Study of the value of SPECT lung perfusion imaging in optimizing lung cancer radiotherapy plan for lung function protection / 中华放射肿瘤学杂志

Objective:To evaluate the application value of SPECT lung perfusion imaging in guiding radiotherapy path, optimizing the radiotherapy plan for lung cancer and protecting lung function during radiotherapy for locally advanced non-small cell lung cancer.Methods:In this study, 84 patients with stage Ⅲ non-resectable non-small cell lung cancer were randomly divided into the control group ( n=44) and observation group ( n=40). In the control group, radiotherapy plan based on conventional CT images was delivered, and two plans based on the lung function information suggested by conventional CT and SPECT lung perfusion imaging: P1 and P2 were given in the observation group. All patients in the observation group were finally treated according to the P2 plan. The incidence of radiation pneumonitis, and changes in lung function before and after radiotherapy were statistically compared between two groups. The dose-volume parameters of P1 and P2 were statistically compared. Results:After the plan was optimized, the incidence of radiation pneumonitis in the observation group was significantly reduced and the decline of lung function was significantly improved (both P≤0.001). The functional dose parameters were significantly improved in the P2 plans (both P<0.05), whereas the irradiation dose of organs at risk did not significantly change ( P>0.05). Conclusion:SPECT lung perfusion imaging optimizes the intensity-modulated radiotherapy plan, which can reduce the functional lung dose and increase the tumor radiotherapy dose without increasing the irradiation dose of other organs at risk.

The research status and development trend of EGFR gene exon 20 insertion mutant non-small cell lung cancer / 中华肿瘤杂志

The successful application of tyrosine kinase inhibitor (TKI) has kicked off the targeted therapy of epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC) since the discovery of EGFR gene mutations. Patients harboring the two most classic representative mutations of EGFR gene including exon 19 in-frame deletion or exon 21 L858R mutation could get significant clinical benefits from EGFR-TKIs compared to traditional chemotherapy. Among other approximately 10% of EGFR gene mutation type, exon 20 insertion occupies the first place. Available research had demonstrated that EGFR exon 20 insertion in NSCLC was highly malignant and most insertion variants showed de novo drug resistance towards current approved 1st to 3rd generation EGFR-TKIs, with much poorer clinical prognosis. Currently, there is a lack of comprehensive research and clinical guideline on the treatment of this specific mutation. In this article, we review the pathogenesis, amino acid sequence variants and current management of EGFR exon 20 insertion mutant NSCLC. Moreover, we come up with the emphasis on the treatment challenges and further development of this rigid mutation in NSCLC.

Progress of maintenance therapy for advanced non-small-cell lung cancer / 国际肿瘤学杂志

The efficacy of the standard first-line chemotherapy regimen for advanced non-small cell lung cancer (NSCLC) has reached a plateau.Study confirmed that chemotherapy drugs and molecular targeted drug maintenance treatment can prolong the survival of patients with advanced NSCLC.Immunotherapy has become a maintenance treatment for advanced NSCLC,and further research is needed to confirm its efficacy.

Analysis of human papillomavirus infection in non-small cell lung cancer / 国际肿瘤学杂志

Objective To detect the infection of human papillomavirus (HPV)in patients with non-small cell lung cancer (NSCLC)and explore the relationship between HPV infection and clinicopathological features.Methods HPV detection and genotyping in 156 cases of NSCLC were performed using a new liquid chip based on Luminex.Patient clinical characteristics were also recorded,and the relationship between HPV infection and clinicopathological features was studied.Results Of the 156 tumor-DNA samples tested,40 (25.6%)cases showed presence of HPV-DNA,of which 37 cases were of a high-risk HPV type (16,18,33, 58).The differences were statistically significant between the HPV-positive and HPV-negative groups in gender (χ2 =4.387,P =0.036),smoking (χ2 =8.130,P =0.004),histologic type (χ2 =4.075,P =0.044)and lymph node metastasis (χ2 =7.082,P =0.008).The differences were not statistically significant between the HPV-positive and HPV-negative groups in age (χ2 =0.013,P =0.910),differentiated degree (χ2 =1.727, P =0.189),clinical stages (χ2 =0.179,P =0.672),distant metastasis (χ2 =3.012,P =0.083).Logistic regression analysis revealed that lymph node metastasis alone was an independent predictive factor of HPV infection in NSCLC (OR =0.384,95%CI:0.153-0.967,P =0.042),and gender (OR =1.402,95%CI:0.522-3.769,P =0.503),smoking (OR =0.506,95%CI:0.194-1.322,P =0.506),histologic type (OR =0.393,95%CI:0.133-0.161,P =0.091)were not independent predictive factors of HPV infection. Conclusion The infection of HPV presents in part of Chinese NSCLC patients,and HPV infection may be connected with occurrence and development of lung cancer.

