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Compared with surgery and radiofrequency ablation, stereotactic body radiation therapy (SBRT) has similar efficacy for local treatment of colorectal cancer with pulmonary oligometastasis, but it applies to a wide range of people. Oligometastasis of colorectal cancer may have radiation resistance, and good local control can be achieved by increasing the dose. The prescription dose and prognostic factors of SBRT in the treatment of lung oligometastasis of colorectal cancer have not been determined. There are no serious toxicities in most studies, but there are still radiation-related adverse events.
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Purpose@#Fractionated radiotherapy as well as concomitant and adjuvant chemotherapy such astemozolomide for postoperative high-grade glioma (HGG) patients improves progressionfreesurvival and overall survival. Multiple factors such as chemotherapy, radiotherapy,tumor grade, residual tumor volume, and genetic modifications might play a role in the formationof cognitive impairment. The risk factors of cognitive impairment in postoperativepatients with HGG receiving radiotherapy and chemotherapy remains a concern in this population.The purpose of this study was to identify risk factors for cognitive impairment inpatients of postoperative HGG. @*Materials and Methods@#A total of 229 patients with HGG who underwent surgery were analyzed. Cognitive impairmentwas defined as a decrease of Cognitive Assessment Montreal (MoCA)’s score in atleast two cognitive domains or any MoCA’s score of less than 26 points at the time of studycompared with baseline level. Multiple potential risk factors including methylated status ofthe O6-methylguanine-DNA methyltransferase (MGMT) promoter, glioma World HealthOrganization (WHO) grade, residual tumor volume, education, and sex were analyzed. Coxunivariate and multivariate regression analysis was used to detect the significant risk factorsfor cognitive impairment. @*Results@#At the end of follow-up among the 229 patients, 147 patients (67%) developed cognitiveimpairment. 82 patients (36%) remained in normal cognitive condition. In multivariate analysis,unmethylated MGMT promoter (hazard ratio [HR], 1.679; 95% confidence interval [CI],1.212 to 2.326; p=0.002), glioblastoma (HR, 1.550; 95% CI, 1.117 to 2.149; p=0.009),and residual tumor volume > 5.58 cm3 (HR, 1.454; 95% CI, 1.047 to 2.020; p=0.026) wereindependent risk factors for cognitive impairment. @*Conclusion@#Methylated status of the MGMT promoter, glioma WHO grade, and residual tumor volumemight be risk factors for the cognitive impairment in postoperative patients with HGG.
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OBJECTIVE： To establish the method for the content determination of related substance in Terazosin hydrochloride tablets. METHODS： HPLC and principal component self-control with correction factor were adopted. The determination was performed on Agilent Zorbax Eclipse XDB C18 column with mobile phase consisted of acetonitrile-perchloric acid solution （20 ∶ 80， V/V） at the flow rate of 1.0 mL/min. The detection wavelength was set at 246 nm， and sample size was 20 μL. The column temperature was 50 ℃. The linear equations of terazosin hydrochloride， impurity A， B， C were drawn. The correction factors of each impurity related to terazosin hydrochloride were calculated by slope， and relative retention time was used to determine the position of impurities. The contents of impurity A， B and C in 3 batches of Terazosin hydrochloride tablets were determined and compared with the results of impurity control method. RESULTS： The relative retention time of impurity A， B， C was 0.39， 0.74， 2.77， respectively； the linear range of them were 0.25-3.0 μg/mL， respectively. The correction factors were 0.75， 1.09， 0.84， respectively. The detection limits were 0.35， 0.51， 0.43 ng， and the limits of quantification were 0.70， 1.02， 0.86 ng， respectively. The contents of impurity A， B and C in 3 batches of Terazosin hydrochloride tablets were 0.11％-0.13％， 0.03％ and 0.09％-0.12％； impurity B did not detected. The results are consistent with the determination of impurity control method. CONCLUSIONS： The method is simple， rapid and accurate for the content determination of related substances A， B， C in Terazosin hydrochloride tablets.
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PET-CT plays a increasing important role in the treatment of lung cancer.Compared with CT,the advantage of PET-CT is obvious,which is more accuracy when determine a metastasis and identify inflammatory lesions.What's more,on the basis of the accuracy staging,PET-CT change many strategies which were based on traditional image,resulting in improving the treatment effect.While the assessment and prediction of the efficacy by PET-CT also exerted an important influence on the formulation of treatment strategies.
