Counting loss correction in ³⁷Ar activity measurement based on Geant4 simulation / 中国辐射卫生

@#<b>Objective</b> To correct the counting loss of ³⁷Ar below the activity threshold during the measurement of the absolute activity of the inert radioactive gas ³⁷Ar using the proportional counter filled with gas. <b>Methods</b> Monte Carlo simulation with Geant4 was performed to establish a proportional counter model and output the energy deposition spectrum of ³⁷Ar, which were used to simulate and analyze the causes and correction of counting loss. <b>Results</b> The photon detection efficiency was only 38.7% at 60 kPa. The counting loss was mainly caused by the wall effect produced by the photons, which could be reduced by increasing the gas pressure and corrected by extrapolation. The influence of wall effect at 100 kPa was 4.4%, and the deviation between simulation and experiment was < 0.6%. <b>Conclusion</b> A factor could be calculated by Geant4 simulation for the correction of counting loss, thus achieving the accurate measurement of ³⁷Ar activity by proportional counter.

Protective effect of Sarcandra glabra on radiation-induced parotid injury in rats / 中华放射医学与防护杂志

Objective To study the changes of inflammatory response and apoptosis in parotid gland tissues of rats after X-ray irradiation,and to explore the protective effect and possible mechanism of Sarcandra glabra on radiation-induced parotid injury in rats.Methods A total of 120 male rats were randomly divided into 5 groups (24 for each):control group,single irradiation group,radiation combined withahigh (26.8g· kg-1 · d-1),moderate (13.4g· kg-1 ·d-1) and low (6.7g· kg-1 · d-1) dosage of Sarcandra glabra group.The parotid gland of rats in the irradiation group received 15 Gy X-ray.Rats in each group were anesthetized with 2％ pentobarbital sodium (0.16 ml/100 g) at 10,40 and 70 d after irradiation and blood was collected from abdominal aorta.ROS levels in blood serum of each group were detected on the 10th,40th and 70th days after irradiation.After parotid gland tissue was taken,the pathological changes and ultrastructural changes were observed by hematoxylin-eosin (HE) staining and transmission electron microscopy,respectively.The expression level of TNF-α in parotid gland tissue was detected by immunohistochemistry,and apoptosis of parotid cells was detected by TUNEL assay.Results The content of ROS and the expression of TNF-α protein in the single irradiation group were simultaneously increased compared with the control group (t =-24.723,-35.013,-19.515,P＜ 0.05;t =-13.563,43.519,-15.249,P＜ 0.05),while they were reduced by Sarcandra glabra in a dosage dependent manner,especially in the high dosage group of Sarcandra glabra (t =5.295,8.138,6.545,P＜0.05;t =10.093,-7.868,10.539,P＜0.05).In the control group,the parotid gland tissue structure was intact,without congestion,exudation,edema,etc.For the single irradiation group,the parotid gland tissue became hyperemia,edema and inflammatory cell infiltration at 10 d after irradiation followed by fibrosis at 40 d after irradiation.These pathological alterations in the parotid gland tissue were significantly recovered when the rats were treated with Sarcandra glabra before irradiation,and the tissue damage was negatively correlated with drug dosage.TUNEL assay showed that the apoptosis rate of parotid gland cells in the single irradiation groups was higher than that in the control group (t=-4.639,-3.979,P＜0.05).Conclusions Sarcandra glabra protects parotid gland from radiation damage by scavenging radiation-induced ROS and declining inflammatory response,and thus it may be applied as a potential protective agent for radiation injury.

Protective effect of Sarcandra glabra on radiation-induced parotid injury in rats / 中华放射医学与防护杂志

