Treatment outcomes of patients with FIGO Stage I/II uterine cervical cancer treated with definitive radiotherapy: a multi-institutional retrospective research study

The purpose of this study was to analyze the patterns of care and outcomes of patients with FIGO Stage I/II cervical cancer who underwent definitive radiotherapy (RT) at multiple Japanese institutions. The Japanese Radiation Oncology Study Group (JROSG) performed a questionnaire-based survey of their cervical cancer patients who were treated with definitive RT between January 2000 and December 2005. A total of 667 patients were entered in this study. Although half of the patients were considered suitable for definitive RT based on the clinical features of the tumor, about one-third of the patients were prescribed RT instead of surgery because of poor medical status. The RT schedule most frequently utilized was whole-pelvic field irradiation (WP) of 30 Gy/15 fractions followed by WP with midline block of 20 Gy/10 fractions, and high-dose-rate intracavitary brachytherapy (HDR-ICBT) of 24 Gy/4 fractions prescribed at point A. Chemotherapy was administered to 306 patients (46%). The most frequent regimen contained cisplatin (CDDP). The median follow-up time for all patients was 65 months (range, 2–135 months). The 5-year overall survival (OS), pelvic control (PC) and disease-free survival (DFS) rates for all patients were 78%, 90% and 69%, respectively. Tumor diameter and nodal status were significant prognostic indicators for OS, PC and DFS. Chemotherapy has potential for improving the OS and DFS of patients with bulky tumors, but not for non-bulky tumors. This study found that definitive RT for patients with Stage I/II cervical cancer achieved good survival outcomes.     

Radiation therapy for primary vaginal carcinoma

Brachytherapy plays a significant role in the management of cervical cancer, but the clinical significance of brachytherapy in the management of vaginal cancer remains to be defined. Thus, a single institutional experience in the treatment of primary invasive vaginal carcinoma was reviewed to define the role of brachytherapy. We retrospectively reviewed the charts of 36 patients with primary vaginal carcinoma who received definitive radiotherapy between 1992 and 2010. The treatment modalities included high-dose-rate intracavitary brachytherapy alone (HDR-ICBT; two patients), external beam radiation therapy alone (EBRT; 14 patients), a combination of EBRT and HDR-ICBT (10 patients), or high-dose-rate interstitial brachytherapy (HDR-ISBT; 10 patients). The median follow-up was 35.2 months. The 2-year local control rate (LCR), disease-free survival (DFS), and overall survival (OS) were 68.8%, 55.3% and 73.9%, respectively. The 2-year LCR for Stage I, II, III and IV was 100%, 87.5%, 51.5% and 0%, respectively (P = 0.007). In subgroup analysis consisting only of T2–T3 disease, the use of HDR-ISBT showed marginal significance for favorable 5-year LCR (88.9% vs 46.9%, P = 0.064). One patient each developed Grade 2 proctitis, Grade 2 cystitis, and a vaginal ulcer. We conclude that brachytherapy can play a central role in radiation therapy for primary vaginal cancer. Combining EBRT and HDR-ISBT for T2–T3 disease resulted in good local control.     

Long-term results of high-dose-rate brachytherapy and external-beam radiotherapy in the primary treatment of endometrial cancer

In this report we update our long-term follow-up results of the prospective study whose aim was to evaluate the efficacy of high-dose-rate (HDR) brachytherapy in combination with external-beam radiotherapy (EBRT) in the treatment of medically inoperable endometrial cancer. Between 1995 and 1998, 29 patients with stages I-III medically inoperable carcinoma of endometrium were treated with definitive irradiation. All patients underwent combined intracavitary HDR brachytherapy and EBRT. The EBRT dose was 50 Gy with midline shield from 16 Gy. The HDR brachytherapy dose was 50 Gy, delivered in 5 fractions in a weekly schedule. Overall survival (OS) at 5 and 10 years was 48.3% and 20.7%, respectively. Disease-specific survival (DSS) at 5 and 10 years was 73.5% and 67.9%, respectively. The 10-year DSS rate was 73.5% for all stages, 85.7% for Stage I disease, 71.4% for Stage II, and 16.7% for stage III disease. Late Grade 1-2 radiation complications were observed in 4 patients (13.8%). Our long-term follow-up confirms that HDR brachytherapy with EBRT appears to be an effective and safe treatment for stage I and II medically inoperable endometrial cancer.     

