Survival benefit of concurrent chemoradiotherapy for advanced ampulla of Vater cancer

BACKGROUND Currently,there is no standard adjuvant therapy for patients with resected ampulla of Vater(AoV)cancer.AIM To evaluate the effectiveness of adjuvant concurrent chemoradiotherapy(CCRT)in patients with advanced AoV cancer who underwent curative resection.METHODS This single-centered,retrospective study included 29 patients with advanced AoV cancer who underwent pancreaticoduodenectomy between 2006 and 2018.The impact of CCRT on advanced AoV cancer was analyzed.RESULTS The 1-,3-,and 5-yr recurrence-free survival(RFS)rates for patients with advanced AoV cancer were 82.8%,48.3%,and 40.8%,respectively,and the overall survival(OS)rates were 89.7%,62.1%,and 51.7%,respectively.Lymphovas-cular invasion was found to be a significant risk factor for RFS and OS in patients with advanced AoV cancer in the univariate analysis,whereas T stage and lymph node metastasis were significantly associated with OS in the multivariate analysis.Compared to the patients who did not receive adjuvant CCRT,those who received adjuvant CCRT did not show statistically significant improvements in the RFS and OS,although they had a significantly lower average age and significantly higher platelet-to-lymphocyte ratio.CONCLUSION Adjuvant CCRT did not improve survival outcomes in patients with advanced AoV cancer.These findings contribute to existing knowledge on the effectiveness of CCRT in this patient population and provide important insights for clinical decision-making.

Concurrent chemoradiotherapy for cervical cancer： background including evidence-based data, pitfalls of the data, limitation of treatment in certain groups

Concurrent chemoradiotherapy （CCRT） is regarded as the standard treatment for locally advanced uterine cervical cancer （LACC）, including stage Ib2-IVa disease [International Federation of Gynecology and Obstetrics （FIGO） staging]. However, approximately a third of eligible patients in previous studies died of LACC despite receiving CCRT. The therapeutic significance of CCRT alone in stage Ⅲ-IVa disease has not yet been confirmed. Effective treatment of some LACC is beyond the scope of CCRT. The objective of the present review is to highlight some challenging work aimed at overcoming this seemingly intractable disease. CCRT with increased peak concentrations of cisplatin （CDDP）, surgery following CCRT, adjuvant chemotherapy （CT） following CCRT, and neoadjuvant CT followed by CCRT are strategies expected to enhance the therapeutic efficacy of CCRT. If patients with LACC were divided into those with low-risk or high-risk systemic disease or prognoses, novel strategies should be assessed in the group with high-risk disease.

Phase 1/2 study of concurrent chemoradiotherapy with weekly irinotecan hydrochloride for advanced/recurrence uterine cancer:A multi-institutional study of Kansai Clinical Oncology Group

Objective:Concurrent chemoradiotherapy using cisplatin was thought to be standard treatment for squamous cell carcinoma of cervix,but it had not been effective for adenocarcinoma.Concurrent chemoradiotherapy using irinotecan hydrochloride(CPT-11)had been effective for colorectal cancer,thus,we chose CPT-11 as a candidate for gynecologic adenocarcinoma.To evaluate the maximum tolerated dose(MTD)of weekly CPT-11 with external pelvic radiotherapy,a phase 1/2 study was conducted according to modified Fibonacci method.Methods:Eligible patients were advanced uterine cancer with measurable diseases[performance score(PS):0-2].Study period was from August 1 st,2002 to December 31 st,2008.The starting dose level(DL)of CPT-11 was 30 mg/m2(DL1)given weekly for 4 weeks.Subsequently,dose escalation was scheduled in 10 mg/m2 increments to 60 mg/m^2(DL4).The fixed radiotherapy consisted of whole pelvic 1.8 Gy/d,once a day in weekday for five weeks and it amounted to 45 Gy(25 fractions)in total.Results:Seventeen patients were enrolled.As for toxicities,one(1/17:5.9%)grade(G)4 neutropenia lasting 7 days had been seen in DL4.G2 diarrhea was identified in 35.3%(6/17)of the patients,and 11.8%(2/17)G3 diarrhea was observed in DL3 and DL4.Thus,the MTD of CPT-11 was defined as dose of 60 mg/m^2.The recommended dose was decided as 50 mg/m^2.The response rate was 88.2%[9 complete response(CR),3 partial response(PR),3 stable disease(SD),2 not evaluable(NE)].Disease control rate at 1 month after treatment completion was 100%but distant metastases were found in 24%(4/17)in longer outcome.Conclusions:MTD was 60 mg/m^2 and recommended dose was set as 50 mg/m2.This concurrent chemoradiation using weekly CPT-11 was feasible at 50 mg/m^2,and it might be effective even in adenocarcinoma of the uterus.

