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.

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.

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 twofield,chest and abdomen,lymphadenectomy.METHODS:A total of 530 cases with middle and lower thoracic esophageal carcinoma in our hospital from January 2008 to April 2009 were selected and analyzed,of which 219 cases received right chest,upper abdominal incision Ivor-Lewis surgery and simultaneously underwent mediastinal and abdominal two-field lymphadenectomy.If regional lymph node metastasis occurred within the recurrent laryngeal nerve,the patients would receive bilateral supraclavicular radiotherapy(DT=5000c Gy)to be adopted at postoperative 4-5 wk(Group A)or cervical lymphadenectomy at postoperative 3-4 wk(Group B).If there were no regional lymph node metastases within the recurrent laryngeal nerve,the patients only underwent two-field,chest and abdomen,lymphadenectomy(Group C).RESULTS:In 219 cases who underwent two-field lymphadenectomy,91 cases were diagnosed with regional lymph node metastasis within the recurrent laryngeal nerve.Of them,48 cases received cervical radiotherapy,and 43 cases underwent staging lymphadenectomy;128patients were not given the follow-up treatment of cervical radiotherapy because there was no regional lymph node metastasis within the recurrent laryngeal nerve.Five-year survival rates in group A and B were 47%and50%,respectively,with no statistical difference between them,and the rate in group C was 58%.CONCLUSION:For patients with middle and lower thoracic esophageal carcinoma combined with lymph node metastasis within the recurrent laryngeal nerve,cervical radiotherapy can be a substitute for surgery and provide benefit.

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.

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.

乳腺癌保乳术后应用3D技术填充瘤腔进行适形放疗的临床研究

目的探究乳腺癌保乳术后应用3D技术填充瘤腔进行适形放疗的靶区剂量、不良反应及美容度。方法选择2021年1月至2022年12月西安交通大学第一附属医院收治的48例乳腺癌患者,按照手术不同分为3D技术填充瘤腔组(24例)及对照组(24例)。全部患者均开展乳腺癌根治手术治疗,仅保乳方式不同,术后实施强度调控适形放射治疗计划下的加速部分乳腺照射。结果应用3D技术填充瘤腔保乳术后放疗的适形度指数及均匀性指数均明显高于常规保乳术后放疗(P<0.05)。3D技术填充瘤腔保乳术后放疗的肺及心脏危及器官剂量(平均剂量),肺的V 5、V 10、V 20、V 30、V 40及V 50均显著低于常规保乳术后放疗组(P<0.05)。2组患者的皮肤损伤、心律失常、骨髓抑制及消化道反应发生率差异无统计学意义。3D技术填充瘤腔保乳术后组患者的美容度要显著优于常规保乳术后患者(P<0.05)。结论乳腺癌保乳术后应用3D技术填充瘤腔显著增强乳腺的美容度,且不影响放疗的安全及有效性。

不同组织学分级乳腺癌放疗患者生理特征参数差异及5年预后的影响因素分析

目的 分析不同组织学分级乳腺癌放疗患者生理特征参数差异及5年预后的影响因素。方法 回顾性选取2015年4月至2018年4月在江苏省肿瘤医院接受放疗的80例乳腺癌患者进行研究。根据Bloom Richardson标准将患者进行组织学分级,并将其分为0~Ⅰ级组(n=30)和Ⅱ~Ⅲ级组(n=50)。分析0~Ⅰ级和Ⅱ~Ⅲ级患者生理特征参数(年龄、肿瘤位置、体重指数、胸围和患侧乳腺体积)的差异;经随访记录5年后0~Ⅰ级和Ⅱ~Ⅲ级患者的局部复发、远处转移、总生存率;分析预后良好组和预后不良组患者的生理特征参数差异;并建立多因素Logistic模型,分析影响不同乳腺癌预后的独立危险因素。结果 Ⅱ~Ⅲ级组体重指数>24 kg/m^(2)、胸围≥90 cm、患侧乳腺体积≥350 cm^(3)的患者比率分别为64.00%、80.00%、76.00%,均明显高于0~Ⅰ级组(33.33%、30.00%、36.67%),差异均有统计学意义(P<0.05)。Ⅱ~Ⅲ级组患者的局部复发率、远处转移率分别为32.00%、40.00%,均高于0~Ⅰ级组(10.00%、16.67%),5年总生存率为64.00%,低于0~Ⅰ级组(86.67%),差异均有统计学意义(P<0.05)。80例乳腺癌患者5年后的预后良好58例,预后良好率为72.50%,预后不良22例,预后不良率为27.50%。预后不良组与预后良好组患者年龄≥60岁、体重指数>24 kg/m^(2)、胸围≥90 cm、患侧乳腺体积≥350 cm^(3)、组织学Ⅱ~Ⅲ级比率比较,差异均有统计学意义(P<0.05)。单因素分析结果显示,年龄、体重指数、胸围、患侧乳腺体积、组织学分级均是影响乳腺癌5年预后的危险因素(P<0.05)。多因素Logistic分析结果显示,年龄≥60岁、体重指数>24 kg/m^(2)、胸围≥90 cm、患侧乳腺体积≥350 cm^(3)、组织学Ⅱ~Ⅲ级均是影响乳腺癌患者放疗5年预后的独立危险因素(P<0.05)。结论 体重指数、胸围和患侧乳腺体积等生理特征与乳腺癌组织学分级有关,同时也是威胁乳腺癌放疗远期预后的独立危险因素。

