Background and purpose:The local tumor control rate of non-small-cell lung cancer treated with conventionally fractionated radiotherapy is low.Hypofractionated radiotherapy performed by conformal irradiation techniques can improne the local control rate.But further studies for appropriate fraction dose and toxicity for hypofractionation should be done.The purpose of this study was to prospectively evaluate the safety and efficacy of three-dimensional conformal hypofractionated radiotherapy for non-small-cell lung cancer(NSCLC).Methods:According to the dose-volume histogram(DVH) V_(20), patients were divided into three groups:① V_(20)≤20%,②20%30%,grade Ⅲ RP was observes in 2 of 5 patients and grade Ⅳ RP in 1 patient who died of lung function failure.No grade≥Ⅲ radiation esophagitis was observed.25 patients were evaluated with 8 complete responses,13 partial responses,3 stable diseases and 1 progressive disease.Conclusions:For three-dimensional conformal hypofractionated radiotherapy V_(20) level should be controlled below 30%,the treatment plan with V_(20)≥30% should be changed to palliative treatment.More studies are needed to confirm its efficacy.

Objective To investigate the clinical effect of five-step sequential method for hemorrhagic radiation cystitis.Methods From April 2015 to April 2018,512 cases of hemorrhagic radiation cystitis patients in 6 provincial tumor hospital were retrospectively analyzed.12 cases were male patients,and 497 cases were female.Patients'average age was (60.1 ± 8.2) years (53-71 years).Hematuria appeared in 2.9 years on average after radiotherapy(ranged 0.5 to 13 years).According to the severity of hematuria,480 patients were classified as mild and 32 patients as severe.The step 1 was drug conservative symptomatic treatment.Thrombin solution or sodium hyaluronate was used for bladder perfusion in step 2.The step 3 was transurethral electrocoagulation.The step 4 was interventional embolization.The step 5 was hyperbaric oxygen therapy.Mild patients were treated from the first step,and the severe patients were treated rom step 3,and combined with step 1.Overactive bladder symptom score (OABSS) was used to assess the improvement of patients'symptoms.Results No obvious complications occurred in step 1,2,3,5.Mild hip pain occurred at step 4.Recurrent hemorrhage rate were 6.7％ (2/30) in mild patients group and 10.5％ (2/19) in severe respectively in step 4.The total effective rate of step 1 in mild patients group was 65.2％ (313/480),step 1 + 2 was 84.2％ (404/480),step 1 + 2 + 3 was 95.6％ (459/480),step 1 + 2 + 3 + 4 was 98.3％ (472/480),and step 1 +2 +3 +4 +5 was 100％ (480/480).The effective rate of step 3 + 1 treatment was 59.4％ (19/32) in severe patients group,step 3 + 1 + 4 was 68.8％ (22/32),and step 3 + 1 +4 +5 was 100％ (32/32).The OABSS scores of mild and severe patients decreased after treatment (P＜0.01).Condusion Five-step sequential therapy could be an effective method for the treatment of hemorrhagic radiation cystitis.

Objective:To explore the repair methods and effects of refractory wounds in patients after spinal internal fixation operation .Methods:The study was a retrospective observational study. From November 2020 to October 2023, 10 patients with refractory wounds after spinal internal fixation operation were admitted to the Department of Burns and Plastic Surgery of Changde Hospital of Xiangya School of Medicine of Central South University. They were 3 males and 7 females, aged 35 to 68 years. There were 6 cases of thoracolumbar tuberculosis, 3 cases of thoracolumbar fracture, and 1 case of recurrent sacrococcygeal chordoma with skin, soft tissue, and bone defects after radical resection. The wound areas after debridement were 6.0 cm×1.5 cm to 27.0 cm×6.5 cm. The wound repair operation was decided to perform in the primary stage or in the secondary stage according to the wound situation. Two patients with type Ⅰ wounds were treated with debridement, direct suture, and continuous irrigation and drainage with catheter after operation. Eight patients with type Ⅱ wounds were repaired with local flaps (including rotation flap with dermis-fat flap at the end), muscle flaps, or muscle flaps combined with local flaps. The flap sizes were 10.0 cm×5.0 cm to 27.0 cm×14.0 cm, and the sizes of muscle flap were 8.0 cm×5.0 cm×4.0 cm to 17.0 cm×9.5 cm×2.0 cm. The wounds in flap donor areas were sutured directly. The wound treatment methods of patients with type Ⅱ wounds were recorded. The wound healing was observed after operation. The infection and recurrence of wounds, the retention of internal fixation materials, and spinal motor function were observed during follow-up.Results:Among patients with type Ⅱ wounds, there were 3 cases applied with local flaps (including 1 case with rotation flap with dermis-fat flap at the end), 3 cases with muscle flaps (including 1 case with latissimus dorsi muscle flap and 2 cases with erector spinal muscle flaps), and 2 cases with muscle flaps (1 case with latissimus dorsi muscle flap and 1 case with erector spinal muscle flap) combined with local flaps. Only 1 case with secondary defects after radical surgery of sacrococcygeal chordoma had poor wound healing which healed after dressing change, and the wounds of the remaining 9 cases all healed well. During the follow-up of 4 to 18 months, no infection or recurrence of local wounds developed in 10 patients, the internal fixation materials were not loosening, and there was no significant limitation in spinal motor function.Conclusions:For refractory wounds after spinal internal fixation operation, according to the wound type of patients, debridement, suture, irrigation, and drainage in the primary stage, or transplantation of local flaps, muscle flaps, muscle flaps combined with local flaps are performed in the primary stage or in the secondary stage. These methods are proved to have reliable therapeutic effects, not only repairing the wounds, but also retaining the internal fixation materials.

