scholarly journals Individualized Radiation Dose Escalation Based on the Decrease in Tumor FDG Uptake and Normal Tissue Constraints Improve Survival in Patients With Esophageal Carcinoma

2016 ◽  
Vol 16 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Jinbo Ma ◽  
Zhaoyang Wang ◽  
Chengde Wang ◽  
Ercheng Chen ◽  
Yaozong Dong ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Dose ◽  
Esophageal Carcinoma ◽  
Dose Escalation ◽  
Normal Tissue ◽  
Metabolic Response ◽  
Survival Rates ◽  
Complete Metabolic Response ◽  
Computer Tomography Scan ◽  
Overall Survival Rates

Background: To determine whether individualized radiation dose escalation after planned chemoradiation based on the decrease in tumor and normal tissue constraints can improve survival in patients with esophageal carcinoma. Methods: From August 2005 to December 2010, 112 patients with squamous esophageal carcinoma were treated with radical concurrent chemoradiation. Patients received positron emission tomography-computer tomography scan twice, before radiation and after radiation dose of 50.4 Gy. All patients were noncomplete metabolic response groups according to the Response Evaluation Criteria in solid tumors. Only 52 patients with noncomplete metabolic response received individualized dose escalation based on tumor and normal tissue constraints. Survival and treatment failure were observed and analyzed using SPSS (13.0). Results: The rate of complete metabolic response for patients with noncomplete metabolic response after dose escalation reached 17.3% (9 of 52). The 2-year overall survival rates for patients with noncomplete metabolic response in the conventional and dose-escalation groups were 20.5% and 42.8%, respectively( P = .001). The 2-year local control rates for patients were 35.7% and 76.2%, respectively ( P = .002). When patients were classified into partial metabolic response and no metabolic response, 2-year overall survival rates for patients with partial metabolic response were significantly different in conventional and dose-escalation groups (33.8% vs 78.4%; P = .000). The 2-year overall survival rates for patients with no metabolic response in two groups (8.6% vs 15.1%) did not significantly differ ( P = .917). Conclusion: Individualized radiation dose escalation has the potential to improve survival in patients with esophageal carcinoma according to increased rate of complete metabolic response. However, further trials are needed to confirm this and to identify patients who may benefit from dose escalation.

Is there a role for neoadjuvant radiation dose escalation in esophageal cancer? A meta-analysis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 102-102
Author(s):  
Laila Lobo ◽  
Danny Yakoub ◽  
Caroline Ripat ◽  
Rishika Sharma ◽  
Raphael Yechieli
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Radiation Dose ◽  
Esophageal Carcinoma ◽  
Meta Analysis ◽  
Survival Rates ◽  
Fistula Formation ◽  
Significant Difference ◽  
Patient Reported

102 Background: In treating esophageal cancer chemo-radiation is used in the definitive as well as neo-adjuvant setting. Optimal dosage of radiation for best outcome has been debated. The aim of this study is to evaluate clinical outcomes of lower radiation dosage compared to higher. Methods: Online search for studies comparing radiation dose from 1990 to present was performed. Primary outcome was overall-survival rates for up to 5 years. Secondary outcomes included post-treatment complications and treatment response. A cut point of 51 Gy and less was considered as lower dose and greater than 51 Gy was considered higher dose. Quality of included studies was evaluated by STROBE criteria. Relative Risk (RR) and 95% Confidence Intervals (CI) were calculated from pooled data. Results: The search strategy yielded 142 studies, 12 met our selection criteria and included 1876 patients receiving radiation for resectable esophageal carcinoma. Of these patients, 1057 received lower and 819 were treated with greater than 51 Gy. Median age was 63 and 64 years for lower and higher radiation dose respectively. Meta-analysis showed no statistically significant difference in survival and toxicities between the two groups. 1 year overall survival (RR = 0.97, 95% CI 0.84-1.13, p = 0.69), 2 year overall survival (RR = 1.29, 95% CI 0.76-2.19, p = 0.34), 3 year overall survival (RR = 1.18, 95% CI 0.83-1.68, p = 0.37), 4 year overall survival (RR = 1.37, 95% CI 0.64-2.94, p = 0.41), 5 year overall survival (RR = 1.11, 95% CI 0.72-1.69, p = 0.64), Esophagitis (RR = 0.76, 95% CI 0.39-1.50, p = 0.43), Dermatitis (RR = 0.98, 95% CI 0.12-7.94, p = 0.99), Fistula formation (RR = 0.72, 95% CI 0.32-1.60, p = 0.42), Hematologic complications (RR = 1.10, 95% CI 0.20-6.02, p = 0.91), Stricture formation (RR = 1.39, 95% CI 0.54-3.58, p = 0.5). Conclusions: Lower radiation dose appears to be as effective as higher dose in esophageal carcinoma with similar toxicity profile and survival rates. Larger prospective randomized trials, focusing on patient-reported quality-of-life are required to consolidate these results.