Relationship between C-reactive protein and specific survival time in non-small cell lung cancer patients treated with chemotherapy / 肿瘤研究与临床

Objective To evaluate the association between C-reactive protein (CRP) blood levels and specific survival time of non-small cell lung cancer (NSCLC) patients treated with chemotherapy.Methods Data from 96 advanced (stage ⅢB/Ⅳ) NSCLC patients were analyzed.All patients were divided into two groups based on the enrolled time as follows the initial treatment group (48 cases) and retreatment group (48 cases).According to 0.6 mg/L and 7.3 mg/L of CRP which were the 1/3 and 2/3 of CRP concentrations,respectively,the 96 patients were divided into low,intermediate and high groups.Kaplan-Meier and Cox proportional-hazard models were used to evaluate the relationship between the CRP level and survival time.Results After adjusting for age,sex,smoking history,histological type and stage of lung cancer,a significant relationship between CRP and survival time was observed (P ＜ 0.05).Such significant differences of survival time were also observed in both of the adenocarcinoma (P ＜ 0.001) and squamous with poorly differentiated (P =0.032) subtypes.On stratification analysis by chemotherapy status,the circulating CRP level in retreatment group was correlated well with survival time (P ＜ 0.001).However,the influence of circulating CRP levels on survival time in initial group did not reach statistical significance (P =0.296).For all patients,the hazard ratio with high CRP levels for NSCLC-specific survival was 1.15 (95 ％ CI 0.82-1.61) compared with that of low CRP levels.The hazard ratio for the initial treatment group and retreatment group were 0.52 (95 ％ CI 0.16-1.74) and 1.77 (95 ％ CI 0.73-4.26),respectively.Patients with high circulating CRP level also responded poorly to chemotherapy.Conclusion A high level of circulating CRP is associated with an inferior response and survival outcome in NSCLC patients treated with chemotherapy.

The Expression and Clinical Significance of RhoB and E-Cadherin in Non-Small-Cell Lung Cancer Tissues / 天津医药

Objective To investigate the expressions of RhoB and E-cadherin in non-small-cell lung cancer (NSCLC), and their clinical significances thereof. Methods Immunohistochemical staining was applied to detect expres-sions of RhoB and E-cadherin in 116 samples of NSCLC (NSCLC group) and 116 samples of normal lung tissues (control group). Correlations of expressions of RhoB and E-cadherin to clinical pathological parameters and prognosis were analyzed in two groups. Results The expression intensities of RhoB and E-cadherin were significantly lower in NSCLC group than those in control group (57.76%vs 87.07%,54.31%vs 85.34%,P＜0.01). There were significant differences in the expres-sion of RhoB between different pathological types, differentiation and lymph node metastasis in NSCLC group. There were significant differences in the expression of E-cadherin between different TNM stages, differentiation and lymph node metas-tasis in NSCLC group. The expression of RhoB was positively correlated with the expression of E-cadherin ( r=0.503,P＜0.01). The 3-year survival rates were significantly higher in patients with high expression of RhoB (83.93%) than those in pa-tients with low expression of RhoB (40.00%, Log-rank χ2=18.992,P＜0.01). The 3-year survival rates were significantly higher in patients with high expression of E-cadherin (85.11%) than those in patients with low expression of E-cadherin (44.93%, Log-rankχ2=16.680,P＜0.01). Further multivariate analysis suggested that both lower expressions of RhoB and E-cadherin and lymph node metastasis were prognostic indicators for NSCLC (P＜0.001). Conclusion The expressions of RhoB and E-cadherin showed a good correlation in NSCLC. Detecting the expression of RhoB combined with E-cadherin may give a clue on clinicopathological features and prognosis in patients with NSCLC.

