Chemotherapy and radiotherapy:Could they contribute to the development of new tumors and metastases?

Objective: Both chemotherapy and radiotherapy have demonstrated high effectiveness as the best mechanisms in the fight against cancer;however, various studies seem to confirm that they could also favor the development of other unwanted effects of great importance for the patient. The main objective of this study is to find out the possible existence of this type of links. Method: This is a systematic literature review that seeks to find out which and how long cases of late interactions related to chemotherapy and radiotherapy treatments have been known. The bibliographic review was carried out based on references published in the last five years. Results: Various studies confirm the possible relationship between chemotherapy and radiotherapy treatments with the development of new undesirable side effects, especially as a consequence of the hepatotoxicity generated in the case of chemotherapy and radiation in radiotherapy. However, in this last type of treatment, the problems raised are really few. Conclusions: The existence of a risk of suffering new unwanted side effects after different types of treatment seems to have been demonstrated, especially in the case of chemotherapy. In the case of radiotherapy, adverse effects are practically non-existent, although they are no less important.

Radiotherapy as valid modality for hepatocellular carcinoma with portal vein tumor thrombosis

Although the current standard treatment for hepatocellular carcinoma(HCC) with portal vein tumor thrombosis(PVTT) is sorafenib, many previous studies have established the need for a reliable local modality for PVTT control, which is a major cause of liver function deterioration and metastasis. Additionally, there is growing evidence for the prognostic significance of PVTT classification according to the location of tumor thrombosis. Favorable outcomes can be obtained by applying local modalities, including surgery or transarterial chemoembolization, especially in second-order or distal branch PVTT. Rapid control of PVTT could maintain or improve liver function and reduce intrahepatic as well as distant metastasis. Radiotherapy(RT) is one of the main locoregional treatment modalities in oncologic fields, but has rarely been used in HCC because of concerns regarding hepatic toxicity. However, with the development of advanced techniques, RT has been increasingly applied in HCC management. Randomized studies have yet to definitively prove the benefit of RT, but several comparative studies have justified the application of RT in HCC. The value of RT is especially noticeable in HCC with PVTT; several prospective and retrospective studies have reported favorable outcomes, including a 40% to 60% objective response rate and median overall survival of 15 mo to 20 mo in responders. In this review, we evaluate the role of RT as an alternative local modality in HCC with PVTT.

Tumor regression grades:Potential outcome predictor of locally advanced rectal adenocarcinoma after preoperative radiotherapy

AIM:To analyze tumor regression grade(TRG)for prognosis of locally advanced rectal adenocarcinoma(LARA)treated with preoperative radiotherapy.METHODS:One hundred and ninety patients with clinical stageⅡ/ⅢLARA were studied.All patients underwent radical surgery(between 2004 and 2010)after 30-Gy/10-fraction preoperative radiotherapy(preRT).All 190 patients received a short course of preRT and were reassessed for disease recurrence and survival;the slides of surgical specimens were reviewed and classified according to Mandard TRG.We compared patients with good response(Mandard TRG1 or TRG2)vs patients with bad/poor response(Mandard TRG3-5).Outcomes evaluated were 5-year overall survival(OS),5-year disease-free survival(DFS),and local,distant and mixed recurrence.Fisher’s exact test orχ2 test,logrank test and proportional hazards regression analysis were used to calculate the probability that Mandard TRG was associated with patient outcomes.RESULTS:One hundred and sixty-six of 190 patients(87.4%)were identified as Mandard bad responders(TRG3-5).High Mandard grade was correlated with tumor height(41.7%<6 cm vs 58.3%≥6 cm,P=0.050),yp T stage(75%yp T0-2 vs 25%yp T3-4,P=0.000),and yp N stage(75%yp N0 vs 25%yp N1,P=0.031).In univariate survival analysis,Mandard grade bad responders had significantly worse OS and DFSthan good responders(TRG1/2)(OS,83.1%vs 96.4%,P=0.000;DFS,72.3%vs 92.0%,P=0.002).In multivariate survival analysis,Mandard bad responders had significantly worse DFS than Mandard good responders(DFS 3.8 years(95%CI:1.2-12.2 years,P=0.026).CONCLUSION:Mandard grade good responders had a favorable prognosis.TRG may be a potential predictor for DFS in LARA after pre-RT.

Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy

Background: Gross target volume of primary tumor(GTV?P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma(NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity?modulated radiotherapy(IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to ind a suitable cut?of value of GTV?P for prognosis prediction.Methods: Clinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver oper?ating characteristic(ROC) curves were used to identify the cut?of values of GTV?P for the prediction of diferent end?points [overall survival(OS), local relapse?free survival(LRFS), distant metastasis?free survival(DMFS), and disease?free survival(DFS)] and to test the prognostic value of GTV?P when compared with that of the American Joint Committee on Cancer T staging system.Results: The 358 patients with locally advanced NPC were divided into two groups by the cut?of value of GTV?P as determined using ROC curves: 219(61.2%) patients with GTV?P ≤46.4 mL and 139(38.8%) with GTV?P >46.4 mL. The 3?year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV?P ≤46.4 mL than in those with GTV?P > 46.4 mL(all P < 0.05). Multivariate analysis indicated that GTV?P >46.4 mL was an independent unfavorable prognostic factor for patient survival. The ROC curve veriied that the predictive ability of GTV?P was superior to that of T category(P < 0.001). The cut?of values of GTV?P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4 mL, respectively.Conclusion: In patients with locally advanced NPC, GTV?P >46.4 mL is an independent unfavorable prognostic indi?cator for survival after IMRT, with a prognostic value superior to that of T category.

Precision radiotherapy for brain tumors A 10-year bibliometric analysis

OBJECTIVE： Precision radiotherapy plays an important role in the management of brain tumors. This study aimed to identify global research trends in precision radiotherapy for brain tumors using a bibliometric analysis of the Web of Science. DATA RETRIEVAL： We performed a bibliometric analysis of data retrievals for precision radiotherapy for brain tumors containing the key words cerebral tumor, brain tumor, intensity-modulated radiotherapy, stereotactic body radiation therapy, stereotactic ablative radiotherapy, imaging-guided radiotherapy, dose-guided radiotherapy, stereotactic brachytherapy, and stereotactic radiotherapy using the Web of Science. SELECTION CRITERIA： Inclusion criteria： （a） peer-reviewed articles on precision radiotherapy for brain tumors which were published and indexed in the Web of Science; （b） type of articles： original research articles and reviews; （c） year of publication： 2002-2011. Exclusion criteria： （a） articles that required manual searching or telephone access; （b） Corrected papers or book chapters. MAIN OUTCOME MEASURES： （1） Annual publication output; （2） distribution according to country; （3） distribution according to institution; （4） top cited publications; （5） distribution according to journals; and （6） comparison of study results on precision radiotherapy for brain tumors. RESULTS： The stereotactic radiotherapy, intensity-modulated radiotherapy, and imaging-guided radiotherapy are three major methods of precision radiotherapy for brain tumors. There were 260 research articles addressing precision radiotherapy for brain tumors found within the Web of Science. The USA published the most papers on precision radiotherapy for brain tumors, followed by Germany and France. European Synchrotron Radiation Facility, German Cancer Research Center and Heidelberg University were the most prolific research institutes for publications on precision radiotherapy for brain tumors. Among the top 13 research institutes publishing in this field, seven are in the USA, three are in Germany, two are in France, and there is one institute in India. Research interests including urology and nephrology, clinical neurology, as well as rehabilitation are involved in precision radiotherapy for brain tumors studies. CONCLUSION： Precision radiotherapy for brain tumors remains a highly active area of research and development.

CLINICAL STUDY ON ACUPUNCTURE TREATMENT OF SIDE REACTIONS OF RADIOTHERAPY AND CHEMOTHERAPY FOR MALIGNANT TUMOR

Forty-two cancer patients were randomly divided into acupuncture plus radiotherapy chemotherapy (acupuncture) group and radiotherapy-chemotherapy (control) group. The indexes ob served were the counts of leukocytes and thrombocytes, and the activities of both natural killer (NK) cells and intCrleukin(IL) - 2. The findings showed that the counts of both leukocytes and thrombo cytes in acupuncture group had no significant changes while those of control group lowered consider ably, displaying a significant difference between the two groups (P< 0.01 ). The activities of NK cells and IL - 2 of acupuncture group raised apparently while that of NK cells and IL - 2 in control group lowered markedly. There was a significant difference between the two groups (P < 0.01 ). In acupuncture group, radiotherapy and chemotherapy induced symptoms of the d1gest1ve system and ner vous system were strikingly less than those of the control group, suggesting that acupuncture can pro nouncedly ameliorate radiotherapy and chemotherapy induced symptoms of arrest of bone marrow, im munosuppression, digestive system and nervous system.

