Adenoid cystic carcinoma of parotid gland treated with surgery and radiotherapy: long-term outcomes, QoL assessment and review of the literature

To assess outcomes, toxicity and quality-of-life (QoL) of patients with parotid gland adenoid cystic carcinoma (PGACC) treated by surgery and postoperative radiotherapy. Between 1995 and 2010, 46 patients with PGACC were treated with parotidectomy±neck dissection followed by radiotherapy. Endpoints were loco-regional control (LRC), distant metastasis-free (DMFS), disease-free (DFS), cause-specific (CSS), and overall survival (OS), late toxicity, and QoL. After a median follow-up of 58 months (range 4-171), the 5-year Kaplan-Meier estimates of LRC, DMFS, DFS, CSS, and OS were 88%, 78%, 75%, 80%, and 67%, respectively and the 8-year rates were 88%, 75%, 72%, 77%, and 64%, respectively. On multivariate analysis, T-stage, N-stage, tumor grade, and perineural invasion correlate significantly with DMFS and DFS. The overall 5-year cumulative incidence of grade ≥2 late toxicity was 9%. QoL-scores deteriorate during and shortly after treatment but returned in all scales to almost baseline levels within 6 months. Excellent LRC rates were achieved in patients with PGACC treated by surgery and postoperative radiotherapy with low rate of late side-effects and preservation of good QoL. Despite the effective local therapy, 9 of 46 patients (20%) failed distantly. Because effective treatment strategies for this problem are lacking, prospective trials are needed to determine the role of adjuvant systemic or targeted therapy in patients at high risk of DM.     

FDG PET-CT对复发鼻咽癌疗效及预后评价研究

目的 评价FDG PET-CT显像对复发鼻咽癌疗效监测及其预后评估价值。方法 2008—2013年经病理或影像学确诊的92例复发鼻咽癌,按中国2008鼻咽癌临床分期标准再分期。Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为8、11、39、34例,其中复发T分期(rT₁)、rT₂、rT₃、rT₄期患者分别为10、11、38、33例。28例同时伴有颈淋巴结复发。所有患者均于疗前行全身或头颈部FDG PET-CT并接受放疗±化疗,分别分析SUV_max及临床各因素与临床预后关系。Kaplan-Meier法计算OS、DFS、LRFS、RRFS、DMFS,Logrank法检验和单因素预后分析,Cox模型多因素预后分析。结果 3年OS、DFS、LRFS、RRFS、DMFS分别为33.6%、32.1%、32.8%、31.8%、33.7%。肿瘤SUV_max中位数为8.35(2.70~21.50)。与3年OS相关最佳截断点SUV_max为7.0,SUV_max≤7.0、>7.0患者3年OS分别为42.0%、28.3%(P=0.019)。单因素分析显示年龄、SUV_max、rN分期与OS相关(P=0.023、0.019、0.002),多因素分析显示SUV_max和rN分期是OS、DFS、DMFS影响因素(HR=1.68,P=0.045和HR=2.23,P=0.003;HR=1.67,P=0.042和HR=2.39,P=0.001;HR=1.77,P=0.025和HR=2.40,P=0.001)。结论 SUV_max可能是影响复发鼻咽癌OS、DFS、DMFS的有效预后因素。     

Detection of thymidylate synthase expression in lymph node metastases of colorectal cancer can improve the prognostic information.

PURPOSE: The level of thymidylate synthase (TS) in primary colorectal cancer (CRC) has been reported as a prognostic marker. The purpose of this study was to determine whether TS expression in lymph node metastases of Dukes' C CRC is a prognostic marker. PATIENTS AND METHODS: TS expression in the primary tumor and lymph node metastases from 348 patients with Dukes' C CRC was retrospectively assessed using immunohistochemistry and the monoclonal antibody TS 106. The patients had all been enrolled onto our previous study of 862 CRC patients who were included in Nordic trials that randomly assigned the patients to either surgery alone or surgery plus adjuvant chemotherapy. RESULTS: TS expression in lymph node metastases was a distinct prognostic marker in the entire study group for overall survival (OS; P = .02) and disease-free survival (DFS; P = .04). A low TS expression in the lymph node metastases correlated with a better clinical outcome. In the subgroup of patients treated with surgery alone, the expression of TS in lymph node metastases also had a prognostic value for OS (P = .04) and DFS (P = .03), but this was not the case for the other subgroup who received adjuvant fluorouracil-based chemotherapy (OS, P = .5; DFS, P = .2). The expression of TS in the primary tumor only had a significant prognostic value among patients who were treated with surgery alone (OS, P = .03; DFS, P = .03) and not among the entire patient population. CONCLUSION: These data show that TS expression in lymph node metastases is a prognostic marker for patients with Dukes' C CRC.     

