11.Under what circumstances should chemotherapy be proactive and under what circumstances should it not be too aggressive? Today’s chemotherapy has moved from the previous palliative treatment to radical chemotherapy, that is, some tumors can be cured by chemotherapy, these tumors include: malignant lymphoma, choriocarcinoma, testicular cancer, childhood leukemia, neuroblastoma, rhabdomyosarcoma, etc. Whether it is preoperative, postoperative or recurrence, chemotherapy for these tumors should be proactive, otherwise the chance of cure will be lost. In addition, for tumors that have been proven to improve survival with postoperative adjuvant chemotherapy, such as premenopausal breast cancer, osteosarcoma, testicular tumors, etc., postoperative chemotherapy has an important position, otherwise it is difficult to cure once there is dissemination, so chemotherapy also needs to be active. There are also some tumors that cannot be cured by chemotherapy but can significantly improve clinical symptoms and prolong survival, such as multiple myeloma and advanced breast cancer, etc. As long as patients can tolerate the treatment, chemotherapy should also be active. Wen Bingji, Department of Medical Oncology, 113th Hospital of the Chinese People’s Liberation Army, chemotherapy is not suitable for all tumor patients. For those whose general condition is too poor, abnormal liver and kidney function, obvious anemia, leukocyte and platelet reduction, infection and fever, and cardiomyopathy, chemotherapy should be cautious, because chemotherapy drugs are poorly selective, and while killing tumor cells, they have different degrees of toxicity to various tissues and organs, which is undoubtedly to those organs that are already dysfunctional. This will undoubtedly add to the problem of organ failure. In addition, patients who have relapsed after multiple courses of radiotherapy and chemotherapy should also be careful with chemotherapy, usually these patients have used many chemotherapy drugs and have developed certain resistance, and the tolerance of bone marrow function, liver and kidney function has decreased. Some tumors are not sensitive or even resistant to chemotherapy, such as primary liver cancer, pancreatic cancer, etc. The effect of conventional chemotherapy is poor, and it is not advisable to be too aggressive in chemotherapy for such patients, otherwise they will get less benefits and more toxic side effects. 12.What are the criteria for evaluating the efficacy after chemotherapy for solid tumors? The criteria for evaluating the efficacy after chemotherapy for solid tumors are: complete remission (CR), partial remission (PR), stability (S) and progression (P); CR is the complete disappearance of all visible lesions maintained for more than 4 weeks; PR is the reduction of the product of the double diameter of the mass by 50% (or the sum of the single diameter by 30%, RECIST standard, the same below) or more, maintained for 4 weeks; P is the increase of one or more lesions by 25% (or the sum of the single diameter by 20%) or more, or the increase of the single diameter by 20%. P is one or more lesions increased by more than 25% (or total increase of single diameter by 20%) or new lesions appeared; S is between PR and PD. Clinical efficiency is the number of people who achieved CR and PR as a percentage of the total number of people treated, and clinical control rate is the number of people who achieved CR, PR and SD as a percentage of the total number of people treated. The ability to achieve CR or PR after chemotherapy for solid tumors is an indicator of effective lesion control, but there are many patients who have no significant change in lesion size after chemotherapy, but the tumor-related symptoms, such as pain and fever, have significantly reduced or disappeared, and the patient’s general condition has improved and the quality of life has improved, which is also a sign of tumor control. For patients with advanced tumor, more emphasis is placed on improving patients’ quality of life. As long as there is no fatal damage to important organs, some patients can survive with tumor for many years. 13.What is adjuvant chemotherapy and what is its importance in tumor treatment? Before and after surgery or radiotherapy for solid tumors, chemotherapy is applied to shrink the primary tumor and eliminate the tiny metastases that may remain, so as to reduce the recurrence and metastasis of tumors and improve the cure rate. It is divided into preoperative chemotherapy (neoadjuvant chemotherapy), intraoperative chemotherapy and postoperative chemotherapy. Adjuvant chemotherapy is very important to improve the cure rate and prolong the survival of tumor patients. The treatment of solid tumor is mainly based on surgery, but even if many tumors are radically resected or even enlarged, some patients will still have recurrence and metastasis after surgery, and current research believes that before the primary tumor is resected, tumor cells are continuously shed into the blood circulation and distributed throughout the body with blood flow, most of which are eliminated by the body’s immune defense function, but a few remain in the body and regrow under certain environmental conditions, becoming the source of recurrence. Most of them are eliminated by the body’s immune defense function, but a few remain in the body and grow again under certain environmental conditions, becoming the source of recurrence. Therefore, after the elimination of local lesions by surgery or radiotherapy, if combined with systemic chemotherapy, it can eliminate as many remaining tumor cells in the body as possible with a small tumor load, reduce recurrence, improve the cure rate and prolong the survival period. The results of adjuvant chemotherapy in clinical application also fully prove this point. 