Evaluation of Quality of Life and Psychological Response in Recurrent and Metastatic Tumors Treated with Palliative Radiotherapy

Objective: We evaluated the effects of palliative radiotherapy for cancer recurrence or metastasis on patient QOL and psychophysiology. Materials and Methods: Sixty seven patients who received palliative radiotherapy between 2014 and 2015 were enrolled. Patient diseases were bone metastasis in 51 patients, lymph node metastasis in 7 patients, brain metastasis in 2 patients, local recurrence in 3 patients, and others in 4 patients. Median irradiated dose was 30 Gy in 10 fractions for palliative radiotherapy. We used the questionnaires EORTC-QLQ-C30 and EORTC-QLQ-C15-PAL to evaluate patient QOL and the Hospital Anxiety and Depression Scale to evaluate patient mental healthcare at the start and at the end of radiotherapy. Results: As compared to scores at the start of radiotherapy, at the end of radiotherapy, NRS and face scale significantly decreased. On the other hand, Eastern Cooperative Oncology Group Performance Status did not show any changes during palliative radiotherapy. In functional scales, average scores of RF2 and EF also improved. In symptom scales, average scores of FA, PA, and SL improved. In bone metastasis group, global health status/QOL, PA, and SL significantly improved. There was relationship between anxiety improvement and QOL improvement after palliative radiotherapy. Nausea and vomiting scores of EORTC-QLQ-C15-PAL were associated with the irradiated volume of palliative radiotherapy for pelvic region. Conclusion: Patient QOL of was improved by palliative radiotherapy regardless of PS. The possibility of palliative radiotherapy having a positive influence on patient psychophysiology was also suggested in younger age.

Dosimetric Impact of Tumor Position and Lung Density Variations in Lung Stereotactic Body Radiotherapy

Purpose of this study was to evaluate the variation of the dose to gross tumor volume (GTV) related to tumor position and lung density for lung stereotactic body radiotherapy (SBRT) using a virtual phantom. The density of the equivalent lung surrounding the GTV (10 mm diameter) was defined as 0.10, 0.15, 0.25, 0.35, and 0.45 g/cm3. A planning target volume (PTV) was generated by adding a uniform 8 mm margin to the internal target volume (ITV). We defined that the 99% of the GTV should be covered by 100% of the prescribed dose using Monte Carlo (MC) calculation. The GTV structure was replicated from ITV to the PTV periphery at 1 mm intervals. Planned dose to the GTV was defined as the predicted dose in the replicated GTV structure. Simulated dose to the GTV was defined as the calculated dose in the replicated GTV structure taking into account the tumor position error. D99 of the planned dose to the GTV at the 8 mm shift position was 78.1%, 81.6%, 87.3%, 91.4% and 94.4% at equivalent lung densities of 0.10, 0.15, 0.25, 0.35, and 0.45 g/cm3, respectively. D99 of the simulated dose to the GTV at the 8 mm shift position was 96.9%, 95.3%, 94.2%, 95.1 % and 96.3% at equivalent lung densities of 0.10, 0.15, 0.25, 0.35, and 0.45 g/cm3, respectively. Planned dose to GTV is strongly dependent on lung density and tumor position errors, while simulated dose to GTV does not show any significant dependence.

