Short-term efficacy of camrelizumab combined with induction chemotherapy followed by concurrent chemoradiotherapy for patients with locally advanced nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective:To investigate the clinical effect and safety of camrelizumab combined with induction chemotherapy followed by concurrent chemoradiotherapy for patients with locally advanced nasopharyngeal carcinoma (NPC).Methods:A total of 24 patients with stage Ⅲ-IV A NPC were recruited prospectively to receive two cycles of camrelizumab combined with induction chemotherapy (docetaxel 75 mg/m 2+ cisplatin 25 mg/m 2 for three consecutive days) followed by concurrent chemoradiotherapy (prescription doses: 6 996 cGy in 33 fractions for PGTV and PGTV nd, 6 006 cGy in 33 fractions for PTV 1, 5 096 cGy in 28 fractions for PTV 2, and concurrent cisplatin chemotherapy with a dose of 75 mg/m 2). The short-term efficacy and adverse reactions were evaluated. Results:After induction therapy, nasopharyngeal lesions showed an objective response rate (ORR) of 91.6%, including 45.8% of complete response (CR) and 45.8% of partial response (PR); cervical lymph nodes showed an ORR of 95.8% (CR: 4.2%; PR: 91.6%). Seventeen patients accepted a reexamination under a nasopharyngoscope, and the biting biopsy result indicated that 13 patients among them had complete pathologic response. After concurrent chemoradiotherapy, nasopharyngeal lesions and cervical lymph nodes showed CR rates of 83.3% and 91.7% and PR rates of 16.7% and 8.3%, respectively. After the induction therapy, 13 patients with stage IV A NPC had ORR (PR) rates of 92.4% and 92.4%, respectively, at nasopharyngeal lesions and cervical lymph nodes. After concurrent chemoradiotherapy, the patients with stage IV A NPC had CR rates of 84.6% and 92.3% and PR rates of 15.4% and 7.7%, respectively, at nasopharyngeal lesions and cervical lymph nodes. Major adverse reactions include leukopenia, granulopenia, anemia, radioactive acute oropharyngeal mucositis and dermatitis, digestive tract reaction, fatigue, hypothyroidism, aminotransferase elevation, and reactive capillary hyperplasia. Conclusions:Camrelizumab combined with induction chemotherapy followed by concurrent chemoradiotherapy can achieve high short-term efficacy for patients with locally advanced nasopharyngeal carcinoma, without increasing the incidence of adverse reactions. Its long-term efficacy deserves further research.

Research progress in diagnosis and intervention of sarcopenia in patients with head and neck cancer / 国际生物医学工程杂志

Sarcopenia is a common clinical syndrome in cancer patients and is becoming an independent poor prognostic factor. Studies have shown that an appropriate increase in protein, vitamin D, Omega-3, and other nutrient intake combined with exercise, while ensuring appropriate energy intake, can improve or even reverse sarcopenia. In this review, the research progress in the assessment and diagnosis, epidemiological features, clinical outcomes, and interventions for sarcopenia in patients with head and neck cancer was reviewed.

Numerical simulation of the focal region modulation to realize uniform temperature distribution during high-intensity focused ultrasound brain tumor therapy / 生物医学工程学杂志

The temperature during the brain tumor therapy using high-intensity focused ultrasound (HIFU) should be controlled strictly. This research aimed at realizing uniform temperature distribution in the focal region by adjusting driving signals of phased array transducer. The three-dimensional simulation model imitating craniotomy HIFU brain tumor treatment was established based on an 82-element transducer and the computed tomography (CT) data of a volunteer's head was used to calculate and modulate the temperature distributions using the finite difference in time domain (FDTD) method. Two signals which focus at two preset targets with a certain distance were superimposed to emit each transducer element. Then the temperature distribution was modulated by changing the triggering time delay and amplitudes of the two signals. The results showed that when the distance between the two targets was within a certain range, a focal region with uniform temperature distribution could be created. And also the volume of focal region formed by one irradiation could be adjusted. The simulation results would provide theoretical method and reference for HIFU applying in clinical brain tumor treatment safely and effectively.

