EGFR-TKI单药与传统化疗方案治疗进展期NSCLC安全性的网状meta分析

目的对一至三代表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)与传统化疗方案治疗进展期非小细胞肺癌(NSCLC)的安全性进行比较,同时采用网状meta分析方法评价三代EGFR-TKI与一、二代之间的安全性。方法检索PubMed、Embase、Cochrane图书馆、中国生物医学文献数据库、中国知网、万方数字化期刊全文数据库、维普数据库,检索时限均为从建库至2020年12月,搜集EGFR-TKI单药对比铂类为基础培美曲塞化疗方案的随机对照试验(RCT)。筛选文献、提取资料,并用Cochrane系统评价偏倚风险评估工具对纳入研究的RCT进行偏倚风险评估,采用RevMan 5.3软件、STATA 15.1软件进行meta分析。结果meta分析结果显示,试验组(EGFR-TKI单药)、对照组(培美曲塞联合铂类)患者的腹泻[相对危险度(RR)=2.16,95%置信区间(CI)0.742~6.297,P>0.05]、便秘(RR=0.44,95%CI 0.187~1.039,P>0.05)发生率比较差异均无统计学意义。试验组白细胞减少发生率、中性粒细胞减少发生率、贫血发生率、血小板减少发生率、食欲不振发生率、恶心发生率均低于对照组(RR=0.21,95%CI 0.10~0.41,P<0.001;RR=0.21,95%CI 0.08~0.55,P<0.001;RR=0.26,95%CI 0.13~0.51,P<0.001;RR=0.39,95%CI 0.24~0.64,P<0.001;RR=0.39,95%CI 0.28~0.55,P<0.001;RR=0.30,95%CI 0.24~0.37,P<0.001);试验组皮疹发生率高于对照组(RR=9.63,95%CI 6.30~14.72,P<0.001)。对一至三代EGFR-TKI的不良反应进行网状meta分析结果显示,三代EGFR-TKI奥希替尼组白细胞减少发生率要高于一、二代EGFR-TKI,贫血发生率与埃克替尼组相似,但高于吉非替尼组和阿法替尼组(均P<0.05)。结论一至三代EGFR-TKI的血液系统、消化系统不良反应发生率均低于传统化疗方案;三代EGFR-TKI与一、二代相比,在白细胞减少及贫血发生率方面各具优势。

基于UHPLC-MS技术的NSCLC血浆生物学标志物的筛选及鉴定研究

目的研究UHPLC-MS技术的NSCLC血浆生物学标志物的筛选及鉴定。方法本研究纳入符合非小细胞肺癌临床诊断标准的60例NSCLC患者,随机分为两组,接受靶向治疗(TACE)的非小细胞肺癌患者为鉴别诊断组,未接受靶向治疗的NSCLC患者为正常对照组。结果在60例NSCLC患者中,通过LC-MS/MS技术共检测到552个生物标志物。在其中17个生物标志物中,有8个出现在已知的EGFR突变患者中,另7个出现在ALK融合患者中,6个出现在HER2突变患者中。此外,NSCLC患者血浆中含有丰富的非编码RNA(miRNA),包括58个miRNA和23个mRNA。结论本研究中,采用LC-MS/MS技术对NSCLC患者血浆进行分析,可快速、高效地获得血浆样品中的生物学标志物。这些标志物可以作为NSCLC诊断的潜在生物学标志物,并且可以用于预测肿瘤进展和不良预后。

