Risks of diabetes mellitus and impaired glucose tolerance induced by intermittent versus continuous androgen-deprivation therapy for advanced prostate cancer / 中华男科学杂志

Objective@#To investigate the correlation of intermittent androgen-deprivation therapy (IADT) and continuous androgen-deprivation therapy (CADT) for advanced prostate cancer (PCa) with the risks of secondary diabetes mellitus (DM) and impaired glucose tolerance (IGT).@*METHODS@#We conducted a retrospective case-control study of the advanced PCa patients treated by IADT or CADT in our hospital from January 2013 to December 2015. Based on the levels fasting blood glucose and 2-hour postprandial blood glucose, results of oral glucose tolerance test, and clinical symptoms of the patients, we statistically analyzed the IADT- or CADT-related risk factors for DM and IGT and the relationship of the body mass index (BMI), hypertension, smoking, and alcohol consumption with secondary DM and IGT.@*RESULTS@#IADT was given to 53 (46.5%) of the patients, aged (69.1 ± 4.3) years, and CADT to 61 (53.5%), aged (70.2 ± 5.7) years. No statistically significant differences were observed in clinical characteristics between the two groups of patients (P > 0.05). BMI, blood pressure, smoking and drinking exhibited no significant influence on the development of DM or IGT either in the IADT (P > 0.05) or the CADT group. The incidence of IGT was significantly lower in the IADT than in the CADT group (P = 0.03), but that of DM showed no statistically significant difference between the two groups (P = 0.64).@*CONCLUSIONS@#Compared with CADT, IADT has a lower risk of IGT and a higher safety in the treatment of advanced prostate cancer.

Influence of registration based on different reference markers on the displacement of the geometry consisted of all clips in the cavity for external-beam partial breast irradiation at moderate deep inspiration breath holding / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the influence of registration based on different reference markers on the displacement of the geometry consisted of all clips in the cavity for external-beam partial breast irradiation at moderate deep inspiration breath holding assisted by active breathing control device.</p><p><b>METHODS</b>Twenty-seven early stage breast cancer patients feasible for external beam partial breast irradiation (EB-PBI) were selected. The patients undertaken three-dimensional computed tomography (3DCT) simulation scan at moderate deep inspiration breath holding (mDIBH) assisted by active breathing control device, and two sets of mDIBH CT images were got and transferred to the Pinnacle 3 planning system. All of the silver clips were delineated and a geometry consisted of all clips were generated. On the account of automatic registration of mDIBH CT images, manual registration was carried out based separately on the topside clip in the cavity, the labeled skin at anterior surface of the cavity at central level and the metal mark on the body surface near the cavity, then the displacements of center of the geometry in left-right (LR), anterior-posterior (AP) and superior-inferior (SI) directions based separately on the three registrations were measured.</p><p><b>RESULTS</b>The displacements of center of the geometry in LR, AP and SI directions based on registration of the clips, the labeled skin and the metal mark were (0.61 ± 0.62)mm vs. (1.11 ± 1.21)mm vs. (1.31 ± 1.55)mm, (0.63 ± 0.59)mm vs. (0.92 ± 0.93)mm vs. (1.19 ± 1.24)mm and (0.91 ± 0.96)mm vs. (2.13 ± 2.12)mm vs. (1.93 ± 1.55)mm, respectively. Compared the displacements of center of the geometry in the same direction between the three registrations, significant differences were found only in SI direction between clip registration and skin registration, clip registration and mark registration (t = 5.045, 7.210 and P = 0.025, 0.007) . Compared the displacements of center of the geometry between three dimensional directions for each reference registration, there was no significant difference (all P > 0.05).</p><p><b>CONCLUSIONS</b>When EB-PBI is carried out in state of mDIBH, measurement of the intrafraction displacement based on registration of the clip in the cavity is a reasonable selection. Otherwise, excessive margin enlargement of PTV in SI direction will be generated if the regional skin or metal mark is selected as registration reference.</p>

Effects of high-flux hemodialysis on plasma adrenomedullin and sustained hypotension in elderly hemodialysis patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sustained hypotension during hemodialysis (HD) is an important clinical issue. Plasma adrenomedullin (AM) is increased in HD patients with sustained hypotension, but little is known about whether removing AM can improve hypotension. The objective of this study was to investigate the beneficial effects of hemodialysis using a high-flux dialyzer on removal of increased plasma AM levels and improving low blood pressure in elderly HD patients with sustained hypotension.</p><p><b>METHODS</b>Forty-eight elderly patients (age 65 or older) who had undergone maintenance HD for more than one year were recruited and studied. We evaluated plasma levels of AM in sustained hypotension (SH; n = 28) and normotensive (NT; n = 20) patients. The patients with hypotension were further divided into two subgroups and treated with either high-flux dialyzer or low-flux dialyzer for 3 months. Plasma adrenomedullin levels and blood pressure were analyzed at days 0 and 181.</p><p><b>RESULTS</b>Plasma levels of AM were significantly higher in SH than in NT patients ((24.92 ± 3.7) ng/L vs. (15.52 ± 6.01) ng/L, P < 0.05), and were inversely correlated with mean arterial blood pressure (MAP) at pre-HD. After 3 months, the level of plasma AM in high-flux group was decreased ((24.58 ± 4.36) ng/L vs. (16.18 ± 5.08) ng/L, P < 0.05), but MAP was increased ((67.37 ± 4.31) mmHg vs. (74.79 ± 3.59) mmHg, P < 0.05). There was no obvious change in low-flux group.</p><p><b>CONCLUSIONS</b>Plasma AM levels were significantly elevated in elderly HD patients with SH. High-flux dialyzer therapy can decrease plasma AM level and improve hypotension.</p>

