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Background: Cisplatin-based chemoradiation is the standard of care for patients with locally advanced cervical cancer. Nevertheless, an increasing number of radio-resistant tumors still recur.Methods and Design: Three hundred cervical cancer patients with FIGO stages IB2-IVA and no para-aortic lymphadenopathy (> 10 mm) will be enrolled. All patients will be randomly divided into four arms to receive either (1) intensity modulated radiation therapy (IMRT), (2) RapidArc, (3) positron emission tomography/computed tomography (PET/CT) with F-18 fluorodeoxyglucose (FDG), or (4) Comet assay-guided IMRT, PET/CT, and Comet assay-guided RapidArc. All patients will receive definitive radiotherapy consisting of external beam whole pelvic radiation therapy and high-dose rate intracavitary brachytherapy. Cisplatin 30 mg/m2 weekly will be administered concurrently for five courses. Two to four cycles of TP (Taxol 135 mg/m2, D1, and DDP 75 mg/m2, D1-3) sequential chemotherapy will be performed according to MRI or PET/CT after cisplatin-based chemoradiation. The primary outcome measure is progression-free survival, and the second outcome measures are overall survival and time to progression.Discussion: RapidArc has an obvious advantage in improving the degree of target coverage, improving organs at risk, sparing healthy tissue, and significantly reducing the treatment time. FDG-PET/CT can increase the agreement between biopsies and delineated tumor volume and has the potential to positively impact the course of treatment. The Comet assay is attractive as a potential clinical test of tumor radiosensitivity. During radiotherapy, accurately defining disease areas is critical to avoid the unnecessary irradiation of normal tissue. Based on FDG-PET/CT and Comet assay, higher doses can be safely delivered to accurate tumor volumes, while the doses to the bladder and rectum are relatively low.Trial Registration: ClinicalTrials.gov Protocol Registration and Results System Receipt Release Date: May 21, 2017 - Retrospectively registered. NCT03163979 . [ABSTRACT FROM AUTHOR]

Purpose: To explore the clinical efficacy and safety of bevacizumab combined with temozolomide dose-dense regimen in the treatment of recurrent glioma., Methods: The clinical data of 102 patients with recurrent glioma after surgery, radiotherapy or chemotherapy treated in our hospital from March 2016 to December 2018 were retrospectively analyzed. There were 51 patients undergoing bevacizumab combined with temozolomide treatment (Bevacizumab group), and the remaining 51 patients received temozolomide treatment alone (Control group). The clinical data of all patients were collected, the short-term efficacy, adverse reactions after treatment and quality of life score were compared between the two groups, and the levels of serum immune factors were recorded. The patients were followed up, and the overall survival (OS) rate and progression-free survival (PFS) rate were recorded., Results: All patients underwent bevacizumab treatment for 2-12 cycles, with an average of 6.3 cycles. The objective response rate (ORR) was 47.1% (24/51) and 23.5% (12/51), and the clinical benefit rate (CBR) was 82.4% (42/51) and 60.8% (31/51), respectively, in the Bevacizumab group and Control group. Both ORR and CBR in the Bevacizumab group were superior to those in the Control group. After treatment, the scores of the SF-36 scale significantly rose in the two groups. After treatment, the levels of serum vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), interleukin-2 (IL-2) and IL-6 obviously declined in the two groups compared with those before treatment, while they were obviously lower in the Bevacizumab group than those in the Control group. The median OS was 9.2 months and 8.7 months, and the median PFS was 4.1 months and 3.3 months, respectively, in the Bevacizumab group and the Control group. Log-rank test revealed that the OS had no statistically significant difference between the two groups, but the PFS in the Bevacizumab group was remarkably better than that in the Control group., Conclusions: Bevacizumab combined with temozolomide can significantly improve the clinical efficacy, increase the quality of life of patients, and delay the progression of recurrent glioma, with tolerable adverse reactions.

Angiogenesis is an important process for the cell growth of normal and tumor tissues. Vasculogenic mimicry (VM) is a newly described vascular network structure that was first described in aggressive melanomas. To find out whether VM also exists in astrocytomas and to examine its clinical significance, we studied 80 malignant astrocytoma samples using immunohistochemistry coupled with periodic acid-Schiff (PAS) staining. To explore the possible therapeutic methods of anti-VM formation, we cultured astrocytoma cells using three-dimensional Matrigel and investigated the effects of Endostar, an endothelial cell growth inhibitor, on astrocytoma cell growth, invasion, and VM formation. VM structures were found in 8 samples of malignant astrocytomas, seven of which were grade IV astrocytomas. Glioblastoma U251 cells cultured in Matrigel formed vessel-like loops and networks, mimicking the features of VM in vivo, whereas such structures were not found in cultured normal astrocytes or well-differentiated astrocytoma SHG44 cells. In addition, treatment with Endostar led to a dose- and time-dependent inhibition of proliferation and invasion of both U251and SHG44 cells, but VM formation by U251 cells in vitro was not prominently affected. In conclusion, VM is frequently detected in aggressive glioblastomas, and the presence of VM may constitute a new predictor for poor prognosis in astrocytoma patients. Although Endostar has broad anti-tumor effects due to anti-angiogenesis and anti-tumor cell mechanisms, its inhibitory effects on VM formation by U251cells in vitro are not remarkable., (Copyright © 2011 Elsevier GmbH. All rights reserved.)