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Objective To evaluate the clinical efficacy and analyze relevant prognostic factors of simultaneous integrated boost intensity-modulated radiation therapy ( SIB-IMRT ) for esophageal squamous cell carcinoma. Methods A total of 101 patients diagnosed with esophageal squamous cell carcinoma received SIB-IMRT from 2009 to 2015. The prescribed dose of PTV was 5040 cGy/28 times ( 180 cGy/time) and the dose for planning gross tumor volume (PGTV) was 6020 cGy/28 times (215 cGy/time) or 6160 cGy/28 times ( 220 cGy/time) simultaneously. The total treatment time was 5. 5 weeks ( once a day, 5 times a week).The adverse events, mode of treatment failure,l-,3-and 5-year local control (LC) and overall survival ( OS) rates were observed. Results The quantity of patients who completed the 1-,3-and 5-year follow-up was 101, 84 and 45, respectively. The 1-,3-and 5-year LC rates were 81. 6％,70. 4％ and 68. 4％, respectively. The 1-, 3-and 5-year OS rates were 72. 3％, 49. 4％ and 45. 2％, respectively. The median survival time was 36 months. Univariate and multivariate analyses showed that clinical staging ( stageⅠ/Ⅱ/Ⅲ) and tumor response ( complete remission/ partial remission/no remission ) were the prognostic factors of OS (P=0. 016,0. 000,0. 005,0. 000).There were no significant differences in the LC and OS between the two groups of 215 cGy and 220 cGy (P=0. 283,0. 951).The incidence rates of grade 1,2,3 acute pneumonitis were 10. 9％(11/101),2. 0％(2/101) and 2. 0％(2/101), respectively. The incidence rates of grade 1, 2, 3 acute esophagitis were 63. 4％( 64/101 ) , 10. 9％( 11/101 ) and 4. 0％( 4/101 ) , respectively. No acute esophageal perforation or hemorrhage occurred. Five patients experienced late pneumonitis ( two died) . One case developed late lemostenosis, two cases developed esophageal perforation and hemorrhage, and two patients experienced esophageal hemorrhage. The patients treated with a fractionated dose of 220 cGy had a higher incidence rate of acute pneumonitis and upper gastrointestinal adverse reactions than those receiving 215 cGy ( P= 0. 062, 0. 024 ) . The local failure and recurrence accounted for 62. 5％ of all treatment-related failures. Conclusions SIB-IMRT yields high long-term clinical efficacy and tolerable adverse events in the treatment of esophageal squamous cell carcinoma. Compared with the dose of 215 cGy, the fractionated dose of 220 cGy fails to improve LC and OS rates, whereas enhances the risk of adverse events. The clinical staging and short-term clinical efficacy are the prognostic factors of survival rate.
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Objective To investigate the differences of clinical efficacy and untoward reaction of different chemotherapy regi‐mens for patients with malignant glioma on different expression levels of O6‐methylguanine‐DNA‐methyltransferase(MGMT) ,in order to provide references for clinical treatment .Methods Totally 90 cases of patients with malignant glioma in our hospital from January 2011 to January 2013 were selected ,among them ,64 cases of MGMT negative expressing patients were divided into group A and group B with 32 cases in each group ,and 26 cases of MGMT positive expressing patients were enrolled into the group C . Group A was treated with combination of radiotherapy ,teniposide and nimustine ,group B was treated with radiotherapy‐temozolo‐mide combination regimen ,group C was treated with combination of radiotherapy ,teniposide and nimustine .The untoward reactions of the three groups were compared ,and the survival rate was observed after one year follow‐up .Results The hemoglobin ,leuko‐cyte ,granulocyte ,platelet ,bleeding ,alanine aminotransferase ,creatinine ,urea nitrogen ,peripheral neuritis ,untoward reactions a‐mong the three groups had no statistically significant differences (P>0 .05);the incidence rates of nausea and vomiting ,diarrhea , constipation among the three groups had statistically significant differences(P<0 .05) ,in which group C was significantly higher than that of group A and group B(P<0 .05) .Only one case in the group C was lost in the one year follow‐up .The median survival time was 10 months in group A and group B ,and was 7 months in group C .The median survival time in group C was significantly lower when compared with that in group A and group B(χ2 =7 .673 ,P=0 .006 ;χ2 =6 .395 ,P=0 .011) ,while there was no signifi‐cant difference of median survival time between group A and group B(χ2 =0 .063 .P=0 .802) .Conclusion The long‐term prognosis of patients with negative MGMT expression might be significantly worse than that of patients with negative MGMT expression in glioma .
