Background The application of guidance template in interstitial brachytherapy (ISBT) was expected to improve target coverage and sparing organs at risk for locally advanced cervical cancer (LACC). The purpose of this study was to compare dosimetric and procedural outcomes of template-guided ISBT against free-handed ISBT. Methods Consecutive patients with LACC were prospectively enrolled at Sichuan Cancer Hospital from February to September 2025. A novel 3D-printed free-assembled interstitial template (FAIT), featuring a tandem with optimized non-coplanar needle channels, was invented and utilized for ISBT. Each patient underwent both FAIT-guided and free-handed high-dose-rate ISBT within 3 days with a random sequence. Treatment plans were generated in the Oncentra planning system with a 600 cGy prescription, and dosimetric parameters including high-risk clinical target volume (HRCTV) D 90 , dose of organs at risk (OARs) (D 1cc and D 2cc for bladder, rectum, sigmoid and bowel) were extracted. The number of interstitial needles and implantation time were also recorded. Data were presented as mean ± standard deviation and compared using paired Student’s t -tests. Statistical significance was defined as P < 0.05. Results 55 patients received both FAIT-guided and free-handed ISBT procedures after pelvic external beam radiotherapy (EBRT) of 45-50.4 Gy with 25–28 fractions. Most patients were stage ⅡB (n = 34, 61.8%) and squamous cell carcinoma (n = 49, 89.1%), and mean post-EBRT HRCTV volume was 61.8 ± 21.3 cm 3 . There was no significant difference on the number of needles used in FAIT-guided and free-handed ISBTs (4.88 ± 0.90 vs. 4.76 ± 1.24, P = 0.30). FAIT guidance shortened implantation time (5.83 ± 1.93 vs 8.03 ± 2.71 min, P < 0.0001) and achieved higher HRCTV D90 (611.38 ± 35.12 vs 580.86 ± 64.65 cGy, P < 0.01), with similar OAR doses (P > 0.05). Conclusions Improved target volume dose coverage and shortened needle implantation time were achieved with the application of the novel 3D-printed FAIT in ISBT. This novel template had high clinical utility and was worthy of further promotion and application.

12125 Background: To explore the early intervention timing of recombinant human thrombopoietin (rhTPO) for cancer treatment-induced thrombocytopenia (CTIT) in cervical squamous cell carcinoma (CSCC) patients during concurrent chemoradiotherapy. Methods: Patients with stage I-IVa CSCC who developed CTIT during radical concurrent chemoradiotherapy were prospectively enrolled in our study. rhTPO intervention was used at the first presentation of G1 or G2 CTIT during concurrent chemotherapy respectively. The key indexes, including nadir platelet count, platelet recovery time, platelet transfusion and incidence of G3-5 CTIT were recorded in two groups. χ² test was used for the effective analysis, and univariate and multivariate analyses logistic regression analysis was used to predict the potential factors for the G3-5 CTIT. Results: From February 2021 to June 2024, 204 CSCC patients who developed CTIT during radical chemoradiotherapy at Sichuan Cancer Hospital were prospectively enrolled. 75 patients who occurred G1 and G2 CTIT at the first presentation during concurrent chemoradiotherapy received rhTPO intervention. They were included in the intent-to-treat (ITT) population analysis. According to the timing of the rhTPO intervention, the patients were divided into G1 group (100×10 9 /L>PLT>75×10 9 /L) and G2 group (75×10 9 /L>PLT>50×10 9 /L). For effective analysis, the nadir platelet count in G1 group was greater than that in G2 group (67 × 10 9 /L vs. 54 × 10 9 /L, p = 0.000), and the platelet recovery time in G1 group was shorter than that in G2 group (8 days vs. 14 days, p = 0.003). Moreover, patients in G1 group had a significantly lower incidence of G3-5 CTIT than that in G2 group (14.3% vs. 35%, p = 0.04). In two groups, only 1 patient in G2 group received 4 apheresis platelet units transfusion. Univariate and multivariate analysis showed the early intervention of the rhTPO was a substantial factor for decreasing the incidence of G3-5 CTIT. The sensitivity was 0.67 and the specificity was 0.74. Conclusions: For CSCC patients received with radical concurrent chemoradiotherapy, the early intervention of rhTPO was a substantial factor for decreasing the incidence of G3-5 CTIT. It could significantly improve the nadir platelet count, shorten the platelet recovery time, and reduce the incidence of G3-5 CTIT, thereby ensuring the uninterrupted continuation of treatment. Platelet recovery time and the degree of CTIT. Data Baseline platelet count(×10 9 /L) Days with platelet count recover ≥100×10 9 (Days) Minimal mean platelet count（×10 9 /L） Incidence of G3-5 CTIT(%) G1 group 172±64.92 8±5.86 67±15.81 14.3 G2 group 166±78.43 14±9.59 54±14.37 35 P value 0.76 0.003* 0.000* 0.04* *Statistically significant.

