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1.
Article de 0 | WPRIM | ID: wpr-831090

RÉSUMÉ

Purpose@#The purpose of this study was to compare the survival and toxicities in cervical esophageal squamous cell carcinoma (CESCC) treated by concurrent chemoradiothrapy with either three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) techniques. @*Materials and Methods@#A total of 112 consecutive CESCC patients were retrospectively reviewed. 3D-CRT and IMRT groups had been analyzed by propensity score matching method, with sex, age, Karnofsky performance status, induction chemotherapy, and tumor stage well matched. The Kaplan-Meier method and Cox proportional hazards model were used for overall survival (OS) and progression-free survival (PFS). Toxicities were compared between two groups by Fisher exact test. @*Results@#With a median follow-up time of 34.9 months, the 3-year OS (p=0.927) and PFS (p=0.859) rate was 49.6% and 45.8% in 3D-CRT group, compared with 54.4% and 42.8% in IMRT group. The rates of grade ≥ 3 esophagitis, grade ≥ 2 pneumonitis, esophageal stricture, and hemorrhage were comparable between two groups, while the rate of tracheostomy dependence was much higher in IMRT group than 3D-CRT group (14.3% vs.1.8%, p=0.032). Radiotherapy technique (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.01 to 0.79) and pretreatment hoarseness (HR, 0.12; 95% CI 0.02 to 0.70) were independently prognostic of tracheostomy dependence. @*Conclusion@#No survival benefits had been observed while comparing IMRT versus 3D-CRT in CESCC patients. IMRT with fraction dose escalation and pretreatment hoarseness were considered to be associated with a higher risk for tracheostomy dependence. Radiation dose escalation beyond 60 Gy should be taken into account carefully when using IMRT with hypofractionated regimen.

2.
Article de Anglais | WPRIM | ID: wpr-167298

RÉSUMÉ

PURPOSE: Previous studies reported an association between an increased risk of tongue cancer and radiation treatment for nasopharyngeal carcinoma (NPC). This study compared the clinicopathologic characteristics and outcomes of tongue squamous cell carcinoma (TSCC) in patients with and without a history of radiotherapy for NPC. MATERIALS AND METHODS: From 1965 to 2009, a total of 73 patients were diagnosed with TSCC with a history of radiotherapy for NPC. The patients were matched in a 1:3 ratio with patients with sporadic TSCC according to age, sex, and year of the TSCC diagnosis. The primary endpoint was the overall survival. RESULTS: The median interval from NPC to TSCC was 82 months. The NPC survivors were more likely to be diagnosed with a more advanced T classification, less likely to have lymph node involvement, and more likely to have the tumor located in the dorsum of the tongue than sporadic TSCC. Regarding the histologic characteristics, the NPC survivors were more likely to have a weak lymphocytic host response, low tumor budding, and low risk of a worse pattern of invasion. The sporadic TSCC patients had a better overall survival (hazard ratio, 0.690; p=0.033) than the NPC survivors. In competing risks analysis, the cumulative incidence functions for the competing event (documented non-tongue cancer death) were significantly higher in the NPC survivors (Gray's test, p=0.001). CONCLUSION: TSCC patients with a history of radiotherapy for NPC appear to have particular clinicopathologic features, a poorer survival, and are more likely to die from non-tongue cancer causes than those with sporadic TSCC.


Sujet(s)
Humains , Carcinome épidermoïde , Études cas-témoins , Classification , Diagnostic , Cellules épithéliales , Incidence , Noeuds lymphatiques , Seconde tumeur primitive , Pronostic , Radiothérapie , Survivants , Tumeurs de la langue , Langue
3.
Ai zheng ; Ai zheng;(12): 514-521, 2015.
Article de Anglais | WPRIM | ID: wpr-349567

