Clinical Characteristics and Prognostic Analysis of 107 Patients with Bronchioloalveolar Carcinoma

OBJECTIVE To study the clinical characteristics and prognostic factors for bronchioloalveolar carcinoma. METHODS Clinical data from 107 inpatient cases at The Cancer Hospital of Tianjin Medical University, from 1990-2000, were retrospectively reviewed. RESULTS The overall 1, 3 and 5-year survival rates were 88.7, 64.8 and 48.6% respectively. The main prognostic factors were tumor diameter (P= 0.022), bronchial stump (P=0.016), TNM stage (P=0.000), T stage (P= 0.002), N stage (P=0.000) and postoperation radiotherapy (P=0.001). Cox regression analysis suggested that the TNM stage (P=0.000) and tumor diameter (P=0.015) are independent factors affecting the prognosis. CONCLUSION The overall survival rate of BAC patients was superior to those with other non-small cell lung cancer (NSCLC). The TNM stage and tumor diameter were independent factors affecting the prognosis for BAC.     

Lack of Prognostic Effect of Carbonic Anhydrase-9, Hypoxia Inducible Factor-1α and Bcl-2 in 286 Patients with Early Squamous Cell Carcinoma of the Glottic Larynx Treated with Radiotherapy

AimsTo evaluate the prognostic significance of potential tumour markers of hypoxia and apoptosis in early squamous cell carcinoma of the glottic larynx managed with radiotherapy.Materials and methodsIn total, 382 patients with T1 and T2 squamous cell carcinoma of the glottic larynx (vocal cords) received radical radiotherapy (50–55 Gy, in 16 fractions in 98% of cases). Pre-treatment haemoglobin was available for 328 patients; biopsy samples were available for 286. Immunohistochemistry was carried out for carbonic anhydrase-9 (CA-9), hypoxia inducible factor-1α (HIF-1α) and Bcl-2.ResultsAt 5 years, locoregional control was achieved in 88.2%, cancer-specific survival in 95.0% and overall survival in 78.7%. Adverse prognostic factors for locoregional tumour recurrence were pre-treatment haemoglobin <13.0 g/dl (P = 0.035, Log rank test; sensitivity 0.28, specificity 0.84) and stage T2 rather than T1 (P = 0.002). The effect of haemoglobin level on locoregional control was not significant when stratified by the median of 14.2 g/dl (P = 0.43) or as a continuous variable (P = 0.59). High CA-9 (P = 0.11), HIF-1α (P = 0.67) and Bcl-2 (P = 0.77) expression had no prognostic significance.ConclusionsHigh CA-9, HIF-1α and Bcl-2 do not add to the prognostic significance of tumour stage and lower haemoglobin in predicting failure of local control in early glottic larynx squamous cell carcinoma managed with radiotherapy. The effect of haemoglobin was not strong enough to be useful as a prognostic biomarker.     

Evaluation of Intraoperative Radiotherapy for Gastric Carcinoma

OBJECTIVE To study the proper sites and doses of intraoperative radiotherapy (IORT) for gastric carcinoma and the effects of this treatment.METHODS A total of 106 cases of stage Ⅰ- Ⅳ gastric carcinoma who received a D2 or D3 radical resection operation combined with IORT were analyzed. Sixty-seven patients with gastric cancer of the antrum and body received distal gastrectomy. The sites of irradiation were at the celiac artery and hepatoduodenal ligament area. Another 39 patients with carcinoma of the cardia and upper part of the gastric body and whole stomach received proximal gastrectomy or total gastrectomy. The sites of irradiation for this group were the upper margin of the pancreas and the regional paraaorta.The therapeutic effects (including survival and complications) of these 106cases who received a combined operation IORT (IORT group) were compared with 441 cases treated during the same time period by a radical resection operation alone (operation group).RESULTS The radiation dose below 30 Gy was safe. The therapeutic method of the operation combined with IORT did not prolong the survival time of patients with stage Ⅱ and Ⅳ gastric cancer, but the 5-year survival rates of patients with stage Ⅱ and Ⅲ gastric cancers were significantly improved.While the 5-year survival rates of the stage Ⅲ cancer patients receiving D2 resection combined with IORT had marked improvement, for those receiving a D3 radical resection, only the postoperative survival rates at 3 and 4 years of those cases in stages Ⅲ cancers were improved (P＜0.005-0.001). The 5-year survival rate for those patients was raised only 4.7%(P＞0.05).CONCLUSION The 5-year survival rates of patients with stages Ⅱ and Ⅲ gastric carcinoma who received a D2 lymphadenectomy combined with IORT were improved and had no influence on the postoperative complications and mortality.     

