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Objective:To assess the impact of preoperative short-course radiotherapy combined with neoadjuvant chemotherapy on elderly patients with locally advanced rectal cancer after a 2-year follow-up.Methods:In this retrospective cohort study, we included 446 consecutive cases of elderly patients diagnosed and treated for locally advanced rectal cancer(stage Ⅱ-Ⅲ with T3-T4 and/or positive regional lymph nodes)at the First People's Hospital of Shangqiu city from January 2012 to December 2019.The patients were divided into two groups based on the treatment method: an observation group(107 cases)and a control group(339 cases).The patients in the observation group underwent preoperative short-course radiotherapy combined with neoadjuvant chemotherapy.The regimen included short-term radiotherapy(25 Gy over 1 week in 5 fractions)followed by 4 courses of chemotherapy(CAPOX regimen).On the other hand, the control group received concurrent radiotherapy and chemotherapy.The regimen involved 50 Gy over 5 weeks in 25 fractions and concurrent capecitabine chemotherapy.Afterward, total rectal mesentery resection was performed, and postoperatively, 2 and 6 courses of CAPOX chemotherapy were continued.Follow-up was conducted until 31 December 2021, with the primary observation being the disease-free survival(DFS)of patients in both groups.Secondary observations included overall survival(OS)time, lesion progression-free survival(PFS)time, local recurrence rate, and the rate of acute toxicity events.Cox regression analyses were conducted to compare the factors influencing DFS.Results:Among the 446 patients, 303(67.9%)were male and 143(32.1%)were female.The patients in the observation group were found to be younger and had a higher proportion of Eastern Collaborative Oncology Group(ECOG)physical status score 0 compared to the control group(both P<0.05).Additionally, the two groups differed significantly in terms of MRI T stage, N stage, distance from the external anal verge, rectal mesorectal fascial infiltration, pathological stage, and chemotherapy-to-surgery time interval(all P<0.05).Throughout a mean follow-up period of(20.7±3.5)months, there were 76 deaths, 89 distant metastases, and 32 local recurrences.The results of Kaplan-Meier survival analysis revealed that the observation group had a higher disease-free survival(DFS)rate at 2 years of follow-up compared to the control group[73.8%(79/107) vs.68.1%(231/339), Log-rank χ2=2.676, P=0.041].Additionally, the median DFS time was longer in the observation group[19(12, 22)months]compared to the control group[16(11, 19)months]( Z=2.774, P=0.038).Furthermore, the observation group exhibited a significantly longer OS time[26(21, 33)months]compared to the control group[22(18, 14)months]( Z=2.879, P=0.032).However, the median PFS time was similar in both groups[20(14, 25)months vs.16(12, 21)months]( Z=1.545, P=0.123).The incidence of distant metastasis was 18.7%(20/107)in the observation group and 20.4%(69/339)in the control group(Log-rank χ2=0.341, P=0.708), indicating no significant difference.Similarly, there was no significant difference in the risk of local recurrence between the observation group[9.3%(10/107)]and the control group[6.5%(22/339)](Log-rank χ2=0.996, P=0.318).In terms of adverse reactions, there was no statistically significant difference in the incidence of grade≥3 acute toxic reactions between the two groups[19.6%(21/107) vs.12.1%(41/339), Log-rank χ2=1.661, P=0.148].A multifactorial Cox regression analysis revealed that age( HR=0.586, P=0.005), ECOG score( HR=0.721, P=0.028), MRI T-stage( HR=0.605, P=0.008), rectal mesenteric fascial infiltration( HR=1.649, P=0.012), and distance from the external anal verge( HR=0.638, P=0.041)were associated with DFS. Conclusions:The findings indicate that the combination of preoperative short-course radiotherapy and neoadjuvant chemotherapy in elderly patients with locally advanced rectal cancer demonstrates favorable short-term effectiveness and safety.This approach shows promise in improving outcomes for elderly patients with locally advanced rectal cancer.
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Purpose:To analyze the prognostic factors of non-Hodgkin's lymphoma in nasal cavity.Methods:From Feb. 1985 to Jul. 1996, 143 patientsof non- Hodgkin's lymphoma in nasal cavity have been treated in our hospital by radiotherapy alone, chemotherapy alone and radiotherapy with chemotherapy.Results:The complete response rate of all 143 patients was 53.1%(70/143). The main failure site is distant extranodal infiltration especially the invasion of skin. Failure at primary site and lymph node is not common. The main factor influencing local and distant failure is the stage of disease.The failure rate of stage Ⅰ, stageⅡ and stageⅢ-Ⅳ is 29.7%(30/101),87.5%(28/32) and 90.0%(9/10), respectively . The distant extranode invasion rate is 54.2%(45/83) and 35.9%(14/39) in T cell and B cell type disease respectively. In those stage Ⅰ patients with lesions beyond nasal cavity , the distant failure rate have not shown any difference between groups of radiotherapy alone and radiotherapy with chemotherapy. In contrast, in patients of stageⅡ～Ⅳ disease, the distant failure rate is less in patients received radiotherapy with chemotherapy than in patients received radiotherapy alone. Conclusions:Chemotherapy could improve the survival rate and decrease the distant failures for the patients of advanced non- Hodgkin's lymphoma in nasal cavity. The failures always occur in 2 weeks after initial treatment and the prognosis of the failure patients is very poor.
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Purpose: In order to improve the treatment results of post-operative irradiation, a comparison is made between radiotherapy only and radiotherapy plus cisplatin infusion in the bladder after surgery for carcinoma of the bladder. Methods: 83 patients with carcinoma of the bladder were treated by radiotherapy plus cisplatin infusion of the bladder after surgery as study group and another 77 patients were treated with radiotherapy only as control group. Results: The 1-, 3- and 5 -year survival rates and no evidence of disease rates in study group were 97. 6% (81/83), 82. 7 % (67/81), 89. 6% (60/ 67) and 94.0%(78/83), 89. 7% (70/78) , 84. 3%(59 /70); they were 92. 2% (71/77), 84. 5% (60/71), 75.0% (45/60) and 88. 3% (68/77), 77.9% (53/68), 73. 6% (39/53) in the control group, respectively. The relapse and metastasis rates were 15.7% (13/83) and 8.4% (7/83) in study group;; 23.4% (18/77) and 18.2% (14/77) in the control group(P