Pretreatment quality of life of inoperable non-small cell lung cancer patients referred for primary radiotherapy

This study examined the association between the most important prognostic factors in non-small cell lung carcinoma (NSCLC) and self-reported pretreatment quality of life (QoL) and the impact of the presence, severity and changes in respiratory symptoms on general symptoms and QoL. The study included 262 patients. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC QLQ-LC13 were used to assess symptoms and QoL before radiotherapy. Patients with inoperable NSCLC showed major differences in self-reported QoL as a function of clinical prognostic factors. A significant association was found between World Health Organization (WHO) performance status and QoL but not other prognostic factors. Dyspnoea was the only respiratory symptom associated significantly with general symptoms, physical and psychosocial functioning and QoL. Furthermore, changes in dyspnoea were associated significantly with changes in physical and role functioning, global QoL and fatigue as assessed 6 weeks after radiotherapy. These results indicate that palliation of dyspnoea may have a significant beneficial effect on QoL and that palliation of other respiratory symptoms is not necessarily associated with improvement of general symptoms, physical and psychological functioning or global QoL.     

Survival and quality of life after hypofractionated stereotactic radiotherapy for recurrent malignant glioma

Purpose To prospectively evaluate efficacy, side effects and quality of life in patients with recurrent malignant glioma after hypofractionated stereotactic radiotherapy. Methods and materials From 1/2003 to 8/2005, 15 patients with recurrent malignant glioma were prospectively scheduled for hfSRT with 5 × 7 Gy (90%-isodose). Median gross tumor volume and planning target volume were 5.75 (range, 0.77–21.94) and 22.4 (range, 4.22–86.79) cc, respectively. Irradiation was performed with the dedicated stereotactic radiosurgery system Novalis™ (BrainLAB, Heimstetten, Germany). Results Rates of remission, no change and progressive disease were 27%, 33%, and 40%, respectively, after a median follow-up of 9 months. Progression-free survival rates at 6 and 12 months were 75% and 53% respectively. Quality of life, measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire scores could be kept stable in two thirds of the patients for a median time of 9 months, respectively. Conclusion: Hypofractionated stereotactic radiotherapy with 5 × 7 Gy of recurrent high grade glioma is an effective treatment that helps to maintain quality of life for an acceptable period, comparable to the results obtained with current chemotherapy schedules. Combined approaches of radiotherapy, chemotherapy and other targeted therapies deserve further inverstigation.     

Clinical study of TS-1 therapy for inoperable and recurrent gastric cancer

The clinical efficacy and safety of TS-1 therapy were studied retrospectively in patients with inoperable and recurrent gastric cancer. The subjects were 45 patients who were treated with TS-1 for more than 4 weeks at our center between May 1999 and July 2002. The objective overall response rate was 32% (14/44; 95% confidence interval, CI, 19-48). The response rate in the chemo-naive patients was 44% (11/25; 95% CI, 24-65), and that in the patients with previous chemotherapy was 16% (3/19; 95% CI, 3.4-40). Although doses or durations of TS-1 administration were reduced in 22 patients (reduction group) due to adverse effects or poor performance status, they achieved a fairly high response rate of 38% (8/21). For primary lesions, the response rate was 30% (8/27). The prevalence of adverse reactions with a grade of 3 or 4 was 36%. However, the prevalence of each grade 3 or 4 adverse effect was relatively low, at 13% for neutropenia, and around 5% for anorexia, nausea, vomiting, and diarrhea. The median administration period was 10 weeks (4-47 weeks) in all patients and 11 weeks (6-47 weeks) in the reduction group. The relative dose intensity was 0.89 in all patients and 0.81 in the reduction group. In patients who were treated until August 2001, the median survival time (MST) was 13 months with 1-year and 2-year survival rates of 53% and 14%, respectively. These results were similar to those reported in the phase II study for the new drug approval. This study demonstrated the reproducible activity and safety of TS-1 in practice.     