Impact of concurrent chemotherapy on definitive radiotherapy for women with FIGO IIIb cervical cancer

The purpose of this retrospective study is to investigate the impact of concurrent chemotherapy on definitive radiotherapy for the International Federation of Gynecology and Obstetrics (FIGO) IIIb cervical cancer. Between 2000 and 2009, 131 women with FIGO IIIb cervical cancer were treated by definitive radiotherapy (i.e. whole pelvic external beam radiotherapy for 40–60 Gy in 20–30 fractions with or without center shielding and concomitant high-dose rate intracavitary brachytherapy with 192-iridium remote after loading system for 6 Gy to point A of the Manchester method). The concurrent chemotherapy regimen was cisplatin (40 mg/m²/week). After a median follow-up period of 44.0 months (range 4.2–114.9 months) and 62.1 months for live patients, the five-year overall survival (OS), loco-regional control (LRC) and distant metastasis-free survival (DMFS) rates were 52.4, 80.1 and 59.9%, respectively. Univariate and multivariate analyses revealed that lack of concurrent chemotherapy was the most significant factor leading to poor prognosis for OS (HR = 2.53; 95% CI 1.44–4.47; P = 0.001) and DMFS (HR = 2.53; 95% CI 1.39–4.61; P = 0.002), but not for LRC (HR = 1.57; 95% CI 0.64–3.88; P = 0.322). The cumulative incidence rates of late rectal complications after definitive radiotherapy were not significantly different with or without concurrent chemotherapy (any grade at five years 23.9 vs 21.7%; P = 0.669). In conclusion, concurrent chemotherapy is valuable in definitive radiotherapy for Japanese women with FIGO IIIb cervical cancer.     

External beam boost irradiation for clinically positive pelvic nodes in patients with uterine cervical cancer

The purpose of this study was to retrospectively analyze the treatment results of boost external beam radiotherapy (EBRT) to clinically positive pelvic nodes in patients with uterine cervical cancer. The study population comprised 174 patients with FIGO stages 1B1–4A cervical cancer who were treated with definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT). Patients with positive para-aortic or common iliac nodes (≥10 mm in the shortest diameter, as evaluated by CT/MRI) were ineligible for the study. Fifty-seven patients (33%) had clinically positive pelvic nodes. The median maximum diameter of the nodes was 15 mm (range, 10–60 mm) and the median number of positive lymph nodes was two (range, one to four). Fifty-two of 57 patients (91%) with positive nodes were treated with boost EBRT (6–10 Gy in three to five fractions). The median prescribed dose of EBRT for nodes was 56 Gy. The median follow-up time for all patients was 66 months (range, 3–142 months). The 5-year overall survival rate, disease-free survival rate and pelvic control rate for patients with positive and negative nodes were 73% and 92% (P = 0.001), 58% and 84% (P < 0.001), and 83% and 92% (P = 0.082), respectively. Five of 57 node-positive patients (9%) developed pelvic node recurrences. All five patients with nodal failure had concomitant cervical failure and/or distant metastases. No significant difference was observed with respect to the incidence or severity of late complications by application of boost EBRT. The current retrospective study demonstrated that boost EBRT to positive pelvic nodes achieves favorable nodal control without increasing late complications.     

