Background: Local tumor failure remains a major problem after radiation-based nonsurgical treatment for unresectable locally advanced Non-Small Cell Lung Cancer （NSCLC）and inoperable stage II NSCLC .The aim of this study was to evaluate the feasibility of Simultaneous Integrated Boos of intensity modulated radiation therapy (SIB-IMRT) to Stage II-III NSCLC with metastatic lymph nodes. Methods: Patients were diagnosed by pathology or PET-CT. PTV was divide into two parts as follow, the PTV of primary tumor (PTVp) and the PTV of metastatic lymph nodes (PTVn) .The radiation doses were simultaneously prescripted 78Gy (BED = 101.48Gy) for PTVp and 60-65Gy (BED = 73.6-81.25Gy) for PTVn, 26f/ 5.2 weeks .Response was scored according to WHO criteria. Radiotherapy toxicity was scored according to RTOG criteria .Hematology and gastrointestinal toxicity were scored according to CTCAE1.0 criteria. Results: A total of 20 patients were enrolled. 17 patients were diagnosed by pathology and 3 patients were diagnosed by PET-CT . All patients were treated with SIB-IMRT. The objective response rate (ORR) was 90%, with CR 25%, PR 65%, NC 10% and PD 0%. Although Radiation toxicitiy was common, there were no grade≥3，with Radiation pneumonitis (10 cases), esophagitis (17 cases) and dermatitis (12 cases). The local control rates at 1, 3 and 5 years were 85%, 75% and 70%, respectively. The overall survival（OS）and local progression-free survival(LPFS) rates at 1, 3 and 5 years were 90%, 42.6%, 35.5% and 84.4%, 35.5% , 28.4%, respectively. The MST was 24 months. Conclusions: SIB-IMRT can significantly improve ORR and suivival for stage II-III NSCLC with metastatic lymph nodes , with high safety and satisfactory efficacy . Keywords: cancer/non-small-cell lung cancer; radiation therapy /SIB-IMRT; efficacy; safety Retrospective Trial Registration： (ChiCTR 2000029304)

The impact of primary tumour radiotherapy on the prognosis for non-small-cell lung cancer (NSCLC) with controlled malignant pleural effusion (MPE-C) (MPE-C-NSCLC) is unclear. This study aimed to analyze the efficacy and safety of primary tumor radiotherapy in patients with MPE-C-NSCLC. Patients and Methods: A total of 186 patients with MPE-C-NSCLC were enrolled and divided into two groups. The patients in the D group were treated with only drugs. Those in the RD group were treated with drugs plus primary tumour radiotherapy. The Kaplan-Meier method was used for survival analysis, and the Log rank test was used for between-group analysis and univariate prognostic analysis. The Cox proportional hazards model was used to perform multivariate analyses to assess the impacts of factors on survival. Propensity score matching (PSM) was matched based on clinical characteristics, systematic drug treatment and drug response to further adjust for confounding factors. Results: The overall survival (OS) rates at 1, 2, and 3 years for the RD group and D group were 54.4%, 26.8%, and 13.3% and 31.1%, 11.5%, and 4.4%, respectively; the corresponding MSTs were 14 months and 8 months, respectively (χ 2 =15.915, p<0.001). There was a significant difference in survival by PSM (p=0.027).Before PSM, multivariate analysis showed that metastasis status (organ≤3 and metastasis≤5), primary tumour radiotherapy, chemotherapy cycles≥4, and drug best response (CR+PR) were independent predictors of prolonged OS. After PSM, primary tumour radiotherapy and drug best response (CR+PR) were independent predictors of prolonged OS were still independent predictors of prolonged OS. There were no grade 4-5 radiation toxicities. Conclusion:For MPE-C-NSCLC, the response of systemic drug treatment plays a crucial role in survival outcomes, and we also should pay attention to primary tumour radiotherapy in addition to systematic drug treatment.

This study examined the reaction mechanism, influencing factors and toxicity of diclofenac sodium (DS) degradation by ultraviolet (UV)/chlorine process. The UV/chlorine was capable of eliminating DS from water. The DS degradation during the UV/chlorine process followed a pseudo-first-order kinetic model that was influenced by chlorine dosage, solution pH, humic acid and bicarbonate concentrations. The free chlorine affects not only DS elimination, but the contribution of various active species as well. Increasing free chlorine dosage from 1 to 7 mg·L-1 increased the first-order rate constant of NaClO, ·OH and reactive chlorine species (RCS) from 0.00063, 0.00328 and 0.00203 min−1 to 0.00233, 0.0101 and 0.0974 min−1, respectively, and increased the contribution of RCS from 8.20% to 75.71%, while the contribution of UV, NaClO, and ·OH were declined from 76.02%, 2.54% and 13.24% to 14.63%, 1.81%, and 7.85%, respectively. The contribution of RCS became increasingly prominence with the increment of free chlorine dosage. The kobs,UV/chlorine,DS value decreased from 0.0797 to 0.0445 min-1 as pH increased from 5.0 to 8.0. The presence of bicarbonate and natural organic matter both exerted an inhibitory effect on DS degradation. Eleven intermediate products were identified and the degradation pathway involved C-N cleavage, condensation, hydroxylation, and decarboxylation was proposed. The UV/chlorine process effectively reduced acute toxicity and was superior to chlorination. The genotoxicity induced by a chlorinated solution treated by the UV/chlorine process exhibited negative genotoxicity. These results show that the UV/chlorine process is capable for the degradation and detoxification of DS.