Background Adult head and neck rhabdomyosarcoma (HNRMS) is an exceptionally rare malignancy, and there is a paucity of data and research dedicated to understanding its characteristics and management in adult populations. This study aimed to assess the outcomes and identify survival predictors in adult HNRMS. Methods We retrospectively evaluated 42 adult patients (> 16 years) with HNRMS who received radiotherapy (RT)-based treatment at our institute between 2008 and 2022. We analysed the clinical characteristics and prognosis of these patients, including the locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS), using the Kaplan–Meier method. The chi-square and Fisher’s exact tests were used to analyse differences between groups for dichotomous and categorical variables, respectively. Survival rates were calculated using the Kaplan–Meier method. Prognostic variables were assessed through univariate Cox analyses. Results The median patient age was 28 years (range, 16–82 years). Alveolar RMS was the most common histological type, observed in 21 patients (50.0%), followed by embryonal in 16 patients (38.1%). The anatomic sites of origin were orbital in one (2.4%), parameningeal in 26 (61.9%), and non-orbital/non-parameningeal in 15 (35.7%) patients. Nineteen patients (45.2%) had regional lymph node metastasis, and five patients (11.9%) presented with distant metastatic disease. Distant metastasis ( n = 17) was the primary cause of treatment failure. At a median follow-up of 47.0 months, the 5-year LRFS, PFS, and OS rates were 69.0%, 39.7%, and 41.0%, respectively. Univariate analysis revealed that tumour size, lymph node involvement, and the local treatment pattern (surgery and RT vs. RT alone) were significant predictors of survival. Conclusions The main failure pattern in patients with HNRMS receiving RT-based treatment was distant metastasis. Tumour size > 5 cm and lymph node involvement were predictors of worse LRFS. Multimodality local treatment, combining surgery and RT, is effective and provides survival benefits.

目的 术后放疗是软组织肉瘤综合治疗的重要组成部份,本研究通过对近10年来北京大学肿瘤医院收治的软组织肉瘤术后患者进行回顾性分析,旨在探讨软组织肉瘤术后放射治疗的疗效和预后影响因素.方法 选取2008-03-01-2017-05-31日北京大学肿瘤医院收治的392例软组织肉瘤患者作为研究对象,所有患者均接受术后放疗.其中,低度恶性269例,中度恶性61例,高度恶性62例;多次术后复发31例,首次术后复发82例.术后放疗全部采用6 MV或10 MV深部X线外照射,加或不加6～15 MeV电子线照射,总剂量PTV低度恶性肉瘤为45～60 Gy/5周,中度恶性肉瘤为65 Gy/6.5周,高度恶性肉瘤或切缘残留为70Gy/7周.应用寿命表法统计生存率,应用Kaplan-Meier法进行预后的单因素分析,应用Cox比例风险模型进行预后多因素回归分析.结果 随访8～118个月,中位随访时间为60个月.中位生存时间为30个月,1、3和5年生存率分别为92.1％(361/392)、81.9％(321/392)和61.5％(241/392),5年局部复发率为5.9％(23/392),5年远处转移率为13.0％(51/392).单因素分析显示,肿瘤大小、患者性别、临床分期、恶性程度、调强放疗与预后密切相关,均P值＜0.05.多因素分析显示,临床分期、肿瘤大小、恶性程度和调强放疗具有独立预后意义,均P值＜0.05.结论 术后放疗能提高软组织肉瘤患者生存率,降低术后局部复发率.

