放疗同期IP方案化疗治疗局部晚期食管癌临床研究

目的 探讨放疗同期IP方案化疗治疗局部晚期食管癌的临床疗效及毒性反应.方法 将68例局部晚期食管癌患者随机分为IP方案同期放疗组(研究组)35例和单纯放疗组(对照组)33例.两组放疗均采用常规分割放射治疗,总剂量60 Gy.化疗采用放疗第1天开始伊市替康(国产艾力):第1、8天65 mg/m2静脉点滴;DDP:第1、8天30mg/m2静脉点滴,每21天为1周期,共4周期.结果 研究组治疗晚期食管癌缓解率(91.4%)明显优于单放组(66.7%),两年总生存率及一、二年的无疾病进展生存率前者也明显好于后者,具统计学差异(P<0.05).IP方案组恶心呕吐、骨髓抑制(白细胞减少)和腹泻的发生率高于单放组.结论 IP方案化疗同期放疗治疗局部晚期食管癌疗效肯定,能提高患者生存率,虽毒副反应增加,但患者可耐受,值得临床推广应用.     

中药艾迪注射液配合化疗治疗晚期食管癌22例的临床观察

目的:观察艾迪注射液配合化疗治疗晚期食管癌患者的疗效。方法:43例晚期食管癌患者随机分为2组:研究组22例,采用艾迪注射液配合多西他赛联合顺铂方案化疗;对照组21例,仅采用相同方案化疗。观察2组患者的有效率、毒性反应和顺应性。结果:研究组患者的总有效率高于对照组(59.1%vs47.6%,P=0.03)。研究组3～4级毒性反应发生率低于对照组(27.2%vs52.4%,P=0.01)。研究组接受的平均化疗疗程数高于对照组(4.7vs3.4,P=0.03)。研究组需要化疗减量和延迟的比例低于对照组。结论:艾迪注射液联合化疗治疗晚期食管癌患者,可提高缓解率、降低毒性反应并提高耐受性。     

康艾联合低剂量择菲治疗老年晚期非小细胞肺癌的临床研究

目的 评价康艾注射液联合低剂量择菲对老年晚期非小细胞肺癌的临床疗效.方法 58例老年晚期非小细胞肺癌患者,随机分为治疗组30例,对照组28例.两组均采用低剂量择菲单药化疗,治疗组在化疗同时加用康艾注射液.结果 治疗后治疗组KPS评分及体重增加明显高于对照组(P<0.05).治疗组不良反应低于对照组,但无显著差异(P>0.05).结论 康艾可改善老年晚期非小细胞肺癌患者生活质量,未增加化疗的不良反应.     

拉米夫定联合TACE治疗原发性肝癌合并肝硬化30例

目的: 探讨拉米夫定联合肝动脉化疗栓塞(TACE)治疗HBV DNA阳性合并肝硬化的肝细胞癌(HCC)患者的疗效和预后.方法:将60例HBV DNA阳性合并肝硬化中、晚期HCC患者随机分为TACE 拉米夫定治疗组(30例), 单纯TACE对照组(30例), 观察比较两组患者HBV DNA定量、Child-pugh积分及2年生存率.结果: 治疗1年及2年后，治疗组HBV DNA阳性率均显著低于对照组(χ2 = 9.788, P = 0.002, χ2 = 3.962, P = 0.047), 肝功能Child-pugh积分治疗组明显小于对照组(7.13±1.30 vs 8.44±1.79, 7.40±1.35 vs 9.09±1.76, 均P<0.05). 治疗组和TACE组2年生存率分别为66.67%和36.67%(P<0.05).结论:TACE联合应用拉米夫定治疗HBV DNA阳性合并肝硬化的HCC患者, 可抑制乙型肝炎病毒复制, 保护患者肝功能, 提高患者生存率.     

