Purpose: To evaluate the efficacy and the side effects of 3 D-conformal radiotherapy for malignant thoracic tumor. Methods: Between September 1999 and August 2002, 36 patients with malignant thoracic tumor were treated with 3D-conformal radiotherapy. Twenty-two patients had primary lung cancer, 12 patients had metastatic lung cancer, and 2 patients had malignant mediastinal tumor. All 36 patients were pathologically confirmed. Squamous cell carcinoma 16 cases, adenocarcinoma 15 cases, small cell carcinoma 2 cases, embryonal carcinoma 1 case, malignant thymoma 1 case and sarcoma 1 case. For the primary tumor, conventional radiotherapy was first used to 50Gy/25F/5W, followed by 3D-conformal radiotherapy 16-20Gy(4Gy per fraction, 3 fractions per week) with MLC or cone from 5 ~6 non coplanar or coplanar static ports. For metastatic tumor, using arc therapy to only 28-40Gy(4Gy per fraction, 3 fractions per week, 7-10 fractions) with cone from 1 ~ 4 arcs. Tumor volumes from 1. 85 cm3 to 104. 61 cm3 with a median of 24. 96 cm3 in 3D-CRT. Results: To evaluate the effects, thoracic CT scan was taken two months after completion of 3D-conformal radiotherapy. In 34 evaluated patients, 13 cases obtained CR, 14 PR, 5 NC, and 2PD. The overall 1 and 2-year survival rates were 74. 1% and 38.4%. Toxicity consisted of grade 1 acute radiation pneumonitis in 17 patients, grade 2 in 10 patients, grade 3 in 1 patients, and 2 patients dead of radiation pneumonitis ( with non coplanar technique), late complication was radiation pulmonary fibrosis, grade 1 in 20 cases, grade 2 in 8 cases. Conclusions: 3D-conformal radiotherapy as complement of conventional external beam radiotherapy for malignant thoracic tumor can obtain better short-term effects, although the survival is yet to be investigated. But attention must be given to the irradiation technique, the irradiation volume should not be too large and beams angles appropriately adjusted to avoid excessive irradiated volume in normal lung.

Objective:To study the effects of Shixinyatong buccal tablets(SBT)in patients after the extraction of mandibular third molar.Methods:150 cases of patients were divided into 3 groups(n =50).After tooth extraction the patients in SBT,cephalosporin and control groups were given SBT at 0.6 g,4 times per day,cepholosporin 0.5 g,2 times per day and no drug respectively.At the 3rd and 5th day the patients were followed up and their local symptoms were scored.The data were statistically analyzed with SAS 9.0 soft ware.Results:Between SBT and cepholosporin or control group there was no statistical difference in demographic data and impac-tion types of the teeth(P >0.05).The total symptom integral,primary symptom integral,minor symptoms,wound pain,redness, swelling degree and oral odor in SBT group were lower than those in control group(P <0.05)at the 5th day after tooth extraction.Be-tween SBT group and cephalosporin group there was no significant difference(P >0.05)in the total symptom integral,primary symp-tom integral,secondary symptom integral at the 3rd and the 5th day.Conclusion:Shixinyatong buccal tablet is effective in the preven-tion of complications after the extraction of mandibular third molar.

