Pneumocystis pneumonia in stage IIIA lung adenocarcinoma with immune-related acute kidney injury and thoracic radiotherapy:A case report

BACKGROUND Immune checkpoint inhibitors(ICIs)are therapeutic agents for advanced and metastatic non-small cell lung cancer(NSCLC)with high clinical antitumor efficacy.However,immune-related adverse events occur in 20%of these patients and often requiring treatment with immunosuppressive agents,such as corticosteroids.Consequently,this may increase the risk of patients to opportunistic infections.Pneumocystis jirovecii pneumonia(PJP),a rare but serious opportunistic infection typically observed in patients with human immunodeficiency virus,can also occur in cancer patients undergoing long-term glucocorticoid treatment.CASE SUMMARY We report a case of a 56-year-old male with squamous NSCLC treated with triplimab combined with paclitaxel,carboplatin,and radical thoracic radiation therapy.Following this regimen,he developed acute kidney injury(AKI)with elevated creatinine levels.After concurrent radical chemoradiotherapy ended,he developed a grade 3 immune-related AKI.High-dose corticosteroids were administered to treat AKI,and renal function gradually recovered.Corticosteroids were reduced to a dose of 10 mg prednisone equivalent daily eight weeks later;however,he developed severe pneumonia with spontaneous pneumothorax.Next-generation sequencing of the bronchoscopic lavage revealed PJP co-infection with herpes simplex virus 1 and cytomegalovirus.The inflammation was more severe in areas exposed to radiation.Piperacillin-tazobactam,acyclovir,sulfamethoxazole,and trimethoprim were used to control the infection.The patient recovered,and immunotherapy was terminated.CONCLUSION PJP is rare but can occur in patients with ICI adverse events and should be differentiated from tumor progression or immune-related adverse events.Thoracic radiation may increase risk,necessitating careful monitoring and prevention.

The commensal consortium of the gut microbiome is associated with favorable responses to anti-programmed death protein 1 (PD-1) therapy in thoracic neoplasms

Objective:Immune checkpoint inhibitors have revolutionized cancer therapy for multiple types of solid tumors,but as expected,a large percentage of patients do not show durable responses.Biomarkers that can predict clinical responses to immunotherapies at diagnosis are therefore urgently needed.Herein,we determined the associations between baseline gut commensal microbes and the clinical treatment efficiencies of patients with thoracic neoplasms during anti-programmed death protein 1(PD-1)therapy.Methods:Forty-two patients with advanced thoracic carcinoma who received anti-PD-1 treatment were enrolled in the study.Baseline and time-serial stool samples were analyzed using 16S ribosomal RNA gene sequencing.Tumor responses,patient progression-free survival,and overall survival were used to measure clinical outcomes.Results:The diversities of the baseline gut microbiota were similar between responders(n=23)and nonresponders(n=19).The relative abundances of the Akkermansiaceae,Enterococcaceae,Enterobacteriaceae,Carnobacteriaceae and Clostridiales Family XI bacterial families were significantly higher in the responder group.These 5 bacterial families acted as a commensal consortium and better stratified patients according to clinical responses(P=0.014).Patients with a higher abundance of commensal microbes had prolonged PFS(P=0.00016).Using multivariable analysis,the abundance of the commensal consortium was identified as an independent predictor of anti-PD-1 immunotherapy in thoracic neoplasms(hazard ratio:0.17;95%confidence interval:0.05–0.55;P=0.003).Conclusions:Baseline gut microbiota may have a critical impact on anti-PD-1 treatment in thoracic neoplasms.The abundance of gut commensal microbes at diagnosis might be useful for the early prediction of anti-PD-1 immunotherapy responses.

Effect of bilateral supraclavicular postoperative radiotherapy in middle and lower thoracic esophageal carcinoma

AIM: To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving two-field, chest and abdomen, lymphadenectomy.

Is there a place for optimizing thoracic radiotherapy in limited-stage small cell lung cancer after twenty years?

