Clinical efficacy and prognosis of breast cancer patients with ipsilateral supraclavicular lymph node metastases treated with multi-modality therapy at diagnosis / 中华放射肿瘤学杂志

Objective To investigate the clinical efficacy and prognostic factors of breast cancer patients with ipsilateral supraclavicular lymph node metastasis (ISLNM) receiving neoadjuvant chemotherapy,surgery combined with radiotherapy at diagnosis.Methods Therapeutic outcomes of 65 breast cancer patients with ISLNM treated in our hospital between 1999 and 2013 were retrospectively analyzed.All patients were pathologically diagnosed with breast cancer.They were complicated with ISLNM,without distant metastasis confirmed by pathological or imaging examinations.All patients received multi-modality therapy consisting of neoadjuvant chemotherapy,surgery and postoperative radiotherapy.KaplanMeier method was adopted to calculate the overall survival (OS),progression-free survival (PFS) and supraclavicular lymph node recurrence (SCFR).The differences between two groups were statistically analyzed by the log-rank test.Results The median follow-up time was 66 months (range:6-137 months).Five patients had SCFR after corresponding treatment.The overall 5-year SCFR,OS and PFS rates were 9.2％,71.5％ and 49.5％,respectively.Following preoperative chemotherapy,the complete response (CR) of supraclavicular lymph node was a prognostic factor affecting OS.The 5-year OS rates in patients with and without CR were 81.4％ and 53.9％ (P=O.035).The size of supraclavicular lymph node (≤ 1 cm vs.＞ 1 cm at diagnosis was a risk factor of the SCFR (0％ vs.21.0％,P=0.037) and OS rates (≤1 cm vs.＞1 cm:86.1％ vs.55.6％,P =0.001).Conclusions Breast cancer patients with ISLM at diagnosis can obtain high OS rate and excellent tumor control after undergoing multi-modality therapy consisting of preoperative chemotherapy,surgery and postoperative radiotherapy.

Radiotherapy of soft tissue sarcoma / 中华放射肿瘤学杂志

Radiation therapy is one of the primary treatment of soft tissue sarcomas.Pre-or postoperative radiotherapy can reduce the risk of tumor local recurrence.Extended local resection combined with pre-or postoperative radiotherapy can achieve long-term survival comparable to those of amputation while preserve the limb function.With the progress of radiation technology in recent years,radiation induced damages of normal tissue is declined.

Effect of postoperative adjuvant radiotherapy on treatment outcome of patients with localized soft tissue sarcoma / 中华放射肿瘤学杂志

Objective To investigate the treatment outcome of patients with localized soft tissue sarcoma (STS) and related prognostic factors,with a focus of the role of postoperative radiotherapy in the treatment of STS.Methods A retrospective analysis was performed for the clinical data of 203 STS patients who underwent organ preservation surgery in Fudan University Shanghai Cancer Center from July 2000 to July 2010.Of all the patients,76(37.4％) received adjuvant radiotherapy,which was delivered via anterior-posterior parallel opposed fields at a dose of 45-70 Gy.The Kaplan-Meier method was used to calculate survival rates,the log-rank test was used for survival difference analysis,and the Cox proportional hazards model was used for multivariate analysis.Results The follow-up rate was 100％.The 5-year overall survival (OS) rate,local failure-free survival rate,and distant metastasis-free survival rate were 69.1％,69.2％,and 68.0％,respectively.The multivariate analysis showed that pathological subtype,tumor size,resection margin status,and postoperative radiotherapy were influencing factors for OS.Among these factors,postoperative radiotherapy was associated with a significantly reduced risk of local recurrence in STS patients (HR=0.327,95％ CI 0.177-0.605,P=0.000) and a significantly increased OS rate (HR=0.489,95％ CI 0.266-0.897,P=0.021).Conclusions Postoperative radiotherapy can reduce local recurrence and improve OS in patients with localized STS,and further studies are needed to clarify its role.

Research status of postoperative radiotherapy for non-small cell lung cancer / 中华放射肿瘤学杂志

A considerable proportion of patients with non small cell lung cancer (NSCLC) require postoperative adjuvant therapy,postoperative radiotherapy is an important part of the treatment,this article review the role and value of postoperative radiotherapy for NSCLC patients in recent years.

