Risk factors and clinical characteristics of Pneumocystis jirovecii pneumonia in lung cancer
Eun Hye LeeEun Young KimSang Hoon LeeYun Ho RohAh Young LeemJoo Han SongSong Yee KimKyung Soo ChungJi Ye JungYoung Ae KangYoung Sam KimJoon ChangMoo Suk Park
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Solid malignancies are associated with the development of Pneumocystis jirovecii pneumonia (PJP). This study aimed to evaluate the risk factors for PJP among patients with lung cancer. This retrospective case-control study compared patients who had lung cancer with PJP (n = 112) or without PJP (n = 336) matched according to age, sex, histopathology, and stage. PJP definition was based on (i) positive PCR or direct immunofluorescence results for pneumocystis, (ii) clinical symptoms and radiological abnormalities that were consistent with a pneumonic process, and (iii) received targeted PJP treatment. The development of PJP was associated with radiotherapy (RTx), concurrent chemoradiotherapy (CCRTx), lymphopenia, and prolonged high-dose steroid therapy (20 mg of prednisolone equivalent per day for ≥3 weeks). Multivariate analysis revealed independent associations with prolonged high-dose steroid therapy (odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.06-3.63; p = 0.032) and CCRTx (OR: 2.09, 95% CI: 1.27-3.43; p = 0.004). Steroid use was frequently related to RTx pneumonitis or esophagitis (29 patients, 43.3%). Prolonged high-dose steroid therapy and CCRTx were risk factors for PJP development among patients with lung cancer. As these patients had a poor prognosis, clinicians should consider PJP prophylaxis for high-risk patients with lung cancer.Lung cancer is still a leading cause of cancer mortality in the world. The incidence of lung cancer in developed countries started to decrease mainly due to global anti-smoking campaigns. However, the incidence of lung cancer in women has been increasing in recent decades for various reasons. Furthermore, since the screening of lung cancer is not as yet very effective, clinically applicable molecular markers for early diagnosis are much required. Lung cancer in women appears to have differences compared with that in men, in terms of histologic types and susceptibility to environmental risk factors. This suggests that female lung cancer can be derived by carcinogenic mechanisms different from those involved in male lung cancer. Among female lung cancer patients, many are non-smokers, which could be studied to identify alternative carcinogenic mechanisms independent from smoking-related ones. In this paper, we reviewed molecular susceptibility markers and genetic changes in lung cancer tissues observed in female lung cancer patients, which have been validated by various studies and will be helpful to understand the tumorigenesis of lung cancer.
Genetic predisposition
Epidemiology of cancer
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This chapter contains sections titled: Introduction The great debate: surgery versus radiotherapy Surgery plus adjuvant radiotherapy How does radiotherapy work? Methods of radiotherapy administration Radiotherapy simulation and planning Radiotherapy treatment factors Optimising radiotherapy treatment Treatment-related toxicities Acute radiotherapy toxicities Late radiotherapy toxicities Second malignancies Radiotherapy and quality of life Conclusion Frequently asked questions Resources References
Adjuvant radiotherapy
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Objective:To study on whether radiotherapy affects on T cell subgroups,and to research on the effects of immunoenhancing agents on the immune side effects of radiotherapy.Methods:Sixty-six malignant tumour patients were divided into two groups,radiotherapy alone and radiotherpay plus immunoinhancing agents therapy groups.All patients were subjected to high energy X-rays and electronic rays outer local reginal therapy.T cell subgroups levels were measured before and after the radiotherapy.Results:CD 3,CD 4 and CD 8 decreased significantly after radiotherapy (P0.05) in radiotherapy alone group.There were no differences in CD 3,CD 4 and CD 8 before and after radiotherapy in the group of radiotherapy plus immunoinhancing agents therapy.Conclusions:Radiotherapy may cause the decrease in T cells of all subgroups and immunoinhancing agents may antagonize the side effects of radiotherapy. [
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Objective To analyze the effects between three different therapy materials for non-small cell lung cancer(NSCLC).Methods 327 patients who suffered from NSCLC were treated by radiotherapy alone,radiotherapy after operation,and chemotherapy combined with radiotherapy.Results The 3-and 5-year survival rates of radiotherapy after operation were higher than radiotherapy alone and chemotherapy combined radiotherapy groups; radiotherapy alone higher than chemotherapy combined radiotherapy groups.Conclusions There was on relationship between the survival rate and the pathological classification,but there was a close relationship between the clinical stage and the selecting therapy in survival rate.
