Phase Ⅰ/Ⅱ study of gemcitabine and oxaliplatin chemotherapy in combination with concurrent 3-D conformal radiotherapy for locally advanced non-small cell lung cancer

Background and objective Recent studies have showed that combination of chemotherapy and radiotherapy might result in better outcome for locally advanced non-small cell lung cancer (NSCLC). The aim of this study is to determine the maximal tolerance dose (MTD) and efficacy of full-dose gemcitabine and oxaliplatin when given concurrently with 3-dimentional radiation therapy (3D-RT) for locally advanced NSCLC. Methods Oxaliplatin was administered at a fixed dose of 130mg/m^2, and gemcitabine was administered at a starting dose of 800mg/m^2 with an incremental dose gradient of 200mg/m^2 for 3 dose levels. MTD was defined as the immediate dose level lower than the dose at which dose-limiting toxicity (DLT) occurred in more than one-third of the patients. The chemotherapy was administered at 3-week cycle. The RT was given as 3-D conformal manner at a single daily dose of 2Gy for 5 days per week. Results Twenty-two patients were evaluable and distributed to three different dose levels: 6 at level 1, 8 at level 2 and 8 at level 3. Pulmonary toxicity, esophageal and hematologic toxicity were the main DLT. Grade Ⅲ acute pulmonary toxicity occurred in one patient each at level 2 and level 3, both with V20>20%, and grade Ⅲ esophagitis in two patients at level 3. The MTD of gemcitabine in this study was 1000mg/m^2. The overall response rate was 75.0% (9/12). The 1- and 2-year survival rate was 70.0% and 30.5% respectively. The median time to progression was 8.7 months (range 5--11.8 months). Conclusion With reduced radiation volume, gemcitabine of 1000mg/m^2 in combination with oxaliplatin of 130mg/m^2 was effective and could be safely administered for NSCLC.

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

瞄准：为 unresectable 与 FOLFOX4 化疗在联合调查三维的保角的放射疗法(3-DCRT ) 的效果周期性的直肠的癌症。方法：有 unresectable 的 48 个病人周期性的直肠的癌症被与在 2001 年 9 月和 2003 年 10 月之间的 FOLFOX4 化疗相结合的 3-DCRT 或 3-DCRT 使随机化并且对待。为没有优先的放射历史的病人，起始的放射被传统的方法与 40 Gy 的肿瘤剂量给整个骨盆，为周期性的损害由 3-DCRT 列在后面到 60 Gy (范围 56-66 Gy ) 的中部的全部的累积肿瘤剂量；为放射以后的周期性的病人， 3-DCRT 直接为周期性的损害被给 40 Gy (36-46 Gy ) 的中部的肿瘤剂量。为在学习组的病人，有 FOLFOX4 政体的二周期化疗与放射疗法并发地被给，为收到常规骨盆放射的病人交上第五个星期，第一个周期和第二个周期与放射的开始同时给或为直接收到 3-DCRT 的病人交上 3-DCRT 的最后星期。顺序的 FOLFOX4 政体化疗在学习被给病人的另外一个 2-4 周期(一般水准 3.6 周期) 组织，在在 chemoradiation 以后的 2-3 wk 开始。症状 relieve，肿瘤反应，幸存和毒性的结果在学习组和控制组之间被记录并且比较。结果：为学习组和控制组，疼痛缓和率是 95.2% 和 91.3%(P 】 0.05 ) ；全面反应率是 56.5% 和 40.0%(P 】 0.05 ) ；1 年、 2 年的幸存率是 86.9% ， 50.2% 和 80.0% ， 23.9% ，与 25 瞬间和 16 瞬间的中部的生存时间(P 【 0.05 ) ；2 年的远转移率是 39.1% 和 56.0%(P = 0.054 ) 分别地。副作用，除了是的外部神经病，相对，在学习的 severer 组织，是类似的在二个组和井容忍了。结论：三维的保角的放射疗法为周期性的直肠的癌症是的 unresectable 与 FOLFOX4 化疗结合了一条可行、有效的治疗学的途径，和罐头减少远转移率并且改进幸存率。

