AIM: To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving two-field, chest and abdomen, lymphadenectomy.
Objective: Radiation therapy is an important component of the multidisciplinary management of esophageal carcinoma. Three-dimensional conformal radiation therapy requires the precise definition of the target volume. ...Objective: Radiation therapy is an important component of the multidisciplinary management of esophageal carcinoma. Three-dimensional conformal radiation therapy requires the precise definition of the target volume. We aimed to compare the treatment results and radiation toxicities between three-dimensional conformal radiotherapy (3D-CRT) and conventional radiotherapy (CR) for patients with cervical and thoracic esophageal carcinoma. Methods: From June 2004 to December 2006, a random study was performed on 106 patients treated with 3D-CRT or CR, 53 patients in each group. The patients in CR group received conventional radiotherapy in 2.0 Gy/f, 5 f/week and total dose was 66-70 Gy in 6.5 or 7 weeks. The patients in 3D-CRT group were treated by 3D-CRT in 2.0 Gy/f, 5 f/week and total dose was 64-70 Gy in 6 weeks. The local control rates, survival rates and radiation toxicities for the two groups were investigated. Results: The 1-year and 3-year local control rates were 83.0% and 60.4% in 3D-CRT group and 64.2% (x^2 = 4.853, P = 0.028) and 32.1% (x^2 = 9.812, P = 0.002) in CR group. The 1-year and 3-year survival rates were 73.6% and 50.9% in 3D-CRT group and 54.7% (x^2 = 4.102, P = 0.043) and 32.1% (x^2 = 3.886, P = 0.049) in CR group. Between the two groups, there was no significant difference in radiation toxicities. Conclusien: The 1-year and 3-year local control rates and survival rates of patients with esophageal carcinoma treated by 3D-CRT is superior to CR. However, longer-term results and radiation toxicity need further study which involves more patients and prolonged follow-up.展开更多
AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized contr...AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized controlled trials(RCTs) that compared neoadjuvant chemoradiotherapy plus surgery(CRTS) with surgery alone(S) for esophageal cancer.According to the test of heterogeneity,a fi xed-effect model or a random effect model was used and the odds ratio(OR) was the principal measure of effects.RESULTS:Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C(Cochrane Reviewers' Handbook 4.2.2).OR(95% CI,P value),expressed as CRTS vs S(values>1 favor CRTS arm),was 1.19(0.94-1.48,P=0.28) for 1-year survival,1.33(1.07-1.65,P=0.69) for 2-year survival,1.76(1.42-2.19,P=0.11) for 3-year survival,1.41(1.06-1.87,P=0.11) for 4-year survival,1.64(1.28-2.12,P=0.40) for 5-year survival,0.82(0.39-1.73,P<0.0001) for rate of resection,1.53(1.33-2.84,P=0.007) for rate of complete resection,1.78(1.14-2.78,P=0.79) for operative mortality,1.12(0.89-2.48,P=0.503) for all treatment mortality,1.33(0.94-1.88,P=0.04) for the rate of adverse treatment,1.38(1.23-1.63,P=0.0002) for local-regional cancer recurrence,1.28(0.85-1.58,P=0.60) for distant cancer recurrence,and 1.27(0.86-1.65,P=0.19) for all cancer recurrence.A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients.The 5-year survival benefi t was most pronounced when chemotherapy and radiotherapy were given concurrently(OR:1.45,95% CI:1.26-1.79,P=0.015) instead of sequentially(OR:0.85,95% CI:0.64-1.35,P=0.26).CONCLUSION:Compared with surgery alone,neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence.Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.展开更多
Postoperative radiotherapy (PRT) is widely advocated for patients with squamous cell carcinomas of the head and neck that are considered to be at high risk of recurrence after surgical resection. The aims of this stud...Postoperative radiotherapy (PRT) is widely advocated for patients with squamous cell carcinomas of the head and neck that are considered to be at high risk of recurrence after surgical resection. The aims of this study were to evaluate the treatment outcomes of PRT for patients with laryngeal carcinoma and to identify the value of several prognostic factors. We reviewed the records of 256 patients treated for laryngeal squamous cell carcinoma between January 1993 and December 2005. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank test was employed to identify significant prognostic factors for DFS and OS. The Cox proportional hazards model was applied to identify covariates significantly associated with the aforementioned endpoints. Our results showed the 3-, 5-, and 10-year DFS for all patients were 69.9%, 59.5%, and 34.9%, respectively. The 3-, 5-, and 10-year OS rates were 80.8%, 68.6%, and 38.8%, respectively. Significant prognostic factors for both DFS and OS on univariate analysis were grade, primary site, T stage, N stage, overall stage, lymph node metastasis, overall treatment times of radiation, the interval between surgery and radiotherapy, and radiotherapy equipment. Favorable prognostic factors for both DFS and OS on multivariate analysis were lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment. In conclusion, our data suggest that lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment are favorable prognostic factors for DFS and OS and that reducing the overall treatment times of radiation to 6 weeks or less and the interval between surgery and radiotherapy to less than 3 weeks are simple measures to remarkably improve treatment outcome.展开更多
Four major studies(Checkmate577,Keynote-590,Checkmate649 and Attraction-4)of locally advanced esophageal cancer published in 2020 have established the importance of immunotherapy,represented by anti-programmed death p...Four major studies(Checkmate577,Keynote-590,Checkmate649 and Attraction-4)of locally advanced esophageal cancer published in 2020 have established the importance of immunotherapy,represented by anti-programmed death protein(PD)-1 in postoperative adjuvant treatment and advanced first-line treatment of locally advanced or advanced esophageal cancer and esophagogastric junction cancer,from the aspects of proof of concept,long-term survival,overall survival rate and progression-free survival.For unresectable or inoperable nonmetastatic esophageal cancer,concurrent radiotherapy and chemotherapy is the standard treatment recommended by various guidelines.Because its curative effect is still not ideal,it is necessary to explore radical radiotherapy and chemotherapy in the future,and it is considered to be promising to combine them with immunotherapeutic drugs such as anti-PD-1.This paper mainly discusses how to combine radical concurrent radiotherapy and chemotherapy with immunotherapy for unresectable local advanced esophageal cancer.展开更多
Background:Radiotherapy following primary operation is strongly recommended for salivary gland carcinomas(SGCs)with adverse features.The interval between surgery and the initiation of radiotherapy(SRT)varied and a pro...Background:Radiotherapy following primary operation is strongly recommended for salivary gland carcinomas(SGCs)with adverse features.The interval between surgery and the initiation of radiotherapy(SRT)varied and a prolonged SRT may cause failure of cancer treatment.However,the association of SRT with survival is unclear in major SGCs.Methods:This retrospective study included a total of 346 patients who underwent radiotherapy after the pri-mary operation from Fudan University Shanghai Cancer Center from 2005 to 2020.The best cutoffvalue of the SRT was determined by the maximum log-rank statistic method.The primary endpoint of the study was over-all survival(OS).Correlations between variables and OS were conducted by the univariable analysis using the Log-rank method,and a multivariate Cox proportional hazards regression was performed to identify the indepen-dent prognostic factors associated with OS.The estimated survival rates were captured using the Kaplan-Meier method.Results:With a median follow-up time of 70.31 months,the estimated 5-year OS,LRFS,and DMFS were 83.3%,80.1%,and 75.9%,respectively.The cutoffvalue for SRT was 8.5 weeks,while age,T stage,N stage,perineural invasion(PNI),pathological aggression,chemotherapy,and SRT were associated with OS in the univariable analysis.The Cox regression analysis demonstrated that older age(P<0.001),T3-4 tumors(P=0.007),positive N stage(P<0.001),pathological aggression(P=0.014),and longer SRT(P=0.009)were independent prognostic factors for major SGCs.Using the stratification model,we observed that delay in the SRT was associated with worse OS(P=0.006)in the high-risk group,whereas no significant difference was observed in the low-risk subgroup(P=0.61).Conclusions:The delay in the initiation of postoperative radiotherapy may be a prognostic factor for patients with major SGCs.It was suggested that radiotherapy should be delivered within 8.5 weeks following the operation,especially for patients with≥2 risk factors,including older age,high pathological aggression,T3-4 tumors,and positive N stage.展开更多