Epithelial ovarian cancer: definitive radiotherapy for limited recurrence after complete remission had been achieved with aggressive front-line therapy

The purpose of this study was to assess the efficacy and toxicity of definitive radiotherapy (RT) for the recurrence of epithelial ovarian cancer, which is limited to one or two gross regions, after complete remission had been achieved with aggressive front-line therapy. Twenty-seven patients were treated with definitive RT and were retrospectively analyzed. Their median tumor size was 3.0 cm. Twenty-six (96%) patients received external irradiation at a median total dose of 60 Gy, and a median daily dose of 2 Gy. Only two patients received intracavitary brachytherapy. Twenty (74%) of the 27 patients received systemic chemotherapy for the treatment of a limited recurrent tumor followed by definitive RT. Six (22%) of the patients received concurrent chemotherapy and seven (26%) of the patients also underwent regional hyperthermia during definitive RT. Twenty-two (82%) patients had an objective response (CR: 11, PR: 11). The 2-year overall survival, progression-free survival and local (in-field) control rates after RT were 53%, 39% and 96%, respectively. The toxicities were mild, no Grade 3 or higher toxicity was observed in any of the patients. The tumor size( < 3 cm), period between front-line therapy and RT (≥2 year) and objective tumor response (CR) were significant prognostic factors of the overall survival rate. In conclusion, definitive RT for limited recurrence of epithelial ovarian cancer achieves a better local control rate without severe toxicity, and it may therefore be a potentially effective modality for inducing long-term survival in selected patients.     

A retrospective study of small-pelvis radiotherapy plus image-guided brachytherapy in stage I–II non-bulky cervical squamous cell carcinoma

We herein report a retrospective analysis of the efficacy of a combination therapy of pelvic irradiation that excluded the common iliac lymph nodes region and image-guided brachytherapy (IGBT) for non-bulky (≤4 cm) cervical cancer. Thirty-three patients with stage I–II cervical squamous cell carcinoma (≤4 cm) and without pelvic/para-aortic lymphadenopathy who were treated with definitive radiotherapy alone between February 2009 and September 2016 were included. The radiotherapy consisted of CT-based small-pelvis irradiation (whole pelvis minus common iliac lymph node area) of 20 Gy/10 fractions followed by pelvic irradiation with a midline block of 30 Gy/15 fractions and IGBT of 24 Gy/4 fractions (6 Gy/fraction for high-risk [HR] clinical target volume [CTV] D90%). In-room computed tomography (CT) imaging with applicator insertion was used for brachytherapy planning, with physical examinations and diagnostic magnetic resonance imaging (MRI) also being referred to for determination of HR CTV. Over a median follow-up of 60.5 months (range, 7–89), two patients developed distant recurrence and one developed local and distant recurrence. Two patients died from cervical cancer, one from hepatocellular carcinoma and one from non-cancerous disease. The 2/5-year local control (LC), progression-free survival (PFS) and overall survival (OS) rates were 100%/96.7%, 93.8%/90.6% and 93.9%/93.9%, respectively. No pelvic/para-aortic lymph node recurrence was observed. There were no late complications of grade 3 or higher in the small bowel, large bowel/rectum, or bladder. Our results suggest that a combination therapy of IGBT plus small-pelvis irradiation excluding common iliac lymph nodes provides reasonable clinical outcomes and can be a treatment option in non-bulky (≤4 cm) cervical squamous cell carcinoma.     

Efficacy and safety of nedaplatin-based concurrent chemoradiotherapy for FIGO Stage IB2–IVA cervical cancer and its clinical prognostic factors

Cisplatin-based concurrent chemoradiotherapy (CCRT) is a standard treatment for cervical cancer, but nedaplatin-based CCRT is not routinely administered. We evaluated the efficacy and safety of nedaplatin-based CCRT (35 mg/m² weekly) and analyzed prognostic factors for survival among 52 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage IB2–IVA cervical cancer treated from 1999 to 2009. Patients were treated with a combination of external beam radiotherapy of 40–56 Gy (in 20–28 fractions) and 13.6–28.8 Gy (in 2–4 fractions) of high-dose-rate (HDR) intracavitary brachytherapy or 18 Gy (in 3 fractions) of HDR interstitial brachytherapy. Overall survival (OS), progression-free survival (PFS), and local control (LC) were estimated using the Kaplan–Meier method. The Cox proportional hazard model was used for multivariate analysis. Acute and late toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.0. The median follow-up period was 52 months. The median patient age was 63 years. The 5-year OS, PFS and LC rates were 78%, 57% and 73%, respectively. Multivariate analysis showed that histologic type, maximum tumor diameter, and pretreatment hemoglobin level were independent risk factors for PFS. Regarding adverse effects, 24 patients (46%) had acute Grade 3–4 leukopenia and 5 (10%) had late Grade 3 gastrointestinal toxicities. No patient experienced renal toxicity. Nedaplatin-based CCRT for FIGO Stage IB2–IVA cervical cancer was efficacious and safe, with no renal toxicity. Histologic type, maximum tumor diameter, and pretreatment hemoglobin level were statistically significant prognostic factors for PFS.     

