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Brain metastases are common in oncologic patients. Stereotactic radiosurgery (SRS) is an effective treatment for oligo brain metastases. However, SRS is not suitable for large metastatic lesions. Fractionated stereotactic radiation therapy (FSRT) is a new option for the treatment of brain metastases. It can deliver high doses of radiation to tumor while protecting the normal tissues and organs outside the irradiation field as much as possible and maintaining good local control rate of tumors. This article reviews the dose-response relationship and adverse reactions of FSRT with different fractionated dose schemes, and the progress of FSRT combined with targeted therapy and immunotherapy.
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Objective To discuss the therapeutic effect of chemoradiotherapy on 74 patients with early stage nasal NK/T cell lymphoma and their prognostic factors. Methods 74 patients with early nasal NK/T cell lymphoma that were treated in Shanxi Cancer Hospital from January 2005 to November 2013 were analyzed retrospectively. Among them, 28 patients received radiotherapy alone, 10 patients received concurrent chemoradiotherapy and 36 patients received alone. In 36 patients with chemotherapy, 25 cases were treated with CHOP (cyclophosphamide+doxorubicin+vincristine+prednisone), 4 cases were treated with DICE (dexamethasone + etoposide + cisplatin + isofosfamide) and 7 cases were treated with L-asparaginase +dexamethasone+ifosfamide+methotrexate + etoposide. According to Ann Arbor classification, 60 patients were stage Ⅰ and 14 patients were stage Ⅱ. Kaplan-Meier test was used for survival analysis, log-rank method was used for single factor analysis, and Cox proportional hazard model was used for multi factor analysis. Results All patients completed the treatment. 24 patients were died. 3-year overall survival (OS) rate was 72.5 %. The OS rate in simple radiotherapy group was 92.7 %, simple chemotherapy group was 62.3%, and the concurrent chemoradiotherapy group was 79.1%. The OS rates in simple radiotherapy and simple chemotherapy groups had statistical difference (χ2 = 10.676, P 0.05). In radiotherapy alone group, the rates of complete remission (CR), partial remission (PR), stable rate and progress rate of disease were 89.3%(25/28), 7.1%(2/28), 3.6%(1/28), and 0;in chemotherapy alone group, they were 55.6 % (20/36), 25.0 % (9/36), 8.0 % (3/36), and 11.1 % (4/36); in concurrent chemoradiotherapy group, they were 80.0 % (8/ 10), 10.0 % (1/10), 0, and 10.0 % (1/10), respectively. There was significant difference between radiotherapy group and chemotherapy group (χ2 = 8.584, P0.05). Single factor analysis showed that age, ECOG score, B symptoms, Ann Arbor stage, IPI and treatment options were related to the prognosis. Multivariate analysis showed that age, ECOG score and Ann Arbor stage were independent prognostic factors. Conclusions As the main treatment method of early stage nasal NK/T cell lymphoma, radiotherapy can obtain good short-term curative effect and long-term curative effect. Age, ECOG score, B symptoms, Ann Arbor stage, IPI and treatment options are related to survival prognosis. Age, ECOG score and Ann Arbor stage are the independent prognostic factors.
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Objective To investigate the effect of pretreatment serum hemoglobin (Hb) level on the prognosis of early-stage extranodal nasal-type NK/T-cell lymphoma.Methods A retrospective analysis was performed on the clinical data of 175 patients with stage Ⅰ or Ⅱ extranodal nasal-type NK/T-cell lymphoma who were admitted to The Tumor Hospital Affiliated to Shanxi Medical University from 2000 to 2015.The inclusion criteria included Ann Arbor Ⅰ/Ⅱ stage, the primary tumor located in the upper aerodigestive tract, without other malignant diseases, and complete clinical information and follow-up data.Of the 175 patients, 67 received chemotherapy alone, 8 received radiotherapy alone,100 received radiotherapy and chemotherapyed.The survival rate was calculated using the Kaplan-Meier method.The log-rank test was used for univariate prognostic analysis.The Cox regression model was used for multivariate prognostic analysis.Results The univariate analysis showed that pretreatment serum Hb level (≥120 g/L), lactate dehydrogenase (LDH) level (normal), Eastern Cooperative Oncology Group (ECOG) score (0-1), Ann Arbor stage (IE), and radiotherapy were associated with significantly improved progression-free survival (PFS) and overall survival (OS)(P=0.000-0.046).The multivariate analysis showed that pretreatment serum Hb level, LDH level, ECOG score, and Ann Arbor stage were independent prognostic factors for PFS and OS (P=0.000-0.040).Conclusion Patients with a high pretreatment serum Hb level (≥120 g/L) have a better prognosis than those with a low pretreatment serum Hb level (<120 g/L).
