Concurrent chemoradiotherapy combined with enteral nutrition support:a radical treatment strategy for esophageal squamous cell carcinoma patients with malignant istulae

Background: Concurrent chemoradiotherapy(CCRT) significantly increases the survival rate of esophageal squa?mous cell carcinoma(ESCC) patients with malignant fistulae. Recent clinical evidence has shown the benefits of enteral nutrition for malnourished cancer patients. In this study, we aimed to validate that, with the support of enteral nutrition, ESCC patients who develop malignant fistulae might be able to complete CCRT and achieve long?term survival.Methods: We reviewed the medical records of 652 patients with ESCC who received definitive CCRT at Sun Yat?sen University Cancer Center between January 2010 and December 2012. Treatment outcome and toxicity were ret?rospectively evaluated in 40 ESCC patients with malignant fistulae. All the 40 patients were treated with CCRT and evaluated by clinical nutritionists using nutrition risk screening(NRS) before, during, and after treatment. Twenty?two patients received a nasogastric tube, and 18 underwent percutaneous endoscopic gastrostomy feeding. The median energy intake was 2166 kcal/day. Treatment response was evaluated at 3 months after the completion of CCRT.Results: With a median follow?up of 18 months(range, 3–39 months), patients' 1?year overall survival(OS) rate was 62.5%, and the estimated OS time was 25.5 months. Univariate analysis showed that the NRS score(P n NRS score(P se to treatment(P < 0.001) were sig= 0.003), increase i= 0.024), fistula closure(P = 0.011), and responnifi?cantly associated with OS. Multivariate analysis showed that tumor response(P = 0.044) and increase in NRS score(P = 0.044) were independent predictors of OS. Grade 3 vomiting was observed in 8 patients(20.0%), grade 3 neutro?penia was observed in 11 patients(27.5%), and grade 3 cough was observed in 13 patients(32.5%); 2 patients(5.0%) died of massive bleeding during treatment.Conclusions: CCRT combined with enteral nutrition support is effective for ESCC patients with malignant fistulae. Patients have an increased potential to be cured, especially those who experience complete response and have an increase in NRS score. Careful observation and nutrition support are required for patients with advanced T?category ESCC who undergo CCRT.

Radiotherapy with neoadjuvant chemotherapy versus concurrent chemoradiotherapy for ascending-type nasopharyngeal carcinoma:a retrospective comparison of toxicity and prognosis

Background:In the era of intensity?modulated radiotherapy(IMRT),the role of neoadjuvant chemotherapy(NACT)in treating ascending?type nasopharyngeal carcinoma(NPC)is under?evaluated.This study was to compare the efficacy of NACT followed by IMRT(NACT+RT)with the efficacy of concurrent chemoradiotherapy(CCRT)on ascending?type NPC.Methods:Clinical data of 214 patients with ascending?type NPC treated with NACT+RT or CCRT between Decem?ber 2009 and July 2011 were analyzed.Of the 214 patients,98 were treated with NACT followed by IMRT,and 116 were treated with CCRT.The survival rates were assessed using Kaplan–Meier analysis,and the survival curves were compared using a log?rank test.Results:The 4?year overall survival,locoregional failure?free survival,distant failure?free survival,and failure?free sur?vival rates were not significantly different between the two groups(all P>0.05).However,patients in the CCRT group exhibited more severe acute adverse events than did patients in the NACT+RT group during radiotherapy,includ?ing leukopenia(30.2%vs.15.3%,P=0.016),neutropenia(25.9%vs.11.2%,P=0.011),and mucositis(57.8%vs.40.8%,P=0.028).After radiotherapy,patients in the CCRT group exhibited significantly higher rates of xerostomia(21.6%vs.Conclusions:The treatment outcomes of the NACT+RT and CCRT groups were similar;however,CCRT led to higher rates of acute and late toxicities.NACT+RT may therefore be a better treatment strategy for ascending?type NPC.

