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Objective:To analyze the prognosis of patients with isolated regional recurrence (RR) after mastectomy, and evaluate the efficacy of radiotherapy and identify the optimal radiation target volumes.Methods:Clinical data of 144 patients with first isolated RR after mastectomy between 2001 and 2018 were retrospectively analyzed. All patients had not received post-mastectomy radiotherapy. The primary endpoints consisted of the subsequent locoregional recurrence (sLRR), distant metastasis (DM), progression-free survival (PFS) and overall survival (OS).Results:With a median follow-up of 82.5 months after RR, the 5-year sLRR, DM, PFS and OS rates for the entire group were 42.1%, 71.9%, 22.9% and 62.6%, respectively. Local plus systemic therapy was an independent favorable prognostic factor for sLRR ( P<0.001) and PFS ( P=0.013). The sLRR rate in the surgery plus radiotherapy group was the lowest ( P<0.001). Surgery plus radiotherapy significantly reduced the 5-year risk of recurrence within the initially involved nodal regions ( P<0.001). Patients with chest wall irradiation obtained the 5-year subsequent chest wall recurrence rate of 12.1% compared to 14.8%( P=0.873) for those without chest wall irradiation. The subsequent supraclavicular recurrence rate was lower in patients with prophylactic supraclavicular irradiation than that without prophylactic supraclavicular irradiation (9.9% vs. 23.8%, P=0.206). The incidence rates of initially uninvolved axillary and internal mammary nodal recurrence were below 10% regardless of prophylactic irradiation or not. Conclusions:Patients with RR alone have an optimistic 5-year OS in the contemporary era. Comprehensive locoregional treatment including surgery and radiotherapy combined with systemic therapy is recommended. The chest wall, axillary and internal mammary nodal prophylactic irradiation should not be routinely performed for all patients with RR. The value of supraclavicular prophylactic irradiation remains to be evaluated.
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Objective:To investigate the radiation field and dose selection of patients with isolated chest wall recurrence (ICWR) after modified radical mastectomy, and analyze the prognostic factors related to subsequent chest wall recurrence.Methods:Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center, Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed. None of the patients received postoperative adjuvant radiotherapy. After ICWR, 48 patients (73.6%) underwent surgery and 155 patients (77.1%) received radiotherapy. Kaplan-Meier method was used to calculate the post-recurrence progression-free survival (PFS) rates and the difference was compared by log-rank test. Multivariate analysis was performed using Cox regression model. Competing risk model was adopted to estimate the subsequent local recurrence (sLR) rates after ICWR and the difference was compared with Gray test. Multivariate analysis was conducted using F&G analysis. Results:With a median follow up of 92.8 months after ICWR, the 5-year PFS rate was 23.2%, and the 5-year sLR rate was 35.7%. Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval o F>12 months had a lower sLR rate. Patients with recurrence interval o F>48 months, local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate. Among the 155 patients who received chest wall radiotherapy after ICWR, total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone (34.0% vs. 15.4%, P=0.004). Chest wall radiation dose (≤60 Gy vs.>60 Gy) exerted no significant effect upon the sLR and PFS rates (both P>0.05). In the 53 patients without surgery, the 5-year PFS rates were 9.1% and 20.5%( P=0.061) with tumor bed dose ≤60 Gy and>60 Gy, respectively. Conclusions:Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer, including total chest wall radiation plus local boost. The radiation dose for recurrence should be increased to 60 Gy, and it should be above 60 Gy for those who have not undergone surgical resection. In addition, patients with ICWR still have a high risk of sLR, and more effective treatments need to be explored.
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Small cell lung cancer (SCLC) is a type of malignancy with poor prognosis, and no advance in medication has been made for about 30 years except immune checkpoint inhibitor (ICI), which demonstrated efficacy in recent years. The response rate of programmed death-1 (PD-1) inhibitor alone or its combination with cytotoxic T-lymphocyte antigen-4 (CTLA-4) inhibitor as subsequent therapy was 10%-33% and the response duration was persistent. The combination of programmed death ligand-1 (PD-L1) inhibitor with chemotherapy resulted in longer survival versus chemotherapy alone. Nevertheless, comparing with immunotherapy-sensitive tumors such as non-small cell lung cancer (NSCLC), efficacy in SCLC is still unsatisfied and this is maybe associated with its immune inhibitory characteristics. This review describes the current research about immune characteristics of SCLC, including tumor infiltrating of lymphocytes (TIL) and immune inhibitory cells, PD-L1 and major histocompatibility complex (MHC) expression in tumor as well as changes of peripheral immune cells. We also review the prognostic and predictive values of these immune characteristics. .
