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RTOG 0617 trial has indicated that no benefit can be obtained in the overall survival of locally advanced non-small cell lung cancer patients by improving the prescribed dose, which promotes the adjustments to the strategies of dose escalation. Currently, multiple studies have been designed to explore more effective approaches to boost dose, such as dose boosts based on increased 18FDG-uptake regions, simultaneous integrated boost intensity-modulated radiotherapy and modulation of dose fractions, which have achieved a series of progress. The widespread application of PET-CT and intensity-modulated radiotherapy offers broad space for the dose escalation and optimization.
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RTOG 0617 trial has indicated that no benefit can be obtained in the overall survival of locally advanced non-small cell lung cancer patients by improving the prescribed dose,which promotes the adjustments to the strategies of dose escalation.Currently,multiple studies have been designed to explore more effective approaches to boost dose,such as dose boosts based on increased 18FDG-uptake regions,simultaneous integrated boost intensity-modulated radiotherapy and modulation of dose fractions,which have achieved a series of progress.The widespread application of PET-CT and intensity-modulated radiotherapy offers broad space for the dose escalation and optimization.
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Objective Investigate the relationship between gross tumor volume (GTV)-related factors including GTV-T volume,the maximum thickness of the esophageal lesion plane and GTV-T volume/length(GTV-T volume divided by the length of the lesion calculated by the number of GTV-T layers) and the locoregional failure of radical intensity-modulated radiation therapy (IMRT) for esophageal carcinoma.Methods A total of 133 patients with esophageal cancer undergoing radical IMRT were enrolled.The factors related to GTV-T including GTV-T volume,the maximum thickness of the esophageal lesions,GTV-T volume/length were calculated.The relationship between GTV-T related factors and local recurrence of tumors was retrospectively analyzed.Results There was positively linear association between the locoregional failure rate of GTV-T and the volume of GTV-T.The volume of GTV-T tumor was 36 cm3,the maximum wall thickness was 2.5 cm,and the GTV-T volume/length was calculated as 5.3 cm2.These critical values could be utilized to predict the risk of locoregional failure of IMRT for esophageal carcinoma.Conclusions The GTV-T factors can be adopted to predict the local control and the risk of locoregional failure of radical IMRT for esophageal carcinoma to certain extent.
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Objective To analyze the effects of gross tumor volume(GTV-T)and positive lymph node volume(GTV-LN)on the prognosis of radical concurrent chemoradiotherapy for esophageal squamous cell carcinoma(ESCC). Methods A total of 79 patients with stage N1ESCC undergoing radical radiotherapy in our hospital from 2012 to 2015 were enrolled as subjects. GTV-T and GTV-LN were calculated by the Pinnacle39.0 treatment planning system. The receiver operating characteristic(ROC)curves were used to evaluate the value of the GTV-LN/GTV-T ratio in the prediction of local recurrence(LR)and distant metastasis(DM)of ESCC. Results The median follow-up time was 17.2 months in all patients. The ROC curves were made using the GTV-LN/GTV-T ratio. The optimal cut-off values of GTV-LN/GTV-T ratio for predicting the risk of LR and DM were 0.34 and 0.59, respectively. The statistical analysis revealed that the LR rates were 50% and 8% in patients with GTV-LN/GTV-T ratios of<0.34 and ≥0.34, respectively(P<0.01), while the DM rates were 11% and 43% in patients with GTV-LN/GTV-T ratios of<0.59 and ≥0.59, respectively(P= 0.003). Conclusions The GTV-LN/GTV-T ratio may be a predictor of LR and DM in patients with ESCC. Further studies on the GTV-LN/GTV-T ratio may help to make personalized chemoradiotherapy strategies for patients with ESCC.
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Objective To investigate the application of 3D reconstruction system in the clinical departments of the hospital.Methods 3D reconstruction system had its architecture,main features,working flow and principle of auto preprocessing software introduced,and then applied to auto preprocessing of PACS images to realize auto reconstruction,which had the function of 3D post processing.Results 3D reconstruction system gifted the doctor in clinical departments with the access to the images and after treatment,and changed the traditional working mode in imaging department.Conclusion Fusion imaging has 3D reconstruction as the main technique,which eliminates the deficiency in reading radiological images and innovates medical service mode.
