Application Of Chemoradiotherapy Research Articles

Clinical effect of postoperative chemoradiotherapy in resected advanced laryngeal squamous cell carcinoma.

Laryngeal squamous cell carcinoma (LSCC) is one of the most prevalent types of head and neck malignancies. Advanced LSCC has failed to demonstrate a satisfactory prognosis, despite the progresses in the diagnosis and treatment, and the optimal treatment modality continues to be debated. To evaluate the clinical utility and survival outcomes of adjuvant chemoradiotherapy (CRT) for patients with resected advanced LSCC, a retrospective analysis of 232 patients with LSCC who had undergone total laryngectomy and neck dissection between 2005 and 2010 was conducted. Of the 232 eligible patients, 167 patients (72%) received surgery alone, whereas 65 patients (28%) received surgery + adjuvant CRT. In the overall cohort, the 5- and 10-year overall survival (OS) rates were 55.2 and 48.3%, respectively. Multivariate analysis revealed that the clinical stage was significantly associated with OS. However, the N classification was an independent indicator in disease-free survival and laryngeal cancer-specific survival. In those patients with stage IV disease, patients receiving adjuvant CRT exhibited a markedly improved survival benefit compared with patients receiving surgical treatment only, following propensity score matching of the data (P<0.05). The application of adjuvant CRT confers additional survival benefits in comparison with surgery-only treatment regimens for advanced LSCC. However, additional prospective studies are required.

The Advisability of Neoadjuvant Chemoradiotherapy of Rectal Cancer in Geriatric Patients

A comparative analysis of the efficacy and safety of neoadjuvant chemoradiotherapy (CRT) in colorectal- cancer patients older and younger than 60 years was performed. It has been determined that the risk of complications of neoadjuvant CRT, as well as the degree of its adverse effect on the outcomes of subsequent surgical treatment, does not significantly depend on the age of the patients. However, the application of preoperative CRT in geriatric patients is associated with a less significant increase in disease-free survival compared with younger patients. Thus, the factor of age should not restrict the use of neoadjuvant CRT in patients with satisfactory general somatic status and the absence of severe complications of the tumor process.

Neoadjuvant chemoradiotherapy in combined treatment of patients with rectal cancer

OBJECTIVE. The article analyzed an efficacy and safety of application of neoadjuvant chemoradiotherapy (CRT) in elderly and senile patients with rectal cancer. MATERIAL AND METHODS. An analysis of treatment results was made in 267 patients, who were divided into two groups. The first group (n = 142) underwent combined treatment that included prolonged course of neoadjuvant CRT followed by surgery. The second group of 125 patients underwent surgery without application of CRT. The patients of both groups were subdivided according their age. The subgroup “A” consisted of young and middle age patients. The subgroup “B” included geriatric patients. Comparative analysis was made between the same age subgroups. RESULTS. The age factor didn’t significantly influence on the risk of complications of neoadjuvant CRT and its adverse effects on subsequent outcome of surgery. The application of preoperative CRT in geriatric patients accompanied by less significant growth of recurrence-free survival compared with young patients. CONCLUSIONS. The age factor shouldn’t restrict the application of neoadjuvant CRT in patients with satisfactory general health status and absence of tumor complication process.

Abdominoperineal Resection in the Treatment of Locally-advanced Low Rectal Cancer: Is Preoperative Chemoradiation Advantageous?

