Effects of Se, Zn and Cu levels on chemoradiotherapy related toxicity in patients with locally advanced lung cancer

Lung cancer, with 12% of overall new cancer cases globally, has considerable mortality rate. Chemotherapy and radiotherapy are the most common treatment modalities apart from surgery. Both, chemo- and radio- therapies, are known to have side affects. Trace elements are reported to influence the radiotherapy related adverse effects in the body. In this context, here, we investigated whether there is a difference in serum Se, Zn and Cu levels in patients receiving chemoradiotherapy (CRT) due to lung cancer when compared to healthy individuals and to evaluate effects of serum trace element levels measured before and after therapy on CRT related toxicity. This prospective study included 50 patients received CRT due to lung cancer and 50 healthy individuals. Serum selenium (Se), zinc (Zn), and copper (Cu) levels were measured before and after radiotherapy in patients with cancer, while a single measurement was performed in controls. When serum trace element levels were compared between patients with lung cancer and healthy controls, a significant difference was found in Zn level. A significant difference was detected between serum Cu and Se levels measured before and after CRT in patients with lung cancer (P <0.001 and P =0.019). In the assessment of acute toxicity during, a significant difference was detected when Cu and Zn levels measured before and after treatment were compared. Our study indicates significant decreases in plasma Zn and Cu levels after radiotherapy, suggesting paying attention to nutritional status regarding these micronutrients and other antioxidant agents. Thus, Zn and Cu supplementation may reduce adverse effects in patients receiving CRT.

A cyclodextrin-based nanoformulation achieves co-delivery of ginsenoside Rg3 and quercetin for chemo-immunotherapy in colorectal cancer

The immune checkpoint blockade therapy has profoundly revolutionized the field of cancer immunotherapy. However, despite great promise for a variety of cancers, the efficacy of immune checkpoint inhibitors is still low in colorectal cancer (CRC). This is mainly due to the immunosuppressive feature of the tumor microenvironment (TME). Emerging evidence reveals that certain chemotherapeutic drugs induce immunogenic cell death (ICD), demonstrating great potential for remodeling the immunosuppressive TME. In this study, the potential of ginsenoside Rg3 (Rg3) as an ICD inducer against CRC cells was confirmed using in vitro and in vivo experimental approaches. The ICD efficacy of Rg3 could be significantly enhanced by quercetin (QTN) that elicited reactive oxygen species (ROS). To ameliorate in vivo delivery barriers associated with chemotherapeutic drugs, a folate (FA)-targeted polyethylene glycol (PEG)-modified amphiphilic cyclodextrin nanoparticle (NP) was developed for co-encapsulation of Rg3 and QTN. The resultant nanoformulation (CD-PEG-FA.Rg3.QTN) significantly prolonged blood circulation and enhanced tumor targeting in an orthotopic CRC mouse model, resulting in the conversion of immunosuppressive TME. Furthermore, the CD-PEG-FA.Rg3.QTN achieved significantly longer survival of animals in combination with Anti-PD-L1. The study provides a promising strategy for the treatment of CRC.

Dosimetric parameters of heart and left ventricle – comparison of 3D CRT and IMRT in left cancer breast

Background: Conformal Radiotherapy techniques adapting to the ballistics of delineated volumes allowed significant reduction in excess radiation induced mortality however the increasing number of long-term survivors and expanding use of cardiotoxic drug highlight the persistent need for maximal cardiac possible sparing. The low dose volume of left ventricle are better predictor of acute coronary events than mean heart dose. Materials and Methods: 38 post-MRM patients were randomized to treatment by 3Dimensional Conformal Radiotherapy (3D CRT) and Intensity Modulated Radiotherapy (IMRT) technique. Two tangential beams were used in 3D CRT technique while five to seven (mostly tangential beams) were used in inversely planned IMRT technique. The dose volume parameters of planning target volume, heart and left ventricle were compared. Results: The dosimetry of Planning target volume showed significantly better coverage in IMRT technique (D90, D95) however the D50 was comparable in both the techniques. In dosimetry of heart, the high dose volumes (V30, V40) were nearly comparable in both the techniques. The other dose volume parameters (V5, V10, V20, V25, D33, D67, D100) and the mean dose were significantly lesser in 3D CRT technique along with significantly better sparing of left ventricle (Dmean and V5). Conclusion: The dosimetry of target volume was better with IMRT technique, but this was accompanied by a huge increase in dose to whole heart and specifically the left ventricle which has strong potential to translate into an increased cardiotoxicity. A better distribution of the target region may be obtained by multiple segmentation of the two tangential fields in 3D CRT plans with further reduction in dose to heart and left ventricle.

