Validation of a Patient-Reported Outcome Measure for Moist Desquamation among Breast Radiotherapy Patients

There has been an increasing interest in patient-reported outcome (PRO) measures in both the clinical and research settings to improve the quality of life among patients and to identify when clinical intervention may be needed. The primary purpose of this prospective study was to validate an acute breast skin toxicity PRO measure across a broad sample of patient body types undergoing radiation therapy. Between August 2018 and September 2019, 134 women undergoing adjuvant breast radiotherapy (RT) consented to completing serial PRO measures both during and post-RT treatment and to having their skin assessed by trained trial radiation therapists. There was high patient compliance, with 124 patients (92.5%) returning to the clinic post-RT for at least one staff skin assessment. Rates of moist desquamation (MD) in the infra-mammary fold (IMF) by PRO were compared with skin assessments completed by trial radiation therapists. There was high sensitivity (86.5%) and good specificity (79.4%) between PRO and staff-reported presence of MD in the IMF, and there was a moderate correlation between the peak severity of the MD reported by PRO and assessed by staff (rho = 0.61, p < 0.001). This prospective study validates a new PRO measure to monitor the presence of MD in the IMF among women receiving breast RT.     

Can Radiotherapy Empower the Host Immune System to Counterattack Neoplastic Cells? A Systematic Review on Tumor Microenvironment Radiomodulation

Despite the rising evidence in favor of immunotherapy (IT), the treatment of oncological patients affected by so-called “cold tumors” still represents an open issue. Cold tumors are characterized by an immunosuppressive (so-called cold) tumor microenvironment (TME), which favors host immune system suppression, cancer immune-escape, and a worse response to IT. However, the TME is not a static element, but dynamically mutates and can be changed. Radiotherapy (RT) can modulate a cold microenvironment, rendering it better at tumor killing by priming the quiescent host immune system, with a consequent increase in immunotherapy response. The combination of TME radiomodulation and IT could therefore be a strategy for those patients affected by cold tumors, with limited or no response to IT. Thus, this review aims to provide an easy, rapid, and practical overview of how RT could convert the cold TME and why cold tumor radiomodulation could represent an interesting strategy in combination with IT.     

XN-1型放射治疗CT定位系统的研制与应用

目的对自行研制的XN-1型放射治疗CT定位系统的使用方法和功能进行介绍与验证.方法本系统由定位框架和定位软件组成,定位框架以往已经报道.软件为在Windows平台上应用OpenGL三维图形工具自主研发的软件系统.本系统能够建立基于定位框架的三维坐标系,对身体外轮廓、肿瘤及其周围重要器官进行三维重建,通过射束方向视图(beam's eye view, BEV)功能进行模拟,确定出靶中心点的空间坐标、各照射野的方向、大小和源瘤距等放疗参数,从而实现精确模拟定位.对模拟靶进行了验证,并对食管癌和脑肿瘤病例进行了比较.结果本系统确定的模拟靶之中心点坐标、照射野的方向和大小等,经与模拟定位片对比验证,证明达到精确定位要求.对临床病例的定位结果也与模拟定位机方法一致.结论本系统能够对全身各部位肿瘤进行精确的CT立体定位,能够提供常规放疗所需各项定位参数.具有精确度高、显示直观、稳定可靠等优点,适合国情,具有重要推广应用价值.     

重离子治疗恶性肿瘤对机体免疫功能的影响

目的 通过检测患者免疫球蛋白、T细胞亚群及NK细胞的变化.探讨重离子放射治疗恶性肿瘤是否对机体免疫功能产生影响.方法 将26例经病理学证实的恶性肿瘤患者采用重离子束局部外照射,在治疗前后分别取患者外周血,采用化学发光法,用全自动生化分析仪测定血清IgG、IgA、IgM的量,用流式细胞仪检测放疗前后T细胞亚群及NK细胞比例.结果 NK细胞、CD4^＋ T细胞、CD8^＋T细胞及CD4^＋ T/CD8^＋T在治疗前后无明显变化,免疫球蛋白IgG、IgA、IgM在治疗前后无明显变化.结论 重离子治疗对免疫功能无明显影响.     

