Simultaneous Chemoradiotherapy Research Articles

Lipiodol emulsion as a dual chemoradiation-sensitizer for pancreatic cancer treatment

Pancreatic ductal adenocarcinoma (PDAC) has a low survival rate and limited treatment options. Concurrent chemoradiotherapy is considered beneficial to improve tumor control, but the low drug bioavailability at tumor site and the low radiation tolerance of surrounding healthy organs greatly limits its effectiveness. Lipiodol, a natural drug carrier used in clinical transarterial chemoembolization, has shown potential as a radiosensitizer due to its high Z element iodine composition. Thus, this study aims to repurpose lipiodol as a sensitizer to simultaneously enhance chemo- and radiotherapy for PDAC. To this end, a stable lipiodol emulsion (IOE) loaded with gemcitabine is designed using clinically approved surfactants. At in vivo level, IOE demonstrates better radiotherapeutic effect than existing nanoradiosensitizers and enhanced drug bioavailability over free drug, leading to significant tumor inhibition and improved survival rates under concurrent chemo-radiotherapy. This may due to the sustained drug release, homogenous spatial distribution, and long-term retention ability of IOE in solid PDAC tumor. Furthermore, to better understand the functioning mechanism of drug-loaded IOE, in vitro study is conducted to reveal the ROS- and DNA damage-related therapeutic pathways. Lastly, a comprehensive toxicity assessment also proves the good biocompatibility and safety of as-prepared IOE. This study offers a clinically feasible sensitizer for simultaneous chemoradiotherapy and holds potential for other types of cancer treatment in clinics.

The effect of the relative dose intensity of chemoradiotherapy on the effectiveness of therapy of locally advanced unresectable non-small cell lung cancer

The purpose of the study. To estimate the number of patients with the preservation of relative dose intensity (RDI) ≥ 80 % of first-line antitumor therapy in patients with unresectable non-small cell lung cancer (NSCLC), and to compare the effectiveness of therapy in groups with optimal and lower RDI.Patients and methods. The study included 30 patients (25 men and 5 women) with locally advanced unresectable NSCLC. The median age was 57 years. The main criterion for inclusion in the study was morphologically verified NSCLC with stage IIIB-IIIC of the disease. All patients underwent simultaneous chemoradiotherapy. According to the histogenesis of the tumor process, patients with a squamous cell variant prevailed.Results. The data obtained from 22 (73.3 %) patients who retained a relative dose intensity of RDI > 80 % demonstrated that given dose intensity is sufficient to achieve a stable antitumor effect. In 8 (26.7 %) cases, however, the RDI was less than 80 %, which affected the effectiveness of the treatment. The median follow-up for overall survival (OS) was 29.2 months, progression-free survival (PFS) was 15.1 months, and local control was 21.9 months. in all patients included in the analysis. The indicators of OS in the second year had an advantage in the group of patients with RDI < 80 % and amounted to 73.3 % compared with 60.5 % in patients with RDI > 80 %. PFS was higher in the group of patients with high dose intensity, in the first year of follow-up it was 75.6 % compared with the group of patients with RDI < 80 % (62.5 %), in the second year of follow-up, PFS was 27.2 % and 20.8 %, respectively. Local control was 90.2 % in the first year in the group of patients with RDI > 80 % and 62.5 % in the group of patients with RDI < 80 %. The second year of follow-up demonstrated the advantage of the group of patients with RDI >80 % in terms of local control and amounted to 48.1 % versus 34.7 %, respectively.Conclusion. The results obtained show that maintaining relative dose intensity at a high level has a positive effect on survival rates and local control of patients with locally advanced unresectable NSCLC. However, there is a cohort of patients who did not receive the planned amount of treatment, due to the high toxicity of simultaneous chemoradiotherapy. It is necessary to develop new approaches to concomitant therapy aimed at reducing the toxicity of the combined treatment and achieving maximum antitumor effect.

Survival benefit of combined immunotherapy and chemoradiotherapy in locally advanced unresectable esophageal cancer: an analysis based on the SEER database.

