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Objective:To analyze the prognosis and influencing factors of different radiotherapy modes in patients with brain metastases from non-small cell lung cancer (NSCLC), and to explore the best benefit population with radiotherapy boost under different prognostic scores.Methods:634 patients with brain metastasis from NSCLC admitted to the Fourth Hospital of Hebei Medical University from 2013 to 2015 were analyzed retrospectively. According to different radiotherapy modes, they were divided into three groups: no radiotherapy group ( n=330), whole-brain radiotherapy group (WBRT)( n=127) and whole-brain radiotherapy combined with boost group (WBRT+ boost)( n=177). The intracranial progression-free survival (iPFS) and overall survival (OS) were calculated by Kaplan-Meier method. The multivariate prognostic factors were analyzed by the Cox models. Results:The median iPFS and OS of all patients were 6.9 months and 9.0 months, respectively. In the no radiotherapy, WBRT and WBRT+ boost groups, the 1-year iPFS was 15.1%, 16.3% and 40.2%( P=0.002), and the 1-year OS was 33.7%, 38.2% and 48.1%( P<0.001), respectively. Multivariate survival analysis demonstrated that different radiotherapy modes were the independent factors affecting iPFS and OS. Subgroup analysis revealed that for patients with 1-3 brain metastases, the 1-year OS and iPFS in the WBRT+ boost group were better than those of WBRT alone ( P=0.026, P=0.044) when GPA score was 2.5-4.0; the 1-year OS and iPFSin the WBRT+ boost group were better than those of WBRT alone ( P=0.036, P=0.049) when there was no targeted therapy; for patients with ≥4 brain metastases, the 1-year iPFS in the WBRT+ boost group was better than that of WBRT alone ( P=0.019, P=0.012) when GPA score was 2.5-4.0 and there was no targeted therapy. When the GPA score was 0-2 or there was targeted therapy, the 1-year OS and iPFS in the WBRT+ boost group were better than those of WBRT alone, but the difference was not statistically significant (all P>0.05). Conclusions:Radiotherapy can significantly improve the iPFS and OS of NSCLC patients with brain metastases. When the number of brain metastases is 1-3, GPA score is 2.5-4.0 or no targeted therapy, boost may improve the iPFS and OS; when the number of brain metastases is more than 4, GPA score is 2.5-4.0 or no targeted therapy, boost may only bring iPFS benefit; when GPA score is 0-2 or targeted therapy, boost may not benefit significantly.
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Objective:To explore the optimal local treatment pattern of supraclavicular lymph node in breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastasis (sISLM).Methods:Clinical data of 128 breast cancer patients with sISLM admitted to the Fourth Hospital of Hebei Medical University from 2010 to 2015 were retrospectively analyzed. Among them, 68 cases were treated with supraclavicular lymph node dissection combined with radiotherapy, and 60 cases received radiotherapy alone. The locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS) and overall survival (OS) were statistically compared between two groups.Results:Univariate analysis demonstrated that the 5-year LRFS, DMFS, PFS and OS did not significantly differ between two groups (all P>0.05). Multivariate analysis revealed that the local treatment pattern of supraclavicular lymph node was an independent prognostic factor for the 5-year DMFS, PFS and OS (all P<0.05). Subgroup analysis showed that when radiotherapy alone was performed, the 5-year OS of patients in the supraclavicular region radiation dose of>50 Gy group were significantly better than that in the 50 Gy group ( P=0.047). When supraclavicular lymph node dissection combined with radiotherapy was delivered, if the number of dissection was less than 10, the 5-year LRFS, DMFS, PFS, OS of patients in the>50 Gy group were all better than those in the 50 Gy group numerically without statistical significance (all P>0.05). If the number of dissection was ≥10, the 5-year LRFS, DMFS, PFS, OS in the 50 Gy group were better than those in the>50 Gy group numerically, whereas significant difference was only found in the 5-year DMFS ( P=0.028). Conclusions:Supraclavicular lymph node dissection combined with radiotherapy may be the optimal local treatment pattern for supraclavicular lymph node. When radiotherapy alone is performed, a radiation boost to the supraclavicular region may improve OS. When supraclavicular lymph node dissection combined with radiotherapy is performed, if the degree of dissection is low, a radiation boost to the supraclavicular region may bring clinical benefits. However, if the degree of dissection is high, a radiation boost to the supraclavicular region may not bring significant clinical benefits.
