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Objective:To compare the predictive ability of SpO 2/FiO 2(S/F) and ROX index on the failure of high-flow nasal cannula(HFNC)therapy in children with acute respiratory failure after congenital heart disease surgery, and to identify the best cut-off point. Methods:Through a case-control study, the clinical data of 371 children with acute respiratory failure after congenital heart surgery treated with HFNC admitted to Guangzhou Women and Children′s Medical Center from January 2018 to December 2021 were retrospectively analyzed.The primary outcome was the need for re-intubation within 48 h after extubation of invasive ventilation.The ability of S/F and ROX index to predict HFNC failure was compared, and the optimal cut-off point was determined based on the area under the curve (AUC) of receiver operating characteristic curve.Results:A total of 371 children were included, of whom 27 (7.3%) eventually required mechanical ventilation within 48 h. The S/F prediction accuracy was highest after 6 h of HFNC treatment(AUC=0.712, 95% CI 0.599-0.825, P=0.001), and the best cut-off point for S/F was 178 mmHg(1 mmHg=0.133 kPa)(sensitivity 74.9%, specificity 69.6%). Whereas the prediction accuracy of the ROX index was highest after 12 hours of HFNC treatment, the AUC was 0.737(95% CI 0.623-0.851, P=0.002), and the best cut-off point of the ROX index was 5.865(sensitivity 72.4% specificity 66.7%). The difference in AUC between S/F after 6 h of HFNC treatment and ROX after 12 h was not statistically significant ( P=0.444), with higher sensitivity and specificity, and earlier prediction time(6 hours) in the former. Conclusion:Children with acute respiratory failure after congenital heart surgery have a strong predictive ability of S/F after 6 h of HFNC treatment, and the risk of HFNC treatment failure is higher in children with S/F <178 mmHg.
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BACKGROUND@#Endocrine therapy (ET) and ET-based regimens are the preferred first-line treatment options for hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (HR+/HER2- MBC), while chemotherapy (CT) is commonly used in clinical practice. The aim of this study was to investigate the efficacy and clinical outcome of ET and CT as first-line treatment in Chinese patients with HR+/HER2- MBC.@*METHODS@#Patients diagnosed with HR+/HER2-MBC between January 1st, 1996 and September 30th, 2018 were screened from the Chinese Society of Clinical Oncology Breast Cancer database. The initial and maintenance first-line treatment, progression-free survival (PFS), and overall survival (OS) were analyzed.@*RESULTS@#Among the 1877 included patients, 1215 (64.7%) received CT and 662 (35.3%) received ET as initial first-line treatment. There were no statistically significant differences in PFS and OS between patients receiving ET and CT as initial first-line treatment in the total population (PFS: 12.0 vs. 11.0 months, P = 0.22; OS: 54.0 vs . 49.0 months, P =0.09) and propensity score matched population. For patients without disease progression after at least 3 months of initial therapy, maintenance ET following initial CT (CT-ET cohort, n = 449) and continuous schedule of ET (ET cohort, n = 527) had longer PFS than continuous schedule of CT (CT cohort, n = 406) in the total population (CT-ET cohort vs. CT cohort: 17.0 vs . 8.5 months; P <0.01; ET cohort vs . CT cohort: 14.0 vs . 8.5 months; P <0.01) and propensity score matched population. OS in the three cohorts yielded the same results as PFS.@*CONCLUSIONS@#ET was associated with similar clinical outcome to CT as initial first-line treatment. For patients without disease progression after initial CT, switching to maintenance ET showed superiority in clinical outcome over continuous schedule of CT.
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Humans , Female , Breast Neoplasms/metabolism , Receptor, ErbB-2/metabolism , Progression-Free Survival , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Disease Progression , Treatment OutcomeABSTRACT
Magnetic resonance-guided radiotherapy (MRgRT) not only offers real time magnetic resonance (MR) imags with high-resolution and good soft tissue contrast to guide the delineation of the target volume during simulation and daily radiotherapy, but also reveals the position and shape changes of the target volumes and organs at risk (OAR) during treatment dynamically, which provides the evidence for the individual-adptive planning revision. Thus, MRgRT has the potential to dramatically impact cancer research and treatment. And this treatment mode is theoretically more suitable for the disease with obvious tissue deformation, such as breast. In this review, application of MR scanner with a linear accelerator (MR-linac) in radiotherapy workflows for breast cancer patients was summarized, and its implications and opportunities on breast cancer irradiation were highlighted.
