老年腹腔淋巴结转移癌患者97例三维适形放疗的疗效

目的分析三维适形放射治疗老年性腹腔淋巴结转移癌患者的疗效及预后因素分析。方法回顾性分析97例接受三维适形放疗的老年性腹腔淋巴结转移癌患者的临床资料。所有患者中位年龄67岁(60～78岁),原发瘤部位明确,95例(97.9%)原发瘤有病理学证实。腹腔共有转移灶136个,转移灶中位体积35.7 cm3(4.6～123.8 cm3)。腹腔淋巴结转移灶均接受三维适形放疗,中位剂量58 Gy(36～70 Gy)。采用Kaplan-Meier法计算生存率,采用Log-rank法进行单因素分析,采用COX比例风险模型筛选影响预后因素。结果 97例患者治疗后总有效率(CR+PR)84.6%,中位生存期为9个月,1、2、3年生存率分别为37.5%、14.7%、4.8%。单因素分析发现原发瘤部位、病理类型、合并其他部位转移、腹腔淋巴结转移瘤体积、放疗剂量对预后具有明显统计学意义。多因素分析显示腹腔淋巴结转移瘤体积、放疗剂量是影响患者预后的独立因素。结论对于老年性腹腔淋巴结转移癌患者,三维适形放射治疗能有效改善症状、提高生活质量。     

立体定向放射治疗原发性肝癌伴下腔静脉癌栓的疗效评价

目的评价立体定向放疗治疗肝细胞癌伴下腔静脉癌栓的疗效。方法在66例肝细胞癌伴下腔静脉癌栓患者中,36例接受立体定向放射治疗,30例未接受放射治疗。结果 36例接受伽玛刀治疗的癌栓患者,12例（33.3%）癌栓完全缓解,10例（27.8%）部分缓解,13例（36.1%）稳定,1例（2.8%）进展。癌栓治疗有效率为61.1%,1年生存率为27.8%,中位生存期为9.8个月;未放疗的30例患者1年生存率为11.5%,中位生存期为3.5个月。多因素分析显示,放疗组病人生存情况与肝内病灶单多发有关。Child-Pugh分级是影响预后的主要因素。结论立体定向放射治疗可明显延长肝细胞癌伴有下腔静脉癌栓患者的生存期。     

原发性中枢神经系统淋巴瘤23例临床分析

目的 探讨原发性中枢神经系统淋巴瘤(PCNSL)的诊断、合理治疗方案和预后的相关因素.方法 收集天津医科大学肿瘤医院2005年1月至2007年12月经病理证实且随访资料完整的23例免疫功能正常的PCNSL患者,其中男10例,女13例,中位年龄50岁.行腰穿检查者18例,检查出瘤细胞者4例.8例行开颅手术切除,15例行立体定向活检术.4例行全颅放疗,6例行以大剂量甲氨蝶呤为基础的联合化疗,13例行放疗联合化疗.分析其治疗、临床特点与预后之间的联系.结果 Kaplan-Meier分析显示本系列患者中位生存期45.0个月,3年生存率56.5％.Log-Rank检验发现放疗联合化疗组(43.8和30.0个月)与化疗组(39.7和29.7个月)的总生存期及肿瘤无进展生存期明显长于单纯放疗组(25.7和19.8个月,P值均＜0.05);放疗联合化疗组的总生存期长于单纯化疗组(P＜0.05),2组间肿瘤无进展生存期无明显差异(P＞0.05).结论 病理诊断仍是确诊的金标准,脑脊液检查发现瘤细胞者也可确诊.以全颅放疗联合化疗为主的综合治疗优于单纯放疗或化疗.     

