Hospital Li Ruikai-Neoadjuvant clinical treatment of esophageal cancer Shouguang Fu Jingyi, City People’s Hospital-Talking about a case of gastric cancer clinical treatment third prize: Zhang Jianxin, Shanting District People's Hospital, Zaozhuang City-Treatment of advanced esophageal cancer cases, Lei Shaokui, People's Hospital of Weng'an County, Guizhou-Clinical treatment of low rectal cancer Hepatobiliary and Pancreatic Tumor Special Session First Prize: Han Chao, Xintai People's Hospital, Shandong Province-A case of advanced pancreatic cancer immunotherapy Second Prize: Jiaxiang County People's Hospital, Shandong Province Han Guangcheng-Clinical Treatment of Primary Liver Cancer Cases Guizhou Province Dafang County People’s Hospital Luo Jun-the third prize for clinical treatment of primary liver cancer disease: Huang Wulang, Affiliated Hospital of Jinggangshan University-a case of comprehensive treatment of advanced gallbladder cancer shared with Wang Wenzhong from Sui County Hospital of Traditional Chinese Medicine-immunotherapy of primary liver cancer case Congratulations to the above-mentioned grassroots doctors.
I would like to stay true to my original aspirations and forge ahead
.
For more exciting content of the 2021 CSCO, please follow the medical oncology channel~
.
One hundred "cases" and one case collection activity is sponsored by the Beijing Xisk Clinical Oncology Research Foundation, the Chinese Society of Clinical Oncology (CSCO), and co-organized by the medical community.
Through the model of case collection, it builds academic communication bridges and focuses on standardized tumor diagnosis and treatment.
, Collect standardized diagnosis and treatment cases from the majority of young and middle-aged doctors, especially primary doctors, to promote the process of standardized tumor diagnosis and treatment
.
The 24th National Oncology Conference and the 2021 Chinese Society of Clinical Oncology (CSCO) academic annual meeting was officially held yesterday
.
At the grassroots special session of the Beijing Xisk Clinical Oncology Research Foundation this afternoon, the final evaluation site of this year's "100 cases" selection item-the classic case show SHOW (digestive tract & hepatobiliary and pancreatic special session) was officially unveiled
.
The digestive tract special session invited Professor Li Jin from Dongfang Hospital of Tongji University, Professor Xu Ruihua from Sun Yat-sen University Cancer Center, Professor Shen Lin from Peking University Cancer Hospital, Professor Zhang Xiaotian from Peking University Cancer Hospital, Professor Chen Gong from Sun Yat-sen University Cancer Center, Professor Liu Jing from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Professor Huang Chen from the First People's Hospital Affiliated to Shanghai Jiaotong University, and Professor Cai Muyan from the Cancer Center of Sun Yat-sen University served as tutors to comment on selected cases and discuss hot topics
.
For the hepatobiliary and pancreatic special session, Professor Qin Shukui from the General Hospital of Eastern Theater Command, Professor Liang Jun from Peking University International Hospital, Professor Liang Houjie from Southwest Hospital of Army Military Medical University were invited as consultants, Professor Chen Xiaofeng from Jiangsu Provincial People's Hospital, Professor Fang Weijia from the First Affiliated Hospital of Zhejiang University School of Medicine, Shanghai Professor Shi Yan from Ruijin Hospital Affiliated to Jiaotong University School of Medicine, Professor Gong Xinlei from Nanjing Jinling Hospital, and Professor Xue Junli from Oriental Hospital Affiliated to Tongji University served as mentors to comment on selected cases and discuss hot topics
.
What kind of sparks will be produced by young doctors at the grassroots level on the same stage as academic experts? Let us find out! General View of the Cases of Gastrointestinal Tumor by Primary Doctors▌ Case 1: Discussion on the combined treatment plan of radiotherapy and immune and anti-angiogenesis therapy for recurrence of esophageal cancer after surgery A case of “posterior abdominal lymph node metastasis”
.
The patient completed palliative radiotherapy with a dose of 30 Gy/15 times (the original plan was 50 Gy/25 times, and the patient refused to continue radiotherapy due to gastrointestinal reactions) synchronously recombinant human endostatin 210mg (micro-pumping 72 hours) and Sindili Monoclonal antibody 200 mg, D1 treatment for 2 cycles
.
Then continue to complete 2 cycles of recombinant human endostatin 210 mg (micro-pumped 72 h) combined with Sintilizumab 200 mg, D1 treatment
.
After completing 2 cycles of treatment, she refused to be treated again because of her weakness, significant weight loss, and stomach nausea
.
▌ Case 2: Treatment experience of gastric emptying disorder after colon cancer surgery Cheng Jianbo, deputy chief physician of Fufeng County People's Hospital, shared a case of colon cancer
.
