Locally advanced non-small cell lung cancer(NSCLC) continues to be a challenging disease to treat. With high rates of both local and distant failures, there is signiicant interest in inding more biologically active ch...Locally advanced non-small cell lung cancer(NSCLC) continues to be a challenging disease to treat. With high rates of both local and distant failures, there is signiicant interest in inding more biologically active chemotherapy regimens that can contribute to reduce both failures. The phase III PROCLAIM trial, recently published in the Journal of Clinical Oncology entitled "PROCLAIM: randomized phase III trial of pemetrexed–cisplatin or etoposide–cisplatin plus thoracic radiation therapy followed by consolidation chemotherapy in locally advanced nonsquamous non-small-cell lung cancer", compared two diferent chemotherapy regimens given concurrently with radiotherapy in patients with stage III non-squamous lung cancer: pemetrexed plus cisplatin versus cisplatin plus etoposide. Both groups received consolidation chemotherapy. After enrolling 598 of planned 600 patients, the study was stopped early due to futility as no diference was seen in the primary end-point of overall survival. Since PROCLAIM was designed as a superiority trial, these results suggest that pemetrexed regimens do not ofer a clinical advantage over standard cisplatin plus etoposide. There are some subpopulations who might still beneit from pemetrexed, especially if clinicians are concerned about myelosuppression-related adverse events. Future trials are needed to investigate novel biologic agents and irradiation techniques that can result in more durable local and distant disease control in locally advanced NSCLC.展开更多
The management of localized breast cancer has changed dramatically over the past three to four decades.Breastconserving therapy,which involved lumpectomy followed by adjuvant irradiation,is now widely considered the s...The management of localized breast cancer has changed dramatically over the past three to four decades.Breastconserving therapy,which involved lumpectomy followed by adjuvant irradiation,is now widely considered the standard of care in women with early-stage breast cancer.Accelerated partial breast irradiation(APBI),which involves focal irradiation of the lumpectomy cavity over a short period of time,has developed over the past two decades as an alternative to whole breast irradiation(WBI).Multiple APBI modalities have been developed including brachytherapy,external beam irradiation,and intraoperative irradiation.These new technigues have provided early-stage breast cancer patients with shorter treatment duration and more focused irradiation,delivering very high biological doses to the region at a high risk of failures over a much shorter treatment course as compared with conventional radiotherapy.However,the advantages of APBI over conventional radiotherapy are controversial,including a higher risk of complications reported in retrospective literature and shorter follow-up duration in the intraoperative APBI trials.Nevertheless,APBI presents a valuable alternative to WBI for a selected population of women with early-stage breast cancer.展开更多
Background:Invasive micropapillary carcinoma(IMPC)is an uncommon subtype of breast cancer.Previous studies of this subtype demonstrated a higher propensity for lymph node metastases as compared with invasive ductal ca...Background:Invasive micropapillary carcinoma(IMPC)is an uncommon subtype of breast cancer.Previous studies of this subtype demonstrated a higher propensity for lymph node metastases as compared with invasive ductal carci-noma(IDC).The purpose of the present study was to determine the clinical characteristics,outcomes,and propensity for lymph node metastasis of patients with IMPC of the breast recorded in the National Cancer Database(NCDB).Methods:Records of patients with IMPC diagnosed between 2004 and 2014 were retrieved from the NCDB.Log-rank test was performed to evaluate associations of clinical characteristics with overall survival(OS).Cox proportional hazards model was used to determine variables associated with OS.Results:Overall,2660 patients with IMPC met the selection criteria;the 5-year OS rate was 87.5%and 24.9%of patients had nodal involvement at presentation.Patients with≥4 positive lymph nodes