Objective@#To study the changes of inflammatory response and apoptosis in parotid gland tissues of rats after X-ray irradiation, and to explore the protective effect and possible mechanism of Sarcandra glabra on radiation-induced parotid injury in rats.@*Methods@#A total of 120 male rats were randomly divided into 5 groups(24 for each): control group, single irradiation group, radiation combined with a high(26.8 g·kg-1·d-1), moderate(13.4 g·kg-1·d-1) and low(6.7 g·kg-1·d-1) dosage of Sarcandra glabra group. The parotid gland of rats in the irradiation group received 15 Gy X-ray. Rats in each group were anesthetized with 2% pentobarbital sodium (0.16 ml/100 g) at 10, 40 and 70 d after irradiation and blood was collected from abdominal aorta. ROS levels in blood serum of each group were detected on the 10th, 40th and 70th days after irradiation. After parotid gland tissue was taken, the pathological changes and ultrastructural changes were observed by hematoxylin-eosin (HE) staining and transmission electron microscopy, respectively. The expression level of TNF-α in parotid gland tissue was detected by immunohistochemistry, and apoptosis of parotid cells was detected by TUNEL assay.@*Results@#The content of ROS and the expression of TNF-α protein in the single irradiation group were simultaneously increased compared with the control group (t=-24.723, -35.013, -19.515, P<0.05; t=-13.563, 43.519, -15.249, P<0.05), while they were reduced by Sarcandra glabra in a dosage dependent manner, especially in the high dosage group of Sarcandra glabra (t=5.295, 8.138, 6.545, P<0.05; t=10.093, -7.868, 10.539, P<0.05). In the control group, the parotid gland tissue structure was intact, without congestion, exudation, edema, etc. For the single irradiation group, the parotid gland tissue became hyperemia, edema and inflammatory cell infiltration at 10 d after irradiation followed by fibrosis at 40 d after irradiation. These pathological alterations in the parotid gland tissue were significantly recovered when the rats were treated with Sarcandra glabra before irradiation, and the tissue damage was negatively correlated with drug dosage. TUNEL assay showed that the apoptosis rate of parotid gland cells in the single irradiation groups was higher than that in the control group (t=-4.639, -3.979, P<0.05).@*Conclusions@#Sarcandra glabra protects parotid gland from radiation damage by scavenging radiation-induced ROS and declining inflammatory response, and thus it may be applied as a potential protective agent for radiation injury.

Risk factors affecting patient comfort in nitrous oxide inhalation?induced conscious sedation status during colonoscopy / 中华消化内镜杂志

Objective To evaluate the effects of nitrous oxide inhalation on conscious sedation of patients during colonoscopy and analyze its risk factors. Methods From October 2016 to July 2017, a total of 154 patients undergoing colonoscopy were included in the study. The comfort level was rated using Modified Gloucester Comfort Scale ( MGCS). Factors affecting comfort level were analyzed by univariate analysis and multivariate Logistic regression, and then a comfort stratification predicting model was created. Results All 154 patients finished colonoscopy. The mean time of ideal anesthesia state was 195. 15 s. Among the 154 cases, 115 ( 74. 7%) were identified as comfort ( grade of MGCS from 1 to 3) and 39 (25. 3%) were rated as discomfort ( grade of MGCS from 4 to 5). Multivariate regression indicated that age ≥60 years ( P＝0. 000, OR＝1. 074, 95%CI: 1. 036-1. 114) and mild anxiety ( P＝0. 018, OR＝3. 338, 95%CI: 1. 227-9. 079) were associated with comfort level during colonoscopy.The established model with the age (X1) and mild anxiety (X2) was P＝eY/(1+eY), Y＝－3. 812+0. 071X1+1. 205X2(no anxiety was assigned 1, mild anxiety was assigned 2), and the area under the receiver operating characteristics curve was 0. 746 (95%CI: 0. 661-0. 830), which showed moderate predictive power of the final model. The model reached the highest predictive accuracy when the Yoden Index was 0. 838 with sensitivity of 50. 4% and specificity of 89. 7% for predicting comfort level of patients in conscious sedation status induced by nitrous oxide inhalation during colonoscopy. Conclusion Nitrous oxide can ease pain during colonoscopy, especially for patients over 60 years old and with anxiety. We can use it as an option according to actual circumstance in practice.

