With the increasing utilization of cancer therapy, the incidence of lung injury associated with these treatments continues to rise. The recognition of pulmonary toxicity related to cancer therapy has become increasingly critical, for which interstitial lung disease (ILD) is a common cause of mortality. Cancer therapy-related ILD (CT-ILD) can result from a variety of treatments including chemotherapy, targeted therapy, immune checkpoint inhibitors, antibody-drug conjugates, and radiotherapy. CT-ILD may progress rapidly and even be life-threatening; therefore, prompt diagnosis and timely treatment are crucial for effective management. This review aims to provide valuable information on the risk factors associated with CT-ILD; elucidate its underlying mechanisms; discuss its clinical features, imaging, and histological manifestations; and emphasize the clinical-related views of its diagnosis. In addition, this review provides an overview of grading, typing, and staging treatment strategies used for the management of CT-ILD.
Humans ; Lung Diseases, Interstitial/diagnosis* ; Neoplasms/therapy* ; Risk Factors ; Immune Checkpoint Inhibitors/adverse effects* ; Antineoplastic Agents/therapeutic use*

Patients with severe tumors do not refer to the patients with end-stage tumors,but rather to the patients with a performance status(PS)score between 2 and 4 in certain stages due to various reasons,such as acute or chronic comorbidities,tumor itself,or treatment-related adverse events.To these patients,there is a high probability of achieving survival benefit and/or improvement in PS scores after synergistic management of available life-support technologies and anti-tumor therapies based on dynamic and precise testing.Elderly patients with tumors frequently present with one or more chronic illnesses and have poor toler-ance and compliance to treatment.Moreover,their treatment regimens often lack high-quality clinical evidence,making them more susceptible to developing severe tumors.The management of severe tumors in the elderly is based on three basic diagnosis and treatment technologies:dynamic and precise detection,powerful life support technologies,and skillful application of current anti-tumor treatments.In specific clinical practice,the following 7 flexible and individualized treatment strategies should be adopted for different tumor types:1.concurrent management of cancer and comorbidities,2.upgrading and downgrading of anti-tumor drugs based on PS score,3.dynamic accurate detection,4.skillful combinations for increasing efficacy and reducing toxicity,5.complete overview,paying equal attention to systemic therapy and local therapy,6.safety first in medication for the elderly,7.multi-discipli-nary participation,individualized and comprehensive treatment.This article introduced the concept of severe tumors in the elderly and the associated management strategies,to increase awareness and provide feasible guidance for clinical practice.

Objective: To analyze the treatment of advanced non-small cell lung cancer (NSCLC) with performance status (PS) scores between 2 and 4, in order to improve the diagnosis and treatment of these patients. Methods: A total of 36 patients with advanced NSCLC with hypoxemia were reviewed. The clinical data of disease characteristics, etiology, complications, manifestation, therapy, progression, and secondary biopsy were collected. The clinical efficacy was graded according to the Response Evaluation Criteria In Solid Tumors (RECIST): complete response (CR), partial response (PR), stable disease (SD) and disease progression (PD). Results: All patients had hypoxemia, of whom 86.1% (31 patients) had complications and 55.6% (20 patients) had noninvasive ventilator for respiratory support. 77.8% (28 cases) received broad-spectrum antibiotic treatment, and 78.6% of them got lung osmotic relief after the anti-infection treatment. 15 cases received bedside fiberoptic bronchoscopy suction, of whom two cases were treated with airway stent deposition due to airway obstruction, four cases with thoracic drainage, four cases with anticoagulation, and one with thrombolytic therapy. After these supportive treatment, the PS score of these patients decreased from 3.4±0.5 to 2.5±0.7, while SPO₂ improved from (89.0±5.2)% to (95.0±3.5)%. As first-ling anti-cancer treatment, nine patients were administrated with targeted medicine orally, 13 patients with a combined chemotherapy of pemetrexed plus bevacizumab or carboplatin, eight patients with paclitaxel plus carboplatin, four patients with gemcitabine plus carboplatin, and two patients with docetaxel plus gemcitabine. In the first response evaluation, there were one case of CR, 23 cases of PR, four cases of SD, and eight cases of PD, with a clinical benefit rate of 66.7% and a disease control rate of 77.8%. A total of 22 patients experienced disease progression, of whom eight cases had a secondary biopsy and six cases had gene sequencing. Of these 36 patients, 10 (27.8%) patients survived at the last follow-up, with a progression-free survival of (10.0±6.5) months. Conclusion Besides prompt anti-cancer treatment and best supportive treatment should be incorporated to improve PS and improve outcome.

