Whole breast ultrafractionation radiotherapy after breast-conserving surgery in early breast cancer: A single-center, prospective, observational study from China

Objective:This single-center,prospective,observational study was designed to investigate the toxicities,patient-reported outcome(PRO),and dosimetric analysis of whole breast ultrafractionation radiotherapy(RT)after breast-conserving surgery(BCS)in early breast cancer(BC).Patients and methods:Patients diagnosed with BC stage I,II and treated with BCS were enrolled.A dose of 26 Gray(Gy)in five fractions was prescribed to the whole breast and tumor bed.Clinical endpoints included toxicities,PRO,and dosimetric analysis.PRO was measured by the European Organization for Research and Treatment of Cancer general quality of life questionnaire(EORTC QLQ-C30)and the BC-specific questionnaire(EORTC QLQ-BR23)questionnaires.Results:Between January 2022 and June 2023,62 female patients were enrolled.The median age was 45 years.Most patients(83.9%)were diagnosed with pathological stage I disease.The median planning target volume(PTV)was 456.4 mL.The minimum,maximum,and mean doses,and D95(dose of PTV irradiated volume more than 95%)to PTV were 20.2,28.8,27.2,and 26.3 Gy,respectively.The median mean lung dose and percentage lung volume receiving 8 Gy(V8)were 3.6 Gy and 13.4%,respectively.The median mean heart dose,V1.5(percentage of organ volume irradiated with 1.5 Gy or higher),and V7(percentage of organ volume irradiated with 7 Gy or higher)were 0.6 Gy,6.8%,and 0.4%,respectively.Cosmetic effects before RT showed no obvious differences compared to that post RT.No toxicities of grade 3 or higher occurred.Five patients had asymptomatic radiation pneumonia(grade 1),and 12 patients had radiation dermatitis(grade 1).No factor was significantly related to radiation dermatitis or radiation pneumonia.For the EORTC QLQ-C30 and QLQ-BR23 questionnaires,all function and symptom scores before RT had no significant differences compared with that after RT,1−2 months after RT,and 3−4 months after RT.Ultrafractionation RT did not worsen PRO.The 1-year crude local control was 100%.Conclusion:Whole breast ultrafractionation RT after BCS in early BC has no severe toxicities and does not affect PRO.These results need to be further validated with a longer follow-up and a larger sample size.

Assessing the Clinical Efficacy and Effectiveness of Sentinel Lymph Node Biopsy Combined with Breast-Conserving Surgery for Early-Stage Breast Cancer

Objective:To analyze the impact of sentinel lymph node biopsy(SLNB)combined with breast-conserving surgery in the clinical treatment of early-stage breast cancer.Methods:80 patients with early-stage breast cancer admitted to the Second Department of Breast Surgery at Dezhou Second People’s Hospital from September 2020 to September 2022 were selected and randomly divided into a control group and an observation group using the random number table method,with 40 cases in each group.The control group underwent a modified radical mastectomy,while the observation group underwent SLNB combined with breast-conserving surgery.The surgical efficacy and prognosis between the two groups were compared.Results:The observation group exhibited shorter operation,hospitalization,and extubation times,as well as less intraoperative blood loss and drainage volume,all of which were significantly better than those in the control group(P<0.05).Additionally,the observation group demonstrated a higher rate of excellent breast cosmetology and quality of life,with lower complication incidence,significantly outperforming the control group(P<0.05).There was no statistical difference in the metastasis rate and recurrence rate between the two groups(P>0.05).Conclusion:The combination of SLNB and breast-conserving surgery proves highly effective for patients with early-stage breast cancer,presenting fewer complications and enhancing both breast cosmetic outcomes and quality of life.

Clinical significance of S100A7 protein in predicting recurrence of breast cancer in patients undergoing breast-conserving surgery with radiotherapy