416例鼻咽癌调强放疗远期生存与影响因素分析

目的 总结鼻咽癌调强放疗(IMRT)的远期生存与影响因素。方法 本院2001—2009年采用IMRT技术治疗初程鼻咽癌患者 416例,鼻咽原发灶、阳性淋巴结的大体肿瘤体积处方剂量为 70~78 Gy,临床靶体积处方剂量为60 Gy,淋巴结阴性引流区处方剂量为 50~56 Gy。Ⅲ+Ⅳ期 333例中 187例接受以顺铂30 mg/m²每周1次为主的同期化疗。Kaplan-Meier法计算生存率并Logrank法检验和单因素预后分析,Cox法多因素预后分析。结果 随访率98.0%,随访超过 5年的 158例。影响总生存的因素有性别(χ²=4.59,P=0.03)、年龄(χ²=11.20,P=0.00)、T分期(χ²=19.40,P=0.00),N分期(χ²=18.00,P=0.00),T分期影响局部控制(χ²=34.80,P=0.00),T分期、N分期均影响无瘤生存率和无远处转移生存(χ²=33.50、21.20,P=0.00、0.00和 χ²=11.90、14.60,P=0.01、0.01)。Ⅲ+Ⅳ期 333例中同期放化疗(187例)和单纯放疗(146例)的 5年局部控制率为82.2%和90.7%(χ²=1.72, P=0.19)、总生存率为70.2%和83.4%(χ²=1.42,P=0.23)、无瘤生存率为62.8%和73.2%(χ²=2.83,P=0.09)、无远处转移生存率为78.0%和83.2%(χ²=0.37,P=0.55)。结论 鼻咽癌IMRT取得较好疗效,但同期化疗的作用仍有待进一步证实。     

Outcomes and prognostic factors of conformal radiotherapy versus intensity-modulated radiotherapy for nasopharyngeal carcinoma

Introduction

This study retrospectively compared outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) treated with conformal radiotherapy (CRT) and intensity-modulated radiotherapy (IMRT).

Materials and methods

The treatment records of 182 patients treated with IMRT and 198 patients treated with CRT from April 2005 to December 2007 in our hospital were reviewed. The clinical characteristics, treatment outcomes (including survival analysis and acute and late toxicity), and prognostic factors of the two groups were compared.

Results

The 4-year local?Cregional control (LRC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) of the IMRT and CRT groups were 93.6 and 85.3?%, 79.1 and 73.6?%, 74.7 and 65.0?%, and 83.5 and 72.1?%, respectively. The acute radiation dermatitis and xerostomia of the two groups were significantly different (P?<?0.05). In the IMRT group, OS between different T stages could not be well separated. Multivariate analysis revealed that, in the CRT group, the clinical stage and T and N stages were significant prognostic factors for OS, DMFS, and DFS and that T stage was a significant prognostic factor for LRC. In the IMRT group, T and N stages had no predictive value for outcomes.

Conclusions

Compared with CRT, IMRT has a better prognosis and less adverse effects. For IMRT, T stage was not a significant prognostic factor for LRC, DMFS, DFS, or OS. An effective treatment strategy is needed for distant control. With the increasing use of IMRT and continued modulation of treatment strategies for NPC, the current staging system faces great challenges.     

