Efficacy of concurrent chemoradiotherapy with thalidomide and S-1 for esophageal carcinoma and its influence on serum tumor markers

BACKGROUND Although the current conventional treatment strategies for esophageal carcinoma(EC)have been proven effective,they are often accompanied by serious adverse events.Therefore,it is still necessary to continue to explore new therapeutic strategies for EC to improve the clinical outcome of patients.AIM To elucidate the clinical efficacy of concurrent chemoradiotherapy(CCRT)with thalidomide(THAL)and S-1(tegafur,gimeracil,and oteracil potassium capsules)in the treatment of EC as well as its influence on serum tumor markers(STMs).METHODS First,62 patients with EC treated at the Zibo 148 Hospital between November 2019 and November 2022 were selected and grouped according to the received treatment.Among these,30 patients undergoing CCRT with cis-platinum and 5-fluorouracil were assigned to the control group(Con),and 32 patients receiving CCRT with THAL and S-1 were assigned to the research group(Res).Second,inter-group comparisons were carried out with respect to curative efficacy,incidence of drug toxicities,STMs[carbohydrate antigen 125(CA125)and macrophage inflammatory protein-3α(MIP-3α)],angiogenesis-related indicators[vascular endothelial growth factor(VEGF);VEGF receptor-1(VEGFR-1);basic fibroblast growth factor(bFGF);angiogenin-2(Ang-2)],and quality of life(QoL)[QoL core 30(QLQ-C30)]after one month of treatment.RESULTS The analysis showed no statistical difference in the overall response rate and disease control rate between the two patient cohorts;however,the incidences of grade I–II myelosuppression and gastrointestinal reactions were significantly lower in the Res than in the Con.Besides,the post-treatment CA125,MIP-3α,VEGF,VEGFR-1,bFGF,and Ang-2 Levels in the Res were markedly lower compared with the pre-treatment levels and the corresponding post-treatment levels in the Con.Furthermore,more evident improvements in QLQ-C30 scores from the dimensions of physical,role,emotional,and social functions were determined in the Res.CONCLUSION The above results demonstrate the effectiveness of THAL+S-1 CCRT for EC,which contributes to mild side effects and significant reduction of CA125,MIP-3α,VEGF,VEGFR-1,bFGF,and Ang-2 Levels,thus inhibiting tumors from malignant progression and enhancing patients’QoL.

Comparative efficacy and safety between endoscopic submucosal dissection,surgery and definitive chemoradiotherapy in patients with cT1N0M0 esophageal cancer

BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.

Stage IV malignant transformation of mature cystic teratoma palliatively treated with concurrent chemoradiotherapy:A case report

BACKGROUND Malignant transformation(MT)of mature cystic teratoma(MCT)has a poor prognosis,especially in advanced cases.Concurrent chemoradiotherapy(CCRT)has an inhibitory effect on MT.CASE SUMMARY Herein,we present a case in which CCRT had a reduction effect preoperatively.A 73-year-old woman with pyelonephritis was referred to our hospital.Computed tomography revealed right hydronephrosis and a 6-cm pelvic mass.Endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)revealed squamous cell carci-noma.The patient was diagnosed with MT of MCT.Due to her poor general con-dition and renal malfunction,we selected CCRT,expecting fewer adverse effects.After CCRT,her performance status improved,and the tumor size was reduced;surgery was performed.Five months postoperatively,the patient developed dis-semination and lymph node metastases.Palliative chemotherapy was ineffective.She died 18 months after treatment initiation.CONCLUSION EUS-FNB was useful in the diagnosis of MT of MCT;CCRT suppressed the disea-se and improved quality of life.

