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Objective:To explore the clinical efficacy and safety of the camrelizumab combined with apatinib and chemotherapy as second-line or later therapy in human epidermal growth factor receptor-2 (HER-2) negative advanced gastric cancer.Methods:A total of 66 patients with HER-2 negative advanced gastric cancer and first-line treatment failure in Shandong Cancer Hospital Affiliated to Shandong First Medical University from March 2018 to September 2021 were selected. They were divided into study group ( n=22) and control group ( n=44) according to the different treatment regimens. The patients in the study group were treated with camrelizumab combined with apatinib and chemotherapy, and the patients in the control group were treated with chemotherapy alone. The short-term efficacy, progression-free survival (PFS) , overall survival (OS) and the occurrence of adverse reactions were compared, and Cox regression analysis was used to analyze the influencing factors of prognosis. Results:After at least 2-4 cycles of treatment, the ORR in the study group and the control group were 9.1% (2/22) and 0 (0/44) respectively, with no statistically significant difference ( P=0.108) . DCR in the two groups were 77.3% (17/22) and 45.5% (20/44) respectively, with a statistically significant difference ( χ2=6.03, P=0.014) . The study group didn’t reach median OS and the median OS in the control group was 11.7 months, with no statistically significant difference ( χ2=1.59, P=0.207) . The study group didn’t reach median PFS and the median PFS in the control group was 3.2 months, with a statistically significant difference ( χ2=10.13, P=0.001) . Multivariate Cox regression analysis showed that treatment method was an independent influencing factor for PFS in patients with HER-2 negative advanced gastric cancer ( HR=0.33, 95% CI: 0.15-0.75, P=0.008) . In terms of adverse reactions, there was a statistically significant difference in the incidence of elevated alanine aminotransferase between the study group and the control group [31.8% (7/22) vs. 6.8% (3/44) , χ2=5.32, P=0.021]. There were no adverse-related deaths in both groups. Conclusion:Compared with chemotherapy alone, camrelizumab combined with apatinib and chemotherapy as a second-line or later therapy in HER-2 negative advanced gastric cancer can prolong PFS and improve DCR, but the incidence of elevated alanine aminotransferase increases significantly.
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Modern medical imaging techniques,such as computed tomorgraphy (CT),magnetic resonance imaging (MRI) and position emission tomorgraphy/computed tomorgraphy (PET-CT) can accurately delineate the gross target volume (GTV) of hepatocellular carcinoma (HCC).Comparison of postoperative pathological subclinical lesions,imaging and clinical parameters contributes to the precise delineation of clinical target volume (CTV).Moreover,radiotherapy-assisted techniques,such as fourdimensional computed tomography (4DCT),compression of abdomen,active breathing control and respiratory gating,can minimize the internal target volume (ITV).In addition,immobilization with vacuum cushion and body membrane can reduce the set-up error,minimize the planning target volume (PTV) and avoid or decrease the irradiation error or missing irradiation.All these approach can minimize the target volume,elevate the dose and reduce the complications during radiotherapy for HCC.In this article,the research progress on the target delineation for external beam radiotherapy in HCC patients was reviewed.