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 Association of chemotherapy with survival in stage II colon cancer patients who received radical surgery: a retrospective cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhihao Lv ◽  
Yuqi Liang ◽  
Huaxi Liu ◽  
Delong Mo
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Prediction Models ◽  
Radical Surgery ◽  
Survival Rates ◽  
Stage Ii ◽  
Survival Prediction ◽  
Stage Ii Colon Cancer ◽  
Overall Survival Rates

Abstract Background It remains controversial whether patients with Stage II colon cancer would benefit from chemotherapy after radical surgery. This study aims to assess the real effectiveness of chemotherapy in patients with stage II colon cancer undergoing radical surgery and to construct survival prediction models to predict the survival benefits of chemotherapy. Methods Data for stage II colon cancer patients with radical surgery were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (1:1) was performed according to receive or not receive chemotherapy. Competitive risk regression models were used to assess colon cancer cause-specific death (CSD) and non-colon cancer cause-specific death (NCSD). Survival prediction nomograms were constructed to predict overall survival (OS) and colon cancer cause-specific survival (CSS). The predictive abilities of the constructed models were evaluated by the concordance indexes (C-indexes) and calibration curves. Results A total of 25,110 patients were identified, 21.7% received chemotherapy, and 78.3% were without chemotherapy. A total of 10,916 patients were extracted after propensity score matching. The estimated 3-year overall survival rates of chemotherapy were 0.7% higher than non- chemotherapy. The estimated 5-year and 10-year overall survival rates of non-chemotherapy were 1.3 and 2.1% higher than chemotherapy, respectively. Survival prediction models showed good discrimination (the C-indexes between 0.582 and 0.757) and excellent calibration. Conclusions Chemotherapy improves the short-term (43 months) survival benefit of stage II colon cancer patients who received radical surgery. Survival prediction models can be used to predict OS and CSS of patients receiving chemotherapy as well as OS and CSS of patients not receiving chemotherapy and to make individualized treatment recommendations for stage II colon cancer patients who received radical surgery.

scholarly journals Long Noncoding RNA Lnc-TLN2-4:1 Suppresses Gastric Cancer Metastasis and Is Associated with Patient Survival

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yuyun Wu ◽  
Ningbo Hao ◽  
Suming Wang ◽  
Xin Yang ◽  
Yufeng Xiao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Noncoding Rna ◽  
Tumor Metastasis ◽  
Cancer Metastasis ◽  
Survival Rates ◽  
Migration And Invasion ◽  
Poor Overall Survival ◽  
Low Expression ◽  
Overall Survival Rates

Gastric cancer (GC) is one of the most common malignancies worldwide, and the tumor metastasis leads to poor outcomes of GC patients. Long noncoding RNAs (lncRNAs) have emerged as new regulatory molecules that play a crucial role in tumor metastasis. However, the biological function and underlying mechanism of numerous lncRNAs in GC metastasis remain largely unclear. Here, we report a novel lncRNA, lnc-TLN2-4:1, whose expression is decreased in GC tissue versus matched normal tissue, and its low expression is involved in the lymph node and distant metastases of GC, as well as poor overall survival rates of GC patients. We further found that lnc-TLN2-4:1 inhibits the ability of GC cells to migrate and invade but does not influence GC cell proliferation and confirmed that lnc-TLN2-4:1 is mainly located in the cytoplasm of GC cells. We then found that lnc-TLN2-4:1 increases the mRNA and protein expression of TLN2 in GC cells and there is a positive correlation between the expression of lnc-TLN2-4:1 and TLN2 mRNA in GC tissue. Collectively, we identified a novel lncRNA, lnc-TLN2-4:1, in GC, where lnc-TLN2-4:1 represses cell migration and invasion. The low expression of lnc-TLN2-4:1 is associated with poor overall survival rates of GC patients. These suggest that lnc-TLN2-4:1 may be a tumor suppressor during GC metastasis.

scholarly journals Survival and prognostic factors in HIV-infected adults treated with Antiretroviral Therapy in a Malaysian referral hospital: A retrospective cohort study

2019 ◽  
Author(s):  
Lee Sing Chet ◽  
Siti Azrin Ab Hamid ◽  
Norsa'adah Bachok ◽  
Suresh Kumar Chidambaram
Keyword(s):  
Overall Survival ◽  
Cohort Study ◽  
Prognostic Factors ◽  
Antiretroviral Therapy ◽  
Haemoglobin Level ◽  
Retrospective Cohort ◽  
Survival Rates ◽  
Baseline Haemoglobin ◽  
History Of ◽  
Overall Survival Rates

