To observe the effect of Shenlong Oral Liquid（SLOL）combined with radiotherapy in treating nasopharyngeal carcinoma (NPC). Methods: Effects of the combined therapy, including clinical effects, changes of cellular immunity and side effects, in treating 60 NPC patients (in the treated group) were observed and compared with those of the other 60 patients treated with radiotherapy alone (in the control group). Results: (1)The side effects of radiation in the treated group were lower than those in the control group significantly (P＜0.05). (2) The short-term remission rate of nasopharyngeal and neck metastatic tumor in the two groups was not significantly different (P＞0.05). (3) The dose for complete remission of nasopharyngeal and neck tumor in the treated group was lower than that in the control group (P<0.01). (4) No change of T-lymphocyte subsets was found in the treated group after treatment, but in the control group , OKT3,OKT4,and OKT4/OKT8 ratio were markedly decreased (P＜0.05). (5) The survival rate in the treated group was higher than that in the control group, but with no statistical significance (P=0.0518). Conclusion: The combined therapy of NPC with SLOL and radiotherapy is able to reduce side-effect of radiotherapy, improve the cellular immunity, reduce the dose of radiation for tumor remission and enhance the therapeutic effect of radiotherapy. It showed a trend of raising the long-term survival rate of NPC patients.

To observe the effect of radiotherapy (RT) combined with ginseng polysaccharide (GSP) injection in treating nasopharyngeal carcinoma (NPC) and its influence on immune function.Methods: One hundred and thirty-one patients of NPC were randomly divided into two groups, the RT-GSP group (n=64) treated with RT and GSP, and the control group (n=67) treated with conventional radiotherapy, to observe the local cancer remission rate, 1-year total survival rate, no tumor survival rate and no remote metastasis survival rate. Moreover, the changes of T-lymphocyte subsets, natural killer cell (NK) activity and lymphokine-activated killer cell (LAK) activity before and after treatment were determined.Results: Clinical examination conducted 3 months after treatment showed that the complete remission rate in the RT-GSP group was 96.6%, and in the control group 93.3%, the complete remission rate of cervical lymph node metastasis in the two groups was 85.7% and 78.0%, the NPC remission rate shown by CT 60.3% and 51.7%, respectively. Re-examination carried out 1 year after treatment showed that the total survival rate in the two groups was 100% and 96.5%, tumor free survival rate 84.4% and 74.6%, and no remote metastasis survival rate 93.8% and 88.1% respectively. The activity of NK cell and LAK cell as well as T3, T4 value in peripheral blood increased significantly in the RT-GSP group (all P<0.05) after treatment, while with the control group, no significant influence on NK and LAK activities were shown but significant lowering of T3, T4 was, P<0.05. No toxic-adverse reaction of GSP was found.Conclusion: GSP has certain immune function improving effect in NPC patients during RT, and it could also eliminate the occurred adverse reaction to RT and improve the general condition of patients.

交互分析模式团体教育在食管鳞状细胞癌放射治疗患者中的应用效果

目的 探讨基于交互分析模式的团体教育在食管鳞状细胞癌放射治疗患者中的应用效果,找出疗效更为突出的团体教育方式,为临床应用提供理论基础.方法 选取2014年8月—2015年7月接受治疗的69例患者为对照组,2015年8月—2016年7月接受治疗的77例患者为观察组.对照组采用常规团体教育方式进行管理,观察组采用基于交互分析模式的团体教育方式进行管理.采用GQOLI-74生活质量综合量表、自我效能感量表(SUPPH)和汉密尔顿抑郁量表(HRSD)、汉密尔顿焦虑量表(HAMA)来调查患者的生存质量、自我效能感以及负性情绪.通过询问医护人员来调查患者的治疗依从度,同时收集患者并发症发生情况.结果 干预后观察组生存质量评分中躯体功能、心理功能、物质功能高于对照组,差异有统计学意义(P<0.05).干预后观察组自我效能感各项得分均高于对照组,抑郁、焦虑水平低于对照组,治疗总依从率高于对照组,并发症发生率低于对照组,差异均有统计学意义(P<0.05).结论 基于交互分析模式的团体教育能提高患者生存质量和自我效能感,缓解患者负性情绪,降低并发症发生率.

