Objective To investigate efficacy and toxicity of XELOX or FOLFOX4 regimen as neoadjuvant concurrent chemoradiotherapy for stage Ⅱ/Ⅲ middle and low rectal cancer. Methods From June 2011 to March 2014, 120 patients with stage Ⅱ/Ⅲ middle and low rectal cancer who underwent the surgical treatment were enrolled in The Fifth People’s Hospital of Qinghai Province, then were randomly divided into radiotherapy+FOLFOX4 regimen group and radiotherapy+XELOX regimen group. The radiotherapy and chemotherapy were performed simultaneously before the radical resection of rectal cancer. Three-dimensional conformal radiotherapy: 1.8–2.0 Gy/times, 5 times/week, a total of 25 times, the total dose was 45.0–50.0 Gy. At the same time, 2 cycles of chemotherapy were performed according to the FOLFOX4 program (oxaliplatin+leucovorin+5-fluorouracil) or XELOX regimen (capecitabine tablet+oxaliplatin). The radical surgery was performed on 4 to 8 weeks after the preoperative chemoradiotherapy, then 8 to 12 cycles of FOLFOX4 chemotherapy and 4 to 6 cycles of XELOX chemotherapy were completed in the radiotherapy+FOLFOX4 regimen group and the radiotherapy+XELOX regimen group respectively on 1 month after the radical surgery. The curative effect and the occurrence of acute toxicity were observed. Results ① There were no significant differences in thegeneral data such as the gender, age, cT stage, cN stage, TNM stage, histological type, differentiation degree, etc. between the two groups(P>0.05). ② The reduced staging rates of cT and cN in the radiotherapy+XELOX regimen group was 63.3% (38/60) and 86.7% (52/60), respectively, which was significantly higher than that in the radiotherapy+FOLFOX4 regimen group〔38.3% (23/60) and 53.3% (32/60), respectively〕 , the differences were statistically significant (P<0.05). ③ The complete response rate and the effective rate (complete response rate+partial response rate) in the radiotherapy+XELOX regimen group were significantly higher than those in the radiotherapy+FOLFOX4 regimen group (P<0.05). ④ The overall 3-year survival rate in the radiotherapy+XELOX regimen group was significantly higher than that in the radiotherapy+FOLFOX4 regimen group (P<0.05). There were no significant differences in the 3-year disease-free survival rate, distant metastasis rate, and local recurrence rate between the two groups (P>0.05). ⑤ All the patients suffered from 3 to 4 degrees toxicities, however, the incidence rates of the overall toxicity and the diarrhea toxicity in the radiotherapy+XELOX regimen group were significantly lower than those in the radiotherapy+FOLFOX4 regimen group (P<0.05). Conclusion Preliminary results of limited cases in this study show that XELOX regimen is more effective and less acute toxicity than FOLFOX4 regimen for preoperative concurrent chemoradiotherapy for patients with stage Ⅱ/Ⅲ middle and low rectal cancer.
ObjectiveCompare the two-degrade collimator (MLC) angle selection's impact on plan quality and operational efficiency for volumetric intensity-modulated radiotherapy (VMAT) in the treatment planning system, and to explore the scheme for treatment plan optimization. MethodsTwenty patients with nasopharyngeal carcinoma underwent the treatment between March and December 2013 were randomly selected and planned for SIBVMAT treatment with different parameters set in the range of 0-60°with 15°interval for collimator angles. Planned dose distribution to the target volumes, organs at risk, and monitor units were compared. ResultsAs the MLC angle increased, target conformal index and homogeneity index had a trend to became deteriorated. The optimal plans were 0°and 15°, while 45°and 60°plans gave poor protection for the organ at risk compare to other angle plans and the monitor units were significantly increased. ConclusionChange the MLC angle had visible impact on treatment plans,there was a trend to deteriorate with the MLC angle increased, but small changes in MLC angle range can theoretically reduce the influence from leakage radiation on the human body.
