Ⅰ期子宫内膜癌术后放疗的临床分析

目的 回顾分析265例Ⅰ期子宫内膜癌术后放疗疗效和不良反应。方法 1999—2012年进行术后放疗的Ⅰ期子宫内膜癌患者共265例。病理类型为子宫内膜样腺癌占85.3%(226例)。根据FIGO2009手术—病理分期。术后辅助放疗方式包括盆腔外照射35例(13.2%)、单纯阴道内照射107例(40.4%)和内外照射联合治疗123例(46.4%)。Kaplan-Meier法计算生存率并Logrank检验差异,Cox模型进行预后因素分析。结果 5年随访率为85.7%。5年OS、PFS、局部复发、远处转移率分别为92.8%、89.7%、4.5%、6.4%。发生3级急性放射性肠炎者仅1例(0.4%),3、4级骨髓抑制者分别为4例(1.5%)、1例(0.4%),1例(0.4%)出现3级慢性肠炎。多因素分析显示子宫下段受累是影响OS和PFS的预后因素(P=0.041、0.001),放疗前贫血是影响OS的因素(P=0.048)。 结论 子宫内膜样腺癌为主的Ⅰ期内膜癌患者进行术后辅助放疗的疗效良好,不良反应轻微,放疗前贫血和子宫下段受累是影响OS的重要因素。     

Benefit of adjuvant radiotherapy in surgically staged stage I-II endometrial carcinoma

AIMS AND BACKGROUND: This study was performed to determine the treatment outcomes and patterns of failure following external beam therapy in patients with pathological stage I-II endometrial carcinoma. STUDY DESIGN: Eighty-three patients with stage I-II endometrial carcinoma surgically staged who were found to have high risk factors and who received postoperative radiation therapy are the subject of this report. High risk factors were: histologic grade II-III, depth of myometrial invasion (DMI) > or =1/2, stage II, poor prognostic histology (clear cell, papillary serous cell) and lymphovascular invasion. RESULTS: Recurrences were observed in six patients. The recurrences were located in the vagina (1), lung (2), liver (1), and paraaortic lymph nodes (1). Five of the six recurrences were stage IC and II. The overall survival (OS), cause-specific survival (CSS) and disease-free survival (DFS) at five years were 82.9%, 85.0% and 81.3%, respectively. DMI, grade, age and cervical stromal invasion had a significant impact on CSS. CONCLUSION: Adjuvant radiotherapy decreases the rate of relapse in pathologically staged high-risk stage I-II endometrial carcinoma patients. After reviewing the other studies on this subject we conclude that vaginal cuff brachytherapy alone could be used in stage IA grade III and stage IB grade I-II patients because the recurrence rate is low; pelvic radiotherapy + vaginal cuff brachytherapy should be used for stage IC-II disease. Distant metastases occurred in five of our patients and represent a significant type of failure.     

老年食管鳞癌患者单纯放疗和同步放化疗的有效性和安全性比较

目的比较老年食管鳞癌患者(年龄≥65岁)单纯放疗(RT)和同步放化疗(CCRT)的有效性和安全性。方法收集2010年1月至2016年12月于本院首程接受根治性放疗的122例老年食管鳞癌患者,根据治疗情况分为RT组81例和CCRT组41例(替吉奥单药23例、奈达铂单药2例、雷替曲塞联合奈达铂7例和多西他赛联合奈达铂5例),采用实体瘤疗效评价标准RECIST 1.1版评价近期疗效,药物毒性反应标准NCI-CTC 4.0版评价药物毒副反应,急性放射反应评分标准(RTOG/EORTC)评价放疗毒副反应,根据随访数据进行预后分析并采用Cox比例风险回归模型进行多因素分析。结果RT组的总有效率和疾病控制率分别为84.0%和98.8%,与CCRT组92.7%和100.0%的差异无统计学意义(P>0.05)。RT组的中位无进展生存期(PFS)和总生存期(OS)分别为16.1个月和23.8个月,与CCRT组19.7个月和27.1个月的差异无统计学意义(P>0.05)。单因素分析显示影响PFS的因素包括ECOG评分、T分期和放疗剂量,影响OS的因素包括ECOG评分、T分期、N分期、临床分期和放疗剂量,多因素分析显示ECOG评分和放疗剂量是影响PFS的独立预后因素,而ECOG评分和N分期是影响OS的独立预后因素。最常见急性不良反应为放射性食管炎和骨髓抑制(多为1~2级),RT组未发生3~4级不良反应,CCRT组3~4级急性放射性食管炎、放射性肺炎和骨髓抑制的发生率升高至7.3%(3/41)、9.6%(4/41)和7.3%(3/41),差异均有统计学意义(P<0.05)。结论老年食管鳞癌行根治性放疗,放疗剂量提高至60~65 Gy,患者耐受性良好,可延长生存并提高生活质量。是否同步放化疗应综合评估后慎重选择。     

