OBJECTIVE: To compare the clinical efficacy between thermo-electroacupuncture at yaosanzhen and oral celecoxib in the treatment of chronic lumbar muscle strain with cold dampness. METHODS: A total of 80 patients with chronic lumbar muscle strain of cold dampness were randomly divided into an observation group (40 cases, 1 case dropped out) and a control group (40 cases, 2 cases were excluded). The observation group was treated with thermo-electroacupuncture at yaosanzhen (bilateral Shenshu [BL23], Dachangshu [BL25], Weizhong [BL40]), disperse-dense wave was selected, with a pulse cycle of 0.08 s, current intensity of 1-3 mA, with needles heated to approximately 45 ℃, the duration was 25 min per session, once a day. The control group was given oral celecoxib capsules, once daily, 200 mg each time. Six sessions as one course, with a 1-day interval between courses, 2 courses were required in both groups. The TCM syndrome score, visual analogue scale (VAS) score, Oswestry disability index (ODI) score, and Japanese Orthopedic Association (JOA) score before and after treatment in both groups were compared. The serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), thromboxane B2 (TXB2) and C-reactive protein (CRP) were detected using ELISA method before and after treatment in both groups. The clinical efficacy was evaluated in both groups after treatment. RESULTS: After treatment, the TCM syndrome scores, VAS scores, ODI scores and serum levels of TNF-α, IL-6, TXB2, CRP in both groups were reduced compared with those before treatment (P<0.01), while the JOA scores were increased (P<0.01)；the TCM syndrome score, VAS score, ODI score and serum levels of TNF-α, IL-6, TXB2, CRP in the observation group were lower than those in the control group (P<0.01, P<0.05), and the JOA score was higher than that in the control group (P<0.01). The total effective rate of the observation group was 92.3% (36/39), which was superior to 78.9% (30/38) in the control group (P<0.05). CONCLUSION Thermo-electroacupuncture at yaosanzhen can alleviate pain symptom in patients with chronic lumbar muscle strain of cold dampness, regulate lumbar function, reduce the levels of inflammatory factors, and the therapeutic effect is superior to oral celecoxib.
Humans ; Male ; Female ; Middle Aged ; Adult ; Electroacupuncture ; Acupuncture Points ; Sprains and Strains/genetics* ; Cold Temperature ; Tumor Necrosis Factor-alpha/blood* ; Interleukin-6/blood* ; Aged ; Treatment Outcome ; Young Adult ; C-Reactive Protein/metabolism* ; Chronic Disease/therapy* ; Lumbosacral Region/physiopathology*

Objective:To evaluate the preliminary clinical efficacy and safety of stereotactic body radiation therapy (SBRT) in combination with targeted therapy for metastatic renal cell carcinoma (mRCC).Methods:Clinical data of 58 patients with mRCC who were treated with SBRT in combination with targeted therapy in Sun Yat-sen University Cancer Center from June 2013 to December 2018 were retrospectively analyzed. Among them, 79.3% patients were classified as intermediate or high risk according to International Metastatic Renal Cell Carcinoma Database Consortium Criteria. The median biologically equivalent dose (BED) was 147 Gy (67 to 238 Gy).Results:Overall, 32, 13, 7, 5 and 1 patients received SBRT for 1, 2, 3, 4 and 6 metastatic sites (105 lesions) and 71.4% of them were bone lesions. Targeted therapy was continued during SBRT. With a median follow-up of 9.4 months (range 2.7 to 40.1 months), 18 patients died. The 1-year local control rate was 97.4%. The 1-year progression-free survival was 50.3%. The 1-and 2-year overall survival was 72% and 53%. Approximately 85% patients experienced pain relief after SBRT. Patients who achieved complete or partial response after SBRT obtained better overall survival than those with stable disease or disease progression (1-year overall survival: 83% vs. 48%, P=0.021). In the whole cohort, 6 cases developed Grade Ⅲ adverse events, 4 of which were Grade Ⅲ myelosuppression, 1 case of Grade Ⅲ neuropathy and 1 case of radiation-induced skin injury. Conclusion:Preliminary study reveals that combined use of targeted therapy and SBRT is an efficacious and safe treatment of advanced mRCC.

Objective We aimed to analyze the clinical efficacy and treatment-related complications in patients with T4besophageal squamous cell carcinoma (SCC) who received concurrent CRT,and to explore the potential prognostic factors related to survival. Methods Between 2010 and 2015,143 patients with T4b esophageal SCC treated with CRT were analyzed, including 71% patients with trachea and/or bronchus invasion and 44% patients with aorta and/or large vessel invasion. The median radiation dose was 60 Gy ( range, 44-68 Gy ) with conventional fractionation, including 69 patients ( 48%) treated with three-dimensional conformal radiotherapy and 74 patients ( 52%) treated with intensity-modulated radiotherapy. All patients received concurrent platinum-based chemotherapy during radiotherapy. Kaplan-Meier method was used to analyze the survival,the log-rank test was used to examine group differences,and the Cox regression model was used for multivariate analysis. Results The median overall survival ( OS) time for the whole cohort was 12. 2 months. The 2-and 3-year OS rates were 34% and 29%,respectively. A total of 51 patients experienced ≥2 severe non-hematological complications,including 42 esophageal fistula,6 pneumonia,and 3 esophageal hemorrhage. Patients with severe complications showed significantly worse survival than those without complications (6. 9 months vs.20. 4 months,P＜0. 01).Multivariate analysis revealed that TNM stage and severe complications were independent prognostic factors for OS. Conclusions Patients with T4b esophageal SCC who received CRT showed satisfactory survival but with high risk of severe complications. Therefore,prevention and treatment of severe complications is the key to improve efficacy.

