Implantation of 125Ⅰ seeds for recurrence cervical node of head and neck tumor after external beam radiotherapy

Objective To summarize the efficacy and the feasibility of 125I seed implantation for recurrence cervical lymph node of head and neck tumor after radiotherapy or radiotherapy plus neck dissection. Methods Thirty-six patients with the recurrence cervical lymphnode of head and neck tumor after radiotherapy (17 patients) or radiotherapy plus neck dissection (19 patients) were treated with 125I seed implantation guided by ultrasound or CT under local anesthesia. The median number of seeds was 27( range from 3 to 78 ). Postoperative quality evaluation were routinely obtained for all patients. The actuarial D90 ranged from 90-160 Gy (median, 130 Gy). Results The follow-up rate was 100%. The number of the patients who were followed up over 1-and 2-year were 11 and 3. The overall response rate was 81%. The 1-and 2-year over local control rates, over survival rates were 69% and 35%, 50% and 22%, respectively.The 1-and 2-year local control rates in patients with recurrence node after radiotherapy plus neck dissection were 72% and 54%, while those were 67% and 50% in patients with recurrence node after radiotherapy,respectively (χ2=00,P=0.965). The 1-and 2-year survival rates in two groups were 48%, 13% , and 51%, 39%, respectively (χ2=0.17, P=0.676). Conclusions 125I seed implantation is a safe,minimal invasive with low morbidity and high efficacy salvage treatment method for cervical lymph node recurrence of head and neck tumor after radiotherapy with or without neck dissection.     

Neck dissection for recurrent and persistent lymph nodes of nasopharyngeal carcinoma after radiotherapy： effect and choice

Objective:To investigate lhe best surgical mode for the patients of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy.Methods:The dinical data of 88 patients of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy were analyzed retrospectively.The levets of involved lymph nodes and the relationship among the levels were analyzed;the survival rate and recurrent rate of the surgical modes including radical neck dissection(RND),modified radical neck dissection(MRND),selective neck dissection(SND),and lymph node resection(LNR)were analyzed;the role of postoperative radiotherapy was evaluated.Results:(1)The recurrent and persistent lymph nodes mainly located in level Ⅱ(55.6%and 58.6%,respectively),next was level Ⅲ and rarely in level Ⅳ.Ⅴand Ⅰ,but the number of levels Ⅳ,Ⅴ and Ⅰ with cencer-bearing lymph nodes was relatively more tban that of clinical measurement.(2)Patients with lymph nodes involved in level Ⅲ and Ⅳ.usually,have other levels involved simultaneously;the percentages were 63.6%and 88.9%,respectively.However,the lymph nodes in level Ⅱ and Ⅴ were mainly isolated.(3)The 5-year survival rate and recur-rent rate of the whole group were 42.77%and 22.7%,respectively.(4)The 5-year survival rates of RND,MRND.SND,and LMR groups were 39.75%,60.00%,37.87%,and 44.10%,respectively;the differences were insignificant(Log-rank:1.0,P=0.8011):the recurrent rate between the extensive and local surgery groups were insignificant(X2=0.470,P=0.493).(5) The 5-year survival rates of the patients with and without postoperative radiotherapy were 39.06% and 45.26%.respectively;the difference was insignificant (Log-rank=0.06.P=0.8138).Conclusion:The extensive surgery was recommended when the recurrent and persistent lymph nodes were more than one level jnvolved or very large or immovable,otherwise,the SND should be performed and postoperative radiotherapy was important compensation if necessary.     

Long-term outcome of 160 patients with stage Ⅱb cervical carcinoma treated with pre-operative and intra-operative radiotherapy

Objective To investigate the 5-and 10-year survival and complications of patients with stage Ⅱb cervical carcinoma treated by pre-operative photon radiotherapy (POPRT) plus brachytherapy (192Ir) and selective lymphadenectomy hysterectomy (SLH) plus intra-operative electron radiotherapy (IOERT). Methods From February 1997 to May 2007, 160 patients with stage Ⅱb cervical carcinoma were treated by POPRT of 20 Gy in 10 fractions to the whole pelvis, 192Ir brachytherapy of 14 Gy in 2fractions, followed by IOERT of 18 -20 Gy to the whole pelvis during SLH one week after. Results The follow-up rate was 98.1%. The number of patients followed-up for 5 and 10 years was 143 and 135,respectively. The 5-year overall survival rate, disease-free survival rate and local control rate of all patients were 89.4%, 86. 3% and 96. 3%, with the corresponding 10-year rates of 84.4%, 81.0% and 95.0%,respectively. The radiation-induced rectitis and cystitis were 5.0% and 0. 6%, respectivly. The rate of hydronephrosis and lower extremity edema was 6. 3% and 1.3%, respectively. Conclusions Combination of EBRT plus 192Ir brachytherapy and SLH plus IOERT could improve the survival and local control of patiens with cervical carcinoma, with only a few side effects.     

