ABSTRACT
Objective@#To investigate the safety and efficacy of 3-dimensional (3D) printing noncoplanar templates (PNCT) assisted computer tomography (CT) guided radioactive125I seed implantation (RISI) for the treatment of recurrent cervical carcinoma (RCC) after external beam radiotherapy (EBRT). @*Methods@#A total of 103 patients with inoperable post-EBRT RCC were included in this retrospective study. A total of 111 lesions received RISI. Eight lesions were at the pelvic center, 75 lesions were at the pelvic lateral, and 28 lesions were extra-pelvic metastasis. The median prescription dose was 120 Gy. The primary end points were adverse events and local control (LC), and the secondary end points were overall survival (OS) and progression-free survival. @*Results@#Grade 2 adverse events of acute nausea, diarrhea, and pollakiuria occurred in 1, 2, and 1 patient, respectively. One patient suffered from grade 3 acute proctitis. Late toxicity was observed in 2 patients with rectovaginal fistula. No grade 5 toxicity occurred. The 3-year LC and OS rates were 75.1% and 20.8%, respectively. The median OS was 17 months. The multivariate analysis showed that the minimum dose received by the “hottest” 90% of the gross tumor volume (D 90 ) ≥130 Gy, squamous cell carcinoma, hemoglobin ≥80 g/L and good short-term efficacy (complete response or partial response) were independent predictors of LC and OS (all p<0.05). @*Conclusions@#3D-PNCT assisted CT-guided RISI is a safe, effective, and minimally invasive modality for RCC. The hemoglobin level, pathological type, dose distribution and short-term efficacy are considered as independent factors for clinical outcomes.
ABSTRACT
Objective:To study the dosimetric differences and short-term efficacy between intracavitary/interstitial brachytherapy (IC/ISBT) and conventional intracavitary brachytherapy (ICBT).Methods:Forty-five patients with locally advanced cervical cancer were treated with IC/ISBT and ICBT. Points A (A 1, A 2), D 90%, D 100%, organs at risk, and the doses of bladder, colon, rectum and small intestine were calculated and the short-term efficacy was observed between two groups. Results:Point A dose was significantly improved in IC/ISBT compared with ICBT ( P<0.05). The D 90% and D 100% in IC/ISBT were significantly higher than those in ICBT (both P<0.05). After brachytherapy, IC/ISBT could obtain a significantly larger increase in target dose when residual tumor diameter was ≥3 cm compared with ICBT ( P<0.05). The D 2cm 3 and D 0.1cm 3 of bladder, rectum, colon and small intestine did not significantly differ between IC/ISBT and ICBT (all P>0.05). The 1-, 3-and 6-month clinical efficacy did not significantly differ between two technologies (all P>0.05). Conclusion:During brachytherapy for locally advanced cervical cancer (residual tumor diameter ≥3 cm), IC/ISBT significantly increases the doses of target area and point A without increasing the dose of organs at risk or lowering the short-term clinical efficacy, which has significant dosimetric advantages.
ABSTRACT
Objective To study the short-term efficacy of computed tomography (CT)-guided iodine-125(125I) radioactive seed implantation in the treatment of hypoxic tumors.Methods Twenty-two patients treated with 125I radioactive seed implantation in our department from 2014 to 2016 were divided into hypovascular tumor group (hypoxic group,n =12) and hypervascular tumor group (non-hypoxic group,n=10) based on the hemodynamics of solid tumor evaluated by color Doppler ultrasound.The enhanced CT images were loaded to the three-dimensional particle implantation planning system for preoperative planning.After 125I radioactive seed implantation,the D90 for target volume was verified to be 106-128 cGy.Treatment outcomes were evaluated according to the World Health Organization criteria at 1-3 months after surgery.Results In all the patients,the overall response rate was 82％ at 3 months after surgery.There were no significant differences in response (complete response + partial response) rates at 1,2,or 3 months after surgery between the hypoxic group and the non-hypoxic group (P=0.840,0.696,0.840).Conclusions In the treatment of solid malignant tumor,125I radioactive seed implantation can overcome the resistance of hypoxic tumor to radiotherapy in vitro and achieve satisfactory short-term efficacy.
ABSTRACT
Objective This study was to investigate the lymph node metastasis pattern in thoracic esophageal squamous cell carcinoma (ESCC),and analyze the risk factors to provide reference for the delineation of radiotherapy target.Methods A total of 319 patients with thoracic ESCC who underwent surgical treatment at the second hospital of Dalian medical university were analyzed retrospectively.The lymph nodes around esophageal were divided into 20 groups according to the mapping scheme of the American Thoracic Society (ATS) modified by Casson et al.Analyzed the pattern of lymph node metastasis and its relationship with tumor location,tumor length,depth of invasion,pathological grade,and vessel invasion.Results The lymph node metastatic rate was 48.90％ (156/319),while the metastatic ratio of lymph node (LMR) was 15.70％ (562/3 581).The lymph node metastatic rates had gradually increasing trend with tumor sites descending (upper ESCC 35.48％,middle ESCC 47.06％ and lower ESCC 56.43％),but no statistically significance (P ＞ 0.05) was observed.In the whole 20 groups,the higher node metastasis stations of upper thoracic ESCC LMR were 1,2,4,5,7,9 (x2 =27.38,P ＜ 0.05),while the middle thoracic ESCC LMR were 2,4,5,7,8M (x2 =57.77,P ＜ 0.05),and the lower thoracic ESCC LMR were 4,5,7,8L,16,17,20 (x2 =28.88,P ＜ 0.05),with statistically significance.So the main lymph node metastasis stations were paraesophageal nodes,tracheobronchial nodes,paratracheal nodes,aroticopumonary nodes,left gastric nodes,subcarinalnodes and celiac nodes.The univariate analysis revealed that lymph node metastasis was correlated with the tumor length,depth of invasion,pathological grade,and presence of vascular invasion (x2 =6.82,26.04,36.26,4.56respectivcly,P ＜ 0.05).The muhi-variate regression analysis showed that tumor length and depth of tumor invasion were independent risk factors for lymph node metastasis (OR =2.212,2.123,P ＜ 0.05).Conclusions The factors influencing lymph node metastasis in thoracic ESCC include tumor length,depth of invasion,pathological grade,and presence of vascular invasion,which should be carefully considered during the target delineation of radiotherapy for esophageal carcinoma.
