Aryl hydrocarbon hydroxylase inducibility in lung cancer patients undergoing radiotherapy

Aryl hydrocarbon hydroxylase (AHH) inducibility was studied in cultured lymphocytes from 21 healthy control subjects and from 15 lung cancer patients selected for radiation therapy. AHH inducibility of the patients was measured prior to, during and at the end of radiation therapy. Four of 15 patients had values comparable to the healthy controls. Cellular DNA and protein measurements of cultured lymphocytes were the same for patients and healthy controls. There was no significant difference in the percentage of lymphoblast formation and percentage of cell survival between the two groups. Radiation therapy reduces the number of lymphocytes in vivo and the amount of lymphoblast formation in vitro. AHH inducibulity is signifcantly lowered by radiation in the patients who had very high inducibility at pre-treatment level. DNA and protein contents of cultured lymphocytes did not change during radiation therapy.     

An educational intervention for newly-diagnosed cancer patients undergoing radiotherapy

This is a prospective, randomized pilot trial of an educational intervention for newly-diagnosed cancer patients under going radiotherapy. The trial was conducted in a relatively rural area in northwest Texas. Our hypothesis was that the intervention would reduce psychological distress. A group of 31 patients who were predicted by the Omega Screening Instrument to be at high risk for psychological distress were selected to be the subjects for this study. The patients were randomly assigned either to the intervention (n = 15) or to a control group (n = 16). The intervention was a series of three one-hour individual sessions which gave information about radiotherapy and cancer, coping strategies, and communication skills. The sessions occurred during the second, third, and fourth weeks of each patient's radiotherapy. Psychological distress was measured with the Brief Symptom Inventory (BSI) at study entry, and one and three months later. We also used the Inventory of Current Concerns (ICC) to determine the specific areas of concern which were correlated with psychological distress. Knowledge gained was measured with a 15-item multiple choice test which we developed from the factual material in the intervention and which we administered to both groups at entry, one month and three months. The intervention group's mean scores on the BSI Depression subscale fell over the three months on study, while those of the control group rose. The difference was statistically significant. However, the BSI scores overall were not different between the groups. Psychological distress in both groups was correlated most closely with Health, Existential, and Self-Appraisal concerns on the ICC. Knowledge, as measured by the multiple choice test, did not increase in the intervention group, and there was no statistically significant difference between the scores of the intervention and control groups at any time. Since the BSI Depression scale has independent convergent validity with other measures of depression, we believe that the change in the intervention group's Depression scores could represent a meaningful effect. However, the lack of any measurable increase in knowledge suggests that any benefit of the educational intervention was probably non-specific, resulting more from individual attention than from information gained.     

放射治疗对宫颈癌病人DNA损伤及hprt基因突变的初步研究

目的：评价放射治疗对宫颈癌患者造成的遗传学损伤。方法：取15例宫颈鳞癌放疗患者放疗前及放疗累积剂量为0Gy、10Gy、20Gy、30Gy、40Gy、50Gy、60Gy时的外周静脉血,以彗星实验检测淋巴细胞的DNA损伤,采用多核细胞法测hprt基因位点突变率。结果：各累积剂量组淋巴细胞DNA拖尾率比照射前显著升高（P〈0.01）,并且在0-60Gy之间,拖尾率与累积照射剂量之间成线性关系。各累积剂量组尾长比照射前均增加（P〈0.01）,在照射剂量累积30Gy时,尾长均值达最大。尾长与累积剂量间不成线性关系。hprt基因位点突变率在照射后升高,与照射前相比,在照射累积剂量为30Gy、40Gy和50Gy时,显示有统计学意义差别（P〈0.05）。hprt基因突变率与累积剂量间呈现较好的剂量-效应关系。结论：宫颈癌患者放疗后造成外周血淋巴细胞DNA损伤及hprt基因突变,hprt基因突变和彗星实验用于评价放疗造成的损伤,具有较高的敏感性。     

放疗期间宫颈癌患者疾病不确定感与应对方式的研究

目的：探讨放疗期间宫颈癌患者疾病不确定感与应对方式之间的关系。方法：应用疾病不确定感量表（MUIS）和Jalowiec的应对量表（JCS-60）对68例放疗期宫颈癌患者进行调查。结果：放疗期间宫颈癌患者疾病不确定感总得分为（93.06±7.91）。乐观是患者应用最多的应对方式,得分为（2.11±0.45）。情感宣泄应用最少,得分为（0.97±0.62）。疾病不确定感与逃避、宿命、情感宣泄应对方式呈正相关（ r＝0.285,P＝0.02;r＝0.369,P＝0.002;r＝0.248,P＝0.045）。不可预测与自我依赖呈负相关（ r＝-0.265,P＝0.031）。结论：放疗期间宫颈癌患者疾病不确定感与应对方式存在相关性,医护人员应关注并了解患者的疾病不确定感,通过针对性地提供相关信息,降低患者的疾病不确定感,帮助病人建立有效的应对方式。     

Does nutrition influence quality of life in cancer patients undergoing radiotherapy?

