1-and 2-year Overall Survival Rates Research Articles

Outcomes of extra-cranial stereotactic body radiotherapy for metastatic breast cancer: Treatment indication matters

Background and purposeTo summarize the clinical outcomes of stereotactic body radiotherapy (SBRT) for metastatic breast cancer (mBC) from a large institution. Materials and methodsPatients with mBC who received extra-cranial SBRT to metastatic lesions from 2011 to 2017 were identified. Treatment indications were: oligometastases, oligoprogression, and local control of dominant tumor (CDT). Endpoints included overall survival (OS), progression-free survival (PFS), local control (LC) and cumulative incidence of starting/changing chemo or hormonal therapy (SCT). Univariate and multivariate analyses were used to identify predictive factors. ResultsWe analyzed 120 patients (193 treated metastatic lesions) with a median follow up of 15.25 months. 1-and 2-year LC rates were 89% and 86.6%, respectively. 1-and 2-year OS rates were 83.5% and 70%, respectively, with treatment indication and molecular subtype being the predictive factors on MVA. 1-year OS was 91.0%, 78.5% and 63.9% for oligometastases, oligoprogression and CDT, respectively (p = 0.003). The worst OS was seen in basal subtype with 1-and 2-year OS rates of 59.2% and 39.5% (p = 0.01). Treatment indication was found to be predictive for PFS and lower rates of SCT on MVA. 1-and 2-year PFS rates were 45% and 32%, respectively. The 1-year PFS for oligometastases, oligoprogression, and CDT was 66%, 19.6%, and 14.3%, respectively (p < 0.001). The cumulative incidence of SCT at 1-year was 12% for oligometastases, 39.7% for oligoprogression and 53.3% for CDT (p < 0.001). ConclusionPatients treated for oligometastases have better OS and PFS than those treated for oligoprogression or CDT. SBRT may delay SCT in mBC patients, particularly those with oligometastases. SBRT provided an excellent LC in mBC patients.

Retrospective clinical analysis of 133 cases of stage IV esophageal cancer

Objective To investigate the clinical significance of radiotherapy for stage Ⅳ esophageal cancer. Methods Clinical data of 133 stage Ⅳ esophageal cancer patients admitted to our hospital from 2012 to 2018 were retrospectively analyzed. All patients were assigned into the radiochemotherapy (n=89) and chemotherapy groups (n=44). The survival analysis was performed by Kaplan-Meier method. The multivariate prognostic analysis was conducted by Cox’s regression model. Results The 1-, 2-and 3-year overall survival rates of the entire cohort were 53.5%, 20.4% and13.6% respectively. Cox’s regression analysis showed that gender, ECOG score, number of distant metastases, and whether the primary lesions received radiotherapy were the independent prognostic factors (all P 50Gy and ≤50Gy was 14.3 months and 8.2 months (P<0.05), 8.6 months and 2.8 months for the PFS (P<0.05), and 15.2 months and 4.7 months for the LRFS (P<0.05), respectively. The number of distant metastases and the clinical efficacy for primary lesions were the independent prognostic factors in the radiochemotherapy group (both P<0.05). Conclusion Radiotherapy can improve the clinical prognosis of patients with stage Ⅳ esophageal cancer. Key words: Esophageal neoplasm/radiochemotherapy; Esophageal neoplasm/chemotherapy; Prognosis

Prognostic analysis of recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgical treatment

Objective To evaluate the clinical efficacy and prognostic factors of recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery. Methods From December 2011 to December 2015, 152 cases of recurrent thoracic esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery were retrospectively analyzed. The overall survival (OS) after treatment failure, clinical efficacy and prognostic factors of different salvage treatments were analyzed. OS was calculated by Kaplan-Meier method. Prognostic analysis was performed by using multivariate Cox regression model. Results The median interval of the first recurrence was 10.6(2.0 to 69.1) months. The median OS after recurrence was 8.0(0.8 to 43.3) months. The 1-, 2-and 3-year OS rates after recurrence were 36.0%, 15.1% and 5.2%, respectively. The median OS of patients with locoregional recurrence alone, distant metastasis alone and locoregional recurrence combined with distant metastasis was 11.3(1.8 to 43.3) months, 6.7(1.2 to 28.6) months and 5.1(0.8 to 22.9) months, respectively. Multivariate analysis demonstrated that neoadjuvant chemotherapy (P=0.009), ypTNM stage (P=0.012), comprehensive treatment after recurrence (P=0.000) and locoregional recurrence (P=0.026) were independently correlated with the OS of patients with recurrent esophageal squamous cell carcinoma. Conclusions Neoadjuvant therapy, ypTNM stage, recurrence pattern and post-recurrence treatment are the independent risk factors for clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery. Clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy is not satisfactory. After recurrence, combined treatment mode should be adopted according to the site of recurrence and neoadjuvant treatment mode to maximize the benefits of salvage treatment. Key words: Esophageal neoplasm, recurrent/ neoadjuvant treatment; Locoregional recurrence; Distant metastasis; Prognosis

