BACKGROUNDIn recent years, neoadjuvant chemoradiotherapy (NCRT) combined with surgeryhas been gradually applied in patients with locally advanced thoracic esophagealcancer, but its effectiveness and safety remains unc...BACKGROUNDIn recent years, neoadjuvant chemoradiotherapy (NCRT) combined with surgeryhas been gradually applied in patients with locally advanced thoracic esophagealcancer, but its effectiveness and safety remains unclear. In this clinical trial, weprospectively investigated the efficacy and safety of NCRT plus surgery in thetreatment of thoracic esophageal squamous cell carcinoma (TESCC).AIMTo investigate the efficacy and safety of NCRT combined with surgery in thetreatment of potentially resectable TESCC.METHODSThirty patients with advanced TESCC hospitalized in our hospital from July2016 to June 2019 were prospectively studied. All patients received NCRT, whichincluded intensity modulated conformal radiotherapy (40-44 Gy/20-22f, 2 Gy/f)and chemotherapy (paclitaxel 150-175 mg/m2d1, 22 + lobaplatin 25-30 mg/m2d2,23 for two cycles). Surgery was performed after radiotherapy and chemotherapy.The effectiveness and safety of these treatments were observed.RESULTSAmong these 30 patients, complete response was achieved in two cases (6.7%) andpartial response in 26 cases (86.7%), yielding an objective response rate of 100%.All patients underwent radical surgery successfully. The R0 resection rate was100%, and the pathologic complete response rate was 33.3%. The incidence ofgrade III- IV granulocytopenia was 10% during the NCRT, and anastomoticleakage occurred in one patient after surgery.CONCLUSIONFor patients with potentially resectable TESCC, NCRT can effectively reduce thetumor size, increase R0 resection rate, and achieve obvious pathologicaldegradation, with mild adverse reactions. Thus, it is worthy of wider clinicalapplication.展开更多
This article comprehensively reviews research progress in prostate cancer radiation therapy.It provides an overview of fundamental principles,encompassing the disease’s epidemiology,pathological mechanisms,and radiat...This article comprehensively reviews research progress in prostate cancer radiation therapy.It provides an overview of fundamental principles,encompassing the disease’s epidemiology,pathological mechanisms,and radiation sensitivity,alongside technological advancements.The clinical application,technological progress,and efficacy evaluation of moderate hypofractionated radiation therapy and ultra hypofractionated radiation therapy are discussed.Diagnostic and monitoring techniques specific to radiation therapy are analyzed,alongside prevailing controversies and challenges.Finally,the review outlines future prospects,including novel radiotherapy techniques,multidisciplinary collaboration trends,and the evolving role of radiation within comprehensive treatment.The findings demonstrate continuous technological and clinical evolution in prostate cancer radiotherapy,yet emphasize the need for further exploration to optimize treatments and improve patient survival and quality of life.展开更多
BACKGROUND Albumin-bound paclitaxel(ABP)has been used as second-and higher-line treatments for advanced esophageal cancer,and its efficacy and safety have been well demonstrated.Lobaplatin(LBP)is a third-generation pl...BACKGROUND Albumin-bound paclitaxel(ABP)has been used as second-and higher-line treatments for advanced esophageal cancer,and its efficacy and safety have been well demonstrated.Lobaplatin(LBP)is a third-generation platinum antitumor agent;compared with the first two generations of platinum agents,it has lower toxicity and has been approved for the treatment of breast cancer,small cell lung cancer,and chronic granulocytic leukemia.However,its role in the treatment of esophageal cancer warrants further investigations.AIM To investigate the efficacy and safety of induction chemotherapy with ABP plus LBP followed by concurrent radiochemotherapy(RCT)for locally advanced esophageal cancer.METHODS Patients with pathologically confirmed advanced esophageal squamous cell carcinoma(ESCC)at our hospital were enrolled in this study.All patients were treated with two cycles of induction chemotherapy with ABP plus LBP followed by concurrent RCT:ABP 250 mg/m^(2),ivgtt,30 min,d1,every 3 wk;and LBP,30 mg/m^(2),ivgtt,2 