Is Escalated Radiation Dose in Definitive Chemoradiotherapy Better for Inoperable Esophageal Carcinoma? A Meta-Analysis and Systematic Review

Purpose: This study aimed to compare the survival benefits between different total radiation doses in definitive chemoradiotherapy (dCRT) for inoperable esophageal carcinoma (EC) based on modern radiotherapy techniques. Methods: A systematic review was performed by searching the databases of PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science. All studies published prior to November 30, 2022, comparing radiation dose and disease-related outcomes in EC patients. The hazard ratio (HR) and odds ratio (OR) were used to describe the risk of outcomes and toxicities. Results: Seven prospective trials involving 1124EC patients were enrolled for analyses. The results revealed that the effect on overall survival (HR = 0.99, 95% CI = 0.85 - 1.16, P = 0.94), local progression-free survival (HR = 0.83, 95% CI = 0.58 - 1.17, P = 0.29), local regional progression-free survival (HR = 0.94, 95% CI = 0.76 - 1.17, P = 0.61), progression-free survival (HR = 0.90, 95% CI = 0.71 - 1.13, P = 0.35) was similar in the high-dose and standard-dose groups. Additionally, a high radiation dose exhibited a potential disadvantage in respiratory toxicities when compared with a standard dose (4.8% vs 2.2%, OR 2.11, P = 0.06). Conclusions: The efficacy of the HD group (≥60 Gy) and the SD group (approximately 50 Gy) for inoperable local advanced EC was similar. However, the HD group exhibited a high radiation dose exhibited a potential disadvantage in respiratory toxicities when compared with a standard dose. Simultaneously, the final results of several ongoing prospective trials regarding the optimal radiation dose in dCRT are awaited.

Effectiveness and safety of combined nimotuzumab and S-1 chemotherapy with concurrent radiotherapy for locally advanced esophageal cancer in malnourished and elderly patients:A prospective phaseⅡstudy

Objective:Definitive chemoradiotherapy(dCRT)is the standard treatment for unresectable locally advanced esophageal cancer.However,this treatment is associated with substantial toxicity,and most malnourished or elderly patients are unable to complete this therapy.Therefore,there is a need for a more suitable radiotherapy combination regimen for this population.This study was aimed to evaluate the efficacy and safety of a combination regimen comprising chemotherapy with nimotuzumab and S-1 and concurrent radiotherapy for patients with fragile locally advanced esophageal cancer with a high Nutritional Risk Screening 2002(NRS-2002)score.Methods:Eligible patients with unresectable esophageal carcinoma who had an NRS-2002 score of 2 or higher were enrolled.They were treated with S-1 and nimotuzumab with concurrent radiotherapy,followed by surgery or definitive radiotherapy.The primary endpoint was the locoregional control(LRC)rate.Results:A total of 55 patients who met the study criteria were enrolled.After completion of treatment,surgery was performed in 15 patients and radiotherapy was continued in 40 patients.The median follow-up period was 33.3[95%confidence interval(95%CI,31.4−35.1)]months.The LRC rate was 77.2%(95%CI,66.6%−89.4%)at 1 year in the entire population.The overall survival(OS)rate and event-free survival(EFS)rate were 57.5%and 51.5%at 3 years,respectively.Surgery was associated with better LRC[hazard ratio(HR)=0.16;95%CI,0.04−0.70;P=0.015],OS(HR=0.19;95%CI,0.04−0.80;P=0.024),and EFS(HR=0.25;95%CI,0.08−0.75;P=0.013).Most adverse events were of grade 1 or 2,and no severe adverse events occurred.Conclusions:For malnourished or elderly patients with locally advanced esophageal cancer,radiotherapy combined with nimotuzumab and S-1 is effective and has a good safety profile.

Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma:A meta-analysis

AIM:To compare neoadjuvant chemoradiotherapy and surgery with surgery alone for resectable esophageal carcinoma. METHODS:We used MEDLINE and EMBASE databases to identify eligible studies and manual searches were done to ensure no studies were missed.Trial validity assessment was performed and a trial quality score was assigned. RESULTS:Eleven randomized controlled trials(RCTs) including 1308 patients were selected.Neoadjuvant chemoradiotherapy significantly improved the overall survival compared with surgery alone.Odds ratio(OR) [95%confidence interval(CI),P value],expressed as neoadjuvant chemoradiotherapy and surgery vs surgery alone,was 1.28(1.01-1.64,P=0.05)for 1-year survival,1.78(1.20-2.66,P=0.004)for 3-year survival,and 1.46(1.07-1.99,P=0.02)for 5-year survival.Postoperative mortality increased in patients treated by neoadjuvant chemoradiotherapy(OR: 1.68,95%CI:1.03-2.73,P=0.04),but incidence of postoperative complications was similar in two groups (OR:1.14,95%CI:0.88-1.49,P=0.32).Neoadjuvant chemoradiotherapy lowered the local-regional cancer recurrence(OR:0.64,95%CI:0.41-0.99,P=0.04), but incidence of distant cancer recurrence was similar (OR:0.94,95%CI:0.68-1.31,P=0.73).Histological subgroup analysis indicated that esophageal squamous cell carcinoma did not benefit from neoadjuvantchemoradiotherapy,OR(95%CI,P value)was 1.16(0.85-1.57,P=0.34)for 1-year survival,1.34 (0.98-1.82,P=0.07)for 3-year survival and 1.41 (0.98-2.02,P=0.06)for 5-year survival. CONCLUSION:Neoadjuvant chemoradiotherapy can raise the survival rate of patients with esophageal adenocarcinoma.

p53 negativity, CDC25B positivity, and metallothionein negativity are predictors of a response of esophageal squamous cell carcinoma to chemoradiotherapy

AIM： Esophageal squamous cell carcinoma is generally sensitive to chemoradiotherapy （CRT）, but some cases are not. Using a retrospective analysis, we aimed to identify the predictors of the response by esophageal squamous cell carcinoma to definitive CRT. METHODS： The intensities of expression of p53, Ki67, Bci-2, Bax, olclin D1, VEGF, CDC25B, and metallothionein （MT） were evaluated immunohistochemically in the biopsy specimens obtained before CRT, and the intensities of their expression were tested for correlations with the clinical effects of CRT. RESULTS： The esophageal squamous cell carcinomas with negative p53, positive CDC25B, and negative MT expression were found to be significantly more sensitive to CRT. In addition, p53 positivity and CDC25B positivity respomd well to CRT. CONCLUSION： Esophageal squamous cell carcinomas with negative p53,positive CDC25B, and negative MT expressions respond well to CRT. Even with p53 positivity, if with CDC25B positivity, CRT can be expected. 2005 The WJG Press and Elsevier Inc. All rights reserved

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.

Predictive factors of survival in patients treated with definitive chemoradiotherapy for squamous cell esophageal carcinoma

AIM： The aim of the study was to evaluate the predictive factors of survival in patients with locally advanced squamous cell esophageal carcinoma （LASCOC） treated with definitive chemoradiotherapy （CRT） regimen based on the 5FU/CDDP combination. METHODS： All patients with LASCOC treated with a definitive CRT using the 5FU/CDDP combination between 1994 and 2000 were retrospectively included. Clinical complete response （CCR） to CRT was assessed by esophageal endoscopy and C-F-scan 2 mo after CRT completion. Prognostic factors of survival were assessed using univariate and multivariate analysis by the Cox regression model. RESULTS： A total of 116 patients were included in the study. A CCR to CRT was observed in 86/116 （74.1%）. The median survival was 20 mo （range 2-114） and the 5-year survival was 9.4%. Median survival of responder patients to CRT was 25 mo （range 3-114） as compared to 9 mo （range 2-81） in non-responder patients （P 〈 0.001）. In univariate analysis, survival was associated with CCR （P 〈 0.001）, WHO performance status 〈 2 （P = 0.01）, tumour length 〈 6 cm （P = 0.045） and weight loss 〈 10% was in limit of significance （P = 0.053）. In multivariate analysis, survival was dependant to CCR （P 〈 0.0001）, weight loss 〈 10% （P = 0.034） and WHO performance 〈 2 （P = 0.046）. CONCLUSION： Our results suggest that survival in patients with LASCOC b＇eated with definitive CRT was correlated to CCR, weight loss and WHO performance status.