Thoracic radiotherapy(TRT)is one of the main treatments in limited-stage small cell lung cancer(LS-SCLC).Hyperfractionated TRT(45 Gy,1.5 Gy twice daily)has been the standard of care(SOC)since Turrisi and colleagues published the results of their clinical trial in 1999.Two meta-analyses have demonstrated the benefits of concurrent chemotherapy and TRT in terms of intrathoracic disease control at 2 years and 3-year overall survival(OS).The phase 2 trial by Grønberg et al(2016)comparing once-daily hypofractionated TRT to twice-daily hyperfractionated TRT in LS-SCLC found similar outcomes in both groups in terms of response rate,progression-free survival(PFS),grade 3-4 adverse effects,and OS.The CONVERT trial,published in 2017,failed to demonstrate the superiority of the conventional scheme(once-daily TRT)vs twice-daily radiotherapy,despite the application of modern radiotherapy techniques and a quality assurance programme,thus confirming the twice-daily hyperfractionated regimen as the SOC.At the 2020 American Society of Clinical Oncology(ASCO)annual meeting,Grønberg et al reported preliminary findings from a phase 2 trial comparing two different TRT dose regimens(45 Gy vs 60 Gy),both administered twice daily.Those data demonstrated a marked improvement in 2-year survival rates in the high dose arm(70.2%vs 46.1%,P=0.002),despite similar objective response rates and PFS outcomes.Those findings provide a new treatment alternative to consider:Hyperfractionated,high-dose TRT.However,the results of that trial will need to be validated in a large,randomized phase 3 study.The results of the phase 2 CALCG 30610 trial will help to clarify the optimal dose and regimen.The potential role of upfront immunotherapy,which early data suggest may improve OS,also needs to be determined.

Validation of the prognostic model for palliative radiotherapy in older patients with cancer

BACKGROUND Older patients are more likely to have a poor performance status and comor-bidities.There is a reluctance to extensively investigate and treat older patients.As elderly individuals and patients with neoplasms each increase in number,palliative treatment of older patients is expected to grow as an issue.AIM To investigated the role of palliative radiotherapy in older patients and patients who were expected to demonstrate a therapeutic effect.METHODS From February 2019 to February 2022,33 patients aged≥80 years underwent palliative radiotherapy.The prognosis in palliative care study predictor(PiPS),palliative prognostic index(PPI),and delirium-palliative prognostic score(D-PaP)models were used for prognosis prediction.D-PaP scores calculated according to the doctor's prediction of clinical prediction of survival(CPS)were excluded and then analyzed for comparison.Radiation was prescribed at a dose of 2.5-7 Gy per fraction,up to a median of 39 Gy10(range,28-75 Gy10).RESULTS The median follow-up was 2.4 months(range,0.2-27.5 months),and 28 patients(84.8%)showed subjective symptom improvements following treatment.The 2-and 6-month survival rates of all patients were 91.5%and 91.5%,respectively.According to regression analysis,the performance status index,symptom type,and radiation dose all showed no significant correlation with the treatment re-sponse.When survival was expected for>55 days in the PiPS model,the 2-month survival rate was 94.4%.For patients with PPI and D-PaP-CPS values of 0-3.9 points,the 2-month survival rates were 90.0%and 100%,respectively.For patients with a score of≥4 points,the 2-month survival rates were 37.5%and 0%,res-pectively.Core Tip:This is a retrospective study to investigate the role of palliative radiotherapy in older patients and patients who were expected to demonstrate a great therapeutic effect.The prognosis in palliative care study predictor,palliative prognostic index,and delirium-palliative prognostic score models were used for prognosis prediction.Most of patients showed subjective symptom improvements following treatment.The prognosis prediction model showed good correlation with survival.In order to increase the therapeutic effectiveness in palliative radiotherapy,it is necessary to assess a patient's exact prognosis and select appropriate patients accordingly.INTRODUCTION The incidence of cancer is high among individuals 60-69 years old and is 11 times greater among those≥65-years-old compared to those<65-years-old.For this reason,about half of all cancer cases are diagnosed in individuals aged≥70 years,and older patients account for a large portion of the total population regarding the prevalence of cancer[1].Cancer is one of the most significant diseases in older patients.About 60%of all cancer-related deaths occur in older patients aged 70 years[1,2].Moreover,cancer accounts for about one-third of the causes of death in the elderly population[1,2].When choosing a cancer treatment,both the characteristics of the cancer and the overall health status of the patient,such as their general condition and any underlying diseases,should be considered[2].Older patients have a shorter life expectancy than younger patients;moreover,they typically have many accompanying underlying diseases and have a poorer general condition.For this reason,older patients are often rejected from receiving active testing and treatment services.Therefore,even if other factors,such as the underlying disease,are the same in young and old patients,older patients typically receive less treatment due to the simple fact that they are older[3].Palliative treatment is a treatment approach that improves the pain and symptoms of a patient and their quality of life.Although palliative treatment is applicable regardless of patient age and the type and severity of their disease,most patients requiring palliative treatment are cancer patients.Palliative radiotherapy is relatively effective for cancer patients and tends to be a well-tolerated treatment.Although some studies have reported the usefulness of palliative radiotherapy in elderly patients,a large number of patients and caregivers are not receiving treatment due to fears of treatment,the risks of side effects,and doubts about treatment effectiveness[1].Since actual age is not always associated with physical ability,the determination of treatment based solely on age can be an obstacle preventing appropriate treatment opportunities.The importance of palliative care is increasing due to the recent growth of the elderly population,as well as,the increase in cancer incidence,and the changes in traditional views or perceptions,such as a growing acceptance of the pursuit of a dignified death[4].Therefore,in this study,we investigated the role of palliative radiotherapy in older patients and in patients who are expected to show a great therapeutic effect.

