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08 July 2019, Volume 46 Issue 7 Previous Issue    Next Issue

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Clinical research of intercalated combination of osimertinib and docetaxel in T790M mutationpositive lung adenocarcinoma patients with bone metastasis in the southern Hainan Province Chen Long, Lin Ling, Wang Cuiying, Wang Lin, He Donglei, Feng Jun 2019, 46 (7):  399-403.  doi: 10.3760/cma.j.issn.1673-422X.2019.07.002 Abstract ( 1150 )   PDF (795KB) ( 599 )   Save ObjectiveTo study the clinical application of intercalated combination of osimertinib and docetaxel in T790M mutationpositive lung adenocarcinoma patients with bone metastasis in the southern Hainan Province. MethodsT790M mutationpositive lung adenocarcinoma patients with bone metastasis in the southern Hainan Province treated at the Third People′s Hospital of Hainan Province from January 2018 to October 2018 were enrolled, and they were divided into intercalated combination of osimertinib and docetaxel group (n=32) and osimertinib group (n=28) according to the treatment. The patients in intercalated combination of osimertinib and docetaxel group received oral osimertinib (80 mg, qd), and received docetaxel (75 mg/m2, repeated in threeweek intervals) when taking to tumor progression, and oral osimertinib treatment (80 mg, qd) was maintained until tumor partial response or stable disease after chemotherapy. The patients in osimertinib group received oral osimertinib (80 mg, qd). The patients in both groups received zoledronic acid. The response rate, disease control rate, overall survival (OS) and the incidence of adverse reactions of both groups were contrastively analyzed. ResultsThe response rate of intercalated combination of osimertinib and docetaxel group (62.5%, 20/32) was higher than that of osimertinib group (35.7%, 10/28), and disease control rate (93.8%, 30/32) was also higher than that of osimertinib group (67.9%, 19/28), with statistically significant differences (χ2=4.286, P=0.038; χ2=6.687, P=0.010). The median OS of intercalated combination of osimertinib and docetaxel group was 10.0 months, which was longer than that of osimertinib group (9.0 months), with statistically significant difference (χ2=5.917, P=0.015). Moreover, the adverse reactions in both groups were all grade Ⅰ or Ⅱ, which could be relieved or improved through symptomatic treatment. ConclusionIntercalated treatment of osimertinib with docetaxel is safe and effective in T790M mutationpositive lung adenocarcinoma patients with bone metastasis in the southern Hainan Province. It can prolong the survival time of patients. References | Related Articles | Metrics

