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.
【Abstract】Objective To find out if apoptosis is induced after intra-radiotherapy and its effects on pericarcinomal tissue. Methods From 1994 to 1998, 44 patients with unresectable liver cancer received 32P-GMS intra-radiotherapy. After 2 to 6 months the tumors in 3 cases could be resected and we used this cases as the treatment group. We use 4 patients with resectional HCC of same age, diseased region, differentiated but without anyother therapy as the control group. The TUNEL staining was used to stain the resected tissue, and the apoptosis index was counted. Results The apoptosis index of carcinoma was 29%～34%, average (31±16)% in the treatment group and that of the control group was 4%～6%, average (5±12.2)%. The apoptosis index of pericarcinomal tissue was 27%～37%, average (35±11)% in the treatment group and that of the control group was 0.3%～5%, average (4.1±3.3)%. Conclusion 32P-GMS intra-radiotherapy can enhance the apoptosis of HCC and its adjacent tissue.
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.
Objective To evaluate the safety and efficacy of neoadjuvant therapy followed by minimally invasive esophagectomy (MIE) for locally advanced esophageal cancer. Methods We retrospectively analyzed clinical data of 56 consecutive patients with locally advanced esophageal cancer treated by neoadjuvant therapy followed by surgery in our hospital between January 2015 and December 2016. There were 51 males and 5 females. The patients were divided into 2 groups. Neoadjuvant therapy followed by open surgery esophagectomy group was as an OE group with 25 patients aged 61 (50-73) years. And neoadjuvant therapy followed by MIE was as a MIE group with 31 patients aged 60 (55-79) years. Results The pathologic complete response (pCR) rate of 28 patients with neoadjuvant concurrent chemoradiotherapy was significantly higher than that of 28 patients with neoadjuvant chemotherapy (21.4% vs. 10.7%, P<0.05). The operation time, intraoperative blood loss, R2 rate and the number of lymph nodes dissection in the MIE group were obviously better than those of the OE group with statistical differences (P<0.05). However, there was no significant difference in the number of resected lymph nodes along the bilateral recurrent laryngeal nerves and lymph node metastasis rate (P>0.05) between the two groups. The incidence of postoperative respiratory complications in the MIE group was lower than that of the OE group (P=0.041). There was no significant difference between the two groups in the incidence of other complications, re-operation, re-entry to ICU, median length of stay or perioperative deaths (P>0.05). There was only one patient with neoadjuvant concurrent chemoradiotherapy in the OE group died due to gastric fluid asphyxia caused by trachea-esophageal fistula. Conclusion Neoadjuvant therapy followed by MIE for locally advanced esophageal cancer is safe and feasible. The oncological outcomes seem comparable regardless of OE.
ObjectiveTo compare the dosimetric differences among the double-arc volumetric-modulated arc therapy (VMAT), 7 field intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3D-CRT) techniques in treatment planning for cervical cancer as adjuvant radiotherapy. MethodFifteen patients who underwent adjuvant chemotherapy for cervical cancer between March 1st and September 30th, 2013 were chosen to be our study subjects through random sampling. Under Pinnacle 9.2 planning system, the same CT image was designed through three different techniques:VMAT, IMRT and 3D-CRT. We then compared target zone fitness index, evenness index, D98%, D2%, D50% among those different techniques. Monitor unit (MU) and treatment time were also analyzed. ResultsThree techniques showed similar target dose coverage. The IMRT and VMAT plans achieved better target dose conformity, which reduced the V20 of the pelvic, the V50 of the rectum and bladder, as well as the V40/50 of the small intestine (P<0.05). The VMAT technique showed few dosimetric advantages over the IMRT technique. VMAT technique had the advantages of less MU (P>0.05) and shorter overall treatment time (P<0.01) compared with IMRT technique. ConclusionsThe IMRT and VMAT plans achieve similar dose distribution to the target, and are superior to the 3D-CRT plans, in adjuvant radiotherapy for cervical cancer. VMAT technique has the advantages of less MU and shorter overall treatment time.
