Chinese Clinical Oncology

The experimental study on chemopreventive effect of mustard seed on chemically induced colorectal tumor in mice

LI Xinyan，GUO Wen，YUAN Haifeng，QIU Enqi，YUAN Kui

Chinese Clinical Oncology. 2013, 18 (2): 97.

Abstract ( 1171 )

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Objective To investigate the chemopreventive effects of mustard seed（MS） on azoxymethane （AOM） induced colorectal tumor in mice and to explore its anticancerrelated mechanisms.Methods A total of 60 mice of Kunming species were randomly divided into 4 groups of 15 each： AOM alone， AOM+5％MS， AOM+10％MS and the control group （normal saline）. Colorectal tumorigenesis was induced by injecting AOM 10 mg／kg， subcutaneously， once a week for three weeks. Different doses of MS were given in diet during the study. Thirty-six weeks later， mice were sacrificed under cervical dislocation. The large intestine was isolated and flushed with icecold normal saline. The site， size and number of tumors were recorded. The incidence， the average number and the inhibitory rate of colorectal tumor in each group was determined. Tumor tissues were fixed, dehydrated and paraffinembedded. The histological type was determined by HE staining. Expression of PCNA protein in tumor tissue was detected by immunohistochemical staining and tumor cell proliferation index （PI） was calculated. Apoptosis of tumor tissue was detected by TUNEL staining and tumor cell apoptosis index （AI） was calculated too. Results No tumor was found in control group. The colorectal tumor incidence， as compared to AOM model group （86.7％）， was reduced to 60.0％ by the 5％ diet of mustard seeds and to 41.7％ by the 10％ diet of mustard seeds. The tumor incidence rates of the three groups were significantly different（P=0.048）， with the highest incidence rate in AOM model group， followed by 5％MS intervention group， 10％MS intervention group minimum. Tumor burden （tumors／mouse） was 2.20±1.21 in the AOM model group. Compared with model group， tumor burden was 1.07±1.10 in 5％MS intervention group， and 0.67± 0.89 in 10％MS intervention group（P＜0.05）. PI in 10％MS intervention group was 32.0±3.9， which was lower than that in the AOM model group（59.9±4.4） and 5％MS intervention group（41.7±4.9）， with significant differences（P＜0.05）. AI in 10％MS intervention group was 15.0±2.4，which was higher than that in the AOM model group （6.9±1.4） and 5％MS intervention group（9.3±1.5）， with significant differences （P＜0.05）. Conclusion The mustard seeds possess chemopreventive activity against colorectal cancer induced by AOM in mice， and can reduce the incidence of tumor and average number of tumor. The mustard seeds can reduce the expression of PCNA in colorectal tumor tissue, inhibit tumor cell proliferation and induce apoptosis of tumor cells.

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Schedule-dependent effects of oxaliplatin in combination with ginsenoside Rg3 on human hepatocellular carcinoma cell line SMMC-7721

HUA Qiong，HUA Haiqing，YANG Aizhen，QIN Shukui

Chinese Clinical Oncology. 2013, 18 (2): 102.

Abstract ( 1329 )

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Objective To observe the effects of oxaliplatin in combination with ginsenoside Rg3 on human hepatomacellular carcinoma cell line SMMC-7721 in vitro，and explore the underlying mechanism. Methods SMMC-7721 cells were treated with oxaliplatin or ginsenoside Rg3 alone or in three different schedules： oxaliplatin was given prior to， after， or simultaneously with ginsenoside Rg3.The proliferation of SMMC-7721 cells was determined by MTT assay.The cell cycle distribution and apoptosis rate were analyzed by flow cytometry. The expression of cell cycle related protein：cyclin D1 was measured by Western blotting. Results The inhibition of cell proliferation was significant when SMMC-7721 cells were treated with oxaliplatin or ginsenoside Rg3 alone or in three different schedules： oxaliplatin was given prior to，after，or simultaneously with ginsenoside Rg3.Oxaliplatin plus ginsenoside Rg3 revealed a better effect than ginsenoside Rg3 given prior to oxaliplatin（P＜0.05），similar to oxaliplatin given prior to ginsenoside Rg3（P＞0.05）. The effect of first using oxaliplatin was better than first using ginsenoside Rg3（P＜0.05）.By flow cytometry，oxaliplatin caused cell cycle arrest at S phase，G₂／M phase，while ginsenoside Rg3 blocked cells at G₀／G₁ phase.The apoptosis rate of combining oxaliplatin with ginsenoside Rg3 was similar to oxaliplatin given prior to ginsenoside Rg3（P＞0.05），they blocked cells at G₂／M phase，and both of the groups had a higher apoptotic rate than oxaliplatin given after ginsenoside Rg3（P＜0.05）.The result of Western blotting revealed that the protein level of cyclin D1 was lower in the dual-therapy groups than that in the monotherapy groups.The protein level of cyclin D1 was lower in SMMC-7721 cells treated with oxaliplatin given prior to ginsenoside Rg3 and oxaliplatin plus ginsenoside Rg3. Conclusion The dualtherapy groups have a significant inhibitory effect on the proliferation of SMMC-7721 compared to the monotherapy groups.A synergistic effect in SMMC-7721 cells receiving oxaliplatin followed by ginsenoside Rg3 is similar to that in those receiving oxaliplatin plus ginsenoside Rg3，and the efficacy of the two groups is better than that of oxaliplatin given after ginsenoside Rg3.This is probably due to that the two groups block cells at S phase and G₂／M phase，then induce apoptosis of the cells， and reduce the expression of cyclin D1.