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

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

Comparison of outcomes for patients with medically inoperable Stage I non-small-cell lung cancer treated with two-dimensional vs. three-dimensional radiotherapy

PURPOSE: This retrospective analysis was performed to assess the outcomes of three-dimensional (3D) conformal radiotherapy and two-dimensional (2D) planning. METHODS AND MATERIALS: Between 1978 and 2003, 200 patients with Stage I non-small-cell lung cancer (NSCLC) were treated with radiotherapy alone at M.D. Anderson Cancer Center. Eighty-five patients were treated with 3D conformal radiotherapy. For the 3D group, median age, radiation dose, and follow-up was 73 (range, 50-92), 66 Gy (range, 45-90.3 Gy), and 19 months (range, 3-77 months), respectively; and for the 2D group, 69 (range, 44-88), 64 Gy (range, 20-74 Gy), 20 months (range, 1-173 months), respectively. Overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) rates were analyzed. RESULTS: There was no statistically significant difference in patient and tumor characteristics between 2D and 3D groups, except the 3D patients were older (p = 0.006). The OS, DSS, and LRC rates were significantly higher in patients who were treated by 3D conformal radiotherapy. Two- and 5-year OS for the 3D group were 68% and 36%, respectively, and 47% and 10% in the 2D group (p = 0.001). DSS at 2 and 5 years for the 3D group were 83% and 68%, respectively, vs. 62% and 29% in the 2D group (p < 0.001). LRC rates at 2 and 5 years for patients in the 3D group were 77% and 70% and 53% and 34% in the 2D group (p < 0.001). On univariate analysis elective, nodal irradiation was associated with decreased OS, DSS, and LRC. On multivariate analysis, 3D conformal radiotherapy was associated with increased OS and DSS. Male sex, age > or =70, weight loss > or =5%, and tumor size > or =4 cm were associated with decreased OS and DSS. CONCLUSIONS: This study demonstrates that 3D conformal radiotherapy improves outcomes in patients with medically inoperable Stage I NSCLC compared with 2D treatment and is an acceptable treatment for this group of patients.     

Prognostic value of maximum standardized uptake value measured by pretreatment 18F-FDG PET/CT in locally advanced head and neck squamous cell carcinoma

Purpose/objectives

To evaluate the prognostic impact of maximum standardized uptake value (SUV_max) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) undergoing pretreatment [F-18] fluoro-d-glucose-positron emission tomography/computed tomography (FDG PET/CT) imaging.

Materials/methods

Fifty-eight patients undergoing FDG PET/CT before radical treatment with definitive radiotherapy (±concomitant chemotherapy) or surgery + postoperative (chemo)radiation were analyzed. The effects of clinicopathological factors (age, gender, tumor location, stage, Karnofsky Performance Status (KPS), and treatment strategy) including primary tumor SUV_max and nodal SUV_max on overall survival (OS), disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) were evaluated. Kaplan–Meier survival curves were generated and compared with the log-rank test.

Results

Median follow-up for the whole population was 31 months (range 2.3–53.5). Two-year OS, LRC, DFS and DMFS, for the entire cohort were 62.1, 78.3, 55.2 and 67.2%, respectively. Median pretreatment SUV_max for the primary tumor and lymph nodes was 11.85 and 5.4, respectively. According to univariate analysis, patients with KPS < 80% (p < 0.001), AJCC stage IVa or IVb vs III (p = 0.037) and patients undergoing radiotherapy vs surgery (p = 0.042) were significantly associated with worse OS. Patients with KPS < 80% (p = 0.003) or age ≥65 years (p = 0.007) had worse LRC. The KPS < 80% was the only factor associated with decreased DFS (p = 0.001). SUV_max of the primary tumor or the lymph nodes were not associated with OS, DFS or LRC. The KPS < 80% (p = 0.002), tumor location (p = 0.047) and AJCC stage (p = 0.025) were associated with worse cancer-specific survival (CSS). According to Cox regression analysis, on multivariate analysis KPS < 80% was the only independent parameter determining worse OS, DFS, CSS. Regarding LRC only patients with IK < 80% (p = 0.01) and ≥65 years (p = 0.01) remained statistically significant. Nodal SUV_max was the only factor associated with decreased DMFS. Patients with a nodal SUV_max > 5.4 presented an increased risk for distant metastases (HR, 3.3; 95% CI 1.17–9.25; p = 0.023).

