Perspective of radiotherapy for ovarian metastasis from small cell lung cancer / 西安交通大学学报(医学版)

【Objective】 To evaluate the therapeutic value of radiotherapy for ovarian metastasis from small cell lung cancer. 【Methods】 Two patients with ovarian metastasis from small cell lung cancer were recruited, and the value of radiotherapy in the system treatment strategies was analyzed combined with literature reports. 【Results】 The two patients both benefited from local radiotherapy plus system treatment. One was still in complete remission, and compared to that reported in the literature, the local PFS improved to 21 months. 【Conclusion】 Although the prognosis of small cell lung cancer with ovarian metastasis is still poor, radiotherapy might be one of the systematic treatment strategies for improving the survival time of these patients.

The influence of Inc parameterin the Monaco planning system on left-breast cancer volumetric modulated arc therapy planning / 西安交通大学学报(医学版)

【Objective】 To analyze the influence of different Inc parameters in the Monaco planning system on the left breast cancer volumetric modulated arc therapy (VMAT) planning, in the hope of providing some reference for plan design. 【Methods】 Seventeen left-breast cancer patients who were receiving radical radiotherapy were selected. The plans were enrolled in the design of VMAT with the same optimization conditions but different Inc parameters in the Monaco planning system. All plans used different Inc parameters like 10°, 20°, 30°, and 40°. The results of the plan were compared. The dosimetric parameters of the PTV and the organs at risk inquired by the plan were analyzed. The SPSS software was used for calculating the differences between the VMAT plans and evaluating the quality of the plans. 【Results】 The different Inc parameters affected the dosimetric parameters D98%, D2%, D50%, V55 Gy of PTV and CI, HI (F=10.528, F=15.154, F=15.513, F=16.979, F=4.632, F=14.277, all P<0.05). The MU of the four groups significantly differed (F=4.632, P<0.05), and the difference of V10 on the ipsilateral lung was significant (F= 3.324, P<0.05), the remaining parameters in the four groups had no statistically significant difference. 【Conclusion】 For the left-breast cancer volumetric modulated arc therapy, the smaller of Inc parameter on the plan had better dose distribution and conformity index while the monitor units increased. 40° was not suitable for the breast cancer VMAT plan, and the high amount beyond the range would increase the toxic and side effects on the skin.

The significance of radiotherapy in local treatment of recurrent and metastatic mucinous tubular spindle cell carcinoma of the kidney / 西安交通大学学报(医学版)

【Objective】 To analyze the clinical and pathological characteristics of mucinous tubular and spindle cell carcinoma （MTSCC） in the kidney so as to evaluate the value of radiotherapy in local treatment of refractory MTSCC. 【Methods】 A case of MTSCC with recurrent recurrence and metastasis was reported， and the existing literature on MTSCC was reviewed and analyzed to explore the value of radiotherapy in the treatment of MTSCC. 【Results】 After three operations， postoperative pathology of the patient showed mucinous tubular and spindle cell carcinoma of the kidney. Radiotherapy was performed in the first recurrence area， and long-term follow-up in the tumor bed area showed no recurrence. 【Conclusion】 MTSCC， a rare renal epithelial tumor， has the low-grade malignance in most cases， and rarely recurs and has metastasis. This patient had repeated recurrence and metastasis before surgery， but after tumor bed radiotherapy after the first recurrence no lesion was found， suggesting that radiotherapy plays a certain role in preventing local recurrence. It is necessary to further explore the value of radiotherapy in the treatment of MTSCC.

4D cone beam CT based radiotherapy target accuracy in stereotactic body radiotherapy for lung tumor in the middle or lower lobe / 西安交通大学学报(医学版)

