BACKGROUND Albumin-bound paclitaxel(ABP)has been used as second-and higher-line treatments for advanced esophageal cancer,and its efficacy and safety have been well demonstrated.Lobaplatin(LBP)is a third-generation pl...BACKGROUND Albumin-bound paclitaxel(ABP)has been used as second-and higher-line treatments for advanced esophageal cancer,and its efficacy and safety have been well demonstrated.Lobaplatin(LBP)is a third-generation platinum antitumor agent;compared with the first two generations of platinum agents,it has lower toxicity and has been approved for the treatment of breast cancer,small cell lung cancer,and chronic granulocytic leukemia.However,its role in the treatment of esophageal cancer warrants further investigations.AIM To investigate the efficacy and safety of induction chemotherapy with ABP plus LBP followed by concurrent radiochemotherapy(RCT)for locally advanced esophageal cancer.METHODS Patients with pathologically confirmed advanced esophageal squamous cell carcinoma(ESCC)at our hospital were enrolled in this study.All patients were treated with two cycles of induction chemotherapy with ABP plus LBP followed by concurrent RCT:ABP 250 mg/m^(2),ivgtt,30 min,d1,every 3 wk;and LBP,30 mg/m^(2),ivgtt,2 h,d1,every 3 wk.A total of four cycles were scheduled.The dose of the concurrent radiotherapy was 56-60 Gy/28-30 fractions,1.8-2.0 Gy/fraction,and 5 fractions/wk.RESULTS A total of 29 patients were included,and 26 of them completed the treatment protocol.After the induction chemotherapy,the objective response rate(ORR)was 61.54%,the disease control rate(DCR)was 88.46%,and the progressive disease(PD)rate was 11.54%;after the concurrent RCT,the ORR was 76.92%,the DCR was 88.46%,and the PD rate was 11.54%.The median progression-free survival was 11.1 mo and the median overall survival was 15.83 mo.Cox multivariate analysis revealed that two cycles of induction chemotherapy followed by concurrent RCT significantly reduced the risk of PD compared with two cycles of chemotherapy alone(P=0.0024).Non-hematologic toxicities were tolerable,and the only grade 3 non-hematologic toxicity was radiation-induced esophagitis(13.79%).The main hematologic toxicity was neutropenia,and no grade 4 adverse event occurred.CONCLUSION Induction chemotherapy with ABP plus LBP followed by concurrent RCT is effective in patients with locally advanced ESCC,with mild adverse effects.Thus,this protocol is worthy of clinical promotion and application.展开更多
More than 60% of lung cancer patients in Europe and the USA are older than 65 years at the time of diagnosis. Despite this, elderly patients are generally under-represented in clinical trials. That being so, a general...More than 60% of lung cancer patients in Europe and the USA are older than 65 years at the time of diagnosis. Despite this, elderly patients are generally under-represented in clinical trials. That being so, a general consensus on how to treat elderly patients is still far from being achieved. In this review, we address some of the issues and challenges surrounding the treatment of older cancer patients and radiochemotherapy. We discuss the existing evidence related to radio-chemotherapy in the elderly, focusing primarily on the lung cancer (NSCLC and SCLC) most commonly seen in older patients, and making general treatment recommendations.展开更多
