Objective:To evaluate the impact of postoperative radiotherapy (RT) and associated risk factors on the prognosis of patients undergoing postmastectomy breast reconstruction (PMBR) for breast cancer.Methods:A retrospective analysis was conducted on 1593 breast cancer patients who underwent PMBR at Tianjin Medical University Cancer Institute & Hospital between January 2010 and October 2023. Patients were divided into an RT group ( n = 351) and a non-RT group ( n =1242) based on whether postoperative radiotherapy was administered. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoint was the incidence of revision surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used for pairing. Continuous variables were compared between the two groups using the independent samples t-tests, while categorical variables were compared using chi-square tests, and survival analysis was performed using the Kaplan-Meier method. Cox proportional hazards model was used to analyze survival influencing factors, and include propensity factors with P<0.2 in univariate analysis into multivariate analysis. Results:In the RT group, there were 3 deaths (0.9%) and 21 cases of disease progression (6.0%); in the non-RT group, 7 patients died (0.56%) and 40 experienced disease progression (3.22%). The median OS was 20.1 months (range: 0.1-164.9), and the median PFS was 19.5 months (range: 0.1-160.9). Pregnancy-associated breast cancer and higher N stage were identified as significant risk factors for OS, while neoadjuvant therapy, absence of adjuvant chemotherapy or endocrine therapy, and higher T stage were significant risk factors affecting patients' PFS. Radiotherapy significantly reduced the survival risk for PMBR patients with pregnancy-associated breast cancer or those receiving neoadjuvant therapy ( P=0.019, 0.027). Compared with other reconstruction methods, implant-based reconstruction was associated with a lower incidence of postmastectomy revision surgery(10.5% vs. 17.0%, P<0.001). Even after radiotherapy, the revision surgery incidence for implant-based reconstruction remained lower than that of other methods (12.2% vs. 14.2%, P=0.591). Compared with other reconstruction types, expander-based reconstruction was associated with an increased incidence of revision surgery (31.9% vs. 10.9%, P<0.001). Conclusions:Postmastectomy radiotherapy can reduce survival risk in PMBR patients with pregnancy-associated breast cancer or who received neoadjuvant therapy, showing positive effects on OS and PFS in high-risk patients. Pregnancy, higher T/N stage, and specific treatment strategies are critical factors influencing the prognosis of PMBR patients. Implant-based reconstruction is associated with a lower incidence of revision surgery, which remains low even after RT, whereas expander-based reconstruction may increase the long-term risk of revision surgery.

With the discovery of programmed cell death protein 1 (PD-1) and its ligand (PD-L1), the crucial role of the immune microenvironment in tumor therapy has been increasingly recognized. In recent years, as research on the interaction between ionizing radiation and the immune system has deepened, low-dose radiotherapy (LDRT) has emerged, based on the concept that LDRT can alleviate the immunosuppressive state of the tumor microenvironment. High-dose radiotherapy (HDRT), on the other hand, can kill in-situ tumors and thus release more tumor antigens. Therefore, combining HDRT with LDRT and integrating it with immunotherapy-collectively known as the "radiotherapy-induced scopal effect" (RadScopal)-has become a promising new therapeutic approach. This review summarizes the mechanisms and clinical studies of this mixed-dose irradiation strategy, aiming to provide a detailed theoretical basis and reference for the clinical application of RadScopal technology.