Giant hibernoma of the thoracic pleura and chest wall

Hibernoma is a rare tumor containing prominent brown adipocytes that resemble normal brown fat.Brown fat(versus white fat) is predominantly found in hibernating mammals and infants.Brown fat adipocytes contain a higher number of small lipid droplets and a much denser concentration of mitochondria.The tumor can occur in a variety of locations however the extremities,followed by the head and neck,have been the most common sights.All variants of hibernoma described have followed a benign course with the majority presenting as a small,lobulated,nontender lesions.We present a case of a giant hibernoma arising from the pleura which invaded the intra and extra-thoracic chest.

Factors influencing comfort level in head and neck neoplasm patients receiving radiotherapy

Objective:To determine factors that influence comfort in head and neck neoplasm patients receiving radiotherapy.Methods:In total,200 head and neck neoplasm patients receiving radiotherapy were recruited from three tertiary first class hospitals.They were assessed by Radiotherapy Comfort Questionnaire for patients with head and neck neoplasm,Social Support Scale,and Medical Coping Modes Questionnaire.Results:The total score of comfort was 60.54±8.32.Multiple linear regression analysis indicated that number of radiation treatments,family accompaniment,educational level,resignation coping mode,complications due to diabetes,accompanying chemotherapy,and the utilization of social support significantly influenced comfort level(p<0.05).Among these,number of radiation treatments,complications due to diabetes,accompanying chemotherapy,and resignation coping were negative factors.Conclusion:Encouraging utilization of social support systems and a positive coping mode is important for increasing comfort level in head and neck neoplasm patients during radiotherapy.Nurses should pay particular attention to those patients during later stages of radiotherapy or chemotherapy,with diabetes,without family accompaniment,and with lower education level.

Malignant neoplasms of the uterus following radiation therapy for cervical carcinoma: a clinical study of 47 cases

