A modified Phase I trial of radiation dose escalation in 3D conformal radiation therapy with concurrent vinorelbine and carboplatin chemotherapy for non-small-cell lung cancer

The Radiation Therapy Oncology Group reported a maximum tolerated dose of 74 Gy for patients with non-small cell lung cancer (NSCLC); however, it was unclear whether this dose could be safely administered to Asian patients due to differences in their physique compared to Western patients. We therefore conducted a modified Phase I trial to determine whether 70 Gy could be safely delivered to Chinese patients with NSCLC undergoing 3D-conformal radiation therapy (3D-CRT) with concurrent chemotherapy. Previously untreated NSCLC patients received 3D-CRT (2 Gy/day, 5 fractions per week). Three dose levels were examined: 62, 66 and 70 Gy. Two cycles of concurrent chemotherapy (vinorelbine and carboplatin) were started on the first day of radiation therapy. Dose-limiting toxicity (DLT) was defined as severe or life-threatening side effects that altered the continued implementation of chemoradiotherapy. Among the 19 patients recruited in this study, most of the haematologic and non-haematologic toxicities were mild to moderate and clinically manageable. Only one patient, in the 70 Gy cohort, experienced a DLT of Grade 3 radiation-induced pneumonia. The overall response rate was 77.8% (14/18). The median progression-free survival (PFS) was 12 months, and the 1-year PFS was 37.6%. Our results support both the feasibility of incorporating 3D-CRT with concurrent vinorelbine and carboplatin and a dose escalation to 70 Gy for Chinese patients with NSCLC, based on the acceptable toxicity and encouraging overall response and survival rates. A further evaluation of this regimen in a prospective Phase II trial is ongoing.     

Preoperative assessment and staging of breast cancer: preliminary communication

A prospective study has been carried out in 172 women to determine the sensitivity of methods to detect occult metastatic disease in the skeleton and liver. With the exception of bone scintiscans, the results of these tests bore little relationship to recurrence rates. On the other hand, knowledge of the histopathology of the lower axillary (pectoral) lymph nodes is of value in this respect.

A follow-up study is also reported which confirms the importance of accurate measurements of the primary tumour clinical node status and oestrogen receptor contact of the tumour in defining prognostic groups. Elastosis (estimated in 165 tumours) did not prove to be a useful prognostic index.

     

Routine management of locally advanced cervical cancer with concurrent radiation and cisplatin. Five-year results

Background  

Globally, cervical cancer primarily affects socially disadvantaged women. Five randomized trials were the foundation for adopting cisplatin-based chemotherapy during radiation as the standard of care for high-risk patients after primary radical hysterectomy who require adjuvant radiation and for locally advanced patients treated with definitive radiation. These results were obtained in clinical trials performed in carefully prepared academic centers; hence, we sought to determine whether these results could be reproduced when patients were treated on an out-of-protocol basis.     

Adjuvant chemotherapy and immunotherapy for colorectal cancer: preliminary communication

Following surgical resection of Dukes' B or C colorectal cancers 72 patients have been randomly allocated to receive: 5-fluorouracil; or 5-fluorouracil and levamisole; or no treatment. Adjuvant treatment was continued for one year. 66 patients remain evaluable for up to 24 months. Preliminary results show no significant differences in survival or recurrence rates. Two patients receiving 5-fluorouracil and levamisole developed severe, but reversible, neutropenia. Other side effects were uncommon.     

Medical radiation exposure in the U.S. in 2006: preliminary results

Medical radiation exposure of the U.S. population has not been systematically evaluated for almost 25 y. In 1982, the per capita dose was estimated to be 0.54 mSv and the collective dose 124,000 person-Sv. The preliminary estimates of the NCRP Scientific Committee 6-2 medical subgroup are that, in 2006, the per capita dose from medical exposure (not including dental or radiotherapy) had increased almost 600% to about 3.0 mSv and the collective dose had increased over 700% to about 900,000 person-Sv. The largest contributions and increases have come primarily from CT scanning and nuclear medicine. The 62 million CT procedures accounted for 15% of the total number procedures (excluding dental) and over half of the collective dose. Nuclear medicine accounted for about 4% of all procedures but 26% of the total collective dose. Medical radiation exposure is now approximately equal to natural background radiation.     

Mean esophageal radiation dose is predictive of the grade of acute esophagitis in lung cancer patients treated with concurrent radiotherapy and chemotherapy

The intention of this research was to define the predictive factors for acute esophagitis (AE) in lung cancer patients treated with concurrent chemotherapy and three-dimensional conformal radiotherapy. The data for 72 lung cancer patients treated with concurrent chemoradiotherapy between 2008 and 2010 were prospectively evaluated. Mean lung dose, mean dose of esophagus, volume of esophagus irradiated and percentage of esophagus volume treated were analysed according to esophagitis grades. The mean esophageal dose was associated with an increased risk of esophageal toxicity (Kruskal-Wallis test, P < 0.001). However, the mean lung dose and the volume of esophagus irradiated were not associated with an increased risk of esophageal toxicity (Kruskal-Wallis test, P = 0.50 and P = 0.41, respectively). The mean radiation dose received by the esophagus was found to be highly correlated with the duration of Grade 2 esophagitis (Spearman test, r = 0.82, P < 0.001). The mean dose of esophagus ≥28 Gy showed statistical significance with respect to AE Grade 2 or worse (receiver operating characteristic curve analysis, 95% CI, 0.929–1.014). In conclusion, the mean esophageal dose was significantly associated with a risk of esophageal toxicity in patients with lung cancer treated with concurrent radiotherapy and chemotherapy.     

