Phase II study of combination therapy of radiation and local administration of OK-432 for esophageal cancer

Background. From 1993 to 1996, 38 patients (32 men and 6 women) with T1-4NxM0 esophageal cancer (International Union Against Cancer [UICC], 1987) entered into a phase II study of combination therapy of radiation and local administration of the biological resporse modifier, OK-432. The average age of the patients was 64 years. The average tumor length was 7.9cm. Seven patients were T1; 12, T2-3; and 19, T4. Methods. OK-432 (0.5mg) was administered endoscopically around the cancerous lesion at the beginning of radiotherapy, and the same dose of OK-432 was given in the same manner 2 weeks later. X-ray irradiation was given at a daily dose of 1.6–1.8 Gy, five fractions a week. The mean total dose was 62 Gy. Results. Complete response (CR) was achieved in 23 of the 38 patients (60.5%) and partial response (PR) was achieved in the remaining 15 patients. The 3-year cause-specific survival rate was 39.6% (overall, 29.4%). The 3-year survival rates of CR and PR patients were 74%, and 0.0%, respectively, and the 2-year survival rate of PR patients was 7.8%, a significant difference (P < 0.001). The 3-year survival rates of the T1-3 and T4 patients (UICC, 1987) were 73.0% and 14.0%, respectively, a significant difference (P < 0.001). The 3-year survival rates of the 9 patients with tumors less than 5 cm in length, and of the 18 patients with tumors 5–10cm long were 80% and 54.2%, respectively. In the 11 patients pith tumors more than 10 cm in length, the 2-year survival rate was 9.0%. The 3-year survival rate of the 18 patients with tumors less than 7 cm was 92.3 %, and the 2-year survival rate of the 20 patients with tumors over 7cm long was 16.7%/x, a significant difference (P < 0.001). All 38 patients were discharged in good condition and were able to take food orally. Conclusion. This combination therapy could contribute not only to improving the survival rate, but also to improving the patients' quality of life.     

Laparoscopy significantly improves the perceived preoperative stage of gastric cancer

Background The aim of this study was to examine the accuracy of laparoscopy in staging patients with gastric cancer in comparison with preoperative computed tomography (CT) examination.Methods One hundred patients out of a consecutive series of 258 patients with gastric adenocarcinoma underwent a preoperative staging CT followed by a staging laparoscopy. The strengths of the agreement between the CT stage, the laparoscopic stage, and the final histopathological stage were determined by the weighted Kappa statistic (Kw).Results The strengths of agreement between the CT stage and the final histopathological stage were Kw = 0.336 (95% confidence interval [CI]; 0.172–0.5; P = 0.0001) for T stage and 0.378 (95% CI; 0.226–0.53; P = 0.0001) for M stage, compared with 0.455 (95% CI; 0.301–0.609; P = 0.0001) and 0.73 (95% CI; 0.596–0.864; P = 0.0001) for the laparoscopic T and M stages, respectively. Unsuspected metastases that were not detected by CT, were found in 21 patients at laparoscopy, all of whom had T3 or T4 locally advanced tumors evident on CT.Conclusions Preoperative laparoscopic staging of gastric cancer is indicated for potential surgical candidates with locally advanced disease in the absence of metastases on CT.An original article presented at The British Society of Gastroenterology, Birmingham, 2002 (Gut 2002; 50 [Suppl. II] A8).     