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China is a country with high incidence of esophageal cancer. In recent years, with the deepening research, the value of neoadjuvant therapy in locally advanced resectable esophageal cancer has been widely approved by clinicians, compared with surgery alone or adjuvant therapy. However, the survival results of different neoadjuvant therapy options may be quite different, and many problems remain unresolved. In this article, a systemic literature review was carried out to summarize the radiotherapy target, radiotherapy dose, chemotherapy regimen of neoadjuvant chemoradiotherapy and time to surgery, as well as review the research status and progress on targeted therapy and immunotherapy as neoadjuvant therapy for esophageal cancer.
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【Objective】 To investigate the feasibility of differentiation of human AB plasma hematopoietic stem/progenitor cells (HSCs/HPCs) from peripheral blood into mature erythrocytes. 【Methods】 Hematopoietic stem/progenitor cells were induced to be differentiated into mature erythrocytes in the medium supplemented with 5% FBS, 3% FBS + 2% human AB plasma and 8% human AB plasma, respectively, and inoculated in 24-well culture plate at the density of 1×106/mL. Cell proliferation and morphological changes were observed in three different groups. Flow cytometry was used to detect erythroid terminal differentiation markers, i. e. GPA, Band3 and α4(α4-integrin), and late erythroid cell enucleation in different group. The effects of different culture conditions on HSCs/HPCs differentiation into mature erythrocytes were compared. 【Results】 The cell growth and proliferation multiples of the three groups (8% human AB plasma, 5% FBS and 3% FBS+ 2% human AB plasma) were 2 573±116 vs 2 514±246 vs 2 539±119(P>0.05), respectively. The morphological changes of the three groups were similar. With the extension of culture time, the cells differentiated from proerythroblasts to basophils, polychromatic erythroblasts and positive erythroblasts, and almost all of them differentiated into erythrocytes enucleation on day 21. GPA expression and enucleation rate(%) of the three groups were 97.17±1.91 vs 94.95±1.61 vs 96.15±1.38, and 85.1±3.26 vs 86.93±5.96 vs 86.5±3.36(P>0.05), respectively. 【Conclusion】 The differentiation of HSCs/HPCs from peripheral blood plasma into mature erythrocytes from human AB was similar to that of fetal bovine serum.
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【Objective】 To analyze and master the serological and genetic characteristics of the samples with CisAB subtype and their genetic background. 【Methods】 From January 2018 to January 2022, blood samples with discrepant ABO blood typing results, from Zhengzhou voluntary blood donors and hospital patients, were subjected to phenotypic classification using micro column gel card and tube method, as well as amplification of exons 6 and 7 in ABO gene using PCR. The pedigrees of individuals with the same CisAB subtype but different serological typing results in the same family were analyzed. 【Results】 11 The forward typing of 12 samples was AB type, and unexpected antibodies against weaker antigens were found in 11 serum samples, including 9 cases with strong antigen A, 2 cases with strong antigen B, and 1 case with consistent forward and reverse typing results. Gene sequencing confirmed that 11 cases were CisAB01 subtype and 1 case was CisAB05 subtype.Among them, 7 cases had the genotype of CisAB01/O and serological phenotype of A2B3; 2 cases had the genotype of CisAB01/B and phenotype of A2B; 2 cases had the genotype of CisAB01/A and serological phenotype of A1Bx and A1B3; 1 case had the phenotype of AxB. In the CisAB01 family, 1 case of CisAB01/O with A2B3 phenotype and 1 case of CisAB01/B with A2B phenotype were detected. In the CisAB05 family, 2 CisAB05/O01 and 1 CisAB05/O02 were detected. 【Conclusion】 The serological phenotypes of different individuals in the same CisAB01 family can be different when paired with different ABO alleles. It is advisable to accurately identify the CisAB subtype genes with molecular biological methods to ensure blood transfusion safety.
