Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy

Background: Gross target volume of primary tumor(GTV?P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma(NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity?modulated radiotherapy(IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to ind a suitable cut?of value of GTV?P for prognosis prediction.Methods: Clinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver oper?ating characteristic(ROC) curves were used to identify the cut?of values of GTV?P for the prediction of diferent end?points [overall survival(OS), local relapse?free survival(LRFS), distant metastasis?free survival(DMFS), and disease?free survival(DFS)] and to test the prognostic value of GTV?P when compared with that of the American Joint Committee on Cancer T staging system.Results: The 358 patients with locally advanced NPC were divided into two groups by the cut?of value of GTV?P as determined using ROC curves: 219(61.2%) patients with GTV?P ≤46.4 mL and 139(38.8%) with GTV?P >46.4 mL. The 3?year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV?P ≤46.4 mL than in those with GTV?P > 46.4 mL(all P < 0.05). Multivariate analysis indicated that GTV?P >46.4 mL was an independent unfavorable prognostic factor for patient survival. The ROC curve veriied that the predictive ability of GTV?P was superior to that of T category(P < 0.001). The cut?of values of GTV?P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4 mL, respectively.Conclusion: In patients with locally advanced NPC, GTV?P >46.4 mL is an independent unfavorable prognostic indi?cator for survival after IMRT, with a prognostic value superior to that of T category.

CLINICAL STUDY ON ACUPUNCTURE TREATMENT OF SIDE REACTIONS OF RADIOTHERAPY AND CHEMOTHERAPY FOR MALIGNANT TUMOR

Forty-two cancer patients were randomly divided into acupuncture plus radiotherapy chemotherapy (acupuncture) group and radiotherapy-chemotherapy (control) group. The indexes ob served were the counts of leukocytes and thrombocytes, and the activities of both natural killer (NK) cells and intCrleukin(IL) - 2. The findings showed that the counts of both leukocytes and thrombo cytes in acupuncture group had no significant changes while those of control group lowered consider ably, displaying a significant difference between the two groups (P< 0.01 ). The activities of NK cells and IL - 2 of acupuncture group raised apparently while that of NK cells and IL - 2 in control group lowered markedly. There was a significant difference between the two groups (P < 0.01 ). In acupuncture group, radiotherapy and chemotherapy induced symptoms of the d1gest1ve system and ner vous system were strikingly less than those of the control group, suggesting that acupuncture can pro nouncedly ameliorate radiotherapy and chemotherapy induced symptoms of arrest of bone marrow, im munosuppression, digestive system and nervous system.

Dosimetric consequences of tumor volume changes after kilovoltage cone-beam computed tomography for non-operative lung cancer during adaptive intensity-modulated radiotherapy or fractionated stereotactic radiotherapy

Objective The aim of this study was to investigate tumor volume changes with kilovoltage cone-beam computed tomography （kV-CBCT） and their dosimetric consequences for non-operative lung cancer during intensity-modulated radiotherapy （IMRT） or fractionated stereotactic radiotherapy. Methods Eighteen patients with non-operative lung cancer who received IMRT consisting of 1.8-2.2 Gy/fraction and five fractions per week or stereotactic radiotherapy with 5-8 Gy/fraction and three fractions a week were studied, kV-CBCT was performed once per week during IMRT and at every fraction during stereotactic radiotherapy. The gross tumor volume （GTV） was contoured on the kV-CBCT images, and adaptive treatment plans were created using merged kV-CBCT and primary planning computed tomogra- phy image sets. Tumor volume changes and dosimetric parameters, including the minimum dose to 95% （D95） or 1% （D1） of the planning target volume （PTV）, mean lung dose （MLD）, and volume of lung tissue that received more than 5 （Vs）, 10 （Vl0）, 20 （V20）, and 30 （V30） Gy were retrospectively analyzed. Results The average maximum change in GTV observed during IMRT or fractionated stereotactic radio- therapy was -25.85% （range, -13.09% --56.76%）. The D95 and Dr of PTV for the adaptive treatment plans in all patients were not significantly different from those for the initial or former adaptive treatment plans. In patients with tumor volume changes of 〉20% in the third or fourth week of treatment during IMRT, adap- tive treatment plans offered clinically meaningful decreases in MLD and V5, V10, V20, and V30; however, in patients with tumor volume changes of 〈 20% in the third or fourth week of treatment as well as in patients with stereotactic radiotherapy, there were no significant or clinically meaningful decreases in the dosimetric parameters. Conclusion Adaptive treatment planning for decreasing tumor volume during IMRT may be beneficial for patients who experience tumor volume changes of 〉20% in the third or fourth week of treatment.

