scholarly journals External beam radiotherapy with or without californium-252 neutron brachytherapy for treatment of recurrence after definitive chemoradiotherapy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Wen-an Wu ◽  
Yi-ping Yang ◽  
Jing Liang ◽  
Jin Zhao ◽  
Jian-sheng Wang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Time ◽  
Median Survival Time ◽  
Response Rate ◽  
External Beam Radiotherapy ◽  
Survival Rates ◽  
External Beam ◽  
Definitive Chemoradiotherapy ◽  
Overall Survival Rates

AbstractWe aimed to evaluate the application of external beam radiotherapy (EBRT) combined with californium-252 (252Cf) neutron intraluminal brachytherapy (NBT) in patients with local recurrent esophageal cancer after definitive chemoradiotherapy (CRT). Sixty-two patients with local recurrent esophageal squamous cell carcinoma after definitive CRT were retrospectively analyzed; 31 patients underwent NBT+EBRT, and 31 received EBRT alone. The response rate; 1-, 2-, and 3-year overall survival rates; and adverse event occurrence rates were compared between these two patient groups. The response rate was 83.87% (26/31) in the NBT+EBRT group and 67.74% (21/31) in the EBRT group (p < 0.001). The 1-, 2-, and 3-year overall survival rates were 80.6%, 32.3%, and 6.5%, respectively, in the EBRT group, with a median survival time of 18 months. The 1-, 2-, and 3-year overall survival rates were 83.8%, 41.9%, and 6.9%, respectively, in the NBT+EBRT group, with a median survival time of 19 months. The differences between the groups were not significant (p = 0.352). Regarding acute toxicity, no incidences of fistula or massive bleeding were observed during the treatment period. The incidences of severe and late complications were not significantly different between the two groups (p = 0.080). However, the causes of death for all patients differed between the groups. Our data indicate that 252Cf-NBT+EBRT produces favorable local control for patients with local recurrent esophageal cancer after CRT, with tolerable side effects.

FA03.02: IS SURGERY STILL NECESSARY IN RESECTABLE OESOPHAGEAL CANCER? META-ANALYSES OF DEFINITIVE CHEMORADIOTHERAPY VERSUS TRIMODALITY THERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 6-6
Author(s):  
Daan Voeten ◽  
Chantal Den Bakker ◽  
Donald Van Der Peet
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Survival Rates ◽  
Oesophageal Carcinoma ◽  
Risk Of Bias ◽  
Survival Advantage ◽  
Definitive Chemoradiotherapy ◽  
Trimodality Therapy ◽  
Meta Analyses ◽  
Overall Survival Rates

Abstract Background Standard therapy for resectable oesophageal carcinoma is trimodality therapy (TMT) consisting of neoadjuvant chemoradiotherapy and oesophagectomy. Evidence of survival advantage of TMT over organ preserving definitive chemoradiotherapy (dCRT) is inconclusive. The aim of this study is to compare survival between TMT and dCRT. Methods A systematic review and meta-analyses were conducted. Randomised controlled trials and observational studies on primary resectable, curatively treated, oesophageal carcinoma patients above 18 years were included. Three online databases were searched for studies comparing TMT with dCRT. Primary outcomes were two-, three- and five-year overall survival rates. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs and cohort studies. Results Thirty-two studies described in 35 articles were included in this systematic review, thirty-three were included in the meta-analyses. Two-, three- and five-year overall survival was significantly lower in dCRT compared to TMT, with relative risks (RR) of 0.69 (95%CI, 0.57–0.83), 0.76 (95%CI, 0.63–0.92), and 0.57 (95%CI, 0.47–0.71) respectively. However, when only analysing studies with equal patient groups at baseline no differences for two-, three- and five-year overall survival were found with RRs of 0.83 (95%CI, 0.62–1.10), 0.81 (95%CI 0.57–1.14), 0.63 (95%CI, 0.36–1.12). The forest plot for three-year overall survival is presented in figure 1. Figure 1. 3 year overall survival rates Conclusion Despite limitations of the available evidence these meta-analyses suggest there is no survival advantage for TMT over dCRT, assuming comparable groups at baseline. Selection of surgical candidates in oesophageal carcinoma should be part of personalised and tailored care. Disclosure All authors have declared no conflicts of interest.