宫颈癌复发及预后临床因素分析

目的探讨宫颈癌患者的临床因素与其复发及预后的关系。方法回顾分析我院收治的80例宫颈癌患者的临床资料,采用Kaplan—Meier法计算总生存率,Log—rank法检验和单因素预后分析,采用Logistic回归分析临床因素与复发间的相关性,并运用COX回归分析临床因素与预后间的相关性。结果患者的FIGO分期、病理分化程度、组织学类型、术后辅助放化疗以及淋巴结转移是影响复发的相关因素（P〈0．05）。Logistic多因素分析结果显示：FIGO分期、病理分化程度、组织学类型、淋巴结转移以及术后辅助放化疗是影响复发的独立因素。患者的发病年龄、FIGO分期、肿瘤直径、病理分化程度、肌层浸润深度、组织学类型、术后辅助放化疗以及淋巴结转移是影响预后的相关因素（P〈0．05）。COX回归多因素分析结果显示：年龄、FIGO分期,病理分化程度、肌层浸润深度、组织学类型、淋巴结转移以及术后辅助放化疗是影响预后的独立因素。结论临床分期晚、低分化、非鳞癌以及淋巴转移是影响宫颈癌的预后和复发的主要危险因素,发病年龄、肿瘤直径以及肌层浸润深度为影响宫颈癌预后的一个重要因素,其治疗也值得进一步探讨。     

Association Between Receipt of Definitive Treatment for Localized Prostate Cancer and Adverse Health Outcomes: A Claims-Based Approach

ObjectivesThis study aimed to examine adverse health outcomes associated with receipt of definitive treatments (prostatectomy, intensity-modulated radiation therapy [IMRT] and brachytherapy).MethodsWe identified men aged 65 years and older who received a new diagnosis of localized prostate cancer from 4 state cancer registries (CA, FL, NJ, and TX) during the years 2006 to 2013. We merged the registry records for this cohort with Medicare enrollment and claims. We constructed indicators of treatment-related adverse outcomes using diagnosis codes reported on the claims. Stage 1 models the choice of definitive treatment versus active surveillance. Stage 2 examines the probability of experiencing a treatment-related adverse health outcome among men who chose definitive treatment.ResultsNotably, 81.4% of our cohort of 61 187 men received definitive treatment whereas 18.6% were monitored with active surveillance. The 5-year prostate cancer death rate was 0.28% to 1.75% irrespective of treatment received. Men monitored with active surveillance experienced minimal adverse health outcomes (0.16%-0.75%). The risks of urinary incontinence associated with prostatectomy were 31 and 39.5 percentage points higher than brachytherapy and IMRT, respectively. For erectile dysfunction, the risks were nearly 23 and 27.5 percentage points higher, respectively, than brachytherapy and IMRT. Prostatectomy was associated with lower risk of urinary dysfunction and bowel dysfunction than either brachytherapy or IMRT. Compared with brachytherapy, IMRT was associated with a lower risk of erectile dysfunction (32%), urinary incontinence (84%), and urinary dysfunction (30%).ConclusionsThis evidence should be of value to patient-physician decision making regarding the choice of definitive treatments versus active surveillance for men with localized disease.     

