Mid-Autumn Festival of Guangzhou Fuda Cancer Hospital’s surgeons: Being on duty and rescuing patients

Vacation is valuable, but life is more precious comparatively. With doctors’ perseverance and dedication, patients can reunite with family and enjoy their happy time. We have to express our gratitude to doctors: Thanks for your hard work!

Dr. Niu Lizhi, director Zhu Weibing and other medical staff were rescuing patient at operation room.

Mid-Autumn Festival, to most people, it’s a day for family’s reunion. With a full moon hanging in the sky, family sits around the table and enjoys the happiness of reunion satisfactorily. However, to doctors, it’s just a normal day. Even it means being on duty and rescuing patients.

 

Recently, an article named “Warmest Story at Mid-Autumn Festival' was spread in doctors’ friend circle. The story was about a doctor Xiao Bai who still stuck to his post at Mid-Autumn Festival, which was sincere and moving.

 

At operation room of Guangzhou Fuda Cancer Hospital, a moving scene was witnessed at the same day…

 

In the morning of September 15, director Zhu Weibing who hasn’t had vacation for a long time was about to go hike during Mid-Autumn Festival holiday. The routine was scheduled. When he was going to leave, an urgent call made him rush to hospital.

 

In the ICU, a Malaysian patient with intestinal lymphoma hospitalized at FUDA’s condition became worse with obnubilation suddenly. When the doctor visited the patient checked patient’s situation, he called Zhu Weibing immediately.

 

Zhu Weibing has forgotten how many holidays were spent at first aid room. He recalled that he has never enjoyed Mid-Autumn Festival Holiday since it’s carried out.

 

At mean time, like usual, president Niu Lizhi still changed shift and made ward round. He has been used to it that every holiday is duty day.

 

After checking patient’s condition, Niu Lizhi and Zhu Weibing realized the severity of patient’s state immediately. “Perform operation right away!” Because symptoms like mental confusion, incontinence and low index of oxygen saturation and so on showed in the morning of that day, doctors decided to perform operation at once after discussion.

 

Time is life. Preparatory work was completed intensely. While communicating with patient’s family and telling them the risks of the operation, patient was having abdomen CT scan.

 

The result showed that patient’s abdomen was full of effusion. Therefore, doctor conducted drainage through catheter for him. But the most serious condition is that patient’s colon was rupturing. Waste leaked in abdomen, which had to be cleaned immediately.

 

Zhu Weibing informed medical staff of operation room urgently. Related doctors and nurses on the duty and on vacation went back to their work within the shortest time without any complaint.

 

At 3 p.m., patient received anesthesia, and the operation was started. Niu Lizhi, Zhu Weibing and other medical staff were fighting for life like usual.

Medical staff was visiting the patient.

After 5 hours, it’s 8 p.m. When every family was lighting the lantern and appreciating the full moon, surgeons of Fuda Cancer Hospital finally finished the operation. The patient was out of danger and everyone felt relieved.

Getting down from the operating table, director Zhu Weibing felt thirsty and wanted to drink some juice, but all stores were closed. “Being a surgeon was hard and busy, but I has been used to it from several decades. Since I chose this job, I have to work hard.”

 

We can stand endless overtime just for conscience and responsibility. The oath of Hippocrates we took is not lie. Once we took, we will remember for life.

 

“Today if we enjoy Mid-Autumn Festival holiday, patients can’t enjoy their Mid-Autumn Festival. As a doctor, saving patients is my responsibility and mission. It’s our greatest relief to watch patients being rescued. ” President Niu Lizhi said. From his eyes, we saw a bit regret. He was sorry for he couldn’t spend time with family and said, “It’s work. I have no choice! Compared with family, patients need us more at such moment.”

What Should Be the Alternative When Cancer Is Unresectable?

Introduction to the conference

With the purpose of further standardization and promotion of minimally-invasive ablation treatment for cancer, China Forum on Ablation Therapy in conjunction with the 3rd China Forum on Embolization Therapy was convened from August 4th to 7th, 2016, in Tianjin, together with the establishment of Ablation Expert Committee at the same time. Apart from well-known experts and scholars abroad, the conference also brought together specialists from varying medical fields including epidemiology, surgery, medicine, radiotherapy, medical imaging, pathology to address on new technologies and concepts. Prof. Niu Lizhi, president of Fuda Cancer Hospital affiliated to Jinan University School of Medicine, upon the invitation, delivered a keynote speech titled New Minimally-invasive Treatment of Pancreatic Cancer- Argon-Helium Cryosurgery and NanoKnife Therapy (irreversible electroporation).

