淋巴结阳性胸段食管鳞癌术后放化疗临床研究

目的 对淋巴结阳性胸段食管鳞癌术后放化疗与术后放疗进行回顾性分析,观察其疗效和不良反应.方法 选择首程治疗行胸段食管鳞癌三野淋巴结清扫根治术,术后病理有淋巴结转移、无远处转移患者304例,其中术后放疗组140例,术后放化疗组164例.术后放疗剂量50 Gy,化疗方案为顺铂加紫杉醇,21 d为1个周期,平均2.35个周期/例.结果 术后放化疗组和术后放疗组3年总生存率、无瘤生存率分别为65.7%和52.8%(χ2=6.90,P=0.009)、62.5%和52.8%(χ2=4.75,P=0.029);锁骨上区淋巴结转移率、远处转移率、总复发转移率分别为1.8%和7.1%(χ2=5.21,P=0.022)、18.3%和27.9%(χ2=3.94,P=0.047)、27.4%和39.3%(χ2=4.80,P=0.028);早期不良反应的中性粒细胞减少、放射性食管炎、胃肠道反应分别为96.3%和32.1%(χ2=140.31,P=0.000)、37.2%和26.4%(χ2=4.01,P=0.045)、23.2%和5.0%(χ2=19.77,P=0.000);晚期不良反应分别为6.1%和5.0%(χ2=0.17,P=0.678).结论 淋巴结阳性胸段食管鳞癌术后放化疗能提高生存率和无瘤生存率,降低锁骨上区淋巴结转移率、远处转移率和总复发转移率,早期不良反应重于单纯术后放疗,但患者能耐受治疗.

Abstract：

Objective To retrospectively analyze the treatment results and side effects of postoperative chemoradiotherapy and postoperative radiotherapy of thoracic esophageal squamous cell carcinoma (EPC) with positive lymph nodes.Methods Three hundred and four patients of thoracic EPC were initially treated with three-field lymphadenectomy, with pathological positive lymph nodes and without distant metastases;and randomly divided into two groups:140 patients of the simple postoperative radiotherapy (RT) and 164 patients of postoperative chemoradiotherapy (CRT).The median total dose was 50 Gy.The regimen of concurrent chemotherapy included cisplatin and taxol, and the intermission was 21 days;the median cycles were 2.35.Results The 3-year overall survival rates were 65.7% of CRT and 52.8% of RT (χ2=6.90,P=0.009), and The 3-year disease-free survival rates were 62.5% of CRT and 52.8% of RT (χ2=4.75,P=0.029).The incidences of the supraclavicular lymph-node metastases were 1.8% and 7.1%(χ2=5.21,P=0.022), respectively;and the incidences of distant metastases were 18.3% and 27.9%(χ2=3.94,P=0.047), respectively;and the incidences of overall metastases and recurrences were 27.4% and 39.3%(χ2=4.80,P=0.028), respectively.Early side effects included granulopenia (96.3% and 32.1%,χ2=140.31,P=0.000), radiation-induced esophagitis (37.2% and 26.4%,χ2=4.01,P=0.045),and gastrointestinal toxicity (23.2% and 5.0%,χ2=19.77,P=0.000).Late side effects were 6.1% and 5.0%(χ2=0.17,P=0.678), respectively.Conclusions Postoperative chemoradiotherapy of thoracic EPC with positive lymph nodes can improve the overall survival and disease-free survival, decrease the incidence of the supraclavicular metastases, the distant metastases, the total metastases and recurrences.More severe early side effects were observed in chemoradiotherapy than in the radiotherapy group,but well tolerated.     

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.     

调强放疗联合培美曲塞和顺铂同期化疗局部晚期非小细胞肺癌的临床研究

目的 探讨调强放疗结合培美曲赛和顺铂同期化疗局部晚期非小细胞肺癌的疗效及副反应.方法 42例Ⅲ期非小细胞肺癌患者(ⅢA期25例,ⅢB期17例)接受DT66 Cy调强放疗,疗中给予培美曲塞500 mg/m2静脉滴注第1天,顺铂75 mg/m2静脉滴注第1天,21 d为1个周期,共4个周期.放化疗在同大开始进行,先化疗后放疗.2例放疗总量54 Gy,2例56 Gy;3例完成了2周化疗,1例完成了 3周化疗.结果 34例患者完成了治疗计划.全组总有效率为79%,1年总生存率为65%.≥3级骨髓抑制2例,3级放射性食管炎3例,≥2级放射性肺炎4例,3级黏膜炎1例.结论 培美曲赛和顺铂同期放化疗局部晚期非小细胞肺癌患者具有较好的近期疗效,副反应可耐受.

