Clinical application and safety evaluation of injectable cross-linked sodium hyaluronate isolation gel in radical hypofractionated radiation therapy for prostate cancer / 中华放射肿瘤学杂志

Objective:To evaluate the safety and feasibility of applying injectable cross-linked sodium hyaluronate isolation gel in radical hypofractionated radiation therapy for prostate cancer.Methods:In this prospective study, patients at Beijing Hospital who were pathologically diagnosed with clinical stage T 1-2N 0M 0 prostatic acinar adenocarcinoma by puncture and underwent radical radiation therapy were included. All patients received ultrasound-guided cross-linked sodium hyaluronate isolation gel injection and image-guided intensity-modulated radiation therapy (IG-IMRT). The prescription dose was moderately hypofractionated, with a prescription dose of 60 Gy in 20 fractions for 5 times a week, once daily, which was delivered to 95% of the planning target volume (PTV) of prostate and seminal vesicle. Analyze the prostate rectal spacing (PRS) at the baseline, on the day of injection, during the radiotherapy, 1 month and 3 months after radiotherapy, changes in rectal volume before and after injection, and incidence of rectum-related side effects. The changes in all indexes before and after injection were analyzed by using t-test. Results:A total of 13 patients were enrolled from March 2022 to February 2023. The isolation gel maintained morphologic stability without significant spatial changes during radiotherapy, and the mid-prostate had the best effect, with PRS up to 1 cm. At 3 months after radiotherapy, the isolation gel was seen to decreased in volume with a certain absorptive capacity. The irradiated volume of rectum was decreased significantly in all patients after gel injection, and the mean volumes of rectal V 60 Gy , V 50 Gy , V 30 Gy , and V 20 Gy before and after injection were 1.923% vs. 0.280%, 10.255% vs. 3.172%, 29.602% vs. 18.800%, and 49.452% vs. 40.259% (all P<0.005). The average values (range) of rectal V 60 Gy , V 50 Gy , V 30 Gy , V 20 Gy decreases were 84.9%( 29% - 100%), 69.6%(27%-100%), 36.3%(0%-75%), and 17.8%(0%-50%), respectively. No grade 3-4 side effects occurred in all patients, and there were no common grade 1-2 rectal side effects such as diarrhea, rectal bleeding, proctitis and anal pain, etc. Only one patient developed grade 1 constipation during radiotherapy. Conclusion:Injection of Chinese made cross-linked sodium hyaluronate isolation gel can significantly reduce the irradiated volume of rectum and the incidence of rectal toxicities in prostate cancer patients undergoing radical radiotherapy.

Current status of research on prediction of radiotherapy induced adverse reactions by radiation genomics / 中华放射肿瘤学杂志

The occurrence and severity of radiotherapy-induced adverse events cannot be accounted for or predicted by therapeutic and clinical factors alone.Evidence suggests that genetic variants are associated with adverse effects following radiotherapy.Radiation genomics is the study of genetic variants associated with radiotherapy toxicity.Radiation genomics aims to develop a risk prediction model and uncover the biological mechanisms responsible for radiotherapy toxicity.With the advances in genomics and bioinformatics in the past two decades,radiation genomics has evolved from candidate gene studies to genome-wide association studies,with a series of progress.In this review,we will discuss the study background,design,approaches,challenges,and future directions for radiation genomics.

Clinical value of false positive of Down’ s syndrome screening for premature rupture of membranes / 局解手术学杂志