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Clinical study on FOLFOX 4 regimen as systemic chemotherapy for advanced primary liver carcinoma

YANG Liuqing， QIN Shukui， ZHAO Ningli， HUA Haiqing， LIU Xiufeng， CHEN Yingxia， WANG Lin，ZHU Yan

Chinese Clinical Oncology. 2013, 18 (2): 108.

Abstract ( 1232 )

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Objective To observe the efficacy and safety of oxaliplatin（OXA） combined with LV／5-FU as FOLFOX 4 regimen for patients with primary liver carcinoma（PLC）. Methods From July 2004 to July 2012，77 patients were treated with FOLFOX 4 regimen as systemic chemotherapy. FOLFOX4 regimen， namely OXA 85 mg／m² iv，d1； LV 200 mg／m² iv 2h，d₁and d₂； 5-FU 400 mg／m²，iv bolus，d₁and d₂； 5-FU 600 mg／m²， CIV 22 h，d₁ and d₂， two weeks was a cycle. Tumor evaluation was performed every 3 cycles according to RECIST 1.0 criteria. The time to progression（TTP） and overall survival（OS） were observed. Serum AFP level was also monitored according to the schedule. Toxicities were evaluated according to NCI-CTC 3.0 and OXA special Levi neurotoxicity criteria. Results Seventy-seven patients were observed and 72 were evaluatable for efficacy. Three patients obtained partial response（PR），37 patients stable disease（SD） and 32 patients disease progression（PD）.The objective response rate（RR） was 4.2％ and disease control rate（DCR） was 55.6％.The median TTP and median OS were 2.7 months and 6.1 months， respectively. AFP response rate was 11.1％.The stratified analysis showed the efficacy of patients who received systemic therapy before was not inferior to that of initial treatment patients， but patients who have portal vein invasion or extrahepatic metastasis had worse efficacy and prognosis. The main observed adverse effects were leucopenia and mild periphery neurotoxicity. Conclusion Systemic chemotherapy with OXAbased FOLFOX 4 regimen for advanced PLC shows better disease control and survival benefit with mild adverse effects. Thus， it’s worthy of further clinical application widely.

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Clinical observation of albuminbound paclitaxel in the treatment of osteosarcoma with lung metastasis

NIU Xiaohui， YANG Yongkun， HUANG Zhen， XU Hairong

Chinese Clinical Oncology. 2013, 18 (2): 114.

Abstract ( 1215 )

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Objective To evaluate the efficacy and adverse effects of albuminbound paclitaxel as the secondline treatment for osteosarcoma with lung metastasis. Methods Nineteen osteosarcoma patients with lung metastasis failed with firstline chemotherapy were received albuminbound paclitaxel（125140mg／m²iv d₁， d₈）. Twentyone days were regarded as a cycle.The efficacy was assessed according to RECIST 1.0 standard and adverse effect was evaluated by NCI-CTC 3.0 standard. Results The efficacy of 19 patients could be evaluated. No case achieved CR， with 1 PR， 5 SD and 13 PD. The disease control rate was 31.6％， and the response rate was 5.3％. The median progression free survival was 2.2 months. The adverse effect was grade one leucopenia in two cases， and other adverse effects were not observed. Conclusion Albumin-bound paclitaxel as the secondline treatment for osteosarcoma patients with lung metastasis is effective and well-tolerated.

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Expression of β-catenin and colorectal cancer stem cells marker EpCAM^high／CD44⁺in colorectal cancer and their clinical significance

LIU Dan，SUN Jinghua，ZHU Jinming，ZHOU Huan，ZHANG Yang

Chinese Clinical Oncology. 2013, 18 (2): 117.

