含铂类为基础化疗联合放疗治疗完全梗阻性食管癌

目的通过化、放续贯治疗手段解决完全梗阻性食管癌进食梗阻症状，完成放射治疗。提高局部控制率，延长生存期。方法回顾分析1999年4月-2003年10月本院收治完全梗阻性食管癌21例，占全部放射治疗食管癌病例2．4％，这21例完全梗阻性食管癌均为胸段食管癌，完全不能进食时间3～10天。分为两组：10例单纯放疗组，11例为化、放疗续贯治疗组。10例单纯放疗采用常规分割放疗。每次180～200cGy／F，每周5次。另11例采用先化疗，“DF”方案8例，“NP”方案3例，在化疗后12—18天进行放射治疗。放疗为常规分割放疗。分割剂量、方法同单纯放疗组。结果10例单纯放疗组有9例在放疗开始后1～4周，因进食梗阻症状不能改善终止放疗。有1例放疗6周，10例均不能改善进食症状。分别在接受放疗后1—2个月内死亡。中位生存期40天。另11例化疗、放疗综合治疗组在化疗后1～7天，11例均能改善进食梗阻。除1例在化疗后第3周因全身情况差未完成放疗，余10例均完成放疗。放疗期和放疗后全身情况相对差。血液性毒性相对大，中位生存期14个月。两组治疗有显著性差异。P〈0．0001。结论完全梗阻性食管癌单纯放疗疗效不佳。用先化疗缓解进食梗阻症状效果好。再通过放射治疗控制肿瘤生长，提高局部控制率，延长生存期。

Clinical Effect of Biafine in Preventing and Treating Radioactive Skin Destruction of Nasopharyngeal Carcinoma Patients Caused by Concurrent Intensity- Modulated Radiotherapy and Chemotherapy

OBJECTIVE To observe the clinical effect of Biafine cream in preventing and treating radioactive skin destruction of nasopharyngeal carcinoma （NPC） patients induced by synchronized intensity-modulated radiotherapy and chemotherapy. METHODS The patients were treated with Varian-600CD 6 MV X-ray three-dimensional （3D） conformal intensity-modulation radiotherapy （IMRT）, with a 120-blade multiple leaf-blade grating and in combination with synchronal Capecitabine chemotherapy. Fifty-one patients undergoing radiotherapy and chemotherapy were randomized into 2 groups： 25 in the treatment group received a Biafine cream application following the first radiotherapy and / or chemotherapy, while the other 26, served as controls. They received no application of the cream, but only followed normal procedures for conventional radiotherapy and health education. RESULTS The rate of the skin-reaction was 100% in the patients of both groups. A mild radiation reaction （grade-Ⅰ and Ⅱ） occurred as follows： 88.0% （22/25 cases） in the treatment group and 57.7% （15/26 cases） in the control group. A grade-Ⅲ radiation reaction developed in 12.0% （3/25 cases） in the treatment group, and 42.3% （11/26 cases） in the controls. There was a significant difference, P〈0.01 between the two groups. Concerning the degree of the skin response before the patients received a dose of 40 Gy, the radiation reaction emerged in 32.0% （8/25） of the cases in the treatment group, and in 96.2% （25/26） of the cases of the control group. CONCLUSION Biafine cream can effectively reduce the acute irradiation or chemotherapy-induced dermal injury. It can alleviate the patients＇ suffering, improve their quality of life, and can ensure less injurious radiotherapy.

Survey of Radiosensitizing Agents (Synthesized Chemicals and Gene Therapeutic Agents) Since 2000

Radiotherapy has played an important role in treatment of tumor patientssince it appeared about 80 years ago, and has been an indispensable part of the management of about50% of tumors (especially 60% - 70% of malignant tumors). Currently, radiotherapy is used in simpleand palliative therapy, adjuvant therapy after or before surgery, simultaneous radio-chemotherapy,combined BRM (biological response modifier) therapy, ets. Radiosensitizing agents enhance theradiation effects on tumor cells so as to have better responses in radiotherapy. Tumor intrinsicradiosensitivity is affected by the hy-poxic level in solid tumor, the ability of the cells torepair the radiation-induced DNA damage, the number of cells which have a clonogenic capability toreestablish uncontrolled cell growth, the amount of dividing cells, and the distribution of cellsthroughout the cell cycle. Consequently , it is necessary and useful to add one or moreradiosensitizing agents in radiotherapy to increase the radio-sensitivity of tumor cells.

