食管癌同期放化疗不同放疗剂量远期疗效分析

目的 比较食管癌同期放化疗不同放疗剂量的LC、长期OS及临床不良反应情况。方法 选取2004—2013年间本院接受同期放化疗的373例食管鳞癌患者,根据放疗剂量分为<60 Gy组99例、60 Gy组155例、>60 Gy组119例。采用Kaplan-Meier法计算LC、OS率并Logrank检验和单因素预后分析,Cox模型多因素预后分析。结果 放疗剂量<60 Gy组,60 Gy组和>60 Gy组3、5、7、10年样本量分别为97、96、56、38例,146、141、72、17例和118、115、56、20例,其LC率分别为55.3%、51.4%、48.9%、48.9%,65.1%、60.1%、55.1%、55.1%和49.4%、45.1%、37.7%、37.7%(8年)(P=0.020);OS率分别为35.4%、26.1%、22.0%、22.0%,49.0%、41.3%、32.1%、28.9%和31.1%、25.2%、14.5%、12.9%(8年)(P=0.000)。单因素分析结果显示肿瘤体积≤44 cm³、Ⅰ—Ⅱ期患者60 Gy组LC率优于<60 Gy组(P=0.040、0.035),而OS率则优于其他两组(P=0.001、0.003,P=0.045、0.006);而对于肿瘤体积>44 cm³、Ⅲ期患者60 Gy组LC率优于>60 Gy组(P=0.011、0.015),OS率优于其他两组(P=0.045、0.006,P=0.033、0.002)。>60 Gy组RE、RP发生率高于其他两组(P=0.007、0.033)。多因素分析结果显示放疗剂量及非手术T分期、N分期是预后影响因素(P=0.004、0.008、0.037)。结论 食管癌同期放化疗剂量以60 Gy为优,接受>60 Gy放疗剂量患者不良反应显著增加。     

1837例鼻咽癌疗效的回顾性分析

目的 总结我院鼻咽癌常规放疗的疗效和经验.方法 回顾性分析2000年1月至2003年12月收治的1837例经病理证实的初治鼻咽癌患者.年龄8～87岁(48岁),男1403例,女434例,男:女=3.2:1.1992年福州分期T1、T2、T3、T3期分别为364、995、274、204例,N0、N1、N2、N3期分别为412、801、514、110例.Ⅰ、Ⅱ、Ⅲ、ⅣA、ⅣB期分别为77、777、668、291、24例.959例局部晚期患者中,单纯放疗363例,综合治疗596例.855例接受以顺铂为基础化疗.鼻咽原发病灶主要采用60Coγ线、6MV X线常规分割照射,1.8～2.0 Gy/次,总剂量30.6～74.0 Gy.常规放疗结束后如鼻咽镜或CT提示有肿瘤残存者,则通过耳后野、颅底野、后装及适形加量6～20 Gy.颈部放射源用60Coγ线、180 kV X线和9 MeV电子束,N0期患者仅照射上颈部,有颈部转移者照射全颈.预防总剂量50～56 Gy,根治总剂量60～68 Gy.结果 中位随访54个月,5年总生存率、无瘤生存率、无复发生存率、无远处转移生存率分别为67.42%、63.25%、86.47%和80.31%.Ⅰ、Ⅱ、Ⅲ、ⅣA、ⅣB期的5年生存率分别为88%、74.8%、65.9%、52.4%、20%.Ⅲ+ⅣA期959例中单纯放疗、综合治疗的5年生存率分别为63.7%和60.7%(P=0.216).Ⅲ期668例中单纯放疗(279例)和综合治疗(389例)的5年生存率分别为65.2%和66.5%(P=0.810).单因素分析显示与总的牛存有关的因素有性别、T分期、N分期、M分期、92福州分期、贫血、治疗前LDH水平、化疗、后装治疗及面颈联合野.多因素Cox回归分析显示性别、T分期、N分期、92福州分期与总生存有关.结论 鼻咽癌常规治疗5年生存率达67.4%,总生存与性别、T分期、N分期、M分期、福州分期、贫血等有关.     