Objective To determine the efficacy of palliative radiotherapy in treating tumor-stage cutaneous T-cell lymphoma/mycosis fungoides (MF).
Methods From January 2008 to January 2013, a total of 11 patients with tumor-stage MF were treated with local radiation therapy in Peking Union Medical College Hospital. The median age of these patients was 53.36±14.45 years. Female-male ratio was 1:1.2. The average course of disease was 10.82±3.37 years. All the patients were treated with local electronic beam irradiation with a total median dosage of 48.55±9.51 (40-74) Gy in an average of 24.55±5.57 (20-40) fractions, 5 fractions per week.
Results The median follow-up time was 55.27±29.3 (13-103) months. No severe acute or chronic side effects of irradiation were observed. Complete clinical response (CR) rate of the radiated sites was 54.5%(6/11), partial response (PR) rate was 36.4%(4/11), and the overall response rate (CR+PR) was 90.9%. One patient showed no response.
Conclusion Local radiotherapy with psolaren plus ultraviolet A and/or interferon maintaining treatment is an effective palliative therapy in the treatment of tumor-stage MF patients.

Current concepts in glioblastoma imaging

高位骶骨肿瘤前后联合入路局部刮除置管灌注化疗放疗术对骶神经功能影响的评价

Objective To analyze the influence on the functions of the sacral nerves after curettage and local pouring chemotherapy and radiotherapy by the approach in anterior with posterior to treat the high sacral tumors. Methods 24 cases, include their oncology results and functions of the sacral nerves were analyzed. Results Average follow up 56 months, 3 malignant cases were died of the tumor metastasis. 4 recurrent cases were recurred after treatment between 13 to 32 months. For the tumor curettage demand, the one side S2 nerve of 2 cases and the S2, 3 nerve of 1 case were cut off. The other case's sacral nerves were reserved completely. Conclusions This treatment method by local chemotherapy and radiotherapy to treat the high sacral tumors was not influence on the functions of the sacral nerves.

153钐改善骨转移癌痛疗效观察

Objective To evaluate the effect of 153Sm EDTMP in the bone metastatic cancer pains.Methods In treatment group(32 patients with bone metastatic diseases) 153Sm EDTMP were given by infusion for one time.In control group,32 patients received radiotherapy. The radio dose was DT30Gy,5 times per week for 2 weeks.Pain relief was used as criteria of response at the time treatment finished and 6 months later.Results At the time treatment finished,there were statistically differences in pain relief between two groups.Pains relief rate was superior to control group after 6 months (P< 0.05).Conclusion Treatment with 153Sm EDTMP one time can reduce apparently pains caused by bone metastases,which is conveniently used and well tolerated.

非常规分割放疗乳腺癌转移性癌痛的疗效

Objective To investigate therapeutic effect of rapidly divided radiotherapy in the management of pain due to bone metastases in mammary cancer. Method 20 patients among 33 received rapidly divided radiotherapy in 25 lesions, DTU-5CTY a time, 2～ 3 times a week, total dose was 15～ 30 Gy. 13 patients (22 lesions ) received routine dividing radiotherapy, DT 4～ 5 Gy each time, 5 times a week, total dose was 40～ 60 Gy. Result In rapidly divided group, total analgesic rate was 95.0% (19/20). In routine dividing group, total analgesic rate was 69.3% . There was no significant difference between the 2 groups (P >0.05). Pain was controlled in 84% of lesions in rapidly divided group 2 week after radiotherapy. Analgesic rate of DT 20～ 30 Gy went up to 45.5% . Differences between 2 groups were significant statistically (P< 0.01).Conclusion Rapidly divided radiotherapy is rapid and reliable in managing pain. Patients can endure its toxicological and adverse reactions . It's therapeutic effect is comparable with that of routine divided radiotherapy.

