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Safety and efficacy of three-dimensional conformal radiotherapy combined with temozolomide in treatment of diffuse brainstem gliomas.

Heng-hu FANG ; Qing NIE ; Jing-bo KANG ; Fang-ming LI ; Chang-lan CAI

Chinese Journal of Oncology.2011;33(9):707-709.

OBJECTIVETo study the safety and efficacy of three-dimensional conformal radiotherapy in combination with temozolomide in treatment of patients with diffuse brainstem glioma.

METHODSTwelve patients with MRI-confirmed diffuse brainstem glioma received 54 Gy three-dimensional conformal radiotherapy for 6 weeks with 1.8 Gy per fraction, 5 times per week. All of the patients were given daily oral temozolomide 75 mg/m(2) during radiotherapy. Four weeks after radiotherapy, all of the patients received 6 cycles of temozolomide, each cycle lasted 5 days with 28 days interval between each two cycles. 150 mg/m(2) of temozolomide was given for the first cycle for five days, followed by 200 mg/m(2) of the drug for the rest of the cycles if no significant drug-related toxicities were observed. Magnetic resonance imaging and laboratory tests were performed to evaluate the efficacy and adverse reactions.

RESULTSIn the 12 patients, CR was 1 case (8.3%), PR 6 cases (50.0%), SD 2 cases (16.7%), and PD 3 cases (25.0%). The overall clinical benefit rate was 75.0%. Progression-free survival rate was 75.0% (9/12) at 6 months and 50.0% (6/12) at 1 year. The one-year overall survival rate was 75.0%. There were no severe temozolomide-related toxicities.

CONCLUSIONSConcurrent temozolomide with three-dimensional conformal radiotherapy and followed by 6 cycles of temozolomide chemotherapy for diffuse brainstem gliomas have a better clinical efficacy, good tolerance and with no severe toxicities.

Adolescent ; Adult ; Antineoplastic Agents, Alkylating ; adverse effects ; therapeutic use ; Brain Injuries ; etiology ; Brain Stem Neoplasms ; pathology ; therapy ; Chemoradiotherapy ; Child ; Dacarbazine ; adverse effects ; analogs & derivatives ; therapeutic use ; Disease-Free Survival ; Female ; Glioma ; pathology ; therapy ; Humans ; Leukopenia ; chemically induced ; Male ; Middle Aged ; Radiation Injuries ; etiology ; Radiotherapy, Conformal ; adverse effects ; methods ; Remission Induction ; Survival Rate ; Young Adult

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Efficacy of late accelerated hyperfractionated conformal radiotherapy combined with capecitabine for esophageal carcinoma.

Wei SHENG ; Xin-zhi FENG ; Jun-qing HAN

Chinese Journal of Oncology.2011;33(9):702-706.

OBJECTIVETo evaluate the efficacy of late accelerated hyperfractionated conformal radiotherapy (LACF) combined with capecitabine on esophageal carcinoma.

METHODSOne hundred and sixty eight patients of esophageal cancer were randomly divided into 3 groups, including the radiotherapy alone group (CF) which received conventional conformal radiotherapy to a total of 60 - 66 Gy, LCAF group which received conventional fractionated conformal radiotherapy during the first two-thirds of the treatment to a dose about 40 Gy/20F/4W, then followed by late accelerated hyperfractionated conformal radiotherapy, twice daily radiotherapy at 1.3 Gy per fraction to a total dose about 64 - 69 Gy, and LCAF + C group (late accelerated hyperfractionated radiotherapy combined with capecitabine), in which patients were treated as the same as the LCAF group, except that they were treated with capecitabine (1.5 g po bid) from beginning of the radiotherapy to the end.

