The Role of Postoperative Radiotherapy on Stage N2 Non-small Cell Lung Cancer

Background and objective The clinical value of postoperative radiotherapy (PORT) in stage N2 nonsmall-cell lung cancer (NSCLC) is controversy. The aim of this study is to analyze the efficacy of PORT in subgroup of stage N2 NSCLC, which can help clinicians to choose proper patients for PORT. Methods Clinical data of 359 patients with stage N2 NSCLC treated with radical surgery between Mar. 2000 and Jul. 2005 were retrospectively reviewed. Two hundred and seven patients received adjuvant chemotherapy and one hundred and four patients received adjuvant radiotherapy. First, the group of patients were analyzed to evaluate the factors affecting the overall survival. The all patients were divided based on tumor size and the number of lymph node metastasis station (single station or multiple station) so as to evaluate the role of PORT. The endpoint was overall survival (OS) and local recurrence-free survival (LRFS). Kaplan-Meier method was used to calculate the OS, LRFS and Log-rank was used to compare the difference in OS and LRFS between different groups. Results The median duration of follow-up was 2.3 years. 224 patients died. The median survival was 1.5 years and 1, 3, 5-year survival were 78%, 38% and 26%. Univariate analysis showed tumor size, the number of lymph node metastasis station and PORT were correlated with OS. Among patients, 5-year survival rates in PORT and non-PORT were 29% and 24% (P=0.047) respectively. In subgroups, PORT was related with high survival in patients with multiple station N2 compared to non-PORT: 36% vs 20% (P=0.013) and 33% vs 15% (P=0.002) in patients in patients with tumor size > 3 cm. Also, it was related with low local recurrence compared to non-PORT: 65% vs 48% (P=0.006) and 62% vs 48% (P=0.033). Conclusion PORT can improve overall survival for N2 NSCLC, especially the patients with the factors as follows: tumor size > 3 cm and multiple station N2 can benefit from PORT more or less

Chemoradiotherapy-Induced CD4+ and CD8+ T-Cell Alterations to Predict Patient Outcomes in Esophageal Squamous Cell Carcinoma

Purpose and Objectives: Chemoradiotherapy (CRT) is an important component of treatment for patients with locally advanced esophageal squamous cell carcinoma (ESCC). Recent research findings support the role of CRT in activating an anti-tumor immune response. However, predictors of CRT efficacy are not fully understood. The aim of this study was to measure CRT-induced changes to lymphocyte subpopulations and to evaluate the prognostic value of lymphocyte alterations for patients with ESCC.Materials and Methods: In total, this pilot study enrolled 64 patients with ESCC who received neo-adjuvant CRT or definitive CRT. Peripheral blood samples were collected before and during treatment and were analyzed by flow cytometry for CD19, CD3, CD4, CD8, CD56, and CD16. Relationships between lymphocyte subset alterations and overall survival (OS) and progression-free survival (PFS) were evaluated using the log-rank test and a Cox regression model.Results: The median follow-up period was 11.8 months (range, 4.0–20.2 months). Compared to pre-treatment specimens, post-treatment blood samples had decreased proportions of CD19+ B-cells and increased proportions of CD3+ and CD8+ T-cells (all P < 0.05). Univariate and multivariate analysis showed that increased CD4+ T-cell ratios after CRT independently predicted superior PFS (hazard ratio [HR] = 0.383; 95% confidence interval [CI] = 0.173–0.848, P = 0.017) and that increased CD8+ T-cell ratios predicted improved OS (HR = 0.258; 95% CI = 0.083–0.802, P = 0.019). Patients with both increased CD4+ and CD8+ ratios had a superior PFS and OS, compared to patients with an increased CD4+ ratio only or CD8+ ratio only or neither (1-year PFS rate 63 vs. 25%, 1-year OS rate 80 vs. 62%, P = 0.005 and 0.025, respectively).Conclusions: CRT-induced increases in CD4+ and CD8+ T-cell ratios are reliable biomarker predictors of survival in patients with ESCC