PURPOSE: To investigate in cancer patients referred for radiotherapy (RT): (1) quality of life (QoL), nutritional status and nutrient intake, at the onset and at the end of RT; (2) whether individualised nutritional counselling, despite symptoms, was able to enhance nutrient intake over time and whether the latter influenced the patient's QoL; and (3) which symptoms may anticipate poorer QoL and/or reduced nutritional intake. MATERIAL AND METHODS: One hundred and twenty-five patients with tumours of the head-neck/gastrointestinal tract (high-risk: HR), prostate, breast, lung, brain, gallbladder, uterus (low-risk: LR) were evaluated before and at the end of RT. Nutritional status was evaluated by Ottery's Subjective Global Assessment, nutritional intake by a 24-h recall food questionnaire and QoL by two instruments: EUROQOL and the European Organisation for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30. RESULTS: Baseline malnutrition was prevalent in HR vs. LR (P=0.02); nutritional intake was associated with nutritional status (P=0.007); the latter did not change significantly during RT. In LR, baseline energy intake was higher than EER (P=0.001), and higher than HR' intake (P=0.002); the latter increased (P<0.03), in spite of symptom increase anew and/or in severity (P=0.0001). According to both instruments, QoL was always better in LR vs. HR (P=0.01); at the end of RT, QoL improvement in HR was correlated with increased nutritional intake (P=0.001), both remained stable in LR. CONCLUSIONS: Individualised nutritional counselling accounting for nutritional status and clinical condition, was able to improve nutritional intake and patients' QoL, despite self-reported symptoms.     

Treatment of anemia by recombinant human erythropoietin in cancer patients undergoing radiotherapy

Anemia is a deficiency in red blood cells or in the hemoglobin (Hb) levels that leads to a decrease in the transport capacity of oxygen in the blood, which can reduce tolerance in radiotherapy (RT) and chemotherapy. The relationship between anemia and hypoxia, however, is complex and influenced by multiple variables. Although the blood Hb values that might develop hypoxia in tumors were not described clearly, optimal oxygen pressure was accepted in patients with an Hb value of 12–14 g/dL. Erythropoietin is a glycoprotein, which acts via EPOR to stimulate the growth, to prevent apoptosis, and to induce differentiation of red blood cell precursors. RhuEPO‐α and ‐β are classically administered subcutaneously three times per week at doses ranging from 150 to 300 IU/kg. Darbepoetin‐α has been shown to exhibit a longer elimination half‐life, thus allowing a once‐weekly administration at the dose of 2.25 µg/kg. Side‐effects related to rhuEPO include hypertension and thromboembolic events. RhuEPO can be used effectively in the treatment of anemia in patients with solid tumor being treated by RT or chemoradiotherapy. Furthermore, the use of rhuEPO has been demonstrated to have a sustained beneficial impact on quality of life in cancer patients. However, the role of combination of rhuEPO with external RT still remains inconclusive and several clinical trials have been pointed increased mortality in patients treated with rhuEPO. In this paper, the probable radiobiological effects of anemia in patients treated with RT, the beneficial and adverse effects of rhuEPO, and related studies are reviewed. Future directions for the use of rhuEPO are proposed.     

Prevalence of anemia in cancer patients undergoing radiotherapy: prognostic significance and treatment

As the antitumor activity of radiation is mediated via its interaction with oxygen to form labile free radicals, the intratumoral oxygen level has an important influence on the ability of radiation therapy to kill malignant cells. By decreasing the oxygen-carrying capacity of the blood, anemia may result in tumor hypoxia and may have a negative influence on the outcome of radiotherapy for various malignancies, even for small tumors not normally assumed to be hypoxic. In addition, anemia also has a negative effect on the quality of life of cancer patients, as evidenced by worsening fatigue. As a high proportion (about 50%) of cancer patients undergoing radiotherapy are anemic prior to or during treatment, strategies to correct anemia and/or the resultant tumor hypoxia are increasingly being considered an important component of treatment. In particular, epoetin alfa (recombinant human erythropoietin), which has proved an effective and well-tolerated means of raising hemoglobin levels in anemic patients receiving radiotherapy, potentially could reverse the negative prognostic influence of a low hemoglobin in patients with certain malignancies. Radiation oncologists need to be aware of the possibility of anemia in cancer patients undergoing radiotherapy so that timely intervention can be instituted whenever anemia is diagnosed.     