炙甘草汤加减联合PD-1治疗晚期NSCLC(气阴两虚型)的疗效

目的:分析炙甘草汤加减联合程序性死亡受体1(programmed cell death protein-1,PD-1)治疗晚期非小细胞肺癌(nonsmall cell lung cancer,NSCLC)(气阴两虚型)的临床疗效。方法:回顾性分析2020年12月至2022年12月就诊于吉林省肿瘤医院、长春中医药大学附属医院的晚期NSCLC(气阴两虚型)患者72例,随机分为两组各36例,对照组(PD-1单抗)、治疗组(PD-1单抗联合炙甘草汤加减)。主要观察指标为免疫功能(CD3^(+)、CD3^(+)/CD4^(+)、CD3^(+)/CD8^(+))和生存质量评分(KPS),次要观察指标为客观缓解率(objective response rate,ORR)、中医症候积分、血清肿瘤标志物癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、细胞角蛋白片段(CYFRA211)、免疫相关不良反应(胃肠毒性、肺毒性、肝毒性、甲状腺毒性)发生率。结果:治疗组在调节免疫功能CD3^(+)、CD3^(+)/CD4^(+)、CD3^(+)/CD8^(+),提高患者生存质量在T3时间点、T4时间点、降低肿瘤标志物CEA、CY211、改善中医证候咳嗽、乏力、心悸、腹泻的症状和减少免疫相关性肺炎、腹泻方面,均优于对照组(P<0.05)。两组患者客观缓解率分别为治疗组36.1%,对照组25.0%,无显著性差异(P>0.05)。结论:炙甘草汤加减联合PD-1治疗晚期NSCLC的患者,可以显著增强免疫功能,提高临床疗效,减少免疫相关不良反应且安全性较好。

CHMP4C通过调控PI3K/AKT信号通路影响NSCLC细胞增殖与凋亡

目的:探究染色质修饰蛋白4C(CHMP4C)对非小细胞肺癌(NSCLC)进展及顺铂敏感性的影响及其机制。方法:通过免疫组化检测CHMP4C在NSCLC癌组织和癌旁组织中的表达情况。利用实时荧光定量PCR(RT-qPCR)和蛋白免疫印迹法(Western blot)检测CHMP4C在NSCLC细胞系中的表达水平。细胞计数试剂盒(CCK-8)和细胞克隆实验检测细胞活力及半数抑制浓度IC50;流式细胞术检测细胞周期和凋亡。Western blot分析细胞凋亡相关蛋白(caspase 3、Bad)及PI3K/AKT信号通路中关键蛋白的表达水平。另外,我们采用动物模型进一步验证CHMP4C对体内肿瘤生长的影响。结果:CHMP4C在NSCLC癌组织和细胞系中高表达,与肿瘤T分期显著相关(P<0.05)。敲低CHMP4C抑制细胞增殖,促进细胞凋亡,并将细胞阻滞在S期(P<0.05)。敲低CHMP4C可抑制PI3K/AKT信号通路活化,然而激活PI3K/AKT信号通路逆转了CHMP4C敲低对NSCLC细胞的影响(P<0.05)。利用顺铂处理细胞后发现NSCLC细胞生长受抑制,且CHMP4C表达降低;敲低CHMP4C联合顺铂治疗明显诱导肿瘤细胞凋亡,抑制肿瘤细胞增殖(P<0.05)。在动物实验中,CHMP4C敲低的肿瘤体积小于对照组,其ki67表达显著降低,而caspase 3表达升高(P<0.05)。结论:CHMP4C在NSCLC癌组织及细胞系中高表达,在体内及体外实验中敲低CHMP4C可抑制NSCLC细胞增殖,促进细胞凋亡,增强顺铂治疗的敏感性;CHMP4C可能通过PI3K/AKT信号通路参与NSCLC进展与顺铂耐药。

