西妥昔单抗联合适形调强放疗和化疗治疗鼻咽癌的临床分析

目的：：分析西妥昔单抗联合适形调强放疗和化疗治疗鼻咽癌的临床疗效,毒性反应和预后因素。方法：纳入2006年3月至2011年3月在我院初治,无远处转移的Ⅱ～Ⅳ期鼻咽癌共72例。西妥昔单抗初始剂量为400 mg／m2,之后为每周250 mg／m2。所有患者接受适形调强放疗,接受诱导和／或同步化疗。结果：中位随访60.5月（5～110月）。全组患者3年、5年无局部区域复发生存率（local regional recurrence-free survival,LRRFS）、无远处转移生存率（distant metastasis free-survival ,DMFS）、无进展生存率（progression-free survival,PFS）;总生存率（overall survival,OS）分别为86.1％,75.4％;79.2％,67.9％;77.8％,66.7％和88.9％,76.7％。Ⅱ～Ⅲ期和Ⅳ期患者的5年 PFS 及 OS 分别为83.3％,97.1％和51.7％,58.3％。4例患者出现局部区域复发,共有17例患者出现远处转移。死亡14例患者中8例死于单纯远处转移。单因素分析显示肿瘤分期为 PFS 和 OS 的预后因素（P ＝0.0146,P＝0.0021）。分别有62.5％和4.2％患者发生3和4级口腔粘膜炎。14例患者出现颞叶损伤。结论：西妥昔单抗联合 IMRT 加化疗治疗鼻咽癌的临床疗效较好,毒性反应可耐受。值得扩大样本量以及开展前瞻性随机对照试验进一步研究。     

Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation

BACKGROUND:

It has been shown that concomitant chemotherapy (C) with reirradiation (ReRT) is feasible and effective for select patients with recurrent or second primary head and neck cancer (HNC). To examine potential prognostic factors associated with survival, the authors of this report retrospectively reviewed the outcomes of patients who received CReRT.

METHODS:

The study cohort comprised previously irradiated patients with nonmetastatic disease from 9 consecutive phase 1 and 2 protocols for poor‐prognosis HNC. For all patients, reirradiation (ReRT) was delivered with concurrent chemotherapy. Chemotherapy generally was 5‐fluorouracil, hydroxyurea, and a third agent.

RESULTS:

One hundred sixty‐six patients were identified, including 81 patients who underwent surgical resection or debulking before enrollment. The median ReRT dose was 66 gray. After a median follow‐up of 53 months among surviving patients, the median overall survival (OS) was 10.3 months. The 2‐year rates for OS, disease‐free survival, locoregional control, and freedom from distant metastasis were 24.8%, 19.9%, 50.7%, and 61.4%, respectively. Thirty‐three patients (19.9%) died of treatment‐related toxicity. In subgroup analysis, survival was significantly reduced in patients who received previous concurrent chemoradiotherapy (CRT) compared with patients who were naive to CRT (2‐year OS rate, 10.8% vs 28.4%; P = .0043). In multivariable analysis, prior CRT was associated independently with OS along with surgery before protocol treatment, full‐dose ReRT, and radiotherapy interval.

CONCLUSIONS:

CReRT achieved a long‐term cure for a small group of patients with recurrent or second primary HNC. Previous treatment with CRT was among the important prognostic factors for survival. Because of the associated risk of severe toxicity, CReRT should be limited only to carefully selected patients. Cancer 2011;. © 2011 American Cancer Society.     

Twice-daily reirradiation for recurrent and second primary head-and-neck cancer with gemcitabine, paclitaxel, and 5-fluorouracil chemotherapy

