Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy

BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent recurrence after liver cancer resection.However,there are multiple RT techniques available,and the differ-ential effects of these techniques in preventing postoperative liver cancer re-currence require further investigation.AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival(OS)and disease-free survival(DFS)and to determine the optimal strategy.METHODS This study involved network meta-analyses and followed the PRISMA guidelines.The data of qualified studies published before July 10,2023,were collected from PubMed,Embase,the Web of Science,and the Cochrane Library.We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints.The magnitudes of the effects were determined using risk ratios with 95%confidential intervals.The results were analyzed using R software and STATA software.RESULTS A total of 12 studies,including 1265 patients with hepatocellular carcinoma(HCC)after liver resection,were included in this study.There was no significant heterogeneity in the direct paired comparisons,and there were no significant differences in the inclusion or exclusion criteria,intervention measures,or outcome indicators,meeting the assumptions of heterogeneity and transitivity.OS analysis revealed that patients who underwent stereotactic body radiotherapy(SBRT)after resection had longer OS than those who underwent intensity modulated radiotherapy(IMRT)or 3-dimensional conformal RT(3D-CRT).DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS.Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT.IMRT,a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT,may be a preferred option.

An investigation of the influence of intestinal flora in external traditional Chinese medicine therapy

External therapy,which has been used for millennia to treat disease,has now become the newest member of complementary and alternative therapies.A growing number of clinical studies and animal experiments have shown that external therapy exerts a positive effect on the intestinal flora.In this paper,we review the research related to external therapy on various systemic diseases and focus on changes in the intestinal flora.We found that studies on external therapy are dominated by acupuncture and tuina,primarily aimed at the treatment of digestive and neurological diseases.However,the deeper mechanism of regulation of the intestinal flora by external therapy has not yet been experimentally confirmed.

Application of Statistical Process Control for Setting Action Thresholds as Quality Assurance of Dose Verifications in External Beam Radiotherapy

Purpose: To test the concept of Statistical Process Control (SPC) as a Quality Assurance (QA) procedure for dose verifications in external beam radiation therapy in conventional and 3D Conformal Radiotherapy (3D-CRT) treatment of cervical cancer. Materials and Methods: A study of QA verification of target doses of 198 cervical cancer patients undergoing External Beam Radiotherapy (EBRT) treatments at two different cancer treatment centers in Kenya was conducted. The target doses were determined from measured entrance doses by the diode in vivo dosimetry. Process Behavior Charts (PBC) developed by SPC were applied for setting Action Thresholds (AT) on the target doses. The AT set was then proposed as QA limits for acceptance or rejection of verified target doses overtime of the EBRT process. Result and Discussion: Target doses for the 198 patients were calculated and SPC applied to test whether the action limits set by the Process Behavior Charts could be applied as QA for verified doses in EBRT. Results for the two sub-groups of n = 3 and n = 4 that were tested produced action thresholds which are within clinical dose specifications for both conventional AP/PA and 3D-CRT EBRT treatment techniques for cervical cancer. Conclusion: Action thresholds set by SPC were within the clinical dose specification of ±5% uncertainty for both conventional AP/PA and 3D-CRT EBRT treatment techniques for cervical cancer. So the concept of SPC could be applied in setting QA action limits for dose verifications in EBRT.

Outcomes of External-Beam Radiation Therapy Boost with Conventional Fractionation in Cervical Cancer: A Retrospective Analysis about 133 Cases