Cardiac resynchronization therapy in patients with heart failure and moderately reduced ejection fraction: Could it trigger a super-response?

Background/Aim Despite the well-established benefits of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with left ventricular ejection fraction (LVEF) ≤35%, many patients with less reduced EF remain refractory to optimized medical treatment and at high risk of morbidity and mortality. The objective of the study is to evaluate the effects of CRT in optimally treated patients with New York Heart Association (NYHA) classes II–IV, LVEF of 36–45%, and left bundle branch (LBBB), including clinical, structural and biochemical response. Methods A selected group of HF patients have been implanted with CRT-P devices and were followed up for 6 months at 4, 12 and 24 weeks. Clinical assessment included NYHA class, quality of life and 6-min walk distance (6 MWD) test. Echocardiographic assessment included LV dimensions and function and left atrial volume. Serum N-terminal pro b-type natriuretic peptide (NT-ProBNP) was measured at the same intervals. Results This prospective single center study included 23 patients. NYHA functional class significantly improved after CRT-P (p < 0.0001), associated with improvement in QOL (p < 0.0001) and 6 MWD, which increased, from 145.7 ± 20.1 m to 219.5 ± 42.2 m (p < 0.0001). Mean QRS duration showed significant shortening from 164.4 ± 13.2 ms to 126.4 ± 13.6 ms (p < 0.0001). CRT induced reverse remodeling with reduction in both left ventricular end diastolic diameter (LVEDD) from 68.95 ± 5.05 mm to 62.8 ± 4.47 mm, p = 0.0002 and left ventricular end systolic diameter (LVESD) from 54.1 ± 4.5 mm to 46.5 ± 4.1 mm, p < 0.0001, and significant increase in LVEF (from 40.3 ± 2.8 to 48.3 ± 4.2 mm, p < 0.0001). The biochemical response to CRT showed significant reduction in serum NT-ProBNP from 1025.6 ± 363.1 pg/ml to 594.9 ± 263.5 pg/ml (p < 0.0001). Conclusions Symptomatic HF patients on maximal optimized medical treatment who have LBBB and baseline LVEF 35–45% appeared to derive significant clinical and structural benefit from CRT.

Probable Controversy of Cardiac Resynchronization Therapy on the Adaptive Energy Metabolism of Hypertrophied and Insufficient Heart in Democratic Republic of Congo

Background: It is reported that 20 to 30% of patients are not responders to this treatment (Cardiac Resynchronization Therapy). The reasoning in this merely theoretical paper shows the plausible danger that can be brought by measurements apparatus, in the occurrence the CRT especially when it is sophisticated. Objective: In Physical Cardiochemistry field our overall purpose is to bring a contribution to heart health. It is needful to draw attention for caregivers and manufacturers, especially with respect to the magnetism these apparatuses may exhibit. Methods: The Observation and documentary research are used. It is recalled hereby successively energy metabolism in healthy cardiomyocyte, adaptive energy metabolism of a hypertrophied and insufficient heart, cardiac resynchronization therapy and energy metabolism of the cardiomyocyte with its potential effects on both glucose oxidation and fatty acids oxidation. Results: It is shown a plausible interaction between oxygen magnetic field, paramagnetic by nature, and pacemaker and/or defibrillator electromagnetic field according to the sacral principle of “like dissolves like” with all evil consequences on patients. Conclusion: It will be necessary to evaluate later not only the behavior of the various energetic substrates of a hypertrophied heart as a function of the variation of the magnetic field strength but also the content of the probable substances produced in the presence of a magnetic field and with a potentially harmful effect on cardiac function. Convinced technology has its setbacks, the pacemakers and/or defibrillators manufacturers are invited to a greater rigor, greater caution and sustained care in building these devices. In next publication study of a case (CRT-D), where the diabetes has been observed, will be outlined.