Treatment outcomes of different induction chemotherapy regimens combined with in-tensity-modulated radiotherapy in nasopharyngeal carcinoma / 中国肿瘤临床

Objective:The role of induction chemotherapy(IC)and preferred regimens is not very clear in non-endemic nasopharyn-geal carcinoma(NPC)in northern China.Methods:A total of 170 pathologically proven locoregional advanced NPCs between January 2012 and December 2014 were included in this analysis.One hundred and twenty-six were men and 44 patients were women.Accord-ing to the American Joint Committee on Cancer(AJCC)7th stage system,48 patients were T1-2 and 77 patients were T3-4;48 patients were N0-1 and 122 patients were N2-3;27 patients were stageⅡ,105 patients were stageⅢ,and 38 patients were stage IVa-b.Re-sults:The median follow-up time was 34 months.The 3-year overall survival(OS),locoregional failure-free survival(LRFS),distant me-tastasis-free survival(DMFS),and disease-free survival(DFS)were 82.8%,91.5%,76.7%,and 69.1%,respectively.Multivariate analyses showed that IC with TPF(docetaxel,carboplatin,and fluorouracil)or TP(docetaxel and cisplatin)presented superior DFS and DMFS compared with PF(cisplatin+5-FU)[DFS-hazard ratio(HR):1.820,95% confidence interval(CI):1.013-3.271,P=0.045;DMFS-HR:2.240, 95% CI:1.017-4.090,P=0.045].Conclusions:The IC regimens appeared to affect patients' outcomes,and TP-containing IC regimens conferred better DFS and DMFS than PF regimens.

Clinical features and prognosis analysis of 15 cases of extra-nodal nasal-type natural killer/T-cell lymphoma originated from the larynx / 中华放射肿瘤学杂志

Objective To analyze the clinical features and prognosis of extra-nodal nasal NK/T cell lymphoma originated from the larynx. Methods Clinical data of 15 cases of extra-nodal nasal NK/T-cell lymphoma originated from the larynx were retrospectively analyzed. The overall survival ( OS ) and progression-free survival ( PFS) were calculated by Kaplan-Meier survival analysis. The effect of different clinical factors on the clinical prognosis was assessed by univariate analysis. Results Among 15 patients,13 cases were male and 2 female. The median age of onset was 40 years. In 8 cases,the lesions were confined to the larynx,and only 4 cases suffered from cervical lymph node involvement. According to Ann Abor staging, 11 cases were classified as grade I,3 as gradeⅡand 1 as gradeⅢ.The median OS was 28. 0 months and the 5-year OS was 32. 0％.The median PFS was 24. 7 months and the 5-year PFS was 33. 3％.Among 14 patients with stage Ⅰ/Ⅱ,the clinical prognosis of patients receiving combined chemo-radiotherapy was significantly better than those of their counterparts undergoing radiotherapy or chemotherapy alone ( median OS:37. 2 vs. 11. 2 vs.3. 7 months,P=0. 004) . Conclusion Extra-nodal nasal NK/T cell lymphoma originated from the larynx is extremely rare, predominantly in middle-aged male patients. The general condition is relatively favorable. Patients present with multiple lesions in the early stage and relatively poor prognosis. The clinical efficacy of chemotherapy combined with radiotherapy is probably higher compared with that of radiotherapy or chemotherapy alone.