Objective To observe the clinical effects of radiotherapy and/or chemotherapy in the treatment of nasal and Waldeyer ring natural killer (NK)/T cell lymphoma and to analyze the prognostic factors.Methods Between January 20,2000 and December 21,2010,109 patients with nasal NK/T cell lymphoma and 21 patients with Waldeyer ring NK/T cell lymphoma were admitted to our hospital; the diagnosis was confirmed by immunohistochemistry.According to the Ann Arbor staging system,116 patients were classified as stage Ⅰ E,and 14 as stage Ⅱ E.Thirty patients received radiotherapy alone;2 patients received chemotherapy alone; 98 patients received radiochemotherapy.Results The follow-up rate was 100％.Seventy-eight patients were followed up for at least 5 years.The complete remission (CR) rate was 89.2％ in all patients.The CR rates of stage Ⅰ E patients and stage Ⅱ E patients were 88.8％ and 92.9％,respectively (x2 =0.02,P =0.837).The CR rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 86％ and 96％,respectively (x2 =1.44,P =0.230).The five-year overall survival (OS) rate and disease-free survival (DFS) rate of all patients were 58.0％ and 57.2％,respectively.The five-year OS rates of stage Ⅰ E patients and stage Ⅱ E patients were 60.6％ and 36.3％,respectively (x2 =0.25,P =0.615) ;the five-year DFS rates of stage Ⅰ E patients and stage Ⅱ E patients were 59.7％ and 36.3％,respectively (x2 =0.21,P =0.648).The five-year OS rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 70.0％ and 48.4％,respectively (x2 =0.01,P =0.933) ; the five-year DFS rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 65.6％ and 48.4％,respectively (x2 =0.09,P =0.764).The grade 3-4 toxicity rates of radiotherapy alone and radiochemotherapy were 6.7％ and 54.1％,respectively (x2 =41.38,P=0.002).The radiation dose to the primary lesion and Eastern Cooperative Oncology Group (ECOG) score were correlated with OS (x2 =3.1 8,P =0.005 ; x2 =2.97,P =0.008).Conclusions The clinical effect of radiochemotherapy is similar to that of radiotherapy alone in the patients with stage ⅠE and ⅡE nasal and Waldeyer ring NK/T cell lymphoma,but radiochemotherapy has higher toxicity than radiotherapy alone.The radiation dose to the primary lesion and ECOG score are the influential factors for OS.

Objective To compare diagnostic values of the 2015 American Thyroid Association (ATA) Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer with the thyroid imaging reporting and data system (TI-RADS) for sonographic malignancy risk stratification of thyroid nodules.Methods From November 2011 to December 2015,485 thyroid nodules in 331 patients (mean age,42.9 years± 10.4)were included in this study.Characteristics includingsize,composition,shape(nonparallel or parallel),margin,echogenicity,calcifications and extrathyroidal extension of thyroid nodules were evaluated.Every nodule was stratificated by criteria set by TI-RADS and ATA guidelines,and malignant rate of each risk stratification were calculated and analysed.With pathology as the gold standard,different cutoff were taken to diagnose malignant nodules,and the sensitivity,specifity,positive predictive value,negativepredictive value and accuracy of the two methodologies were calculated at each cutoff.And the two methodologies were evaluated and measured by ROC curve.Finally their Kappa value were calculated at the best cutoff.Results Of the 485 thyroid nodules,96 were benign and 389 were malignant.The malignancy rates under TI-RADS category 2,3,4a,4b,4c,and 5 nodules were 0,12.0％ (3/25),22.2％ (10/45),29.8％ (14/47),99.2％ (261/363) and 100％ (101/101).Malignancy rates under ATA guidelines of benign,very low,low,intermediate,and high suspicion for malignancy were 0,12.5％ (1/8),16.1％ (10/62),27.7％ (13/47),and 99.2％ (365/368).There were significant differences inside each patterns (P ＜ 0.01) respectively and high correlation between risk stratification with TI-RADS (r=0.70) and ATA guidelines (r=0.83).Areas under the ROC curve of the TI-RADS and ATA guidelines classifications were 0.966 and 0.959.Best cut-off point for diagnosing malignant by TI-RADS and ATA guideline classifications were ≥ 4c and ≥ high suspicion,and at that point,diagnostic value of TI-RADS and ATA guidelines were nearly the same(sensitivity,93.1％vs 93.8％;specificity,97.9％ vs 96.9％;PPV,99.5％ vs 99.2％;NPV,75.7％vs 79.5％;and accuracy,94.0％vs94.4％),and there was no significant differences (P=0.50,P=0.50,P=0.50,P=0.53,P=0.55),Kappa=0.97.Conclusions Both TI-RADS and the ATA guidelinesprovide effective malignancy risk stratification for thyroid nodules.The diagnosticvalue of TI-RADS when considering ≥ 4c and ATA guidelines when considering ≥ high-suspicion nodules as malignant were nearly the same and both high.

Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver diseases worldwide and covers a series of pathological manifestations from hepatic steatosis to inflammation, fibrosis, and even liver cirrhosis. NAFLD is associated with a wide range of extrahepatic diseases, including metabolic syndrome, cardiovascular disease, chronic kidney disease, endocrine diseases, obstructive sleep apnea-hypopnea syndrome, psoriasis, and skeleton-muscle diseases. The major causes of death in patients with NAFLD include cardiovascular disease, malignancies, and liver-related complications, suggesting that extrahepatic diseases associated with NAFLD should be taken seriously by clinicians. This article reviews the research advances in extrahepatic diseases associated with NAFLD, so as to provide ideas for clinical assessment and treatment.