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Objective To investigate the therapeutic effects,adverse effects,and patterns of failure of elective irradiation of lymphatic drainage area (extended-field) and involved-field irradiation in three-dimensional radiotherapy (3DRT) in patients with esophageal cancer via a Meta-analysis.Methods The databases Wanfang Data,CNKI,VIP,CBM,PubMed,Embase,and Cochrane Library were searched to collect the controlled clinical trials on extended-field irradiation and involved-field irradiation in 3DRT in patients with esophageal cancer.Stata 11.0 was used for data analysis.The odds ratio (OR) with 95％ confidence interval was used to describe the differences between two groups.Results According to the inclusion and exclusion criteria,a total of 12 controlled clinical trials involving 1 095 patients with esophageal cancer were included in this meta-analysis.The results of the meta-analysis showed that compared with the involved-field irradiation group,the extended-field irradiation group had a significantly reduced rate of out-field failure in patients with esophageal cancer who received 3DRT (OR=3.727,P=0.007),but showed significantly higher rates of grade ≥ 3 acute radiation pneumonitis and radiation esophagitis (acute radiation pneumonitis:OR =0.348,P =0.001;radiation esophagitis:OR =0.385,P =0.000).The two groups had similar 1-,2-,and 3-year local control rate and overall survival rate (local control rate:OR=0.966/0.946/0.732,P=0.837/0.781/0.098;overall survival rate:OR=0.952/1.149/0.768,P=0.756/0.422/0.120),as well as a similar distant metastasis rate (OR=0.986,P=0.937).Conclusions Compared with involved-field irradiation,extended-field irradiation can reduce the rate of out-field failure in patients with esophageal cancer who receive 3DRT.However,it does not have significant advantages in local control rate and overall survival rate and has an increased incidence rate of adverse effects.
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Objective To investigate the association between social support and family cohesion, adaptability of rural patients undergoing maintenance hemodialysis (MHD). Methods Between August 2012 and November 2012, 94 patients with incident hemodialysis from rural areas in Hebei province were consecutively recruited in the study. The social support inventory (SSI) and the Chinese version of the family adaptability and cohesion evaluation scales (FACESII-CV) were employed in the investigation 3 months after the start of hemodialysis. Pearson correlation analysis was used to estimate the relationship between social support and familiarity, adaptability in rural MHD patients. Results The score on the family cohesion the adaptability were lower than norm(all P<0.001). The social support was associated with family cohesion and adaptability. The total scores on social support, emotional support and material support were positively associated with the scores on the family cohesion and adaptability (P<0.05). Conclusions The family cohesion and adaptability in rural patients undergoing hemodialysis are both at a lower level and are closely related to emotional and material supports. The higher they get social support, the higher the levels in family cohesion and adaptability.
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Radiotherapy is an importment local treatment for non-small cell tung cancer. In recent years,with the development of molecular biology and radiotherapy technique and the update of equipment,radiation pattern with different doses segmentation and the concept of the combined therapy including radiotherapy and chemotherapy have been applied in clinic gradually,which get better effects.
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Objective To evaluate the impact of gross tumor volume(GTV)on prognosis of three-dimensional conformal radiotherapy(3DCRT)in esophageal carcinoma.Methods From Jan.2004 to Oct.2007,131 stageⅠ-Ⅲb patients with unreseetable esophageal carcinomas who received 3DCRT with 60 Gy/ 30f/6w were analyzed retrospectively.The effectiveness of related prognostic factors on survival was evaluated by univariate and multivariate analyses.Results The following-up rate was 100%.By univariate analysis,the 1-,2-and 3-year local tumor control rates were 71%,64%and 60%for patients with GTV volume≤40 cm3,and 43%,32%and 28%for those with GTV volume>40 cm3(X2=13.16,P=0.000).respectively.The 1-,2-and 3-year local tumor control rates were 67%,59%,59%for T1+2 patients,62%,53%,50%for T3 patients,and 41%,28%,19%for T4 patients,respectively(X2=13.25,P=0.001).The 1-,2-and 3-year survival rates were 78%,53%,46%for patients of GTV volume≤40 cm3 and 45%.27%and 7%for patients of GTV volume>40 cm3(X2=21.55,P=0.000).The 1-,2-and 3-year survival rates were 71%,50%and 39%for patients with T1+2,68%,46%and 25%with T3,and 36%,18%and 15%with T4,repectively(X2=14.35,P=0.001).The 1-,2-and 3-year survival rates for patients with tumor length≤5 cm were 75%,50%and 44%,compared with 53%,35%and 18%with tumor length>5cm(X2=5.99,P=0.014).By multivariate analysis,GTV volume and T stage were likelv to be independent prognostic factors for local tumor control rates(X2=7.07,P=0.008;X2=6.63,P=0.036).Only the GTV volume was associated with the overall survival rate(X2=15.82,P=0.000).Conclusions GTV volume is independent prognostic factor.The larger the GTV volume is,the worse the prognosis will be.