Concurrent gemcitabine and cisplatin combined with 3D conformal radiotherapy for stage III non-small cell lung cancer

对加 cisplatin 的并发的 gemcitabine 的毒性和功效为阶段 III 非小的房间肺癌症(NSCLC ) 与三维的保角的放射疗法相结合的学习客观。有病理地诊断的 NSCLC 的 36 个病人收到了放射疗法和并发的化疗的方法。与 IIIb 有有阶段 IIIa 和 14 个病人的 22 个病人。放射疗法在常规分别被给 60 70 Gy 的一个总数。化疗包括了 gemcitabine (600 mg/m 2) 和 cisplatin (20 mg/m 2), 一次每星期。结果 32 个病人收到了 60 72 Gy 的全部的剂量。二个病人收到了二个病人收到了的 56 Gy 和另外一个 58 Gy。34 个病人 6 星期化疗收到了 4，当二个病人收到了仅仅化疗的 2 个星期时。全面反应率(CR + PR ) ，完全的反应率(CR ) ，部分反应率(PR ) 是 83.3%(30/36 ) ， 11.1%(4/36 ) 并且 72.2%(26/36 ) 分别地。中部的后续持续时间是 18.4 个月。1 年、 2 年的全面幸存率是 77.8%(28/36 ) 并且 55.6%(20/36 ) 分别地。为阶段 III 非小的房间肺癌症与三维的保角的放射疗法相结合的结论并发的 gemcitabine 和 cisplatin 有效、很好容忍。孤独术语的结果需要推进学习。

A study of transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy for local advanced pancreatic cancer

Objective: To evaluate the clinical effect of transarterial infusion chemotherapy of gemcitabine plus three dimen- sional conformal radiotherapy on patients with local advanced pancreatic cancer. Methods: Fifty-one patients with local ad- vanced pancreatic cancer from June 2002 to February 2004 were enrolled, twenty-four patients of combined group were treat- ed with transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy, while twenty-seven patients of control group were treated only with transarterial infusion chemotherapy of gemcitabine. Results: There were significant statistical differences between two groups in clinical benefit response (91.7% versus 74.1%, P < 0.01) and overall remission rate (70.8% versus 33.3%, P < 0.01). The 6-month survival rate, 12-month survival rate and 24-month survival rate of combined group were 83.3%, 62.5% and 37.5% respectively, while that of control group were 55.6%, 33.3% and 11.1% respectively. This showed significant difference between the two groups. Conclusion: Transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy may be better than single transarterial infusion chemotherapy of gemcitabine in improving survival rates and elongating survival time of patients with local advanced pancreatic cancer.

Clinical Research on Three-Dimensional Conformal Radiotherapy of Non-Small Cell Lung Cancer