Objective To assess the clinical effectiveness, safety and cost-effectiveness of adjuvant radiotherapy(RT) for endometrial cancer compared to other treatmen. Method The following electronic databases were searched: MEDLINE, EMBAS, CancerLit, CBMdisc, CNKI. The Cochrane Library (Issue 3, 2007). Correlative websites, such as ‘google’, were searched by hand. The studies included in the references of eligible studies were additionally searched RCTs of adjuvant radiotherapy before March, 2007 comparing adjuvant radiotherapy with other treatment for endometrial cancer were included. Eligible RCTs were assessed for quality by two reviewers independently: criteria of concealment of treatment, blinding, standard validity and reliability of outcome measures, withdraw rate, intention-to-treat analysis and homogeneity between centers were analyzed for each study. All data were performed by a meta-analysis. Result Seven RCTs met the inclusion criteria/ Methodological quality was level B. Five RCTs were compared adjuvant radiotherapy (external beam radiotherapy (EBRT) and /or intracavitary radiotherapy (ICRT) with other treatment, Two RCTs including one RCT was compared two different fractionation schedules for postoperative vagina high-dose-rate(HDR) irradiation in endometrial carcinoma the other RCT was compared two different radiotherapy method (pelvic radiotherapy and vagina radiotherapy vs vagina radiotherapy) for endometrial carcinoma. No survival different were identified; none of the studies was powered enough to show a survival benefit. But who received RT had fewer local (pelvic and/or vagina) recurrences compared to women not receiving RT. Adverse effects is found more often in RT than in not RT, there is less localrecurrences in combined radiotherapy (pelvic radiotherapy and vagina radiotherapy) than in vagina radiotherapy. lowdose vagina radiotherapy had few vagina shortening than high-dose radiotherapy, there are the same 5-overall surviva, local recurrences and distant recurrences. Conclusions Adjuvant radiotherapy for endometrial can cer can better control local recurrences than observation for postoperative endometrial cancer. Effects about overall survival, distant recurrences and disease-free survival are similar; low-dose vagina radiotherapy has few vagina shortening than high-dose radiotherapy, there are the same 5-years overall survival, local recurrences and distant recurrences for endometrial cancer, there is less local recurrences in combined radiotherapy (pelvic radiotherapy plus vagina radiotherapy) than in vagina radiotherapy for endometrial cancer; postoperative high-dose brachytherapy can get good cost-effectiveness; Effect of adjuvant radiotherapy for overall survival and disease-free survival of endometrial carcinoma are needed to further assessed by rigorously designs, randomized, double-blind, placebo-controlled trials adjuvant radiotherapy for endometrial carcinoma.
ObjectiveTo construct a multimodal imaging radiomics model based on enhanced CT features to predict tumor regression grade (TRG) in patients with locally advanced rectal cancer (LARC) following neoadjuvant chemoradiotherapy (NCRT). MethodsA retrospective analysis was conducted on the Database from Colorectal Cancer (DACCA) at West China Hospital of Sichuan University, including 199 LARC patients treated from October 2016 to October 2023. All patients underwent total mesorectal excision after NCRT. Clinical pathological information was collected, and radiomics features were extracted from CT images prior to NCRT. Python 3.13.0 was used for feature dimension reduction, and univariate logistic regression (LR) along with Lasso regression with 5-fold cross-validation were applied to select radiomics features. Patients were randomly divided into training and testing sets at a ratio of 7∶3 for machine learning and joint model construction. The model’s performance was evaluated using accuracy, sensitivity, specificity, and the area under the curve (AUC). Receiver operating characteristic curve (ROC), confusion matrices, and clinical decision curves (DCA) were plotted to assess the model’s performance. ResultsAmong the 199 patients, 155 (77.89%) had poor therapeutic outcomes, while 44 (22.11%) had good outcomes. Univariate LR and Lasso regression identified 8 clinical pathological features and 5 radiomic features, including 1 shape feature, 2 first-order statistical features, and 2 texture features. LR, support vector machine (SVM), random forest (RF), and eXtreme gradient boosting (XGBoost) models were established. In the training set, the AUC values of LR, SVM, RF, XGBoost models were 0.99, 0.98, 1.00, and 1.00, respectively, with accuracy rates of 0.94, 0.93, 1.00, and 1.00, sensitivity rates of 0.98, 1.00, 1.00, and 1.00, and specificity rates of 0.80, 0.67, 1.00, and 1.00, respectively. In the testing set, the AUC values of 4 models were 0.97, 0.92, 0.96, and 0.95, with accuracy rates of 0.87, 0.87, 0.88, and 0.90, sensitivity rates of 1.00, 1.00, 1.00, and 0.95, and specificity rates of 0.50, 0.50, 0.56, and 0.75. Among the models, the XGBoost model had the best performance, with the highest accuracy and specificity rates. DCA indicated clinical benefits for all 4 models. ConclusionsThe multimodal imaging radiomics model based on enhanced CT has good clinical application value in predicting the efficacy of NCRT in LARC. It can accurately predict good and poor therapeutic outcomes, providing personalized clinical surgical interventions.
Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision （TME） in treatment for locally advanced lower rectal cancer. Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively. Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken. The efficacy was assessed by recording results of clinical and pathological examination. The function of sphincter was also recorded. Results All 31 patients underwent TME operation. The complication morbidity and mortality was 12.9% （4/31） and 3.2% （1/31），respectively. As a result of the preoperative management，the tumor was reduced by an average of 21.9%， down-regulation of T stage was observed in 48.4% （15/31） patients，the frequency of lymph node metastasis decreased from 83.9% （26/31） to 38.7% （12/31）. Pathological complete response was observed in 5 patients （16.1%） and the total response rate was 74.2% （23/31），grade 3/4 toxicity was occurred in 2 （6.5%） patients. 84.6% （22/26） of patients underwent sphincter preservation surgery reserved good function of sphincter. Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe，which can lead to pathological complete response，decrease the tumor stage and the rate of lymph node metastasis，and can also increase the efficacy of operation.
Non-coding RNA (ncRNA) is a newly discovered functional RNA different from messenger RNA, which can participate in the regulation of tumor occurrence and development. Studies have shown that ncRNA can participate in the regulation of radiotherapy response to gastric cancer, and its mechanism may be related to its influence on DNA damage repair, gastric cancer cell stemness, apoptosis, and activation of epidermal growth factor receptor signal pathway. This article summarizes the mechanism of ncRNA regulating the response of gastric cancer to radiotherapy, and looks forward to the potential clinical application of ncRNA in the resistance of gastric cancer to radiotherapy.
Thymoma is aggressive and persistent, but does not belong to malignant tumors. In treatments, their optimal treatment protocols still need to be studied and how about the role and the place of use of postoperative radiotherapy is not clear. Some retrospective studies indicate a direction: for the first stage of thymoma, it is adequately treated with complete resection alone. For the second stage of the thymoma, postoperative radiotherapy needs further indications. For the third and fourth stages of thymoma, postoperative radiotherapy plays an important role. A research shows that the radiation dose at 50 Gy is suitable for microscopic tumors, and higher dose of radiation is suitable for macroscopic tumors. With the development of radiotherapy technology, its application scope becomes larger and larger. What kind of the role and the place for radiotherapy in the treatment of thymoma and what is the optimal management of thymoma need to be treated prudently.
