| PartⅠ:Primary Analysis of The Failure Pattern and The Corelation Betweet Stage/Prognosis and Biomarker in Patients with Gastric CancerPurpose:To retrospectively analyse the failure pattern with radical resection and the corelation betweet stage/prognosis and biomarker in gastric cancer patients.Material and methods:Between Jan 2002 and Dec.2006,84 randomized selected patients were enrolled into the database analysis,including 8 with clinical stageⅠ,20 with clinical stageⅡ,21 with clinical stageⅢA,22 with clinical stageⅢB and 13 with clinical stageⅣ,male 61 and female 23,All of these patients undergone R0 gastrectomy,61(72.6%) patients undergone D2 resection,collected biomarker including:preoperative tumor marker:CEA,AFP,CA199,CA50,CA72-4 and CA24-2;postoperative-immunohistochemical(ICH)outcome:Bax,Bcl-2,P27,CyclinD1, TOPO-Ⅱ,MDR,GST-π,Ki67 and AgNOR;EGFR,P21,P53,PCNA,C-myc and Neu. Results:Among the documented recurrences,locoregional sites were involved as any part of the recurrence pattern in 18 patients(56%).Distant sites were involved as any part of the recurrence in 12 patients(38%) and peritoneal recurrence was detected as any part of the recurrence in 11 patients(34%).3-year LCR,PFS and OS were 66%,64% and 61%respectively.logistic regression analysis show Ki67 and TOPO-Ⅱwere correlated with staging;cyclinD1,CEA,CA72-4 had correlation with prognosis;cyclinD1,CEA had correlation with localregional recurrence;PCNA had association with remote metastasis;bcl-2,ki67,c-myc2 and Neu were correlated with lympha node metastasis.univariate verified that primary lesion,lympha node metastasis,clinical staging,level of cyclinD1 and CEA were correlated with survival;multivariate shew localregional recrrence was the independent prognostic factors.Conclusions:The present study indicate that the dominant failure pattern is local recurrence,and high level of CEA,low expression of cyclin D1 resulted in poor prognosis,and then these patients may need more radical or specific treatment.,and present study proposes reference and foundation for knowing about the biological behavior of gastric cancer,and also for finding out independent molecular biological prognostic factor hence guiding clinic intervention tragedies. PartⅡ:Postoperative Radiation Combined with Triple Regimen Chemotherapy in Locally Advanced Adenocarcinoma of The Stomach and Gastroesophageal JunctionPurpose:To evaluate the safty and efficacy of postoperative radiation combined with adjuvant triple regimen chemotherapy in the postoperative treatment of locally advanced gastric and gastroesophageal junction carcinoma.Methods and Materials:During April 2002 to July 2008,97 consecutive and nonselected patients with stage T3-4,or N+ gastric and gastroesophageal junction cancer patients were treated postoperatively.Of them 51(53%) underwent D2 desection.Seventy-seven percent(77/97) patients received adjuvant concurrent chemoradiotherapy(5-fluorouracil or Capecitabine) and 23%patients were with radiation only.The radiation dose ranged from 43.2-50.4 Gy(median 45Gy).All patients received triple regimen adjuvant chemotherapy of ECF and variant.Patients were divided into two groups according to the cycles of chemotherapy received. Sixty-one percent(59/97) patients received(?)4cycles were recorded as group 1 and the rest 38 were in the group 2.Results:Eighteen(19%) patients experienced Grade 3 acute complications,one patient experienced anastomotic stoma 3 months after completion of the chemoradioation,and 1(1%)patients died as a adjuvant chemotherapy induced toxicity(liver function failure and fever).After a median follow-up of 17 months,for the whole group,the 3-year local control,disease-free survival and overall survival rate was 90%,61%and 70%respectively.For patients with concurrent chemoradiation or radiation alone,the 3-year local control,DFS and OS rate similar and were 90%,61%and 73%and 90%,57%and 64%,respectively(p＞0.05). Patients benefit from 4 or more cycles of chemotherapy,the 3-year DFS and OS was 74%and 77%for groupl and 41%and 59%for group 2 respectively(p＜0.05).Local control rate for groupl and group 2,was 87%and 94%respectively(p＞0.05). Multivariate analyses revealed that pN category was an independent prognostic factor for locoregional control while peritoneal metastasis was an independent factor to predict overall survival(p＜0.05).Conclusions:This study showed concurrent chemoradiation followed by adjuvant triple regimen chemotherapy is feasible and tolerable in postoperative gastric cancer patients.Patients may be benefit from more cycles of adjuvant chemotherapy. Prospective randomized study of large number of patients is needed. PartⅢ:Variation of Clinical Target Volume and Common Organs Definition in Three-Dimensional Conformal Radiation Therapy for Post-Operative Gastric CancerPurpose:Currently,three-dimensional conformal radiation therapy(3D-CRT) planning relies on the interpretation of computed tomography(CT) axial images for defining the clinical target volume(CTV).This study investigates the variation among multiple observers and different CT scans to define the CTV used in 3D-CRT for postoperative gastric cancer.Methods and Materials:Four observers independently delineated the CTVs and common organ(LIVER and KIDNEY) from the CT simulation data of 10 postoperative gastric cancer patients undergoing 3D-CRT.To determine interobserver variation,we evaluated the derived volume,the maximum dimensions,and the isocenter for each examination of CTV.We assessed the reliability in the CTVs among the observers by correlating the variation for each class of measurements.This was estimated by intraclass correlation coefficient(ICC),with 1.00 defining absolute correlation.and we try to find the slices with more variations by compare the conformity index(CI).Results:For the whole group,the average volume and SD percent of CTV,L-KIDNEY,R-KIDNEY AND LIVER was 674.56cm~3(20.5%),149.18 cm~3 (8.7%),141.29 cm~3(15.1%) and 1000.83 cm~3(13.8%),respectively.The inter-CT average distance between the gravity center of CTV,LIVER,L-KIDNEY AND R-KIDNEY was 0.40,0.56,0.65 and 0.6cm,respectively;for inter-observer was 0.98,0.53,0.16 and 0.15cm.The inter-observer and inter-CT maximum,minimum and average CI was 83.21%,63.89%and 70.64%and 85.97%,76.01%and 81.79%.The ICC of inter-observer was was 0.941(0.897-0.969).The inter-observer and inter-CT ICC of X,Y and Z was 0.886,0.840 and 0.942 and 0.961,0.989 and 0.944.the average variation was:32.5mm,22mm and 16.24mm,respectively.Conclusions:In the volume of CTV for postoperative gastric cancer,there was significant variation among multiple observers while there was no variation betweet differnt CT scan,and there was no variation in the volume of common organ contour.There was excellent agreement from the same observer,and there are more variation between observer.In the same CT scan,there was excellent agreement too,however the variation of common organ between different CT scan may come from spatial location.In the analysis of X,Y and Z,there was no significant variation.The slices with low CI were more likely to appear at the diaphragmatic fornix slice,the lower verge of hilum of spleen and porta hepatis slice,then para-esophageallymphy nodesregionaland abdominal aorta-inferior vena cava slice.And the variation in cranio-caudal orientation from inter-observer was more predominant compared to the one from inter-CT. |
PDF Full Text Request