Evaluation of BED-CEIA assay with dried blood spot specimens in China / 中华流行病学杂志

Objective To study the feasibility of using dried blood spot (DBS) specimens in BED-CEIA assay and to estimate the HIV-1 incidence with DBS in China. Methods 10 313 participants from 27 voluntary counseling and testing(VCT) sites were enrolled in this study. Both plasma and DBS specimens were collected. 349 eligible pairs of HIV-1 positive specimens confirmed by Western Blot were available for BED-CEIA and the results compared. Negative control, low positive control, high positive control and calibrator in DBS were used to evaluate the stability and repeatability of the detection results of DBS specimens. Results Of the total HIV positives, 294 and 53 participants were tested as long-term or recent HIV infections by both DBS and plasma specimens. Two participants showed different results from DBS and plasma specimens, but their final An values were close to the cutoff value of BED-CEIA assay. The concordance rate between the two types of specimens was 99.43% and the R2 linear of the stability and repeatability results of DBS specimens reached 0.9551 and 0.95, respectively. Conclusion Although some individual specimens showed different results, the incidence rates calculated from both types of specimen were equivalent. DBS specimens were suitable for estimating the HIV incidence and could be popularized in China. However, further studies regarding window period and adjustment coefficients of BED-CEIA assay are needed.

Neoadjuvant chemoradiation therapy in patients with surgically treated esophageal cancer.

Over the past 10 years, 232 patients were treated at the East Carolina School of Medicine for cancer of the esophagus. Of these, 73 received neoadjuvant chemoradiation therapy and subsequent surgical resection. The results in this group suggest improved cancer control, with 18 patients (25%) remaining free of recurrence 3 years after treatment, compared with 11 out of 159 patients (7%) in the group that was not treated with neoadjuvant therapy (p < 0.0001). The 5-year recurrence-free survival with neoadjuvant chemoradiotherapy and surgery was 16% (12/73) compared with 3% (5/159) with other types of therapy. Two protocols of neoadjuvant chemoradiotherapy with subsequent surgery were compared: I: Split-course, once-a-day radiotherapy and concomitant cisplatinum/5-fluorouracil followed by esophagectomy. II: Accelerated, twice-a-day radiotherapy with concomitant triple chemotherapy using cisplatinum/5-fluorouracil/vinblastine followed by transhiatal extrathoracic esophagectomy. The survival rate was similar in the two groups of patients but the complication rate was higher in group II. Neoadjuvant chemoradiation therapy and the techniques of transhiatal esophagectomy may have contributed to the improved results in the treatment of esophageal carcinoma. Accelerated radiotherapy with triple chemotherapy was more toxic and did not give better survival rates than split-course, once-a-day, conventional, fractionated-protracted radiotherapy combined with two drugs.

Survival of patients with squamous cell carcinoma of the supraglottic larynx--thirty-five-year experience with radiotherapy.

A retrospective comparison of treatment policies in two institutions revealed a change in the reliance on radiotherapy. Since 1978, high-energy, high-dosage radiotherapy has played a prominent role in the primary therapy of squamous cell carcinoma of the supraglottic larynx. Statistically, the overall determinate survival rate has improved compared with results during the preceding period, but the death rate from intercurrent disease and second primary cancers has remained unchanged. Improved cancer control and patient survival were restricted to clinical tumor stages III, T4N0, and T4N1. The choice of primary therapy and the radiation dose and fractionation pattern were important variables influencing the survival. A description of the data is followed by a critical analysis of the significance of the findings, in view of the fact that the treatments were performed in two different institutions at different time periods.

Recurrence after different primary treatment for cancer of the supraglottic larynx.

Retrospective analysis of patient records at two hospitals was performed with the principal goal of clarifying the role of primary radiotherapy ill patients with squamous cell carcinoma of the supraglottic larynx. Primary surgery was frequently performed during the first period from 1958 to 1978. Primary radiotherapy with surgery in reserve was the prevailing therapy during the second period from 1978 to 1993. Fewer recurrences were observed during the second period. The improved results were apparent mainly in patients with the more advanced stages (III, T4N0 and T4N1). Analysis of many factors suggest that the more frequent choice of primary radiotherapy with surgery in reserve, or applied as preoperative treatment, with optimal dosage and technique, might have contributed to the improved results.

Prognostic factors in patients with nasopharyngeal carcinoma.

From 1971 to 1985 a total of 122 patients with non-distant metastatic nasopharyngeal carcinoma were treated at the Norwegian Radium Hospital with radiation doses that increased from 50 Gy (at 2 Gy/fractions) to 70 Gy (at 2 Gy/fractions) during the treatment period. Possible relationship between the increase in dose and survival time was investigated. The median cancer-specific survival time was 50 months, and the median crude survival time 38 months. No correlation was found between radiation dose and survival time. In a multivariate analysis histology was found to be the most important prognostic factor for survival with a relative risk of death from cancer of 3.4 and 3.2 for non-keratinizing carcinoma and squamous cell carcinoma respectively compared with undifferentiated carcinoma. When assessed in terms of N category the relative death risk for N2/N3 was 2.1 compared to N0/N1.