Conclusions

The pretreatment nodal SUV_max in patients with locally advanced HNSCC is prognostic for DMFS. However, according to our results primary tumor SUV_max and nodal SUV_max were not significantly related to OS, DFS or LRC. Patients presenting KPS < 80% had worse OS, DFS, CSS and LRC.

     

Improved survival outcomes with the incidental use of beta-blockers among patients with non-small-cell lung cancer treated with definitive radiation therapy

BackgroundPreclinical studies have shown that norepinephrine can directly stimulate tumor cell migration and that this effect is mediated by the beta-adrenergic receptor.Patients and methodsWe retrospectively reviewed 722 patients with non-small-cell lung cancer (NSCLC) who received definitive radiotherapy (RT). A Cox proportional hazard model was utilized to determine the association between beta-blocker intake and locoregional progression-free survival (LRPFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS).ResultsIn univariate analysis, patients taking beta-blockers (n = 155) had improved DMFS (P < 0.01), DFS (P < 0.01), and OS (P = 0.01), but not LRPFS (P = 0.33) compared with patients not taking beta-blockers (n = 567). In multivariate analysis, beta-blocker intake was associated with a significantly better DMFS [hazard ratio (HR), 0.67; P = 0.01], DFS (HR, 0.74; P = 0.02), and OS (HR, 0.78; P = 0.02) with adjustment for age, Karnofsky performance score, stage, histology type, concurrent chemotherapy, radiation dose, gross tumor volume, hypertension, chronic obstructive pulmonary disease and the use of aspirin. There was no association of beta-blocker use with LRPFS (HR = 0.91, P = 0.63).ConclusionBeta-blocker use is associated with improved DMFS, DFS, and OS in this large cohort of NSCLC patients. Future prospective trials can validate these retrospective findings and determine whether the length and timing of beta-blocker use influence survival outcomes.     

鼻咽癌IMRT同期EGFR单抗和同期化疗与单纯IMRT的回顾对照研究

目的 回顾性对比IMRT同期EGFR单抗、同期化疗和单纯IMRT治疗鼻咽癌的疗效及不良反应。方法 将2008—2012年间收治的68例接受IMRT同期EGFR单抗的Ⅱ—Ⅳ_b期初治鼻咽癌患者纳入BRT组,应用SAS软件进行1∶2配对形成单纯IMRT (IMRT)组136例及同期放化疗(CCRT)组136例,共340例。Kaplan-Meier法计算生存率并Logrank检验,Cox模型分析预后因素。结果 BRT、IMRT、CCRT组3年样本数分别为14、69、47例。全组3年OS、DFS、LRC、DMFS分别为91.2%、80.2%、93.1%、87.2%。BRT、IMRT、CCRT组的3年OS分别为91.9%、 92.1%、89.9%(P=0.379),3年DFS分别为82.1%、77.9%、81.6%(P=0.594),3年LRCR分别为98.2%、90.6%、93.0%(P=0.249),3年DMFS分别为85.2%、85.2%、90.3%(P=0.383)。多因素分析提示T分期及同期EGFR单抗是LRC的影响因素(P=0.034、0.032)。结论 鼻咽癌单纯IMRT即可达较好疗效。三组之间整体疗效相近,但BRT组有提高LRC的趋势。     

Clinicopathologic prognostic markers of survival: an analysis of 259 patients with malignant melanoma ≥1 mm

The histopathologic status of the sentinel node (SN) and the ulceration of the primary tumor are important indicators of the clinical outcome of melanoma patients. The purpose of this study was to investigate potential correlations between prognostic factors and the sentinel lymph node status as well as their influence on disease-free survival (DFS), distant metastases-free survival (DMFS), and overall survival (OS). The medical records of 259 melanoma patients who underwent sentinel lymph node dissection between 2000 and 2006 were analyzed. DFS, DMFS, and OS were assessed. A uni- and a multivariate analysis to determine prognostic factors were performed. Histologic type, Clark’s level, and Breslow’s tumor thickness were the only parameters that showed a significant correlation with a positive SN. The univariate analysis revealed SN positivity (DFS and DMFS: p < 0.001; OS: p = 0.039) and ulceration (DFS: p < 0.001; DMFS: p = 0.001; OS: p = 0.003) to be significant prognostic markers. However, ulceration was the only independent prognostic factor for OS that was upheld by the multivariate analysis (p = 0.006; HR 3.89; CI 1.48–10.27). In stage I/II melanoma patients, ulceration of the primary tumor was the strongest prognostic factor for RFS, DMFS, and OS and superior to the pathology status of the SN.     