h,d1,every 3 wk.A total of four cycles were scheduled.The dose of the concurrent radiotherapy was 56-60 Gy/28-30 fractions,1.8-2.0 Gy/fraction,and 5 fractions/wk.RESULTS A total of 29 patients were included,and 26 of them completed the treatment protocol.After the induction chemotherapy,the objective response rate(ORR)was 61.54%,the disease control rate(DCR)was 88.46%,and the progressive disease(PD)rate was 11.54%;after the concurrent RCT,the ORR was 76.92%,the DCR was 88.46%,and the PD rate was 11.54%.The median progression-free survival was 11.1 mo and the median overall survival was 15.83 mo.Cox multivariate analysis revealed that two cycles of induction chemotherapy followed by concurrent RCT significantly reduced the risk of PD compared with two cycles of chemotherapy alone(P=0.0024).Non-hematologic toxicities were tolerable,and the only grade 3 non-hematologic toxicity was radiation-induced esophagitis(13.79%).The main hematologic toxicity was neutropenia,and no grade 4 adverse event occurred.CONCLUSION Induction chemotherapy with ABP plus LBP followed by concurrent RCT is effective in patients with locally advanced ESCC,with mild adverse effects.Thus,this protocol is worthy of clinical promotion and application.展开更多
BACKGROUND Many studies have investigated the relationships between vitamins and esophageal cancer(EC).Most of these studies focused on the roles of vitamins in the prevention and treatment of EC,and few studies have ...BACKGROUND Many studies have investigated the relationships between vitamins and esophageal cancer(EC).Most of these studies focused on the roles of vitamins in the prevention and treatment of EC,and few studies have examined the changes in vitamin nutritional status and their influencing factors before and after chemotherapy for EC.Chemotherapy may have a considerable effect on EC patients’vitamin levels and hematological indicators.AIM To research the nutritional status of multiple vitamins in EC patients during chemotherapy and to assess its clinical significance.METHODS EC patients admitted to our center from July 2017 to September 2020 were enrolled in this study.Serum concentrations of nine vitamins(A,D,E,B9,B12,B1,C,B2 and B6),hemoglobin,total protein,albumin,blood calcium,blood phosphorus concentrations and body mass index(BMI)were measured in all EC patients.The changes in nine vitamins,hematological indicators and BMI were compared before and after two cycles of chemotherapy.The possible influential factors were analyzed.RESULTS In total,203 EC patients receiving chemotherapy were enrolled in this study.Varying degrees of vitamin A,D,C and B2 deficiency and weight loss were found in these patients,and the proportions of vitamin B2 and vitamin C deficiencies increased significantly after chemotherapy(both P<0.05).Serum concentrations of vitamins A,C,B2 and B6 and BMI before and after chemotherapy were statistically significant(all P<0.05).Multivariate analysis showed that vitamin A levels significantly differed between male and female EC patients,whereas vitamin D concentration significantly differed in EC patients in different stages(all P<0.05).Correlations were observed between the changes in serum concentrations of vitamin A and C before and after two cycles chemotherapy and the change in BMI(P<0.05).Hemoglobin,total protein,serum albumin and blood calcium concentrations significantly decreased in EC patients after chemotherapy(all P<0.05),while the blood phosphorus level significantly increased after chemotherapy(P<0.05).Using the difference in vitamin concentrations as the independent variables and the difference in BMI as the dependent variable,logistic regression analysis revealed statistically significant differences for vitamin A,vitamin D and vitamin C(F=5.082,P=0.002).CONCLUSION Vitamin A,D,C and B2 were mainly deficient in patients with EC during chemotherapy.Multivitamin supplementation may help to improve the nutritional status,chemotherapy tolerance and efficacy.展开更多