Sequential chemotherapy and radiotherapy as sandwich therapy for the treatment of high risk endometrial cancer

Objective

The purpose of this retrospective study was to assess the tolerability and efficacy of sequential chemotherapy and radiotherapy for the treatment of high risk endometrial cancer.

Methods

We conducted a retrospective study of previously untreated high risk endometrial cancer patients who received sequential chemotherapy and radiotherapy in accordance with the sandwich approach from June 2008 until June 2011. High risk endometrial cancer patients underwent complete surgical staging followed by adjuvant therapy encompassing sequential chemotherapy, radiation therapy and consolidation chemotherapy.

Results

The study analysis comprised 32 endometrial cancer patients. All subjects were treated with carboplatin and paclitaxel chemotherapy; currently, 186 cycles have been administered and 94% of patients have completed the planned number of cycles. Grade 3 neutropenia developed in 1 (3.1%) patient; there was no incidence of grade 4 neutropenia. Moreover, we observed grade 3 anemia in four (12.5%) patients and grade 4 anemia in one (3.1%) patient. One (3.1%) patient developed grade 3 thrombocytopenia; grade 4 thrombocytopenia was not observed. Five patients exhibited progressive disease, three of whom have since expired; mean progression free survival and follow-up were 17.4 months and 18.9 months, respectively.

Conclusion

The preliminary results from our study suggest that the sandwich approach to treating high risk endometrial cancer patients is feasible. Hematologic toxicity was well tolerated and non-hematologic toxicity was mild and easily managed. Further study of this novel regimen in a larger patient population with extended follow-up is necessary.     

Hypofractionated conformal radiotherapy in carcinoma of the prostate: five-year outcome analysis

PURPOSE: Recent publications have indicated that the alpha/beta ratios for carcinoma of the prostate are much lower than had originally been thought, suggesting that prostate cancer may be highly sensitive to fraction size. We have reviewed our unique experience of the use of 3.13 Gy fractions in a large cohort of men treated homogeneously in a single institute. MATERIALS AND METHODS: The outcome for 705 men with T1-T4, N0, M0 prostate cancer who received conformal radiotherapy between 1995 and 1998 at this center was analyzed. No patient received hormonal manipulation. Mean age was 68 years (range: 49-84 years). Median pretreatment PSA was 13 ng/mL (range: 0.6-270 ng/mL). Disease characteristics were as follows: Stage T1, 125 (18%); T2, 365 (52%); T3/4, 215 (30%); Gleason 2-6, 463 (66%); Gleason 7-10, 242 (34%); pretreatment PSA < or =10 ng/mL, 291 (41%); 10 to < or =20, 228 (32%); >20, 186 (27%). Median follow-up was 48 months (range: 1-82 months). Biochemical-free survival (bNED) was defined by the American Society for Therapeutic Radiology and Oncology consensus definition. Radiotherapy was delivered to a planning target volume (prostate plus all/base of the seminal vesicles dependent on risk criteria with a 1-cm margin) with a 4-field conformal technique to a dose of 50 Gy in 16 daily fractions over 22 days. RESULTS: The 5-year bNED survival was significantly associated (p < 0.001) with pretreatment PSA, stage, and Gleason score. Five-year bNED rates with respect to pretreatment characteristics were as follows: 73% (PSA < or =10), 52% (>10-20), 35% (>20), 64% (Stage T1/2), 38% (T3/4), 61% (Gleason score 2-6), and 46% (Gleason > or =7). When patients were grouped into good (Stage T1/2, PSA < or =10 ng/mL, and Gleason score <7) (n = 181), intermediate (1 raised value) (n = 247), or poor (2 or more raised values) (n = 277) prognostic groups, the bNED was, respectively, 82%, 56%, and 39%. Radiation Therapy Oncology Group Grade > or =2 bowel toxicity was 5% and bladder 9%. CONCLUSIONS: These data indicate that the delivery of a relatively low total dose using a hypofractionated regime results in similar tumor control and normal-tissue toxicity to 65-70 Gy delivered in 1.8-2 Gy fractions. These data suggest that this is an acceptable regime for good-prognosis patients. However, because of the evidence for a dose effect at doses above 70 Gy with "conventional fractionation," we are now treating intermediate- and poor-risk patients within a hypofractionated dose escalation trial to 60 Gy in 20 fractions using intensity- modulated radiotherapy.     