分次立体定向适形放疗治疗头颈部恶性肿瘤(附31例报告)

对31例头颈部恶性肿瘤患者行分次立体定向适形放疗，采用6MVX线照射，3～5个射野，整体铅模适形，以90％等剂量曲线包绕靶区边缘为处方剂量线，每次剂量2～5Gy，1次／d，每周5d。常规放疗后局部加量为30-36．8Gy，单用三维适形放疗者总剂量为48-60．8Gy。结果完全缓解16例，部分缓解14例，1、2、3、4a生存率分别为80．6％、51．6％、19．4％、9．7％。提示分次立体定向适形放疗技术治疗头颈部恶性肿瘤安全有效。     

154例小细胞肺癌预后因素分析

目的分析小细胞肺癌(Small Cell Lung Cancer,SCLC)的生存状况及预后的相关因素。方法收集154例经病理或细胞学确诊的SCLC患者的临床资料,分析影响预后的因素。结果 (1)1年生存率局限期84.0%,广泛期54.9%,全组65.6%,中位生存期(Median Survival Time,MST)局限期24个月,广泛期13个月,全组15个月。(2)单因素分析局限期男性、胸部放疗者MST明显延长,广泛期性别、肝转移、化疗周期、胸部放疗影响患者预后。(3)多因素分析肝转移、化疗周期为独立预后因素。(4)全组分析性别、分期可能是预后影响因素,肝转移、化疗周期、胸部放疗是独立影响因素。结论性别、分期可能与SCLC生存相关,肝转移、化疗周期、胸部放疗是影响SCLC预后的独立因素。     

肝转移瘤的适形放射治疗

目的观察适形放射治疗对肝转移瘤的治疗效果方法1997－09／1998－04我们采用立体定向适形放射治疗8例肝转移瘤（分别有1～5个转移灶），并进行了术后随访．肿瘤的临床靶体积（CTV）为0．6cm3～232cm3（平均36．4cm3），计划靶体积（PTV）最小照射量为每次照射3．96Gy～6．30Gy（平均5．08Gy），PTV最大照射量为每次照射5．63Gy～10．88Gy（平均6．84Gy），处方剂量（PD）为4．0Gy～6.5Gy（平均5．13Gy），分2～8次进行适形放射治疗．结果治疗过程中无1例死亡.患者一般状况的计分标准（KPS）：术前20～90分（平均58．8分），术后30～100分（平均71．2分）．实体瘤疗效标准：完全缓解（CR）：2例：部分缓解（PR）：3例；无变化（NC）：2例；进展（PD）：1例.在术后2mo～9mo随访期间，我们观察到87.5％的受照射肿瘤得到控制62．5％的肿瘤缩小或消失.结论立体定向适形放射治疗对肝转移瘤有良好的治疗效果.     

胰腺癌肝转移患者的临床病理特征及预后的影响因素分析

目的探讨胰腺癌伴肝转移患者的临床病理特征及预后的影响因素。方法回顾性分析2012年7月至2016年6月间海军军医大学第一附属医院肿瘤科收治的67例初治胰腺癌伴肝转移患者的临床资料, 分析患者生存时间与年龄、性别、肿瘤位置、体力活动状态评分、肿瘤标志物、远处转移器官数目、原发灶放疗情况、一线化疗方案、接受一线化疗周期数和肝转移灶行肝动脉化疗栓塞术(TACE)等临床病理特征的关系。采用Kaplan-Meier法绘制生存曲线, 采用单因素和多因素COX回归模型分析胰腺癌伴肝转移患者的独立预后危险因素。结果随访至2018年12月31日, 67例胰腺癌伴肝转移患者均已死亡。单因素分析结果显示, 肿瘤标志物阳性、远处转移器官数目≥2个、一线化疗周期数≤2次、原发灶未接受放疗和肝转移灶未行TACE治疗患者的中位生存时间显著短于肿瘤标志物阴性、远处转移器官数目1个、一线化疗周期数≥3次, 原发灶接受放疗和肝转移灶行TACE治疗的患者, 差异有统计学意义(P值均<0.05);多因素分析结果显示, 肿瘤标志物阳性(HR=0.567, 95%CI 0.332～0.954, P=0.031)、远处转移器...     