RESULTSThe short-term results of the 3 groups were 74.0%, 85.5% and 95.2%, respectively (P = 0.006). The local control rates at 1, 3 and 5 years were 64.0%, 30.0%, 24.0% in the CF group, 81.8%, 65.5%, 58.2% in the LCAF group and 90.1%, 77.8%, 74.6% in the LCAF+C group, respectively. The 1-, 3- and 5-year survival rates of the 3 groups were 58.0%, 20.0%, 8.0%; 78.2%, 36.4%, 17.0% and 85.7%, 55.6%, 30.2%, respectively. The effect of LCAF+C group was better than that of LCAF group and CF group. The incidence of acute tracheitis and acute esophagitis in the LCAF+C group and LCAF group was higher than that in the CF group, but there was no stastistically significant difference between the 2 groups. There was no statistically significant difference in distant metastasis in the 3 groups.

CONCLUSIONSCapecitabine, as an effective chemosensitizater combined with late accelerate hyperfractionated radiotherapy can improve the short-term results of treatment of esophageal cancer. The value of this combined treatment in distant metastasis reqires further study in the clinic.

Antimetabolites, Antineoplastic ; therapeutic use ; Capecitabine ; Carcinoma, Squamous Cell ; mortality ; pathology ; therapy ; Chemoradiotherapy ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Dose Fractionation ; Esophageal Neoplasms ; mortality ; pathology ; therapy ; Esophagitis ; etiology ; Fluorouracil ; analogs & derivatives ; therapeutic use ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Radiation Pneumonitis ; etiology ; Radiotherapy, Conformal ; adverse effects ; methods ; Remission Induction ; Survival Rate

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Multicenter phase II clinical trial of arsenic trioxide injection in the treatment of primary hepatocarcinoma.

Feng-lian QU ; Xue-zhi HAO ; Shu-kui QIN ; Ji-wei LIU ; Guang-jie SUI ; Qiang CHEN ; Tao QU ; He-ping ZHANG ; Yan SUN

Chinese Journal of Oncology.2011;33(9):697-701.

OBJECTIVETo evaluate the effect and adverse effects of arsenic trioxide (As2O3) in the treatment of primary hepatocarcinoma patients, and conduct the pharmacokinetics study.

METHODSA total of one hundred and eleven advanced primary hepatocarcinoma patients in five centers were treated with As2O3 injection 7 - 8 mg/m(2) i.v. qd for 14 days and was repeated after 7 - 14 days. Evaluation of the clinical response and adverse effects was conducted after two cycles of treatment. The patient who had reached partial PR and SD was treated continuously until disease progression or intolerance.

RESULTSAmong the 102 patients evaluable for clinical efficacy analysis, there were 7 PR, 71 SD and 24 PD, the response rate was 6.9% and the clinical benefit rate was 76.5%. The quality of life was improved in 22.5% of patients. The pain relief rate was 71.7%, time to progress (TTP) was 97 days, and the median survival time (MST) was 195 days. The major adverse effects were reversible WHO I-II grade gastrointestinal reactions and bone marrow suppression. The results of pharmacokinetic study showed that the distribution and elimination characteristics in vivo was found to be a two-compartment model. The plasma elimination half-life was (23.94 ± 18.39) h.

CONCLUSIONSAs2O3 is effective in the management of primary hepatocarcinoma, with a significant analgesic effect. To some extent, it can extend TTP and MST in advanced liver cancer patients, while the treatment is well tolerated in the majority of patients.

Adult ; Aged ; Antineoplastic Agents ; administration & dosage ; adverse effects ; pharmacokinetics ; therapeutic use ; Arsenicals ; administration & dosage ; adverse effects ; pharmacokinetics ; therapeutic use ; Carcinoma, Hepatocellular ; blood ; drug therapy ; pathology ; Disease Progression ; Female ; Follow-Up Studies ; Half-Life ; Humans ; Injections ; Leukopenia ; chemically induced ; Liver Neoplasms ; blood ; drug therapy ; pathology ; Lung Neoplasms ; drug therapy ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Nausea ; chemically induced ; Neoplasm Staging ; Oxides ; administration & dosage ; adverse effects ; pharmacokinetics ; therapeutic use ; Quality of Life ; Remission Induction ; Survival Rate ; Vomiting ; chemically induced

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Impact of 2009 FIGO staging system on the diagnostic value of preoperative MRI staging of endometrial carcinoma.

