Efficacy and safety of gefitinib or docetaxel in Chinese patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) who had failed previous platinum-based first-line chemotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety of gefitinib or docetaxel in Chinese patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) who had failed previous platinum-based first-line chemotherapy.</p><p><b>METHODS</b>We retrospectively reviewed 222 Chinese NSCLC patients in the subgroup of INTEREST (gefitinib versus docetaxel in previously treated non-small cell lung cancer) study. Survival analysis was evaluated by Kaplan-Meier method, and Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to compare the quality of life between gefitinib group and docetaxel group.</p><p><b>RESULTS</b>A total of 222 patients were analyzed in this subgroup study. 107 patients were treated with gefitinib, and 115 patients treated with docetaxel. There were all balanced between the two groups in terms of sex, age, staging and pathology in patient characteristics. The median overall survival in the two groups was similar (11 months in the gefitinib group vs. 14.0 months in the docetaxel group, P = 0.783). The progression-free survival (PFS) was also similar between the two groups (median PFS: 3.4 months in gefitinib group vs. 3.8 months in docetaxel group, P = 0.214). The response rate in gefitinib group was significantly higher than that in the docetaxel group (21.9% vs. 9.1%, P = 0.016).</p><p><b>CONCLUSION</b>The efficacy of gefitinib is similar with that of docetaxel in pretreated patients with locally advanced or metastatic NSCLC, however, gefitinib is more favorable in the tolerance and quality of life improvement.</p>

Influence of sulfonylureas on cardiovascular system: Progress in basic research and clinical research / 第二军医大学学报

Previous studies have showed that sulfonylureas possess a bidirectional effect on cardiovascular system: they can raise the coronary artery tone, aggravate ischemic injury to the cardiovascular tissues, and accelerate cardiac hypertrophy through closing cardiovascular ATP-sensitive K+ channels; meanwhile, they can also regulate glucolipid metabolism, modulate inflammatory reaction and inhibit atherosclerosis through activating peroxisome proliferator-activated receptors. Clinical-epidemiological study showed different opinions on whether sulfonylureas can increase the mortality of patients with cardiovascular diseases.

Identification and AHLs Detection of Dominant Bacterium of Sea Cucumber (Apostichopus japonic) Infected with the Skin Ulceration Syndrom / 微生物学通报

The skin ulceration syndrome of sea cucumber is a kind of desease induced by bacterium.In order to investigate the bacterium of infected sea cucumber and detect the N-acyl-homoserine lactones(AHLs) se-cretion of the bacterium,7 bacterial strains were isolated from the infected sea cucumber.These strains were identified by physiological-biochemical characteristics and 16S rDNA sequence.Results show that strain C6 belongs to Tenacibaculum,strain 4 belongs to Shewanella putrefaciens group,strain TB belongs to Vibrio,strain BP2,BP3,BP4 and BP6 belong to Pseudoalteromonas,respectively.AHLs were detected with strain Agrobacterium tumefaciens KYC55.Among these bacterial strains,strain C6,4,TB,BP3 and BP4 can se-cret AHLs,while strain BP2 and BP6 can’t.And the AHLs activity differs,from the highest to the lowest are 4,TB,BP4,BP3 and C6.

Detection and prognostic significance of micrometastasis in peripheral blood of patients with non-small cell lung cancer treated by chemo-radiation therapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the prognostic significance of micrometastasis (MM) in peripheral blood of patients with non-small cell lung cancer (NSCLC) treated by chemo-radiation therapy.</p><p><b>METHODS</b>Peripheral blood was taken from 67 NSCLC patients before and after definitive chemo-radiation therapy. CK19 mRNA of the peripheral blood was measured by nested RT-PCR and both their relationship with clinicopathological features and prognostic significance were further investigated.</p><p><b>RESULTS</b>The micrometastasis-positive rates were 65.7% (44/67) and 32.8% (22/67), respectively, before and after the treatment. The micrometastasis-positive rate before treatment was closely in correlation with N-stage (P = 0.014). In contrast, it turned out to be more closely related with histological types (P = 0.019), weight loss (P = 0.01), KPS status (P = 0.027) as well as N-stage (P = 0.032) after chemo-radiation therapy. 4-yr distant metastasis rates (DMR) for micrometastasis-positive and -negative patients were 78.3% and 70.4%, respectively, before the treatment (P = 0.544) while they were 100% and 62.9%, respectively, after the chemoradiation (P < 0.001). The median survival time (MST) and 4-yr overall survival rate (OSR) for pretreatment micrometastasis-positive and -negative patients were 13.8 months and 17.6 months, and 18.2% and 17.4%, respectively (P = 0.619), while for post-treatment micrometastasis-positive and -negative patients they were 7.8 months and 27.6 months and 0 and 26.4%, respectively (P < 0.001). Multivariate analysis showed that the post-treatment positive micrometastasis was an independent unfavorable prognostic factor (P = 0.000).</p><p><b>CONCLUSION</b>Detection of micrometastasis in peripheral blood may possess a prognostic significance after definitive chemo-radiation therapy. Micrometastasis-negative patients have better prognosis compared to those with positive micrometastasis.</p>