Ⅲ期非小细胞肺癌164例治疗效果及预后分析

选取164例Ⅲ期非小细胞肺癌患者,行单纯放疗53例,序贯治疗（先化疗后放疗）72例,同步治疗（化疗与放疗同时进行）39例。其中29例常规放疗后行三维适形放疗。化疗方案为NP（长春瑞滨＋顺铂）或DP（多西他赛＋顺铂）。结果随访到155例患者的中位生存时间为13个月,1、3a生存率分别为56．1％和14．3％。单纯放疗、序贯治疗及同步治疗的中位生存时间及1、3a生存率分别为11个月、43．4％、8．0％,13个月、56．9％、13．3％,18个月、71．8％、23．9％。单因素分析显示治疗方式、KPS评分、临床分期、放疗剂量、治疗前血红蛋白等因素与患者预后有关。多因素分析显示KPS评分和治疗方式是独立预后因素。认为对Ⅲ期非小细胞肺癌患者应予化疗加放疗综合治疗;对KPS评分≥80分的患者行同步治疗可延长生存时间。     

三维适形放疗联合卡培他滨口服治疗胃癌肝转移效果观察

目的观察三维适形放疗（3DCRT）联合卡培他滨口服治疗胃癌肝转移的疗效。方法对27例不能手术的胃癌肝转移患者行3DCRT,2～3Gy／次,5次／周,总剂量45～58Gy／15—29次,3—6周;同时口服卡培他滨800mg／m^2、2次／d,21d为1个周期,共3个周期。结果本组完全缓解2例,部分缓解18例,无变化4例,进展2例,有效率为76．9％。疾病中位进展时间为4个月,1年生存率为53．8％,中位生存期为7．5个月。不良反应主要为Ⅰ-Ⅱ级。结论3DCRT联合卡培他滨口服治疗胃癌肝转移疗效较好,不良反应较轻。     

胸部放疗剂量对诱导化疗后未进展ES-SCLC患者临床预后的影响

目的探讨胸部放疗剂量对诱导化疗后未进展ES-SCLC患者临床预后的影响。方法回顾性分析我院2010年1月-2015年12月收治诱导化疗后未进展ES-SCLC患者共108例临床资料,其中18例单纯接受化疗,90例则加用胸部放疗;同时根据放疗剂量进行分组,比较不同组,中位总生存时间和无进展生存时间,采用Cox回归模型分析临床预后影响因素。结果:①放疗组患者中位总生存时间和无进展生存时间显著长于化疗组(P<0.05);②放疗B组,中位总生存时间显著长于化疗组(P<0.05);放疗C组和放疗D组总生存时间和无进展生存时间均显著长于放疗A组、放疗B组、化疗组(P<0.05);③单因素分析结果显示,同步放化疗、肝或骨转移、病灶转移数量及放疗剂量,是患者总生存时间预后影响因素(P<0.05);同时病灶转移数目和放疗剂量是患者无进展生存时间预后影响因素(P<0.05)。Cox回归模型分析结果显示,同步放化疗、病灶转移数量及放疗剂量是患者总生存时间预后独立影响因素(P<0.05);病灶转移数量和放疗剂量是患者无进展时间独立影响因素(P<0.05);④倾向性评分匹配因素包括年龄、吸烟、KPS评分、体重减轻,转移灶个数、转移器官个数、脑转移、肝骨转移、同步放化疗、放疗时机、分割方式及脑预防;倾向性评分匹配分析结果显示,高剂量放疗患者中位总生存时间和无进展生存时间均显著长于低剂量放疗患者(P<0.05)。结论诱导化疗后未进展ES-SCLC患者加用胸部放疗有助于改善临床预后,同时给予49.5~53.7Gy放疗剂量在延长生存时间方面更具优势,在此基础上增加或减少放疗剂量均未明显增加生存获益。     

Long-term outcomes and prognostic factors for patients with esophageal cancer following radiotherapy

