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Objective:To systematically evaluate the efficacy and safety between neoadjuvant chemoradiotherapy followed by surgery and immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer.Methods:Literature review was performed from PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang, CNKI and VIP from the inception date to February, 2020 using the key words including "pancreatic neoplasm, pancreatic cancer, surgery, preoperative chemoradiotherapy, neoadjuvant chemoradiotherapy" in both English and Chinese. The randomized controlled clinical trials (RCTs) of neoadjuvant chemoradiotherapy followed by surgery versus immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer were searches. Literature screening, data extraction and estimation of the risk of bias were independently conducted by two researchers. The HR and 95% CI were used for estimating the overall survival time. The R 0 resection rate, overall incidence of postoperative complications, and mortality rate throughout treatment were assessed by the RR and 95% CI. The heterogeneity of the studies was analyzed using the I2 test. Results:A total of 4 RCTs were included. Among 400 patients, 197 cases were assigned into the neoadjuvant chemoradiotherapy combined with surgery group and 203 in the immediate surgery group. The results of Meta-analysis showed that patients in the neoadjuvant chemoradiotherapy followed by surgery group obtained longer overall survival ( HR=0.76, 95% CI: 0.60-0.97, P=0.03) and higher R 0 resection rate ( RR=1.72, 95% CI: 1.40-2.13, P<0.01). Besides, the overall incidence of postoperative complications ( RR=1.02, 95% CI: 0.73-1.43, P=0.90) and mortality rate throughout treatment ( RR=1.19, 95% CI: 0.48-2.93, P=0.71) did not significantly differ between two groups. Conclusions:During the treatment of resectable or borderline resectable pancreatic cancer, neoadjuvant chemoradiotherapy followed by surgery may bring more survival benefits than immediate surgery and does not increase the incidence of postoperative complications and mortality rate throughout treatment. Therefore, neoadjuvant chemoradiotherapy followed by surgery can be used as a recommended treatment for patients with resectable or borderline resectable pancreatic cancer.
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Objective:To systematic review the clinical efficacy and safety of neoadjuvant chemotherapy and neoadjuvant concurrent chemoradiotherapy for resectable esophageal squamous cell carcinoma.Methods:Literature search was performed from Web of Science, Pubmed, Cochrane Library, Embase, CBM, Wanfang Data, CNKI and Chongqing VIP. The clinical controlled studies of neoadjuvant chemotherapy versus neoadjuvant concurrent chemoradiation in the treatment of resectable esophageal squamous cell carcinoma was searched. Relevant outcome indicators were analyzed by Revman 5.3 statistical software.Results:Nine studies were included, with a total of 1, 369 patients. Compared with the neoadjuvant chemoradiotherapy, the neoadjuvant chemotherapy had lower overall survival rates at 3 and 5 years( OR=0.68, 95% CI: 0.53-0.86, P<0.05; OR=0.51, 95% CI: 0.34-0.77, P<0.05) , lower pathological complete remission rate( OR=0.28, 95% CI: 0.18-0.45, P<0.05)and R0 resection rate( OR=0.39, 95% CI: 0.22-0.68, P<0.05), The total postoperative complication rate is similar( OR=1.07, 95% CI: 0.75-1.51, P>0.05). Conclusion:Neoadjuvant concurrent radiochemotherapy maybe superior to neoadjuvant chemotherapy among patients with resectable esophageal squamous cell carcinoma.
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Objective To systematically evaluate the efficacy and safety between neoadjuvant concurrent chemoradiotherapy followed by surgery and surgery alone in the treatment of resectable esophageal squamous cell carcinoma.Methods Literature review was performed from Embase,PubMed,Web of Science,Cochrane Library,CBM,Wanfang Data,CNKI and Chongqing VIP.The randomized controlled clinical trials of concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma were retrieved.The meta-analysis of survival data,R0 resection rate,incidences of postoperative complications and peritreatment mortality was conducted by using RevMan 5.3 software.Results A total of 1450 patients from 11 controlled clinical trials were included in this meta-analysis.The results of the meta-analysis showed that concurrent chemoradiotherapy followed by surgery group had significantly higher 2-and 5-year overall survival rate (RR=1.14,95％CI:1.05-1.23,P=0.00) and progression-free survival rate (RR=1.56,95％CI:1.05-2.32,P=0.03).R0 resection rate were also improved in concurrent chemoradiotherapy followed by surgery group (RR=1.10,95％CI:1.05-1.14,P=0.00).Compared with the surgery alone group,the incidence of arrhythmia in the concurrent chemoradiotherapy plus surgery group was.significantly higher (RR=2.45,95％CI:1.37-4.38,P=0.00).However,there was no significant difference in the overall incidence of postoperative complications (RR=1.12,95％CI:0.79-1.59,P=0.51) and incidence of peritreatment mortality (RR=1.78,95％CI:0.90-3.52,P=0.10) between two groups.Conclusions Neoadjuvant concurrent chemoradiotherapy followed by surgery improves the survival and R0 resection rate over surgery alone among patients with resectable esophageal squamous cell carcinoma,whereas it does not increase the risk of postoperative complications.Consequently,neoadjuvant concurrent chemoradiotherapy followed by surgery is an optimal treatment for patients with resectable esophageal squamous cell carcinoma.