【Objective】 To investigate setup and respiratory movement residual error with the guidance of online four-dimensional cone beam computed tomography (4DCBCT) and the impact on margins required to internal target volume (ITV) margin during stereotactic body radiotherapy (SBRT) of lung tumor in the middle or lower lobe. 【Methods】 Twenty SBRT treatment patients with lung tumor in the middle or lower lobe were enrolled for treatment residual error retrospective analysis. Thermoplastic masks were used as immobilization devices during SBRT treatment. ITV was determined by 4DCBCT simulation. A total of 76 4DCBCT scans before the treatment were recorded to determine the setup and respiratory residual error for ITV margins. 【Results】 The setup and respiratory movement error were significantly reduced with the guidance of online 4DCBCT during radiotherapy. The setup residual errors were respectively (0.07±0.12)cm, (0.03±0.29)cm and (0.04±0.14)cm in right-left (RL), superior-inferior (SI) directions and anterior-posterior (AP) directions. The respiratory movement residual errors were respectively (-0.06±0.07)cm, (0.02±0.26)cm and (0.02±0.11)cm in RL, AP, and SI directions. Based on setup and respiratory movement residual errors, the PTV margins of NSCLC were reduced from 1.13 cm, 2.15 cm and 0.90 cm to 0.50 cm, 0.59 cm and 0.56 cm in RL, AP and SI directions, respectively, calculated with recipe by VanHerk. 【Conclusion】 With the guidance of online 4DCBCT, the setup and respiratory movement residual error cannot be ignored during SBRT of lung tumor in the middle or lower lobe. The ITV margin required after online 4DCBCT correction for the patients enrolled in the study would be approximatively 0.6 cm around to ensure an accurate dose to the target tumor and reduce the dose to normal tissues.

Application status and progress of precision radiotherapy / 西安交通大学学报(医学版)

Radiotherapy is one of the main means of tumor treatment. With the progress of tumor radiotherapy technology and the rapid development of computer technology, radiophysics, radiobiology, imaging and functional imaging, revolutionary progress has been made in tumor radiotherapy. Precision radiotherapy requires accurate radiotherapy positioning, planning and design, and dose calculation. It involves 3D image processing technology, high-precision dose calculation algorithm and cutting-edge linear accelerator series technology. Recent years has witnessed remarkable progress of precision radiotherapy in the comprehensive treatment of tumors. This paper reviews the value of precision radiotherapy in the comprehensive treatment of tumors and predicts its application prospect.

Involved field irradiation(IFI)versus elective nodal irradiation(ENI)in combination with concurrent chemotherapy for esophageal thoracic squamous cell cancer:a prospective,randomized, multicenter,controlled study / 中华放射肿瘤学杂志

Objective This study was conducted to evaluate treatment-related toxicities,the patterns of failure,overall survival(OS)and progression-free survival(PFS)by comparing IFI with ENI in combination with chemotherapy. Methods Eligible patients were treated with concurrent chemoradiotherapy and randomized into either an IFI or ENI arm. The primary end points wereacute treatment-related toxicities. The secondary end points were patterns of failure,OS and PFS. Kaplan?Meier survival rate of the method for calculating the Logrank test difference method. Results Between April 2012 and October 2016,a total of 228 patients were enrolled from nine centers in china. Grade≥3,Grade≥2 radiation esophagitis and pneumonitis in the IFI arm were significantly lower than that of the ENI arm(P=0.018,0.027).No significant differences were observed in overall failure rates,loco-regional failure,distant failure rates,in-field and out-field lymph node failure between the two arms(P=0.401,0.561,0.510,0.561,0.681).The 1-,2-, 3-,4-yearand median OS in the ENI arm and IFI arm were 84.1%,57.3%,39.4%,31.6%,28 months and 83.6%,62.1%,44.5%,31.5%,32 months(P=0.654),respectively. The 1-,2-,3-yearand median PFS in the ENI arm and IFI arm were 71.9%,42.3%,32.7%,20 months and 70.1%,45.0%,35.9%,22 months (P=0.885),respectively. Conclusions Compared to ENI,IFI resulted in decreased radiation pneumonitis and esophagitis without sacrificing loco-regional lymph nodal control,PFS and OS in thoracic ESCC. Clinical Trial Registry Chinese Clinical trail registry,registration number:NCT01551589.

Clinical feasibility of atlas-based auto-segmentation software in radiotherapy for cervical cancer / 中华放射肿瘤学杂志

Objective To investigate the time efficiency and accuracy of atlas-based auto-segmentation ( ABAS ) software with different atlas template numbers and layers of computed tomography ( CT ) scans in delineation of the target tissues of cervical cancer patients receiving radiotherapy . Methods The CT images from 20, 40, 60, 80, 100, and 120 patients with cervical cancer were separately selected as atlas templates for MIM auto-segmentation software, and the CT-based tumor volumes of another 20 patients with cervical cancer were manually contoured by physicians. The quality of contours obtained automatically from the software and manual contouring was compared by one-way analysis of variance ( ANOVA ) , randomized block ANOVA, and least significant difference t test. The impact of atlas template numbers and layers of CT scans on the accuracy and time efficiency of MIM software was analyzed based on the time spent in delineation, dice similarity coefficient, and overlap index. Results Taking manual contouring as the reference, no significant differences were observed in the accuracy and time efficiency of auto-contouring when atlas template numbers ranged from 20 to 120(all P>005). The ABAS auto-contouring significantly shortened the time for target contours when the layers of CT scans were less than 65 ( all P>005 ) , but reduced the accuracy of rectal contours (P=0000), while CT scans with 67 layers achieved the highest accuracy of rectal contours ( P= 0037 ) . Conclusions The ABAS software shows an advantage in delineation of the target tissues of cervical cancer patients receiving radiotherapy, and 20 templates are suggested to construct this atlas. The CT scans with 65 layers are recommended for patients when target tissues include the bladder, femur, and spinal cord, and CT scans with 67 layers are recommended for patients when target tissues include the rectum.