The preliminary study on clinical application of CRT+ARC technique in patients with locally advanced lung cancer / 实用肿瘤学杂志

Objective This paper investigated the clinical application of CRT+ARC technique in locally advanced lung cancer. Methods A total of 100 patients with locally advanced lung cancer who underwent radiotherapy in our hospital from March 1,2016 to March 1,2017 were randomly assigned to the experimental and control groups. Each group consisted of 50 patients. The CRT+ARC plans were made for the experimental group,and the CRT + intensity-modulated radiotherapy(IMRT)(CRT+IMRT) plans for the control group. According to the World Health Organization( WHO) criteria,the short-term efficacy of patients was as-sessed. According to the imaging examination and the Radiation Therapy Organization Group(RTOG)standard,the occurrence of major side effects of radiation pneumonia was identified. Results The effective rate of treatment was 82% in the experimental group and 76% in the control group. There was no difference in the effective rate between the two groups(χ2 =0. 542,P=0. 461). The incidence of pneumonia in the experimental group was 22% ,and 18% in the control group. There was also no difference in the incidence of pneumonia between the two groups(χ2 =0. 250,P=0. 617). Conclusion In the clinical application of locally advanced lung cancer, CRT+ARC technique has no difference in the short-term efficacy and the main side effects of radiation pneumonitis compared with CRT+IMRT.

Correlation of Caries Experience and Activity between Mothers and Their Children Using a Colorimetric Test / 대한소아치과학회지

The purpose of this study was to compare the validity of Cariview®, a new colorimetric caries activity test, with CRT® bacteria, a conventional bacterial culture method. In addition, this study assesses the correlation between the dental caries experience and activity between mothers and their children.34 pairs of mothers and their children under the age of 6 years participated in this study with informed consent. After filling out a questionnaire and oral examination, the two caries activity tests above were performed on each subject.In the results, Cariview® scores were statistically significant with children's caries experience (r = 0.598, p <0.01) and showed higher correlation than CRT® bacteria scores. Cariview® scores showed statistically significant correlation with the number of decayed teeth in both mothers and children (p <0.05). In both Cariview® and CRT® bacteria tests, there was no statistically significant correlation between caries experience and caries activity (p > 0.05).Cariview® colorimetric test will be clinically useful for predicting future caries risk and establishing a preventative strategy in pediatric dentistry.

An analysis on related influence factors of the long-term curative effect of 3D conformal radiotherapy for patients with esophagus cancer / 中国医学装备

Objective: To explore related influence factors of the long-term curative effect of 3D conformal radiotherapy for patients with esophagus cancer. Methods: 472 patients with esophageal cancer were carried out simulative location by using CT, and they were implemented radical operative 3D conformal radiotherapy. And their basic documents and image documents were analyzed by using single factor analysis, and then these screened factors were token into Cox model to carry out multiple-factor analysis so as to seek the influence factor of long-term curative effect. Results: The 1 year, 3-year and 5-year survival rate of all of patients were 71.0%, 33.1% and 26.2%, respectively. The results of single factor analysis showed that series of factors, included parts of stratification, length of lesion, the longest diameter of the lesion, largest anteroposterior diameter of lesion, the largest transverse diameter of lesion, wall thickness of lesions, GTV-E, GTV-LN, GTV-T, whether out invasion, whether lymph node metastasis, lymph node metastasis model and the number of lymph nodes under X-ray, were significantly relative with long-term prognosis of patients. And then, the multiple-factor analysis of Cox model showed that the longest diameter of the lesion and GTV-T were the independent factor that can influence the long-term prognosis (OR=1.647, OR=1.379, P<0.05). Conclusion:GTV-T and the longest diameter of lesion on the CT image of patients with esophagus cancer can influence the long-term curative effect of 3D conformal radiotherapy for esophagus cancer. Therefore, they should be applied as the important evaluation index in formulating therapeutic schedule.

