Impact of boost irradiation on pelvic lymph node control in patients with cervical cancer

Radiation therapy (RT) for metastatic pelvic lymph nodes (PLNs) is not well established in cervical cancer. In this study the correlation between size of lymph nodes and control doses of RT was analyzed. Between January 2002 and December 2007, 245 patients with squamous cell carcinoma of the cervix treated with a combination of external beam irradiation with or without boost irradiation and high-dose rate brachytherapy were investigated. Size of lymph node was measured by computed tomography before RT and just after 50 Gy RT. Of the 245 patients, 78 had PLN metastases, and a total of 129 had enlarged PLNs diagnosed as metastases; 22 patients had PLN failure. The PLN control rate at 5 years was 79.5% for positive cases and 95.8% for negative cases. In cases with positive PLNs, 12 of 129 nodes (9.3%) developed recurrences. There was significant correlation between PLN control rate and size of PLN after 50 Gy (<10 mm: 96.7%, ≥ 10 mm: 75.7 % (P<0.001)). In addition, the recurrence in these poor-response nodes was significantly correlated with dose of RT. Nine of 16 nodes receiving ≤ 58 Gy had recurrence, but none of 21 nodes receiving > 58 Gy had recurrence (P = 0.0003). These results suggested that the response of lymph nodes after RT was a more significant predictive factor for recurrence than size of lymph node before RT, and poor-response lymph nodes might require boost irradiation at a total dose of > 58 Gy.     

c-Met mRNA、HGF mRNA的表达与宫颈癌患者盆腔淋巴结转移的相关性研究

目的探讨c-Met mRNA、HGF mRNA在宫颈癌患者体内的表达水平,分析影响宫颈癌患者盆腔淋巴结转移的相关因素。方法选取2012年6月-2014年6月在广元市妇幼保健院院进行手术治疗和组织活检的宫颈组织样本124例,其中宫颈癌92例,宫颈上皮内瘤变Ⅱ~Ⅲ级16例,正常宫颈组织16例。采用实时荧光PCR检测技术测定124例组织样本中c-Met mRNA和HGF mRNA的表达量,分析c-Met mRNA、HGF mRNA表达量、临床分期、年龄、组织类型、肌层浸润深度、脉管浸润、组织分化程度、肿瘤直径9个因素与盆腔淋巴结转移的相关性。结果 c-Met mRNA和HGF mRNA在宫颈癌组织中表达量显著高于在其他两种类型组织中的表达量(P0.05);c-Met mRNA表达量、HGF mRNA表达量、肌层浸润深度、脉管浸润、组织分化程度5个因素与宫颈癌患者盆腔淋巴结转移相关(P0.05)。结论 c-Met mRNA、HGF mRNA的高表达是引起宫颈癌患者盆腔淋巴转移的相关性因素。     

宫颈癌调强放疗骨盆受照射剂量与骨髓抑制的临床研究

目的 研究宫颈癌调强放疗时骨盆受照射剂量、体积与急性骨髓抑制的相关性,探讨放射治疗中骨盆骨髓保护的必要性,降低急性骨髓抑制发生率,提高患者的生活质量。方法 选取在徐州医科大学附属医院放射治疗科行盆腔调强放疗的80例宫颈癌患者,根据有无发生≥2级急性骨髓抑制,分为急性骨髓抑制组(试验组)40例、无骨髓抑制组(对照组)40倒。比较2组间骨盆剂量体积参数(Dmax、Dmean、V5、V10、V15、V20、V30、V40、V50)与≥2级急性骨髓抑制的相关性。结果 急性骨髓抑制组骨盆Dmax、Dmean、V5、V10、V15、V20、V30、V40高于无骨髓抑制组,2组间Dmean、V5、V10、V15、V20差异有统计学意义(t分别=2.365、2.157、2.127、2.251、4.800,P<0.05)。结论 盆体外照射时急性骨髓抑制与骨盆受照射剂量、体积有关,骨盆对放射线较敏感,应注意保护。     

RapidArc radiotherapy for whole pelvic lymph node in cervical cancer with 6 and 15 MV: a treatment planning comparison with fixed field IMRT

Dosimetric differences were investigated among single and dual arc RapidArc and fixed-field intensity-modulated radiotherapy (f-IMRT) treatment plans for whole pelvic irradiation of lymph nodes. A total of 12 patients who had undergone radical surgery for cervical cancer and who had demonstrated multiple pelvic lymph node metastases were treated with radiotherapy. For all 12 cases, 7-field IMRT, single-arc RapidArc and dual-arc RapidArc were applied with 6 MV and 15 MV X-ray energies. The radiation dosimetric parameters for the different plans were compared with one another. All the plans met the clinical requirements. The homogeneity, conformity and external volume indices of f-IMRT and dual-arc RapidArc were better than for single-arc RapidArc (P < 0.05), while the differences between f-IMRT and dual-arc RapidArc were not significant. There were no significant differences in the radiation dose to organs at risk, except for the small bowel receiving >40 Gy (f-IMRT and dual-arc < single-arc, P < 0.05). The differences in dose distributions between the two applied X-ray energies for each of the modality plans were not significant. RapidArc plans resulted in fewer monitor units than the corresponding f-IMRT plans. Also, there were no differences between the two photon energies, except for a reduction in the number of MUs for 15 MV (P > 0.05). Compared to f-IMRT, no significant dosimetric benefits were found using RapidArc for whole pelvic lymph node irradiation. However, RapidArc has been associated with shorter treatment time and fewer monitor units, supporting the case for its safety and efficacy for pelvic irradiation.     