Association between the timing of brain metastases and the prognosis of small cell lung cancer

Objective To investigate the association between the timing of brain metastases and the prognosis of patients with small cell lung cancer (SCLC). Methods A retrospective analysis was performed in 131 patients with limited-stage SCLC firstly metastasized to the brain were admitted to our hospital from 2007 to 2015.According to the median bone metastasis-free survival (BMFS), all patients were divided into A group (BMFS≤10 months, n=61) and B group (BMFS>10 months, n=70). The survival rates were analyzed using the Kaplan-Meier method. Between-group comparison was performed by log-rank test. The Cox regression model was used for multivariate prognostic analysis. Results In all 131 patients, the median overall survival (OS) and 1-, 2-, and 3-year OS rates were 22.5 months, 87.3%, 44.7%, and 20.8%, respectively. The median OS after brain metastases and 1-and 2-year OS rates were 9.3 months, 39.3% and 14.8%, respectively. No statistical significance was observed in the median OS after brain metastases between the A and B groups (8.6 vs. 9.3 months, P=0.695). Moreover, the OS after brain metastases did not significantly differ in patients without PCI or those receiving different therapies after brain metastases between two groups (P=0.240-0.731). Conclusions The timing of SCLC with brain metastases is significantly correlated with the OS rather than the OS after brain metastases. Therefore, prevention of brain metastases may be an effective approach to prolong the OS of patients with SCLC. Key words: Carcinoma, small cell lung/radiotherapy; Neoplasm metastasis/brain; Timing of metastasis; Prognosis

Survival analysis for patients with T4b squamous cell carcinoma of thoracic esophagus receiving concurrent chemoradiotherapy

Objective We aimed to analyze the clinical efficacy and treatment-related complications in patients with T4b esophageal squamous cell carcinoma (SCC) who received concurrent CRT, and to explore the potential prognostic factors related to survival. Methods Between 2010 and 2015, 143 patients with T4b esophageal SCC treated with CRT were analyzed, including 71% patients with trachea and/or bronchus invasion and 44% patients with aorta and/or large vessel invasion. The median radiation dose was 60 Gy (range, 44-68 Gy) with conventional fractionation, including 69 patients (48%) treated with three-dimensional conformal radiotherapy and 74 patients (52%) treated with intensity-modulated radiotherapy. All patients received concurrent platinum-based chemotherapy during radiotherapy. Kaplan-Meier method was used to analyze the survival, the log-rank test was used to examine group differences, and the Cox regression model was used for multivariate analysis. Results The median overall survival (OS) time for the whole cohort was 12.2 months. The 2-and 3-year OS rates were 34% and 29%, respectively. A total of 51 patients experienced ≥2 severe non-hematological complications, including 42 esophageal fistula, 6 pneumonia, and 3 esophageal hemorrhage. Patients with severe complications showed significantly worse survival than those without complications (6.9 months vs.20.4 months, P<0.01). Multivariate analysis revealed that TNM stage and severe complications were independent prognostic factors for OS. Conclusions Patients with T4b esophageal SCC who received CRT showed satisfactory survival but with high risk of severe complications. Therefore, prevention and treatment of severe complications is the key to improve efficacy. Key words: Esophageal neoplasms/chemoradiotherapy; Prognosis

Comparison of clinical prognosis between stereotactic body radiotherapy and surgical treatment for early-stage non-small cell lung cancer after propensity score matching

Objective To evaluate the clinical efficacy between stereotactic body radiotherapy (SBRT) and surgical treatment for stage Ⅰ-Ⅱ non-small cell lung cancer (NSCLC). Methods Clinical data of 120 patients with early-stage NSCLC who underwent SBRT or surgical treatment in Zhejiang Cancer Hospital from 2012 to 2015 were retrospectively analyzed. Propensity score matching was carried out between two groups. Sixty eligible patients were enrolled in each group. In the SBRT group, the 80% isodose line covered 95% of the planning target volume, and the 100% isodose line covered 100% of the internal gross tumor volume. The fractional dose was 5-15 Gy and the median biologically equivalent dose was 100 Gy (range: 57.6-150.0 Gy). In the operation group, 32 patients underwent video-assisted thoracoscopic lobectomy and 9 patients underwent wedge resection or segmentectomy. Results All patients successfully completed corresponding treatment and were followed up. The median follow-up was 32.3 months (range: 8.6-68.4 months). In the operation group, 3 patients died from infection within postoperative 90 d, whereas no case died in the SBRT group (P=0.079). In the SBRT group, 3 patients died of other factors besides tumor (cerebral infarction, heart disease, etc.) during follow-up. Local-regional recurrence occurred in 12 patients including 5 cases in the operation group and 7 in the SBRT group (P=0.543). In the operation group, 11 patients experienced distant metastases with a median disease-free survival (DFS) of 33.5 months. In the SBRT group, 6 patients had distant metastases and the median DFS was 38.4 months (P=0.835, P=0.178). In the SBRT group, the 1-and 3-year overall survival rates were 93% and 83%, and 95% and 83% in the operation group (P=0.993). Conclusions The 1-and 3-year overall survival rates and local control rate do not significantly differ between SBRT and operation for patients with early-stage NSCLC. Key words: Lung neoplasms/stereotactic body radiotherapy; Lung neoplasms/surgery; Treatment outcome

