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Objective:To compare the efficacy of concurrent and asynchronous radiochemotheray for early extranodal nasal natural killer/T-cell lymphoma (NKTCL).Methods:From 2007 to 2020, 278 patients with early NKTCL treated with comprehensive treatment in the Affiliated Tumor Hospital of Guizhou Medical University were recruited. According to the adjusted Nomogram-revised risk index (NRI) prognostic model, there were 49 cases in the good prognostic group without adverse prognostic factors (age>60 years old, increased serum lactate dehydrogenase (LDH), ECOG score ≥2, primary tumor invasion (PTI), Ann Arbor stage Ⅱ, and 229 cases in the poor prognostic group with any adverse prognostic factors. 145 of these cases were treated with concurrent radiochemotherapy, and 133 of them were treated with asynchronous radiochemotherapy.Results:The 5-year overall survival (OS) rate of the whole group was 71.0%, and the progression-free survival (PFS) rate was 67.6%. The 5-year OS rate in the good prognostic group was 95.6%, and 65.4% in the poor prognostic group ( P<0.001). In the poor prognostic group, the 5-year OS rates of patients with NRI=1(low-and moderate-risk group), NRI=2(moderate-and high-risk group), NRI≥3(high-risk group) were 72.1%, 61.1% and 47.7%, respectively ( P=0.007). There was no significant difference in curative effect between the concurrent and asynchronous radiochemotherapy groups. The 5-year OS rates were 70.6% and 69.8%( P=0.783), and the 5-year PFS rates were 67.6% and 65.2%( P=0.631). Further stratified analysis showed that the 5-year OS rates of patients with NRI=1 receiving concurrent and asynchronous radiochemotherapy were 73.1% and 76.5%( P=0.576), 62.6% and 69.3%( P=0.427) for those with NRI=2, and 58.1% and 42.3% for those with NRI≥3( P=0.954). Conclusions:Comprehensive treatment can significantly improve the prognosis of early NKTCL in the poor prognostic group. In the sequence of radiotherapy and chemotherapy, there is no significant difference in 5-year OS and PFS rates between concurrent and asynchronous radiochemotherapy. Sequential treatment with better tolerance can be adopted for early NKTCL with poor prognosis.
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Objective To investigate the value of induction chemotherapy in the treatment of stage N2.3M0 nasopharyngeal carcinoma with plasma Epstein-Barr virus (EBV) DNA＞4000 copies/ml.Methods A retrospective study was performed on clinical data from 210 patients with stage N2-3M0 nasopharyngeal carcinoma and plasma EBV DNA＞4000 copies/ml who were admitted to our hospital from 2009 to 2013.In the 210 patients,101 received induction chemotherapy plus concurrent chemoradiotherapy (NCRT) and 109 concurrent chemoradiotherapy alone (CCRT).The survival rates were calculated by the Kaplan-Meier method.The log-rank test was used for the analysis of survival rates and univariate analysis of the impacts of the changes in the plasma EBV DNA level after induction chemotherapy on the prognosis.Results The 3-year sample size was 154.The NCRT group had significantly higher 3-year disease-free survival (DFS) and distant metastasis-free survival (DMFS) rates than the CCRT group (80.1％ vs.70.6％,P =0.029;87.1％ vs.76.0％,P=O.036),while there was no significant difference in 3-year overall survival (OS) rate between the two groups (88.0％ vs.80.4％,P =0.210).Patients with stage N2 disease in the NCRT group had significantly higher 3-year DFS and DMFS rates than those in the CCRT group (P=O.031,O.014).Patients with stage N3 disease in the NCRT group had significantly higher 3-year OS,DFS,and DMFS rates than those in the CCRT group (P=0.029,0.012,0.019).In all the patients,the 3-year OS and DMFS rates were improved with the increase in the cycle number of induction chemotherapy (P =0.020,0.021).In the NCRT group,patients treated with 2,3,and 4 cycles of induction chemotherapy before radiotherapy had plasma EBV-DNA clearance rates of 51.85％,76.92％,and 88.57％,respectively (P=0.004).Using the complete clearance of plasma EBV-DNA as a predictor of progression,the sensitivity for the above three groups was 62.50％,66.67％ and 75.00 (P=0.910),respectively,and the specificity was 57.89％,90.00％ and 96.77％ (P=0.000),respectively.Conclusions In the treatment of nasopharyngealcarcinoma with plasma EBV DNA ＞ 4 000 copies/m1,induction chemotherapy improves DFS and DMFS inpatients with stage N2-3 M0 disease and OS in patients with stage N3 disease;induction chemotherapy dose not improve recurrence-free survival rate.The prognosis and plasma EBV DNA clearance rate are improved with the increase in the cycle number of induction chemotherapy.Using the complete clearance of plasma EBV DNA as a predictor of progression,the sensitivity and specificity in patients treated with 4 cycles of chemotherapy are superior over those in patients treated with 2 or 3 cycles of chemotherapy.