Xeroderma pigmentosum group D 751 polymorphism as a predictive factor in resected gastric cancer treated with chemo-radiotherapy

AIM: To evaluate the potential association of xeroderma pigmentosum group D (XPD) codon 751 variant with outcome after chemo-radiotherapy in patients with resected gastric cancer. METHODS: We used PCR-RFLP to evaluate the genetic XPD Lys751Gln polymorphisms in 44 patients with stage Ⅲ (48%) and Ⅳ (20%) gastric cancer treated with surgery following radiation therapy plus 5-fluorouracil/ leucovorin based chemotherapy. RESULTS: Statistical analysis showed that 75% (12 of 16) of relapse patients showed Lys/Lys genotype more frequently (P = 0.042). The Lys polymorphism was an independent predictor of high-risk relapse-free survival from Cox analysis (HR: 3.07, 95% CI: 1.07-8.78, P = 0.036) and Kaplan-Meir test (P = 0.027, log-rank test). CONCLUSION: XPD Lys751Gln polymorphism may be an important marker in the prediction of clinical outcome to chemo-radiotherapy in resected gastric cancer patients.

Intensity-modulated radiation therapy with concurrent chemotherapy for locally advanced cervical and upper thoracic esophageal cancer

AIM： To evaluate the dosimetry, efficacy and toxicity of intensity-modulated radiation therapy （IMRT） and concurrent chemotherapy for patients with locally advanced cervical and upper thoracic esophageal cancer. METHODS： A retrospective study was performed on 7 patients who were definitively treated with IMRT and concurrent chemotherapy. Patients who did not receive IMRT radiation and concurrent chemotherapy were not included in this analysis. IMRT plans were evaluated to assess the tumor coverage and normal tissue avoidance. Treatment response was evaluated and toxicities were assessed. RESULTS： Five- to nine-beam IMRT were used to deliver a total dose of 59.4-66 Gy （median： 64.8 Gy） to the primary tumor with 6-MV photons. The minimum dose received by the planning tumor volume （PTV） of the gross tumor volume boost was 91.2%-98.2% of the prescription dose （standard deviation [SD]： 3.7%-5.7%）. The minimum dose received by the PTV Of the clinical tumor volume was 93.8%-104.8% （SD： 4.3%-11.1%） of the prescribed dose. With a median follow-up of 15 rno （range： 3-21 too）, all 6 evaluable patients achieved complete response. Of them, 2 developed local recurrences and 2 had distant metastases, 3 survived with no evidence of disease. After treatment, 2 patients developed esophageal stricture requiring frequent dilation and 1 patient developed tracheal-esophageal fistula. CONCLUSION： Concurrent IMRT and chemotherapy resulted in an excellent early response in patients with locally advanced cervical and upper thoracic esophageal cancer. However, local and distant recurrence and toxicity remain to be a problem. Innovative approaches are needed to improve the outcome.

Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment

AIM： To evaluate the utility of local tumor therapy combined with percutaneous transhepatic bilian/drainage （PTBD） for malignant obstructive bilian/disease. METHODS： A total of 233 patients with malignant billan/obstruction were treated in our hospital with PTBD by placement of metallic stents and/or plastic tubes. After PTBD, 49 patients accepted brachytherapy or extraradiation therapy or arterial infusion chemotherapy. The patients were followed up with clinical and radiographic evaluation. The survival and stent patency rate were calculated by Kaplan-Meier survival analysis. RESULTS： Twenty-two patients underwent chemotherapy （11 cases of hepatic carcinoma, 7 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy）, and 14 patients received radiotherapy （10 cases of cholangiocardnoma, 4 cases of pancreatic carcinoma）, and 13 patients accepted brachytherapy （7 cases of cholangiocarcinoma, 3 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy）. The survival rate of the local tumor treatment group at 1, 3, 6, and 12 months was 97.96%, 95.92%, 89.80%, and 32.59% respectively, longer than that of the non treatment group. The patency rate at 1, 3, 6, and 12 months was 97.96%, 93.86%, 80.93%, and 56.52% respectively. The difference of patency rate was not significant between treatment group and non treatment group. CONCLUSION： Our results suggest that local tumor therapy could prolong the survival time of patients with malignant biliary obstruction, and may improve stent patency.

