ABSTRACT
Objective:To compare the dosimetry and efficacy of intracavitary brachytherapy (ICBT) and intracavitary/interstitial brachytherapy (IC+ ISBT) based on CT image guidance in the treatment of stage Ⅲ B cervical cancer. Methods:Clinical data of 93 patients with stage Ⅲ B cervical cancer treated in Department of Radiotherapy of Jilin Cancer Hospital from June 2014 to February 2017 were analyzed retrospectively. According to the results of Gynecological examination and pelvic MRI before brachytherapy, confirming the size of residual tumor and the degree of parauterine infiltration, all patients were divided into the ICBT and IC+ ISBT groups. The D 90%, D 100%, V 100% and D 2cm 3 of bladder and rectum were compared, and the short-term and long-term efficacy was observed between two groups. Results:The median follow-up time was 60 months. The 5-year local control rate, distant metastasis-free survival rate and overall survival rate of all patients were 83%, 71% and 68%, respectively. Compared with the ICBT group, HR-CTV D 90% in the IC+ ISBT group was all more than 85 Gy, while there was no significant difference between two groups ( P=0.188). The D 2cm 3 of bladder and rectum in the IC+ ISBT group was significantly decreased by 7 Gy and 8 Gy (both P<0.01), and the distant metastasis-free survival rate was significantly improved ( P=0.009). The 5-year local control rate in the HR-CTV volume>60 cm 3 in the IC+ ISBT group was significantly higher than that in the IC group ( P=0.029). Conclusion:For patients with Ⅲ B cervical cancer, IC+ ISBT can not only ensure target coverage, but also significantly reduce the incidence of distant metastasis and the dose of organs at risk, and significantly improve the local control rate of large tumors.
ABSTRACT
Objective@#To investigate the curative effect and prognostic factors of radical radiotherapy for cervical cancer.@*Methods@#A total of 211 patients with stage ⅠA-ⅢB cervical cancer who underwent therapy in department of radiotherapy, Tumor Hospital of Jilin province between June 2014 and February 2017, were analyzed retrospectively. All patients received radical radiotherapy with or without concurrent chemotherapy. Short-term and long-term efficacy and related prognostic factors were observed. Kaplan-Meier method was used for survival analysis, Log-rank test was used for univariate analysis, and Cox proportional hazards regression model was used for multivariate analysis.@*Results@#The 2-year overall survival (OS) and disease free survival (DFS) were 83.4% and 72.5%, respectively. During the follow-up periods, 46 patients (21.8%) died, including two from non-tumor-related diseases, and one from second primary colon cancer. Totally 57 patients (27%) had recurrence and metastasis, including 16 (28.1%) with local recurrence, 27 (47.4%) with distant metastasis, and 14 with local recurrence and distant metastasis(24.6%). Univariate analysis showed that 2-year OS and DFS were significantly correlated with pathological type, pre-treatment squamous cell carcinoma antigen (SCC) value and FIGO stage (OS: χ2=7.123, 6.014, 8.398, P<0.05; DFS: χ2=11.832, 8.003, 7.731, P<0.05). In addition to the above factors, 2-year DFS was also associated with pelvic lymph node metastasis (χ2=9.286, P<0.05). Multivariate analysis showed that pathological type, pre-treatment SCC value and FIGO stage were independent prognostic factors of OS(HR=2.963, 2.473, 2.574, P<0.05). The independent prognosis factors affecting DFS included pathological type, pre-treatment SCC value and pelvic lymph node metastasis (HR =3.014, 1.988, 1.914, P<0.05).@*Conclusions@#By means of radical radiotherapy, cervical cancer patients with adenocarcinoma, pre-treatment SCC levels ≥30 ng/ml and advanced stage have poor prognosis, so more active treatment strategy should be adopted.
ABSTRACT
Objective To investigate the curative effect and prognostic factors of radical radiotherapy for cervical cancer. Methods A total of 211 patients with stage ⅠA-ⅢB cervical cancer who underwent therapy in department of radiotherapy, Tumor Hospital of Jilin province between June 2014 and February 2017, were analyzed retrospectively. All patients received radical radiotherapy with or without concurrent chemotherapy. Short-term and long-term efficacy and related prognostic factors were observed. Kaplan-Meier method was used for survival analysis, Log-rank test was used for univariate analysis, and Cox proportional hazards regression model was used for multivariate analysis. Results The 2-year overall survival (OS) and disease free survival (DFS) were 83. 4％ and 72. 5％, respectively. During the follow-up periods, 46 patients (21. 8％) died, including two from non-tumor-related diseases, and one from second primary colon cancer. Totally 57 patients (27％) had recurrence and metastasis, including 16 (28. 1％) with local recurrence, 27 (47. 4％) with distant metastasis, and 14 with local recurrence and distant metastasis ( 24. 6％) . Univariate analysis showed that 2-year OS and DFS were significantly correlated with pathological type, pre-treatment squamous cell carcinoma antigen (SCC) value and FIGO stage (OS: χ2 = 7. 123, 6. 014, 8. 398, P < 0. 05; DFS: χ2 = 11. 832, 8. 003, 7. 731, P < 0. 05). In addition to the above factors, 2-year DFS was also associated with pelvic lymph node metastasis ( χ2 =9. 286, P<0. 05). Multivariate analysis showed that pathological type, pre-treatment SCC value and FIGO stage were independent prognostic factors of OS (HR= 2. 963, 2. 473, 2. 574, P<0. 05). The independent prognosis factors affecting DFS included pathological type, pre-treatment SCC value and pelvic lymph node metastasis (HR = 3. 014, 1. 988, 1. 914, P< 0. 05). Conclusions By means of radical radiotherapy, cervical cancer patients with adenocarcinoma, pre-treatment SCC levels ≥30 ng/ ml and advanced stage have poor prognosis, so more active treatment strategy should be adopted.