Purpose: An abdominoperineal resection (APR) has a poor prognosis. However, limited studies about the prognostic factors in APR and the role of preoperative chemoradiotherapy (CRT) have been performed even though in rectal cancer, the application of preoperative CRT provides better local control compared to postoperative CRT. The aim of this study was to identify the prognostic factors and the impact of preoperative CRT in patients who undergo an APR. Methods: A retrospective analysis was conducted with a total of 133 patients who underwent an APR, cT3, cT4, or cN(+) patients, for rectal cancer between January 1995 and October 2004. Fifty-one patients treated with preoperative CRT (Group 1) were compared with 82 APR patients treated with postoperative CRT (Group 2). Oncologic outcomes were compared between the two groups, and the clinicopathologic factors affecting the treatment outcomes were evaluated. Results: The median follow-up period was 61.2 mo (range 6 to 194 mo). Circumferential margin (CRM) involvement was significantly associated with local recurrence (LR) and with disease-free survival in APR patients (P<0.001, P=0.011). The 5-yr LR rate was significantly lower in Group 1 than in Group 2 (P=0.013) in the univariate analysis, but no difference was noted in multivariate analysis (P=0.315). In Group 1, CRM involvement, tumor size, and lymph node metastasis were significantly lower than they were in Group 2 (P=0.043, P=0.003, P<0.001). Conclusion: For achieving adequate oncologic outcomes in APR patients, an adequate CRM should be acquired with an optimal operation. In addition, preoperative CRT would be helpful for high-risk APR patients with a threatening CRM margin, providing the benefit of tumor downstaging.

Long-term efficacy of perioperative chemoradiotherapy on esophageal squamous cell carcinoma

To investigate the role of perioperative chemoradiotherapy (CRT) in the treatment of locally advanced thoracic esophageal squamous cell carcinoma (ESCC). Using preoperative computed tomography (CT)-based staging criteria, 238 patients with ESCC (stage II-III) were enrolled in this prospective study between January 1997 and June 2004. With informed consent, patients were randomized into 3 groups: preoperative CRT (80 cases), postoperative CRT (78 cases) and surgery alone (S) (80 cases). The 1-, 3-, 5- and 10-year survival were followed up. Progression-free survival (PFS) was chosen as the primary endpoint by treatment arm measured from study entry until documented progression of disease or death from any cause. The secondary endpoint was overall survival (OS) determined as the time (in months) between the date of therapy and the date of death. Other objectives were surgical and adjuvant therapy complications. With median follow-up of 45 mo for all the enrolled patients, significant differences in the 1-, 3-, 5-, 10-year OS (91.3%, 63.5%, 43.5%, 24.5% vs 91%, 62.8%, 42.3%, 24.4% vs 87.5%, 51.3%, 33.8%, 12.5%, P = 0.0176) and PFS (89.3%, 61.3%, 37.5%, 18.1% vs 89.1%, 61.1%, 37.2%, 17.8% vs 84.5%, 49.3%, 25.9%, 6.2%, P = 0.0151) were detected among the 3 arms. There were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm (P > 0.05). For the patients who had radical resection, significant differences in median PFS (48 mo vs 61 mo vs 39.5 mo, P = 0.0331) and median OS (56.5 mo vs 72 mo vs 41.5 mo, P = 0.0153) were detected among the 3 arms, but there were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm (P > 0.05). The local recurrence rates in the preoperative CRT, postoperative CRT group and S group were 11.3%, 14.1% and 35%, respectively (P < 0.05). No significant differences were detected among the 3 groups when comparing complications but tended to be in favor of the postoperative CRT and S groups (P > 0.05). Toxicities of CRT in the preoperative or postoperative CRT arms were mostly moderate, and could be quickly alleviated by adequate therapy. Rational application of preoperative or postoperative CRT can provide a benefit in PFS and OS in patients with locally advanced ESCC.