Dosimetric comparison of static intensity-modulated radiation therapy and volumetric modulated arc therapy in lymphoma patients received mediastinal radiation Zhang Wenjue, Ding Zhen, Wang Yuenan, Guo Zhi, Jiang Wei, Peng Miao, Liang Jun, Chen Zhijian, Ren Hua, Wang Lyuhua 2019, 46 (7):  404-409.  doi: 10.3760/cma.j.issn.1673-422X.2019.07.003 Abstract ( 812 )   PDF (725KB) ( 596 )   Save ObjectiveTo compare target dosimetric distribution and normal tissue radiation between different static intensitymodulated radiation therapy (IMRT) plans and volumetric modulated arc therapy (VMAT), and to identify the best IMRT plan for lymphoma patients needed mediastinal radiation. MethodsA total of 11 patients with lymphoma who received first course radiotherapy in the mediastinal region after chemotherapy in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from March 2017 to January 2019 were included in the study. There were 8 males and 3 females, 2 patients were in Ann Arbor stage ⅠⅡ, and 9 cases in ⅢⅣ stage. There were 6 patients with Hodgkin lymphoma (HL) and 5 patients with nonHodgkin lymphoma (NHL). Patients with HL and NHL were given prescript doses of 36 Gy and 50 Gy, respectively. Three plans were designed for each patient: static 5FIMRT, 7FIMRT and VMAT plan. The target dosimetric distribution, normal tissue radiation dose, and efficiency of each plan were evaluated. ResultsThe mean conformity index (CI) and homogeneity index (HI) values of plan target volume (PTV) in 5FIMRT, 7FIMRT, VMAT plan were 0.64±0.06, 0.67±0.05, 0.76±0.04 (F=17.045, P＜0.001) and 1.07±0.01, 1.07±0.01, 1.09±0.01 (F=9.258, P=0.001), respectively. VMAT showed significantly better CI than two static IMRT plans (both P<0.001), but worse HI (both P<0.001). The lungs low dose irradiation volume (V5) and high dose irradiation volume (V30) in 5FIMRT, 7FIMRT, VMAT plan were (43.98±7.77)%, (42.71±4.98)%, (55.92±8.16)% (F=8.281, P=0.001) and (8.19±2.97)%, (8.25±2.87)%, (7.53±3.16)% (F=0.140, P=0.870), respectively. The volume of low dose irradiation in lungs of VMAT plan was significantly higher than 5FIMRT and 7FIMRT plans (both P＜0.001), while high dose volume was no significant difference. The left and right breast low dose irradiation volume (V4) in 5FIMRT, 7FIMRT and VMAT plan were (24.29±8.14)%, (23.87±7.70)%, (80.17±22.92)% (F=14.505, P=0.005) and (22.12±13.28)%, (21.13±13.01)%, (81.77±20.76)% (F=13.938, P=0.006), respectively. VMAT showed significantly higher breast low dose irradiation volume than static IMRT plan (both P＜0.05). The number of monitor units and treatment time in 5FIMRT, 7FIMRT, VMAT plan were (1 622±281) MU, (1 729±286) MU, (411±75) MU (F=105.277, P<0.001) and (6.79±0.93) min, (7.42±0.95) min, (4.98±0.00) min (F=29.545, P＜0.001), respectively. VMAT showed significantly less monitor units than static IMRT (both P<0.001) and shorter treatment time (both P<0.001). ConclusionFor lymphoma patients who have the indication of mediastinal radiotherapy, VMAT is highly efficient and has no definite dose advantage, the static 5FIMRT or 7FIMRT plan has good conformal and uniform target area, and some organs at risk exposure is even lower. References | Related Articles | Metrics

Empirical versus diagnosticdriven antifungal therapy for hematological malignancies patients with invasive fungal disease Zheng Shanshan, Guo Zhi, Chen Lina, Liu Xuanyong, Chen Liping, Huang Jiayi, Chen Xiao 2019, 46 (7):  410-414.  doi: 10.3760/cma.j.issn.1673-422X.2019.07.004 Abstract ( 627 )   PDF (716KB) ( 408 )   Save ObjectiveTo compare the clinical efficacy of empirical therapy and diagnosticdriven therapy in the treatment of the hematological malignancies patients complicated with invasive fungal disease (IFD). MethodsThe clinical data of patients with hematological malignancies undergoing antifungal treatment in the Department of Hematology and Lymphoma of Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from August 2017 to August 2018 were analyzed retrospectively. A total of 68 patients met the inclusion criteria, of which, 28 received the empirical therapy and 40 received the diagnosticdriven therapy. Then the differences of the incidence of IFD, IFDrelated mortality, days of hospitalization and antifungal treatment between the two groups were compared. ResultsThe incidence of IFD in the diagnosticdriven therapy group was higher than that in the empirical therapy group ［27.5% (11/40) vs. 7.1% (2/28), χ2=4.414, P=0.036］. While the rates of IFDrelated mortality were 7.5% (3/40) and 3.6% (1/28) respectively, with no statistically significant difference (χ2=0.459, P=0.498). The number of antifungal treatment days in the diagnosticdriven therapy group was greater than that in the empirical therapy group ［(15.9±3.3) d vs. (13.1±2.5) d, t=-3.654, P=0.001］. While the numbers of hospitalization days were similar in the two groups ［(20.1±2.1) d vs. (19.4±2.3) d］, with no statistically significant difference (t=-1.273, P=0.208). ConclusionBoth diagnosticdriven therapy and empirical therapy are helpful to early antifungal treatment, and they should be performed properly combined with the actual clinical conditions. References | Related Articles | Metrics

