BACKGROUND Approximately 30%of patients with localized prostate cancer(PCa)who undergo radical prostatectomy will develop biochemical recurrence.In these patients,the only potentially curative treatment is postoperati...BACKGROUND Approximately 30%of patients with localized prostate cancer(PCa)who undergo radical prostatectomy will develop biochemical recurrence.In these patients,the only potentially curative treatment is postoperative radiotherapy(PORT)with or without hormone therapy.However,the optimal radiotherapy dose is unknown due to the limited data available.AIM To determine whether the postoperative radiotherapy dose influences biochemical failure-free survival(BFFS)in patients with PCa.METHODS Retrospective analysis of patients who underwent radical prostatectomy for PCa followed by PORT-either adjuvant radiotherapy(ART)or salvage radiotherapy(SRT)-between April 2002 and July 2015.From 2002 to 2010,the prescribed radiation dose to the surgical bed was 66-70 Gy in fractions of 2 Gy;from 2010 until July 2015,the prescribed dose was 70-72 Gy.Patients were grouped into three categories according to the total dose administered:66-68 Gy,70 Gy,and 72 Gy.The primary endpoint was BFFS,defined as the post-radiotherapy prostatespecific antigen(PSA)nadir+0.2 ng/mL.Secondary endpoints were overall survival(OS),cancer-specific survival(CSS),and metastasis-free survival(MFS;based on conventional imaging tests).Treatment-related genitourinary(GU)and gastrointestinal(GI)toxicity was evaluated according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria.Finally,we aimed to identify potential prognostic factors.BFFS,OS,CSS,and MFS were calculated with the Kaplan-Meier method and the log-rank test.Univariate and multivariate Cox regression models were performed to explore between-group differences in survival outcome measures.RESULTS A total of 301 consecutive patients were included.Of these,93(33.6%)received ART and 186(66.4%)SRT;22 patients were excluded due to residual macroscopic disease or local recurrence in the surgical bed.In this subgroup(n=93),43 patients(46.2%)were Gleason score(GS)≤6,44(47.3%)GS 7,and 6(6.5%)GS≥8;clinical stage was cT1 in 51(54.8%),cT2 in 35(39.3%),and cT3 in one patient(1.1%);PSA was<10 ng/mL in 58(63%)patients,10-20 ng/mL in 28(30.6%),and≥20 ng/mL in 6(6.4%)patients.No differences were found in BFFS in this patient subset versus the entire cohort of patients(P=0.66).At a median follow-up of 113 months(range,4-233),5-and 10-year BFFS rates were 78.8%and 73.7%,respectively,with OS rates of 93.3%and 81.4%.The 5-year BFFS rates in three groups were as follows:69.6%(66-68 Gy),80.5%(70 Gy)and 82.6%(72 Gy)(P=0.12):the corresponding 10-year rates were 63.9%,72.9%,and 82.6%(P=0.12),respectively.No significant between-group differences were observed in MFS,CSS,or OS.On the univariate analysis,the following variables were significantly associated with BFFS:PSA at diagnosis;clinical stage(cT1 vs cT2);GS at diagnosis;treatment indication(ART vs SRT);pre-RT PSA levels;and RT dose 66-68 Gy vs.72 Gy(HR:2.05;95%CI:1.02-4.02,P=0.04).On the multivariate analysis,the following variables remained significant:biopsy GS(HR:2.85;95%CI:1.83-4.43,P<0.001);clinical stage(HR:2.31;95%CI:1.47-4.43,P=0.01);and treatment indication(HR:4.11;95%CI:2.06-8.17,P<0.001).Acute grade(G)1 GU toxicity was observed in 11(20.4%),17(19.8%),and 3(8.3%)patients in each group(66-68 Gy,70 Gy and 72 Gy),respectively(P=0.295).Acute G2 toxicity was observed in 2(3.7%),4(4.7%)and 2(5.6%)patients,respectively(P=0.949).Acute G1 GI toxicity was observed in 16(29.6%),23(26.7%)and 2(5.6%)patients in each group,respectively(P=0.011).Acute G2 GI toxicity was observed in 2(3.7%),6(6.9%)and 1(2.8%)patients,respectively(P=0.278).No cases of acute G3 GI toxicity were observed.CONCLUSION The findings of this retrospective study suggest that postoperative radiotherapy dose intensification in PCa is not superior to conventional radiotherapy treatment.展开更多