Objective To evaluate the efficacy and safety of recombinant adenovirus-p53(rAdp53) injection combined with radiotherapy and hyperthermia in the treatment of unresectable advanced soft tissue sarcoma.Methods In this retrospective study, we evaluated 76 patients with unresectable advanced primary or recurrent soft tissue sarcoma treated in our hospital from November 2005 to November 2012.These patients received radiotherapy and hyperthermia with rAdp53(p53 group, n=41) or without rAdp53(control group, n=35).rAdp53((1-2)×1012viral particles each time, once a week, 8 times on average) was injected into the tumor or infused into the pelvic cavity.Radiotherapy (2 Gy each time, 5 times a week) was performed for the planning target volume at 56.3±5.3 Gy in the p53 group and 58.1±4.2 Gy in the control group, with no significant difference between the two groups (P>0.05).Superficial or deep thermotherapy was employed 8 times on average (twice a week).Clinical features, response rate, time to progression (TTP), overall survival (OS), and adverse events were compared between the two groups (P>0.05).The Kaplan-Meier method was used to calculate OS;the log-rank test was used for survival difference analysis and univariate prognostic analysis;the chi-square test was used for comparison of categorical data.Results At 2 months after treatment, the p53 group had significantly increased response rate (partial response+ complete response+ stable disease)(85% vs.54%, P=0.003) and local control rate (49% vs.23%, P=0.020) as well as prolonged TTP (12 months vs.5 months, P=0.010) and OS (48 months vs.31 months, P=0.049), as compared with the control group.No adverse events caused by radiotherapy and hyperthermia except transient fever were seen in the two groups.Conclusions Concurrent radiotherapy and hyperthermia combined with rAdp53 injection is effective and safe for patients with advanced soft tissue sarcoma.

Patients with unresectable advanced soft-tissue sarcomas (STS) receiving radiotherapy or/and chemotherapy still have a poor prognosis. This study aimed to evaluate retrospectively the efficacy and safety of recombinant adenovirus-p53 (rAd-p53) gene therapy combined with radiotherapy and hyperthermia for advanced STS. A total of 71 patients with advanced unresectable STS treated at the authors' center from April 2007 to November 2014 were included. Of these 71 patients, 36 cases received rAd-p53 therapy combined with radiotherapy and hyperthermia (p53 group), while 35 cases received radiotherapy and hyperthermia alone (control group). Short-term therapeutic efficacies, long-term survival outcomes, and adverse events were evaluated and compared between groups. Compared to the control group, the p53 group had a significantly higher disease control rate (83.33% vs. 54.29%; p=0.008) and a lower progressive disease rate (16.67% vs. 45.71%; p=0.018). In addition, rAd-p53 treatment significantly improved the progression-free survival and overall survival of STS patients. Cox regression indicated that rAd-p53 treatment significantly reduced the risks for disease progression or death event for STS patients. Furthermore, there was no significant difference in all adverse events, except for transient fever, which occurred in 89% of patients with rAd-p53 therapy. rAd-p53 combined with radiotherapy and hyperthermia can effectively improve the therapeutic efficacy and survival outcomes in patients with advanced unresectable STS, providing a new therapeutic strategy.

e21514 Background: To evaluate the efficacy and safety for the treatment of advanced soft tissue sarcoma with recombinant human adenovirus p53 (rAd-p53, Gendicine) injection and radiotherapy. Methods: From October 1, 2001, to May 1, 2013, 37 advanced soft tissue sarcoma patients have been treated with rAd-p53 plus radiotherapy. Gene therapy: multipoint injection of rAd-p53 within the neoplasm was given to head and neck as well as abdominal and pelvic tumor by ultrasound guided and to pulmonary metastatic lesion by CT guided. rAd-p53 was injected or perfused 1 × 1012 VP / 2 ml once a week for 3-16 weeks, and the average was 7 ± 2 weeks. Radiotherapy: radiotherapy was delivered 48-72 hours after the first rAd-p53 perfusion to a cumulative dose of 16-70 Gy / 8-35 fractioins / 2-7 weeks (average dose, 52.0 ± 5.0 Gy). Results: The rates of CR, PR, SD accounted for 8.1% (3/37), 43.2% (16/37) and 48.6% (18/37), respectively. All 18 patients of SD achieved the purpose of relieving pain and reducing local symptoms...