Abstract Background: It is well established that antiretroviral therapy (ART) is beneficial in reducing the mortality among patients with human immunodeficiency virus (HIV). In Malaysia, there is lack of study and information regarding the overall survival rates and prognostic factors for survival in HIV-infected adults treated with ART. Therefore, this study aimed to assess and compare the survival rates as well as to identify the prognostic factors for survival among HIV adults in Malaysia.Methods: A retrospective cohort study was conducted by reviewing the medical records of HIV patients who started ART between year 2007 and 2016 at a tertiary referral hospital in Malaysia. ART-naive adults aged 15 years and above were included and those who were transferred out were excluded. After applying inclusion and exclusion criteria, there were 339 cases eligible in this study. Systematic sampling method was applied. Kaplan Meier survival curve and log-rank test were used to compare the overall survival rates. Cox proportional hazards regression was applied to determine the prognostic factors for survival.Results: The estimated overall survival rates were 95.9%, 93.8%, 90.4%, 84.9%, and 72.8% at 6 months, 1 year, 3 years, 5 years and 10 years, respectively. The overall survival rates were significantly different according to age group (p<0.001), employment status (p<0.001), transmission mode (p=0.003), and history of illicit drug use (p=0.017), baseline CD4 cell count (p<0.001), baseline haemoglobin level (p<0.001), tuberculosis co-infection (p<0.001), hepatitis co-infection (p=0.008), first NRTI (p<0.001) and history of defaults (p=0.021). Based on multiple Cox regression, patients who were anaemic had 3.76 times (95% CI: 1.97, 7.18; p<0.001) higher hazard of death than their non-anaemic counterparts. The hazard risk was 2.09 times (95% CI: 1.10, 3.96; p=0.024) higher among HIV patients co-infected with tuberculosis compared to those who were not. Conclusion: Overall survival rates were higher than low-income countries but lower than in high-income countries, and comparable with middle-income countries. Low baseline haemoglobin level and tuberculosis co-infection were strong prognostic factors for HIV survival

scholarly journals Primary Cutaneous Anaplastic Large-Cell Lymphoma: A Surveillance, Epidemiology, and End Results Database Analysis from 2005-2016

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4022-4022
Author(s):  
Cesar Gentille Sanchez ◽  
Joe Ensor ◽  
Akshjot Puri ◽  
Jasleen K. Randhawa ◽  
Shilpan S. Shah ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck ◽  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Survival Rates ◽  
Large Cell ◽  
Seer Database ◽  
Skin Site ◽  
Large Cell Lymphoma ◽  
Overall Survival Rates

Introduction Primary cutaneous anaplastic large-cell lymphoma (PCALCL) is a rare T-cell lymphoma that presents as a solitary or grouped nodules. It is characterized by anaplastic-appearing cells that are usually ALK negative but have high expression of CD30. There is paucity of epidemiologic data on PCALCL. A prior analysis of the Surveillance, Epidemiology, and End Results (SEER) database by Yu et al. reported only 157 cases from 1973 to 2004. We are presenting an analysis of the patients diagnosed with PCALCL after 2004. Methods We used the SEER database to retrospectively identify patients diagnosed with PCALCL from 2005 to 2016. The database collects data from cancer registries covering approximately 26% of the US population and was used to estimate frequencies and overall incidence rate. Survival was analyzed using the Kaplan-Meier method and log-rank tests were used to compare survival distributions. We assessed the effect of primary skin site (head and neck) and increasing age on survival as they were suggestive of decreased overall survival on multivariate analysis of the 1973-2004 cohort. P < 0.05 was considered statistically significant for all analysis. Results There were 501 cases of PCALCL recorded from 2005 to 2016. Median follow-up was 52 months. The overall incidence rate was found to be 0.12/1,000,000 age adjusted to the 2000 US standard population. More than 50% of the cases were diagnosed after 2010. The median age at diagnosis was 61 years (2-97 years). It was seen most frequently in White (72.9%) patients followed by Hispanic (10.2%) and Black (9.4%) patients. The male to female ratio was 1.42. The most common primary sites affected were the skin of the lower limbs and hip (26.4%) and head and neck (21.3%). A 33.4% of patients required treatment which was mainly excisional (1 patient required amputation). Notably, PCALCL was diagnosed as a second or third malignancy in 19.2% of cases. Overall survival rates at 5 years and 10 years were found to be 80.6% (95% CI: 76.3%, 84.3%) and 61.5% (95% CI: 54.1%, 68.1%) respectively. Age greater than 60 years old was significantly associated with a lower survival (89.7% vs 54.4%, p<0.0001). Survival was not significantly different if head and neck was the site of the primary lesion (64.2% vs 60.8%, p = 0.4371). Conclusion Our analysis of the SEER database for PCALCL is the largest done to our knowledge. Although the number of cases has almost tripled since 2005, it is still a rare type of cutaneous T-cell lymphoma. Lower extremities and hips are the most frequent primary skin site. Only a third of the patients required treatment with overall survival rates of more than 80% by 5 years. Older age (more than 60 years old) is associated with a worse outcome. Head and neck as the primary skin site does not appear to be associated to lower survival as previously thought. Disclosures No relevant conflicts of interest to declare.

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