Non-metastatic stage IV nasopharyngeal carcinoma patients: analysis of the pattern of relapse and survival.

BACKGROUND AND PURPOSE: The objective of this study is to analyze the mode of recurrence patterns and survival of our 96 non-metastatic stage IVA and IVB nasopharyngeal carcinoma (NPC) patients. PATIENTS AND METHODS: A total of 234 previously untreated, histologically confirmed non-metastatic NPC patients were treated in our department between 1993 and 2001. Among them 96 patients (41%) were staged as IVA or B disease. All patients were uniformly staged using the fifth edition of AJCC/UICC staging system. There were 76 male and 20 female patients. Their ages ranged from 9 to 72 years (median age: 43.5). Histopathological diagnosis was WHO 2 and 3 in 89 (93%) patients. All patients were treated with external radiotherapy and 77 out of 96 patients (80%) with stage IV disease received either concomitant or neoadjuvant cisplatin based combined chemotherapy regimens. Median follow-up time was 30 months (range: 4-101 months). RESULTS: At the time of this analysis, 60 (62%) patients were alive and 48 of them were free of disease. Local recurrence rate was found to be significantly higher in stage IVA patients (28 vs. 11%, P=0.02) and distant metastasis rate was significantly higher in stage IVB patients (40 vs. %8, P=0.0001). The 3 year overall (OS), disease free (DFS), loco regional relapse free (LRRFS) and distant metastasis free survival (DMFS) rates were 71, 74, 77 and 94% for stage IVA and 60, 46, 77 and 58% for stage IVB patients, respectively. Three year LRFS rates for stage IVA and IVB were 77 and 89%, respectively (P=0.1). Age older than 40 years was found to be statistically significant adverse prognostic factor both for OS (P=0.01) and LRRFS (P=0.005) in univariate analysis. Advanced N status was an unfavorable prognostic factor both for OS (P=0.03), DFS (P=0.0004) and DMFS (P=0.0003). DMFS was adversely affected by the presence of cranial nerve palsy at diagnosis (P=0.01), advanced T status (P=0.03) and advanced N status (P=0.0003). In univariate analysis treatment with chemotherapy was found to be an unfavorable prognostic factor for DMFS (P=0.02). According to the multivariate analysis, older age (>40 year of age) was a significant independent prognostic factor for OS (P=0.02), DFS (P=0.05) and LRRFS (P=0.01). Patients with advanced N status had worse OS (P=0.03), DFS (P<0.0001) and DMFS (P=0.07). Patients treated with chemotherapy as an adjuvant to radiotherapy had tended to have a better DFS (P=0.04). CONCLUSIONS: The local relapse was the major cause of failure in patients with stage IVA disease, and distant metastasis was the predominant treatment failure in stage IVB patients. While stage IVA patients may benefit more intensive local treatment strategies, stage IVB patients definitely need more systemic treatment.     