PURPOSE: We previously demonstrated the efficacy of concurrent gemcitabine, paclitaxel, and 5-fluorouracil in conjunction with twice-daily (1.5-Gy) radiotherapy delivered on alternating weeks (TFGX(2)) in locally advanced head-and-neck cancer. Here, we report the clinical outcome and late toxicity of TFGX(2) in a subset of patients previously irradiated to the head and neck. METHODS AND MATERIALS: Twenty-nine previously irradiated patients, presenting with recurrent or second primary head-and-neck cancer, underwent TFGX(2). Twelve patients underwent attempted surgical resection before chemoradiotherapy, 10 of whom were left with no measurable disease. Patients with measurable disease received a median radiation dose of 72 Gy; those with no measurable disease received a median dose of 61 Gy. The cumulative dose ranged from 74.4 to 156.4 Gy (mean, 125.7 Gy; median, 131.0 Gy). RESULTS: The median follow-up was 19.1 months (50.9 months for living patients). The 5-year overall survival rate was 34.5%, and the locoregional control rate was 54.5%. In patients with measurable disease at treatment, the 5-year overall survival and locoregional control rate was 26.3% and 45.1%, respectively, compared with 50.0% (p = 0.14) and 70% (p = 0.31), respectively, for those with no measurable disease. Measurable disease and radiation dose were highly statistically significant for overall survival and locoregional control on multivariate analysis. Of 14 patients assessable for late toxicity, 3 developed Grade 4-5, 8 Grade 2-3, and 3 Grade 0-1 toxicity. CONCLUSION: Aggressive reirradiation with chemotherapy in locally advanced head-and-neck cancer provides a chance for long-term cure at the expense of toxicity. Attempted surgical resection before chemoradiotherapy improved disease control and survival.     

卡瑞利珠单抗治疗复发或晚期转移性食管鳞癌临床疗效及免疫相关不良反应观察

目的:探讨卡瑞利珠单抗治疗复发或晚期转移性食管鳞癌的临床疗效以及免疫相关不良反应。方法:回顾性分析88例复发或晚期转移性食管鳞癌患者的治疗经过和疗效,将患者随机分为免疫联合化疗组、化疗组各44例,统计客观缓解率（objective remission rate,ORR)、疾病控制率(disease control rate,DCR)、无进展生存期(progress free survival,PFS)、总生存期（overall survival,OS）,用Kaplan-Meier法绘制生存曲线,用log-rank检验进行影响PFS和OS的单因素分析、COX风险回归模型进行多因素分析,并观察免疫相关不良反应。结果:免疫联合化疗组和化疗组的ORR分别为8例（18%）和4例（9%）,DCR分别为31例（70%）和20例（45%）,免疫联合化疗较单纯化疗可延长患者mPFS（5.5个月vs 3.5个月,P=0.007）和mOS（11.25个月vs 7.75个月,P＜0.001）。ECOG评分、肿瘤分化程度和转移部位数量是PFS和OS的影响因素。免疫相关不良反应主要有毛细血管增生症、甲状腺功能减低、乏力、食欲减退等,但多为1-2级,经对症处理后均可缓解。结论:卡瑞利珠单抗联合化疗较单纯化疗在复发或晚期转移性食管鳞癌中可明显延长PFS和OS,临床疗效显著,且安全性良好。     

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

BACKGROUND:

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

METHODS:

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

RESULTS:

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

CONCLUSIONS:

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

Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy

BACKGROUND: The current study was conducted to determine whether there were differences in outcome for patients with unresectable locally advanced pancreatic cancer (LAPC) who received treatment with chemoradiation therapy (CR) versus induction chemotherapy followed by CR (CCR). METHODS: Between December 1993 and July 2005, 323 consecutive patients with LAPC were treated at the authors' institution with radiotherapy and concurrent gemcitabine or fluoropyrimidine chemotherapy. Two hundred forty-seven patients received CR as initial treatment, and 76 patients received a median of 2.5 months of gemcitabine-based induction chemotherapy prior to CR. Most patients received a radiation dose of 30 grays in 10 fractions (85%) concurrently with infusional 5-fluorouracil (41%), gemcitabine (39%), or capecitabine (20%). RESULTS: The median follow-up was 5.5 months (range, 1-63 months). For all patients, the median overall survival (OS) and progression-free survival (PFS) were 9 months and 5 months, respectively, and the 2-year estimated OS and PFS rates were 9% and 5%, respectively. The median OS and PFS were 8.5 months and 4.2 months, respectively, in the CR group and 11.9 months and 6.4 months, respectively, in the CCR group (both P < .001). The median times to local and distant progression were 6.0 months and 5.6 months, respectively, in the CR group and 8.9 and 9.5 months, respectively, in the CCR group (P = .003 and P = .007, respectively). There was no significant difference in the patterns of failure with the use of induction chemotherapy. CONCLUSIONS: The results from this analysis indicated that, by excluding patients with rapid distant progression, induction chemotherapy may select patients with LAPC for optimal benefit from consolidative CR. The authors believe that this strategy of enriching the population of patients who receive a locoregional treatment modality merits prospective randomized evaluation.     