AIM:To evaluate long-term outcomes and prognostic factors for esophageal squamous cell carcinoma(SCC) treated with three dimensional conformal radiotherapy(3D-CRT).METHODS:Between January 2005 and December 2006,153 patients(120 males,33 females) with pathologically confirmed esophageal SCC and treated with 3D-CRT in Cancer Hospital of Shantou University were included in this retrospective analysis.Median age was 60 years(range:37-84 years).The proportion of tumor location was as follows:upper thorax(including the cervical region),73(48%);middle thorax,73(48%);lower thorax,7(5%),respectively.The median radiation dose was 64 Gy(range:50-74 Gy).Fifty four cases(35%) received cisplatin-based concurrent chemotherapy.Univariate and multivariate analysis were performed to determine the association between the correlative factors and prognosis.RESULTS:The five-year overall survival rate was 26.3%,with a median follow-up of 49 mo(range:3-66 mo) for patients who were still alive.On univariate analysis,lesion location,lesion length by barium esophagogram,computed tomography imaging characteristics including Y diameter(anterior-posterior,AP,extent of tumor),gross tumor volume of primary lesion(GTV-E),volume of positive lymph nodes(GTV-LN),and the total target volume(GTV-T = GTV-E + GTVLN) were prognostic for overall survival.By multivariate analysis,only the Y diameter [hazard ratio(HR) 2.219,95%CI 1.141-4.316,P = 0.019] and the GTV-T(HR 1.372,95%CI 1.044-1.803,P = 0.023) were independent prognostic factors for survival.CONCLUSION:The overall survival of esophageal carcinoma patients undergoing 3D-CRT was promising.The best predictors for survival were GTV-T and Y diameter.     

Therapeutic effects and prognostic factors in three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma

AIM: To evaluate the therapeutic efficacy of threedimensional conformal radiotherapy (3D-CRT) combined with transcatheter arterial chernoembolization (TACE) on the patients with hepatocellular carcinoma (HCC).METHODS: Between 1998 and 2001, 94 patients with HCC received 3D-CRT combined with TACE. A total 63 patients had a Okuda stage Ⅰ lesion and 31 patients had stage Ⅱ. The median tumor size was 10.7 cm (range 3.0-18 cm), and liver drrhosis was present in all the patients. There were 43 cases of class A and 51 dass B. TACE was performed using lipiodol,5-fluorouracil, cisplatin, doxorubicin hydrochloride and mitomycin, followed by gelatin sponge cubes. Fifty-nine patients received TACE only one time, while the others 2 to 3 times. 3D-CRT was started 3-4 wk after TACE. All patients were irradiated with a stereotactic body frame and received 4-8 Gy single high-dose radiation for 8-12 times at the isocenter during a period of 17-26 d (median 22 d).RESULTS: The median follow-up was 37 mo (range 10-48 mo) after diagnosis. The response rate was 90.5%. The overallsurvival rate at 1-, 2-, and 3- year was 93.6%, 53.8% and 26.0% respectively, with the median survival of 25 too. On univariate analysis, age (P=-0.026), Child-Pugh classification for cirrhosis of liver (P=0.010), Okuda stage (P=-0.026),tumor size (P=0.000), tumor type (P=0.029), albuminemia (P=0.035), and radiation dose (P=0.000) proved to be significant factors for survival. On multivariate analysis,age (P=-0.024), radiation dose(P=-0.001), and tumor size (P=0.000) were the significant factors.CONCLUSION: 3D-CRT combined with TACE is an effective and feasible approach for HCC. Age, radiation dose and tumor size were found to be significant prognostic factors for survival of patients with HCC treated by 3D-CRT combined with TACE. Further study for HCC is needed to improve the treatment efficacy.     