The patient had symptoms of incomplete intestinal obstruction again on the second day after admission, and was given laxative enema and other symptomatic treatments, and the symptoms were relieved
.
After multidisciplinary discussion, combined with the wishes of patients and family members, laparoscopic surgical exploration was performed to relieve the obstruction
.
The patient experienced repeated nausea and vomiting on the 5th day after surgery, without abdominal pain or bloating, and he could defecate on his own
.
Give patients continuous gastrointestinal decompression, nutritional support, intramuscular injection of metoclopramide, and traditional Chinese medicine physiotherapy and other symptomatic treatments
.
The patient recovered and was discharged satisfactorily 32 days after the operation
.
▌ Case 3: Metastatic HER2-positive gastric cancer, targeted therapy combined with chemotherapy, liver metastases improved significantly, Fu Jingyi, attending physician at Shouguang City People’s Hospital, shared a case of advanced gastric cancer with multiple metastases
.
The patient received oxaliplatin 195 mg d1 + capecitabine 1.
5 g, twice a day, d1-14 regimen chemotherapy for 2 cycles, and combined trastuzumab targeted therapy for 2 cycles
.
There was no obvious gastrointestinal reaction during chemotherapy, and no bone marrow suppression after chemotherapy
.
After 2 cycles of treatment, the curative effect of intrahepatic metastases improved significantly
.
▌ Case 4: Comprehensive consideration of low rectal cancer ileal fistula surgery Lei Shaokui, deputy chief physician of Weng'an County People's Hospital in Guizhou Province, shared classic cases of clinical treatment of low rectal cancer
.
After admission, the patient was given complete blood routine, biochemical, coagulation function, virology, electrocardiogram, chest X-ray and other related examinations
.
Full-abdominal CT and whole-abdomen enhanced CT understand the surrounding conditions of the tumor and the presence or absence of liver metastasis, and exclude surgical contraindications
.
Later, laparoscopic radical resection of rectal cancer (Dixon operation) and ileal fistula were performed
.
After the operation, diet, somatostatin inhibits the secretion of digestive juice, nutrition, and supportive treatment are given
.
Hindgut function was restored, and the liquid diet was given without abnormalities and then gradually changed to a normal diet
.
▌ Case 5: A patient with advanced esophageal cancer undergoes surgery after neoadjuvant treatment, and Li Ruikai, deputy chief physician of the postoperative pathology pCR Chaozhou Central Hospital, shared a case of advanced esophageal cancer neoadjuvant treatment
.
The patient was treated with neoadjuvant therapy before the operation.
The treatment plan was: albumin paclitaxel 400mg + cisplatin 60mg d1 30mg d2+ tislelizumab 200mg, a total of 3 cycles of treatment
.
After 3 courses of neoadjuvant treatment, no obvious side effects were found.
The patient's swallowing obstruction and other symptoms were significantly improved.
The patient's various indicators were normal and the general condition was good.
The PS score was 0, and the mass was significantly reduced, which met the requirements of the operation.
, After radical resection of esophageal cancer, the pathology achieved pathological complete remission (pCR) after the operation
.
Gastrointestinal tumor tutor group focus on the issue.
For esophageal cancer, neoadjuvant immunization combined with chemotherapy after surgery, if R0 resection is performed, and pathology shows pCR, it is necessary to complete 4 to 6 courses of chemotherapy after surgery or just immunization Maintenance treatment? Professor Liu Jing shared his views: "According to the recommendations of relevant guidelines, the current standard treatment for locally advanced esophageal cancer is still concurrent radiotherapy and chemotherapy.
At this stage, treatment methods such as immunotherapy combined with chemotherapy are still being explored
.
Some patients are unable to tolerate problems.
Refusal to accept neoadjuvant radiotherapy, so clinicians may choose chemotherapy combined with immunotherapy
.
However, there is currently no large-scale phase III clinical study of neoadjuvant chemotherapy combined with immunotherapy.
In other words, there is no evidence-based medicine for this treatment.
Sufficient
.
If the patient achieves pCR after receiving this treatment, the follow-up treatment still needs to be individualized exploration
.
Personally, it is first necessary to judge whether the patient has a full course of treatment before surgery.
For the situation of the above case 5, it is recommended to give up chemotherapy after surgery.
The patient is given immune maintenance therapy alone, and we look forward to more follow-up related clinical studies
.
” For the patient of Case 5, Professor Zhang Xiaotian said: “In this case, the preoperative therapeutic effect of immunotherapy or chemotherapy plays a major role.
Still need to further judge
.
The
patient's postoperative treatment tolerance needs to be considered as a priority
.
It is worth noting that although the patient has reached pCR, there is still a risk of recurrence, so postoperative monitoring cannot be ignored either
.
"Accelerated Rehabilitation Surgery advocates early eating.
