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Objective:To investigate the dosimetric effects of prone immobilization devices combined with a belly board (PIDBBs) in the intensity-modulated radiotherapy (IMRT) for gynecologic cancers.Methods:A total of 20 patients with cervical or endometrial cancer treated with radiotherapy in the Third Affiliated Hospital of Sun Yat-sen University from August 2020 to June 2021 were retrospectively analyzed. Two sets of body contours were outlined for each patient. One set of body contours did not contain the immobilization devices, and the other contour set included the immobilization devices. For each patient, doses were calculated for the two sets of contours using the same 7-field IMRT plan and were recorded as Plan without and Plan with. The dosimetric difference caused by the immobilization devices was assessed by comparing the parameter values in the dose-volume histograms (DVHs) and by plan subtraction. The Gafchromic EBT3 film and anthropomorphic phantom were used to verify the calculated doses. Results:The target coverage and average dose of Plan with were lower than those of Plan without. Specifically, the V50 Gy, V49 Gy, and Dmean of planning target volume (PTV) decreased by 19.75%, 7.99%, and 2.54% ( t = 8.96, 10.49, 22.09, P < 0.01), respectively. The V40 Gy, V30 Gy, V20 Gy, V15 Gy, and Dmean of skins increased by 51.79%, 51.05%, 45.72%, 33.63% and 10.80% ( t = -2.54, -5.63, -15.57, -24.06, -13.88, P < 0.01), respectively. Doses to other organs at risk (OARs) showed no significant differences. As indicated by the EBT3 measurements, the doses to skins of the abdomen and pelvis on the anthropomorphic phantom increased by approximately 37.24% ( t = 10.86, P<0.01). Conclusions:Although PIDBBs can effectively reduce the low dose to the small intestine, the radiation attenuation caused by them can reduce the PTV coverage of radiotherapy plans and increase the doses to abdominal and pelvic skins sharply, especially for patients requiring irradiation of the groin and perineum.
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Objective This article retrospectively analyzed the efficacy,toxicity,survival and related factors affecting progno-sis of patients with small cell lung cancer(SCLC)who had recurrence or progression after first-course chemoradiotherapy. Methods A total of 86 patients with recurrence or progression recurrence after SCLC chemotherapy and radiotherapy from January 2007 to De-cember 2015 in Harbin Medical University Cancer Hospital were enrolled. Patients were divided into the re-treatment group to re-ceive secondary treatment with radiotherapy combined with chemotherapy and two control groups to receive secondary treatment with radiotherapy alone or chemotherapy alone. The factors affecting the prognosis of SCLC re-treatment were analyzed. The short-term and long-term efficacy,overall survival and toxicity of three groups were compared. Results The median progression-free survival time of the re-treatment group,radiotherapy group,and chemotherapy alone group was 4 months(1~20 months),2 months(1 ~7 months)and 3 months(1~6 months). There was no statistical difference(P>0. 05). The median overall survival time was 25 months (3~135 months)in the re-treatment group and 8 months in the radiotherapy group(1-59 months)and 12 months(1~108)in the chemotherapy alone group,the difference was statistically significant ( P <0. 05 ). The 1 -,2 -,and 3 -year survival rates were 73. 70% ,52. 10% and 47. 40% in the re - treatment group; 32. 90% 、 21. 90% and 21. 90% in the radiotherapy group, and 45. 40% ,19. 90% and 19. 90% in the chemotherapy alone group. The long-term effect of the re-treatment group was better than that of the radiotherapy group and the chemotherapy alone group(P<0. 05). Conclusion Re-treatment of patients with SCLC who failed after receiving radiotherapy and chemotherapy for the first time can prolong the survival time of patients and improve the life quality of patients. If the patient's physical condition permits,the treatment should be selective radiotherapy and chemotherapy as well as tolerable toxicity or side effects. Among them,patients with no distant metastasis and recurrent radiotherapy dose ≥5 000 cGy had greater survival benefit. However,the late toxic and side effects,and complications of patients after re-treatment are still to be further observed.
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About 15% to 20% of patients with small cell lung cancer(SCLC)have brain metastases at the time of initial di-agnosis,and more than 80% of patients eventually develop brain metastases. Whole brain radiotherapy(WBRT) is the standard treat-ment for brain metastases in lung cancer. Whole brain prophylactic irradiation(PCI)is an effective treatment for preventing brain me-tastases in SCLC. With the improvement of treatment technology and the standard of treatment,the survival of SCLC patients is pro-longed. The use of spiral tomography(TOMO) technology for hippocampal-protected WBRT in PCI or brain metastasis can reduce neurocognitive impairment and improve the life quality of patient.