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Objective:To study the radiation-sensitizing effects of nimotuzumab and X-ray radiotherapy on human esophageal carcino-ma KYSE450 cells. Methods:Human esophageal carcinoma cells KYSE450 were treated with nimotuzumab, irradiation, and the combi-nation of both. Cell growth inhibition was evaluated by MTT assay, and cell cycle distribution and apoptosis were analyzed by flow cy-tometry assay. Cell radiosensitivity was tested by clonogenic assay, and the survival curve was fitted using multi-target single-hit mod-el. The combination and accelerated radiation groups were tested by microarray technology, and the differentially expressed genes were screened among the two groups. Results:The growth of KYSE450 cells was inhibited in three groups, namely, the group treated with nimotuzumab, the group treated with irradiation, and the group treated with both. The group treated with both nimotuzumab and irradiation resulted in the highest inhibition rate (35.25%±5.62%) compared with that of the nimotuzumab (16.12%±8.73%) and ir-radiation groups (27.64%± 6.66%) (F=10.953, P<0.001). The highest rates of G2 phase arrest and cell apoptosis were observed in the group treated with the combination of nimotuzumab (29.37%±7.29%) (F=17.299, P<0.001) and irradiation (18.80%±2.03%) (F=85.691, P<0.001). Multi-target single-hit model showed that the values of SF2, Do, and Dq in the group with both treatments were smaller than those of the irradiation group with sensitization enhancement ratio of 1.63, which confirmed the radiosensitization effect of ni-motuzumab on KYSE450 cells. Microarray technology analysis found that nimotuzumab can enhance the radiosensitivity of esophageal squamous cell carcinoma by cutting the genes of EGF/PDGF signaling pathways. Conclusion:This experiment shows that nimotuzumab can effectively inhibit the growth of human esophageal cancer cell KYSE450. Nimotuzumab can also promote apoptosis and G2 phase arrest when combined with X-ray radiotherapy, thereby enhancing the radiosensitivity of KYSE450 cells. This effect is associated with cutting the genes of EGFR signaling pathways.
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Objective To investigate the effect and clinical significance of neoadjuvant radiotherapy for the expression of CD44v6 in lung squamous cell carcinoma tissues. Methods Fifty cases lung squamous cell carcinoma patients confirmed by aspiration biopsy from May 2013 to January 2015 were collected in Yangquan Coal Mine Group Genernal Hospital,including 20 cases of patients with stageⅢA were treated with neoadjuvant radiotherapy before surgery,and then performed surgery after neoadjuvant therapy. The expression of CD44v6 was detected by immunohistochemistry. The correlation between CD44v6 and clinicopathological features was analyzed by chi?square test. Results Immunohistochemical staining of CD44v6 was performed in tumor tissue of puncture biopsy, the positive rate expression of CD44v6 was 72%( 36/50 ) , it was associated with lymphatic metastasis(χ2 =3. 964, P=0. 046 ) and advanced TNM stage (Ⅲ+Ⅳstage ) (χ2 =4. 276, P=0. 039 ) . The positive expression of CD44v6 protein in tumor tissue was significantly decreased in 20 patients with neoadjuvant radiotherapy compared with before radiotherapy(7. 23±1. 45 vs. 11. 42±1. 31,t=2. 524,P=0. 025). Conclusion Positive expression of CD44v6 in human lung squamous cell carcinoma is related to the malignant clinicopathological features. Neoadjuvant radiotherapy before operation may improve prognosis via down?regulating CD44v6 expression.
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Objective To discuss dosimetric advantage,compliance,efficacy and prognostic factors of whole brain conformal intensity-modulated radiotherapy ( IMRT ) combined with synchronous dosage for treatment of brain metastases.Methods Forty-one patients with metastatic tumor to the brain were confirmed by computed tomography (CT) or magnetic resonance imaging (MRI).They received whole brain irradiation and simultaneous integrated boost to bulky metastases by IMRT.Gross tumor volume(GTV) DT 4994-6990 cGy/ 22-30 fractions/4.4-6.0 weeks,whole brain DT 3990-5000 cGy/22-30 fractions/4.4-6.0 weeks.Results The median follow-up time was 6.4 months.The overall response rate,the median survival time and the overall survival at 1 year were 65.8 ％,8 months,24.4 ％.The brain-stem,spinalcord,lens,opticnerves were in the limited dose.In 21 patients,radioactive brain edema was happened,the rest did not appear early and late radiation reaction.Conclusion Whole brain irradiation using simultaneous integrated boost to bulky lesion by IMRT show an improvement in dose distribution and significant effect to patients with brain metastases.The therapy is well-tolerated and effective.