Alternating weekly administration of paclitaxel and gemcitabine: a phase II study in patients with advanced non-small-cell lung cancer

Background We sought to evaluate toxicity and efficacy of an alternating week schedule of paclitaxel and gemcitabine in patients with advanced non-small-cell lung cancer (NSCLC).Methods Patients (n=27, mean age 56 years, range 27–73 years) received paclitaxel (100 mg/m² i.v. infusion over 1 h) on days 1 and 15 alternating with gemcitabine (1000 mg/m²) on days 8 and 22 of a 36-day cycle. Responses were evaluated after three cycles, and after the proposed six cycles.Results In total, 116 cycles were administered (mean 4.25 cycles per patient). Haematological toxicity was slight: febrile neutropenia (n=1) and neutropenia grade III–IV (n=5). Non-haematological toxicities included arthromyalgia grade II (n=6) and neurotoxicity grade III (n=1). Objective response was 29%, stable disease 25% and disease progression 46%. Median duration of response was 8 months (95% CI 5–11 months), median progression-free survival was 7 months (95% CI 4–11 months), median overall survival was 13 months (95% CI 7–17 months) and survival at 1 year was 52%.Conclusions A regimen of alternating weekly paclitaxel and gemcitabine is feasible in patients with advanced NSCLC, showing a lower toxicity profile compared with other platinum-based combinations, which makes this novel scheme attractive for these patients.     

Comparison of American Joint Committee on Cancer pathologic stage T3a versus T3b urothelial carcinoma: Analysis of patient outcomes

BACKGROUND:

The radical cystectomy experience at Vanderbilt University Medical Center was scrutinized to determine whether there was a difference in survival between patients with lymph node‐negative pathologic T3a versus pathologic T3b urothelial carcinoma of the bladder.

METHODS:

Pathologic and clinical data were reviewed on patients who underwent radical cystectomy for urothelial carcinoma between 1995 and 2005. We excluded patients with nontransitional cell cancer, lymph node disease, or with unknown lymph node status. Of the 790 reviewed patients, 75 patients (9.4%) were diagnosed with pathologic T3 urothelial cancer of the bladder. The impact of pathologic substaging (pT3a vs pT3b) was examined to determine the effect on overall, disease‐specific, and recurrence‐free survival.

RESULTS:

The mean age was 68.6 years (36 years to 83 years). Median overall follow‐up was 25.3 months (1.13 months to 130.17 months). Median follow‐up for patients alive at last follow‐up was 55.9 months (25.3 months to 130.2 months). Actuarial overall survival at 5 years was 29.5% for pT3a and 29.3% for pT3b (P = .79). Actuarial disease‐specific survival at 5 years was 54.1% for pT3a and 42.4% for pT3b (P = .21). Actuarial recurrence‐free survival at 5 years was 68.1% for pT3a and 71.9% for pT3b (P = .53).

CONCLUSIONS:

There were no significant differences in overall, disease‐specific, or recurrence‐free survival when comparing lymph node‐negative pT3a versus pT3b urothelial cancer of the bladder following radical cystectomy. Simplification of pathologic staging for urothelial carcinoma of the bladder should be considered at future revisions of the American Joint Committee on Cancer staging system. Cancer 2009. © 2009 American Cancer Society.     

Esthesioneuroblastoma — a clinicopathologic study and role of DNA topoisomerase alpha

Esthesioneuroblastoma (ENB) differs from adrenal neuroblastomas in its histopathologic and biologic characteristics. Hyams grading and Kadish staging have shown correlation with survival. Scant data are available on proliferation indices and prognosis. We retrospectively reviewed the clinicopathologic characteristics of ENB. Both Kadish and UCLA staging systems were used. Hyams grading was simplified into low and high grade. DNA topoisomerase II alpha labeling index (T2α LI) was obtained in 8 cases using immunohistochemistry. Of the 19 cases studied, 14 were males and 5 females. Age range was 2 to 62 years (average 27 years). The mass primarily involved the nose in 12 (63%) and paranasal sinuses in 7 cases (37%). Patients presented with nose block in 19 (100%), epistaxis in 10 (53%), proptosis in 9 (47%) and loss of vision in 6 cases (32%). Bony involvement was seen in 7 cases (37%), and intracranial spread in one case (5%). Thirteen (68%) were low-grade tumors and 6 were (32%) high-grade. There was no statistically significant difference between the low-and high-grade ENB in age (years) (p=0.2882), duration of symptoms (months) (p=0.5636), and either in the Kadish (p=0.5456) or the UCLA staging system (p=0.7771). The difference in DNA topoisomerase alpha labeling index between the low-and highgrade ENB (medians: 10.4 and 22.3, respectively) was not statistically significant (p=0.0714), but it was suggestive of a positive association. The results of this study should be interpreted with caution, because of the limited sample size. Three cases recurred locally, one each stage A, B and C, but all low-grade. This preliminary study suggests the need to combine a simplified histologic grading with accurate staging in a reasonable attempt to assess local progression in esthesioneuroblastoma. Larger studies may clarify the role of T2α LI in improving histologic grading. The study was presented at the World Federation of Neurosurgical Societies Tumor Meeting held at Jaipur, India, October 11–13, 2004.     