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Background and purpose:The effect of TPF (docetaxel, cisplatin and 5-lfuorouracil) induction chemotherapy plus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma is unclear. This study aimed to compare the outcomes and tolerance of neoadjuvant chemotherapy with TPF versus cisplatin and 5-lfuorouracil (PF) followed by concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma patients.Methods:Patients with locoregionally advanced nasopharyngeal carcinoma were randomly divided into 2 groups: Group TPF and Group PF. Group TPF: One hundred and sixteen nasopharyngeal carcinoma patients received TPF consisting of docetaxel at 60 mg/m2 on day 1, cisplatin at 60 mg/m2 on day 1, and 5-lfuorouracil at a dose of 750 mg/m2by 24 h continuous infusion for 5 days for 3 cycles with a 21 day interval; Group PF: One hundred and sixteen nasopharyngeal carcinoma patients received PF consisting of cisplatin at 80 mg/m2 on day 1, and 5-lfuorouracil at a dose of 750 mg/m2by 24 h continuous infusion for 5 days for 3 cycles with a 21 day interval. After the completion of neoadjuvant chemotherapy, all the patients received intensity modulated radiation therapy (IMRT) with concomitant chemotherapy consisting of 2 cycles of cisplatin at 80 mg/m2 on day 1 and day 22. The prescribed doses were 6 810 cGy at 2.27 Gy/fraction to the gross tumor volume (GTV) with 5 daily fractions per week for 6 weeks. The acute toxicity and tumor response rate (RR), including complete response (CR) and partial response (PR), were evaluated. Addition-ally, the 5-year progress-free survival (PFS) rates and overall survival (OS) rates were further evaluated.Results:RR of Group TPF was higher than that of group PF at the end of neoadjuvant chemotherapy and within 13 weeks of the completion of concurrent chemoradiotherapy. The median recurrence time of TPF group was 2.98 years, and the 5-year PFS was 84.48%. The median recurrence time of PF group was 2.32 years, and the 5-year PFS was 82.75%. There was no statistically signiifcant difference between the 2 groups (P=0.458). The 5-year OS of TPF group was 87.06%, and for the PF group was 85.34%. There was no statistically signiifcant difference between the 2 groups (P=0.274). The incidence of leukopenia, thrombocyte penia, liver and kidney damage, diarrhea and mucosa necrosis in TPF group were signiifcantly higher than those in PF group (P<0.001). TheⅢ andⅣ degrees adverse reactions in TPF group were sig-niifcantly higher than those in PF group (P<0.001).Conclusion:TPF induction chemotherapy was not superior to the PF regimen for locoregionally advanced nasopharyngeal carcinoma patients. It should not be recommended in terms of more acute toxicity.
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Background: Advanced (Stage III and IV) Squamous Cell Carcinomas of the head and neck (SCCHN) produce severe functional impairment, considerable morbidity, and significant mortality. Over the past 2 decades, organ-sparing efforts using either induction chemotherapy or concurrent chemotherapy and radiotherapy (RT) have become popular and have demonstrated equivalent or superior survival rates compared with surgery and/or RT alone, with a survival rate of approximately 40% at 5 years. Although the addition of chemotherapy to RT enhances toxicity, randomized trials and meta analyses have documented improved survival clearly compared with the results from RT alone. Initially, most combinations included once-daily RT combined with cisplatin either alone or with 5-fluorouracil (5-FU). There was number of toxicities of high grades associated with these drugs, and also difficulty in their administration. We have retrospectively studied nanoparticle paclitaxel with RT on concurrent setting as an alternative. Methods: We have retrospectively studied data of patients of advanced SCCHN treated with nanoparticle paclitaxel along with RT. Nanoparticle paclitaxel was administered at a dose of 80 mg/m2 over one hour infusion once weekly along with RT, 60 Gray (Gy) in 30 fractions, five days per week, over 6 weeks. Results: Total numbers of patient in this study were 28 with median age of 49 years. 78.57% of patient had stage IV disease and 21.43% stage III. Overall response rate was 68% with complete response (CR) in 29% and partial response (PR) in 39%. Conclusions: The use of nanoparticle paclitaxel along with RT is safe, feasible, efficacious and cost effective. Intensive randomized studies with large sample size are required in this direction.
