Treatment outcomes and late toxicities of 869 patients with nasopharyngeal carcinoma treated with definitive intensity modulated radiation therapy: new insight into the value of total dose of cisplatin and radiation boost

This study was to report the long-term outcomes and toxicities of nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). From 2009 to 2010, 869 non-metastatic NPC patients treated with IMRT were retrospectively enrolled. With a median follow-up of 54.3 months, the 5-year estimated local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were 89.7%, 94.5%, 85.6%, 76.3%, 84.0%, respectively. In locally advanced NPC, gender, T, N, total dose of cisplatin more than 300 mg/m² and radiation boost were independent prognostic factors for DMFS and DFS. Age, T, N and total dose of cisplatin were independent prognostic factors for OS. Radiation boost was an adverse factor for LRFS, RRFS, DMFS and DFS. Concurrent chemotherapy was not an independent prognostic factor for survival, despite marginally significant for DMFS in univariate analysis. Concurrent chemotherapy increased xerostomia and trismus, while higher total dose of cisplatin increased xerostomia and otologic toxicities. In conclusion, IMRT provided satisfactory long-term outcome for NPC, with acceptable late toxicities. Total dose of cisplatin was a prognostic factor for distant metastasis and overall survival. The role of concurrent chemotherapy and radiation boost in the setting of IMRT warrants further investigation.     

非转移性T4期鼻咽癌的预后影响因素分析

目的探讨非转移性ⅣA期鼻咽癌的预后影响因子。方法初治的T4N0~3M0 (UICC 1997版分期)鼻咽癌患者145例纳入临床研究,分析患者的复发、转移、生存情况及预后影响因素。结果145例患者的5年OS、CCS、PFS、DLRFS、DMFS分别为59.2％、61.3％、53.0％、71.6％、62.6％。多因素分析显示：颈动脉鞘区受侵是影响DLRFS、DMFS的不良预后因素,UICC N分期是影响DLRFS、 DMFS的独立预后因素;颈动脉鞘区受侵是影响CCS的独立不良预后因素,年龄、颈部照射剂量、UICC N分期是影响CCS的独立预后因素。单因素分析显示: 颈动脉鞘区受侵、UICC N分期是影响CCS、PFS的预后因素,同期化疗或放疗联合化疗虽提示有提高DMFS及提高CCS的趋势,但差异无统计学意义（P＞0.05）。结论颈动脉鞘区受侵、UICC N分期是影响非转移性T4期鼻咽癌的重要预后因子。     

基于MRI的淋巴结包膜侵犯与鼻咽癌3DRT的预后关系

目的 探讨基于MRI的鼻咽癌患者区域淋巴结包膜侵犯的临床特征与鼻咽癌3DRT的预后关系。方法 收集2009年—2013年间本院477例采用3DRT初治鼻咽癌患者资料,分析患者区域淋巴结包膜侵犯的临床特征及预后关系。结果 区域淋巴结包膜侵犯组216例,无包膜侵犯组261例。有包膜侵犯和无包膜侵犯组的中位生存期分别为38.5个月和39.0个月,3年OS、PFS、LRFS、DMFS分别为81.9%、65.8%、87.8%、80.3%和90.7%、85.0%、95.8%、92.9%(P=0.000)。单因素分析结果显示N分期及淋巴结包膜侵犯是影响鼻咽癌患者OS、PFS、LRFS及DMFS的重要影响因素(P=0.000~0.004),而T分期、TNM分期与鼻咽癌患者OS、PFS、DMFS相关(P均=0.000)。Cox模型多因素分析显示T分期是影响鼻咽癌患者生存的预测因子,淋巴结包膜侵犯是影响鼻咽癌患者PFS、LRFS、DMFS因素。结论 淋巴结包膜侵犯患者容易出现局部复发或远处转移,是鼻咽癌患者重要预后因素。     