Impact of Survival Rate and Safety Analysis of Concurrent Chemoradiotherapy in Patients with Recurrent Cervical Cancer

Objective:To investigate the effect of concurrent chemoradiotherapy on the survival rate and safety of patients with recurrent cervical cancer.Methods:A total of 107 patients with recurrent cervical cancer who were treated in our hospital from March 2016 to January 2019 were retrospectively analyzed and randomly divided into the control group(n=53)and the observation group(n=54)and treated conventionally.On this basis,the control group was treated with radiotherapy,and the observation group was treated with concurrent radiotherapy and chemotherapy.The clinical efficacy,cellular immune index,survival rate and rate of adverse reactions were compared between the two groups.Results:Compared with the total effective rate of 79.25%in the control group,the observation group was 94.44%,and the difference was statistically significant(P<0.05).After treatment,the levels of NK,CD3+,and CD4+in the two groups were higher than before the treatment,and the observation group was higher than the control group.The difference was statistically significant(P<0.05).Compared with the adverse reaction rate of 18.87%in the control group,the observation group was 11.11%,but the difference was not statistically significant(P>0.05).Conclusion:Concurrent chemoradiotherapy for patients with recurrent cervical cancer has a significant effect,which not only can effectively improve the cellular immune index and the survival rate of patients,but also have high safety.

Clinical observation of Shengxuebao Mixture in treating anemia after concurrent chemoradiotherapy for cervical cancer

Objective:To investigate the efficacy of the Shengxuebao Mixture in treating anemia after concurrent chemoradiotherapy for cervical cancer.Methods:The patients who met the criteria were randomly divided into the study group(n=30)and the control group(n=30).The study group was treated with Shengxuebao Mixture(15 ml once,three times a day)for 30 days,and the control group was treated with ferrous succinate tablets(0.1 g,twice a day),folic acid tablets(5 mg,three times a day),and vitamin B12 tablets(25μg,once a day)for 30 days.Observed the hemoglobin level,erythropoietin level,TCM syndrome score,karnofsky performance status score before and after treatment in the two groups,compared the relevant data and clinical efficacy between the two groups and observed the adverse drug reactions at the same time.Results:The age,pathological type,stage,baseline hemoglobin level,erythropoietin level,TCM syndrome score,and karnofsky performance status score were comparable between the two groups(P>0.05).The hemoglobin level of the two groups after treatment was higher than before treatment(P<0.05).After treatment,the hemoglobin level in the study group was significantly higher than that in the control group(P<0.05),and the number of effective cases in the study group was more than that in the control group,and the effective rate in the study group was higher than that in the control group(P<0.05).The erythropoietin level of the two groups after treatment was lower than before treatment(P<0.05).After treatment,the erythropoietin level in the study group was significantly lower than that in the control group(P<0.05).The TCM syndrome score of the study group decreased significantly after treatment(P<0.05),but there was no significant change in the control group(P>0.05).After treatment,the TCM syndrome score of the study group was significantly lower than that of the control group(P<0.05),and the number of effective cases in the study group was more than that in the control group,and the effective rate in the study group was higher than that in the control group(P<0.05).There was no significant change in the karnofsky performance status score of the study group after treatment(P>0.05),but the karnofsky performance status score of the control group decreased significantly(P<0.05).After treatment,the karnofsky performance status score of the study group was higher than that of the control group(P<0.05),and the number of effective cases in the study group was more than that of the control group,and the effective rate was higher than that of the control group(P<0.05).And there were no obvious adverse reactions in this study.Conclusion:To some extent,this study showed that the Shengxuebao Mixture has a definite effect in treating anemia after concurrent chemoradiotherapy for cervical cancer,can promote the use of erythropoietin,improve TCM syndromes and stabilize the quality of life of patients.

