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Lung cancer is the malignant tumor with the highest mortality in the world, of which non-small cell lung cancer (NSCLC) accounts for about 80%. The orderly combination of surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy is currently the main treatment modality for NSCLC. Liquid biopsy has been increasingly used in clinical practice in recent years due to its advantages of being non-invasive and overcoming tumor heterogeneity, of which circulating tumor DNA (ctDNA) is one of the most commonly used analytical indicators, and ctDNA detection may play a role in the treatment of NSCLC. This article reviews new developments in the use of ctDNA for prognostic assessment, recurrence monitoring and efficacy prediction in NSCLC patients.
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Objective:To investigate the effects of enteral nutrition on the incidence of treatment complications, results from nutritional indexes and proportions of immune cell subsets in elderly patients with esophageal carcinoma during concurrent chemoradiotherapy.Methods:From January 1, 2020 to December 31, 2020, 108 elderly patients(≥60 years)undergone concurrent chemoradiotherapy for esophageal carcinoma at Quanzhou First Hospital and eligible for inclusion were enrolled in the case-control study.They were randomly divided into the study group(enteral nutrition group)and the control group(normal diet group), with 54 cases in each group.The incidence of complications, results from nutritional indexes and immune cell subsets of the two groups were analyzed according to data type.Results:The incidence of bone marrow suppression(Grade Ⅰ-Ⅱ)in the study group(37.0%)was significantly lower than that in the control group(63.0%)( χ2=7.259, P<0.01). The incidence of bone marrow suppression(Grade Ⅲ-Ⅳ)in the study group(11.1%)was significantly lower than that in the control group(27.8%)( χ2=4.788, P<0.05). The levels of hemoglobin, total serum protein and albumin were(121.36±11.63)g/L, (73.78±7.79)g/L and(40.95±3.52)g/L in the study group and(106.45±10.85)g/L, (63.12±8.35)g/L and(35.54±4.12)g/L in the control group, respectively, after 4 weeks of radiotherapy and chemotherapy( P<0.05). The proportions of CD3+ and CD4+ were(64.15±5.84)% and(48.64±4.28)% in the study group and(59.25±6.27)% and(45.27±4.52)% in the control group, respectively, after 4 weeks of radiotherapy and chemotherapy( P<0.05). The proportion of CD8+ was(26.93±3.63)% in the study group and(30.35±3.36)% in the control group after 4 weeks of radiotherapy and chemotherapy( P<0.05). Conclusions:During concurrent chemoradiotherapy for elderly patients with esophageal carcinoma, enteral nutrition with adjustment based on patient's food intake can reduce patients' nutritional risk and modulate the proportion of immune cell subsets, thus reducing the occurrence of bone marrow suppression.
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Objective@#To evaluate the safety and efficacy of helical tomotherapy using simultaneously integrated boost and simultaneous integrated protection technique in the treatment of unresectable biliary tract cancers.@*Methods@#The data of 23 patients with unresectable biliary tract cancer who received tomotherapy-based hypofractionated radiotherapy at Comprehensive Cancer Centre of Drum Tower Hospital,the Affiliated Drum Tower Clinical College of Nanjing Medical University between February 2015 and October 2017 were analyzed. There were 10 males and 13 females, aged from 40 to 85 years(median:58 years). Pathological type included intrahepatic cholangiocarcinomas(n=11), gallbladder cancers(n=6),extrahepatic cholangiocarcinomas(n=6). The irradiated sites covered primary tumors and areas of local invasion,including metastatic lymph nodes which were confined to the abdominal or retroperitoneal space. Dose escalation was achieved using simultaneously integrated boost(SIB) technique, and simultaneous integrated protection(SIP)technique was used to protect gastrointestinal tracts and other adjacent organs. Cox regression modal and Kaplan-Meier analysis were used to analyze the associations between patients′ characteristics and overall survival(OS).@*Results@#The median total radiation dose was 54 Gy(range: 28-72 Gy)and median biologically effective dose(BED)was 74.4 Gy(range: 37.8-115.2 Gy).The median planning target volume(PTV)was 445.79 cm3(range:126.02-950.12 cm3). Based on the various PTV,patients received 2.4-6.0 Gy/fraction with 8-28 fractions. The local control rate was 65.2% and the median OS was 11.3 months(range:2.1-31.9 months).The most common cause of death was out-field failure and only 3 patients died of in-field failures. The longest survival was 31.9 months. BED≥70 Gy significantly improved OS,compared to BED<70 Gy(16.8 months vs.5.1 months)(HR=0.146, 95%CI:0.028-0.762, P=0.022). No patients developed grade ≥4 toxicities.@*Conclusions@#Helical tomotherapy-based hypofractionated radiotherapy is effective and well tolerated for patients with unresectable biliary tract cancer. The dose escalation with higher BED could improve the survival for such patients.
