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Objective:To evaluate the prognostic factors and the value of definitive pelvic radiotherapy in patients with stage Ⅳ B hematogenous metastatic cervical squamous cell carcinoma. Methods:Clinical data of 80 patients with Ⅳ B stage squamous cell carcinoma admitted to Zhejiang Cancer Hospital from 2006 to 2016 were retrospectively analyzed. The survival analysis was conducted by Kaplan- Meier method. Prognostic factors were analyzed by Cox models. Results:The 1-, 2-and 5-year overall survival (OS) and progression-free survival (PFS) rates were 52.5%, 26.3%, 16.8% and 25%, 13.8%, 8.8%, with a median OS of 13.8 months and a median PFS of 5.6 months, respectively. The most common site of metastasis was bone (51.3%), followed by lung (36.3%) and liver (26.3%). Univariate analysis revealed that chemotherapy combined with definitive pelvic radiotherapy and ≥6 cycles of chemotherapy were positively correlated with OS and PFS, whereas ECOG performance status score of 3-4 and liver metastasis were negatively correlated with OS and PFS. In multivariate analysis, liver metastasis ( HR=2.23, 95% CI: 1.01-4.91, P=0.048) and ECOG performance status score of 3-4( HR=2.01, 95% CI: 1.03-3.91, P=0 0.040) were significantly correlated with poor OS. Subgroup multivariate analysis showed that compared with chemotherapy±palliative radiotherapy, systemic chemotherapy combined with definitive pelvic radiotherapy significantly improved OS ( HR=0.39, 95% CI: 0.18-0.84, P=0.016). Compared with double drugs combined with<4 cycles of chemotherapy, double drugs in combination with ≥4 cycles of chemotherapy significantly improved OS ( HR=0.32, 95% CI: 0.15-0.68, P=0.003). Conclusions:Patients with low ECOG performance status score or liver metastasis obtain poor prognosis. Definitive pelvic radiotherapy combined with chemotherapy can enhance clinical prognosis of patients with Ⅳ B stage hematogenous metastatic cervical squamous cell carcinoma.
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Objective:To evaluate the safety and preliminary efficacy of total neoadjuvant therapy (TNT) model of" neoadjuvant chemoradiotherapy plus consolidation neoadjuvant chemotherapy (CNCT) followed by surgery" for locally advanced gastric cancer.Methods:From 2018 to 2020, 28 patients clinically diagnosed with locally advanced gastric adenocarcinoma or Siewert Ⅱ/Ⅲ adenocarcinoma gastroesophageal junction cancer were prospectively enrolled. The neoadjuvant chemoradiotherapy (NCRT) was delivered with a total dose of 45 Gy, 1.8 Gy/f. Concurrent chemotherapy was S-1 at a dose of 40-60 mg twice daily. Then, patients received four to six cycles of CNCT of SOX regimen at three weeks after neoadjuvant chemoradiotherapy. D 2 lymphadenectomy was performed at 4-6 weeks after CNCT. Results:A total of 28 patients completed the whole therapy. Grade 3 or above adverse events occurred in 3 cases (11%) during CCRT, including thrombocytopenia, leukopenia and anorexia; 2 cases (7%) developed leukopenia and 3 cases (11%) of thrombocytopenia during CNCT. Twenty patients (71%) completed the surgery. The proportion of patients with pathological complete remission (pCR) was 50%. Three patients experienced surgical complications including anastomotic leak, anastomotic stenosis and intra-abdominal sepsis. All were recovered after symptomatic treatment.Conclusion:Interim analysis results demonstrate that TNT can yield significant down-staging for patients with locally advanced gastric cancer, which causes tolerable adverse events and postoperative complications.