Improvement, clinical course, and quality of life after palliative radiotherapy for recurrent glioblastoma

The purpose of this review is to assess the palliative effect of re-irradiation in adult patients with recurrent supratentorial glioblastoma (GBM) previously treated with adjuvant or primary radiation therapy, with or without chemotherapy. From a comprehensive literature search, studies were identified reporting on survival, progression, and quality of life endpoints including, but not limited to, EORTC QLQ-C30 questionnaire, clinical symptoms, and ability to reduce dexamethasone. Data from more than 300 GBM patients (grade 3 anaplastic gliomas were excluded) demonstrate that re-irradiation yields 6-month PFS of 28% to 39% and 1-year overall survival of 18% to 48%, without additional chemotherapy (median value 26%). Patients with Karnofsky performance status <70 appeared to be at higher risk of early progression and apparently had lesser benefit from re-irradiation. Clinical improvement was observed in 24% to 45% of the patients. Most studies suggest that stabilization of the performance status is a realistic aim. In the studies reporting on corticosteroid usage during and after re-irradiation, 20% to 60% of the patients achieved a reduction in steroid dependency. Serious late toxicity was uncommon, especially after conventional treatment and fractionated stereotactic radiotherapy (FSRT). In light of recent technological advances such as FSRT and intensity modulated radiotherapy, which permit maximal sparing of normal brain, re-treatment seems attractive, and deserves scientific validation. Even fraction sizes of 3 to 5 Gy seem to be well tolerated in limited-volume recurrences as long as the total dose is limited to 30 to 35 Gy. Salvage chemotherapy or targeted agents should be prospectively tested against re-irradiation alone.     

Phase II study of epirubicin in inoperable or recurrent gastric cancer

A phase II clinical trial of epirubicin, a new anthracycline anticancer antibiotic, was carried out in 41 patients with inoperable or recurrent gastric cancer. Epirubicin was administered by i.v. injection; the dosages were either 40-60 mg/m2 every three weeks (Regimen A) or 20-30 mg/m2/day for 3 days every three weeks (Regimen B). Twenty-one patients were entered into Regimen A, and 20 into Regimen B. Of 31 evaluable patients, 16% (5/31) experienced objective response (PR); i.e., 20% (three of 15) treated with Regimen A and 13% (two of 16) with Regimen B, showing that there was no significant difference in the rate of response between the two regimens. Adverse effects observed were relatively mild in most cases and included anemia, leukopenia, thrombocytopenia, anorexia, nausea/vomiting, diarrhea, stomatitis and alopecia. Tachycardia and extrasystole were observed in 3 cases but disappeared upon discontinuation of the treatment. In conclusion, epirubicin seemed to have therapeutic activity comparable to that of doxorubicin in gastric cancer while being less toxic than doxorubicin, and is expected to become a better alternative to the latter drug.     

Pulmonary function and quality of life after VMAT-based stereotactic ablative radiotherapy for early stage inoperable NSCLC: a prospective study

ObjectivesTo analyze changes in pulmonary function and quality of life (QoL) at different time points after Stereotactic Ablative Radiotherapy (SABR) for early stage inoperable lung cancer, and potential correlations between radiation dose-volume parameters and pulmonary toxicity or changes in pulmonary function tests (PFT) and QoL.Materials and methodsFrom July 2012 to October 2013, 30 patients were enrolled in this prospective observational study. Complete PFT were performed and Lung Cancer Symptoms Scale (LCSS) questionnaire administered prior to SABR; all patients then underwent Computed Tomography (CT) scan and PFT at 45, 135, 225 and 315 days after SABR, together with LCSS questionnaire. Clinical lung toxicity and radiological toxicity (acute and late) were prospectively recorded by using the Radiation Therapy Oncology Group (RTOG) scoring system.ResultsA decline in Slow Vital Capacity (SVC), Forced Expiratory Volume in 1 s (FEV₁), Single-breath lung diffusing capacity (D_LCO) and blood partial pressure of oxygen (PaO₂) was seen at 135 days post-SABR. PaO2 values rescued to normal levels at 315 days. None of the baseline PFT parameters resulted to be associated with the occurrence of pulmonary toxicity or with late radiological changes. Mean V5, V10, and V20 and MLD_2Gy were higher in patients who developed radiation pneumonitis, even if not significantly associated at Cox regression analysis. LCSS QoL showed a significant worsening of the single item fatigue at 135 days after SABR.ConclusionsA small (mean 10%) but significant decline in lung volumes and D_LCO was recorded after SABR, with clinical impact of such change difficult to estimate in individual patients. Global QoL was not significantly impaired. Dose-volume parameters did not emerge as significantly predictive of any clinical, radiological or functional toxicity.     

