Cervix carcinoma, concurrent chemoradiotherapy, and salvage of isolated paraaortic lymph node recurrence

PURPOSE: To determine the effect of concurrent chemoradiotherapy on the outcome of invasive cervical carcinoma patients with disease recurrence isolated to the paraaortic lymph nodes. METHODS AND MATERIALS: Between 1987 and 2003, 816 cervical carcinoma patients received radiotherapy at Mallinckrodt Institute of Radiology. Of these 816 patients, 14 had clinically or radiographically detected isolated paraaortic lymph node metastases. Before 1998, imaging was done if warranted by the presence of one or more classic findings, including lower extremity edema, sciatic pain, and hydronephrosis. After 1998, radiographic imaging was a routine part of follow-up for all patients. The median age at recurrence was 42.5 years (range, 32-54 years). Follow-up for all living patients was current at last follow-up. Full-dose radiotherapy equaled at least 45 Gy. RESULTS: All 7 patients with a classic finding of recurrence, none of whom had been treated to at least 45 Gy and concurrent chemotherapy, were dead of disease within 1.5 years. The 7 patients without a classic finding of recurrence, all of whom had been treated with salvage full-dose concurrent chemoradiotherapy, had a 5-year overall survival rate of 100% (p <0.01). CONCLUSION: Salvage concurrent full-dose chemoradiotherapy afforded excellent survival of patients who did not have classic findings but had disease recurrence exclusively in the paraaortic lymph nodes. The effectiveness of salvage concurrent full-dose chemoradiotherapy in patients with symptomatic disease recurrence remains unclear. However, chemotherapy or radiotherapy alone produced dismal survival in patients with classic findings of recurrence.     

Hyperfractionated radiotherapy with concurrent chemotherapy for para-aortic lymph node recurrence in carcinoma of the cervix

PURPOSE: To evaluate efficacy, toxicity, and patterns of relapse in patients treated with hyperfractionated radiotherapy (HFRT) with concurrent chemotherapy for para-aortic lymph node (PALN) recurrence of cervical carcinoma. METHODS AND MATERIALS: Between September 1997 and October 2000, 12 cervical carcinoma patients with isolated PALN recurrence who had previously received radical or postoperative radiotherapy were treated with HFRT and concurrent chemotherapy. The initial FIGO stage was Stage IB in 4 (33%) patients, Stage IIA in 2 (17%), and Stage IIB in 6 (50%). The radiation field encompassed the gross recurrent PALN with the superior margin at the upper end of the T12 body and the inferior margin between L5 and S1. The fractionated dose was 1.2 Gy in 2 daily fractions, and the median total dose was 60 Gy. The weekly concurrent chemotherapy consisted of paclitaxel in 11 patients and cisplatin in 1. The median number of cycles of chemotherapy was 5. RESULTS: The latent period to PALN recurrence from the time of initial treatment for all patients ranged from 2 to 92 months (median: 12 months). One month after treatment, the clinical tumor response evaluated was complete in 33% (4/12) and partial in 67% (8/12). The 3-year overall survival rate and median survival were 19% and 21 months, respectively. The latent period to PALN recurrence was the only significant prognostic factor; the median survival of patients who relapsed in < or =24 months from the initial treatment of cervical carcinoma was 13 months vs. 45 months for those relapsed at >24 months (p = 0.026). Grade 3-4 hematologic toxicity developed in 2 patients. Six (50%) patients experienced Grade 2 nausea. There were no late gastrointestinal or neurologic complications during the follow-up period. Subsequent distant metastases after PALN treatment developed in 58% (7/12). CONCLUSION: HFRT of 60 Gy to PALN with concurrent chemotherapy could be regarded as an effective treatment modality without significant acute or late toxicity. Patients with a latent period >24 months until PALN recurrence had a more favorable survival rate than those with a latent period 相似文献   