Objective:To evaluate the impact of postoperative radiotherapy (RT) and associated risk factors on the prognosis of patients undergoing postmastectomy breast reconstruction (PMBR) for breast cancer.Methods:A retrospective analysis was conducted on 1593 breast cancer patients who underwent PMBR at Tianjin Medical University Cancer Institute & Hospital between January 2010 and October 2023. Patients were divided into an RT group ( n = 351) and a non-RT group ( n =1242) based on whether postoperative radiotherapy was administered. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoint was the incidence of revision surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used for pairing. Continuous variables were compared between the two groups using the independent samples t-tests, while categorical variables were compared using chi-square tests, and survival analysis was performed using the Kaplan-Meier method. Cox proportional hazards model was used to analyze survival influencing factors, and include propensity factors with P<0.2 in univariate analysis into multivariate analysis. Results:In the RT group, there were 3 deaths (0.9%) and 21 cases of disease progression (6.0%); in the non-RT group, 7 patients died (0.56%) and 40 experienced disease progression (3.22%). The median OS was 20.1 months (range: 0.1-164.9), and the median PFS was 19.5 months (range: 0.1-160.9). Pregnancy-associated breast cancer and higher N stage were identified as significant risk factors for OS, while neoadjuvant therapy, absence of adjuvant chemotherapy or endocrine therapy, and higher T stage were significant risk factors affecting patients' PFS. Radiotherapy significantly reduced the survival risk for PMBR patients with pregnancy-associated breast cancer or those receiving neoadjuvant therapy ( P=0.019, 0.027). Compared with other reconstruction methods, implant-based reconstruction was associated with a lower incidence of postmastectomy revision surgery(10.5% vs. 17.0%, P<0.001). Even after radiotherapy, the revision surgery incidence for implant-based reconstruction remained lower than that of other methods (12.2% vs. 14.2%, P=0.591). Compared with other reconstruction types, expander-based reconstruction was associated with an increased incidence of revision surgery (31.9% vs. 10.9%, P<0.001). Conclusions:Postmastectomy radiotherapy can reduce survival risk in PMBR patients with pregnancy-associated breast cancer or who received neoadjuvant therapy, showing positive effects on OS and PFS in high-risk patients. Pregnancy, higher T/N stage, and specific treatment strategies are critical factors influencing the prognosis of PMBR patients. Implant-based reconstruction is associated with a lower incidence of revision surgery, which remains low even after RT, whereas expander-based reconstruction may increase the long-term risk of revision surgery.

With the discovery of programmed cell death protein 1 (PD-1) and its ligand (PD-L1), the crucial role of the immune microenvironment in tumor therapy has been increasingly recognized. In recent years, as research on the interaction between ionizing radiation and the immune system has deepened, low-dose radiotherapy (LDRT) has emerged, based on the concept that LDRT can alleviate the immunosuppressive state of the tumor microenvironment. High-dose radiotherapy (HDRT), on the other hand, can kill in-situ tumors and thus release more tumor antigens. Therefore, combining HDRT with LDRT and integrating it with immunotherapy-collectively known as the "radiotherapy-induced scopal effect" (RadScopal)-has become a promising new therapeutic approach. This review summarizes the mechanisms and clinical studies of this mixed-dose irradiation strategy, aiming to provide a detailed theoretical basis and reference for the clinical application of RadScopal technology.

Objective:To explore the mortality and risk factors for chronic obstructive pulmonary disease (COPD)-related mortality in patients with non-metastatic non-small cell lung cancer (NSCLC).Methods:This retrospective cohort study included patients aged 18-80 diagnosed with NSCLC between 2010 and 2019 from the Surveillance, Epidemiology and End Results (SEER) database. Cohort 1 enrolled 89 621 cases of non-metastatic NSCLC to calculate COPD-related mortality; Cohort 2 included 71 949 elderly patients with non-metastatic NSCLC to investigate the risk factors of COPD-related mortality in non-metastatic NSCLC patients using a competing risks model.Results:COPD-related mortality rate was 2.86% among non-metastatic NSCLC patients . COPD-related mortality rate increased with age, with a COPD-related mortality rate of 3.24% in patients aged 60 to <80 years, accounting for 90.9% of COPD related deaths in the whole age group with non-metastatic NSCLC. In the univariate competing risks model, advanced age, male, white race, squamous cell carcinoma, negative lymph node metastasis, no surgical treatment, radiotherapy, no chemotherapy, low-income population and single were identified as risk factors for COPD-related mortality. The multivariate competing risks model revealed that advanced age (70-74 years old: HR=1.24, 95% CI: 1.09-1.42; 75-79 years old: HR=1.23, 95% CI: 1.07-1.41), squamous cell carcinoma ( HR=1.75, 95% CI: 1.60-1.92), radiotherapy ( HR=1.58, 95% CI: 1.41-1.70) were independent risk factors for COPD-related mortality (all P<0.05). Conclusions:COPD-related mortality rate is high in non-metastatic NSCLC patients. Aged over 70 years old, squamous cell carcinoma and radiotherapy are risk factors for COPD-related death.

Deterministic method is a numerical calculation method based on photon-electron coupled transport with high computational accuracy and speed, which has been widely applied in photon radiotherapy dose calculation in recent years. However, this method has been introduced into radiotherapy for only a short period of time, which has been rarely studied in China, and systematic understanding of its characteristics is still lacking. In this article, the principles of deterministic method, current development state and clinical application were reviewed, aiming to provide reference for carrying out relevant research.