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Objective:To evaluate therapeutic efficacy and adverse reactions of synchronous chemoradiotherapy combined with gamma knife therapy for pelvic lymph node metastasis of cervical cancers. Methods:Data of 42 cervical cancer patients who suffered from residual pelvic lymph node metastasis and received concurrent chemoradiotherapy were retrospectively analyzed. Intensity-modu-lated radiotherapy was used in the treatment. The prescribed doses of planning target volume and pelvic metastasized lymph node of the planned gross tumor volume were 50.4 Gy/28 F and 59.92 Gy/28 F, respectively. The combined internal irradiation dose was 6 Gy/6 F. Concurrent chemotherapy was administered with 40 mg/m2·w cisplatin. Three months after chemoradiotherapy was completed, the pa-tients with residual pelvic positive lymph node received additional dose ranging from 10 Gy to 15 Gy at three or four fractions by using a gamma knife. Results:Near-term efficacy was 83.3%(35/42) in three months. Local control rates were 88.1%(37/42), 83.3%(35/42), and 76.2%(32/42) in 6, 9, and 12 months, respectively. The 1-and 2-year survival rates were 77.5%(31/40) and 70.0%(28/40), re-spectively. The incidence rates of radiation enteritis, proctitis, cystitis, gut toxicity, and neutrocytopenia were 11.9%(5/42), 38.1%(16/42), 7.1%(3/42), 90.5%(38/42), and 85.7%(36/42), respectively, and the majority of these conditions were classified as grades I and II. Conclusion:Synchronous chemoradiotherapy combined with gamma knife therapy is an effective and feasible treatment method for pelvic lymph node metastasis of cervical cancer;this method exhibits a minimal adverse reaction.
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Objective To investigate the efficacy and safety of induction chemotherapy(DDP + 5-FU)followed by concurrent chemo-radiotherapy(CCRT)in patients with locoregional advanced nasopharyngeal carcinoma (NPC).Methods 42 patients with locoregional NPC were enrolled in the study.Before CCRT,patients were assigned to receive two cycles of chemotherapy(DDP 20mg/m2 d1～5 ;5-FU 750mg/m2 d1～5)every three weeks.Then the same chemotherapy was given from the first day of standard radiotherapy.Results All patients completed planned treatment and were eligible for toxicity and response analysis.After induction chemotherapy,9 patients achieved complete response in nasopharynx and 12 patients achieved CR in regional nodes;Three months after radiotherapy,41 patients achieved CR in nasopharynx and 34 patients achieved CR in regional nodes.Induction PF was well tolerated and the most common acute high-graded toxicity of CCRT was grade Ⅲ mucositis(35.7％)and grade Ⅲ vomiting (16.7％).At median follow-up of 15 months,the overall survival rate was 100％,two-year cumulative local recurrence rate was 4.8％ and distant metastasis rate was 2.4％.Conclusion Induction PF chemotherapy plus concurrent chemo-radiotherapy was tolerable and satisfactory for patients with locoregional NPC.
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Objective To evaluate the recent effects of concurrent versus sequential chemo-radio-therapy in treatment for locally advanced non-small-cell lung cancer (NSCLC). Methods The clinical data of 39 patients with locally advanced NSCLC were analyzed retrospectively. The sequential therapy was 23 (sequential group) ,and the concurrent therapy (concurrent group)was 16. The total radiation dose was 60 ～ 65 Gy by conventional fractionation radiotherapy. In sequential group,the patients received induction chemotherapy for two cycles followed by conventional radiation therapy. In concurrent group,the patients re-ceived radiation therapy,at the same time the docetaxe was given every week. Results The recent efficien-cy(62.5%) of concurrent therapy was higher than that(43.5% )of sequential therapy. The clinical remission rate of the two groups was similar. Conclusion Concurrent chemo-radiotherapy in locally advanced NSCLC can increase the recent effect. The concurrent treatment method of docetaxel + three-dimensional conformal radiotherapy is advocated.