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Objective To observe the patients hemodynamic reactions to the different stimula-tions under different blood concentrations of propofol with remifentanil.Exerting the response surface methodology,the half of the maximum effective concentration of propofol and the interaction index of propofol with remifentanil were calculated.Methods A total of 120 patients for scheduled abdominal surgery,randomly divided into 12 groups(n = 10).TCI 12 different concentration combinations of propofol with remifentanil,also the the hemodynamic reactions to harmful stimulations of intubation and incising were observed.The data were analyzed by responding surface analysis.Results The in-teraction index of propofol and remifentanil under intubation was 0.523 0±0.223 7,that under inci-sing 0.361 3±0.148 4,half of the maximum effective concentration of propofol for intutation and in-cising was (6.878 7 ± 1.832 1 ) μg/ml and (4.41 1 6 ± 0.902 5 ) μg/ml respectively. Conclusion Propofol and remifentanil have a synergistic inhibitory effect on harmful cardiovascular reaction among Chinese.During the endotracheal intubation,the requirements of half of the maximum effective concentration of propofol and intensity of the synergy with remifentanil are greater than those during the incising.
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Reactivation of hepatitis B virus (HBV) in cancer patients with HBV infection during or after chemoradiotherapy can lead to acute liver injury,even death.Antiviral prophylaxis can reduce the occurrence of HBV reactivation and its associated morbidity.However,there is no unified standard to guide antiviral treatment.Therefore,multidisciplinary collaboration and more prospective study should be carried out to identify the individual antiviral treatment plan.
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Objective To investigate the reproducibility and consistency in contouring parotid gland volume based on computed tomography (CT) and magnetic resonance (MR) images in patients with nasopharyngeal carcinoma during radiotherapy.Methods Twenty-seven patients with nasopharyngeal cancer in Shandong Cancer Hospital from December 2012 to May 2013 were randomly enrolled and underwent intensified CT and MR imaging before radiotherapy.The parotid gland were contoured with unified standard on both CT and T1-MR images by 11 radiotherapists.Specifically,one radiotherapist sketched the parotid gland on CT and MR images for ten times as intra-group comparison,the other ten were asked to sketch the parotid gland on CT and MR images only once as inter-group comparison.The intra-and inter-group's variations of parotid gland volumes were analysed.Results The average volumes of intra-group on CT and MR images were (33.8 ±9.4) cm3(L),(33.2±7.6) cm3(R) and (24.4 ±7.6) cm3(L),(22.5 ±7.4) cm3(R).As well,for inter-group the average volumes were (34.6 ± 12.1) cm3 (L),(34.3 ± 9.0) cm3 (R) and (24.6 ± 7.6) cm3 (L),(23.2 ± 8.1) cm3(R),respectively.The volume variable ratios on CT images were (6.8 ± 1.5)％ (L),(6.3 ± 1.5) ％ (R) for intra-group and (18.0 ± 4.8) ％ (L),(17.4 ± 4.6) ％ (R) for inter-group.Similarly,the intra-and inter-group ratios for contouring on MR images reached (2.3 ±0.4)％ (L),(2.1 ±0.7)％ (R) and (4.7 ±0.7)％ (L),(5.0±0.6)％ (R),respectively.Conclusion Parotid gland contouring based on MR images has a better reproducibility and consistency than that based on CT images.It is beneficial to get a more objective and true indicator to estimate the radiation injury of parotid gland.
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Small cell lung cancer with brain metastasis is the most common type in brain metastasis tumors with the poor prognosis. Researches show that prophylactic cranial irradiation is not only effective in the prevention and treatment of limited disease brain metastases of small cell lung cancer,but also effective for extensive disease. Moreover,certain medications such as mannitol,nimustine etc also play an important sup-porting role,but there are many other uncertain parts in terms of prevention and treatment remaining controver-sial and needing further research.
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Photoacoustic flow cytometry (PAFC) is a novel flow cytometry which integrates high-pulse repetition-rate lasers,fast signal acquisition algorithms and focused ultrasound transducers to assess deep vessels.The technical principle is that the cells in blood or lymph flow are irradiated with several laser beams with different wavelengths,then laser-induced PT effects are detected by corresponding schematics.PAFC is characterized by its high efficiency,no invasion and real-time detection,which makes it possible to detect tumor cells in circulation or in lymphatic system dynamically and in real time.So for,it is considered as one of the most promising techniques in cancer research.This article will address the principle,application and several problems of PAFC.
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Radiotherapy after breast conserving surgery for breast cancer is an important part of comprehensive therapy,and breast conserving surgery combined with radiotherapy for early stage breast cancer has been widely recognized.Modern radiotherapy techniques including three-dimensional conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) have obtained reasonable application in breast conserving therapy.Radiation reaction and cosmetic result are important factors to evaluate radiotherapy after breast conserving surgery.Radiation reactions and cosmetic results of different radiotheraies are different and each has its own characteristics.