Objective To analyze survival benefits of radiotherapy in patients with nasopharyngeal carcinoma (NPC) with distant metastases and analyze relevant prognostic factors.Methods Medical records of 329 patients newly diagnosed with metastatic NPC screened from the Surveillance,Epidemiology and End Results (SEER) database (199 of 329 patients received radiotherapy) between 2010 and 2015 were retrospectively analyzed.Overall survival (OS) and disease-specific survival (DSS) were calculated by Kaplan-Meier curve.The effect of different clinicopathological factors on the clinical prognosis of metastatic NPC patients was evaluated by logrank test and Cox regression analysis.Results The median follow-up time was 12 months.The 3-and 5-year OS rates were 27.4％ and 19.7％.The median OS was 17.9 months.Univariate analysis demonstrated that patients aged＜ 50 years,male,undifferentiated type,stage T3 or T4,positive regional lymph node,brain and liver metastases and 1-2 metastatic sites obtained OS and DSS benefits at 3 years after radiotherapy.Univariate and multivariate Cox analyses after propensity score matching showed that radiotherapy was an independent prognostic factor for metastatic NPC (OS,P=0.004;DSS,P=0.014).Besides,patients aged 60-69 years (OS,P=0.033;DSS,P=0.045),keratinizing squamous cell carcinoma (OS,P＜ 0.05;DSS,P＜ 0.05),stage T4 (OS,P =0.002;DSS,P =0.024),1-2 metastatic sites (OS,P =0.039;DSS,P =0.058),3-4 metastatic sites (OS,P =0.003;DSS,P =0.005) and no chemotherapy (OS,P=0.000;DSS,P=0.000) had poor OS and DSS,whereas sex,race and degree of differentiation exerted no effect on OS and DSS.Conclusions Radiotherapy can significantly improve the OS and DSS of patients with metastatic NPC.Prospective and randomized controlled studies are required to further explore the role of radiotherapy in the management of metastatic NPC.

Objective: To study the effect of remifentanil combined with propofol target-controlled infusion on anesthesia of gynecological laparoscopic surgery. Methods: From August 2016 to August 2018, 132 patients who needed to undergo gynecological laparoscopy in the Maternal and Child Health Care Hospital of Qujing were selected.The patients were randomly divided into two groups according to the principle of simple randomization, with 66 cases in each group.The observation group was given.remifentanil combined with propofol administered by target-controlled infusion for anesthesia.The control group were given fentanyl intravenous anesthesia.The clinical efficacy of the two groups was observed. Results: The onset time of anesthesia[(1.3±0.3)min], awake time[(5.2±1.5)min], anesthesia recovery time[(19.6±5.3)min]and analgesic time[(23.6±3.5)min]in the observation group were all shorter than those in the control group[(3.1±0.6)min, (5.0±3.5)min, (4.06±4.8)min, (48.3±4.4)min](t=12.742, 15.102, 11.265, 12.354, all P<0.0). At 1 min after hemodynamic intubation, 10 min after pneumoperitoneum, 30 min after operation and 30min after operation, the heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the observation group were (82.38±7.45)times/min, (85.65±8.54)times/min, (77.58±8.65)times/min, (80.12±7.77)times/min, SBP: (136.25±20.14)mmHg, (140.36±18.02)mmHg, (129.14±15.24)mmHg, (131.25±16.19)mmHg, DBP: (986.45±11.02)mmHg, (86.59±10.11)mmHg, (80.17±8.29)mmHg, (82.52±8.17)mmHg, which were better than those in the control group[herat rate: (88.14±10.01)times/min, (95.36±8.48)times/min, (86.58±7.33)times/min, (87.48±8.47)times/min; SBP: (140.28±21.57)mmHg, (144.59±21.35)mmHg, (137.33±18.47)mmHg, (136.25±18.47)mmHg; DBP: (90.0±10.14)mmHg, (90.25±11.24)mmHg, (84.25±10.14)mmHg, (82.55±8.84)mmHg](F=1.320, 1.245, 1.365, all P<0.05). Conclusion Remifentanil combined with propofol target controlled infusion for patients undergoing gynecological laparoscopic surgery is helpful to enhance the anesthetic effect, and has a short pharmacodynamic effect, which is conducive to ensuring the quality of surgery.Therefore, it is worthy of popularizing in clinical practice.