Abstract ( 1133 )

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Objective To explore the role of Wnt／β-catenin signalling pathway in the maintenance， invasion and metastasis of colorectal cancer stem cells. Methods Double immunohistochemical staining was used to detect the expression of EpCAM^high／CD44⁺which was regarded as the marker of colorectal cancer stem cells in 80 cases of colorectal cancer and 10 corresponding liver metastases. The SP method of immunohistochemistry was used to detect the expression of the key protein β-catenin in the Wnt pathway in these tissues mentioned before. The expression and correlation of β-catenin and EpCAM／CD44 in colorectal cancer were analyzed and their roles in the biological behavior of colorectal cancer were analyzed. Results The abnormal expression of β-catenin in colorectal cancer was 55.0％（44／80），significantly higher than 10％（2／20）in the paraneoplastic normal intestinal mucosa（P＜0.05）.The positive expression of EpCAM／CD44 in colorectal cancer was 66.3％（53／80），which was higher than 0 in the paraneoplastic normal intestinal mucosa. In the 80 cases of colorectal cancer， the abnormal expression of β-catenin has no correlation with gender， age and the magnitude of the tumor（P＞0.05）， but it was significantly correlated with degree of differentiation， depth of invasion， clinical stage and metastasis（P＜0.05）. In the colorectal cancer， the expression of EpCAM^high／CD44⁺ cells had no correlation with gender and the magnitude of the tumor（P＞0.05）， but it was significantly correlated with age， degree of differentiation， depth of invasion， clinical stage and metastasis（P＜0.05）. In the corresponding liver metastases， EpCAM^high／CD44⁺ cells were detected too. In cases with abnormal expression of β-catenin， the positive expression rate of EpCAM／CD44 was significantly higher than those with normal expression of β-catenin（84.1％ vs. 44.4％）， and the difference was statistically significant（P＜0.05）. Positive correlation could be found between the expressions of β-catenin and EpCAM^high／CD44⁺（r=0.417, P=0.000）. Conclusion The abnormal activation of Wnt／β-catenin signalling pathway may prompt the abnormal proliferation of the colorectal cancer stem cells， which leads to the recurrence and metastasis of the cancer.

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Expression of macrophage migration inhibitory factor in osteosarcoma and its correlation with prognosis

CAI Teng，WU Sujia，FAN Gentao，CHU Litao

Chinese Clinical Oncology. 2013, 18 (2): 123.

Abstract ( 1071 )

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Objective To investigate the expression of macrophage migration inhibitory factor（MIF） in osteosarcoma， and explore the relationship between MIF and clinicopathological factors and prognosis. Methods Immunohistochemistry was applied to detect expression of MIF in 61 osteosarcoma tissues and 15 corresponding adjacent tissues（＞5.0cm at the outer edge of the tumor tissue）. The relationship between MIF expression and clinicopathological factors of osteosarcoma was evaluated by chi-square test. Survival was calculated by KaplanMeier method, and survival analysis was proceeded by Cox regression. Results The positive rate of MIF in osteosarcoma tissues was 62.3％， and in adjacent tissues was 33.3％. The difference was statistically significant（P=0.043）. The expression of MIF was significantly correlated with lung metastasis（P=0.006）， but not related with sex， age， location， clinical stage and pathological type. The threeyear survival rate of patients with MIF positive expression was lower than that of those with MIF negative expression（70.3% vs. 95.8%, P=0.019）. Cox proportional hazards regression analysis confirmed that Enneking staging was an independent prognostic facor of osteosarcoma， while MIF was not. Conclusion MIF may play an important role in metastasis in osteosarcoma， so might be employed to evaluate the prognosis of osteosarcoma patients.

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Clinical significance and measurement of serum levels of tumor necrosis factor-α in osteosarcoma

TANG Lina， HU Beibei， LIN Feng， YAO Yang，ZHENG Shuier， GUO Yuewu

Chinese Clinical Oncology. 2013, 18 (2): 126.

Abstract ( 1034 )

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Objective To investigate the serum level of tumor necrosis factor-α（TNF-α） in patients with osteosarcoma pretreatment and its correlation with prognosis. Methods The serum levels of TNF-α in 56 patients with osteosarcoma before chemotherapy and 50 healthy people were detected by ELISA method. The factors affecting the serum TNF-α level of osteosarcoma patients and the correlation of TNF-α with prognosis were also studied. Results The expression of serum TNF-α pretreatment of 56 osteosarcoma patients was （32.08 ± 19.68） pg／ml， higher than （18.00 ± 19.88） pg／ml of the healthy people. There were statistical significances（P=0.04）. The level of TNF-α in osteosarcoma patients was correlated to alkaline phosphatase（P=0.002） and stage（P=0.026）. In osteosarcoma patients， the median overall survival（OS） in elevated TNF-α group（n=44） was 22.2 months， lower than 32.1 months in normal TNF-α group. There were statistical significances（P=0.037）.Conclusion The level of serum TNF-α in patients with osteosarcoma is significantly increased， and is correlated to prognosis. The detection of serum TNF-α has certain value for prognosis and treatment of osteosarcoma.

