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08 November 2023, Volume 50 Issue 11 Previous Issue    Next Issue

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The effects of different dose calculation grid size by Monaco planning system on the dosimetry of T4 nasopharyngeal carcinoma Li Jinzhi, Zhao Biao, Wen Xiaobo, Zhang Ming, Yuan Meifang, Sun Mengzhen, Pu Qin, Yang Yi 2023, 50 (11):  641-649.  doi: 10.3760/cma.j.cn371439-20230605-00122 Abstract ( 48 )   HTML ( 14 )   PDF (1455KB) ( 36 )   Save Objective To analyze the effects of different dose calculation grid size of Monaco system on the physical and biological dosimetry of target area and organ at risk （OAR） in T4 nasopharyngeal carcinoma. Methods A total of 18 patients with stage T4 nasopharyngeal carcinoma who received radiotherapy in the Department of Radiotherapy of Yunnan Cancer Hospital from October 2020 to April 2022 were selected to complete the delineation of target areas and OAR in the Monaco 5.11.03 system，and the volumetric intensity modulated arc therapy （VMAT） plan was developed on the 3 mm grid with the optimization mode of target area priority. The 3 mm grid group plan was replicated without changing any other parameters，and the physical plan was re-established on the 1，2，4 and 5 mm grids，and then the five plans were normalized to the prescription dose to cover 95% of the target volume. The planning time，D2%，D50%，D98%，conformity index （CI），homogeneity index （HI），gradient index （GI），tumor control probability （TCP），D2% and Dmean of important OAR around the target area were calculated and statistically analyzed. Results Planning primary tumor gross target volume（PGTVp）：The D2% of 1，2，3，4 and 5 mm groups were （76.94±0.66），（75.98±0.76），（75.56±0.67），（75.67±0.73） and （75.94±0.85） Gy，respectively，with a statistically significant difference （F=9.86，P<0.001）. The CI of 1，2，3，4 and 5 mm groups were 0.75±0.05，0.78±0.04，0.78±0.05，0.79±0.04 and 0.78±0.04，respectively，with a statistically significant difference （F=2.61，P=0.041）. There were statistically significant differences in D50%，D98%，HI，equivalent uniform dose （EUD） and tumor control probability （TCP） among the groups （H=17.14，P=0.002； F=9.35，P<0.001； H=25.43，P<0.001 ； F=5.85，P<0.001； H=17.65，P=0.001）. There was no statistically significant difference in GI among the groups （P>0.05）. Pairwise comparison showed that D2% in 2，3，4，5 mm groups compared with 1 mm group，D50% in 5 mm group compared with 2，3 mm groups，D98% in 4 mm group compared with 1，2 mm groups，D98% in 5 mm group compared with 1，2，3 mm groups，CI in 5 mm group compared with 1 mm group，HI in 2，3，4，5 mm groups compared with 1 mm group，EUD in 3 mm group was compared with 1 mm group，EUD in 5 mm group compared with 2，3 mm groups，TCP in 3 mm group compared with 1 mm group，and TCP in 5 mm group compared with 3 mm group，there were statistically significant differences （all P<0.05）. Planning nodal gross target volume （PGTVn）：The D2% of 1，2，3，4 and 5 mm groups were （76.36±0.59），（75.36±0.62），（75.04±0.68），（75.25±0.72） and （75.39±0.77） Gy，respectively，with a statistically significant difference （F=10.32，P<0.001）. The HI of 1，2，3，4 and 5 mm groups were 1.08（1.08，1.08），1.07（1.06，1.07），1.06（1.06，1.07），1.06（1.06，1.07），1.06（1.06，1.07），1.06（1.06，1.08），respectively，with a statistically significant difference （H=22.00，P<0.001）；There were statistically significant differences in D50%，D98% and EUD among the groups （H=11.79，P=0.019； H=20.49，P<0.001； F=12.14，P=0.016）. Pairwise comparison showed that there were statistically significant differences in D2% between 2，3，4，5 mm groups and 1 mm group，D98% between 4 mm group and 1 mm group，D98% between 5 mm group and 1，2 mm groups，HI between 2，3，4 mm groups and 1 mm group，and EUD between 3 mm group and 1 mm group （all P<0.05）. Planning primary tumor clinical target volume 1 （PCTVp1）： The D2% of 1，2，3，4 and 5 mm groups were （76.59±0.63），（75.64±0.65），（75.64±0.98），（75.41±0.70） and （75.71±0.84） Gy，respectively，with