Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.933
Filtrar
1.
Medicine (Baltimore) ; 99(17): e19453, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332598

RESUMO

This study aimed to retrospectively analyze the efficacy and safety of esophagectomy and postoperative radiotherapy (PORT) for patients with thoracic esophageal squamous cell carcinoma (TESCC) in the young-old (aged between 65 and 75 years).The clinical data of 166 young-old patients with esophageal cancer who underwent esophagectomy and PORT from May 2004 to May 2018 in The First Affiliated Hospital of Nanjing Medical University and The PLA Cancer Center, Jinling Hospital were analyzed. The Kaplan-Meier method was used to calculate overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). The log-rank method was used to test the differences. The Cox regression model was used for the multivariate prognostic analysis.The follow-up rate was 98.5%, and the median follow-up time was 41.2 months. The whole 1-, 3-, and 5-year OS rates were 92.0%, 69.3%, and 58.3%, respectively, and the median OS was 64.7 months (95% CI, 58.3-71.1). The median DFS was 57.9 months (95% CI, 47.4-68.4), and the 1-, 3-, and 5-year DFS rates were 84.8%, 61.5%, and 44.6%, respectively. The median LRFS was 60.8 months (95% CI, 50.5-71.0), and the 1-, 3-, and 5-year LRFS rates were 85.8%, 64.94%, and 53.9%, respectively. The median DMFS was 65.0 months (95% CI, 60.6-69.6), and the 1-, 3-, and 5-year DMFS rates were 91.9%, 77.0%, and 67.5%, respectively. Pathological T staging, lymph node metastasis, pathologic staging, and Karnofsk Performance Status (KPS) were the main factors affecting prognosis. In addition, T staging, lymph node metastasis are also independent prognostic factors. Little severe toxicity was observed.The result indicates that PORT for TESCC patients who can tolerate surgery is safe in the young-old. The efficacy is similar to that of previous patients including younger populations. Pathological T and N stage are major factors that affect prognosis. Concurrent chemotherapy may not improve the survival of the young-old patients undergoing postoperative radiotherapy.


Assuntos
Neoplasias Esofágicas/radioterapia , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/radioterapia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia/métodos , Fatores Etários , Idoso , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/mortalidade , Carcinoma de Células Escamosas do Esôfago/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Prognóstico , Doses de Radiação , Radioterapia Adjuvante , Estudos Retrospectivos , Fatores Sexuais , Taxa de Sobrevida
2.
Anticancer Res ; 40(4): 2065-2072, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234898

RESUMO

BACKGROUND/AIM: The aim of this multi-center retrospective study was to investigate the results of stereotactic body radiotherapy (SBRT) for pulmonary oligometastases from esophageal cancer. PATIENTS AND METHODS: Oligometastases from the esophagus were identified from a dataset of a Japanese survey. The Kaplan-Meier method and Cox regression were applied to perform analyses. RESULTS: A total of 114 patients with 132 pulmonary oligometastases were collected. The 3-year local control rate, freedom from further metastasis (FFFM) rate and overall survival (OS) rate were 70.2%, 25.3% and 37.5%, respectively. Performance status (PS) (PS 1 vs. PS 0, p<0.01), disease-free interval (p=0.03) and history of local therapy for metastasis (p=0.01) had significant relationships with FFFM and only PS was an independent prognostic factor for OS (PS 1 vs. PS 0, p=0.02; PS 2-3 vs. PS 0, p=0.04). CONCLUSION: SBRT for pulmonary oligometastases from esophageal cancer provided good local control and survival.


Assuntos
Neoplasias Esofágicas/radioterapia , Neoplasias Pulmonares/radioterapia , Radiocirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Modelos de Riscos Proporcionais
3.
Anticancer Res ; 40(4): 2387-2392, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234942

RESUMO

BACKGROUND: For patients with esophageal squamous cell carcinoma (ESCC) with oligo-recurrence (OR) after previous curative radiotherapy and not eligible for radical resection, the role of radical re-irradiation was not clear. Therefore, we aimed to investigate the outcome and prognostic factors of such patients. PATIENTS AND METHODS: We identified patients with OR of ESCC after previous curative radiotherapy and were treated with radical re-irradiation within 2012-2018 via an in-house prospectively established database. The characteristics of patients, disease, treatment, and outcome were retrospectively obtained via chart review. The first day of re-irradiation was defined as the index date. Overall survival was calculated via the Kaplan-Meier method. Log-rank test was used for univariate analysis and Cox regression method was used for multivariable analysis. RESULTS: We identified thirty patients for analyses. After a median follow-up of 9 (range=2-76) months, the 5-year overall survival rate was 21%. Four patients with possible radiotherapy-related complication in need of inpatient care were identified. Gross tumor volume was the only significant prognostic factor in both univariate and multivariable analyses. CONCLUSION: We found that radical definitive re-irradiation may lead to one-fifth long-term survivors of patients with OR after previous curative radiotherapy for ESCC, and the gross tumor volume was the only significant prognostic factor for these patients. Randomized controlled trials should be considered to compare radical re-irradiation with the current standard of care (systemic therapy) for this population.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias Esofágicas/radioterapia , Recidiva Local de Neoplasia , Reirradiação/métodos , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/patologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
4.
Anticancer Res ; 40(3): 1661-1664, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132071