While simultaneous chemoradiotherapy remains the established therapeutic modality for patients afflicted with locally advanced esophageal cancer, the effectiveness of this radical approach falls short of the desired outcome. Numerous investigations have illuminated the prospect of enhancing therapeutic efficacy through the amalgamation of chemoradiotherapy and immunotherapeutic interventions. Consequently, we embarked on an examination to scrutinize the potential survival advantages conferred by the confluence of chemoradiotherapy and immunotherapy in relation to locally advanced unresectable esophageal carcinoma, drawing upon the extensive SEER database for our analysis. We extracted clinicopathological attributes and survival statistics of patients afflicted with locally advanced unresectable esophageal carcinoma, diagnosed within the temporal span encompassing the years 2004-2014 and 2019-2020, from the extensive SEER database. To discern disparities in both overall survival (OS) and cancer-specific survival (CSS) between the cohorts subjected to chemoradiotherapy combined with immunotherapy and chemoradiotherapy alone, we employed analytical tools such as Kaplan-Meier analysis, the Log-rank test, the Cox regression proportional risk model, and propensity-matched score (PSM) methodology. A total of 7,758 eligible patients were encompassed in this research, with 6,395 individuals having undergone chemoradiotherapy alone, while 1,363 patients received the combined treatment of chemoradiotherapy and immunotherapy. After 1:4 propensity score matching, 6,447 patients were successfully harmonized, yielding a well-balanced cohort. The Kaplan-Meier curves demonstrated a substantial enhancement in OS (P = 0.0091) and CSS (P < 0.001) for the group subjected to chemoradiotherapy combined with immunotherapy as compared to chemoradiotherapy alone. Further multivariable analysis with PSM confirmed that chemoradiotherapy combined with immunotherapy benefits OS(HR=0.89, 95% CI 0.81-0.98) and CSS (HR=0.68, 95% CI 0.61-0.76). In addition, Univariable and multivariable Cox regression analyses of the matched patient groups unveiled several independent prognostic factors for OS and CSS, including sex, age, marital status, tumor location, tumor size, pathologic grade, SEER historic staging, and treatment modality. Among these factors, being female, married, and receiving chemoradiotherapy combined with immunotherapy emerged as independent protective factors, while age exceeding 75 years, non-superior segment tumor location, tumor size greater than 6cm, Grade 3-4 pathology, and regional SEER historic staging were all found to be independent risk factors. The survival advantage of the chemoradiotherapy combined with the immunotherapy group over the chemoradiotherapy alone group was substantial. This investigation furnishes compelling evidence that the integration of immunotherapy with chemoradiotherapy confers a noteworthy survival advantage when contrasted with conventional chemoradiotherapy for individuals grappling with locally advanced unresectable esophageal carcinoma.

Trimodale Therapie des muskelinvasiven Blasenkarzinoms – eine äquivalente Alternative zur Operation im lokalisierten Tumorstadium?

BackgroundThe standard treatment of muscle-invasive bladder cancer is cystectomy with pelvic lymphadenectomy. Primary organ-preserving trimodal treatment is considered an alternative to radical surgery.ObjectiveThe concept and results of trimodal treatment, consisting of initial transurethral resection of the bladder tumor (TURBT) followed by simultaneous chemoradiotherapy (CRT), are presented.Material and methodsAn evaluation of retrospective case series and prospective treatment optimization studies on organ-preservation concepts was carried out. Comparative meta-analyses comparing cystectomy with trimodal treatment are presented.ResultsA complete TURBT including bladder mapping and tumor ground biopsy should be done before CRT. Radiosensitization should be with cisplatin-based chemotherapy or with a combination of 5‑fluorouracil and mitomycin C. Complete response rates after TURBT plus CRT are achieved by 60–90% of patients and 5‑year survival rates of 40–75%, with preservation of the bladder in approximately 80% of surviving patients.ConclusionTrimodal treatment is a viable alternative to radical cystectomy with curative intention for patients with muscle-invasive urinary bladder cancer. Patients with early tumors (cT2/3N0) are particularly suitable in whom the initial TURBT leads to complete tumor resection (R0). Older patients can also benefit from this approach.