Survival rates in patients with primary metastatic breast cancer over a 10-year period: A retrospective analysis based on individual patient data from a multicenter data bank.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1577-1577
Author(s):  
Jana Barinoff ◽  
Philipp Harter ◽  
Florian Heitz ◽  
Christine Dittmer ◽  
Sherko Kuemmel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Metastatic Breast Cancer ◽  
Survival Rate ◽  
Survival Time ◽  
Median Survival Time ◽  
Survival Rates ◽  
Metastatic Breast ◽  
Data Bank ◽  
Therapy Options

1577 Background: Approximately 6% of patients with breast cancer have distant metastases at the time of the initial diagnosis. The aim of this analysis was to examine the overall survival rate over time and to investigate the effect of new therapy options. Methods: This retrospective analysis was performed based on the data bank of the Clinic for Gynaecological Oncology/ Dr. Horst Schmidt Klinik, Wiesbaden and the Clinic for Gynaecological Oncology and Senology/ Kliniken Essen Mitte, Essen. The patients with primary metastatic breast cancer (pmBC) who were diagnosed and treated at the accredited breast cancer centres of these clinics were enrolled between 1998 and 2007. The date of diagnosis was used to define 2 specifically chosen 5-year periods: 1998–2002 and 2003–2007. The follow-up time was on average 76 months. The Breslow Test was used to evaluate changes in the median survival time and to detect factors associated with the increase in survival rates. Results: Two hundred sixteen patients with complete baselines were analysed. Ninety patients were diagnosed between 1998 and 2002, and 126 patients received their diagnosis of pmBC between 2003 and 2007. The tumour-biological factors were the same in both groups, whereas the therapeutic concepts were different—the later group (2003–2007) received more aromatase inhibitors, taxane-based chemotherapy and trastuzumab. This finding resulted in an increased median survival time from 31 months in the years 1998–2002 to 44 months in the group with the first diagnosis between 2003 and 2007. Conclusions: Primary metastatic breast cancer occurred at constant rates over last 10 years. The tumour findings did not change in the time between the two examined groups; however, the treatment options in the 2003–2007 group included newly approved therapies. The time period of the first diagnosis was detected as a risk factor for overall survival. Those patients diagnosed in the more recent time frame had a significantly improved survival rate. The establishment of new therapy options may explain this finding.

PS02.032: PRETREATMENT INFLAMMATORY STATUS INFLUENCES THE PROGNOSIS OF CT4B ESOPHAGEAL CARCINOMA PATIENTS UNDERGOING DEFINITIVE CHEMORADIOTHERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 129-129
Author(s):  
Kotaro Sugawara ◽  
Koichi Yagi ◽  
Masato Nishida ◽  
Hiroharu Yamashita ◽  
Yasuyuki Seto
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Esophageal Carcinoma ◽  
Poor Prognosis ◽  
Conflicts Of Interest ◽  
Survival Rates ◽  
Clinical Staging ◽  
Definitive Chemoradiotherapy ◽  
Inflammatory Status ◽  
Overall Survival Rates