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From synchronous metastasis to metachronous metastasis and from oligometastasis to disseminated metastasis, distant metastatic nasopharyngeal carcinoma (stage IV B) has great heterogeneity. The prognosis of stage IV B nasopharyngeal carcinoma patients with distant metastases is closely related to the anatomical characteristics of metastases. Therefore, it is necessary to subdivide M 1 stage to lay the foundation for individualized treatment of patients with metastatic nasopharyngeal carcinoma. In addition to systemic chemotherapy, the primary tumors and metastatic lesions should be considered during the treatment of newly-diagnosed metastatic nasopharyngeal carcinoma. Currently, there is a lack of recognized treatment modes for newly-diagnosed stageⅣ B nasopharyngeal carcinoma, and more studies are needed to evaluate the clinical benefits of different treatment methods.
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In recent years, increasing evidence has shown that hyperthermia is safe, effective and causes low toxicity. Hyperthermia can exert synergistic effect with other treatments, such as radiotherapy and chemotherapy. It has become an important adjuvant anti-tumor treatment secondary to surgery, chemotherapy, radiotherapy and biological treatment. Hyperthermia can improve the efficacy of radiotherapy and chemotherapy by directly inhibiting tumor cells and heat-induced radiosensitizing effect. Hence, hyperthermia is gradually applied in the multimodality treatment of tumors. In this article, we intend to review the research progress on the application of tumor hyperthermia in conventional radiotherapy, chemotherapy, immunotherapy and new biomaterials.
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Rectal cancer is one of the most common malignant tumors in China,and the proportion of elderly patients is also increasing.Due to the lack of prospective evidence-based medical research for elderly patients,no consensus on the optimal treatment model has been reached.In this article,relevant researches on the comprehensive treatment strategy of locally advanced rectal cancer in the elderly patients were reviewed,aiming to provide reference for individualized treatment of elderly patients.
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Objective To investigate the clinical significance of radiotherapy for stage Ⅳ esophageal cancer.Methods Clinical data of 133 stage Ⅳ esophageal cancer patients admitted to our hospital from 2012 to 2018 were retrospectively analyzed.All patients were assigned into the radiochemotherapy (n=89)and chemotherapy groups (n=44).The survival analysis was performed by Kaplan-Meier method.The multivariate prognostic analysis was conducted by Cox's regression model.Results The 1-,2-and 3-year overall survival rates of the entire cohort were 53.5％,20.4％ and13.6％ respectively.Cox's regression analysis showed that gender,ECOG score,number of distant metastases,and whether the primary lesions received radiotherapy were the independent prognostic factors (all P＜0.05).The 1-,2-and 3-year survival rates in the radiochemotherapy group were 61％,29％ and19％,and 40％,4％,0％ in the chemotherapy group,respectively.In the radiochemotherapy group,the progression-free survival (PFS) and local progression-free survival (LPFS) were 8 months and 12.6 months,significantly longer compared with 4.7 months and 5.3 months in the chemotherapy group (both P＜0.05).The OS of patients receiving dose＞50Gy and ≤50Gy was 14.3 months and 8.2 months (P＜0.05),8.6 months and 2.8 months for the PFS (P＜0.05),and 15.2 months and 4.7 months for the LRFS (P＜0.05),respectively.The number of distant metastases and the clinical efficacy for primary lesions were the independent prognostic factors in the radiochemotherapy group (both P＜0.05).Conclusion Radiotherapy can improve the clinical prognosis of patients with stage Ⅳ esophageal cancer.
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Rectal cancer is one of the most common malignant tumors in China, and the proportion of elderly patients is also increasing. Due to the lack of prospective evidence-based medical research for elderly patients, no consensus on the optimal treatment model has been reached. In this article, relevant researches on the comprehensive treatment strategy of locally advanced rectal cancer in the elderly patients were reviewed, aiming to provide reference for individualized treatment of elderly patients.