Survival analysis of preoperative involved-field irradiation with concurrent chemotherapy for patients with Siewert′s type II and III adenocarcinoma of esophagogastric junction

Objective To analyze the clinical efficacy, toxicity and survival prognosis of patients diagnosed with Siewert type Ⅱ and Ⅲ locally advanced adenocarcinoma of esophagogastric junction (AEG) undergoing preoperative involved-field irradiation with concurrent chemotherapy. Methods A total of 45 cases were recruited in this prospective clinical trial. Prior to surgery, patients received 2 cycles of chemotherapy with XELOX and concurrent radiotherapy (a total of 45 Gy in 25 fractions, 5 times weekly). After 6-8 weeks, they underwent surgical resection. After the surgery, patients received 6 cycles of adjuvant chemotherapy. The completion of preoperative neoadjuvant chemoradiotherapy, postoperative pathological status, TNM down-staging effect and adverse reactions were observed. Kaplan-Meier method was applied to estimate survival analysis. Results All 45 patients completed preoperative neoadjuvant chemoradiotherapy. Among them, 39 patients completed 2 cycles of chemotherapy, and 6 patients completed 1 cycle of chemotherapy. The median time of surgical interval was 6 weeks. The R0 resection rate was 96%.The pathological complete response (pCR) rate was 22%. The TNM down-staging rate was 69%.The incidence of acute radiation-induced esophagitis or gastritis was 44% and the incidence of radiation-induced pneumonitis was 7%. The incidence of grade 1-3 leukocytopenia, thrombocytopenia and neutropenia was 78%, 47% and 44%, respectively. In terms of gastrointestinal reactions, the incidence of nausea, vomiting and loss of appetite was 62%, 24% and 71%, respectively. No hematologic or nonhematologic adverse effects was observed at grade 4 or 5.The median follow-up time was 30 months. 11 patients died of cancer, 1 patient was treatment-related death in the perioperative period and 1 patient died of pneumonia. The 1-, 2-and 3-year progression-free survival (PFS) rates were 90%, 70% and 67%, respectively. The 1-, 2-and 3-year overall survival rates were 95%, 80% and 75%, respectively. The 1-, 2-and 3-year local control rates were 95%, 84% and 84%, respectively. The 1-, 2-and 3-year distant metastasis rates were 7%, 25% and 25%, respectively. Conclusions Preoperative involved-field irradiation with concurrent chemotherapy yields relatively high clinical efficacy and is well tolerated by patients with Siewert type Ⅱ and Ⅲ locally advanced AEG.Patients are recommended to receive 4 cycles of adjuvant chemotherapy following neoadjuvant chemoradiotherapy and surgery. Key words: Adenocarcinoma of esophagogastric junction/radiotherapy; Adenocarcinoma of esophagogastric junction/chemotherapy; Prognosis; Drug tolerance

Clinical efficacy and safety of randomized phase 2 trial of pemetrexed-cisplatin or docetaxel-cisplatin plus thoracic intensity-modulated radiation therapy in patients with stage IV lung adenocarcinoma