The administration of second-line or subsequent immune checkpoint inhibitors (ICIs) in previously treated patients with advanced solid cancers has been clinically investigated. However, previous clinical trials lacked an appropriate primary endpoint for efficacy assessment. This systematic review aimed to explore the most optimal early efficacy endpoint for such trials. Phase 2 or 3 clinical trials involving patients with advanced solid cancers with disease progression following standard first-line therapy receiving second-line or subsequent ICI administration, with adequate survival outcome data, were included from PubMed, Embase, Web of Science, and Cochrane Library databases before February 2023. Quality assessment was conducted using the Cochrane tool and Newcastle–Ottawa Quality Assessment Scale for Cohort Studies for randomized controlled trials (RCTs) and non-randomized trials, respectively. Objective response rate (ORR) and progression-free survival (PFS) at 3, 6, and 9 months were investigated as potential early efficacy endpoint candidates for 12-month overall survival (OS), with a strong correlation defined as Pearson’s correlation coefficient r ≥ 0.8. A total of 64 RCTs comprising 22,725 patients and 106 non-randomized prospective trials involving 10,608 participants were eligible for modeling and external validation, respectively. RCTs examined 15 different cancer types, predominantly non-small-cell lung cancer (NSCLC) (17, 28

PURPOSE:The purpose of this study was to evaluate the efficacy of recombinant human superoxide dismutase (rhSOD) enemas in radiation-induced acute rectal injury (RARI) in patients with locally advanced cervical cancer. METHODS AND MATERIALS:In this phase 3, randomized, open-label trial (NCT04819685) conducted across 14 medical centers in China from June 2021 to August 2023, all patients received concurrent chemoradiation therapy (CCRT). The experimental group was treated with a rhSOD enema during chemoradiation therapy, and the control group had no enema. The Common Terminology Criteria for Adverse Events (version 5.0) was used to evaluate radiation therapy-induced side effects. Endoscopic appearance was assessed using the Vienna Rectoscopy Score. The primary endpoint in the acute phase was the occurrence rate and duration of grade ≥1 (≥G1) diarrhea during CCRT. Secondary endpoints included the occurrence rate and duration of ≥G2 and ≥G3 diarrhea, ≥G1 and ≥G2 diarrhea lasting at least 3 days, and damage to the rectal mucosa due to radiation therapy measured by endoscopy. RESULTS:Two hundred and eighty-three patients were randomly divided into the experimental (n = 141) or control group (n = 142). The mean number of ≥G1 and ≥G2 diarrhea days were significantly lower in the experimental group than in the control group (3.5 and 0.8 days vs 14.8 and 4.5 days, respectively; P < .001). The incidence of ≥G2 diarrhea decreased from 53.6% to 24.1% when rhSOD enemas were used. Use of antidiarrheals was lower in the experimental group (36.2% vs 55.7%, P < .001). Three patients felt intolerable or abdominal pain after rhSOD enema. RARI grades in the experimental group tended to be lower than those in the control group (P = .061). Logistic regression analysis revealed that rhSOD enema was associated with a lower occurrence rate of ≥G1/2 diarrhea for at least 3 days (P < .001). CONCLUSIONS:The results of this study suggest that rhSOD enema is safe and significantly reduces the incidence, severity, and duration of RARI, protecting the rectal mucosa.