Objective To investigate the relationship between the expression of S100A7 protein and prediction of recurrence and prognosis of breast cancer in patients undergoing breast-conserving surgery combined with radiotherapy.Methods 349 samples of carcinoma tissue wax blocks were selected from January 2011 to January 2014 in Qingdao Central Hospital.All the patients had undergone breast-conserving surgery.We analyzed S100A7 expression in tumor tissue by immunohistochemical staining.Using univariate and multivariate analyses,we evaluated the relationship between S100A7 and clinical results,to explore independent risk factors for local regional recurrence(LRR).Results The positive expression of S100A7 in the recurrence group(66.7%)was significantly higher than in the non-recurrence group(38.4%),P=0.025.A log-rank test showed that high S100A7 expression was significantly correlated with 5-year regional recurrence free survival rate(RFS)(94.9%vs 89.5%,P=0.0408),distant metastasis free survival rate(DFS)(95.4%vs 83.5%,P<0.001),and overall survival rate(OS)(99.0%vs 92.5%,P=0.0011).Histological grade,vessel carcinoma embolus,lymph node metastasis,S100A7 expression,and tumor size were factors that influenced RFS.Multivariate analysis of the Cox proportional hazard model showed that high S100A7 expression was an independent risk factor that affected breast cancer RFS(HR=6.864,95%CI:1.575-29.915,P=0.01).Thus,we concluded that high S100A7 expression is associated with increased risk of LRR and distant metastasis of breast cancer after breast-conserving surgery and postoperative radiotherapy.S100A7 can be used as a molecular marker to screen for patients with high recurrence risk after breast-conserving surgery.

Application of Deep Inspiration Breath Hold Technique in Radiotherapy After Breast- Conserving Surgery for Left Breast Cancer and Its Improvement on Cardiac Dose

Objective:To analyze the application of deep inspiration breath hold technique in radiotherapy after breast-conserving surgery for left breast cancer and the improvement of cardiac dose.Methods:A total of 45 patients with left breast cancer treated in our hospital after breast-conserving surgery were selected,and the selection time was set from January 2020 to August 2022.All patients received radiotherapy.The right breast,heart,and lung volumes,and dose parameters of the heart,lungs,right breast,and left anterior descending coronary artery were compared under free breathing(FB)and deep inspiration breath hold(DIBH)technical modes.Results:The heart volume of the DIBH group was smaller than that of the FB group,and the left and right lung volumes were significantly larger than those of the FB group.In the DIBH group,the heart dose parameters V5,proper lung dose parameters,and left anterior descending coronary artery dose parameters were found lower than that of the FB group,and the differences were statistically significant(P<0.05).Conclusion:Compared with FB,the DIBH technique can reduce the heart’s size and increase the lung volume when used for radiotherapy after breast-conserving surgery for left breast cancer.It also reduces the dose to the heart,right lung,and left anterior descending coronary artery,thus protecting the heart and lungs.

Breast-conserving surgery and combined therapy for women breast cancer: a report of 216 cases

Objective： To explore the therapeutic effect and associated techniques of breast-conserving therapy on patients with clinical stage Ⅰ and stage Ⅱ breast cancer. Methods： 216 female patients with breast cancer underwent breast-conserving therapy from December 1993 to October 2004. Their data were analyzed retrospectively. The breast-conserving therapy consisted of lumpectomy or quadrant removal of the breast, postoperative radiotherapy, chemotherapy and endocrine therapy. Of them, 209 patients underwent axillary lymph node dissection. Results： There were no operative complications. 216 patients were followed-up 3 to 147 months, the medial follow-up time was 78 months. The local recurrence rate was 1.85%. Two patients died and one of them was not related with breast cancer. Presence or absence of fibrosis, shape of breast, asymmetry, pigmentation and handle were taken into consideration for cosmetic evaluation by the patients and experienced breast surgeon. Breasts were scored cosmetically as excellent and good in 199 patients, the rate of satisfactory was 92.13%. Conclusion： Breast-conserving therapy for early breast cancer is e safe end effective therapy. It has less trauma end less complications and can also raise the quality of life in the patients. But we must obey the strict indications and reasonable techniques.

Application of Ultimate Oncoplastic Surgery in Breast-Conserving Surgery

Objective To investigate the application of oncoplastic surgery in breast-conserving surgery.Methods We retrospectively analyzed the clinical data of 103 breast cancer patients who underwent breast-conserving surgery in the First Affiliated Hospital of Henan University.All the patients were female whose tumor volume-to-breast volume ratio was greater than 20%.Fifty-two patients were treated with oncoplastic breast-conversing surgery(observation group),and 51 patients were treated with traditional breast-conserving surgery(control group).The volume of resected tissue,subjective satisfaction with breast shape,objective score of breast shape,and follow-up were compared between the two groups.Results In the observation group,the weight of resected breast tissue was 64.2–172.1 g,with a median of 98.7 g.In the control group,the weight of resected breast tissue was 67.5–175.7 g,with a median of 102.3 g.After 12 months of follow-up,the subjective satisfaction rate and objective score of breast shape in the observation group were significantly better than those in the traditional breast-conserving surgery group(P<0.05).There was no recurrence,metastasis,or death in the two groups.There was no significant difference in postoperative complications between the two groups(P>0.05).Conclusion Oncoplastic breast-conserving surgery leads to better cosmetic results and a more satisfactory clinical results.

