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Objective To investigate localized regional recurrence after chemotherapy and chest radiotherapy in limited stage small cell lung cancer (LS-SCLC),and explore the relationship between recurrence location and radiotherapy and chemotherapy and its influencing factors.Methods From 2006 to 2014,pathological LS-SCLC treated in CAMS,125 patients had local recurrence,Kaplan-Meier statistical method was used to analyze the survival rate and PFS of each recurrence site.Log-rank was used to compare the survival rate of each group.Univariate analysis includes Chi-squareand t-test for the factors for the recurrence site.Multivariate analysis using Logistic regression.Results The 1-,2-and 5-year overall survival rates were 92.0％,46.4％ and 14.7％,respectively.The median progression time was 12.96 months,The median survival time after progression was 1 1.5 months,and the 1-,2-,and 5-year overall survival rates were 45.0％,23.0％,and 10.0％,respectively.The recurrence sites include intrapulmonary recurrence (67 patients),regional lymph nodes (21 patients),simultaneous intrapulmonary and regional lymph nodes (28 patients),and contralateral or supraclavicular lymph nodes (9 patients).The median survival time were 23.96 months,24.76 months,23.23 months,and 18.66 months,and the 2-year survival rates were 49％,52％,46％,and1 1％,respectively (P=0.000,0.004,0.008).In 6 patients (4.0％),5 patients were located in the supraclavicular region,and 1 patient (0.8％) in the field.Conclusions For LS-SCLC undergoing IMRT and chemotherapy,the local failure location is mainly located in the pulmonary,and further treatment of the split dose and targets requires further clinical exploration.
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Breast cancer is the most frequent cancer among women and also the leading cause of cancer related deaths in women. The patterns of failures in carcinoma breast seem to differ by cell type, pathological stage and by the treatment modality instituted. Breast cancers can recur locally, regionally and distantly. Survival rates decrease progressively as the stage of the disease increases. Aims & Objectives: To evaluate the patterns of failure in patients with Breast Carcinoma after definitive treatment modalities. Methods: We conducted an analytical, nonrandomized, cross-sectional study on the Patterns of Failure in 1238 patients with primary breast cancer who reported to our Regional Cancer Centre from 2002 to 2010. Results: A total of 1238 patients with 1189 females and 49 males were evaluated. Most of the patients were above fifty years of age with breast lump being the most common presentation. Infiltrating ductal carcinoma was the most common histology and stage II being the commonest stage of presentation. Most of the patients were hormone receptor positive and Her 2 neu receptor negative. Overall local failure was 3.9%, regional failure 2.7% and distant failure 22.5%. Overall 5 year disease free survival was 78.4%. Conclusion: The most common form of local failure is chest wall recurrence, regional failure is supraclavicular lymphadenopathy and distant failure is bone metastasis. The 5 year disease free survival is lower for all the stages when compared to world scenario. This may be attributed to more aggressive disease behaviour in our patients.
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Objective This study was conducted to evaluate treatment-related toxicities,the patterns of failure,overall survival(OS)and progression-free survival(PFS)by comparing IFI with ENI in combination with chemotherapy. Methods Eligible patients were treated with concurrent chemoradiotherapy and randomized into either an IFI or ENI arm. The primary end points wereacute treatment-related toxicities. The secondary end points were patterns of failure,OS and PFS. Kaplan?Meier survival rate of the method for calculating the Logrank test difference method. Results Between April 2012 and October 2016,a total of 228 patients were enrolled from nine centers in china. Grade≥3,Grade≥2 radiation esophagitis and pneumonitis in the IFI arm were significantly lower than that of the ENI arm(P=0.018,0.027).No significant differences were observed in overall failure rates,loco-regional failure,distant failure rates,in-field and out-field lymph node failure between the two arms(P=0.401,0.561,0.510,0.561,0.681).The 1-,2-, 3-,4-yearand median OS in the ENI arm and IFI arm were 84.1%,57.3%,39.4%,31.6%,28 months and 83.6%,62.1%,44.5%,31.5%,32 months(P=0.654),respectively. The 1-,2-,3-yearand median PFS in the ENI arm and IFI arm were 71.9%,42.3%,32.7%,20 months and 70.1%,45.0%,35.9%,22 months (P=0.885),respectively. Conclusions Compared to ENI,IFI resulted in decreased radiation pneumonitis and esophagitis without sacrificing loco-regional lymph nodal control,PFS and OS in thoracic ESCC. Clinical Trial Registry Chinese Clinical trail registry,registration number:NCT01551589.
