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Objective:To evaluate the efficacy and safety of interstitial brachytherapy for locally recurrent and metastatic advanced gynecologic tumors.Methods:The data of patients with local recurrence and metastasis of advanced gynecological tumors who underwent brachytherapy in Shanxi Province Cancer Hospital from June 2020 to July 2021 were retrospectively analyzed. Objective remission rate (ORR) was compared among patients grouped according to the size, location of the lesion, and progression-free survival (PFS) before recurrence. Kaplan-Meier method was used to analyze the PFS after recurrence and group comparison was performed by using log-rank (Mantal-Cox) test. Multivariate Cox proportional hazard model was used to analyze the influencing factors of PFS after recurrence. The acute and advanced radiation injuries were also summarized.Results:A total of 20 patients were enrolled and the whole ORR was 80% (16/20). Subgroup analysis showed that 13 patients with focal length < 4 cm had objective remission, and 3 patients with focal length ≥ 4 cm had objective remission; the difference in ORR between the two groups was statistically significant ( P = 0.007). And 3 cases out of 6 cases with PFS time less than 6 months before recurrence and 13 cases out of 14 cases with PFS time equal to or more than 6 months before recurrence all had objective remission, and the difference was statistically significant ( P = 0.061). The median follow-up time was 6 months (1-13 months). By the end of follow-up, 9 patients (45%) had disease progression. Univariate survival analysis showed that patients with focal length < 4 cm (≥ 4 cm vs. < 4 cm: HR = 4.192, 95% CI 0.992-17.710, P = 0.029), PFS time before recurrence ≥ 6 months (≥ 6 months vs. < 6 months: HR = 0.163, 95% CI 0.038-0.696, P = 0.004), and radiation dose ≥ 15 Gy (≥ 15 Gy vs. < 15 Gy: HR = 0.207, 95% CI 0.049-0.881, P = 0.016) had better PFS after recurrence, but multivariate Cox regression analysis showed that the above factors were not independent factors of PFS after recurrence (all P > 0.05). None of 20 patients had radiation injury of rectum and bladder above grade 3. Conclusion:The therapeutic effect of interstitial brachytherapy for local recurrence and metastasis of advanced gynecological tumors is clear and safe.
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Objective To compare the efficacy and toxicity of paclitaxel and carboplatin regimen concurrent chemoradiotherapy and radiotherapy alone in the treatment of stage Ⅲ cervical cancer.Methods A retrospective analysis of 158 patients with stage Ⅲ cervical cancer who were admitted to Shanxi Provincial Cancer Hospital from May 2009 to October 2012 was conducted.According to different treatment methods,86 patients were in the concurrent chemoradiotherapy group and 72 patients were in the radiotherapy group.The efficacy and adverse reactions of the two groups were compared.Results The effective rate (complete remission + partial remission) in the concurrent radiotherapy group and radiotherapy group was 95.3％ (82/86) and 84.7 ％ (61/72),respectively,and the difference was statistically significant (x2 =5.15,P =0.023).The 1-,2-,3-,and 5-year survival rates of the concurrent radiotherapy group and radiotherapy group were 93.0 ％ (80/86),77.9 ％ (67/86),68.6 ％ (59/86),60.5 ％ (52/86),and 81.9 ％ (59/72),61.1％ (44/72),41.7 ％ (30/72),36.1％ (26/72),respectively,and the differences were statistically significant (x2 values were 4.55,5.29,11.56,9.30,all P ＜ 0.05).The short-term adverse reactions in the concurrent chemoradiotherapy group and radiotherapy group were mainly myelosuppression and gastrointestinal reactions,and the incidence of myelosuppression was 87.2 ％ (75/86) and 50.0 ％ (36/72),respectively,and the difference was statistically significant (x2 =25.96,P ＜ 0.01);the incidence of gastrointestinal reactions was 91.9 ％ (79/86) and 20.8 ％ (15/72),respectively,and the difference was statistically significant (x2 =82.04,P ＜ 0.01).The incidence of radiation proctitis in the concurrent radiotherapy and chemotherapy group was 17.4 ％ (15/86) and 16.7 ％ (12/72),respectively,and the difference was not statistically significant (x2 =0.017,P =0.89);the incidence of radiation cystitis was 7.0 ％ (6/86) and 5.6 ％ (4/72),respectively,and the difference was not statistically significant (x2 =0.134,P =0.71).Conclusion Paclitaxel and carboplatin regimen chemotherapy combined with radiotherapy can improve the survival rate of patients with stage Ⅲ cervical cancer,and the adverse reactions are tolerable.
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The expensive production of bioethanol is because it has not yet reached the 'THREE-HIGH' (High-titer, high-conversion and high-productivity) technical levels of starchy ethanol production. To cope with it, it is necessary to implement a high-gravity mash bioethanol production (HMBP), in which sugar hydrolysates are thick and fermentation-inhibitive compounds are negligible. In this work, HMBP from an atmospheric glycerol autocatalytic organosolv pretreated wheat straw was carried out with different fermentation strategies. Under an optimized condition (15% substrate concentration, 10 g/L (NH4)2SO4, 30 FPU/g dry matter, 10% (V/V) inoculum ratio), HMBP was at 31.2 g/L with a shaking simultaneous saccharification and fermentation (SSF) at 37 degrees C for 72 h, and achieved with a conversion of 73% and a productivity of 0.43 g/(L x h). Further by a semi-SFF with pre-hydrolysis time of 24 h, HMBP reached 33.7 g/L, the conversion and productivity of which was 79% and 0.47 g/(L x h), respectively. During the SSF and semi-SSF, more than 90% of the cellulose in both substrates were hydrolyzed into fermentable sugars. Finally, a fed-batch semi-SFF was developed with an initial substrate concentration of 15%, in which dried substrate (= the weight of the initial substrate) was divided into three portions and added into the conical flask once each 8 h during the first 24 h. HMBP achieved at 51.2 g/L for 72 h with a high productivity of 0.71 g/(L x h) while a low cellulose conversion of 62%. Interestingly, the fermentation inhibitive compound was mainly acetic acid, less than 3.0 g/L, and there were no other inhibitors detected, commonly furfural and hydroxymethyl furfural existing in the slurry. The data indicate that the lignocellulosic substrate subjected to the atmospheric glycerol autocatalytic organosolv pretreatment is very applicable for HMBP. The fed-batch semi-SFF is effective and desirable to realize an HMBP.
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Biofuels , Carbohydrates , Chemistry , Cellulose , Chemistry , Ethanol , Metabolism , Fermentation , Furaldehyde , Chemistry , Glycerol , Chemistry , Hydrolysis , TriticumABSTRACT
Objective To investigate the feasibility and potential advantages of RapidArc applied to the radiotherapy of the postoperative rectal cancer.Methods 8 postoperative patients with rectal cancer were selected to be treated with a dose of 50Gy in fraction of 2Gy every time and 5 times a week.IMRT and RapidArc were used respectively to compare different target conformities,homogeneity index,dose-volume histogram data,treatment times and monitor units.Results The conformal index by RapidArc was 0.89±0.02 which was better than those by 5F-IMRT,0.87±0.02 (t =3.286,P ＜ 0.05),while the homogeneity index of target volume (1.060±0.005) and average dose [(52.55±0.76) Gy] by RapidArc were a little less than the homogeneity index of target volume (1.064±0.007) and average dose [(52.90±0.82) Gy] by 5F-IMRT (t =-1.459,-1.000,P ＞ 0.05).The exposure dose and mean dose of bladder and small bowel in high dose region by RapidArc were lower than those by 5F-IMRT,as well as bone marrow.The differences were statistical significant (P ＜ 0.05).The monitor units by RapidArc and by 5F-IMRT were (631±68) MU and (1046±146) MU,respectively (t =-5.830,P ＜ 0.05),while the mean treatment times were (78±5) s and (348±29) s,respectively (t =-26.358,P ＜ 0.05).Conclusion Compared with 5F-IMRT,RapidArc improves the target conformities and lowers the exposure dose for the organs at risk in high dose region while using fewer monitor units and less treatment time,which helps comforting patients and improving the efficiency.
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Objective To compare the differences of target-volume(PTV) coverage and organ at risk (OAR) protection between three dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy(IMRT) for patients with pelvis metastasis of cervical cancer underwent radical hysterectomy and pelvic lymphadenectomy. To explore the optimal treatment methods for pelvis metastasis of cervical cancer.Methods 10 patients with pelvis metastasis of cervical cancer underwent radical hysterectomy and pelvic lymphadenectomy were selected for this study. The images scanned by CT were transferred to treatment planning system to generate 3DCRT and IMRT plans. The impacts of 3DCRT on PTV were compared with those of IMRT. Isodose line and dose volume histograms(DVH) were used to evaluate to the dose-distribution in PTV and OAR. Results For 95 % confidence interval, the margin from CTV to PTV was 1 cm. Conformal indexs (CIs) of PTV for 3, 4, 5 and 6 fields 3DCRT were 0.46, 0.67, 0.68 and 0.68, respectively. When beyond 4 fields, the advantage of adding fields was not significant. CIs of PTV for 5, 7, 9, 11 and 13 fields IMRT were 0.75, 0.83 0.84, 0.85 and 0.85, respectively. When beyond 9 fields, the advantage of adding fields was not significant. The maximum dose of the bowl and spine cord in IMRT plans were lower than that in the 3DCRT plans (P <0.05). Maximum dose of OAR had no significant differences (includingt the bone, recttum and bladder) between IMRT and 3DCRT plans. Conclusion For patients with pelvis metastasis of cervical cancer after radical surgery, 4 fields planning in 3DCRT and 9 fields planning in IMRT are feasible. At high dose levels, the IMRT plans can more significantly protect the bowl and spine cord and decrease the radiation volume of colorectal and urinary bladder at risk than 3DCRT, so IMRT may potentially diminish probability of the normal tissue complications.
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Objective To evaluate the impact of different factors on long-term results in cervical carcinoma patients initially treated by surgery followed by radiotherapy. Methods In 1998, 525 cervical carcinoma patients were admitted, among whom 346 patients were first treated by surgery. 302 of these 525 patients were given postoperative radiotherapy. The stage distribution of these 302 patients were: stage I 142;stage Ⅱa 121;stage Ⅱb 23;and stage Ⅲa 16. ~ 60 Co ? or 6MV X-ray was used for radiotherapy. Perpendicular portals were alternately irradiated to 44-50Gy/4-5 week. Extending the portal, increasing the dose after constricting portal, adding intracavitary afterloading irradiation and adjuvant chemotherapy were carried out according to the different clinical requirements. Results The 5-year survival rate was 89.4%,77.7%,56.5% and 56.3% in stage I, Ⅱa, Ⅱb and Ⅲa lesion, respectively(?~2=22.22,P