Long-term outcome of 160 patients with stage Ⅱb cervical carcinoma treated with pre-operative and intra-operative radiotherapy

Objective To investigate the 5-and 10-year survival and complications of patients with stage Ⅱb cervical carcinoma treated by pre-operative photon radiotherapy (POPRT) plus brachytherapy (192Ir) and selective lymphadenectomy hysterectomy (SLH) plus intra-operative electron radiotherapy (IOERT). Methods From February 1997 to May 2007, 160 patients with stage Ⅱb cervical carcinoma were treated by POPRT of 20 Gy in 10 fractions to the whole pelvis, 192Ir brachytherapy of 14 Gy in 2fractions, followed by IOERT of 18 -20 Gy to the whole pelvis during SLH one week after. Results The follow-up rate was 98.1%. The number of patients followed-up for 5 and 10 years was 143 and 135,respectively. The 5-year overall survival rate, disease-free survival rate and local control rate of all patients were 89.4%, 86. 3% and 96. 3%, with the corresponding 10-year rates of 84.4%, 81.0% and 95.0%,respectively. The radiation-induced rectitis and cystitis were 5.0% and 0. 6%, respectivly. The rate of hydronephrosis and lower extremity edema was 6. 3% and 1.3%, respectively. Conclusions Combination of EBRT plus 192Ir brachytherapy and SLH plus IOERT could improve the survival and local control of patiens with cervical carcinoma, with only a few side effects.     

74例隆突型皮肤纤维肉瘤的治疗与预后分析

Objective： To study treatment and prognostic factor in 74 patients with dermatofibrosarcoma protuberans. Methods： From August 1990 to November 1999, 74 patients with dermatofibrosarcoma protuberans （DFSP） confirmed by pathology were treated in Cancer Hospital of Sun Yat-sen University. 72 cases were given wide excision and 2 cases were given local excision. All of 74 cases, 52 cases had surgical resection alone, and 22 cases had surgical resection combined with radiotherapy. Total dose of radiotherapy was 50-70 Gy. Results： The rate of recurrence was 36.1% for all patients. The 5-year recurrence-free survival （RFS） rate was 66%. The 5-year recurrence-free survival rates for resection alone and combined with radiotherapy were 58% and 90%, respectively （P=-0.0187）. The 5-year recurrence-free survival rates for positive microscopic margins and negative microscopic margins were 57% and 75%, respectively （P=0.0468）. Conclusion： Post-operation radiotherapy is an effective treatment to decrease the recurrence rate for the patients with positive microscope, or the patients without suitable surgical treatment.     

1030例早期乳腺癌术后放疗不同年龄组的预后分析

Objective To analyze the prognostic value of age in patients with early stage breast cancer. Methods The clinical characteristics of 1030 patients with early stage breast cancer (the number of positive axillary lymph nodes was less than 3) were retrospectively reviewed. Of all the patients, 468(stage Ⅰ, n = 227; and stage Ⅱ , n = 241) received breast conserving surgery (BCS) and 562 (stage Ⅰ, n =184; and stage Ⅱ, n= 378) received modified mastectomy. Patients were divided into young-age group (≤35,136 patients), middle-age group (> 35-≤60,738 patients) and old-age group (> 60,156 patients).The number of patients without postoperative radiation therapy after BCS is 16, 60 and 39 in the three groups, respectively. Two-dimensional conventional fractionated radiotherapy was administered. The prognostic value of the tumor size, status of axillary lymph nodes or hormonal receptors, postoperative radiation therapy were analyzed. Results The follow-up rate was 97.86%. Of 795 patients followed up more than 5 years, 110,569 and 116 patients were devided into the three groups, respectively. There were 40, 202 and 87 patients without radiation therapy in the three groups. The 5-year recurrence rates of the three groups were 6. 2%, 8. 7% and 10. 4% (χ2 = 1.14, P= 0.567). The 5-year distant metastasis rates were4.3% , 9.5 % and2. 5% (χ2 = 5.31 , P = 0. 070) . The5 - year survival rates were9l. 2% , 92. 6%and 82. 1% (χ2 = 6. 83, P = 0.033). The young-age group had more tumors smaller than 2. 0 cm (65.4%), less positive axillary lymph nodes (13.2%), poorer differential tumor and less positive hormone acceptors (48.0%). Of patients with tumor larger than 2. 0 cm who had no radiotherapy after BCS, the 5-year survival rates were 94%, 87% and 71% (χ2= 20.69, P= 0.000) in the three groups. The corresponding recurrence rates were 23%, 18% ,7%, (χ2 = 9. 97, P = 0. 007), and distant metastasis rates were23%, 25% and 10% (χ2 =8.51, P=0. 014). Conclusions The age is an important prognostic factor in patients with early stage breast cancer undergoing BCS, but not in those undergoing modified mastectomy.     

