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Flash radiotherapy 闪光放射治疗
Pub Date : 2019-11-15 DOI: 10.3760/CMA.J.ISSN.1004-4221.2019.11.014
Wei Zhao, Yuan Tian, Hao Peng
Flash radiotherapy (Flash-RT) is a treatment modality that uses the normal tissue sparing regimen induced by ultra-high dose rate and ultra-fast irradiation. Compared to conventional dose rate radiotherapy, Flash-RT has the potential to provide the isoefficacy for tumors while achieving the remarkable normal tissue protection. Due to this unique feature, Flash-RT is attracting more and more attention from the radiotherapy community. An abundance of groups from both academia and industry are extensively studying the therapeutic ratio and underlying biological mechanisms. Here, we review the prior knowledge about Flash-RT and summarize the results that have been reported from various groups using both in vitro and animal studies with different experimental protocols. We also discuss possible biological mechanisms and the challenging of implementing Flash-RT, as well as its possible options for clinical applications. Key words: Flash radiotherapy; Dose rate; Dosimetry; Hypoxia; Ultra-fast irradiation
闪光放射治疗(Flash RT)是一种使用超高剂量率和超快辐射诱导的正常组织保留方案的治疗方式。与常规剂量率放疗相比,Flash RT有可能在实现显著的正常组织保护的同时,为肿瘤提供等效性。由于这种独特的特性,Flash RT越来越受到放射治疗界的关注。来自学术界和工业界的许多团体正在广泛研究治疗比例和潜在的生物学机制。在这里,我们回顾了先前关于Flash RT的知识,并总结了使用不同实验方案的体外和动物研究从各个小组报告的结果。我们还讨论了可能的生物学机制和实施Flash RT的挑战,以及其临床应用的可能选择。关键词:闪光放射治疗;剂量率;剂量测定;缺氧;超快辐照
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引用次数: 3
Analysis of the poor prognostic factors affecting 48 cases of cervical stump carcinoma 48例宫颈残端癌预后不良因素分析
Pub Date : 2019-11-15 DOI: 10.3760/CMA.J.ISSN.1004-4221.2019.11.009
Y. Mu, Seyiti Ayinuer, K. Gulina
Objective To explore the poor prognostic factors of patients with cervical stump carcinoma, aiming to provide certain reference for the clinical diagnosis and treatment. Methods Clinical data of 48 patients with cervical stump carcinoma admitted to the Affiliated Tumor Hospital of Xinjiang Medical University from January 1, 2005 to December 1, 2016 were retrospectively analyzed. A total of 19 patients (40%) withⅠA-ⅡA stage cervical stump carcinoma were treated with surgery+ adjuvant therapy and 29 patients (60%) in ⅡB-Ⅳ stage received radiotherapy combined with chemotherapy. The median age of onset was 51 years old. Uterine fibroids were the main cause of subtotal hysterectomy. The average time interval from subtotal hysterectomy to definite diagnosis was 10.76 years. Results The 1-, 3-, 5-year survival rate was 98%, 83% and 74%, respectively. Univariate analysis demonstrated the time interval from subtotal hysterectomy (P=0.016), tumor diameter (P=0.016), clinical stage (P=0.036), histological grade (P=0.009), lymph node metastasis (P=0.044), parametrial invasion (P=0.046), myelosuppression (P=0.013) and radical surgery (P=0.019) were the poor prognostic factors of cervical stump carcinoma. Conclusions Poor prognosis of patients with cervical stump carcinoma is correlated with tumor diameter, clinical stage, histological grade, lymph node metastasis, parametrial invasion and myelosuppression. Histological grade is an independent risk factor. Key words: Cervical stump; Malignant neoplasm/radiochemotherapy; Prognosis