The Effect of Hypofractionated Radiotherapy on Tumor Control and Survival in Patients with High-Risk Breast Cancer

BACKGROUND Adjuvant radiotherapy is given following surgery in breast cancer patients. Hypofractonated radiotherapy can significantly reduce the waiting time for radiotherapy, working load on machines, patient visits to radiotherapy departments and medical costs. Material and Methods 244 patients with high-risk breast cancer (stage IIB, stage III and stage IA with any of the following criteria: lymphovascular invasion, hormonal receptor negative, young age) who underwent Breast conservative surgery (BCS) or Modified radical mastectomy (MRM) were enrolled in this study. All patients received adjuvant radiotherapy with different hypofractionation schedules either 3900 cGY/13 fractions or 4240 cGY/16 fractions or 4005 cGY/15 fractions using linear accelerator with 6 MV photon beam. Lateral/Medial tangential and Ipsilateral supraclavicular fields were employed and the ipsilateral axilla was also irradiated if required to the same dose with posteroanterior field. Patients were followed every 3 mons for the first 2 years and every 6 mons thereafter. Outcomes were analyzed in terms of tumor control and survival. Results 244 patients with high-risk breast cancer requiring postoperative radiotherapy to the intact breast or chest wall were treated. The mean age was 48 years (range 28 - 69 years). The 5-year locoregional free survival of all patients was 93.8% the local relapse reported in 15 patients (6.2%) 7 patients at site of operated scar & 8 patients at the regional lymph nodes. The median follow up period was 75 months ranged from 49 to 102 months. Distant metastasis free survival was 92.2%, the distant metastasis reported in 19 patients which represent (7.8%) of all patients, median survival is 75 months ranged from 49 to 102 months and overall survival was 88.6%. Conclusion It is concluded that hypofractionated radiotherapy is a simple and effective protocol in patients with high-risk breast cancer regarding tumor control and survival.

Application of proton MR spectroscopy on evaluation of radiotherapy treated intracranial tumors

Objective： To evaluate the clinical application of proton magnetic resonance spectroscopy （1HMRS） in patients with radiotherapy treated intracranial tumors. Methods： Forty patients with intracranial tumors underwent multivoxel 1HMRS examination before and after radiotherapy. The concentrations of N-acetyl aspartate （NAA）, choline （Cho） and creatine （Cr） were obtained both in the tumors and the contralateral normal brain regions, The ratios of NANCr, Cho/Cr and Cho/NAA were calculated at the same time and follow-up one year. Results： （1） After radiotherapy, tumors inhibited by radiation had decreased Cho, NAA and Cr on proton MRS. Some cases showed necrotic wave. （2） During the one year follow-up, local tumor recurred in 8 cases and their Cho and Cho/NAA increased high again. Other cases without recurrence, HMRS showed no change. Conclusion： Multivoxel proton MR spectroscopy is available for study of tumor metabolites after radiotherapy and it is a valuable method in the evaluation of radiotherapy treated tumors,

Effect of radiotherapy on tumor markers and serum immune-associated cells in patients with esophageal cancer

Objective This study aimed to investigate the effect of radiotherapy on serum immune-associated cells and tumor markers in patients with esophageal cancer.Methods A total of 87 patients with esophageal cancer admitted to our hospital between October 2016 and July 2020 were selected as the observation group,and all patients received radiotherapy.A total of 87 healthy volunteers who underwent physical examination at our hospital during the same period were selected as the control group in order to compare the changes in serum immune-associated cells and tumor markers between the two groups.Results The levels of carcinoembryonic antigen(CEA),cancer antigen(CA)125,CA72-4,C-terminus of cytokeratin(CYFRA)21-1,and squamous cell carcinoma(SCC)antigen in the observation group before radiotherapy were higher than those in the control group,and the differences were significant(P<0.05).The levels of CEA,CA125,CA72-4,CYFRA21-1,and SCC antigen in the research group after radiotherapy were significantly lower than those before radiotherapy,but were still significantly higher than those in the control group(P<0.05).The levels of CD3+,CD4+,CD4+/CD8+,and natural killer cells in the research group before and after radiotherapy were significantly lower,while the levels of Treg and CD8+cells were significantly higher than those in the control group(P<0.05).The levels of CD3+,CD4+,and CD4+/CD8+cells in the observation group after radiotherapy were lower,while the levels of CD8+cells were significantly higher than those before radiotherapy(P<0.05).Conclusion Radiotherapy can effectively reduce the level of serum tumor markers in patients with esophageal cancer;these antigens and cells can be used as tumor markers of esophageal cancer in order to determine its prognosis.However,radiotherapy has adverse effects on the immune function of the body.The reasons behind this need to be further studied and analyzed.