The role of radiotherapy for thymic carcinoma

OBJECTIVE: The aim of this study is to evaluate retrospectively the role of radiotherapy for thymic carcinoma. METHODS: Between 1973 and 1998, 14 patients with thymic carcinoma were treated at Gunma Prefectural Cancer Center. Two patients who had hematogenous metastasis were excluded from this study, therefore 12 patients were analyzed. The Masaoka staging system was used; four patients were diagnosed with stage III disease and eight patients with stage IV disease. The pathological subtype according to the World Health Organization histological criteria for thymic tumors was squamous cell carcinoma (low-grade histology) in six cases and undifferentiated carcinoma (high-grade histology) in six. Ten patients underwent thoracotomy, and two patients underwent excisional biopsy without thoracotomy. Ten patients (83%) received radiotherapy as a curative intent, and the median dose was 60 Gy. Systemic chemotherapy was administered to four patients (33%), and the majority (75%) of the regimens contained cisplatin. RESULTS: The 3-year overall survival rate was 25%. Histological subtype (low-grade versus high-grade), surgical resection (complete versus incomplete), radiotherapy and chemotherapy were evaluated as prognostic factors in a univariate analysis. Low-grade histology and complete resection were good prognostic factors, although these were not statistically significant. Patients who received radiotherapy had a better outcome than those who did not. The major sites of recurrence were the pleura and pericardium. Recurrence within the radiation field was observed in one of seven patients in whom failure patterns could be evaluated. CONCLUSION: Complete resection is mandatory if possible. Radiotherapy plays an important role in treating thymic carcinoma in terms of reducing local recurrence and prolonging survival time. Establishment of an innovative treatment protocol that includes chemotherapy is necessary to control intrathoracic relapse and distant metastasis.     

Incompletely resected rectum, recto-sigmoid, or sigmoid carcinoma: results of postoperative radiotherapy and prognostic factors

Postoperative radiotherapy was given in 40 patients with gross or microscopic pathologically proven residual disease after surgical resection of rectum, recto-sigmoid, or sigmoid carcinoma. The radiotherapy target volume included the pelvis with (9 patients) or without (31 patients) the perineum. Median total dose of radiation was 50 Gy (range 30-60). One patient received 30 Gy, 10 received greater than 30 to 40 Gy, 13 received greater than 40 to 50 Gy, and 16 patients received greater than 50 to 60 Gy. The median follow-up in the survivors (16 patients) was 53 months (range: 16-85). Probability of survival with censoring for death due to intercurrent disease was 36% at 5 years. Survival for patients with microscopic residual disease (21 patients) was 40% at 5 years compared to 12% for those with gross residual disease (19 patients) (p = 0.09). Twenty-five patients relapsed. All but one relapse occurred earlier than 50 months after radiotherapy. Approximately half (12/25) of the relapses were observed within 6 months after radiotherapy. Local relapse inside the radiotherapy portals was observed in 9/40 (22%) patients. Therapy-related urogenital complications occurred in no patient and gastro-intestinal complications in three patients (7%). In one patient they were scored WHO grade 4 and in two patients WHO grade 3. Prognostic factors were analyzed using the Cox proportional hazards model. For survival differentiation, grade (p less than 0.001), stage (p = 0.04), and perineal irradiation (p = 0.03) were independent prognostic factors. With relapse-free survival as the endpoint, only stage (p = 0.003) was a statistically significant prognostic factor. There was a trend toward a better relapse-free survival when the perineum was included in the radiation portals (p = 0.09).     