Objective To develop a MOSAIQ Integration PlatformCHN (MIP) based on the workflow of radiotherapy (RT) and to meet the actual requirements in China and the special needs for the radiotherapy department.Methods MIP used C/S (client-server) structure mode running on the local network in the hospital and its database was based on the Treatment Planning System (TPS) and MOSAIQ database.Five network servers,as the core hardware,supplied data storage and network service based on cloud services.The core software was developed based on Microsoft Visual Studio Platform using C# network programming language.The MIP server could simultaneously offer network service for about 200 workstations,including entry,query,statistics,and print of data.Results MIP had 15 core function modules,such as Notice,Appointment,Billing,Document Management (application/execution),and System Management,which almost covered the whole workflow of radiotherapy.Up to June 2016,the recorded data in the MIP were as follows:13546 patients,13533 plan application forms,15475 RT records,14656 RT summaries,567048 billing records,and 506612 workload records.Conclusions The MIP based on the RT workflow has been successfully developed and used in clinical practice.It is an important part of radiotherapy information system construction with the advantages of intuitive operation,real-time performance,data security,and stable operation.It is digital,paperless,user-friendly,and convenient for the retrieval and statistics of data as well as information sharing and department management,and can significantly improve the efficiency of the department.More functions can be added or modified to enhance its potentials in research and clinical practice.

OBJECTIVETo investigate the feasibility of Xelox(capecitabine plus oxaliplatin) in the volumetric modulated arc therapy(VMAT)-based preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer(LARC).

METHODSClinical data of 141 LARC patients in our hospital from April 2011 to April 2013 treated by preoperative CRT based on VMAT with concurrent Xelox followed by surgery were analyzed retrospectively. There were 95 men and 46 women, and the median age was 56 years old. Clinical staging was stage II( in 33 cases(18 cases with II(a, 11 cases with II(b, 4 cases with II(c) and stage III( in 108 cases(1 case with III(a, 52 cases with III(b, 55 cases with III(c). The target doses were 50 Gy for PTV1 in 25 fractions and 46 Gy for PTV2 in 23 fractions.

RESULTSAll the patients completed the planned radiotherapy, and only 2 cases were interrupted with acute grade 3 diarrhea. The overall incidence of grade 3 hematologic and non-hematologic adverse events during CRT was 9.9% and 16.3% respectively without grade 4 toxicity. Operation was performed after a median interval of 54 days(34-86 days) following CRT. The R0 resection rate was 100%, sphincter preservation rate for low rectal cancer was 45.8%(33/72), postoperative complication morbidity was 17.0%(24/141), pCR rate was 32.6%(46/141), and rates of pathological down-staging for the primary tumor, lymph node and clinical stage were 87.2%, 88% and 90.1%, respectively.

CONCLUSIONSXelox is feasible and well tolerated in the treatment of VMAT-based preoperative CRT for patients with LARC, with excellent rates of pCR and pathological down-staging.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Capecitabine ; Chemoradiotherapy ; Deoxycytidine ; administration & dosage ; analogs & derivatives ; Feasibility Studies ; Female ; Fluorouracil ; administration & dosage ; analogs & derivatives ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Organoplatinum Compounds ; administration & dosage ; Radiotherapy, Intensity-Modulated ; Rectal Neoplasms ; pathology ; therapy ; Treatment Outcome

Objective To define individualized internal target volume (ITV) for hepatocellular car-cinoma using four-dimensional (4D) CT, and to compare the differences in target volume definition and dose distribution among 3D, 4D and respiratory-gated plans. Methods 4DCT scanning was obtained for 12 pa-tients with hepatoceUular. Gross tumor volume (GTV), clnical target volume (CTV) and normal tissues were contoured on all 10 respiratory phases of 4DCT images. The 3D, 4D and gated treatment plans were prepared for each patient using three different planning target volumes (PTVs): 1) PTV3D was derived from a single CTV plus conventional margins;2) PTV4D was derived from ITV4D, which encompassed all 10 CTVs plus setup margins (SMs);3) PTV_(Gating) was derived from ITV_(Gating), which encompassed 3 CTVs within ga-ting-window at end-expiration plus SMs. The PTV volume and dose distribution were compared among differ-ent plans. Results The PTV3D was the largest in all 12 patients, but still missed partial target volume in 5 patients when comparing with PTV4D. Both the 4D plans and the gated plans spared more normal tissues than the 3D plans, especially the hver. Without increasing normal tissue dose, the 4D plans allowed for increas-ing the calculated dose from (50.8±2.0) Gy (3D plans) to (54.7±3.3) Gy, and the gated plans could further increase the dose to (58.0±3.9) Gy. Conclusions The 4DCT-based plans can ensure optimal tar-get coverage with less irradiation of normal tissues and allow dose escalation when compared with 3D plans.Respiratory gated radiotherapy can further reduce the target volumes to spare more surrounding tissues, espe-cially for patients with large extent of respiratory mobility.

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