Cost effectiveness and health-related quality of life of chemoradiotherapy versus radiation therapy alone in elderly head and neck cancer patients

PurposeRadiotherapy (RT) constitutes a mainstay in the treatment of elderly patients with head and neck cancer (HNC), but use of simultaneous chemoradiotherapy (CRT) remains controversial. We have conducted a prospective analysis based on real-world patient data to examine the health-related quality of life (HRQoL) and cost effectiveness (CE) of CRT vs. RT in elderly HNC patients.MethodsEligible participants ≥ 65 years treated in a large tertiary cancer center between July 2019 and February 2020 who completed the validated EQ-5D-5L questionnaire (health state index [HI] and visual analog scale [VAS]) before and after RT were included. CE referred to direct medical costs, including diagnosis-related group (DRG)-based billings for inpatients and uniform assessment standard (EBM)-based costs for outpatients. The primary endpoint was cost (euros [€]) per quality-adjusted life year (QALY). The incremental cost-effectiveness ratios (ICERs) were calculated. Costs and QALYs were not discounted for short overall survival (OS).ResultsBaseline HRQoL was 0.878 (±0.11) in the CRT group and 0.857 (±0.17) in the RT group. Upon completion of therapy, HRQoL amounted to 0.849 (±0.14) in the CRT and 0.850 (±0.13) in the RT group. The mean treatment-related cost in the CRT cohort was €22,180.17 (±8325.26) vs. €18,027.87 (±26,022.48) in the RT group. The corresponding QALYs amounted to 2.62 in the CRT and 1.91 in the RT groups. The ICER was €5848.31.ConclusionThis is the first analysis from the German health care system demonstrating that the addition of chemotherapy to RT for selected elderly HNC patients is cost effective and not associated with a significant HRQoL decline.

Uterine Carcinosarcoma after Prolonged Antiestrogenic Therapy-Pathohistological Characteristics, Immunohistichemical Analysis, Prognosis and Complex Treatment: A case report with literature review

Uterine carcinosarcoma (UCS) is a rare aggressive neoplasm.We present a clinical case with UCS, developed during along-term five years adjuvant tamoxifen treatment and ovarian suppression with LHRH agonist on the occasion of invasive ductal breast carcinoma. Crucial for obtaining diagnosis of this rare aggressive neoplasm is the strict pathohistological and immunohistochemical analysis, carried out by an experienced pathologist. Every patient with a history of breast carcinoma is a subject for periodic monitoring. Genital bleeding is required to perform a separated endometrial abrasion with a precise histological study. For UCS / III C2 FIGO stage without distant metastases is necessary to conduct a maximal surgical tumor reduction, involving ever total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, peritoneal cytology, and omentectomy, followed by a combined simultaneous chemo-radiotherapy of tumor bed and pelvic lymph nodes, definitive radiotherapy of para-aortical lymph nodes, as well as adjuvant chemotherapy.

Long-term efficacy and safety of simultaneous integrated boost radiotherapy in non-operative esophageal squamous cell carcinoma: a multicenter retrospective data analysis (3JECROG R-05)