Abstract：

Objective To observe the therapeutic effect and toxicity of chemoradiation of locally advanced non-small cell lung cancer by intensity modulated irradiation combined with pemetrexed and cisplatin. Methods Fourty-two patients presented with Ⅲ - stage non-small cell lung cancer(Ⅲ、 25 patients, ⅢB 17 patients)received concurrent chemoradiotherapy. Intensity modulated irradiation technique was used to the total dose of 66 Gy and concurrent chemotherapy consisted of pemetrexed 500 mg/m2 on Day 1 and cisplatin 75 mg/m2 on Day 1 by intravenous infusion once every 3 weeks at the initiation of radiation.Patients received 4 cycles of chemotherapy. Results Thirty-four patients finished the whole of therapeutic schedule. And 2 patients received radiation with total dose of 54 Gy, 2 patients 56 Gy;3 patients received 2 cycles of chemotherapy, 1 patients 3 cycles of chemotherapy. Total effective rate was 79%. There were 2 patients with ≥3 grade marrow depression, 3 patients with 3 grade radiation esophagitis, 4 patients with ≥2 radiation pneumonitis, and 1 patient with 3 grade mucositis. The 1-year survival rate was 65%.Conclusion Recent effect was favourable and toxicity was tolerable for chemoradiation of locally advanced non-small cell lung cancer by intensity modulated irradiation combined with pemetrexed and cisplatin.     

局部晚期宫颈癌CT图像引导下192Ir三维腔内后装治疗剂量体积参数与疗效关系

目的 观察CT图像引导下192Ir三维腔内后装治疗的肿瘤靶区及危及器官受照射体积剂量参数与肿瘤局部控制率及晚期副反应之间关系.方法 10例局部晚期宫颈癌患者在完成盆腔外照射40 Gy及同期化疗后开始每周1次的CT图像引导下192Ir三维腔内后装治疗,每次治疗前进行CT扫描定位,勾画肿瘤靶区(GTV、CTV)和危及器官,利用PLATO治疗计划系统进行逆向治疗计划设计及优化,CTV单次处方剂量为6 Gy,治疗5～7次.结果 1年盆腔控制率为90%,1～2级放射性肠炎发生率为50%,无≥3级副反应.90%CTV等效生物剂量(BED)和相当于2 Gy分次的等效剂量(EQD2)分别为(95.50±7.81)Gy和(79.73±6.57)Gy(α/β=10).90%GTV的BED和EQD2分别为(101.86±7.27)Gy和(84.95±6.1)Gy(α/β=10).90%处方剂量对GTV、CTV的覆盖率分别为92%±4%、87%±7%.直肠、乙状结肠2 cm3体积受到的最小照射剂量分别为(74.97±1.64)、(67.93±4.30)Gy(EQD2,α/β=3).与二维治疗计划相比,三维治疗计划在没有改变A点剂量、直肠参考点剂量情况下提高了GTV、CTV的90%体积受照射剂量及90%处方剂量对GTV、CTV的覆盖率.结论 CT图像引导下192Ir三维腔内后装治疗提高了处方剂量对肿瘤靶区的覆盖率,1年盆腔控制率为90%且无严重副反应,远期疗效观察中.

Abstract：

Objective To investigate the correlation between dose volume histogram(DVH)of tumor targets and organs at risk(OAR)at CT-image based 192Ir brachytherapy and effects and complications for patients with locally advanced cervical cancer. Methods Ten patients with FIGO stage ⅢB cervical cancer received CT image-based 192Ir intracavitary brachytherapy after 54 Gy of three-dimentional four-field pelvic external beam radiotherapy and concurrent weekly cisplatin chemotherapy. Before each brachytherapy,CT images were acquired with applicators in place. Gross tumor volume(GTV), clinical target volume (CTV)and OAR were contoured and inverse treatment planning was designed and optimized by using PLATO treatment planning system. Conventional two-dimensional plans were also designed for comparison.The total intracavitary brachytherapy dose was 30 -42 Gy in 5 -7 fractions. The patients were followed, and the local control and complications were analyzed. The biologically equivalent dose(BED)and biologically equivalent dose in 2 Gy fractions(BED2)for GTV, CTV and OAR were calculated. The minimum dose in the most irradiated tissue volume 2 cm3(D2 cm3)adjacent to the applicator of the sigmoid colon, rectum,bladder and small bowel was determined from the DVH. Results The 1-year local pelvic control rate was 90% and grade 1-2 late complication of sigmoid colon and rectum was 50%. No grade 3 or more complications developed. On CT-image based planning, the BED and BED2 to 90% of the CTV(D90)were 95.50 Gy ± 7. 81 Gy and 79. 73 Gy ± 6. 57 Gy. The BED and BED2 to 90% of the GTV(D90)were 101.86 Gy ± 7.27 Gy and 84. 95 Gy ± 6. 1 Gy. The volume enclosed by 90% of prescribed dose(V90)for GTV and CTV were 92% ±4% and 87% ±7% respectively. The D2cm3 for rectum and sigmoid colon were 74. 97 Gy ±1.64 Gy and 67. 93 Gy ± 4. 30 Gy(EQD2, α/β = 3). Comparing with 2D brachytherapy plans , CT - image based planning has improved D90 and V90 for GTV and CTV with similar dose at point A and rectum reference point. Conclusions Computer tomography-image based 192Ir brachytherapy has resulted in the better dose distribution to the tumor targets with excellent tumor control and acceptable toxicity.     

