RESUMEN
Background/aim: To assess the efficacy and side effects of concurrent weekly chemotherapy and radiotherapy with simultaneous integrated boost (SIB) technique for nasopharyngeal cancer (NPC). Materials and methods: total of 51 consecutive patients with diagnosis of NPC were treated between February 2010 and December 2015. The median dose for PTV70 (range: 6082) was given in 33 fractions (range: 3135). Forty-five of the patients received concomitant weekly chemotherapy between 37 cycles (median 6). Eleven patients received neoadjuvant and thirty-nine patients received adjuvant chemotherapy. Results: At a median follow-up 43 months (range: 276) the estimated 5-year overall survival and disease-free survival were 74.6% and 62.6%, respectively. Conclusion: In radiotherapy of advanced NPC, generally a considerable amount of normal head and neck tissues might have to be irradiated in addition to gross tumor volume, involved node, and elective neck irradiation. Together with chemoradiotherapy, poor oral hygiene and inadequate nutritional support result in excessive morbidity. Despite loco-regional success of concurrent chemoradiotherapy, distant metastasis is still the major pattern of treatment failure in the intensity modulated radiotherapy era. We need to improve our adjuvant chemotherapy regimens or develop new drugs.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioradioterapia , Neoplasias Nasofaríngeas/patología , Neoplasias Nasofaríngeas/terapia , Radioterapia de Intensidad Modulada , Adolescente , Adulto , Anciano , Niño , Supervivencia sin Enfermedad , Relación Dosis-Respuesta a Droga , Relación Dosis-Respuesta en la Radiación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Nasofaríngeas/mortalidad , Neoplasias Nasofaríngeas/radioterapia , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
The aim of this study was to investigate the prognostic significance of standardized uptake value (SUV) on 18 fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with nasopharyngeal carcinoma (NPC). Thirty-four patients who have histologically proven NPC and underwent 18F-FDG PET/CT were included in this study. After 18F-FDG PET/CT, all the patients received radiation therapy and 32 of them received concomitant weekly chemotherapy. The maximum SUV (SUVmax) at the primary tumor and the SUVmaxof the highest neck nodes were determined. The SUVmax-T ranged from 5.00 to 30.80 (mean: 15.37 ± 6.10) and there was no difference between SUVmax-T values for early and late stages (P = 0.99). The SUVmax-N ranged from 3.10 to 23.80 (mean: 13.23 ± 5.76). There was no correlation between SUVmax-T and SUVmax-N (r = 0.111, P = 0.532). There was no difference between the SUVmax-T and the positivity of neck lymph nodes (P = 0.169). The ability of SUVmaks-N to predict stage was obtained by a receiver operating characteristic (ROC) analysis. The area under the curve is 0.856 and the best cut-off value is 7.88. There was a good correlation between SUVmax-N and stage. While the mean SUVmax-T for the alive patients was slightly lower than that for the dead (14.65 ± 5.58 vs. 20.30 ± 7.92, P = 0.061), the difference between the groups was not statistically significant. Furthermore, there was no statistically significant difference for SUVmax-N between these two groups (P: 0.494). Cox-regression analysis showed that an increase in SUVmax-T and SUVmax-N was associated with death risk (relative risk [RR]: 1.13, P = 0.078 and RR: 1.052, P = 0.456, respectively). SUVmax-T and SUVmax-N were independent prognostic factors for survival in NPC patients. This will help the clinicians in choosing suitable candidates for more aggressive treatment modalities.
RESUMEN
OBJECTIVE: In this report, we determined the efficacy and the toxicity of low dose weekly gemcitabine with radiotherapy, in medically unfit or refused surgery muscle-invasive bladder cancer (BC) patients. MATERIALS AND METHODS: From 2008 to 2012, 15 patients were included into the retrospective analysis. Weekly gemcitabine was administered at a rate of 50 mg/m(2) with a median dose of 63 Gy radiotherapy. RESULTS: The median age was 69 (range, 55-86). Median follow-up was 15 months (range, 5-53 months). A complete response was achieved in 12 patients (80%). Median progression free survival and overall survival were 15 months (range, 7-23 months) and 18 months (range not calculated), respectively. Local recurrence was found in 3 patients (20%) and distant recurrence was found in 5 patients (33.3%) for the entire group. While salvage surgery was performed on 1 patient, salvage chemotherapy was delivered for 4 patients. Treatment was well tolerated, there was no treatment interruption or instances of toxic death. A serious toxicity (grade 3) cystitis was seen in only 1 patient. CONCLUSIONS: Multimodality treatment of muscle invasive BC proved a feasible and effective treatment option. Gemcitabine based chemoradiation is an active treatment option with a low toxicity profile for patients with muscle invasive BC, who are not suitable medically or refused to surgery.