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In the past 20 years, the multidisciplinary treatment model based on evidence-based medicine has significantly increased the rate of sphincter-preservation operation for rectal cancer. How to preserve rectum and anal function, avoid permanent colostomy, and improve post-operative quality of life of patients while ensuring radical resection of tumor, remains to be a key and hot topic in surgical treatment of rectal cancer. Based on literatures and clinical experiences, the authors summarize issues of sphincter preservation operation and comprehensive treatment, including intersphincteric resection, conformal sphincter preservation operation, total neoadjuvant therapy and radioimmunotherapy, for ultra-low rectal cancer, in order to provide reference for the colleagues.
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With the development of neoadjuvant therapy, the treatment of pancreatic cancer has entered the era of comprehensive diagnosis and treatment consisting of surgery, chemo-therapy and radiotherapy. In recent years, the concept of 'total neoadjuvant therapy' has become one of the important treatment methods for locally advanced rectal cancer. The authors focus on pancrea-tic cancer, introduce the development status of total neoadjuvant therapy in pancreatic cancer and summarize the current controversies and challenges in the application of total neoadjuvant therapy in pancreatic cancer, in order to further standardize the diagnosis and treatment of pancreatic cancer and improve the overall level of pancreatic cancer treatment in China.
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Objective To analyze the clinical application value of double J tube in the protection of renal function and the relief of urinary tract obstruction in patients with postoperative treatment after cervical cancer surgery. Methods There were 81 patients with cervical cancer(stageⅠA&ⅠB&ⅡA)selected in our hospital from June 2013 to June 2016 who were treated with postoperative radiotherapy.Patients were divided into observation group(indwelling double J tube group, n=39) and control group (conventional treatment group, n=42). After the treatment, data of hydronephrosis, creatinine and urea nitrogen were compared between the two groups. Data of complications associated with indwelling ureteral stent including fever,infection,low back pain,percussion pain in renal region and radiation cystitis were recorded.Results The total incidence rate of hydronephrosis (10.3% vs. 33.3%) and the incidence of mild renal hydrocephalus (5.1% vs. 21.4%) were less in observation group than those in the control group(P<0.05).There were no significant differences in incidence rates of hydronephrosis and mild renal hydrocephalus between the two groups.The levels of creatinine[(116.9±43.0)μmol/L vs.(170.8±68.4)μmol/L]and urea nitrogen[(5.4±1.9)mmol/L vs.(7.7±2.5)mmol/L]were lower in the observation group than those in the control group(P<0.05).Except for the urea nitrogen of the observation group,there were significant differences in creatinine and urea nitrogen before and after treatment between two groups(P<0.05).During the indwelling of the double J tube, there were no significant differences in the incidences of fever, infection, lumbago, renal percussion pain and radiation cystitis between observation group and control group(P>0.05).Conclusion It is effective,safe and feasible to prevent ureteral obstruction and protect renal function by indwelling double J tube in patients with postoperative treatment after cervical cancer surgery.
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Background and purpose:When the patients with nasopharyngeal carcinoma (NPC) receive radiotherapy, their thyroids are inevitably involved. As a result, thyroid damage occurs. This study aimed to explore the effects of intensity modulated radiation therapy (IMRT) on dynamics of thyroid blood flow in patients with NPC.Methods:A total number of 68 patients with NPC were enrolled in the study who received primary treatment of radical radiation and chemotherapy from Jul. 2012 to Oct. 2013. And the TMN stage was fromⅡ toⅣc according to UICC 2010. The treatment method consisted of 2 cycles of TPF induction treatment, concurrent radiation therapy (IMRT) with 2 cycles of DDP and 2 cycles of adjuvant therapy sequentially. Before radiotherapy, at the end of radiotherapy, 3 and 6 months after radiotherapy, serum free triiodothyronine (FT3), free thyroxin (FT4) and thyroid-stimulating hormone (TSH) concentrations of all cases were detected by electrochemiluminescence. The highest systolic velocity, mean velocity, minimum diastolic velocity, resistance index, and the value of all thyroid diameter lines were measured by type-B ultrasound.Results:All the patients were followed up for 6 months. Hypothyroidism: the incidence of immediate clinical hypothyroidism after radiotherapy was 5.9%; 3 months later, the incidence was 13.2%; and 6 months later, the incidence was 26.5%. The difference in volume change between before radiotherapy and at the end of radiotherapy had no statistical signiifcance (P>0.05). The difference in volume change between 3 and 6 months after radiotherapy had statistical signiifcance (P0.05).Conclusion:The incidence of hypothyroidism may increase with time after radiotherapy. The volume may decrease with the increased dose of radiotherapy and the follow-up time. The patients with NPC after radiotherapy should be tested for thyroid lesions routinely. The thyroid dose-volume parameter V40 may be a predictor for acute radioactive thyroid lesions. The study did not reveal temporarily that hypothyroidism was associated with thyroid ultrasound blood lfow velocity.