Present status and future direction of clinical trials in advanced endometrial carcinoma

Endometrial adenocarcinoma is staged surgically, and advanced endometrial carcinoma is considered to be FIGO stage III and IV. The Gynecologic Oncology Group (GOG) has come a long way in developing new strategies in the management of advanced endometrial carcinoma. Combining surgery, radiation, and chemotherapy, the 5-year survival has improved to between 40-60% in newly diagnosed advanced endometrial carcinoma. Recent findings in GOG184 indicate that multiple risk factors noted at the time of surgical staging could lead to concurrent clinical trials that could be completed expeditiously rather than a subsequent ten year long phase III trial including all the various risk subgroups of patients. This review is a focus on the accomplishments of the GOG in advanced endometrial carcinoma with an emphasis on future challenges.     

４１例老年食管癌的临床特点和放疗疗效观察

目的　探讨７０岁以上老年食管癌的临床特点和放疗疗效及耐受性。方法　收集２００４年１月至２００６年５月４１例７０岁以上单纯放疗的老年食管癌患者的完整临床病理资料,包括首发症状、病变部位、病变长度、临床分期和合并症情况。全组２５例行常规放疗,１６例行三维适形放疗（３-ＤＣＲＴ）,均采用常规分割,放疗剂量为６０～７０Ｇｙ。结果　４１例老年食管癌患者中,进食梗阻为首发症状的占７３.２％,胸下段占４３.９％,病变长度＞５ｃｍ占５８.５％;按非手术治疗食管癌的临床分期：Ⅰ期１７例,Ⅱ期１６例,Ⅲ期８例;合并其他慢性疾病的占６５.９％,合并两种以上的占５１.２％。全组近期有效率为８７.８％（３６／４１）;ＫＰＳ评分提高占７３.２％;未发生３级以上不良反应;１、３年生存率为分别５１.２％和１７.１％。结论　进食梗阻仍是老年食管癌的首发症状,胸下段病变多见,病变长度长,合并症多见;放射治疗近期疗效及耐受性好,患者生活质量提高,是７０岁以上老年食管癌的有效治疗手段之一。     