ABSTRACT
Intraoperative radiotherapy (IORT) is a radiotherapy method that uses a radiotherapy device to provide a brachytherapy with single high-dose radiation to a target tissue (primary tumor beds,residual tumors,and lymphatic drainage areas) during surgery,which includes intraoperative electron beam radiotherapy and high-dose-rate intraluminal brachytherapy.Nowadays,the implementation of precise radiation dose is an important part of multidisciplinary,individualized treatment of tumors.IORT achieves precise treatment by maximizing the radiation dose to the target volume and protecting surrounding normal tissues as much as possible.This article describes the recent research on IORT.
ABSTRACT
Objective To preliminarily explore the delineation of clinical target volume in intensity-modulated radiotherapy for para-aortic lymph node metastases in patients with gynecological malignancies.Methods A retrospective analysis was performed on 56 gynecological tumor patients with para-aortic lymph node metastases who were admitted to our department from January 2010 to September 2016.The number and distribution of metastatic para-aortic lymph nodes were determined by imaging method.Results A total of 108 positive para-aortic lymph nodes were found in the 56 patients,with 1-4(mean,2) positive para-aortic lymph nodes per patient.The mean diameter of positive para-aortic lymph nodes was 2.3 cm (1.2-4.0 cm).A total of 20 metastatic lymph nodes (19%) were located at the L4 level,38(35%) at the L3 level,44(41%) at the L2 level,and 6(5%) at the L1 level.There were 71 metastatic lymph nodes (66%) at the left side of the para-aortic region,20 metastatic lymph nodes (19%) between the abdominal aorta and the vena cava,and 17 metastatic lymph nodes (15%) at the right side of the inferior vena cava.Conclusions For patients with gynecological malignancies,nodal contouring for the para-aortic region should not be defined by a fixed circumferential margin around the vessels.The left side of the para-aortic region should be covered adequately;the upper target should be extended up to the renal artery,and needs to be further extended for patients who have nodal involvement near the renal arteries and veins.
ABSTRACT
Objective:To investigate the effect of antlerbase on the radiation carcinogenesis by observing the effect of antlerbase on the expressions of Notch2 gene and immune function of the mice with thymic lymphomas induced by ionizing radiation.Methods:Ninety BALB/c mice were randomly divided into control group,irradiation group and irradiation combined with drug group (combined group)(n=30).The thymic lymphoma models of mice were made by X-ray irradiation in irradiation group and combined group;after establishing the animal models,the mice in combined group were fed with chow containing antlerbase superfine powder.After 6 months,the whole blood and thymic tissue were taken,then RT-PCR and Western blotting methods were used to detect the mRNA and protein expressions levels of Notch2 gene in the thymic lymphoma tissue;ELISA method was used to detect the serum immunoglobulin (IgG,IgA,IgM)levels and SOD kit was used to detect the serum SOD activities of the tumor mice.Results:The incidences of thymic lymphoma in irradiation group and combined group were 53.33%(16/30)and 36.67% (11/30),respectively.Compared with control group,the expression levels of mRNA and protein of Notch2 gene in thymic lymphoma of the mice in irradiation group were significantly increased (P <0.05);compared with irradiation group,the expression levels of mRNA and protein of Notch2 gene in combined group were decreased (P <0.05);compared with control group,the levels of IgG,IgA,and IgM in serum of the mice in irradiation group were decreased (P < 0.05 ); compared with irradiation group, the levels of IgG, IgM, hemoglobin and the activity of SOD in serum of the mice in combined group were increased (P < 0.05 ). Conclusion:Ionizing radiation can activate the high expression of Notch2 gene and protein and decrease the immune function of mice,it might be one of the mechanisms for the occurrence of radiation carcinogenesis;antlerbase can decrease the incidence of radiation carcinogenesis by inhibiting the expression of Notch2 gene and increasing the immune function of mice,which might play an role in restraining tumor.