Small cell lung cancer ( SCLC ) is one common type of lung cancer in China. No remarkable progress has been made in systemic therapy for SCLC since the 90’ s. However, there are some advances in radiotherapy ( RT) for SCLC, which make it possible to improve treatment outcomes of SCLC. Those advances are mainly made in thoracic RT and prophylactic cranial irradiation for extensive?stage SCLC, radiation dose and technology of thoracic RT for limited?stage SCLC, and significance of prophylactic cranial irradiation for early?stage SCLC. The paper reviews the research advances in the East and West to provide some help and references for readers.

Chemotherapy, molecular targeted therapy, and hormonal therapy are essential components of medical oncology. Al-though cancer patients significantly benefit from the emergence of various new anticancer drugs, none of these treatments can directly address drug resistance. Radiation therapy is one of the three conventional cancer treatment methods. Nearly two-thirds of cancer pa-tients accept radiation therapy during treatment. However, radiation resistance is a significant barrier affecting the therapeutic effect of this procedure. Epithelial–mesenchymal transition (EMT) is a biologic process that enables a polarized epithelial cell to undergo multi-ple biochemical changes. These changes enable the cell to assume the functions of a mesenchymal cell phenotype. These functions have been extensively studied and are related to embryogenesis, tumor invasiveness, and metastasis. In recent years, increasing evidence sug-gests that EMT is closely linked with tumor treatment resistance. The study of the relation between EMT and tumor treatment resistance is expected to contribute to the prevention of drug resistance and radiation resistance and thus improve treatment efficacy to provide benefit to cancer patients. This article explores this issue.

Objective To study the relation between Child Turcotte classification and pathology, diagonsis, prognosis and fibrosis index as well as its significance. Methods The levels of hyaluronic acid(HA), type Ⅲ procollagen(PCⅢ), Laminin(LN) and type Ⅳ collagen(Ⅳ C) were detected by enzyme linked immunoadsordent assay(ELISA) or radioimmunoassay(RIA). Pathomorphology was observed in 68 patients with cirrhosis. Results Level of HA in serum was positively correlated with cirrhotic severity, but other fibrosis indexes could not reflect cirrhotic severity. Child Turcotte classification was concordant with the pathological changes. The concordance rate of Child Turcotte classification B or C patients with pathologic diagnosis was up to 97.8%. The recovery rate of Child Turcotte classification A patients was up to 95.5%. Fatality rate of Child Turcotte classification C patients was up to 96.9%. Conclusion Child Turcotte classification is closely correlated with the severity of hepatic fibrosis, severity of pathological changes in liver and prognosis of patients. It is of clinical value in the reflection of severity of hepatic cirrhosis.

Objective To evaluate the potential role of the separately p73 gene polymorphism on hepatocellular carcinoma(HCC) susceptibility.Methods A hospital-based case-control study was conducted in 100 cases HCC patients and 100 cases age,sex-matched cancer-free controls in the same region.The matrix-assisted laser desorption ionization time-of-flight mass spectrometry and DNA sequencing methods were used to analyze polymorphisms of p73 genetic polymorphisms (G4C14-A4T14).Using χ2 test to exam the differences of genotype between the HCC group and control group,logistic regression was used to analysis odds ratio(Oddsratios,OR) and 95%CI(Confidence Intervals,CI),adjusted for age and sex,analysis the association between SNPs of P73 polymorphisms and HCC.All the results were analyzed by SPSS 18.0.Results (1)The differences of age(χ2=0.185,P=0.667),gender(χ2=0.026,P=0.873),drinking status(χ2=0.427,P=0.514),and family history (χ2=0.058,P=0.809)of cancer composition between HCC group and control group were not statistically significant.(2)There were CC,CT and TT three genotypes in p73 rs1801173 C/T.The frequencies of CC,CT and TT genotypes of P73 C/T in controls and HCC cases were 65.0%,28.2%,6.8 % and 62.2%,31.1%,6.7%,respectively,and there was no significant difference between the two groups(χ2=0.326,P=0.568).(3)When stratifying by age,gender,smoking status,alcohol consumption,HBV carrier status and family history of cancer we found that the variant genotypes of GC/AT + AT/AT in P73 was associated with a significantly increased risk of HCC among HbsAg-positive individuals(χ2=3.916,P=0.048) and female(χ2=6.545,P=0.01),and there were no significant correlation with age,smoking,alcohol consumption,family history of cancer.Conclusion (1)p73 G4C14-to-A4T14 dinucleotide polymorphism may play a role in the development of chronic HBV-infected HCC in the Chinese population.(2)p73 G4C14-to-A4T14 dinucleotide polymorphism may play a role in the development of chronic HCC in female of Chinese population.