A Prospective Study on Therapeutic Gain by Concurrent Chemoradiotherapy for Stage Ⅱ-Ⅳa Nasopharyngeal Carcinoma

The benefit achieved by concurrent chemoradiotherapy（CCR） and sequential chemoradiotherapy（SCR） vs radiotherapy（RT） alone for patients with stage Ⅱ-Ⅳa nasopharyngeal carcinoma（NPC） was compared.A total of 113 patients with stage Ⅱ-Ⅳa NPC were allotted into CCR group（n=38）,SCR group（n=36） and RT alone group（n=39）.All patients were irradiated with the same RT technique to ≥66 Gy at 2 Gy per fraction,conventional 5 fractions/week in all groups.The CCR group received concurrent chemotherapy of weekly cisplatin for 7 weeks,and the SCR group received neoadjuvant and（or） adjuvant chemotherapy.The results showed that the 3-and 5-year overall survival rate was significantly higher in CCR group than in RT alone group（92.16% vs 61.54%,81.58% vs 51.28%,P〈0.005）.The median survival time was significantly longer in CCR group than in RT alone group（67.8 months vs 52.7 months,P〈0.005）.It was concluded that CCR could significantly improve overall survival rate,progression-free survival rate,and median survival time when compared with RT alone.

Phase Ⅰ/Ⅱ study of gemcitabine and oxaliplatin chemotherapy in combination with concurrent 3-D conformal radiotherapy for locally advanced non-small cell lung cancer

Background and objective Recent studies have showed that combination of chemotherapy and radiotherapy might result in better outcome for locally advanced non-small cell lung cancer (NSCLC). The aim of this study is to determine the maximal tolerance dose (MTD) and efficacy of full-dose gemcitabine and oxaliplatin when given concurrently with 3-dimentional radiation therapy (3D-RT) for locally advanced NSCLC. Methods Oxaliplatin was administered at a fixed dose of 130mg/m^2, and gemcitabine was administered at a starting dose of 800mg/m^2 with an incremental dose gradient of 200mg/m^2 for 3 dose levels. MTD was defined as the immediate dose level lower than the dose at which dose-limiting toxicity (DLT) occurred in more than one-third of the patients. The chemotherapy was administered at 3-week cycle. The RT was given as 3-D conformal manner at a single daily dose of 2Gy for 5 days per week. Results Twenty-two patients were evaluable and distributed to three different dose levels: 6 at level 1, 8 at level 2 and 8 at level 3. Pulmonary toxicity, esophageal and hematologic toxicity were the main DLT. Grade Ⅲ acute pulmonary toxicity occurred in one patient each at level 2 and level 3, both with V20>20%, and grade Ⅲ esophagitis in two patients at level 3. The MTD of gemcitabine in this study was 1000mg/m^2. The overall response rate was 75.0% (9/12). The 1- and 2-year survival rate was 70.0% and 30.5% respectively. The median time to progression was 8.7 months (range 5--11.8 months). Conclusion With reduced radiation volume, gemcitabine of 1000mg/m^2 in combination with oxaliplatin of 130mg/m^2 was effective and could be safely administered for NSCLC.

Neoadjuvant chemotherapy plus intensity-modulated radiotherapy versus concurrent chemoradiotherapy plus adjuvant chemotherapy for the treatment of locoregionally advanced nasopharyngeal carcinoma:a retrospective controlled study

Background:In the era of intensity-modulated radiotherapy(IMRT),the role of neoadjuvant chemotherapy(NAC)for locoregionally advanced nasopharyngeal carcinoma(NPC)is under-evaluated.The aim of this study was to compare the efficacy of NAC plus IMRT and concurrent chemoradiotherapy(CCRT)plus adjuvant chemotherapy(AC)on locoregionally advanced NPC.Methods:Between January 2004 and December 2008,240 cases of locoregionally advanced NPC confirmed by pathologic assessment in Sun Yat-sen University Cancer Center were reviewed.Of the 240 patients,117 received NAC followed by IMRT,and 123 were treated with CCRT plus AC.The NAC+IMRT group received a regimen that included cisplatin and 5-fluorouracil(5-FU).The CCRT+AC group received cisplatin concurrently with radiotherapy,and subsequently received adjuvant cisplatin and 5-FU.The survival rates were assessed by Kaplan-Meier analysis,and the survival curves were compared using a log-rank test.Multivariate analysis was conducted using the Cox proportional hazard regression model.Results:The 5-year overall survival(OS),locoregional relapse-free survival(LRRFS),distant metastasis-free survival(DMFS),and disease-free survival(DFS)were 78.0,87.9,79.0,and 69.8%,respectively,for the NAC+IMRT group and78.7,84.8,76.2,and 65.6%,respectively,for the CCRT+AC group.There were no significant differences in survival between the two groups.In multivariate analysis,age(<50 years vs.>50 years)and overall stage(Ⅲvs.Ⅳ)were found to be independent predictors for OS and DFS;furthermore,the overall stage was a significant prognostic factor for DMFS.Compared with the CCRT+AC protocol,the NAC+IMRT protocol significantly reduced the occurrence rates of grade 3-4 nausea-vomiting(6.5 vs.1.5%,P=0.023)and leukopenia(9.7 vs.0.8%,P=0.006).Conclusions:The treatment outcomes of the NAC+IMRT and CCRT+AC groups were similar.Distant metastasis remained the predominant mode of treatment failure.