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Objective@#To systematically evaluate the efficacy and safety between neoadjuvant concurrent chemoradiotherapy followed by surgery and surgery alone in the treatment of resectable esophageal squamous cell carcinoma.@*Methods@#Literature review was performed from Embase, PubMed, Web of Science, Cochrane Library, CBM, Wanfang Data, CNKI and Chongqing VIP. The randomized controlled clinical trials of concurrent chemoradiotherapy followed by surgery versus surgery alone in the treatment of resectable esophageal squamous cell carcinoma were retrieved. The meta-analysis of survival data, R0 resection rate, incidences of postoperative complications and peritreatment mortality was conducted by using RevMan 5.3 software.@*Results@#A total of 1450 patients from 11 controlled clinical trials were included in this meta-analysis. The results of the meta-analysis showed that concurrent chemoradiotherapy followed by surgery group had significantly higher 2-and 5-year overall survival rate (RR=1.14, 95%CI: 1.05-1.23, P=0.00) and progression-free survival rate (RR=1.56, 95%CI: 1.05-2.32, P=0.03). R0 resection rate were also improved in concurrent chemoradiotherapy followed by surgery group (RR=1.10, 95%CI: 1.05-1.14, P=0.00). Compared with the surgery alone group, the incidence of arrhythmia in the concurrent chemoradiotherapy plus surgery group was significantly higher (RR=2.45, 95%CI: 1.37-4.38, P=0.00). However, there was no significant difference in the overall incidence of postoperative complications (RR=1.12, 95%CI: 0.79-1.59, P=0.51) and incidence of peritreatment mortality (RR=1.78, 95%CI: 0.90-3.52, P=0.10) between two groups.@*Conclusions@#Neoadjuvant concurrent chemoradiotherapy followed by surgery improves the survival and R0 resection rate over surgery alone among patients with resectable esophageal squamous cell carcinoma, whereas it does not increase the risk of postoperative complications. Consequently, neoadjuvant concurrent chemoradiotherapy followed by surgery is an optimal treatment for patients with resectable esophageal squamous cell carcinoma.
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Objective The role of additional docetaxel chemotherapy in the treatment of localised high-risk prostate cancer (PCa) remains a controversy.This meta-analysis aimed to investigate the effect of additional docetaxel chemotherapy on localised high-risk PCa.Methods A computerized search was performed in Pubmed,Embase,Cochrane Library,Web of Science,CBM,CNKI,VIP and Wanfang Data to collect clinical controlled trails on localised high-risk PCa treated with docetaxel chemotherapy from the inception to April 2019.The Review Manager 5.3 software was used to perform meta-analysis of survival data and adverse events.Results Six literatures were enrolled,including 3 187 patients.Compared with the standard treatment (local treatment combined with endocrine therapy) group,the progression-free survival (PFS) was prolonged in the standard treatment plus docetaxel group,and the difference was statistically significant.[hazard ratio (HR) =0.75,95 ％ CI 0.65-0.86,P ＜ 0.01].Patients in the standard treatment plus docetaxel group had longer overall survival (OS) and biochemical recurrence-free survival (BRFS) in comparison with standard treatment group,but the difference was not statistically significant (HR =0.843,95％CI 0.68-1.01,P =0.06;HR =0.86,95％ CI 0.69-1.07,P =0.17).In terms of safety,the incidence of adverse reactions was increased in the standard treatment plus docetaxel group,including the incidence of grade ≥3 neutropenia (RR =44.14,95％ CI 19.15-101.71,P ＜0.01),the incidence of grade ≥ 3 febrile neutropenia (RR =13.4,95 ％ CI 7.93-22.65,P ＜ 0.01) and the incidence of grade ≥ 3 diarrhea (RR =13.43,95 ％ CI 3.21-56.16,P ＜ 0.01).Conclusions Additional docetaxel chemotherapy could significantly improve the PFS in localised high-risk PCa patients.OS and BRFS were prolonged,but the difference was not statistically significant.