PhaseⅡstudy of induction chemotherapy followed by concurrent chemoradiotherapy with raltitrexed and cisplatin in locally advanced nasopharyngeal carcinoma

Objective:For locally advanced nasopharyngeal carcinoma(LA-NPC)patients,high incidences of distant metastases and severe treatment related toxicities are the main obstacles needed to be overcome.Raltitrexed,a specific thymidylate synthase inhibitor with a convenient administration schedule,has an acceptable and manageable toxicity,and possesses radio-sensitizing properties.To investigate the efficacy and safety of raltitrexed and cisplatin induction chemotherapy and concurrent chemoradiotherapy(IC+CCRT)in patients with LA-NPC,a phaseⅡclinical study was conducted.Methods:Sixty eligible patients with LA-NPC were enrolled into this study.A raltitrexed-cisplatin combination was used as part of an IC+CCRT regimen.Raltitrexed-cisplatin IC was given once every 3 weeks(q3 w)for two cycles,followed by raltitrexed-cisplatin based CCRT q3 w for two cycles.Intensity-modulated radiotherapy(IMRT)was given for all enrolled patients.Results:All patients were included in survival analysis according to the intent-to-treat principle.The objective response rate(ORR)3 months after treatment was 98%.The 2-year overall survival(OS)rate was 92%.The median relapse-free survival(RFS)time was 30.5[95%confidence interval(95%CI),28.4-32.3]months.The 2-year RFS rate was 85%.The 2-year local failure-free survival(LFFS)rate was 97%and the 2-year distant metastasis-free survival(DMFS)rate was 88%.Acute toxicities were mostly grade 2 and 3 reactions in bone marrow suppression,gastrointestinal side effect and oropharyngeal mucositis.Only two patients occurred grade 4 acute toxicities,one was bone marrow suppression and the other was dermatitis radiation.Conclusions:The combination of raltitrexed and cisplatin has a comparable efficacy to those in standard firstline therapy.

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.

Endoscopic debulking resection with additive chemoradiotherapy:Optimal management of advanced inoperable esophageal squamous cell carcinoma

BACKGROUND There is no remedial strategy other than definitive chemoradiotherapy for patients with advanced esophageal squamous cell carcinoma(ESCC) who are not eligible to undergo surgical treatment.AIM To introduce a novel therapy called endoscopic debulking resection(Ed R) followed by additive chemoradiotherapy(CRT) and evaluate its efficacy and safety.METHODS Advanced, inoperable ESCC patients between 1 January 2015 and 30 December 2019 were investigated retrospectively. Patients who received Ed R followed by CRT were deemed the Ed R + CRT group and those without CRT were deemed the Ed R group. Overall survival(OS), progression-free survival(PFS), and adverse events were evaluated.RESULTS A total of 41 patients were enrolled. At a median follow-up of 36 mo(range: 1-83), the estimated 1-, 2-, and 3-year cumulative OS rates of patients who underwent Ed R plus additive CRT were 92.6%, 85.2%, and 79.5%, respectively, which were higher than those of patients who underwent Ed R alone(1-year OS, 83.3%;2-year OS, 58.3%;3-year OS, 50%;P = 0.05). The estimated 2-year cumulative PFS rate after Ed R + CRT was 85.7%, while it was 61.5% after Ed R(P = 0.043). According to the univariate and multivariate Cox regression analyses, early clinical stage(stage ≤ IIB) and additive CRT were potential protective factors for cumulative OS. No severe adverse events were observed during the Ed R procedure, and only mild to moderate myelosuppression and radiation pneumonia were observed in patients who underwent additive CRT after Ed R.CONCLUSION Ed R plus CRT is an alternative strategy for selective advanced inoperable ESCC patients.