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Objective:To assess the prognostic factors of World Health Organization(WHO)grade Ⅱ gliomas.Methods:A total of 146 patients diagnosed with WHO grade Ⅱ gliomas were treated at Jiangxi Province Tumor Hospital between June 1997 and April 2015,in-cluding 90 gross total resections(GTRs)and 56 partial resections.According to the 2007 WHO grading system of gliomas,there were 96 astrocytomas,30 oligodendrogliomas,and 20 oligoastrocytomas.Results:The median follow-up time was 88 months.Five-year overall survival(OS)and progression-free survival(PFS)rates were 75.7% and 60.0%,respectively,and 10-year OS and PFS rates were 57.4% and 37.8%,respectively.Univariate analysis of OS revealed statistically significant differences in age,sex,subventricular zone (SVZ) invasion, peritumoral edema, residual tumor volume, preoperative tumor size and numbers, and the extent of resection (P<0.05). Compared with astrocytoma patients, oligodendroglioma patients had better OS and PFS (P=0.040 and 0.049, respectively). Among those factors,sex,SVZ invasion,residual tumor volume,preoperative tumor numbers,and the extent of resection were like-wise significant for PFS (P<0.05). Multivariate analysis revealed that the extent of resection, SVZ invasion, and peritumoral edema were independent prognostic factors for OS(P<0.05)and the extent of resection and tumor numbers were independent prognostic fac-tors for PFS(P<0.05).Sixty patients developed recurrences,including 53 tumor bed failures and 7 intracranial disseminations.Conclu-sions:The extent of resection,SVZ invasion and peritumoral edema may be independent prognostic factors for OS in low-grade glio-mas.Postoperative radiotherapy would improve PFS for patients who underwent GTRs.The major pattern of failure was tumor bed re-currence.
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Objective To observe the curative effect,failure pattern and treatment-related toxicities of elective nodal irradiation (ENI) and involved field irradiation (IFI) in patients with thoracic esophageal squamous cell carcinoma treated with radical radiotherapy, and determine the reasonable target delineation of radiotherapy. Methods Using prospective randomized controlled design, a total of 86 patients with thoracic esophageal squamous cell carcinoma were randomly allocated to two groups:ENI group(n=39)and IFI group(n=47).Both groups received concurrent chemoradiotherapy.In ENI group,the high-risk lymphatic drainage area received prophylactic irradiation on the basis of IFI group.After the treatment, all patients were followed up for 3~33 months.The median follow-up period was 15 months.The short-term effective rate, one year survival rate, progression free survival rate and the local control rate of two groups were calculated. The survival curve was drawn by the Kaplan-Meier method,and the survival rate was compared using the Log-rank method.Meanwhile, the treatment failure pattern and incidence of adverse reactions were analyzed in the two groups. Results There was no significant difference in effective rate between ENI group and IFI group (92.3% vs. 95.7%,χ 2=0.460, P>0.05). The one-year survival rates were 66.7% and 68.1% for the two groups,respectively.The progression-free survival rates were 56.4% and 53.2% respectively.The local control rates were 92.3% and 87.5% respectively,with no statistical difference(P>0.05). The median survival time was 15 months at the end of the follow-up for group ENI and group IFI, and there was no significant difference in survival rate between two groups(Log-rank χ2=1.520,P=0.218).There were 35 cases with treatment failure in all 86 patients, of which 17 cases were in group ENI and 18 cases in group IFI. The regional failure rates were 35.9% and 27.7% in ENI and IFI groups respectively,distant metastasis rates were 20.5% and 14.9% respectively,in-field failure rates were 30.8% and 23.4% respectively, and out-of-field failure rates were 4.3% and 5.1% respectively, which showed no significant differences (P>0.05). There were no significant differences in side effects, the incidence of bone marrow suppression,gastrointestinal reactions,radiation esophagitis and radiation-induced lung injury between two groups (P>0.05). Conclusion ENI shows similar recent efficacy, failure patterns, adverse reactions and prognosis with IFI for thoracic esophageal squamous cell carcinoma patients receiving radical radiotherapy. So IFI treatment is recommended to minimize the exposure dosage of normal tissue.