黔南地区苗汉女性乳腺癌患者腋窝淋巴结转移及影响因素比较研究

目的探讨黔南地区苗汉女性乳腺癌患者腋窝淋巴结转移影响因素。方法选择诊断为乳腺癌的女性患者97例,按民族分苗族组50例,汉族组47例,比较两民族女性乳腺癌患者腋窝淋巴结转移及预后危险因素。结果苗族组50例中腋窝淋巴结转移者24例,转移率为48.00%;其中Luminal A型、Luminal B型、HER2/neu型和Basal-like型转移率为42.11%、53.33%、25.00%和58.33%。汉族组47例中腋窝淋巴结转移者15例,转移率为31.91%;其中Luminal A型、Luminal B型、HER2/neu型和Basal-like型转移率为31.25%、38.89%、0.00%和30.00%,两组比较差异有统计学意义(P0.05)。单因素Logistic回归分析年龄、民族、妊娠次数、肿瘤部位、组织学分级、病理类型、脉管浸润、ER、HER2/neu和Ki67表达与腋窝淋巴结转移有关(P0.05),多因素分析民族、妊娠次数、组织学分级、ER和Ki67为影响腋窝淋巴结转移的独立危险因素。结论黔南地区苗、汉女性乳腺癌患者腋窝淋巴结转移影响因素有差异,影响腋窝淋巴结转移的独立危险因素为民族、妊娠次数、组织学分级、ER和Ki67。     

不同负压引流强度下宫颈癌妇女手术切口愈合状况对比

目的 探究不同负压引流强度下宫颈癌妇女手术切口愈合状况.方法 80例宫颈癌手术患者随机分为无负压组(26例)、低负压组(27例)及高负压组(27例),比较各组甲级愈合率脂肪液化例数、血小板衍生因子(PDGF)、转化生长因子-β (TGF-β).结果 低、高负压组甲级愈合率为均为88.88％,显著高于无负压组甲级愈合率(P＜0.05):3组间切口脂肪液化并发症差异不显著(P＞0.05).术后第3天,低、高负压组较无负压组切口渗液引流量小,引流管留置的时间短,差异有统计学意义(P＜0.05);术后第3天,各组患者的PDGF及TGF-β含量均显著高于术后第1天(P＜0.05);术后第3天,高负压组患者的PDGF及TGF-β含量显著高于低负压组(P＜0.05).结论 相对于低压和无压,高负压引流强度下更有利于官颈癌妇女手术切口的愈合.     

The effects of two HDR brachytherapy schedules in locally advanced cervical cancer treated with concurrent chemoradiation: a study from Chiang Mai, Thailand

Efficacy of different schedules of HDR brachytherapy in concurrent chemoradiotherapy was evaluated. The study compared the effectiveness of the two HDR brachytherapy schedules which have the same Biological Effective Dose (BED) in locally advanced cervical carcinoma that was treated with concurrent chemoradiotherapy. Included in the study were 377 randomly selected patients with advanced carcinoma of the cervix uteri who were treated during the period 2004-2006. Patients were divided into Group I: 7.2 Gy × 3 fractions and Group II: 6 Gy × 4 fractions. With a median follow-up time of 35 months, local control, disease-free survival and overall survival rates were 80.8%, 63.4%, 98.8% in group I and 86.7%, 63.8%, 97.3% in group II, respectively. There was no statistical significance in terms of local control, disease-free survival, overall survival and complication rates between the two treatment schedules which could be observed. Seven patients in group I developed acute grade 2-4 GI toxicities and two patients in group II. In GU toxicities, there were three patients in group I and three patients in group II who developed grade 2-4 toxicities. In late toxicity, no patient developed grade 3-4 GU toxicities in group I while two patients developed grade 3-4 GU toxicities in group II. In GI toxicities, there were five and six patients in group I and group II, respectively, who developed grade 3-4 severity. Both HDR schedules seem to be safe and effective for the treatment of locally advanced cervical cancer.     

Design,development of water tank-type lung phantom and dosimetric verification in institutions participating in a phase I study of stereotactic body radiation therapy in patients with T2N0M0 non-small cell lung cancer: Japan Clinical Oncology Group trial (JCOG0702)

A domestic multicenter phase I study of stereotactic body radiotherapy (SBRT) for T2N0M0 non-small cell lung cancer in inoperable patients or elderly patients who refused surgery was initiated as the Japan Clinical Oncology Group trial (JCOG0702) in Japan. Prior to the clinical study, the accuracy of dose calculation in radiation treatment-planning systems was surveyed in participating institutions, and differences in the irradiating dose between the institutions were investigated. We developed a water tank-type lung phantom appropriate for verification of the exposure dose in lung SBRT. Using this water tank-type lung phantom, the dose calculated in the radiation treatment-planning system and the measured dose using a free air ionization chamber and dosimetric film were compared in a visiting survey of the seven institutions participating in the clinical study. In all participating institutions, differences between the calculated and the measured dose in the irradiation plan were as follows: the accuracy of the absolute dose in the center of the simulated tumor measured using a free air ionization chamber was within 2%, the mean gamma value was ≤0.47 on gamma analysis following the local dose criteria, and the pass rate was >87% for 3%/3 mm from measurement of dose distribution with dosimetric film. These findings confirmed the accuracy of delivery doses in the institutions participating in the clinical study, so that a study with integration of the institutions could be initiated.