RESUMO

BACKGROUND/AIM: Elderly patients with metastatic esophageal cancer may benefit from individualized therapies. A tool to predict the survival of such patients with brain metastases was created. PATIENTS AND METHODS: In 11 elderly patients (≥65 years) receiving whole-brain irradiation (WBI) for brain metastases from esophageal cancer, age, gender, performance status, number of brain metastases, metastases outside the brain, time between cancer diagnosis and WBI, and WBI regimen were evaluated for survival. RESULTS: On univariate analyses, age ≥73 years (p=0.046) and time between diagnosis of esophageal cancer and WBI ≤6 months (p=0.046) were significantly associated with poorer survival. On multivariate analysis, both showed a trend. Based on these two factors, the following points were assigned: age ≤72 years=1 point, age ≥73 years=0 points; time between cancer diagnosis and WBI >6 months=1 point, and ≤6 months=0 points. Three prognostic groups were thus formed: 0, 1 and 2 points. Survival rates of these groups at 6 months were 0%, 0% and 40% (p=0.012), respectively. CONCLUSION: This new tool allows estimation of survival and treatment individualization in elderly patients irradiated for brain metastases from esophageal cancer.


Assuntos
Neoplasias Encefálicas/secundário , Irradiação Craniana/métodos , Neoplasias Esofágicas/complicações , Idoso , Neoplasias Encefálicas/mortalidade , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/radioterapia , Feminino , Humanos , Masculino , Prognóstico , Taxa de Sobrevida , Resultado do Tratamento
5.
Zhonghua Zhong Liu Za Zhi ; 42(2): 139-144, 2020 Feb 23.
Artigo em Chinês | MEDLINE | ID: mdl-32135649

RESUMO

Objective: To evaluate the prognostic factors of T1-2N0M0 esophageal squamous cell carcinoma (ESCC) treated with definitive radiotherapy. Methods: The clinical data of 196 patients with T1-2N0M0 ESCC who were treated with definitive radiotherapy in 10 hospitals were retrospectively analyzed. All sites were members of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG). Radiochemotherapy were applied to 78 patients, while the other 118 patients received radiotherapy only. 96 patients were treated with three-dimensional conformal radiotherapy (3DCRT) and 100 treated with intensity-modulated radiotherapy (IMRT). The median dose of plan target volume(PTV) and gross target volume(GTV) were both 60 Gy. The median follow-up time was 59.2 months. Log rank test and Cox regression analysis were used for univariat and multivariate analysis, respectively. Results: The percentage of normal lung receiving at least 20 Gy (V(20)) was (18.65±7.20)%, with average dose of (10.81±42.05) Gy. The percentage of normal heart receiving at least 30 Gy (V(30)) was (14.21±12.28)%. The maximum dose of exposure in spinal cord was (39.65±8.13) Gy. The incidence of radiation pneumonia and radiation esophagitis were 14.80%(29/196) and 65.82%(129/196), respectively. The adverse events were mostly grade 1-2, without grade 4 toxicity. Median overall survival (OS) and progression-free survival (PFS) were 70.1 months and 62.3 months, respectively. The 1-, 3- and 5-year OS rates of all patients were 75.1%、57.4% and 53.2%, respectively. The 1-, 3- and 5-year PFS rates were 75.1%、57.4% and 53.2%, respectively. Multivariate analysis demonstrated that patients'age (HR=1.023, P=0.038) and tumor diameter (HR=1.243, P=0.028)were the independent prognostic factors for OS, while tumor volume were the independent prognostic factor for PFS. Conclusions: Definitive radiotherapy is a promising therapeutic method in patients with T1-2N0M0 ESCC. Patients' age, tumor diameter and tumor volume may impact patients' prognosis.