术后放疗与术后化疗辅助治疗子宫内膜癌的Meta 分析

目的：全面评价术后放疗与术后化疗辅助治疗子宫内膜癌的有效性和安全性,为临床合理选择提供决策依据。方法计算机检索 EMBase、PubMed、Cochrane Library、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VIP）,检索截止时间为2015年8月31日。全面收集术后放疗与术后化疗辅助治疗子宫内膜癌的随机对照试验（RCT）,两名评价者独立评价纳入文献的方法学质量并交叉核对提取资料,采用 RevMan 5．1软件进行统计分析。结果最终纳入3篇 RCT（1121例子宫内膜癌患者）,Meta 分析结果显示,与术后化疗辅助治疗相比,术后放疗并不能提高子宫内膜癌5年生存率（RR ＝0．94,95％CI 为0．80～1．10,Z ＝0．77,P ＝0．440）、5年无疾病进展生存率（RR ＝0．98,95％CI 为0．90～1．07,Z ＝0．52,P ＝0．610）和降低复发率（RR ＝1．06,95％CI 为0．91～1．24,Z ＝0．75,P ＝0．450）,但可降低3～4级血小板减少症（RR ＝0．13,95％CI 为0．07～0．27, Z ＝5．62,P ＜0．00001）和3～4级中性粒细胞减少症（RR ＝0．01,95％CI 为0．00～0．03,Z ＝8．27,P ＜0．00001）,差异有统计学意义。对于Ⅲ～Ⅳ期子宫内膜癌患者而言,与术后放疗相比,术后化疗辅助治疗可以提高晚期子宫内膜癌的5年生存率（RR ＝0．79,95％CI 为0．68～0．91,Z ＝3．15,P ＝0．002）和5年无疾病进展生存率（RR ＝0．82,95％CI 为0．69～0．97,Z ＝2．31,P ＝0．020）,且差异有统计学意义。结论当前证据表明,与术后放疗相比,术后化疗可能会提高晚期患者的生存率,其远期疗效尚待大样本高质量的 RCT 进一步证实。     

Outcomes of robotic surgery for endometrial cancer in elderly women

IntroductionFew data have been reported on robot-assisted surgery in elderly. The objectives were to compare feasibility, complication data, and survival of patients under and upper the age of 70 who are managed for endometrial cancer by robot-assisted laparoscopy.Materials and methodsThis is a retrospective comparative single-center study including patients treated between January 2007 and December 2016. Patients were divided into 2 groups: less than 70 years and greater than or equal to 70 years. The primary endpoint was the rate of complications. The secondary endpoints were conversion rate and follow-up.Results148 patients were included: 86 under 70 (group A) and 62 aged 70 and over (group B). More adhesiolysis was performed in group B (p < .01); the pelvic and para-aortic lymph node dissection rates were not different between both groups (p = .2 and p = .9). The operating times were significantly longer in group B (220.1 vs. 234.4 min, p = .02). The conversion rate was similar between the 2 groups (p = .7). The tumors were endometrioid adenocarcinomas for 77.9 and 66.7% respectively (p = .2), with grade 3 tumors more represented in older patients (24.4% vs. 48.4%, p < .01). There were more tumors at high risk of recurrence after 70 years (33.7 vs. 45.2%, p = .04). No significant difference was found for postoperative complications. There was no difference in overall survival (p = .7) or progression-free survival (p = .2). Undertreated women rate was similar in both groups (p = .1).ConclusionRobotic surgery appears feasible and reproducible and could bring a benefit and allow optimal surgery without increasing the morbidity in the management of endometrial cancers whatever the age is.     

Long-term outcome after radiotherapy for FIGO stage IIIB and IVA carcinoma of the cervix

PURPOSE: To report the long-term outcome after radiotherapy with curative intent for Stage IIIB and IVA carcinoma of the cervix. METHODS AND MATERIALS: We retrospectively reviewed 91 patients treated with radiotherapy with curative intent at the University of Florida between January 1980 and December 2003 for Stage IIIB (84 patients) or IVA (7 patients) carcinoma of the cervix. RESULTS: The median follow-up of the surviving patients was 8.8 years. The 5- and 10-year estimates of local control, regional control, locoregional control, relapse-free survival, and overall survival were 53% and 53%, 55% and 47%, 34% and 29%, 30% and 26%, and 29% and 21%, respectively. Ninety percent of the recurrences occurred within 2 years of treatment. Of these, 60% of all failures were local, 29% were regional, and 11% were distant failures alone. Also, 17% of the failures were in the paraaortic nodes with no evidence of failure in the pelvis. Univariate and multivariate analyses were conducted with the endpoint of relapse-free or overall survival. No factor was statistically significant. Complications from therapy were scored using the Radiation Therapy Oncology Group grading system; the overall severe late complication rate was 13% (Grade 3-5). CONCLUSION: This series is one of the most mature of published reports. With long-term follow-up, approximately one-third of patients with Stage IIIB or IVA carcinoma of the cervix were cured, with a 13% complication rate.     