Combined modality therapy for stage ⅠB cervical cancer

Objective:To evaluate the current approaches for multimodality therapy for stage ⅠB cervical cancer. Methods:The relevant literature has served as a source for identified high or intermediate risks and management of stage ⅠB cervical cancer. Result:The high risks include pelvic lymph node metastasis (PLNM), positive resection margin (PRM), and the in-volvement of parametrium (IPM). The intermediate risks include deep stromal invasion (DSI), bulky tumor size ( BTS), lymphovascular space invasion (LVSI). Adeno-carcinomatous histo-type is the new risk feature relevant to poor prognoses. Both radical hysterectomy plus bilateral pelvic lymph node dissection(PLND) and radical radiotherapy have proven to be equally effec-tive. Surgery is more performed for stage ⅠB1 disease;radiotherapy or chemoradiotherapy is preferable for stage ⅠB2 disease. For patients with one high risk or two of intermediate risks, radical hysterectomy plus PLND followed by concurrent chemoradiotherapy can improve overall survival(OS) and disease-free survival (DFS). Conclusion:The management should be indi-vidualized for stage ⅠB cervical cancer. The optimized multidisciplinary therapy can benefit pa-tients with the best cure and minimum morbidity and complications.

Uterine papillary serous carcinoma (UPSC) was established as a distinct type of endometrial carcinoma by Lauchlan in 1981 and Hendrickson et al in 1982, and accounted for 1% ～ 10% of endometrial cancers. Theoccurencer of papillary patterns of endometrial adenocarcincma had been reportedly recognized since 1900, while until the late 1970s several authors have had described a variant of papillary endometrial cancer. UPSC is a morphologically unique variant of endometrial carcinoma that is pathologically defined by the presence of high nuclear grade, distinct papillary architechtural changes, psammoma bodies, and extensive lymph- vascular space invasion. CA125 is often mentioned a usefultumor marker either for diagnosis before starting treatment or in monitoring recurrence. The ptimal treatment of UPSC is controversial and appears to be dependent upon the stage of the disease. Primary surgery comprised of TAH/BSO and complete staging is the mainstay of treatment. The patients with recurrent UPSC in many studies were treated with various combinations of surgery, radiation therapy, and chemotherapy. The molecular basis for the general poor response of UPSC to adjuvant chemotherapy and radiotherapy is not well understood. UPSC tumors are more often aneuploid and contain overexpressed mutant p53 protein as compared to encdometrioid adenocarcinoma. Unlike patients with adenocarcinoma of the endomeutrium, women with UPSC were less likely to be obese, hypertensive, or diabetic.

Primary central nervous system germ celltumors (CNS-GCTs) in children and adolescents have unique clinical features and methods of treatment compared with those in adults. There is little information about Chinese children and adolescents with CNS-GCTs. Therefore, in this study we retrospectively analyzed the clinical features and treatment outcome of Chinese children and adolescents with primary CNS-GCTs. Between January 2002 and December 2012, 57 untreated patients from a single institution were enrol ed. They were diagnosed with CNS-GCTs after pathologic or clinical assessment. Of the 57 patients, 41 were males and 16 were females, with a median age of 12.8 years (range, 2.7 to 18.0 years) at diagnosis;43 (75.4%) had non-germinomatous germ cell tumors (NGGCTs) and 14 (24.6%) had germinomas; 44 (77.2%) had localized disease and 13 (22.8%) had extensive lesions. Fifty-three patients completed the prescribed treatment, of which 18 underwent monotherapy of surgery, radiotherapy, or chemotherapy, and 35 underwent multimodality therapies that included radiotherapy combined with chemotherapy or surgery combined with chemotherapy and/or radiotherapy. PEB (cisplatin, etoposide, and bleomycin) protocol was the major chemotherapy regimen. The median follow-up time was 32.3 months (range, 1.2 to 139 months). Fourteen patients died of relapse or disease progression. The 3-year event-free survival (EFS) and overal survival rates for al patients were 72.2%and 73.8%, respectively. The 3-year EFS was 92.9%for germinomas and 64.8%for NGGCTs (P=0.064). The 3-year EFS rates for patients with NGGCTs who underwent monotherapy and multimodality therapies were 50.6% and 73.5%, respectively (P = 0.042). Our results indicate that multimodality therapies including chemotherapy plus radiotherapy were better treatment option for children and adolescents with CNS-GCTs.