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Objective The prognostic role of PD-L1 expression in surgically resected lung adenocarcinoma(ADC)remains controversial. The aim of present study was to investigate the prognostic value of PD-L1 combined with CD8 +TILs expression in pa-tients with resectable lung adenocarcinoma. Methods A total of 104 patients with lung adenocarcinoma who underwent radical resec-tion were enrolled at the Affiliated Tumor Hospital of Harbin Medical University from January 2009 to December 2012. Immunohisto-chemistry was used to detect the expression of PD-L1 and CD8 +TILs in primary tumor specimens. Its clinical pathological factors and its relationship with prognosis were statistical analysis. Results The positive expression rate of PD -L1 in tumor cells was 38. 5% (40/104),and the positive rate of CD8 +TILs was 44. 2% (46/104). There was a significant correlation between the expres-sion of CD8 +TILs and TNM stages of patients with resectable ADC. The Kaplan-Meier survival analysis showed that low expression of PD-L1 and high expression of CD8 +TILs were significantly associated with disease -free survival ( DFS) and overall survival ( OS),and could be used as an independent predictors for predicting prognosis of patients with resectable ADC. Conclusion The ex-pression of PD-L1 and CD8 +TILs in the postoperative specimens can help to judge the prognosis of patients. This study has certain significance for immunotherapy of PD-1/PD-L1 pathway in patients with surgically resected ADC.
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Objective To investigate the consensus and controversies on the delineation of radiotherapy target volume for patients with locally advanced non-small cell lung cancer (LA-NSCLC).Methods Questionnaires including 15 questions on the delineation of radiotherapy target volume of NSCLC were sent to 12 radiation departments in China in November 2015.A patient with LA-NSCLC was selected by Fudan University Shanghai Cancer Center, and simulation CT images and medical history data were sent to the 12 radiation departments.Twelve radiation oncologists from the 12 radiation departments showed and explained the delineation of radiotherapy target volume of their own, and the patient was discussed by all experts in the sixth multidisciplinary summit forum of precise radiotherapy and chemotherapy for tumor and lung cancer.Results All receivers of the questionnaire answered the questions.The standard lung window width/level for the delineation of lung cancer was 800-1600/-600 to-750 HU, and the mediastinum window was 350-400/20-40 HU.Respiratory movement was measured by stimulator, 4D-CT, and stimulator+4D-CT with 2-5 mm expansion based on experience.The primary clinical target volume (CTV) was defined as gross target volume (GTV) plus 5-6 mm for squamous carcinoma/5-8 mm for adenocarcinoma.The metastatic lesion of mediastinal lymph nodes was delineated as 5 mm plus primary lesion in 6 departments and as primary lesion in another 6 departments.Of the 12 departments, 10 applied 5 mm of set-up error, 1 applied 3 mm, and 1 applied 4-6 mm.For V20 of the lungs, 10 departments defined it as<30%, 1 as<35%, and 1 as 28%.Nine departments defined the radiation dose of concurrent chemoradiotherapy (CCRT) for LA-NSCLC as 60 Gy in 30 fractions, 62.7 Gy in 33 fractions in 1 department, 50-60 Gy in 25-30 fractions in 1 department, and 60-70 Gy in 25-30 fractions in 1 department.For the delineation of target volume for the LA-NSCLC patient treated with CCRT, the primary planning target volume (PTV) was defined as GTV plus organ movement (IGTV) and set-up error (GTV→IGTV→PTV) in 3 departments, as CTV plus organ movement (ITV) and set-up error (GTV→CTV→ITV→PTV) in 8 departments, and as CTV plus set-up error/IGTV plus 5-6 mm for squamous carcinoma/5-8 mm for adenocarcinoma (CTV) and set-up error (GTV→CTV→PTV/GTV→IGTV→CTV→PTV) in 1 department.For the delineation of PTV in the mediastinal lymph node, GTV→IGTV→PTV was performed in 3 departments, GTV→CTV→ITV→PTV in 8 departments, and GTV→CTV→PTV in 1 department.For 10%-100% patients with LA-NSCLC, the radiation field needed to be replanned when 38-50 Gy was completed.There was no unified standard for the optimal standardized uptake value (SUV) of positron emission tomography (PET)-computed tomography (CT) simulation and delineation.Seven departments had applied magnetic resonance imaging (MRI) simulation and 10 departments had applied stereotactic body radiation therapy (SBRT) for the treatment of early-stage NSCLC.For the delineation of PTV for early-stage NSCLC (T1-2N0M0), GTV→IGTV→PTV was performed in 5 departments, IGTV→PTV in 3 departments, and GTV→CTV→ITV→PTV in 2 departments.In all the 12 departments, peripheral early-stage NSCLC was given 6.0-12.5 Gy/fraction, 3-12 fractions and central early-stage NSCLC was given 4.6-10.0 Gy/fraction, 5-10 fractions.The results of discussion on the delineation of target volume for the patient were as follows:respiratory movements should be measured by 4D-CT or simulator;the lung window width/level is 1600/-600 HU and the mediastinal window width/level is 400/20 HU;the primary controversy is whether the involved-field irradiation or elective nodal irradiation should be used for the delineation of CTVnd in the mediastinal lymph node.Conclusions Basic consensus is reached for the delineation of target volume in LANSCLC in these aspects:lung window width/level, respiratory movements and set-up error, primary lesion delineation, the radiation dose in CCRT, and the optimal time for replanning the radiation field.There are controversies on the optimal SUV in the delineation of target volume based on PET-CT simulation, the optimal dose fractionation in SBRT for early-stage NSCLC, and the delineation of CTVnd.
