ABSTRACT
Objective:To investigate the value of nomogram based on intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and MRI-derived radiomics for predicting recurrence after concurrent chemoradiotherapy (CCRT) in patients with locally advanced cervical cancer (LACC).Methods:Clinical data of 111 patients with ⅠB-ⅣA cervical cancer who underwent CCRT at Anhui Provincial Hospital from December 2014 to December 2019 and were continuously followed up were retrospectively analyzed. Pre-treatment IVIM-DWI parameters (ADC, D, D * and f) and pre- and post-treatment 3D texture parameters (from axial T 2WI) of the primary lesions were measured. Least absolute shrinkage and selection operator (LASSO) algorithm and multivariate logistic regression analysis were used to filter texture features and calculate radiomics score (Rad-score). A Cox regression model was used to analyze independent risk factors for recurrence after CCRT in patients with LACC and construct a nomogram. Results:External beam radiotherapy dose, f value , pre-treatment Rad-score and post-treatment Rad-score ( HR=0.204, 3.253, 2.544, 7.576) were the independent prognostic factors for recurrence after CCRT in cervical cancer patients and jointly formed the nomogram. The area under curve (AUC) of the nomogram for predicting 1-, 3- and 5-year disease-free survival (DFS) was 0.895, 0.888 and 0.916, with internal validation C-indexes of 0.859, 0.903 and 0.867, respectively. The decision curves analysis showed that the nomogram has a higher net clinical benefit compared to other models, and the clinical impact curves further visualized its predictive accuracy. Conclusions:The nomogam based on IVIM-DWI and radiomics has high clinical value in predicting recurrence after CCRT in patients with LACC, providing reference for prognostic assessment and individualized treatment of cervical cancer patients.
ABSTRACT
Advanced non-small cell lung cancer(NSCLC)accounts for all NSCLC 45% . In recent years,chemotherapy combined with radiotherapy has become a new standard for NSCLC. On NSCLC radiothera-py and chemotherapy(CRCT),radiation total dose,fractionation method,different chemotherapy combined with radiotherapy have many details in the efficiency and toxicity tolerance,which are still in the exploration.
ABSTRACT
Objective: To evaluate the clinical effect and adverse reactions of radioactive seed interstitial brachytherapy com-bined with etoposide (EP) regimen concurrent chemoradiotherapy treatment for locally advanced non-small cell lung cancer. Methods:All 24 cases of locally advanced non-small cell lung cancer received three-dimensional conformal intensity modulated radiation therapy by using 6 MV X-ray to obtain 95%60-66 Gy/30-33 F planning target volume. All cases received radiation therapy five times a week. EP regimen chemotherapy concurrent with radiotherapy was given to 24 patients. The therapy included VP-16, 60 mg/m2 intravenous in-fusion for 1 d to 5 d, and DDP 50 mg/m2 intravenous infusion on the 1st, 8th, and 28th therapy day. Chemotherapy with EP regimen was given for four cycles, in which two cycles were given during radiotherapy and the remaining cycles were completed after radiotherapy. The patients were reexamined three months after concurrent chemoradiotherapy was completed. Patients with residual tumor, con-firmed via positron emission tomography/computed tomography, underwent 125I radioactive seed implantation interstitial brachytherapy to complement the dose of tumor. Results: The response rate was 83.3% (20/24); the local control rates of 3, 6, 9, 12, 18, and 24 months were 87.5% (21/24), 83.3% (20/24), 75.0% (18/24), 70.8% (17/24), 58.3% (14/24), and 50.0% (12/24). The median survival was 20.2 months. The one-year survival rate was 62.5%, and the two-year survival rate was 37.5%. The following main toxicities were observed:the incidence of radiation-induced lung injury was 25%;the incidence of radiation esophagitis was 33.3%;the incidence of grades Ⅰ to Ⅱ gastrointestinal reactions was 82.3%; the incidence of reducing neutropenia was 87.5%, in which the incidence of gradesⅠtoⅡwas 75.0%, gradeⅢwas 12.5%, and gradeⅣwas 0%. Conclusion:EP regimen concurrent radiotherapy and chemo-therapy combined with radioactive seed interstitial brachytherapy for locally advanced non-small cell lung cancer is effective and has few serious adverse reactions, thus making this approach worthy of promotion.