Three-dimensional conformal radiotherapy combined with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer

AIM： To investigate the effect of three-dimensional conformal radiotherapy （3-DCRT） in combination with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer. METHODS： Forty-eight patients with unresectable recurrent rectal cancer were randomized and treated by 3-DCRT or 3-DCRT combined with FOLFOX4 chemotherapy between September 2001 and October 2003. For the patients without prior radiation history, the initial radiation was given to the whole pelvis by traditional methods with tumor dose of 40 Gy, followed by 3-DCRT for the recurrent lesions to the median total cumulative tumor dose of 60 Gy （range 56-66 Gy）; for the post-radiation recurrent patients, 3-DCRT was directly given for the recurrent lesions to the median tumor dose of 40 Gy （36-46 Gy）. For patients in the study group, two cycles chemotherapy with FOLFOX4 regimen were given concurrently with radiotherapy, with the first cycle given simultaneously with the initiation of radiation and the second cycle given in the fifth week for patients receiving conventional pelvis radiation or given in the last week of 3-DCRT for patients receiving 3-DCRT directly. Another 2-4 cycles （average 3.6 cycles） sequential FOLFOX4 regimen chemotherapy were given to the patients in the study group, beginning at 2-3 wk after chemoradiation. The outcomes of symptoms relieve, tumor response, survival and toxicity were recorded and compared between the study group and the control group. RESULTS： For the study group and the control group, the pain-alleviation rates were 95.2% and 91.3%（P〉 0.05）; the overall response rates were 56.5% and 40.0% （P〉0.05）; the 1-year and 2-year survival rates were 86.9%, 50.2% and 80.0%, 23.9%, with median survival time of 25 mo and 16 mo （P〈 0.05）; the 2-year distant metastasis rates were 39.1% and 56.0% （P= 0.054）, respectively. The side effects, except peripheral neuropathy which was relatively severer in the study group, were similar in the the two groups and well tolerated. CONCLUSION： Three-dimensional conformal radiotherapy combined with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer is a feasible and effective therapeutic approach, and can reduce distant metastasis rate and improve the survival rate.

Anemia and long-term outcome in adjuvant and neoadjuvant radiochemotherapy of stage Ⅱ and Ⅲ rectal adenocarcinoma:The Freiburg experience(1989-2002)

AIM： To evaluate the long-term outcome of standard 5-FU based adjuvant or neoadjuvant radiochemotherapy and to identify the predictive factors, especially anemia before and after radiotherapy as well as hemoglobin increase or decrease during radiotherapy. METHODS： Two hundred and eighty-six patients with Union International Contre Cancer （UICC） stage Ⅱ and Ⅲ rectal adenocarcinomas, who underwent resection by conventional surgical techniques （low anterior or abdominoperineal resection）, received either postoperative （n = 233） or preoperative （n = 53） radiochemotherapy from January 1989 until July 2002. Overall survival （OAS）, cancer-specific survival （CSS）, disease-free survival （DFS）, local-relapse-free （LRS） and distant-relapse-free survival （DRS） were evaluated using Kaplan-Meier, Log-rank test and Cox＇s proportional hazards as statistical methods. Multivariate analysis was used to identify prognostic factors. Median follow-up time was 8 years. RESULTS： Anemia before radiochemotherapy was an independent prognostic factor for improved DFS （risk ratio 0.76, P= 0.04） as well as stage, grading, R status （free radial margins）, type of surgery, carcinoembryonic antigen （CEA） levels, and gender. The univariate analysis revealed that anemia was associated with impaired LRS（better local control） but with improved DFS. In contrast, hemoglobin decrease during radiotherapy was an independent risk factor for DFS （risk ratio 1.97, P= 0.04）. During radiotherapy, only 30.8% of R0-resected patients suffered from hemoglobin decrease compared to 55.6% if R1/2 resection was performed （P= 0.04）. The 5-year OAS, CSS, DFS, LRS and DRS were 47.0%, 60.0%, 41.4%, 67.2%, and 84.3%, respectively. Significant differences between preoperative and postoperative radiochemotherapy were not found. CONCLUSION ： Anemia before radiochemotherapy and hemoglobin decrease during radiotherapy have no predictive value for the outcome of rectal cancer. Stage, grading, R status （free radial margins）, type of surgery, CEA levels, and gender have predictive value for the outcome of rectal cancer.

