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The rapid progress on immunotherapy and targeted therapy has brought long-term survival benefits for locally advanced non-small cell lung cancer (NSCLC). The oncology community has also paid more attention to the local treatment for advanced NSCLC, especially for patients with limited metastatic lesions, also known as oligo-metastasis. Many studies have reported that oligo-metastatic NSCLC patients could benefit from the combination of local and systematic treatment, and even to be cured. In recent years, with the advances in radiation technology, stereotactic body radiation therapy (SBRT) has achieved precise high-dose radiotherapy for small target tumors. Currently, SBRT has been widely applied in the treatment of inoperable early lung cancer, and its application value and safety in patients with advanced lung cancer are also being actively explored. In this article, the research status, progress and future development direction of SBRT in the treatment of oligo-metastatic NSCLC were discussed.
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BACKGROUND@#With the aging of the population and the increased importance of lung cancer screening, the number of early-stage lung cancer patients has been on the rise in recent years, which can be classified into operable early-stage lung cancer and inoperable early-stage lung cancer. The most common pathological type is non-small cell lung cancer (NSCLC). Stereotactic body radiation therapy (SBRT) is the optimal treatment for inoperable early-stage NSCLC. The aim of this study was to investigate the prognosis of early-stage NSCLC patients treated with SBRT and its influencing factors in order to reduce the side effects of radiotherapy and improve the survival and quality of life.@*METHODS@#Clinical data and follow-up outcomes of early-stage NSCLC patients treated with SBRT in our hospital from August 2010 to August 2020 were collected. Kaplan-Meier method was used to assess the prognosis, and the Cox proportional risk model was used for multivariate prognostic analysis.@*RESULTS@#A total of 165 patients were included with a median follow-up time of 43.2 (range: 4.8-132.1) mon. The local control (LC) rates at 1-yr, 2-yr and 5-yr were 98.1%, 94.8% and 86.5% respectively. Karnofsky performance status (KPS) score greater than 80 was an independent prognostic factor for LC (P=0.02). The overall survival (OS) rates at 1-yr, 2-yr and 5-yr were 97.6%, 93.0% and 68.9% respectively. A biological equivalent dose when α/β=10 (BED10) greater than 132 Gy was an independent prognostic factor for OS (P=0.04). Progression-free survival (PFS) rates at 1-yr, 2-yr and 5-yr were 93.3%, 79.5% and 55.3% respectively. The distance metastasis free survival (DMFS) rates at 1-yr, 2-yr and 5-yr were 94.5%, 83.2% and 58.4% respectively. BED10 greater than 150 Gy was an independent prognostic factor for DMFS (P=0.02). The regional control (RC) rates at 1-yr, 2-yr and 5-yr were 98.8%, 95.4% and 87.9% respectively.@*CONCLUSIONS@#SBRT is effective in treating early-stage NSCLC. KPS greater than 80 is an independent prognostic factor for LC; BED10 greater than 132 Gy is an independent prognostic factor for OS; BED10 greater than 150 Gy is an independent prognostic factor for DMFS.
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Humans , Carcinoma, Non-Small-Cell Lung/pathology , Lung Neoplasms/pathology , Radiosurgery/methods , Early Detection of Cancer , Quality of Life , Prognosis , Small Cell Lung Carcinoma , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To provide a reliable and stable animal model for investigating the molecular pathogenesis of radiation-induced liver disease (RILD). Methods Ninety C57BL/6J mice were divided into control, 20 Gy, 25 Gy, 30 Gy and 35 Gy radiation groups. The mice were executed at 4 weeks after radiation and the levels of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase in the liver serum were measured. HE staining was performed on the pathological liver tissues. Masson staining was performed at 36 weeks after radiation. Results Compared with the control group, the fatality rate was higher in the 30 and 35 Gy radiation groups, and the body weight significantly decreased in the 20 and 25 Gy radiation groups. Compared with the control group, alanine aminotransferase significantly increased in mice exposed to 20 Gy, while aspartate aminotransferase and alanine aminotransferase increased in mice exposed to 25 Gy. No significant changes were observed in the livers of the mice in the 20 and 25 Gy radiation groups, but pathological examination showed liver damage induced by both 20 and 25 Gy radiation. Conclusion A stable and reliable mouse model of RILD was constructed for treatment with linear accelerator. The mouse model of RILD constructed for stereotactic body radiation therapy using linear accelerator has significant research implications for the exploration of RILD.
