ABSTRACT
Objective:To explore the clinical effect and application value of simultaneous modulated accelerated radiotherapy (SMART) in the suspicious positive lymph nodes of head and neck.Methods:From January 2017 to February 2019, 60 patients with suspected positive lymph nodes in the head and neck in the Hanzhong Central Hospital of Shaanxi Province were divided into experimental group and control group according to different treatment plans, and 30 patients in each group were included. In the experimental group, 63.36 to 66.66 Gy patients were treated with SMART, while in the control group, 54.12 to 60.06 Gy patients were treated with conventional neck prophylactic radiation. In order to evaluate the feasibility of the method, the change of the short diameter of the largest cross section of the suspicious positive lymph nodes in the two groups were observed, and the adverse reactions in the treatment of the two groups were analyzed.Results:There was no significant difference between the two groups before treatment ( P>0.05). After treatment, the size of short diameter of lymph nodes in the two groups was smaller than that before treatment. The maximum short diameter of the largest cross section of lymph nodes in the experimental group was smaller than that before treatment: (0.43 ± 0.07) cm vs. (0.72 ± 0.10) cm, and the difference was statistically significant ( P<0.05). In the control group, the maximum short diameter of the largest cross section of lymph node decreased after treatment, and the difference was not statistically significant ( P>0.05). After treatment, the reduction of the short diameter in the experimental group was more obvious than that in the control group. The maximum short diameter of the largest cross section between the two groups: (0.43±0.07) cm vs. (0.66±0.08)cm was statistically significant ( t = 11.523, P<0.05). Before treatment, hemoglobin (HGB) levels of the two groups were in the normal physiological range, and there was no significant difference between the two groups ( P>0.05); the white blood cell (WBC) levels of the two groups at different time after treatment were compared: in the first week (7.83 ± 2.53) × 10 9/L vs. (8.26 ± 3.16) × 10 9/L, in the third week (7.14 ± 3.65) × 10 9/L vs. (7.08 ± 2.53) × 10 9/L, in the fifth week (5.47 ± 2.81) × 10 9/L vs. (6.41 ± 2.57) × 10 9/L, and in the seventh week (4.36 ± 2.59) × 10 9/L vs. (4.98 ± 1.64) × 10 9/L, and there were statistical differences ( P<0.05), which indicated that the WBC index levels of the two groups were gradually decreased during the treatment, and the decreased degree of the experimental group was higher than that of the control group. The levels of HGB and PLT were maintained in the normal physiological range before and after treatment, and there was no significant difference between the two groups ( P>0.05). The main complications in the treatment of the experimental group were xerostomia and stomatitis. The adverse reactions in the control group were pain in the target area of radiotherapy. There was no significant difference between the two groups ( P>0.05). Conclusions:The application of IMRT is an effective method for the treatment of occult lymph node metastasis, and it is also a therapeutic diagnostic method, which can provide evidence for the study of the law of lymph node metastasis in the head and neck. The safety and tissue tolerance of IMRT in the treatment of suspicious positive lymph nodes in the head and neck are good, which can be used for the suspicious lymph nodes in the head and neck. The treatment of positive lymph nodes and the evaluation of patients′ prognosis provide an effective way of clinical treatment.
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Objective To study the clinical efficiency and adverse reactions of simultaneous modulated accelerated radiotherapy (SMART)and intensity-modulated radiation therapy (IMRT)in advanced cervical cancer. Methods Sixty patients with advanced cervical cancer were collected from April 2011 to April 2017 in our hospital. The 60 patients were randomly divided into experimental group (30 cases)and control group (30 cases)by using stratified randomization method. The two groups were given intracavitary irradiation and concur-rent chemotherapy. The patients in experimental group were treated with SMART and the patients in control group were treated with IMRT. 95％ planned target volume was 50. 4 Gy/ 28 F in the two groups and the dose for IMRT with simultaneous integrated boost was 64. 4 Gy/ 28 F to the planning target volume. Disease progres-sion,survival time and adverse reactions of the two groups were compared. Results At the end of radiothe-rapy,the experimental group had 23 patients with complete response (CR),4 patients with partial response (PR),2 patients with unaltered stable disease (SD),1 patient with progressive disease (PD),and the control group had 22 patients with CR,3 patients with PR,3 patients with SD,2 patients with PD. The overall effi-ciency of the experimental group was slightly higher than that of the control group (90. 0％ vs. 83. 3％),but the difference was not statistically significant (χ2 = 0. 144,P = 0. 704). After 3 months of radiotherapy,the experimental group had 28 patients with CR,1 patient with PR,1 patient with PD,and the control group had 22 patients with CR,2 patients with PR,3 patients with SD,3 patients with PD. The overall efficiency of the experimental group (96. 7％)was higher than that of the control group (96. 7％ vs. 80. 0％),but the diffe-rence was not statistically significant (χ2 = 2. 588,P = 0. 108). The median overall survival time of the experi-mental group and control group were 43 months and 38 months,and the difference was statistically significant (χ2 = 7. 087,P = 0. 008). The 1-year survival rates of the two groups were 96. 6％ and 85. 7％,and the 3-year survival rates were 86. 2％ and 60. 7％,respectively. There were no significant differences in the inci-dences of gastrointestinal reaction (66. 7％ vs. 63. 3％,χ2 = 0. 073,P = 0. 787),urinary system reaction (33. 3％ vs. 30. 0％,χ2 = 0. 077,P = 0. 781)and bone marrow suppression (83. 3％ vs. 86. 7％,χ2 =0. 000,P = 1. 000)between the two groups. Conclusion The efficiency of advanced cervical cancer patient treated with SMART is better than IMRT,and the adverse reactions are tolerable,which is worthy of clinical promotion.
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Objective: To evaluate the clinical efficacy and safety of simultaneous modulated accelerated radiotherapy (SMART) in patients with locally metaphase or advanced cervical cancer. Methods: Total of 92 patients with locally metaphase or advanced cervical cancer treated in First Affiliated Hospital of Jinan University from January 2012 to January 2014 were collected and the clinical medical records were retrospectively analyzed. Of 92 patients, 68 patients who received SMART combined with weekly paclitaxel liposome and lobaplatin chemotherapy were designated into study group, and 24 patients who received threedimensional conformal radiotherapy combined with weekly paclitaxel liposome and lobaplatin chemotherapy were designated into control group. The clinical efficacy, survival and the safety were compared between the two groups. Results: The overall response rate of study group was 85.29%, which was significantly higher than that of the control group (58.33%, P = 0.022). The median survival time of the study group was 31 months, which was significantly longer than that of the control group (25 months). The incidence rate of marrow suppression in study group was lower than that in the control group (P = 0.041). The incidence rate of gastrointestinal reaction had no significant difference between the two groups (P = 0.704). The incidence rates of radiation-induced rectitis and cystitis were both lower than those in the control group (P = 0.001, P = 0.018). Conclusion: The efficacy of SMART combined with weekly paclitaxel liposome and lobaplatin chemotherapy is remarkable with tolerable adverse reactions. It is worth of further clinical application.