Application of intra-arterial infusion chemotherapy in concurrent chemoradiation therapy of local advanced cervical cancer / 实用放射学杂志

Objective To investigate the feasibility and clinical efficacy of intra-arterial infusion chemotherapy within concurrent chemoradiation therapy (CCRT)for local advanced cervical cancer (LACC:Stage Ⅰb2 - Ⅳa).Methods 42 LACC patients were treated with CCRT combining with intra-arterial infusion chemotherapy (CCRT group),and another 60 LACC patients were under-went radiotherapy alone (control group).The clinical efficacy,adverse reactions and overall survivals (OAS)were evaluated,be-tween the two groups,respectively.Results Overall response rate was 92.8% in CCRT group.Of 42 patients,24 had achieved complete response (CR)in CCRT group (57.1%).The 5-year overall survival rate in CCRT group was 76.2%,which was signifi-cantly higher than that of control group (49.3%),respectively (P =0.01).Multivariate COX proportional hazards model revealed that the clinical stage(P =0.01 6),pelvic positive lymph nodes (P =0.007)were independent factors of monitoring prognosis of LACC patients treated with CCRT combining with intra-arterial infusion chemotherapy.Conclusion CCRT with intra-arterial infu-sion chemotherapy is a safe and effective method for LCCA,and clinical stage and pelvic positive lymph node were independent fac-tors of the prognosis of patients.

Comparison of concurrent chemoradiation therapy with weekly cisplatin versus monthly fluorouracil plus cisplatin in FIGO stage IIB-IVA cervical cancer / 부인종양

OBJECTIVE: Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer. METHODS: We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen. RESULTS: Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237). CONCLUSION: Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.

Comparison of concurrent chemoradiation therapy with weekly cisplatin versus monthly fluorouracil plus cisplatin in FIGO stage IIB-IVA cervical cancer / 부인종양

OBJECTIVE: Concurrent chemoradiation therapy (CCRT) is the standard treatment for locally advanced cervical cancer. Although the optimal chemotherapeutic regimen is not yet defined, previous randomized trials have demonstrated that 5-fluorouracil (5-FU) plus cisplatin every 3 weeks and weekly cisplatin are the most popular regimens. The purpose of this study was to compare the outcomes of weekly CCRT with cisplatin and monthly CCRT with 5-FU plus cisplatin for locally advanced cervical cancer. METHODS: We retrospectively reviewed data from 255 patients with FIGO stage IIB-IVA cervical cancer. Patients were classified into two CCRT groups according to the concurrent chemotherapy: weekly CCRT group, consisted of CCRT with weekly cisplatin for six cycles; and monthly CCRT group, consisted of CCRT with cisplatin and 5-FU every 4 weeks for two cycles followed by additional consolidation chemotherapy for two cycles with the same regimen. RESULTS: Of 255 patients, 152 (59.6%) patients received weekly CCRT and 103 (40.4%) received monthly CCRT. The mean follow-up period was 39 months (range, 1 to 186 months). Planned CCRT was given to 130 (85.5%) patients in weekly CCRT group and 84 (81.6%) patients in monthly CCRT group, respectively. Severe adverse effects were more common in the monthly CCRT group than in the weekly CCRT group. There were no statistically significant differences in progression-free survival and overall survival between the two groups (p=0.715 and p=0.237). CONCLUSION: Both weekly CCRT and monthly CCRT seem to have similar efficacy for patients with locally advanced cervical cancer, but the weekly cisplatin is better tolerated.

Variable uterine uptake of FDG in adenomyosis during concurrent chemoradiation therapy for cervical cancer

To avoid improper tumor volume contouring in radiation therapy (RT) and other invasive procedures, we report a case of uterine adenomyosis showing increased 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/computed tomography (CT) mimicking malignant tumor in a 44-year-old woman during concurrent chemoradiation therapy (CCRT) for uterine cervical cancer. The adenomyosis was not associated with her menstrual cycle or with normal endometrium uptake, and it resolved one month after completion of RT. This case indicates that uterine adenomyosis in a premenopausal woman may show false positive uptake of 18FDG-PET/CT associated with CCRT.

