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Objective To evaluate prospectively the side effects and tolerance of docetaxel with concurrent late-course hyperfractionated radiotherapy after breast-conserving surgery for stage T1-T2 breast cancer, and to assess the value of this treatment in shortening the treatment time and reducing the economic burden among patients. Methods A total of 20 patients with T1-T2 breast cancer were recruited after they underwent breast-conserving surgery. The acute radiation response classification, treatment completion rate, disease-free survival, hospital stays, and treatment costs were observed. Radiotherapy for all patients was started before the last single-agent docetaxel chemotherapy. Results The completion rate of treatment and the good rate of cosmetic effect reached 100%. The main adverse reactions were hematological toxicity (leukopenia) and skin reactions, which were tolerated. The median follow-up time was 30.1 months, and the follow-up rate was 100%. The average total treatment time of this hyperfractionated radiotherapy with concurrent docetaxel was four weeks, and the total hospitalization cost savings was approximately 10, 000 yuan. The 21-month disease-free survival rate was 100%. Conclusion Stage T1-T2 breast cancer can tolerate hyperfractionated radiotherapy with concurrent chemotherapy after a breast-conserving operation. The procedure results in good local control and satisfactory cosmetic effects, with high health and economic value.
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OBJECTIVE: To explore the effect of perioperative and postoperative chemotherapy on the prognosis of patients with advanced gastric cancer after resection. METHODS: From January 2004 to December 2016, a retrospective cohort of 277 stage IV gastric cancer patients after surgical treatment of gastric resection was enrolled in Department of General Surgery,Nanfang Hospital, Southern Medical University. Among them, 228 underwent surgical resection combined with postoperative adjuvant chemotherapy(postoperative chemotherapy group, group A), and preoperative chemotherapy plus surgery resection and postoperative chemotherapy in 49 cases(perioperative chemotherapy group, group B). After generating propensity scores with eight covariates, including gender, age, biological classifications, completion of chemotherapy, depth of tumor infiltration, lymph nodemetastasis, the extent of lymph nodes dissection and type of gastrectomy, 49 patients in group A were one-to-one matched with 49 patients in group B. Kaplan-merier method was used for survival analysis, and Cox proportional risk regression model was used to analyze independent survival risk factors of patients with advanced gastric cancer undergoing surgical resection. RESULTS: Before propensity scores matching(PSM), biological classifications(P<0.001),the completion of chemotherapy(P<0.001), depth of tumor infiltration(P<0.001), lymph node metastasis(P=0.049), the extent of lymphnode dissection(P=0.001) and the type of gastrectomy(P=0.001) significantly differed between two groups. While after PSM, only the completion of chemotherapy were vital different between two groups. After PSM,median survival time of group A and B were 16(95% CI 10.36-21.64) vs 29(95% CI 17.24-40.76) months, which showed not significant difference(P=0.191). The univariate analysis showed that biological classifications, the completion of chemotherapy, lymph node metastasis and the extent of lymphnode dissection were survival prognosis factors. And the multivariate analysis showed that the chemotherapy cycles≤ 2 cycles, lymph node metastasis and the extent of lymphadenectomyless than D2 were independent poor prognostic factors for advanced gastric cancer patients performed with gastrectomy. Notably, the order of chemotherapy and surgery was not independent variate of prognosis(perioperative chemotherapy vs. postoperative chemotherapy: HR 0.986,95%CI 0.539-1.806,P=0.964). CONCLUSION: Perioperative chemotherapy is not the independent variable to improve prognosis of resected advanced gastric cancer patients.Nonetheless, perioperative chemotherapy could benefit patient's chemotherapy tolerance and compliance, which could be attributed to the superiority in survival compared to postoperative chemotherapy. The finding could offer reference and guidance for further design of perspective studies for advanced gastric cancer patients.