后程三维适形放疗同步化疗治疗局部晚期鼻咽癌的临床价值

目的 探讨后程三维适形放疗(three-dimensional conformal radiotherapy,3D-CRT)同步化疗治疗局部晚期鼻咽癌的疗效和毒副反应.方法 72例局部晚期鼻咽癌患者,采用抽签法随机分为后程3D-CRT同步化疗组和单纯常规放疗组.同步化疗组先采用常规放疗至36 Gy/18次,后程予鼻咽部采用3D-CRT,且在整个放疗过程中,同时给予顺铂联合5-氟尿嘧啶化疗2周期.而放疗组则单纯给予常规放疗.结果 同步化疗组的完全缓解率为 91.7 %,明显高于放疗组的 72.2 %(P<0.05).同步化疗组的局部复发率(13.9 %)明显低于放疗组(36.1%)(P<0.05),而其远处转移率(11.1 %)亦明显低于放疗组(33.3%)(P<0.05).两组的3年生存率分别为82.3%和56.1%,同步化疗组优于放疗组(P<0.05).而同步化疗组的骨髓抑制发生率则高于放疗组(P<0.05).结论 后程3D-CRT同步化疗对局部晚期鼻咽癌有较好的疗效,且毒副反应能耐受.     

小柴胡汤联合吉西他滨化疗对晚期胰腺癌的疗效观察

[目的]观察小柴胡汤联合吉西他滨化疗对晚期胰腺癌的临床疗效.[方法]晚期胰腺癌患者72例,随机分为对照组(36例)和治疗组(36例),对照组仅予吉西他滨单药静脉化疗,治疗组在吉西他滨化疗间歇期口服小柴胡汤,2个周期后评价2组近期疗效、临床受益反应率及不良反应.[结果]治疗组客观有效率、临床受益反应率均高于对照组(38.89％:27.78％、83.33％:58.33％),差异均有统计学意义(P＜0.05).治疗组与化疗药物有关的消化道不良反应和骨髓抑制发生率,均略低于对照组.[结论]对晚期胰腺癌患者采用小柴胡汤联合吉西他滨化疗在改善症状,提高生活质量及近期疗效方面较单一药物化疗优势明显,值得临床推广应用.     

经纤维支气管镜局部化疗治疗气管支气管结核的疗效及方案研究

目的 探讨合理的经纤维支气管镜局部化疗治疗气管支气管结核的方案.方法 对255例予全身化疗联合经纤维支气管镜局部化疗的气管支气管结核患者的疗效等进行回顾性分析.其中局部注入异烟肼+丁胺卡那霉素+利福平者(多药组)49例,局部注入异烟肼+利福平者(双药组)152例,局部单用利福平者(单药组)54例.结果 ①多药组和双药组平均治疗次数[(4.3±3.9)次,(5.0±4.0)次]少于单药组[(9.9±5.2)次](P<0.01).②经纤维支气管镜局部化疗4周后,50%以上的患者镜下病变缩小或消失,三组的好转率差异无统计学意义.③经纤维支气管镜局部化疗4周后,三组患者胸片或胸CT病变均有不同程度的吸收,但差异无统计学意义.④局部化疗治疗终止时,三组胸片或胸CT病变吸收总有效率依次为82%、80%、44%,多药组和双药组优于单药组(P<0.05).⑤局部化疗治疗终止时,多药组支气管狭窄的发生率(16.3%)高于双药组(4.6%)和单药组(5.6%)(P<0.05).结论 经纤维支气管镜局部注人异烟肼+利福平,给药次数较少,疗效较好,不良反应小,是气管支气管结核局部治疗的最佳方案.     

PTEN在食管癌中的表达及其与微血管密度和临床病理特征的关系

目的:探讨抑癌基因PTEN在食管癌及癌旁正常组织中的表达, 及其与微血管密度(MVD)和临床病理特征的关系.方法:选用食管鳞癌手术切除病理标本48例,手术远端正常食管组织标本40例. 采用免疫组织化学SP法检测PTEN编码蛋白的表达水平,CD31抗体进行血管内皮染色、计算微血管密度, 分析PTEN在不同组织中的表达与MVD和食管癌组织分化程度、浸润深度、淋巴结转移的关系.结果:食管鳞癌组织中PTEN编码蛋白阳性表达率低于癌旁正常食管黏膜组织(52.08%vs 92.50%, P<0.01), 而其MVD值显著高于癌旁正常组织(41.72±8.67 vs 21.01±3.85, P<0.01); Ⅰ、Ⅱ、Ⅲ级鳞癌PTEN阳性表达率有显著差异(75.0% vs 55.0% vs 33.33%, 均P<0.05), MVD值差异无统计学意义; 癌组织侵及浅肌层以上与深肌层PTEN与MVD值的表达有显著差异(77.27% vs 42.31%; 35.49±5.89vs 46.01±6.27, 均P<0.01); 淋巴结转移组与非转移组PTEN阳性表达率无显著差异, MVD值差异则有统计学意义(46.71±7.89 vs 35.92±2.54, P<0.01).结论:抑癌基因PTEN、MVD在食管癌中表达的高低, 与肿瘤的生长、浸润和转移相关.PTEN基因表达的突变或缺失能促进肿瘤血管的形成, 可作为临床治疗和判断预后的依据.     