全乳切除术后放射治疗对前哨淋巴结微转移早期乳腺癌患者预后影响的Meta分析

目的:荟萃文献,对比分析前哨淋巴结微转移早期乳腺癌患者全乳切除术后行与未行放射治疗的预后。方法:检索中国生物医学文献数据库(China Biology Medicine,CBM)、中国期刊全文数据库(China National Knowledge Infrastructure,CNKI)、维普(VIP)、万方数据库、PubMed数据库、Embase数据库、Web of science(WOS)数据库、Cochrane数据库,由2名研究者各自独立对入选研究的有关试验设计、研究对象特征、研究结果等进行摘录,采用纽卡斯尔渥太华量表进行质量评价,采用Stata 17.0及Review Manager 5.4进行Meta分析。结果:最终筛选出9篇相关文献,均为回顾性研究。中位随访30~98个月。术后放射治疗组与非放射治疗组乳腺癌特异性生存期(breast cancer-specific survival,BCSS)差异无统计学意义(HR=1.18,95%CI:0.94~1.48,Z=1.43,P=0.15);两组无病生存期(disease-free survival,DFS)差异亦无统计学意义(HR=0.51,95%CI:0.07~3.62,Z=-0.668,P=0.50);两组总生存期(overall survival,OS)差异亦无统计学意义(HR=1.02,95%CI:0.93~1.12,Z=0.39,P=0.70)。结论:前哨淋巴结微转移早期乳腺癌患者(T0、T1~2NmiM0)全乳切除术后予以放射治疗并不能改善患者的BCSS、DFS、OS。

右乳腺癌术后内乳放疗效果及安全性的研究

目的 探讨右侧乳腺癌改良根治术后腋窝淋巴结转移≥4枚患者行内乳电子线放射照射的近期疗效及放射性肺炎的风险因素研究。方法 选择行右侧乳腺癌改良根治术,且腋窝淋巴结转移≥4枚患者100例,其中N2期66例,N3期34例。所有患者接受规范的新辅助或术后辅助化疗、靶向及内分泌治疗。放疗方案右侧锁骨上下区采用调强X线放疗,右侧胸壁野及右侧内乳区采用电子线,放疗剂量均为50 Gy/25次。观察患者近期疗效及放射性肺炎的发生情况,进一步探索放射性肺炎发生的高危因素。结果 患者清扫腋窝淋巴结的中位数为22枚,而淋巴结阳性的中位数为7枚。中位随访39.5个月,区域淋巴结复发1例,胸壁复发2例,远处转移4例,死亡1例。1级放射性肺炎38例(38%),2级放射性肺炎2例(2%)。Logistic分析显示,放疗后2级淋巴细胞降低是导致放射性肺炎的独立因素。结论 右侧乳腺癌改良根治术后行内乳区电子线放疗安全可行,并未额外增加不良反应。放疗后发生2级及以上淋巴细胞降低是发生放射性肺炎的高危因素。

