Radiotherapy and prognostic analysis of breast cancer patients with isolated regional recurrence after mastectomy / 中华放射肿瘤学杂志

Objective:To analyze the prognosis of patients with isolated regional recurrence (RR) after mastectomy, and evaluate the efficacy of radiotherapy and identify the optimal radiation target volumes.Methods:Clinical data of 144 patients with first isolated RR after mastectomy between 2001 and 2018 were retrospectively analyzed. All patients had not received post-mastectomy radiotherapy. The primary endpoints consisted of the subsequent locoregional recurrence (sLRR), distant metastasis (DM), progression-free survival (PFS) and overall survival (OS).Results:With a median follow-up of 82.5 months after RR, the 5-year sLRR, DM, PFS and OS rates for the entire group were 42.1%, 71.9%, 22.9% and 62.6%, respectively. Local plus systemic therapy was an independent favorable prognostic factor for sLRR ( P<0.001) and PFS ( P=0.013). The sLRR rate in the surgery plus radiotherapy group was the lowest ( P<0.001). Surgery plus radiotherapy significantly reduced the 5-year risk of recurrence within the initially involved nodal regions ( P<0.001). Patients with chest wall irradiation obtained the 5-year subsequent chest wall recurrence rate of 12.1% compared to 14.8%( P=0.873) for those without chest wall irradiation. The subsequent supraclavicular recurrence rate was lower in patients with prophylactic supraclavicular irradiation than that without prophylactic supraclavicular irradiation (9.9% vs. 23.8%, P=0.206). The incidence rates of initially uninvolved axillary and internal mammary nodal recurrence were below 10% regardless of prophylactic irradiation or not. Conclusions:Patients with RR alone have an optimistic 5-year OS in the contemporary era. Comprehensive locoregional treatment including surgery and radiotherapy combined with systemic therapy is recommended. The chest wall, axillary and internal mammary nodal prophylactic irradiation should not be routinely performed for all patients with RR. The value of supraclavicular prophylactic irradiation remains to be evaluated.

Radiotherapy for and prognosis of breast cancer patients with isolated chest wall recurrence after mastectomy / 中华放射肿瘤学杂志

Objective:To investigate the radiation field and dose selection of patients with isolated chest wall recurrence (ICWR) after modified radical mastectomy, and analyze the prognostic factors related to subsequent chest wall recurrence.Methods:Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center, Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed. None of the patients received postoperative adjuvant radiotherapy. After ICWR, 48 patients (73.6%) underwent surgery and 155 patients (77.1%) received radiotherapy. Kaplan-Meier method was used to calculate the post-recurrence progression-free survival (PFS) rates and the difference was compared by log-rank test. Multivariate analysis was performed using Cox regression model. Competing risk model was adopted to estimate the subsequent local recurrence (sLR) rates after ICWR and the difference was compared with Gray test. Multivariate analysis was conducted using F&G analysis. Results:With a median follow up of 92.8 months after ICWR, the 5-year PFS rate was 23.2%, and the 5-year sLR rate was 35.7%. Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval o F>12 months had a lower sLR rate. Patients with recurrence interval o F>48 months, local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate. Among the 155 patients who received chest wall radiotherapy after ICWR, total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone (34.0% vs. 15.4%, P=0.004). Chest wall radiation dose (≤60 Gy vs.>60 Gy) exerted no significant effect upon the sLR and PFS rates (both P>0.05). In the 53 patients without surgery, the 5-year PFS rates were 9.1% and 20.5%( P=0.061) with tumor bed dose ≤60 Gy and>60 Gy, respectively. Conclusions:Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer, including total chest wall radiation plus local boost. The radiation dose for recurrence should be increased to 60 Gy, and it should be above 60 Gy for those who have not undergone surgical resection. In addition, patients with ICWR still have a high risk of sLR, and more effective treatments need to be explored.

The role of prognostic nutritional index for clinical outcomes of gastric cancer after total gastrectomy.