Stereotactic body radiotherapy in pancreatic adenocarcinoma

Background:Stereotactic body radiotherapy(SBRT)in pancreatic cancer allows high delivery of radiation doses on tumors without affecting surrounding tissue.This review aimed at the SBRT application in the treatment of pancreatic cancer.Data sources:We retrieved articles published in MEDLINE/PubMed from January 2017 to December 2022.Keywords used in the search included:“pancreatic adenocarcinoma”OR“pancreatic cancer”AND“stereotactic ablative radiotherapy(SABR)”OR“stereotactic body radiotherapy(SBRT)”OR“chemoradiotherapy(CRT)”.English language articles with information on technical characteristics,doses and fractionation,indications,recurrence patterns,local control and toxicities of SBRT in pancreatic tumors were included.All articles were assessed for validity and relevant content.Results:Optimal doses and fractionation have not yet been defined.However,SBRT could be the standard treatment in patients with pancreatic adenocarcinoma in addition to CRT.Furthermore,the combination of SBRT with chemotherapy may have additive or synergic effect on pancreatic adenocarcinoma.Conclusions:SBRT is an effective modality for patients with pancreatic cancer,supported by clinical practice guidelines as it has demonstrated good tolerance and good disease control.SBRT opens a possibility of improving outcomes for these patients,both in neoadjuvant treatment and with radical intent.

Present situation and prospect of immunotherapy for unresectable locally advanced esophageal cancer during peri-radiotherapy

Four major studies(Checkmate577,Keynote-590,Checkmate649 and Attraction-4)of locally advanced esophageal cancer published in 2020 have established the importance of immunotherapy,represented by anti-programmed death protein(PD)-1 in postoperative adjuvant treatment and advanced first-line treatment of locally advanced or advanced esophageal cancer and esophagogastric junction cancer,from the aspects of proof of concept,long-term survival,overall survival rate and progression-free survival.For unresectable or inoperable nonmetastatic esophageal cancer,concurrent radiotherapy and chemotherapy is the standard treatment recommended by various guidelines.Because its curative effect is still not ideal,it is necessary to explore radical radiotherapy and chemotherapy in the future,and it is considered to be promising to combine them with immunotherapeutic drugs such as anti-PD-1.This paper mainly discusses how to combine radical concurrent radiotherapy and chemotherapy with immunotherapy for unresectable local advanced esophageal cancer.

贝伐珠单抗联合TP化疗方案治疗晚期NSCLC的疗效及预后观察

目的探讨贝伐珠单抗联合TP(紫杉醇+顺铂)化疗方案治疗晚期非小细胞肺癌(NSCLC)的疗效及对预后的影响。方法选取晚期NSCLC患者78例,随机分为A组(39例,予以TP化疗方案)和B组(39例,予以TP化疗方案+贝伐珠单抗)。比较2组的客观缓解率(ORR)、疾病控制率(DCR)和血清肿瘤标志物[血管内皮生长因子(VEGF)、细胞角蛋白19片段(CYFRA21-1)、癌胚抗原(CEA)]水平。记录治疗期间肝肾功能损害、白细胞减少、中性粒细胞减少、血小板减少、胃肠道反应等不良反应发生情况。自实施治疗日始对患者进行随访,统计2组患者的5年生存率、无进展生存期(PFS)和总生存期(OS)。结果B组ORR、DCR分别为58.97%、89.74%,分别高于A组的35.90%、71.79%(P<0.05)。治疗后2组血清VEGF、CYFRA21-1、CEA水平均降低,且B组低于A组(P<0.05)。2组肝、肾功能损害,白细胞减少,中性粒细胞减少,血小板减少,胃肠道反应发生率均无明显差异(P>0.05)。B组5年生存率为20.51%,与A组(12.82%)相比无明显差异(P>0.05)。Kaplan-Meier生存曲线显示,B组的中位PFS长于A组(8.9 vs 7.2个月)(P<0.05);B组的中位OS长于A组(25.6 vs 17.9个月)(P<0.05)。结论相比于TP化疗方案治疗晚期NSCLC,联合贝伐珠单抗可提高ORR和DCR,延长PFS和OS,且可降低VEGF、CYFRA21-1、CEA肿瘤标志物水平。