307例Ⅱ—Ⅲ期食管癌同期放化疗预后分析

目的 分析食管癌同期放化疗的疗效和影响因素。方法 2006—2014年间接受3DRT食管癌患者 307例,其中Ⅱ期 73例、Ⅲ期 234例。中位放疗剂量60 Gy,同期化疗方案为PF (166例)、TP (82例)、单药P (59例)。采用Kaplan-Meier法计算OS、PFS率并Logrank法检验和单因素预后分析,Cox模型多因素预后分析。结果 3、5年样本量分别为130、45例,1、3、5年OS和PFS率分别为85.6%、53.8%、36.9%和74.6%、43.7%、33.1%,中位OS、PFS期分别为41.6、29.8个月。单因素分析显示影响OS和PFS因素为T分期、N分期、临床分期、病变部位、病变长度和化疗方案(P=0.007和0.013、0.000和0.000、0.000和0.000、0.002和0.000、0.141和0.005、0.018和0.165)。多因素分析显示T分期、N分期、病变部位、化疗方案是影响OS因素(P=0.024、0.000、0.007、0.028),病变部位、病变长度、N分期是影响PFS因素(P=0.004、0.033、0.035)。放疗剂量 50~60、>60~70 Gy的中位OS期和PFS期分别为47.4、37.8个月(P=0.469)和34.1、25.1个月(P=0.233)。结论 Ⅱ—Ⅲ期食管癌同期放化疗可获得较好的生存,联合用药优于单药,低剂量与高剂量放疗疗效相近,不良反应可耐受。     

FDG uptake correlates with recurrence and survival after treatment of unresectable stage III non-small cell lung cancer with high-dose proton therapy and chemotherapy

ABSTRACT: BACKGROUND: We studied whether maximum standardized uptake values (SUV) from [18F] PET/CT predict clinical outcome after concurrent proton/chemotherapy for stage III non-small cell lung cancer (NSCLC). METHODS: Eighty-four patients were treated prospectively with 74 Gy(RBE) proton therapy and concurrent chemotherapy. PET/CT scans were available before (SUV1) and within 6 months after (SUV2) treatment. The predictive value of clinical and PET/CT factors were analyzed with univariate and multivariate Cox regression models. RESULTS: Median survival time was 29.9 months. At 3 years, the local recurrence-free survival (LRFS) rate was 34.8%; distant metastasis-free survival (DMFS), 35.4%; progression-free survival (PFS), 31.2%; and overall survival (OS), 37.2%. Patients with SUV2 [greater than or equal to] 3.6 (the median) had high rates of LR (p = 0.021). Of 12 clinicopathologic features evaluated in univariate analysis, only KPS, SUV1, and SUV2 predicted LRFS, DMFS, PFS, and OS (p <0.05). Multivariate analysis showed that KPS (p = 0.025) and SUV2 (p = 0.017) were independently prognostic for LRFS and that SUV1, SUV2, and KPS were independently prognostic for DMFS, PFS, and OS (p <0.05). CONCLUSIONS: SUV2 predicted LRFS, and SUV1 and SUV2 predicted DMFS, PFS, and OS, in patients with stage III NSCLC treated with concurrent chemotherapy and high-dose proton therapy.     

新辅助治疗联合手术治疗后复发食管鳞癌再程治疗的预后分析

目的 分析新辅助治疗联合手术治疗后复发的食管鳞癌再程治疗疗效及影响预后因素。方法 回顾分析2011-2015年间新辅助治疗+手术治疗后失败的152例胸段食管鳞癌治疗失败后总生存(OS)及不同挽救治疗的疗效及预后因素。Kaplan-Meier法计算OS,Cox模型多因素预后分析。结果 术后首次复发的中位间隔时间为10.6(2.0~69.1)个月。复发后的中位OS期为8.0(0.8~43.3)个月。全组患者复发后的1、2、3年OS率分别为36.0%、15.1%、5.2%。单纯局部区域复发、单纯远处转移、局部区域复发合并远处转移患者进展后中位OS期分别为11.3(1.8~43.3)、6.7(1.2~28.6)、5.1(0.8~22.9)个月。多因素分析显示新辅助化疗、ypTNM分期、复发后综合治疗、局部区域复发与复发食管鳞癌OS相关(P=0.009、0.012、0.000、0.026)。结论 新辅助治疗模式、ypTNM分期、复发模式及复发后治疗模式是是影响新辅助治疗+手术治疗后复发食管鳞癌的预后因素。新辅助治疗后复发食管鳞癌总体预后不佳,复发后应根据复发位置、新辅助治疗模式、患者体力状态等因素采用综合治疗模式以使患者取得最大挽救治疗获益。     

