Prognostic value of estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 in node positive breast cancer patients treated by mastectomy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic value of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (Her-2) in node-positive breast cancer patients treated by mastectomy.</p><p><b>METHODS</b>The clinicopathological data of 835 breast cancer patients treated by mastectomy from January 2000 to December 2004 were retrospectively analyzed. All had positive axillary nodes without distant metastases and with the immunohistochemistry staining of ER, PR and Her-2 available. 764 (91.5%) patients received anthracycline- and/or taxanes-based chemotherapy. 464 (55.6%) patients received hormonal therapy. Eight (1%) patients received trastuzumab. Postmastectomy radiotherapy were given to 352 out of 437(80.5%)patients with T3-T4 and/or N2-N3 disease and 68 out of 398(20.9%)patients with T1-2N1 disease. Patients were classified into 4 subgroups according to the status of hormone receptors (ER and PR, Rec) and Her-2: Rec(-)/Her-2(-) (triple negative), Rec(-)/Her-2(+), Rec(+)/Her-2(+) and Rec(+)/Her-2(-). End points were isolated locoregional recurrence (LRR), distant metastases (DM), disease-free survival (DFS) and overall survival (OS).</p><p><b>RESULTS</b>141 (16.9%) patients were Rec(-)/Her-2(-), 99 (11.9%) Rec(-)/Her-2(+), 157 (18.8%) Rec(+)/Her-2(+) and 438 (52.5%) Rec(+)/Her-2(-). Patients with Rec(+)/Her-2(-) breast cancer had a significantly lower 5-year LRR rate than others (6.2% vs. 12.9%, P = 0.004). Compared with patients with Rec(+) breast cancer, patients with Rec(-) breast cancer had significantly higher 5-year DM rate (26.4% vs. 19.7%, P = 0.0008), lower DFS rate (66.7% vs. 75.6%, P = 0.0001) and lower OS rate (71.4% vs. 84.2%, P = 0.0000). In multivariate analysis, Rec(+)/Her-2(-) was significantly associated with lower risk of LRR. Rec(-) was an independent prognostic factor for higher risk of DM, decreased DFS and OS.</p><p><b>CONCLUSION</b>ER, PR and Her-2 are independent prognostic factors for locoregional recurrence and survival in node-positive breast cancer patients treated by mastectomy.</p>

Postmastectomy radiotherapy in moderate-and high-risk elderly breast cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the role of postmastectomy radiotherapy (PMRT) in moderate- and high-risk elderly breast cancer patients.</p><p><b>METHODS</b>The clinicopathological data of 874 breast cancer patients treated with mastectomy and axillary dissection were retrospectively analyzed. The T1-2N1 patients were defined as moderate- risk (IR) group, and T3-4 and/or N2-3 cases as high-risk (HR) group. The locoregional recurrence (LRR) and overall survival (OS) rates were calculated and compared according to different age groups and radiotherapy status. Kaplan-Meier method and Log-rank test was used for calculation and comparison of the survival curves of different patient groups.</p><p><b>RESULTS</b>The median follow up time was 47 months. 108 (12.4%) patients were > or = 65 years. For patients who were < 65 and > or = 65 years, 18.1% and 15.3% received PMRT in the IR group, and 82.7% and 52.2% received PMRT in the HR group, respectively. For patients > or = 65 years, the 5-year LRR rates were 0% and 14.2% (P = 0.242) and 5-year OS rates were 100% and 75.2% (P = 0.159) for the PMRT-IR and non-PMRT-IR groups, respectively. The 5-year LRR rates were 0% and 14.1% (P = 0.061), 5-year OS rates were 84.6% and 77.4% (P = 0.597) for the PMRT-HR and non-PMRT-HR groups, respectively. For patients < 65 years, the 5-year LRR rates were 0% and 9.9% (P = 0.035) and 5-year OS rates were 87.0% and 82.1% (P = 0.739) for the PMRT-IR and non-PMRT-groups, respectively. The 5-year LRR rates were 7.2% and 26.1% (P = 0.000), 5-year OS rates were 79.2% and 57.7% (P = 0.000) for the PMRT-HR and non-PMRT-HR groups, respectively.</p><p><b>CONCLUSION</b>With the increasing of age, there is a trend of decreasing use of postmastectomy radiotherapy in high-risk breast cancer patients. Postmastectomy radiotherapy can improve the locoregional control for high-risk patients and maybe considered even for those who are > or = 65 years.</p>