有高危因素的早期宫颈癌患者术后紫杉醇联合卡铂同期化放疗的疗效和安全性观察

目的评价紫杉醇联合卡铂同期放疗(CCRT)在治疗有高危因素早期宫颈癌术后的疗效和毒副反应。方法收集本科2008年7月1日至2011年6月30日收治ⅠB1～ⅡB宫颈鳞癌根治术后有高危因素的患者54例,其中行同期化放疗15例,39例行序贯放疗。同期化疗方案为紫杉醇(135 mg/m~2)联合卡铂(AUC=5)于放疗第一周进行一个疗程。辅助化疗方案同同期化疗,于放疗结束后开始,每21天一个疗程。比较同期化放疗和序贯放疗的复发率、无进展生存期(PFS)和总生存期(OS)以及急性期和晚期不良反应。结果 54例患者均按计划完成治疗,同期化放疗的中位放疗剂量50 Gy(46～52 Gy,每次2 Gy)和人均化疗次数4次(3～5次)与序贯放疗相似(P=0.60和P=0.34)。在中位随访20个月(8～43个月)期间发现,同期化放疗较序贯放疗能减少局部复发率(0/15 vs 9/39,P=0.04),而两组无进展生存期(log-rank,P=0.26)和总生存期(log-rank,P=0.51)相似。同期化放疗患者出现3～4级血液学不良反应比例高于序贯放疗(4/15 vs 1/39,P=0.03),而3级胃肠道急性不良反应相似(4/15 vs 5/39,P=0.22),随访期间两组患者未发现3～4级晚期不良反应。结论紫杉醇联和卡铂的同期化放疗能减少有高危因素的早期宫颈癌术后患者局部复发,并有较好耐受性。     

Long Term Outcomes of Preoperative versus Postoperative Concurrent Chemoradiation for Locally Advanced Rectal Cancer: Experience from Ramathibodi Medical School in Thailand

Objectives: The study analyzed and compared the long term outcome in locally advanced rectal cancer treatedwith preoperative and postoperative concurrent chemoradiation (CCRT). Materials and Methods: A retrospectivereview of 105 patients with stage T3-T4 or regional lymph node positive adenocarcinoma of rectum treated withpreoperative or postoperative CCRT at Ramathibodi Hospital during 2005 to 2010 was performed. The results oftreatment were reported with 5-year overall survival (OS), 5- year locoregional recurrence free survival (LRFS),and toxicity according to preoperative versus postoperative concurrent chemoradiation (CCRT) groups. Results:Among 105 patients, 34 (32%) were treated with preoperative CCRT and 71 (68%) with postoperative CCRT.At the median follow-up time of 50.5 months (range 2-114 months), five-year OS and LRFS of all patients were87% and 91.6%, respectively. The study found no difference in 5-year OS (81.7% vs 89.2 %) or LRFS (83.4%vs 95.1%) between preoperative versus postoperative CCRT. Seven cases of loco-regional recurrence werediagnosed, 4 (11.8%) after preoperative CCRT and 3 (4.2%) after postoperative CCRT. The recurrent siteswere anastomosis in all patients. There was no significant factor associated with outcome after univariate andmultivariate testing. Grade 3 or 4 acute and late complications were low in both preoperative and postoperativeCCRT groups. Conclusions: Locally advanced rectum cancer patients experience good results with surgery andadjuvant concurrent chemoradiation.     

Feasibility and effectiveness of postoperative adjuvant concurrent chemoradiation therapy in Japanese patients with high-risk early-stage cancer of the uterine cervix

BACKGROUND: This study was undertaken to evaluate the feasibility and effectiveness of postoperative concurrent chemoradiation (CCRT) in patients with high-risk early-stage cervical cancer who were treated by radical hysterectomy and pelvic lymphadenectomy. METHODS: From July 2001 to September 2005, CCRT was performed in 37 patients who had undergone radical hysterectomy with pelvic lymph node dissection at Nagoya University Hospital. Adjuvant chemotherapy consisted of cisplatin (70 mg/m(2) on day 1) and 5-fluorouracil (5-FU; 700 mg/m(2) per day on days 1-4) every 4 weeks for a total of three cycles. Pelvic radiotherapy was started concurrently with the first cycle of chemotherapy. The radiation dose was 45 Gy in 25 fractions. A nonrandomized control group of 52 patients who had undergone radiation therapy alone after radical hysterectomy between 1991 and 2000 served for historical comparison. RESULTS: In the CCRT group, the incidences of grade 3/4 toxicities were 24.3% for neutropenia, 8.1% for nausea and vomiting, and 18.9% for diarrhea. The 5-year progression-free survival (PFS) rates in the CCRT group and control group were 89.2% and 69.2%, respectively (P = 0.0392). CONCLUSION: This study showed that adjuvant CCRT with cisplatin and 5-FU could be safely performed and improved the prognosis in Japanese patients with high-risk early-stage cervical cancer after radical hysterectomy.     

