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Objective:To analyze the correlation of epidermal growth factor receptor (EGFR) expression in esophageal cancer tissues with sensitivity of radical radiotherapy and prognosis of patients.Methods:A total of 98 esophageal cancer patients admitted to the Affiliated Hospital of Jiangnan University from January 2017 to July 2019 were selected, and all patients received radical radiotherapy. The efficacy was assessed after 4 weeks of radiotherapy, partial remission (PR) + complete remission (CR) was treated as the sensitive group and disease progression (PD) + stable disease (SD) was treated as the tolerated group. The expression of EGFR in cancer tissues and paraneoplastic tissues (more than 5cm from the margin of cancer tissues) was measured by using immunohistochemistry. The expression of EGFR in cancer tissues and paraneoplastic tissues and the clinicopathological characteristics of the sensitive and tolerant groups were compared. Cox proportional risk model was used to analyze the factors influencing the prognosis of esophageal cancer patients; the Kaplan-Meier method was used to analyze the relationship between EGFR expression in cancer tissues and prognosis of patients.Results:The positive expression rate of EGFR in esophageal cancer tissues (66.3%, 65/98) was higher than that in paraneoplastic tissues (29.6%, 29/98), and the difference between the two groups was statistically significant (χ 2=26.49, P < 0.001). All 98 patients successfully completed radical radiotherapy, including 4 cases of CR, 60 cases of PR, 26 cases of SD and 8 cases of PD. The proportion of patients with highly differentiated and tumor length ≤1.5 cm in the sensitive group was higher than that in the tolerant group, and the differences were statistically significant (all P < 0.05). The positive expression rate of EGFR in cancer tissues in the sensitive group (56.3%, 36/64) was lower than that in the tolerant group (85.3%, 29/34), and the difference between the two groups was statistically significant ( χ2=8.39, P < 0.001). Multifactorial Cox regression analysis showed that poor differentiation, tumor long diameter >1.5 cm, and positive EGFR expression were independent risk factors for overall survival in patients with esophageal cancer (all P < 0.05). The difference in overall survival between patients with positive and negative EGFR expression was statistically significant ( χ2=9.70, P = 0.002). Conclusions:Highly-expressed EGFR in esophageal cancer tissues may suggest low sensitivity of radical radiotherapy and poor prognosis of patients.
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Objective:To compare the toxicity and prognosis of patients with stage Ⅲ cervical cancer treated using different regimens.Methods:A retrospective analysis was carried out for 194 patients with stage Ⅲ cervical cancer determined according to the revised 2018 International Federation of Gynecology and Obstetrics staging system (16 cases of stage Ⅲ A, 23 cases of stage Ⅲ B, 136 cases of stage Ⅲ C1, and 19 cases of stage Ⅲ C2) admitted to the First Affiliated Hospital of Soochow University from January 2010 to December 2020. They were divided into a radical radiotherapy±chemotherapy group (81 cases) and a radical hysterectomy + radiotherapy±chemotherapy group (113 cases) according to different treatment method. The difference in toxicity between the two groups was determined using the χ2 test. The survival curves and progression-free survival curves were plotted using the Kaplan-Meier method, and the Log rank test was also performed. The differences in toxicity and prognosis were further analyzed in 136 patients with stage Ⅲ C1 cervical cancer result patients in the radical radiotherapy±chemotherapy group were more likely to have hemoglobin decline ( χ2=10.68, P=0.004), rectal mucositis ( χ2=14.41, P=0.001), and vaginal fistula ( χ2=7.16, P=0.012) of grades 3 and 4. Patients in the radical