Objective:To study the effect of cisplatin-based concurrent radiochemotherapy on the malignant degree of advanced cervical cancer and the expression of proto-oncogene and tumor suppressor genes.Methods: A total of 82 ...Objective:To study the effect of cisplatin-based concurrent radiochemotherapy on the malignant degree of advanced cervical cancer and the expression of proto-oncogene and tumor suppressor genes.Methods: A total of 82 patients with advanced cervical cancer who were treated in our hospital between July 2013 and December 2016 were collected and divided into control group and observation group according to random number table, with 41 cases in each group. The control group of patients received radiotherapy alone, while the observation group of patients received cisplatin-based concurrent radiochemotherapy. Tumor marker levels in serum as well as proto-oncogene and tumor suppressor gene expression in tumor tissue were compared between two groups of patients before and after treatment.Results:Before treatment, differences in tumor marker levels in serum as well as proto-oncogene and tumor suppressor gene expression in tumor tissue were not statistically significant between two groups of patients. After treatment, serum tumor markers SCC, CA50, CA724 and CEA levels of observation group were significantly lower than those of control group;proto-oncogene DEK, c-myc and PIK3CA mRNA expression in tumor tissue were significantly lower than those of control group;tumor suppressor genes p53, SOCS-1, FHIT and PTEN mRNA expression in tumor tissue were significantly higher than those of control group.Conclusions:Cisplatin-based concurrent radiochemotherapy can effectively reduce the tumor malignancy and balance the proto-oncogene / tumor suppressor gene expression in patients with advanced cervical cancer.展开更多
Objective: To study the effects of preoperative concurrent radiochemotherapy on the cancer cell infiltration and angiogenesis in local advanced gastric cancer lesions. Methods: A total of 68 patients who were diagnose...Objective: To study the effects of preoperative concurrent radiochemotherapy on the cancer cell infiltration and angiogenesis in local advanced gastric cancer lesions. Methods: A total of 68 patients who were diagnosed with locally advanced gastric cancer in this hospital between February 2015 and April 2017 were selected as the research subjects and randomly divided into two groups, the radiochemotherapy group received capecitabine + cisplatin chemotherapy combined with intensity modulated radiation therapy before operation, and chemotherapy group received preoperative capecitabine + cisplatin chemotherapy. The gastric cancer lesions surgically removed from two groups of patients were collected to determine the expression of proliferation-related genes, invasion-related genes and angiogenesis-related genes. Results:Rab27B, Bax, Caspase-3, PTPN13, E-cadherin and THBS2 protein expression in gastric cancer lesions of radiochemotherapy group were greatly higher than those of chemotherapy group whereas EZH2, PRR1, EPHA2, HDAC5, N-cadherin, Twist1, ANGPTL2, ANGPTL5, GOLPH3 and HIF-1 protein expression were greatly lower than those of chemotherapy group. Conclusion: Preoperative concurrent radiochemotherapy has inhibitory effect on the cancer cell infiltration and angiogenesis in local advanced gastric cancer lesions.展开更多
Objective:To assess the safety and efficacy of the combination of recombinant adenovirus-p53 (rAd-p53) with radiochemotherapy for treating unresectable pancreatic carcinoma.Methods:The eligible patients received concu...Objective:To assess the safety and efficacy of the combination of recombinant adenovirus-p53 (rAd-p53) with radiochemotherapy for treating unresectable pancreatic carcinoma.Methods:The eligible patients received concurrent rAd-p53 intratumoral injection and radiochemotherapy.Intratumoral injection of rAd-p53 was guided by B ultrasound.Radiochemotherapy consisted of intensity-modulated radiotherapy (IMRT) at two dose levels and intravenous gemcitabine (Gem).For radiotherapy,gross target volume (GTV) and clinical target volume (CTV) were 55-60 Gy and 45-55 Gy in 25-30 fractions,respectively.Concurrent intravenous gemcitabine was administered at 350 mg/m2,weekly,for 6 weeks.The primary end points included toxicity,clinical benefit response (CBR) and disease control rate (DCR).The secondary end points included progression-free