局部晚期食管鳞癌新辅助放疗剂量与病理完全缓解关系分析

目的 探讨接受新辅助放化疗的局部晚期食管鳞癌患者新辅助放疗剂量与病理完全缓解(pCR)的关系。方法 收集2017-2019年间在四川大学华西医院肿瘤中心经病理确诊为食管鳞癌并接受新辅助放化疗和手术的 116例局部晚期患者临床资料。116例患者中 40~45Gy组 80例,≥45Gy组 36例,分析两组术后pCR率。结果 全组患者的pCR率为38.8%(45/116),40~45Gy组与≥45Gy组的pCR率分别为44%(35/80)和28%(10/36)(P=0.105)。结论 术前新辅助采用较高的放疗剂量不增加局部晚期食管鳞癌的pCR率,有必要进行前瞻性的临床研究确定合适的新辅助放疗剂量。     

Predictors of pathologic complete response in patients with residual flat mucosal lesions after neoadjuvant chemoradiotherapy for locally advanced rectal cancer

ObjectiveThe accurate prediction of tumor response to neoadjuvant chemoradiotherapy (nCRT) remains challenging. Few studies have investigated pathologic complete response (ypCR) prediction in patients with residual flat mucosal lesions after treatment. This study aimed to identify variables for predicting ypCR in patients with residual flat mucosal lesions after nCRT for locally advanced rectal cancer (LARC).MethodsData of patients with residual flat mucosal lesions after nCRT who underwent radical resection between 2009 and 2015 were retrospectively collected from the LARC database at Peking University Cancer Hospital. Univariate and multivariate analyses of the association between clinicopathological factors and ypCR were performed, and a nomogram was constructed by incorporating the significant predictors.ResultsOf the 246 patients with residual flat mucosal lesions included in the final analysis, 56 (22.8%) had ypCR. Univariate and multivariate analyses showed that pretreatment cT stage (pre-cT) ≤T2 (P=0.016), magnetic resonance tumor regression grade (MR-TRG) 1−3 (P=0.001) and residual mucosal lesion depth =0 mm (P<0.001) were associated with a higher rate of ypCR. A nomogram was developed with a concordance index (C-index) of 0.759 and the calibration curve showed that the nomogram model had good predictive consistency. The follow-up time ranged from 3.0 to 113.3 months, with a median follow-up time of 63.77 months. The multivariate Cox regression model showed that the four variables in the nomogram model were not risk factors for disease-free survival (DFS) or overall survival (OS).ConclusionsCompletely flat mucosa, early cT stage and good MR-TRG were predictive factors for ypCR instead of DFS or OS in patients with LARC with residual flat mucosal lesions after nCRT. Endoscopic mucosal re-evaluation before surgery is important, as it may contribute to decision-making and facilitate nonoperative management or organ preservation.     

Morbidity and mortality after surgery in patients with disseminated or locally advanced cancer receiving systemic chemotherapy

All postoperative complications and mortality were analyzed in a diverse group of patients operated upon by the authors during a ten-year period. These patients shared only two common factors: 1) known locally advanced or disseminated cancer, and 2) systemic chemotherapy within three weeks (either pre- or postoperatively) of major surgery. One hundred eighty-six operations were performed on 175 patients. The overall mortality in this series was 2.2% (four patients), with a complication rate of 5.9% (11 patients). Despite the known detrimental effects of widespread cancer and cytotoxic agents on wound healing, appropriate surgical intervention can be accomplished with an acceptable mortality and morbidity in patients with locally advanced or disseminated cancer who are receiving systemic chemotherapy.     

The effect of induction chemotherapy on tumor volume and organ-at-risk doses in patients with locally advanced oropharyngeal cancer

Background and purpose

To retrospectively report changes in gross tumor volume (GTV) and organ-at-risk (OAR) doses after induction chemotherapy (IC) in oropharyngeal cancer using different contouring strategies.

Materials and methods

GTV and OARs were delineated on pre- and post-IC planning CT. Two post-IC GTV contours were made: (1) a ‘consensus set’ using published guidelines (GTV_consensus), and (2) ‘visible set’, delineating only visible post-IC GTV (GTV_visible). Pre-IC interactively optimized volumetric modulated arc therapy plans were generated. The pre-IC planning constraints served as the starting point for both post-IC plans. Results reflect pooled data from all 10 patients.

Results

Mean reduction in volume post-IC was 24% and 47% for consensus and visible primary tumor and 57% and 60% for consensus and visible nodes. Compared to pre-IC plans, average mean OAR dose for post-IC GTV_consensus plans was significantly lower for CL parotid. For GTV_visible plans both parotids, upper/lower larynx, inferior pharyngeal constrictor and cricopharyngeal muscles were significantly lower. However reductions compared with post-IC GTV_consensus plans were modest (1.6/1.5/1.2/3.7/5.9/2.6 Gy, respectively).