Dosimetrical optimization study of intensity modulated radiotherapy for intact breast / 中国癌症杂志

Background and purpose:Intensity-modulated radiotherapy(IMRT) can significantly improve the dosimetric distribution of both the target and organs at risk compared to tangential irradiation for whole breast. However,its optimized methods remain different and conflicting for many radiotherapy institutions.In order to achieve the optimized planning of IMRT for the irradiation of intact breast,we investigated different optimizing methods in three dimensional radiotherapy planning system.Methods:Ten patients with early-stage breast cancer after breast conserving surgery were eligible for the study.Two kinds of plans were performed on each patient in three-dimensional treatment planning system,inverse planning IMRT and forward planning IMRT which included 3 different optimizing methods as manual optimizing(MO),multiple points optimizing(PO) and automated inverse optimizing(AO).Various parameters were used to evaluate the efficacy of different IMRT plans.All plans were compared using dose volume histograms(DVH) for the planning target volume(PTV) and organs at risk(OARs).Results:For MO,PO,AO forward plans and inverse plans,median number of segments were 5,5.5,5 and 20 respectively,and mean total MU were 225.8, 228.4,226.4 and 345.8 MU,respectively.Comparing the different forward planning optimizations,the best target coverage and dose homogeneity of PTV was observed in AO plans(P(?)0.01),and PO and AO plans showed a better reduction of OARs exposure compared with MO plans(P(?)0.05).A further improvement of dose homogeneity in the PTV and better sparing of OARs was achieved using inverse planning(P(?)0.05).Conclusion:Forward planning IMRT with AO optimization for intact breast irradiation could provide both efficacy and dosimetric advantages better than others.The inverse IMRT plan showed more potential in improving the dosimetric outcomes.However,further studies are required for inverse optimizing plans.

A dosimetery study on different irradiation technique for esophageal carcinoma by 3 dimensional treatment planning system(3D-TPS) / 中国癌症杂志

Background and purpose:Coventional radiation has been used for decades,but the 3D dose distribution has not been studied as yet.In this study,different treatment plans of conventional irradiation technique for esophageal carcinoma have been evaluated by 3-D TPS.Methods:Five patients with esophageal carcinoma at upper-thoracic and five patients at middle-thoracic were enrolled in this study.Three conventional treatment plans were created for each patient,with a prescribed dose of 70 Gy.For tumor at upper-thoracic,plan 1 consisted of one anterior field and bilateral posterior oblique fields with wedges,plan 2 consisted of anterior bilateral oblique fields with wedges ,plan 3 consisted of a pair of AP-PA portals,then followed by right anterior oblique portals and left posterior oblique portals to spare spine cord.For tumor at middle thoracic,plan 1 consisted of one anterior field and bilateral posterior oblique fields.Plan 2 consisted of a pair of AP-PA portals and followed by another pair of parallel-opposed lateral off- cord fields as boost.Plan 3 used the same plan as for the lesion at upper-thoracic.The evaluation of each treatment plan was carried out by dose-volume histogram(DVH).Results:For tumor at upper-thoracic,on average,the maximum dose to spinal-cord in plan 3 was (57.1?4.9)Gy,and was higher than that in plan 1 and plan 2.Plan 1 increased mean lung dose from (12.8?2.1)Gy to (18.2?4.1)Gy(P=0.045)compared with plan 2,but it improved the homogenous dose of PTV2,especially in the patient with long tumor.For tumor at middle-thoracic,on average,plan 2 increased mean lung dose from (11.9?1.1)Gy to (13.0?0.6)Gy(P=0.045) compared with plan 3.Plan 2 increased V_(20) and V_(30) from (23.6?2.3)% to (29.2?1.9)%(P=0.004) and (13.9?2.3)% to (20.9?1.3)%(P=0.006) compared with plan 1.The trachea volume of(?)70 Gy(V_(70))in plan 3 was larger than that in plan 1[(20.3?15.9)% VS (10.5?9.8)%,P=0.058].Conclusion:For tumor at upper-thoracic,plan 1 and 2 were superior to plan 3.Irradiation to lung in plan 2 was lower than that in plan 1,but plan 1 improved the homogenous dose of PTV2 compared with plan 2,especially for patient with longer lesion.For tumor at upper-thoracic,plan 2 increased irradiation dose to lung compared with plan 1 and plan 3.Plan 1 was comparable with plan 3,but the dose of trachea in plan 1 may lower than that in plan 3.

