Patients with Locally Advanced Esophageal Carcinoma Nonresponder to Radiochemotherapy: Who Will Benefit From Surgery?

Background In patients who are nonresponders to primary radiochemotherapy (RCT), prognosis is poor, leading mostly to palliation. Salvage surgery may have a survival benefit otherwise complete. Our aim was to identify predictors of R0 resection in these patients. Methods In 98 nonresponders with locally advanced infracarinal tumors, curative salvage surgery was attempted. Resection was R0 in 62.2% and incomplete in 37.8% of cases. Univariate and multivariate analyses included pre-RCT and post-RCT variables collected prospectively. Results Overall survival was higher in the R0 resection group (18.4 vs 8.6 months, P < .001). Independent predictors of R0 resection were tumor height ≤ 5 cm on barium swallow (P = .045) and aortic contact ≤ 90° on computed tomography (P = .039) evaluated after RCT. Three groups of patients were constructed: 1, tumor height ≤ 5 cm with aortic contact ≤ 90° (n = 43); 2, tumor height between 6 and 10 cm with aortic contact ≤ 90° (n = 32); and 3, aortic contact > 90°, irrespective of tumor height (n = 23). Rates of R0 resection were 81%, 53%, and 39%, respectively (P = .001). Conclusion Salvage esophagectomy should be systematically attempted in nonresponders with tumor height ≤ 5 cm on barium swallow and aortic contact ≤ 90° on computed tomography and discussed case by case for other patients. Presented in part and rewarded at the Second French-Speaking Conference of Digestive and Hepatobiliary Surgery, Paris, France, December 2006.     

A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy

Background This study aimed to compare the oncologic results for local excision via transanal endoscopic microsurgery (TEM) and those for laparoscopic resection (LR) via total mesorectal excision in the treatment of T₂ N₀, G_1-2 rectal cancer after neoadjuvant therapy with both treatments, incorporating a 5-year minimum follow-up period. Methods The study enrolled 70 patients whose malignancy was staged at admission as T₂ N₀, G_1-2 rectal cancer located within 6 cm of the anal verge with a tumor diameter less than 3 cm. Of these patients, 35 were randomized to TEM and 35 to LR. The patients in both groups previously had undergone high-dose radiotherapy (5,040 cGy in 28 fractions over 5 weeks) combined with continuous infusion of 5-flurouracil (200 mg/m²/day). Results The median follow-up period was 84 months (range, 72–96 months). Two local recurrences (5.7%) were observed after TEM and 1 (2.8%) after LR. Distant metastases (2.8%) occurred in one case each after TEM and LR. The probability of survival for rectal cancer was 94% for TEM and 94% for LR. Conclusions The study shows similar results between the two treatments in terms of local recurrences, distant metastases, and probability of survival for rectal cancer. An erratum to this article can be found at     

晚期鼻咽癌诱导化疗+同步放化疗与诱导化疗+放疗疗效比较

目的 比较诱导化疗+同步放化疗与诱导化疗+放疗在T3～4N0～1M0和T1～4N2～3M0期鼻咽癌患者的疗效.方法 对2002-2005年间收治的92分期为Ⅲ、Ⅳa期的400例鼻咽癌患者随机分为诱导化疗+同步放化疗组和诱导化疗+放疗组,其中对T3～4N0～1M0(197例)和T1～4N2～3M0(203例)期分别进行亚组分析.放疗采用常规分割方案,化疗采用氟尿嘧啶脱氧核苷+卡铂.结果 中位随访3.9年,随访率96.2%.T3～4N0～1M0期鼻咽癌患者诱导化疗+同步放化疗组(104例)和诱导化疗+放疗组(93例)的3年总生存率、无瘤生存率、无局部区域复发生存率、无远处转移生存率分别为84.0%和85.9%(χ2=0.08,P=0.780)、77.0%和72.0%(χ2=0.44,P=0.510)、89.5%和92.3%(χ2=0.65,P=0.420)、84.9%和77.0%(χ2=1.59,P=0.210);T1～4 N2～3 M0期(97例和106例)的分别为67.4%和82.2%(χ2=3.48,P=0.060)、61.5%和68.0%(χ2=1.86,P=0.170)、86.2%和87.0%(χ2=0.57,P=0.450)、66.2%和75.6%(χ2=2.07,P=0.150).急性毒副反应只有白细胞减少诱导化疗+同步放化疗比诱导化疗+放疗严重,其余相似.结论 采用诱导化疗+同步放化疗方案未能较诱导化疗+放疗进一步提高T3～4N0～1M0、T1～4N2～3M0期鼻咽癌总生存率.     