鼻咽癌疗前原发灶及区域淋巴结坏死与3DRT预后关系

目的 探讨鼻咽癌患者原发灶及区域淋巴结坏死的临床特征与鼻咽癌预后关系。方法 收集2009—2013年间粤北人民医院 477例初治鼻咽癌患者的临床资料,根据疗前影像学鼻咽部原发灶及区域淋巴结坏死情况、MRI及CT检查,分析疗前鼻咽部原发灶及区域淋巴结坏死的临床特征及与3DRT预后关系。采用Kaplan-Meier法计算生存率,Logrank检验和单因素分析及Cox模型多因素预后分析。结果 疗前有肿瘤坏死者 219例(45.9%),无肿瘤坏死者 258例(54.1%)。有肿瘤坏死与无坏死的中位生存期分别为37个月与40个月,3年OS、PFS、LRFS及DMFS率分别为78.2%与93.7%、63.8%与86.7%、87.0%与96.3%及79.7%与93.4%(P均=0.000)。单因素分析结果显示肿瘤坏死是影响患者OS、PFS、LRFS、DMFS的重要影响因素(P均=0.000),而T分期、N分期及临床分期与患者OS、PFS、DMFS相关(P=0.000~0.004)。多因素分析显示疗前肿瘤坏死是影响4种生存的预测因子(P=0.001~0.022),T分期是影响LRFS、DMFS的预测因子(P=0.016、0.006),N分期是影响PFS的预测因子(P=0.000)。结论 疗前存在肿瘤坏死患者易出现复发或转移,生存期更短。在T分期、N分期基础上参考肿瘤坏死状态有利于临床医师制定更加合理的治疗方案和改善预后。。     

IMRT同期化疗在Ⅲ期鼻咽癌中作用分析

目的 探讨IMRT同期化疗对Ⅲ期鼻咽癌患者预后的影响和作用。方法 回顾性分析2001-2008年间中山大学肿瘤防治中心接受单纯IMRT和IMRT同期铂类药物化疗的 251例Ⅲ期鼻咽癌患者,分析相关预后因子和探讨IMRT同期化疗作用。采用Kaplan-Meier法计算生存率,组间差异比较采用log-rank检验,Cox模型预后因素分析。结果 全组 10年无局部区域复发生存(LRFS)、无远处转移生存(DMFS)、无进展生存(PFS)和总生存(OS)率分别为88.6%、81.1%、68.8%和75.1%。单因素和多因素分析显示N分期和鼻咽肿瘤体积是最重要的预后影响因素,同期化疗有助于改善患者PFS和OS (均 P<0.05)。T3N0-1期患者单纯放疗组和同期放化疗组各生存指标均相近(10年LRFS为93.8%∶93.2%,P=0.933;10年DMFS为80.9%∶86.8%,P=0.385;10年PFS为70.6%∶77.7%,P=0.513;10年OS为71.8%∶83.6%,P=0.207);T1-3N2期患者同期放化疗的LRFS、PFS和OS优于单纯放疗(10年LRFS为87.3%∶66.7%,P=0.016;10年PFS为70.2%∶41.0%,P=0.003;10年OS为78.5%∶51.7%,P=0.008),DMFS有提高趋势(10年DMFS为80.3%∶66.4%,P=0.103)。结论 IMRT中同期化疗的加入有助于改善Ⅲ期鼻咽癌患者预后,在N2期组获益较为明显,需要根据患者治疗失败风险予以个体化治疗方案。     

The role of concurrent chemotherapy in intensity-modulated radiotherapy for patients with stage Ⅲ nasopharyngeal carcinoma

Objective To investigate the clinical efficacy of concurrent chemotherapy in intensity-modulated radiotherapy (IMRT) for patients with stage Ⅲ nasopharyngeal carcinoma (NPC). Methods Clinical data of 251 patients with stage Ⅲ NPC treated with IMRT alone or concurrent chemoradiotherapy (CCRT) at Sun Yat-sen University Cancer Center from February 2001 to December 2008 were retrospectively analyzed. The prognostic factors of NPC were analyzed and the efficacy of CCRT was assessed. The survival rate was calculated by Kaplan-Meier method. The differences between two groups were analyzed by log-rank test. The prognostic factors were analyzed by Cox model. Results The 10-year locoregional-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) for NPC patients were 88.6%, 81.1%, 68.8% and 75.1%, respectively. Univariate and multivariate analyses demonstrated that N staging and nasopharyngeal tumor volume were the most important prognostic factors, and concurrent chemotherapy significantly improved PFS and OS (both P<0.05). In T3N0-1 patients, there was no significant difference in survival indexes between IMRT alone and CCRT (10y-LRFS:93.8% vs. 93.2%, P=0.933;10y-DMFS:80.9% vs. 86.8%, P=0.385;10y-PFS:70.6% vs. 77.7%, P=0.513;10y-OS:71.8% vs. 83.6%, P=0.207). For T1-3N2 patients, CCRT was significantly better than radiotherapy alone in LRFS, PFS, and OS (10y-LRFS:87.3% vs. 66.7%, P=0.016;10y-PFS:70.2% vs. 41.0%, P=0.003;10y-OS:78.5% vs. 51.7%, P=0.008), whereas there was an increasing trend in DMFS (10y-DMFS:80.3% vs. 66.4%, P=0.103). Conclusions Concurrent chemotherapy can improve clinical prognosis of stage Ⅲ NPC patients, and the most survival benefits are obtained in the N2 group. Individualized treatment options should be delivered based on the risk of treatment failure.     