Ablation therapy brings a new hope for cancer patient

It is statistically shown that nearly one-third of families in China might be threatened by cancer in the next decade. More seriously, 80% of cancer patients are already at advanced stage upon the first diagnosis, leaving them no opportunity of having surgical resection, for lacking in awareness of tumor prevention. In such a case, how to improve the survival rate and life quality of cancer patients has become an important issue in today's medical field.

Surgical resection, chemotherapy, radiotherapy are the three conventional treatments for cancer, which, however, are only effective in 20%-30% cancer patients. With the development of imaging technology, interventional oncology has already become one of four “pillars” in cancer treatment.

Prof. Niu Lizhi pointed out that interventional treatment, the fastest developing ablation treatment today, includes thermal ablation (Radiofrequency, microwave) and cold ablation (cryoablation and liquid nitrogen); irreversible electroporation (NanoKnife) is neither cold nor hot special technique; there are some technologies in development, such as laser, focused ultrasound etc.

Ablation therapy can not only bring hope for those middle-advanced cancer patients with urecsectable tumor, but can also achieve the same curative effect as surgery in treating some early-staged cancers, like liver cancer, kidney cancer and prostate cancer.

Different types of ablation technology are applicable to different tumors, for example, thermal ablation including RF, microwave are mainly used for treating liver cancer, while cryosurgical ablation are more suitable for prostate and kidney cancer; NanoKnife with the advantage of being neither hot or cold stands out as a preferential treatment for pancreatic cancer which is particularly intolerable to thermal ablation.

Local ablation has advantages in treating pancreatic cancer 

The modern cryosurgical ablation represented by argon-helium technology emerging in the last 20th century together with IRE (irreversible electroporation, namely, NanoKnife) that rapidly developed in recent years both brings a new hope of life to cancer patients with inoperable tumor.

Prof. Niu Lizhi highlighted the advantage of cryoablation and NanoKnife in treating pancreatic cancer in his speech. 

In recent years, pancreatic cancer morbidity dramatically rises in China and many other Asian countries and regions, along with the change in dietary structure (meat takes up increasingly higher proportion in resident's dietary) and living environment, etc.

Surgical resection, as the primary option in treating pancreatic cancer (regarded as the king of cancer), is however rarely applied in real terms for the late detection. And chemotherapy, as another optional treatment, is insensitive to pancreatic cancer in practical terms. In recent years, Fuda Cancer Hospital conducted a series of treatments including argon-helium cryotherapy, NanoKnife effectively treating numerous middle-advanced stage cancer patients, and basically achieved its aim at controlling tumor progression, improving life quality and prolonging survive time.

Prof. Niu Lizhi introduced that Fuda Cancer Hospital took the lead in developing Nanoknife therapy in Mainland China in July 2015, and it was also the first hospital to report preclinical study of Nano-knife ablation on pancreatic cancer, which proves that NanoKnife makes no destruction on bile duct, portal vein and other important intracorporal organs (see Journal of Interventional Radiology, 2015).

In addition, Fuda Cancer Hospital has already published seven papers on NanoKnife therapy for pancreatic cancer in US Pancreas-the world’s most authoritative journal in the field of pancreas.

Up to now, Fuda Cancer Hospital has performed NanoKnife ablation on over 140 cancer patients, and half of those patients are pancreatic cancer patient.

During the 5th International (Guangzhou) Forum for Cancer Treatment held on Jul. 2nd, 2016, two IRE procedures were live broadcast. The surgeon was Prof. Niu Lizhi. One of these two patients, a 55-year old Hong Kong SAR resident, had repeated fever and abdominal pain since early 2016. After inspected, he was found a tumor measuring about 3.8cm in pancreatic tail and diagnosed with pancreatic cancer. On the live broadcast, Prof. Niu performed IRE on the pancreatic tumor under the guidance of ultrasound and CT scan. The procedure went successfully and intraoperative bleeding was only 2ml, which greatly wowed all the guests present.

Prof. Niu Lizhi pointed out that Nanoknife has more advantages compared with other ablation technologies. For example, it is selective for tissue ablation, which damages cells rather than vascular walls, nerves, bile ducts, intestinal canal and so on. The ablation procedure can be displayed by ultrasound, CT or MR, ensuring that ablation effect was to the best therefore. Therefore, Nanoknife ablation, especially applicable to the tumor around great vessels, hepatic hilus, gallbladder, bile duct and ureter, shows unique advantages in treating pancreatic and liver cancer.

