Radiotherapy-induced second primarymalignant neoplasms / 中华放射医学与防护杂志

Radiotherapy is one of the most important treatments of malignant tumors. However, after the radiotherapy combined with surgery and systemic therapy significantly improved the prognosis of cancer patients, somelong-term survivors after radiation exposure were diagnosed as second primary malignancies such as breast cancer, esophageal cancer, rectal cancer, bladder cancer, and sarcoma. This paper mainly discusses the radiotherapy-induced second primary neoplasms in terms of the dose-effect relationship, incubation period, influencing factors, diagnosis, treatment, and prognosis.

Comparison of high-resolution diffusion-weighted imaging and diffusion kurtosis imaging for prediction of radiotherapy response in patients with nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective In this prospective study,the performance between high-resolution diffusion-weighted imaging ( DWI) and diffusion kurtosis imaging ( DKI) for prediction of radiotherapy response in patients with nasopharyngeal carcinoma was compared. Methods Forty-one patients pathologically diagnosed with NPC received IMRT. All patients underwent conventional MRI,high-resolution DWI and DKI before and after radiotherapy (1-2 d after the plan dose was administered).All patients received conventional MRI during follow-up at 3,6,9 and 12 months after radiotherapy. According to the RECIST 1. 1( response evaluation criteria in solid tumors),all patients were divided into the response group (RG;n＝36) and non-response group (NRG;n＝5). The mean kurtosis coefficient (Kmean) and the mean diffusion coefficient (Dmean) of DKI and apparent diffusion coefficient ( ADC) of DWI were analyzed before and after radiotherapy. Results Among 41 patients,36 cases were assigned into the RG group and 5 in the NRG group. Before and after radiotherapy, all parameters significantly differed between two groups ( P＝0. 000-0. 013) except for the Dmeanand ADC prior to radiotherapy. At the end of radiotherapy,the sensitivity of Kmeanwas calculated as 87. 5% and the specificity was 91. 3% for predicting local control (optimal threshold＝0. 30, AUC: 0. 924; 95%CI: 0. 83-1. 00 ). Conclusion Kmeanvalue after radiotherapy is a potential biomarker for the early evaluation of clinical efficacy of radiotherapy in NPC patients.

Clinical study of the effect of oral ulcer protective agent on the prevention and treatment of radioactive oral mucositis in nasopharyngeal carcinoma and serum inflammatory factors / 中华放射肿瘤学杂志

Objective To evaluate the clinical efficacy of oral ulcer protective agent in the prevention and treatment of oral mucositis in nasopharyngeal carcinoma (NPC) radiotherapy and its effect upon serum inflammatory factors.Methods A total of 90 patients diagnosed with nasopharyngeal carcinoma presenting with grade I oral mucositis caused by radiotherapy in our hospital were selected and randomly divided into two groups.In the experimental group,oral ulcer protective agent was given,and Kangfuxin gargle was administered in the control group.The incidence time and degree of radioactive oral mucositis,visual analogue scale (VAS) pain score,serum levels of CRP,TGF-β1,IL-6 and T lymphocyte subsets were statistically compared between two groups by independent-sample t-test.Results At 4 and 6 weeks after corresponding treatment,the incidence of grade Ⅱ and Ⅲ oral mucositis in the experimental group was significantly lower than that in the control group (P=0.018,0.021,0.027,0.014)).In the experimental group,the incidence of moderate and severe pain assessed by VAS was significantly lower compared with that in the control group (P=0.019,0.025);After corresponding treatment,the CRP levels in both groups were down-regulated and the CRP level in the experimental group was considerably lower than that in the control group (P=0.013).The levels of TGF-β1 and IL-6 in the control group were significantly increased (P=0.015、0.021),whereas dramatically declined in the experimental group (P=0.012,0.019).CD3(+),CD4 (+),CD8(+) and CD4(+)/CD8(+) were remarkably elevated in two groups,and more significant increase was observed in the experimental group (P=0.024,0.036,0.029,0.017).Conclusions Oral ulcer protective agent can effectively inhibit the progression of oral mucosal injury,shorten the healing time and relieve the pain of oral mucosal injury in patients with NPC.,which is worthy of clinical application.

A clinical study of induction chemotherapy ± concurrent chemoradiotherapy for stage N2-3 M0 nasopharyngeal carcinoma with plasma Epstein-Barr virus DNA＞4000 copies/ml / 中华放射肿瘤学杂志

Objective To investigate the value of induction chemotherapy in the treatment of stage N2.3M0 nasopharyngeal carcinoma with plasma Epstein-Barr virus (EBV) DNA＞4000 copies/ml.Methods A retrospective study was performed on clinical data from 210 patients with stage N2-3M0 nasopharyngeal carcinoma and plasma EBV DNA＞4000 copies/ml who were admitted to our hospital from 2009 to 2013.In the 210 patients,101 received induction chemotherapy plus concurrent chemoradiotherapy (NCRT) and 109 concurrent chemoradiotherapy alone (CCRT).The survival rates were calculated by the Kaplan-Meier method.The log-rank test was used for the analysis of survival rates and univariate analysis of the impacts of the changes in the plasma EBV DNA level after induction chemotherapy on the prognosis.Results The 3-year sample size was 154.The NCRT group had significantly higher 3-year disease-free survival (DFS) and distant metastasis-free survival (DMFS) rates than the CCRT group (80.1％ vs.70.6％,P =0.029;87.1％ vs.76.0％,P=O.036),while there was no significant difference in 3-year overall survival (OS) rate between the two groups (88.0％ vs.80.4％,P =0.210).Patients with stage N2 disease in the NCRT group had significantly higher 3-year DFS and DMFS rates than those in the CCRT group (P=O.031,O.014).Patients with stage N3 disease in the NCRT group had significantly higher 3-year OS,DFS,and DMFS rates than those in the CCRT group (P=0.029,0.012,0.019).In all the patients,the 3-year OS and DMFS rates were improved with the increase in the cycle number of induction chemotherapy (P =0.020,0.021).In the NCRT group,patients treated with 2,3,and 4 cycles of induction chemotherapy before radiotherapy had plasma EBV-DNA clearance rates of 51.85％,76.92％,and 88.57％,respectively (P=0.004).Using the complete clearance of plasma EBV-DNA as a predictor of progression,the sensitivity for the above three groups was 62.50％,66.67％ and 75.00 (P=0.910),respectively,and the specificity was 57.89％,90.00％ and 96.77％ (P=0.000),respectively.Conclusions In the treatment of nasopharyngealcarcinoma with plasma EBV DNA ＞ 4 000 copies/m1,induction chemotherapy improves DFS and DMFS inpatients with stage N2-3 M0 disease and OS in patients with stage N3 disease;induction chemotherapy dose not improve recurrence-free survival rate.The prognosis and plasma EBV DNA clearance rate are improved with the increase in the cycle number of induction chemotherapy.Using the complete clearance of plasma EBV DNA as a predictor of progression,the sensitivity and specificity in patients treated with 4 cycles of chemotherapy are superior over those in patients treated with 2 or 3 cycles of chemotherapy.