Objective To observe the lung protection of Astragalus membranaceus against radiotherapy to intermediate-stage and terminal thoracic neoplasm, and its influence on TNF-α and ET expression.Methods The patients with intermediate-stage and terminal thoracic neoplasm under radiotherapy were divided into a treatment group and a control group.Patients in the treatment group took 10 ml of Asragalus membranaceus twice a day.for consecutive 6 months from the beginning of radio therapy.TNF-α and ET in the plasma were measured before and after the radiotherapy.The clinical symptom,iconographic changes and lung diffusion were observed from the 15th day of radiotherapy.Results The TNF-α and ET in plasma afterthe radiotherapy were(2.48±0.75)as/ml and(69.32±23.03)pg/ml for the treatment group,and(5.12±1.01)ns/ml and(97.87±37.83)pg/ml for the control group with the statistial difference(x2=7.49,6.57,P<0.001).The decrease of CO diffusion 5 and 10 months after the radiotherapy in the treatment group was statistically different compared with that in the control group(x2=3.98,3.78,P<0.05).There was a statistical difference of the incidence of acute radiation pneumonitis and pulmonary fibrosis between these two groups(P<0.05).Conclusions Astragalus membranaceus could inhibit the excess expression of TNF-α and ET in plasma and reduce the deterioration of diffusion after radiotherapy,so that it can be used for intervention of lung injuries from radiotherapy.

Objective To investigate the risk factors for acute radiation esophagitis andpneumonitis after radiation therapy in esophageal cancer (EC) patients with diabetes or hypertension.Methods A total of 373 EC patients receiving three dimensional conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) were included in this study.Among these patients,42 showed concurrent with diabetes and 99 with hypertension.Radiation esophagitis or pneumonitis in patients with or without diabetes,and with or without hypertension were monitored in the 1-year follow up,respectively.Results The prevalence of grade 1,2,3 and 4 radiation esophagitis in diabetes and non-diabetes patients was 40.5％,38.1％,14.3％,4.8％ and 66.2％,27.8％,2.7％,1.8％,respectively,while that of the grade 1,2 and 3 radiation pneumonitis in diabetes and non-diabetes patients was 31.0％,16.7％,9.5％ and 30.8％,15.7％,1.2％,respectively.The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with diabetes and was significantly higher than those with non-diabetes (x2 =13.573,12.279,P ＜ 0.05).The prevalence of grade 1,2,3 and 4 radiation esophagitis in hypertension and non-hypertension patients was 49.5％,38.4％,8.1％,3.0％ and 68.2％,25.5％,2.6％,1.8％,respectively,while that of the grade 1,2 and 3 radiation pneumonitis in hypertension and non-hypertension patients were 30.3％,18.2％,5.1％ and 31.0％,15.0％,1.1％,respectively.The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with hypertension was significantly higher than those with non-hypertension (x2 =5.695、5.422,P ＜ 0.05).Diabetes is an independent risk factor for grade 3 or above acute radiation esophagitis and pneumonitis.Conclusions Diabetes or hypertension might be risk factors for severe radiation esophagitis and pneumonitis in EC patients receiving radiation therapy.