Radiation therapy for carcinoma of the uterine cervix: comparison of two brachytherapy schedules

We compared the survival rates and late effects for two groups of cervical cancer patients treated with almost the same external radiotherapy but different remote afterloading systems (RALS) for high-dose-rate intracavitary radiation therapy regimens. A total of 218 patients with carcinoma of the uterine cervix were treated. For 98 patients, intracavitary brachytherapy was delivered with 6–7.5 Gy/fraction to Point A (Group A), and for 120, 5 Gy/fraction with a modified source step size (Group B). The 3-year cause-specific survival rates by stage and treatment schedule were Group A: 91% and Group B: 96% in Stage I, 89% and 92% in Stage II, 64% and 75% in Stage III, 44% and 69% in Stage IV. The survival curves did not reveal any statistically significant differences at any stage. The 3-year cumulative local failure rates were 14% in Group A and 7% in Group B (P = 0.1202), while the actuarial rates of developing rectal complication (Grade 2 or more) at 3 years were 25% in Group A and 4% in Group B (P < 0.0001). This retrospective analysis suggests that a low dose per fraction with modified source step size is advantageous because of yielding almost the same local control but with fewer rectal complications.     

宫颈鳞癌淋巴结转移特点、相关因素及预后分析

目的:阐明宫颈癌诸多临床病理生理因素与淋巴结转移的相关性,揭示宫颈癌淋巴结转移的规律及其对预后的影响,并针对具有不同淋巴结转移特点的宫颈癌患者制定个体化治疗方案。方法:回顾性分析中山大学肿瘤防治中心1993年12月~1996年12月收治的Ιa-Ⅱb期、以手术治疗为主的99例宫颈鳞癌患者的淋巴结转移特点、临床病理生理因素、预后及其相互关系。结果:①99例宫颈癌患者总体5年生存率60.6%,其中无淋巴结转移者5年生存率70.0%,有淋巴结转移者5年生存率36.7%。②较晚的临床分期,原发病灶大于或等于4 cm,病理分化程度较低者,有较高的淋巴结转移率,反之淋巴结转移率低。③宫颈癌单侧及单站淋巴结转移者预后好于双侧及多站淋巴结转移者;有髂总淋巴结转移者预后极差,单侧仅有闭孔淋巴结转移者5年生存率67.0%,与无淋巴结转移者相近(71.0%)。④宫颈癌闭孔淋巴结转移率最高,其它部位淋巴结转移者多合并有闭孔淋巴结转移。结论:①淋巴结转移是影响宫颈癌预后的重要因素。②临床分期、原发灶大小与宫颈癌淋巴结转移呈正相关,分化程度与淋巴结转移呈负相关。③闭孔淋巴结可能是宫颈癌的前哨淋巴结。④髂总淋巴结转移者,治疗应更积极、个体化,单侧闭孔淋巴结转移者,预后较好,或可免行术后补充治疗,而代之以密切随访。     

基于Cox风险回归分析的相关因素对判断Ⅰa~Ⅱb期宫颈癌5年预后的临床价值

目的分析影响宫颈癌患者预后的相关因素,为临床诊治提供参考依据。方法选择2013年3月—2016年1月浙江中医药大学附属湖州中医院收治的宫颈癌患者80例,根据第3年生存状况分为复发组与未复发组,并进一步分析两组患者临床病理资料的差异性。建立单因素和多因素Cox模型,分析影响宫颈癌患者生存时间的独立风险因素。根据患者5年生存状况将其分为生存组、死亡组,并比较两组患者微血管密度(MVD)、血清鳞状细胞癌抗原(SCC-Ag)、基质金属蛋白酶-9(MMP-9)、T细胞免疫球蛋白黏蛋白分子4(Tim-4)、程序性死亡配体-1(PD-L1)水平。结果复发组患者在宫颈癌国际妇产科联盟(FIGO)分期、组织分级、颈管受累、淋巴结转移及宫旁浸润方面与未复发组相比,差异均有统计学意义(均P<0.05)。单因素分析结果显示,绝经状态、FIGO分期、颈管受累、宫旁浸润及淋巴结转移与宫颈癌患者预后具有相关性(均P<0.05);患者年龄、肿瘤大小、组织分级、肌层浸润、神经侵犯、术后放疗及术后化疗与宫颈癌患者预后无相关性(均P>0.05)。生存组MVD、SCC-Ag、MMP-9、Tim-4及PD-L1分别为:(49.87±9.33)个/mm²、(0.75±0.31)ng/ml、(810.34±177.7)ng/ml、(14.37±6.26)ng/ml及(3.91±1.35)%水平显著低于死亡组(58.58±10.13)个/mm²、(9.16±3.33)ng/ml、(929.14±193.06)ng/ml、(18.80±9.21)ng/ml及(10.02±3.66)%,差异均有统计学意义(均P<0.05)。FIGO分期、颈管受累、淋巴结转移、MVD、SCC-Ag、MMP-9、Tim-4及PD-L1水平均可独立影响宫颈癌患者生存时间。模型的验证结果与预测结果相似,且构建的风险模型的真实性和可靠性较高。结论FIGO分期、颈管受累、淋巴结转移、MVD、SCC-Ag、MMP-9、Tim-4及PD-L1水平均可作为宫颈癌患者生存时间的独立影响因素。     