Objective To explore the clinical value of false positive of Down’ s Syndrome Screening for premature rupture of membranes in the second trimester of pregnancy. Methods From Jan. 2009 to Jul. 2013, there were 321 cases who were in the second trimester of high risk pregnancy recieved Down’ s Syndrome Screening. Their fetals have been excluded chromosome or organ abnormality, and there was no fetal organ structure abnormal through sequence prenatal ultrasound examinations. Results of their pregnancy have been followed-up, and pregnancy outcomes of 346 cases who were of low risk were followed-up at the same time. Results Among the 321 cases, there were 14 ca-ses of abortion because of PROM ( gestational age less than 28 weeks);17 cases of premature delivery because of PROM, including 9 cases whose gestational age were from 28 to 34 weeks and 8 cases whose gestational age were from 34 weeks to 37 weeks;and 7 cases of neonatal asphyxia. In the low risk group, abortion because of PROM occured in 6 cases before 28 weeks, 3 cases between 28 to 34 weeks, and 4 ca-ses between 34 to 37 weeks, and neonatal asphyxia occured in 3 cases. Conclusion Comparing with Down’ s screening false positive preg-nant women and the low risk group, the false positive group have a higher occurrence of PROM, Down’ s screening is a potential high risk in-dex as a predictor of PROM.

Outcome of concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) for patients with locally advanced non-small-cell lung cancer (LA-NSCLC).</p><p><b>METHODS</b>Clinical data of 251 patients with stage III (76 IIIA and 175 IIIB) NSCLC who received CCRT as initial treatment between Jan 2001 and Dec 2010 in our hospital were reviewed. A median total radiotherapy dose of 60 Gy (range, 50-74 Gy) were delivered. 174 patients were treated with IMRT, 51 with 3D-CRT and 26 with 2D-radiotherapy. EP chemotherapy regimen was administered in 112 patients, PC regimen in 99 patients, topotecan regimen in 18 patients and other regimens in the remaining 22 patients. The efficacy and toxicity of CCRT were retrospectively analyzed.</p><p><b>RESULTS</b>244 patients were assessable for response, including 6 (2.5%) patients with CR, 183 (75.0%) with PR, 42 (17.2%) with SD and 13 (5.3%) with PD. At a median follow-up period of 20 months, the 1-, 3-, 5- year OS were 69.2%, 31.2%, 23.2%, respectively, and the median OS was 21 months. The 1-, 3-, 5- year PFS were 40.9%, 22.1%, 17.7%, respectively, and the median PFS was 10 months. Patients with stage IIIA NSCLC achieved better 5-year OS than that with IIIB NSCLC (29.2% vs. 20.7%, χ2=2.254, P=0.133). Failure pattern was assessable in 244 patients, including 61 (25.0%) locoregional progression alone, 55 (22.5%) distant metastasis alone and 77 (31.6%) with both. The rates of grade≥3 radiation pneumonitis, esophagitis and hematologic toxicity were 4.4%, 11.2% and 26.4%, respectively.</p><p><b>CONCLUSIONS</b>CCRT provide stage III NSCLC patients favorable outcome with acceptable toxicity. CCRT is standard therapeutic approach for patients with unresectable locally advanced NSCLC.</p>

Efficacy and Cost Effectiveness Analysis of Five Different Therapeutic Schemes for Chronic Hepatitis B / 中国医师杂志

Objective To observe the clinical efficacy and the economic effectiveness of different therapeutic schemes for Chronic hepatitis UB.Methods Patients with Chronic Hepatitis B were treated by using different drugs:Interferon ?1b(group A),Lamivudine(group B),Interferon ?1b combination with Lamivudine(group C),Interferon ?1b combination with thymotentin(group D),Interferon ?1b combination with thymosin alphal(group E).Evaluation was carried out with pharmacoeconomic cost-effectiveness.Results At the end of therapy,the clearance rate of serum HbeAg was lowest in group B(10 94%),the other groups were more than 50%.The clearance rate of serum HBV-DNA was higher in group B and C than in the other groups,it was 85 94%,87 93% respectively.Normalizing ALT values was higher in group C,group D and group E than in group A and group B.The costs of several therapeutic schemes were RMB 8156 7(group A),6935(group B),15091 7(group C),26033 4(group D) and 89978 4(group E) yuans,respectively.Conclusions According to the evaluation with pharmacoeconomic cost-effectiveness analysis,the therapeutic scheme of Interferon ?1b,Lamivudine and Interferon ?1b combination with Lamivudine is best one for treating chronic hepatitsi B,in this groups,Interferon ?1b combination with Lamivudine was better than the other two groups.