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Background and purpose:Concurrent chemo-radiotherapy(CCRT) was considered the best treatment plan for advanced nasopharyngeal carcinoma(NPC),but there was no uniform conclusion as to which category of patients and which chemotherapy associated radiotherapy would have the best therapeutic effect. As the standard treatment plan for advanced NPC, DDP concurrent chemo-radiotherapy was recommended by some scholars. DDP can raise the expression of inducible nitric oxide synthase(iNOS) protein and synthesize nitric oxide (NO) with anti-tumor effects, so we considered whether the therapeutic effect could be predicted and the corresponding treatment plan could be selectived to detect the iNOS expression in the pretherapy NPC tissues.The purpose of this study was to investigate the relation between the expression of iNOS protein and the nasopharyngeal tumor with complete response or with residue after DDP concurrent chemo-radiotherapy, so that the most appropriate plan of treatment can be adopted and the complete response rate of nasopharyngeal tumor can be raised. Methods:All patients were poorly differentiated NPC.The expression of iNOS protein was examined in 30 patients of nasopharyngeal tumor with complete response and 30 patients with residual tumor after DDP concurrent chemo-radiotherapy by immunohistochemical staining (SP method).None of the patients had received radiotherapy and chemotherapy.Results:Immunohistochemical examination revealed that iNOS expression in the NPC tissues was located in both the nucleus and cytoplasm of the tumorous tissues. The intensity of iNOS expression was stronger in the nucleus than in the cytoplasm of the tumorous tissues.The positive rates of iNOS protein expressions were 71.67%(43/60) in NPC tissues. It was 86.67% and 53.33% in 30 tumors with complete response and with residual tumor, respectively. The difference was statistically significant.The rate of iNOS strong postive expressions in the group of residual tumors was higher than that of the group with complete response. It was statistically different,but weak and moderate postive expressions did not have statistical difference.Conclusions:According to the difference of iNOS expression, it is a valuable method to select the most appropriate plan of treatment and the complete response rate of nasopharyngeal tumor can be raised.
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Objective Prospective comparison was done on concurrent chemo-radiotherapy and se- quential chemo-radiotherapy for unresectable stageⅢnon-small cell lung cancer(NSCLC) and to evaluate three different regimens of concurrent chemo-radiotherapy.Methods Ninety-six such patients were ran- domized into four groups:1.sequential chemo-radiotherapy group received two cycles of induction chemother- apy with 40 mg/m~2 of cisplatin on D 1-3,29-31 and 100 mg/m~2 of etoposide on D 1-3,29-31 before conven- tional radiotherapy,2.concurrent chemo-radiotherapy group 1 received 100 mg/m~2 etoposide on D 1-3 and DDP 40 mg/m~2 on D 1-3,D 29-31,iv.drip,3.concurrent chemo-radiotherapy group 2 received concurrent chemotherapy with 40 mg/m~2 of paclitaxel every Monday during conventional radiotherapy,4.concurrent chemo-radiotherapy group 3 received concurrent chemotherapy with 40 mg/m~2 of paclitaxel every Monday during three-dimensional conformal radiotherapy.All patients were irradiated with 2.0 Gy/fraction,5 frac- tions/week,to a total dose of 60-64 Gy.They all received two cycles of consolidation themotherapy with 40 mg/m~2 of cisplatin on D 1-3 and 100 mg/m~2 of etoposide on D 1-3.Results The overa/1 response rate was 67%,71%,71% and 79% for sequential ehemo-radiotherapy group,concurrent chemo-radiotherapy group 1,2 and 3,respectively.There was a significant difference between the concurrent chemo-radiotherapy and sequential chemo-radiotherapy(P＜0.05).The 1-,3-and 5-year overall survival rate(OS) was 54%,8% and 4%;71%,17% and 8%;79%,17% and 8%;83%,46% and 13%,respectively for the four groups. The difference among all these groups(P=0.017) was significant.It was also significant between the con- current chemo-radiotherapy group 1 and 3 (P=0.046).The difference of distant metastasis rate among all the groups was statistically insignificant (P＞0.05) also was the difference of toxicity (P＞0.05),but the severe toxicity of concurrent chemo-radiotherapy groups 1 and 2 were higher than the sequential chemo-radio- therapy group and concurrent chemo-radiotherapy group 3.Conclusions Better locoregional progression- free survival and overall survival of unresectable stageⅢnon-small cell lung cancer could be achieved by concurrent chemo-radiotherapy as compared with sequential chemo-radiotherapy though at the expense of in- crease in toxicity.With the combination of concurrent chemo-radiotherapy and conforrnal radiotherapy,the o- verall survival rate could be much improved with miider toxicity.
