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Objective:To investigate the clinic opathological features, treatment and prognosis of children newly diagnosed with ependymoma.Methods:Clinical data of 127 pediatric ependymoma (EPN) patients (0-16 years old) treated with tumor resection and postoperative radiotherapy at Xinhua Hospital Affiliated to Shanghai Jiao Tong University between 2001 and 2021 were retrospectively analyzed. Among them, 53 children were female and 74 were male. Local control (LR), event-free survival (EFS) and overall survival (OS) rates were analyzed by Kaplan-Meier method. The relationship between clinic opathological factors and clinical prognosis, and the effect of treatment on clinical prognosis of patients were analyzed by Cox proportional hazards model.Results:At a median follow-up time of 29 months (3-251 months), the 3-year OS and EFS rates were 89.5% and 71.5%, respectively. For patients undergoing incomplete resection followed by postoperative adjuvant radiotherapy, the 3-year LR, OS and EFS rates were 78.3%, 65.8% and 85.7%, respectively. A total of 43 children were aged <3 years old when diagnosed and 84 aged ≥3 years old. The interval time between surgery and radiotherapy in children aged <3 years old was 91 d, and 35.5 d in those aged ≥3 years old ( P<0.001). For patients <3 years old, the median EFS was 90 months when initiating radiotherapy within ≤70 d after surgery, compared to 43 months for those who initiated radiotherapy at >70 d after surgery ( P=0.053). According to fifth edition of the WHO classification of tumors of the central nervous system (WHO CNS5), 39 children were classified as posterior fossa ependymoma group A (PFA group). The OS and EFS rates in the PFA group were significantly less than those in other groups (3-year OS rate were 69.2% vs. 94.6%, P<0.001; 3-year EFS rate were 46.9% vs. 79.1%, P<0.001). In the PFA group, 12 patients received postoperative adjuvant chemotherapy, 14 did not receive chemotherapy, and whether chemotherapy was given was unknown in 13 cases. No significant differences were observed in OS and EFS between patients treated with and without chemotherapy ( P=0.260, P=0.730). Univariate Cox analysis showed that tumor location and WHO CNS5 molecular classification were significantly associated with EFS, and WHO CNS5 molecular classification was significantly correlated with OS. Multivariate Cox analysis showed that tumor location in the posterior fossa was an independent risk factor for EFS ( HR=2.72, 95% CI=1.1~6.71, P=0.03). Conclusions:Patients newly diagnosed with pediatric ependymoma can obtain favorable survival after surgery combined with postoperative adjuvant radiotherapy. Patients with residual tumors can achieve favorable LC and survival after postoperative adjuvant radiotherapy. Delaying of radiotherapy tends to lead to poor survival for patients aged <3 years old when diagnosed. Children in the PFA group obtain worse prognosis compared to their counterparts in other groups. The tumor location in the posterior fossa is an independent risk factor for pediatric ependymoma.
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Objective:To investigate the clinical features of pediatric patients with intracranial primary non-germinomatous germ cell tumors (NGGCT) and evaluate the treatment outcomes and prognostic factors of NGGCT.Methods:Clinical data of 40 children with NGGCT who were treated with radiotherapy (RT) at our department between November 2008 and June 2019 were retrospectively analyzed. Ninety percent of them received craniospinal irradiation (CSI). All children received platinum-based chemotherapy. Survival analysis was conducted using the Kaplan-Meier estimate. The prognostic factors were analyzed by log-rank test.Results:The primary sites were pineal gland, sellar / suprasellar region and basal ganglia. The median age of onset was 108 months (20-204 months). The median follow-up time was 33 months (8-131 months), and the 3-year and 5-year overall survival (OS) rates were 82.0%. The 3-year and 5-year progression-free survival (PFS) rates were 78.6% and 73.0%. Univariate analysis showed that increased alpha-fetoprotein (AFP) ( P=0.02), age at first diagnosis>10 years ( P=0.006), metastasis at first diagnosis ( P<0.001), and the pathological type (choriocarcinoma, yolk sac tumor and / or embryonal carcinoma) ( P=0.036) were independent adverse prognostic factors. Conclusions:Increased AFP, age>10 years at first diagnosis, tumor metastasis and pathological type were independent adverse prognostic factors of NGGCT. The overall prognosis of NGGCT children is worse than that of their counterparts with germinoma, and multidisciplinary intensive therapy is needed to improve survival.