RÉSUMÉ

<p><b>BACKGROUND</b>Insulin-like growth factor-binding protein-3 (IGFBP-3) is suggested to predict the radiosensitivity and/or prognosis of patients with esophageal squamous cell carcinoma (ESCC). The present study was designed to investigate the clinical and prognostic effects of IGFBP-3 on ESCC.</p><p><b>METHODS</b>IGFBP-3 was detected by immunohistochemistry in paraffin-embedded tissues from 70 ESCC patients treated with radiotherapy alone and further examined by western blotting analysis in 10 pairs of fresh ESCC tissues and adjacent non-malignant esophageal specimens. Receiver operating characteristic (ROC) analysis was used to determine cut-off scores for tumor positivity and to evaluate patient survival status. The χ(2) test was performed to analyze the association of IGFBP-3 expression with clinical characteristics and radiotherapy response. Associations between prognostic outcomes and IGFBP-3 expression were investigated using Kaplan-Meier analysis and the Cox proportional hazards model.</p><p><b>RESULTS</b>The threshold for IGFBP-3 positivity was set to greater than 65% [area under the ROC curve (AUC)=0.690, P<0.019]. Of the 70 ESCC patient tissues tested, 32 (45.7%) were defined as having high IGFBP-3 expression. The levels of IGFBP-3 protein expression were decreased in 70.0% (7 of 10) of ESCC tissues compared with adjacent non-malignant esophageal tissue. In addition, IGFBP-3 expression was associated with pathologic classification (P<0.05 for T, N, and M categories and clinical stage). Patients with elevated protein level of IGFBP-3 in the tumor had an improved radiotherapy response and prolonged overall survival (P<0.001).</p><p><b>CONCLUSIONS</b>High level of IGFBP-3 expression in ESCC associates with early clinical stages and are predictive for favorable survival of the patients treated with radiotherapy.</p>


Sujet(s)
Humains , Technique de Western , Carcinome épidermoïde , Tumeurs de l'oesophage , Immunohistochimie , Protéine-3 de liaison aux IGF , Estimation de Kaplan-Meier , Pronostic , Modèles des risques proportionnels , Courbe ROC , Radiosensibilisants
4.
Ai zheng ; Ai zheng;(12): 189-197, 2015.
Article de Anglais | WPRIM | ID: wpr-349602

RÉSUMÉ

<p><b>INTRODUCTION</b>It is important to decrease the radiation exposure of normal tissue in intensity-modulated radiation therapy (IMRT). Minimizing planning target volume (PTV) margins with more precise target localization techniques can achieve this goal. This study aimed to quantify the extent to which organs at risk (OARs) are spared when using reduced margins in the treatment of nasopharyngeal carcinoma (NPC).</p><p><b>METHODS</b>Two IMRT plans were regenerated for 40 patients with NPC based on two PTV margins, which were reduced or unchanged following cone beam computed tomography online correction. The reduced-margin plan was optimized based on maximal dose reduction to OARs without compromising target coverage. Dosimetric comparisons were evaluated in terms of target coverage and OAR sparing.</p><p><b>RESULTS</b>Improvements in target coverage occurred with margin reduction, and significant improvements in dosimetric parameters were observed for all OARs (P < 0.05) except for the right optic nerve, chiasm, and lens. Doses to OARs decreased at a rate of 1.5% to 7.7%. Sparing of the left parotid and right parotid, where the mean dose (Dmean) decreased at a rate of 7.1% and 7.7%, respectively, was greater than the sparing of other OARs.</p><p><b>CONCLUSIONS</b>Significant improvements in OAR sparing were observed with margin reduction, in addition to improvement in target coverage. The parotids benefited most from the online imaging-guided approach.</p>


Sujet(s)
Humains , Carcinomes , Tumeurs du rhinopharynx , Organes à risque , Glande parotide , Exposition aux rayonnements , Radiométrie , Dosimétrie en radiothérapie , Planification de radiothérapie assistée par ordinateur , Radiothérapie conformationnelle avec modulation d'intensité
5.
Zhonghua zhong liu za zhi ; (12): 708-713, 2013.
Article de Chinois | WPRIM | ID: wpr-267471