1030例早期乳腺癌术后放疗不同年龄组的预后分析

Objective To analyze the prognostic value of age in patients with early stage breast cancer. Methods The clinical characteristics of 1030 patients with early stage breast cancer (the number of positive axillary lymph nodes was less than 3) were retrospectively reviewed. Of all the patients, 468(stage Ⅰ, n = 227; and stage Ⅱ , n = 241) received breast conserving surgery (BCS) and 562 (stage Ⅰ, n =184; and stage Ⅱ, n= 378) received modified mastectomy. Patients were divided into young-age group (≤35,136 patients), middle-age group (> 35-≤60,738 patients) and old-age group (> 60,156 patients).The number of patients without postoperative radiation therapy after BCS is 16, 60 and 39 in the three groups, respectively. Two-dimensional conventional fractionated radiotherapy was administered. The prognostic value of the tumor size, status of axillary lymph nodes or hormonal receptors, postoperative radiation therapy were analyzed. Results The follow-up rate was 97.86%. Of 795 patients followed up more than 5 years, 110,569 and 116 patients were devided into the three groups, respectively. There were 40, 202 and 87 patients without radiation therapy in the three groups. The 5-year recurrence rates of the three groups were 6. 2%, 8. 7% and 10. 4% (χ2 = 1.14, P= 0.567). The 5-year distant metastasis rates were4.3% , 9.5 % and2. 5% (χ2 = 5.31 , P = 0. 070) . The5 - year survival rates were9l. 2% , 92. 6%and 82. 1% (χ2 = 6. 83, P = 0.033). The young-age group had more tumors smaller than 2. 0 cm (65.4%), less positive axillary lymph nodes (13.2%), poorer differential tumor and less positive hormone acceptors (48.0%). Of patients with tumor larger than 2. 0 cm who had no radiotherapy after BCS, the 5-year survival rates were 94%, 87% and 71% (χ2= 20.69, P= 0.000) in the three groups. The corresponding recurrence rates were 23%, 18% ,7%, (χ2 = 9. 97, P = 0. 007), and distant metastasis rates were23%, 25% and 10% (χ2 =8.51, P=0. 014). Conclusions The age is an important prognostic factor in patients with early stage breast cancer undergoing BCS, but not in those undergoing modified mastectomy.     

Preoperative Chemoradiotherapy for Inflammatory Breast Cancer

OBJECTIVE To observe the effect of preoperative chemoradiotherapy for inflammatory breast cancer. METHODS From December 1996 to December 2000, we received and treated 21 patients with inflammatory breast carcinoma with a combined-modality treatment. The chemotherapy protocol consisted of cyclophos-phamide (CTX), pirarubicin (THP-ADM) and 5-fluorouracil (5-FU) or CTX, 5-Fu and methotrexate (MTX). The same infusion scheme was repeated on day 21. After 3-4 cycles the patients were treated with radiotherapy. When the radiation dose reached 40 Gy, the patients who were unable or unwilling to under go an operation received continued radiotherapy. When the radiation dose to the supra clavicular fossa and internal mammary lymph nodes reached 60 Gy and 50 Gy respectively, the radiotherapy was stopped. Chemotherapy was then continued with the original scheme. Patients who had indications for surgery and were willing to under go an operation received no treatment for 2 weeks, after which a total mastectomy was performed. Chemotherapy and radiotherapy was resumed with the original scheme after the operations. When the radiation dose reached 50 Gy, radiotherapy was stopped. RESULTS All patients were followed-up for more than 5 years with a follow-up rate of 100%. The overall 3 and 5-year survival rates of these patients were 42.9%, and 23.8% respectively. For patients in Stage IIIB the 3 and 5-year survival rates were 50.0% and 27.8% respectively, and for patients in Stage IV, the 3 and 5-year survival rates were both 0.0%. There was a significant difference between the 2 stage groups (P<0.05, x2=11.60). For patients who received an operation, the 3 and 5-year survival rates were 80.0% and 33.3% respectively, For patients who were not treated with an operation, the 3 and 5 -year survival rates were both 0.0%, There was a significant difference between the operated and non-operated groups (P<0.05, x2=11.64). CONCLUSION The prognosis of inflammatory breast carcinoma is poor. Before operation, a combined -modality treatment (first chemotherapy, then local therapy, finally chemotherapy and radiotherapy) is the best treatment method.     

The recurrence and survival of oral squamous cell carcinoma: a report of 275 cases

Oral squamous cell carcinoma （OSCC） is a common malignant tumor of the head and neck, and recurrence is an important prognostic factor in patients with OSCC. We explored the factors associated with recurrence of OSCC and analyzed the survival of patients after recurrence. Clinicopathologic and follow-up data of 275 patients with OSCC treated by surgery in the Cancer Institute and Hospital of Tianjin Medical University between 2002 and 2006 were analyzed. Recurrence factors were analyzed with Chi- square or Fisher＇s exact test and multivariate analysis. The prognosis of patients after recurrence was analyzed with the Kaplan-Meier method and log-rank test. The recurrence rate was 32.7%. The recurrence time ranged from 2 to 96 months, with a median of 14 months. Univariate analysis showed that T stage, degree of differentiation, pN stage, flap application, resection margin, and lymphovascular invasion were factors of recurrence （P 〈 0.05）. Multivariate analysis showed that T stage, degree of differentiation, and pN stage were independent factors of recurrence （P 〈 0.001）. The differences in gender, age, tumor site, region of lymph node metastasis, and perineural invasion between the recurrence and non-recurrence groups were not significant （P 〉 0.05）. Kaplan-Meier and log-rank tests showed that the 2- and 5-year survival rates were significantly lower in the recurrence group than in non-recurrence group （67.6% vs. 88.0%, 31.8% vs. 79.9%, P 〈 0.001）. Therefore, to improve prognosis, we recommend extended local excision, flap, radical neck dissection, and adjuvant chemoradiotherapy for patients more likely to undergo recurrence.     