Accuracy of detecting residual disease after neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma (preSINO trial): A prospective multicenter diagnostic cohort study

Background: After neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer, high pathologically complete response (pCR) rates are being achieved especially in patients with squamous cell carcinoma (SCC). An active surveillance strategy has been proposed for SCC patients with clinically complete response (cCR) after nCRT. To justify omitting surgical resection, patients with residual disease should be accurately identified. The aim of this study is to assess the accuracy of response evaluations after nCRT based on the preSANO trial, including positron emission tomography with computed tomography (PET-CT), endoscopy with bite-on-bite biopsies and endoscopic ultrasonography (EUS) with fine-needle aspiration (FNA) in patients with potentially curable esophageal SCC. Methods: Operable esophageal SCC patients who are planned to undergo nCRT according to the CROSS regimen and are planned to undergo surgery will be recruited from four Asian centers. Four to 6 weeks after completion of nCRT, patients will undergo a first clinical response evaluation (CRE-1) consisting of endoscopy with bite-on-bite biopsies. In patients without histological evidence of residual tumor (i.e. without positive biopsies), surgery will be postponed another 6 weeks. A second clinical response evaluation (CRE-2) will be performed 10-12 weeks after completion of nCRT, consisting of PET-CT, endoscopy with bite-on-bite biopsies and EUS with FNA. Immediately after CRE-2 all patients without evidence of distant metastases will undergo esophagectomy. Results of CRE-1 and CRE-2 as well as results of the three single diagnostic modalities will be correlated to pathological response in the resection specimen (gold standard) for calculation of sensitivity, specificity, negative predictive value and positive predictive value. Discussion: If the current study shows that major locoregional residual disease (> 10% residual carcinoma or any residual nodal disease) can be accurately (i.e. with sensitivity of 80.5%) detected in patients with esophageal SCC, a prospective trial will be conducted comparing active surveillance with standard esophagectomy in patients with a clinically complete response after nCRT (SINO trial). Trial registration: The preSINO trial has been registered at ClinicalTrials.gov as NCT03937362 (May 3, 2019)

Seismic stratigraphy of the central South China Sea basin and implications for neotectonics

Coring/logging data and physical property measurements from International Ocean Discovery Program Expedition 349 are integrated with, and correlated to, reflection seismic data to map seismic sequence boundaries and facies of the central basin and neighboring regions of the South China Sea. First-order sequence boundaries are interpreted, which are Oligocene/Miocene, middle Miocene/late Miocene, Miocene/Pliocene, and Pliocene/Pleistocene boundaries. A characteristic early Pleistocene strong reflector is also identified, which marks the top of extensive carbonate-rich deposition in the southern East and Southwest Subbasins. The fossil spreading ridge and the boundary between the East and Southwest Subbasins acted as major sedimentary barriers, across which seismic facies changes sharply and cannot be easily correlated. The sharp seismic facies change along the Miocene-Pliocene boundary indicates that a dramatic regional tectonostratigraphic event occurred at about 5 Ma, coeval with the onsets of uplift of Taiwan and accelerated subsidence and transgression in the northern margin. The depocenter or the area of the highest sedimentation rate switched from the northern East Subbasin during the Miocene to the Southwest Subbasin and the area close to the fossil ridge in the southern East Subbasin in the Pleistocene. The most active faulting and vertical uplifting now occur in the southern East Subbasin, caused most likely by the active and fastest subduction/obduction in the southern segment of the Manila Trench and the collision between the northeast Palawan and the Luzon arc. Timing of magmatic intrusions and seamounts constrained by seismic stratigraphy in the central basin varies and does not show temporal pulsing in their activities.Keywords: South China Sea, Neotectonism, Core-well-seismic integration, Seismic facies, Seismic stratigraphy, IODP Expedition 34