RÉSUMÉ

<p><b>OBJECTIVE</b>The purpose of this study was to investigate the value of postoperative chemotherapy for locally advanced rectal cancer patients who reached pathological ypT1-4N0 after neo-adjuvant chemoradiotherapy.</p><p><b>METHODS</b>We performed a retrospective study of 104 patients treated with preoperative chemoradiotherapy followed by radical resection, who achieved pathological ypT1-4N0, between Mar 2003 and Dec 2010. There were 73 patients who received postoperative adjuvant chemotherapy, and the other 31 patients did not. The distribution of final pathologic stages for these patients was ypT1-2N0 in 39 cases and ypT3-4N0 in 65 cases.</p><p><b>RESULTS</b>The median follow-up was 41 months. The 3-year overall survival rate (OS) and recurrence-free survival rate (RFS) for the whole group (ypT1-4N0) were 93.4% and 85.3%, respectively. The 3-year OS and RFS in the adjuvant chemotherapy group and non-adjuvant chemotherapy group were 95.5%, 88.6% and 88.6%, 77.2%, respectively. There were no significant differences in 3-year RFS (P = 0.108) and OS (P = 0.106) between the two groups. The 3-year local recurrence and distant metastasis rates in the adjuvant chemotherapy group were 4.1% (3/73) and 5.5% (4/73), while for the non-adjuvant chemotherapy group, the 3-year local recurrence rate and distant metastasis rate were 3.2% (1/31) and 16.1% (5/31), respectively. Significant difference was found in distant metastasis rates (P = 0.030) between the two groups, but not in local recurrence rates (P = 0.676).Further subgroup analysis indicated that for the ypT1-2N0 patients, there were no significant differences in 3-year OS (P = 0.296) and RFS (P = 0.939) between the adjuvant and non-adjuvant chemotherapy groups, while negative results displayed in 3-year local recurrence rates (P = 0.676) and distant metastasis rates (P = 0.414). However, for patients with ypT3-4N0, significant differences were showed in both the 3-year OS (P = 0.034) and RFS (P = 0.025), and further analysis revealed that the 3-year distant metastasis rate was significantly higher in the non-adjuvant chemotherapy group than in the adjuvant chemotherapy group (P = 0.010) , but with non-significant difference in the 3-year local recurrence (P = 0.548).</p><p><b>CONCLUSIONS</b>Adjuvant chemotherapy may not improve survival for ypT1-2N0 patients. However, it may be clinically meaningful for ypT3-4N0 patients by decreasing distant metastasis rate. Further randomized controlled clinical trials are needed to confirm our results.</p>


Sujet(s)
Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Adénocarcinome , Traitement médicamenteux , Anatomopathologie , Radiothérapie , Chirurgie générale , Protocoles de polychimiothérapie antinéoplasique , Utilisations thérapeutiques , Chimioradiothérapie adjuvante , Traitement médicamenteux adjuvant , Désoxycytidine , Utilisations thérapeutiques , Fluorouracil , Utilisations thérapeutiques , Études de suivi , Leucovorine , Utilisations thérapeutiques , Traitement néoadjuvant , Métastase tumorale , Récidive tumorale locale , Stadification tumorale , Composés organiques du platine , Utilisations thérapeutiques , Période postopératoire , Radiothérapie conformationnelle , Tumeurs du rectum , Traitement médicamenteux , Anatomopathologie , Radiothérapie , Chirurgie générale , Études rétrospectives , Taux de survie
6.
Article de Chinois | WPRIM | ID: wpr-357134

RÉSUMÉ

<p><b>OBJECTIVE</b>To study the influence of preoperative chemoradiotherapy (CRT) on pulmonary function and postoperative pulmonary complications in esophageal cancer patients.</p><p><b>METHODS</b>Pulmonary function and postoperative pulmonary complications of 63 esophageal cancer patients undergoing preoperative CRT and operation in Cancer Center of Sun Yat-sen University between 2002 and 2013 were collected retrospectively. The influence of preoperative CRT on pulmonary functional indexes and postoperative pulmonary complications were analyzed.</p><p><b>RESULTS</b>After preoperative CRT, DLco% decreased significantly (83.7±17.7 vs. 96.4±17.8, P<0.01), while no obvious changes in other indexes were found. Postoperative pulmonary complication rate was 34.9% (22/63), including 19 cases of pneumonia and 3 cases of acute pulmonary injury/acute respiratory distress syndrome. Differences in postoperative pulmonary complication rates were not statistically significant between patients with DLco% <80 and those with DLco% ≥80 patients (29.7% vs. 41.7%, P>0.05), and between patients with DLco% decline ≥15% and those with DLco% decline <15% patients (31.6% vs. 37.8%, P>0.05).</p><p><b>CONCLUSION</b>Preoperative CRT can damage the diffusion function but not ventilation function of esophageal cancer patients, and does not increase the postoperative pulmonary complication rate.</p>