survival (PFS) and overall survival (OS).Results:Fifteen eligible patients were enrolled.Eight patients (53.3%) were evaluated as CBR and 12 (80%) achieved DCR.The median PFS and OS were 6.7 and 13.8 months,respectively.One-year PFS and OS were 40.0% and 51.1%,respectively.There were 8 (53.3%) patients reported grade 3 toxicities including neutropenia (6 patients,40%),fever (1 patient,6.7%) and fatigue (1 patient,6.7%).There was no grade 4 toxicity reported.Conclusion:Combination of rAd-p53 in unresectable pancreatic carcinoma showed encouraging efficacious benefit and was well tolerated.Long-term follow-up is needed to confirm the improvement of PFS and OS.展开更多
AIM:To evaluate the long-term outcome of standard5-FU based adjuvant or neoadjuvant radiochemotherapyand to identify the predictive factors,especially anemiabefore and after radiotherapy as well as hemoglobinincrease ...AIM:To evaluate the long-term outcome of standard5-FU based adjuvant or neoadjuvant radiochemotherapyand to identify the predictive factors,especially anemiabefore and after radiotherapy as well as hemoglobinincrease or decrease during radiotherapy.METHODS:Two hundred and eighty-six patientswith Union International Contre Cancer(UICC)stageⅡ and Ⅲ rectal adenocarcinomas,who underwentresection by conventional surgical techniques(lowanterior or abdominoperineal resection),receivedeither postoperative(n=233)or preoperative(n=53)radiochemotherapy from January 1989 until July 2002.Overall survival(OAS),cancer-specific survival(CSS),disease-free survival(DFS),local-relapse-free(LRS)and distant-relapse-free survival(DRS)were evaluatedusing Kaplan-Meier,Log-rank test and Cox's proportionalhazards as statistical methods.Multivariate analysis wasused to identify prognostic factors.Median follow-uptime was 8 years.RESULTS:Anemia before radiochemotherapy was anindependent prognostic factor for improved DFS(riskratio 0.76,P=0.04)as well as stage,grading,R status(free radial margins),type of surgery,carcinoembryonicantigen(CEA)levels,and gender.The univariate analysisrevealed that anemia was associated with impaired LRS (better local control)but with improved DFS.In contrast,hemoglobin decrease during radiotherapy was anindependent risk factor for DFS(risk ratio 1.97,P=0.04).During radiotherapy,only 30.8% of RO-resected patientssuffered from hemoglobin decrease compared to 55.6%if R1/2 resection was performed(P=0.04).The 5-yearOAS,CSS,DFS,LRS and DRS were 47.0%,60.0%,41.4%,67.2%,and 84.3%,respectively.Significantdifferences between preoperative and postoperativeradiochemotherapy were not found.CONCLUSION:Anemia before radiochemotherapyand hemoglobin decrease during radiotherapy have nopredictive value for the outcome of rectal cancer.Stage,grading,R status(free radial margins),type of surgery,CEA levels,and gender have predictive value for theoutcome of rectal cancer.展开更多
Objective The aim of this study was to investigate the ability of intravoxel incoherent motion(IVIM) diffusion-weighted magnetic resonance imaging(MRI) to diagnose cervical cancer and to evaluate the response of uteri...Objective The aim of this study was to investigate the ability of intravoxel incoherent motion(IVIM) diffusion-weighted magnetic resonance imaging(MRI) to diagnose cervical cancer and to evaluate the response of uterine cervical cancer to radiochemotherapy(CRT).Methods This prospective study was approved by the institutional review board, and informed consent was obtained from all patients. A total of 23 patients with primary cervical cancer who were undergoing CRT and 16 age-matched healthy subjects were prospectively recruited for IVIM(b = 0–800 s/mm2) and standard pelvic MRI. Bi-exponential analysis was performed to derive f(perfusion fraction), D*(pseudo-diffusion coefficient), and D(true molecular diffusion coefficient) in cervical cancer(n = 23) and the normal cervix(n = 