The prognostic significance of pretreatment squamous cell carcinoma antigen levels in cervical cancer patients treated by concurrent chemoradiation therapy and a comparison of dosimetric outcomes and clinical toxicities between tomotherapy and volumetric modulated arc therapy.

BACKGROUND: To analyze the prognostic factors associated with stage IB-IVA cervical cancer in patients who underwent concurrent chemoradiation therapy (CCRT) and to compare the clinical toxicities and dosimetric parameters of organs at risk between the different radiotherapy techniques. METHODS: This retrospective study enrolled 93 patients with stage IB-IVA cervical cancer who underwent definitive CCRT between April 2009 and December 2017. Nine patients (9.7%) received 3DCRT, 43 patients (46.2%) underwent VMAT, and 41 patients (44.1%) received tomotherapy, and all of them followed by brachytherapy using a 2D planning technique. The treatment outcomes and related prognostic factors were analyzed. We also compared the clinical toxicities and dosimetric parameters between the different techniques used for the last 30 patients. RESULTS: With a median follow-up of 52.0 months, the 5-year overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRRFS), and distant metastases-free survival (DMFS) were analyzed. In a Cox proportional hazards regression model, pretreatment SCC Ag > 10 ng/mL was a significant prognostic factor for PFS (hazard ratio [HR] 2.20; 95% confidence interval [CI] 1.03-4.70; P = 0.041), LRRFS (HR, 3.48; 95% CI 1.07-11.26; P = 0.038), and DMFS (HR 2.80; 95% CI 1.02-7.67; P = 0.045). Increasing the rectal volume receiving a radiation dose exceeding 30 Gy (V30 of rectum; odds ratio [OR] 1.15; 95% CI 1.10-1.30; P = 0.03) was associated with a higher possibility of ≥ Grade 2 acute radiation therapy (RT)-related diarrhea. The median rectal V30 values were 56.4%, 97.5%, and 86.5% for tomotherapy, 3-dimensional conformal radiation therapy (3DCRT), and volumetric modulated arc therapy (VMAT), respectively (P < 0.001). In addition, the chance of experiencing ≥ Grade 2 acute diarrhea were 10.0%, 66.7%, and 54.5% for tomotherapy, 3DCRT, and VMAT, respectively (P = 0.029). CONCLUSIONS: Patients with pretreatment SCC Ag ≤ 10 ng/mL have better PFS, LRRFS, and DMFS than those with pretreatment SCC Ag > 10 ng/mL. The rectal V30 is a significant predictor of severe acute diarrhea. Tomotherapy significantly decreased the rectal V30, reducing the severity of acute RT-related diarrhea during external beam RT. Trial registration This study was approved by the institutional review board at Kaohsiung Medical University Hospital. The registration number is KMUHIRB-E(I)-20190054 and retrospectively registered on 2019/3.

Preliminary exploration and evaluation of POL intervention in young students at high-risk of AIDS / 中国学校卫生

Objective@#Explore the feasibility of POL intervention based on life skills in young students at high-risk of AIDS, and to provide reference for POL intervention.@*Methods@#Nine potential POLs were recruited from young students at high risk of AIDS in Xi’an, and received life-skill-based interventions from May to October in 2017. A unified approach was adopted before the intervention. The effect of intervention was evaluated at 1 month and 3 months after the intervention.@*Results@#The difference in POLs peer status and psychosocial ability scores was not significant after the intervention. The scores of persistence efficacy dimension of condom use efficacy before, 1-month and 3-month after the intervention were (10.56±1.88)(11.11±2.21)(12.89±2.09)(F=6.84, P<0.05) respectively. No significant changes were found in AIDS-related knowledge and behavior before and after the intervention. POL has increased from 108 students before intervention to 216 publicity coverage after three months intervention, however, the difference was not statistically significant. Feasibility analysis of the POL intervention showed that 8 of the POLs considered to be "very useful".@*Conclusion@#Life skill-based POL intervention for young students at high-risk of AIDS has a wide coverage and reasonable acceptance, as well as condom use adherence. The long-term effectiveness still needs to be verified.