Postoperative adjuvant chemotherapy with mitomycin C and UFT for curatively resected rectal cancer. Results from the Cooperative Project No.7 Group of the Japanese Foundation for Multidisciplinary Treatment of Cancer

Background. This study was conducted to evaluate the significance of postoperative adjuvant chemotherapy using mitomycin C (MMC) and UFT (tegafur; uracil at 1:4 molar ratio) in combination for rectal cancer. Methods. The Japanese Foundation for Multidisciplinary Treatment of Cancer conducted a prospective randomized controlled trial in 834 patients who had undergone curative resection for rectal cancer (T3 or T4 and/or Nl, N2, or N3 according to TNM classification) from February 1986 to December 1988. The patients were randomly allocated to a treatment group (MMC/UFT, 416 patients) and a control group (surgery alone, 418 patients). For the patients in the treatment group, 20 mg of MMC was sprinkled on the operating field upon completion of surgery. MMC was injected intravenously (6 mg/m²) on day 7, and then once a month for months 1–6 after surgery. UFT was administered at 400mg/day, orally, for 1 year, beginning 3 weeks after surgery. Results. There was no difference, in the 5-year survival rate between the two groups, but the 5-year disease-free survival rate in the MMC/UFT group (68.9%) was significantly higher than that (59.3%) in the control group (P = 0.006). The 5-year cumulative local recurrence rate was significantly lower in the MMC/UFT group (11.6%) than in the control group (19.0%) (P = 0.007). Conclusion. We conclude that the adjuvant use of longterm oral UFT and intermittent MMC (i.v.) improves the disease-free survival rate of patients with curatively resected rectal cancer (T3 or T4 and/or N1, N2, or N3).     

Brain Metastases in Patients with Ovarian Carcinoma: Prognostic Factors and Outcome

Between January 1975 and April 2001, 8,225 patients with ovarian cancer were seen at The University of Texas M. D. Anderson Cancer Center. Brain metastases developed in 72 of these patients (0.9%). The medical records of these patients were reviewed to assess the incidence of these metastases and their correlates of survival, as well as to describe the various treatment modalities used against them and their respective outcomes. The mean age of patients at the time of brain metastasis diagnosis was 53.7 years. The median interval between the diagnosis of the primary cancer and brain metastasis was 1.84 years. Neurological deficit, headache, and seizure were the most common symptoms. The brain was the only site of metastasis in 43% of patients. Multiple metastases were seen in 65% of them, although this may be a slight underestimate, as brain metastases in 17% of patients were evaluated prior to the magnetic resonance imaging era. The median survival time after the diagnosis of brain metastases was 6.27 months (95% CI, 4.48–8.06 months). The combination of surgical resection and whole-brain radiation therapy (WBRT) resulted in a longer survival time (median, 23.07 months) than did WBRT alone (median, 5.33 months) or surgery alone (median, 6.90 months) (p < 0.01 in both instances, multivariate Cox proportional hazards model analysis). The prognosis for patients with brain metastases from ovarian cancer appears to be poor. The existence of systemic dissemination at the time of brain metastasis was associated with a worse survival trend. The only significant predictor of survival in our series was the treatment modality. In particular, the resection of brain metastasis from ovarian cancer followed by WBRT appeared to be superior to resection alone or WBRT alone.     