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Clinical observation of combination regimen contains lobaplatin for advanced metastatic breast cancer

LIU Delin，SUN Weili，WU Yuan，LIU Peiyan

Chinese Clinical Oncology. 2013, 18 (2): 129.

Abstract ( 1072 )

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Objective To observe the efficacy and toxicity of combination regimen contains lobaplatin in treatment of advanced metastatic breast cancer.
Methods From January 2010 to May 2012，47 patients with advanced metastatic breast cancer were enrolled in this study. Lobaplatin（30mg/m²） combined with another chemotherapeutic agents were given to patients. Twentyone to twentyeight days was a cycle.The efficacy and side effects were evaluated after at least two cycles of chemotherapy. Results Therapeutic efficacy and adverse reactions could be evaluated in all patients with no CR patient，13 cases of PR，22 cases of SD and 12 cases of PD.The response rate （RR） was 27.7％ and the disease control rate （DCR） was 74.5％.Stratification analysis by ER， HER-2 status or second-line and third／more than thirdline chemotherapy， no significant differences were found between the DCR and RR. Thirtysix patients had progressed at the deadline of follow-up. The median time to progression was 4.7 months（95％CI：4.1-5.3 months）.The main side effects were myelosuppression，fatigue and gastrointestinal reaction，which were mosty in grade 1-2 and alleviated by symptomatic treatment. Conclusion Combination regimen contains lobaplatin for advanced metastatic breast cancer patients is effective and well tolerated.

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Clinical observation of neoadjuvant chemotherapy in triple negative breast cancer with TAC and TP regimens

RUAN Hanguang，XIONG Juan，WU Meng， WANG Hong，XIONG Daiqun，LIU Shaolong，LI Zhangyun，LEI Qiumo

Chinese Clinical Oncology. 2013, 18 (2): 133.

Abstract ( 1364 )

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Objective To compare the efficacy and adverse events of TAC and TP regimens as neoadjuvant chemotherapy for triple negative breast carcinoma（TNBC）. Methods One hundred and two cases of TNBC patients with pathological diagnose were divided into TAC group（52 cases） and TP group（50 cases）. TAC group：docetaxel 75mg／m² or taxol 135mg／m² iv d₁，ADM 40mg／m² or epirubicin 75mg／m² iv d₂，CTX 600mg／m² iv d₁；TP group： docetaxel 75mg／m² or taxol 135mg／m² iv d₁，cisplatin 30mg／m² iv d₂-d₄. All patients were operated after neoadjuvant chemotherapy for 2-4 cycles at a interval of 21 days. The efficacy and adverse reaction were evaluated. Results In TAC group， 5 cases gained pathological complete response，35 cases gained partial response，9 cases was stable. In TP group， 4 cases gained pathological complete response， 32 cases gained partial response， 5 cases was stable. There was no significant difference in the pathological complete response rate between two groups（P=0.774）， and the overall response rate（RR） was with no significant difference too（P=0.568）. There were 12 cases with progressive disease after chemotherapy for 2 cycles, 3 cases in TAC group and 9 cases in TP group. There were 2 cases with atrial extrasystoles in TAC group, 3 cases with impairment of kidney in TP group. 3-4 degree toxicity of hematologic rate and alopecia rate in TAC group were higher than those of TP group； but 3-4 degree incidence rate of gastrointestinal reaction in TP group were higher than that in TAC group. There were significant statistical differences（P=0.000）.Conclusion TAC and TP regimens for triple negative breast cancer patients is effective and well tolerated.

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Clinical observation of lobaplatin combined etoposide or irinotecan for advanced small cell lung cancer

FU Qiang， SONG Anping， XIAO Xiaoguang， HUANG Liu， QIN Kai， YUAN Xianglin

Chinese Clinical Oncology. 2013, 18 (2): 137.

Abstract ( 806 )

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Objective To observe the efficacy and safety of lobaplatin（LBP） combined with etoposide or irinotecan for patients with advanced small cell lung cancer（SCLC）. Methods Forty-five patients with histologically diagnosed SCLC were divided into two groups. The LE regimen group（lobaplatin 30mg／m² iv d₁， VP-16 100mg iv d₁-d₃，21 days were a cycle） had 25 patients and the LI regimen group（lobaplatin 30mg／m² iv d₁， irinotecan 60 mg／m² iv d₁，d₈，d₁₅，28 days were a cycle） had 20 patients. The efficacy and toxicity were evaluated after at least two cycles of chemotherapy. Results Forty-five patients were evaluable for response， in which 2 achieved complete response（CR）， 24 partial responses（PR）， and the response rate（RR） was 57.8％. The RR in LE regimen group was 48.0％（12／25）， while in LI regimen group was 70.0％（14／20）. The median overall survival（OS） of LE regimen and LI regimen were 8.0 months and 7.0 months， respectively（P=0.255）. The main toxicities were reversible bone marrow suppression and gastrointestinal reaction. Grade 3-4 thrombocytopenia rate was 17.8％（8／45）， the occurence rate was higher in LI regimen than LE regimen（30.0％ vs. 8.0％， P=0.002）. All grade 3-4 diarrhea was all occurred in patients with LI regimen（8.9％，4／45）, who were retreated patints too. There was no treatmentrelated death. Conclusion Lobaplatin combined with etoposide or irinotecan is effective and tolerated for patients with advanced small cell lung cancer，and worth further study.