目的探讨影响宫颈残端癌患者预后的因素,为临床诊断和治疗提供一定的参考。方法回顾性分析2005年1月1日至2016年12月1日新疆医科大学附属肿瘤医院收治的48例宫颈残端癌患者的临床资料。ⅠA ~ⅡA期宫颈残端癌19例(40%)采用手术+辅助治疗,ⅡB ~Ⅳ期29例(60%)采用放化疗联合治疗。发病年龄中位数为51岁。子宫肌瘤是子宫次全切除术的主要原因。从子宫次全切除术到确诊的平均时间间隔为10.76年。结果1、3、5年生存率分别为98%、83%、74%。单因素分析显示,子宫次全切除术时间间隔(P=0.016)、肿瘤直径(P=0.016)、临床分期(P=0.036)、组织学分级(P=0.009)、淋巴结转移(P=0.044)、参数性侵(P=0.046)、骨髓抑制(P=0.013)和根治性手术(P=0.019)是影响宫颈残端癌预后的因素。结论宫颈残端癌患者预后不良与肿瘤直径、临床分期、组织学分级、淋巴结转移、参数性侵及骨髓抑制有关。组织学分级是一个独立的危险因素。关键词:宫颈残端;恶性肿瘤/ radiochemotherapy;预后
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引用次数: 0
Radiation-induced changes in small world network in patients with nasopharyngeal carcinoma: a three-dimensional structure MRI imaging study 鼻咽癌患者放射引起的小世界网络改变:三维结构MRI成像研究
Pub Date : 2019-11-15 DOI: 10.3760/CMA.J.ISSN.1004-4221.2019.11.003
X. Xin, Chen Chuandong, Churong Li, Jie Li, Pei Wang, Yin Tian, G. Yin, J. Lang
Objective To investigate the radiotherapy (RT)-induced changes in the brain structural network in patients with nasopharyngeal carcinoma (NPC). Methods Three-dimensional structural magnetic resonance data (3D-T1W) was adopted to investigate the structural network in 103 patients with NPC before and after receiving RT. The structural networks were then reconstructed using 3D-T1W. The radiation-induced changes in topology properties of small world network were analyzed by using graph theoretical analysis. Results Patients showed small world properties before and after RT. Compared with the pre-RT group, the global and local efficiency were lower, the shortest path length was longer and the clustering coefficient was less in the post-RT group. In addition, the hub regions in the post-RT group were significantly different from those in the pre-RT group, mainly located in the left rolandic operculum, right inferior frontal gyrus, right parahippocampal gyrus, right lingual gyrus, bilateral supramarginal gyrus, left superior temporal gyrus and temporal pole of the right middle temporal gyrus. Conclusion It is speculated that RT leads to high efficiency of network topology and information transmission, which provides a novel perspective for exploring the RT-induced brain changes, diagnosis of RT-induced injury and evaluation of RT efficacy. Key words: Nasopharyngeal neoplasm/radiotherapy; Voxel-based morphometry; Gray matter; Small world property
目的探讨放疗(RT)对鼻咽癌(NPC)患者脑结构网络的影响。方法采用三维结构磁共振(3D-T1W)对103例鼻咽癌患者接受rt前后的结构网络进行研究,并利用3D-T1W对结构网络进行重建。利用图论分析方法分析了辐射引起的小世界网络拓扑性质变化。结果患者在放疗前后均表现出小世界特征,与放疗前相比,放疗后患者整体和局部效率较低,最短路径长度较长,聚类系数较低。此外,rt后组中枢区与rt前组有显著性差异,主要位于左侧罗兰盖、右侧额下回、右侧海马旁回、右侧舌回、双侧边缘上回、左侧颞上回和右侧颞中回颞极。结论推测RT可提高网络拓扑和信息传递的效率,为RT致脑改变的探索、RT致损伤的诊断和RT疗效的评价提供了新的视角。关键词:鼻咽肿瘤/放疗;分布形态测量学;灰质;小世界性质
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引用次数: 0
Adjuvant trastuzumab reduces locoregional recurrence in women who underwent mastectomy without radiation therapy for HER-2-positive breast cancer: a retrospective analysis with propensity score matching 辅助曲妥珠单抗减少了未接受HER-2-阳性乳腺癌症放射治疗的乳房切除术妇女的局部复发:倾向评分匹配的回顾性分析