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Objective@#To investigate the clinical significance of radiotherapy for stage Ⅳ esophageal cancer.@*Methods@#Clinical data of 133 stage Ⅳ esophageal cancer patients admitted to our hospital from 2012 to 2018 were retrospectively analyzed. All patients were assigned into the radiochemotherapy (n=89) and chemotherapy groups (n=44). The survival analysis was performed by Kaplan-Meier method. The multivariate prognostic analysis was conducted by Cox’s regression model.@*Results@#The 1-, 2-and 3-year overall survival rates of the entire cohort were 53.5%, 20.4% and13.6% respectively. Cox’s regression analysis showed that gender, ECOG score, number of distant metastases, and whether the primary lesions received radiotherapy were the independent prognostic factors (all P<0.05). The 1-, 2-and 3-year survival rates in the radiochemotherapy group were 61%, 29% and19%, and 40%, 4%, 0% in the chemotherapy group, respectively. In the radiochemotherapy group, the progression-free survival (PFS) and local progression-free survival (LPFS) were 8 months and 12.6 months, significantly longer compared with 4.7 months and 5.3 months in the chemotherapy group (both P<0.05). The OS of patients receiving dose> 50Gy and ≤50Gy was 14.3 months and 8.2 months (P<0.05), 8.6 months and 2.8 months for the PFS (P<0.05), and 15.2 months and 4.7 months for the LRFS (P<0.05), respectively. The number of distant metastases and the clinical efficacy for primary lesions were the independent prognostic factors in the radiochemotherapy group (both P<0.05).@*Conclusion@#Radiotherapy can improve the clinical prognosis of patients with stage Ⅳ esophageal cancer.
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In China, radical esophagectomy remains the main strategy for resectable esophageal cancer. However, the high locoregional recurrence rate and hematogenous metastasis rate are the main causes of surgical failure. Therefore, whether postoperative adjuvant therapy can become one of the important means for esophageal cancer remains controversial. In this article, the research progress on the postoperative recurrent pattern and adjuvant therapy for esophageal carcinoma was reviewed to provide references for clinicians.
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Objective To evaluate the survival and prognostic factors of esophageal cancer treated with definitive ( chemo ) radiotherapy by applying novel radiation techniques including three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT). Methods Clinical data of 2762 patients with non-operated esophageal squamous cell carcinoma who underwent definitive ( chemo ) radiotherapy from 2002 to 2016 in 10 hospitals were retrospectively analyzed.The prognostic factors were also identified and analyzed. Results The median follow-up time was 60. 8 months. The 1-, 2-, 3-and 5-year overall survival (OS) of all patients was 71. 4％,48. 9％,39. 3％,and 30. 9％,respectively.The 1-,2-,3-and 5-year progression-free survival (PFS) was 59.5％,41.5％,35.2％,and 30％,respectively.The median survival was 23 months.The median time to progression was 17. 2 months.Multivariate analysis demonstrated that age, primary tumor location, clinical stage, tumor target volume, EQD2 and treatment mode were the independent prognostic factors for OS.Primary tumor location,clinical stage,tumor target volume and EQD2 were the independent prognostic factors for PFS. Conclusions In this first large-scale multi-center retrospective analysis of definitive ( chemo) radiotherapy for esophageal squamous cell carcinoma in China, the 5-year OS of patients with esophageal squamous cell carcinoma is significantly improved by 3DCRT, IMRT combined with chemotherapy drugs. However, the findings remain to be validated by prospective clinical trials with high-level medical evidence.
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Along with the intensification of the aging trend,the proportion of elderly patients suffering from esophageal cancer has been ever increased.Radiotherapy plays a pivotal role in the treatment of esophageal cancer in the elderly patients considering their relatively poor tolerance of surgery and high risk of postoperative complications.In this review,the development in the comprehensive treatment of esophageal cancer in the elderly was summarized.
