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Objective:To analyze the failure patterns and survival after stereotactic body radiotherapy (SBRT) in patients with T 1-2N 0M 0 non-small cell lung carcinoma (NSCLC). Methods:Clinical data of early-stage NSCLC patients who received SBRT at Zhejiang Cancer Hospital from January 2012 to September 2018 were retrospectively analyzed. The primary observed endpoint was the pattern of disease progression, which was divided into intra-field recurrence, regional lymph node recurrence and distant metastasis. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox's model.Results:A total of 147 patients with 156 lesions were included. The median follow-up time was 44.0 months (16.5-95.5 months). A total of 57 patients (38.8%) progressed: 14 patients (24.5%) had recurrence with the 1-, 3-, and 5-year local recurrence rates of 2.0%, 10.9%, and 14.3%, respectively; 36 patients (63.2%) had Distant metastasis with the 1-, 3- and 5-year distant metastasis rates of 12.2%, 22.4% and 28.6%, respectively; and 7 patients (12.3%) had recurrence complicated with distant metastasis. The 3-, 5- and 7-year OS rates were 80.5%, 64.2% and 49.9% for all patients, respectively. The median OS was 78.4 months. The 3-, 5- and 7-year PFS rates were 64.8%,49.5% and 41.5%, with a median PFS of 57.9 months (95% CI: 42.3-73.5 months). Univariate and multivariate analyses showed that biologically equivalent dose and age were the factors affecting the efficacy of SBRT (both P<0.05). Conclusion:Distant metastasis is the main failure pattern in patients with T 1-2N 0M 0 NSCLC after SBRT. High-risk population should be selected for further systematic treatment to improve the efficacy.
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The current recommendation for postoperative radiotherapy for esophageal cancer in China is mainly based on the data of incomplete two-field dissection of open left thoracotomy. At present, the type of surgery for esophageal cancer gradually transitions from open left thoracotomy to open right thoracotomy and from open esophagectomy to minimally invasive esophagectomy (MIE). Patients with early-stage esophageal cancer are selected as candidates for MIE. MIE is less invasive than open esophagectomy, and the right thoracic approach is conducive to more thorough lymph node dissection. However, few data and related studies are available on the patterns of failure after MIE in esophageal cancer, and guiding an adjuvant therapy is difficult. The feasibility of an adjuvant therapy for selective high-risk patients and the optimized treatment after MIE remains to be explored in clinical practice. In this regard, this article aims to review the safety of MIE, long-term survival outcomes, postoperative recurrence patterns, and recurrence rates of patients to discuss the value of postoperative adjuvant therapy and guide clinical treatment.
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The current recommendation for postoperative radiotherapy for esophageal cancer in China is mainly based on the data of incomplete two-field dissection of the left thoracotomy (category 2B evidence). However, the surgery of esophageal cancer is undergoing a period of transformation, which has gradually transitioned from left thoracotomy to right thoracotomy, and from open surgery to minimally invasive surgery. Compared with incomplete two-field dissection of left thoracotomy, complete two-field / cervical thoracic and abdominal three-field dissection of right thoracotomy could more thoroughly dissect the upper mediastinum and cervical lymph nodes. Hence, theoretically, it yields a lower recurrence rate of regional lymph nodes and prolongs the survival time. However, under the new technical conditions, whether the tumor recurrence pattern and recurrence rate after esophageal cancer surgery will change significantly compared with the past, whether postoperative radiotherapy still has the value of local control and survival benefits, and whether the indications of postoperative radiotherapy need to be adjusted accordingly have not been determined. Based on the above considerations, the changes in surgical methods for esophageal cancer at the current stage, the survival status of right thoracotomy and postoperative patterns of failure were summarized, aiming to evaluate the value of adjuvant radiotherapy under the condition of right thoracotomy.
