放射联合复方苦参注射液治疗食管癌临床分析

  目的 探讨食管癌在放疗中联合应用复方苦参注射液疗效及减少放疗的毒副作用。方法 对126例初次入院食管癌放疗患者进行回顾性分析；一组行单纯超分割放疗（单放组），总剂量DT 66 ~ 74 Gy／6 ~ 7周，2.2～2.4 Gy／日。另一组在超分割放疗的同时加用复方苦参注射液（综合组）20 ml加入生理盐水500 ml静脉滴注，每日一次连用20 d。结果 放疗结束时食管片分级，综合治疗组Ⅰ级片占60.4 %明显高于单放组41 %（χ2=4.57；P＜0.05）；综合组1年生存率73.6 %明显高于单放组54.8 %（χ2 = 4.63；P＜0.05）；单放组放射性食管炎及放射性气管炎发生率明显高于综合组（P＜0.05；P＜0.01）。结论 食管癌放疗的同时加用复方苦参注射液，具有增敏和降低放疗毒副作用。     

Adjuvant versus salvage radiotherapy in prostate cancer: multi-institutional retrospective analysis of the Spanish RECAP database

Purpose

To compare adjuvant radiotherapy (ART) to salvage radiotherapy (SRT) after radical prostatectomy (RP) in a cohort of prostate cancer (PCa) patients. The primary aim was to comparatively assess 2- and 5-year biochemical relapse-free survival (BRFS). A secondary aim was to identify predictors of survival.

Patients and methods

Data were acquired from the RECAP database, a population-based prostate cancer registry in Spain. Inclusion criteria included RP (with or without lymphadenectomy) followed by ART or SRT. A total of 702 patients were analyzed. Pre-RT PSA values (>0.5 vs. ≤0.5 ng/ml), pathological stage (T1–2 vs. T3–4), post-surgical Gleason score (≤7 vs. 8–10), margin status (positive vs. negative), hormonal treatment (yes vs. no), and RT dose (≤66 Gy vs. >66 Gy) were evaluated to assess their impact on BRFS.

Results

The mean patient age in the ART and SRT groups, respectively, was 64 years (range 42–82) and 64.8 years (range 42–82). Median follow-up after RT in the whole sample was 34 months (range 3–141). A total of 702 patients were included: 223 (31.8%) received ART and 479 (68.2%) SRT. BRFS rates (95% CI) in the ART and SRT groups at months 24 and 60 were, respectively: 98.1% (95.9–100.0%) vs. 91.2% (88.2–94.2%) and 84.5% (76.4–92.6%) vs. 74.0% (67.4–80.7%) (p = 0.004). No significant differences in OS were observed (p = 0.053). The following variables were significant predictors of biochemical recurrence in the SRT group: (1) positive surgical margin status (p = 0.049); (2) no hormonotherapy (p = 0.03); (3) total prostate dose ≤66 Gy (p = 0.004); and pre-RT PSA ≥0.5 ng/ml (p = 0.013).

Conclusions

This is the first nationwide study in Spain to evaluate a large cohort of PCa patients treated with RP followed by postoperative RT. ART yielded better 2- and 5-year BRFS rates, although OS was equivalent. These findings are consistent with most other published studies and support ART in patients with adverse prognostic characteristics after radical prostatectomy. Prospective trials are needed to compare immediate ART to early SRT to better determine their relative benefits.

     

早期声门型喉癌放射治疗的预后因素分析

目的：分析单纯放射治疗早期声门型喉癌（TINOMO）的预后因素。方法：1958年8月至1994年12月，肿瘤医院共收治 行单纯放射治疗的TINOMO声门型喉鳞癌238例，其中男性220例，女性18例。用6、8MNVX射线或^60Co予平行对穿野放射治疗，中位放射总剂量为68Gy，中位治疗时间52d，中位放射野大小22．5cm^2。用Kaplan-Meier计算生存率和局部控制率，Logrank法做差异检验。Cox回归法统计影响局部控制率（LC）和总生存率（OS）的预后因素。结果：中位随访时间127个月（4－410 个月）。5、10年总生存率分别为84．0％和74．9％。5年局部控制率为82．1％。44例在随访过程中出现局部复发（41例为原发部位复发，2例为颈部淋巴结复发，1例因失访复发部位不祥），23例出现第二原发肿瘤。对LC不利的预后影响因素为局部大肿块、前联合受侵和治疗过程中血红蛋白下降。结论：单纯放射治疗TINOMO声门型喉癌可得到很好的局部控制率，但局部大肿块、前联合受侵和血红蛋白在治疗过程中下降是对局部控制不利的预后因素。     