Treatment option and outcome for patients with primary non-Hodgkin's lymphoma of the nasal cavity / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The optimal treatment for primary non-Hodgkin's lymphoma (NHL) of the nasal cavity remains controversial. This study was to analyze the initial response rate of radiotherapy and chemotherapy, and the influence of different treatment modalities on prognosis.</p><p><b>METHODS</b>From January 1996 to December 2002, the clinical data of 129 patients with previously untreated nasal NHL were retrospectively reviewed with all lesions confirmed by pathology. 116 patients were morphologically diagnosed as having nasal NK/T cell lymphoma. The immunophenotype was available in 57 cases and 52 (91.2%) of them were confirmed as NK/T-cell lymphoma. According to the Ann Arbor Staging System, 102 patients had stage I(E), 22 stage II(E), and 5 stage IV(E) disease. Among the 124 patients with stage I(E) and II(E) diseases, 22 patients received radiotherapy alone, 7 chemotherapy alone, and 95 combined modality therapy (CMT). Of these 95 patients treated with CMT, 45 patients were treated with radiotherapy followed by chemotherapy, and 50 with chemotherapy followed by radiotherapy. The primary treatment for stage IV(E) patients was chemotherapy with or without radiotherapy to the primary tumor.</p><p><b>RESULTS</b>The overall 5-year survival (OS) and disease free survival (DFS) for all patients was 68.0% and 55.8%, respectively. It was 71.7% and 60.9% for stage I(E), and 70.6% and 47.0% for stage II(E), respectively (P > 0.05). The OS and DFS at the 5th year were 83.1% and 68.0% for patients who achieved complete response (CR), and 18.0% and 15.5% for those who did not, respectively (P = 0.000). Of the 124 patients with stage I(E) and II(E) disease, 67 patients were treated with radiotherapy alone (22 patients) or radiotherapy followed by chemotherapy (45), whereas 57 were treated with chemotherapy followed by radiotherapy (50) or chemotherapy alone (7). The CR rate after radiotherapy was 74.7%, however, it was only 19.3% after chemotherapy (P = 0.000). Of the 46 patients with PR, SD or PD after chemotherapy, 42 still had locoreginally localized lesion and 31 of these patients achieved CR by following radiotherapy which revealed satisfactory results. For stage I(E) and II(E) disease, the 5-year OS and DFS were 76.0% and 65.0% for radiotherapy with or without chemotherapy, and 74.4% and 56.2% for chemotherapy followed by radiotherapy. The difference was statistically not significant. However, 7 stage I(E) and II(E) patients were treated with chemotherapy alone, and 4 of them died of disease progression, with 1-year survival of 26.7%.</p><p><b>CONCLUSION</b>The majority of Chinese patients with primary nasal NHL are NK/T cell in origin. The complete response rate by radiotherapy is much higher than that by chemotherapy. The addition of chemotherapy to radiotherapy did not improve the survival of patients with early stage nasal lymphoma. Radiotherapy is suggested as the primary treatment for stage I(E) and II(E) nasal NK/T cell lymphoma.</p>

Comparison of preliminary results of involved-field with extended field radiotherapy combined with chemotherapy for early stage Hodgkin's disease / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate whether involved-field (IF) radiotherapy is equally effective and less toxic in comparison with extended-field (EF) radiotherapy for patients with early-stage Hodgkin's disease (HD) who received combined modality therapy.</p><p><b>METHODS</b>The data of 88 early-stage HD patients treated with combined modality therapy were retrospectively reviewed. According to Ann Arbor classification, 12 patients (13.7%) had stage IA disease, 56 stage IIA (63.6%), and 20 IIB (22.7%). Forty-two (47.7%) patients underwent involved field radiotherapy (IF group), whereas the other 46 (52.3%) received extended field radiotherapy (EF group).</p><p><b>RESULTS</b>Of 6 patients who developed recurrence, 3 (7.1%) were in IF group and the other 3 (6.5%) in EF group. Only one patient's recurrence developed inside the radiation field in EF group. Three patients (7.2%) in IF group and 9 (19.5%) in EF group had WHO grade 1 and 2 leukopenia (P = 0.089). Overall survival rate at 1-, 2- and 3-year was 100.0%, 97.1%, and 97.1% in IF group versus 100.0%, 100%, and 95.8% in EF group (P = 0.86), respectively. Freedom from progression survival rate at 1-, 2- and 3-year was 97.6%, 94.8%, and 91.7% in IF group versus 97.8%, 93.2%, and 93.2% in EF group (P = 0.65), respectively.</p><p><b>CONCLUSION</b>Compared with extended-field radiotherapy, involved-field radiotherapy is equally effective and less toxic for patient with early-stage Hodgkin's disease treated with combined modality therapy.</p>

