Prevalence rate and influencing factors of uremic pruritus in hemodialysis patients in Anhui province / 安徽医科大学学报

Objective @#To explore the prevalence of uremic pruritus (UP) in patients with maintenance hemodialy sis (MHD) in Anhui Province and its influential factors .@*Methods @#Patients with MHD were enrolled in 27 hemo dialysis centers in Anhui Province . Clinical data were compared .@*Results @#A total of 3 025 patients with MHD were included . The prevalence of UP was 63.3% , among them , mild UP 55.9% and moderate to severe UP 7.4% . The prevalence rates of UP in southern Anhui , central Anhui and northern Anhui were 75.4% , 63.6% and 57.9% . The prevalence of total UP in ≤30 years , 31 - 50 years , 51 - 70 years and ≥71 years was 53.5% ,59.8% , 65.4% and 65.9% . The prevalence of total UP and moderate to severe UP increased with age ( P < 0.01) . Age , age of dialysis , proportion of hypertension , 25(hydroxy) vitamin D3 [25(OH)D3 ] , proportion of low flux dialyzer usage and proportion of calcium phosphorus binder usage in UP group were higher than those in the group without UP. However , the levels of diastolic blood pressure , hemoglobin ( Hb) and hemodialysis filtration ratio in the UP group were lower than those in the non UP group (P < 0.05) . By comparison , the age , hyperten sion and diabetes of patients in moderate and severe UP group were higher than those in mild UP group , while the proportion of non calcium phosphorus binding was lower than that in mild UP group ( P < 0.05) . Binary Logistic regression analysis showed that high 25(OH)D3 was associated with a higher risk of UP in MHD patients , and high throughput dialyzer use was associated with a lower risk of UP in MHD patients ( P < 0.05) .@*Conclusion @#The prevalence rate of UP in maintenance hemodialysis patients in Anhui province is 63.3% . The prevalence of UP is the highest in southern Anhui , and the prevalence of total UP and moderate to severe UP increases with age . High 25(OH)D3 levels are a risk factor for UP in MHD patients , and the use of high throughput dialyzers can reduce the risk of UP in MHD patients .

Genetic analysis of 32 fetuses with cerebellar hypoplasia diagnosed by prenatal ultrasound: a retrospective study / 中华围产医学杂志

Objective:To explore the genetic causes of cerebellar hypoplasia (CH) diagnosed by prenatal ultrasound.Methods:This retrospective study involved 32 fetuses with CH diagnosed by prenatal ultrasound in Wuxi Maternal and Child Health Hospital from January 2014 to December 2022. Prenatal ultrasound findings and genetic testing results for amniotic fluid were collected and analyzed. The correlation between fetal CH and genetic abnormality was analyzed. A descriptive statistical method was used for data analysis.Results:(1) General data: The 32 mothers were (28.0±4.9) years old, ranging from 18 to 37 years old; the gestational age at amniocentesis was (24.2±4.0) weeks, ranging from 18 +3 weeks to 37 +2 weeks. Apart from one case lost to follow-up, the other 31 cases terminated the pregnancies, including 30 terminated before 28 weeks of gestation and one at 33 weeks of gestation due to unmarried status. (2) Ultrasonic features: Among the 32 cases, 30(93.8%) were complicated by intracranial or extracranial abnormalities including cardiac abnormalities (15 cases), dilated lateral ventricles (ten cases), and abnormalities in limbs (eight cases) and face (nine cases). Two CH cases (6.2%) were isolated. (3) Genetic testing: Among the 32 cases, 13 cases (40.6%) had normal results of amniotic fluid karyotype analysis and single nucleotide polymorphism (SNP) array. Among the 19 cases with abnormal amniotic fluid test results (59.4%), 16 cases have abnormal results in amniotic fluid karyotype analysis and SNP array detection [nine cases were numerical abnormalities, including five cases of trisomy-18, three of trisomy-21, and one of trisomy-13; seven cases were chromosomal structural abnormalities, including four cases of terminal deletion of chromosome 5 (Cri-du-Chat syndrome) and three cases of reciprocal translocation of chromosomes]. There was no abnormality in karyotype analysis of amniotic fluid in three cases. Still, their SNP array test results showed copy number variations (CNV) [one of 6q terminal deletion, one of 6q terminal deletion with 5p15.33 duplication, and one of 6q terminal deletion with 15q26.3 duplication; all variations were of unknown significance]. (4) Of the 19 cases with abnormal SNP array results, 17 were accompanied by abnormal intracranial/extracranial ultrasound findings. Among them, ten cases showed cardiac malformation, seven showed lateral ventricular widening, and seven showed limb abnormality. Conclusions:Numerical abnormalities, CDCS, and 6q terminal deletion are the most common genetic causes of CH diagnosed by prenatal ultrasound. Chromosome microarray analysis should be recommended for fetuses with ultrasound-diagnosed CH to evaluate fetal prognosis accurately.