Pelvic insufficiency fracture after definitive radiotherapy for uterine cervical cancer: retrospective analysis of risk factors

The purpose of this study is to determine the incidence, clinical characteristics and risk factors of postradiation pelvic insufficiency fracture (PIF) in women with uterine cervical cancer. We reviewed the medical records of 126 patients who received definitive radiotherapy (RT) for uterine cervical cancer between 2003 and 2009 at our institution. Among them, 99 patients who underwent at least one computed tomography (CT) or magnetic resonance imaging of the pelvis during their follow-up at more than 6 months were included in this analysis. The relationship between the incidence of PIF and several patient- and treatment-related factors was analyzed. The median follow-up period was 21 months. Of the 126 patients, 33 (with a total of 50 lesions) were diagnosed with PIF. The 2-year cumulative incidence was 32%. Univariate analysis showed that age ≥70 years (P= 0.0010), postmenopausal state (P = 0.0013), and lower CT density of bone and bone marrow (P= 0.020) significantly related to PIF. In a multivariate analysis, of the 59 patients whose CT densities were evaluable, lower CT density was the only significant factor associated with PIF (P = 0.0026). In conclusion, postradiation PIFs were detected in a considerable number of patients after definitive RT for cervical cancer. Predisposing factors were older age, postmenopausal state, and decreased density of bone and bone marrow on CT.     

Irradiation of normal mouse tissue increases the invasiveness of mammary cancer cells

Purpose:?Treatment of breast tumours frequently involves irradiating the whole breast to reach malignant microfoci scattered throughout the breast. In this study, we determined whether irradiation of normal tissues could increase the invasiveness of breast cancer cells in a mouse model.

Materials and methods:?Non-irradiated MC7-L1 mouse mammary carcinoma cells were injected subcutaneously in irradiated and non-irradiated thighs of Balb/c mice. The invasion volume, tumour volume, blood vessel permeability and interstitial volumes were monitored by magnetic resonance imaging (MRI). Slices of normal tissue invaded by cancer cells were examined by histology. Activity of matrix metalloproteinase -2 and -9 (MMP -2 and -9) in healthy and irradiated tissues was determined, and the proliferation index of the invading cancer cells was evaluated.

Results:?Three weeks after irradiation, enhancement of MC7-L1 cells invasiveness in irradiated thighs was already detected by MRI. The tumour invasion volume continued to extend 28- to 37-fold compared to the non-irradiated implantation site for the following three weeks, and it was associated with an increase of MMP-2 and -9 activities in healthy tissues. The interstitial volume associated with invading cancer cells was significantly larger in the pre–irradiated sites; while the blood vessels permeability was not altered. Cancer cells invading the healthy tissues were proliferating at a lower rate compared to non-invading cancer cells.

Conclusion:?Implantation of non-irradiated mammary cancer cells in previously irradiated normal tissue enhances the invasive capacity of the mammary cancer cells and is associated with an increased activity of MMP-2 and -9 in the irradiated normal tissue.     

Role of CD4 and CD8 T-lymphocytes,B-lymphocytes and Natural Killer cells in the prediction of radiation-induced late toxicity in cervical cancer patients

Purpose:?To analyse the role of in vitro radio-induced apoptosis of lymphocyte subpopulations as predictive test for late effects in cervical cancer patients treated with radiotherapy.

Methods and materials:?Ninety-four consecutive patients and four healthy controls were included in the study. Toxicity was evaluated using the Late Effects Normal Tissue-Subjective, Objective, Management, and Analytic (LENT-SOMA) scale. Peripheral blood lymphocyte subpopulations were isolated and irradiated at 0, 1, 2 and 8 Gy, and then collected 24, 48 and 72 h after irradiation. Apoptosis was measured by flow cytometry.

Results:?Radiation-induced apoptosis increased with radiation dose and time of incubation, and data fitted to a semi-logarithmic model defined by two constants: α (percentage of spontaneous cell death) and β (percentage of cell death induced at a determined radiation dose). Higher β values in cytotoxic T-lymphocytes (CD8) and bone cells (B-lymphocytes) were observed in patients with low bowel toxicity (hazard ratio (HR)?=?0.96, p?=?0.002 for B-cells); low rectal toxicity (HR?=?0.96, p?=?0.020; HR?=?0.93, p?=?0.05 for B and CD8 subpopulations respectively); low urinary toxicity (HR?=?0.93, p?=?0.003 for B-cells) and low sexual toxicity (HR?=?0.93, p?=?0.010 for CD8-cells).

