Abstract To further standardize the procurement management of reagents and consumables in disease control and prevention institutions in Zhejiang Province and facilitate incorruptible health building, the procurement management for reagents and consumables in Zhejiang disease control and prevention institutions was created by Zhejiang Provincial Center for Disease Control and Prevention in 2019. Based on three-layer architecture of SaaS, PaaS and IaaS, this platform, which is easy to perform, safe and practical, provides modular portal website services, and its main functions include procurement budget management, procurement plan management, order management, bidding management, contract management, execution-of-contract and acceptance, and payment management. This platform, which was initiated to be run on early 2020, was found to be improve the procurement efficiency, safe management costs, reduce the internal control risk, and facilitate the containment of COVID-19, which may provide the support to improving procurement management and laboratory capability in disease control and prevention institutions.

Objective:To evaluate the safety and tolerance of sequential thoracic radiotherapy combined with PD-1/PD-L1 inhibitors in patients with extensive-stage small cell lung cancer (ES-SCLC) after induction systemic therapy.Methods:ES-SCLC patients from a phase I trial and a real-world study were enrolled for those who received thoracic radiotherapy after induction systemic treatment (chemotherapy/chemotherapy combined with PD-1/PD-L1 inhibitors) and consolidated with PD-1/PD-L1 inhibitors. These two studies were both approved by the Ethics Committee of Chinese Academy of Medical Sciences Cancer Hospital (Clinical Trials.gov number, NCT03971214, NCT04947774).Results:Between January 2019 and March 2021, a total of 11 patients with ES-SCLC were analyzed, aged 52-73 years, with a median age of 62 years. Among them, five patients (45.5%) received induction chemotherapy and six patients (54.5%) received chemotherapy combined with PD-1/PD-L1 inhibitor, and then all received intensity-modulated thoracic radiotherapy after evaluation of systemic treatment efficacy. Two patients developed treatment-related grade G3-5 toxicity (18.2%, 1 treatment-related pneumonitis and 1 radiation esophagitis). G 1-G 2 hematologic toxicity, pneumonia, and anorexia were common mild toxicities. Only one patient (9.1%) terminated immunotherapy due to immune-related pneumonitis. During a median follow-up time of 12.5 months (range: 3.5-16.4 months), the median disease progression-free survival and overall survival was 7.4 months (95% CI: 6.9-8.0 months) and 14.6 months (95% CI: 9.0-20.2 months), respectively. Conclusions:Sequential thoracic radiotherapy followed by PD-1/PD-L1 inhibitor is safe and feasible in patients with ES-SCLC after induction therapy. Given that both thoracic radiotherapy and immunotherapy benefits the ES-SCLC in survival, this comprehensive treatment modality warrants further investigation.

Objective:To summarize survival outcomes and prognostic factors in esophageal cancer (EC) patients treated with intensity-modulated radiotherapy (IMRT).Methods:A retrospective analysis was performed on the clinical and follow-up data of 1 637 patients with EC who were admitted to our hospital from January 2005 to December 2017 and met the inclusion criteria.The 5-year overall survival (OS), progression-free survival (PFS) and pattern of recurrence were analyzed. The Kaplan-Meier method was used to calculate survival rates, Log-rank test for univariate analysis and Cox method for multivariate analysis were used to detect survival difference.Results:1-year, 3-year and 5-year OS and PFS of the entire group were 65.9% and 45.8%, 34.2% and 25.0%, 27.0% and 18.5%, respectively. Median OS and PFS were 19.4 months (95% CI=18.0-20.7 months) and 10.4 months (95% CI=9.3-11.3 months), respectively. Univariate analysis showed that the sex, KPS, tumor location, T stage, N stage, M stage, TNM stage, radiation dose and treatment modality were prognostic factors for 5-year OS and PFS of EC patients ( P<0.05). Multivariate analysis indicated that the sex, KPS, TNM stage, radiation dose and treatment modality were independent prognostic factors for 5-year OS and PFS ( P<0.05). Conclusions:EC patients treated with IMRT can obtain a promising survival. The sex, KPS, TNM stage, radiation dose and treatment modality are independent prognostic factors for prognosis.