多参数MRI纹理分析预测直肠癌患者放射治疗后早期股骨头坏死

目的 探讨多参数MRI(mpMRI)纹理分析预测直肠癌患者放射治疗(放疗)后早期股骨头坏死(FHN)的价值。方法 回顾性分析52例接受盆腔放疗直肠癌患者放疗前2周及放疗后3个月内的盆腔MRI,其中31例未见FHN,21例出现早期FHN(Ⅰ期16例,Ⅱ期5例)。采用3D-slicer软件基于T1WI、T2WI和弥散加权成像(DWI)分割右侧股骨头,并提取其纹理参数;对比放疗前后纹理参数,将差异有统计学意义的放疗前参数纳入多因素logistic回归分析,建立模型T1WI、模型T2WI、模型DWI及模型T1WI+T2WI+DWI。根据放疗后影像学所见行股骨头坏死骨循环研究协会(ARCO)分期,以受试者工作特征(ROC)曲线分析单一纹理参数及联合模型预测直肠癌患者放疗后早期FHN的效能。结果 T1WI及T2WI纹理参数中,放疗前股骨头能量及均匀性高于放疗后;DWI纹理参数中,放疗前股骨头能量高于、而长行程高灰度强调及短行程高灰度强调低于放疗后。上述放疗前纹理参数单一预测直肠癌患者放疗后早期FHN的曲线下面积(AUC)为0.581~0.712,模型T1WI、模型T2WI、模型DWI和模型T1WI+T2WI+DWI的AUC分别为0.660、0.713、0.770和0.853。结论 mpMRI纹理分析可有效预测直肠癌患者放疗后早期FHN。

系统免疫炎症指数对根治性放疗Ⅲ期肺鳞癌患者长期生存的预测价值

目的探讨系统免疫炎症指数(SII)对接受根治性放疗的Ⅲ期肺鳞癌患者长期生存的预测价值。方法回顾性收集接受根治性放疗的Ⅲ期肺鳞癌患者的临床资料。计算患者放疗前1周内的SII及相关炎症指标,同时应用X-Tile软件确定最佳截断值。分析患者的生存情况以及SII对患者总生存(OS)及无进展生存(PFS)的影响。结果共纳入了453例患者,低SII组336例(<1277.3),高SII组117例(≥1277.3)。高SII组的中位OS和中位PFS均较低SII组缩短(OS:20.8个月vs.31.0个月,Log-rankχ2=18.015,P<0.01;PFS:13.0个月vs.21.0个月,Log-rankχ2=15.062,P<0.01)。多因素Cox回归分析显示,高SII是患者OS(HR=1.628,95%CI:1.294~2.047,P<0.001)和PFS(HR=1.559,95%CI:1.240~1.961,P<0.001)的独立危险因素,其他的影响因素包括较晚的TNM分期、放疗疗效欠佳,HALP评分下降。结论SII可作为接受根治性放疗Ⅲ期肺鳞癌患者长期生存的评价指标,SII升高提示预后较差。

