Long-Term Safety and Efficacy of CT-Guided I125 Radioactive Seed Implantation as a Salvage Therapy for Recurrent Head and Neck Squamous Carcinoma: A Multicenter Retrospective Study.

PURPOSE: To investigate the safety and efficacy of CT-guided I125 radioactive seed implantation (RSI) as a salvage therapy for recurrent head and neck squamous carcinoma (rHNSC) after external beam radiotherapy (EBRT) or surgery. MATERIALS AND METHODS: This is a multicenter retrospective study of 113 patients (83 males; median age 57 years) with rHNSC who underwent CT-guided I125 RSI between February 2003 and December 2017. Of the included patients, 107 patients previously received EBRT and 65 patients received surgery and all were ineligible or rejected for salvage surgery and/or repeat EBRT. RESULTS: During a median follow-up duration of 20 months (range, 3-152 months), 87 patients died. The 1-, 2-, 3-, and 5-year local control rate were 57.4%, 41.8%, 29.3%, and 15.2%, respectively. The median time to progression was 15 months [95% confidence interval (CI), 6.1-23.9 months]. The median overall survival (OS) was 20 months (95% CI, 12.4-27.6 months). The 1-, 2-, 3-, and 5-year OS rate were 63.6%, 44.6%, 29.9%, and 21.7%, respectively. Univariate and multivariate analyses revealed that KPS score and postoperative D90 were significantly associated with patients' OS. The complications were mainly grade I/II skin and mucosal reactions: 18 cases (15.9%) of grade I/II and eight cases (7.0%) of grade III radiation dermatitis, and 14 cases (12.4%) of grade I/II and three cases (2.7%) grade III mucosal reactions. No grade IV or severer complications were found. CONCLUSION: CT-guided I125 RSI may be safe as a salvage therapy for rHNSC after EBRT/surgery, yielding promising efficacy compared with historical data. KPS score and postoperative D90 may be significantly associated with OS.

[Application of early continuous renal replacement therapy in the bundle treatment of severe pneumonia].

OBJECTIVE: To explore the role of early continuous renal replacement therapy (CRRT) in bundle treatment of severe pneumonia. METHODS: Seventy severe pneumonia patients admitted to respiratory intensive care unit (RICU) of Second Affiliated Hospital of Xuzhou Medical University from January 2013 to June 2017 were enrolled. The patients were randomly divided into routine treatment group and CRRT treatment group, with 35 patients in each group. All patients were treated with bundle therapy, and those in CRRT treatment group was treated with CRRT daily on the basis of conventional bundle therapy. The mode was continuous veno-venous hemofiltration (CVVH), lasting 8-24 hours at a time. On the day of admission and the treatment of 1, 3, 5, 7 days, the fasting venous blood was collected. Inflammatory stress and immune parameters including procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and CD4+ cells were determined by enzyme linked immunosorbent assay (ELISA) or flow cytometer. The incidence of acute respiratory distress syndrome (ARDS) and mortality within 7 days were observed in the two groups. RESULTS: Seventy patients with severe pneumonia were enrolled. There was no significant difference in the serum PCT, IL-6, TNF-α or CD4+ before treatment between the two groups. With the prolongation of treatment time, the PCT, IL-6 and TNF-α levels were gradually decreased, and the CD4+ was gradually increased. Compared with routine treatment group, PCT and TNF-α in CRRT treatment group were significantly decreased since the 3rd day [PCT (µg/L): 3.11±1.28 vs. 3.76±1.42, TNF-α (ng/L): 98.61±11.58 vs. 119.47±12.38], and CD4+ was significantly increased (0.39±0.03 vs. 0.35±0.03, all P < 0.05). The changes in IL-6 of CRRT treatment group was delayed, the statistical significance was found since the 5th day as compared with routine treatment group (ng/L: 35.43±12.39 vs. 52.86±10.78, P < 0.05). Compared with routine treatment group, the incidence of ARDS [11.43% (4/35) vs. 31.43% (11/35)] and mortality [0% (0/35) vs. 11.43% (4/35)] within 7 days in CRRT treatment group were significantly lowered (both P < 0.05). CONCLUSIONS: CRRT in the early stage of bundle therapy for severe pneumonia is not only suggested to remove inflammatory mediators and improve immune function, but an opportunity and effective way to reduce complications and delay rapid progression of severe pneumonia. It provides the opportunity and condition for comprehensive treatment.

[The significance of multi-criteria decision analysis for the bundle treatment of severe pneumonia].

OBJECTIVE: To determine the effect of multi-criteria decision analysis (MCDA) on the effect of bundle treatment for severe pneumonia. METHODS: A prospective historical control observation was conducted. Seventy-five patients with severe pneumonia having received MCDA (from January 2013 to August 2014) were assigned as intervention group. MCDA group was set up by the medical staff. Bundled treatment plan was composed of the MCDA evaluation results, anti-infection, phlegm and other conventional treatment measures which was adjust on time until the patient was transferred out of the respiratory intensive care unit (RICU) or died. Seventy patients with severe pneumonia before receiving MCDA (from August 2010 to December 2012) were set as historical control group. Comparison of general condition before treatment and the incidence of hospital infection, average hospitalization cost, duration of RICU stay and mortality between these two groups were performed. RESULTS: There were no statistically significant differences in gender, age, past history, and acute physiology and chronic health evaluation II (APACHE II) score at admission between two groups. Compared with control group, the incidence of hospital infection [1.33% (1/75) vs. 11.43% (8/70), χ2 = 4.723, P = 0.030], mean hospitalization cost in RICU (10 thousand Yuan: 3.44 ± 0.79 vs. 3.76 ± 0.91, t = 2.265, P = 0.025), length of RICU stay (days: 15.01 ± 4.22 vs. 16.92 ± 4.79, t = 2.552, P = 0.012) and mortality in RICU [8.0% (6/75) vs. 21.4% (15/70 ), χ2 = 5.272, P = 0.032] in intervention group was significantly decreased. CONCLUSIONS: Application of MCDA in the bundle treatment of severe pneumonia could elevate the scientificalness of decision, and reduce the medical cost. Additionally, MCDA is worth to be generalized because the implementation of guidelines can improve the clinical outcome and prognosis of the patients.