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Objective:To investigate the prognosis and influencing factors of different treatment strategies in T 3-T 4 nasal sinus adenocarcinoma. Methods:The data of 93 cases of T 3-T 4 stage nasal sinus adenocarcinoma diagnosed from 2006 to 2018 were retrospectively analyzed. All patients were divided into combined operation group and non-operation group. The survival status and failure mode after corresponding treatment were analyzed. The enumeration data were analyzed by Chi-square test or Fisher's exact test. Survival analysis was performed by Kaplan-Meier method. Univariate analysis was conducted by log-rank test. Multivariate prognostic analysis was performed by Cox model. Results:The average follow-up time in the whole cohort was 81.3 months (18-156 months). By the end of follow-up, a total of 38.7% (36/93) of patients had local recurrence, 14.0% (13/93) had distant metastasis, 17.2% (16/93) had local recurrence complicated with distant metastasis, and 28.0% (26/93) were stable. The overall 2-, 5-, and 10-year overall survival (OS) and progression free survival (PFS) rates were 83.5%, 59.3%, 31.8% and 73.6%, 40.7% and 25.3%, respectively. In univariate analysis, the PFS and OS of patients aged 46-64 years old (all P<0.001), male ( P=0.022, P=0.001), patients with lesions located in the maxillary sinus ( P=0.001, P<0.001), adenoid cystic carcinoma ( P=0.001, P<0.001), non-invasion of orbital / clivus ( P=0.041, P<0.001), GTV P dose>64 Gy ( P=0.003, P=0.006) and N 1 stage ( P=0.014, P=0.014) were statistically different among different treatment modes. Multivariate analysis showed that age ≥65 years old ( P=0.012, P=0.005), orbital / clival invasion ( P<0.001, P=0.005), and GTV p dose ≤64 Gy ( P<0.001, P=0.011) were the independent adverse prognostic factors affecting PFS and OS in T 3-T 4 stage nasal sinus adenocarcinoma. Conclusions:The local failure rate of T 3-T 4 stage nasal sinus adenocarcinoma is high after treatment. Age, orbital / clival invasion, and GTV p dosage are the independent adverse prognostic factors. Surgery based intervention is superior to other treatment strategies.
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Objective:To evaluate the effect of reducing clinical target volume (CTV) on local control and overall survival in postoperative intensity-modulated radiotherapy (IMRT), and analyze the patterns of failure, aiming to provide clinical basis for postoperative IMRT delineation of CTV for parotid gland cancer in the era of precision radiotherapy.Methods:Clinical data of 126 patients who were pathologically diagnosed with parotid gland cancer and treated with parotidectomy as well as postoperative radiotherapy were retrospectively analyzed. All patients were divided into two groups according to the prozone of CTV. It was delineated to the anterior border of parotid gland in group A, and delineated to the anterior border of masseter in group B. Actuarial estimates of local recurrence-free survival, regional recurrence-free survival, distant metastasis-free survival and overall survival were obtained with the Kaplan-Meier method. Univariate prognostic analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox regression model.Results:The 5-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS) and overall survival (OS) in groups A and B were 96.7% vs. 91.3%, 96.7% vs. 90.2%, 86.9% v s. 81.3% and 86.0% vs. 81.4%, respectively. There were no significant differences in these parameters between two groups. Of 126 patients with parotid carcinoma, 7 had local recurrence. There were 2 cases in group A which 1 recurred in-field and 1 recurred out- field. And there were 5 cases in group B which 4 recurred in-field and 1 recurred marginally. Univariate analysis showed that age was associated with LRFS. Age, N stage and pathological grading were associated with OS. Cox multivariate analysis revealed that age, N stage and pathological grading were the independent influencing factors of OS. Conclusions:Reducing the CTV would not increase the risk of local recurrence in patients with parotid gland carcinoma without tumor extravasation and negative surgical margins. There is no significant difference in survival benefit compared to those delineated to the anterior border of the masseter muscle. The delineation of CTV should be treated differently according to the risk factors.