三维适形放疗治疗局部晚期非小细胞肺癌的疗效

目的 评价三维适形放疗治疗局部晚期非小细胞肺癌(NSCLC)的疗效.方法 527例局部晚期NSCLC患者中,253例接受三维适形放疗,274例接受常规放疗.三维适形放疗组中,接受化放综合治疗者159例(62.8%).放射剂量为50～59 Gy者49例, 60 Gy者127例,＞60 Gy者77例.常规放疗组中,接受放化综合治疗者127例(46.4%).放射剂量为50～59 Gy者75例,60 Gy者151例,＞60 Gy者48例.结果 三维适形放疗组患者的1、3、5年总生存率分别为73.3%、26.1%和14.4%,中位生存时间为20.1 个月;常规放疗组患者的1、3、5年总生存率分别为61.0%、13.8%和8.0%,中位生存时间为15.6 个月(P=0.002).三维适形放疗组患者的1、3、5年肿瘤专项生存率分别为79.0%、33.3%和20.8%,常规放疗组患者分别为65.1%、16.7%和11.2%(P＜0.001).三维适形放疗组患者的1、3、5年局部区域控制率分别为71.6%、34.3%和31.0%;常规放疗组患者分别为57.3%、22.1%和19.2%(P=0.002).多因素分析结果显示,KPS评分、治疗前血红蛋白、放疗方法和近期疗效是NSCLC患者总生存和肿瘤专项生存的独立影响因素,三维适形放疗组的总生存率和肿瘤专项生存率较常规放疗组显著提高(OR分别为0.762和0.680,均P＜0.01).两组患者放射性食管炎和放射性肺炎的发生率差异无统计学意义(P＞0.05).结论 采用三维适形放疗技术,能够提高局部晚期NSCLC患者的生存率.

Abstract：

Objective To compare the treatment results of three-dimensional conformal radiotherapy (3D-CRT) and conventional radiotherapy (2D) for patients with locally advanced non-small-cell lung cancer (NSCLC). Methods Five hundred and twenty seven patients with stage Ⅲ NSCLC treated between Jan 2000 and Dec 2006 were included in this study. Among them, 253 cases were treated with 3D-CRT, and 274 with conventional radiotherapy. In the 3D group,159(62.8%)patients ceceived chemoradiotherapy, 77 with total radiotherapy dose of >60 Gy, 49 with 50-60 Gy. In the 2D group, 127(46.4%)patients received chemoradiotherapy,48 with total radiotherapy dose of >60 Gy,75 with 50-60 Gy. Results The 1-, 3-, 5-year overall survival rates(OS)and median survival time for patients treated with 3D-CRT were 73.3%, 26.1%, 14.4% and 20.1 months, respectively, and that of patients treated with 2D radiotherapy were 61.0%, 13.8%, 8.0% and 15.6 months, respectively (P=0.002). The 1-, 3-, 5-year cause-specific survival rates(CSS) were 79.0%, 33.3%, and 20.8% for the 3D group and 65.1%, 16.7%, 11.2%, respectively, for the 2D group (P=0.000). The 1-, 3-, and 5-year locoregional control rates were 71.6%, 34.3% and 31.0% for patients treated with 3D radiotherapy and 57.3%, 22.1% and 19.2%, respectively, for patients treated with 2D treatment(P=0.002). The results of multivariate analysis showed that 3D-CRT, KPS, clinical tumor response and pretreatment hemoglobin level were independently associated with increased OS and CSS. No statistically significant differences were found between the radiation complications in the two groups. Conclusions The results of our study demonstrate that 3D-conformal radiotherapy improves the survival rate in patients with stage Ⅲ NSCLC compared with that of 2D radiation therapy.     

鼻咽癌根治放疗后残留病变的两种推量治疗方法疗效比较

Objective： To compare the efficacy between stereotactic radiotherapy （SRT） and intracavitary brachytherapy （brachytherapy） in residual tumor of nasopharyngeal carcinoma （NPC） after treating with conventional external beam radiotherapy. Methods： 60 patients with residual tumor of NPC after radical external beam radiotherapy （range 68 to 72 Gy） were randomized into SRT group （27 patients） and brachytherapy group （33 patients）. Patients in SRT group received boost treatment of 10-20 Gy, 2-3 fractions, once every other day; patients in brachytherapy group were treated with boost 10-20 Gy, 5 Gy per fraction, twice a week. Results： Efficacy in the near future： in SRT group, the complete recession （CR）, partial recession （PR） and no change （NC） rates were 77.8% （21/27）, 18.5% （5/27）, 3.7% （1/27）, respectively and the efficacy rate was 96.3% （CR ＋ PR）; in brachytherapy group： the CR, PR and NC rates were 75.8% （25/33）, 18.2% （6/33）, 6.1% （2/33）, respectively and the efficacy rate was 93.9% （CR ＋ PR）. The efficacy rates of the above two groups were compared （x^2 = 0.032, P 〉 0.05）. Long term efficacy： in SRT group, 1-year and 3-year survival rates were 96.3%, 66.5% respectively and the median live time was 48 months; in brachytherapy group： 1-year and 3-year survival rates were 93.9%, 60.2% respectively and the median live time was 46 months. The survival rates of two groups were compared （x^2 = 0.172, P 〉 0.05）. Conclusion： Both boost techniques of SRT and brachytherapy had elevated efficacy in patients with residual tumor of NPC and there was no obvious difference between the efficacy of the near and long term in SRT and brachytherapy group.     

