RESUMEN
Objective: This study aims to analyze the therapeutic effect and prognostic factors of carcinoma of parotid gland (CPG). Methods: Data on 103 CPG patients were retrospectively analyzed. The patients were divided into the simple surgery group (Group One) and post-operative radio-chemotherapy group (Group Two). Kaplan-Meier survival analysis, Log-rank test, and Cox re-gression analysis were employed to analyze the five-year overall survival. Chi-square test was applied to compare the local control rate and recurrence-free survival. Logistic regression analysis was used to determine the correlation between all factors and the local control rate. Results:For all patients, the five-year local control rate, five-year recurrence-free survival rate, and five-year overall survival rate were 71.49%, 69.61%, and 76.10%respectively. The five-year local control ratio (81.96%vs. 61.90%), five-year recurrence-free surviv-al (78.69%vs. 59.52%), and five-year overall survival (88.12%vs. 68.50%) were significantly improved in Group Two compared with Group One. The logistic regression analysis showed that the therapeutic method, T staging, as well as pN(+) neck and tumor differentia-tion were significantly correlated to the five-year local control rate and five-year recurrence-free survival (P<0.01). Cox regression anal-ysis showed that therapeutic method, T stage, as well as pN(+) neck and tumor differentiation were significantly correlated to the five-year overall survival (P<0.01). Conclusion:Post-operative radio-chemotherapy can improve the local control and overall survival rates. This therapeutic method is applicable to patients with T3-4 tumors, as well as pN(+) neck and middle-low differentiation.
RESUMEN
Objective To evaluatc the efficacy and safcty of recombinant endostatin (Endostar)combined with concurrent radio-chemotherapy (CRCT) in patients with unresectable stage Ⅲ non-small cell lung cancer (NSCLC).Methods From March 2009 to November 2011,47 patients received threedimensional conformal radiotherapy of 60-66 Gy in 30-33 fractions over 6-7 weeks And concurrent chemotherapy of docetaxel 65 mg/m2 and cisplatin 65 mg/m2.Endostar was administered once a week before and on week 2,4,6 during CRCT at a dose level of 7.5 mg/m2/d.Tumor response was evaluated with thoracic CT scans performed 4 weeks after completion of treatment in accordance with RECIST 1.1 criteria.Acute toxicities were evaluated in accordance with CTCAE 3.0.Results Forty-four patients completed treatment and toxicity evaluation,42 patients completed evaluation of efficacy.Five patients achieved complete response,29 partial response,3 stable disease,and 5 progressive disease,2 were net assessed.Overall response rate was 77％.One-year overall survival rate was 81％,and one-year progression-free survival rate was 51％.Twelve patients died,2 died of treatment related toxicities,8 of cancer,and 2 of unknown causes.Nineteen patients developed grade 3/4 neutrocytopenia,grade 3 acute esophagitis and pneumonitis were observed in 4 and 4 patients,respectively,and 1 patient died of pneumonitis.No patient developed cardiovascular toxicities and hemorrhage.Conclusions Endostar combined with CRCT for unresectable stage Ⅲ NSCLC was safe and the short term outcomes were promising.Further investigations are warranted.
RESUMEN
Objective To evaluate the toxicities and long-term survival of a pilot study of radical surgery followed by concurrent capecitabine and radiotherapy for stage Ⅱ/Ⅲ rectal cancer patients.Methods From March 1,2005 to December 31,2007,131 pathologically proved stage Ⅱ and Ⅲ rectal cancer patients received radical surgery followed by chemoradiotherapy and adjuvant chemotherapy.Capecitabine was delivered daily in twice,for 2 weeks followed by a 2nd cycle after a rest of 7 days during radiotherapy,with the dosage of 1600 mg/m2/d.Three-dimensional conformal radiotherapy was encouraged to the dose of 50 Gy in 25 fractions,and Oxaliplatin/5-fluorouracil or leucovorin based adjuvant chemotherapy was recommended.Results Grade 3 +4 toxicities during concurrent chemoradiotherapy were observed in 28.2％ of patients.The follow-up rate was 93.9％.The 3-year overall survival (OS),locoregional-free survival and distant metastasis-free survival rates were 85.1％,96.7％ and 79.5％,respectively.Among the 31 patients with relapse,5 had loco-regional recurrence and 28 had distant metastasis.Univariate analysis indicated that patients with low and moderate-low differentiated adenocarcinoma,no adjuvant chemotherapy,stage ⅢC disease or positive lymph node ratio (LNR) more than 30％ had lower OS ( x2 =15.49,15.85,8.80 and 9.76,P ＝ 0.000,0.000,0.011 and 0.002 ).Patients with N2 disease had more loco-regional recurrence.Patients with stage ⅢC,without adjuvant chemotherapy,or LNR more than 30％ were at higher risk of distant metastasis ( x2 =6.51,11.57 and 9.70,P =0.034,0.001 and 0.002 ).However,patients who didn ' t receive adjuvant chemotherapy were likely to have low differentiated adenocarcinoma and T4 stage disease ( x2 =7.20,6.48,P =0.027,0.039).Conclusions After radical surgery and concurrent eapecitabine and radiotherapy for stage Ⅱ/Ⅲ rectal cancer patients,loco-regional recurrence rate is pretty low.Distant metastasis is the main treatment failure.