非小细胞肺癌脑转移预后影响因素

目的探讨非小细胞肺癌脑转移的生存情况及预后影响因素。方法选取我院2014年6月至2018年12月确诊139例非小细胞肺癌脑转移患者,收集临床资料并随访生存时间。运用Kaplan-Meier法对每个临床因素的不同水平进行生存分析,Log-rank法进行生存曲线的比较。采用单因素、多因素分析方法来筛选非小细胞肺癌脑转移的预后影响因素。结果本研究139例患者中位生存时间为11.2个月,对症支持组、全脑放疗组、靶向治疗组、全脑放疗+靶向治疗组、全脑放疗+化疗+靶向治疗组分别为8.1个月、10.1个月、14.6个月、16.7个月、23.4个月。单因素分析显示病理类型、发生脑转移的时间、EGFR突变的状态、RPA分级以及治疗方式对非小细胞肺癌脑转移的发生有显著影响作用。多因素分析表明KPS评分、RPA分级、治疗方法、发生脑转移的时间及EGFR突变状态是影响生存期的独立预后因素。结论经积极治疗(化疗+全脑放疗+靶向治疗)脑转移瘤患者可以获得更长生存期,高KPS评分、RPA I级、异时性脑转移及EGFR敏感突变型是非小细胞肺癌脑转移的预后良好因素。     

Three-dimensional conformal radiotherapy combined with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer

AIM: To investigate the effect of three-dimensional conformal radiotherapy (3-DCRT) in combination with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer. METHODS: Forty-eight patients with unresectable recurrent rectal cancer were randomized and treated by 3-DCRT or 3-DCRT combined with FOLFOX4 chemotherapy between September 2001 and October 2003. For the patients without prior radiation history, the initial radiation was given to the whole pelvis by traditional methods with tumor dose of 40 Gy, followed by 3-DCRT for the recurrent lesions to the median total cumulative tumor dose of 60 Gy (range 56-66 Gy); for the post-radiation recurrent patients, 3-DCRT was directly given for the recurrent lesions to the median tumor dose of 40 Gy (36-46 Gy). For patients in the study group, two cycles chemotherapy with FOLFOX4 regimen were given concurrently with radiotherapy, with the first cycle given simultaneously with the initiation of radiation and the second cycle given in the fifth week for patients receiving conventional pelvis radiation or given in the last week of 3-DCRT for patients receiving 3-DCRT directly. Another 2-4 cycles (average 3.6 cycles) sequential FOLFOX4 regimen chemotherapy were given to the patients in the study group, beginning at 2-3 wk after chemoradiation. The outcomes of symptoms relieve, tumor response, survival and toxicity were recorded and compared between the study group and the control group. RESULTS: For the study group and the control group, the pain-alleviation rates were 95.2% and 91.3% (P>0.05); the overall response rates were 56.5% and 40.0% (P>0.05); the 1-year and 2-year survival rates were 86.9%, 50.2% and 80.0%, 23.9%, with median survival time of 25 mo and 16 mo (P<0.05); the 2-year distant metastasis rates were 39.1% and 56.0% (P=0.054), respectively. The side effects, except peripheral neuropathy which was relatively severer in the study group, were similar in the the two groups and well tolerated. CONCLUSION: Three-dimensional conformal radiotherapy combined with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer is a feasible and effective therapeutic approach, and can reduce distant metastasis rate and improve the survival rate.     