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Clinical observation of raltitrexed combination with irinotecan versus FOLFIRI regimen as secondline treatment for advanced colorectal cancer

XIE Dacheng， LI Ning， WANG Jingjue， JIANG Weihua， WAGN Liwei， ZHOU Fei

Chinese Clinical Oncology. 2013, 18 (2): 140.

Abstract ( 1141 )

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Objective To compare the efficacy and safety between biweekly raltitrexed and irinotecan with FOLFIRI for patients with metastatic colorectal cancer.Methods A total of 50 patients with metastatic colorectal carcinoma were included into the study. There were 25 patients for irinotecan plus raltitrexed regimen group（treatment group： raltitrexed 2.5mg／m² iv d₁， irinotecan 180mg／m² iv d₁） and 25 patients for FOLFIRI group（control group： irinotecan 180mg／m² iv d₁, leucovorin 400mg／m² iv d₁， fluorouracil 400mg／m² iv d₁， fluorouracil 2400mg／m² iv 46-48 h）. Both two regimens were 14 days as a cycle，and a total of 12 cycles was applied unless there was evidence of disease progression or intolerance of treatment. The efficacy was evaluated every 3-cycle chemotherapy and side effects were evaluated every cycle. Results Patients in treatment group received 1 CR， 4 PR， 18 SD， 2 PD； and in control group were 2 PR， 19 SD， 4 PD. No statistical difference was found between two groups in regard to response rate（20％ vs. 8％） and disease control rate（92％ vs. 84％）. Raltitrexed and irinotecan regimen had higher frequency of grade 1-2 transaminase increase（24％ vs. 4％，P＜0.05）， while FOLFIRIF regimen had higher frequency of grade 1-2 neutropenia（48％ vs. 20％， P＜0.05） and mucositis（32％ vs. 8％， P＜0.05）. Conclusion Raltitrexed and irinotican regimen is effective for metastatic colorectal cancer. It has lower toxicity compared with FOLFIRI regimen.

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Application of the carbohydrate antigen detection for diagnosis and treatment in non-small cell lung cancer

WU Xiaojin， MI Yanyan， HU Ankang， WANG Wei， SANG Chunli， FENG Sumei，YIN Yongmei， ER Yunxiang

Chinese Clinical Oncology. 2013, 18 (2): 144.

Abstract ( 810 )

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Objective To explore the clinical significance of the carbohydrate antigen detection for diagnosis and treatment in non-small cell lung cancer（NSCLC）. Methods The levels of serum CA19-9， CA242， CA125 and CA153 of 60 confirmed patients with NSCLC were measured by multiple tumor marker protein chip detection system and were compared with benign lung lesions control group and the healthy control group. Results The positive rate of serum CA19-9， CA242， CA125 and CA153 in the lung cancer group were higher than benign lung lesions control group and healthy control group， but there was particularly apparent difference in serum CA19-9， CA125 and CA153（P＜0.05）. The positive rates of serum CA199 and CA125 in the patients with lung adenocarcinoma were significantly higher than those in patients with squamous cell carcinoma（P＜0.05）.The positive rates of 4 carbohydrate antigens raised with clinical stages. The positive rates of CA125 and CA153 in stage Ⅰ-Ⅱ were 38.5% and 30.8%, which were higher than those of CA19-9 and CA242, with significant differences（P＜0.05）. Conclusion The carbohydrate antigen for diagnosis and treatment of NSCLC has considerable clinical values， can be used as auxiliary examination to the conventional methods in detecting NSCLC.

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Malignant serous cavity effusion cell blocks in the application of molecular pathological diagnosis

ZHANG Ying， ZHOU Yu， MEI Jia， CAO Xiaohui

Chinese Clinical Oncology. 2013, 18 (2): 147.

Abstract ( 1204 )

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Objective To evaluate the value of malignant serous cavity effusion cell blocks in the application of molecular pathological diagnosis. Methods Tumor cells were collected and embedded into cell blocks through stratified centrifugal from 85 cancer patients with malignant serous cavity effusion， then were detected by immunohistochemistry， fluorescence in situ hybridisation（FISH） and gene sequencing methods. Results The tumor cells of cell block section were rich and remained histological structures. Immunohistochemistry staining could assist diagnosis and tumor parting. FISH and gene sequencing could provide gene amplification and mutation situation. Ten caces of EGFR gene amplification and 8 caces of EGFR gene mutation were observed in 30 non-small cell lung cancer samples. Conclusion Malignant serous cavity effusion cell blocks are useful for the diagnosis and determing the primary source of tumor， which can instruct targeted therapy.