Objective To investigate the clinical outcomes and toxicity in patients with locally advanced cervical cancer treated with supplementary applicator guided-intensity modulated radiation therapy (IMRT) based on conventional intracavitary brachytherapy (IC/IMRT). Population Large high risk clinical target volume (HR-CTV) volume (>40cc) at the time of brachytherapy cervical cancer patients were recruited. Methods This study is a retrospective analysis of 76 patients with locally advanced cervical cancer (FIGO IIB-IVA) treated with concurrent chemo-radiotherapy followed by IC/IMRT between June 2010 and October 2016. External radiotherapy (45 Gy in 25 fractions) with cisplatin chemotherapy treated before IC/IMRT. The prescription dose for HR-CTV and IR-CTV were 6 Gy and 5 Gy per fraction for 5 fractions respectively. Results: Mean HR-CTV was 65.8±23.6 cc at the time of brachytherapy. D90 for HR-CTV and IR-CTV were 88.7±3.6 Gy and 78.1±2.5 Gy. D2cc for bladder, rectum, sigmoid and small intestine were 71.8±3.8 Gy, 64.6±4.9 Gy, 63.9±5.3 Gy and 56.7±8.7 Gy respectively. Median follow-up was 85 months (47.9-124.2 months). Five-year local recurrence free survival rate, metastasis recurrence free survival rate, disease free survival rate and cancer special survival rate were 87.6%, 82.4%, 70.9% and 76.3%, respectively. The grade 1+2 gastrointestinal and urinary late toxicities were 15.8% and 21.1%, while grade 3 late toxicities were 3.9% and 5.2%, respectively. Neither acute nor late grade 4 gastrointestinal or urinary toxicities were seen. Conclusions: The combination of ICBT with an applicator-guided supplementary IMRT boost achieved an excellent local control and overall survival with low toxicity for bulky residual cervical tumor

e13601 Background: The drug approval and clinical use of immune checkpoint inhibitors (ICIs) were different among de novo and previously treated cancer patients. The purpose of this study is to investigate progression-free survival (PFS) and objective response rate (ORR) as earlier primary endpoints in previously treated advanced or metastatic solid cancers in immunotherapy era. Methods: This systematic review included phase 2 and 3 clinical trials in previously treated advanced or metastatic solid cancers receiving ICIs, through literature search on databases up to 2022. Quality control was performed, where studies with high risk of bias were excluded. Prediction models were first established using randomized controlled trials (RCTs), and then externally validated in the phase 2 non-randomized trials. Trial-level surrogacy analysis was conducted by correlating PFS hazard ratio (HR) and overall survival (OS) HR. Correlation analysis within checkpoint inhibitor arms was performed between ORR, 3-, 6-, and 9-month PFS rates and 12-month OS rate. The correlation was evaluated using the Pearson correlation coefficient r in weighted linear regression, with weight equal to patient size. High, medium strength, and low correlation was defined as r ≥ 0.85, 0.7 < r < 0.85, and r ≤ 0.7, respectively. Sensitivity analyses were performed to assess the consistency of predictive model by leaving trials of one cancer type out at a time. Results: A total of 64 phase 2 or 3 RCTs with 22,011 patients and 96 phase 2 non-randomized trials with 10,288 patients were included in modeling and validation, respectively. The most common primary endpoint in RCTs and non-randomized trials was OS (38 [59%]) and ORR (72 [75%]). The mostly used endpoint assessment criteria were RECIST v1.1 in both RCTs (59 [92%]) and non-randomized trials (88 [92%]). In trial-level surrogacy, PFS HR showed a low correlation with OS HR ( r, 0.52; 95% confidence interval [CI], 0.23–0.78). Within the checkpoint inhibitor treatment arms in RCTs, there was a high correlation between 6-month PFS and 12-month OS ( r, 0.85; 95% CI, 0.76–0.90), and 9-month PFS and 12-month OS ( r, 0.85; 95% CI,0.80–0.90), with a medium strength correlation between 3-month PFS and 12-month OS ( r, 0.79; 95% CI, 0.65–0.89) and a low correlation between ORR and 12-month OS ( r, 0.13; 95% CI, 0.10–0.76). In external validation, when 6-month PFS was used to predict 12-month OS, there was a good calibration between actual and predicted 12-month OS. Sensitivity analysis demonstrated reasonable overall consistency. Conclusions: For phase 2 non-randomized, observational checkpoint inhibitor trials enrolling previously treated advanced or metastatic solid cancers, we recommended 6-month PFS rate as primary surrogate endpoint. For RCTs, gold standard endpoint OS should be persistently used and should not be replaced by earlier endpoints PFS or ORR.