新辅助治疗联合手术治疗后复发食管鳞癌再程治疗的预后分析

目的 分析新辅助治疗联合手术治疗后复发的食管鳞癌再程治疗疗效及影响预后因素。方法 回顾分析2011-2015年间新辅助治疗+手术治疗后失败的152例胸段食管鳞癌治疗失败后总生存(OS)及不同挽救治疗的疗效及预后因素。Kaplan-Meier法计算OS,Cox模型多因素预后分析。结果 术后首次复发的中位间隔时间为10.6(2.0~69.1)个月。复发后的中位OS期为8.0(0.8~43.3)个月。全组患者复发后的1、2、3年OS率分别为36.0%、15.1%、5.2%。单纯局部区域复发、单纯远处转移、局部区域复发合并远处转移患者进展后中位OS期分别为11.3(1.8~43.3)、6.7(1.2~28.6)、5.1(0.8~22.9)个月。多因素分析显示新辅助化疗、ypTNM分期、复发后综合治疗、局部区域复发与复发食管鳞癌OS相关(P=0.009、0.012、0.000、0.026)。结论 新辅助治疗模式、ypTNM分期、复发模式及复发后治疗模式是是影响新辅助治疗+手术治疗后复发食管鳞癌的预后因素。新辅助治疗后复发食管鳞癌总体预后不佳,复发后应根据复发位置、新辅助治疗模式、患者体力状态等因素采用综合治疗模式以使患者取得最大挽救治疗获益。     

晚期三阴性乳腺癌的临床特征及生存分析

目的 分析晚期三阴性乳腺癌(TNBC)的临床特征,探讨影响其预后的因素.方法 收集1999年1月至2007年12月间134例晚期TNBC患者的临床资料,回顾性研究其临床特点、生存状况及预后因素.结果 134例患者确诊为晚期TNBC的中位年龄为45岁.6例为初治Ⅳ期,128例为初治Ⅰ一Ⅲ期,经手术等治疗后出现局部复发或远处转移.14例为局部复发及区域淋巴结转移,75例为远处转移,45例患者为同时出现局部复发及远处转移.最常见的远处转移部位是肺,其中51.7%(62/120)的患者同时出现2个部位以上的转移.随访至2009年6月30日,死亡75例(56.0%).全组患者的中位总生存时间(OS)为26.5个月(95%C/为20.5～32.6个月),1、3、5年预期总生存率分别为80.9%、37.1%和30.1%.初诊转移部位为单发骨转移患者预后好,7例患者的中位OS为84.2个月.111例晚期接受一线方案化疗的患者中位OS为28.5个月,23例未接受化疗的患者中位OS为12.6个月,差异有统计学意义(P=0.0001).一线化疗有效(完全缓解+部分缓解)患者45例,疾病稳定患者39例,疾病进展患者12例.化疗有效患者的中位OS为36.1个月,明显高于疾病稳定患者(20.8个月)和进展患者(14.0个月),差异有统计学意义(P=0.0108).单因素预后分析结果显示,是否远处转移、复发转移后是否接受化疗以及一线化疗疗效对患者的5年OS有显著影响(P<0.05).Cox比例风险模型分析结果显示,是否接受一线化疗以及一线化疗疗效是影响晚期TNBC预后的独立因素.结论,TNBC易早期出现局部复发和远处转移,且内脏转移及多部位转移的比率较高,可能与其侵袭性高和缺乏有效的治疗手段有关.晚期TNBC患者预后较差,化疗能够改善其预后.

