A novel predictor for the use of concurrent chemotherapy in early-stage cervical cancer with intermediate-risk factors.

Objective: For early-stage cervical cancer patients experiencing radical surgery, postoperative radiotherapy was recommended for patients with a combination of intermediate-risk factors. However, there was no consensus on whether to administer concurrent chemotherapy. The aim of the study was to confirm the clinical value of the controlling nutritional status (CONUT) score in guiding the use of concurrent chemotherapy during postoperative radiotherapy. Methods: A total of 969 patients with FIGO stage IB-IIA cervical cancer were retrospectively analyzed. Kaplan-Meier survival analysis was performed to compare disease-free survival (DFS) and cancer-specific survival (CSS) rates between different group. A Cox proportional hazards regression test was used to conduct multivariate analyses. Results: For the patients in the high CONUT group (≥3), the addition of concurrent chemotherapy had better 5-year DFS (91.2 % vs. 72.8 %, P = 0.005) and CSS (93.8 % vs. 77.4 %, P = 0.013) than those without it. Meanwhile, the patients with concurrent chemotherapy had less rate of locoregional recurrence (8.5 % vs 16.7 %, P = 0.034) and distant metastases (11.7 % vs 30.4 %, P = 0.015). The multivariate analysis showed that concurrent chemotherapy was detected to be a factor significantly associated with DFS (P = 0.011), local control (P = 0.041), distant metastasis (P = 0.005) and CSS (P = 0.023). For the patients in low CONUT group (<3), there was no difference in prognosis between patients. Conclusion: Pretreatment CONUT score may be a predictive factor for the use of concurrent chemotherapy in early-stage cervical cancer with intermediate-risk factors during postoperative radiotherapy, and it can be helpful to determine the adjuvant treatment scheme.

The effectiveness of consolidation chemotherapy in high-risk early-stage cervical cancer patients following concurrent chemoradiation after radical surgery.

OBJECTIVE: Studies determining which early-stage cervical cancer patients with high-risk factors benefit from consolidation chemotherapy after postoperative concurrent chemoradiotherapy (CCRT) are limited and inconsistent. The aim of this study was to evaluate the value of consolidation chemotherapy in early-stage cervical cancer. METHODS: From 2010 to 2019, a retrospective review was conducted among high-risk early-stage cervical cancer patients who were treated with postoperative CCRT or consolidation chemotherapy after postoperative CCRT. Disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method and compared using the log-rank test. RESULTS: A total of 293 patients with early-stage cervical cancer were included in this study. A total of 188 patients were in the consolidation chemotherapy group, and 105 patients were in the postoperative CCRT alone group. The median follow-up was 48.3 months (range: 3-123 months). In the survival analyses, no significant differences in DFS (P = 0.21) or OS (P = 0.15) were observed between the groups. The grade 3-4 leukopenia and neutropenia rates in the consolidation group were higher than those in the concurrent chemoradiotherapy alone group (54.8% vs. 28.6%, P = 0.02; 49.4% vs. 10.5%, P = 0.001, respectively). For patients with ≥2 positive lymph nodes or ≥2 high-risk factors, consolidation chemotherapy significantly improved DFS (P = 0.013 and P = 0.002) and OS (P < 0.001 and P < 0.001) compared with CCRT alone. CONCLUSION: For early-stage cervical cancer, consolidation chemotherapy after postoperative CCRT improved survival outcomes in patients with ≥2 positive lymph nodes or ≥2 high-risk factors.

A Novel Risk Factor for Para-Aortic Lymph Node Recurrence After Definite Pelvic Radiotherapy in Stage IIIB Cervical Cancer.

Background: Studies determining which patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIB disease benefit from prophylactic extended-field irradiation (EFRT), which can reduce para-aortic lymph node (PALN) failure rates, are limited. The study was designed to evaluate the value of the controlling nutritional status (CONUT) score as a risk factor for predicting PALN recurrence and identifying potential indications of prophylactic EFRT. Methods: From 2010 to 2015, a retrospective review was conducted among patients with FIGO stage IIIB cervical cancer who were treated with definitive pelvic radiotherapy or concurrent chemoradiotherapy. We analyzed para-aortic lymph node metastasis-free survival (PALNMFS) using Kaplan-Meier curves. Multivariate analyses were performed using Cox regression models. Results: A total of 116 patients with FIGO stage IIIB cervical cancer were included in the study and the median follow-up was 42.2 months (range: 3.5-104.2 months). Multivariate analysis revealed that the CONUT score (HR: 3.141; 95% CI: 2.321-5.436; P < .001) and ≥3 pelvic lymph node metastases (HR: 2.235; 95% CI: 1.428-11.242; P < .001) were independent risk predictors of PALNMFS. Compared with the low CONUT group (score<3), the high CONUT group (score≥3) was associated with a significantly worse 3-year disease-free survival rate (46.9 vs 69.5%, P = .001), a significantly lower 3-year overall survival rate (68.5 vs 79.7%, P = .016) and a significantly lower PALNMFS rate (74.8 vs 96.4%, P < .001). Conclusions: A high CONUT score (score≥3) and ≥3 pelvic metastatic lymph nodes were significant predictors of PALNMFS after pelvic radiation in FIGO stage IIIB cervical cancer patients. Patients with these risk factors might benefit from prophylactic EFRT.