RESUMEN
Objective To investigate the radiation-induced esophageal toxicities in Ⅲ stage non-small cell lung cancer (NSCLC) treated by three-dimensional conformal radiotherapy (3DCRT) combined with concurrent chemotherapy, and to find the relevant predictive factors. Methods From September 2006 to October 2007, 37 patients with stage Ⅲ NSCLC were treated by 3 DCRT (60 Gy in 30-34 fractions) con-currently with navelbine and cisplatin (NP). Chemotherapy was given in the first and fifth week. Univariate and multivariate analyses and receiver operating characteristic curves (ROC) were used to assess the associ-ation of radiation-induced esophagitis and correlated factors. Results Of all the patients, 91.89% (34/37) developed radiation-induced esophagitis, including grade 1 in 11 patients, grade 2 in 9, grade 3 in 14 and grade 4 in none. According to Spearman correlative analysis, the correlative factors included mean esophagus dose (MED), the LETT_(40)、LETT_(45)、LETT_(50)、LETT_(55)、LETT_60)of esophagus.All the 11 factors had good correlation with esophagitis in univariate analysis, while only V_55 was independ-ently associated with esophagitis in multivariate analysis. The ROC analysis indicated that the cut-off point of the curve was 30% with the area under ROC curve of 0.906, (P=0.000). Grade 2 or 3 radiation esophagi-tis occurred in all the patients with esophageal V_55 > 30%, while only in 36% ( 8/22 ) of those with V_55<30%. Conclusions 3DCRT combined with concurrent chemotherapy in patients with stage Ⅲ NSCLC could develop severe esophagitis. Dosimetric parameters (MED, LETT_(40),LETT_(45),LETT_(50),LETT_(55),LETT_(60),V_(40),V_(45),V_50,V_55,V_(60))are related with esophagitis,V_55 with V_55 > 30% being the most valuable predictor.
RESUMEN
Objective To evaluate the outcome of radiotherapy for locally advanced pancreatic cancer. Methods From January 2000 to December 2007,41 patients with inoperable locally advanced (stage Ⅲ) pancreatic cancer were treated with three-dimensional conformal radiation therapy(3DCRT) or intensity-modulated radiation therapy (IMRT). Among these patients, 30 received concurrent radio-chemo-therapy. Results The median survival time(MST) and 1-year overall survival were 9.2 months and 23%. Patients with pretreatment KPS≥80 ,no regional lymph nodes metastasis, and CR/PR after radiotherapy had better prognosis. The corresponding MSTs were 11.1 months vs 5.8 months (χ2 = 7.50, P = 0.006), 10. 8months vs 6.5 months (χ2 = 5.67, P = 0.017), and 19.5 months vs 9.1 months (χ2= 7.28, P = 0. 007), re-spectively. Concurrent radio-chemotherapy tended to improve the overall survival (χ2 = 3.25, P = 0. 072). After radiotherapy, 18 patients had clinical benefit response, mainly being abdominal pain relief. Neither grade 4 hematologic nor grade 3 non-hematologic toxicities were observed. Conclusions For patients with locally advanced pancreatic cancer, both 3DCRT and IMRT are effective in alleviation of disease-related symptoms. Patients with better porformance status before treatment, no regional lymph nodes metastasis, and better response to radiotherapy may have better prognosis. Concurrent radio-chemotherapy trend to improve overall survival when compared with radiotherapy alone.
