摘要:

The aim of this study was to determine if the response to preoperative radiation and chemotherapy with continuous infusion 5-fluorouracil (5-FU) was predictive for survival among patients with locally advanced rectal cancer. Preoperative chemoradiation (CTX/XRT) that delivered 45 Gy in 25 fractions over 5 weeks with continuous infusion 5-FU (300 mg/m2/day) was given to 117 patients. The pretreatment stage distribution, as determined by endorectal ultrasound (u), included uT2N0 in 2%, uT3N0 in 47%, uT3N1 in 49%, and uT4N0 in 2% of cases; endorectal ultrasound was not performed in 13% of cases (15 patients). Approximately 6 weeks after completion of CTX/XRT, surgery was performed. Adjuvant chemotherapy, consisting of 400 to 425 mg/m2of 5-FU plus 20 mg/m2leucovorin for 5 days, was administered every 28 days for 4 to 6 cycles after surgical resection. Among the 74 patients treated with adjuvant chemotherapy, the preoperative stage of disease was 31 with T3N0 and 43 T3N1. Median follow-up was 46 months (range 2 to 89 months). The pathologic tumor stages were Tis-2N0 in 26%, T2N1 in 5%, T3N0 in 21%, T3N1 in 15%, T4N0 in 5%, and T4N1 in 1%; a complete response (CR) to preoperative CTX/XRT was pathologically confirmed in 32 (27%) of patients. Tumor down-staging occurred in 72 (62%) cases. A sphincter-saving procedure (SP) was possible in 59% of patients. The median DFS and overall survival rates for responders were 46 months and 47 months, respectively; for non-responders these outcome measures were 38 months and 41 months, respectively. Log-rank analysis showed that the distant metastatic-free survival rates improved with any response to CTX/XRT (p< 0.00001), CR to CTX/XRT (p< 0.009) and SP (p< 0.012). Likewise, these parameters also significantly influenced DFS rates (CTX/XRTp< 0.00001; CRp< 0.006; and SPp< 0.008). Control of pelvic disease was influenced by clinical size (p< 0.002) and SP (p< 0.016) on univariate analysis. On multivariate analysis only clinical size (p< 0.002) continued to be a significant factor for local control. Factors on multivariate analysis that resulted in significant improvements in cancer-specific survival included any response to preoperative CTX/XRT (p< 0.017) and administration of adjuvant chemotherapy (p< 0.034). Any response to preoperative CTX/XRT improved distant metastatic-free and disease-free survival rates. Multivariate analysis confirmed that a response to preoperative CTX/XRT predicted for improvements in overall survival among patients with locally advanced rectal cancer. Patients who fail to respond to preoperative 5-FU based chemotherapy given concomitantly with radiation have higher rates of distant metastases with adjuvant 5-FU therapy.

ISSN:0277-3732    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Between 1989 and 1994, a prospective clinical trial tested the safety and efficacy of concomitant boost accelerated superfractionated (CBASF) radiotherapy for patients with locally advanced cervix cancer. CBASF radiotherapy included 45 Gy/25 fractions to the pelvis and a 14.4 Gy/9 fraction concomitant boost to the primary tumor, followed by brachytherapy for a total point A dose of 85 Gy to 90 Gy. The 22 patients of International Federation of Gynecology and Obstetrics stages IIIA-IVA who received CBASF radiotherapy now have a median follow-up time of more than 8 years. The 7-year actuarial rates of local control and overall survival are 81% and 36%, respectively. Serious late toxicity included bowel injury requiring colostomy in eight patients within 2.5 years after treatment, but no other severe toxicity was observed after longer follow-up intervals. The local control and survival rates achieved with CBASF radiotherapy were higher than those observed within a matched contemporaneous cohort of patients treated with standard radiotherapy alone at the same institution (p= 0.1 for local control, 0.09 for survival). The encouraging trend toward improved tumor control, tempered by the complication rate, suggests an opportunity to apply more sophisticated radiotherapy techniques that might sustain the favorable effects of dose intensification while mitigating the normal tissue toxicity.

ISSN:0277-3732    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Eighty-nine breasts in 85 patients were treated by lumpectomy and then radiotherapy from a Co-60 source only. The supraclavicular field was nonsplit. Eighty percent were in their 40s, 60s, or 70s with almost equal distribution. The majority of cases (80%) was T1 followed by T2 (18%). Axillary dissection was not done in 26% of patients. The majority (84%) had infiltrating ductal carcinoma; 6% had carcinoma in situ only. The dose to the breast including the boost was in the range of 6,000 cGy to 7,000 cGy in 96%, whereas in 4% it was in the range of 5,000 cGy. Forty-four patients (49%) with N0 did not have nodal irradiation. The dose to the nodes in the remaining patients ranged from 5,040 to 6,840 cGy. The cosmetic result was good to excellent in 99% of evaluated patients. There was telangiectasia in 1, arm edema in 2, no fibrosis in supraclavicular–tangential fields junction and no other soft-tissue or bone complications. Fifteen percent died; 6% had no evidence of cancer, and 9% had metastatic disease. Two had local recurrence, but with salvage mastectomy and systemic therapy were alive and well. The use of external photons only for breast irradiation and a nonsplit supraclavicular field yielded good results compared with alternative methods.