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Objective To explore the prognostic factors of middle and advanced esophageal neoplasms treated by traditional Chinese medicine combined with radiotherapy.Methods A total of 462 esophageal neoplasms patients treated by traditional Chinese medicine combined with radiotherapy from March 2009 to March 2012 in Civil Administration Hospital of Hebei Province were retrospectively analyzed.The overall median survival time and the survival rate of 1,3 and 5 years were calculated by using life table.Log-rank test was used for single-factor analysis and Cox model was used for multiple-factor analysis.Results The median survival time of 462 esophageal neoplasm patients was 24.2 months (12.9-36.6 months).The survival rate of 1,3 and 5 years was 80.3 ％,30.6 ％ and 10.5 ％ respectively.Single-factor analysis showed that the age (x2 =89.773,P =0.000),tumor diameter (x2 =102.373,P =0.000),clinical staging (x2 =128.903,P =0.000),concomitant with other diseases (x2 =65.366,P =0.000) and the short term effect (x2 =64.948,P =0.000) were associated with prognosis of middle and advanced esophageal neoplasms treated by traditional Chinese medicine combined with radiotherapy.Multiple-factor analysis showed that the age (RR =1.625,95 ％ CI 1.251-2.111,P=0.000),clinical staging (RR =2.437,95 ％ CI 1.874-3.168,P=0.000),concomitant with other diseases (RR =1.1.628,95 ％ CI 1.278-2.076,P =0.000) and the short term effect(RR =1.865,95 ％ CI 1.594-2.182,P =0.000) were the independent prognosis factors for middle and advanced esophageal neoplasms treated by traditional Chinese medicine combined with radiotherapy.Conclusion Elderly patients,esophageal neoplasms in stage Ⅲ,concomitant with other diseases and poor short-term effect could influence the prognosis of the patients with middle and advanced esophageal neoplasms treated by traditional Chinese medicine combined with radiotherapy.
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Objective To observe the efficacy and adverse reactions of ubenimex combined with radiotherapy for the treatment of early nasopharyngeal carcinoma. Methods A total of 129 patients with early nasopharyngeal carcinoma who were admitted to the 163th Hospital of PLA, the Second Affiliated Hospital of Hunan Normal University from October 2013 to September 2016 were retrospectively analyzed. Three-dimensional conformal radiotherapy was used in the control group and ubenimex combined with three-dimensional conformal radiotherapy was taken in the study group. Radiation injury response, quality of life and therapeutic effects of patients in both groups were observed respectively. Results The fatigue incidence of the study group was lower than that of the control group (57.8 % vs. 75.4 %, χ2= 4.481, P= 0.034). Karnofsky score (χ2=6.345, P=0.042; χ2=6.382, P=0.041, respectively) and weight change (χ2=6.014, P= 0.049; χ2= 6.351, P= 0.042, respectively) had statistical differences in both groups in the end of radiotherapy and 3 months after radiotherapy. 1-year non-distant metastasis survival rate (92.2 %, 59/64) in the study group was significantly higher than that in the control group (80.0 %, 52/65) (χ2=3.989, P=0.046). Conclusion Ubenimex combined with radiotherapy for early nasopharyngeal carcinoma can improve the patients' quality of life, reduce the radiation injury response and increase the metastasis-free survival rate.