Objective:To explore the strategy of how to select an effective flap for reconstruction of the surgical defect in clavicular region after resection of malignant tumour and care for the aesthetic appearance of the flap donor site.Methods:A retrospective observational study was conducted. Twenty-three patients with soft tissue malignant tumour in clavicle region were treated, from March 2017 to April 2023, in the Department of Burn and Plastic Surgery of Changde Hospital, Xiangya School of Medicine, Central South University (the First People’s Hospital of Changde). The patients were 13 males and 10 females, aged 21 to 72 years old. Ten patients were of dermatofibrosarcoma protuberans, 6 of fibrosarcoma, 3 of squamous cell carcinoma of skin, 3 of undifferentiated pleomorphic sarcoma and 1 of mucinous adenocarcinoma. Nine patients had the first surgery and 14 were with tumour recurrence and had previousely received one or more surgery in other hospitals. The tumour size ranged from 2.0 cm×4.5 cm×1.0 cm to 10.0 cm×16.0 cm×3.0 cm. After radical resection, the sizes of surgical defect ranged from 9.0 cm×12.0 cm to 16.0 cm×22.0 cm. All the clavicular soft tissue malignancies had radical resection, and the secondary surgical defects were further modified to reduce the short and long dimensions of the defects. Flaps were selected according to the short dimension, depth and skin elasticity of the flap donor site. Of the 23 patients, 3 were treated with free inguinal flaps, 9 with ipsilateral pedicled latissimus dorsi flaps or thoracodorsal artery perforator flaps, 5 with free deep inferior epigastric artery perforator flap (DIEPF), 5 with free anterolateral thigh flap (ALTF) and 1 with free rectus abdominis flap. The modified defects sized 5.0 cm × 11.0 cm-12.0 cm×19.0 cm after the suture of margin and base of the defects (defects were reduced and modified). The flap sizes were 7.0 cm×13.0 cm-14.0 cm×23.0 cm. After surgery, the wound healing was observed through the visits of outpatient clinic, and telephone and WeChat interviews. According to the nature of the tumours, the patients were regularly reviewed at outpatient clinic to determine the local recurrence and metastasis of the tumour.Results:One pedicled latissimus dorsi myocutaneous flap was found with a greater tension after surgery. After partial removal of sutures and dressing changes, the secondary suture was performed 1 week later and the wound healed smoothly. A postoperative venous crisis was discovered in a free ALTF. It was monitored and re-anastomosed within 24 hours after surgery, and the flap survived and the wound healed smoothly. Otherwise, the rest of flaps achieved good blood supply and the wounds at the recipient and donor sites healed in one stage. In the postoperative follow-up, all flaps in the clavicular region were found good in appearance with no obvious swelling, and the donor sites healed well without scar contracture or dysfunction. One patient with a squamous cell carcinoma died of lung metastasis at 13 months after surgery. The rest of patients were found no tumour recurrence and had completed postoperative follow-up.Conclusion:After radical resection of malignant soft tissue tumours in the clavicular region, appropriate flaps were selected according to the size (short diameter) and depth of the modified defects, as well as the skin elasticity and relaxation of the flap donor site, hence to facilitate the direct suture of the flap donor site. It not only effectively reconstructs the surgical defect in clavicular region, but also minimises the damage to the flap donor site and achieves an aesthetic appearance at the flap donor site.