18 F-FLT PET/CT对食管鳞癌放化疗效果预测研究

背景与目的： ¹⁸ F-FLT是一种细胞增殖的示踪剂。探索 ¹⁸ F-FLT PET/CT对食管鳞癌根治性放（化）疗效果的预测价值。方法：对根治性放（化）疗的初治食管鳞癌患者,放疗前及放疗第4周行 ¹⁸ F-FLT PET/CT扫描,记录原发灶的SUV _max-T 、转移淋巴结的SUV _max-N 等参数。随访患者总生存期（overall survival,OS）及无进展生存期（progression-free survival,PFS）,分析PET/CT参数与患者预后的关系。结果：共入组39例患者,25例完成2次PET/CT扫描。 ¹⁸ F-FLT的SUV _max-T 由基线6.63下降到1.22,淋巴结SUV _max-N 由3.69下降到1.84,但下比例与生存率无关。 ¹⁸ F-FLT PET/CT的基线SUV _max-N ＜5.00的患者,其OS明显高于SUV _max-N ≥5.00的患者（P=0.002）。结论：对根治性放（化）疗食管鳞癌,治疗前的基线 ¹⁸ F-FLT PET/CT的淋巴结SUV _max-N 是一个较好的预测预后参数。放疗4周时,病灶在 ¹⁸ F-FLT PET/CT扫描中的SUV值明显下降,但不能预测预后。     

鼻咽癌调强放疗疗效及预后影响因素分析(附691例)

目的:回顾性分析我院采用调强放疗(intensity-modulated radiotherapy,IMRT)治疗鼻咽癌的疗效及预后影响因素.方法:收集2009年01月至2015年08月691例鼻咽癌患者的临床资料进行生存分析.结果:中位随访时间为62.8个月,全组患者5年总生存(overall survival,OS...     

局部晚期鼻咽癌TPF方案诱导化疗加紫杉醇或顺铂同期IMRT疗效分析

目的 分析局部晚期鼻咽癌TPF诱导化疗加紫杉醇或顺铂同期IMRT的疗效。     

Combined chemoradiation vs radiation therapy alone in stage-II nasopharyngeal carcinoma: A meta-analysis of the published literature

The aim of this meta-analysis was to evaluate the efficacy and toxicity of adding chemotherapy to radiotherapy (RT) in the treatment of stage-II nasopharyngeal carcinoma (NPC). We searched Pubmed, Cochrane Library, Embase, China National Knowledge Internet, China Biology Medicine, VIP, and Wanfang database for studies of the RT with or without chemotherapy in patients with stage-II NPC that were published in any language. Analyses were carried out using RevMan 5.3 software. The relative risk was used to evaluate the data, the I² test was used to compare heterogeneity, sensitivity analysis was used to evaluate the stability and reliability of the results. There were 16 studies with 3038 patients that were included in this analysis. Risk ratios (RR) of 1.04 (95% CI: 1.01-1.06), 1.05 (95% CI: 1.00-1.10), 1.05 (95% CI: 1.02-1.07), and 1.00 (95% CI: 0.97-1.03) were observed for overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFS), and distant metastasis-free survival (DMFS). Subgroup analysis showed that compared with conventional RT alone, chemoradiation (CRT) could significantly improve OS (RR = 1.09, 95% CI: 1.03-1.15), PFS (RR = 1.20, 95% CI: 1.08-1.35), and LRFS (RR = 1.09, 95% CI: 1.04-1.14), but did not significantly improve the rate of DMFS (RR = 1.03, 95% CI: 0.94-1.12). However, compared with intensity modulated radiation therapy alone, CRT did not significantly improve the rate of OS (RR = 1.01, 95% CI: 0.99-1.03), PFS (RR = 0.99, 95% CI: 0.95-1.03), LRFS (RR = 1.02, 95% CI: 0.99-1.05), and DMFS (RR = 0.99, 95% CI: 0.96-1.01). Compared with conventional RT alone, CRT could significantly improve patients’ prognoses in terms of OS, PFS, and LRFS for stage-II NPC, but not DMFS, and CRT can provide greater benefits from concurrent chemotherapy than neoadjuvant chemotherapy. With intensity modulated radiation therapy, the stage-II NPC patients did not benefit from the addition of chemotherapy.     

