Hui Fang

Use of sequential endorectal US to predict the tumor response of preoperative chemoradiotherapy in rectal cancer

BACKGROUND AND AIMSnAccurate prediction of the response to preoperative chemoradiotherapy (CRT) potentially assists in the individualized selection of treatment. Endorectal US (ERUS) is widely used for the pretreatment staging of rectal cancer, but its use for preoperatively predicting the effects of CRT is not well evaluated because of the inflammation, necrosis, and fibrosis induced by CRT. This study assessed the value of sequential ERUS in predicting the efficacy of preoperative CRT for locally advanced rectal cancer.nnnMETHODSnForty-one patients with clinical stage II/III rectal adenocarcinoma were enrolled prospectively. Radiotherapy was delivered to the pelvis with concurrent chemotherapy of capecitabine and oxaliplatin. Total mesorectal excision was performed 6 to 8 weeks later. EUS measurements of primary tumor maximum diameter were performed before (ERUS1), during (ERUS2), and 6 to 8 weeks after (ERUS3) CRT, and the ratios of these were calculated. Correlations between ERUS values, tumor regression grade (TRG), T down-staging rate, and pathologic complete response (pCR) rate were assessed, and survival was analyzed.nnnRESULTSnThere was no significant correlation between ERUS2/ERUS1 and TRG. The value of ERUS3/ERUS1 correlated with pCR rate and TRG but not T down-staging rate. An ERUS3 value of 6.3xa0mm and ERUS3/ERUS1 of 52% were used as the cut-off for predicting pCR, and patients were divided into good and poor prognosis groups. Although not statistically significant, 3-year recurrence and survival rates of the good prognosis group were better than those of the poor prognosis group.nnnCONCLUSIONSnSequential ERUS may predict therapeutic efficacy of preoperative CRT for locally advanced rectal cancer. (Clinical trial registration number: NCT01582750.).

Clinical and prognostic differences between ALK-negative anaplastic large cell lymphoma and peripheral T cell lymphoma, not otherwise specified: a single institution experience.

Clinical differences between anaplastic lymphoma kinase (ALK)-negative anaplastic large-cell lymphoma (ALK− ALCL) and peripheral T cell lymphoma, not otherwise specified (PTCL-NOS), remain unclear. The aim of this study was to compare the clinical and prognostic features of these two lymphoma types. We retrospectively analyzed 167 patients with ALK− ALCL (nu2009=u200948) and PTCL-NOS (nu2009=u2009119). Compared with ALK− ALCL patients, PTCL-NOS patients exhibited distinct differences in clinical features with a propensity for more advanced stages, frequent extranodal involvement, and a poor performance status, leading to a higher risk group according to the International Prognostic Index or Prognostic Index for PTCL-NOS. Patients with ALK− ALCL were associated with a higher complete response rate (47.9 vs. 31.0xa0%; Pu2009=u20090.041) after initial chemotherapy than patients with PTCL-NOS. The prognosis was significantly different between two subtypes, with a 5-year overall survival (OS) rate of 57.9xa0% for ALK− ALCL and 23.9xa0% for PTCL-NOS (Pu2009=u20090.002). The subgroup analysis showed significant differences in OS and progression-free survival between the two subtypes in early-stage diseases, but not in advanced-stage diseases. We conclude that patients with ALK− ALCL showed favorable clinical features, higher chemosensitivity, and a superior outcome than those with PTCL-NOS.

A prospective phase I study of hypo-fractionated neoadjuvant radiotherapy for locally advanced gastric cancer

BackgroundPrevious studies have reported that neoadjuvant chemoradiotherapy can downstage the advanced gastric cancer. However, no studies are available on the application of hypo-radiotherapy to neoadjuvant radiotherapy. This study sought to assess the maximum tolerated dose (MTD) and dose-limited toxicity (DLT) of hypo-fractionated chemoradiotherapy for local advanced gastric cancer.MethodPatients with cT3–4 and/or lymph node-positive locally advanced gastric cancer or Siewert II/III esophagogastric junction adenocarcinoma were enrolled. Preoperative chemoradiation was followed by 3xa0cycles of oxaliplatin + S-1 neoadjuvant chemotherapy with an interval duration of 3–4xa0weeks. D2 resection was performed 2–4xa0weeks after neoadjuvant therapy. Three cycles of adjuvant chemotherapy were planned after surgery. Intensity-modulated radiotherapy (IMRT) was used. The radiotherapy dose level was defined using three levels, namely, 40.0xa0Gy/2.5xa0Gy, 41.6xa0Gy/2.6xa0Gy, 43.2xa0Gy/2.7xa0Gy delivered concurrently with S-1 at 80xa0mg/m2.ResultsFrom May 2016 to Dec 2016, nine patients with a median age of 63xa0years were enrolled in this study. The most common grade I-III adverse events were leukopenia (88.9%), nausea (88.9%), vomiting (77.8%) and weight loss (66.7%). Grade III adverse events consisted of vomiting and weight loss.ConclusionThe MTD of hypo-fractionated radiotherapy for locally advanced gastric cancer was 40.0xa0Gy/2.5xa0Gy, and the DLTs were vomiting and weight loss.Trial registrationClinicaltrials.gov ID: NCT03427684 (Retrospectively registered on February 9, 2018).