Assessment of extended-field radiotherapy for stage IIIC endometrial cancer using three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and helical tomotherapy

PURPOSE: To perform a dosimetric comparison of three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and helical tomotherapy (HT) plans for pelvic and para-aortic RT in postoperative endometrial cancer patients; and to evaluate the integral dose (ID) received by critical structures within the radiation fields. METHODS AND MATERIALS: We selected 10 patients with Stage IIIC endometrial cancer. For each patient, three plans were created with 3D-CRT, IMRT, and HT. The IMRT and HT plans were both optimized to keep the mean dose to the planning target volume (PTV) the same as that with 3D-CRT. The dosimetry and ID for the critical structures were compared. A paired two-tailed Student t test was used for data analysis. RESULTS: Compared with the 3D-CRT plans, the IMRT plans resulted in lower IDs in the organs at risk (OARs), ranging from -3.49% to -17.59%. The HT plans showed a similar result except that the ID for the bowel increased 0.27%. The IMRT and HT plans both increased the IDs to normal tissue (see Table 1 and text for definition), pelvic bone, and spine (range, 3.31-19.7%). The IMRT and HT dosimetry showed superior PTV coverage and better OAR sparing than the 3D-CRT dosimetry. Compared directly with IMRT, HT showed similar PTV coverage, lower Ids, and a decreased dose to most OARs. CONCLUSION: Intensity-modulated RT and HT appear to achieve excellent PTV coverage and better sparing of OARs, but at the expense of increased IDs to normal tissue and skeleton. HT allows for additional improvement in dosimetry and sparing of most OARs.     

子宫内膜癌放射治疗疗效分析

为了观察放疗对子宫内膜癌的影响。对我院1987年～1990年72例接受放疗的子宫内膜癌患者进行分析。根据1971年FIGO标准，Ⅰ期24例、Ⅱ期41例、Ⅲ期7例。病理分类：腺癌58例、腺鳞癌6例、透明细胞癌2例。年龄：35～76岁，平均年龄57．96岁。治疗方法：全盆大野照射，盆腔中平面剂量为DT40GY～50GY，腔内治疗X点剂量20～40GY，A点剂量20GY～30GY。5例单纯体外照射、14例单纯腔内、53例体外加腔内。38例患者放疗后行全子宫及双侧附件切除，术后病理证实，部分病例无肿瘤残存。腔内放疗作为全盆外照后的补充放疗能有效地控制子宫内膜肿瘤。总五年存活率为52．6％，Ⅰ～Ⅱ期五年存活率为：Ⅰ期58％、Ⅱ期51．14％、Ⅲ期28．77％。单纯放疗可适用于Ⅰ、Ⅱ期子宫内膜癌不宜手术的患者。对病期较晚、手术不能切除干净的晚期患可行全量放疗，然后争取行子宫及双侧附件切除。为了提高单纯放疗疗效，在放射治疗前临床医生应尽可能全面的掌握肿瘤的信息。     

Analysis of prognostic factors and patterns of recurrence in patients with pathologic stage III endometrial cancer

