Nutritional factors as predictors of response to radio-chemotherapy and survival in unresectable squamous head and neck carcinoma

BACKGROUND AND PURPOSE: This study sought to evaluate nutritional prognostic factors before treatment in patients with unresectable head and neck cancer treated by concomitant radio-chemotherapy. METHODS AND MATERIALS: Seventy-two consecutive patients were treated. We studied the potential effects of CRP, Alb, preAlb, orosomucoid, weight, weight history, BMI, PINI, OPR and NRI on response to treatment, Event-Free Survival (EFS) and Overall Survival (OS). Effects of potential risk factors on OS and on EFS were analyzed by computing Kaplan-Meier estimates, and curves were compared using the log-rank test. RESULTS: All biological nutritional factors were statistically correlated with the response to radio-chemotherapy. In multivariate analysis, only CRP (p=0.004) remained statistically significant. A statistical correlation was found between Alb and EFS in multivariate analysis (p=0.04). The factors influencing OS in univariate analysis were Alb (p=0.008), CRP (p=0.004), orosomucoid (p=0.01) and NRI (p=0.01), response to radio-chemotherapy (p<0.001) and staging (p=0.04). In multivariate analysis, only the response to radio-chemotherapy (p<0.001) remained significant. CONCLUSIONS: This study illustrates the prognostic value of nutritional status. CRP and Alb may be useful in the assessment of advanced head and neck cancer patients at diagnosis and for stratifying patients taking part in randomized trials.     

Evaluation of quality of life of patients with oral squamous cell carcinoma. Comparison of two treatment protocols in a prospective study

BACKGROUND AND PURPOSE: In recent years, various therapeutic concepts have been developed for treating oral cancer, these include preoperative simultaneous "neoadjuvant" radio-chemotherapy and one-stage-surgery with tumour ablation and reconstruction. When considering long-term survival, there is substantial evidence that the neoadjuvant therapy is superior to the primary surgical approach with postoperative radiation. Both treatment concepts, however, have a strong impact on the quality of life. PATIENTS AND METHODS: This study prospectively evaluates and compares quality of life in 53 patients with oral cancer treated according to a neoadjuvant concept or primarily surgically, using the questionnaires QLQ C-30 and H and N35 by the EORTC. RESULTS: Initially both groups showed a marked reduction in the quality of life. Despite a clear improvement in the first postoperative year baseline values were not reached in most of the scores. Specific long-lasting impairments in the symptom scales concerning oral functions were found in both treatment arms. In the neoadjuvant therapy group, however, especially global health and the emotional status were reduced to a higher degree than in the other group. This was particularly noticeable in the early treatment phase. CONCLUSIONS: Following an initial deterioration of quality-of-life after 3 months a gradual improvement of physical and psychological function was observed in the course of the first post-treatment year in both groups. Severe side effects can be observed. These side effects vary strongly in their individual expression. Limitations in the quality of life can be justified, if the more aggressive therapy resulted in a better disease free survival.     

放化疗联合热疗治疗宫颈癌疗效和安全性的Meta分析

目的系统评价放化疗联合热疗治疗中晚期宫颈癌的疗效和安全性。方法计算机检索h e Cochrane Library(2013年7期)、PubMed、EMbase、CBM、VIP、CNKI和WanFang Data数据库,检索时限均为从建库至2013年7月,纳入有关放化疗联合热疗治疗中晚期宫颈癌的文献。由2名评价员按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析。结果共纳入9个RCT,693例患者。Meta分析结果显示:与放化疗组相比,放化疗联合热疗组的1年生存率[OR=3.05,95%CI(1.70,6.68),P=0.005]、2年生存率[OR=2.29,95%CI(1.19,4.38),P=0.01]、总有效率[OR=3.66,95%CI(2.31,5.81),P<0.000 01]均明显上升,且差异有统计学意义,但两组不良反应发生率差异无统计学意义。结论放化疗联合热疗能明显提高中晚期宫颈癌患者的远期和近期疗效。但受纳入研究数量和质量的限制,上述结论仍有待更多高质量的研究予以验证。     