Clinical feasibility of atlas-based auto-segmentation software in radiotherapy for cervical cancer / 中华放射肿瘤学杂志

Objective To investigate the time efficiency and accuracy of atlas-based auto-segmentation ( ABAS ) software with different atlas template numbers and layers of computed tomography ( CT ) scans in delineation of the target tissues of cervical cancer patients receiving radiotherapy . Methods The CT images from 20, 40, 60, 80, 100, and 120 patients with cervical cancer were separately selected as atlas templates for MIM auto-segmentation software, and the CT-based tumor volumes of another 20 patients with cervical cancer were manually contoured by physicians. The quality of contours obtained automatically from the software and manual contouring was compared by one-way analysis of variance ( ANOVA ) , randomized block ANOVA, and least significant difference t test. The impact of atlas template numbers and layers of CT scans on the accuracy and time efficiency of MIM software was analyzed based on the time spent in delineation, dice similarity coefficient, and overlap index. Results Taking manual contouring as the reference, no significant differences were observed in the accuracy and time efficiency of auto-contouring when atlas template numbers ranged from 20 to 120(all P>005). The ABAS auto-contouring significantly shortened the time for target contours when the layers of CT scans were less than 65 ( all P>005 ) , but reduced the accuracy of rectal contours (P=0000), while CT scans with 67 layers achieved the highest accuracy of rectal contours ( P= 0037 ) . Conclusions The ABAS software shows an advantage in delineation of the target tissues of cervical cancer patients receiving radiotherapy, and 20 templates are suggested to construct this atlas. The CT scans with 65 layers are recommended for patients when target tissues include the bladder, femur, and spinal cord, and CT scans with 67 layers are recommended for patients when target tissues include the rectum.

Primary pancreatic neuroendocrine neoplasms:a clinicopathological analysis of 60 cases / 临床与实验病理学杂志

Purpose To study the clinicopathological characteristics of primary pancreatic neuroendocrine neoplasms. Method 60 cases of resected pancreatic neuroendocrine neoplasms according to the WHO (2010) classification of the digestive system of neuroen-docrine tumor to evaluate morphological standard, and combining with the literature to discuss the clinicopathological characteristics. Results Among the 60 cases, 23 cases were male patients, the rest were females, with male and female ratio of 1 ∶ 1. 61. The age of the patients were ranged from 19 to 69 years, with mean age of 49. 38 ± 11. 60 years. Tumor maximum diameter ranged from 0. 5 to 16 cm, and the mean diameter was 3. 29 ± 3. 53 cm. 30 cases located in the pancreatic head, 27 cases in the body and end of the pancre-as and 3 cases in the neck. Pathological examination showed the G1 (24 cases), G2 (25 cases), G3 (9 cases), and mixed adenon-euroendocrine carcinoma ( MANEC) in 2 cases. Immunohistochemical staining showed that NSE, CgA, Syn, and CD56 were diffusely positive expression. 45 patients were followed up for 4~80 months, 7 cases died, of which 1 case was G2, 4 cases were G3, and 2 ca-ses were MANEC. Conclusion Primary pancreatic neuroendocrine neoplasms is a relatively rare pancreatic malignant tumor, and the diagnosis is based primarily on histologic features and immunohistochemical examination. Accurate pathological assessment has impor-tant value to guide clinical treatment and prognosis.