ISSN:0277-3732    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The role of p53 overexpression in the development of stomal recurrence was studied in patients with T1 glottic cancer who had undergone salvage laryngectomy after primary radiotherapy failure (first recurrence). The role of subglottic extension of the recurrent tumor in the development of stomal recurrence was also studied. One hundred fourteen patients with T1 squamous cell carcinoma of the glottic larynx were irradiated with curative intent. A local recurrence (first recurrence) developed in 23 patients (20%), and salvage laryngectomy was performed for 20 of these patients. No postlaryngectomy radiation therapy was included in the treatment of recurrences. Several risk factors thought to be significant in the development of stomal recurrence were analyzed in these 20 patients. Prognostic factors analyzed include: p53 overexpression in the preradiation biopsy specimen, subglottic extension of the first recurrence, thyroid cartilage and lymph node involvement at the time of first recurrence, emergency tracheostomy performed before salvage laryngectomy, and the laryngectomy procedure performed for first recurrence. Presence of p53 protein in the preradiation biopsy specimen of laryngeal cancer did not show any adverse effect on the development of stomal recurrence. Stomal recurrence developed in 27% of patients with positive biopsies and in 20% of patients with negative biopsies (p= 1.00). Subglottic extension of the first recurrence was associated with an increased incidence of stomal recurrence. Rates of stomal recurrence were 6% in patients without subglottic extension and 100% in patients with subglottic extension (p= 0.001). All other risk factors studied showed no effect on stomal recurrence. In this study, p53 overexpression showed no effect on the development of stomal recurrence after salvage laryngectomy in patients with T1 glottic cancer. Conversely, subglottic extension of the recurrence was found to be strongly associated with stomal recurrence. All other factors analyzed showed no effect on stomal recurrence.

ISSN:0277-3732    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

From January 1994 to September 1998, all inoperable cases of cancer of the esophagus at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India were given external beam radiotherapy (EBRT) 36 Gy/18 times by anteroposterior pair. After EBRT, those patients who could be intubated with 16 F Levine’s tube either directly or after endoscopic dilatation were given intraluminal brachytherapy (ILBT) 36 Gy in 48 hours at 1 cm. Others were treated by EBRT by posterior oblique fields 24 Gy/12 times. Fifty-eight patients who received EBRT and ILBT formed the study group. Fifty percent had middle one third growth and except for three, all were squamous cell carcinoma (95%). Fifty-nine percent required postradiation endoscopic dilatation. The overall survival rate was 24% at the end of 1 year. In one patient, tracheoesophageal fistula developed 4 months after treatment. Mild-to-moderate acute esophagitis developed in 10% of the patients, and 2% had slight hemoptysis, but these were not significant enough to interrupt treatment. There was no treatment-related mortality. Thirty-four patients (59%) were followed up for 6 months to 5 years (mean, 9.6 months). Three patients had follow-up of more than 3 years with no evidence of disease. EBRT with ILBT, with intermittent esophageal dilatations as required, offers very good palliation in advanced inoperable cancer of the esophagus.

ISSN:0277-3732    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The lymphomas are a group of lymphoproliferative disorders that can be divided histologically in the two main groups of Hodgkin’s and non-Hodgkin’s lymphoma. They sometimes present in the head and neck, and the diagnosis and management require a multidisciplinary approach. An unusual case is described presenting at an advanced stage because of patient delay in seeking medical help.

ISSN:0277-3732    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

In our hospital from October 1980 to February 2000, 2,010 patients with suspected thoracic cavum cancer were diagnosed by nonaspiration puncture with multiple-hole type and surface trough-type biopsy needles. The positive rate of cytology or pathology examination for lesions in pleura, mediastinum, and lung tissue were 88.6% (148/167), 83% (297/358), and 80.2% (1,191/1,485), respectively. The mean positive rate in all cases was 81.4% (1,636/2,010). Complications rates for pneumothorax or hemoptysis were 1.3% and 0.8%, respectively, in this group. Such revised puncture needles have been used by us in various organs, such as brain tumors, metastatic lymph nodes of head and neck cancers, malignant disease of breast, liver, kidney, prostate, rectum and bone, etc. The use of such nonaspiration puncture needles is very simple, safe, and effective; even for beginners with this technique, the rate of successful diagnoses is fairly high.