Conclusion

IC in patients with oropharyngeal carcinoma results in substantial reductions in GTVs. If post-IC GTVs are used, which is contrary to current consensus, statistically significant but relatively small OAR dose reductions are observed.     

Prognostic factors and predictive model in patients with advanced biliary tract adenocarcinoma receiving first‐line palliative chemotherapy

BACKGROUND:

Advanced biliary tract adenocarcinoma (BTA) has been a rare but fatal cancer. If unresectable, palliative chemotherapy improved the quality and length of life, but to the authors' knowledge, prognostic factors in such patients have not been well established to date. In the current study, prognostic factors were investigated in patients with advanced BTA receiving first‐line palliative chemotherapy.

METHODS:

Data from 213 patients with advanced BTA who were in prospective phase 2 or retrospective studies from September 2000 through October 2007 were used.

RESULTS:

With a median follow‐up duration of 29.7 months, the median overall survival (OS) was 7.3 months (95% confidence interval [95% CI], 6.3 months‐8.3 months). A Cox proportional hazards model indicated that metastatic disease (hazards ratio [HR], 1.521; P = .011), intrahepatic cholangiocellular carcinoma (HR, 1.368; P = .045), liver metastasis (HR, 1.845; P < .001), Eastern Cooperative Oncology Group performance status (HR, 1.707; P < .001), and alkaline phosphatase level (IU/L) (HR, 1.001; P < .001) were statistically significant independent predictors of poor prognosis. Patients were classified into 3 risk groups based on the prognostic index (PI), which was constructed using the regression coefficients of each variable. The median OS was 11.5 months (95% CI, 9.6 months‐13.5 months) for the low‐risk group (PI ≤ 1.5; n = 67), 7.3 months (95% CI, 5.7 months‐8.9 months) for the intermediate‐risk group (PI > 1.5 but ≤ 2.2; n = 75), and 3.6 months (95% CI, 2.9 months‐4.1 months) for the high‐risk group (PI > 2.2; n = 70 [P < .001]).

CONCLUSIONS:

Five prognostic factors in patients with advanced BTA were identified. The predictive model based on PI appears to be promising and may be used for the management of individual patients and to guide the design of future clinical trials, although external validation is needed. Cancer 2009. © 2009 American Cancer Society.     

The clinical observation of neoadjuvant chemotherapy in locally advanced breast cancer with DX regimen

The recent clinical curative effect and adverse events of docetaxel and capecitabine （DX） of neo- adjuvant chemotherapy in patients with locally advanced breast cancer was discussed. Methods： The data of 72 cases of neoadjuvant chemotherapy （DX） in locally advanced breast cancer after 4 cycles were retrospectively analyzed. Docetaxel 75 mg/m^2 by infusion 1 h on dl, capecitabine 2000 mg/m^2 by oral for twice daily on d1-14, 21 days was a cycle. Results： All 72 patients were assessed for efficacy and adverse events. The total effective rate was 80.5% （58/72）, including pathological complete response （pCR） was 7 （9.7%）, clinical complete remission （cCR） was 15（20.8%）, clinical partial response （PR） was 43 （59.7%）, stable disease （SD） was 8 （11.1%） and progressive disease （PD） was 6 （8.3%）. The main adverse events were gastrointestinal reactions and bone marrow suppression. The 3 to 4 degrees of adverse reactions including granulocytopenia in 7 patients （20.6%）, hand-foot syndrome in 6 patients （15.2%）. Conclusion： The DX regimen provide a favorable efficacy and safety profile in patients with locally advanced breast cancer for neoadjuvant chemotherapy.     

Outcomes of trimodality CROSS regimen in older adults with locally advanced esophageal cancer

