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Objective To evaluate the efficacy and safety of intensity modulated radiation therapy (IMRT) for whole-brain radiotherapy with simultaneous integrated boost for brain metastases.Methods From January 2015 to January 2017,120 patients with brain metastases undergoing hospital radiotherapy at the First People's Hospital and the Second People's Hospital of Yulin City of Guangxi Zhuang Autonomous Region were randomly divided into three dimensional conformal radiation therapy (3DCRT) group (n =60) and IMRT group (n =60) by envelope method.The curative effects of the two groups and the changes of patient's mental states before and after radiotherapy were compared.Results The median survival times of patients in 3DCRT group was 11.5 months,and the 6 months and 1 year survival times rates were 83.3％ and 35.0％ respectively.The median survival times of patients in IMRT group was 12.9 months,and the 6 months and 1 year survival rates were 86.7％ and 38.3％ respectively.There was no significant difference in prognosis between the two groups (x2 =0.143,P =0.705).There were 8 cases with complete remission,38 cases with partial remission,11 cases with stable disease,3 cases with progressive disease in 3DCRT group,and there were 9,40,9,2 cases in IMRT group respectively.There was no statistically significant difference in short-term efficacy between the two groups (Z =-0.641,P =0.520).Univariate analysis results showed that recursive partitioning analysis (RPA) classification (x2=53.484,P ＜0.001),extracranial lesions control (x2=13.392,P ＜ 0.001),whether the midline offset (x2 =4.427,P =0.035) were prognostic factors.Multivariate analysis results showed that RPA classification (HR =2.631,95 ％ CI:1.884-3.673,P ＜ 0.001),extracranial lesions control (HR =1.697,95％ CI:1.034-2.786,P =0.037),whether the midline offset (HR =1.787,95％ CI:1.118-2.856,P =0.015) were the independent prognostic factors for the overall survival.According to the results of activities of mini-mental state examination,the scores of 3DCRT group before and after radiotherapy were 27.12 ± 2.42 and 26.08 ± 2.42 respectively,with a significant difference (t =2.723,P =0.009);and the scores of IMRT group before and after radiotherapy were 26.57 ± 3.09 and 27.20 ± 2.46 respectively,with no significant difference (t =-1.610,P =0.1 13).Conclusion IMRT for whole-brain radiotherapy with simultaneous integrated boost is an effective treatment for multiple brain metastases,which can relieve symptoms,prolong survival time and improve quality of life.
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OBJECTIVE:To investigate the characteristics and regularity of pediatric adverse drug reactions(ADR)in our hos-pital in order to promote rational drug use of children. METHODS:In retrospective study,378 pediatric ADR cases collected from our hospital during 2010-2014 were analyzed statistically. RESULTS:Among 378 pediatric ADR cases,255 cases were male (67.46%),and 123 cases were female (32.54%);the incidence of ADR in patients aged from one year to three years were the highest (27.51%);most of the cases were induced by intravenous injection,accounting for 87.57%(331 cases);sterile powder for injection was main dosage form (236 cases,62.43%) anti-infective agents were the major cause of ADR in respect of drug types (50.26%),among which cephalothin ranked the first place(43.68%);the lesion of skin and its appendants were the most common clinical manifestation of ADR(56.35%),such as erythra and pruritus. And most of the cases were cured(64.29%)or im-proved(34.66%)after treatment. CONCLUSIONS:The occurrence of ADR are related to multiple factors,such as administration route and drug varieties. Great importance should be attached to indication,route of adiminstration,method,speed and so on,in order to promote rational drug use and reduce the occurrence of ADR.
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OBJECTIVE:To evaluate the clinical efficacy of liraglutide and insulin glargine in the treatment of type 2 diabetes mellitus (T2DM) and conduct pharmacoeconomic analysis, and to provide economical and reasonable T2DM treatment plan. METHODS:80 T2DM patients were randomized into liraglutide group and insulin glargine group,with 40 cases in each group. Both groups were given Metformin hydrochloride sustained-release tablet orally 0.5-2.0 g/d,and diabetes mellitus diet and sport training guide after oral antidiabetic drug withdrawal of previous treatment plan. Liraglutide group was given Liraglutide injection hypodermically,0.6-1.2 mg,qd;insulin glargine group was given insulin glargine hypodermically at 22 o’clock,initial dose of 0.2 IU/(kg·d),adjusted according to the levels of PG,FBG,nocturnal blood glucose level till FBG≤7 mmo1/L and 2 h PG ≤10 mmol/L in both group. Treatment course of 2 groups lasted for 12 weeks. The changes of FBG,2 h PG,HbA1c and BMI were ob-served in 2 groups before and after treatment. 2 therapy plans were evaluated and compared by cost-minimization analysis. RE-SULTS:After treatment,the levels of FBG,2 h PG and HbA1c decreased significantly in 2 groups,compared to before treatment, with statistical significance (P0.05). After treat-ment,BMI of liraglutide group decreased significantly compared with before treatment and insulin glargine group,with statistical significance (P0.05). Cost-minimization analysis showed that the cost of insulin glargine group in reducing FBG,2 h PG and HbA1c were less than liraglutide group,but were more than liraglutide group in reducing BMI. Sensitivity analysis demonstrated the stability and reliability of cost-minimization analysis. CONCLUSIONS:Lira-glutide and insulin glargine have the same clinical efficacy,but insulin glargine need lower cost in blood glucose control,and liraglutide is better therapy plan for body weight control.
