Analysis of the 10-year survival results of patients with esophageal squamous cell carcinoma achieving clinical complete remission after radical radiotherapy / 中华放射肿瘤学杂志

Objective:To investigate the long-term prognosis and failure mode of patients with esophageal squamous cell carcinoma who achieved clinical complete remission (cCR) after receiving radical radio (chemo) therapy.Methods:Clinical data of 183 patients with esophageal squamous cell carcinoma eligible for inclusion criteria who received treatment in our hospital from January 2009 to December 2012 were retrospectively analyzed. The factors that affected the long-term prognosis of patients were identified, and the failure mode of cCR patients and the prognosis after failure were analyzed. SPSS 19.0 statistical software was used for data analysis.Results:As of the follow-up date, the 1-, 3-, 5-, and 10-year overall survival (OS) rates and disease-free survival (DFS) rates of the entire group were 83.1%, 53.4%, 36.2%, 12.8% and 68.9%, 45.9%, 30.5%, 12.0%, respectively. The median OS and DFS were 41.3 months and 33.4 months. The results of multivariate analysis showed that cT staging, cN staging and prescribed dose were the independent factors affecting the OS ( P=0.001, <0.001, 0.003); hoarseness, lesion length, cT staging, cN staging and prescribed dose were the independent factors that affected the DFS ( P=0.002, 0.033, 0.009, <0.001, 0.003). In the whole group, 72 cases (39.3%) had local regional recurrence, 58 cases (31.7%) had distant metastasis, and 26 cases (14.2%) had local regional recurrence with distant metastasis. Among 104 patients after treatment failure, the prognosis of patients receiving salvage treatment was significantly better than that of their counterparts receiving maintenance treatment ( χ2=39.153, P<0.001). Conclusions:The long-term prognosis of patients with esophageal squamous cell carcinoma who achieved cCR after receiving radical radio (chemo) therapy is still unsatisfactory. Clinically, it is necessary to strengthen the clinical observation and follow-up of these patients. The main treatment failure mode of cCR patients is local regional recurrence. Active salvage treatment can significantly improve clinical prognosis of these patients.

Research progress on application of artificial intelligence in radiotherapy for gynecological malignancy / 中华放射肿瘤学杂志

The gynecological malignancy has a high incidence and mortality. More efficient treatment methods still need to be explored to improve the survival benefits. Artificial intelligence (AI) aims to intelligently process the original problems by simulating the thinking way of human brain. It has obtained significant progress in gynecological malignancy, with great potential in the field of cancer diagnosis and treatment. This paper reviews the application of AI in the diagnosis and treatment of gynecological malignancy, and mainly introduces the research progress on AI in the radiotherapy. This paper mainly focuses on the key issues such as automatic delineation, dose prediction, radiotoxicity prediction and efficacy prediction, and discusses the current benefits and limitations of AI in radiotherapy of gynecological malignancy.

Radioterapia en cáncer de la región maxilofacial / Radiation therapy in cancer of the maxillofacial region

RESUMEN Introducción: La Radiobiología es la ciencia perteneciente a la biología que estudia los efectos de los distintos tipos de radiación sobre la materia viva. Objetivo: Identificar la evidencia científica respecto a la radioterapia del paciente con cáncer en la región maxilofacial. Métodos : Se realizó una revisión de la de literatura acerca del tema en motores de búsqueda como: las bases de datos electrónicas PubMed, Medline, Cochrane, Hinari y SciELO. Para la búsqueda de la información se utilizaron las palabras clave: cáncer de cabeza y cuello, tratamiento del cáncer de la región maxilofacial, radioterapia, braquiterapia y tipos de radioterapia. Resultados: Para el tratamiento se necesita evaluar las características del tumor y determinar el estadio tumoral, la localización y extensión de la enfermedad, así como los hallazgos patológicos que dictan la conducta adecuada como la cirugía, radioterapia, quimioterapia, terapia hormonal, inmunoterapia y terapia dirigida. La dosis máxima tolerada en relación con los órganos críticos oscila entre 50 y 76 Gy. Con la braquiterapia se puede colocar la fuente radiactiva dentro del paciente en cavidades anatómicas cerca del tumor o en el lecho tumoral. Esto permite administrar dosis elevadas de irradiación muy eficaces, al tumor o zona de riesgo. Los efectos adversos de las radiaciones ionizantes según la célula afectada pueden ser daño genético y somático. Conclusiones: En el tratamiento del cáncer la radioterapia es una opción primordial, siempre con el precepto que ofrezca buenos resultados en cuanto a eficacia, tolerabilidad y calidad de vida, al causar el menor daño posible a los enfermos y con las nuevas tecnologías puede incrementar el éxito y garantizar que el procedimiento continúe con calidad.