Influence of active breathing control on the dose distribution in the target of forward whole-breast intensity-modulated radiotherapy after breast conserving surgery / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the influence of intrafraction and interfraction target displacement on the dose distribution in the target of forward whole-breast intensity-modulated radiotherapy (IMRT) assisted by active breathing control (ABC).</p><p><b>METHODS</b>Each of the selected patient who had received breast conserving surgery was immobilized and received the primary CT simulation assisted by ABC device to get five sets of CT images in three different breathing status, including free breathing (FB) (one set), moderate deep inspiration breathing hold (mDIBH)(two sets) and deep expiration breathing hold (DEBH) (2 sets). After 10 to 15 fractions of radiation, the repeated CT simulation was completed and the same five sets of CT images were obtained at FB, mDIBH, and DEBH, respectively. In the Pinnacle3 treatment planning system, the forward IMRT planning was completed on the first set of mDIBH CT images from the primary CT simulation, and the planning was separately copied by the special system order to the second set of CT images from the primary CT simulation and to the first set of CT images from the repeated CT simulation, keeping the primary angle, direction, size and shape of the MLC field and prescribed dose un-changed. the volumes covered by selected high dose area in the selected segment were compared.</p><p><b>RESULTS</b>In the planning based on the first set of mDIBH CT images from the primary CT simulation, the volume irradiated by equal and more than 103% of prescribed dose in the segment was (1.16 +/- 0.39) cm3, and the volumes were (3.88 +/- 1.07) cm3 and (51.66 +/- 8.68) cm3 in the plannings copied from the first set of mDIBH CT images from the primary CT simulation respectively to the second set of CT images from the primary CT simulation and first set of CT images from the repeat CT simulation, the difference of the volume in the two plannings based on the two set mDIBH CT image from the primary CT simulation was not statistically significant (t = -1.672, P = 0.103). The difference of the volume in the two plannings based on the two sets of mDIBH CT images respectively from the primary and repeat CT simulations had a significant difference (t = -5.728, P < 0.01).</p><p><b>CONCLUSION</b>If the same threshold of mDIBH is maintained during IMRT after breast conserving surgery, the influence of the intrafraction target displacement on the dose distribution is not significant. However, if set-up error is not adjusted, the interfraction change of position of the segment given to cover the high dose area in the IMRT planning will be significant, resulting in a significant change of dose distribution in the breast.</p>

The rule of metastatic pelvic lymph node distribution in patients with early stage cervical carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the distribution of metastatic pelvic lymph nodes in the women with early stage cervical carcinoma, and the feasibility of dividing these nodes into three stations in those patients.</p><p><b>METHODS</b>(99m)Tc-DX of 2 ml was injected into the cervix to a depth of 5 to 10 mm at 3, 6, 9, 12 o'clock positions preoperatively in 196 patients with early stage cervical cancer. Pelvic lymphadenectomy and radical hysterectomy were performed in all patients. Pelvic lymph nodes were detected by gamma-probe. The sentinel lymph nodes (SLN) were determined if the radioactivity reached 5 times higher than that in the ipsilateral nodes. All resected pelvic lymph nodes were examined by histopathology with HE stained serial sections.</p><p><b>RESULTS</b>Of the 196 patients, 41 were found to have metastasis in 83 lymph nodes. The metastatic rate was 78.3% (65/83) in the parametrial and obturator lymph nodes, 20.5% (17/83)in the internal and external iliac lymph nodes, 1.2% (1/83) in the commmon iliac lymph nodes. Of the 22 patients with metastatic parametrial lymph nodes, metastatic external iliac lymph nodes were detected in 5 patients, and metastatic internal iliac lymph nodes in 3 patients. Among the 19 patients with metastatic obturator lymph nodes, metastatic external iliac lymph nodes were found in 4 patients, and metastatic internal iliac lymph nodes in 3 cases. It was shown by Chi-sqare test that the metastases in parametrial and/or obturator lymph nodes were positively correlated with lymph node metastases in other pelvic sites. Eighty-one SLN were found to have metastasis. The metastatic rate of parametrial and obturator SLN was 79.0% (64/81) versus 21.0% (17/81) of internal and external iliac SLN. No statistically significant difference in 1- and 3-yr survival was observed between the groups with and without metastasis in parametrial and obturator lymph nodes, while the 5-yr survival rate in the patients without metastatic lymph node was 93.2%, significantly higher than that of patients with lymphatic metastasis (65.1%).</p><p><b>CONCLUSION</b>It is feasible for cervical cancer to divide the pelvic lymph nodes into three levels. The level I lymph nodes consist of parametrial and obturator lymph nodes. Internal and external iliac lymph nodes can be considered as level II lymph nodes, and the common iliac and inguinal lymph nodes as level III nodes. A rational treatment plan can be made according to the distribution of metastatic pelvic lymph nodes.</p>