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Objective@#The role of additional docetaxel chemotherapy in the treatment of localised high-risk prostate cancer (PCa) remains a controversy. This meta-analysis aimed to investigate the effect of additional docetaxel chemotherapy on localised high-risk PCa.@*Methods@#A computerized search was performed in Pubmed, Embase, Cochrane Library, Web of Science, CBM, CNKI, VIP and Wanfang Data to collect clinical controlled trails on localised high-risk PCa treated with docetaxel chemotherapy from the inception to April 2019. The Review Manager 5.3 software was used to perform meta-analysis of survival data and adverse events.@*Results@#Six literatures were enrolled, including 3 187 patients. Compared with the standard treatment (local treatment combined with endocrine therapy) group, the progression-free survival (PFS) was prolonged in the standard treatment plus docetaxel group, and the difference was statistically significant. [hazard ratio(HR)=0.75, 95%CI 0.65-0.86, P<0.01]. Patients in the standard treatment plus docetaxel group had longer overall survival (OS) and biochemical recurrence-free survival (BRFS) in comparison with standard treatment group, but the difference was not statistically significant (HR=0.843, 95%CI 0.68-1.01, P=0.06; HR=0.86, 95%CI 0.69-1.07, P=0.17). In terms of safety, the incidence of adverse reactions was increased in the standard treatment plus docetaxel group, including the incidence of grade ≥3 neutropenia (RR=44.14, 95%CI 19.15-101.71, P<0.01), the incidence of grade ≥3 febrile neutropenia (RR=13.4, 95%CI 7.93-22.65, P<0.01) and the incidence of grade ≥3 diarrhea (RR=13.43, 95%CI 3.21-56.16, P<0.01).@*Conclusions@#Additional docetaxel chemotherapy could significantly improve the PFS in localised high-risk PCa patients. OS and BRFS were prolonged, but the difference was not statistically significant.
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Objective To systematically evaluate the clinical efficacy and safety between high-dose (74 to 80 Gy) and conventional-dose (64.0 to 70.2 Gy) conventionally fractionated external beam radiotherapy for stage T1b-4No-1M0 prostate cancer in this meta-analysis.Methods A literature search was performed in PubMea,ambasa,aochrane Librara,aeb of Scienca,aBa,aanfang Data,aNKI and Chongqing VIP to collect clinical trials on high-dose versus conventional-dose conventionally fractionated external beam radiotherapy of prostate cancer from the inception to July 1,2018.The included literatures were evaluated by Cochrane quality evaluation criteria and subject to meta-analysis by using Review Manager 5.3 statistical software.Results A total of 7 randomized controlled clinical trials involving 4 132 patients were included in the meta-analysis.The meta-analysis showed that the high-dose and conventional-dose groups yielded similar 10-year overall survival (RR=1.01,95％CI:0.96 to 1.07,P=0.64) and 10-year prostate cancer-specific survival (RR=1.01,95％CI:0.98 to 1.03,P=0.47).The biochemical failure rate in the high-dose group was significantly lower than that in the conventional-dose group (RR =0.78,95％CI:0.70 to 0.86,P＜0.01).Compared with the conventional-dose groua,ahe incidence of late grade ≥ 2 gastrointestinal and genitourinary adverse reactions (RR=1.48,95％CI:1.31 to 1.67,P＜0.01;RR=1.35,95％CI:1.06 to 1.73,P=0.02) was significantly higher in the high-dose group.Conclusion High-dose conventionally fractionated external beam radiotherapy has advantages in reducing the biochemical failure rate of patients with stage T1b-4N0-1M0 prostate cancer.Nevertheless,whether it can improve overall survival and prostate cancer-specific survival remains to be validated.High-dose radiotherapy also induce a higher incidence rate of late grade ≥ 2 gastrointestinal and genitourinary adverse reactions compared with conventional-dose radiotherapy.