OBJECTIVE To investigate the clinical efficacy and toxic effect of the 3-dimensional conformal radiation therapy(3DCRT)for non- small cell lung cancer(NSCLC). METHODS Fifty-two patients with the Stage-I and IV NSCLC were treated with 3DCRT.Cross analysis of the clinical data was conducted in the comparison between the 52 cases with 3DCRT and the other 50 cases with the conventional radiation therapy (CRT).In the 3DCRT group,only the primary tumor and positive lymph-node draining area were included in the clinical target area,setting 4 to 6 coplanar or non-coplanar irradiation fields,with 2 Gy or 3 Gy/fraction,1 fraction a day and 5 fractions per week. The total dose ranged from a test dose(DT)of 66 Gy to 72 Gy.In the CRT group,the field area contained the primary tumor plus the homolateral hilum of the lung,the mediastinum superior or hol-mediastinum,and opposed anteroposterior irradiation.When the dosage reached DT 36～40 Gy,an oblique portal administered radiation was conducted in order to avoid injuring the spinal cord. The DT was 1.8～2.0 Gy/fraction,1 fraction a day,5 fractions per week,with a total dose of 60 Gy to 70 Gy. RESULTS The therapeutic effect(CR+PR)was 90.4% in the 3DCRT group,and was 72% in the CRT group.There was statistically significant difference between the two groups,P<0.01. There was a clinical symptom improvement attained by 96.5% and 86.4% respectively in the two groups,and there was a statistically significant difference between the groups,P<0.01.The 6-month, 1 and 2-year overall survival rates were 92.3%,75.0% and 42.3% in the 3DCRT group,and 76%,60% and 30% in the CRT group, respectively.There was a significant difference in the 6-month overall survival rate between the groups,P<0.05.There was no obvious significant difference in the 1 and 2-year overall survival rates between the two groups,P>0.05.The toxic reaction was 12.5% and 23.7% respectively in the 3DCRT and CRT groups. Acute radioactive esophagitis and leucopenia were markedly lower in the 3DCRT group than in the CRT group.There was a statistically significant difference between the groups,P<0.05.No toxic reaction of Stage-Ⅲand over was found in the 3DCRT group during radiation therapy. CONCLUSION The 3DCRT method has a satisfactory short- term efficacy and improvement of clinical symptoms in treating NSCLC,with a mild toxic reaction and good tolerance in patients. It can be used for enhancing the tumor-control rate and bettering the quality of life.

A Rare Case of Non-small Cell Lung Carcinoma Squamous Phenotype with Epstein-Barr Virus Positivity with Prolonged Response to both Chemotherapy and Radiotherapy

We present a rare challenging case of metastatic non-small cell lung cancer with Epstein-Barr virus positivity that was also diagnosed with pulmonary tuberculosis at the same time. Palliative chemotherapy gemcitabine and carboplatin was started after two weeks of anti-tuberculosis treatment with the hopes that this period would be sufficient to keep acid fast bacilli non-viable to minimise risk of tuberculosis re-activation due to chemotherapy induced immunosuppression. She completed four cycles of chemotherapy and six months of anti-tuberculosis treatment with good results and minimal side effects. Two years later, there was disease recurrence in cervical and mediastinal lymph nodes which was treated with local treatment i.e. surgery and palliative radiotherapy. It has been two years since last radiotherapy and overall more than five years since diagnosis with no active disease at present. Given the complexity and rarity of this case, significant multidisciplinary team involvement, including oncologists and radiation oncologists, pulmonologists with special interest in tuberculosis and pathologists was necessary throughout.

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

目的：系统评价口服肠内营养支持对接受放化疗的肺癌患者的临床疗效与可行性.方法：计算机检索相关主要中英文数据库,并手工检索相关营养学杂志.采用The Cochrane Colla boration’stool for assessingrisk of bias5.1.0进行质量评价,RevMan5.1软件进行统计分析.由于纳入的研究之间有明显的临床异质性和其他潜在的差异,不适合行meta分析,因此行简要定性分析更加合适.结果：最终纳入5个随机对照试验（RCT）,其中3个RCT研究对象接受化疗,1个RCT研究对象接受放疗,1个RCT研究对象接受放疗及化疗.综合的分析结果提示口服肠内营养仅能够显著提高接受化疗肺癌患者的能量和蛋白质摄入量,然而对于体重、营养状态、生存质量、治疗反应或者生存时间没有显著影响.结论：现有的证据不足以证明常规口服肠内营养支持能使接受放化疗的肺癌患者获益,由于样本量少,各研究之间差异大,更多高质量的随机对照试验有待进行.