早期非小细胞肺癌放疗预后影响因素分析

 目的　分析早期非小细胞肺癌（NSCLC）放射治疗的疗效及预后影响因素。方法　收集不能或不愿手术的早期NSCLC患者81例。其中鳞状细胞癌60例,腺癌16例,腺鳞癌及未分型癌5例。常规放疗45例,三维适形放疗36例;剂量为50～96 Gy。Kaplan-Meier法和Log-rank法比较生存率,Cox回归分析法进行多因素分析。结果　全组中位生存时间34个月,总1、3、5年生存率分别为88.7 %、41.9 %、21.8 %。单因素分析显示：不同Karnofsky评分（χ2＝19.56,P＝0.000）、临床分期（χ2＝8.83,P＝0.003）、肿瘤直径（χ2＝8.13,P＝0.004）、近期疗效（χ2＝14.87,P＝0.000）对生存影响差异有统计学意义。多因素回归分析显示放射治疗前Karnofsky评分（χ2＝11.27,P＝0.001）和肿瘤直径（χ2＝4.89,P＝0.027）是影响早期NSCLC患者预后的独立因素。结论　放射治疗前Karnofsky评分、肿瘤直径对早期NSCLC患者放射治疗的预后可能产生明显影响。     

Effectiveness of accelerated radiotherapy for patients with inoperable non-small cell lung cancer (NSCLC) and borderline prognostic factors without distant metastasis: a retrospective review

Purpose: The standard treatment for patients with unresectable or medically inoperable non-small cell lung cancer (NSCLC) and good prognostic factors (e.g., weight loss [WL] ≤5% and Karnofsky performance status [KPS] ≥70) is induction chemotherapy followed by definitive radiotherapy to the primary site at 1.8–2.0 Gy per fraction with a total dose of 60–63 Gy to the target volume. Patients with poor prognostic factors usually receive radiotherapy alone, but the fractionation schedule and total dose have not been standardized. To attempt to optimize irradiation doses and schedule, we compared the effectiveness of accelerated radiotherapy (ACRT) alone to 45 Gy at 3 Gy per fraction with standard radiation therapy (STRT) of 60–66 Gy at 2 Gy per fraction in regard to tumor response, local control, distant metastasis, toxicity, and survival.

Methods and Materials: Fifty-five patients treated with radiation for NSCLC at The University of Texas M. D. Anderson Cancer Center between 1990 and 1994 were identified. All 55 patients had node-positive, and no distant metastasis (N+, M0) of NSCLC. Two cohorts were identified. One cohort (26 patients) had borderline poor prognostic factors (KPS less than 70 but higher than 50, and/or WL of more than 5%) and was treated with radiotherapy alone to 45 Gy over 3 weeks at 3 Gy/fraction (ACRT). The second cohort (29 patients) had significantly better prognostic factors (KPS ≥70 and WL ≤5%) and was treated to 60–66 Gy over 6 to 6 weeks at 2 Gy per fraction (STRT) during the same period.

Results: In the first cohort treated by ACRT, the distribution of patients by AJCC stage was IIB 8%, IIIA 19%, and IIIB 73%. Sixty-two percent had KPS <70, and 76% had a WL of >5%. The maximum response rate as determined by chest X-ray was 60% among 45 of 55 patients who were evaluable for response: combined complete responses (20%) and partial responses (40%). Overall survival in these patients was 13% at 2 and 5 years, with a locoregional control rate of 42% and a freedom from distant metastasis rate of 54%. The ACRT cohort treated with 3 Gy per fraction had significantly lower KPS scores (p = 0.003) and greater WL (p = 0.063) than the cohort STRT treated with 2 Gy per fraction. However, treatment results and toxicity were not significantly different between the two cohorts in spite of significantly better prognostic factors in the STRT cohort.

Conclusions: Despite having worse prognostic factors, the cohort treated with radiotherapy alone to 45 Gy at 3 Gy per fraction over 3 weeks (ACRT) had response rates, locoregional control, and overall survival comparable to those in the cohort treated by a total dose of 60–66 Gy at 2 Gy per fraction over 6 to 6 weeks (STRT). Given that accelerated treatment schedules decrease treatment time and cost less, these may, in the current health care environment, be important factors for health care providers to consider in treating patients who have locally advanced NSCLC and borderline poor prognostic factors.     

