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Objective:To analyze the correlation between the volume of irradiated pelvic bone marrow and acute hematologic toxicity (HT), in order to provide clinical data to reduce the risk of acute HT and optimize the radiotherapy plan.Methods:From October 2017 to May 2019, 41 LARC patients who received neoadjuvant concurrent chemoradiotherapy (CCRT) were retrospectively reviewed in our center. All patients were treated with 5-field intensity-modulated radiotherapy (IMRT), and the prescription dose delivered to PTV was 45-50.4 Gy in 25-28 fractions. Capecitabine or 5-fluorouracil (5-FU) wasadministered daily 5 days a week during radiotherapy. Different HTswere recorded according to National Cancer Institute Common Toxicity Criteria Version 5.0 (NCI-CTC.V5.0) based on laboratory tests. The volume of PBM or each site (coxal, sacrum, femoral) receiving more than x Gy refers to as TVx, CVx, SVx, and FVx, respectively. Logistic regression was performed to evaluate the association between the volume of irradiated pelvic bone marrow and different HT. Generalized additive model (GAM) and piecewise regression were used to further analyze the possible nonlinear relationship and threshold effect between them. Results:Multivariate logistic regression analysis showed that low-dose of irradiated total pelvic bone marrow volume ( TV5) and coxal bone marrow volume ( CV5, CV10) were significantly correlated with Grade ≥2 leukopenia( P<0.05). There was a significant negative correlation between the sacrum bone marrow volume ( SV5, SV10) and Grade ≥2 leukopenia ( P<0.05). A thresholdeffect has been observed between CV10 and Grade ≥2 leukopenia by Generalized additive model (GAM) and piecewise linear regression. The threshold between CV10 and Grade ≥2 leukopenia was 575 ml, OR (95% CI) was 1.85 (1.08, 3.16). Conclusions:In neoadjuvant IMRT of rectal cancer, CV is a better predictor of acute HT induced by CCRT than TV. The irradiated volume of CV associated with acute HT was mainly low-dose levels ( CV5, CV10). The thresholds of our study ( CV10= 575 ml) could be a good reference for the optimization of the radiotherapy plan.
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Objective:To investigate the correlation between the X-ray cross-complementary gene 1 (XRCC1) rs25487 gene polymorphism and the effect of neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC).Methods:This research was a prospective cohort study consisting of 55 patients with LARC who were treated in the Affiliated Hospital, Guizhou Cancer Hospital of Guizhou Medical University from August 2018 to July 2019. The XRCC1 rs25487 genotype was detected, followed by neoadjuvant chemoradiotherapy. The logistic regression with adjusted confounding factors was used to analyze the relationship between down-staging of T-stage and N-stage and XRCC1 rs25487 gene polymorphism. The stratified analysis was used to explore interactions of neutrophil lymphocyte ratio (NLR) based on logistic regression.Results:The frequencies of all genotypes were in accordance with Hardy-Weinberg equilibrium. After adjusting confounding factors, compared to patients with AA genotype, patients with GG genotype had lower rate of down-staging of T-stage after neoadjuvant radiotherapy ( OR=0.1, P<0.05). However, there was no statistically significant difference between GA and AA genotypes ( P>0.05). There was interactions between AA/GA genotypes and NLR, which affected the down-staging of T-stage after radiotherapy. Conclusions:XRCC1 rs25487 gene polymorphism is associated with the efficacy of neoadjuvant radiotherapy and concurrent system chemotherapy in patients with LARC, which may be used as a predictor of the efficacy of neoadjuvant intensive therapy.
