早期舌鳞状细胞癌的疗效分析

目的 分析不同方法治疗Ⅰ、Ⅱ期舌鳞癌的疗效.方法 回顾性分析103例Ⅰ、Ⅱ期舌鳞癌患者,比较单纯手术、单纯放疗和综合治疗(术前或术后放疗)的疗效及其影响因素.结果Ⅰ、Ⅱ期患者的5年生存率分别为82.4%和80.O%(P=0.361),其中单纯手术组、单纯放疗组和综合治疗组的5年生存率分别为90.3%、68.4%和84.0%(P=0.104),局部复发率分别为2.5%、35.7%和5.7%(P＜0.001).隐匿性淋巴结转移率为23.8%,其中Ⅱ区的转移率(19.0%)最高.局部复发、区域复发是影响患者预后的独立因素,单纯手术即能获得满意的局部控制,而低分化鳞癌易出现区域复发.结论 选用单纯手术治疗早期舌癌,如采用择区性颈淋巴清扫术,清扫范围为Ⅰ～Ⅳ区.     

Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy: report of 549 cases

PURPOSE: To analyze the significance of the number of metastatic lymph nodes on survival with and without the addition of prophylactic postoperative radiotherapy (RT) after radical resection of thoracic esophageal carcinoma. METHODS AND MATERIALS: A total of 549 thoracic esophageal squamous cell cancer patients who had undergone radical resection were randomized by the envelope method into a surgery-alone group (S, n = 275) and a surgery plus RT group (S+R, n = 274). We performed a retrospective review of all patients according to the extent of metastasis. The patients were classified into three groups: Group 1, 269 patients (49.0%) without lymph node involvement; Group 2, 159 patients (29.0%) with one to two positive nodes; and Group 3, 121 patients (22.0%) with three or more positive lymph nodes. RESULTS: For the same T stage (T3), the 5-year survival rate for Groups 1, 2, and 3 was 50.6%, 29.3%, and 11.7%, respectively (p = 0.0000). For patients with Stage III, the 5-year survival rate for Groups 1 (T4N0M0), 2 (T3-T4N1M0), and 3 (T3-T4N2M0) was 58.1%, 30.6%, and 14.4%, respectively (p = 0.0092). The 5-year survival rate of the S and S+R groups with positive lymph nodes (Groups 2 and 3) was 17.6% and 34.1% (p = 0.0378). In the positive lymph node groups, the incidence of failure by intrathoracic lymph node metastasis and supraclavicular lymph node metastasis in the S+R group (21.5% and 4.6%, respectively) was lower than in the S group (35.9% and 19.7%, respectively; p <0.012). In the negative lymph node group, the incidence of failure by intrathoracic lymph node metastasis in the S and S+R groups was 27.8% and 13.3%, respectively (p = 0.006). Hematogenous metastasis was the greatest (27.5%) in Group 3 (three or more positive lymph nodes). CONCLUSION: The number of metastatic lymph nodes is one of the important factors affecting the survival of patients with thoracic esophageal carcinoma. In our study, postoperative RT improved the survival of patients with positive lymph nodes. Additionally, postoperative RT reduced the incidence of intrathoracic recurrence and supraclavicular lymph node metastasis for all patients.     

Clinical benefit of chemosensitivity test for patients with regional lymph node-positive esophageal squamous cell carcinoma

BACKGROUND AND OBJECTIVES: Patients who have undergone resection for lymph node-positive esophageal squamous cell carcinoma are at high risk of recurrence and early death. The role of the postoperative adjuvant chemotherapy in this population needs to be determined. The present study was designed to determine whether the chemosensitivity test in fresh human esophageal squamous cell carcinoma, using highly purified tumor cells, correlates with the clinical response. METHODS: A retrospective review of all patients with resected squamous cell carcinoma of the thoracic esophagus between 1993 and 2000 was performed. We determined the chemosensitivity for cisplatin (CDDP), 5-fluorouracil (5-FU), mitomycin C, and adriamycin in vitro in fresh human esophageal squamous cell carcinoma using the MTT assay. Regional lymph node-positive (N1) patients who received sequential postoperative chemotherapy were compared with lymph node positive patients who underwent surgery alone. RESULTS: A total of 50 patients were reviewed, and chemosensitivity tests were successfully performed in 46 patients: 20 patients received surgery alone (S group), and 26 patients received surgery plus postoperative chemotherapy (SC group) according to results of MTT assay using highly purified tumor cells. When the SC group was divided into an SC-low group (inhibition rate of CDDP + 5-FU was below 85%, n = 15) and an SC-high group (over 85%, n = 11), the SC-high group showed more significant survival prolongation than the S group or the SC-low group (P < 0.01). CONCLUSIONS: Our results suggest that the results of the conventional MTT assay may be useful in evaluating the optimum adjuvant chemotherapy for patients with regional lymph node positive (pN1) esophageal squamous cell carcinoma.     