192Ir近距离腔内放疗联合体外逆向调强放射治疗宫颈癌160例疗效观察

目的 研究¹⁹²Ir高剂量率腔内放疗加体外逆向调强放疗（IMRT）治疗宫颈癌的疗效及放射反应。方法 160例宫颈癌患者采取¹⁹²Ir高剂量率腔内放疗加体外逆向调强放疗（IMRT）放射治疗，体外全盆腔照射IMRT，6MV X射线DT 45~50 Gy，5次/周，1.8~2 Gy/次。全盆腔放疗结束后行¹⁹²Ir腔内治疗1次/周，5~8 Gy/次，总剂量21~24 Gy。结果 全组1年、3年生存率分别为100%和78.75%，Ⅱ、Ⅲ期3年生存率分别为80%和63.89%，患者3年生存率I期与Ⅱ期、Ⅲ期与IV期有明显统计学差异（100%、80%，63.89%、16.67%，P<0.05），Ⅱ期、Ⅲ期无明显统计学差异（80%、63.89%，P>0.05）。病理I级与Ⅲ级的Ⅱ期患者生存率有明显差异（100%、53.33%，P<0.05）。病理I级与Ⅲ级的Ⅲ期患者生存率有明显差异（100%、33.33%，P<0.05）。IV期各病理分级的患者生存率均无明显差异（P>0.05）。Ⅱ、Ⅲ期患者中肿瘤直径<4 cm与肿瘤直径>4 cm的3年生存率有明显差异（P<0.05），而IV期患者肿瘤直径<4 cm与肿瘤直径>4 cm的3年生存率无明显差异（P>0.05）。早期放射性直肠炎反应发生率21.8%，膀胱反应发生率7.5%，晚期放射性直肠炎发生率7%，晚期膀胱炎反应发生率5%，直肠阴道瘘0.625%。结论 ¹⁹²Ir高剂量率腔内加体外适形调强放疗治疗宫颈癌疗效好，毒副反应较少。     

子宫内膜癌复发高危因素的分析

目的分析总结导致子宫内膜癌复发的高危因素。方法选择2005年2月～2010年2月间某院治疗子宫内膜癌的300例患者,将随访中发现的133例患者选为复发组,其他167例患者为未复发组。对复发组及未复发组两组患者分别进行治疗方式、组织学分型、病理学分型、肌层浸润深度、淋巴转移及腹腔细胞学等多方位的对比,以此总结两组的不同,得到导致子宫内膜癌复发的高危因素。结果在300例参与研究的子宫内膜癌病例中,133例术后复发,复发率44.33%。复发组中单纯手术治疗的患者占65.41%,而手术治疗+放、化疗的患者占34.59%;复发组中G1的复发率为21.05%,G2的复发率为24.06%,G3的复发率为54.89%;内膜样腺癌患者复发率84.96%%,腺癌伴鳞状上皮分化患者复发率3.76%,浆液性腺癌患者复发率5.26%,透明细胞癌患者复发率6.02%;肌层浸润深度﹤1/2的患者复发率为37.59%,肌层浸润深度≥1/2的患者复发率为62.41%;淋巴结转移阳性患者占63.91%,阴性患者占36.09%;腹腔细胞学阳性患者占67.67%,阴性患者占32.33%。结论子宫内膜癌的复发与患者的治疗方式、组织学分型、病理学分型、肌层浸润深度、淋巴转移及腹腔细胞学等有着密切的关系,需要临床医生在治疗过程中提高注意。     