Objective： To study the characteristics and clinical features of uterine neoplasms developed after radiation therapy for cervical carcinoma. Methods： Clinical data of 47 cases of uterine neoplasms occurred following radiation therapy for cervical carcinoma were retrospectively reviewed. Results： The median age at uterine neoplasms diagnosis was 62 years （range： 38-77 years）, and the median latency period from initial therapy to development of uterine neoplasms was 14 years （range： 5-35 years）. Thirty of 47 cases were endometrial carcinoma, of which 3 were uterine papillary serous carcinoma （UPSC）. Seventeen of 47 patients were uterine sarcoma, all of those were carcinosarcoma. The distribution by stage, grade, and histology of 30 cases of endometrial carcinoma was as follows： stage Ⅰb, 1 case; stage Ⅰc, 2 cases; stage Ⅱ, 6; stage Ⅲa, 4; stage Ⅲb, 2; stage Ⅲc, 11; stage Ⅳ, 4 cases; grade 1, two cases; grade 2, nine; grade 3 （include 3 UPSC patients）, seventeen; unknown grade, two; endometriod, 27; UPSC, 3 cases; 7 of 30 cases of endometrial carcinoma had recurrences （23.3%）, at median time to recurrence was 24 months, and their median survival time was 26 months. The overall 3- and 5-year survival rates were 60% and 38%, respectively. Of the 17 cases of uterine sarcoma, the median survival was 10 months, 6 patients occurred recurrence （35.9%）, at a median time to recurrence was 9 months, and their median survival was 6 months. The overall 3- and 5-year survival rates were 12% and 0, respectively. Conclusion： The main uterine neoplasms development after radiation therapy for cervical carcinoma is endometrial carcinomas, of which there is a preponderance of high-risk histological subtypes and a poor prognosis. Most of the uterine sarcomas occurred following radiation therapy for cervical carcinoma are carcinosarcomas and the prognosis is very poor.

Application of Video-Assisted Thoracic Surgery in the Standard Operation for Lung Tumors

OBJECTIVE To evaluate the indication and short-term outcomes of video assisted thoracic surgery （VATS） for lung tumors. METHODS Data of 306 consecutive patients undergoing VATS pulmonary resection between January 2009 and August 2010 in Cancer Institute ＆ Hospital, Chinese Academy of Medical Sciences were retrospectively reviewed. RESULTS There were 7 patients who underwent open thoracotomy, accounting for 2.29% （7/306）. The overall morbidity rate of complications and the mortality rate induced by VATS was 1.63% （5/306） and 0.33% （1/306）, respectively. There were no significant differences in morbidity and mortality rate between the patients receiving the VATS and the patients receiving the OT. The overall hospitalization, postoperative length of stay （LOS） and chest tube duration in the VATS lobectomy group （n = 167） were shorter than those in the open thoracotomy （OT）, but the operative time in the VATS group was longer than that in the OT group （n = 124）. There were no significant differences in the number of station of lymph nodal dissection （LND） and number of LND in pathological stage I between VATS group and OT group, but significant differences were found in the number of station of LND and the number of LND in pathological stage II and stage IIIA between the 2 groups. Compared with those who underwent OT wedge resection （n = 72）, the patients who underwent VATS wedge resection （n = 108） had shorter operative time, chest tube duration and hospital LOS, and there were no significant differences in morbidity of the complications and mortality between the 2 groups. CONCLUSION VATS lobectomy can be performed for patients with clinical stage I lung cancer （with tumor diameter smaller than 5 cm, without hilar and mediastinal lymph node enlargement）. VATS lobectomy is superior to OT lobectomy in short-term outcomes, although further studies exploring long-term outcomes through longer follow-up is needed to determine the oncologic equivalency between the VATS and the open lobectomy. VATS is also superior to OT in pulmonary wedge resection.

Prospective Study of Infrared-Guided Patient Setup for Fractionated Thoracic Radiation

Objective: The standard practice in fractionated radiation of using of visual alignment of tattoos with weekly portal imaging for radiation setup can miss setup errors. We previously reported on the feasibility of using an automated infrared-guided positioning system (iGPS) for daily radiation setup. In this study, we prospectively evaluate whether use of iGPS can improve daily setup errors for patients with thoracic malignancies. Methods: Multiple external infrared markers were placed on patients undergoing thoracic radiation at the time of simulation. Patients were immobilized using vacuum immobilization bag and wing-board. Patients were aligned for treatment using only the iGPS system. Daily portal images were then taken, and shifts in patient position were recorded. Differences between isocenter position using iGPS versus daily portal imaging were calculated. Results: Data were collected for 698 treatment sessions for 27 patients. We found that in 94.0%, 96.4%, and 93.7% of treatment sessions, isocenter position differed between iGPS and daily portal imaging by ≤5 mm in the left/right(L/R), anterior/posterior(A/P), and superior/inferior(S/I) directions, respectively. Isocenter position differed by 5 - 10 mm in 5.7% (L/R), 3.6% (A/P), and 5.9% (S/I) of treatment sessions, and by >10 mm in 0.3% (L/R), 0.0% (A/P), and 0.4% (S/I) of treatment sessions. Three-dimensional shifts were also calculated, with differences in isocenter position as follows: 94.9% ≤5 mm, 5.1% 5 - 10 mm, and 0.2% >10 mm. This compares favorably to our prior studies. Discussion: Daily treatment setup using an infrared-guided patient positioning system, correlates well with daily portal imaging and may help to improve daily treatment setup for patients with thoracic malignancies.