The 10-Year Local Recurrence and Partial Breast Radiotherapy for Early Breast Cancer Tmarted by Conservative Surgery

To study the local recurrence and the role of whole breast radiotherapy for early breast cancer treated by conservative surgery. METHODS From April 1990 to December 2000, 49 patients with early primary breast cancer were treated by conservative surgery in our hospital. The cases were comprised of Stage 0, 1; Stage Ⅰ, 31; and Stage Ⅱa, 17. Forty cases underwent quadrantectomy plus axillary lymph node dissection, and the other 9 cases had lumpectomy alone. Irradiation, which was received by 39 patients, was administered by using low tangential half fields with 6 MV X-ray to decrease the pulmonary irradiative volume. The dose to the whole breast was 45 Gy/22 ～23f/4.5W, then a 15 Gy boost dose was delivered to the tumor bed by an electron beam. The other patients underwent an irradiated regional field according to postoperative pathology. RESULTS All patients were followed-up for 10 years or more. The 10- year local recurrence rates, distant metastasis rates and survival rates were 6.1%, 4.1% and 98.0% respectively. All of the 3 patients who had a local recurrence had infiltrative carcinomas and negative lymph nodes. The 10-year local recurrence rate was higher （2.6% vs. 20.0%） with nonpostoperative whole breast radootherapy, but the statistical difference was not marked because of the low number of cases. All of the recurrent lesions localized within 3 cm of the primary lesion. CONCLUSION Original recurrence of the tumor was the main type of local recurrence. Radiotherapy after conservative surgery is very essential. After conservative surgery it is feasible that irradiation can be delivered alone to the neighboring region of the tumor bed. Partial breast radiotherapy can substitute for whole breast radiotherapy.     

131例食管鳞癌三维适形放疗预后因素分析

目的 探讨影响食管磷癌放疗的预后因素.方法 回顾分析2004--2007年本科非手术并采用CT模拟定位及三维适形放疗的131例Ⅰ～Ⅲb期食管磷癌患者资料和影响预后因素.放疗采用6 MV X线,靶区剂母60Gy分30次6周完成.结果 随访率为100%.单因素分析结果 显示原发灶大体肿瘤体积(GTV)≤40 cm3和>40 cm3的1、2、3年局部控制率分别为71%、64%、60%和43%、32%、28%(x2=13.16,P=0.000).T1+2期和T3期及T4期的分别为67%、59%、59%和62%、53%、50%及41%、28%、19%(X2=13.25,P=0.001).GTV≤40 cm3和>40 cm3的1、2、3年生存率分别为78%、53%、46%和45%、27%、7%(X2=21.55,P:0.000),T1+2期和T3期及T4期的分别为71%、50%、39%和68%、45%、25%及36%、18%、15%(X2=14.35,P=0.001),原发灶肿瘤长度≤5cm和>5 cm的分别为75%、50%、44%和53%、35%、18%(X2=5.99,P=0.014).多因素分析结果 显示GTV、T分期均影响局部控制率(X2=7.07,P=0.008;X2=6.63,P=0.036),而生存率仅与GTV有关(X2=15.82,P=0.000).结论 食管鳞癌GTV可作为显著影响预后的独立因素,GTV越大者预后越差.

Abstract：

Objective To evaluate the impact of gross tumor volume(GTV)on prognosis of three-dimensional conformal radiotherapy(3DCRT)in esophageal carcinoma.Methods From Jan.2004 to Oct.2007,131 stageⅠ-Ⅲb patients with unreseetable esophageal carcinomas who received 3DCRT with 60 Gy/ 30f/6w were analyzed retrospectively.The effectiveness of related prognostic factors on survival was evaluated by univariate and multivariate analyses.Results The following-up rate was 100%.By univariate analysis,the 1-,2-and 3-year local tumor control rates were 71%,64%and 60%for patients with GTV volume≤40 cm3,and 43%,32%and 28%for those with GTV volume>40 cm3(X2=13.16,P=0.000).respectively.The 1-,2-and 3-year local tumor control rates were 67%,59%,59%for T1+2 patients,62%,53%,50%for T3 patients,and 41%,28%,19%for T4 patients,respectively(X2=13.25,P=0.001).The 1-,2-and 3-year survival rates were 78%,53%,46%for patients of GTV volume≤40 cm3 and 45%.27%and 7%for patients of GTV volume>40 cm3(X2=21.55,P=0.000).The 1-,2-and 3-year survival rates were 71%,50%and 39%for patients with T1+2,68%,46%and 25%with T3,and 36%,18%and 15%with T4,repectively(X2=14.35,P=0.001).The 1-,2-and 3-year survival rates for patients with tumor length≤5 cm were 75%,50%and 44%,compared with 53%,35%and 18%with tumor length>5cm(X2=5.99,P=0.014).By multivariate analysis,GTV volume and T stage were likelv to be independent prognostic factors for local tumor control rates(X2=7.07,P=0.008;X2=6.63,P=0.036).Only the GTV volume was associated with the overall survival rate(X2=15.82,P=0.000).Conclusions GTV volume is independent prognostic factor.The larger the GTV volume is,the worse the prognosis will be.     