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Objective:To explore the influencing factors of all-cause death in patients with acute myocardial infarction (AMI) and renal insufficiency(RI), and establish a clinical prediction tool.Methods:Collected 727 patients who were hospitalized in Beijing Anzhen Hospital from January 1st 2014 to April 31th 2019, and diagnosed as AMI with RI. Recorded the patients' baseline characteristics, past medical history, current complications, laboratory and auxiliary examination results, treatment methods (included target vessel reconstruction methods, medications, etc.), and follow-up patients for all-cause deaths. Firstly, multivariate Cox regression analysis was used to construct the model in the training set(485 cases). Secondly, the receiver operating characteristic curve ( ROC), calibration curve and clinical decision curve analysis (DCA) were drawn in the validation set(242 cases) to further verify the effect of the prediction model. Finally, a nomogram was developed based on the verified risk factors. Results:Multivariate Cox regression analysis found that there were nine predictors for the prognosis of all-cause death in patients with AMI & RI, the dangerous factors included women, comorbidities, high direct bilirubin, cardiogenic shock, respiratory failure, co-infection and hemofiltration; the protective factors included PCI and taking aspirin. Model evaluation results showed that the AUC of the validation set was 0.82; the calibration line was close to the ideal calibration line, and the slope≈1, the intercept≈0, and the fitting effect was good. Clinical decision-making when the all-cause mortality rate was 35%, the net benefit of active intervention patients based on the Cox model was 38%. A visual nomogram model was developed based on the prognostic risk factors that have been evaluated and predicted to be good. Conclusion:Women, with a history of comorbidities, direct high bilirubin, combined with cardiogenic shock, combined with respiratory failure, combined infection, hemofiltration, PCI and taking aspirin, these nine factors will affect all causes of AMI & RI. For the probability of death, the model developed in this research has high accuracy.
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Stereotactic body radiotherapy (SBRT/SABR) has become an important option in the treatment of early non-small-cell lung cancer (NSCLC). Radiation pneumonitis (RP) is the main side effect of early NSCLC patients after SBRT/SABR. Patient factors, tumor factors and treatment factors are all associated with the occurrence of RP in early NSCLC patients after SBRT/SABR. In recent years, relevant studies have further clarified the relationship between these factors and RP. In addition, the prediction factors related to RP occurrence are further discussed. In this paper, relevant research progresses in recent years were reviewed.
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Objective:To evaluate the spatial position and functional parameters of 18F-FDG PET-CT and diffusion-weighted imaging (DWI) before and during radiotherapy (RT) based on the medium of 3DCT in patients with esophageal cancer and to explore whether the high-signal area derived from DWI can be used for individualized definition of the volume in need of dose-escalation for esophageal cancer. Methods:Thirty-two patients with esophageal cancer treated with concurrent chemoradiotherapy or neoadjuvant chemoradiation sequentially underwent repeated 3DCT, 18F-FDG PET-CT and enhanced MRI scans before RT and at the 15 th time of RT. All images were fused with the 3DCT images by deformable registration. The gross tumor volume (GTV) was delineated based on PET Edge on the first and second 3DCT, PET-CT and DWI and corresponding T 2-weighted MRI (T 2W-MRI) fused images, and defined as GTV CTpre and GTV CTdur, GTV PETpre, GTV PETdur, GTV DWIpre and GTV DWIdur, respectively. SUV (SUV max, SUV mean, SUV peak), MTV, TLG, ADC (ADC min and ADC mean) values and △SUV (△SUV max, △SUV mean, △SUV peak), △MTV, △TLG, △ADC (△ADC mean and △ADC min) of lesions were measured before and during RT. Results:The differences in SUV (SUV max, SUV mean, SUV peak), MTV, TLG, ADC mean and ADC min of the GTV before and during RT were statistically significant (all P<0.001). The tumor ADC and SUV values before and during RT showed no significant correlation, and there was no correlation between △ADC and △SUV (both P>0.05). The conformity index (CI) of GTV PETpre to GTV DWIpre was significantly higher than that of GTV PETdur to GTV DWIdur ( P<0.001). The shrinkage rate of maximum diameter (△LD DWI)(24%) and the shrinkage rate of tumor volume (VRR DWI)(60%) based on DWI during RT were significantly greater than the corresponding PET-based △LD PET (14%) and VRR PET (41%)( P=0.017 and P<0.001). Conclusions:The location of high residual FDG uptake based on PET-CT yields poor spatial matching compared with the area with residual high signal based on DWI during RT. Tumor ADC and SUV values may play complementary roles as imaging markers for prediction of patterns of failure and for definition of the volume in need of dose-escalation. In addition, the shrinkage rates of tumor maximum diameter/volume based on DWI during RT are significantly faster than those based on PET-CT. Therefore, the feasibility of selecting boosting of the high signal area derived from DWI for individualized definition of the volume for esophageal cancer is not clear.