非高发地区初诊远处转移鼻咽癌患者生存及预后的单中心分析

  目的  分析非高发地区初治远处转移鼻咽癌患者的生存情况及预后因素。  方法  回顾性分析2008年6月至2015年12月四川省肿瘤医院收治的91例初诊远处转移鼻咽癌患者,所有患者均接受原发灶的根治性放疗,放疗剂量为66.0~76.6 Gy（中位剂量71.0 Gy）。87例患者采用以铂类为基础的化疗方案（1~7个周期）,未行化疗4例,放疗期间同步靶向治疗17例（尼妥珠单抗或西妥昔单抗）。初治时完成转移灶的局部治疗49例（放疗48例,孤立肺转移手术1例）。患者治疗结束后每3个月随访1次。采用KaplanMeier法计算生存率,采用Cox回归模型进行多因素分析。  结果  中位随访时间41个月。患者1、2、3年生存率分别为83.4%、58.6%、43.3%,中位生存期为32（6~87）个月。转移灶数目>3个（P=0.020）及转移灶无局部治疗（P=0.034）是患者总生存预后不良的独立影响因素。  结论  对于初诊远处转移鼻咽癌,予原发灶根治性放疗（≥66.0 Gy）剂量联合转移灶局部治疗可以改善患者生存率。      

90例皮肤癌放射治疗临床分析

目的　回顾性分析单纯放射治疗的皮肤癌病例。探讨其临床疗效、美容效果及影响因素。方法　对1986年1月～1992年12月经病理证实,单纯放射治疗的皮肤癌共90例进行了回顾性分析。结果　总的5年生存率为68.9%,其中:T1期93.3%,T2期75%,T3期556%,T4期375%。T分型越早,5年生存率越高(P<0.05)。基底细胞癌5年生存率811%,鳞状细胞癌5年生存率60.4%,基底细胞癌5年生存率高于鳞状细胞癌(P<0.05)。照射剂量<60Gy5年生存率38.5%,60～70Gy为742%,>70Gy为714%,<60Gy组5年生存率低于60～70Gy组(P<0.05);>70Gy组与60～70Gy组5年生存率相仿(P>0.05)。浅层X线与电子束治疗5年生存率分别为667%及718%,差异无意义(P>0.05)。1度、2度、3度远期放射性皮肤反应在浅层X组分别为533%、367%、10%,电子束组分别为843%、125%、31%,浅层X线组美容效果较电子束组差(P<005)。结论　皮肤癌放射治疗的疗效与T分期、病理类型有关,照射剂量以60～70Gy/6～7周为宜。电子束治疗皮肤癌在美容效果方面优于浅层X线。     

196例鼻咽癌患者疗效分析

目的:回顾性分析鼻咽癌治疗疗效,并分析影响预后的因素。方法:对在我科接受根治性放射治疗的196例鼻咽癌患者进行随访,所有患者均接受6MV-X线照射,剂量范围64～80Gy。其中37例患者配合化疗,化疗方案均采用5-FU DDP,化疗周期2～4周期。结果:全组患者5年和10年的总生存率分别为53.10%和39.90%。单因素分析发现,性别、临床分期、T分期、N分期、原发灶剂量和下颈淋巴引流区剂量是影响预后的因素。多因素分析仅提示临床分期明显影响预后。结论:鼻咽癌放射治疗的疗效确切,临床分期、T分期、N分期是影响预后最主要的因素,提高早期患者的检出率是提高治疗鼻咽癌疗效的关键。     

202例老年鼻咽癌放化疗疗效分析

目的 回顾分析初诊老年鼻咽癌的放、化疗结果、不良反应和预后因素。方法 2004—2007年共202例60岁以上的初诊老年鼻咽癌患者在本院接受根治性放疗或化疗,男165例、女37例,中位年龄65岁。AJCC第六版分期标准Ⅰ期1例、Ⅱ期25例、Ⅲ期120例、Ⅳ a或Ⅳ b期56例。所有患者放疗剂量≥66 Gy,72、3%(146例)局部进展期患者联合化疗。Cox 法多因素预后分析。结果 随访率为100%。5年局部控制率、区域淋巴结控制率、无远处转移生存率、无瘤生存率及总生存率分别为93%、94%、82%、74%及和67%。经多因素分析发现肿瘤T、N分期及年龄是影响总生存及无远处转移生存的预后因素(P=0、006、0、002、0、008及0、020、0、002、0、022)。严重的急性不良反应包括4级放射性皮炎1例(0、5%)、放射性黏膜炎2例(1、0%)、骨髓抑制5例(2、5%)。结论 老年鼻咽癌患者放化疗耐受性可,针对分期较晚及一般状态较好的60~74岁患者应采取积极的综合治疗。     