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Objective To explore the effect of prognosis of consolidation radiotherapy for patients after R0 resection of local recurrence after radical mastectomy. Methods Totally 110 breast cancer patients with local recurrence receiving R0 resection were admitted and treated in our hospital from January 1st, 2003 to November 30th, 2015 were retrospectively analyzed. Results The median local progression time of 74 patients receiving consolidation radiotherapy ( 67.3％) was remarkably better than that of those without radiotherapy(36 patients, 32.7％), and the difference was statistically significant (χ2 =8. 526, P<0.05). Meanwhile, there was no statistically significant difference (P>0.05) of distance disease-free survival and overall survival between the radiotherapy group and the non-radiotherapy group. Multifactor analysis indicated that pseudo-adjuvant endocrine therapy (χ2 =7.541,95％CI:27.1％ -80.4％, P <0.05), DDFS(≥2 years vs. <2 years,χ2 =4.068,95％CI:101.4％ -267％,P<0. 05) and pseudo-adjuvant radiotherapy(χ2 =14.126, 95％CI:21.7％ -80.4％, P <0. 05 ) were the independent risk factors affecting the OS of patients with local recurrence after R0 resection. Conclusions For the patients with local recurrence after R0 resection of local recurrence, it is recommended that consolidation radiotherapy should be done and the radiation field should include the same side of the chest wall and clavicle area lymphatic drainage area.
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Objective To investigate the expressions of miR-210-3p,miR-221-3p,miR-21-5p and miR-150-Sp in the plasma of breast cancer patients before and after radiotherapy in order to establish reliable early biomarkers of non-uniform radiation injuries.Methods Blood samples were collected from 13 patients before radiotherapy (0 Gy) and 24 h after radiotherapy of 2,10,20,30 Gy.The miRNAs in the blood plasma were detected with qRT-PCR.Results The levels of miR-210-3p,miR-221-3p,miR-21-5p had no significant difference among different dosage groups after radiotherapy(P ＞ 0.05).There was no significant difference between the expression of miR-150-5p before and after 2 Gy radiotherapy (P ＞ 0.05).While the relative level of miR-150-5p gradually decreased to 0.808,0.605,0.565 (x2 =18.76,P ＜ 0.05) with increased accumulative dosage of 10,20,and 30 Gy,respectively.In addition,the miR-150-5p expression levels had no relationship (P ＞ 0.05) with situations (positive or negative group) of human epidermal growth factor receptor 2 (HER2),estrogen receptor (ER) and progesterone receptor (PR) in the breast cancer cells.Conclusions Ionizing radiation could reduce the expression of miR-150 in the plasma of breast cancer patients in a dose-dependent manner.
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As a significant treatment for tumors, radiotherapy is often considered a local therapy.However, an increasing number of researches indicate that reasonable radiation dose schedules can improve the tumor environment, induce immunogenic tumor cell death, provide in situ vaccine, and stimulate systemic antitumor effect.Meanwhile, immunotherapy can enhance the effect induced by radiotherapy, which has been proved in preclinical studies and is widely investigated in clinical studies.This review focuses on the immune response and mechanisms of radiotherapy, and advances in the application of radiotherapy in combination with immunotherapy.
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Objective To develop an early diagnosis strategy for radiation-associated breast angiosarcoma after breast cancer radiotherapy (RABASBCR) and to avoid the misdiagnosis of this disease.Methods A systematic search of PubMed for published reports of RABASBCR cases was performed.The clinical manifestations and radiological features in the early stage of disease,as well as biopsies,were analyzed to screen out valuable markers for early diagnosis and develop the early diagnosis strategy for RABASBCR.Results Fifty-five original articles involving 80 RABASBCR patients were selected for this analysis.Twenty-four (30％) of the 80 patients were misdiagnosed;the median time of misdiagnosis was 3 months (1-24 months).The earliest symptom was skin changes in 76 (95％) of the 80 patients.The misdiagnosis rates of ultrasound,mammography,computed tomography,and magnetic resonance imaging for RABASBCR were 9/9,31/32,2/2,and 1/5,respectively.The misdiagnosis rates of fine needle biopsy,core needle biopsy,and incisional biopsy were 7/14,12/25,and 10/26,respectively.Conclusions By analyzing published case reports,we have set up the early diagnosis strategy for RABASBCR with reference to the Cahan criteria.