We encounter patients with gastrointestinal function not recovering in clinical work.
What aspects should we pay attention to? Professor Huang Chen said: "Before advancing accelerated rehabilitation surgery, we must accurately locate the path suitable for entering the clinical path.
Of patients, such as elderly or severely malnourished patients, are not suitable for accelerated rehabilitation surgical treatment concepts
.
In addition, for patients who adopt the concept of accelerated rehabilitation surgery, the gastrointestinal function cannot be recovered after the operation, the accelerated rehabilitation surgical treatment mode must be quickly reversed, and the routine perioperative treatment should be returned, such as fasting, intravenous nutritional support, Promote gastrointestinal motility and so on
.
"A basic view of the case of hepatobiliary and pancreatic tumors by primary doctors▌ Case 1: Immunization combined with chemotherapy for metastatic pancreatic ductal adenocarcinoma, with a median PFS of 8 months.
Han Chao, attending physician at Xintai City People’s Hospital in Shandong Province, shared a case of advanced pancreatic cancer with combined immunotherapy
.
the patients receiving natalizumab for Raleigh gemcitabine 200 mg + 1.
6 g d1,8 + oxaliplatin 150 mg d2 (every three weeks)
.
As of March this year, the patient has completed eight cycles of combination chemotherapy in immune, up Partial remission (PR)
.
The median progression-free survival (PFS) of this patient is as long as 8 months
.
Tirelizumab combined with chemotherapy provides clinicians with new treatment ideas and is expected to become a treatment for metastatic pancreatic catheters The first-line plan for adenocarcinoma
.
▌ Case 2: The treatment and thinking of immune pneumonia after lenvatinib combined with immunotherapy in the treatment of primary liver cancer Han Guangcheng, the attending physician of Jiaxiang County People’s Hospital in Shandong Province, shared the clinical treatment of primary liver cancer
.
The patient received lenvatinib combined immunotherapy (once every two weeks) for 13 cycles
.
The patient developed immune pneumonia after 6 cycles of PD-1 monoclonal antibody.
After treatment, the condition was relieved.
After 5 months, the immunotherapy was restarted
.
▌ Case 3: Practice and discussion of immunotherapy combined with chemotherapy in the treatment of advanced gallbladder cancer Huang Wulang, attending physician at Jinggangshan University Affiliated Hospital, shared a case of comprehensive treatment of advanced gallbladder cancer
.
The patient underwent a cycle of gemcitabine + cisplatin chemotherapy after surgery.
In the second cycle, the patient was unable to tolerate capecitabine single-agent oral chemotherapy due to bone marrow suppression and gastrointestinal symptoms
.
Relevant research results suggest that immune combined chemotherapy has broad application prospects in the treatment of gallbladder cancer
.
After discussion in the department, the patient was given a combined treatment plan of chemotherapy + radiotherapy + immunotherapy
.
The treatment plan is to continue capecitabine chemotherapy for 3 weeks; precise radiotherapy 12 times per cycle; tislelizumab 200 mg for 3 weeks
.
In the fourth course of chemotherapy and the second course of immunotherapy, the patient developed moderate anemia, leukopenia, and anorexia, and chemotherapy was stopped
.
Modification plan: tislelizumab 200mg, once every 3 weeks
.
At present, the patient has undergone 10 cycles of immunotherapy and 8 cycles of single-agent immunotherapy for nearly 10 months after surgery
.
The patient's general condition is normal, and the diet is normal; the weight has increased compared with the previous period, and the abdominal examination has no obvious positive signs; the tumor indicators are completely normal, and the reexamination of the abdominal CT indicates that the liver metastases are stable
.
▌ Case 4: Practice of clinical treatment of primary liver cancer Luo Jun, the attending physician of Dafang County People's Hospital in Guizhou Province, shared classic cases of clinical treatment of primary liver cancer
.
The patient underwent hepatic artery chemoembolization (TACE) for four cycles, and received sorafenib 0.
4 g orally twice a day.
Because of grade 3 hand-foot syndrome, the dose was adjusted to 0.
2 g orally twice a day , The maintenance treatment has been well tolerated by patients so far
.
▌ Case 5: Immune therapy for primary liver cancer, with definite curative effect, Wang Wenzhong, attending physician at Suixian Traditional Chinese Medicine Hospital, Shangqiu City, Henan Province, shared the use of immunotherapy for primary liver cancer cases
.
In response to the patient’s condition, the clinician first launched a multidisciplinary diagnosis and treatment (MDT).
The patient was stage IIIa, with a tumor larger than 10 cm combined with portal embolism, liver function Child B stage, and color Doppler ultrasound showed intraportal blood flow signals.
The opportunity for surgical resection has been lost, and TACE+ system treatment can be considered
.