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Objective To study the impacts of bladder filling status on the dosimetric parameters of the target volume and organs at risk (OAR) in intensity-modulated radiotherapy (IMRT) for prostate cancer.Methods Ten localized prostate cancer patients without serious complications treated with IMRT were selected for this study.These patients underwent CT scans of the whole pelvic cavity three times in different bladder filling status (empty and injected with 150 ml and 300 ml of normal saline) to obtain three series of pelvic CT images.The three sets of CT images were transferred to the treatment planning system.The target volume and OAR such as the rectum,bladder,and femoral heads were contoured by the same doctor.The treatment planning was performed and optimized by the physicist.The dosimetric parameters of the target volume and OAR in three bladder filling status were subjected to analysis by paired t-test.Results If the bladder filling status was consistent in orientation and radiation,the bladder filling status was not associated with the dosimetric parameters of the target volume and femoral heads (P =0.077-0.998 ; P =0.219-0.969) ;it had significant impacts on the dosimetric parameters of the bladder (P =0.000-0.562) and some dosimetric parameters of the rectum (P =0.000-0.645),and bladder filling was favorable for the protection of the bladder and rectum.If the bladder filling status was not consistent in orientation and actual radiation,the calculated planning target volume,the dosimetric parameters of the bladder,and some dosimetric parameters of the rectum were different from those in actual treatment (P =0.000-0.913).Conclusions For the prostate cancer patients treated with IMRT,it is recommended to keep the bladder well and consistently filled.
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Objective To evaluate the antitumor effects of interferon (IFN)γ-endostatin based gene radiotherapy in a metastatic breast tumor model of mice, and to elucidate the possible mechanisms involved. Methods Murine mammary adenocarcinoma 4T1 cells transfected with pEgr-IFN-γ and pEgrendostatin plasmids were irradiated with 2-20 Gy of X-rays. IFN-γ and endostatin levels in the culture supernatants were measured. Female BALB/c mice were inoculated with 1 × 105 of 4T1 cells by mammary fat pad injection, and divided randomly into control, empty vector, gene therapy (pEgr-IFN-γ and pEgrendostatin), radiotherapy, and combined gene-radiotherapy groups. Tumor/body weight ratio, lung metastases, and survival of the tumor-bearing mice were observed. Splenic cytotoxic T-lymphocyte (CTL)and natural killer (NK) cell activity and intratumor microvessel density were also assessed. Results Irradiation significantly enhanced the section of IFN-γ and endostatin from the transfected 4T1 cells.Compared with gene therapy or radiotherapy alone, combined gene-radiotherapy resulted in the maximal attenuation in tumor growth rate, lung metastases and increased survival. The activities of CTL and NK cells were significantly enhanced and intratumor microvessel density reduced ( t = 2. 120-22.140, P ＜ 0.05 ).Conclusions IFN-γ-endostatin-based gene-radiotherapy could provide a potential antitumor effect in a murine metastatic breast tumor model, which may be related to IFN-γ-stimulated CTL and NK cell activation, and endostatin-induced antiangiogenic activity. Gene-radiotherapy could serve as a neoadjuvant therapy for the locally advanced breast cancer.