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Objective:To explore the clinical value of Ki-67 and human epidermal growth factor receptor 2 (HER-2) in salivary duct carcinoma in stage Ⅲ-Ⅳ A. Methods:The data of 52 cases of locally advanced salivary duct carcinoma(SDC) diagnosed from January 2012 to December 2020 were retrospectively analyzed. All patients underwent radical surgery and postoperative radiotherapy. Among them, 15.4% of patients had local recurrence, 28.8% had distant metastasis, 17.3% had regional recurrence with distant metastasis. The relationship between clinical features, pathological features such as Ki-67 and HER-2 and prognosis such as local recurrence and distant metastasis was analyzed.Results:The average follow-up time was 37.6 months. The 1- and 2-year local recurrence free survival, distant metastasis free survival, progression free survival were 86.5%, 73.1%, 65.4% and 67.3%, 55.8%, 46.2% respectively. The 3-year progression free survival rate was 33.3%. Comparison between groups showed that age ≥ 65 years old, T stage, TNM stage, vascular tumor thrombus, radiotherapy dose <60 Gy, Ki-67 positive index and HER-2 positive were related to the prognosis of different stages. In multivariate analysis, only age, Ki-67 positive index ≥ 60% and HER-2 protein (3+ ) were independent poor prognostic factors for locally advanced SDC ( t =5.16, 9.84, 8.23, P<0.05). Conclusions:In stage Ⅲ-Ⅳ A SDC, only radical surgery and postoperative radiotherapy have a high rate of distant metastasis. Ki-67 positive index and HER-2 positive are independent adverse prognostic factors.
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Objective:To investigate the effect of apatinib on radiosensitivity of glioma cells U87MG and its potential mechanism.Methods:U87MG cells were divided into control group, apatinib group, radiation group and combination group treated with apatinib and radiation. The effect of different concentrations of apatinib (5, 10, 20, 40, 80 μmol/L) on cell proliferation was detected by CCK8 assay. The effect of apatinib on cell migration and invasion was detected by wound-healing assay and transwell assay, respectively. The effect of apatinib on cell radiosensitivity was detected by plate cloning assay, the cell apoptosis rate was detected by flow cytometry, and the protein expressions of Bax and Bcl-2 were detected by Western blot.Results:Apatinib significantly inhibited the proliferation of U87MG cells in a manner depended on the drug treatment time and radiation. Compared with the radiation group, the cell proliferation, migration and invasion in the combination group were inhibited much significantly ( t=9.857, 18.704, 4.197, P<0.05), so that the value of D0, Dq and SF2 of the combination group was lower, resulting in a radiosensitivity enhancement ratio (SER D0 ) of 1.3. Moreover, compared with the radiation group, the apoptosis rate of the combination group was increased, the expression of Bcl-2 protein was decreased, and the expression of Bax protein was increased ( t=16.187, 8.890, 5.222, P< 0.05). Conclusions:Apatinib inhibits cell proliferation, invasion and migration, induces apoptosis and increases radiosensitivity of glioma cells.
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Objective:To evaluate effect of different induction chemotherapy on the clinical efficacy of concurrent intensity-modulated radiotherapy (IMRT) and chemotherapy and identify the prognostic factors in non-endemic locally-advanced nasopharyngeal carcinoma patients.Methods:Clinical data of 210 patients with stage Ⅲ-Ⅳ B(excluding stage T 3-4N 0M 0) nasopharyngeal carcinoma treated in our hospital from 2012 to 2017 were retrospectively analyzed. According to the efficacy of different induction chemotherapy, all patients were divided into the effective group (14 cases of complete remission and 165 cases of partial remission) and ineffective group (31 cases of stability and 0 case of progression). Survival analysis was performed by Kaplan- Meier method. Multivariate analysis was conducted by using Cox′s regression model. Results:Compared with the ineffective group, the 3-year overall survival (OS)(89.2% vs. 74.2%, P=0.005), recurrence-free survival (RFS)(93.0% vs. 81.9%, P=0.010) and progression-free survival (PFS)(80.2% vs. 58.1%, P=0.005) were significantly higher in the effective group, whereas the distant metastasis-free survival did not significantly differ between two groups (84.1% vs.69.7%, P=0.070). Multivariate analysis showed that the tumor response to induction chemotherapy was an independent prognostic factor for OS, RFS and PFS. Conclusions:Tumor response to induction chemotherapy might be a prognostic factor for non-endemic locally-advanced nasopharyngeal carcinoma patients. Clinical prognosis of patients with poor response to induction chemotherapy is even worse. More intensive treatment and closer follow-up may be needed for these patients.