Prognostic value of iASPP for nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective To evaluate the prognostic value of iASPP for nasopharyngeal carcinoma (NPC).Methods One hundred and thirty patients with nasopharyngeal carcinoma were initially diagnosed and treated between January and December 2012 in Department of Radiation Oncology of the First Affiliated Hospital of Guangxi Medical University.The clinical staging was classified according to the cancer staging criteria 2009 AJCC/UICC.All patients were treated by IMRT.Cisplatin-based concurrent chemotherapy was given to patients with stages Ⅲ-ⅣB disease.Immunohistochemistry was used to detect the expression of iASPP in the carcinoma tissues,and the clinicopathological features were compared among the patients with different expressions of iASPP.Furthermore,the relationship between the expression of iASPP and the efficacy in patients was explored.Results Of 130 patients,positive expression of iASPP was observed in 86 patients (66.2％),and negative expression in 44 patients (33.8％).There was significant difference in the positive expression rate of iASPP among the patients with different N-stage and clinical stages(x2 =7.565,4.947,P ＜ 0.01).At three months after treatment,no significant difference was found in the response rate of tumor with different expression of iASPP.In univariate analysis,the expression of iASPP was significant predictor of 3 year-DMFS (x2 =4.335,P =0.037) and PFS (x2 =6.640,P =0.01).Furthermore,N-stage was significant predictor of 3y-DMFS (x2 =8.058,P =0.005),PFS (x2 =9.554,P =0.002) and OS (x2 =6.987,P =0.008),respectively.By using multivariate Cox analysis,the expression of iASPP and N-stage was independent prognostic factors for PFS (x2 =4.336,5.228,P ＜ 0.05),respectively.Conclusions Positive expression of iASPP may be a poor prognostic factor for NPC patients.

Relationship between positive lymph nodes and distant metastasis after intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To explore the relationship between positive cervical lymph nodes and distant metastasis after intensity-modulated radiotherapy(IMRT)in patients with nasopharyngeal carcinoma(NPC). Methods A retrospective analysis was performed on the clinical data of 474 patients who were newly diagnosed with NPC but no distant metastasis and received IMRT from 2010 to 2012. The survival rates were calculated by the Kaplan-Meier method. The log-rank test was used for comparison of survival rates and univariate prognostic analysis. The multivariate analysis was made by the Cox regression model. Results In the 474 patients, 400 had positive cervical lymph nodes and 122 had residual masses in the neck after IMRT. The four-year distant metastasis, overall survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival(DMFS)rates were 13.71%(65/474), 82.9%, 81.4%, 93.5%, and 86.3%, respectively. The univariate and multivariate analyses showed that treatment approach, lymph node metastases in lower neck Ⅳ/Ⅴb/Ⅴcregions, the greatest diameter of the positive cervical lymph nodes, the diameter of residual lymph nodes, and time to lymph node recession were independent prognostic factors for DMFS(all P<0.05). Conclusions Chemoradiotherapy can reduce the distant metastasis rate after IMRT for NPC. The larger the cervical lymph nodes are,the more likely there are residual masses;the larger the residual cervical lymph nodes are, the higher risk of distant metastasis there is. Large cervical lymph nodes(≥6 cm),residual masses larger than 1 cm,and residual masses at 3 months after IMRT are negative prognostic factors for DMFS after IMRT for NPC. Better intervention treatment approaches need to be explored.

Dose constraints of optic nerves and chiasm in locally advanced nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy / 中华放射肿瘤学杂志

Objective To investigate the tolerated dose of the optic nerves and chiasm in patients with locally advanced nasopharyngeal carcinoma(NPC)treated with intensity-modulated radiotherapy (IMRT). Methods A retrospective analysis was performed on dose characteristics and the incidence of radiation optic neuropathy in 108 patients with locally advanced NPC treated with IMRT at D 2>55 Gy in the optic nerves and chiasm in our hospital between May 2009 and December 2013. The Common Terminology Criteria for Adverse Events(CTCAE)Version 3.0 grading criteria were used for evaluating adverse reactions of the optic nerves and optic chiasm.A logistic regression analysis was performed to assess the risk factors for the development of radiation-induced optic neuropathy(RION). Results No patient had severe RION (grade 3-5),although 7 of the 108 patients had mild optic nerve disorder(grade 1-2). No patient-or treatment-related factors were found to be associated with the development of RION(P>0.05). With a median follow-up of 46 months(range,13-91 months),the 3-year estimated overall survival,local recurrence-free survival,and distant metastasis-free survival rates were 90.0%,94.5%,and 86.4%, respectively. Conclusions The dose constraint of<55 Gy derived for optic nerves and chiasm from conventional radiotherapy does not seem to apply to IMRT. For advanced NPC patients treated with IMRT, the dose constraints of optic nerves and chiasm might be relaxed in order to improve target coverage.