The purpose of this article is to evaluate the relationship between the nutrition-based microenvironment and clinicopathological information for gastric cancer patients and to investigate the prognostic value of nutrition index for gastric cancer patients undergoing total gastrectomy. We retrospectively collected clinical information of 245 gastric cancer patients who underwent total gastrectomy in our hospital between January 1st 2005 and December 30th 2015. According to the prognostic nutritional index (PNI) level, they were divided into low PNI (< 43) group and high PNI (≥ 43) group. The relationship between PNI and the disease-free survival (DFS) and overall survival (OS) were analyzed by statistical analysis. Univariate analyses demonstrated that TNM stage (p = 0.025), patients age (p = 0.042), lymph node metastasis (p = 0.028), tumor differentiation (p = 0.037) and a low PNI (p = 0.033) were closely correlated with a poor prognosis. In multivariate analysis, TNM stage (p = 0.027) and a low PNI (p = 0.041) were found to be independently associated with poor survival. Additionally, when age was considered as a stratified factor, univariate analyses demonstrated that low PNI correlated with shorter DFS in non-elderly (< 65) patients (p = 0.022) and shorter DFS (p = 0.036) and OS (p = 0.047) in elderly (≥ 65) patients. The low prognostic nutritional index is an independent risk factor associated with poor gastric cancer survival which represents the nutritional microenvironment. Patients with low pre-operative prognostic nutritional index levels should be observed more closely after surgery to prevent the occurrence of post-operative complications in the near future.

Immune Characteristics of Small Cell Lung Cancer / 中国肺癌杂志

Small cell lung cancer (SCLC) is a type of malignancy with poor prognosis, and no advance in medication has been made for about 30 years except immune checkpoint inhibitor (ICI), which demonstrated efficacy in recent years. The response rate of programmed death-1 (PD-1) inhibitor alone or its combination with cytotoxic T-lymphocyte antigen-4 (CTLA-4) inhibitor as subsequent therapy was 10%-33% and the response duration was persistent. The combination of programmed death ligand-1 (PD-L1) inhibitor with chemotherapy resulted in longer survival versus chemotherapy alone. Nevertheless, comparing with immunotherapy-sensitive tumors such as non-small cell lung cancer (NSCLC), efficacy in SCLC is still unsatisfied and this is maybe associated with its immune inhibitory characteristics. This review describes the current research about immune characteristics of SCLC, including tumor infiltrating of lymphocytes (TIL) and immune inhibitory cells, PD-L1 and major histocompatibility complex (MHC) expression in tumor as well as changes of peripheral immune cells. We also review the prognostic and predictive values of these immune characteristics.
.

Low-dose bevacizumab as an effective pre-treatment for peri-tumoral brain edema prior to CyberKnife radiosurgery: A case report.

A 75-y-old Chinese female patient diagnosed with lung adenocarcinoma with brain metastasis suffered severe nausea and vomiting, and these symptoms were contraindications for CyberKnife treatment. Neither mannitol, nor dexamethasone, relieved the symptoms. However, after the patient received a single dose of bevacizumab (200 mg, 2.9 mg/kg), the patient's symptoms were significantly relieved. The patient subsequently completed a successful CyberKnife treatment. In addition, the patient received an oral treatment of gefitinib. At 15 months post treatment, the patient's brain tumor was controlled. Thus, administration of bevacizumab at a low dose (2.9 mg/kg) may significantly alleviate peri-tumoral brain edema and its symptoms, thereby facilitating radiosurgery treatment.