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PURPOSE : We conducted a phase II trial of the addition of a paclitaxel and cisplatin regimen as induction chemotherapy to concurrent thoracic radiation therapy and weekly paclitaxel and cisplatin in locally advanced unresectable stage III non-small cell lung cancer. The endpoints were to determine the applicability, safety, response rate and survival statistics. MATERIALS AND METHODS : The induction chemotherapy consisted of paclitaxel 175 mg/m2 given 3 hours on day 1 and cisplatin 75 mg/m2 given over 1 hour on day 2 repeated 3 weeks for two cycles. Thoracic radiation therapy 63 Gy/35 fractions in daily 1.8 Gy fractions along with paclitaxel 45 mg/m2/1 hr and cisplatin 20 mg/m2/1 hr given 2~4 hours before irradiation repeated every week for 6 cycles. To minimize the toxicities of a concurrent portion of treatment, the treatment planning for thoracic radiation therapy was done throughly with the assistance of a planning CT scans and computerized radiation treatment planning system. RESULTS : Twenty-nine patients were enrolled between Sep 1999 to Sep 2002. The overall response rate after the induction chemotherapy was 79.3%. Due to the refusal of further treatment, 1 patient left the trial. Twenty-three (79.3%) of the 29 patients received the concurrent portion of treatment. Five (17.2%) patients received the radiation therapy alone, two due to refusal, two for decreased performance stati, one due to pulmonary abscess. After completion of the entire course of treatment, 5 (17.2%) patients gained the complete remission and the overall response rate of 79.3%. With a median follow-up of 22 months, the 1-, 2- and 3-year overall survival rates were 75.7, 53.4 and 41.6%. The progression free survival rates were 52.5 and 20.5% at 1- and 2-year, respectively. Induction chemotherapy was well tolerated. Among 23 patients who completed the entire course of treatment including the concurrent portion, 6 (34.8%) suffered hematologic toxicities more than grade 3, 2 (8.7%) had esophagitis greater than grade 3 and 3 (13.3%) had radiation pneumonitis greater than grade 3. CONCLUSION : We concluded that weekly Paclitaxel+ Cisplatin with concurrent radiotherapy following 2 cycles of induction chemotherapy with Paclitaxel+Cisplatin repeated 3 weeks is effective and welltolerated, should be further evaluated in a randomized phase III trial
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung , Chemoradiotherapy , Cisplatin , Disease-Free Survival , Disulfiram , Esophagitis , Follow-Up Studies , Induction Chemotherapy , Lung Abscess , Paclitaxel , Radiation Pneumonitis , Radiotherapy , Survival Rate , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: This retrospective study was conducted to analyze the hypothesis that with neoadjuvant chemotherapy of vinblastine, bleomycin, and cisplatin followed by radical hysterectomy or radiation therapy and concurrent chemoradiation with cisplatin based regimen would improve survival in patients with barrel-shaped or bulky-endophytic (Diameter > 4cm) cervical carcinomas than those of radiation alone or combined radiation and surgery. STUDY DESIGN: Eighty-eight patients with barrel-shaped or bulky-endophytic cervical carcinomas, treated at the Hanyang University Hospital from 1983 to 1997, were the subjects of this investigation. Fifty-six of these patients were treated by neoadjuvant chemotherapy followed by radical hysterectomy with bilateral pelvic lymphadenectomy ( Stage I b2, 8; IIa, 15; IIb, 20; III- IV, 13), twelve patients were treated by neoadjuvant chemotherapy followed by radiation therapy ( Stage Ilb, 4; IIJ-IV, 8), and twenty patients were treated by concurrent chemo-radiotherapy ( Stage IIb, 2; III-IV, 18). RESULTS: The incidence of parametrial extension and pelvic lymphnode metastases was higher in patients with barrel-shaped or bulky-endophytic cervical carcinomas than non-barrel-shaped cervix (p .025: .001). 5-years disease free survival rate was determined for patients treated by neoadjuvant chemotherapy followed by radical hysterectomy with bilateral pelvic lymphadenectomy was 73.3 %. For patients treated by neoadjuvant chemotherapy followed by radiation therapy it was 45.7%. For patients treated by concurrent chemo-radiotherapy it was 46.1%. CONCLUSION: These data support an improvement in survival of patients with barrel-shaped or bulky-endophytic cervical carcinomas treated by neoadjuvant chemotherapy followed by radical hysterectomy or radiation therapy and concurrent chemo-radiotherapy.