Correlation between the Changes in Lung Function and Lung Density Changes in Patients Following Radio- (Chemo-) Therapy for Thoracic Carcinomas

Purpose: In this analysis we focused on the correlation of patients’ lung function (PFT) data and lung density changes (ΔHU) detected in follow-up CTs. Material and Methods: PFT and lung function data were available for 58 patients 12 weeks and 47 patients 6 months after radio- (chemo-) therapy for thoracic carcinomas (NSCLC, SCLC and esophageal carcinoma). The follow-up CT scans were matched with the planning CT scans of each patient and then subtracted to calculate ΔHU for each voxel using customized research software. PFT data regarding e.g. vital capacity (VC), total lung capacity (TLC) and diffusion capacity for carbon monoxide (DLCO) were collected before and at several follow-up appointments after treatment. Results: 12 weeks after therapy there was a statistically significant correlation between difference in DLCO and the maximum ΔHU as well as the difference in TLC and the minimum ΔHU. 6 months after treatment there was a significant correlation between the difference in VC and DLCO with numerous lung density parameters, e.g. the mean and median lung density changes and the 75th percentile of ΔHU. There was no significant correlation between the PFT parameters FEV1, pCO2 and pO2 and any lung density parameter at any follow-up appointment. Conclusion: There is a significant correlation between DLCO and ΔHU 6 months after treatment that most likely reflects the underlying pathological mechanisms in terms of the development of fibrotic lung tissue after RT. The relevance of the significant correlations 12 weeks after RT is questionable.

The Sino-French 2012 Conference in Thoracic Oncology:an international academic platform for in-depth exchange on comprehensive research

The Sino-French 2012 Conference in Thoracic Oncology, held November 17-18, 2012, was hosted by the Department of Thoracic Surgery at Sun Yat-sen University Cancer Center and organized in collaboration with two prestigious French hospitals: Institute Gustave Roussy and Marie Lannelongue Hospital. The conference was established by leading experts from China and France to serve as an international academic platform for sharing novel findings in basic research and valuable clinical practice experiences. Hot topics including innovation in surgical techniques, diagnosis and staging of early-stage lung cancer, minimally invasive surgery, multidisciplinary treatment of lung cancer, and progress in radiotherapy for lung cancer were explored. Highlights of the conference presentations are summarized in this report.

Postoperative chemoradiotherapy with capecitabine and oxaliplatin vs.capecitabine for pathological stage N2 rectal cancer

Objective:Several studies have been conducted on the effects and toxicity of adding oxaliplatin to fluorouracilbased or capecitabine-based chemoradiotherapy(CRT)regimens as significantly increasing the toxic response without benefit to survival.In this study,we further explored the role of these two postoperative CRT regimens in patients with pathological stage N2 rectal cancer.Methods:This study was a subgroup analysis of a randomized clinical trial.A total of 180 patients with pathological stage N2 rectal cancer were eligible,85 received capecitabine with radiotherapy(RT),and 95 received capecitabine and oxaliplatin with RT.Patients in both groups received adjuvant chemotherapy[capecitabine and oxaliplatin(XELOX);or fluorouracil,leucovorin,and oxaliplatin(FOLFOX)]after CRT.Results:At a median follow-up of 59.2[interquartile range(IQR),34.0−96.8]months,the three-year diseasefree survival(DFS)was 53.3%and 64.9%in the control group and the experimental group,respectively[hazard ratio(HR),0.63;95%confidence interval(95%CI),0.41−0.98;P=0.04].There was no significant difference between the groups in overall survival(OS)(HR,0.62;95%CI,0.37−1.05;P=0.07),the incidence of locoregional recurrence(HR,0.62;95%CI,0.24−1.64;P=0.33),the incidence of distant metastasis(HR,0.67;95%CI,0.42−1.06;P=0.09)and grade 3−4 acute toxicities(P=0.78).For patients with survival longer than 3 years,the conditional overall survival(COS)was significantly better in the experimental group(HR,0.39;95%CI,0.16−0.96;P=0.03).Conclusions:Our results indicated that adding oxaliplatin to capecitabine-based postoperative CRT is safe and effective in patients with pathological stage N2 rectal cancer.