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 o...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.展开更多
Objective To evaluate clinical feasibility and efficacy of endoscopic metal stenting combined with radiotherapy for treatment of medium and late stages of esophageal carcinoma. Methods Thirty-four patients of late s...Objective To evaluate clinical feasibility and efficacy of endoscopic metal stenting combined with radiotherapy for treatment of medium and late stages of esophageal carcinoma. Methods Thirty-four patients of late stage esophageal carcinoma were treated with endoscopic stent implantation in combination with radiotherapy. Evaluations of CES stainless steel metal stent on the effect of radiation, clinical symptom alleviation and complication and survival rates in both groups were made. Results ①CES stainless steel metal stent had no effect on radiation dosage distribution. ②Dysphagia was markedly alleviated in both groups and different complication rates were observed between the two groups. ③Six, nine and twelve month survival rates of inpatients treated with combined therapies were significantly higher than in simple stent implantation patients. Conclusion Endoscopic metal stenting in combination with radiotherapy was a feasible and practical management in treating medium and late stages esophageal carcinoma and was superior to simple metal stent implantation.展开更多
AIM: To explore the relationship between serum p53 antibodies (p53-Abs) and clinicopathological characteristics and therapeutic effect in patients with esophageal carcinoma (EC), and to investigate sequential cha...AIM: To explore the relationship between serum p53 antibodies (p53-Abs) and clinicopathological characteristics and therapeutic effect in patients with esophageal carcinoma (EC), and to investigate sequential changing regularity of serum pS3-Abs after radiotherapy. METHODS: The serum pS3-Ab levels were detected in 46 EC patients and 30 healthy adults by enzyme linked immunosorbent assay (ELISA). The blood samples were collected on the day before radiotherapy and on the administration of an irradiation dose of 20 Gy/10 f/12 d, 40 Gy/20 f/24 d and 60 Gy/30 f/36 d after radiotherapy. RESULTS: The level and positive rate of serum pS3-Abs in EC patients were significantly higher than those in normal individuals (P 〈 0.05). Serum anti-p53 antibodies were positive in 18 of 46 EC patients (39.1%). The positive rate of pS3-Abs in EC was related to histological grade, disease stage and lymph node metastasis (P 〈 0.05), but it was not significantly related to sex, age and to the size and site of tumor. The level and positive rate of p53-Abs had significant differences between before radiotherapy and after administration of an irradiation dose of 40 Gy/20 f/24 d and 60 Gy/30 f/36 d (P 〈 0.05 orP 〈 0.01). The positive rate of p53-Abs in EC patients with effect was significantly lower than that in those without effect after radiotherapy (P 〈 0.0001).CONCLUSION: Detection of serum p53-Abs is helpful to the diagnosis of esophageal carcinoma. Monitoring for sequential change of serum p53-Abs before and after radiotherapy in patients with esophageal carcinoma is also useful to evaluate the response to the treatment and prognosis of the patients.展开更多
Objective: To observe the effect of Kang'ai Injection (康艾注射液, KAI) on serum level of soluble interleukin-2 receptor (sIL-2R) and vascular endothelial growth factor (VEGF) in patients with esophageal carci...Objective: To observe the effect of Kang'ai Injection (康艾注射液, KAI) on serum level of soluble interleukin-2 receptor (sIL-2R) and vascular endothelial growth factor (VEGF) in patients with esophageal carcinoma (EC) during radiotherapy (RT), and to investigate its synergistic effect with RT and its influence on immunological function of the body. Methods: One hundred and seventy patients with EC, who had missed the chance of surgical operational therapy, were assigned to the treated group (90 cases) and the RT group (80 cases), and at the same time a control group consisting of 80 inpatients without tumors was set up. Patients in the RT group were treated with RT alone but KAI was given additionally to those in the treated group, with 50 ml given once per day via intravenous dripping, 15 days as one course, and 2 courses administered in total. The immediate therapeutic efficacy and changes of serum slL-2R and VEGF levels were observed, and the effect of KAI on patients' quality of life (QOF) was evaluated by Karnofsky scoring. Results: In 16 patients of the treated group it was completely remission (OR), in 54 partially remission (PR), in 18 it was stabilized disease (SD) and in 2 progressive disease (PD), with the total effective rate (CR + PR) as 77.8%, while in those of the control group it was 12, 46, 18, 4 and 72.5%, respectively, the immediate therapeutic efficacy in the treated group was somewhat better than that in the RT group, but showed no statistical significance (P〉0.05). Serum levels of slL-2R and VEGF in all the patients before treatment were higher than those in the control group, which were decreased after treatment in both groups (P〈0.05), but the improvement in the treated group was better than that in the RT group, showing significant difference (P〈0.05), and patients' QOF improved more significantly in the former as well (62.2 % vs 40.0%, P〈 0.05). Conclusion: KAI in combination with RT in treating patients with EC could enhance the immunological function of patients, improve their QOF and enhance their sensitivity to RT.展开更多
Objective Malnutrition and cachexia are common in esophageal squamous cell carcinoma(ESCC)patients undergoing radiotherapy.This study evaluated how malnutrition-and cachexia-related indicators,including the albumin-to...Objective Malnutrition and cachexia are common in esophageal squamous cell carcinoma(ESCC)patients undergoing radiotherapy.This study evaluated how malnutrition-and cachexia-related indicators,including the albumin-to-globulin ratio(AGR),and their changes during radiotherapy predict the treatment outcomes.Methods We reviewed a total of 172 ESCC patients receiving radiotherapy(as a primary cohort)and performed a Cox regression analysis on potential prognostic factors,including the AGR,as well as the TNM stage and concomitant chemotherapy.A subsequent receiver operating characteristics(ROC)curve and Kaplan Meier survival analysis was performed for ESCC patients stratified by the average AGR cut-off point.Results In addition to the well-documented factors(i.e.TNM stage and concomitant chemotherapy),the average AGR was a significant prognostic factor for ESCC patients receiving radiotherapy.By plotting the ROC curve of the average AGR with regard to the ESCC prognosis,we obtained cut-off points for the overall patients(cut-off point:1.5,AUC:0.636),for patients with stageⅡ/Ⅲdisease(cut-off point:1.5,AUC:0.611),and for patients with stageⅣdisease(cut-off point:1.84,AUC:0.900).The ESCC patients with higher average AGR had a significantly more favorable OS compared with those with a lower average AGR.Notably,ESCC patients who had an increasingΔAGR during radiotherapy had a considerably more favorable OS compared with those with a decreasingΔAGR.All of these findings were reproducible in the validation cohort.Conclusion A lower average AGR is indicative of a poorer prognosis for ESCC patients following radiotherapy.Improving the nutritional status and preventing or ameliorating cachexia might contribute to improving the prognosis of ESCC patients.展开更多
