Objective To report the outcome of gefitinib for Chinese patients with advanced nonsmall cell lung cancer(NSCLC) at Peking Union Medical College Hospital. Methods From Oct. 2002 to Apr. 2006,204 patients with advanced NSCLC received oral ZD1839(250 mg/d)treatment. The were 110(59.9%)men and 94(40.1%)women aged between 25 and 85 years. Thirty-two patients had squamous cell carcinoma, 125 adenocarcinoma, 30 bronchoalveolar carcinoma or adenocarcinoma with partial bronchoalveolar carcinoma, 6 adenosquamous carcinoma. and 11 unspecified. Twenty-six patients had no history of chemotherapy, 62 had no disease progression after chemotherapy, and 111 failed to prior one or more regimens. Median survival was calculated using the Kaplan-Meier method and a Cox regression analysis was used to detect differences in median survival between strata. Results The median survival of all patients and of patients failed to prior chemotherapy were 16.3 months(95% confidential interval CI, 14.5-18.2)and 12.5 months(95% CI 9.3-15.7). The rate of 1-year survival was 57%. The obiective tumor response rate and stable disease rate were 31.4% and 41.7% respectively.The median survival were significantly related with ECOG scores,pathology types,disease progression after chemotherapy,objective efficacy of gefitinib and changes of short-breathing. Among 26 patients with no prior chemotherapy,the median survival was not statistically significant compared with that of other patients. Among the enrolled patients,111 had disease progression and 62 had stable disease after prior chemotherapy, and their median survivals was statistically different. At the time of this analysis. 142 patients had disease progression,58 of whom withdrew from taking gefitinib,and 84 continued gefitinib therapy until death. The median survivals for these subgroups were not significantly different. Among 142 patients with disease progression, 40 received other systemic treatment, the median survival was statistically significant compared with that of other patients. Objective response was significantly related with age,smoking status,pathological type,change of short-breathing and rashes induced by gefitinib. Adverse events were generally mild(grade 1 and 2)and reversible. The most frequent adverse events were rash 72.6%(138/190)and diarrhea 33.7%(64/190).Conclusion Our studv suggests that treatment with gefitinib may be well tolerate and beneficial for some Chinese patients after failure of prior chemotherapy.

Objective To assess the outcome of pemetrexed as monotherapy for Chinese patients with advanced non-small cell lung cancer ( NSCLC) at the Peking Union Medical College Hospital.Methods From February 2006 to August 2009, 69 patients with advanced NSCLC, including 36 (52.2% ) men and 33 (47.8%) women, received pemetrexed monotherapy.Six patients had squamous cell carcinoma, 57 adenocarcinoma, 6 unspecified.Median survival (MS) and progress-free survival (PFS) were calculated using the Kaplan-Meier method.Results Adverse events (AEs) were generally mild (grade 1 and 2) and reversible. The most frequent AEs were gastrointestinal adverse events, skin rash, fever and fatigue. Total 5 cases with 3/4 grade AEs were reported, including fever, fatigue, rash, decreased platelets and elevated ALT/AST. The objective tumour response rate and stable disease rate were 10.1% (7/69) and 47.8% (33/69) respectively. Median PFS of all patients was 4.7 months (95% CI 3.0 -6.4) and mean overall survival was 14.7 months (95% CI 11.5 - 17.9).Conclusions Our study suggests that treatment with pemetrexed may be well-tolerated and beneficial for some Chinese patients after failure of prior chemotherapy. The rate of disease control is high and the frequency of 3/4 grade AEs is very low.

Choledochoscopic minimally invasive gallbladder-preserving cholecystolithotomy is a surgical method for preserving the gallbladder in the treatment of gallstones, and recurrence of gallstones is a hot topic for gallbladder-preserving cholecystolithotomy. The postoperative recurrence rate of gallstones can be reduced by selecting appropriate surgical indications and adopting effective preventive measures after surgery. This article reviews the indications for minimally invasive gallbladder-preserving cholecystolithotomy and postoperative preventive measures for the recurrence of gallstones, in order to better understand the influencing factors for recurrence and provide guidance for the treatment of gallstones by minimally invasive gallbladder-preserving cholecystolithotomy.