Assuntos
Neoplasias Esofágicas/radioterapia , Carcinoma de Células Escamosas do Esôfago/radioterapia , Antineoplásicos/uso terapêutico , Quimiorradioterapia , Relação Dose-Resposta à Radiação , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/tratamento farmacológico , Carcinoma de Células Escamosas do Esôfago/mortalidade , Carcinoma de Células Escamosas do Esôfago/patologia , Humanos , Prognóstico , Dosagem Radioterapêutica , Radioterapia Conformacional , Radioterapia de Intensidade Modulada , Estudos Retrospectivos
6.
Cancer Radiother ; 24(1): 21-27, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32001131

RESUMO

PURPOSE: Radiotherapy is the main treatment method for patients with locally advanced, unresectable esophageal cancer. The aim of this study is to compare overall survival (OS) using 3D radiotherapy (3DRT) alone with concurrent chemoradiotherapy (CCRT) in 296 non-surgical esophageal carcinoma patients. PATENTS AND METHODS: Over 10 years, of the 480 patients with esophageal carcinoma treated with 3DRT with or without chemotherapy, 148 patients each comprised 3DRT and CCRT groups after propensity score matching. RESULTS: The 5- and 10-year OS (P=0.337) and PFS (P=0.715) rates for 3DRT alone were 22.0%, 14.4% and 26.1%, 23.2%, respectively, compared with 28.8%, 18.6% and 34.7%, 29.1% for CCRT, respectively. CCRT did not improve 5-year and 10-year OS or PFS in 60-70Gy group (OS: 27.5% and 25.2%; 17.9% and 17.0%, P=0.938; PFS: 38.3% and 31.8%; 31.9% and 27.8%, P=0.890) nor reduce 10-year hematogenous metastasis (31.7% and 28.3%, P=0.698). CCRT improved 5-year OS and PFS of 50.0-59.9Gy group (OS: 33.3% and 12.0%, P=0.029; PFS: 33.1% and 10.6%, P=0.081). For 3DRT, the 5-year OS and PFS rates were significantly better in the 60-70Gy group (P=0.017) compared with 50.0-59.9Gy group (P=0.002). For CCRT group, 5-year OS and PFS favored the 50.0-59.9Gy group, but the difference was insignificant. Major toxicities were greater with CCRT compared with 3DRT. CONCLUSION: For non-surgical esophageal carcinoma patients, 3DRT combined with CCRT was effective in prolonging both OS and PFS.


Assuntos
Quimiorradioterapia , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/radioterapia , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , China/epidemiologia , Neoplasias Esofágicas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Intervalo Livre de Progressão , Dosagem Radioterapêutica
7.
Br J Radiol ; 93(1107): 20190224, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31317768

RESUMO

The combination of radiotherapy and immunotherapy is one of the most promising strategies for cancer treatment. Recent clinical results support the pre-clinical experiments pointing to a benefit for the combined treatment in metastatic patients. Charged particle therapy (using protons or heavier ions) is considered one of the most advanced radiotherapy techniques, but its cost remains higher than conventional X-ray therapy. The most important question to be addressed to justify a more widespread use of particle therapy is whether they can be more effective than X-rays in combination with immunotherapy. Protons and heavy ions have physical advantages compared to X-rays that lead to a reduced damage to the immune cells, that are required for an effective immune response. Moreover, densely ionizing radiation may have biological advantages, due to different cell death pathways and release of cytokine mediators of inflammation. We will discuss results in esophageal cancer patients showing that charged particles can reduce the damage to blood lymphocytes compared to X-rays, and preliminary in vitro studies pointing to an increased release of immune-stimulating cytokines after heavy ion exposure. Pre-clinical and clinical studies are ongoing to test these hypotheses.


Assuntos
Neoplasias Esofágicas/radioterapia , Radioterapia com Íons Pesados/métodos , Terapia com Prótons/métodos , Radioimunoterapia/métodos , Morte Celular , Citocinas/metabolismo , DNA/efeitos da radiação , Dano ao DNA , Neoplasias Esofágicas/imunologia , Humanos , Imunoterapia/economia , Mediadores da Inflamação/metabolismo , Linfócitos/efeitos da radiação , Linfopenia/etiologia , Raios X/efeitos adversos
8.
Int J Radiat Oncol Biol Phys ; 106(1): 67-72, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31622698