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Dosimetric comparison between Rapid Arc and fixed gantry dynamic IMRT for upper esophageal cancer

CHEN Tingting， ZHANG Xizhi， HUA Wei， WANG Buhai， LI Jun，ZHANG Xianwen，MAO Dongjun

Chinese Clinical Oncology. 2013, 18 (2): 151.

Abstract ( 1093 )

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Objective To compare the dosimetric difference between Rapid Arc and fixed gantry dynamic intensity modulated radiation therapy（IMRT） for upper esophageal cancer. Methods For ten cervical esophageal cancer cases， dIMRT plan（five fixed-fields）and Rapid Arc plan were generated by Varian Eclipse 8.6 treatment planning systerm. Dose volume histograms were adopted for the statistics of D2， D98， conformal index（CI）， homogeneity index（HI） of GTV and PTV， dose volumetric parameters of normal tissues，lung and spinal cord， total accelerator output monitor units and total treatment time. Results When Rapid Arc compared to dIMRT， there were significant differences in D₂，D₉₈，V₁₀₀， CI and HI of GTV（P＜0.05）， and there were only significant differences in D₂， CI and HI of PTV（P＜0.05）. Rapid Arc had more advantages in GTV and PTV. The D₁ of spinal cord was（3644.15±72.89）cGy for Rapid Arc and（3810.69±97.51）cGy for dIMRT（P＜0.05）.The V₂₀ and mean dose of lung were（13.65±2.19）％，（893.95±102.43）cGy for Rapid Arc and（15.14±1.24）％，（882.86±120.67）cGy for dIMRT（P＞0.05）. The number of monitor units were 482±36 and 763±89 in Rapid Arc and dIMRT; the treatment time were （102±19）s and （336±41）s. Conclusion Compared to the dIMRT， Rapid Arc showes similar or better effects in the target dose distribution， it has the advantages in less monitor units and less total treatment time， it reduces the irradiation doses on oragans at risk better. Moreover， it gets better HI and CI.

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Application of CBCT and ultrasound technology in HIFU combined with IMRT for pancreatic cancer

LU Qiyong， LEI Weijie

Chinese Clinical Oncology. 2013, 18 (2): 155.

Abstract ( 1051 )

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Objective To investigate the application of cone-beam computed tomography （CBCT） and ultrasonic technology guided high intensity focused ultrasound （HIFU） combined with intensity modulated radiation therapy （IMRT） for pancreatic cancer. Methods The method of HIFU combined IMRT was used on 21 pancreatic cancer patients collected from December 2010 to June 2012. The treatment effect of HIFU was assessed through the doppler ultrasound， the treatment doses and times of next fraction were regulated according to patient tolerance， the tumor and its blood supply. CBCT guided IMRT was executed with a total dose from 58Gy to 70Gy， and 2Gy at one time， 5 fractions a week， lasting for 6-7 weeks. The setup error and PTV boundary after CBCT guided IMRT were analyzed.The pain relief effect and KPS score were evaluated. Results The total fractions of HIFU were 6-18. The IMRT treatment precision was less than 2mm on average with CBCT guiding. Twelve patients'pain all alleviated completely； 8 patients' pain alleviated partially and 1 case was invalid. There was no serious complication occurred with a total efficacy of 95.0％ in 21 patients. The KPS score of patients before treatment was 46.8±9.1, which was lower than that after treatment（87.1±8.3）, showing significant differences（P＜0.05）. Three patients died， and the average survival time was 10 months. Conclusion With a substantial increase in treatment precision， the combination of HIFU and IMRT enhanced the tumor control ability，deceases the dose of organs at risk to a safe value，and the complications are reduced with improved living quality of patients.

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Clinical significance of colposcopy on screening cervical intraepithelial neoplasia in cytological negative and smooth cervices

SHI Dianyun， CHEN Saiying， SUN Yan

Chinese Clinical Oncology. 2013, 18 (2): 159.