Introduction: Radiobiology is the science belonging to the biology that studies the effects of the different types of radiation on the lively matter. Objective: Identifying the scientific evidence in relation to radiation therapy of the patient with cancer of the maxillofacial region. Methods: A literature revision was carried out in search engines as: The electronic data bases PubMed, Medline, Cochrane, Hinari, and SciELO. For the search for information the key words used were head and neck cancer, treatment of the cancer of the maxillofacial region, radiation therapy, brachytherapy and types of radiation therapy. Results: For the treatment it is needed to evaluate the characteristics of the tumor and to determine the tumor stage, the location and extension of disease, as well as the pathological findings that dictate the conduct made suitable like the surgery, radiation therapy, chemotherapy, hormonal therapy, immunotherapy and directive therapy. The maximum dose tolerated relating to the critical organs oscillates between 50 and 76 Gy. With the brachytherapy the radioactive source inside the patient can place itself in reservoirs, close to the tumor or in the tumor area. This allows managing dose lifted of irradiation very effective, to the tumor or zone of risk. The adverse effects of the ionizing radiations according to the impaired cell can be genetic and somatic damage. Conclusions: In the treatment of cancer, radiation therapy is a primary option, always with the precept that offers good results as to efficacy, tolerance and quality of life, causing the smaller possible damage to the sick and with the new technologies it can increase success and guarantee that a procedure keeps on being high-quality.

New frontiers in endovascular therapies for locally advanced hepatocellular carcinoma / Novas fronteiras em terapias endovasculares para carcinoma hepatocelular localmente avançado

Abstract Hepatocellular carcinoma is the most common primary malignant liver tumour and is a leading cause of death worldwide. Despite the advent of screening programmes, most cases of hepatocellular carcinoma are diagnosed late (in an advanced stage) which precludes curative treatments such as surgery and ablation. Therefore, intra-arterial locoregional treatments now play a central role in the management of advanced hepatocellular carcinoma, such treatments ranging from trans-arterial chemo-embolisation to the more recently developed trans-arterial radio-embolisation technique. In this essay, we discuss the state of the art of intra-arterial treatment for locally advanced hepatocellular carcinoma and the future directions for such treatment.

Resumo O carcinoma hepatocelular é o tumor hepático maligno primário mais frequentemente observado, sendo uma das principais causas de mortalidade mundial. Apesar do advento dos programas de triagem, na maioria dos casos o diagnóstico tardio está associado a um estágio avançado da doença que impede o tratamento curativo, como cirurgia ou ablação. Assim, os tratamentos locorregionais intra-arteriais têm agora um papel central no gerenciamento avançado do carcinoma hepatocelular, passando por quimioembolização transarterial e radioembolização. Neste ensaio, discutimos o estado da arte do tratamento intra-arterial atualmente disponível para o carcinoma hepatocelular localmente avançado e suas direções futuras.

Research progress on epigenetics in the repair of radiation-induced DNA damage in tumors / 中华放射肿瘤学杂志

Radiotherapy kills tumor cells by radiation-induced DNA double-strand breaks (DSB), however, abnormal DSB repair in tumor cells often leads to radioresistance, in which epigenetics plays an important role. Targeting aberrant epigenetic markers may be a potential means of cancer radiosensitization, but the clinical application of the combination of epigenetic drugs and radiotherapy requires further investigation. This article reviews the latest research progress the role of epigenetics in the repair of radiation-induced DNA damage in tumors.