Analysis of radiotherapy strategy for 110 breast cancer patients after R0 resection of local recurrence after radical mastectomy / 中华放射医学与防护杂志

Objective To explore the effect of prognosis of consolidation radiotherapy for patients after R0 resection of local recurrence after radical mastectomy. Methods Totally 110 breast cancer patients with local recurrence receiving R0 resection were admitted and treated in our hospital from January 1st, 2003 to November 30th, 2015 were retrospectively analyzed. Results The median local progression time of 74 patients receiving consolidation radiotherapy ( 67.3％) was remarkably better than that of those without radiotherapy(36 patients, 32.7％), and the difference was statistically significant (χ2 =8. 526, P<0.05). Meanwhile, there was no statistically significant difference (P>0.05) of distance disease-free survival and overall survival between the radiotherapy group and the non-radiotherapy group. Multifactor analysis indicated that pseudo-adjuvant endocrine therapy (χ2 =7.541,95％CI:27.1％ -80.4％, P <0.05), DDFS(≥2 years vs. <2 years,χ2 =4.068,95％CI:101.4％ -267％,P<0. 05) and pseudo-adjuvant radiotherapy(χ2 =14.126, 95％CI:21.7％ -80.4％, P <0. 05 ) were the independent risk factors affecting the OS of patients with local recurrence after R0 resection. Conclusions For the patients with local recurrence after R0 resection of local recurrence, it is recommended that consolidation radiotherapy should be done and the radiation field should include the same side of the chest wall and clavicle area lymphatic drainage area.

Treatment with everolimus for a patient with systemic metastatic breast cancer results in severe pulmonary injury: a case report.

Everolimus has been used in patients with hormone receptor-positive breast cancer. This study reports that treatment with everolimus alone induced severe pulmonary injury in a patient with systemic metastatic breast cancer. A 58-yearold woman with systemic metastatic breast cancer was treated with everolimus alone for 4 weeks and developed severe cough and dyspnea. Computed tomography (CT) scan of the chest showed a progressive lung tumor accompanied by bilateral pulmonary homogeneous ground-glass opacity, especially in the inferior lobe of the left lung. Laboratory examinations revealed a high frequency of monocytes, higher levels of serum alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and C-reactive protein as well as mild hypoxemia and hypocarbia. However, she had no evidence of infection with mycoplasma pneumoniae, chlamydia, pneumocystis, tuberculosis, influenza A virus, and was negative for serum galactomannan (GM) antigen assay. She was suspected to have drug-induced interstitial pneumonia. Everolimus treatment was stopped, and treated with methylprednisolone and empiric antibiotic therapy for 7 days. She received further corticosteroid treatment and felt much better, accompanied by clearance of lung inflammation; she was discharged from hospital. Our experience suggests that treatment with everolimus alone may cause severe pulmonary injury and should be considered carefully in cases of patients with systemic metastatic breast cancer.

Radiotherapy induced microRNA expression in the plasma of breast cancer patients / 中华放射医学与防护杂志

Objective To investigate the expressions of miR-210-3p,miR-221-3p,miR-21-5p and miR-150-Sp in the plasma of breast cancer patients before and after radiotherapy in order to establish reliable early biomarkers of non-uniform radiation injuries.Methods Blood samples were collected from 13 patients before radiotherapy (0 Gy) and 24 h after radiotherapy of 2,10,20,30 Gy.The miRNAs in the blood plasma were detected with qRT-PCR.Results The levels of miR-210-3p,miR-221-3p,miR-21-5p had no significant difference among different dosage groups after radiotherapy(P ＞ 0.05).There was no significant difference between the expression of miR-150-5p before and after 2 Gy radiotherapy (P ＞ 0.05).While the relative level of miR-150-5p gradually decreased to 0.808,0.605,0.565 (x2 =18.76,P ＜ 0.05) with increased accumulative dosage of 10,20,and 30 Gy,respectively.In addition,the miR-150-5p expression levels had no relationship (P ＞ 0.05) with situations (positive or negative group) of human epidermal growth factor receptor 2 (HER2),estrogen receptor (ER) and progesterone receptor (PR) in the breast cancer cells.Conclusions Ionizing radiation could reduce the expression of miR-150 in the plasma of breast cancer patients in a dose-dependent manner.