Effect of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma

AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized controlled trials(RCTs) that compared neoadjuvant chemoradiotherapy plus surgery(CRTS) with surgery alone(S) for esophageal cancer.According to the test of heterogeneity,a fi xed-effect model or a random effect model was used and the odds ratio(OR) was the principal measure of effects.RESULTS:Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C(Cochrane Reviewers' Handbook 4.2.2).OR(95% CI,P value),expressed as CRTS vs S(values>1 favor CRTS arm),was 1.19(0.94-1.48,P=0.28) for 1-year survival,1.33(1.07-1.65,P=0.69) for 2-year survival,1.76(1.42-2.19,P=0.11) for 3-year survival,1.41(1.06-1.87,P=0.11) for 4-year survival,1.64(1.28-2.12,P=0.40) for 5-year survival,0.82(0.39-1.73,P<0.0001) for rate of resection,1.53(1.33-2.84,P=0.007) for rate of complete resection,1.78(1.14-2.78,P=0.79) for operative mortality,1.12(0.89-2.48,P=0.503) for all treatment mortality,1.33(0.94-1.88,P=0.04) for the rate of adverse treatment,1.38(1.23-1.63,P=0.0002) for local-regional cancer recurrence,1.28(0.85-1.58,P=0.60) for distant cancer recurrence,and 1.27(0.86-1.65,P=0.19) for all cancer recurrence.A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients.The 5-year survival benefi t was most pronounced when chemotherapy and radiotherapy were given concurrently(OR:1.45,95% CI:1.26-1.79,P=0.015) instead of sequentially(OR:0.85,95% CI:0.64-1.35,P=0.26).CONCLUSION:Compared with surgery alone,neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence.Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.

Will the collaboration of surgery and external radiotherapy open new avenues for hepatocellular carcinoma with portal vein thrombosis?

Portal invasion of hepatocellular carcinoma(HCC)occurs in 12.5%-40%of patients diagnosed with cancer and yields poor clinical outcomes.Since it is a common cause of inoperability,sorafenib was regarded as the standard treatment for HCC in the Barcelona Clinic of Liver Cancer guidelines.However,the median survival of the Asian population was only approximately 6 mo,and the tumor response rate was less than moderate(<5%).Various locoregional modalities were performed,including external beam radiotherapy(EBRT),transarterial chemoembolization,hepatic arterial infusion chemotherapy,and surgery,alone or in combination.Among them,EBRT is a noninvasive method and can safely treat tumors involving the major vessels.Palliative EBRT has been commonly performed,especially in East Asian countries,where locally invasive HCC is highly prevalent.Although surgery is not commonly indicated,pioneering studies have demonstrated encouraging results in recent decades.Furthermore,the combination of neo-or adjuvant EBRT and surgery has been recently used and has significantly improved the outcomes of HCC patients,as reported in a few randomized studies.Regarding systemic modality,a combination of novel immunotherapy and vascular endothelial growth factor inhibitor showed results superior to that of sorafenib as a first-line agent.Future clinical trials investigating the combined use of these novel agents,surgery,and EBRT are expected to improve the prognosis of HCC with portal invasion.

Primary rectal squamous cell carcinoma treated with surgery and radiotherapy

Primary squamous cell carcinoma of the rectum is a rare malignancy,and the discrete dual lesions of rectum are even rarer.There is currently no effective and satisfactory treatment for this disease.Here we report a case of an elderly female with bi-primary squamous cell carcinoma of the rectum treated with radical resection and radiotherapy.The patient is still alive 43mo after the initial curative resection of the tumor.We suggest that surgery as the primary treatment followed by concomitant radiotherapy may be an effective protocol for elderly patients with rectal squamous cell carcinoma.

