BACKGROUND:Tissue patch is used to increase bone mass after mandibular molar extraction, which is conducive to late-stage repair, but it is unexpectedly found that after implantation of tissue patch, incidence of dry socket is significantly reduced.OBJECTIVE:To assess the efficacy of tissue patch for the control of dry socket caused by mandibular molar extractionvia the method of systematic review. METHODS:MEDLINE (OVID), CENTRAL, EMBASE and CBM were searched for clinical randomized controled trials and clinical controled trials. The keywords were “dry socket, tissue patch, acelular dermis matrix, tooth extraction” in English and Chinese. The references of the included studies and 19 Chinese dental journals were hand-searched. Two reviewers independently assessed the risk of bias using Cochrane Colaboration’s tool, and extracted data. Meta-analysis was delivered with Revman 5.1.RESULTS AND CONCLUSION:Eight studies, including five randomized controled trials and three clinical controled trials, were included. Totaly 2 052 participants were involved. Seven of the included studies had moderate risk of bias and one had high risk of bias. Meta analysis showed that implantation of the tissue patch into the extraction socket could reduce 86% of the risk of dry socket (relative risk=0.14, 95% confidence interval [0.08, 0.26], P < 0.000 01). Sensitivity analysis showed that this outcome was relatively stable. Implantation of tissue patch into extraction socket could significantly reduce the risk of dry socket, but more randomized controled trials are needed.

Objective To investigate the efficacy and prognostic factors in patients with stage Ⅰ b and Ⅱ a cervical carcinoma by radical radiotherapy.Methods Between January 1999 and January 2012,108 patients with stage Ⅰ b and Ⅱ a cervical carcinoma received radical radiotherapy in Cancer Hospital,Chinese Academy of Medical Sciences were included and analyzed retrospectively.Patients of stage Ⅰ b1,Ⅰ b2,Ⅱa1 and Ⅱa2 were 18 (16.7％,18/108),38 (35.2％,38/108),33 (30.6％,33/108) and 19 (17.6％,19/108),respectively.Results The 5-year overall survival rate was 76.2％ and the 5-year disease free survival rate was 75.6％.Totally 25 (23.1％,25/108) patients developed recurrent disease,16 of them (64％,16/25) had local recurrences,6 (24％,6/25) had distant metastases and 3 cases had both local recurrence and distant metastases.Among patients with recurrent disease,23 died and 2 survive with tumor.Totally 24 patients died,23 of them died due to tumor recurrence and the other one died of other reason.The univariate analysis showed that,lymph node metastasis,squamous cell carcinoma antigen (SCC) levels before treatment,SCC levels after treatment 1 month had relation with overall survival time in patients with stage Ⅰ b and Ⅱ a cervical carcinoma (all P ＜ 0.05).The multivariate analysis showed that,lymph node metastasis and SCC levels after treatment 1 month were the independent prognostic factors for overall survival time for the cervical squamous cell carcinoma (OR =2.5,4.4 ; all P ＜ 0.05).Conclusions By means of radical radiotherapy,stage Ⅰ b and Ⅱ a cervical carcinoma patients with lymph node metastasis and SCC levels≥ 1.5 mg/L after treatment one month have poor prognosis.While,stage Ⅰ b and Ⅱ a patients with concurrent chemoradiotherapy after neoadjuvant chemotherapy did not affect the prognosis.The 5-year survival rate with concurrent chemoradiotherapy was higher than that of radiotherapy.