RESUMO

PURPOSE: Patients with locally advanced and metastatic esophageal cancer are usually affected by cancer-related symptoms, which worsen their performance status and quality of life. The aim of this study was to determine the efficacy of short-course accelerated radiation therapy for symptomatic palliation in a low resourced setting where only a 2-dimensional radiation therapy (RT) technique was available. METHODS AND MATERIALS: A phase II trial based on Simon's 2-stage design was planned. A total dose of 12 Gy in 4 fractions, twice per day, over 2 days, ≥8 hours apart, using a 2-dimensional conventional RT technique was delivered with a Cobalt 60 unit (Equinox, Best Theratronics, Ottawa, Ontario). Symptoms were graded using the International Atomic Energy Agency scoring system. RESULTS: A total of 17 patients were treated (male/female = 10/7; median age, 50.0 years; range, 27-78 years; histology: 6 adenocarcinomas and 11 squamous cell carcinomas; tumor site: 4 gastresophageal junction and 13 esophagus). The most frequent baseline symptoms were dysphagia or regurgitation (100%), odynophagia (76%), and chest or back pain (53%). At 1 month after RT, all patients were alive with palliative response rates (complete plus partial) for dysphagia, regurgitation, odynophagia, and chest or back pain of 76%, 82%, 69%, and 56%, respectively. No patients presented acute ≥G3 toxicity. CONCLUSIONS: Short-course accelerated radiation therapy treatment, planned and delivered using a conventional 2-dimensional RT technique, was effective and well tolerated for the symptomatic palliation of locally advanced or metastatic esophageal cancer. This schedule may be useful for RT centers in developing countries to reduce treatment times, costs, and patient waiting times before treatment.


Assuntos
Adenocarcinoma/radioterapia , Carcinoma de Células Escamosas/radioterapia , Neoplasias Esofágicas/radioterapia , Cuidados Paliativos/métodos , Adulto , Idoso , Transtornos de Deglutição/etiologia , Países em Desenvolvimento , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Junção Esofagogástrica , Etiópia , Feminino , Humanos , Avaliação de Estado de Karnofsky , Refluxo Laringofaríngeo/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Hipofracionamento da Dose de Radiação
9.
Radiat Oncol ; 14(1): 232, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856866

RESUMO

OBJECTIVE: This study aims to investigate a hybrid automated treatment planning (HAP) solution that combines knowledge-based planning (KBP) and script-based planning for esophageal cancer. METHODS: In order to fully investigate the advantages of HAP, three planning strategies were implemented in the present study: HAP, KBP, and full manual planning. Each method was applied to 20 patients. For HAP and KBP, the objective functions for plan optimization were generated from a dose-volume histogram (DVH) estimation model, which was based on 70 esophageal patients. Script-based automated planning was used for HAP, while the regular IMRT inverse planning method was used for KBP. For full manual planning, clinical standards were applied to create the plans. Paired t-tests were performed to compare the differences in dose-volume indices among the three planning methods. RESULTS: Among the three planning strategies, HAP exhibited the best performance in all dose-volume indices, except for PTV dose homogeneity and lung V5. PTV conformity and spinal cord sparing were significantly improved in HAP (P < 0.001). Compared to KBP, HAP improved all indices, except for lung V5. Furthermore, the OAR sparing and target coverage between HAP and full manual planning were similar. Moreover, HAP had the shortest average planning time (57 min), when compared to KBP (63 min) and full manual planning (118 min). CONCLUSION: HAP is an effective planning strategy for obtaining a high quality treatment plan for esophageal cancer.


Assuntos
Neoplasias Esofágicas/radioterapia , Bases de Conhecimento , Órgãos em Risco/efeitos da radiação , Planejamento da Radioterapia Assistida por Computador/métodos , Adulto , Automação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos
10.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 75(12): 1383-1393, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31866636

RESUMO

This study aimed to evaluate the influence of change in respiratory motion on matchline (ML) and reduction of the effect by increasing ML levels of field matching technique in passive scattering proton therapy for esophageal cancer. To evaluate the influence of respiratory motion in terms of stability, we measured relative dose around ML using a respiratory motion phantom. The relative error was -0.5% when the respiratory motion phantom worked stable, whereas there was obvious change that the relative error was -25.5% when the difference of amplitude between upper field and lower field was one side 3 mm on each cranially and caudally direction. In clinical case of the seven esophageal cancer patients simulated by the treatment planning system, assuming the difference of amplitude was 3 mm, the relative error of maximum (minimum) dose in clinical target volume around ML against the original treatment plan were 5.8±1.2% (-6.0±2.7%), 3.3±0.9% (-3.8±1.0%), and 2.4±0.5% (2.6±0.8%) on average (±SD) when ML levels were 2, 4, and 6, respectively. Increasing ML levels can reduce the influence of respiratory motion.