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Objective To systematically evaluate the efficacy and safety between neoadjuvant therapy followed by radical surgery and definite chemoradiotherapy in the treatment of Ⅰ B2-Ⅱ B cervical cancer.Methods A computerized search was performed in PubMed,Embase,Cochrane Library,Web of Science,CBM,Wanfang Data,CNKI and VIP to collect controlled clinical trials related to neoadjuvant therapy followed by radical surgery versus definite chemoradiotherapy in the treatment of ⅠB2-ⅡB cervical cancer.The meta-analysis of survival data and adverse events was performed by Review Manager 5.3 software.Results Nine controlled clinical trials involving 3 914 patients were included in this meta-analysis.There were no significant differences in overall survival (HR =0.83,P =0.31) and progression-free survival (HR=O.85,P=0.57) between two groups.Compared with patients receiving definite chemoradiotherapy,those in the neoadjuvant therapy group had a significantly lower risk of irradiation enteritis (RR=0.27,P=0.03),whereas no significant difference was observed in the risk of irradiation cystitis (RR=0.30,P=0.34) and grade ≥ 3 neutropenia (RR=0.77,P=0.46) between two groups.Conclusion In the treatment of locally advanced ⅠB2-Ⅱ B cervical cancer,two modalities show similar survival benefits.Although the neoadjuvant therapy group yields a lower incidence of irradiation enteritis,the incidence rates of irradiation cystitis and grade ≥3 neutropenia do not significantly differ between two groups.Neoadjuvant therapy followed by radical surgery is not superior to the standard therapeutic regime.
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treatment of LS-SCLC, two fractionation modes show similar short-term efficacy and survival benefits. However, hyperfractionated radiotherapy causes a higher incidence of radiation esophagitis than conventionally fractionated radiotherapy. Given that hyperfractionated radiotherapy is not superior to conventionally fractionated radiotherapy,conventionally fractionated radiotherapy is recommended for treating LS-SCLC.
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Objective To investigate the effect of liver kinase B1(LKB1) on the radiosensitivity of subcutaneous xenograft tumor of lung cancer H460 cells in nude mice.Methods Human lung cancer H460 cells were implanted into female nude mice (BALB/c-nu) to establish a subcutaneous xenograft tumor model of lung cancer.A total of 24 female nude mice in which the model was successfully established were equally and randomly divided into four groups:pEGFP-Ctrl plasmid (empty vector plasmid) group, irradiation (IR)+pEGFP-Ctrl plasmid group, pEGFP-LKB1 plasmid (overexpressing LKB1) group, and IR+pEGFP-LKB1 plasmid group.The growth of xenograft tumors was observed and the tumor inhibition rate and enhancement factor (EF) were calculated.The expression of LKB1 in each group was measured by immunohistochemistry and Western blot to analyze the relationship between LKB1 and radiosensitivity.Results Compared with the pEGFP-Ctrl plasmid group, the IR+pEGFP-Ctrl plasmid group, pEGFP-LKB1 plasmid group, and IR+pEGFP-LKB1 plasmid group showed varying degrees of inhibition of tumor growth, particularly in the IR+pEGFP-LKB1 plasmid group, and the tumor inhibition rates were 31.30%, 14.78%, and 43.48%, respectively.The EF of LKB1 in the IR+pEGFP-LKB1 plasmid group was 1.18.The immunohistochemistry and Western blot showed that LKB1 could be effectively expressed in the pEGFP-LKB1 plasmid group and IR+pEGFP-LKB1 plasmid group, but not in the other two groups.Conclusions The subcutaneous xenograft tumor model of human lung cancer H460 cells has been successfully established in nude mice.LKB1 has a radiosensitizing effect on the subcutaneous xenograft tumor of lung cancer H460 cells in nude mice.