Prognostic value of anemia in patients with extranodal nasal-type NK/T cell lymphoma:A multi-center study from CLROG / 中华放射肿瘤学杂志

Objective To evaluate the prognostic value of anemia in patients diagnosed with extranodal nasal-type natural killer (NK)/T cell lymphoma (NKTCL).Methods Clinical data of 1 225 NKTCL patients receiving the first course of treatment from 10 medical institutions in China were retrospectively analyzed.According to the diagnostic criteria in China,anemia was defined as the hemoglobin (Hb) level＜ 120 g/L for the male and＜ 110 g/L for the female from the sea-level area.The severity of anemia was classified into the extremely severe anemia (Hb ≤ 30 g/L),severe anemia (31-60 g/L),moderate anemia (61-90 g/L) and mild anemia (＞90 g/L).Results Among 1 225 patients,199(16.2％) were complicated with anemia,who had more adverse prognostic factors compared with their counterparts without anemia.Among NKTCL patients with anemia,the proportion of patients with stage Ⅱ-ⅣV,a median age＞ anemia,Eastern Cooperative Oncology Group (ECOG) score of 2-4 and NK/T-cell lymphoma prognostic index (NKTCLPI) ≥ 2 was relatively high.Patients with anemia obtained worse clinical prognosis than those without anemia.The 5-year overall survival (OS) and progression-free survival (PFS) in NKTCL patients with anemia were calculated as 49.4％ and 35.4％,significantly lower compared with 63.3％ and 56.0％ in their counterparts without anemia (both P＜0.01).Single factor analysis demonstrated that anemia,age,ECOG score,group B symptom,lactate dehydrogenase,primary tumor site,primary tumor invasion and staging were the prognostic factors of OS and PFS.Multivariate analysis revealed that anemia was still the independent prognostic factor.Conclusions Anemia is not common in patients with NKTCL and these patients obtain poor clinical prognosis.Anemia is an independent prognostic factor for patients with NKTCL.

Understanding of radiation enteritis and its possible pathogenic mechanism / 中华放射肿瘤学杂志

Radiation enteritis significantly affects the quality of life in the patients receiving radiotherapy due to pelvic tumor.As an intestinal inflammation related to radiotherapy, radiation enteritis is an inflammation of the mucous membrane in nature based on some basic research.Studies demonstrate that programmed necroptosis might play a role in the development of inflammatory bowel disease;therefore, as a subtype of inflammatory bowel disease, programmed necroptosis also might play a role in the development and progression of radiation enteritis.This paper aims to review the studies about the nature and pathogenic mechanism in order to contribute to the treatment of radiation enteritis and improve patients'' quality of life.

Progress in the application of rituximab in treating primary mediastinal B-cell lymphoma / 中华放射肿瘤学杂志

Primary mediastinal large B-cell lymphoma (PMBCL) is morphologically similar to diffuse large B-cell lymphoma (DLBCL) and nodular sclerosis Hodgkin lymphoma.For most PMBCL patients, chemotherapy plus consolidation radiotherapy showed that the latter could improve PMBCL responsiveness and progression-free survival (PFS), and its combined use with chemotherapy demonstrated higher therapeutic efficacy.Recent clinical studies suggested that rituximab and anthracycline chemotherapy regimens could increase PMBCL treatment efficacy, reduce early treatment failure, enhance PFS and overall survival, and improve prognosis.Although rituximab combined with some high-intensity chemotherapy without radiotherapy have achieved good results, many studies still support the use of post-immunochemotherapy consolidation mediastinal radiotherapy.Based on the results of a few studies with a small sample size, patients who were assessed as complete metabolic remission by PET following high-intensity immunochemotherapy may omit consolidation radiotherapy.However, these results will need to be further confirmed by large-sample multicenter clinical trials.Consolidation radiotherapy is recommended for patients with poor prognostic factors or PET score>3.