深度学习与机器学习预测NSCLC的N分期

本文利用深度学习和机器学习技术,提出一种基于PET和CT图像的非小细胞肺癌(Non-Small Cell Lung Cancer,NSCLC)肿瘤N分期预测方法,以提高N分期的准确率和稳定性。使用深度学习残差神经网络3D Resnet50提取NSCLC的CT与PET影像特征,并将特征降维到32维;将多模态特征进行拼接,输入机器学习模型进行NSCLC的N分期预测。最终,本文所提出的基于深度学习和机器学习预测NSCLC肿瘤分期预测方法的预测准确率在训练集达到了1.0,测试集上达到了0.852,平均受试者工作特征曲线下面积(Receiver Operating Characteristic,ROC)超过了0.91。实验表明,基于深度学习和机器学习的NSCLC肿瘤预测方法可以提高非小细胞肺癌N分期的准确率和稳定性,具有良好的应用前景和实际应用价值。

Radiotherapy for hyoid bone metastasis from lung adenocarcinoma:A case report

BACKGROUND Metastasis to the hyoid bone is an exceptionally rare occurrence,with documented cases limited to breast,liver,colon,skin,lung,and prostate cancers.This report highlights an unusual case involving the metastasis of lung adenocarcinoma to the hyoid bone,accompanied by a distinctive headache.Previous documentation involved surgical resection of the hyoid mass.We present a case displaying the benefits of palliative radiotherapy.CASE SUMMARY A 72-year-old non-smoking,non-alcoholic woman,initially under investigation for a year-long elevation in absolute lymphocyte count,presented with a monthlong history of intermittent throat pain.Despite negative findings in gastroenterological and otolaryngologic examinations,a contrast-enhanced chest computed tomography scan revealed a mediastinal mass and questionable soft tissue thickening in her left anterolateral neck.Subsequent imaging and biopsies confirmed the presence of lung adenocarcinoma metastasis to the hyoid bone.The patient was treated with platinum-based chemo-immunotherapy along with pembrolizumab.Ultimately,the lung cancer was unresponsive.Our patient opted for palliative radiation therapy instead of surgical resection to address her throat pain.As a result,her throat pain was alleviated,and it also incidentally resolved her chronic headaches.This is the second documented case of lung adenocarcinoma metastasizing to the hyoid bone.CONCLUSION Palliative radiotherapy may add to the quality of life in symptomatic patients with cancer metastatic to the hyoid bone.

NSCLC胸腔积液EGFR基因突变、肿瘤标记物水平及其预后观察

目的 观察非小细胞肺癌(NSCLC)患者胸腔积液中表皮生长因子受体(EGFR)基因突变检出率、肿瘤标记物水平及其预后。方法 选取本院接受治疗的117例晚期NSCLC合并胸腔积液患者作为研究对象,根据患者治疗前胸腔积液的EGFR基因突变检测结果分为EGFR突变型(突变组)与未突变型(野生组)。突变组患者接受酪氨酸激酶抑制剂(TKI)治疗,野生组患者接受常规化疗。比较两组肿瘤标志物水平、临床病理学特征、近期疗效及预后结局。结果 117例NSCLC患者中47例发生EGFR突变,突变率为40.17%。与野生组比较,突变组血清癌胚抗原(CEA)水平以及腺癌、TNM分期Ⅳ期占比升高(P<0.05),糖类抗原125(CA125)、鳞状细胞癌抗原(SCCA)、细胞角蛋白19(CYFRA21-1)水平以及吸烟、低分化程度占比降低(P<0.05)。突变组患者总疗效优于野生组(P<0.05);生存率高于野生组(P<0.05);中位生存时间长于野生组(P<0.05)。结论 EGFR突变型NSCLC患者的血清CEA水平高于野生型,CA125、SCCA、CYFRA21-1水平低于野生型,同时突变型患者采用TKI治疗的近期疗效及预后优于接受常规化疗的野生型患者。