BACKGROUND Pembrolizumab combined with chemotherapy has been proven effective as firstline therapy in patients with advanced esophageal cancer.Few trials have assessed the safety and efficacy of this treatment in pati...BACKGROUND Pembrolizumab combined with chemotherapy has been proven effective as firstline therapy in patients with advanced esophageal cancer.Few trials have assessed the safety and efficacy of this treatment in patients with locally advanced disease.AIM To analyze long-term outcomes of pembrolizumab in locally advanced or metastatic esophageal squamous cell carcinoma(ESCC)in the real world.METHODS Patients with advanced ESCC admitted to our center from October 2019 to October 2021 were enrolled in this study.Clinical staging of the patients was based on the 8th edition of the American Joint Committee on Cancer TNM staging system.The patients received different treatments based on clinical stage.In brief,patients with locally advanced and resectable ESCC received neoadjuvant therapy combined with surgery.For those who were not candidates for resection,radical concurrent chemoradiotherapy plus pembrolizumab was more preferable.Patients with metastatic ESCC or who were unsuitable for radiotherapy underwent chemotherapy in combination with pembrolizumab.Long-term survival outcomes such as overall survival(OS),progression-free survival,disease-free survival,long-term adverse effects(AEs),immune maintenance therapy and predictors of immune checkpoint inhibitors(ICIs)efficacy were evaluated.RESULTS A total of 55 patients with advanced ESCC were enrolled in this retrospective,observational study.The median age was 61 years(range 44-74),with 47.3%(26/55)of the patients in stage IV and 45.5%of the patients had the tumor(25/55)located in the middle third of the esophagus.The median OS in all patients was not reached.The 12-mo OS rate among all patients was 78.8%and the 18-mo OS rate was 72.7%.9 patients died due to tumor progression and 7 patients died due to treatment-related complications.The therapeutic effect evaluated at the interim evaluation was significantly reflected in the long-term outcome.Patients with complete response or partial response in all patients(P=0.005)and in the chemoradiotherapy plus pembrolizumab group(P=0.007)obtained a better prognosis than non-responders.A total of 20 patients(20/55,36%)received immune maintenance therapy.Baseline peripheral blood biomarkers of the neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,and neutrophil-to-(leukocyte-neutrophil)ratio did not predict the efficacy of ICIs.CONCLUSION Pembrolizumab combined with chemotherapy or radiotherapy resulted in favorable long-term survival in patients with locally advanced or metastatic ESCC,with safe and manageable long-term AEs.展开更多
基金the Open Project of National Clinical Research Center for Geriatric Diseases(No:NCRCG-PLAGH-2017004)Fang Liu has received research funding from Clinical Research Support Fund of PLA General Hospital(No:2016FCCXYY-2004).
文摘BACKGROUNDIn recent years, neoadjuvant chemoradiotherapy (NCRT) combined with surgeryhas been gradually applied in patients with locally advanced thoracic esophagealcancer, but its effectiveness and safety remains unclear. In this clinical trial, weprospectively investigated the efficacy and safety of NCRT plus surgery in thetreatment of thoracic esophageal squamous cell carcinoma (TESCC).AIMTo investigate the efficacy and safety of NCRT combined with surgery in thetreatment of potentially resectable TESCC.METHODSThirty patients with advanced TESCC hospitalized in our hospital from July2016 to June 2019 were prospectively studied. All patients received NCRT, whichincluded intensity modulated conformal radiotherapy (40-44 Gy/20-22f, 2 Gy/f)and chemotherapy (paclitaxel 150-175 mg/m2d1, 22 + lobaplatin 25-30 mg/m2d2,23 for two cycles). Surgery was performed after radiotherapy and chemotherapy.The effectiveness and safety of these treatments were observed.RESULTSAmong these 30 patients, complete response was achieved in two cases (6.7%) andpartial response in 26 cases (86.7%), yielding an objective response rate of 100%.All patients underwent radical surgery successfully. The R0 resection rate was100%, and the pathologic complete response rate was 33.3%. The incidence ofgrade III- IV granulocytopenia was 10% during the NCRT, and anastomoticleakage occurred in one patient after surgery.CONCLUSIONFor patients with potentially resectable TESCC, NCRT can effectively reduce thetumor size, increase R0 resection rate, and achieve obvious pathologicaldegradation, with mild adverse reactions. Thus, it is worthy of wider clinicalapplication.