ISSN:0277-3732    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

On the basis of preclinical and clinical data, we designed a phase II study to determine the efficacy and feasibility of high-dose epirubicin plus docetaxel (Taxotere) with lenograstim support, as first-line therapy for patients with advanced breast cancer. Patients with histologic evidence of metastatic breast cancer, without previous chemotherapy, adequate organ functions, Eastern Cooperative Oncology Group performance status less than 2, and signed informed consent entered in the trial. Treatment consisted of premedication the day before the treatment day for 3 consecutive days (dexamethasone 16 mg o.r. and 5-HT3 antagonists). On the treatment day 1, epirubicin 130 mg/m2was administered as a 15-minute intravenous infusion followed 1 hour later by 1-hour intravenous infusion of docetaxel 100 mg/m2. Cycles were repeated every 21 days, for a maximum of 8 cycles. Lenograstim (5 &mgr;g/kg, s.c.) was started 48 hours later (day 4) and was given daily for 10 consecutive days. Response evaluation was made after the third cycle was applied, following World Health Organization criteria. Responding patients received five additional cycles. Median time to progression and survival were calculated according to the Kaplan-Meier method. A total of 32 patients have been included in the study. A total of 236 courses were delivered. A total response rate of 87.5% (95% confidence interval [CI] of 77–98) was obtained. There were 11 complete responses and 17 partial responses. Toxicity was mild, with a low incidence of undesirable effects (7 cycles, 2.9% were delayed from 3 to 6 days because of neutropenia). After a median follow-up time of 490 days (range, 131–966 days), the median time to progression was 490 days (95% CI 314–575), and the median survival was 604 days (95% CI 513–785). This epirubicin plus docetaxel regimen is an efficient treatment for patients with advanced breast cancer. The lenograstim support allows the administration of such a chemotherapy regimen with a modest incidence of side effects. A larger number of patients need to be evaluated.

ISSN:0277-3732    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The prognosis of malignant pleural mesothelioma is poor, with a median survival time from diagnosis of 7 to 17 months. At present there is no standardized treatment of this neoplasia. Between July 1995 and January 1999, 22 patients with malignant pleural mesothelioma were enrolled in our study. The characteristics of patients were: 16 men and 6 women; median age 61 years (range, 49–77 years); stage (according to Butchart): 8 patients stage I, 10 stage II, 2 stage III, and 2 stage IV; cytologic diagnosis in 5 cases and histologic diagnosis in 17 cases. The treatment consisted of mitoxantrone 10 mg/m2intravenous (IV) or intrapleural (IPL), methotrexate 35 mg/m2IV, and mitomycin 7 mg/m2IV on day 1 and repeated every 3 weeks, with mitomycin in alternate cycles (MMM regimen). One complete response (4.5%) (42 months of duration) and 6 partial responses (27.3%) (5, 5, 7, 9, 14, and 19 months of duration) were achieved; the overall response rate (ORR) was 31.8% (95% CI, 12.4–51.3%); 7 patients were stable under this treatment (31.8%). According to the pathologic type, ORR for the only epithelial type was 39.9% (95% CI, 15.2–64.8%). Median time to progression was 6 months (range, 1–22). The overall median survival time was 13.5 months (range, 1–50); the median survival time of responders significantly differed from that of nonresponders (18.0 versus 8.5 months;p= 0.017). This treatment produced a considerable clinical benefit, with improvement of dyspnea (68.4%) and pain (33.3%); 15 of 19 patients (78.9%) with pleural effusion at the time of diagnosis showed an important reduction in pleural fluid during chemotherapy. Hematologic toxicity was the main side effect; World Health Organization grade III to IV of neutropenia, anemia, and thrombocytopenia were observed in 81.8%, 13.6%, and 22.7% of patients, respectively. From the data presented here, this regimen can be considered active in the treatment of malignant pleural mesothelioma.

ISSN:0277-3732    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

In 35 patients with recurrent gastric cancer who had undergone curative gastrectomy, serum carcinoembryonic antigen (CEA) and CA 19-9 (carbohydrate antigen) tumor marker levels were investigated. At least one tumor marker was elevated in 24 (68.6%) patients. The levels of serum CA 19-9 and CEA markers were increased in 20 (57.1%) and 12 (34.3%) patients, respectively. This difference was not statistically significant. However, it may be important in terms of clinical practice.

ISSN:0277-3732    

出版商:OVID    

年代:2001

数据来源: OVID