a statistically significant difference （F=9.53，P<0.001）. The D50% of 1，2，3，4，5 mm groups were （72.09±0.34），（71.85±0.39），（71.82±0.45），（72.04±0.56），（72.43±0.66） Gy，respectively，with a statistically significant difference （F=4.20，P=0.019）. There was no statistically significant difference in the other indexes among the groups （all P>0.05）. Pairwise comparison showed that there were statistically significant differences in D2% between 2，3，4，5 mm groups and 1 mm group，and in D50% between 2，3 mm groups and 1 mm group （all P<0.05）. Planning nodal clinical target volume 1（PCTVn1）： There were no statistically significant differences in all indexes among the groups （all P>0.05）. Planning clinical target volume 2 （PCTV2）： The D2% of 1，2，3，4 and 5 mm groups were （75.57±0.50），（74.87±0.67），（74.51±0.51），（74.61±0.63） and （75.00±0.74） Gy，respectively，with a statistically significant difference （F=8.27，P<0.001）. Pairwise comparison showed that the D2% of the 2，3，4 mm groups were significantly different from that of the 1 mm group （all P<0.05）. The calculation time of physical plan in 1，2，4 and 5 mm groups was 987.00（848.00，1 091.00），120.50（99.75，134.00），26.00 （24.00，34.25） and 21.50（18.75，34.75）s，respectively，with a statistically significant difference （H=61.62，P<0.001）. Pairwise comparison showed that there were statistically significant differences in the calculation time between 4 mm group and 1，2 mm groups，5 mm group and 1，2 mm groups （all P<0.05）. There was no statistically significant difference in the dosimetric parameters of OAR around the target area among the groups （all P>0.05）. Conclusion The physical dose and biological dose of the important OAR around the target area and the target area change with the change of dose calculation grid size when formulating the physical plan of radiotherapy for T4 nasopharyngeal carcinoma. Considering the quality of the physical plan and the calculation time，when the Monaco system formulates the VMAT plan for T4 nasopharyngeal carcinoma patients，the plan can be optimized on the 3 mm computing grid and copied to the 1 mm computing grid for recalculation. Figures and Tables | References | Related Articles | Metrics

Tendency of elderly patients with breast cancer to choose comprehensive treatment mode and its influencing factors Geng Rui, Ma Junqiang, Guo Qiang, Niu Zhaofeng 2023, 50 (11):  650-654.  doi: 10.3760/cma.j.cn371439-20230315-00123 Abstract ( 50 )   HTML ( 6 )   PDF (700KB) ( 29 )   Save Objective To analyze the tendency of elderly patients with breast cancer in the choice of treatment methods and related influencing factors. Methods The data of 312 elderly patients with unilateral breast cancer treated in Yuncheng Central Hospital from January 2013 to December 2017 were collected for retrospective analysis. All patients' treatment options were analyzed，and the age of patients who chose different treatment options was compared. Univariate and logistic regression were used to analyze the chemotherapy choice tendency of elderly breast cancer patients，and Cox proportional risk model was used to analyze the influencing factors of 5-year survival of elderly breast cancer patients. Results In the whole patient population，the selection rates of surgery，chemotherapy，radiotherapy，endocrine therapy and targeted therapy were respectively 97.44% （304/312），81.41% （254/312），7.05% （22/312），68.27% （213/312），3.85% （32/312）. The mean age of all patients was （67.94±6.55） years. There were no statistically significant differences in the age of patients with different treatment methods （all P>0.05）. The results of univariate analysis showed that，there were statistically significant differences in the depth of invasive cancer （t=3.11，P=0.002），number of axillary lymph node metastasis （t=6.54，P<0.001），comorbidities （t=-4.85，P<0.001） and Eastern Cooperative Oncology Group （ECOG） score （t=-4.56，P<0.001） between chemotherapy and non-chemotherapy patients，and there were no statistically