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Objective To analyze the clinical value of chemotherapy combined with endocine therapy after standard treatment failure for advanced metastatic breast cancer.Methods 30 metastatic breast cancer patients after standard treatment failure were analyzed.Etoposide (75-100 mg/d) wasused on days 1-10,followed by 11 days of rest combined with medroxyprogesterone 0.5 g,twice per day,or megestrol 160 mg/d for 21 days.Clinical effects and life quility were analysed.Results The median treatment line of this therapy was 6 (range 3-9).The clinical benefit rate is 16.7 ％ (5/30),and the median progression free survival (PFS) was 4.0 months (range 1.0-13.0 months).Conclusion The combination of chemotherapy (etoposide) and endocrine therapy (progesterone) is a choice of treatment after standard drug failure for advanced mastatic breast cancer patients.
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Objective To evaluate the correlation of the clinical effects and prognosis in patients receiving medical ovarian suppression (goserelin)combined with anastrozole treatment with premenopausal metastatic breast cancer.Methods 44 hormone dependent mastatic breast cancer patients were treated by goserelin,3.6mg hypodermic injection every 28 days and anastrozole 1 mg were administered orally,clinical effects and prognosis were analysed.Results The clinical benefit rates of goserelin combination with anastrozole in patients with metastatic breast cancer were 52.4 ％(23/44),and the median progression free survival (PFS)was 8.3(5.3-11.2)months.In the analysis of whether to accept chemotherapy,the PFS of the not received chemotherapy group was better than received chemotherapy group (16.9 months vs 5.8 months P=0.048).Conclusion The combination of goserelin and anastrozole is an effective endocrine therapy regiment for patients with premenopausal metastatic breast cancer.It can be recommended for the premenopausal and hormone dependent mastatic breast cancer patients.
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Objective To analysis the relationships between bone markers, bone-specific alkaline phosphatase (BAP) and cross-linked telopeptide of type Ⅰ collage (ICTP), and bone metastasis of breast cancer.Methods A total of 217 patients' serum were collected.The 217 cases were divided into two groups:109 cases with bone metastasis, 108 cases without bone metastasis. Serum BAP and ICTP was measured by ELISA. The relationships between factors of bone metastasis and serum levels of BAP, ICTP were analyzed.Results The levels of serum BAP and ICTP in bone metastases group were significantly higher than those in non-bone metastasis group[BAP:24.8 μg/L(7.60-213.70 μg/L) vs 21.2 μg/L(7.3～68.8 μg/L),ICTP:7.0μg/L(1.4～32.4 μg/L) vs 4.1 μg/L(0.0～15.8 μg/L) (P=0.003,P=0.000)].The level of serum BAP and ICTP in patients with multiple bone metastasis was significantly higher than that in patients with single bone metastasis[BAP:32.3 μg/L(9.A～213.7 μg/L) vs 18.1 μg/L(7.6～60.0 μg/L),ICTP:7.6 μg/L(1.4～32.4 μg/L) vs 4.9 μg/L(1.8～10.5 μg/L),(P=0.001,P=0.010)].The sensibility of BAP and ICTP was 45.0 ％ (49/109)and 46.8 ％ (51/109),respectively.The specificity of ICTP and BAP was 83.3 ％ (90/108)and 84.3 ％ (91/108),respectively.Joint detection of BAP and ICTP had improved sensibility in the diagnosis of bone metastasis in breast cancer patients. Conclusion Joint detection of serum bone biochemical markers ICTP and BAP have a little values for diagnosing bone metastasis in breast cancer patients.
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Anti-angiogenesis drug has become an important method and a hot research field for treating cancers.Drugs such as bevacizumab,sunitinib,sorafenib,lapatinib,achieved good clinical effect in treating breast cancers,but they also brought a lot of problems that need to be concerned.