Application of MR-guided radiotherapy for brain metastases / 中华放射肿瘤学杂志

Radiotherapy (RT) is the primary local treatment modality for brain metastases, which are common secondary malignancies. Image-guidance system such as cone beam computed tomography (CBCT) may be not applicable to adaptive radiotherapy (ART), as well as hypofractionated RT in brain metastases, because it cannot clearly show the shrinkage and deformation of intracranial tumors, and the peritumoral edema changes in a real-time manner. Magnetic resonance (MR) image has high spatial resolution and soft tissue contrast and no radiation dose burden compared with CBCT. MR-guided adaptive radiotherapy (MR-gART) allows real-time tracking of deformation and position changes of the intracranial tumors, and enables online planning reconstruction during the treatment process. MR-gART could deliver high dose irradiation to the tumors while reducing the radiation dose of important organs at risk around, which contributes to achieving precision RT. In this work, the application of MR-gART in brain metastases was reviewed.

Prevalence rate and influencing factors of restless leg syndrome in maintenance hemodialysis patients in Anhui province / 中华肾脏病杂志

Objective:To explore the prevalence rate of restless leg syndrome (RLS) and its related influencing factors in patients with maintenance hemodialysis (MHD) in Anhui province.Methods:It was a cross-sectional study, including regular MHD patients in blood purification centers of 27 hospitals in southern, central and northern Anhui province from January to March 2020. The investigation included general demographic characteristics, primary diseases, complications, dialysis-related conditions and drug use. According to the presence or absence of RLS, the patients were divided into RLS group and non-RLS group, and the differences of clinical data between the two groups were compared. Logistic regression analysis method was used to analyze the influencing factors of RLS.Results:The study included 3 025 MHD patients, aged (54.8±12.8) years old, with 1 819 males (60.1%) and 1 206 females (39.9%). The dialysis age was (5.5±3.8) years. The prevalence rates of RLS in MHD patients were 8.8% (265/3 025), of which 13.7% (77/561), 7.7% (88/1 145) and 7.6% (100/1 319) in southern, central and northern Anhui province, respectively. The prevalence rates of RLS in MHD patients in secondary and tertiary hospitals were 9.5% (55/577) and 8.6% (210/2 448), respectively. Proportion of hypertension, dialysis age, intact parathyroid hormone, alkaline phosphatase, 25(OH)D3, and proportions of secondary hyperparathyroidism, erythropoietin use, iron supplements, active vitamin D use, calcimimetic use, dialysis blood flow <250 ml/min and low-flux dialyzers in RLS group were higher than those in non-RLS group, while hemoglobin level and proportions of non-calcium-phosphorus binders and high-flux dialyzers were lower than those in non-RLS group (all P<0.05). Multivariate logistic regression analysis results showed that long dialysis age ( OR=1.188, 95% CI 1.031-1.369, P=0.017) and high alkaline phosphatase ( OR=1.007, 95% CI 1.001-1.013, P=0.047) were correlated with a higher risk of RLS in MHD patients. Conclusions:The prevalence rate of RLS in MHD patients in Anhui province is 8.8%. The prevalence rates of RLS in MHD patients in southern, central and northern Anhui province are 13.7%, 7.7% and 7.6%, respectively. The prevalence rate of RLS in secondary and tertiary hospitals are 9.5% and 8.6%, respectively. Long dialysis age and high alkaline phosphatase are associated with a high risk of RLS in MHD patients.

Diagnosis of fetal closed spina bifida without subcutaneous mass with prenatal ultrasound / 中华围产医学杂志