Study on the target movement in external-beam partial breast irradiation with active breathing control after breast-conserving surgery / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the displacement of surgical clip and cavity during different respiratory status, intrafraction and interfraction for the patients treated by external-beam partial breast irradiation (EB-PBI) assisted by active breathing control (ABC) device after breast-conserving surgery.</p><p><b>METHODS</b>After breast-conserving surgery, twenty-five patients with stage I/II breast cancer who was identified to be feasible for EB-PBI underwent CT-simulation positioning assisted with ABC device. Five series of CT images were done during three respiratory status, which included one series of images during free breathing status (FB), two series of images during moderate deep inspiration breath hold (mDIBH), two series of images during deep expiration breath hold (DEBH) at 75% maximum inspiration capacity, and all of the five series of images were transferred to ADAC Pinnacle3 treatment planning system. This procedure was repeated after 10 - 15 days. The targets were delineated and the first appeared clips were marked by the same radiotherapist on the CT images in mDIBH and DEBH status from the first CT simulation positioning to analyze the displacement of the targets produced by respiratory status. The targets were also delineated and all of the clips were marked by the same radiotherapist on another two series of CT images during mDIBH from the first and repeated CT-simulation positioning for analyzing the intrafraction and interfraction movement of cavity and clips, respectively.</p><p><b>RESULTS</b>There was a significant difference between mDIBH and DEBH in the movement of the point of interest (POI) of the first appeared clip in the directions of X (0.22 cm), Y (1.27 cm) and Z axis (0.50 cm) (chi2 =9.558, P = 0.008); and this was also found to be present in the movement of POI of the cavity in the directions of X (0.10 cm), Y (1.08 cm) and Z axis (0.50 cm) (chi2 = 20.44, P <0.01). Regardless of the clip and the cavity, the movement extent along the direction of Y axis was the biggest. However, no significant difference was found in the displacements of POI of the geometric form constructed by all clips in the directions of X (0.09 cm, 0.68 cm), Y (0.14 cm, 0.37 cm) and Z axis (0.25 cm, 0.50 cm) in the same respiratory status of mDIBH at different moment in the intrafraction and interfraction, respectively; and this was also found in the displacements of POI of the cavity in the direction of X (0.15 cm, 0.66 cm), Y (0.17 cm, 0.45 cm) and Z axis (0.25 cm, 0.75 cm)in the same respiratory status of mDIBH at different moment in the intrafraction and interfraction, respectively.</p><p><b>CONCLUSION</b>The margin of planning target volume for external beam partial breast irradiation in different respiratory status is found to be different, the margin displacement along the different axis is also different in free breathing status. However, it can be controlled almost at the same extent in moderate deep inspiration breath hold if assisted by active breathing control device.</p>

Value of positron emission tomography-CT imaging combined with continual detection of CA_(125) in serum for diagnosis of early asymptomatic recurrence of epithelial ovarian carcinoma / 中华妇产科杂志

Objective To evaluate the value of positron emission tomography(PET)-CT imaging combined with continual detection of CA_(125)in serum for diagnosis of early recurrent ovarian epithelial carcinoma.Methods Twenty six patients received PET-CT imaging,who were all diagnosed as primary epithelial ovarian cancer of stage Ⅱ-Ⅳ and had complete remission after cytoreductive surgery and multiple courses of chemotherapy in Shandong Provincial Cancer Hospital.After a steady period,all patients experienced progressive rising of CA_(125)values 3 times in 2 months.But no positive lesion was found by CT, or although suspicious positive focus was found,the recurrent and(or)metastatic extent was not definite. Out of 26 patients,16 were delivered rechemotherapy and(or)radiotherapy,and 10 received re- cytoreductive surgery.Results(1)Of 26 patients,the value of CA_(125)was more than 35 kU/L in 17,and in 14 of 17,pelvic or abdominal cavity recurrence was diagnosed by CT and PET-CT,and 4 showed simuhaneously distant metastasis on PET-CT.In the remaining 3 patients of which CT findings were negative,2 had pelvic and abdominal cavity recurrence,and one had bone metastasis on PET-CT.Of 9 patients with progressive rising CA_(125)levels but the value was less than cut-off(