Preoperative hyperfractionated radiotherapy with concurrent chemotherapy in resectable esophageal cancer

PURPOSE: To evaluate the local control rates, survival rates, and patterns of failure for esophageal cancer patients receiving preoperative concurrent chemotherapy and hyperfractionated radiotherapy followed by esophagectomy. METHODS AND MATERIALS: From May 1993 through January 1997, 94 patients with resectable esophageal cancers received continuous hyperfractionated radiation (4,800 cGy/40 fx/4 weeks), with concurrent FP chemotherapy (5-FU 1 g/m(2)/day, days 2-6, 30-34, CDDP 60 mg/m(2)/day, days 1, 29) followed by esophagectomy 3-4 weeks later. If there was evidence of disease progression on preoperative re-evaluation work-up, or if the patient refused surgery, definitive chemoradiotherapy was delivered. Minimum follow-up time was 2 years. RESULTS; All patients successfully completed preoperative treatment and were then followed until death. Fifty-three patients received surgical resection, and another 30 were treated with definitive chemoradiotherapy. Eleven patients did not receive further treatment. Among 91 patients who received clinical reevaluation, we observed 35 having clinical complete response (CR) (38.5%). Pathologic CR rate was 49% (26 patients). Overall survival rate was 59.8% at 2 years and 40.3% at 5 years. Median survival time was 32 months. In 83 patients who were treated with surgery or definitive chemoradiotherapy, the esophagectomy group showed significantly higher survival, disease-free survival, and local disease-free survival rates than those in the definitive chemoradiation group. CONCLUSION: Preoperative chemoradiotherapy in this trial showed improved clinical and pathologic tumor response and survival when compared to historical results. Patients who underwent esophagectomy following chemoradiation showed decreased local recurrence and improved survival and disease-free survival rates compared to the definitive chemoradiation group.     

Chemoradiotherapy in locally advanced cancers of the uterine neck. Retrospective study of 92 patients treated at the Institute Curie between 1986 and 1998]]

PURPOSE: The prognosis of locally advanced cervix cancers is poor with metastatic and local recurrence risks. Recent publications reported that concurrent chemotherapy and pelvic radiation increased local control compared to radiotherapy alone. Chemotherapy could also decrease metastatic recurrences. We report 92 cases of patients with locally advanced cervix cancer treated between 1986 and 1998 at the Institut Curie. PATIENTS AND METHODS: Concurrent chemoradiation was exclusive in 51 cases and added to surgery in 41 cases. Chemotherapy with 5FU-Cisplatin-Mitomycin C-Vindesin (protocol A) was performed for 43% of patients and 57% of them received 5FU-Cisplatin alone (protocol B). RESULTS: Median follow-up was 64 months (6-149 months). Five-year disease-free survival rate was 47% and local control rate was 70%. Disease-free survival was correlated with therapeutic response. After exclusive chemoradiation, the good responsive patients had a better DFS (54% vs 26%, p = 0.018). In the surgery group, those patients with sterilized lymph nodes and tumours had also a higher DFS (76% vs 47%, p = 0.036). Toxicity was higher with protocol A. CONCLUSION: From our study, it appears that local control of advanced cervix cancers is better with combined chemoradiotherapy but disease-free survival stays low according to the metastatic evolution. Metastasis without local recurrence remained frequent in our study. 5FU-CDDP chemotherapy has a lower toxicity and is as effective as 5FU-CDDP-Mitomycin C-Vindesin protocol, in association with radiotherapy.     

Chemoradiation and adjuvant chemotherapy in cervical cancer.

PURPOSE: Radiotherapy is the standard treatment for locally advanced cervical cancer, but treatment results remain disappointing, particularly for women with bulky central disease. We investigated the role of concurrent chemoradiation and adjuvant chemotherapy in a randomized trial. PATIENTS AND METHODS: Two hundred twenty patients with bulky stage I, II, and III cervical cancer were randomized to receive either standard pelvic radiotherapy or chemoradiation (epirubicin 60 mg/m(2)) followed by adjuvant chemotherapy with epirubicin 90 mg/m(2) administered at 4-week intervals for five additional cycles. RESULTS: Fifty-nine patients have relapsed, with a median follow-up duration of 77 months. Patients who received epirubicin radiation therapy showed a significantly longer disease-free (P =.03) and cumulative survival (P =.04). Patients who received radiation alone had significantly more distant metastasis than those who received chemoradiation (P =.012). There was no difference in long-term local tumor control (P =.99). CONCLUSION: Survival benefit has been demonstrated in patients treated with chemoradiation followed by adjuvant chemotherapy with epirubicin as compared with patients treated with standard pelvic radiotherapy alone.     