Advances of Pulmonary Adenocarcinoma with Micropapillary Pattern

Lung adenocarcinoma with micropapillary pattern (MPP) is a kind of rare high invasive malignant tumor, which has been noticed because of high mortality. In 2011, the new pathological classification of lung adenocarcinoma classify it as an independent pathological type, researches on the individual treatment of the disease had been gradually expanded. Recent studies have demonstrated that lung adenocarcinoma with MPP has obvious heterogeneities in metastasis mechanism, clinical pathology, imageology, therapeusis and prognosis. In this paper, we discuss the progress of metastasis mechanism and clinical relevance in lung adenocarcinoma with MPP

Study on the Level of Coordinated Development of Marine Ecological Civilization: Take Jiaodong as an example

Marine ecological civilization is the concentrated embodiment of ecological civilization thought in marine field, is the innovation and development in the process of marine governance in China. Since ecological civilization was included in the overall plan of "five-in-one" socialist cause with Chinese characteristics, ecological civilization construction has been raised to an unprecedented height. The ocean is an important area of the country′s overall ecological civilization construction. The core of marine ecological civilization is people-centered, so as to realize overall planning on land and sea and harmony among people, and promote the building of a maritime power. In view of this, this paper puts forward the view of coordinated development of marine ecological civilization, and takes Jiaodong as an example to analyze the basic conditions for the coordinated development of marine ecological civilization in five cities of Jiaodong. At the same time, the index system of the coordinated development of marine ecological civilization is constructed, and the level of the coordinated development of regional marine ecological civilization is comprehensively evaluated, in order to expand the achievements of marine ecological civilization construction and provide a new perspective and approach for the regional coordinated development

Controllable Magnetism of CoO Nanoparticles Modified by the Reduced Graphene Oxide

Rocksalt CoO nanoparticles (CNPs) have been prepared with a facile solvothermal method. To control the magnetism of CNPs, the reduced graphene oxide (RGO) is adopted to engineer the CNPs. Enwrapped by the atomic-layered carbon sheets, the CNPs can be reduced locally. The CoO/RGO composites were prepared by one-pot and two-pot synthetic methods, respectively. Compared with the CoO/RGO raw composite that have no magnetization hysteresis loop, the weak and the strong hysteresis loops emerged successively via heating the particles at different temperatures and maintaining their nanoscales. The magnetism can be adjusted by controlling the temperature via two routes. By the one-pot synthetic route, the CNPs can be reduced sharply, and an obvious hysteresis is available around 400 °C, which is ascribed to the appearance of Co nanoclusters decorated in the corners of CNPs. By the two-pot synthetic route, a weak and gradually enhanced hysteresis can be observed, and its magnetic properties should be ascribed to the topological defects of RGO. Our findings have opened a new way to acquire nanoparticles with controllable magnetism

Optimizing lung cancer radiation treatment worldwide in COVID-19 outbreak

COVID-19 has spread around the planet, sending billions of people into lockdown as health services struggle to cope. By April 2020, there are over a million two hundred thousand confirmed cases and more than sixty-five thousand deaths worldwide Meanwhile in Asia, where the disease began, the spread continues, in China it seems for now to have passed its peak. Italy, Spain, France, and the US have been the countries more affected in terms of deaths. The coronavirus is more dangerous to the elderly and those with certain pre-existing medical conditions which is precisely the profile of lung cancer patients. Essential cancer services should be delivered but all steps should be taken to protect patients and the health workforce from infection with COVID-19. This presents a major challenge to radiotherapy (RT) departments worldwide in curbing the spread of COVID-19 while ensuring the continuity of services. In RT, shortening overall treatment time to reduce the number of patients present in the department is an important consideration. An international panel, including the majority of countries most affected by the COVID-19 pandemic, with expertise in the management of cancer in high-volume comprehensive centres from the largest societies of radiation oncology worldwide have come together to share their experience on COVID-19 preparedness in the context of lung cancer RT to deliver optimal care in such exceptional circumstances, based on the latest evidence. A comprehensive systematic review of the literature through a PubMed search was undertaken. Given that lung cancer is one of the most common and severe pathologies in radiation oncology departments, the following recommendations require particularly urgent consideration. The decision-making paths strongly depend on locally available resources, and a tailored approach should be used to attend lung cancer patients during this pandemic.Peer reviewe