A Case of Bilateral Secondary Pneumothorax Shortly after the Completion of Concurrent Chemoradiotherapy for Tongue Cancer

Metastatic lung tumours rarely lead to development of pneumothorax, and no case of bilateral secondary pneumothorax due to lung metastases arising from tongue cancer has been reported. Here, we report a case of a patient with tongue cancer with lung metastases complicated by bilateral secondary pneumothorax soon after the completion of concurrent chemoradiotherapy. A 39-year-old man with cervical lymph node metastases originating from pT2N0M0 tongue cancer underwent neck dissection and postoperative concurrent chemoradiotherapy. Shortly after the completion of chemoradiotherapy, he developed bilateral secondary pneumothorax. Subsequently, he underwent partial lung resection for the pulmonary fistulae for diagnostic and therapeutic purposes;nodular lesions found in both the lungs. The diagnosis of secondary pneumothorax was based on histopathological findings. Although all pulmonary fistulae disappeared after partial lung resection, he died of the primary disease despite our best efforts to control the metastatic pulmonary lesions.

Phase I Study to Determine MTD of Docetaxel and Cisplatin with Concurrent Radiation Therapy for Stage Ⅲ Non-Small Cell Lung Cancer

Objective： To evaluate the maximum tolerated dose （MTD） of docetaxel （DCT） and cisplatin （DDP） concurrently with three dimensional （3D） conformal radiotherapy or IMRT for patients with locally advanced non-small cell lung cancer （stage IIIa and IIIb） after 2–4 cycles of induction chemotherapy. Methods： Fourteen patients with histological/cytological proven stage III non–small-cell lung cancer were eligible. 3D or IMRT radiotherapy （60-70Gy in 30-35 fractions, 6-7weeks, 2 Gy/fraction） was delivered concurrently with cisplatin and docetaxel, 2 cycles during concurrent chemoradiotherapy （CCRT）. The level I dosage was composed of 56 mg/m2 DCT, on day 1 and 28mg/m2 DDP, on day 1 and day 2. The level II was composed of 60 mg/m2 DCT, on day 1 and 30 mg/ m2 DDP, on day 1 and day 2. The level III was composed of 64 mg/m2 DCT, on day 1 and 32 mg/ m2 DDP, on day 1 and day 2. Results： Fourteen patients were allocated and finished concurrent chemoradiotherapy. The dose-limiting neutropenia was at the dose Level III （64 mg/m2） and occurred in 2 of 5 patients. No dose limiting non-hematologic or hematologic toxicity occurred in the other patients. Conclusions： Patients with locally advanced non-small cell lung cancer may tolerate 60mg/m2 docetaxel and 60mg/m2 cisplatin for 2 cycles during concurrent radiotherapy after 2-3 cycles of induction chemotherapy.