Abstract：

Objective To characterize the sites of distant recurrence and clinical outcomes in a cohort of Chinese patients with metastatic triple-negative breast cancer (TNBC ). Methods One hundred and thirty-four patients with metastatic TNBC treated at Cancer Hospital of CAMS from January 1999 to December 2007 were included in this study. Hie clinicopathological features and long-term survival of the patients were retrospectively analyzed. Results The median age of the patients was 45 years. Most patients (72.7% ) had a higher predilection for visceral metastasis and early recurrence within the first two years of follow-up. Six patients (4.5%) presented with stage Ⅳ disease, 14 patients were diagnosed with locoregional recurrence after mastectomy, 75 patients with distant metastases, and 45 patients with both locoregional recurrence and distant metastasis. The most common site of first recurrence was the lung, and 62(51.7% )of the patients had more than two sites of metastasis. By July 30, 2009, 75 patients died of breast cancer (56.0%). The median overall survival (OS) was 26. 5 months [95% confidence interval (CI), 20. 5-32. 6 months]. The l-,3- and 5-year overall survivals ( OS) were 80. 9% ,37. 1% and 30.1% , respectively. The median overall survival time of 58 patients with single site of metastasis was 28.5 months, longer than that of patients with more than two sites of metastases. Patients whose initial distant recurrence was bone metastasis only (7 patients) had better prognosis, with a median OS of 84.2 months. The median OS (28.5 vs. 12.6 months, P =0.0001) differed significantly between patients who received first-line chemotherapy and those who did not. Forty-five of the 96 patients with measurable disease achieved complete/partial response (CR/PR), 39 patients had stable disease (SD), and 12 patients had disease progression (PD). The median OS was 36.1 months in patients with CR/PR, 20. 8 months with SD, and 14 months with PD, respectively. The median OS of patients with CR/PR was significantly longer than that of patients with SD/PD (P =0. 0106). Distant metastasis, first-line chemotherapy and clinical response were significantly related with OS by univariate analysis. Furthermore, first-line chemotherapy and the clinical response were demonstrated to be an independent prognostic factor by multivariate analysis. Conclusions Recurrence risk and mortality are considerably higher in TNBC patients within the early years of follow-up. TNBC patients have a higher risk of multiple and visceral metastases, and poorer survival, which might attribute to its aggressive clinical behavior and lack of effective regimens. Our findings also suggest that chemotherapy can effectively improve the clinical outcome of those patients.     

Positive effect of high RKIP expression on reduced distant metastasis by chemotherapy when combined with radiotherapy in locoregionally advanced nasopharyngeal carcinoma: a prospective study

The purpose of this prospective study is to investigate the predictive and prognostic significance of the Raf kinase inhibitory protein (RKIP) in locoregionally advanced nasopharyngeal carcinoma (NPC). Immunohistochemical assays were performed to detect the RKIP protein expression of samples from 212 patients with locoregionally advanced NPC. All patients were assigned randomly into the inductive chemotherapy plus radiation therapy (IC + RT) group, the concurrent chemoradiotherapy (CCRT) group, the inductive chemotherapy plus concurrent chemoradiotherapy (IC + CCRT) group, and the radiation therapy alone (RT) group. The patients in the IC + RT group were treated with IC using 2?C3 cycles of cisplatin (80 mg/m²) and fluorouracil (500 mg/m²), repeated every 3 weeks, followed by radiotherapy. Those in the CCRT group were treated with weekly cisplatin (40 mg/m²) for 6?C7 cycles during radiotherapy. In the IC + CCRT group, the chemotherapy prior to radiation was similar to the cisplatin?Cfluorouracil regimen in the IC + RT group, whereas it cisplatin regimen was identical to that in the CCRT group. The results show that RKIP is an independent prognostic factor for 5-year distant metastasis?Cfree survival (DMFS), overall survival (OS), and progression-free survival (PFS). Patients with high RKIP expression benefited more from reduced metastasis in the IC + RT and the IC + CCRT group, with improved OS and PFS in each treatment group compared with that among patients with low RKIP expression. In the high RKIP expression subgroup, chemotherapy combined with radiotherapy improved the DMFS when compared with the RT group, but this effect was not observed in the low RKIP expression subgroup. RKIP was predictive of distant metastasis with good sensitivity and specificity. Clinically, high RKIP expression inhibited distant metastasis in advanced NPC, and its detection might be used to predict distant metastasis with good sensitivity and specificity. The effect of chemotherapy on distant metastasis in combined chemoradiotherapy might be related to the RKIP expression level. Patients with high RKIP expression showed more improved OS and PFS than their low RKIP expression counterparts. Higher RKIP expression improves the DMFS of patients who receive inductive high-dose cisplatin-based chemoradiotherapy, with or without concurrent cisplatin. Low RKIP expression is also a predictive marker for cancer progression and metastasis, which could be used to stratify patients with high risk of metastasis and death.     