Objective To observe the recent curative effect of postoperative radiotherapy in soft tissue sarcoma.Methods 176 cases of soft tissue sarcoma patients were partially extended resection surgery and postoperative radiotherapy.The radiotherapy start time after surgery 17-81 d,average 39 d;33 cases three-dimensional conformal or intensity modulated radiotherapy,143 cases conventional radiotherapy.Most of the patients with high-energy X-ray,74 cases with electron irradiation or electronic line X-ray mixed irradiation.The average radiation dose was 57.6 GY,conventional fractionation.Results This group of patients,13 patients did not complete the radiotherapy,7 cases of interruption due to radiotherapy skin reactions,4 cases of non-health reasons,1 case recurrence within the radiation field in the radiotherapy,1 case of lung infection.6 cases of local recurrence,the recurrence rate of 3.4%.Acute reactions,including 166 cases of acute injury of skin and mucous membrane,37 cases of leucopenia,15 cases of neutropenia.Late reaction,including 139 cases of the skin and mucosa of chronic injury,107 cases of subcutaneous tissue fibrosis,2 cases of femoral neck fracture.Conclusion Soft tissue sarcoma curative effect of postoperative radiotherapy is better.

Objective To evaluate the effects and safety of CMNa on radiosensitivity enhacement for malignant tumors.Methods According to the standard protocol of CMNa Ⅳ stage clinic trial.80 patients with malignant tumors were treated with 3DCRT or conventional radiotherapy,2 Gy/fraction and five fractions weekly. Concomitance CMNa were applied in intravenous 800 mg/m2,three times weekly.The treatment effects and side- effects were observed.Results The curative effeet rates were 91.7%for cervical cancer.85.7% fornasopharynx cancer,56.7%for esophageal cancer,54.5%for lung cancer.40%for liver and gall cancer.The total curative effect rate was 62.6%and the tumor eontrol rate was 100%.The side-effects occulrence rates of mucosa and skin which were grades 1 to 2,were 51.3%and 46.3%,respectively,which were the highest in all side-effects.There were no statistical significances between before and after treatment on the side-effects and blood test.Conclusions CMNa combined with radiotherapy call enhance the control rates of tumors with low toxicity and high safety.

OBJECTIVE:To investigate the time of whole brain irradiation and the prognostic factors for non-small lung cancer patients with brain metastasis. METHODS:From August 1996 to December 2003, 147 patients with brain metastasis from non-small cell lung cancer received whole brain irradiation. The patients were divided into two groups: with or without symptoms caused by brain metastasis, each group was then divided into two sub-groups, early whole brain irradiation group (the interval between the diagnosis of brain metastasis and the brain irradiation < or = one month) and late group ( the interval > one month ). Univariate and multivariate analysis (Cox regression) as well as Kaplan-Meier method in SPSS software package 11.5 was used to analyze the data of the 147 patients including 72 with brain metastasis symptom and 75 without. RESULTS:The median survival time (MS) of patients with or without extracranial metastasis was 9.9 months and 11.3 months (P = 0.0002). Multivariate analysis indicated that extracranial metastasis was an independent prognostic factor (P = 0.0004). For 72 patients with brain metastasis symptom, the MS of the patients with and without extracranial metastasis was 9.3 months and 11.3 months (P = 0.0036). The MS of patients with early and late whole brain irradiation was 11.4 months and 9.2 months (P = 0.001). Multivariate analysis showed that extracranial metastasis, the interval between the diagnosis of brain metastasis and the whole brain irradiation were independent prognostic factors. However, for 75 patients without brain metastasis symptom, the MS difference of those with early or late whole brain irradiation was not statistically significant (P = 0.1643). CONCLUSION:The extracranial metastasis in non-small cell lung cancer patients with brain metastasis is an independent prognostic factors. Early whole brain irradiation may improve the survival for those with brain metastasis symptoms.