胸腔镜辅助单孔与多孔肺段切除术治疗早期NSCLC的应用价值

目的探讨胸腔镜下单孔与多孔肺段切除术对早期非小细胞肺癌(Non-small cell lung cancer,NSCLC)患者代谢反应及心肺耐力的影响。方法选取2017年6月-2022年10月南通市第一人民医院早期NSCLC患者92例,根据简单随机数字表法分为多孔组与单孔组,各46例。单孔组采取胸腔镜单孔肺段切除术,多孔组采取胸腔镜多孔肺段切除术。比较两组围术期情况、术前及术后3 d代谢反应指标[视黄醇结合蛋白(Retinol-binding protein,RBP)、转铁蛋白(Transferrin,TRF)、前白蛋白(Prealbumin,PA)]水平、心肺耐力[6 min步行距离(6 min walking distance,6MWT)、疲劳指数、呼气峰流速(Peak expiratory velocity,PEF)、第1 s用力呼气容积(Forced expiratory volume 1 s,FEV1)]和并发症发生率。结果(1)两组手术时长、淋巴结清扫数目比较,差异无统计学意义(P>0.05),单孔组术中失血量、引流量少于多孔组,引流管放置时间、住院时长短于多孔组,差异有统计学意义(P<0.05)。(2)术后3 d两组PA、TRF、RBP水平较术前下降,但单孔组PA、TRF、RBP水平高于多孔组,差异有统计学意义(P<0.05)。(3)术后3 d两组6MWT、PEF、FEV1较术前降低,疲劳指数较术前增高,但单孔组6MWT、PEF、FEV1高于多孔组,疲劳指数低于多孔组,差异有统计学意义(P<0.05)。(4)单孔组并发症发生率(4.35%)低于多孔组(17.39%),差异有统计学意义(P<0.05)。结论采取胸腔镜单孔及多孔肺段切除术治疗早期NSCLC均可取得良好效果,但单孔术式可减少失血量,对代谢状态及心肺耐力影响较小,利于机体功能及早康复,且可降低并发症发生风险。

IHC、FISH、qRT-PCR检测NSCLC ALK融合基因的对比分析

目的对比分析免疫组化(IHC)、荧光原位杂交(FISH)、实时荧光定量PCR(qRT-PCR)检测非小细胞肺癌(NSCLC)ALK融合基因情况。方法收集453例NSCLC标本。随机选取IHC检测的ALK融合基因不同表达程度标本40例[ALK(-)、(+)、(2+)、(3+)标本各10例],采用FISH和qRT-PCR法分别检测各组ALK融合基因表达水平,并进行一致性分析。结果IHC与FISH、qRT-PCR的ALK融合基因检测结果比较,IHC ALK(-)/(3+)与FISH、qRT-PCR检测结果一致率均为100%,具有高度一致性(r=0.781、r=0.740,P<0.05)。FISH与qRT-PCR的检测结果一致率为97.5%,具有高度一致性(r=0.943,P<0.05)。结论FISH、qRT-PCR法与IHC法检测在不同表达程度ALK融合基因样本中检测结果存在差别,IHC敏感性更高。FISH、qRT-PCR法在ALK融合基因样本的检测结果具有高度一致性。