Study on N staging system for nasopharyngeal carcinoma based on intensity-modulated radiotherapy and RTOG guidelines for cervical lymph node levels / 中华放射肿瘤学杂志

Objective To propose a new N staging system for nasopharyngeal carcinoma based on intensity-modulated radiotherapy (IMRT) and Radiation Therapy Oncology Group (RTOG) guidelines for cervical lymph node levels.Methods A retrospective analysis was performed in 324 patients with newly diagnosed nasopharyngeal carcinoma who had no distant metastasis confirmed by pathology and received IMRT in the Department of Radiation Oncology in The First Affiliated Hospital of Guangxi Medical University from January 2010 to December 2011.They were restaged according to the 7thedition of UICC/AJCC staging system for nasopharyngeal carcinoma.The survival rates were estimated using the Kaplan-Meier method and the log-rank test was used for univariate prognostic analysis.The Cox proportional hazards model was used for multivariate prognostic analysis.Results Of 324 patients,269(83.0%) had lymph node metastasis.The median follow-up was 58 months (6-77 months).The 5-year overall survival,disease-free survival,relapse-free survival,and distant metastasis-free survival rates were 84.8%,77.1%,92.7%,and 80.5%,respectively.Univariate and multivariate analyses of patients with positive cervical lymph nodes revealed that retropharyngeal lymph node status,cervical lymph node level,and laterality were evaluated as independent prognostic factors for nasopharyngeal carcinoma.According to the hazard ratio calculated,the N staging system was revised as follows:N0:no regional lymph node metastasis;N1:VⅡ a or/and unilateral levels (I,Ⅱ,Ⅲ,Va) involvement;N2:bilateral levels (I,Ⅱ,Ⅲ,Va) involvement;N3:levels IVa,Vb,and IVb+Vc involvement.Conclusions The proposed N staging system is based on IMRT and RTOG guidelines for lymph node levels and more practical,and can provide highly objective prediction of outcome and guide treatment in nasopharyngeal carcinoma.

Effect of Sarcandra Glabra on the expression of TGF-β1/Smads in miniature pig of radiation-induced lung injury / 中华放射医学与防护杂志

Objective To study the effect of Sarcandra Glabra on the expression of signal transduction molecules of TGF-β1/Smads signaling pathway in miniature pig of radiation-induced lung injury.Methods 75 miniature pigs were divided into control group,radiation group and radiation plus medication group randomly.At 1 week before exposure of right lung with 15 Gy γ-rays,the miniature pigs in radiation plus medication group were given Sarcandra glabra,while those in the other groups received an equal amount of saline.Right lung were taken at weeks 2,4,8,12 and 24 after irradiation,the pathological changes in the lung tissue were observed by HE staining,and the expression of mRNA and protein of TGF-β1,Smad2,Smad3,and Smad7 were detected by real-time PCR and western blotting,respectively.Results Sarcandra glabra reduced the inflammation and fibrosis of the lung tissue in miniature pig after irradiation.Compared with control group,the expressions of TGF-β1 and Smad3 were significantly increased at 2 weeks after irradiation(P ＜ 0.05),Smad2 and Smad7 were increased at 8 and 12 weeks after irradiation(P ＜ 0.05),respectively,in the radiation group.Compared with the radiation group,the expressions of TGF-β1 and Smad2 were significantly decreased(P ＜ 0.05) from the fourth and eighth week,respectively,Smad3 had no obvious change while Smad7 was significantly increased from the second week in the radiation plus medication group (P ＜ 0.05).Conclusions Sarcandra Glabra plays protective effect on radiation-induced lung injury in miniature pig by regulating TGF-β1,Smad2 and Smad7 expressions in the TGF-β1/Smads signaling pathway.

