Objective To evaluate the effectiveness and safety of intraluminal brachytherapy (ILBT) in prolonging survival and the period free of symptoms for patients with unresectable bile duct cancer. Methods We searched MEDLINE (1977 to May 2007), CNKI (1979 to May 2007) and CBM Disk (1979 to May 2007). The qual ity of included studies was assessed according to the guidance in the Cochrane Handbook for Systematic Reviews of Interventions. Results One randomized controlled trial involving 42 patients with unresectable bile duct cancer fulfilled the inclusion criteria. This found that the median survival time was longer for patients treated with endoprostheses and ILBT compared to those treated with endoprostheses alone (387.9 days versus 298.0 days, Plt;0.05). The stent patency time in patients who were treated with endoprostheses and ILBT was longer than for those treated with endoprostheses alone (378.4 days versus 245.5 days, Plt;0.01). The reductions in bil irubin (mol/l) and alkal ine phosphatase (kat/l) before and after drainage in patients who were treated with endoprostheses and ILBT were similar to those treated with endoprostheses alone (Mean ±SD of bil irubin: before: 219.3 ± 40.5, after: 23.1 ± 37.1 versus before: 227.3 ± 39.8, after: 22.5 ± 44.2; Mean ± SD of alkal ine phosphatase: before: 10.3 ± 5.1. after: 3.6 ± 2.9 versus before: 11.7 ± 5.8, after: 3.7 ± 2.9). No severe adverse effects were observed in the trial. Conclusion Current evidence suggests that ILBT for unresectable bile duct cancer may improve the survival time of patients, prolong the time they spend symptom free, improve their quality of l ife and reduce the burden of treatment. However, it may increase toxicity in normal tissues, which can be managed by adjusting radiation dosage. No serious adverse effects were observed in the 42 patients in the trial in this review. More randomized controlled trials with large sample size are needed to provide rel iable results.
ObjectiveTo evaluate the clinical efficacy, safety, and survival outcomes of CT-guided iodine-125 seed implantation in patients with stage Ⅲ–Ⅳ pancreatic cancer, and to analyze the relevant factors influencing prognosis. MethodsClinical data of patients with stage Ⅲ–Ⅳ pancreatic cancer who underwent CT-guided iodine-125 seed implantation and had complete follow-up records at the First Affiliated Hospital of Army Medical University from June 2013 to February 2023 were retrospectively collected. Post-treatment efficacy, the Karnofsky performance status (KPS) score and numeric rating scale (NRS) score for pain at one month post-procedure, and postoperative complications were analyzed. The overall survival (OS) was also analyzed. Univariate and multivariate Cox proportional hazards regression models were employed to identify risk factors influencing OS. ResultsA total of 44 eligible patients with stage Ⅲ–Ⅳ pancreatic cancer were included in this study. According to the response evaluation criteria in solid tumors 1.1 criteria, the objective response rate was 61.4% (27/44) and the disease control rate was 95.5% (42/44). At one month postoperatively, the KPS score significantly improved from a preoperative value of (78.18±5.40) points to (86.82±5.18) points (P<0.001); the pain NRS score significantly decreased from a preoperative median [interquartile range (IQR)] of 4 (3, 5) to 1 (0, 2.5), P<0.001. The preoperative planned target volume D90 was 120 (116, 125) Gy, and the postoperative delivered D90 was 124 (119, 127) Gy (P=0.060). The median overall survival (OS) was 17.0 months for stage Ⅲ patients and 12.0 months for stage Ⅳ patients (P=0.05). Multivariate analysis revealed that clinical stage [Stage Ⅳ vs. Ⅲ: HR (95%CI)=2.29 (1.16, 4.50), P=0.016] and gross tumor volume [HR (95%CI)=1.01 (1.00, 1.02), P=0.012] were independent prognostic factors affecting OS. ConclusionsBased on the retrospective analysis results of this study, CT-guided iodine-125 seed implantation, as a local treatment modality for stage Ⅲ–Ⅳ pancreatic cancer, can effectively achieve local tumor control, alleviate pain, improve quality of life, and prolong survival of patients, with particularly significant benefits observed in stage Ⅲ patients, and demonstrates a favorable safety profile. Clinical stage Ⅳ and increased gross tumor volume are identified as independent factors affecting OS. This technique provides a treatment option for patients with inoperable stage Ⅲ–Ⅳ pancreatic cancer.