老年人食管癌三维适形放射治疗疗效分析

目的 探讨老年食管癌患者三维适形放射治疗(放疗)的疗效及其预后相关因素.方法 回顾性分析2001年1月至2007年8月在我院接受三维适形放疗的89例65岁及以上老年食管癌患者的临床资料,分析生存率及预后的影响因素. 结果 全组1、2、3和4年局部无复发生存率分别为65.2%、43.0%、27.3%和22.3%.全组1、2、3和4年生存率分别为68.5%、48.8%、36.8%和25.2%,中位生存期21.5个月.单因素分析显示影响预后的因素有:放疗前进食情况(χ~2=6.26,P=0.012)、T分期(χ~2=8.80,P=0.003)、N分期(χ~2=4.33.P=0.038)、临床分期(χ~2=7.88,P=0.005)、CT显示瘤体最大直径(χ~2=10.88,P=0.004)、近期疗效(χ~2=5.28,P=0.022)、化疗(χ~2=5.49,P=0.019);而性别(χ~2=0.74,P=0.390)、年龄(χ~2=1.89,P=0.170)、食管造影显示病变长度(χ~2=2.38,P=0.123)、CT显示病变长度(χ~2=2.69,P=0.101)、原发肿瘤部位(χ~2=2.12,P=0.146)、并存症(χ~2=0.03.P=0.874)、照射方式(χ~2=0.04.P=0.847)和放疗剂量(χ~2=0.24,P=0.627)与预后无关.Cox多因素分析显示治疗前进食情况(P=0.002)、临床分期(P=0.007)和化疗(P=0.011)为独立的预后影响因素.89例中发生0、1、2、3级急性期放射性食管炎分别为20、30、32、7例.发生0、1、2、3和5级急性放射性肺炎分别为57、20、8、2和2例.至随访结束已死亡60例,死于局部复发或病情未控制29例(48.4%)、死于远处转移11例(18.3%)、死于局部复发伴远处转移者5例(8.3%),其他原因死亡15例(25.0%). 结论 老年食管癌患者三维适形放疗是安全有效的,放疗前进食梗阻轻、临床分期早,三维适形放疗预后好;反之预后差.联合化疗可以提高放疗疗效.     

Radiation therapy for portal venous invasion by hepatocellular carcinoma

AIM: To clarify the efficacy and safety of three-dimensional conformal radiotherapy (3-D CRT) for this disease and to specify patient subgroups suitable for this treatment. METHODS: Fifty-two patients with HCC received PVI-targeted radiation therapy from January 1995 through December 2003. Portal venous invasion (PVI) was found in the second or lower order branches of the portal vein in 6 patients, in the first branch in 24 patients and in the main trunk in 22 patients. Child classifications of liver function before radiation therapy were A, B, and C for 19, 24 and 2 patients, respectively. All patients received three-dimensional conformal radiotherapy with a total dose ranging from 39 to 60 Gy (57.0 Gy in average). RESULTS: Overall survival rates at 1, 2, 3, 4, and 5 years were 45.1%, 25.3%, 15.2%, 10.1%, and 5.1%, respectively. Univariate analysis revealed that Child status, the number of tumor foci, tumor type, transcatheter arterial embolization (TAE) after radiation therapy were statistically significant prognostic factors. Multivariate analysis showed that the number of tumor foci and TAE after radiation therapy were statistically significant. CONCLUSION: The results of this study strongly suggest the efficacy of 3-D CRT as treatment for PVI in HCC. 3-D CRT is recommended in combination with post-radiation TAE for PVI of HCC with 5 tumor foci or less in the liver and with Child A liver function.     

Late survival of non-small cell lung cancer patients with brain metastases. Influence of treatment.

The presence of brain metastasis in lung cancer patients is a highly unfavorable event that usually allows only palliative treatment. A retrospective study was conducted to evaluate the prognostic factors in patients with non-small cell lung cancer (NSCLC) associated with brain metastases. From July 1984 through June 1990, a total of 50 patients with NSCLC associated with symptomatic brain metastasis seen at National Taiwan University Hospital were included. Patients who had incomplete cancer staging workup or loss of follow-up were excluded. Several possible prognostic variables were analyzed initially with univariate analysis and subsequently with multivariate analysis with maximal partial likelihood ratio test in the Cox model. In the univariate analysis, several factors, including number of brain metastases, treatment for brain metastasis with brain tumor resection (BTR) or whole brain radiation therapy (WBRT), and chemotherapy (C/T) after brain metastasis were found to have significant influence on the survival. However, in the multivariate analysis, patients receiving BTR, WBRT, and/or C/T lived significantly longer. The median survival of patients treated with BTR was nine months, eight months in patients with C/T, and seven months in patients with WBRT. Taken together, these patients had a median survival of seven months, which was significantly longer than patients treated with supportive care only (with a median survival of two months). Treatment of brain metastases with WBRT, BTR, C/T, or in combinations also improved the quality of life. We conclude that NSCLC patients with brain metastases should be more aggressively treated with WBRT, BTR, C/T, or in combinations than supportive care only.     