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.

沙利度胺预防胸部肿瘤放疗联合免疫检查点抑制剂治疗所致相关性肺炎的效果

目的:探讨沙利度胺预防胸部肿瘤放疗联合免疫检查点抑制剂(ICI)治疗所致相关性肺炎的效果。方法:选取2022年6月—2023年6月平阴县人民医院收治的80例胸部肿瘤患者作为研究对象,以随机数表法分为观察组与对照组,各40例。两组均进行放疗联合ICI治疗,对照组采取安慰剂治疗,观察组采取沙利度胺治疗。比较两组相关性肺炎、炎症因子、肺纤维化指标、生活质量及治疗安全性。结果:观察组相关性肺炎发生率低于对照组,差异有统计学意义(P<0.05);观察组治疗后肿瘤坏死因子-α(TNF-α)、转化生长因子β(TGF-β)、白细胞介素-6(IL-6)、透明质酸酶(HA)、层粘连蛋白(LN)、Ⅲ型前胶原肽(PC-Ⅲ)水平低于对照组,欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)各项评分均高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:沙利度胺预防胸部肿瘤放疗联合ICI治疗所致相关性肺炎的效果较好,可降低炎症因子水平及肺纤维化程度,提高生活质量,治疗安全性良好。

立体定向放疗联合信迪利单抗和贝伐珠单抗治疗不可切除原发性肝癌的效果分析

目的探讨立体定向放疗联合信迪利单抗和贝伐珠单抗治疗不可切除肝癌的效果、安全性及预后指标。方法选取2022年3月—12月在中国人民解放军总医院第五医学中心放射治疗科接受立体定向放疗联合信迪利单抗和贝伐珠单抗类似物(双达方案)治疗的42例不可切除原发性肝癌患者,给予计划靶区处方剂量为36~50 Gy,分5~6次,连续照射,后序贯双达方案治疗,每3周为1个疗程,直至出现肿瘤进展或严重不良反应。采用Kaplan-Meier法计算总生存率和无进展生存率,并采用Log-rank检验进行比较;Cox比例风险模型分析影响预后的相关因素。结果中位随访时间为21.6个月,客观缓解率为69%,疾病控制率为85.7%,中位无进展生存期为10.0个月(95%CI:6.7~13.0),中位总生存期为23.3个月(95%CI:14.7~31.8)。不良反应多为1~2级,未发生致命性不良反应。治疗后6~8周AFP应答组中位总生存期显著优于AFP未应答组(未达到vs 11.8个月,P=0.007)。多因素分析显示AFP应答与患者良好的预后相关(HR=0.31,95%CI:0.13~0.75,P=0.009)。结论对于不可切除肝癌患者,立体定向放疗联合双达方案可改善患者生存且安全性可控,治疗后6~8周AFP水平下降>50%可作为潜在预后指标。

