| Lung cancer is not only the most commonly diagnosed cancer worldwide,but it is still the leading cause for cancer-related death.In our country,lung cancer has also the most morbidity rate and mortality rate.Lung cancer mainly consists of non-small cell lung cancer(NSCLC)and small cell lung cancer(SCLC).NSCLC accounts for more than 80% of all lung cancer cases.The major treatment methods for NSCLC are surgery,chemotherapy,radiotherapy and targeted therapy.There may not have any visible symptom in the early stage,so the percentage of diagnosed cases was only 20%.About 80% of lung cancer patients are at locally advanced or metastatic stage when diagnosed.Stage III locally-advanced non-small cell lung cancer(LANSCLC)represents approximately 30% of new NSCLC diagnoses per year.In the past several decades,the technologies of multidisciplinary treatment for lung cancer has greatly improved.Despite aggressive treatment,5-year overall survival is only 15–20%.Therefore,much work is needed to improve outcomes in this population.Solving how to extending the life span while improving the quality of life has become to our goal.The standard treatment of locally advanced non-small cell lung cancer remains conventional fractionated radiotherapy and concurrent platinum-based chemotherapy.However,a significant percentage of patients diagnosed with advanced stage non-small cell lung cancer are also elderly and have comorbidities,poor performance status,and potentially poor tolerance to standard concurrent therapy.The research was carried out to evaluate the long term surival and complications of thehypofractionated radiation therapy for locally advanced non-small cell lung cancer,and to analysis the prognostic factors.From August 2009 to March 2013,a retrospective analysis was carried out,75 patients form Affiliated Hospital of the Armed Police Logistics college received high-dose radiotherapy and eligible for the analysis.There were 57 males and 18 females.Among them,the median age was 66.5 years(range 44-85 years),stage IIIA in 32 and stage IIIB in43.There were 56 cases treated with radiotherapy alone,19 cases with sequential chemoradiotherapy.There were 36 cases received three-dimensional conformal radiotherapy,39 cases accepted intensity modulated radiation therapy.The median equivalent dose was59.64Gy(39~82.5Gy).Patients were fixed with thermoplastic film while quiet respiration and supine position.When the CT scan was performed,the CT images were transferred and restructured in three dimension by the treatment planning system(TPS).Then doctor delineated gross tumor volume(GTV),clinical target volume(CTV),planning target volume(PTV)and the organ at risk(OAR),ensured the OAR dosage less than their tolerance dose.The clinical evaluation of patients in the recent 3 months after radiotherapy were carried out according RECIST 1.1 criteria.Follow-up time had been to 2016.4.Use SPSS22.0 software for Statistical analysis.Survival was analyzed by the Kaplan-Meier method.Univariate survival analysis was performed with the method of Log-rank test to determine associations between overall survival rate and related prognostic factors,and COX proportional hazard model was used for multivariate survival analysis.P<0.05 was defined as significant difference in statistic.The toxicity reaction to the patients were evaluated and graded by criterion of RTOG's injury grade standard.All patients were successfully completed radiotherapy.After radiotherapy,CR in 8 cases,PR in 52 cases,SD in 12 cases,PD in 3 cases,and the total efficiency rate is 80%.The median overall survival time andprogression-freesurvival time were 20 months and 12 months,the 1-,2-and3-years survival rates were 70%,38.9%,24.9%,respectively.With univariate analysis,gender,the maximum diameter of tumor,KPS score,clincal stage,dose and short-time curative effect were significantly associated with overall survival rate.Multiple analysis showed gender,dose and short-time curative effect were independent prognostic factors.No treatment-related death in the whole course of radiotherapy.The rate of acute radiation pneumonitis was 28%,grade 1 in 11 cases,grade 2 in 8cases,grade 3 in 2 cases,No patient experienced grade 4 acute RT-related pneumonitis The rate of acute radiation