Two cases of cisplatin-induced permanent renal failure following neoadjuvant chemotherapy for esophageal cancer

AbstractIntroductionWe experienced two esophageal cancer patients who developed severe acute renal failure after neoadjuvant chemotherapy with cisplatin and 5-fluorourasil.Presentation of caseAfter administration of cisplatin, their serum creatinine increased gradually until they required hemodialysis and their renal failure was permanent. In both cases, renal biopsy examination indicated partial recovery of the proximal tubule, but renal function did not recover. After these events, one patient underwent definitive radiotherapy and the other underwent esophagectomy for their esophageal cancers, while continuing dialysis. Both patients are alive without cancer recurrence.DiscussionIn these two cases of cisplatin-induced renal failure, renal biopsy examination showed only slight disorder of proximal tubules and tendency to recover.ConclusionAlthough cisplatin-related nephrotoxicity is a well-recognized complication, there have been few reports of renal failure requiring hemodialysis in cancer patients. In this report, we present their clinical courses and the pathological findings of cisplatin-related renal failure

Outcomes of definitive chemoradiotherapy for stage iva (T4b vs. n4) esophageal squamous cell carcinoma based on the japanese classification system: A retrospective single-center study

The differences in prognoses or progression patterns between T4b non-N4 and non-T4b N4 esophageal squamous cell carcinoma post chemoradiotherapy (CRT) is unclear. This study compared the outcomes of CRT for stage IVa esophageal squamous cell carcinoma according to T/N factors. We retrospectively identified 66 patients with stage IVa esophageal squamous cell carcinoma who underwent definitive CRT at our center between January 2009 and March 2013. The treatment outcomes, i.e., progression patterns, prognostic factors, and toxicities based on version 5.0 of the National Cancer Institute Common Terminology Criteria for Adverse Events, were studied. The patients (56 men and 10 women) had a median age of 67 (range: 37–87) years. The T/N classifications were T4b non-N4 (28/66), non-T4b N4 (24/66), and T4b N4 (14/66). Objective response was achieved in 57 patients (86.4%, (95% confidence interval, 74.6–94.1%)). There were no significant differences between the T/N groups in terms of overall survival, progression-free survival, and progression pattern. We found no significant differences in prognoses or progression patterns among patients with T4b non-N4, non-T4b N4, and T4b N4 esophageal squamous cell carcinoma. Thus, it seems impractical to modify CRT regimens based on T/N factors

Differences in treatment and survival between elderly patients with thoracic esophageal cancer in metropolitan areas and other areas

To address the major issue of regional disparity in the treatment for elderly cancer patients in an aging society, we compared the treatment strategies used for elderly patients with thoracic esophageal cancer and their survival outcomes in metropolitan areas and other regions. Using the national database of hospital-based cancer registries in 2008-2011, patients aged 75 years or older who had been diagnosed with thoracic esophageal cancer were enrolled. We divided the patients into two groups: those treated in metropolitan areas (Tokyo, Kanagawa, Osaka, Aichi, Saitama, and Chiba prefectures) with populations of 6 million or more and those treated in other areas (the other 41 prefectures). Compared were patient backgrounds, treatment strategies, and survival curves at each cancer stage. In total, 1236 (24%) patients from metropolitan areas and 3830 (76%) patients from nonmetropolitan areas were enrolled. Patients in metropolitan areas were treated at more advanced stages. There was also a difference in treatment strategy. The 3-year survival rate among cStage I patients was better in metropolitan areas (71.6% vs. 63.7%), and this finding mainly reflected the survival difference between patients treated with radiotherapy alone. For cStage II-IV patients, there were no differences. Multivariable Cox proportional hazard analysis including interaction terms between treatment areas, cStage, and the first-line treatments revealed that treatments in the metropolitan areas were significantly associated with better survival among patients treated with radiotherapy alone for cStage I cancer. Treatment strategies for elderly patients with thoracic esophageal cancer and its survival outcomes differed between metropolitan areas and other regions

Neoadjuvant Chemoradiotherapy Followed by Esophagectomy with Three-Field Lymph Node Dissection for Thoracic Esophageal Squamous Cell Carcinoma Patients with Clinical Stage III and with Supraclavicular Lymph Node Metastasis