Pub Date : 2019-11-15 DOI: 10.3760/CMA.J.ISSN.1004-4221.2019.11.007
H. Jing, Shulian Wang, Yu Tang, Yong-wen Song, H. Fang, Jianyang Wang, Jiang-hu Zhang, J. Jin, Yueping Liu, S. Qi, Yuan Tang, Ning Li, Bo Chen, N. Lu, Yexiong Li
Objective To investigate the locoregional benefit from adjuvant anti-HER-2 target therapy and the possibility of omitting postmastectomy radiation therapy (PMRT) in HER-2 positive breast cancer patients. Methods Clinical data of 1398 patients diagnosed with HER-2+ breast cancer admitted to our hospital who underwent mastectomy without PMRT from 2009 to 2014 were retrospectively analyzed, and 370 of them received adjuvant anti-HER-2 target therapy mainly with trastuzumab. Results Anti-HER-2 target therapy significantly improved the disease-free survival (DFS) and overall survival (OS), whereas reduced the locoregional recurrence (LRR) insignificantly. Multivariate analysis demonstrated that anti-HER-2 target therapy improved the locoregional recurrence-free survival (LRRFS)(P=0.06). After propensity score matching, the 5-year LRR rate was 4.4% vs. 6.4%(P=0.070) for those treated with and without anti-HER-2 target therapy. Subgroup analysis revealed that the locoregional control benefit was only significant in patients with pathological Grade Ⅰ-Ⅱtumors (2.5% vs. 5.9%, P=0.046). For patients with pN1 tumors with and without anti-HER-2 target therapy, the 5-year LRR rate was 8.2% vs. 12.3%(P=0.150). Patients with hormone receptor-positive tumors obtained significant benefit from anti-HER-2 target therapy. The 5-year LRR rate could be less than 5% in patients with favorable risk factors who received anti-HER-2 target therapy. Conclusions Anti-HER-2 target therapy with trastuzumab can improve the LRRFS of patients with HER-2+ breast cancer after mastectomy. Nevertheless, patients with radiotherapy indications have to receive radiotherapy due to relatively high recurrence rate. Newly approved dual HER-2 blockade is a promising approach to further reduce LRR. Subgroup analysis is required to identify the low-risk patients. Key words: Breast neoplasm/target therapy; HER-2 gene; Locoregional recurrence; Locoregional recurrence-free survival
目的探讨辅助抗HER-2靶向治疗癌症HER-2阳性乳腺癌的局部疗效及省略术后放疗(PMRT)的可能性。方法回顾性分析我院2009-2014年收治的1398例HER-2+乳腺癌症患者在未经PMRT的情况下行乳房切除术的临床资料,其中370例患者接受了以曲妥珠单抗为主的辅助抗HER-2靶向治疗。结果抗HER-2靶向治疗能显著提高患者的无病生存率(DFS)和总生存率(OS),但局部复发率(LRR)降低不显著。多因素分析表明,抗HER-2靶向治疗提高了局部无复发生存率(LRRFS)(P=0.06)。在倾向评分匹配后,接受和不接受抗HER-2目标治疗的患者的5年LRR率分别为4.4%和6.4%(P=0.070)。亚组分析显示,局部区域控制获益仅在病理性Ⅰ-Ⅱ级肿瘤患者中显著(2.5%对5.9%,P=0.046)。对于有和没有抗HER-2靶向治疗的pN1肿瘤患者,5年LRR率为8.2%对12.3%(P=0.050)。激素受体阳性肿瘤患者从抗HER-2目标治疗中获得显著获益。在接受抗HER-2靶向治疗的具有有利危险因素的患者中,5年LRR率可能低于5%。结论曲妥珠单抗抗HER-2靶向治疗能改善癌症HER-2+患者乳房切除术后的LRRFS。然而,有放疗指征的患者由于复发率相对较高,不得不接受放疗。新批准的双重HER-2阻断是一种有希望进一步降低LRR的方法。需要进行亚组分析以确定低风险患者。关键词:乳腺肿瘤/靶向治疗;HER-2基因;局部复发;局部无复发生存率
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引用次数: 0
The microdamage of " morphologically normal white matter" in patients with nasopharyngeal carcinoma after radiotherapy and its correlation with the irradiation dose 鼻咽癌放疗后“形态正常白质”的微损伤及其与放疗剂量的相关性