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Objective To compare the efficacy and adverse reactions of intensity-modulated radiation therapy (IMRT) and conventional pelvic field radiation therapy for middle and advanced cervical cancer. Methods A total of 144 patients with stageⅡB-ⅢB cervical cancer from October 2007 to September 2012 were divided into IMRT group (72 cases), and routine radiotherapy group (72 cases) by using random number table method. The IMRT group was exposed to the 6 MV-X line 7 field, a dose of 46-50 Gy for planning target volume (PTV), 54-60 Gy for gross tumor volume (GTVnd) simultaneously integrated boosted, in 25-28 fractions. The central block of lead 4 cm was changed to 4 fields irradiation, adding to 46-54 Gy for the conventional group after 30-40 Gy of the whole pelvic field. The total dose for the two groups of patients was 30-45 Gy, after completed 30 Gy in vitro exposure, to the cavity irradiation, 5-7 Gy/fraction, and synchronous cisplatin (DDP) sensitization chemotherapy was done synchronously. Results The recent complete remission, partial remission, overall survival ratio of two groups were compared respectively, and the difference was not statistically significant (P > 0.05). The difference in 1 year survival rate of IMRT group and routine radiotherapy group was not statistically significant (χ2= 1.455, P> 0.05). The difference in 3 and 5 year survival rate was statistically significant [76.4 % (55/72) vs. 59.7 % (43/72); 72.2 % (52/72) vs. 55.6 %(40/72), P< 0.05]. Acute radiotherapy major adverse reactions included the digestive system, urinary system, skin response and haematological toxicity (bone marrow suppression). The incidence and degree of skin response in IMRT group was lower than that in routine radiotherapy group (P<0.05). The adverse effects of late radiotherapy were mainly rectal, bladder, skin response and hematological toxicity (bone marrow suppression). The incidence rectal and skin response in IMRT group was lower than that in routine radiotherapy group (P< 0.05). Conclusion The IMRT can improve the survival rate of advanced cervical cancer patients for 3-5 years, reduce the adverse effects of acute and terminal radiotherapy, and improve the quality of life.
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Objective To observe and compare the curative effects of zoledronic acid (ZA) combined with radiotherapy and ZA combined with chemotherapy in the treatment of bone metastasis of non-small cell lung cancer (NSCLC). Methods Seventy-eight patients with NSCLC bone metastasis treated by radiotherapy or chemotherapy were taken in our hospital from January 2010 to June 2014, including 39 cases of ZA combined conventional fractionation radiotherapy (radiotherapy combined group), and 39 cases of ZA combined with chemotherapy (paclitaxel liposome + cisplatin) (chemotherapy combined group). Each group had 39 cases. WHO objective evaluation standard, efficacy evalulation of solid tumor metastasis and curative effect standard grading of pain, anticancer agent toxicity classification standard, Karnofsky standard were used for evaluating and analyzing the patients with primary lung tumor, bone metastasis, degree of pain, adverse reactions and functional status (once before and after the treatment). Results The efficiency rate of primary lung tumor, the efficiency rate of bone metastasis, the total effective rate of pain relief and the improvement rate of functional status (Karnofsky score increased by 10 points or more)in the radiotherapy combined group and chemotherapy combined group were 82.05 % (32/39) vs. 79.49 % (31/39), 48.72 % (19/39) vs. 51.28 %(20/39), 82.05 % (32/39) vs. 84.62 % (33/39), 66.67 % (26/39) vs. 71.79 % (28/39) respectively, and the differences were not statistically significant (the values of x2 were 0.224, 0.237, 0.195, 0.259 respectively, all P> 0.05); Although the two groups showed low-grade fever, bone marrow suppression, esophagitis, liver and kidney damage, gastrointestinal reactions and other adverse reactions, the adverse reactions of two groups were close to [28.21 % (11/39) vs. 30.77 % (12/39)] (x2 = 0.314, P> 0.05). Fortunately, these reactions were controlled well after symptomatic treatment. Conclusion ZA combined with radiotherapy or chemotherapy is a safe and effective way for bone metastasis of NSCLC, which should be taken based on the individual condition of the patients.
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Objective To investigate the clinical value of radiotherapy combined with xeloda monotherapy in the treatment of elderly patients with rectal cancer.Methods 80 elderly patients with rectal cancer were retrospectively collected.The patients were assigned into study group (n=43) or control group (n=37) according to the treatment way.The study group adopted radiotherapy combined with xeloda,while the control group only treated with radiotherapy.The main indicators included major clinical outcomes (3-year survival rate,recurrence rate,progression free survival),and postoperative health related quality of life and major complications of the two groups were observed.Results Compared with the control group,the 3-year recurrence rate of the study group decreased significantly (25.58% vs.48.65%,x2=4.579,P=0.032);the progression free survival was significantly prolonged [(42.58±7.63)months vs.(34.95±6.30)months,t=7.495,P=0.000];the quality of health related life after 1 year increased significantly [(75.50±8.11) vs.(69.76±9.58),t=3.295,P=0.002].There were no significant differences in postoperative major complications (granulocyte reduction,diarrhea,nausea,vomiting,hand foot syndrome and sensory neuropathy) and 3-year survival rate between the two groups (all P>0.05).ConclusionRadiotherapy combined with xeloda chemotherapy helps improve progression free survival and recurrence rate in elderly patients with rectal cancer.