Objective To evaluate the clinical efficacy and toxicity of concurrent pemetrexed-cisplatin (PP) or docetaxel-cisplatin (DP) with intensity-modulated radiation therapy (IMRT) in patients with stage ⅠV lung adenocarcinoma. Methods Stage IV lung adenocarcinoma patients with unknown EGFR mutation status or wild-type admitted to Guizhou Cancer Hospital from 2011 to 2016 were randomly assigned into the PP (n=50) and DP groups (n=51). All patients received concurrent IMRT of the chest at a prescription dose of 60-70 Gy. Primary endpoint was 1-year survival rate, and secondary endpoint was acute toxicity. Results The overall response rate was 68.0% and 72.5% in the PP and DP groups (χ2=0.250, P=0.617). The median survival time was 19.6 months (95%CI 13.9-25.3) versus 12.1 months (95%CI 10.7-13.5) in the PP and DP groups. The 1-, 2-and 3-year overall survival rates were 72.0% versus 52.9%, 28.0% versus 17.6%, and 16.0% versus 13. 7%, respectively in the PP and DP groups (P=0.049). In the PP and DP groups, the incidence of grade 3-4 leukopenia was declined by 48% and 63%(P=0.098), and the incidence of grade 3-4 neutropenia was decreased by 34% and 65%(P=0.002), the incidence of grade 3-4 anemia was reduced by 38% and 10%(P=0.024), and the incidence of grade 3-4 thrombocytopenia was declined by 40% and 14%(P=0.003). The incidence rate of grade 2 pneumonitis (P=0.625) and grade 3 esophagitis (P=0.484) were similar in both groups. No patients experienced ≥grade 3 pneumonitis or ≥ grade 4 radiation esophagitis. Conclusions Pemetrexed-cisplatin combined with chemoradiotherapy yields higher clinical efficacy compared with docetaxel-cisplatin plus concurrent chemoradiation in the treatment of stage ⅠV lung adenocarcinoma. The incidence of radiation pneumonitis and esophagitis is similar. The incidence and severity of hematological toxicity does not significantly differ between two groups. Treatment-related toxicity is tolerable in both groups. Clinical Trial Registration Chinese Clinical Trial Registry (ChiCTR-TRC-13004184). Key words: Stage IV lung adenocarcinoma; Radiotherapy; Intensity-Modulated; Pemetrexed; Docetaxel; Phase 2 trial

Efficacy evaluation of rescue treatment for 218 patients with recurrent esophageal cancer after radical resection

Objective To evaluate the efficacy of rescue treatment for recurrent esophageal cancer after radical esophagectomy, and to provide insights into the development of comprehensive treatment for esophageal cancer. Methods The clinical data of 218 patients who were confirmed with recurrent metastatic esophageal cancer after R0 resection and received rescue treatment in our hospital from 2004 to 2014 were retrospectively reviewed. The survival rate was determined by the Kaplan-Meier method. Univariate and multivariate prognostic analyses were performed using the log-rank test and Cox proportional hazards model, respectively. Results The median post-recurrence follow-up time was 53 months. The 1-and 3-year overall survival (OS) rates after recurrence were 57.2% and 24.4%, respectively. Among the 163 patients with local recurrence, the 1-and 3-year OS rates were 70% and 42% for patients treated with chemoradiotherapy (n=40), 55% and 24% for those with radiotherapy alone (n=106), and 23% and 8% for those with supportive therapy (n=13)(chemoradiotherapy vs. radiotherapy alone P=0.045, radiotherapy alone vs. supportive therapy P=0.004; none of the patients who were treated with chemotherapy alone survived for one year or more). Univariate analysis showed that N staging, TNM staging, and post-recurrence rescue treatment regimen were independent prognostic factors for esophageal cancer (all P=0.001). On the other hand, multivariate analysis indicated that only rescue treatment regimen was the independent prognostic factor for esophageal cancer (P=0.013). Conclusions Rescue chemoradiotherapy or radiotherapy alone can bring significant survival benefits for patients with recurrent and metastatic, especially locally recurrent, esophageal cancer following radical esophagectomy. Key words: Neoplasms recurrence, esophageal/radiotherapy; Neoplasms recurrence, esophageal/chemoradiotherapy; Combined treatment; Prognosis

Effect of tumor volume and radiation dose on the prognosis of hepatocellular carcinoma patients treated with whole body gamma knife

Objective To examine the effects of gross tumor volume (GTV) and radiation dose on the prognosis of hepatocellular carcinoma (HCC) patients treated with whole body gamma knife. Methods The clinical data of 69 HCC patients who underwent body gamma knife treatment from January 2012 to June 2015 in the Radiotherapy Center of the PLA General Hospital were retrospectively reviewed. Based on a 50% or 60% isodose coverage of the planning target volume (PTV), patients were treated with a radiation dose of 4-5 Gy per fraction, and a total marginal dose of 36-50 Gy (median dose 45 Gy). Short-term efficacy, overall survival (OS), and the adverse effect of the treatment were evaluated. The optimal cut-off tumor volume was identified using the receiver operating characteristic curve, and survival was determined by the Kaplan-Meier method. Univariate and multivariate analyses were performed using the log-rank test and Cox proportional hazards regression model, respectively. Results The overall short-term response rate of the 69 patients was 67%. The 1-and 2-year OS rates were 62% and 40%, respectively, with a median survival of 18.6 months. The multivariate analysis showed that gross tumor volume (GTV) 93 cm3(P=0.665). Conclusions GTV is an independent prognostic factor for overall survival of HCC patients. Although high-dose radiotherapy provides survival benefits to patients with small GTV, it is not necessarily suitable for patients with large GTV. Key words: Liver neoplasms/stereotactic radiotherapy; Gross tumor volume; Prognosis

