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Objective:To evaluate the 3-year survival outcomes and late injury between the self-designed patent single-channel applicator, which was modified from the traditional tandem applicator and wrapped with a oval-shield alloy around the source channel and standard Fletcher-type applicator in the high-dose-rate brachytherapy for cervical cancer.Methods:Patients initially diagnosed with cervical cancer in the Affiliated Hospital of Southwest Medical University from December 2011 to April 2017 were enrolled and randomly assigned into the external beam radiotherapy (EBRT)+ single-channel intracavitary applicator group (the patent single-channel group) and EBRT+ the Fletcher applicator group. The whole pelvis irradiation was delivered with 6-MV photons via a four-field box variant or anterior and posterior parallel fields. Five to six fractions of intracavitary brachytherapy were performed at a dose of 7 Gy at point A once a week after 30 Gy (Equivalent Dose in 2 Gy at point A: 80-90 Gy). Chemotherapy was given with intravenous injection of cisplatin at a dose of 40 mg/m 2 once weekly during EBRT. Clinical efficacy and safety were evaluated after corresponding treatment. Results:In total, 150 eligible cases were assigned into the Fletcher applicator group and 149 cases into the patent single-channel group. Up to December 2020, all patients had been followed up for 3 years, and the median duration of follow-up was 61 months. In the Fletcher group, the 3-year overall survival, progression-free survival and locoregional failure-free survival was 76.3%, 78.1% and 75.4%, and 83.8%, 80.3% and 85.5% in the single-channel group, respectively. In the Fletcher group, the cumulative rate of grade 3-4 late rectal complications was 3.3% and 6.7% in the single-channel group ( P=0.122). The cumulative rate of grade 3-4 bladder complications was 1.3% in the Fletcher group and 0.7% in the single-channel group ( P=1.000). Conclusion:The self-designed patent single-channel intracavitary applicator yields equivalent long-term clinical efficacy and safety to the standard Fletcher-type three-channel applicator in the HDR brachytherapy for uterine cervical cancer.
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Objective@#To preliminarily evaluate the safety of the coplanar template-assisted 192Ir hypofractionated stereotactic ablative brachytherapy (SABT) in patients with locally advanced non-small cell lung cancer (LA-NSCLC), and assess the effect of template-assisted technology upon the accuracy of SABT by comparing the consistency of dosimetric parameters between preoperative and operative plans.@*Methods@#Fifteen patients histologically confirmed with LA-NSCLC (stage ⅡB-ⅢA) were recruited and received the template-assisted SABT delivered in a risk-adapted fractionation (30 Gy/1F). Preoperative planning, template-assisted needle implantation, operative planning and implementation were performed in all patients. Dosimetric results of preoperative and operative plans were statistically compared by assessing the dosimetric parameters of gross tumor volume (HI, CI, D90, V100 and V150) and organ at risk(V5, V20 and mean dose of bilateral lung, D2cc of spinal cord. The incidence of perioperative complications of SABT was recorded. The safety and feasibility of SABT were evaluated.@*Results@#Slight changes were noted in terms of target dose and irradiated dose to the lung between preoperative and operative plans without statistical significance (both P>0.05). No severe adverse events, such as severe pneumothorax, hemothorax and hemoptysis were observed.@*Conclusions@#Application of the template-assisted SABT can enhance the accuracy of implantation, maintain the consistency of the dosimetric parameters between the preoperative and operative plans and guarantee the clinical efficacy.