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Objective To analyze the 10-year survival outcome and failure patterns for patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT),aiming to provide reference for optimized treatment for NPC.Methods Clinical data of 866 patients with NPC receiving IMRT from January 2001 to December 2008 were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier estimator.Univariate analysis was carried out by log-rank test and multivariate analysis was performed using Cox proportional hazards model.Results The median follow-up time was 132 months.The 10-year local recurrence-free survival (LRFS),distant metastasis-free survival (DMFS),progression-free survival (PFS) and disease specific survival (DSS) were 92.0％,83.4％,75.7％ and 78.6％,respectively.A total of 210 patients died including 124 patients (59.0％) from distant metastasis,which was the primary cause of death,and 47 (22.3％) from local regional recurrence.Independent negative factors of DSS included age＞50 years (P=0.00),LDH ≥ 245 IU/L (P=0.00),Hb＜ 120 g/L (P=0.01),T2-T4 staging (P=0.00),N1-N3 staging (P=0.00) and GTV-nx＞20 cm3(P=0.00).The 10-year LRFS,DMFS and DSS of stage Ⅱ NPC patients did not significantly differ after IMRT alone and chemoradiotherapy (P=0.83,0.22,0.23).For patients with stage Ⅲ NPC,the 10-year LRFS and DSS in the chemoradiotherapy arm were significantly higher than those in the IMRT alone (P=0.01,0.01),whereas no statistical significance was observed in the DMFS between two groups (P=0.14).The overall survival of stage Ⅳa+Ⅳb NPC patients is relatively poor.Conclusions IMRT can improve the long-term survival of NPC patients.Distant metastasis is the primary failure pattern.Patients with stage Ⅰ-Ⅱ NPC can obtain satisfactory survival outcomes after IMRT alone.The addition of chemotherapy can further enhance the LRFS and DSS of stage Ⅲ NPC patients.However,the optimal therapeutic strategy remains to be urgently investigated for stage a+ Ⅳb NPC patients.
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PURPOSE: This study examined the effects of glass infiltration treatments on the shear bond strength (SBS) between zirconia core and ultra low-fusing porcelain veneer. MATERIALS AND METHODS: The zirconia specimens were classified into 4 groups (n = 12): Untreated zirconia (group Z), zirconia coated ZirLiner (group ZL), glass-infiltrated zirconia (group ZG), glass-infiltrated and sandblasted zirconia (group ZGS). A cylinder of ultra low-fusing veneer porcelain was build up on each disk (6 mm × 3 mm). SBS was measured using a universal testing machine. Scanning electron microscope and Energy Dispersive X-ray spectroscopy were used to evaluate the surface of zirconia and failure pattern after SBS. RESULTS: SBS value of group ZGS was significantly lower than that of other groups (P < .05). No significant differences were detected among group ZL, group Z and group ZG. CONCLUSION: Glass infiltration is not effective to the bond strength between zirconia and ultra low-fusing porcelain veneer. Sandblasting also dramatically decreased the bonding strength.
Subject(s)
Dental Porcelain , Glass , Spectrometry, X-Ray EmissionABSTRACT
Objective To explore the treatment effect and failure patterns associated with different clinical target volume on patients with esophageal carcinoma treated with 5-filed intensity modulated radiotherapy (IMRT), and to determine whether involved field irradiation (IFI) is practicable in these patients. Methods A total of 88 patients with esophageal carcinoma between January 2012 to June 2014 underwent IMRT in our hospital, were divided into IFI group and elective nodal irradiation(ENI) group according to the CTV range for a concurrent control study. Results One-year and two-year survival rate in IFI group and ENI group were 75.0%, 45.5% and 70.5%, 43.2% respectively (P > 0.05). Local failure rate in IFI and ENI groups was 27.3% and 22.7% respectively, distant metastasis failure rates 22.7% and 18.2% respectively and regional failure rate outside the radiation field 11.4% and 4.5%, which showed no statistical difference (P > 0.05). Subgroup analysis indicated failure outside the radiation field tended to increase for primary lesion located in the up thoracic or clinical stageⅠ in IFI group. The volume dose histogram of lung V5, V20, V30 and mean lung dose of ENI group were greater than that of IFI group, while V5 of lung and the mean lung dose had statistical difference. Conclusions The survival rate and local control rate have no significant differencein IFI group and ENI group, so IFI is feasible for some esophageal carcinoma, but it should be cautious to choose IFI for those primary lesion located in the up thoracic or clinical stageⅠ.
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Objective To evaluate the multimodal treatment outcomes and patterns of treatment failure in esthesioneuroblastoma at a single institution. Methods One hundred and twelve patients who were newly diagnosed with esthesioneuroblastoma but no distant metastasis in our institution from 1979 to 2014 were retrospectively analyzed. The treatment modes, outcomes, and patterns of treatment failure in these patients were analyzed. According to the modified Kadish staging system, the numbers of patients with stage A, B, C, and D esthesioneuroblastoma were 1, 23, 60, and 28, respectively. Fifty?one patients received surgery and postoperative radiotherapy with or without chemotherapy;forty?six patients received radiotherapy with or without chemotherapy;eleven patients received preoperative radiotherapy and surgery with or without chemotherapy;three patients received surgery with or without chemotherapy; one patient received chemotherapy alone. The survival rates were calculated using the Kaplan?Meier method. Results In all patients, the 5?year sample size was 44, and the 5?year overall survival ( OS ) and disease?free survival ( DFS) rates were 66?4% and 54?7%, respectively. The 5?year OS and DFS rates were 91% and 82% in patients who received preoperative radiotherapy and surgery with or without chemotherapy, 80% and 66% in patients who received surgery and postoperative radiotherapy with or without chemotherapy, and 46% and 37% in patients who received radiotherapy with or without chemotherapy. Three patients treated with surgery alone had relapse of the disease;one patient treated with palliative chemotherapy survived 6 months. Treatment failed in 47 ( 42%) out of 112 patients. In patients with failed treatment, 53% had distant metastasis as the first pattern of treatment failure, 36% had locoregional relapse, and 11% had concurrent distant metastasis and locoregional relapse. Conclusions Surgery combined with radiotherapy is still the recommended multimodal treatment regimen for esthesioneuroblastoma. The multimodal treatment achieves satisfactory local?regional control rate and treatment outcomes in the treatment of esthesioneuroblastoma. The major pattern of treatment failure is distant metastasis.
