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Ionizing radiation can induce the death of lymphatic endothelial cells, leading to structural damage, dysfunction, and reduction of lymphatic vessels, which poses a negative impact on radiotherapy. However, it can also induce tumor cells and tumor-infiltrated immune cells to secrete various cytokines and promote tumor-associated lymphangiogenesis, which favors anti-tumor therapy and improve anti-tumor immunity. Studying the changes in lymphatic vessels after ionizing radiation may be a way to explore the synergistic anti-tumor effects of radiotherapy and immunotherapy. This review summarized the morphological changes in lymphatics after ionizing radiation, the molecular mechanisms for the effects of ionizing radiation on lymphatic vessels, and the clinical value of lymphatic changes after ionizing radiation, aiming to provide ideas for the study of the effects of ionizing radiation on lymphatic vessels.
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In recent years, heavy ion beams have received great attention in the field of malignant tumor radiotherapy due to their radiation physics and biological characteristics. The high rate of local tumor control is one of its advantages, but the control rate of metastatic lesions is still crucial in the treatment of most malignant tumors. Clinical studies on the combined conventional radiotherapy and immunotherapy suggest that the combination of the two can not only control the primary lesions, but may also reduce or completely eliminate distant metastatic lesions. High linear energy transfer radiation, especially heavy ion beams, may have stronger potential in combined immunotherapy. Therefore, this article focuses on the basic research progress of heavy ion beams regulating anti-tumor immune effects and their combined application with immunotherapy.
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Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood.Radiation therapy has been integrated into the primary treatment of most patients with rhabdomyosarcoma, but which in turn potentially induces severe acute and late toxicities.Proton therapy in recent years has been more and more used in the treatment of rhabdomyosarcoma, which is safe and effective, with no serious adverse events.Compared with conventional photon therapy, proton therapy has distinct physical advantages and enables greater precision in the delivery of tumoricidal radiation doses with reduced irradiation of normal tissues, and improves quality of life for patients.Additional follow-up and prospectively studies are needed to determine whether proton therapy truly reduces the incidence and severity of late effects in comparison to patients treated with modern photon techniques.
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Objective To assess the efficacy and safety of the carbon ion radiotherapy for stage Ⅰ non-small cell lung cancer (NSCLC).Methods We searched multiple electronic bibliographic databases,including the Cochrane library,PubMed,EMBASE,China Journal Full-text Database,Chinese Biomedical Database,and the Wanfang Database to assemble the available studies of carbon ion radiotherapy for stage Ⅰ non-small cell lung cancer.MetaAnalyst Beta 3.13 and STATA 12.0 software were used to combine the extracted data.Results Ten studies (seven trials) were included.The overall survival rates of 1,3 and 5 years were 95.1％,68.5％ and 45.9％,respectively.The local control rates of 1,3 and 5 years were 90.2％,76.7％ and 81.2％,respectively.The cause specific survival rate of 1,3 and 5 years were 82.9％,58.5％ and 57.3％,respectively.The rate of primary recurrence and total recurrence were 45.8％ and 11％,respectively.The rates of total death and death from lung cancer were 52.4％ and 28.3％,respectively.There were differences observed between T1 stage and T2 stage in regards to five year overall survival rate,total recurrence,lung cancer death,and grade 1 and grade 2 skin toxicities.Conclusions Available data demonstrate that carbon ion radiotherapy,in general,is a safe and feasible treatment modality for stage Ⅰ NSCLC.Although current results are promising,more evidence is required before carbon ion radiotherapy can become the international standard treatment for lung cancer patients.
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Objective To evaluate the efficacy of the carbon ion radiotherapy for prostate cancer by Meta-analysis.Methods We searched the Cochrane library,PubMed,EMBASE,China Journal Fulltext Database,Chinese Biomedical Database,and Wanfang Database from their inception to December 2015,in order to collect clinical trial data of carbon ion radiotherapy for prostate cancer.References included within these studies were also retrieved.Meta-analysis was performed using MetaAnalyst Beta 3.13 and STATA 12.0 software.Results Six studies (eight clinical trials) were included.The results of Meta-analysis show that,the overall survival rates of 3,4,5 and 8 years were 95.7％,90.9％,91.8％ and 83.9％,respectively.The cause specific survival rate of 4 and 5 years were 97.1％ and 97.6％.The bNED rate of 3,4,5 and 8 years were 88％,86.3％ and 79.1％,respectively.The local control rates of 3,4 and 5 years were 98.1％,97.1％ and 98.4％,respectively.The rate of total death,prostate cancer death and intercurrent death were 7％,2.4％ and 7％,respectively.Different T-stage may affect the fiveyear of overall survival rate,bNED rate and cause specific survival rate.Conclusions The current evidence shows that carbon ion radiotherapy in gcncral is a fcasiblc trcatmcnt for prostate cancer,whether carbon ion is better than other radiotherapy,prospective,randomized,controlled clinical trial to get more evidence is required for carbon ion radiotherapy versus standard treatment for prostate cancer patients.