Objective To discuss the imaging technology and characteristic of perfusion-weighted imaging in rabbit models of hepatic VX2 tumors. Methods Twenty-eight New Zealand rabbits were implanted in liver with VX2 tumor by tissue block. After routine scans were performed on 1.5 T MR scanner, 28 New Zealand white rabbits with VX2 carcinoma were divided randomly into treatment group and control group. Treatment group was divided randomly into group A, group B and group C, 7 animals per group. Perfusion weighted imaging(PWI) was performed in day 14, 25 and 35, respectively, after tumor implantation in all animals. Select the regions of interest (ROI) of the VX2 tumor center, tumor border and pars-tumor parenchyma. Maximal signal reduction slope ( SRSmax ) of the signal intensity versus time curves were created as quantitative variable, and the parameters were calculated and compared in all groups. Results Maximal signal reduction slope ( SRSmax ) of the signal intensity versus time curves were studied in 4 groups, 23 VX2 rabbits,7,5 and 6 in group A , B and C, respectively. The SRSmax of tumor center were ( 12. 6 ± 3.4), ( 9. 8 ± 2. 6 ) and ( 1.0 ± 0. 4 ), the difference was significant ( F = 10. 855, P < 0. 05 ). The SRSmax of tumor border were(48. 3 ± 2.4), (46. 2 ± 1.5 ) and (43. 6 ± 1.8 ) ( P > 0. 05 ). The SRSmax of para-tumor parenchyma were ( 14.4 ± 3.0 ), ( 12. 2 ± 1. 4 ) and ( 14. 8 ± 5.0 ) ( P > 0. 05 ). The difference was significant in different ROI in treatment groups( F value was 7. 435,8. 625 and 12. 595, respectively, P < 0. 05 ). Conclusion PWI can be used in evaluating the liver tumor angiogenesis and angio-degeneration with the treatment of HIFU. It will be possible for qualitative analysis of rabbit models of hepatic VX2 tumors by different treatments.

Objective To study the DWI characteristics,Bcl-2 gene expression and the relevance of the DWI and Bcl-2 in rabbit models of hepatic VX2 tumors after three-dimensional conformal radiation therapy(3D-CRT).Methods Forty hepatic VX2 tumor models were successfully created.After the tumor grew to more than 1 cm in diameter,28 tumor models were treated with 3D-CRT and then divided into four groups using random number table.The remaining 12 tumor models were used as controls and randomly assigned to each group.MR scanning were performed at different times(1st day,5th day,10 th day,15 th day) for each group respectively.ROIs of the VX2 tumor tissue and normal liver tissue were taken and ADC values measured with calculation of their ratio.Expression of apoptotic Bcl-2 gene was determined by using Rt-PCR method.ADC value with their ratio and the relative gray value of Bcl-2/β-actin were calculated using one dimensional analysis of variance and two samples t-test at different times,compared within the group and between groups.Results On the 1st,5 th,10 th and 15 th day,the ADC ratios of the radiotherapy groups were 0.55±0.13,1.32±0.27,0.96±0.34,0.72±0.17 respectively,the corresponding ADC ratios of control groups were 0.69±0.20,0.78±0.24,0.71±0.23,0.79±0.21.The ratio of ADC values for radiotherapy group and the control group were compared,t value was 1.283(P＞0.05),4.974(P＜0.01),3.191(P＜0.01),0.776(P＞0.05)respectively for each group.On the 1st,5 th,10 th and 15 th day,the Bcl-2 gene relative gray value of the radiotherapy groups were 0.92±0.31,0.56±0.28,0.42±0.24 and 0.31±0.15 respectively,the corresponding Bcl-2 gene relative gray value of control group were 1.18±0.50,1.15±0.43,1.16±0.41,1.46±0.19.The Bcl-2 gene relative gray value for radiotherapy groups and the control groups were compared,with t value 0.987(P＞0.05),3.863(P＜0.01),5.401(P＜0.01),5.894(P＜0.01)respectively.The ADC value ratio and Bcl-2 gene relative gray value correlation analysis showed that there was significant negative correlation(r=-0.493,P＜0.01).Conclusion DWI ADC values can reflect the dynamic changes at the molecular level for hepatic VX2 tumors after radiotherapy at different times.

Objective To evaluate the double-arterial phase and portal venous phase scanning in the detection of hepatocellular carcinoma with multi-slice sprial CT (MSCT).Methods Ninety-four patients with hepatocellular carcinoma were examined by abdominal plain CT and early areterial phase (EAP),late arterial phase(LAP),portal venous phase(PVP).Contrast agent of 100 ml (300 mg I/ml) was administrated intravenously by 3 ml/s,for scanning of EAP at 20 to 22 s,LAP at 34 to 37s.and PVP at 60 s.Chi-square test was carried out to compare the sensitivity among various phases.Resuits A total 0f 318 1esions was detected pathologically,with 86 lesions less than 3 cm in size and 232 lesions more than 3 cm.For the early arterial phase,late artefial and portal venous phase,the sensitivity was 39.5%(34),67.4%(58),44.2%(38)respectively for the small tumors,which showed significant differences between phases(X2=15.38,P<0.01).For the large tumors,the sensitivity was 89.6%(208),99.6%(231), 99.1%(230),respectively(X2=39.09,P<0.01).All had positive predictive values of 100%.If the tumors were taken together,the sensitivity was 76.1%(242),90.9%(289),84.3%(268).and the positive predictive value was 88.3%(242/274),86.3%(289/335),93.7%(268/286)for the early arterial phase,late arterial and portal venous phase respectively.There was significant difference of sensitivity and positive predictive value between phases(X2=25.62,9.29,P<0.05).Conclusion Double-arterial phase could improve the detection of tumors,especially for small hepatocellular earcinoma. and late arterial phase scanning is particularly important.

Medical disputes are long-existing and tough social contradictions.In recent years,the third-party mediation is tried out and proved to be an innovative solution to medical disputes.This paper takes Jining medical rights safeguard association as an example to darify the significance of the third-party mediation in handling medical disputes and safeguarding legal rights of patients.