术前同期放化疗治疗肺上沟瘤的疗效分析

Objective: To compare the clinical effect and toxicities of preoperative concurrent chemoradiotherapy (CT/RT)with radiotherapy (RT) alone in patients with superior sulcus lung tumor. Methods: Fifty-six patients with superior sulcus lung tumor were divided randomly into two groups: twenty-six patients received concurrent chemoradiotherapy, the other thirty patients received only radiotherapy. For both groups, the same radiation technic was given with the convention fraction. The total dose was 45 Gy/25 Fr/5 Wk. For the CT/RT group, the patients were also given with concurrent chemotherapy (navelbine 15-18 mg/m2 on the 1st and 8th day, cisplatin 60 mg/m2 on the 1 st day). Results: The rate of complete resection in the CT/RT group was significantly higher than that in the RT group (92.3% vs 80%, P ＜ 0.05). The complete pathological response rate and 2-year survival rate in the CT/RT group were significantly higher than those in the RT group (P ＜ 0.01, P ＜ 0.01). The incidences of grades Ⅲ-Ⅳ radiation esophagitis and leukopenia in the CT/RT group were significantly higher than those in the RT group (23.1% and 23.1% vs 6.7% and 0, P ＜ 0.01, P ＜ 0.01). Conclusion: Preoperative concurrent chemoradiotherapy has the potential of improving the survival rate of superior sulcus lung tumors. Though this treatment regimen also increases the acute toxic effect, all patients can tolerate it. It is expected to be a new "standard treatment" for this malignant tumor.     

Effects of dosimetric inadequacy on local control and toxicities in the patients with T4 nasopharyngeal carcinoma extending into the intracranial space and treated with intensity-modulated radiotherapy plus chemotherapy

Background:To protect neurological tissues,underdosing occurs in most cases ofT4 nasopharyngeal carcinoma (NPC) with intracranial extension.In this study,we aimed to evaluate the effect of dosimetric inadequacy on local control and late neurological toxicities for patients treated with intensity-modulated radiotherapy (IMRT) plus chemotherapy.Methods:We prospectively enrolled patients who had non-metastatic T4 NPC with intracranial extension treated between January 2009 and November 2013.The prescribed dose was 66.0-70.4 Gy to the primary planning target volume (primary gross tumor volume [GTVp;i.e.,the nasopharyngeal tumor] + 5.0 mm).Dose-volume histogram parameters were calculated,including minimum point dose (Dmin) and dose to 95％ of the target volume (D9s).All patients received chemotherapy with the cisplatin,5-fluorouracil,and docetaxel regimen.Survivals were estimated using the Kaplan-Meier method and compared using the log-rank test.Results:In total,41 patients were enrolled.The local partial response rate was 87.8％ after induction chemotherapy.With a median follow-up of 51 months,7 patients experienced failure in the nasopharynx;the 3-year local failure-free survival and overall survival rates of the 41 patients were 87.4％ and 90.2％,respectively.The actual mean Dmin to the GTVp was 55.2 Gy (range 48.3-67.3 Gy),and D9s was 61.6 Gy (range 52.6-69.0 Gy).All doses received by neurological organs remained well within their dose constraints.No patients developed temporal lobe necrosis or other neurological dysfunctions.Conclusions:With relative underdosed IMRT plus effective chemotherapy,the patients achieved satisfactory local control with few late toxicities of the central nervous system.Determining the acceptable extent of dosimetric inadequacy requires further exploration.     