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Objective To determine the prognostic factors in patients with stage pT3N0M0 thoracic esophageal squamous cell carcinoma (TSCC) after esophagectomy, and to compare the effects of different treatment modalities on the prognosis of patients.Methods A retrospective analysis was conducted on 480 patients with stage pT3N0M0 TSCC from 2007 to 2010 to determine the prognostic factors in the patients, and to compare the effects of different treatment modalities on their prognosis.Survival rate was calculated using the Kaplan-Meier estimator, and multivariate analysis of prognostic factors was performed using the Cox model.Results Of the 439, 333, and 278 patients who completed the 1-, 3-, and 5-year follow-up, respectively, the 1-, 3-, and 5-year overall survival (OS) rates were 90.0%, 68.7%, and 57.9%(median 87 months, 95% confidence interval (CI=74.7-99.4), respectively, and the 1-, 3-, and 5-year disease-free survival (DFS) rates were 82.3%, 60.4%, and 52.3%(median 71.3 months, 95%CI=55.1-87.5), respectively.In order to account for the different constituent ratios of some clinical and pathological data between the three groups of patients, 55 patients in each group were matched using propensity score matching (PSM)(all P>0.05).It was found that the post-PSM 1-,3-, and 5-year OS and DFS were significantly different between patients who received surgery only, postoperative chemotherapy (POCT), and postoperative chemoradiotherapy/radiotherapy (POCRT/RT)(P=0.000 and 0.006,respectively).Multivariate Cox analysis showed that age, lesion location, and treatment modality were independent prognostic factors for OS and DFS (P=0.029,0.004,0.000 and P=0.009,0.003,0.002), and the length of lesion was also an independent prognostic factor for DFS (P=0.003).Conclusions Although the rate of post-operative treatment failure is still high among patients with stage pT3N0M0 TSCC, POCRT/PORT can improve the prognosis and the 5-year OS and DFS of these patients.However, further large-sample prospective studies will be required to confirm these findings.
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Objective:To investigate the efficacy of postoperative chemotherapy in patients with early-stage pulmonary large cell neu-roendocrine carcinoma (LCNEC) after resection. Methods:A cohort of 50 patients who underwent resection and systematic nodal dissection for LCNEC between January 2008 and December 2014 in our institution was retrospectively reviewed. The patients were divided into adjuvant chemotherapy group (32 cases) and non-chemotherapy group (18 cases). Follow-up information was investigated. Results:The median survival and the 5-year survival rate were 48 months and 72.5%for the adjuvant chemotherapy group whereas 29 months and 35.6%for the non-adjuvant chemotherapy group, respectively. Univariate and multivariate analyses using Cox's proportional hazard models showed that postoperative chemotherapy was a signifi cant prognostic factor for OS (P=0.005;hazard ratio=0.281, P=0.008, respectively). Conclusion:Postoperative chemotherapy is beneficial to patients with early-stage pulmonary LCNEC after complete resection.
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Objective To compare the efficacy and safety between postoperative chemoradiotherapy and postoperative chemotherapy alone in patients with gastric cancer by a meta-analysis of randomized controlled trials (RCTs).Methods Chinese Scientific Journal Full-Text Database (January 1979-June 2013),VIP (January 1989-June 2013),Chinese Biomedical Literature Database (January 1978-June 2013),Cochrane Library (Issue 6,2013),PubMed (January 1966-June 2013),and EMBASE (January 1974-June 2013) were searched to identify RCTs of postoperative chemoradiotherapy versus chemotherapy alone in patients with gastric cancer.The obtained data were analyzed using RevMan 5.2 and Stata 12.The difference between two groups was estimated by calculating the risk ratio (RR) with 95％ confidence interval (CI).Results A total of 1 143 patients from 11 RCTs were included in the meta-analysis according to the inclusion and exclusion criteria.Our results showed that postoperative chemoradiotherapy significantly increased 1-,2-,and 3-year overall survival rates (RR =1.20,95％ CI=1.10-1.30,P=0.00; RR =1.34,95％ CI=1.16-1.56,P=0.00; RR =2.62,95％ CI=1.72-3.97,P=0.00) and 3-and 5-year disease-free survival rates (RR =1.10,95 ％ CI =1.00-1.21,P =0.04; RR =1.27,95％ CI =1.02-1.60,P =0.04).The incidence of grade 3 or 4 gastrointestinal tract reactions,liver function impairment,bone marrow suppression,and hand-foot syndrome was low and showed little difference between two groups (P =0.03-0.78).Conclusions Postoperative chemoradiotherapy can prolong the survival of patients with gastric cancer,and the patients have good tolerance to chemotherapy drugs.
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Objective To analyze and evaluate neoadjuvant chemotherapy's value and significance in combining with surgical treatment for limited small cell lung cancer(LD-SCLC).Methods A total of 94 LD-SCLC patients underwent complete resections combined with chemotherapy between January 2000 and January 2011 in Shanghai Pulmonary Hospital.Among these cases,initial two cycles of neoadjuvant chemotherapies were performed for all pathologically confirmed patients (Group A),and initial operations followed by adjuvant chemotherapy were administered to patients without pathology (Group B).The survival rate was analyzed by log-rank test and Kaplan-Meier method.Multivariate analysis of the prognostic factors was performed using Cox's regression model.Results Group A included 43 cases and Group B included 51 cases.The mean age was (56.37 ± 10.18) years.According to the 6th edition of Tumor,Node,Metastasis(TNM) classification of lung cancer,54 cases were at stage Ⅰ or Ⅱ,40 cases were at stage Ⅲ.Overall 5-year survival(5-YS) was 27％.The 5-YS for patients with stage Ⅰ-Ⅱ was notably better than that of stage Ⅲ (34％ vs 20％,P =0.033).For patients with stage Ⅲ,the 5-YS of Group A was significantly better than that of Group B(34％ vs 12％,P =0.020),besides median overall survival for Group A and Group B were 46 and 15 months(P =0.009).Furthermore,the results of multivariate analysis showed that neoadjuvant chemotherapy,surgery and histopathology of SCLC were independent factors that strongly affected survival and prognosis.Conclusion In combined surgical treatment for LD-SCLC,neoadjuvant chemotherapy obviously improved the prognosis of patients with stage Ⅲ.Therefore,it was very important and necessary that pre-surgical neoadjuvant chemotherapy was administered to resectable stage Ⅲ LD-SCLC patients.