Chemoradiation for adenocarcinoma of the anus

PURPOSE: To assess the efficacy and limitations of definitive chemoradiation for adenocarcinoma of the anal canal and to propose a treatment strategy that addresses the limitations of treatment. METHODS AND MATERIALS: Between 1976 and 1998, 16 patients with localized adenocarcinoma of the anal canal were treated with radiotherapy with or without chemotherapy with curative intent. Available histologic slides were reviewed for evidence of primary adenocarcinoma of anal duct origin. The treatment results for these patients were compared with those of a group of patients with epidermoid histologic features who were all treated with definitive chemoradiation (55 Gy with concurrent 5-fluorouracil and cisplatin, n = 92) between 1989 and 1998. The hospital records were reviewed for all patients. Patients with epidermoid carcinoma presented with more advanced primary tumors (42% vs. 19% Stage T3 or greater). All adenocarcinoma patients were treated with radiotherapy (median dose 55 Gy): 11 received concurrent 5-fluorouracil-based chemotherapy and 5 received radiotherapy alone. The initial surgical procedures included abdominoperineal resection, excisional biopsies (n = 5), and local excision (n = 1). Abdominoperineal resection was performed as salvage therapy after local recurrence in 5 patients. The Kaplan-Meier method was used to calculate 5-year actuarial pelvic control, distant disease control, disease-free survival, and overall survival. The median follow-up was 45 months (range 5-196) for patients with adenocarcinoma and 44 months (range 9-115) for patients with epidermoid histologic features. RESULTS: Both local and distant recurrence rates were significantly greater in the adenocarcinoma patients. Of 16 patients with adenocarcinoma, 7 (5-year actuarial rate 54%) had recurrence at the primary site compared with 16 (5-year actuarial rate 18%) of 92 patients with epidermoid histologic features (p = 0.004). Distant disease developed in more patients with adenocarcinoma (5-year actuarial rate 66%) than in patients with epidermoid carcinoma (5-year actuarial rate 10%, p <0.001). The 5-year actuarial disease-free survival and overall survival rate for adenocarcinoma patients was 19% and 64%, respectively, compared with 77% (p <0.0001) and 85% (p = 0.017) for those with epidermoid carcinoma. CONCLUSION: Patients with localized adenocarcinoma of the anus treated with definitive chemoradiation had high rates of pelvic failure and distant metastasis compared with comparably staged patients with epidermoid histologic features treated similarly. On the basis of these limitations, we recommend preoperative chemoradiation followed by abdominoperineal resection to maximize pelvic disease control and consideration of adjuvant chemotherapy to address the problem of micrometastatic disease.     

同步放化疗与新辅助化疗联合手术加辅助放疗治疗Ⅱb期宫颈癌的对比分析

目的:分析比较根治性放疗联合双药同步化疗与新辅助化疗联合根治性子宫切除术加术后辅助放疗治疗FIGO Ⅱb宫颈癌的复发转移率,无进展生存期(PFS),总生存期(OS),不良反应及预后影响因素.方法:回顾性分析2008年9月至2013年12月期间中南大学湘雅二医院肿瘤中心及妇科收治的初治FIGO Ⅱb期宫颈癌患者,共计91例.按照治疗方式分为两组:①同步放化疗组49例:根治性放疗联合双药同步化疗,3周方案连续4至6周期;②新-术-放疗组42例:先予以2至3周期新辅助化疗,然后行根治性子宫切除及盆腔淋巴结清扫术加术后辅助放疗.比较两种治疗方式的疗效及不良反应有无差异,并通过Cox回归模型分析影响预后的因素.结果:同步放化疗组和新-术-放疗组5年无进展生存率分别为80.8%、74.6%,总生存分别为85.6%、81.8%,两组间5年无进展生存率及总生存差异均无统计学意义(分别为P=0.43和P=0.62).同步放化疗组随访期间6例患者(12.24%)出现死亡,新-术-放疗组7例(16.67%)患者死亡,两组之间差异无统计学意义(P=0.55).同步放化疗组2例(4.08%)患者出现复发和(或)转移,新-术-放疗组4例(9.52%)出现复发和(或)转移,两组之间差异无统计学意义(P=0.42).Ⅲ-Ⅳ级近期毒副反应同步放化疗组出现3例(6.12%),新-术-放疗组出现2例(4.76%),两组之间差异无统计学意义(P=1);远期毒副反应中,无Ⅲ级及以上的慢性放射性反应发生,同步放化疗组4例(8.16%)患者出现放射性肠炎,新-术-放疗组同样4例(9.52%)患者出现放射性肠炎,另外2例(4.76%)患者出现下肢水肿,两组之间差异无统计学意义(P=0.50).Cox回归比例风险模型分析肿瘤直径大于4 cm是无进展生存期和总生存期的预后不良因素(P均<0.05).结论:同步放化疗与新辅助化疗联合根治性手术加术后辅助放疗治疗FIGO Ⅱb期宫颈癌的复发转移率、无进展生存期及总生存期无统计学意义(P>0.05).同步放化疗与新辅助化疗联合根治性手术加术后辅助放疗治疗FIGO Ⅱb期宫颈癌的近期及远期毒性反应无统计学意义(P>0.05).     