Stage III non-small-cell lung cancer treated with high-dose hyperfractionated radiation therapy and concurrent low-dose daily chemotherapy with or without weekend chemotherapy: retrospective analysis of 301 patients

We investigated the outcome in patients with stage III non-small-cell lung cancer (NSCLC) treated with high-dose hyperfractionated radiation therapy (Hfx RT) and concurrent chemotherapy (CHT) consisting of carboplatin (C) and etoposide (E). During three prospective randomized phase III and one prospective phase II study enrolling a total of 536 patients, 301 patients were treated with high-dose Hfx RT (69.6 Gy) and either low-dose daily CE (50 mg each) (n = 163) or daily CE (30 mg each) accompanied by "weekend" CE (100 mg of each on Saturdays and Sundays) (n = 138). The median survival time for all 301 patients is 22 months and 5-year survival is 24%. Median local recurrence-free survival (LRFS) time is 21 months and 5-year local recurrence-free survival is 32%. The median time to distant metastasis is 25 months, and 5-year distant metastasis-free survival (DMFS) is 35%. Only the type/schedule of CHT administration did not influence overall survival, LRFS, and DMFS. On multivariate analyses using these three endpoints, age stage, interfraction interval, and type/schedule of CHT administration did not predict survival, LRFS, and DMFS, while gender, KPS, and weight loss did. Only high grade hematologic toxicity was more frequent in weekend CHT group. High dose Hfx RT and concurrent low-dose daily CE with or without weekend CE is an active treatment approach in stage III NSCLC that led to high overall survival, LRFS, and DMFS rates.     

Prognostic significance of PET assessment of metabolic response to therapy in oesophageal squamous cell carcinoma

Objectives:

The role of maximum standard uptake value (SUVmax) at baseline and after induction chemotherapy (CT) on positron emission tomography (PET) as an imaging biomarker has not been well established in oesophageal squamous cell carcinoma (SCC). In this retrospective analysis, we investigated the prognostic significance of various PET metrics in oesophageal SCC patients treated with induction chemotherapy followed by concurrent chemoradiotherapy (CRT).

Methods:

A total of 57 patients were treated with CRT; 52 patients received induction chemotherapy and 10 patients underwent surgery following CRT. Scans were independently analysed by a nuclear medicine physician blinded to patient outcome. Using region of interest analysis, SUVmax and metabolic tumour volume (MTV) were calculated for the index lesion and lymph node metastases in each patient. Kaplan–Meier analysis was used to evaluate overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS). Cox proportional hazards regression was used to assess correlation between outcomes and PET metrics.

Results:

Median follow-up for those who are alive was 4.4 years, with a median survival for all patients of 2.9 years. The 3-year OS, DFS, DMFS and LRFS rates were 47, 40, 44 and 36%, respectively. Using a pre-established cutoff of a 35% decrease in SUVmax from baseline to post-induction PET, 3-year OS for responders (⩾35% decrease from baseline) was 64%, whereas non-responders (<35% decrease from baseline) had a 3-year OS of 15% (P=0.004).

Conclusions:

The pre-specified 35% decrease in SUVmax after induction chemotherapy was prognostic for OS. Baseline and post-induction PET metrics provide prognostic information for oesophageal SCC.     