Improving Outcomes in NSCLC: Optimum Dose Fractionation in Radical Radiotherapy Matters

IntroductionWe analyzed a comprehensive national radiotherapy data set to compare outcomes of the most frequently used moderate hypofractionation regimen (55 Gy in 20 fractions) and conventional fractionation regimen (60–66 Gy in 30–33 fractions).MethodsA total of 169,863 cases of NSCLC registered in England from January 2012 to December 2016 obtained from the Public Health England were divided into cohort 1 (training set) diagnosed in 2012 to 2013 and cohort 2 (validation set) diagnosed in 2014 to 2016. Radiotherapy data were obtained from the National Radiotherapy Dataset and linked by National Health Service number to survival data from the Office of National Statistics and Hospital Episode Statistics, from which surgical data and Charlson comorbidity index were obtained. Of 73,186 patients with stages I to III NSCLC, 12,898 received radical fractionated radiotherapy (cohort 1—4894; cohort 2—8004). The proportional hazards model was used to investigate overall survival from time of diagnosis. Survival was adjusted for the prognostic factors of age, sex, stage of disease, comorbidity, other radical treatments, and adjuvant chemotherapy, and the difference between the treatment schedules was summarized by hazard ratio (HR) and 95% confidence interval. The significance of any difference was evaluated by the log likelihood test.ResultsOf patients with stages I to III NSCLC, 17% to 18% received radical fractionated radiotherapy. After adjustment for independent prognostic factors of age, stage, comorbidity, and other radical and adjuvant treatments, patients in cohort 1 treated with the 2.75 Gy per fraction regimen had a median survival of 25 months compared with 29 months for patients treated with the 2 Gy per fraction regimen (HR = 1.16, p = 0.001). Similarly, in cohort 2, the respective median survival values were 25 and 28 months (HR = 1.10, p = 0.02).ConclusionsBig data analysis of a comprehensive national cohort of patients with NSCLC treated in England suggests that compared with a 4-week regimen of 55 Gy in 20 fractions, a 6-week regimen of conventional daily fractionation to a dose of 60 to 66 Gy at 2 Gy per fraction is associated with a survival benefit. Within the limitations of the retrospective big data analysis with potential selection bias and in the absence of randomized trials, the results suggest that conventional fractionation regimens should remain the standard of care.     

Influence of hemoglobin levels on survival after radical treatment of esophageal carcinoma with radiotherapy

Introduction The objetive was to investigate the possible progn ostic value of blood hemoglobin concentration in the outcome of radical treatment for locally advanced esophageal carcinoma. Materials and method This was a retrospective analysis of data for 85 patients treated for locally advanced esophageal carcinoma between January 1991 and January 1997 with chemoradiotherapy alone or as neoadjuvant therapy. All patients received chemotherapy (4 cycles of cisplatin 100 mg/m² on day 1, and continuous infusion 5-fluorouracil 1 g/m² per day on days 1–5) with concomitant radiotherapy (40 Gy at 2 Gy/session to the esophageal tumor and mediastinum). The response was evaluated after 4 weeks. 69 patients continued toreceive chemoradiotherapy only to a total dose of 60–64 Gy to the esophageal tumor with a 2-cm margin. Sixteen patietns underwent radical surgery. Hemoglobin levels were measured before combined treatment in all patients. The prognostic value of hemoglobin concentration was analyzed statistically, along with other patient-, tumor- and treatment-related factors. Results Mean follow-up time: 82 months (range 60–99 months). Chemoradiotherapy was followed by an overall clinical response of 69.4%, with complete clinical response in 24.7% of the patients. Mean survival time was 12 months, and overall likelihood of survival after 3 years was 13%. Mean time to progression: 5 months. Median survival time was 12 months in the 69 patients who underwent chemoradiotherapy alone, and 26 months in patients who underwent radical surgery. Univariate analysis showed a hemoglobin value of >13 g/dl to be a prognostic factor for better survival, along with performance status according to the ECOG classification, weight loss <10%, tumor stage, tumor length, and complete response to chemoradiotherapy. Multivariate analysis showed that only hemoglobin concentration was an independent prognostic factor: for each unit increase in hemoglobin level, the risk of death from esophageal carcinoma decreased by 5%. In the subgroup of patients who did not undergo surgery, hemoglobin concentration was also an independent prognostic factor along with complete clinical response. Conclusions As found for other solid tumors, hemoglobin level was a determining factor in the prognosis for treatment outcome in patients with esophageal carcinoma. Our findings require confirmation in randomized studies and further documentation of the probable benefits of correcting hemoglobin levels.     