Abstract Background The outcome of definitive chemoradiotherapy (dCRT) for patients with cT4b esophageal carcinoma (EC) remains poor. Also, few studies focused on the prognostic factors in cT4b EC patients undergoing dCRT. Methods 80 patients undergoing dCRT for cT4b EC between 2006 and 2016 were retrospectively reviewed. All were in ECOG-PS 0–1. For evaluation of the pretreatment status, we employed demographic data, BMI, inflammatory marker (CRP), nutritional marker (Alb, prognostic nutritional index (PNI)) and tumor factors (clinical staging, pretreatment stenosis, tumor marker). Results There were 62 men with a mean age of 65 years (range, 41–83 years). 77 patients were squamous cell carcinoma, while 3 were adenocarcinoma. There were 12 (15%) patients with cM1 (lym) status. 36 (45.0%) patients had esophageal stenosis. 70 patients had cN + before dCRT, while 22 had cN + after dCRT. 30 patients (37.5%) had a CRP > 10 mg/l before dCRT, while 15 patients (18.8%) were in poor-nutritional status (PNI < 40). Of 80 patients, 1 patient gave up the treatment developing cerebral infarction. We analyzed survival in the 79 patients completing dCRT. Esophageal perforations were occurred in 5 (6.3%) patients. The 1- and 3-year overall survival rates were 59.8% and 38.3%, respectively. Salvage surgery was performed in 29 (36.3%) patients. R0 resection was achieved in 20 (69.0%) patients. Surgery-related death was developed in 3 patients. Pathological complete response was found in 10 (34.5%) patients. The 1- and 3-year overall survival rates of these 29 patients were 64.3% and 40.5%, respectively. Lastly, we evaluated prognostic factors in 79 patients. In univariable analysis, PNI < 40 (HR 2.43, 95% CI 1.19–4.63, P = 0.02), CRP ≥ 10 mg/l (HR 2.21, 95% CI 1.23–3.95, P = 0.01), pretreatment stenosis (HR 1.68, 95% CI 0.94–3.00, P = 0.08), cN + status after dCRT (HR 1.84, 95% CI 0.98–3.33, P = 0.06) were associated with poor prognosis. Subsequent multivariable Cox proportional hazards model revealed that CRP ≥ 10 mg/l (HR 2.00, 95% CI 1.03–3.81, P = 0.04) and cN + status after dCRT (HR 2.02, 95% CI 1.05–3.73, P = 0.03) were both independent risk factors for poor prognosis. Conclusion The outcome of dCRT for cT4b EC is acceptable. Pretreatment inflammatory status significantly influences the prognosis of patients undergoing dCRT. Disclosure All authors have declared no conflicts of interest.

Effect of weight loss on survival in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy and surgery.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24076-e24076
Author(s):  
Tao Li
Keyword(s):  
Overall Survival ◽  
Weight Loss ◽  
Esophageal Cancer ◽  
Esophageal Carcinoma ◽  
Survival Rates ◽  
Neoadjuvant Chemoradiotherapy ◽  
Severe Weight Loss ◽  
Low Weight ◽  
Weight Loss Group ◽  
Overall Survival Rates

e24076 Background: This study aimed to determine the impact of weight loss during neoadjuvant chemoradiotherapy on the survival of patients with esophageal carcinoma. Methods: We retrospectively examined 102 consecutive patients with esophageal carcinoma who underwent neoadjuvant chemoradiotherapy followed by radical resection at Sichuan Cancer Hospital & Institute between 2003 and 2017. The patients were divided into three groups based on the amount of body weight lost during neoadjuvant chemoradiotherapy: severe weight loss (>10%), high weight loss (5%–10%), and low weight loss (<5%). The correlations of weight loss with toxicity, progression-free survival, and overall survival were investigated. Results: The median overall survival was 49.7 months in the low weight loss group compared with 35.4 and 25.1 months in the high and severe weight loss groups ( P = 0.041). The 1-year overall survival rates in the severe, high, and low weight loss groups were 62.5%, 85.0%, and 90.7%, respectively; the corresponding 3-year overall survival rates were 21.9%, 47.3%, and 68.8%, respectively, and the corresponding 5-year overall survival rates were 21.9%, 31.0%, and 44.4%, respectively. The multivariate analysis indicated that a pathological complete response and severe weight loss were independent prognostic factors for overall survival. Any leukopenia ( P = 0.024), leukopenia of at least grade 3 ( P = 0.021), and anemia ( P = 0.042) occurred more frequently in the severe weight loss group. Conclusions: Weight loss during neoadjuvant CRT is an independent and adverse prognostic factor in esophageal carcinoma patients, whereas a stable weight confers a better prognosis. Keywords: esophageal cancer, prognosis, weight loss, neoadjuvant chemoradiotherapy, toxicity.

scholarly journals Role of adjuvant radiation therapy after radical hysterectomy in patients with stage IB cervical carcinoma and intermediate risk factors

2021 ◽  
pp. ijgc-2021-002489
Author(s):  
Dimitrios Nasioudis ◽  
Nawar A Latif ◽  
Robert L Giuntoli II ◽  
Ashley F Haggerty ◽  
Lori Cory ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cervical Carcinoma ◽  
Radical Hysterectomy ◽  
Adjuvant Radiotherapy ◽  
Survival Rates ◽  
External Beam ◽  
Intermediate Risk ◽  
Node Negative ◽  
Stage Ib ◽  
Overall Survival Rates