significant differences in age （t=-0.52，P=0.604），pathological type （χ2=4.96，P=0.084），surgical type （χ2=0.21，P=0.899），tumor differentiation degree （χ2=3.28，P=0.194），estrogen receptor （χ2=0.99，P=0.321），progesterone receptor （χ2=0.89，P=0.346），and human epidermal growth factor receptor-2 （χ2=0.58，P=0.445）. The results of multifactor analysis showed that types of comorbidities （OR=0.91，95%CI： 0.85-0.99，P=0.024） and ECOG score （OR=0.95，95%CI： 0.92-0.99，P=0.007） were independent influencing factors for the use of chemotherapy after surgery in elderly breast cancer patients. A total of 74 patients died within 5 years after surgery，and the 5-year overall survival rate was 76.28%. More axillary lymph node metastasis （RR=1.26，95%CI： 1.09-1.46，P=0.001） and more complications （RR=1.07，95%CI： 1.02-1.13，P=0.007） were risk factors for prognosis. Conclusion Surgery and chemotherapy are the main treatment methods for elderly patients with breast cancer. ECOG score and number of complications can directly affect the results of chemotherapy selection for such patients，the number of axillary lymph node metastasis and complications had significant influence on the long-term survival of the patients. Figures and Tables | References | Related Articles | Metrics

Construction of pathological classification prediction model for malignant pulmonary pure ground-glass nodule patients based on CT imaging Chen Yu, Xu Hua, Liu Hai, Chen Shixin 2023, 50 (11):  655-660.  doi: 10.3760/cma.j.cn371439-20230704-00124 Abstract ( 56 )   HTML ( 8 )   PDF (971KB) ( 28 )   Save Objective To construct the pathological classification prediction model for malignant pulmonary pure ground-glass nodule（pGGN） patients based on CT imaging and to analyze the predictive efficacy. Methods A total of 193 pulmonary pGGN patients with histopathological findings who underwent surgical treatment in 3201 Hospital from January 2018 to December 2022 were retrospectively included，with 217 lesions. All patiens were divided into invasive adenocarcinoma group （68 patients，73 lesions） and non-invasive adenocarcinoma group （125 patients，144 lesions） based on whether they were invasive adenocarcinoma； The clinical feature data and CT imaging parameters were compared between the two groups； Multivariate logistic regression analysis was used to analyze the risk factors of malignant lung pGGN diagnosed as invasive adenocarcinoma； A logistic prediction model for pathological classification of malignant lung pGGN was constructed to analyze its predictive efficacy using receiver operator characteristic （ROC） curves. Results The percentages of burr signs in invasive adenocarcinoma group and non-invasive adenocarcinoma group were 34.25% （25/73） and 5.56% （8/144），respectively； The proportion of internal vascular signs was 93.15% （68/73） and 18.75% （27/144），respectively； The air bronchial signs were 67.12% （49/73） and 12.50% （18/144），respectively，with statistically significant differences （χ2=30.93，P<0.001； χ2=108.95，P<0.001； χ2=67.72，P<0.001）. The maximum CT value of nodular plain scan in invasive adenocarcinoma group （-527.82±72.95）HU，was significantly higher than that in non-invasive adenocarcinoma group （-592.79±86.47）HU，with a statistically significant difference （t=-5.50，P<0.001）. The results of multivariate analysis showed that spicule sign （OR=8.93，95%CI： 1.99-39.97，P=0.004），air bronchial sign （OR=8.16，95%CI： 2.91-22.86，P<0.001），internal vascular sign （OR=48.39，95%CI： 14.81-158.07，P<0.001） and the maximum CT value of plain scan （OR=1.01，95%CI： 1.00-1.02，P=0.001） were independent factors for the diagnosis of malignant pulmonary pGGN as invasive adenocarcinoma. Using burr sign，air bronchogram sign，internal vascular sign，maximum CT value of plain scan，and logistic regression model P-value to predict the pathological classification of malignant lung pGGN，the optimal cutoff values were 0.50，0.50，0.50，-547.23 HU，0.46，and the area under the curve was 0.64，0.77，0.87，0.69 and 