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With the extension of human life expectancy, the threat of cancer to human beings has become increasingly prominent. Cancer has become the first cause of death for urban and rural residents in China. As the disease progresses, many patients have metastases in other sites besides the primary malignant tumors. Hence, it is of significance to choose effective treatment methods. Body gamma knife treatment is an accurate stereotactic radiotherapy that can render higher doses to the tumors and better protect surrounding normal tissues. A large number of clinical trials have demonstrated that body gamma knife treatment of lung metastases, liver metastases and adrenal metastases can obtain relatively high local control rates. In this article, the application of body gamma knife in the treatment of metastatic tumors was reviewed.
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Stereotactic body radiation therapy (SBRT) refers to the use of stereotactic isocentric rotation technology, which concent rates high-energy radiation in the target area for a large dose of irradiation, causing irreversible biological damage, while the normal tissue is not or less exposed. Currently, SBRT is the standard treatment for inoperable patients with early non-small cell lung cancer (NSCLC). The efficacy of SBRT in the treatment of peripheral and central lung cancer has been validated, whereas there is no consensus on the dose and fractionation, which remains to be further explored. The clinical efficacy of SBRT combined with immunotherapy needs to be further studied. Therefore, the optimal dose and fractionation of SBRT for early peripheral and central NSCLC were discussed, the difference in the clinical efficacy among SBRT, lobectomy and thoracoscopic surgery was analyzed and the clinical efficacy of SBRT combined with immunotherapy was assessed, aiming to provide theoretical basis for the application of SBRT in clinical practice.
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Objective@#To investigate the expression of DNA damage repair factor PDZ binding kinase (PBK) and matrix metalloproteinase 9 (MMP-9) in cervical cancer and the effect on clinical outcomes of concurrent chemoradiotherapy.@*Methods@#A total of 65 cervical cancer pathological specimens were collected from January 2014 to July 2016. Immunohistochemistry was used to detect PBK and MMP-9 expression in the specimens.External irrsdeation was treated with intensity-modulated radiation therapy at a dose of 50 Gy/25 F. After 18 times of external irradiation, high-dose rate postoperative treatment was giver at a dose of 30-36 Gy/5-6 F which lasts 3-4 weeks. Weekly chemotherapy with Cisplatin(DDP) begins simultaneously at the beginning of external irradiation. DDP was administered intravenously at a dosage of 40 mg/m2 for 2 to 6 week. All patients were followed-up as routine. The relationship between clinical characteristics and prognosis of patients and the expression of PBK and MMP-9 were analyzed.@*Results@#PBK was expressed in 92.3% of tissues and MMP-9 was expressed in 69.2% of tissues. The expression of PBK was positively associated with overall survival (OS) and disease progression-free survival (PFS) of cervical cancer patients (χ2=4.324, 8.068, P<0.05). The expression of MMP-9 was related with PFS (χ2=5.134, P<0.05). Patients with PBK and MMP-9 expression suffered poor OS and PFS (χ2=5.382, 9.364, P<0.05).@*Conclusions@#PBK and MMP-9 could be a biomarker to predict the prognosis of cervical cancer.
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@# Objective To investigate the survival status of people with disabilities in urban areas of Lanzhou, China and discuss the correlation of their quality of life to disability attitude and quality of care and support of disabled people. Methods From August to November, 2016, 606 persons with disability registered in Chengguan District of Lanzhou were selected by multistage stratified cluster sampling. They were investigated in home-based visit with World Health Organization Quality of Life-Disability Scale for physical disability, World Health Organization-Disability Attitude Scale and World Health Organization Quality of Care and Support Scale-Disability Scale. Results The quality of life scored in average of (40.76±14.79), and different with the demographic characteristics (P<0.05). Pearson's correlation analysis showed that the score in all fields of quality of life and the total score positively correlated with most dimensions of disability attitude score (r>0.080, P<0.05) and most dimensions score of quality of care and support (r>0.083, P<0.05).Conclusion It is important to strengthen the precise security system for people with disabilities, and strive to establish a full-cycle, all-round social support system for them.