Pub Date : 2019-11-15 DOI: 10.3760/CMA.J.ISSN.1004-4221.2019.11.010
Wenting Ren, Chao Sun, R. Wu, Ying Cao, Xin Liang, Ying-jie Xu, P. Ma, Fei Han, T. Lu, J. Yi, J. Dai
Objective To explore the correlation between microdamage in white matter and radiotherapy dose at early stage after radiotherapy (RT) in patients with nasopharyngeal carcinoma (NPC). Methods Thirty-three patients who were initially diagnosed with NPC were recruited and received diffusion tensor imaging (DTI) scan and neuro-cognitive scale test within 1 week before RT and the first day after RT. DTI-related characteristic parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ‖), and radial diffusivity (λ⊥) were calculated based on whole-brain voxel analysis method. Paired t-test was conducted to evaluate statistical significance between pre-RT and post-RT groups. In the subgroup analysis, all the subjects were divided into 3 groups according to the average dose of temporal lobe, and each group was set with an equal dose interval range. The DTI-related parameters of whole brain pre-RT and post-RT in each group were statistically compared. All the statistical results were corrected by FDR with a threshold of P 100. Results FA, MD, λ‖ and λ⊥in the post-RT group significantly differed compared with those in the pre-RT group (P<0.05). The values of FA, MD, λ‖ and λ⊥were 0.455±0.016, (9.893±0.403)×10-4, (13.441±0.412)×10-4 and (8.231±0.429)×10-4, respectively. Subgroup analysis showed that the extent and degree of λ‖ and λ⊥ changes were exacerbated with the increase of the average dose of temporal lobe after RT. Particularly in high-dose group, the average dose range was 25-35 Gy and the extent of regions with significant changes was significantly larger than those in the medium-dose (15-25 Gy) and low-dose groups (5-15 Gy)(P<0.05). Conclusions DTI can be utilized to detect" normal" brain tissue microdamage in NPC patients at early stage after RT. The average radiation dose of temporal lobe may be one of the reasons for the severity of cerebral microdamage. In the future, DTI technique may be useful for guiding exposure dose of organs at risk during RT planning and to evaluate the cohort with a high risk of cerebral microdamage at early stage after RT, thereby protecting normal cerebral tissues to the maximum extent. Key words: Diffusion tensor imaging; Nasopharyngeal neoplasm/radiotherapy; Radiation-induced brain injury; Dosimetry
目的探讨鼻咽癌放疗后早期白质微损伤与放疗剂量的相关性。方法对33例初次诊断为鼻咽癌的患者在放疗前1周和放疗后第1天进行弥散张量成像(DTI)扫描和神经认知量表测试,基于全脑体素分析方法计算径向扩散率(λõ)。进行配对t检验以评估RT前组和RT后组之间的统计学显著性。在亚组分析中,根据颞叶的平均剂量将所有受试者分为3组,每组设定相等的剂量间隔范围。对各组RT前后全脑DTI相关参数进行统计学比较。所有统计结果均通过FDR进行校正,阈值为P100。结果放疗后组FA、MD、λ‖和λõ与放疗前组比较有显著性差异(P<0.05),FA值分别为0.455±0.016、9.893±0.403×10-4、13.441±0.412×10-4和8.231±0.429×10-4。亚组分析表明,随着RT后颞叶平均剂量的增加,平均剂量范围为25~35Gy,有显著变化的区域明显大于中剂量组(15~25Gy)和低剂量组(5~15Gy)(P<0.05)。颞叶的平均辐射剂量可能是脑微损伤严重的原因之一。未来,DTI技术可能有助于在RT计划期间指导风险器官的暴露剂量,并在RT后的早期评估大脑微损伤风险较高的队列,从而最大限度地保护正常脑组织。关键词:扩散张量成像;鼻咽肿瘤/放射治疗;放射性脑损伤;剂量测定法
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引用次数: 0