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Objective To compare the efficacy and toxicity of nedaplatin and cispaltin chemotherapy combined with intensity modulated radiotherpy ( IMRT) in the treatment of locally advanced nasopharygeal carcinoma (NPC) patients in unendemic area. Methods From January 2014 to July 2016, sixty-two pairs of patients with stageⅢ-ⅣB NPC patients who underwent radical radiotherapy were selected for pair analysis (nedaplatin group and cisplatin group, 62 cases for each group). The nedaplatin group was treated with IMRT concurrent with nedaplatin at a dose of 100 mg/m2 every three-weeks for 2 -3 cycles, and sequential adjuvant chemotherapy of nedaplatin + fluorouracil regimen for 2 to 3 courses. The cisplatin group was treated with IMRT concurrent with cisplatin at a dose of 80 mg/m2 every three-weeks for 2-3 cycles, and sequential adjuvant chemotherapy of cisplatin + fluorouracil regimen for 2 to 3 courses. Results The 2-year overall survival ( OS ) of nedaplatin group and cisplatin group was 89. 9％ and 91. 1％, local recurrence free survival ( LRFS ) 90. 5％ and 93. 5％, regional recurrence free survival ( RRFS ) 96. 4％ and 96. 0％, and distant metastasis free survival ( DMFS ) 85. 9％ and 90. 3％, respectively. There were no significant differences between nedaplatin group and cisplatin group ( P >0. 05 ) . In the occurrence of acute toxicity, during concurrent chemoradiotherapy and adjuvant chemotherapy, the incidence of grade 3-4 vomiting in nedaplatin group was significantly lower than that in cisplatin group. During adjuvant chemotherapy, the incidence of grade 3 - 4 thrombocytopenia in nedaplatin group was significantly higher than that in cisplatin group. Conclusions For NPC patients with stage Ⅲ-ⅣB in unendemic area, the 2-year survival rates of nedaplatin group was silimiar to cisplatin group, while the incidence of grade 3 -4 vomiting was significantly lower than that in cisplatin group. Nedaplatin maybe an alternative chemotherapy for patients who cannot tolerate cisplatin chemotherapy.
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Objective To investigate the value of computed tomography (CT)-magnetic resonance imaging (MRI) image fusion in target volume delineation of postoperative precise radiotherapy for gliomas.Methods Thirty-six patients newly diagnosed with gliomas were enrolled and received postoperative intensity-modulated radiotherapy.Landmark (L) combined with manual fusion (M) and maximization of mutual information (MI) was used for image fusion.Target volume and organs at risk were delineated based on CT images and fused images,respectively.Comparison of the volume was made by pairwise t test.The distance from a landmark on CT image to the corresponding one on MRI image was calculated.The volume method and geometric center method were used to calculate the degree of volume overlap and changes in central positions after image fusion.Results The L+M+MI method achieved a high registration accuracy in image fusion,with a registration error less than 2 mm.In patients with grade Ⅲ-V gliomas,the CT images yielded significantly smaller gross tumor volume (GTV) and clinical target volume (CTV) than the MRI images (74.62±46.91 vs.105.99±58.86 cm3,P=O.042;304.03± 130.05 vs.387.94± 150.12 cm3,P=0.040).After image fusion,the smallest change in central position occurred in the chiasma (1.32± 1.42 mm),and the largest change occurred in CTV (7.99± 11.06 mm),followed by GTV and the brain stem.Conclusions CT-MRI image fusion helps to reduce the uncertainty of target volume delineation in patients with gliomas,especially in those with edema and residual tumor after surgery.
