Prediction model of radiation pneumonitis after chemoradiotherapy for esophageal cancer based on dosiomics / 中华放射肿瘤学杂志

Objective:To study the risk factors and prediction model of radiation pneumonitis (RP) after radical chemoradiotherapy for locally advanced esophageal cancer based on dosiomics.Methods:Clinical data of 105 patients with esophageal cancer undergoing radical chemoradiotherapy at Zhejiang Cancer Hospital between January 2020 and August 2021 were retrospectively analyzed. RP was scored using the National Cancer Institute's Common Terminology Criteria for Adverse Events version 5.0 (CTCAE 5.0). Clinical factors, traditional dosimetric features and dosiomics features were collected, respectively. The features for predicting PR were analyzed by limma package. Support vector machine, k-nearest neighbor, decision tree, random forest and extreme gradient boosting were used to establish the prediction model, and the ten-fold cross-validation method was employed to evaluate the performance of the model. The differences of this model when different features were chosen were analyzed by delong test.Results:The incidence of RP in the whole group was 21.9%. One clinical factor, 6 traditional dosimetric features and 42 dosiomics features were significantly correlated with the occurrence of RP (all P<0.05). Support vector machine using linear kernel function yielded the optimal prediction performance, and the area under the receiver operating characteristic (ROC) without and with dosiomics features was 0.72 and 0.75, respectively. The models established by support vector machine, random forest and extreme gradient boosting were significantly different with and without dosiomics features (all P<0.05). Conclusion:The addition of dosiomics features can effectively improve the performance of the prediction model of RP after radiotherapy for esophageal cancer.

Failure mode and long-term survival after neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma / 中华放射肿瘤学杂志

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.

Analysis of prognostic factors in 135 patients with pulmonary metastasis from esophageal squamous cell carcinoma / 中华放射肿瘤学杂志

Objective:To investigate the prognostic factors of patients with esophageal squamous cell carcinoma with pulmonary metastasis.Methods:Clinical characteristics of 135 esophageal squamous cell carcinoma patients presenting with pulmonary metastasis after treatment in Zhejiang Cancer Hospital from 2008 to 2018 were retrospectively analyzed. Thesurvival rate was calculated by Kaplan-Meier method. Univariate analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox models.Results:The median follow-up time of 135 patients with esophageal squamous cell carcinoma was 94.2 months (19.5-258.9 months), and 109 patients died (80.7%). The 1-and 2-year overall survival rates were 47.4% and 25.1%, with the median survival time was 11.1 months (7.3-14.9 months). Univariate prognostic analysis showed that age, number of lung metastases, treatment of lung metastases, lymph node metastasis, distant organ metastasis, and the interval between the first treatment and lung metastasis were the prognostic factors of esophageal squamous cell carcinoma with lung metastasis (all P<0.05). Multivariate analysis demonstrated that age and number of lung metastases were the independent prognostic factors for patients with esophageal squamous cell carcinoma with lung metastases (all P<0.05). Conclusions:Age and number of lung metastases are the independent prognostic factors for patients with esophageal squamous cell carcinoma with lung metastases. Surgery or radiotherapy-based regional therapy can enhance clinical prognosis.

Risk factors and dosimetric limitations for acute radiation pneumonitis after gemcitabine induction chemotherapy for non-small cell lung cancer / 中华放射肿瘤学杂志

Objective:To summarize the incidence of acute radiation pneumonitis (ARP) after gemcitabine induction chemotherapy for non-small cell lung cancer (NSCLC) and identify the high risk factors and dosimetric limitations of ARP after gemcitabine induction chemotherapy.Methods:We retrospectively analyzed 191 NSCLC cases who were received gemcitabine induction chemotherapy and chest radiotherapy in radiotherapy department of Zhejiang Cancer Hospital between January 2010 and December 2010. Base line data, treatment information and the incidence of ARP after treatment were collected. The risk factors of ARP were analyzed with univariate and multivariate Logistic regression method.Results:A total of 49 patients developed ≥ grade Ⅱ ARP, accounting for 25.7% of all cases. Univariate analysis indicated that the probability of ARP in patients who received the cumulative dose of gemcitabine ≥ 9.0 g was 3.45 times higher than that in those treated at a dose of < 9.0 g ( P=0.015). Radiation dose ≥ 50 Gy was significantly correlated with the occurrence of ARP ( P=0.008). The risk of ARP was increased by 7.69 times if the time interval between radiotherapy and chemotherapy was within 10 weeks ( P=0.047). Among the dosimetric parameters, V 5Gy, V 20Gy, V 30Gy and mean lung dose (MLD) of bilateral lungs were 45%, 22%, 16%, and 1 200 cGy respectively. All of them could effectively predict the occurrence of ARP (all P≤0.001). Multivariate analysis indicated that only radiotherapy dose ( P=0.044) and V 5Gy( P=0.02) were the independent predictors of ARP. Conclusions:For NSCLC patients who receive gemcitabine induction chemotherapy, the cumulative dose of gemcitabine, the interval time between chemotherapy and radiotherapy and the radiation dose are associated with the occurrence of ARP. We should strictly limit the total lung dosimetric parameters, such as V 5Gy, V 20Gy, V 30Gy and MLD to reduce the incidence of ARP.