PURPOSE: To retrospectively assess prognostic factors and patterns of recurrence in patients with pathologic Stage III endometrial cancer. METHODS AND MATERIALS: Between 1989 and 2003, 107 patients with pathologic International Federation of Gynecology and Obstetrics Stage III endometrial adenocarcinoma confined to the pelvis were treated at our institution. Adjuvant radiotherapy (RT) was delivered to 68 patients (64%). The influence of multiple patient- and treatment-related factors on pelvic and distant control and overall survival (OS) was evaluated. RESULTS: Median follow-up for patients at risk was 41 months. Five-year actuarial OS was significantly improved in patients treated with adjuvant RT (68%) compared with those with resection alone (50%; p = 0.029). Age, histology, grade, uterine serosal invasion, adnexal involvement, number of extrauterine sites, and treatment with adjuvant RT predicted for improved survival in univariate analysis. Multivariate analysis revealed that grade, uterine serosal invasion, and treatment with adjuvant RT were independent predictors of survival. Five-year actuarial pelvic control was improved significantly with the delivery of adjuvant RT (74% vs. 49%; p = 0.011). Depth of myometrial invasion and treatment with adjuvant RT were independent predictors of pelvic control in multivariate analysis. CONCLUSIONS: Multiple prognostic factors predicting for the outcome of pathologic Stage III endometrial cancer patients were identified in this analysis. In particular, delivery of adjuvant RT seems to be a significant independent predictor for improved survival and pelvic control, suggesting that pelvic RT should be routinely considered in the management of these patients.     

子宫内膜癌术后辅助放疗的临床观察

 目的　评价高危子宫内膜癌术后辅助放疗的价值。方法　具有高危因素的子宫内膜癌 184例 ,12 6例接受术后放疗 ,5 8例行单纯手术 ,比较两组的局部复发率及 5年生存率。结果　在早期 (Ⅰ、Ⅱ期 )子宫内膜癌 ,术后放疗组与单纯手术组的局部复发率分别为 7.5 %、2 1.9% (P <0 .0 1)。 5年生存率分别为 88.1%、6 8.2 % ,两组差异呈显著性 (P <0 .0 1) ,在晚期 (Ⅲ、Ⅳ期 )子宫内膜癌 ,两组的 5年生存率为 35 .6 %、2 9.4 % (P >0 .0 1)。结论　术后辅助盆腔放疗可以提高具有高危因素的Ⅰ、Ⅱ期子宫内膜癌的 5年生存率 ,降低局部复发率 ,对于Ⅲ、Ⅳ期子宫内癌 ,术后放疗不能改善 5年生存率。     

Pathologic features of endometrial carcinoma in elderly women

It has been estimated that more than two-thirds of cancers occur in people over 65 years of age: endometrial cancer (EC) is the most common gynaecologic cancer in the U.S. and represents the fourth most common malignancy in women. Some authors have reported that EC in elderly women was more aggressive, histologically less-differentiated and often non-endometrioid when compared with EC in the younger population. The purpose of this retrospective study is to evaluate the pathologic features of EC in women 70 years old or over compared with those of younger patients. Between 1987 and 1997, 174 patients with EC were surgically treated: 52 women were 70 years old or over. Two-thirds of both groups had surgical Stage I tumors: 54% of surgical Stage I tumors in the elderly had myometrial invasion more than 50% compared with 32% in the younger group (p<0.01). On the whole 37% of elderly patients had Stage IC tumors compared with 21% in younger women (p<0.01). Seventy-five percent of elderly women had Grade 2 or 3 tumors compared with 55% of younger patients (p<0.005). The majority of EC was endometrioid in both groups: 8% of elderly patients had clear-cell carcinomas compared with 4% of younger women (p not significant). No elderly patients showed nodal metastasis (0 out of 10): 9% of younger women had pelvic or para-aortic metastasis. The median follow-up was 78 months. The overall survival in the elderly and in the younger group was 80% and 93%, respectively (p<0.01): in elderly women overall survival significantly varied according to histotype and depth of myometrial invasion in Stage I tumors. In conclusion patients 70 years old or over have a high probability of surgical Stage I EC but a significantly higher probability of deep myometrial invasion and less-differentiated tumors than younger women: the prognosis w as good but poorer than for younger patients.     