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@#We reported three cases of stageⅢ/N2 non-small cell lung cancer (NSCLC) treated with neoadjuvant immunotherapy and stereotactic body radiation therapy (SBRT) in our hospital, including 2 males and 1 female with a mean age of 65.7 years. The patients received two doses of the programmed cell death protein-1 inhibitor toripalimab after 1 week of SBRT. Thereafter, surgery was planned 4-6 weeks after the second dose. One patient achieved pathologic complete response, one achieved major pathologic response (MPR), and one did not achieve MPR with 20% residual tumor. There were few side effects of toripalimab combined with SBRT as a neoadjuvant treatment, and the treatment did not cause a delay of surgery.
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Objective:To realize the automatic evaluation of the target conformity, dose overflow, dose drop and other indicators in stereotactic body radiation therapy (SBRT) plan for the early non-small cell lung cancer (NSCLC) in the Eclipse planning system.Methods:Eclipse Scripting API application development interface and C# programming language were used to develop it with script plug-ins combined with independent programs. According to the requirements of the NSCLC SBRT plan in Radiation Therapy Oncology Group (RTOG) 0915 report, the automatic evaluation of related indicators was realized. A rule of equal interval sampling and double thresholds was designed during the period, which could more accurately and conveniently evaluate the dose drop outside the target area.Results:13 clinical cases of NSCLC SBRT plans were randomly selected, the method in this study and the module equipped with the Eclipse system to were utilized to evaluate and compare the results. It was concluded that the results of the two methods were in line with the clinical requirements, and the former was more efficient ( P<0.05). Conclusions:The NSCLC SBRT plan evaluation software in this article has a friendly interface. It can not only realize the automatic evaluation of target conformity, dose overflow and dose drop, but also effectively improve work efficiency and better serve the clinical and scientific research work of radiotherapy.
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Objective:To investigate the prognostic factors of patients with esophageal squamous cell carcinoma with pulmonary metastasis.Methods:Clinical characteristics of 135 esophageal squamous cell carcinoma patients presenting with pulmonary metastasis after treatment in Zhejiang Cancer Hospital from 2008 to 2018 were retrospectively analyzed. Thesurvival rate was calculated by Kaplan-Meier method. Univariate analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox models.Results:The median follow-up time of 135 patients with esophageal squamous cell carcinoma was 94.2 months (19.5-258.9 months), and 109 patients died (80.7%). The 1-and 2-year overall survival rates were 47.4% and 25.1%, with the median survival time was 11.1 months (7.3-14.9 months). Univariate prognostic analysis showed that age, number of lung metastases, treatment of lung metastases, lymph node metastasis, distant organ metastasis, and the interval between the first treatment and lung metastasis were the prognostic factors of esophageal squamous cell carcinoma with lung metastasis (all P<0.05). Multivariate analysis demonstrated that age and number of lung metastases were the independent prognostic factors for patients with esophageal squamous cell carcinoma with lung metastases (all P<0.05). Conclusions:Age and number of lung metastases are the independent prognostic factors for patients with esophageal squamous cell carcinoma with lung metastases. Surgery or radiotherapy-based regional therapy can enhance clinical prognosis.