Objective: To compare the dosimetric differences among Target-Segmented Plan (TSP), Non-TSP, and conventional static 8-field intensity modulated radiation therapy (8F-IMRT) plan for post-mastectomy irradiation of left-sided breast cancer patients. Methods: This study enrolled thirty consecutive breast cancer patients who underwent radical mastectomy and treated with post-op radiation in Department of Radiation Oncology, Renmin Hospital of Wuhan University from June 2017 to November 2018.The clinical target volume (CTV) included the ipsilateral chest wall, supra/infra-clavicular, high-risk partial axillary in high risk, and internal mammary nodes (IMN). The organs at risk (OARs) near the targets, including ipsilateral lung, heart, contralateral breast, ipsilateral humeral head and spinal cord, were contoured as well. The maximum distance of PTV′s tangent to the outermost side of the affected lung was more than 2 cm. Depending on the maximum distance, the patients were classified into three groups: A(<3 cm), B(3~4 cm) and C(>4 cm), respectively. Three types of treatment plans (TSP, Non-TSP and 8F-IMRT) were created for each patient using the Eclipse treatment planning system with the same dose optimization objective . The dose-volume histograms were compared for the PTVs and OARs. Results: All plans achieved the intended dose criteria.The D_98% of TSP was lower than that of Non-TSP and 8F-IMRT (Z=-3.294, -3.266, P<0.05). However, the homogeneity index (HI) and conformal index (CI) of the three plans had no statistically significant difference among the three plans (P>0.05). Non-TSP required more Monitor Units (MUs)than the other two plans (Z=-3.04, -2.669, P<0.05). The D_mean of TSP was higher than that of 8F-IMRT (Z=-3.181, P<0.05). Compared with Non-TSP and 8F-IMRT plans, TSP significantly reduced V_{5 Gy}, V_{10 Gy}, V_{20 Gy} and D_meanof ipsilateral lung and heart in all patients (lung: V_{5 Gy}: Z=-3.408, -3.408; V_{10 Gy}: Z=-3.408, -3.408; V_{20 Gy}: Z=-3.408, -3.124; D_mean: Z=-3.408, -3.408, P<0.05; heart: V_{5 Gy}: Z=-3.408, -3.408; V_{10 Gy}: Z=-3.408, -3.408; V_{20 Gy}: Z=-2.499, -3.067; D_mean: Z=-3.408, -3.408, P<0.05). The D_mean of contralateral breast in Non-TSP was higher than that in TSP and 8F-IMRT (Z=-2.954, -2.215, P<0.05), and the D_maxhas no significant difference in (P>0.05). There was no significant difference in spinal cord D_max among the three plans, but the D_mean of humeral head in 8F-IMRT was higher than that in TSP and Non-TSP (Z=-3.01, -2.442, P<0.05). In the three groups, the mean amplitude of difference comparing Non-TSP and 8F-IMRT with TSP in ipsilateral lung(V_{5 Gy}, V_{10 Gy}, V_{20 Gy}) and heart(V_{5 Gy}, V_{10 Gy}, D_mean) satisfied the relation: D(N-T, A)<D(N-T, B) <D(N-T, C)和D(8F-T, A)<D(8F-T, B) <D(8F-T, C). Conclusions For post-mastectomy left-sided breast cancer patients, TSP is not only dosimetrically feasible as Non-TSP and 8F-IMRT treatment techniques, but also could effectively reduce the irradiation volume of the ipsilateral lung and heart in the low dose area with minimum adverse dosimetric impact on the treatment targets and other OARs.The advantage of TSP is more prominent with increasing curvature of the clinic target volume.

As the leading cause of death among lung cancer patients, brain metastasis occurs in approximately 10 percent of non-small cell lung cancer (NSCLC) patients at first diagnosis.Whole-brain radiation therapy (WBRT) is still the standard treatment for patients with brain metastasis, however, the efficacy of WBRT reaches a plateau.It has been proved that tyrosine kinase inhibitors (TKIs) make considerable therapeutic effect for NSCLC patients with brain metastasis.The combination therapy of TKIs with WBRT may provide new major treatment for epidermal growth factor receptor (EGFR) mutant NSCLC with brain metastasis.