RESUMEN
Objective To analyze the clinical results and prognostic factors of patients with early-stage primary gastric mucosa-associated lymphoid tissue(MALT) lymphoma. Methods Seventy-seven pa-tients with primary gastric MALT lymphoma treated from 1985 to 2006 were retrospectively analyzed. All pa-tients were pathologically confirmed as MALT lymphoma in stage Ⅰ ,Ⅱ and ⅡE (by modified Blackedge staging system). Thirty-seven patients had stage Ⅰ disease,23 stage Ⅱ and 17 stage ⅡE. Sixty patients un-derwent surgical resection and 17 received non-surgical treatment. Survival rates were calculated by the Kap-lan-Meier analysis with the Logrank test. Results With a median follow up of 57 months for the surviving patients(ranging from 1 to 198 months for all patients), the 5-year overall survival rate, disease-free survival rate,loco-regional control rate and distant metastasis free survival rate were 74% ,70% ,76% and 87% ,re-spectively. In univariate analysis, clinical stage was significantly associated with overall survival. Patients with stage Ⅰ or Ⅱ disease had a better overall survival than those with stage ⅡE (P = 0.01). Tumor size and surgical resection were significantly associated with disease-free survival. Patients with primary tumor 8 cm or less in diameter had better disease-free survival than those with primary tumor more than 8 cm in diameter(P =0.03). Patients who underwent complete resection had better disease-free survival than those who under-went incomplete resection or no surgery (P =0.02). Clinical stage, tumor size and surgical resection were significantly associated with loco-regional control. Patients with stage Ⅰ or Ⅱ disease had better loco-regional control than those with stage ⅡE (P = 0. 03). Patients with primary tumor 8 cm or less in diameter had better loco-regional control than those with primary tumor more than 8 cm in diameter(P =0.01). Patients who un-derwent complete resection had better loco-regional control than those who underwent incomplete resection or no surgery(P=0.03). Patients with stage Ⅰ and Ⅱ disease treated with surgery had more local recurrence, and patients treated without surgery tended to recur systematically. Patients with stage ⅡE disease tended to recur locally in spite of surgery or not. Conclusions The efficacy of surgical and non-surgical treatment for primary gastric MALT lymphoma are similar. Surgical resection is no longer a necessary approach in the primary treatment. Clinical stage is an important prognostic factor for primary gastric MALT lymphoma.
RESUMEN
PURPOSE: This study reports the results of the use of preoperative concurrent radiochemotherapy (CRCT) for the treatment of locoregionally advanced esophageal cancer. MATERIALS AND METHODS: From 1998 through 2005, 61 patients with intrathoracic esophageal cancer at stages II-IVB (without distant organ metastasis and presumed to be respectable) received preoperative CRCT. CRCT consisted of radiotherapy (45 Gy /25 fractions /5 weeks) and FP chemotherapy (5-FU 1 g/m2/day, days 1-4 and 29-32, Cisplatin 60 mg/m2/day, days 1 and 29). An esophagectomy was planned in 4~6 weeks after the completion of CRCT. RESULTS: There were two treatment-related deaths. Among the 61 patients, 53 patients underwent surgery and 17 patients achieved a pathological complete response (pCR). The overall survival (OS) rates of all 61 patients at 2 and 5 years were 59.0% and 38.0%, respectively. The rates of OS and disease-free survival (DFS) of the surgically resected patients at 2 and 5 years were 61.6%, 40.1% and 53.3%, 41.8%, respectively. By univariate analysis, achieviement of pCR and a clinically uninvolved distant lymph node (cM0) were favorable prognostic factors for OS and DFS. There were 27 patients that experienced a relapse-a locoregional relapse occurred in 5 patients, a distant metastasis occurred in 12 patients and combined failure occurred in 10 patients. CONCLUSION: The results of the current study are favorable. pCR and an uninvolved distant lymph node were found to be favorable prognostic factors.