16). The apparent diffusion coefficient(standard ADC) was calculated. The independent-samples t-test and paired-samples t-test were used for comparisons.Results Pre-treatment cervical cancer had the lowest standard ADC(1.15 ± 0.13 × 10-3 mm2/s) and D(0.89 ± 0.10 × 10-3 mm2/s) values, and these were significantly different from the normal cervix and posttreatment cervical cancer(P = 0.00). The f(16.67 ± 5.85%) was lowest in pre-treatment cervical cancer and was significantly different from the normal cervix and post-treatment cervical cancer(p = 0.012 and 0.00, respectively). No difference was observed in D*.Conclusion IVIM is potentially promising for differentiating between the normal cervix and cervical cancer because pre-treated cervical cancer has low perfusion and diffusion IVIM characteristics. Further, the standard ADC, D, and f of cervical cancer showed a tendency to normalize after CRT; thus, IVIM may be useful for monitoring the response to CRT in cervical cancer.展开更多
文摘BACKGROUND Albumin-bound paclitaxel(ABP)has been used as second-and higher-line treatments for advanced esophageal cancer,and its efficacy and safety have been well demonstrated.Lobaplatin(LBP)is a third-generation platinum antitumor agent;compared with the first two generations of platinum agents,it has lower toxicity and has been approved for the treatment of breast cancer,small cell lung cancer,and chronic granulocytic leukemia.However,its role in the treatment of esophageal cancer warrants further investigations.AIM To investigate the efficacy and safety of induction chemotherapy with ABP plus LBP followed by concurrent radiochemotherapy(RCT)for locally advanced esophageal cancer.METHODS Patients with pathologically confirmed advanced esophageal squamous cell carcinoma(ESCC)at our hospital were enrolled in this study.All patients were treated with two cycles of induction chemotherapy with ABP plus LBP followed by concurrent RCT:ABP 250 mg/m^(2),ivgtt,30 min,d1,every 3 wk;and LBP,30 mg/m^(2),ivgtt,2 h,d1,every 3 wk.A total of four cycles were scheduled.The dose of the concurrent radiotherapy was 56-60 Gy/28-30 fractions,1.8-2.0 Gy/fraction,and 5 fractions/wk.RESULTS A total of 29 patients were included,and 26 of them completed the treatment protocol.After the induction chemotherapy,the objective response rate(ORR)was 61.54%,the disease control rate(DCR)was 88.46%,and the progressive disease(PD)rate was 11.54%;after the concurrent RCT,the ORR was 76.92%,the DCR was 88.46%,and the PD rate was 11.54%.The median progression-free survival was 11.1 mo and the median overall survival was 15.83 mo.Cox multivariate analysis revealed that two cycles of induction chemotherapy followed by concurrent RCT significantly reduced the risk of PD compared with two cycles of chemotherapy alone(P=0.0024).Non-hematologic toxicities were tolerable,and the only grade 3 non-hematologic toxicity was radiation-induced esophagitis(13.79%).The main hematologic toxicity was neutropenia,and no grade 4 adverse event occurred.CONCLUSION Induction chemotherapy with ABP plus LBP followed by concurrent RCT is effective in patients with locally advanced ESCC,with mild adverse effects.Thus,this protocol is worthy of clinical promotion and application.
文摘More than 60% of lung cancer patients in Europe and the USA are older than 65 years at the time of diagnosis. Despite this, elderly patients are generally under-represented in clinical trials. That being so, a general consensus on how to treat elderly patients is still far from being achieved. In this review, we address some of the issues and challenges surrounding the treatment of older cancer patients and radiochemotherapy. We discuss the existing evidence related to radio-chemotherapy in the elderly, focusing primarily on the lung cancer (NSCLC and SCLC) most commonly seen in older patients, and making general treatment recommendations.