Abstract ( 1170 )

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Objective To evaluate the clinical value of the video colposcopy in screening cervical intraepithelial neoplasia（CIN） in cytological negative and smooth cervices by optically gynecological examination. Methods A total of 1050 women， whose cervices showed smooth by optical examination and cytological negative， were examined with electronic colposcopy in gynecological clinic， and biopsy was taken when the double abnormality of acetowhite epithelium and iodine negative， and other abnormal images were shown. A restrospective analysis of these cases was performed. Results （1） Four hundred and fiftyeight of 1050 cases were examined by biopsy, including 56 cases of abnormal tissue with cervical polyp or polypoid tumors. Among them， 68 cases of CIN were found， including 11 cases of CINⅡ／CINⅢ.（2） Seventytwo of 1050 cases showed the doubleabnormality of acetowhite epithelium and iodine negative. Among them， 64 cases were CIN determined by biopsy. And the positive predictive value of the doubleabnormality of acetowhite epithelium and iodine negative under colposcopy was 88.9％， with a false negative rate of 3.3％.（3） Among 458 women who were examied by biopsy， only one of 350 samples from cervical polyp tissue was CIN（0.3％）， while 67 of 164 samples from the tissues with abnormal colposcopic images were found to be CIN（40.9％）， indicating the close relation between abnormal colposcopic findings and CIN.（4） The results of agedistribution analysis showed that， in the 164 cases with abnormal featares under colposcopy， the incidence of double abnormality of acetowhite epithelium and iodine negative was higher in the age of sexual activity， just the same as the age distribution feature of CIN； while single abnormality of iodine negative appeared more in the age of over 50 years. Conclusion Abnormal features displayed by colposcopy， especially the double abnormality of acetowhite epithelium and iodine negative， has an important significance for the screening of cervical precancerous lesions such as CIN. For this purpose， colposcopic examination is necessary even for the cases of cytological negative and smooth cervices.

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Efficacy observation of ginsenoside Rg3 combined with FOLFOX 4 regimen for patients with carcinoma of rectum

CHEN Dafu， ZHUANG Yongjing， HUANG Jianqiang

Chinese Clinical Oncology. 2013, 18 (2): 163.

Abstract ( 1021 )

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Objective To evaluate the efficacy and safety of ginsenoside Rg3 combined with FOLFOX 4 regimen on patients with carcinoma of rectum. Methods Fifty-two patients after radical resection of rectal carcinoma were randomly divided into two groups. FOLFOX 4 chemotherapy regimen （L-OHP 85mg／m² iv，d₁； CF 200mg／m² iv，d₁-d₂； 5-FU 400mg／m² iv bolus firstly， then 5-FU 600mg／m² iv，d₁-d₂， and two weeks was a cycle） was used in simple chemotherapy group and Rg3combined chemotherapy group underwent Rg3（Rg3 40mg／d po，bid）for 2 months combined with FOLFOX 4. The changes of serum VEGF levels were detected by ELISA method. The quality of life, longterm efficacy and toxicity were evaluated. Results After twomonth treatment，KPS score of Rg3combined chemotherapy group was 75.0±8.3，which was significantly higher than that of simple chemotherapy group （P＜0.05）. Compared with simple chemotherapy group， toxic reactions such as sensory neurotoxicity， naupathia and vomiting were decreased in Rg3-combined chemotherapy group （P＜0.05）. Moreover， serum VEGFs posttreatment of Rg3combined chemotherapy group was 123.26±54.83ng／ml，which was significantly lower than that of simple chemotherapy group （256.71±78.11ng／ml，P＜0.05）. Five-year survival rate of Rg3combined chemotherapy group was 61.4％， which was significantly higher than that of simple chemotherapy group （47.6％，P＜0.05）. Conclusion Rg3 combined with FOLFOX 4 regimen is effective for patients with carcinoma of rectum，is superior to simple FOLFOX 4 chemotherapy， and it can improve quality of life. It may have practical clinical value and worth to study further.

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Clinical analysis of surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus

ZHANG Yiwen， PENG Weixiong， LIANG Jian

Chinese Clinical Oncology. 2013, 18 (2): 166.

Abstract ( 957 )

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Objective To investigate the efficacy of surgical treatment of hepatocellular carcinoma（HCC） with portal vein tumor thrombi（PVTT）.Methods From January 1998 to December 2008，the data of 34 patients of hepatocellular carcinoma with PVTT who had undergone operation were analyzed retrospectively. Results There were 2 cases of death within one month after operation，32 patients gained good recovery. Twentynine cases were followed up（90.6％），the median survival time was 16.2 months，the overall 1-，2-，3-，4-，5-year survival rates were 51.7％，37.9％，24.1％，10.3％ and 3.4％，respectively. There were 23 patients who recevied portal vein（PV） and hepatic artery catheterizing chemotherapy；the overall 1-，2-，3-，4-，5-year survival rates were 57.1％，42.9％，28.6％，14.3％ and 4.7％，respectively.The median survival time was 19.6 months.There were 9 patients with only surgical operation； the overall 1-，2-，3-，4-，5-year survival rates were 45.0％，22.2％，11.1％，0 and 0， respectively. The median survival time was 13.5 months. There were statistical differences between two groups（P＜0.05）. Conclusion Resection of HCC and removal of tumor thrombus in the portal vein is an effective method for hepatocellular carcinoma with tumor thrombus in the portal vein. Postoperative catheterizing chemotherapy may increase survival rates.