食管癌术后淋巴结转移对生存率的影响和放射治疗的意义

目的 分析淋巴结转移个数对生存率的影响及放射治疗的意义。方法 495例食管癌根治性手术切除患者,随机分为单一手术组(275例)和术后放疗组(220例),根据淋巴结转移的个数分为3组：A组无淋巴结转移,占47．2％;B组淋巴结转移个数1～2枚,占29．5％;C组淋巴结转移个数≥3枚,占23．2％。结果(1)相同T分期(T3)时,A、B、C三组的5年生存率分别为52．6％、28．8％和10．9(P=0．0000);在C组,单一手术和术后放疗者的5年生存率分别为0和19．3％(P=0．0336)。(2)在淋巴结阳性组(B C组),单一手术和术后放疗者的胸内淋巴结转移率分别为35．9％和21．2％(P=0．014),锁骨上淋巴结转移率分别为19．7％和4．4％(P=0．000);在淋巴结阴性组(A组),单一手术和术后放疗的胸内淋巴结转移率分别为27．8％和10．3％(P=0．003);A、B、C三组的腹腔淋巴结转移率分别为3．9％、9．4％和17．5％(P=0．000)。血行转移率以C组最高,为27．8％。结论 淋巴结转移个数是影响食管癌生存率的因素之一。淋巴结转移个数≥3枚时,血行转移率高,是全身化疗的指征。术后放疗降低了放疗部位淋巴结转移率,明显提高了C组生存率。     

食管癌根治术后预防性放射治疗的临床价值

目的：分析食管癌根治术后预防性放射治疗的临床价值。方法：495例食管癌根治性手术切除术,随机分为单一手术组（275例）和术后放疗组（220例）。术后3－4周开始放射治疗。双锁骨上区为5周50Gy,25次;全纵隔为5－6周50－60Gy,25-30次。结果：全组5年生存率为39．4％。单一手术组和术后放疗组的5年生存率差异无显著性（P＝0.4474)。单一手术组和术后放疗组的Ⅲ期患者,其5年生存率分别为13．1％和35．1％（P=0.0027)。术后放疗组的胸内淋巴结、锁骨上淋巴结转移率和吻合口复发率分别为16．2％、3．1％和0．5％,单一手术组分别为25．9％、13．2％和5．8％（P＜0．05）。吻合口狭窄的发生率单一手术组为1．8％,术后放疗组为4．1％（P＞0．05）。结论：术后预防性放疗可提高Ⅲ期食管癌根治术后的生存率,降低放疗部位淋巴结转移率和吻合口的复发率;术后预防性放疗可提高Ⅲ期食管癌根治术后的生存率,降低放疗部位淋巴结转移率和吻合口的复发率;术后放疗不增加吻合口狭窄等并发症。     

Phase II studies of a single agent and a cis-platinum-based two-drug combination in patients with non-small cell lung cancer

Phase II studies of single agent and CDDP-based two drug combination were performed in 189 patients with inoperable non-small cell lung cancer. Six drug regimens were performed: CDDP alone, VDS alone, Epi-ADM alone, CDDP + VDS, CDDP + CPA, CDDP + ADM. The response rates were 15.4% (6/39) with CDDP alone, 8.0% (2/25) with VDS alone, 6.1% (2/33) with Epi-ADM alone, 26.7% (8/30) with CDDP + VDS, 14.3% (4/28) with CDDP + CPA, 17.6% (6/34) with CDDP + ADM and one CR was performed with CDDP + ADM. In patients with no prior chemotherapy, the response rates were 20.0% (6/30), 11.8% (2/17), 12.5% (2/16), 26.7% (8/30), 16.0% (4/25) and 25.0% (3/12), respectively. The median survival times were 25, 27, 23, 33, 25, and 45 weeks, respectively. The efficacy of CDDP in non-small cell lung cancer patients was re-confirmed, and that of CDDP + VDS, CDDP + ADM was suggested. No death due to toxicity occurred and toxicity was generally tolerable.     