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Objective To preliminarily evaluate the safety of the coplanar template-assisted 192Ir hypofractionated stereotactic ablative brachytherapy (SABT) in patients with locally advanced non-small cell lung cancer (LA-NSCLC),and assess the effect of template-assisted technology upon the accuracy of SABT by comparing the consistency of dosimetric parameters between preoperative and operative plans.Methods Fifteen patients histologically confirmed with LA-NSCLC (stage ⅡB-ⅢA) were recruited and received the template-assisted SABT delivered in a risk-adapted fractionation (30 Gy/1F).Preoperative planning,template-assisted needle implantation,operative planning and implementation were performed in all patients.Dosimetric results of preoperative and operative plans were statistically compared by assessing the dosimetric parameters of gross tumor volume (HI,CI,D90,V100 and V150) and organ at risk (V5,V20 and mean dose of bilateral lung,D2cc of spinal cord.The incidence of perioperative complications of SABT was recorded.The safety and feasibility of SABT were evaluated.Results Slight changes were noted in terms of target dose and irradiated dose to the lung between preoperative and operative plans without statistical significance (both P＞0.05).No severe adverse events,such as severe pneumothorax,hemothorax and hemoptysis were observed.Conclusions Application of the template-assisted SABT can enhance the accuracy of implantation,maintain the consistency of the dosimetric parameters between the preoperative and operative plans and guarantee the clinical efficacy.
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Objective@#To evaluate whether the self-designed single-channel intracavitary applicator yields equivalent clinical efficacy and safety to the standard Fletcher-type three-channel applicator in the high-dose-rate (HDR) brachytherapy for uterine cervical cancer.@*Methods@#From December 2011 to April 2017, patients initially diagnosed with cervical cancer were randomly assigned into the external beam radiotherapy (EBRT)+ single-channel intracavitary applicator group (the patent single-channel group) and EBRT+ the Fletcher applicator group. Whole pelvis irradiation was delivered with 6-MV photons via a four-field box variant or anterior and posterior parallel fields. Five to six fractions of intracavitary brachytherapy were performed at a dose of 7 Gy at point A once a week after 30 Gy (BED at point A: 80-90 Gy). Chemotherapy was given with intravenous injection of cisplatin at a dose of 40 mg/m2 once weekly during EBRT.Clinical efficacy and safety were evaluated after the treatment.@*Results@#In total, 150 eligible cases were assigned into the Fletcher applicator group and 149 cases into the patent single-channel group. The short-term clinical efficacy and acute toxicity did not significantly differ between two groups. The response rate was 94.0% in the Fletcher group, and 94.7% in the patent single-channel group. In the Fletcher applicator group, 76(50.7%) patients developed ≥ grade 3 hematologic toxicity and 61(40.9%) in the patent group (P=0.195).@*Conclusions@#The self-designed patent single-channel intracavitary applicator yields equivalent clinical efficacy and safety (acute toxicity) to the standard Fletcher-type three-channel applicator in the HDR brachytherapy for uterine cervical cancer.@*Clincal Trial Registration@#Chinese Clinical Trial Registry (ChiCTR-TRC-12002321).
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Objective@#To investigate the possibility and diagnostic efficiency of 18F-NaF PET/CT bone scan after oral administration (PO) by comparing with that of intravenous injection (IV).@*Methods@#Fifty patients (19 males, 31 females; average age: (52.8±11.7) years) with cancer who underwent PET/CT scans after oral and intravenous administration of 18F-NaF respectively with an interval of 2-7 d from June 2015 to September 2016 were prospectively enrolled. Single-phase 18F-NaF PET/CT was performed 60 min after IV, and dual-phase 18F-NaF PET/CT was performed 60 and 120 min after PO. All PET/CT images were reviewed, lesions were counted, and maximum standardized uptake value (SUVmax) and target/non-target (T/NT) ratios were calculated and compared. Paired t test was used.@*Results@#Forty-one patients (15 males, 26 females; average age: (53.5±10.4) years) who finished all PET/CT scans were enrolled. The images at 120 min after PO was visually similar to the images at 60 min after IV. Three modalities detected the same cases and lesions (35 positive cases: 25 malignant, 8 benign, 2 cases with indefinite diagnosis; 302 lesions: 172 malignant, 108 benign, 22 ambiguous lesions). The SUVmax-PO60 min and SUVmax-PO120 min were lower than the SUVmax-IV60 min in the same lesion (18.22±12.64, 26.60±19.49 vs 28.07±16.34; t values: -12.36 and -3.59, both P<0.05). A total of 194 lesions were included for T/NT ratio analysis. T/NTIV60 min, T/NTPO60 min and T/NTPO120 min were 2.76±1.30, 2.87±1.50, 2.98±1.42, respectively, and T/NTPO120 min was higher than T/NTIV60 min (t=3.18, P<0.05).@*Conclusion@#18F-NaF PET/CT images after PO, especially at 120 min post-PO, has similar diagnostic power of lesion-detection and SUVmax-measurement with IV.