Definitive radiotherapy for carcinoma of the vagina: Outcome and prognostic factors

: Primary carcinoma of the vagina is an uncommon tumor. Because of the long-standing interest in this disease at our institution a substantial number of patients with this disease has been accumulated, and this retrospective review was performed to define disease outcome, to delineate significant prognostic factorsm and to provide treatment guidelines. : This was a retrospective review of 301 patients with vaginal carcinoma (271 with squamous cell and 30 with adenocarcinoma) who received definitive radiotherapy between 1953 and 1991. Prognostic factors for outcome (local control, pelvic control, metastatic relapse, survival, and complications) were evaluated using univariate and multivariate techniques. : Patients disease was staged using the International Federation of Gynecology and Obstetrics (FIGO) system, and stages were distributed as follows: 0, 37 (12%); I, 65 (22%); II, 122 (40%); III, 60 (20%); and IVA, 17 (6%). Treatment varied according to stage, with brachytherapy predominating for early disease by external beam playing a prominent role for more advanced disease. Patients with in situ disease received brachytherapy alone ot transvaginal orthovoltage irradiation. FOr Stage I, brachytherapy alone was used in 25, external beam and brachytherapy in 38, and transvaginal alone in 2. For Stage II, brachytherapy alone was used in 20, external and brachytherapy in 66, and external irradiation alone in 36. For stage III, external and brachytherapy was used in 15, and external alone in 45. Two patients with Stage IVA received brachytherapy alone, 10 received a combination of external and brachytherapy, and 6 received external irradiation alone. Total doses ranged from 10 to 154 Gy (mean 74.7 Gy, median 70.0 Gy), but only 18 (6%) received less than 55 Gy. At a median follow-up of 13 yearsm the 5-, 15-, 20-, ans 25-year survival rates were 60%, 49%, 38%, and 23%, respectively. Beyond 5 years the survival rates relative to those for age-matched females in the general population were between 50 and 65%. Actuarial local recurrence rates were 23%, and 26% at 5, 10, and 15 years. Actuarial pelvic relapse rates were 26%, 30% and 31% at 5, 10, and 15 years, and metastatic rates at those times were 15%, 18%, and 18%. Adenocarcinoma (nonclear cell) was a significantly worse disease than squamous cell carcinoma. The major determinants of local control for squamous carcinoma were tumor bulk (specified by size in centimeters, or by FIGO stage), tumor site (upper lesions faring better than other), and tumor circumferential location (lesions involving the posterior wall faring worse). Tumor bulk was an important determinant of metastatic relapse, but failure to acieve local control was also an independently significant determinant of metastases. Salvage after forst relapse was uncommon and the survival rate at 5 years after relapse was only 12%. Serious complictions occured in 39 patients with an actuarial incidence of 19% at 20 years. : Vaginal carcinoma poses a formidable therapeutic challenge. The disease is heterogeneous with respect to its prognostic factors. Nonclear cell adenocarcinoma has an extremely poor prognosis and should be distinguished from squamois carcinoma. Both external beam and brachytherapy play crucial roles in management and most patients with disease beyond in situ should receive a significant component of external irradiation prior to brachytherapy.     