Clinical study of docetaxel combined with concurrent radiotherapy in patients with advanced nasopharyngeal carcinoma

Objective： The aim of this study was to study the short-term curative effects and adverse reactions of docetaxel （DOC） in concurrent chemoradiotherapy compared to DDP plus 5-Fu （DF） combined with concurrent radiotherapy in patients with advanced nasopharyngeal carcinoma. Methods： Thirty-three patients in the experimental group （DOC group） were given DOC 25 mg/m2 ivgtt, dl, 7 times, concurrent radiotherapy was performed from dl. Thirty-three patients in the control group （DF group） were given cisplatin 25 mg/@ivgtt dl-3 and 5-Fu 550 mg/m2iv, dl-5, 3 weeks a cycle, 2 cycles, and concurrent radiotherapy was performed from dl. Six MV X-ray and 9 MeV electronic line for external irradiation were adopted in concur- rent radiotherapy. Results： The response rates of DOC group and DF group were 90.9% and 93.9%, the rates of neutropenia were 45.45% and 67.74%, and the rates of oral mucositis were 60.61% and 90.32%. Conclusion： The difference of short- term curative effects between DOC group and DF group was not statistically significant in patients with advanced nasopha- ryngeal carcinoma. The rates of adverse reactions were lower in DOC group. DOC combined with concurrent radiotherapy could be a new choice for patients with advanced nasopharyngeal carcinoma.

Feasibility of Concurrent Radiotherapy and Paclitaxel-Based Chemotherapy after Conservative Surgery for Breast Cancer

Purpose: Our prospective phase II trial aims to show the feasibility of adjuvant paclitaxel-based concurrent chemoradiotherapy (CCRT) following doxorubicin and cyclophosphamide (AC) to get the survival benefit of taxanes addition and avoid delay of radiotherapy. Patients and Methods: A total of 63 patients with pT1-2, and pN1-3, M0 breast cancer underwent conservative surgery followed by adjuvant 4 cycles AC followed by 4 cycles Paclitaxel 175 mg/m2 every 3 weeks. Adjuvant radiotherapy started during the first and second cycle of paclitaxel (CCRT). Toxicities evaluated at the base time, weekly during radiation therapy and every 3 months for 24 months for skin, pulmonary, cardiac, lymphedema, subcutaneous fibrosis and cosmoses. Survival reported at 2-year median follow-up. Results: At median follow up time of 24 months (6 - 30), we did not report any toxicity postpone or stop treatment and only two patients had grade III acute dermatitis. Fifty-two patients (82.5%) had satisfactory cosmoses and none of the patients developed local recurrence. Conclusion: Three-weekly paclitaxel during radiotherapy is considered safe without significant complications and acceptable cosmoses with excellent local control and could be considered to avoid radiotherapy delay.

Clinical Study on Simultaneous Modulated Accelerated Radiotherapy and Concurrent Chemotherapy for Locally Advanced Nasopharyngeal Carcinoma

OBJECTIVE To evaluate the clinical efficacy and toxicities of simultaneous modulated accelerated radiotherapy （SMART） and concurrent chemotherapy for locally advanced nasopharyngeal carcinoma. METHODS Eightyseven patients with nasopharyngeal carcinoma received SMART from April 2002 to September 2006. According to the UICC staging system, 30 patients were diagnosed as stage IIb, 42 patients stage III, 13 patients stage IVa and 2 patients stage IVb. The intensitymodulated radiotherapy was delivered with the ＂step and shoot＂ SMART technique with the prescribed dose of 66-76 Gy （2.2-2.4 Gy/day） to the gross tumor volume （GTV） and positive neck lymph nodes （GTVLN）, with 60 Gy （2.0 Gy/day） to the highrisk clinical target volume （CTV1）, encompassing the area around the nasopharynx and the upper neck, and with 54 Gy （1.8 Gy/day） to the lowrisk clinical target volume （CTV2）, including the lower neck and supraclavicular area. Among all the patients, 31 received 2 cycles of SMART concurrently with 5 fluorouracil （5-Fu） and cisplatin （the FP group） and 56 received 2 cycles of concurrent cisplatin. All the patients received 3 to 4 cycles of adjuvant combination chemotherapy of cisplatin and 5fluorouracil starting from the 1st month after completion of SMART. RESULTS With a median follow up of 59 months （ranging from 19 to 85 months）, the 1, 2 and 3year overall survival rates were 100%, 94.6% and 91.3% respectively. Acute mucositis and pharyngitis were more frequently observed in the FP group than in the cisplatin group. CONCLUSION SMART technique provides an excellent opportunity to spare normal tissue and is probably more biologically effective. Combination of single cisplatin was more tolerable.