hysterectomy+ radiotherapy±chemotherapy group were more likely to have increased aspartate aminotransferase ( χ2=10.96, P=0.002) and alanine aminotransferase ( χ2=8.49, P=0.010). The differences were statistically significant. The 5-year progression-free survival rate of the radical radiotherapy±chemotherapy group was 58.3%, which was lower than that of the radical hysterectomy + radiotherapy±chemotherapy group (74.5%; χ2=5.33, P=0.021). Among the 136 patients with stage Ⅲ C1 cervical cancer, the ones in the radical radiotherapy±chemotherapy group (34 cases) were more likely to develop rectal mucositis ( χ2=13.25, P=0.003), while the ones in the radical hysterectomy + radiotherapy±chemotherapy group (102 cases) were more likely to have elevated aspartate aminotransferase ( χ2=6.18, P=0.046). The differences were statistically significant. The 5-year survival rates of the radical radiotherapy±chemotherapy group and the radical hysterectomy+ radiotherapy±chemotherapy group were 85.5% and 86.3%, respectively. The difference was not statistically significant ( P=0.893). The 5-year progression-free survival rates of the radical radiotherapy±chemotherapy group and the radical hysterectomy + radiotherapy±chemotherapy group were 65.6% and 77.1%, respectively. The difference was not statistically significant ( P=0.244). Conclusions:For patients with stage Ⅲ cervical cancer, the ones in the radical radiotherapy±chemotherapy group were more likely to progress and have a poorer prognosis compared with the ones in the radical hysterectomy+ radiotherapy±chemotherapy group. For patients with stage Ⅲ C1 cervical cancer, there was no significant difference in the prognosis of patients between the groups. The two treatment method lead to different toxicity, with no obvious advantages and disadvantages. Considering the risks and economic burdens caused by surgery, radical radiotherapy and chemotherapy is recommended for patients with stage Ⅲ C1 cervical cancer.
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Objective:To compare the efficacy and prognosis of elective nodal irradiation (ENI) combined with nedaplatin chemotherapy and involved field irradiation (IFI) combined with nedaplatin chemotherapy in the radical radiotherapy treatment of patients with cervical or upper thoracic esophageal cancer.Methods:Seventy-eight patients with cervical or upper thoracic esophageal cancer in Hai'an Traditional Chinese Medicine Hospital from February 2017 to February 2020 were selected and divided into ENI group and IFI group according to random number table method, with 39 cases in each group. The ENI group was treated with ENI combined with nedaplatin chemotherapy, while the IFI group was treated with IFI combined with nedaplatin chemotherapy. After 2 months of treatment, the therapeutic effect and the dose of lung irradiation were compared between the two groups, and the occurrence of adverse reactions and prognosis were compared.Results:The total effective rate and disease control rate were 69.23% (27/39) and 82.05% (32/39) in IFI group, and 64.10% (25/39) and 74.36% (29/39) in ENI group, there was no significant difference between the two groups ( χ2 = 0.23, P = 0.631; χ2 = 0.68, P = 0.411). The lung irradiation doses of V 5 Gy and V 20 Gy in IFI group were lower than those in ENI group (both P < 0.05). The incidence rates of bone marrow suppression and radiation lung injury in IFI group were lower than those in ENI group (all P < 0.05). By the end of follow-up, the survival rates of IFI group and ENI group were 76.92% (30/39) and 66.67% (26/39), respectively. There was no significant difference in overall survival between the two groups ( χ2 = 1.06, P = 0.300). Conclusions:ENI and IFI combined with nedaplatin chemotherapy in the radical radiotherapy treatment of cervical and upper thoracic esophageal cancer have similar efficacy and prognosis, but IFI can reduce the lung radiation dose and the incidence of adverse reactions.