had shorter OS than node-negative patients,whereas patients with 1-3 positive nodes had similar OS to node-negative patients.Age<65 years,receipt of radiotherapy,and estrogen receptor positivity were also associated with prolonged OS.The benefit of radiotherapy was limited to IMPC patients undergoing lumpectomy;there was no benefit for the patients undergoing mastectomy(regardless of nodal positivity/negativity).Conclusions:Favorable prognostic factors of IMPC patients included age<65 years,<4 positive lymph nodes,receipt of radiotherapy,and estrogen receptor positivity.The results presented herein suggest a survival benefit asso-ciated with radiotherapy in IMPC treatment,though this may be limited to the patients treated with lumpectomy.展开更多
Background:Technical advances in radiotherapy delivery have simultaneously enabled dose escalation and enhanced bladder and rectal sparing.However,the optimal radiation fractionation regimen for localized prostate can...Background:Technical advances in radiotherapy delivery have simultaneously enabled dose escalation and enhanced bladder and rectal sparing.However,the optimal radiation fractionation regimen for localized prostate cancer is unclear.Laboratory and clinical evidence suggest that hypofractionation may improve the therapeutic ratio of radiotherapy.We report our institutional outcomes using moderately hypofractionated,intensity-modulated radio-therapy(IMRT),and an endorectal balloon,with emphasis on long-term biochemical control and treatment-related adverse events in patients with localized prostate cancer.Methods:Between January 1997 and April 2004,596 patients with cT1-T3 prostate cancer underwent IMRT using a moderate hypofractionation regimen(76.70 Gy at 2.19 Gy/fraction)with an endorectal balloon.Using D’Amico clas-sification,226(37.9%),264(44.3%),and 106(17.8%)patients had low-,intermediate-,or high-risk disease,respectively.The majority of intermediate-and high-risk patients received androgen deprivation therapy.Biochemical relapse-free survival(bRFS)was evaluated using 2005 Phoenix criteria and estimated using the Kaplan-Meier method.Results:The median follow-up was 62 months.Overall 5-and 10-year bRFS rates were 92.7%and 87.7%.For low-,intermediate-,and high-risk patients,the 5-year bRFS rates were 96.9%,93.3%,and 82.0%,respectively;the 10-year bRFS rates were 91.4%,89.3%,and 76.2%,respectively.Prostate-specific antigen,Gleason score,and T stage were significant predictors of bRFS(all P<0.01).The 5-year rates of severe(≥Grade 3)adverse events were very low:1.2%for gastrointestinal events and 1.1%for genitourinary events.Conclusions:Long-term outcomes after moderately hypofractionated IMRT are encouraging.Moderate hypofrac-tionation represents a safe,efficacious,alternative regimen in the treatment of localized prostate cancer.展开更多
文摘Locally advanced non-small cell lung cancer(NSCLC) continues to be a challenging disease to treat. With high rates of both local and distant failures, there is signiicant interest in inding more biologically active chemotherapy regimens that can contribute to reduce both failures. The phase III PROCLAIM trial, recently published in the Journal of Clinical Oncology entitled "PROCLAIM: randomized phase III trial of pemetrexed–cisplatin or etoposide–cisplatin plus thoracic radiation therapy followed by consolidation chemotherapy in locally advanced nonsquamous non-small-cell lung cancer", compared two diferent chemotherapy regimens given concurrently with radiotherapy in patients with stage III non-squamous lung cancer: pemetrexed plus cisplatin versus cisplatin plus etoposide. Both groups received consolidation chemotherapy. After enrolling 598 of planned 600 patients, the study was stopped early due to futility as no diference was seen in the primary end-point of overall survival. Since PROCLAIM was designed as a superiority trial, these results suggest that pemetrexed regimens do not ofer a clinical advantage over standard cisplatin plus etoposide. There are some subpopulations who might still beneit from pemetrexed, especially if clinicians are concerned about myelosuppression-related adverse events. Future trials are needed to investigate novel biologic agents and irradiation techniques that can result in more durable local and distant disease control in locally advanced NSCLC.