Evaluation of an algorithm-based automatic treatment planning module for volumetric-modulated arc therapy planning in nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To evaluate the performance of progressive optimization algorithm-based Auto-Planning module in automated volumetric-modulated arc therapy(VMAT)planning for nasopharyngeal carcinoma. Methods Thirteen treated VMAT plans of nasopharyngeal carcinoma were re-planed with Auto-Planning module. Only one cycle of automated optimization of the Auto-Planning module was performed for each plan without any manual intervention. The dosimetric parameters of the automated treatment plans were compared with those of the manual plans. Paired t-test was used for statistical analysis. The time required for automated planning using the Auto-Planning module was also measured. Results All plans generated with the Auto-Planning module met the routine dosimetric requirements and were acceptable for clinical use. The homogeneity index of targets was superior in the automated plans than in manual plans(P= 0.000).In addition,the automated plans had significantly improved protection for some organs at risk than the manual plans. The mean dose to the left and right parotids were reduced by 7.75 Gy(P=0.000)and 5.79 Gy(P=0.000)in the automated plans,respectively. Furthermore,the V60(0.58% vs. 3.12%,P=0.000)and Dmean(34.11 Gy vs. 40.78 Gy,P= 0.000)of the mandible were also significantly lower with Auto-Planning than with manual planning. Conclusions Auto-Planning module can improve the overall quality and consistency of treatment plans,and reduce the workload and time of treatment planning,resulting in substantially enhanced treatment planning efficiency.

Prognosis and staging of primary bone lymphoma:an analysis of 40 patients / 中华放射肿瘤学杂志

Objective To retrospectively analyze the treatment outcomes and prognostic factors for primary bone lymphomas ( PBL) . Methods Forty patients with PBL who were admitted to our center from 1964 to 2014 were enrolled as subjects. In those patients, 10 were treated with chemotherapy alone, 10 with radiochemotherapy, 10 with postoperative chemotherapy, 9 with postoperative radiochemotherapy, and 1 with surgery alone. The median radiation dose was 36 Gy. The Kaplan?Meier method was used to calculate survival rates . The log?rank test was used for survival difference analysis and univariate prognostic analysis . Results The follow?up rate was 100%. The 3?year sample size was 36. In all patients, the 1?and 3?year overall survival rates were 60% and 42%, respectively, while the 1?and 3?year disease?free survival rates were 45%and 34%, respectively. The univariate analysis showed that no pathological fracture at diagnosis, normal lactate dehydrogenase level, an International Prognostic Index score of ≤1, early clinical stage ( stageⅠE ) , complete response after initial treatment, no less than 6 cycles of chemotherapy, a radiation dose of≥40 Gy, no progression outside radiation field after radiotherapy, and grade<3 bone marrow suppression during the treatment were prognostic factors for survival ( P=0. 027, 0. 037, 0. 000, 0. 016, 0. 000, 0. 000, 0. 022, 0. 014, and 0. 030). Conclusions The incidence of PBL is low. Comprehensive treatment can achieve satisfactory outcomes. As a PBL staging system, Ann Arbor has limitations. The staging of PBL should be based on local bone destruction and metastasis.

Clinical decision on a patient with esthesioneuroblastoma / 中国肿瘤临床

Olfactory neuroblastoma is a rare malignant tumor. Although multiple therapeutic modalities including surgery, radio-therapy, or chemotherapy could be used in patients with olfactory neuroblastoma, no standardized treatment has been achieved. This re-view introduces a case of adult olfactory neuroblastoma treated by a multiple disciplinary team in Tianjin Medical University Cancer In-stitute and Hospital. This review also aims to explore a complete set of diagnostic and treatment practices for the benefit of future pa-tients.

Multi-disciplinary diagnosis and treatment of a malignant pheochromocytoma with multiple metastases / 中国肿瘤临床

Malignant pheochromocytomas are rare tumors that arise from chromaffin tissue, and the diagnostic criterion of malig-nancy is based on the development of metastases. In the case a patient suffers the tumor with liver, lung and bone metastases. However, the test results of tumor markers, gastroscopy, chest and abdominal CT, and PET-CT examination are hard to make a definite diagnosis. The patient was finally diagnosed with malignant pheochromocytoma with liver, lung and bone metastases following the needle biopsy of liver and underwent the excision of a right adrenal pheochromocytoma. Therapeutic standard for the malignant pheochromocytomas is not available so far. It is reported that chemotherapeutic CVD regimen (cyclophosphamide, vincristine, and daecarbazine) and suni-tinib may be effectual in the alike cases. The patient received two cycles of CVD and one cycle of sunitinib, nevertheless, slow progres-sion of the disease remained after the treatment. The results of multi-disciplinary treatment have suggested that 131I-MIBG may just be a choice for this patient.