Malnutrition occurs frequently in patients with cancer. Indeed, a variety of nutritional and tumor-related factors must be taken into account in these patients. Recognizing this relationship, we aimed to prospectively evaluate the risk factors that influence weight loss in patients undergoing radiotherapy with oral nutritional supplementation and dietetic counseling. Weight loss of 74 patients during radiotherapy and 1 month after treatment was analyzed. Parameters such as age, gender, tumor location, tumor stage, Eastern Cooperative Oncology Group performance status (ECOG PS) score, and the use of chemotherapy were analyzed to evaluate their influence on weight loss. All patients underwent oral nutritional supplementation and dietetic counseling. Forty-six (65.7%) patients lost weight, with a mean weight loss of (4.73 ± 3.91) kg, during radiotherapy. At 1 month after treatment, 45 (66.2%) patients lost weight, presenting a mean weight loss of (4.96 ± 4.04) kg, corresponding to a (6.84 ± 5.24)% net reduction from their baseline weight. Head and neck cancer patients had a mean weight loss of (3.25 ± 5.30) kg, whereas the remaining patients had a mean weight loss of (0.64 ± 2.39) kg (P=0.028) during radiotherapy. In the multivariate analysis, the head and neck tumor location (P = 0.005), use of chemotherapy (P = 0.011), and ECOG PS score of 2-3 (P = 0.026) were considered independent risk factors. Nutritional status and parameters, such as tumor location (especially the head and neck), the use of chemotherapy, and the ECOG PS score, should be evaluated before radiotherapy because these factors can influence weight loss during radiotherapy and 1 month after treatment.

Neoadjuvant chemotherapy plus radiotherapy is the most common treatment regimen for advanced nasopharyngeal carcinoma (NPC). Whether chronomodulated infusion of chemotherapy can reduce its toxicity is unclear. This study aimed to evaluate the toxic and therapeutic effects of sinusoidal chronomodulated infusion versus flat intermittent infusion of cisplatin (DDP) and 5-fluorouracil (5-FU) followed by radiotherapy in patients with locoregionally advanced NPC. Patients with biopsy-diagnosed untreated stages III and IV NPC (according to the 2002 UICC staging system) were randomized to undergo 2 cycles of sinusoidal chronomodulated infusion (Arm A) or flat intermittent constant rate infusion (Arm B) of DDP and 5-FU fol owed by radical radiotherapy. Using a“MELODIE”multi-channel programmed pump, the patients were given 12-hour continuous infusions of DDP (20 mg/m2) and 5-FU (750 mg/m2) for 5 days, repeated every 3 weeks for 2 cycles. DDP was administered from 10:00 am to 10:00 pm, and 5-FU was administered from 10:00 pm to 10:00 am each day. Chronomodulated infusion was performed in Arm A, with the peak deliveries of 5-FU at 4:00 am and DDP at 4:00 pm. The patients in Arm B underwent a constant rate of infusion. Radiotherapy was initiated in the fifth week, and both arms were treated with the same radiotherapy techniques and dose fractions. Between June 2004 and June 2006, 125 patients were registered, and 124 were eligible for analysis of response and toxicity. The major toxicity observed during neoadjuvant chemotherapy was neutropenia. The incidence of acute toxicity was similar in both arms. During radiotherapy, the incidence of stomatitis was significantly lower in Arm A than in Arm B (38.1%vs. 59.0%, P = 0.020). No significant differences were observed for other toxicities. The 1-, 3-, and 5-year overal survival rates were 88.9%, 82.4%, and 74.8%for Arm A and 91.8%, 90.2%, and 82.1%for Arm B. The 1-, 3-, and 5-year progression-free survival rates were 91.7%, 88.1%, and 85.2%for Arm A and 100%, 94.5%, and 86.9% for Arm B. The 1-, 3-, and 5-year distant metastasis-free survival rates were 82.5%, 79.1%, and 79.1%for Arm A and 90.2%, 85.2%, and 81.7%for Arm B. Chronochemotherapy significantly reduced stomatitis but was not superior to standard chemotherapy in terms of hematologic toxicities and therapeutic response.

Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma (NPC); however, it is not known whether locoregional radiotherapy targeting the primary tumor and regional lymph nodes affects the survival of patients with metastatic NPC. Therefore, we aimed to retrospectively evaluate the benefits of locoregional radiotherapy. A total of 408 patients with metastatic NPC were included in this study. The mortality risks of the patients undergoing supportive treatment and those undergoing chemotherapy were compared with that of patients undergoing locoregional radiotherapy delivered alone or in combination with chemotherapy. Univariate and multivariate analyses were conducted. The contributions of independent factors were assessed after adjustment for covariates with significant prognostic associations (P<0.05). Both locoregional radiotherapy and systemic chemotherapy were identified as significant independent prognostic factors of overall survival (OS). The mortality risk was similar in the group undergoing locoregional radiotherapy alone and the group undergoing systemic chemotherapy alone [multi-adjusted hazard ratio (HR) = 0.9, P = 0.529]; this risk was 60% lower than that of the group undergoing supportive treatment (HR = 0.4, P = 0.004) and 130% higher than that of the group undergoing both systemic chemotherapy and locoregional radiotherapy (HR = 2.3, P < 0.001). In conclusion, locoregional radiotherapy, particularly when combined with systemic chemotherapy, is associated with improved survival of patients with metastatic NPC.

血红蛋白持续下降是鼻咽癌放疗患者的不良预后因素

Background and Objective: Anemia can not only reduce the quality of life of patients with cancer, but also affect their survival. This study was to investigate the prognostic value of hemoglobin (Hb) level in patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy. Methods: Clinical data of 520 NPC patients received definitive radiotherapy between 2000 and 2002 at Sun Yat-sen University Cancer Center were analyzed. Patients were stratified into normal Hb level and anemia groups according to their Hb levels before, during, and after radiation. Anemia was defined according to World Health Organization criteria as Hb level < 130 g/L in men and < 120 g/L in women. Hb continuous decrease group and non-decrease group were defined according to Hb changes in the patients during radiotherapy. Loco-regional recurrence-free survival (LRFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method. Multivariate analysis was performed using the Cox model to analyze the prognostic factors. Results: Before radiation, the 5-year LRFS rates were 60.9% in anemia group and 63.9% in normal Hb level group (P = 0.337); the 5-year OS rates were 65.2% and 71.0%, respectively (P = 0.299). During radiation, the 5-year LRFS rates were 56.7% in anemia group and 67.9% in normal Hb level group (P = 0.013); the 5-year OS rates were 61.0% and 75.9%, respectively (P = 0.001). After radiation, the 5-year LRFS rates were 59.6% in anemia group and 64.9% in normal Hb level group (P = 0.169); the 5-year OS rates were 65.0% and 71.9%, respectively (P = 0.090). The 5-year LRFS and OS rates were significantly lower in Hb continuous decrease group than in Hb non-decrease group (59.1% vs. 69.3%, P = 0.032; 66.2% vs. 76.4%, P=0.011). Multivariate analysis showed that the continuous decrease of Hb was an independent prognostic factor for OS. Conclusion: The change in Hb level during radiotherapy is an important prognostic factor affecting the OS of NPC patients.