Induction chemotherapy followed by weekly paclitaxel and carboplatin with concurrent radiotherapy in inoperable stage Ⅲ non-small cell lung cancers: results of a phase Ⅱ trial

Objective： several trials have suggested the superiority of concurrent chemoradiotherapy. It has been hypothesized that the addition of systemic dose sequential chemotherapy to concurrent chemoradiotherapy, as induction or as consolidation, might further improve survival rates. So we sought to evaluate the safety and efficacy of induction paclitaxel and carboplatin followed by weekly paclitaxel and carboplatin with concurrent radiotherapy in inoperable stage III non-small cell lung cancer （NSCLC）. Methods： Fifty-six patients with stage III inoperable NSCLC received induction chemotherapy with 2 cycles of paclitaxel 200 mg/m2 and carboplatin AUC-6 every 3 weeks then patients were assigned to concurrent chemoradiotherapy with paclitaxel 45 mg/m2 and carboplatin AUC-2 weekly along with concurrent radiotherapy at dose of 60 Gy （1.8 Gy/d x 5 d/week）. Results： Median age of the 56 eligible patients was 61 years, most of them were males （87.5%）. Squamous cell carcinoma was the most common pathological type （55.4%） and 85.7% had a performance status of 1. The majority of patients were presented with stage IIIB （62.5%）. Neutropenia was the most common toxicity during induction therapy （12.5% expressed grade 3） whereas esophagitis was the most common non hematologic adverse reaction during concurrent chemoradiotherapy （14.3% of grade 3）. The overall response rate was 71.6% with complete response in 19.6%. After median follow up of 20 months, the median survival time was 13 months （95% CI： 10.917-15.083） and 1 year overall survival rate was 53.6%. Conclusion： This regimen has demonstrated an acceptable toxicity profile and encouraging response to treatment. Evaluation of this regimen in larger number and a phase III trial are recommended.

Analysis of preoperative concurrent chemoradiotherapy for superior sulcus lung tumor

Objective： To compare the clinical effect and toxicities of preoperative concurrent chemoradiotherapy （CT/RT） with radiotherapy （RT） alone in patients with superior sulcus lung tumor. Methods： Fifty-six patients with superior sulcus lung tumor were divided randomly into two groups： twenty-six patients received concurrent chemoradiotherapy, the other thirty patients received only radiotherapy. For both groups, the same radiation technic was given with the convention fraction. The total dose was 45 Gy/25 Fr/5 Wk. For the CT/RT group, the patients were also given with concurrent chemotherapy （navelbine 15-18 mg/m^2 on the 1st and 8th day, cisplatin 60 mg/m^2 on the 1st day）. Results： The rate of complete resection in the CT/RT group was significantly higher than that in the RT group （92.3% vs 80%, P 〈 0.05）. The complete pathological response rate and 2-year survival rate in the CT/RT group were significantly higher than those in the RT group （P 〈 0.01, P 〈 0.01）. The incidences of grades Ill-IV radiation esophagitis and leukopenia in the CT/RT group were significantly higher than those in the RT group （23.1% and 23.1% vs 6.7% and 0, P 〈 0.01, P 〈 0.01）. Conclusion： Preoperative concurrent chemoradiotherapy has the potential of improving the survival rate of superior sulcus lung tumors. Though this treatment regimen also increases the acute toxic effect, all patients can tolerate it. It is expected to be a new ＂standard treatment＂ for this malignant tumor.