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Objective To explore the feasibility and application in quantifying the rabbit central nervous system by using magnetic resonance diffusion tensor imaging(DTI)sequences.Methods 12 normal New Zealand rabbits were used to scan the brain and spinal cord of rabbits by DTI sequence of 1.5T MR machine,and the normal apparent diffusion coefficient(ADC)and fractional anisotropy (FA)values were obtained in the different regions of the brain and every spinal segment of rabbits,to analyse the characteristics and regularity of numerical changes.Results The average ADC value in the brain of rabbits was (0.87±0.08)×10-3mm2/s,the average FA value was 0.23±0.09;the average ADC value in cervical spinal cord was (1.05±0.14)×10-3mm2/s,the average FA value was 0.55±0.08.The average ADC value in thoracic spinal cord was (1.14±0.12)×10-3mm2/s,and the average FA value was 0.57±0.06;the average ADC value in lumber spinal cord was (1.20±0.12)×10-3mm2/s,and the average FA value was 0.61±0.06.Conclusion FA average value in the brain is lower than that in spinal cord (P<0.001),the difference is related to the distribution of nerve fibers and physiological curvature of spine.ADC average value in the brain is lower than that in spinal cord(P<0.001),this is related to the volume of spinal canal and the peripheral structure of spinal cord.The difference of FA value in the brain and spinal cord is higher than ADC value.
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Objective To explore the relationship between the overlap volume of organ at risk (OAR) and target (Voverlap) and the mean dose to OAR (DmOAR) in intensity-modulated radiotherapy (IMRT).Methods Fifty randomly selected patients undergoing IMRT for nasopharyngeal carcinoma (NPC) and an equal number of patients undergoing radical IMRT for cervical cancer in our hospital were enrolled as subjects.The relationship between Voverlap and DmoAR in IMRT was analyzed.The Matlab software was used to generate function to fit the relationship between Voverlap and DmOAR for different OARs.Results The Voverlap varied among patients with NPC or cervical cancer.The ratio of Voverlap to the volume of OAR (VOAR) was positively correlated with the ratio of DmOAR to the prescribed dose (Dp) (all P=0.01).A function was generated to fit the correlation between Voverlap/VOAR ratio and DmOAR/Dp ratio.Conclusions In IMRT,patients have different Voverlap/VoAR ratios due to varicd target volume,disease stages,OAR filling status,and OAR volume.As criteria for plan verification,a specific DmOAR value for each OAR should be calculated before radiotherapy planning based on the corresponding correlation function and the Voverlap/VoAR ratio with a fixed dose prescription.It can be used to reduce the subjective influence on the optimization of radiotherapy planning.
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Objective To analyze the effect of needle arrangement on the lung dose in interstitial brachytherapy for lung cancer. Methods For 15 patients undergoing interstitial brachytherapy for lung cancer, a virtual radiotherapy plan in which needle arrangement was not restricted by the ribs was designed and compared with the original plan. For the two plans, V5, V20, V30, and mean lung dose(MLD)of the whole lung were determined when the prescribed doses were 10,30, 60, and 120 Gy, respectively. The data were analyzed by Wilcoxon signed-rank test. Results The lung V5,V20, V30, and MLD were significantly smaller in the virtual plan than in the actual plan(all P<0.05). Conclusions Irregular needle arrangement prevents a further reduction in the lung dose in interstitial brachytherapy for lung cancer. In the implantation surgery, therefore, the needles should be arranged as regularly as possible.