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PURPOSE: We evaluated the failure pattern of the celiac axis, gastric lymph node, and treatment outcome in the upper and mid-esophageal region of cancer patients treated by definitive radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, retrospectively. MATERIALS AND METHODS: The study constituted the evaluation 108 patients with locally advanced esophageal cancer receiving radiotherapy or a combination of radiotherapy and chemotherapy at Chonbuk National University Hospital from January 1986 to December 2006. In total, 82 patients treated by planned radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, were analysed retrospectively. The study population consisted of 78 men and 2 women (mean age of 63.2 years). In addition, 51 patients received radiotherapy alone, whereas 31 patients received a combination of radiation therapy and chemotherapy. The primary cancer sites were located in the upper portion (17 patients), and mid portion (65 patients), respectively. Further, the patients were in various clinical stages including T1N0-1M0 (7 patients), T2N0-1M0 (18 patients), T3N0-1M0 (44 patients) and T4N0-1M0 (13 patients). The mean follow up period was 15 months. RESULTS: The various treatment outcomes included complete response (48 patients), partial response (31 patients) and no response (3 patients). The failure patterns of the lymph node were comprised of the regional lymph node (23 patients) and the distance lymph node which included celiac axis and gastric lymph node (13 patients). However, metastasis was not observed in the regional and distant lymph node in 10 patients, whereas 36 patients were not evaluated. Furthermore, of the 13 patients who developed celiac axis and gastric lymph node metastases, 3 were in stage T1N0-1M0 and 10 were in stage T2-4N0-1M0. A complete response appeared in 12 patients, whereas a partial response appeared in 1 patient. The mean survival time of the patients who appeared for regional and distant lymph node metastasis was 14.4 and 7.0 months, respectively. CONCLUSION: In locally advanced esophageal cancer patients, who were treated by definitive radiotherapy without celiac axis and gastric lymph node irradiation, the distant lymph node metastasis rate was high and the overall survival rate was lower compared to the regional lymph node metastasis. The incidence of regional and distant lymph node metastasis was high in patients who appeared beyond clinical stage T2 and received radiotherapy alone.
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Female , Humans , Male , Axis, Cervical Vertebra , Esophageal Neoplasms , Follow-Up Studies , Incidence , Lymph Nodes , Neoplasm Metastasis , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
The purpose of this study was to evaluate the clinical effectiveness of a plasma arc light and light emitting diode (LED), compared with shear bond strength and the failure pattern of brackets bonded with visible light in direct bonding. Brackets were bonded with Transbond XT to 60 human premolars embedded in the resin blocks according to different light-curing methods. Then, the shear bond strength of each group was measured using a universal testing machine (Instron) and the adhesive failure pattern after debonding was visually examined by light microscope. The results were as follows: 1. The shear bond strength showed no significant difference between the visible light and light emitting diode, but the plasma arc light exhibited a significantly lower shear bond strength compared with the visible light and light emitting diode. 2. In the visible light and light emitting diode, adhesive failure patterns were similar. Bond failure occurred more frequently at the enamel-adhesive interface. 3. The bonding failure of brackets bonded with plasma arc light occurred more frequently at the bracket-adhesive interface. The results of this study suggest that plasma arc light, light emitting diode and visible light are all clinically useful in the direct bonding of orthodontic brackets.