Analysis of Clinical Effect of Concurrent Chemo/radiotherapy in the Treatment of Advanced Cervical Cancer

The study aimed to analyze the efficacy and adverse effects of concurrent chemo/radiotherapy in the treatment of advanced cervical cancer,and the efficacy and safety of concurrent chemo/radiotherapy were evaluated to standardize the treatment.First of all,retrospective analysis was carried out,and 30 cases of advanced cervical cancer treated in hospitals from 2013 to 2018 were included in the study.30 cases of concurrent chemo/radiotherapy were included in the synchronous group,and 30 cases of radical radiotherapy alone were included in the radiotherapy group.The results showed that the CR rate and remission rate in the synchronous group were 43.3%and 93.3%,which were higher than those in the radiotherapy group(26.7%and 80.0%).The 3-year survival rate of the synchronous group was 80.0%,which was higher than that of the radiotherapy group,with a statistically significant difference(P<0.05).There was no significant difference in 3-year all-cause mortality,5-year survival and 5-year allcause mortality between the two groups.The tumor-free survival time in the synchronous group was(24.4±8.2)months,which was higher than that in the radiotherapy group(17.0±8.5)months,and the difference was statistically significant(P<0.05).Therefore,compared with radiotherapy alone,concurrent chemo/radiotherapy in the treatment of advanced cervical cancer can improve the 3-year survival rate and prolong the tumor-free survival time.However,it did not increase 5-year survival rate,and bone marrow suppression and gastrointestinal reactions were increased.

Initial outcome of induction chemotherapy followed by radiotherapy and concurrent weekly paclitaxel for stage Ⅲ non-small cell lung cancer

Objective： The aim of our study was to evaluate the toxicity and efficacy of induction chemotherapy （ICT） followed by three-dimensional conformal radiotherapy （3D CRT） and concurrent weekly paclitaxel on unresectable non-small cell lung cancer （NSCLC）. Methods： Stage III NSCLC patients with favorable conditions were treated with 2 to 4 cycles of carboplatin （AUC = 5-6, dl） combined with paclitaxel （175 mg/m〈 dl）, then followed by weekly paclitaxel （40 mg/m2） and concurrent 3D CRT within 3-4 weeks. The prescription dose was given as high as possible under the condition that V20 〈 31% and spinal cord dose 〈 50 Gy. Results： Thirty-one patients were enrolled. ICT was well tolerated. During the concurrent chemoradiotherapy, the treatment of 3 patients was ended ahead of the schedule because of severe pulmonary and heart toxicities; the treatment of 2 patients was delayed for 7 and 12 days because of fatigue. Myelosuppression was mild （16/31）： all were grade 1-2 except 1 was grade 3. Lymphocytopenia was more obvious （29/31, grade 3 in 21）. Three patients developed grade 3 radiation-induced esophagitis, and 2 developed grades 3-4 radiation-induced pneumonitis. Two developed grade 3 esophageal stricture. No grades 3-4 pulmonary fibrosis was observed. The overall response rate was 74.1%. The 1-, 2-, 3-year overall survival rates were 74.2%, 41.9%, and 34.6%, respectively, with the median survival time of 18.5 months. The 1-, 2-, 3-year local progression-freely survival rates were 64.5%, 32.3%, and 20.5%, respectively, with the median local progression-freely survival time of 14.3 months. Conclusion： The program of ICT followed by weekly paclitaxel and 3D CRT is accomplished in most of the favorable stage III NSCLC patients. The toxicity is tolerable, and the response rate is inspiriting.

Induction chemotherapy with albumin-bound paclitaxel plus lobaplatin followed by concurrent radiochemotherapy for locally advanced esophageal cancer

BACKGROUND Albumin-bound paclitaxel(ABP)has been used as second-and higher-line treatments for advanced esophageal cancer,and its efficacy and safety have been well demonstrated.Lobaplatin(LBP)is a third-generation platinum antitumor agent;compared with the first two generations of platinum agents,it has lower toxicity and has been approved for the treatment of breast cancer,small cell lung cancer,and chronic granulocytic leukemia.However,its role in the treatment of esophageal cancer warrants further investigations.AIM To investigate the efficacy and safety of induction chemotherapy with ABP plus LBP followed by concurrent radiochemotherapy(RCT)for locally advanced esophageal cancer.METHODS Patients with pathologically confirmed advanced esophageal squamous cell carcinoma(ESCC)at our hospital were enrolled in this study.All patients were treated with two cycles of induction chemotherapy with ABP plus LBP followed by concurrent RCT:ABP 250 mg/m^(2),ivgtt,30 min,d1,every 3 wk;and LBP,30 mg/m^(2),ivgtt,2 h,d1,every 3 wk.A total of four cycles were scheduled.The dose of the concurrent radiotherapy was 56-60 Gy/28-30 fractions,1.8-2.0 Gy/fraction,and 5 fractions/wk.RESULTS A total of 29 patients were included,and 26 of them completed the treatment protocol.After the induction chemotherapy,the objective response rate(ORR)was 61.54%,the disease control rate(DCR)was 88.46%,and the progressive disease(PD)rate was 11.54%;after the concurrent RCT,the ORR was 76.92%,the DCR was 88.46%,and the PD rate was 11.54%.The median progression-free survival was 11.1 mo and the median overall survival was 15.83 mo.Cox multivariate analysis revealed that two cycles of induction chemotherapy followed by concurrent RCT significantly reduced the risk of PD compared with two cycles of chemotherapy alone(P=0.0024).Non-hematologic toxicities were tolerable,and the only grade 3 non-hematologic toxicity was radiation-induced esophagitis(13.79%).The main hematologic toxicity was neutropenia,and no grade 4 adverse event occurred.CONCLUSION Induction chemotherapy with ABP plus LBP followed by concurrent RCT is effective in patients with locally advanced ESCC,with mild adverse effects.Thus,this protocol is worthy of clinical promotion and application.

