Mandard Tumour Regression Grade,Perineural Invasion,Circumferential Resection Margin and Post-chemoradiation Nodal Status Strongly Predict Outcome in Locally Advanced Rectal Cancer Treated with Preoperative Chemoradiotherapy

AimsThe pathology of tumours after chemo/radiotherapy for locally advanced rectal cancer can be difficult to interpret. The ypTNM staging does not accurately predict outcomes. Therefore, we developed a new prognostic index for this purpose.Materials and methodsThe Nottingham Rectal Cancer Prognostic Index (NRPI) is based on a study of 158 patients with locally advanced rectal cancer treated with preoperative chemo/radiotherapy at Nottingham University Hospital between April 2001 and December 2008. Patients were treated with radiotherapy to a dose of 50 Gy in 25 fractions over 5 weeks with/without concurrent capecitabine chemotherapy. Surgery was carried out after an interval of 6–10 weeks. Factors found to be significant on univariate analysis to predict for disease-free (DFS) and overall survival were further explored in multivariate analysis. The significant factors (Mandard tumour regression grade, perineural invasion, circumferential resection margin status and nodal status) were weighted to establish a score for the index. The median follow-up was 40 months (range 3–90 months).ResultsOn survival analysis, four distinct prognostic groups were found: Score 0 = excellent prognosis, 1–3 = good prognosis, 4–8 = moderate prognosis, 9–14 = poor prognosis. The NRPI significantly predicted both DFS and overall survival (P < 0.0001). DFS at 5 years was 95, 63, 25 and 0% for the four groups. On multivariate analysis the NRPI was found to be the strongest predictor of DFS including nodal and circumferential resection margin status (P < 0.0001). It was a stronger predictor of overall survival than the American Joint Committee on Cancer/Dukes staging (P < 0.0001).ConclusionsThe NRPI allocates patients into distinct prognostic categories. This seems to be a much stronger predictive factor than the American Joint Committee on Cancer/Dukes staging. This requires further validation, but seems to be a useful clinical index for future studies.     

Feasibility of preoperative and postoperative chemoradiotherapy in gastric adenocarcinoma. Two phase II studies done in parallel. Fédération Francophone de Cancérologie Digestive 0308

BackgroundFor resectable gastric cancer, both postoperative chemoradiotherapy and perioperative chemotherapy demonstrate high-level evidence for improved survival in Western populations. To evaluate the feasibility of pre- or postoperative chemoradiotherapy, we proposed two multicentre phase II studies.Patients and methodsPatients with localised, histologically confirmed gastric cancer and Eastern Cooperative Oncology Group (ECOG) performance status <2 judged suitable for curative resection were eligible. Eligible patients were assigned to either preoperative chemoradiotherapy followed by surgical resection or surgical resection followed by chemoradiotherapy depending on each centre. Chemoradiotherapy regimen included four courses of FOLFIRI (5 Fluorouracil, Leucovorin, Irinotecan) regimen then Concurrent fluorouracil at 200 mg/m²/d by continuous infusion 5 days each week. A dose of 50 Gy in 25 fractions in the preoperative study, or 45 Gy in 25 fractions in the postoperative study, was delivered. The primary end-point for both studies was the proportion of patients, who completed the therapeutic sequence.ResultsBetween September 2007 and January 2010, 63 patients were included in both studies. The postoperative study was stopped for futility at the first step. In the preoperative study, 31 patients (73.8%, confidence interval (CI) 95%: 65.8–90.1%) received complete therapeutic sequence. Serum albumin and dietary restriction evaluated by QLQ-STO22 (Quality of Life-Stomach module) score were significantly linked with chemoradiotherapy feasibility in univariate analysis with respectively Odds-ratio (OR) 1.16 [CI 95%: 1.01–1.33] and 0.17 [0.03–0.89], p = 0.04. Median overall survival time was 26.4 months in the preoperative study.ConclusionFeasibility of chemoradiotherapy was not achieved for these studies: 73.8% (CI 95%: 65.8–90.1) and 42.9% (CI 95%: 21.8–66%) in preoperative and postoperative settings respectively.     

Influence of human papillomavirus and p16INK4a on treatment outcome of patients with anal cancer

BackgroundThe purpose of this study was to evaluate HPV-DNA and p16^INK4a (p16) expression as prognostic markers for outcome in patients with anal cancer.MethodsFrom January 2000 to December 2011 a cohort of 105 anal cancer patients was treated with definitive chemoradiation at our institution. Tumor biopsies from 90 patients were analyzed for HPV-DNA by polymerase chain reaction and for p16 expression by immunohistochemistry.ResultsMedian follow-up was 48.6 months (range 2.8–169.1 months). HPV-DNA or p16-expression was found in 75 anal cancers each (83.3%), concordance was detectable in 70 tumors (77.8%). Significantly improved overall survival (OS) [77.1% vs. 51.4%, p = 0.005], progression-free survival (PFS) [64.0% vs. 35.0%, p < 0.001] and improved local control [81.0% vs. 55.9%, p = 0.023] was found for concomitant HPV- and p16-positive anal carcinomas (cHPPAC) in univariate analysis. Multivariate analysis showed better OS [p = 0.015] and PFS [p = 0.002] for cHPPAC.ConclusionThe combination of HPV-DNA and p16 can be used as an independent prognostic parameter in anal cancer patients.     