Investigation and analysis of the reasons for omission of adjuvant radiotherapy after breast-conserving surgery for early-stage breast cancer / 中华放射肿瘤学杂志

Objective To investigate and analyze the reasons for the omission of adjuvant radiotherapy after breast-conserving surgery (BCS) in patients with breast cancer.Methods The clinicopathologial characteristics and socioeconomic data of 55 breast cancer patients undergoing BCS without postoperative adjuvant radiotherapy in our hospital from 2012 to 2016 were retrospectively analyzed.Results Among the 55 patients who did not receive radiotherapy,25 patients were due to low local recurrence risk,12 patients were due to economic or family reasons,12 patients were due to fear of adverse reactions of radiotherapy,and 5 patients were not recommended by primary physicians for radiotherapy.In addition,3 cases with multiple distant metastases and 3 cases with concomitant thyroid cancer didn't received radiotherapy.Conclnsions Low risk local recurrence is the main reason for the omission of adjuvant radiotherapy,followed by the fear of radiation-induced toxicity and poor financial support.Patient education and medical insurance may improve the adjuvant radiotherapy compliance.

Treatment of cancer-related fatigue / 国际肿瘤学杂志

Cancer-related fatigue(CRF) is one of the important symptoms for cancer patients,especially for the long-term survival patients after treatment.Its complexity and interdependency with other symptoms make it difficult to identify the clear underlying mechanisms. No single etiologic model provides a satisfactory explanation of cancer-related fatigue.For mild fatigue,non-pharmacological therapy is recommended.Non-pharmacological therapy combined with pharmacological therapies is recommended for patients with moderate and severe fatigue.

Application of hypofractionated conformal radiotherapy in non-small cell lung cancer / 国际肿瘤学杂志

Hypofractionated conformal radiotherapy is capable to deliver much higher doses to the cancer than is possible with standard techniques. Recently there is data suggesting that the early stage nonsmall cell lung cancer ( NSCLC) which is not suitable to surgery is likely to benefit from this regimen, with low lung toxicity. Manyphase Ⅰ-Ⅱ studies showed that the patients with locally advanced NSCLC are well-tolerated to hypofractionated conformal radiotherapy. The model of radio-physic and relative clinical studies suggest that hy-pofractionation would not increase the risk of radiation pneumonitis compared to standard therapy.

Radiosensitizing effects of cyclooxygenase-2 selective inhibitor LM-1685 on A549 human lung adenocarcinoma cells / 中华放射医学与防护杂志

Objective To investigate the radiosensitizing effects of cyclooxygenase-2 selective inhibitor LM-1685 on A549 cells in vitro.Methods A549 human lung adenocarcinoma cell line was used in this study.Cell growth kinetics Was determined using MTT assay.Cell survival was analyzed by clonogenic assay.The change of cell cycle Was measured by flow cytometry.Results LM-1685 inhibited the growth of A549 cells,showing a dose-dependent and time-dependent manner.LM-1685(50/μmol/L),either with or without IL-1β,showed the radiosensitizing effects on A549 cells,and the sensitizing enhancement ratio(SER)was 1.12 and 1.06,respectively.LM-1685(50 μmol/L)abrogated radiation-induced G2/M arrest of the tested A549 cells.Conclusions Cyclooxygenase-2 selective inhibitor can enhance the radiosensitivity of A549 cell line.Abrogation of radiation-induced G2/M arrest could be part of the mechanism.