Background Gallbladder cancer (GBC) is an uncommon malignancy with high recurrent rate and poor prognosis. This study investigates the recurrent patterns of postoperative GBC, with the aim to guide the adjuvant treatments, including the radiotherapy. Methods Retrospectively analyzed the 109 GBC patients who underwent surgery in our institution from January 2013 to 2018. Clinical follow-up revealed 54 recurrent cases, of which 40 had detailed locations of recurrence. The sites of recurrence were recorded and divided into the tumor bed, corresponding lymphatic drainage area, intrahepatic recurrence, and the other distant metastasis. Results The median follow-up time is 34 months (IQR: 11–64). The median disease-free survival (DFS) and overall survival (OS) were 48.8 months and 53.7 months, respectively. Through univariate analysis, risk factors for DFS and OS include tumor markers (CA199 and CEA), hepatic invasion, perineural invasion, lymphovascular invasion, TNM staging and tumor differentiation. Through multivariate analysis, risk factors for DFS include hepatic invasion and TNM staging, and for OS is TNM staging only. Of the 40 cases with specific recurrent sites, 29 patients (29/40, 72.5%) had recurrence in the potential target volume of postoperative radiotherapy (PORT), which include tumor bed and corresponding lymphatic drainage area. The common recurrent lymph node groups included abdominal para-aortic lymph node (No.16, 15/29), hepatoduodenal ligament lymph node (No.12, 8/29), retro-pancreatic head lymph node (No.13, 7/29) and celiac axis lymph node (No.9, 4/29). Twenty cases with recurrences inside the potential PORT target volume were accompanied by distant metastasis. Another 11 cases had distant metastasis alone, so totally 31 cases developed distant metastasis (31/40, 77.5%), including 18 cases with hepatic metastasis. Conclusion The recurrence and metastasis rates are high in GBC and adjuvant therapy is needed. Up to 75% of the recurrent cases occurred in the potential target volume of postoperative radiotherapy, suggesting that postoperative radiotherapy has the possible value of improving local-regional control. The potential target volume of radiotherapy should include the tumor bed, No.8, No.9, No.11, No.12, No.13, No.14, No. 16a2, No. 16b1 lymph node groups.

The pathogenesis, clinical phenotype, treatment strategy, and family management of hereditary tumor syndromes are different from those of sporadic tumors. Nearly a quarter of patients with colorectal cancer show significant familial aggregation and genetic predisposition, and 5 to 10% are associated with definite genetic factors. According to the clinical phenotype, it can be divided into nonpolyposis syndrome and polyposis syndrome. Among the polyposis syndrome patients with definite clinical symptoms, there are still some patients with unknown etiology (especially attenuated familial adenomatous polyposis), which is a difficult problem in clinical diagnosis and treatment. Therefore, for this rare disease, it is urgent to carry out multicenter studies, complete the gene variation spectrum, explore new pathogenic factors, and accumulate clinical experience. This article mainly introduces the research progress and related work of colorectal polyposis syndrome in China.

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Background As the standard practice of our institution, 60Gy is prescribed to PGTV and 54Gy to PTV in the radical radiotherapy of non-small cell lung cancer (NSCLC). We estimate whether this practice could achieve similar tumor control, and protect lymphocyte at the same time. Methods Failure patterns of 46 stage III NSCLC patients received radical radio-chemotherapy were analyzed. Target delineation criterion were as follows: GTV include primary tumor and involved lymph nodes, PGTV expanded from GTV with 5-8mm to compensate for genomic uncertainty. CTV include high-risk area, PTV was extended from CTV with set-up error. 60Gy was prescribed for PGTV, 54Gy for PTV over 30 fractions. The relationship between lymphopenia during radiotherapy and dose-volume parameter was evaluated using Spearman’s correlation analysis. Results With median follow-up of 21.06 months, 22 local-regional recurrence were evidenced, 13 patients have in-field recurrence, one patient failure marginally, and the other 8 patients have out-of field recurrence. Lymphocyte is the most sensitive cell to radiation, lymphopenia during radiotherapy was associated with both PTV(r = 0.489, p = 0.003) and PGTV(r = 0.313, p = 0.076), with larger volume predicted severe lymphopenia. In addition, we observed Lung V(5), V(10) and most of heart or aorta DVH parameters (from V10-V50) are important predictors for lymphocyte nadir. Conclusions Delivered 54Gy to subclinical lesions does not compromise marginal recurrence risk, at the same time lower severe radiation-induced lymphopenia risk. This finding supports further exploration of dosage reduction to CTV in locally advanced NSCLC.