56例局部晚期非小细胞肺癌三维适形放疗加化疗的长期疗效分析

目的 分析局部晚期非小细胞肺癌(NSCLC)三维适形放疗(3DCRT)疗效和不良反应,以及影响预后的因素.方法 资料完整的56例Ⅲ期NSCLC患者纳入分析.其中男36例,女20例,年龄32～84岁.鳞癌28例,腺癌20例,腺鳞癌1例.ⅢA期32例,ⅢB期24例.单纯放疗14例,化放疗42例.放疗采用加速器6 MV X线照射,1.8～3.0 Gy/次,30～69 Gy.化疗采用紫杉醇或多西紫杉醇或长春瑞滨+顺铂或卡铂一线方案.结果 随访率为96%,随访满3、5年者分别为14、10例.完全缓解5例,部分缓解34例,有效率为70%.1、3、5年生存率分别为62%、25%、17%,中位生存时间为20个月.Logrank检验显示临床分期、卡氏评分、肿瘤体积、放疗剂量、治疗模式、近期疗效显著影响生存率,Cox回归分析显示临床分期、治疗模式和近期疗效为独立预后因素.急性放射性肺炎2级1例、3级1例,晚期放射性肺炎2级1例、3级1例.急性放射性食管炎1级20例、≥2级5例.骨髓抑制1+2级15例、>2级4例.结论 3DCRT治疗局部晚期NSCLC对临床分期较早、放疗剂量≥60Gy的化放疗、近期疗效好的患者生存率较好,放射性损伤在可接受范围.

Abstract：

Objective To analyze the efficacy,complications and prognostic factors of three-dimensional conformal radiotherapy(3 DCRT)for locally advanced non-small cell lung cancer(NSCLC).Methods 56 patients who were treated either by radiotherapy alone(14 patients)or radiotherapy plus chemotherapy(42 patients)from Jan.2005 to Feb.2008 were enrolled.The patient cohort consisted of 36 men and 20 women,median age 62,median total dose 60 Gy.Results The following-up rate was 96%.The number of patients completed follow-up were 14 and 10,respectively at 3-year and 5-year.The response rate of 3DCRT was 70%.with complete mmission 9%and partial remission 61%.The 1-、3-、and 5-.year survival rates were 62%、25% and 17%,respectively,and the median survival time(MST)was 20 months.By logrank test,clinical stage,KPS perfomance,tumor volume,radiation dose,treatment regimen and response to treatment showed statistically dramatic impact on overall survival.By Cox muhivariable regression,the independent adverse prognostic factors by both univariate analysis and multivariate analysis were clinical stage,treatment type,and response to treatment.Grade 2 acute radiation pneumonitis was observed in 1 patient and grade 3 in 1 patient.Late grade 2 lung injury developed in 1 patient,and grade 3 in 1 patient.Acute grade 1 radiation esophagitis were observed in 20 patients.and above Grade 2 in 5patients.Acute grade 1+2 hematologic toxicity developed in 15 patients,and above Grade 2 developed in 4 patients.Conclusions 3 DCRT was feasible in the treatment of locally advanced NSCLC with acceptable normal tissue toxicity.Relative early stage.radio-chemotherapy with total radiation dosage≥60 Gy and good immediate tumor response are favorable prognostic factors for overall survival.     

尼妥珠单抗联合化疗治疗晚期非小细胞肺癌

目的 评价尼妥珠单抗联合化疗治疗晚期非小细胞肺癌(NSCLC)的价值.方法 回顾性分析2009年1月至2010年10月采用尼妥珠单抗联合化疗的37例晚期NSCLC患者的临床资料.其中Ⅲb期12例,Ⅳ期25例.采用尼妥珠单抗联合铂类为基础的化疗方案24例,尼妥珠单抗联合非铂类药物的化疗方案13例.尼妥珠单抗联合化疗作为一线方案患者10例,二线方案23例,三线方案4例.结果 37例患者共计化疗137个周期,平均每例3.7个周期.其中完全缓解(CR)1例,部分缓解(PR)9例,稳定(SD)16例,进展(PD)11例,有效率(RR)为27.0%,临床获益率(CBR)为70.3%.主要毒副反应为骨髓抑制和胃肠道反应,仅有1例患者出了Ⅰ度座疮样皮疹.结论 尼妥珠单抗联合化疗治疗晚期NSCLC患者可提高疗效,且耐受性良好.