BACKGROUND Esophageal squamous cell carcinoma(ESCC)is one of the main causes of human death.It is usually already in middle or advanced stage when diagnosed due to its hidden symptoms in early stage.Therefore,patients...BACKGROUND Esophageal squamous cell carcinoma(ESCC)is one of the main causes of human death.It is usually already in middle or advanced stage when diagnosed due to its hidden symptoms in early stage.Therefore,patients have already lost the best surgical timing when diagnosed.Radiotherapy and chemotherapy are standard treatment methods for ESCC clinically,but the efficacy and prognosis of patients from them are still unsatisfactory.Therefore,it is of great clinical significance to seek for biomarkers that can predict the radiotherapy and chemotherapy response and prognosis of ESCC patients.AIM To explore the clinical value of plasma miR-21 and miR-93 in ESCC.METHODS A total of 128 ESCC patients admitted to the First Affiliated Hospital of Zhenzhou University were enrolled as a study group and treated with concurrent radiotherapy and chemotherapy,and other 45 healthy people during the same period were enrolled as a control group.The expression of plasma miR-21 and miR-93 was determined using quantitative real-time polymerase chain reaction,and the correlation of expression of plasma miR-21 and miR-93 with clinical pathological parameters about the patients was analyzed.The receiver operating characteristic(ROC)curve was adopted to assess the diagnostic value of plasma miR-21 and miR-93 for clinical pathological features of ESCC patients,the Logistic regression analysis adopted to analyze the risk factors for radiotherapy and chemotherapy efficacy in ESCC patients,and the Cox regression analysis to identify the prognostic factors for ESCC patients.RESULTS The study group showed significantly higher relative expression of plasma miR-21 and miR-93 than the control group(P<0.01).The area under the ROC curve(AUC)of plasma miR-21 for diagnosing T stage,N stage,M stage,and pathological differentiation of ESCC was 0.819,0.758,0.824,and 0.725,respectively,and that of plasma miR-93 for diagnosing T stage,N stage,and M stage of ESCC was 0.827,0.815,and 0.814,respectively.The AUC of combined plasma miR-21 and miR-93 for predicting radiotherapy and chemotherapy efficacy before radiotherapy and chemotherapy was 0.894,and the AUCs of them for predicting the 3-year overall survival(OS)were 0.861 and 0.807,respectively.T stage(P<0.05),M stage(P<0.05),miR-21(P<0.01),and miR-93(P<0.05)were independent risk factors for radiotherapy and chemotherapy efficacy,and T stage(P<0.01),N stage(P<0.05),M stage(P<0.01),miR-21(P<0.01),and miR-93(P<0.01)were independent prognostic factors for ESCC patients.CONCLUSION MiR-21 and miR-93 can be adopted as effective biomarkers for predicting radiotherapy and chemotherapy efficacy in ESCC and the 3-year OS of ESCC patients.展开更多
Background: Insulin?like growth factor?binding protein?3(IGFBP?3) is suggested to predict the radiosensitivity and/or prognosis of patients with esophageal squamous cell carcinoma(ESCC). The present study was designed...Background: Insulin?like growth factor?binding protein?3(IGFBP?3) is suggested to predict the radiosensitivity and/or prognosis of patients with esophageal squamous cell carcinoma(ESCC). The present study was designed to investi?gate the clinical and prognostic efects of IGFBP?3 on ESCC.Methods: IGFBP?3 was detected by immunohistochemistry in parain?embedded tissues from 70 ESCC patients treated with radiotherapy alone and further examined by western blotting analysis in 10 pairs of fresh ESCC tissues and adjacent non?malignant esophageal specimens. Receiver operating characteristic(ROC) analysis was used to determine cut?of scores for tumor positivity and to evaluate patient survival status. The χ2 test was performed to analyze the association of IGFBP?3 expression with clinical characteristics and radiotherapy response. Associations between prognostic outcomes and IGFBP?3 expression were investigated using Kaplan–Meier analysis and the Cox proportional hazards model.Results: The threshold for IGFBP?3 positivity was set to greater than 65% [area under the ROC curve(AUC)(45.7%) were deined as having high IGFBP?3 expression= 0.690, P < 0.019]. Of the 70 ESCC patient tissues tested, 32. The levels of IGFBP?3 protein expression were decreased in 70.0%(7 of 10) of ESCC tissues compared with adjacent non?malignant esophageal tissue. In addition, IGFBP?3 expression was associated with pathologic classiication(P < 0.05 for T, N, and M categories and clinical stage). Patients with elevated protein level of IGFBP?3 in the tumor had an improved radiotherapy response and prolonged overall survival(P < 0.001).Conclusions: High level of IGFBP?3 expression in ESCC associates with early clinical stages and are predictive for favorable survival of the patients treated with radiotherapy.展开更多
Postoperative radiotherapy is a major treatment for patients with maxillary sinus carcinoma. However, the irregular resection cavity poses a technical difficulty for this treatment, causing uneven dose distribution to...Postoperative radiotherapy is a major treatment for patients with maxillary sinus carcinoma. However, the irregular resection cavity poses a technical difficulty for this treatment, causing uneven dose distribution to target volumes. In this study, we evaluated the dose distribution to target volumes and normal tissues in postoperative intensity-modulated radiotherapy (IMRT) after placing a water-filled balloon into the resection cavity. Three postoperative patients with advanced maxillary sinus carcinoma were selected in this trial. Water-filled balloons and supporting dental stents were fabricated according to the size of the maxillary resection cavity. Simulation CT scans were performed with or without water-filled balloons, IMRT treatment plans were established, and dose distribution to target volumes and organs at risk were evaluated. Compared to those in the treatment plan without balloons, the dose (D98) delivered to 98% of the gross tumor volume (GTV) increased by 2.1 Gy (P = 0.009), homogeneity index (HI) improved by 2.3% (P = 0.001), and target volume conformity index (TCI) of 68 Gy increased by 18.5% (P = 0.011) in the plan with balloons. Dosimetry endpoints of normal tissues around target regions in both plans were not significantly different (P > 0.05) except for the optic chiasm. In the plan without balloons, 68 Gy high-dose regions did not entirely cover target volumes in the ethmoid sinus, posteromedial wall of the maxillary sinus, or surgical margin of the hard palate. In contrast, 68 Gy high-dose regions entirely covered the GTV in the plan with balloons. These results suggest that placing a water-filled balloon in the resection cavity for postoperative IMRT of maxillary sinus c arcinoma can reduce low-dose regions and markedly and simultaneously increase dose homogeneity and conformity of target volumes.展开更多
BACKGROUND Salivary gland cancer is a rare disease in which cancer cells form in the tissues of the salivary glands.It mostly occurs in the glands that have secretion functions,such as the parotid gland,sublingual gla...BACKGROUND Salivary gland cancer is a rare disease in which cancer cells form in the tissues of the salivary glands.It mostly occurs in the glands that have secretion functions,such as the parotid gland,sublingual gland and submandibular gland.This is very rare when it occurs in other nonsecreting glands.Here,we report one case of salivary gland carcinoma occurring in the thymus and discuss related diagnoses and treatment progress.CASE SUMMARY One 33-year-old middle-aged man presented with a thymus mass without any clinical symptoms when he underwent regular physical examination.Later,the patient was admitted to the hospital for further examination.Computed tomography(CT)showed that there was a mass of 3 cm×2.8 cm×1.5 cm in the thymus area.The patient had no symptom of discomfort or tumor-related medical history before.After completing the preoperative examinations,it was confirmed that the patient had indications for surgery.The surgeon performed a transthoracoscope"thymectomy+pleural mucostomy"for him.During the operation,the tumor tissue was quickly frozen,and the symptomatic section showed a malignant tumor.The final pathological result suggested thymus salivary gland carcinoma-mucoepidermoid carcinoma(MEC).In the second month after surgery,we performed local area radiotherapy for the patient,with a total radiation dose of 50.4 Gy/28Fx.After 12 mo of surgery,the patient underwent positron emission tomography-CT examination,which indicated that there was no sign of tumor recurrence or metastasis.After 16 mo of operation,CT scan re-examination showed that there was no sign of tumor recurrence or metastasis.As of the time of publication,the patient was followed up for one and a half years.He had no sign of tumor recurrence and continued to survive.CONCLUSION The incidence of MEC in the thymus is low,and its diagnosis needs to be combined with clinical features and imaging methods.Histopathological analysis plays a key role in the diagnosis of the disease.Patients with early-stage disease have a good prognosis and long survival period.In contrast,patients with advanced-stage disease have a poor prognosis and short survival period.Combining radiotherapy and chemotherapy in inoperable patients may prolong survival.展开更多
