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Objective:To investigate the effects of CT simulation positioning and three-dimensional conformal radiotherapy combined with regimen of paclitaxel and cisplatin (TP) on serum squamous cell carcinoma antigen (SCC) level and prognosis in patients with advanced esophageal cancer.Methods:A total of 80 cases of advanced esophageal cancer patients in People′s Hospital of Xinjiang Uygur Autonomous Region from June 2016 to October 2017 were selected and randomly divided into treatment group and control group, with 40 cases in each group. The control group was treated with CT simulation positioning three-dimensional combined cisplatin and Docetaxel, and the treatment group was treated with CT simulation positioning three-dimensional combined TP regimen. The clinical efficacy, tumor marker levels [serum SCC, carcinoembryonic antigen (CEA), carbohydrate antigen-199 (CA-199), human cytokeratin 21-1 fragment (CYFRA21-1)], Karnofsky functional status (KPS) score, Quality of Life(QOL) score, progression free survival period and incidence of adverse reactions were compared between the two groups.Results:After treatment, the total effective rate in the treatment group was 70.00%, which was significantly higher than 55.00% in the control group ( P<0.05); the levels of serum SCC, CEA, CA-199 and CYFRA21-1 in the two groups after treatment were significantly lower than those before treatment ( P<0.05), and those in the treatment group were significantly lower than those in the control group ( P<0.05); after treatment, the QOL and KPS scores in the two groups were significantly higher than those before treatment ( P<0.05), and the scores in the treatment group were significantly higher than those in the control group ( P<0.05); The progression free survival time in the treatment group was significantly longer than that in the control group ( P<0.05); The incidence of adverse reactions in the treatment group was 15.00%, which had no significant difference compared with 25.00% in the control group ( P>0.05). Conclusions:CT simulation positioning three-dimensional combined with TP regimen in the treatment of advanced esophageal cancer has obvious effect, can effectively reduce the level of tumor markers, improve the patient′s physical function and quality of life, improve prognosis , and does not increase the survival rate of adverse reactions, which is safe and effective.
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Objective To observe the long?term survival and adverse reactions in patients with stage T4 N (+) Ⅲ middle and lower thoracic esophageal carcinoma undergoing intensity?modulated radiotherapy ( IMRT) . Methods From 2004 to 2010, 300 patients with stage T4 N (+) Ⅲ middle and lower thoracic esophageal carcinoma, consisting of 202 treated with three?dimensional conformal radiotherapy ( 3DCRT ) and 98 treated with IMRT, were enrolled as subjects. All patients received conventionally fractionated radiotherapy with a prescribed dose of 60 Gy. The long?term survival and adverse reactions were compared between patients treated with the two different radiotherapy regimens. The survival rates were calculated by the Kaplan?Meier method and analyzed by the log?rank test. Results The 5?and 7?year sample sizes were 239 and 120, respectively. The 3DCRT group had significantly lower 1?, 3?, 5?, and 7?year local control (LC) and overall survival (OS) rates than the IMRT group (64. 4% vs. 68. 3%, 40. 6% vs. 55. 3%, 38. 3% vs. 51. 9%, 34. 2% vs. 51. 9%, P=0. 048;54. 5% vs. 63. 3%, 19. 8% vs. 34. 7%, 14. 7% vs. 24. 4%, 10. 9% vs. 20. 3%, P=0. 013) . The stratified analysis showed that for patients older than 65 years, with the length of esophageal lesion>8. 0 cm before radiotherapy, the largest diameter of esophageal lesion in computed tomography image>4. 6 cm, gross tumor volume ( GTV)>60 cm3 , metastases to adjacent tissues or organs, stage N2 , and without chemotherapy, the IMRT group had a significantly higher OS rate than the 3DCRT group (P=0. 022,0. 003,0. 022,0. 034,0. 016,0. 044,0. 047). The GTV Dmin and GTVD100 were significantly higher in the IMRT group than in the 3DCRT group ( P=0. 000,0. 000) , while the Dmax of the spinal cord was significantly lower in the IMRT group than in the 3DCRT group ( P=0. 000) . Compared with the 3DCRT group, the IMRT group had a significantly higher incidence of acute radiation?induced esophagitis, particularly grade 1?2 esophagitis (P=0. 000). The mortality rate caused by local tumor was significantly higher in the 3DCRT group than in the IMRT group ( P= 0. 039 ) . Conclusions In the treatment of locally advanced middle and lower thoracic esophageal carcinoma, IMRT is safe and effective;it significantly improves the LC rate and long?term survival without severe toxicity to normal tissues. The results of this retrospective study need to be confirmed by prospective randomized controlled studies.