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Objective:To investigate the effect of peripheral blood neutrophil-to-lymphocyte ratio (NLR) before radical radiotherapy on overall survival (OS) of patients with esophageal squamous cell carcinoma.Methods:The clinical data of 359 patients with esophageal squamous cell carcinoma from March 2011 to January 2017 in Shanxi Provincial Cancer Hospital were retrospectively analyzed. The gender, age, smoking index, Karnofsky score, lesion site, lesion length, tumor length, TNM stage, concurrent chemoradiotherapy, NLR, etc., were observed. Receiver operating characteristic (ROC) curve was drawn according to patients' NLR to find the optimal cut-off value, the patients were divided into the low NLR group and the high NLR group, and the OS of the two groups was analyzed. Univariate log-rank test and multivariate Cox analysis were used to determine the factors affecting the OS of patients.Results:The area under the curve (AUC) of NLR for predicting OS was 0.576, the best cut-off value for OS prediction was 2.103 6, and the sensitivity and specificity were 60.8% and 55.2%, respectively. According to the best cut-off value of peripheral blood NLR 2.103 6, the 359 patients were divided into the low NLR group (NLR < 2.103 6, 156 cases, 43.5%) and high NLR group (NLR ≥ 2.103 6, 203 cases, 56.5%). There were statistical differences in gender ( χ2 = 8.960, P = 0.003) and lesion length ( χ2 = 12.948, P = 0.002) between low NLR group and high NLR group. Univariate analysis showed that the lesion length, NLR, N stage, M stage and total TNM clinical stage were influencing factors affecting OS of patients (all P < 0.05). Multivariate Cox regression analysis showed that the lesion length ( HR = 1.456, 95% CI 1.215-1.745, P < 0.01), NLR ( HR = 1.313, 95% CI 1.020-1.690, P = 0.035) and N stage ( HR = 1.768, 95% CI 1.391-2.248, P < 0.01) were independent influencing factors affecting OS of patients with esophageal squamous cell carcinoma before radical radiotherapy. Conclusions:Peripheral blood NLR is an independent influencing factor affecting OS of esophageal squamous cell carcinoma patients before radical radiotherapy. NLR has important reference value for predicting the OS of patients with esophageal squamous cell carcinoma after radical radiotherapy.
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Objective:To explore the clinical value of cryoablation technology in the treatment of patients with primary tumor recurrence after radical radiotherapy for prostate cancer.Methods:The clinical data of 21 patients with prostate cancer recurrence after radical radiotherapy in the Fudan University Affiliated Cancer Hospital from August 2017 to February 2021 was retrospectively analyzed. The average age was 73.1 (57.3-85.0) years old, and the Gleason score was 6 in 5 cases, 7 in 8 cases, and ≥8 in 8 cases. The clinical stage of the first diagnosis: 13 cases of cT 2 stage; 8 cases of cT 3 stage. The baseline PSA before radiotherapy was 35.3 (6.4-78.5) ng/ml, and the lowest PSA after radiotherapy was 1.8 ng/ml. After a median follow-up of 8 (3-12) months, all patients were detected with persistently elevated PSA. Pelvic MRI and PSMA SPECT showed that the primary prostate lesion had recurred. PSA before cryoablation was 4.1 (1.8-14.4) ng/ml. Comprehensive assessment of preoperative examination showed that the patient only had a recurrence of the primary tumor, and no lymph node or distant metastasis was seen. An argon-helium cryogenic surgical treatment system was used to place 1 to 3 cryo-needles for recurring lesions, and cryoablation was performed using two cold and hot cycles. Observation indicators include prognostic indicators such as PSA, recurrence and metastasis, and the occurrence of adverse reactions. Results:Complications after cryoablation include: 2 cases of urinary retention, 1 case of urinary tract infection, and 2 cases of urination with tissue shedding. The PSA of 11 cases decreased rapidly 2 to 3 months after operation, and dropped to the lowest median value of 0.4 (0.003 to 2.8) ng/ml. After cryoablation, the median follow-up was 18 (6-51) months. Imaging examinations in 1 case showed that the prostate still had limited diffusion or increased PSMA uptake, and 4 cases had PSA progression but no recurrence or metastasis. The median recurrence time for advanced patients was 13 (4-36) months. Larger prostate volume ( P<0.001) and higher blood PSA before ablation( P=0.021) were related to biochemical recurrence. Conclusions:Prostate cryoablation could delay the progression of the primary tumor after radical radiotherapy for prostate cancer. The incidence of complications such as urinary retention and urinary tract infection is not high, and it is generally safe and controllable.