文摘Objective:To study the effect of cisplatin-based concurrent radiochemotherapy on the malignant degree of advanced cervical cancer and the expression of proto-oncogene and tumor suppressor genes.Methods: A total of 82 patients with advanced cervical cancer who were treated in our hospital between July 2013 and December 2016 were collected and divided into control group and observation group according to random number table, with 41 cases in each group. The control group of patients received radiotherapy alone, while the observation group of patients received cisplatin-based concurrent radiochemotherapy. Tumor marker levels in serum as well as proto-oncogene and tumor suppressor gene expression in tumor tissue were compared between two groups of patients before and after treatment.Results:Before treatment, differences in tumor marker levels in serum as well as proto-oncogene and tumor suppressor gene expression in tumor tissue were not statistically significant between two groups of patients. After treatment, serum tumor markers SCC, CA50, CA724 and CEA levels of observation group were significantly lower than those of control group;proto-oncogene DEK, c-myc and PIK3CA mRNA expression in tumor tissue were significantly lower than those of control group;tumor suppressor genes p53, SOCS-1, FHIT and PTEN mRNA expression in tumor tissue were significantly higher than those of control group.Conclusions:Cisplatin-based concurrent radiochemotherapy can effectively reduce the tumor malignancy and balance the proto-oncogene / tumor suppressor gene expression in patients with advanced cervical cancer.
基金Natural Science Foundation Project of Science&Technology Department of Sichuan Province No:14JC0178.
文摘Objective: To study the effects of preoperative concurrent radiochemotherapy on the cancer cell infiltration and angiogenesis in local advanced gastric cancer lesions. Methods: A total of 68 patients who were diagnosed with locally advanced gastric cancer in this hospital between February 2015 and April 2017 were selected as the research subjects and randomly divided into two groups, the radiochemotherapy group received capecitabine + cisplatin chemotherapy combined with intensity modulated radiation therapy before operation, and chemotherapy group received preoperative capecitabine + cisplatin chemotherapy. The gastric cancer lesions surgically removed from two groups of patients were collected to determine the expression of proliferation-related genes, invasion-related genes and angiogenesis-related genes. Results:Rab27B, Bax, Caspase-3, PTPN13, E-cadherin and THBS2 protein expression in gastric cancer lesions of radiochemotherapy group were greatly higher than those of chemotherapy group whereas EZH2, PRR1, EPHA2, HDAC5, N-cadherin, Twist1, ANGPTL2, ANGPTL5, GOLPH3 and HIF-1 protein expression were greatly lower than those of chemotherapy group. Conclusion: Preoperative concurrent radiochemotherapy has inhibitory effect on the cancer cell infiltration and angiogenesis in local advanced gastric cancer lesions.
文摘Objective:To assess the safety and efficacy of the combination of recombinant adenovirus-p53 (rAd-p53) with radiochemotherapy for treating unresectable pancreatic carcinoma.Methods:The eligible patients received concurrent rAd-p53 intratumoral injection and radiochemotherapy.Intratumoral injection of rAd-p53 was guided by B ultrasound.Radiochemotherapy consisted of intensity-modulated radiotherapy (IMRT) at two dose levels and intravenous gemcitabine (Gem).For radiotherapy,gross target volume (GTV) and clinical target volume (CTV) were 55-60 Gy and 45-55 Gy in 25-30 fractions,respectively.Concurrent intravenous gemcitabine was administered at 350 mg/m2,weekly,for 6 weeks.The primary end points included toxicity,clinical benefit response (CBR) and disease control rate (DCR).The secondary end points included progression-free survival (PFS) and overall survival (OS).Results:Fifteen eligible patients were enrolled.Eight patients (53.3%) were evaluated as CBR and 12 (80%) achieved DCR.The median PFS and OS were 6.7 and 13.8 months,respectively.One-year PFS and OS were 40.0% and 51.1%,respectively.There were 8 (53.3%) patients reported grade 3 toxicities including neutropenia (6 patients,40%),fever (1 patient,6.7%) and fatigue (1 patient,6.7%).There was no grade 4 toxicity reported.Conclusion:Combination of rAd-p53 in unresectable pancreatic carcinoma showed encouraging efficacious benefit and was well tolerated.Long-term follow-up is needed to confirm the improvement of PFS and OS.