Three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the response and tolerance in hepatocellular carcinoma (HCC) patients treated by three-dimensional conformal radiotherapy (3DCRT) combined with. transcatheter arterial chemoembolization (TACE).</p><p><b>METHODS</b>Fourty-six HCC patients confirmed by cytology or histology were studied. All patients underwent TACE 1 to 3 courses. Then they received 3DCRT after an interval of about one month. 3DCRT was given with the field covering the tumor with a generous margin. 6 MV X-ray was used. The total dose was 30 - 54 Gy, in daily 2 Gy fractions. Immediate response was recorded according to the WHO criteria carried out by serial CT scan one month after 3DCRT. Irradiation toxicities were scored by the RTOG criteria. Acute liver toxicity was graded according to the common toxicity criteria (CTC) of National Cancer Institute. Late toxicity was focused on radiation-induced liver disease (RILD).</p><p><b>RESULTS</b>Partial response was observed in 8 (17.4%) patients. Stable disease and progressive disease was observed in 35 (76.1%) patients and 3 (6.5%) patients, respectively. No complete response was observed at the time of the response evaluation. The overall survival rate at 1-, 2- and 3-year was 60.9%, 39.1% and 28.3%, respectively, with a median survival period of 16 months. The 1-, 2- and 3-year local progression-free rate was 73.9%, 56.5% and 39.1%, respectively. The 1-, 2- and 3-year distant metastasis rate was 15.2%, 21.7% and 34.8%. Univariate analysis showed that favorable prognostic predictors for survival were: T3 stage, CACA 2001 stage I, absence of portal thrombosis, Child-Pugh grade A and irradiation dose of >45 Gy. Irradiation dose and liver cirrhosis were identified by Cox-regression analysis as independent predictors for survival. Two patients experienced CTC grade 1 acute hepatic toxicity and three patients experienced grade 3 acute hepatic toxicity. Two patients developed RILD. Three patients experienced RTOG grade 1 acute gastrointestinal complication and one patient experienced acute gastrointestinal bleeding. Five patients experienced RTOG grade 1 leucopenia, and five patients experienced grade 2 leucopenia.</p><p><b>CONCLUSION</b>3DCRT combined with TACE is safe and effective for HCC. It is worthy of a further dose escalation study.</p>

Prognostic factor of primary liver cancer treated by hypofractionated three-dimensional conformal radiotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the toxicity and efficacy of primary liver cancer (PLC) treated by hypofractionated three-dimensional conformal radiotherapy (3DCRT) and investigate the prognostic factors.</p><p><b>METHODS</b>Between April 1999 and August 2003, 128 PLC patients received hypofractionated 3DCRT. According to UICC/AJCC staging system, there were 83 T3 patients, 45 T4, with none of them having lymph node metastasis. The mean value of gross tumor volume (GTV) was (458.92 +/- 429.8) cm(3) (6.2-2097 cm(3)). Thirty-four patients had portal vein tumor thrombosis (PVTT). 108 patients had Child-Pugh Grade A liver cirrhosis and 20 Child-Pugh Grade B liver cirrhosis. All patients received a total dose of (53.6 +/- 6.6) Gy/4-8 Gy per fraction/3 fractions per week. Forty-eight of these patients received 3DCRT combined with transarterial chemoembolization (TACE).</p><p><b>RESULTS</b>Seven patients died within 3 months after the treatment were dismissed from the series. The response rate (CR + PR) was 55% (67/121). The overall 1-, 2-, and 3-year survival rate was 65.0%, 43.3%, and 33.1%, respectively. T stage (P = 0.001), GTV (P = 0.0001), PVTT (P = 0.0001) and Child-Pugh Grade (P = 0.0001) had significant impact on the overall survival. However, only GTV and Child-Pugh Grade were independent significant prognostic factors by Cox-regression analysis, (P = 0.044 and P = 0.015).</p><p><b>CONCLUSION</b>T stage, GTV, PVTT and Child-Pugh Grade have significant impact on the overall survival in primary liver cancer patients treated by three-dimensional conformal radiotherapy. But only GTV and Child-Pugh Grade are independent prognostic factors.</p>