Progress in adjuvant therapy decision-making after endoscopic resection of early esophageal cancer 内镜下早期食管癌切除术后辅助治疗决策的研究进展
Pub Date : 2019-11-15 DOI: 10.3760/CMA.J.ISSN.1004-4221.2019.11.015
F. Lingling, M. Yu, H. Zhouguang
Both endoscopic resection and surgery are the common treatment modes for early esophageal cancer. Compared with radical surgery, endoscopic resection has the advantages of less trauma, quicker recovery, lower cost, less complications, the preservation of the normal anatomy, the physiological function of the esophagus, and higher postoperative quality of life. For patients with a high risk of lymph node metastasis, endoscopic resection alone can lead to inadequate treatment, which need adjuvant therapies. Currently, the common adjuvant therapies consist of adjuvant radiochemotherapy and adjuvant radiochemotherapy combined with surgery. How to combine endoscopic resection with adjuvant therapy to bring maximal benefits to patients has become the hot topic in the field of clinical researches. In this article, the current research status, progress and challenges in the combination of endoscopic resection and adjuvant therapy for the treatment of high-risk patients were reviewed. Key words: Esophageal neoplasm/endoscopic resection; Esophageal neoplasm/surgery; Esophageal neoplasms/chemoradiotherapy; Progress
内镜切除和手术是早期食管癌常见的治疗方式。与根治性手术相比,内镜切除具有创伤小、恢复快、费用低、并发症少、保留正常解剖结构、食道生理功能、术后生活质量高等优点。对于淋巴结转移的高危患者,单纯内镜切除可能导致治疗不足,需要辅助治疗。目前常见的辅助治疗包括辅助放化疗和辅助放化疗联合手术。如何将内镜切除与辅助治疗相结合,使患者获得最大的利益,已成为临床研究领域的热点。本文就内镜切除与辅助治疗联合治疗高危患者的研究现状、进展及面临的挑战进行综述。关键词:食管肿瘤/内镜切除;食管肿瘤/手术;食管肿瘤/化疗;进步
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引用次数: 0
Research progress on application of the combination of radiotherapy and immune-checkpoint blockade in treatment of stage III unresectable non-small cell lung cancer 放疗联合免疫检查点阻断治疗III期不可切除非小细胞肺癌的研究进展
Pub Date : 2019-11-15 DOI: 10.3760/CMA.J.ISSN.1004-4221.2019.11.016
Rutian Li, Zhengfei Zhu, Lifeng Wang, Jing Yan, Yingtzu Yan, Baorui Liu
Chemoradiation has been the standard treatment of stage Ⅲ unresectable non-small cell lung cancer (NSCLC) for a long period of time. However, the clinical efficacy of chemoradiation has not been significantly improved in recent two decades. In the past 2-3 years, the role of immune-checkpoint inhibitors in metastatic NSCLC has been persistently strengthened. Moreover, the synergistic effect between radiotherapy and immune-checkpoint blockade has been conformed in pre-clinical and clinical studies. Recent clinical trials have demonstrated that the combination of radiotherapy and immune-checkpoint blockade has been proven to be more effective in the treatment of stage Ⅲ unresectable NSCLC. In this article, the latest clinical studies since 2017 regarding the application value of this combined treatment of stage Ⅲ unresectable NSCLC were summarized. Key words: Lung neoplasm/radiotherapy; Immune-checkpoint blockade; Research progress
长期以来,放化疗一直是Ⅲ期不可切除非小细胞肺癌(NSCLC)的标准治疗方法。然而,近二十年来,放化疗的临床疗效并没有显著提高。在过去的2-3年中,免疫检查点抑制剂在转移性NSCLC中的作用不断加强。此外,在临床前和临床研究中,放疗与免疫检查点阻断之间的协同作用已得到证实。最近的临床试验表明,放疗和免疫检查点阻断联合治疗Ⅲ期不可切除的非小细胞肺癌更有效。本文对2017年以来该联合治疗Ⅲ期不可切除NSCLC应用价值的最新临床研究进行综述。关键词:肺肿瘤/放疗;Immune-checkpoint封锁;研究进展