Dermatofibromas are benign soft tissue tumors that predominantly affect the limbs, and more rarely the chest.Keloidal dermatofibroma is a rare subtype with distinct clinicopathological features and an aggressive clini...Dermatofibromas are benign soft tissue tumors that predominantly affect the limbs, and more rarely the chest.Keloidal dermatofibroma is a rare subtype with distinct clinicopathological features and an aggressive clinical course. By researching the evolution of the disease in this study, we aimed to summarize our experience of managing a rare patient who underwent five surgeries for keloidal dermatofibroma that developed sequentially in the upper arm and chest and propose a novel treatment for keloidal dermatofibroma. We concluded that keloidal dermatofibroma involving larger areas, high tension sites, and multiple localizations can be treated using the principles of pathological scar management.展开更多
Since the beginning of 2017,Chinese Journal of Cancer has published a series of important questions in cancer research and clinical oncology,which spark diverse thoughts,interesting communications,and potential collab...Since the beginning of 2017,Chinese Journal of Cancer has published a series of important questions in cancer research and clinical oncology,which spark diverse thoughts,interesting communications,and potential collabora-tions among researchers all over the world.In this article,8 more questions are presented as follows.Question 86.In which circumstances is good supportive care associated with a survival advantage in patients with cancer?Question 87.Can we develop animal models to mimic immunotherapy response of cancer patients?Question 88.What are the mechanisms underlying hepatitis B virus-associated non-hepatocellular cancers?Question 89.Can we more pre-cisely target tumor metabolism by identifying individual patients who would benefit from the treatment?Question 90.What type of cranial irradiation-based prophylactic therapy combination can dramatically improve the survival of patients with extensive small-cell lung cancer?Question 91.How can postoperative radiotherapy prolong overall survival of the patients with resected pIIIA-N2 non-small cell lung cancer?Question 92.What are the key molecular events that drive oral leukoplakia or erythroplakia into oral cancer?Question 93.How could we track the chemothera-peutics-driven evolution of tumor genome in non-small cell lung cancer for more effective treatment?展开更多
文摘BACKGROUND Approximately 30%of patients with localized prostate cancer(PCa)who undergo radical prostatectomy will develop biochemical recurrence.In these patients,the only potentially curative treatment is postoperative radiotherapy(PORT)with or without hormone therapy.However,the optimal radiotherapy dose is unknown due to the limited data available.AIM To determine whether the postoperative radiotherapy dose influences biochemical failure-free survival(BFFS)in patients with PCa.METHODS Retrospective analysis of patients who underwent radical prostatectomy for PCa followed by PORT-either adjuvant radiotherapy(ART)or salvage radiotherapy(SRT)-between April 2002 and July 2015.From 2002 to 2010,the prescribed radiation dose to the surgical bed was 66-70 Gy in fractions of 2 Gy;from 2010 until July 2015,the prescribed dose was 70-72 Gy.Patients were grouped into three categories according to the total dose administered:66-68 Gy,70 Gy,and 72 Gy.The primary endpoint was BFFS,defined as the post-radiotherapy prostatespecific antigen(PSA)nadir+0.2 ng/mL.Secondary endpoints were overall survival(OS),cancer-specific survival(CSS),and metastasis-free survival(MFS;based on conventional imaging tests).Treatment-related genitourinary(GU)and gastrointestinal(GI)toxicity was evaluated according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria.Finally,we aimed to identify potential prognostic factors.BFFS,OS,CSS,and MFS were calculated with the Kaplan-Meier method and the log-rank test.Univariate and multivariate Cox regression models were performed to explore between-group differences in survival outcome measures.RESULTS A total of 301 consecutive patients were included.Of these,93(33.6%)received