ABSTRACT
Objective:To assess the safety and efficacy of induction chemotherapy with cisplatin and docetaxel followed by radia-tion concurrent with weekly cisplatin for unresectable, locally advanced esophageal cancer. Methods: Thirty-three patients with T3N0M0 to T4N2M0 thoracic esophageal squamous cell carcinoma without celiac lymph node metastasis were included in the study. They were treated with cisplatin (75 mg/m2 d1, d22) and docetaxel (75 mg/m2 d1, d22) neoadjuvant chemotherapy followed by three-dimensional conformal radiotherapy (60Gy/30F/6w) concurrent with cisplatin (30 mg/m2 d1, 8, 15, 22, 29, 36 from the beginning of radiation). Results:Grade 4 hematological toxicities were observed in 13.33%(4/33) of the patients after the neoadjuvant chemother-apy. No grade 3 or above hepatic or renal toxicities were found. During concurrent chemoradiation, the highest grade 3 hematological toxicities were observed in the erythrocyte, granulocyte, and macrophage at 21.21%(7/33), 15.15%(5/33), and 3.01%(1/33), respec-tively. No grade 2 or above hepatic or renal toxicities were observed. Grade 3 radiation esophagitis was observed in 9.1%(3/33) of the patients, whereas grade 3 and above radiation esophagitis or grade 1 and above acute radiation pneumonitis did not occur. The evalua-tion results after treatment completion were 84.85%(28/33), 12.12%(4/33), and 3.03%(1/33) for CR+PR, SD, and PD , respectively. Two months after treatment completion, the results changed to 75.76%(25/33), 9.10%(3/33), and 15.15%(5/33), respectively. Overall, 15 patients died. The one-year survival rate was 66.4%. Local failure was approximately 46.67%(7/15), whereas the local+distant fail-ure was approximately 26.67%(4/15). Therefore, local failure is the main pattern of failure in esophageal cancer. Conclusion:The re-sults indicate that neoadjuvant chemotherapy with cisplatin and docetaxel followed by radiotherapy concurrent with weekly cisplatin for locally advanced esophageal cancer is safe. Local failure remains the main pattern of failure in esophageal cancer.
ABSTRACT
Objective To investigate the local-regional recurrence of nasopharyngeal carcinoma (NPC) 5 years after conventional radiotherapy and its prognosis.Methods From August 1989 to Decem ber 1999,1384 patients with newly histo-pathologicatly diagnosed NPC were treated with conventional radia tion.350 out of 1277 followed-up patients were diagnosed as local-regional failure.The intervals between completion of radiation and tumor relapse ranged from 6 months to 171 months.There were 62 patients with local-regional recurrence 5 years after the radiotherapy,including 41 in nasopharynx,19 in neck and 2 in na sopharynx and neck simultaneously.Thirty-seven patients with late local-regional recurrence received a sec ond course conventional radiotherapy.Results The median survival time was 44 months(95% CI = 30.4 -57.6) of patients with re-irradiation comparing with 14 months (95% CI = 7.1-20.8) of those without. The 5 year survival rate after re-irradiation was 42%.Conclusions Local-regional recurrence of nasopha ryngeal carcinoma can oeoure 5 years after radiotherapy.Second course converntional radiotherapy possesses good results.