新辅助化疗联合同期放化疗治疗局部晚期鼻咽癌的毒副反应及近期疗效

Background and Objective: Concurrent chemoradiation therapy (CCRT) is the standard treatment for patients with locally advanced nasopharyngeal carcinoma (NPC). The effect of neoadjuvant chemotherapy followed by CCRT has not been determined. Therefore, we conducted 2 phase II studies to evaluate the efficacy and safety of neoadjuvant chemotherapy with a regimen of docetaxel, cisplatin, and 5-fluorouracil (5-Fu) (TPF) followed by radiotherapy and concurrent cisplatin in patients with stage-Ill and -IV (A - B) NPC. This article is the preliminary report on treatment-related toxicities and response. Methods: Graded according to the 2002 American Joint Committee on Cancer (AJCC) staging criteria, only patients with stage-Ill or -IV(A - B) poorly differentiated or undifferentiated NPC (World Health Organization type ll/lll) were included. We planned to recruit 52 patients with stage-Ill disease and 64 patients with stage-IV(A - B) disease. All patients received neoadjuvant chemotherapy with TPF (docetaxel 75 mg/m2, day 1; cisplatin 75 mg/m2, day 1; 5-Fu 500 mg/(m2·day), continuous intravenous infusion for 120 h), every 3 weeks for 3 cycles, followed by weekly cisplatin (40 mg/m2) concurrent with radiotherapy. Three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) were used. Gross disease planning target volume (PTV), high-risk and low-risk subclinical PTV doses were prescribed at 70-76 Gy, 66-70 Gy, and 60-61.25 Gy at 1.75-2.0 Gy per fraction. The lower neck or supraclavicular fields may be treated with conventional AP/PA fields for a total of 54 Gy at 1.8 Gy per fraction. Patients were evaluated for tumor response after the completion of neoadjuvant chemotherapy, and at 3 months after radiation according to the Response Evaluation Criteria In Solid Tumors (RECIST). The latest version of the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE 3.0) was used for grading all adverse events. Results: Fifty-nine patients were evaluable for treatment response. Thirty patients had stage-Ill disease and 29 patients had stage-IV (A-B). All patients completed FIT to the prescribed dose and 2 cycles of neoadjuvant chemotherapy, with 51 patients (86.4%) completing 3 cycles. A total of 50 (84.7%) and 39 patients (66.1%) completed 4 weeks and 5 weeks of cisplatin during CCRT, respectively. The overall response rate in the primary site and the neck region were 94.9% [complete response (CR) in 25.4%] and 100% (CR in 19.6%) after completing neoadjuvant chemotherapy. At 3 months after RT, the CR rates increased to 96.6% and 90.2%, respectively. After a median follow-up of 14.3 months, we observed 5 treatment failures and 2 deaths. The 1-year overall survival, distant metastasis-free survival, and locoregional relapse-free survival rates were 100%, 95.7%, and 97.7%, respectively. The rates of grade 3/4 myelosuppression and anorexia/nausea/vomiting during neoadjuvant chemotherapy were 55.9% and 16.9%, respectively. The corresponding rates were 11.9% and 23.7% during CCRT. Grade 3/4 mucositis, skin desquamation, and xerostomia occurred in 6.8%, 44.1%, and 27.1% of patients, respectively. There were no treatment-related deaths. Conclusions: Neoadjuvartt chemotherapy with TPF followed by CCRT was well tolerated with a manageable toxicity profile. Preliminary results are encouraging and warrant further investigation.