食管癌同步放化疗的疗效及预后因素分析

目的 探讨食管癌同步放化疗的疗效及影响预后的因素。方法 2008—2015年符合入组条件的食管鳞癌患者135例。采用2DRT (56例)或3DRT (79例)技术60~64 Gy (1.8~2.0 Gy/次),同步化疗采用氟尿嘧啶+顺铂或紫杉醇+顺铂方案,分别在放疗的第1、5周给予。采用Kaplan-Meier法计算OS、PFS率并Logrank检验及单因素分析,Cox模型行多因素分析。结果 1、3、5年样本数分别为96、31、16例,OS率分别为74.0%、39.0%、28.6%,中位OS期为25个月;PFS率分别为57.3%、27.3%、16.6%,中位PFS期为15个月。单因素分析结果显示临床分期、放疗方式、M分期是影响OS和PFS的因素(P=0.006、0.000、0.032和0.017、0.004、0.000)。多因素结果显示临床分期、放疗方式是影响OS和PFS的因素(P=0.006、0.000和0.033、0.023)。结论 对于非手术治疗的食管癌患者,根治性同步放化疗应作为首选治疗方案,疗效和耐受性可。     

不同转移部位对广泛期小细胞肺癌患者治疗 预后的影响

背景与目的:小细胞肺癌(small cell lung cancer,SCLC)是肺癌中恶性程度最高的病理学类型,易发生远处转移,转移部位及肿瘤负荷对患者的预后有一定预测作用.比较不同远处转移部位及转移器官个数对广泛期SCLC患者预后的影响,以期为临床决策提供参考.方法:收集2014年5月—2019年2月在同济大学附属...     

Propensity score matching analysis of cisplatin-based concurrent chemotherapy in low risk nasopharyngeal carcinoma in the intensity-modulated radiotherapy era

Background

Patients with stage II nasopharyngeal carcinoma were reported to benefit from adding cisplatin-based concurrent chemotherapy to two-dimensional conventional radiotherapy. But this benefit becomes uncertain in the intensity-modulated radiotherapy (IMRT) era, owing to its significant advantage.

Methods

We enrolled 661 low risk (T1N1M0, T2N0-1M0 or T3N0M0, the 2010 UICC/AJCC staging system) patients who underwent IMRT with or without concurrent chemotherapy. Particularly, patients with IMRT alone or IMRT plus cisplatin-based concurrent chemotherapy were equally matched using propensity-score matching method. Overall survival (OS), distant metastasis-free survival (DMFS) and locoregional relapse-free survival (LRFS) were assessed with Kaplan-Meier method, log-rank test and Cox regression.

Results

Among 661 patients, IMRT alone achieved parallel OS (P = 0.379), DMFS (P = 0.169) and LRFS (P = 0.849) to IMRT plus concurrent chemotherapy. In the propensity-matched cohort of 482 patients, similar survival were observed between both arms (4-years OS 97.4% vs 96.1%, P = 0.134; DMFS 96.5% vs 95.1%, P = 0.763; LRFS 93.8% vs 91.5%, P = 0.715). In multivariate analysis, cisplatin-based concurrent chemotherapy did not lower the risk of death, distant metastasis or locoregional relapse. And this association remained unchanged in subgroups by age, sex, histology and stage.

Conclusions

In this study, low risk nasopharyngeal carcinoma patients who underwent IMRT could not benefit from cisplatin-based concurrent chemotherapy.     