Objective:To analyze the survival benefits and treatment related toxic effects of simultaneous integrated boost intensity-modulated radiotherapy (SIB-RT) for non-operative esophageal squamous cell carcinoma patients.Methods:The data of 2 132 ESCC patients who were not suitable for surgery or rejected operation, and underwent radical radiotherapy from 2002 to 2016 in 10 hospitals of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG) were analyzed. Among them, 518 (24.3%) cases underwent SIB (SIB group) and 1 614 (75.7%) cases did not receive SIB (No-SIB group). The two groups were matched with 1∶2 according to propensity score matching (PSM) method (caliper value=0.02). After PSM, 515 patients in SIB group and 977 patients in No-SIB group were enrolled. Prognosis and treatment related adverse effects of these two groups were compared and the independent prognostic factor were analyzed.Results:The median follow-up time was 61.7 months. Prior to PSM, the 1-, 3-, and 5-years overall survival (OS) rates of SIB group were 72.2%, 42.8%, 35.5%, while of No-SIB group were 74.3%, 41.4%, 31.9%, respectively ( P=0.549). After PSM, the 1-, 3-, and 5-years OS rates of the two groups were 72.5%, 43.4%, 36.4% and 75.3%, 41.7%, 31.6%, respectively ( P=0.690). The univariate survival analysis of samples after PSM showed that the lesion location, length, T stage, N stage, TNM stage, simultaneous chemoradiotherapy, gross tumor volume (GTV) and underwent SIB-RT or not were significantly associated with the prognosis of advanced esophageal carcinoma patients who underwent radical radiotherapy ( P<0.05). Cox model multivariate regression analysis showed lesion location, TNM stage, GTV and simultaneous chemoradiotherapy were independent prognostic factors of advanced esophageal carcinoma patients who underwent radical radiotherapy ( P<0.05). Stratified analysis showed that, in the patients whose GTV volume≤50 cm 3, the median survival time of SIB and No-SIB group was 34.7 and 30.3 months ( P=0.155), respectively. In the patients whose GTV volume>50 cm 3, the median survival time of SIB and No-SIB group was 16.1 and 20.1 months ( P=0.218). The incidence of radiation esophagitis and radiation pneumonitis above Grade 3 in SIB group were 4.3% and 2.5%, significantly lower than 13.1% and 11% of No-SIB group ( P<0.001). Conclusions:The survival benefit of SIB-RT in patients with locally advanced esophageal carcinoma is not inferior to non-SIB-RT, but without more adverse reactions, and shortens the treatment time. SIB-RT can be used as one option of the radical radiotherapy for locally advanced esophageal cancer.

Objective:To summarize survival outcomes and prognostic factors in esophageal cancer (EC) patients treated with intensity-modulated radiotherapy (IMRT).Methods:A retrospective analysis was performed on the clinical and follow-up data of 1 637 patients with EC who were admitted to our hospital from January 2005 to December 2017 and met the inclusion criteria.The 5-year overall survival (OS), progression-free survival (PFS) and pattern of recurrence were analyzed. The Kaplan-Meier method was used to calculate survival rates, Log-rank test for univariate analysis and Cox method for multivariate analysis were used to detect survival difference.Results:1-year, 3-year and 5-year OS and PFS of the entire group were 65.9% and 45.8%, 34.2% and 25.0%, 27.0% and 18.5%, respectively. Median OS and PFS were 19.4 months (95% CI=18.0-20.7 months) and 10.4 months (95% CI=9.3-11.3 months), respectively. Univariate analysis showed that the sex, KPS, tumor location, T stage, N stage, M stage, TNM stage, radiation dose and treatment modality were prognostic factors for 5-year OS and PFS of EC patients ( P<0.05). Multivariate analysis indicated that the sex, KPS, TNM stage, radiation dose and treatment modality were independent prognostic factors for 5-year OS and PFS ( P<0.05). Conclusions:EC patients treated with IMRT can obtain a promising survival. The sex, KPS, TNM stage, radiation dose and treatment modality are independent prognostic factors for prognosis.