Cancer of the tonsil. Improved survival with combination therapy

One hundred seventy-four cases of squamous cell cancer of the tonsil (SCCT) were reviewed. Radiation therapy (RT) alone was used in 81 patients, surgery alone (S) in 19 patients, preoperative RT + S in 49 patients, and chemotherapy [( C] methotrexate plus bleomycin plus cisplatin) in 25 patients. The 5-year survival was 83% in Stage I (n = 21), 72% in Stage II (n = 19), 23% in Stage III (n = 34), and 15% in Stage IV (n = 100). RT and S were equally effective in Stages I and II. In Stage III, the 5-year survival for RT + S was 31% versus 11% for RT alone; and in Stage IV, the respective 3- and 5-year survivals for RT + S were 24% and 15% versus 6% and 0%, respectively, for RT alone. There was an 84% response rate to C, and the patients who completed C + RT + S had 3- and 5-year survival rates of 41.7% and 32%, respectively. Our results indicate that RT + S appears to offer better survival in Stage III and IV SCCT. The high response rate in early survival data seen with C + RT + S suggests a promising role for this approach.     

Long-term administration of low-dose cisplatin plus 5-fluorouracil prolongs the postoperative survival of patients with esophageal cancer

To evaluate the efficacy of long-term postoperative adjuvant chemotherapy with low-dose cisplatin (CDDP) plus 5-fluorouracil (5-FU) (CDDP/5-FU), we retrospectively examined 167 patients with squamous cell carcinoma of the esophagus who received the treatment after curative surgery (R0 resection). We classified the patients into the following three groups according to their postoperative therapies and analyzed their outcomes: a) low-dose CDDP (10 mg body(-1) day(-1) x 5 days) plus 5-FU (250-500 mg body(-1) day(-1) x 5 days) repeated every 6 months for 3 years, with an oral fluoropyrimidine (5-FU 150-200 mg body(-1) day(-1) or UFT 300-400 mg body(-1) day(-1)) administered between each treatment cycle (low-dose CDDP/5-FU group, 98 patients); b) high-dose CDDP (80 mg body(-1) day(-1) x 1 day) plus 5-FU (750-1,000 mg body(-1) day(-1) x 5 days) administered once only, followed by treatment with an oral fluoropyrimidine (5-FU 150-200 mg body(-1) day(-1) or UFT 300-400 mg body(-1) day(-1)) for 3 years (high-dose CDDP/5-FU group, 17 patients); or c) surgery alone (surgery alone group, 52 patients). The 3-year survival rates were 83.7% in the low-dose CDDP/5-FU group, 61.4% in the high-dose CDDP/5-FU group, and 62.2% in the surgery alone group; the difference between the low-dose CDDP/5-FU group and surgery alone group was significant (log-rank, p<0.05). A significantly better outcome in the low-dose CDDP/5-FU group than in the surgery alone group was associated with pStage III disease (p<0.001), pN1 lymph node metastasis (p<0.001), and lymphatic invasion (p<0.01). We conclude that long-term postoperative treatment with low-dose CDDP/5-FU is therapeutically beneficial and prolongs survival in patients with esophageal cancer who have regional lymph node metastasis or lymphatic invasion.     