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Objective To retrospectively analyze the nutritional status of patients with malignant tumors prior to the primary radiotherapy,aiming to to provide clinical evidence for the rational application of nutritional support during radiotherapy. Methods The nutritional status of 68 patients with malignant tumors admitted our department from August 2016 to May 2017 was investigated. All patients received primary radiotherapy. The Nutrition Risk Screening 2002 was utilized to assess the nutrition risk. The body mass index ( BMI ) , hemoglobin, total protein, albumin, pre-albumin and C-reactive protein levels were detected and statistically analyzed. Results The incidence of nutritional risk of 68 patients with primary radiotherapy was 6％, and the incidence of malnutrition was 5. 9％. All patients presenting with nutritional risk and malnutrition were diagnosed with head and neck and gynecological malignant tumors. Twenty-four patients had elevated levels of C-reactive protein, 16 had decreased levels of hemoglobin, 17 developed decreased levels of prealbumin,1 had a decline in the level of albumin and 5 presented with a decrease in the levels of total protein. The nutritional status and clinical parameters were evaluated between patients who had/had not received chemotherapy before radiotherapy. The BMI,C-reactive protein,hemoglobin and prealbumin levels significantly differed between two groups ( all P< 0. 01 ) , whereas the remaining parameters did not significantly differ. The BMI, C-reactive protein, hemoglobin and prealbumin levels significantly differed between patients who had/had not underwent surgery prior to radiotherapy ( all P<0. 01 ) . Conclusions Analysis of the nutritional status of patients receiving primary radiotherapy demonstrates that patients with head and neck, and gynecological malignant tumors are more likely to suffer from nutritional risk and malnutrition compared with those with other types of malignant tumors. Compared with patients who have not received chemotherapy/surgery before radiotherapy, those who have underwent chemotherapy/surgery have worse nutritional status. Besides,more significant changes are observed in the levels of C-reactive protein, hemoglobin and prealbumin than the levels of albumin and total protein.
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Objective To investigate the consensus and controversies on the delineation of radiotherapy target volume for patients with locally advanced non-small cell lung cancer (LA-NSCLC).Methods Questionnaires including 15 questions on the delineation of radiotherapy target volume of NSCLC were sent to 12 radiation departments in China in November 2015.A patient with LA-NSCLC was selected by Fudan University Shanghai Cancer Center, and simulation CT images and medical history data were sent to the 12 radiation departments.Twelve radiation oncologists from the 12 radiation departments showed and explained the delineation of radiotherapy target volume of their own, and the patient was discussed by all experts in the sixth multidisciplinary summit forum of precise radiotherapy and chemotherapy for tumor and lung cancer.Results All receivers of the questionnaire answered the questions.The standard lung window width/level for the delineation of lung cancer was 800-1600/-600 to-750 HU, and the mediastinum window was 350-400/20-40 HU.Respiratory movement was measured by stimulator, 4D-CT, and stimulator+4D-CT with 2-5 mm expansion based on experience.The primary clinical target volume (CTV) was defined as gross target volume (GTV) plus 5-6 mm for squamous carcinoma/5-8 mm for adenocarcinoma.The metastatic lesion of mediastinal lymph nodes was delineated as 5 mm plus primary lesion in 6 departments and as primary lesion in another 6 departments.Of the 12 departments, 10 applied 5 mm of set-up error, 1 applied 3 mm, and 1 applied 4-6 mm.For V20 of the lungs, 10 departments defined it as<30%, 1 as<35%, and 1 as 28%.Nine departments defined the radiation dose of concurrent chemoradiotherapy (CCRT) for LA-NSCLC as 60 Gy in 30 fractions, 62.7 Gy in 33 fractions in 1 department, 50-60 Gy in 25-30 fractions in 1 department, and 60-70 Gy in 25-30 fractions in 1 department.For the delineation of target volume for the LA-NSCLC patient treated with CCRT, the primary planning target volume (PTV) was defined as GTV plus organ movement (IGTV) and set-up error (GTV→IGTV→PTV) in 