ObjectiveTo investigate the outcomes of observation-alone versus adjuvant radiotherapy for patients with lymph node negative FIGO 2018 stage IB cervical carcinoma following radical hysterectomy with negative prognostic factors.MethodsThe National Cancer Database was accessed and patients with no history of another tumor, diagnosed with intermediate risk (defined as tumor size 2–4 cm with lymph-vascular invasion or tumor size >4 cm) pathological stage IB squamous, adenosquamous carcinoma or adenocarcinoma of the cervix between January 2010 and December 2015 who underwent radical hysterectomy with lymphadenectomy and had negative tumor margins were identified. Overall survival was assessed following generation of Kaplan–Meier curves and compared with the log-rank test. A Cox model was constructed to control for a priori selected confounders known to be associated with overall survival.ResultsA total of 765 patients were identified and adjuvant external beam radiotherapy was administered to 378 patients (49.4%). There was no difference in overall survival between patients who did and did not receive adjuvant radiotherapy, P=0.44: 4-year overall survival rates were 88.4% and 87.1% respectively. After controlling for patient age, histology, and surgical approach, the administration of adjuvant radiotherapy was not associated with better survival (HR 0.86, 95% CI 0.54 to 1.38). For patients who received adjuvant radiotherapy, there was no survival difference between those who did (n=219) and did not (n=159) receive concurrent chemotherapy, P=0.36: 4-year overall survival rates were 89.8% and 86.3%, respectively.ConclusionIn a large cohort of patients with lymph node negative, margin negative, stage IB cervical carcinoma, with negative prognostic factors, the administration of adjuvant external beam radiation therapy was not associated with a survival benefit compared with observation alone.

20 TREATMENT OPTIMIZATION AND PROGNOSTIC FACTORS IN ADVANCED ESOPHAGEAL CANCER

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
B Jakšić ◽  
M Prpić ◽  
J Murgić ◽  
A Prgomet Sečan ◽  
M Zovak ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Dose Rate ◽  
External Beam Radiotherapy ◽  
High Dose Rate ◽  
High Dose ◽  
External Beam ◽  
Radical Treatment ◽  
Intraluminal Brachytherapy

Abstract   Esophageal cancer is a disease with high mortality due to advanced stage at the time of diagnosis in patients with poor general condition and/or multiple comorbidities which makes them unsuitable for radical treatment. The goal of this clinical trial is finding optimal treatment for this group of patients. Methods Hypothesis of this clinical trial is that sequential use of high dose rate intraluminal brachytherapy, external beam radiotherapy and chemotherapy decreases symptoms of disease, improves quality of life and prolongs overall survival in patients with esophageal cancer that are not candidates for radical treatment. We have included patients with esophageal cancer that are not candidates for radical treatment. Statistical analysis was done only for the patients that have completed planned treatment and not for the intent to treat population. Therefore, statistical analysis was done for 39 patients, 22 in control group and 17 in interventional group. Results In a survival analysis adapted for AJCC stage of the disease, addition of sequential chemotherapy improves overall survival statistically significant (P = 0.004). Sequential use of high dose rate intraluminal brachytherapy and external beam radiotherapy decreases the degree of: dysphagia (P = 0.001), odynophagia (P = 0.002) and regurgitation (P = 0.008) statistically significant. Decrease of a pain degree is statistically significant only with the use of sequential chemotherapy (P = 0.031). Sequential use of chemotherapy does not improve control over dysphagia (P = 0.872), odynophagia (P = 0.872) and regurgitation (P = 0.872) any further. Patients of female gender have greater improvement of regurgitation score (P = 0.068), pain score (P = 0.09) and quality of life (P = 0.019). Conclusion Sequential use of high dose rate intraluminal brachytherapy and external beam radiotherapy provides a safe use of high radiotherapy doses with minimal exposure of organs at risk, according to dose-volume histogram analysis. Sequential use of chemotherapy, after high dose rate intraluminal brachytherapy and external beam radiotherapy, improves overall survival in patients with esophageal cancer that are not candidates for radical treatment, in comparison to patients who do not receive chemotherapy (P = 0.09).