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Objective:To explore the drug application in the postoperative chemotherapy for the patients with non-small cell lung cancer. Methods:The chemotherapy regimens, drug utilization and adverse drug reactions in the non-small cell lung cancer patients received postoperative chemotherapy in 2012 were statistically analyzed in a retrospective study. Results:Totally 8 kinds of chemother-apy regimens were used in 156 cases. The NC( vinorelbine + carboplatin) regimen was used most frequently and the PC( pemetrexed+ carboplatin) regimen was with the highest expense. Proton pump inhibitors, recombinant human erythropoietin and lentinan were the top three in the adjuvant drugs used in the treatment. Conclusion:It is necessary to further standardize the postoperative chemo-therapy for non-small cell lung cancer patients. Thoracic surgeons along with pharmacists should strengthen the drug use monitoring during the whole treatment process to promote the rational drug use.
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Objective To compare postoperative adjuvant chemoradiotherapy with adjuvant chemotherapy in patients with gastric cancer by a meta-analysis.Methods PubMed,EMbase,Cochrane Library,Wanfang,CNKI,VIP,and CBM databases were searched to identify the controlled clinical trials of postoperative adjuvant chemoradiotherapy versus adjuvant chemotherapy for gastric cancer.The obtained data were analyzed using RevMan 5.2.5 and Stata 12.0.The difference between two groups was estimated by calculating the odds ratio (OR) with 95％ confidence interval (CI).Results A total of 12 controlled clinical trials involving 1674 gastric cancer patients,which were selected according to inclusion and exclusion criteria,were included in this meta-analysis.The meta-analysis showed that the 3-and 5-year survival rates were significantly higher in the adjuvant chemoradiotherapy group than in the adjuvant chemotherapy group (OR=2.96,95％ CI=1.75-5.03,P=0.000; OR=1.45,95％ CI=1.06-1.99,P =0.020);the local recurrence rate was significantly lower in the adjuvant chemoradiotherapy group than in the adjuvant chemotherapy group (OR =0.50,95％ CI =0.34-0.72,P =0.000) ; there was no significant difference in distant metastasis rate between the two groups (OR =0.79,95％ CI =0.58 -1.07,P =0.130).Conclusions The meta-analysis of existing study results shows that compared with adjuvant chemotherapy alone,adjuvant chemoradiotherapy is a relatively safe and effective postoperative treatment for gastric cancer.
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Objective To investigate the impact of enteral nutrition (EN) through jejunal feeding tube on the nutritional status and immunologic function of patients during chemotherapy after total gastrectomy.Methods Totally 86 patients with gastric cancer who had undergone total gastrectomy with radical resection and jejunostomy received adjuvant venous chemotherapy in our department from January 2009 to June 2010.They were divided into EN group ( n =43 ) and control group ( n =43 ) according to the hospitalization number.The EN group maintained the jejunostomy tube until the end of 6 courses of chemotherapy,and was given EN support for 7 days through jejunal tube during each course of chemotherapy; the control group removed the tube before chemotherapy without further dietary restriction or nutrition support.The nutritional and immunologic indicators on the 1 st day before chemotherapy and the 1st day after 6 chemotherapy courses were measured.ResultsThree patients in the EN group withdrew from the study because of catheter blockage or catheter loss and 2 patients in the control group failed to complete the trial because of chemotherapy side effects or economic reasons; 81 patients entered the final analysis.After 6 courses of chemotherapy,both groups experienced body weight loss,but the percentage is significantly lower in EN group than in control group (6.9％ ± 0.95％ vs.11.2％ ± 1.32％,P =0.0000).Compared with the nutritional status before the first chemotherapy,the prognosis nutritional index (PNI) in both groups declined after the 6th chemotherapy.Such decline was not statistically significant in EN group ( P =0.1534) but was significant in control group (P =0.0000).The PNI in EN group after chemotherapy was significantly higher than that in control group (P =0.0040).The levels of IgG,NK,CD4 +,and CD4 +/CD8 + were significantly higher in EN group than in control group ( P =0.0083,0.0143,0.0000,and 0.0000,respectively) after chemotherapy.ConclusionEN during postoperative chemotherapy may improve the nutritional status and immunologic function in gastric cancer patients after total gastrectomy.