Cáncer anal: resultados clínicos, toxicidades y supervivencia libre de colostomía comparando técnicas de radioterapia conformada tridimensional versus radioterapia de intensidad modulada / Anal cancer: clinical results, toxicities and colostomy-free survival comparing three-dimensional conformal radiotherapy techniques versus intensity modulated radiotherapy

Las técnicas definitivas de quimio-radioterapia para el cáncer anal, radioterapia tridimensional conformada (3DCRT) o radioterapia de intensidad modulada (IMRT) dan excelentes resultados a largo plazo. Evaluamos resultados en centros de radiación basados en la comunidad. Se evaluaron retrospectivamente 281 pacientes tratados con quimio-radioterapia definitiva para carcinoma anal loco-regional, entre 2006 y 2014. El 95% realizó quimioterapia. Se evaluaron datos de toxicidades, progresión de la enfermedad y necesidad de colostomía durante el período de seguimiento. La supervivencia global, supervivencia libre de progresión y colostomía libre se calcularon con métodos de Kaplan-Meier. La edad media fue 63.7 años con seguimiento medio de 60 meses. Ciento sesenta y nueve pacientes recibieron IMRT y 112 recibieron 3DCRT. La dosis total media tumoral fue 54 Gy. El 80% experimentó complicaciones agudas, y el 56% requirió interrupción de tratamiento. No hubo diferencias significativas en supervivencia global, supervivencia libre de progresión, supervivencia libre de colostomía ni control local a dos años entre ambos grupos. La IMRT tuvo menos suspensión del tratamiento (48% vs. 65%) (p=0.0261). El grupo IMRT tuvo una reducción significativa de todas las toxicidades agudas ≥3 y gastrointestinales (GI) tardías, en comparación con los tratados con 3DCRT. Esta serie representa una de las mayores comparaciones 3DCRT vs. IMRT para el tratamiento definitivo de cáncer anal. Los resultados a largo plazo no difieren significativamente en función de la técnica de radioterapia (RT). La IMRT reduce todas las toxicidades ≥ grado 3 y la necesidad de interrupción en comparación con 3DCRT (AU)

The definitive techniques of chemo-radiotherapy for anal cancer, 3DCRT or IMRT, give excellent long-term results. We evaluated results in community-based radiation centers. We retrospectively evaluated 281 patients treated with definitive chemo-radiotherapy for locoregional anal carcinoma, between 2006 and 2014. The 95% performed chemotherapy. Toxicity data, progression of the disease, need of colostomy during the follow-up period were evaluated. Global survival (GS), progression free survival (PFS), and free colostomy survival (CFS) were calculated with Kaplan-Meier methods. Mean age was 63.7 years with a mean follow-up of 60 months. One hundred and sixty nine patients received IMRT and 112 received 3DCRT. The total mean tumor dose was 54 Gy. The 80% experienced acute complications, and 56% required treatment interruption. There was no significant difference in GS, PFS, CFS or local control at two years between both groups. The IMRT had less treatment discontinuation (48% vs. 65%) (p = 0.0261). The IMRT group had a significant reduction in all acute toxicities ≥3 and late gastrointestinal, compared with those treated with 3DCRT. This series represents one of the largest 3DCRT vs. IMRT comparisons for the definitive treatment of anal cancer. The long-term results do not differ significantly depending on the RT technique. The IMRT reduces all toxicities ≥ grade 3 and the need for interruption compared to 3DCRT (AU)

Dosimetric study of intensity modulated direct aperture optimization radiation therapy for testicular seminoma / 医疗卫生装备

Objective To compare the field-matching techniques and dosimetric characteristics in the target area of testicular seminoma including the abdominal and pelvic cavities between direct aperture optimization intensity modulated radiation therapy (DAO-IMRT) and 3D conformal radiation therapy (3D-CRT),and to analyse the advantages and disadvantages of DAO-IMRT.Methods DAO-IMRT and 3D-CRT plans were designed with Pinnacle treatment planning system for 7 testicular seminoma patients,and the characteristics of both the irradiation methods were analyzed and evaluated by means of the parameters like dose homogeneity indexes,dose volume histograms and etc.Results DAO-IMRT had the hot and cold volumes in the target areas both significantly smaller than those by 3D-CRT,while the conformity index and homogeneity index superior to those by 3D-CRT.The mean doses (Dmean) by DAO-IMRT of the organs at risk (OAR) except the left femur head were all lower than those by 3D-CRT,aud the V15 values of liver,double kidney,small intestine and rectum by DAO-IMRT were statistically lower than those by 3D-CRT (P＜0.01).3D-CRT had the V5 values of OAR all lower than those by DAO-IMRT,in which the differences of double kidney,small intestine,bladder,left femur head and normal tissues were significant statistically (P＜0.05).The monitor units by DAO-IMRT roughly doubled when compared with those by 3D-CRT,and the difference was also significant (P＜0.01).Conclusion DAO-IMRT with easy operation and high reliability can avoid the connection of fields in the target area of testicular seminoma,and is superior to 3D-CRT in dosimetry.