多西紫杉醇与培美曲塞分别联合奈达铂在晚期NSCLC二线化疗中的应用效果评估

目的:探究多西紫杉醇与培美曲塞分别联合奈达铂在晚期非小细胞肺癌(NSCLC)二线化疗中的应用效果。方法:将2021年1月至2022年12月郑州大学第一附属医院收治的110例NSCLC患者纳入研究。使用数字随机表法分为多西紫杉醇组和培美曲塞组,两组各55例。培美曲塞组患者接受培美曲塞联合奈达铂治疗,多西紫杉醇组患者接受多西紫杉醇联合奈达铂治疗。以21d为1个疗程,治疗4个疗程。观察两组患者的治疗效果,肿瘤标志物水平[鳞状细胞癌抗原(SCC-Ag)、癌胚抗原(CEA)、细胞质胸苷激酶1(TK1)],生活质量[肺癌功能治疗评价量表(FACT-L)评分]和毒副反应发生率(胃肠道反应、肾功能受损、骨髓抑制)。结果:培美曲塞组患者治疗有效率高于多西紫杉醇组(P<0.05);培美曲塞组患者SCC-Ag、CEA、TK1水平低于多西紫杉醇组(P<0.05);培美曲塞组患者FACT-L评分高于多西紫杉醇组(P<0.05);两组毒副反应发生率差异不显著(P>0.05)。结论:培美曲塞联合奈达铂可延缓晚期NSCLC患者的病情进展,在二线化疗中疗效显著,能够提高患者的生活质量。

Hemostatic radiotherapy for bleeding gastrointestinal

Hemostatic radiotherapy is a non-invasive treatment for bleeding gastrointestinal(GI)tumors,promoting tumor shrinkage,blood supply reduction,and fibrotic tissue formation.It is effective in cases where traditional interventions are insufficient or contraindicated and can prevent recurrent bleeding in patients with GI bleeding histories.Hypofractionation schedules are also effective for tumor control and patient compliance.

Platycodin D inhibits angiogenic vascular mimicry in NSCLC by regulating the eIF4E-mediated RNA methylome

The treatment of non-small cell lung cancer(NSCLC)remains a challenge due to tumor evolution during anti-angiogenesis therapies,in which the mechanism of vascular mimicry(VM)is believed to result in ineffective treatment[1].To conquer this challenge,substantial effort has recently been devoted to seeking out natural compounds on account of their multitarget actions.As a traditional herbal medicine,platycodin D(PD)is the major bioactive monomer derived from Platycodon grandiflorum(P.grandiflorum)and is used as an expectorant for pulmonary disease in Asia[2].

外周血标志物检测识别免疫检查点抑制剂治疗NSCLC免疫相关毒性风险的临床观察

目的探讨外周血标志物识别免疫检查点抑制剂(ICIs)治疗晚期非小细胞肺癌(NSCLC)免疫相关毒性(irAE)风险的临床意义。方法回顾性分析2018年8月至2023年4月在右江民族医学院附属医院接受ICIs的195例晚期NSCLC患者,随访并记录irAE。比较irAE与患者临床病理特征的关系。采用Kaplan-Meier法绘制无进展生存时间(PFS)曲线,生存差异行Log-rank检验。采用Logistic多因素回归模型分析影响irAE的因素。采用受试者工作特征(ROC)曲线评价外周血标志物对irAE的诊断效能。采用R软件构建列线图。结果全组患者中位随访时间为7.91个月(1.0~45.63个月),ICIs的中位给药周期为4(1~49)个周期。57例患者发生irAE,主要包括肺炎、腹泻、脂肪酶/淀粉酶升高和皮肤反应等。irAE组患者基线NLR、PLR、MLR和LDH水平高于无irAE患者(P<0.001)。与无irAE组患者比较,发生irAE患者的ORR更高(47.37%vs.25.36%;P=0.003)。无irAE组患者的中位PFS(313天,95%CI:242~383天)略长于irAE组(235天,95%CI:199~270天),差异无统计学意义(P=0.144)。Logistic多因素回归分析显示,NLR、PLR和ICIs治疗情况是影响irAE的独立因素(P<0.05)。训练队列和验证队列的C指数接近,分别为0.71和0.75。校准曲线的拟合度较高,证实了该列线图具有较高的预测值。结论基线NLR和PLR及多线治疗ICIs可能是影响晚期NSCLC患者irAE的因素。

Signal intensity changes of dentate nucleus on plain MR T1WI innasopharyngeal carcinoma patients after radiotherapy andmultiple injections of gadolinium-base contrast agent