Analysis of the Long-term Effect of Intraoperative Radiotherapy （IORT） for Non-Small Cell Lung Carcinoma （NSCLC）

OBJECTIVE To analyze the long-term effects of treatment with an operation ＋ postoperative irradiation （A group） and an operation＋intraoperative radiotherapy＋postoperative irradiation （B group） in non-small cell lung cancer patients. METHODS Through a prospective randomized clinical trial, a total of 154 patients with non-small cell lung carcinoma were divided into two groups of 77 cases. Among the 154 cases, there were 134 squamous carcinomas, 17 adenocarcinomas and 3 adeno-squamous carcinomas. TNM staging： there were 17 in Stage Ⅰ, 76 in Stage Ⅱ and 61 in Stage Ⅲ.A dosage of 15～25 Gy IORT, energy 9-16 MeV electrons, was delivered to the tumors. The doses given were 40～60 Gy postoperation. RESULTS The local control rates in A and B groups were 49.4% and 62.3% respectively （P〈0.05）. The survivals at 3, 5 and 7 years for group A were 40.3%, 27.3%, and 5.2% and for group B 44.2%, 28.6% and 6.5% （P〉0.05）. There were 16 deaths from radiotherapy complications, with 2 cases in group A and 14 in group B. CONCLUSION IORT＋postoperative irradiation can enhance the local control rate of non-small cell lung cancer patients and reduce the recurrent rates, but it can not improve long-term survival.     

Carcinoma of the maxillary antrum — A 10 year experience

A retrospective analysis was performed of 250 cases of carcinoma of the maxillary antrum seen over a 10 years period (1975–1984). 98.24% patients were seen in T3 and T4 stages (UICC 1985). 40.7% patients presented with clinically palpable nodes. 42.9% patients were treated by radical radiation and 18.6% by a combination of preoperative radiation followed by surgery. Rest 38.5% patients were treated with palliative intention. Three year disease free survival was 39.58% with radiation alone and 51.91% with combined modality treatment which includes patients salvaged by surgery. Failures were mainly at the local site, 75.86% with radiation alone and 60% with combined modality treatment. Combined modality treatment, preferably preoperative radiation followed by radical surgery, gives the best results in the management of carcinoma of the maxillary antrum.     

Prognostic Significance of the Mucin Component in Stage Ⅲ Rectal Carcinoma Patients

Background: Although mucinous adenocarcinoma has been recognized for a long time, whether it is associatedwith a poorer prognosis in colorectal cancer patients is still controversial. Many studies put emphasis on mucinousadenocarcinoma containing mucin component ≥50%. Only a few studies have analyzed cases with a mucincomponent <50%. Objectives: This study aimed to analyze the prognostic value of different mucin componentproportions in patients with stage Ⅲ rectal cancer. Materials and Methods: Clinical, pathological and follow-updata of 136 patients with the stage III rectal cancer were collected. Every variable was analyzed by univariateanalysis, then multivariate analysis and survival analysis were further performed. Results: Univariate analysisshowed pathologic T stage, lymphovascular invasion, and histological subtype were statistically significant for DFS.Pathologic T stage was significant for OS. Histological subtype and lymphovascular invasion were independentprognostic factors in multivariate analysis for DFS, and histological subtype was the only independent prognosticfactor for OS. Survival curves showed the survival time of mucinous adenocarcinoma (MUC) was shorter thannon-MUC (adenocarcinomas with a mucin component <50% and without mucin component). Conclusions:Histological subtype (tumor with different mucin component) was an independent prognostic factor for bothDFS and OS. Patients with MUC had a worse prognosis than their non-MUC counterparts with stage Ⅲ rectalcarcinoma.     

Radiotherapy for Carcinoma of the Esophagus： Progress of Treatment and Research in China

ABSTRACT Carcinoma of the esophagus is a common malignancy in China. Radiotherapy is one of the most important modalities of treatment. This article provides a review of the natural history of this disease, the results of radiotherapy for esophageal cancer and the recent advances in radiation techniques in China. Significant progress has been made in this area of research and treatment. Combined treatment modalities and new therapies are being evaluated and may be expected to contribute to improved patient outcomes and better palliation of symptoms in the future.     

Evaluation of the Curative Effect of External Beam Radiotherapy and Brachytherapy for Tongue Carcinoma

OBJECTIVE To evaluate the curative effect of external beam radiothera-py (EBRT) and brachytherapy (BT) for tongue carcinoma. METHODS From 1991 to 2003, 35 patients received EBRT and BT in our department. We analyzed their curative and side effects retrospectively. RESULTS Local control was 80%. The 3-year overall (OS) and disease specific survival (DSS) rates were 75% and 79%. One patient developed metastases. Three patients (9%) developed different late complications. CONCLUSIONS Local regional control, survival, and complications in patients with tongue carcinoma treated by EBRT and BT have been satis-factory.     

Synchronous Hepatocellular Carcinoma and Gastric Carcinoma—A Case Report with Review of the Literature

Purpose

The study was designed to investigate the clinicopathological correlations, relationship to apoptotic index, and prognostic significance of estrogen receptor beta expression in colorectal carcinoma.

Methods

The study was carried out on 40 patients with newly diagnosed colorectal cancer. The patients?? data were collected prospectively and the 2?years overall survival was the endpoint. Estrogen receptor beta expression was assessed by immunohistochemistry. Apoptotic body index was calculated by counting apoptotic cells using the modified TUNEL assay.