Treatment results and prognostic analysis of 1093 primary nasopharyngeal carcinoma: the experience of a single institution of Guangzhou in the beginning of the 21st century

Objective： To analyze the treatment results of primary nasopharyngeal carcinoma （NPC） treated in our institution in the beginning of the 21st century to identify key failures and late effects for refining future treatments. Methods： 1093 patients with primary NPC treated during December 2001 and June 2003 were retrospectively analyzed. The distribution according to the AJCC/UICC （2002 edition） staging system was stage Ⅰ in 5.8%, stage Ⅱ 40.2%, stage Ⅲ 32.7% and stage Ⅳa-b 21.3%. Four different ERT techniques were used： fluoroscopy simulation conventional radiotherapy （CR） in 74.3% of patients, computer tomography simulation conventional radiotherapy （CT-sim CR） 14.2%, three-dimensional conformal radiotherapy （3D-CRT） 6.3%, intensity modulated radiotherapy （IMRT） 5.2%. In the whole series, 46.7% of patients had additional treatment with chemotherapy. Results： The 4-year local failure-free rate （LFFR）, nodal failure-free rate, distant metastasis-free rate, progression-free survival and overall survival （OS） was 89.6%, 96.1%, 85.9%, 73.0% and 82.4%, respectively. The stage was the most important prognostic factor. The 4-year OS and LFFR of patients treated by CR, CT-sim CR, 3D-CRT and IMRT was 80.2%, 89.8%, 89.8%, 92.4% and 87.7%, 96.4%, 91.0%, 96.5%, respectively. The morbidity and degree of xerostomia and trismus were lower in the patients treated by 3D-CRT and IMRT than by CR and CT-sim CR. Conclusion： Treatment results of primary NPC in our institution have been substantially improved. Distant metastasis is the main failure. The CT simulation and conformal radiotherapy can enhance the OS and LFFR, and conformal radiotherapy can reduce the morbidity and degree of late effects.

Preoperative therapy in locally advanced esophageal cancer

Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer(T2 or greater or node positive); however, a high rate of disease recurrence(systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment(preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy(radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.

Clinical efficacy of oral enteral nutrition in lung cancer patients receiving chemotherapy and/or radiotherapy： a systematic review of randomized controlled trials

Background and Objectives： the effects of oral enteral nutrition （EN） in lung cancer patients receivingchemotherapy and/or radiotherapy were controversial, so we made a systematic review to analyze the clinicalefficacy of EN in lung cancer patients after chemotherapy and/or radiotherapy. Methods and Study Design：Pertinent studies were identified by searching in PubMed, Embase, Web of Science, Cochrane Library, ChinaNational Knowledge Infrastructure （CNKI）, WanFang Database, China Biomedical Literature database （CBM） andChinese Science and Technology Periodical Database （VIP）. Energy intake, protein intake, weight and other datawere extracted. Results： Finally, 5 randomized controlled trials （RCTs） were included in this systematic review.Patients in 3 studies received chemotherapy, in 1 with radiotherapy and in 1 with chemo-radiotherapy. Thecombined results showed that EN significantly increased energy and protein intake in lung cancer duringchemotherapy, while there was no significant effect on other results after patients had received chemotherapyand/or radiotherapy. Conclusions： Limited evidence is available to judge whether EN can improve clinical effect oflung cancer with or without chemotherapy and/or radiotherapy, as clinical heterogeneity and other potentialvariation existed in this review. Further studies are needed.