Study on the feasibility of quality improvement for automatic plans based on rapid plan model.

Objective: To study whether an interactive improved internal feedback system with the model can be established, we compared the plans generated by two automatic planning models. Methods: Seventy cases of pelvic patients were selected. Intensity-modulated radiation therapy (IMRT) plans (P0) generated by the clinical model (M0) were imported into the Rapid plan model to establish a dose-volume histogram. The predicted model through automatic planning model in clinical, and the new rapid plan model (M1) was generated by training and structure matching settings. The 70 new IMRT plans (P1) were generated by M1, and the new rapid plan model (M2) was trained by P1. In this same method, 70 IMRT plans (P2) were generated by M2. Dosimetric differences between P1 and P2 were then compared and analyzed. Results: For the model parameters, R2 and X2 in P2 were higher than those in P1, and the CD values of the bladder, right femoral head, and rectum in P1 were higher than those of corresponding organs in P2. The studentized residual (SR) value of the bladder and SR and difference of estimate values of the left femoral head and right femoral head in P1 were lower than P2. In planning, (D2, D98, and HI) P1 were better than P2 (P < 0.01); the bladder V10 and left femoral head V40 in P2 were lower than in P1 by 0.08% and 0.15%, respectively (P < 0.05); others in P2 were higher than those in P1 (P < 0.05) except the bladder V20, Dmean, rectum V10, V20, V30, right femoral head V10, and V40; and the MUs of P2 was lower than that of P1 for 132.2 (P < 0.05). Conclusion: The stability of M2 is stronger than that of M1. Therefore, the interactive improved internal feedback system within the model of "plan-model-plan-model" is feasible and meaningful.

Absorption enhancement in visible range from Fano resonant silicon nanoparticle arrays embedded in single crystal Mg:Er:LiNbO3synthesized by direct ion implantation.

Fano resonant Si nanoparticles (NPs) are synthesized in single-crystal Mg:Er:LiNbO3using ion implantation and subsequent thermal annealing. The structural and optical properties of the Si NPs embedded in the crystal have been investigated. Spherical particles with radius of about 60 nm are observed by cross-sectional transmission electron microscope, while ion beam analysis are used to characterize the NPs formation process. The absorption of the Mg:Er:LiNbO3crystals have been enhanced significantly due to the embedded Si NPs, which are induced by the Fano resonance effect in the visible light wavelength band. Periodic structures of spherical Si particles model is proposed and analyzed using the Mie theory to study the optical response features and local fields. As a result, numerical simulations demonstrate that periodicities of the array of Si NPs can yield narrow resonant peaks connected with multiple light scattering by the NPs and displaying a Fano-type resonant profile. The wavelengths of the absorption peak show clear red shift with increasing the radius of NPs and the peak intensity can be enhanced by decreasing the array period. This work opens an avenue to modulate the optical filed by embedding Fano resonant Si NPs for potential application in optical devices.

Investigation of optical absorption enhancement of plasmonic configuration by graphene on LiNbO3-SiO2structure.

A novel plasmonic structure is demonstrated by combining graphene with a planar LiNbO3thin layer, which is simple and easy to fabricate compared to the complex design of general graphene surface plasmons devices. Graphene from the chemical vapor deposition is investigated and characterized to be a continuous and uniform monolayer or fewlayer. LiNbO3capped by graphene layer show an extraordinary absorption enhancement in an attenuated total reflection (ATR) measurement at a wide bandwidth of 500-4000 cm-1, which can be explained by resonance absorption resulting from the coupling of graphene surface plasmons with optical modes of LiNbO3-SiO2Fabry-Perot cavity and LiNbO3planar waveguide. The simulation results are generally consistent with the ATR experimental results. The absorption spectra versus temperature of this plasmonic configuration is also investigated, which show that increasing the testing temperature not only highlights the atomic vibrational peaks of graphene, but also enhances the absorption at several characteristic absorption frequencies due to the enhanced coupling between the surface plamons excitations and the optical modes.

Investigation of novel optical and waveguide characteristics for an air-graphene-LiNbO3system.