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Humans , Adhesives , Bicuspid , Light , Orthodontic Brackets , PlasmaABSTRACT
PURPOSE: This retrospective study was conducted to compare early preliminary results of breast conservation therapy (BCT) with mastectomy in early breast cancer. MATERIALS AND MEHTODS: We evaluated 171 women with AJCC stage I and II breast cancer who had been treated at Kangnam St. Mary's Hospital from March 1989 to August 1996. Eighty-eight patients underwent mastectomy and 85 patients did conservative surgery with breast irradiation. In the BCT group, all patients received whole breast irradiation to a total dose of 45~50 Gy/5~6 wks, followed by a boost to the original tumor site at least 60 Gy. Chemotherapy was administered to 29 (34.1%) patients in BCT and 40 (45.5%) in mastectomy, with various sequencing of surgery and/or radiation. We compared survival rate, patterns of failure in each treatment group and the prognostic factors that had a significant effect on treatment failure. The median follow-up time was 63 months (19~111 months). Log rank test was used to estimate the prognostic factors for treatment failure. RESULTS: Overall survival, disease free survival, locoregional recurrence and distant metastasis rates were not significantly different between the two treatment groups. During the follow-up period, 11 patients (12.5%) in the mastectomy group and 10 patients (11.8%) in the BCT group were failed. Six local recurrences occurred after mastectomy and 5 after BCT. Five patients failed at distant site in mastectomy and 4 in BCT. Of the local recurrence cases, five of 6 mastectomy patients and 3 of 5 BCT patients were alive with no evidence of disease after salvage surgery and/or chemoirradiation. Our results indicated that the major influence on survival was distant metastasis. Unfortunately, control of distant metastasisis was not frequently achieved. Even with salvage systemic therapy or radiotherapy, most of distant metastasis patients died or had uncontrolled disease in both treatment groups: only one of 4 BCT patients and none of mastectomy patients were alive without disease. There was no apparent difference in the incidence rate of contralateral breast cancer and non-breast 2nd primary tumor between the two treatment groups. Univariate Log-rank test identified the N stage and the involved axillary LN number as distinct prognostic factors that were highly predictive of treatment failure in both treatment groups. Additionally, marginal status in BCT and histologic nuclear grade in the mastectomy group were risk factors for treatment failure (p<0.05). CONCLUSION: Although further careful follow-up is necessary to confirm the trends evident in this series, it would appear that patterns of failure and survival rate following conservative surgery and radiotherapy in early breast cancer are similar to those following mastectomy. The great majority of patients with local recurrence had an exellent salvage rate in both treatment groups. Therefore, these preliminary short term results support BCT as an equally effective management for early breast cancer as an alternative to mastectomy.
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Female , Humans , Breast Neoplasms , Breast , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Incidence , Mastectomy , Neoplasm Metastasis , Radiotherapy , Recurrence , Retrospective Studies , Risk Factors , Survival Rate , Treatment FailureABSTRACT
PURPOSE: The aim of this study is to analyze the treatment failure patterns and the risk factors for locoregional or distant failure of uterine cervical carcinoma treated with radiation therapy. MATERIALS AND METHODS: A retrospective analysis was undertaken of 154 patients treated with curative radiation therapy in Gyeongsang National University Hospital from April 1989 through December 1997. According to FIGO classification, 12 patients were stage IB, 24 were IIA, 98 were IIB, 1 were IIIA, 17 were IIIB, 2 were IVA. RESULTS: Overall treatment failure rate was 42.1% (65/154), and that of complete responder was 31.5% (41/130). Among 65 failures, 25 failed locoregionally, another 25 failed distantly, and 15 failed locoregionally and distantly. Multivariate analysis confirmed tumor size (>4 cm) as risk factor for locoregional failure, and tumor size (>4 cm), pelvic lymph node involvement as risk factors for distant failure. CONCLUSION: On the basis of results of our study and recent published data of prospective randomized study for locally advanced uterine cervical carcinoma, we concluded that uterine cervical carcinoma with size more than 4 cm or pelvic lymph node involvement should be treated with concurrent chemoradiation.
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Humans , Classification , Lymph Nodes , Multivariate Analysis , Radiotherapy , Retrospective Studies , Risk Factors , Treatment Failure , Uterine Cervical NeoplasmsABSTRACT
The purpose of this study was to determine whether the application of chlorhexidine varnish affects the shear bond strength and failure pattern of orthodontic brackets or not. The experimental group consisted of 22 human premolars which extracted after chlorhexidine varnish application (4 times for 1 week interval) in vivo, and the control group consisted of 22 human premolars which extracted without any pre-treatment. After all teeth wee etched with 37% phosphoric acid gel, metal orthodontic brackets (Q-3002, RMO, USA) were bonded to each tooth using auto-polymerizing orthodontic resin (Ortho-One, Bisco, USA) with the same bonding procedure. The shear bond strength was measured with Instron universal testing machine (model 4466, Instron Ltd., England), and the failure pattern of each bracket was examined with Scanning Electron Microscope (SM 840A, JEOL, Japan). The data were analysed statistically with t-test. The results were as follows: 1. Application of chlorhexidine varnish had no significant effect on the shear bond strength of the orthodontic bracket. 2. There was no significant difference in the failure pattern of orthodontic bracket between the experimental group and the control group.
