Application of immune checkpoint inhibitors in the comprehensive treatment of advanced non-small cell lung cancer / 国际肿瘤学杂志

In recent years,immunotherapy has become an important part of the treatment for advanced non-small cell lung cancer (NSCLC).Tumor cells can escape from the body's immune system by mediating various immune escape mechanisms,among which programmed death-1/programmed death ligand-1 (PD-1/ PD-L1) mediated immune escape plays an important role.Currently,chemotherapy,radiotherapy and molecular targeted therapy have certain limitations in the treatment of advanced NSCLC.Recent studies have found that the combined application of PD-1/PD-L1 inhibitor and other treatment methods has certain synergistic effect,thus enhances the anti-tumor effect and further prolongs the survival of patients.Immunotherapy brings not only changes in the treatment patterns of NSCLC,but also challenges in the screening of target population and the management of treatment-related adverse reactions.Summarizing the research progress on immune checkpoint inhibitors in the comprehensive treatment of advanced NSCLC can provide reference for the best treatment of NSCLC.

Clinical study of S-1 chemotherapy plus high-low oxygen radiotherapy synchronously in treatment of locally advanced pancreatic cancer / 肿瘤研究与临床

Objective To evaluate the clinical efficacy and adverse reactions of S-1 chemotherapy plus high-low oxygen radiotherapy synchronously in treatment of patients with locally advanced pancreatic cancer. Methods Sixty-four patients with locally advanced pancreatic cancer in Rizhao People's Hospital and the Affiliated Hospital of Qingdao University from January 2013 to October 2015 were randomly divided into study group and control group by using envelope method, in which the study group was treated with oral administration of S-1 plus high-low oxygen radiation synchronously and the control group with intravenous gemcitabine chemotherapy. The efficiency, disease control rate, clinical benefit rate, distant metastasis rate, survival rate and adverse reactions of the two groups were compared. Results The effective rates of the study group and the control group were 70.4 %(19/27)and 32.1 %(9/28),the difference was statistically significant (χ2=8.04,P<0.01), and the disease control rates were 88.9 % (24/27) and 67.9 % (19/28) (χ2= 3.56, P >0.05). The clinical benefit rates of the study group and the control group were 77.8 % (21/27) and 57.1 % (16/28) (χ2=2.66,P >0.05), and the distant metastasis rates were 63.0 %(17/27) and 71.4 %(20/28) (χ2=0.45, P > 0.05). The 1-year survival rates of the study group and the control group were 63.0 % (17/27) and 32.1 % (9/28), and the 2-year survival rates were 37.0 % (10/27) and 10.7 % (3/28), the differences were statistically significant (χ2= 5.24, P < 0.05; χ2= 5.28, P< 0.05). While there were no significant difference in the incidence of serious adverse reactions between the two groups (P> 0.05). Conclusion The treatment of locally advanced pancreatic cancer with S-1 plus high-low oxygen radiotherapy synchronously is better than that with intravenous gemcitabine chemotherapy in terms of effective rate, 1-year survival rate and 2-year survival rate,with no increase of adverse reactions.

Value of low doses of gemcitabine chemotherapy combined with high-low oxygen radiotherapy synchronously for therapy of patients with locally advanced pancreatic cancer / 中华胰腺病杂志

Objective To evaluate the efficacy and adverse effects of low doses gemcitabine chemotherapy combined with synchronous high-low oxygen radiotherapy in patients with locally advanced pancreatic cancer.Methods Fifty-six patients with locally advanced pancreatic cancer were randomly divided into two groups by envelop method:radio-chemotherapy group or chemotherapy group.Patients in radio-chmotherapy group were treated with low doses of gemcitabine chemotherapy ( 600 mg/m2 ) combined with high-low oxygen radiotherapy synchronously,paients in chmotherapy group were treated with full doses of gemcitabine chemotherapy ( 1000 mg/m2).The short-term effect,distant metastasis rate,clinical benefit rate,survival rate and adverse events of two groups were observed.Results There was one patient achievedcomplete relief and 15 patients achieved partial relief in radio-chemotherapy group with an overall effective rate of 66.7％ (16/24) ; there were 9 patients achieved partial relief in chemotherapy group with an overall effective rate of 36.0％ (9/25),the difference between the two groups was statistically significant (X2 =4.6082,P =0.0318 ).The clinical benefit rates were 83.3 ％ ( 20/24 ) and 60％ ( 15/25 ),respectively,the difference between the two groups was not statistically significant ( P =0.070).The distant metastasis rates were 66.7％(16/24) and 72％ (18/25),respectively,the difference between the two groups was not statistically significant (P =0.6855).The 12,24 months survival rates were 62.5％ vs 32％,37.5％ vs 12％,the difference between the two groups was statistically significant ( P =0.0325,0.0380).The incidence of serious adverse events was 45.8％ and 4 0 ％ without statistical difference.Conclusions Low doses of gemcitabine chemotherapy combined with high-low oxygen radiotherapy synchronously is better than full doses of gemcitabine chemotherapy with regard to total effective rates and 12,24 months survival rates,with no obvious increase in the incidence of serious adverse events.