ⅠB2、ⅡA2期宫颈癌根治术中联合腹主动脉旁淋巴结切除术的应用价值探讨

目的探讨ⅠB2、ⅡA2期宫颈癌根治术中联合腹主动脉旁淋巴结切除术的临床价值。方法2010年1月至2013年3月共收治106例ⅠB2、ⅡA2期宫颈癌患者,其中仅行宫颈癌根治术55例患者为对照组,行宫颈癌根治术同时联合腹主动脉旁淋巴结切除术51例患者为观察组;两组术后均辅以放化疗。比较两组手术情况、复发率,并分析临床病理因素与盆腔、腹主动脉旁淋巴结转移的相关性。结果观察组复发率为15．7％（8／51）,明显低于对照组的38．2％（21／55）,差异有统计学意义（P〈0．05）;而两组并发症发生率[27．5％（14／51）比30．9％（17／55）]、术中出血量[（326．1±59．1）ml比（316．1±51．2）ml]及盆腔淋巴结阳性率[56．9％（29／51）比58．2％（32／55）]比较差异均无统计学意义（P〉0．05）。观察组中腹主动脉旁淋巴结阳性率为17．6％（9／51）,盆腔淋巴结转移个数与腹主动脉旁淋巴结转移呈正相关（P〈0．01）。结论在宫颈癌根治术中联合腹主动脉旁淋巴结切除术同时术后辅以放化疗,可降低其复发率,且不增加并发症,同时宫颈癌腹主动脉旁淋巴结转移数与盆腔淋巴结转移有关。     

Prognostic factors associated with radiotherapy for cervical cancer with computed tomography-detected para-aortic lymph node metastasis

Patients with cervical cancer diagnosed with a para-aortic lymph node (PALN) metastasis by computed tomography (CT) scan were analyzed to identify associated prognostic factors. A total of 55 patients were reviewed, and 27 of these patients underwent extended-field radiotherapy (EFRT). The median PALN dose in patients receiving EFRT was 45 Gy (range, 27–57.6 Gy). Of the 55 patients, 28 underwent pelvic radiotherapy (RT); concurrent chemoradiotherapy (CCRT) was administered to 41 patients. The Kaplan–Meier method was used to calculate the actuarial rate. Multivariate analysis was performed using the Cox proportional hazards model. Five-year overall survival (OS) rates were 41% and 17.9% in patients undergoing EFRT and pelvic RT (P = 0.030), respectively. Age < 53 years (P = 0.023), FIGO Stage I–II (P = 0.002), and treatment with EFRT (P = 0.003) were independent predictors of better OS. The use of CCRT (P = 0.014), Stage I–II (P = 0.002), and treatment using EFRT (P = 0.036) were independent predictors of distant metastasis. In patients undergoing EFRT plus CCRT, the 5-year OS was 50%. Three-year PALN disease-free rates were 8.8%, 57.9% and 100% (P < 0.001) in CCRT patients who received PALN doses of 0 Gy, ≤45 Gy and ≥50.4 Gy, respectively. Although PALN metastasis is thought to be distant metastasis in cervical cancer, EFRT plus CCRT shows a good outcome, particularly in younger patients in an early FIGO stage. Cervical cancer with a PALN metastasis should not be considered incurable. Doses ≥50.4 Gy for treating PALN may result in better disease control.     