Purpose: This study was performed to investigate the association of Glasgow prognostic score (GPS), combined positive score (CPS), and clinicopathological characteristics of locally advanced rectal cancer. Methods: Between February 2012 and February 2018, 103 patients with locally advanced rectal cancer treated by neoadjuvant chemoradiotherapy and total mesorectal excision (TME) were retrospectively evaluated. Results: According to the classification of the GPS, 85 (82.5%), 13 (12.6%), and 5 patients (4.9%) were classified as a score of 0, 1, and 2, respectively. Patients were classified into the GPS-low group (GPS of 0, n = 85) and GPS-high group (GPS of 1 or 2, n = 18) with an area under the curve of 0.582 for overall survival (OS). The mean programmed death-ligand 1 (PD-L1) CPS of the whole group was 2.24 (range, 0–70). The PD-L1 CPS of the GPS-high group was higher than the GPS-low group (P < 0.001). Multivariate analysis by Cox proportional hazards model indicated that GPS was associated with OS and diseasefree survival (DFS). Furthermore, PD-L1 CPS was associated with DFS (hazard ratio, 1.050; 95% confidence interval, 1.017– 1.083; P = 0.003). Conclusion Elevated GPS was related to the PD-L1 CPS. GPS and PD-L1 CPS were associated with the prognosis of locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by TME.

Objective: To evaluate whether any association exists between peripheral blood cell-based inflammatory biomarkers obtained before adjuvant chemoradiotherapy and adverse events (AEs) and survival of patients with pathological stage Ⅱ/Ⅲ rectal cancer treated by adjuvant chemoradiotherapy. Methods: A total of 109 rectal cancer patients were included. The prognostic abilities of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and neutrophil to albumin ratio (NAR) for overall survival (OS) were calculated by the receiver operating characteristic (ROC) curves. Results: NAR was associated with the occurrence of grade ≥2 leukopenia (OR=4.442, 95% CI: 1.216-16.221, P<0.05). The 5-year OS rates of patients with NAR ≥ 0.055 and patients with NAR<0.055 were 68.2% and 83.9%, respectively (P>0.05). The 5-year disease-free survival (DFS) rates of patients with NAR ≥ 0.055 and patients with NAR<0.055 were 59.1% and 76.8%, respectively (χ²=3.887, P<0.05). Multivariate analysis by Cox proportional-hazards model showed that NAR was significantly associated with OS (HR=3.035, 95% CI: 1.021-9.019, P<0.05). Conclusions These results suggest that NAR obtained before adjuvant chemoradiotherapy might serve as an independent biomarker for predicting AEs and prognosis in rectal cancer treated with adjuvant chemoradiotherapy.

Objective:To analyze the differences in clinical outcomes and toxicities between postoperative radiotherapy alone and postoperative radiochemotherapy for soft tissue sarcoma (STS), as well as the related factors affecting clinical prognosis of STS patients.Methods:Retrospective analysis of patients diagnosed with primary STS admitted to Zhejiang Cancer Hospital from May 2012 to May 2019 was performed, who received adjuvant radiotherapy after surgery, combined with or without postoperative chemotherapy. A total of 100 patients were enrolled and divided into postoperative radiotherapy group ( n=52) and postoperative radiochemotherapy group ( n=48). The median follow-up time was 65 months (24-124 months). The local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-related toxicities were recorded in two groups. The survival rate was calculated by Kaplan-Meier analysis. Log-rank test was used for univariate analysis, and Cox model was used for multivariate analysis. Results:In multivariate analysis, the maximum tumor diameter was an independent predictor of local tumor recurrence ( HR=4.80, 95% CI=1.16-19.85, P=0.031), distant metastasis ( HR=4.67, 95% CI=1.53-14.26, P=0.007) and OS ( HR=4.10, 95% CI=1.35-12.48, P=0.013). In addition, the degree of myelosuppression in patients in postoperative radiochemotherapy was significantly higher than that in their counterparts in postoperative radiotherapy group ( P<0.001). Conclusions:In the limited number of patients, radiochemotherapy has no advantages over radiotherapy alone in distant metastasis or survival rate. Besides, it increases toxicities, but the overall tolerability is favorable. It is necessary to conduct prospective randomized studies in a large population and subgroup analysis of histological subtypes, aiming to obtain results with better reference value.