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Objective To evaluate the value of 18 F?NaF PET/CT and MRI in the diagnosis of skull?base bone invasion ( SBBI) in patients with nasopharyngeal carcinoma( NPC) . Methods Sixty?three NPC patients (45 males, 18 females;age range 23-72 years) were enrolled in this prospective study. Pa?tients underwent 18 F?NaF PET/CT and MRI to confirm whether the skull base was invaded. The reference standard was based on the follow?up imaging in 6 months. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the two imaging modalities were calculated. χ2 test was used to analyze their difference. The SBBI foci and their distribution detected by the two imaging modalities were compared. Results Thirty?four NPC patients demonstrated SBBI in follow?up imaging. The diagnostic sen?sitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18 F?NaF PET/CT were 97.1%(33/34), 89.7%(26/29), 91.7%(33/36), 96.3%(26/27) and 93.7%(59/63), respective?ly. For MRI, the parameters were 91.2%(31/34), 86.2%(25/29), 88.6%(31/35), 89.3%(25/28) and 88.9%(56/63), respectively. The diagnostic efficiency of the two imaging modalities had no significant difference (χ2=0.162-1.062, all P>0.05) . 18 F?NaF PET/CT detected 133 lesions and MRI detected 97 le? sions, and the clivus was the most common site of SBBI. Conclusions 18 F?NaF PET/CT and MRI have similar diagnostic efficiency in detecting SBBI. 18 F?NaF PET/CT can detect more lesions than MRI do, and has potential advantage for detecting tiny bone lesions in skull base.
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Objective To study the iso-center point coincidence of two accelerators with treatment planning system (TPS) based on γ passing rates of intensity-modulated radiotherapy (IMRT) plan verification.Methods Twenty-one IMRT plans were verified by Varian accelerator and twenty by Elekta accelerator with a gamma criterion of 3 mm/3％.The passing rates were measured when the iso-center point of TPS had-2,-1,0,1,and 2 mm shift in the x or y direction.A binomial curve of γwas fit to figure out the values of the two accelerators on the x and y axes when γ value reached the maximum.The γ pass rate difference was analysed by x2 test.Results The mean values of γ-2,γ-1,γ0,γ1,and γ2 in the x direction were (92.56±3.27) ％,(96.53± 1.82) ％,(96.13± 1.41) ％,(90.14± 2.87) ％,and (82.28± 4.69) ％ for Varian accelerator,and (94.82± 2.04) ％,(97.05± 2.02) ％,(98.38± 1.33) ％,(97.96± 1.44) ％,and (94.49±2.34)％ for Elekta accelerator.There was no significant difference in the mean value of γ0between the two accelerators (P=0.332).When γvalue reached the maximum,the values on the x and y axes were0.65 and-0.30 mm for Varian accelerator and 0.01 and 0.30 mm for Elekta accelerator,respectively.Conclusions In the same TPS,different accelerators have different degrees of coincidence of the actual field center point with the iso-center point of TPS,to which more attention should be paid in clinical practice.
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The Ⅳ stage esophageal cancer refers to exist regional lymph nodes and distant organs in patients with metastases. Palliative chemotherapy and radiotherapy is the primary treatment. With the deepening of the clinical study,radiotherapy and chemotherapy are no longer single treatment,chemotherapy combined molecular targeted drugs,chemo-radiotherapy and some new treatment methods have been gradually recognized, and especially molecular targeted drugs began to establish its position in the treatment of tumor. Application of various methods individual or combined treatment can effectively prolong survival and improve the quality of life.
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MicroRNAs are one kind of endogenous noncoding small-molecular RNAs,which play an important role in regulating gene expression,cell proliferation and differentiation and a series of life activity.Hepatocellular carcinoma is a common malignant and life-threatening tumor with a high incidence and low 5-year survival rate.In recent years,the results of researches show that microRNAs in hepatocellular carcinoma have the function of oncogenes or tumor suppressor genes as well as having a close relationship with the occurrence,progression,diagnosis,treatment and prognosis of hepatocellular carcinoma.