Objective: To analyze the survival benefits and treatment related toxic effects of simultaneous integrated boost intensity-modulated radiotherapy (SIB-RT) for non-operative esophageal squamous cell carcinoma patients. Methods: The data of 2 132 ESCC patients who were not suitable for surgery or rejected operation, and underwent radical radiotherapy from 2002 to 2016 in 10 hospitals of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG) were analyzed. Among them, 518 (24.3%) cases underwent SIB (SIB group) and 1 614 (75.7%) cases did not receive SIB (No-SIB group). The two groups were matched with 1∶2 according to propensity score matching (PSM) method (caliper value=0.02). After PSM, 515 patients in SIB group and 977 patients in No-SIB group were enrolled. Prognosis and treatment related adverse effects of these two groups were compared and the independent prognostic factor were analyzed. Results: The median follow-up time was 61.7 months. Prior to PSM, the 1-, 3-, and 5-years overall survival (OS) rates of SIB group were 72.2%, 42.8%, 35.5%, while of No-SIB group were 74.3%, 41.4%, 31.9%, respectively (P=0.549). After PSM, the 1-, 3-, and 5-years OS rates of the two groups were 72.5%, 43.4%, 36.4% and 75.3%, 41.7%, 31.6%, respectively (P=0.690). The univariate survival analysis of samples after PSM showed that the lesion location, length, T stage, N stage, TNM stage, simultaneous chemoradiotherapy, gross tumor volume (GTV) and underwent SIB-RT or not were significantly associated with the prognosis of advanced esophageal carcinoma patients who underwent radical radiotherapy (P<0.05). Cox model multivariate regression analysis showed lesion location, TNM stage, GTV and simultaneous chemoradiotherapy were independent prognostic factors of advanced esophageal carcinoma patients who underwent radical radiotherapy (P<0.05). Stratified analysis showed that, in the patients whose GTV volume≤50 cm(3), the median survival time of SIB and No-SIB group was 34.7 and 30.3 months (P=0.155), respectively. In the patients whose GTV volume>50 cm(3), the median survival time of SIB and No-SIB group was 16.1 and 20.1 months (P=0.218). The incidence of radiation esophagitis and radiation pneumonitis above Grade 3 in SIB group were 4.3% and 2.5%, significantly lower than 13.1% and 11% of No-SIB group (P<0.001). Conclusions: The survival benefit of SIB-RT in patients with locally advanced esophageal carcinoma is not inferior to non-SIB-RT, but without more adverse reactions, and shortens the treatment time. SIB-RT can be used as one option of the radical radiotherapy for locally advanced esophageal cancer.

Application of Novel Hollow Carbon Nanosphere Drug-Loading System in Chemotherapy of Esophageal Squamous Cell Carcinoma.

With the continuous improvement of carbon nanotube synthesis and purification technology and the continuous improvement of carbon nanotube dispersion technology, carbon nanotubes have played an increasingly important role in the treatment of malignant tumours. One of the hot spots. Compared with other carbon nanotube materials, the carbon nanosphere drug loading system is more suitable for loading hydrophobic drugs, and the drug loading capacity is higher than other one-dimensional two-dimensional carbon nano-materials. In addition, carbon nanospheres of a suitable size are more easily absorbed by tumour cells and can carry a large amount of drugs for transport in the blood. And the pore structure of the carbon nanosphere is adjustable, and the drug release can be controlled by adjusting the pore size, and the pore diameter is generally less than 10 nm to prevent the drug from being released in advance. Esophageal cancer is one of the most frequently occurring malignancies in China, and the incidence of esophageal cancer ranks 8th in the world. Palliative chemotherapy is t he main treatment method for patients with advanced esophageal cancer. Simultaneous chemoradiotherapy has relatively obvious advantages in improving the survival rate of patients. It is of great significance to study the application of carbon nanosphere drug-loading system in chemoradiotherapy for esophageal squamous cell carcinoma. Therefore, in this study under the hydrothermal method, which is one of the commonly used methods for the synthesis of hollow carbon nanospheres, carboxymethyl chitosan was used as a carbon precursor, and the targeted drug erlotinib was loaded with carbon nanospheres. A new hollow nano-carbon sphere drug-loading system (HNCSDLS) was prepared and related characterizations were carried out. At the same time, the morphology, properties, in vitro and in vivo toxicity, bio-distribution, and anti-tumour activity of HNCSDLS were also studied in this study using scanning electron microscopy flow cytometry, laser confocal, spectrometer, cell proliferation experiment, and in vivo fluorescence imaging experiment Detection. The results of this study indicate that HNCSDLS has high biocom-patibility and stability, can be quickly distributed in the cytoplasm, and avoids lysosomal clearance. It can effectively deliver erlotinib to the tumour site, extend the drug's in vivo circulation time, inhibit tumour growth, reduce the toxicity of erlotinib to heart and kidney tissues, and increase its antitumor activity.

