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Objective:To determine the regional boundary of para-aortic lymph node (PAN) metastasis in cervical cancer, and to explore the clinical target volume (CTV) margin.Methods:Eight-six patients with cervical cancer metastasis to PAN below and above left renal vein (LRV) were retrospectively included in this study. The anatomical relationship of the metastatic PANs and surrounding structures were analyzed according tocontrast-enhanced computed tomography (CT) and three dimensional reconstruction images.Results:Eight-six patients had metastatic PANs belowLRV: metastatic nodes were located onthe medial side of ovarian vessels and ureters, behind the renal veins, duodenum, mesenteric vessels, in front of the anterior border of lumbar vertebra and psoas. The inferior mesenteric vein was close to the left anterior side of PANs. Where the duodenum appeared, no node was presenton the anterolateral side of the inferior vena cava (IVC).Above the LRV, 27 patients had retrocrural node involvement along the azygos and hemiazgos vein, and 25/27 cases were located below the junction level of cardia and oesophagus, and 5/27 patients had metastatic lymph nodes between IVC and the right crura of diaphragm, all below the level of coeliac trunk artery.Conclusions:CTV margin delineation of PAN below and above LRV is recommended:superiorly, the junction level of cardia and oesophagus; laterally, crura and the medial side of ovarian vessels and ureters and inferior mesenteric vein; anteriorly, the posterior side of the coeliac trunk artery and renal veins and duodenum, mesenteric vessels; posteriorly, the anterior border of lumbar vertebra and psoas.
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Objective To investigate the value of introvoxel incoherent motion(IVIM)using 3.0 T MRI to evaluate response to concurrent chemoradiotherapy(CCRT)in patients with advanced uterine cervix cancer. Methods From July 2015 to December 2016,63 patients with advanced(≥ⅡB)cervical cancer diagnosed by clinical and imaging study, who had completed CCRT plan in Henan Cancer Hospital, were prospectively enrolled.Pelvic MRI protocol including T1WI,T2WI,IVIM and dynamic contrasted enhanced scans were performed in each patient before CCRT and 3 weeks after starting therapy(total dose of 30 Gy), and at the end of therapy (total dose of 90 Gy, 8 weeks after therapy). The mean values of ADC, true molecular diffusion coefficient(D),pseudodiffusion coefficient(D*)and perfusion fraction(f)in each tumor at pre-therapy, in the middle of therapy and post-therapy were measured and recorded as ADC-pre, D-pre, D*-pre,f-pre;ADC-mid,D-mid,D*-mid,f-mid and ADC-post,D-post,D*-post,f-post,respectively;the change rates of these parameters during and after therapy (recorded as ΔADC-mid, ΔD-mid, ΔD*-mid, Δf-mid;ΔADC-post, ΔD-post, ΔD*-post, Δf-post) were also calculated. Patients were classified into response group and non-response group,according to response evaluation criteria in solid tumors after CCRT.MRI imaging study was performed in each patient within 1 month after CCRT to follow up,and tumor regression rate was calculated.The Mann-Whitney U test was used to compare differences of parameters and their change rates between response group and non-response group. Spearman correlation analysis was performed to assess relationships between parameters, parameter change rates and tumor regression rate. Logistic regression model was applied to find potential ADC values for predicting therapeutic response. ROC was used to analyze efficacy of ADC values for evaluating therapeutic response in advanced uterine cervix cancer after CCRT. Results The mean value of tumor maximum diameter before and after therapy was (47.5 ± 12.9) and(12.8 ± 10.0)mm,tumor regression rate was(66.7 ± 33.6)%.Forty-eight patients were in the response group and 15 in the non-response group.The mean value of ADC-pre,D-pre,D*-pre and f-pre was 0.74(0.43, 1.14)×10-3,0.58(0.33,0.91)×10-3,12.12(2.30,21.4)×10-3mm2/s,9.65%(4.45%,13.89%),respectively.Tumor regression rate had positive correlation with ADC-pre and D-pre (r=0.773,0.840;P<0.05). Responders had increased ADC-pre, D-pre values than non-responders, which had statistically significant difference (P<0.05). Responders had increased ADC-mid, D-mid and f-mid values than non-responders, which had statistically significant difference (P<0.05), tumor regression rate had positive correlation with ADC-mid, D-mid and f-mid (r=0.808,0.834,0.563;P<0.05). Responders had increased ADC-post, D-post and f-post values than non-responders,which had statistically significant difference(P<0.05),tumor regression rate had positive correlation with ADC-post and D-post (r=0.799, 0.829;P<0.05).Tumor regression rate had positive correlation with ΔADC-mid,ΔD-mid,Δf-mid(r=0.526,0.573,0.454;P<0.05)and with ΔADC-post,ΔD-post, Δf-post (r=0.541, 0.555, 0.388;P<0.05). Responders had increased ΔADC-mid, ΔD-mid, Δf-mid and ΔADC-post, ΔD-post, Δf-post, which had statistically significant difference (P<0.05). Logistic regression analysis revealed only ADC-pre and D-post could be independent factors to predict therapeutic response in advanced uterine cervix cancer after CCRT,values of B,Wald,odds ratio and P was 22.488,8.431,1.429, 0.004 and 16.542,8.517,1.779,0.004.ROC analysis showed the area under the curve(AUC)of ADC-pre, D-pre,ΔADC-mid,ΔD-mid,Δf-mid,ΔADC-post,ΔD-post and Δf-post for predicting therapeutic response in advanced uterine cervix cancer after CCRT were 0.890,0.926,0.942,0.851,0.803,0.929,0.951 and 0.906, respectively. Conclusion The IVIM parameters before and during CCRT process and their changes are valuable for predicting and evaluating therapeutic response in advanced uterine cervix cancer after CCRT, with high clinical practice value.
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Objective To determine the anatomic distribution of metastatic inguinal nodes in gynecological malignancies,and to explore the delineation of clinical target volume(CTV). Methods A retrospective study was performed among 34 patients with gynecological malignancies and inguinal lymph node metastases. According to the anatomic distribution of metastatic inguinal nodes, CTV covering more than 95% of inguinal lymph nodes and the relationship of inguinal nodes with the femoral vein, greater saphenous vein and its branches, superficial fascia, and deep fascia were analyzed using vascular enhancement images obtained by computed tomography and magnetic resonance imaging as well as 3D reconstruction using the Eclipse Planning System. Results The 34 patients had a total of 145 positive inguinal nodes. In the 131 superficial nodes below the inguinal ligament, 129 were located between the superficial fascia and the deep fascia;the upper group of superficial nodes,containing 25 nodes,was located at 1 cm above the public symphysis and along superficial iliac circumflex vein;the middle group,containing 85 superficial nodes and 11 patients with single superficial node metastasis,was located at the same level of the public symphysis and close to the junction of the saphenous vein and the femoral vein;the lower group, containing 21 superficial nodes,was beneath the public symphysis and along the greater saphenous vein and medial and lateral superficial femoral veins.The 14 deep nodes were located on the medial side of the femoral vein. There were no positive nodes on the posterolateral side of the link between the posterolateral edge of the femoral vein and medial edge of the sartorius muscle. The upper edge of CTV kept 142 lymph nodes beneath the upper edge of the superior pubis ramus and left 3 lymph nodes up to the upper edge of the femoral head. The lower edge of CTV kept 143 lymph nodes above the lower edge of the lesser trochanter and left 2 lymph nodes at 2 cm beneath the lower edge of the lesser trochanter. Conclusions For CTV covering 98% of positive inguinal nodes, the anterior edge is the superficial fascia;the medial edge is composed by the inguinal ligament and the border of medial muscle to the femoral vessels;the posterolateral edge is the link between the posterolateral edge of the femoral vein and the medial edge of the sartorius muscle;the upper edge is the upper border of the femoral head;the lower edge is the lower border of the lesser trochanter.
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Objective To observe the role of programmed cell death 5(PDCD5) gene combined with cisplatin for inducing the ap-optosis of human lung adenocarcinoma A549 cells and to investigate its possible mechanism .Methods The PDCD5 recombinant plas-mid was transiently transfected into A549 cells by lipofectamine .Its transfection efficiency was detected by RT-PCR .The expressions of trasfected PDCD5 protein ,Bcl-2 and Survivin protein were examined by Western bolt .The apoptosis of A549 cells by single PDCD5 and its combination with cisplatin was measured by the MTT method and the flow cytometry .Results PDCD5 recombinant plasmid was transfect into A549 cells successfully .The Western blot results showed that the expression of PDCD5 protein in the transfection recombinant plasmid group was higher than that in the blank control group and the transfection empty plasmid group ,while the expres-sion of Bcl-2 and Survivin protein was lower than that in the other two groups ,the difference was statistically significant (P<0 .05) . The MTT and flow cytometry results demonstrated that the cell apoptosis rate in the transfection recombinant plasmid group was higher than that in the blank control group and the transfection empty plasmid group (P<0 .05) .Conclusion PDCD5 gene may pro-mote cisplatin induced A549 cells apoptosis .
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Objective To construct and identify the RNAi eukaryotic vector of Skp2 gene and to observe its interfering effect on the growth of SPC-A-1 lung cancer cells.Methods The specific shRNA sequence was designed and synthesized according to the Skp2 cDNA sequence in GenBank.The sequence was cloned into plasmid pGenesil-1.Then recombinant vector was transfected into SPC-A-1 lung cancer cells by Lipofectamine 2000.The expressions of Skp2 mRNA were analyzed by RT-PCR and the levels of Skp2 protein were detected by Western blot.The cell growth suppression was analyzed by MTT assay.Distribution of cell cycle was assessed by flow cytometry.Results The sequence of template and specific siRNA was correct by sequence analysis.Obvious decrease was observed in the levels of Skp2 mRNA and Skp2 protein after Skp2 shRNA transfection(P
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Objective To analyze the apoptosis mechanisms of K562 cells in a PI3K-AKT-dependent manner.Methods K562 cells were cultured in vitro for experiments below:the proliferation assay of K562 cells detected by MTT,the analysis of apoptosis rate and cell cycle of K562 cells measured by flow cytometry(FCM),the construction of chronic myeloid leukemia(CML) animal model through the subcutaneous inoculation of K562 cells to 12 BALB/c-nu/nu nude mice,the early apoptosis changes of K562 cells detected by TdT-mediated dUTP nick end labeling(TUNEL) and the in vitro and in vivo changes of N-ras,PI3K,AKT1,IKK-?,NF-?B1 at transcription level detected by RT-PCR.Results Simvastatin inhibited the proliferation of K562 cells and induced their G0/G1 arrest and significant apoptosis.N-ras and most genes of PI3K-AKT signal pathway were expressed differentially in vitro.K562 cells on nude mice could be induced to apoptosis by simvastatin and the apoptotic index increased with the dose accumulation of simvastatin(P=0.000).The differential mRNA expression changes of N-Ras and most genes of PI3K-AKT signal pathway in K562 cells were observed after treatment of simvastatin at different doses(P=0.000 or P=0.003).However,mRNA expres-sion of the genes in PI3K-AKT pathway in vitro differed to that in vivo.Conclusion The differential expression at transcription levels of N-ras and the most genes in PI3K-AKT pathway that are involved in anti-apoptosis in K562 cells,to some degree,indicates that simvastatin can induce the apoptosis of K562 cells in a PI3K-AKT pathway-dependent fashion in vitro.The animal experiments confirm that there are different mechanisms of simvastatin in inducing the apoptosis of K562 cells in vitro and in vivo.