Intraarterial iododeoxyuridine infusion combined with irradiation. A pilot study.

The halogenated pyrimidine, iododeoxyuridine (IUdR), enhances cytotoxicity of ionizing irradiation experimentally. Continuous intraarterial infusion of IUdR was combined with irradiation to maximize drug concentration in tumor and reduce potential systemic toxicity. Percutaneous tumor-specific artery catheterization was utilized in five patients, with delivery of IUdR (20 mg/kg/day) by continuous infusion 5 days prior to irradiation treatments and continued for 10-14 days. Infusion vessels included the internal mammary, the internal iliac, the renal, the common femoral, and the bronchial arteries. Conventional radiotherapy fields, fractionation, and total doses were utilized, and therapy was well tolerated. Low-grade leukopenia and thrombocytopenia was observed several weeks following infusion. A clinically nonsignificant skin reaction was observed within the irradiation fields 2-3 weeks after initiation of irradiation in several patients. No alopecia or stomatitis was observed. This study minimizes initial hepatic dehalogenation of IUdR when given by intraarterial administration. Two patients have been free of disease for over 20 years, with no long-term toxicity from IUdR therapy.

Primary irradiation, surgery or combined therapy in squamous cell carcinoma of the larynx. A comparison of treatment results from two centers.

We compared two groups of patients with squamous cell carcinoma of the larynx. Group 1 consisted of 483 patients treated from 1958 through 1978. Primary surgery was selected in 41% pre- or postoperative radiation therapy in 16% and primary radiation therapy in 43%. Group 2 consisted of 247 patients treated from 1978 through 1983. Primary surgery was selected in only 1.6%, pre- or postoperative radiation therapy in 23%, and primary radiation therapy, with surgery in reserve for residual or recurrent carcinoma, in 76%. Although the results were comparable for patients with early stage tumors in the two groups, significantly higher local-regional tumor control rates and corrected survival rates were recorded for patients with advanced tumors in group 2. More patients survived with a cancer-free functional larynx, the surgical salvage rates were higher, the complication rates and the death rates lower in group 2 compared to group 1.

Changing aspects in the treatment of squamous cell carcinoma of the oral tongue.

Two groups of patients were compared. In group 1, consisting of 304 patients treated from 1958 to 1972 (minimum observation time of 5 years), the local and regional control rate was 35 per cent. In group 2, consisting of 126 patients treated 1978 to 1983 (median observation time of 58 months), the local and regional control rate was 60 per cent (p less than 0.0001). The local and regional control rates were improved for all stages, but the differences were significant only for stages T1N0, T2N0, T3N0 and TXN2,3. The actuarial survival rates also showed improvement in group 2 patients. The incidence of treatment failure, with regard to the neck alone or tongue and neck combined, decreased from 51 per cent to 27 per cent with the newer techniques. The greatest improvement was observed in patients with T1N0 and T2N0 tumors. There was also a decrease in the failure rates in patients with the more advanced tumors.

Sightsaving therapy in retinoblastoma. Experience with external megavoltage radiotherapy.

In Norway, sightsaving therapy in retinoblastoma has only been given to least affected eyes in bilaterally affected children. The results in 8 eyes given external high energy radiotherapy are reported. Additional focal therapy was given to 3 eyes for residual tumours and to one eye with new tumour at the ora serrata. Cataract was treated in 2 of the 3 eyes in which it developed. Vitrectomy was performed in 2 eyes with vitreous haemorrhage and persisting vitreous haze. Secondary enucleation has been avoided in all eyes 3-9 years after irradiation. One patient developed metastases in the temporal region at the enucleated side. Visual acuity is 6/12-6/6 if the macula has not been destroyed by tumour or focal therapy. Sightsaving therapy is presently also offered to unilateral cases and worst affected eyes in bilateral cases if the eyes belong to Reese-Ellsworth groups I-IV.

Salivary gland malignant neoplasms: treatment and prognosis.

A retrospective analysis of 183 patients with malignant salivary gland tumors treated between 1955 and 1978 is presented. The analysis showed that radiation therapy lowered the recurrence rates after surgery and controlled approximately one-third of the inoperable tumors. A dose-response relationship exists and the data suggest that the radiation dose should not be less than that corresponding to a CRE-value of 1950 reu (70 Gy/7 weeks). Histology, location and clinical stage are important prognostic factors.

Bleomycin and radiation therapy in squamous cell carcinoma of the upper aero-digestive tract: a phase III clinical trial.