Results

Estrogen receptor beta positivity was detected in 65% of colorectal cancer cases, while estrogen receptor alpha positivity was found in only 7% of cases. The rate of estrogen receptor beta immunoreactivity was significantly higher in low-grade colorectal tumors. The median apoptotic index in estrogen receptor beta positive cases was significantly higher than in estrogen receptor beta negative cases (6% versus 3%; p?=?0.01). The median overall survival was higher in estrogen receptor beta positive cases (22 versus 18?months); however, the difference was not statistically significant.

Conclusions

The study results reinforce the importance of the estrogen receptor beta rather than the estrogen receptor alpha in colorectal cancer. Lack of estrogen receptor beta expression is associated with loss of differentiation and decreased apoptosis. Future studies should include validation of estrogen receptor beta as a prognostic marker and exploration of its role as a target in the management of colorectal cancer.     

Is There a Role for Radiotherapy in the Primary Management of Primary Central Nervous System Lymphoma? A Single-centre Case Series

AimsIn recent years, the optimum primary management of primary central nervous system lymphoma (PCNSL) has evolved from combined modality chemoradiotherapy to chemotherapy alone. We describe a single-centre case series of PCNSL with a view to assessing the role of radiotherapy in primary disease management.Materials and methodsWest of Scotland PCNSL cases between 2001 and 2010 were identified by neuropathology. Observational data were collected retrospectively from case notes and electronic systems.ResultsForty-nine patients fulfilled the eligibility criteria. The median age was 61 years. Chemotherapy with a view to consolidation radiotherapy on completion was delivered to 61% (n = 30). Regimens varied, but were generally methotrexate-based. Chemotherapy was discontinued prematurely in 80% (n = 24) due to progressive disease (n = 12), intolerable toxicity (n = 7) or death (n = 4). In all patients who progressed or did not tolerate chemotherapy, treatment was changed to immediate salvage radiotherapy; modal irradiation was 40 Gy. Radiotherapy alone was delivered to those not suitable for chemotherapy (18%, n = 9) and best supportive care to those with poor performance status (18%, n = 9). The overall median survival was 8 months. In those receiving single modality radiotherapy or chemotherapy, the median survival was 5 and 8 months, respectively. For those completing chemoradiotherapy in its entirety, 3 year survival was 100%; in groups receiving salvage radiotherapy despite progressive disease or chemotherapy toxicity, moderate survival was maintained with immediate radiotherapy with 3 year survival rates of 33 and 60%, respectively.ConclusionsAlthough chemotherapy alone remains the optimal treatment of PCNSL, out with clinical trials only a minority of patients complete chemotherapy due to toxicity and disease progression; in such patients, immediate salvage radiotherapy provides an effective and safe alternative with maintenance of good outcomes.     

A Multicentre UK Study of Outcomes of Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy ± Chemotherapy

AimsTo report the outcomes of nasopharyngeal carcinoma in adults across three large centres in a non-endemic region in the era of intensity-modulated radiotherapy (IMRT).Materials and methodsAdult patients with nasopharyngeal carcinoma treated in three large cancer centres with IMRT ± chemotherapy with curative intent between 2009 and 2016 were identified from institutional databases. Radiotherapy was delivered with 70 Gy in 33–35 daily fractions. A univariable analysis was carried out to evaluate the relationship of patient, tumour and treatment factors with progression-free survival (PFS) and overall survival.ResultsIn total, 151 patients were identified with a median follow-up of 5.2 years. The median age was 52 years (range 18–85). Seventy-five per cent were of Caucasian origin; 75% had non-keratinising tumours; Epstein Barr virus status was only available in 23% of patients; 74% of patients had stage III or IV disease; 54% of patients received induction chemotherapy; 86% of patients received concurrent chemotherapy. Five-year overall survival, PFS, local disease-free survival, regional disease-free survival and distant disease-free survival were 70%, 65%, 91%, 94% and 82%, respectively. Keratinising squamous cell carcinoma, older age, worse performance status, smoking and alcohol intake were associated with inferior overall survival and PFS.ConclusionsLocal, regional and distant disease control are relatively high following IMRT ± chemotherapy in a non-endemic population. There was considerable heterogeneity in terms of radiotherapy treatment and the use of chemotherapy, encouraging the development of treatment protocols and expert peer review in non-endemic regions.     

Dietary Patterns and Risk of Ductal Carcinoma of the Breast: A Factor Analysis in Uruguay

Breast cancer (BC) shows very high incidence rates in Uruguayan women. The present factor analysis ofductal carcinoma of the breast, the most frequent histological type of this malignancy both in Uruguay and inthe World, was conducted at a prepaid hospital of Montevideo, Uruguay. We identified 111 cases with ductal BCand 222 controls with normal mammograms. A factor analysis was conducted using 39 food groups, allowingretention of six factors analyzed through logistic regression in order to obtain odds ratios (OR) associated withductal BC. The low fat and non-alcoholic beverage patterns were inversely associated (OR=0.30 and OR=0.45,respectively) with risk. Conversely, the fatty cheese pattern was positively associated (OR=4.17) as well as thefried white meat (OR=2.28) and Western patterns (OR 2.13). Ductal BC shared similar dietary risk patterns asthose identified by studies not discriminating between histologic type of breast cancer.