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Radiotherapy is a pivotal method in cancer treatment harbouring immunomodulatory effects. Radiotherapy combined with immunotherapy has been proven to yield promising preliminary results in certain types of tumors. Most studies have concentrated on the dose fractionation of radiotherapy and timing of radiotherapy and immunotherapy. With the development of related studies, attention has been gradually paid to the influence of target volume upon circulating lymphocytes and tumor microenvironment. The interaction between target volume and immunotherapy has been valued. For tumors not suitable for hypofractionated radiotherapy, such as advanced esophageal cancer, conventional fractionated radiotherapy has been adopted. The volume and planning of target volume play a pivotal role in radiotherapy combined with immunotherapy. This article illustrates the feasibility of radiotherapy combined with immunotherapy, theory and conception of optimizing target volume.
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Glioblastoma multiforme (GBM,WHO grade IV) contains some glioma stem cells which have unique self-renewal capacity and multilineage potency.There are numerous neural stem cells in the subventricular zone (SVZ) of adult human brain;it may also act as a storehouse of glioma stem cells that can promote the development and recurrence of a tumor.GBM involving SVZ is prone to early recurrence and intracranial metastasis after resection,so irradiation of the SVZ potentially influences the survival of GBM patients.This review provides a summary of related experimental and clinical studies,and discusses the value of irradiation of the SVZ in GBM patients and the direction of future research.
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Chemoradiotherapy is a major treatment for inoperable esophageal carcinoma (EC).However, there is still controversy over the target volume for radiation, particularly nodal target volume.EC is characterized by a high rate of lymph node metastasis, and its metastatic pattern is not always predictable.Elective nodal irradiation (ENI) will increase the radiation field, which may increase the incidence of adverse events.Some investigators used involved-field irradiation (IFI) to reduce treatment-related toxicities without compromising survival.Studies have demonstrated that regional and distant micrometastases can be controlled, to some extent, by chemotherapy, incidental irradiation, and the abscopal effects of radiation.With either ENI or IFI, EC recurrence is usually found in the primary tumor and at distant sites, without survival difference.These data suggest that IFI is feasible in EC patients.
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Surgery remains an important therapeutic method for localized esophageal cancer, but the 5?year survival rate of patients undergoing surgical resection alone is only 20%?25%. Early studies show that postoperative radiotherapy reduced regional recurrence rate, but did not increase the survival rate. Most recent studies show that stage Ⅲ or lymph node?positive patients can obtain survival benefit from postoperative radiotherapy, and patients in pT2?3 N0 M0 stage may also benefit from postoperative radiotherapy. The recommended radiotherapy target volumes include bilateral supraclavicular areas, superior mediastinum, subcarinal area, and tumor bed. It is recommended in most studies that regional lymph nodes in the upper abdomen should be included in patients with lower?segment lesions. The locally advanced patients may benefit more from postoperative radiotherapy combined with chemotherapy. The significance of postoperative radiotherapy for esophageal squamous cell carcinoma, target volume design, and combined chemotherapy need individualized consideration and more clinical evidence.
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The use of adjuvant extemal-beam RT is well established in the postoperative treatment of glioblastoma multiforme (CBM).It is consensus that target volume should be determined based on the fusion images of MRI and CT,but the inclusion of peritumoural edematous is controversial.The vast majority of recurrences occur within 2 cm of the original tumor site orin radiation field.There is no inevitable relation between the degree of peritumoral edema and recurrence model.The clinical and pathological characteristics may be as predictive and prognostic factors for the treatment of GBM.Target volume delineation for CBM tend to individual,which can maintain known outcomes and reduce treatment toxicity.