诱导化疗加三维适形放疗同步化疗不可手术的局部晚期非小细胞肺癌的疗效分析

目的 探讨诱导化疗+三维适形放疗(3DCRT)联合顺铂单药(每周方案)同步化疗不可手术的局部晚期非小细胞肺癌(NSCLC)的疗效和毒副反应.方法 76例局部晚期NSCLC患者(ⅢA期42例,ⅢB期34例)先接受2个周期的诱导化疗,再行3DCRT(DT 64～74 Gy,中位68 Gy)+同步顺铂(25 mg/m2,每周1次,共6～7周)化疗.结果 诱导化疗后2例达CR,32例达PR,有效(CR+PR)率为45%.同步化放疗后8例达CR,47例达PR,有效率为72%.全组中位生存期和中位无进展生存期分别为16.6个月和10.3个月,1、2、3年总生存率和无进展生存率分别为67%、35%、21%和42%、15%、6%.ⅢA期和ⅢB期的中位生存期、中位无进展生存期分别为19.7个月和15.6个月、10.8个月和9.4个月.主要的毒副反应为放射性食管炎、放射性肺炎、恶心呕吐和白细胞减少.治疗后45例肿瘤局部复发或(和)远处转移,其中4例照射野内复发,3例癌性胸水,38例远处转移.结论 诱导化疗后3DCRT+顺铂单药同步化放疗不可手术的局部晚期NSCLC的疗效和耐受性较好,可进一步研究.     

术后放疗在T1-2N0M0期SCLC治疗中的意义

目的 探讨术后放疗对早期SCLC预后影响。方法 回顾分析我院1997—2010年临床分期为T_1-2N₀M₀期且行根治性切除术的71例SCLC患者临床资料,31例术后放疗,55例术前或术后化疗。Kaplan-Meier法计算LR率、远处转移率及生存率并Logrank法检验及单因素预后分析,Cox模型多因素预后分析。结果 5年样本数32例,5年OS率及LR率分别为52%和22%,术后是否放疗对生存无影响(P=0.524)。对于术后N (-)患者行放疗与未行放疗者中位OS分别为47.3个月与96.8个月(P=0.561),5年LR率分别为39%与23%(P=0.934)。对于术后N (+)患者行放疗者中位生存明显高于未行放疗者(66.7、34.6个月,P=0.016),行放疗者5年LR率亦明显低于未行放疗者(5%、75%,P=0.004)。全组患者远处转移率为30%,术后放疗与否对患者远处转移率无影响(P=0.576)。结论 术后放疗明显降低了术后N (+) SCLC患者LR率并提高了生存,而对N (-)患者反而有降低生存趋势,建议术后N (+)的SCLC患者行术后放疗。     

局部晚期胃癌根治术后复发部位分析及对术后放疗意义的探讨

目的 分析局部晚期胃癌根治术后(＞D1术)患者首次失败部位和影响复发的因素,评估术后辅助同期放化疗的必要性.方法 对2002-2004年在本院接受胃癌根治术(R0切除,＞D1淋巴结清扫)、病理诊断为T3～4N0～1M0期或TxN2～3M0期,复查超过1年且有完备医学书写记录的297例患者的临床、病理资料进行回顾分析.Ⅱ、Ⅲa,Ⅲb,Ⅳ期(M0)患者分别占19.5%、52.2%、17.8%、10.4%.76.1%患者接受了术后辅助化疗,仅2例接受了术后放疗.结果 全组中位随访时间61个月,随访率为92.3%.145例患者出现术后复发,中位复发时间26个月.复发患者中局部区域复发82例,与全组远处转移的79例相当.局部区域复发部位主要为残胃、吻合口、腹腔或腹膜后淋巴结;远处转移最多见于肝脏和肺.单因素分析影响局部区域复发的主要临床病理因素为病理类型(χ2=11.50,P=0.009)、淋巴结检出总数(χ2=6.65,P=0.010)、淋巴结阳性(χ2=5.80,P=0.016)、淋巴结包膜受侵(χ2=5.15,P=0.023)和病理分期(χ2=7.86,P=0.049).多因素分析显示病理类型、淋巴结检出总数、病理分期和Borrmann分型为影响局部区域复发的独立预后因素(χ2=6.77、19.33、17.84、6.02,P=0.009、0.000、0.000、0.014).结论 胃癌根治术后、＞D1淋巴结清扫且接受术后化疗者术后局部区域复发仍为主要失败原因,建议对局部区域复发高危患者行术后同期放化疔的前瞻性研究.