95例老年鼻咽癌患者单纯放疗远期疗效分析

目的 评价单纯放疗老年鼻咽癌患者的远期疗效及不良反应。方法 回顾分析本院1995—1998年间经病理证实的初治无远处转移、年龄≥65岁的老年鼻咽癌患者95例的临床资料,分析其远期生存率及不良反应。采用Kaplan-Meier法计算局部控制率和无远处转移生存率,Logrank法单因素预后分析,Cox模型多因素预后分析。结果 随访率为98%。3、5、8年局部控制率和无远处转移生存率分别为89%、87%、84%和85%、79%、79%。急性不良反应主要为1、2级血液学反应(34例)、皮肤反应(61例)和口腔黏膜炎(63例);晚期不良反应主要为听力下降(8%)、张口困难(10%)和颅神经损伤(5%)。单因素分析结果显示影响局部控制率因素有放疗是否中断(χ²=7.45,P=0.006)、颈部淋巴结疗效(χ²=4.17,P=0.041),影响无远处转移生存率有T分期(χ²=4.16,P=0.032)、N分期(χ²=4.66,P=0.031)、放疗是否中断(χ²=9.42,P=0.002);多因素分析结果显示影响局部控制率因素有放疗是否中断(χ²=6.19,P=0.013)和颈部淋巴结疗效(χ²=12.26,P=0.002),影响无远处转移生存率因素有N分期(χ²=15.06,P=0.000)和放疗是否中断(χ²=21.62,P=0.000)。结论 老年鼻咽癌患者行单纯常规放疗即可取得较好疗效且不良反应较轻;N分期早、放疗顺利完成和颈部淋巴结完全缓解的远期预后良好。     

Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy

Background:Gross target volume of primary tumor (GTV?P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma (NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity?modulated radiotherapy (IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to ifnd a suitable cut?off value of GTV?P for prognosis prediction. Methods:Clinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver oper?ating characteristic (ROC) curves were used to identify the cut?off values of GTV?P for the prediction of different end?points [overall survival (OS), local relapse?free survival (LRFS), distant metastasis?free survival (DMFS), and disease?free survival (DFS)] and to test the prognostic value of GTV?P when compared with that of the American Joint Committee on Cancer T staging system. Results:The 358 patients with locally advanced NPC were divided into two groups by the cut?off value of GTV?P as determined using ROC curves: 219 (61.2%) patients with GTV?P≤46.4mL and 139 (38.8%) with GTV?P>46.4mL. The 3?year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV?P≤46.4mL than in those with GTV?P>46.4mL (allP<0.05). Multivariate analysis indicated that GTV?P>46.4mL was an independent unfavorable prognostic factor for patient survival. The ROC curve veriifed that the predictive ability of GTV?P was superior to that of T category (P<0.001). The cut?off values of GTV?P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4mL, respectively. Conclusion:In patients with locally advanced NPC, GTV?P>46.4mL is an independent unfavorable prognostic indi?cator for survival after IMRT, with a prognostic value superior to that of T category.     

伴骨转移的非小细胞肺癌化疗同期三维放疗预后分析

目的 探讨非小细胞肺癌(NSCLC)骨转移的胸部原发灶三维放疗在综合治疗中的作用。方法 选取2003-2010年间伴骨转移的95例Ⅳ期NSCLC化疗≥2周期且同期胸部三维放疗的前瞻性研究资料,其中47例单纯骨转移、48例合并其他脏器转移。Kaplan-Meier法计算生存率,Logrank法组间比较及单因素预后分析,Cox模型行多因素预后分析。结果 随访率95%。1、2、3年生存率分别为44%、17%、9%。单因素分析显示原发灶计划靶体积放疗剂量≥63 Gy、原发肿瘤治疗有效和化疗≥4周期者生存延长(P=0.001、0.037、0.009)。单纯骨转移和合并其它转移患者分别进行分析,原发灶计划靶体积放疗剂量≥63 Gy仍是影响其生存的因素(P=0.045、0.012)。单纯骨转移患者原发肿瘤分期T₁+T₂期较T₃+T₄期患者生存延长(P=0.048)。多因素分析显示原发灶计划靶体积放疗剂量≥63 Gy和单纯骨转移能延长总生存(P=0.036、0.035)。结论 NSCLC骨转移胸部原发灶三维放疗技术及剂量在综合治疗中对改善生存具有重要作用。     