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Objective:To investigate the workflow, efficacy and safety of MR-Linac in liver malignancies.Methods:Clinical data of 15 patients with hepatocellular carcinomas (HCC) or liver metastases treated with MR-Linac between November 2019 and July 2021 were retrospectively analyzed. The workflow of MR-Linac was investigated and image identification rate was analyzed. Patients were followed up for response and toxicity assessment.Results:Fifteen patients (6 HCC, 8 liver metastases from colorectal cancer, 1 liver metastasis from breast cancer) were enrolled. A total of 21 lesions were treated, consisting of 10 patients with single lesion, 4 patients with double lesions and 1 patient with triple lesions. The median tumor size was 2.4 cm (0.8-9.8 cm). The identification rate for gross tumor volume (GTV) in MR-Linac was 13/15. Although GTV of two patients were unclearly displayed in MR-Linac images, the presence of adjacent blood vessel and bile duct assisted the precise registration. All the patients were treated with stereotactic body radiation therapy (SBRT). For HCC, the median fraction dose for GTV or planning gross tumor volume (PGTV) was 6 Gy (5-10 Gy) and the median number of fractions was 9(5-10). The median total dose was 52 Gy (50-54 Gy) and the median equivalent dose in 2 Gy fraction (EQD 2Gy) at α/ β= 10 was 72 Gy (62.5-83.3 Gy). For liver metastases, the median fraction dose for GTV or PGTV was 5 Gy (5-10 Gy) and the median number of fractions was 10(5-10). The median total dose was 50 Gy (40-50 Gy) and the median EQD 2Gy at α/ β=5 was 71.4 Gy (71.4-107.1 Gy). At 1 month after SBRT, the in-field objective response rate (ORR) was 8/13 and the disease control rate was 13/13. At 3-6 months after SBRT, the in-filed ORR was increased to 6/6. During the median follow-up of 4.0 months (0.3-11.6), 4-month local progression-free survival, progression-free survival and overall survival were 15/15, 11/15 and 15/15, respectively. Toxicities were mild and no grade 3 or higher toxicities were observed. Conclusions:MR-Linac provides a platform with high identification rates of liver lesions. Besides, the presence of adjacent blood vessel and bile duct also assists the precise registration. It is especially suitable for liver malignancies with promising local control and well tolerance.
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Objective:To investigate the efficacy and safety of camrelizumab combined with stereotactic body radiation therapy (SBRT) in the treatment of advanced oligometastaticnon-small cell lung cancer (NSCLC).Methods:Eighty-six patients with advanced oligometastatic NSCLC who met the inclusion and exclusion criteria from March 2020 to August 2021 in the Second People′s Hospital of Yibin were divided into the control group (43 cases) and the treatment group (43 cases) according to the random number table method, the control group was given camrelizumab combined with conventional radiotherapy, and the treatment group was given camrelizumab combined with SBRT. After 8 weeks of treatment, the efficacy of the two groups was evaluated, the occurrence of side effects in the two groups was counted, the serum tumor markers [carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag), cytokeratin 19 fragment anti-21-1 (CYFRA21-1)] levels were detected.Results:The objective effective rate of the treatment group was significantly higher than that of the control group:: 72.09% (31/43) vs. 51.16%(22/43), the difference was statistically significant ( P<0.05); the incidence of radiation pneumonia in the treatment group was significantly lower than that in the control group: 4.65% (2/43) vs. 18.60% (8/43), the difference was statistically significant ( P<0.05), and there was no significant difference in the incidences of other side effects such as cutaneous capillary endothelial proliferation (CCEP), liver damage, hypothyroidism, and radiation esophagitisbetween the treatment group and the control group ( P>0.05); the levels of serum CEA, SCC-Ag, CYFRA21-1after treatmentin the two groups were significantly lower than those before treatment, treatment group: treatmentgroup: (8.81 ± 4.82) ng/L vs. (81.67 ± 50.88) ng/L, (1.13 ± 0.55) ng/L vs. (1.56 ± 1.03) ng/L and (2.92 ± 0.99) ng/L vs. (4.63 ± 1.39) ng/L, controlgroup: (30.49 ± 19.44) ng/L vs. (89.91 ± 50.10) ng/L, (1.56 ± 1.23) ng/L vs. (1.86 ± 1.33) ng/L and (4.01 ± 2.10) ng/L vs. (5.03 ± 3.44) ng/L. and the levels after treatment in the treatment group were significantly lower than those in the control group, and there were statistical differences ( P<0.05). Conclusions:Camrelizumab combined with SBRT treatment for patients with advanced oligometastatic NSCLC can effectively reduce the levels of serum CEA, SCC-Ag, CYFRA21-1, and significantly improve the short-term efficacy, with relatively low incidence of toxic side effects.