Assuntos
Neoplasias Esofágicas , Movimento (Física) , Terapia com Prótons , Neoplasias Esofágicas/radioterapia , Humanos , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador
11.
BMC Cancer ; 19(1): 927, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533656

RESUMO

BACKGROUND: The clinical target volume (CTV) for postoperative radiotherapy for thoracic esophageal squamous cell carcinoma (TESCC) needs to be defined. The study aim was to map metastatic lymph nodes (LNMs) in a computed tomography (CT)-based atlas and delineate the postoperative radiotherapy target area. METHODS: Sixty-nine TESCC patients with first recurrent regional LNMs after esophagectomy were included. The LNM epicenters were registered onto corresponding anatomic axial CT images of a standard patient in the treatment position, with reference to the surrounding vascular and bony structures. The LNM sites were based on lymph node map of esophageal cancer, AJCC 8th. The lymph metastasis risk for different segments of thoracic esophagus was assessed. RESULTS: One hundred and seventy-nine LNMs were mapped onto standard axial CT images. The upper-middle mediastinum region (station 1 to 8 M) contained 97% of metastases in the upper segment of thoracic esophagus, 90% in the middle segment, and 66% in the lower one. Advanced pathological stage (≥IIIB) might be a predictive factor for upper abdominal region (UAR) relapse in lower TESCC. Lower cervical para-tracheal LNMs were within a 4.3-cm bilaterally expanded area from the midline of the body and a 2.2-cm expanded area from the anterior of vertebral body, from the superior border of the C7, to the inferior border of the first thoracic vertebra. CONCLUSION: A modified target from the upper border of C7 to the lower border of caudal margin of the inferior pulmonary vein level could cover the high-risk area of TESCC underwent postoperative radiotherapy. UAR seems to be an elective irradiation target for lower TESCC at pathological IIIB stage and higher.


Assuntos
Neoplasias Esofágicas/radioterapia , Carcinoma de Células Escamosas do Esôfago/radioterapia , Metástase Linfática/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/secundário , Carcinoma de Células Escamosas do Esôfago/cirurgia , Feminino , Humanos , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Tomografia Computadorizada por Raios X
12.
Radiat Oncol ; 14(1): 161, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481064

RESUMO

BACKGROUND: The prognosis of N categories for patients with non-surgical esophageal carcinoma based on the number of metastatic lymph nodes is controversial. The present study analyzes prognostic implications of the number, extent, and size of metastatic lymph nodes for patients with esophageal squamous cell carcinoma (ESCC) treated with definitive (chemo-)radiotherapy to provide more information on treatment strategy. METHODS: We reviewed 357 ESCC patients treated with definitive radiotherapy between January 2013 and March 2016 retrospectively. We assessed potential associations between the involved extent (N0, 1 region, 2 regions, and 3 regions), number (N0, 1-2, 3-6, and ≥ 7), and size (N0, ≤2 cm, and > 2 cm) of metastatic lymph nodes and overall survival. Multivariate analyses of the clinicopathological factors were performed using the Cox proportional hazard model. RESULTS: 5-year survival rates were 43.6% for patients in the N0 group and 29.3% in the N+ group (p = 0.001). Kaplan-Meier analyses for all cases revealed that there were significant differences in survival based on the extent (the OS rates at 3 years were 53.3% for patients in the N0 group, 45.7% in the 1 region-involved group, 28.0% in the 2 regions-involved group, and 13.3% in the 3 regions-involved group, P < 0.001), number (the OS rates at 3 years were 49.0% for patients in the 1-2 LNs group, 27.8% in the 3-6 LNs group, 0 in the ≥7LNs group, P < 0.001), and size (the OS rates at 3 years were 41.6% for patients in the LNs ≤2 cm group and 20.7% in the LNs > 2 cm group, P = 0.001) of metastatic LNs. One hundred seventy-two patients (48.2%) had experienced GTV failure, 157 (43.1%) had distant failure, 49 (13.7%) had out-of-GTV nodal failure, and 70 patients (19.6%) had no evidence of disease at the last follow-up. Nodal status correlated statistically with GTV failure. Patients with LN metastases in the abdominal region had worse survival rates than those with metastases in the other regions. The extent and number of metastatic LNs, T category, Primary tumor location, and chemotherapy were independent prognostic factors of OS in multivariate analyses. CONCLUSIONS: For patients with ESCC who received definitive (chemo-)radiotherapy, the number, extent, and size of metastatic LNs were prognostic factors, particularly of the T2/3 disease. Patients with LN metastases in the abdominal region had worse survival.


Assuntos
Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/mortalidade , Linfonodos/patologia , Radioterapia de Intensidade Modulada/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/radioterapia , Carcinoma de Células Escamosas do Esôfago/radioterapia , Carcinoma de Células Escamosas do Esôfago/secundário , Feminino , Humanos , Linfonodos/efeitos da radiação , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Dosagem Radioterapêutica , Estudos Retrospectivos , Taxa de Sobrevida
14.
Anticancer Res ; 39(8): 4279-4283, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366518