食管癌根治性放疗后局部复发再程三维适形放疗临床分析

目的 研究食管癌根治性放疗后局部复发行再程三维适形放疗(3DCRT)的安全性、疗效及影响生存预后因素.方法 回顾性分析2010年1月至2014年4月本院收治的46例食管癌根治性放疗后局部复发行3DCRT再程治疗患者的治疗效果,并应用Log-rank进行单因素预后分析,用Cox比例风险模型进行预后的多因素分析.结果 6例患者未完成放疗,40例患者顺利完成放疗,3DCRT总有效率为80.0％ (32/40).1、2年生存率分别为47.5％ (19/40)、20.0％ (8/40).再程放疗中出现2+3级的放射性消化道反应19例(47.5％)、放射性肺炎14例(35.0％)、造血系统毒性反应6例(15.0％)、心脏毒性4例(10.0％),全组均未出现4度以上放射性损伤及治疗相关性死亡.单因素分析显示年龄(x2=8.432,P=0.015)、放疗间隔时间(x2=7.006,P=0.008)、放疗剂量(x2=18.718,P=0.000)、大体肿瘤体积(GTV) (x2=10.121,P=0.006)、辅助化疗(x2=5.014,P=0.025)、肿瘤长度(x2=7.391,P=0.025)、野内复发(x2 =9.933,P=0.002)、肿瘤控制情况(x2=14.665,P=0.001)与预后密切相关;病变部位有影响总生存的趋势(x2=5.493,P=0.064);多因素分析显示年龄(x22=4.759,P=0.029)、放疗间隔时间(x2 =4.139,P=0.041)、GTV (x2=4.799,P=0.024)、肿瘤控制情况(x2=4.501,P=0.030)是影响总生存时间的重要因素.结论 对于食管癌根治性放疗后局部复发患者,3DCRT再程放疗虽然毒性反应大,但其可提高近期疗效.年龄、放疗间隔时间、GTV、肿瘤控制情况是再程放疗的预后因素.     

Multivariate analysis of treatment outcome in patients with esophageal carcinoma treated with definitive radiotherapy

To evaluate patient characteristics and treatment factors influencing outcome of patients treated with definitive radiotherapy, we performed retrospective analysis. From 1983 to 2000, 154 patients who were diagnosed as esophageal carcinoma without distant metastasis received definitive radiotherapy with (N = 90) or without (N = 64) systemic chemotherapy. One hundred forty-two males and 12 females were entered in the analysis. Thirty-four patients received an additional boost of intracavitary brachytherapy (ICBT). The median patient age was 68 years (range: 46-86). Disease stage was distributed as stage I, II, III, and IV for 33, 42, 33, and 45 patients, respectively. External beam radiotherapy was prescribed with a median 63 Gy (range: 38-77.8 Gy). The 2- and 5-year overall survival (OAS) and local control (LC) rates were 40.8/18.4% and 48.6/28.9%, respectively. In uni-/multivariate analyses, significant prognostic factors of OAS proved to be advanced T stage, absence of ICBT, and age less than 65 years. As for LC, adverse prognostic factors of uni/multivariate analysis were advanced T stage and poor performance status. The pretreatment T stage showed the most powerful influence on both survival and LC. Combination use of ICBT is proven to refine treatment outcome, although eligible criteria should be decided by a prospective study.     

Chemotherapy for muscle-invasive bladder cancer treated with definitive radiotherapy: persisting uncertainties

Radical cystectomy for invasive bladder cancer remains the standard of care in many parts of the world, including North America and many parts of Europe; however, a large body of international experience from single institutions and cooperative groups indicates satisfactory results with bladder-sparing approaches in appropriately selected patients. Overall, selective bladder preservation with trimodality therapy, consisting of transurethral resection of the bladder tumor, radiation, and chemotherapy, can achieve complete response rates of 70%, long-term survival rates of 40-50%, and survival rates with an intact bladder of 30-45%. Neoadjuvant chemotherapy followed by radiotherapy might provide up to 5% additional long-term absolute survival benefit compared with radiotherapy alone, although the studies to support this are not appropriately powered. Concomitant chemoradiation provides high response rates and disease control, although the level of evidence for this approach and the follow-up data are even less robust than those for neoadjuvant chemotherapy. Although direct comparison of surgically based and radiotherapy-based approaches would be very useful, it is highly unlikely that such a trial could ever be completed among the patients treated by the clinicians who routinely deal with invasive bladder cancer.     