Survival analysis of platinum‐refractory patients with advanced esophageal cancer treated with docetaxel or best supportive care alone: a retrospective study

The survival benefit of second‐line chemotherapy with docetaxel in platinum‐refractory patients with advanced esophageal cancer (AEC) remains unclear. A retrospective analysis of AEC patients with Eastern Cooperative Oncology Group performance status (PS) ≤ 2 was performed, and major organ functions were preserved, who determined to receive docetaxel or best supportive care (BSC) alone after failure of platinum‐based chemotherapy. The post‐progression survival (PPS), defined as survival time after disease progression following platinum‐based chemotherapy, was analyzed by multivariate Cox regression analysis using factors identified as significant in univariate analysis of various 20 characteristics (age, sex, PS, primary tumor location, etc) including Glasgow prognostic score (GPS), which is a well‐known prognostic factor in many malignant tumors. Sixty‐six and 45 patients were determined to receive docetaxel and BSC between January 2007 and December 2011, respectively. The median PPS was 5.4 months (95% confidence interval [CI] 4.8–6.0) in the docetaxel group and 3.3 months (95% CI 2.5–4.0) in the BSC group (hazard ratio [HR] 0.56, 95% CI 0.38–0.84, P = 0.005). Univariate analysis revealed six significant factors: treatment, PS, GPS, number of metastatic organs, liver metastasis, and bone metastasis. Multivariate analysis including these significant factors revealed three independent prognostic factors: docetaxel treatment (HR 0.62, 95% CI 0.39–0.99, P = 0.043), better GPS (HR 0.61, 95% CI 0.46–0.81, P = 0.001), and no bone metastasis (HR 0.31, 95% CI 0.15–0.68, P = 0.003). There was a trend for PPS in favor of the docetaxel group compared with patients who refused docetaxel treatment in the BSC group (adjusted HR 0.61, 95% CI 0.29–1.29, P = 0.20). Docetaxel treatment may have prolonged survival in platinum‐refractory patients with AEC.     

Prognostic factors in definitive radiochemotherapy of advanced inoperable esophageal cancer

The aim of this study was to assess the efficacy and prognostic factors of definitive radiochemotherapy (RCT) for inoperable esophageal cancer. Between 1995 and 2005 all patients with inoperable esophageal cancer that underwent concurrent RCT were included in this retrospective study. Conventional computed tomography-based treatment planning as well as 3D-conformal radiotherapy (RT) was used. Maximum radiotherapy dose was 63 Gy. Chemotherapy consisted of cisplatin (20 mg/m(2) d1-5 and 29-33) and 5-FU (650-1000 mg/m(2) d1-5 and 29-33). Patients not suitable for RCT received radiotherapy alone. Toxicity was measured according to common toxicity criteria (CTC). Two hundred three consecutive patients with inoperable esophageal cancer that received definitive therapy were identified in this time period (160 with squamous cell carcinoma and 43 with adenocarcinoma). The 2-year overall survival probability was 21.2% whereas the progression-free survival at 2 years was 13.8% for all patients. In the univariate analysis, type of histology, T-stage, N-stage, application of chemotherapy, and the radiation dose were significantly correlated with overall/progression-free survival. Moreover, multivariate analysis revealed an independent prognostic impact for N-stage, radiation dose, and concurrent chemotherapy. Definitive RCT is an important palliative treatment option for patients with inoperable esophageal cancer. N-stage, radiation dose, and concurrent chemotherapy are important prognostic factors for survival.