Dosimetric comparison of postoperative intensity-modulated radiotherapy for stage Ⅱ - Ⅲ rectal cancer / 中华放射肿瘤学杂志

ObjectiveTo explore the optimal method of protecting bone marrow in postoperative concurrent chemoradiotherapy of stage Ⅱ - Ⅲ rectal cancer by comparing two techniques of intensitymodulated radiotherapy (IMRT). MethodsFifteen patients with stage Ⅱ - Ⅲ rectal cancer after surgery had CT simulation. Clinical target volume, small bowel, bladder and bone marrow were contoured. Two IMRT treatment plannings with and without bone marrow-sparing (BMS-IMRT and IMRT) were separately designed. The dose distribution was compared based on that 95％ of the planning target volume received the prescribed dose. ResultsBMS-IMRT had an advantage over IMRT in terms of conformity indices ( 1. 06∶1. 04, t =- 2. 61, P =0. 023 ), but inferior to I M RT for homogeneity indices ( 0. 81 : 0. 75, t =- 2. 34, P =0.037)).Compared with IMRT, BMS-IMRT reduced the V5, V10, V20, V30, V40 of bone marrow (97.09％∶98.72％, t=-2.34, P=0.037;92.38％∶96.46％, t=-2.41, P=0.033;83.36％∶91.70％, t=-3. 18, P=0.008;51.47％∶69.65％, t=-4.92, P=0.000;36.34％∶49.57％, t=-2.66, P =0. 021 ). The doses received by small bowel and bladder were similar between BMS-IMRT and IMRT, except that the V20 of bladder was lower in BMS-IMRT (77. 32％∶92. 39％, t =-3.52, P=0. 004). Conclusions BMS-IMRT reduces low dose volume of bone marrow without increasing dose to other risk organs.BMS-IMRT might reduce acute hematologic toxicity and increase the feasibility of postoperative concurrent chemoradiotherapy in stage Ⅱ -Ⅲ rectal cancer.

The impact of respiratory motion and active breathing control on the displacement of target area in patients with gastric cancer treated with post-operative radiotherapy / 中华放射肿瘤学杂志

Objective To assess the impact of respiratory motion on the displacement of target area and to analyze the discrimination between free breathing and active breathing control (ABC) in patients with gastric cancer treated with post-operative radiotherapy. Methods From January 2005 to November 2006, 22 patients with post-operatively confirmed gastric cancer were enrolled in this study. All diseases were T_3/ N +, staging Ⅱ - Ⅳ. Patients were CT scanned and treated by radiation with the use of ABC. Image J software was used in image processing, motion measurement and data analysis. Surgical clips were implanted as fiducial marks in the tumor bed and lymphatic drainage area. The motion range of each clip was measured in the resultant-projection image. Motions of the clips in superior-inferior (S-I), right-left (R-L) and anterior-posterior (A-P) directions were determined from fluoroscopy movies obtained in the treatment position. Results The motion ranges in S-I, R-L and A-P directions were 11.1 mam, 1.9 mm and 2.5 mm (F = 85.15, P = 0. 000) under free breathing, with 2.2 mm, 1.1 mm and 1.7 nun under ABC (F = 17.64, P = 0. 000), and the reduction of motion ranges was significant in both S-I and A-P directions (t = 4.36, P = 0. 000;t = 3.73,P = 0.000). When compared with under free-breathing, the motion ranges under ABC were kept unchanged in the same breathing phase of the same treatment fraction, while significant increased in different breathing phase in all three directions (t = - 4.36, P = 0. 000; t = - 3.52, P = 0.000; t =-3.79, P = 0. 000), with a numerical value of 3.7 mm, 1.6 mm and 2.8 mm, respectively (F = 19.46, P = 0. 000) . With ABC between different treatment fractions , the maximum displacements were 2.7 mm, 1.7 mm and 2.5 mm for the centre of the clip cluster (F =4.07,P =0. 019), and were 4.6 mm, 3.1 mm and 4.2 mm for the clips (F =5.17 ,P =0.007). The motion ranges were significant increased in all the three directions (t = - 4.09, P=0.000 ; t =-4.46, P = 0.000 ; t = - 3.45, P =0.000). Conclusions In the irradiation of post-operative gastric cancer, the maximum displacement of organ motions induced by respiration is in S-1 direction and the minimum in R-L direction under free breathing. The use of ABC can reduce the motions significantly in S-I and A-P directions, and the same changes exist in both inter-and intra-fraction treatment.