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Objective To explore the value of diffusion kurtosis imaging (DKI) in predicting radiotherapy sensitivity of esophageal cancer from the animal model level.Methods BALB/c nude mice were subcutaneously injected with Eca-109 cell lines to form xenograft tumors.The tumors received a single dose of 15 Gy (6 MV X-rays) in the experimental group or had no any treatment as control.The volume of transplanted tumor,the change of ADC,MK and MD values,and the tumor cell density and necrosis ratio of these two groups were observed at the corresponding time points.Results The growth of xenograft volume in the experimental group was suppressed and it was significantly smaller than that in the control group (t=3.206-6.149,P＜0.05) at the 7th day after radiotherapy.From the 3rd day after radiotherapy,the ADC and MD values of the experimental group were significantly higher than those of the control group,and the MK values was lower than those in the control group (tADC =-11.018--2.049,tMD =-6.609--2.052,tMK =2.492-9.323,P＜0.05).Meanwhile,the tumor cell density of the control group was higher than that of the experimental group,and the proportion of necrosis in the experimental group was higher than that in the control group (tdensity =-8.387--2.239,t is =2.980-17.430,P＜0.05).Conclusions A single large dose radiation could inhibit the growth of xenograft.ADC,MK,MD values changed at the early stage prior to morphological changes of tumor in consistent with the change of cell density and necrosis ratio.DKI has the potential value in predicting radiotherapy sensitivity of esophageal carcinoma.
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Objective@#To explore the value of diffusion-weighted magnetic resonance imaging (MR-DWI) technique in predicting the efficacy of radiotherapy in patients with esophageal cancer, using experimental animal models.@*Methods@#BALB/c nude mice were subcutaneously injected with Eca-109 cell lines and then tumor formed. The experimental group (16 cases) received a single dose of 15 Gy (6 MV X-rays) delivered by a medical linear accelerator, while the control group (24 cases) did not receive any treatment. The two groups were scanned every other day, started one day before the radiotherapy. The scanning sequences included T1-weight imaging, T2-weight imaging, and DWI. The observation time was 1 month. According to the changes of the tumor volume and apparent diffusion coefficient (ADC) value of the two groups, 7 key time points were selected to observe the difference of cell density and tissue necrosis ratio between the two groups (6 cases in each group).@*Results@#From day 7 after radiotherapy, the experimental group had statistically smaller volume of transplanted tumors than the control group, namely (1.729±0.906) cm3 vs (2.671±0.915) cm3(P<0.05). From day 3 after radiotherapy, the experimental group had statistically higher ADC values [(1.017±0.255)×10-6 vs (0.833±0.142)×10-6 mm2/s, P<0.05], lower cell density of transplanted tumor (25.56±1.40 vs 33.48±4.18%, P<0.05), and less proportion of tissue necrosis [(32.19±1.21) % vs (29.16±2.16)%, P<0.05], respectively. The ADC value was negatively correlated with cell density (r=-0.703, P<0.001) and positively correlated with tissue necrosis ratio (r=0.658, P=0.003).@*Conclusions@#Single dose of large fraction radiotherapy could inhibit the growth of xenograft. ADC values may change at the early stage prior to morphological changes of tumor. The change of cell density and necrosis ratio of transplanted tumor are in line with the change of ADC value. MR-DWI has the value of early prediction of esophageal cancer radiotherapy efficacy.
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Objective@#To analyze the effect to the prognosis of tumor site on the patients of colorectal cancer after curative resection with different stage.@*Methods@#Clinicopathological and follow-up data of 2 097 colorectal carcinoma cases undergoing resection at Fourth Hospital of Hebei Medical University from January 2008 to March 2015 were retrospectively analyzed. There were 421 patients in left-sided colorectal cancer (LCC) group (including carcinoma in cecum, ascending colon , hepatic flexure, and transvers colon) , 386 in right-sided colorectal cancer (RCC) group (including carcinoma in splenic flexure, descending colon and sigmoid colon) and 1 290 in rectal cancer (RECC) group. Clinicopathologic features in patients with different tumor location were compared. 5-year overall survival rate were compared among the 3 groups. Patients were stratified by different stage to analyze the effect of tumor location on the prognosis. χ2test and Kruskal-Wallis rank-sum test were used to compare the clinicopathological features among the 3 groups, Kaplan-Meier curve and Log-rank test were used to analyze prognosis, respectively.@*Results@#No significant differences were identified between the three groups in age, family history, N stage and intestinal obstruction. Significant difference were found in gender among LCC, RCC and RECC group (male were 62.5% vs. 54.9% vs.56.3%, χ2=6.040, P=0.049) . Compared with LCC group and RCC group, RECC group had more well and moderately differentiated adenocarcinoma patients (89.7% vs. 86.0% vs. 82.4%, χ2=10.712 and 17.385, P=0.013 and 0.001) , more stage Ⅰ patients (17.1% vs. 6.9% vs. 6.5%, χ2=37.459 and 37.208, P=0.000 and 0.000) , and less likely to be stage T4 (44.7% vs. 76.7% vs.78.5%, χ2=128.015 and 133.704, P=0.000 and 0.000), metastasis (2.6% vs. 5.7% vs. 3.6%, χ2=1 417.167 and 1 424.217, P=0.000 and 0.000) and intestinal obstruction (11.3% vs. 21.1% vs. 24.4%, χ2=25.846 and 41.141, P=0.000 and 0.000). Five-year survival rate reduced in turn in the patients with RECC, LCC and RCC(70.9%, 59.8%, 58.9%, χ2=11.577, P=0.009). In the subgroup of stage Ⅲ, patients with different tumor location had different overall survival (χ2=9.878, P=0.007). Compared to right-sided colon cancer patients, rectal ones had significantly better overall survival (χ2=9.271, P=0.002); but in the subgroup of stage Ⅰ, Ⅱ and stage Ⅳ, patients with different tumor location had similar overall survival (P were 0.124, 0.888, 0.263, respectively).@*Conclusions@#Colorectal cancer patients with tumor location had different clinicopathologic features. Patients with rectal cancer had better five-year survival rate than those with left located and right located colon cancer. Tumor location had different effects on the prognosis according to the different TNM stage-subgroups.