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Objective To explore the dosimetric difference between different radiotherapy technologies in the treatment of early peripheral stage non?small ?cell lung cancer ( NSCLC ) . Methods Four?dimensional computed tomography scans and delineation of target volumes and organs at risk ( OARs) were performed in 5 patients pathologically diagnosed with stage T1/T2 peripheral NSCLC who were admitted from 2014 to 2015. Target volumes contained gross tumor volume (GTV), internal target volume (ITV), and planning target volume (PTV). ITV was contoured on the maximum intensity projection images. PTV was defined as ITV plus a 5 mm margin. OARs contained the heart, lung, esophagus, and spinal cord. The Monaco 5. 0 treatment planning system was used to design three plans. The three?dimensional conformal radiotherapy (3DCRT) plan had 11 fields in the diseased lung covering the PTV plus a 0. 2 cm margin. The sliding window intensity?modulated radiotherapy ( SW?IMRT ) plan had 9 fields in the same areas as the 3DCRT plan. The volumetric modulated arc therapy ( VMAT) plan had the gantry rotating 180° around the diseased lung. The evaluation criteria referred to the RTOG 0618 trial. Comparison was made by paired t test. Results The SW?IMRT plan had a significantly better homogeneity index than the 3DCRT plan ( 1. 03 vs. 1. 24,P= 0. 017 ) . Compared with the VMAT plan, the mean monitor units in the 3DCRT plan was significantly reduced by 24. 5%( P=0. 022) . The V30 and V40 of the 3DCRT plan were significantly reduced by 29. 4% and 28. 4%, respectively, compared with the SW?IMRT plan ( P=0. 003,0. 006) and 56. 7%and 59. 7%, respectively, compared with the VMAT plan ( P=0. 041,0. 019) . Conclusions 3DCRT may be an appropriate radiotherapy method for early stage NSCLC.
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[ Abstract] Objective To investigate the clinical efficacy of preoperative three-dimensional radiotherapy (3DRT) with or without concurrent chemotherapy for esophageal carcinoma.Methods We retrospectively analyzed 103 esophageal carcinoma patients who received preoperative 3DRT with or without concurrent chemotherapy from 2004 to 2014 in Cancer Hospital CAMS.The median radiation dose was 40 Gy, and the TP or PF regimen was adopted for concurrent chemotherapy if needed.The overall survival (OS) and disease-free survival ( DFS) were calculated by the Kaplan-Meier method, and the survival difference and univariate prognostic analyses were performed by the log-rank test.The Cox proportional hazards model was used for multivariate prognostic analysis.Results The number of patients followed at 3-years was 54.The 3-year OS and DFS rates were 61.1% and 54.9%, respectively, for all patients.There were no significant differences between the 3DRT and concurrent chemoradiotherapy (CCRT) groups as to OS (P=0.876) and DFS (P=0.521).The rates of complete, partial, and minimal pathologic responses of the primary tumor were 48.0%, 40.2%, and 11.8%, respectively.There were significant differences in OS and DFS between the complete, partial, and minimal pathologic response groups (P=0.037 and 0.003). No significant difference in pathologic response rate was found between the 3DRT and CCRT groups (P=0.953).The lymph node metastasis rate was 26.5%, and this rate for the complete, partial, and minimal pathologic response groups was 14%, 30%, and 67%, respectively, with a significant difference between the three groups (P=0.001).The OS and DFS were significantly higher in patients without lymph node metastasis than in those with lymph node metastasis (P=0.034 and 0.020).The surgery-related mortality was 7.8% in all patients.Compared with the 3DRT group, the CCRT group had significantly higher incidence rates of leukopenia (P=0.002), neutropenia (P=0.023), radiation esophagitis (P=0.008), and radiation esophagitis ( P=0.023).Pathologic response of the primary tumor and weight loss before treatment were independent prognostic factors for OS and DFS (P=0.030,0.024 and P=0.003,0.042). Conclusions Preoperative 3DRT alone or with concurrent chemotherapy can result in a relatively high complete pathologic response rate, hence increasing the survival rate.Further randomized clinical trials are needed to confirm whether preoperative CCRT is better than 3DRT in improving survival without increasing the incidence of adverse reactions.
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Objective To evaluate the safety of helical tomotherapy (HT) for hepatocellular carcinoma confined to the liver,and to investigate the efficacy of HT by comparison with three-dimensional conformal radiotherapy (3DCRT).Methods In June 2011,hypofractionated HT was performed in 35 patients with unresectable hepatocellular carcinoma confined to the liver who had no distant metastasis or tumor thrombosis.The dose in each fraction increased from 2.4 Gy to 5.0 Gy with a median dose of 3.2 Gy.The median dose for the total treatment was 50.0 Gy.Within the same period,45 patients received conventionally fractionated 3DCRT with a median dose of 54.0 Gy.The adverse reactions,clinical outcomes,and survival time were compared between the two groups.The survival rate was calculated with Kaplan-Meier method,and log-rank test was used to estimate statistical significance of survival differences.Multivariate analysis of survival was carried out with Cox' s regression model.Results There were no significant differences in adversc reactions between the two groups.The objective response rate was significantly higher in the HT group than in the 3DCRT group (60％ vs.33％,P=0.024).There was no significant difference in the disease control rate between the two groups (94％ vs.89％,P=0.459).The HT group showed significantly higher 1-,2-,and 3-year overall survival rates than the 3DCRT group (97％ vs.80％,P=0.025;81％ vs.55％,P =0.008;67％ vs.50％,P =0.048).The multivariate analysis indicated that tumor smaller than 8 cm,transarterial chemoembolization before radiotherapy,and HT were associated with improved survival (P=0.005;P =0.000;P=0.002).Conclusions HT shows an advantage in precise treatment of hepatocellular carcinoma confined to the liver.With acceptable toxicity,hypofractionated HT shortens the treatment duration and improves the survival in patients.