Neoadjuvant chemoradiotherapy (NCRT) plus radical esophagectomy is currently the standard treatment for resectable esophageal or gastroesophageal junction (GEJ) carcinoma. The aim of this study is to evaluate the efficacy and safety of neoadjuvant immunotherapy in resectable esophageal or GEJ carcinoma. Prospective clinical trials investigating efficacy and/or safety of neoadjuvant immunotherapy with immune checkpoint inhibitors (ICIs) followed by radical esophagectomy in patients with newly diagnosed resectable esophageal or GEJ carcinoma were identified through literature search. Quality assessment was performed by using the Newcastle–Ottawa scale. Preliminary treatment outcomes of pathologically complete response (pCR, ypT0N0) and grade 3-4 adverse effects (AEs) were pooled together and then compared with standard NCRT of the historical control CROSS study by Chi-square (χ2) test. A two-sided P value < 0.05 was considered statistically significant. A total of 17 eligible non-randomized trials with 455 participants were included into analysis. The most common primary endpoint was pCR (n = 7, 41%), and the median sample size and follow-up period was 23 patients and 7.9 months, respectively. For patients receiving neoadjuvant immunotherapy, the overall pCR, R0 resection, and grade 3-4 AE rates were 33.2%, 95.5%, and 35.1%, respectively. For esophageal squamous cell carcinoma (ESCC) and adenocarcinoma (EAC), neoadjuvant immunochemoradiotherapy showed no significant improvement in pCR rate than NCRT (ESCC, 50% vs 48.7%, P = 0.9; EAC, 32.6% vs 23.1%, P = 0.22). Grade 3-4 AEs were the most common in patients with neoadjuvant immunochemoradiotherapy, significantly higher than immunochemotherapy (46.7% vs 32.8%, P = 0.04) and NCRT (46.7% vs 18.1%, P < 0.0001). In conclusion, for patients with resectable esophageal or GEJ carcinoma, the addition of ICIs to standard NCRT could not improve pCR rate in both ESCC and EAC, but significantly increased the risk of severe AEs. Large-scale phase 3 randomized trials were urgently needed to further confirm the survival benefit and safety profile of neoadjuvant immunotherapy.

We read the report of Chow et al. entitled “Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy and esophagectomy for the treatment of esophageal and gastroesophageal carcinoma – A systematic review and meta-analysis [1]’’ with great interest. In this manuscript, a meta-analysis comparing definitive chemoradiotherapy with neoadjuvant chemoradiotherapy followed by surgery for esophageal and gastroesophageal carcinoma was performed using literature-based evidence. With comprehensive quality assessment, seven observational studies and one randomized controlled trial (RCT) were included in the statistical analysis.

Background and purpose: The aim of this study is to develop a prognostic nomogram, quantify survival benefit, and guide risk-dependent adjuvant therapy for locally advanced esophageal squamous cell carcinoma (LA-ESCC) after esophagectomy. Materials and methods: This was a single-center, retrospective study of consecutive LA-ESCCs treated by curative-intent esophagectomy with internal validation and independent external validation in a randomized controlled trial. After factor selection by the least absolute shrinkage and selection operator regression, a nomogram was developed to estimate 5-year overall survival (OS) based on the Cox proportional hazards model. The area under the curve (AUC) and calibration plot were used to determine its discriminative and predictive capacities, respectively. Survival improvement from adjuvant therapy was quantified and plotted corresponding to nomogram score. Results: A total of 1077, 718, and 118 patients were included for model development, internal validation, and external validation, respectively. The nomogram identified eight significant prognostic factors: gender, pathological T and N stages, differentiation, surgical margin, lymphovascular invasion, number of lymph node resection, and adjuvant therapy. The nomogram showed superior discriminative capacity than TNM stage (AUC: 0.76 vs. 0.72, p < 0.01), with significant survival differences among different risk stratifications. The calibration plot illustrated a good agreement between nomogram-predicated and actual 5-year OS. Consistent results were concluded after external validation. At least 10% 5-year OS improvement from adjuvant chemoradiotherapy and chemotherapy was expected in almost all patients (nomogram score 110 to 260) and patients mainly with high-intermediate risk (nomogram score 159 to 207), respectively. Conclusions: The clinicopathological nomogram predicting 5-year OS for LA-ESCC after esophagectomy was developed with high accuracy. The proposed nomogram showed better performance than TNM stage and provided risk-dependent and individualized adjuvant treatment recommendations.

