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Objective:To evaluate the efficacy of postoperative radiotherapy (PRT) for dermatofibrosarcoma protuberans (DFSP).Methods:A systematic review and meta-analysis of articles published before February 23, 2019 were conducted. A total of 655 studies were retrieved consisting of 195 DFSP patients. Among them, 50 cases were assigned into the PRT group and 145 cases in the surgery alone (SA) group. The recurrence rate was statistically compared between two group.Results:Meta-analysis showed that the recurrence rate in the PRT group was significantly lower than that in the SA group (8% vs. 24.1%, OR=0.28, P=0.010). The recurrence rate of patients with positive margins in the PRT group was significantly lower compared with that in the SA group (8% vs. 61.5%, P=0.002). The recurrence rate of patients with negative margins in the PRT group had a decreasing trend than that in the SA group (6% vs. 21.6%, P=0.205). Conclusions:The recurrence rate of surgery combined with PRT is lower than that of SA. The recurrence rate of patients with positive margins is higher than that of those with negative margins. For patients with positive margins, PRT can decrease the recurrence rate. The recurrence rate trends to decline in patients with negative margins after receiving PRT.
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Objective To evaluate the dosimetric characteristics of base dose plan compensation (BDPC) optimization method applied on the intensity-modulated radiotherapy (IMRT) for upper esophageal carcinoma,based on the Eclipse treatment planning system.Methods Nineteen patients were included.For each case initial IMRT plan was generated and further optimized respectively by the two following methods:the BDPC method and hot and cold spot control (HCSC) method.Then the BDPC and HCSC plans were compared concerning planning-target-volume (PTV) coverage,conformity index (CI),and homogeneity index (HI),as well as organ-at-risk (OAR) sparing,planning time,monitor unit (MU) and delivery time.Results Compared with the HCSC plans,the BDPC plans provided superior CI and HI (Z =-3.662,-3.745,P ＜ 0.05),as well as lower D2％ (near-maximum dose) (Z =-3.823,P ＜ 0.05) and comparable D98％ (near-minimum dose) (P ＞ 0.05) for PTV64 (high-risk PTV),and provided superiorCI (Z=-3.340,P＜0.05),lower D95％ and D98％ (Z=-3.582,-2.616,P＜0.05) for PTV54 (low-risk PTV).The BDPC plans also provided slightly lower doses to the spinal cord and lung compared with the HCSC plans (Z =-3.625--3.369,P ＜ 0.05).Moreover,the planning time [(26.05 ±0.88) min] for BDPC plans was less than that of the HCSC plans [(33.73 ± 3.24) min] (Z =-3.823,P ＜0.05).The MU of the BDPC plans (1 019 ± 167) was higher than that of the HCSC plans (1 003 ±159) (Z=-2.616,P＜0.05),while the delivery time [(3.52 ±0.29) min] was more than that of the HCSC plans [(3.50±0.28) min] (Z=-2.548,P＜0.05).Conclusions The BDPC optimization method can significantly improve target dose homogeneity and conformity with effective reduction of the dose to OARs for upper esophageal carcinoma.Moreover,it is simple and can improve the treatment planning efficiency.
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Objective To investigate the prognostic value of lymph node status evaluated by computed tomography (CT) in cervical carcinoma treated with radical chemoradiation therapy.Methods 209 patients with FIGO stage Ⅰ B-ⅣA uterine cervical carcinoma treated with radical chemo radiation therapy were enrolled.Lymph node status was evaluated based on site,number and size respectively by CT.Kaplan-Meier method was used to analyze the impact of lymph node status as well as other pathoclinical factors on overall survival (OS).Cox regression model was used to explore the relationship between independent prognostic factors and OS.Results Lymph node metastasis rates for stage Ⅰ B,Ⅱ,Ⅲ and ⅣA patients were 16.7 ％ (1/6),48.2 ％ (68/141),57.4 ％ (31/54) and 87.5 ％ (7/8),respectively.Variate analysis showed that FIGO stage,anemia before treatment,para-aortic lymph node metastasis,and the number (≥3) and size (maximum diameter ≥ 2.0 cm) of CT positive lymph node were significant unfavorable prognostic factors for OS (P ＜ 0.05).FIGO stage,the number of lymph nodes metastasis,pathologic diagnosis and treatment regimen were identified to be independent prognostic factors in multivariate analysis.Conclusion Under current therapeutic strategy of concomitant chemoradiotherapy,lymph node metastatic status evaluated by pretreatment CT is still a significant and independent prognostic factor for cervical cancer.