Aiming at the disadvantages of traditional direct aperture optimization (DAO) method, such as slow convergence rate, prone to stagnation and weak global searching ability, a gradient-based direct aperture optimization (GDAO) is proposed. In this work, two different optimization methods are used to optimize the shapes and the weights of the apertures. Firstly, in order to improve the validity of the aperture shapes optimization of each search, the traditional simulated annealing (SA) algorithm is improved, the gradient is introduced to the algorithm. The shapes of the apertures are optimized by the gradient based SA method. At the same time, the constraints between the leaves of multileaf collimator (MLC) have been fully considered, the optimized aperture shapes are meeting the requirements of clinical radiation therapy. After that, the weights of the apertures are optimized by the limited-memory BFGS for bound-constrained (L-BFGS-B) algorithm, which is simple in calculation, fast in convergence rate, and suitable for solving large scale constrained optimization. Compared with the traditional SA algorithm, the time cost of this program decreased by 15.90%; the minimum dose for the planning target volume was improved by 0.29%, the highest dose for the planning target volume was reduced by 0.45%; the highest dose for the bladder and rectum, which are the organs at risk, decreased by 0.25% and 0.09%, respectively. The results of experiment show that the new algorithm can produce highly efficient treatment planning a short time and can be used in clinical practice.
ObjectiveTo understand the progress of postmastectomy radiotherapy (PMRT) in patients with T1–2N1M0 breast cancer. MethodThe studies and the treatment guidelines relevant to PMRT in the patients with T1–2N1M0 breast cancer in recent years were analyzed and summarized. ResultsThe ability of PMRT to improve the prognosis of patients with T1–2N1M0 breast cancer remained controversial. Owing to the patients with T1–2N1M0 breast cancer were heterogeneous, and the indications for PMRT had not been standardized. With the increasing use of neoadjuvant chemotherapy for early-stage breast cancer, some studies had attempted to formulate decisions about PMRT based on changes in tumor characteristics before and after neoadjuvant chemotherapy, but the findings were currently controversial. ConclusionsWhether PMRT can improve prognosis and decision-making for patients with T1–2N1M0 breast cancer is still controversial. Some ongoing clinical trials may provide some references for the optimal decision-making of PMRT for patients with T1–2N1M0 breast cancer.
Objective To evaluate the influence of resection status, pathological type, pathological stage and postoperative adjuvant therapy on prognosis of surgically treated thymic carcinoma. Methods In this retrospective study, 56 patients with surgically treated thymic carcinoma in the Department of Thoracic Surgery, Peking Union Medical College Hospital from January 2005 to December 2015 were enrolled. There were 30 males and 26 females aged 52.1±11.5 years ranging from 22 to 81 years. The survival curve was performed by Kaplan-Meier method. The prognostic factors affecting overall survival (OS) and disease-free survival (DFS) were analyzed by one-way analysis of variance (ANOVA). Results R0 resection was performed in 37 patients (67.9%), and other resections in 19 (32.1%); 13 patients suffered thymic carcinoma with Masaoka stage Ⅰ-Ⅱ, 26 Ⅲ, and 17 Ⅳ. Low-grade thymic carcinoma was found in 42 patients, and high-grade in 14. Postoperative radiotherapy, chemotherapy and chemoradiotherapy were performed on 17, 12 and 18 patients respectively and 9 patients were untreated. Forty-one patients was followed up for 1 to 10 years, and the follow-up rate was 73%. The 1-, 3- and 5-year OS rates were 93%, 74% and 61%, respectively. Resection status and pathological stage affected OS. Postoperative radiotherapy after R0 resection affected DFS, but did not affect OS. Conclusion Most patients with thymic carcinoma after surgery can survive for a long period, and R0 resection is the most important prognostic factor of thymic carcinoma. Postoperative radiotherapy after R0 resection in patients with Masaoka stage Ⅱ-Ⅲ is recommended.
Objective To discuss the important role of preoperative chemoradiotherapy in the treatment of mid-low rectal cancer. Methods From the surgical point of view, the evidences from clinic trials in literatures of recent years and also from the results of our single institution were analyzed. Results Preoperative radiotherapy with total dosage of 50 Gy had showed more and more advantages in the past two decades. Preoperative radiotherapy with concomitant chemotherapy had definite effects in downing stage and improving local control, while its role in sphincter preserving kept in controversy. However, this combined preoperative therapies had not improved long-term survival in rectal cancer. By now, there were no proper indicators to predict the effects of therapies. Conclusion Preoperative chemoradiotherapy is still the only way to improve the rate of R0 resection and decrease the rate of local currence after surgery for patients with mid-low advanced rectal cancer.
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.