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Objective To establish radiation?resistant lung carcinoma cell lines, and to investigate the changes in morphology, apoptosis, invasive migration, and epithelial?mesenchymal transition ( EMT) in cells. Methods The radiation?resistant lung carcinoma cell lines were obtained by exposure of lung carcinoma cell lines, A549 and H1299, to radiation with a low dose in fractions, a sublethal dose, or a gradually increasing dose. The morphological changes in cells, radiosensitivity, survival rates after exposure, apoptosis rates, changes in invasive migration, and expression of EMT marker proteins were evaluated using microscopy, colony formation assay, CCK?8 assay, flow cytometry, transwell migration assay, and Western blot, respectively. Results Radiation with a gradually increasing dose successfully induced the radiation?resistant cell lines, A549R and H1299R. The morphological study showed that the morphology of radiation?resistant cells was converted to the morphology of mesenchymal cells. Compared with A549 and H1299 cells, the values of D0 , Dq , and SF2 were significantly increased in A549R ( P=0.017,P=0.001,P=0.000) and H1299R (P=0.033,P=0.000,P=0.008) cells, respectively;the values of α and α/β were significantly reduced in A549R (P=0.018;P=0.007) and H1299R (P=0.001;P=0.009) cells, respectively. The survival rates in A549R and H1299R cells after exposure to radiation with various doses were significantly higher than those in the control groups (all P<0.05). After exposure, the apoptosis rates were significantly reduced in A549R and H1299R cells ( P=0.02,P=0.01);the invasion and migration rates were significantly increased in A549R (P=0.000;P=0.001) and H1299R (P=0.001,P=0.002) cells;the expression of E?cadherin was significantly down?regulated in A549R and H1299R cells (P=0.00,P=0.01), while the expression of vimentin was significantly elevated in A549R and H1299R cells ( P= 0. 02, P= 0. 01 ) . Conclusions The radiation?resistant lung carcinoma cell lines are successfully established. Both cell lines show enhanced invasion and migration, which may be associated with EMT.
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Objective To explore the prognostic factors of non-small-cell lung cancer (NSCLC) patients with brain metastasis. Methods 122 NSCLC patients with brain metastasis from Jan 2007 to Dec 2012 were incorporated, and followed with death as the end. The influence factors of prognosis were retrospective analyzed. Kaplan-Meier method was used for survival analysis, the Log-rank test for single factor analysis,and Cox regression model for multiple factors analysis. Results The single-factor and multi-factor analysis showed that the influence factors of prognosis were age, pathological type, number of intracranial metastasis, presence of extracranial metastasis, treatment, Karnofsky score, the original site control situation (P0.05). The average survival times of patients with palliative symptomatic treatment, simple whole brain radiotherapy, whole brain radiotherapy local lesion plus the amount of radiation, whole brain radiotherapy local lesion plus the amount of radiation combined with chemotherapy were (2.14 ±0.19) months, (7.28 ±0.60) months, (16.90 ±1.35) months, (17.7±1.12) months, 1 year survival rates were 0, 8.5%, 71.0%, 93.3%. Survival analysis showed that there was statistical significance among the four groups (P= 0.000). Conclusion The age, pathological type, number of intracranial metastasis, presence of extracranial metastasis, treatment, Karnofsky score, the original site control situation are the prognosis factors in NSCLC patients with brain metastasis, therefore the treatment of these patients should be comprehensively analyzed.
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Objective To evaluate the effectiveness of psychological health intervention in the elderly urban residents living on minimum subsistence allowances, and to search for a suitable psychological health intervention strategy. Methods The 112 elderly persons living on minimum subsistence allowances in Xuzhou were selected by stratified cluster sampling, and they were matched with 112 controls. The elderly persons living on minimum subsistence allowances were divided into intervention group and control group. A general intervention based on community involved psychological health and care lecture, psychodrama treatment and psychological consultancy was made on the intervention. The SCL-90 was used to evaluate the psychological health status and effectiveness of psychological health intervention. Results The elderly persons living on minimum subsistence allowances had higher SCL-90 scores compared with other residents, and their psychological health status was serious. After the psychological health intervention, the SCL-90 scores were all lower in intervention group than in control group [ interpersonal relationship sensitiveness: (1.13 ± 0. 39) vs.(1.26±0.26), t=2.12, P=0.04; gloom: (1.23±0.66) vs. (1.43±0.24), t=2.08, P=0.04;anxiety: (1. 18±0.50) vs. (1.38±0.34), t=2.17, P=0.03; hostility: (1.24±0.49) vs. (1.40±0.28), t=2.03, P=0.04; other factor: (1. 31±0.56) vs. (1.49±0.31), t=2.04, P=0.04; total score: (115.89± 17.21) vs. (122.64± 10.41), t=2.42, P=0.02]. Conclusions The psychological health parameters are improved by psychological health intervention.
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Based on the development of clinical radiobiology and combined with teaching practice for recent years,we have preliminarily surveyed the teaching reform about this curriculum and proposed some advices about the clinical radiobiology teaching reform.