Epidemiologic features and trends of leukemia in Shenzhen during 2001-2015 Lei Lin, Ji Yong, Shang Qinggang, Peng Ji, Ren Hua 2019, 46 (7):  415-419.  doi: 10.3760/cma.j.issn.1673-422X.2019.07.005 Abstract ( 891 )   PDF (1311KB) ( 984 )   Save ObjectiveTo describe the incidence trend of leukemia in Shenzhen during 2001 to 2015, and to provide base data for designing prevention and treatment strategies on leukemia. MethodsThe leukemia incidence data and population data collected by Shenzhen Cancer Registry from 2001 to 2015 were used in our analysis. The crude incidence, agestandardized incidence rate by Chinese standard population (ASR China) and agestandardized incidence rate by world standard population (ASR world) were calculated. The annual percentage change (APC) of the incidence was analyzed by Joinpoint regression. ResultsShenzhen Cancer Registry registered 2 106 new cases of leukemia from 2001 to 2015. The crude incidence was 6.31 per 100 000, with 6.75 per 100 000 ASR China and 7.15 per 100 000 ASR world. Cumulative rate (074 years) was 0.63%, and truncated rate (3564 years) was 7.03 per 100 000. From the perspective of gender distribution, the incidence of male was significantly higher than female, with a sex ratio of 1.38∶1. In terms of time trend, the incidence of leukemia was stable, and the Joinpoint regression showed that APC=-0.09%(95%CI: -1.60%1.41%, P=0.92). In terms of subtypes, acute myelocytic leukemia (AML) accounted for 17.66% of the total cases, and the incidence of AML has increased during 2001 to 2015 (APC=13.34%, 95%CI: 5.71%21.51%, P<0.01). The median age of leukemia patients was 36 years old, and the mean age was 37.29 years old. The two peaks of the incidence were 14 and 8084 age groups, and the ASR incidences were 9.13 per 100 000 and 39.40 per 100 000 respectively. ConclusionThe incidence of leukemia is very high in Shenzhen. Children and the elderly are at high risk of leukemia. Government needs to guide institutions to carry out research to reduce the incidence of leukemia. References | Related Articles | Metrics

Effect of ubiquitin-specific protease on radiosensitivity of tumor Zhou Qifen, Wu Chunlin 2019, 46 (7):  420-422.  doi: 10.3760/cma.j.issn.1673-422X.2019.07.006 Abstract ( 591 )   PDF (701KB) ( 556 )   Save Ubiquitin-specific protease is a member of the deubiquitinating enzyme family, which can reverse the ubiquitination of proteins and stabilize proteins. It affects radiosensitivity of tumor by regulating DNA damage, cell cycle, nuclear factor-κB signaling pathway, Nrf2-Keap1 signaling pathway and oncogene c-myc. It is expected to become a new target for tumor radiotherapy sensitization. References | Related Articles | Metrics

Clinical application of exosomal miRNA as biomarker in breast cancer Cao Lixia, Shi Zhendong, Liu Jingjing, Zhang Jin 2019, 46 (7):  423-426.  doi: 10.3760/cma.j.issn.1673-422X.2019.07.007 Abstract ( 648 )   PDF (706KB) ( 588 )   Save MicroRNA (miRNA) has a tumorspecific expression profile and plays an important role in the occurrence and progression of tumors. It is protected from RNase in body fluids through the inclusion of exosomes and translocates genetic information horizontally between breast cancer cells. Recent studies on exosome miRNA have found that it is closely related to the occurrence, diagnosis, treatment and prognosis of breast cancer. The indepth study in this field can provide theoretical basis for the clinical application of exosome miRNA as a biomarker for breast cancer. References | Related Articles | Metrics

Research progress of cryoablation in the treatment of lung cancer Ma Yuankun, Ni Jixiang, Zhao Tianming, Hu Xuehua, Yang Yuting 2019, 46 (7):  427-429.  doi: 10.3760/cma.j.issn.1673-422X.2019.07.008 Abstract ( 851 )   PDF (701KB) ( 624 )   Save Clinical studies have confirmed that cryoablation is a safe and effective treatment for lung cancer. Cryoablation has been clinically used in the treatment of various types of lung cancer, and has achieved good therapeutic effects. Some of the complications of cryoablation can be alleviated after symptomatic treatment. However, cryoablation still needs further research and exploration in clinical applications. References | Related Articles | Metrics