Expression profile of nasal NK/T cell lymphoma by cDNA microarray / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the changes of gene expression profile in nasal NK/T cell lymphoma.</p><p><b>METHODS</b>Total RNA was extracted from the fresh nasal NK/T cell lymphoma tissue and normal lymph node. Fluorescent labeled cDNA was obtained through synthesizing process by reverse transcription. After hybridization in the two identical microarrays consisting of 4096 genes, overexpressed or underexpressed tumor related genes were analyzed.</p><p><b>RESULTS</b>In both experimental group and control group, there were six samples. A total of 365 (8.9%) genes was found to be differentially expressed by a factor of twofold or greater in both of two identical cDNA microarrays, which included oncogenes, tumor supressor genes, cell cycle regulators, apoptotic and antiapoptotic factors, DNA transcription factors, DNA repair and recombination factors, signal transduction genes, protein translation genes, as well as a large number of metabolic genes. Thirty-seven of these genes were found to be differentially expressed by a factor of fourfold or greater. The biochemical functions of these differentially expressed genes were diverse.</p><p><b>CONCLUSION</b>This study demonstrates that many different kinds of genes are possibly involved in the initiation and progression of nasal NK/T lymphoma. cDNA microarray technique is useful in screening cancer gene expression for nasal NK/T lymphoma.</p>

Prognostic factors and treatment outcome in early stage nasal NK/T cell lymphoma / 中华血液学杂志

<p><b>OBJECTIVE</b>To analyze initial response rate of radiotherapy and chemotherapy for early nasal NK/T-cell lymphoma, and its prognostic factors.</p><p><b>METHODS</b>From January 1996 to December 2002, 116 patients with nasal NK/T-cell lymphoma were diagnosed pathologically. Immunophenotyping was performed in 50 cases. According to Ann Arbor staging classification, 95 patients were stage I(E) and 21 II(E). Of the 116 patients, 22 received radiotherapy alone, 6 chemotherapy alone and 88 combined modality therapy (CMT), including, 41 radiotherapy followed by chemotherapy, and 47 chemotherapy followed by radiotherapy.</p><p><b>RESULTS</b>The 5-year overall survival (OS) rate and disease free survival (DFS) rate for all patients was 74.1% and 61.5%, respectively. For stage I(E) and II(E) patients, the 5-year OS rate was 75.1% and 68% (P = 0.45), and DFS rate was 64.7% and 47.8%, respectively (P = 0.07). The 5 year OS rate and DFS rate were 86.5% and 71.5% for patients who achieved complete response (CR), and 18.4% and 17.2% for those who didn't, respectively (P = 0.000). Sixty-three patients were treated with radiotherapy alone or radiotherapy followed by chemotherapy, while 53 with chemotherapy followed by radiotherapy or chemotherapy alone. The CR rate for radiotherapy was 74.6% while for chemotherapy was 20.8% (P = 0.000). The 5-year OS rate and DFS rate were 76.8% and 65.4% for radiotherapy with or without chemotherapy, and 78.8% and 61.8% for chemotherapy followed by radiotherapy (P > 0.05). Multivariate analysis by COX regression showed that CR rate was the only independent prognostic factor.</p><p><b>CONCLUSION</b>The CR rate of radiotherapy is much higher than that of conventional chemotherapy. Addition of chemotherapy to radiotherapy do not improve the survival of patients with early stage nasal NK/T-cell lymphoma. Radiotherapy is the primary treatment for stage I and II nasal NK/T-cell lymphoma.</p>

