Evaluation of clinical efficacy after combinational treatment of esophageal cancer using target artery perfusion of verapamil and chemotherapy
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Background: This study aimed to investigate the clinical efficacy of target artery perfusion of verapamil combined with chemotherapy in treating esophageal cancer (EC).
Methods: A total of 46 patients with EC (stage III and IV) were treated with verapamil combined with chemotherapy via target artery infusion. Two to four courses per month of the treatment were administrated. Imaging modalities used in staging EC before and after treatment include gastroscopy/endoscopic ultrasonography, computed tomography (CT) combined with 64-detector-row gemstone spectral imaging/3.0-T magnetic resonance imaging (MRI). The clinical beneficial rate and survival time were also evaluated. Results: Out of 46 patients, 2 cases achieved complete remission (CR) and 39 cases achieved partial remission (PR). There were 3 cases had no change and 2 cases with progressive disease. The overall effective rate (CR + PR) was 89.13%. After treatment, dysphagia in 42 patients was significantly improved except 5 cases with narrow type. A total of 11 cases with hoarseness caused by recurrent laryngeal nerve paralysis before therapy recovered normal voice and another 7 cases were completely relieved. Forty-five patients were treated with 1 course of radiotherapy, and 1 patient was treated by operation after 2 to 4 courses of treatment and clinical tumor stage had decreased. A total of 42 patients (91.30%) survived for more than a year, 24 patients (52.17%) survived for more than 2 years, and 12 patients (26.09%) survived for more than 3 years. Patients also achieved better Karnofsky performance status (KPS) scores, body weight, and positive clinical benefit of the dosage of analgesics, which were 91.30% (42/46), 52.17% (24/46), and 66.67% (4/6), respectively. No significant complication was observed before and after verapamil.
Conclusions: Target artery infusion of verapamil combined with chemotherapy drug significantly reduced the clinical tumor stage of advanced EC (≥ stages III), improved the quality of life, and prolonged the survival time. And patients regained the opportunity of radical radiotherapy or surgery when the clinical tumor stages were decreased.Cite
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Objective To evaluate super-selective interventional chemotherapy combined with systemic chemotherapy in treating postoperative gliomas.Methods During the period of 2005-2009,a total of 46 patients with glioma were encountered in our hospital.According to the principle of patient's free will the involved patients were divided into two groups.Study froup(n = 25):after operation the patients received routine radiotherapy,which was followed by super-selective interventional chemotherapy combined simultaneously with systemic chemotherapy.Control group(n = 21):after operation the patients received routine radiotherapy,which was followed by systemic chemotherapy only.The patients were regularly followed up.Cranial CT checkups were made to determine the tumor size,and the results were evaluated with Karnofsky scores.The clinical data were analyzed and compared between two groups.Results In the study group,the side-effects and complications included epileptic seizures(n = 3),eye pain(n = 5),headache(n = 9),nausea and vomiting(n = 8) and thrombopenia(n = 1).In the control group,the side-effects and complications were as follows:epileptic seizures(n = 1),headache(n = 7),nausea and vomiting(n = 6) and thrombopenia(n = 3).No death occurred in either of the two groups.The patients were followed up for an average period of 2.3 years.Before chemotherapy no statistically significant difference in tumor size existed between two groups(P 0.05).One year after the chemotherapy,the tumor volume in study group was reduced by 67.11%,while it was 45.79% in control group.By using independent sample t test analysis,the difference between two groups was of statistical significance(P 0.05).Wilcoxon rank sum test and Karnofsky prognostic score analysis indicated that the prognosis of study group was much better than that of control group(P 0.05).Conclusion In comparison with routine radiotherapy plus simple systemic chemotherapy,routine radiotherapy plus superselective interventional chemotherapy as well as systemic chemotherapy can more effectively inhibit tumor growth,relieve clinical symptoms and improve living quality.Therefore,it is of clinical value to make a further study of this technique.