The Results Observation on Adjuvant Chemotherapy with Microwave Hyperthermia and Stereotactic Radiotherapy in Retreated Elderly Patients with Advanced (III/IV Stage) Lung Cancer

Objective: To evaluate the significance of adjuvant chemotherapy and radiotherapy (Gamma-knife) in the elderly patients with retreated advance lung cancer. Methods 83 patients (age 50 to 81 years) with retreating advanced (III/IV stage) lung cancer were divided into three groups according to patients received treating by different methods. The cases were treated by synchronous chemo-radiotherapy (A group), sequentially chemo-radiotherapy (B group) and continuous systematized chemotherapy alone (C group). The systemic 3-dimensional orientation apparatus was used in radiotherapy. The chemotherapy regimen in combined radiotherapy was given by common first line regimen on lung cancer. The regimen of chemotherapy combated with whole body hyperthermia by using micro-wave on abodeman about 2 or 3 line was used in C group only. Results: The overall responses rates (RR) of A, B and C groups were 17.1%, 11.5% and 31.8%, but it was non-significance difference (P > 0.05). Overall responses rates (RR) of III and IV stage groups were 18.2% and 20.0%. The average overall survival time (OS) and median survival time (MST) of the patients treated by chemotherapy (C group) were highest about 14.2 and 9.3 months (respectively at A group 6.7 and 6.0 months. P < 0.01), in which B group was longer than A group (P < 0.05), and 95.5% CI value was not overlap. The total survival time of postoperative patients was longer in the various groups by different treated than that in non-operations. Conclusion: The rates (RR) of III and IV stage groups were non-significance difference. The higher of ORR, OS and MST in a few patients of re-treated advanced lung cancer was presented in case with treated by continuous system chemotherapy. There were survival superiority in initial postoperative patients groups by different treated. It is a profitable and effect treatment that the pure reasonable systemic chemotherapy was used for elderly case with advanced retreated lung cancer.

Postoperative UFT-/Tegafur-based Chemotherapy Versus Postoperative Radiotherapy for Early-stage Non-small Cell Lung Cancer:A Systematic Review and Network Meta-analysis

Background:Both of UFT-/Tegafur-based postoperative chemotherapy and postoperative radiotherapy have made large progress in treatment of early-stage non-small cell lung cancer.While it is unclear that,whether UFT-/Tegafur-based postoperative chemotherapy is superior to postoperative radiotherapy for early-stage non-small cell lung cancer with no direct evidence.Methods:Electronic databases(Pubmed,embase,cochrane library and clinicaltrials.gov)were searched to obtain relevant studies.This systematic review and meta-analysis is reported in accordance with the Preferred Items for Systematic Reviews and Meta-analysis(PRISMA)Statement and was registered at International Prospective Register of Systematic Reviews(number CRD42018095979).Sensitive analysis was conducted by excluding overweight studies.Funnel plot and egger’s test were performed to conduct publication bias.Results:Twenty-one randomized control trials were included.Our results suggested UFT-/Tegafur-based postoperative chemotherapy could improve overall survival over postoperative radiotherapy[HR=0.69(0.59-0.80),p=0.000].But subgroup analysis about stage showed there was no significant difference between them,no matter of stage I,II and III.As to chemotherapy regime,both UFT-/Tegafur+platinum+vinca alkaloid[HR=0.68(0.56-0.82),p=0.000]and UFT-/Tegafur only[HR=0.66(0.54-0.79),p=0.000]were superior to radiotherapy.Subgroup analysis about radiotherapy delivery method and dose showed,significant improvement of chemotherapy over radiotherapy for Cobalt-60 only[HR=0.54(0.39-0.75),p=0.000],Cobalt-60 and linac[HR=0.69(0.59-0.81),p=0.000]and≥45 Gy[HR=0.64(0.54-0.75),p=0.000],but not for linac only[HR=0.78(0.60-1.03),p=0.081]and≥45 Gy[HR=0.86(0.67-1.11),p=0.241].Conclusion:UFT-/Tegafur-based postoperative chemotherapy was superior to postoperative radiotherapy for improving overall survival of early-stage non-small cell lung cancer,but it is not always so under certain circumstance,such as RT delivery method and radiation dose.Of course,it is imperative to further explore differences in specific stage,such as I A and I B.