Abstract：

Objective To evaluate the role of nimotuzumab in combination with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). Methods The clinical data of 37 NSCLC patients who received nimotuzumab in combination with chemotherapy in Tianjin Medical University Cancer Hospital from January 2009 to October 2010 were retrospectively reviewed. Of the thirty-seven patients, 12patients were in stage Ⅲ B, 25 patients in stage Ⅳ. Twenty-four patients recived platinum-based chemotherapy in combination with nimotuzumab, 13 patients recived nonplatinum-based chemotherapy in combination with nimotuzumab. Ten patients received nimotuzumab in combination with chemotherapy as first-line regimen, 23 patients as second-line regimen, 4 patients as third-line regimen. Results Of the 37advanced NSCLC patients who received nimotuzumab in combination with chemotherapy, the total number ofchemotherapy were 137 cycles, the mean number was 3.7 cycles. One patient had complete remission (CR), 9 patients had partial remission (PR), 16 cases had stable disease (SD), and 11 patients hadprogressive disease (PD). The response rate (RR) was 27% and clinical benefit rate (CBR) was 70.3%.The main side effects were bone marrow suppression and gastrointestinal reactions. Grade I acneiform rash was found in one patient. Conclusion The regimen of nimotuzumab in combination with chemotherapy can improve the response rate and was well tolerated in patients with advanced non-small cell lung cancer.     

High-dose-rate brachytherapy boost following concurrent chemoradiotherapy for esophageal carcinoma.

PURPOSE: To assess the efficacy, toxicity, and the optimum dose of high-dose-rate brachytherapy following chemoradiotherapy (CRT) compared with a historical group of patients treated with a combination of external beam and brachytherapy (RT alone). METHODS AND MATERIALS: Fifty-three patients with localized esophageal cancer received concurrent chemoradiotherapy followed by brachytherapy. The chemotherapy regimen was a combination of cisplatin 60 mg/m2 on day 1 and fluorouracil 600 mg/m2 continuous infusion from days 1-4 during the first and last week of external irradiation. Radiotherapy consisted of external irradiation to a total dose of 40-61 Gy (median 50 Gy) and brachytherapy to 8-24 Gy (median 16 Gy) in 2-4 fractions. RESULTS: Acute toxicity was well tolerated. A fistula occurred in one patient 1 week after completion of external irradiation. Local control was achieved in 32/53 (60%) compared with 42% of the RT group (p = 0.029). Local control rates of the CRT group were significantly better than those of the RT group in Stages II and III. Late toxicity (esophageal ulceration and strictures) occurred in 18 (34%) of the CRT group compared with 12% in the RT group (p = 0.013). Severe late toxicity (RTOG/EORTC criteria Grade 3-4) occurred in six patients (15%) whose chemotherapy was followed by 16-24 Gy via brachytherapy compared with 2.5% in the RT group (p = 0.010). CONCLUSION: Combined chemoradiotherapy and brachytherapy boost achieved better local control than radiotherapy alone. However, a high level of severe late toxicity was observed especially with 16-24 Gy via brachytherapy.     

Radiation therapy with or without chemotherapy for cervical cancer with periaortic lymph node metastasis

The purpose of this article is to evaluate the efficacy of chemoradiation therapy (CRT) and radiation therapy (RT) alone for cervical cancer with periaortic nodal metastasis (PANM). Twenty-one patients with cervical cancer with PANM were identified. Eleven patients received concomitant CRT with cisplatin-based chemotherapy and 10 received RT alone. The median age was 44 years. Ten, 5, and 6 patients had International Federation of Gynecology and Obstetrics stages IB, IIB, and IIIB disease. The RT doses to point A and the periaortic region were 80 to 85 Gy (low dose rate equivalent) and 45 Gy. The median follow-up was 26 months (range 3 to 141 months). The 1- and 3-year disease-specific survival were 81.8% and 81.8%, and 70% and 30%, respectively, for the CRT and RT groups, (P = 0.11). The 1- and 3-year pelvic and periaortic control rates (PPC) were 100% and 100% (CRT), and 56.3% and 42.2% (RT) (P = 0.03). The 1- and 3-year free-from-distant metastasis (DM) rates were 81.8% and 81.8% (CRT), and 78.7% and 49.2% (RT) (P = 0.54). All patients who developed DM died of their disease. CRT is a feasible treatment option to improve the PPC for these patients. Because of the high rate of distant metastasis despite PPC, more effective systemic therapy should be explored.     