AIM: The aim of the present study is to use immunohisto chemical methods to investigate the clinical implications of tumor markers in esophageal squamous cell carcinoma and evaluate their impact on prognosis. METHODS:...AIM: The aim of the present study is to use immunohisto chemical methods to investigate the clinical implications of tumor markers in esophageal squamous cell carcinoma and evaluate their impact on prognosis. METHODS: From November 1990 to December 1996, 47 patients were treated with preoperative radiation followed by radical esophagectomy. All patients were confirmed pathologically as suffering from squamous cell carcinoma. Immunohistochemical stain was done for PCNA, cyclinDl protein expression and DNA content analyzed by image cytometry. Kaplan-Meier method for single prognostic factor and log-rank test was used to test the significant difference. Cox stepwise regression model and prognosis index model were used for survival analysis with multiple prognostic factors. RESULTS: Radio-pathological change, T stage and N stage, as the traditional prognostic factors had statistical difference in 3-, 5- and 10-year survival rates. While, tumor cell proliferating marked PCNA, cyclinDl and DNA content served as independent prognostic factors of esophageal carcinoma. There was definitely an identity between the single and multiple factor analyses. PI was more accurate to evaluate the prognosis of esophageal carcinoma. CONCLUSION: It is possible that tumor cell proliferating marked PCNA, cyclinD1 and DNA content would become the endpoints for evaluating the prognosis of esophageal carcinoma.展开更多
AIM:To assess the effects of neoadjuvant chemoradiotherapy(CRT) on the presence of extracapsular lymph node involvement(LNI) and its prognostic value in patients with resected esophageal cancer.METHODS:Two hundred and...AIM:To assess the effects of neoadjuvant chemoradiotherapy(CRT) on the presence of extracapsular lymph node involvement(LNI) and its prognostic value in patients with resected esophageal cancer.METHODS:Two hundred and ninety-eight patients with advanced esophageal cancer underwent esophagectomy between 1997 and 2006.One hundred and ninety patients(63.8%) were treated with neoadjuvant CRT prior to resection.A total of 986 metastatic LNs were examined.Survival of the patients was analyzed according to intra-and extra-capsular LNI.RESULTS:Five-year survival rate was 22.5% for the entire patient population.Patients with extracapsular LNI had a 5-year survival rate of 16.7%,which was comparable to the 15.8% in patients with infiltrated nodes of the celiac trunk(pM1lymph).In contrast to patients treated with surgery alone,neoadjuvant therapy resulted in signif icantly(P = 0.001) more patients with pN0/M0(51.6% vs 25.0%).In 17.6% of the patients with surgery alone vs 16.8% with neoadjuvant CRT,extracapsular LNI was detected.Neoadjuvant therapy does not reduce the occurrence of extracapsular LNI.CONCLUSION:Extracapsular LNI is an independent negative prognostic factor not influenced by neoadjuvant CRT.In a revised staging system for esophageal cancer,extracapsular LNI should be considered.展开更多
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 chemoradiothera...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.展开更多
BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcino...BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcinoma(ESCC).AIM To investigate the difference in the failure patterns of stage pT3-4N0-3M0 ESCC patients with or without PORT.METHODS Patients with stage pT3-4N0-3M0 ESCC,who underwent surgery with or without PORT,were enrolled in this study.The primary endpoint was to investigate the difference in the failure patterns between patients with or without PORT after esophagectomy.The secondary endpoint was to estimate whether patients with stage pT3-4 ESCC could achieve a disease-free survival(DFS)advantage after receiving adjuvant PORT.Statistical analyses were performed by the Kaplan-Meier method,Cox regression model,and Chi-squared test or Fisher’s exact test.RESULTS In total,230 patients with stage pT3-4N0-3M0 ESCC were included in this study.Fifty-six patients who received PORT were screened from a prospective cohort(S+R arm).And 174 patients involving surgery alone were retrospectively selected from July 2006 to October 2014(S arm).There were no significant differences in the clinical or pathological characteristics of patients between the two arms,except for tumor location(P=0.031).The failure patterns between the two arms were significantly different(P<0.001).Patients in the S arm had a significantly higher proportion of locoregional recurrence and a lower proportion of distant metastasis than those in the S+R arm(92.0%vs 35.7%,P<0.001 and 19.0%vs 75.0%,P<0.001,respectively).The difference in the median DFS between the two arms was statistically significant(12.7 vs 8 mo,P=0.048).Univariate analysis and multivariate analysis both demonstrated that the number of lymph node metastases≥3(HR=0.572,95% CI:0.430-0.762,P<0.001)was an independent poor prognostic factor for DFS in patients with stage pT3-4N0-3M0 ESCC.CONCLUSION PORT could improve DFS and local control of patients with stage pT3-4N0-3M0 ESCC.However,further studies need to be conducted to control hematogenous metastasis after PORT.展开更多
Radiotherapy represents an essential treatment approach for esophageal cancer.Over recent years,immunotherapy combined with chemotherapy has become the first-line standard treatment for patients with advanced esophage...Radiotherapy represents an essential treatment approach for esophageal cancer.Over recent years,immunotherapy combined with chemotherapy has become the first-line standard treatment for patients with advanced esophageal cancer.Several phase III studies on immunotherapy combined with radiotherapy for locally advanced esophageal cancer are currently underway.Sufficient evidence-based medical data are urgently needed to support the integration of immunotherapy and chemoradiotherapy as a new treatment strategy for patients with locally advanced esophageal cancer.This consensus,formulated based on the latest study results,in-depth research,and thorough discussions,provides a comprehensive set of recommendations.The document extensively covers treatment strategies and evaluation methods for radiotherapy combined with immunotherapy across patients with operable esophageal cancer,inoperable locally advanced esophageal cancer,and advanced esophageal cancer.Moreover,common complications and radiation-related issues associated with radiotherapy combined with immunotherapy are discussed,serving as clinical guidance.Our expert group comprised members from the Professional Committee of Radiation Oncology,China Anti-Cancer Association,the Branch of Radiation Oncology,Chinese Medical Association,and the Branch of Radiation Oncology Treatment Physician,Chinese Medical Doctor Association.展开更多
基金Supported by grant from Doctoral Startup Project of Liaoning Provincial Science and Technology Department,No.20121133
文摘AIM: To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving two-field, chest and abdomen, lymphadenectomy.