Molecular alterations in precancerous lesions of esophageal squamous cell carcinoma Chang Chen, Wang Mingrong 2019, 46 (7):  430-433.  doi: 10.3760/cma.j.issn.1673-422X.2019.07.009 Abstract ( 650 )   PDF (706KB) ( 569 )   Save Esophageal squamous cell carcinoma (ESCC) is one of the most predominant malignancies worldwide. ESCC develops gradually from the precancerous lesions. The researches about biomarkers mainly concentrate in the nucleic acid and protein, including cytogenetic abnormalities, amplifications, deletions, mutations, breakage and fusions of genomic DNA, expression changes of mRNA, microRNA (miRNA) and long noncoding RNA (lncRNA) in RNA level, and expression level, subcellular localization, and posttranslational modifications of proteins. Studies on the molecular alterations in precancerous lesions and early cancer of t he  esophagus  will contribute to the exploration of biomarkers for early diagnosis and intervention targets for this  disease. References | Related Articles | Metrics

Research progress of prognosis-related lncRNA molecular markers in gastric cancer Liu Hui, Chang Ziwei, Zhang Qiumeng, Zhang Chao, Jing Liwei 2019, 46 (7):  434-438.  doi: 10.3760/cma.j.issn.1673-422X.2019.07.010 Abstract ( 592 )   PDF (718KB) ( 605 )   Save Researches on gene sequencing find that long non-coding RNA (lncRNA) does not encode protein, however, it participates in the biological pathway of gastric cancer and plays a certain role in the process of prognosis and outcome of gastric cancer. With the generation of gene databases and the popularity of computer algorithms, the researches on the prognosis-related lncRNA of gastric cancer are gradually increasing. The bioinformatics study of prognosisrelated lncRNA of gastric cancer can provide ideas for experimental researches. It is expected to provide evidence for the diagnosis and treatment of gastric cancer and improve prognosis by exploring more lncRNAs that are related to the prognosis of gastric cancer. References | Related Articles | Metrics

Maintenance treatment for advanced gastric cancer Yao Yang, Jia Yingjie, Deng Renfen, Li Xiaojiang, Kong Fanming 2019, 46 (7):  439-442.  doi: 10.3760/cma.j.issn.1673-422X.2019.07.011 Abstract ( 741 )   PDF (708KB) ( 1080 )   Save S-1 and capecitabine are relatively ideal agents for maintenance treatment of advanced gastric cancer. In clinical trials of using immune and targeted drugs for maintenance treatment of advanced gastric cancer, ipilimumab fails to obtain positive results, ramucirumab has not obtained research data, and trial regimens of maintenance treatment with trastuzumab, bevacizumab and avelumab have all shown initial efficacy. Traditional Chinese medicine therapy has shown some effectiveness in maintenance treatment, which still needs further researches. References | Related Articles | Metrics

New strategies for the treatment of clear cell renal cell carcinoma: target the metabolic reprogramming Chen Liang, Peng Min, Weng Yiming, Song Qibin 2019, 46 (7):  443-446.  doi: 10.3760/cma.j.issn.1673-422X.2019.07.012 Abstract ( 769 )   PDF (711KB) ( 560 )   Save For the last decade, the incidence of kidney neoplasms has shown an obvious rising trend in the world. The most common histopathological type of kidney neoplasms is clear cell renal cell carcinoma (ccRCC), which has a poor prognosis. ccRCC is generally accompanied by reprogramming of glucose, fatty acid, glutamine, tryptophan and arginine metabolic networks and pathways. Reprogramming of metabolic networks and pathways enables tumor cells to proliferate rapidly, survive in conditions of nutrient depletion and hypoxia, and escape surveillance by epidemic systems. New strategies have been developed to the treatment of ccRCC by targeting key proteins or enzymes involved in metabolic reprogramming pathways. References | Related Articles | Metrics