Clinical Outcome of Definitive Radiotherapy and/or Surgery in T1-2N0M0 Glottic Squamous Cell Carcinoma: A Single Institution Retrospective Report

Background: The current treatment options of early glottic carcinoma are radiotherapy;trans laser microsurgery, and open surgery. However, the best treatment is still controversial due to lack of randomized controlled trials. We aimed to evaluate the treatment results and the prognostic factors of local control of early glottic squamous cell carcinoma patients (GSCC) T1-2N0M0 treated at our institution. Material and Methods: We retrospectively studied the charts of 52 patients with early GSCC T1-T2N0M0 from 2010-2015 at the Clinical Oncology Department, Ain-Shams University. 24 patients had T1 and 28 had T2 early glottic carcinoma. The overall survival OS, local control rate, and laryngeal preservation rate were evaluated. Kaplan-Meier method, Cox proportional hazards model were used to analyze the data. Results: Median duration of follow-up was 13 months. Thirty-eight patients received radiation treatment alone (73.1%), 7.7% of the patients underwent surgery alone, and 19.2% of the patients had surgery combined with radiotherapy. Local recurrence after radiation failure developed in 6/52 patients, all had T2 disease and were salvaged by total laryngectomy. The ultimate local control rate was 88.5%, and the ultimate laryngeal preservation rate was 77.2% (40/52 patients). The median OS of the 52 patients was 13 months (range 2 - 46 months). Univariate analysis of factors associated with poor local control showed that age > 60 years was the only significant factor (P = 0.048). Conclusion: Radiotherapy achieves high local control and laryngeal preservation rates for patients with early glottic carcinoma, and is associated with a low rate of severe complications compared to surgery. Salvage surgery is feasible after radiotherapy failure.

Toxicity of Hypofractionated Radiotherapy Following Breast Conservative Surgery in Breast Cancer

Background:Adjuvant radiotherapy has increased disease-free and overall survival rates in breast cancer. Conventionally fractionated radiotherapy delivers 50 Gy over 5 weeks which is the standard approach. A shorter duration of hypofractionated radiotherapy (HFRT) will be more convenient for patients and treatment providers if found safe and equally effective. Material and Methods: Fifty-four breast cancer patients who underwent breast conservative surgery (BCS) were enrolled in this study. The patients received 4005 cGy/15 fractions. A boost to the tumor bed was administered in all patients. In this study, radiotherapy induced toxicity was evaluated. Results: In this study, the median age of our patients was 48 years with age ranged from 28 to 69 years. Acute skin toxicity was assessed, and it was noted that grade 2 skin toxicity was shown in only 6 patients (11.1%) at the end of radiotherapy and disappeared after 6 weeks of treatment. Late skin toxicity (telangectasia, hyperpigmentation, and subcutaneous fibrosis) was assessed and showed that most patients had grade 0 toxicity with no grade 3 toxicity at all. Regarding pulmonary toxicity, 5 patients (9.3%) developed acute pneumonitis and as regards chronic lung toxicity, it was evident in only 3 patients, 2 patients (3.7%) were grade 1 and 1 patient (1.9%) was grade 2. Cardiac toxicity was evident in 2 patients (7.1%) of the left breast cancer patients. Regarding lymphoedema, most patients that showed lymphoedema were grade 1. Conclusion: The results confirm the safety and feasibility of adjuvant hypofractionated whole breast radiotherapy in breast cancer patients in terms of acute and late toxicity.

Adjuvant chemoradiotherapy versus surgery alone for gastric adenocarcinoma

Objective:Despite resection with curative intent,a majority of patients with gastric cancer will develop disease recurrence.Postoperative adjuvant chemo-radiotherapy increase the curability of surgery,prevent local recurrence and improve survival.Methods:Between December 2005 and February 2010,33 patients were eligible for the study,17 patients were randomly assigned for chemo-radiotherapy (GI) and 16 patients with surgery alone (GII).Patients in GI received chemotherapy (fluorouracil,425 mg/m 2/day,and leucovorin,20 mg/m 2/day,for 5 days) was initiated on day 1 and was followed by chemo-radiotherapy beginning 28 days after the start of the initial cycle of chemotherapy.Chemo-radiotherapy consisted of 4500 cGy of radiation at 180 cGy/day,five days/week for five weeks,with fluorouracil (400 mg/m 2/day) and leucovorin (20 mg/m 2/day) on the first four and the last four days of radiotherapy.One month after the completion of radiotherapy,two five-day cycles of fluorouracil (425 mg/m 2/day) plus leucovorin (20 mg/m 2/day) were given one month apart.Results:Grade 3 gastrointestinal toxicity was more common (23.2%) while grade 3 hematological toxicity were (5.8%).Both 3-year survival (53%) and disease free survival (41%) rates were higher in GI than in GII in which they were 43.7% and 31% respectively.Relapse rate was higher in GII (56.3%) than in GI (35.3%).Conclusion:The present study revealed that chemo-radiotherapy after gastric resection in patients with gastric adenocarcinoma improves survival and relapse rates with manageable toxicities.However,studies with larger number of patients are recommended to confirm our results.