Comparisons of remnant primary,residual, and recurrent gastric cancer and applicability of the 8th AJCC TNM classification for remnant gastric cancer staging

BackgroundBecause there is no well-established postoperative staging system for patients with remnant gastric cancer (RGC), we compared the overall survival of patients categorized with the 8th AJCC TNM staging system.MethodA total of 391 patients underwent surgery for RGC at our institution between 1996 and 2019. Among them, 201 patients received their first surgery at our institution and 190 received primary surgery elsewhere. We retrospectively reviewed their medical records and classified each according to Kaminishi’s classification and the 8th AJCC TNM staging system for comparison and analysis.ResultsAll 201 patients who underwent their first operation at our institution for malignancy were classified as primary (n = 41, 20.4%), residual (n = 103, 51.2%), and recurrent (n = 57, 28.4%) RGC. The 5-year overall survival (OS) rates for the primary, residual, and recurrent RGC groups were 78.1%, 73.8% and 56.0%, respectively (p = 0.004). In a multivariate analysis, RGC classification was an independent prognostic factor along with the TNM staging system (p = 0.001). However, there was no significant difference in OS between the three groups of the same TNM stage. In addition, the OS of each stage related to primary cancer was not significantly different from the OS of RGC patients classified in TNM staging.ConclusionThe RGC classification system we used may reflect the comprehensive aspects of previous disease states and predict the prognosis of patients with gastric cancer. In addition, the 8th AJCC TNM classification is a practical and applicable staging system for RGC.     

Combined radiotherapy for inoperable esophageal cancer

Among 112 patients with inoperable esophageal cancer treated with high-dose intraluminal brachytherapy and distant irradiation, objective response was in 84.8%. Predominantly local complications were reported in 78.6%. Recurrences were detected in 63.5% during follow-up, with mean relapse-free period being 107 days. Mean survival time was 15.3 months (1-, 2- and 3-year survival--58.8; 22.3 and 12.9%, respectively) which was comparable to similar results of palliative esophagectomy for gastric cancer.     

A case of inoperable gastric small cell carcinoma effectively treated by chemotherapy and radiotherapy

We herein report a case of advanced gastric small cell carcinoma treated by chemotherapy and radiotherapy. A 69-year-old man was admitted to our hospital presenting with appetite loss and body weight loss. He was diagnosed to have an inoperable gastric small cell carcinoma with severe lymph node metastases and left adrenal gland metastasis. Chemotherapy with TS-1/paclitaxel, cisplatin/irinotecan and cisplatin/etoposide was sequentially performed. Primary and metastatic foci had obviously diminished. Eighteen months after the initial therapy, he had dysarthrosis and multiple brain metastases were found. Metastatic foci were decreased and his symptom was improved by successful radiotherapy. We conclude that chemotherapy and radiotherapy are effective for primary and metastatic lesions of gastric small cell carcinoma.     

宫颈癌放疗后生活及性生活质量分析

目的 调查宫颈癌放疗患者生活质量、性生活质量及其影响因素。方法 本研究纳入2013-2018年间北京协和医院放疗科诊治的87例疗前未绝经宫颈癌患者,采用宫颈癌生活质量评估量表及女性性功能指标量表进行评估。收集患者人口学及治疗资料,采用多元线性回归分析其影响因素。结果 生活质量总分平均值为114(100~126),其中生理状况19(16~21)、社会家庭状况21(18~24)、情感状况19(17~21),功能状况19(14~22),附加关注状况39(34~43);放疗结束时间是影响总分(P=0.034)、生理状况(P=0)、功能状况(P=0.008)的因素,社会家庭状况是影响社会家庭维度的因素(P=0.010)。性生活总分平均值为8.0(5.0~20.5分),其中性欲望1.8(1.2~3.0)、性唤醒1.5(0~2.7)、阴道润滑0.3(0~3.6)、性高潮0(0~3.6)、满意度3.2(2.0~4.0)、性交痛0(0~3.6)。97%受调查者总分<27分(84/87),存在性功能障碍。年龄是影响性唤醒(P=0.005)、阴道润滑(P=0.039)的因素,职业是影响性交痛(P=0.004)的因素。结论 未绝经宫颈癌患者的生活质量受多因素影响,应积极处理放疗相关并发症以提高患者生活及性生活质量。     