目的:研究宫颈癌图像引导调强放射治疗(image guided radiation therapy,IGRT)同步剂量补偿腔内后装治疗(intracavitary brachytherapy,ICBT)中膀胱、直肠、高危临床靶区(high risk clinical target volume,HRCTV)和中危临床靶区(intermediate risk clinical target volume,IRCTV)体积对器官受照剂量的影响.方法:回顾性分析64例根治性宫颈癌患者数据,每位患者至少接受了2次IGRT+ICBT,处方剂量HRCTV D90％=600 cGy,IRCTV D90％=500 cGy,分别按照膀胱、直肠、HRCTV、IRCTV的体积将患者数据分为高、低两组,统计这两组数据的靶区Dmin、D90％,危及器官的热点剂量(D0.1cm3、D1cm3和D2cm2)和D50％,采用统计学软件分析器官体积对剂量分布的影响.结果:靶区的Dmin和D90％均不受膀胱、直肠体积的影响.增加膀胱体积会明显地增加膀胱的热点剂量,但是未明显降低膀胱D50％.膀胱体积的改变不影响直肠的受照剂量.小肠的受照剂量随着膀胱体积的增加而减小.高体积组直肠的热点剂量明显高于低体积组(P<0.001),不过两组之间直肠D50％的改变不明显.增加靶区的体积并不会明显降低靶区的最小剂量Dmin,随着靶区体积的增加,膀胱、直肠的D50％都有显著增加.结论:宫颈癌IGRT+ICBT治疗中膀胱体积增大会增加膀胱的热点剂量,但可以降低小肠的热点剂量,建议根据不同患者保护不同器官的需要,选择合适的膀胱充盈程度.直肠应始终处于排空状态,以减小直肠所受的照射剂量.

Background PD-1 inhibitor have demonstrated significant efficacy in the treatment of recurrent or refractory gynecologic cancer. However, the clinical data among Chinese patients is still limited. In this study, the efficacy and safety of toripalimab in the treatment of recurrent or refractory gynecologic cancer was evaluated. Methods A retrospective analysis of patients with recurrent or refractory gynecologic cancer who were treated with toripalimab in Sichuan Cancer Hospital from September 2019 to December 2020 was performed. The treatment regimens included toripalimab monotherapy or toripalimab in combination with other therapies (eg, radiotherapy, chemotherapy, targeted therapy). Statistical analysis of the objective response rate(ORR), progression-free survival(PFS), and toxicity after the treatment was carried out. Results In total 18 recurrent or refractory gynecologic cancer patients who received toripalimab were reviewed in this study, including 12 patients with cervical cancer, 3 patients with vulvar cancer, 2 patients with uterine tumor, and 1 patient with pelvic wall squamous cell carcinoma. The patients previously received ≤1 line of treatment for advanced or recurrent cancer. The median follow-up period was 8 months [3.17–19.27 months]. The overall ORR was 33.3% (6/18), DCR was 77.8% (14/18), and median PFS was 8 months [95% CI: 6.53-NA].For patients who received toripalimab as monotherapy, the ORR was 22.2% (2/9), DCR was 66.7% (6/9), and median PFS was 11.8 months (95% CI: 6.53-NA). For patients treated with toripalimab combination therapy, the ORR was 44.4% (4/9), DCR was 88.9% (8/9), and median PFS was 8 months (95% CI: 6.23-NA). Select treatment related AEs (TRAEs) of any grade were observed in 46.7% (7/18) patients. Grade 3 hepatotoxicity was recorded in 1 case. There was no treatment-related deaths. Conclusions Toripalimab as monotherapy or Toripalimab combining with traditional anti-cancer therapy shows promising efficacy and acceptable toxicity in Chinese recurrent or refractory gynecologic cancer