A group of 222 consecutive patients admitted with squamous cell carcinoma of the upper aero-digestive tract were studied in a prospectively randomized and stratified clinical trial. One-half of the patients received bleomycin injected intramuscularly 1 hour before the radiation treatment daily for 5 days a week; the other half received radiation therapy without the added chemotherapy. The total dose of radiation in both groups was about the same, and was given with curative intent even to the patients with advanced tumors who constituted the majority in both groups. Interstitial radiation as boost therapy or surgery was added in patients with residual tumor if the lesions were considered operable and the patient's condition would allow surgery. The addition of bleomycin did not increase the combined local and regional tumor control rates nor did it improve the survival, but did significantly increase the morbidity and the complication rate.

Incidence and control of occult neck node metastases from squamous cell carcinoma of the anterior two-thirds of the tongue.

Cervical lymph node metastases developed in 45% of patients with T1N0 squamous cell carcinomas of the oral tongue in spite of local control of the primary lesions in 79%. The control rate for the neck of those who converted from a negative to a positive neck (N0-N+) was 33%. Neck node metastases developed in 49% of patients with T2N0 tumors. The control rate of the primary tumor was 32%, and the control rate of the neck of those whose neck nodes converted (N0-N+) was 16%. Neck node metastases developed in 42% of patients with T3N0 tumors. The control rate of the primary tumors was 33%, and the control rate of the neck of those who converted (N0-N+) was 7%. The development of neck node metastases in patients after treatment of the primary tongue carcinoma is of grave prognostic significance. The use of elective treatment to the neck at initial treatment can prevent metastases in the neck from developing if the primary tumor is under control.

Squamous-cell carcinoma of the tongue: preoperative interstitial radium and external irradiation. Part II: Survival.

The authors evaluated 300 cases of squamous-cell carcinoma of the anterior two thirds of the tongue treated from 1958 through 1972. Effects of treatment on absolute and relative survival were determined by the log rank method. Selection was non-random, based on the extent of the primary tumor, age, and general condition. Surgery, irradiation, or a combination of preoperative interstitial high-intensity radium needles and resection gave similar results in patients with tumor smaller than 4 cm (T1T2N0). In patients with larger tumor (T3N0) or mobile, unilateral neck metastases (TXN1), irradiation plus surgery produced better survival than irradiation alone. Different radiation techniques are analyzed. Elective external irradiation to the neck is recommended in all cases, even if no enlarged lymph nodes can be palpated.

Squamous-cell carcinoma of the tongue: preoperative interstitial radium and external irradiation. Part I: Local and regional control.

Results of therapy in 300 patients with squamous-cell carcinoma of the anterior two thirds of the tongue are presented in terms of control of the primary tumor (local) and metastases to the lymph nodes of the neck (regional). Correlation between clinical stage and control was good, with the best results being obtained in stage T1N0 (84% control of tongue, 69% control of neck) and the poorest results in TX N2N3 (9% and 11%, respectively). Different methods of treatment were analyzed separately for various stages of disease and compared with results from other institutions. Possible methods of improving treatment are discussed.

Carcinoma of the tongue in Norway and Wisconsin. I. Incidence and prognosis related to sex and age.

The records of 503 patients with carcinoma of the tongue diagnosed between 1958 and 1972 were reviewed. The preponderance of tongue carcinoma among men was confirmed both in The Norwegian Radium Hospital (NRH) and the University of Wisconsin Hospitals (UW), but it was relatively more frequent among women in NRH and in UW than in southern Europe. More women had on presentation less advanced tumors at NRH than at UW. The incidence of tongue carcinoma in Norway increased steadily with age for both sexes. The sex ratio did not change in Norway such as in England, Canada and the United States. Tumor of the posterior one-third of the tongue was relatively infrequent in women both in NRH and UW, in agreement with reports from other countries. The length of survival was analysed and no significant sex difference was demonstrated. The younger patients had less advanced tumors and a better prognosis.

Carcinoma of the tongue in Norway and Wisconsin. II. Influence of site and clinical stage on local control of the tumor.

The local control rates in patients with squamous cell carcinoma of the tongue, treated between 1958 and 1972, were determined by retrospective analysis of the records of 339 patients at the Norwegian Radium Hospital and of 164 patients at the University of Wisconsin Hospitals. The correlation between the clinical stage and the local control rate was good in Norway, less striking in Wisconsin. As the tumor grew in size it generally became increasingly difficult to control. Irradiation and surgery appeared relatively satisfactory in patients with tumors in early stages, but were often inadequate in the advanced tumors. The differences observed between Norway and Wisconsin were statistically significant only for the tumors of the base of the tongue and T2N0, T3N0 and TxN1 tumors of the anterior two-thirds of the tongue.