<Emphasis Type="Italic">MTHFR</Emphasis> genotypes and breast cancer survival after surgery and chemotherapy: a report from the Shanghai Breast Cancer Study

Summary Methylenetetrahydrofolate reductase (MTHFR) regulates the intracellular folates pool for DNA synthesis and methylation. Sequence variations in MTHFR (nucleotides 677 (CT) and 1298 (AC)) result in allozymes with decreased activity. The 677TT genotype is associated with increased toxicity of methotrexate and increased clinical response to 5-fluorouracil in treatment of cancers including breast cancer. We evaluated MTHFR genotypes and breast cancer survival in a cohort of 1067 Chinese women diagnosed with breast cancer between 1996 and 1998 who received surgery and chemotherapy. Life table method was used to calculate 5-year survival rates. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) after adjusting for potential confounding factors. Median follow-up time was 5.2 years; 5-year survival was 84.6%. Sixty-six percent carried a 677T allele and 31% carried a 1298 C allele. We found that overall 5-year breast cancer survival did not differ significantly across all genotypes (85.3% for 677 CC and 83.8% for 677TT; 83.8% for 1298 AA and 79.1% for 1298 CC). However, carrying the 677T allele was associated with non-significant increased risk of death for subjects with late stage disease (stages III–IV) (HR=1.80, 95% CI: 0.79–4.14 for TT vs. CC, p for trend=0.15), particularly among those who had survived past the second year (HR=2.97, 95% CI: 1.10–7.98, p for trend=0.04). The A1298C genotypes were not significantly associated with risk of death. This study suggests that the MTHFR C677T polymorphisms may affect long-term survival from advanced breast cancer.     

Impact of treatment modality and number of lesions on recurrence and survival outcomes after treatment of colorectal cancer liver metastases

Background

Ablative strategies have been used to treat and facilitate hepatic resection (HR) in patients with otherwise unresectable colorectal liver metastases (CLM). We evaluated the efficacy of HR, concomitant HR and ablation and isolated ablation on recurrence and survival outcomes after treatment of CLM in patients with 1-4 and ≥5 lesions, respectively.

Methods

A retrospective review of a prospectively collected hepatobiliary surgery database was performed on patients who underwent treatment for isolated CLM between 1990 and 2010. Pre-operative and treatment characteristics were compared between patients who underwent HR, concomitant HR and ablation and ablation alone. The impact of treatment modality on survival and recurrence outcomes was determined.

Results

A total of 701 patients met inclusion criteria; 550 patients (78%) had 1-4 lesions and 151 patients (22%) had ≥5 lesions. Overall median survival for the entire cohort was 35 months with 5- and 10-year survival of 33% and 20%, respectively. Overall median and 5-year recurrence-free survival (RFS) was 13 months and 21%, respectively. For patients with 1-4 lesions, median survival was 37 months with 5-year survival of 36%. Stratified by procedure type, 5-year survival was 41% in patients who underwent HR, 35% in patients who underwent concomitant HR and ablation and 13% in patients who underwent ablation alone (P<0.001). For patients with ≥5 lesions, median survival was 28 months with 5-year survival of 23% without difference between treatment groups (P=0.078).

Conclusions

HR appears to be the most effective strategy for patients with 1-4 lesions. When ≥5 lesions are present, ablative strategies are useful in facilitating HR in otherwise unresectable patients.     