Preventive Wrapping of the Fragile Tracheobronchial Wall Using a Flap of Latissimus Dorsi Muscle during Esophagectomy after Chemoradiotherapy

Background: Thanks to significant recent progress in the application of chemoradiotherapy (CRT) in the treatment of esophageal cancer, the numbers of operations on patients who have undergone preoperative CRT are increasing. In these patients, preoperative CRT often leads to formation of an unstable, scleroid layer comprised of what appears to be scar tissue around the tracheobronchial wall. This scleroid layer must be removed with the tumor, thereby weakening the wall. Method: We performed preventive intrathoracic transposition of a pedicled latissimus dorsi muscle flap on 6 patients with clinically T4 esophageal cancer (6 males; age: 63–75 years). All 6 patients had undergone preoperative CRT (median, 43.0 Gy; range, 32.0–60.0 Gy; with cisplatin + 5-fluorouracil infusion) to relieve direct invasion of the airway. Results: In 6 patients, preventive use of a pedicled latissimus dorsi muscle flap resulted in uneventful recovery from the tracheobronchial wall weakness. Anastomotic leakage, recurrent nerve paralysis and pneumonia occurred in 2 patients each (33.3%); there were no life-threatening complications or operation-related deaths, however. Conclusions: When performing an esophagectomy for thoracic esophageal squamous-cell cancer in patients who have received preoperative CRT, the weakened tracheobronchial wall can potentially be reinforced using a pedicled latissimus dorsi muscle flap.

A population based analysis of surgical and adjuvant therapy for resectable gastric adenocarcinoma

6596 Background: The utilization of adjuvant therapy after resection for gastric adenocarcinoma has become standard of care since the publication of the Intergroup 0116 data. The resection of at least 15 lymph nodes (LN) has been shown to improve staging accuracy. The aims of this study were: 1) to assess current practice patterns in the treatment of gastric cancer, 2) to determine the association between the use of chemoradiotherapy (CRT) and patient survival. Methods: Data from the Oregon State Cancer Registry were abstracted for demographics, disease stage, resection type, number of LNs resected, adjuvant CRT, and survival for the years 1996–2006. Only patients with resection for stage IB-III disease were selected for analysis. Patients were divided into those who received treatment through year 2001 (group 1) and after 2001 (group 2). The x2 test was used to compare the application of CRT between groups. Number of LNs sampled was evaluated with the Mann-Whitney U test. Univariate and multivariate analyses of survival were performed with the Kaplan-Meier log-rank test and the Cox proportional hazards model. Results: There were 313 patients who met study criteria. Adjuvant therapy was employed in 14.2% of cases in group 1 vs 33.3% in group 2 (p<0.001). The median number of LNs sampled in group 1 was 10 compared to 11 in group 2 (p=0.026). Thirty-five percent of patients had at least 15 nodes sampled irrespective of resection type. Survival analysis demonstrated a 5 month median survival advantage for patients that received CRT (Table). Conclusions: Although the proportion of patients who received adjuvant CRT increased after publication of Intergroup 0116 data, 66% of patients that were eligible did not receive CRT. Patients who received stage-appropriate adjuvant therapy demonstrated a trend toward improved survival. The number of LNs sampled did not appear to influence survival. Future efforts should focus on removing barriers to the receipt of adjuvant therapy following resection of gastric adenocarcinoma. Survival analysis for patients with resectable gastric adenocarcinoma Category Median Survival (months) P value Univariate P value Multivariate Hazard Ratio (95% CI) T Stage - 0.027 0.011 NA T1 47 NA NA T2 23 0.068 2.67 (0.93–7.67) T3 13 0.012 3.80 (1.34–10.77) T4 16 0.010 4.67 (1.45–15.00) N Stage - 0.071 0.020 NA N0 21 NA NA N1 16 0.008 1.64 (1.14–2.37) N2 13 0.038 1.59 (1.03–2.45) >15 Nodes Sampled - 0.868 0.738 0.94 (0.67–1.33) No 17 Yes 17 CRT - 0.300 0.099 0.71 (0.48–1.07) No 15 Yes 20 CRT, chemoradiotherapy; CI, confidence interval No significant financial relationships to disclose.

特集 （２） ハイパーサーミアが著効を示した症例 温熱併用放射線化学療法が著効を示した下顎へん平上皮癌の１例

特集 （２） ハイパーサーミアが著効を示した症例 温熱併用放射線化学療法が著効を示した下顎へん平上皮癌の１例