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Objective To evaluate the efficacy of three-dimensional conformal radiotherapy (3DCRT) and prognostic factors for stage Ⅲ non-small cell lung cancer (NSCLC).Methods From 2000 to 2010,474 patients with stage Ⅲ NSCLC undergoing 3DCRT were enrolled as subjects.Those patients,consisting of 382 males and 92 females,had a median age of 63 years.In those patients,211 had stage ⅢA NSCLC and 263 had stage ⅢB NSCLC;165 were treated with radiotherapy alone and 309 with chemoradiotherapy;55 were treated with conventional radiotherapy plus 3DCRT,340 with 3DCRT,and 79 with intensity-modulated radiotherapy;the median equivalent dose was 60 Gy (44-77 Gy).The Kaplan-Meier method,log-rank test,and Cox model were used for survival rate calculation,univariate analysis,and multivariate analysis,respectively.Results The follow-up rate was 96.6％.In all patients,the 1-,3-,and 5-year overall survival rates were 63.0％,24.9％,and 17.8％,respectively;the median survival time was 18 months.The univariate analysis showed that sex,age,immediate response,radiotherapy method,fractionation scheme,chemotherapy,and radiation pneumonitis (RP) were prognostic factors (P=0.004,0.001,0.000,0.007,0.004,0.009,0.049).The multivariate analysis showed that sex,age,immediate response,radiotherapy method,and RP were independent prognostic factors (P=0.006,0.000,0.000,0.003,0.048).Patients with radiation doses of 60-66 Gy had the best prognosis of all.Conclusions In patients with stage Ⅲ NSCLC undergoing 3DCRT,female patients,patients at a young age,patients with satisfactory immediate response,patients treated with full-course 3DCRT,and patients with grade 0-1 RP have better prognosis than others.3DCRT combined with chemotherapy improves survival in patients.A radiation dose of 60-66 Gy is recommended.
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Objective To determine the maximum tolerated dose ( MTD) and dose?limiting toxicity ( DLT) of weekly PTX and DDP concurrent postoperative radiotherapy in Chinese women with high?and intermediate?risk early cervical cancer. Methods Women with high risks postoperative cervical carcinoma, ECOG≤2 were eligible. Pelvis RT (6/10 MV X?ray,3DCRT 40 Gy/20f,para?metrial boost 10?20 Gy/5?10f) was followed by 2?4f brachytherapy applications ( 192 Ir,5 Gy/f) . Concurrent weekly chemotherapy was started at DDP 20 mg/m2 and PTX 10 mg/m2 weekly,and escalated in three?patient cohorts according to 3+3 methods. Results 25 patients were enrolled and treated over seven doses levels until dose?limiting toxicity (DLT) was reached. Median age was 48 years (range,34?66).All of patients finished RT in 7 weeks. Grade 3,4 non?hematologic toxicities were diarrhea and observed in two patients (4 cycles,DLT) at level 7.Grade 3,4 hematologic,principally leukopenia and neutropenia,and occurs late cycles. One grade 4 leukopenia and neutropenia was observed at dose level 6 but not seen in three additional patients. No one was delayed treatment time by concurrent chemotherapy.22 patients finished 6 cycles. Median follow?up is 59. 5 months. Three patients have died of cancer metastasis and recurrence. One patient has died of respiratory failure. Conclusions Combination PTX and DDP administered concurrently with pelvic EBRT can be safely administered at the MTD of DDP 35 mg/m2 and PTX 30 mg/m2 weekly for six cycles in Chinese women with postoperative cervical cancer.