Introduction: External-beam radiation therapy boost is a treatment option in cervical cancer when brachytherapy is not feasible. Though less effective than brachytherapy, some encouraging results have been reported from some institutions experiences. We conducted this study to assess outcomes of EBRT boost for our patients at National Institute of Oncology in Rabat. Patients and Methods: We collected data from patients treated for cervical cancer between January 2012 and December 2015. Patients, tumor and treatment characteristics were collected. Overall survival (OS), disease-free survival (DFS) and prognostic factors influencing DFS were assessed. Results: One hundred and thirty-three patients were enrolled. Median age was 52 years. Patient haemoglobin level ranged from 3.9 to 15.5 g/dl [mean: 11.2 g/dl]. Most tumors were classified stage III/IVA (63.2%) according to the FIGO classification. Regional lymph node metastases (pelvic and or para-aortic) were observed in 45.1%. Median total dose to tumor was 69.6 Gy (ranging from 66 to 70 Gy). Overall treatment time was protracted, with a median of 60 days. Most of patients received concurrent chemotherapy (94.7%) and the number of cycle ranged from 2 to 7 (median = 5). The follow-up median was 31.3 months, ranging from 6.2 to 96.8 months. At the first visit, most patients achieved complete response (80.5%). Five years OS and DFS were 47% and 44% respectively. In univariate and multivariate analysis, regional lymph nodes metastasis (presence or absence) and haemoglobin level (≤11 g/dl and >11 g/dl) were the two significant and independent prognostic factors influencing DFS (HR: 1.86;p = 0.01 for the former) (HR: 0.59;p = 0.03 for the latter). Conclusion: Our study showed that EBRT boost in conventional fractionation was an acceptable treatment option for cervical cancer unamenable to brachytherapy, especially in the two subgroups of patients that are those without pelvic and/or para-aortic lymph node metastasis and those with haemoglobin level above 11 g/dl.

Hypothesis on how Distance External Qi Therapy works

Distance External Qi Therapy(DEQT)is a form of Distance Intention Healing.Though it is getting popular,there is still no clear explanation on how it works.This article highlights the plausibility of supporting the mechanism of DEQT with the theory of quantum entanglement.

Clinical Observation on Treatment of Moderate and Severe Periodical Mastalgia with TCM Hot-wet Compress Therapy

[Objectives] To observe the clinical therapeutic efficacy of local hot-wet compress therapy of digestion ointment prescription on the patients with moderate and severe mastalgia. [Methods] Firstly,60 patients with mastalgia were selected,and divided into the experimental group and control group( 30 cases for each group). The control group was treated with acupuncture at distal point,and the experimental group was treated with TCM local hot-wet compress therapy combined with acupuncture at distal point. Then,the clinical therapeutic efficacy of two groups was compared. [Results]The experimental group was superior to the control group in relieving the breast pain,improving emotional integral,reducing breast lumps,improving lump texture,and improving TCM syndrome integral( P < 0. 05). [Conclusions]The digestion ointment prescription local hot-wet compress therapy has a significant therapeutic effect on treatment of mastalgia and can significantly improve the breast pain symptom of patients.

The use of traditional Chinese medicine internally and externally combined with auricular acupuncture point bloodletting in the treatment of vulvar leukoplakia

Vulvar leukoplakia refers to the chronic disease of degeneration and hypopigmentation of the skin and mucous membrane of the vulva with unbearable itching in women, seriously affecting the quality of life. The main treatment of western medicine for vulvar leukoplakia is the external use of glucocorticoids or estrogen, resulting to the high recurrence rate and side effects. Traditional Chinese medicine (TCM) has the characteristics of the overall concept and dialectical treatment with a variety of ways. Literature review in recent years found that the treatment of TCM decoction combined with external therapies, such as external fumigation, acupuncture and other treatments, or the combination of TCM decoction and external western medicine hormone ointment, can obtain good effects in vulvar leukoplakia. During the clinical practice, we found that the use of TCM internally and externally combined with auricular acupuncture point bloodletting was highly effective with unique advantages in the treatment of vulvar leukoplakia, providing the ideas guidance for clinicians.