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OBJECTIVE: To analyze patterns of abdominopelvic failures and to define subgroups for the use of adjuvant radiotherapy in the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer (EOC). METHODS: We reviewed 149 patients treated with debulking surgery followed by intravenous taxane and platinum chemotherapy between 1999 and 2008. Patient characteristics, patterns of failure, abdominopelvic failure APF-free survival (APFFS) and overall survival (OS) were analyzed. RESULTS: The median age of the patients was 51 years. Thirty-two patients (21.5%) were found to have residuum >2 cm after surgery. The median pretreatment CA-125 was 604 and 54.4% of patients had a decline in CA-125 > or =90% between pretreatment and at postoperative 1 month. With a median follow-up of 50 months, 79 patients (53.0%) experienced abdominopelvic failure (APF). The 5-year APF-free survival rate was 41.1%. Lymph node metastasis, size of residual disease, and decline in CA-125 were found to be significant prognostic factors for APF upon multivariate analysis. The group of patients in whom abdominopelvic irradiation was indicated as definitive postoperative treatment comprised 55% of the overall patient population and their 5-year survival rate was 68%. CONCLUSION: The stratification was suggested to predict APF based on lymph node metastasis, size of residual tumor, and decline in CA-125. Adjuvant radiotherapy covering the whole abdominopelvis using the intensity modulation technique may be considered to reduce APF in FIGO stage III EOC patients with intermediate risk.
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Humans , Bridged-Ring Compounds , Follow-Up Studies , Gynecology , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Neoplasm, Residual , Neoplasms, Glandular and Epithelial , Obstetrics , Ovarian Neoplasms , Platinum , Radiotherapy, Adjuvant , Survival Rate , TaxoidsABSTRACT
PURPOSE: To investigate the treatment outcome and failure patterns after definitive chemoradiation therapy in locally advanced, unresectable esophageal cancer. MATERIALS AND METHODS: From February 1994 to December 2002, 168 patients with locally advanced unresectable or medically inoperable esophageal cancer were treated by definitive chemoradiation therapy. External beam radiation therapy (EBRT) (42~46 Gy) was delivered to the region encompassing the primary tumor and involved lymph nodes, while the supraclavicular fossa and celiac area were included in the treatment area as a function of disease location. The administered cone-down radiation dose to the gross tumor went up to 54~66 Gy, while the fraction size of the EBRT was 1.8-2.0 Gy/fraction qd or 1.2 Gy/fraction bid. An optional high dose rate (HDR) intraluminal brachytherapy (BT) boost was also administered (Ir-192, 9~12 Gy/3~4 fx). Two cycles of concurrent FP chemotherapy (5-FU 1,000 mg/m2/day, days 2~6, 30~34, cisplatin 60 mg/m2/day, days 1, 29) were delivered during radiotherapy with the addition of two more cycles. RESULTS: One hundred sixty patients were analyzable for this review [median follow-up time: 10 months (range 1~149 months)]. The number of patients within AJCC stages I, II, III, and IV was 5 (3.1%), 38 (23.8%), 68 (42.5%), and 49 (30.6%), respectively. A HDR intraluminal BT was performed in 26 patients. The 160 patients had a median EBRT radiation dose of 59.4 Gy (range 44.4~66) and a total radiation dose, including BT, of 60 Gy (range 44.4~72), while 144 patients received a dose higher than 40 Gy. Despite the treatment, the disease recurrence rate was 101/160 (63.1%). Of these, the patterns of recurrence were local in 20 patients (12.5%), persistent disease and local progression in 61 (38.1%), distant metastasis in 15 (9.4%), and concomitant local and distant failure in 5 (3.1%). The overall survival rate was 31.8% at 2 years and 14.2% at 5 years (median 11.1 months). Disease-free survival was 29.0% at 2 years and 22.7% at 5 years (median 10.4 months). The response to treatment and N-stage were significant factors affecting overall survival. In addition, total radiation dose (> or =50 Gy vs. <50 Gy), BT and fractionation scheme (qd. vs. bid.) were not significant factors for overall survival and disease-free survival. CONCLUSION: Survival outcome after definitive chemoradiation therapy in unresectable esophageal cancer was comparable to those of other series. The main failure pattern was local recurrence. Survival rate did not improve with increased radiation dose over 50 Gy or the use of brachytherapy or hyperfractionation.
