Abstract: There is a lacking of effective therapeutic strategies in the treatment of advanced prostatic sarcoma with high-frequency microsatellite instability (MSI-H) or mismatch repair deficient (dMMR). In this study, we present the first described a case of advanced MSI-H and dMMR prostatic sarcoma in elderly patients with multiple comorbidities, who received an anti-PD-L1 monoclonal antibody (durvalumab) as the first-line treatment and achieved partial remission (PR) without visible adverse events. A 91-year-old male patient presented with frequent urination and defecation difficulty for over three months, aggravating for ten days. Digital rectal examination showed the prostate gland was III° enlargement and tough with a smooth surface. The MRI showed occupying lesions in the prostate without distant metastasis. Then, the prostate biopsy showed poorly differentiated small round cell malignant tumor and considered prostatic sarcoma. Immunohistochemistry showed MSI-H and dMMR prostatic sarcoma. Durvalumab alone was applied at a cycle of every 21 days (500 mg/day) for 18 months and achieved PR two months since the treatment. During the treatment, we didn't observe rash, immune-related pneumonia, hepatitis, and other adverse events. Also, no recurrence or metastasis was observed until now. Durvalumab is effective and safe in the treatment of advanced MSI-H or dMMR prostatic sarcoma in an elderly patient. It is promising to be an available choice for advanced prostate sarcoma, which is unsuitable for surgery, conventional chemotherapy, and radiotherapy.
Objective
To explore the safety, effectivity and dosimetric continence of 3D-printing coplanar template(3D-PCT)combined with CT-guided 125I seed implantation in the treatment of non-small cell lung cancer(NSCLC).
Methods
From May 2014 to November 2016, a total of 20 NSCLC patients who were suitable for 125I seed implantation were recruited in this study. Of all the patients, 10 received 125I seed implantation treatment by CT-guided combined with 3D-PCT (3D group), and the rest, by free-hand puncture combined with CT-guided 125I seed implantation (free-hand group). During two days before the surgery, the patients received the CT scan. Then the digital imaging and communications in medicine(DICOM) was collected to input to the Brachytherapy Treatment Planning System(BTPS). The dose parameters including D90, D100, V100, V150, conformal index(CI), external index(EI), and homogneneity index(HI) were compared between pre-operation and post-operation. Pair t-test and single sample t-test were performed.
Results
V150 in 3D group between preoperation and postoperation showed statistically significant difference(t=-2.916, P 0.05). However, the number of seeds, V100, EI, HI in free-hand group between preoperation and postoperation showed statistically significant difference(t=-2.516, 2.492, 4.725, 7.258, P 0.05). Comparison of indicuted that there was significant difference in V100, V150, CI, EI, HI and dose error rate between the 3D group and the free-hand group with single sample t test, the result showed V100, CI, EI, HI between two groups(t=2.598, 2.278, 4.637, 4.616, -4.785, P 0.05).
Conclusions
CT-guided 125I seed implantation brachytherapy combined with 3D-PCT for treatment of NSCLC safe is feasible, and dose controllable, and there is a certain advantage in the spatial distribution of seed compared with free-hand puncture.
Key words:
3D-printing; Coplanar template; Free hand; 125I seed implantation; Non small cell lung cancer
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