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Tumor radiotherapy is established on the basis of clinical oncology, radio-physics and radiobiology, and has become one of the three major therapeutic methods for malignant tumors. With the pace of socialist construction in China, the subject of radiotherapy in Shanxi province has developed from scratch and from small to large for more than 60 years. Remarkable achievements have been made in the establishment of departments, the updating of technical equipment, the increase of employees and clinical scientific research. This article reviews and summarizes the development history of tumor radiotherapy in Shanxi province.
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Objective To evaluate the prognostic value of anemia in patients diagnosed with extranodal nasal-type natural killer (NK)/T cell lymphoma (NKTCL).Methods Clinical data of 1 225 NKTCL patients receiving the first course of treatment from 10 medical institutions in China were retrospectively analyzed.According to the diagnostic criteria in China,anemia was defined as the hemoglobin (Hb) level＜ 120 g/L for the male and＜ 110 g/L for the female from the sea-level area.The severity of anemia was classified into the extremely severe anemia (Hb ≤ 30 g/L),severe anemia (31-60 g/L),moderate anemia (61-90 g/L) and mild anemia (＞90 g/L).Results Among 1 225 patients,199(16.2％) were complicated with anemia,who had more adverse prognostic factors compared with their counterparts without anemia.Among NKTCL patients with anemia,the proportion of patients with stage Ⅱ-ⅣV,a median age＞ anemia,Eastern Cooperative Oncology Group (ECOG) score of 2-4 and NK/T-cell lymphoma prognostic index (NKTCLPI) ≥ 2 was relatively high.Patients with anemia obtained worse clinical prognosis than those without anemia.The 5-year overall survival (OS) and progression-free survival (PFS) in NKTCL patients with anemia were calculated as 49.4％ and 35.4％,significantly lower compared with 63.3％ and 56.0％ in their counterparts without anemia (both P＜0.01).Single factor analysis demonstrated that anemia,age,ECOG score,group B symptom,lactate dehydrogenase,primary tumor site,primary tumor invasion and staging were the prognostic factors of OS and PFS.Multivariate analysis revealed that anemia was still the independent prognostic factor.Conclusions Anemia is not common in patients with NKTCL and these patients obtain poor clinical prognosis.Anemia is an independent prognostic factor for patients with NKTCL.
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Objective There is still a lack of effective clinical prognostic factors for predicting outcomes and guiding treatments in extranodal nasal-type NK/T-cell lymphoma (NKTCL).This study was aimed to investigate the clinical features and prognostic role of primary tumor burden (PTB).Methods A total of 1383 patients were recruited from ten hospitals, including 947 stage Ⅰ patients (68.5%), 326 stage Ⅱ patients (23.6%), and 110 stage Ⅲ-IV patients (8.0%).There were 751 patients (54.3%) presenting with high PTB (H-PTB).The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was conducted for survival difference analysis.Meanwhile, a multivariate analysis was performed using the Cox regression model.Results H-PTB was associated with high invasive potential, high frequency of B symptoms, advanced stage, regional lymph node involvement, lactate dehydrogenase elevation, and poor performance status.The patients with H-PTB had significantly lower 5-year overall survival (OS) and progression-free survival (PFS) rates than those with low PTB (L-PTB)(OS:50.2% vs.72.1%, P=0.000;PFS:41.8% vs.62.5, P=0.000).PTB was an independent prognostic factor for both OS (HR=1.851) and PFS (HR=1.755) according to the Cox multivariate analysis.Moreover, H-PTB was associated with significantly lower locoregional control (LRC) in early-stage NKTCL, and the 5-year LRC rate was 71.6% in patients with H-PTB and 84.3% in those with L-PTB (P=0.000).Conclusions H-PTB is associated with multiple adverse clinical features in NKTCL, and it is an independent indicator for poor outcomes and LRC.H-PTB can be used as a reliable indicator for risk stratification and treatment decision.
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Primary hepatic lymphoma (PHL) is an extremely rare disease without any unified diagnostic criterion.The symptoms are usually nonspecific.Liver biopsy remains the most valuable tool for diagnosis of PHL.The predominant histology of PHL is diffuse large B-cell lymphoma.The therapeutic modalities are variable,including surgery,chemotherapy,radiotherapy,or combination of the various processes.This article described a 33-year-old man with diffuse large B-cell PHL who was treated at the Affiliated Cancer Hospital of Shanxi Medical Univeitity Blood Disease Diagnosis and Treatment Center in February 2014.The patient benefited from eight-cycle chemotherapy.At present,the patient is disease-free and undergoes regular follow-up.
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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 evaluate the prognosis influencing factors of early non-small cell luny cancer (NSCLC) after radiotherapy.Methods 81 early NSCLC patients received definitive radiotherapy and were eligible.Among these patients,60 were diagnosed as squamous cell carcinoma,16 were adenocarcinoma and 5 were diagnosed through imaging instead of pathology.45 patients received conventional radiotherapy,36 patients received three dimensional conformal radiotherapy (3D-CRT),All of them received a total dose of 50-96 Gy with a median dose of 67.8 Gy. Kaplan-Meier survival curves and Cox regression model analysis were applied to evaluate the survival and prognostic factors. Results The median survival time was 34 months.The 1-,3- and 5-year survival rates (OS) were 88.7 ％,41.9 ％,21.8 ％,respectively.Karnofsky performance status≥80,Clinical stage, diameter≤4 cm and the therapeutic effect were associated with improving overall survival.Cox hazards model showed that Karnofsky performance status≥ 80 and diameter≤4 cm were likely to be independent positive prognostic factors. Conclusion Karnofsky performance status and tumor diamater can be used to evaluate the prognosis of early NSCLC after radiotherapy.