142例侵袭性纤维瘤病的临床特点及预后分析

Objective Aggressive fibromatosis is a rare kind of soft tissue tumor and was evaluated by few large studies. This study was to evaluate the clinical characteristics and identify the prognostic factors of this disease. Methods One hundred and forty-two patients with aggressive fibromatosis treated from January 1983 to August 2009 in Tianjin Medical University Cancer Hospital were retrospectively reviewed.The prognostic value of clinical and treatment factors was analyzed. Univariate analysis was performed with Log-rank test and Multivariate analysis was performed with Cox regression model. Results The follow-up rate is 93.7% and the median follow up time was 54 months (range,6 -208 months). Sixty-three patients had a minimum follow up time of 5 years and 6 patients had a minimum follow up time of 10 years. The male/female ratio was 1/1.84. The disease was most popular in women aged from 18 to 35 years old. The disease frequently occurred in the trunk (55.6%) and extremity (31.7%). All patients received surgery,and 46 received radiotherapy. The 5-year and 10-year local recurrence rates were 24. 4% and 31.1%,respectively. The 5-year and 10-year overall survival rates were both 99. 3%. Univariate analysis revealed that factors correlated with local recurrence were tumor size ( χ2 = 4. 37, P = 0. 037 ) and margin status (χ2 = 12. 36,P =0. 002). Multivariate analysis revealed that margin status was an independent risk factor (RR = 2. 219; χ2 = 9. 47,P = 0. 002) and radiotherapy was an independent protective factor ( RR = 0. 360;χ2 = 4. 95, P = 0. 026 ) for disease recurrence. When radiotherapy was delivered, the 10-year local recurrence rate decreased from 70. 1% to 20. 7% in patients with positive margin ( χ2 = 4. 22, P = 0. 040 )and decreased from 19.8% to 10.4% (χ2= 0.90, P= 0.344) in patients with negative margin.Conclusions Radical resection is the mainstay of treatment for aggressive fibromatosis. Postoperative radiotherapy can reduce the recurrent rate for patients with positive margin. In patients with negative margin,the role of radiotherapy should to be further evaluated in large clinical trials.     

原发性骨淋巴瘤的疗效和预后因素分析

目的 回顾分析原发性骨淋巴瘤(PBL)患者的疗效和预后因素.方法 1994-2009年间本中心收治的PBL患者31例,均经病理证实为非霍奇金淋巴瘤,其中Ⅰ E、Ⅱ E、ⅣE期分别为22、4、5例.全组单纯手术1例、单纯放疗1例、单纯化疗2例、术后化疗4例、放化疗23例,放疗剂量中位数字为50 Gy.结果 随访时间中位数45.2个月.随访率为83.9%.随访满10年者9例.全组治疗后5、10年总生存率分别为92%、92%,无进展生存率分别为79%、70%.非联合放化疗组的完全缓解率为50%、进展或复发为2/8、复发时间中位数为6.8个月,联合放化疗组相应为65%、13%、39.1个月.单因素分析显示年龄≤50岁(χ2=5.32,P=0.021)及美国东部肿瘤协作组(ECOG)体力状况(PS)评分0～1分(χ2=5.48,P=0.019)为生存预后因素,国际预后指数评分≤1分(χ2=7.81,P=0.005)及ECOG PS评分0～1分(χ2=18.70,P=0.000)为无进展生存预后因素.结论 PBL患者预后良好,放化疗应作为首选治疗方法,放疗剂量≥40 Gy较安全可行.年轻及一般状况较好患者预后更好.

Abstract：

Objective To retrospectively analyze the treatment results and prognostic factors in patients with primary bone lymphomas (PBL).Methods Thirty-one patients with PBL treated between April 1994 and May 2009 at Sun Yat-sen University Cancer Center were analyzed.All patients were diagnosed by pathology.Twenty-two patients had stage Ⅰ E, 4 patients had stage Ⅱ E and 5 patients had stage ⅣE diseases.One patient was treated with surgical resection alone, 1 patient with radiotherapy (RT) alone, 2 patients with chemotherapy (CT) alone and 4 patients with resection followed by chemotherapy.The remaining 23 patients received CT combined with RT.The median radiation dose was 50 Gy.Results The median follow-up time was 45.2 months.The follow-up rate was 83.9%.Nine patients had a follow-up time of 10 years.The 5-year and 10-year overall survival rates were 92% and 92%, respectively.The 5-year and 10-year disease-free survival rates were 79% and 70%, respectively.In the group who received non-combined chemoradiotherapy, the complete response rate was 50%, the incidence of progression or recurrence was 2/8 and the median recurrence time was 6.8 months.In the group who received combined chemoradiotherapy, the complete response rate was 65%, the incidence of progression or recurrence was 13% and the median recurrence time was 39.1 months.In univariate analyses, favorable prognostic factors for survival included age≤50 years (χ2=5.32,P=0.021) and ECOG PS score 0-1(χ2=5.48,P=0.019).Favorable prognostic factors for DFS included IPI score≤1(χ2=7.81,P=0.005) and ECOG PS score 0-1(χ2=18.70,P=0.000).Conclusions Treatment results of patients with PBL can be generally well.CT combined with RT appears to be the treatment of choice.RT dose ≥40 Gy is safe and feasible.Younger age and better performance status are associated with a better outcome.     