文摘This article comprehensively reviews research progress in prostate cancer radiation therapy.It provides an overview of fundamental principles,encompassing the disease’s epidemiology,pathological mechanisms,and radiation sensitivity,alongside technological advancements.The clinical application,technological progress,and efficacy evaluation of moderate hypofractionated radiation therapy and ultra hypofractionated radiation therapy are discussed.Diagnostic and monitoring techniques specific to radiation therapy are analyzed,alongside prevailing controversies and challenges.Finally,the review outlines future prospects,including novel radiotherapy techniques,multidisciplinary collaboration trends,and the evolving role of radiation within comprehensive treatment.The findings demonstrate continuous technological and clinical evolution in prostate cancer radiotherapy,yet emphasize the need for further exploration to optimize treatments and improve patient survival and quality of life.
文摘BACKGROUND Albumin-bound paclitaxel(ABP)has been used as second-and higher-line treatments for advanced esophageal cancer,and its efficacy and safety have been well demonstrated.Lobaplatin(LBP)is a third-generation platinum antitumor agent;compared with the first two generations of platinum agents,it has lower toxicity and has been approved for the treatment of breast cancer,small cell lung cancer,and chronic granulocytic leukemia.However,its role in the treatment of esophageal cancer warrants further investigations.AIM To investigate the efficacy and safety of induction chemotherapy with ABP plus LBP followed by concurrent radiochemotherapy(RCT)for locally advanced esophageal cancer.METHODS Patients with pathologically confirmed advanced esophageal squamous cell carcinoma(ESCC)at our hospital were enrolled in this study.All patients were treated with two cycles of induction chemotherapy with ABP plus LBP followed by concurrent RCT:ABP 250 mg/m^(2),ivgtt,30 min,d1,every 3 wk;and LBP,30 mg/m^(2),ivgtt,2 h,d1,every 3 wk.A total of four cycles were scheduled.The dose of the concurrent radiotherapy was 56-60 Gy/28-30 fractions,1.8-2.0 Gy/fraction,and 5 fractions/wk.RESULTS A total of 29 patients were included,and 26 of them completed the treatment protocol.After the induction chemotherapy,the objective response rate(ORR)was 61.54%,the disease control rate(DCR)was 88.46%,and the progressive disease(PD)rate was 11.54%;after the concurrent RCT,the ORR was 76.92%,the DCR was 88.46%,and the PD rate was 11.54%.The median progression-free survival was 11.1 mo and the median overall survival was 15.83 mo.Cox multivariate analysis revealed that two cycles of induction chemotherapy followed by concurrent RCT significantly reduced the risk of PD compared with two cycles of chemotherapy alone(P=0.0024).Non-hematologic toxicities were tolerable,and the only grade 3 non-hematologic toxicity was radiation-induced esophagitis(13.79%).The main hematologic toxicity was neutropenia,and no grade 4 adverse event occurred.CONCLUSION Induction chemotherapy with ABP plus LBP followed by concurrent RCT is effective in patients with locally advanced ESCC,with mild adverse effects.Thus,this protocol is worthy of clinical promotion and application.
基金Health Bureau of the Department of Logistics and Security of the Central Military Commission of China,No.17BJZ47.