Study of dosimetric variations introduced by anatomic changes during intensity-modulated radiotherapy / 国际生物医学工程杂志

Objective To analyze the anatomic changes and dosimetric variations of patients with head-and-neck cancer during intensity-modulated radiotherapy and to assess the necessity of re-planning the treatment course.Methods Twenty-one nasopharyngeal carcinoma patients were selected to receive the second CT scan in the course of intensity-modulated radiotherapy,targets and organs at risk were re-contoured on the new CT images with the help of deformable registration software.Actual dose distribution delivered by the original treatment plan was calculated on the second CT image,and then the volume and doses of targets and organs at risk were compared between the planning CT and second CT.Results The volume of patient's head-and-neck outlines and GTVnd decreased significantly,the volume of cord and brainstem didn't change much,while the volume of left and right parotids decreased significantly by (24.23 ± 12.15)％ and (25.82± 10.46)％,respectively.The parameters D95％ and Dmean of PGTVnx kept stable,but the parameters D1cc of spinal cord PRV and brainstem PRV increased by (8.12± 10.32)％ and (14.60±18.85)％ respectively.The mean dose of the left and right parotids increased significantly by (27.43±17.67)％ and (26.76±12.46)％,respectively.Conclusion The anatomical changes of patients undergoing intensity-modulated radiotherapy will cause significant dosimetric variations of the cord,brainstem and parotids,so it's meaningful and necessary to re-design the treatment plan in the course of radiotherapy.Repeat CT imaging and replanning during the course of IMRT is essential to ensure adequate doses to target volumes and safe doses to normal tissue.

A case study of primary testicular lymphoma：diagnosis and treatment strategies / 中国肿瘤临床

Primary testicular lymphoma comprises 1% to 9% of testicular neoplasms and represents 1% to 2% of all non-Hodg-kin lymphomas. Histologically, the majority of the tumor consists of diffuse large B-cell non-Hodgkin lymphomas that are of intermedi-ate- or high-grade neoplasm. Clinically, the disease typically presents as a painless testicular swelling that develops over a span of weeks to months. B symptoms such as fever, weight loss, and anorexia are present in 25% to 41% of the patients. This tumor is an ag-gressive type, with frequent invasion of the epididymis, spermatic cord, and scrotum, as well as a marked tendency to relapse, especial-ly in the CNS. The treatment is mainly based on orchiectomy (mostly in stages ⅠE and ⅡE) regardless of its association with prophy-lactic irradiation of the scrotum and administration of intrathecal chemotherapy, cyclophosphamide, doxorubicin, vincristine, and pred-nisone regimen chemotherapy plus rituximab (R-CHOP) (stages ⅢE and ⅣE) and radiotherapy. The multi-modality treatment marked-ly improved progression-free and overall survival. We introduce as reference one case that received a multidisciplinary comprehensive discussion in the Department Lymphoma, Tianjin Medical University Cancer Hospital.

Preliminary Analysis of Intensity Modulated Radiation Therapy for 20 Patients with Nasopharyngeal Carcinoma / 中国肿瘤临床