伊立替康联合顺铂治疗晚期食管癌27例

目的:观察伊立替康联合顺铂方案(IP)和顺铂联合氟尿嘧啶(DF)方案治疗晚期食管癌的近期疗效及毒副反应.方法:收集我科2006-07/2007-11晚期食管癌患者59例病例资料,比较在疗效和副反应间的差异.其中治疗组27例,采用IP方案,对照组32例,采用DF方案,21 d为1周期.在化疗期间均常规水化利尿,完成至少2周期化疗后进行评价疗效.结果:IP方案组与DF方案组间有效率(44.4% VS 28.1%,P<0.05)及控制率(81.5%VS 53.1%,P<0.05)差异有显著性.主要的毒副反应为恶心呕吐,IP方案组发生率为88.8%,DF方案组发生率为90.6%,无统计学差异;其次为骨髓抑制,IP方案组发生率为77.7%,DF方案组为46.8%,差异有显著性(P<0.05);再次为腹泻,IP方案组发生率为33.3%,DF方案组为9.4%,差异有显著性(P<0.05).结论:IP方案较DF方案治疗晚期食管癌增加疗效,同时也增加了血液系统毒性和腹泻的发生率,但副反应临床上患者尚可以耐受,值得推广应用.     

S100A2基因及其蛋白在食管癌中的表达及其临床意义

目的:观察S100A2 mRNA及其蛋白在食管鳞状细胞癌组织中的表达及其与食管癌临床病理特征之间的关系,并探讨其在食管癌发生、发展中的作用及临床应用价值.方法:收集40例手术切除的食管鳞状细胞癌标本,同时取40例手术切缘食管正常黏膜组织.应用免疫组织化学S-P法检测其中S100A2蛋白的表达,原位分子杂交技术检测S100A2mRNA的表达.结果:S100A2 mRNA及S100A2蛋白在食管鳞状细胞癌组织中阳性表达率均明显低于正常食管黏膜(77.5% vs 100%,72.5% vs 100%,均P<0.01); 其中高、中、低分化三组间差异均有显著性(均P<0.05),并且高、中分化组S100A2 mRNA的阳性表达率均明显高于低分化组(分别为93.3%vs 85.7%,86.7%vs 85.7%,均P<0.05);无淋巴结转移组S100A2 mRNA阳性表达率均明显高于有淋巴结转移组(分别为92%vs 53.3%,92%vs 40%,均P<0.01).食管鳞状细胞癌组织中S100A2 mRNA和S100A2蛋白的表达呈明显正相关(r=0.607,P<0.001).结论:S100A2在食管癌的发生发展中具有重要作用,并可能作为判断食管癌生物学行为的重要参考指标.     

新辅助放化疗对中晚期食管鳞癌病理分期及预后的影响

目的:评估新辅助放化疗对中晚期食管鳞癌病理分期及预后的影响。方法:1991-01/2000-12中晚期食管鳞癌患者473例,随机分为4组,新辅助放疗组(n= 118)、新辅助化疗组(n=119)、新辅助放化疗组(n=118)及对照组(单纯手术)(n=118),统计分析4组在切除率、病理分期、并发症、生存期等方面的差别结果:放疗组、化疗组、放化组与对照组相比均可提高根治性切除率(97.5%,86.6%,98.3% vs 73.7%,均P<0.01);放疗组、放化组与对照组相比有明显降期作用(P<0.01);而化疗组没有明显降期作用.放疗组、化疗组、放化组与对照组相比,手术并发症无明显增加(P>0.05),放疗组、放化组的3a生存率相比对照组显著提高(69.5%,73.7% vs 53.4%,均P<0.01).放化组的5a生存率优于放疗组,但无统计学意义(45.O% vs 40.7%,P>0.05).结论:合理应用新辅助放化疗可提高中晚期食管鳞癌患者生存期并提高其生存质量.     

