Objective:To investigate the dosimetric differences between non-coplanar volumetric modulated arc therapy (VMAT) and non-coplanar fixed-field intensity-modulated radiotherapy (IMRT) of Monaco treatment planning system (TPS) in hippocampus-avoidance whole-brain radiation therapy with simultaneous integrated boost(HA-WBRT+SIB) for brain metastases,so as to provide a practical and feasible treatment plan for clinical work. Methods:A total of 22 patients with brain metastases were retrospectively selected. Two radiotherapy plans,which included non-coplanar VMAT and non-coplanar fixed field IMRT of HA-WBRT+SIB,were designed for each patient. The dose distribution,the machine units (MU) of plan,and verification of pre-treatment plan in target area and organs at risk (OARs) between two plans were compared under meeting the prescribed dose requirements of target volume. Results:There were no significant differences in covered volumes (V50 and V55) of 50 and 55 Gy dose,maximum dose (Dmax),heterogeneity index(HI) and conformity index(CI) of planning gross tumor volume(PGTV) between the two plans (P>0.05). For whole-brain planning target volume (PTV-brain-SIB),there was no significant difference in the dose that was covered by 98％ volume (D98％) between IMRT and VMAT (P<0.05). VMAT plan could significantly improve the covered volume of 30 Gy dose (V30) of PTV-brain-SIB,and decrease HI value and increase CI value,and the differences of them between VMAT and IMRT were significant (t=-6.366,3.289,-8.343,P<0.05),respectively. The Dmax values of left and right eyes of VMAT plan were significantly lower than those of IMRT plan,and the differences were significant (t=5.784,5.351,P<0.05),respectively. The Dmax value of right inner ear of VMAT plan was higher than that of IMRT plan,and the difference was significant (t=-2.848,P<0.05). VMAT could significantly increase D100％ value of left and right hippocampus,which was higher than that of IMRT plan,and the differences of them between two plans were significant (t=-2.564,-6.578,P<0.05),respectively. The MU of IMRT plan was significantly lower than that of VMAT plan,and the difference was significant (t=-6.249,P<0.05). The treatment time of VMAT plan was (294.1±16.4) s,which was significantly less than that of IMRT plan,and the difference of that between two plans was significant (t=-7.400,P<0.001). Under the standards of 3％/2 mm and 2％/2 mm of γ analysis,the γ pass rates of IMRT plan were respectively (99.1±0.6)％ and (97.6％±1.0)％,which were significantly higher than those of VMAT plan,and the differences of them were significant (t=-2.733,t=-5.780,P<0.001),respectively. Conclusion:The non-coplanar VMAT and non-coplanar fixed field IMRT based on the Monaco TPS can produce clinically acceptable results for HA-WBRT+SIB in patients with brain metastases. Compared with IMRT,VMAT has better advantage in dose distribution of target volume,and higher treatment efficiency,but IMRT can better protect the hippocampus and reduce the number of MU.

Objective:To investigate the dosimetric differences between non-coplanar volumetric modulated arc therapy (VMAT) and non-coplanar fixed-field intensity-modulated radiotherapy (IMRT) of Monaco treatment planning system (TPS) in hippocampus-avoidance whole-brain radiation therapy with simultaneous integrated boost(HA-WBRT+SIB) for brain metastases,so as to provide a practical and feasible treatment plan for clinical work. Methods:A total of 22 patients with brain metastases were retrospectively selected. Two radiotherapy plans,which included non-coplanar VMAT and non-coplanar fixed field IMRT of HA-WBRT+SIB,were designed for each patient. The dose distribution,the machine units (MU) of plan,and verification of pre-treatment plan in target area and organs at risk (OARs) between two plans were compared under meeting the prescribed dose requirements of target volume. Results:There were no significant differences in covered volumes (V50 and V55) of 50 and 55 Gy dose,maximum dose (Dmax),heterogeneity index(HI) and conformity index(CI) of planning gross tumor volume(PGTV) between the two plans (P>0.05). For whole-brain planning target volume (PTV-brain-SIB),there was no significant difference in the dose that was covered by 98％ volume (D98％) between IMRT and VMAT (P<0.05). VMAT plan could significantly improve the covered volume of 30 Gy dose (V30) of PTV-brain-SIB,and decrease HI value and increase CI value,and the differences of them between VMAT and IMRT were significant (t=-6.366,3.289,-8.343,P<0.05),respectively. The Dmax values of left and right eyes of VMAT plan were significantly lower than those of IMRT plan,and the differences were significant (t=5.784,5.351,P<0.05),respectively. The Dmax value of right inner ear of VMAT plan was higher than that of IMRT plan,and the difference was significant (t=-2.848,P<0.05). VMAT could significantly increase D100％ value of left and right hippocampus,which was higher than that of IMRT plan,and the differences of them between two plans were significant (t=-2.564,-6.578,P<0.05),respectively. The MU of IMRT plan was significantly lower than that of VMAT plan,and the difference was significant (t=-6.249,P<0.05). The treatment time of VMAT plan was (294.1±16.4) s,which was significantly less than that of IMRT plan,and the difference of that between two plans was significant (t=-7.400,P<0.001). Under the standards of 3％/2 mm and 2％/2 mm of γ analysis,the γ pass rates of IMRT plan were respectively (99.1±0.6)％ and (97.6％±1.0)％,which were significantly higher than those of VMAT plan,and the differences of them were significant (t=-2.733,t=-5.780,P<0.001),respectively. Conclusion:The non-coplanar VMAT and non-coplanar fixed field IMRT based on the Monaco TPS can produce clinically acceptable results for HA-WBRT+SIB in patients with brain metastases. Compared with IMRT,VMAT has better advantage in dose distribution of target volume,and higher treatment efficiency,but IMRT can better protect the hippocampus and reduce the number of MU.