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Objective To evaluate the efficacy and adverse effects of radical three-dimensional conformal radiotherapy (3DRT) alone or combined with chemotherapy in elderly patients (≥70 years) with esophageal cancer.Methods The clinical data of 116 esophageal cancer patients who were aged 70 years or older and received radical 3DRT ± chemotherapy from 2008 to 2013 were retrospectively analyzed.Of the 116 patients,32 received concurrent chemoradiotherapy,24 received sequential chemoradiotherapy,and 60 received radiotherapy alone.Overall survival (OS) and progression-free survival (PFS) rates were determined using the Kaplan-Meier method,and survival difference analysis and univariate prognostic analysis was performed using the log-rank test.Multivariate prognostic analyses were performed using the Cox proportional hazard model.Results The follow-up rate was 100％.The 2-and 3-year sample sizes were 102 and 77,respectively.The 1-,2-,and 3-year OS rates were 59.1％,38.4％,and 23.2％,respectively,and the PFS rates were 61.9％,37.9％,and 0％,respectively.The median OS for the patients treated with concurrent chemoradiotherapy,sequential chemoradiotherapy,and radiotherapy alone were 22.3,18.0,and 12.4 months,respectively (P =0.044).The median OS was significantly different between patients treated with 60 Gy and ＜60 Gy in radiotherapy (24.7 vs.10.9 months,P =0.036),but not significantly different between those treated with 60 Gy and ＞ 60 Gy (24.7 vs.18.7 months,P =0.938).Multivariate analysis indicated that sex,presence or absence of combined chemotherapy,and radiotherapy dose were independent influencing factors for OS (P=0.003,0.042,and 0.037,respectively).Conclusions Radical 3DRT ± chemotherapy are well tolerated in elderly patients with esophageal cancer and equally effective as in those younger than 70 years.Patients treated with radical concurrent chemoradiotherapy have a better prognosis than those treated with sequential chemoradiotherapy and radiotherapy alone.Radiotherapy with a dose of 60 Gy effectively improves the survival compared with doses less than 60 Gy,which suggests that 60 Gy is the optimal dose in radiotherapy.
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Objective To investigate the efficacy and safety of three?dimensional radiotherapy (3DRT) with concurrent chemotherapy for stage IV non?small?cell lung cancer ( NSCLC). Methods A total of 198 eligible patients from 2008 to 2012 were enrolled as subjects. With an age ranging between 18 and 80 years and a Karnofsky Performance Status ( KPS) score of 70 or more, those patients had no contraindication for radiotherapy and chemotherapy, and were newly diagnosed with stage IV NSCLC confirmed by histology or cytology, as well as limited metastatic disease (≤3 organs). Survival rates and acute toxicities in those patients were evaluated. Results The 3?year follow?up rate was 98?? 5% and the 3?year sample size was 165. The median overall survival (OS) and progression?free survival (PFS) were 13?? 0 months (95% CI,11?? 7 ?14?? 3 months) and 9?? 0 months (95% CI,7?? 7 ?10?? 3 months), respectively, while the 1?, 2?, and 3?year OS rates were 53?? 5%, 15?? 8%, and 9?? 2%, respectively. Multivariate analysis showed that a primary tumor volume smaller than 134 cm3 , a stable or increased KPS score after treatment, and a radiation dose of 63 Gy or more were independent prognostic factors for longer survival time ( P=0?? 008;P= 0?? 010;P= 0?? 014). The incidence rates of grade 3?4 neutropenia, thrombocytopenia, anemia, grade 3 radiation esophagitis, and grade 3 radiation pneumonitis were 37?? 9%, 10?? 1%, 6?? 9%, 2?? 5%, and 6?? 6%, respectively. The main cause of death was distant metastasis, and only 10% of the patients died of recurrence alone. Conclusions 3DRT with concurrent chemotherapy achieves satisfactory treatment outcomes with tolerable toxicities for stage IV NSCLC. Primary tumor volume, change in the KPS score after treatment, and radiation dose are independent prognostic factors for OS.Clinical Trial Registry Chinese Clinical Reistry,registration number:ChiCTRC10001026.
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Objective To evaluate the safety and feasibility of three-dimensional conformal radiation therapy combined with tegafur in treating locally recurrent rectal cancer. Methods A total of 32 patients with locally recurrent rectal cancer were treated with chemoradiotherapy ( CRT) . Radiotherapy was delivered to a total of 45 Gy in 25 fractions followed by a boost of 18 Gy in 10 fractions using three dimensional radiotherapy planning. Tegafur was given orally[80 mg·(m2)-1·d-1] on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40, and 43-47 during radiotherapy. Results Most of the adverse effects were mild. Grade 3-4 toxic effects occurred in 12. 5% of patients. Thirty-one patients completed full course of CRT, while one patient discontinued chemotherapy due to Grade 4 thrombocytopenia. There were 3 cases (9. 4%) with complete response, 21 cases (65. 6%) with partial response, and the overall response rate was 75. 0%. Overall pain response (complete and partial pain relief) was achieved in 96. 9% of patients. The 1- and 2-year overall survival rate was 71. 0% and 56. 5%, respectively. Conclusion 3D-CRT combined with tegafur for locally recurrent rectal cancer is feasible with high patient compliance and tolerable toxicities.