Multidisciplinary diagnosis and treatment nutritional support intervention for gastrointestinal tumor radiotherapy:Impact on nutrition and quality of life

BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem.This study aims to provide a scientific basis for improving clinical treatment effects,quality of life,and prognosis of patients with gastrointestinal tumors.AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment(MDT)nutrition intervention model on patients with gastrointestinal tumors.METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023.Using a random number table,120 patients were randomly divided into MDT and control groups with 60 patients in each group.To analyze the effect of MDT on the nutritional status and quality of life of the patients,the nutritional status and quality of life scores of the patients were measured before and after the treatment.RESULTS Albumin(ALB),transferrin(TRF),hemoglobin(Hb),and total protein(TP)levels significantly decreased after the treatment.The control group had significantly lower ALB,TRF,Hb,and TP levels than the MDT group,and the differences in these levels between the two groups were statistically significant(P<0.05).After the treatment,the MDT group had significantly more wellnourished patients than the control group(P<0.05).The quality of life total score,somatic functioning,role functioning,and emotional functioning were higher in the MDT group than in the control group.By contrast,pain,fatigue,nausea,and vomiting scores were lower in the MDT group than in the control group(P<0.05).CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients.The study provides a rigorous theoretical basis for improving the prognosis of cancer patients.In the future,we intend to provide additional treatment methods for improving the quality of life of patients with cancer.

Neuroendocrine tumor metastatic to the orbit treated with radiotherapy

Neuroendocrine tumors are rare neoplasms that infrequently metastasize to the orbit.Given that patients with these tumors may have prolonged survival despite dissemination,maintaining quality of life by providing early diagnosis and effective treatment to preserve vision and comfort is a fundamental issue.We report the case of a79-year old woman who presented with well-differentiated metastatic neuroendocrine tumor to the liver with no carcinoid syndrome and was started on intramuscular long-acting octreotide with disease stabilization.Two years later she developed right-sided diplopia associated with mild eye discomfort,proptosis and reddening.An magnetic resonance imaging showed a 2.1 cm mass in the right orbit and further biopsy confirmed a neuroendocrine tumor metastasis.The patient was treated with a four-week course of stereotactic radiotherapy to the right orbital metastasis(4000 cGy in 20 fractions)with minor conjunctivitis as the only side effect.Eighteen months later,she remains well with no visual loss.

Effect of Tumor Infiltrating Lymphocyte on Local Control of Rectal Cancer after Preoperative Radiotherapy

Objective： To study the effect of tumor infiltrating lymphocytes at cancer nest on local control of rectal cancer after preoperative radiotherapy. Methods： From Jan. 1999 to Oct. 2007, a total of 107 patients with rectal cancer were reviewed. They were treated by preoperative radiotherapy, 30 Gy/10 fractions/12 days. Two weeks later, the patient underwent a surgical operation. Their pathological samples were kept in our hospital before and after radiotherapy. Lymphocyte infiltration （LI） degree, pathologic degradation and fibrosis degree after radiotherapy in paraffin section were evaluated under microscope. Results： After followed-up of 21 months （2-86 months）, a total of 107 patients were reviewed. Univariate analysis showed that lymphocyte infiltration （LI）, fibrosis and pathologic changes after radiotherapy were significant factors on local control. Logistic regression analysis showed that LI after radiotherapy was a significant effect factor on local control. Conclusion： LI, fibrosis and pathologic degradation after radiotherapy are significant for local control of rectal cancer after preoperative radiotherapy. LI after radiotherapy was a significantly prognostic index for local control of rectal cancer after preoperative radiotherapy.

