Nasopharyngeal carcinoma(NPC) occurs frequently in Southern China, and radiotherapy is the main treatment method. At present, intensity‐modulated radiotherapy is widely used, which has improved ...efficacy in patients with NPC and reduced toxicity and side effects. Recently, helical tomography radiotherapy, proton radiotherapy, carbon particle radiotherapy, and other radiotherapy techniques have been used for the clinical treatment of NPC. Individualized nasopharyngeal cancer targets have also been explored. This paper reviews the research progress in radiotherapy techniques and target volume for NPC
Nasopharyngeal carcinoma occurs frequently in Southern China, and radiotherapy is the main treatment method. At present, intensity modulated radiotherapy (IMRT) has been widely used, which has improved the efficacy of nasopharyngeal carcinoma patients and reduced the toxicity and side effects. In recent years, helical tomography radiotherapy, proton radiotherapy, carbon particle radiotherapy and other radiotherapy techniques have been used in the clinical treatment of nasopharyngeal carcinoma. This paper reviewed the progression and clinical applications of theses new radiotherapy technique on nasopharyngeal carcinoma.
The induction of senescence for cancer treatment has provoked considerable interest recently. Metformin, a first-line drug for diabetes mellitus type 2, appears to be associated with a lower risk and ...improved outcomes in hepatocellular carcinoma (HCC). The mechanism involved in function of metformin in HCC is poorly understood. We show that low doses of metformin induced hepatoma cell senescence characterized by accumulation of senescence-associated β-galactosidase activity (SA-β-gal) and the senescence marker Dec1, whereas the higher doses initiated apoptotic cell death. Metformin-induced senescence was accompanied by enhanced phosphorylation levels of AMP-activated protein kinase (AMPK) and its downstream target acetyl-CoA carboxylase (ACC). The expression of acetylated p53 at Lys382 (Ac-p53) and p21 was also increased, while phosphorylation of p53 at Ser15 (p-p53), p53, p16 and pRB was rarely altered after metformin treatment. Moreover, inhibition of AMPK decreased p-AMPK, p-ACC, Ac-p53 and p21 expression, diminished SA-β-gal staining and restored hepatoma cell proliferation. In addition, p53 siRNA transfection attenuated metformin-induced SA-β-gal staining. Intriguingly, co-expression of SIRT1 and p53 dramatically reduced the levels of Ac-p53, however, low doses of metformin treatment partially reversed the effect of SIRT1 on p53 acetylation and elevated SA-β-gal activity. These observations indicate that activation of the AMPK pathway promotes senescence in hepatoma cells exposed to low concentrations of metformin in a p53-dependent manner. Further, low doses of metformin may have the potential to be used as an adjuvant to HCC therapy.
Purpose
: This study aims to compare the dosimetric differences in intensity-modulated proton therapy (IMPT) using pencil beam scanning technology and intensity-modulated photon-based radiotherapy ...(IMRT) in hypofractionated whole-breast irradiation (HF-WBI) and find out the more beneficial technique.
Methods and Materials
: Eight breast cancer (BC) patients with pathological stage T1 ~ 2N0M0 were immobilized and underwent 4D-CT scanning used deep inspiration breath-hold (DIBH) technology. The IMPT and IMRT plans were designed for each patient. The IMPT plans used two en-face beam angles. IMRT plans were designed using the field in field technique. The optimization constraints of the two types of plans were identical. Prescription dose and regimen was 40.05 Gy (relative biological effect RBE)/15 fx with a 10 Gy (RBE)/5 fx boost, five fractions a week. A dose of 95% of the target volume should not be less than the prescribed dose. The target coverage was evaluated using D1, D2, D50, D95, D98, and D99. The target dose distribution and conformity were evaluated using the Conformity index (CI) and the homogeneity index (HI). The Organs at risk (OARs) were evaluated using mean dose (Dmean) and maximum dose (Dmax). Ipsilateral Lung and Contralateral Lung were evaluated additionally using V5, V10, V20, V30.
Results
: The mean dose (Dmean) of the Heart (
P
= 0.012), Ipsilateral Lung (
P
= 0.036), Contralateral Lung (
P
= 0.012), and Spinal Cord (
P
= 0.012) were significantly reduced in IMPT plans. The IMPT also showed a tendency to reduce the V20 (
P
= 0.05) and V30 (
P
= 0.05) of the Ipsilateral Lung. But there was no significant difference in target coverage, homogeneity, and conformity between the IMRT and IMPT plans.
Conclusion
: Compared to IMRT, the IMPT using pencil beam scanning technology can spare OARs without compromising target coverage in BC patients undergoing HF-WBI, which potentially reduce the incidence of radiation-related adverse effects and thus may positively impact long-term survival.
Two cycles of induction chemotherapy (IC) followed by 2 cycles of platinum-based concurrent chemoradiotherapy (CCRT) (2IC+2CCRT) for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) is ...widely adopted but not evidence-confirmed. This study aimed to determine the clinical value of 2IC+2CCRT regarding efficacy, toxicity and cost-effectiveness.
This real-world study from two epidemic centers used propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses. The enrolled patients were divided into three groups based on treatment modality: Group A (2IC+2CCRT), Group B (3IC+2CCRT or 2IC+3CCRT) and Group C (3IC+3CCRT). Long-term survival, acute toxicities and cost-effectiveness were compared among the groups. We developed a prognostic model dividing the population into high- and low-risk cohorts, and survivals including overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS) and locoregional relapse-free survival (LRRFS) were compared among the three groups according to certain risk stratifications.