Xiao-duo YU ; Han OUYANG ; Meng LIN ; Chun-wu ZHOU ; Rong ZHANG

Chinese Journal of Oncology.2011;33(9):692-696.

OBJECTIVETo analyze the changes of 2009 FIGO staging system compared with the 1988 FIGO staging system of endometrial carcinoma and evaluate the diagnostic value of MRI staging by the 2009 FIGO criteria.

METHODSA retrospective study was performed on 63 consecutive patients with pathologically confirmed endometrial carcinoma who were treated by surgery initially from January to December 2009. The diagnostic value of preoperative MRI by the 2009 FIGO staging system was compared with that using the 1988 FIGO system, respectively.

RESULTSAccording to the 2009 FIGO staging system of endometrial carcinoma, stage Ia was defined as no or less than half myometrial invasion, which included stage Ia (confined to endometrium) and stage Ib (invasion less than half of the myometrium) of the 1988 FIGO staging system. Stage Ib assessed by the 2009 FIGO system was the same as the stage Ic of 1988 FIGO system, indicating the lesions more than half myometrial invasion. Endocervical glandular involvement only (stage IIa of 1988 FIGO system) was classified as stage I. Positive cytology of ascites (stage IIIa of 1988 FIGO system) was excluded by the 2009 FIGO criteria. Using the 1988 FIGO system, the accuracy of MRI for the evaluation of endometrial carcinoma of stage Ia, Ib, Ic, whole stage I, IIa, IIb, whole stage II, IIIa, IIIb, IIIc, whole stage III and IVb were 95.2%, 79.4%, 81.0%, 84.1%, 96.8%, 90.5%, 90.5%, 92.1%, 98.4%, 92.1%, 82.5%, and 98.4%, respectively, while using the 2009 FIGO system, the accuracy of MRI of stage Ia, Ib, whole stage I, II, IIIa, IIIb, IIIc, whole stage III and IVb were 88.9%, 81.0%, 88.9%, 92.1%, 98.4%, 98.4%, 92.1%, 88.9% and 98.4%, respectively.

CONCLUSIONSThe 2009 FIGO staging system is simplified on the basis of the 1988 FIGO system. It gives an improved accuracy of MRI in evaluating the stage I to III endometrial carcinoma.

Adenocarcinoma ; diagnosis ; pathology ; surgery ; Adult ; Aged ; Endometrial Neoplasms ; diagnosis ; pathology ; surgery ; Female ; Humans ; Hysterectomy ; International Agencies ; Magnetic Resonance Imaging ; methods ; Middle Aged ; Myometrium ; pathology ; Neoplasm Invasiveness ; Neoplasm Staging ; methods ; Preoperative Period ; Retrospective Studies

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Clinical implications of the new TNM staging system for thoracic esophageal squamous cell carcinoma.

Wen-tao FANG ; Jian FENG ; Teng MAO ; Shi-jie FU ; Wen-hu CHEN

Chinese Journal of Oncology.2011;33(9):687-691.

OBJECTIVETo evaluate THE clinical significance of the 2009 UICC staging system for thoracic esophageal squamous cell carcinoma.

METHODSTwo hundred and nine patients with thoracic esophageal squamous cell carcinoma undergone selective cervico-thoraco-abdominal lymphadenectomy were reviewed retrospectively and restaged according to the new 2009 UICC staging system. The relationship between individual stages and survival were analyzed accordingly.