The clinical effects of concurrent radiochemotherapy in cases suffered from stages III to IVa nasopharyngeal carcinoma

Objective： The aim of the study was to investigate the clinical effects of concurrent radiochemotherapy in treating locally advanced （Stages III-IVa） nasopharyngeal carcinomas （NPCs）. Methods： A total of 95 patients who suffered from nasopharyngeal carcinoma （Stages III-IVa） was divided into two groups： Group concurrent radiochemotherapy （Group CCRT, n = 49） and Group radiotherapy （Group RT, n = 46）. The two groups were both delivered conventional fractionated radiotherapy, while Group CCRT was delivered three cycles chemotherapy of PF （DDP ＋ 5-Fu） regimen or PLF （DDP ＋ 5-Fu ＋ CF） regimen. Results： The complete remission rate and total remission rate of Group CCRT were higher than those of Group RT, and the differences were of statistical importance （X2 = 4.72-7.19, P 〈 0.05）. The one-year overall survival （OS） rate was calculated by life table method, in Group CCRT, it was higher than that of Group RT and the difference was of statistical importance （X2 = 4.24, P 〈 0.05）. The 3-year overall survival （OS） rate, nasopharyngeal control rate and cervical lymph nodes＇ control rate of Group CCRT were all higher than those of Group RT and the differences were of statistical importance （X2 = 4.28-4.40, P 〈 0.05）. The 5-year overall survival （OS） rate and metastasis-free rate of Group CCRT were higher than those of Group RT and the differences were of statistical importance （X2 = 3.96-8.26, P 〈 0.05）. The incidence rates of acute toxicities in Group CCRT were obviously higher than those in Group RT, and the difference of gastrointestinal reaction was of statistical importance （X2 = 11.70, P 〈 0.05）. Conclusion： This study has demonstrated that concurrent radiochemotherapy can improve the remission rate, overall survival rate and locally control rate. The toxicities of concurrent radiochemotherapy can be tolerated by the patients.

Radiation therapy concurrent with weekly cisplatin therapy for loco-regionally advanced nasopharyngeal carcinoma:outcomes of a clinical trial

Objective:The purpose of this study was to define the maximum tolerated dose(MTD) by describing the doselimiting toxicity(DLT) of weekly cisplatin concurrently with conventional plus 3-dimensional conformal radiotherapy(CT + 3DCRT) in patients with loco-regionally advanced nasopharyngeal carcinoma(NPC).Methods:Patients with loco-regionally advanced NPC(III/IVa stage) were enrolled into a dose-escalating study.Toxicity was graded according to Common Terminology Criteria for Adverse Events version 3.0(CTCAE v3.0).MTD was defined when 2 of 6 patients developed DLT.The starting dose of cisplatin was 15 mg/m2/w,with a subsequent dose escalation of 5 mg/m2/w in cohorts of 3 new patients.CT + 3DCRT was given to the nasopharynx and the upper neck;the lower neck was treated by a single anterior field irradiation.The prescription dose was 70-80 Gy by 35-40 fractions to the nasopharynx gross tumor,and 66-70 Gy by 33-35 fractions to the positive neck lymph nodes.Results:From Jun.2008 to Sep.2009,24 patients received complete chemoradiotherapy,and all of them were eligible for toxicity evaluation.On the first five dose levels of 15 mg/m2/w and 35 mg/m2/w,no patient experienced DLT.On the next dose level of 40 mg/m2/w,1 patient experienced DLT of grade 3 myelosuppression for 1.4 weeks,and among the additional 3 patients,no one developed DLT.On the seventh dose level of 45 mg/m2/w,all the patients developed grade 3 myelosuppression for more than 1 weeks,and the dose-escalating trial stopped.The 23(95.8%) patients achieved clinical complete remission(CR) in the local site;22(91.7%) achieved CR in the regional site,and all patients got CR 3 months later.After a median follow-up of 16.4 months,1 patient developed liver metastases 2 months later,1 patient developed bone metastases 10 months later and 22 kept disease-free survival.Conclusion:The MTD of cisplatin weekly with concurrent CT + 3DCRT for local advanced NPC is 40 mg/m2/w,with myelosuppression as DLT.