Long-term effect and radiation side reaction of different boost methods in patients with local remnants of locally advanced nasopharyngeal carcinoma after curative radiotherapy / 实用医学杂志

Objective To investigate the long-term effect and radiation side reaction of different boost methods in patients with local remnants of locally advanced nasopharyngeal carcinoma after curative radiotherapy Methods Based on the retrospective analysis , 102 patients with local remnants of locally advanced nasopharyngeal carcinoma, after curative radiotherapy, were enrolled from February 2009 to May 2011. Forty-nine patients received gamma knife boost and 53 patients received 3-dimensional conformal radiotherapy (3D-CRT). The long-term effect and radiation side reaction were compared between the two groups. Results The 1-year, 3-year, and 5-year relapse-free survival rate (RFS) in the gamma knife boost group and the 3D-CRT group was 97.8%, 90.0%, 80.8%, and 94.3%,76.1%,72.9%, respectively (P < 0.05). No significant differences of the overall survival and metastasis-free survival rate wer found in two groups , as well as the long-term radioactive reaction. Conclusion The gamma knife boost is better than 3D-CRT with respect to local control rate , but the long-term radiation side reactions were similar between the methods.

Clinical Observation of Tegafur Gimeracil Oteracil Potassium Combined with 3D-CRT and Microwave Hy-perthermia in the Treatment of Elderly Patients with Local Advance Esophageal Cancer / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of tegafur gimeracil oteracil potassium combined with 3D-CRT and microwave hyperthermia in the treatment of elderly patients with local advance esophageal cancer. METHODS:48 cases of local advance esophageal cancer were divided into group A,B and C according to random number table method,with 16 cases in each group according to random number table method. Group A was given 3D-CRT with total dose of 60-66 Gy totnlly for 6-7 weeks;group B was additionally given tegafur gimeracil oteracil potassium 60 mg/(m2·d),bid,on the basis of group A 3 weeks for a course of treatment,until the end of radvotherapy;group C was additionally given thermotherapy on the basis of group B 3 weeks for a course of treatment,until the end of radvotherapy. Clinical efficacy,1-year survival rate,dysphagia,weight and KPS score were compared among 3 groups,and the occurrence of toxic reactions(radioactive esophagitis,radioactive pneumonia, bone marrow suppression and gastrointestinal reaction) were observed in 3 groups. RESULTS:Total effective rate,1-year survival rate and the remission rate of dysphagia of group C were 93.75%,87.50% and 93.75%,which were significantly higher than those of group A(50.00%,50.00% and 56.25%)and B(68.75%,68.75% and 68.75%),with statistical significance(P0.05). The incidence of radioactive esophagitis and radioactive pneumonia in group C were significantly lower than in group A and B,with statistical significance(P0.05). CONCLUSIONS:Tegafur gimeracil oteracil potassium combined with 3D-CRT and microwave hyperthermia in the treat-ment of elderly patients with local advance esophageal cancer further improves clinical efficacy and survival rate,but shows low inci-dence of toxic reaction.

Immunogenic Cell Death Induced by Ginsenoside Rg3: Significance in Dendritic Cell-based Anti-tumor Immunotherapy

Cancer is one of the leading causes of morbidity and mortality worldwide; therefore there is a need to discover new therapeutic modules with improved efficacy and safety. Immune-(cell) therapy is a promising therapeutic strategy for the treatment of intractable cancers. The effectiveness of certain chemotherapeutics in inducing immunogenic tumor cell death thus promoting cancer eradication has been reported. Ginsenoside Rg3 is a ginseng saponin that has antitumor and immunomodulatory activity. In this study, we treated tumor cells with Rg3 to verify the significance of inducing immunogenic tumor cell death in antitumor therapy, especially in DC-based immunotherapy. Rg3 killed the both immunogenic (B16F10 melanoma cells) and non-immunogenic (LLC: Lewis Lung Carcinoma cells) tumor cells by inducing apoptosis. Surface expression of immunogenic death markers including calreticulin and heat shock proteins and the transcription of relevant genes were increased in the Rg3-dying tumor. Increased calreticulin expression was directly related to the uptake of dying tumor cells by dendritic cells (DCs): the proportion of CRT+ CD11c+ cells was increased in the Rg3-treated group. Interestingly, tumor cells dying by immunogenic cell death secreted IFN-gamma, an effector molecule for antitumor activity in T cells. Along with the Rg3-induced suppression of pro-angiogenic (TNF-alpha) and immunosuppressive cytokine (TGF-beta) secretion, IFN-gamma production from the Rg3-treated tumor cells may also indicate Rg3 as an effective anticancer immunotherapeutic strategy. The data clearly suggests that Rg3-induced immunogenic tumor cell death due its cytotoxic effect and its ability to induce DC function. This indicates that Rg3 may be an effective immunotherapeutic strategy.