增强CT模拟定位用于胸部肿瘤对放疗剂量分布的影响研究

目的探讨增强CT模拟定位用于胸部肿瘤对放疗剂量分布的影响。方法选取2020年10月至2023年10月本院收治的胸部肿瘤患者122例,所有患者均行平扫CT及增强CT模拟定位,由医师在增强CT上进行靶区勾画,后复制于平扫图像。分析比较两种检查方案造影剂应用前后勾画器官及治疗靶体积(PTV)的CT增加值变化、各器官靶区受到的平均剂量以及两组照射时机器跳数(MU)变化。结果增强CT的心脏、动静脉血管及食管的CT增加值高于平扫CT(P<0.05),肺部、脊髓以及靶区CT增加值两种方案间差异无统计学意义(P>0.05);增强CT及平扫CT各器官靶区受到的平均剂量差异无统计学意义(P>0.05);增强CT对6MV X线照射治疗MU值略高于平扫CT,但组间差异无统计学意义(P>0.05)。结论增强CT模拟定位用于胸部肿瘤对放疗剂量有一定影响,在临床治疗过程中,需注意造影剂对胸部肿瘤放疗患者的影响,同时在放疗及检查过程中注重对正常、敏感组织的保护。

胸部肿瘤多程放疗剂量学研究

目的:研究在胸部肿瘤放疗过程中采用多程放疗的剂量学优势,并对多程放疗计划的划分阶段进行探索。方法:选取2022年5月至2023年10月在某院接受过胸部放疗且在放疗过程中修改过治疗计划的患者18例。所有患者采用Varian Eclipse 15.6计划系统进行计划设计,采用容积旋转调强放疗(volume modulated arc therapy,VMAT)技术在Halcyon加速器上进行治疗。比较首程计划与二程计划的计划靶区和危及器官的剂量学参数,同时采用3%/2 mm的标准对患者首程治疗过程中每个治疗野的穿射剂量一致性进行分析。结果:首程计划与二程计划靶区的适形性指数和均匀性指数相近,差异无统计学意义(P均>0.05),二程计划靶区的体积明显缩小,差异有统计学意义(P<0.05)。修改治疗计划后,双肺的V_(5)、V_(20)、D_(mean)和心脏的V_(30)均显著降低,差异有统计学意义(P<0.05)。随着治疗次数的增加,穿射剂量一致性逐渐下降,多数患者在首程放疗中断时穿射剂量一致性平均值为80.8%。结论:胸部肿瘤多程放疗能明显降低肺等危及器官的受照射剂量,穿射剂量一致性检测结果降低到80%附近时是修改治疗计划的最佳时机。

Long-term outcomes and prognostic factors for patients with esophageal cancer following radiotherapy

AIM:To evaluate long-term outcomes and prognostic factors for esophageal squamous cell carcinoma(SCC) treated with three dimensional conformal radiotherapy(3D-CRT).METHODS:Between January 2005 and December 2006,153 patients(120 males,33 females) with pathologically confirmed esophageal SCC and treated with 3D-CRT in Cancer Hospital of Shantou University were included in this retrospective analysis.Median age was 60 years(range:37-84 years).The proportion of tumor location was as follows:upper thorax(including the cervical region),73(48%);middle thorax,73(48%);lower thorax,7(5%),respectively.The median radiation dose was 64 Gy(range:50-74 Gy).Fifty four cases(35%) received cisplatin-based concurrent chemotherapy.Univariate and multivariate analysis were performed to determine the association between the correlative factors and prognosis.RESULTS:The five-year overall survival rate was 26.3%,with a median follow-up of 49 mo(range:3-66 mo) for patients who were still alive.On univariate analysis,lesion location,lesion length by barium esophagogram,computed tomography imaging characteristics including Y diameter(anterior-posterior,AP,extent of tumor),gross tumor volume of primary lesion(GTV-E),volume of positive lymph nodes(GTV-LN),and the total target volume(GTV-T = GTV-E + GTVLN) were prognostic for overall survival.By multivariate analysis,only the Y diameter [hazard ratio(HR) 2.219,95%CI 1.141-4.316,P = 0.019] and the GTV-T(HR 1.372,95%CI 1.044-1.803,P = 0.023) were independent prognostic factors for survival.CONCLUSION:The overall survival of esophageal carcinoma patients undergoing 3D-CRT was promising.The best predictors for survival were GTV-T and Y diameter.

Radiotherapy of double primary esophageal carcinoma

INTRODUCTIONDouble primary esophageal carcinoma is defined ashaving two loci of squamous cell cancersimultaneously or consecutively developing indifferent sites of esophagus.This rare diseaseappears mostly in the literature as case reports,reports about its treatment are even moreinfrequent.Here we present our experiences