Similar Outcomes of Standard Radiotherapy and Hypofractionated Radiotherapy Following Breast-Conserving Surgery.

BACKGROUND: Adjuvant radiation therapy is commonly administered to breast cancer patients who received breast-conserving surgery. However, lengthy treatment times of standard radiotherapy pose certain challenges. Here, we performed a prospective controlled study comparing standard radiation to hypofractionated radiotherapy in terms of efficacy and outcome. MATERIAL AND METHODS: Eighty breast cancer patients (tumor stage pT1-2N0-1M0) who had undergone breast-conservation surgery were randomly divided into 2 groups (40 patients/group). The experimental group received 43.2 Gy to the whole breast in 18 fractions for 24 days with a concomitant boost (50.4 Gy) to the tumor bed. The control group received 45 Gy to the whole breast in 25 fractions for 44 days with a boost to the tumor bed of 59 Gy. Survival, locoregional recurrence, adverse effects, and aesthetic results were all considered for analysis. RESULTS: The following criteria were included as part of study follow-up: local control, survival, adverse skin reactions, cosmetic outcome, and hematological toxicity. At a median follow-up of 27 months (follow-up rate 100%), there were no statistical differences in any of the categories between the 2 groups. The 2-year survival rate of both groups was 100% without any locoregional recurrence. Although there was some skin toxicity, these instances were not severe and they cleared on their own within 6 weeks. The most common problems encountered by patients were breast fibrosis and altered pigmentation. CONCLUSIONS: A shortened whole-breast hypofractionated irradiation schedule with a concomitant boost is as effective as standard radiation and may be a reasonable alternative following breast conservation surgery.

The relationship between the radiation dose of pelvic-bone marrow and lymphocytic toxicity in concurrent chemoradiotherapy for cervical cancer.

OBJECTIVE: The purpose of this study is to verify the correlation between medium and low radiation doses of the pelvic-bone marrow and the incidence of lymphocytic toxicity during concurrent chemoradiotherapy for cervical cancer. MATERIALS AND METHODS: This research included 117 cervical cancer patients, who received concurrent chemoradiotherapy. Radiotherapy included external-beam radiation therapy and brachytherapy. The dosimetry parameters include the Volume receiving 5 Gy (V5), 10 Gy (V10), 20 Gy (V20), 30 Gy (V30), 40 Gy (V40), 50 Gy (V50), and the mean dose (D mean) of the bone marrow. Lymphocytic toxicity was calculated from lowest lymphocytic count after two cycles of concurrent chemotherapy. RESULTS: During concurrent chemoradiotherapy, the incidence of lymphocytic toxicity is 94.88%. The incidence of grade 3-4 toxicity is 68.38%. Multivariate analysis findings show that the dosimetry parameters V5, V10, V20, and V30 are significantly correlated with lymphocytic toxicity. The patients are divided into small-volume subgroups and large-volume subgroups based on the cutoff values. The relative risk of both grade 1-4 and grade 3-4 lymphocytic toxicity is significantly lower in the small-volume subgroups than in the large-volume subgroups (P < 0.05). Kaplan-Meier analysis shows that the incidence of both grade 1-4 and grade 3-4 lymphocytic toxicity of the small-volume subgroups is significantly lower than that of the large-volume subgroups (P < 0.05). CONCLUSION: There is a significant correlation between a medium and low dose of pelvic-bone-marrow radiation and incidence of lymphocytic toxicity. Reducing the volume of medium and low radiation doses could effectively reduce incidence of lymphocytic toxicity.

[Concurrent chemoradiotherapy for stage III non-small cell lung cancer].

OBJECTIVE: To evaluate the immediate efficacy and acute toxicity of cisplatin-based induction chemotherapy followed by weekly concomitant chemoradiotherapy and concomitant chemoradiotherapy followed by consolidation chemotherapy in unresectable stage III NSCLC. METHODS: A total of 118 patients were pathologically diagnosed as stage III N SCLC. Among them, 77 patients (A group) received two cycles of cisplatin-based induction chemotherapy, followed by 6 weekly cycles of paclitaxel 45 mg/m(2) (n = 45) and gemcitabine 350 mg/m(2) (n = 32) in combination with thoracic radiotherapy; 41 patients (B group) received concomitant chemoradiotherapy (cisplatin 50 mg/m(2), d1, 8, 29, 36/etoposide 50 mg/m(2), d1-5, 29-33, n = 18, paclitaxel 45 mg/m(2)/weekly × 6/carboplatin AUC = 2/weekly × 6, n = 23) followed by consolidation chemotherapy. All thoracic radiotherapy dose are 2 Gy per fraction and day to a total dose of 58-60 Gy. RESULTS: The total response rate of A and B groups was 80.5% and 75.6% respectively (P = 0.534). According to subgroup analyses, no statistically significant differences existed according to chemotherapy (P = 0.557). The main side-effects were neutropenia, radiation esophagitis, radiation pneumonitis and nausea/vomiting. The gemcitabine group was statistically significant different in neutropenia. CONCLUSION: Different chemotherapeutic agents in combination with thoracic radiotherapy are clinically feasible with a moderate toxicity. Their profiles of efficacy and toxicity are comparable to each other.