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Chemoradiotherapy , Neoplasm Metastasis , Esophageal NeoplasmsABSTRACT
PURPOSE: This study was to evaluate the survival and pattern of failure after radiation therapy of sino-nasal cancer using partial attenuation filer and wedged beams and to help radiotherapy planning of sino-nasal cancer. MATERIALS AND METHODS: Between February 1992 and March 2003, 17 patients with sino-nasal cancers underwent radiation therapy using partial attenuation filter at Dongsan Medical Center, Keimyung university. There were 9 male and 8 female patients. Patients' age ranged from 40 to 75 years (median 59 years). There were 10 patients of maxillary sinus cancer, 7 patiens of nasal cancer. The histologic type was squamous cell carcinoma in 11, adenoid cystic carcinoma in 4 and olfactory neuroblastoma in 2. The distribution of clinical stage by the AJCC system was 3 for stage II, 7 for III and 6 for IV. The five patients were treated with radiation alone and 12 patients were treated with surgery and postoperative radiation therapy. The range of total radiation dose delivered to the primary tumor was from 44 to 76 Gy (median 60 Gy). The follow- up period ranged from 3 to 173 months with median of 78 months. RESULTS: The overall 2 year survival rate and disease free survival rate was 76.4%. The 5 year and 10 year survival rate were 76.4% and 45.6% and the 5 year and 10 year disease free survival rate was 70.6%. The 5 year disease free survival rate by treatment modality was 91.6% for postoperative radiation group and 20% for radiation alone group, statistical significance was found by treatment modality (p=0.006). There were no differences in survival by pathology and stage. There were local failure in 5 patients (29%) but no distant failure and no severe complication required surgical intervention. CONCLUSION: Radiation therapy of sino-nasal cancer using partial attenuation filter was safe and effective. Combined modality with conservative surgery and radiation therapy was more advisable to achieve loco-regional control in sino-nasal cancer. Also we considered high precision radiation therapy with dose escalation and development of multi-modality treatment to improve local control and survival rate in advanced sino-nasal cancer
Subject(s)
Female , Humans , Male , Carcinoma, Adenoid Cystic , Carcinoma, Squamous Cell , Disease-Free Survival , Esthesioneuroblastoma, Olfactory , Maxillary Sinus Neoplasms , Nose Neoplasms , Pathology , Radiotherapy , Survival RateABSTRACT
PURPOSE: We tried to investigate the outcome and patterns of failure of endometrial cancer patients who were treated with surgery and postoperative radiation therapy (RT). MATERIALS AND METHODS: Eighty-three patients with endometrial cancer who received postoperative RT between May 1979 and August 2000 were included in this retrospective study. Forty-one patients received total abdominal hysterectomy, 41 patients received Wertheim's operation and 1 underwent vaginal hysterectomy. Pelvic lymph node dissection or pelvic lymph node sampling was done in 56 patients and peritoneal cytology was done in 35. All the patients were staged according to 1988 FIGO (International Federation of Gynecology and Obstetrics) staging system; 2 were stage IA, 23 were stage IB, 20 were stage IC, 4 were stage IIA, 5 were stage IIB, 9 were stage IIIA, 2 were stage IIIB and 18 were stage IIIC. The histologic diagnoses were adenocarcinoma in seventy-four patients (89%). The histologic grades were Grade 1, 2 and 3 in 21 (25%), 43 (52%) and 10 (12%) patients, respectively. All the patients received external beam RT (EBRT) with a median dose of 5,040 cGy (range: 4,500~5,075 cGy) to the whole pelvis. Five patients with pathologically confirmed paraaortic lymph node metastasis received 4500 cGy to the paraaortic