A nomogram model based on cone beam CT radiomics combined with clinical features and dosimetric parameters predicting radiation pneumonitis in patients with esophageal cancer receiving radiotherapy / 中华放射肿瘤学杂志

Objective:To develop and validate a nomogram model for predicting radiation-induced pneumonitis in esophageal cancer based on CBCT radiomics characteristics combined with clinical characteristics and lung dosimetric parameters.Methods:Clinical data, dosimetric parameters and CBCT images of 96 patients with thoracic middle esophageal squamous cell carcinoma treated by intensity-modulated radiation therapy (IMRT) from 2017 to 2019 were analyzed retrospectively. The CBCT images of each patient in three different time periods were obtained. All patients were assigned randomly into the primary cohort ( n=67) and validation cohort ( n=29). Double lungs were selected as the region of interest (ROI), and 3D-slicer software was used for image segmentation and feature extraction. The LASSO regression were applied to identify candidate radiomic features and construct the Rad-score. The optimal time period, clinical and dosimetric parameters were selected to construct the nomogram model, and then the area under the receiver operating characteristic curve (AUC) was used to evaluate the prediction effect of the model. Results:The predictive capacity of the model in the first time period was the highest. In the primary cohort, the AUC was 0.700(95% CI: 0.568-0.832), the sensitivity was 61.5%, and the specificity was 75.0%. In the validation cohort, the AUC was 0.765(95% CI: 0.588-0.941), the sensitivity was 84.6% and the specificity was 64.7%, respectively. In the combined nomogram model, the AUC in the primary cohort was 0.836(95% CI: 0.700-0.918), the sensitivity was 96.0% and the specificity was 54.8%. In the validation cohort, the AUC was 0.905(95% CI: 0.799-1.000), the sensitivity was 92.9% and the specificity was 73.3%, respectively. The diagnostic efficiency of combined nomogram model was the best. Conclusions:The nomogram model based on early lung CBCT radiomics has certain predictive efficiency for RP. The model of lung CBCT radiomics in early stage of radiotherapy can predict RP of esophageal cancer. The nomogram model based on Rad-score combined with V 5Gy, MLD and tumor stage yields better predictive accuracy, which can be used as a quantitative prediction model for RP.

Linfoma testicular primario tipo B de célula grande: aspectos clínicos, histopatológicos, diagnóstico terapéutico y pronósticos / Large cell type B primary testicular lymphoma: clinical, histopathological, therapeutic diagnosis and prognostic aspects

RESUMEN Fundamento: el linfoma testicular constituye entre el 1 y el 9 % de los tumores testiculares, es el tumor testicular maligno más frecuente en los varones mayores de 50 años. El pronóstico es reservado debido a una gran tendencia a la propagación sistémica temprana. La presentación clínica más habitual, dolor testicular a la palpación y espontáneo, con aumento del volumen y de la consistencia testicular. Su tratamiento se sustenta en tres pilares fundamentales: orquiectomía, quimioterapia y radioterapia. Objetivo: describir un enfermo con linfoma testicular tipo B de célula grande. Presentación del caso: paciente masculino de 55 años de edad, hipertenso, fumador 10 cigarrillos al día, bebedor ocasional. Acude a consulta por aumento de volumen testicular izquierdo. En la analítica se observa elevación del lactato deshidrogenasa. Ecografía: teste izquierdo con ecogenicidad muy heterogénea, parénquima desestructurado, sin lesiones nodulares. Engrosamiento difuso del epidídimo. Vascularización incrementada. Se realiza orquiectomía radical inguinal, al ser el diagnóstico anatomopatológico linfoma difuso de células grandes tipo B, en la actualidad ha sido tratado con quimioterapia, por presentar además afectación ósea. Pero ha evolucionado favorablemente. Conclusiones: el linfoma testicular es una enfermedad poco frecuente, a pesar de ser considerado el tumor testicular más común en mayores de 60 años. En su mayoría se trata de linfomas no Hodgkin difusos de grado intermedio alto de malignidad e inmunofenotipo B. El pronóstico siempre es reservado debido a su gran tendencia a la propagación sistémica. El tratamiento está basado en la cirugía (orquiectomía radical inguinal), quimioterapia y radioterapia.