Beliefs among pulmonologists and thoracic surgeons in the therapeutic approach to non-small cell lung cancer

STUDY OBJECTIVES: The physicians who initially evaluate patients with non-small cell lung cancer (NSCLC) strongly impact the course of therapy. Their beliefs in treatment and prognosis may contribute to practices of variable quality and appropriateness. We sought to better describe beliefs among pulmonologists and thoracic surgeons who were selected for guiding early therapy and referrals in patients with NSCLC. DESIGN: Mail questionnaire focusing on survival estimates, treatment perceptions, and referral patterns. PARTICIPANTS: Twelve hundred pulmonologists and 800 thoracic surgeons who were clinically active members of the American College of Chest Physicians. MEASUREMENTS AND RESULTS: Response rates of 50% for pulmonologists and 52% for thoracic surgeons were obtained after two mailings. Five-year survival estimates for patients with resected stage I NSCLC revealed that 30% of respondents overestimated survival rates and 18% underestimated survival rates. The underestimation of survival rate was found among more respondents who are practicing pulmonology than thoracic surgery (22% vs 10% [corrected], respectively), who were trained before 1980 than after 1980 (29% vs 10% [corrected], respectively), and who were seeing < 10 lung cancer patients annually than those who were seeing > 25 (31% vs 0.14%, respectively). Beliefs in the survival benefit of adjuvant chemotherapy or of radiation in stage I-IIIA disease divided respondents within both specialties. Chemotherapy plus radiation vs radiation alone in unresectable stage IIIA-B NSCLC was viewed as benefiting survival less often by physicians seeing < 10 lung cancer patients annually rather than > 25 (57% vs 77% [corrected], respectively) and by physicians underestimating rather than correctly estimating survival in early-stage disease (58% vs 72% [corrected], respectively). Chemotherapy was believed to confer survival benefits in patients with stage IV disease by one third of respondents. CONCLUSIONS: Certain physician characteristics, particularly the length of time since training and NSCLC patient volume, are associated with beliefs not conclusively supported in the medical literature or with opinions inconsistent within and between specialties.     

Ovarian cancer

Ovarian cancer accounts for 4% of all cancers in women and is the leading cause of death from gynaecologic malignancies. Because early-stage ovarian cancer is generally asymptomatic, approximately 75% of women present with advanced disease at diagnosis. Survival is highly dependent on stage of disease: 5-year survival in patients with early-stage is 80-90% compared to 25% for patients with advanced-stage disease. For all patients, a comprehensive surgical staging should be performed to obtain the histological confirmation of diagnosis and to evaluate the extent of disease. Patients with early-stage should both be optimally staged and be treated with adjuvant platinum-based chemotherapy if they have a medium or high-risk tumour. For advanced disease the currently recommended management is primary cytoreductive surgery followed by platinum-paclitaxel combination chemotherapy. Appropriate salvage therapy is based on the timing and nature of recurrence and the extent of prior chemotherapy. Surgical resection should be considered in patients with long-term remission, especially in those with isolated recurrences and good performance status. Platinum-based combination represents the standard second-line chemotherapy in patients with platinum-sensitive relapsed ovarian cancer. Salvage chemotherapy in platinum-refractory patients usually results in low response rates and short survival.     