Sphincter necrosis after Chemoradiotherapy by anal squamous cell carcinoma Case report of a rare complication with review of the literature

Background: Anal carcinoma is a rare tumor, accounting for around 2–4% of all GI carcinomas. An increase in frequency has been described recently. The maximum age was 70 years. Simultaneous chemoradiotherapy(CRT) was able to establish itself as the standard therapy due to the potential for preservation of continence. Combined CRT with 5-fluorouracil (5-FU) and mitomycin-C (MMC) is currently the treatment of choice for all anal squamous cell carcinomas(SCC). The indication for abdominoperineal resection is today only as a

A Case of Buccal Mucosal Cancer with Function Preserved by Mold Irradiation

Surgical resection or brachytherapy has been used for curative treatment of oral cancer. Although only limited facilities perform brachytherapy, treatment results are as good as those of surgical resection and allow functional preservation. We report here the use of high-dose-rate brachytherapy with a remote after-loading system for mold irradiation for buccal mucosal cancer, in which function is expected to be impaired by surgical treatment. The patient was a woman in her 80s who visited a dental clinic complaining of pain in the left buccal mucosa. She was referred to our department, where a tumor with a rough surface of 39 mm×22 mm was found on the left buccal mucosa. Computed tomography showed a contrast-enhanced soft-tissue mass on the left cheek, with a thickness of 20 mm. Subsequent biopsy of the lesion revealed squamous cell carcinoma, and the tumor was classified as cT2N0M0 （stage Ⅱ）. Surgical resection would be expected to cause dysfunction through the skin on the cheek, therefore simultaneous chemoradiotherapy was planned. The thickness of the oral mucosa should be less than 15 mm, but was 20 mm in this case, making brachytherapy unsuitable. We therefore created a mold device using the occlusion plate to extend the buccal mucosa and maintain contact with the source of radiation, allowing irradiation of the tumor. Mold irradiation was performed using 192-Ir at a total dose of 60 Gy. The patient remains recurrence-free as of 2 years 6 months after mold irradiation.

Firsthand experience of chemoradiotherapy in patients with localized small cell lung cancer. Retrospective assessment

Introduction. In modern recommendations for the treatment of localized small cell lung cancer (SCLC), preference is given to socalled «early» chemoradiotherapy (CRT), which has a number of limitations due to its pronounced toxicity. With regard to prophylactic brain irradiation (PBI), although there is reliable evidence that it is necessary, PBI cannot be performed on all patients due to the frequent refusals of the patients themselves and the accompanying neurological pathology. The article presents own experience of therapy of patients with localized SCLC with the analysis of accumulated data. Materials and methods. Retrospective assessment of treatment results of patients with localized SCLC was carried out. The analysis included data on 63 patients. 47 patients received simultaneous CRT and 16 patients received consecutive CRT. The results of simultaneous CRT were evaluated first. 27 patients received “early” CRT, while 20 patients received “late” CRT. Results. The PFS median for the group of early CRT was 9.5 months (95% CI 4.2–14.9) and for the group of “late” CRT it was 11.8 months (6.4–17.1). The difference is statistically unreliable. The median of total survival rate was higher in the group of “early” CRT, despite the fact that PFS was lower. The OS median in the group of “early” CRT was 27.9 months (95% CI 2.1–53.7), and in the group of “late” – 24.8 months (95% CI 13.3–36.1). The difference is statistically unreliable. Prophylactic brain irradiation (PBI) in the group of patients with simultaneous CRT was received by 26 patients (55%). The results of overall survival show the crucial importance of PBI in patients with localized SCLC. The OS median in patients who received PBI was 45.9 months (95% CI 21.2–70.5), in patients who did not receive PBI – 21.7 months (95% CI 14.3–29). The difference is statistically significant, p = 0.01. As for complications, 2nd degree esophagitis was recorded more frequently in the group of early CRT – 57% in the group of early CRT and 42% in the group of late CRT, 3rd degree esophagitis was recorded in 1 patient in each group, the difference is not significant. Grade 3–4 hematological toxicity was observed in 5 patients in the group of early CRT and 2 patients in the group of late CRT, the difference is also unreliable. The OS median in the group of patients who received consecutive CRT was 27.1 months (95% CI 18.2–37.6), and the OS median in the group of patients who received simultaneous CRT was 27.9 months (95% CI 18.9–36.9). Conclusions. The obtained data show an unreliable advantage of the “early” CRT over the “late” CRT in terms of overall survival. However, no differences in median time before progression of both local and general ones were obtained. It is extremely important to perform PBI in patients with localized SCLC, as the survival rate in the assessed group of patients doubled.