Impact of simultaneous assay, the PCNA, cyclinDl, and DNA content with specimens before and after preoperative radiotherapy on prognosis of esophageal cancer-possible incorporation into clinical TNM staging system

AIM: The aim of the present study is to use immunohisto chemical methods to investigate the clinical implications of tumor markers in esophageal squamous cell carcinoma and evaluate their impact on prognosis. METHODS: From November 1990 to December 1996, 47 patients were treated with preoperative radiation followed by radical esophagectomy. All patients were confirmed pathologically as suffering from squamous cell carcinoma. Immunohistochemical stain was done for PCNA, cyclinDl protein expression and DNA content analyzed by image cytometry. Kaplan-Meier method for single prognostic factor and log-rank test was used to test the significant difference. Cox stepwise regression model and prognosis index model were used for survival analysis with multiple prognostic factors. RESULTS: Radio-pathological change, T stage and N stage, as the traditional prognostic factors had statistical difference in 3-, 5- and 10-year survival rates. While, tumor cell proliferating marked PCNA, cyclinDl and DNA content served as independent prognostic factors of esophageal carcinoma. There was definitely an identity between the single and multiple factor analyses. PI was more accurate to evaluate the prognosis of esophageal carcinoma. CONCLUSION: It is possible that tumor cell proliferating marked PCNA, cyclinD1 and DNA content would become the endpoints for evaluating the prognosis of esophageal carcinoma.

Adjuvant Pelvic Radiotherapy vs.Sequential Chemoradiotherapy for High-Risk StageⅠ-ⅡEndometrial Carcinoma

Objective To explore if the addition of adjuvant chemotherapy with paclitaxel and carboplatin to radiotherapy confers an advantage for overall survival （OAS）, and progression free survival （PFS）; to assess the incidence of relapses over standard pelvic radiotherapy; and to evaluate the related toxicity in high-risk stage I-II endometrial carcinoma Methods Medical records were reviewed to identify high-risk stage I-1I endometrial carcinoma cases treated in the Clinical Oncology and Nuclear Medicine department between 2002 and 2008 with adjuvant radiotherapy alone （arm Ⅰ）（57 patients） or with sequential carboplatin （AUCS-6） and paclitaxel （135-175 mg/m^2） with radiotherapy （arm Ⅱ） （51 patients）. Radiotherapy was performed through the four-field box technique at doses of 45-50 Gy （1.8 Gy/day × 5 days/week）. Results The toxicity was manageable and predominantly hematologic with a grade 3 neutropenia and thrombocytopenia in 9.8% and 6% of the patients in arm Ⅰ and arm Ⅱ, respectively, without febrile neutropenia. All patients experienced hair loss. Chernoradiotherapy arm was associated with a lower incidence rate of relapse （9.8% vs. 22.7%）. After a median follow-up period of 48 months, the 5-year OAS and PFS rates for chemoradiotherapy-treated patients were significantly more favorable than those who did not receive chemotherapy （P=0.02 and 0.03, respectively）. In arm I, the OAS and PFS rates were 73.7% and 66.7% compared with those in arm II, whose rates were 90.2% and 84.3%. Conclusions Adjuvant chemoradiation with paclitaxel and carboplatin improved the survival rates and decreased the recurrence rates in patients with high-risk stage Ⅰ-Ⅱ endometrial carcinoma. Chemotherapy was associated with an acceptable rate of toxicity. However, a prospective study with a larger number of patients is needed to define a standard adjuvant treatment for high-risk stage Ⅰ-Ⅱ endometrial carcinoma.

Rectal cancer treatment: improving the picture

Multidisciplinary approach for rectal cancer treatment is currently well defined. Nevertheless, new and promising advances are enriching the portrait. Since the US NIH Consensus in the early 90's some new characters have been added. A bird's-eye view along the last decade shows the main milestones in the development of rectal cancer treatment protocols. New drugs, in combination with radiotherapy are being tested to increase response and tumor control outcomes. However, therapeutic intensity is often associated with toxicity. Thus, innovative strategies are needed to create a better-balanced therapeutic ratio. Molecular targeted therapies and improved technology for delivering radiotherapy respond to the need for accuracy and precision in rectal cancer treatment.

