Objective We searched and reviewed medical evidence to find the guide of treatment for local advanced nasopharyngeal carcinoma. Methods Firstly, we put forward clinical questions. Secondly, we searched medical evidence from Medline (1985-2002), Embase (1984-2000), Cochrane library (2002.1) and ACP. And then we reviewed the results. The key words we used were "nasopharyngeal carcinoma, chemotherapy and radiotherapy randomized" and "meta analysis or randomized control trial". Results Through searching, we got 17 papers including 1 systematic review and 16 randomized control trials, in which there were 8 prospective randomized phase Ⅲ trials. Most of these trials concluded that combination chemo-radiotherapy were better than radiotherapy alone. We think these results were suitable for our patient’treatment decision. Conclusion To treat our patients,we choosed the method of the mutimodality of squeitial neoadjuvant chemotherapy, concurrent chemo-radiotherapy and adjuvant chemotherapy with the drug doses down-adjusted.
Colorectal cancer (CRC) is a prevalent malignant tumor worldwide. With the development of medical technology, the treatment strategies of CRC are constantly improving and updating. The aim of treating CRC is not only to improve outcomes but also to maintain organ function and enhance quality of life. For patients with locally advanced rectal cancer, a variety of neoadjuvant treatment options are available and it is important to choose an individualized strategy. Immune checkpoint inhibitors have become an important part of the first- and posterior-line treatment for patients with deficient mis-match repair or high microsatellite instability colorectal cancer in metastatic colorectal cancer, and the emergence of new targets and drugs has further improved treatment efficacy and long-term survival. Furthermore, an increasing number of studies have confirmed the potential the value of predicting and guiding treatment for minimal residual disease. This article summarizes the representative research results, guideline updates, and important academic conference reports in the field of colorectal cancer.
Objective To evaluate the efficacy and side effect of non-conventional fractionated radiotherapy for head and neck cancer.Methods Trials were identified by searching CENTRAL, MEDLINE, EMBASE, Chinese Biological Medicine Database (CBMdisc) and Chinese VIP Database. We handresearched the data from 10 kinds of important Chinese journals. Two reviewers assessed and extracted the studies. The following primary outcomes were assessed: complete relief (CR), overall survival (OS), acute side effect and late side effect. Results Twenty-three trials involving 8 411 patients were included. Thirteen trials were of good quality, and the rest were of poor quality. Meta-analysis of these trials showed that: (1) non-conventional fractionated radiotherapy vs conventional fractionated radiotherapy: ① Only S-HART and CAIR resulted in higher CR, RR=1.21 (95%CI 1.02 to 1.44), 3.31 (95%CI 1.16 to 9.42), respectively; ② Only HRT could improve 2-year OS (RR=1.32, 95%CI 1.13 to 1.54), but this difference wasn’t found in 5-year follow up; ③ Most of the non-conventional fractionated radiotherapy could increase acute side effects, but not the late ones; (2) non-conventional fractionated radiotherapy combined with concurrent chemotherapy vs non-conventional fractionated radiotherapy: ① Only C-HRT resulted in higher CR (RR=1.58, 95%CI 1.18 to 2.11); ② Higher 2-year OS could be gained when combined with chemotherapy (RR=1.35, 95%CI 1.18 to 1.54), and only C-HRT resulted in higher 5-year OS (RR=1.57, 95%CI 1.19 to 2.07). ③ Acute and late side effects of radiotherapy would not increase when combined with chemotherapy. Conclusion It can not be concluded that non-conventional fractionated radiotherapy can improve the CR and OS of head and neck cancer, for a small number of patients, but it will get effect when combined with concurrent chemotherapy, and would not increase acute or late side effects. The effects of HRT and C-HRT should be cared specially.
