[Combined radiotherapy and pre-radiation chemotherapy with cisplatin and 5-fluorouracil for advanced esophageal carcinoma. II. Clinical evaluation in cases with higher than T2 stage].
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Thirteen patients with previously untreated advanced squamous cell carcinoma of the esophagus were treated with pre-radiation chemotherapy followed by radiation therapy. The chemotherapy consisted of two or three cycles of Cisplatin and 120 hour continuous infusion of 5-Fluorouracil. Three patients showed complete response (CR), three partial response (PR), three minor response (MR) and four non-response (NR). The overall response rate was 46%. The predominant side effects were nausea, vomiting and anorexia. Mild or moderate degree of anemia and leukocytopenia were also noticed. However, no serious toxicity was observed. Radiation therapy was administered to eleven of the thirteen patients, excluding one patient who refused it and one patient who died during chemotherapy. In two of the eleven cases, however, radiotherapy was discontinued because of MR, and surgery was performed. In one additional case, post-radiotherapy surgery was performed. One of these three cases received curative esophagectomy. After definitive treatment, CR was obtained in 54% (7 of 13), PR in 15% (2 of 13), MR in 15% and NR in 15%. The non-effective patients (PR + MR + NR) died within nine months after the initiation of treatment. Two of the CR patients later died, one due to local recurrence and another due to aortic-esophageal fistula with no residual cancer discovered at autopsy. The remaining CR patients are still alive and well, after 11.5 to 32 months. Although the follow-up period is yet short, the combination of radiation therapy with pre-radiotherapy chemotherapy appears to be an effective treatment.Keywords:
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Esophagectomy
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The effects of ondansetron hydrochloride (OND) were studied through 11 courses of chemotherapy, including 70 mg/m2 of cisplatin, in 9 patients with advanced esophageal cancer. During the observation period of 5 days, 4 mg of OND was given intravenously on the day of cisplatin infusion and orally for consecutive 4 days, and nausea was controlled by over 70%. Vomiting was controlled by over 80%. The inhibitory effect of OND on nausea and vomiting was found in 72.7% on the day of cisplatin injection and 88.9% overall. No other side effects of OND except slight increases in total bilirubin and LDH were found in any patient. These findings suggest that intravenous and oral administration of OND may inhibit chemotherapy-induced nausea and vomiting in patients with advanced esophageal cancer.
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To observe and evaluate the result of the advanced cervical cancer treated with con-current chemotherapy and radiotherapy(CCR).Thirty-two cases with advanced cervical cancer(stageⅡb toⅢ)were treated with concurrent chemotherapy and radiotherapy(group A).Chemotherapy consisted of VCR,DDP and PYM.Full dose of external irradiation combined with intracavitary radiation was adopt.Thirty-two cases(group B)in the same period treated with radiotherapy alone served as con-trols.After3months'treatment,response rate(CR+PR)in group A was90.63%,while in group B was54.17%(P0.05).The3-year survival rate in group A was84.38%,while in group B was53.13%.The result of CCR was significantly better than that of conventional radiotherapy.The major side effects in group A were mild leucopoenia,appetite,nausea and vomiting.But toxicity due to chemotherapy was usu-ally reversible.All patients could complete the treatment plans in time.[Conclusions]Chemotherapy with VBP and regimen concurrent radiation therapy may improve the3-year survival rate of advanced cervical cancer,the toxicity are tolerable.
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Abstract We have devised a two‐stage operation for poor‐risk patients with carcinoma of the thoracic esophagus. The first‐stage operation consists of a right thoracotomy, subtotal esophagectomy, and lymph node dissection. Two to three weeks later, the second‐stage operation of esophageal reconstruction with gastric tube is performed under laparotomy. During this 3‐week period of no esophagus, the nutritional status can be adequately maintained by intravenous hyperalimentation. We describe herein the technique, postoperative complications, and mortality of our two‐stage operation as compared with events during an ordinary one‐stage operation for carcinoma of the thoracic esophagus.
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Chemotherapy (with 5-fluorouracil and either mitomycin-C or cis-platinum) combined with radiotherapy was used either for palliation or as preoperative therapy in 67 patients with squamous cell carcinoma of the esophagus. In 25 patients having chemotherapy and 5000-6000 rads, good local palliation was obtained in 11 (49%) without surgery. In the remaining 25 patients, swallowing was restored with a variety of procedures (primarily Celestine tube or gastric bypass). The average survival time was seven months and two patients are still alive at 9 and 12.5 months. Of 42 patients receiving preoperative chemotherapy and radiotherapy, 35 had surgery. Of these, 13 (37%) had complete eradication of their tumors with no histologic evidence of carcinoma in the resected esophagus or associated lymph nodes. In another six (17%), the only evidence of tumor was small microscopic foci of cancer cells in the wall of the esophagus. The 6-, 12-, and 24-month survival rates for patients having surgery after the combined preoperative chemotherapy and radiotherapy were 83 per cent, 52 per cent, and 30 per cent, respectively. These results are far superior to those previously obtained.
