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Objective:To investigate the value of radiotherapy in patients with stage Ⅳ B thoracic esophageal squamous cell carcinoma (ESCC) at initial diagnosis. Methods:A total of 199 patients with stage Ⅳ B thoracic ESCC at initial diagnosis (according to UICC/AJCC Eighth Edition Esophageal and Esophagogastric Junction Cancer TNM Staging) who were treated in the Fourth Hospital of Hebei Medical University between January 2010 to December 2016 were recruited. Winthin the whole group, 130 patients (65.3%) had distant lymph node metastases alone, 51 cases (25.6%) of solid organ metastases alone and 18 cases (9.0%) of solid organ complicated with distant lymph node metastases. Among them, 16 patients (8.0%) were treated with chemotherapy alone, 50 cases (25.1%) of radiotherapy alone, 133 cases (66.8%) of radiochemotherapy (81 patients treated with concurrent radiochemotherapy and 52 patients treated with sequential radiochemotherapy). The survival rate was calculated by Kaplan-Meier method and the difference was analyzed by log-rank test. Clinical prognosis was assessed by multivariate Cox regression model. Results:The median overall survival (OS) of the entire cohort was 12.3 months (95% CI: 10.6-15.4m), and the 1-, 2-, 3-and 5-year OS rates were 52.1%, 25.2%, 19.1%, and 11.5%, respectively. Multivariate analysis showed that tumor length, the number of metastatic organs, and treatment modalities were the independent prognostic factors for OS. There was no significant difference in OS between concurrent radiochemotherapy and sequential radiochemotherapy ( P=0.955). The OS of patients in the radiotherapy dose of ≥6000 cGy group was significantly longer than that of their counterparts in the 4500-5039 cGy and 5040-6000 cGy groups (both P<0.001). Conclusions:For stage Ⅳ B thoracic ESCC patients at initial diagnosis, tumor length ≤3cm, single organ metastasis, and radiochemotherapy strategy are significantly correlated with longer OS. For stage Ⅳ ESCC patients with good physical status, radiotherapy can be supplemented on the basis of systemic chemotherapy. Concurrent or sequential radiochemotherapy needs to be individualized. If patients are tolerable, radiochemotherapy is recommended to the primary tumor or non-regional metastatic lymph nodes, aiming to prolong the OS of patients.
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Objective@#To observe the variation trend of the peripheral blood lymphocyte-to-monocyte ratio (LMR) during radiotherapy in patients with esophageal cancer and analyze the relationship between LMR and the radiation-induced injury, aiming to provide parameters for accurate evaluation of radiotherapy responses and clinical efficacy.@*Methods@#Clinical data of 248 eligible patients undergoing definitive radiotherapy in our department from January 2013 to December 2015, 248 were retrospectively analyzed. The routine peripheral blood examination was performed weekly before, during and at the end of radiotherapy. The absolute number of lymphocyte and monocyte was recorded to calculate the LMR. The standard classification of LMR value was conducted based on the median value of each parameter. All data including the lesion length, lesion location, clinical stage and LMR were analyzed using the Kaplan-Meier, cox and logistic regression methods, respectively.@*Results@#LMR displayed an exponential decline during radiotherapy. Univariate analysis showed that the average LMR value was the influential factor of overall survival (P=0.011) and progression-free survival (P=0.017). The mean LMR value almost exerted significant effect upon local control rate (P=0.053). No significant correlation was observed between the mean LMR value and radioactive esophagitis and pneumonitis. Stratified analysis based on the results of multivariate analysis demonstrated that patients with higher average LMR value still had longer survival. Logistic regression model revealed that the length of esophageal lesion and irradiation pattern were the influential factors of the mean LMR value.@*Conclusions@#LMR value displays an exponential decline during radiotherapy. The greater amplitude prompts the worse prognosis. The wider the irradiation field and the greater decrease in LMR exert more obvious impact on the prognosis.
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Objective To observe the variation trend of the peripheral blood lymphocyte-tomonocyte ratio (LMR) during radiotherapy in patients with esophageal cancer and analyze the relationship between LMR and the radiation-induced injury,aiming to provide parameters for accurate evaluation of radiotherapy responses and clinical efficacy.Methods Clinical data of 248 eligible patients undergoing definitive radiotherapy in our department from January 2013 to December 2015,248 were retrospectively analyzed.The routine peripheral blood examination was performed weekly before,during and at the end of radiotherapy.The absolute number of lymphocyte and monocyte was recorded to calculate the LMR.The standard classification of LMR value was conducted based on the median value of each parameter.All data including the lesion length,lesion location,clinical stage and LMR were analyzed using the Kaplan-Meier,cox and logistic regression methods,respectively.Results LMR displayed an exponential decline during radiotherapy.Univariate analysis showed that the average LMR value was the influential factor of overall survival (P=0.011) and progression-free survival (P=0.017).The mean LMR value almost exerted significant effect upon local control rate (P=0.053).No significant correlation was observed between the mean LMR value and radioactive esophagitis and pneumonitis.Stratified analysis based on the results of multivariate analysis demonstrated that patients with higher average LMR value still had longer survival.Logistic regression model revealed that the length of esophageal lesion and irradiation pattern were the influential factors of the mean LMR value.Conclusions LMR value displays an exponential decline during radiotherapy.The greater amplitude prompts the worse prognosis.The wider the irradiation field and the greater decrease in LMR exert more obvious impact on the prognosis.