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Objective To analyze the efficacy and safety of erlotinib associated conformal intensity modulated radiotherapy in treatment (IMRT) of locally advanced pancreatic carcinoma. Methods The clinical data of 23 patients with locally advanced pancreatic carcinoma were retrospectively analyzed. The patients′ therapeutic methods: erlotinib was taken continuously and orally at 100 mg/time, 1 time/d until disease progressed or serious adverse reactions happened; intensity modulated radiotherapy (IMRT) was used combined with erlotinib at 50.4 Gy, 1 time/d, 1.8 Gy/time, 5 times/week, total 28 times. Tumor response was evaluated at the end of radiotherapy after 4 weeks. Results In 23 patients, there was partial response in 10 cases, stable disease in 9 cases and progress disease in 4 cases. The objective response rate was 43.5%(10/23), and the median survival time was 11.3 months. Adverse reactions included fatigue, rash, bone marrow suppression, nausea and diarrhea. The adverse reactions were mostly tolerable with grade 1-2. Conclusions Erlotinib combined with IMRT is safe and effective in patients with locally advanced pancreatic carcinoma, which is worthy of further study.
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Objective@#To evaluate the patterns of recurrence and their value on target delineation for postoperative radiotherapy (RT) in patients with stage Ⅲ thoracic esophageal squamous cell carcinoma (ESCC) after esophagectomy.@*Methods@#395 patients (302 male and 93 female) of stage Ⅲ thoracic ESCC after radical resection were enrolled in this study. Among them, 375 patients were treated with two-field and other 20 with three-field esopahgectomy. 97 patients were treated with surgery alone, 212 with adjuvant postoperative chemotherapy (CT), 56 with radiotherapy (RT) and 30 with CT plus RT. Diagnosis of recurrence was primarily based on CT images, some of which were biopsy confirmed. The location and patterns of tumor recurrence were analyzed.@*Results@#The overall failure rates was 75.7% (299/395). Locoregional recurrence (LR) was found in 48.4% of the patients, distant metastasis (DM) in 16.2%, and LR plus DM in 4.3%. There were 208 patients occurred with LR, 26.9% (56) recurred in supraclavicular/neck (51 in supraclavicular), 69.7% (145) in mediastinum (88.7% in upper-mediastinum), and 19.7% (41) in upper abdomen (38 in para-aortic lymph node). Chi-square test and logistic multivariate regression analysis showed that TNM stage and adjuvant therapy were significantly associated with LR (P<0.05). Postoperative RT reduced LR (mainly LR in mediastinum), but postoperative CT did not decrease LR.@*Conclusions@#The recurrence rate is very high in stage Ⅲ thoracic ESCC patients, LR is the main pattern of failure. TNM stage is one of the most important factors for LR. Postoperative radiotherapy can reduce LR but postoperative chemotherapy does not decrease LR. Upper-mediastinum is the most common site of recurrence, followed by supraclavicular and para-aortic regions; these areas should be considered as the key target of postoperative radiotherapy.
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Ductal carcinoma in situ belongs to the early stage of breast cancer.The treatment of ductal carcinoma in situ is similar with that of the breast cancer.Because of the low mortality rate in patients with ductal carcinoma in situ,there was an excessive treatment in the treatment of ductal carcinoma in situ.So the key to the treatment of ductal carcinoma in situ was to improve the quality of life.The present study shows that the effect of conserving surgery with radiotherapy is same with mastectomy's in the treatment of breast ductal carcinoma in situ.Sentinel lymph node biopsy can also be used to evaluate the patient's axillary status.For patients with ductal carcinoma in situ with breast conserving surgery,radiotherapy and endocrine therapy can reduce the recurrence rate of ipsilateral breast cancer.Radiotherapy and endocrine therapy have also become the standard treatment for ductal carcinoma in situ.