Clinical effect analysis of supraclavicular lymph node metastasis of esophageal cancer by chemoradi-ation therapy / 中国医师杂志

Objective To evaluate the clinical curative effect,survival rate and adverse reactions of three-dimensional conformal radiotherapy(3D-CRT )in combination with chemotherapy on lymph nodes metastasis of esophageal carcinoma.Methods Using supraclavicular 3D-CRT combined with chemotherapy on and simple 3D-CRT supraclavicular lymph node metastasis of esophageal cancer patients,3D-CRT com-bined synchronous chemotherapy (treatment group),51 cases,only 3D-CRT 49 cases (control group).3D-CRT combined synchronous chemotherapy 51 cases (treatment group),simple 3D-CRT 49 cases (control group).These patients 3D-CRT were given the total dose of 50 ~60Gy/25 ~30F.TN chemotherapy regi-mens were applied:paclitaxel 135 mg/m2 ,d1;Nedaplatin 25 mg/m2 ,d1,1 ~3,21 days cycle in fist week and fourth week.Results Local control and treatment group survival rates in 1,2 year were significantly higher than that of control group (P <0.05).Treatment group adverse reaction rate is higher than the con-trol group,but there was no statistically significant difference.Conclusions The recent curative effect and survival rate could be significantly improved by 3D-CRT joint TN synchronous chemotherapy regimen for pa-tients with supraclavicular lymph node metastasis of esophageal cancer,but the relatively high incidence of adverse reactions,clinical application should be considered comprehensively according to actual situation.

A dosimetric comparison of three-dimensional conformal and intensity-modulated radiotherapy in locally advanced pancreatic cancer and a study of the clinical efficacy / 中华放射医学与防护杂志

Objective To compare the dose distribution between three-dimensional conformal radiotherapy(3D-CRT) and intensity-modulated radiotherapy (IMRT) in treating locally advanced pancreatic cancer,and report the efficacy of IMRT combined with regional chemotherapy using gemcitabine (GEM).Methods Ten patients with locally advanced pancreatic cancer were enrolled in this study.3D-CRT and IMRT plans were designed for each patient.The dose distributions of target volume and normal tissues were analyzed using the dose volume histogram (DVH).Twenty-five locally advanced pancreatic cancers patients who were treated by IMRT combined with regional chemotherapy using gemcitabine (combined group) were retrospective analyzed,as well as 25 hospitalized patients of the same period who were treated by regional chemotherapy using gemcitabine alone (chemotherapy alone group).The therapeutic efficacy and adverse events were compared between two groups.Results IMRT plans decrease the mean dose and volume of duodenum,liver,stomach,both kidney and small bowel that received highdose irradiation.The 1-,2-year survival rate of the combined group and chemotherapy alone group was 60％,28％ and 36％,12％.The median survival time of two groups was 15 and 10 months,respectively (x2 =4.16,P ＜0.05).The total response rate of the combined group and the chemotherapy alone group was 64％ and 32％,respectively (x2 =5.13,P ＜ 0.05).The upper gastrointestinal side-effect rate of the combined group was higher than that of the chemotherapy alone group(Z =-2.354,P ＜ 0.05).There was no statistic significance in hematologic toxicity,liver and renal functional damage between the two groups.Conclusions Compared with 3D-CRT plan,IMRT plan could reduce the dose of organ at risks.IMRT combined with regional chemotherapy using gemcitabine could significantly improve the survival rate of patients with locally advanced pancreatic cancer with mild adverse events.