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Objective To investigate the clinical values of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET-CT) and magnetic resonance imaging (MRI) in precise radiotherapy after surgery in patients with oropharyngeal squamous cell carcinoma.Methods A total of 53 patients with oropharyngeal squamous cell carcinoma were enrolled and underwent PET-CT and MRI imaging within two weeks after surgery.The detection rates of residual lesions and lymph node metastases after surgery by PET-CT and MRI were compared on the basis of the pathological results of biopsy.The gross tumor volume (GTV) and clinical target volume (CTV) determined by PET-CT and MRI were compared;the normally distributed data were analyzed using the t test, and the skewed distribution data by the Wilcoxon rank sum test.The sensitivity, specificity, accuracy, positive predictive value and negative predictive value in predicting precise radiotherapy after surgery, as determined by PET-CT and MRI, were compared with the chi-square test.Results Fourteen patients had residual lesions after surgery.The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET-CT in detecting residual lesions after surgery were significantly higher than those of MRI (92.86%, 94.87%, 86.67%, 97.37%, and 94.34% vs.57.14%, 76.92%, 47.06%, 83.34%, and 71.70%, all P0.05).For the 14 patients with residual lesions, GTVPET/CT was significantly smaller than GTVMRI(45.62±22.13 cm3 vs.60.61±23.12 cm3, P=0.034), so did CTV (125.54±17.53 cm3 vs.142.18±21.22 cm3, P=0.011).There was no significant difference between CTVPET-CT and CTVMRI in 39 patients without residual lesions after surgery (117.87±17.66 cm3 vs.128.05±20.65, P=0.099).Conclusions PET-CT is superior to MRI in detecting the residual lesions and lymph node metastases after surgery in patients with oropharyngeal squamous cell carcinoma, which provides valuable information for radiotherapy planning.
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Objective To research the influence of docetaxel on radiosensitivity in papillary thyroid carcinoma TPC-1 cells.Methods 6 MV X-ray irradiation and deocetaxel were incubated separately or jointly with TPC-1 cells.Proliferation inhibition of docetaxel on TPC-1 cells was detected by CCK-8 method.Radiosensitization of docetaxel was measured by clone formation assay.Flow cytometry (FCM) was employed to analyze cell apoptosis and cycle progression.Western blot assay was applied to examine the expressions of Bax and Bcl-2 proteins.Results The proliferation inhibition effect depended on the concentration and treatment time of docetaxel with IC50 value of 6.06 (24 h),1.39 (48 h),and 0.09 μg/ml (72 h),respectively.The value of SF2,D0,Dq in the radiation treatment group combined with docetaxel were obviously lower than those in the radiation alone group.The SER of docetaxel was 1.53.Following treatment with 0.05 μg/ml docetaxel combined with radiation for 24,48,72 h,the ratios of apoptosis in TPC-1 cells were 31.67％,44.57％,70.20％,which were higher than that of radiation alone group(t =-146.56,-15.13,-19.15,P ＜ 0.05).FCM measurement showed that cell cycle arrest in G2/M phase in the cells treated with docetaxel and radiation was much more obvious than the group of radiation alone (t =-79.17,P ＜ 0.05).In addition,in the combination treatment group,the expression of Bax increased (t =93.56,P ＜ 0.05) while the expression of Bcl-2 decreased (t =41.02,P ＜ 0.05).Conclusions Docetaxel can enhance the radiosensitivity of TPC-1 cells by promoting cell cycle arrest,induction of apoptosis and formation of associated proteins Bax/Bcl-2.
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Objective To investigate the mechanism of the radiosensitivity effect of Cox-2 gene in esophageal cancer.Methods Cox-2 specific siRNA was constructed and transfected to EC9706 cells to downregulate intracellular Cox-2 expression.The expressions of MMP-2,Bcl-2 mRNA,AKT and phosphorylated AKT proteins were assayed after radiation.Colony formation,cell proliferation,apoptosis and cell invasion in vitro were examined as well.One-way ANOVA method was used to analyze the data.Results Affter 2 and 4 Gy irradiation,a significant increase in the mRNA expression of Bcl-2 was observed in the Cox-2 up-regulation group (F =3.36,4.32,P ＜ 0.05).In the group of Cox-2 downregulation,the expression of MMP-2 mRNA was significantly reduced(F =3.86,8.09,P ＜ 0.05).Affter irradiation,a significant decreaseof Bcl-2 mRNA (F =3.73,5.64,P ＜ 0.05) as well as an increase of Bax(F =7.03,7.42,P ＜ 0.05) was detected,and the levels of total and phosphorylated AKT proteins had the highest level in the Cox-2 upregulation group and had the lowest level in the Cox-2 downregulation group.In the Cox-2 downregulation group,the apoptosis induction obviously increased with dose (F =317.40,P ＜ 0.05),and the proportion of cells in Go-G1 phase gradually increased but the proportion of cells in S and G2-M phases decreased,concomitant with the obvious suppression of cell proliferation,in addition,cell invasion was decreased.Conclusions Downregulation of intracellular Cox-2 mRNA expression,concomitant with subsequent downregulation of MMP-2 and Bcl-2 and upregulation of Bax,resulted in reduction of the invasion and metastatic capabilities of tumor cells,and induction of Go-G1 phase arrest and apoptosis.Downregulation of AKT and phosphorylated AKT (pAKT) protein expression might also interfere with the capability of the PI3K/Akt signal transduction pathway to resist radiotherapy.