The development of brachytherapy in China gained the world’s attention

By Dr. Niu Lizhi  executive president of Jinan University School of Medicine affiliated Fuda Cancer Hospital

June 28th, 2016, the second day of the 2016 ABS World Congress-American Brachytherapy Society, was the time for Chinese experts to demonstrate the development of brachytherapy in China. The congress has witnessed the speeches of over 10 Chinese medical experts and 20 wall posters. The original research in China has gained the word’s attention. In particular, the scientific literacy and Englishproficiency of Chinese doctors are inspiring. I firmly believe that the development of brachytherapy for cancer holds a bright future in China.

                   CIBS members and chairman of the congress

On the same day, Prof. Zhang Fujun, Prof. Wang Junjie and Prof. Zhang Jianguo from Interventional Brachytherapy Branch, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-cancer Association established official relations with ABS, which has for the first time secured China’s Brachytherapy Society’s place in the world arena. It is fair to say that the day is a milestone in the history of brachytherapy in China.

Expert meetings

ABS World Congress-American Brachytherapy Society and CIBS held their first official meeting in San Francisco on June 28th, 2016. Prof. David Gaffney, incumbent chairman of ABS/WCB, Prof. Steven Frank, former chairman of ABS/WBC, Secretary Ms. Cate Yashar, CFO Firas Mourtada, the executive director Mr. Rick Guggolz met the incumbent chairman Prof. Zhang Fujun, former chairman Prof. Wang Junjie, vice-chairman Prof. Zhang Jianguo, after-loading therapy expert Prof. Cheng Guanghui of Interventional Brachytherapy Branch, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-cancer Association and discussed matters, including cooperation, exchange visits, young doctor training, etc.

Prof. Wang Junjie delivered a speech titled “China Brachytherapy Update-Current Situation & Prospectives”, introducing to the audience the status quo of Brachytherapy in China, 3D Printing Individual Templates Guided Brachytherapy and technology promotion. Prof. Zhang Fujun briefed to the participants the achievements made in the field of brachytherapy in China in the past ten years and more, especially the innovations made in radioactive particle stent and 3D printing.

Experts from other countries spoke highly of the innovation spirit of Chinese doctors shown in developing radioactive particle stent, 3D printing and rapid degradation particle chain and have tentatively reached an accord that a special session on seed implantation therapy will be set up for Chinese experts at the next session of forum to be held in Boston in April 2017. Moreover, several leaderships and experts from foreign Societies will be invited to attend China Academic Conference on Seed Implantation for Cancer or China Congress of Brachytherapy for enhanced communication and understanding to make World Congress of Brachytherapy to be held in China.

Congress summery

June 28th, 2016 was the day for Chinese experts to demonstrate the development of brachytherapy in China. At the congress, 10 delegates from Chinese delegation delivered speeches and 20 wall posters were put up, which have gained the word’s attention. In particular, the scientific literacy and Englishproficiency of Chinese doctors are quite inspiring.

Prof. Niu Lizhi, Jinan University School of Medicine affiliated Fuda Cancer Hospital delivered a speech and had his paper posted

At the congress, several Chinese experts showed to the participants the research on radioactive seeds for solid tumors. Prof. Wang Juan from Hebei General Hospital reported the research on radioactive seeds implantation therapy for retroperitoneal tumor. Prof. Li Yuliang from the Second Hospital of Shandong University reported the research on seed implantation therapy for pancreatic cancer. Prof. Niu Lizhi from Jinan University School of Medicine affiliated Fuda Cancer Hospital reported radioactive seeds implantation therapy for cardiac tumor and pancreatic tumor. In addition, the reports delivered by experts from Tianjin Medical University, Jiangsu Province Hospital, Chinese PLA General Hospital have gained extensive attention from the participants.

In recent years, China has made significant development in the field of radioactive seeds implantation therapy for cancer. The innovative research and superb achievement made by Chinese experts can be shown in the following aspects:

1、Seed chain

An US study shows that when it comes to seed implantation in the prostate cancer, the rate of seed displacement to lung by using particle chain is much lower than that of chainless seed implantation. Moreover, using particle chain has guaranteed the uniform distribution of the seeds and the dosage also, which is the main reason why doctors from the US give preference to particle chain. The degradation of particle chain needs 90 days. In comparison, the degradation of particle chain material, a patent owned by Prof. Zhang Fujun from China only takes 10 days. Medical experts showed great interest in the new material, hoping that Prof. Zhang Fujun could commercialize it in the shortest term.