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Objective:To compare the differences of postoperative clinical target volume of internal mammary lymph node (CTV ImlN) by different delineation methods, and to explore the reasonable method of CTV ImlN delineation after internal mammary lymph node dissection (ImlND). Methods:A total of 20 breast cancer patients who had undergone modified radical mastectomy (MRM) with ImlND on the affected side and had complete preoperative and postoperative CT images were selected. The CTV (CTV pr-I, CTV pr-a) of both sides of ImlN were delineated on preoperative CT images according to RTOG guideline. On postoperative CT images, three different methods including deformation image registration (DIR) method, visual contrast method and precise measurement method, were employed to delineate the postoperative CTV ImlN of the affected side. The targets were named as CTV DIR, CTV V and CTV M, respectively. The central displacement, target volume, degree of inclusion (DI) and conformity index (CI) of CTV pr-a, CTV V, CTV M and CTV DIR were compared. Results:The central displacement of CTV V, CTV M and CTV DIR from CTV pr-a was 2.17 cm, 1.44 cm and 1.25 cm, respectively. The target volume of CTV pr-a, CTV pr-I, CTV V, CTV M and CTV DIR was 2.10 cm 3, 2.17 cm 3, 2.04 cm 3, 1.88 cm 3 and 2.07 cm 3 respectively. There was no significant difference in the target volume (all P>0.05). The CI values of CTV V-CTV pr-a and CTV M-CTV pr-a were both 0.16, and that of CTV DIR-CTV pr-a was 0.43. The CI value of CTV DIR was significantly higher than those of CTV V and CTV M (both P<0.01). The DI values of CTV V-CTV pr-a, CTV M-CTV pr-a and CTV DIR-CTV pr-a were 0.26, 0.24 and 0.58, respectively. The DI value of CTV DIR was significantly higher than those of CTV V and CTV M (both P<0.01). Conclusions:It is difficult to accurately delineate the CTV ImlN for patients after ImlND. However, the spatial position fitness of the target region delineated by DIR method is better than those by visual contrast and precise measurement methods.