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Objective To investigate the long-term survival of esophageal squamous cell carcinoma (ESCC) patients of different ages after three-dimensional conformal radiotherapy (3 DCRT).Methods From July 2003 to September 2008,769 patients with stage Ⅰ-Ⅲ ESCC were eligible for the analysis.All patients were treated with 3DCRT.The prescribed dose was 50-70 Gy (median,60 Gy),1.8-2.0 Gy per fraction,5 fractions per week.The Kaplan-Meier method was used to calculate overall survival (OS) and local control (LC) rates; the log-rank test was used for survival difference analysis and univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis.Results The follow-up rate was 98.3％.For all patients,the 1-,3-,and 5-year LC rates were 76.3％,52.8％,and 48.5％,respectively,and the 1-,3-,and 5-year OS rates were 70.1％,36.2％,and 23.0％,respectively.The 1-,3-,and 5-year OS rates were 71.2％,38.8％,and 24.9％,respectively,for patients aged 45-74 years,versus 69.6％,26.6％,and 15.4％ for patients aged 75-89 years (P =0.008).Multivariate prognostic analysis showed that age was also a prognostic factor in ESCC patients after 3DCRT.A total of 620 patients died.Patients aged 45-74 years had a significantly higher proportion of individuals that died of distant metastasis (23.9％ vs.14.2％,P =0.009),while patients aged 75-89 years had a significantly higher proportion of individuals that died of non-cancer diseases (14.1％ vs.4.9％,P=0.000).Conclusions Survival varies between ESCC patients of different ages after 3DCRT.The survival of elderly ESCC patients is poor,and the relatively high mortality from non-cancer diseases may be an important reason for poor survival.
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Objective To evaluate the role of thoracic three-dimensional conformal radiotherapy (3DCRT) in patients with extensive-stage small cell lung cancer (ES-SCLC).Methods A total of 171 patients with ES-SCLC admitted from 2004 to 2009 were included in the study.Eighty-six patients received thoracic 3DCRT and systemic chemotherapy (CT),while 85 patients received systemic CT alone.3DCRT was delivered at 1.5 Gy/fraction twice daily or 2.0 Gy/fraction once daily,with a total dose ranging from 40 to 62 Gy.The CT regimen consisted of carboplatin/cisplatin and etoposide.The survival time and survival rate were calculated by the Kaplan-Meier method,and the log-rank test was used for univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis.Results The follow-up rate was 100％.The median overall survival (OS) time and the 2-and 5-year OS rates were 15 months,31.5％,and 2.4％,respectively,for all patients;they were 18 months,35.3％,and 2.4％,respectively,for the CT/3DCRT group,versus 12 months,14.5％,and 2.4％ for the CT group (P =0.023).The median progression-free survival (PFS) time and the 1-and 2-year PFS rates were 8 months,27.5％,and 2.4％,respectively,for all patients;they were 9 months,35.4％,and 6.0％,respectively,for the CT/3DCRT group,versus 6 months,20.5％,and 6.0％ for the CT group (P =0.004).In the CT/3DCRT group,the 22 patients who received 45 Gy at 1.5 Gy/fraction twice daily had a median PFS time of 11 months,versus 9 months for the 26 patients who received 60 Gy at 2.0 Gy/fraction once daily (P =0.037).Multivariate analysis revealed that receiving ≥ 4 cycles of CT (P =0.001) and 3DCRT (P =0.008) were favorable prognostic factors for OS.Conclusions Thoracic 3DCRT can improve the OS and PFS in patients with EDSCLC,and it has good efficacy when delivered with a total dose of 45 Gy at 1.5 Gy/fraction twice daily.Thoracic 3DCRT and receiving ≥4 cycles of CT are independent favorable prognostic factors for OS.
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Objective To evaluate the effect of GTV volume on response of esophageal carcinoma.Methods From Jan.2004 to Dec.2008,72 cases newly diagnosed N0 stage thoracic esophageal carcinomas were included in this retrospective study.All treatment plans were set up and designed by CT simulator and 3D TPS.They received dose 56-70 Gy/27-33F/6-7w with 6MV X-ray.The GTV,the tumor length and maximum diameters were measured on the treatment planning system with the X-ray.RECIST standard was applied to evaluate the radiotherapy response of esophageal carcinoma.The effectiveness of related prognostic factors on survival was evaluated by univariate analyses.Results The short-term response with CR were 79％ with length ＜ 5 cm,48％ with 5-7 cm and 26％ with length ＞7 cm(P =0.003).The 1-,2-,3-and 5-year survival rates were 93％,79％,69％,69％ ; 91％,61％,46％,46％ and 80％,46％,28％,22％ (P =0.037).The short-term response with CR were 56％ with maximum diameters ≤3 cm and 33％ with maximum diameters ＞ 3 cm(P =0.033).The 1-,2-,3-and 5-year survival rates were 91％,72％,55％,37％ and 80％,45％,30％,30％ (P =0.037).The short-term response with CR were 52％ with GTV volume≤40 cm3 and 30％ with GTV volume ＞40 cm3(P =0.059).The 1-,2-,3-and 5-year survival rates were 91％,67％,51％,41％ and 80％,43％,27％,27％ (P =0.047).In the multivariate analysis,the length of GTV was likely to be the most important factor for the short-term response(P =0.005,0.014).Conclusions GTV volume,the tumor length and maximum diameters are factors for short-term response of N0 stage esophageal carcinoma.The GTV length is independent prognostic factor.The GTV length is the worse the prognosis will be.