A new T staging system for nasopharyngeal carcinoma based on magnetic resonance imaging and intensity-modulated radiotherapy / 中华放射肿瘤学杂志

Objective To establish a new T staging system for nasopharyngeal carcinoma ( NPC) based on magnetic resonances imaging ( MRI) and intensity?modulated radiotherapy ( IMRT) . Methods A retrospective analysis was performed on the clinical data of 608 patients who were newly diagnosed with non?metastatic NPC by MRI and treated with IMRT in our hospital from 2008 to 2010. All patients were staged according to the 7th edition of the UICC/AJCC staging system for NPC. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The Cox regression model was used for multivariate analyses. To deal with the deficiency in the current UICC/AJCC staging system, a new T staging system for NPC was established and systematically evaluated. Results The 5?year follow?up rate was 94?5%. The 5?year overall survival (OS), disease?free survival, local relapse?free survival (LRFS), and distant metastasis?free survival rates were 81?5%, 80?1%, 86?0%, and 81?1%, respectively. The univariate and multivariate analyses showed that the anatomic structures of nasopharynx, parapharyngeal space, and skull base were influencing factors for the OS rate (P=0?000?0?045). New T staging criteria were proposed based on the risk differences and survival curves:stage T1:invasion of the nasopharynx, parapharyngeal space, oropharynx, nasal cavity, skull base, and internal pterygoid muscle;stage T2:invasion of the external pterygoid muscle, paranasal sinus, intracalvarium, infratemporal fossa, and cranial nerves. The proposed T staging system achieved a good separation in both OS and LRFS curves. Conclusions The proposed new T staging system gives an objective prognostic prediction in patients with NPC, which provides an exploratory attempt toward a new clinical staging system for NPC.

A multicenter, prospective, randomized study of intensity-modulated radiother apy combined with different chemotherapy regimens for locally advanced nasopharyngeal carcinoma / 中华放射肿瘤学杂志

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.

The study on lung injury of minipigs' right-thorax with a single high-dose γ-ray irradiation / 中华放射医学与防护杂志

Objective To explore the influence and mechanism of cytokines and protein expression of alveolar epithelial type (ACE) Ⅱ cells in Bama minipigs' right-thorax with a single 15 Gy dose irradiation.Methods All minipigs received either right thoracic irradiation or sham-irradiation under anesthesia.At 4,8,12 and 24 week post-irradiation,5 minipigs respective and random from irradiarion groups and control group were sacrificed to remove the lungs.The protein expression of surfactant associated protein (SP)-A,transforming growth factor (TGF)-β1,Vimentin and E-cadherin were detected by Western blot.The protein expression of α-smooth muscle actin (SMA) was detected by immunohistochemistry.The co-localization of SP-A and α-SMA was visualized by double immunofluorescence staining.Results At 4,8,12 and 24 week post-irradiation,a significant increase in the protein expression of α-SMA,TGF-β1 and Vimentin were observed in irradiated lung compared to sham-irradiated controls(α-SMA:t =2.46-3.26,P ＜0.05;TGF-β1:t =2.96-3.52,P ＜0.05;Vimentin:t =3.24-5.05,P ＜ 0.05).By contrast,the protein expression of SP-A and E-cadherin in irradiation group was lower than it in control group (SP-A:t =3.62-4.65,P ＜ 0.05;E-cadherin:t =2.53-4.15,P ＜ 0.05).Moreover,at 8 week after irradiation,under confocal laser scanning microscope,the co-localization of SP-A and α-SMA was observed in irradiated alveolar epithelium cells,and it was not observed in sham-irradiated controls.Conclusions These data demonstrate that E-cadherin,SP-A and TGF-β1 may act as sensitive predictors of radiation-induced lung injury(RILI).Irradiation may lead to ACE Ⅱ cells achieving a mesenchymal phenotype,namely,epithelial to mesenchymal cells transition occurs,and ACE Ⅱ cells play the important part in the development of RILI by epithelial-mesenchymal transition.

Proto-oncogene Bmi-1 and head and neck cancer / 国际肿瘤学杂志

Bmi-1 is a core member of the polycomb group genes.As a proto-oncogene,Bmi-1 plays an important role in cell self-renewal,proliferation and apoptosis.Several studies have shown that Bmi-1 is highly expressed in some head and neck malignant tumors,such as nasopharyngeal cancer and laryngeal carcinoma.Furthermore,the expression level of Bmi-1 is closely related to the occurrence,development,incursion and prognosis of tumor.Bmi-1 is expected to become a novel tumor molecular marker,and provides a new direction for the treatment of the head and neck malignant tumor.

