Combination chemotherapy composed of mFOLFOX 6, FOLFIRI 2 and surgery and radiation therapy for locoregional recurrences and multiple lung metastases from rectal cancer--a case report

A 61-year-old man underwent amputation of the rectum for advanced lower rectal cancer in April 2005. UFT-E granules were administered orally daily at 400 mg/body/day following surgery. He developed perineal pain and perineal discharges following an increase the CEA level in April 2006. PET revealed a tumor in the perineum and multiple lung metastases. Chemotherapy with mFOLFOX 6 for 8 courses and FOLFIRI 2 for 4 courses were administered since July in 2006. Although CT revealed a the reduction in multiple lung metastases, CEA was increased to over a maximum 109, high fever continued and the pinealtumor was enlarged in December 2006. The patient underwent resection of the perinealmass, but he developed perinealsevere pain and perinealdischarge. So radiotherapy of the pelvic region was given at a total dose of 40 Gy(given 2 Gy each fragment)followed by administration of FOLFIRI 2 for 12 courses. After chemoradiotherapy, the CEA level was remarkably decreased. PET could not detect any mass in lung fields and revealed a little accumulation in the pelvic region. Chemotherapy with FOLFIRI 2 is administered monthly now, and the CEA level has been within the normal range since July of 2007. The pineal pain and pineal discharge disappeared, so the quality of life has improved dramatically.     

胃癌单纯手术与术后合并化疗的远期疗效比较：附170例分析

A prospective randomized comparative study on 5-year survival rates in 170 cases of stomach cancer was done. All were treated by surgery, herein, 82 received postoperative chemotherapy. The 5-year survival rates were 40.2% and 21.6% in combination group (surgery plus chemotherapy) and surgery alone group (P less than 0.01), 56.4% and 30.2% in patients treated by radical operation combined with chemotherapy and radical operation alone (P less than 0.01), 60.5% and 36.9% in patients with Stage II and III lesions as treated by radical operation plus chemotherapy and by radical operation alone (P less than 0.05). The results suggest that chemotherapy after surgery improve the long term survival rate in patients with stomach cancer.     

Outcome of pediatric pineoblastoma after surgery, radiation and chemotherapy

INTRODUCTION: Pineoblastomas are a category of supratentorial primitive neuroectodermal tumors (sPNETs) occurring in the pineal gland; some studies support the impression that patients with pineoblastomas have a worse prognosis than those with other sPNETs. METHODS: We reviewed the medical records and tissue sections of all patients with the diagnosis of pineoblastoma that were treated at the Dana-Farber Cancer Institute/Children's Hospital Boston Pediatric Brain Tumor Program between 1986 and 2005. RESULTS: Thirteen patients with the pathologic diagnosis of pineoblastoma were treated at our Hospital; 11 of these cases had complete records suitable for study. The median age was 8 years 8 months (5 F, 6 M). Surgical, radiation and chemotherapeutic regimens varied from case to case. Three patients had gross total resection and are alive and free of disease, versus four of eight with subtotal resection or biopsy only. Patients who received CSI and multi-agent chemotherapy had improved overall survival. CONCLUSIONS: Seven of eleven patients with pineoblastoma are currently alive and free of disease, reflecting an improved outcome and longer survival than previously appreciated. Gross total surgical resection appeared to correlate with improved survival, as did treatment with craniospinal irradiation and multi-agent chemotherapy. Further study of this group of patients as a distinct diagnostic entity will be necessary to determine optimal therapy.     

122例老年直肠癌患者外科治疗的临床分析

背景与目的:老年直肠癌患者常常合并其他疾病,其手术方案的选择需要综合考虑各种因素。本研究的目的是探讨65岁以上老年直肠癌患者的治疗方案及影响其预后的因素。方法:回顾性分析中国医学科学院肿瘤医院1987年1月至1998年12月间收治的122例老年直肠癌患者的临床资料。全组患者均经手术治疗,其中腹会阴联合根治术45例,直肠前切除术66例,Hartmann术7例,经肛直肠癌局部切除术4例。术后发生并发症者10例(8.2%),无术后30天内死亡病例。采用Kaplan-Meier法进行生存分析,log-rank检验进行统计学比较;应用Cox比例风险模型进行多因素分析。结果:全组总的3年及5年生存率分别为76.4%、61.0%。无淋巴结转移组(DukesA、B期)3年及5年生存率分别为81.6%、70.6%,有淋巴结转移组(DukesC期)分别为60.9%、40.4%,两组比较有显著性差异(χ2=10.1,P<0.01)。直肠癌的组织学类型、肿瘤大小及是否合并其它脏器疾病等因素对预后没有显著性影响(P>0.05)。Cox比例风险模型分析表明淋巴结转移状况是影响预后的重要独立因素。结论:老年直肠癌患者经合理的围手术期处理,大多能耐受手术,并可获长期生存;淋巴结转移状况是影响其预后的重要因素。     

