Application of tangent-arc technology for deep inspiration breath-hold radiotherapy in left-sided breast cancer.

Objective: To explore the advantages of dosimetry and the treatment efficiency of tangent-arc technology in deep inspiration breath-hold radiotherapy for breast cancer. Methods: Forty patients with left-sided breast cancer who were treated in our hospital from May 2020 to June 2021 were randomly selected and divided into two groups. The first group's plan was a continuous semi-arc that started at 145° ( ± 5°) and stopped at 325° ( ± 5°). The other group's plan, defined as the tangent-arc plan, had two arcs: the first arc started at 145° ( ± 5°) and stopped at 85° ( ± 5°), and the second arc started at 25° ( ± 5°) and stopped at 325° ( ± 5°). We compared the target dose, dose in organs at risk (OARs), and treatment time between the two groups. Results: The target dose was similar between the continuous semiarc and tangent-arc groups. The V5 of the right lung was significantly different between the two groups (Dif 5.52, 95% confidence interval 1.92-9.13, t=3.10, P=0.004), with the patients in the continuous semi-arc and tangent-arc groups having lung V5 values of (9.16 ± 1.62)%, and (3.64 ± 0.73)%, respectively. The maximum dose to the spinal cord was (1835.88 ± 222.17) cGy in the continuous semi-arc group and (599.42 ± 153.91) cGy in the tangent-arc group, yielding a significant difference between the two groups (Dif 1236.46, 95% confidence interval 689.32-1783.6, t=4.57, P<0.001). The treatment times was (311.70 ± 60.45) s for patients in the continuous semi-arc group and (254.66 ± 40.73) s for patients in the tangent-arc group, and there was a significant difference in the mean number of treatment times between the two groups (Dif 57.04, 95% confidence interval 24.05-90.03, t=3.5, P=0.001). Conclusion: Both the continuous semi-arc and tangent-arc plans met the clinical prescription dose requirements. The OARs received less radiation with the tangent-arc plan than the continuous semi-arc plan, especially for the lung (measured as V5) and the spinal cord (measured as the maximum dose). Tangent-arc plan took significantly less time than the continuous semi-arc, which can greatly improve treatment efficiency. Therefore, tangent-arc plans are superior continuous semi-arc plans for all cases.

Prognostic Value of Radiotherapy and Chemotherapy in Stage I-III Merkel Cell Carcinoma.

PURPOSE: Merkel cell carcinoma (MCC) is a highly malignant cancer associated with dismal survival outcomes. Surgery is the cornerstone for the management of MCC, but the benefit of radiotherapy (RT) and chemotherapy (CT) is still controversial. We aimed to investigate the prognostic value of RT and CT in the management of stage I-III MCC patients using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS: Patients with a histopathological diagnosis of MCC between 2010 and 2016 were included. The primary endpoint of this study was overall survival (OS). The prognostic significance for OS was analyzed by Cox proportional hazard regression model. RESULTS: A total of 1,691 patients were identified in the SEER database. Over half of the patients had received RT (56.7%), and 9.8% of the patients were documented to have received CT. The median OS for the entire cohort was 66.0 months, and the 5-year OS rate was 53.8%. In the multivariate analysis, receiving RT was associated with significantly improved OS (P < 0.001), while receiving CT significantly negatively impacted OS (P = 0.010). In stage III patients who underwent treatment based on surgical resection, RT was still demonstrated to be a positive factor (P = 0.002), while CT had no significant association with OS in the univariate analysis (P = 0.295). CONCLUSIONS: The current data in the SEER database are consistent with earlier studies supporting the benefit of adjuvant RT for stage I-III MCC patients, but caution should be taken regarding the routine use of CT. For stage III MCC patients, the value of adjuvant CT needs to be confirmed in future studies.

A comparative study of auto-contouring softwares in delineation of organs at risk in lung cancer and rectal cancer.