Conclusions:?Radiation-induced CD8 T-lymphocytes and, for the first time, B-lymphocytes apoptosis can predict differences in late toxicity in cervical cancer patients.     

Electrophysiological,biochemical and ultrastructural effects of radiotherapy on normal rat sciatic nerve

Abstract

Purpose: The aim of the present study was to evaluate the electrophysiological, biochemical and ultrastructural changes on the rat sciatic nerve after radiotherapy.

Material and Methods: Thirty male Wistar albino rats were divided into three groups as: Control group (n = 10), Group I: 3 months after radiotherapy (n = 10), and Group II: 6 months after radiotherapy (n = 10). Groups I and II were irradiated with a ⁶⁰Co gamma source. A dose of 20 Gy in 10 fractions was applied to Groups I and II. Compound motor action potentials (CMAP) were recorded in all groups. Superoxide dismutase (SOD) and catalase (CAT) activities and malondialdehyde (MDA) levels were measured in the sciatic nerve of rats using the biochemical methods. Ultrastructural changes were determined by electron microscopy.

Results: In Groups I and II, the amplitude of CMAP was significantly lower and the latency was significantly higher than that of the control group. There were no significant differences between Groups I and II regarding the CMAP amplitude and latency. The MDA levels were significantly increased, whereas the SOD and CAT activities were significantly decreased in experimental groups when compared with the control group. However, there were no significant changes in these parameters between Groups I and II. Degeneration in myelinated nerve fibers was observed ultrastructurally only in the experimental groups. Significant changes were observed between the control group and experimental groups in terms of ultrastructural myelin grading score and axonal damage score. No significant differences were found between Groups I and II.

Conclusions: These findings indicated that the dose of 20 Gy in 10 fractions radiotherapy caused neuropathic damages in normal rat sciatic nerve 3 and 6 months after irradiation.     

伽玛刀治疗22例原发视神经鞘脑膜瘤的疗效分析

目的 探讨采用伽玛刀进行低分割、高剂量的分次立体定向放射治疗（FSRT）治疗原发性视神经鞘脑膜瘤的疗效。方法2004年8月至2010年3月收治原发性视神经鞘脑膜瘤22例患者,均采用Hyper SGSI型立体定向体部伽玛射线放射治疗系统进行FSRT治疗,1例进行常规分割,单次剂量2Gy;21例行低分割、高剂量的FSRT治疗,单次剂量3～5Gy靶区累积剂量为36～40Gy。治疗后6个月随访1次,中位随访时间25个月,观察患者的临床症状改善情况、视力保全率及肿瘤控制情况。 结果 截止于末次随访,全组患者的视力控制率为77.3％（17／22）,其中视力改善4例,稳定13例,下降3例,失明2例。视力控制率随时间变化略有下降,1年视力控制率为95.0％（19／20）,2年视力控制率为75.0％（9／12）,但差异无统计学意义（P＞0.05）。肿瘤控制率为100.0％,最大径缩小＞50％的8例（36.4％）,缩小25％～50％的11例（50.0％）,缩小＜10％～25％的3例（13.6％）。突眼症状改善率为100.0％,治疗前突眼度为（17.3±2.7）mm,治疗后突眼度为（14.9±1.5）mm（P＜0.05）。有10例患者出现治疗相关反应,对症治疗可恢复。 结论 采用低分割、高剂量的FSRT治疗原发视神经鞘脑膜瘤的疗效确切,但视力改善不明显,对于确切分割模式及剂量尚需进一步探讨。     

三维适形放疗联合高压氧治疗恶性上腔静脉阻塞症的相关研究

目的：探讨三维适形放疗联合高压氧提高恶性上腔静脉阻塞症治疗疗效的可能性。方法：采用随机分组的方法将恶性肿瘤合并上腔静脉阻塞症的患者分为单纯放疗组（单放组）与放疗加高压氧组（联合组）,其中联合组和单放组各23例。结果：联合组有效率为82．6％,单放组有效率65．21％,两组之间的差异有统计学意义（P〈0．05）。两组患者治疗中不良反应差异有统计学意义,联合组优于单放组。结论：三维适形放疗联合高压氧治疗可提高恶性上腔静脉阻塞症的疗效,且不良反应有所减轻。