Clinical results of stereotactic body radiotherapy for Stage I small-cell lung cancer: a single institutional experience

The purpose of this study was to evaluate the treatment outcomes of stereotactic body radiotherapy (SBRT) for Stage I small-cell lung cancer (SCLC). From April 2003 to September 2009, a total of eight patients with Stage I SCLC were treated with SBRT in our institution. In all patients, the lung tumors were proven as SCLC pathologically. The patients'' ages were 58–84 years (median: 74). The T-stage of the primary tumor was T1a in two, T1b in two and T2a in four patients. Six of the patients were inoperable because of poor cardiac and/or pulmonary function, and two patients refused surgery. SBRT was given using 7–8 non-coplanar beams with 48 Gy in four fractions. Six of the eight patients received 3–4 cycles of chemotherapy using carboplatin (CBDCA) + etoposide (VP-16) or cisplatin (CDDP) + irinotecan (CPT-11). The follow-up period for all patients was 6–60 months (median: 32). Six patients were still alive without any recurrence. One patient died from this disease and one died from another disease. The overall and disease-specific survival rate at three years was 72% and 86%, respectively. There were no patients with local progression of the lesion targeted by SBRT. Only one patient had nodal recurrence in the mediastinum at 12 months after treatment. The progression-free survival rate was 71%. No Grade 2 or higher SBRT-related toxicities were observed. SBRT plus chemotherapy could be an alternative to surgery with chemotherapy for inoperable patients with Stage I small-cell lung cancer. However, further investigation is needed using a large series of patients.     

Cancer of the pelvis: definitive three-dimensional conformal radiotherapy for patients with isolated recurrence in the para-aortic lymph nodes

The purpose of this study was to evaluate the outcome of definitive three-dimensional conformal radiotherapy (RT) for isolated para-aortic lymph node (LN) recurrence in patients with controlled primary cancer of the pelvis. Twenty-four consecutive patients with isolated para-aortic LN recurrence were retrospectively analyzed. The patients were included in this study if they were eligible to receive definitive RT for abdominal para-aortic LN recurrence with controlled primary cancer of the pelvis without other distant/recurrent diseases. The median time between the front-line therapy and RT for isolated para-aortic LN metastases was 21 months. Nineteen (79%) patients had an objective tumor response. In-field failure occurred in four patients (17%), while failure outside of the irradiated field was recognized in 12 patients (50%). The overall survival, progression-free survival and local control rates at 5 years were 56%, 29% and 72%, respectively. Statistically significant prognostic factors of the overall survival rate in the univariate analyses were an objective tumor response (P = 0.0098) and the time between front-line therapy and RT (P = 0.033). The maximum tumor size was a significant prognostic factor of the overall survival rates in the multivariate analyses (P = 0.046). The toxicities were mild; leukopenia of Grade 3 was detected in one patient, and no Grade 3 or higher non-hematological toxicity was observed. In conclusion, definitive three-dimensional RT for isolated abdominal para-aortic LN recurrence in patients with controlled primary cancer of the pelvis may be feasible, and can provide a relatively longer-term survival. The results justify further investigation of higher dose RT using modern RT planning techniques.     

Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer

It has been suggested that pain control during intracavitary brachytherapy for cervical cancer is insufficient in most hospitals in Japan. Our hospital began using caudal epidural anesthesia during high-dose-rate (HDR) intracavitary brachytherapy in 2011. The purpose of the present study was to retrospectively investigate the effects of caudal epidural anesthesia during HDR intracavitary brachytherapy for cervical cancer patients. Caudal epidural anesthesia for 34 cervical cancer patients was performed during HDR intracavitary brachytherapy between October 2011 and August 2013. We used the patients'' self-reported Numeric Rating Scale (NRS) score at the first session of HDR intracavitary brachytherapy as a subjective evaluation of pain. We compared NRS scores of the patients with anesthesia with those of 30 patients who underwent HDR intracavitary brachytherapy without sacral epidural anesthesia at our hospital between May 2010 and August 2011. Caudal epidural anesthesia succeeded in 33 patients (97%), and the NRS score was recorded in 30 patients. The mean NRS score of the anesthesia group was 5.17 ± 2.97, significantly lower than that of the control group''s 6.80 ± 2.59 (P = 0.035). The caudal epidural block resulted in no side-effects. Caudal epidural anesthesia is an effective and safe anesthesia option during HDR intracavitary brachytherapy for cervical cancer.