分层次个性化健康干预在子宫内膜癌术后化疗患者中应用效果

目的 探讨分层次个性化健康干预在子宫内膜癌术后化疗患者中应用效果.方法 依据干预方法将84例子宫内膜癌患者分为对照组(n=41)和研究组(n=43),对照组患者给予常规健康指导,观察组患者在此基础上给予分层次个性化健康干预.比较两组患者胃肠功能恢复时间、健康知识掌握程度、自我照护能力、生活质量、患者满意度及复发情况.结果 研究组患者的胃肠功能恢复时间明显短于对照组(P﹤0.01).干预后,两组患者知识测评、自护技能、自护责任感、自护概念评分及健康知识掌握程度评分均高于本组干预前(P﹤0.05),且研究组患者知识测评、自护技能、自护责任感、自护概念评分及健康知识掌握程度评分均高于对照组(P﹤0.05).干预后,研究组患者生理功能、社会功能及躯体功能评分均高于本组干预前和对照组(P﹤0.01).研究组患者健康指导、服务态度、基础干预、指导干预技术、患者安全评分均明显高于对照组(P﹤0.05).研究组患者的复发率为4.65％,低于对照组患者的24.39％(P﹤0.05).结论 分层次个性化健康干预可有效提高子宫内膜癌术后化疗患者的生活质量、自我照护能力,降低复发率,患者满意度高.     

术后放疗与术后化疗辅助治疗子宫内膜癌的Meta 分析

目的：全面评价术后放疗与术后化疗辅助治疗子宫内膜癌的有效性和安全性，为临床合理选择提供决策依据。方法计算机检索 EMBase、PubMed、Cochrane Library、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VIP），检索截止时间为2015年8月31日。全面收集术后放疗与术后化疗辅助治疗子宫内膜癌的随机对照试验（RCT），两名评价者独立评价纳入文献的方法学质量并交叉核对提取资料，采用 RevMan 5．1软件进行统计分析。结果最终纳入3篇 RCT（1121例子宫内膜癌患者），Meta 分析结果显示，与术后化疗辅助治疗相比，术后放疗并不能提高子宫内膜癌5年生存率（RR ＝0．94，95％CI 为0．80～1．10，Z ＝0．77，P ＝0．440）、5年无疾病进展生存率（RR ＝0．98，95％CI 为0．90～1．07，Z ＝0．52，P ＝0．610）和降低复发率（RR ＝1．06，95％CI 为0．91～1．24，Z ＝0．75，P ＝0．450），但可降低3～4级血小板减少症（RR ＝0．13，95％CI 为0．07～0．27， Z ＝5．62，P ＜0．00001）和3～4级中性粒细胞减少症（RR ＝0．01，95％CI 为0．00～0．03，Z ＝8．27，P ＜0．00001），差异有统计学意义。对于Ⅲ～Ⅳ期子宫内膜癌患者而言，与术后放疗相比，术后化疗辅助治疗可以提高晚期子宫内膜癌的5年生存率（RR ＝0．79，95％CI 为0．68～0．91，Z ＝3．15，P ＝0．002）和5年无疾病进展生存率（RR ＝0．82，95％CI 为0．69～0．97，Z ＝2．31，P ＝0．020），且差异有统计学意义。结论当前证据表明，与术后放疗相比，术后化疗可能会提高晚期患者的生存率，其远期疗效尚待大样本高质量的 RCT 进一步证实。     

The role of radiotherapy for high-risk endometrial cancer

High-risk endometrial cancer comprises an uncommon group of tumors, which includes pathological stage III adenocarcinoma and all stages of papillary serous carcinoma. Optimal management of this class of malignant female genital neoplasms is surgical resection, including debulking of any gross abdominopelvic disease. This article analyzes the literature concerning the use of adjunctive radiotherapy. The data presented suggest that postoperative whole abdominal radiotherapy may improve outcome in selected subsets of patients within this high-risk group. Future clinical investigations will greatly benefit from the anticipated published results of two completed prospective cooperative group clinical trials that involve whole abdominal irradiation.     