lymph nodes. Fifteen patients received low-dose intracavitary brachytherapy after their EBRT. A total dose of 7,500~9,540 cGy (median dose: 8511) was prescribed to the vaginal surface. RESULTS: Overall, 11 patients (13%) experienced disease relapse: 4 with initial stage I or II disease and 7 with initial stage III disease. Among the 54 stage I or II patients, 1 (2%) relapsed in the pelvis only, 2 (4%) relapsed in the vagina and distant organs, and 1 (2%) relapsed in the paraaortic lymph nodes (PANs). Among the 29 stage III patients, 1 (3%) relapsed in the vagina. The most common sites of failure for the stage III patients were the peritoneum (3 patients, 10%), PANs (2 patients, 7%), and lung (2 patients, 7%). With a median follow-up period of 86 months, the overall survival (OS) and disease-free survival (DFS) rates at 5 years were 87% for both. The five-year DFS rate was 93%, 100% and 74% for the stage I, II and III patients, respectively. Three patients experienced severe radiation-related late complications: RTOG (Radiation Therapy Oncology Group) grade 3 radiation cystitis was seen in one patient, and grade 3 bowel obstruction was seen in two patients. CONCLUSIONS: Postoperative RT was useful for controlling pelvic disease. The major patterns of failure for stage III patients were peritoneal seeding and distant metastasis. Selective use of whole abdominal radiotherapy or adjuvant chemotherapy may improve the therapeutic outcome of these patients.
Subject(s)
Female , Humans , Adenocarcinoma , Brachytherapy , Chemotherapy, Adjuvant , Cystitis , Diagnosis , Disease-Free Survival , Endometrial Neoplasms , Follow-Up Studies , Gynecology , Hysterectomy , Hysterectomy, Vaginal , Lung , Lymph Node Excision , Lymph Nodes , Neoplasm Metastasis , Pelvis , Peritoneum , Radiotherapy , Recurrence , Retrospective Studies , VaginaABSTRACT
PURPOSE: To analyze the patterns of failure and prognostic factors affecting the local control and survivals in anal cancer treated with definitive radiotherapy, and to find the most effective treatment modality. MATERIALS AND METHODS: Thirty consecutive patients, with primary cancers of the anal canal, were treated using radiotherapy, both with and without 5-FU based concurrent chemotherapy. According to the AJCC tumor stage, six patients hadwere stage I, 11 had stage II, 2 had stage IIIA, and 11 had stage IIIB tumors. The median radiation dose was 45 Gy (30-72 Gy), and with 23 patients receivinged concurrent chemotherapy (5-FU and mitomycin C in 12 patients, 5-FU and cisplatin in 7, and other drugs in 4). The Mmedian follow up period was 43 months, (ranginge, from 8- to 99 months). RESULTS: Among the 1630 patients who16 were treated without surgical resection beforeprior to the radiotherapy, and a complete remission was observed in 12 patients (75%), a partial remission in 3 (19%), and a local progression in the other one patient. The Llocal failures, including persistent disease, were observed in 10 (33%), and the patients with higher T-stages (T3-4) had higher rates of local failure rates (T1-2, 21% vs. T3-4, 72%, p=0.03). Distant metastases were found in 4 patients (13%). The five year survival and disease free survival rates were 64% and 53%, respectively. The factors which affectinged the 5 year local relapse free survival were T-stage (74.9% in T1-2 vs. 28.6% in T3-4, p=0.01), and the existence of a gross tumor beforeprior to radiotherapy (84.6%, no residual vs. 45.1% with residual, p=0.03). CONCLUSION: A Llocal recurrence was the major failure pattern in anal cancers, and the factors affecting a local failure were the T-stage and tumor volume beforeprior to radiotherapy. A Rradiation dose around 45 Gy was sufficient to control tumors of the earlier T stage tumors, but a higher dose should be considered for with more advanced lesions.