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Objective To investigate the treatment options and prognostic factors of limited-stage small cell cancer of the esophagus.Methods A retrospective analysis of 58 limited-stage cases admitted to Shandong Cancer Hospital Affiliated to Shandong University from June 2009 to July 2017 was performed.Kaplan-Meier and log-rank methods were used for survival analysis.Cox regression model was used for prognostic factors analysis.Results The median overall survival (OS) of the whole group was 21.3 months (5.3-97.2 months).The 6-month,1-year,2-year,3-year and 5-year survival rates were 93％,84％,44％,28％ and 11％ respectively.Univariate analysis suggested that treatment and stage affected patient survival.The median OS of the chemotherapy,chemotherapy + radiotherapy,surgery + chemotherapy and surgery + chemotherapy + radiotherapy groups were 14.5,18.0,23.8 and 46.5 months respectively,with a significant difference (x2 =11.148,P =0.011).The combination therapy was better than chemotherapy alone (all P ＜ 0.05),but there was no significant difference between the different combinations of treatments (all P ＞ 0.05).The median OS of the stage Ⅱ,Ⅲ,patients were 27.0,17.8 and 9.9 months respectively,with a significant difference (x2 =48.114,P ＜ 0.001).The prognosis of patients with stage Ⅱ and Ⅲ was better than that of patients with stage Ⅳ (both P ＜0.001),but there was no significant difference in OS between stage Ⅱ and stage Ⅲ patients (P ＞0.05).Multivariate analysis found that treatment (HR =0.567,95％ CI:0.387-0.830,P =0.004) and stage (HR =3.009,95 ％ CI:1.811-4.999,P ＜ 0.00 1) were independent prognostic factors for OS.The stratified analysis found no significant difference in the prognosis between the surgical and non-surgical patients (median OS:28.6 and 16.9 months;x2 =3.938,P =0.052).Preoperative neoadjuvant therapy did not improve the prognosis of the patients (17.8 months vs.43.4 months;x2 =0.571,P =0.450).The analysis showed that there was no statistical difference in OS between patients with Ki-67 index ≤ 80％ and ＞ 80％(median OS:16.9 and 24.5 months;x2 =3.341,P =0.068).Conclusion The treatment and stage are independent prognostic factors for patients with limited-stage small cell cancer of the esophagus.The effect of chemotherapy alone is poor for patients with limited-stage small cell cancer of the esophagus.Multimodality therapy can benefit patients.
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Primary mediastinal B-cell lymphoma (PMBCL) is aggressive B-cell lymphoma with unique clinicopathologic characteristics.However,under the new classification of PMBCL,whether R-CHOP was the standard first-line immunotherapy regimen remains a controversy.The DA-EPOCH-R is not inferior to R-CHOP,but attention should be paid to the toxic effects.PMBCL is a radiosensitive disease,but radiotherapy did not as the front-line therapy for PMBCL.A biopsy is required for positive PET/CT after immunotherapychemotherapy to determine the further treatment of PMBCL.Recurrent/refractory PMBCL,with poor prognosis,salvage immunochemotherapy is often used followed by high-dose chemotherapy and autologous stem cell transplant.PD-1 overexpression is common in recurrent/refractory PMBCL,and immune checkpoint inhibitors are potential to be an important treatment option.Recently,the development of molecular medicine has provided a new basis for the selection of targets in PMBCL,however,it needs to be further confirmed by clinical trials.
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Objective To evaluate the dosimetric imnpact of the fixed position of two-degrade collimator in the treatment of breast cancer after radical mastectomy using intensity-modulated radiotherapy (IMRT) technique.Methods A total of ten patients with breast cancer were treated with radical mastectomy and radiotherapy sequaciously involving the supraclavicular region and the chest wall.Two different IMRT treatment plans were designed for each patient:0°,40° and two tangential field.There was no restriction on the position of two-degrade collimator(IMRT-1) (P ＞ 0.05).The beam angles and the parameters were as same as IMRT-1,but fixed the position of the two-degrade collimator of 0° and 40° at the inferior border of the supraclavicular (IMRT-2).The dose distribution of target volume and normal tissues,conformal index (CI),and heterogeneous index (HI) were estimated with the dose volume histogram (DVH) for the two intensity modulated modes.Results The CI were 0.79 and 0.73 (Z =-2.316,P＜0.05),and the HI of the IMRT-2 plans was not different from IMRT-1 (P ＞ 0.05).Considering the dose volunes of the ipsilateral lung in two plans,the values of V5,V10,D of IMRT-2 were significantly less than those of IMRT-1 (Z =-2.805,-2.812,-2.521,P ＜ 0.05).Meanwhile,the D of the contralateral lung,D of heart and D of the contralateral breast from the IMRT-2 were all lower than those oflMRT-1 (Z=-2.666,-2.701,-2.310,P＜0.05).There was no significant difference in the values of V20,V30 of the ipsilateral lung,V30 of heart and between IMRT-1 and IMRT-2 (P ＞0.05).Conclusions Compared with IMRT-1,IMRT-2 with fixed position of the two-degrade collimator could significantly reduce the low dose region of the lung and heart.It may be used as an effective alternative for breast cancer after radical mastectomy irradiation.