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Objective: To study the effect and side effect of advanced ovarian cancer treated by chemotherapy combined with radiotherapy. Methods: Seventy two cases of advanced ovarian cancer can not accepted operation were divided into 2 groups. Group 1 received chemotherapy,treated by IPA 3 times, 3 weeks a circle. Chemotherapy combined with radiotherapy was given to Group 2, treated by IPA 1 times , all pelvis field accepted radiotherapy (6MV-X Ray) DT40GY/4W,thenreduced the field and dosage to DT10~20GY/1~2W. Chemotherapy was given after a week,3 weeks a circle. Results: The efficient rate (CR+PR) were 77.8% and 100% respectively.1,3 years survival rate were 60.1%、32.7% and 73.1%、48.2%. Side effects included prolonged nausea and vomiting,leukopenia. Conclusion: Chemotherapy combined radiotherapy may increased local control rate and survival rate .The side effect was lower. It is a safe and efficient therapy for advanced ovarian cancer.
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Objective:To evaluate the treatment efficacy and complications of chemotherapy combined with radiotherapy after radical surgery for progressing gastric carcinoma. Methods: Seventy patients with progressing gastric carcinoma were randomly divided into two groups: thrity-five patients received chemotherapy and radiotherapy(CT-RT group),35 paeients rectived chemotherapy(CT group), CT-RT group patients were given with 6/15MV X-ray total tumors dose was(45～50)Gy/(23～25)f .Chemotherapy regimen was ELF(VP-16,CF and 5-FU). Results: The 1-year, 2-year, 3-year survival rates in CT-RT group and CT group were 82.9%,71.4%,65.7% and 60.0%,34.3%,28.6%(P0.05). 3-year frel neoplasms survival rates were 57.1% and 20.0%(P0.05).The major toxic effects were nausea/vomiting, myelosuppression was similar in two groups. Conclusion: Chemotherapy plus radiotherapy can increase the survival rate in patients with radical surgery for progressing gastric carcinoma ,The major adverse effects were nausea/vomiting and myelosuppression,the patients were tolerable.
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We generally choose transhiatal esophagectomy (THE) for patients with high risk for postoperative complications and for carcinoma of the lower thoracic esophagus, even if the tumor is in the advanced stage. In order to define indications for THE in esophageal cancer patients, we investigated 40 THE cancer patients according to the expressions of EGF/EGFR, p53 and p21. In patients with stages I, II, III and IV tumors, 5-year survival rates were 66.7%, 28.6%, 30.0% and 11.4%, respectively. The sites of first recurrence were the lymphnodes (n = 10) and single organs (n = 10). Dissemination (n = 3) and local recurrence (n = 2) were also seen as a first recurrence. According to EGF/EGFR, 5-year survival rate was 69% and 14% in the low and high EGF/EGFR groups, respectively. According to p53 expression, 5-year survival was 60% and 30% in the negative and positive groups, respectively; according to p21 expression, 5-year survival was 71% and 0% in the negative and positive groups, respectively. Significant difference was seen in EGF/EGFR and p21 groups. These data support less invasive surgery for some patients even for esophageal cancer patients. THE is a less invasive surgery, that also implies fewer curative procedure. Our results also showed that THE alone will be the only curative procedure necessary for some patients. We can determine therapeutic procedures using these new factors, and thus avoid unnecessary excess surgical stress in esophageal cancer patients.
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Objective: To evaluate the efficacy and toxicity of OXA-LV5FU2 regimen as the neoadjuvant chemotherapy in the treatment of patients with advanced/metastatic gastric cancer. Methods: Thirty-two patients were treated with OXA-LV5FU2 chemotherapy before operation. Neoadjvant chemotherapy regimens containing OXA 100mg/m2 iv 2hr d1, LV 200mg/m2 iv 2hr followed by 5-Fu 400mg/m2 iv bolus and 5-Fu 1g/m2 iv 48～72 hr d1,2 were administered every 2 to 3 weeks for 3 to 4 cycles before local treatment. The response in the primary tumor and the chemotherapy toxicity were observed. Results: Twenty-seven patients were treated with surgery. The radical resection was carried out in 16 cases. The response in the primary tumor: clinical efficacy rate was 46.9% (3.1% CR , 43.8% PR, 34.4% SD and 18.8% PD ). Ten of the 32 cases were downstaged. The most common toxicities were nausea/vomiting, peripheral neuropathy, leukocytopenia, alopecia, and hepatosis. The toxicities relieved after symptomatic treatment. There was no any death during treatment. Conclusion: OXA-LV5FU2 is a very effective and well tolerated regimen as neoadjvant chemotherapy for advanced gastric cancer.
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A 70-year-old patient with advanced esophageal cancer with invasion to the aorta was treated by combined chemotherapy of TS-1 and CDDP with radiotherapy. TS-1 (80 mg/m2) was administered for 14 days followed by 14 days rest, CDDP (70 mg/m2) was administered by 24 h continuous intravenous infusion at day 8 after the start of TS-1. Radiotherapy (5 days/week) at 2 Gy/day was concurrently started from the beginning of chemotherapy for 3 weeks. After the end of the first course, leukocytopenia of grade 2 and thrombocytopenia of grade 2 were observed. The second course of chemoradiotherapy was suspended for 1 week. After recovery from the toxicity, the second course was started. After the 2 courses of chemoradiotherapy, endoscopic examination with biopsy revealed the disappearance of the esophageal cancer. Combined chemotherapy of TS-1 and CDDP was administered 2 times after chemoradiotherapy. After this therapy, endoscopy and a CT showed a complete clinical response. No severe adverse effects were observed during this therapy. Combined chemotherapy of TS-1 and CDDP with radiotherapy can be effective for advanced esophageal cancer.
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