Comparison of efficacy and safety of preoperative and postoperative concurrent chemoradiotherapies for stage Ⅲ-Ⅳ A gastric cancer / 中华放射医学与防护杂志

Objective:To compare the efficacy and safety of preoperative and postoperative concurrent chemoradiotherapies in the treatment of stage Ⅲ-Ⅳ A gastric cancer patients who underwent D2 lymphadenectomy with R0 resection. Methods:A retrospective analysis was conducted on the clinical data of patients with stage Ⅲ-Ⅳ A gastric cancer who underwent D2 lymphadenectomy with R0 resection in the Affiliated Cancer Hospital of Zhengzhou University from 2012 to 2019. Among these patients, 25 received preoperative chemoradiotherapy (group A) and 22 received postoperative chemoradiotherapy (group B). The disease-free survival (DFS), overall survival (OS), local recurrence rate, distant metastasis rate, and adverse reactions were compared between both groups. The total dose, single dose, fractions, and duration of radiotherapy for all the patients were 45-50.4 Gy, 1.8-2.0 Gy, 25-28 fractions, and 5-6 weeks, respectively. The target areas were delineated in accordance with the ASTRO and EORTC-ROG guidelines. Results:There was no statistical difference in clinical baseline characteristics between the two groups. The median follow-up was 48 months (3-72 months). The 1-year OS of group A was significantly higher than that of group B (92% vs. 54.5%, χ2= 5.68, P = 0.017). The 3-year OS and DFS of the two groups were 56% vs. 40.9% ( P> 0.05) and 51.4% vs. 31.8% ( P> 0.05), respectively. There was no significant difference in the local recurrence rate between both groups ( P> 0.05), but the distant metastasis rate of group A was significantly lower than that of group B ( χ2= 6.01, P = 0.014). There was no significant difference in digestive side effects and myelosuppression between both groups ( P> 0.05). Conclusions:For patients with stageⅢ-Ⅳ A gastric cancer after D2 lymphadenectomy with R0 resection, the preoperative and postoperative chemoradiotherapies yield similar efficacy and safety. However, compared to postoperative chemoradiotherapy, preoperative chemoradiotherapy improves the 1-year OS and reduces the distant metastasis rate.

Correlation Between cyclin G1 Expression and Efficacy of Radiotherapy on Primary Hepatocellular Carcinoma / 肿瘤防治研究

Objective To investigate the correlation between cyclin G1 expression and the efficacy of radiotherapy on HCC. Methods The expression of cyclin G1 in biopsy specimens of 68 patients who received radiotherapy was detected by immunochemistry. The correlation between cyclin G1 expression and clinicopathological characteristics was analyzed by chi-square test. The correlation between cyclin G1 expression and OS or PFS was evaluated by Kaplan-Meier analysis. Univariate and multivariate analyses were used for the relation between clinicopathological characteristics and OS or PFS. Results The expression of cyclin G1 was related to portal vein tumor embolus, clinical stage and alpha fetoprotein. Survival analysis showed that the OS and PFS of patients with low expression of cyclin G1 were significantly higher than those with high cyclin G1 expression (P < 0.05). Multivariate analysis showed that cyclin G1 was an independent risk factor for DFS of patients with HCC. Conclusion High expression of cyclin G1 is an adverse prognostic factor for HCC patients who received radiotherapy.

Study of the relationship between radiation-induced taste cell injury and radiation mode in mice / 中华放射肿瘤学杂志

Objective:To investigate the relationship between radiation mode and radiation-induced taste cell injury in mouse models.Methods:The head and neck of adult C57/bl mice were exposed to 8 Gy irradiation for 1, 2 and 3 times and sacrificed at 2, 4, 7 and 14 d after irradiation. Frozen sections of taste papilla tissues were treated with specific markers by immunohistochemical staining. The changes of proliferative cells and the number of type Ⅱtaste cells at different time points under different radiation modes were observed. The effect of different radiation dose patterns upon the taste cells was assessed.Results:The count of proliferative cells was decreased significantly on the 2 nd day after radiation, and rapidly recovered to normal level on the 4 th day after radiation, which was not correlated with the dose mode. The number of type Ⅱ taste cells was decreased on the 2 nd day of the first 8 Gy radiation, decreased to the lowest on the 4 th day of the second and third 8 Gy radiation, and rose slowly on the 7 th day. Conclusions:Radiation can initially decrease and subsequently increase the number of proliferative cells to normal range. Besides, it can gradually repair the type Ⅱ taste cell injury. After high-dose irradiation, the decrease of progenitor cells with proliferative function leads to a synchronous decrease in the number of taste function cells, which may be the reason why taste dysfunction cannot be recovered for a long time after radiotherapy.