The optical characteristics of a planar thin film waveguide system composed of air-graphene-LiNbO3have been investigated. Monolayer or bilayer graphene of high quality are characterized by Raman spectroscopy, scanning electron microscopy and atomic force microscopy. The refractivity and reflectivity of the air-graphene-LiNbO3system are measured experimentally and compared with those of a LiNbO3waveguide by the prism coupling method. The reflectivity shows an overall decrease due to the lower transmittance for graphene on the LiNbO3substrate. The refractivity increases significantly at the wavelength of 1540 nm, which may be attributed to the generation of graphene surface plasmons excited by infrared radiation. A shaped air-graphene-LiNbO3waveguide is designed and simulated by Mode Solutions. The distribution of an optical field is performed and analyzed. The preparation of the proposed air-graphene-LiNbO3structure incorporates the commonly used chemical vapor deposition and thin film transfer techniques, and is compatible with existing optoelectronic integration processes, which can be employed for building various optical integrated devices.

Enhancement of near-infrared photoluminescence in Mg:Er:LiNbO3 containing Au nanoparticles synthesized by direct ion implantation.

Embedded gold (Au) nanoparticles (NPs) are formed in Mg:Er:LiNbO3 single crystals by Au ion implantation and subsequent thermal annealing. Absorption of the Mg:Er:LiNbO3 crystals with Au NPs is found to be enhanced significantly in the visible light wavelength band owing to the localized surface plasmon resonance (LSPR) effect. The calculated LSPR effect by Mie theory shows good agreement with the absorption spectra. A significantly enhanced Er related photoluminescence (PL) at 1.54 µm for crystals with Au NPs is also observed compared with samples without Au NPs. Energy transfer between Au NPs and Er is found to be responsible for the PL enhancement in the as-implanted samples while local field enhancement induced by LSPR is considered the dominant factor in the annealed samples. The dependence of PL enhancement on NP size makes it possible to tailor intensity by varying the annealing temperature. An avenue to enhance and modulate the PL of dielectrics with embedding Au NPs synthesized by ion implantation is presented in this study.

Dosimetric study of three-dimensional static and dynamic SBRT radiotherapy for hepatocellular carcinoma based on 4DCT image deformable registration.

The purpose of this work was to determine the actual dose received by normal tissues during four-dimensional radiation therapy (4DRT) composed of ten phases of four-dimensional computer tomography (4DCT) images. The analysis was performed by tracking the hepatocellular carcinoma SBRT. Data were acquired from the tracking of each phase with the beam aperture for 28 hepatocellular carcinoma patients, and the data were used to generate a cumulative plan, which was compared to a three-dimensional (3D) plan formed from a merged target volume based on 4DCT images in a radiation treatment planning system (TPS). The change in normal tissue dose was evaluated in the plan using the parameters V5, V10, V15, V20, V25, V30, V35, and V40 (volumes receiving 5, 10, 15, 20, 25, 30, 35, and 40 Gy, respectively) in the dose-volume histogram for the liver; the mean dose was analyzed for the following tissues: liver, left kidney, and right kidney. The maximum dose was analyzed for the following tissues: bowel, duodenum, esophagus, stomach, and heart. There was a significant difference in the dose between the 4D planning target volume (PTV) (average 115.71 cm3 ) and ITV (169.86 cm3 ). The planning objective was for 95% of the volume of the PTV to be covered by the prescription dose, but the mean dose for the liver, left kidney and right kidney had an average decrease of 23.13%, 49.51%, and 54.38%, respectively. The maximum dose for the bowel, duodenum, esophagus, stomach, and heart had an average decrease of 16.77%, 28.07%, 24.28%, 4.89%, and 4.45%, respectively. Compared to 3D RT, the radiation volume for the liver V5, V10, V15, V20, V25, V30, V35, and V40 using the 4D plans had a significant decrease (P ï¹¤ 0.05). The 4D method creates plans that permit sparing of the normal tissues more than the commonly used ITV method, which delivers the same dosimetric effects to the target.

Fabrication and analysis of single-crystal KTiOPO4 films with thicknesses in the micrometer range.

Single-crystal potassium titanyl phosphate (KTiOPO4, KTP) films with thicknesses less than 5 µm are obtained by using helium (He) implantation combined with ion-beam-enhanced etching. A heavily damaged layer created by a 4×10(16) cm(-2) fluence of 2 MeV He implantation is removed by means of wet chemical etching in hydrofluoric acid (HF). Thus, free-standing films of KTP with thicknesses in the range of 3-5 µm are obtained. The etching rate can be adjusted over a wide range by choosing temperature and HF concentration, as well as annealing conditions. Sharp etching edges and the smooth surface of the film indicate that a high selective-etching rate is achieved in the damaged layer, and the remaining part of the crystal is undamaged. X-ray and Raman-scattering results prove that KTP films have good single-crystal properties.