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Internal mammary nodes are part of the first stop of mammary gland lymphatic drainage.It plays an important role in the process of occurrence and development of breast cancer.Whether irradiation internal mammary nodes or not is still a larger controversy.At present,for the early stage patients,the efficacy of internal mammary lymph node irradiation is not clear.For the patients with positive axillary lymph nodes,inboard or central quadrant lesions,postoperative radiotherapy of internal mammary nodes has a certain value.
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Objective To assess the efficacy and safety of intensity-modulated radiation therapy (IMRT) for nasopharyngeal neoplasm.Methods PubMed,EMBASE,Cochrane Library,CBM,CNKI,VIP and WanFang Data were fully searched up from creating database to June 15,2012.Randomized controlled trials (RCTs) of IMRT versus conventional radiotherapy (CRT) for nasopharyngeal neoplasm were included.The quality of included studies was evaluated by two individual researchers and data were analyzed by using RevMan 5.1 software.Results Fifteen RCTs were included.Meta-analyses suggested that patients treated by IMRT had a higher fractional stimulated parotid salivary flow rate and a higher stimulated whole salivary flow rate than CRT.IMRT can significantly reduce the acute xerostomia (RR =0.46,P ＜ 0.000 1),reaction of mucosa(RR =0.g6,P =0.04),reaction of skin (RR =0.33,P ＜ O.000 1),long-dated xerostomia (RR ＝0.28,P =0.01) and limitation of mouth opening (RR =0.42,P =0.008).And IMRT trended to improve short-term efficacy (RR =1.22,P =0.02) and long-term survival (RR =1.25,P =0.04).Moreover,IMRT trended to shorten the treatment time while increasing the costs.Conclusion Compared with CRT,IMRT trends to be superior for nasopharyngeal neoplasm.However,because of small sample size,the results need to be proved by more clinical trials.
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ObjectiveTo evaluate the clinical efficacy and safety of gefitinib versus docetaxel in previously treated non-small cell lung cancer.Methods Literatures were searched on database like PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature Database,China Journal Full Text Database,and Chinese Scientific Journals Full Text Database and Wanfang Database.All the relevant randomized controlled trials that gefitinib versus docetaxel in non-small cell lung cancer patients who have previously received chemotherapy were collected,and the quality of the included trials was assessed by Cochrane Systematic Review Handbook 5.0.2. Meta-analyses were conducted by RevMan 5.0 software. Results Four studies were involved and 2 257 patients were included.Meta-analysis showed that gefitinib can improve objective response rate and quality of life in local advanced non-small cell lung cancer patients who have previously received chemotherapy compared with docetaxel ( P ＜ 0.05) ； and it's low in the 3-4 level adverse reaction rate (P ＜ 0.05 ).But there was no significant difference in overall survival rate,symptoms improving rate and progression-free survival rate (P ＞ 0.05).ConclusionsGefitinib is superior to docetaxel in the objective response rate with local advanced or metastatic non-small cell lung cancer patients who have previously received chemotherapy.The quality of life of the patients is improved significantly.Because of it has high drug tolerance and high safety,gefitinib can be actively promoted application as a kind of current effective second-line drugs at present,but the survival aspect needs to be studied further.
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With a view to patterns of local recurrence after breast conserving surgery, whole breast irradiation(WBI) after surgery is controversial and partial-breast irradiation(PBI) came up. Many clinical trials related with accelerated partial-breast irradiation using a variety of radiotherapeutic techniques such as interstitial brachytherapy (IBT), MammoSite Radiation Therapy System, intraoperative radiotherapy(IORT), threedimensional conformal radiotherapy(3-DCRT)and intensity modulated radiation therapy(IMRT) in selected patients have been carried out. Accelerated partial-breast irradiation that provides faster, more convenient treat-ment demonstrates local control rate and safety comparable to that of whole breast irradiation. Partial breast irradiation may be an alternative way to whole breast radiotherapy and will be one of the standard treatments in women with early breast cancer seeking breast conservation.
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Objective To evaluate the toxicity and efficacy of carbon ion radiotherapy for cutaneous malignant melanoma. Methods Form December 2006 to May 2009, 13 patients with superficial malignant melanoma were treated with carbon ion radiotherapy in the Institute of Modern Physics, Chinese Academy of Sciences. The total dose was 60 -66 GyE in 6 -12 fractions within 6 -12 days. The disease was Stage Ⅱ_a in 2, Ⅱ_b in 3, Ⅱ_c in 5, and Ⅲ_c in 3 patients. The toxicities were assessed according to the Radiation Therapy Oncology Group (RTOG) criteria, and the efficacy was evaluated with WHO criteria. Results The median follow-up time was 13.5 months (range, 1 -25 months) and the follow-up rate was 100%. Of the 13 patients, 10(77%) achieved complete remission (CR), and 3(23%) partial remission (PR). The overall response rate (RR) was 100%, and the median survival time was 21.3 months (95% CI, 18. 1 -24.5 months). The grade 0, 1,2 and 3 skin reaction occurred in 3, 6, 2 and 2 patients, respectively. The hematologic toxicities were mild. Conclusions Carbon ion radiotherapy is a safe and effective treatment for cutaneous malignant melanoma.