Clinical research of SRT and 3D-CRT on treatment of brain metastasis form lung cancer / 重庆医学

Objective To assess the evaluation of SRT (Stereotactic radiotherapy ) and 3D-CRT (Three-dimensional conformal ra-diotherapy)on treatment of brain metastasis from lung cancer .Methods From June 2009 to June 2011 ,74 patients with multiple brain metastasis(brain metastasis ≤3 ,tumor mass ≤3 cm) from lung cancer were analyzed retrospectively ,37 patients received 3D-CRT alone were retrospectively compared with 37 patients who received SRT alone .the results was evaluated by median survival time(MS) ,local control(LC) and toxicity effect .Results The median survival time(MS) was 9 .3 ,which 8 .6 months after 3D-CRT ,and 10 .6 months after SRT .the local control rate was 73 .5% for 3D-CRT ,and 79 .6% for SRT after 3 months .there was no difference between two groups on toxicity effect from stastic .Conclusion The SRT was a efficacious methods for the treatment of brain metastasis from lung cancer ,which could improve the local control rate ,but there was no more toxiticy .

Comparison of dosimetry in radiotherapy for craniospinal irradiation / 中华放射医学与防护杂志

Objective To explore the dosimetry of simplified intensity modulated radiotherapy (sIMRT)in the spinal component of craniospinal irradiation(CSI)compared with conventional plan(3D-CRT).Methods Five previously treated patients were adopted to generate 3D-CRT,3-and 5-field slMRT plans.The prescribed dose was 36 Gy to the planning target volume(PTV)in 20 fractions.The dose distributions of target volume and normal tissues,and homogeneity index(HI)were ananlyzed using the dose volume histogram.The total monitor units(MUs)were also analyzed to compare the delivery time indirectly.Results For 3D-CRT plans,the region of the neighbouring fields only received 70％ of the prescribed dose,and the maximum dose delivered in the normal tissues was increased to approximately 140％ of the prescribed dose.The homogeneity index(HI)of 3-and 5-field sIMRT were 0.09 ± 0.01 and 0.08 ±0.01,respectively,superior to that of 3D-CRT(0.18 ± 0.02,t=7.80,7.65,P＜0.05).The values of V10 for the heart of 3-and 5-field sIMRT were(8.4 ± 1.9)％ and(8.4 ± 2.0)％,respectively,lower than that of 3D-CRT((36.0 ± 6.0)％(t=13.3,13.0,P＜0.05).V20 for the thyroid gland were (12.4±1.5)％ and(12.4±1.6)％,respectively,lower than(69.4±5.7)％ of 3D-CRT(t=26.3,26.4,P＜0.05).V20 for the larynx were(17.2 ± 1.2)％ and(17.9 ± 1.5)％,respectively,lower than that of 3D-CRT[(89.4±7.0)％(t=25.5,26.5,P＜0.05)].V30for the NTwas(4.4±1.4)％,(4.9± 1.9)％,lower than that of 3 D-CRT[(31.9 ± 6.1)％(t=8.5,10.1,P＜0.05)].The averaged values of total MUs for 3-and 5-field sIMRT were 1100 ± 177 and 1160 ±204,respectively,higher than that of 3D-CRT(640 ± 151).Conclusions Compared with the 3D-CRT CSI technique,3-and 5-field sIMRT have better dose distribution and can improve target dose uniformity and protect the organs at risk.

Comparison of dosimetry between inversely optimised intensity-modulated radiotherapy and threedimensional conformal radiotherapy using the field-in-field after breast-conserving surgery / 中华放射医学与防护杂志