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Objective To assess the therapeutic efficacy and prognostic factors in elderly patients with stage Ⅲ non-small cell lung cancer (NSCLC) after three-dimensional conformal radiotherapy (3DCRT).Methods A retrospective analysis of 124 stage Ⅲ NSCLC patients aged 70 or over who had received treatment with 3DCRT was conducted retrospectively in this study.There were 99 male and 25 female patients,with a median age of 74 years(range:70-84).The median dose was 60 Gy(range 50-72 Gy).Eighty-three patients were treated with radiotherapy alone,27 with sequential and 14 with concurrent radiochemotherapy.Results The end date of follow-up was August 30,2013.After 3DCRT,the 1-,3-and 5-year overall survival (OS) were 61.1％,23.8％ and13.2 ％,respectively,and the median survival time was 18 months.Univariate analysis revealed that gender,obstructive pneumonia,dosage,method of therapy and immediate effect were related to OS(x2 =3.957,6.398,7.147,12.307 and 11.035,respectively;P=0.047,0.011,0.008,0.002 and 0.001,respectively).Multi-variable analysis indicated that age,gender,obstructive pneumonia,dosage and method of therapy were independent prognostic factors for OS.The OS time was longer inpatients who were female,aged over 75,with no obstructive pneumonia or dosage≥ 60 Gy.Compared with radiotherapy alone,sequential radiochemotherapy increased OS while concurrent radiochemotherapy decreased OS.Conclusions Sex,age,obstructive pneumonia and dosage affect the survival of elderly stage Ⅲ NSCLC patients treated with three-dimensional conformal radiotherapy.Concurrent radiochemotherapy should be considered with caution
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Objective To measure the placing position error of different body position by analog positioning machine in patients with different body mass index (BMI) during radiotherapy for rectal cancer, then calculate the clinical target volume (CTV) to plan target volume (PTV) margins (Mptv). Methods Thirty-six patients with rectal cancer were selected, and the patients were divided into vacuum bag group (18 cases) and routine belly board group (18 cases) according to method of placing position. The BMI was calculated. Each patient was treated with positive and lateral position X-ray film before treatment and once a week during the radiotherapy. The data were contrasted with digitally rendered radiographs (DRR) of three-dimensional conformal radiotherapy plan system, then the placing position error on X, Y and Z axis was calculated, and the Mptv on X, Y and Z axis of patients with different BMI was calculated. Results The placing position error on X, Y and Z axis gradually increased with the increase of BMI in vacuum bag group and routine belly board group, and there were statistical differences (P<0.01 or <0.05). The Mptv on X, Y and Z axis in patients with normal BMI were 4.60, 5.51 and 5.29 mm respectively. The Mptv on X, Y and Z axis in patients with overweight were 5.48, 6.81 and 6.16 mm respectively. The Mptv on X, Y and Z axis in patients with obesity were 8.92, 8.59 and 7.02 mm respectively. Conclusions The rectal cancer patients with overweight and obesity have more placing position error. The influence of BMI should be considered when the patient's Mptv is determined.
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Objective To investigate the risk factors of nosocomial infections in patients with head and neck cancer during radiotherapy .Methods Clinical data of 189 patients with head and neck cancer receiving radiotherapy in Huzhou Central Hospital during August 2011 and December 2014 were retrospectively studied .Chi-square test and multivariate Logistic regression analysis were performed to explore the risk factors of nosocomial infections in patients during radiotherapy .Results Among 189 patients with head and neck cancer receiving radiotherapy , nosocomial infection was observed in 64 (33.86%) patients.Univariate analysis showed that radiation-induced oral mucositis (χ2 =11.47, P<0.01), underlying disease (χ2 =6.59, P<0.05), stage of tumor Ⅲ-Ⅳ (χ2 =4.36, P<0.05), whole-neck radiation (χ2 =7.64, P <0.05), dose of radiation ≥50 Gy(χ2 =8.92, P <0.05), combined chemotherapy (χ2 =6.53, P<0.01), invasive operation (χ2 =4.21, P<0.05), PS score=1 (χ2 =3.58, P<0.05) and low body mass index (χ2 =9.56, P <0.05) were risk factors of nosocomial infections . Multivariate Logistic regression analysis indicated that radiation-induced oral mucositis ( OR=3.46, χ2 =8.72, P<0.01),underlying disease (OR=1.91, χ2 =4.66, P<0.05), stage of tumor Ⅲ-Ⅳ (OR=2.01,χ2 =5.22, P<0.05), whole-neck radiation (OR=1.78,χ2 =4.89, P<0.05), dose of radiation ≥50 Gy (OR=1.69,χ2 =3.25, P<0.05), combined chemotherapy (OR=1.84, χ2 =6.91, P<0.05) and low body mass index (OR=1.53, χ2 =2.59, P<0.05) were independent risk factors of nosocomial infection.Conclusions Nosocomial infections are popular in patients with head and neck cancer during radiotherapy.Radiation-induced oral mucositis, underlying disease, stage of tumor, radiation field, dose of radiation, combined chemotherapy and body mass index are associated with the occurrence of nosocomial infections in these patients .