Concurrent chemoradiotherapyof different radiation doses and different irradiation fields for locally advanced thoracic esophageal squamous cell carcinoma:A randomized,multicenter,phase Ⅲ clinical trial

Background:Concurrent chemoradiotherapy(CCRT)is the standard treatment for locally advanced esophageal squamous cell carcinoma(ESCC).However,the optimal radiotherapy regimen,particularly in terms of total dose and planned range of irradiation field,remains unclear.This phase III clinical trial aimed to compare the survival benefits between different radiation doses and different target fields.Methods:This trial compared two aspects of radiation treatment,total dose and field,using a two-by-two factorial design.The high-dose(HD)group received 59.4 Gy radiation,and the standard-dose(SD)group received 50.4 Gy.The involved field irradiation(IFI)group and elective nodal irradiation(ENI)group adopted different irradiation ranges.The participants were assigned to one of the four groups(HD+ENI,HD+IFI,SD+ENI and SD+IFI).The primary endpoint was overall survival(OS),and the secondary endpoints included progressionfree survival(PFS).The synergy indexwas used to measure the interaction effect between dose and field.Results:The interaction analysis did not reveal significant synergistic effects between the dose and irradiation field.In comparison to the target field,patients in IFI or ENI showed similar OS(hazard ratio[HR]=0.99,95%CI:0.80-1.23,p=0.930)and PFS(HR=1.02,95%CI:0.82–1.25).TheHDtreatment did not show significantly prolonged OS compared with SD(HR=0.90,95%CI:0.72–1.11,p=0.318),but it suggested improved PFS(25.2 months to 18.0 months).Among the four groups,the HD+IFI group presented the best survival,while the SD+IFI group had the worst prognosis.No significant difference in the occurrence of severe adverse events was found in dose or field comparisons.Conclusions:IFI demonstrated similar treatment efficacy to ENI in CCRT of ESCC.The HD demonstrated improved PFS,but did not significantly improve OS.The dose escalation based on IFI(HD+IFI)showed better therapeutic efficacy than the current recommendation(SD+ENI)and is worth further validation.

Effects of concurrent chemoradiotherapy on serum tumor markers, MMP-9, VEGF and inflammatory factors in patients with endometrial carcinoma after operation

Objective:To investigate effects of concurrent chemoradiotherapy on serum tumor markers, vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9) and inflammatory factors in patients with endometrial carcinoma after operation.Methods: A total of 86 patients with endometrial carcinoma treated by surgery were selected as objects of study, according to random data table they were divided into control group (n=42) and observation group (n=44), patients of two groups were all underwent hysterectomy and bilateral adnexectomy treatment, on this basis, the control group was given radiotherapy treatment, observation group patients received concurrent chemotherapy treatment, the levels of serum tumor markers, VEGF, MMP-9 and inflammatory factor of the two groups before and after treatment were compared.Results: Before treatment, there was no significant difference in CA-125, HE4, VEGF, MMP-9, TNF-α, CRP and IL-6 levels between the observation group and the control group;After treatment, the levels of CA-125, HE4, VEGF, MMP-9, TNF-α, CRP and IL-6 in the two groups were significantly lower than those in the group before treatment, and the difference was statistically significant;After treatment, the levels of CA-125, HE4, VEGF, MMP-9, TNF-α, CRP and IL-6 in the observation group were significantly lower than those in the control group, the difference was statistically significant.Conclusion:The concurrent radiotherapy and chemotherapy can effectively reduce the levels of serum tumor markers, VEGF and MMP-9, and effectively decrease the inflammatory stress response in patients with endometrial carcinoma after operation, with critical clinical value.