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The major treatments of non-small cell cancer (NSCLC) contain surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy and the combinations of them. Among them, stereotactic body radiation therapy (SBRT) is applied more and more extensively. Based on the immunoregulatory effects of SBRT, the combination with immune checkpoint inhibitors (ICIs) is used in all stages of NSCLC. This kind of treatment mode needs to be continuously explored to maximize the radio-immunity synergistic effect.
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Objective:To investigate the workflow, feasibility and advantages of respiratory navigator-guided stereotactic body radiation therapy (SBRT) of liver malignancies on the magnetic resonance linear accelerator (MR-linac).Methods:Clinical data of 10 patients with liver cancer treated with respiratory navigator-guided SBRT on the MR-linac from September to December 2021 were analyzed retrospectively. All patients underwent CT and MR simulated localization, and plain, enhanced and 4D CT scan, and T 1 3D MR and T 2 3D MR images were collected. The expiratory 4D CT was chosen to design the reference plan. The T 2 3D navigator MR image (end-exhalation) was collected before treatment, the target position was adjusted or the target shape was modified in combination with the real-time monitoring 2D MR image and appropriate online adaptive planning process was selected. Then, the ability of CT, T 2 3D and T 2 3D navigator MR images to display the tumor was evaluated by naked eye. The changes of target volume were calculated. Dosimetric differences between the adaptive and reference plans were compared. The efficacy and adverse reactions of patients were evaluated. Results:In the free breathing state, the T 2 3D navigator MR image was significantly better than T 2 3D MR image to clearly display the tumor and its boundary. The adaptive plans of adapt-to-position (ATP) and adapt-to-shape (ATS) adopted by 10 patients was 37 times and 22 times respectively. The tumor subsided significantly in 3 patients. The average target conformal index (CI) of the adaptive plans was no different from that of the reference plans, but the gradient index (GI) was higher ( P<0.05), especially in the ATS plans. Compared to the reference plans, the normal liver V 5 Gy, V 10 Gy and D mean were almost the same, but the average MU was increased with a significant difference in the ATP adaptive plans ( P<0.05). The average of MU, segments and normal liver D mean and V 10 Gy in the ATS adaptive plans were lower than those in the reference plans, and the liver V 5 Gy was slightly increased. Seven patients were evaluated after 1 month and 3 months. The local control of lesions was promising. Toxicities were mild and no grade 3 or higher toxicities were observed. Conclusion:Respiratory navigator on MR-linac improves the visual clarity of tumors and online MR images, and shows its advantages to guide the adaptive precision radiotherapy of liver tumors, especially in SBRT.
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Objective:To evaluate the difference between conventional fractionation radiotherapy (CRT) and stereotactic body radiation therapy (SBRT) in lung cancer.Methods:A model was constructed based on convolution operation and finite element method, simulating the dose delivered to circulating lymphocytes (CL) in radiotherapy. The model was trained on a training group ( n=3) and validated in an independent validation group between SBRT ( n=10) and CRT ( n=10). The peak cumulative dose of circulating lymphocyte (PCDC) was compared between the two schemes, and the effect of different PTV volumes and treatment time on the cumulative dose was also analyzed. The correlation between PCDC and CL change value was discussed. Results:In the training group, PCDC with CRT to CL were 1.26 Gy,1.79 Gy, 2.54 Gy in PTV of 38 cm 3, 63 cm 3 and 114 cm 3, and PCDC with SBRT to CL were 0.84 Gy, 1.22 Gy, 1.55 Gy in PTV of 38 cm 3, 63 cm 3, 114 cm 3, respectively. PCDC gap of SBRT to CL was decreased by 0.42 Gy, 0.57 Gy, 0.99 Gy, respectively. In the validation group, the lymphocyte change value in SBRT and CRT were (1.10±0.64)×10 9/L and (0.42±0.48)×10 9/L, and there was significant difference ( P=0.015). PCDC in SBRT and CRT were 3.56 (2.79, 3.82) Gy and 1.24 (0.697, 1.73) Gy, and there was significant difference ( P<0.001). There was a positive correlation between lymphocyte change value and PCDC ( r=0.455, P<0.05). Conclusions:SBRT, compared to CRT, will lead to lower PCDC and CL lymphocyte change value, which may cause a greater impact on the difference of PCDC along with the enlargement of PTV. CRT and large PTV volume may cause more significant effect upon the body immune function.