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We produced and identified the monoclonal antibodies against Brucella melitensis U‐lipoprotein OMP19 .A DNA fragment coding omp19 of Brucella melitensis was amplified by PCR ,and inserted into the vector of pET‐30a(+ ) ,the result‐ant recombinant plasmid ,which we designated as pET‐30a(+ )/omp19 .We then transformed the plasmid into BL21(DE3) competent cells for the expression of the OMP19 protein .After induction with different concentrations of IPTG ,the colleted cells were analyzed by SDS‐PAGE ,and then OMP19 monoclonal antibodies were prepared through hybridoma technology . These mAbs were tested to reactivity to rOMP19 and nature membrance proteins (NMP) of Brucella melitensis by Western blot and IEST .We successfully constructed an expression vector of pET 30a(+ )/omp19 .An IPTG‐induced expression of the OMP19 protein (19 kDa in molecular weight) was demonstrated by SDS‐PAGE .The fusion protein existed in the form of solu‐ble ,and the OMP19 protein of high purity could be obtained by Ni‐NTA .Western blot assay showed that the refolded protein could be recognized by the anti‐serum against Brucella melitensis .Twenty‐three mAbs to OMP19 was produced in which 91 .30% were IgG1 ,twenty‐two (95 .65% ) mAbs could recognize nature OMP19 protein ,and eighteen (78 .26% ) mAbs could recognize NMP ,four mAbs could react with Brucella melitensis .The protein maintained good immunogenicity and twenty‐three mAbs were obtained ,which we believe provides a good protein candidate for the immunological research .
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Objective To investigate the expression of Vacuolar-H +-ATPase (V-ATPase) and P-glyeoprotein (P-gp) protein in colon carcinoma tissues,the correlation between the expression of V-ATPase and P-gp and their clinicopathological significance.Methods In samples from 80 cases of colon cancer,20 cases of colon adenoma and 10 cases of normal colonic mucosa tissues,the expression of V-ATPase and P-gp protein were detected by immunohistochemical method,their relationship was analyzed,the clinicopathological features and prognosis were evaluated.Results In colon cancer,V-ATPase and P-gp protein expression was 72％ and 80％,higher than that in colon adenomas (40％,35％),and in normal colon mucosa (20％,20％),the difference was statistically significant (P ＜ 0.05).There was a positive correlation between the expression of V-ATPase and that of P-gp (r =0.567,P ＜0.01).V-ATPase and P-gp protein expression in colon cancer was associated with TNM stage,lymph node metastasis and tumor differentiation (P ＜ 0.05).Patients with high V-ATPase expression had lower 5-year survival rate than those with low V-ATPase expression (P =0.023),and 5-year recurrence rate was higher than those with low expression (P =0.024).Conclusions The expression of V-ATPase is up-regulated in colon cancer,there is a positive correlation with colon cancer progress and metastasis,and high V-ATPase protein expression predicts poor prognosis.
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Objective To obtain the lung adenocarcinoma initiating cells from the A 549 cell line based on paclitaxel treatment combination with serum-free cultivation and to validate spared cells can represent tumor initiating cells (TICs) .Methods After dis-sociated by trypsogen ,about 106 /mL cells were suspended in serum-free medium supplemented with 0 .4% bovine serum albumin (BSA) ,insulin ,basic fibroblast growth factor (bFGF) ,human recombinant epidermal growth factor (EGF) and obtained spheroid cells .At the second passage ,paclitaxel was added at a concentration of 100 nmol/L for 48 h and then replaced with completely fresh medium once or twice per week until new spheroids emerged .Results The subpopulation of cells that survived serum-free cultiva-tion and paclitaxel treatment could highly express the cluster of differentiation 133/cluster of differentiation (CD133/CD326) mo-lecular markers and have features of stemness including differentiation ,high expression of cancer stem cells (CSCs)-associated genes and stronger capability of tumorigenesis .Conclusion The survived subpopulation that highly express the CD 133/CD326 molecu-lar markers presenting the characteristics of stemness in vitro and in vivo ,and could be used in future researches of biological functions .