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Objective To evaluate the incidence of and risk factors for esophageal fistula and fatal bleeding after intensity?modulated radiotherapy ( IMRT) for esophageal cancer. Methods Clinical data were collected from 128 patients with esophageal cancer who received radical IMRT in our hospital from January 2012 to December 2014. According to the incidence of esophageal fistula and fatal bleeding, those patients were divided into control group ( n= 105 ) and severe complications group ( n= 23 ) . In the severe complications group,12 patients had esophageal fistula and 11 fatal bleeding. Between?group comparison was made by χ2 test. The Cox model was used for the multivariate analysis. Results Chest and back pain in the initial diagnosis,clinical stage cT4 ,tumor type ( ulcerative) ,gross tumor volume ( GTV)>50 cm3 ,and GTV maximum diameter>2?45 cm were risk factors for esophageal fistula and fatal bleeding after radiotherapy for esophageal cancer (P=0?042,0?042,0?019,0?046,0?002).The multivariate analysis showed that tumor type ( ulcerative) and GTV maximum diameter were independent risk factors for esophageal fistula and fatal bleeding ( P=0?010,HR=0?329,95% CI:0?142?0?763;P=0?009,HR=3?805,95% CI:1?404?10?312) . Conclusions The efficacy of IMRT is severely restricted by the incidence of esophageal fistula and fatal bleeding. For patients with an ulcerative type of esophageal cancer or a GTV max diameter of>2?45 cm,the chemoradiotherapy plan should be optimized to reduce the risk of severe complications.
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Wnt signaling pathway participates in the physiological process of cell growth, differentiation, migration and apoptosis.Its abnormal activation is closely related to the tumorigenesis and progression.Wnt signa-ling is also known to regulate the process of proliferation,angiogenesis,adhesion,invasion and metastasis of tumor cells in non-small-cell lung cancer.There are a lot of members in Wnt signaling pathway and their expression levels affect the prognosis of non-small-cell lung cancer.It plays an instructive role in the individualized treat-ment of non-small-cell-lung cancer to lucubrate the relation between Wnt signaling pathway and the tumori-genesis and progression of non-small-cell lung cancer.
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Objective:To observe the locoregional recurrence and survival of stageⅢA-N2 non-small cell lung cancer (NSCLC) after in-duction chemotherapy and surgery, to analyze the prognosis influenced by nodal downstaging, and to explore the necessity for postop-erative radiotherapy. Methods:A total of 116 cases of stageⅢA-N2 NSCLC were treated with induction chemotherapy and surgery be-tween January 2009 and June 2014. These cases underwent R0 resection. Kaplan-Meier method was employed to calculate the local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) of the patients. Log-rank test was con-ducted to compare the differences between groups. Cox models were used to perform multivariate analysis. Results:The median fol-low-up of the patients was 24.42 months. The numbers of patients with pN0, pN1, and pN2 were 40 (34.5%), 16 (13.8%), and 60 (51.7%), respectively. The 3-year local recurrence rates of patients with pN0, pN1, and pN2 were 27.5%, 56.2%, and 51.7%, respectively. In the group treated with adjuvant chemotherapy, the 3-year local-recurrence rates of patients with pN0, pN1, and pN2 were 26.9%, 58.3%, and 46.2%, respectively. Multivariate analysis revealed that the significant predictor of LRFS was pN0 during the surgery. The LRFS of patients with pN0 was greater than that of the patients with pN1 (P=0.048). The LRFS of patients with pN1 was not significantly associated with that of patients with pN2 (P=0.314). The 5-year OS rate of the groups was 46.6%. The multivariate analysis also demon-strated that pT1, pN0-1, and induction chemotherapy effects were associated with OS. The patients with pN2 yielded a poorer OS than those with pN0 and pN1 (P<0.05). The patients with pN0 did not significantly differ from those with pN1 in terms of OS (P=0.412). Conclu-sion:Although the occurrence of pathologic downstaging is a well-known positive prognostic indicator after stageⅢ-N2 NSCLC is sub-jected to chemotherapy, the local-recurrence rate of nodal-downstaged patients remains high, even when they receive adjuvant che-motherapy. Therefore, new postoperative strategies after induction chemotherapy and surgery should be developed.