ABSTRACT Background: testicular lymphoma constitutes between 1 and 9 % of testicular tumors; it is the most frequent malignant testicular tumor in men over 50 years of age. The prognosis is reserved due to a great tendency to early systemic spread. The most common clinical presentation is testicular pain on palpation and spontaneous, with increased volume and testicular consistency. Its treatment is based on three fundamental pillars: orchiectomy, chemotherapy and radiotherapy. Objective: to describe a patient with large cell type B testicular lymphoma. Case report: 55-year-old male patient, hypertensive, smoker 10 cigarettes a day, occasional drinker. He goes to consultation due to left testicular volume increase. In the laboratory tests, the lactate dehydrogenase is elevated. Ultrasound Scand: Left testicle with very heterogeneous echogenicity, unstructured parenchyma, no nodular lesions. Diffuse thickening of the epididymis. Increased vascularization. Inguinal radical orchiectomy is performed, the anatomic-pathological diagnosis being diffuse large B cell type lymphoma, it has now been treated with chemotherapy, because he alsopresented bone involvement. But he has evolved favorably. Conclusions: testicular lymphoma is a very rare entity, despite being considered the most common testicular tumor in people over 60 years of age. The majority are diffuse non-Hodgkin lymphomas of high intermediate degree of malignancy and immune-phenotype B. The prognosis is always reserved due to its great tendency to systemic spread. The treatment is based on surgery (radical inguinal orchiectomy), chemotherapy and radiotherapy.

Radiation-induced angiosarcoma: case report / Angiossarcoma induzido por radiação: relato de caso

ABSTRACT Angiosarcoma of the breast accounts for less than 1% of breast tumors. This tumor may be primary or secondary to previous radiation therapy and it is also named "radiogenic angiosarcoma of the breast", which is still a rare entity with a poor prognosis. So far, there are only 307 cases reported about these tumors in the literature. We present a case of a 73-year-old woman with a prior history of breast-conserving treatment of right breast cancer, exhibiting mild pinkish skin changes in the ipsilateral breast. Her mammography was consistent with benign alterations (BI-RADS 2). On incisional biopsy specimens, hematoxylin-eosin showed atypical vascular lesion and suggested immunohistochemisty for diagnostic elucidation. Resection of the lesions was performed and histology showed radiogenic angiosarcoma. The patient underwent simple mastectomy. Immunohistochemistry was positive for antigens related to CD31 and CD34, and C-MYC oncogene amplification, confirming the diagnosis of angiosarcoma induced by breast irradiation. A delayed diagnosis is an important concern. Initial skin changes in radiogenic angiosarcoma are subtle, therefore, these alterations may be confused with other benign skin conditions such as telangiectasia. We highlight this case clinical aspects with the intention of alerting to the possibility of angiosarcoma of the breast in patients with a previous history of adjuvant radiation therapy for breast cancer treatment. Sixteen months after the surgery the patient remains asymptomatic.

RESUMO Os angiossarcomas de mama representam menos de 1% dos tumores da mama e podem ser primários ou secundários à radioterapia prévia. Tais tumores são chamados de "angiossarcomas radiogênicos da mama" e representam uma entidade mais rara ainda e de prognóstico ruim. Atualmente, na literatura, são encontrados apenas 307 casos desses tumores. Relatamos o caso de uma mulher de 73 anos, com história prévia de tratamento conservador de câncer de mama direita, apresentando alteração rósea discreta em pele da mama homolateral. A mamografia demostrou resultado compatível com alterações benignas (BI-RADS 2). No material de biópsia incisional, a hematoxilina-eosina demonstrou lesão vascular atípica e sugeriu imuno-histoquímica para elucidação diagnóstica. A paciente foi submetida à ressecção de lesões, e a histologia demonstrou angiossarcoma radiogênico. Em seguida, mastectomia simples foi realizada. A imuno-histoquímica demonstrou positividade para os antígenos relacionados a CD31 e CD34, e a amplificação do oncogene C-MYC confirmou o diagnóstico de angiossarcoma induzido por radiação mamária. O atraso no diagnóstico constitui questão importante. Considerando que as alterações iniciais da pele do angiossarcoma radiogênico são sutis e podem ser confundidas com outras condições benignas da pele, como telangiectasias, neste relato destacamos os aspectos clínicos, no intuito de alertar sobre a possibilidade de angiossarcoma de mama em pacientes com história prévia de radioterapia adjuvante para tratamento de câncer de mama. A paciente permaneceu assintomática 16 meses após a cirurgia.