Effect of TACE combined with radiotherapy on the expression of serum tumor markers and malignant molecules in patients with primary large liver cancer

Objective:To investigate the effect of TACE combined with radiotherapy on the expression of serum tumor markers and malignant molecules in patients with primary large liver cancer.Methods:A total of 90 patients with primary large liver cancer who were treated in our hospital between September 2016 and September 2018 were retrospectively analyzed and divided into the control group(n=51)who received radiotherapy and the TACE group(n=39)who received TACE combined with radiotherapy.The expression levels of serum tumor markers,angiogenesis indexes and apoptosis molecules were compared between the two groups before and after treatment.Results:Before treatment,there were no statistically significant differences in the expression levels of serum tumor markers,angiogenesis indexes or apoptotic molecules between the two groups.After treatment,the serum levels of tumor markers AFP,AFu,CGT,CEA and CA19-9 in the TACE group were lower than those in the control group;the serum levels of angiogenesis indexes HGF,VEGF,MMP-9 and EGFR were lower than those in the control group;the serum levels of apoptosis molecules Bax,Caspase-4 and Caspase-10 were higher than those in the control group,while the levels of Bcl-2 and Survivin were lower than those in the control group.Conclusion:TACE on the basis of radiotherapy can further reduce the tumor malignancy in primary large liver cancer patients.

Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy

Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma(NPC) in the intensity?modulated radiotherapy(IMRT) era.Methods: We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center(South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging(MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniicant explanatory variables.Results: The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiicant prognostic fac?tor for local failure(P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho's location of the cervical lymph nodes were signiicant prognostic factors for both distant failure and disease failure(all P < 0.05). Intracranial extension had signiicant prognostic value for distant failure(P = 0.040).Conclusions: The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiicant prognostic parameters for local control have also been altered substantially.

COMBINATION OF PRONE POSITION AND INTENSITY-MODULATED RADIATION THERAPY (IMRT) REDUCES SMALL BOWEL DOSES IN RADIATION THERAPY FOR GYNECOLOGIC MALIGNANCIES

Objective： To evaluate if the combination of both prone position on a belly board and intensity-modulated radiotherapy （IMRT） further reduces the radiation dose to small bowel in pelvic RT for gynecologic malignancies. Methods： Conformal pelvic RT plans were computed in 13 patients with gynecologic malignancies who had pre-existing planning computed tomography （CT） scans in both the supine position and prone position on a belly board. There were 10 cervical cancer and 3 endometrial cancer patients. A limited arc technique （180° arc length） and an extended arc technique （340° arc length） were used in IMRT plans. Normal tissue regions of interest （ROI） included small bowel, large bowel and bladder. Dose and volume for normal tissue structures were traced and compared between supine and prone plans using the paired t-test. Results： For the limited arc technique, prone position using a belly board device improved small bowel sparing. Analysis of the results showed a 12~26 Gy reduction of volume of small bowel irradiation compared to the supine position. With the extended arc technique, there was no obvious radiation reduction in the prone position. Large bowel and bladder dose showed no significant differences between prone and supine position with either technique. Conclusion： Prone positioning on a belly board decreases the small bowel dose in gynecologic pelvic IMRT, and the magnitude of improvement depended on the limited arc IMRT technique used.