Efficacy and feasibility of cisplatin-based concurrent chemoradiotherapy for nasopharyngeal carcinoma

OBJECTIVE: To investigate the efficacy and feasibility of a cisplatin-based concurrent chemoradiotherapy (CRT) protocol based on Intergroup Study 0099 for nasopharyngeal carcinoma (NPC). METHODS: Sixteen patients with stage II-IVB NPC were treated with a protocol of cisplatin-based concurrent CRT and adjuvant chemotherapy from 1998 to 2002. Three courses of cisplatin (80 mg/m2) were scheduled during 70 Gy of radiotherapy (RT), and two agents of adjuvant chemotherapy (FP regimen: cisplatin 80 mg/m2 and 5-fluorouracil 800 mg/m2/day by 4-day continuous infusion) were challenged. Overall survival (OS) and relapse-free survival (RFS) rates were calculated by the Kaplan-Meier method. RESULTS: Median follow-up duration was 45 months. Both 3-year OS and RFS rates were 81%. Proportions of patients who tolerated each scheduled treatment were 94% for RT, 63% for concurrent chemotherapy and 38% for adjuvant chemotherapy. CONCLUSIONS: Our protocol of the cisplatin-based concurrent CRT followed by adjuvant chemotherapy consisting of FP regimen was effective for Japanese patients with NPC. However, the doses and numbers of cycle of chemotherapy need to be modified because of the low compliance rate. Larger numbers of data accumulation and/or multi-institutional trials may be warranted to confirm the efficacy of this protocol.     

28例不能手术的肝外胆道系统肿瘤放化疗疗效分析

目的 评价放疗晚期肝外胆道系统肿瘤的疗效。方法 对28例手术不可切除的肝外胆道系统肿瘤采用放化疗，其中胆囊癌13例，肝外胆管癌15例。15例采用常规放疗，中位照射剂量45Gy（30～60Gy），13例采用三维适形放疗（3DcRT）多野（3～5个野）照射或加量，中位照射剂量55Gy（50～70Gy）。12例单纯放疗，16例放化结合。化疗方案为氟尿嘧啶500mg，2次／周，或氟尿嘧啶500mg＋顺铂30mg，1次／周，疗程3～6个周期。结果 全部患者近期有效率14％。全组中位生存期9．4个月（2～28个月）。1、2年生存率分别为38％、15％；其中1年生存率胆囊癌为46％，肝外胆管癌为27％，3DCRT为42％，常规放疗为33％，单纯放疗为37％，放疗＋化疗为31％；〈50Gy的为29％，≥50Gy的为45％。只有照射剂量（≥50Gy）对1年生存率有影响（X^2=5．31，P=0．023）。急性消化道反应1～2级为57％，3级为18％，仅有25％的出现1～2级血液毒性反应。结论 对晚期肝外胆道系统肿瘤采用放化疗可取得一定疗效，且副作用可耐受。     

Radiation dose >=54 Gy and CA 19--9 response are associated with improved survival for unresectable, non-metastatic pancreatic cancer treated with chemoradiation

ABSTRACT: BACKGROUND: Unresectable pancreatic cancer (UPC) has low survival. With improving staging techniques and systemic therapy, local control in patients without metastatic disease is becoming clinically important. We investigated whether the radiation dose used in chemoradiation (CRT) as definitive treatment for UPC and the CA 19--9 response to therapy have an impact on overall survival (OS). METHODS: From 1997--2009 46 patients were treated with CRT for non-metastatic UPC. Median prescribed RT dose was 54 Gy (range 50.4-59.4 Gy). All patients received concurrent chemotherapy (41: 5-fluorouracil, 5: other) and 24 received adjuvant chemotherapy. RESULTS: 41 patients were inoperable due to T4 disease and 5 patients with T3 disease were medically inoperable. Five patients did not complete CRT due to progressive disease or treatment-related toxicity (median RT dose 43.2 Gy). Overall, 42 patients were dead of disease at the time of last follow-up. The median and 12 month OS were 8.8 months and 35%, respectively. By univariate analysis minimum CA 19--9 post-CRT of <90 U/mL was favorably associated with OS (12.3 versus 8.8 months, p = 0.012). Radiotherapy dose >=54 Gy trended towards improved OS (11.3 versus 6.8 months, p = 0.089). By multivariable analysis a delivered RT dose of >=54 Gy (HR 0.47, p = 0.028) and minimum CA 19--9 post-CRT of <90 U/mL (HR 0.35, p = 0.008) were associated with OS. CONCLUSIONS: CRT as definitive treatment for UPC had low survival. However, our retrospective data suggest that patients treated to >=54 Gy or who experienced a minimum post-CRT CA 19--9 <90 U/mL had improved likelihood of long-term survival.     