Multi-institutional analysis of cervical esophageal carcinoma patients treated with definitive chemoradiotherapy: TROD 01-005 study

The aim of this study was to examine the prognostic factors and treatment outcomes of cervical esophageal carcinoma (CEC) patients who underwent definitive chemoradiotherapy (CRT). The clinical data of 175 biopsy-confirmed CEC patients treated with definitive CRT between April 2005 and September 2021 were retrospectively analyzed. The prognostic factors predicting overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) were assessed in uni- and multivariable analyses. The median age of the entire cohort was 56 years (range: 26–87 years). All patients received definitive radiotherapy with a median total dose of 60 Gy, and 52% of the patients received cisplatin-based concurrent chemotherapy. The 2-year OS, PFS, and LRFS rates were 58.8%, 46.9%, and 52.4%, respectively, with a median follow-up duration of 41.6 months. Patients’ performance status, clinical nodal stage, tumor size, and treatment response were significant prognostic factors for OS, PFS, and LRFS in univariate analysis. Non-complete treatment response was an independent predictor for poor OS (HR = 4.41, 95% CI, 2.78–7.00, p < 0.001) and PFS (HR = 4.28, 95% CI, 2.79–6.58, p < 0.001), whereas poor performance score was a predictor for worse LRFS (HR = 1.83, 95% CI, 1.12–2.98, p = 0.02) in multivariable analysis. Fifty-two patients (29.7%) experienced grade II or higher toxicity. In this multicenter study, we demonstrated that definitive CRT is a safe and effective treatment for patients with CEC. Higher radiation doses were found to have no effect on treatment outcomes, but a better response to treatment and a better patient performance status did.     

Clinical prognostic factors in patients with locally advanced (stage III) nonsmall cell lung cancer treated with hyperfractionated radiation therapy with and without concurrent chemotherapy: single-Institution Experience in 600 Patients

BACKGROUND:

Influence of potential clinical prognostic factors on overall survival (OS), local progression‐free survival (PFS), and distant metastasis‐free survival (MFS) in patients with locally advanced nonsmall cell lung cancer treated with hyperfractionated radiation therapy (HFX RT) with or without concurrent chemotherapy was investigated.

METHODS:

Three phase 3 and 2 phase 2 studies have been designed and executed with a total of 600 patients. HFX RT alone was given in 127 and HFX RT‐chemotherapy was given in 473 patients. HFX RT doses were either 64.8 grays (Gy) or 69.6 Gy using 1.2 Gy twice daily, or 67.6 Gy using 1.3 Gy twice daily. Chemotherapy consisted of concurrent carboplatin and etoposide in 409 patients and concurrent carboplatin and paclitaxel in 64 patients. Sex, age, Karnofsky performance score (KPS), weight loss (>5%), stage, histology, interfraction interval, and treatment (the addition of concurrent chemotherapy) were investigated as potential prognostic factors.

RESULTS:

The median OS, median local PFS, and median distant MFS times were 19, 21, and 23 months, respectively. Five‐year OS, local PFS, and distant MFS rates were 19%, 29%, and 35%, respectively. Univariate and multivariate analysis showed that only age did not influence OS and local PFS, whereas female sex, lower KPS, less pronounced weight loss, lower stage, squamous histology, shorter interfraction interval, and treatment independently predicted better OS and local PFS. Only age and treatment did not influence distant MFS, whereas histology was of borderline significance.

CONCLUSIONS:

This study identified independent prognosticators of treatment outcome. These results may have implications for future studies in this disease. Cancer 2011. © 2011 American Cancer Society.     

Pre-treatment Hemoglobin Levels are Important for Bladder Carcinoma Patients with Extravesical Extension undergoing Definitive Radiotherapy

Purpose: To evaluate prognostic factors affecting local control (LC), distant metastases-free survival (DMFS)and overall survival (OS) in bladder carcinoma patients undergoing extravesical extension. Patients and Methods:We retrospectively reviewed the charts of 61 consecutive patients with T3 or T4 bladder carcinoma, treated withdefinitive radiotherapy from 1999 through 2007. Results: Median age was 69 years and follow-up was 29 months.The LC rate was 33% at 4 years and was increased in patients with a Hb≥12 g/dl (p=0.003) or a LDH<180 U/L(p=0.021) and in those who received concurrent chemotherapy (p=0.022) on univariate analysis. DMFS wasaffected by anemia (Hb<12 g/dl) (p=0.039), the absence of chemotherapy (p=0.034) and the presence of newlydiagnoseddisease (p=0.01). The OS rate was 19% at 4 years. Non-pure transitional cell carcinoma histologicaltype (p=0.024), anemia (p=0.004), elevated LDH (p=0.003), and newly diagnosed disease (p=0.011) were poorprognostic factors on univariate analyses for OS. Anemia was the only negative prognostic factor for LC (p=0.03),DMFS (p=0.002) and OS (p<0.0001) on multivariate analysis. Conclusion: Pre-treatment Hb level is the mostimportant prognostic factor in patients treated with definitive radiotherapy, so that anemia may act as a surrogatebiological marker for aggressive disease.     