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Objective To investigate the role of three-dimensional (3D) radiotherapy to the thoracic primary tumor in non-small cell lung cancer (NSCLC) patients with bone metastases during chemotherapy with concurrent 3D radiotherapy.Methods From 2003 to 2010,the clinical data of 95 stage Ⅳ NSCLC patients with bone metastases were collected.All patients received 3D radiotherapy to the thoracic primary tumor and at least 2 cycles of chemotherapy.Of the 95 patients,47 had only bone metastases,and 48 had metastases to bones and other organs.The Kaplan-Meier method was used to calculate overall survival (OS) rates.The log-rank test was used for survival difference analysis and univariate prognostic analysis.The Cox regression model was used for multivariate prognostic analysis.Results The follow-up rate was 95％.The 1-,2-,and 3-year OS rates were 44％,17％,and 9％,respectively.The univariate analysis showed that radiation dose to the planning target volume (PTV) of primary tumor of ≥ 63 Gy,response to treatment of primary tumor,and at least 4 cycles of chemotherapy were favorable prognostic factors for OS in all patients (P =0.001,0.037,and 0.009).Radiation dose to the PTV of primary tumor of ≥ 63 Gy remained the favorable prognostic factor for OS in patients with only bone metastases and those with metastases to bones and other organs (P =0.045 and 0.012).Among patients with only bone metastases,those with T1 + T2 primary tumors had longer OS than those with T3 + T4 primary tumors (P =0.048).The multivariate analysis showed that radiation dose to the PTV of primary tumor of ≥ 63 Gy and metastases to bones only were independent favorable prognostic factors for OS in all patients (P =0.036 and 0.035).Conclusions For NSCLC patients with bone metastases,3D radiotherapy to the thoracic primary tumor and its dose play an important role in improving OS during chemotherapy with concurrent 3D radiotherapy.
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ObjectiveTo prospectively investigate the impact of short-time response on survival of concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT) for stage Ⅳ non-small cell lung cancer (NSCLC). Methods From Jan.2003 to Oct.2010,201 patients with pathologically or cytologically proven stage Ⅳ NSCLC were included.All patients received platinum-based chemotherapy.Of the 167 patients eligible for analysis,the median number of chemotherapy were 4 cycles.The median dose for planning target volume (PTV) of thoracic primary tumor was 63 Gy.Response was scored according to WHO criteria. Survival was calculated by Kaplan-Meier method and compared using the Logrank. Cox regression model were used to examine the effect of response on overall survival.ResultsThe follow-up rate of 201 patients was 97.5％.with 201,170 and 134 patients finished ＜ 1,1 -2 and ≥3 years' follow-up.For the 167 patients eligible for analysis,the CR,PR,NC and PD rate of primary tumor was 5.4％,65.9％,21.0％ and 7.7％,respectively.The effective group ( CR + PR) and ineffective group ( NC + PD) was 71.3％ and 28.7％,respectively.The median survival time (MST) for patients with CR,PR,NC and PD was 22.6,13.4,8.8 and 4.8 months,respectively ( χ2 =44.79,P =0.000).The MST for effective and ineffective group was 13.9 and 7.6 months,respectively in the whole group ( χ2 =8.3 0,P =0.004 ),12.1months and 7.3 months in those treated with 2 - 3 cycles chemotherapy ( χ2 =7.71,P =0.007 ),and 13.9months and 7.9 months in those treated with 2 -5 cycles chemotherapy and radiation dose to PTV ≥36 Gy ( χ2 =4.00,P =0.045 ).No significant MST difference was detected between patients of effective group and ineffective group treated with 4 -5 cycles chemotherapy ( χ2 =0.67,P =0.413),or those treated with 4 -5 cycles of chemotherapy and radiation dose to primary lesion ≥36 Gy (χ2 =0.00,P =0.956).Multivariate analysis showed that 4-5 cycles of chemotherapy and CR and PR achieved in primary tumor (β =0.182,P=0.041 ) were independent favorable factors for survival. Conclusion CCTTRT can improve local control,and prolong the survival time for Stage Ⅳ NSCLC.