Objective:To report the preliminary results of intensity modulated radiation therapy(IMRT)for 20 nasopharyngeal carcinoma patients.Methods:A total of 20 patients with nasopharyngeal carcinoma received IMRT in our hospital between January 2007 and April 2008.Five patients were of stage Ⅱ,13 patients were of stage Ⅲ,and 2 patients were of stage Ⅳ.The prescribed dose 69.96 Gy was delivered to the gross tumor volume(PTV)and positive neck nodes(PTVnd);59.36 Gy to the clinical target volume(PTV1),covering the upper neck and area around the nasopharynx;and 50.96 Gy to the low neck and supreclavicular area (PTV2).The dose to 50% of the parotid was≤35 Gy.The maximum dose to the lens.pituitary gland,temporo-mandibular joint,mandible,and temporal lobe was 9,54,60,70,and 60 Gy.The maximum dose to the brainstem,spinal cord,optic nerve and optic chiasma(PRV)was 54,40,54,and 54 Gy,respectively.All of the patients received 1 or 2 circles of chemothrapy before IMRT.Results:The median follow-up time was 14 months.The one-year overall survival was 94.1%.One patient died of osseous metastasis and respiratory failure and 3 patients developed distant metastasis.Acute toxicity was mostly Grade Ⅰ to Grade Ⅱ.Seventeen patients had grade Ⅰ xerostomia.Three patients suffered from grade Ⅰ acute oral mucosa reaction and 12 patients had grade Ⅱ acute oral mucosa reaction.Analysis of the dose-volume histograms (DVHs) showed that the mean dose delivered to the PTV,PTVnd,PTV1 and PTV2 was 73.4,74.1,67.8,and 54.1 Gy,respectively.The median dose to 50% of the right and left parotid glands was 43.9 Gy and 41.9 Gy,respcetively.The average value of maximum dose to the left and right lens was 8.06 and 8.12 Gy,respectively.The average value of maximum dose to the brainstem,spinal cord,left and right optic nerve and optic chiasma PRV was 60.6,46.6,50.0,55.0,and 56.0 Gy,respectively.Conclusion:IMRT can achieve satisfactory dose distdbution to nasopharyngeal carcinoma and surrounding tissues in NPC patients,protect normal tissues during the treatment and improve local control rate.

Conservative resection combined with adjuvant radiotherapy for extremity soft tissue sarcoma / 国际肿瘤学杂志

Adjuvant radiotherapy can reduce resection range,increase the possibility of organ reservation and maintain satisfactory living quality without affecting local control rate.Adjuvant radiotherapy in combination with conservative surgery has become the standard of care for extremity soft tissue sorcoma.The indications and technological aspects as well as the perspectives are overviewed in this article.

Experimental study of antisense epidermal growth factor receptor enhancing the radiosensitivity of human lung cancer cell line spc-a-1 / 中华放射医学与防护杂志

Objective To explore whether antisense-EGFR could enhance the radiosonsitivity of human lung cancer spc-a-1 cell line.Methods The spc-a-1 cells were transfected with antisenso.EGFR-pcDNA3 by lipofectamine 2000(pcDNA3 antiEGFR group).Two other groups were used for comparison:control group(spc-a-1 cell without transfection)and pcDNA3 group(spc-a-1 cell transfeeted with pcDNA3 which did not contain antisense EGFR).Cell clones that stable expressing antisense-EGFR wa8 selected with G41 8 and the suppression of the expression of EGFR mRNA and protein were detected by RT-PCR and Western blot.The influence of antisense-EGFR on cell cycle was testified by flow cytometry assay.The cell apoptosis was analyzed by flow cytometry after 8 Gy irradiation.Further,cells of each group were irradiated with X-rays at the dose of 0,2,4,6 and 8 Gy.Dose-survival curve of each group was established by colony-forming assay.Results The expression of EGFR mRNA and protein were significantly inhibited after antisense-EGFR-pcDNA3 transfection.The cells arrested at the G2/M phase in the pcDNA3 antiEGFR group,control group and pcDNA3 group were (29.53±1.91)%,(13.7±1.30)%and(12.40±1.34)%,respectively.The apoptosis index of spc-a-1 cells in the antisonse-EGFR combined with irradiation group was obviously higher than that of the comparable groups [(39.24±1.57)%,(13.79±0.63)%and(15.02±0.85%)].The values of D0,Dq,SF2 of pcDNA3 antiEGFR group declined obviously compared with the control group(2.11,2.49,0.84 vs 1.19,0.15,0.32).Conclusions Antisense-EGFR could induce the G2/M cell cycle arrest,promote cell apoptosis and inhibit the ability of sublethal cell damage repair induced by irradiation,80 that it could significantly improve the radiosensitivity of spc-a-1 cell in vitro.