A retrospective study of different treatments of limited‐stage small‐cell esophageal carcinoma and associated prognostic factor analysis

Primary, small‐cell esophageal carcinoma (SCEC) is a rare but highly malignant tumor. Due to lack of randomized, controlled, prospective studies, there are currently no unified treatment modalities for SCEC. This study retrospectively analyzed the outcomes of different treatments and prognostic factors that influence overall survival in patients with limited‐stage SCEC. The study included 106 patients pathologically diagnosed with limited‐stage SCEC at Huai'an First People's Hospital, Nanjing Medical University (Huai'an, China), between 1998 and 2007. There were 66 males and 40 females, with a median age of 58 years (range: 45–77 years). Fourteen patients received surgery alone, 42 received surgery and postoperative chemotherapy, 11 received radiotherapy alone, and 39 received concurrent chemoradiotherapy. Combined modality treatment with and without chemotherapy yielded 5‐year survival rates (5YSRs) of 27.2% and 0%, respectively. Associated median survival times were 22 months and 11 months, respectively, with a hazard ratio (HR) of 2.30 (95% confidence interval [CI]: 1.42–3.73, P = 0.001). Among patients treated with surgery plus postoperative chemotherapy or with concurrent chemoradiotherapy, the 5YSRs were 31.0% and 23.1%, respectively. Median survival times were 26 months and 18 months, with an HR of 1.25 (95% CI: 0.75–2.09, P = 0.725). Multivariate survival analysis using Cox regression model showed that chemotherapy was a positive independent prognostic factor for SCEC (HR 2.92, 95% CI: 1.25–6.80). Chemotherapy‐based combined modality treatment appears to increase the long‐term survival of patients with limited‐stage SCEC. Similar overall survival rates results are achieved with surgery combined with chemotherapy as with concurrent chemoradiotherapy, with chemotherapy being an independent prognostic factor. Randomized, controlled, prospective studies are needed to identify optimal chemotherapy regimens for treating SCEC.     

Role of surgery in a case-control study of patients with clinical stage IIIA small cell lung cancer

BackgroundThe role of surgery in the multidisciplinary treatment of clinical stage IIIA small cell lung cancer is yet to be verified. This study was performed to determine the benefit of surgery in patients with stage IIIA small cell lung cancer.MethodsPatients diagnosed with stage IIIA small cell lung cancer at Shanghai Pulmonary Hospital from 2005 to 2015 were included and divided into two groups: the surgery with neoadjuvant and adjuvant chemotherapy group and the concurrent chemo-radiotherapy group. Overall survival was compared between the two groups. A multivariate Cox regression model was constructed to evaluate factors associated with overall survival.ResultsOf 69 patients with stage IIIA small cell lung cancer during the study period, 40 patients (58%) underwent surgery with neoadjuvant and adjuvant chemotherapy, and 29 patients (42%) underwent concurrent chemo-radiotherapy. Patients in the surgery with neoadjuvant and adjuvant chemotherapy group had a longer overall survival compared with patients in the concurrent chemo-radiotherapy group (median survival: 33.1 vs. 16.2 months, respectively; 2-year overall survival: 44.2% vs. 14.9%, respectively; log-rank: P=0.045). A multivariate analysis revealed that surgery with neoadjuvant and adjuvant chemotherapy (hazard ratio: 0.374; 95% confidence interval: 0.173–0.808, P=0.012) was independently associated with overall survival.ConclusionsPatients with stage IIIA small cell lung cancer treated with surgical resection plus chemotherapy demonstrated longer overall survival compared with those who underwent concurrent chemo-radiotherapy. Surgery may be an option for clinical stage IIIA small cell lung cancer after induction chemotherapy in selected patients.     

Esophagectomy for locally advanced esophageal cancer, followed by chemoradiotherapy and adjuvant chemotherapy