Conservative treatment of stage III lung cancer using chemoradiotherapy in hypofractionation mode, case report

Lung cancer is a leader in the world in terms of morbidity and mortality. Moreover, the number of patients with locally advanced forms of non-small cell lung cancer exceeds 30% of all newly diagnosed cases. The standard of treatment for patients with inoperable stage III lung cancer is chemoradiotherapy. Currently, ways to increase the effectiveness of chemoradiotherapy are being considered, in particular, local escalation of the radiation dose to the tumor, which allows personalizing approaches in the treatment of this category of patients. One of the most common complications of chemoradiotherapy is post-radiation pulmonitis, which requires timely diagnosis and treatment with glucocorticosteroids in severe cases. We present a case report of a patient with locally advanced non-small cell lung cancer who received treatment as part of simultaneous chemoradiotherapy in the hypofraction mode, complicated by post-radiation pulmonitis. Successful treatment of complications led to the restoration of the general condition of the patient; during the follow-up examination, a complete response to the specific treatment was recorded. Thus, a promising method of treating patients with inoperable stage III non-small cell lung cancer is the option of simultaneous chemoradiotherapy with local escalation of the radiation dose to the tumor, while being wary of complications such as pulmonitis, allows for timely diagnosis and treatment of the condition.

Age-dependent hemato- and nephrotoxicity in patients with head and neck cancer receiving chemoradiotherapy with weekly cisplatin.

In cases of simultaneous chemoradiotherapy (CRT), early recognition of toxic side effects is important, as drug discontinuation may prevent further injury. It appears favorable to undertake further steps to investigate whether patient subgroups behave differently depending on their toxicity profile. We retrospectively analyzed 125 consecutive patients with non-metastasized carcinoma of the head and neck who were treated with CRT (cisplatin 40 mg/m2 weekly) in 2013/2014. Patients were planned to receive six cycles of cisplatin. Statistical analyses were performed using the chi2 test, t-test, Kaplan-Meier method, and the log-rank test, as appropriate. Eighty-six patients did not reach the intended sixth cycle (68.8%; 60.0% of whom were ≥60years, p < 0.05). Acute kidney injury (glomerular filtration rate <60 mL/min/1.73m2) was the most common reason for drug discontinuation (26.7%; 82.6% of whom were ≥60years; p < 0.01), followed by leukopenia <3/nL (23.3%; 75% of whom were <60years; p < 0.01) and infection (11.6%). Patients who underwent ≥5cycles were associated with prolonged overall survival and metastasis-free survival after CRT (p < 0.02; median follow-up 24months), especially patients <60years. Acute kidney injury was the most common side effect in patients ≥60years, whereas leukopenia characteristically occurred significantly more often in younger patients. Discontinuing cisplatin during CRT was associated with aworse outcome, especially in patients <60years.

Effect of preoperative radiotherapy with boost dose to lateral pelvic lymph node on the prognosis of patients with locally advanced rectal cancer