Objective:To analyze the survival benefits and treatment related toxic effects of simultaneous integrated boost intensity-modulated radiotherapy (SIB-RT) for non-operative esophageal squamous cell carcinoma patients.Methods:The data of 2 132 ESCC patients who were not suitable for surgery or rejected operation, and underwent radical radiotherapy from 2002 to 2016 in 10 hospitals of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG) were analyzed. Among them, 518 (24.3%) cases underwent SIB (SIB group) and 1 614 (75.7%) cases did not receive SIB (No-SIB group). The two groups were matched with 1∶2 according to propensity score matching (PSM) method (caliper value=0.02). After PSM, 515 patients in SIB group and 977 patients in No-SIB group were enrolled. Prognosis and treatment related adverse effects of these two groups were compared and the independent prognostic factor were analyzed.Results:The median follow-up time was 61.7 months. Prior to PSM, the 1-, 3-, and 5-years overall survival (OS) rates of SIB group were 72.2%, 42.8%, 35.5%, while of No-SIB group were 74.3%, 41.4%, 31.9%, respectively ( P=0.549). After PSM, the 1-, 3-, and 5-years OS rates of the two groups were 72.5%, 43.4%, 36.4% and 75.3%, 41.7%, 31.6%, respectively ( P=0.690). The univariate survival analysis of samples after PSM showed that the lesion location, length, T stage, N stage, TNM stage, simultaneous chemoradiotherapy, gross tumor volume (GTV) and underwent SIB-RT or not were significantly associated with the prognosis of advanced esophageal carcinoma patients who underwent radical radiotherapy ( P<0.05). Cox model multivariate regression analysis showed lesion location, TNM stage, GTV and simultaneous chemoradiotherapy were independent prognostic factors of advanced esophageal carcinoma patients who underwent radical radiotherapy ( P<0.05). Stratified analysis showed that, in the patients whose GTV volume≤50 cm 3, the median survival time of SIB and No-SIB group was 34.7 and 30.3 months ( P=0.155), respectively. In the patients whose GTV volume>50 cm 3, the median survival time of SIB and No-SIB group was 16.1 and 20.1 months ( P=0.218). The incidence of radiation esophagitis and radiation pneumonitis above Grade 3 in SIB group were 4.3% and 2.5%, significantly lower than 13.1% and 11% of No-SIB group ( P<0.001). Conclusions:The survival benefit of SIB-RT in patients with locally advanced esophageal carcinoma is not inferior to non-SIB-RT, but without more adverse reactions, and shortens the treatment time. SIB-RT can be used as one option of the radical radiotherapy for locally advanced esophageal cancer.

Objective: To carry out an assessment on the public health risk of imported infectious diseases in Jinhua, so as to provide evidence for prevention and control strategies. Methods : Twenty-nine imported infectious diseases were recruited. A risk assessment index system was established by Delphi method and analytic hierarchy process. The actual values of each index of twenty-nine imported infectious diseases were obtained through special investigation,literature review and consultation. The risk scores were calculated by the improved technique for sequencing by approximate ideal solution (TOPSIS) and classified according to median. Results : Among 41 experts recruited, 38 experts were engaged in infectious disease prevention and control, 31 had senior professional titles, and all had worked for more than 10 years. Through three rounds of consultation by Delphi method and analytic hierarchy process, the risk assessment index system (target level) included four items in criteria levels, which were response capacity, public health impact, the possibility of import and local transmission and population vulnerability in a descending order of weight; twenty-seven indicators, with international attention level, levels of medical institutions with confirmed cases, the emergency response capacity of Centers for Disease Control and Prevention (CDCs) , and effective vaccines with wide coverage weighed higher. There were eleven high-risk diseases, high response capacities lay in dengue, malaria, Zika virus disease and Chikungunya fever. The response capacities for sixteen of the eighteen low-risk diseases were insufficient, especially in emergency response capacity of CDCs, laboratory testing capacity and hospital infection control ability. Conclusion Jinhua has strong capacities to deal with the incidence of dengue fever, malaria, Zika virus disease and Chikungunya fever, compared with other imported infectious diseases.

Objective : To learn the situation of vaccine management in Zhejiang Province by SWOT analysis,so as to provide basis for normalization and standardization of vaccine management. Methods: Through supervision and investigation,the data of vaccine management related human resources and information construction of the CDCs in Zhejiang Province were collected. The comprehensive evaluation of vaccine management in Zhejiang Province was carried out by SWOT analysis,and the SWOT matrix was established for suggestions. Results: The advantages of vaccine management in Zhejiang Province lay in the standardized management of purchase and supply,the construction of vaccine management information system and the guarantee of cold chain system;the disadvantages lay in the insufficient allocation of human resources,new problems of cold chain management,the lack of standardized vaccine management mode and the incomplete coverage of vaccine and vaccination information system;the opportunities lay in the legalization of vaccine management,“Healthy Zhejiang”initiative and the “one run at most”reform in healthcare services;the threats lay in the shortage of vaccine,the gap between the expectation of the public on vaccine management and the current situation,and the reduced capacity of vaccine deployment in the provincial CDC. We should constantly improve the construction of vaccine management system,strengthen the standardized administration,regularly carry out risk assessment on vaccine management,accelerate the full coverage of vaccine and vaccination management information system,and explore the standard operation procedure of vaccine management in Zhejiang Province. Conclusions Although some achievements have been made in vaccine management in Zhejiang Province,there is still a gap from the goals of high-efficiency,high-level,normalization and standardization. The standardization and full coverage of the information system of vaccine management should be strengthen in the next stage.