Combined preoperative chemotherapy and radiation for locally advanced rectal carcinoma

To determine the efficacy of combined preoperative chemotherapy and radiation therapy for locally advanced rectal carcinoma and the rate of sphincter conservation, a retrospective survey of 39 patients with locally advanced rectal carcinoma treated with various 5-fluorouracil- and leukovorin-based chemotherapy regimens and radiation prior to surgery in a single institution was reviewed. Toxicity, local control and survival were evaluated and compared to previous studies with similarly staged patients. Long-term follow-up was available on 35 patients. The actuarial local failure was 5.7% while the actuarial 5-year survival was 87%. The mortality rate was low (2.5%) and the rate of long-term serious complications acceptable (11.4%). Combined preoperative chemotherapy and radiation provided excellent local regional control despite the poor prognostic factors associated with size, fixation, and the initial advanced tumor stage with acceptable morbidity. In addition, patients with tumors located in the lower third of the rectum may be able to undergo sphincter-sparing surgery. Although the median follow-up is relatively short (32.4 months), the results are in accordance with previous studies of neoadjuvant combined chemotherapy and radiation for locally advanced rectal carcinoma in terms of local and distant control.     

Combination chemotherapy and radiation for palliation of hepatocellular carcinoma.

Twenty seven patients with hepatocellular carcinoma were treated by sequential methotrexate (75 mg/m2) and 5-fluorouracil (5-FU) (750 mg/m2) on day 1 followed on days 8-36 by external beam radiotherapy (total dose 30 cGy). The response was assessed by liver size on clinical examination. One patient had complete response, and six patients had partial response. The overall response to the treatment was 25.9%. More than a 50% reduction in serum alfa-fetoprotein level was noted in 66.6% patients. Seventy-one percent of patients had palliation of pain following therapy. The median survival of responders was 11 months and of nonresponders, 2 months. Radiation was discontinued in two patients who developed radiation hepatitis. Additional trials with different dosages and schedules are needed to fully evaluate this form of therapy.     

Neoadjuvant, surgery and adjuvant chemotherapy without radiation for esophageal cancer

BACKGROUND: A phase II trial to evaluate neoadjuvant (NAD), surgery and adjuvant (AD) combination chemotherapy without radiation therapy (RT) for patients with esophageal adenocarcinoma staged with endoscopic ultrasound and CT as T3N1 was carried out. METHODS: Thirty-three eligible patients were enrolled. NAD therapy was administered in two 49-day cycles and included cisplatin, floxuridine, paclitaxel and leucovorin. Esophageal resection was performed followed by AD therapy. RESULTS: Thirty-three patients initiated NAD therapy; 10 experienced grade 3 and 4 toxicities, which included leucopenia, fatigue, nausea, diarrhea and stomatitis. Additionally, 16 patients experienced grade 1 and 2 hematologic and non-hematologic toxicities. Fifteen patients were down-staged, of whom five were T2, seven were T1, and three had nodal disease with no evidence of residual cancer in the esophageal bed. Fifteen patients remained T3, and two showed progressive disease. Thirty-two patients proceeded to surgery and 30 were resected. Although all resected patients were eligible for AD therapy, 15 did not receive it either because of patient refusal or surgeon recommendation. Fifteen patients received AD therapy: nine who had remained T3 and six who had down-staged. Three patients experienced grade 3 and 4 toxicities similar to those in NAD therapy. Six patients had grade 1 and 2 toxicities. Kaplan-Meier estimates of overall survival at 1, 3 and 5 years were 73% (95% CI: 58-88%), 52% (95% CI: 34-69%) and 29% (95% CI: 13-45%), respectively. Median survival was 42 months. CONCLUSION: Deletion of RT may safely allow for more aggressive chemotherapy and increase chances of survival. The results need to be confirmed in a randomized phase II or larger phase III trial.     