Severe complications in advanced esophageal cancer treated with radiotherapy after intubation of esophageal stents: a questionnaire survey of the Japanese Society for Esophageal Diseases

PURPOSE: A questionnaire survey was performed to evaluate the complications and prognosis of esophageal cancer treated with esophageal intubation before or during radiotherapy. METHODS AND MATERIALS: Clinical data were accumulated on a total of 47 patients treated at 17 institutions in Japan. Five patients had Stage II, 30 Stage III, and 11 Stage IV, and the stage was unknown in 1 patient. Covered expandable metallic stents were inserted in 30 patients, uncovered expandable metallic stents in 13, plastic or silicon prosthesis in 3, and an unknown type in 1 patient. Esophageal stenting was performed before the start of RT for 23 patients and during the course of RT for 24 patients. The reasons for the stenting were severe stricture in 32 patients (Group 1) and esophageal fistula in 15 patients (Group 2). RESULTS: The most frequent toxicity was formation or worsening of esophageal fistulas in 13 patients (28%), followed by massive hematemesis or GI bleeding in 10 patients (21%). In total, 24 patients (51%), including 10 patients with possible treatment-related deaths (Grade 5), had nonhematologic toxicities of Grade 3-5. The interval from the start of RT to the nonhematologic toxicity ranged from 16 to 312 days (median 78). The incidence of toxicities was higher for Group 1 (59%) than for Group 2 (33%), although the difference was not statistically significant. The median survival time for those with Stage II-III and Stage IV was 5 and 3.5 months, respectively. CONCLUSIONS: Patients with esophageal intubation before or during RT have a high risk of life-threatening complications, especially for those with severe esophageal stricture. Because long survival is expected for a substantial proportion of patients with locally advanced esophageal cancer after chemoradiotherapy, palliative intubation should be delayed until radiotherapy or chemoradiotherapy appears to have failed.     

Failure patterns in patients with esophageal cancer treated with definitive chemoradiation

BACKGROUND:

Local failure after definitive chemoradiation therapy for unresectable esophageal cancer remains problematic. Little is known about the failure pattern based on modern‐day radiation treatment volumes. We hypothesized that most local failures would be within the gross tumor volume (GTV), where the bulk of the tumor burden resides.

METHODS:

We reviewed treatment volumes for 239 patients who underwent definitive chemoradiation therapy and compared this information with failure patterns on follow‐up positron emission tomography (PET). Failures were categorized as within the GTV, the larger clinical target volume (CTV, which encompasses microscopic disease), or the still larger planning target volume (PTV, which encompasses setup variability) or outside the radiation field.

RESULTS:

At a median follow‐up time of 52.6 months (95% confidence interval, 46.1‐56.7 months), 119 patients (50%) had experienced local failure, 114 (48%) had distant failure, and 74 (31%) had no evidence of failure. Of all local failures, 107 (90%) were within the GTV, 27 (23%) were within the CTV, and 14 (12%) were within in the PTV. On multivariate analysis, GTV failure was associated with tumor status (T3/T4 vs T1/T2; odds ratio, 6.35; P = .002), change in standardized uptake value on PET before and after treatment (decrease >52%: odds ratio, 0.368; P = .003), and tumor size (>8 cm, 4.08; P = .009).

CONCLUSIONS:

Most local failures after definitive chemoradiation for unresectable esophageal cancer occur in the GTV. Future therapeutic strategies should focus on enhancing local control. Cancer 2011;. © 2011 American Cancer Society.     