Precision radiotherapy for brain tumors A 10-year bibliometric analysis

OBJECTIVE： Precision radiotherapy plays an important role in the management of brain tumors. This study aimed to identify global research trends in precision radiotherapy for brain tumors using a bibliometric analysis of the Web of Science. DATA RETRIEVAL： We performed a bibliometric analysis of data retrievals for precision radiotherapy for brain tumors containing the key words cerebral tumor, brain tumor, intensity-modulated radiotherapy, stereotactic body radiation therapy, stereotactic ablative radiotherapy, imaging-guided radiotherapy, dose-guided radiotherapy, stereotactic brachytherapy, and stereotactic radiotherapy using the Web of Science. SELECTION CRITERIA： Inclusion criteria： （a） peer-reviewed articles on precision radiotherapy for brain tumors which were published and indexed in the Web of Science; （b） type of articles： original research articles and reviews; （c） year of publication： 2002-2011. Exclusion criteria： （a） articles that required manual searching or telephone access; （b） Corrected papers or book chapters. MAIN OUTCOME MEASURES： （1） Annual publication output; （2） distribution according to country; （3） distribution according to institution; （4） top cited publications; （5） distribution according to journals; and （6） comparison of study results on precision radiotherapy for brain tumors. RESULTS： The stereotactic radiotherapy, intensity-modulated radiotherapy, and imaging-guided radiotherapy are three major methods of precision radiotherapy for brain tumors. There were 260 research articles addressing precision radiotherapy for brain tumors found within the Web of Science. The USA published the most papers on precision radiotherapy for brain tumors, followed by Germany and France. European Synchrotron Radiation Facility, German Cancer Research Center and Heidelberg University were the most prolific research institutes for publications on precision radiotherapy for brain tumors. Among the top 13 research institutes publishing in this field, seven are in the USA, three are in Germany, two are in France, and there is one institute in India. Research interests including urology and nephrology, clinical neurology, as well as rehabilitation are involved in precision radiotherapy for brain tumors studies. CONCLUSION： Precision radiotherapy for brain tumors remains a highly active area of research and development.

Cryoablation combined with radiotherapy for hepatic malignancy:Five case reports

BACKGROUND The survival of patients treated with monotherapy for hepatic malignancies is not ideal.A comprehensive program of cryoablation combined with radiotherapy for the treatment of hepatic malignancies results in less trauma to the patients.It may provide an option for the treatment of patients with advanced hepatic malignancies.CASE SUMMARY We reported 5 cases of advanced-stage hepatic malignancies treated in our hospital from 2017-2018,including 3 cases of primary hepatocellular carcinoma and 2 cases of metastatic hepatic carcinoma.They first received cryoablation therapy on their liver lesions.The procedure consisted of 2 freeze-thaw cycles,and for each session,the duration of freezing was 13-15 min,and the natural rewarming period was 2-8 min.Depending on the tumor size,the appropriate cryoprobes were selected to achieve complete tumor ablation to the greatest extent possible.After cryoablation surgery,intensity-modulated radiotherapy(IMRT)for liver lesions was performed,and the radiotherapy regimen was 5400 cGy/18f and 300 cGy/f.None of the 5 patients had adverse events above grade II,and their quality of life was significantly improved.Among them,4 patients were free of disease progression in the liver lesions under local control,and their survival was prolonged;3 patients are still alive.CONCLUSION Our clinical practice demonstrated that cryoablation combined with IMRT could be implemented safely.The definitive efficacy for hepatic malignancies needs to be confirmed in larger-size sample prospective studies.

A CLINICAL STUDY FOR EVALUATING EARLY RADIOTHERAPY EFFECT IN PATIENTS WITH BRAIN TUMOR USING ^(99)Tc^m-HL91 SPECT

Objective： The purpose of this study was to evaluate the early radiotherapy effect using ^99Tc^m-HL91 SPECT in patients with brain tumors. Methods： Twenty-one patients with brain tumors who were treated by radiotherapy were studied. KPS grade, tumor size on ^99Tc^m-HL91 SPECT, tumor size on MRI, and ratio of T/N （tumor counts/sec over normal brain tissue counts/sec） were investigated before ,during and after radiotherapy. Results： The average tumor size on ^99Tc^m-HL91 SPECT and MRI was 11.34±5.88 cm^2, 9.46±5.66 cm^2, respectively before radiotherapy. The tumor size on ^99Tc^m-HL91 SPECT was not in accordance with to that on MRI （P〈0.05）. KPS grade, tumor size on ^99Tc^m-HL91 SPECT and ratio of T/N had significance differences before, during and after radiotherapy （P〈0.05）, but the tumor size on MRI imaging had no significance differences before, during and after radiotherapy （P〉0.05）. The rate of symptom improvement was 80% during radiotherapy and 100% after radiotherapy. The rates of imaging remission based on the brain tumor size on ^99Tc^m-HL91 SPECT, MRI and T/N were 75%, 15%, and 80%, respectively during radiotherapy. The agreement rates between imaging remission diagnosed by those three methods and symptom improvement were 70%, 40%, and 60% respectively during radiotherapy. The rates of imaging remission based on the brain tumor sizes on ^99Tc^m-HL91 SPECT, MRI and T/N were 100%, 25%, and 95% respectively after radiotherapy. The agreement rates between imaging remission diagnosed by those three methods and symptoms improvement were 100%, 20%, and 95% respectively after radiotherapy. Conclusion： The tumor size on ^99Tc^m-HL91 SPECT is a valuable tool for evaluating early radiotherapy effect of brain tumor in process of radiotherapy. T/N is not a feasible method in evaluating radiotherapy effect of brain tumor because it may show elevation unrelated to the curative effect during radiotherapy.