Objective To evaluate the role of transbrochial needle aspiration (TBNA) in the diagnosis of patients with enlarged mediastinal and/or hilar lymph node. Methods Patients with mediastinal and/or hilar lymphoadenopathy proven by CT scan were eligible for TBNA as reported. All specimens were directly and instantly smeared for pathological examination. Results From June 1 2004 to December 31 2007, 164 patients were examined: including 80 lung cancers, 69 lung bengin diseases, 2 other malignancy tumor, and 13 without definite diagnosis. Total 260 lymph nodes were punctured. TBNA procedures were successfully carried out in 445/463(96.1%). Sensitivity of TBNA was 82. 5 % (66/80) in patients who had been proven to suffer from bronchogenic carcinoma. There were 25 patients that diagnosis of lung cancer was pathologically determined by TBNA only. A total of 122 lymph nodes in the 80 lung cancer patients were aspirated by TBNA with a positive rate of 65. 6% (80/122). Severe complications were rare except small amount of bleeding at the TBNA site (100/164, 61.0%). From June 1 2006 to December 31 2007, lymph node tissues able to make histology diagnosis were yield in 73.5% (64/87) patients. Through histology pathology, the sensitivities of TBNA were 53. 3% (8/15) for sarcoidosis and 78.6% (33/42) for lung cancer. Conclusion TBNA is quite safe and helpful in diagnosis and staging of bronchogenic carcinoma, and in diagnosis of benign lung diseases.

Objective To evaluate four detectors for the off-axis ratio profile measurements of a CyberKnife system, and provide reference and suggestions for selecting and using the correct detectors. Methods Profiles were acquired by using four detectors, PTW-60017, PTW-60018, PTW-60019 and IBA-SFD, at different depths for different collimator sizes, with the detector stem being oriented both perpendicular and parallel to the central beam axis. The differences of profiles and the influence of detector orientation on measurement result were analyzed. Results All full width at half maximum ( FWHM) of field measured by four detectors in parallel orientation was larger than that in actual field size. The deviation was increased with the size of collimator and measurement depth, with the maximum deviation of 1. 9 mm. The maximum deviation of FWHM among four detectors was 0. 2 mm. The penumbra was the smallest for IBA-SFD, and the largest for PTW-60019. The maximum deviation of penumbra was 0. 3 mm. The IBA-SFD tended to over-respond in the out-of-field region when the collimator size was larger than 30 mm. Both FWHM and penumbra in perpendicular orientation were smaller than those in parallel orientation for PTW-60017, PTW-60018 and PTW-60019, especially at 5 mm collimator. However, the trend was opposite for IBA-SFD. With the increase of collimator aperture, the difference between the right and left penumbra acquired by four detectors was increased, with more obvious stem effects. Conclusions Similar profiles were acquired by four detectors, but the detector characteristics and effects of detector orientations should be considered.

OBJECTIVETo arrive at correct diagnosis of pulmonary solitary nodule by clinical manifestation and chest CT scan.

METHODSNinety-eight patients with pulmonary solitary nodule were treated from 1990 to 2000. Their CT findings with clinical manifestations were correlated with the pathology results.

RESULTSOf 98 patients, there were 46 (46.9%) lung cancers, 14 (14.3%) benign tumors, 38 (38.8%) tuberculosis. Fifty-six (57.1%) patients had been asymptomatic or only associated with cough and sputum. 50% of these patients had stage I lung cancer. Tuberculosis was diagnosed more frequently in young patients with protracted feverishness, night sweats, chest and back pain, whereas lung cancer was more common in older patients who were asymptomatic or associated only with cough, sputum and hemoptysis. Lesions with well-defined margin, smooth and in the middle lobe by chest CT was suggestive of benign tumor, while those with irregular margin, un-even density, spiculated margin, lobulated contour and pleural shrinkage were more commonly associated with lung cancer. Those with calcification and in the lower lobe implied tuberculosis.

CONCLUSIONScreening of high risk population is useful in finding early lung cancer. Pulmonary solitary nodule can be correctly diagnosed chiefly by referring to the clinical manifestations and characteristics of chest CT scans. Nodules less than 1cm across are difficult to diagnose and, therefore, exploration is indicated.

Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Radiography, Thoracic ; Solitary Pulmonary Nodule ; diagnosis ; diagnostic imaging ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary ; diagnostic imaging ; etiology

Objective:To investigate the effect of Halo-Vest on the dose distribution of different radiotherapy techniques for primary cervical spine malignant tumors.Methods:Ten patients with primary cervical spine malignancies who underwent radiotherapy after Halo-Vest surgery were retrospectively studied. The IMRT and VMAT plans were designed on the contoured CT images including Halo-Vest delineations using Monaco planning system. The IMRT and VMAT plans with the same field parameters were duplicated to the CT images without the Halo-Vest delineations, and the dose distribution was recalculated. The dose distribution of the target, organs at risk and normal tissues was analyzed and compared for the plans with and without the Halo-Vest delineation.Results:For most dosimetric parameters of VMAT plans, the mean deviations induced by the Halo-Vest were less than 1%, except for PGTV 107%. Without Halo-Vest delineation, the mean maximum dose of spinal cord and spinal cord-PRV increased by 0.38 Gy and 0.42 Gy ( Z=-2.803, -2.803, P<0.05), respectively. The mean Dmean of spinal cord and spinal cord PRV increased by 0.35 Gy and 0.37 Gy, respectively ( Z=-2.703, -2.701, P<0.05). The maximum deviation observed in the mean V5, V30, and Dmean of mucosa, thyroid, parotid gland, mandible, mandibular joint, and normal tissues was 0.74%. For IMRT plans, larger dosimetric deviations than VMAT plans were observed in PTV and PGTV, most of which were more than 1.0% and the maximum deviation was 4.55%. The absence of Halo-Vest delineation increased the mean maximum dose of spinal cord and spinal cord-PRV by 0.48 Gy and 0.59 Gy ( P>0.05), respectively. The mean Dmean of spinal cord and spinal cord PRV increased by 0.57 Gy and 0.59 Gy, respectively ( Z=-2.293, -2.293, P<0.05). The maximum deviation of other organs at risk was 1.98%. Conclusions:There are no clinically significant dose differences for VMAT planning with or without Halo-Vest delineation on the CT images. But the dosimetric impact of absent or partial Halo-Vest delineation on IMRT planning is relatively large and should be considered.