Application of SWO technique in IMRT plan of post-operative cervical cancer / 中华放射医学与防护杂志

Objective To investigate the impact of segment weight optimization(SWO) technique on the intensity modulated radiation therapy(IMRT) plan for post-operative cervical cancer regarding the number of segments,monitor units (MU),the target homogeneity index (HI),conformal index (CI) and dose distribution of target volume and normal tissues.Methods Ten patients with stage Ⅰ and Ⅱ cervical cancer after radical resection were randomly selected for this study.The initial IMRT treatment plans were generated using ELEKTA XIO 4.62 system based on the step and shoot method (S-IMRT plan).With the same directions of fields and optimization parameters,the SWO tool was introduced to optimize the IMRT plans further (SWO-IMRT plan).Then the number of segments and MU were compared between the S-IMRT plan and SWO-IMRT plan.By using the dose-volume histogram (DVH),the target homogeneity index (HI),conformal index (CI) and dose distribution in the volumes of target and normal tissues were also analyzed.Results Compared with S-IMRT plan,the average number of segments in SWO-IMRT plan was decreased from 96 ± 4 to 87 ± 4 (t =10.049,P ＜ 0.05),and MU was increased from(638.79±35.02)) cGy to (672.03 ±39.07) cGy (t =3.5952,P ＜0.05).The maximum and mean doses of the planning target volume (PTV) decreased (t =2.262,2.323,P ＜ 0.05).A reduction of the maximum dose in the spinal cord was also observed [from (3856.00 ± 112.14) cGy to (3750.00 ± 141.38) cGy,t =3.976,P ＜ 0.05].The values of V30,V40,V50 in bladders,rectal V30 and L-femoral V50 were reduced in the SWO-IMRTplan (t=4.223,5.801,7.534,2.451,2.269,3.976,P ＜0.05).However,there was no significant difference in target homogeneity index(HI),conformal index (CI),rectal V40,V50,L-femoral V30,V40,V50,R-femoral V40 and V50.Conclusions The application of SWO technique in the IMRT planning for cervical post-operative cancer could reduce the total number of segments,doses in the spinal cord and bladder,but increase the total number of MU.As a result,the spinal cord and bladder toxicity can be reduced which enables an opportunity for dose escalation of gross tumor volume (GTV).SWO technique provides clinicians with an optional optimization solution in IMRT plan for post-operative cervical cancer patients.

Down-regulation of miR-21 expression enhances the radiosensitivity of TE-1 cells in vitro / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the effect of miR-21 down-regulation on the radiosensitivity of TE-1 cells in vitro.</p><p><b>METHODS</b>TE-1 cells were transfected via lentivirus with a vector containing the antisense oligonucleotides of miR21, and the subclones with stable down-regulation of miR21 expression were selected with puromycin and designated as TE-1-miR21(-), whose expression level of miR21 was determined using real-time quantitative PCR. The radiosensitivity of TE-1 and TE-1-miR21(-) cells were evaluated with colony formation assay, and the expressions of β-catenin was determined using Western blotting and RT-PCR. Flow cytometry was used to analyze the proportion of p75NTR(+) cells in TE-1 and TE-1-miR21(-) cells.</p><p><b>RESULTS</b>A cell subclone stably expressing a low level of miR21 was obtained and verified by real-time quantitative PCR. Colony formation assay showed an enhanced the radiosensitivity of TE-1-miR21(-) cells compared to parental TE-1 cells. RT-PCR revealed no significant changes in β-catenin mRNA expression in TE-1-miR21(-) cells, whereas its β-catenin protein expression was markedly suppressed by high-dose (8 and 10 Gy) irradiation. Flow cytometry assay showed a decreased proportion of p75NTR(+) cells in TE-1-miR21(-) cells compared to that in TE-1 cells.</p><p><b>CONCLUSION</b>Down-regulation of miR21 can enhance the radiosensitivity of TE-1 cells, which might result from the inactivation of wnt/β-catenin signal pathway and a decreased p75NTR(+) cell proportion.</p>

Prospective randomized trial of surgery combined with preoperative and postoperative radiotherapy for rectal carcinoma / 西安交通大学学报·英文版

Objective: To assess the effect of surgery combined with preoperative and postoperative radiotherapy ("sandwich" treatment) in rectal carcinoma. Methods: From October 1990 to January 2002, 260 patients with stage II (117 patients) and stage III (143 patients) rectal carcinoma were randomly divided into three groups: "sandwich" group (92 patients, group A), postoperative radiotherapy group (98 patients, Group B) and operation group (70 patients, Group C). The preoperative accelerated hyperfractionation (15 Gy/6f/3d) was given for "sandwich" group which was followed by conventional postoperative fractionation (DT 35-40 Gy/3.5-4 weeks). Patients in Group B were given postoperative radiotherapy (DT 50 Gy/5 weeks). Patients treated with surgery alone served as control. Results: The local recurrence rates of Group A, B and C were 5.4%(5/92), 16.3%(16/98) and 64.3%(45/70), respectively (χ2 = 5.726, P = 0.017); and the distant metastasis rates were 6.5%(6/92), 28.6%(28/98) and 31.4%(22/70), respectively (χ2 = 15.703, P = 0.001). The 3-year survival rate was 86.9%(80/92), 62.2% (61/98) and 51.4%(36/70), respectively (χ2 = 15.141, P = 0.001). The 5-year survival rate was 68.5%(63/92), 54.1%(54/98) and 41.4%(29/70), respectively (χ2 = 4.218, P = 0.04). The I and II grades of radiation enterocolitis in Group A and Group B were 7.6%(7/92) and 6.1%(6/98), respectively (χ2 = 0.164, P = 0.685). Conclusion: Surgery combined with preoperative and postoperative radiotherapy can improve the survival rate and reduce the local recurrence rate in rectal carcinoma patients with stage Duke's B (II) and C (III).