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Objective:To develop and validate a nomogram model for predicting radiation-induced pneumonitis in esophageal cancer based on CBCT radiomics characteristics combined with clinical characteristics and lung dosimetric parameters.Methods:Clinical data, dosimetric parameters and CBCT images of 96 patients with thoracic middle esophageal squamous cell carcinoma treated by intensity-modulated radiation therapy (IMRT) from 2017 to 2019 were analyzed retrospectively. The CBCT images of each patient in three different time periods were obtained. All patients were assigned randomly into the primary cohort ( n=67) and validation cohort ( n=29). Double lungs were selected as the region of interest (ROI), and 3D-slicer software was used for image segmentation and feature extraction. The LASSO regression were applied to identify candidate radiomic features and construct the Rad-score. The optimal time period, clinical and dosimetric parameters were selected to construct the nomogram model, and then the area under the receiver operating characteristic curve (AUC) was used to evaluate the prediction effect of the model. Results:The predictive capacity of the model in the first time period was the highest. In the primary cohort, the AUC was 0.700(95% CI: 0.568-0.832), the sensitivity was 61.5%, and the specificity was 75.0%. In the validation cohort, the AUC was 0.765(95% CI: 0.588-0.941), the sensitivity was 84.6% and the specificity was 64.7%, respectively. In the combined nomogram model, the AUC in the primary cohort was 0.836(95% CI: 0.700-0.918), the sensitivity was 96.0% and the specificity was 54.8%. In the validation cohort, the AUC was 0.905(95% CI: 0.799-1.000), the sensitivity was 92.9% and the specificity was 73.3%, respectively. The diagnostic efficiency of combined nomogram model was the best. Conclusions:The nomogram model based on early lung CBCT radiomics has certain predictive efficiency for RP. The model of lung CBCT radiomics in early stage of radiotherapy can predict RP of esophageal cancer. The nomogram model based on Rad-score combined with V 5Gy, MLD and tumor stage yields better predictive accuracy, which can be used as a quantitative prediction model for RP.
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The role of postoperative adjuvant therapy is crucial for breast cancer. Also, there is no doubt that the combination of effective postoperative radiotherapy and adjuvant systemic therapy can not only reduce the local recurrence rate, but also improve the survival rate of patients. Although the timing of postoperative radiotherapy and part of systemic therapy is clear, some part of treatment regimens still remain elusive. In particular, the safety of concurrent therapy of postoperative consolidation chemotherapy and postoperative radiotherapy in patients with neoadjuvant chemotherapy, the safety of concurrent therapy of postoperative dual-targeted therapy and postoperative radiotherapy in HER2-positive patients, and the safety of simultaneous radiotherapy of small molecule inhibitors need to be further clarified. This article reviews the related papers on the sequence selection of postoperative radiotherapy and postoperative adjuvant systemic therapy for breast cancer.
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Objective:To investigate the effectiveness of abdominal compression in tumor motion and the target volume, and analyze the suitable margins of planning target volume (PTV) for patients treated with lung-SBRT based on 4DCT.Methods:Patients diagnosed with peripheral pulmonary tumor were enrolled. The patients were divided into the whole group, upper-middle-lobe group (group A) and the lower-lobe group (group B). Each patient underwent 3DCT, 4DCT with abdominal compression (4DCT com) and 4DCT with free breath (4DCT free) scans. The GTVs were delineated and IGTVs on these images. PTV MIP 5 mm, PTV MIP 4 mm, PTV MIP 3 mm were constructed with a 5, 4, 3 mm margin in left-right (LR), anterior-posterior (AP) directions and cranial-caudal (CC) directions. Results:The median motion vector with compression reduced by 30.92% in whole group, increased by 3.42% in group A and reduced by 18.80% in group B, respectively. And there were no significant differences of TMA LR, TMA AP, TMA CC and motion vector by the Wilcoxon test ( P>0.05). The median sizes of IGTV MIP com , IGTV MIP free and IGTV10 com, IGTV10 free were 4.01, 5.36 cm 3and 6.59, 7.65 cm 3, with statistically significant difference ( Z=-3.45, -3.14, P<0.01). The median ratio of DI of IGTV CBCT com in PTV MIP 5 mm, PTV MIP 4 mm and PTV MIP 3 mm≥95% was 100%, 100% and 83.33%, respectively. Conclusions:The patients′ respiratory pattern changed with abdominal compression and abdominal compression is useful in reducing the size of IGTV MIP and IGTV10, which could reduce the target volume and protect the normal tissue. Adding a 4 mm margin to IGTV MIP com based on 4DCT account for respiration in SBRT is a tendency for precise radiotherapy.