Comparison of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in treating locally advanced esophageal squamous cell carcinoma

Objective To compare the efficacy of neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant chemotherapy (NCT) in treating locally advanced esophageal squamous cell carcinoma. Methods We retrospectively analyzed a total of 177 patients who received NCRT (72 patients) or NCT (105 patients) combined with surgery for esophageal squamous cell carcinoma from January 2009 to October 2015 in the Affiliated Cancer Hospital of Zhengzhou University. The survival rate was analyzed using the Kaplan-Meier method. Results Among the 177 patients (clinical stage cT2-4N0-1M0), the 2-and 3-year sample sizes were 44 and 26 in the NCRT group, and 47 and 28 in the NCT group. The pathological complete response (pCR) rate was significantly higher in the NCRT group than in the NCT group (22% vs. 10%, P=0.019). There were no significant differences in the incidence of postoperative complications, mortality, and recurrence rate between the two groups (all P>0.05). The 2-and 3-year overall survival rates for the NCRT group were 74% and 51%, versus 64% and 51% for the NCT group (P=0.527); the 2-and 3-year disease-free survival rates for the NCRT group were 54% and 50%, versus 54% and 46% for the NCT group (P=0.379). Conclusions Compared with NCT, NCRT significantly increases the pCR rate without increasing postoperative complications and mortality in esophageal squamous cell carcinoma patients. However, since the survival rate is similar between the two groups, the efficacy of NCRT and NCT remains to be verified by further prospective, multi-centered, and large-sample studies. Key words: Esophageal neoplasms/chemotherapy; Esophageal neoplasms/chemoraidotherapy; Adjuvant chemoradiotherapy; Prognosis

Surgical treatment of 56 patients with hilar cholangiocarcinoma in a single center

Objective To study the safety and efficacy of surgical treatment for hilar cholangiocarcinoma (HC). Methods We retrospectively analyzed the clinical data of 56 patients with HC who underwent resection at the Beijing YouAn Hospital, Capital Medical University, from January 2010 to July 2015. The patients were divided into two groups according to the types of operations: the minor hepatectomy group (n=12) and the major hepatectomy group (n=44). The postoperative complications, mortality and long-term survival rates were compared and the clinical data were analyzed using uni- and multivariate analyses to examine the significant factors of survival. Results (1) The morbidity rates of the two groups were 33.3% and 63.6%, respectively, with the latter group being significantly higher than the former group; (2) The 1-and 3-year overall survival rates were 60% and 15% in the minor liver resection group and 64% and 15% in the major resection group, and there was no significant difference between the two groups (P>0.05). The median survival was 16 months; (3) The median survival of R0 resection was significantly longer than the R1/R2 resection group (22 months vs 10 months, P<0.05); (4) Age, preoperative CA19-9 level, vascular invasion, surgical margin, tumor differentiation and nodular metastasis were significantly correlated with prognosis on univariate analysis. Multivariate analysis showed surgical margin and tumor differentiation to be significant prognostic factors. Conclusions R0 resection obviously prolonged survival of HC patients, and histopathology negative surgical margin should be emphasized. With R0 resection, minor liver resection significantly reduced postoperative complications and mortality in selected patients. Key words: Hilar cholangiocarcinoma; Minor hepatectomy; Postoperative complications; Resection; Survival rate

A clinical study of salvage radiotherapy for supraclavicular lymph node metastasis in patients with esophageal cancer