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Pregnancy associated breast cancer (PABC) has many special characteristics,such as the clinical manifestation,pathology,diagnosis,treatment and prognosis.Due to the delay of diagnosis,the survival rate is low and the prognosis is poor.Early diagnosis and comprehensive individualized treatment with operation,radiotherapy and chemotherapy are needed to improve the prognosis of patients and prolong the survival period.
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Objective To compare the dosimetry of three different radiation therapy plans [threedimensional conformal radiation therapy (3DCRT),intensity modulated radiation therapy (IMRT),intensity modulated arc radiotherapy (IMAT)].Methods Selected 15 cases with middle thoracic esophageal cancer,Varian Eclipse 8.6 planning systems were designed with 3DCRT,IMRT,IMAT,3DCRT using 5-8 coplanar radiation fields,IMRT using 7 coplanar radiation fields,IMAT using 2 radians.Three planned dose difference were compared.Results Compared with 3DCRT,IMRT and IMAT were better with heterogeneity index (HI),conformality index (CI),VPTV 95 ％,V5,V20,V35 of total lung,and V30 of heart (t =2.531,P＜ 0.05).There was no statistically significant difference for the V10,V15,V25,V30 mean dose of total lung,the mean dose of heart,the maximum dose of spinal cord,and the minimum dose of PTV among the three plans (t =1.325,P ＞0.05).Conclusion IMAT and IMRT are similar in the middle thoracic esophageal cancer radiotherapy target volume dose coverage and organs at risk protection,they are better than 3DCRT.IMAT in the monitor units and delivery time are less than IMRT.
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18 F-FDG PET-CT has been widely used for the diagnosis,staging and assessment of therapeutic response in patients with non-small cell lung cancer (NSCLC).In particular,the technique plays an important role in the prediction of the response to therapy in patients with locally advanced NSCLC.It can dynamically observe the tumor tissue metabolism,and according to the changes of 18 F-FDG uptake by visual or quantitative analysis,before and after treatment,allow prediction of the early efficacy of locally advanced NSCLC with chemotherapy and (or) radiotherapy in clinical or sub-clinical levels.
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Radiotherapy is an effective mean of treatment of gastric cancer. Combination of radiotherapy and chemotherapy in gastric cancer preoperative, postoperative and palliatie treatments can increase the local control rate and the survival rate of gastric cancer patients. With the development of three-dimensional conformal and intensity modulated radiotherapy, the radiotherapy is being more extensively applied in the comprehensive treatment of gastric cancer.
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Objective To investigate a feasibility of treatment planning in thoracic esophageal carcinoma with 3-deoxy-3-fluorothymidine (FLT) PET-CT and to compare with fluorodeoxyglucose (FDG) PET-CT based on dosimetric analysis.MethodsTwenty-two patients with esophageal squamous cell carcinoma detected by FLT and FDG PET-CT were enrolled.The gross tumor volumes ( GTV ),clinical target volume(CTV) and planning target volume ( PTV ) were delineated using treatment planning system of Philips Pinnacle3 based on the optimal threshold of FLT and FDG PET-CT respectively,and to make two groups simulation treatment planning.The parameters of dose-volume histograms in two groups planning were compared in the similar direction and ensuring prescribed dose line surround 95% target volume.Results The values of GTV,CTV and PTV in FLT PET-CT planning were less than those of FDG,that dose received by spinal cord in two planning were not significantly yet ( t = - 1.60,- 1.55,all P ＞ 0.05 ).While,the values in mean lung dose,V5,V10,V30,V40 and V50 of bilateral lung,mean heart dose,and V30 of heart in FLT PET-CT planning were significant lower than those of FDG( t = -5.442 - -2.637,all P ＜0.05).Conclusions Compared with FDG,FLT PET-CT based treatment planning brings potential benefits for lungs and heart.