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Subject To compare the irradiation-induced injury and clinical efficacy between SIB-IMRT and LB-IMRT for early-stage breast cancer after breast-conserving surgery.Methods:From November 2002 to February 2012, 353 early breast cancer patients who underwent IMRT after breast-preserving surgery at Shandong Cancer Hospital were selected, of whom 218 patients receiving SIB-IMRT and 135 patients receiving LB-IMRT.The prescription dose of the SIB-IMRT group was the ipsilateral breast (PTV b ) 1.8-1.9 Gy, 27-28 times, and concurrent tumor bed (PTV t) 2.15-2.3 Gy, 27-28 times. In the LB-IMRT group, the prescription dose was PTV b 2.0 Gy, 25 times, followed by PTV t boost 2.0 Gy, 5-8 times. Results:The median follow-up time was 92 months. The excellent, good, fair, and poor cosmetic results in the SIB-IMRT and LB-IMRT groups were 10.1% and 12.6%, 85.8% and 80.7%, 3.7% and 5.2%, 0.5%, and 0.7%, respectively ( P=0.731). The 5-year locoregional recurrence rates (LRRs) in the SIB-IMRT and LB-IMRT groups were 3.21% and 5.93% and the 10-year LRRs were 4.13% and 6.67%, respectively ( P=0.209, 0.280). The 3-, 5-, 8-, and 10-year overall survival rate in the SIB-IMRT and LB-IMRT groups were 97.7% and 97.8%, 96.3% and 95.2%, 94.9% and 92.0%, 93.6% and 90.3%, respectively ( P=0.288). The 3-, 5-, 8-, and 10-year disease-free survival in the SIB-IMRT and LB-IMRT groups were 95.4% and 93.8%, 91.8% and 87.7%, 89.9% and 84.1%, 89.0% and 82.1%, respectively ( P=0.160). Conclusion:There is no significant difference in the cosmetic effect, local control rate, and survival rate between SIB-IMRT and LB-IMRT after breast-preserving surgery in patients with early-stage breast cancer. SIB-IMRT is a safe and feasible treatment.
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Objective:To investigate the application value of 18F-FDG PET-CT combined with MRI in the radiotherapy for esophageal carcinoma by comparing the differences in the gross target volume (GTV), position length delineated on the end expiratory (EE) phase of 4DCT, PET-CT and T 2-weighted MRI (T 2W-MRI). Methods:Twenty-six patients with thoracic esophageal cancer scheduled to receive concurrent chemoradiotherapy sequentially underwent 3DCT, 4DCT, PET-CT and enhanced MRI for thoracic localization. All images were fused with the 3DCT images by deformable registration. GTV CT, GTV 50% GTV PET2.5, GTV MRI and GTV DWI were delineated on 3DCT, the EE phase of 4DCT images, PET-CT with the thresholds of SUV≥2.5, T 2W-MRI and diffusion-weighted images, respectively. Results:GTV PET2.5 was significantly larger than GTV 50% and GTV MRI ( P<0.001 and P=0.008), whereas the volume of GTV MRI was similar to that of GTV 50%( P=0.439). Significant differences were observed between the CI of GTV MRI to GTV 50% and GTV PET2.5 to GTV 50%( P=0.004). The conformity indexes (CIs) of GTV MRI to GTV CT and GTV PET2.5 to GTV CT were statistically significant ( P=0.004 and P=0.039). The CI of GTV MRI to GTV PET2.5 was significantly smaller than that of GTV MRI to GTV 50%, GTV MRI to GTV CT, GTV PET2.5 to GTV 50% and GTV PET2.5 to GTV CT ( P=0.000-0.021). The length of gastroscopy was similar to those of GTV PET2.5 and GTV DWI (both P>0.05), and there was no significant difference in the length between GTV PET2.5 and GTV DWI ( P=0.072). Conclusion:GTV MRI yields significantly different volume and poor spatial matching compared with GTV PET2.5. The application of PET-CT combined with MRI under respiratory gating system in the delineation of GTV should be used with caution in thoracic squamous esophageal cancer. MRI-DWI can replace PET-CT to help determine the upper and lower boundaries of GTV based on CT images.