Objective:To investigate the prenatal ultrasound findings and clinical prognosis in fetal closed spina bifida without subcutaneous mass.Methods:This retrospective study included nine fetuses diagnosed with closed spina bifida without subcutaneous mass by prenatal ultrasound in Women's Hospital of Jiangnan University from October 2016 to February 2022. Descriptive analysis was used to summarize the ultrasonographic features, MRI findings, genetic testing results, pregnancy outcomes and follow-up data.Results:The diagnosis of fetal closed spina bifida without subcutaneous mass was confirmed in all cases by MRI, X-ray examination or ultrasound after termination or neonatal surgery. Four cases presenting with various degrees of sacral vertebra defects had caudal regression syndrome complicated by other malformations. Two cases had dermal sinus, presenting with subcutaneous hypoechoic sinus tract connecting to the spinal canal. Lipoma terminalis were found in two fetuses who presented with intraspinal hyperechoic mass. One fetus with diastematomyelia showed short linear strong echoes and double spinal cord echoes in the spinal canal with butterfly vertebrae. The location of the conus medullaris was lower in seven cases and normal in one fetus. The other one case had unclear position of the conus medullaris. No postoperative complications occurred in the two cases (one with dermal sinus and one with lipoma terminalis) receiving postnatal surgery and both infants grew and developed normally. Fetal death occurred in one case and six pregnancies were terminated.Conclusions:Closed spina bifida without subcutaneous mass typically has ultrasonographic features. Detection of spinal cord echoes in the spinal canal can improve the prenatal detection rate. Whether it is complicated with malformation affects its prognosis. Prenatal ultrasound diagnosis may provide information for prognosis consultation and postpartum treatment.

Prenatal diagnosis of Cri-du-chat syndrome: analysis of 11 cases / 中华围产医学杂志

Objective:To investigate the ultrasonographic and genetic features of Cri-du-chat syndrome (CDCS).Methods:In this retrospective study, cases with CDCS diagnosed in Wuxi Maternal and Child Health Care Hospital from 2004 to 2021 and with complete data were reviewed to describe and analyze the maternal serum prenatal screening, non-invasive prenatal testing (NIPT), ultrasound, genetic examination data, and pregnancy outcomes.Results:All cases were diagnosed by karyotype analysis, seven of them were diagnosed prenatally through amniotic fluid, and four were diagnosed after birth through peripheral blood. Five of the seven cases diagnosed prenatally had an abnormal serological screening, including two cases with 5p- indicated by NIPT. Of the 11 cases, prenatal ultrasonography showed cerebellar transverse diameter less than －2 SD in eight cases, including four with cerebellar hypoplasia (CH), two with fetal growth restriction, and two with cranial diameters less than －2 SD. One case was shown with an increased nuchal translucency, accompanying bilateral choroid plexus cysts of the lateral ventricles, and suspected persistent left superior vena cava. No obvious ultrasound abnormality was observed in the remaining two cases. Among the seven cases diagnosed prenatally, excluding one case that refused parental verification, further single nucleotide polymorphism array (SNP array) showed that all six cases inherited the de novo mutations from the parents. The cytogenetic analysis found the breakpoints at 5p13, 5p14, and 5p15 in five, three, and three cases. All seven pregnancies were terminated in the second trimester. Four children diagnosed postnatally presented with CDCS phenotype during the follow-up at three years old. Conclusions:Fetal CDCS should be considered with CH detected by prenatal ultrasonography, though the correlation between CH and CDCS still needs further investigation. Gene mapping with an SNP array is helpful for phenotypic profiling and genetic counseling.

Prenatal diagnosis and postnatal follow-up of 27 cases with 15q11.2 BP1-BP2 microdeletion syndrome / 中华围产医学杂志

Objective:To summarize the prenatal diagnosis and postnatal follow-up of 15q11.2 BP1-BP2 microdeletion syndrome (Burnside-Butler syndrome, BBS), and provide a reference for the management of BBS.Methods:A retrospective analysis was performed on 27 singleton pregnancies with fetal BBS that were prenatally diagnosed by single nucleotide polymorphism(SNP) array of amniotic fluid in Wuxi Maternity and Child Health Care Hospital from January 2017 to September 2021. Prenatal diagnosis indications, serological screening, prenatal ultrasound features, SNP array results, and postnatal growth and development were described and summarized.Results:(1) Of the 27 cases, the indications of prenatal diagnosis in 14 cases were abnormal sonographic findings, including eight cases with increased nuchal translucency, two with cleft lip and palate/alveolar process cleft, one with fetal multiple joint contracture syndrome, one with fetal right diaphragmatic hernia and single umbilical artery, one with suspected fetal duodenal atresia and one with nasal bone absence. Other indications included high risk of Down syndrome by serological screening in six cases, history of adverse pregnancy in six cases, and advanced age in one case. (2) Karyotyping of amniotic fluid in these 27 BBS fetuses showed normal results and SNP array indicated the deletion range of 311.8-855.3 kb. Parental verification of 23 cases confirmed one was a new mutation, seven were inherited from the father and 15 from the mother. (3) Five pregnancies were terminated in the second trimester and the remaining 22 cases were live births. (4) The median follow-up of the 22 children was 1 year 8 months (range 0.5 months to 4 years 3 months), which found low body weight and/or growth retardation in six cases, low body weight with language retardation in one case, low body weight with growth retardation and hyperactive behavior in one case, language retardation with left ear appendage in one case, cleft palate accompanied by duodenum/cleft lip and alveolar cleft in two cases without abnormal development after surgical treatment, and no abnormal growth in the remaining 11 cases.Conclusion:For BBS fetuses, the proportion of ultrasound abnormalities is high but with a low specificity in prenatal diagnosis, and the risk of abnormal postnatal growth and development/behavior is high, which requires continuous monitoring.