Experience of completely video-assisted thoracoscopic sleeve lobectomy / 中华胸心血管外科杂志

Objective Summarize 8 cases of non-small cell lung cancer (NSCLC) that has accepted completely video-as-sisted thoracoscopic sleeve lobectomy in People's Hospital of Peking University in china,to explore the safety,effectiveness indications and experience of this procedure.Methods Between September 2011 and December 2011,Medical records of 8 cases of non-small cell lung cancer that has accepted complete thoracoscopic sleeve lobectomy were reviewed (7 male,1 female).Median patient age was 62.4 years.And median maximal diameter of solid tumors was 2.3 cm.This group consisted of 5 cases of right upper lobe sleeve lobectomy,2 case of left lower lobe sleeve lobectomy and 1 case of left upper lobe sleeve lobectomy.The operation procedure was completely VATS anatomic sleeve lobectomy combined with systematic lymph node resection (at least 3 groups of lymph nodes in the mediastinum area).All procedure were underwent under general anesthesia with double-lumen endotracheal intubation.The patient was placed lateral decubitus position.Three incision were made at the seventh intercostal space on the median axillary line,the fourth intercostal space anterior axillary line and the seventh intercostal space subscapularis line.Bronchial were anastomosed combine with simple continuous suture anastomosis of membranous part of bronchus and simple interrupted suture anastomosis of cartilaginous part of bronchus,and then covered by? Surrounding tissue with blood supply? Results All procedures were carried out smoothly without serious complication.The median operative time was 240min median,the median bronchial anastomosis time was 45 min,the median blood loss was 200 ml,and median number of resected lymph nodes was 19.8.There were no conversion to open thoracotomy.Post operative show pathology squamous cell carcinoma in 7 cases and adenocarcinoma in 1 case.pTNM staging show 1 case of T1a N0 M0,4 cases of T1b N0 M0,2 case of T1b N1 M0 and 1 case of T1b N2 M0.There was 1 case of slight post operative complication.The median postoperative chest tube drainage duration was 7 days,and median postoperative hospital stay was 9 days.All patients were well during the followed up for 3-8 months.Conclusion Completely thoracoscopic sleeve lobectomy was a safe and effective surgical procedure for patients with non-small cell lung cancer; the operative incision placed at the fourth intercostal space anterior on the axillary line was convenient for anastomosis; anastomosis combine with simple continuous suture anastomosis of membranous part of bronchus and simple interrupted suture anastomosis of cartilaginous part of bronchus was a fast and secure mode; keeping azygos vein does not affect the anastomosis.

Clinical study of gemcitabine plus cisplatin combined with in the treatment of advanced non-Small cell lung cancer / 中国基层医药

Objective To investigate the efficacy and toxicities of gemcitabine and cisplatin as a chemother-apy regimen for patients with advanced non-small cell lung cancer (NSCLC). Methods Thirty-five patients with NSCLC were enrolled in this study. C, emeitabine was given on day 1 and 8 at a dose of 1000 mg/m~2 and cisplatin at a dose of 25 mg/m~2 on day 1 to 3. The chemotherapy was repeated every 28 days, after 2 cycles for evaluating response. Results Complete response (CR), partial response (PR) ,stable disease (SD) and progressive disease (PD) were observed in 0,14,16 and 5 cases, respectively, with a response rate (RR) of 40. 0%. The RR in initial treatment group was found more than that in the retreatment group (52. 2% vs 16.7% ,P<0. 05).The main toxicities were tol-erable, which included myelosuppression, nausea, vomiting, and liver damage. Conclusion Gemcitabine combined with cisplatin is effective and safe in the treatment of NSCLC, especially in the initial treatment patients.