Radiation Therapy and Simultaneous Chemotherapy for Recurrent Cervical Carcinoma

Purpose: To evaluate the efficacy and toxicity in patients with recurrence of cervical cancer treated with radiotherapy and simultaneous chemotherapy.Patients and Methods: Between 1987 and 2001, 24 patients with recurrent cervical carcinoma were treated with concurrent chemoradiotherapy. Nine patients had incomplete tumor resection prior to radiation therapy. Irradiation was delivered to a total dose of 60 Gy, in three patients with central recurrences supplemented by brachytherapy. One patient was treated with brachytherapy alone. Simultaneous chemotherapy was done as a combined therapy of 5-fluorouracil-(5-FU, 600 mg/m²/d1–5, 29–33) and cisplatin (20 mg/m²/d1–5, 29–33; 16/24 patients) or of 5-FU (1,000 mg/m²/d1–5, 29–33) and mitomycin C (10 mg/m²/d2, 30; 1/24 patients). Cisplatin alone (25 mg/m²/d1–5) and carboplatin alone (800 mg/m²/d1–5) were administered in 5/24 patients (21%) and 2/24 patients (8%).Results: The 5-year local recurrence-free survival rate was 37%, disease-free survival 33%, and overall survival 34%. Grade 3 toxicity (NCI-CTC grade 3) occurred mainly as diarrhea (38%), leukopenia (33%), and nausea (21%). Severe toxicity (grade 4) was not seen in any of the patients.Conclusion: Radiation therapy with simultaneous chemotherapy for recurrences of cervical cancer is an effective treatment with acceptable toxicity.     

Ⅱ，Ⅲ期乳腺癌术后同步放化疗可行性研究

目的：通过对比观察Ⅱ,Ⅲ期乳腺癌术后放疗同步与非同步两组患者治疗过程的近期不良反应及耐受性,探讨乳腺癌术后同步放化疗的可行性。方法：乳腺癌术后患者分为放化疗同步组（36例）和放化疗非同步组（31例）,观察治疗过程中不良反应。结果：同步组和非同步组患者均能完成术后辅助性放化疗,Ⅲ度以上白细胞减少发生率以及Ⅲ度放射性皮炎同步组较非同步组多,但两组间比较无显著性差异（P＞0．05）。恶心呕吐、肝肾功能损害发生率以及心电图异常发生率两组间比较无显著性差异（P＞0．05）。结论：乳腺癌术后放化疗同步进行是可行的。     

食管癌患者放化疗期间合并恶性食管瘘的营养干预

目的：探讨营养支持干预对放化疗期间恶性食管瘘患者预后的影响。方法：回顾分析2010年1月-2012年12月本科收治的40例食管癌合并恶性食管瘘患者,总结营养干预方法、瘘管愈合情况及放化疗副反应发生情况。结果：40例患者中,32例瘘管闭合,6例未闭合予出院定期复查,2例死亡;放化疗治疗期间,副作用大多数为1~2级,8例出现3级及以上的呕吐,11例出现3级及以上的中性粒细胞减少,13例出现3级及以上的咳嗽。结论：营养风险筛查和肠内营养支持能有效提高食管癌合并恶性食管瘘的患者对放化疗的耐受性,完成相关治疗,并促进瘘口的愈合,值得在临床推广。     

Initiatives for education,training, and dissemination of morbidity assessment and reporting in a multiinstitutional international context: Insights from the EMBRACE studies on cervical cancer

In 2008, the GEC ESTRO Gyn network launched the first multiinstitutional, observational, and prospective international study on MRI-guided brachytherapy in locally advanced cervical cancer patients (EMBRACE-I). EMBRACE-I was followed by EMBRACE-II from 2016 and ongoing. Among the aims of the EMBRACE studies are to benchmark morbidity outcomes and develop dose-volume effects and predictive models for morbidity. The EMBRACE studies collect both physician (CTCAE v.3) and patient (EORTC QLQ-C30/CX24) reported outcomes, including baseline information, in a regular follow-up schedule. The EMBRACE studies feature high numbers of patients (EMBRACE-I N = 1416, EMBRACE-II N = 1500 expected) enrolled from many institutions worldwide (EMBRACE-I n = 23, EMBRACE-II n = 45). This large-scale multiinstitutional approach offers a unique opportunity to investigate and develop new strategies for improving the quality of assessment and reporting of morbidity.This report presents an overview of the challenges and pitfalls regarding the assessment and reporting of morbidity encountered during more than a decade of development and research activities within the EMBRACE consortium.This includes the recognition and evaluation of inconsistencies in the morbidity assessment, and consequently, the provision of assistance and training in the scoring procedure to reduce systematic assessment bias.In parallel, a variety of methodological approaches were tested to comprehensively summarize morbidity outcomes, and a novel approach was developed to refine dose-effect models and risk factor analyses.The purpose of this report is to present an overview of these findings, describe the learning process, and the strategies that have consequently been implemented regarding educational activities, training, and dissemination.     

特定波段红外灸对放化疗肿瘤患者升白细胞作用观察

目的　观察特定波段红外灸对放化疗肿瘤患者的升白细胞作用。方法　采用自制以 15 μm为辐射中心的特定波段红外灸疗仪对放化疗肿瘤患者足三里、关元、膈俞和悬钟穴施灸。结果　红外灸治疗第 1星期 ,患者白细胞计数即较治疗前提高 8.36 % ,但无统计学意义 ;至红外灸第 3星期 ,患者白细胞计数较灸前升高 35 .38% ,与灸前比较有显著差异 (P <0 .0 2 )。结论　特定波段红外灸对放化疗肿瘤患者有明显升白细胞作用。