Two weeks after surgery, he was given apatinib 250 mg, once a day + carrelizumab 200 mg, once every two weeks
.
After 1 year of treatment with apatinib + carrelizumab, the patient has a definite effect
.
Due to economic reasons, carrelizumab treatment was stopped, and oral apatinib treatment was continued
.
Later, because carrelizumab was added to the medical insurance reimbursement scope, the patient continued to receive carrelizumab + apatinib oral treatment, and is still under treatment with this regimen
.
The focus of the hepatobiliary and pancreatic tumor tutors group broadcast.
For patients with multiple and huge liver lesions, which account for ≥70% of the whole liver, how is the interventional treatment relatively safe? Professor Fang Weijia said: "For this patient, superselective embolization can be considered
.
If the patient is in Child B stage, hepatic artery infusion chemotherapy (HAIC) is relatively safer
.
The choice of HAIC and TACE is based on liver function
.
"What is the future application prospects of the ctDNA project for early screening of liver cancer? How does its sensitivity and specificity compare with traditional AFP and abdominal ultrasound screening? Can it be included in liver cancer guidelines in the future? Professor Gong Xinlei said: "Professor Xu Ruihua published The results of a clinical study of ctDNA methylation status for early diagnosis of liver cancer in the Nature publication show that the sensitivity and specificity of ctDNA is higher than that of traditional serum AFP detection, which is of great value for distinguishing liver cancer patients from chronic hepatitis patients
.
Of course, the ctDNA project also has the problems of high cost and high technical requirements
.
Looking forward to a larger sample of research in the future to strengthen its evidence-based medical evidence
.
"Immune pneumonia after the application of immunotherapy is relieved, how to evaluate the conditions or timing of reactivation of immunity? Considering the tailing effect of immunotherapy, how to adjust the treatment cycle after reactivation of immunotherapy? Professor Xue Junli shared: "Target The issue of immune restart raised in Case 2 of the Hepatobiliary and Pancreatic Special Session.
I personally think that the level that needs to be considered is the severity of the patient's immune-related adverse reactions (irAE).
If the patient has severe irAEs during the course of immunotherapy, the immune restart may be more serious.
High risk
.
Secondly, it is necessary to consider the patient's response to irAE treatment.
If the patient's irAE still persists and cannot be relieved after receiving treatment, the time point for immune restart will be postponed indefinitely
.
In addition, the level that clinicians need to consider is the choice of drugs to control irAE.
Patients have not been able to effectively control irAE during previous treatment, which means that the choice of drugs within the range of available drugs will be greatly reduced
.
In this case, there is a higher risk of immune restart
.
"Finally, the level to be considered is the patient's personal wishes.
If the patient's personal wishes are not strong, the value of immune restart is not high
.
As for the tailing effect of immunotherapy, whether it is necessary to extend the treatment cycle after restarting immunotherapy is currently not supported by evidence-based medical evidence
.
"What are the common adverse reactions of PD-1 drugs and treatment methods? Professor Shi Yan analyzed: "Clinicians need to strengthen and broaden the management awareness of patients with irAE.
Secondly, clinicians need to establish a good communication relationship with patients before treatment.
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Furthermore, evaluation and monitoring after medication is essential
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It is worth mentioning that the patient's discomfort such as fatigue with no obvious cause may be a'signal' that prompts the patient to have irAE
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"Which grassroots doctors are out of the two major sessions? First prize in the digestive tract tumor special session: Cheng Jianbo from Fufeng County People's Hospital-Colon cancer treatment case Second prize: Chaozhou Central Hospital Li Ruikai-Neoadjuvant clinical treatment of esophageal cancer Shouguang Fu Jingyi, City People’s Hospital-Talking about a case of gastric cancer clinical treatment third prize: Zhang Jianxin, Shanting District People's Hospital, Zaozhuang City-Treatment of advanced esophageal cancer cases, Lei Shaokui, People's Hospital of Weng'an County, Guizhou-Clinical treatment of low rectal cancer Hepatobiliary and Pancreatic Tumor Special Session First Prize: Han Chao, Xintai People's Hospital, Shandong Province-A case of advanced pancreatic cancer immunotherapy Second Prize: Jiaxiang County People's Hospital, Shandong Province Han Guangcheng-Clinical Treatment of Primary Liver Cancer Cases Guizhou Province Dafang County People’s Hospital Luo Jun-the third prize for clinical treatment of primary liver cancer disease: Huang Wulang, Affiliated Hospital of Jinggangshan University-a case of comprehensive treatment of advanced gallbladder cancer shared with Wang Wenzhong from Sui County Hospital of Traditional Chinese Medicine-immunotherapy of primary liver cancer case Congratulations to the above-mentioned grassroots doctors.
I would like to stay true to my original aspirations and forge ahead
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