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Recently,the incidence rate of small cell lung cancer in elderly patients has been increasing . The mainly therapeutic approach of small cell lung cancer consists of radiotherapy ,chemotherapy and surgery ,with the treatment purpose of prolonging survival time and improving life quality .As the huge development of accurate radiotherapy technology occurred in the past a few years ,radiotherapy could play more and more important roles in the treatment with elderly patients .Yet,there is no unified standards of treatment for small cell lung cancer in eld-erly patients.Therefore,we give a review on the latest processes and research on the treatment of small cells lung cancer in elderly patients .
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The recurrence rate of non -small cell lung cancer ( NSCLC) patients after radiotherapy and chemotherapy have been increasing .The therapy scheme consists of reirradiation、chemotherapy、and chemoradio-therapy,with the purpose of improving the local control and prolonging the survival time .Reirradiation is feasible for locally recurrence of non -small-cell lung cancer patients , treatment is security and could better improve quality of life in patients .The majority of patients are tolerable and have better short -term efficacy , No severe short term radiation induced injury is observed .But the long term radiation induced injury and long term efficacy need further investigation .In the present paper ,we review the roles of reirradiation for locally recurrence of non -small-cell lung cancer patients after radiotherapy and chemotherapy and the progress in clinical research .
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Objective To compare the efficacy and toxicity of inductive chemotherapy with pemetrexed followed by radiotherapy for patients with lung adenocarcinoma .Methods Patients with stage Ⅲa/b or Ⅳ and histologically confirmed lung adenocarcinoma were evaluated from July 2008 to April 2012 ( n=95 ) .Patients re-ceived inductive chemotherapy with pemetrexed or paclitaxel followed by thoracic radiotherapy or chemotherapy with pemetrexed alone,respectively.Primary end point was the tumor response rate (RR),progression-free sur-vival(PFS),1-year survival rate and toxicity.Results Tumor RR were 83.3%,81.8%and 62.5% in three groups of inductive chemotherapy with pemetrexed or paclitaxel followed by thoracic radiotherapy or chemotherapy with pemetrexed alone ,respectively.PFS was 12.0 months,10.9 months and 5.7 months.The 1-year survival rate was 80.0%,78.7%and 46.8%.Tumor RR and PFS were statistically superior in pemetrexed/radiotherapy versus pemetrexed alone ,and toxicity was significantly lower than in paclitaxel /radiotherapy.Conclusion The treatment of pemetrexed/radiotherapy for lung adenocarcinoma could prolong the survival of patients .Compared with the treatment of paclitaxel/radiotherapy ,pemetrexed/radiotherapy provides similar efficacy with better tolera-bility and more convenient administration .
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Primary tracheal tumor is an uncommon disease in clinical oncology .It tends to be misdiag-nosed in very early stage ,as well as lack of standards for staging and treatment nowdays .The main strategy for the treatment of primary tracheal tumors is surgical comprehensive treatments .But as the huge development of modern radiotherapy technology the past a few years ,radiotherapy could play more and more important roles in the treat-ment of tracheal tumors.Meanwhile,the application of tracheal scaffold have provided the patients with tracheal tumors some new choices on the treatments .Yet,there are no guildline for the standard of the surgery ,the dose of the radiotherapy and the definition for the tumor target volumes .Here,we give a review on the latest process and research on the treatment of primary tracheal tumors .
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Objective To investigate the clinical characteristics and the risk factors of hospital-acquired pneumonia(HAP) in the patients with intracerebral hemorrhage(ICH) .Methods The clinical data of 1 184 cases of ICH complicating HAP from Sep .2009 to Sep .2012 were analyzed retrospectively and statistically .Results The incidence rate of HAP was 13 .0% in these ICH patients , the detected pathogens were in turn Gram-negative bacilli(63 .4% ) ,Gram-positive cocci(26 .7% ) and fungi(9 .9% );the risk factors of HAP in ICH patients were related with the age of patients ,underlying disease ,length of hospital stay ,conscious state ,tracheoto-my ,amount of cerebral hemorrhage ,bulbar palsy and nutritional status .Conclusion The patients with ICH are easy to develop HAP .Aiming at the above risk factors ,the comprehensive measures should be adopted to reduce the incidence rate of HAP in ICH patients .