Screening and the costs of treating colorectal cancer: some preliminary results

This paper describes a hospital costing analysis of 85 colorectal cancer patients treated in the context of a randomised control trial at the Queen's Medical Centre, Nottingham. Estimates are presented for investigation, surgical and inpatients costs. Comparisons between study and control group patients reveal only a small difference in overall costs of treatment.     

Thrombolytic therapy in patients with acute brain infarction: favorable preliminary results in Maastricht

OBJECTIVE: To assess the feasibility of acute thrombolysis for ischaemic stroke in clinical practice. DESIGN: Prospective. METHOD: On July 1st, 1998 thrombolytic therapy for ischaemic stroke was introduced in the University Hospital Maastricht, the Netherlands. All patients admitted with ischaemic stroke were prospectively registered during the first year. Of all patients with ischaemic stroke, it was determined how many were potentially eligible for thrombolysis within 3 hours of stroke symptom onset, and how many of these patients were actually treated with thrombolysis. Furthermore, the reasons for exclusion from thrombolytic therapy were assessed. Several baseline and clinical patient characteristics were noted. RESULTS: During the first year 18 ischaemic stroke patients were treated with thrombolysis within 3 hours of stroke onset. These 18 patients constituted 7% of all 256 ischaemic stroke patients and 18% of the potentially eligible patients who arrived in the hospital within 3 hours. More than 40% of the ischaemic stroke patients were not eligible for thrombolysis due to late arrival in the hospital. There were no major complications in the 18 treated patients: 3 patients developed an asymptomatic haemorrhagic transformation of the infarct. CONCLUSION: Acute thrombolysis for ischaemic stroke within 3 hours from stroke onset is feasible, and can under specific conditions be applied in clinical practice. Only 7% of all ischaemic stroke patients underwent thrombolysis. This percentage of patients could be increased by an earlier presentation of patients to the hospital.     

巨块型宫颈癌术后大分割放疗加同期化疗临床研究的初步结果

目的探索中晚期宫颈癌根治性术后大分割放疗+同期化疗的疗效及毒性。方法 2007年7月至2012年6月,50例行广泛全子宫切除+盆腔淋巴结清扫术后的巨块型Ib、IIa、IIb期宫颈癌患者纳入分析。治疗采用大分割放疗+同步化疗:放疗方案为3 Gy/次,每周5次,总剂量39 Gy;同步化疗方案为顺铂35~40 mg/m2,每周1次的同步化疗。观察5年无局部复发生存率(LRFS)、5年无瘤生存率(DFS)、5年无远处转移生存率(FDMS)、5年总生存率(OS)以及不良反应。结果 5年DFS为74.1%、5年LRFS为86.1%、5年FDMS为80.4%、5年OS为74.7%。所有病例整体治疗耐受性较好,虽然3/4级急性黏膜反应发生率为14%,但未发现严重的胃肠道事件或新的安全性问题。结论宫颈癌术后大分割同步放化疗不良反应可接受,治疗依从性好,总体疗效满意,但需随机对照试验进一步证实。     

同步放化疗治疗术后复发性直肠癌的近期疗效观察

目的评价三维适形放疗同步化疗治疗术后复发性直肠癌的近期疗效及毒副反应。方法 15例术后复发性直肠癌采用同步放化疗,先盆腔适形放疗46Gy,后缩野继续适形放疗肿瘤补量,使肿瘤总量达到60～70Gy;化疗采用XELOX方案,于放疗第1、21、42天开始同步进行3周期。结果患者中位随访时间为1年,治疗后3个月、1年复查,局部控制率达到86.7%,症状缓解率达到93.3%,1年生存率为86.7%。不良反应主要有胃肠道反应、骨髓抑制、神经毒性,多为1～2级。结论三维适形放疗同步化疗可提高术后复发性直肠癌的控制率,改善患者生活质量,延长生命,不良反应可以耐受。     

调强适形放疗同期TP方案化疗治疗食管上段癌的临床研究

目的 探讨调强适形放疗（IMRT）同期TP方案（多西他赛＋顺铂）化疗治疗食管上段癌的疗效、局部控制率、生存率及不良反应.方法 78例食管上段癌患者以双盲法随机分为IMRT联合同期化疗组（放化组）和单纯IMRT组（放疗组）,每组39例.放化组采用IMRT,总剂量6 400 cGy/32次,5次/周,同期应用TP方案化疗每周1次;放疗组单纯采用IMRT.观察分析各组近期疗效、局部控制率、生存率、不良反应.结果 放化组完全缓解17例,部分缓解20例,稳定2例,总有效率为94.9％（37/39）;放疗组完全缓解9例,部分缓解19例,稳定11例,总有效率为71.8％（28/39）.放化组总有效率高于放疗组,差异有统计学意义（P＜0.05）.放化组3年局部控制率为69.2％（27/39）,明显高于放疗组的35.9％（14/39）,差异有统计学意义（P＜0.05）.放化组3年生存率为74.4％（29/39）,明显高于放疗组的43.6％（17/39）,差异有统计学意义（P＜0.05）.结论 IMRT同期TP方案化疗较单纯IMRT提高了近期疗效、局部控制率、生存率,其近期和远期不良反应可以耐受.