Effect of capacity for liquor on vomiting induced by chemotherapy in male patients with nasopharyngeal carcinoma / 国际肿瘤学杂志

Objective To explore the effect of the single maximum of alcohol consumption on vomiting induced by chemotherapy in male patients with nasopharyngeal carcinoma.Methods According to the single maximum of alcohol consumption,48 cases of male patients with nasopharyngeal carcinoma were divided into two groups:group A (small capacity for liquor group 10-50 g),group B (large capacity for liquor group ＞50 g).The amount of alcohol intake was assessed by a questionnaire.The responses of vomiting and the effects of antiemetic therapy between the two groups during the first cycle after induction chemotherapy were observed.Results The incidence rates of vomiting induced by chemotherapy between the two groups were 52.0％ and 17.4％,respectively.There were significant differences between the two groups (x2 =6.273,P ＜0.05).The incidence rates of grade 0,1,2 and 3 of vomiting in group A were 48.0％,20.0％,20.0％,12.0％,in group B were 82.6％,13.0％,4.4％,O,respectively.There were significant differences between the two groups (x2 =6.013,P =0.024).In the two groups,the complete control rate for acute vomit were 48.0％ and 82.6％ (x2 =6.273,P =0.012),for delayed vomit were 36.0％ and 65.2％ (x2 =4.090,P =0.043).There were also significant differences between the two groups.Conclusion With the increasing of capacity for liquor,the incidence of vomiting is significantly reduced,the degree of vomiting is distinctly alleviated,and the antiemetic efficacy is distinctly increased.

Research progress of nedaplatin in the treatment of nasopharyngeal carcinoma / 国际肿瘤学杂志

Inductive chemotherapy and concurrent chemoradiotherapy have been a focus on the clinical research in the treatment of nasopharyngeal carcinoma.Cisplatin,as a kind of representative platinum drug,can improve the curative effect,but it also brings a lot of side effects to nasopharyngeal carcinoma patients.The new kind of platinum drug-nedaplatin,can not only guarantee the curative effect but also reduce the side effects of chemotherapy.

Multicenter safety study on cetuximab combined with intensity modulated radiotherapy and concurrent chemotherapy of cisplatin in locoregionally advanced nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To evaluate the safety of cetuximab combined with intensity-modulated radiotherapy (IMRT) plus concurrent cisplatin chemotherapy in locoregionally advanced nasopharyngeal carcinoma (NPC) in a Chinese multicenter clinical study.MethodsFrom July 2008 to April 2009,100Patients with primary stage Ⅲ- Ⅳb non-keratinizing NPC were enrolled.The planned dose of IMRT to gross tumor volume and positive cervical lymph nodes was 66.0-75.9 Gy and 60-70 Gy in 30-33 fractions.Cisplatin (80 mg/m2,q3 week (w)) and cetuximab (400 mg/m2 one w before radiation,and then 250mg/m2 per w) were given concurrently.The adverse events (AEs) were graded according to common terminology criteria for adverse events v3.0.ResultsThe compliance of the entire group of patient was satisfactory.Actual median dose to gross tumor volume was 69.96 Gy,and the median dose to positive cervical lymph nodes was 68 Gy.Median dose of cisplatin was 133 mg,median first-dose of cetuximab was 690 mg,and median weekly dose was 410 mg.AEs were well tolerated and manageable,mainly consisting of acneiform skin eruptions,dermatitis and mucositis.Grade 4 mucositis was observed in 2％ of the patients and no other grade 4 AEs were observed.ConclusionsThe combined treatment modality of IMRT +concurrent chemotherapy + cetuximab in loco-regionally advanced NPC is well tolerated.

A prospective, multicentric clinical study of intensity modulated radiotherapy in the treatment of nasopharyngeal carcinoma / 中华放射肿瘤学杂志

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.