2、MR

The focus of the current session of conference is that many hospitals in the US have been performing brachytherapy under MR guidance especially for pelvic organ tumors in that MR is the most accurate imaging examination for pelvic organs, such as prostate, uterine neck, rectum and anus. Brachytherapy for tumors in these organs requires precise positioning. MR-guided brachytherapy has just started in China. Prof. Li Chengli from Shandong Medical Imaging Research Institute is an authoritative expert in MR-guided brachytherapy. We believe with his effort, MR-guided brachytherapy will be more and more widely used in China.

3、Brain tumor

An American hospital carried out a research where radioactive seeds are inserted into the surrounding tissue after primary brain tumor resection in order to prevent tumor recurrence. The research showed that radioactive seed implantation in the surrounding tissue after primary tumor resection can reduce the recurrence rate of tumor. Prof. Hu Xiaokun, chairman of Image Technology Branch, Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-Cancer Association, has made remarkable achievement in the field of seeds implantation for brain tumor. Regrettably, he didn’t make it to attend the current session of congress. We hope he could attend the next session of congress to show to the world his research achievement.

Indian experts carried out research on radioactive seeds for head and neck tumor

4、Head and neck tumor

Head and neck tumor are the tumors of the highest incidence rate in India. The application of high dose rate Iridium-192 has achieved good curative effect as it is shown in the pictures below. The team of professors represented by Prof. Zhang Jianguo has made the most brilliant achievement in the field of brachytherapy for head and neck tumor. The clinical result and research achievement in brachytherapy for neck and head tumor are leading the world and have gained the attention of the participating experts.

      Indian experts carried out research on radioactive seeds for head and neck tumor

5、Vertebral tumor

Vertebrae are the most common site of metastases. Applying radioactive I-125 seeds implantation on metastatic vertebral tumor after failure of radiotherapy or when radiotherapy is not applicable is the innovation made by Chinese medical experts. Both team of professors represented by Prof. Wang Junjie from Peking University Third Hospital and team of professors represented by Prof. Huang Xuequan shared with the participants their experience and research on radioactive seeds for vertebral tumors, the good therapeutic effect of which has gained the attention of foreign experts.

6、Lung cancer

At the current session of forum, the only research report on brachytherapy for lung cancer was made by the team of professors represented by Prof. Zhang Fujun from Sun Yat-sen University. They reported the significant efficacy of radioactive I-125 seeds implantation for metastatic lung cancer and primary and unresectable lung tumors as well as the significant increase of local control rate and prolongation of survival time. The study was published in Radiology-the top magazine in interventional treatment. 

7、Radioactive seeds stent

The team of professors represented by Prof. Guo Jinhe from Southeast University reported the research results of animal experiment and clinical studies on radioactive seeds stent for tracheal-caused stenosis. The strategy has not only solved the problem of tracheal stenosis but also enabled the radioactive seeds to treat cancer, which has prevented tumor recurrence and effectively prolonged the survival time of cancer patients. The study was published in the well-known magazine Lancet Oncology.

Low-dose-rate seed VS high-dose-rate seed: each has its own strength

In the US, high-dose-rate seeds (including Palladium-103, Iridium-192) are used to treat solid tumors, prostate cancer excluded. High-dose-rate seeds can be taken away within a short period of time after radiating the tumor tissue, which can be classified into temporary seed implantation. In comparison, low-dose-rate seeds have to be implanted in the tumor for a long term, which falls into the category of permanent seed implantation. The advantages of temporary seed implantation are short irradiation time and good short-term effect though it also has its downside. Prof. Wang Juan from Hebei General Hospital noted that the protection of high-dose-rate seed is more difficult than that of the low-dose-rate one, which better suits Chinese condition. The advantage of low-dose-rate is that the total irradiation dosage can be increased. According to research from Japan, good tolerance is noted when prostate cancer patients were given I-125 seeds implantation, the radioactivity of which is up to 200GY. It also shows the safety of low-dose-rate seed implantation.

In a nutshell, both low-dose-rate seed and high-dose-rate seed have their own strength and are suitable for different tumors. We hope that seeds with different dose rates will be available for cancer patients in China.