摘要:目的：探討超聲引導下組織間插植內照射治療中晚期宮頸癌的意義和效果。方法:回顧性分析32例中晚期宮頸癌患者,采用超聲引導下腫瘤組織間插植內照射+外照射。結果：有23例腫瘤脫落,宮頸原形出現,其余7例腫瘤縮小50%以上,持續時間均≥1個月,另有2例腫塊縮小＜50%,即CR為719%,PR為218%,NC為63%,PD為0%。結論：超聲引導下插植內照射是一種治療中晚期宮頸癌的安全有效的近距離放療技術。Abstract: Objective: To evaluate the efficacies of interstitial implant brachytherapy by ultrasoundguided for moderately advanced and advanced cervical carcinoma. Methods: Thirytwo patients with cervical cancer ⅡbⅣ who received interstitial implant brachytherapy by ultrasoundguided and routine irradiation. Results: 719% cases achieved complete remission (CR), 219% cases partial remission (PR), 63% cases no change(NC),0% case progressed disease（PD）. Conclusion: Interstitial implant brachytherapy by ultrasoundguided is an effective method for cervical tumor.
Objective To observe the different clinical response patterns of uveal melanoma (UM) patients after external scleral plaque radiotherapy (PRT), and to investigate the risk factors of secondary enucleation after treatment failure. MethodsA single-centre retrospective study. Demographic baseline characteristics and clinical data were collected from 465 UM patients treated with 125I external scleral PRT at Beijing Tongren Hospital from March 2011 to September 2017. Among them, 217 were male and 248 were female, tumor all occurred monocularly. The mean age of subjects was 46.7±12.1 years. Reasons for secondary enucleation included local tumor treatment failure, glaucoma, scleral necrosis and patient request. Tumor grading was based on the grading standards established by the American Joint Committee on Cancer (AJCC). The pattern of tumor response after PRT was classified as degenerated type, growth type, stable type or other types according to literature criteria. The median follow-up time after PRT was 59 months to observe tumor changes. Complete follow-up records of 3 or more color doppler ultrasound imaging (CDI) was available in 245 cases. A t-test was performed to compare the patient's age, intraocular pressure, best corrected visual acuity, tumor thickness and maximum basal diameter before treatment; a chi-square test was performed to compare the patient's gender, AJCC T classification of the tumor, whether the ciliary body was involved, presence of subretinal fluid, optic disc invasion and vitreous hemorrhage, tumor shape and location. Kaplan-Meier survival analysis was used to estimate the cumulative probability of secondary enucleation after extra-scleral PRT. Univariate and multivariate Cox proportional hazards regression analyses were used to evaluate the relationship between tumor characteristics and secondary enucleation after extra-scleral PRT. ResultsAmong 465 patients, eecondary enucleation was performed on 78 (16.8%, 78/465) patients during the follow-up period. The 1, 3 and 5 year secondary enucleation rates were 5.4%, 9.3% and 17.1%, respectively. Eye preservation was successful in 387 cases (83.2%, 387/465). Patients treated by secondary enucleation had a larger maximum basal diameter of tumor, a higher proportion of irregular and diffuse morphology, a cumulative macular involved and a higher AJCC T classification, the difference was statistically significant (P＜0.05). There were 115, 76, 27, and 27 cases of degenerated type, stable type, growth type, and other type, respectively. The tumor thickness of the growth type and other types was significantly smaller than that of the degenerated type and the stable type, and the difference was statistically significant (P＜0.05). Univariate Cox analysis showed that the maximum basal diameter of the tumor (HR=1.19), tumor thickness (HR=1.08), AJCC T classification (HR=1.90), growth type response pattern (relative to degenerated type response pattern) (HR=4.20) was associated with failure of eye preservation (P＜0.05). In the multivariate Cox analysis, the largest tumor basal diameter (HR=1.24) and the growth type response pattern (relative to the degenerated type response pattern) (HR=4.59) were still associated with failure of eye preservation (P＜0.05). ConclusionsThe tumor thickness of UM patients with growing and other response patterns after PRT is smaller before treatment; the maximum basal diameter of the tumor and the growing response pattern are independent risk factors for secondary enucleation.