Randomized Phase II Trial Comparing Chemoradiotherapy with Chemotherapy for Completely Resected Unsuspected N2-Positive Non–Small Cell Lung Cancer

IntroductionWe investigated whether concurrent chemoradiotherapy (CCRT) would increase survival in patients with completely resected unsuspected N2-positive NSCLC versus in patients who received adjuvant chemotherapy alone.MethodsEligible patients were randomly assigned (1:1) to either the CCRT arm or the chemotherapy arm. In the CCRT arm, patients received concurrent thoracic radiotherapy (50 Gy in 25 fractions) with five cycles of weekly paclitaxel (50 mg/m²) and cisplatin (25 mg/m²), followed by two additional cycles of paclitaxel (175 mg/m²) plus cisplatin (80 mg/m²) at 3-week intervals. In the chemotherapy arm, patients received four cycles of adjuvant paclitaxel (175 mg/m²) and carboplatin (area under the curve = 5.5) every 3 weeks. The primary end point was disease-free survival.ResultsWe enrolled and analyzed 101 patients (51 received CCRT and 50 received chemotherapy). In all, 74 and 27 patients were preoperatively staged as N0 and N1 diseases, respectively. The baseline characteristics were well balanced between the two arms. The median disease-free survival of the CCRT arm was 24.7 months, which was not significantly different from that of the chemotherapy arm (21.9 months) (hazard ratio = 0.94, 95% confident interval: 0.58–1.52, p = 0.40). There was no difference in overall survival (74.3 months in CCRT arm and 83.5 months in the chemotherapy arm) (hazard ratio = 1.33, 95% confident interval: 0.71–2.49).ConclusionsThere was no survival benefit from adjuvant CCRT compared with from platinum-based chemotherapy alone for completely resected unsuspected N2-positive NSCLC. However, the role of sequential radiotherapy administered after adjuvant chemotherapy is being evaluated, and further study is needed to evaluate the optimal radiotherapy approach for completely resected N2-positive NSCLC.     

Toxicity profile and clinical outcomes in locally advanced head and neck cancer patients treated with induction chemotherapy prior to concurrent chemoradiation

The use of induction chemotherapy prior to chemoradiation for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) remains controversial. We explored whether toxicity from induction chemotherapy influenced the delivery of concurrent chemoradiation. Among 171 consecutive previously unirradiated patients with HNSCC treated with combined chemotherapy and radiation, we identified 66 patients with stage III-IVB head and neck carcinoma who were treated with induction chemotherapy prior to planned chemoradiation. The most common induction regimen was docetaxel, cisplatin and 5-FU (TPF; 80%) for 2 to 3 cycles. Mean radiation dose was 72 Gy (range, 36-75 Gy). Concurrent chemotherapy regimens included cisplatin (26%), cetuximab (5%) and 5-fluorouracil/hydroxyurea (65%)-based regimens. At a median follow-up of 27 months (range, 9-56 months), the 2-year locoregional control and distant control rates were 85 and 86%, respectively. The 2-year disease-free survival and overall survival rates were 74 and 80%, respectively. Although there were no grade 5 toxicities during induction chemotherapy, 26% of patients required hospitalization for adverse events, including 5% needing intensive care. The most common high grade adverse events were grade 4 neutropenia (21%) and neutropenic fever (17%). Six percent of patients were unable to tolerate concurrent chemotherapy. The 2-year disease-free survival was significantly higher in patients able to complete induction and concurrent chemoradiation as planned (83 vs. 27%, p<0.001). Induction chemotherapy followed by concurrent chemoradiation results in promising survival rates in our cohort of advanced head and neck carcinoma patients. Due to severe toxicities in a subset of patients, this strategy is only recommended in selected high-risk patients who are carefully followed by an experienced multidisciplinary team.     