3 departments, as CTV plus organ movement (ITV) and set-up error (GTV→CTV→ITV→PTV) in 8 departments, and as CTV plus set-up error/IGTV plus 5-6 mm for squamous carcinoma/5-8 mm for adenocarcinoma (CTV) and set-up error (GTV→CTV→PTV/GTV→IGTV→CTV→PTV) in 1 department.For the delineation of PTV in the mediastinal lymph node, GTV→IGTV→PTV was performed in 3 departments, GTV→CTV→ITV→PTV in 8 departments, and GTV→CTV→PTV in 1 department.For 10%-100% patients with LA-NSCLC, the radiation field needed to be replanned when 38-50 Gy was completed.There was no unified standard for the optimal standardized uptake value (SUV) of positron emission tomography (PET)-computed tomography (CT) simulation and delineation.Seven departments had applied magnetic resonance imaging (MRI) simulation and 10 departments had applied stereotactic body radiation therapy (SBRT) for the treatment of early-stage NSCLC.For the delineation of PTV for early-stage NSCLC (T1-2N0M0), GTV→IGTV→PTV was performed in 5 departments, IGTV→PTV in 3 departments, and GTV→CTV→ITV→PTV in 2 departments.In all the 12 departments, peripheral early-stage NSCLC was given 6.0-12.5 Gy/fraction, 3-12 fractions and central early-stage NSCLC was given 4.6-10.0 Gy/fraction, 5-10 fractions.The results of discussion on the delineation of target volume for the patient were as follows:respiratory movements should be measured by 4D-CT or simulator;the lung window width/level is 1600/-600 HU and the mediastinal window width/level is 400/20 HU;the primary controversy is whether the involved-field irradiation or elective nodal irradiation should be used for the delineation of CTVnd in the mediastinal lymph node.Conclusions Basic consensus is reached for the delineation of target volume in LANSCLC in these aspects:lung window width/level, respiratory movements and set-up error, primary lesion delineation, the radiation dose in CCRT, and the optimal time for replanning the radiation field.There are controversies on the optimal SUV in the delineation of target volume based on PET-CT simulation, the optimal dose fractionation in SBRT for early-stage NSCLC, and the delineation of CTVnd.
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Objective To investigate the better radiation modalities for single and multiple brain metastases.Methods Between July 2005 and July 2008,50 patients with single or multiple brain metastases were retrospectively analyzed.The primary cancer of all patients were controlled.Thirty patients with whole brain radiotherapy and stereotactic radiosurgery were included in the combination group,and 20 patients with stereotactic radiosurgery were included in another group.Stereotactic radiosurgery prescription doses of 45％-75％ isodose line were used to wrap around the planning target,which was 15-20 Gy in edge and 30-45 Gy in center.Stereotactic radiosurgery was performed once.Whole brain radiotherapy total dose was 40 Gy,which was given to patients by 2 Gy in 1 fraction,1 fraction every day,5 times every week.Results The efficient rate of combination group was 90％ (27/30),and single group was 60％ (12/20).It was obviously higher in combination group (x2 =6.294,P =0.012).For combination group,the 1-year survival rate was 50％ (15/30) and the 2-year survival rate was 30％ (9/30).However,for another group,the 1-year survival rate was 35％ (7/20) and the 2-year survival rate was 15％ (3/20).The survival rates of two groups were no difference (x2 =1.096,P =0.295 ; x2 =1.480,P =0.224).There were no patients survived more than 3 years in both groups.Stratified analyses showed that the l-year survival rates of the patients with single brain metastasis were no difference in two groups (100.0％ vs 66.7％,x2 =1.556,P =0.212).Whereas the 1-year survival rate in combination group of the patients with multiple brain metastases was higher than that in single group (42.3％ vs 29.4％,x2 =11.023,P =0.001).There were no statistically significant differences in 2-year survival rates in both groups with single and multiple brain metastases (75.0％ vs 66.7％,x2 =1.200,P =0.273 ; 23.1％ vs 5.9％,x2 =3.782,P =0.052).Conclusion Whole brain radiotherapy and stereotactic radiosurgery are important treatment modalities for single or multiple brain metastases.The optimal treatment modality for single brain metastasis is stereotactic radiosurgery,while it is a good choice to make whole brain radiotherapy and stereotactic radiosurgery for multiple brain metastases.