Clinical and Experimental Study of the Effect of Xilixin Granule Combined with Radiotherapy on Malignant Tumors

Objective: To observe the effect of Xilixin Granule combined with radiotherapy in treating malignant tumors. Methods:Thirty six patients of pulmonary or nasopharyngeal carcinoma were treated with Xilixin granule (XLXG) combined with radiotherapy and compared their efficacy with that of 31 patients treatedby Zhenqi Fuzheng granule combined with radiotherapy for control. Results: The symptoms of YinDeficiency syndrome in the treated group were obviously improved, the leucocyte decreased by 5. 6%, while inthe control group it reached 25. 8%, the 3 year survival rate was significantly higher in the treated group (75.0%) than that in the control group (51. 6 % ). Animal experiment revealed that XLXG had the effects of tumorinhibition, it could Increase white blood cells, platelets and hemoglobin of patients, especially in using largedosage. Conclusion: XLXG have some protective effect against radiotherapeutic damage in patients with malignant tumor.

细胞焦亡及其在肿瘤放疗中的作用机制研究进展

细胞焦亡是一种新型细胞死亡方式,在肿瘤研究中具有双向调节作用,一方面,诱导细胞焦亡促进癌细胞死亡,抑制肿瘤细胞增殖,增强放化疗敏感性、改善抗肿瘤免疫;另一方面,放射治疗是恶性肿瘤治疗的重要手段,焦亡诱发放射性炎症损伤,影响放疗疗效,但细胞焦亡在放疗中的潜在作用机制尚未完全阐明。本文通过概述细胞焦亡在抗肿瘤治疗中的作用机制以及细胞焦亡在放疗中的双重作用,并对细胞焦亡在放疗中的应用及困境进行展望,探讨靶向细胞焦亡提高放疗疗效及减轻放射性损伤的可行性,期望为放疗后续作用机制研究提供参考,为放疗靶向焦亡研究提供新方向。

肿瘤放疗与营养治疗观点:基础营养与精准营养并重

营养不良是恶性肿瘤放疗患者常见合并症和并发症。营养不良会降低放疗疗效,增加放疗不良反应,甚至会缩短患者生存时间,降低生存质量,同时放疗也可能会加重营养不良。营养治疗对接受放疗的肿瘤患者至关重要,对接受放疗的肿瘤患者进行规范、有效的营养治疗具有重要意义。肿瘤营养治疗,应作为一线基础治疗,贯穿肿瘤治疗始终,恶性肿瘤患者“围放疗期”十分有必要进行全程化营养管理。肿瘤是一种代谢性疾病,基础营养治疗除了要满足肿瘤患者基本目标能量、蛋白质及营养素需求外,还应该积极探索饮食调节、靶向肿瘤代谢、免疫营养等方面的个体化精准营养治疗。肿瘤营养治疗不仅补充能量和营养素,还调节肿瘤免疫与代谢,甚至提高生存率。基础营养和精准营养疗法应该并重。同时,肿瘤患者在治疗期间会遭受各种心理和生理上的打击,多模式整合康复能协同提高患者康复水平,使临床康复一体化。在放疗患者中开展以营养治疗为基础的多模式整合康复临床应用效果也亟待大型随机对照试验等进一步验证。

盆腔恶性肿瘤术后放疗小肠保护研究进展(综述)

放疗技术在盆腔恶性肿瘤新辅助及术后辅助治疗中地位不断提高,放射性肠炎发病率居高不下,小肠保护显得格外重要,临床通过改进放疗技术、体位固定技术、充盈膀胱等尽可能减少小肠的照射剂量体积。该文就盆腔恶性肿瘤术后放疗中小肠保护的预防措施及未来发展方向做简要总结。