Prognostic value of preoperative radiological staging assessed by computed tomography in patients with nonmetastatic colon cancer

PurposeThis study evaluated the prognostic value of preoperative locoregional staging in patients with colon cancer and who underwent curative resection.MethodsA total of 536 consecutive patients who underwent curative resection for colon cancer from February 1999 to November 2007 were prospectively enrolled. The clinicopathological variables, including the radiological staging using computed tomography, were analyzed for the prognostic significance.ResultsThe 5-year overall survival rates of the patients with radiological T1, T2, T3, and T4 were 96%, 89%, 75%, and 79%, respectively (P = 0.028). The 5-year overall survival rates were 83%, 76%, and 54%, respectively, for patients with radiological N0, N1, and N2 disease (P < 0.001). The 5-year overall survival rates of the patients with radiological TNM (tumor–node–metastasis) stages I, II, and III were 90%, 81%, and 70%, respectively (P < 0.001) and the 5-year overall survival rates of the patients with pathological TNM stages I, II, and III were 93%, 80%, and 70%, respectively (P = 0.001). On multivariate analysis, the radiological T and N categories remained independent prognostic factors for both overall survival and disease-free survival.ConclusionRadiological staging is an independent predictor of long-term survival in the preoperative setting.     

原发扁桃体非霍奇金淋巴瘤的预后因素

目的：评价原发扁桃体非霍奇金淋巴瘤（NHL）的肿瘤侵犯范围（T分期）和国际预后指数（IPI）的预后价值,并对早期患者提出治疗建议。方法：回顾分析306例原发扁桃体NHL,根据Ann Arbor分期,I期35例,II期178例,Ⅲ期49例,Ⅳ期44例,根据1997年AJCC TNM分期标准,TI 29例,T2 142例,T3 117例,T4 18例,I期单纯放射治疗12例,综合治疗23例,Ⅱ期单纯放射治疗57例,单纯化疗2例,综合治疗119例,Ⅲ,Ⅳ期以化疗为主,结果：T1,T2,T3和T4的5年癌症相关生存率（CSS）分别为73．8％,59．0％,56．5％和26．5％（P＜0．05）,IP1评分0分,1分和2或3分的5年CSS分别为69．9％,49．0％和25．0％（P＜0．01）,II期单纯放疗和综合治疗的5年无瘤生存率（DFS）分别为46．2％和60．4％（P＜0．05）,多因素分析证明,影响预后的因素有一般状态,B症状,Ann Arbor分期,T分期和IPI,结论：原发肿瘤T分期和IPI是扁桃体NHL重要的预后因素,综合治疗改善了II期扁桃体NHL的DFS。     

食管癌患者肿瘤体积对 T分期及预后的影响分析

目的：探讨食管癌患者大体肿瘤体积（ gross tumor volume,GTV）对T分期及预后的影响。方法收集198例行根治性切除治疗的食管癌患者的临床资料,观察不同GTV分级的病理T分期分布情况、5年生存情况以及局部区域复发率和远处转移率。结果 GTV 分级与T 分期总符合率为72．16％,一致性分析显示两者存在一致性（ Kappa ＝0．402,P＜0．01）。随着GTV分级升高T分期逐渐增加,且相邻T分期GTV分布有重叠现象;随着GTV分级升高食管癌患者整体生存率呈逐渐下降趋势,差异具有统计学意义（χ2＝21．900,P＝0．000）。 GTVⅠ级组和Ⅱ级组1、3、5年生存率及平均生存时间均显著高于GTVⅢ级组,差异具有统计学意义（P＜0．05）。随着GTV分级升高食管癌患者整体局部区域复发率先下降后升高,差异具有统计学意义（χ2＝7．58,P＝0．023）;随着GTV分级升高食管癌患者整体远处转移率呈现逐渐升高趋势,但差异无统计学意义（χ2＝0．579,P＝0．797）。结论随着食管癌患者GTV增大T分期逐渐增加,5年生存率逐渐下降,局部复发率和远处转移率逐渐增加。     