化疗依从性对局邵晚期鼻咽癌患者疗效影响的研究

目的 评价化疗依从性对诱导+同期放化疗与诱导化放疗治疗局部晚期(Ⅲ、Ⅳ_a期)鼻咽癌疗效的影响.方法 对400例患者经意向性治疗(ITT)分析后选择依从性较好的314例进行符合方案集(PP)分析.将314例患者分为诱导+同期放化疗组(127例)和诱导化放疗组(187例),其中诱导加同期放化组为完成全部两程诱导化疗和至少两程同期化疗,诱导化放组为完成全部两程诱导化疗.放疗采用传统二维放疗技术,全组均采用~(60)Co γ线或直线加速器6～8 MV X射线照射,颈后三角区域应用8～12 MeV电子线治疗.诱导化疗采用氟尿嘧啶脱氧核苷+卡铂联合,同期化疗采用单药卡铂.结果 随访率为96.2%,随访满3年者295例.诱导+同期放化疗组的3+4级毒副反应发生率比诱导化放疗组要高(23.6%:13.4%;χ~2=5.50,P=0.019)且后者无4级反应.两组3年总生存率(78.1%:84.6%)、无瘤生存率(74.3%:70.1%)、无局部区域复发生存率(89.7%:89.5%)和无远处转移生存率(78.9%:76.5%)均相似(χ~2=0.61、0.12、0.10、0.05,P=0.435、0.731、0.748、0.825).结论 对局部晚期鼻咽癌患者,诱导+同期放化疗与诱导化放疗方案的3年生存率相似但严重毒副反应发生率高.     

Adjuvant concurrent chemoradiotherapy with intensity-modulated pelvic radiotherapy after surgery for high-risk, early stage cervical cancer patients

PURPOSE: This study was undertaken to assess local control and toxicity with adjuvant intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy (CCRT) for early stage cervical cancer. PATIENTS AND METHODS: Between June 2004 and February 2007, 54 patients with early stage cervical cancer (stage IB-IIA) with high-risk factors for treatment failure after surgery were treated with adjuvant pelvic IMRT and CCRT. Adjuvant chemotherapy consisted of cisplatin (50 mg/m2) weekly for 4 to 6 courses. All the patients received 50.4 Gy of external beam radiotherapy with IMRT in 28 fractions and 6 Gy of high-dose rate vaginal cuff brachytherapy in 3 insertions. RESULTS: Adjuvant CCRT with IMRT provided good local tumor control in posthysterectomy cervical cancer patients with high-risk pathologic features. The 3-year locoregional control and disease-free survival were 93% and 78%, respectively. Histology and lymph node metastasis were indicators for disease-free survival. Low acute and chronic treatment-related toxicities were noted with IMRT. All the patients completed the radiotherapy treatment without any major toxicity. In terms of chronic toxicity, only 1 patient had grade 3 genitourinary toxicity and none had grade 3 gastrointestinal toxicity. CONCLUSION: Our results indicate that adjuvant CCRT with IMRT technique for adjuvant treatment of early stage cervical cancer is associated with excellent local control and low toxicity.     

The addition of induction chemotherapy to preoperative, concurrent chemoradiotherapy improves tumor response in patients with esophageal adenocarcinoma

BACKGROUND: Tumor viability assessed by pathologic analysis of resected specimens in patients with preoperatively treated esophageal adenocarcinoma (EAC) is a prognostic indicator. The feasibility of induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) and surgery for patients with locoregionally advanced EAC has been demonstrated. In this study, the authors evaluated the efficacy of CCRT compared with traditional concurrent chemoradiotherapy (CRT). METHODS: The authors retrospectively reviewed 247 consecutive patients with EAC who presented for planned surgery after treatment with either CCRT or CRT from January 1997 through August 2003. Patient demographics, comorbidities, and tumor characteristics were analyzed. Pathologic tumor response, overall survival, and disease-free survival were assessed according to treatment. RESULTS: One hundred seventeen patients received CCRT, and 130 patients received CRT before planned surgical resection. CCRT resulted in a 64% tumor response rate compared with a 51% tumor response rate in the CRT group (odds ratio, 1.73; P = .035). In the CCRT group, the median overall survival was 55 months, and the 3-year overall survival rate was 59%; in the CRT group, the median overall survival was 25 months, and the 3-year overall survival rate was 41% (hazard ratio [HR], 0.69; P = .041). In the CCRT group, the median disease-free survival was 43 months, and the 3-year disease-free survival rate was 54%; in the CRT group, the median disease-free survival was 18 months, and the 3-year disease-free survival rate was 36% (HR, 0.72; P = .047). Subset analysis of patients with clinical Stage III/IVA disease showed a median overall survival of 51 months with a 3-year overall survival rate of 58% in the CCRT group and a median overall survival of 20 months with a 3-year overall survival rate of 28% in the CRT group (HR, 0.57; P = .019). CONCLUSIONS: In patients with EAC, CCRT improved tumor response significantly compared with traditional CRT alone. Overall survival and disease-free survival were increased in patients who received CCRT, especially in the subset of patients who had more advanced disease.     