Objective To evaluate the outcomes and the prognostic factors for advanced squamous cervical cancer after concurrent chemoradiotherapy (CCRT).Methods Totally 172 patients with International Federation of Gynecology and Obstetrics stage Ⅱ b-Ⅳ who were treated in Cancer Hospital,Chinese Academy of Medical Sciences between January 2007 and December 2008 were retrospectively analyzed.Patients were received external radiotherapy,high-dose rate brachytherapy and cisplatin-based chemotherapy concurrently.Results The median follow-up period was 54.5 months.The 2-year and 5-year overall survival (OS) were separately 81.5％ and 68.8％.The 2-year and 5-year progress-free survival (PFS) were separately 69.2％ and 63.1％.Using univariate analysis followed with multivariate analysis,the results showed that these clinicopathological factors including stage (Ⅲ and above versus Ⅱ b; P =0.021,HR =1.95 ; P =0.020,HR =1.86),maximum diameter of local tumor size (＞4 versus ≤4 cm; P =0.009,HR =2.55 ; P =0.033,HR =1.94),squamous cell carcinoma antigen (SCC) level before treatment (＞3 versus ≤3 μg/L; P =0.010,HR =2.47; P =0.013,HR =2.09) and retroperitoneal lymph node status on imaging (para-aortic lymph node positive versus negative,P =0.009,HR =3.00,P=0.010,HR =2.74; pelvic lymph node positive only versus negative,P =0.044,HR =1.98,P =0.033,HR =1.92) had the significant effect on OS and PFS.Patients with no above adverse prognostic factor were assigned to Group A (n =18),those with one factor were assigned to Group B (n =43),and those with no less than two factors were assigned to Group C (n =1 11).Among three groups,the 2-year OS were separately 94.1％,97.7％ and 73.1％,the 5-year OS were separately 81.4％,90.1％ and 58.6％,the 2-year PFS were separately 88.2％,90.4％ and 57.9％,the 5-year PFS were 82.4％,87.9％ and 50.0％.The results showed that group C was significant difference from Group A or B in OS and PFS (all P ＜ 0.05),while Group A had no significant difference from Group B in OS and PFS (P ＞ 0.05).Conclusions Stage Ⅲ or above,maximum diameter of local tumor size ＞ 4 cm,SCC level ＞ 3 μg/L before treatment and positive retroperitoneal lymph nodes on imaging are four independent adverse factors for prognosis of squamous cervical cancer of advanced stage after CCRT.The treatment of patients with no less than two adverse factors should be considered to be improved.

Objective To discuss the clinical characteristics,treatment and prognostic factors of brain metastasis from gynecological cancers.Methods Clinical records of 25 brain metastasis patients from gynecological cancers admitted from January 1999 to January 2009 were reviewed retrospectively.The curative effects of different treatments were compared.The prognostic factors were determined using the Cox regression model.Results There were 14 cases ovarian malignant tumor,6 cases cervical carcinoma and 5 cases uterine malignant tumor.Seven cases (28％,7/25 ) had solitary metastatic lesion in the brain.Extracranial metastases were detected in 18 cases (72％,18/25 ).Five patients only received one kind of treatment,and the mean survival time was 4.0 months (0.5 to 9.5 months).Sixteen patients received combined treatment,3 of them received combined treatment including surgery,and the mean survival time was 8.4 months (4.1 to 13.4 months) ; 13 of them received chemotherapy and radiotherapy,and the mean survival time was 14.2 months (4.3 to 58.1 months).Four patients received only palliative supportive care,and the survival time was only 0.1 to 1.0 month.The Cox regression model showed that Karnofsky performance status scale,with or without extracranial metastases and the treatment method were the independent prognostic factors of brain metastasis from gynecological cancers ( P ＜ 0.05 ).Conclusion The incidence of brain metastasis from gynecological cancers is low and the prognosis is very poor.Combined treatments may get better effects.

Objective To solve the problem of the skin resource and skin quality after excision of skin scar and other lesions to a certain extent. Methods Using the skin external expander that was designed and developed by the authors, we expanded skin at the given time and quantity. Results 28 patients had received the treatment, and they all had a large proportion of skin-scard. Obviously their skin-scar was eliminated throughly after using the skin external expander and commissure being hooked in. These 28 cases have shown that there would be no chance for the patients to suffer from hyperplastic akin-scard after their first stage of treatment. Conclusion The skin external expander is really a new method to solve the problem of the skin resource and skin quality after exscinding skin scar and other lesions to a certain extent.

Objective To compare the homogeneity and conformity of dose distribution in the target and the dose to the organs at risk among 3-dimensional conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) and simplified intensity modulated radiation therapy (sIMRT), and then to evaluate the clinical value of sIMRT for cervical cancer. Methods Ten patients with cervical canc-er receiving radical radiotherapy and brachytherapy were enrolled. Before radiotherapy, CT was performed and target volumes were delineated. The clinical target volume (CTV) included supravaginal portion, cervi-cal stump, paracervical tissue, common iliac lymph nodes, internal and external iliac lymph nodes, obtura-tor lymph nodes, sacral lymph nodes, and the surrounding tissues. If the vagina was involved, the target vol-ume included the whole vagina. Margins between planning target volume (PTV) and CTV were 10 mm in the anterior direction, and 5 mm in other directions. The prescribed dose was 95% PTV receiving 45 Gy in 25 fractions of 1.8 Gy. The dose volume histogram, conformity index, homogeneity index and treatment time per faction were compared. Results Among the three radiotherapy techniques, 3DCRT had the best homo-geneity of dose distribution, while there was no significant difference between IMRT and slMRT. According to the conformity of dose distribution, sIMRT was better than 3DCRT, but worse than IMRT. Comparing the bladder sparing, IMRT was the best followed by sIMRT. The volume of the small intestine receiving high dose was increased significantly with slMRT when compared with IMRT. And the treatment time per faction was4, 10 and 18 minutes for3 DCRT, sIMRT and IMRT, respectively. Conclusions sIMRT could re-duce the work intensity of the staff, shorten the treatment time per fraction, and simplify the authenticate procedure, which is cost-effective and suitable in the treatment of cervical cancer.