Prospective randomized trial of surgery combined with preoperative and postoperative radiotherapy for rectal carcinoma / 药物分析学报

Objective To assess the effect of surgery combined with preoperative and postoperative radiotherapy ("sandwich" treatment) in rectal carcinoma. Methods From October 1990 to January 2002, 260 patients with stage Ⅱ (117 patients) and stage Ⅲ (143 patients) rectal carcinoma were randomly divided into three groups: "sandwich" group (92 patients, group A), postoperative radiotherapy group (98 patients, Group B) and operation group (70 patients, Group C). The preoperative accelerated hyperfractionation (15 Gy/6f/3d) was given for "sandwich" group which was followed by conventional postoperative fractionation (DT 35 - 40 Gy/3.5 - 4 weeks). Patients in Group B were given postoperative radiotherapy (Dr 50 Gy/5 weeks). Patients treated with surgery alone served as control. Results The local recurrence rates of Group A, B and C were 5.4% (5/92), 16.3% (16/98) and 64.3% (45/70), respectively (X2 =5.726, P=0.017); and the distant metastasis rates were 6.5% (6/92), 28. 6%(28/98) and 31.4%(22/70), respectively (X2 =15. 703, P= 0. 001). The 3-ycar survival rate was 86. 9%(80/92), 62.2%(61/98) and 51.4%(36/70), respectively (X2 =15. 141, P=0. 001). The 5-year survival rate was 68. 5%(63/92), 54.1%(54/98)and 41.4%(29/70), respectively (X2 =4. 218, P=0.04). The Ⅰ and Ⅱ grades of radiation entero-colitis in Group A and Group B were 7.6% (7/92) and 6.1% (6/98), respectively (X2 = 0. 164, P= 0. 685). Conclusion Surgery combined with preoperative and postoperative radiotherapy can improve the survival rate and reduce the local recurrence rate in rectal carcinoma patients with stage Duke's B (Ⅱ) and C (Ⅲ).

Study on differentiation of rats embryonic stem cells cultured in BRL-CM into neural precursor cells / 西安交通大学学报·英文版

Objective: To investigate whether buffalo rat liver cell-conditioned medium (BRL-CM) can be used as the culture medium of embryonic stem (ES) cells, and to get relatively pure neural precursor cells (NPCs) for treatment aim. Methods: Mouse ES cells were cultured in BRL-CM and medium contain leukemia inhibitory factor (LIF), respectively. NPCs were selectively cultured in serum-free medium. Alkaline phosphatase activity was visualized with NBT/BCIP and nestin antigen was detected with immunocytochemical methods. Results: BRL-CM could be used as an efficiency culture condition instead of LIF in ES cells culture. About 86% of cells derived from ES cells in the serum-free culture were NPCs. Conclusion: BRL-CM can replace LIF to use in ES cell culture. High purity of NPC can be induced from ES cells with serum-free culture method.

Synergistic effect of all-trans-retinoic acid and interferon-? on proliferation, apoptosis and invasion of human glioma cell line SHG-44 / 西安交通大学学报(医学版)

Objective To investigate the synergistic effect of all-trans-retinoic acid (ATRT) and interferon-?(IFN-?) on the proliferation, apoptosis and invasion of human glioma cell line SHG-44. Methods The glioma cellular proliferation capacity was observed with MTT assay, the cell cycle distribution and the apoptotic rate were measured with flow cytometry, and the invasion capacity was assayed in a Transwell cell culture chamber. Results The proliferation capacity and invasion capacity decreased, and the apoptotic rate and percentage of cells in G 1 phase increased in the glioma cells treated by combination of RATA and IFN-?. Conclusion RATA and IFN-? combined have synergistic effects in inhibiting glioma cells and inducing the apoptosis.