Pediatric intracranial ependymoma: the roles of surgery,radiation and chemotherapy

Management of pediatric intracranial ependymomas poses a major challenge, and optimal treatment remains controversial. We sought to investigate the roles of surgery, radiation, and chemotherapy in a historical cohort. Thirty-nine children, age 21 or younger, with non-metastatic intracranial ependymomas were treated from 1972 to 2008. Median age was 8 years (range 0.2–19.1). Twenty-one patients (54%) underwent GTRs, and 18 (45%) underwent STRs. Twenty-six patients (67%) received upfront adjuvant RT (67%), and 14 (44%) received adjuvant chemotherapy. Twenty-four patients had disease recurrence and 12 died. Only one patient recurred after 5 years. Median PFS was 2.7 years and median OS was 20 years. Fifteen year PFS and OS were 30 and 67%. Adjuvant RT was associated with improved PFS (P = 0.045), and remained significant after adjusting for EOR (P = 0.04). Greater EOR trended towards prolonged survival, but did not reach statistical significance (P = 0.156). Of the patients that underwent GTR, the median PFS was 38 months for those treated with adjuvant RT versus 30 months for those that were not treated with RT. Of the patients that had STR, the median PFS for those treated with RT was 26.3 months versus 6.9 months for those were not treated with RT. In conclusion, for localized intracranial pediatric ependymomas, adjuvant RT is associated with improved PFS, even after adjusting for EOR. Our findings suggest the benefit of RT even in the presence of GTR. Future prospective studies with larger sample number are needed to validate our findings.     

Combination of operation, chemotherapy and radiation for AFP producing gastric cancer--a case report

We report a case of AFP producing gastric cancer after a combination of operation, chemotherapy and radiation. A 70-year-old man was admitted complaining of abdominal fullness. He was diagnosed as having type 3 advanced gastric cancer with multiple lymph node metastasis, including No. 8p lymph node, by endoscopy and computed tomography. Distal gastrectomy and D2 lymph node dissection were performed after chemotherapy using S-1, low-dose CDDP and CPT-11. Histopathological study showed moderately differentiated adenocarcinoma, and immunohistochemical study revealed a few AFP-positive tumor cells. Postoperatively, radiation (50 Gy) was performed for paraaortic lymph node metastasis and right hepatic lobectomy for liver metastasis. However, about 2 months after hepatic lobectomy, liver metastasis was diagnosed again by computed tomography, and radiation (30 Gy) was performed. He died 13 months after first surgery.     

Neoadjuvant chemotherapy, surgery, and postoperative radiation therapy for invasive thymoma.

Between January 1988 and June 1990, seven previously untreated patients with histologically confirmed and clinically staged IIIa invasive thymoma (IT) were enrolled in a prospective, single treatment arm study of neoadjuvant chemotherapy (NC) followed by surgery and postoperative radiation therapy (4600 to 6000 cGy). The NC included three cycles of cisplatin (75 mg/m2 on day 1), epirubicin (100 mg/m2 on day 1), and etoposide (120 mg/m2 on days 1, 3, and 5), every 3 weeks. All patients showed a partial response (greater than 50%) and underwent complete (n = 4) or incomplete (gross [n = 1] or microscopic [n = 2] residual tumor) surgical resection. Histologic examination was negative for two completely resected patients. Projected 2-year survival was 80%; all patients but one currently are alive and disease-free. This approach appeared to be feasible and may be a new therapeutic choice in the management of IT, but its use on a regular basis should be reserved until a larger number of patients and longer follow-up are available.     