RESULTSThe five-year overall and cause-specific survivals were 35.0% and 38.8%, respectively. Depth of invasion (T, P = 0.004), number of metastatic lymph nodes (N, P < 0.001), distant lymph node metastasis (M, P = 0.003), complete resection (R, P = 0.005) were significantly related to postoperative survival. On the other hand, location of primary tumor (L, P = 0.743) and histological grade (G, P = 0.653) were not significantly related to long-term prognosis. Upon stratification, the 5-year survival for T4a (32.0%) was significantly better than that of T4b (0, P < 0.001), but was similar to that of T3 (28.4%, P = 0.288). Patients without nodal involvement (47.8%, P < 0.001) and those with single station nodal disease (37.5%, P < 0.001) had significantly better survival than patients having 2 or more stations of lymph node metastasis (11.3%). Also patients without nodal involvement and those with metastasis confined to a single field (34.2%) had significantly better survival than patients having nodal diseases in 2 fields (12.1%) and 3 fields (0, P < 0.001). The 5-year survival for cervical metastasis after complete resection was 20.0%. Upon multivariate analysis, depth of tumor invasion (P = 0.001, RR = 1.635), numbers of metastatic nodal stations (P = 0.043, RR = 1.540) and fields (P = 0.010, RR = 2.187) were revealed as independent risk factors for long-term survival.

CONCLUSIONSThe new UICC staging system effectively predicts long-term prognosis for thoracic esophageal squamous cell carcinoma. Depth of tumor invasion and extent of lymph node involvement are two most important prognostic factors. To improve surgical outcomes, much effort is needed to increase the accuracy of preoperative staging and to include effective induction therapies into a multidisciplinary setting.

Carcinoma, Squamous Cell ; pathology ; surgery ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; Female ; Follow-Up Studies ; Humans ; International Agencies ; Lymph Node Excision ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; methods ; Retrospective Studies ; Survival Rate

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Clinicopathological characteristics of clear cell type meningioma.

Xiao LI ; Ru-jun XU ; Hong ZHOU

Chinese Journal of Oncology.2011;33(9):685-686.

Adolescent ; Adult ; Aged ; Diagnosis, Differential ; Ependymoma ; pathology ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Meningeal Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Meningioma ; diagnostic imaging ; metabolism ; pathology ; surgery ; Mucin-1 ; metabolism ; Oligodendroglioma ; pathology ; Tomography, X-Ray Computed ; Vimentin ; metabolism ; Young Adult

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Association between CTLA-4 gene polymorphism and susceptibility to cervical cancer.

Hua LI ; Yi-feng ZHOU ; Hong-yan GUO ; Tong SUN ; Wen-hua ZHANG ; Dong-xin LIN

Chinese Journal of Oncology.2011;33(9):681-684.

OBJECTIVETo investigate the association between CTLA-4 +49A/G polymorphisms and the risk of susceptibility to cervical cancer.

METHODSA hospital-based case-control study was conducted. 314 cases with primary cervical cancer and 320 healthy controls were collected and genotyped by PCR-based RFLP for +49A/G polymorphisms in the CTLA-4 gene.

RESULTSThe A allele and AA genotype of CTLA-4 gene were 32.5% and 9.6% in the patients, and 25.8% and 5.6% in the controls, respectively. Subjects with CTLA-4 +49AA genotype conferred a higher risk of cervical cancer (OR = 2.06, 95%CI: 1.10 - 3.85; P = 0.024). However, the correlation between AA genotype in CTLA-4 polymorphisms and clinicopathological characteristics was not significant.

CONCLUSIONThe results of this study suggest that CTLA4 gene is associated with cervical cancer risk and may be a susceptible gene of cervical cancer.

Adenocarcinoma ; genetics ; metabolism ; pathology ; surgery ; Adult ; Aged ; Alleles ; CTLA-4 Antigen ; genetics ; metabolism ; Carcinoma in Situ ; genetics ; metabolism ; pathology ; surgery ; Carcinoma, Squamous Cell ; genetics ; metabolism ; pathology ; surgery ; Case-Control Studies ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Humans ; Middle Aged ; Neoplasm Staging ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length ; Risk Factors ; Uterine Cervical Neoplasms ; genetics ; metabolism ; pathology ; surgery

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Biological significance of relationship between nuclear localization of Rac1 and progression of gastric carcinoma.