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Objective@#To investigate the curative effect and prognostic factors of radical radiotherapy for cervical cancer.@*Methods@#A total of 211 patients with stage ⅠA-ⅢB cervical cancer who underwent therapy in department of radiotherapy, Tumor Hospital of Jilin province between June 2014 and February 2017, were analyzed retrospectively. All patients received radical radiotherapy with or without concurrent chemotherapy. Short-term and long-term efficacy and related prognostic factors were observed. Kaplan-Meier method was used for survival analysis, Log-rank test was used for univariate analysis, and Cox proportional hazards regression model was used for multivariate analysis.@*Results@#The 2-year overall survival (OS) and disease free survival (DFS) were 83.4% and 72.5%, respectively. During the follow-up periods, 46 patients (21.8%) died, including two from non-tumor-related diseases, and one from second primary colon cancer. Totally 57 patients (27%) had recurrence and metastasis, including 16 (28.1%) with local recurrence, 27 (47.4%) with distant metastasis, and 14 with local recurrence and distant metastasis(24.6%). Univariate analysis showed that 2-year OS and DFS were significantly correlated with pathological type, pre-treatment squamous cell carcinoma antigen (SCC) value and FIGO stage (OS: χ2=7.123, 6.014, 8.398, P<0.05; DFS: χ2=11.832, 8.003, 7.731, P<0.05). In addition to the above factors, 2-year DFS was also associated with pelvic lymph node metastasis (χ2=9.286, P<0.05). Multivariate analysis showed that pathological type, pre-treatment SCC value and FIGO stage were independent prognostic factors of OS(HR=2.963, 2.473, 2.574, P<0.05). The independent prognosis factors affecting DFS included pathological type, pre-treatment SCC value and pelvic lymph node metastasis (HR =3.014, 1.988, 1.914, P<0.05).@*Conclusions@#By means of radical radiotherapy, cervical cancer patients with adenocarcinoma, pre-treatment SCC levels ≥30 ng/ml and advanced stage have poor prognosis, so more active treatment strategy should be adopted.
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Objective To investigate the curative effect and prognostic factors of radical radiotherapy for cervical cancer. Methods A total of 211 patients with stage ⅠA-ⅢB cervical cancer who underwent therapy in department of radiotherapy, Tumor Hospital of Jilin province between June 2014 and February 2017, were analyzed retrospectively. All patients received radical radiotherapy with or without concurrent chemotherapy. Short-term and long-term efficacy and related prognostic factors were observed. Kaplan-Meier method was used for survival analysis, Log-rank test was used for univariate analysis, and Cox proportional hazards regression model was used for multivariate analysis. Results The 2-year overall survival (OS) and disease free survival (DFS) were 83. 4％ and 72. 5％, respectively. During the follow-up periods, 46 patients (21. 8％) died, including two from non-tumor-related diseases, and one from second primary colon cancer. Totally 57 patients (27％) had recurrence and metastasis, including 16 (28. 1％) with local recurrence, 27 (47. 4％) with distant metastasis, and 14 with local recurrence and distant metastasis ( 24. 6％) . Univariate analysis showed that 2-year OS and DFS were significantly correlated with pathological type, pre-treatment squamous cell carcinoma antigen (SCC) value and FIGO stage (OS: χ2 = 7. 123, 6. 014, 8. 398, P < 0. 05; DFS: χ2 = 11. 832, 8. 003, 7. 731, P < 0. 05). In addition to the above factors, 2-year DFS was also associated with pelvic lymph node metastasis ( χ2 =9. 286, P<0. 05). Multivariate analysis showed that pathological type, pre-treatment SCC value and FIGO stage were independent prognostic factors of OS (HR= 2. 963, 2. 473, 2. 574, P<0. 05). The independent prognosis factors affecting DFS included pathological type, pre-treatment SCC value and pelvic lymph node metastasis (HR = 3. 014, 1. 988, 1. 914, P< 0. 05). Conclusions By means of radical radiotherapy, cervical cancer patients with adenocarcinoma, pre-treatment SCC levels ≥30 ng/ ml and advanced stage have poor prognosis, so more active treatment strategy should be adopted.