Effect of combined treatment with salvage radiotherapy plus androgen suppression on quality of life in patients with recurrent prostate cancer after radical prostatectomy

PURPOSE: To examine the effect of salvage radiotherapy (RT) plus 2-year androgen suppression (AS) on quality of life (QOL). METHODS AND MATERIALS: A total of 74 patients with biopsy-proven local recurrence or PSA relapse after radical prostatectomy were treated with salvage RT plus 2-year AS, as per a phase II study. Quality of life was prospectively assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30-Item Version 3.0 with the added prostate cancer-specific module at baseline and predefined follow-up visits. RESULTS: Patients experienced a significant increase in bowel dysfunction (23%) by the end of RT (p < 0.0001). This bowel dysfunction improved after RT but remained slightly elevated (5-10%) throughout the 2-year AS period. This extent of residual bowel dysfunction would be considered of minimal clinical importance. A similar, but less pronounced, pattern of change did occur for urinary dysfunction. Erectile function showed no change during RT, but had an abrupt decline (10%) with initiation of AS that was of moderate clinical significance (p < 0.01). None of the other QOL domains demonstrated a persistent, significant change from baseline that would be considered of major clinical significance. CONCLUSION: The combined treatment with salvage RT plus 2-year AS had relatively minor long-term effects on QOL.     

Controversial issues in chemotherapy for inoperable gastric cancer

Randomized trials demonstrated the significantly improved survival benefit of 5-fluorouracil (5-FU) based chemotherapy in patients with unresectable advanced gastric cancer (AGC) in comparison with best supportive care (BSC). However there is no chemotherapy considered worldwide to be the standard treatment for AGC and there is no consensus as to whether combination or single agent therapy is preferable. Therefore, 2 large Phase III studies JCOG 9912 5-FU vs TS-1 vs CPT + CDDP and TS-1 vs TS-1 + CDDP are now ongoing to establish an acceptable frontline standard for patients with AGC. We need to develop new agents and combination chemotherapy regimens to achieve greater survival benefit in AGC.     

The prognostic impact of quality of life assessed with the EORTC QLQ-C30 in inoperable non-small cell lung carcinoma treated with radiotherapy.

PURPOSE: The purpose of this study was to assess the prognostic significance of pretreatment quality of life (QoL) scores and symptom scores in a group of patients treated with high dose radiotherapy. MATERIAL AND METHODS: A total of 198 patients treated with external irradiation (>/=60 Gy) were included. In all these patients, baseline QoL was assessed using the EORTC QLQ-C30. The prognostic significance of a number of non-QoL and QoL parameters with regard to survival was estimated in both univariate and multivariate analyses. RESULTS: In a multivariate model including the non-QoL parameters, performance status, weight loss and N-classification were independent prognostic factors for survival. After entering the QoL parameters in the model, global QoL was the strongest prognostic factor, while performance status lost its significance. Subsequently, a significant interaction term was found between N-classification and global QoL, indicating that global QoL was an independent prognostic factor but that the effect varied as a function of N-status. In N+ patients, the median survival in the group with low scores for global QoL was 4.5 months, which was significantly worse (P<0.0001) compared with the high score group in which the median survival was 12.9 months. CONCLUSION: Global QoL is a strong prognostic factor for survival in patients with NSCLC who have pathological lymph nodes at presentation and who are treated with radical or curative radiotherapy.     

甲羟孕酮对胃癌患者化疗期间生活质量的影响

目的观察甲羟孕酮（medroxyprogesterone,MPA）在肿瘤化疗期间及化疗后,对食欲、进食情况、体重变化以及全身情况的辅助作用。方法71例晚期胃癌患者随机分为两组,分别接受单纯化疗或化疗联合甲羟孕酮治疗,观察治疗期间及化疗后,食欲、食量、体重变化以及全身情况变化。结果治疗后MPA＋化疗组63.9%（23/36例）食量增加,55.5%（20/36例）体重增加,KPS评分增加〉10分占69.4%（25/36例）。单纯化疗组14.3%（5/35例）食量增加,8.5%（3/35例）体重增加,KPS评分增加〉10分占17.1%（6/35例）,差异有统计学意义（P〈0.001）。结论胃癌患者化疗时辅以甲羟孕酮可使消化道反应明显减轻,提高食欲,改善患者生活质量。     