Sujet(s)
Femelle , Humains , Mâle , Adulte d'âge moyen , Chimioradiothérapie , Tumeurs de l'oesophage , Traitement médicamenteux , Radiothérapie , Poumon , Soins périopératoires , Complications postopératoires , Études rétrospectives
7.
Article de Chinois | WPRIM | ID: wpr-322477

RÉSUMÉ

<p><b>OBJECTIVE</b>To study the clinical characteristics, pathological features, diagnosis, therapy and prognosis of primary small cell carcinoma of the larynx (PSCCL).</p><p><b>METHODS</b>Six cases of PSCCL collected from 1990 to 2009 was retrospectively analyzed. The diagnosis was confirmed by pathological examination. Among six patients, one case belonged to stage III, and the others were in stage IVA. One case abandoned treatment; one case received chemotherapy; one case underwent supraglottic hemilaryngectomy and adjuvant chemoradiotherapy; one case underwent induction chemotherapy, radiotherapy and consolidation chemotherapy. Two cases received induction chemotherapy, concurrent chemoradiation and consolidation chemotherapy. The drug regimens included bleomycin, fluorouracil, cisplatin, etoposide and taxel for 3-6 cycles. The radiotherapy technique included conventional radiotherapy, CT-Sim and three dimensional conformal radiation therapy with (60)Co or 4 MV X-ray for 60 - 66 Gy during 6 - 7 weeks.</p><p><b>RESULTS</b>The time of follow-up was 3 - 24 months and the median was 13 months. Two patients applied with concurrent chemoradiation were alive without tumor. The patient abandoning therapy died of respiratory failure, and the others died of lung or liver metastasis after 8 - 12 months.</p><p><b>CONCLUSIONS</b>PSCCL is a disseminated disease, so the pretreatment evaluation is necessary. Concurrent chemoradiation is an ideal treatment model for this disease.</p>


Sujet(s)
Adulte , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Carcinome à petites cellules , Diagnostic , Thérapeutique , Association thérapeutique , Tumeurs du larynx , Diagnostic , Thérapeutique , Pronostic , Études rétrospectives
8.
Ai zheng ; Ai zheng;(12): 420-424, 2010.
Article de Anglais | WPRIM | ID: wpr-292568

RÉSUMÉ

<p><b>BACKGROUND AND OBJECTIVE</b>Extraskeletal Ewing's sarcoma (EES) is a rare, rapidly growing, round-cell, malignant tumor that can develop in the soft tissues at any location. This study was to analyze the clinical features, diagnosis and treatment of EES.</p><p><b>METHODS</b>Clinical data of 18 patients with EES, treated at between Cancer Center of Sun Yat-sen University between 1995 and 2007, were analyzed.</p><p><b>RESULTS</b>Of the 18 patients, 13 were male and 8 were female, aged from 8 months to 60 years. Twelve (66.7%) patients were between 5-25 years of age. Eight (44.4%) patients had tumors originated from low extremities.Sixteen patients had masses at their first visit. Sixteen patients were treated by the combined modality therapy, and 2 patients were treated by the single modality therapy. The 1-, 3- and 5- year actuarial survival rates were 82.4%, 64.2% and 32.1%, respectively. The presence of metastatic disease at the time of diagnosis and the mode of treatment were prognostic factors.</p><p><b>CONCLUSIONS</b>EES is common in adolescent. It often manifests as a localized mass. The combined modality therapy is recommended for this disease. The presence of metastatic disease at the time of diagnosis and the mode of treatment are prognostic factors.</p>