Asunto(s)
Humanos , Quimioradioterapia , Cisplatino , Supervivencia sin Enfermedad , Quimioterapia , Neoplasias Esofágicas , Esofagectomía , Ganglios Linfáticos , Metástasis de la Neoplasia , Reacción en Cadena de la Polimerasa , Radioterapia , Recurrencia , Resultado del TratamientoRESUMEN
PURPOSE: To report the early results of preopeartive concurrent radio-chemotherapy (CRCT) for treating rectal cancer. MATERIALS AND METHODS: From June 1999 to April 2002, 40 rectal cancer patients who either had lesions with a questionable resectability or were candidates for sphincter-sacrificing surgery received preoperative CRCT. Thirty-seven patients completed the planned CRCT course. 45 Gy by 1.8 Gy daily fraction over 5 weeks was delivered to the whole pelvis in the prone position. The chemotherapy regimens were oral UFT plus oral leucovorin (LV) in 12 patients, intravenous bolus 5-FU plus LV in 10 patients, and intravenous 5-FU alone in 15 patients (bolus infusion in 10, continuous infusion in 5). Surgery was planned in 4~6 weeks of the completion of the preoperative CRCT course, and surgery was attempted in 35 patients. RESULTS: The compliance to the current preoperative CRCT protocol was excellent, where 92.5% (37/40) completed the planned treatment. Among 35 patients, in whom surgery was attempted after excluding two patients with new metastatic lesions in the liver and the lung, sphincter-preservation was achieved in 22 patients (62.9%), while resection was abandoned during laparotomy in two patients (5.7%). Gross complete resection was performed in 30 patients, gross incomplete resection was performed in one patient, and no detailed information on the extent of surgery was available in two patients. Based on the surgical and pathological findings, the down-staging rate was 45.5% (15/33), and the complete resection rate with the negative resection margin 78.8% (26/33). During the CRCT course, grade 3~4 neutropenia developed in four patients (10.8%). Local recurrence after surgical resection developed in 12.1% (4/33), and distant metastases after the preoperative CRCT start developed in 21.6% (8/37). The overall 3-years survival rate was 87%. CONCLUSION: Preoperative CRCT in locally advanced rectal cancer is well tolerated and can lead to high resection rate, down-staging rate, sphincter preservation rate, however, longer term follow-up will be necessary to confirm these results.
Asunto(s)
Humanos , Adaptabilidad , Quimioterapia , Fluorouracilo , Estudios de Seguimiento , Laparotomía , Leucovorina , Hígado , Pulmón , Metástasis de la Neoplasia , Neutropenia , Pelvis , Posición Prona , Neoplasias del Recto , Recurrencia , Tasa de SupervivenciaRESUMEN
Purpose:To evaluate the effect of late accelerated hyperfractionated radiotherapy (LCAHFR) combined with chemotherapy on advanced esophageal cancer.Methods:176 cases of advanced esophageal cancer were treated from March 1994 to March 1997.Patient were divided into 2 groups, including radiotherapy alone group (80 cases) receiving conventional irradiation to a total of 64～70 Gy and combined treatment group (96 cases) which received LCAHFR groups plus chemotherapy with PF regimen. Combined treatment group patients were treated with conventional fractionated radiotherapy during the firs two thirds of the treatment to a dose about 40 Gy/20 F/4 weeks. This was followed by accelerated hyper fractioned radiotherapy using reduced fields, twice daily at 1.5 Gy per fraction to a dose about 24～30 Gy.All cases of the combined treatment group were treated with PF(DDP 20 mg iv drip on days 1 to 5,and 5 FU 750 mg iv drip on days 1 to 5,Every 28 days as one cycle).All patients were followed for ≥ 5 years.Results:The short term results of LCAHFR combined with chemotherapy was better than that of radiotherapy alone. The difference between these two groups was statistically significant( P 0.05).The one , three and five year survival rate were 69.8%,51.1%,29.2% in combined group and 46.3%,21.3%,11.3% in simple irradiation alone group. The survival rates in the combined group were much better than those in simple radiotherapy group( P
RESUMEN
Purpose:To evaluate the efficacy of radiotherapy and chemotherapy in patients with stage Ⅰ and Ⅱ non small cell lung cancer.Methods:From 1991 to 1996,21 patients with stage Ⅰ and Ⅱ non small cell lung cancer were treated.According to the 1997 UICC Staging System, 3 patients had stage Ⅰb disease, 2 stage Ⅱa,and 16 stage Ⅱb.16 patients were confirmed by histopthology,and 5 cases by cytopathology.18 patients had squamous cell carcinoma,2 adenocarcinoma,and 1 mixed squamous cell and adenocarcinoma.21 patients were treated by 6 Mv X or 18 Mv X, received 56 Gy～70 Gy (total dose), at 2 Gy per day.Chemotherapy: 19 patients were treated by MVP(MMC?VDS?DDP). 2 squamous patients were not treated with chemotherapy.19 patients were treated with chemotherapy after radiotherapy 1～7 weeks,and were treated 1～5 cycles.Results:The overall 5 year survial for all patients was 19%.19 patients have died,13 died of tumor,and because of local failure and metastasis.6 patients died of other causes.Conclusions:Non operative treatment is an effective treatment for non small cell lung cancer.