Analysis of psychological distress in elderly patients with head and neck cancer receiving radiotherapy / 中华放射肿瘤学杂志

Objective:To evaluate the psychological pain of patients with head and neck cancer aged ≥60 years old before and after intensity-modulated radiotherapy (IMRT).Methods:Distress Thermometer (DT)(Chinese version) was used to investigate the degree and problems of psychological pain before and after IMRT for 85 elderly patients with head and neck cancer. The results before and after IMRT were compared by paired t-test. Relevant factors were identified by Logistic regression analysis. Results:The median age in the cohort was 66 years old (60-85 years old). The incidence rates of psychological pain were 73% and 87% before and after IMRT ( P<0.001). The corresponding incidence rates of severe distress were 6% and 34%( P<0.001). The main distress problems before IMRT were memory loss/attention deficit, worry, oral pain, economic problems, stress, sleep problems, and dry nose. The significantly-increased distress problems after IMRT were oral pain, constipation, eating, nausea, and dry nose. Logistic regression analysis showed gender ( OR=5.520, 95% CI 1.437-21.212, P=0.013), pre-treatment PG-SGA score ( OR=1.220, 95% CI 1.048-1.421, P=0.010) and medical insurance ( OR=0.230, 95% CI 0.053-0.995, P=0.049) were the relevant factors of the severe psychological distress before IMRT. Occupation ( OR=2.286, 95% CI 1.291-4.050, P=0.005) and medical insurance ( OR=0.089, 95% CI 0.029-0.276, P<0.001) were the relevant factors of severe psychological distress after IMRT. Conclusion:The incidence rate of distress is high in elderly patients with head and neck cancer before IMRT, which can be aggravated after IMRT, primarily the treatment-related physical pain problems.

Analysis of the factors influencing the efficacy of concurrent chemoradiotherapy for locally advanced head and neck squamous cell carcinoma: based on a phase Ⅲ clinical randomized controlled study / 中华放射肿瘤学杂志

Objective:To identify the population who can obtain clinical benefit from concurrent chemoradiotherapy through the survival analysis during concurrent chemoradiotherapy in different subgroups.Methods:All data from a phase Ⅲ randomized controlled clinical trial were collected to compare the efficacy between preoperative concurrent chemoradiotherapy and preoperative radiotherapy from 2002 to 2012 in Cancer Hospital of the Chinese Academy of Medical Sciences. A total of 222 patients received radiation therapy with a median dose of 69.96 Gy (27.56-76.00 Gy). The cisplatin chemotherapy regimen was adopted and the median dose was 250 mg (100-570 mg). In total, 98 patients received intensity-modulated radiotherapy (IMRT). The survival analysis was conducted with Kaplan- Meier method and univariate analysis was performed with log-rank test. The multivariate prognostic analysis was conducted with Cox’s regression model. Results:The median follow-up time was 59 months (7-139 months). Among them, 104 patients were assigned in the chemoradiotherapy group and 118 patients in the radiotherapy alone group. The local and regional recurrence rates did not significantly differ between two groups (both P>0.05), while chemoradiotherapy tended to decrease the distant metastasis rate compared with the radiotherapy alone (14.4% vs. 24.6, P=0.058). Univariate analysis showed that concurrent chemoradiotherapy significantly increased the local recurrence-free survival in the early N stage subgroup ( P=0.009), and there was an increasing trend in patients aged≤55 years and female patients ( P=0.052, 0.066). The distant metastasis-free survival was significantly improved in T 4( P=0.048), N 3( P=0.005), non-IMRT treatment ( P=0.001) and hypopharyngeal carcinoma ( P=0.004) subgroups, there was an increasing trend in male ( P=0.064), high-and moderate-grade squamous cell carcinoma ( P=0.076) and non-surgical treatment subgroups ( P=0.063). Multivariate analyses showed that concurrent chemoradiotherapy significantly prolonged the progression-free survival and overall survival in patients aged≤55 years ( P=0.017 and 0.039), women ( P=0.041 and 0.039), high-and moderate-grade squamous cell carcinoma ( P=0.006 and 0.022), N 3 stage ( P=0.001 and 0.017), non-surgical treatment ( P=0.007 and 0.033) and non-IMRT treatment subgroups ( P=0.030 and 0.024), and it significantly increased the progression-free survival in patients with hypopharyngeal carcinoma ( P=0.022). Conclusion:Concurrent chemoradiotherapy can be actively delivered for young age, female, high-and moderate-grade squamous cell carcinoma, N 3 stage, non-surgical treatment and non-IMRT treatment patients.