The Inhibitory Effects of Rh-endostatin(YH-16) in Combination with Radiotherapy on Lung Adenocarcinoma A549 in Mice and the Underlying Mechanisms

In order to investigate the inhibitory effects of Endostar(rh-endostatin,YH-16)in combination with radiotherapy on lung adenocarcinoma A549 in mice and the interaction mechanisms of combined therapy,the transplantation tumor models of A549 lung adenocarcinoma were established.When the largest diameter of tumor reached 1.0cm,all nude mice were randomly divided into 4 groups:Endostar group,radiotherapy group,radiotherapy plus Endostar(combined treatment)group,and control group(n=6 in each group).The largest d...

Stereotactic conformal radiotherapy of hepatic metastases:clinical analysis of 8 cases

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Meta-analysis of late course accelerated hyperfractionated radiotherapy combined with FP chemotherapy for esophageal carcinoma

Background and Objective:Although there are many randomized clinical trials of late course accelerated hyperfractionated radiotherapy (LCAHFR) combined with FP chemotherapy for esophageal cancer, the efficacy and toxicity are controversial. This study was to evaluate the efficacy and toxicity of LCAHFR combined with FP chemotherapy in treating esophageal cancer. Methods: Reports of randomized clinical trials on LCAHFR combined with FP chemotherapy for esophageal cancer published between January 1999 and January 2009 were researched through Wanfang, CNKI, and PubMed databases. RevMan4.2 software was used for Meta-analysis. Results: Twenty-one reports, including 2030 patients, were included in the meta-analysis. Of the 2030 patients, 1006 underwent LCAHFR (LCAHFR group), and 1024 underwent LCAHFR combined with FP chemotherapy (combination group). Compared with those of the LCAHFR group, the 1-, 2-, 3-, 5-years survival rates and 1-, 2-, 3-year local control rates of the combination group were significant increased, and the acute toxicity was also increased, but chronic toxicity showed no significant difference. C onclusions: LCAHFR combined with FP chemotherapy can improve the survival rate and the local control rate of the patients with esophageal cancer. The increased acute toxicity need to be concerned, whereas the chronic toxicity needs a long-term observation.

End of Life Experience of Symptom Cluster and Their Management in Hong Kong Chinese Patients with Lung Cancer Who Receive Palliative Radiotherapy

Breathlessness, fatigue, and anxiety are distressing symptoms for patients with advanced lung cancer, however, they are not relieved by palliative RT and are often viewed as neglected areas of clinical practice. This paper aims to review def initions of, and explore patients' experiences of, breathlessness, fatigue, and anxiety. Further, it will outline existing approaches, both pharmacological and non-pharmacological, to treat them. Current treatments and perceptions of these symptoms will be discussed in the context of Hong Kong health care service. The review of literature also shows that breathlessness, fatigue and anxiety appears to have similar emotional origins. A contemporary approach of using a common pyschoeducational intervention to treat these symptoms together as a cluster in end of life care will be discussed.

Late course three-dimensional conformal radiotherapy for esophageal carcinoma

我们的学习的目的是近来评估临床的结果和尖锐副作用的目的路线为食道的癌的三维的保角的放射疗法(3DCRT ) 。从 2004 年 1 月的方法到 2006 年 10 月，有食道的癌的 70 个病人收到了迟了的功课 3DCRT。他们的临床的数据回顾地被分析。短期的临床的结果，尖锐副作用，本地控制率和幸存率被评估。结果完全的反应率是 62.9% ，部分反应率是 35.7% ，并且全面反应率是 98.6% 。1- ， 2 年、 3 年的本地控制率分别地是 77.1% ， 51.4% 和 45.7% 。1- ， 2 年、 3 年的全面幸存率分别地是 75.7% ， 54.3% 和 38.6% 。中部的幸存时间是 26 个月。结论这种技术近来功课 3DCRT 是为食道的癌的有效治疗并且趋于改进全面幸存率。

Carbon ion radiotherapy for synchronous choroidal melanoma and lung cancer: A case report

