Local radiotherapy (LRT) is reported to be of survival benefit for advanced non-small cell lung cancer (NSCLC) in accumulating evidence, but research on the optimal initial time point remains scarce. This IRB-approved retrospective analysis identified patients diagnosed with stage IIIb–IV unresectable lung adenocarcinoma who initiated front-line LRT at our institution between 2017 and 2020. The receiver operating characteristic (ROC) curve analyses were used to cut off the initial time of LRT (before and beyond 53 days). Patients were divided into two groups: one early to initiate radiotherapy group (≤53 days, EAR group) and one deferred radiotherapy group (>53 days, DEF group). The Kaplan–Meier method was used to estimate time-to-event endpoints; the Cox proportional hazard model was used to find out predictors of progression-free survival (PFS) and overall survival (OS). A total of 265 patients with a median age of 57 were enrolled. The median follow-up time was 26.4 months (ranging from 2.2 to 69.7 months). The mOS was 38.6 months and mPFS was 12.7 months. Age >60, bone and brain metastases, multisite metastases, and EGFR 19 mutation were independent predictors associated with OS. Early initiation of local radiotherapy within 53 days after diagnosis resulted in better PFS, but not in OS. A better OS was observed in patients with bone metastasis who underwent local radiotherapy initiated within 53 days.
Background Radiation therapy used to treat pelvic and abdominal tumors can cause acute or chronic radiation enteropathy. Chronic radiation intestinal fibrosis is one of the most common causes of gastrointestinal complaints. Here, we aimed to clarify that the supplement of dietary fiber inulin can alleviate chronic radiation-induced intestinal fibrosis by altering the gut microbiota, and to elucidate the mechanism. Results Inulin supplements have been shown to elevate the abundances of bacterial that produce short-chain fatty acids (SCFAs) and increased fecal concentrations of microbially derived SCFAs. In validation experiment, transplantation of inulin-derived gut microbiota and metabolite alleviated colonic fibrosis in a mouse model of chronic radiation enteropathy. Treatment with inulin-derived gut microbiota metabolites significantly reduced the expression of fibrosis-related genes and collagen synthesis-related genes in the mouse embryonic fibroblast cell line NIH/3T3. In NIH/3T3 cell lines, the use of inulin-derived metabolites also inhibited the expression of genes related to the extracellular matrix synthesis pathway. Conclusions These evidences highlight that inulin might be employed as a safe and effective supplement to fight against chronic radiation intestinal fibrosis. Our finding also provides a novel insight into targeting changes in gut microbiota to treat radiation enteropathy.
Rationale:Paraganglioma is rare in children and most pheochromocytomas originate in the adrenal gland.Patient concerns:The clinical characteristics, diagnosis, and managements in a 9-year-old boy who presented with vomiting and occasional headache with a blood pressure of 210/170 mm Hg was retrospectively reviewed. CT scan of the chest revealed a 7 × 5-cm-sized soft tissue mass in the left paraspinal area. Biochemical reports revealed elevated levels of serum norepinephrine, urine norepinephrine, urine dopamine, and serum neuron specific enolase.Diagnoses:The immunohistochemical studies suggested that the tumor was a paraganglioma of the posterior mediastinum.Interventions:The patient underwent mass resection with thoracotomy. Before operation, the patient was prepared by orally administering captopril, propranolol hydrochloride, and phenoxybenzamine. Body fluid volume was also prepared by vein and mouth in 3 days.Outcomes:The patient was followed up postoperatively for 1 year without recurrence.Lessons:We should be highly vigilant the pediatric tumor of the posterior mediastinum with vomiting and headache as the first clinical manifestation.
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