Clinical efficacy and prognosis of 85 patients with extracranial metastatic breast cancer receiving radiotherapy / 中华放射肿瘤学杂志

Objective:To evaluate the clinical efficacy of radiotherapy in the treatment of extracranial metastatic breast cancer, and to investigate the significance and prognostic factors of whole-lesion radiotherapy (WLRT).Methods:Clinical data of 85 patients with extracranial metastatic breast cancer treated with radiotherapy between 2014 and 2019 were retrospectively analyzed. Thirty-six patients were assigned into the WLRT group and 49 in the non-WLRT group. The local control (LC), progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan- Meier method, log-rank test and univariate prognostic analysis. Cox proportional hazards model was used for multivariate prognostic analysis. Results:The median follow-up time was 26.7 months. The 2-year LC, PFS, OS rates were 77%, 26%, 77%, respectively. The 2-year LC (91% vs. 67%, P=0.001), PFS (47% vs. 8%, P<0.001), OS rates (84% vs. 71%, P=0.010) in the WLRT group were significantly higher than those in the non-WLRT group, respectively. Multivariate analysis demonstrated that WLRT was an independent favorable prognostic factor for the LC, PFS and OS. Furthermore, bone metastasis alone was associated with improved LC and positive hormone receptor status was correlated with improved OS. Conclusions:WLRT has the potential to prolong the survival of patients with extracranial metastatic breast cancer. The patients with bone metastases alone obtain better LC, whereas those with negative hormone receptor status has worse OS.

Prenatal diagnosis and genetic counseling in 19 cases with 22q11.2 microduplications / 中华医学遗传学杂志

OBJECTIVE@#Patients with 22q11.2 microduplications have highly variable clinical phenotypes. The clinical manifestations and prognosis of 19 fetuses carrying 22q11.2 microduplications were analyzed.@*METHODS@#The fetuses were analyzed by single nucleotide polymorphism array (SNP array), which was followed by parental validation. Pregnancy outcome and clinical features of the newborns were analyzed in order to delineate genotype-phenotype correlation.@*RESULTS@#Two fetuses were identified by karyotyping analysis of amniotic fluid samples. SNP array revealed that all have carried a 468.8 kb~3.4 Mb duplication in 22q11.2 region. Two couples have refused parental verification. Seven cases were inherited from the mother, 6 were from the father, and 4 cases were de novo in origin. Three couples opted termination of the pregnancy. One fetus perished at birth. Five newborns showed delayed growth, the remaining 10 were normal.@*CONCLUSION@#The prenatal phenotype of fetuses carrying 22q11.2 microduplications are nonspecific, and the phenotypes of survivors may become more diverse along with increased age. Professional evaluation and long-term follow-up should be recommended.

Effects of different combinations of comprehensive treatment on survival of patients with locally advanced head and neck squamous cell carcinoma: post-hoc analysis of a phase Ⅲ randomized controlled clinical trial / 中华放射肿瘤学杂志

Objective:To compare the effects of comprehensive treatment with different combinations of radiotherapy, chemotherapy and surgery on the survival of patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC).Methods:From September 2002 to May 2012, 222 patients were enrolled in a randomized controlled clinical trial to compare the clinical efficacy between preoperative radiotherapy and preoperative concurrent chemoradiotherapy. The chemotherapy was performed at the beginning of the radiotherapy, with cisplatin 30 mg/m 2 every week. Conventional radiotherapy or intensity-modulated radiotherapy (IMRT) was adopted. Clinical efficacy was evaluated during radiotherapy to 50 Gy in all patients. Whether surgery or original treatment regime was given was determined according to the clinical efficacy. The survival of different therapeutic methods was analyzed by Kaplan- Meier method. Results:The median follow-up time was 59 months (7-139 months). All patients were divided into four groups: radiotherapy group (R group, n=84), concurrent chemo-radiotherapy group (R+ C group, n=67), preoperative radiotherapy group (R+ S group, n=34) and preoperative concurrent chemoradiotherapy group (R+ C+ S group, n=37). The 5-year overall survival rates were 32%, 44%, 51%, and 52%, respectively (R+ C+ S group vs. R group, P=0.047). The 5-year progression-free survival rates were 34%, 48%, 49%, and 61%, respectively (R+ C Group vs. R group, P=0.081; R+ C+ S group vs. R group, P=0.035). The 5-yeal distant metastasis-free survival rates were 70%, 85%, 65%, and 73%, respectively (R+ C group vs. R+ S group, P=0.064; R+ C group vs. R+ S group, P=0.016). Conclusions:Compared with radiotherapy alone, comprehensive treatment with different combinations can improve the long-term survival of LA-HNSCC patients. Radiotherapy combined with chemotherapy has a tendency to improve the distant metastasis-free survival rate, The optimal comprehensive treatment modality that improves the overall survival of LA-HNSCC patients remains to be explored.