放化疗前后子宫颈癌组织中TGF-β1的表达及临床意义

目的:探讨TGF-β1在放化疗前后子宫颈癌组织中的表达情况及其临床意义.方法:应用免疫组化法(S-P法)对放化疗前后对照的子宫颈癌组织80例,CIN 50例以及正常子宫颈组织30例的TGF-β1蛋白表达情况进行检测.结果:TGF-β1在子宫颈癌中阳性表达率65％,明显高于CIN组的38％,以及对照组的16.67％ (p...     

Locally advanced rectal cancer: The importance of a multidisciplinary approach

Rectal cancer accounts for a relevant part of colorectal cancer cases, with a mortality of 4-10/100000 per year. The development of locoregional recurrences and the occurrence of distant metastases both influences the prognosis of these patients. In the last two decades, new multimodality strategies have improved the prognosis of locally advanced rectal cancer with a significant reduction of local relapse and an increase in terms of overall survival. Radical surgery still remains the principal curative treatment and the introduction of total mesorectal excision has significantly achieved a reduction in terms of local recurrence rates. The employment of neoadjuvant treatment, delivered before surgery, also achieved an improved local control and an increased sphincter preservation rate in low-lying tumors, with an acceptable acute and late toxicity. This review describes the multidisciplinary management of rectal cancer, focusing on the effectiveness of neoadjuvant chemoradiotherapy and of post-operative adjuvant chemotherapy both in the standard combined modality treatment programs and in the ongoing research to improve these regimens.     

中晚期宫颈癌同步放化疗的临床研究

目的:分析同步放化疗对于中晚期宫颈癌患者的临床治疗效果及不良反应.方法:选取33例我科治疗的中晚期宫颈癌患者,随机分为观察组16例和对照组17例,观察组采取同步放化疗,对照组仅使用根治性放疗,比较两组患者的近期疗效、3年生存率及不良反应等.结果:(1)观察组患者中CR 13例,PR 2例,SD 1例;对照组中CR 11例,PR 2例,SD 3例,还有1例患者为PD,经比较发现观察组疗效明显优于对照组(P<0.05).(2)经比较发现,观察组IIb期和III期患者3年生存率高于对照组(P<0.05),而两组IV期均无3年生存病例(P>0.05);观察组复发和远处转移均明显低于对照组(P<0.05).(3)对照组骨髓抑制和胃肠道反应明显低于观察组(P<0.05);两组患者发射型直肠炎、尿道炎及膀胱炎差异不明显(P>0.05).结论:同步放化疗较单纯放疗能提高中晚期宫颈癌3年生存率,并有效降低局部复发率及远处转移率,临床使用安全.     

Ⅲ期非小细胞肺癌同步放化疗所致急性食管损伤研究

目的 观察三维适形放疗(3DCRT)联合长春瑞滨+顺铂(NP)同步化疗Ⅲ期非小细胞肺癌(NSCLC)的急性放射性食管炎发生情况,并对相关因素进行分析,以求得到合理的预测性指标.方法 37例Ⅲ期NSCLC患者接受3DCRT及NP方案同步化疗,放疗处方剂量60 Cy,1.8～2.0Cy/次,5次/周,共30～34次,于放疗开始的第1、5周给予同步化疗,观察急性放射性食管炎发生情况并进行相关因素及受试者工作特征(ROC)曲线分析.结果 全组食管炎总发生率为92%(34例),其中0级3例,1级11例,2级9例,3级14例,无4级发生.单因素分析显示食管接受的平均剂量、LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_(60)、V_(40)、V_(45)、V_(50)、V_(55)、V_(60)均与放射性食管炎具有较好相关性,能预测急性放射性食管炎发生;多因素分析结果提示食管V_55是预测放射性食管炎的最有价值的指标.ROC曲线分析结果示曲线下面积为0.906(P=0.000),曲线界值V_(55)=30%;食管V_(55)>30%组与≤30%组≥2级放射性食管炎发生率分别为100%(15/15)和36%(8/22).结论 对局部晚期NSCLC进行3DCRT结合同步化疗可出现较严重放射性食管炎,食管接受的平均剂量、LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_(60)、V_(40)、V_(45)、V_(50)、V_(55)、V_(60)可较好预测放射性食管炎的发生,V_(55)可能是最有价值的预测性指标,当V_55>30%时2、3级急性放射性食管炎的发生率可能会明显增加.     

Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: Prospective randomized trial

Background and purpose

Concomitant radio-chemotherapy is the gold standard treatment for unresectable head and neck carcinomas. Placement of prophylactic gastrostomy has been proposed to provide adequate nutrition during the therapeutic sequence. The objectives of this study were to assess the impact of prophylactic gastrostomy on the 6-month quality of life, and to determine the factors related to this quality of life.

Materials and methods

Design. randomized, controlled, open study (“systematic percutaneous gastrostomy” versus “no systematic gastrostomy”). Patients. squamous cell head and neck carcinoma (stages III and IV, UICC 1997). Setting. oncological departments of French university teaching hospitals. Treatment. optimal concomitant radio-chemotherapy. Evaluations. T0 baseline evaluation, T1 during the treatment, T2 end of the treatment, and T3 6-month post-inclusion. Primary endpoint. 6-month quality of life (Qol) assessed using SF36, EORTC QLQ-C30, EORTC QLQ H&N35 questionnaires.

Results

The Qol changes from baseline included a decline (T1 and T2) followed by an improvement (T3). Qol at 6 months was significantly higher in the group receiving systematic prophylactic gastrostomy (p = 10⁻³). Higher initial BMI and lower initial Karnofsky index were significant factors related to a higher 6-month Qol.

Conclusions

The study results suggest that prophylactic gastrostomy improves post-treatment quality of life for unresectable head and neck cancer patients, after adjusting for other potential predictive quality of life factors.     

18F-FDG PET for assessment of therapy response and preoperative re-evaluation after neoadjuvant radio-chemotherapy in stage III non-small cell lung cancer

Purpose The aim of this study was to evaluate FDG-PET for assessment of therapy response and for prediction of patient outcome after neo-adjuvant radio-chemotherapy (NARCT) of advanced non-small cell lung cancer (NSCLC). Methods Seventy patients with histologically proven stage III NSCLC underwent FDG-PET investigations before and after NARCT. Changes in FDG uptake and PET findings after completion of NARCT were compared with (1) the histology of tumour samples obtained at surgery or repeat mediastinoscopy, and (2) treatment results in terms of achieved operability and long-term survival. Results The mean average FDG uptake of the primary tumours in the patient group decreased significantly during NARCT (p = 0.004). Sensitivity, specificity and overall accuracy of FDG-PET were 94.5%, 80% and 91%, respectively, for the detection of residual viable primary tumour, and 77%, 68% and 73%, respectively, for the presence of lymph node metastases. A negative PET scan or a reduction in the standardised uptake value (SUV) of more than 80% was the best predictive factor for a favourable outcome of further treatment. Progressive disease according to PET (new tumour manifestations or increasing SUV) was significantly correlated with an unfavourable outcome (p = 0.005). In this subgroup, survival of patients who underwent surgery was not significantly different from survival among those who did not undergo surgery, whereas for the whole patient group, complete tumour resection had a significant influence on outcome. Conclusion FDG-PET is suitable to assess response to NARCT in patients with stage III NSCLC accurately. It was highly predictive for treatment outcome and patient survival. PET may be helpful in improving restaging after NARCT by allowing reliable assessment of residual tumour viability.