Sujet(s)
Adolescent , Adulte , Enfant , Enfant d'âge préscolaire , Femelle , Humains , Nourrisson , Mâle , Adulte d'âge moyen , Jeune adulte , Antigène CD99 , Antigènes CD , Métabolisme , Protocoles de polychimiothérapie antinéoplasique , Utilisations thérapeutiques , Tumeurs osseuses , Molécules d'adhérence cellulaire , Métabolisme , Association thérapeutique , Membre inférieur , Tumeurs du poumon , Récidive tumorale locale , Maladie résiduelle , Radiothérapie de haute énergie , Sarcome d'Ewing , Diagnostic , Métabolisme , Anatomopathologie , Chirurgie générale , Thérapeutique , Tumeurs des tissus mous , Diagnostic , Métabolisme , Anatomopathologie , Chirurgie générale , Thérapeutique , Taux de survie , Vimentine , Métabolisme
9.
Zhonghua zhong liu za zhi ; (12): 932-937, 2006.
Article de Chinois | WPRIM | ID: wpr-316263

RÉSUMÉ

<p><b>OBJECTIVE</b>To evaluate the long-term effect of sodium glycididazole (CMNa) as a hypoxic radiosensitizer on the radiotherapy for nasopharyngeal carcinoma.</p><p><b>METHODS</b>Between May 1999 and May 2002, 211 patients with pathologically confirmed nasopharyngeal carcinoma were randomized into group-A treated by radiotherapy plus CMNa or group-B by radiotherapy alone. The staging was determined according to 92' Fuzhou staging systerm. The type, procession and dosage of radiotherapy were identical in both groups. The early adverse effect grade was assessed based on the CTC2.0 criteria and the late adverse effects were evaluated according to the RTOG/EORTC criteria. The median follow-up time was 52 months. All the data was analyzed by the SPSS 13.0 software. Characteristics and adverse events of these patients were compared between the two groups using t-test and the Wilcoxin rank sum test. Time-to-event curves were estimated using the Kaplan-Meier method. The prognostic parameters were analyzed using univariate analysis and the Cox multivariate regression analysis.</p><p><b>RESULTS</b>The clinical data of the two groups were comparable. The 3-year survival was 88.4% in group-A, while 75.2% in group-B, with a statistically significant difference between two groups (P = 0.010). Univariate analysis showed that the 3-year survival was statistically correlated with N-staging ((N0-1, 86.9%, N2-3 73.8%, P < 0.001), T-staging (T1-2 85.6%, T3-4 79.3%, P = 0.014), TNM staging (P = 0.039), and whether using CMNa or not during rediotherapy (Group-A 88.4%, Group-B 75.2%, P = 0.010). The 5-year recurrence-free survival, 5-year metastasis-free survival and 5-year overall survival were 75.8%, 74.9% and 77.7% in Group-A, while 63.0%, 63.0% and 62.4% in Group-B with a statistically significant difference between two groups (0.013, 0.022 and 0.010, respectively). If stratified in the subgroups, the overall survival of stage III - IV patients was statistically different between group A and B (P = 0.009), however, not of stage I - II patients (P = 0.502). Cox multivariate regression analysis showed that the independent prognostic parameters for survival were N-stage (RR = 3.288) , T-stage (RR = 2.147) and use of CMNa during rediotherapy (RR = 0.407). However, there was no statistically significant difference between two groups in acute or late adverse effects on nervous system or heart, which suggested that use of CMNa during radiotherapy would not aggravate the toxicity caused by radiotherapy.</p><p><b>CONCLUSION</b>Sodium glycididazole is well tolerable effective as a hypoxic radiosensitizer, which can improve the efficacy of radiotherapy and the long-term result of nasopharyngeal carcinom a patients, especially for the stage III - IV patients.</p>


Sujet(s)
Adolescent , Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Études de suivi , Estimation de Kaplan-Meier , Métronidazole , Utilisations thérapeutiques , Analyse multifactorielle , Tumeurs du rhinopharynx , Anatomopathologie , Radiothérapie , Stadification tumorale , Pronostic , Modèles des risques proportionnels , Radiosensibilisants , Utilisations thérapeutiques , Facteurs temps , Résultat thérapeutique , Vomissement
10.
Zhonghua zhong liu za zhi ; (12): 122-125, 2005.
Article de Chinois | WPRIM | ID: wpr-331212