A CLINICAL STUDY FOR EVALUATING EARLY RADIOTHERAPY EFFECT IN PATIENTS WITH BRAIN TUMOR USING ^(99)Tc^m-HL91 SPECT

Objective： The purpose of this study was to evaluate the early radiotherapy effect using ^99Tc^m-HL91 SPECT in patients with brain tumors. Methods： Twenty-one patients with brain tumors who were treated by radiotherapy were studied. KPS grade, tumor size on ^99Tc^m-HL91 SPECT, tumor size on MRI, and ratio of T/N （tumor counts/sec over normal brain tissue counts/sec） were investigated before ,during and after radiotherapy. Results： The average tumor size on ^99Tc^m-HL91 SPECT and MRI was 11.34±5.88 cm^2, 9.46±5.66 cm^2, respectively before radiotherapy. The tumor size on ^99Tc^m-HL91 SPECT was not in accordance with to that on MRI （P〈0.05）. KPS grade, tumor size on ^99Tc^m-HL91 SPECT and ratio of T/N had significance differences before, during and after radiotherapy （P〈0.05）, but the tumor size on MRI imaging had no significance differences before, during and after radiotherapy （P〉0.05）. The rate of symptom improvement was 80% during radiotherapy and 100% after radiotherapy. The rates of imaging remission based on the brain tumor size on ^99Tc^m-HL91 SPECT, MRI and T/N were 75%, 15%, and 80%, respectively during radiotherapy. The agreement rates between imaging remission diagnosed by those three methods and symptom improvement were 70%, 40%, and 60% respectively during radiotherapy. The rates of imaging remission based on the brain tumor sizes on ^99Tc^m-HL91 SPECT, MRI and T/N were 100%, 25%, and 95% respectively after radiotherapy. The agreement rates between imaging remission diagnosed by those three methods and symptoms improvement were 100%, 20%, and 95% respectively after radiotherapy. Conclusion： The tumor size on ^99Tc^m-HL91 SPECT is a valuable tool for evaluating early radiotherapy effect of brain tumor in process of radiotherapy. T/N is not a feasible method in evaluating radiotherapy effect of brain tumor because it may show elevation unrelated to the curative effect during radiotherapy.

Klatskin tumor treated by inter-disciplinary therapies including stereotactic radiotherapy: A case report

In view of the poor prognosis of patients with cholangiocarcinoma （CCC）, there is a need for new therapeutic strategies. Inter-disciplinary therapy seems to be most promising. Radiotherapy is an effective alternative to surgery for hilar CCC （Klatskin tumors） if an adequate radiation dose can be delivered to the liver hilus. Here, we describe a patient for whom we used a stereotactic radiotherapy technique in the context of an inter-disdplinary treatment concept. We report a 45-year-old patient with a locally advanced Klatskin tumor. Explorative laparotomy showed that the tumor was not resectable. A metallic stent was implanted and the patient was treated by stereotactic radiotherapy using a body frame. A total dose of 48 Gy （3×4 Gy/wk） was administered. Therapy was well tolerated. After 32 too, local tumor recurrence and a chest wall metastasis developed and were controlled by radio-chemotherapy. After more than 56 mo with a good quality of life, the patient died of advanced neoplastic disease. Stereotactic radiotherapy led to a long-term survival of this patient with a locally advanced Klatskin tumor. In the context of inter-disciplinary treatment concepts, this radiotherapy technique is a promising choice of treatment for patients with hilar CCC.

Observation of the therapeutic efficacy of stereotactic radiotherapy in 44 cases of retroperitoneal metastatic tumor

Objective: To investigate the therapeutic effects of stereotactic radiotherapy for retroperitoneal metastatic tumor. Methods: From August 1997 to October 2004, 44 patients with retroperitoneal metastatic tumors were treated with stereotactic radiotherapy. The planning target volume was encompassed by 90%–95% isodose line. Fractional dose was from 6 Gy to 8 Gy, and they were treated 2–3 times per-week and 4–8 times in all. The total radiation doses of PTV were from 32 Gy to 48 Gy. Re- sults: After the radiotherapy, the pain was obviously relieved in 81.8% patients. Three months after completion of radiotherapy passed and then, abdominal CT was performed to evaluate the results. The whole effective rate was 81.8% [CR 27.7% (12/44) and PR 54.5% (24/44)], and six months after radiotherapy, CR was 27.7% (12/44) and PR was 59.1% (26/44). The middle survival time was 12 months. Conclusion: It is suggested that stereotactic radiotherapy for retroperitoneal metastatic tumor is a safe and effective method.