BACKGROUND Despite being the most common intraocular malignancy among adults,choroidal melanoma is a rare cancer type,even more so when accompanied by lung cancer.We report a patient with synchronous choroid melanoma and lung cancer treated with carbon ion radiotherapy(CIRT).CASE SUMMARY A 41-year-old woman was transferred to our center with a diagnosis of choroidal melanoma in her right eye.During the examination,we found a right lung tumor that was histologically diagnosed as lung cancer.The patient was treated with CIRT for both malignant neoplasms.The CIRT dose was 70 photon equivalent doses(GyE)in five fractions for the right eye choroidal melanoma and 72 GyE in 16 fractions for the right lung cancer.At 3 mo after CIRT,the choroidal melanoma completely disappeared,as did the right lung cancer 7 mo after;the patient was in complete remission.CONCLUSION CIRT may be an effective treatment for double primary lung cancer and choroid melanoma.

Analysis of the Long-term Effect of Intraoperative Radiotherapy (IORT) for Non-Small Cell Lung Carcinoma (NSCLC)

OBJECTIVE To analyze the long-term effects of treatment with an op-eration + postoperative irradiation (A group) and an operation+intraoperative radiotherapy+postoperative irradiation (B group) in non-small cell lung cancer patients. METHODS Through a prospective randomized clinical trial, a total of 154 patients with non-small cell lung carcinoma were divided into two groups of 77 cases. Among the 154 cases, there were 134 squamous carcinomas, 17 adenocarcinomas and 3 adeno-squamous carcinomas. TNM staging: there were 17 in StageⅠ, 76 in Stage Ⅱ and 61 in Stage Ⅲ. A dosage of 15～25 Gy IORT, energy 9～16 MeV electrons, was delivered to the tumors. The doses given were 40～60 Gy postoperation. RESULTS The local control rates in A and B groups were 49.4% and 62.3% respectively (P<0.05). The survivals at 3, 5 and 7 years for group A were 40.3%, 27.3%, and 5.2% and for group B 44.2%, 28.6% and 6.5% (P>0.05). There were 16 deaths from radiotherapy complications, with 2 cases in group A and 14 in group B. CONCLUSION IORT+postoperative irradiation can enhance the local control rate of non-small cell lung cancer patients and reduce the recurrent rates, but it can not improve long-term survival.

Evaluation of whole-course three-dimensional conformal radiotherapy combined with late-course accelerated hyperfractionated radiotherapy for esophageal carcinoma patients

学习的目的是评估整个功课的三维的保角的放射疗法(3DCRT ) 的治疗学的效果和安全的目的与食道的癌在病人上与迟了功课的加速的 hyperfractionated 放射疗法(LCAFR ) 结合了。有食道的癌的 101 个病人被划分成二个组的方法。观察组(49 个盒子) 被整个功课的 3DCRT 对待。在控制组(52 个盒子) 的病人被常规放射疗法对待。临床的效率和放射毒性在二个组之间被比较。结果包括放射食道炎(63.2%) 和气管炎(49.0%) 的副作用在观察组减少了，但是二个组之间没有重要差别(69.2% 和 55.7% 在控制) 。在观察的组的1-，2年、3年的肿瘤本地人控制率和全面幸存率显著地与控制组相比被改进，分别地87.8%，75.5%，63.3%对71.2%，55.8%，42.3%和85.7%，71.4%，46.7%对69.2%，51.9%，26.9%(所有 P < 0.05 )。整个功课的 3DCRT 的治疗学的效果为食道的癌与 LCAFR 相结合的结论比常规放射疗法优异。

Radioenhancing effect of earthworm capsule medication on radiotherapy in the treatment of patients with carcinoma of esophagus or lung

Earthworm capsule is an extract from earthworm made in our laboratory.From1986 to 1989,486 patients with carcinoma of esophagus or lung were randomly divided into 2groups,one group received radiotherapy alone(control group)and the other radiotherapycombined with earthworm capsules(treatment group).All cases were diagnosedpathologically or cytologically.In a two-month treatment course,earthworm capsuleswere given orally twice a day,2～3 capsules each time,each capsule containing 60 mg ofthe extract.Compared with the control group,the CR(complete remission)rate andCR+PR(partial remission)rate in patients with carcinoma of esophagus treated byradiotherapy in combination with earthworm capsule increased 9.7%(P【0.01) and 9.6%(P【0.05),while in patients with carcinoma of lung,they increased 10.6%(P【0.05)and13.5%(P【0.05),respectively.The earthworm capsule caused irritation in the alimentarytract,the patients displaying slight nausea and vomiting(16.7% in thecombination treatment group and 10.0% in the control group).However,these side ef-fects could be alleviated when capsules were taken after meal or with honey concomitantly.No deleterious effects on the heart,liver,kidney,skin,hematopoietic or nervous systemwere seen.