ABSTRACT
Objective To evaluate the outcomes and prognostic factors of distant metastasis in patients with advanced cervical squamous cell carcinoma treated with concurrent chemoradiotherapy (CCRT). Methods A total of 118 patients with International Federation of Gynecology and Obstetrics (FIGO, 2009 version) stageⅡb-Ⅳa cervical squamous cell carcinoma treated with CCRT between 2006 and 2010 in the Second Affiliated Hospital of Dalian Medical University were analyzed. Their median age was 48 years (range, 23-70 years). FIGO stages were as follows:Ⅱb stage 56 cases,Ⅲa stage 6 cases,Ⅲb stage 52 cases, andⅣa stage 4 cases. Of the all patients, 55 cases showed bulkly tumor (tumor size>4 cm) and 35 cases were pelvic lymph node positive. Forty patients had pretreatment hemoglobin (Hb) levels no greater than 110 g/L. Patients with elevated squamous cell carcinoma antigen (SCC-Ag) >1.5 μg/L before CCRT and at one month after CCRT were 91 cases and 34 cases, respectively. Kaplan-Meier method was used to estimate survival. For the analysis of prognostic factors affecting distant metastasis, log-rank test was used for univariate analysis, and Cox proportional hazard model was used for multivariate analysis. Results Thirty-seven patients were diagnosed with recurrence, 19 cases of whom developed distant metastasis, 13 cases developed loco-regional recurrence and 5 cases had both distant and loco-regional recurrence. The 5-year overall survival rates and distant disease-free survival of all patients were 64.0% and 78.8%, respectively. Two patients had grade 3 acute gastrointestinal toxicity (mainly diarrhea) and 20 cases had grade 3 to 4 hematologic toxicity. Seven patients experienced grade 3 to 4 late toxicity, 5 cases of them were gastrointestinal and 2 cases were genitourinary toxicity. Univariate analysis showed that FIGO stages, SCC-Ag level at one month after treatment, pretreatment hemoglobin level, and pelvic lymph node metastasis were significantly correlated with distant metastasis (all P<0.05). Multivariate analysis showed that FIGO stage, SCC-Ag level at one month after treatment, and pelvic lymph node metastasis were independent prognostic factors for distant metastasis (all P<0.05). Conclusions For stageⅡb-Ⅳa cervical squamous cell carcinoma, the regimen of CCRT was efficacious and safe. The predictive factors for distant metastasis in patients withⅡb-Ⅳa stage squamous cell carcinoma of cervix treated with CCRT included FIGO stage, SCC-Ag level at one month after treatment, and pelvic lymph node metastasis. New treatment strategies should be considered to control distant metastasis for these patients.
ABSTRACT
Objective To investigate the patterns of intrathoracic lymph node metastasis in nonsmall cell lung cancer (NSCLC) and to provide a theoretical basis for the delineation of radiotherapy target volume.Methods A retrospective analysis was performed on the clinical data of 314 NSCLC patients after operation.Our focus was to investigate the distribution characteristics and metastatic extent of intrathoracic lymph nodes and their relationship with tumor size,pathological type,and primary site.Comparisons between groups were made by one-way analysis of variance.Results The frequencies of metastases to lymph nodes at stations 4,5,7,10,and 11 were all above 12％,while those at stations 1,2,3,6,8,and 9 were all below 12％.The lymph node metastasis rate was similar on the primary tumor site (P =0.102).The patients with T3 and T4 NSCLC had a significantly higher frequency of N2 lymph node metastasis than those with T1 and T2 NSCLC (17.0％ vs.11.6％,P =0.002) ;the patients with adenocarcinoma had a significantly higher frequency of N2 lymph node metastasis than those with squamous cell carcinoma (34.5 ％ vs.23.2％,P =0.008).Conclusions For patients with T3 and T4 NSCLC of adenocarcinoma subtype,we should highlight the lymph nodes at stations 4,5,7,10,and 11 when delineating the radiotherapy target volume after operation.
ABSTRACT
Objective To evaluate the recent effects of concurrent versus sequential chemo-radio-therapy in treatment for locally advanced non-small-cell lung cancer (NSCLC). Methods The clinical data of 39 patients with locally advanced NSCLC were analyzed retrospectively. The sequential therapy was 23 (sequential group) ,and the concurrent therapy (concurrent group)was 16. The total radiation dose was 60 ～ 65 Gy by conventional fractionation radiotherapy. In sequential group,the patients received induction chemotherapy for two cycles followed by conventional radiation therapy. In concurrent group,the patients re-ceived radiation therapy,at the same time the docetaxe was given every week. Results The recent efficien-cy(62.5%) of concurrent therapy was higher than that(43.5% )of sequential therapy. The clinical remission rate of the two groups was similar. Conclusion Concurrent chemo-radiotherapy in locally advanced NSCLC can increase the recent effect. The concurrent treatment method of docetaxel + three-dimensional conformal radiotherapy is advocated.