Objective To investigate the efficacy of hypofractionated radiotherapy(HFRT)com-bined with programmed cell death protein-1/programmed cell death ligand-1(PD-1/PD-L1)inhibitors in sequential with granulocyte-macrophage colony-stimulating factor(GM-CSF)and interleukin-2(IL-2)for the treatment of advanced metastatic solid tumors.Methods A prospective single-center single-arm study was designed for patients failed standard treatments for advanced refractory solid tumors in the Department of Radiotherapy of Jiangyin Hospital affiliated to Nantong University,and eli-gible patients were given quadruple therapy:HFRT(5 to 8 Gy × 2 to 3 f)once every 21 days for at least 2 cycles;200 μg GM-CSF from the 1st to 7 th day of radiotherapy,and 2 million IU IL-2 from the 8thto 14th day.Within 1 week after the completion of HFRT,PD-1/PD-L1 inhibitors were used for treatment.The above treatment strategy was repeated.GM-CSF and IL-2 were treated for 6 cycles,fol-lowed by maintenance with PD-1/PD-L1 inhibitors until disease progression(PD)or intolerable toxici-ty occurred.Objective response rate(ORR)and treatment-related adverse events were analyzed.Results From January 9,2021 to June 15,2023,totally 40 patients were enrolled,with follow-up of 2.8 to 31.0 months and a median follow-up of 9.9 months,and 39 patients(97.5％)completed at least one time tumorsite evaluation within the non-radiotherapy target area.97.5％of patients had canc-ers,2.5％had soft tissue sarcomas,and 20.0％had received immune checkpoint inhibitors(ICIs)at baseline check.The ORR was 30.8％,and the disease control rate(DCR)was 71.8％;the ORR for non-small cell lung cancer(NSCLC)was 28.6％,and the DCR was 57.1％;the ORR for colorectal cancer was 14.3％,and the DCR was 71.4％;the ORR for gastric cancer was 16.7％,and the DCR was 66.7％;28 patients(70.0％)had treatment-related adverse events(TRAE),4 patients(10％)had TRAE≥level 3,and the most common types of TRAE were fatigue,fever and hypothyroidism.Conclusion The treatment of HFRT combined with immune checkpoint inhibitors in sequential with GM-CSF and IL-2 is well tolerated and toxicity accepted in patients with advanced metastatic solid tumors,which may provide a new method for salvage treatment of patients with ad-vanced metastatic solid tumors.

Objective To investigate the efficacy of hypofractionated radiotherapy(HFRT)com-bined with programmed cell death protein-1/programmed cell death ligand-1(PD-1/PD-L1)inhibitors in sequential with granulocyte-macrophage colony-stimulating factor(GM-CSF)and interleukin-2(IL-2)for the treatment of advanced metastatic solid tumors.Methods A prospective single-center single-arm study was designed for patients failed standard treatments for advanced refractory solid tumors in the Department of Radiotherapy of Jiangyin Hospital affiliated to Nantong University,and eli-gible patients were given quadruple therapy:HFRT(5 to 8 Gy × 2 to 3 f)once every 21 days for at least 2 cycles;200 μg GM-CSF from the 1st to 7 th day of radiotherapy,and 2 million IU IL-2 from the 8thto 14th day.Within 1 week after the completion of HFRT,PD-1/PD-L1 inhibitors were used for treatment.The above treatment strategy was repeated.GM-CSF and IL-2 were treated for 6 cycles,fol-lowed by maintenance with PD-1/PD-L1 inhibitors until disease progression(PD)or intolerable toxici-ty occurred.Objective response rate(ORR)and treatment-related adverse events were analyzed.Results From January 9,2021 to June 15,2023,totally 40 patients were enrolled,with follow-up of 2.8 to 31.0 months and a median follow-up of 9.9 months,and 39 patients(97.5％)completed at least one time tumorsite evaluation within the non-radiotherapy target area.97.5％of patients had canc-ers,2.5％had soft tissue sarcomas,and 20.0％had received immune checkpoint inhibitors(ICIs)at baseline check.The ORR was 30.8％,and the disease control rate(DCR)was 71.8％;the ORR for non-small cell lung cancer(NSCLC)was 28.6％,and the DCR was 57.1％;the ORR for colorectal cancer was 14.3％,and the DCR was 71.4％;the ORR for gastric cancer was 16.7％,and the DCR was 66.7％;28 patients(70.0％)had treatment-related adverse events(TRAE),4 patients(10％)had TRAE≥level 3,and the most common types of TRAE were fatigue,fever and hypothyroidism.Conclusion The treatment of HFRT combined with immune checkpoint inhibitors in sequential with GM-CSF and IL-2 is well tolerated and toxicity accepted in patients with advanced metastatic solid tumors,which may provide a new method for salvage treatment of patients with ad-vanced metastatic solid tumors.