Complicaciones de la radioterapia: fenómeno de Lhermitte gatillado por calor: caso clínico / Complications of radiotherapy: Lhermitte phenomenon triggered by heat: report of one case

Lhermitte phenomenon is a neurological symptom described as a sensation of electric shock that radiates from the back towards the extremities, which appears when a patient flexes the neck. A transient myelopathy as a late complication of radiotherapy is associated with this symptom. It appears two to four months after treatment and disappears spontaneously. We report a 45 years old female with a neck malignant melanoma treated with surgery and adjuvant radiotherapy. She experienced the Lhermitte phenomenon that was triggered by heat. This phenomenon must be differentiated from the Uhthoff phenomenon.

Preliminary analysis of the factors influencing the secondary external auditory canal carcinoma of nasopharyngeal cancer / 中华放射肿瘤学杂志

Objective In order to investigate the clinical features and influence factors for incidence in patients with radiation-induced external auditory canal carcinoma (RIEACC).Methods The nasopharyngeal carcinoma (NPC) 16 patients who were diagnosised RIEACC after radiotherapy in the Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from January 1990 to December 2017 were retrospectively analysis.The influence factors analysis were used Logistic regression analysis.Results Univariate analysis showed that age,somking history,family history of cancer and NPC stage were the influencing factors.Multi-factor logistic regression analysis showed that age,family history of cancer and NPC stage were independent risk factors.Conclusions RIEACC is rare complication of NPC patients received radiotherapy,which is also a multifactorial outcome.Age,family history of cancer and NPC stage is preliminary the main influencing factor.Although RIEACC has a low incidence,its malignancy should be highly vigilant.

Effect of different nutritional support methods on esophageal cancer patients receiving radiotherapy / 中华放射肿瘤学杂志

Objective To compare the effect of nutritional support with and without tube feeding on the incidence of adverse reactions in radiotherapy for esophageal cancer.Methods A total of 120 esophageal cancer patients with high-risk factors receiving radiotherapy were selected and randomly assigned into the tube feeding (TF,n=60) and non-tube feeding groups (NTF,n=60) according to the random number method.Nutritional interventions were performed during radiotherapy in both groups.The incidence of esophagitis and myelosuppressioa,aulmonary infectioa,autritional status and the completion of radiotherapy were observed and statistically compared between TF and NTF groups.Results In the TF groua,ahe incidence of ≥ grade 2 esophagitis was lower than that in the NTF group.The incidence of grade 3 esophagitis significantly differed between two groups (P＜ 0.05).The incidence of grade 1-2 myelosuppression did not differ between two groupa,ahereas the incidence of grade 3 myelosuppression in the TF group was significantly lower than that in the NTF group (P＜0.05).In the TF groua,ahe incidence of pulmonary infection was remarkably lower than that in the NTF group (P＜0.05).The changes of BMI and prealbumin in the TF group were better than those in the NTF group (both P＜0.05).One patient in the NTF group failed to complete the radiotherapy due to grade Ⅳ esophagitia,and 5 cases in the NTF group (P＜ 0.05).In the TF groua,ahe length of hospital stay was significantly shortened by 6.2 d on average (P＜ 0.05).Conclusions During radiotherapy for esophageal cancer patients with high-risk factora,autritional support with tube feeding can effectively reduce the incidence of adverse reactiona,amprove the completion rate of treatmena,and shorten the average length of hospital stay.