Nedaplatin concurrent with three-dimensional conformal radiotherapy for treatment of locally advanced esophageal carcinoma

AIM:To evaluate the efficacy and toxicity of nedaplatin(NDP)concurrent with radiotherapy in the treatment of locally advanced esophageal carcinoma.METHODS:Sixty-eight patients with locally advanced esophageal carcinoma were randomized into either a NDP group(n=34)or a cisplatin(DDP)group(n=34).The NDP group received NDP 80-100 mg/m2iv on day 1+leucovorin(CF)100 mg/m2iv on days 1-5+5-fluorouracil(5-FU)500 mg/m2iv on days 1-5.The DDP group received DDP 30 mg/m2iv on days 1-3+CF 100 mg/m2on days 1-5+5-FU 500 mg/m2iv on days 1-5.The treatment was repeated every 4 wk in both groups.Concurrent radiotherapy[60-66 Gy/(30-33f)/(6-7 wk)]was given during chemotherapy.RESULTS:There was no significant difference in the short-term response rate between the NDP group and DDP group(90.9%vs 81.3%,P=0.528).Although the 1-and 2-year survival rates were higher in the NDP group than in the DDP group(75.8%vs 68.8%,57.6%vs 50.0%),the difference in the overall survival rate was not statistically significant between the two groups(P=0.540).The incidences of nausea,vomiting and nephrotoxicity were significantly lower in the NDP group than in the DDP group(17.6%vs 50.0%,P=0.031;11.8%vs 47.1%,P=0.016;8.8%vs 38.2%,P=0.039).There was no significant difference in the incidence of myelosuppression,radiation-induced esophagitis or radiation-induced pneumonia between the two groups.CONCLUSION:NDP-based concurrent chemoradiotherapy is effective and well-tolerated in patients with locally advanced esophageal carcinoma.NDP-based regimen has comparable efficacy to DDP-based regimen but is associated with lower incidences of gastrointestinal and renal toxicity.

Quality of life and survival outcomes of patients with inoperable esophageal squamous cell carcinoma after definitive radiation therapy:A multicenter retrospective observational study in China from 2015 to 2016

Objectives:To investigate the health-related quality of life(HRQL)of long-term survivors of inoperable esophageal squamous cell carcinoma(ESCC)treated with definitive radiation therapy,the real-world trends in the use of advanced radiation techniques,and their impact on the survival outcomes of ESCC patients.Methods:In this multicenter retrospective observational study,the medical records related to demographics and treatment of ESCC patients who were treated with definitive radiation therapy at 14 provincial hospitals in China from 1 January 2015 to 31 December 2016 were analyzed.A HRQL questionnaire was completed by survivors and collected by doctors at the final follow-up.The difference in quality of life between patients with or without recurrence was compared using the Wilcoxon-Mann-Whitney test.Overall survival(OS)was estimated using the Kaplan-Meier method and the group differences were assessed by unstratified log-rank test.The Cox proportional hazards model with Efron’s method of tie handling was used to calculate the risk factors for OS.Results:The data of a total of 3,308 patients were collected for this study,248 were excluded because of missing data,and a final of 3,060 patients were included in the analysis.Most patients(2,901;94.8%)received intensity-modulated radiotherapy(IMRT)/volumetric-modulated arc therapy(VMAT)/tomotherapy(TOMO).The 5-year OS rate was 30%.Patients who received either two-dimensional radiotherapy(2DRT;HR,2.43[95%CI,1.70-3.47];P<0.001)or three-dimensional radiotherapy(3DRT;HR,1.45[95%CI,1.14-1.84];P=0.003)had a significantly increased risk of death compared to those who received IMRT/VMAT/TOMO.Of the 716(23.4%)long-term survivors who completed the HRQL questionnaire,nearly 70%patients were still able to swallow normally or almost normally,and>80%patients did not experience weight loss.Nearly 80%patients found life very enjoyable or were fairly enjoying life.Conclusions:This large,multicenter retrospective study on ESCC patients who received definitive radiation ther-apy found that most ESCC survivors are satisfied with their quality of life.Most patients received advanced radiation technology.Patients who received either 2DRT or 3DRT had a significantly increased risk of death compared to those who received advanced radiation technology.