14.When should preoperative adjuvant chemotherapy be performed? Preoperative adjuvant chemotherapy, also known as neoadjuvant chemotherapy, refers to the application of chemotherapy before surgery to shrink the tumor, reduce and eliminate the subclinical cancer cells around the tumor, increase the chance of surgical resection or reduce the scope of surgical resection, and also eliminate the possible distant micro-metastases and reduce the chance of recurrence and metastasis. Preoperative chemotherapy has been applied to stage II and III breast cancer, stage IIIa non-small cell lung cancer, and osteosarcoma, and has achieved positive efficacy. For example, for stage IIIa non-small cell lung cancer, which refers to locally advanced stage with ipsilateral mediastinal and inferior ramus lymph node metastasis, it is very difficult to cut the lymph nodes in such patients and the 5-year survival rate after surgery is very low. In foreign countries, 2-3 cycles of chemotherapy are used first to shrink the tumor and then surgery, which improves the surgical resection rate and has certain benefits for long-term survival. The treatment effect is the same as that of radical surgery, and the aesthetic appearance of the breast is preserved. 15.When should intraoperative adjuvant chemotherapy be performed? During resection surgery, chemotherapy drugs are injected directly into the tissues adjacent to the tumor and the lymph node areas to eliminate potential microscopic cancer foci or chemotherapy-sensitive tumors. Intraoperative chemotherapy is less commonly used in clinical practice, and its benefits are still inconclusive. Some authors reported that intraoperative fluorouracil was given intraoperatively to patients with pancreatic adenocarcinoma in the tumor bed and lymph node bed, while systemic fluorouracil was given intravenously by drip, and it was found that the 3- to 5-year survival rate of intraoperative chemotherapy was significantly higher than that of the surgery-only group. 16.When should postoperative adjuvant chemotherapy be performed? Postoperative adjuvant chemotherapy refers to the application of chemotherapy after surgical resection of tumor to destroy possible distant metastases and improve the cure rate. For example, in the past, osteosarcoma was often treated by surgery alone, and many patients had recurrence and metastasis soon after surgery, and the 5-year survival rate was only 10%. In addition, for colorectal cancer patients with lesions invading the plasma membrane and lymph node metastasis, the treatment with fluorouracil plus levamisole for one year after surgery can reduce the recurrence rate by 41% and mortality rate by 33%, and this treatment has become the routine treatment for postoperative colorectal cancer. Tumors for which postoperative adjuvant therapy has been confirmed to improve the cure rate include breast cancer, colorectal cancer, osteosarcoma, testicular tumors, and certain soft tissue sarcomas (e.g. rhabdomyosarcoma). There are also some tumors for which the efficacy of postoperative adjuvant chemotherapy is still uncertain, but if the lesions are extensive at the time of surgery, the tumor invasion is deeper and the lymph nodes have metastasis, postoperative chemotherapy should also be considered, such as non-small cell lung cancer, gastric cancer, etc. 17.Why chemotherapeutic drugs can cause immune deficiency, what are the clinical manifestations and what should be done? Chemotherapeutic drugs are not strong in selective inhibition, and they have certain toxicity to some normal immunologically active cells, such as granulocytes, lymphocytes and macrophages, while killing tumor cells, and also to normal proliferating epithelial cells, such as gastrointestinal epithelial cells and germ cells. All these lead to low immune function of the body. The use of chemotherapeutic agent cyclophosphamide to suppress immune rejection during organ transplantation also indicates that chemotherapeutic agents can suppress the immune function of the body. Immunocompromise is often clinically manifested by poor appetite, fatigue, weakness, and susceptibility to infectious diseases, such as viral colds, herpes zoster, bacterial infections of the respiratory, gastrointestinal, and urinary tracts, etc. Immune function tests may reveal decreased activity of macrophages, natural killer cells, and abnormal T4/T8 ratio. Immune function depression caused by chemotherapy drugs can be gradually recovered after stopping the drugs. Chinese herbal medicine and biological response modifiers can help a lot to promote the recovery of the body’s immune function. During the rest period of chemotherapy, patients can take supportive herbs and apply some immune regulating agents, such as thymidine and immune ribonucleic acid, which can help the immune function to recover. 