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引用次数: 0
Application of deep inspiration breath-hold technique in radiotherapy 深吸气屏气技术在放射治疗中的应用
Pub Date : 2019-11-15 DOI: 10.3760/CMA.J.ISSN.1004-4221.2019.11.001
R. Zhong, S. Bai
In radiotherapy for thoracic and abdominal tumors, the negative effect of respiratory movement on radiotherapy persist throughout the whole process of radiotherapy. Deep inspiration breath-hold technique (DIBH) is a method of respiratory movement management in radiotherapy, which can reduce the negative effect of respiratory movement upon radiotherapy in the whole process of radiotherapy. Meantime, DIBH technique has its own characteristics and operation requirements compared with other respiratory movement management measures (such as 4D CT, gated technology and tracking, etc.). The aim of this review was to introduce the advantages, disadvantages and the application status of DIBH technique. Key words: Deep inspiration breath-hold; Neoplasm/radiotherapy
在胸腹肿瘤放疗中,呼吸运动对放疗的负面影响贯穿整个放疗过程。深吸气屏气技术(DIBH)是放疗中呼吸运动管理的一种方法,可以在整个放疗过程中减少呼吸运动对放疗的负面影响。同时,与其他呼吸运动管理措施(如4D CT、门控技术、跟踪等)相比,DIBH技术有其自身的特点和操作要求。本文综述了DIBH技术的优缺点及应用现状。关键词:深吸气屏气;肿瘤/放射疗法
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引用次数: 0
Experimental study of ginsenoside Rg3 in the treatment of acute radiation proctitis in rat models 人参皂苷Rg3治疗急性放射性直肠炎大鼠模型的实验研究
Pub Date : 2019-11-15 DOI: 10.3760/CMA.J.ISSN.1004-4221.2019.11.012
Tingting Hu, Hongyi Cai
Objective To evaluate the efficacy of ginsenoside Rg3(GRg3) in the treatment of acute radiation proctitis in rat models. Methods On the 7th day after 21.5 Gy irradiation, 100 rats were divided into the control group (normal saline, n=20), GRg3 group (gavage of 20 mg/kg, 40 mg/kg and 80 mg/kg GRg3, n=20 for each dose) and Smecta mixture enema group (n=20). After 2 weeks, all rats were anesthetized with chloral hydrate (3 ml/kg) and approximately 5 ml of blood sample was collected from the abdominal aorta prior to sacrifice. The rectal tissues were taken and prepared for detection of Bax and NF-κB contents and HE staining to observe the pathological changes of the rectal tissues. After the blood samples were centrifuged, the supernatants were collected for ELISA to detect the serum levels of IL-2, IL-6, TNF-α and MPO in each group. Results In the GRg3 group, the serum inflammatory cytokines, serum MPO concentration and the concentration of Bax and NF-κB in the intestinal tissues of rats were decreased along with the increasing dose of GRg3. These parameters in the high-dose GRg3 group were significantly lower than those in the saline group (all P 0.05), suggesting that GRg3 exerted good therapeutic effect on acute radiation proctitis in rat models. Conclusions GRg3 can significantly reduce the concentration of inflammatory cytokines, Bax and NF-κB in the intestinal tissues of rat models with acute radiation proctitis, which is more efficacious than the normal saline. GRg3 can be used to treat acute radiation proctitis in rat models. Key words: Ginsenoside Rg3; Acute radiation proctitis; Rat