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Objective To analyze the clinic characteristics, lifetime and prognostic factors of young female breast cancer patients. MethodsClinical data of 155 patients under 35 years of age with breast cancer were retrospectively reviewed and followed up.ResultsThe positive rate of hormone receptors was 61.6 % (77/125) in all cases who had been detected receptor status. The median survival time in hormone receptors positive and negative group were 119.0 and 51.3 months (P＜0.01), and 5-year survival rates were 68 % and 33 %, respectively. For patients who had been treated with adjuvant tamoxifen (47.1%), the median survival time was 182 months which longer than without tamoxifen (P ＜0.05). The median disease-free survival time and median survival time were 24 and 91 months in all cases. The overall 3-, 5- and 10-year survival rates were 79 %, 60 % and 51%, respectively. Multifactor analysis with the COX model indicated that tumor size, axillary metastatic status, tamoxifen treatment and overexpression of Her-2 were independent prognostic factors. While clinic stage and hormone receptors status might be referenced prognostic factors. ConclusionYoung women breast cancer patient may have good prognosis if multimodality treatment is conducted. Tumor size, axillary metastatic status, adjuvant endocrine therapy and overexpression of Her-2 are independent prognostic factors.
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Cardiotoxicity associated with anthracyclines and trastuzumab is discussed from clinical manifestations, pathogenesis, risk factors, monitoring methods, prevention and treatment.
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Metastatic breast cancer (MBC) is a heterogeneous disease that has a variety of different clinical scenarios. There are few recognized therapeutic standards for MBC. Combining recent international guidelines and consensus recommendations with our clinical practice experience, the article will introduce and comment many sides about the treatment for MBC patients.
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<p><b>OBJECTIVE</b>To evaluate the efficacy and adverse effects of lentaron for postmenopausal patients with recurrent and metastatic breast cancer.</p><p><b>METHODS</b>Thirty-four patients with recurrent and metastatic breast cancer received 250 mg lentaron by intramuscular injection every 2 weeks for at least one month.</p><p><b>RESULTS</b>In 34 patients who were evaluable for efficacy and toxicity, the complete response rate (CR), partial response rate (PR), disease stabilization rate (SD) and progressive disease rate (PD) were 0%, 14.7%, 58.8% and 26.5%. The clinical benefit rate (CR + PR + SD >/= 6 months) was 50.0%. (17/34) with 12 patients (35.3%) having SD for at least 6 months. The response rates for bone, soft tissue and visceral metastasis were 28.6% (3/14), 13.6% (3/22) and 5.3% (1/19), respectively. There were no severe adverse effects in the treatment bylentaron.</p><p><b>CONCLUSION</b>Lentaron is a well tolerated agent with reasonable efficacy but low toxicity for postmenopausal patients with recurrent and metastatic breast cancer.</p>
Subject(s)
Female , Humans , Androstenedione , Therapeutic Uses , Antineoplastic Agents , Therapeutic Uses , Breast Neoplasms , Drug Therapy , Pathology , Disease Progression , Neoplasm Metastasis , Neoplasm Staging , Postmenopause , Treatment OutcomeABSTRACT
To evaluate the effect of mobilization of peripheral blood stem cells (PBSC) with high dose cyclophosphamide combination chemotherapy and G-CSF in breast cancer patients, a new mobilization protocol was designed on the basis of standard combination chemotherapy regimen, in which the dose of cyclophosphamide was raised to 2 to 4 times, and G-CSF began to be used at the dose of 150 micro g twice everyday when white blood cell (WBC) decreased below 1.0 x 10(9)/L. PBSC collection was performed while WBC increased over 5.0 x 10(9)/L during bone marrow recovering. The PBSC mobilization protocol was completed in 10 patients, the median nadir of WBC was 0.8 (0.4 - 1.0) x 10(9)/L, the median time of PBSC collection was 2 (2 - 4), the median number of collected CD34(+) cells was 6.43 (1.99 - 8.75) x 10(6)/kg. The results showed that the protocol, high dose cyclophosphamide combination chemotherapy, was an optimal PBSC mobilization regimen in breast cancer patients.
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How to select endocrine agents for patients with ER-positive/ Her-2 -positive breast cancer has been a difficult question. Increasing evidences shows a consistent results that an association between Her-2 overexpression and poor response of endocrine treatment, tamoxifen and the third generation aromatase inhibitors has the similar poor efficacy. The treatment strategy for such patients should prefer chemotherapy alone or in combination with trastuzumab, and endocrine therapy combining with trastuzumab may be the development strategy.