Complete pathological response in locally advanced non-small-cell lung cancer patient: A case report

BACKGROUND Chemotherapy and radiotherapy followed by durvalumab is currently the standard treatment for locally advanced node-positive non-small-cell lung cancer(NSCLC).We describe the case of a patient with locally advanced node-positive NSCLC(LA-NSCLC)treated in a phase II prospective protocol with chemotherapy,accelerated hypofractionated radiotherapy(AHRT)and surgery in the preimmunotherapy era.CASE SUMMARY A 69-year-old male,ex-smoker(20 PY),with a Karnofsky performance status of 90,was diagnosed with locally advanced squamous cell lung carcinoma.He was staged by total body computed tomography(CT)scanning,and integrated 18Ffluorodeoxyglucose positron emission tomography/CT scan[cT4 cN3 cM0,stage IIIC according to TNM(tumor-node-metastasis)8th edition]and received AHRT between chemotherapy cycles,in accordance with the study protocol(EudractCT registration 2008-006525-14).At the end of the study the patient underwent surgery,which was not part of the protocol,and showed a complete pathological response.CONCLUSION This case report confirms that AHRT can be used successfully to treat primary LA-NSCLC with bilateral mediastinal lymph node involvement.Our case is of particular interest because of the pathological response after AHRT and the lack of surgical complications.We hypothesize that this radiotherapeutic approach,with its proven efficacy,could be delivered as a short course reducing treatment costs,increasing patient compliance and reducing toxicity.We are currently investigating the possibility of combining hypofractionation,chemotherapy and immunotherapy for patients with LA-NSCLC.

Feasibility of cetuximab and chemoradiotherapy combination in Chinese patients with unresectable stage Ⅲ non-small cell lung cancer:a preliminary report

Objective： In recent years, the combination of cetuximab and chemoradiotherapy （CRT） has been used to treat stage III non-small cell lung cancer （NSCLC）; however, limited data are available for Chinese patients. Herein, we report preliminary data from a phase I/II study testing the combination of cetuximab with inductive chemotherapy, followed by concurrent CRT （CCRT） in Chinese patients with stage III NSCLC. Methods： Eligibility criteria were Zubrod performance status （PS） 0-1, forced expiratory volume in 1 second （FEV1） 〉_1.2 L and adequate organ function. Enrolled patients received weekly cetuximab （initial dose of 400 mg/m2 on day 1 of week 1 and a maintenance dose of 250 mg/m2 on week 2 to the end of CCRT） with cisplatin/vinorelbine （NP） chemotherapy （every 3 weeks for 2 cycles from week 2, followed by two cycles of concomitant NP chemotherapy and intensity-modulated thoracic radiotherapy （TRT） （60-66 Gy/2 Gy）. The primary endpoints were toxicity and feasibility. All patients received positron emission tomography- computerized tomography （PET-CT） scans within the 2 weeks prior to enrollment. Univariate analyses were used to assess the correlation between SUV-T, SUV-N, SUV-TOTAL, gender, age, histology, tumor-node- metastasis （TNM） stage, PS and smoking status and survival. Survival curves were generated for different populations using the Kaplan-Meier method and compared using a log-rank test. Results： Seventeen patients were enrolled and 16 completed the full regime. The overall response rate （ORR） was 58.8% and 82.3% after the induction and CCRT phases, respectively. With a median follow-up duration of 27.6 months, the median survival was 27.6 months [95% confidence interval （CI）： 11.3-43.9 months] with 1- and 2-year survival rates of 88.2% （95% CI, 60.6-96.9%） and 58.8% （95% CI, 60.6-77.8%）, respectively. Three patients remain progression-free to date, and the median progression-free survival （PFS） was 13.5 months （95% CI, 6.8-20.2 months）. No treatment-related death occurred; however, 76% of the patients experienced grade 3＋ adverse events （AEs）, including nansea/vomiting, intestinal obstruction, and esophagitis （〈6%）, while other AEs were mostly of hematological nature （71%）. The cut-off values for SUV-T and SUV-TOTAL were 11 and 20, respectively. Univariate analyses revealed SUV-TOTAL （P=0.027）, SUV-T （P=0.025）, and PS （P=0.006） as potential survival predictors, with a hazard ratio （HR） of 3.4, 3.7, and 9.9, respectively. Conclusions： The combination of cetuximab with induction chemotherapy followed by CCRT appears feasible and promising. Local and locoregional maximal SUVs, defined by 18F-FDG PET-CT scanning, may represent a prognostic indicator for long-term survival for these patients, which warrants further study.