T3-T4期声门型喉癌颈淋巴结转移情况及其与预后的关系

背景与目的:声门型喉癌颈淋巴结转移率低,有关报道不多,本研究旨在探讨T3-T4期声门型喉癌颈淋巴结转移的相关因素及其对预后的影响。方法:回顾性分析我院1992～2000年收治T3-T4期声门型喉癌83例的临床资料,对颈淋巴结转移率、转移淋巴结的分布、影响cN0颈部复发的因素(颈部预防性放疗、病理分级及T分期)、淋巴结转移与预后的关系。结果:T3-T4期声门型喉癌,总的颈淋巴结转移率为20.5%,cN0颈部复发率为14.3%。绝大多数转移淋巴结位于同侧Ⅱ、Ⅲ、Ⅳ区,仅1例位于对侧Ⅱ区。cN0者中,颈部预防性放疗与颈部观察在颈部复发率上无差异(P=0.772);病理分级影响cN0颈部复发率(P=0.028);不同T分期颈部复发率无差异(P=0.217)。cN 患者预后明显差于cN0患者(P<0.001);cN0颈部复发不影响预后(P=0.460)。对T3-T4期声门型喉癌cN 患者采用治疗性颈清扫;对cN0患者颈部可密切观察,待出现淋巴结复发再积极治疗。结论:T3-T4期声门型喉癌主要转移至同侧Ⅱ、Ⅲ、Ⅳ区;病理组织分化级别越差,cN0颈部复发的风险越大;cN0颈部复发与预后无关;对cN0患者颈部可进行密切观察;对出现淋巴结复发者应积极治疗。     

A randomized study of cisplatin versus cisplatin plus vindesine for non-small cell lung carcinoma.

Between August 1983 and March 1985, a randomized study was conducted that compared cisplatin (CDDP) (80 mg/m2 on day 1) alone with CDDP plus vindesine (VDS) (3 mg/m2 on days 1, 8, and 15) in 160 consecutive patients with inoperable non-small cell lung cancer (NSCLC). There were no complete responses. The response rate for CDDP plus VDS (22 of 77 patients, 29%) was significantly higher than that for CDDP alone (9 of 78 patients, 12%) (P less than 0.05). However, no difference existed in the median duration of response (20 weeks for CDDP plus VDS versus 20 weeks for CDDP alone) or the median survival time (45 weeks for CDDP plus VDS versus 39 weeks for CDDP alone). No significant differences in toxicity were detected between the two arms; myelosuppression, alopecia, and peripheral neuropathy occurred more frequently with CDDP plus VDS and there was one lethal episode of hepatorenal syndrome in the CDDP plus VDS arm. Among the variables Eastern Cooperative Oncology Group (ECOG) performance status (PS), age, sex, stage, weight loss, serum lactate dehydrogenase (LDH) level, albumin level, histologic cell type, and chemotherapy arm, only chemotherapy arm was a significant factor leading to a major response (P = 0.019, multiple logistic regression analysis). The significant predictors of survival were PS (P = 0.000), sex (P = 0.000), and stage (P = 0.002) (Cox's proportional hazards model), with a PS of 0 or 1, female sex, and lower stage yielding the best survival. Although a significantly higher response rate was obtained in the combination arm than in the single agent arm, the survival benefit to patients receiving such combination chemotherapy was not determined and more effective chemotherapy regimens are required.     

食管癌新辅助放化疗的前瞻性临床研究

目的 评价术前辅助性放化疗在食管癌治疗中的价值。方法 对术前临床分期为Ⅱ、Ⅲ期,无外科手术和放化疗禁忌证的97例食管癌患者进行随机对照分组：综合治疗组48例,对照组49例。综合治疗组患者采用5-氟脲嘧啶 顺铂(5-Fu DDP)化疗2个周期后,再进行放射治疗,放疗使用直线加速器分三野照射放疗12次,剂量36Gy;治疗结束后3周进行手术。对照组采用单纯手术治疗。采用Kaplan-Meier法计算两组生存率,χ^2和Logrank方法检验两组中各项观察指标的差异。结果 综合治疗组和对照组根治性切除率分别为85．4％和65．3％(P=0．0181);病理淋巴结转移率分别为21．7％和45．7％(P=0．0194),综合治疗组T分期比对照组亦显著降低(P=0．0036);局部区域复发率分别为34．8％和58．70%(P=0．0236),而手术后的并发症发生率两组无明显差异。综合治疗组生存率明显优于对照组,尤其以辅助治疗后获得缓解的患者5年生存率最高达56．5％。结论 术前放化疗能降低术后病理淋巴结转移率、缩小肿瘤和有明显降期作用;能降低局部和区域复发率及明显提高患者长期生存率：能提高根治性手术切除率,并不增加手术并发症。     