Long-Term Results of 2-Dimensional Radiation Therapy in Patients with Nasopharyngeal Cancer / 대한방사선종양학회지

PURPOSE: To analyze the treatment outcomes, complications, prognostic factors after a long-term follow-up of patients with nasopharyngeal carcinoma treated with radiation therapy (RT) alone or concurrent chemoradiation therapy (CCRT). MATERIALS AND METHODS: Between December 1981 and December 2006, 190 eligible patients with non-metastatic nasopharyngeal carcinoma were treated at our department with a curative intent. Of these patients, 103 were treated with RT alone and 87 patients received CCRT. The median age was 49 years (range, 8~78 years). The distributions of clinical stage according to the AJCC 6th edition included I: 7 (3.6%), IIA: 8 (4.2%), IIB: 33 (17.4%), III: 82 (43.2%), IVA: 31 (16.3%), IVB: 29 (15.3%). The accumulated radiation doses to the primary tumor ranged from 66.6~87.0 Gy (median, 72 Gy). Treatment outcomes and prognostic factors were retrospectively analyzed. Acute and late toxicities were assessed using the RTOG criteria. RESULTS: A total of 96.8% (184/190) of patients completed the planned treatment. With a mean follow-up of 73 months (range, 2~278 months; median, 52 months), 93 (48.9%) patients had relapses that were local 44 (23.2%), nodal 13 (6.8%), or distant 49 (25.8%). The 5- and 10-year overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates were 55.6% and 44.5%, 54.8% and 51.3%, in addition to 65.3% and 57.4%, respectively. Multivariate analyses revealed that CCRT, age, gender, and stage were significant prognostic factors for OS. The CCRT and gender were independent prognostic factors for both DFS and DSS. There was no grade 4 or 5 acute toxicity, but grade 3 mucositis and hematologic toxicity were present in 42 patients (22.1%) and 18 patients (9.5%), respectively. During follow-up, grade 3 hearing loss in 9 patients and trismus in 6 patients were reported. CONCLUSION: The results of our study were in accordance with findings of previous studies and we confirmed that CCRT, low stage, female gender, and young age were related to improvement in OS. However, there are limitations in the locoregional control that can be achieved by CCRT with 2D conventional radiation therapy. This observation has led to further studies on clarifying the efficacy of concurrent chemotherapy by intensity modulated radiation therapy.

Clinicopathologic Characteristics of Anal Cancer

PURPOSE: This study was performed to evaluate clinicopathologic features in anal canal carcinoma. METHODS: Among the 43 patients who were diagnosed with anal cancer at Kangnam St. Mary's Hospital, from June 1990 to June 2008, 31 patients were analyzed retrospectively. Concurrent chemoradiotherapy was performed on twenty-one patients with anal cancer. Chemotherapy with 5-FU/mitomycin and radiotherapy were started at the same time. An external beam radiation dose to the primary lesion and pelvis was modified from 4,500 to 6,000 cGy. RESULTS: Among the 31 patients with anal cancer, the dominant histologic type was squamous cell carcinoma (n=25), followed by adenocarcinoma (n=6). Twenty-nine (93.5%) of these cancers were located in the anal canal and 2 (6.5%) in the anal margin. Among the 25 patients with squamous cell carcinoma, 20 cases were treated by concurrent chemoradiotherapy. The 5-year survival rate among squamous cell carcinoma cases was 83.3% for the concurrent chemoradiation group and 50.0% for the no concurrent chemoradiation group, which was statistically significant (P=0.05). Among the squamous cell carcinoma patients, there was no significant difference in survival rates between concurrent chemoradiation group (n=17) and concurrent chemoradiation with surgical resection group (n=8) (87.5% vs 68.8%; P=0.596). CONCLUSION: In the squamous cell carcinoma treatment, concurrent chemoradiation therapy can offer better outcomes.

Transanal Endoscopic Microsurgery after Preoperative Concurrent Chemoradiation Therapy in Selected Distal Rectal Cancer Patients

PURPOSE: Preoperative concurrent chemoradiation (CCRT) therapy may allow higher rates of tumor resectability and sphincter-saving procedures. Transanal endoscopic microsurgery (TEM) has become increasingly common in the management of selected patients with early rectal cancer. The aim of this study is to evaluate the clinical outcomes of selected patients with distal rectal cancer treated with TEM after CCRT. METHODS: Between June 2000 and August 2004, 7 patients with clinically T2 or T3 rectal cancer underwent TEM after CCRT. Pretreatment and preoperative clinical stages were estimated by using endorectal ultrasound or computed tomography and digital rectal exam. CCRT was performed with radiation therapy of 4,500 cGy/25 fractions over 5 weeks with 5-FU based chemosensitization. TEM was performed 4~7 weeks following the completion of therapy. RESULTS: The mean age was 54.9 (35~70) years and the median follow-up period was 23.0 (5~57) months. The lesions were located between 2 to 6 cm above the anal verge (median 3.0 cm). Pre- treatment T staging was estimated as T3 in 1 case and T2 in 6 cases, and post-treatment T staging was estimated as complete remission (CR) in 2 cases, T1 in 3 cases, and T2 in 2 patients. Pathologic evaluation revealed tumor downstaging in 6 patients, including 3 patients (42.9%) with CR. In all cases, there was no tumor on the resection margin. There have been no recurrences during the follow-up period. CONCLUSIONS: TEM after CCRT therapy appears to be an effective alternative treatment to radical resection for highly selected patients with T2 and T3 distal rectal cancer.