Adjuvant chemotherapy versus adjuvant concurrent chemoradiotherapy after radical surgery for early-stage cervical cancer:a randomized,non-inferiority,multicenter trial

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB–IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415–1.757;P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.

Computed tomography-based delta-radiomics enabling early prediction ofshort-term responses to concurrent chemoradiotherapy for patients withnon-small cell lung cancer

Objective:To explore the potential of computed tomography(CT)-based delta-radiomics in predicting early shortterm responses to concurrent chemoradiotherapy for patients with non-small cell lung cancer(NSCLC),in order to determine the optimal time point for the prediction.Methods:A total of 20 patients with pathologically confirmed NSCLC were prospectively enrolled in this study,who did not receive surgical treatment between February 2021 and February 2022.For each case,a total of 1,210 radiomic features(RFs)were extracted from both planning CT(pCT)images along with each of the subsequent three weeks of CT images.EffectiveΔRFs were selected using intra-class correlation coefficient(ICC)analysis,Pearson's correlation,ANOVA test(or Mann-Whitney U-test),and univariate logistic regression.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve was used to evaluate the potential to predict short-term responses of different time points.Results:Among the 1,210ΔRFs for 1-3 weeks,121 common features were retained after processing using ICC analysis and Pearson's correlation.These retained features included 54 and 58 of all time points that differed significantly between the response and non-response groups for the first and third months,respectively(P<0.05).After univariate logistic regression,11 and 44 features remained for the first and third months,respectively.Finally,eightΔRFs(P<0.05,AUC=0.77-0.91)that can discriminate short-term responses in both at 1 and 3 months with statistical accuracy were identified.Conclusion:CT-based delta-radiomics has the potential to provide reasonable biomarkers of short-term responses to concurrent chemoradiotherapy for NSCLC patients,and it can help improve clinical decisions for early treatment adaptation.

Association between IDEAL-IQ MRI fat fraction quantification and pelvic bone marrow reserve function in concurrent chemoradiotherapy for cervical cancer

Objective:To analyze the association between iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantification sequence(IDEAL-IQ)magnetic resonance imaging(MRI)of bone marrow fat fraction and bone marrow reserve function during concurrent chemoradiotherapy for cervical cancer.Methods:The study retrospectively analyzed twenty-six patients with stage IB1 to IVA cervical cancer treated between February 2020 and November 2020.All patients received concurrent chemoradiotherapy that included platinum alone or combined paclitaxel and platinum.Pelvic IDEAL-IQ MRI(plain and enhanced)was performed before and after treatment.Regions of interest,including the fifth lumbar vertebra,sacrum,ilium,ischium,and femoral neck,were manually delineated,and the bone marrow fat fraction was measured.Peripheral blood cell counts were recorded during treatment,and the relationship between the fat fraction values and changes in the blood cell counts was explored.Results:IDEAL-IQ MRI bone marrow fat fraction was associated with platelet nadir and platelet decline during treatment.The average pelvic bone marrow fat fraction before chemoradiotherapy was moderately negatively correlated with platelet count nadir during concurrent chemoradiotherapy(r=-0.450,P?0.021).The change in average pelvic bone marrow fat fraction through chemoradiotherapy was moderately positively correlated with the degree of thrombocytopenia(r=0.399,P=0.044).Conclusion:Bone marrow fat content quantified by IDEAL-IQ was associated with platelet count nadir and the degree of thrombocytopenia in patients with cervical cancer undergoing concurrent chemoradiotherapy.