Objective To evaluate the efficacy of salvage radiotherapy for supraclavicular lymph node metastasis (SLNM) after initial treatment in patients with esophageal cancer. Methods A total of 117 patients with SLNM after radical resection for esophageal cancer were enrolled as subjects from 2006 to 2012. All patients received three-dimensional radiotherapy with 1.8-2.0 Gy per cycle, 5 cycles a week. The survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The Cox model was used for multivariate analysis. Results The follow-up rate was 100%. In all the patients, the 1-and 3-year overall survival (OS) rates were 38.5% and 14.1%, respectively. The 1-and 3-year OS rates were significantly higher in patients treated with salvage radiotherapy or radiochemotherapy (n=100) than in patients without any salvage treatment (n=17)(42% vs. 18%, P=0.008; 17% vs. 0%, P=0.008). The patients treated with radiochemotherapy (n=32) had significantly higher 1-and 3-year OS rates than those treated with radiotherapy alone (n=68)(59% vs. 34%, 36% vs. 11%, P=0.002) or without any salvage treatment (n=17)(59% vs. 18%, 36% vs. 0%, P=0.002). Patients without visceral metastasis (n=80) had significantly higher 1-and 3-year OS rates than those with visceral metastasis (n=37)(44% vs. 27%, P=0.002; 22% vs. 0%, P=0.002). Patients with supraclavicular doses of ≥60 Gy in salvage radiotherapy (n=75) had significantly higher 1-and 3-year OS rates than those with supraclavicular doses of<60 Gy in salvage radiotherapy (n=25)(75% vs. 25%, P=0.000; 24% vs. 8%, P=0.000). The multivariate analysis using the Cox model showed that supraclavicular doses of ≥60 Gy, mediastinal metastasis, visceral metastasis, and salvage treatment method were independent factors for survival (P=0.001, 0.015, 0.009, 0.025). Conclusions Salvage radiotherapy can improve the survival of patients with SLNM in esophageal cancer. Salvage radiotherapy or radiochemotherapy is highly recommended for patients with SLNM alone. A radiation dose of ≥60 Gy in salvage radiotherapy improves survival in patients. Key words: Esophagus neoplasms; Supracevicular lymph node metastasis; Salvage treatment; Prognosis

Prognosis and staging of primary bone lymphoma: an analysis of 40 patients

Objective To retrospectively analyze the treatment outcomes and prognostic factors for primary bone lymphomas (PBL). Methods Forty patients with PBL who were admitted to our center from 1964 to 2014 were enrolled as subjects. In those patients, 10 were treated with chemotherapy alone, 10 with radiochemotherapy, 10 with postoperative chemotherapy, 9 with postoperative radiochemotherapy, and 1 with surgery alone. The median radiation dose was 36 Gy. The Kaplan-Meier method was used to calculate survival rates. The log-rank test was used for survival difference analysis and univariate prognostic analysis. Results The follow-up rate was 100%. The 3-year sample size was 36. In all patients, the 1-and 3-year overall survival rates were 60% and 42%, respectively, while the 1-and 3-year disease-free survival rates were 45% and 34%, respectively. The univariate analysis showed that no pathological fracture at diagnosis, normal lactate dehydrogenase level, an International Prognostic Index score of ≤1, early clinical stage (stage ⅠE), complete response after initial treatment, no less than 6 cycles of chemotherapy, a radiation dose of ≥40 Gy, no progression outside radiation field after radiotherapy, and grade<3 bone marrow suppression during the treatment were prognostic factors for survival (P=0.027, 0.037, 0.000, 0.016, 0.000, 0.000, 0.022, 0.014, and 0.030). Conclusions The incidence of PBL is low. Comprehensive treatment can achieve satisfactory outcomes. As a PBL staging system, Ann Arbor has limitations. The staging of PBL should be based on local bone destruction and metastasis. Key words: Lymphoma, bone/radiotherapy; Lymphoma, bone/chemotherapy; Lymphoma, bone/radiochemtherapy; Prognosis

Preliminary analysis of the efficacy of helical tomotherapy combined with targeted therapy for stage IV non-small cell lung cancer

Objective To explore the efficacy and security of helical tomotherapy (radical radiotherapy) combined with targeted therapy for stage Ⅳ non-small cell lung cancer (NSCLC). Methods The data of 19 patients with stage Ⅳ NSCLC were retrospectively analyzed. The efficacy and security were observed by SPSS 20.0 statistical software. Results Among 19 patients, there were 6 cases complete remission (CR), 8 cases partial remission (PR), 4 cases stable disease (SD), 2 cases progressive disease (PD). The response (CR+PR) rate was 73.7 % (14/19). The 1-and 2-year local control rates were 73.7 %, 47.4 %, respectively. The 1-year progression-free survival rate was 31.6 %. The median survival time was 13 months, and the 1-and 2-year overall survival rates were 52.6 %, 26.3 %, respectively. The median survival time of females, non-smokers or targeted therapy synchronous radiotherapy was longer than that of male, smokers or targeted therapy sequential radiotherapy, respectively (21 months vs 8 months, P=0.014; 21 months vs 6 months, P=0.007; 18 months vs 6 months, P=0.026). There were no significant differences of age, number of metastatical organs or targeted drug categories between two groups (P>0.05). All patients could tolerate the adverse reactions without treatment-related death. Conclusion The effect of helical tomotherapy combined with targeted therapy for stage Ⅳ NSCLC is desirable. Key words: Carcinoma, non-small-cell lung; Targeted therapy; Radiotherapy

Analysis of efficacy and prognostic factors of postoperative intensity-modulated radiotherapy with or without chemotherapy in rectal cancer