Objective To evaluate the effect of concurrent chemotherapy with radiotherapy for locally advanced pancreatic cancer (LAPC). Methods Thirty-six cases of LAPC were treated with concurrent chemoradiotherapy from June 1998 to December 2004. The regimens of chemotherapy were as follows: A. 13 patients, 5-Fu 500mg, twice a week; B. 16 patients, 5_Fu 500 mg + DDP 300 mg, once a week; C. 7 patients, gemcitabine (GEM) 600 mg, once a week. All the patients were administered such regimens for 3_7 weeks. Twenty patients were treated with conventional radiation therapy (CRT), the median dose was 50 Gy (ranged from 21 to 60 Gy). Sixteen patients were treated with three_dimensional conformal radiation therapy (3D-CRT), the median dose was 60Gy (ranged from 50 to 70 Gy). Results Clinical benefit response (CBR) was 41.6% (15/36 patients). The overall response rates (CR+PR), SD rates, PD rates were 11.1% (4 patients), 66.6% (24 patients), 22.2% (8 patients), respectively. The response rate (CR+PR) of 3D-CRT was 16.6%, which was significantly higher than that in the CRT (5%) (P=0.017). The overall 1- and 2-year survival rates were 33.1%, 11.2%, respectively. The 1-year survival rates were 41.2% and 27.7% in 3D-CRT group (18 patients) and CRT group (20 patients), respectively. The difference between the two groups was statistically significant (P=0.41). 41.6% of the patients showed grade 1-2 hematologic toxicity, 8.3% for the grade 3 hematologic toxicity. Grade 1-2 gastrointestinal toxicity was observed for 52.8% patients, Grade 3 was for 2.8% patients. Conclusion The combined modality treatment is an effective method for LAPC, and the side effects are acceptable.;

The study was to evaluate the safety and the efficacy of recombinant adenovirus-p53 (Adp53, trademarked as Gendicine) combined with radiotherapy in nasopharyngeal carcinoma (NPC) patients. A controlled clinical trial on Gendicine combined with radiotherapy, that is, gene therapy + radiotherapy (GTRT), was conducted in 24 patients, and 25 patients treated with radiotherapy alone (RT) formed the control group. In the GTRT group, Gendicine 1x1012 virus particle (vp) was intratumorally injected once a week over to eight weeks, and concurrent irradiation was given.

OBJECTIVETo evaluate the efficacy and safety of recombinant adenovirus-p53 gene (Gendicine) therapy combined with radiotherapy for head and neck squamous-cell carcinoma (HNSCC).METHODSFrom Oct. 2001 to May 2003, a randomized controlled clinical trial on Gendicine combined with radiation in 36 patients (gene therapy + radiotherapy, GTRT) vs. radiotherapy alone in 33 patients (RT) with HNSCC was completed. In the GTRT group, Gendicine 1 x 10(12) VP (virus particle) was injected intratumorally once a week for eight weeks, and concurrently followed by irradiation. For both groups, the conventional fractionation 2 Gy/f, five fractions a week to a total dose of 70 Gy, was given to either primary tumor or neck lymph nodes. Tumor response was assessed by CT image at 40 Gy, 70 Gy, 2 months after treatment to evaluate the response rate of CR, PR, SD and PD.RESULTSWild-type p53 gene significantly enhanced radiotherapeutic effectiveness in patients with HNSCC (P < 0.05). The CR rate of tumors treated by GTRT was increased by nearly 2.31 times more than that of tumors treated by RT alone. No dose-limiting toxicity and adverse events were noted, except transient fever after Gendicine administration.CONCLUSIONIntratumoral injection of Gendicine to HNSCC patients is safe and effective. The apparent improved results of combined therapy with Gendicine and radiation suggest that p53 gene therapy has promising therapeutic potential in cancer treatment.