Conservative surgery followed by radical radiotherapy in the management of stage I carcinoma of the breast

Since October 1976, the treatment policy in our Radiotherapy Center for Stage I carcinoma of the breast has been excision of the tumor mass, when it was cosmetically suitable, followed by irradiation to the breast and periphereal lymphatics. Eighty-three patients were admitted between October 1976 and March 1980. They underwent local excision of the tumor and then received 5000 rad in 5 weeks to the breast, supraclavicular, axillary and internal mammary chain lymph nodes. Each field was treated every day. A boost was then given to the scar, bringing the dose up to 6500 rad, calculated at maximum tumor depth, depending upon the size of the tumor prior to surgery. Cosmetic results were quite good, and the local control rate at 54 months is 98 %. The survival with no evidence of disease (NED) at 54 months (actuarial) is 83 %. There have been 10 failures: 8 distant, 1 local (in axilla, controlled by surgery, actually NED), and 1 local and distant (scar and brain). Both local failures were found within 12 months after treatment, and 8/ 10 of the failures within 24 months. Twenty-one out of 83 patients have had complications (25.3% ); of these, 28.8% were surgical and the remainder resulted from radiotherapy after surgery, either from radiotherapy alone or from combination of treatments. Of the total of 21 complications, 18 were mild and 3 were serious. Of those 3 serious complications (3.6 %), 2 were a result of radiotherapy, and one because an ill-advised axillary dissection prior to radiotherapy gave a negative axilla and a serious arm edema and painful shoulder. This was the worst complication in the total of 83 patients. These results compare favorably with the results achieved in the same Hospital with radical surgery as far as local tumor control and survival with no evidence of disease (NED) is concerned. The results also compare with the great majority of surgical series reported in the literature, allowing us to conclude that patients treated with radiation have nothing to lose and much to gain by preserving the breast.     

The survival outcome and patterns of failure in node positive endometrial cancer patients treated with surgery and adjuvant radiotherapy with curative intent

Objective

The purpose of this study was to evaluate the patterns of failure, overall survival (OS), disease-free survival (DFS) and factors influencing outcome in endometrial cancer patients who presented with metastatic lymph nodes and were treated with curative intent.

Methods

One hundred and twenty-six patients treated between January 1996 to December 2008 with surgery and adjuvant radiotherapy were identified from our service''s prospective database. Radiotherapy consisted of 45 Gy in 1.8 Gy fractions to the whole pelvis. The involved nodal sites were boosted to a total dose of 50.4 to 54 Gy.

Results

The 5-year OS rate was 61% and the 5-year DFS rate was 59%. Grade 3 endometrioid, serous, and clear cell histologies and involvement of upper para-aortic nodes had lower OS and DFS. The number of positive nodes did not influence survival. Among the histological groups, serous histology had the worst survival. Among the 54 patients relapsed, only three (6%) failed exclusively in the pelvis and the rest of the 94% failed in extrapelvic nodal or distant sites. Patients with grade 3 endometrioid, serous and clear cell histologies did not influence pelvic failure but had significant extrapelvic failures (p<0.001).

Conclusion

Majority of node positive endometrial cancer patients fail at extrapelvic sites. The most important factors influencing survival and extrapelvic failure are grade 3 endometrioid, clear cell and serous histologies and involvement of upper para-aortic nodes.     

老年食管癌患者放疗疗效及相关临床因素分析

目的 探讨老年食管癌患者放射治疗的近远期疗效及其影响因素。方法 回顾性分析哈尔滨医科大学附属第三医院70例自2001年1月—2007年12月间以放疗为主要治疗手段,年龄≥70岁的老年食管癌患者的近期疗效,1、2、3年生存率及其相关临床因素和毒副反应的耐受情况。结果 放疗后总有效率为88.5%。1、2、3年总生存率及无病生存率分别是62.28%和10.80%、27.51%和7.20%、13.89%和3.40%。单因素及多因素分析显示,影响生存期的主要因素为病变的长度、治疗前转移情况(P＜0.05)。急性放射性肺反应、急性放射性食管反应及骨髓抑制发生率分别为24.3%、64.3%和48.6%。结论 放射治疗老年食管癌患者近期疗效显著,耐受性好;影响其生存期的主要因素是治疗前病灶长度及是否有转移。     