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Esophageal cancer is one of the most high incidence of malignant tumors in China. However, the evaluation of chemoradiotherapy curative effect for esophageal cancer is lack of accurate and uniform criteria. In recent years, the imaging evaluation methods for chemoradiotherapy response in esophageal cancer have made some progress. The methods mainly include X-ray barium examination, endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT), and so on. Imaging examination has the advantages of safety, non-invasion and repeatability, and so on, which is a progressing tool for curative effect evaluation. Current status of the application of medical imaging which is used to evaluate esophageal cancer chemoradiotherapy curative effect were reviewed in this paper.
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Objective To evaluate the relationship between sternum protection and bone marrow suppression in postoperative radiotherapy for esophageal carcinoma. Methods Total of 98 postoperative patients with thoracic esophageal carcinoma were randomly divided into experimental group (52 cases) and control group (46 cases). All patients were given intensity-modulated radiotherapy (IMRT), with the dose of 50-50.4 Gy. The patients in experimental group were irradiated by 6 fields (4-fields in front, 2-fields behind) which were crossed to avoid direct exposure to the sternum. The patients in control group were irradiated by 5 fields (3-fields in front, 2-fields behind) with front-middle of the field passing through the sternum. Concurrently all patients received 2 cycles of cisplatin chemotherapy. Results Dmean, V20 and V30 of the sternum in the experimental group were (20.21 ±3.60) Gy, (40.78 ±7.19) % and (33.78 ±9.44) %, which were lower than those in the control group [(30.91±5.21) Gy, (81.01±4.81) %, (51.60±6.84) %], respectively (P 0.05). Both the incidence rates of bone marrow suppression at 14th day and 35th day after radiotherapy were significantly higher in the control group (52.2%, 73.9%) than those in the experimental group (28.8 %, 50.0 %) (P< 0.05), and the incidence rate of bone marrow suppression at 7th day after radiotherapy was similar between the two groups. Conclusion Protecting and sketching for sternum in postoperative radiotherapy for esophageal carcinoma can reduce the incidence of bone marrow suppression effectively, which would not increase the radiation dose in the lung, heart and spinal cord.
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Objective To explore the function of stereotactic radiation therapy (SRT) and wholebrain radiation therapy (WBRT) in treatment of multiple brain metastasis tumor.Methods Fifty-two patients with multiple brain metastasis tumor were retrospectively analyzed.The patients were divided into simple stereotactic radiation therapy group (22 cases) and whole-brain radiation therapy + stereotactic radiation therapy group (30 cases) according to the radiation therapy method.The median overall survival time and distant brain tumor recurrence rate in 1 year etc.were compared between 2 groups.Results There were no statistical differences in the median overall survival time and fatality rate between simple stereotactic radiation therapy group and whole-brain radiation therapy + stereotactic radiation therapy group:13.0 months (95％ CI 8.05-27.84) vs.13.4 months (95％ CI 8.57-19.48),86.36％ (19/22) vs.86.67％ (26/30),P＞ 0.05.The distant brain tumor recurrence rate in 1 year in simple stereotactic radiation therapy group was significantly higher than that in whole-brain radiation therapy + stereotactic radiation therapy group:45.45％ (10/22) vs.20.00％ (6/30),and there was statistical difference (x2 =3,861,P =0.049).Conclusion Stereotactic radiation therapy and whole-brain radiotherapy can achieved similar median overall survival time.