食管癌再程放疗的临床观察

目的探讨食管癌放疗后局部复发再程放疗的治疗价值,并分析再程放疗及放疗联合化疗的疗效和不良反应。方法采用回顾性分析方法,对开封市中心医院2005-05-18-2010-05-21收治的41例食管癌患者,分为单纯再程放疗组20例及化疗联合再程放疗组21例,对其疗效、不良反应等进行比较。结果单纯再程放疗组有效率(RR)为45.00%(9/20),化疗联合再程放疗组为85.71%(18/21),差异有统计学意义,χ2=8.25,P=0.035。单纯再程放疗组1年生存率为45.00%(9/20),2年为25.00%(5/20),3年为10.00%(2/20);化疗联合再程放疗组1年生存率为52.38%(11/21),2年为28.57%(6/21),3年为14.29%(3/21);2组差异无统计学意义,χ2=0.05,P=0.975。单纯再程放疗组急性放射性食管炎发生率为75.00%(15/20),≥2级者为45.00%(9/20);化疗联合再程放疗组则分别为90.45%(19/21)和52.39%(11/21);2组差异无统计学意义,z=-0.877,P=0.380。单纯再程放疗组急性放射性肺炎发生率为20.00%(4/20),≥2级者为5.00%(1/20);化疗联合再程放疗组分别为23.81%(5/21)和9.52%(2/21);2组差异无统计学意义,z=-0.361,P=0.718。单纯再程放疗组骨髓抑制发生率为45.00%(9/20),≥2级者为5.00%(1/20);化疗联合再程放疗组分别为57.14%(12/21)和23.81%(5/21);2组差异无统计学意义,z=-1.228,P=0.220。结论食管癌放疗后局部复发再程放疗仍是有效治疗的手段,联合化疗是可行的,并能提高治疗效果,不良反应可耐受。     

后程超分割放射治疗食管癌的临床分析

目的评价后程超分割放射治疗食管癌的疗效及放射反应.方法对96例食管癌随机分为后程超分割组(后超组)和常规组,每组48例.经病理证实76例,后超组39例,常规组37例,均为鳞癌.男性65例,女性31例.年龄41～70岁,中位年龄57.1岁.病变部位胸上段21例,胸中段63例,胸下段12例.病变长度<5.0cm29例,5.0～7.0cm57例,>7.0cm10例.全部采用60Co外照射,常规组1次/d,2.0Gy/次,5次/周,总剂量64Gy,32分次,44d完成.后超组放射治疗前2/3疗程同常规组,照射到40Gy后改为1.15～1.25Gy/次,2次/d,间隔6～8h,使总剂量达到68～70Gy,44～45d完成.结果随访率为96.9%.1、3、5年生存率后超组为81.1%、44.1%、26.8%,常规组为61.7%、25.1%、16.9%.后超组1、3年生存率高于常规组(u值为2.97及2.64,P<0.01),5年生存率无显著性意义(u=1.71,P>0.05).后超组和常规组放射性食管炎的发生率分别为27.1%及16.7%(χ2=1.52,P=0.20);放射性支气管炎的发生率后超组为18.8%,常规组为12.5%(χ2=0.71,P=0.40).结论食管癌后程超分割治疗1、3生存率高于常规组,患者对后程超分割所引起的副作用能够耐受不影响治疗.     

中晚期食管癌同时放、化疗疗效观察

目的：观察放疗联合TP方案同时化疗治疗中晚期食管癌的疗效。方法：放疗联合TP方案（Taxel＋DDP）同时化疗综合治疗中晚期食管癌33例,单纯放射治疗中晚期食管癌3 3例。结果 ：放化组和单放组的近期疗效总有效率分别为84.8%和66.7%,1、2、3年生存率分别为75.7%、51.5%、39.4%和57.8%、30.3%、24.2%,放化组明显优于单放组（P〈0.05）。两组间远处转移率无显著性差异（P〉0.05）。同时放化组的毒副反应高于单放组,经对症处理后患者能耐受,不影响治疗。结论：同时放化疗优于单纯放射治疗,可明显提高中晚期食管癌的疗效。     

Long-term results of radiotherapy for intracranial germinoma: a multi-institutional retrospective review of 126 patients