Late course shrinking gross tumor volume (GTV) and boost radiotherapy for a special left lung cancer patient whose right lung was resected: a case report

We reported a special case of a locally advanced squamous cell carcinoma of the left lung. Due to pulmonary tuberculosis, the patient had underwent a complete right-side pulmonary lobectomy 20 years ago. Left lung supports his life, he is unable to carry on an operation treatment, so he accepted radiotherapy. Firstly, we defined gross tumor volume (GTV1) by CT simulation location, three-dimensional conformal radiotherapy (3D-CRT) was used until tumor dose reached 50 Gy/25 f. Secondly, by repeating the planning CT scan, defined GTV2, continued to radiotherapy by 2.5 Gy/f until the dose was 65 Gy/31 f. Using the same method for third CT scan, defined GTV3, continued to radiotherapy by 3 Gy/f until the total dose was 74 Gy/34 f. After radiotherapy, the patient acquired complete response and he had no obvious side-effect of radiotherapy. There has been no recurrence for 5 years now.

Dosimetric consequences of tumor volume changes after kilovoltage cone-beam computed tomography for non-operative lung cancer during adaptive intensity-modulated radiotherapy or fractionated stereotactic radiotherapy

Objective The aim of this study was to investigate tumor volume changes with kilovoltage cone-beam computed tomography （kV-CBCT） and their dosimetric consequences for non-operative lung cancer during intensity-modulated radiotherapy （IMRT） or fractionated stereotactic radiotherapy. Methods Eighteen patients with non-operative lung cancer who received IMRT consisting of 1.8-2.2 Gy/fraction and five fractions per week or stereotactic radiotherapy with 5-8 Gy/fraction and three fractions a week were studied, kV-CBCT was performed once per week during IMRT and at every fraction during stereotactic radiotherapy. The gross tumor volume （GTV） was contoured on the kV-CBCT images, and adaptive treatment plans were created using merged kV-CBCT and primary planning computed tomogra- phy image sets. Tumor volume changes and dosimetric parameters, including the minimum dose to 95% （D95） or 1% （D1） of the planning target volume （PTV）, mean lung dose （MLD）, and volume of lung tissue that received more than 5 （Vs）, 10 （Vl0）, 20 （V20）, and 30 （V30） Gy were retrospectively analyzed. Results The average maximum change in GTV observed during IMRT or fractionated stereotactic radio- therapy was -25.85% （range, -13.09% --56.76%）. The D95 and Dr of PTV for the adaptive treatment plans in all patients were not significantly different from those for the initial or former adaptive treatment plans. In patients with tumor volume changes of 〉20% in the third or fourth week of treatment during IMRT, adap- tive treatment plans offered clinically meaningful decreases in MLD and V5, V10, V20, and V30; however, in patients with tumor volume changes of 〈 20% in the third or fourth week of treatment as well as in patients with stereotactic radiotherapy, there were no significant or clinically meaningful decreases in the dosimetric parameters. Conclusion Adaptive treatment planning for decreasing tumor volume during IMRT may be beneficial for patients who experience tumor volume changes of 〉20% in the third or fourth week of treatment.

Analysis of preoperative concurrent chemoradiotherapy for superior sulcus lung tumor

Objective： To compare the clinical effect and toxicities of preoperative concurrent chemoradiotherapy （CT/RT） with radiotherapy （RT） alone in patients with superior sulcus lung tumor. Methods： Fifty-six patients with superior sulcus lung tumor were divided randomly into two groups： twenty-six patients received concurrent chemoradiotherapy, the other thirty patients received only radiotherapy. For both groups, the same radiation technic was given with the convention fraction. The total dose was 45 Gy/25 Fr/5 Wk. For the CT/RT group, the patients were also given with concurrent chemotherapy （navelbine 15-18 mg/m^2 on the 1st and 8th day, cisplatin 60 mg/m^2 on the 1st day）. Results： The rate of complete resection in the CT/RT group was significantly higher than that in the RT group （92.3% vs 80%, P 〈 0.05）. The complete pathological response rate and 2-year survival rate in the CT/RT group were significantly higher than those in the RT group （P 〈 0.01, P 〈 0.01）. The incidences of grades Ill-IV radiation esophagitis and leukopenia in the CT/RT group were significantly higher than those in the RT group （23.1% and 23.1% vs 6.7% and 0, P 〈 0.01, P 〈 0.01）. Conclusion： Preoperative concurrent chemoradiotherapy has the potential of improving the survival rate of superior sulcus lung tumors. Though this treatment regimen also increases the acute toxic effect, all patients can tolerate it. It is expected to be a new ＂standard treatment＂ for this malignant tumor.