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In recent years, the application of immune checkpoint inhibitors (PD-1/PD-L1/CTLA-4, etc.) in the treatment of non-small cell lung cancer (NSCLC) has developed rapidly. However, the response rate of immune checkpoint inhibitors alone is as low as 15%-30%. There are still many problems in clinical practice, such as limited benefit population, lack of effective biomarkers and treatment resistance, etc. Compared with conventional fractionated radiotherapy, stereotactic body radiation therapy (SBRT) has the characteristics of higher single dose, less irradiation times and stronger immune activation ability. It has shown good anti-tumor effect in patients with advanced NSCLC oligometastasis. The combination of immune checkpoint inhibitors and SBRT is the development trend of tumor therapy. Preclinical and clinical studies show that SBRT can enhance the efficacy of immunotherapy in patients with NSCLC. In the initial study, single-lesion SBRT was first recommended to reduce potential toxicity. However, more and more studies have confirmed the feasibility and necessity of multi-lesion SBRT. In this review, we not only elucidated the mechanism and the latest progress upon combined use of SBRT and immune checkpoint inhibitors in advanced NSCLC oligometastasis, but also explored the basic and clinical research of multi-lesion SBRT combined with immunotherapy, aiming to guide clinical practice.
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Small cell lung cancer (SCLC) is a poorly differentiated, rapidly aggressive and highly chemoradio-sensitive malignancy. Recent research finds that stereotactic body radiation therapy (SBRT) is well tolerated in the treatment of early-stage SCLC with excellent locoregional control rates. This paradigm could offer comparable overall survival and cancer-specific survival with surgery or conventional concurrent chemoradiotherapy. Presently, SBRT has become one of the standard treatment options for patients with stage I-IIA SCLC. Due to the enlightened role of SBRT in the treatment of SCLC, this review aims to discuss the clinical research to date in the application status, clinical value and developing tendency of SBRT in the treatment of patients with early-stage SCLC.
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Objective:To compare the efficacy of stereotactic body radiotherapy(SBRT) and surgery in treating intrapulmonary recurrence of non-small cell lung cancer (NSCLC) after radical surgery.Methods:A retrospective analysis was conducted on NSCLC patients, who underwent radical surgery at the Cancer Hospital Affiliated to University of Chinese Academy of Sciences from November 2012 to December 2018 and then received SBRT or secondary surgery because of postoperative intrapulmonary recurrence. The survival rates of these patients were calculated using the Kaplan-Meier method. The comparison between the two groups was made using the Log-rank method, and the univariate and multivariate analysis was made using the Cox regression method.Results:Among 62 eligible patients, 33 received SBRT and 29 received secondary surgery, and they were divided into the SBRT group and the surgery group accordingly. For the SBRT and surgery groups, the median follow-up time was 45.8 months and 37.4 months, the 3-year locoregional control rate (LRCR) 79.8% and 90.2%, respectively ( P > 0.05), the progression-free-survival (PFS) 58.5% and 42.3%, respectively ( P >0.05), and the overall survival (OS) 78.0% and 85.5%, respectively ( P >0.05). The multivariate analysis suggested that treatment method, Charlson comorbidity index (CCI), and adjuvant drug therapy were independent prognostic factors for PFS ( P = 0.027, 0.013, 0.001). Conclusions:The efficacy of SBRT and surgery is comparable for patients with intrapulmonary recurrence of NSCLC after radical surgery.