Objective To explore the efficacy and prognostic factors of postoperative intensity-modulated radiotherapy (IMRT) with or without chemotherapy in rectal cancer. Methods A retrospective analysis was performed on the clinical data of 218 patients with rectal cancer, who underwent postoperative IMRT in our hospital from January 2009 to December 2013.The Kaplan-Meier method was used to calculate survival rate; the log-rank test was used for survival difference analysis and univariate prognostic analysis; the Cox regression model was used for multivariate prognostic analysis. Results The follow-up rate was 97.7%. The 1-and 3-year overall survival rates were 90.8% and 75.2%, respectively, the 1-and 3-year disease-free survival rates were 85.3% and 70.5%, respectively, and the 1-and 3-year locoregional recurrence-free survival rates were 96.7% and 88.1%, respectively. The incidence of grade 3-4 acute adverse reactions was 28.4%, mainly manifested as leukopenia (13.8%) and diarrhea (11.0%). Univariate prognostic analysis showed that preoperative carcinoembryonic antigen (CEA) and CA199 levels, maximum tumor diameter, tumor location, degree of differentiation, depth of tumor invasion, number of lymph node metastases, TNM stage, perineural invasion, surgical procedure, total mesorectal excision, preoperative bowel obstruction, and preoperative anemia were the predictors of survival (P=0.006, 0.000, 0.000, 0.017, 0.000, 0.016, 0.000, 0.011, 0.001, 0.006, 0.037 and 0.010). Multivariate prognostic analysis showed that preoperative CEA level, tumor location, TNM stage, preoperative bowel obstruction, and preoperative anemia were the predictors of survival (P=0.000, 0.000, 0.000, 0.001 and 0.001). Conclusions Postoperative IMRT with or without chemotherapy is an effective method for rectal cancer with mild adverse reactions and high compliance. Preoperative CEA level, tumor position, TNM stage, preoperative bowel obstruction, and preoperative anemia are independent prognostic factors for the overall survival. Key words: Rectal neoplasms/radiochemotherapy; Radiotherapy, intensity-modulated radiotherapy; Prognosis

Clinical efficacy of CyberKnife radiotherapy for locally advanced pancreatic carcinoma

Objective To assess the efficacy and safety of CyberKnife radiotherapy in the treatment of locally advanced pancreatic carcinoma. Methods The data of 59 patients with locally advanced pancreatic carcinoma who were treated with CyberKnife radiotherapy from 2006 to 2014 were retrospectively analyzed. The tumor volume ranged from 13. 0 cm3 to 125. 1 cm3 with a median value of 27. 1 cm3. A dose of 35-50 Gy(median value = 45 Gy)in 3-8 fractions(median value = 5 fractions)was prescribed. The tumor progression was evaluated based on computed tomography. The overall survival(OS)and local progression-free survival(LPFS)rates were calculated using the Kaplan-Meier method. Results The 1-and 2-year sample sizes were 26 and 17, respectively. The 1-and 2-year OS rates were 54% and 35%, respectively, while the 1-and 2-year LPFS rates were 91% and 70%, respectively. The median OS and LPFS times were 12. 5 and 10.9 months, respectively. The overall incidence of grade 1-2 acute and late gastrointestinal toxicity was 61%. One patient with grade 3 late gastrointestinal toxicity had incomplete intestinal obstruction. Conclusions CyberKnife radiotherapy can achieve excellent treatment outcomes and mild complications in the treatment of locally advanced pancreatic carcinoma. Key words: Pancreatic neolasms/CyberKnife radiotherapy; Treament outcome; Undoward effect

Clinic results of 121 nasopharyngeal carcinoma patients treated by helical tomotherapy

Objective To summarize the outcome of nasopharyngeal carcinoma ( NPC) treated by helical tomotherapy in the Chinese PLA general hospital. Methods Between September 2007 and August 2010, 121 newly diagnosed NPC patients were treated by radiotherapy with Tomotherapy system, with ( n =90) or without ( n = 31) concurrent chemotherapy or molecular target therapy. The prescription dose was 70 - 74 Gy/33f to primary tumor and positive lymph node planning target volume,60. 0 - 62. 7 Gy/33f to high risk planning target volume, and 52 -56 Gy/33f to low risk planning target volume. Acute side-effects were evaluated with RTOG/EORTC criteria. Results The remission rate of primary lesion and positive lymph nodes was 95. 0％ and 99. 0％ , respectively. The follow-up rate was 100％ . The number of patients with 1 ,2 and 3 years followed-up were 99 , 49 , and 7. The 1-, 2-and 3-year local relapse-free survival rates were 97. 30％ , 97. 3％ and 97. 3％ , respectively. The 1-,2-and 3-year nodal relapse-free survival rates were 100％ , 100％ and lOO％, respectively. The 1-, 2-and 3-year distant metastasis-free survival rates were 98. 4％ , 96. 3％ and 96. 3％ , respectively. The 1-, 2-and 3-year overall survival rates were 96. 5％ ,92. 6％ and 86. 8％ , respectively. Acute toxicities of skin, oral mucosa and xerostomia with grade 0,1,2 and 3 were 5. 0％ , 74. 4％ , 15. 7％ and 4. 9％ ; 0. 8％ , 37. 2％ , 57. 9％ and 4. 1％ ; 3. 3％ , 53. 7％ ,43. 0％ and 0％ , respectively. Xerostomia restored with time, no grade 2 or more xerostomia was observed 1 year after radiation therapy. Concurrent chemotherapy significantly increased incidence of mucositis,esophagitis and tracheitis. Conclusion Helical tomotherapy is efficient, secure and effective modality for the treatment of nasopharyngeal carcinoma. Key words: Nasopharyngeal neoplasms/radiotherapy; Radiotherapy,helical tomotherapy; Toxicities; Prognosis