TNM 分期与Lugano分期在预测原发性胃肠道恶性淋巴瘤患者生存中的作用比较*

目的：比较TNM 与Lugano 分期系统在预测原发性胃肠道恶性淋巴瘤患者5 年生存率中的价值。方法：收集2001年2月至2013年8 月手术治疗的原发性胃肠道恶性淋巴瘤患者73例。所有患者分别使用TNM 及Lugano 系统进行分期。5 年生存率为生存比较的主要指标,Kaplan-Meier 法绘制生存曲线,并行Log-rank 检验。Cox 回归分析方法检验不同临床因素对患者生存的影响。结果：本组患者中位随访时间42.4（1.3～158.6）个月,5 年生存率77.82% 。使用TNM 系统分期时,Ⅰ、Ⅱ、Ⅲ期和Ⅳ期患者的5 年生存率分别为100.0% 、90.0% 、67.4% 和22.2%（χ2= 17.795 6,P = 0.000 5）。 使用Lugano 分期时,Ⅰ、Ⅱ、ⅡE 期和Ⅳ期患者的5年生存率分别为100.0% 、100.0% 、70.7% 和46.2%（χ2= 15.677 6,P = 0.001 3）。 Cox 分析提示肿瘤浸润深度（P = 0.018 1）和远处转移（P = 0.003）是原发性胃肠道恶性淋巴瘤患者生存的独立预后因素。结论：TNM 分期较Lugano 分期可以更好地预测原发性胃肠道恶性淋巴瘤患者的5 年生存率。     

非手术治疗食管癌临床分期标准的临床应用与探讨

目的 参考中国非手术治疗食管癌临床分期修改方案对 784例食管癌三维适形放疗患者进行预后分析与评价,探讨此分期对食管癌非手术治疗预后的预测价值及有待修改之处。     

Combination of Docetaxel, Epirubicin and Vinorelbine Administered Every 2 Weeks as First-line Therapy in Patients with Metastatic Breast Cancer: A Dose-finding Study

Aims. To assess efficacy and optimum combination dosage of intravenous docetaxel (T), epirubicin (E) and vinorelbine (N) administered every 2 weeks and without colony stimulating factor (CSF) support in patients with metastatic breast cancer (MBC). Patients and method. Patients (n = 51) with MBC were consecutively assigned to four different dose levels (DL) to receive (in mg/m²): Level I = T35 + E30 + N25; Level II = T30 + E30 + N25; Level III = T30 + E25 + N25; and Level IV = T25 + E25 + N25. Consecutive cycles were delayed if absolute neutrophil and/or platelet counts fell below 1.5 × 10⁹ and 100 × 10⁹l^–1, respectively. Treatment at a given dose level was suspended if 33% or more of patients included in a given cohort had unacceptable toxicity. Results. The patients evaluable for toxicity (n = 48) received 448 cycles (median 9; range 1–23). There was neutropenia G 3–4 in 30 patients (63%) with fever in 3 (6%). The G 2–3 non-hematological toxicities were alopecia in 39 patients (81%), mucositis in 11 (23%), and nausea/vomiting in 8 (17%). There were no toxic deaths. Treatment delay or dose reduction after first cycle occurred in 30% of patients treated in all DLs, except the fourth. Objective response was achieved in 29 of the 47 evaluable patients (58%; 95% CI: 50–66). The median duration of response, time-to-progression and overall survival were 13, 11 (range 8–14) and 20 (range 16–24) months, respectively. Conclusion. The combination of docetaxel, epirubicin and vinorelbine without CSF support ought not to exceed 25 mg/m² every 2 weeks. The efficacy is no greater than other existing regimens for first-line treatment of MBC.     

Staging of breast cancer: What standards should be used in research and clinical practice?