Effect of tumor length on clinical stage for non-operative esophageal squamous cell carcinoma patients——multicenter retrospective data analysis (3JECROG R-01D) / 中华放射肿瘤学杂志

Objective To retrospectively analyze the effect of tumor length on the prognosis in stage Ⅱ/Ⅲ esophageal squamous cell carcinoma (ESCC) patients treated with definitive radiotherapy and to evaluate the role of tumor length in clinical stage for non-operative ESCC patients.Methods The data of 2 086 ESCC patients who were treated with definitive radiotherapy from 2002 to 2016 in 10 hospitals (3JECROG) were analyzed.The effect of tumor length on overall survival (OS) was analyzed and stratified analysis of tumor length was done in different stages of ESCC.Results The median OS and median progression-free survival (PFS) time of the whole group were 25.6 months and 18.2 months respectively.The Cox multivariate analysis showed that treatment moda,aga,alinical stage and tumor length were independent prognostic factors.The median,1-,3-,and 5-year OS were 28.9 months,77.3％,45.0％,and 36.3％ versus 21.9 months,69.9％,37.9％,and 28.1％ for patients with ≤ 5 cm and patients ＞ 5 cm respectively (P＜0.05).For stage Ⅱ patienta,abe median OS were 42.1 and 38.9 months respectively in ≤ 5 cm group and＞5 cm group (P=0.303).And for stage Ⅲ patienta,abe median OS were 23.9 and 19.3 months respectively in ≤5 cm group and＞5 cm group (P＜0.001).The median OS with N1was 24.1 and 18.4 montha,aespectively in ≤5 cm group and＞5 cm group (P＜0.001).Conclusions The tumor length was an independent prognostic factor for stage Ⅱ/Ⅲ patients treated definitive radiotherapy.The tumor length may be helpful in clinical staging of ESCa,aspecially for stage Ⅲ and N1.

Artificial Intelligence: opportunities and challenges in radiotherapy / 中华放射肿瘤学杂志

Artificial Intelligence are emerging as poweful tools for many field including medicine.It has be applied to radiation therapy in different degree,such as automatic OAR or tumor volume segmentation,automatic radiotherapy planning,prediction of toxicity and prognostic,etc.In this article,the research progress on Artificial Intelligence in the radiotherapy for malignant tumor was reviewed.

Research progress on dosage and segmentation of thoracic radiotherapy for limited-stage small cell lung cancer / 中华放射肿瘤学杂志

At present,surgery,systemic chemotherapy,thoracic radiotherapy and prophylactic cranial irradiation have been widely recognized to treat the limited-stage small cell lung cancer.In recent decades,no significant breakthrough has been reached in drug therapy.In the field of radiotherapy,the timing,target volume,mode of dose fractionation and prophylactic cranial irradiation are the hot issues.In this article,the research progress on the dose and the mode of dose fractionation for limited-stage small cell lung cancer was briefly analyzed.

Clinical efficacy of radical rectal cancer surgery combined with irradiation in treatment of rectal cancer and its effect on angiogenesis and survival rate / 中华放射肿瘤学杂志

Objective To evaluate the clinical efficacy of radical surgery combined with irradiation in the treatment of rectal cancer and its effect on the angiogenesis and survival rate.Methods A total of 200 colorectal cancer patients admitted to Zhengzhou Central Hospital from March,2014 to March,2015 were recruited and divided into the observation group (n=105) and control group (n=95) by using random number table method.In the control group,radical surgery was performed,and radical surgery combined with irradiation was conducted in the observation group.The clinical efficacy,the serum levels of vascular endothelial growth factor-C (VEGF-C) and prostaglandin E2(PGE2) were statistically compared between the control and observation groups.The changes of the microvascular morphology and microvessel density (MVD) in the rectal cancer tissues were observed and recorded.The 3-year survival rate was calculated during postoperative follow-up.Results After corresponding treatment,the clinical overall response rate was 86.67％ in the observation group,and 70.53％ in the control group (P＞0.05).The 2-year survival rate did not significantly differ between two groups (P＞0.05).The 3-year survival rate in the observation group was significantly higher than that in the control group (P＜0.05).After treatment,the serum levels of VEGF-C and PGE2 were significantly improved in two groups (both P＜0.05).In the observation group,the serum levels of VEGF-C and PGE2 were significantly lower compared with those in the control group (both P＜0.05).The microvessel morphology in the cancer tissues remarkably differed between two groups.The microvessel diameter did not significantly differ,whereas the lumen diameter in the observation group was significantly smaller than that in the control group.The MVD in the observation group was 12.25±3.35,significantly lower than 28.14± 17.26 in the control group (P＜0.05).Conclusion Radical surgery combined with irradiation is an efficacious treatment of rectal cancer,which can effectively improve the serum levels of VEGF-C and PGE2,decrease the MVD,reduce the lumen diameter in the cancer tissues,lower the angiogenesis in rectal cancer and enhance the survival rate,which deserves widespread application in clinical practice.