Impact of Postoperative Radiotherapy and Chemotherapy on Survival for Patients with Node Positive Oral Cancer

Purpose: The aim of the present study is to compare between the use of post-operative concurrent chemotherapy and radiotherapy alone on survival for patients with high risk oral cavity tumors at the National cancer Institute of Egypt, undergoing surgery and receiving adjuvant treatment. Patients and Methods: This is a retrospective study, which was carried out at the National Cancer Institute (Cairo University) on patients with node positive oral cavity cancer diagnosed between the year 2000 and 2008. The study included 60 patients (45 males and 15 females) with median age 57 years old. The patients underwent surgery, followed by postoperative radiotherapy 60 Gy/6 weeks versus postoperative radiotherapy 60 Gy/6 weeks with concurrent cisplatin 100 mg/m2 at day 1, day 22 and day 43. Results: Regarding use of concurrent chemotherapy, there was a significant difference in overall survival rate and locoregional control favoring patients who received concurrent chemotherapy and radiotherapy, 3 years and 5 years overall survival rates respectively were 53.8% and 40.4% compared to 37.5% and 26.3% for patients who didn’t receive any chemotherapy with (p 0.038) for 5 years. Regarding age, there was a significant difference in overall survival rate favoring patients ≤57 years in both arm groups, 3 years and 5 years overall survival rates respectively were 51.6% and 38.9% compared to 28.3% and 18.9% for patients >57 years with (p 0.028) for 5 years. Conclusion: We recommend for oral cavity tumor patients at the NCI of Egypt who have positive neck nodes to be treated with concurrent chemo-radiotherapy rather than radiotherapy alone especially by using the new techniques as intensity modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT).

复方苦参注射液配合同期放化疗治疗鼻咽癌的临床观察

目的:探讨复方苦参注射液配合同期放化疗治疗鼻咽癌的临床治疗效果及对放射性口腔黏膜炎、放射性皮炎和其他放化疗不良反应的影响。方法:采用回顾性分析,选取2021—2022年该院肿瘤科收治的100例鼻咽癌患者,依据治疗方法分为观察组(n=48)和对照组(n=52)。对照组患者的治疗方案为同步放化疗,调强适形放疗,期间使用顺铂治疗;观察组患者在对照组的基础上联合复方苦参注射液静脉滴注,1日1次,连续应用14 d,停用7 d;两组患者的治疗周期均为6周。比较两组患者的近期疗效,治疗期间放射性口腔黏膜炎、放射性皮炎及其他放化疗不良反应的发生率。结果:治疗后,观察组患者客观缓解率为91.7%(44/48),高于对照组的88.5%(46/52),但差异无统计学意义(P>0.05)。治疗期间,观察组患者放射性口腔黏膜炎、放射性皮炎发生率低于对照组,差异均有统计学意义(P<0.05);两组患者骨髓抑制发生率的差异无统计学意义(P>0.05)。观察组患者消化道不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:复方苦参注射液配合同步放化疗用于鼻咽癌患者,可减少放疗所致的放射性口腔黏膜炎、放射性皮炎,降低消化道不良反应发生率,提高同步放化疗的安全性。

多参数MRI联合螺旋CT预测ⅢCr期宫颈癌同步放化疗后复发的临床价值

目的研究多参数MRI联合SCT预测ⅢCr期宫颈癌同步放疗(CCRT)后复发的临床价值。方法回顾性分析医院2018.01~2020.01间70例行同步放化疗后出现复发的ⅢCr期宫颈癌患者(复发组)以及66例无复发者的多参数MRI以及SCT检查资料,以临床诊断作为“金标准”,采用McNemar检验,分别计算多参数MRI以及SCT在诊断宫颈癌复发中的灵敏度、特异度及准确度,并绘制ROC曲线,分析多参数MRI联合SCT诊断宫颈癌复发的价值。结果经局部穿刺以及随访发现,共70例患者被证实为宫颈癌复发,66例患者为非复发,其中复发组患者MRI检查参数ADC_(min)、ADC_(max)、ADC_(mean)、K^(trans)、K_(ep)以及V_(e)水平显著低于对照组(P<0.05);以临床诊断作为“金标准”,检验发现,多参数MRI在诊断宫颈癌复发中的灵敏度及特异度分别为85.71%、89.39%。SCT在诊断宫颈癌复发中的灵敏度及特异度分别为55.71%、81.82%。绘制ROC曲线证实多参数MRI联合SCT在预测ⅢCr期宫颈癌同步放化疗后复发中的的AUC=0.941,95%CI(0.895~0.987),灵敏度及特异度分别为94.30%与93.90%。结论多参数MRI在诊断ⅢCr期宫颈癌CCRT后复发中的价值高于SCT,但两者联合使用能有效提高宫颈癌复发的临床诊断效果。