Radiotherapy requires the target area and the organs at risk to be contoured on the CT image of the patient. During the process of organs-at-Risk (OAR) of the chest and abdomen, the doctor needs to contour at each CT image. The delineations of large and varied shapes are time-consuming and laborious. This study aims to evaluate the results of two automatic contouring softwares on OARs definition of CT images of lung cancer and rectal cancer patients. The CT images of 15 patients with rectal cancer and 15 patients with lung cancer were selected separately, and the organs at risk were manually contoured by experienced physicians as reference structures. And then the same datasets were automatically contoured based on AiContour (version 3.1.8.0, Manufactured by Linking MED, Beijing, China) and Raystation (version 4.7.5.4, Manufactured by Raysearch, Stockholm, Sweden) respectively. Deep learning auto-segmentations and Atlas were respectively performed with AiContour and Raystation. Overlap index (OI), Dice similarity index (DSC) and Volume difference (Dv) were evaluated based on the auto-contours, and independent-sample t-test analysis is applied to the results. The results of deep learning auto-segmentations on OI and DSC were better than that of Atlas with statistical difference. There was no significant difference in Dv between the results of two software. With deep learning auto-segmentations, auto-contouring results of most organs in the chest and abdomen are good, and with slight modification, it can meet the clinical requirements for planning. With Atlas, auto-contouring results in most OAR is not as good as deep learning auto-segmentations, and only the auto-contouring results of some organs can be used clinically after modification.

OGDH is involved in sepsis induced acute lung injury through the MAPK pathway.

BACKGROUND: Acute lung injury (ALI) induced by sepsis is a common cause of death in clinical practice, and there remains a lack of clinical effective treatment. Cecal ligation and puncture (CLP) is a classic animal model of sepsis, which can induce ALI. Studies have shown that in the lung injury cell model, OGDH (oxoglutarate dehydrogenase) transcription is up-regulated, which is a potential therapeutic target for acute pneumonia. The purpose of this study was to confirm the effects of OGDH on lung injury and inflammation in animal and cell models, and to explore its mechanism. METHODS: By analyzing the GSE16650 gene set, the upregulated OGDH gene was detected in the lung injury cell model. In a sepsis animal model established by CLP and a lung injury cell model, RT-PCR, immunohistochemistry, WB, and other techniques were used to verify the upregulation of OGDH expression, which was then was down-regulated with shRNA to confirm its relationship with ALI. Further, ELISA, RT-PCR, and WB were used to detect the effect of OGDH on the expression of pro-inflammatory factors including IL-1ß, IL-6, IL-18, and TNF-α. The downstream pathway of OGDH was predicted using KEGG and GSEA tools and verified by WB and immunofluorescence. RESULTS: The results showed OGDH was highly expressed in a lung injury cell model and the lung tissue of ALI mice induced by CLP, and downregulation of OGDH alleviated sepsis induced ALI. In animal models and cell models, the expression of OGDH was positively correlated with the expression of pro-inflammatory factors. OGDH may act through the MAPK pathway. CONCLUSIONS: Under the pathological condition of sepsis, OGDH amplifies the inflammatory response through the MAPK pathway, releases pro-inflammatory factors, and induces ALI.

Changes in the Psychological State of Medical Personnel in the Department of Radiotherapy at a Tertiary Care Teaching Hospital in China during the Epidemic.

OBJECTIVES: The aim of the present study was to investigate changes in the psychological state of medical personnel in the Department of Radiotherapy during the COVID-19 epidemic. METHODS: Psychological state was evaluated using the Pittsburgh Sleep Quality Index (PSQI), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS). All three questionnaires were first completed by medical personnel on 17-18 February 2020 and were repeated every 3 months thereafter until 17-18 August. The number and intentions of patients receiving radiotherapy (RT) in our department were also collected. RESULTS: Twenty medical personnel participated in the present study. The global PSQI score recorded in August was significantly lower than that recorded in February (P = 0.045). Among the seven components of the PSQI, sleep quality (P = 0.048) and daytime dysfunction (P = 0.006) in August were significantly improved compared with February, whereas SDS and SAS did not significantly differ among the three different time points. The proportion of patients who received palliative radiotherapy was significantly higher on 18 May than on 17 February (P = 0.005). CONCLUSIONS: Medical personnel in the Department of Radiotherapy experienced a significantly elevated incidence of sleeping problems during the early COVID-19 outbreak period. Multiple combinations of protective measures to avoid infection could improve sleep quality and ensure the safe delivery of RT to cancer patients.

Multimodal treatment based on thyroidectomy improves survival in patients with metastatic anaplastic thyroid carcinoma: a SEER analysis from 1998 to 2015.