Effect of Endostar combined with concurrent chemoradiotherapy in patients with locally advanced cervical cancer

ObjectiveTo explore the value of Endostar in the clinical application of locally advanced cervical cancer.MethodsA total of 107 patients with locally advanced cervical cancer who received concurrent chemoradiotherapy(CCRT)in the Department of Radiotherapy,the First Affiliated Hospital of Soochow University and Changzhou No.2 People's Hospital between January 2018 and December 2020 were enrolled in this retrospective study.There were 30 cases in the Endostar combined with CCRT(E-CCRT)group and 77 in the CCRT group.Propensity score matching(PSM)was used to reduce confounding factors.The short-term efficacy and long-term survival rate were compared between the E-CCRT group and the CCRT group.ResultsAfter matching,the objective response rates in the E-CCRT group and CCRT group were 86.7%and 63.3%,respectively,with statistically significant difference(χ^(2)=4.356,P=0.037).But there were no statistically significant differences in the disease control rates(96.7%vs.86.7%,χ^(2)=0.873,P=0.350),3-year overall survival(OS)rates(86.7%vs.83.3%,P=0.681),and 3-year disease-free survival(DFS)rates(both 76.7%and 76.7%,P=0.869).There was no statistically significant difference in the incidence of adverse reactions between the two groups.ConclusionsE-CCRT can improve the response of locally advanced cervical cancer patients without increasing the occurrence of adverse reactions,and has the potential to become a new treatment regimen for cervical cancer.

Prognostic value of serum soluble Fas in patients with locally advanced unresectable rectal cancer receiving concurrent chemoradiotherapy

Objective: This study was designed to detect the changes of serum soluble Fas (sFas) levels in patients with locally advanced unresectable rectal cancer (LAURC),and to explore its prognostic value of response.Methods: Soluble samples were obtained from LAURC subjects,treated by concurrent chemoradiotherapy,before treatment and one month after treatment.Healthy donor serum samples were used as controls.sFas concentration was measured by enzyme-linked immunosorbent assay (ELISA).Results: The sFas levels before treatment and one month after treatment were both significantly higher in LAURC subjects than in healthy controls [(8.79±1.39) and (7.74±1.32) vs.(5.53±1.13) ng/L,P<0.01].The sFas levels before treatment and one month after treatment were significantly lower in the response group (complete and partial responses) than in the non-response group (stable and progressive diseases) [(8.50±1.25) vs.(10.17±1.26) ng/L,P<0.01 and (7.50±1.24) vs.(8.90±1.13) ng/L,P<0.01,respectively].The one-year survival rate was 54.2% and 82.6% in those with sFas levels >8.79 ng/L and <8.79 ng/L before treatment (P<0.02),respectively,50.0% and 87.0% in those with sFas levels >7.74 ng/L and <7.74 ng/L one month after treatment (P<0.01),respectively.Conclusions: The sFas level is higher in LAURC subjects than in healthy controls.Concurrent chemoradiotherapy can reduce sFas levels in LAURC patients.The monitoring of sFas may provide prognostic information for LAURC patients.

Clinical observation of gemcitabine and concomitant three-dimensional conformal radiotherapy in the treatment of locally advanced non-small cell lung cancer

Objective: To evaluate the clinical effect of gemcitabine and concurrent three-dimensional conformal radiation therapy (3D-CRT) for locally advanced non-small cell lung cancer (NSCLC) . Methods: From April 2002 to June 2005, 38 pa-tients with inoperable stage III NSCLC were treated with gemcitabine and 3D-CRT simultaneously. Chemotherapy consisted of intravenously gemcitabine 350 mg/m2 on days 1, 8, 15, 22, 29, 36. 3D-CRT was delivered up to a total dose of 60–64 Gy with a 2.0 Gy dose fraction per day, 5 days per week. Results: The overall response rates of primary tumor and mediastinum metastatic node were 86.8% (33/38) and 90.6% (29/32) respectively, and 91.7% (22/24) and 78.6% (11/14) for squamous cell carcinoma and adenocarcinoma respectively. The acute side effects of patients were mostly myelosuppression, nausea, vomiting, radiation-induced esophagitis and pneumonitis (RTOG I/II), however, all of them were cured. Conclusion: Con-current application of gemcitabine and 3D-CRT can improve the overall response rate for locally advanced NSCLC without aggravating the side effects.