Abstract Systemic inflammatory response markers are associated with poor survival in many types of malignances. This study aimed to evaluate the prognostic value of preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and C-reactive protein (CRP) in patients with non-small cell lung cancer (NSCLC). We retrospectively evaluated 254 NSCLC patients who underwent radical surgery between January 2012 and April 2014 in the Sichuan Provincial Cancer Hospital. The cut-off values of NLR, PLR, LMR, and CRP were determined according to the receiver operating characteristic curve, and the correlation of NLR, PLR, LMR, and CRP with prognosis was analyzed based on the cut-off value. The cut-off value for NLR, PLR, LMR, and CRP were 3.18, 122, 4.04, and 8.8, respectively. Univariate analysis showed that age (P = .022), tumor-node-metastasis (TNM) stage (P < .001), T stage (P = .001), and N stage (P < .001) were significantly correlated with disease-free survival (DFS), while age (P = .011), TNM stage (P < .001), T stage (P = .008), N stage (P < .001), and PLR (P = .001) were significantly correlated with overall survival (OS). In multivariate analysis, age (hazard ratio [HR]: 1.564, 95% confidence interval [CI]: 1.087–2.252, P = .016) and TNM stage (HR: 1.704, 95% CI: 1.061–2.735, P = .027) remained independent risk factors affecting DFS, while age (HR: 1.721, 95% CI: 1.153–2.567, P = .008), TNM stage (HR: 2.198, 95% CI: 1.263–3.824, P = .005), and PLR (HR: 1.850, 95% CI: 1.246–2.746, P = .002) were independent risk factors affecting OS. The preoperative PLR is superior to NLR, LMR, and CRP as a biomarker for evaluating the prognosis of patients undergoing curative surgery for NSCLC.

目的 探讨宫颈癌中免疫细胞的浸润模式及预后价值.方法 对肿瘤与癌症基因组图谱(TCGA)309例宫颈癌肿瘤样本的基因表达谱进行分析,通过CIBERSORT计算22种免疫细胞类型的比例.Cox回归模型分析浸润免疫细胞及免疫检查点分子基因表达与预后的关系.结果 宫颈癌肿瘤组织中巨噬细胞、γδT细胞、活化的CD4+记忆性T细胞、滤泡辅助性T细胞、浆细胞,未活化的肥大细胞比较丰富.高水平CD8+T细胞,活化的CD4+记忆性T细胞及未活化的肥大细胞与较高总生存率相关(P＜0.05),而高水平未活化的CD4+记忆性T细胞及活化的肥大细胞与较低总生存率相关(P＜0.05).活化的CD4+记忆性T细胞及活化的肥大细胞为宫颈癌患者生存的独立预后因素(P＜0.05).免疫检查点分子基因表达(CD274,PDCD1,CTLA4,ICOS)与CD4+记忆性T细胞浸润水平呈正相关(P＜0.05),与活化的肥大细胞浸润水平呈负相关(P＜0.05).ICOS是宫颈癌患者生存的独立预后因素基因表达.结论 肿瘤浸润免疫细胞在宫颈癌患者预后中具有重要作用,同时也为宫颈癌免疫治疗揭示了潜在的生物标志物和靶点.

Objective: To evaluate the value of preoperative neutrophil to lymphocyte ratio (NLR) and platelet to lym-phocyte ratio (PLR) in predicting the prognosis of patients with non-small cell lung cancer. Methods: The clinicopathologic data of 280 NSCLC patients undergoing radical surgery from January 2012 to April 2014 in Sichuan Cancer Hospital were ret-rospectively analyzed according to the receiver operating characteristic curve (ROC). The critical values of NLR and PLR were determined. The correlation between NLR and the prognosis of patients and that between PLR and the prognosis of pa-tients was analyzed, respectively. Results:NLR=3. 25 and PLR=122 were selected as the critical values. Univariate analy- sis showed that TNM staging, T staging, and N staging were related to disease-free survival (DFS), and the P values were 0. 001, 0. 007, and less than 0. 001; age, TNM staging, T staging, N staging, and PLR were associated with overall sur-vival ( OS), P values were 0. 006, < 0. 001, 0. 035, <0. 001, <0. 001, respectively. Multivariate analysis showed that TNM staging ( HR: 1. 627, 95% CI: 1. 030~2. 568, P=0. 037) was an independent risk factor affecting DFS. Age (HR: 1. 785, 95% CI: 1. 216~2. 622, P=0. 003), TNM stage (HR: 2. 094, 95% CI: 1. 231~3. 560, P=0. 006) and PLR (HR: 1. 833, 95% CI: 1. 257~2. 674, P=0. 002) were independent risk factor affecting OS. Conclusion: PLR may be used as an indicator to evaluate the prognosis of patients undergoing radical surgery for NSCLC.