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Malignant tracheoesophageal fistula (MTEF) is pathological communication between the respiratory tracts such as the trachea or bronchia and the esophagus because of malignant tumor dissemination through them.Radiography is an important adjunctive technology in the diagnosis of MTEF,and the location and size of fistula often need the further diagnosis of bronchoscopy and esophagoscopy.The patients are often with an unfavourable prognosis once developed MTEF,and are treated usually with the aim of symptom palliation and life quality improvement.The individual treatment includes esophageal stenting,esophageal exclusion and esophagus bypass,fistula exclusion and repair,radiotherapy and others effective therapy according to the patients condition.These therapies will prolong the life span and improve the life quality of patients.MTEF is not absolute contraindication for chemoradiotherapy.Despite its acute toxicity,this concurrent chemoradiothe rapy protocol appears feasible and effective at closing esophageal malignant fistula,especially in patients in a good general condition and without metastasis.
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Objective To investigate a feasibility of treatment planning in thoracic esophageal carcinoma with 3-deoxy-3-fluorothymidine (FLT) PET-CT and to compare with fluorodeoxyglucose (FDG) PET-CT based on dosimetric analysis.MethodsTwenty-two patients with esophageal squamous cell carcinoma detected by FLT and FDG PET-CT were enrolled.The gross tumor volumes ( GTV ),clinical target volume(CTV) and planning target volume ( PTV ) were delineated using treatment planning system of Philips Pinnacle3 based on the optimal threshold of FLT and FDG PET-CT respectively,and to make two groups simulation treatment planning.The parameters of dose-volume histograms in two groups planning were compared in the similar direction and ensuring prescribed dose line surround 95% target volume.Results The values of GTV,CTV and PTV in FLT PET-CT planning were less than those of FDG,that dose received by spinal cord in two planning were not significantly yet ( t = - 1.60,- 1.55,all P ＞ 0.05 ).While,the values in mean lung dose,V5,V10,V30,V40 and V50 of bilateral lung,mean heart dose,and V30 of heart in FLT PET-CT planning were significant lower than those of FDG( t = -5.442 - -2.637,all P ＜0.05).Conclusions Compared with FDG,FLT PET-CT based treatment planning brings potential benefits for lungs and heart.
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Obiective To observe the clinical effect of treating upper respiratory infection induced coughing with atomizated ioint of compound liquorice oral solution and ipratropium bromide.Methods 69 cases of respiratory tract infection induced coughing were randomly recruited into A,B,and C group.Group A was treated with atomizated joint of compound liquorice oral solution and ipratropium bromide;Group C was treated with azithromycin and levofloxaein;Group B was treated with the combined therapy of Group A and Group C.Clinical effects and side effects were observed after the treatment.Results Symptom scores of cough in group A and group B were lower than those in group C.The difference was statistically significant(P＜0.05).Dry mouth and throat complaints disappeared in group A and group A and group B after the treatment.Conclusion Tomizated ioint of compound liquorice oral solution and ipratropium bromide had good therapeutic effects in treating cough induced by upper respiratory infection.