Biological effects of different fractionated irradiation on pancreas after / 中华放射医学与防护杂志

Objective To investigate the damages on pancreas after different fractionated irradiation in rats.Methods Eighy healthy adult Wistar rats were randomly divided into four groups with 20 rats in each group as conventional fractionated irradiation group with 2 Gy per fraction to a dose of 12 Gy,hypofractionated radiation group with one fraction of 12 Gy,middle-dose fractionated radiation group with 6 Gy per fraction to a dose of 12 Gy in the interval of 4 days and control group without radiation.Changes in weight,fasting blood glucose and amylase were measured and morphological changes were observed in different periods.Results In the experimental groups,the reduction was observed in fasting glucose at 4 d,reached a minimum of (3.1 ±0.1 ) mmol/L,(LSD-t =20.06 -28.74,P ＜0.001 ) and the increase of amylase was found after 4th and 7th day,reached a maximum of (84.5 ±6.4) U/L(Dunnett's-t=23.10 -46.10,P ＜ 0.001 ),both more obvious in hypofractionated radiation group than those of conventional fractionated radiation group and middle-dose fractionated radiation group ( LSD-t =8.72-9.71,Dunnett's-t =7.11,P ＜ 0.05 ),however the levels in conventional fractionated radiation group was nearly to middle-dose fractionated radiation group (P ＞ 0.05 ) and became normal at 14 d.Under light microscope,the necrosis of acinarcells was observed in hypofractionated radiation group at 4th d,interstitial fibrogenesis were found at 14 d,the fibrogenesis were found in pancreatic island at 21 d,and the hyperplasia of acinarcells was observed at 42 d.The same changes were found in conventional fractionated radiation group and middle-dose fractionated radiation group,which were gently and lately than those of hypofractionated radiation group.Conclusions Radiation injury is not more serious after middle-dose fractionated radiotherapy than that after conventional fractionated irradiation,when the proper fractional dose and intervals are chosen.

The efficacy of inspiring carbogen and low concentration oxygen combined with late course accelerated hyperfraction radiotherapy on esophageal carcinoma / 中国基层医药

Objective To evaluate the efficacy of inspiring carbogen and low concentration oxygen combined with late coupe accelerated hyperfraction radiotherapy on esophageal carcinoma.Methods 74 patients with esophageal carcinoma were randomly divided into two groups:the trial group and the centrol group,which consisted of 37 patients respectively.6MV X-ray was employed in the two groups.The schedule of the trial group was as following:conventional radiotherapy of 1.8～2.0Gy per day was employed during the first phase to a total dose of 38～40Gy,followed by late course accelerated hyperfraetion radiotherapy(twice fractions per day,interval between two fractions more than 6 hours,1.3～1.4Gy per fraction,middle total dose of 64.2Gy).Carbogen and low concentraetion oxygen was inspired during the course of radiation.Results 71 patients were enrolled.At the end of radiation at a total dose of 38～40Gy,complete remission rate(CRR)in the trial group was 31%,whereas that in the control group was 19%(P＞0.05),when the whole radiotherapy was finished,the CRR was 57%and 31%(P＜0.05)respectively,and one month after radiotherapy.the CRR was 71%and 33%respectively(P＜0.01).Six months after radiotherapy,the CRR WaLa 74%and 36%respectively(P＜0.01).Thelocal controlrate of sixmonthswas 91% and 72% respectively in the two groups(P＜0.05).Conclusions Inspiring carbogen and low concentration oxygen combined with late course accelerated hyperfraction radiotherapy may sigllificantly improve short-term efficacy and local control rate in esophageal carcinoma patients in Ⅰ～Ⅲstage.Furthermore,its side effects can be tolerated,and its elongating life time of patients may be prognostic.

Long-term survival of hypoxia radiotherapy for carcinoma of uterine cervix / 中华放射肿瘤学杂志

Objective To evaluate the relationship between long-term survival rate and protection to marrow and lymphoid tissues in the pelvis with hypoxia radiotherapy for uterine cervical carcinoma. Methods 113 patients, confirmed as having carcinoma of uterine cervix by pathology, were randomly divided by the envelope method into two groups: hypoxia radiotherapy group(HRG,57 patients) and conventional radiotherapy group (CRG,56 patients). HRG was given by sustained inhaling hypoxia gas (oxygen physical volume=0.105) for two minutes before the start of radiotherapy till the end of radiotherapy of each field and then repeated for the other field in the same way. The duration of irradiation to each field was less than five minutes. CRG was given with conventional radiotherapy. The irradiation dose in the midpelvical plane was 20-50Gy depending on the different stages of cervical carcinomatous lesion. The dose of four-divided-field in the parametria was 15-34Gy.The dose at point A of intracavitary therapy was 15-35Gy. Results The decreased value of peripheral blood white cells after treatment was (1.36?1.27)?109/L in HRG and (2.97?1.19)?109/L in CRG(P