Objectives To investigate the protective effect and mechanism of a gonadotropin-releasing hormone antagonist(GnRH-ant) against an ovarian function injury induced by pelvic radiotherapy in a rat model.Method 1.Ten female Wistar rats were randomly assigned to gonadotropin-releasing hormone agonist(GnRH-a) and GnRH-ant groups using the random number table method.The rats were subcutaneously injected with goserelin (0.25 mg once)or cetrorelix (5 μg/day for 10 days).Changes in luteinizing hormone(LH) and estradiol(E2) in each group were dynamically observed.2.Forty female Wistar rats were randomly divided into four groups(control,GnRH-ant,R,and GnRH-ant +R) and then given corresponding treatments.Ovarian wet weight,levels of serum LH,E2,and AMH,and the number of follicles at every stage were compaed between groups through analysis of variance and independent sample t-test.Results 1.In the GnRH-a group,LH and E2 levels increased initially and then gradually decreased,reaching a low value in approximately 10 d.In the GnRH-ant group,LH and E2 levels decreased rapidly,reaching the minimum value in 4 d without flare-up effect.2.After pelvic radiotherapy,the ovarian wet weight in the GnRH-ant+R group was significantly higher[(58.3±9.1) mg vs.(37.8±7.1) mg,t=5.61,P=0.000]than that in group R.In the GnRH-ant+R group,the levels of E2[(57.49±13.45) pg/mL vs.(16.64±6.54) pg/mL,t=8.64,P=0.000] and AMH[(5.47±1.32) mIU/mL vs.(2.23±0.72) mIU/mL,t=6.81,P=0.000] were significantly higher than those in group R.The FSH level in GnRH-ant+R group was significantly lower[(27.74±7.75) mIU/mLvs.(8.35 ±1.43) mIU/mL,t=7.75,P=0.000] than that in group R.The number of primordial and primary follicles in group GnRH-ant+R was significantly higher(46.2±12.3 vs.27.6±5.1,t=4.42,P=0.000) than that in group R.Conclusions GnRH-ant can rapidly induce ovarian inhibition without flare-up effect.Subcutaneous injection of GnRH-ant before pelvic radiotherapy can inhibit the ovary and stop the follicles in the primary and primordial follicle stages,thus reducing the damage induced by radiotherapy.

目的 本文旨在自主研发一套可以完成临床靶区勾画功能的系统,满足放疗临床的基本需求.方法 本系统以Visual C++作为开发平台,全面支持DICOM标准文件的操作.结果 系统能够完成多时序CT间或CT与MRI图像之间的配准、临床靶区与危及器官的勾画等基本功能.结论 该系统操作简单,运行稳定,作为自主开发的系统,提供开展图像数据相关研究工作的接口,未来可添加更多的临床实用功能.

目的:运用iQC模体对IVS(LinaTech)、iViewGT(Elekta)和aS1000(Varian)三种型号的新类型电子射野影像装置(EPID)系统影像质量进行定量分析.方法:采用EPID影像质量的图像畸变、空间分辨率和低对比度3个质量控制指标,对医院加速器进行月检.运用iQC(LinaTech)检测模体对医院Synergy(Elekta)、Unique(Varian)和600CD(Varian)加载IVS等3台加速器的EPID系统进行影像质量测试,收集15次的测试数据进行统计分析,定量分析不同类型EPID成像质量的差异.结果:三种类型的EPID图像质量均能满足临床需求,获取的EPID图像在图像畸变和低对比度两项检测指标上无统计学差异;IVS在空间分辨率上明显优于iViewGT和aS1000,差异有统计学意义.结论:IVS作为新类型EPID系统可以满足临床影像质量要求,与iViewGT和aS1000相比较,在空间分辨率上具有明显优势.