406例鼻咽癌患者颈部及Ⅴ区后缘间隙淋巴结转移的预后分析

  目的  回顾性分析鼻咽癌患者伴有颈部及Ⅴ区后缘间隙淋巴结转移的预后情况,为颈部淋巴结分区及鼻咽癌N分期的进一步修订提供参考。  方法  选取2011年12月至2016年6月成都军区总医院经病理确诊为鼻咽癌的患者406例,分析伴有颈部及Ⅴ区后缘间隙淋巴结转移患者的预后情况。  结果  406例患者的5年总生存率（overall survival,OS）、无进展生存率（progressionfree survival,PFS）、无局部复发生存率（local relapse-free survival,LRFS）、无远处转移生存率（distant metastasis-free survival,DMFS）分别是75.0%、63.4%、87.2%和81.8%。伴有Ⅴ区后缘间隙淋巴结转移患者的3年OS、PFS、LRFS、DMFS分别是51.5%、22.7%、90.0%和41.3%。N3期患者伴或不伴有Ⅴ区后缘间隙淋巴结转移的3年OS、PFS、LRFS、DMFS分别是43.9%和84.7%（P=0.002）、12.9%和55.4%（P=0.006）、88.9%和80.3%（P=0.649）、33.0%和85.9%（P＜0.001）。单因素分析显示N分期是影响OS、PFS、DMFS的预后因素（P＜0.05）,多因素分析显示Ⅴ区后缘间隙淋巴结转移是影响DMFS的独立预后因素（P＜0.05）。  结论  鼻咽癌患者伴有Ⅴ区后缘间隙淋巴结转移预后差,且该区淋巴结转移预示患者远处转移的风险增加。建议将Ⅴ区后缘间隙作为头颈部肿瘤一个新的颈部分区。      

术前同步放化疗后yp0-Ⅰ期直肠癌预后分析

目的 探讨局部晚期直肠癌术前同步放化疗后yp0-Ⅰ期的预后及影响因素。方法 ２００８-２０１３ 年纳入研究８７ 例局部晚期直肠癌术前同步放化疗后ｙｐ０-Ⅰ期患者,均接受术前同步放化疗后４～８ 周进行ＴＭＥ。放疗给予全盆腔外照射４５.０～５０.４ Ｇｙ,同步给予单药卡培他滨或卡培他滨联合奥沙利铂化疗。采用Ｋａｐｌａｎ?Ｍｅｉｅｒ 法计算ＬＲＦＳ、ＤＭＦＳ、ＤＦＳ 和ＯＳ 并Ｌｏｇｒａｎｋ 检验和单因素预后分析,Ｃｏｘ 模型多因素预后分析。结果　术前同步放化疗与手术间隔中位时间为５１ ｄ。ＴＭＥ 术后共４５％接受了术后辅助化疗。３ 年ＬＲＦＳ、ＤＭＦＳ、ＤＦＳ 和ＯＳ 分别为９８％、９３％、９３％和９６％。多因素分析发现基于疗前临床分期和术后病理分期的降期深度评分与ＤＭＦＳ、ＤＦＳ 相关（Ｐ ＝ ０.０２０、０.００５）。降期深度评分５ 分为界值,预测３ 年ＤＦＳ 的ＲＯＣ 的ＡＵＣ 值为０.８０３。结论　术前同步放化疗后ｙｐ０-Ⅰ期直肠癌的长期生存结果较好。降期深度评分可以预测预后     

Prognostic Value of 18F-FDG PET/CT Metabolic Parameters in Splenic Marginal Zone Lymphoma