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Objective To investigate the effect of the extent of postoperative prophylactic radiotherapy after radical surgery on the long-term survival in patients with thoracic esophageal carcinoma.Methods A retrospective analysis was performed on the clinical data of 201 patients with thoracic esophageal cancer who received postoperative prophylactic radiotherapy after radical surgery from 2000 to 2007.The effect of the extent of radiotherapy on survival was evaluated,and the possible prognostic factors were subjected to multivariate Cox regression analysis.The Kaplan-Meier method was used to calculate overall survival (OS) rates,and the log-rank test was used for survival difference analysis.Results The 5-year follow-up rate was 97.0％.The OS rates for patients who received radiotherapy to the whole mediastinum,whole mediastinum + lymph nodes along the left gastric artery,whole mediastinum + bilateral supraclavicular regions,upper and middle mediastinum + bilateral supraclavicular regions,and whole mediastinum + bilateral supraclavicular regions + lymph nodes along the left gastric artery were 21.7％,37.1％,38.7％,34.8％,and 19.8％,respectively (P =0.406).Multivariate analysis showed that postoperative N stage was the independent prognostic factor (P =0.009).After prophylactic irradiation,metastases to the supraclavicular lymph nodes,lymph nodes in the upper and middle mediastinum,and abdominal lymph nodes were observed in 11,34,and 10 patients,respectively.Conclusions The extent of postoperative prophylactic radiotherapy after radical surgery for thoracic esophageal carcinoma only includes upper and middle mediastinum and bilateral supraclavicular regions.
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Objective To observe the acute skin and mucous membrane reactions in patients treated with concurrent radiochemotherapy for nasopharyngeal carcinoma,and to analyze the influencing factors.Methods A total of 85 nasopharyngeal carcinoma cases treated with concurrent radiochemotherapy were enrolled in the study.Fifteen clinical and laboratory indexes,including BMI,radiation dose,degree of acute oral mucous and skin reactions and blood routine test were observed weekly.Univariate and multivariate regression analysis were performed to assess the factors,and screen the independent factors.Results Multiple-factor analysis showed that the risk factors cloesly related with acute radioactive oral mucosa reactions were smoking history(OR =3.467,P ＜ 0.05),single-dose of gross tumor volume (GTV) ＞2.15 Gy(OR =3.393,P ＜ 0.05),while those with acute radiation skin reactions were diabetes history(OR =87.859,P ＜ 0.05) and hemoglobin values 1 week before radiotherapy ＞ 130 g/L (OR =21.404,P ＜ 0.05).Conclusions In the patients treated with concurrent radiochemotherapy for nasopharyngeal carcinoma,smoking history and single-dose of GTVnx is the independent risk factors of acute radiation oral mucosa reactions,while diabetes history and hemoglobin values I week before radiotherapy are the independent factors of acute skin reactions.