文摘The management of localized breast cancer has changed dramatically over the past three to four decades.Breastconserving therapy,which involved lumpectomy followed by adjuvant irradiation,is now widely considered the standard of care in women with early-stage breast cancer.Accelerated partial breast irradiation(APBI),which involves focal irradiation of the lumpectomy cavity over a short period of time,has developed over the past two decades as an alternative to whole breast irradiation(WBI).Multiple APBI modalities have been developed including brachytherapy,external beam irradiation,and intraoperative irradiation.These new technigues have provided early-stage breast cancer patients with shorter treatment duration and more focused irradiation,delivering very high biological doses to the region at a high risk of failures over a much shorter treatment course as compared with conventional radiotherapy.However,the advantages of APBI over conventional radiotherapy are controversial,including a higher risk of complications reported in retrospective literature and shorter follow-up duration in the intraoperative APBI trials.Nevertheless,APBI presents a valuable alternative to WBI for a selected population of women with early-stage breast cancer.
文摘Background:Invasive micropapillary carcinoma(IMPC)is an uncommon subtype of breast cancer.Previous studies of this subtype demonstrated a higher propensity for lymph node metastases as compared with invasive ductal carci-noma(IDC).The purpose of the present study was to determine the clinical characteristics,outcomes,and propensity for lymph node metastasis of patients with IMPC of the breast recorded in the National Cancer Database(NCDB).Methods:Records of patients with IMPC diagnosed between 2004 and 2014 were retrieved from the NCDB.Log-rank test was performed to evaluate associations of clinical characteristics with overall survival(OS).Cox proportional hazards model was used to determine variables associated with OS.Results:Overall,2660 patients with IMPC met the selection criteria;the 5-year OS rate was 87.5%and 24.9%of patients had nodal involvement at presentation.Patients with≥4 positive lymph nodes had shorter OS than node-negative patients,whereas patients with 1-3 positive nodes had similar OS to node-negative patients.Age<65 years,receipt of radiotherapy,and estrogen receptor positivity were also associated with prolonged OS.The benefit of radiotherapy was limited to IMPC patients undergoing lumpectomy;there was no benefit for the patients undergoing mastectomy(regardless of nodal positivity/negativity).Conclusions:Favorable prognostic factors of IMPC patients included age<65 years,<4 positive lymph nodes,receipt of radiotherapy,and estrogen receptor positivity.The results presented herein suggest a survival benefit asso-ciated with radiotherapy in IMPC treatment,though this may be limited to the patients treated with lumpectomy.
文摘Background:Technical advances in radiotherapy delivery have simultaneously enabled dose escalation and enhanced bladder and rectal sparing.However,the optimal radiation fractionation regimen for localized prostate cancer is unclear.Laboratory and clinical evidence suggest that hypofractionation may improve the therapeutic ratio of radiotherapy.We report our institutional outcomes using moderately hypofractionated,intensity-modulated radio-therapy(IMRT),and an endorectal balloon,with emphasis on long-term biochemical control and treatment-related adverse events in patients with localized prostate cancer.Methods:Between January 1997 and April 2004,596 patients with cT1-T3 prostate cancer underwent IMRT using a moderate hypofractionation regimen(76.70 Gy at 2.19 Gy/fraction)with an endorectal balloon.Using D’Amico clas-sification,226(37.9%),264(44.3%),and 106(17.8%)patients had low-,intermediate-,or high-risk disease,respectively.The majority of intermediate-and high-risk patients received androgen deprivation therapy.Biochemical relapse-free survival(bRFS)was evaluated using 2005 Phoenix criteria and estimated using the Kaplan-Meier method.Results:The median follow-up was 62 months.Overall 5-and 10-year bRFS rates were 92.7%and 87.7%.For low-,intermediate-,and high-risk patients,the 5-year bRFS rates were 96.9%,93.3%,and 82.0%,respectively;the 10-year bRFS rates were 91.4%,89.3%,and 76.2%,respectively.Prostate-specific antigen,Gleason score,and T stage were significant predictors of bRFS(all P<0.01).The 5-year rates of severe(≥Grade 3)adverse events were very low:1.2%for gastrointestinal events and 1.1%for genitourinary events.Conclusions:Long-term outcomes after moderately hypofractionated IMRT are encouraging.Moderate hypofrac-tionation represents a safe,efficacious,alternative regimen in the treatment of localized prostate cancer.