Objective To observe the therapeutic efficacy and complications of plaque radiotherapy (PRT) combined with transpupillary thermotherapy (TTT) on choroidal melanoma (CM). Methods Thirty unilateral CM patients (30 eyes, including 15 males and 15 females) were treated by PRT and TTT. The visual acuity ranged from 0.1 to 0.8 with an average of 0.3plusmn;0.2. The largest base diameter of tumor ranged from 6.8 mm to 17.9 mm with an average of (11.3plusmn;2.8) mm；The tumor height ranged from 3.9 mm to 10.6 mm with an average of (7.2plusmn;2.4) mm. The criteria of controlled local tumor: based on B-scan ultrasound measurement, the tumor was considered as ldquo;growingrdquo; if tumor height increased 2 mm or tumor largest base diameter increased 250 mu;m, otherwise the tumor was considered ldquo;controlledrdquo;. The followup ranged from 15 to 57 months with an average (33.01plusmn;9.81) months. The local tumor control rate, enucleation rate and visual acuity, complications after treatment were observed.Results The tumor largest base diameter after treatment ranged from 4.6 mm to 17.0 mm with an average (9.79plusmn;3.35) mm, which had statistically significant difference（t=2.195，F=0.49；P=0.032) with that before treatment. The tumor height after treatment ranged from 2.7 mm to 11.9 mm with an average (5.19plusmn;2.57) mm, which had statistically significant difference（t=2.069，F=0.018；P=0.0435) with that before treatment. At the end of follow up, the tumor largest diameter and height increased in two eyes respectively compared with those before treatment. Local tumor control rate was 86.7%. Three eyeballs were enucleated after treatment，the enucleation rate was 10.0%. The visual acuity remained unchanged in 12 eyes，improved in one eye and decreased in 17 eyes. Treatment complications included radiation retinopathy in 12 eyes (40.0%), secondary retinal detachment in three eyes (10.0%), secondary glaucoma in one eye (3.3%), cataract in four eyes (13.3%) and dry eye syndrome in five eyes (16.7%). Conclusion PRT combined with TTT is an effective therapy for choroidal melanoma with less complications.
ObjectiveTo evaluate the possible role of the expression of insulin-like growth factor-1 receptor (IGF-1R) in determining rectal cancer radiosensitivity. MethodsThe paired preradiation biopsy specimens and postoperative specimens were obtained from 87 patients with rectal cancer in the department of digestive tumor surgery, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2009 to December 2010. The IGF-1R expression was examined by immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR). The tumor radiosensitivity was defined according to Rectal Cancer Regression Grade, then the relation between the IGF-1R expression and tumor radiosensitivity was evaluated. ResultsCompared with the preradiation biopsy specimens, IGF-1R expression significantly increased in the paired postoperative specimens of the residual cancer cells (Plt;0.001). The IHC result demonstrated IGF-1R overexpression was significantly associated with a poor response to radiotherapy (rs=0.401, Plt;0.001); RT-PCR detection of IGF-1R expression on preradiation biopsy specimens also showed that IGF-1R mRNA negative patients had a higher radiation sensitivity (rs=0.497, Plt;0.001). ConclusionDetection of IGF-1R expression may predict radiosensitivity of preoperative irradiation for rectal cancer.
Objective To analyze the efficacy of breast-conserving surgery with adjuvant radiation therapy (BCS+RT) vs. mastectomy (MAST) for early breast cancer among young Chinese patients. Methods Young female breast cancer patients (≤40 years old) treated at West China Hospital of Sichuan University between January 1st, 2008, and December 31st, 2019 were analyzed for clinical staging, molecular subtypes, surgical techniques, and prognostic assessments using follow-up data. Results Of 974 eligible patients in this study, 211 underwent BCS+RT and 763 underwent MAST. The Kaplan-Meier analyses indicated that there was no significant difference in the 5-year locoregional recurrence-free survival rate (99.1% vs. 99.4%, P=0.299), distant metastasis-free survival rate (97.9% vs. 96.4%, P=0.309), breast cancer-specific survival rate (100.0% vs. 97.0%, P=0.209), or overall survival rate (99.4% vs. 96.8%, P=0.342) between patients who underwent BCS+RT and those who underwent MAST. The multiple Cox proportional hazards regression analyses revealed that the treatment approach (BCS+RT or MAST) did not significantly predict locoregional recurrence-free survival (P=0.427), distant metastasis-free survival (P=0.154), breast cancer-specific survival (P=0.155), or overall survival (P=0.263). Subgroup analyses showed that there was no statistically significant difference in survival outcomes between BCS+RT and MAST in different clinical stages or molecular subtypes. Clinical stage and molecular subtype should also not be regarded as independent factors in deciding the treatment approach. Conclusions Receiving BCS+RT or MAST treatment does not affect the survival outcomes of young early-stage breast cancer patients, showing similar efficacy across various clinical stages and molecular subtypes. Choosing BCS+RT is considered safe for early-stage young female breast cancer patients eligible for breast conservation.