Clinical features, treatment and prognosis of 136 patients with primary non-Hodgkin's lymphoma of the nasopharynx / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics, international prognostic index and treatment of primary non-Hodgkin's lymphoma (NHL) of the nasopharynx.</p><p><b>METHODS</b>From January 1983 to December 1997, 136 patients with previously untreated NHL of the nasopharynx were retrospectively reviewed. All patients were confirmed pathologically and classified by Working Formulation system. There were 18 patients with high-grade, 77 intermediate, 2 low-grade and 39 unclassifiable lymphoma. According to Ann Arbor classification, 25 patients had stage I, 91 stage II, 12 stage III and 8 stage IV lesions. Primary therapy was radiotherapy alone in 13 patients and radiotherapy combined with chemotherapy in 12 patients with stage I disease. In 88 patients with stage II, radiotherapy alone was given to 31 patients, and a combination of radiotherapy and chemotherapy to 57 patients. Chemotherapy was primary treatment for advanced stage III/IV diseases.</p><p><b>RESULTS</b>The overall survival rate (OS), cancer specific survival rate (CSS) and disease-free survival rate (DFS) at 5 and 10 years for all patients were 56.2%, 61.2%, 51.1% and 48.3%, 58.0%, 46.5%, respectively. As for international prognostic index (IPI), the 5-year CSS was 70.9% for 0 risk factor, 44.9% for 1 risk factor, 30.0% for 2 or 3 risk factors, respectively (P = 0.004). For stage I patients, the 5-year CSS was 83.1% for RT alone and 82.2% for combined modality therapy, respectively (P = 0.779). For patients with stage II, the 5-year CSS was 46.0% for radiotherapy alone and 70.9% for combined modality therapy. There was significant difference between them (P = 0.04). Multivariate analysis by Cox regression showed that Ann Arbor stage, B symptom and IPI were independent prognostic factors.</p><p><b>CONCLUSION</b>International prognostic index is an important prognostic factor for Non-Hodgkin's lymphoma of the nasopharynx and the combined modality therapy may be optimal for the stage II patients.</p>

Post-mastectomy radiotherapy with different fractionated dose schemes in early breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the effect of post-mastectomy radiotherapy with different fractionated dose schemes for early breast cancer.</p><p><b>METHODS</b>From January 1987 to January 1993, 367 patients with early breast cancer were given post-mastectomy radiotherapy with three different fractionated dose schemes. 149 patients received conventional radiotherapy with 50 Gy/25 fractions/5 weeks (Group A). 177 patients received 45 Gy/15 fractions/5 weeks (Group B). Forty-one patients were treated with 23 Gy/4 fractions/17 days (Group C). 257 patients received systemic therapy (chemotherapy and/or endocrine therapy).</p><p><b>RESULTS</b>The overall 5-year survival and 5-year disease-free survival rates were 87.4% and 89.6%. The 5-year disease-free survival rate were 90.8%, 86.5% and 84.6% for A, B and C groups (P = 0.16). The corresponding loco-regional failure rates were 2.7%, 2.8% and 2.4%, respectively. There was no statistically significant difference in the local control and efficacy of the three groups.</p><p><b>CONCLUSION</b>With similar 5-year tumor-free survival rates by the conventional fractionation and hypofractionation, the scheme with 45 Gy/15 fractions/5 weeks has the advantage of giving less factions, which is suitable for a unit with limited radiation resources. The course of hypofractionation with 23 Gy/4 fractions/17 days is much shorter than conventional radiotherapy, which may benefit patients with higher risk of metastasis who need to undergo chemotherapy earlier. This study warrants further investigations.</p>

Treatment of early stage primary tonsil non-Hodgkin's lymphoma / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the treatment for patients with early stage primary tonsil non-Hodgkin's lymphoma (NHL).</p><p><b>METHODS</b>Two hundred and thirteen patients with previously untreated early stage primary tonsil NHL were reviewed. All patients were pathologically confirmed. According to Ann Arbor classification, 35 patients were stage I, 178 stage II. The primary treatment for stage I was radiotherapy alone in 12 and combined modality therapy (CMT) in 23 patients. The primary treatment for stage II was radiotherapy alone in 57,chemotherapy alone in 2, and CMT in 119 patients.</p><p><b>RESULTS</b>The 5-year overall survival, cancer specific survival (CSS) AND disease-free survival (DFS) for the early stage primary tonsil non-Hodgkin's lymphoma were 65%, 70% and 61%, respectively. The 5-year CSS was 63% for the radiotherapy alone group and 72% for the CMT group (p = 0.064), and the 5-year DFS were 56% for the radiotherapy alone group and 62% for the CMT group. For patients with stage I disease, The 5-year CSS were 100% in both radiotherapy alone and CMT groups, and the 5-year DFS were 100% and 80% in these two groups (p = 0.148), respectively. There was no significant difference of efficacy between the two treatment s for the patients with stage I disease. For the patients with stage II disease, the 5-year CSS was 58% in radiotherapy alone group and 66% in CMT group (p = 0.051). However, CMT significantly improved DFS in stage II disease, with a 5-year DFS of 46% for radiotherapy alone and 60% for CMT (P = 0.046).</p><p><b>CONCLUSION</b>Patients with stage I tonsil non-Hodgkin's lymphoma treated with radiotherapy alone or CMT can achieve an excellent outcome. CMT significantly improve the DFS in stage II patients. There was a trend that CMT improved the survival rates in the patient with early stage disease. It was suggested that CMT should be used for the patients with early stage primary tonsil non-Hodgkin's lymphoma.</p>