Advances in antitumor immune mechanisms of radiotherapy in combination with immunotherapy / 军事医学

As a significant treatment for tumors, radiotherapy is often considered a local therapy.However, an increasing number of researches indicate that reasonable radiation dose schedules can improve the tumor environment, induce immunogenic tumor cell death, provide in situ vaccine, and stimulate systemic antitumor effect.Meanwhile, immunotherapy can enhance the effect induced by radiotherapy, which has been proved in preclinical studies and is widely investigated in clinical studies.This review focuses on the immune response and mechanisms of radiotherapy, and advances in the application of radiotherapy in combination with immunotherapy.

Study on early diagnosis strategy for radiation-associated breast angiosarcoma after breast cancer radiotherapy / 中华放射肿瘤学杂志

Objective To develop an early diagnosis strategy for radiation-associated breast angiosarcoma after breast cancer radiotherapy (RABASBCR) and to avoid the misdiagnosis of this disease.Methods A systematic search of PubMed for published reports of RABASBCR cases was performed.The clinical manifestations and radiological features in the early stage of disease,as well as biopsies,were analyzed to screen out valuable markers for early diagnosis and develop the early diagnosis strategy for RABASBCR.Results Fifty-five original articles involving 80 RABASBCR patients were selected for this analysis.Twenty-four (30％) of the 80 patients were misdiagnosed;the median time of misdiagnosis was 3 months (1-24 months).The earliest symptom was skin changes in 76 (95％) of the 80 patients.The misdiagnosis rates of ultrasound,mammography,computed tomography,and magnetic resonance imaging for RABASBCR were 9/9,31/32,2/2,and 1/5,respectively.The misdiagnosis rates of fine needle biopsy,core needle biopsy,and incisional biopsy were 7/14,12/25,and 10/26,respectively.Conclusions By analyzing published case reports,we have set up the early diagnosis strategy for RABASBCR with reference to the Cahan criteria.

Progestin as an alternative treatment option for multi-treated recurrent triple-negative breast cancer.

OBJECTIVE: Patients with recurrent triple-negative breast cancer (TNBC) currently have no established treatment option other than chemotherapy. However, long-term chemotherapy is often difficult due to adverse effects. A previous study documented a 10%-30% response rate of progestins in oestrogen receptor-negative breast cancer. The aim of this study was to investigate the effect of medroxyprogesterone/megestrol acetate (MPA/MA) in patients with recurrent TNBC. METHODS: This retrospective observational analysis included 51 patients with recurrent TNBC; 17 were treated with MPA/MA and 34 underwent chemotherapy. The two groups were matched at a 1:2 ratio according to age, metastatic sites, and salvage treatment lines. Efficacy was compared using the χ2 and rank-sum tests. Progression-free survival (PFS) was calculated using the Kaplan-Meier method, and the two groups were compared using the log-rank test. RESULTS: The two groups were well balanced in terms of age, disease-free survival, number of metastases, and salvage therapy lines. Clinical benefit rates in the MPA/MA and chemotherapy groups were 52.94% and 73.53%, respectively (χ2 test, p = 0.208), and median PFS was comparable between groups (log-rank test, p = 0.135). Median PFS of 1st-6th-line salvage treatments was shorter in the MPA/MA group than in the chemotherapy group (log-rank test, p = 0.036), but median PFS of ≥7th-line salvage treatments was comparable (log-rank test, p = 0.139). Eight patients discontinued chemotherapy due to adverse effects, and one patient withdrew from MPA treatment because of weight gain. CONCLUSIONS: Progestins (MPA/MA) are an alternative treatment option for multi-treated recurrent TNBC.

Exploratory study of chemotherapy combined with endocrine therapy for metastatic breast cancer after standard treatment failure / 肿瘤研究与临床

Objective To analyze the clinical value of chemotherapy combined with endocine therapy after standard treatment failure for advanced metastatic breast cancer.Methods 30 metastatic breast cancer patients after standard treatment failure were analyzed.Etoposide (75-100 mg/d) wasused on days 1-10,followed by 11 days of rest combined with medroxyprogesterone 0.5 g,twice per day,or megestrol 160 mg/d for 21 days.Clinical effects and life quility were analysed.Results The median treatment line of this therapy was 6 (range 3-9).The clinical benefit rate is 16.7 ％ (5/30),and the median progression free survival (PFS) was 4.0 months (range 1.0-13.0 months).Conclusion The combination of chemotherapy (etoposide) and endocrine therapy (progesterone) is a choice of treatment after standard drug failure for advanced mastatic breast cancer patients.