Radiation Recall Reaction:Two Case Studies Illustrating an Uncommon Phenomenon Secondary to Anti-Cancer Agents

Radiation recall phenomenon is a tissue reaction that develops throughout a previously irradiated area,precipitated by the administration of certain drugs.Radiation recall is uncommon and easily neglected by physicians;hence,this phenomenon is underreported in literature.This manuscript reports two cases of radiation recall.First,a 44-year-old man with nasopharyngeal carcinoma was treated with radiotherapy in 2010 and subsequently developed multi-site bone metastases.A few days after the docetaxel-based chemotherapy,erythema and papules manifested dermatitis,as well as swallowing pain due to pharyngeal mucositis,developed on the head and neck that strictly corresponded to the previously irradiated areas.Second,a 19-year-old man with recurrent nasal NK/T cell lymphoma initially underwent radiotherapy followed by chemotherapy after five weeks.Erythema and edema appeared only at the irradiated skin.Both cases were considered chemotherapeutic agents that incurred radiation recall reactions.Clinicians should be knowledgeable of and pay attention to such rare phenomenon.

Analysis of the Prognosis for Patients with Stage T3N0-1M0 Nasopharyngeal Carcinoma Treated by Chemotherapy Combined with Radiotherapy

OBJECTIVE To investigate the relationship between the therapeutic modality and prognostic factors for the patients with T3N0-1M0 nasopharyngeal carcinoma. METHODS The clinical data from 127 cases of T3N0-1M0 nasopharyngeal carcinoma patients with initial treatment, during the period from January 4th, 2000 to November 12th, 2001, were retrospectively analyzed. The cases were divided into Group A with simple radiotherapy (90) and Group B with the radiation therapy combined with chemotherapy (37), based on various patients' conditions. In group B, inductive chemotherapy was conducted for 18 cases, inductive chemotherapy plus homochronous chemotherapy for 5 and homochronous chemotherapy for 14. RESULTS The 5-year overall survival (OS) in the groups A and B was 73.4% and 72.3% respectively (P>0.05); the cancer-correlated survival (CCS) in the 2 groups was 76.4% and 72.3% respectively (P>0.05); the disease-free survival (DFS) in group A and B was 65.5% and 71.7% respectively (P<0.05). A multiple analysis showed that the mode of radiation therapy plus chemotherapy was a favorable independent impact factor for DFS. CONCLUSION Chemotherapy plus radiotherapy can improve the DFS of patients with T3N0-1M0 nasopharyngeal carcinoma, but fails to prolong the survival time of the patients. The modality of chemotherapy plus radiotherapy is not the necessary choice in treatment of patients with T3N0-1M0 nasopharyngeal carcinoma.

Current Research on Consolidation Therapy and Follow-up Health Care in Advanced Non-small Cell Lung Cancer Patients

Following concurrent radio-chemotherapy or first-line chemotherapy for advanced non-small cell lung cancer （NSCLC）, continuous maintenance therapy given to patients with stable disease （SD） and follow-up treatment is called consolidation therapy. Concerning NSCLC patients with a non-operable dry Stage-IIIB （N3） disease, i.e. contra-lateral mediastinal and hilar lymph node, or homolateral/contra-lateral scalene and Troisier sign, a 2 or 3-course of standard-dosage Taxotere consolidation therapy can be performed after concurrent radio-chemotherapy. In pursuance of evidence-based medicine （EBM）, low-dose Taxotere maintenance therapy, and biological targeted therapy of patients with appropriate symptoms are suitable for second-line therapy for moist of the Stage-ⅢB （malignant pleural effusion） and Ⅳ patients.