Subject(s)
Female , Humans , Bleomycin , Cervix Uteri , Cisplatin , Disease-Free Survival , Drug Therapy , Hysterectomy , Incidence , Lymph Node Excision , Neoplasm Metastasis , Retrospective Studies , VinblastineABSTRACT
Background and purpose:The prognosis of advanced esophageal carcinoma is poor,there are no standard regimens for these patients. This study was to observe and evaluate the clinical feasibility and effi cacy of combined esophageal stent insertion with radiotherapy and concurrent chemotherapy in the treatment of locally advanced esophageal carcinoma. Methods:66 patients with esophageal carcinoma who were not suitable for operation were analyzed retrospectively. In the therapy group,stent was placed in order to relieve esophageal stenosis,and then followed by 3D-CRT and concurrent chemotherapy,while patients in the control group were treated with the placement of stent alone. According to the evaluating standards of WHO and Stooler classifi cation,we evaluated the effi cacy. Results:In the study group,72.2% of 36 cases was observed as partial response(PR),and 13.9% with complete response(CR),overall response rate was 86.1%. 6 and 12 months survival rates were 88.9% and 72.2% in the study group,compared to 53.3% and 26.7% in the control group,respectively(P
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PURPOSE: The aim of this study was to evaluate local control and long-term survival of concurrent hyperfractionated radiotherapy with CDDP/VP-16 chemotherapy in limited stage small cell lung cancer. MATERIALS AND METHODS: From April 1992 to April 1997, twenty-nine patients with limited stage small cell lung cancer received cisplatin 25 mg/m plus etoposide 120 mg/m(2) on day 1, 2 and 3. Chemotherapy was repeated every 4 weeks for a total of 4 courses. Radiation was given to 60 Gy in 50 twice-daily fractionation separated by at least 6 hours, 5 days per week Thoracic radiotherapy was started with first coese of chemotherapy for 28.8 Gy. After 12 days break, radiotherapy was resumed with second course of chemotherapy for another 31,2 Gy. RESULTS: Twenty-eight patients (96.6%) were evaluable. Patient characteristics include: median age 58.4 years (range 45-67); clinical stage 1IIa 13 pts, stage IIIb 15 pts; ECOG performance status 0 (8 pts), 1 (16 pts) and 2 (4 pts). Objective responses were 21 complete response, 6 partial response, 1 stable disease with overall response rate of 96.4%. Grade III and IV toxicities were leukopenia in 23/28 pts, thrombocytopenia in 8/28 pts, stomatitis in 10/28 pts, and alopecia in 8/28 pts. The median survival time was 19.2 months with 1 year, 2 year, 3 year, and 4 year actuarial survival rates and RFS are 65.6%, 30.6%, 30.6%, 24.5%, and 65.3%, 52.8%, 52.8%, 42.2%, respectively. Overall survival rate according to TNM stage, weight loss, age and sex were not statistically significant. Pattems of relapse were local only in 2 pts, systemic only in 7 pts, and local plus systemic in 1 pt, and brain was the most frequent systemic recurrent site (4 pts). CONCLUSION: Concurrent hyperfractionated radiotherapy with CDDP/VP-16 chemotherapy seems to produce better local contml and survival rates in limited stage small cell lung cancer.