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Objective To evaluate the clinical efficacy and analyze the prognostic factors of radiotherapy after breast-conserving surgery for stage Ⅰ-Ⅱ breast cancer patients.Methods Clinical efficacy of adjuvant radiotherapy in 1 376 patients with stage Ⅰ and Ⅱ (T1-2 N0-1 M0/T3NoM0) breast cancer after undergoing unilateral breast-conserving surgery between 1999 and 2013 was retrospectively reviewed.Among them,930 patients (67.6％) received radiotherapy combined with chemotherapy including 517 receiving radiotherapy followed by chemotherapy and 413 receiving chemotherapy followed by radiotherapy.In total,1 055 patients (76.7％) were treated with endocrine therapy.Eighty-six patients (39.6％) positive for HER-2 received targeted therapy.The overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method.Univariate analysis was performed by Log-rank test and multivariate analysis was conducted by Cox regression method.Results The median follow-up time was 55 months.The quantity of patients receiving follow-up for ≥ 10 years was 90.The 5-and 10-year OS rates for all patients were 98.6％ and 91.5％,and 94.6％ and 82.8％ for 5-and 10-year DFS rates.Mutivariate analysis revealed that age (P=0.016),T staging (P =0.006),N staging (P =0.004),lymphovascular invasion (P =0.038) and time interval between radiotherapy and surgery (P=0.048) were independent prognostic factors for DFS rate.Multivariate analysis demonstrated that N staging (P=0.044) and ER (P=0.026) were independent prognostic factors for DFS in the radiotherapy alone group.Conclusions The radiotherapy-based comprehensive treatment yields favorable clinical outcomes for stage Ⅰ-Ⅱ breast cancer patients after undergoing breast conserving surgery.The prognostic factors for DFS include age,T staging,N staging,lymphovascular invasion and the time interval between radiotherapy and breast-conserving surgery.In the radiotherapy alone group,DFS rate is associated with N staging and ER level.
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Objective To evaluate the toxicity and efficacy of post-operative chemoradiotherapy for gastric cancer. Methods Forty-five gastric cancer patients treated with post-operative radiation ± concurrent chemotherapy were retrospectively analyzed. Among them, 14 were female and 31 were male. The median age was 54 (30-72) years. Pathology stages were IB-IV. Radiotherapy of doses from 45 Gy/25fx to 55 Gy/30fx was delivered to the tumor bed and regional lymph nodes with 3D conformal or IMRT technology.Concurrent chemotherapy agent was fluorouracil or capacitabine. Results All patients except 2 (4%)completed radiotherapy as planned. The most common acute toxicities were hematologic and gastrointestinal effects. The incidence of the patients was 56% with mild nausea/vomiting,71% and 7% with grade Ⅰ / Ⅱ and Ⅲ leucopenia, and 38% with grade Ⅰ/Ⅱ hypodynamia and anepithymia. The 1-year overall survival,relapse-free survival and local control rates were 87% ,82% and 95%, respectively. Conclusions Postoperative chemoradiation for patients with locally advanced gastric cancer is tolerable. Our study shows the advantage of post-operative chemoradiation for local control. However,further prospective randomized trial is needed to validate the efficacy.
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Objective To review the recent studies on the multidrug resistance of breast cancer. Methods The literatures of recent years on the studies of multidrug resistance, multidrug resistance protein and breast cancer resistance protein were reviewed. Results Multidrug resistance resulted from multiple factors. How to identify the sensibility of chemotherapy drugs and select individual therapeutic regime early were important to improve the survival rate and life quality of breast cancer patients.Conclusion These studies on multidrug resistance of breast cancer are helpful to predicting the effect and outcome of chemotherapy and overcoming the barrier of drug resistance.
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Objective To improve the therapeutic response and survival of locally advanced pancreatic cancer treated with radiochemotherapy. Methods Fifty nine patients with stage Ⅱ Ⅲ pancreatic cancer were divided into two groups: 33 patients were treated with three dimensional conformal radiotherapy (3DCRT) plus regional intra arterial infusion chemotherapy (CT)and 26 patients received 3DCRT alone.Results The response (pain alleviating) rates were 78.8% in 3DCRT+CT group and 80.8% in 3DCRT group,while the overall response (CR+PR) rates were 78.8% and 42.3% (P