Objective To evaluate the effect of preoperative radiotherapy with boost dose to lateral pelvic lymph nodes (LPN) on the prognosis of patients with locally advanced rectal cancer (LARC) treated with preoperative simultaneous chemoradiotherapy. Methods The clinical data of 116 LARC patients with complete follow-up who received adjuvant chemoradiotherapy and curative resection between March 2011 and April 2017 in Liuzhou Worker's Hospital were analyzed retrospectively. The patients were classified into two groups according to the LPN metastatic status from preoperative image: patients without suspected LPN metastasis who received preoperative simultaneous chemoradiotherapy (pelvic irradiation: 45-50.4 Gy; chemotherapy regimen: based on 5-fluorouracil) plus radical operation (the regular group, 85 cases), and patients with suspected LPN metastasis who received local boost radiation on the basis of whole radiotherapy in pelvic cavity (the boost group, 31 cases). Additional radiation boost with a total dose of 59.4-61.6 Gy to LPN was administrated to patients in the boost group. The adverse reactions of acute radiotherapy in both groups were compared by using χ2 test and Fisher exact test. Kaplan-Meier method was used to make survival analysis and Log-rank was used to make the testing. Results The common acute adverse reactions of both groups were grade 1-2 in newly adjuvant chemoradiotherapy. Significant acute adverse reactions (grade 3 or higher) in the regular group and the boost group included diarrhea [15.3% (13/85) vs. 19.4% (6/31), χ2= 0.273, P= 0.601], leukopenia [9.4% (8/85) vs. 9.7% (3/31), χ2= 0.006, P= 0.941], and radiodermatitis [4.7% (4/85) vs. 6.5% (2/31), P= 0.657]. The median follow-up time was 30.3 months (11.1-82.3 months). Locoregional recurrence occurred in 10 patients of the regular group and 4 patients of the boost group, and 16 patients and 6 patients died of the regular group and the boost group respectively. Kaplan-Meier survival results showed that there were no significant differences in local recurrence-free survival rate (χ2= 0.121, P= 0.728) and overall survival rate (χ2= 0.605, P= 0.469). Conclusion Radiotherapy boost to LPN can offset the poor prognosis of LPN metastases on patients with LARC and can be considered as a safe and effective treatment option for LARC patients with suspected LPN metastasis. Key words: Rectal neoplasms; Lateral pelvic lymph nodes; Simultaneous chemoradiotherapy; Radiation boost

Treatment of Squamous Cell Carcinoma of the Esophagus Synchronously Associated with Head and Neck Cancer.

The aim of this study was to clarify the treatment strategy for synchronous squamous cell carcinoma of the esophagus (ESCC) and head and neck cancer (HNC). Treatment outcomes of 91 patients with synchronous ESCC and HNC were evaluated. Thirty-eight patients received simultaneous definitive chemoradiotherapy (CRT) and 15 patients underwent simultaneous resection. Among the patients who received simultaneous CRT, adverse events (grade 3-5) were recognized in 14 patients (40%), including one case of death due to aspiration pneumonia. Complete response was observed in 22 patients with ESCC (58%) and 19 patients with HNC (50%). The five-year survival rate was 44%. There were no in-hospital deaths after simultaneous resection; however, postoperative complications were recognized in 4 patients. The five-year OS was 70%. The treatment of synchronous ESCC and HNC must be decided by adopting a strategy that is appropriate for each case. Both simultaneous CRT and simultaneous resection are feasible and effective treatment options.

SYNCHRONOUS COMBINED THERAPY IN ONCOLOGY

There are presented the main principles and possibilities of simultaneous chemoradiotherapy, including intra-tumoral administration of antitumor drugs in combination with irradiation of primary bone tumors with soft tissue components, metastatic damage of bones, soft tissue tumors as well as superficial tumors and metastases. On the example of 23 patients the high efficiency of synchronous combined therapy is showed. The possibility of using low total doses of ionizing radiation in order to significantly increase the local cytotoxicity of antitumor drugs directly in the tumor focus is substantiated. The proposed variant of synchronous combined therapy makes it possible to obtain a pronounced local effect with minimal systemic toxicity.

Clinical Outcome of Induction Chemotherapy and Simultaneous Chemo Radiotherapy in Stage IIIA or IIIB Inoperable Non-Small Cell Lung Cancer

Clinical Outcome of Induction Chemotherapy and Simultaneous Chemo Radiotherapy in Stage IIIA or IIIB Inoperable Non-Small Cell Lung Cancer

Long-term results of combined and complex treatment of patients with locally advanced HER2-positive breast cancer