胸段食管癌伴纵隔淋巴结转移调强放疗疗效分析

  目的  比较并分析调强放疗伴或不伴同步化疗治疗胸段食管癌伴纵隔淋巴结转移的结果。  方法  回顾性分析江苏省肿瘤医院放疗科2007年1月至2008年1月共49例接受调强放疗的食管癌患者, 均经胃镜病理证实且胸部CT示纵隔淋巴结肿大。17例接受单纯调强放射治疗(单放调强组), 32例接受调强放疗同步FP方案化疗治疗(同步放化组)。同步化疗方案为复方氟尿嘧啶80 mg/m2, d1~5, 奈达铂70 mg/m2, d1。放疗从化疗第1天开始, 单放调强组方案为6MV-X线IMRT放疗GTV 60~70 Gy, CTV 54~63 Gy, 同步放化组方案为6MV-X线IMRT放疗GTV 60 Gy, CTV 54 Gy。分次剂量为GTV 2.0 Gy/次, CTV 1.8 Gy/次。6~7周完成。  结果  全组患者均顺利完成治疗计划, 不良反应小, 中位随访时间为34个月, 随访率为97%单放调强组与同步放化组1、2、3年局控率分别为93.3%、60.9%、25.4%和90.3%、78.7%、58.1%(χ2=3.198, P=0.074), 1、2、3年生存率分别为88.2%、44.1%、29.4%和93.5%、71.1%、55.9%(χ2=4.733, P=0.030)。两组不良反应主要为急性放射性食管炎, 调强放疗同步化疗组骨髓抑制发生率较单纯调强放疗组高, 经对症处理后, 两组患者均顺利完成治疗计划, 无一例因不良反应终止或延长治疗时间。  结论  调强放疗同步化疗组较单纯调强放疗组能提高伴纵隔淋巴结转移的胸段食管癌患者生存率,不良反应能耐受。      

Combined chemo- and radiotherapy vs. radiotherapy alone in the treatment of primary, nonresectable adenocarcinoma of the rectum

PURPOSE: In a randomized study in primarily inextirpable rectal cancer, conventional radiotherapy to reduce the tumor mass was compared with combined chemotherapy and radiotherapy. METHODS AND MATERIALS: The combined treatment (CRT) was given every other week, four times, during a 7-week period. The drugs used were methotrexate, 5-fluorouracil in bolus injection followed by continuous infusion and leucovorin rescue. Radiotherapy (RT) was given simultaneously with five 2-Gy fractions in 3 days to a dose of 10 Gy to a total dose in the four courses of 40 Gy. This regimen was compared with radiotherapy in 2-Gy fractions to a total dose of 46 Gy in the radiotherapy group. Surgery was performed 3-4 weeks after finished treatment. Seventy patients were included between November 1988 and August 1996; 36 patients were allocated to RT and 34 to CRT. RESULTS: Twenty-five (74%) of the patients in the CRT group underwent a locally radical resection with 20 (59%) patients without any known metastases. The corresponding figures in the RT group were 23 (64%) and 18 (50%), respectively. Among the patients who underwent any tumor resection, 5/29 (17%) in the CRT group and 12/27 (44%, p = 0.05) in the RT group have had a local recurrence. After a locally radical resection, the corresponding figures are 4% and 35% (p = 0.02), respectively. Local disease-free survival was significantly superior in the CRT group (66% at 5 years) compared with the RT group (38%, p = 0.03 log-rank test). Five-year survival was 29% (9 patients) in the CRT group and 18% (6 patients) in the RT group, a nonsignificant difference (p = 0.3). Five patients in the RT group did not complete planned treatment, mainly due to the appearance of metastatic disease. In this group toxicity was usually of Grade 0-1. In the experimental group, the toxicity usually was Grade 2 or higher, and 6 patients did not manage to fulfill the planned treatment due to toxicity. CONCLUSION: In this study, with fewer included patients than intended, resectability rates were high in both groups. The addition of chemotherapy to radiotherapy significantly improved local control rates, but no statistically significant difference was found in survival between the groups. The acute toxicity after CRT was higher than after RT alone, but manageable.     