Objective To evaluate the survival and prognostic factors of esophageal cancer treated with definitive ( chemo ) radiotherapy by applying novel radiation techniques including three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT). Methods Clinical data of 2762 patients with non-operated esophageal squamous cell carcinoma who underwent definitive ( chemo ) radiotherapy from 2002 to 2016 in 10 hospitals were retrospectively analyzed.The prognostic factors were also identified and analyzed. Results The median follow-up time was 60. 8 months. The 1-, 2-, 3-and 5-year overall survival (OS) of all patients was 71. 4％,48. 9％,39. 3％,and 30. 9％,respectively.The 1-,2-,3-and 5-year progression-free survival (PFS) was 59.5％,41.5％,35.2％,and 30％,respectively.The median survival was 23 months.The median time to progression was 17. 2 months.Multivariate analysis demonstrated that age, primary tumor location, clinical stage, tumor target volume, EQD2 and treatment mode were the independent prognostic factors for OS.Primary tumor location,clinical stage,tumor target volume and EQD2 were the independent prognostic factors for PFS. Conclusions In this first large-scale multi-center retrospective analysis of definitive ( chemo) radiotherapy for esophageal squamous cell carcinoma in China, the 5-year OS of patients with esophageal squamous cell carcinoma is significantly improved by 3DCRT, IMRT combined with chemotherapy drugs. However, the findings remain to be validated by prospective clinical trials with high-level medical evidence.

OBJECTIVETo investigate the dosimetric benefit of 4D-CT in the planning target volume (PTV) definition process compared with conventional PTV definition using general margin in radiotherapy of lung cancer.

METHODSA set of 4D-CT images and multiphase helical CT scans were obtained in 10 patients with lung cancer. The radiotherapeutic plans based on PTV determined by 4D-CT and in addition of general margin were performed, respectively. The 3D motion of the centroid of GTV and the 3D spatial motion vectors were calculated. The differences of the two kinds of PTVs, mean lung dose (MLD), V5,V10,V15,V20 of total lung, mean heart dose (MHD), V30 and V40 of heart, D99 and D95 were compared, and the correlation between them and the 3D spatial motion vector was analyzed.

RESULTSThe PTV4D in eight patients were smaller than PTVconv, with a mean reduction of (13.0 ± 8.0)% (P = 0.018). In other two patients, whose respiration motion was great, PTV4D was larger than PTVconv. The mean 3D spatial motion vector of GTV centroid was (0.78 ± 0.72)cm. By using 4D-CT, the mean reduction of MLD was (8.6 ± 9.9)% (P = 0.037). V5, V10, V15, V20 of total lung were decreased averagely by (7.2 ± 10.5)%, (5.5 ± 8.9)%, (6.5 ± 8.4)% and (5.7 ± 7.4)%, respectively (P < 0.05 for all). There was a significant positive correlation between PTV4D/PTVconv and the 3D spatial motion vector of the GTV centroid (P = 0.008). A significant inverse correlation was found between D994D/D99conv and the 3D spatial motion vector of the GTV centroid (P = 0.002). D994D/D99conv, (MLDconv-MLD4D) /MLDconv, total lung (V5conv-V54D)/V5conv, total lung (V10conv-V104D)/V10conv, (MHDconv-MHD4D)/MHDconv, heart (V30conv-V304D)/V30conv were inversely correlated with PTV4D/PTVconv (P < 0.05 for all).

CONCLUSIONS4D-CT can be used to evaluate the respiration motion of lung tumor accurately. The 4D-CT-based PTV definition and radiotherapeutic planing can reduce the volume of PTV in patients with small respiration motion, increase the intra-target dose, and decrease the dose of normal tissue sequentially. For patients with large respiration motion, especially those more than 1.5-2 cm, this method can avoid target miss, meanwhile, not increase the dose of normal tissue significantly.

Four-Dimensional Computed Tomography ; methods ; Humans ; Lung ; physiopathology ; Lung Neoplasms ; radiotherapy ; Movement ; Radiometry ; Radiotherapy Planning, Computer-Assisted ; methods ; Respiration ; Tomography, X-Ray Computed ; methods