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OBJECTIVE:To explore the clinical significance of water-soluble vitamins for injection in supportive care of postoperative tumor patients undergoing chemotherapy.METHODS:Water-soluble vitamins for injection was given to64post operative patients with gastrointestinal malignancy in treatment group for3days before chemotherapy and for7days after chemotherapy;adenosine triphosphate,coenzyme a and kalium chloratum were given to60patients in control group for the same period.Nutritional and oral mucosa condition,hemoglobin and hepatic function were observed before and after chemotherapy.RESULTS:Appetite increased in71.8%patients in treatment group,none was observed in control group(P
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OBJECTIVES: The poor survival rates among patients receiving surgery alone for stages II and III non-small cell lung cancer prompted several trials of adjuvant therapy after resection. We performed a prospective phase II study in patients with stage II-IIIA non-small cell lung cancer after resection to evaluate the feasibility, activity and toxicity of the postoperative sequential MVP chemotherapy and radiotherapy. METHODS: Between February 1991 and May 1995, 60 patients with resected stage II, IIIA non-small cell lung cancer received 2 cycles of MVP combination chemotherapy (Mitomycin-C 6 mg/m2, Vinblastine 6 mg/m2, Cisplatin 60 mg/m2) within 3 weeks after surgery, followed by thoracic irradiation (5,040 cGy after complete resection and 900 cGy booster to microscopically positive resection margin at 1.8 Gy per fraction) within 3-4 weeks after chemotherapy. RESULTS: Forty nine men and 11 women with a median age of 60.5 years (range 33-81 years) were included. During the median follow-up period of 828 days (61-2,015 days), 25 patients had developed recurrence. Among the 25 failures, 3 were local relapse only and 20 were distant metastasis only and 2 had both local and distant sites of recurrence. Three-year overall survival and event-free survival were 43% and 37%, respectively. Neutropenia of grade I-II was observed only in 13 patients. Eleven patient showed grade I-II radiation pneumonitis and 32 had grade I-II radiation esophagitis. CONCLUSION: Postoperative sequential MVP chemotherapy and radiotherapy in resected stage II-IIIA non-small cell lung cancer is well-tolerated and shows interesting activity.
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Female , Humans , Male , Carcinoma, Non-Small-Cell Lung , Cisplatin , Disease-Free Survival , Drug Therapy , Drug Therapy, Combination , Esophagitis , Follow-Up Studies , Mitomycin , Neoplasm Metastasis , Neutropenia , Prospective Studies , Radiation Pneumonitis , Radiotherapy , Recurrence , Survival Rate , VinblastineABSTRACT
PURPOSE: Since February 1991, a prospective study for non-small cell lung cancer patients who underwent radical resection and had a risk factor of positive resection margin or regional lymph node metastasis has been conducted to evaluated the effect of MVP chemotherapy and radiotherapy on the pattern of failure, disease free and oerall survival, and tolerance of combined treatment. MATERIALS AND METHODS: Twenty nine patients were registered to this study until Sep. 1993 ; of these 26 received planned therapy. Within 3 weeks after radical resection, two cycles of MVP(Motomycin C 6 mg/m2 , Vinblastin 6 mg/m2 , Cisplatin 6 mg/m2 ) chemotherapy was given with 4 weeks intervals. Radiotherapy (5040 cGy tumor bed dose and 900 cGy boost to high risk area) was started 3 to 4 weeks after chemotherapy. RESULTS: One and two year overall survival rates were 76.5% and 8.6% respectively. Locoregional failure developed in 6 patients (23.1%) and distant failure in 9 patients(34.6%). Number of involved lymph nodes, resection margin positivity showed some correlation with failure pattern but T-stage and N-stage showed no statistical significance. The group of paients who received chemotherapy within 2 weeks postoperatively and radiotherapy within 70 days showed lower incidence of distant metastasis. Postoperative combined therapy were well tolerated without definite increase of complication rate, and compliance rate in this study was 90%. CONCLUSION: 1) MVP chemotherapy showed no effect on locoregional recurrence, ut appeared to decrease the distant metastasis rate and 2) combined treatments were well tolerated in all patients. 3) he group of patients who received chemotherapy within 2wweks postoperatively and radiotherapy within 70 days showed lower incidence of distant metastasis. 4)Addition of chemotherapy to radiotherapy failed to increase the overall or disease free survival.