文摘Objective: Radiation therapy is an important component of the multidisciplinary management of esophageal carcinoma. Three-dimensional conformal radiation therapy requires the precise definition of the target volume. We aimed to compare the treatment results and radiation toxicities between three-dimensional conformal radiotherapy (3D-CRT) and conventional radiotherapy (CR) for patients with cervical and thoracic esophageal carcinoma. Methods: From June 2004 to December 2006, a random study was performed on 106 patients treated with 3D-CRT or CR, 53 patients in each group. The patients in CR group received conventional radiotherapy in 2.0 Gy/f, 5 f/week and total dose was 66-70 Gy in 6.5 or 7 weeks. The patients in 3D-CRT group were treated by 3D-CRT in 2.0 Gy/f, 5 f/week and total dose was 64-70 Gy in 6 weeks. The local control rates, survival rates and radiation toxicities for the two groups were investigated. Results: The 1-year and 3-year local control rates were 83.0% and 60.4% in 3D-CRT group and 64.2% (x^2 = 4.853, P = 0.028) and 32.1% (x^2 = 9.812, P = 0.002) in CR group. The 1-year and 3-year survival rates were 73.6% and 50.9% in 3D-CRT group and 54.7% (x^2 = 4.102, P = 0.043) and 32.1% (x^2 = 3.886, P = 0.049) in CR group. Between the two groups, there was no significant difference in radiation toxicities. Conclusien: The 1-year and 3-year local control rates and survival rates of patients with esophageal carcinoma treated by 3D-CRT is superior to CR. However, longer-term results and radiation toxicity need further study which involves more patients and prolonged follow-up.
文摘AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized controlled trials(RCTs) that compared neoadjuvant chemoradiotherapy plus surgery(CRTS) with surgery alone(S) for esophageal cancer.According to the test of heterogeneity,a fi xed-effect model or a random effect model was used and the odds ratio(OR) was the principal measure of effects.RESULTS:Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C(Cochrane Reviewers' Handbook 4.2.2).OR(95% CI,P value),expressed as CRTS vs S(values>1 favor CRTS arm),was 1.19(0.94-1.48,P=0.28) for 1-year survival,1.33(1.07-1.65,P=0.69) for 2-year survival,1.76(1.42-2.19,P=0.11) for 3-year survival,1.41(1.06-1.87,P=0.11) for 4-year survival,1.64(1.28-2.12,P=0.40) for 5-year survival,0.82(0.39-1.73,P<0.0001) for rate of resection,1.53(1.33-2.84,P=0.007) for rate of complete resection,1.78(1.14-2.78,P=0.79) for operative mortality,1.12(0.89-2.48,P=0.503) for all treatment mortality,1.33(0.94-1.88,P=0.04) for the rate of adverse treatment,1.38(1.23-1.63,P=0.0002) for local-regional cancer recurrence,1.28(0.85-1.58,P=0.60) for distant cancer recurrence,and 1.27(0.86-1.65,P=0.19) for all cancer recurrence.A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients.The 5-year survival benefi t was most pronounced when chemotherapy and radiotherapy were given concurrently(OR:1.45,95% CI:1.26-1.79,P=0.015) instead of sequentially(OR:0.85,95% CI:0.64-1.35,P=0.26).CONCLUSION:Compared with surgery alone,neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence.Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.
基金supported by a grant from the Natural Science Foundation of Guangdong Province, P. R. China (No. 9151008901000223)
文摘Postoperative radiotherapy (PRT) is widely advocated for patients with squamous cell carcinomas of the head and neck that are considered to be at high risk of recurrence after surgical resection. The aims of this study were to evaluate the treatment outcomes of PRT for patients with laryngeal carcinoma and to identify the value of several prognostic factors. We reviewed the records of 256 patients treated for laryngeal squamous cell carcinoma between January 1993 and December 2005. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank test was employed to identify significant prognostic factors for DFS and OS. The Cox proportional hazards model was applied to identify covariates significantly associated with the aforementioned endpoints. Our results showed the 3-, 5-, and 10-year DFS for all patients were 69.9%, 59.5%, and 34.9%, respectively. The 3-, 5-, and 10-year OS rates were 80.8%, 68.6%, and 38.8%, respectively. Significant prognostic factors for both DFS and OS on univariate analysis were grade, primary site, T stage, N stage, overall stage, lymph node metastasis, overall treatment times of radiation, the interval between surgery and radiotherapy, and radiotherapy equipment. Favorable prognostic factors for both DFS and OS on multivariate analysis were lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment. In conclusion, our data suggest that lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment are favorable prognostic factors for DFS and OS and that reducing the overall treatment times of radiation to 6 weeks or less and the interval between surgery and radiotherapy to less than 3 weeks are simple measures to remarkably improve treatment outcome.
基金Supported by Natural Science Foundation of Fujian Province,No.2021J011259.
文摘Four major studies(Checkmate577,Keynote-590,Checkmate649 and Attraction-4)of locally advanced esophageal cancer published in 2020 have established the importance of immunotherapy,represented by anti-programmed death protein(PD)-1 in postoperative adjuvant treatment and advanced first-line treatment of locally advanced or advanced esophageal cancer and esophagogastric junction cancer,from the aspects of proof of concept,long-term survival,overall survival rate and progression-free survival.For unresectable or inoperable nonmetastatic esophageal cancer,concurrent radiotherapy and chemotherapy is the standard treatment recommended by various guidelines.Because its curative effect is still not ideal,it is necessary to explore radical radiotherapy and chemotherapy in the future,and it is considered to be promising to combine them with immunotherapeutic drugs such as anti-PD-1.This paper mainly discusses how to combine radical concurrent radiotherapy and chemotherapy with immunotherapy for unresectable local advanced esophageal cancer.