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Objective To evaluate the efficacy and safety of adding neoadjuvant chemotherapy following neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer.Methods A total of 80 patients confirmed with locally advanced rectal cancer were enrolled during January 2012 and December 2015 in Guizhou Medical University Affiliated Cancer Hospital and were randomized with the method of lottery into the experimental group and the control group.In the experimental group,40 patients received 4 cycles of FOLFOX4 after chemoradiotherapy and then had total mesorectal excision (TME).Another 4 cycles of FOLFOX4 were administered after surgery.In the control group,40 patients had TME surgery 6-8 weeks after chemoradiotherapy and received 8 cycles of FOLFOX4 as adjuvant chemotherapy.Pelvic radiotherapy dose was 50 Gy in 25 fractions,5 days per week for 5 weeks.5-Fu continuous infusion was administered throughout radiotherapy.The pCR rate,downstaging rate,R0 resection rate,local recurrence rate,distant metastasis rate,survival rate,incidence of toxicities,surgical complications and completion of treatment were observed.Results The pCR rate was 20.0％ in the experimental group and 5.0％ in the control group (x2 =4.114,P ＜ 0.05).The downstaging rate was 77.4％ in the experimental group and 55.6％ in the control group(P ＞ 0.05).No statistically significant difference was observed in R0 resection rate,3-year local recurrence rate,3-year distant metastasis rate and 3-year survival rate between the two groups (P ＞ 0.05).Patients in the experimental group had higher completion rate of 8 cycles of systemic chemotherapy (87.1％ vs.61.5％,x2 =4.985,P ＜0.05).No statistically significant difference was observed in acute toxicities and postoperative complications.Conclusions Adding systemic chemotherapy after neoadjuvant chemoradiotherapy for locally advanced rectal cancer has significantly higher pCR rate and lower toxicities and side events compared with chemoradiotherapy alone.Longer follow-up and larger scale of clinical research are needed.Trial registration Chinese clinical trial registry,ChiCTR-IPR-17010454.
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Objective To evaluate prognostic factors of patients with cerebral postoperative glioma treated with three-dimensional conformal radiotherapy (3DCRT). Methods62 patients with cerebral glioma who had residual tumor received 3DCRT. Factors such as gender, age, location of the glioma, pathological type, pathological grade, degree of surgical resection, combined chemotherapy, radiation dose, Karnofsky score before treatment were analyzed to show wether the impact on prognosis, Drawing survival curve with the Kaplan-Meier method, Log-rank test for univariate analysis and multivariate analysis were performed by using COX regression model.ResultsLast follow-up time was April 1, 2009. Median follow-up was 22 months, 43patients died. The 1-, 2- and 3-year overall survival rate were 65.7 %, 34.2 % and 20.5 %. In univariate analysis, the survival was related to age (P=0.008), pathological grade (P=0.016), degree of surgical resection (P=0.000), Karnofsky score before treatment (P =0.018). In COX multivariate modal, age (P =0.031), degree of surgical resection (P =0.000), Kamofsky score before treatment (P =0.035) were independent prognostic factors. ConclusionAge ＜40 years, Karnofsky score before treatment ≥70 and mostly resection are independent factors for predicting better survival of glioma patients.
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Objective To compare the dosimetry difference among three-dimensional conformal radiotherapy (3 DCRT),simplified intensity-modulated radiotherapy (sIMRT) and intensity-modulated radiotherapy (IMRT) in whole pelvic irradiation in postoperative rectal carcinoma,in order to optimize the protocol for clinical practice.Methods From 2006 to 2008,10 patients with stage II and ID rectal cancer after radical resection (Dixon surgery) participated in this study.3DCRT,sIMRT and IMRT were performed for each patient.The dose distribution of target volume and normal tissues,conformal index (CI) and HI were analyzed using the dose-volume histogram (DVH).Results The CI for PTV of IMRT and sIMRT was superior to that of 3DCRT.3DCRT had the best HI in PTV target area dose distribution,while IMRT was similar with sIMRT,however,there were no significant difference among them.As regarded as the protection on organs at risk,for bladder,IMRT was superior to 3DCRT and slightly better than sIMRT;for small intestine,sIMRT showed better performance than 3DCRT while IMRT was better than sIMRT but with no significant difference;for colon,no dosimetry difference was found among three plans;for caput femoris,IMRT and sIMRT were better than 3DCRT.Additionally,sIMRT was similar to 3DCRT in MU of segments,but significantly lower than IMRT.The mean values of total MU for 3DCRT,sIMRT and IMRT were 569.73 ±48.69,542.97 ±69.78,and 770.25 ±73.12,respectively.Conclusions All of 3DCRT,sIMRT and IMRT could provide target area with sufficient and accurate dose,meanwhile they could also protect organs at risk well on rectal cancer after radical resection.Compared with 3DCRT plan and IMRT plan,sIMRT plan might be the optimal plan for clinical practice.