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Objective To evaluate the efficacy of Gant-Miwa and anal encircling procedure with Xiaozhiling injection for complete rectal prolapse.Methods Clinical data of 16 patients with complete rectal prolapse undergoing Gant-Miwa and anal encircling procedure with Xiaozhiling injection between Feb.2011 and Nov.2014 were retrospectively analyzed.Results All patients were operated successufully and theirs prolapse symptons disappeared.Urinary retention was found in 3 cases,2 cases were observed a replase who were infected in the area of the anal operation,1 cases was found delayed healing of perianal incision,and 2 cases were happened constipation duing to the rectal stenosis.Complications wasn't happened such as bleeding,perianal abscess,anal fistula,and so on.Thirteen cases were followed-up of average 2.2 years and 2 cases were observed postoperative recurrance.Conclusions Gant-Miwa and anal encircling procedure with Xiaozhiling injection for the treatment of complete rectal prolapse is a procedure with minimally trauma,fewer complications and low recurrence rate,which is worth promoting after innovation and improvement.
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Objective To evaluate the correlation of different fractionation schedules in radiotherapy with the local control ( LC) and overall survival ( OS) rates in patients with extensive?stage small cell lung cancer ( ES?SCLC ) , and to figure out the relationship between different fractionation schedules in radiotherapy and the prognosis of ES?SCLC. Methods One hundred and ten patients newly diagnosed with ES?SCLC from February 2010 to March 2015 received chemoradiotherapy. According to the radiation dose, all patients were divided into hypo?fractionation group ( 30?45 Gy/3 Gy/10?15 f, n=31) and conventional fractionation group ( 54?60 Gy/1?8?2?0 Gy/27?30 f, n=79) . In all patients, 90?9% had stageⅣSCLC;21 patients had brain metastasis;39 patients were treated with prophylactic cranial irradiation ( PCI ) . The Kaplan?Meier method was used to calculate the survival time and log?rank test was used for between?group comparison. Between?group comparison of categorical data was made by χ2 test. Results The number of patients followed?up were 85 at 2?years. In all patients, the 2?year OS, progression?free survival ( PFS) , and LC rates were 27?7%, 17?5%, and 38?9%, respectively. The hypo?fractionation group had similar prognosis to the conventional fractionation group. There were no significant differences in the 2?year OS, PFS, and LC rates between the two groups ( 35% vs. 26%, P=0?886;18% vs. 16%, P=0?560;67% vs. 36%, P=0?159) . There was also no significant difference in the 2?year OS rate between patients treated with and without PCI (44% vs. 18%, P=0?044). In 84 patients with treatment failure, 11 had local recurrence, 41 had distant metastasis, and 32 had local recurrence plus distant metastasis. Conclusions The hypofractionated radiotherapy has similar efficacy but substantially shortened radiation time compared with conventionally fractionated radiotherapy. The palliative hypofractionated radiotherapy requires further study for ES?SCLC.
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Objective To discuss the best method to treat deep perianal abscess and to investigate the clinical efficacy and value of the procedure of percutaneous catheter drainage guided by ultrasound in treatment.Ninteen patients with deep abscess underwent the procedure from Jan.2012 to May.2013.Methods Clinical data of 19 patients were analyzed retrospectively,including 16 male cases and 3 female cases.Results The average age is 39.8.All patients were cured without complications.The average length of stay is 7.8 days,a mean follow-up of 6.6 months after discharge,no patient with recurrence or fistula.Conclusion No specific performance of colorectal carcinoid,surgical resection is the most effective method of the treatment of colorectal carcinoid,the procedure should be individual treatment.However,the long term prognosis need to be explored in the future.
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Colonoscopy has become the most commonly used method to the diagnosis and treatment of colorectal diseases at present.Colonoscopic perforation is considered the most serious complication with high mortality, especially in the patients with certain risk factors and iatrogenic factors, despite of its low incidence.According to the clinical features in the period of perioperative colonoscopy, early detection of colonoscopic perforation is a prerequisite for successful treatment and the key to lower mortality.So far in the treatment,some methods can be selected, including conservative treatment, open surgery, laparoscopic surgery and endoscopy folders, etc.Clinical judgement and analysis of disease should be specific and accurate, but not to be generalized.Doctors should adopt reasonable and effective treatment options according to clinical performance, the size of perforation,intestinal readiness, time of diagnosis, colon primary lesion and so on.