IntroductionSplenic marginal zone lymphoma (SMZL) is an indolent non-Hodgkin lymphoma usually with a good prognosis, but no clear metabolic behavior at fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). The aim of our analysis was to investigate the prognostic role of baseline 18F-FDG PET/CT parameters in SMZL.Materials and MethodsWe retrospectively included 42 patients who received 18F-FDG-PET/CT before any treatments, and PET images were evaluated visually and semi-quantitatively by measuring lesion to liver (L-L) maximum standardized uptake volume (SUVmax) ratio (L-L SUV R), lesion to blood-pool SUVmax ratio (L-BP SUV R), metabolic tumor volume, and total lesion glycolysis. Progression-free (PFS) and overall survival (OS) curves were plotted according to the Kaplan-Meier method.ResultsIn all patients, an increased splenic FDG uptake (higher than the background) was identified, showing the presence of diffuse spleen uptake in 35 patients and focal uptake in the remaining 7 patients. At a median follow-up of 51 months, relapse or progression of disease occurred in 23 patients with an average time of 38.1 months from the baseline 18F-FDG PET/CT, and death occurred in 4 patients with an average time of 26.8 months. The estimated 2-year PFS and OS rates were 78% and 90%, respectively, whereas 5-year PFS and OS rates were 63% and 82%, respectively. At multivariate analysis, only L-L SUV R and L-BP SUV R were independent prognostic factors for PFS. In addition, no significant association was discovered for OS, considering all features.ConclusionsL-L SUV R and L-BP SUV R were independently correlated with PFS.     

Clinical outcome and predictors of survival and pneumonitis after stereotactic ablative radiotherapy for stage I non-small cell lung cancer

ABSTRACT: BACKGROUND: Stereotactic ablative radiotherapy (SABR) can achieve excellent local control rates in early-stage non-small cell lung cancer (NSCLC) and has emerged as a standard treatment option for patients who cannot undergo surgery or those with isolated recurrences. However, factors that may predict toxicity or survival are largely unknown. We sought here to identify predictors of survival and pneumonitis after SABR for NSCLC in a relatively large single-institution series. METHODS: Subjects were 130 patients with stage I NSCLC treated with four-dimensional computed tomography (4D CT) --planned, on-board volumetric image--guided SABR to 50 Gy in 4 fractions. Disease was staged by positron emission tomography/computed tomography (PET/CT) and scans were obtained again at the second follow-up after SABR. RESULTS: At a median follow-up time of 26 months, the 2-year local control rate was 98.5%. The median overall survival (OS) time was 60 months, and OS rates were 93.0% at 1 year, 78.2% at 2 years, and 65.3% at 3 years. No patient experienced grade 4--5 toxicity; 15 had radiation pneumonitis (12 [9.3%] grade 2 and 3 [2.3%] grade 3). Performance status, standardized uptake value (SUV)max on staging PET/CT, tumor histology, and disease operability were associated with OS on univariate analysis, but only staging SUVmax was independently predictive on multivariate analysis (P = 0.034). Dosimetric factors were associated with radiation pneumonitis on univariate analysis, but only mean ipsilateral lung dose >=9.14 Gy was significant on multivariate analysis (P = 0.005). CONCLUSIONS: OS and radiation pneumonitis after SABR for stage I NSCLC can be predicted by staging PET SUVmax and ipsilateral mean lung dose, respectively.     

FDG PET-CT对复发鼻咽癌疗效及预后评价研究

目的 评价FDG PET-CT显像对复发鼻咽癌疗效监测及其预后评估价值。方法 2008—2013年经病理或影像学确诊的92例复发鼻咽癌,按中国2008鼻咽癌临床分期标准再分期。Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为8、11、39、34例,其中复发T分期(rT₁)、rT₂、rT₃、rT₄期患者分别为10、11、38、33例。28例同时伴有颈淋巴结复发。所有患者均于疗前行全身或头颈部FDG PET-CT并接受放疗±化疗,分别分析SUV_max及临床各因素与临床预后关系。Kaplan-Meier法计算OS、DFS、LRFS、RRFS、DMFS,Logrank法检验和单因素预后分析,Cox模型多因素预后分析。结果 3年OS、DFS、LRFS、RRFS、DMFS分别为33.6%、32.1%、32.8%、31.8%、33.7%。肿瘤SUV_max中位数为8.35(2.70~21.50)。与3年OS相关最佳截断点SUV_max为7.0,SUV_max≤7.0、>7.0患者3年OS分别为42.0%、28.3%(P=0.019)。单因素分析显示年龄、SUV_max、rN分期与OS相关(P=0.023、0.019、0.002),多因素分析显示SUV_max和rN分期是OS、DFS、DMFS影响因素(HR=1.68,P=0.045和HR=2.23,P=0.003;HR=1.67,P=0.042和HR=2.39,P=0.001;HR=1.77,P=0.025和HR=2.40,P=0.001)。结论 SUV_max可能是影响复发鼻咽癌OS、DFS、DMFS的有效预后因素。