Outcome and patterns of recurrence of nonbilharzial pure squamous cell carcinoma of the bladder: a contemporary review of The University of Texas M D Anderson Cancer Center experience

BACKGROUND: Nonbilharzial squamous cell carcinoma (SCC) of the bladder is a rare entity in the Western hemisphere. To further understanding of its natural history, a contemporary experience with management and outcome of this disease was reviewed. METHODS: Between 1988 and 2003, 27 patients with pure SCC were treated at the center. Charts were reviewed to assess impact of therapy on survival and patterns of recurrence in those that died of disease. RESULTS: The 2-year overall survival and recurrence-free survival (RFS) rates were 47.6% and 32.8%, respectively, with a median follow-up of 15.3 months in survivors. Eight patients received initial chemotherapy and/or radiation therapy with the intent of performing surgical consolidation. In 5 of these patients surgical consolidation was not performed due to rapid progression of disease and death. Of the 3 patients who were treated with neoadjuvant therapy (1 with chemotherapy, 1 with radiation, and 1 with chemoradiation) and had surgical consolidation, 2 (67%) were downstaged at cystectomy and remain disease-free. In 10 of 20 patients who underwent radical cystectomy the disease recurred after a median duration of 5.1 months and 7 died: 3 of local recurrence, 1 of distant recurrence, and 3 of both. History of superficial transitional cell carcinoma that differentiated into pure SCC (P = .035; hazards ratio [HR] of 3.73) and treatment by radical cystectomy (P = .002; HR of 0.19) were associated with RFS. CONCLUSIONS: In select patients with resectable disease, radical cystectomy remains the mainstay of therapy for pure SCC of the bladder. Locoregional recurrence is the primary cause of death in the majority of patients. The role for neoadjuvant therapy is unclear.     

同步放化疗治疗食管癌术后复发的临床效果及预后因素分析

目的:分析同步放化疗治疗食管癌术后复发患者的治疗效果及预后因素。方法:回顾性分析103例食管癌术后复发患者行同步放化疗的治疗结果及预后因素。所有患者行同步放化疗,中位放疗剂量60Gy。治疗后1~3月评价肿瘤的治疗反应。结果:中位随访时间30个月（3~103月）。3年总生存率47.6%,中位存活时间35月。总体反应率70.9%（73/103),完全缓解率41.7%（43/103)。单因素分析显示同步放化疗后肿瘤的反应（P=0.000)、至复发的时间(P=0.028)及ECOG评分(P=0.090),有益于总生存率,多因素分析显示同步放化疗后肿瘤的反应(P=0.000)及ECOG评分(P=0.010)为总生存率的独立预后因素。同步放化疗后,共70例患者出现肿瘤进展,39例局部复发,22例远处转移,9例远处转移伴局部复发。结论:同步放化疗是治疗食管癌术后复发的有效手段,治疗后取得完全缓解的患者预后较好。     

Definitive radiotherapy in the management of isolated vaginal recurrences of endometrial cancer

PURPOSE: The aim of our study was to assess prognostic factors and overall survival after salvage radiotherapy for patients who had endometrial carcinoma and who experienced an isolated vaginal recurrence. METHODS AND MATERIALS: We reviewed the records of 50 patients treated at our institution between 1967 and 2003 for an isolated vaginal recurrence of endometrial carcinoma. Initial treatment for endometrial carcinoma was definitive surgery in 49 patients and definitive radiotherapy in 1 patient. The median time from initial diagnosis of endometrial carcinoma to recurrence was 25 months (range, 4-179 months). Three patients (6%) received external-beam radiotherapy alone, 8 patients (16%) received brachytherapy only, and 39 patients (78%) received combined external-beam radiation therapy and brachytherapy. Median dose of radiation to the recurrence was 60 Gy (range, 16-85 Gy). Overall survival was calculated by the Kaplan-Meier method. Endpoints were measured from the date of diagnosis of the vaginal recurrence. Median follow-up of survivors after recurrence was 53 months (range, 8-159 months). RESULTS: The 5-year and 10-year disease-free and overall survivals were 68% and 55%, and 53% and 40%, respectively. On multivariate analysis, age (p = 0.0242), Grade 1 or 2 vs. Grade 3 tumor (p = 0.002), and size of recurrence (p < 0.001) were significant predictors of overall survival. All patients who had Grade 3 disease were dead by 3.6 years from the time of recurrence. Five patients experienced a Grade 3 or 4 complication. CONCLUSIONS: Patients treated with radiotherapy for an isolated vaginal recurrence can be cured in over 50% the cases. Radiotherapy is well tolerated, with a low risk of complications. Factors predictive of overall survival include tumor grade, patient age at recurrence, and tumor size.     