High-risk factors of retropharyngeal lymph node metastasis in patients with hypopharyngeal carcinoma based on magnetic resonance imaging / 中华放射肿瘤学杂志

Objective:To analyze the incidence and high-risk factors of lymph node metastasis in the retropharyngeal region of hypopharyngeal squamous cell carcinoma based on magnetic resonance imaging (MRI), aiming to guide the delineation of clinical target area.Methods:Clinical data of patients who were pathologically diagnosed with hypopharyngeal carcinoma from January 2012 to September 2018 in our center were retrospectively analyzed. All patients received head and neck MRI before treatment. The diagnosis of lymph node metastasis and the delineation of primary gross target volume (GTV p) and lymph nodes target volume (GTV nd) were determined by all the radiation oncologists in head and neck group through twice weekly general round discussion. The cut-off points of GTV p and GTV nd were defined by establishing the receiver operating characteristic curve. All patients were divided into the high GTV p, low GTV p and high GTV nd and low GTV nd groups. Chi-square test was used for univariate analysis and logistic regression was utilized for multivariate analysis to analyze the high-risk factors of patients with retropharyngeal lymph node metastasis. Results:A total of 326 patients were included in this study, 295 of whom were diagnosed with cervical lymph node metastasis, accounting for 90.5%. The most common involved area was Level Ⅱ a, followed by Level Ⅲ, Level Ⅱ b, Level IV, Level Ⅶ a (retropharyngeal), Level V a, and Level V b. The incidence of retropharyngeal lymph node metastasis was 21.5%, and the incidence was 53.1% in patients with primary tumor located in the posterior pharyngeal wall. Univariate and multivariate analyses showed that patients with tumor originated from the posterior pharyngeal wall ( P=0.002), bilateral cervical lymph node metastasis ( P=0.020), larger GTV p (greater than 47 cm 3, P=0.003), and larger GTV nd (greater than 22 cm 3, P=0.023) were significantly associated with the occurrence of retropharyngeal lymph node metastasis. Conclusions:The incidence of retropharyngeal lymph node metastasis is high in hypopharyngeal carcinoma, especially in patients with primary tumors in the posterior pharyngeal wall, bilateral cervical lymph node metastasis and larger primary burden. Therefore, for patients with these risk factors, it is highly recommended that the clinical target area should be delineated to include the retropharyngeal lymph node drainage area.

Analysis of clinical efficacy of hypofractionated precision radiotherapy for lung metastases / 中华放射肿瘤学杂志

Objective:To evaluate the efficacy and safety of hypofractionated radiotherapy for lung metastases (LMs).Methods:From March 2007 to April 2019, 193 patients with 317 LMs including 124 male and 69 female admitted to our hospital were enrolled. The median age was 58 years old and the median KPS was 80. The primary tumors were mainly distributed in the lung (33.7%), colorectum (21.2%), head and neck (13.5%) and breast (10.9%), respectively. The clinical efficacy and side effects of hypofractionated radiotherapy for LMs were evaluated.Results:The median follow-up time was 59.9 months (95% CI: 55.1-64.6 months). Among 193 patients with 317 LMs, 90.7% of them were treated with 4D-CT, 69.4% for intensity-modulated radiation therapy (IMRT), 28.0% for volumetric-modulated arc therapy (VMAT) and 2.6% for tomotherapy (TOMO), respectively. The median gross tumor volume (GTV) and planning target volume (PTV) were 5.0 cm 3(0.2-142.3 cm 3) and 12.0 cm 3(1.0-200.1 cm 3). The prescription dose regimen was 60 Gy in 4 to 15 fractions. The median dose for PTV was 60 Gy (45-70 Gy) and biological effective dose was 96 Gy (60-150 Gy), respectively. The 1-, 3-and 5-year local control rates (LCR) were 95.7%, 91.3% and 89.9%, respectively. The median time from primary cancer diagnosis to lung metastases was a prognostic factor for LCR ( P=0.027). The overall survival (OS) and progression-free survival (PFS) rates were 90.1%, 60.8%, 46.2%, and 54.3%, 30.3%, 19.9%, respectively. The median time from primary cancer diagnosis to lung metastases and extrapulmonary metastases was the prognostic factor for OS and PFS. No Grade 3 toxicities were seen. Conclusion:Image-guided hypofractionated precision radiotherapy is an efficacious and safe treatment for LMs.