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Humans , Anal Canal , Anus Neoplasms , Cisplatin , Disease-Free Survival , Drug Therapy , Fluorouracil , Follow-Up Studies , Mitomycin , Neoplasm Metastasis , Radiotherapy , Recurrence , Tumor BurdenABSTRACT
PURPOSE: To evaluate treatment results of breast conserving surgery and radiation therapy including survival rates, patterns of failure, and complication and to analyze prognostic factors. MATERIALS AND METHODS: Retrospective analysis was carried out for 111 (112 cases) consecutive patients with breast cancer treated by radiation therapy after breast conserving surgery from October 1994 to April 1997. The median follow up was 45 months (range 10~66). AJCC staging was as follows: 16 cases (14%) for ductal carcinoma in situ, 46 cases (41%) for stage I, 33 cases (30%) for stage IIa, and 17 cases (15%) for stage IIb. Radiation therapy after breast conserving surgery was delivered to whole breast with 50.4 Gy and additional 10 Gy electron beam boost to tumor bed. Adjuvant CMF or CAF chemotherapy was performed in 61 patients. RESULTS: Overall three- and five-year survivals were 99% and 95%, and progression-free survival were 93%, 87%, respectively. Treatment failure occurred in 11 cases (10%); loco-regional recur rence in six; distant metastasis in five. Univariate analysis showed prognostic factor affecting survival was only T-stage. Acute radiation dermatitis were found in five cases (4%), and chronic complications were found in five (4%); one case with amputation of nipple, two cases with lymphedema requiring rehabilitation therapy and two cases with symptomatic radiation pneu monitis requiring steroid therapy. CONCLUSION: Breast conserving therapy of early breast cancer including ductal carcinoma in situ showed high survival rates and low complications, and T stage was prognostic factor for survival. But further follow-up should be needed.
Subject(s)
Humans , Amputation, Surgical , Breast Neoplasms , Breast , Carcinoma, Intraductal, Noninfiltrating , Dermatitis , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Lymphedema , Mastectomy, Segmental , Neoplasm Metastasis , Nipples , Radiotherapy , Rehabilitation , Retrospective Studies , Survival Rate , Treatment FailureABSTRACT
226 patients with carcinoma of the uterine cervix treated with curative radiation therapy at the Department of Therapeutic Radiology, Dongsan hospital, Keimyung university, School of medicine, from July, 1988 to May, 1991 were evaluated. The patients with all stages of the disease were included in this study. The maximum and mean follow up durations were 60 and 43 months. The radiation therapy consisted of external irradiation to the whole pelvis (2700~4500 cGy) and boost parametrial doses(for a total of 4500~6300 cGy) with midline shill(4x10 cm), and combined with intracavitary irradiation irradiation(5700~7500 cGy to point A). The distribution of patients according to the stage was as follows: stage IB 37(16.4%), stage IIA 91 (40.3%), Stage IIB 58(25.7%), stage III 32(13.8%), stage IV 8 (3.5%). The overall failure rate was 23.9%(54 patients). The failure rate increased as a function of stage from 13.5% in stage 1B to 15.4% in stage IIA, 25.9% in stage IIB, 46.9% in stage III, and 62.5% in stage IV. The pelvic failure alone were 32 patients and 11 patients were as a components of other failure, and remaining 11 patients had distant metastasis only. Among the 43 patients of locoregional failure, 28 patients were not controlled initially and in other words nearly half of total failures were due to residual tumor. The mean medial paracervical(point A) doses were 6700 cGy in stage IIB, 7200 cGy in stage IIA, 7450 cGy in stage IIB, 7600 cGy in stage III and 8100 cGy in stage IV. The medial paracevical doses showed some correlation with tumor control rate in early stage of disease (stage Ib, IIA), but there were higher central failure rate in advanced stage in spite of higher paracervical doses. In advanced stage, failure were not reduced by simple Increment of paracervical doses. To improve a locoregional control rate in advanced stages, it is necessary to give additional treatment such as concomitant chemoradiation.