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Objective To establish a optimal method and threshold of 3-deoxy-3-fluorothymidine (FLT) PET-CT in delineating the biological target length of gross tumor in esophageal carcinoma, and to compare FLT PET-CT with other imaging modalities including esophagoseopy, esophagography, CT and flu-orodeoxyglucose (FDG) PET-CT. Methods Twenty-four patients with esophageal squamous cell carcinoma treated with radical surgery were enrolled. Before surgery, all the patients underwent FLT PET-CT, esepha-goscopy and esophagography. Twenty-two patients also received FDG PET-CT scan. Gross tumor volumes (GTV) were delineated using seven different threshold of FLT PET-CT: visual interpretation, standardized uptake value (SUV) 1.3, SUV 1.4, SUV 1.5, 20% of maximum standard uptake value (SUV_(max)), 25% SUV_(max), and 30% SUV_(max). Three different thresholds of FDG PET-CT were used, including visual interpre-tation, SUV 2.5, and 40% SUV_(max). The length of tumors on FLT PET-CT scan were measured and recorded as L_(FLTvis), L_(FLT1.3), L_(FLT1.4), L_(FLT1.5), L_(FLT20%), L_(FLT25%), and L_(FLT30%), respectively. The length of tumors on FDG PET-CT scan were recorded as L_(FDGvis), L_(FDG2.5), and L_(FDG40%), respectively. The length of tumors on CT, esophagography and esophagoscopy were recorded as L_(CT), L_(X-ray) and L_(Scopy). All of these results were com-pared with the length of gross tumor in the reseeted specimen measured by pathological examination (L_(Path)), Results The L_(Path) was (4.90±2.14) cm. The Length of tumors delineated by different methods, being from short to long, were L_(FDG40%), L_(Scopy), L_(X-ray),L_(FLT1.5),L_(CT),L_(FLT30%),L_(FLTvis),L_(FLT1.4),L_(FLT25%), L_(FDG2.5),L_(FDGvis),L_(FLT1.3),L_(FLT20%). The mean values were (3.85±1.52), (4.46±2.23), (4.63± 2.37), (4.64±2.38),(4.69± 1.85),(4.75±2.19) ,(4.85±2.33),(4.87±2.35),(5.05±2.20), (5.08± 2.19) ,(5.10±2.22), (5.21±2.40) and (5.53±2.17) cm,respectively. The correlation coefficients were 0.91,0.93,0.88, 0.95, 0.90, 0.81,0.96, 0.96, 0.80, 0.99, 0.99, 0.95 and 0. 79 , respective-ly. All the P values were 0. 000. L_(FLT1.4) of FLT PET-CT and L_(FDG2.5) of FDG PET-CT were found more ap-proximate to L_(Path). There was no significant difference between L_(FLT1.4) and L_(FDG2.5) (1= 1.23, P = 0.232), and the correlation coefficient was 0.96 (P = 0. 000). Conclusions Thresholds of SUV 1.4 on FLT PET-CT and SUV 2.5 on FDG PET-CT could optimally estimate the tumor length measured by pathological examina-tion, and could be objective and simple methods for semiquantitative analysis.
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Superior vena cava syndrome(SVCS) is caused by malignant tumour, often showing tumour crisis. The prognosis is bad. It will endanger the life frequently if not cured in time. It is argued which is the preferred treatment on radiotherapy, chemotherapy, surgery or colligate therapy etc. Now we introduce briefly correlated study in the near future, pointting out the colligate therapy trend of SVCS.
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ObjectiveTo study the effect of transcatheter hepatic arterial infusion (TAI) and stereotaxic radiotherapy (SR) for unresectable liver cancer. MethodsFrom June 1997 to July 1999, TAI and SR were used to treat 36 patients with unresectable liver cancer. The first step was interventional chemotherapy(TAI) which consisted of CF 300?mg,5-FU 1?000～1?500?mg, CDDP 60～80?mg, and ADM 60～80?mg (or MMC 10～20?mg). Stereotaxic radiotherapy was given after two sessions or between the two sessions of TAI. The planned target volume was encompassed by more than 70%～90% isodose line, tumor dose from 5?Gy to 8?Gy per fraction, total number was 5～8 fractions. ResultsThe total effective rate were 94% and 97% judged by CT at 3 and 6 months respectively. The 1-,2-year survival rates were 85% and 68%,respecctively. ConclusionCompared with radiotherapy alone and interventional chemotherapy alone, the combined therapy results in higher therapeutic effect and longer remission time in patients with unresectable liver cancer.
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Objective To assess the early response and acute side effects of late course stereotactic radiosurgery (LCSR) for stage Ⅲ b lung squamous cell carcinoma. Methods From June 1997 to July 1999, 136 patients with stage Ⅲ b squamous cell carcinoma of lung were treated with the conventional radiotherapy of 40 Gy followed by LCSR to the residual lesion. Stereotactic radiosurgery was given in the 5～6th weeks, 5～8 Gy per fraction with the total doses ranging from 24 to 38 Gy. Results Five patients were excluded from this study due to distant metastases and acute complications. The remaining 131 patients were analyzed to evaluate the early responses and acute complications. Acute radiation induced esophagitis occurred in 41.2% of patients (Grades Ⅰ Ⅱ (RTOG), 4.4% Grade Ⅲ). Acute radiation induced pneumonitis was observed in 16.9 % of patients ( Grades Ⅰ Ⅱ (RTOG),5.2% Grade Ⅲ). The overall response rate (CR+PR) was 86.3% for the primary tumor, and 92.4% for metastatic mediastinal lymph nodes. Conclusions LCSR is well tolerated in most patients with stage Ⅲ b squamous cell carcinoma of lung. The early responses of LCSR in the of tumor are better than the conventional radiotherapy.Remote results await further follow up.