A phase Ⅱ trial of comprehensive treatment based on radiotherapy in leptomeningeal metastasis / 中华放射肿瘤学杂志

Objective:To evaluate the efficacy and safety of comprehensive treatment based on radiotherapy for patients with leptomeningeal metastases (LM) in this prospective study.Methods:A total of 93 patients diagnosed with LM admitted to our hospital undergoing whole brain radiotherapy (WBRT) or craniospinal irradiation (CSI) with or without simultaneous boost from 2014 to 2017 were enrolled. The dynamic changes of clinical signs and symptoms, enhanced magnetic resonance imaging (MRI), cerebrospinal fluid cytology and liquid biopsy detection were recorded. The primary endpoint was overall survival (OS), the secondary endpoints were local control (LC), intracranial progress-free survival (IPFS), brain metastasis specific survival (BMSS) and toxicity.Results:The major primary disease was non-small cell lung cancer. The whole cohort received WBRT with boost (40 Gy in 20 fractions (f) for WBRT and 60 Gy in 20 f for boost), focal radiation to LM, WBRT and CSI (40 Gy in 20 f or 50 Gy in 25 f for WBRT and 36 Gy in 20 f for CSI). For 20 patients, tumor cells were identified and intrathecal chemotherapy was performed. Sixty-three patients received target therapy. The median follow-up time was 33.8 months. The 1-year OS, LC and IPFS was 62.4%, 77.2% and 52.6%, respectively. The median survival time was 15.9 months, and the median BMSS was 42.2 months. Treatment-related grade 3-4 adverse events were rare and only 8 cases was observed to have grade 3 hematological toxicity.Conclusion:Reasonable comprehensive treatment including precise radiotherapy, intrathecal chemotherapy and targeted therapy can be well tolerated and prolong the survival time of LM patients.

Patterns of regional spread and the value of elective neck treatment for oral mucosal melanoma / 中华放射肿瘤学杂志

Objective:To investigate the patterns of regional lymphatic spread and the value of elective neck treatment (ENT) in oral mucosal melanoma (OMM).Methods:In this retrospective analysis, 61 OMM patients with no distant metastasis treated in Cancer Hospital of Chinese Academy of Medical Sciences between 1984 and 2016 were recruitred. The regional lymph node distribution of cN+ disease, the value of ENT in cN 0 disease, the failure patterns and prognostic factors were retrospectively analyzed. Results:Overall, 55.7% of the patients were clinical/pathological cN+ . The most frequently involved locations were the level Ⅰ b (76%), followed by level Ⅱ and level Ⅲ. For cN 0 patients, the 5-year regional failure-free survival rate was 91.7% in patients who received at least ipsilateral level Ⅰ b-Ⅲ ENT and 52.4% in patients who did not receive at least ipsilateral level Ⅰ b-Ⅲ ENT ( P=0.036). The regional failure rate was 6% for patients treated with at least ipsilateral leve Ⅰ b-Ⅲ ENT, while in their counterparts who did not receive at least ipsilateral level Ⅰ b-Ⅲ ENT was 46%( P=0.035). For the regional failure pattern, the most frequently failure sites were level Ⅰ b (93%), level Ⅱ(50%) and level Ⅲ(36%). Conclusions:The cervical lymph node metastasis rate is relatively high in OMM patients. The pathway of regional LN spread follows a regular pattern. The most frequently involved regions for clinical/pathological cN+ and regional failure are both level Ⅰ b-Ⅲ. Elective treatment including at least ipsilateral level Ⅰ b-Ⅲ ENT should be recommended for OMM patients with cN 0.