【摘要】 目的 研究千伏級錐形束CT（kV-cone beam CT，kV-CBCT）影像用于鼻咽癌調強放射治療計劃劑量計算的可行性和精確度。 方法 2010年7-9月7例鼻咽癌患者 ，獲取每例患者的第1天放射治療時的kV-CBCT影像。用CIRS062密度模體和患者自身特定區域亨氏單位值（hounsfield unit，HU）映射的兩種方法重新刻度亨氏單位值-相對電子密度（HU-RED）表，分別進行劑量計算，并與在傳統扇形束CT（FBCT）影像上的原放射治療計劃結果進行對比，包括輻射劑量分布、靶區和危及器官的劑量體積直方圖（DVH）。 結果 kV-CBCT影像的治療計劃和原治療計劃在劑量分布和DVH上有較好的一致性。在劑量分布的比較上采用了γ分析（2%/2 mm標準的通過率），用基于模體的HU-RED表得到的治療計劃與原治療計劃對比，在經過等中心冠狀面、矢狀面和橫斷面的通過率分別為92.7%±3.5%、95.1%±3.1%和95.7%±3.4%，用基于患者的HU-RED表得到治療計劃與原治療計劃對比的通過率分別為94.8%±2.7%、96.6%±2.9%和97.4%±2.7%。DVH的統計數據表明，兩種方法得到的kV-CBCT治療計劃和原治療計劃相比較，靶區和危及器官劑量偏差大多數在2%以內。有1例因在橫斷面發生了明顯的旋轉誤差，導致在橫斷面的通過率很低，DVH統計數據較原計劃偏差較大。 結論 kV-CBCT影像可以用來做輻射劑量計算，基于患者自身影像生成的HU-RED表的治療計劃較原治療計劃有更高的符合度。【Abstract】 Objective To evaluate the feasibility and accuracy of dose calculation based on cone beam CT (CBCT) data sets for intensity modulated radiation therapy (IMRT) planning of nasopharyngeal cancer (NPC). Methods Seven NPC patients were selected. The kV-CBCT images for each patient were acquired on the first treatment day. Two correction strategies were used to generate the cone beam HU value vs relative electron density calibration tables which named CIRS062 phantom based HU-RED tables and patient specific HU-RED tables respectively for dose calculation. The dose distributions and dose volume histograms (DVHs) of the target and organs at risk (OAR) based on kV-CBCT images were compared to the plans based on the fan-beam CT (FBCT). Results The DVH and dose distribution comparison between plans based on the FBCT and those on the CBCT showed good agreements. The γ analysis with a criterion of 2 mm/2% was used for the comparison of dose distribution at the coronal plane, sagital plane and cross plane through the isocenter point. The passing rate from phantom based HU-RED tables were (92.7±3.5) %, (95.1±3.1) %, and (95.7±3.4)%, respectively. The passing rates from the patient specific HU-RED tables were (94.8±2.7) %, (96.6±2.9) %, and (97.4±2.7) %, respectively. The dose difference between plans based on CBCT and those based on FBCT was within 2% at most patients by analyzing DVH based parameters. Only one patient who had significant rotation setup error resulted in the low passing rate and disagreement in DVH. Conclusion The CBCT images can be used to do dose calculation in IMRT planning of NPC. The differences between plans based on HU-RED tables generated by specific patient and the original plans are less than those between plans based on CIRS062 phantom based HU-RED tables and the original plans.
Objective To summarize the specific treatment for a patient diagnosed with recurrence of hepatocellular carcinoma following liver transplantation. Methods Considering the patient’s condition, multidisciplinary team (MDT) consultation of the specialists in radiology, oncology, radiotherapy, and liver surgery was conducted. Results After the MDT consultation, the patient was advised to receive surgery if the metastasis could be excluded. Surgical removal of the mass located at the body and tail of pancreas+splenectomy+enterodialysis was conducted. The alpha fetoprotein (AFP) level and abdominal CT were reviewed and no recurrence was found during the follow up period (by the end of May. 2018). Conclusion The MDT mechanism could provide individualized treatment for patients with complicated hepatocellular carcinoma and benefit those patients.
Objective To develop tailored treatment regimens for a patient with simultaneous liver metastasis of rectal cancer. Methods Considering the patient's specific condition of different teatment stage, the specialists of oncology, imaging, gastroenterology, hepatic surgery, and radiotherapy conduct multidisciplinary consultation. Results After hepatic metastatic tumor was resected, 4 cycles of XELOX chemotherapy combined with radiotherapy, tumor recurrence did not found in the liver. After resection of rectal cancer, the patient received 6 cycles of XELOX. The CEA and the thoracic, abdominal CT and pelvic MRI were reviewed 9 months after operation and no recurrence of the tumor was found. Conclusion The MDT mechanism can provide individualized treatment for patients with advanced rectal cancer and benefit these patients.