Abstract：

Objective The benefit of adjuvant chemoradiotherapy remains controversial for gastric cancer patients treated with more than D1 dissection. This retrospective analysis is to distinguish the first site of recurrence in patients treated with curative resection and more than D1 dissection and to find any feasible adjuvant concurrent chemoradiotherapy recommendation for them. Methods All patients treated between January 2002 and December 2004 who met the following criteria were analyzed: primary gastric or gastroesophageal cancer, underwent curative gastrectomy ( UICC R0 ) and more than D1 lymphadenectomy,pathologically staged as T3-4N0-1 M0, or any Tx N2-3M0. There were 297 patients analyzed and 19.5%,52. 2%, 17. 8% , 10. 4% of patients had stage Ⅱ ( T3 N0 M0, T1 N2 M0 ), Ⅲa, Ⅲb and Ⅳ ( M0 ) diseases,respectively. 76. 1% of patients received adjuvant chemotherapy, while Only 2 patients underwent adjuvant radiotherapy. Failure patterns and the prognostic factors for locoregional recurrence were analyzed. Results The median follow-up time was 61 months and the follow-up rate was 92. 3%. 145 patients developed recurrence with a median recurrent time of 26 months. Locoregional recurrence was observed in 82 patients and distant metastasis in 79 patients. Gastric stump, anastomosis, intra-abdominal lymph nodes were the most common sites of locoregional recurrence. Liver and lung were the most frequent sites of distant metastasis. Prognostic variables for locoregional recurrence were identified after univariate analysis,including pathologic type ( χ2 = 11.50, P = 0. 009 ), total number of dissected lymph nodes ( χ2 = 6. 65,P =0. 010), the number of positive lymph node ( χ2 =5. 80,P =0. 016), lymph node capsular invasion ( χ2 =pathologic type, total number of dissected lymph nodes, lymph node capsular invation, AJCC TNM stage and Borrmann type were independent prognostic factors for locoregional recurrence ( χ2 = 6. 77,19. 33,17. 84 and 6. 02,P =0. 009,0. 000,0. 000 and 0. 014). Conclusions Locoregional recurrence remains the main cause of failure for locally advanced gastric or gastroesophageal cancer patients even though the patients have had more than D1 lymphadenectomy. The role of adjuvant concurrent hemoradiotheray for those patients is warranted.     

93例复发性卵巢癌疗效分析

目的预测卵巢癌易复发因素,分析复发性卵巢癌(ROC)患者的疗效与预后。方法回顾性分析93例ROC患者的临床资料。采用单变量分析ROC患者无瘤生存期(DFI)影响因素。评估不同治疗方法对ROC患者无进展生存期(PFS)和复发后总生存时间(OS)的影响。结果初次治疗后DFI单变量分析显示:肿瘤的组织分化程度、临床分期、初次术后残留肿瘤大小、初次手术后化疗疗程数与DFI有关(均P<0.05)。93例ROC患者中,手术组:44例患者行二次肿瘤细胞减灭术(SCS),并联合化疗和(或)靶向治疗;非手术组:49例患者行单纯化疗和(或)靶向治疗。手术组PFS和复发后OS均较非手术组有所延长;手术组中:CA125≤150 U/L的患者OS和PFS较CA125>150 U/L的患者均有所延长(均P<0.05);术前影像学检查提示复发肿瘤个数≤3的患者术后OS和PFS较复发肿瘤个数>3的患者均有所延长(P<0.05)。结论肿瘤病理分化程度越高、临床分期越早、初次术后残余病灶越小以及术后化疗疗程越规范足量的卵巢癌患者DFI越长、复发越晚。卵巢癌复发时CA125≤150 U/L、影...     

Relationship Between the SER Treatment Period and Prognosis of Patients with Small Cell Lung Cancer

Purpose: To explore the relationship between SER (time between the start of any treatment and the end of radiation therapy) and the survival of patients with limited-stage small cell lung cancer. Materials and Methods: Between 2008 and 2013, 135 cases of limited-stage small cell lung cancer (LS-SCLC) treated with consecutively curative chemoradiotherapy were included in this retrospective analysis. In terms of SER, patients were divided into early radiotherapy group (SER<30 days, n=76) and late radiotherapy group (SER≥30 days, n=59) with a cutoff of SER 30 days. Outcomes of the two groups were compared for overall survival. Results: For all analyzable patients, median follow-up time was 23.8 months and median overall survival time was 16.8 months. Although there was no significant differences in distant metastasis free survival between the two groups, patients in early radiotherapy group had a significantly better PFS (p=0.003) and OS (p=0.000). Conclusions: A short SER may be a good prognostic factor for LD-SCLC patients treated with concurrent chemoradiotherapy.