0.96，respectively. The sensitivity was 34.25%，67.12%，93.15%，82.19% and 89.04%，and the specificity was 94.44%，87.50%，81.25%，46.53% and 92.36%，respectively，with the Jordan index being 28.69%，54.62%，74.40%，28.72% and 81.40%. Conclusion Patients with malignant pulmonary pGGN who have concomitant spicule sign，air bronchial sign，internal vascular sign，and maximum CT value on plain scan have a higher risk of being diagnosed with invasive adenocarcinoma； The predictive model constructed based on spicule sign，air bronchial sign，internal vascular sign，and maximum CT value on plain scan has shown good predictive performance in assisting the differential diagnosis of malignant pulmonary pGGN pathological classification. Figures and Tables | References | Related Articles | Metrics

The efficacy and safety of recombinant human thrombopoietin in the treatment of thrombocytopenia caused by tumor radiotherapy Wang Bing, Wang Aifu, Liu Wenshu, Fan Jiaojiao, Tian Weicheng, Wang Weili, Liu Boyu 2023, 50 (11):  661-667.  doi: 10.3760/cma.j.cn371439-20230730-00125 Abstract ( 62 )   HTML ( 8 )   PDF (733KB) ( 44 )   Save Objective To observe the efficacy and safety of recombinant human thrombopoietin （rhTPO） in the treatment of radiation induced thrombocytopenia （RIT）. Methods From January 2019 to March 2021，204 cases （including 101 cases of radiotherapy alone and 103 cases of concurrent chemoradiotherapy） were collected retrospectively after radiotherapy and with decreased in blood platelet count <75×109/L in Jilin Cancer Hospital. These patients received rhTPO 15 000 U，once a day，subcutaneous，for at least 4 consecutive days，or met the withdrawal criteria blood platelet count ≥100×109/L，or the absolute value of blood platelet increase ≥50×109/L. The characteristics of blood platelet decline，treatment efficacy，and safety were analyzed. Results The numbers of radiotherapy treatments with platelets lower than 75×109/L in the radiotherapy alone group and the concurrent chemoradiotherapy group were 19 （13，22） and 13 （10，17） times，respectively，indicating that patients in the concurrent chemoradiotherapy group experienced platelet decline earlier （Z=-5.27，P<0.001），the lowest values of platelet decline in the two groups were 68 （45，74）×109/L and 62 （44，74）×109/L，respectively，with no statistically significant difference （Z=-1.15，P=0.252）. After received rhTPO treatment，the numbers of days that the two groups of patients had platelets <50×109/L were 7 （3，13）d and 7 （5，11）d，respectively，with no statistically significant difference （Z=-1.13，P=0.281）. After the patients received radiotherapy，rhTPO was started when the platelet count dropped to <75×109/L. The number of days required to recover to 75×109/L was 4 （2，10）d in the radiotherapy alone group and 4 （2，8）d in the concurrent chemoradiotherapy group，with no statistically significant difference （Z=-1.07，P=0.285）； the number of days required for platelets to recover to 100×109/L or for the absolute value to increase by 50×109/L was 8 （6，14）d in the radiotherapy alone group and 11 （8，16）d in the concurrent chemoradiotherapy group. The recovery time of the concurrent chemoradiotherapy group was longer than that of the radiotherapy alone group （Z=-3.64，P<0.001）. Regardless of the baseline level，there was no statistically significant difference in the number of days for platelets to recover to 75×109/L after rhTPO treatment between the radiotherapy alone group and the concurrent chemoradiotherapy group （Z=-1.42，P=0.155； Z=-0.97，P=0.332）. The number of days required for the two groups of patients to recover to 100×109/L or for the absolute value to increase by 50×109/L were 8 （6，14）d and 11 （8，16）d，respectively，with a statistically significant difference （Z=-3.64，P<0.001）. The numbers of days required for the two groups of patients with baseline platelets ≥50×109/L to recover to 100×109/L or for the absolute value to increase by 50×109/L were 8 （4，12）d and 10 （8，16）d，respectively，with a statistically