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Objective To explore the basic ingredients of the tree shrew’ s( Tupaia belangeri) milk and compare with the dairy ingredients of other milks.Methods We select ten seed tree shrews after delivery ( 1 ~21 ) d with lactation mother tree shrews, and use artificial passive breastfeeding method let the young tree shrews suck breast milk,we took the milk from the young tree shrews in the stomach, directly using aseptic operation with a syringe immediately, once every two days, for consecutive three to five times, and a total of 18 mL milk was taken from each seed tree shrew.Then the milk was detected according to the national standard method for component testing.Results The total solid content of the tree shrew’ s milk was 43.63%, including 26.01%of fat, 10.41%of protein, 0.45% of lactose and 0.99%of ash content.Compared with cow's milk, the tree shrew’ s milk contained 3.36 times of total solid contents, 1.24 times of ash, 2.74 times of protein, 6.67 times of fat, and 0.09 times of lactose.Compare with baby formula milk, the tree shrew’ s milk contained 1.44 times of total solid contents, 0.20 times of ash, 0.58 times of protein, 1.53 times of fat, and 0.06 times of lactose.The trace mineral composition of the tree shrew’ s milk showed that the calcium, phosphorus, potassium, sodium, magnesium, and iron contents were 1.83 times, 2.73 times, 1.25 times, 1.93 times, 1.28 times, and 1.48 times higher than those in the cow's milk, and were 0.66 times, 0.85 times, 0.34 times, 0.26 times, 0.85 times, 0.24 times lower than those in baby formula milk.Conclusions The main nutrients of tree shrew’ s milk is of high fat, high protein and low sugar, and it can provide a basis for tree shrews artificial brood and breeding work.
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Objective To assess the tolerance of elderly patients with esophageal carcinoma to chemoradiotherapy through.Methods A retrospective analysis of 596 elderly patients with esophageal carcinoma receiving chemoradiotherapy was conducted.Patients were divided into radiachemotherapy group and radiotherapy group,and according to age,patients were divided into four age groups (aged 70-74,75-79,80 80 and 85years and over).The tolerance to treatment was assessed by Charlson index.Results 185 patients completed chemoradiotherapy,113 patients reduced the dose of chemotherapy (reduction group),81 patients unfinished chemoradiotherapy (unfinished CRT group),160 patients completed radical radiotherapy alone (unfinished RT group),and 57 patients incompleted radiotherapy.Further analysis found that the tolerance to treatment in reduction group had significant differences between patients aged ≥ 75 years and ＜ 75 years (x2 =6.815,P=0.009),and between WIC ≥ 1 and ＜ 1(x2 =10.636,P=0.001); the tolerance to treatment in unfinished CRT group had significantly differences between aged ≥ 80 years and ＜80 years (x2 =63.842,P=0.000),and between WIC =0,1 and ≥ 2 (x2 =21.153,P=0.000).Conclusions Further age re-grouping and WIC assessment is necessary before treating esophageal cancer patients.Reduction of therapy dosage is more beneficial for patients aged ≥ 75 years and WIC≥1,and greater caution is required in chemotherapy for patients aged ≥ 80 years and WIC＞1.
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Objective:To test the expression of Minichromosome maintenance complex component 7(MCM7) protein in hepato-cellular carcinoma(HCC) of different species including human, rat and tree shrew (tupaia) by cross-species oncogenomics approach, and to investigate the relationship between the expression of MCM7 and the development of hepatocellular carcinoma and its clinical significance. Methods:Western blot and Immunohistochemistry were applied to detect the expression levels of MCM7 protein in HCC tissues,corresponding HCC-adjacent liver tissues and normal liver tissues collected from different species including human, rat and tree shrew, respectively. The clinicopathologic factors were also analyzed with the results of Immunohistochemistry. Results:Western blot analysis showed that the expression of MCM7 protein in HCC tissues of human and rat were higher than that in corresponding HCC-ad-jacent liver tissues and normal liver tissues, respectively and significantly (P0.05).There was also no significant difference between HCC-adjacent liver tis-sues and normal liver tissues in three species (P>0.05). Immunohistochemical analysis showed that MCM7 protein was mainly ex-pressed in nucleus of HCC cells, and the positive rate of MCM7 protein in HCC tissues of human, rat and tree shrew were significantly higher than that in corresponding HCC-adjacent liver tissues and normal liver tissues, respectively (P0.05). Moreover, the protein level of MCM7 was intimately related to patient's HCC stage, extrahepatic metastases and postoperative recurrence (P<0.05). Conclusion:MCM7 protein might play a pivotal role in hepatocarcinogenesis. In addition, it was probably related to patient's HCC stage, extrahepatic metastases and postoperative recurrence. It seems very likely that MCM7 may be applied as a new molecular target in HCC prevention and treat-ment.