Distinct Immune Cell Populations Define Response to Anti-PD-1 Monotherapy and Anti-PD-1/Anti-CTLA-4 Combined Therapy

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Hypoxia and Radiation Response in Human Tumors

This study demonstrates by an updated analysis of an ongoing prospective study that tumor oxygenation, as measured with a validated standardized polarographic needle electrode method before treatment, powerfully predicts the prognosis of patients receiving radiotherapy for intermediate and advanced stage cancer of the uterine cervix. First evidence for a host component in tumor oxygenation based on a significant correlation between median pO(2) values determined in normal subcutaneous fatty tissue and in cervical cancer is also presented. Further investigations are necessary to clarify whether tumor hypoxia is just a marker of intrinsic tumor aggressiveness or whether the negative impact of tumor hypoxia on survival is related to radiobiological mechanisms caused by hypoxia per se, which may include (1) the reduced oxygen enhancement effect, (2) increased radioresistance due to expression of genes for cell cycle delay and stress proteins, and/or (3) accelerated tumor progression to more radioresistant and metastatic variants by increased genetic heterogeneity.     

Radiation Therapy for Pediatric Brain Tumors using Robotic Radiation Delivery System and Intensity Modulated Proton Therapy

PurposeThis study recruited 2 centers with expertise in treating pediatric brain tumors with robotic radiation delivery system photon therapy and proton therapy, respectively, to study the plan quality and dose deposition characteristics of robotic radiation delivery system photon therapy and intensity modulated proton therapy (IMPT) plans.Methods and MaterialsA total of 18 patients clinically treated with the robotic radiation delivery system were planned with IMPT. Cases were planned per the standard of care of each institution but respected the same planning objectives. The comparison included 3 aspects: plan quality, dose fall-off characteristics around the target volume, and the volume of the high-, intermediate-, and low-dose baths.ResultsAll robotic radiation delivery system and IMPT plans met the planning objectives. However, IMPT significantly reduced the maximum dose to organs at risk away from the planning target volume (PTV), such as the cochlea and eye (P < .05), and the mean dose to the normal brain (P < .05). No statistically significant difference was observed in the maximum dose to the optical pathway and brain stem. Robotic radiation delivery system plans demonstrated a sharper dose fall-off within 5 mm around the PTV (P < .05), whereas IMPT significantly lowered the dose to the normal tissue beyond 10 mm from the PTV (P < .05). The robotic radiation delivery system offers a smaller high-dose bath whereas IMPT offers a smaller low-dose bath (P < .05). However, the difference in intermediate dose is not statistically significant.ConclusionsIn general, robotic radiation delivery system plans exhibit reduced high-dose exposure to normal tissue, and IMPT plans have considerably smaller volumes of low-dose exposure with differences in medium-range dose baths increasingly favoring protons as tumor size increases.     

头部面罩固定技术在脑瘤调强适形放疗中的应用

目的探讨头部面罩固定技术在脑瘤调强适形放疗中的效果。方法采集首次定位时体位的电子图像,并与CT扫描后,核对DDR图前的体位及首次放疗前的DDR图对比,误差1～2mm者进行重新摆位并及时纠正。结果入组的129例患者中,X轴（左右方向）零误差有123例,占95.35%,误差在2mm以内有6例占4.65%;Y轴（头足方向）零误差有124例,占96.12%,误差在2mm以内有5例,占3.88%;Z轴（前后方向）零误差有122例,占94.57%,误差在2mm以内有7例,占5.43%。结论头部面罩固定技术应用于脑瘤调强适形放疗,体位移动少,重复性及固定性好,准确度高。     

Radiation Therapy and the Management of Intramedullary Spinal Cord Tumors

The use of radiation therapy in the management of intramedullary spinal cord tumors remains controversial. Several studies indicate that the use of postoperative radiation therapy modestly improves both local control and survival in spinal cord ependymomas and astrocytomas. Modern treatment planning and imaging allow more accurate target definition and respect for related normal tissue tolerances.     

Surgery and Polychemotherapy of Non-Functional Endocrine Pancreatic Tumors: a Case Report with a Dramatic Clinical Response

Abstract

Endocrine pancreatic tumors (EPT) are a rare clinical entity, representing 5% of all pancreatic tumors. Nonfunctional subtypes (NF-EPT) often present themselves at diagnosis in a locally advanced or metastatic stage. Therapeutic planning of these neoplasias is based on a multidisciplinary integration of surgery and medical treatments. The Authors describe a case of NF-EPT with massive metastatic spread after cytoreductive surgery, with impressive response to polychemotherapy with 5-fluorouracil, epirubicin and dacarbazine. The various options concerning chemotherapic treatment of these tumors are reviewed.     