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Objective To investigate the way to accurately delineate gross tumor volume (GTV) of high grade gliomas(HGG) for intensity modulated radiation therapy (IMRT) by using computed tomography (CT) and magnetic resonance imaging (MRI) image fusion technique. Methods CT and MRI images were fused from 19 patients. The GTV of each patient were independently delineated by one chief doctor and one resident doctor on CT and MRI image. The GTV contoured on CT (GTVCT), MRI (GTVMRI) were measured, and composite volumes (GTVCT+MRI) were the sum of CT-defined GTV and MRI-defined GTV. The differences of these volumes were compared. Results Whether chief or resident doctors delineated, all were GTVMRI ＞GTVCT(P ＜0.050). The percentages of GTVMRI on GTVCT+MRI were (98.57±7.00)% by chief doctors, and (97.84±10.00)% by resident doctors. Compared the difference between GTVCT and GTVMRI in postoperative patients and preoperative patients, P =0.046, and the difference between chief doctors and resident doctors was statistically significant for GTV defined by CT (P =0.020), but not by MRI and composite image (P ＞0.050).Conclusion The GTV of HGG patients must be delineated on both CT image and MRI image, including using CT and MRI image fusion. But the composite volumes(GTVCT+MRI) should be the sum of CT-defined GTV and MRI-defined GTV. Especially for the postoperative patients,delineating GTV should be taken more attention. And the GTV should be delineated by doctors with full experiences.
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Objective To evaluate and analyse the prognostic factors of cerebral glioma treated with radiotherapy. Methods Records of 162 patients with cerebral glioma. Cox model was used for univariate and multivariate analysis. Results Mean follow- up time was 30 months, 14 patients relapsed, and 45 patients died. Univariate analysis showed that histologic grade, histologic type, Karnofsky performance state before radiotherapy, extent of resection, and age were significant predictors in association with overall survival rate of patients with glioma. Multivariate analysis showed that histologic grade, histologic type, age, Kamofsky before radiotherapy, extent of resection,and radiotherapy technology were independent prognostic factors of glioma. Conclusion Low grade, AC and OD, age≤40 years, Kamofsky >80 before radiotherapy, and total resection axe independent factors for predicting better survival of glioma patients.
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Objective To study the value of serum S-100B protein in the diagnosis of cerebral radi-ation injuries in patients with brain malignant tumor. Methods Serum S-100B protein level was deteetod by enzyme-linked immunosorbent assay in 56 patients with brain malignant tumor before, during and after radio-therapy. Effects of dose and method of radiotherapy, peritumoral edema degree and Karnofsky performance status on serum S-100B level were studied. Results The levels of serum S-100B protein in the patients be-fore radiotherapy and control group were 0. 039μg/L and 0.044 μg/L ( t = 1.48 ,P =0. 186). The levels of serum S-100B protein before, in the middle of (30-40 Gy) and after (60 -70 Gy) radiotherapy were 0.044 μ/L, 0.049 μ/L and 0.079 μg/L, respectively ( F = 67.26, P = 0.000). The differences after ra-diotherapy were also significant among patients with three methods of radiotherapy (F = 20.32, P = 0.000), different degree of pefitumoral edema ( F = 12.94, P =0. 000 ) and Karnofsky perforrnanee status ( t = 2.71, P =0.007). Conclusions High level of serum S-100B protein is associated with cerebral radiation injuries in patients with brain malignant tumor, which is influenced by the dose and method of radiotherapy, Karnof-sky performance stares and degree of peritumoral edema. High level of serum S-100B protein may serve as an early predictor of cerebral radiation injury.
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Objective To investigate the curative effect of synchronous radio-chemotherapy in medium-term and advanced cervical carcinoma. Methods 168 cases of medium-term and advanced cervical carcinoma were selected. The treatment group(grout A) included 84 pathologically verified cases of stage Ⅱ～Ⅳ cervical carcinoma. Each patient was given DDP with hydration at the dose of 40 mg/m2 intravenously.The treatment cycle was performed once every week for 3--4 circles. Radiotherapy was given at the same time. 60Co was used for external radiation with a total dose of 50 Gy, 192 Ir afterloading unit was used for brachytherapy at the dose of 7 Gy per week at point A with a total dose of 42 Gy. The control group (group B)included 84 cases of cervical carcinoma at the same stage in the corresponding period who received radiotherapy only.Short-term effect ,2-year survival rate and complications were observed. Results Effective rate was 92.85 %(78/84) in group A and 79.76 %(67/84) in group B respectively 3 months after radiotherapy, showing a significant difference(χ2 =6.10,P <0.05). 2-year survival rate was higher in group A (83.95 %) than in Group B(60.98 %) (χ2 =9.4,P<0.05). Local recurrent and distant metastasis were lower in Group A than Group B. In group A, there were tolerable bone marrow inhibition and reaction of digestive tract. Conclusion Synchronous radiotherapy and chemotherapy can remarkably improve the survival rate of medium-term and advanced cervical carcinoma. The application of DDP is effective and safe,and its side effect can be accepted by patients, but the long-term effect needs further observation.
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Gliomas is the primary intracraniai tumors.It is mainly principle that treatment with surgery followed a comprehensive treatment.As the growth of glioma infiltrating,difficult surgical resection of all clean and easy to relapse,so post-operative adjuvant radiation therapy occupie an important position.In order to explore for brain glioma effect,mainly on the gliomas means of the status and progres with various radiation therapy and radiotherapy combined with chemotherapy.