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Aims and Background To evaluate the efficacy of combined radiation therapy and continuous infusion of 5-fluorouracil in patients with locally advanced carcinoma of the pancreas. Methods Between January 1992 and June 1999, 31 patients with locally advanced adenocarcinoma of the pancreas were treated in our Institute. In 20 patients, the tumor (65%) was located in the head of the pancreas and in 11 (35%) in the body or tail; 13 cases also showed involved nodes. Radiation therapy consisted in a median dose of 63 Gy in 33-36 fractions applied to the tumor and regional lymph nodes. Chemotherapy with 5-fluorouracil in continuous infusion, 250 mg/m 2 daily, was administered in the first and fifth week of the radiation therapy. Thereafter, 22 patients received 3-10 cycles of adjuvant chemotherapy with same doses. Median follow-up of the series was 20 months. The toxicity of the treatment was scored according to WHO criteria. All patients underwent nutritional assessment at the time of radiochemotherapy. Results The median overall survival was 15.2 months (range, 4-42). At restaging, 17 cases (55%) showed no change and 14 (45%) a partial remission. At the end of radiochemotherapy in 8 (26%) of the cases there was indication for pancreatectomy, which was executed in 4 patients. At the time of the study, 2 patients (6.4%) were surgically proven disease free. Eleven of the 13 cases (85%) presenting involved nodes showed that the enlarged lymph nodes had disappeared. Nineteen patients (61%) are alive with clinical evidence of disease and 2 cases are alive with liver metastases; 8 patients (26%) died for disease. In 74% of cases there was complete pain control. Tolerance to the regimen was good. Nutritional assistance was evaluated and was found to be correlated to survival. Conclusions The results of the series confirm a good tolerance with low acute toxicity. Tumor down-staging and resectability rates were high, together with prolonged survival and a good quality of life.
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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.
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Purpose We evaluated the treatment efficacy including survival and recurrence, and factors associated with recurrence in osteosarcoma patients treated with preoperative chemotherapy, surgery, and adjuvant chemotherapy. Materials and methods Forty nine patients with osteosarcoma were treated with preoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion for 3 cycles, followed by surgery. According to the pathologic response, if tumor was necrotized more than 90%, the same adjuvant chemotherapy was reintroduced for 3 cycles, and if the response was not enough, then the salvage regimen was introduced. Plain chest film and chest CT scan were taken monthly and every 3 months, respectively. When tumor recurred, the metastasectomy was performed whenever possible. Results Forty three patients were evaluable with amedian follow up of 53 months. Five-year disease-free and overallsurvival rate was 47.0% and 66.9%, respectively. The recurrence was observed in 22 patients (51.2%) with median time of 12.5 months. Baseline alkaline phosphatase (ALP) was the only significant factor for recurrence (p=0.03) and the patients with the possibility of metastasectomy recurrence showed higher post-relapse survival compared to other treatment modalities (26 momths vs 5~12 months). Conclusion These results indicates that pre- and postoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion showed comparable treatment efficacy and acceptable toxicities.
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Objective To evaluate the clinical efficacy of intraarterial chemotherapy (IAC) in patients with advanced and/or recurrent cervical cancer, and to determine the optimal time of chemotherapy administration. Methods From February 1990 to December 1996, 40 patients with pathologically confirmed advanced and recurrent cervical cancer were treated with intraarterial chemotherapy in our hospital. The age of the patients ranged between 27 and 67 years, with a mean age of 48.28 and a median of 49. IAC was administered for 1-3 courses every 4-6 weeks for each patient. The Seldinger′s technique was used in all patients. The catheter was introduced via femoral artery on one side (usually on the right side), and the combined antineoplastic agents were infused into contralateral internal iliac artery and/or the ipsilateral branches supplying the involved area. 13 patients had received no prior therapy before initiating intraarterial chemotherapy, whereas 27 patients had received prior treatment of pelvic surgery, and / or radiotherapy, with or without systematic chemotherapy. If the results of the evaluation indicated that surgery was feasible, radical surgery was performed. The patients whose tumors were inoperable received radiation therapy consisting of external irradiation and intracavity irradiation, with or without systematic chemotherapy. Survival was computed by Kaplan Meier estimate and the difference in the treatment efficacy was evaluated by the Cox regression method. Results The mean follow up was 30.9 months (range, 3 0 to 120 0 months). Nine patients had a complete response, and 14 had a partial response. No change in 12, and disease progressed in 5. The overall response rate was 57.5% (CR, 9, PR, 14). The prolonged survival was observed in patients responding to the treatment (with a mean survival time of 76 months, vs. 14 months for the patients who had not responded to the IAC). For the patients had received no prior therapy before initiating intraarterial chemotherapy, the response rate was 100% with a mean survival duration of 105 months (12.1-120 months). Whereas for patients who had received prior treatment of pelvic surgery, and / or radiotherapy, with or without systematic chemotherapy, the response rate was only 37% with mean survival duration of only 17 months (median 14 0 months). The response to chemotherapy did not relate to clinical stage or the histological types (whether it was squamous cell carcinoma or adenocarcinoma). The most frequently observed adverse effects were fever, leukopenia, nausea, and vomiting. Severe skin and subcutaneous necrosis (erosion or ulceration) on the buttock and vulvae was observed in three patients (7.5%). Conclusion IAC should be administered prior to surgery and/or radiotherapy, or concurrently with pelvic radiation to improve the response and survival rate for patients with advanced and recurrent cervical cancer.