The study included 73 women with stage III HER2-positive locally advanced breast cancer (BC) which received simultaneous chemoradiotherapy in combination with targeted therapy. Patients were stratified into two groups: in the first group patients in the neoadjuvant received concomitant chemoradiotherapy in combination with trastuzumab, in the second group patients were prescribed no targeted therapy. The therapy with trastuzumab appeared to be the most effective. 3-year survival rate in the first group was 85.5%, 73.3% – in the second group, 5-year survival rate was 73.9% and 40.3% respectively (p<0.05). Herewith, disease-free survival was higher in the trastuzumab group, but the difference did not reach statistical significance. 3-year disease-free survival rate in the first group was 71.4%, 47.6% – in the second group, 5-year disease-free survival was 40.9% and 26.0% respectively (p=0.06). In addition, the study analyzed the influence of radical mastectomy surgery on long-term outcomes, and explored the efficacy of different fractionation regimes. The findings led to the conclusion that the combined chemoradiotherapy in combination with targeted therapy is an effective treatment for patients with the HER2-positive locally advanced BC. Provided that this therapy is not inferior to the comprehensive treatment which includes surgery and can be used as an independent method of treatment without surgery and associated complications.

Postoperative adjuvant therapy for resectable thoracic esophageal squamous cell carcinoma: a retrospective analysis of 426 cases.

The aim of this study was to evaluate the value of postoperative adjuvant therapy for resectable thoracic esophageal squamous cell carcinoma (ESCC) in China. We retrospectively analyzed 426 eligible patients seen between October 2007 and November 2011. Specifically, we assessed clinicopathological characteristics and the disease-free and overall survival rates. Of the 426 patients, 272 cases underwent surgery alone, and 154 cases received postoperative adjuvant therapy (67 cases with radiotherapy, 57 cases with chemotherapy, and 30 cases with simultaneous chemoradiotherapy). The median follow-up time was 48.0months (23.0-72.0months), and the median survival time was 48.4months (1.0-72.0months). We found a significant difference between the surgery-alone and adjuvant therapy groups in the status of lymph node (LN) metastasis (N stage; P<0.01), but there were no differences between the two groups with regard to other clinicopathological characteristics, including age, sex, lesion location, T stage, differentiation grades, surgery approach, or average number of LN dissections. The 5-year disease-free survival (DFS) rates of the surgery-alone and adjuvant therapy groups were 48.9 and 37.1%, respectively (P<0.001); no significant difference was found in 5-year overall survival (OS) rate between the two groups (P>0.05). A stratification analysis based on N stage suggested that the 5-year DFS and OS rates were similar in N0-N3 subgroups (P>0.05), except that patients with surgery alone had a higher 5-year DFS than those with postoperative adjuvant therapy in N0 subgroup (P=0.013). Our data suggest that patients with resectable thoracic ESCC may not benefit from postoperative adjuvant therapy. Further prospective studies are required to elucidate the utility of postoperative adjuvant therapy and to standardize individualized treatments for resectable ESCC.

Prognostic value of SPARC expression in unresectable NSCLC treated with concurrent chemoradiotherapy.

The aim of the present study was to determine the predictive/prognostic value of the secreted protein, acidic and rich in cysteine (SPARC) in cases of unresectable, locally advanced, non-small cell lung cancer. The study included 84 patients with Stage IIIA-B non-small cell lung cancer, undergoing simultaneous chemoradiotherapy including radiotherapy at a dose of 66 Gy and weekly docataxel (20 mg/m2) and cisplatin (20 mg/m2). SPARC expression was studied in biopsy material by immunohistochemical methods and correlations with treatment responses or survival were evaluated. Median overall survival was 16±2.73 (11.55-20.46) months for low expression vs 7±1.79 months (7.92-16.08) months for high expression (p=0.039), while median local control was 13±2.31 (8.48-17.5) months for low expression vs 6±0.85 (4.34-7.66) months for high expression (p=0.045) and median progression-free survival was 10±2.31 (5.48-14.5) months for low expression vs 6±1.10 (3.85-8.15) months for high expression (p=0.022). In both univariate and multivariate analyses, high SPARC expression was associated with significantly shorter overall survival (p=0.003, p=0.007, respectively), local control (p=0.008, p=0.036) and progression-free survival (p=0.004, p=0.029) when compared to low SPARC expression. No significant difference was detected between high and low SPARC expression groups regarding age, sex, T stage, N stage, histopathology and stage-related patient characteristics. High SPARC expression was identified as a poor prognostic factor in cases with locally advanced NSCLC treated with concurrent chemoradiotherapy.