临床I、Ⅱ期舌体鳞癌患者预后的多因素分析

背景与目的：影响临床I、Ⅱ期舌体鳞癌患者预后的因素很多,本文旨在探讨影响其预后的主要因素。方法：回顾性分析147例临床I、Ⅱ期舌体鳞癌的长期随访资料,生存分析采用寿命表达,组间比较用log-rank检验,多因素分析采用Cox模型及Logistic回归分析。结果：单因素分析提示病理分级（中、低分化鳞癌）、颈淋巴结阳性、病理分期（Ⅲ、Ⅳ期）、饮酒史、原发灶复发、继发灶复发、原发灶和继发灶复发以及肿瘤复发均是影响预后的危险因素（P＜0．05）;多因素分析发现局部区域复发（P＝0．000）和病理分期（P＝0．045）影响预后;Logistic回顾分析提示颈淋巴结阳发性（P＝0．003）和饮酒史（P＝0．012）与局部区域复发显著相关。结论：影响临床I、Ⅱ期舌体鳞癌预后的主要因素是局部区域复发和病理分期（Ⅲ、Ⅳ期）,而颈淋巴结阳性和饮酒史是局部区域复发的危险因素。     

Non-inflammatory skin involvement in breast cancer, histologically proven but without the clinical and histological T4 category features

BACKGROUND: The study evaluates characteristics and prognostic significance of breast cancer with histologically proven non-inflammatory skin involvement but without the clinical and histological features that are mandatory for inclusion in the T4 category. METHODS: We compared retrospectively the clinical course of 55 patients with this clinico-pathologic entity to the outcome of a control group of 309 consecutive patients with tumors of the same size but without skin involvement. The median follow-up time was 6.6 years in the study and 8.4 years in the control group. Two subsets were analyzed: (A) 1.1-2.0 cm (T1c); (B) 2.1-5.0 cm (T2). RESULTS: The distribution of TNM stages within Study Group A was: Stage I: 28.6%, Stage II: 61.9%, Stage III: 9.5%. The distribution within Study Group B was: Stage II: 67.7%, Stage III: 23.5%, and Stage IV: 8.8%. Differences in disease-specific survival (DSS) between study and control groups were not significant. In multivariate analysis, skin involvement was not a significant variable, while lymph node involvement was found to be significant for worse outcome (Group A: HR=3.99 [1.33-12.05], P=0.014; Group B: HR=2.37 [1.37-4.08], P=0.002). CONCLUSION: Breast carcinomas with histologically proven skin involvement without the clinical and histological correlate are a heterogeneous group of cases, but the majority of the patients have Stage I/II disease. While lymph node involvement had a most significant effect on DSS, skin involvement was not a significant prognostic factor. Physicians must be aware of this clinico-pathologic entity in order not to misclassify these cases as T4 and consider them falsely as being locally advanced breast cancer.     

内外照射加化疗联合治疗食管癌临床分析

目的 分析外照射、腔内近距离治疗及化疗治疗食管癌的疗效及其与外照射比较。方法 １２０例食管癌随机分成４组,每组３０例。Ⅰ组为外照射,Ⅱ组为外照射加腔内照射,Ⅲ组为外照射加化疗,Ⅳ组为内照射加化疗。外照射采用＾６０Ｃｏ治疗,２Ｇｙ／次,５次／周,总剂量６０－７４Ｇｙ;腔内照射６－８Ｇｙ／次,１次／周,总量１８～２４Ｇｙ;化疗用卡铂,１００ｍｇ／ｄ,５次／周,总量１０００ｍｇ。结果 Ⅱ～Ⅳ组的１,２,３年生存率高于Ⅰ组（Ｐ〈０．０５）。Ⅰ～Ⅳ组的３年生存率分别为１３．３％、３６．７％、４０．０％和４６．７％,死于肿瘤复发及未控分别为７２．２％、４０．０％、４３．７％和３８．４％（Ｐ〈０．０５）,远处转移率无明显差异。结论 外照射与近距离治疗和化疗的综合治疗可提高食管癌局部控制率和１,２,３年生存率。     