王凌教授从“虚-痰-郁-火”辨证治疗恶性肿瘤放化疗及靶向治疗后虚劳经验

恶性肿瘤是虚劳的主要病因,放化疗、靶向治疗虽有抗肿瘤功效,但其副作用常加重虚劳证候。王凌教授辨证治疗恶性肿瘤放化疗及靶向治疗后虚劳证候,以“脏腑气血阴阳诸虚劳损”为病变之本,虚性证素包括肾精不足、脾胃虚损、肺肾阴亏,实性证素为湿浊、痰浊、气郁、阴火,病性本虚标实,“气阴两虚、痰湿郁火”为基本病机。补肾填精、健脾益胃、清热润肺、化湿祛痰、疏肝柔肝为主要治法,扶正祛邪,燮理阴阳,以平为期。

深部高频热疗对放射性肺炎预防作用的临床研究

目的探讨深部高频热疗预防肺恶性肿瘤患者放射性肺炎发生的作用。方法非随机选取2020年1月—2022年11月在贵阳市第一人民医院血液肿瘤科进行放射治疗的84例肺恶性肿瘤患者,按不同的治疗方法分为对照组和热疗组,每组42例。对照组患者单独采用放化疗,热疗组患者在放化疗的同时采用深部高频热疗。比较两组放射性肺炎发生率、肺功能、炎性因子水平。结果热疗组患者放射性肺炎发生率为9.52%(4/42),低于对照组的38.10%(16/42),差异有统计学意义(χ^(2)=10.730,P<0.05)。治疗后,热疗组肺功能和炎性因子水平均优于对照组,差异有统计学意义(P均<0.05)。结论深部高频热疗预防放射性肺炎的效果确切。

恶性肿瘤放疗患者家庭营养管理研究进展

营养不良是恶性肿瘤放疗患者主要并发症之一,因此帮助恶性肿瘤放疗患者最大程度改善营养状况非常重要,营养干预是改善患者营养不良的重要手段。家庭营养管理是医院营养管理的延伸,对促进恶性肿瘤放疗患者身体恢复、提高生存质量具有重大意义。本文从恶性肿瘤放疗患者家庭营养管理模式、干预方式以及改进方向进行综述,以期为更好地促进患者营养状况的改善,提高患者生活质量提供参考。

放疗中心脏照射剂量体积与自主神经功能紊乱关系的研究

背景与目的:晚期癌症患者心脏自主神经功能紊乱(autonomic dysfunction,AD)的发生率为65%~80%,AD导致的头晕、心悸及疲乏等神经衰弱症状,即使充分休息也难以缓解,严重影响患者的生存质量。同时,心血管自主神经系统对心率、心肌功能和心肌血流具有重要调节作用,AD会增加患者心血管疾病的发病率和死亡风险。AD不仅是一种功能状态,而且可能是整体心肌病变的早期标志。研究显示,在调整年龄、性别和心血管危险因素后,先前的辐射暴露与静息心率增高及运动后心率恢复异常等AD表现相关,但是目前放疗对心脏自主神经功能影响的相关研究尚少,具体的损伤效应及损伤发生的剂量阈值尚不明确。本研究通过对比放疗前后的心率变异性(heart rate variability,HRV)分析参数差异,探讨胸部放疗对恶性肿瘤患者心脏自主神经功能的影响,通过对比病例组和对照组间的剂量学差异,探索发生AD的剂量学相关危险因素,为优化放疗方案的剂量分布提供理论依据,以期改善患者的预后和减少并发症的发生。方法:前瞻性收集2023年2月—2023年12月华北理工大学附属医院放疗科收治的行胸部放疗的恶性肿瘤患者。纳入标准:①经病理学检查证实为恶性肿瘤(肺癌、乳腺癌或食管癌)患者;②有放疗适应证;③美国东部肿瘤协作组(Eastern Cooperative Oncology Group,ECOG)评分0~1分;④心电图、心脏彩超等检查无明显异常;⑤患者知情同意并签署同意书。排除标准:①曾接受过胸部放疗;②治疗前自觉明显心悸、胸闷和胸痛的患者;③合并糖尿病、心脏病等严重基础疾病;④目前正在使用抗心律失常药物;⑤不能耐受放疗以及随访过程中失访或脱失者。采用HRV分析评估放疗后自主神经功能的变化情况,将出现AD的患者纳入病例组,其余患者纳入对照组,采用单因素和多因素logistic回归分析方法探索胸部放疗后发生AD的剂量学相关危险因素和心脏限量。本研究经华北理工大学附属医院伦理委员会批准(伦理编号:20230228020)。结果:本研究共收集到符合本研究条件的胸部肿瘤患者89例,其中有41例(46%)患者放疗后发生了心脏AD,病例组心脏最高受照剂量(D_(max))(6273.500 cGy vs 4675.900 cGy,P<0.001)、心脏平均受照剂量(D_(mean))(1513.700 cGy vs 452.050 cGy,P<0.001)和心脏受到5 Gy以上剂量照射的体积占心脏总体积的百分比(V_(5))(49.000%vs 21.250%,P<0.001)、V_(20)(30.500%vs 7.300%,P<0.001)、V_(30)(18.700%vs 3.600%,P<0.001)、V_(40)(10.900%vs 1.500%,P<0.001)明显高于对照组,多因素logistic回归分析结果显示,心脏V_(30)是心脏AD发生的独立危险因素[OR(95%CI)=1.583(1.093~2.291),P=0.015],心脏V_(30)能预测放射性心脏损伤的发生,曲线下面积为0.788,且17.1%是心脏V_(30)预测心脏AD发生的最佳截断值。结论:胸部放疗后,心脏AD患者的心脏照射剂量体积明显高于对照组患者,当心脏V_(30)高于17.1%时,患者发生心脏AD的风险明显升高。