动态增强MRI在鼻咽癌患者预后评估中的作用研究

目的本文旨在探讨动态增强MRI(DCE-MRI)与鼻咽癌放化疗患者预后的评估作用。方法选取2011年1月至2014年12月我院鼻咽纤维镜病理活检证实的鼻咽癌患者77例,放化疗前行DCE-MRI以采集相关参数,包括正性增强积分PEI、最大上升斜率MSI、最大下降斜率MSD、达峰时间TTP等。同时采用免疫组化方法检测HIF-1α的表达,利用Kaplan-Meier曲线分析患者的生存率。结果 HIF-1α的阳性率为75.57%。与HIF-1α阴性的患者相比较,HIF-1α阳性的患者的缓解率、控制率、生存率明显降低,肿瘤转移率明显增高(P0.05)。另外,HIF-1α阳性的患者的第1、2、3年的无瘤生存率明显低于HIF-1α阴性的患者(P0.05)。与HIF-1α阴性患者相比,HIF-1α阳性患者的MSD、PEI、MSI和TTP显著增高(P0.05)。结论 DCE-MRI相关参数与HIF-1α阳性高度相关,预示着鼻咽癌放化疗患者预后不良,对于鼻咽癌预后的评估具有重要的价值。     

放疗结合同步化疗治疗晚期子宫颈癌的疗效观察

目的　探讨放疗结合同步化疗治疗晚期子宫颈癌的疗效。方法　从 1 996年 1月至 1 998年 1月 58例晚期子宫颈癌 (Ⅲb期 )行常规体外照射加腔内后装治疗 ,并同步给予顺铂 30mg静脉滴注 ,连用 5日 ,三周后重复 ,共用两次。并以同时期的 60例单纯放疗的Ⅲb期子宫颈癌进行疗效对比观察。结果　放疗化疗组与单纯放疗组疗效对比 ,其 5年生存率分别为 62 .1 %和 46 .7% ,P <0 .0 5 ,有显著差异。晚期子宫颈癌综合治疗组疗效明显优于单纯组 ,可明显提高晚期子宫颈癌的生存率。综合组在治疗中副作用主要为胃肠反应 ,在应用 5 -羟色胺受体拮抗剂(枢复宁 ,恩丹西酮 )与氟美松联合止吐方案后 ,均能顺利完成治疗计划。结论　放疗与化疗同步治疗晚期子宫颈癌疗效好 ,且副作用可以耐受     

宫颈癌患者治疗前后生存质量调查

目的:调查分析宫颈癌患者治疗前后的生存质量。方法:采用宫颈癌生存质量调查表,对72例宫颈癌患者治疗前、手术后1周、放化疗期间及治疗后3个月分别进行12项生存质量指标调查,并进行相关分析。结果:宫颈癌患者术后1周或放化疗期间生存质量评分较治疗前明显下降(P0.05),经过对症治疗和心理支持,治疗结束后3个月时基本恢复到治疗前水平。结论:宫颈癌患者手术后及放化疗期间的生存质量明显下降。临床应重视这一时期患者的合理治疗及心理支持,以降低不良反应的发生率及程度,提高患者生存质量。     

A Review of Immunotherapy for Stage III and Metastatic Non-Small Cell Lung Cancer and the Rationale for the ECOG-ACRIN EA5181 Study

ECOG‐ACRIN EA5181 is a phase III prospective, randomized trial that randomizes patients undergoing chemo/radiation for locally advanced non‐small cell lung cancer (LA‐NSCLC) to concomitant durvalumab or no additional therapy, with both arms receiving 1 year of consolidative durvalumab. Radiation dose escalation failed to improve overall survival in RTOG 0617. However, conventionally fractionated radiation to 60 Gy with concomitant chemotherapy is associated with a high risk of local failure (38%–46%). It is hoped that concomitant immunotherapy during chemo/radiation can help decrease the risk of local failure, thereby improving overall survival and progression‐free survival with acceptable toxicity. In this article, we review conventional chemo/radiation therapy for LA‐NSCLC, as well as the quickly evolving world of immunotherapy in the treatment of non‐small cell lung cancer and discuss the rationale and study design of EA5181.Implications for PracticeThis article provides an up‐to‐date assessment of how immunotherapy is reshaping the landscape of metastatic non‐small cell lung cancer (NSCLC) and how the impact of this therapy is now rapidly moving into the treatment of patients with locally advanced NSCLC who are presenting for curative treatment. This article reviews the recent publications of chemo/radiation as well as those combining immunotherapy with chemotherapy and chemo/radiation, and provides a strategy for improving overall survival of patients with locally advanced NSCLC by using concomitant immunotherapy with standard concurrent chemo/radiation.