Technical and Dosimetric Study of Four Facio-cervical Fields Conformal Radiotherapy for Nasopharyngeal Carcinoma

Objective: The aim of this study is to establish the methods of four facio-cervical fields′conformal radiotherapy(4F-CRT) for nasopharyngeal carcinoma (NPC), and to optimize the methods for clinical practice. Methods and Materials: 40 patients with untreated NPC of T1-T4 (1997AJCC Staging System) were rolled into this study. Conventional and four facio-cervical fields conform plans were designed for each patient using Pinnacle 8.0 three-dimension treatment planning system(3D-TPS): 1) Improved plan, four facio-cervical fields′conform plans, anterior, posterior facio-cervical and 2 lateral opposing facio-cervical fields; 2) Conventional plan, two lateral opposing facio-cervical fields only with the same dose delivered to the target in each plan, dose volume histograms(DVHs) of the targets and normal organs, brain stem, spinal cord, parotid glands, and temporal mandibular joints(TMJs) were compared and the dose distribution were evaluated. Results: 1) The dose distribution of the improved plan could meet the requirements for the target volume. 2) There was not any significant difference in the dose of spinal cord between the two plans. The mean doses of Dmax for brain stem in conventional plan were much lower than those in the improved plan, though both were within safety limits. 3) Compared with the conventional plans, the improved plan significantly decreased the hotspot areas in the target volume and had better parotid glands and temporal mandibular joints sparing effect. Conclusion: Compared with the conventional plan, the improved plan provides satisfactory dose coverage to the tumor volume and better sparing of the parotid gland, TMJs and other normal tissues in external beam radiotherapy of NPC.

Long-term outcomes and prognostic factors for patients with esophageal cancer following radiotherapy

AIM:To evaluate long-term outcomes and prognostic factors for esophageal squamous cell carcinoma(SCC) treated with three dimensional conformal radiotherapy(3D-CRT).METHODS:Between January 2005 and December 2006,153 patients(120 males,33 females) with pathologically confirmed esophageal SCC and treated with 3D-CRT in Cancer Hospital of Shantou University were included in this retrospective analysis.Median age was 60 years(range:37-84 years).The proportion of tumor location was as follows:upper thorax(including the cervical region),73(48%);middle thorax,73(48%);lower thorax,7(5%),respectively.The median radiation dose was 64 Gy(range:50-74 Gy).Fifty four cases(35%) received cisplatin-based concurrent chemotherapy.Univariate and multivariate analysis were performed to determine the association between the correlative factors and prognosis.RESULTS:The five-year overall survival rate was 26.3%,with a median follow-up of 49 mo(range:3-66 mo) for patients who were still alive.On univariate analysis,lesion location,lesion length by barium esophagogram,computed tomography imaging characteristics including Y diameter(anterior-posterior,AP,extent of tumor),gross tumor volume of primary lesion(GTV-E),volume of positive lymph nodes(GTV-LN),and the total target volume(GTV-T = GTV-E + GTVLN) were prognostic for overall survival.By multivariate analysis,only the Y diameter [hazard ratio(HR) 2.219,95%CI 1.141-4.316,P = 0.019] and the GTV-T(HR 1.372,95%CI 1.044-1.803,P = 0.023) were independent prognostic factors for survival.CONCLUSION:The overall survival of esophageal carcinoma patients undergoing 3D-CRT was promising.The best predictors for survival were GTV-T and Y diameter.