Research progress in radiotherapy for brain metastases of non-small cell lung cancer / 中华放射肿瘤学杂志

Since the first application of whole brain radiation therapy (WBRT) to brain metastases in 1950 s,it has been regarded as a standard treatment for brain metastases of non-small cell lung cancer (NSCLC).Recently,more accurate radiotherapy technique and more effective systemic therapy have been developed.Especially,the molecular targeted drugs are upgraded rapidly with stronger targeting capability and better permeability of the central nervous system.With the prolonged survival of patients,long-term damage to the nervous system induced by WBRT causes widespread concerns.This article will review the related controversies and research progress in the application of WBRT to NSCLC with brain metastases in modern integrated therapy.

Study on the correlation between acute radionuclitidis and improved body mass index in intensity-modulated radiation therapy after cervical cancer surgery / 中华放射肿瘤学杂志

Objective To investigate the relationship between the body mass index (BMI)/body mass index improved (BMIIMPd) and the dose of the small intestine as well as the acute radiation colitis in the intensity-modulated radiation therapy after cervical cancer surgery.Methods Thirty-nine cervical cancer patients underwent postoperative adjuvant radiotherapy.All patients received Philips large bore CT scan for enhanced CT scan,target delineation and organ at risk.All patients were treated with a single arc 10 MV VMAT plan.The correlation between the radiation dose of the small intestine and the acute radiation enteritis and BMI/BMIIMPd was analyzed.Results The BMI was calculated as (22.23±2.80) kg/m2,BMIIMPd was (21.49±3.95) kg/m2,the small intestine volume VSI was (1 155.71 ± 419.33)cc3.The volume of the small intestine received more than 10 Gy (V10_SI) VMAT was (66.50± 27.01) ％,and the equivalent uniform dose (EUD) and normal tissue complication probability (NTCP) were (4 098.87± 184.93) cGy and (7.98±8.73)％.One way ANOVA demonstrated that under the VMAT technology,the BMIIMPd,V30,V40,EUD (or=50) and NTCP in the small intestine were the influencing factors of the occurrence of acute radiation enteritis.Conclusions If the improved BMIIMPd is utilized to distinguish the BMI,the high dose area of the small intestine will be larger and the incidence of acute radiation enteritis will be higher for patients with BMIIMPd between 10.1 and 16.9(normal and thin).Conventional BMI cannot be utilized as a basis for the prediction of the incidence of acute radiation enteritis in patients with cervical carcinoma.

Clinical efficacy and prognosis of breast cancer patients with ipsilateral supraclavicular lymph node metastases treated with multi-modality therapy at diagnosis / 中华放射肿瘤学杂志

Objective To investigate the clinical efficacy and prognostic factors of breast cancer patients with ipsilateral supraclavicular lymph node metastasis (ISLNM) receiving neoadjuvant chemotherapy,surgery combined with radiotherapy at diagnosis.Methods Therapeutic outcomes of 65 breast cancer patients with ISLNM treated in our hospital between 1999 and 2013 were retrospectively analyzed.All patients were pathologically diagnosed with breast cancer.They were complicated with ISLNM,without distant metastasis confirmed by pathological or imaging examinations.All patients received multi-modality therapy consisting of neoadjuvant chemotherapy,surgery and postoperative radiotherapy.KaplanMeier method was adopted to calculate the overall survival (OS),progression-free survival (PFS) and supraclavicular lymph node recurrence (SCFR).The differences between two groups were statistically analyzed by the log-rank test.Results The median follow-up time was 66 months (range:6-137 months).Five patients had SCFR after corresponding treatment.The overall 5-year SCFR,OS and PFS rates were 9.2％,71.5％ and 49.5％,respectively.Following preoperative chemotherapy,the complete response (CR) of supraclavicular lymph node was a prognostic factor affecting OS.The 5-year OS rates in patients with and without CR were 81.4％ and 53.9％ (P=O.035).The size of supraclavicular lymph node (≤ 1 cm vs.＞ 1 cm at diagnosis was a risk factor of the SCFR (0％ vs.21.0％,P=0.037) and OS rates (≤1 cm vs.＞1 cm:86.1％ vs.55.6％,P =0.001).Conclusions Breast cancer patients with ISLM at diagnosis can obtain high OS rate and excellent tumor control after undergoing multi-modality therapy consisting of preoperative chemotherapy,surgery and postoperative radiotherapy.