Objective To investigate the prevalence of dyslipidemia in elderly population.Methods In 2004,862 elderly population in medical examination were studied.Serum cholesterol,triglyceride,high-density lipoproteins(HDL) and low-density lipoproteins(LDL) were measured.Results Cholesterol,triglycerides,HDL cholesterol and LDL cholesterol levels in women were significantly higher than men(P

Objective To evaluate the therapeutic effects of endoscopic biliary double stents for advanced malignant hilar biliary obstruction.Methods From January 2007 to December 2010,double stents was attempted in 28 patients (15 men and 13 women,median age 66.4 years (44-88 years),including 9 with Bismuth Ⅱ,8 with type Ⅲa,5 with type Ⅲb and 6 with type Ⅳ.A total of 23 consecutive patients ( 11 men and 12 women,median age 65.8 years (42-83 years) with malignant hilar obstruction undergoing a therapy with single stent were recruited as the control group,including 7 with Bismuth Ⅱ,5 with Ⅲa,6 with Ⅲlb and 5 with Ⅳ.The rates of successful drainage,complications,mean survival time of patients and the average duration of biliary stent patency were compared between the two groups.Results Successful rate of cannulation was both 100％ in the two groups.Successful rate of drainage and complications of double stent group were 96.4％ (27/28) and 17.9％ (5/28),and these two variables of single stent group were 87.0％ (20/23) and 13.0％ (3/23),which were not significantly different (P ＞0.05).23 patients (82.1％ ) in double stent and 19 ( 82.6％ ) in single stent group were followed up.The average duration of stent patency and mean survival time of double stent group were ( 129 ±48.5) d and ( 187 ±94.5) d,which were superior to those of the single stent group,i.e.( 102 ±37.8) d and ( 103 ±98.5) d.Conclusion Double stenting is an effective therapy for malignant hilar obstruction of Bismuth Ⅱ and above.It is superior to single stent method in the mean duration of patency and mean survival time.

Objective To explore the reasonable radiotherapy range by analyzing the patterns and characteristics of intra-thoracic lymph node metastasis in small cell lung cancer (SCLC).Methods One hundred and fifty patients with limited-stage SCLC who received radical resection of primary tumor and systemic intra-thoracic lymph node dissection were included in the study.All the lymph nodes in each area were recorded and examined pathologically to analyze the patterns and characteristics of intra-thoracic lymph node metastasis.Results A total of 2372 lymph nodes were found in 631 areas,and a total of 413 positive lymph nodes (17.4％) were found in 188 lymph node areas (29.8％ ).Intra-thoracic lymph node metastasis were found in 88 patients,with a positive rate of 58.7％.The frequencies of metastasis in the area 11,10,7,5,4 were much higher than those in the other areas,and central located lesions and the higher T-stage lung tumors were more likely to develop intra-thoracic lymph node metastasis (x2 =15.32,39.72;P =0.000,0.000,respectively).Tumors located in the right upper lobe and right middle/lower lobe had a higher tendency of metastasis to the areas 4,7,10 and 4,7,10,11,respectively.Tumors located in the left upper lobe and left lower lobe had a higher tendency of metastasis to the areas 4,5,6,10 and 4,7,9,10,11,respectively.Mediastinal lymph node metastasis (N2 ) were found in 72 patients,among whom 29 patients (40.3％ ) had skipping N2 metastasis without hilar metastasis.Tumors located in the upper lobe had a tendency of skipping metastasis to the upper mediastinum,while tumors located in the middle/lower lobe had a tendency of skipping metastasis to the upper and lower mediastinum.Conclusions The lymph node metastases in SCLC follow the lymphatic drainage routes,that is,from intrapulmonary to the hilar and then to the mediastinum,but with some skipping metastases.Tumors located in different lobes have different high risk lymph node areas for metastasis,and elective irradiation to these lymph node areas maybe increase radiotherapy gain ratio in SCLC.