Comparative study of conventional MRI between Duchenne muscular dystrophy and Becker muscular dystrophy / 中国医学影像技术

Objective: To investigate the value of conventional MRI in differential diagnosis of Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD). Methods: The imaging data of the hip and thigh muscles of 697 patients with dystrophinopathy were retrospectively analyzed, and the similarities and differences of signs between DMD and BMD were compared. Results: The distribution of muscle fat infiltration in DMD and BMD patients was consistent, the total fat infiltration degree of DMD patients was higher than BMD patients (P=0.034), with the most obvious gluteus maximus, rectus femoris and sartorius; there was no significant difference in the degree of total muscle edema (P=0.065), however, the edema of the posterior thigh and sartorius of DMD was significantly higher than that of BMD. The selective involvement of muscle atrophy and hypertrophy was consistent between DMD and BMD patients, the frequency of atrophy of BMD lateral femoris, middle femoris, medial femoris, Semimembranosus and long head of biceps was significantly higher than that of DMD (P0.05). Conclusion: Conventional MRI can differentiate DMD from BMD.

Quantification of fat content of lower limbs using iterative decomposition of water and fat with asymmetry and least squares estimation?quantitative fat imaging in Duchenne muscular dystrophy / 中华放射学杂志

Objective To evaluate the fatty infiltration of lower limbs (pelvis, thighs and calf) by using iterative decomposition of water and fat with asymmetry and least squares estimation‐quantitative fat imaging (IDEAL‐IQ) in Duchenne muscular dystrophy (DMD) patients, and correlate muscle fat fraction(FF) with clinical assessments. Methods The prospective study method was applied, twenty‐one patients with DMD were diagnosed by genetic analysis and/or muscle biopsy and twenty‐one age‐matched healthy control subjects, were evaluated using IDEAL‐IQ, calculating fat fraction (FF) of muscles in the lower limbs. The clinical data of patients, such as age, height, weight, course of disease, time to walk 10 m, Medical Research Council Scale score, were collected. The age and height between DMD group and control group were compared by independent sample t test. The weight, BMI and FF values between two groups were compared by independent samples nonparametric tests (Mann‐Whitney U tests). K related samples nonparametric test (Friedman test) was used for comparison of FF values between pelvic muscles, thighs muscles and calf muscles. The relationships between FF values and clinical assessments were investigated using Spearman correlation test. Results The mean FF of pelvic muscles [13.1(6.9, 33.8)] was significantly higher than that of the thighs muscles [8.3 (23.4, 4.5)] and calf muscles [8.3 (23.4, 4.5)] (all P<0.05) in DMD group. The FF of all the pelvic muscles in DMD were significantly higher than that of the control group muscles (all P<0.05). The gluteus maximus had the greatest mean FF values [34.7 (26.4, 63.7)] in pelvic muscles. The FF of all the thigh muscles in DMD were significantly higher than that of the control group muscles, except for the sartorius, adductor longus and gracilis (Z=0.69, 1.67 and 1.22, respectively, P=0.489, 0.094 and 0.222, respectively). The adductor magnus had the greatest mean FF values [27.2 (12.4, 58.5)] in thigh muscles. The FF of all the calf muscles in DMD were significantly higher than that of the control group muscles, except for the tibialis anterior and tibialis posterior (Z value was1.77 and 1.85, respectively, P value was 0.076 and 0.064, respectively). The gastrocnemius lateral had the greatest mean FF values [7.4 (4.6, 20.9)] in calf muscles. The mean FF value of pelvic muscles (r=0.679, 0.704,?0.761, 0.755, respectively, all P<0.001), thighs muscles (r=0.801, 0.813,?0.738, 0.706, respectively, all P<0.001) and calf muscles (r=0.502, 0.682,?0.637, 0.664, respectively, all P<0.05) were significantly correlate with age, course of disease, %MRC and time to walk 10 m. Conclusions The fat infiltration of lower limbs in DMD patients showes a distinct involvement pattern. IDEAL‐IQ technique is able to quantitatively and objectively evaluate the degree of fat infiltration of lower limbs in DMD, and it has great value in clinical application.