BACKGROUND: The aim of this retrospective study was to evaluate multimodal treatments consisting of surgery, radiotherapy (RT) and chemotherapy (CT) in metastatic anaplastic thyroid carcinoma (ATC) patients using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS: Patients with a histopathologic diagnosis of ATC between 1998 and 2015 were included. The endpoint of this study was overall survival (OS). The prognostic significance in terms of OS was analyzed by univariate and multivariate analyses. RESULTS: A total of 433 metastatic ATC patients were identified. The median OS was two months, with a 1-year OS rate of 6.9%. In the multivariate analysis, the factors significantly correlated with OS were age [<68 vs. ≥68 years old, P=0.032, hazard ratio (HR) =1.252], tumor size (<7 vs. ≥7 cm, P=0.004, HR =1.418; <7 cm vs. unknown, P=0.005, HR =1.424), surgery at the primary site (none/unknown vs. less than thyroidectomy, P<0.001, HR =0.623; none/unknown vs. thyroidectomy, P=0.001, HR =0.616), use of RT (P<0.001, HR =0.562) and use of CT (P<0.001, HR =0.621). In the subgroup analysis, the combination of thyroidectomy, RT and CT demonstrated the best OS outcome when compared with other therapeutic modalities. CONCLUSIONS: Surgery, RT and CT were all strong prognostic factors for improved OS in metastatic ATC patients. In addition, treatment approaches consisting of thyroidectomy were beneficial compared with nonsurgical treatment. However, given the limited benefit of only a few months in the clinic, we suggest that thyroidectomy in combination with RT and CT should be delivered in selected patients with caution for better management of metastatic ATC.

Trends and predictors of survival for small cell carcinoma of the cervix uteri: A SEER population study.

OBJECTIVE: Small cell carcinoma of the cervix uteri (SCCC) is an uncommon cancer associated with unsatisfactory survival outcomes. We aimed to investigate the incidence and prognostic factors of survival in SCCC patients using the Surveillance, Epidemiology, and End Results database. METHODS: Eligible patients with histopathologic diagnoses of SCCC were identified between 2004 and 2015. Overall survival (OS) and cause-specific survival (CSS) for the included patients were calculated using the Kaplan-Meier method. Univariate and multivariate analyses of clinical factors were performed using Cox proportional hazard regression models. RESULTS: We identified 272 SCCC patients based on predefined criteria. The average incidence of SCCC was 1.01 % per year between 2004 and 2015. The median OS and CSS were 17.0 and 19.0 months, respectively, accompanying with 5-year OS rate was 26.3 % and 5-year CSS rate was 30.1 %. In the multivariate analysis, advanced age (age ≥ 65 years old), late FIGO stage, surgery at the primary site, radiotherapy (RT) and chemotherapy (CT) were strong prognostic factors for OS. The corresponding variables for CSS were: advanced age, late FIGO stage, RT and CT. In the subgroup analysis for nonsurgical management of SCCC, the combination of RT and CT provided the best survival outcomes when compared with other therapeutic modalities. Again, advanced age was interrelated to worse survival outcomes for both OS and CSS. CONCLUSIONS: SCCC is an infrequent disease with aggressive nature, which lead to poor survival outcomes. In addition to other known parameters, advanced age is a strong predictive factor for OS and CSS. The combination of RT and CT was the best therapeutic strategy for patients who received nonsurgical management.

Prognostic Value of the Geriatric Nutritional Risk Index in Patients Exceeding 70 Years Old with Esophageal Squamous Cell Carcinoma.

To investigate the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in esophageal squamous cell carcinoma (ESCC) patients treated with radiotherapy (RT) or definitive concurrent chemoradiotherapy (dCRT). Fifty-two ESCC patients were included from July 2014 to December 2018. RT was delivered at a dose of 1.8-2.0 Gy per day to a total dose of 50-60 Gy. Tumor response was assessed using the RECIST 1.1 system. Overall survival (OS) and progression-free survival (PFS) were calculated and compared with the Kaplan-Meier method. Multivariate analysis of predictive factors of response and survival was performed using a logistic regression and a Cox model, respectively. In multivariate analysis, GNRI score (HR 0.278, P = 0.036) was the only independent prognostic factor for tumor response. As for survival outcomes, GNRI score (OS: HR 0.505, P = 0.028; PFS: HR 0.583, P = 0.045) and treatment modality (OS: HR 0.356, P = 0.015; PFS: HR 0.392, P = 0.0014) were both independent prognostic factors for better OS and PFS. Additionally, there was no correlation between GNRI score and treatment modality (Spearman's ρ = 0.200; P = 0.154). In conclusion, routine use of the GNRI criteria may help in the risk stratification of elderly patients undergoing RT/dCRT. The dCRT treatment could provide survival benefits for elderly ESCC patients.