esophagitis was 38.67%.grade 1 in22 patients,grade 2 in 7 patients.4 patients occurred acute skin injury,2cases in grade 1,2 cases in grade 2.6 patients suffered Chest wall pain in different degrees.The rate of Late lung injury was 13.34%,4 cases in grade1,6 cases in grade 2.The rate of Late esophagus injury was 16%,9 cases in grade 1,3 cases in grade 2.The hypofractionated radiotherapy has a shorter treatment time,avoiding the cancer stem cells accelerated proliferation.It can increase the gains ratio of radiotherapy and improve short efficacy.With minimal toxicity and good tolerance,hypofractionated radiation therapy can provide excellent long effective in treating locally advanced non-small cell lung cancer.With multivariate analysis,gender,dose,short-time response were the independent risk prognostic factors.There is better prognosis in female,with high dose or with good short-time response after hypofractionated radiation therapy.In general,the locally advanced non-small cell lung cancer patients' survival rate,survival time and local control effect can be improved by hypofractionated radiotherapy,which showed its effectiveness.The hypofractionated radiotherapy has a shorter treatment time,which prove that hypofractionated radiotherapy has nice social and economic effect.Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer related death in women worldwide.In the past several decades,advances in surgical techniques and targeted therapy have been achieved for this disease,however,the prognosis of breast cancer is still suboptimal.A variety of prognostic factors including TNM stage,estrogen receptor(ER)status,and histologicalgrade are proposed and implemented in clinical practice3.Unfortunately,these biomarkers provide limited prognostic value and the accuracy is lacked.Therefore,more reliable and efficient prognostic factors for breast cancer are needed to stratify high risk populations.More recently,a rare subpopulation of cancer cells,named cancer stem cells(CSCs),has drawn researchers' attention.CSCs are thought to play crucial roles in initial,progression,metastasis,and recurrence of cancer,due to their ability to self-renew and form the tumor mass.The discovery of CSCs and their characteristics have contributed to new insight into the molecular mechanism of tumorgenesis and development.CD133(also known as prominin-1)is also a transmembrane5-domain glycoprotein.Previous studies have identified CD133 as a CSC marker related to tumorigenesis and progression in plenty of solid tumors,including breast cancer,colorectal cancer,non-small cell lung cancer,and gastric cancer.CD133 has been commonly used as a cancer stem cell marker in breast cancer.However,the correlation between CD133 and clinicalpathological characteristics and prognosis in breast cancer remains inconsistent.This study was aimed to to elucidate whether CD133 overexpression would correlate with breast cancer clinicopathology andprognosis and to explain the clinical value of CD133 based on the meta-analysis evidence.The electronic search was conducted through the databases of Pub Med,Embase and Web of Science up to October 21,2016.Pooled odds ratios(ORs),hazard ratios(HRs)with 95% confidence intervals(CIs)were calculated.Publication bias was estimated using Begg's test and Egger's test.A total of 11 studies involving 1447 patients were included in this meta-analysis.The data showed that CD133 expression was correlated with G3 tumor grade(OR=1.82,95%CI=1.4-2.36,p<0.001),presence of lymph node metastasis(OR=2.21,95%CI=1.75-2.79,p<0.001),negative progesterone receptor status(OR=0.62,95%CI=0.47-0.81,p=0.001),negative estrogen receptor status(OR=0.4,95%CI=0.19-0.86,p=0.018),advanced TNM stage(OR=2.74,95%CI=2.05-3.66,p<0.001)and positive HER2 status(OR=2.00,95%CI=1.04-3.85,p=0.039).Furthermore,CD133 expression was correlated with poor OS(HR=2.04,95%CI=1.32-3.14,p<0.001).There was no significant publication bias in this meta-analysis.The present meta-analysis demonstrated that CD133 expression was correlated with several clinicopathological characteristics and poor prognosis.CD133 can be considered as an effective tool for pathological diagnosis and prognostic prediction in breast cancer. |
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