Objective To observe changes of plain MR T1WI signal intensity of dentate nucleus in nasopharyngeal carcinoma patients after radiotherapy and multiple times of intravenous injection of gadolinium-based contrast agent(GBCA).Methods Fifty patients with pathologically confirmed nasopharyngeal carcinoma and received intensity-modulated radiotherapy were retrospectively enrolled as the nasopharyngeal carcinoma group,and 50 patients with other malignant tumors and without history of brain radiotherapy were retrospectively enrolled as the control group.All patients received yearly GBCA enhanced MR examinations for the nasopharynx or the head.T1WI signal intensities of the dentate nucleus and the pons on same plane were measured based on images in the year of confirmed diagnosis(recorded as the first year)and in the second to the fifth years.T1WI signal intensity ratio of year i(ranging from 1 to 5)was calculated with values of dentate nucleus divided by values of the pons(ΔSI i),while the percentage of relative changes of year j(ranging from 2 to 5)was calculated withΔSI j compared toΔSI 1(Rchange j).The values of these two parameters were compared,and the correlation ofΔSI and GBCA injection year-time was evaluated within each group.Results No significant difference of gender,age norΔSI 1 was found between groups(all P>0.05).The second to the fifth yearΔSI and Rchange in nasopharyngeal carcinoma group were all higher than those in control group(all P<0.05).Within both groups,ΔSI was positively correlated with GBCA injection year-time(both P<0.05).Conclusion Patients with nasopharyngeal carcinoma who underwent radiotherapy and multiple times of intravenous injection of GBCA tended to be found with gradually worsening GBCA deposition in dentate nucleus,for which radiotherapy might be a risk factor.

Targeting the organelle for radiosensitization in cancer radiotherapy

Radiotherapy is a well-established cytotoxic therapy for local solid cancers, utilizing high-energy ionizing radiation to destroy cancer cells. However, this method has several limitations, including low radiation energy deposition, severe damage to surrounding normal cells, and high tumor resistance to radiation. Among various radiotherapy methods, boron neutron capture therapy (BNCT) has emerged as a principal approach to improve the therapeutic ratio of malignancies and reduce lethality to surrounding normal tissue, but it remains deficient in terms of insufficient boron accumulation as well as short retention time, which limits the curative effect. Recently, a series of radiosensitizers that can selectively accumulate in specific organelles of cancer cells have been developed to precisely target radiotherapy, thereby reducing side effects of normal tissue damage, overcoming radioresistance, and improving radiosensitivity. In this review, we mainly focus on the field of nanomedicine-based cancer radiotherapy and discuss the organelle-targeted radiosensitizers, specifically including nucleus, mitochondria, endoplasmic reticulum and lysosomes. Furthermore, the organelle-targeted boron carriers used in BNCT are particularly presented. Through demonstrating recent developments in organelle-targeted radiosensitization, we hope to provide insight into the design of organelle-targeted radiosensitizers for clinical cancer treatment.

凝血指标预测立体定向治疗NSCLC脑转移疗效

目的:分析凝血指标对非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移患者立体定向放射外科(stereotactic ra-dio surgery,SRS)治疗预后的预测价值。方法:回顾性收集2015年10月至2018年9月在天津市环湖医院确诊为NSCLC脑转移并行SRS治疗的512例患者临床资料,分析总体生存(overall survival,OS)率与无进展生存(progression-free survival,PFS)率,运用Cox多因素分析影响预后相关因素,并基于Cox多因素分析绘制工作特征(receiver operating characteristic,ROC)曲线,运用曲线下面积(area under the ROC curve,AUC)分析凝血指标对NSCLC脑转移行SRS治疗患者预后的预测价值。结果:1、2、3、4年的PFS分别为79.9%、69.9%、56.6%、43.2%,OS分别为93.4%、83.2%、69.9%、57.6%。吸烟、纤维蛋白原(fibrinogen,Fib)<3.22 g/L、凝血酶原时间(prothrombin time,PT)<11.69 s、D-二聚体(D-dimer,D-D)<0.51μg/L与较长的PFS率相关(P<0.05);活化部分凝血活酶时间(activated partial thromboplastin time,APTT)<21.05 s、Fib<3.22 g/L、D-D<0.51μg/mL与较长的OS率相关(P<0.05)。吸烟、Fib<3.22 g/L、D-D<0.51μg/mL与较长的PFS率显著相关(P<0.05);Fib<3.22 g/L、D-D<0.51μg/mL与较长的OS率显著相关(P<0.05)。Fib与D-D联合检测预测NSCLC脑转移患者SRS治疗预后的AUC显著高于Fib与D-D单独检测(P<0.05)。结论:凝血指标与SRS治疗的NSCLC脑转移患者预后有一定相关性,Fib与D-D为患者预后独立危险因素,可用于评估其预后,两组指标联合评估价值可能更优,具有进一步深入研究的价值。