Concomitant Boost Radiotherapy after Conservative Breast Surgery in Early Breast Cancer

Background: Radiation therapy after breast conserving surgery is a standard part of treatment for invasive breast cancer. Based on radiobiological models, it was found that shorter radiation schedules offered the promise of equivalent local control to standard radiation therapy by giving larger doses per fraction in shorter period of time. Methods: This study included 36 female patients with operable invasive stage I-II breast cancer. These patients underwent microscopic wide local excision of the primary tumor and lymph node dissection. They received adjuvant radiotherapy. The radiation dose was 40 Gy total dose in 15 fractions for whole breast and additional dose of 9 Gy in three consecutive fractions was delivered to tumour cavity simultaneously. Results: Mean age was 52 years (range: 30 - 67);most patients were of stage II disease and Grade II was the most common one. Invasive ductal carcinoma was reported in 94.4% and 72.2% of patients were hormone receptor positive. After median follow-up of 52 months, all patients were alive and ipsilateral local recurrence was reported in 1 case only. Grade IV radiation toxicity was not observed;moist desquamation was the most common acute reaction (61%) with grade III in 5.5% followed by dry desquamation in 55.6% of grade I only. Grade I erythema was recorded in 41.7% and grade II in 11%. Fibrosis was the most frequent late reaction (44.3%) with grade II in 11% followed by telengectesia then pigmentation (41.7%, 33.3% respectively). Conclusion: The regimen used in this study appears promising with acceptable acute toxicities and convenient for our patients and has the advantage of economic use of radiation facilities. However, larger number of patients and longer period of follow-up are needed for further evaluation.

乳腺癌患者保乳术中放疗与术后全乳放疗的疗效、安全性及美容效果比较

目的 比较乳腺癌患者保乳术中放疗与术后全乳放疗的疗效、安全性及美容效果。方法 选择98例乳腺癌患者,均行保乳术。依照入院顺序分成A组(n=49)、B组(n=49),分别实施术后全乳放疗、术中放疗。比较两组并发症情况、美容效果、肿瘤标志物水平、远期预后。结果 B组并发症发生率为8.16%,显著较A组的24.49%低(P<0.05);B组美容优良率为89.80%,明显较A组的65.31%高(P<0.05);术后8周,两组血清糖类抗原(carbohydrate antigen, CA)125、癌胚抗原(carcinoembryonic antigen, CEA)水平均低于术前(P<0.05),组间比较差异无统计学意义(P>0.05);B组局部复发、转移、生存率分别为6.12%、0.00%与100.00%,与A组的2.04%、2.04%、97.96%比较差异无统计学意义(P>0.05)。结论 乳腺癌患者保乳术中放疗的远期效果和术后全乳放疗相当,但术中放疗可减少并发症的发生,提高乳房美容效果。