significant difference （Z=-3.12，P=0.002）. However，there was no statistically significant difference in the number of days required for the two groups of patients with baseline platelets <50×109/L to recover to 100×109/L or for the absolute value to increase by 50×109/L （Z=-1.88，P=0.061）. The total platelet elevation rate of rhTPO within 20 days of radiotherapy treatment for both groups of patients was 93.63% （191/204），of which 95.05% （96/101） was for radiotherapy alone and 92.23% （95/103） for concurrent chemoradiotherapy，with no statistically significant difference （χ2=0.68，P=0.410）. In addition，there was no statistically significant difference in gender（χ2=3.47，P=0.063），age（χ2=2.79，P=0.095），TNM staging（χ2=5.07，P=0.167），and baseline platelet count（χ2=0.62，P=0.822） between the two groups.During the radiotherapy cycle，27 patients （13.23%） received blood platelet infusion，and 158 patients （77.45%） completed the radiotherapy plan without interruption. No rhTPO-related adverse reactions were found. Conclusion rhTPO in the treatment for RIT can effectively promote the recovery of blood platelet without any adverse reactions，and has good safety. Figures and Tables | References | Related Articles | Metrics

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Value of extracellular vesicle DNA as an indicator of tumor liquid biopsy molecules Yin Shuhui, Wen Rong, Miao Shufang 2023, 50 (11):  668-671.  doi: 10.3760/cma.j.cn371439-20230523-00126 Abstract ( 46 )   HTML ( 5 )   PDF (682KB) ( 39 )   Save Extracellular vesicle （EV） is widely distributed and fully involved in the regulation of various aspects of cellular physiology. As active carriers of molecular biomarkers and mediators of intercellular communication，EV is involved in the occurrence，development，metastasis，drug resistance and other links of tumors. The EV，which can be obtained from a variety of body fluids and are highly homologous to tissues，plays an important role in the maintenance of cell homeostasis and the exchange of substances and information between cells，thus becoming an ideal biomarker for tumor diagnosis and treatment. In the emerging liquid biopsy application，EV DNA can be used as a molecular marker for the diagnosis and prognosis evaluation of many kinds of tumors，and it is the most potential molecular marker of liquid biopsy in the field of tumor diagnosis and treatment. References | Related Articles | Metrics

Progress of immunotherapy-based strategy in triple-negative breast cancer Xie Lulu, Ding Jianghua 2023, 50 (11):  672-676.  doi: 10.3760/cma.j.cn371439-20230722-00127 Abstract ( 64 )   HTML ( 5 )   PDF (735KB) ( 33 )   Save Triple-negative breast cancer （TNBC） represents a distinct subtype of breast cancer，characterized by unique clinical traits including early lung metastasis，elevated recurrence rates，and diminished survival prospects. Owing to the lack of estrogen receptor，progesterone receptor，and human epidermal growth factor receptor 2 expression，concrete therapeutic targets remain elusive，thereby confining available clinical treatment methods. In the context of advanced TNBC，chemotherapy remains the predominant therapeutic approach. In recent years，with the in-depth study of tumor microenvironment，new immunotherapy targets have been discovered one after another. Thus，immunotherapy-based combined therapy strategies have brought new hope in patients with advanced TNBC. References | Related Articles | Metrics