Efficacy and safety of intraoperative radiotherapy in rectal cancer:A systematic review and meta-analysis

BACKGROUND In recent years,intraoperative radiotherapy(IORT)has been increasingly used for the treatment of rectal cancer.However,the efficacy and safety of IORT for the treatment of rectal cancer are still controversial.AIM To evaluate the value of IORT for patients with rectal cancer.METHODS We searched PubMed,Embase,Cochrane Library,Web of Science databases,and conference abstracts and included randomized controlled trials and observational studies on IORT vs non-IORT for rectal cancer.Dichotomous variables were evaluated by odds ratio(OR)and 95%confidence interval(CI),hazard ratio(HR)and 95%CI was used as a summary statistic of survival outcomes.Statistical analyses were performed using Stata V.15.0 and Review Manager 5.3 software.RESULTS In this study,3 randomized controlled studies and 12 observational studies were included with a total of 1460 patients,who are mainly residents of Europe,the United States,and Asia.Our results did not show significant differences in 5-year overall survival(HR=0.80,95%CI=0.60-1.06;P=0.126);5-year disease-free survival(HR=0.94,95%CI=0.73-1.22;P=0.650);abscess(OR=1.10,95%CI=0.67-1.80;P=0.713),fistulae(OR=0.79,95%CI=0.33-1.89;P=0.600);wound complication(OR=1.21,95%CI=0.62-2.36;P=0.575);anastomotic leakage(OR=1.09,95%CI=0.59-2.02;P=0.775);and neurogenic bladder dysfunction(OR=0.69,95%CI=0.31-1.55;P=0.369).However,the meta-analysis of 5-year local control was significantly different(OR=3.07,95%CI=1.66-5.66;P=0.000).CONCLUSION The advantage of IORT is mainly reflected in 5-year local control,but it is not statistically significant for 5-year overall survival,5-year disease-free survival,and complications.

Analysis of effect of external therapies of traditional Chinese medicine on eczema by data mining

Objective:To determine medication regularity external therapies of Traditional Chinese medicine of eczema by data mining.Methods:Papers were retrieved from databases Pubmed,CNKI,WF,VIP,CBM,Web of Science and Embase.From the establishment of the database to April 2020 were searched.The main points of Medication Regularity were established with Excel 2016 software;the characteristics and laws in external therapies of Traditional Chinese medicine Treatment of eczema were analyzed with the relevance rule and cluster analysis Methods in data mining technology.Results:The property and flavor of the herbs mainly used were cold,bitter,while the channel which are mostly involved included liver meridian,lung meridian and Bladder Meridian,The analysis of association rules showed that kushen and difuzi had the highest correlation.The clustering analysis figured out 7groups of the herbs.Conclusion:The study presents the common pair herbs in the treatment of external therapies of Traditional Chinese medicine of eczema,which provides the approach to syndrome differentiation and medication in clinical treatment of eczema.

Research progress of external therapies of traditional Chinese medicine in the treatment of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)is a common chronic liver disease characterized by diffuse hepatic steatosis.With the improvement of people's living standard,the incidence rate of NAFLD has been increasing,which has become one of the global health problems in 21st Century.However,there is no specific drug or standard treatment for NAFLD,which brings challenges to treatment.Acupuncture,moxibustion,massage and other external therapies based on the characteristics of traditional Chinese medicine have obvious curative effect in the clinical treatment of NAFLD,but the mechanism has not been systematically explained,which makes the clinical promotion evidence insufficient.This paper aims to summarize the researches on the treatment of NAFLD by external therapies of traditional Chinese medicine in recent years,and analyze its possible mechanism,so as to provide a scientific theoretical basis for future basic experiments and clinical research,and form a set of standardized clinical diagnosis and treatment scheme with the characteristics of traditional Chinese medicine.

Summary and clinical application of Zhuang medicine medicated thread moxibustion

Zhuang medicine medicated thread moxibustion is a kind of external therapy with ethnic medicine characteristics that spreads in Guangxi Zhuang region.It has a wide range of clinical application and significant curative effect,and can be used to treat diseases such as internal medicine,surgery,dermatology,gynecology,pediatrics,and five sense organs.Through reviewing and combing the literature on the Zhuang medicine medicated thread moxibustion in recent years,this paper summarizes and prospects its clinical application,with a view to further explaining the basic principles and application rules of Zhuang medicine medicated thread moxibustion and digging its clinical value.