The current standards in radiotherapy of high-grade gliomas (HGG) are based on anatomic imaging techniques, usually computed tomography (CT) scanning and magnetic resonance imaging (MRI). The guidelines vary depending on whether the HGG is a histological grade 3 anaplastic glioma (AG) or a grade 4 glioblastoma multiforme (GBM). For AG, T2-weighted MRI sequences plus the region of contrast enhancement in T1 are considered for the delineation of the gross tumor volume (GTV), and an isotropic expansion of 15 to 20 mm is recommended for the clinical target volume (CTV). For GBM, the Radiation Therapy Oncology Group favors a two-step technique, with an initial phase (CTV1) including any T2 hyperintensity area (edema) plus a 20 mm margin treated with up to 46 Gy in 23 fractions, followed by a reduction in CTV2 to the contrast enhancement region in T1 with an additional 25 mm margin. The European Organisation of Research and Treatment of Cancer recommends a single-phase technique with a unique GTV, which comprises the T1 contrast enhancement region plus a margin of 20 to 30 mm. A total dose of 60 Gy in 30 fractions is usual y delivered for GBM, and a dose of 59.4 Gy in 33 fractions is typical y given for AG. As more than 85% of HGGs recur in field, dose-escalation studies have shown that 70 to 75 Gy can be delivered in 6 weeks with relevant toxicities developing in<10%of the patients. However, the only randomized dose-escalation trial, in which the boost dose was guided by conventional MRI, did not show any survival advantage of this treatment over the reference arm. HGGs are amongst the most infiltrative and heterogeneous tumors, and it was hypothesized that the most highly aggressive areas were missed;thus, better visualization of these high-risk regions for radiation boost could decrease the recurrence rate. Innovations in imaging and linear accelerators (LINAC) could help deliver the right doses of radiation to the right subvolumes according to the dose-painting concept. Advanced imaging techniques provide functional information on cellular density (diffusion MRI), angiogenesis (perfusion MRI), metabolic activity and cellular proliferation [positron emission tomography (PET) and magnetic resonance spectroscopy (MRS)]. All of these non-invasive techniques demonstrated good association between the images and histology, with up to 40% of HGGs functional y presenting a high activity within the non-contrast-enhanced areas in T1. New LINAC technologies, such as intensity-modulated and stereotactic radiotherapy, help to deliver a simultaneous integrated boost (SIB)>60 Gy. Trials delivering a SIB into a biological GTV showed the feasibility of this treatment, but the final results, in terms of clinical benefits for HGG patients, are stil pending. Many issues have been identified: the variety of MRI and PET machines (and amino-acid tracers), the heterogeneity of the protocols used for image acquisition and post-treatment, the geometric distortion and the unreliable algorithms for co-registration of brain anatomy with functional maps, and the semi-quiescent but highly invasive HGG cells. These issues could be solved by the homogenization of the protocols and software applications, the simultaneous acquisition of anatomic and functional images (PET-MRI machines), the combination of complementary imaging tools (perfusion and diffusion MRI), and the concomitant addition of some ad hoc targeted drugs against angiogenesis and invasiveness to chemoradiotherapy. The integration of these hybrid data wil construct new synthetic metrics for ful y individualized treatments.

Postoperative external beam radiotherapy was considered the standard adjuvant treatment for patients with glioblastoma multiforme until the advent of using the drug temozolomide (TMZ) in addition to radiotherapy. High-dose volume should be focal, minimizing whole brain irradiation. Modern imaging, using several magnetic resonance sequences, has improved the planning target volume definition. The total dose delivered should be in the range of 60 Gy in fraction sizes of 1.8-2.0 Gy. Currently, TMZ concomitant and adjuvant to radiotherapy has become the standard of care for glioblastoma multiforme patients. Radiotherapy dose-intensification and radiosensitizer approaches have not improved the outcome. In spite of the lack of high quality evidence, stereotactic radiotherapy can be considered for a selected group of patients. For elderly patients, data suggest that the same survival benefit can be achieved with similar morbidity using a shorter course of radiotherapy (hypofractionation). Elderly patients with tumors that exhibit methylation of the O-6-methylguanine-DNA methyltransferase promoter can benefit from TMZ alone.

In this issue of the Chinese Journal of Cancer, European experts review current standards, trends, and future prospects in the difficult domain of high-grade glioma. In al fields covered by the different authors, the progress has been impressive. For example, discoveries at the molecular level have already impacted imaging, surgery, radiotherapy, and systemic therapies, and they are expected to play an increasing role in the management of these cancers. The European Organization for Research and Treatment of Cancer (EORTC) has pioneered new treatment strategies and contributed to new standards. The articles in this issue will cover basic molecular biological principles applicable today, novel surgical approaches, innovations in radiotherapy planning and delivery, evidence-based standards for radiotherapy alone or combined with chemotherapy, current standards and novel approaches for systemic treatments, and the important but often neglected field of health-related quality of life. Despite the advances described in these articles, the overall prognosis of high-grade glioma, especially glioblastoma, remains poor, and more research is needed to address this problem.

Radiotherapy for Lowly Malignant Cranial Inflammatory Myofibroblastic Tumor Accompanied with Intracranial Invasion: Case Report and Literature Review

Inflammatory myofibroblastic tumor (IMT) is rare in clinical practice. As its treatment mainly involves surgery, radiotherapy alone is seldom reported in literature. Here we report a case of lowly malignant cranial IMT with intracranial invasion in a female patient. As surgery was not suitable, intensity modulated radiation therapy (IMRT) was administered. After radiotherapy, the cranial lesions tended to show efficacy.