文摘Background:Radiotherapy following primary operation is strongly recommended for salivary gland carcinomas(SGCs)with adverse features.The interval between surgery and the initiation of radiotherapy(SRT)varied and a prolonged SRT may cause failure of cancer treatment.However,the association of SRT with survival is unclear in major SGCs.Methods:This retrospective study included a total of 346 patients who underwent radiotherapy after the pri-mary operation from Fudan University Shanghai Cancer Center from 2005 to 2020.The best cutoffvalue of the SRT was determined by the maximum log-rank statistic method.The primary endpoint of the study was over-all survival(OS).Correlations between variables and OS were conducted by the univariable analysis using the Log-rank method,and a multivariate Cox proportional hazards regression was performed to identify the indepen-dent prognostic factors associated with OS.The estimated survival rates were captured using the Kaplan-Meier method.Results:With a median follow-up time of 70.31 months,the estimated 5-year OS,LRFS,and DMFS were 83.3%,80.1%,and 75.9%,respectively.The cutoffvalue for SRT was 8.5 weeks,while age,T stage,N stage,perineural invasion(PNI),pathological aggression,chemotherapy,and SRT were associated with OS in the univariable analysis.The Cox regression analysis demonstrated that older age(P<0.001),T3-4 tumors(P=0.007),positive N stage(P<0.001),pathological aggression(P=0.014),and longer SRT(P=0.009)were independent prognostic factors for major SGCs.Using the stratification model,we observed that delay in the SRT was associated with worse OS(P=0.006)in the high-risk group,whereas no significant difference was observed in the low-risk subgroup(P=0.61).Conclusions:The delay in the initiation of postoperative radiotherapy may be a prognostic factor for patients with major SGCs.It was suggested that radiotherapy should be delivered within 8.5 weeks following the operation,especially for patients with≥2 risk factors,including older age,high pathological aggression,T3-4 tumors,and positive N stage.
基金supported by funds from the Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education MinistryNational Nature Science Fund, Support Grant 81301932+2 种基金the grants from the University Cancer Foundation via the Sister Institution Network Fund at The University of Texas MD Anderson Cancer Center and, in part, by the National Institutes of Health through MD Anderson Cancer Center Support Grant (CA016672)as some of these studies were performed in the North Campus Flow Cytometry and Cellular Imaging Core (PI: Ronald A. De Pinho, MD)supported by the grant from the Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry, China
文摘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.
文摘Objective To evaluate clinical feasibility and efficacy of endoscopic metal stenting combined with radiotherapy for treatment of medium and late stages of esophageal carcinoma. Methods Thirty-four patients of late stage esophageal carcinoma were treated with endoscopic stent implantation in combination with radiotherapy. Evaluations of CES stainless steel metal stent on the effect of radiation, clinical symptom alleviation and complication and survival rates in both groups were made. Results ①CES stainless steel metal stent had no effect on radiation dosage distribution. ②Dysphagia was markedly alleviated in both groups and different complication rates were observed between the two groups. ③Six, nine and twelve month survival rates of inpatients treated with combined therapies were significantly higher than in simple stent implantation patients. Conclusion Endoscopic metal stenting in combination with radiotherapy was a feasible and practical management in treating medium and late stages esophageal carcinoma and was superior to simple metal stent implantation.
基金Technology Research and Exploration Funds of Gansu Province, No. 0709TCYA030
文摘AIM: To explore the relationship between serum p53 antibodies (p53-Abs) and clinicopathological characteristics and therapeutic effect in patients with esophageal carcinoma (EC), and to investigate sequential changing regularity of serum pS3-Abs after radiotherapy. METHODS: The serum pS3-Ab levels were detected in 46 EC patients and 30 healthy adults by enzyme linked immunosorbent assay (ELISA). The blood samples were collected on the day before radiotherapy and on the administration of an irradiation dose of 20 Gy/10 f/12 d, 40 Gy/20 f/24 d and 60 Gy/30 f/36 d after radiotherapy. RESULTS: The level and positive rate of serum pS3-Abs in EC patients were significantly higher than those in normal individuals (P 〈 0.05). Serum anti-p53 antibodies were positive in 18 of 46 EC patients (39.1%). The positive rate of pS3-Abs in EC was related to histological grade, disease stage and lymph node metastasis (P 〈 0.05), but it was not significantly related to sex, age and to the size and site of tumor. The level and positive rate of p53-Abs had significant differences between before radiotherapy and after administration of an irradiation dose of 40 Gy/20 f/24 d and 60 Gy/30 f/36 d (P 〈 0.05 orP 〈 0.01). The positive rate of p53-Abs in EC patients with effect was significantly lower than that in those without effect after radiotherapy (P 〈 0.0001).CONCLUSION: Detection of serum p53-Abs is helpful to the diagnosis of esophageal carcinoma. Monitoring for sequential change of serum p53-Abs before and after radiotherapy in patients with esophageal carcinoma is also useful to evaluate the response to the treatment and prognosis of the patients.
文摘Objective: To observe the effect of Kang'ai Injection (康艾注射液, KAI) on serum level of soluble interleukin-2 receptor (sIL-2R) and vascular endothelial growth factor (VEGF) in patients with esophageal carcinoma (EC) during radiotherapy (RT), and to investigate its synergistic effect with RT and its influence on immunological function of the body. Methods: One hundred and seventy patients with EC, who had missed the chance of surgical operational therapy, were assigned to the treated group (90 cases) and the RT group (80 cases), and at the same time a control group consisting of 80 inpatients without tumors was set up. Patients in the RT group were treated with RT alone but KAI was given additionally to those in the treated group, with 50 ml given once per day via intravenous dripping, 15 days as one course, and 2 courses administered in total. The immediate therapeutic efficacy and changes of serum slL-2R and VEGF levels were observed, and the effect of KAI on patients' quality of life (QOF) was evaluated by Karnofsky scoring. Results: In 16 patients of the treated group it was completely remission (OR), in 54 partially remission (PR), in 18 it was stabilized disease (SD) and in 2 progressive disease (PD), with the total effective rate (CR + PR) as 77.8%, while in those of the control group it was 12, 46, 18, 4 and 72.5%, respectively, the immediate therapeutic efficacy in the treated group was somewhat better than that in the RT group, but showed no statistical significance (P〉0.05). Serum levels of slL-2R and VEGF in all the patients before treatment were higher than those in the control group, which were decreased after treatment in both groups (P〈0.05), but the improvement in the treated group was better than that in the RT group, showing significant difference (P〈0.05), and patients' QOF improved more significantly in the former as well (62.2 % vs 40.0%, P〈 0.05). Conclusion: KAI in combination with RT in treating patients with EC could enhance the immunological function of patients, improve their QOF and enhance their sensitivity to RT.
基金This work was supported by grants from the Natural Science Foundation of Guangdong Province(2018A030307050)the National Natural Science Foundation of China(82071973)+3 种基金the Natural Science Foundation of Guangdong Province(2020A1515011022)the Department of Education of Guangdong Province(2017KTSCX071)the Special Fund for Science and Technology of Guangdong Province(190829105556145)the Special Fund for Science and Technology Innovation Strategy of Guangdong Province(180918114960704).
文摘Objective Malnutrition and cachexia are common in esophageal squamous cell carcinoma(ESCC)patients undergoing radiotherapy.This study evaluated how malnutrition-and cachexia-related indicators,including the albumin-to-globulin ratio(AGR),and their changes during radiotherapy predict the treatment outcomes.Methods We reviewed a total of 172 ESCC patients receiving radiotherapy(as a primary cohort)and performed a Cox regression analysis on potential prognostic factors,including the AGR,as well as the TNM stage and concomitant chemotherapy.A subsequent receiver operating characteristics(ROC)curve and Kaplan Meier survival analysis was performed for ESCC patients stratified by the average AGR cut-off point.Results In addition to the well-documented factors(i.e.TNM stage and concomitant chemotherapy),the average AGR was a significant prognostic factor for ESCC patients receiving radiotherapy.By plotting the ROC curve of the average AGR with regard to the ESCC prognosis,we obtained cut-off points for the overall patients(cut-off point:1.5,AUC:0.636),for patients with stageⅡ/Ⅲdisease(cut-off point:1.5,AUC:0.611),and for patients with stageⅣdisease(cut-off point:1.84,AUC:0.900).The ESCC patients with higher average AGR had a significantly more favorable OS compared with those with a lower average AGR.Notably,ESCC patients who had an increasingΔAGR during radiotherapy had a considerably more favorable OS compared with those with a decreasingΔAGR.All of these findings were reproducible in the validation cohort.Conclusion A lower average AGR is indicative of a poorer prognosis for ESCC patients following radiotherapy.Improving the nutritional status and preventing or ameliorating cachexia might contribute to improving the prognosis of ESCC patients.