Effect of different therapeutic methods on survival of stage Ⅰ-Ⅱ A cervical cancer patients complicated with postoperative intermediate risk factors / 中华放射肿瘤学杂志

Objective To compare the effect of different therapeutic methods upon the survival of stage Ⅰ-Ⅱ A cervical cancer patients with intermediate risk factors and explore the optimal treatment for patients with early-stage cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy.Methods Clinical data of 323 patients with the following intermediate risk factors of lymphovascular space invasion,depth of stromal invasion or tumor size ＞ 4 cm were retrospectively analyzed.The impact of observing (NT),chemotherapy (CT),radiotherapy (RT) and concurrent chemoradiotherapy (CCRT) on survival was statistically compared.The Kaplan-Meier method was used to survival analysis,and log-rank test difference,Cox model was used to prognostic factor analysis.Results The 5-year progression-free survival (PFS) and overall survival (OS) of all patients were 79.0％ and 84.8％.Univariate and multivariate analyses demonstrated that TS＞ 4 cm and therapeutic method were the independent prognostic factors of PFS.The number of risk factors and therapeutic method were the independent prognostic factors of OS.In the whole group,both RT and CCRT could improve the prognosis of patients with no statistical significance (P＞0.05).In the subgroup analysis,for patients with a single intermediate risk factor (low risk group),CT could significantly prolong the PFS (P=0.026) rather the 5-year OS (P=0.692).Compared with NT and CT,RT and CCRT could improve the PFS and OS,whereas no statistical significance was noted between the RT and CCRT (both P＞0.05).For those with ≥2 risk factors (high risk group),CCRT could significantly prolong the PFS compared with CT (84.9％ vs.70％;P=0.006),but did not improve the OS (P=0.107).Compared with RT,CCRT could significantly improve the PFS and OS (both P＜0.05).Conclusion For patients with only one risk factor,RT can enhance the clinical prognosis.CCRT can improve the clinical prognosis of stage Ⅰ-Ⅱ A cervical cancer patients with ≥ 2 risk factors.

Prognostic factors in patients with stage Ⅳ small cell lung cancer: A nomogram prediction model based on different doses of thoracic radiotherapy / 中华放射肿瘤学杂志

Objective To evaluate the effect of different doses of thoracic radiotherapy (TRT) upon the clinical prognosis of patients with extensive-stage (stage Ⅳ) small cell lung cancer (ES-SCLC) and establish a Nomogram prediction model.Methods Clinical data of 144 patients pathologically diagnosed with ES-SCLC undergoing TRT in Tianjin Medical University Cancer Hospital from month,2010 to month,2016 were retrospectively analyzed.Clinical characteristics,treatment data and responses were evaluated.A Nomogram was established by using Cox's proportional hazard regression model to predict the overall survival (OS).The prediction capability and accuracy were assessed by the concordance index (C-index) and a calibration curve between the model and verification groups.Results The median follow-up time was 31.9 months.The 2-year OS rate was 20.3％.The Nomogram model demonstrated that TRT dose,liver metastases,oligometastases/polymetastases,number of chemotherapy cycle and response to chemotherapy were significantly correlated with clinical prognosis.The calibration curve revealed that the predicted and actual OS were highly consistent.The C-index was calculated as 0.701.In the subgroup analyses,patients with high-dose TRT obtained significantly better OS than their counterparts with low-dose TRT.Conclusion The Nomogram prediction model based on different TRT doses can accurately predict the OS rate of ES-SCLC patients,which is an individualized model for predicting the survival probability.