BackgroundChemoradiotherapy for Esophageal cancer followed by Surgery (CROSS regimen) is standard of care for locally-advanced esophageal cancer. We evaluated CROSS completion rates, toxicity, and postoperative outcomes between older and younger adults receiving trimodality therapy.MethodsRetrospective analysis of patients with locally-advanced esophageal cancer who underwent CROSS regimen from May 2016 to January 2020 at a single academic center. Outcomes of those aged ≥70-years-old and <70 years-old were analyzed.ResultsOf 201 patients, 136 were <70 and 65 were ≥70 years. Older adults were more likely to be male (91% vs. 79%; p = 0.045), have higher ECOG scores (median 1 vs. 0; p = 0.003), Charlson-comorbidity index (median 6 vs. 4; p < 0.001), and undergo open procedures (20% vs. 8% p = 0.008). Most completed CROSS regimen (78% vs. 84% respectively) with similar rates of treatment discontinuation and dose reduction (all p > 0.05). Time to surgery following neoadjuvant therapy was similar between age groups, except in those ≥80-years-old as compared to <70-years-old (p < 0.05). Overall toxicity rates were similar (68% vs. 71% respectively; p = 0.676). Only rates of delirium (19% vs. 5%) and urinary retention (9% vs. 0%) were higher in older adults (both p < 0.05). Length of stay, discharge disposition, mortality, and overall survival were similar. Age was not an independent risk factor for complication, neoadjuvant toxicity or completion, surgery timing, nor worse overall or recurrence-free survival (p > 0.05).ConclusionTrimodality CROSS regimen for esophageal cancer in older adults is feasible, with similar completion rates and postoperative outcomes as compared to their younger counterparts.     

进展期胃癌新辅助化疗原发灶病理完全缓解5 例报告及文献复习*

进展期胃癌不可切除率及术后复发率较高,新辅助化疗联合手术切除是最常见的胃癌多学科综合治疗方法之一,具有以下优点：使肿瘤降期,提高R 0 切除率;对于高强度化疗的耐受性较辅助化疗好,化疗完成率较辅助化疗高;提供活体药敏检测从而避免不必要的手术。虽然高强度化疗产生更高的客观反应率,但是进展期胃癌经新辅助化疗获得病理完全缓解的仍然较少,且缺乏相关诊治规范。现介绍在广西医科大学附属肿瘤医院胃肠外科予新辅助化疗后获得病理完全缓解的5 例进展期胃癌,以探讨该类患者的临床病理特征、合理的综合治疗决策及预后的相关因素,使临床诊疗更加规范,患者更多获益。     

局部进展期食管鳞癌新辅助放化疗与新辅助化疗比较

目的 比较局部进展期食管鳞癌NCRT与NCT疗效。方法 收集2009-2015年在本院分别接受NCRT与NCT联合手术治疗的177例食管鳞癌患者资料,其中NCRT组72例,NCT组105例。采用Kaplan-Meier法生存分析。结果 两组总样本量177例(临床分期cT_2-4N_0-1M₀期),2、3年样本量NCRT组分别为44、26例,NCT组分别为47、28例。NCRT组pCR率为22%,明显高于NCT组10%(P=0.019)。两组术后并发症发生率和死亡率、复发率均相近(P均>0.05)。NCRT组与NCT组2、3年OS率分别为74%、51%与64%、51%,DFS率分别为54%、50%与54%、46%(P=0.527、0.379)。结论 NCRT较NCT可明显提高局部进展期食管鳞癌患者pCR率,同时并未增加术后并发症发生率和死亡率,但两组患者生存无差异,最终结果仍需前瞻性、多中心、大样本研究证实。     

EOX方案术前治疗局部进展期可切除胃癌的临床疗效及安全性

目的:探讨EOX方案术前治疗局部进展期可切除胃癌患者的临床疗效及安全性。方法:纳入2014年12月至2018年6月在我院腹部外科接受EOX方案术前化疗后行手术治疗的50例cT3N0M0-cT4bN3M0期的胃癌患者的临床资料,分析临床疗效及毒副反应。结果:45例患者的数据可用于分析,其中13例（28.9%）患者达完全缓解（CR）,10例（22.2%）患者达部分缓解（PR）,22例（48.9%）患者处于病灶稳定状态（SD）,未出现病情进展的病例,疾病控制率（CR+PR+SD）达100%,客观缓解率（CR+PR）为51.1%。3个周期化疗后行D2淋巴结清扫的胃癌根治手术,39例（86.7%）患者达到R0切除,6例（13.3%）患者为R1切除。术后进行病理退缩分级（TRG）,10例（22.2%）完全退缩（0）,6例（13.3%）中等退缩（1）,17例（37.8%）轻微退缩（2）,12例（26.7%）无退缩（3）。化疗过程中无化疗相关死亡病例。化疗期间发生的毒副反应主要为恶心呕吐、血液学毒性、神经毒性、脱发等,其中恶心总发生率为84%,呕吐总发生率为44%,3、4级恶心呕吐反应发生率为13.3%。血液学毒性反应中,白细胞减少总发生率为57.8%,3、4级白细胞减少为8.9%。神经毒性及脱发毒副反应发生率较高,分别为55.6%与91.1%,其3、4级毒副反应发生率分别为2.2%与17.8%。均经对症处理后症状缓解。手术R0切除率为86.7%,术后并发症发生率为4.4%。截止2019年8月,1年生存率为93.3%。结论:EOX方案术前治疗局部进展期胃癌具有较好疾病控制率和病理反应率,可提高R0手术切除率,不增加术后并发症,通过个体化剂量调整,毒副反应可控,值得进一步临床研究。     