Subject(s)
Humans , Bicuspid , Chlorhexidine , Orthodontic Brackets , Paint , ToothABSTRACT
PURPOSE: This study was performed to determine the optimal treatment volume of patients treating with radiation therapy for intracranial germ cell tumor. MATERIALS AND METHODS: From 1993 to 1998, 19 patients with intracranial germ cell tumors treated by gamma knife radiosurgery were analyzed. The location of tumor was as follows; 9 cases on pineal region, 1 case on suprasellar region, and 9 cases of multiple lesion. 7 patients were pathologically verified; 5 cases of germ cell tumor and 2 cases of non germinomatous germ cell tumor. Tumor volume was ranged from 2.4 cm3 to 74 cm3. Irradiation dose was 10 Gy to 20 Gy with 50% isodose curve. Follow up period was 10 months to 54 months. RESULTS: Recurrences were observed in 14 cases among 19 (74%) patients. Complete remission and partial remission were achieved in 2 (11%) and 10 (53%) respectively. No response was observed in 7 (36 %). 2 cases were recurred within original tumor bed. 6 cases were recurred beyond but contiguous with tumor bed. Ventricular relapses separated from pretreatment tumor bed were 3. Spinal recurrences were 4. Among 8 recurred cases of which tumor volume is smaller than 20 cm3, 2 were recurred within original tumor bed, 4 were recurred beyond but contiguous with tumor bed, and 1 spinal recurrence. Meanwhile, 6 cases of which tumor volume larger than 20 cm3, 1 case was recurred beyond but contiguous with tumor bed, 2 ventricular recurrences separated with original tumor bed, and 3 spinal recurrences. 5 cases which did not show any recurrence sign showed characteristics of single lesion, tumor volume smaller than 20 cm3 and normal tumor marker. All of 4 cases of spinal recurrences happened in the case having ventricular invasion or lesion. Among 9 cases having multiple lesion, only 3 cases recurred within original tumor bed or around tumor bed, the other 6 cases recurred separated from pretreatment tumor bed. CONCLUSION: Gamma knife radiosurgery is not recommended for the treatment of intracranial germ cell tumor. It is because of small treatment volume and inadequate radiation dose that are characteristics of gamma knife radiosurgery. Tumor volume, ventricular invasion or ventricular lesion in multiple lesion are important factors to be considered for the wide field radiation therapy. Tumor volume smaller than 20 cm3, single lesion, no ventricular lesion or invasion, and normal tumor marker are ideal indications for small involved field radiation therapy. Prophylactic spinal irradiation seems to be necessary when there is ventricular lesion, ventricular invasion, and multiple lesions. When the tumor volume is larger than 20 cm3, multiple lesions, abnormal tumor marker, and whole ventricular irradiation or partial brain irradiation would be possible and neoadjuvant chemotherapy would be most beneficial in these group.
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Humans , Brain , Drug Therapy , Follow-Up Studies , Germ Cells , Neoplasms, Germ Cell and Embryonal , Radiosurgery , Recurrence , Tumor BurdenABSTRACT
A Retrospective study to analyze the failure pattern in locally advanced stomach cancer, trated with radical surgery and post-op chemotherapy was perfomed. Among 107 patients who underwent radical gastrectomy in Asan Mdical Center between June 1989 and August 1990. there were 20 stage II(T2NO,T2N1) and 87 stage III(T3N1,T3N2) and 91 patients were eligible for study. 57 patients treated with 6 cycles of postop adjuvant chemotherapy. A mong 57 patients treated with postop adjuvant chemotherapy, local failure occurred in 21% and distant failure in 12%. Among 34 patients who were not treated with postop chemotherapy, local failure occurred in 24% and distant failure in 26%. Among 29 failures including 13 locoregional, 9 distant metastasis and 7 locoregional and distant metastasis, 11 cases recurred in the anastomotic aite, 3 in the gastric bed, 7 in the regional lymph nodes and peritoneal seeding occurred in 6 cases. The true incidences of gastric bed, nodal and peritoneal failures may be higher in the longer follow-up or reoperative or autopsy series. Our data suggest that postop chemocherapy is beneficial by reducing distant failure rate. Potop adjuvant locoregional radiotherapy in addition to the systemic adjuvant therapy may reduce the local failure rate and potentially benefit in at least 20% of patients who developed the local failure only.