A Survey of Research on Treatment of Pediatric Diarrhea with Massage Ying-Ming

Pediatric diarrhea is a common pediatric disease.Massage has broad application prospects in the treatment of pediatric diarrhea,which is an ideal treatment for pediatric diarrhea.In this paper,the etiology analysis of pediatric diarrhea,classification of traditional Chinese medicine(TCM),massage techniques and other aspects were reviewed.In order to provide reference for the clinical application of pediatric massage in the treatment of diarrhea.

Research progress on non-drug treatment of diabetic kidney disease

Diabetic kidney disease is one of the most serious and common chronic complications of diabetes and one of the leading causes of death in diabetic patients.In the case of diabetic kidney disease,sustained proteinuria is irreversible until it develops into end-stage renal disease.Drug treatment of diabetic kidney disease is relatively limited.More and more evidences into the effectiveness and safety that related non-drug treatments not only have the characteristics of simple operation and high safety,but also can improve the clinical symptoms of patients with diabetic kidney disease,reduce laboratory indicators,and delay disease progression.This article summarizes the recent literature on non-drug treatment of diabetic kidney disease such as exercise therapy,acupuncture therapy,acupoint application,auricular acupoint pressing pill therapy,moxibustion therapy,in order to provide reference for clinical treatment.

Spectroscopy and Light Emitting Diodes Based System in Characterizing External Beam Therapy 3 Films for Solar Ultraviolet Measurement

Gafchromic external beam therapy 3(EBT3)film has widely been used in medical field applications.Principally,the EBT3 film’s color gradually changes from light green to darker color under incremental exposures by ionizing or even non-ionizing ultraviolet(UV)radiation.Peak absorbance of the EBT3 film can be used to predict absorbed doses by the film.However,until today,related researches still rely on spectrometers for color analysis of EBT3 films.Hence,this paper presents a comparative analysis between results produced by the spectrometer and a much simpler light-emitting diode-photodiode based system in profiling the color changes of EBT3 films after exposure by solar UV radiation.This work has been conducted on a set of 50 EBT3 samples with incremental solar UV exposure(doses).The wavelength in the red region has the best sensitivity in profiling the color changes of EBT3 films for low solar UV exposure measurement.This study foresees the ability of blue wavelength to profile films with a large range of solar UV exposure.The LED(light emitting diode)-based optical system has produced comparable measurement accuracies to the spectrometer and thus,with a potential for replacing the need for a multipurpose spectroscopy system for simple measurement of light attenuation.

Salvage treatments for prostate-specific antigen relapse of cT3N0M0 prostatic adenocarcinoma after radical prostatectomy combined with neoadjuvant androgen deprivation

Objective The aim of the study was to evaluate the efficiency of salvage treatments for prostate specific antigen(PSA)relapse of cT3N0M0 prostatic adenocarcinoma(PCa)after radical prostatectomy(RP)combined with neoadjuvant androgen deprivation(ADT).Methods A total of 332 patients with cT3N0M0 PCa were enrolled in the prospective study and received RP and pelvic lymph node dissection with neoadjuvant ADT for 3 months.All patients with PSA relapse were treated with salvage external beam radiation therapy(RT)and ADT for 6 months.Results The 5-year postoperative PSA relapse rate was 40.96%(136/332).The patients have been divided into the PSA relapse and PSA relapse-free groups in order to compare patient characteristics.The ratio of patients with Gleason score≥8 and positive surgical margin in the PSA relapse group were significantly higher than those of in the PSA relapse-free group(P=0.01).The mean duration between the start of operative treatment and PSA relapse was 31 months.Salvage treatment to all 136 PSA relapse patients led to favorable outcomes.PSA relapse was not observed after salvage treatment by the end of follow-up.The 5-year overall survival rates of the PSA relapse and PSA relapse-free groups were 94.9%and 93.9%,respectively.Conclusion In pursuit of curative treatment,our study showed that RP combined with neoadjuvant ADT is an aggressive multimodality strategy associated with lower PSA relapse and better survival outcomes for stage cT3N0M0 PCa patients.Patients with PSA relapse after RP may benefit from early aggressive salvage RT combined with short-term ADT.