Combination chemotherapy of paclitaxel, carboplatin and gemcitabine in patients who have received prior cisplatin-based chemotherapy

The objective of this study was to evaluate the efficacy and toxicity of combination chemotherapy with paclitaxel, carboplatin and gemcitabine in patients with advanced urothelial carcinoma, who have received prior cisplatin-based chemotherapy. Eligible patients had pathologically proven measurable metastatic urothelial carcinoma. Between April 2005 and May 2009, 8 patients with a mean age of 7 0 years were treated every 3 weeks with paclitaxel (200 mg/m2 on day 1), carboplatin (AUC= 5/body on day 1) and gemcitabine (800 mg/m2 on day 1 and 8). A total of 4 0 (median 4) cycles were administered. None of the 8 patients achieved a complete response(CR), but 3 patients (37. 5%) achieved a partial response (PR) and 3 were stable with the disease(SD). The median overall survival time and the median progression-free survival time were 8. 0 and 4. 5 months, respectively. Grade 4 hematological toxicities included neutropenia in 6 cycles (15. 0%), thrombocytopenia in 8 cycles (20. 0%) and anemia in 11 cycles (27. 5%). Three of the 8 patients had febrile neutropenic episodes, and no toxic death was observed. Our results suggest that the combination chemotherapy of paclitaxel, carboplatin and gemcitabine was effective, and an acceptable treatment for patients with advanced urothelial carcinoma who have received prior cisplatin-based chemotherapy.     

Combined chemotherapy, radiation, and surgery for epithelial cancer of the anal canal

Combined chemotherapy and radiation therapy have been reported to produce a high incidence of complete regression of epithelial cancer of the anal canal, resulting in prolonged disease-free survival. This modality has been advocated as an alternative to abdominoperineal resection as a primary treatment for this disease. Our group treated 19 patients between 1979 and 1985. Treatment included two infusions of 5-fluorouracil (1000 mg/m2/24 hours), one dose of mitomycin C (15 mg/m2), and simultaneous whole-pelvis radiation (3000 rad). The complete response rate was 88%. Three patients had anal cancer incompletely controlled by that therapy. They underwent abdominoperineal resections and are alive without disease at 10, 39, and 43 months, respectively. Actuarial disease-free survival at 40 months was 87.5 +/- 8.8 (% +/- standard error of the mean [SEM]). Complications included gastrointestinal, hematologic, and cutaneous toxicity. These results confirmed a high complete response rate to this therapy. Local treatment failures may occur, but these may be salvaged with abdominoperineal resection.     

Treatment of ovarian cancer with surgery, short-course chemotherapy and whole abdominal radiation

BACKGROUND: The primary aim was to induce a high number of pCR in early(FIGO IC, JIB + C)-and advanced (FIGO ffl—IV)—stageovarian cancer with a surgery plus 4 cycles of cisplatin andmeiphalan (PAMP) regimen. The second objective was to preventrelapse with WAR in patients in remission after chemotherapy. PATIENTS AND METHODS: 218 eligible patients were treated after staging laparotomywith cisplatin 80 mg/sqm iv. on day 1 and melphalan 12 mg/sqmi.v. on day 2 q 4 weeks. Response was verified by second-looklaparotomy. WAR was carried out with the open field techniqueon a linear accele rator (daily dose: 1.3 Gy, total dose: 29.9Gy) in patients with pathological or clinicaJ CR or pathologicalPR with microscopical residual disease. RESULTS: 146/218 patients (67%, 95% CI: 61%–73%) responded to PAMIP:56 (26%) achieved pCR, 24 (11%), cCR, 56 (26%) pPR and 10 (5%)cPR (c=clinical, p=pathological). Multivariate analyses revealedthat in advanced stages (92 cases in remission), the achievementof pCR was the most important factor for longer time to failure(TIF) and survival. Only 5 1/118 (43%) patients in remissionreceived WAR Early-stage patients <=55 years were more likelyto have WAR than patients older than 55 years (77% vs. 23%;p= 0.02). Advanced-stage patients with cCR were less likelyto be irradiated than patients with pCR or pPR (10% vs. 51%;p= 0.003). Toxicity of PAMP was acceptable with 10% of WHO grade4 hematologic toxicity. Acute hematological toxicity of WARcaused interruption (3 3%) or incompleteness (3 3%) of irradiationin the majority of patients. CONCLUSIONS: PAMP is an effective treatment for advanced ovarian cancer witha 67% response rate after 4 cycles. For the majority of patientsin remission, WAR as a consolidation treatment was hardly feasible.For these patients new treatment modalities to consolidate remissionare needed. advanced ovarian cancer, chemotherapy, cisplatin, melphalan, second-look surgery, whole abdominal radiation