Comparative analysis between induction chemotherapy combined with concurrent chemoradiotherapy and chemoradiotherapy alone for thoracic esophageal squamous cell carcinoma / 中华放射肿瘤学杂志

Objective To compare the clinical efficacy and safety between induction chemotherapy (IC) followed by concurrent chemotherapy (CRT) and CRT alone in patients with inoperable thoracic esophageal squamous cell carcinoma (ESCC).Methods Between 2002 and 2015,clinical data of 267 thoracic ESCC patients undergoing definitive CRT based on docetaxel combined with cisplatin were retrospectively analyzed.Through a matched case-control study,85 patients receiving IC combined with CRT were matched to those undergoing CRT alone at a ratio of 1vs.1,according to age,gender,performance status,tumor location,tumor length,and TNM staging as the matching factors.Clinical efficacy and safety between two groups were statistically compared.Kaplan-Meier survival analysis was used to analyze the survival.The log-rank test was adopted to examine within-group differences.The Cox regression model was used for multivariate analysis.Results The median follow-up time for 170 patients was 18 months (range,3-72 months).The overall objective response rates in the IC and CRT groups were 74.1％ and 58.8％(P=0.035).The 3-year overall survival (OS) and progress-free survival (PFS) rates in the IC group were 44.2％ and 34.8％,significantly higher than 29.7％ and 15.4％ in the CRT group (P=0.028,P=0.015).Subgroup analysis revealed that patients responsive to IC obtained significantly better OS (P=0.002),PFS (P=0.001),and local recurrence-free survival (LRFS)(P=0.002) compared with the IC non-responder,whereas the distant metastasis-free survival (DMFS) did not significantly differ (P=0.166).The incidence rate of grade 3-4 leukopenia in the IC group was significantly higher than that in the CRT group (38.8％ vs.24.7％,P=0.048).Multivariate analysis revealed that age and the addition of IC were independent prognostic factors for OS (P=0.003,0.016).Conclusions Compared with concurrent CRT,IC in combination with CRT can yield better short-term efficacy and longer survival for ESCC patients.The risk of hematological toxicity in the IC group is relatively higher but tolerable.Prospective randomized trials are required to confirm the clinical efficacy and safety of IC for thoracic ESCC patients.

Recurrence risk stratification of esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy / 中华放射肿瘤学杂志

Objective To analyze the pattern of recurrence risk and investigate the association between pathological staging and recurrence risk in patients with esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (CRT). Methods Clinical data of 174 patients with advanced thoracic ESCC treated with neoadjuvant CRT between 2002 and 2015 were retrospectively analyzed. All patients received preoperative concurrent platinum-based chemotherapy with conformal radiotherapy (40-50. 4 Gy,conventional fractionation) combined with surgery. Kaplan-Meier method was utilized to analyze the survival,the log-rank test was conducted to compare the differences between groups,and the Cox regression model was used for multivariate analysis. Results The median follow-up time was 53. 9 months. A total of 44. 8% of patients achieved pathological complete response, and 59 patients ( 33. 9%) recurred after neoadjuvent CRT.The postoperative recurrence rate was 22. 2% for patients with pathological stage 0/I,38. 7% for stageⅡand 68. 2% for stageⅢ(P=0. 000).The 5-year recurrence-free survival (RFS) rates were 74. 7%, 61. 4% and 20. 9% for patients with pathological stage 0/Ⅰ,ⅡandⅢ,respectively (P=0. 000).In total,20. 5% of patients with pathological stage 0/I orⅡrecurred after postoperative 3 years, whereas all patients with pathological stageⅢrecurred within postoperative 2 years. Multivariate analysis demonstrated that age,clinical TNM staging,chemotherapy regimen,and pathological response after CRT were independent prognostic factors affecting the RFS ( P= 0. 027, 0. 047, 0. 010, 0. 005). Conclusions Pathological stage is significantly correlated with the recurrence risk in ESCC patients after neoadjuvant CRT.Risk-based surveillance strategies can be defined according to different pathologial staging.