A phase I trial of high-dose palliative radiotherapy plus concurrent weekly Vinorelbine and Cisplatin in patients with locally advanced and metastatic NSCLC

The role of concurrent chemoradiotherapy (CRT) in patients with non-small-cell lung cancer (NSCLC) unsuitable for radical therapy but who require locoregional treatment has not been defined. The aims of this phase I trial were thus to develop a novel regimen of weekly chemotherapy concurrent with high-dose palliative RT (40 Gy/20 fractions) and assess its tolerability, objective and symptomatic response rates. Eligible patients had stage I-IIIB NSCLC unsuitable for radical RT or limited stage IV disease, ECOG PS相似文献   

Equivalent outcome of patients with clinical Stage IIIA non-small-cell lung cancer treated with concurrent chemoradiation compared with induction chemotherapy followed by surgical resection

PURPOSE: To compare the outcome of induction chemotherapy followed by surgery (C/S) and concurrent chemoradiotherapy (CRT) for clinical Stage IIIA non-small-cell lung cancer (NSCLC). METHODS AND MATERIALS: Between 1990 and 2000, 107 patients underwent either induction C/S (n = 55) or concurrent CRT (n = 52) for clinical Stage IIIA NSCLC at The University of Texas M. D. Anderson Cancer Center. Patient and tumor characteristics were balanced in the two treatment groups with respect to T and N stage, race, median age, performance status, weight loss, and histologic findings. In the C/S group, induction chemotherapy included two to four cycles of cisplatin-based chemotherapy followed by lobectomy and mediastinal lymph node dissection. Postoperative RT was delivered in 35 patients, with referral for RT made at the discretion of the treating physician. CRT consisted of three cycles of cisplatin-based chemotherapy given every 3 weeks concurrent with RT to 60-63 Gy in 30-35 fractions in 27 patients and 69.6 Gy in 58 fractions (b.i.d.) in 25 patients. Local control, overall disease-free survival, and distant metastasis-free survival rates were calculated using the Kaplan-Meier method. The median follow-up duration was 20 months in all patients and 32 months in surviving patients. RESULTS: No statistically significant differences were found in the end points measured in the two treatment groups. Specifically, the median survival time was 31 and 27 months and the 5-year overall survival rate was 33% and 30% in the C/S and CRT groups, respectively. Likewise, the 5-year local control (58% vs. 61%), disease-free (24% vs. 23%), and distant metastasis-free (44% vs. 36%) survival rates in the two groups were not significantly different. In the C/S group, postoperative RT significantly improved the 5-year local control rate from 33.8% to 81.5% (p = 0.007) but did not significantly improve overall survival. Additionally, patients in the C/S group whose disease responded to induction chemotherapy had a significantly improved 5-year overall survival rate (50%) compared with those who had stable or progressive disease (16%, p = 0001). CONCLUSION: Treatment of Stage IIIA NSCLC using either induction C/S or CRT resulted in similar outcomes in terms of local control and median overall, 5-year overall, distant metastasis-free, and disease-free survival. However, patients undergoing induction C/S often needed postoperative RT to achieve local control equivalent to that achieved with concurrent CRT. Advances in radiation-based treatment as reflected in this study have resulted in similar outcomes compared with modern induction C/S. To improve survival, however, newer systemic agents that reduce and control distant metastasis are required.     

Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: results from the Italian multicenter randomized study.

PURPOSE: Neoadjuvant chemotherapy (NACT) and radical surgery (RS) have emerged as a possible alternative to conventional radiation therapy (RT) in locally advanced cervical carcinoma. In 1990, a phase III trial was undertaken to verify such a hypothesis in terms of survival and treatment-related morbidity. PATIENTS AND METHODS: Patients with squamous cell, International Federation of Gynecology and Obstetrics stage IB2 to III cervical cancer were eligible for the study. They received cisplatin-based NACT followed by RS (type III to V radical hysterectomy plus systematic pelvic lymphadenectomy) (arm A) or external-beam RT (45 to 50 Gy) followed by brachyradiotherapy (20 to 30 Gy) (arm B). RESULTS: Of 441 patients randomly assigned to NACT+RS or RT, eligibility was confirmed in 210 and 199 patients, respectively. Treatment was administered according to protocol in 76% of arm A patients and 72% of arm B patients. Adjuvant treatment was delivered in 48 operated patients (29%). There was no evidence for any significant excess of severe morbidity in one of the two arms. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 58.9% and 55.4% for arm A and 44.5% and 41.3% for arm B (P =.007 and P =.02), respectively. Subgroup survival analysis shows OS and PFS rates of 64.7% and 59.7% (stage IB2-IIB, NACT+RS), 46.4% and 46.7% (stage IB2-IIB, RT) (P =.005 andP =.02), 41.6% and 41.9% (stage III, NCAT+RS), 36.7% and 36.4% (stage III, RT) (P =.36 and P =.29), respectively. Treatment had a significant impact on OS and PFS. CONCLUSION: Although significant only for the stage IB2 to IIB group, a survival benefit seems to be associated with the NACT+RS compared with conventional RT.