Correlations between alterations of T-helper 17 cells and treatment efficacy after concurrent radiochemotherapy in locally advanced cervical cancer (stage IIB-IIIB): a 3-year prospective study

Background::Recently,T-helper 17(Th17)cells have been proved to play an important role in promoting cervical cancer.But,till now,few study has been carried out to understand the involvement of these cells in efficacy of anti-tumor treatments.This study aimed to investigate the alterations in the percentage of circulating Th17 cells and related cytokines in locally advanced cervical cancer(LACC)patients before and after concurrent chemoradiotherapy(cCRT)and to analyze the correlations between the alterations in Th17 cells and treatment efficacy.Methods::A prospective study with 49 LACC(International federation of gynecology and obstetrics[FIGO]stage IIB-IIIB)patients and 23 controls was conducted.Patients received the same cCRT schedule and were followed up for 3 years.Circulating Th17 cells(CD3+CD8-interleukin[IL]-17+T cells)and related cytokines IL-17,transforming growth factor-β(TGF-β),IL-10,IL-23,IL-6,and IL-22 were detected before and after cCRT.Correlations between alterations of circulating Th17 cells and treatment efficacy were analyzed.Kaplan-Meier analysis was used for overall survival(OS)and progression-free survival(PFS).Results::We found that 40 patients finished the entire cCRT schedule and met the endpoint of this study.The percentage of circulating Th17 cells in the LACC patients was higher than that in the controls,and it significantly decreased after cCRT(P<0.05).After cCRT,patients were divided into two groups based on the average of the Th17 cells declined.The subgroup of patients with a prominent decrease in circulating Th17 cells after cCRT had a higher treatment efficacy and longer PFS and OS times.Compared with the control patients,LACC patients had higher IL-6,IL-10,IL-22,TGF-βlevels and a lower IL-23 level(P<0.05).After cCRT,IL-6,IL-10,IL-17,IL-23 level significantly increased and TGF-βlevel significantly decreased compared with the levels before cCRT(P<0.05).Conclusion::Circulating Th17 cells in the LACC patients(FIGO stage IIB-IIIB)were higher than those in the controls,but they generally decreased after cCRT.A more pronounced decrease in circulating Th17 cells after cCRT was correlated with better therapeutic effect and longer PFS and OS times.

宫颈癌同步放化疗急性放射性肠炎的剂量学参数分析

目的 探索宫颈癌放疗患者肠道剂量与急性放射性肠炎(ARE)的相关性。方法 回顾性分析2014-2019年间158例宫颈癌同步放化疗患者的临床资料,根据CTCAE 5.0将ARE≥2级的患者归为ARE≥2级组,否则归为ARE <2级组。从剂量体积直方图中提取患者肠道剂量参数,采用单因素及多因素logistic回归分析ARE≥2级与肠道剂量学参数的相关性。结果 26例(16.46%)患者发生≥2级ARE。营养不良、三维适形放疗的患者ARE≥2级的发生率高于营养良好、调强放疗的患者(P <0.05);发生ARE≥2级的患者肠袋V5、V40和直肠V50高于ARE <2级的患者(P <0.05);ROC曲线显示肠袋V5和V40是ARE≥2级的显著预测因子(AUC> 0.7,P <0.05)。结论 宫颈癌同步放化疗的患者应考虑肠袋V5和V40剂量,合理优化放疗计划,以期降低ARE≥2级的发生率。