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PURPOSE: We first analyzed the prognostic power of albumin-to-alkaline phosphatase ratio (AAPR) before radical radiotherapy (RT) in non-metastatic nasopharyngeal carcinoma (NPC) patients. MATERIALS AND METHODS: The records of 170 patients with biopsy-proven, non-metastatic NPC treated by radical RT between 1998 and 2016 at our institution were retrospectively reviewed. Median follow-up duration was 50.6 months. All patients received intensity-modulated RT and cisplatin based chemotherapy before, during, or after RT. The major treatment of patients was based on concurrent chemoradiotherapy (92.4%). The AAPR was calculated by the last value of both albumin and alkaline phosphatase within 1 month immediately preceding RT. The optimal cut-off level of AAPR was determined by using Cutoff Finder, a web-based system. Propensity score matching (PSM) analysis was performed. RESULTS: The optimal cut-off level of AAPR was 0.4876. After PSM analysis of whole cohort, an AAPR was not related to survival outcomes. In PSM analysis for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC), an AAPR ≥ 0.4876 was related to better overall survival (OS), progression-free survival (PFS), and locoregional relapse–free survival (LRRFS) (OS: hazard ratio [HR], 0.341; 95% confidence interval [CI], 0.144 to 0.805; p=0.014; PFS: HR, 0.416; 95% CI, 0.189 to 0.914; p=0.029; and LRRFS: HR, 0.243; 95% CI, 0.077 to 0.769; p=0.016, respectively). CONCLUSION: The AAPR, inexpensive and readily derived from a routine blood test, could be an independent prognostic factor for patients with LA-NPC. And it might help physicians determine treatment plans by identifying the patient's current status. Future prospective clinical trials to validate its prognostic value are needed.
Subject(s)
Humans , Alkaline Phosphatase , Chemoradiotherapy , Cisplatin , Cohort Studies , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Hematologic Tests , Prognosis , Propensity Score , Prospective Studies , Radiotherapy , Retrospective StudiesABSTRACT
PURPOSE: The current study was conducted in order to evaluate the clinical outcome of radical radiotherapy (RT) with or without chemotherapy for elderly patients with stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Between 1990 and 2010, 125 patients, aged 70 years or more, received radical RT with or without chemotherapy for treatment of stage III NSCLC. We reviewed the patients' prognostic factors, including comorbidities. Comorbidity status was evaluated using a simplified comorbidity score (SCS). Of the patients reviewed, 82 received radical RT alone, whereas the other 43 patients underwent chemoradiotherapy (CRT). A platinum-based chemotherapy regimen was most commonly used (42/43). RESULTS: The two-year overall-survival (OS) and progression-free survival (PFS) rates were 32.2% and 21.8%, respectively. SCS was the independent prognostic factor for OS. In the frail elderly subgroup with a SCS of > or =10, CRT demonstrated a significant difference in PFS, but not in OS. In contrast, OS and PFS following CRT were significantly superior to RT in the fit elderly subgroup with a SCS of <10. The incidence of severe pulmonary toxicities in the frail elderly subgroup was significantly higher than that in the fit elderly subgroup. CONCLUSION: Multiple comorbidities evaluated according to the SCS are related to poor OS in elderly patients with stage III NSCLC. CRT improved clinical outcome when compared to RT in the fit elderly subgroup, however, the gain from this treatment was negated in the frail elderly subgroup with multiple comorbidities. Therefore, evaluation of comorbidity is necessary in order to determine whether chemotherapy should be combined with RT in elderly patients with stage III NSCLC.