同步放化疗治疗晚期鼻咽癌Ⅲ期临床研究的初步疗效分析

[目的]评价同步放化疗治疗局部晚期鼻咽癌的疗效。[方法]2002年6月～2006年6月153例局部晚期鼻咽癌患者随机分成同步放化疗组（同步组,n=82）和单纯放疗组（单放组,n=71）。同步组化疗方案为泰素25mg/m^2,或顺铂30mg/m^2,共6～8周。两组放疗方案相同,放疗技术采用常规或IMRT,原发肿瘤和阳性淋巴结总剂量为70～76Gy。[结果]治疗结束时,同步组的淋巴结CR率稍高于单放组（52.0%vs.48.5%,P=0.058）。2年总生存率、无瘤生存率、无局部复发存率和无远处转移率同步组为93.5%、83.3%、96.3%和86.7%,单放组为87.3%、76.2%、95.3%和80.4%,差异均无显著性。在Ⅲ期患者中,同步组2年无远处转移生存率为96.9%,显著高于单放组的78.9%（P=0.034）。[结论]同步放化疗降低了Ⅲ期鼻咽癌患者远处转移率,提高无瘤生存率,远期结果等待进一步随访。     

Transurethral Resection of Bladder Tumor (TUR-BT) then Concomitant Radiation and Cisplatin Followed by Adjuvant Gemcitabine and Cisplatin in Muscle Invasive Transitional Cell Carcinoma (TCC) of the Urinary Bladder

Purpose: To evaluate the efficacy, safety, and tolerance of bladder preservation trimodality protocol combining maximal transurethral resection of bladder tumor (TURBT) with concomitant chemoradiation (CCRT) followed by adjuvant chemotherapy in patients with muscle invasive transitional cell carcinoma (TCC) of the bladder. Patients and Methods: Between January 2004 and May 2006, 40 patients with invasive TCC (T2-T4a) presented to the Radiation Oncology and Urosurgery departments - Ain Shams University hospitals and were enrolled in this prospective phase II study. Patients were treated using concurrent cisplatin and 45Gy radiotherapy (induction phase) after maximal TUR-BT. Patients were reevaluated 2 weeks after induction CCRT, by cystoscopy, repeated biopsy and urine cytology. Those with complete pathologic response (CR) received consolidation CCRT to 64.8Gy. Patients with less than CR were advised to undergo radical cystectomy (RC). Four cycles of adjuvant gemcitabine 1250mg/m2 on days 1 and 8 and cisplatin 70mg/m2 on day 1, repeated every 3 weeks, were given following definitive therapy. Results: Twenty-four patients achieved CR after initial 45Gy CCRT, 22 of them received additional consolidation CCRT. Eight of 14 patients who did not achieve CR after induction CCRT underwent RC. A total of 30 patients (75%) received adjuvant chemotherapy. Twenty percent (20%) and 13.7% of patients experienced at least one severe (grade 3) toxicity during induction and consolidation phase of CCRT, respectively, mainly neutropenia, cystitis, proctatitis and nausea and vomiting, while 46% experienced at least one severe (grade 3 or 4) toxicity during adjuvant chemotherapy, mainly neutropenia (32%), thrombocytopenia (11%) and nausea and vomiting (29%). Local and/or regional failure was recorded in 40% of patients and distant metastasis was reported in 25%. Eighteen patients (45%) retained functioning and healthy urinary bladder at the end of follow-up. The 2-year actuarial survival and progression free survival (PFS) were 67% (95% CI 52.2%-82.7%) and 58% (95% CI 42.3%-74.0%), respectively. There was significantly better 2 year survival for patients having complete TUR-BT before CCRT. Conclusion: Trimodality approach is a reasonable and safe alternative to RC with manageable toxicities. Longer follow-up with a larger number of patients is necessary to assess its impact on overall and disease-free survival. Key Words: Bladder cancer , Chemoradiotherapy , Cisplatin , Gemcitabine.