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Objective To establish a optimal method and threshold of 3-deoxy-3-fluorothymidine (FLT) PET-CT in delineating the biological target length of gross tumor in esophageal carcinoma, and to compare FLT PET-CT with other imaging modalities including esophagoseopy, esophagography, CT and flu-orodeoxyglucose (FDG) PET-CT. Methods Twenty-four patients with esophageal squamous cell carcinoma treated with radical surgery were enrolled. Before surgery, all the patients underwent FLT PET-CT, esepha-goscopy and esophagography. Twenty-two patients also received FDG PET-CT scan. Gross tumor volumes (GTV) were delineated using seven different threshold of FLT PET-CT: visual interpretation, standardized uptake value (SUV) 1.3, SUV 1.4, SUV 1.5, 20% of maximum standard uptake value (SUV_(max)), 25% SUV_(max), and 30% SUV_(max). Three different thresholds of FDG PET-CT were used, including visual interpre-tation, SUV 2.5, and 40% SUV_(max). The length of tumors on FLT PET-CT scan were measured and recorded as L_(FLTvis), L_(FLT1.3), L_(FLT1.4), L_(FLT1.5), L_(FLT20%), L_(FLT25%), and L_(FLT30%), respectively. The length of tumors on FDG PET-CT scan were recorded as L_(FDGvis), L_(FDG2.5), and L_(FDG40%), respectively. The length of tumors on CT, esophagography and esophagoscopy were recorded as L_(CT), L_(X-ray) and L_(Scopy). All of these results were com-pared with the length of gross tumor in the reseeted specimen measured by pathological examination (L_(Path)), Results The L_(Path) was (4.90±2.14) cm. The Length of tumors delineated by different methods, being from short to long, were L_(FDG40%), L_(Scopy), L_(X-ray),L_(FLT1.5),L_(CT),L_(FLT30%),L_(FLTvis),L_(FLT1.4),L_(FLT25%), L_(FDG2.5),L_(FDGvis),L_(FLT1.3),L_(FLT20%). The mean values were (3.85±1.52), (4.46±2.23), (4.63± 2.37), (4.64±2.38),(4.69± 1.85),(4.75±2.19) ,(4.85±2.33),(4.87±2.35),(5.05±2.20), (5.08± 2.19) ,(5.10±2.22), (5.21±2.40) and (5.53±2.17) cm,respectively. The correlation coefficients were 0.91,0.93,0.88, 0.95, 0.90, 0.81,0.96, 0.96, 0.80, 0.99, 0.99, 0.95 and 0. 79 , respective-ly. All the P values were 0. 000. L_(FLT1.4) of FLT PET-CT and L_(FDG2.5) of FDG PET-CT were found more ap-proximate to L_(Path). There was no significant difference between L_(FLT1.4) and L_(FDG2.5) (1= 1.23, P = 0.232), and the correlation coefficient was 0.96 (P = 0. 000). Conclusions Thresholds of SUV 1.4 on FLT PET-CT and SUV 2.5 on FDG PET-CT could optimally estimate the tumor length measured by pathological examina-tion, and could be objective and simple methods for semiquantitative analysis.
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Objective To pursue a more efficient and effective treatment for cleft lip and palate deformities. Methods Patients with unilateral complete cleft lip and palate at their age of 9 years after were chosen for simultaneous cleft alveolar repair and nasal deformity correction. Muco-periosteal pocket and iliacgranular bone was prepared, and bone grafting was performed conventionally. At the same time of iliac cancellous bone harvesting, a cortical plate was taken and sculpted into a strut of 18 mm in length, 6 mm in width, and 1.5 mm in thickness. A flying bird incision was made at the alar ram and across columella in a V-shape. Then the alar cartilage was detached from the overlying skin, a socket was made at the site of anterior nasal spine. The strut was inserted into the socket between the two medial crura of the alar cartilage. The medial crura was lift 3 mm above the superior edge of the strut, and mattress suture technique was used to secure the bilateral medial crura to the strut graft. Results 24 patients were treated by this technique. All the patients healed uneventfully. Depressed alar base, tilted columella and lower nasal tip were corrected satisfactorily. Conclusion There is no interference in simultaneous cleft alveolar bone grafting and rhinoplasty. Septum strut can provide favorable support for tilted nasal structure and satisfactorily correct nasal deformities. Simultaneous with alveolar grafting, it is much easier in harvesting, and the time of anesthesia and operation is also decreased.[
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Objective:To construct an adenovirus vector harboring human basic fibroblast growth factor (bFGF) cDNA and investigate the expression of bFGF in human umbilical vein endothelial cells (HUVEC) in vitro. Methods: The adenovirus expression vector Ad5-bFGF was constructed by homologous recombination technique. The best value of MOI was tested by transfecting human umbilical vein endothelial cells (HUVEC) with Ad5-GFP. Ad5-bFGF was used to transfect HUVEC at the obtained value of MOI and the expression of bFGF protein was detected by immunocytochemistry method and Western blotting. Results: The best value of MOI for adenovirus 5 to transfect HUVEC was 200 and the transfection rate was 90%. Immunocytochemistry method and Western blotting showed that bFGF was expressed in HUVEC after transfection with Ad5-bFGF and the expression was significantly higher than that in untransfected HUVEC (P