Concurrent chemoradiotherapy with weekly docetaxel versus cisplatin in the treatment of locoregionally advanced nasopharyngeal carcinoma:a propensity score-matched analysis

Background:Promising efficacy and manageable toxicity of docetaxel-based concurrent chemoradiotherapy(CCRT)were reported in head and neck cancer.In addition,the effect of CCRT in combination with cisplatin and/or 5-fluorouracil on both locoregionally advanced and metastatic/recurrent nasopharyngeal carcinoma(NPC)was verified.However,CCRT with docetaxel for locoregionally advanced NPC are not well studied.This study aimed to compare effectiveness and toxicities of CCRT with weekly docetaxel versus tri-weekly cisplatin for locoregionally advanced NPC.Methods:Clinical data of patients with locoregionally advanced NPC newly diagnosed between January 2010 and December 2014 receiving CCRT with either weekly docetaxel(15 mg/m2)or tri-weekly cisplatin(80-100 mg/m2)were reviewed.Propensity score matching at a 1:1 ratio was performed to balance baseline characteristics.Adverse events and survival were compared between the two groups.Results:A total of 962 patients were included as the whole cohort,and 448 patients were matched and were regarded as the matched cohort.The median follow-up duration was 48 months for the whole cohort.The 3-year nodal recurrence-free survival rate was significantly increased for patients treated with docetaxel in both the whole(hazard ratio[HR]=0.37,95%confidence interval[CI]0.19-0.72,P=0.030)and matched cohorts(HR=0.33,95%CI 0.14-0.79,P=0.023).However,no significant differences were observed in overall survival,local recurrence-free survival,and distant metastasis-free survival between the two groups in both cohorts.Significantly higher rates of grade 3 radiodermatitis(6.7%vs.1.8%,P=0.001),mucositis(74.5%vs.37.9%,P<0.001),and leucopenia(2.2%vs.11.6%,P<0.001)were observed in the docetaxel group,but any grade of renal injury(1.8%vs.15.1%,P<0.001),vomiting(18.8%vs.88.3%,P<0.001),and ALT elevation(19.2%vs.31.3%,P=0.027)were more common in the cisplatin group.Conclusions:CCRT with weekly low-dose docetaxel is an effective and tolerable therapeutic regimen for locally advanced NPC.It provides a survival benefit mainly by improving the control of regional lymph node metastases,especially for patients with low pretreatment EBV DNA levels.

白蛋白结合型紫杉醇联合放疗对非小细胞肺癌伴上腔静脉压迫综合征的疗效

目的分析白蛋白结合型紫杉醇联合放疗对非小细胞肺癌(non-small cell lung cancer,NSCLC)伴上腔静脉压迫综合征(superior vena cava syndrome,SVCS)的疗效。方法回顾性分析2019年1月—2022年1月广西医科大学第八附属医院收治的使用白蛋白结合型紫杉醇同期联合放疗的28例NSCLC伴SVCS患者临床资料。分析28例患者的近期疗效、生存时间及不良反应。结果28例NSCLC伴SVCS患者中,客观缓解率(objective response rate,ORR)为71.43%,疾病控制率(disease control rate,DCR)为89.29%,中位无进展生存时间3.30个月(95%CI 2.56~4.04个月),中位生存时间为7.20个月(95%CI 6.44~7.98个月)。化疗线数、T分期是影响患者中位无进展生存期(progression-free survival,PFS)的独立危险因素(P<0.05);化疗线数和N分期是影响总生存期(overall survival,OS)的独立危险因素(P<0.05);不良反应有血液学反应、胃肠道、关节及外周神经毒性、肝肾功能损害及放射急性反应。结论白蛋白结合型紫杉醇联合放疗对NSCLC伴SVCS患者有较好的客观疗效,安全性良好;T分期≤3、N分期<2的患者在治疗中可能获益更大。