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ObjectiveTo investigate the survival and adverse reactions of patients with unresectable cholangiocarcinoma after stereotactic body radiation therapy （SBRT）. MethodsA total of 27 patients with unresectable solitary cholangiocarcinoma without metastasis who underwent SBRT in The Fifth Medical Center of Chinese PLA General Hospital from February 2012 to July 2020 were enrolled. The prescribed dose to planning target volume was 42-60 Gy in 5-8 fractions， with 5-11 Gy/fraction. Among these patients， five patients were also treated with chemotherapy and transcatheter arterial chemoembolization. The 6-， 12-， 18-， and 24-month overall survival （OS） rates， progression-free survival （PFS） rates， and local control （LC） rates were used as the assessment indices for treatment outcome； Common Terminology Criteria for Adverse Events v.4.03 was used to evaluate adverse reactions； the Kaplan-Meier method was used to calculate OS， PFS， and LC rates. ResultsThe median follow-up time was 17 months. For all 27 patients， the 6-， 12-， 18-， and 24-month OS rates were 100%， 88%， 57.5%， and 47.9%， respectively； the 6-， 12-， 18-， and 24-month PFS rates were 74.1%， 58.6%， 47.9%， and 35.9%， respectively； the 6-， 12-， 18-， and 24-month LC rates were 96.3%， 91.9%， 84.8%， and 76.4%， respectively. No grade 3 or above toxic reactions were observed. Five patients were diagnosed with radiation-induced liver injury， but there was no death due to radiation-induced liver injury. ConclusionSBRT is safe and effective in the treatment of unresectable cholangiocarcinoma， with relatively high survival rate， PFS rate， and LC rate and low toxicity， and therefore， SBRT can be used as an alternative treatment method for patients with cholangiocarcinoma who are not candidates for surgery.
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Liver cancer is an important public health issue worldwide. With the improvements in high-throughput sequencing and gene editing techniques in recent years, studies have further revealed the biological mechanism of intestinal microflora in the development, progression, and metastasis of liver cancer via the gut-liver axis, and in particular, it has been found that lipopolysaccharide, a component of the outer membrane of gram-negative bacteria, can cause downstream immune cascade reactions. This article reviews the possible mechanism of action of intestinal microflora lipopolysaccharide in the development and progression of liver cancer from the aspects of the association between intestinal environmental changes and liver cancer, immunoregulation by lipopolysaccharide, and preclinical treatment.
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ObjectiveTo investigate the efficacy and safety of sequential lenvatinib therapy after stereotactic body radiotherapy (SBRT) in the treatment of advanced primary liver cancer. MethodsA total of 18 patients with advanced primary liver cancer who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from October 2018 to May 2019 were enrolled, among whom there were 4 patients with BCLC stage B liver cancer and 14 patients with BCLC stage C liver cancer. The prescribed dose of planning target volume was 48-55 Gy (median 50 Gy) in 6-9 fractions, and the median of single dose was 6 (5-9) Gy per fraction. Oral administration of lenvatinib was given since 1 week after SBRT was finished, with a median medication time of 9.5 (3.6-25.8) months. Follow-up was performed once a month for the first 3 months after treatment and once every 3 months after 3 months of treatment. The Kaplan-Meier method was used to calculate overall survival (OS) rate, progression-free survival (PFS) rate, and local control (LC) rate, and the incidence rates of adverse reactions and complications were also observed. ResultsUp to the follow-up on November 30, 2020, a total of 8 patients died, among whom 3 died of liver failure, 3 died due to tumor progression, 1 died of perforation of gallbladder, and 1 died of gastrointestinal bleeding. At 3, 6, 9, 12, and 18 months of treatment, the OS rates were 100%, 94%, 83%, 72%, and 67%, respectively, the PFS rates were 100%, 67%, 50%, 22%, and 17%, respectively, and the LC rates were 100%, 94%, 94%, 94%, and 94%, respectively; the median OS time was ＞18 months, and the median PFS time was 9 months. Of all patients, 1 (6%) had a grade 3 adverse reaction during SBRT and 2 (11%) experienced a grade 3 adverse reaction during lenvatinib treatment, and no fatal adverse reaction was observed. ConclusionIt is preliminarily proved that sequential lenvatinib therapy after SBRT is an effective and safe treatment method for advanced primary liver cancer.