Evaluating the use of external beam radiation alone in the management of cervix cancer

2017 ◽  
Vol 17 (1) ◽  
pp. 37-43
Author(s):  
Thuraya Al-Hajri ◽  
Naghmeh Isfahanian ◽  
Najlaa Alyamani ◽  
Soha Atallah ◽  
E. Choan ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tumour Size ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Survival Rates ◽  
Cervix Cancer ◽  
External Beam Radiation ◽  
External Beam ◽  
Curative Intent ◽  
Beam Radiation

AbstractAimTo determine the outcome of patients with locally advanced cervix cancer treated with curative intent using external beam radiotherapy (EBRT), without brachytherapy.Materials and methodsA chart review was performed of all patients with cervix cancer who received EBRT alone at our centre from 2000 to 2010. Overall survival and local control were evaluated using Kaplan–Meier survival curves.ResultsIn total, 22 patients were identified. The median age and follow-up were 56 years and 65 months, respectively. The stage included IB to IVB. Main histology was squamous cell carcinoma (82%). Median tumour size was 5·5 cm. Majority treated with 3D conformal techniques and nine patients (41%) were treated with intensity-modulated radiation therapy (IMRT); 14 patients received doses of ≥65 Gy. Most patients (73%) received weekly concurrent cis-platinum. The major reason for not receiving brachytherapy was locally extensive tumour (59%). The 5-year relapse-free survival and overall survival rates were 57 and 50%, respectively. Seven patients (32%) had a component of loco-regional failure, mainly within the cervix. There was a better outcome among the nine patients treated with IMRT to a median dose of 66 Gy with a loco-regional control of 78%.ConclusionsPatients who cannot have brachytherapy may still achieve acceptable rates of loco-regional disease control if high radiation doses (>65 Gy) was delivered.

Are Incidental Minute Pulmonary Nodules Ultimately Determined to Be Metastatic Nodules in Esophageal Cancer Patients?

Oncology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Norihiro Matsuura ◽  
Koji Tanaka ◽  
Makoto Yamasaki ◽  
Kotaro Yamashita ◽  
Tomoki Makino ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Overall Survival ◽  
Esophageal Cancer ◽  
Retrospective Study ◽  
Cancer Patients ◽  
Survival Rates ◽  
Pulmonary Nodules ◽  
Resectable Esophageal ◽  
Resectable Esophageal Cancer ◽  
Overall Survival Rates

<b><i>Purpose:</i></b> Esophageal cancer patients may simultaneously have resectable esophageal cancer and undiagnosable incidental minute solid pulmonary nodules. While the latter is rarely metastatic, only a few studies have reported on the outcomes of such nodules after surgery. In this retrospective study, we assessed the incidence of such nodules, the probability that they are ultimately metastatic nodules, and the prognosis of patients after esophagectomy according to the metastatic status of the nodules. <b><i>Methods:</i></b> Data of 398 patients who underwent esophagectomy for resectable esophageal cancer between January 2012 and December 2016 were collected. We reviewed computed tomography (CT) images from the first visit and searched for incidental minute pulmonary nodules &#x3c;10 mm in size. We followed the outcomes of these nodules and compared the characteristics of metastatic and nonmetastatic nodules. We also assessed the prognosis of patients whose minute pulmonary nodules were metastatic. <b><i>Results:</i></b> Among the patients who underwent esophagectomy, 149 (37.4%) had one or more minute pulmonary nodules, with a total of 285 nodules. Thirteen (4.6%) of these nodules in 12 (8.1%) patients were ultimately diagnosed as being metastatic. Thirteen (8.7%) patients experienced recurrence at a different location from where the nodules were originally identified. Characteristics of the metastatic nodules were not unique in terms of size, SUVmax, or location in the lungs. Two-year and 5-year overall survival rates of patients whose nodules were metastatic were 64.2 and 32.1%, respectively. <b><i>Conclusion:</i></b> The rate of minute pulmonary nodules which were ultimately metastatic was 4.6%. Our findings suggest that esophagectomy followed by the identification of minute pulmonary nodules is an acceptable strategy even if the nodules cannot be diagnosed as being metastatic on the first visit CT due to their small size.

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