文摘BACKGROUND Many studies have investigated the relationships between vitamins and esophageal cancer(EC).Most of these studies focused on the roles of vitamins in the prevention and treatment of EC,and few studies have examined the changes in vitamin nutritional status and their influencing factors before and after chemotherapy for EC.Chemotherapy may have a considerable effect on EC patients’vitamin levels and hematological indicators.AIM To research the nutritional status of multiple vitamins in EC patients during chemotherapy and to assess its clinical significance.METHODS EC patients admitted to our center from July 2017 to September 2020 were enrolled in this study.Serum concentrations of nine vitamins(A,D,E,B9,B12,B1,C,B2 and B6),hemoglobin,total protein,albumin,blood calcium,blood phosphorus concentrations and body mass index(BMI)were measured in all EC patients.The changes in nine vitamins,hematological indicators and BMI were compared before and after two cycles of chemotherapy.The possible influential factors were analyzed.RESULTS In total,203 EC patients receiving chemotherapy were enrolled in this study.Varying degrees of vitamin A,D,C and B2 deficiency and weight loss were found in these patients,and the proportions of vitamin B2 and vitamin C deficiencies increased significantly after chemotherapy(both P<0.05).Serum concentrations of vitamins A,C,B2 and B6 and BMI before and after chemotherapy were statistically significant(all P<0.05).Multivariate analysis showed that vitamin A levels significantly differed between male and female EC patients,whereas vitamin D concentration significantly differed in EC patients in different stages(all P<0.05).Correlations were observed between the changes in serum concentrations of vitamin A and C before and after two cycles chemotherapy and the change in BMI(P<0.05).Hemoglobin,total protein,serum albumin and blood calcium concentrations significantly decreased in EC patients after chemotherapy(all P<0.05),while the blood phosphorus level significantly increased after chemotherapy(P<0.05).Using the difference in vitamin concentrations as the independent variables and the difference in BMI as the dependent variable,logistic regression analysis revealed statistically significant differences for vitamin A,vitamin D and vitamin C(F=5.082,P=0.002).CONCLUSION Vitamin A,D,C and B2 were mainly deficient in patients with EC during chemotherapy.Multivitamin supplementation may help to improve the nutritional status,chemotherapy tolerance and efficacy.
基金The study was reviewed and approved by the Medical Ethics Committee of the General Hospital of the Chinese People’s Liberation Army,No.S2021-265-01.
文摘BACKGROUND Pembrolizumab combined with chemotherapy has been proven effective as firstline therapy in patients with advanced esophageal cancer.Few trials have assessed the safety and efficacy of this treatment in patients with locally advanced disease.AIM To analyze long-term outcomes of pembrolizumab in locally advanced or metastatic esophageal squamous cell carcinoma(ESCC)in the real world.METHODS Patients with advanced ESCC admitted to our center from October 2019 to October 2021 were enrolled in this study.Clinical staging of the patients was based on the 8th edition of the American Joint Committee on Cancer TNM staging system.The patients received different treatments based on clinical stage.In brief,patients with locally advanced and resectable ESCC received neoadjuvant therapy combined with surgery.For those who were not candidates for resection,radical concurrent chemoradiotherapy plus pembrolizumab was more preferable.Patients with metastatic ESCC or who were unsuitable for radiotherapy underwent chemotherapy in combination with pembrolizumab.Long-term survival outcomes such as overall survival(OS),progression-free survival,disease-free survival,long-term adverse effects(AEs),immune maintenance therapy and predictors of immune checkpoint inhibitors(ICIs)efficacy were evaluated.RESULTS A total of 55 patients with advanced ESCC were enrolled in this retrospective,observational study.The median age was 61 years(range 44-74),with 47.3%(26/55)of the patients in stage IV and 45.5%of the patients had the tumor(25/55)located in the middle third of the esophagus.The median OS in all patients was not reached.The 12-mo OS rate among all patients was 78.8%and the 18-mo OS rate was 72.7%.9 patients died due to tumor progression and 7 patients died due to treatment-related complications.The therapeutic effect evaluated at the interim evaluation was significantly reflected in the long-term outcome.Patients with complete response or partial response in all patients(P=0.005)and in the chemoradiotherapy plus pembrolizumab group(P=0.007)obtained a better prognosis than non-responders.A total of 20 patients(20/55,36%)received immune maintenance therapy.Baseline peripheral blood biomarkers of the neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,and neutrophil-to-(leukocyte-neutrophil)ratio did not predict the efficacy of ICIs.CONCLUSION Pembrolizumab combined with chemotherapy or radiotherapy resulted in favorable long-term survival in patients with locally advanced or metastatic ESCC,with safe and manageable long-term AEs.