AIM: To compare the efficacy and toxicity of a three-step combination therapy with post-operative radiation alone for locally advanced esophageal cancer. METHODS: Patients with T3-4 and NO-1 esophageal carcinoma from a number of institutions were non-randomly, prospectively enrolled in the study. All patients underwent single-stage curative en bloc esophagectomy. The patients were then assigned into one of two treatment groups based on treatment consisting of either post-operative concurrent chemoradiotherapy (CCRT) with weekly cisplatin 30 mg/m~2 followed by systemic adjuvant chemotherapy (four monthly cycles of cisplatin 20 mg/m~2 and 5-fluorouracil 1000 mg/m~2 for five consecutive days), or, post-operative radiation alone. The radiotherapy dose was 55-60 Gy for all patients. Primary end-point of this study was to assess the per-protocol patients' improvement of overall survival benefit. Secondary end-point was designed to evaluate both the per-protocol and intent-totreat patients' outcome of survival. RESULTS: A total of 60 patients (n=30 per group) were enrolled in this study. The two groups were generally comparable for demographic characteristics and hematologicai and non-hematological toxicities. The CCRT with weekly cisplatin was well tolerated, with significantly better overall survival (30.9 mo vs 20.7 mo; 95% CI, 27.5-36.4 vs 15.2-26.1) and 3-year survival (70.0% vs 33.7%; P=0.003). Low histological grade of tumor (P<0.001) was associated with favorable survival in these locally advanced patients. CONCLUSION: For locally advanced esophageal cancer, the combination of esophagectomy, post-operative CCRT with weekly cisplatin and systemic adjuvant chemotherapy is well tolerated and effective. A large-scale, prospective randomized trial of this regimen is in progress.     

Post-operative chemotherapy in non-curative gastrectomy for advanced gastric cancer.

BACKGROUND/AIMS: The definitive effects of post-operative chemotherapy for prolonging survival in patients with non-curative gastrectomy for advanced gastric cancer have not been established. METHODOLOGY: Eighty-three patients with advanced gastric cancer who underwent non-curative gastrectomy were divided into 49 patients with post-operative chemotherapy (chemotherapy group) and 34 patients without post-operative chemotherapy (control group). Chemotherapy regimens were as follows: oral 5-fluorouracil (5-FU) alone (n = 22), intravenous mitomycin (MMC) plus 5-FU (n = 20), intravenous methotrexate (MTX) plus 5-FU (n = 3), intravenous cisplatin plus 5-FU (n = 2), and hepatic arterial infusion of 5-FU plus oral 5-FU (n = 2). No prior chemotherapy or radiation therapy was given. RESULTS: Although the age in the control group (mean: 71.9 years) was significantly older than in the chemotherapy group (mean: 66.1 years), there were no significant differences in the other clinical and pathological background data between the two groups. The 1-year survival rate in the chemotherapy group (71.4%) was significantly higher than in the control group (50.0%). However, the 3-year and 5-year survival rates did not significantly differ in the chemotherapy group versus the control group, 30.6% vs. 32.4% and 24.5% vs. 32.4%, respectively. Although a significant difference did not exist between the two groups, median survival after operation in the chemotherapy group (20.5 months) was longer than that in the control group (16.2 months). Furthermore, median survival of patients with peritoneal dissemination in the chemotherapy group (16.4 months) was significantly longer than that in the control group (7.7 months). CONCLUSIONS: Post-operative chemotherapy may contribute to prolonged survival in patients with non-curable advanced gastric cancer, even when patients had peritoneal dissemination. However, the long-term survival rate was not improved by post-operative chemotherapy. More aggressive chemotherapy may be needed to improve the long-term prognosis for such patients.     

Current results of chemotherapy in non-small cell lung cancer

From 1983 to 1988, two prospective randomized studies were conducted in the treatment of patients with inoperable non-small cell lung cancer (NSCLC). The first was a comparison of cisplatin (CDDP) alone vs CDDP plus vindesine (VDS) (CV-1), and the second was the comparison of CDDP plus VDS (CV-2) vs CDDP plus VDS plus mitomycin (MMC) (CVM) vs CDDP plus etoposide alternating with VDS plus MMC (CE/VM). A total of 345 patients entered into these two studies were evaluated. The response rates were 9.3% for CDDP alone, 26.8% for CV-1, 33.3% for CV-2, 42.6% for CVM, and 19.1% for CE/VE. There were significant differences in response rates between CDDP alone and CV-1 (p less than 0.01), and CVM and CE/VM (p less than 0.01). No differences were observed in the durations of response and survival among the five treatment arms. Females responded to chemotherapy better than males, and squamous cell carcinoma responded better than adenocarcinoma. Sex, performance status and stage were significant as prognostic factors in advanced NSCLC patients. Responders to chemotherapy live longer than nonresponders. In conclusion, CVM is considered to be currently best available regimen. No survival benefit has been proved for any treatments for advanced NSCLC. Chemotherapy for NSCLC is still investigational.     