OBJECTIVE:To evaluate the efficacy and safety of recombinant adenovirus-p53 (Adp53, SBN-1) combined with radiotherapy in treatment of head and neck squamous cell carcinoma (HNSCC).METHODS:Forty-two patients with HNSCC were randomly divided into 2 groups: gene therapy + radiotherapy group (GTRT group. n = 20, SBN-1 solution 1 x 10(12) VP was injected intratumorally once a week for 8 weeks and radiotherapy was begun since the 3rd day of gene therapy 5 fractions a week with the with the fraction dosage of 2 Gy and total dosage of 70 GY) and radiotherapy group (RT group. n = 22, the above regimen of radiotherapy was conducted). CT was conducted 5 weeks and 8 weeks after the beginning of treatment and 2 months after the finish of treatment (validation point) to calculate the size of tumor. Patients were monitored for adverse event and serum level of anti-adenoviral antibody. A comparative study was also performed on the immediate response rate by CT at the times when the dosages of 40 Gy and 70 Gy had been given.RESULTS:The average tumor reduction rates were (63 +/- 17)%, (82 +/- 18)%, and (90 +/- 16)% at the 40 Gy time point, 70 Gy time point, and validation point respectively in the GTRT group, all higher than those in the RT group (37 +/- 26)%, (62 +/- 39)%, and (70 +/- 34)% respectively, all P < 0.05. Random control study showed that the radio-sensitized enhancement rate was 1.72 at 40 Gy time point and the CR rate of the GRTR group at the validation point was 1.68 times higher than that of the RT group. Self-controlled study showed that the SBN-1 radio-sensitized enhancement ratio in the 4 GTRT group was 1.69 at 40 Gy time point and the CR rate of the GTRT group at validation point was 253% that of the RT group (P < 0.01). No dose-limiting toxicity and adverse events were noted, except transient fever after SBN-1 administration.CONCLUSION:A potentially effective gene therapeutic agent for HNSCC treatment, intratumoral injection of SBN-1 is safe.

目的评价射频加温治疗深部或表浅巨大肿瘤的临床效果.方法自1999年11月～2001年9月,应用加温合并放射治疗深部或表浅巨大肿瘤54例,其中男性37例,女性17例;年龄26～84岁,中位年龄60岁.肿瘤最大直径<5 cm 18例,5～10 cm 26例,10 cm以上10例.热疗用SR-1000型射频热疗机,频率41 MHz,治疗功率600～900 W,反射功率10～40 W,每周1～2次,每次加温60～90 min,在放射治疗后60 min内进行,加温治疗3～14次,平均加温治疗6次.常规放疗每周5次,每次2 Gy,总剂量36～75 Gy,中位剂量60 Gy.结果全部病例随访3个月以上,可评价病例的总有效率(CR+PR)为74%,CR 16%,PR 58%.表浅肿瘤7例,CR 3例,PR 4例,疗效优于深部肿瘤.并发症:脂肪硬结5例.结论影响疗效的关键是放疗剂量,对深部肿瘤的疗效评价应引入新的标准.

Objective To study the clinical effect of the moderate and severecancer pain by using bufferin plus.Methods Two tablets of bufferin plus were given at one dose.The pain of the patients who had used drugs had been studied continuously 4 to 8 hours.Results The total pain relief rate is 62.22%,including 70.59% with moderate pain and 57.14% with severe pain.Furthermore,there is no significant difference between moderate and severe pain;The onset of therapeutic effect occurs approximately 0.5～1hour.It needs about 1.5 hours to get pain relief and maintenance time is nearly 3.5hours;In terms of the maintenance time,moderate pain's is obvious longer than severe pain's.Conclusion Besause of combining caffeine,buferin plus is better than usual non-steroidal anti-inflammatory drugs (NSAIDS)on analgesic therapeutic effectiveness.This study proved the rule of WHO analgesic step ladder is right.

患者男,61岁.因前列腺癌行睾丸切除术后用快中子、光子放射治疗,8个月后骶会阴、双腹股沟及下腹部放疗照射野形成多个深在溃疡,以中西医治疗无效,创面继续溃烂加深.