Clinical characteristics and outcome of patients with stage III esophageal carcinoma: a single-center experience from Turkey

Esophageal carcinoma is an extremely deadly disease, and prognosis is poor. We retrospectively evaluated stage III esophageal carcinoma patients in our center. Median age of the patients was 52. Men to women ratio were 3/1. Epidermoid carcinoma was the major histology. Incidence of esophageal carcinoma was higher in the distal and middle third of the esophagus. In 19 patients tumor size was more than 5 cm. In total of 17 of the patients were operated. About 58 patients were irradiated. About 45 of the patients were irradiated with curative intent, 31 of them were primarily irradiated and 14 of them were irradiated postoperatively. Only 13 of the patients received concurrent chemoradiotherapy. Overall 1, 2, 3, and 4 year survival rates were 38.9%, 11.1%, 5.6%, and %1.9, respectively and median survival was 12 months. Median survival for tumors located in cervical esophageal, middle esophagus, and distal esophagus were 23, 8, and 14 months, respectively. One, 2, 3, 4 year survival rates of operated patients were 58.8%, 29.4%, 17.6%, 5.9%, respectively and median survival was 23 months. For inoperable patients 1 and 2 year survival rates were 29.7% and 2.7% and median survival was 8 months. Differences between operable and inoperable patients were statistically significant (P: 0.0003). One, 2, 3, 4 years survival results of patients treated with surgery and postoperative radiotherapy was 62.5%, 25%, 12.5%, 12.5% and median survival was 21 months, 1, 2, 3, 4 years survival results of patients treated with surgery and concurrent chemoradiotherapy was 55.6%, 33.3%, 22.2%, and 0% and median survival was 27 months. There was no statistically significant difference between groups (P: 0.5390). During the therapy, disphagia was the major side effect observed in seven patients. Fatigue, pain, and mild weight loss were the other side effects. Three patients could not tolerate the treatment and left the therapy. We demonstrated that stage III esophageal carcinoma is an extremely deadly disease, and in spite of major advances in cancer treatment, prognosis is still poor.     

中高危老年乳腺癌患者改良根治术后放疗的意义

目的 探讨中高危老年(≥65岁)乳腺癌患者改良根治术后放疗(PMRT)的意义.方法 收集874例改良根治术后中高危乳腺癌患者的临床资料,回顾性分析不同年龄组患者接受PMRT的情况和PMRT的作用,其中T3～T4和(或)N2～N3为高危组,T1～T2N1为中危组.结果 ≥65岁的患者108例,占12.4%.与＜65岁的患者相比,≥65岁的患者中,病理学分级为Ⅲ级、N3、高危和化疗患者所占的比例低,而合并其他疾病和有恶性肿瘤史者所占的比例高.≥65岁的患者中,中危组和高危组患者接受放疗的比例分别为15.3%和52.2%;＜65岁的患者中,中危组和高危组患者接受放疗的比例分别为18.1%和82.7%.≥65岁的患者中,中危组放疗和未放疗者的5年局部区域复发率分别为0和14.2%(P=0.242),5年总生存率分别为100%和75.2%(P=0.159);高危组放疗和未放疗者的5年局部区域复发率分别为0和14.1%(P=0.061),5年总生存率分别为84.6%和77.4%(P=0.597).＜65岁的患者中.中危组放疗和未放疗者的5年局部区域复发率分别为0和9.9%(P=0.035),5年总生存率分别为87.0%和82.1%(P=0.739);高危组放疗和未放疗者的5年局部区域复发率分别为7.2%和26.1%(P=0.000),5年总生存率分别为79.2%和57.7%(P=0.000).结论 不同年龄的中危组患者实施PMRT的比例相仿,但对于高危组患者,接受PMRT的比例随着患者年龄的增长而降低.高危老年乳腺癌患者实施PMRT可能可以降低局部区域复发率,应支持放疗.