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Cancer Biomarkers
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To analyze the effects of radiotherapy and its timing on the survival and safety of patients with newly diagnosed distant metastatic NPC in non-high-incidence areas.We retrospectively analyzed 94 newly diagnosed NPC patients with distant metastatic admitted to our hospital from January 2011 to June 2018. They were divided into three groups: no radiotherapy group received chemotherapy alone, early radiotherapy group was combined with radiotherapy during 1 to 3 cycles of chemotherapy, and late radiotherapy group was combined with radiotherapy after 4-6 cycles of chemotherapy were effective. The efficacy and side effects of the three groups were compared, and the prognostic factors were analyzed.The 6-month, 1-year and 2-year PFS were 53.6%, 14.3% and 3.6% in no radiotherapy group, 71.0%, 38.7% and 19.4% in early radiotherapy group, 88.6%, 48.6% and 22.9% in late radiotherapy group; the radiotherapy groups were better than the no radiotherapy group, and the difference was statistically significant (P < 0.017). The 1-year, 2-year and 3-year OS were 75.0%, 32.1% and 0 in no radiotherapy group, 77.4%, 54.8% and 12.9% in early radiotherapy group, 85.7%, 71.4% and 31.4% in late radiotherapy group; the radiotherapy groups were better than the no radiotherapy group, and the differences were statistically significant (P < 0.017). There was no significant difference in OS and PFS between the two radiotherapy groups. Univariate and multivariate analysis showed that HBV (P = 0.031), number of metastases (P = 0.002), liver metastases (P = 0.038), radiotherapy (P < 0.001) and treatment response (P = 0.011) were related to OS. There was no significant difference in the incidence of adverse events (P > 0.017).Early and late combined radiotherapy had similar clinical efficacy and both prolonged PFS and OS for patients with newly diagnosed distant metastatic NPC in non-high-risk areas. If chemotherapy response is expected to be poor, radiotherapy can be received early.
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Objective: To compare efficacy of chemo radiotherapy and single radiotherapy treatment on advanced cervical cancer and its side effects.Methods: A total of 46 cervical cancer cases at II b-IV stage confirmed by pathological analysis were selected and randomly divided into chemo radiotherapy group and radiotherapy group by half.The method and dosage of radiotherapy were the same in two groups.And patients in chemo radiotherapy group also had cisplatin combination chemotherapy for 3 times.every four weeks.Short-term,long-term treatment effects and side effects were observed and compared.Results:The short-term efficacy of chemo radiotherapy group was 95.23%(22/23),significantly higher than 69.20%(16/23) of the radiotherapy alone group(P0.05);3 and 5-year survival rates of chemo radiotherapy group were 86.96% and 65.22%,significant higher than that of the radiotherapy alone group(60.87% and 43.48%)(P0.05);toxicity and radiation adverse reactions of of the radiotherapy alone group was significantly higher than the radiotherapy alone group(P0.05),but after treatment they were tolerable.Conclusions: Synchronous radiochemical therapy have better clinical efficacy than that with radiotherapy alone in treatment of advanced cervical cancer,although with higher toxicity and side effect.But after treatment it can be tolerated,and does not affect the efficacy.