早期鼻腔NK/T细胞淋巴瘤治疗方法和预后分析

Objective To investigate the prognosis of patients with nasal NK/T cell lymphoma receiving different treatment modalities. Methods From 1990 to 2004, 85 patients with stage ⅠE and ⅡE primary nasal NK/T cell lymphomas were retrospectively studied. Twenty patients received chemotherapy of CHOP regimen alone, 11 patients received radiotherapy only, 6 patients received radiotherapy followed by more than 2 cycles of chemotherapy, and 48 patients received more than 2 cycles of chemotherapy followed by radiotherapy. Survival analysis was performed by the Kaplan-Meier method, the difference between groups was evaluated by the Log-rank test, and the Cox regression model was used for multivariate analysis. Results The 5-year overall survival rate (OS) was 40%. The 5-year OS was 57% and 28% for limited stage ⅠE and extended stage ⅠE(X2 =8. 87, P =0. 003), and 23% for stage ⅡE, which was similar to extended stage ⅠE (X2 =0. 19, P-0. 664). The 5-year OS was 13%, 54% and 47% for chemotherapy alone, radiotherapy followed with or without chemotherapy, and chemotherapy followed by radiotherapy, respectively. The last two groups had better OS than chemotherapy alone (P = 0. 030 and 0.049). The 5-year OS was 58% and 12% for patients achieving complete response (CR) and uncomplete response (X2 = 30.68, P = 0. 000).The CR rate was 56% and 86% for radiotherapy of ≤50 Gy and >50 Gy (X2 =6.11, P=0. 013). The corresponding 5-year relapse-free survival rate was 89% and 84% (X2 =0.36, P=0.551). Of 68 patients receiving initial chemotherapy, the CR rate of those who received ≤2, 3-4 and ≥5 cycles was 0, 20%and 3 3 % , respectively (X2 = 7.65 , P = 0. 022) . For 5 0 patients who received ≥ 3 cycles of initial chemotherapy and 17 patients who received initial radiotherapy of ≥40 Gy, the CR rate was 28% and 88%(χ2= 18. 75, P= 0. 000). In patients with pathological nodular and ulcer type, the CR rates with radiotherapy were higher than with chemotherapy (100%: 38%, χ2 = 7.92, P = 0. 005; and 100%: 11%,χ2 = 14.40, P = 0. 000). Multivariate analysis showed that stage and recent effect were the independent prognostic factors. Conclusions The initial radiotherapy with 50 Gy is appropriate for early stage nasal NK/T cell lymphomas. Combined chemotherapy could be used for extended stage ⅠE and ⅡE, but the outcome of CHOP regimen is poor.     

早期鼻腔NK/T细胞淋巴瘤治疗方法和预后分析

Objective To investigate the prognosis of patients with nasal NK/T cell lymphoma receiving different treatment modalities. Methods From 1990 to 2004, 85 patients with stage ⅠE and ⅡE primary nasal NK/T cell lymphomas were retrospectively studied. Twenty patients received chemotherapy of CHOP regimen alone, 11 patients received radiotherapy only, 6 patients received radiotherapy followed by more than 2 cycles of chemotherapy, and 48 patients received more than 2 cycles of chemotherapy followed by radiotherapy. Survival analysis was performed by the Kaplan-Meier method, the difference between groups was evaluated by the Log-rank test, and the Cox regression model was used for multivariate analysis. Results The 5-year overall survival rate (OS) was 40%. The 5-year OS was 57% and 28% for limited stage ⅠE and extended stage ⅠE(X2 =8. 87, P =0. 003), and 23% for stage ⅡE, which was similar to extended stage ⅠE (X2 =0. 19, P-0. 664). The 5-year OS was 13%, 54% and 47% for chemotherapy alone, radiotherapy followed with or without chemotherapy, and chemotherapy followed by radiotherapy, respectively. The last two groups had better OS than chemotherapy alone (P = 0. 030 and 0.049). The 5-year OS was 58% and 12% for patients achieving complete response (CR) and uncomplete response (X2 = 30.68, P = 0. 000).The CR rate was 56% and 86% for radiotherapy of ≤50 Gy and >50 Gy (X2 =6.11, P=0. 013). The corresponding 5-year relapse-free survival rate was 89% and 84% (X2 =0.36, P=0.551). Of 68 patients receiving initial chemotherapy, the CR rate of those who received ≤2, 3-4 and ≥5 cycles was 0, 20%and 3 3 % , respectively (X2 = 7.65 , P = 0. 022) . For 5 0 patients who received ≥ 3 cycles of initial chemotherapy and 17 patients who received initial radiotherapy of ≥40 Gy, the CR rate was 28% and 88%(χ2= 18. 75, P= 0. 000). In patients with pathological nodular and ulcer type, the CR rates with radiotherapy were higher than with chemotherapy (100%: 38%, χ2 = 7.92, P = 0. 005; and 100%: 11%,χ2 = 14.40, P = 0. 000). Multivariate analysis showed that stage and recent effect were the independent prognostic factors. Conclusions The initial radiotherapy with 50 Gy is appropriate for early stage nasal NK/T cell lymphomas. Combined chemotherapy could be used for extended stage ⅠE and ⅡE, but the outcome of CHOP regimen is poor.     

放化疗中不同化疗方式对N3期鼻咽癌预后影响

目的 评价放化疗中不同方式化疗对N3期鼻咽癌患者预后的影响.方法 回顾分析114例N3期鼻咽癌患者资料.9例接受单纯放疗;105例接受以铂类为基础化疗联合放疗,其中同期放化疗37例,诱导化疗+同期放化疗53例,同期放化疗+辅助化疗15例.鼻咽原发灶采用60Co γ线、6 MV X线常规分割照射70 Gy,颈部根治量60～68 Gy,颈部预防量54～60 Gy.结果 中位随访时间54个月,共51例患者死亡.全组5年总生存率为59.1%.单纯放疗、同期放化疗、诱导化疗+同期放化疗、同期放化疗+辅助化疗的5年总生存率分别为17%、51%、68%、71%(X2=15.44,P=0.001),无复发生存率分别为83%、77%、88%、93%(X2=2.34,P:0.505),无转移生存率分别为17%、54%、72%、80%(X2=19.28,P=0.000).结论 诱导化疗+同期放化疗及同期放化疗+辅助化疗方式对N3期鼻咽癌患者比单纯同期放化疗更具优势,最有效治疗方式有待随机研究证实.

