Objective To compare the efficacy between californium?252 ( 252 Cf ) neutron intraluminal brachytherapy combined with external?beam radiotherapy with lead?shielding pelvic parallel opposing field technique and non?lead?shielding four?field box technique for cervical cancer. Methods A total of 52 patients with stage Ⅱa?Ⅲb cervical squamous cell carcinoma who were admitted to our hospital from 2004 to 2007 were enrolled as subjects and paired by clinical stage, age, tumor size, and degree of anemia. The 26 pairs of patients were divided into lead?shielding pelvic parallel opposing field group (lead?shielding group) and non?lead?shielding four?field box group (non?lead?shielding group). For all patients in both groups, 252 Cf neutron brachytherapy was added in external?beam radiotherapy. The local control (LC), overall survival (OS), and disease?free survival (DFS) rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The difference in the incidence of late complications was analyzed using the McNemar method. Results There were significant differences in 5?year LC, OS, and DFS rates between the lead?shielding group and the non?lead?shielding group (85% vs. 81%, P= 0?? 014;89% vs. 73%, P=0?? 013; 89% vs. 73%, P= 0?? 013 ). There was also significant difference in the incidence of late complications between the lead?shielding group and the non?lead?shielding group ( 12% vs. 23%, P=0?? 008). Conclusions When intraluminal brachytherapy combined with external?beam radiotherapy is used to treat cervical cancer, the centers of the front and back fields should be shielded by lead, regardless of whether the parallel opposing field technique or the four?field box technique is used.

Objective To evaluate clinical effect of volume modulated arc therapy ( VMAT) for spinal metastases .Methods Twenty patients with spinal metastases who had been treated with VMAT were chosen to participate in the study .The prescribed dose varied from 45 to 60 Gy within 15 -20 fractions, 3 Gy per fraction, and one fraction per day of VMAT .Pain and quality of life were measured before VMAT and at several time points up to 6 months after treatment , by the numerical rating scale (NRS) and verbal rating scale (VRS) and the quality of life scale for bone metastases (EORTC QLQ-BM22) questionnaire.In addition, Frankel grading was used to evaluate the neurological function of spinal cord.The primary endpoint was frequency and duration of complete pain relief , and the secondary endpoint was death.Results At the end of the follow-up, the number of patients reporting no pain from spinal metastases, as measured by the NRS, increased from 0 of 20 before VMAT to 10 of 14 ( t =20.24, P<0.05) .NRS-reported pain reduction from baseline to 1 weeks and 4 weeks after VMAT were clinically meaningful with NRS score (6.50 ±0.51) at baseline,(4.30 ±0.47)at 1 week and(2.50 ±0.50)at 4 weeks (t=15.98, 27.57, P<0.05).The pain reduction maintained until the end of the follow-up.These improvements were accompanied by significant reduction in opioid use during the first 6 months after VMAT (16 of 20 patients with strong opioid use at baseline vs.6 of 18 at 6 months; t =8.46, P <0.05). According to EORTC QLQ-BM22 questionnaire , patients obtained significant improvement in pain location , severity, and function with the score (46.50 ±1.50)at baseline, (38.35 ±0.98) at 4 weeks(t=21.51, P<0.05).However,no significant alleviation in social psychology was reported (P>0.05).After VMAT, the patients who suffered from nerve function impairment recovered to different extent . No one had radiation-induced injury , such as radiation myelitis , radiation pneumonitis , etc.Median survival time was 10 month.Conclusions VMAT is a safe and effective treatment method for spinal metastases .Significant reductions in patient-reported pain were observed , along with nerve dysfunction improved .The patients′quality of life was significantly improved .VMAT has no late spinal cord toxicities .

Objective: To explore the application effect of tarso-conjunctival flap for one-stage repairing eyelid posterior defect after resection of eyelid tumors. Methods: From June 2014 to December 2016, 33 patients with 33 cases of eyelid posterior tumors were treated, including 21 cases of Pigmented nevus of eyelid, 7 cases of eyelid basal cell carcinoma, 3 cases of eyelid adenocarcinoma and 2 cases of eyelid squamous cell carcinoma. Direct resection was performed for eyelid nevus, Mohs method (intraoperative delivery of frozen sections to control the cut edge) resection was performed for malignant tumors. According to the scope and location of the defect, the tarso-conjunctival flap was used to repair the posterior defect of the eyelid, and the eyelid anterior defect was treated with local flap transfer. Results: All 33 patients were followed up for 3 to 24 months. In addition to the absence of eyelashes in the defect area, one case had mild blepharoptomy (1 mm) and recovered after self-recovery. The remaining cases had recovered in appearance and function of eyelid with no serious complications. Conclusions The flexible application of tarso-conjunctival flap can basically solve the problem of repairing eyelid posterior defect after resection of eyelid tumors. The operation method has clinical practical value.