Chemo-radiotherapy
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The relationship between passive smoking and the onset of Legg-Calvè-Perthes disease is still controversial. Therefore, we conducted the study to systematically evaluate and analyze the relationship. A comprehensive search was conducted. Meta-analysis was performed with RevMan 5.3 software, with the odds ratio as the effect size. Eight English articles with a total of 1379 Legg-Calvè-Perthes disease patients were eventually included. Passive smoking type of family members smoking in indoor (odds ratio = 2.53), paternal smoking (odds ratio = 2.76), maternal smoking (odds ratio = 2.02), maternal smoking during pregnancy (odds ratio = 1.68), using stove indoor (odds ratio = 2.56) are statistically significant ( P < 0.05). For the family members smoking indoor, region may be a confounding factor (European group I 2 = 92%, odds ratio = 2.51; USA group I 2 = 5%, odds ratio = 3.26; and Asian group I 2 = 0%, odds ratio = 2.25). In addition, the type of maternal smoking (odds ratio = 0.80, for 1–10 per day; odds ratio = 2.73, for 10–20 per day; odds ratio = 2.78, for >20 per day) and the type of maternal smoking during pregnancy (odds ratio = 1.36, for 1–9 per day; odds ratio = 2.02, for ≥10 per day) may show a dose-effect relationship. Passive smoking is a risk factor for the onset of Legg-Calvè-Perthes disease, but the specific types of passive smoking (haze, etc.), dose, dose-effect relationship, regional confounding, pathological mechanisms, etc. also require clinicians and researchers to continue exploring.
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Background: Studies about the influence of patient characteristics on mechanical failure of cups in total hip replacement have applied different methodologies and revealed inconclusive results. The fixation mode has rarely been investigated. Therefore, we conducted a detailed analysis of the influence of patient characteristics and fixation mode on cup failure risks. Methods: We conducted a case-control study of total hip arthroplasties in 4420 patients to test our hypothesis that patient characteristics of sex, age, weight, body mass index, and diagnosis have different influences on risks for early mechanical failure in cemented and uncemented cups. Results: Women had significantly reduced odds for failure of cups with cemented fixation (odds ratio = 0.59; 95% confidence interval, 0.43 to 0.83; p = 0.002) and uncemented fixation (odds ratio = 0.63; 95% confidence interval, 0.5 to 0.81; p = 0.0003) compared with that for men (odds ratio = 1). Each additional year of patient age at the time of surgery reduced the failure odds by a factor of 0.98 for both cemented cups (odds ratio = 0.98; 95% confidence interval, 0.96 to 0.99; p = 0.016) and uncemented cups (odds ratio = 0.98; 95% confidence interval, 0.97 to 0.99; p = 0.0002). In patients with cemented cups, the weight group of 73 to 82 kg had significantly lower failure odds (odds ratio = 0.63; 95% confidence interval, 0.4 to 0.98) than the lightest (<64 kg) weight group or the heaviest (>82 kg) weight group (odds ratios = 1.00 and 1.07, respectively). No significant effects of weight were noted in the uncemented group. In contrast, obese patients (a body mass index of >30 kg/m2) with uncemented cups had significantly elevated odds relative to patients with a body mass of <25 kg/m2 (odds ratio = 1.41; 95% confidence interval, 1.03 to 1.91) for early failure of the cups compared with an insignificant effect in the cemented arm of the study. Compared with osteoarthritis as the reference diagnosis (odds ratio = 1), developmental dysplasia (odds ratio = 0.52; 95% confidence interval, 0.28 to 0.97) and hip fracture (odds ratio = 0.38; 95% confidence interval, 0.16 to 0.92) were significantly protective in cemented cups. Conclusions: Female sex and older age have similarly protective effects on the odds for early failure of cemented and uncemented cups. Although a certain body-weight range has a significant protective effect in cemented cups, the more important finding was the significantly increased risk for failure of uncemented cups in obese patients. Patients with developmental dysplasia and hip fracture were the only diagnostic groups with a significantly decreased risk for cup failure, but only with cemented fixation. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
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