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Objective To explore the relationship between severe(≥grade 3 ) radiation pneumonitis (RP) and dose-volume histogram (DVH) parameters for non-small cell lung cancer (NSCLC) treated with three-dimensional conformal radiation therapy (3-DCRT). Methods Ninety-four patients with NSCLC treated with 3-DCRT were retrospectively analyzed. Clinical parameters were analyzed. DVH parameters analyzed were V20, V30, V40,mean lung dose (MLD),normal tissue complication probability(NTCP) ,and total dose. Results Age,sex, Karnofsky scored, performance status, forced expiratory volume in 1 second,presence of weight loss, preexisting lung disease, history of thoracic surgery, and history of chemotherapy were not associated with the risk of severe RP(P>0.05). However,in univariate analyses, V20, V30, V40, MID and NTCP were associated with severe RP(P<0.01). In multivariate analysis, MID and V30 were variable associated with severe RP(P<0.01). The severe RP was 0 when MLD < 10 Gy and 21%(8/39) when MLD between 10 Gy and 20 Gy but 35%(7/20) when MLD > 20 Gy,it was 0 when V30 < 25% and 12%(4/33) when V30 between 25% and 35% but 38%(11/29) when V30 >35%. Conclusion MLD and V30 are significant predictive factors for severe RP and they should be limited to ≤20 Gy and ≤ 35% in order to reduce severe RP.
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Objective To investigate the feasibility of online and offline cone-beam CT (CBCT) guided radiotherapy for lung cancer. Methods Fourteen patients with lung tumor treated by three-dimen-sional conformal radiotherapy were investigated. Online kV CBCT scan,image registration and setup correc-tion were performed before and immediately after radiotherapy. CBCT online-guided correction data were used to calculate the population-based CTV-PTV margins under the condition of non-correction and correction in every fraction respectively. The numbers of initial images and the population-based CTV-PTV margins af-ter the offline compensation of the system setup error were evaluated with the permission of 0.5 mm and 1.5 mm maximal residue error,respectively. Results Under the condition of non-correction,the required mar-gins for total error were 5.7 mm,8.0 mm and 7.8 mm in the left-right(x axis) ,cranio-caudal(y axis) and anterior-posterior(z axis) directions, respectively. When the tumor was corrected in every fraction, the re-quired margins for intra-fraction error were 2.4 mm,2.4 mm and 2.3 mm in x,y and z axes, respectively. To correct the systematic setup error,9 sets of CBCT images for 3.3 mm,3.7 mm and 3.6 mm PTV margins, and 7 sets of CBCT images for 3.9 mm,4.3 mm and 4.3 mm PTV margins in x,y and z axes were necessary when 0. 5 mm and 1.5 mm maximal residue errosr were permited respectively. Conclusions Both of the online CBCT correction and the offline adaptive correction can markedly reduce the impact of setup error and reduce the required PTV margins accordingly. It is feasible to deliver the online and offline image guided ra-diation for patients with lung tumor.
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ce, sIMRT and IMRT radiotherapy techniques can protect the lung and spinal cord well.
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Objective To patient who suffer from middle and late period carcinoma of esophagus radiation therapy and chemotherapy. Observe the effects and the side effects of radiation therapy and chemotherapy.Methods Radiation therapy and chemotherapy 60 examples and radiation therapy 60 examples,radiation use usually divide,DT 40 Gy reduce area of radiation therapy,aroid medulla,add DT 20～30 Gy,its finished after 6～7 weeks.radiation therapy and chemotherapy after 1 and 4 week,DDP 20 mg/d is used.CF 0.1/d ivgtt CF ivgtt 1/2 is used use 5-fu 500 mg/d.iv five days in a routine,every day use radiation therapy and chemotherapy.Results Radiation therapy and chemotherapy 1,2,3 year alive rate are 67%,46%,34%,radiation therapy 1,2,3 year alive rate are 52%,38%,24%,pneumonia of radiation therapy is 14 examples and 12 examples,leukocyte in blood reaction is 26 examples and 17 examples,gastrointestinal effective is 25examples and 9 examples,death is 38 examples and 48 examples,treatment routine is better than compare routine (P＜0.05).Conclusion Radiation with PCF plan chemotherapy treat middle and late period carcinoma of esophagus have hish alive rate side effects and bad effects are low.
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[Objective] To explore effective method for later skin scale cancer. [Method] Apply radio-chemical therapy combined Shun Platinum to 23 cases of said disease, observe clinical effect and toxic and side effects. [Result] 5 cases were completely relieved, 16 partly relieved, 2 stable, the total effective rate 91.3%; toxic and side effects: 4 cases reduced white cells, 13 acute skin reaction. [Conclusion] For the local later skin scale cancer, esp. the cancer ulceration in the skin surface, to take low-density Shun Platinum combined with radio-chemical therapy can improve local treatment, meanwhile without increasing toxic or side effects.