Chemotherapy with concurrent brain and thoracic radiotherapy in brain-only metastases of treatment naive small-cell lung cancer: a phase II study

To study the treatment outcomes of brain-only metastases from small-cell lung cancer (SCLC) at initial diagnose treated by chemotherapy with concurrent brain and thoracic radiotherapy (RT). From Jan 2004 to Jan 2009, 36 treatment-naïve SCLC patients with brain-only metastases in Sun yat-sen University were enrolled. Treatment contained initial EP chemotherapy with concurrent whole-brain radiotherapy (WBRT). EP regimen consisted of etoposide 100 mg/m(2) IV d1-3, cisplatin 80 mg/m(2) IV d1, repeated every 3 weeks. WBRT with total dose of 30 Gy in 10 fractions was started within 1 week from the beginning of chemotherapy followed by thoracic RT including 2 Gy once daily to a total dose of 60 Gy. Treatment responses were evaluated after 3 cycles of chemotherapy. EP regimen was given totally 6 cycles for no tumor progression. Thirty-four patients were evaluable. All of the 20 CNS symptomatic patients experienced symptoms relief. Objective responses in the brain and primary thoracic lesions were observed in 26 (76.5%, 16CR + 10PR) and 29 (85.3%, 23CR + 6PR) patients, respectively. The median survival time (MST) was 19.2 months, and the 1-and 2-year overall survival rates (OS) were 70.6 and 29.4%, respectively, in all patients. Patients with CR response had the longest MST of 21.9 months and 1-and 2-year OS of 93.8 and 43.8%, respectively. Treatment toxicity profiles were acceptable. The treatment strategy of concurrent chemotherapy with brain and thoracic RT might achieve promising survival outcomes comparable to limited-stage SCLC in initially diagnosed SCLC with brain-only metastases.

Efficacy of X-ray stereotactic radiotherapy on brain metastases and prognostic analysis

X-ray stereotactic radiotherapy (SRT) is one of the effective treatments for brain metastases (BM). This study was to evaluate the efficacy of SRT on BM, and investigate prognostic factors. Between July 1999 and December 2004, a total of 122 intracranial lesions in 78 patients with BM were treated using SRT in our Center. Forty-nine patients had a solitary lesion and 29 had multiple (2-6) lesions. The median SRT dose was 15 Gy (11-24 Gy) in single fraction for 38 lesions, and 24 Gy (11-40 Gy) in 2-6 fractions for 84 lesions. SRT was combined with whole brain radiotherapy (WBRT) of 30-40 Gy for 39 patients. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method. Univariate and multivariate analyses were performed by the log-rank test and Cox model, respectively. The median survival time was 12.9 months (1.7-77.4 months). The 1-year intracranial PFS rate was 87.4%. The 1-and 2-year OS rates were 53.9% and 25.8%, respectively. Univariate analysis showed that the 1-year OS rates were higher in the patients with pretreatment KPS of >/= 70, extracranial lesions controlled, or SRT combined with WBRT than in those with KPS of < 70 (60.7% vs. 29.4%, P = 0.002), extracranial lesions uncontrolled (69% vs. 44.9%, P = 0.005), or SRT alone (64.1% vs. 43.4%, P = 0.03). The benefit of treating with WBRT in combination was mainly achieved in the patients with extracranial lesions controlled or with more than one intracranial lesion. Multivariate analysis showed that KPS score and status of extracranial lesions were independent prognostic factors for OS. SRT is an effective and safe modality for BM. SRT combined with WBRT may prolong the survival time of the patients with extracranial lesions controlled or multiple intracranial lesions. Independent prognostic factors for OS are KPS score and status of extracranial lesions.