Objective To compare the dosimetry between inversely optimised intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy using the field-in-field technique (FIF) for whole-breast radiotherapy with a boost to the tumor bed after breast-conserving surgery.Methods IMRT and FIF treatment plans were respectively performed and optimised for 9 patients with early stage leftbreast cancer after breast-concerving surgery.The prescribed dose of breast was 50.4 Gy in 28 fractions,1.8 Gy per fraction and that of tumor bed was 61.6 Gy in 28 fractions,2.2 Gy per fraction.The conformity index,the dose and volume for OAR( organs at risks),time of planning and treatment for the two plans were compared.Results The conformity index(CI) for IMRT was improved compared with the FIF in breast [(1.82±0.16) vs.(2.21±0.15)] and tumor bed [(1.19±0.04) vs.(1.59±0.11),t=2.08,3.97,P ＜ 0.05 ].There was no difference for V20 of ipsilateral lung and V30 of heart between two plans.The Dmax and Dmean of the contralateral lung of FIF were (5.41 ±2.76) and (0.51 ±0.10) Gy,lower than those of IMRT [ (25.72 ± 2.61 ) and (7.46 ± 0.39) Gy,t =-22.44,- 21.14,P ＜ 0.05 ].The Dmax and Dmean of the contralateral breast of FIF were (8.50 ± 5.61 ) and (0.47 ± 0.11 ) Gy,lower than those of IMRT [(27.73±4.30) and (6.38±0.48) Gy,t=-5.66,-14.83,P＜0.05].ForFIF,theV5of the contralateral lung and breast were (0.09 ± 0.09) ％ and (0.45 ± 0.45 ) ％,respectively,lower than those of IMRT,which were (84.66 ±3.06) ％ and (60.79 ±4.94)％ (t =-28.19,- 12.80,P＜0.05).The time of optimised plan was (61.57 ± 0.89) min for FIF and(241.28 ± 1.06) min for IMRT (t=-32.35,P＜0.05),and that of treatment were (16.14±1.42) min for FIF and (29.85 ±0.59) min for IMRT (t =- 8.82,P ＜ 0.05).Conclusions For patients with early stage breast cancer after breast-concerving surgery,IMRT could improve the conformity index of target but increase the dose of eontralateral lung and breast.However,FIF has advantage on the time of optimising plan and treatment.

The Three Dimensional Conformal Radiotherapy for Hyperkeratotic Plantar Mycosis Fungoides

The localized early-stage of Mycosis fungoides (MF) (stage IA-IIA) is usually treated with topical agents, such as nitrogen mustard, steroids, and phototherapy (UVB/PUVA) as first line therapy; response to these initial treatments is usually good. However, hyperkeratotic plantar lesions are clinically rare and have decreased responsiveness to topical agents. For such cases, physicians may consider local radiotherapy. Here, a case of an 18-year-old Korean woman who was treated with three-dimensional conformal radiotherapy (3D-CRT) for hyperkeratotic plantar lesions that were refractory to UVA-1, methotrexate, and topical steroids is reported. Complete remission was attained after radiotherapy. During the one-year follow-up period, there has been no evidence of disease recurrence and no chronic complications have been observed.

Mitoxantrone inhibits growth of melanoma by increasing expression of calreticulin / 中国肿瘤生物治疗杂志

Objective: To investigate the effect of mitoxantrone (MIT) on calreticulin (CRT) expression in B16 cells, and to observe the immune effect of B16-membrane antigen vaccine highly expressing CRT on B16 tumor-bearing mice. Methods: The expression of CRT on membrane of B16 cells was detected by immunofluorescence after treatment with different concentrations of MIT. B16-implanted mouse model was established, and the growth of B16-implanted tumors and CRT expression in B16-implanted tumor tissues were observed after treatment with different concentrations of MIT. Membrane antigen vaccines from both normal B16 cells and MIT-treated B16 cells were prepared, and mice were immunized before B16 cell implantation. The infiltration of immune cells into B16 tumor tissues and the ratios of CD4~+ and CD8~+ T cells in the spleen of B16 tumor-bearing mice were examined by immunohistochemistry and flow cytometry, respectively. Results: Flow cytometry results showed that MIT dose-dependently increased CRT expression on B16 cell membrane, with CRT expression in control and high dosage MIT groups being (29.40±3.57)% and (72.20±2.94)% (P<0.05), respectively. MIT also increased CRT expression in B16 tumor tissues, with those in the control and high dosage MIT groups being 3.21±1.37 and 9.17±1.06 (P<0.05), respectively. MIT effectively inhibited the growth of B16 tumors (P<0.05). Compared with normal B16 cell membrane antigen vaccine, the vaccine highly expressing CRT increased the numbers of DCs and T cells in B16 tumors tissues and the ratios of CD4~+ and CD8(+) T cells in the spleen (P<0.05). Conclusion: MIT can increase CRT expression on membrane of B16 cells. B16-membrane antigen vaccine highly expressing CRT can enhance the infiltration of DCs and T cells in melanoma, thus improving the immune effect of B16-membrane antigen vaccine.