Simple Summary This study aimed to clarify the efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by esophagectomy with three-field lymph node (LN) dissection for clinical Stage III patients and for clinical Stage IVB patients with supraclavicular LN metastasis as the only distant metastatic factor. We observed that NACRT followed by esophagectomy with three-field lymph node dissection is feasible and offers the potential for long-term survival of these patients. It is also suggested that supraclavicular LNs should be treated as regional LNs at least in patients with upper and middle thoracic esophageal squamous cell carcinoma (ESCC). Background: Neoadjuvant chemoradiotherapy (NACRT) followed by esophagectomy is now the standard treatment for patients with resectable advanced thoracic esophageal squamous cell carcinoma (ESCC) worldwide. However, the efficacy of NACRT followed by esophagectomy with three-field lymph node dissection for clinical Stage III patients and for clinical Stage IVB patients with supraclavicular LN metastasis has not yet been determined. Methods: Between 2008 and 2018, 94 ESCC patients diagnosed as clinical Stage III and 18 patients diagnosed as clinical Stage IVB with supraclavicular LN metastasis as the only distant metastatic factor were treated with NACRT followed by esophagectomy with extended lymph node dissection at Akita University Hospital. Long-term survival and the patterns of recurrence in these 112 patients were analyzed. Results: The median follow-up period of censored cases was 60 months. The five-year OS and DSS rates among the clinical Stage III patients were 57.6% and 66.6%, respectively. The five-year OS and DSS rates among the clinical Stage IVB patients were 41.3% and 51.6%, respectively. The most frequent recurrence pattern was distant metastasis (69.2%) in the Stage III patients and LN metastasis (75.0%) in the Stage IVB patients. Conclusion: NACRT followed by esophagectomy with three-field LN dissection is feasible and offers the potential for long-term survival of clinical Stage III ESCC patients and even clinical Stage IVB patients with supraclavicular LN metastasis as the only distant metastatic factor. At least in patients with upper and middle thoracic ESCC, treating supraclavicular LNs as regional LNs seems to be appropriate

STEREOTACTIC IRRADIATION FOR BRAIN METASTASES : ANALYSIS OF PROGNOSTIC FACTORS IN SURVIVAL

Stereotactic radiotherapy (SRT) has become an established therapeutic option for patients withbrain metastases. The purpose of this study was to evaluate the effcacy of SRT for brain metastasesand to identify prognostic factors affecting survival. We analyzed 74 patients with brainmetastases encountered at Akita University from June 2000 to February 2003. The survival ratewas assessed by the Kaplan-Meire method, and the significance of differences was determinedwith the log-rank test. The Cox regression analysis was used adjusting for factors including age,gender, Karnofsky performance status (KPS), tumor volume, tumor number, extracranial diseasestatus. This study showed the median survival after SRT for the whole group was 7.9 months,and KPS and extracranial disease status are independent factors for survival. Patients with KPS<70 and extracranial progressive disease had a very poor outcome with a median survival of 3.3months, and are unlikely to benefit from SR

SAFETY AND TREATMENT OUTCOMES OF STEREOTACTIC BODY RADIOTHERAPY FOR PULMONARY TUMORS : A RETROSPECTIVE SINGLE-CENTER STUDY

Stereotactic body radiotherapy (SBRT) uses hypofractionated and more precise irradiation methods, and has the advantages of shorter duration, better outcomes, and fewer side effects than conventional radiotherapy. However, the optimal dosage remains unclear. The purpose of the study was to analyze our preliminary treatment results and safety. We retrospectively analyzed 32 patients (primary cancer, 22 ; metastatic cancer, 10) who underwent SBRT for pulmonary tumors at our hospital from April 2015 to June 2020. SBRT was performed with escalated dose prescriptions (up to 55Gy in 4 fractions/64Gy in 8 fractions for peripheral/central lesions, respectively). We evaluated the local control rate (LC rate), overall survival (OS), progression-free survival (PFS), disease-specific survival (DSS), and adverse events. The target lesions comprised 22 primary lung cancers and 13 metastatic lung cancers. The 2-year LC, OS, PFS, and DSS rates were 82.5%, 68.3%, 50.5%, and 88.0% for primary lung cancer patients and 83.1%, 29.9%, 23.1%, and 48.6% for metastatic lung cancer patients, respectively. Five cases of radiation pneumonitis of grade 2 or higher, one of grade 1 dermatitis and 1 of esophagitis were observed as adverse events. We showed that the treatment outcomes of SBRT for primary and metastatic lung cancers were mostly acceptable

RADIATION THERAPY FOR STAGE ⅢB UTERINE CERVICAL CANCER AT OUR INSTITUTION : TREATMENT OUTCOMES AND PROGNOSTIC FACTORS

PurposeWe examined the treatment outcomes,prognostic factors,and toxicities after radiotherapy for stage IIIB uterine cervical cancer.Methods and MaterialsWe studied patients with stage IIIB uterine cervical cancer who were both diagnosed and treated with combined external beam radiotherapy(EBRT) and intracavitary brachytherapy(ICBT). We retrospectively analyzed the clinical characteristics(age,primary tumor size,lymph node metastasis,and chemotherapy),5-year overall survival(OS) rate,progressionfree survival(PFS) rate,and late toxicities over grade 3.ResultsA total of 25 patients were enrolled in this study.Overall 23 and 2 patients showed complete and partial response,respectively.The objective response was 100%.The 5-year OS and PFS were 73.4% (95% confidence interval [CI] 55.1-91.6%) and 69% (95% CI 49.5-88.0%), respectively.Primary tumor size ≥40 mm was a prognostic factor for poor OS and PFS (HR : 5.088, p=0.024 and HR : 5.088, p=0.033, respectively). Five patients(20%) developed late toxicities over grade 3 with related radiotherapy.ConclusionsLocal tumor control,OS,PFS,and late toxicity rate in this study were similar to those in previous reports. A bulky tumor was identified as a prognostic factor