ART and 186(66.4%)SRT;22 patients were excluded due to residual macroscopic disease or local recurrence in the surgical bed.In this subgroup(n=93),43 patients(46.2%)were Gleason score(GS)≤6,44(47.3%)GS 7,and 6(6.5%)GS≥8;clinical stage was cT1 in 51(54.8%),cT2 in 35(39.3%),and cT3 in one patient(1.1%);PSA was<10 ng/mL in 58(63%)patients,10-20 ng/mL in 28(30.6%),and≥20 ng/mL in 6(6.4%)patients.No differences were found in BFFS in this patient subset versus the entire cohort of patients(P=0.66).At a median follow-up of 113 months(range,4-233),5-and 10-year BFFS rates were 78.8%and 73.7%,respectively,with OS rates of 93.3%and 81.4%.The 5-year BFFS rates in three groups were as follows:69.6%(66-68 Gy),80.5%(70 Gy)and 82.6%(72 Gy)(P=0.12):the corresponding 10-year rates were 63.9%,72.9%,and 82.6%(P=0.12),respectively.No significant between-group differences were observed in MFS,CSS,or OS.On the univariate analysis,the following variables were significantly associated with BFFS:PSA at diagnosis;clinical stage(cT1 vs cT2);GS at diagnosis;treatment indication(ART vs SRT);pre-RT PSA levels;and RT dose 66-68 Gy vs.72 Gy(HR:2.05;95%CI:1.02-4.02,P=0.04).On the multivariate analysis,the following variables remained significant:biopsy GS(HR:2.85;95%CI:1.83-4.43,P<0.001);clinical stage(HR:2.31;95%CI:1.47-4.43,P=0.01);and treatment indication(HR:4.11;95%CI:2.06-8.17,P<0.001).Acute grade(G)1 GU toxicity was observed in 11(20.4%),17(19.8%),and 3(8.3%)patients in each group(66-68 Gy,70 Gy and 72 Gy),respectively(P=0.295).Acute G2 toxicity was observed in 2(3.7%),4(4.7%)and 2(5.6%)patients,respectively(P=0.949).Acute G1 GI toxicity was observed in 16(29.6%),23(26.7%)and 2(5.6%)patients in each group,respectively(P=0.011).Acute G2 GI toxicity was observed in 2(3.7%),6(6.9%)and 1(2.8%)patients,respectively(P=0.278).No cases of acute G3 GI toxicity were observed.CONCLUSION The findings of this retrospective study suggest that postoperative radiotherapy dose intensification in PCa is not superior to conventional radiotherapy treatment.
文摘Dermatofibromas are benign soft tissue tumors that predominantly affect the limbs, and more rarely the chest.Keloidal dermatofibroma is a rare subtype with distinct clinicopathological features and an aggressive clinical course. By researching the evolution of the disease in this study, we aimed to summarize our experience of managing a rare patient who underwent five surgeries for keloidal dermatofibroma that developed sequentially in the upper arm and chest and propose a novel treatment for keloidal dermatofibroma. We concluded that keloidal dermatofibroma involving larger areas, high tension sites, and multiple localizations can be treated using the principles of pathological scar management.
文摘Since the beginning of 2017,Chinese Journal of Cancer has published a series of important questions in cancer research and clinical oncology,which spark diverse thoughts,interesting communications,and potential collabora-tions among researchers all over the world.In this article,8 more questions are presented as follows.Question 86.In which circumstances is good supportive care associated with a survival advantage in patients with cancer?Question 87.Can we develop animal models to mimic immunotherapy response of cancer patients?Question 88.What are the mechanisms underlying hepatitis B virus-associated non-hepatocellular cancers?Question 89.Can we more pre-cisely target tumor metabolism by identifying individual patients who would benefit from the treatment?Question 90.What type of cranial irradiation-based prophylactic therapy combination can dramatically improve the survival of patients with extensive small-cell lung cancer?Question 91.How can postoperative radiotherapy prolong overall survival of the patients with resected pIIIA-N2 non-small cell lung cancer?Question 92.What are the key molecular events that drive oral leukoplakia or erythroplakia into oral cancer?Question 93.How could we track the chemothera-peutics-driven evolution of tumor genome in non-small cell lung cancer for more effective treatment?