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Objective:To compare the effects of parameters, such as planning target volume (PTV), calculation grid size, and dose threshold, on the dosimetric verification result of three dosimetric verification systems ArcCHECK, SRS MapCHECK, and 3DMap for stereotactic body radiation therapy (SBRT).Methods:Based on the dosimetric verification result of the SBRT plans of 50 patients, this study compared the effects of PTV (<25 cm 3 and ≥25 cm 3), calculation grid size (1.0, 1.5, and 2.0 mm), and dose threshold (5%, 10%, and 15%) on the γ passing rates of the three dosimetric verification systems at five criteria, i. e., 3 mm/3%, 3 mm/2%, 3 mm/1%, 2 mm/3%, and 2 mm/2%. Results:The changes in PTV affected 3DMap more significantly. With an increase in PTV, the γ passing rates of 3DMap at the criteria of 3 mm/3%, 3 mm/2%, 2 mm/3%, and 2 mm/2% increased by 2.2%, 2.2%, 4.4%, and 4.7% ( t=-2.76, -2.17, -4.72, -3.86, P<0.05), respectively. The increase in the calculation grid from 1.0 mm to 1.5 mm had greater effect on MapCHECK, with the γ passing rates at the criteria of 3 mm/3%, 3 mm/2%, 3 mm/1%, 2 mm/3% and 2 mm/2% decreased by 0.7%, 1.1%, 1.7%, 0.9%, 1.5% ( t=-6.15, -6.23, -5.98, -5.11, -8.34, P<0.05), respectively. The increases in the calculation grid from 1.0 mm to 2.0 mm had greater impact on ArcCHECK, with the γ passing rates at the criteria of 3 mm/3%, 3 mm/2%, 3 mm/1%, 2 mm/3%, 2 mm/2% decreased by 1.0%, 1.7%, 2.4%, 1.7%, 2.7% ( t=-4.75, -7.3, -8.63, -7.11, -8.26, P<0.05), respectively. The increase in the dose threshold from 5% to 10% had greater impact on ArcCHECK, with the γ passing rates at the criteria of 3 mm/3%, 3 mm/2%, 2 mm/3% and 2 mm/2% decreased by 1.1%, 1.4%, 2.5%, and 3.0% ( t=5.20, 5.68, 8.17, 9.99, P<0.05), respectively. Moreover, the increase in the dose threshold from 5% to 15% had more impact on 3DMap, with the γ passing rates at the criteria of 3 mm/3%, 3 mm/2%, 2 mm/3%, and 2 mm/2% decreased by 1.6%, 1.7%, 2.8%, and 3.2% ( t=3.25, 2.98, 4.40, 4.21, P<0.05), respectively. Conclusions:Target volume, calculation grid, and dose threshold are influencing factors in the dosimetric verification of three dosimetric verification systems for SBRT. Therefore, the effects of these parameters should be considered for different verification systems in clinical applications.
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Objective: To explore the safety and effectiveness of stereotactic body radiation therapy (SBRT) for oligometastases from colorectal cancer (CRC). Methods: This is a prospective, single-arm phase Ⅱ trial. Patients who had histologically proven CRC, 1 to 5 detectable liver or lung metastatic lesions with maximum diameter of any metastases ≤5 cm were eligible. SBRT was delivered to all lesions. The primary endpoint was 3-year local control (LC). The secondary endpoints were treatment-related acute toxicities of grade 3 and above, 1-year and 3-year overall survival (OS) and progression free survival (PFS). Survival analysis was performed using the Kaplan-Meier method and Log rank test. Results: Petients from 2016 to 2019 who were treated in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Forty-eight patients with 60 lesions were enrolled, including 37 liver lesions and 23 lung lesions. Forty-six patients had 1 or 2 lesions, with median diameter of 1.3 cm, the median biologically effective dose (BED(10)) was 100.0 Gy. The median follow-up was 19.5 months for all lesions. Twenty-five lesions developed local failure, the median local progression free survival was 15 months. The 1-year LC, OS and PFS was 70.2% (95% CI, 63.7%~76.7%), 89.0% (95% CI, 84.3%~93.7%) and 40.4% (95%CI, 33.0%~47.8%). The univariate analysis revealed that planning target volume (PTV) and total dose were independent prognostic factors of LC (P<0.05). For liver and lung lesions, the 1-year LC, OS and PFS was 58.7% and 89.4% (P=0.015), 89.3% and 86.5% (P=0.732), 30.5% and 65.6% (P=0.024), respectively. No patients developed acute toxicity of grade 3 and above. Conclusion: SBRT is safe and effective treatment method for oligometastases from CRC under precise respiratory motion management and robust quality assurance.