18FDG PET/CT标准摄取值与非小细胞肺癌临床分期关系的研究

目的:探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)患者治疗前的18氟脱氧葡萄糖(18F-deoxyglucose,18 FDG) PET／CT标准摄取值(standard uptake value, SUV)与临床分期、原发肿瘤大小及病理学类型的关系。方法:对75例治疗前的NSCLC患者接受18FDG PET／CT检查获得最高SUV (SUVmax)。分析SUVmax与临床分期、原发肿瘤分期、肿瘤大小和病理学类型的关系,并研究SUV在四者组内差异是否有统计学意义。结果:SUVmax与临床分期和原发肿瘤大小均呈正相关(r=0．279,P=0．014;r= 0．645,P=0．001),与肿瘤病理学类型无关(r=-0．077,P=0．507);SUV在两组不同大小肿瘤组(≤3．0 cm和>3．0 cm)间差异有统计学意义,t=-0．647,P=0．015,在各个临床分期组(ⅠA～ⅡB、ⅢA和m B～Ⅳ)间差异有统计学意义,F=3．807,P=0．027,在4个原发肿瘤分期组(T1、T2、T3和T4)间差异有统计学意义,F=8．025,P=0．022,而在不同病理学类型组(鳞癌、腺癌和腺鳞癌)间差异无统计学意义,F=1．911,P=0．155。结论:18FDG PET／CT SUV随肿瘤大小和病期的增加呈升高趋势,可以作为评价NSCLC临床分期的辅助手段,但不能为无法取得病理学诊断的患者提供帮助。     

Tumor volume and uterine body invasion assessed by MRI for prediction of outcome in cervical carcinoma treated with concurrent chemotherapy and radiotherapy

OBJECTIVE: The aim of this study was to evaluate the prognostic significance of primary tumor volume and uterine body invasion assessed by pre-treatment MRI for uterine cervical cancer patient treated with concurrent chemotherapy and radiotherapy. METHODS: A retrospective analysis of 106 patients with IB-IIIB cervical carcinoma was performed. Potential prognostic factors were stage, clinical tumor diameter, histology, age, pelvic lymph node, vaginal extension, parametrial invasion, tumor volume and uterine body invasion status. Multivariate analyses were performed to identify the prognostic factor for overall survival (OS) and disease-free survival (DFS). RESULTS: The 5-year OS, DFS rate were 59.7 and 56.6%. Using multivariate analyses, a large tumor volume (>/=30 ml; P = 0.012) and uterine body invasion (P = 0.020) and positive pelvic lymph node (LN) enlargement (P = 0.040) showed a significantly unfavorable influence on OS. Using these three factors, patients were divided into four subgroups: the OS rates of patients with risk 0 (volume <30 ml, no uterine body invasion, and negative LN), risk 1 (one of these three factors), risk 2 (two of these three factors) and risk 3 (volume >/=30 ml, uterine body invasion, and positive LN) were 96.3, 77.5, 53.0 and 14.8%, respectively (P < 0.0001). CONCLUSIONS: Tumor volume and uterine body invasion determined by MRI were significant prognostic factors for patients with cervical carcinoma. Pelvic lymph node enlargement diagnosed by CT also proved to be a significant prognostic factor in OS. Using these three parameters, we devised a practical and effective model to predict OS.     

Standardised FDG uptake: a prognostic factor for inoperable non-small cell lung cancer

The aim of this study was to investigate the relationship between standardised uptake value (SUV) obtained from [(18)F]fluorodeoxyglucose positron emission tomography (FDG PET) and treatment response/survival of inoperable non-small cell lung cancer (NSCLC) patients treated with high dose radiotherapy. Fifty-one patients were included recording stage, performance, weight loss, tumour volume, histology, lymph node involvement, SUV, and delivered radiation dose. The maximum SUV (SUV(max)) within the primary tumour was a sensitive and specific factor for predicting treatment response. Apart from SUV(max), stage and performance were also independent predictive factors for treatment response. In a multivariate disease-specific survival (DSS) analysis, SUV(max) (P = 0.01), performance status (P = 0.008) and stage (P = 0.04) were prognostic factors. For overall survival (OS), SUV(max) (P = 0.001) and performance (P = 0.06) were important prognostic factors. SUV(max) was an important prognostic factor for survival of inoperable NSCLC patients and a predictive factor for treatment response. Although the number of patients was small, the treatment was not homogeneous and the use of FDG SUV may have had constraints, we still conclude that the FDG SUV is potentially a good indicator for selecting patients for different treatment strategies.     