Objective     To explore the timing and safety of limited-period lung cancer surgery in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods     Clinical data of of patients infected with COVID-19 undergoing lung cancer surgery (an observation group) in the Department of Thoracic Surgery of Guangdong Provincial People's Hospital, the Department of Thoracic Surgery of General Hospital of Southern Theater Command of PLA, and the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Guangdong Pharmaceutical University from December 2022 to January 2023 were retrospectively analyzed and compared with patients who underwent surgery during the same period but were not infected with COVID-19 (a control group), to explore the impact of COVID-19 infection on lung cancer surgery. Results     We finally included 110 patients with 73 patients in the observation group (28 males and 45 females at age of 52.62±12.80 years) and 37 patients in the control group (22 males and 15 females at age of 56.84±11.14 years). The average operation time of the observation group was longer than that of the control group, and the incidence of anhelation was higher than that of the control group (P<0.05). There were no statistcal differences in blood loss, length of hospital stay, moderate or above fever rate, degree of cough and chest pain, or blood routine between the two groups. Conclusion    It is safe and feasible to perform lung cancer surgery early after recovery for COVID-19 patients with lung cancer.

By the end of 2021, a total of 915000 cases of occupational pneumoconiosis and 450000 existing cases have been reported nationwide. Silicosis is a common and serious pneumoconiosis disease caused by long-term inhalation of large amounts of free silica dust and extensive nodular fibrosis in the lungs. Because its specific pathogenic mechanism has not been elucidated and the relevant research progress is slow, there is still a lack of effective therapeutic and interventional drugs. With the increase of national attention and the unique advantages of Chinese materia medica in the treatment of silicosis, more and more studies have been conducted on the treatment of silicosis with active ingredients of Chinese materia medica in China, but most of them are still in preclinical research stage. This article mainly introduced the pharmacological action and mechanism of selected active components of Chinese materia medica in the intervention of silicosis from three aspects: anti-inflammation, anti-oxidation, and intervention of apoptosis, providing ideas for subsequent research and development of new drugs for silicosis. This article argues, it is considered that some traditional Chinese medicines must observe the pathological changes in the treatment of silicosis in the overall animal experiment, clarify their pharmacodynamic effects, and further study the multiple targets and pathways involved in them to elucidate their specific mechanisms of action. At the same time, it can strengthen the analysis of active ingredients of traditional Chinese medicine, or modify the structure of active ingredients, and then enhance its pharmacological activity in the treatment of silicosis, realizing the transformation of preclinical research stage to the results of clinical research.

Non-small cell lung cancer (NSCLC) is the most common pathological type of lung cancer. The systemic antitumor therapy of advanced NSCLC has undergone renovations of chemotherapy, targeted therapy and immunotherapy, which results in greatly improved survival for patients with advanced NSCLC. Immune checkpoint inhibitors (ICIs), especially targeting programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1), has changed the treatment paradigm of NSCLC. ICIs have become the standard treatment for advanced NSCLC without epidermal growth factor receptor(EGFR) mutation or anaplastic lymphomakinase(ALK) translocation in the first- or second-line setting, and for locally advanced NSCLC following concurrent radiotherapy and chemotherapy. ICIs are also promising in adjuvant/neoadjuvant therapy. More and more ICIs have been approved domestically for the treatment of NSCLC. Led by the NSCLC expert committee of Chinese Society of Clinical Oncology (CSCO), this consensus was developed and updated based on thoroughly reviewing domestic and foreign literatures, clinical trial data, systematic reviews, experts' discussion and the consensus(2019 version). This consensus will aid domestic clinicians in the treatment of NSCLC with ICIs.
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Tumor cells and tumor microenvironment (TME) are closely related. It is known that many factors will change the TME, then affect tumor development, however the change of TME is also inseparable from tumor cells. More and more studies have confirmed that the regulation of TME is the key to anti-tumor therapy. Therefore, it is critical to understand the effect of tumor cells on TME.