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Objective:To explore the interobserver variabilities in the delineation of the target volume using simulation three-dimensional computed tomography (3DCT) between the supine and prone positions for external-beam partial breast irradiation (EB-PBI) after breast-conserving surgery (BCS).Methods:Twenty-seven breast cancer patients who were scheduled to receive EB-PBI after BCS from July 2016 to April 2017 were enrolled in this study. All patients underwent axial 3DCT simulation scanning in the supine and prone positions during free breathing. Based on two different simulation 3DCT acquired, the gross target volume (TB) formed by using surgical clips and the clinical target volume (CTV) were delineated by five radiologists using specific guidelines. The following parameters including the target volume, coefficient of variations (COV) and matching degree (MD) were calculated to analyze the interobserver variability. Twenty-seven breast cancer patients who were scheduled to receive EB-PBI after BCS from July 2016 to April 2017 were enrolled in this study.Results:Whether in the supine or prone position, the interobserver variabilities for TB and CTV were statistically significant ( P<0.001, P=0.001, P<0.001, P=0.001). And the intersection of CTV in the prone position was 5.79 cm 3 greater than that in the supine position ( P=0.011). The interobserver variability of COV CTV in the prone positionwas significantly lower than that in the supine position ( P=0.014). And the interobserver variabilities of MDTB TB and MDTB CTV in the prone positionwere statistically greater than those in the supine position, respectively ( P<0.001, P= 0.001). Conclusions:When delineating the target volume of EB-PBI in the prone position, the interobsever variability can be reduced compared with that in the supine position. Hence, it is more reasonable to carry out EB-PBI in the prone position in free breathing.
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Objective:To investigate the effects of clinical characteristics, irradiation techniques and dose-volume parameters on radiation pneumonitis(RP) in thoracic segment esophageal cancer patients, so as to provide reference for the formulation of radiotherapy protocol for thoracic esophageal cancer.Methods:The incidence of RP in 247 patients with thoracic segment esophageal cancer from June 2014 to June 2019 was analyzed retrospectively, then univariate and multivariate analyses were performed on the clinical characteristics, radiation techniques and lung dosimetry parameters of these patients. The area under receiver operating characteristic (ROC) curve was used to verify the diagnostic efficacy of RP≥grade 1, ≥grade 2 and ≥grade 3.Results:There were 118 cases (47.8%)with RP≥grade 1, 54 cases (21.9%)with RP≥grade 2, 17 cases (6.9%)with RP≥grade 3. The result of univariate analysis showed that lung V5- V40 and MLD were both related to the occurrence of RP≥grade 1( Z=-5.802 to -4.306, P<0.05). ≥grade 2, and≥grade 3, respectively( F=0.057 to 11.616、0.087 to 3.392, P<0.05). GTV volume, PTV volume, GTV/lung volume(%) and PTV/lung volume(%) were related to RP≥grade 1( Z=-3.377 to -2.041, P<0.05)and RP≥grade 2( F=3.600 to 9.801, P<0.05). Smoking index >400 was significantly correlated with RP≥grade 3( χ2=13.295, P<0.05), and chronic obstructive pulmonary disease (COPD) was significantly correlated with RP≥grade 1( χ2=9.146, P<0.05). However, there was no significant correlation between RP and different irradiation techniques, chemotherapy factors, radiotherapy dose, esophageal cancer stage and cancer location.The result of multivariate analysis showed that V5 and V40 were independent risk factors of RP≥grade 1(AUC 55.74%、4.13%)、MLD was independent risk factors of RP≥grade 2 (AUC 11.91 Gy), and V5 was independent risk factors of RP≥grade 3(AUC 57.60%). The smoking index>400 was the independent risk factor of RP≥grade 3 ( Wald=5.964, P<0.05), and COPD was the independent risk factor of RP≥1 grade ( Wald=6.110, P<0.05). Conclusions:The incidence of RP is low after radiotherapy for thoracic segment esophageal cancer. The dosimetric parameters such as lung V5, V40, MLD, smoking degree, COPD and other clinical characteristics are closely related to the occurrence of RP of corresponding grades.