超声造影预测局部晚期宫颈癌同步放化疗早期疗效的临床价值

目的 探讨超声造影(CEUS)预测局部晚期宫颈癌(LACC)患者同步放化疗(CCRT)早期疗效的临床价值。方法 选取临沂市肿瘤医院收治的LACC患者65例,于治疗前1周内及体外放疗结束后分别进行CEUS检查,通过定量分析时间-强度曲线(TIC)获得达峰时间(TP)、梯度(Grad)、曲线下面积(Area)及峰值强度(PI);测量治疗前后瘤体最大径,计算肿瘤消退率。体外放疗结束后根据治疗效果分为敏感组53例和不敏感组12例,比较两组上述参数的差异。采用Spearman相关分析法分析CEUS参数与肿瘤消退率的相关性;二元Logistic回归分析筛选预测LACC患者CCRT早期疗效的影响因素;绘制受试者工作特征(ROC)曲线分析其预测效能。结果 65例LACC患者治疗前和体外放疗结束后瘤体最大径分别为(60.7±14.6)mm、(31.2±16.9)mm,肿瘤消退率为(49.2±23.2)%。敏感组治疗前Grad、PI均低于不敏感组,差异均有统计学意义(均P<0.05);敏感组体外放疗结束后Grad、Area及PI均低于不敏感组,TP高于不敏感组,差异均有统计学意义(均P<0.001)。敏感组体外放疗结束后Grad、Area及PI均较治疗前降低,TP较治疗前升高,差异均有统计学意义(均P<0.05)。相关性分析显示,治疗前Grad、PI与肿瘤消退率均呈负相关(r=-0.602、-0.499,均P<0.05);体外放疗结束后Grad、PI与肿瘤消退率均呈负相关(r=-0.859、-0.913,均P<0.05)。二元Logistic回归分析显示,治疗前Grad、PI均为预测LACC患者CCRT早期疗效的独立影响因素(均P<0.05)。ROC曲线分析显示,治疗前Grad、PI预测LACC患者CCRT早期疗效的曲线下面积分别为0.802、0.894。结论 CEUS在预测LACC患者CCRT早期疗效中有一定的临床价值。

贝伐珠单抗联合放化疗对宫颈癌疗效的Meta分析

目的评价贝伐珠单抗联合放化疗治疗宫颈癌的疗效及治疗过程中的安全性。方法对中文数据库维普及英文数据库PubMed等中关于贝伐珠单抗联合放化疗治疗宫颈癌的研究进行检索,收集2010—2023年相关的随机对照试验。采用Review Manager 4.2软件分析患者的完全缓解、部分缓解、疾病稳定及不良反应的发生率,绘制漏斗图评价发表偏倚情况。结果纳入符合本研究的文献9篇,共654例患者(试验组327例,对照组327例)。贝伐珠单抗联合放化疗可提高宫颈癌患者完全缓解、部分缓解和疾病稳定的发生率,不良反应的发生率与单纯放化疗相比,差异无统计学意义(P>0.05)。漏斗图显示纳入的研究尚不认为存在发表偏倚。结论贝伐珠单抗联合放化疗治疗宫颈癌的疗效优于单纯放化疗,与单纯放化疗不良反应的发生率相近。

食管癌患者同步放化疗和序贯放化疗对预后影响的Meta分析

目的比较食管癌患者同步放化疗(concurrent chemoradiotherapy,CCRT)和序贯放化疗(sequential chemoradiotherapy,SCRT)的预后影响。方法计算机检索Cochrane、PubMed、Embase、Web of Science、中国生物医学文献数据库(Chinese biomedical literature database,CBM)、中国知网(China national knowledge infrastructure,CNKI)、维普中文期刊数据库及万方数据库,按照纳入和排除标准筛选文献,用NOS量表对纳入的队列研究进行方法学质量评价,采用Review Manager 5.4软件进行Meta分析。结果共纳入32项队列研究,合计2962名患者。CCRT组的客观缓解率[OR=2.82,95%CI(2.16~3.68),P<0.00001]及1、2、3 a生存率(P<0.00001)均优于SCRT组,而远处转移率没有显著差别[OR=0.82,95%CI(0.55~1.23),P=0.33]。CCRT组白细胞减少[OR=2.90,95%CI(1.79~4.70),P<0.0001]和放射性食管炎[OR=1.90,95%CI(1.46~2.47),P<0.00001]发生率高于SCRT组。结论CCRT组在客观缓解率及1、2、3 a生存率方面较SCRT组更具优势,但白细胞减少及放射性食管炎发生率较高。