Objective To compare the dosimetric parameters between the use of Tandem and Ring (TR;Nucletron#090.617) or Tandem and Ovoid (TO;Nucletron#189.730) applicators during three-dimensional (3D) high-dose rate (HDR) brachytherapy (BT) for cervical cancer.Methods The records of 40 cervical cancer (ⅡB-ⅣA) patients treated with 3D-image-guided HDR-BT were reviewed.Of these 40 patients, 20 were treated with the TO applicator, and 20 with the TR applicator.The D100% and V150% of the clinical target volume (CTV) and the D2 cc of organs at risk (OAR)(the rectum, bladder, and small intestine) during 3D-HDR-BT using TO and TR were compared using the independent sample t-test.ResultsOverall metrics:CTV volume:66.04±13.86 cm3(TR) vs.65.67±15.08 cm3(TO)(P=0.052);CTV D100:3.71±0.34 Gy (TR) vs.3.37±0.49 Gy (TO)(P=0.016);CTV V150%:0.54±0.02(TR) vs.0.56±0.04(TO)(P=0.034);rectum D2 cc:3.38±0.30 Gy (TR) vs.2.95±0.80 Gy (TO)P=0.037);bladder D2 cc:4.33±0.39 Gy (TR) vs.2.93±1.27 Gy (TO)(P=0.00);and small ntestine D2 cc:3.04±1.02 Gy (TR) vs.3.41±0.57 Gy (TO)(P=0.171).Conclusions TR has better CTV coverage than TO during 3D HDR brachytherapy for cervical cancer.In addition, D2 cc of the rectum and bladder were both igher with TR than with TO, though there is no significant dosimetric difference in the small intestine between the two applicators.Therefore, tumor location, extent of invasion, and vaginal conditions should be considered when selecting the suitable pplicator for the treatment of cervical cancer.

Objective To investigate the protective effect of gonadotropin-releasing hormone agonist (GnRHa) on ovarian function in rats during pelvic irradiation and its possible mechanism.Methods 1.Five female Fischer-344 rats were subcutaneously injected with 0.25 mg of GnRHa.Changes in serum follicle-stimulating hormone(FSH),estradiol(E2),and anti-mullerian hormone(AMH) levels were observed continually.2.Forty female rats were randomly divided into four groups(Control,GnRHa,R,and GnRHa+ R) and given their corresponding treatments.At 20 days after pelvic irradiation,the weight;ovarian wet weight;serum FSH,E2,and AMH levels;and follicular numbers of the four groups were compared using one-way ANOVA and independent-sample t-test.The apoptotic index and microvessel density(MVD) in the ovarian tissue of each group were also compared.Results 1.Treatment with GnRHa inhibited ovarian function.Under this treatment,serum FSH and E2 declined,reached the minimum values in approximately 15 days,and then normalized in approximately 20 days.2.After pelvic radiotherapy,the GnRHa+R and R groups showed different degrees of ovarian function damage compared with the control group,but the damage to the GnRHa+R group was less severe compared with that to the other groups.The GnRHa+R group showed higher E2(t =12.79,P ＜ 0.01),lower FSH(t =4.65,P ＜ 0.01),and relatively higher AMH (t =5.65,P＜ 0.01) compared with the R group.Follicular classification revealed significantly more primordial and primary follicles in the GnRHa+R group than in the R group(t=7.70,P＜0.01).Tunnel and CD31 staining showed that the apoptotie index and MVD were significantly higher in the R group than in the GnRHa+R group(t =8.20 and 9.83,both P ＜ 0.05).Conclusions Administration of GnRHa before radiotherapy can significantly decrease radiation damage to ovarian function in rats.GnRHa exerts its protective effect against ovarian functional impairment by inhibiting follicular development in primordial and primary follicles.It decreases the blood supply and oxygen of ovarian tissue,thereby reducing the radiation sensitivity of the ovary.

Objective To compare the differences and characteristics of the dose distribution of the two optimization methods in the three dimensional brachytherapy,and provide the basis for clinieal treatment.Methods Excel 2007 was used to generate random number.And a total of 21 patients of cervical cancer were selected from those who have completed the treatment.Inverse simulated annealing optimization (IPSA) plans were designed for graphical optimization (GO) plans.The dose volume histogram (DVH) parameters of the targets (V100％,V150％) and the organs (D1 cm3,D2cm3) of the two methods were analyzed.Results The targets dose of both plans could meet the prescription requirements.There was no statistically significant difference in the dose parameters of all targets (P ＞ 0.05).The closes of D1 cm3 and D2cm3 in the bladder of IPSA plan were significantly lower than that of the GO plan (t =3.596,3.490,P ＜ 0.05).There was no statistically significant difference in the dose parameters of rectum (P ＞ 0.05).Conclusions For cervix brachytherapy,the GO and IPSA have no effect on targets dose,but IPSA optimization can reduce the maximum dose of bladder.