Magnetic resonance imaging analysis of regional lymph node metastasis in 1 298 cases of nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Regional nodal metastasis in nasopharyngeal carcinoma plays an important role in the definition of radiotherapy area and clinical stage. It is also one of the main factors influencing prognosis. This study was designed to explore the pattern of metastatic lymph nodes for patients with nasopharyngeal carcinoma, which might provide a basis for clinical treatment and research.@*METHOD@#From Jan. 2009 to Jul. 2011, 1 298 histologically diagnosed nasopharyngeal carcinoma patients had routine MRI scan before radiotherapy in The First Affiliated Hospital of Guangxi Medical University. Diagnostic radiologists and radiation oncologists together assessed the nodal distribution according to the guideline CT-based delineation of lymph node levels. Then,Chi-square test was used to analyze the correlations between T stage and nodal metastasis rate and between nodal diameter and nodal extracapsular invasion.@*RESULT@#Of 1298 patients, 1067 (82.2%) had nodal involvement. The distributions were as: 20 in level I b,604 in level II a,883 in level II b,330 in level III, 78 in level IV, 162 in level Va,49 in level Vb,967 in retropharynx. Leap metastasis rate was 0.69%. In these patients, a total of 2464 positive nodes,including 1589 (64.52%) extra capsular spread nodes, were detected. The rate of nodal extracapsular invasion was higher when the axial diameter increased. No significant correlation was found between T stage and nodal involvement.@*CONCLUSION@#The level II and retropharyngeal node are the most frequently involved regions. They have similar metastatic rate and are both the first echo node to metastases of nasopharyngeal carcinoma. Level I metastasis is very low. There is a positive correlation between the proportion of extracapsular spread of metastatic lymph nodes and the axial diameter of lymph nodes. The cervical node involvement of nasopharyngeal carcinoma spread orderly down the neck, and the incidence of skip metastasis is rare. There is no significant difference between T stage and nodal involvement.

Pathogenesis of radiation-induced stomatitis / 国际肿瘤学杂志

Radiation-induced stomatitis is a frequent side effect for head and neck cancer patients undergoing radiotherapy, which affects both the treatment and the life quality. The direct effects of radiation, oxidative stress, transcription factor, proinflammatory cytokine and pathogenic microorganism are involved in the onset of radiation-induced stomatitis. The pathologic process can be divided into five phases including initiation, up-regulation, amplification, ulceration and healing. Understanding of the pathogenesis and risk factors provides basis for prevention and control of radiation-induced stomatitis.

Clinical effects of combined microwave hyperthermia and chemoradiotherapy in treatment of cervical lymph node metastasis of nasopharyngeal carcinoma / 中华物理医学与康复杂志

Objective To evaluate the short- and long-term efficacy of microwave hyperthermia combined with chemoradiotherapy in treating metastatic nasopharyngeal carcinoma to the cervical lymph nodes. Methods A total of 154 cases of stage N2-N3 nasopharyngeal carcinoma (1992 stage system) were randomized into two groups: group A (76 cases, treated with microwave hyperthermia combined with chemoradiotherapy) and group B (78 ca-ses, treated with chemoradiotherapy alone). Both groups received 1 to 2 cycles of chemotherappy with cisplatin and 5-fluorouracil and then received regular radiotherapy. The total doses of radiotherapy were 70-78 Gy/35-39 f, 47-51 d for the primary loci of nasopharynx and 68-72 Gy/34-36 f,46-50 d for the metastatic loci in the neck. Group A received microwave hyperthermia on the metastatic cervical node at the beginning of radiotherapy, with the micro-wave hyperthermia administered for 45 min every time,two times a week, totaling 8 to 14 times. Results The complete extinction rates of neck metastatic carcinoma were 80.3% and 61.5% , respectively, in groups A and B (P<0.05). The overall response rates of neck metastasis in the two groups were 100% and 96.2% , respective-ly. When the cervical lymph node metastasis disappeared, the radiotherapy doses in group A and B were (45.8 ± 5.46 ) Gy and (58.8±5.03 ) Gy, respectively (P<0.01). The 5-year local control rates of cervical lymph node in group A and B were 97.4% and 76.9%(P<0.05 ), respectively. The one-, three- and five- year survival rates were 97.4% , 76.3% and 59.2% respectively, in group A, versus 93.6% (P>0.05) ; and 52.6% (P< 0.01) and 41.0% (P<0.05), respectively, in group B. Conclusions Microwave hyperthermia combined with chemoradiotherapy can elevate the complete extinction rate of cervical lymph node metastasis of nasopharyngeal carcinoma and reduce the radiotherapy dose needed of effective control. The 5-year local control rate of cervical lymph node metastasis in combined therapy group is superior to that in the chemoradiotherapy alone group,and can elevate the long-term survival rate of patients.