Long SU ; Wei XU ; Guang-zhi YAN ; Wei LUO ; Ying-li WANG ; Shuang CHEN ; Yang ZHANG ; Li-hua LIU

Chinese Journal of Oncology.2011;33(9):676-680.

OBJECTIVETo observe the subcellular localization of Rac1 and the expression of Tiam1 and Rac1 in gastric carcinoma, in order to reveal the relationship between the distribution of Rac1 and progression of gastric carcinoma.

METHODSBoth carcinoma and adjacent normal tissue of 48 patients with gastric carcinoma were studied in this study. Tissue distribution and expression of Rac1 and Tiam1 were analyzed by immunohistochemistry and real-time polymerase chain reaction (PCR).

RESULTSCompared with that of adjacent non-cancerous gastric mucosa, the expression of Rac1 in cancer tissues was significantly increased. The positive rate of Rac1 expression was 18.8% (9/48 cases) in adjacent non-neoplastic gastric and 79.2% (38/48 cases) in cancer tissues. The positive staining was mainly located in the cell nuclei (31 samples). The real-time PCR results demonstrated that the expression levels of Tiam1 and Rac1 mRNA in cancerous tissues with nuclear localization of Rac1 were evidently increased. Furthermore, nuclear localization of Rac1 was associated with tumor stage and metastasis.

CONCLUSIONSThe majority of gastric cancer tissues show nuclear dislocalization of Rac1 expression, which may be a sign of abnormal activation of Tiam1-Rac1 pathway. It may suggest enhanced invasion ability of the gastric carcinoma.

Adult ; Aged ; Aged, 80 and over ; Cell Nucleus ; metabolism ; Disease Progression ; Female ; Guanine Nucleotide Exchange Factors ; genetics ; metabolism ; Humans ; Immunohistochemistry ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Metastasis ; Neoplasm Staging ; Polymerase Chain Reaction ; RNA, Messenger ; metabolism ; Stomach Neoplasms ; metabolism ; pathology ; T-Lymphoma Invasion and Metastasis-inducing Protein 1 ; rac1 GTP-Binding Protein ; genetics ; metabolism

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HER-2 expression in advanced gastric cancer and its correlation with clinical features, outcome and prognosis.

Yan WANG ; Jian-ming XU ; Jian-zhi LIU ; Li LIN ; Fei-jiao GE ; Shan-shan LI ; Lie-jun LIU ; Chuan-hua ZHAO

Chinese Journal of Oncology.2011;33(9):671-675.

OBJECTIVETo assess the HER-2 status in Chinese advanced gastric cancer patients and explore its correlation with clinical features, treatment response and prognosis.

METHODSA total of 107 patients with advanced gastric cancer treated in our hospital from December 2005 to November 2008 were included in this retrospective analysis. HER-2 status was determined by immunohistochemisty (IHC) and/or fluorescence in situ hybridization (FISH). The correlations of HER-2 status with tumor location, pathology, treatment response and prognosis were analyzed and the efficacy of different chemottherapy regimens was compared.

RESULTSThe overall positive rate of HER-2 expression was 14.7% (15/102). The HER-2 status was detected by both methods in 102 patients, and the concordance of the two methods was 66.5%. The tumor site distribution was gastroesophageal junction (GEJ) 28.0%, proximal stomach 19.4%, gastric corpus 16.1%, antrum 26.9% and whole stomach 9.7%, respectively. There was no significant difference of HER-2 status among different tumor sites (P = 0.726), and no significant correlation between HER-2 expression and differentiation (P = 0.110). Among the evaluable 51 patients treated by first-line chemotherapy, the total objective effective rate was 23.5%. The median time-to-progression was 7.47 months, and median overall survival time was 11.07 months. The effective rate was 43.8% in patients who received XP regimen chemotherapy (cisplatin + capecitabine), significantly higher than the 14.3% in patients treated with other regimens (P = 0.033). Their overall survival was 14.17 months and 9.53 months, respectively (P = 0.059). The TTP was 6.63 months in HER-2 positive patients and 7.47 months in HER-2 negative patients, with a non-significant difference (P = 0.510). However, there was a improving tendency in the efficacy and OS, showing a effective rate of 45.5% and 17.5% (P = 0.102) and OS of 14.17 months and 10.63 months, respectively (P = 0.205).