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Objective To evaluate the efficacy and toxicity of induction chemotherapy with nedaplatin and docetaxel plus concurrent intensity?modulated radiotherapy ( IMRT) with nedaplatin or cisplatin in the treatment of locally advanced nasopharyngeal carcinoma (NPC). Methods A total of 223 patients with pathologically diagnosed locally advanced NPC in five treatment centers from 2011 to 2012 were randomly divided into two groups. In the test group, one hundred and thirteen patients received two cycles of induction chemotherapy with docetaxel (65 mg/ m2 on day 1) and nedaplatin (80 mg/ m2 on day 1) plus concurrent IMRT with nedaplatin (40 mg/ m2 on day 1). In the control group, 110 patients received two cycles of induction chemotherapy with the same regimens plus concurrent IMRT with cisplatin (40 mg/ m2 on day 1). The survival rates were calculated with the Kaplan?Meier method and the differences in the survival rates between the two groups were analyzed using the log?rank test. Comparison of the incidence rates of adverse reactions between the two groups was made by the chi?square test. Results The follow?up rate was 99?? 1%.The response rates at 3 months after treatment in the two groups were both 100%. The 2?year local recurrence?free, regional recurrence?free, distant metastasis?free, and overall survival rates were 94?? 0%, 94?? 2%, 88?? 2%, and 90?? 3%, respectively, in the test group, versus 93?? 4%, 94?? 1%, 86?? 7%, and 87?? 3% in the control group ( P= 0?? 757、 0?? 478、 0?? 509、 0?? 413). The incidence rates and severity of leucopenia, neutropenia, and thrombocytopenia were significantly higher in the test group than in the control group ( P= 0?? 027 , 0?? 028 , 0?? 035 ) . The incidence rates and severity of hemoglobin reduction and nausea /vomiting were significantly lower in the test group than in the control group (P= 0?? 000,0?? 023). There were no significant differences in the incidence rates of mucositis and xerostomia between the two groups ( P=0?? 483,0?? 781). Conclusions The short?term efficacy of induction chemotherapy with nedaplatin and docetaxel plus concurrent IMRT with nedaplatin is similar to that with cisplatin in the treatment of locally advanced NPC. The mild gastrointestinal reactions can be tolerated by patients. However, the severe myelosuppression should be closely monitored during the treatment.
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Objective To evaluate the treatment efficacy,toxicities and prognostic factors of nasopharyngeal carcinoma ( NPC ) treated with intensity modulated radiation oncology ( IMRT ).Methods Between January 2006 and August 2008,300 patients with pathologically diagnosed NPC from 6 center received IMRT.The number of patients with stage Ⅰ,Ⅱ,Ⅲ and Ⅳa+b disease (UICC/AJCC 2002 staging system) were 6,45,141 and 108,respectively.The prescription doses were as follows:70-74 Gy/30f toplanning target volume of primary nasopharynx tumor ( PTVRλ),68-70 Gy/30f to planning target volume of positive lymphnode (ptvnd),60-64 Gy/30f to higher risk region (PTV1),50-54 Gy/30f to lower risk region (PTV2).Patients with stage Ⅲ and Ⅳa+b disease also received cisplatin-based chemotherapy.Cox method was used for Multivariate analysis.ResultsThe follow-up rate was 99.7％.The 4-year rate of local control,regional control,metastasis-free survival (DMFS),disease-free survival (DFS) and overall survival (OS) was 94.0％,95.5％,87.4％,80.8％,86.1％,respectively.Mucositis was the most severe acute toxicity,with 18.0％grade 1,48.7％grade 2,33.3％grade 3.No patient suffered from grade 4mucositis.Xerostomia was the most common late toxicity,with 12.0％ grade 0,75.7％ grade 1,12.3％grade 2.No grade 3-4 xerostomia was observed.There were 18,15 and 42 patients failed in local,regional and distant metastasis,respectively.Multivariate analysis showed that N stage was the only prognostic factor for OS (x2 =5.17,P=0.023),DMFS (x2 =6.91,P=0.009) and DFS (x2 =8.15,P=0.004) in these patients.ConclusionsIMRT can improve the treatment efficacy of NPC.The acute and late toxicities were tolerated.Distant metastasis becomes the main treatment failure.N stage is a significant prognostic factors.