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Objective To evaluate the respiration-induced dosimetric variance in 3DCRT for midthoracic esophageal carcinoma, in order to guide the radiation oncologist to choose the expansion margin. Methods Ten patients with mid-thoracic esophageal carcinoma were scanned by multi-spiral CT simulator respectively in free breathing ( FB), breath-hold after normal inspiration and expiration ( IBH and EBH )with the same scanning range. Then the CT images of three series were transferred to the treatment planning system. The target volume was outlined following the same standard. Plan1 was designed in the images of FB and transported completely to the images of IBH and EBH as Plan2 and Plan3 respectively to observe the dosimetric variance in target volume. Results For GTV, there was a statistical difference only in V100 of the three plans ( H = 6.423, P = 0.040 ) and no significant difference was found in other indexes. For CTV, the V100 and V95 were better in Plan1 (F=3.992, P=0.030; H=9.920, P=0.007) and no significant difference was found in other indexes. While ()TV, the Dmin, V100 and V95 was better in Plan1 ( F = 3.677, P = 0.039; F = 4.539, P = 0.020; H = 6.846, P = 0.033 ) and no significant difference was found in other indexes. There were no significant differences in all the indexes for the spinal cord and lung in the three plans. Conclusions The change in dose distribution was not so much with the standard expansion. It can meet the needs of clinical treatment.
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Objective To evaluate the respiration-induced target volume motion in 3D-CRT for mid-thoracic esophageal carcinoma in order to guide the radiation oncologist to choose the expansion marginfor ITV.Methods Ten patients with mid-thoracic esophageal carcinoma were scanned by multi-spiral CTsimulator respectively in free breathing(FB),breath.hold after normal inspiration and expiration(IBH and EBH)with the same scanning range.Then the CT images of three series were transfefred to the treatmentplanning system.The target volume was outlined following the same standard.The motion of the centerpoint of GTV,the center point of each slice of GTV and the edge of the GTV in selected slice weremeasured respectively to obtain the comprehensive value of GTV motion。in order to find the appropriate IMvalue according to the 95％confidence interval of the GTV motion.Results①The GTV motion betweenIBH and EBH was(0.19±0.16)cm in the left.right direction,(0.54±0.19)cm in the cranial andcaudal irection.and(0.16±0.14)cm in anterior.posterior directions for the center of GTV,.For thecenter point of each slice of GTV.they ere(0.19±0.15)cm,(0.54±0.16)cm,(0.16±0.13)cm in three directions above.respectively.For the edge of the GTV in selected slice.they were(0.26±0.19)cm,(0.54±0.18)cm,(0.24±0.19)cm,respectively.The comprehensive value of GTV motion between IBH and EBH was(0.23±0.17)cm,(0.54±0.17)cm,(0.21±0.17)cm.respectively.The 95％confidence interval was 0.21-0.25 cm.0.53-0.56 cm and 0.19-0.22 cm in three directions.②The direction of GTV motion：No motion was noticed in 8.2％.while 73.3％to the right side and 18.5％to the left side in the left-right direction when IBH were compared with EBH.100％were moved to caudal in the the cranial and caudal direction[(0.54±0.17)cm].In the anterior-posterior direction,no motion was noticed in 8.2％,while 16.6％to the posterior and 75.2％to the anterior when IBH were compared with EBH.③The GTV motion was correlated with the vafiance of 1ung volumes in IBH-EBH(r=0.683,P=0.032)and not with GTV volume and length.Conclusions Respiration can induce target volume motion in 3 DCRT for mid-thoracic esophageal carcinoma.Compared to EBH.the GTV tends to move to the caudal,the anterior and the ight side in IBH.