Principle and progress of radical treatment for locally advanced esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma is one of the most common malignant tumors in the digestive system in China and the world.Most patients are diagnosed as locally advanced or advanced stage.Concurrent chemoradiotherapy is the standard treatment for locally advanced esophageal squamous cell carcinoma.This study intends to summarize the evidence-based medical evidence of the treatment principle of locally advanced esophageal squamous cell carcinoma,the selection of radiotherapy dose,the outline of radiotherapy target and the selection of chemotherapy scheme.As a result,the effect of radiotherapy and chemotherapy is equivalent to that of surgery for the radical treatment of esophageal squamous cell carcinoma.In the era of immunization,it is recommended to use involved field irradiation.Fluorouracil plus cisplatin regimen is the standard chemotherapy regimen.FOLFOX regimen and paclitaxel plus fluorouracil regimen are optional concurrent chemotherapy regimens.The toxic and side effects of different chemotherapy regimens are different,which can be selected according to the actual situation of patients.

Clinical analysis of PF plus concurrent radiotherapy in locally advanced nasopharyngeal carcinoma

Objective： The prognosis of patients with nasopharyngeal carcinoma （NPC） depends on the stage of the disease at diagnosis. Unfortunately, at diagnosis, most of patients have locally advanced, non-metastatic stage III or IVa disease. The study was to evaluate the efficacy and toxicities of cisplatin plus 5-fluorouracil combined with concurrent radiotherapy for locally advanced nasopharyngeal carcinoma. Methods： Sixty-six patients with locally advanced nasopharyngeal carcinoma received chemotherapy of cisplatin plus 5-fluorouracil jointing concurrent radiotherapy; concurrent radiotherapy started on day 1 in the first cycle of chemotherapy of PF, 5-fluorouraci1500 mg/m^2 intravenous infusion on days 1-5, cisplatin 80 mg/m2 intravenous infusion on days 1-3, 21 days for a cycle, a total of three cycles; nasopharyngeal lesions and positive lymph node were given a total amount of 70 Gy, prophylactic neck radiation were given the amount of 50 Gy, radiotherapy five times a week, Gy/f. Results： All patients who can be evaluated, the response rate （RR） was 100%; 1-, 3- and 5-year overall survival （OS） were 100%, 86.4%, 21.2%, respectively; 3-year, 5-year disease-free survival （DFS） were 72.7% and 18.2%, respective- ly; the average survival time and median survival time were 49.0 months and 48.5 months, respectively; the average survival time and median survival time of DFS were 46.1 months and 46.5 months, respectively. Conclusion： For patients with locally advanced nasopharyngeal carcinoma, who accepted RT combining concurrent chemotherapy of cisplatin plus 5-fluorouracil, clinical efficacy is satisfaction and toxicities could be tolerated.

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.

Nasopharyngeal carcinoma with synchronous breast metastasis:A case report

BACKGROUND Recent reports have described cases of metachronous breast metastasis in patients with nasopharyngeal carcinoma.However,no similar cases of synchronous breast metastasis have been reported,and evidence that can be used to support the clinical diagnosis of stage IV nasopharyngeal carcinoma in patients with concurrent breast metastasis remains lacking.Therefore,additional evidence is required to elucidate the clinical characteristics of this condition and aid in the development of optimal management strategies.CASE SUMMARY We report the case of a 46-year-old woman who visited our hospital with a right breast mass as the first symptom.The first pathological biopsy report suggested triple-negative breast invasive carcinoma.Subsequent imaging revealed a nasopharyngeal mass.Further puncture biopsy of the nasopharyngeal mass,molecular pathological Epstein–Barr virus in situ hybridization,and immunohistochemistry confirmed the diagnosis of nasopharyngeal carcinoma with breast metastasis.The patient did not undergo a mastectomy and achieved complete remission after chemotherapy and radiotherapy.She continued to receive oral chemotherapy as maintenance therapy and experienced no recurrence or metastasis during the 6-month follow-up period.CONCLUSION This case report suggests that breast specialists should carefully rule out secondary breast cancers when diagnosing and treating breast masses.Furthermore,clinicians should aim to identify the pathological type of the tumor to obtain the most accurate diagnosis and prevent excessive diagnosis and treatment.