乳腺癌保乳术后大分割放疗与常规分割放疗的疗效及其安全性比较

目的比较早期乳腺癌保乳术后大分割放疗(HyRt)与常规分割放疗的疗效及其安全性。方法本研究为单中心、前瞻性、随机对照研究,纳入2017年5月-2019年5月唐山市人民医院收治的83例pTis-T2N0M0乳腺癌患者,接受保乳术+前哨淋巴结活检(SLNB),术后采用逆向调强放射治疗(IMRT)技术,采用随机数字表法分为大分割放疗组(n=41)与常规分割放疗组(n=42)。分析两组危及器官受量、治疗疗效、治疗失败模式及放疗相关不良反应。根据NCI CTC AE 3.0标准评估放疗相关不良反应,包括放射性皮炎、放射性肺炎、乳腺/皮肤纤维化、肺纤维化等。结果最终纳入83例乳腺癌患者,中位年龄44(26~67)岁。两组患者的年龄(P=0.443)、TNM分期(P=0.335)、分子分型(P=0.333)、分化程度(P=0.617)、病理类型(P=0.127)等临床参数比较,差异无统计学意义。与常规分割放疗组比较,大分割放疗组患者的患侧肺V5(25.6%vs.33.8%,P=0.015)、患侧肺V20(13.3%vs.17.2%,P=0.042)及患侧肺平均照射剂量(MLD;7.4 Gy vs.10.4 Gy,P=0.020)均明显降低。本组仅3例患者出现远处转移,未观察到区域淋巴结转移及局部复发。大分割放疗组与常规分割放疗组2年无进展生存(PFS)率无明显差异(94.4%vs.85.2%,P=0.818)。与常规分割放疗组比较,大分割放疗组≥Ⅱ级放射性皮炎发生率明显降低(2.4%vs.21.4%,P=0.015);大分割放疗组与常规分割放疗组Ⅰ级乳腺/皮肤纤维化发生率无明显差异(19.5%vs.14.3%,P=0.570),两组均未观察到≥Ⅲ级放疗相关不良反应。结论相较全乳常规放疗同期瘤床加量照射,早期乳腺癌保乳术后患者行HyRt耐受性好,不良反应发生率低,可作为首选的放射治疗模式。

复发性库欣病的最佳治疗选择:再次手术还是放疗

目的比较经蝶切除术(TSS)和放疗(RT)治疗复发性库欣病(CD)的缓解率、复发率和并发症发生情况,为患者诊疗选择提供临床证据学的支持。方法回顾性收集解放军总医院神经外科2010年1月-2022年12月收治的48例复发性CD患者,依据治疗方式的不同分为TSS组(26例)与RT组(22例),其中TSS组患者接受TSS,RT组患者接受RT,在术后1年比较两组患者的缓解率、复发率和并发症的发生情况。结果所有患者接受治疗后症状均有不同程度的改善(P<0.05)。TSS组与RT组患者缓解率分别为57.7%(37.3%~78.0%)和50.0%(27.3%~72.7%),差异无统计学意义(P=0.594);两组患者1年后复发率分别为7.7%(3.3%~18.7%)和9.1%(4.0%~22.1%),差异无统计学意义(P=0.861);两组患者并发症发生率分别为7.7%(-3.3%~18.7%)和4.5%(-4.9%~14.0%),差异无统计学意义(P=0.654)。结论本研究比较了目前在临床常用的治疗复发性CD的手术和RT两种治疗方法,两组患者缓解率、复发率及并发症发生率无显著差异。

联影URT-linac506c直线加速器在乳腺癌保乳手术后放疗中的应用价值

目的研究联影URT-linac506c直线加速器在乳腺癌保乳手术后放疗中的应用价值。方法回顾性选择2023年1—12月就诊于河南省人民医院的乳腺癌保乳手术后接受放射治疗的150例患者,随机分为两组,每组75例,对照组接受医科达infinity直线加速器,观察组接受联影URT-linac506c直线加速器。比较两种直线加速器照射误差、计划靶区的剂量参数、心脏、肺部与乳腺的受照剂量、照射反应。结果观察组X轴、Y轴、Z轴以及旋转角度误差均小于对照组(P<0.05)。两组D 1、D 99、D_(mena)剂量差异无统计学意义(P>0.05)。观察组适形指数、均匀性指数低于对照组(P<0.05)。两组心脏V 30、健侧乳腺D_(mena)照射剂量差异无统计学意义(P>0.05);观察组心脏D_(mena)、肺部患侧D_(mena)、V 30、健侧D_(mena)低于对照组(P<0.05)。所有患者均顺利完成放疗,未出现放疗终止的情况。观察组0~2度反应占比高于对照组(P<0.05),3级反应占比低于对照组(P<0.05)。两组4级反应差异无统计学意义(P>0.05)。结论乳腺癌保乳手术后采用联影URT-linac506c直线加速器放疗效果较好,可减小照射误差,降低计划靶区与危机器官的照射剂量,且皮肤照射反应程度较轻。