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Objective To observe the clinical efficacy and adverse reactions of intensity modulated radiotherapy (IMRT) combined with cisplatin for patients with carcinoma of cervix.Methods One hundred patients with carcinoma of cervix were randomly divided into 2 equal groups to undergo IMRT only (IMRT group)and IMRT combined group (IMRT with cisplatin chemotherapy group),with 50 cases in each.Both groups were treated with external intensity modulated radiotherapy,with the total dose of 50 Gy,2 Gy/fraetion,25 fractions in total,and 5 times/week.Two weeks later,internal radiotherapy followed,with the total dose of 42-48 Gy,1 time/week with 6-8 times and 6-7 Gy/fraction.When the internal radiotherapy began,the external radiotherapy stopped immediately.The combination group was treated concurrently with cisplatin given by intravenous drip once a week,at the dose of 30-40 mg/m2 body surface area for 4-5 weeks,and with total cisplatin dosage of 50-65 mg.Follow-up was conducted for 18 months(3-60 months).The 1-,3-,and 5-year survival rates,local control rate,distant metastasis rate,and disease-free survival rate,blood test,rectum,and bladder were observed.Results The 1-year survival rate,local control rate,distant metastasis rate,and disease-free survival rate did not differ significantly between these 2 groups,however,the 3-and 5-year survival rates,local control rates,distant metastasis rates and disease-free survival rates of the combination group were all significantly better than those of the IMRT group (x2 =3.843,4.336,4.336,4.960,P ＜ 0.05 ; x2 =3.934,4.454,4.000,4.244,P ＜0.05).The incidence rates of radiation proctitis and leukopenia of the combination group were significantly higher than those of the IMRT only group (x2 =4.110,4.320,P ＜ 0.05),whereas the incidence rates of cystitis,anemia,and thrombocytopenia were not significantly different between these 2 groups.No serious grade 3-4 proctitis and cystitis were observed in these 2 groups.Conclusions The IMRT combined with cisplatin chemotherapy shows higher 3-year and 5-year long-term efficacy in the patients with carcinoma of cervix than IMRT only group.
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Objective The aim of this study is to investigate the expression of Survivin in laryngeal car-cinoma and to elucidate the relationship between cell proliferation and the expression of Survivin .Methods The expression and DNA quantification of Survivin in 63 cases of laryngeal carcinoma and 15 cases of normal laryngeal tissues were detected by immunohistochemical staining ( SP) and flow cytometry .Results Forty-five sections of laryngeal carcinoma were positive for survivin as determined by immunohistochemical staining ,but Survivin was undetected in normal laryngeal tissues .The intensity of Survivin expression was significantly increased with tumor differentiation and lymph node metastasis (P0.05).High DNA index(DI)and proliferation index(PI)were detected in laryngeal carcino-ma(P<0.05),and PI was positively correlated with expression of Survivin (P<0.05).Conclusion Survivin overexpression triggers laryngeal carcinoma cell hyperproliferation ,especially in development of laryngeal carcino-ma.These data identify Survivin as an important target in laryngeal carcinoma and provide a translational pathway for developing new therapies against this target .