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ObjectiveTo study the feasibility of RapidArc (RA) associated with active breath coordinator (ABC)for hepatocelluar carcinoma (HCC)radiotherapy comparing of three-dimensional conformal radiotherapy (3DCRT),intensity modulated radiotherapy (IMRT),RA treatment plans in different breath status.Methods12 HCC cases were selected.Three series CT scanning were completed in Free Breathing (FB),End Inspiration Hold (EIH) and End Expiration Hold (EEH) associated with ABC device.3DCRT,IMRT and RA (three 135° arcs) treatment plans were respectively designed on planning target volume (PTV) in different breath status.The dosimetric differences among 3 DCRT,IMRT and RA,among RA plans under different breath status were compared.ResultsThe PTV in FB was larger than in EEHand EIH (160.8 cm3,89.5 cm3,83.1 cm3,F=6.63,P=0.004). The conformity index and homogeneity index of RA plans were better than IMRT and 3DCRT ( 0.92,0.90,0.77,F =72.55,P =0.000 ;0.90,0.89,0.84,F =125.49,P =0.000 ) ;the V20,V30,V40 of normal liver in 3DCRT were higher than IMRT and RA (24％,20％,19％,F=3.56,P =0.032;13％,10％,10％,F=5.74,P =0.004;8％,5％,6％,F =3.72,P =0.027).The normal liver mean dose,V10,V20,V30,V40 of RA plans in FB were higher than in EEH and EIH ( 13.46 Gy,10.25 Gy,9.48 Gy,F =3.627,P =0.038 ;46％,35％,32％,F =2.96,P=0.066;24％,16％,16％,F=3.69,P=0.036;13％,8％,8％,F=4.28,P=0.022;8％,5％,5％,F =2.39,P =0.108 ).The duodenum D5 cm3 of RA in EEH was lower than in FB and EIH (8.78 Gy,19.35 Gy and 11.67 Gy,F =1.56,P =0.224 ).The mean monitor units for 3 DCRT,IMRT,RA was 254.06 MU,626.33 MU and 550.28 MU ( F =147.35,P =0.000 ),while the mean treatment time was 135 s,540 s and 130 s respectively (F =62.83,P =0.000).ConclusionsThe RapidArc applying three 135°arcs with ABC in HCC radiotherapy can achieve better PTV coverage than IMRT with fewer monitor units,shorter treatment time and sparing more normal liver.
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ObjectiveTo explore the effect of radiation dose on survival for stage Ⅳ non-small cell lung cancer (NSCLC) treated with concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT).Methods From Jan.2003 to Jul.2010,201 Stage Ⅳ NSCLC patients were enrolled.Nineteen patients who received only one cycle chemotherapy were not included in survival analysis.Of the 182 patients eligible for survival analysis,all patients received platinum-based chemotherapy of two drugs.The median number of cycles was 4.The median dose to planning target volume of primary tumor ( DTPTV )was 63 Gy. Survival was calculated by Kaplan-Meier method and compared using the Logrank. Cox regression models were used to examine the effect of DTPTV on overall survival.ResultsThe follow-up rate of 201 patients was 97.5％.with 201,170 and 134 patients finished ＜ 1,1 -2 and ≥3 years' follow-up.The 1-,2-,3-year overall survival rate and median survival time was 20％,14％,0％ and 7.1 months;27％,10％,3％ and 9.6 months;and 59％,22％,16％ and 14.9 months,respectively for patients treated with DTPTV ＜ 45.0 Gy,45.0 - 62.1 Gy and ≥63.0 Gy,respectively ( χ2 =27.88,P =0.000 ) ;43％,19％,0％and 1 1 months and 2 0 ％,1 1％,5 ％ and 8 months,respectively for those received 2 - 3 cycles of chemotherapy and radiation dose ≥63 Gy and ＜ 63 Gy,respectively (χ2 =2.99,P =0.084) ;66％,23％,19％ and 16 months and 29％,12％,0％ and 8.8 months,respectively for those received 4 - 5 cycles chemotherapy and radiation dose ≥ 63 Gy and ＜ 63 Gy,respectively (χ2=15.87,P=0.000).No significant difference was found for patients received 2 - 3 cycles chemotherapy concurrently with DTP,Tv ≥63 Gy and 4 -5 cycles chemotherapy concurrently with DTPTV ＜63 Gy,respectively (χ2 =1.93,P =0.165).Multivariate analysis showed that 4 -5 cycles chemotherapy concurrently with DTPTv ≥63 Gy ( β =0.243,P =0.019),and improved KPS after treatment ( β =1.268,P =0.000) were independent favorable factors for survival.ConclusionChemotherapy concurrent with CCTTRT can prolong survival time of patients with stage Ⅳ NSCLC,especially for those treated with DTPTV ≥63 Gy.