食管癌术后区域性复发的放疗

目的探讨食管癌根治术后不同部位复发放疗的疗效和预后影响因素。方法回顾性分析110例食管癌根治术后不同部位复发的病例，其中单纯颈部淋巴结转移17例，纵隔淋巴结转移72例，腹部淋巴结转移5例，吻合口复发16例。放疗采用^60Co或6MV X线，中位照射剂量为62Gy。结果全组放疗后1、2、3、4年总生存率和中位生存期分别为55．4％、30．4％、21．8％、14．5％和14个月。单因素分析显示肿瘤复发部位、症状缓解情况、近期疗效、术后T分期及放疗总剂量与预后有关；多因素分析显示症状缓解情况和术后临床分期为独立预后因素。结论食管癌术后复发放疗可以延长部分患者生存时间，手术时临床分期早以及放疗后症状缓解者预后较好。     

Cancer of the larynx in females

PURPOSE: The aim of this paper is to present results of analysis of 102 females with laryngeal cancer. MATERIALS AND METHODS: Between 1974 and 1995, 102 female patients with cancer of larynx were treated at Radiotherapy Department of Oncology Centre in Kraków. Twenty-six of them had positive familial oncological history. The treatment method depended on stage of disease. Primary radical irradiation was performed in 66 patients, 29 patients received postoperative radiotherapy after surgery (total or partial laryngectomy), seven patients received induction chemotherapy followed by laryngectomy with postoperative radiotherapy or radical irradiation. The median dose applied with radiotherapy was 60 Gy, and dose per fraction was 2 Gy. RESULTS: The actuarial 5-year rates were as follows: 88.9% for overall survival, 84.2% for disease-free survival, and 85.4% for local control. Only tumour stage and nodal involvement were found to be significant factor for all three endpoints. We found that younger patients had more supraglottic primary localisation, and these patients frequently were non-smoker. CONCLUSIONS: The tumour stage and nodal involvement were found to be significant prognostic factors in analysed group of female treated with laryngeal cancer.     

The investigation of <Superscript>125</Superscript>I seed implantation as a salvage modality for unresectable pancreatic carcinoma

Background

To assess the efficacy of intraoperative ultrasound-guided implantation of ¹²⁵I seeds for the treatment of unresectable pancreatic carcinoma, and analyze the associated prognostic factors.

Methods

Twenty-eight patients with pancreatic carcinoma who underwent laparotomy and were considered to have unresectable tumors were included in this study. Nine patients were pathologically diagnosed with Stage II disease, and nineteen patients with Stage III disease. Twenty-eight patients received intraoperative ultrasound-guided ¹²⁵I seed implantation and received a D₉₀ (at least 90% of the tumor volume received the reference dose) ranging from 60 to 163 Gy, with a median of 120 Gy. Seven patients received an additional 35–50 Gy external beam radiotherapy after seed implantation, and ten patients received two to ten cycles of chemotherapy. Overall survival of the patients was calculated and prognostic factors were evaluated.

Results

Of the patients, 94.1% (16/17) achieved good to medium pain relief. The tumor response rate was 78.6% (22/28), and local control was achieved in 85.7% (24/28) of patients. The 1-, 2- and 3-year survival rates were 30%, 11% and 4%, and the median survival was 10.1 months (95% CI: 9.0-10.9). Analysis using the Cox proportional hazards model suggested that patients younger than 60 years and patients who received a D₉₀ higher than 110 Gy may survive for a longer period.

Conclusions

I seed implantation provides a safe and effective method to relieve pain, control local tumor growth and, to some extent, prolong the survival of patients with stage II and III pancreatic disease, without additional complications. Age and accumulated dose may be factors predictive of a favorable outcome for patients with unresectable pancreatic carcinoma treated with ¹²⁵I seeds. These findings need to be validated by conducting further studies with larger cohorts.

     

Non-metastatic Ewing's sarcoma: twenty years of experience suggests that surgery is a prime factor for successful multimodality therapy.