OBJECTIVETo explore ALK protein expression and gene fusion in formalin-fixed and paraffin-embedded (FFPE) specimens obtained from lung cancer by bronchoscopy, and to investigate the relationship between ALK status and clinicopathological characteristics of the patients.

METHODSSeventy-four FFPE samples obtained from lung adenocarcinoma by bronchoscopy were tested for ALK protein expression and gene fusion respectively by immunohistochemistry (IHC) using Ventana D5F3 antibody and fluorescence in situ hybridization (FISH) using ALK break apart probe.

RESULTSsixty-five of the 74 samples were successfully tested by FISH (87.8%, 65/74) . There were 5 FISH-positive cases (7.7%, 5/65) , all with advanced stage carcinoma. Among these five FISH-positive cases, 3 were IHC-positive (4.1%, 3/74) and 2 IHC-negative cases. All the other 69 samples were IHC-negative, including nine FISH-uninformative samples (7 samples were less than 50 tumor cells and 2 samples with weak FISH signal). Both ALK IHC and FISH results were not correlated with age, sex, history of smoking, histological classification, differentiation and lymph node metastasis.

CONCLUSIONSBronchoscopic specimens of lung cancer can be used to detect ALK expression and gene fusion. Immunohistochemistry in combination with FISH test may be more favorable for ALK test.

Adenocarcinoma ; metabolism ; Gene Fusion ; Humans ; Immunohistochemistry ; In Situ Hybridization, Fluorescence ; Lung Neoplasms ; metabolism ; Receptor Protein-Tyrosine Kinases ; metabolism

Objective To evaluate the efficacy and safety of anlotinib in patients with advanced non-small cell lung cancer (NSCLC).Methods Patients with stageⅢB/ⅣNSCLC who progressed after two lines or more regimens were randomized into anlotinib group (12 mg daily from day 1 to 14 of a 21-day cycle) or placebo group with ratio of 2:1. Study drugs or placebo were given until disease progression or intolerable toxicity. The primary endpoint was overall survival (OS), and the second endpoints were progression free survival (PFS), objective response rate, and disease control rate. Results Between April 2015 and December 2015, twenty-four patients were assigned at Peking Union Medical College Hospital. The baseline characteristics of the anlotinib group (n=16) and placebo group (n=8) were fairly comparable. The median OS was 12.7 months in anlotinib group and 11.1 months in placebo group (P=0.460). The median PFS was 4.0 months in anlotinib group and 1.4 months in placebo group (P=0.065). The common adverse events were manageable such as hypertension, hand-foot syndrome, thyroiddy sfunction. No drug-related mortality occurred. Conclusions Anlotinib had a trend of improvement in OS and PFS as third-line treatment or beyond in advanced NSCLC compared with placebo with manageable toxicity.

BACKGROUNDImprovement of quality of life (QoL) is an important endpoint for assessment of treatment of non-small cell lung cancer (NSCLC). This study is to report the changes of QoL before and during the treatment with epidermal growth factor receptor inhibitor, gefitinib, for patients with advanced NSCLC.

METHODSThirty-one eligible patients with NSCLC, who participated in gefitinib compassionate-use program, were enrolled in the study. One oral gefitinib tablet (250mg) was administered every day without interruption unless disease progression or unacceptable toxicity occurred. The impact of treatment on disease-related symptoms and QoL was evaluated with the Chinese versions of European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30 and QLQ-LC13).

RESULTSAfter eight weeks of treatment, the mean scores of four functioning scales (physical, role, emotional and social) and global QoL increased significantly. Mean scores of main general symptoms (fatigue and appetite loss) and disease-related symptoms (dyspnoea, coughing, pain in chest, pain in arm and shoulder and pain in other parts) decreased significantly. Response rate of five functioning and global QoL were all more than 50% after gefitinib treatment. Response rate of main general symptoms and disease-related symptoms varied from 44%-84%. QoL and symptom response correlated with objective tumor response.

CONCLUSIONSGefitinib treatment can improve the QoL and symptoms of advanced NSCLC patients who failed to conventional treatments.