CONCLUSIONSHER-2-positivity rate in Chinese patients with advanced gastric cancer is similar to those reported in the literature. Along with the increasing use of targeted therapy and targeted agents, the efficacy and survival of gastric cancer patients is improving. HER-2-positive patients may benefit from it.

Adenocarcinoma ; drug therapy ; metabolism ; pathology ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Capecitabine ; Cisplatin ; administration & dosage ; Deoxycytidine ; administration & dosage ; analogs & derivatives ; Disease Progression ; Esophagogastric Junction ; pathology ; Female ; Fluorouracil ; administration & dosage ; analogs & derivatives ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Receptor, ErbB-2 ; metabolism ; Retrospective Studies ; Stomach ; pathology ; Stomach Neoplasms ; drug therapy ; metabolism ; pathology ; Survival Rate

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Correlation between EGFR gene mutation and high copy number and their association with the clinicopathological features in Chinese patients with non-small cell lung cancer.

Zhe LI ; Lan-jun ZHANG ; Wu-ping WANG ; Kang GUO ; Jian-yong SHAO ; Tie-hua RONG

Chinese Journal of Oncology.2011;33(9):666-670.

OBJECTIVEThe purpose of this study was to investigate the correlation between gene mutation and gene copy number and their association with the clinical profiles and pathological features in Chinese patients with non-small cell lung cancer (NSCLC).

METHODSSurgical specimens of cancer tissue were collected from 118 NSCLC patients. Gene mutations in exon 19 and exon 21 were detected by real-time PCR and gene copy number was detected by fluorescence in situ hybridization (FISH). Chi-square (χ(2)) test was performed to analyze the correlation between EGFR mutation and gene copy number, and explore their association with clinicopathological features in the NSCLC patients.

RESULTSThe mutation frequency in EGFR was 41.5% (49/118). EGFR mutations occured in 50.0% (48/96) of patients with adenocarinoma and 5.0% (1/20) of patients with squamous cell carcinoma. EGFR gene high copy number was detected in 70.3% (83/118)of the patients. The FISH-positive rate was 78.1% (75/96) in adenocarcinoma and 35.0% (7/20) in squamous cell carcinoma. EGFR mutation and high copy number mainly occurred in the adenocarcinoma, advanced stage, female gender, and non-smoking patients. There was a significant correlation between EGFR gene mutation and gene high copy number.

CONCLUSIONSEGFR gene mutation and gene high copy number are more common in Chinese NSCLC patients with adenocarcinomas, advanced stage, non-smokers and females. There is a significant correlation between gene mutation and gene high copy number. Combined analysis of EGFR mutation and gene copy number by FISH may provide a superior approach in selecting patients who may benefit from anti-EGFR target therapy.

Adenocarcinoma ; genetics ; pathology ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; genetics ; Carcinoma, Non-Small-Cell Lung ; genetics ; pathology ; Carcinoma, Squamous Cell ; genetics ; pathology ; Exons ; Female ; Gene Dosage ; Genes, erbB-1 ; genetics ; Humans ; In Situ Hybridization, Fluorescence ; Lung Neoplasms ; genetics ; pathology ; Male ; Middle Aged ; Mutation ; Mutation Rate ; Neoplasm Staging ; Sex Factors ; Smoking

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