Practice and prospect of artificial intelligence in diagnosis and treatment of gastric cancer Li Jiayi, Wang Yue, Shang Lanlan, Xu Xing, Zhao Yan 2023, 50 (11):  677-682.  doi: 10.3760/cma.j.cn371439-20230510-00128 Abstract ( 106 )   HTML ( 9 )   PDF (710KB) ( 43 )   Save In recent years，artificial intelligence （AI） and oncology are rapidly integrated and developed，gradually moving towards clinical application. In China，the incidence and mortality of gastric cancer rank first among various tumors. The development of AI technologies such as convolutional neural network，narrow-band imaging magnifying endoscope，full-field digital section and survival circulation network has the potential to be applied to early screening，auxiliary diagnosis，pathological diagnosis，prognosis analysis，as well as individualized diagnosis and treatment process of gastric cancer. However，AI medical treatment still has many problems such as insufficient data sample size and difficulty in integration. Reasonable design and application of AI technology is expected to provide more scientific and accurate diagnosis and treatment for patients with gastric cancer，improve the overall survival rate and quality of life of patients with gastric cancer，and achieve more breakthroughs in the medical field. References | Related Articles | Metrics

Potential strategies for targeting tumor-associated macrophages to enhance the efficacy of immune checkpoint inhibitors for colorectal cancer Tao Hong, Yin Hong, Luo Hong, Tao Jiayu 2023, 50 (11):  683-687.  doi: 10.3760/cma.j.cn371439-20230725-00129 Abstract ( 53 )   HTML ( 3 )   PDF (735KB) ( 28 )   Save Tumor-associated macrophage （TAM） plays a key role in tumor progression and metastasis，and their properties are highly dependent on signaling stimuli in the tumor microenvironment（TME）. Moreover，TAM，as a major player in tumor-related inflammation，is associated with the prognosis of multiple solid tumors. Immune checkpoint inhibitor （ICI） was found to significantly improve the survival prognosis of patients with microsatellite instability/mismatched repair deficient colorectal cancer. However，the efficacy of ICI as monotherapy is limited in the vast majority of CRC patients. Although the exact functions of TAM have not been fully elucidated，targeting TAM as a therapeutic strategy significantly enhances the efficacy of ICI in CRC，and TAM also demonstrates important value as predictive biomarkers for CRC prognosis. References | Related Articles | Metrics

Recent progresses of targeted therapy and immunotherapy of hepatocellular carcinoma Jiang Shan, Xu Ximing 2023, 50 (11):  688-695.  doi: 10.3760/cma.j.cn371439-20230605-00130 Abstract ( 96 )   HTML ( 6 )   PDF (762KB) ( 35 )   Save Hepatocellular carcinoma （HCC） is one of the most common malignancies in the world，with a high incidence and fatality rate in China. Since sorafenib opened up a new era of targeted therapy for HCC，drug developers around the world have made a lot of efforts and contributions to the exploration of systematic therapy for HCC. In recent years，novel molecular targeted agents，immune checkpoint inhibitors and their combined treatment regimens in advanced HCC have been implemented for many large samples，international multi-center clinical trials. The results show that the therapeutic effect of immunotherapy combined with targeted therapy and dual immunotherapy have significant advantages compared with that of targeted or immune monotherapy，and have satisfactory safety while prolonging survival and improving the quality of life of patients. References | Related Articles | Metrics

Research progress of pyroptosis in leukemia Zhang Ting, Jia Xiuhong 2023, 50 (11):  696-700.  doi: 10.3760/cma.j.cn371439-20230715-00131 Abstract ( 69 )   HTML ( 2 )   PDF (700KB) ( 28 )   Save Pyroptosis is a programmed cell death mediated by the Gasdermin family of proteins，which is different from apoptosis and necrosis and accompanied by the release of a large number of pro-inflammatory factors. Leukemia is a malignant proliferative disease derived from hematopoietic stem cells，the pathogenesis and progression of which are related to many factors. In recent years，with the in-depth study on the mechanism of pyroptosis，it has been found that pyroptosis is closely related to the occurrence and development of leukemia. Further study of the mechanism of pyroptosis in leukemia can provide a new idea for the diagnosis and treatment of leukemia. References | Related Articles | Metrics