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Objective To investigate the recent curative effect and adverse reactions of radiotherapy combined with temozolomide in non-small cell lung cancer (NSCLC) patients with brain metastases.MethodsThe clinical date of 51 NSCLC patients with brain metastases were retrospective analyzed in Department of Radiation Oncology of Affiliated Hospital of Hebei University.Patients were divided into experimental group (n=26) and control group (n=25) according to the different treatment methods.The experimental group underwent whole brain and local tumor radiotherapy plus temozolomide.The control group only received whole brain and local tumor radiotherapy.The recent curative effect and adverse reactions of the two groups were analyzed.Results The Karnofsky performance status score of patients in the experimental group was obviously improved than that in the control group (76.2±6.4 vs.72.8±5.3), with a significant difference (t=2.06, P=0.04).The total effective rate in the experimental group was higher than that in the control group (80.8% vs.64.0%), but there was no statistically significant difference (χ2=1.80, P=0.18).Compared with the control group, the incidences of nausea and vomiting (80.8% vs.28.0%) and bone marrow suppression (84.6% vs.24.0%) in the experimental group were significantly higher, with significant differences (χ2=14.33, P=0.00;χ2=18.91, P=0.00).There were similar incidences of headache (69.2% vs.60.1%), liver and kidney damage (73.1% vs.64.0%) in the two groups, with no significant differences (χ2=0.47, P=0.49;χ2=0.47, P=0.49).Conclusion Radiotherapy combined with temozolomide can improve the quality of life in NSCLC patients with brain metastases, which has controllable and tolerable adverse reactions.
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Objective To evaluate the correlation of epicardial adipose tissue volume (EATV)with coronary plaques in patients with a coronary artery calcium score of zero.Methods 183 patients with a coronary artery calcium score of zero were selected.They were divided into plaque group and control group according to the findings of CT coronary angiography.Independent t test was used to analyze the difference of EATV between two groups.Results ①EATV was significant higher in plaque group than that in control group (P 0.05), while it was significant higher in plaque group than that in control group for male individuals (P <0.05).③EATV was significant higher in plaque group than that in control group for the individuals with age< 50 years (P <0.05 ),meanwhile it was significant higher in plaque group than that in control group in age≥50 years(P <0.05).Conclusion EATV is correlated with coronary plaques in male patients with a coronary artery calcium score of zero while there is no correlation with female patients.EATV is correlated with coronary plaques in different age patients with a coronary artery calcium score of zero.
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Objective To explore the effect of temozolomide on apoptosis and molecular mechanism in small cell lung cancer (SCLC) cell H446. Methods The effect of temozolomide on the viability of H446 cell was measured by MTT assay.The effect of temozolomide on cell cycle was detected by flow cytometry.The activation of phosphatidyl inositol 3-kinase (PI3K)/AKT signaling pathway and expression level of downstream target genes (Cyclin B1), cell division cycle 2 (Cdc2), Bax, Bcl-2 and Survivin were detected by western blot.Results Temozolomide (50, 100, 200 μmol/L) could inhibit H446 cell viability, and the inhibitory rate was highest at 48 h.Moreover, temozolomide made H446 cell cycle arrested in G2 phase.Western blott showed the expression of PI3K, Cyclin B1, Cdc2, Bcl-2, Survivin and the phosphorylation of AKT were reduced, but the expression of Bax were increased by temozolomide.Conclusion Temozolomide could induce SCLC cell H446 apoptosis via blocking PI3K/AKT signal pathway.
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Objective To explore the effects of silencing H2AX gene on esophageal cancer ECA109 cell xenograft growth and sensitivity to radiotherapy in nude mice.Methods BALB/c nude mice models were established by subcutaneously inoculating differently treated ECA109 cells into nude mice.By random number table method 60 nude mice were divided into six groups,including blank group,irradiation group,negative group,negative with irradiation group,silence group and silence with irradiation group.The nude mice were irradiated with 15 Gy of 6 MV X-rays 21 d after inoculation.After irradiation 48 h,half of each mice group was terminated.The tumor specimens were processed by Western blot,RT-PCR and flow cytometry were used to detect the change in protein levels,RNA levels,and cell cycle.Results The tumor volume was (42.76 ±4.40) mm3 in silence group,significantly smaller than that of the blank group (73.18±8.80) mm3 and the negative group(71.27 ±8.40) mm3(F=67.8,P＜0.01).H2AX protein expression level in the silence group was also significantly lower (0.12 ±0.03 vs.1.12 ±0.11,1.16 ± 0.08,F =34.27,P ＜ 0.01).Relative H2AX mRNA expression level in the silence group was (0.85 ± 0.31),significantly lower than that of the blank group (1.86 ± 0.26) and the negative group (1.82 ±0.24,F =39.45,P ＜ 0.01).Co-immunoprecipitation assay showed that γ-H2AX and MDC1,53BP1 obvious interaction after irradiation,which would be weakened through silencing H2AX.The tumor volumes at different groups had significant difference after irradiation (F =13.56,P ＜ 0.01).The apoptosis rate in the silence group was significantly higher than that of the blank group and the negative group [(24.15±2.25) ％ vs.(13.26±1.54) ％,(12.78±1.47) ％ (F=54.33,P＜0.01)].G2/M phase arrested in the silence with irradiation group lower than that of the radiation group (F =10.21,P ＜ 0.01).Conclusions Silencing H2AX gene expression could inhibit the growth of esophageal cancer ECA109 cell xenograft and increase the radiosensitivity of tumor.