Prospective Phase I Study of Capecitabine and Oxaliplatin Concurrent with Radiation Therapy for the Treatment of Locally Advanced Pancreatic Adenocarcinoma,and Retrospective Comparison to Concurrent 5-Fluorouracil/Radiation and Gemcitabine/Radiation

Purpose  

The aims of this study is to determine the maximum tolerated dose of capecitabine and oxaliplatin (CAPOX) delivered concurrent with radiation therapy (RT) in the treatment of locally advanced pancreatic adenocarcinoma and to retrospectively compare outcomes with this regimen to concurrent 5-fluorouracil or capecitabine with RT (5FU-RT) or concurrent gemcitabine-based chemotherapy with RT (GEM-RT).     

抗PD-1抗体联合治疗晚期肝细胞癌的真实世界研究

目的探讨真实世界中以抗PD-1抗体为基础的疗法在晚期肝细胞癌治疗中的疗效、不良反应及可能影响疗效的因素。方法收集55例接受以PD-1抗体为基础治疗的晚期肝细胞癌患者,回顾性分析其临床特点、疗效及不良反应,并进行随访。结果客观有效率为21.8%,疾病控制率为76.4%。治疗过程中不良反应整体发生率为81.8%,其中3~4级不良反应发生率为14.5%,免疫相关不良反应发生率为58.2%,其中3~4级免疫相关不良反应发生率为3.6%,无治疗相关死亡。55例患者中位无进展生存期为5.0月(95%CI:3.9~6.1),中位生存期11.4月(95%CI:6.5~16.3)。应用抗PD-1抗体前患者肝功能Child-Pugh评分和体能状态ECOG评分是影响治疗有效率和生存时间的主要因素;多因素分析也表明治疗前患者的体能状态ECOG评分和肝功能Child-Pugh评分是影响患者生存的独立预后因素(P<0.001,P=0.034)。结论真实世界中以PD-1抗体为基础的治疗在晚期肝细胞肝癌患者中是安全有效的,其中治疗前患者的体能状态ECOG评分和肝功能Child-Pugh评分是影响患者生存期的独立预后因素。     

同步放化疗或单纯放疗治疗食管癌的疗效观察

目的 观察3DCRT联合同步化疗或单纯3DcRT治疗食管癌的近期有效率、局部控制率、生存率.方法 89例食管癌分为3组.同步放化疗组(A组):给予局部3DCRT,DT 60 Gy,放疗第1、5周给予DDP+5-Fu方案化疗,放疗结束1～2月后巩固化疗3～4周期;3DCRT组(B组):给予局部3DCRT,DT 60～70 Gy;常规放疗组(C组):给予常规放疗DT 68～72 Gy.结果 3组有效率分别为92.86%、83.87%和80.00%(P>0.05).1年控制率为82.14%、77.42%和63.33%(P>0.05);1年生存率为75.00%、67.74%和60.00%(P>0.05);2年控制率为71.43%、64.52%和46.67%(P<0.05);2年生存率为64.29%、51.62%和43.33%(P>0.05);3年控制率为60.71%、45.16%和30.00%(P<0.05);3年生存率为46.43%、41.94%和23.33%(P<0.05).结论 3DCRT联合同步化疗或单纯3DCRT治疗食管癌比常规放疗疗效好,3DCRT联合同步化疗比单纯3DCRT疗效好.     

Concurrent Chemotherapy and Radiation Therapy for Locally Advanced Carcinoma of the Esophagus

A pilot study was undertaken to clarify the efficacy of concurrentchemoradiotherapy against locally advanced esophageal carcinoma.The 20 patients in this study had previously untreated esophagealcarcinoma with evidence of T4 disease and/or distant node metastases.Chemotherapy consisted of protracted infusion of 5-fluorouracilat a dose of 400 mg/m²/day on days 1–5 and 8–12,combined with a 2-h infusion of cisplatinum at 40 mg/m² on days1 and 8. Radiation treatment for the mediastinum was administered5 days per week for 3 wk at 2 Gy/day, along with chemotherapy.These schedules were repeated twice to give a total radiationdose of 60 Gy. For patients who responded, two additional coursesof chemotherapy were administered. Five of the 20 patients hadUICC stage III disease and 15 had stage IV. Seventeen (85%)of the 20 patients exhibited an objective response, including6 (30%) complete responses. Local control was excellent with10 (50%) complete responses. Toxic effects were severe. Majortoxicities were leukocytopenia of grade 3 or more in 45% ofthe patients and esophagitis, including four perforations. Therewere two treatment-related deaths. The median survival timewas 9 mo (range: 2 to 34+). Concurrent chemotherapy and radiotherapywas effective even for locally advanced esophageal carcinoma,but was associated with significant toxicity.