Potentiation of induction of apoptosis by sequential treatment with cisplatin followed by 5-fluorouracil in human oral cancer cells

We examined the mechanism involved in the induction of apoptosis in human oral cancer (B88) cells with 5-fluorouracil (5-FU) and cisplatin (CDDP) combination. Three different combination treatment sequences were evaluated: i) 5-FU administered simultaneously with CDDP for 72 h (sequence I); ii) CDDP administered for 24 h before 5-FU treatment for 48 h (sequence II); and iii) 5-FU administered for 24 h before CDDP treatment for 48 h (sequence III). When combining the two drugs at doses 40% of their respective cytotoxicity, the growth-suppressing ratios were 49, 55, and 40% in sequences I, II, and III, respectively. Caspase 3 was significantly activated in sequence II as compared to its level of activation in sequence I or III. The mitochondrial release of cytochrome c was much greater in sequence II than in sequence III. In addition, activation of caspase 8 was most strongly activated in sequence II as compared with sequences I and III. Activation of caspase-9 was also observed in sequence II, and, to a lesser extent, in sequence III. Finally, although Bcl-2 was reduced in sequence II, no significant change was observed in sequence III. Accordingly, the data presented here demonstrate that sequence II showing a significant increase in the induction of apoptosis of cancer cells, is superior to sequences I and III.     

Three successful cases with CPT-11 + CDDP chemotherapy where S-1 failed to respond to recurrent gastric cancer

We report three successful cases with irinotecan (CPT-11 60 mg/m2) + cisplatin (CDDP 30mg/m2) chemotherapy (once in 2 weeks) where S-1 failed to respond to recurrent gastric cancer. Case 1: A total gastrectomy and splenectomy were performed for a cardiac gastric cancer (T3, N2, H0, P0, CY0, por 1, Stage IIIB). An abdominal CT revealed paraortic lymph node metastases 4 months after the surgery. No reductions were noted after S-1 monotherapy. We next treated this patient with CPT-11 + CDDP. An abdominal CT revealed a CRin after 11 courses. Case 2: A total gastrectomy, splenectomy and cholecystectomy were performed for a cardiac gastric cancer (T3, N3, H0, P0, CY1, tub1, Stage IV). After the surgery, we treated this patient with S-1 mono-therapy. However, we finished this treatment for abdominal recurrence. We next treated this patient with CPT-11 + CDDP. An abdominal CT revealed a CR after 24 courses. Case 3: A distal gastrectomy and cholecystectomy were performed for a pyloric gastric cancer (T2, N1, H0, P0, CY0, tub 2, Stage II). An abdominal CT revealed paraortic lymph node metastases 10 months after the surgery. We treated this patient with S-1 + paclitaxel (PTX) chemotherapy. No reductions were noted after 2 courses. We next treated this patient with CPT-11 + CDDP. An abdominal CT revealed a CR after 8 courses.     

Long-term results after intraoperative radiation therapy for gastric cancer

PURPOSE: We retrospectively analyzed the impact of intraoperative radiation therapy (IORT) on long-term survival in patients with resectable gastric cancer. METHODS AND MATERIALS: From 1991 to 2001, a total of 84 patients with gastric neoplasms underwent gastectomy or subtotal resection with IORT (23 Gy, 6-15 MeV; IORT-positive [IORT(+)] group). Patients with a history of additional neoadjuvant chemotherapy, histologically confirmed R1 or R2 resection, or reoperation with curative intention after local recurrence were excluded from further analysis. The remaining 61 patients were retrospectively matched with 61 patients without IORT (IORT-negative [IORT(-)] group) for Union Internationale Contre le Cancer (UICC) stage, patient age, histologic grading, extent of surgery, and level of lymph node dissection. Subgroups included postoperative UICC Stages I (n = 31), II (n = 11), III (n = 14), and IV (n = 5). RESULTS: Mean follow-up was 4.8 years in the IORT(+) group and 5.0 years in the IORT(-) group. The overall 5-year patient survival rate was 58% in the IORT(+) group vs. 59% in the IORT(-) group (p = 0.99). Subgroup analysis showed no impact of IORT on 5-year patient survival for those with UICC Stages I/II (76% vs. 80%; p = 0.87) and III/IV (21% vs. 14%, IORT(+) vs. IORT(-) group; p = 0.30). Perioperative mortality rates were 4.9% and 4.9% in the IORT(+) vs. IORT(-) group. Total surgical complications were more common in the IORT(+) than IORT(-) group (44.3% vs. 19.7%; p < 0.05). The locoregional tumor recurrence rate was 9.8% in the IORT(+) group. CONCLUSIONS: Use of IORT was associated with low locoregional tumor recurrence, but had no benefit on long-term survival while significantly increasing surgical morbidity in patients with curable gastric cancer.     