Status and thinking on anti-angiogenesis drugs for treatment of breast cancer / 肿瘤研究与临床

Anti-angiogenesis drug has become an important method and a hot research field for treating cancers.Drugs such as bevacizumab,sunitinib,sorafenib,lapatinib,achieved good clinical effect in treating breast cancers,but they also brought a lot of problems that need to be concerned.

Relationships between the levels of serum bone-specific alkaline phosphatase, cross-linked telopeptide of type Ⅰ collage and bone metastasis in patients with breast cancer / 肿瘤研究与临床

Objective To analysis the relationships between bone markers, bone-specific alkaline phosphatase (BAP) and cross-linked telopeptide of type Ⅰ collage (ICTP), and bone metastasis of breast cancer.Methods A total of 217 patients' serum were collected.The 217 cases were divided into two groups:109 cases with bone metastasis, 108 cases without bone metastasis. Serum BAP and ICTP was measured by ELISA. The relationships between factors of bone metastasis and serum levels of BAP, ICTP were analyzed.Results The levels of serum BAP and ICTP in bone metastases group were significantly higher than those in non-bone metastasis group[BAP:24.8 μg/L(7.60-213.70 μg/L) vs 21.2 μg/L(7.3～68.8 μg/L),ICTP:7.0μg/L(1.4～32.4 μg/L) vs 4.1 μg/L(0.0～15.8 μg/L) (P=0.003,P=0.000)].The level of serum BAP and ICTP in patients with multiple bone metastasis was significantly higher than that in patients with single bone metastasis[BAP:32.3 μg/L(9.A～213.7 μg/L) vs 18.1 μg/L(7.6～60.0 μg/L),ICTP:7.6 μg/L(1.4～32.4 μg/L) vs 4.9 μg/L(1.8～10.5 μg/L),(P=0.001,P=0.010)].The sensibility of BAP and ICTP was 45.0 ％ (49/109)and 46.8 ％ (51/109),respectively.The specificity of ICTP and BAP was 83.3 ％ (90/108)and 84.3 ％ (91/108),respectively.Joint detection of BAP and ICTP had improved sensibility in the diagnosis of bone metastasis in breast cancer patients. Conclusion Joint detection of serum bone biochemical markers ICTP and BAP have a little values for diagnosing bone metastasis in breast cancer patients.

Clinical research of medical ovarian suppression combined with anastrozole in the treatment of metastatic breast cancer in premenopausal women / 肿瘤研究与临床

Objective To evaluate the correlation of the clinical effects and prognosis in patients receiving medical ovarian suppression (goserelin)combined with anastrozole treatment with premenopausal metastatic breast cancer.Methods 44 hormone dependent mastatic breast cancer patients were treated by goserelin,3.6mg hypodermic injection every 28 days and anastrozole 1 mg were administered orally,clinical effects and prognosis were analysed.Results The clinical benefit rates of goserelin combination with anastrozole in patients with metastatic breast cancer were 52.4 ％(23/44),and the median progression free survival (PFS)was 8.3(5.3-11.2)months.In the analysis of whether to accept chemotherapy,the PFS of the not received chemotherapy group was better than received chemotherapy group (16.9 months vs 5.8 months P=0.048).Conclusion The combination of goserelin and anastrozole is an effective endocrine therapy regiment for patients with premenopausal metastatic breast cancer.It can be recommended for the premenopausal and hormone dependent mastatic breast cancer patients.