Enhancing Precision in Radiotherapy Delivery: Validating Monte Carlo Simulation Models for 6 MV Elekta Synergy Agility LINAC Photon Beam Using Two Models of the GAMOS Code

The most crucial requirement in radiation therapy treatment planning is a fast and accurate treatment planning system that minimizes damage to healthy tissues surrounding cancer cells. The use of Monte Carlo toolkits has become indispensable for research aimed at precisely determining the dose in radiotherapy. Among the numerous algorithms developed in recent years, the GAMOS code, which utilizes the Geant4 toolkit for Monte Carlo simula-tions, incorporates various electromagnetic physics models and multiple scattering models for simulating particle interactions with matter. This makes it a valuable tool for dose calculations in medical applications and throughout the patient’s volume. The aim of this present work aims to vali-date the GAMOS code for the simulation of a 6 MV photon-beam output from the Elekta Synergy Agility linear accelerator. The simulation involves mod-eling the major components of the accelerator head and the interactions of the radiation beam with a homogeneous water phantom and particle information was collected following the modeling of the phase space. This space was po-sitioned under the X and Y jaws, utilizing three electromagnetic physics mod-els of the GAMOS code: Standard, Penelope, and Low-Energy, along with three multiple scattering models: Goudsmit-Saunderson, Urban, and Wentzel-VI. The obtained phase space file was used as a particle source to simulate dose distributions (depth-dose and dose profile) for field sizes of 5 × 5 cm2 and 10 × 10 cm2 at depths of 10 cm and 20 cm in a water phantom, with a source-surface distance (SSD) of 90 cm from the target. We compared the three electromagnetic physics models and the three multiple scattering mod-els of the GAMOS code to experimental results. Validation of our results was performed using the gamma index, with an acceptability criterion of 3% for the dose difference (DD) and 3 mm for the distance-to-agreement (DTA). We achieved agreements of 94% and 96%, respectively, between simulation and experimentation for the three electromagnetic physics models and three mul-tiple scattering models, for field sizes of 5 × 5 cm2 and 10 × 10 cm2 for depth-dose curves. For dose profile curves, a good agreement of 100% was found between simulation and experimentation for the three electromagnetic physics models, as well as for the three multiple scattering models for a field size of 5 × 5 cm2 at 10 cm and 20 cm depths. For a field size of 10 × 10 cm2, the Penelope model dominated with 98% for 10 cm, along with the three multiple scattering models. The Penelope model and the Standard model, along with the three multiple scattering models, dominated with 100% for 20 cm. Our study, which compared these different GAMOS code models, can be crucial for enhancing the accuracy and quality of radiotherapy, contributing to more effective patient treatment. Our research compares various electro-magnetic physics models and multiple scattering models with experimental measurements, enabling us to choose the models that produce the most reli-able results, thereby directly impacting the quality of simulations. This en-hances confidence in using these models for treatment planning. Our re-search consistently contributes to the progress of Monte Carlo simulation techniques in radiation therapy, enriching the scientific literature.