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Clinical observation of thalidomide in treatment of patients with advanced soft tissue sarcoma

CAI Mingquan， LI Xiaohong， ZHANG Yinghong， LV Xiaojun

Chinese Clinical Oncology. 2013, 18 (2): 169.

Abstract ( 1042 )

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Objective To evaluate the efficacy and side effects of thalidomide in the treatment of advanced soft tissue sarcoma and impact on quality of life. Methods Twenty-two patients with advanced soft tissue sarcoma were given thalidomide 100mg per day and up to 200mg per day seven days later， at the same time patients were given aspirin 75mg per day orally. The efficacy， side effects and quality of life were evaluated every 2 months. Results Two（9.1％） patients had PR， four patients（18.2％） had SD, and disease control rate was 27.3%. Median time to progression was 1 month， median overall survival was 5 months， and the rate of improved quality of life was 136％. The main side effects were constipation， fatigue， somnolence， which were mostly in grade 1-2, and other adverse reactions were rare. Conclusion Thalidomide regimen as third-line treatment for patients with advanced soft tissue sarcoma is effective， and it can improve life quality， and the side effects can be tolerable.

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Rescue experience of nasopharyngeal bleeding after recourse radiotherapy of nasopharyngeal cancer

XU Zhenhua，YI Fengtao，SHAO Zhixiong，SHU Jianshan

Chinese Clinical Oncology. 2013, 18 (2): 172.

Abstract ( 1167 )

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Objective To explore the rescue method of nasopharyngeal bleeding after re-course radiotherapy of nasopharyngeal cancer. Methods Nine patients with epistaxis after radiotherapy of nasopharyngeal cancer therapy were retrospectively analyzed. All the patient received pre- and post-nostril packing hemostasis. Results In the course of rescue, 2 cases died due to suffocation and hemorrhagic shock, repectively. Seven cases survived from bilateral carotid artery angiogaphy. Conclusion Filling up pre- and post-nostril with endovascular embolization combination therapy can improve the success rate of epistaxis after nasopharyngeal cancer recourse radiotherapy, and worth promoting.

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Progress in metastasis suppressor gene BRMS1

GAO Erli， LIN Zhiyuan， YANG Yinlong

Chinese Clinical Oncology. 2013, 18 (2): 174.

Abstract ( 1111 )

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Genes that inhibit metastasis without affecting primary tumor formation at the primary site are known as metastasis suppressor gene. Breast cancer metastasis suppressor 1（BRMS1） was identified as a new metastasis suppressor gene in 2000. Documented studies have confirmed that BRMS1 is a potent metastasis suppressor in many types of tumor not limited to breast cancer. In this review， we provide an overview of its biology function， the relationships with tumor metastasis， action mechanism and clinical significance.

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The detection of circulating tumor cells and its application in lung cancer

YU Xiongbin，OUYANG Xuenong，YU Zongyang

Chinese Clinical Oncology. 2013, 18 (2): 179.

Abstract ( 1069 )

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Circulating tumor cells（CTCs） are increasingly attracted the interest of the people as an entry point to study the process of lung cancer metastasis. The “seed-soil” hypothesis of the nineteenth century on tumor metastasis has predicted the existence of CTCs. But it was only in recent years， a reliable， reproducible experimental methods for the detection and analysis of CTCs has been established. Currently， CellSearch assay has been widely used in clinical and has been certified by the FDA. CTCs counts can be used to guide the prognosis of patients with metastatic tumors， reflect the efficacy of anticancer drugs， and can monitor tumor recurrence. Analysis of CTCs molecular and genetic characteristics may be regarded as a noninvasive “liquid-based biopsy”，and it can reflect the molecular biology and genetics characteristics of the primary tumor tissue. In this review， we will discuss the biological characteristics of CTCs， its role in the process of tumor metastasis， currently the most commonly used detection method and the clinical value in lung cancer.

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KIF5B-RET fusion gene and non-small cell lung cancer

HAN Ying， CHENG Zhiyong， JIANG Liyuan

Chinese Clinical Oncology. 2013, 18 (2): 183.

Abstract ( 1087 )

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Lung cancer is the leading cause of mortality in cancer worldwide. Molecular targeted therapy is the hotpot of lung cancer study in recent years. In 2012， a novel fusion gene KIF5BRET was identified in non-small cell lung cancer. This fusion gene is more frequently detected in the lung adenocarcinoma， with no or little history of cigarette smoking. The mutually exclusive nature of the RET fusions and other oncogenic alterations such as EGFR，K-Ras，ALK，etc.，suggests that the KIF5B-RET fusion is a new driver mutation. It could be a promising molecular target for the personalized diagnosis and treatment of non-small cell lung cancer.

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标准刊号：	ISSN 1009-0460
	CN 32-1577/R