Intensity-modulated radiation therapy for patients with 1 to 3 brain metastases in recursive partitioning analysis class 3.

The prognosis is extremely poor for patients with brain metastases in recursive partitioning analysis (RPA) class 3. It is not clear whether dose elevation for brain lesions in addition to whole-brain radiotherapy could improve survival for those patients. This study aimed to assess the efficacy and safety of dose elevation with intensity-modulated radiation therapy (IMRT) for patients with 1 to 3 brain metastases in RPA class 3.From January 2013 to December 2015, 24 patients with 1 to 3 brain metastases in RPA class 3 were included in this study. The median age was 60 (range 41-85) years and the mean graded prognostic assessment (GPA) score was 1.25 (range 0.5-2). Whole-brain radiotherapy (30 Gy) with a simultaneous integrated boost (SIB) to the brain metastases (totaling 40 Gy) was delivered in 10 fractions using IMRT technique. Survival times and overall safety were assessed. The significance of prognostic variables on survival was assessed by both univariate and multivariate analyses.All of the patients completed the planned SIB schedule. The overall response rate was 66.7%. The median survival time (MST) was 8 months for the entire group of patients. The MST was 5 months for patients with a GPA score of 0.5 to 1 (n = 11 patients) and 12 months with a GPA score of 1.5 to 2 (n = 13 patients). No acute or late toxicities greater than grade 2 were detected. Age and subsequent chemotherapy were significantly associated with MST on univariate and multivariate analyses.It is feasible to elevate radiation doses to 40 Gy using the IMRT technique in RPA class 3 patients with 1 to 3 brain metastases without serious toxicities. The preliminary results are encouraging and further studies with larger cohorts are warranted.

Long-term results of definitive concurrent chemoradiotherapy using S-1 in the treatment of geriatric patients with esophageal cancer.

OBJECTIVE: The aim of this study was to investigate the efficiency and safety of using S-1 as monotherapy and maintenance therapy combined with definitive concurrent radiotherapy for elderly patients with esophageal cancer. PATIENTS AND METHODS: From January 2009 to December 2010, 68 elderly patients were included. Radiotherapy was delivered with a daily fraction of 1.8-2.0 Gy to a total radiation dose of 54.0-60.0 Gy. Preplanned concurrent S-1 (80 mg/m(2)/d) was given on days 1-14, every 3 weeks. After concurrent chemoradiotherapy, maintenance S-1 was repeated up to four cycles. RESULTS: The median age of the enrolled patients was 76 years (range: 70-88 years), and the clinical stages were stage I (two patients), stage II (24 patients), stage III (28 patients), and stage IV (14 patients). A total of 51 (75.0%) patients finished treatment on schedule, with a median of five cycles of S-1, in which 35 (51.5%) patients achieved complete response. The median follow-up time was 42.7 months, and the median overall survival (OS) and progression-free survival (PFS) times were 25.7 months and 21.5 months, respectively. The 1-year, 3-year, and 5-year OS and PFS rates were 70.6%, 41.8%, and 25.9% and 68.1%, 32.9%, and 15.9%, respectively. Grade ≥3 neutropenia and leukopenia were found in 14 patients and 13 patients, respectively. The most common nonhematologic toxicity was esophagitis including six patients and one patient with grades 3 and 4, respectively. Multivariate analysis revealed that cycles of S-1 and complete response were strong factors for OS and PFS. CONCLUSION: For geriatric patients with esophageal cancer, S-1 as monotherapy and maintenance chemotherapy in combination with definitive concurrent radiation therapy yielded satisfactory survival outcomes with tolerable toxicities. More studies are highly warranted to further clarify this issue.