Observation of the effect of organ displacement on target area of intensity-modulated radiotherapy during swallowing for head and neck cancer based on dynamic MRI images / 中华放射肿瘤学杂志

Objective:Continuous acquisition of swallowing images of head and neck cancer patients by using MRI technique was performed to observe and measure the movement regularity and maximum displacement of the soft palate, tongue and larynx.Methods:From July 2018 to October 2018, 20 patients with primary head and neck cancer were chosen randomly, 17 male and 3 female. The median age was 58.5 years (28 to 78 years). Among the 20 patients, 7 patients were diagnosed with nasopharyngeal carcinoma, 3 patients with oral cancer, 5 patients with oropharyngeal cancer, 3 patients with hypopharyngeal cancer, and 2 patients with nasal and paranasal sinuses cancer. Two patients were classified as stage Ⅰ-Ⅱ, 8 patients as stage Ⅲ and 10 patients as stage Ⅳ according to the eighth edition of AJCC.Results:The displacement of the upward movement of the soft palate during swallowing was (1.06±0.31) cm and followed the pattern normal distribution. The displacement of backward movement of the soft palate was (0.83±0.24) cm, which also almost normally distributed. The displacement of backward tongue movement was (0.77±0.22) cm and followed the normal distribution pattern. The displacement of upward tongue movement was 0 in patients with tongue depressor for image acquisition. The mediandisplacement of upward tongue movement in patients without tongue depressor was 1.23 cm (0.59 to 1.41 cm). The displacement of upward laryngeal movement was (1.14±0.22) cm and followed the normal distribution pattern, and the median displacement of forward laryngeal movement was 0.4 cm (0.27 to 0.90 cm).Conclusions:Swallowing movement may occur in head and neck cancer patients during radiotherapy. It can also cause the movement of gross tumor volume (GTV) and surrounding normal tissues. Therefore, extensive attention should be paid to the individual distance between GTV and planning gross tumor volume (PGTV) when making radiotherapy plans, aiming to ensure the prescription dose of cancer.

The application of whole-brain radiotherapy for non-small cell lung cancer with brain metastases: evolution and revolution / 中华放射肿瘤学杂志

Whole brain radiotherapy (WBRT) was widely used clinically as the standard therapy for brain metastases (BM).With the development of radiotherapy technology and systemic therapies,the nonsmall cell lung cancer (NSCLC) patients have prolonged local control rate and median survival time,meanwhile post-radiotherapy intracranial toxicities often lead to serious impacts on the quality of life and neurocognitive function.Therefore,the role WBRT played should have been reevaluated.The purpose of this review is to analyze the clinical application value of WBRT in the context of new treatments for NSCLC with BM,and to predict the main developing directions of WBRT in the future.

The application of whole-brain radiotherapy for non-small cell lung cancer with brain metastases: evolution and revolution / 中华放射肿瘤学杂志

Whole brain radiotherapy (WBRT) was widely used clinically as the standard therapy for brain metastases (BM). With the development of radiotherapy technology and systemic therapies, the non-small cell lung cancer (NSCLC) patients have prolonged local control rate and median survival time, meanwhile post-radiotherapy intracranial toxicities often lead to serious impacts on the quality of life and neurocognitive function. Therefore, the role WBRT played should have been reevaluated. The purpose of this review is to analyze the clinical application value of WBRT in the context of new treatments for NSCLC with BM, and to predict the main developing directions of WBRT in the future.

Clinical characteristics, diagnosis and efficacy of primary lymphoepithelial carcinoma of the parotid gland / 中华放射肿瘤学杂志

Objective@#To analyze the clinical features, diagnosis and prognosis of patients with primary lymphoepithelial carcinoma of the parotid gland.@*Methods@#Clinical data of 13 patients diagnosed with lymphoepithelial carcinoma of the parotid gland in our hospital from 2009 to 2017 were retrospectively analyzed. The median follow-up time was 38.5 months. All patients received radiotherapy after operation.@*Results@#Of 13 patients, 9 cases were male and 4 female. The median age was 33 years. At the initial diagnosis, 9 cases had primary lesions limited to the parotid gland, and 4 cases of lymph node metastases located in Ⅰb and Ⅱ regions of the neck. According to UICC2010 staging, 1 case was classified as stage Ⅰ, 1 as stage Ⅱ, 6 as stage Ⅲ and 5 as stage Ⅳ, respectively. Eleven surgically pathological specimens were tested with EBER in-situ, and 10 cases were positive for EBER. No patient died in the whole group. The 3-year overall survival rate was 100%. The 3-year progression-free survival rate was 76%. The 3-year local control rate was 92%. The 3-year metastasis-free survival rate was 84%.@*Conclusions@#The incidence of lymphoepithelial carcinoma of the parotid gland is relatively low. The pathological features are associated with EB virus. It is prone to present with cervical lymph node metastasis. The possibility of lymph node metastasis of nasopharyngeal carcinoma to the parotid gland should be excluded before treatment. At present, surgery combined with postoperative radiotherapy is the main treatment. The overall survival is favorable. Local recurrence and distant metastasis are the main causes of treatment failure.