真空垫联合CIVCO俯卧位托架在直肠癌放疗摆位中的应用

目的:改进CIVCO俯卧位托架在直肠癌中应用方法,探究真空垫与CIVCO俯卧位托架联合使用(改进型固定组A)与单独使用CIVCO俯卧位托架(一般型固定组B)摆位误差差异,制定真空垫固定下肢流程与要求。方法:基于CBCT(cone beam CT),采集摆位误差数据,回顾性选取2021年10月至2023年4月行俯卧位直肠癌放射治疗患者。改进型固定组32例,一般型固定组32例;两组中又以BMI(body mass index):24 kg/m^(2)为分界值进行亚组分类(肥胖体态A_(1)、B_(1),普通体态A_(2)、B_(2))。通过统计学方法两独立样本t检验,分别比较两组患者在X(lateral,LAT)、Y(length,LNG)、Z(vertal,VRT)三方向摆位误差均值差异;比较亚组间在X、Y、Z三方向摆位误差均值差异。采用秩和检验比较两组三维空间矢量误差差异;卡方检验展示三维空间矢量误差>0.52 cm占比。采用单因素方差分析探究改进型固定组与放疗摆位时间关系,经事后分析各方向误差均值变化趋势。根据PTV边界公式评估改进型固定在俯卧位直肠癌放射治疗临床应用价值。结果:两组摆位误差均值t检验结果:X(t=2.404,P=0.017),Y(t=4.864,P<0.05),Z(t=3.704,P<0.05),三方向误差均值差异有统计学意义。三维空间矢量误差分析结果:改进型固定组0.35(0.25~0.42)cm,一般型固定组0.42(0.29~0.61)cm(Z=-5.783,P<0.05);其中改进型固定组Δ>0.52 cm占比8.7%,一般型固定组Δ>0.52 cm占比28.2%(Z=-5.718,χ^(2)=32.757,P<0.05),差异具有统计学意义,改进型固定组患者其三位空间矢量误差漂移范围更小。两组在X、Y、Z三方向PTV外放值M PTV分别为A(0.51,0.49,0.58)cm,B(0.73,0.92,0.83)cm。基于BMI指数:在A组中误差均值差异X(t=-2.053,P=0.042),Y(t=-4.621,P<0.05),Z(t=-3.676,P<0.05)差异具有统计学意义;在A、B两组肥胖患者中误差均值差异仅发现在Z(t=3.431,P=0.002)差异具有统计学意义,X(t=1.170,P=0.244),Y(t=1.969,P=0.051)差异无统计学意义。在A、B两组普通BMI患者比较中X(t=-2.39,P=0.017),Y(t=-5.734,P<0.05)和Z(t=-2.722,P=0.007)差异有统计学意义。对改进型固定组单因素方差分析,各时段摆位误差均值组间两两比较仅在Y(F=5.951,P<0.05)、Z(F=3.155,P=0.015)方向上不同摆位时期误差均值差异有统计学意义,且第1周摆位误差均值差异大于其他几周(P<0.05)。X(F=0.625,P=0.645)方向上随摆位时间推移误差均值无显著差异。结论:经综合评估真空垫与CIVCO俯卧位托架联合使用对直肠癌俯卧位放疗摆位误差改善总体效果优于单纯使用俯卧位托架,但是改进型固定方式对肥胖患者摆位误差改善仍不甚满意。改进型固定组在全疗程放射治疗过程中,第1周在Y和Z方向上误差较大,相较于第一周治疗随着时间推移Y、Z方向误差整体变小,除第一周之外的其他治疗时段误差是无差异的。摆位可重复性稳定。

Subgroups of peripheral immune effector cells in cervical cancer patients are more sensitive to radiation therapy than chemotherapy

Background:CD8 positive T lymphocytes and natural killer(NK)cells in the peripheral blood of cervical cancer patients exhibit varying sensitivities to radiotherapy and chemotherapy.Methods:A total of 50 healthy peoples and 60 cervical cancer patients were recruited.The patients with cervical cancer were separated into two groups:radiation and chemotherapy,and blood sample were collected before and after treatment.Data on the proportion of CD8 positive T lymphocytes and NK cells were gathered for analytical evaluation.Results:Compared to healthy individuals,patients with cervical cancer exhibit a reduced proportion of CD8 positive T cells within their peripheral blood.And for patients with cervical cancer,radiation therapy has been found to be more effective than chemotherapy in increasing the proportion of CD8 positive T lymphocytes and NK cells.Conclusions:These results suggest that radiation therapy increases the levels of CD8 positive T lymphocytes and NK cells within the peripheral blood of patients with cervical cancer.The study hypothesis that the changes in the percentage of CD8 positive T lymphocytes may serve as a potential indicator for predicting treatment efficacy.

胸段食管癌放疗中双肺剂量学参数与计划参数的相关性分析

目的分析胸段食管癌放疗时双肺剂量学参数与计划参数的相关性。方法选取2020年4月至2023年4月医院收治的99例胸段食管癌放疗患者,采集放射性肺炎相关的剂量学参数如双肺V_(5)、V_(10)、V_(20)、V_(30)和平均剂量(Dmean)等,选取计划参数如处方剂量(DP)、双肺体积(VBL)、靶区体积(VPTV)和靶区与肺重合体积(VOPL)等,分析胸段食管癌放疗中双肺剂量学参数与计划参数的相关性。结果当双肺剂量学参数组合为第1典型变量(V1)、计划参数组合为第1典型变量(U_(1))时,两组典型变量的相关系数ρ=0.848,差异有统计学意义(P<0.05),其他组合的相关系数比较,差异无统计学意义(P>0.05)。其中V_(1)包括双肺剂量学参数中的V_(5)、V_(20)、V_(30)和Dmean,U_(1)包括计划参数中的处方剂量(DP)、双肺体积(VBL)和靶区体积(VPTV)。结论V_(5)、V_(20)、V_(30)和Dmean均是重要的双肺剂量学参数,其中,物理师需密切关注Dmean。计划参数的影响因素包括DP、VBL和VPTV,其中VPTV是影响双肺剂量学参数的重要因素。

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