Early postoperative radiotherapy is associated with improved outcomes over late postoperative radiotherapy in the management of completely resected (R0) Stage IIIA-N2 non-small cell lung cancer.

AIMS: The aim of this study was to evaluate the ideal timing of PORT in the management of completely resected (R0) Stage IIIA-N2 NSCLC. PATIENTS AND METHODS: Between January 2008 and December 2015, patients with known histologies of pathologic Stage IIIA-N2 NSCLC who underwent R0 resection and received PORT concurrent with or prior to two sequential cycles of chemotherapy ("early PORT") or with PORT administered after two cycles of chemotherapy ("late PORT") at multiple hospitals. The primary endpoint was OS; secondary end points included pattern of the first failure, LRRFS, and DMFS. Kaplan-Meier OS, LRRFS, and DMFS curves were compared with the log-rank test. Cox regression analysis was used to determine prognosticators for OS, LRRFS, and DMFS. RESULTS: Of 112 included patients, 41 (36.6%) and 71 (63.4%) patients received early PORT and late PORT, respectively. The median OS, LRRFS, and DMFS were longer for those who received early PORT than for those who received late PORT at the median follow-up of 29.6 months (all p < 0.05). Uni- and multi-variate analyses showed that number of POCT cycles and the combination schedule of PORT and POCT were independent prognostic factors for OS, LRRFS, and DMFS. CONCLUSIONS: Early PORT is associated with improved outcomes in pathologic Stage IIIA-N2 R0 NSCLC patients.

The prognosis factor of adjuvant radiation therapy after surgery in uterine sarcomas.

OBJECTIVE: This retrospective study evaluated the role of adjuvant radiotherapy (AR) after surgery in patients with uterine sarcoma and analyzed the prognostic factors of local-regional failure-free survival (LRFFS) and overall survival (OS). PATIENTS AND METHODS: A study of a total of 182 patients with uterine sarcoma was conducted between June 1994 and October 2014. Adjuvant radiotherapy was defined as postoperative external beam radiation to the pelvis (30-50 Gray/10-25 fractions at five fractions/week). The primary end point was LRFFS, and the secondary end point was OS. Kaplan-Meier curves were compared using the log-rank test. Cox regression analyses were used to determine prognosticators for LRFFS and OS. RESULTS: The median follow-up time of all patients was 75 months, with a 5-year LRFFS of 62.1%. The 2-year and 5-year LRFFS rates were longer for those who received AR than for those who did not receive AR (83.4% vs 70.3%; 78% vs 55.3%; P=0.013). The 5-year OS of all patients was 56.2%, and no significant differences were observed in the 2-year and 5-year OS rates between these two groups (82.7% vs 71.4%; 64.1% vs 51.7%; P=0.067). Importantly, in patients with leiomyosarcoma, the 2-year and 5-year LRFFS and OS rates were longer for those who received AR than for those who did not receive AR (P=0.04 and P=0.02 for the 2-year and 5-year LRFFS, respectively). CONCLUSION: Patients with uterine sarcoma who were treated with AR after surgery demonstrated an improved LRFFS compared with those who were treated with surgery alone, especially those patients with leiomyosarcoma. Therefore, the role of personalized adjuvant radiation for patients with uterine sarcoma still requires further discussion.

[The relationship between Helicobacter pylori in oral cavity and the Hp infection in stomach].

OBJECTIVE: To analyze the relationship between Helicobacter pylori (Hp) in oral cavity and the Hp infection in stomach. METHODS: 102 patients with gastric Hp infection and periodontitis were enrolled in this study. DNA was extracted from subgingival plaques, mouthwashes and stomach mucosa samples by using the glass-milk (SiO2) purification method. To identify the presence of Hp in these samples, PCR (polymerase chain reaction) was carried out, and two pairs of oligonucleotide primer were used to amplify a portion of gene urease C and gene cag A of Hp. RESULTS: The rate of Hp detected in oral cavity was significantly higher in patients with positive Hp in stomach (43.1%, n=58) than in those with negative Hp in stomach (22.7%, n=44, P<0.05). After the treatment for gastric Hp infection for 4 weeks, the eradication rate of Hp in stomach was lower, but only slightly in patients with positive oral Hp (16/25, 64%) than in those with negative oral Hp (24/33, 72.7%). However, this difference became apparent (36.0% vs 63.6%, P<0.05) after one year of the treatment. CONCLUSIONS: The effectiveness of the eradication therapy for gastric Hp infection is affected by the presence of Hp in oral cavity. Oral colonization of Hp may imply that there is a risk of the relapses of gastric and duodenal Hp infection and ulcer after the antibiotics treatment for the eradication of Hp.