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Objective@#To observe the survival and side effects of stereotactic body radiotherapy (SBRT) in large hepatocellular carcinoma (HCC) patients.@*Methods@#Twenty-eight large HCC patients undergoing SBRT in 302 Military Hospital from November 1, 2011 to January 31, 2014 were observed. The prescribed dose was 39-61 Gy/3-9f. Among them, 20 patients simultaneously received transcatheter arterial embolization. The overall survival (OS), progression-free survival (PFS) and local control (LC) rates were calculated by using Kaplan-Meier method. The influencing factors of OS were analyzed by Cox regression model. The influencing factors of radiation-induced liver disease (RILD) were identified by using Logistic regression analysis.@*Results@#The 1-, 2-, 3-and 5-year OS rates were 75%, 57%, 54% and 22%, respectively. The 1-, 2-, 3-and 5-year PFS rates were 59%, 47%, 36% and 18%, respectively. The 1-, 2-, 3-and 5-year LC rates were 92%, 86%, 86% and 86%, respectively. Four patients suffered from RILD and none died from RILD. Child-Pugh classification was the influencing factor of OS and RILD.@*Conclusion@#It is preliminarily believed that SBRT is an alternative and safe treatment for patients with large HCC.
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Objective To observe the survival and side effects of stereotactic body radiotherapy (SBRT) in large hepatocellular carcinoma (HCC) patients.Methods Twenty-eight large HCC patients undergoing SBRT in 302 Military Hospital from November 1,2011 to January 31,2014 were observed.The prescribed dose was 39-61 Gy/3-9f.Among them,20 patients simultaneously received transcatheter arterial embolization.The overall survival (OS),progression-free survival (PFS) and local control (LC) rates were calculated by using Kaplan-Meier method.The influencing factors of OS were analyzed by Cox regression model The influencing factors of radiation-induced liver disease (RILD) were identified by using Logistic regression analysis.Results The 1-,2-,3-and 5-year OS rates were 75％,57％,54％ and 22％,respectively.The 1-,2-,3-and 5-year PFS rates were 59％,47％,36％ and 18％,respectively.The 1-,2-,3-and 5-year LC rates were 92％,86％,86％ and 86％,respectively.Four patients suffered from RILD and none died from RILD.Child-Pugh classification was the influencing factor of OS and RILD.Conclusion It is preliminarily believed that SBRT is an alternative and safe treatment for patients with large HCC.
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Objective To identify impacts of antiviral therapy on the frequency and interferon (IFN)-?-producing ability of circulating type 2 pre-dendritic cells(pDC2)as well as lymphocyte subsets in patients with chronic hepatitis B virus (HBV)infection. Methods Thirty-three patients with chronic HBV infection and 25 healthy individuals as controls were enrolled in our study. Two kinds of drugs, lamivudine and IFN-?, were used in antiviral regimen respectively. Absolute numbers of circulating pDC2 and lymphocyte subsets were analyzed by flow cytometry consecutively. The IFN-?-producing function of peripheral blood mononuclear cells (PBMCs) representing the circulating pDC2 was determined by ELISA assay. Results In patients with chronic HBV infection, the frequency and function of pDC2 decreased compared with those found in healthy controls. After antiviral treatment for 6 months, lamivudine seemed to induce the increase of frequency and absolute number of pDC2. The absolute numbers of peripheral CD8~+ T-cells and NK cells were simultaneously found to ascend. A similar result was also observed in chronically HBV-infected humans with 6 months duration of IFN-? therapy. Conclusions Our results showed that lamivudine or IFN-? antiviral treatment could increase the number of peripheral pDC2 and CD8~+ T-cells in the patients with chronic HBV infection.