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ObjectiveTo explore the feasibility,efficacy and cosmetic effect of three-dimensional conformal external beam partial breast irradiation (EB-PBI) after breast-conserving surgery for the selected Chinese early stage breast cancer patients.MethodsFrom June 2003 to December 2010,Forty-four early stage breast cancer patients underwent EB-PBI after breast-conserving surgery.Twenty patients had CT simulation scan in moderate deep inspiration breathing hold,and twenty-four patients in free breathing.EB-PBI was planned and delivered by three-dimensional conformal radiotherapy (3DCRT)with four noncoplanar beams.The prescribed dose was 3.40 Gy per fraction in thirty-nine patients and 3.85 Gy per fraction in five patients,twice per day at an interval of at least six hours,in five consecutive days.Results The number of patients with follow up time of 2,3 and 5 years were 39,31 and 16.Grade 1 acute radiationinduced dermatitis was observed in 17 patients (39％) at three months.Cosmesis was good or excellent in all cases at six months after radiotherapy and in 95％ cases at two years after radiotherapy.The 2-,3-and 5-year local control rates were 100％,99％ and 94％,respectively.The 2-,3-,and 5-year survival rates were all 100％ and no metastases occurred.Conclusions EB-PBI delivered by 3DCRT is feasible for selected Chinese early stage breast cancer patients after breast-conserving surgery.The cosmetic effect,local control rate and long-term survival rate are satisfactory,and acute radiation toxicity is very low.
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ObjectiveTo determine the maximal tolerated dose and the dose-limiting toxicity of hydroxycamptothecin (HCPT)concurrently combined with three-dimensional conformal radiotherapy (3DCRT) for unresectable or locally relapsed rectal cancer.Methods Twenty-two patients with rectal cancer were enrolled into phase Ⅰstudy between 2004 -2007. HCPT was intravenously administered concurrently with 3DCRT weekly,dose given from 6,8,10 mg/m2 or twice a week,dose given from 4,6,8,10 mg/m2,respectively.Total radiation dose of 50 Gy was delivered to the whole pelvis at a fraction of 2 Gy per day for 5 weeks,with 10 - 16 Gy subsequent boost to tumor area.Dose-limiting toxicities (DLT) were defined as grade 3 or higher non-hematologic toxicity or grade 4 hematologic toxicity.ResultsIn the twice a week group,DLTs of grade 3 diarrhea were observed in 2 patient treated at dose of 6 mg/m2.In the weekly group,DLTs of grade 3 diarrhea and radiation-induced dermatitis were observed in Ⅰ patient at dose of 8mg/m2,and were not observed in the next 3 patients at the same dose level.However,at dose of 10 mg/m2,2 patients had grade 3 diarrhea or nausea.The 5-year overall survival rate was 23％ and the median survival time was 18 months.ConclusionsHCPT given concurrently with 3DCRT is safe and tolerable for patients with unresectable or locally relapsed rectal cancer.Either 8 mg/m2 weekly or 4 mg/m2 twice a week can be recommended for further study.The dose-limiting toxicities are grade 3 diarrhea,nausea and radiation-induced dermatitis.
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ObjectiveThe study is to investigate the predictive values of dosimetric parameters and patient related factors in severe acute radiation pneumonitis (SARP) after concurrent chemoradiotherapy in non-small cell lung cancer (NSCLC).Methods In all,147 NSCLC patients treated with concurrent chemotherapy and 3DCRT between 2006 and 2010 was collected.Independent sample t test was used to compare parameter values between patients with SARP and those without SARP.Logistic regression was used to identify significant determined factor.Predictive value of each parameter was tested by ROC analysis.Pearson correlation was used to analyze correlations between parameters.Represent factors were identified by factor analysis.ResultsThe incidence of SARP was 9.5％ ( 14/147 ).The means lung dose (MLD),V20,V30,V40,and V50 ( x2 =4.87 -6.84,P =0.009 -0.025,respectively ) were determining factors for SARP.Our datasets shows that for SARP ＜5％,MLD,V20,V30,V40 and V50 should be ≤16.77 Gy,V20≤34.15％,.V30 ≤23.62％,.V40 ≤ 18.57％,V50 ≤ 13.02％.ROC analysis show that areas under MLD,V20,V30,V40 and V50 curves was corresponding to 0.678,0.661,0.667,0.677,and 0.651,respectively.In addition,the sensitivity and specificity of each parameter at cutoff values are:78.0％ and 48.1％ for MLD;42.9％ and 82.0％ for V2o ;78.6％ and 52.9％ for V30 ;71.4％ and 61.7％ for V40,and 57.1％ and 67.7％ for V50.Factor analysis suggest that we can choose 1 or 2 parameters from MLD,V20,or V30,and another from V40 or V50 for predicting.The incidence of SARP was greater in patients with tumorsin right lower lung than other locations ( 22.2％ vs 6.7％,x2 =6.19,P =0.0 2 3 ).Conclusions The MLD,V20,V30,V40 and V50 are determining factors for SARP.As predictive value of each parameter alone is relatively week,using two or more parameters to predict SARP is recommended.