RESUMO

BACKGROUND/AIM: To determine whether concurrent chemotherapy with radiotherapy should be performed in elderly patients with esophageal cancer. PATIENTS AND METHODS: A total of 185 patients aged 80 years or older who were treated with definitive radiotherapy alone or combined with chemoradiotherapy for esophageal cancer at seven institutions were enrolled. In order to compare survival rates of patients treated with chemoradiotherapy with those of patients treated with radiotherapy alone, propensity score matching was performed to homogenize the two populations. RESULTS: For the whole patient cohort, the 3-year overall survival (OS) rate was 52.6% and the median survival was 42.5 months. After propensity score matching, the 3-year OS rate for the chemoradiotherapy group was not significantly better than that for the group treated with radiotherapy alone (53.7% vs. 59.9%, p=0.876). CONCLUSION: Concurrent chemotherapy with radiotherapy for esophageal cancer in patients aged 80 years or older did not have significant OS benefit over radiotherapy alone.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Quimiorradioterapia , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Idoso de 80 Anos ou mais , Cisplatino/administração & dosagem , Terapia Combinada , Intervalo Livre de Doença , Neoplasias Esofágicas/patologia , Feminino , Fluoruracila/administração & dosagem , Humanos , Estimativa de Kaplan-Meier , Masculino
15.
J Cancer Res Ther ; 15(4): 849-856, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31436242

RESUMO

Purpose: This study investigated the outcome of elderly patients (≥65 years) with thoracic esophageal squamous cell carcinoma (TESCC) treated with esophagectomy and postoperative radiotherapy (PORT) or definitive radiotherapy (DRT). Patients and Methods: One hundred and ninety patients (median age of 72 years) who received PORT (n = 68) or DRT (n = 122) for TESCC were analyzed. Majority of them showed locally advanced disease (T3/4: 70.5%, N+: 70.5%, Stage III: 51.6%). Compared to patients who received DRT, those who received PORT had lower Age-Adjusted Charlson Comorbidity Index (AACCI) scores (2.49 ± 0.61 vs. 3.73 ± 1.28, χ2 = 7.283; P = 0.000) and higher Karnofsky Performance Scale (KPS) (χ2 = 9.016; P = 0.003) and were of younger ages (68.90 ± 3.00 vs. 75.17 ± 5.71, χ2 = 9.925; P = 0.000). Results: Overall survival (OS) was significantly higher in the PORT group (median, 61.2 months; 95% confidence interval [CI], 46.04-76.36) than in the DRT group (median, 24.37 months; 95% CI, 15.43-33.31). Multivariate analysis showed that treatment method (hazard ratio [HR]: 2.38, 95% CI, 1.46-3.90; P = 0.001), clinical T stage (HR: 0.57, 95% CI, 0.34-0.95; P = 0.031), and lymph node metastasis (HR: 0.51, 95% CI, 0.31-0.84; P = 0.008) were independent prognostic factors. Regarding subgroup analysis, OS of patients receiving PORT was significantly higher than that of DRT in the T3-4 group (HR: 2.98, 95% CI, 1.80-4.92; P = 0.000) and the N+ group (HR: 2.20, 95% CI, 1.26-3.83; P = 0.006). Conclusions: The efficacy of PORT for the treatment of elderly TESCC patients was superior to DRT. With regard to AACCI, KPS, and age, DRT is still a treatment option for elderly TESCC patients, especially for those >75 years of age.


Assuntos
Quimiorradioterapia/mortalidade , Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/mortalidade , Esofagectomia/mortalidade , Radioterapia Conformacional/mortalidade , Radioterapia de Intensidade Modulada/mortalidade , Idoso , Terapia Combinada , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/radioterapia , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/patologia , Carcinoma de Células Escamosas do Esôfago/radioterapia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
16.
Int J Radiat Oncol Biol Phys ; 105(5): 1074-1085, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31461673

RESUMO

PURPOSE: We initially aimed to ascertain the application value of inflammatory indexes in predicting severe acute radiation pneumonitis (SARP). Furthermore, a novel nomogram and risk classification system integrating clinicopathologic, dosimetric, and biological parameters were built to provide individualized risk assessment and accurate prediction of SARP in patients with esophageal cancer who received radiation therapy. METHODS AND MATERIALS: All data were retrospectively collected from 416 esophageal cancer patients in 2 participating institutes. A novel nomogram was constructed that forecasted SARP based on logistic regression analyses. The concordance index, calibration curves, and decision curve analyses were used by both internal and external validation to demonstrate discriminatory and predictive capacity. Moreover, a corresponding risk classification system was generated by recursive partitioning analysis. RESULTS: The Subjective Global Assessment score, pulmonary fibrosis score, planning target volume/total lung volume, mean lung dose, and ratio of change regarding systemic immune inflammation index at 4 weeks in the course of treatment were independent predictors of SARP and finally incorporated into our nomogram. The concordance index of nomogram for SARP prediction was 0.852, which showed superior discriminatory power (range, 0.604-0.712). Calibration curves indicated favorable consistency between the nomogram prediction and the actual outcomes. Decision curve analyses exhibited satisfactory clinical utility. A risk classification system was established to perfectly divide patients into 3 different risk groups, which were low-risk group (6.1%, score 0-158), intermediate-risk group (37.3%, score 159-280), and high-risk group (78.9%, score >280). CONCLUSIONS: The Subjective Global Assessment score, pulmonary fibrosis score, planning target volume/total lung volume, mean lung dose, and ratio of change regarding systemic immune inflammation index at 4 weeks were potential valuable markers in predicting SARP. The developed nomogram and corresponding risk classification system with superior prediction ability for SARP could assist in patient counseling and provide guidance when making treatment decisions.