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Rectal carcinoid tumors are potential malignant and have been considered to be rare for a long time.But in recent years,the incidence has been increasing gradually,maybe due to the development of endoscopic technology,the widespread use of endoscopy for screening and the raising level of awareness.Because of the malignant tendency,early diagnosis and treatment are the most important things for patients.Nowadays,the misdiagnosis rate is still high and it is difficult to make differential diagnosis between benign and malignant tumors.The efficiency of chemotherapy and radiotherapy is not clear.Surgery is the only effective method,but there is no uniform standard for the choice of operation.At present,it is appropriate to consider tumor size,depth of invasion,lymph node,pathological type and other risk factors to determine a surgical modality.Colonoscopy is recognized to be the best means by follow-up and should be carried out regulady in a longer period of time.Therefore,it is important to summarize the diagnosis and treatment of rectal carcinoid.
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BACKGROUND: Emblic leafflower fruit contains rich vitamin C, organic acid and mineral substance. It is indicated in modern research that emblic leaafflower fruit acts on preventing from cancer and anti-aging too. In recent years, more and more concerns have been paid to the researches on functional factor of emblic leafflower fruit and the development of the relevant functional food. It has been verified that emblic leafflower fruit acts on reducing lipid and anti-oxidation in vitro, but there are still lacks of enough basic researches to support it.OBJECTIVE: To probe into mechanism of emblid leafflower fruit on anti-oxidation and protection of vascular endothelial function in rabbits with hyperlipemia.DESIGN: Randomized controlled experimental study based on the experimental animals.SETTING: Atherosclerosis(As) experimental room in a university hospital.MATERIALS: Totally 24 normal NewZealand male rabbits, mass weighted (2.2±0.5) kg.METHODS: The experiment was performed in As Experimental Room of Beijing Anzhen Hospital from September 2001 to May 2002. Totally 24 New Zealand male rabbits were randomized into the control, the power of emblid leafflower fruit group(powder group)(4 g/kg day) and hypercholesterolemia model group (model group), 8 rabbits in each group. In both power and model groups, the rabbits were fed with hypercholesterol food. Oxidase method was applied to assay the content of serum lipid, chemical method to assay the plasma total anti-oxidation and the content of malondialdehyde (MDA), radio-immune method to assay the content of plasma endothelin-1 (ET-1), digoxin labeled probe and tissue hybridism in situ to assay the expression of endothelin mRNA of aortic tunica intima, and image analyzer to assay the area of aortic intimal atherosclerosis plaque and the ratio between the area of tunica intima and the area of tunica media.MAIN OUTCOME MEASURES: The primary outcomes included blood lipid level, serum MDA concentration and the comparison of artery plaque areas. The secondary outcomes included the changes in plasma ET-1.RESULTS: By the comparison between the powder group and model group in triglyceride(TG) and low density lipoprotein cholesterol(LDL-C) were significantly reduced [(11.70 ± 1.73), (14.32 ±2.22) mmol/L, P<0.05; (0.740 ± 0.107), (1.450 ± 0.220) mmol/L, P <0.01 successively]and thehigh density lipoprotein cholesterol(HDL-C) was increased MDA was significantly decreased [ (3.88 ± 0.51 ), (6. 29 ± 1.43 ) mmol / L,P < 0.01 ] and the total anti-oxidation significantly increased [ (10. 771der photo-microscope that the plaque area and the ratio between intima area and media area were remarkably decreased [(39.46±6.53), (50.69± 12.36)mmol/L, P < 0.05; (0. 62 ±0. 32), (1.38 ±0.38) mmol/L, Pgranules of aortic intima ET-1 gene were rem~kably decreased compared with the model group.CONCLUSION: Emblic leafflower fruit prevents from the formation of experimental atheromatous plaque in rabbits probably by regulating rabbit lipid metabolism, improving anti-oxidation to reduce lipid peroxidation and protecting endothelial function to inhibit the expression of artery intima ET-1 gene.