Subject(s)
Aged , Humans , Carcinoma, Non-Small-Cell Lung , Chemoradiotherapy , Comorbidity , Disease-Free Survival , Frail Elderly , IncidenceABSTRACT
PURPOSE: This study evaluated the late rectal complications in cervix cancer patients following treatment with external beam radiotherapy (EBRT) and high dose rate intracavitary radiation (HDR ICR). The factors affecting the risk of developing late rectal complications and its incidence were analyzed and discussed. MATERIALS AND METHODS: The records of 105 patients with cervix cancer who were treated with radical radiotherapy using HDR ICR between July, 1995 and December, 2001 were retrospectively reviewed. The median dose of EBRT was 50.4 Gy (41.4~56.4 Gy) with a daily fraction size of 1.8 Gy. A total of 5~7 (median: 6) fractions of HDR ICR were given twice weekly with a fraction size of 4~5 Gy (median: 4 Gy) to A point using an Ir (Iridium)-192 source. The median dose of ICR was 24 Gy (20~35 Gy). During HDR ICR, the rectal dose was measured in vivo by a semiconductor dosimeter. The median follow-up period was 32 months, ranging from 5 to 84 months. RESULTS: Of the 105 patients, 12 patients (11%) developed late rectal complications; 7 patients with grade 1 or 2, 4 patients with grade 3 and 1 patient with grade 4. Rectal bleeding was the most frequent chief complaint. The complications usually began to occur 5~32 (median: 12) months after the completion of radiotherapy. Multivariate analysis revealed that the measured cumulative rectal BED over 115 Gy3 (Deq over 69 Gy) and the depth (D) of a 5 Gy isodose volume more than 50 mm were the independent predictors for late rectal complications. CONCLUSION: With evaluating the cumulative rectal BED and the depth of a 5 Gy isodose volume as predictors, we can individualize treatment planning to reduce the probability of late rectal complications.
Subject(s)
Female , Humans , Cervix Uteri , Follow-Up Studies , Hemorrhage , Incidence , Multivariate Analysis , Radiotherapy , Retrospective Studies , Semiconductors , Uterine Cervical NeoplasmsABSTRACT
PURPOSE: Prostate specific antigen (PSA) is a useful tumor marker, which is widely used as a diagnostic index and predictor of both treatment and follow-up result in prostate cancer. A prospective analysis was carried out to obtain the period of PSA normalization and the half life of PSA and to analyze the factors influencing the period of PSA normalization. The PSA level was checked before and serially after radical radiotherapy. MATERIALS AND METHODS: Twenty patients with clinically localized prostate cancer who underwent radical external beam radiotherapy were enrolled in this study. Accrual period was from April 1993 to May 1998. Median follow-up period was 26 months. Radiotherapy was given to whole pelvis followed by a boost to prostate. Dose range for the whole pelvis was from 45 Gy to 50 Gy and boost dose to prostate, from 14 Gy to 20 Gy. The post-irradiation PSA normal value was under 3.0 ng/ml. The physical examination and serum PSA level evaluation were performed at 3 month interval in the first one year, and then at every 4 to 6 months. RESULTS: PSA value was normalized in nineteen patients (95%) within 12 months. The mean period of PSA normalization was 5.3 (+/-2.7) months. The half life of PSA of the nonfailing patients was 2.1 (+/-0.9) month. The nadir PSA level of the nonfailing patients was 0.8 (+/-0.5) ng/ml. The period of PSA normalization had the positive correlation with pretreatment PSA level (R2=0.468). The nadir PSA level had no definite positive correlation with the pretreatment PSA level (R2=0.175). The half life of serum PSA level also had no definite correlation with pretreatment PSA level (R2=0.029). CONCLUSION: The PSA level was mostly normalized within 8 months (85%). If it has not normalized within 12 months, we should consider the residual disease in prostate or distant metastasis. In 2 patients, the PSA level increased 6 months or 20 months before clinical disease was detected. So the serum PSA level can be used as early diagnostic indicator of treatment failure.