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Purpose: This study was designed to evaluate the effectiveness and prognostic factors for patients treated with postoperative radiation therapy following surgery or with radiation therapy alone for squamous cell carcinoma of the esophagus. Materials and Methods: We retrospectively analyzed 132 esophageal cancer patients treated with postoperative radiation therapy following surgery or patients who were treated with radiation therapy alone at our institution from 1989 to 2006. Thirty-five patients had stage II disease, 88 patients had stage III disease and nine patients had stage IV disease. Tumors were located at the upper esophagus in 18 patients, the mid esophagus in 81 patients and the distal esophagus in 33 patients. Sixty patients were treated with radiation therapy alone and 72 patients were treated with postoperative radiation therapy following surgery. Eight patients received a dose less than 40 Gy and 78 patients received a dose of 40 to 50 Gy. The remaining 46 patients received a dose of 50 to 60 Gy. The majority of patients who underwent postoperative radiation therapy received a dose of 45 Gy. Results: Actuarial survival rates for all of the patients at two years and five years were 24% and 5%, respectively. The median survival time was 11 months. Survival rates for pati ents who underwent postoperative RT at two years and five years were 29% and 8%, respectively. The corresponding survival rates for patients who received radiation alone were 18% and 2%, respectively. Survival rates at two years and five years were 43% and 15% for stage II disease, 22% and 2% for stage III disease and 0% and 0% for stage IV disease, respectively; these findings were statistically significant. Two-year survival rates for patients with upper, middle and distal esophageal cancer were 19, 29% and 22%, respectively. Although there was a trend of slightly better survival for middle esophageal tumors, this finding was not statistically significant. Complete response to radiation was achieved in 13 patients (22%) and partial response to radiation was achieved in 40 patients (67%) who received radiation alone. No response to radiation was noted in seven patients (12%). A statistically significant difference in survival rates was seen between patients that had a complete response and patients that had a partial response. Two-year survival rates for patients that had a complete response versus patients that had a partial response were 31% and 17%, respectively. There were no survivors for patients with no response as determined at two-year follow-up. Conclusion: We conclude that radiation therapy is an effective treatment for esophageal cancer. Stage and response to radiation therapy were noted to be prognostic factors. A more effective treatment modality is needed to improve long term survival because of the relatively dismal prognosis for this tumor.
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One hundred eleven patients with inoperable but limited-stage small cell lung cancer were treated with three courses of cyclophosphamide (1.5, 2.5, and 3.5 g/m2, respectively) and VP-16-213 followed by methotrexate and thoracic radiotherapy. The total duration of treatment was 3 months. Patients were included who had pleural effusions, contralateral neck nodes, and bone marrow infiltration. The complete response (CR) rate was 56%, the majority confirmed by repeat bronchoscopy, with an 81% overall response rate. The minimum follow-up was 14 months. Median survival for all 111 patients was 11 months and 14 months (1–34+) for complete responders; the median survival was also 11 months for the 91 patients with conventional limited-stage disease, although 15 of the 19 patients alive at 14 months or more were from this subpopulation. There was no significant difference in the survival of those CR patients whose response was confirmed bronchoscopically and patients whose CR was assessed only radiologically and clinically. Forty-four patients with leukopenia (<1000 cells/μl) received intravenous antibiotics for malaise and suspected infection. Close monitoring between treatments and direct access of patients to the hospital was encouraged. The majority of patients improved symptomatically as assessed by Karnofsky and Respiratory scores. These results support the view that short but intensive treatment without long-term or maintenance chemotherapy is beneficial.
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Head and neck cancer treatment achieves good locoregional tumor control rates while causing severe side effects. Therapy with chemotherapeutic drugs administered intravenously is limited because either the concentrations at the tumor site are too low or the total dosages are too high. The evaluation of a technique for short-term intra-arterial infusion chemotherapy is described herein. In a retrospective study, we reviewed the medical records of 97 patients with head and neck cancers who received short-term intra-arterial infusion chemotherapy (62 patients previously untreated, 35 patients with prior radiotherapy). All patients refused further radiotherapy. Response rates, overall survival and adverse effects were the study endpoints. The blood supply of the tumors was controlled with indigocarmine blue infusion and staining of the tumor region. Complete or partial response was found in 67%, 52% and 63% of previously untreated patients and in 25%, 30% and 29%, respectively, of previously irradiated patients for staging groups I–III, IVA and IVB/C. Patients with T3/T4 tumors who were previously irradiated showed a median overall survival of 9 months, and those without pretreatment showed a median overall survival of 22.5 months. None of the patients required tube feeding. No new case of dysphagia, xerostomia, or functional speech and hearing loss was reported. Pain and clinical symptoms were reduced for all patient groups. Indigocarmine staining showed reduced tumor blood supply in previously irradiated regions but good blood supply in untreated regions. Short-term intra-arterial infusion chemotherapy achieves promising response rates and lacks severe adverse effects.
Hematology
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