Background: Bone scan (BS), chest X-rays (CXR), liver ultrasonography (LUS) and laboratory parameters (LP) are frequently used as routine staging procedures for breast cancer patients. These procedures are not always appropriate in either clinical or research settings, regardless of the stage. The aim of this study was to identify groups of patients with differing risks for metastases in order to select more precise standard staging procedures.Patients and methods: The staging data relating to 406 breast cancer patients consecutively referred to our institution between November 1989 and October 1996 were analysed including pathological TNN grading and biological parameters.All of the cases with a positive or suspicious pre-operatory staging and who proved to have metastatic disease before surgery or during the first six months of follow-up were considered true- positive; all of the other cases with a positive or suspicious initial staging but with no evidence of distant metastasis before surgery and with a disease-free survival longer then six months were considered false-positive.In the same way all cases with negative initial staging who relapsed during the first six months of follow-up were considered false-negative and those with negative initial staging and with a disease-free survival longer then six months were considered true-negative.Statistical analysis was performed using Fisher's exact test.Results: BS, CXR and LUS, 388, 399 and 398 examinations respectively, were considered available, and 17 (4.38%), six (1.5%) and four (1%), respectively, proved to be true-positive.A statistically significant difference was observed when our cases were grouped according to T status (T4 vs. T1–T2–T3, P < 0.01) and nodal status (N0–N1 cases with less than three involved nodes and N1 with more than three positive lymph nodes N2 patients, P < 0.01).Conclusions: The present study suggests that breast cancer patients can be divided into three subgroups with different detection rates for distant metastases at staging (0.59%, 2.94% and 15.53%), and that the standard practice should be changed.In the first (T1N0 and T1N1 patients with 3 positive lymph nodes – 41.13% of the patients) and the second group (T2N0, T2N1 with 3 positive lymph nodes, T3N0 and T3N1 patients with 3 positive lymph nodes – 33.49% of the patients) there is no need for a complete set of staging procedures, whereas full procedural staging is needed in the third group of patients (T4, N1 with >3 lymph nodes and N2, 25.37% of the patients).     

Multimodal Treatment in Operable Stage III NSCLC: A Pooled Analysis on Long-Term Results of Three SAKK trials (SAKK 16/96, 16/00, and 16/01)

Introduction

Long-term data on outcomes of operable stage III NSCLC are scarce.

Randomized comparison of early versus late hyperfractionated thoracic irradiation concurrently with chemotherapy in limited disease small-cell lung cancer: A randomized phase II study of the Hellenic Cooperative Oncology Group (HeCOG)

Background:Concurrent platinum–etoposide chemotherapy givenin combination with hyperfractionated thoracic radiation therapy (HTRT) inlimited disease (LD) small cell lung cancer (SCLC) is associated with a highresponse rate and significant prolongation of survival. Given these results,the Hellenic Cooperative Oncology Group (HeCOG) performed a multicenterrandomized phase II study in patients with LD SCLC to evaluate the timing ofHTRT (early vs. late) when given concurrently with chemotherapy. Patients and methods:To be eligible for the study, patients wererequired to have histologically or cytologically proven LD SCLC, confined toone hemithorax and/or ipsilateral mediastinal or supraclavicular lymphnodesand absence of pleural effusion or controlateral supraclavicular lymphnodeinvolvement. Moreover, patients had to have a good performance status andadequate haematological, liver and renal function. Patients with LD SCLC wererandomized to receive HTRT either concurrently with the first (Group A) orwith the fourth (Group B) cycle of chemotherapy. Chemotherapy consisted ofcarboplatin administered at an AUC of six given as an i.v. 1-hour-infusionimmediately followed by etoposide at a dose of 100 mg/m² i.v. asa two-hour infusion for three consecutive days every three weeks up to a totalof six cycles. Prophylactic cranial irradiation was also given to patientsachieving a complete response. Results:42 and 39 patients, were eligible for efficacy evaluationin group A and B respectively. The overall response rate was 76% ingroup A and 92.5% in group B (P = 0.07) with a completeresponse rate of 40.5% and 56.5%, respectively. After a medianfollow-up of 35 months, time to progression was 9.5 months in group A and 10.5in group B (NS) while overall median survival was 17.5 and 17 monthsrespectively (NS). The 2-year survival was 36% in group A and29% in group B (NS) and the 3-year survival 22% and 13%,respectively (NS). The distant relapse rate was 38% in group A and61% in group B (P = 0.046). Severe grade 3–4 anemiawas recorded in 19% of group A and 12.5% of group B (NS), whilesevere leucopenia was recorded in 35.5% and 20.5%(P = 0.09) and neutropenic fever in 5% and 2.5%(NS), respectively. Severe thrombocytopenia did not differ significantlybetween the two treatment groups being 21.5% and 23%,respectively. Severe grade 2–3 esophageal toxicity was 19% ingroup A and 23% in group B (NS), while grade 3 lung toxicity was5% and 7.5% (NS), respectively. No toxicity-related deaths wererecorded. Conclusion:Concurrent administration of HTRT withcarboplatin–etoposide is associated with a high response and survivalrate. Although a trend for higher response rate was recorded in the group ofpatients who received late HTRT, the overall median, 2-year and 3-yearsurvival rates did not differ significantly between the two treatment groups.The toxicity of this promising therapeutic approach was acceptable.Comparative phase III studies with an adequate number of patients arerecommended in order to answer this question.     