Objective To compare the clinical efficacy of neoadjuvant chemotherapy plus vaginal intracavitary irradiation,neoadjuvant chemotherapy alone and vaginal intracavitary irradiation alone followed by radical hysterectomy in patients with stage Ⅰ b2 and Ⅱ a2 bulkly cervical carcinoma.Methods Between January 2000 and December 2009,224 patients with stage Ⅰ b2 and Ⅱ a2 bulkly cervical carcinoma ( tumor diameter ＞ 4 cm) received neoadjuvant therapy combined surgery in Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences were respectively analyzed,and they were divided into 3 groups according to the preoperative neoadjuvant therapy,the neoadjuvant chemotherapy combined vaginal intracavitary irradiation group (chemotherapy combined irradiation group,n =86 ),the neoadjuvant chemotherapy alone group ( chemotherapy group,n =48 ),the vaginal intracavitary irradiation alone group ( irradiation group,n =90).The efficacy,postoperative risk factors,postoperative adjuvant therapy and survival were compared among the 3 groups.Results Among the chemotherapy combined irradiation group,chemotherapy group and irradiation group,the response rate (RR) were respectively 62％ (53/86),42％(20/48) and 37％ ( 33/90 ),and there was significant difference ( P =0.003 ).The comparison of deep stromal invasion,lymph node metastases,lympho-vascular space involvement(LVSI) and other risk factors among the 3 groups,which showed that there were no statistically significant differences ( P ＞ 0.05 ).In chemotherapy combined irradiation group,the percentage of stromal invasion ≥ 1/2 was lower than that in chemotherapy group [ 53％ ( 46/86 ) vs.73％ ( 35/48 ),P =0.027 ],and the percentage of lymph node metastases was significantly lower than irradiation group [ 17％ ( 15/86)vs.29％ (26/90),P =0.046],and the risk factors-free rate was significantly higher than chemotherapy group [ 44％ (38/86)vs.25％ ( 12/48 ),P =0.028 ].Among the chemotherapy combined irradiation group,chemotherapy group and irradiation group,the percentage of postoperative radiation therapy were respectively 47％ (40/86),67％ (32/48)and 62％ (56/90),and the differences were statistically significant (P =0.035).The five-year disease free survival (DFS) was 79％,75％ and 78％,respectively.The five-year overall survival (OS) was respectively 81％,78％ and 81％ among 3 groups,and there were no statistically significant differences (P ＞ 0.05).Among 224 patients,the five-year DFS of the patients with 0,1 and ≥ 2 risk factors after surgery were 90％,75％ and 57％,and OS were 95％,82％ and 65％,and there were no statistically significant differences( P ＜ 0.01,respectively).Of patients without postoperative risk factors,the five-year OS in those without receiving postoperative radiation therapy was 96％,while 89％ in received postoperative radiation therapy patients,there were no statistically significant differences ( P =0.263 ).Conclusion There are no differences of DFS and OS among the neoadjuvant chemotherapy combined vaginal intracavitary irradiation group,the neoadjuvant chemotherapy alone group and the vaginal intracavitary irradiation alone group patients with stage Ⅰ b2 and Ⅱ a2.Patients without risk factors after neoadjuvant therapies have better prognosis.