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The single brain metastases of lung cancer is defined as limited brain metastases .Mechanism of brain metastasis from lung cancer remains to be further studied .Based on surgery ,radiotherapy ,and chemother-apy,the comprehensive treatment on limited brain metastasis of non -small cell lung cancer gets a better result , however ,the indications for combination therapy must be strictly controlled .Increasing radiation doses of local tumor area,followed by whole-brain radiotherapy,can improve tumor local control rate and prolong overall sur-vival.Prophylactic irradiation of whole brain showed no evidence on prolonging the overall survival .For patients with poor general state,targeted drugs combined with whole brain radiotherapy can be tolerated well ,as well as prolonged the overall survival to ertain extent .
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In recent years,the incidence rate and mortality rate of non-small cell lung cancer (NSCLC) in elderly patients have been increasing.The therapy scheme consists of surgery,radiotherapy,chemotherapy and target therapy,with the purpose of prolonging survival time and improving life quality.But there is no unified standards of treatment in elderly non-small cell lung cancer.
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Preoperative radiotherapy combined with chemotherapy and (or) targeted therapy not only reduces the local recurrence of locally advanced rectal cancer and increases the rate of anal preservation and pathologic complete response,but also improves patient compliance.Preoperative neoadjuvant therapy will gradually become the standard treatment for locally advanced rectal cancer.
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Pemetrexed is a novel antifolate which is approved in the USA and Europe for the treatment of non-small-cell lung cancer (NSCLC).Researches reveal that pemetrexed enhances radiation-induced cell inactivation.A series of clinical trials of pemetrexed combined with radiotherapy for NSCLC also demonstrated that pemetrexed provides similar efficacy with lower toxicity and better tolerability than other third-generation chemotherapy drugs.
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Endostatin is a novel anti-angiogenic drug which through multiple pathway inhibits vascular endothelial growth factor expression,to achieve the purpose of the inhibition of tumor angiogenesis.The drug in the treatment of non-small cell lung cancer in pre-clinical study and clinical application show that:used alone have anti-tumor effect; combined with radiotherapy and chemotherapy can obtain short-term curative effect,and does not increase treatment related toxicity.The adverse effect of the drug is mild and can be well tolerated.
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During radiotherapy, ionizing radiation can damage some structures of the heart, including pericardium, myocardium, cardiac valve, conducting system, and coronary artery. Radiation-induced cardiac injury can manifest as abnormalities in many aspects including myocardium enzymes, perfusion imaging, electrocardiogram, strain rate imaging.
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Bcl-2 family plays an important role in cell apoptosis pathway. The ratio of pro-apoptosis members and anti-apoptosis members closely correlates with tumorigenesis, tumor radiosensitivity and progno-sis. Recent years ,according to the correlation of Bcl-2 family and tumor radiosensitivity, many researchers want to find new therapeutic strategies that target Bcl-2 in clinical radiotherapy.
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Objective To explore the radiosensitizatian of paclitaxel in human lung adenocareinoma cells. Methods A human lung adenocarcinoma cell line A973 was used in this study. The cytotoxicity of paclitaxel was investigated by using clonngenic assay to define the IC10,IC50 and IC90. The cells received either radiation(with different doses) alone or paclitaxel administrated before and after irradiation. Cell survival fractions were determined by clonogenic assay. Single hit multi-target model was used to determine survival curve parameters. Flow cytometry was performed to analyze the cell cycle distribution. Results The IC10, IC50 and IC90 of paclitaxel in A973 cells were 0.5,2.6 and 8.7 nmol/L,respectively. According to Do,Dq and SF2 value,the sensitivity enhancement ratio(SER) of IC10 was 0.97,1.01 and 2.00 when paclitaxel was added before irradiation, and 0.97,1.02 and 1.02 when after irradiation ; The SER of IC50 was 1.06,129.00 and 2.61 when paclitaxel was added before irradiation, and 0.94,220. O0 and 2.14 when after irradiation ;The SER of IC90 were 1.00,220. 00 and 2.09 when paclitaxel was added before irradiation,and 0.98,220.00 and 2.09 when after irradiation. The IC10 of paclitaxei failed to increase G2+M arrest of A973 cells.The maximal G2+M accumulation was reached at 2 h and 18 h after IC50 and IC90 of paclitaxel treatment,respectively. Conclusions Paclitaxel is able to enhance the radiation sensitivity of A973 cells. Sequence of treatment is not associated with radiosensitivity. Moderate and high dose of paclitaxel combined with low-dose radiation can produce the best effect of radiosensitiation.