Impact of Adjuvant Chemotherapy Cycles on Prognosis of Resectable Stomach Cancer: A Retrospective Analysis

Aims: The aim of this study was to investigate the effects of adjuvant chemotherapy cycles on the prognosisof patients with post-operative stomach cancer through retrospective analysis. Methods: A total of 128 patientswith gastric cancer who underwent gastrectomy, followed by adjuvant chemotherapy consisting of epirubicin,cisplatin or oxaliplatin, leucovorin, and 5-fluorouracil, according to a defined schedule, were divided into threegroups according to the number of chemotherapy cycles: Group I (<6 cycles); Group II (6 cycles); and GroupIII (>6 cycles). Results: The 5-year overall survival (OS) was 20.8% in Group I, 45.0% in Group II, and 42.9%in Group III, with a median follow-up of 43 months. The 5-year relapse-free survival (RFS) was 15.1% in GroupI, 40% in Group II, and 40% in Group III. The OS and RFS in Groups II and III were significantly betterthan in Group I (OS, p = 0.002 and p=0.003; RFS, P<0.001 and P=0.002). There was no difference in OS (p =0.970) or in RFS (p = 0.722) between Groups II and III. Multivariate Cox hazard analysis determined that thenumber of adjuvant chemotherapy cycles was an independent factor that influenced OS and RFS. Conclusion:Six cycles of adjuvant chemotherapy gave encouraging outcomes in patients with resectable gastric cancer.Further prospective randomized controlled investigations are warranted in a multi-center setting.     

Effective and low toxicity chemoradiotherapy for distant metastatic esophageal cancer

A sixty-seven-year-old male who had T4N4M1 (stage IV) advanced esophageal cancer with bilateral pulmonary and multiple lymph-node metastases received 1-hr drip intravenous infusions of low-dose cisplatin (CDDP) at 7 mg/m2 on Days 1-5, 8-12, 15-19, and 22-26, protracted intravenous infusions of 5-fluorouracil at 200 mg/m2 on Days 1-28, and X-ray therapy of 2 gray/fraction x 5 fractions/week (total 40 Gy; LDFPX therapy). XRT was also administered alone (total 60 Gy). After 1 course of LDFPX therapy, the primary and multiple lymph node metastases responded completely. The bilateral pulmonary metastases were remarkably reduced in size and performance status improved. After that we tried low dose CDDP 10 mg/body twice a week and UFT 600 mg/body (LDP + UFT therapy) on an outpatient basis. Especially, bilateral pulmonary metastases were more reducing tumor size by LDP + UFT therapy. These treatments had a therapeutic effect and very low toxicity. This chemotherapy is thought to be effective against advanced esophageal cancer.     

A patient with esophageal cancer recurrence responding to S-1 combined with cisplatin (CDDP)

We administered a combination chemotherapy of S-1 plus cisplatin (CDDP) therapy to a patient with recurrenced cancer of esophagus in lymph node. S-1 (80 mg/m(2)/day), taken out of the capsule, was administered via the catheter for tube feeding on day 1 to day 21 and CDDP at 60 mg/m(2)/day by intravenous drip infusion on day 8 for 3 weeks followed by a drug-free 2 week period as the first course. After 2 courses, CT findings showed a complete regression of the lymph node for complete response (CR). He has been alive for 10 months without recurrence. Combined use of S-1 and CDDP is effective as chemotherapy for recurrenced esophageal cancer.