RÉSUMÉ

<p><b>OBJECTIVE</b>To analyze treatment and prognostic factors of 74 patients with dermatofibro-sarcoma protuberans (DFSP).</p><p><b>METHODS</b>From August 1990 to November 1999, 74 patients with DFSP confirmed pathologically were treated. There were 52 males and 22 females with a median age of 37 years (range 4 to 80 years) on diagnosis. Seventeen patients were treated by extensive excision and 2 by limited excision. Fifty-two patients had surgical resection alone (S), and 22 postoperative radiotherapy (S + R) of 50-70 Gy. The multivariate parameters were analyzed using Cox model. Kaplan-Meier and Log-Rank test were used to evaluate the results of the recurrence-free survival.</p><p><b>RESULTS</b>The rate of recurrence was 28.4% for all patients. The 5-year recurrence-free survival rate (RFSR) was 66.6% and the 10-year RFSR was 52.5%. The 5-year and 10-year in the S group were 58.4% and 41.2%, compared with 90.0% and 83.3% in the S + R group (P < 0.05). The 5-year and 10-year RFSR in the pathologically positive margin group were 57.5% and 41.4% respectively, compared with the 75.0% and 56.6% in the pathologically negative group (P < 0.05). Multivariate analysis suggested radiotherapy and negative pathological margins were favorable prognostic factors.</p><p><b>CONCLUSION</b>Post-operation radiotherapy and pathological margin are the independent prognostic factors.</p>


Sujet(s)
Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Enfant , Enfant d'âge préscolaire , Femelle , Humains , Mâle , Adulte d'âge moyen , Association thérapeutique , Dermatofibrosarcome , Mortalité , Radiothérapie , Chirurgie générale , Études de suivi , Récidive tumorale locale , Soins postopératoires , Pronostic , Modèles des risques proportionnels , Études rétrospectives , Tumeurs cutanées , Mortalité , Radiothérapie , Chirurgie générale
11.
Article de Chinois | WPRIM | ID: wpr-679338

RÉSUMÉ

Objective The purpose of this study was to investigate the clinical significance of serum vascular endothelial growth factor(S-VEGF)in patients of esophageal squamous cell carcinoma with the end-point of progress-free survival rate.Methods Sera from 89 patients with esophageal squamous carcinoma,who presented and treated with concurrent chemoradiotherapy or surgical resection in Cancer Center d Sun Yat-Sen University from December 2002 to May 2004,were sampled at the time of pre-treatment.30 cases of health individuals without any evidence of disease were selected as control group.For patients with surgical resection were performed with esophagectomy and extended lymphadenectomy.For patients with concurrent chemoradiotherapy comprised of cisplatin and 5-fluorouracil.The radiotherapy dose of 2 Gy per day was initiated on Day 1 of chemotherapy and continued daily for 5 days per week for 6 weeks,for a total close of 60 Gy.Two courses of chemotherapy were given during radiotherapy at 6-week intervals.The serum vascular endothelial growth factor(S- VEGF)levels were measured with a solid phase enzyme Human VEGF Immunoassay ELISA kit.The end point of this study was progress-free survival,and time was calculated from the date of diagnosis to date of relapse or last follow evaluation.Results S-VEGF level of patients with esophageal squamous cell carcinoma was significantly higher than that of heahhy controls(475.93?44.76 pg/ml vs.294.20?23.40 pg/ml;P=0.020).S-VEGF levels in patients with StageⅢand StageⅣdisease were significantly higher than those in patients with Stage I and StageⅡdisease.The 1-year progress-free survival rate d high S-VEGF group(≥475 pg/ml)was significantly lower than that of the low S-VEGF group(<475 pg/ml)(24% vs.66%;P=0.0004).The 1-year progress-free survival rate of the patients with StageⅠand StageⅡdisease was significantly higher than that of patients with StageⅢand StageⅣdisease(71% vs.29%;P=0.0015).The variables were assessed by multivariate analysis using the Cox proportional hazards model,and the results revealed that the clinical stage and the S-VEGF were first and second independent prognosis factor,respectively.Conclusions In the current study,a high S-VEGF was found to be associated with tumor progression,poor treatment response,and poor survival in patients with squamous cell carcinoma of the esophagus.

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