18.Does the drug that costs more money have to be a good drug? In fact, this is a very simple question, the drugs that cost more money are not necessarily good drugs. Why do some people think that drugs that cost more are good drugs? We think it may be that they are not very clear about the concept of good drugs. From a doctor’s point of view, a drug that can really treat a disease with few side effects and is inexpensive is a good drug, and the price of the drug does not affect its efficacy. If someone has lobar pneumonia, then the first drug of choice for treatment should be penicillin. It is the good drug. Because it is safe, effective and reasonably priced. If you choose expensive drugs like Fotaxin or Bacteria Bacteria, although they can also cure the disease, they are not as good as penicillin in terms of their performance to price ratio. The same is true for the treatment of tumors. Only those that are effective for a certain tumor, have little toxic side effects and are reasonably priced are considered good drugs. In the treatment of malignant lymphoma, the more effective drugs are cyclophosphamide, vincristine, prednisone and adriamycin, etc. These drugs have relatively small toxic side effects and are reasonably priced, so doctors consider them to be good drugs, but if tylosin is used to treat Hodgkin’s disease, even though it is expensive, it is not considered a good drug because of its poor effect and obvious side effects. However, the treatment of breast cancer with Tysol is considered to be a better drug because of its outstanding efficacy. The price of the drug is determined by a number of factors. Newly released drugs are more expensive and imported drugs are more expensive as time goes by. The clinical value of the drug is obtained through years of practice, and it will not change because of the adjustment of the price of the drug. When choosing drugs, you should “choose the right one, not the expensive one”. 19.What kind of diet is good during chemotherapy? Tumor patients have many adverse reactions due to chemotherapy, most of which are loss of appetite, loss of taste and abnormal taste. If accompanied with nausea and vomiting, the digestion and absorption will become more problematic, and if no timely measures are taken, malnutrition will occur and the patient will lose weight. Resistance is reduced, leading to infection and even the development of cachexia. Therefore, in chemotherapy, special attention should be paid to diet, reasonable nutrition, adequate nutrition, in order to improve the body’s tolerance to chemotherapy, to ensure the successful completion of chemotherapy and promote recovery. The quality and quantity of nutrition, the form of diet and the way of supply are determined according to different treatments (different chemotherapeutic drugs) and the changes of the patient’s body condition, especially the digestive system. The diet for tumor patients includes common rice, soft rice, semi-runny juice and runny juice, which are supplied according to the patient’s specific condition and digestion and absorption ability. For chemotherapy patients, the food can be seasoned, such as sweetness and freshness to stimulate appetite. On the day of chemotherapy, breakfast is eaten earlier and dinner is eaten later, so that the time in between can reduce nausea and vomiting. If necessary, eat less and more meals. During chemotherapy, attention should also be paid to the planned intake of adequate calories and nutrition. Eat meat, eggs, milk, fish and soy products and other nutrient-rich foods; eat a diet rich in vitamin A and C, such as green vegetables and fruits; do not eat too hot, too hot, too hard and moldy, smoky food; constipated patients should eat laxative foods such as bananas, honey, etc. (except for diabetics). 20, with chemotherapy drugs to “taboo”? As the saying goes: “grains and cereals can not be biased, coarse and fine meal to ensure peace. Many patients and family members have raised the issue of dietary contraindications, in Western medicine that there is no need to avoid food, eat whatever you want, but the diet should also vary from person to person, depending on the disease and treatment, pay attention to adjust the diet structure. Chemotherapy patients more nausea, vomiting, thirsty and disturbed, it is appropriate to eat more fruits, watermelon and other cool and healthy stomach, thirsty food, should not eat too much spicy and greasy things. It is better to eat lighter food. Some chemotherapy drugs (such as 5-fluorouracil) can cause diarrhea, so it is not suitable to eat cold food and fruits at this time. Generally speaking, cancer patients should have a high-protein, high-calorie and high-vitamin diet, and diversify their recipes to supplement the consumption of chemotherapy.