Clinical observation in three-dimensional conformal radiotherapy (3D-CRT) with concurrent chemotherapy in treatment of postoperative cerebral gliomas

Objective:The aim of the study was to investigate the efficacy of three-dimensional conformal radiotherapy (3D-CRT) combined with Temozolomide (TMZ) concurrent chemotherapy in treatment of postoperative cerebral gliomas by prospective randomized controlled trials. Methods: Sixty-two patients with cerebral glioma who had residual tumor were divided into 3D-CRT group (radiotherapy group, n=31) and 3D-CRT with concurrent chemotherapy group (chemoradiotherapy group, n=31) prospectively. All patients received a dose of 50-60 Gy/25-30 F/5-6 weeks by 6 MV-X ray, three-dimensional conformal radiotherapy, 1 f/d, 5 times a week. Chemotherapy regimen was Temozolomide:75 mg/m2/d, concomitantly with radiotherapy, followed by 150-200 mg/m2/d, 5 days, 28 days per cycle, totally 3-6 cycles. Results: The total response rate was 35.3% (11/31) in radiotherapy group. The response rate was 61.3% (19/31) in chemoradiotherapy group. There was significant difference in curative effect (P=0.042). There was no significant difference in survival comparison of two groups (P=0.263). Stratified analysis showed the patients with grade Ⅲ gliomas of chemoradiotherapy group had better prognosis than ones of radiotherapy group (P=0.043). Conclusion: The 3D-CRT with concurrent chemotherapy can improve the survival of cerebral gliomas with pathological grade Ⅲ.

Preoperative Chemoradiotherapy for Inflammatory Breast Cancer

OBJECTIVE To observe the effect of preoperative chemoradiotherapy for inflammatory breast cancer. METHODS From December 1996 to December 2000, we received and treated 21 patients with inflammatory breast carcinoma with a combinedmodality treatment. The chemotherapy protocol consisted of cyclophosphamide （CTX）, pirarubicin （THP-ADM） and 5-fluorouracil （5-FU） or CTX, 5-Fu and methotrexate （MTX）. The same infusion scheme was repeated on day 21. After 3-4 cycles the patients were treated with radiotherapy. When the radiation dose reached 40 Gy, the patients who were unable or unwilling to under go an operation received continued radiotherapy. When the radiation dose to the supra clavicular fossa and internal mammary lymph nodes reached 60 Gy and 50 Gy respectively, the radiotherapy was stopped. Chemotherapy was then continued with the original scheme. Patients who had indications for surgery and were willing to under go an operation received no treatment for 2 weeks, after which a total mastectomy was performed. Chemotherapy and radiotherapy was resumed with the original scheme after the operations. When the radiation dose reached 50 Gy, radiotherapy was stopped. RESULTS All patients were followed-up for more than 5 years with a follow-up rate of 100%. The overall 3 and 5-year survival rates of these patients were 42.9%, and 23.8% respectively. For patients in Stage lliB the 3 and 5-year survival rates were 50.0% and 27.8% respectively, and for patients in Stage IV, the 3 and 5-year survival rates were both 0.0%. There was a significant difference between the 2 stage groups （P〈0.05, X^2=11.60）. For patients who received an operation, the 3 and 5-year survival rates were 80.0% and 33.3% respectively, For patients who were not treated with an operation, the 3 and 5-year survival rates were both 0.0%, There was a significant difference between the operated and nonoperated groups （P〈0.05, X2=11.64）. CONCLUSION The prognosis of inflammatory breast carcinoma is poor. Before operation, a combined-modality treatment （first chemotherapy, then local therapy, finally chemotherapy and radiotherapy） is the best treatment method.

Clinical study on radiofrequency combined with ^(131)I therapy for dedifferentiated thyroid carcinomas

Objective:The aim of this study was to explore clinical efficiency of radio frequency combined with 131I therapy for dedifferentiated thyroid carcinoma.Methods:All patients have been treated by radiofrequency connected with 131I in 29 cases of dedifferentiated thyroid carcinoma which performed radionuclide imaging and Ig array of blood serum before and after therapy,respectively.Results:There were 4(4/29) positive cases of radionuclide imaging before treatment and 19(19/29) cases 2 weeks after therapy,25(25/29) cases of overall efficacy and 15(15/29) curative cases. Conclusion: Radiofrequency connected with 131I improve clinical efficacy of 131I treatment for dedifferentiated thyroid cancer of thyroid in view of higher absorbing 131I of thyroid cancerous cell.