文摘AIM:To evaluate the long-term outcome of standard5-FU based adjuvant or neoadjuvant radiochemotherapyand to identify the predictive factors,especially anemiabefore and after radiotherapy as well as hemoglobinincrease or decrease during radiotherapy.METHODS:Two hundred and eighty-six patientswith Union International Contre Cancer(UICC)stageⅡ and Ⅲ rectal adenocarcinomas,who underwentresection by conventional surgical techniques(lowanterior or abdominoperineal resection),receivedeither postoperative(n=233)or preoperative(n=53)radiochemotherapy from January 1989 until July 2002.Overall survival(OAS),cancer-specific survival(CSS),disease-free survival(DFS),local-relapse-free(LRS)and distant-relapse-free survival(DRS)were evaluatedusing Kaplan-Meier,Log-rank test and Cox's proportionalhazards as statistical methods.Multivariate analysis wasused to identify prognostic factors.Median follow-uptime was 8 years.RESULTS:Anemia before radiochemotherapy was anindependent prognostic factor for improved DFS(riskratio 0.76,P=0.04)as well as stage,grading,R status(free radial margins),type of surgery,carcinoembryonicantigen(CEA)levels,and gender.The univariate analysisrevealed that anemia was associated with impaired LRS (better local control)but with improved DFS.In contrast,hemoglobin decrease during radiotherapy was anindependent risk factor for DFS(risk ratio 1.97,P=0.04).During radiotherapy,only 30.8% of RO-resected patientssuffered from hemoglobin decrease compared to 55.6%if R1/2 resection was performed(P=0.04).The 5-yearOAS,CSS,DFS,LRS and DRS were 47.0%,60.0%,41.4%,67.2%,and 84.3%,respectively.Significantdifferences between preoperative and postoperativeradiochemotherapy were not found.CONCLUSION:Anemia before radiochemotherapyand hemoglobin decrease during radiotherapy have nopredictive value for the outcome of rectal cancer.Stage,grading,R status(free radial margins),type of surgery,CEA levels,and gender have predictive value for theoutcome of rectal cancer.
基金Supported by grants from the the National Natural Science Foundation of China(No.81371524,81271529)the Hubei Provincial Natural Science Foundation of China(No.2014CFB298)
文摘Objective The aim of this study was to investigate the ability of intravoxel incoherent motion(IVIM) diffusion-weighted magnetic resonance imaging(MRI) to diagnose cervical cancer and to evaluate the response of uterine cervical cancer to radiochemotherapy(CRT).Methods This prospective study was approved by the institutional review board, and informed consent was obtained from all patients. A total of 23 patients with primary cervical cancer who were undergoing CRT and 16 age-matched healthy subjects were prospectively recruited for IVIM(b = 0–800 s/mm2) and standard pelvic MRI. Bi-exponential analysis was performed to derive f(perfusion fraction), D*(pseudo-diffusion coefficient), and D(true molecular diffusion coefficient) in cervical cancer(n = 23) and the normal cervix(n = 16). The apparent diffusion coefficient(standard ADC) was calculated. The independent-samples t-test and paired-samples t-test were used for comparisons.Results Pre-treatment cervical cancer had the lowest standard ADC(1.15 ± 0.13 × 10-3 mm2/s) and D(0.89 ± 0.10 × 10-3 mm2/s) values, and these were significantly different from the normal cervix and posttreatment cervical cancer(P = 0.00). The f(16.67 ± 5.85%) was lowest in pre-treatment cervical cancer and was significantly different from the normal cervix and post-treatment cervical cancer(p = 0.012 and 0.00, respectively). No difference was observed in D*.Conclusion IVIM is potentially promising for differentiating between the normal cervix and cervical cancer because pre-treated cervical cancer has low perfusion and diffusion IVIM characteristics. Further, the standard ADC, D, and f of cervical cancer showed a tendency to normalize after CRT; thus, IVIM may be useful for monitoring the response to CRT in cervical cancer.