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Objective To retrospectively investigate the impact of postoperative radiotherapy ( RT) on the relationship between molecular subtype and survival in patients with breast cancer ( BC ) . Methods A total of 716 women who were admitted to our hospital in 2008 and newly received unilateral mastectomy were divided into Luminal A ( LA ) , Luminal B?HER?2?negative ( LB1 ) , Luminal B?HER?2?positive ( LB2) , HER?2 overexpression ( HER?2+) , triple?negative ( TN) , and unassigned subtypes according to the 2011 St. Gallen Consensus. The Cox model was used to analyze the differences in overall survival ( OS) and disease?free survival ( DFS ) rates between subtypes in all patients, RT group, or non?RT group. The Kaplan?Meier method was used to calculate OS and DFS rates. The Cox model was used to perform the factor analysis. Results In all patients, the median follow?up time was 71?4 months;the overall mortality rate was 10?5%;the incidence of treatment failure ( death+relapse+metastasis) was 14?9%;217 patients ( 30?3%) received RT. The multivariate analysis showed that there was no significant difference in OS between subtypes in any group ( all P>0?05 ) . In all patients, patients with LB1 subtype or unassigned subtype had significantly poorer DFS rates than those with LA subtype ( HR= 1?881, P= 0?035;HR= 1?907, P=0?049) . In the non?RT group, patients with LB1 subtype had significantly poorer DFS rates than those with LA subtype (HR=3?324, P=0?01). In the RT group, there was no significant difference in DFS rate between subtypes ( all P>0?05) . The two?dimensional cross analyses of RT and subtype demonstrated that patients with LB1 subtype in the non?RT group had lower OS and DFS rates than patients with LA subtype in the RT group ( P=0?09,0?06) . Conclusions Patients with LB1 subtype have lower OS and DFS rates than patients with LA subtype, especially in the non?RT patients. RT has no impact on the relationship between subtype and prognosis.
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Objective To investigate the long-term survival of esophageal squamous cell carcinoma (ESCC) patients of different ages after three-dimensional conformal radiotherapy (3 DCRT).Methods From July 2003 to September 2008,769 patients with stage Ⅰ-Ⅲ ESCC were eligible for the analysis.All patients were treated with 3DCRT.The prescribed dose was 50-70 Gy (median,60 Gy),1.8-2.0 Gy per fraction,5 fractions per week.The Kaplan-Meier method was used to calculate overall survival (OS) and local control (LC) rates; the log-rank test was used for survival difference analysis and univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis.Results The follow-up rate was 98.3％.For all patients,the 1-,3-,and 5-year LC rates were 76.3％,52.8％,and 48.5％,respectively,and the 1-,3-,and 5-year OS rates were 70.1％,36.2％,and 23.0％,respectively.The 1-,3-,and 5-year OS rates were 71.2％,38.8％,and 24.9％,respectively,for patients aged 45-74 years,versus 69.6％,26.6％,and 15.4％ for patients aged 75-89 years (P =0.008).Multivariate prognostic analysis showed that age was also a prognostic factor in ESCC patients after 3DCRT.A total of 620 patients died.Patients aged 45-74 years had a significantly higher proportion of individuals that died of distant metastasis (23.9％ vs.14.2％,P =0.009),while patients aged 75-89 years had a significantly higher proportion of individuals that died of non-cancer diseases (14.1％ vs.4.9％,P=0.000).Conclusions Survival varies between ESCC patients of different ages after 3DCRT.The survival of elderly ESCC patients is poor,and the relatively high mortality from non-cancer diseases may be an important reason for poor survival.
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Magnetic resonance imaging diffusion weighted imaging (DWI) as a non-radiation and noninvasive examination method,has great help in diagnosis and staging of lung cancer,and the apparent diffusion coefficient (ADC) determination has demonstrated clinical application value in the therapeutic assessment.As an essential complement of CT,MRI-CT imaging infusion improves the accuracy of the target volume sketching in the radiotherapy of lung cancer.