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Objective:To compare positional and volumetric differences between the gross target volumes (GTV) delineated on three-dimensional CT (3D-CT) referencing 18F-FDG PET/CT and the GTV on the deformed image derived from 3D-CT and 18F-FDG PET/CT for primary thoracic esophageal cancer (EC). Methods:Seventy-two patients underwent chemoradiotherapy were enrolled. All the patients sequentially underwent 18F-FDG PET/CT scans for diagnosis and 3D-CT scans for simulation. The GTV 3D was delineated on 3D-CT without referencing 18F-FDG PET/CT. The GTV PET-ref was delineated on 3D-CT referencing 18F-FDG PET/CT. The GTV PET-regwas delineated on the deformed image derived from 3D-CT and 18F-FDG PET/CT by MIM deformable registration software. The differences in position, volume, length, conformity index (CI), and degree of inclusion (DI) of target volumes were compared, respectively. Results:The median volume of GTV 3D, GTV PET-ref, GTV PET-reg were 44.90, 40.36 and 41.15 cm 3, respectively. There was no statistical difference between the volumes of any two targets. The mean lengths of GTV 3D, GTV PET-ref, GTV PET-reg were 8.54, 9.29 and 8.38 cm, respectively. The length of GTV PET-ref was longer than that of GTV 3D ( t=2.134, P<0.05). The median DIs of GTV PET-ref, GTV PET-regin GTV 3D were 0.86, 0.82( Z=-2.741, P<0.05), and that of GTV 3D in GTV PET-ref, GTV PET-reg were 0.87, 0.84 ( Z=-1.429, P<0.05). The median CIs of GTV 3D in GTV PET-ref and GTV PET-reg were 0.72, 0.68 ( Z=2.756, P<0.05), and the difference was significant. The CIs of GTV 3D and GTV PET-ref, GTV 3D and GTV PET-reg, GTV PET-ref and GTV PET-reg had significant negative correlation with the distance of target centers. Conclusions:There was no significant difference between GTV contoured on three-dimensional CT (3D-CT) referencing 18F-FDG PET/CT and the GTV on the deformed image derived from 3D-CT and 18F-FDG PET/CT either in volume size or in spatial position. Therefore, it is recommended that radiation oncologists can refer to the recent diagnostic PET/CT when delineating the gross target volume for primary thoracic esophageal cancer.
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Objective@#To understand the possible transmission route of a family cluster of COVID-19 in Zhengzhou and the potential infectivity of COVID-19 in incubation period, and provide scientific evidence for the timely control of infectious source and curb the spread of the epidemic.@*Methods@#Epidemiological investigation was conducted for a family cluster of COVID-19 (8 cases) with descriptive epidemiological method, and respiratory tract samples of the cases were collected for the nucleic acid detection of 2019-nCoV by RT-PCR.@*Results@#Two primary cases, which occurred on 31 January and 1 February, 2020, respectively, had a common exposure history in Wuhan. The other six family members had onsets on 30 January, 31 January, 1 February (three cases) and 3 February, 2020.@*Conclusions@#In this family cluster of COVID-19, six family members were infected through common family exposure to the 2 primary cases. Five secondary cases had onsets earlier than or on the same day as the primary cases, indicating that COVID-19 is contagious in incubation period, and the home isolation in the early phase of the epidemic might lead to the risk of family cluster of COVID-19.
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In the past two decades, with the introduction of NCCN guidelines, the establishment of a standardized diagnosis and treatment system for breast cancer had begun. The Chinese version of the NCCN guidelines, which combines international standards and Chinese characteristics, was then developed to guide clinical practice. Since 2011, Chinese experts have entered St. Gallen International Expert Consensus Group, and to introduce the latest therapy concepts. On this basis, the Chinese Society of Clinical Oncology has developed guidelines for diagnosis and treatment in line with product accessibility and expert opinions to help clinicians choose the best treatment option. The latest Chinese Society of Clinical Oncology Breast Cancer Guideline will further contribute to the establishment of a standardized diagnosis and treatment system for breast cancer.