Alleviation of Cancerous Pain by External Compress with Xiaozheng Zhitong Paste(消癥止痛方)

Objective： To observe the clinical effectiveness of a topical application of Xiaozheng Zhitong Paste （消癥止痛方, XZ.P） in alleviating the cancerous pain of patients with middle/late stage cancer. Methods： By adopting a random number table, 124 patients enrolled were randomized into the treatment group （64 patients） and the control group （60 patients）. In addition to the basic therapy [including the three-ladder （3L） analgesia] used in both groups, topical application of XZP was given to patients in the treatment group for pain alleviation. The analgesic efficacy was recorded in terms of pain intensity, analgesia initiating time and sustaining time, and the optimal analgesic effect revealing time. Meanwhile, the quality of life （QOL） and adverse reactions that occurred in patients were recorded as well. Results： The total effective rate in the treatment group was 84.38% （54/64）, and in the control group it was 88.33% （53/60）, showing no significant difference between them （P〉0.05）, but the analgesia initiating time and the optimal analgesia effect revealing time in the treatment group were significantly shorter （both P〈0.01）. Moreover, XZP was better in improving patients＇ QOL, showing more significant improvements in the treatment group than those in the control group in aspects of mental condition, walking capacity, working capacity, social acceptability, sleep and joy of living （P〈0.05 or P〈0.01）. Lower incidence of adverse reactions, such as nausea, vomiting, mouth dryness, dizziness, etc., especially constipation, was noted in the treatment group （P〈0.05 or P〈0.01）. Conclusion： Applying an external compress of XZP showed a synergistic action with 3L analgesia for shortening the initiating time and the optimal effect revealing time, and could evidently enhance patients＇ QOL with fewer adverse reactions.

Accelerated partial breast irradiation:Current evidence and future developments

Whole breast irradiation after breast-conserving surgery for early breast cancer has become one of the standard treatment modes for breast cancer and yields the same effect as radical surgery.Accelerated partial breast irradiation(APBI)as a substitute for whole breast irradiation for patients with early breast cancer is a hot spot in clinical research.APBI is characterised by simple high-dose local irradiation of the tumour bed in a short time,thus improving convenience for patients and saving costs.The implementation methods of APBI mainly include brachytherapy,external beam radiation therapy,and intraoperative radiotherapy.This review provides an overview of the clinical effects and adverse reactions of the main technologies of APBI and discusses the prospects for the future development of APBI.

Safety and efficacy of Tongkuaixiao ointment in reliving cancer-induced pain: a multicenter double-blind placebo-controlled randomized trial

OBJECTIVE: To evaluate the safety and efficacy of Tongkuaixiao ointment(TKXO) in treating moderate-to-severe cancer induced somatalgia.METHODS: Totally 130 patients with moderateto-severe cancer induced somatalgia were randomly divided into a TKXO group and a control group.The patients were treated with either TKXO applied externally or placebo, with opioid analgesics orally at the same time. Observation parameters were included numerical rating scale(NRS) scores,analgesic efficacy, initiation effective time, persistent analgesic time, equivalent morphine dose,National Comprehensive Cancer Network(NCCN)grade in Impact of Pain Measurement Scores, and safety and satisfaction extent investigation.RESULTS: NRS scores and NCCN grade in Impact of Pain Measurement Scores decreased significantly after 5-days' treatment in the two groups(P <0.0001). Compared to the control group, initiation effective time was significantly shorter(P < 0.05)and persistent analgesic time was significantly longer(P < 0.01), equivalent oral morphine doses of the first day and the whole treatment course were significantly decreased in the TKXO treatment group(P < 0.01 or P < 0.05). No obvious adverse effects were found in the TKXO group.CONCLUSION: TKXO combined with opioid analgesics possesses the advantages of high efficacy,fast action, long persistent action, safety and convenience in use, and it can reduce the dose of opioid.