Clinical analysis of 155 young female patients with breast cancer / 肿瘤研究与临床

Objective To analyze the clinic characteristics, lifetime and prognostic factors of young female breast cancer patients. MethodsClinical data of 155 patients under 35 years of age with breast cancer were retrospectively reviewed and followed up.ResultsThe positive rate of hormone receptors was 61.6 % (77/125) in all cases who had been detected receptor status. The median survival time in hormone receptors positive and negative group were 119.0 and 51.3 months (P＜0.01), and 5-year survival rates were 68 % and 33 %, respectively. For patients who had been treated with adjuvant tamoxifen (47.1%), the median survival time was 182 months which longer than without tamoxifen (P ＜0.05). The median disease-free survival time and median survival time were 24 and 91 months in all cases. The overall 3-, 5- and 10-year survival rates were 79 %, 60 % and 51%, respectively. Multifactor analysis with the COX model indicated that tumor size, axillary metastatic status, tamoxifen treatment and overexpression of Her-2 were independent prognostic factors. While clinic stage and hormone receptors status might be referenced prognostic factors. ConclusionYoung women breast cancer patient may have good prognosis if multimodality treatment is conducted. Tumor size, axillary metastatic status, adjuvant endocrine therapy and overexpression of Her-2 are independent prognostic factors.

Cardiotoxicity associated with antineoplastic drugs in breast cancer / 肿瘤研究与临床

Cardiotoxicity associated with anthracyclines and trastuzumab is discussed from clinical manifestations, pathogenesis, risk factors, monitoring methods, prevention and treatment.

Clinical practice and thoughts for metastatic breast cancer / 肿瘤研究与临床

Metastatic breast cancer (MBC) is a heterogeneous disease that has a variety of different clinical scenarios. There are few recognized therapeutic standards for MBC. Combining recent international guidelines and consensus recommendations with our clinical practice experience, the article will introduce and comment many sides about the treatment for MBC patients.

Clinical trial of lentaron for postmenopausal patients with advanced breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and adverse effects of lentaron for postmenopausal patients with recurrent and metastatic breast cancer.</p><p><b>METHODS</b>Thirty-four patients with recurrent and metastatic breast cancer received 250 mg lentaron by intramuscular injection every 2 weeks for at least one month.</p><p><b>RESULTS</b>In 34 patients who were evaluable for efficacy and toxicity, the complete response rate (CR), partial response rate (PR), disease stabilization rate (SD) and progressive disease rate (PD) were 0%, 14.7%, 58.8% and 26.5%. The clinical benefit rate (CR + PR + SD >/= 6 months) was 50.0%. (17/34) with 12 patients (35.3%) having SD for at least 6 months. The response rates for bone, soft tissue and visceral metastasis were 28.6% (3/14), 13.6% (3/22) and 5.3% (1/19), respectively. There were no severe adverse effects in the treatment bylentaron.</p><p><b>CONCLUSION</b>Lentaron is a well tolerated agent with reasonable efficacy but low toxicity for postmenopausal patients with recurrent and metastatic breast cancer.</p>

Mobilization of Peripheral Blood Stem Cells with High Dose Cyclophosphamide Combination Chemotherapy and G-CSF in Breast Cancer Patients / 中国实验血液学杂志

To evaluate the effect of mobilization of peripheral blood stem cells (PBSC) with high dose cyclophosphamide combination chemotherapy and G-CSF in breast cancer patients, a new mobilization protocol was designed on the basis of standard combination chemotherapy regimen, in which the dose of cyclophosphamide was raised to 2 to 4 times, and G-CSF began to be used at the dose of 150 micro g twice everyday when white blood cell (WBC) decreased below 1.0 x 10(9)/L. PBSC collection was performed while WBC increased over 5.0 x 10(9)/L during bone marrow recovering. The PBSC mobilization protocol was completed in 10 patients, the median nadir of WBC was 0.8 (0.4 - 1.0) x 10(9)/L, the median time of PBSC collection was 2 (2 - 4), the median number of collected CD34(+) cells was 6.43 (1.99 - 8.75) x 10(6)/kg. The results showed that the protocol, high dose cyclophosphamide combination chemotherapy, was an optimal PBSC mobilization regimen in breast cancer patients.