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Objective To explore the treatment procedure of pediatric vaginal rhabdomyosarcoma ( RMS) using 60 Co high?dose?rate three?dimensional ( 3D ) brachytherapy, and to analyze its dosimetric feasibility. Methods Computed tomography ( CT ) images were collected from five children undergoing radiotherapy for vaginal RMS. Three treatment plans were designed:plan A using 3D conformal radiotherapy with external beam irradiation, plan B using brachytherapy, and plan C using brachytherapy combined with external beam irradiation. Dosimetric parameters for clinical target volume ( CTV ) and organs at risk ( OARs ) were evaluated based on EQD 2 and analyzed using one ? way analysis of variance . Results Compared with plan A, plan C had significantly larger D90, D50, and Dmean for CTV ( all P=0?00), significantly lower doses to the rectum, bladder, and femoral head, and a significantly higher dose to the ovary ( all P=0?00) . Compared with plan B, plan C had a larger D90 for CTV, smaller D50 and Dmean for CTV, a lower dose to the ovary, and higher doses to the rectum, bladder, and femoral head. Among the three plans, plan B had the smallest D2 cm3 for the rectum and bladder. Conclusions The optimal radiotherapy plan for pediatric vaginal RMS should be based on the primary tumor location and residual tumor after surgery. CT image?guided 60 Co high?dose?rate 3D brachytherapy is convenient, effective, and well tolerated by children. It also achieves a high dose to CTV as well as good protection of normal tissue.
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Objective To investigate the effect of local hyperthermia on the morphology and quantity of Langerhans cells (LCs)at challenged skin sites of a mouse model of contact hypersensitivity.Methods Sixty mice were equally divided into 3 groups to be treated with local hyperthermia (37℃,39℃,41℃and 43℃)for 20 minutes at sensitization sites on the back of mice 3 days before (pre-heat group),concurrently with (concurrent-heat group)or 2 days after(post-heat group)sensitization respectively.Five mice which remained unsensitized and untreated served as the controls.Five days after the sensitization,the mice were challenged on the dorsal surface of right ears.Two days after the elicitation,the right ears were resected and immunohistochemistry was performed to observe the morphology and determine the quantity of LCs at challenged sites.Results With the rise in temperature,the number of LCs in the epidermis of ear skin decreased in pre-heat group(321.83±41.81,251.12±16.29,191.41±28.7,128.33±77.61 per square millimeter at 37 ℃,39 ℃,41℃and 43℃,respectively,P0.05)and in the post-heat group(320.83±113.6,398.33±31.91,437.83±29.78,477.25±86.79 per square millimeter at 37℃,39 ℃,41℃and 43℃,respectively,P<0.01).The dendrites of LCs increased in number and length when the temperature lose from 37 ℃ to 41℃,but slightly declined at 43℃.Conclusions Local hyperthermia at sensitization sites could affect the morphology and density of LCs at challenged sites,and the effect is likely associated with the severity of contact hypersensitivity.
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Objective To investigate the clinical viability of pre-eclampsia by measuring the level of ?-HCG in blood,blood calcium,hematocrit(HCT)and the mean arterial blood pressure(mABP).The preventive value of calcium supplement was also evaluated. Methods 356 volunteers'(16th～20th gestational weeks)were measured ?-HCG in blood,blood calcium,HCT,meanwhile mABP from the same patients.If blood ?-HCG≥50 632 IU/L,blood calcium≤2.18 mmol/L,HCT≥0.35 and mABP≥85 mm Hg(1 mm Hg=0.133 kPa),a positive conclusion was made.Women with positive results were randomly divided into test group and control group. Results 71 cases turned out to be positive in this serial test.The positive predictive value was 81.82%,negative predictive value was(97.30%),the sensitivity and specificity were 84.38% and 96.77% respectively.In the study group,the incidence of pre-eclampsia was significantly decreased as compared with the control group(P
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AIM: To study the relation of acute radiation-induced oral mucositis to fungal infection and evaluate the effect of fluconazole in the treatment of patients with fungal infection. METHODS: Seventy-one patients (M 42, F 29; 52 a± s 41 a,11-76 a) with large area of oral mucosas irradiated were into this study. When most serious mucositis, the patients' oral mucosas were checked, 32 patients with fungal infection were treated with fluconazole (fluconazole 100 mg, po, qd×5 d or 150 mg,iv,gtt×3 d). RESULTS: The rate of fungal infection was 45%, the most of patients were infected by candida albicans. Degrees of mucositis between the patients with fungal infection to the patients without fungal infection were significantly different (P<0.05). The patients with fungal infection were treated with fluconazole. Degree of mucositis between the pretreated patients and post-treated patients were significantly different (P<0.05). CONCLUSION: The serious acute radiation-induced oral mucositis has significantly related with fungal infection. The patients with fungus infection treated with antifungal agents (fluconazole) can significantly relieve the reaction of acute radiation-induced oral mucositis.