Assuntos
Neoplasias Esofágicas/radioterapia , Nomogramas , Pneumonite por Radiação/etiologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Doença Aguda , Análise de Variância , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Calibragem , Neoplasias Esofágicas/tratamento farmacológico , Feminino , Humanos , Contagem de Leucócitos , Modelos Logísticos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Fibrose Pulmonar/etiologia , Pneumonite por Radiação/diagnóstico , Radioterapia Conformacional/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco
17.
Radiat Oncol ; 14(1): 119, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286978

RESUMO

BACKGROUND: Radiation therapy is a mainstay in the treatment of esophageal cancer (EC) patients, and photon radiotherapy has proved beneficial both in the neoadjuvant and the definitive setting. However, regarding the still poor prognosis of many EC patients, particle radiation employing a higher biological effectiveness may help to further improve patient outcomes. However, the influence of clinically available particle radiation on EC cells remains largely unknown. METHODS: Patient-derived esophageal adenocarcinoma and squamous cell cancer lines were treated with photon and particle irradiation using clinically available proton (1H), carbon (12C) or oxygen (16O) beams at the Heidelberg Ion Therapy Center. Histology-dependent clonogenic survival was calculated for increasing physical radiation doses, and resulting relative biological effectiveness (RBE) was calculated for each radiation modality. Cell cycle effects caused by photon and particle radiation were assessed, and radiation-induced apoptosis was measured in adenocarcinoma and squamous cell EC samples by activated caspase-3 and sub-G1 populations. Repair kinetics of DNA double strand breaks induced by photon and particle radiation were investigated. RESULTS: While both adenocarcinoma EC cell lines demonstrated increasing sensitivities for 1H, 12C and 16O radiation, the two squamous cell carcinoma lines exhibited a more heterogeneous response to photon and particle treatment; average RBE values were calculated as 1.15 for 1H, 2.3 for 12C and 2.5 for 16O irradiation. After particle irradiation, squamous cell EC samples reacted with an increased and prolonged block in G2 phase of the cell cycle compared to adenocarcinoma cells. Particle radiation resulted in an incomplete repair of radiation-induced DNA double strand breaks in both adenocarcinoma and squamous cell carcinoma samples, with the levels of initial strand break induction correlating well with the individual cellular survival after photon and particle radiation. Similarly, EC samples demonstrated heterogeneous levels of radiation-induced apoptosis that also corresponded to the observed cellular survival of individual cell lines. CONCLUSIONS: Esophageal cancer cells exhibit differential responses to irradiation with photons and 1H, 12C and 16O particles that were independent of tumor histology. Therefore, yet unknown molecular markers beyond histology may help to establish which esophageal cancer patients benefit from the biological effects of particle treatment.


Assuntos
Adenocarcinoma/patologia , Apoptose/efeitos da radiação , Carcinoma de Células Escamosas/patologia , Quebras de DNA de Cadeia Dupla/efeitos da radiação , Neoplasias Esofágicas/patologia , Fótons , Adenocarcinoma/radioterapia , Carcinoma de Células Escamosas/radioterapia , Reparo do DNA/efeitos da radiação , Neoplasias Esofágicas/radioterapia , Humanos , Células Tumorais Cultivadas
18.
Medicine (Baltimore) ; 98(26): e16176, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261551