Abstract：

Objective Nasopharyngeal carcinoma patients with stage N3 disease are prone to develop distant metastasis even treated with standard concurrent chemoradiotherapy(CRT).The aim of this study is to compare the ettlcacy of difierent chemotherapy sequences in these patients.Methotis All patients with histologically proven,carcinoma of the nasopharynx treated between July 1999 and November 2003 were restaged according to the AJCC 2002 stage classification system.A total of 114 patients had AJCC N3 diseases were analyzed retrospectively.Patients were treated by conventional RT technique using 6 MV photons or 60 Coγ-ray with 1.8-2.0 Gy per fraction,5 fractions a week,to a planned dose of 70 Gy.The prophylactic irradiation dose of the neck wss 54-60 Gy.Any positive lymph node was boosted to a total dose of 60-68 Gy.All patients received cisplatin-based chemotherapy of difierent sequences but 9 patients RT alone.CRT regimen was delivered in 37 patients,neoadjuvant chemotherapy(NACT)+CRT regimen in 53 patients and CRT+adjuvant chemotherapy(AC)regimen in 15 patients.Results The prophylactic irradiation dose of the neck wss 54-60 Gy.Any positive lymph node was boosted to a total dose of 60-68 Gy.All patients received cisplatin-based chemotherapy of difierent sequences but 9 patients received RT alone.CRT regimen was delivered in 37 patients,neoadjuvant chemotherapy(NACT)+CRT regimen in 53 patients and CRT+adjuvant chemotherapy(AC)regimen in 15 patients.Results The median follow up time was 54 months(3-117months).The 5-year overall survival rate was 59.1%in whole groups,and with 17%,51%,68%and 71%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=15.44,P=0.001).The 5-year relapse-free survival rates were 83%,77%,88%and 93%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=2.34,P=0.505).The 5-year metastasis-free survival rates were 17%,54%,72%and 80%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=19.28,P=0.000).Conclusions The NACT+CRT and CRT+AC regimens were more effective than CRT alone for N3 disease in the current study.Large prospective,randomized clinieal studies are warranted.     

Efficacy of preoperative intracavitary brachytherapy and surgery in patients with stage ⅠB2 and ⅡA bulky cervical cancer

Objective To analyze the outcomes of preoperative intracavitary brachytherapy plus sur-gery in patients with stage ⅠB2 and ⅡA bulky cervical cancer. Methods From January 2001 to January 2007, 77 patients with stage ⅠB2 and ⅡA bulky cervical cancer were included. The diameter of primary tumor was greater than 4 cm. Preoperative intracavitary brachytherapy with the total dose of 20-30 Gy (0.5 cm below the vaginal mucosa) was delivered by 2-3 fractions, one fraction per week. After an interval of 10-14 days, the efficacies of radiotherapy were evaluated and radical hysterectomy with pelvic lymphade-nectomy was performed. Then the treatment complications, clinicopathological characteristics, survival and recurrence were analyzed. Results The tumor shrinkage was observed in all the patients after intracavitary brachytherapy. The CR, PR and SD were 5% (4/77), 36% (28/77) and 58% (45/77), respectively. Radical hysterectomy was successfully performed in all patients. The complications of the combined therapy were mild and only 5 patients had grade Ⅱ or less hematological or gastrointestinal toxicities. The 5-year o-verall survival rate and pelvic recurrence rate were 83% and 12%, respectively. Conclusions Preoperative intracavitary brachytherapy of 20-30 Gy plus surgery is effective in the treatment of stage ⅠB2 and ⅡA bulky cervical cancer without increasing the treatment complications.     

Efficacy of preoperative intracavitary brachytherapy and surgery in patients with stage ⅠB2 and ⅡA bulky cervical cancer

Objective To analyze the outcomes of preoperative intracavitary brachytherapy plus sur-gery in patients with stage ⅠB2 and ⅡA bulky cervical cancer. Methods From January 2001 to January 2007, 77 patients with stage ⅠB2 and ⅡA bulky cervical cancer were included. The diameter of primary tumor was greater than 4 cm. Preoperative intracavitary brachytherapy with the total dose of 20-30 Gy (0.5 cm below the vaginal mucosa) was delivered by 2-3 fractions, one fraction per week. After an interval of 10-14 days, the efficacies of radiotherapy were evaluated and radical hysterectomy with pelvic lymphade-nectomy was performed. Then the treatment complications, clinicopathological characteristics, survival and recurrence were analyzed. Results The tumor shrinkage was observed in all the patients after intracavitary brachytherapy. The CR, PR and SD were 5% (4/77), 36% (28/77) and 58% (45/77), respectively. Radical hysterectomy was successfully performed in all patients. The complications of the combined therapy were mild and only 5 patients had grade Ⅱ or less hematological or gastrointestinal toxicities. The 5-year o-verall survival rate and pelvic recurrence rate were 83% and 12%, respectively. Conclusions Preoperative intracavitary brachytherapy of 20-30 Gy plus surgery is effective in the treatment of stage ⅠB2 and ⅡA bulky cervical cancer without increasing the treatment complications.