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Humans , Colorectal Neoplasms , Liver/pathology , Lung/pathology , Prospective Studies , Radiosurgery/methodsABSTRACT
Pancreatic cancer is highly malignant, and surgical resection is the only cure method at present. In recent years, neoadjuvant therapy has enabled some patients to be successfully downgraded with surgical treatment, which increased the R0 surgical resection rate and prolonged the survival time of patients, has become an important part in the treatment of pancreatic cancer. However, the applicability and standardization of neoadjuvant therapy for pancreatic cancer still need more advanced evidence. This article reviews whether neoadjuvant therapy should be used for resectable pancreatic cancer, the choice of neoadjuvant chemotherapy, and the progress, advantages and disadvantages of neoadjuvant chemoradiotherapy.
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Objective To explore the dose of template-assisted 192Ir source hypofractionated stereotactic brachytherapy (SABT) for peripheral lung cancer. Methods We retrospectively analyzed the dose parameters of GTV and OARs of 28 peripheral lung cancer patients treated with template-assisted 192Ir-source hypofractionated SABT, and compared the dose parameters between SABT with virtual SBRT. Results The Dmean and V150 for the GTV in the SABT plan were significantly higher than those in the SBRT plan (all P < 0.01). For OARs, all dosimetric parameters in the SABT plan were significantly lower than those in the SBRT plan (all P < 0.01), except for the D1000cm3 and D1500cm3 for the lung (P > 0.05). Conclusion Template-assisted 192Ir source hypofractionated SABT ensures high dose in the gross tumor volume and reduces the dose in organs at risk in the treatment of peripheral lung cancer.
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Objective To explore the incidence of pain flare (PF) in spine metastasis stereotactic body radiotherapy (SBRT) or hypofractionated radiotherapy (HF) and the prophylactical effect of dexamethasone. Methods Sixty-five patients were treated with spine metastasis SBRT and randomly divided into control group (SBRT or HF, n=32) and treatment group (SBRT or HF and 4.5 mg dexamethasone, n=33). The brief pain inventory (BPI) was used to score the pain before, during and after treatment. PF was recorded and compared between two groups. Results The incidence of PF was 24.6% in all patients (control group: 37.5%, treatment group: 12.1%, P=0.018). PF in both group occurred in d1-2, accounting for 62.5% in all PF (control group: 66.7%, treatment group: 50%, P=0.551). The incidences of PF in control group were 66.7% and 33.3% for three and ten fractions scheme, respectively (P=0.001). However, the incidences of PF in treatment group were 50% and 50% for three and ten fractions scheme, respectively (P=0.643). Conclusion Oral dexamethasone has an excellent efficacy in prevention and treatment of PF in spine metastasis SBRT or HF, with significantly decreased incidence of PF. A phase Ⅲ clinical trial is required to finalize the optimal dose and schedule.
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Liver transplantation is an effective approach to treat intrahepatic cholangiocarcinoma (ICC). It is necessary to strictly control surgical indications of ICC because of its high invasiveness, lymph node metastasis and recurrence rate after liver transplantation. Liver transplantation yields high efficacy for single ICC with a diameterof ≤2 cm. For advanced ICC, neoadjuvant therapies including locoregional treatment and systemic chemotherapy should be initially delivered. According to the response of these neoadjuvant therapies, whether liver transplantation should be performed can be determined, and individualized adjuvant therapy should be delivered after operation. At present, multiple gene mutation targets and targeted therapeutic drugs for cholangiocarcinoma have been identified. Comprehensive treatment before and after liver transplantation may expand surgical indications of liver transplantation for ICC and improve clinical prognosis of the recipients. In this article, liver transplantation for ICC, neoadjuvant therapy before liver transplantation, postoperative adjuvant therapy and targeted therapy for ICC were reviewed.