RESUMO

INTRODUCTION: Re-irradiation after radiotherapy is a common treatment for locally recurrent esophageal cancer. However, the side effects of re-irradiation are serious. The most serious adverse reactions of re-irradiation include esophageal perforation and hemorrhage caused by esophageal perforation. Studies have shown that pulsed low-dose rate radiotherapy (PLDR) induces a hypersensitivity effect on tumor tissue and a hyper-repair effect on normal tissue, which can simultaneously reduce damage on the normal tissue and increase the therapeutic effect on the tumor. The objective of this study is to explore whether PLDR can reduce rate of esophageal perforation and improve efficacy in patients with recurrent esophageal squamous cell carcinoma (ESCC) after radiotherapy. METHODS AND ANALYSIS: This study is a prospective, multi-center, open, single-arm clinical trial designed to enroll 27 patients with locally recurrent ESCC after radiotherapy with or without chemotherapy. Re-irradiation will be performed using intensity modulated radiation therapy in 50 Gy/25 fractions. The strategy of PLDR includes dividing 2 Gy into 10 fractions, and administering each irradiating dose of 20 cGy at an interval of 3 minutes before the next low-dose irradiation. The actual dose rate of administration each time will be 16.67 cGy /minute. The primary endpoint in this study is the rate of esophageal perforation. The secondary endpoints are the objective remission rate, the palliative effect on quality of life and pain, and the time of disease progression. The observation time is 2 years after the end of the study. TRIAL REGISTRATION: Clinical trial number: ChiCTR1900020609.


Assuntos
Ensaios Clínicos Fase II como Assunto , Neoplasias Esofágicas/radioterapia , Carcinoma de Células Escamosas do Esôfago/radioterapia , Estudos Multicêntricos como Assunto , Recidiva Local de Neoplasia/radioterapia , Reirradiação , Quimiorradioterapia , Neoplasias Esofágicas/tratamento farmacológico , Carcinoma de Células Escamosas do Esôfago/tratamento farmacológico , Humanos , Recidiva Local de Neoplasia/tratamento farmacológico , Seleção de Pacientes , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/métodos
19.
Medicine (Baltimore) ; 98(30): e16536, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348271

RESUMO

This study aimed to analyze the influence of the radiation field size on the passing rate of the treatment planning system using MatriXX if the field irradiated the circuit.Two sets of static fields which were 10 cm and 30 cm in the left-right direction (X), and was 31 cm to 40 cm in gun-target direction (Y) were designed. In these fields, the gantry was 0 and the monitor units were 200 MU. Two plans from an esophagus carcinoma patient with a planning target volume of 86.4 cm and a cervical carcinoma patient with a planning target volume (PTV) of 2094.1 cm were chosen. The passing rates of these plans were gained without and with protecting the circuit area from lead alloys. The gamma analysis was used and the standard was set to 3%/3 mm.The verification passing rate decreased from 95.0% to 69.2% when X was 10 cm while Y increased from 31 cm to 40 cm. With the protection from low melting point lead alloys, the passing rate was from 96.2% to 89.6%. The results of the second set of plans without lead alloys were similar but the passing rate decreased more sharply. The passing rates of the 2 patients were 99.5% and 57.1%. With the protection of the lead alloys, their passing rates were 99.8% and 72.1%, respectively.The results showed that with the increase of the radiation field size in the Y direction, more areas were irradiated in the circuit, and the passing rate gradually decreases and dropped sharply at a certain threshold. After putting lead alloys above the circuit, the passing rate was much better in the static field but was still less than 90% in the second patient volumetric modulated arc therapy (VMAT) because the circuit was irradiate in other directions. In daily QA, we should pay attention to these patients with long size tumor.


Assuntos
Carcinoma/radioterapia , Neoplasias Esofágicas/radioterapia , Raios gama/uso terapêutico , Planejamento da Radioterapia Assistida por Computador/métodos , Neoplasias do Colo do Útero/radioterapia , Feminino , Humanos , Masculino , Radiometria , Dosagem Radioterapêutica
20.
J Appl Clin Med Phys ; 20(8): 134-140, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31343821

RESUMO

PURPOSE: This work aims to develop a knowledge-based automated dose volume histogram (DVH) prediction module that serves as a plan quality evaluation tool and treatment planning guidance in commercial Pinnacle3 treatment planning system (Philips Radiation Oncology Systems, Fitchburg, WI, USA). METHODS: The knowledge-based automated DVH prediction module was developed with kernel density estimation (KDE) method and applied for Pinnacle3 treatment planning system. Treatment plan data from 20 esophageal cancer cases were used for creating a module to predict DVHs. Twenty additional esophageal clinical plans were evaluated on the developed module. Predicted DVHs were compared with manual ones. Differences between the predicted and achieved DVHs were analyzed. RESULTS: The plan evaluation module was successfully implemented in Pinnacle3 treatment planning system. Strong linear correlations were found between predicted and achieved DVH for organs at risk. Suboptimal treatment plan quality could be improved according to the predicted DVHs by the module. CONCLUSION: The knowledge-based automated DVH prediction module implemented in Pinnacle3 could be used to efficiently evaluate the treatment plan quality and as guidance for further plan optimization.


Assuntos
Automação , Neoplasias Esofágicas/radioterapia , Órgãos em Risco/efeitos da radiação , Guias de Prática Clínica como Assunto/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Planejamento da Radioterapia Assistida por Computador/normas , Software , Humanos , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA