Clinical efficacy and prognostic factors of postoperative adjuvant radiotherapy for pediatric ependymoma / 中华放射肿瘤学杂志

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.

Analysis of therapeutic effect of pediatric patients with intracranial primary non-germinomatous germ cell tumors / 中华放射肿瘤学杂志

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.

The value of cerebrospinal fluid cytology and cell immunochemical staining in diagnosing meningeal carcinomatosis / 中国医师进修杂志

Objective To explore the diagnostic value of cytologic examination of cerebrospinal fluid (CSF) combined with cell immunochemical staining examination in the patients with meningeal carcinomatosis in the clinical track.Methods CSF was centrifuged and precipitated using the StatSpin Cytofuge 12 centrifuge. It was dyed by the May-Grunwald-Giemsa Staining (MGG) method and cell immunochemical staining (S-P method). Clinical data of 16 cases with the diagnosis of meningeal carcinomatosis were retrospectively analyzed. Results Sixteen patients diagnosed meningeal carcinomatosis prior to imaging findings in 11 of 16 patients were diagnosed meningeal carcinomatosis through the cerebrospinal fluid cytology combined with cell immunochemical staining prior to imaging findings. CSF cytology observed the cancer cell pleomorphism. Cell immunochemical staining examination clearly distinguished classification organic source of meningeal carcinomatosis. Conclusions CSF cytology combined with cell immunochemical staining examination is one of the important means in tracking intracranial metastatic tumor in clinic.

Clinical manifestations of portal vein thrombosis and related risk factors in patients with liver cirrhosis / 临床肝胆病杂志

ObjectiveTo investigate the clinical manifestations of portal vein thrombosis (PVT) and related risk factors in patients with liver cirrhosis. MethodsA total of 541 patients with liver cirrhosis who were admitted to the General Hospital of Ningxia Medical University from April 2008 to April 2015 were included in the study; 76 patients with PVT were enrolled in the study group, and another 76 patients without PVT matched for sex, age, and Child-Pugh class were enrolled in the control group. The clinical data and related indicators were analyzed and compared between the two groups. The t-test was applied for comparison of continuous data between groups, the chi-square test was applied for comparison of categorical data between groups, and the unconditional logistic regression model was used to determine the independent risk factors for PVT in liver cirrhosis. ResultsIn the patients with liver cirrhosis and PVT, 421% (32/76) had an insidious onset and 579% (44/76) had obvious clinical manifestations. Most patients had Child-Pugh class B and C cirrhosis. There were significant differences between the two groups in platelet count, blood glucose, percentage of neutrophils, severe esophageal and gastric varices, plasma D-dimer, portal vein width, and thickness of the spleen (all P＜0.05). The unconditional logistic regression model analysis showed that percentage of neutrophils (OR=1.044, P=0.040), plasma D-dimer (OR=0.091, P=0.000), portal vein width (OR=0.030, P=0.008), and thickness of the spleen (OR=0.427, P=0.003) were the influencing factors for PVT. ConclusionPVT may have an insidious onset in patients with liver cirrhosis, or have different clinical manifestations. Cirrhotic PVT usually occurs in patients with advanced liver cirrhosis, and plasma D-dimer, portal vein width, thickness of the spleen, and percentage of neutrophils are the independent influencing factors for PVT in patients with liver cirrhosis.

Effect of positive pressure ventilation on the radiotherapy of Hunmn Primary Lung Cancer of Stage Ⅲ / 中国实用内科杂志

Objective To investigate the effect of positive ventilation pressure on the radiotherapy of primary cancer of stage Ⅲ.Methods 19 patients diagnosed as of primary,cancer of stage Ⅲ were randomly divided into two groups:the combining therapy group and the simple radiotherapy group.The patients of combining therapy group were treated with positive pressure ventilation using BIPAP respirator and radiotherapy.The recently therapy results and the radiotherapy associated side effects were observed between these two groups.Results(1)The combination of radiotherapy and BI- PAP provides significant superiority of local effects over radiotherapy.P