Objective To investigate the relationship between dose-volume histogram (DVH) parameters and the late side effects (LSE) of the rectum in external-beam radiotherapy combined with computed tomography (CT)-based brachytherapy for locally advanced cervical cancer.Methods From 2008 to 2011,18 patients with stage ⅡB-ⅢB cervical cancer received external-beam radiotherapy and CTbased brachytherapy.The DVH parameters of high-risk clinical target volume (HR CTV) D90,point A dose,and D1 cm3 and D2 cm3 of the rectum and bladder were calculated by Oncentra HDR treatment planning system.Survival outcomes were followed up and rectal LSE were evaluated by RTOG/EORTC grades.Results The point A dose and HR CTV D90 were (93.0 ± 5.5) Gy and (73.6 ± 11.9) Gy,respectively.The median follow-up was 26 months.No recurrence was found during follow-up.Eight patients had mild and moderate rectal LSE,and their rectum D2 cm3 and D1 cm3 were significantly higher than those of patients without mild and moderate rectal LSE (D2 cm3:(87.4 ± 3.8) Gy vs.(75.8 ± 7.4) Gy,P =0.004 ; D1 cm3:(96.4±6.6) Gy vs.(80.5± 7.1) Gy,P=0.001).Conclusions HR CTV D90 in CT-based brachytherapy for locally advanced cervical cancer might be lower than that in the MRI-based plan.Rectum D2 cm3 is recommended to be less than 75 Gy.

Objective To evaluate target-volume coverage and organ at risk (OAR) protection achieved with conventional radiotherapy (CRT), three dimensional eonformal radiotherapy (3DCRT) , and intensity-modulated radiotherapy(IMRT) through dosimetric comparison in patients with cervical cancer after hysterectomy. Methods The planning CT scans of 10 patients treated with pelvic radiation after hysterectomy for cervical cancer were used to generate CRT,3DCRT and IMRT plans for this study. Clinical target volume(CTV) was contoured on the individual axial CT slices of every patient. The CTV was then uniformly expanded by 1.0 cm to create the planning target volume (PTV). The small bowel, rectum, bladder, bone marrow, ovaries, and femoral heads were outlined for the organ at risk (OAR) evaluation. The CRT ,3DCRT and IMRT plans were generated using commercial planning software. CRT plan was prescribed to deliver 45 Gy to the reference point,while IMRT and 3DCRT plans were 45 Gy to 95% of the FFV. Isodose line and dose volume histograms(DVH) were used to evaluate the dose distribution in CTV and OAR. Results For 10 patients, the average volume of CTV receiving the prescribed dose of CRT was significantly lower than 3DCRT( Q = 8.27,P ＜ 0.01 ) and IMRT( Q = 8.37, P ＜ 0.01 ), respectively. Comparing with the CRT plan,the 3DCRT and IMRT plans notably reduced the volume of bowel at 30 and 45 Gy levels. The IMRT plan significantly spared rectum and bladder at 30 and 45 Gy levels comparing with the CRT ( P ＜ 0.01 ) and 3DCRT( P ＜ 0.05 ) plans,while the 3DCRT plan significantly spared rectum and bladder at 45 Gy level comparing with the CRT( P ＜0.01 ) plans. For 4 patients with ovarian transposition, the average doses of ovary over 3 Gy were 2 patients with the 3DCRT and IMRT plans, and 2 with all three plans. Conclusions IMRT and 3DCRT are superior to CRT in improving dose coverage of target volume and sparing of OAR ,while IMRT being the best. The superiority of IMRT and 3DCRT is obvious in sparing bone marrow at high dose levels. IMRT,3DCRT and CRT could not spare the transposed ovary effectively.

Objective To analyze the outcomes of preoperative intracavitary brachytherapy plus sur-gery in patients with stage ⅠB2 and ⅡA bulky cervical cancer. Methods From January 2001 to January 2007, 77 patients with stage ⅠB2 and ⅡA bulky cervical cancer were included. The diameter of primary tumor was greater than 4 cm. Preoperative intracavitary brachytherapy with the total dose of 20-30 Gy (0.5 cm below the vaginal mucosa) was delivered by 2-3 fractions, one fraction per week. After an interval of 10-14 days, the efficacies of radiotherapy were evaluated and radical hysterectomy with pelvic lymphade-nectomy was performed. Then the treatment complications, clinicopathological characteristics, survival and recurrence were analyzed. Results The tumor shrinkage was observed in all the patients after intracavitary brachytherapy. The CR, PR and SD were 5% (4/77), 36% (28/77) and 58% (45/77), respectively. Radical hysterectomy was successfully performed in all patients. The complications of the combined therapy were mild and only 5 patients had grade Ⅱ or less hematological or gastrointestinal toxicities. The 5-year o-verall survival rate and pelvic recurrence rate were 83% and 12%, respectively. Conclusions Preoperative intracavitary brachytherapy of 20-30 Gy plus surgery is effective in the treatment of stage ⅠB2 and ⅡA bulky cervical cancer without increasing the treatment complications.