Of 4,042 patients, 1,175 were enrolled, with 660, 419, and 96 included in Groups A, B and C, respectively. Five-year survivals were similar among the three groups after PSM and confirmed by IPTW. Grade 3-4 neutropenia and leukocytopenia were significantly higher in Groups C and B than in Group A (52.1%
41.5%
25.2%; 41.7%
32.7%
25.0%) as were grade 3-4 nausea/vomiting and oral mucositis (29.2%
15.0%
6.1%; 32.3%
25.3%
18.0%). Cost-effective analysis suggested that 2IC+2CCRT was the least expensive, while the health benefits were similar to those of the other groups. Further exploration showed that 2IC+2CCRT tended to be associated with a shorter PFS in high-risk patients, while 3IC+3CCRT potentially contributed to poor PFS in low-risk individuals, mainly reflected by LRRFS.
In LA-NPC patients, 2IC+2CCRT was the optimal choice regarding efficacy, toxicity and cost-effectiveness; however, 2IC+2CCRT and 3IC+3CCRT probably shortened LRRFS in high- and low-risk populations, respectively.
Radiation therapy is used for breast cancer treatments to improve local control and overall survival but may also lead to unwanted complications such as cardiac toxicity and pneumonitis. Deep ...inspirational breath hold (DIBH) has been used to reduce doses to the heart and other organs near the treatment target to lower the risk of radiation-induced complications. In this study, we present our experience on the clinical implementation and application of DIBH for breast cancer patients, its dosimetric benefits in heart and other organ sparing based on comparisons with free breathing plans, effects on the treatment efficiency as represented by treatment imaging, and beam delivery times, as well as challenges during implementation and clinical application at our center.
Metformin, one of the most widely used antidiabetic drugs, has recently been associated with potential antitumorigenic effects. In this study, we evaluated the possible cytotoxic impact of combined ...low doses of metformin and ionizing radiation (IR) on 2 human hepatoma cell lines. The cytotoxic effect of metformin combined with IR was subsequently determined by clonogenic survival and cell cycle assays, assessment of mitochondrial complex I and lactate dehydrogenase (LDH) activity, measurement of cellular adenosine triphosphate (ATP) levels, comet assay and analyses of the formation and disappearance of phosphorylated histone H2AX (γ-H2AX) protein. The combination of metformin and IR caused a much stronger cytotoxicity than the treatment with metformin or IR alone, leading to an ~80% decrease in cell viability and ~35% increase in the accumulation of cells in the G2/M phase of the cell cycle in the 2 hepatoma cell lines. In addition, a reduction in mitochondrial complex I activity (~70%) and a significant increase in LDH activity, as well as lactate production were observed in the cells exposed to metformin. Interestingly, a severe depletion in ATP, increased olive tail moment and the delayed disappearance of γ-H2AX expression were detected in the hepatoma cells treated by metformin plus IR. These findings show that the combination of a low concentration of metformin and IR results in the considerable enhancement of cytotoxic effects in human hepatoma cell lines, leading to decreased DNA repair by reducing ATP production. The data provided in this study may elucidate the remarkable efficiency of this combination treatment and suggest that metformin may be used as a potential adjunct to the radiotherapy of hepatocellular carcinoma.
Metastasis-associated protein 1 (MTA1) is related to tumour metastasis and poor prognosis in various human cancers. The aim of this study was to investigate the expression of MTA1 in nasopharyngeal ...carcinoma (NPC) and explore the prognostic value of MTA1 in NPC patients. The expression of MTA1 in 136 human NPC tissues and 20 normal nasopharyngeal tissues was detected using immunohistochemistry, quantified and classified into low or high expression using a 50 % cut-off level. The relationships of MTA1 expression with the clinical characteristics and survival of patients were analysed. MTA1-positive staining was observed in the nuclei of NPC cells, and MTA1 expression was significantly correlated with T stage (
P
= 0.006), clinical stage (
P
= 0.001) and distant metastasis (
P
< 0.001). Patients with high MTA1 expression exhibited significantly worse distant metastasis-free survival (DMFS) than those with low MTA1 expression (90.75 % vs. 70.81 %,
P
= 0.017). Multivariate survival analysis revealed that MTA1 expression was an independent prognostic factor for DMFS (
P
= 0.038). In this study, high MTA1 expression was significantly associated with poor DMFS in NPC, indicating that MTA1 could serve as a novel biomarker for assessing the metastatic potential of NPC and could act as a possible therapeutic target for the treatment of metastatic nasopharyngeal carcinoma.
Follicular dendritic cells are non-phagocytic, non-lymphoid cells of the immune system that are necessary for antigen presentation and the regulation of reactions in the germinal centers of the lymph ...nodes. Follicular dendritic cell sarcoma is an unusual cancer, particularly in the intra-abdominal region. In the present report we describe an unusual case of retroperitoneal follicular dendritic cell sarcoma that emphasizes the difficulty of diagnosing and treating this tumor. Retroperitoneal follicular dendritic cell sarcoma has only been rarely reported in the literature to date.
A 46-year-old Chinese woman of Han ethnicity presented with chronic right lower quadrant abdominal pain over the preceding 4 weeks. The tumor was resected and submitted to histopathological examination. The case was verified as retroperitoneal follicular dendritic cell sarcoma by microscopic examination and immunohistochemical analysis. After diagnosis, she received postoperative radiotherapy and chemotherapy. She has survived 3 years postoperatively, although she has a pulmonary metastasis.
Retroperitoneal follicular dendritic cell sarcoma may demonstrate aggressive potential. This study indicated that postoperative adjuvant radiotherapy and chemotherapy could extend the survival of a patient with retroperitoneal follicular dendritic cell sarcoma.
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