文摘BACKGROUND Esophageal squamous cell carcinoma(ESCC)is one of the main causes of human death.It is usually already in middle or advanced stage when diagnosed due to its hidden symptoms in early stage.Therefore,patients have already lost the best surgical timing when diagnosed.Radiotherapy and chemotherapy are standard treatment methods for ESCC clinically,but the efficacy and prognosis of patients from them are still unsatisfactory.Therefore,it is of great clinical significance to seek for biomarkers that can predict the radiotherapy and chemotherapy response and prognosis of ESCC patients.AIM To explore the clinical value of plasma miR-21 and miR-93 in ESCC.METHODS A total of 128 ESCC patients admitted to the First Affiliated Hospital of Zhenzhou University were enrolled as a study group and treated with concurrent radiotherapy and chemotherapy,and other 45 healthy people during the same period were enrolled as a control group.The expression of plasma miR-21 and miR-93 was determined using quantitative real-time polymerase chain reaction,and the correlation of expression of plasma miR-21 and miR-93 with clinical pathological parameters about the patients was analyzed.The receiver operating characteristic(ROC)curve was adopted to assess the diagnostic value of plasma miR-21 and miR-93 for clinical pathological features of ESCC patients,the Logistic regression analysis adopted to analyze the risk factors for radiotherapy and chemotherapy efficacy in ESCC patients,and the Cox regression analysis to identify the prognostic factors for ESCC patients.RESULTS The study group showed significantly higher relative expression of plasma miR-21 and miR-93 than the control group(P<0.01).The area under the ROC curve(AUC)of plasma miR-21 for diagnosing T stage,N stage,M stage,and pathological differentiation of ESCC was 0.819,0.758,0.824,and 0.725,respectively,and that of plasma miR-93 for diagnosing T stage,N stage,and M stage of ESCC was 0.827,0.815,and 0.814,respectively.The AUC of combined plasma miR-21 and miR-93 for predicting radiotherapy and chemotherapy efficacy before radiotherapy and chemotherapy was 0.894,and the AUCs of them for predicting the 3-year overall survival(OS)were 0.861 and 0.807,respectively.T stage(P<0.05),M stage(P<0.05),miR-21(P<0.01),and miR-93(P<0.05)were independent risk factors for radiotherapy and chemotherapy efficacy,and T stage(P<0.01),N stage(P<0.05),M stage(P<0.01),miR-21(P<0.01),and miR-93(P<0.01)were independent prognostic factors for ESCC patients.CONCLUSION MiR-21 and miR-93 can be adopted as effective biomarkers for predicting radiotherapy and chemotherapy efficacy in ESCC and the 3-year OS of ESCC patients.
基金supported by a Grant from the National Natural Science Foundation of China (NSFC 81272487)the Foundation of Guangdong Esophageal Cancer Research Institute (M201415)
文摘Background: Insulin?like growth factor?binding protein?3(IGFBP?3) is suggested to predict the radiosensitivity and/or prognosis of patients with esophageal squamous cell carcinoma(ESCC). The present study was designed to investi?gate the clinical and prognostic efects of IGFBP?3 on ESCC.Methods: IGFBP?3 was detected by immunohistochemistry in parain?embedded tissues from 70 ESCC patients treated with radiotherapy alone and further examined by western blotting analysis in 10 pairs of fresh ESCC tissues and adjacent non?malignant esophageal specimens. Receiver operating characteristic(ROC) analysis was used to determine cut?of scores for tumor positivity and to evaluate patient survival status. The χ2 test was performed to analyze the association of IGFBP?3 expression with clinical characteristics and radiotherapy response. Associations between prognostic outcomes and IGFBP?3 expression were investigated using Kaplan–Meier analysis and the Cox proportional hazards model.Results: The threshold for IGFBP?3 positivity was set to greater than 65% [area under the ROC curve(AUC)(45.7%) were deined as having high IGFBP?3 expression= 0.690, P < 0.019]. Of the 70 ESCC patient tissues tested, 32. The levels of IGFBP?3 protein expression were decreased in 70.0%(7 of 10) of ESCC tissues compared with adjacent non?malignant esophageal tissue. In addition, IGFBP?3 expression was associated with pathologic classiication(P < 0.05 for T, N, and M categories and clinical stage). Patients with elevated protein level of IGFBP?3 in the tumor had an improved radiotherapy response and prolonged overall survival(P < 0.001).Conclusions: High level of IGFBP?3 expression in ESCC associates with early clinical stages and are predictive for favorable survival of the patients treated with radiotherapy.
文摘Postoperative radiotherapy is a major treatment for patients with maxillary sinus carcinoma. However, the irregular resection cavity poses a technical difficulty for this treatment, causing uneven dose distribution to target volumes. In this study, we evaluated the dose distribution to target volumes and normal tissues in postoperative intensity-modulated radiotherapy (IMRT) after placing a water-filled balloon into the resection cavity. Three postoperative patients with advanced maxillary sinus carcinoma were selected in this trial. Water-filled balloons and supporting dental stents were fabricated according to the size of the maxillary resection cavity. Simulation CT scans were performed with or without water-filled balloons, IMRT treatment plans were established, and dose distribution to target volumes and organs at risk were evaluated. Compared to those in the treatment plan without balloons, the dose (D98) delivered to 98% of the gross tumor volume (GTV) increased by 2.1 Gy (P = 0.009), homogeneity index (HI) improved by 2.3% (P = 0.001), and target volume conformity index (TCI) of 68 Gy increased by 18.5% (P = 0.011) in the plan with balloons. Dosimetry endpoints of normal tissues around target regions in both plans were not significantly different (P > 0.05) except for the optic chiasm. In the plan without balloons, 68 Gy high-dose regions did not entirely cover target volumes in the ethmoid sinus, posteromedial wall of the maxillary sinus, or surgical margin of the hard palate. In contrast, 68 Gy high-dose regions entirely covered the GTV in the plan with balloons. These results suggest that placing a water-filled balloon in the resection cavity for postoperative IMRT of maxillary sinus c arcinoma can reduce low-dose regions and markedly and simultaneously increase dose homogeneity and conformity of target volumes.