放射性自主神经病变研究进展

放射性自主神经病变是指肿瘤患者在接受放射治疗后出现的一系列自主神经损伤相关症状,如疲劳、头晕、恶心、低血压、静息心率异常等。因自主神经病变症状大多为非特异性的,未能引起临床医师注意,但病变已严重影响患者的生活质量,需要引起重视,故本文对放射治疗后出现的自主神经病变进行综述,目的在于阐明机制,了解影响因素,提供干预措施。

舒适护理在恶性肿瘤放疗患者中的应用效果

目的:分析舒适护理在恶性肿瘤放疗患者中的应用效果。方法:选取2022年6月—2023年6月于连云港市东海县人民医院放疗科进行放疗的恶性肿瘤患者80例作为观察对象,以随机数字表法分成两组,每组40例。对照组采用常规护理,研究组采用舒适护理。比较两组护理效果。结果:护理后,两组血清白蛋白、血清总蛋白水平低于护理前,但研究组高于对照组;两组营养风险筛查表2002评分降低,且研究组低于对照组(P<0.05)。护理后,两组正性态度、自我减压、自我决策评分及总分升高,且研究组高于对照组(P<0.05)。护理后,两组生理机能、生理职能、一般健康状况、躯体疼痛、社会功能、精力、情感职能、精神健康评分升高,且研究组高于对照组(P<0.05)。结论:舒适护理在恶性肿瘤放疗患者中的应用效果良好,可改善患者营养状况,增强患者自我管理能力,对提高患者的生活质量具有积极意义。

基于GLIM标准构建预测肿瘤患者放疗后营养恶化的模型

目的采用全球领导人营养不良倡议(GLIM)标准调查住院放疗患者的营养状况,并构建放疗后营养恶化的预测模型。方法选择2022年1月至2022年12月在中国人民解放军空军特色医学中心放射治疗科放疗的97例住院肿瘤患者,于放疗前行GLIM营养不良评估,后依据放疗后体重是否丢失超过5%,分为营养稳定组(n=57)和营养恶化组(n=40)。利用单因素和多因素Logistic回归分析放疗后患者营养恶化的危险因素,并基于危险因素构建列线图预测模型,随后应用受试者操作特征(ROC)曲线下面积(AUC)、拟合优度检验及决策曲线(DCA)对模型的区分度、精准度及应用价值进行验证。结果纳入观察的97例放疗患者中38例存在营养风险或中/重度营养不良(39.1%),放疗后40例患者出现营养恶化(41.2%)。分析营养稳定与营养恶化组患者的基线情况,年龄、性别、学历、肿瘤部位、基础疾病、是否存在远处转移及入院BMI均无差异。Logistic回归分析示放疗后营养恶化的独立危险因素是:GLIM中/重度营养不良、放疗次数及前白蛋白(P<0.05)。将上述3项危险因素引入R软件建立列线图模型,AUC为0.723(95%CI=0.622~0.825),效准曲线和理想曲线均较好。DCA提示模型具备良好的应用价值。结论GLIM标准是预测肿瘤患者放疗后营养状态恶化的有效工具。基于GLIM评估、放疗次数及前白蛋白构建的列线图可有效预测放疗后患者的营养恶化风险,有望为医务人员采取积极的营养干预提供参考和指导。