792例食管癌三维技术放疗的疗效分析

目的 观察食管鳞状细胞癌三维技术放疗的局部控制率及生存率,并探讨影响因素。方法 回顾分析2003—2008年收治的食管癌患者 792例,采用三维适形放疗(672例)及调强放疗(120例)技术,1.8~2.0 Gy/次,5 次/周,处方剂量 50~70 Gy。同期放化疗 142例,单纯放疗 650例。Kaplan-Meier法计算局部控制率和生存率,Logrank法单因素预后分析,Cox法多因素预后分析。结果随访率为95.8%,随访时间满 5年者 133例。全组1、3、5年局部控制率分别为76.6%、53.2%、48.6%,总生存率分别为70.1%、36.7%、28.0%。单因素预后分析显示T分期、N分期、临床分期、肿瘤体积为影响生存的因素(χ²=20.58~55.60,P均=0.000),多因素预后分析显示N分期、肿瘤体积为影响生存的因素(χ²=6.35、29.23,P=0.012、0.000)。同期放化疗与单纯放疗的 5年局部控制率分别为57.0%和46.8%(χ²=7.34,P=0.007),5年总生存率分别为32.8%和27.6%(χ²=3.42,P=0.064)。结论 三维技术放疗食管癌的远期疗效较二维技术放疗明显提高。T分期、N分期、TNM分期、肿瘤体积是长期生存影响因素。加入同期化疗可提高患者的局部控制率。     

Organ preservation in invasive bladder cancer: Brachytherapy,an alternative to cystectomy and combined modality treatment?

PURPOSE: To evaluate our long-term results of bladder preservation with brachytherapy in the treatment of bladder cancer. METHODS AND MATERIALS: Between 1987 and 2000, 108 patients with T1-G3 and T2-T3a stages of bladder cancer were treated with a transurethral resection (TUR) and a course of external beam radiotherapy (30 Gy in 15 fractions) followed by brachytherapy (40 Gy). All tumors were solitary lesions with a diameter < or =5 cm. Median follow-up was 54 months (range, 1-178 months). RESULTS: The 5-year and 10-year overall survival rates were 62% and 50%, respectively. The 5-year and 10-year disease-specific survival rates were 73% and 67%, respectively. The actuarial local control rate was 73% at 5 and 73% at 10 years, respectively. The 5-year and 10-year disease-specific survival rates for patients with a preserved bladder were 68% and 59%, respectively. Of all long-term surviving patients, 90% preserved their native bladders. The treatment was well tolerated. Acute toxicity was mild. Two patients experienced serious late toxicity: 1 patient developed a persisting vesicocutaneous fistula and the other a stricture of the urethra and ureters. CONCLUSION: For patients with solitary, organ confined invasive bladder cancer < or =5 cm, bladder preservation with brachytherapy is an excellent alternative to radical cystectomy and combined modality treatment.