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Objective To assess the tolerance of elderly patients with esophageal carcinoma to chemoradiotherapy through.Methods A retrospective analysis of 596 elderly patients with esophageal carcinoma receiving chemoradiotherapy was conducted.Patients were divided into radiachemotherapy group and radiotherapy group,and according to age,patients were divided into four age groups (aged 70-74,75-79,80 80 and 85years and over).The tolerance to treatment was assessed by Charlson index.Results 185 patients completed chemoradiotherapy,113 patients reduced the dose of chemotherapy (reduction group),81 patients unfinished chemoradiotherapy (unfinished CRT group),160 patients completed radical radiotherapy alone (unfinished RT group),and 57 patients incompleted radiotherapy.Further analysis found that the tolerance to treatment in reduction group had significant differences between patients aged ≥ 75 years and ＜ 75 years (x2 =6.815,P=0.009),and between WIC ≥ 1 and ＜ 1(x2 =10.636,P=0.001); the tolerance to treatment in unfinished CRT group had significantly differences between aged ≥ 80 years and ＜80 years (x2 =63.842,P=0.000),and between WIC =0,1 and ≥ 2 (x2 =21.153,P=0.000).Conclusions Further age re-grouping and WIC assessment is necessary before treating esophageal cancer patients.Reduction of therapy dosage is more beneficial for patients aged ≥ 75 years and WIC≥1,and greater caution is required in chemotherapy for patients aged ≥ 80 years and WIC＞1.
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Objective To seek the curative effect of stereotactic radiation therapy (SRT) combined with gemcitabine for unresectable advanced pancreatic carcinoma.Methods 24 patients were treated by SRT of 6MV X-ray.Patients were fixed with the rack of stereotactic localization and heated plastics mould.The CT scanning results were put into the treatment planning system.According to the target area of tumor,sensitive organs and moving error drew GTV,CTV and PTV.The best plan was selected by the dose-volume histogram (DVH).5 to 7 beams of non-coplanar radiation ray were chosen.PTV was surrounded by ≥95 ％ isodose curves.Conventional fraction,5 fractions per week,1.8-2 Gy per fraction was used.All patients received a total dose of 50-60 Gy.Gemcitabine was performed 1000 mg/m2,once a week,iv gtt,in the 1st,2nd and 4th,5 th weeks.Results In chemo-radiotherapy,50.0 ％ (12/24) patients showed light nausea,41.7 ％ (10/24) patients showed leucopenia or thrombocytopenia of grade 1 or 2,after symptomatic treatment,all patients completed the planned treatment.In a period of one month to three months,after SRT combined with chemotherapy,appetite improvement was 83.3 ％ (20/24),jaundice disappeared in 6 of 6 patients (100.0 ％),abdominal pain was relieved in 21 of 24 patients (87.5 ％),3 patients were relieved completely among them.The complete remission (CR) rate was 16.7 ％ (4/24) and partial remission (PR) rate was 66.7 ％ (16/24),with CR+PR rate of 83.4 ％ (20/24).One-year survival rate was 70.8 ％ (17/24).As a consequence of cachexia,intestinal obstruction or bleeding,7 patients died within one year.Nobody survived more than 2 years.Conclusions SRT combined with gemcitabine for advanced pancreatic carcinoma may relieve symptoms.It is an effective approach to improve life quality and prolong survival time for advanced pancreatic carcinoma,especially lod and weak patients are more suitable to select SRT combined with gemcitabine.
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Objective To evaluate the application value of domestic image‐guided radiotherapy system XGS‐10 made in Weidu medical company limited in intensity‐modulated radiotherapy for nasopharyngeal carcinoma .Methods A total of 30 nasopharyngeal carcinoma cases with intensity modulated radiatiotherapy by Varian accelerator were incorporated into the study .All patients ac‐cepted image‐guided radiotherapy system XGS‐10 of Chongqing Weidu medical company limited to obtain frontal images and CBCT to obtain CT images respectively .The images were matched with the planning images and target center ,then got the linear set‐up errors of left to right (X) ,superior to inferior (Y) ,and anterior to posterior (Z) ,and the time of acquiring and matching was recor‐ded .Results The correlation of both two instruments′setup errors in X ,Y ,Z direction is good ,the difference of setup errors was within the acceptable range ,and was not statistically significant (P>0 .05) .the time of acquiring images was (15 ± 2)s and that of matching images was (20 ± 2)s by XGS‐10 ;the time of acquiring images was (120 ± 8)s and that of matching images was (240 ± 10)s by Varian CBCT .Conclusion The setup error of XGS‐10 of intensity‐modulated radiotherapy for nasopharyngeal carcinoma was equal to CBCT ,but the time of acquiring and matching time of XGS‐10 was shorter than that of CBCT ,which could shorten the positioning time and reduce radiation dose for patient .As a result ,it is conducive to real‐time clinical radiotherapy guidance .