PURPOSE: Optimal management of radiotherapy (RT) for intracranial germinoma remains controversial. This study was conducted to evaluate the long-term results of RT in patients with these tumors. METHODS AND MATERIALS: The study group consisted of 126 patients with intracranial germinoma (50 patients with pathologically verified germinoma and 76 clinically diagnosed with germinoma by clinical and neuroradiologic signs) who were treated by RT alone between 1980 and 2001. The median age at diagnosis was 17 years (range, 2-47), and various radiation doses and treatment fields were used. Serum human chorionic gonadotropin (hCG) levels were elevated in 18 patients. The median follow-up of the 114 surviving patients was 122 months (range, 13-263). RESULTS: The 10-year actuarial overall survival and cause-specific survival rate for all patients was 90% and 95%, respectively. The 10-year actuarial cause-specific survival rate for patients with and without elevated hCG levels was 94%. Relapses were noted in 10 patients, 7 of whom died of the disease. No in-field relapses at primary sites were observed in 72 patients treated with total doses of 40-50 Gy. The incidence of spinal relapses was 4% (2 of 56) for patients treated with spinal irradiation and 3% (2 of 70) for those without spinal irradiation. After a median 10-year follow-up, 54 (92%) of 59 patients with tumors not involving the neurohypophyseal region and 42 (76%) of 55 patients with tumors involving the neurohypophyseal region had Karnofsky performance status scores of 90-100%. With regard to school education and occupation, 54 (92%) of 59 patients with tumors not involving the neurohypophyseal region and 39 (71%) of 55 patients with tumors involving the neurohypophyseal region were attending school or undertaking occupations. Hormonal replacement therapy was required in 50 (44%) of 114 surviving patients before RT; only 4 patients (4%), all with neurohypophyseal tumors, required hormonal replacement therapy after RT. Clinically evident severe neurocognitive dysfunctions were documented in 10 patients before RT, and no patients treated with total doses of <55 Gy developed apparent neurocognitive dysfunctions or other complications after RT. CONCLUSION: RT was a curative treatment for intracranial germinoma, and elevated serum hCG levels did not affect the prognosis of patients treated by RT alone. A total dose of 40-50 Gy to adequate treatment fields was effective in preventing intracranial relapse, and the incidence of spinal relapses was too low to warrant routine spinal irradiation. Karnofsky performance status scores, educational achievement, and the ability to work were generally good, particularly in patients with tumors that did not involve the neurohypophyseal region. Because most complications, such as hormonal deficiency and neurocognitive dysfunction, were documented before RT and newly diagnosed complications after RT were infrequent, the treatment toxicity faced by germinoma patients appears to be less than anticipated.     

Clinical relevance of hemoglobin level in cervical cancer patients administered definitive radiotherapy

The prognostic impact of pretreatment hemoglobin (Hb) level and its changes during definitive radiotherapy was evaluated by univariate and multivariate analysis in the group of 453 FIGO IB-IIIB cervical cancer patients. Pretreatment anemia (Hb < 12 g/dl) was present in 148 patients (33%), and anemia at the end of irradiation in 48%; in 64% Hb level declined during therapy. Median overall survival in patients with initial Hb >or=12 g/dl was 66 months compared to 22 months in those with lower baseline Hb levels (p = 0.0001). This difference was mainly due to increased risk of distant spread in anemic patients (40% compared to 25% in subjects with pretreatment Hb >or=12 g/dl; p = 0.001). Baseline Hb >or=12 g/dl was also associated with longer disease-free survival and improved local control. Declining Hb level during radiotherapy predicted for impaired 5-year disease-free survival and local control probability. In multivariate analysis, low pretreatment Hb level remained associated with worse overall and disease-free survival, whereas adverse impact of declining Hb level on outcome was not observed. With regard to other clinical factors, stage and tumor extension (uni- or bilateral parametrium involvement for Stage III) were the only independent determinants of prognosis.     

Analysis of 57 nonagenarian cancer patients treated by radical radiotherapy: a survey of eight institutions.

BACKGROUND: As the human society grows more aged, it is considered important to elucidate factors essential in applying radical radiotherapy (RT) to the elderly, with ages as high as 90 years and greater. METHODS: A retrospective survey was conducted for patients 90 years of age or older who received radiotherapy with radical intent in eight leading institutions in Japan from 1990 through 1995. RESULTS: Fifty-seven nonagenarian patients were studied. Their ages ranged up to 98 (median 91) and there was a strong female preponderance (M/F: 16/41). The distribution by site was as follows: head and neck, 16; skin and adnexae, 11; uterine cervix, 7; esophagus, 6. The prevailing histopathological diagnosis was squamous cell carcinoma (34), followed by adenocarcinomas (8). The highest age at RT was 98 years [female, skin cancer, died of senility 2.5 years after treatment, with no evidence of disease (NED)] and the longest survivor is 102 years old (female, glottic cancer T2, age at RT 93, alive NED for 8 years, uses wheel-chair). The rate of completion of treatment was 75% (43/57), if the treatment field was limited to the gross primary tumor volume only and if the cumulative dose was above 80% of the tolerable adult dose. Familial escort was necessary for most of the patients in completing the day-to-day RT. CONCLUSION: Radiotherapy is feasible with radical intent even in the elderly, if the treatment field is limited to the gross primary tumor volume only, if the cumulative dose is above 80% of the tolerable adult dose and if familial support is adequate.