放疗期间宫颈癌患者生存质量及影响因素分析

目的：调查放疗期间宫颈癌患者的生存质量状况,分析其影响因素。方法：采用生存质量核心量表（FACT-G）对109例放疗期间宫颈癌患者进行调查。结果：宫颈癌患者生存质量总分为64.92±14.32,社会/家庭状况得分最高,为18.84±3.34,功能状况得分最低,为13.52±4.43。经济收入、年龄、婚姻状况、疼痛及睡眠是生存质量的影响因素。结论：放疗期间宫颈癌患者生存质量不高,应加强对经济条件差、年轻、单身、疼痛及睡眠质量差的患者的干预,以提高生存质量。     

肿瘤放疗患者口服营养补充专家共识(2017)

恶性肿瘤患者约有40%~80%存在营养问题,营养不良会影响肿瘤放疗患者的治疗和预后。近年来,营养支持在放疗患者的应用越来越受到重视,合理的营养干预有助于改善肿瘤放疗患者营养状况,维持治疗连续性,改善预后。口服营养补充是指南推荐的首选医学营养补充方式,口服营养补充在围放疗期的应用有助于放疗前维持体重和减轻放疗导致的黏膜损伤,放疗中保证患者达到足够营养摄入量,放疗后营养状况的维持等。而目前放疗患者对营养不良的危害认识不足,临床亟待加强营养宣教来帮助患者及家属建立正确的医学营养观念。因此,本共识对肿瘤放疗患者的营养筛查与评估、口服营养补充在围放疗期的应用以及营养宣教提出推荐和建议,为放疗患者营养支持的规范化提供参考意见。     

Changes in cell-mediated immunity in patients undergoing radiotherapy

The cell-mediated immune status of 147 patients who received radiotherapy was evaluated using in vitro tests (PHA, E-rosette and spontaneous blastogenesis) both before and 6 weeks after the end of radiation. All patients had verified malignancies, involving the bronchus in 29 cases, breast in 28, female genital system in 26, head and neck in 20 and bladder in 15. Patients suffering from bronchogenic carcinomas or malignancies of the head and neck showed a relative high degree of immune suppression. Our findings indicate a trend towards some improvement in PHA reactivity, as well as in as the percentage of E-rosette-forming cells after treatment, which is more noticeable in patients with pelvic or breast tumors. A relationship seems to exist between the tumor load and the immune status, which reverts to a normal pattern when the former is extinguished. Moreover, patients with poor clinical response display a profoundly depressed level of immune status without any improvement after treatment.     

Early inhibition of natural and interferon-activated killers in endometrial cancer patients treated with local radiotherapy

The present study was aimed at comparing the effect of clinical staging and radiotherapy on natural killer (NK) and interferon-activated killer (IAK) cell activity in a group of endometrial cancer patients receiving a total dose of 5,000 to 8,000 rads. We report that when compared to age-matched women, a significantly higher number and percentage of patients show low NK and IAK cell activity. At diagnosis, diminished NK activity was seen in about 20% of the patients, while IAK activity was low in 49% of these patients. There was no correlation between these deficiencies and the grade or stage of the disease. In contrast, radiotherapy induced deleterious effects on both populations of NK and IAK cells. These deleterious effects were more pronounced in patients showing a low level of spontaneous NK activity. In an attempt to understand better the mechanism by which the presence of cancer itself and/or radiotherapy affects these activities, we studied in greater detail changes in peripheral blood T-cell numbers and subsets. Before radiotherapy, all lymphocyte counts were within the normal range. In contrast, after radiotherapy the absolute numbers of all T-cell subsets were significantly decreased in the majority of the patients tested, OKT4+ cells being the most radiosensitive and Leu 7+ cells the most radioresistant.     

Pilot study of cytokine profiles in prostate cancer patients undergoing proton or conventional radiotherapy

The mechanisms responsible for normal tissue late effects following radiotherapy are largely unknown and currently no method for predicting such risks is available. Abnormal levels of cytokine production induced by radiation has been suggested as a contributing factor by multiple investigators. The purpose of the present study was to evaluate plasma levels of transforming growth factor-beta 1 (TGF-beta 1), basic fibroblast growth factor (bFGF), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1 beta (IL-1 beta) in patients with prostate cancer scheduled for radiotherapy (protons, photons, or combination of both). It has been recently shown that ionizing radiation can increase expression of these cytokines and there are indications that they may be associated with morbidity. Blood samples were obtained from 20 subjects (age 51-80) before, during the first week, and immediately after the end of therapy; 3 healthy volunteers served as controls. Significant positive correlations (p<0.05) were obtained between bFGF, IL-1 beta, and TNF-alpha and the integral dose of radiation during the first week of treatment. Correlations approaching significance (p<0.1) were obtained with bFGF and acute treatment-related morbidity. A higher integral dose (due to larger irradiated volumes) was delivered with conventional photon compared to proton irradiation. No significance was obtained with any of the cytokines and pretreatment prostate specific antigen (PSA) levels, patient age, grade or stage of disease, or the integral dose by the end of radiation treatment. These results show that large changes occur in the plasma levels of certain cytokines early after initiation of radiotherapy and that treatment of larger volumes is more likely to induce these changes. Our data support further investigation of the role of cytokines during radiotherapy.     