Radiotherapy is important for cancer treatment. However, some patients still experience relapse and exhibit radiation resistance. Mammalian target of rapamycin (mTOR) is the main effector molecule in PI3K/AKT signaling. This molecule is found in two structurally and functionally distinct multi-protein complexes known as the mTOR complex 1 and mTOR complex 2. The mTOR signaling pathway controls the growth, proliferation, survival, and apoptosis of cancer cells. This pathway is closely related to tumori-genesis and treatment response, and is used in sensitizing radiotherapy. mTOR inhibitors regulate radio-sensitization through multiple mechanisms, including cell cycle alterations, DNA repair modulation, and tumor hypoxia reduction. Preclinical studies showed that mTOR inhibitors with tolerable toxicity may be used as an effective modality to overcome radio-resistant tumors. Responses to mTOR inhibitors vary depending on the cell lines. Molecular markers can be used to select suitable patients. Further studies are needed to com-pletely understand the use of mTOR inhibitors in radio-sensitization.

Objective To evaluate the influence of respiration on the radiation dose distribution within target volume in radiotherapy with film dosimetry. Methods Radiation of 50 MU was delivered by a square, round, ellipse, dumb bell, or female shaped filed to the films within a moving or motionless Respiration Motion Phantom respectively, the dose distributions for the two motion status were measured and compared. In order to further verify the impact of respiration, a plank phantom was used on different shifting value: 0, 0.5, 1.0, 1.5 and 2.0 cm, respectively. A square, round, or eUipse-shaped filed was used for irradiation and the distributions in different status were measured and compared with film dosimetry. Iso-dose line comparison, NAT(Normalized Agreement Tests) and γ comparison were used for the comparison of dose distributions. Fs can be an index to reflect the variability of the areas that surrounded by iso-dose lines. (FS90, FS50, FS25 delegates the ratio of the areas that surrounded by 90 %,50 %,25 % iso-dose hne in different situation respectively). Results (1) Compared with motionless situation, the FS90 in horizontal movement situation became small and the FS25 became large. As the displacement became larger, the FS90 became larger and the FS25 became smaller. FS in vertical movement situation, square and dumb bell fields changed while the others didn't have a change. (2)γ and NAT comparison: In the horizontal movement situation, compared with the static phantom, Pγ < 60 % and PNAT < 75 %. Under vertical movement situation, Pγ were less than 85 % for the square, round, dumb bell and female shaped fileds. In the plank phantom verification, Pγ and PNAT became smaller as the movement became larger. Conclusions The respiration can impact on the dose distribution within the target volume in radiotherapy, leading to a smaller area of higher dose level and an expanded area of lower dose level. The influence will become more significant with larger movement of the target.

Although it has been frequently used to treat thoraxic tumors,radiation induced lung injury (RILI) is the major factor of dose limitation in thoracic radiotherapy.Amount of endogenous and exogenous reactive oxygen / nitrogen species (ROS/RNOS) could be generated in the radiated organisms and further cause molecular damage of DNA,protein and membrane lipids,which results in celluar structure damage,dysfunction and RILI.In addition,a series of cytokines could also induce chronic oxidative stresses that contribute to increases in cell membrane permeability,tissue edema and extracellular matrix proteins accumulation and even further result in pulmonary fibrosis.Oxidative stress theory offers new clues and strategies for further understanding the mechanism of RILI,and some anti-oxidative stress drugs may have potential clincial application in RILI treatment.