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ObjectiveTo measure the displacement of solitary pulmonary lesion (SPL) using fourdimensional CT (4DCT), and to compare the planning target volume using 4D maximum intensity projection (MIPMIP) ( PTV4DMIP ) with the empirical PTV3D.Methods Data were acquired from 24 consecutive patients with SPL. For each patient, respiration-synchronized 4DCT images and standard axial CT scans were obtained during free breathing.In lung window setting,the 4D technique was used to measure the displacement of SPL in three dimensions. We compared an PTV created using the MIP (PTV4DMIP) to the PTV created from the gross tumor volume (GTV) enlarged isotropically for each spatial direction by 1.0 cm and 1. 5 cm in the PTV3D1.0cm and PTV3D1.5cm. Results The SPL located in the lower lobe showed significant difference with the upper and middle lobe in y axis (0. 44 cm,0. 92 cm, t =2. 87, P =0. 000),but there was no difference in both x and z axis (0. 27 cm,0. 39 cm,t =1.44 ,P =0. 116 and 0. 29 cm,0. 40 cm,t =1.51, P =0. 227). SPL showed significantly greater displacement in y axis than in both x and z axis [0.60 cm and0. 31 cm (t =4.23,P=0.000) ,0.60 cm and 0.32 cm (t =4.65,P=0. 000)], but there was no significant difference between x and z axis (0. 31 cm,0. 32 cm,t =0. 33 ,P =0. 741 ). There was no statistically difference between the peripheral lung cancer and the pulmonary metastasis tumor in three directions ( x axis : 0. 37 cm,0. 32 cm, t =0. 52, P =0. 223 ; y axis : 0. 54 cm, 0. 95 cm, t =- 1.38, P =0.061;z axis:0.42 cm,0.37 cm, t=0.29, P=0.859).Both PTV3D1.0cm and PTV3D1.5cm showed significantly greater volume than PTV4DMIP(46. 73 cm3 ,86. 52 cm3 and 30. 02 cm3 ,t =- 11.35, - 12. 09,P =0. 000,0. 000). ConclusionsThe displacement of SPL in y axis is much greater than x and z axis. The empirical PTV3D is much bigger than PTV4DMIP, which suggests that 4DMIP provide adequate coverage of the moving target and minimize dose to normal tissues.
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Objective To assess the prognostic value of tumor burden measured by 18F-fluorodeoxy glucose-positron emission tomography ( FDG PET) imaging for stage Ⅲ NSCLC). Methods Fifty-six patients with lung cancer were analyzed, to whom staging PET-CT scans before treatment concurrent chemoradiotherapy and 2-year follow-up were performed. , Relationship between overall survival (OS) and metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) were determined.Results The estimated median OS for the cohort were 14. 5 months. Kaplan-Meier analysis showed that MTV had a significant effect on OS (x2 =5.42 ,P =0. 014). No significant relationship was found between SUVmax and OS ( x2 = 0. 74, P = 0. 391 ). According to multivariate Cox regression analysis, MTV and SUVmax wereassociatedwithincreaseddeath ( x2 = 5.54, P = 0.019; x2 = 4.47, P = 0.031 ). Conclusions This study shows that higher tumor burden assessed by PET MTV is an independent unfavorable prognostic factor in lung cancer, MTV is valuable for predicting overall survival and could be a prognostic factor.
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0.05). Conclusions For patients with locally advanced non-small cell lung cancer, concurrent conformal radiotherapy and chemotherapy followed by consolidation chemotherapy can improve the progression-free survival, but have few effects on overall survival and toxicity. Multicenter clinical trial with more patients should be carried out to confirm the benefit from the additional consolidation chemotherapy.
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Objective:To develop an experimental three-dimensional model by ECV304 cells(human umbilical vein endothelial cell line) for investigating the mechanisms of angiogenesis in vitro.Methods:ECV304 cells were seeded onto three-dimensional collagen gels made of rat-tail collagen.When the endothelial cells were cultured and grown to near confluence,treated with bFGF for 3 to 12 days,and then assessed with inverted phase contrast microscope.Results:The endothelial cells migrated into the gels,formed complex networks by cell cords at different levels through the bottom view,and sprouted capillary-like structures through the side view.Conclusion:ECV304 cells are capable of expressing some early events of angiogenesis in the three-dimensional collagen gels:proliferating,migrating and sprouting and so on.It should be useful for studying angiogenesis in vitro.