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Cisplatin has good effects in the treatment of a variety of solid cancers.Studies have shown that cisplatin can make great contributions in treatment of nasopharyngeal carcinoma through DNA,telomeres,cell cycle,apoptosis,apoptotic volume decrease,cell senescence,NK cells and other channels.
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BACKGROUND: Thermotherapy has achieved remarkable therapeutic effect on patients with esophageal cancer. However, there are still some problems which cannot be answered today, such as the damage of esophageal mucosa during deep thermotherapy when metal stent is placed in esophagus. OBJECTIVE: To study the metal stent-caused damages to esophageal mucosa of pigs in radiofrequency hyperthermia. DESIGN, TIME AND SETTING: Observational study which was performed in the Department of Tumor, Affiliated Hospital of Luzhou Medical College from October 2004 to January 2005. MATERIALS: 13 pigs weighing 35-40 kg were used in this study. Esophagus stent of memory alloy with membrane was provided by Zhiye Medical Apparatus Institute of Changzhou, China METHODS: Five points were located for measurement, i.e. the middle of the stent, the exit of the stent, 2 cm and 4 cm a distance from the exit and 4 cm from the entrance. Esophagus of 13 pigs was heated for 30 minutes by SR-1000 radiofrequency hyperthermia machine in frequency of 40.82 MHz, pole plate of 25 cm Ⅱ 25 cm and power of 500-700 W. MAIN OUTCOME MEASURES: The esophageal mucosa was observed with naked eyes. And optical microscopy was used to observe the changes of the esophageal mucosa. RESULTS: Because one pig died of anesthesia and there were troubles of thermal detector lines in 4 pigs, only 8 pigs were included in the final analysis. Level of damage of esophageal mucosa on five temperature checkpoints was observed from grade 0 to 1 in naked eyes, and the difference of damaged level between five checkpoints was not obvious in statistics (H=2.0, P=0.157). Level of the damage was observed from grade 0 to 2 in microscope, and the difference was not obvious in statistics too (H=2.734, P=0.255). CONCLUSION: Influence of the metal stent on esophageal mucosa can be neglected in radiofrequency hyperthermia, and metal stent does not cause obvious mechanical damage or thermal damage to esophageal mucosa of pigs. It is safe and feasible to carry out radiofrequency hyperthermia on placed metal stent esophagus.
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OBJECTIVE To study the radiose-nsitization by Topotecan on human nasopharyngeal carcinoma in nude mice. METHODS ①To study the maximum tolerance dose of TPT and detect the effective rate of TPT and RT on nude mice. ② Plan of radiosensitization practice:53 nude mice xenografts were distributed to 5 groups:RT 20 Gy group,RT 40 Gy group,TPT 12.5 mg/kg group,TPT 12.5 mg/kg+RT 20 Gy group and the controlgroup. After treatment,the volume of tumors were measured every 3 days in order to value the effective rate [complete remission(CR) + partial remission(PR) ]and regrowth delay time(TGD) and to fit the growth curve. RESULTS This study showed that the effective rates had significant difference among RT20 Gy+TPT 12.5 mg/kg group,RT20 Gy group and TPT12.5 mg/kg group,while that of RT20 Gy +TPT 12.5 mg/kg group and RT40 Gy group had no statistical difference. SER reached to 1.34. CONCLUSION Topotecan has been shown a radiosensitizing effect on human nasopharyngeal carcinoma in vivo.
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Purpose:To study the radiosensitising mechanism of topotecan in cell and molecule level on Nasopharyngeal carcinoma.Methods:To detect cell cycle,apoptosis index and the expression s of apoptosis genes such as p53, bcl2, bax by FCM.Results:The proliferation index of RT20Gy +TPT 12.5mg/kg group was decreased, while the apoptosis index was increased, with statistical signifi cance by comparison with TPT and RT group. Meanwhile, the expressions of apoptos is genes, such as p53,bcl-2,bax had no statistic significance between each grou p and the control group. Conclusions:The mechanisms of radiosensitizion might be its act ion on cell cycle,proliferation index and stimulation of apoptosis.However,the i nduction apoptosis might be independent of P53,bcl-2 and bax genes.