不同方法联合放疗治疗薄型瘢痕疙瘩的疗效及对MMPs、HIF-1α、TGF-β1的影响

目的探讨不同方法联合放疗治疗薄型瘢痕疙瘩的疗效及对基质金属蛋白酶(MMPs)、缺氧诱导因子-1α(HIF-1α)及转化生长因子-β1(TGF-β1)的影响。方法回顾性选取2020年10月至2022年9月内蒙古医科大学附属肿瘤医院(内蒙古自治区肿瘤医院)整形外科收治的胸腹部瘢痕疙瘩患者62例(瘢痕疙瘩数94个),依据治疗方法不同分为激光联合放疗(LCR)组(30例,瘢痕疙瘩数47个)、手术联合放疗(SCR)组(32例,瘢痕疙瘩数47个)。LCR组行CO 2点阵LCR,SCR组行SCR。观察两组治疗12个月后临床疗效、复发情况。比较两组治疗前、治疗12个月后的患者与观察者瘢痕评估量表(POSAS)评分、温哥华瘢痕量表(VSS)评分、瘢痕组织基质金属蛋白酶(MMP)-2、MMP-9、HIF-1α、TGF-β1等细胞因子水平的变化。结果LCR组总有效率(93.62%)大于SCR组(76.60%),复发率(4.26%)小于SCR组(19.15%),差异均有统计学意义(P<0.05)。治疗12个月后,LCR组POSAS、VSS评分分别为(23.96±2.64)、(5.28±0.54)分,均低于SCR组[(33.96±3.59)、(6.55±0.68)分],差异均有统计学意义(P<0.05)。LCR组瘢痕组织MMP-2、MMP-9及HIF-1α、TGF-β1表达量分别为111.65±13.55、106.76±12.68、1.24±0.14、1.10±0.12,均低于SCR组(127.96±14.71、121.08±14.33、1.55±0.17、1.22±0.13),差异均有统计学意义(P<0.05)。两组不良反应发生率比较(38.30%vs.46.81%),差异无统计学意义(P>0.05)。结论LCR和SCR均可改善薄型瘢痕疙瘩症状,抑制瘢痕疙瘩复发,但LCR的治愈率更高,复发率更低,对瘢痕组织MMPs及HIF-1α、TGF-β1表达抑制作用更强,且安全性较高,值得临床推荐。

胶质母细胞瘤治疗现状和困境

胶质母细胞瘤(glioblastoma,GBM)是颅内最常见的原发性恶性肿瘤,治疗困难,预后极差。GBM患者目前一般采用包括手术、放疗和化疗的综合治疗方案,中位生存期仅14.6个月,GBM复发患者中位生存期不超过8个月。新的治疗手段,如靶向治疗、电场治疗、溶瘤病毒、细胞治疗、肿瘤疫苗等不断涌现,在一定程度上延长了GBM患者生存期。但由于肿瘤恶性程度高、异质性高、免疫抑制性微环境、对现有放化疗响应差等原因,治疗效果尚未达到预期。本文对GBM传统治疗和新兴治疗手段进行分析及评述,解析其优点与不足,以期为GBM的治疗方案选择、设计,以及新药、新策略、新仪器设备研发等提供参考和思路。

Advances in regional nodal management of early-stage breast cancer

With the continuous improvement of systemic treatment, reasonable local regional control of early-stage breast cancer can be translated into survival benefits. The optimization of regional nodal management in patients with limited sentinel lymph node(SLN) metastasis needs to be weighed by surgical complications, regional recurrence risk, and lymph node status, as well as other escalating treatment(systemic/radiotherapy) that may result from deescalating surgery. With the effective support and supplementation of systemic therapy and radiotherapy, the management of axillary surgery is developing in a de-escalating trend. The widespread application of neoadjuvant therapy has contributed to optimizing the management of patients with clinically node-negative/imaging nodepositive disease. In clinical practice, it is necessary to consider the residual tumor burden of regional lymph nodes when formulating the optimal irradiation fields in patients with limited positive SLN without axillary lymph node dissection. The combined application of genomic tests and American College of Surgeons Oncology Group Z0011/AMAROS criteria could provide patients with a better strategy of dual de-escalation treatment, which includes the de-escalation of both axillary surgery and systemic treatment. In the era of sentinel lymph node biopsy(SLNB), the regional nodal management of breast cancer should adhere to the concept of “updating ideas, making bold assumptions, and carefully seeking proof”, make full use of the benefits of systemic therapy and radiotherapy to reduce the scope of surgery and complications, and expand the “net benefit” of efficacy and quality of life. This review discusses the optimization of regional nodal management in the era of SLNB, in order to provide reference information for clinicians.