Prognostic significance of uPA and uPAR expression in patients with cervical cancer undergoing radiotherapy

Cervical cancer remains a major health threat. Urokinase serves as a marker of metastatic tumors. The present study aimed to determine whether the expression levels of urokinase plasminogen activator (uPA) and urokinase plasminogen activator receptor (uPAR), before and during the course of radiotherapy, serve as prognostic markers for patients with cervical cancer. Cervical tumor tissue biopsies were collected from 72 patients before radiotherapy and after the completion of external beam radiotherapy (EBRT) before intracavitary brachytherapy. The levels of uPA and uPAR were determined using ELISA assays. The significance of the associations between the protein expression levels and the clinical outcomes of patients was determined. Although irradiation enhanced uPA and uPAR expression in cervical cancer cell lines, average uPA levels significantly decreased in tumors, and uPAR levels significantly increased after EBRT. The levels of uPA increased in 12 patients and decreased in 26 patients; and those of uPAR increased in 13 patients and decreased in two patients. Cox regression analysis revealed that increased expression of uPAR was significantly associated with 5-year overall survival rate [hazard ratio (HR), 3.65; 95% confidence interval (CI), 1.18–11.30]. However, the levels of both proteins before radiotherapy failed to predict clinical outcomes. Other significant predictive factors were partial response (HR 7.22; 95% CI 1.17–44.73) and disease progression (HR, 13.41; 95% CI, 1.17–153.07). These findings indicated that increased expression of uPAR in cervical tumor tissue during radiotherapy may serve as a prognostic marker for patients with cervical cancer.     

放疗对宫颈癌根治术患者卵巢功能影响

目的 在保留并移位卵巢的ⅠB1-ⅡA2期根治术后需辅助放疗的年轻宫颈癌患者中,评估移位卵巢剂量学参数与临床不同卵巢功能状态之间相关性。方法 回顾2015-2017年间86例患者疗前和疗后2年内移位卵巢功能和临床相关症状,并评价放疗技术中移位卵巢的剂量学参数以及移位卵巢的功能状态之间的相关性。术后放疗采用不同体外保护移位卵巢,68例IMRT或VMAT,18例二维等中心放疗。结果 卵巢和PTV最近距离与卵巢剂量≥V5Gy呈负相关(P=0.025)。V8Gy、Dmean与疗后FSH(为卵巢血清卵泡刺激素,FSH)呈正相关(P=0.011、0.020)。即V8Gy体积越大Dmean越高,疗后FSH越高卵巢功能越差。二维技术中≥V5Gy低于三维技术,剂量降低明显。疗后卵巢功能正常者平均年龄33.4岁,而卵巢功能衰竭者平均年龄39.6岁(P=0.007)。不同卵巢状态患者间保留卵巢数目、是否同步化疗均相近,但与疗前FSH、E2(雌二醇)水平相关,即疗前FSH水平越高E2越低,疗后卵巢FSH水平越高E2越低。疗前保留卵巢但功能衰竭者均进行了新辅助化疗且年龄略高。结论 年龄,卵巢 V_{8 Cy}、D_mean,悬吊卵巢与 PTV 最近距离,疗前有无新辅助化疗及放疗技术均会影响移位卵巢功能的保护。     

Radioprotective effects of vitexina for breast cancer patients undergoing radiotherapy with cobalt-60

Vitexina, a product containing the flavonoid vitexin as the main component, is derived from a plant, Vigna radiata (L.), that has been traditionally used in Vietnam for detoxification. This remedy is also used to treat the symptoms of conditions classified as "hot" in traditional medicine. The present study is a randomized, placebo-controlled comparative clinical trial for investigating the radioprotective effects of Vitexina for breast cancer patients undergoing radiotherapy with cobalt-60. No relevant weight loss, (even weight gain), occurred in 70% of patients in the Vitexina group, whereas 73% of the placebo group lost 1 to 2 kg of weight after 6 weeks of radiation therapy. The administration of Vitexina produced a significantly protective effect in peripheral blood cells in amount and in lymphocyte blast-transformation function. Condition of hot was observed in almost all cancer patients in this study by tongue examination. Hot condition did not change in the Vitexina group, but the incidence of hot and extreme hot cases were significantly increased in the placebo group after 6 weeks of radiation therapy. The results suggest that application of medicinal plants of the "clearing heat and detoxification" classification as an adjuvant would be a potential solution in integrative cancer therapy.