目的评价人参皂苷Rg3(GRg3)治疗大鼠急性放射性直肠炎的疗效。方法在21.5Gy照射后第7天,将100只大鼠分为对照组(生理盐水,n=20)、GRg3组(灌胃GRg3 20mg/kg、40mg/kg和80mg/kg,每剂量n=20)和思密达混合灌肠组(n=20)。2周后,用水合氯醛(3ml/kg)麻醉所有大鼠,并在处死前从腹主动脉采集约5ml血样。取直肠组织进行Bax和NF-κB含量检测和HE染色,观察直肠组织的病理变化。离心后,收集上清液进行ELISA检测各组血清IL-2、IL-6、TNF-α和MPO水平。结果GRg3组大鼠血清炎性细胞因子、血清MPO浓度、肠组织Bax和NF-κB浓度均随GRg3剂量的增加而降低。大剂量GRg3组的这些参数明显低于生理盐水组(均P 0.05),表明GRg3对大鼠急性放射性直肠炎模型有良好的治疗作用。结论GRg3能显著降低急性放射性直肠炎模型大鼠肠组织中炎性细胞因子、Bax和NF-κB的浓度,其作用优于生理盐水。GRg3可用于治疗大鼠急性放射性直肠炎模型。关键词:人参皂苷Rg3;急性放射性直肠炎;大鼠
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引用次数: 1
Clinical study of salvage strategy for patients with locally recurrent esophageal cancer after definitive radiochemotherapy 局部复发性食管癌症放化疗后抢救策略的临床研究
Pub Date : 2019-11-15 DOI: 10.3760/CMA.J.ISSN.1004-4221.2019.11.006
Chen Yongshun, Chen Xinyu, Song Hai-xia, Ke Shaobo, C. Guowei, S. Wei, Q. Hu, G. Yi, Chen Jiamei
Objective To investigate the salvage strategy and efficacy for patients with locally recurrent esophageal squamous cell carcinoma after definitive radiochemotherapy. Methods A total of 126 patients who met the inclusion criteria were enrolled in this study and divided into the salvage surgery, salvage radiochemotherapy and best supportive care. Results Fifty-eight of 126 patients received salvage esophagectomy, 52 underwent salvage radiochemotherapy and the remaining 16 patients received best supportive care. The 1-, 3-, 5-year overall survival rates of patients receiving salvage therapy were 51%, 16% and 4% for the three groups, whereas all patients in the best supportive care group died within 12.0 months (P<0.001). The 1-, 3-, 5-year survival rates in the salvage surgery and salvage radiochemotherapy groups were 48%, 20% and 7%, and 51%, 11% and 3%, respectively (P=0.473). Multivariate analysis by Cox proportional hazard model showed that T staging of recurrent tumors and salvage regimen were the independent prognostic factors in patients with locally recurrent esophageal cancer (both P<0.001). Postoperative infection occurred in 16% of the patients in the salvage surgery group, and the incidence of esophagotracheal fistula and mediastinoesophageal fistula was 10% and 6% in the salvage radiochemotherapy group. Conclusions A survival benefit can be elicited by salvage surgery or salvage radiochemotherapy in patients with locally recurrent esophageal cancer after definitive radiochemotherapy. Nevertheless, extensive attention should be paid to the management of postoperative complications in clinical practice. Key words: Esophageal neoplasm, local recurrence/salvage therapy; Prognosis
目的探讨食管鳞癌局部复发患者放化疗后的抢救策略及疗效。方法选取符合入选标准的126例患者,分为补救性手术、补救性放化疗和最佳支持治疗组。结果126例患者中58例接受了补救性食管切除术,52例接受了补救性放化疗,其余16例接受了最佳支持治疗。三组患者接受救助治疗的1、3、5年总生存率分别为51%、16%和4%,而最佳支持治疗组患者均在12.0个月内死亡(P<0.001)。补救性手术组和补救性放化疗组的1、3、5年生存率分别为48%、20%和7%,51%、11%和3% (P=0.473)。Cox比例风险模型多因素分析显示,肿瘤复发T分期和挽救方案是局部复发食管癌患者预后的独立影响因素(P均<0.001)。抢救性手术组术后感染发生率为16%,抢救性放化疗组食管气管瘘和纵隔食管瘘发生率分别为10%和6%。结论食管癌局部复发患者在明确放化疗后,行补救性手术或补救性放化疗可提高患者的生存期。然而,在临床实践中应广泛关注术后并发症的处理。关键词:食管癌;局部复发/挽救治疗;预后
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中华放射肿瘤学杂志
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