Clinical markers of hypoxia and other predictive factors of survival in conservative therapy of squamous-cell carcinoma of the esophagus

BACKGROUND AND AIMS: Carcinoma of the esophagus is an aggressive cancer with a high failure rate after combined local and systemic treatment modalities. One of the factors that could influence the high rate of locoregional persistence is hypoxia. Hypoxic cancers are known to be more aggressive and less responsive to chemo- and radiotherapy. We investigated the effect of several factors on overall survival and several surrogate markers of hypoxia on survival in squamous-cell esophageal cancer. PATIENTS AND METHODS: We conducted a retrospective analysis of 41 curatively treated patients with squamous-cell esophageal cancer: 30 received combined radio- and chemotherapy (cisplatin and 5-FU) and 11 radiotherapy alone. Cox regression analysis was performed to study the effect of several factors on overall survival. RESULTS: Significantly better survival was shown only in patients who were younger, received more cycles of chemotherapy, or had more proximal tumors or less advanced T stage but not for possible clinical surrogate markers for hypoxia, such as levels of hemoglobin before and during treatment or smoking. CONCLUSION: We found no clinical evidence that hypoxia plays a role in survival with squamous-cell esophageal cancer. Number of chemotherapy cycles was, independently of age, predictive of survival. Measurements of in vivo tumor oxygenation could further help in determining the role of tumor hypoxia in esophageal cancer.     

Relapse and late complications in early-stage Hodgkin's disease patients with mediastinal involvement treated with radiotherapy alone or plus one cycle of ABVD.

BACKGROUND AND OBJECTIVE: Patients affected by Hodgkin's disease (HD) in pathologic stage IA-IIA have a strong possibility of remission and long-term survival when treated with radiotherapy to extended fields. However, 20-30% of cases relapse in the five years following treatment and consequently need further therapy. This study examines the occurrence of relapse and other complications in patients with pathologic stage IIA Hodgkin's disease and mediastinal involvement treated in different ways: radiotherapy alone vs radiotherapy plus one cycle of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). DESIGN AND METHODS: Our series consisted of 73 HD patients with mediastinal involvement treated by the Department of Radiation Oncology and the Hematology Department of "La Sapienza" University of Rome from 1983 to 1989. The patients were randomized into two groups according to their initial treatment. The first group contained 37 patients treated, initially, with supradiaphragmatic radiotherapy and para-aortic irradiation (STNI); the second group was made up of 36 patients treated, initially, with supradiaphragmatic radiotherapy and para-aortic irradiation (STNI) combined with one course of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). For 28 (38%) of the patients, the follow-up period was longer than 10 years. The average follow-up period was 114 months (range 22-174 months). Overall survival and relapse-free survival were assessed using the Kaplan and Meier method, while differences were tested by the log-rank test. RESULTS: We recorded twelve cases of relapse after initial treatment. The period of time which elapsed between the end of treatment and the evidence of relapse ranged from 6 to 51 months, with an average of 22 months. Ten relapses occurred in the STNI group and two in the ABVD/STNI group. No statistically significant differences emerged between the two groups in the overall survival analysis but did in the relapse-free survival analysis (p<0.01). In the group treated with ABVD and STNI one patient developed acute non-lymphocytic leukemia and another patient treated at the age of 44 developed primary breast cancer. X-ray-related asymptomatic pulmonary fibrosis was observed in 12 patients: 10 cases in the STNI and ABVD group and 2 cases in the group treated with RT alone. The other sequelae of combined CT/RT treatment in our study were thyroid dysfunction (2 cases, hypothyroidism), whereas the sequela of RT treatment was cardiac disease (2 cases). INTERPRETATION AND CONCLUSIONS: We conclude that one cycle of ABVD and radiotherapy in early-stage HD patients with mediastinal involvement may reduce the risk of relapse. Moreover, the combination of low-toxicity CT and RT, administered preferably to limited fields, in patients who have not undergone laparotomy could be a valid alternative to current treatment for early-stage HD. However, additional data and a longer follow-up are mandatory in order to evaluate late toxicity and the potential risk of treatment.