不能切除和复发的局部进展期胃癌放疗疗效分析

目的 回顾分析不能切除和复发的局部进展期胃癌行腹部放疗的疗效及影响因素。方法 回顾分析2009—2015年我院收治的57例患者,其中不能切除36例(包括局部晚期19例、术后肉眼残留17例),术后复发21例。接受3DCRT 17例、IMRT 40例,照射中位剂量50 Gy (42~60 Gy)。81%患者放疗同期口服氟尿嘧啶类药物化疗。结果 全组患者放疗后中位随访时间为16个月(3.9~77.5个月),放疗后缓解率65%。局部晚期、术后肉眼残留(R₂术后) 、术后复发组放疗后中位生存时间分别为13.9、13.9、19.0个月。全组放疗后2年的预期OS、PFS、LRRFS分别为50%、37%、50%。多因素分析显示病变分组是预后影响因素,而第3站淋巴结受侵并不是不良预后因素。结论 对不能切除及术后复发的局部进展期胃癌进行中等剂量放疗并结合化疗能取得较好的LC并改善患者生存,而术后复发和第3站淋巴结受侵病例均应被视为挽救性放化疗的良好适应征。     

Results of radiotherapy for inoperable locally advanced esophageal cancer

Three hundred and eleven patients with locally advanced esophageal cancer were treated by radiation therapy from 1968 to 1983 at Tokyo Women's Medical College. Of these, 288 patients with previously untreated, histologically confirmed squamous cell carcinoma but previously treated with curative intent, were eligible for analysis. The cumulative 5-year survival rate of 288 patients given radical radiotherapy was 9.0%. Sex, tumor length, and Stage (AJC) had a great influence on prognosis. The five-year survival rate in males was 5.4% and in females was 22.4%. The five-year survival rate in cases with a tumor length of 5 cm or less was 17.7% in 5-10 cm was 10.0%, and in 10 cm or above was 2.8% and they were 20.2% for Stage I, 9.9% for Stage II, and 2.6% for Stage III. There were no significant differences of survival rate among age, tumor site, and tumor type on X ray film. This data suggests that comparatively early, small-volume tumors share a significant potential for cure by radiotherapy, but potent combined therapy is necessary for the treatment of advanced cancers.     

Qigong improves quality of life in women undergoing radiotherapy for breast cancer

BACKGROUND:

Radiotherapy may lead to side effects that undermine patients' quality of life (QOL). Although mind‐body practices like qigong appear to improve QOL in cancer survivors, little is known about their benefits for patients who are receiving radiotherapy. Thus, in the current randomized controlled trial, the authors examined the efficacy of a qigong intervention on QOL in women with breast cancer during and after treatment.

METHODS:

Ninety‐six women with breast cancer were recruited from a cancer center in Shanghai, China, and were randomized to a qigong group (N = 49) or a waitlist control group (N = 47). Women in the qigong group attended 5 weekly classes over 5 or 6 weeks of radiotherapy. QOL outcomes (ie, depressive symptoms, fatigue, sleep disturbance, and overall QOL) and cortisol slopes were assessed at baseline, during treatment, at the end of treatment, 1 month later, and 3 months later.

RESULTS:

The mean age of the women was 46 years (range, 25‐64 years). Seven percent of women had stage 0 disease, 25% had stage I disease, 40% had stage II disease, and 28% had stage III disease. Fifty‐four percent of women underwent mastectomy. Multilevel analyses revealed that women in the qigong group reported less depressive symptoms over time than women in the control group (P = .05). Women who had elevated depressive symptoms at the start of radiotherapy reported less fatigue (P < .01) and better overall QOL (P < .05) in the qigong group compared with the control group, and these findings were clinically significant. No significant differences were observed for sleep disturbance or cortisol slopes.

CONCLUSIONS:

The current results indicated that qigong may have therapeutic effects in the management of QOL among women who are receiving radiotherapy for breast cancer. Benefits were particularly evident for patients who had preintervention elevated levels of depressive symptoms. Cancer 2013. © 2013 American Cancer Society.