Improved survival with adjuvant chemotherapy in locally advanced rectal cancer patients treated with preoperative chemoradiation regardless of pathologic response

ObjectiveThe aim of this study is to examine the effect of postoperative chemotherapy on survival in patients with stage II or III rectal adenocarcinoma who undergo neoadjuvant chemoradiation (CRT) and surgical resection.MethodsA retrospective review of the National Cancer Database (NCDB) from 2006 to 2013 was performed. Cases were analyzed based on pathologic complete response (pCR) status and use of adjuvant therapy. The Kaplan-Meier method was used to estimate overall survival probabilities.Results23,045 cases were identified, of which 5832 (25.31%) achieved pCR. In the pCR group, 1513 (25.9%) received adjuvant chemotherapy, and in the non-pCR group, 5966 (34.7%) received adjuvant therapy. In the pCR group, five-year survival probability was 87% (95% CI 84%–89%) with adjuvant therapy and 81% (95% CI 79%–82%) without adjuvant therapy. In the non-pCR group, five-year survival probability was 78% (95% CI 76%–79%) with adjuvant therapy and 70% (95% CI 69%–71%) without adjuvant therapy. In the non-pCR and node-negative subgroup (ypN-), five-year survival probability was 86% (95% CI 84%–88%) with adjuvant therapy and 76% (95% CI 74%–77%) without adjuvant therapy. In the non-pCR and node-positive subgroup (ypN+), five-year survival probability was 67% (95% CI 65%–70%) with adjuvant therapy and 60% (95% CI 58%–63%) without adjuvant therapy.ConclusionsAdjuvant chemotherapy in stage II or III rectal adenocarcinoma is associated with increased five-year survival probability regardless of pCR status. We observed similar survival outcomes among non-pCR ypN- treated with adjuvant chemotherapy compared with patients achieving pCR treated with adjuvant chemotherapy.     

TP诱导联合DDP同期放化疗治疗局部晚期食管癌临床研究

  目的  研究不适手术的局部晚期食管癌患者行TP方案诱导化疗联合DDP同期放化疗的毒性及疗效。  方法  33例胸段食管鳞癌T₃N₀M_O~T₄N₂M₀期患者（不包括腹腔淋巴结转移）,第1天和第22天行TP方案诱导化疗,多西他赛（艾素）75 mg/m2, DDP 75 mg/m2。第43天开始放疗,采用三维适形放疗,总剂量60 Gy,2 Gy/次,5次/周。同期化疗:DDP 30 mg/m2,1次/周,放疗开始的第1、8、15、22、29、36天给药。  结果  诱导化疗Ⅳ级骨髓毒性为12.12%（4/33）,无Ⅲ级或以上的肝、肾毒性。同期放化疗骨髓毒性最高为Ⅲ级,红细胞、粒细胞、血小板Ⅲ级毒性分别为21.21%（7/33）、15.15%（5/33）、3.03%（1/33）,无Ⅱ级以上的肝肾毒性。Ⅲ级放射性食管炎为9.10%（3/33）,未发现Ⅲ级以上的放射性食管炎及Ⅰ级以上的急性放射性肺炎。治疗结束评价显效（CR+PR）84.85%（28/33）,稳定（SD）12.12%（4/33）,进展（PD）3.03%（1/33）;治疗后2个月评价显效（CR+PR）75.76%（25/33）,稳定（SD）9.10%（3/33）,进展（PD）15.15%（5/33）。全组死亡病例15例。1年生存率66.4%,最主要失败模式是局部失败46.67%（7/15）,局部+远处失败26.67%（4/15）。  结论  局部晚期食管癌患者行TP方案诱导化疗+DDP同期放化疗的毒性可以耐受,局部失败仍然是主要的失败模式。      

CAP方案治疗晚期膀胱癌30例疗效分析

目的：观察ＣＡＰ方案对晚期膀胱癌的疗效和不良反应。方法：ＣＴＸ６００～８００ｍｇ／ｍ２静注ｄ１,ＡＤＭ３０～４０ｍｇ／ｍ２静注ｄ１,ＤＤＰ２０ｍｇ／ｍ２静滴ｄ１～５,３周为一周期。结果：ＣＲ８例（２６６％）,ＰＲ１２例（４０％）,ＮＣ６例（２０％）,ＰＤ４例（１３３％）。结论：ＣＡＰ方案对治疗晚期膀胱癌有效,不良反应少。