文摘BACKGROUND Salivary gland cancer is a rare disease in which cancer cells form in the tissues of the salivary glands.It mostly occurs in the glands that have secretion functions,such as the parotid gland,sublingual gland and submandibular gland.This is very rare when it occurs in other nonsecreting glands.Here,we report one case of salivary gland carcinoma occurring in the thymus and discuss related diagnoses and treatment progress.CASE SUMMARY One 33-year-old middle-aged man presented with a thymus mass without any clinical symptoms when he underwent regular physical examination.Later,the patient was admitted to the hospital for further examination.Computed tomography(CT)showed that there was a mass of 3 cm×2.8 cm×1.5 cm in the thymus area.The patient had no symptom of discomfort or tumor-related medical history before.After completing the preoperative examinations,it was confirmed that the patient had indications for surgery.The surgeon performed a transthoracoscope"thymectomy+pleural mucostomy"for him.During the operation,the tumor tissue was quickly frozen,and the symptomatic section showed a malignant tumor.The final pathological result suggested thymus salivary gland carcinoma-mucoepidermoid carcinoma(MEC).In the second month after surgery,we performed local area radiotherapy for the patient,with a total radiation dose of 50.4 Gy/28Fx.After 12 mo of surgery,the patient underwent positron emission tomography-CT examination,which indicated that there was no sign of tumor recurrence or metastasis.After 16 mo of operation,CT scan re-examination showed that there was no sign of tumor recurrence or metastasis.As of the time of publication,the patient was followed up for one and a half years.He had no sign of tumor recurrence and continued to survive.CONCLUSION The incidence of MEC in the thymus is low,and its diagnosis needs to be combined with clinical features and imaging methods.Histopathological analysis plays a key role in the diagnosis of the disease.Patients with early-stage disease have a good prognosis and long survival period.In contrast,patients with advanced-stage disease have a poor prognosis and short survival period.Combining radiotherapy and chemotherapy in inoperable patients may prolong survival.
基金Supported by the Distinguished Young Teacher Programs Foundation of Ministry of Education of China, No. 2001125
文摘AIM: The aim of the present study is to use immunohisto chemical methods to investigate the clinical implications of tumor markers in esophageal squamous cell carcinoma and evaluate their impact on prognosis. METHODS: From November 1990 to December 1996, 47 patients were treated with preoperative radiation followed by radical esophagectomy. All patients were confirmed pathologically as suffering from squamous cell carcinoma. Immunohistochemical stain was done for PCNA, cyclinDl protein expression and DNA content analyzed by image cytometry. Kaplan-Meier method for single prognostic factor and log-rank test was used to test the significant difference. Cox stepwise regression model and prognosis index model were used for survival analysis with multiple prognostic factors. RESULTS: Radio-pathological change, T stage and N stage, as the traditional prognostic factors had statistical difference in 3-, 5- and 10-year survival rates. While, tumor cell proliferating marked PCNA, cyclinDl and DNA content served as independent prognostic factors of esophageal carcinoma. There was definitely an identity between the single and multiple factor analyses. PI was more accurate to evaluate the prognosis of esophageal carcinoma. CONCLUSION: It is possible that tumor cell proliferating marked PCNA, cyclinD1 and DNA content would become the endpoints for evaluating the prognosis of esophageal carcinoma.
基金Supported by Department of General,Visceral and Cancer Surgery,Center for Integrated Oncology (CIO) Kln Bonn and the Hoff`sche Stiftung
文摘AIM:To assess the effects of neoadjuvant chemoradiotherapy(CRT) on the presence of extracapsular lymph node involvement(LNI) and its prognostic value in patients with resected esophageal cancer.METHODS:Two hundred and ninety-eight patients with advanced esophageal cancer underwent esophagectomy between 1997 and 2006.One hundred and ninety patients(63.8%) were treated with neoadjuvant CRT prior to resection.A total of 986 metastatic LNs were examined.Survival of the patients was analyzed according to intra-and extra-capsular LNI.RESULTS:Five-year survival rate was 22.5% for the entire patient population.Patients with extracapsular LNI had a 5-year survival rate of 16.7%,which was comparable to the 15.8% in patients with infiltrated nodes of the celiac trunk(pM1lymph).In contrast to patients treated with surgery alone,neoadjuvant therapy resulted in signif icantly(P = 0.001) more patients with pN0/M0(51.6% vs 25.0%).In 17.6% of the patients with surgery alone vs 16.8% with neoadjuvant CRT,extracapsular LNI was detected.Neoadjuvant therapy does not reduce the occurrence of extracapsular LNI.CONCLUSION:Extracapsular LNI is an independent negative prognostic factor not influenced by neoadjuvant CRT.In a revised staging system for esophageal cancer,extracapsular LNI should be considered.
文摘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.
基金Supported by Emerging Advanced Technology Joint Research Project of Shanghai Shenkang Hospital Development Center,No.SHDC12017103Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support,No.20161433
文摘BACKGROUND There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy(PORT)after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcinoma(ESCC).AIM To investigate the difference in the failure patterns of stage pT3-4N0-3M0 ESCC patients with or without PORT.METHODS Patients with stage pT3-4N0-3M0 ESCC,who underwent surgery with or without PORT,were enrolled in this study.The primary endpoint was to investigate the difference in the failure patterns between patients with or without PORT after esophagectomy.The secondary endpoint was to estimate whether patients with stage pT3-4 ESCC could achieve a disease-free survival(DFS)advantage after receiving adjuvant PORT.Statistical analyses were performed by the Kaplan-Meier method,Cox regression model,and Chi-squared test or Fisher’s exact test.RESULTS In total,230 patients with stage pT3-4N0-3M0 ESCC were included in this study.Fifty-six patients who received PORT were screened from a prospective cohort(S+R arm).And 174 patients involving surgery alone were retrospectively selected from July 2006 to October 2014(S arm).There were no significant differences in the clinical or pathological characteristics of patients between the two arms,except for tumor location(P=0.031).The failure patterns between the two arms were significantly different(P<0.001).Patients in the S arm had a significantly higher proportion of locoregional recurrence and a lower proportion of distant metastasis than those in the S+R arm(92.0%vs 35.7%,P<0.001 and 19.0%vs 75.0%,P<0.001,respectively).The difference in the median DFS between the two arms was statistically significant(12.7 vs 8 mo,P=0.048).Univariate analysis and multivariate analysis both demonstrated that the number of lymph node metastases≥3(HR=0.572,95% CI:0.430-0.762,P<0.001)was an independent poor prognostic factor for DFS in patients with stage pT3-4N0-3M0 ESCC.CONCLUSION PORT could improve DFS and local control of patients with stage pT3-4N0-3M0 ESCC.However,further studies need to be conducted to control hematogenous metastasis after PORT.
文摘Radiotherapy represents an essential treatment approach for esophageal cancer.Over recent years,immunotherapy combined with chemotherapy has become the first-line standard treatment for patients with advanced esophageal cancer.Several phase III studies on immunotherapy combined with radiotherapy for locally advanced esophageal cancer are currently underway.Sufficient evidence-based medical data are urgently needed to support the integration of immunotherapy and chemoradiotherapy as a new treatment strategy for patients with locally advanced esophageal cancer.This consensus,formulated based on the latest study results,in-depth research,and thorough discussions,provides a comprehensive set of recommendations.The document extensively covers treatment strategies and evaluation methods for radiotherapy combined with immunotherapy across patients with operable esophageal cancer,inoperable locally advanced esophageal cancer,and advanced esophageal cancer.Moreover,common complications and radiation-related issues associated with radiotherapy combined with immunotherapy are discussed,serving as clinical guidance.Our expert group comprised members from the Professional Committee of Radiation Oncology,China Anti-Cancer Association,the Branch of Radiation Oncology,Chinese Medical Association,and the Branch of Radiation Oncology Treatment Physician,Chinese Medical Doctor Association.