Eighty-five patients (37 female, 48 male; median age 14 years) with non-metastatic Ewing's sarcoma received definitive treatment at the University of Texas M.D. Anderson Cancer Center between 1969 and 1988. Multidisciplinary therapy was administered as follows: combination chemotherapy (CC) and local radiotherapy (XRT): 65 patients; CC, XRT and surgery, 19 patients; and XRT and surgery, 1 patient. This permitted a 10-20 year follow-up for 75% of our patients. The overall survival at 5 and 10-20 years was 46.1%, and 37.2%, respectively. At 5 years, 80.5% of live patients had control of local disease. The influence of sex, age, ethnicity, primary site, size, lactic dehydrogenase (LDH) level, presence or absence of systemic symptoms, and XRT dose (<60 Gy and 相似文献   

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.     

114例宫颈癌术后放疗的临床分析

目的 回顾性分析宫颈癌患者术后放疗的疗效、晚期副反应及预后因素.方法 搜集2005年2月前6年接受术后放疗的ⅠA～ⅡB期官颈癌病例114例,其中年龄24～72岁(中位值42.5岁);FIGO临床分期ⅠA期6例、Ⅰb1期51例、Ⅰb2期18例、ⅡA期26例、ⅡB期13例;术后病理为鳞癌92例、腺癌19例、腺鳞癌2例、未分化癌1例.113例采用加速器6、15 MV X线盒式4个野常规放疗40～60 Gy(中位值50 Gy),81例放疗后4周加192Ir近距离治疗,参考点在阴道黏膜下T0.5 cm,1～6次,4～30Gy(中位值16 Gy).87例接受术前或(和)同步增敏化疗.随访5～75个月(中位值20个月),总随访率为92%.结果 2年总生存率、无瘤生存率、盆腔控制率分别为93.1%、88.1%、94.6%,5年总生存率、无瘤生存率、盆腔控制率分别为75.7%、62.3%、85.6%.淋巴结转移及阴道残端阳性为总生存率的独立预后因素,阴道残端阳性为盆腔控制率的独立预后因素,分期、子宫下段受累及阴道残端阳性为无瘤生存率的独立预后因素.16例患者远处转移,最常见转移部位为肺、腹股沟及骨、肝及脑.RTOG分级晚期直肠反应发生率1级11.4%、2级11.4%、3级3.5%,泌尿系反应发生率1级14.0%、2级6.1%、3级0.9%.治疗后出现下肢水肿者8例.结论 术后放疗在盆腔控制率上能达到较满意疗效,且放疗相关晚期副反应是可接受的,远处转移是致死主要问题.     

Multi-institutional study of radiation therapy for isolated para-aortic lymph node recurrence in uterine cervical carcinoma: 84 subjects of a population of more than 5,000

PURPOSE: Most patients who had any recurrent sites of cancer have been considered to be in their last stage of life. However, recent advances of clinical research reveal some patients achieve long-term survival even in recurrence. Furthermore, for patients who had only one recurrent region, radiation therapy could play an important role. As for uterine cervical carcinoma, the most common recurrent site other than the pelvis is the para-aortic lymph nodes. Thus we conducted the current study. PATIENTS AND METHODS: Between 1994 and 2003, more than 5,000 uterine cervical carcinoma patients were treated with curative intended treatments at 13 Japanese hospitals. Of these patients, 84 developed para-aortic lymph node recurrence as the only site of initial tumor progression. These patients were treated with external beam radiation therapy. Radiation therapy protocol was as follows: 1.7-2.0 Gy per fraction, 5 fractions per week, and the mean total dose was 50.8 Gy (25-60 Gy). RESULTS: Three- and 5-year overall survival rates of all patients were 49.5% and 31.3%, respectively. Stratified by symptom sign, 3-year overall survival rate of symptom positive was 27.6% and those of the negative was 56.1% (p = 0.018). Three-year overall survival rates of the total dose > or =51 Gy and that of < or =50 Gy were 58.0% and 42.8%, respectively (p = 0.07). As for morbidity, no patients received Grade 3 or greater late toxicity. CONCLUSIONS: The current study suggested that radiation therapy for isolated para-aortic lymph node recurrence in uterine cervical carcinoma could have a significant impact on survival.