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Objective To analyze the long-term results of fractionated stereotactie radiotherapy(FSRT)for the local residual lesion after the first course of radiotherapy for nasopharyngeal carcinoma.Methods From July 1997 to July 2002,46 patients were treated with FSRT.According to the 1992 Fuzhou staging system,the number of patients was 1,6,30 and 9 with stage Ⅰ,Ⅱ,Ⅲ and Ⅳ disease,respectirely;3,11,27 and 5 with T1,T2,T3 and T4 tumor,respectively;14,16,12 and 4 with N0,N1,N2and N3 disease.Radiotherapy was delivered to tumors with the total of dose 68-70 Gy in 7-8w.Chemotherapy(2 cycles of PVF or POF)was given to the patients with stage Ⅲ and Ⅳ a disease.FSRT was given to the residual disease with the total dose of 18-24 Gy in 3 fractions with an interval of 3-7 days.The reference dose line was 70%-90%.Resuits CR and PR rates in this group were 61%and 39%,respectively.The overall survival rates of each year from 1- to 5-year were 100%,87%,83%,78%and 76%.The 1-,3- and 5-year disease-free survival rates were 100%,93%and 89%;The distant metastasis-free survival rates were 100%,85%and 79%;The local-regional control survival rates were 100%,94%and 91%.Seventeen patients who died during the follow-up period were 1 for local cervical lymph node recurrence,2 for fatal nasopharyngeal hemorrhage,4 for local nasopharynx recurrence,and 10 for distance metastases. Conclusions Fraetionated stereotactic radiotherapy is safe and effective for the patients with residual lesion of nasopharyngeal carcinoma at the primary site after radiotherapy.The optimized fractionation and total dose requires the further investigation.
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<p><b>OBJECTIVE</b>To investigate the distribution of apolipoprotein E (apo E) polymorphism in Chinese Dehong Dai and Kunming Han ethnic groups.</p><p><b>METHODS</b>After the process of extracting genomic DNA from 171 Chinese Dehong Dai and 71 Chinese Kunming Han subjects, the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was used to amplify the fourth exon of apoE, which contains site 112 and 158 in amino acid sequence, and the apoE polymorphism was detected.</p><p><b>RESULTS</b>The genotyping frequencies of apolipoproteinE epsilon 2/2, epsilon 2/3, epsilon 2/4, epsilon3/3, epsilon3/4, epsilon4/4 in Dehong Dai were 0.006, 0.111, 0.006, 0.789, 0.088 and 0.000 respectively, while the genotyping frequencies of apoE epsilon2/2, epsilon2/3, epsilon2/4, epsilon3/3, epsilon3/4, epsilon4/4 in Kunming Han were 0.000, 0.169, 0.014, 0.718, 0.099, 0.000, respectively (P>0.05). The allelic frequencies of apoE epsilon2, epsilon3 and4 in Dehong Dai were 0.064, 0.889, 0.047 respectively, while the allelic frequencies of apoE epsilon2, epsilon3 and epsilon4 in Kunming Han were 0.092, 0.852, 0.056, respectively (P>0.05).</p><p><b>CONCLUSION</b>The results revealed that either the frequency of genotype or that of allele of apoE gene polymorphism showed statistical difference between the ethnic populations. Compared with the data from other nationalities in China, the frequency of epsilon2 allele in Dehong Dai was significantly lower than that in Zhuang nationality (P<0.01); the frequency of epsilon3 allele in Dehong Dai was significantly higher than that in Chaoxian, Hui, Mongolian,Zhuang nationalities (P<0.05) and Uygur nationality (P<0.01); the frequency of epsilon4 allele in Dehong Dai was significantly lower than that in Olunchun nationality (P<0.05) and Uygur, Owenk nationalities (P<0.01). By comparison with the data from the populations of other races, the distribution of apoE gene polymorphism in Dehong Dai population is similar to that in Japanese population (P>0.05), but different from those in Singapore,European and American populations.</p>