Analysis of outcomes and prognostic factors in patients with esophageal cancer after concurrent chemoradiotherapy / 中华放射肿瘤学杂志

Objective To analyze the outcomes and prognostic factors in patients with esophageal cancer after concurrent chemoradiotherapy.Methods A total of 135 patients with esophageal squamous cell carcinoma were enrolled in the clinical study from January 2008 to June 2015.The patients were treated with two-dimensional radiotherapy (56 patients) or three-dimensional radiotherapy (79 patients).The radiotherapy was delivered at a total dose of 60-64 Gy (1.8-2.0 Gy per fraction).The concurrent chemotherapy regimen consisted of fluorouracil plus cisplatin or paclitaxel plus cisplatin and was performed on days 1 and day 29 of radiotherapy.The Kaplan-Meier method was used to calculate overall survival (OS)and progression-free survival (PFS) rates,the log-rank test was used for survival difference analysis and univariate prognostic analysis,and the Cox model was used for multivariate prognostic analysis.Results The 1-,3-,and 5-year sample sizes were 96,31,16,respectively.The 1-,3-,and 5-year OS rates were 74.0％,39.0％,and 28.6％,respectively;the median OS time was 25 months.The 1-,3-,and 5-year PFS rates were 57.3％,27.3％,and 16.6％,respectively;the median PFS time was 15 months.The univariate analysis indicated that clinical stage,radiotherapy method,and M stage were prognostic factors for OS and PFS (P =0.006,0.000,and 0.032;P=0.017,0.004,and O.000).The multivariate analysis showed that clinical stage and radiotherapy method were independent prognostic factors for OS and PFS (P=0.006 and 0.000;P =0.033 and 0.023).Conclusions For non-surgical treatment of patients with esophageal cancer,concurrent chemoradiotherapy is a preferred strategy and has proven to be effective and tolerable.

MRI features of phenylketonuria in brain / 中国医学影像技术

Objective To observe MRI features of intracranial changes in phenylketonuria (PKU) patients.Methods Brain MRI findings of clinically diagnosed 13 PKU patients were analyzed retrospectively.The structure and signal changes of cerebrum,cerebellum and brainstem were observed.Results Posterior horn and triangle high signals were shown in white matter of bilateral lateral ventricle of all 13 patients on T2WI,while the optic radiation was spared.Periventricular white matter abnormal signals at body and anterior horn bilateral lateral ventricle (n=12),bilateral basal ganglia involvement (n=1),extensive white matter involvement (n=1),backward myelination and agenesis of corpus callosum (n=3),and mild macrogyria deformity (n=1) were found.The high signals in lateral periventricular white matter were shown on DWI,with reduction of ADC values in 6 cases.Conclusion Abnormal high signals in brain posterior horn and triangle white matter,optic radiation spared,and corpus callosum and cortical malformations are brain MRI appearances in brain of PKU.

Clinical study of cetuximab combined with concurrent chemoradiotherapy for esophageal squamous cell carcinoma / 中华放射肿瘤学杂志

Objective To determine the feasibility and toxicity of the addition of cetuximab to paclitaxel,cisplatin,and concurrent intensity modulated radiation therapy (IMRT) for patients with esophageal squamous cell carcinoma (ESCC).Methods Nineteen patients with stage Ⅰ to Ⅲ ESCC,without distant organ metastases,were eligible.All patients received cetuximab,an initial dose of 400 mg/m2 in the first week followed by weekly injection of 250 mg/m2,paclitaxel 45 mg/m2 and cisplatin 20 mg/m2 weekly for 7 weeks with IMRT of 59.4 Gy/33 fractions.Results Two patients discontinued because of severe adverse events.Seventeen patients completed the planned treatment protocol.Of whom,12 patients achieved completeremission.The objective response rate was 100％.A median follow-up time was 29.3 months.The 1-year overall survival and recurrence-free survival rate was 100％ and 82％,respectively.Main toxicities including myelosuppression,esophagitis and skin rash happened in 19 patients.Grade ≥2 neutropenia,esophagitis and skin toxicity noted rates was 89％,84％ and 58％,respectively.Local recurrence was found in two patients.Neck lymph node and lung metastasis found in one patient.Conclusions Cetuximab,when combined with paclitaxel,cisplatin and IMRT,is efficient and safe for esophageal squamous cell carcinoma,Further clinical study is needed.