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Objective To discover the role of MCPH1 in DNA double-strand damage induced by ionizing radiation and its relationship with H2AX in esophageal cancer cell ECA109. Methods ECA109 cancer cells accepted 8 Gy 1 h after irradiation were collected for protein extraction and immunofluorescence then MCPH1 and H2AX protein expression and nuclear foci changes were observed. A stable low expression of H2AX cell lines was established and MCPH1 and H2AX protein expression and nuclear foci changes induced by ionizing radiation after silence H2AX were detected. Results (1)A stable low expression of H2AX cell lines in ECA109 cells was successfully constructed. (2)Ionizing radiation could cause the increase of r-H2AX and MCPH1 protein expression, as the same as nuclear focus increase of r-H2AX and MCPH1. (3)The protein level and nucleus focus of r-H2AX and MCPH1 were significantly reduced in ECA109 after silence H2AX. Conclusion MCPH1 is the part of DNA damage response triggered by ionizing radiation and is located in damage response downstream and can be regulated by H2AX.
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Objective To explore the expression of interleukin-17A(IL-17A) in the myocardium of mice with experimental viral myocarditis (VM) and its clinical significance.Methods Fifty-five mice were randomly divided into myocarditis group(n =45) and control group(n =10).Mice in the myocarditis group were inoculated intraperitoneally with 0.1 mL Eagle's solution containing coxsackievirus B3 (CVB3) to establish VM models.However,mice in the control mice were treated with 0.1 mL Eagle's solution.Ten infected mice were sacrificed on day 7,14 and 28 after inoculation,and the control mice were killed on day 28 postinoculation.Myocardial histopathology was determined with hematoxylin and eosin stain.The levels of myocardial IL-17A mRNA and protein expressions were detected by real time quantitative polymerase chain reaction(RQ-PCR) and immunohistochemistry.Serum IL-17A concentration was examined using enzyme linked immunosorbent assay(ELISA).In addition,the relationship between myocardial IL-17A protein levels as well as serum IL-17A concentration and myocardial histopathological scores were analyzed statistically in myocarditis group.Results The levels of myocardial IL-17A mRNA and protein and serum IL-17A concentration on day 7 and 14 after inoculation in myocarditis group increased significantly compared with those in control group(all P ＜ 0.01).Myocardial IL-17A protein levels and serum IL-17A concentration showed significantly positive correlation with the myocardial histopathologic scores in VM group,respectively (r =0.67,0.74,all P ＜ 0.05).Conclusions IL-17A may play a pivotal role in the pathogenesis of VM and is associated with the severity of VM.It can serve as a novel indicator for VM.
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Objective This paper studies on feasibility of low dose CT scanning in lung cancer patients simulated localisation.Methods 62 patients cases of lung cancer are selected.Scan parameter:scan twice by 20/100 mA,the other parameter remain unchanged as voltage of 120 kV,thickness of 5 mm,pitch of 1:1 and scan time of 1 s.After scan,picture quality was evaluated according to excellent,good,bad under different condition.Volume of target was determined by treatment planning system.Data such as dose index value of single helical scan,z-axis scan range,dose length product value and etc.are recorded in order to evaluate radiation dose of patients.Picture quality and the difference of radiation dose were statistically analyzed using Fisher's and pair t-test.Results Picture quality of low dose scanning was a little bit lower than that of normal dose,however,picture quality difference of difference dose scanning was statistically meaningless (number of patients according to excellent,good,bad were 46,13,3 and 50,11,1,P =0.541).There is no obvious difference of target volume under different dose scanning in the same (36.78 cm3,40.35 cm3,t =2.57,P =0.189).Radiation dose of low dose scanning group is far less than that of high dose scanning group and the difference is obvious (133.05 mGy,941.25 mGy,t =-41.24,P =0.000).Conclusions Low dose scanning of 20 mA current during CT simulated localisation tremendously reduces harm that may happen to patients during CT scan,while tumor target delineation and scanned picture quality is guaranteed.