Objective:To investigate the value of primary site surgery in stage Ⅳ non-small cell lung cancer (NSCLC) and associated prognostic factors.Methods:The data of stage Ⅳ primary non-small cell lung cancer initially diagnosed from 2010 to 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database and retrospective analyzed. Propensity-matched analysis was performed to decrease the selection bias between surgery and non-surgery groups. Overall survival (OS) and cancer-specific survival (CSS) were calculated by Kaplan-Meier curves. Log rank test and Cox regression analyses were applied to evaluate the prognostic factors.Results:A total of 4 657 patients were recruited. In the matched population, the median OS of surgery and non-surgery groups were 7 and 3 months. The 3-years OS were 14.6% and 5.0%, respectively. The 3-years CSS were 17.3% and 6.5%, respectively. Univariate and multivariate analyses indicated primary lesion surgery was an independent prognostic factor for OS and CSS ( P<0.001). Subgroup analysis showed that patients with stage Ⅳ NSCLC who <80 years old, White and Black, gender, tumor located in the upper lobe and crossover, moderately and poorly differentiated, adenocarcinoma, T1-2 or T4 stage, N0 or N2, without regional lymph node dissection, without metastatic sites operation, and the number of metastatic organs<3, obtained a better 3-years OS and CSS from primary site surgery ( P<0.05). Conclusion:Primary site surgery can significantly improve the OS and CSS of patients with stage Ⅳ NSCLC carefully selected.

Objective:To investigate the value of primary site surgery in stage Ⅳ non-small cell lung cancer (NSCLC) and associated prognostic factors.Methods:The data of stage Ⅳ primary non-small cell lung cancer initially diagnosed from 2010 to 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database and retrospective analyzed. Propensity-matched analysis was performed to decrease the selection bias between surgery and non-surgery groups. Overall survival (OS) and cancer-specific survival (CSS) were calculated by Kaplan-Meier curves. Log rank test and Cox regression analyses were applied to evaluate the prognostic factors.Results:A total of 4 657 patients were recruited. In the matched population, the median OS of surgery and non-surgery groups were 7 and 3 months. The 3-years OS were 14.6% and 5.0%, respectively. The 3-years CSS were 17.3% and 6.5%, respectively. Univariate and multivariate analyses indicated primary lesion surgery was an independent prognostic factor for OS and CSS ( P<0.001). Subgroup analysis showed that patients with stage Ⅳ NSCLC who <80 years old, White and Black, gender, tumor located in the upper lobe and crossover, moderately and poorly differentiated, adenocarcinoma, T1-2 or T4 stage, N0 or N2, without regional lymph node dissection, without metastatic sites operation, and the number of metastatic organs<3, obtained a better 3-years OS and CSS from primary site surgery ( P<0.05). Conclusion:Primary site surgery can significantly improve the OS and CSS of patients with stage Ⅳ NSCLC carefully selected.

OBJECTIVE: To investigate the efficacy and safety of aromatase inhibitor letrozole in treatment of male children with disorders of sex development (DSD). METHODS: Clinical data of 12 male DSD children with a mean age of 14.6±2.5 years admitted to Peking Union Medical College Hospital from January 2014 to January 2016 were retrospectively analyzed. The patients were treated with letrozole (1.25-2.5 mg, once a day) for 3 months or longer, and followed up for 0.5-2.5 years. Clinical manifestation and laboratory test findings were documented, and the efficacy and safety were evaluated. RESULTS: After half-year treatment, the blood luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone levels of patients increased (all < 0.05), and estrogen levels decreased from baseline ( < 0.05). After 1 year of treatment, the blood testosterone level was significantly higher ( < 0.05); the LH and FSH levels tended to increase and the estrogen level tended to decrease, but there was no significant statistical difference ( >0.05). Semen was routinely detected in 8 patients, and sperms were detected in semen of 3 patients with hypospadias. There were no significant changes in biochemical results after treatment, and no significant adverse event was observed during the treatment. CONCLUSIONS Letrozole can effectively increase testosterone levels in patients with disorders of sex development and promote spermatogenesis, it has no significant adverse effects in short-term administration.
Adolescent ; Child ; Disorders of Sex Development ; drug therapy ; Follicle Stimulating Hormone ; Humans ; Letrozole ; therapeutic use ; Luteinizing Hormone ; Male ; Retrospective Studies ; Testosterone

Radiation induced lung injury (RILI) is a serious complication in patients received thoracic radiotherapy. The main clinical symptom of RILI includes short of breath, low fever and cough, seriously affect the survival of patients. How to better prevent and treat RILI is an urgent problem. Target theory, cytokine theory, free radical theory, and vascular endothelial cell damage theory are the main mechanisms of RILI. Among them, reactive oxygen species (ROS) produced during radiotherapy can induce tissue damage throughout the course of RILI, and have a direct effect on both radiation pneumonitis and radiation-induced lung fibrosis. Anti-oxygen therapy including thiol compounds, antioxidant enzymes, and plant antioxidants have been applied in the prevention and treatment of RILI. This article reviews the research and application of antioxidant therapy in RILI.
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