Predictive factors for the local recurrence and distant metastasis of phyllodes tumors of the breast：a retrospective analysis of 192 cases at a single center

The local recurrence rate of phyllodes tumors of the breast varies widely among different subtypes, and distant metastasis is associated with poor survival. This study aimed to identify factors that are predictive of local recurrence-free survival （LRFS）, distant metastasis-free survival （DMFS）, and overall survival （OS） in patients with phyllodes tumors of the breast. Clinical data of all patients with a phyllodes tumor of the breast （n = 192） treated at Sun Yat-sen University Cancer Center between March 1997 and December 2012 were reviewed. The Pearson X2 test was used to investigate the relationship between clinical features of patients and histotypes of tumors. Univariate and multivariate Cox regression analyses were performed to identify factors that are predictive of LRFS, DMFS, and OS. In total, 31 （16.1%） patients developed local recurrence, and 12 （6.3%） developed distant metastasis. For the patients who developed local recurrence, the median age at the diagnosis of primary tumor was 33 years （range, 17-56 years）, and the median size of primary tumor was 6.0 cm （range, 0.8-18 cm）. For patients who developed distant metastasis, the median age at the diagnosis of primary tumor was 46 years （range, 24-68 years）, and the median size of primary tumor was 5.0 cm （range, 0.8-18 cm）. In univariate analysis, age, size, hemorrhage, and margin status were found to be predictive factors for LRFS （P = 0.009, 0.024, 0.004, and 0.001, respectively）, whereas histotype, epithelial hyperplasia, margin status, and local recurrence were predictors of DMFS （P = 0.001, 0.007, 0.007, and 〈 0.001, respectively）. In multivariate analysis, independent prognostic factors for LRFS included age [hazard ratio （HR） = 3.045, P = 0.005], tumor size （HR = 2.668, P = 0.013）, histotype （HR = 1.715, P= 0.017）, and margin status （HR = 4.530, P〈 0.001）. Histotype （DMFS： HR = 4.409, P= 0.002; OS： HR = 4.194, P= 0.003） and margin status （DMFS： HR = 2.581, P= 0.013;     

84例ⅢA-N 2 期非小细胞肺癌术前新辅助临床治疗结果分析

目的:探讨新辅助结合手术切除治疗ⅢA-N 2 期非小细胞肺癌的临床疗效。方法:收集2008年1 月至2013年7 月上海交通大学附属胸科医院收治的术前明确单侧纵隔淋巴结（且淋巴结短径≥ 1 cm）转移（ⅢA-N 2 期）,经新辅助治疗后再手术的非小细胞肺癌（non-small celll ung cancer ,NSCLC ）91例患者。总结并分析经术前新辅助治疗的反应率以及患者的生存情况并分析影响预后的因素。结果:3 年和5 年总生存期（OS）分别为57.7% 和34.2%;3 年和5 年无病生存期（DFS）分别为37.9% 和30.5% 。在OS和DFS 方面,R 0 和R 1 组之间（P = 0.118;P = 0.369）、新辅助化疗和放化疗组之间（P = 0.771;P = 0.953）、临床反应和无反应组之间（P =0.865;P = 0.862）以及不同组织病理类型组之间（P = 0.685;P = 0.208）比较差异均无统计学意义。肺叶切除及术后病理性淋巴结降期的患者分别优于相应地扩大性切除（P = 0.023;P = 0.024）和未降期（P = 0.036;P = 0.025）的患者。单因素分析显示肺叶切除和术后病理性淋巴结降期为有利的预测因子。多因素分析显示,病理淋巴结降期为术后DFS 的有利预测因子;无吸烟史及肺叶切除为OS的有利预测因子。结论:术前新辅助治疗ⅢA-N 2 期NSCLC 是可行的,能有效地使肿瘤大小及淋巴结降期,预后较为满意;预测预后方面,术后病理性降期要比临床反应更有意义;可行根治性肺叶切除及有病理性淋巴结降期的患者预后更好。