Factors influencing target volume motion in tangential whole breast irradiation for breast cancer / 中华放射肿瘤学杂志

Objective To evaluate the impact of breathing motion on target volume and the factors influencing the set-up errors during tangential whole breast irradiation.Methods From Jan 2003 to Dec 2003,patients with early-stage breast cancer after breast conserving surgery,were selected to be eligible for the study.All patients were immobilized in treatment position by breast beard of Med-Tec 250.The motion of the breast treatment volume was observed on a fluoroscope in different directions under free breathing in 16 patients.The set-up errors in different dimensions during irradiation were measured by weekly portal films (PF) in comparison with digital reconstructed radiographs (DRR) in 11 patients.Results The central lung distance (CLD) variation during free breathing was (2.1?1.2) mm which is greater than the motion to- wards the other directions.By comparing the PF and DRR,the systemic error,random error and overall er- ror in the outer,inner and cranio-caudal directions was 1.9,1.6,2.5 and 2.4,1.7,3.1 and 2.6,2.3, 3.5 mm,respectively.In addition,the discrepancy of the treatment position in cranio-caudal direction and breast volume was most obvious at the beginning 2 weeks with the peak of breast volume at the second week. It decreased gradually during the following 3 weeks.Conclusions This study suggests that the mean value of the motion of the breast target volume during one breathing cycle is less than 2 mm.The set-up errors dur- ing irradiation is the greatest in cranio-caudal direction,suggesting that the fixing precision of the breast board should be further improved.The set-up error during irradiation are most obvious at the beginning two weeks,with the peak of the breast volume in the second week.

Lyman NTCP model analysis of radiaton-induced liver disease in hypofractionated conformal radiotherapy for primary liver carcinoma / 中华放射肿瘤学杂志

Objective To-identify the factors associated with radiation-induced liver disease (RILD) and to describe the probability of RILD using the Lyman normal tissue complication(NTCP) model for primary liver carcinoma(PLC) treated with hypofractionated conformal therapy (CRT).Methods A total of 109 PLC patients treated with hypofractionated CRT were prospectively followed according to the Child-Pugh classification for liver cirrhosis,93 patients in class A and 16 in class B.The mean dose of radi- ation to the isocenter was (53.5?5.5) Gy,fractions of (4.8?0.5) Gy,with interfraction interval of 48 hours and irradiation 3 times per week.Maximal likelihood analysis yielded the best estimates of parameters of the Lyman NTCP model for all patients;Child-Pugh A and Child-Pugh B patients,respectively.Results Of all the patients,17 developed RILD (17/109),8 in Child-Pugh A(8/93 ) and 9 in Child-Pugh B(9/ 16).By multivariate analysis,only the Child-Pugh Grade of liver cirrhosis was the independent factor (P= 0.000) associated with the developing of RILD.The best estimates of the NTCP parameters for all 109 pa- tients were n=1.1,m=0.35 and TD_(50) (1)=38.5 Gy.The n,m,TD_(50) (1) estimated from patients with Child-Pugh A was 1.1,0.28,40.5 Gy,respectively,compared with 0.7,0.43,23 Gy respectively,for patients with Child-Pugh B.Conclusions Primary liver cancer patients who possess Child-Pugh B cirrho- sis would present a significantly greater susceptibility to RILD after hypofractionated CRT than patients with Child-Pugh A cirrhosis.The predominant risk factor for developing RILD is the severity of hepatic cirrhosis in the liver of PLC patients.

Study of prognostic factors in patients with stage I non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the prognostic factors in patients with stage I non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Fifty-eight patients with stage I NSCLC treated from 1991 to 1995 were retrospectively reviewed. The clinical features, histopathology and prognostic factors were analyzed by SPSS10.0 statistic software. The expression of c-myc, MDM2, c-erbB-2, EGFR, p53, p14(ARF), p16(INK4), p21(WAF1) and nm23 was detected by immunohistochemical assay. The overall survival rate, local-regional control rate and distant metastasis rate were observed.</p><p><b>RESULTS</b>The overall survival rate, local-regional recurrent rate and distant metastasis rate were 71.1%, 11.1% and 33.5%, respectively. In univariate analysis, tumor cell differentiation was an independent prognostic factor (P = 0.028); overexpression of c-myc or c-erbB-2 had significantly poor overall survival and high distant metastasis rate (P < 0.05). The total oncogene immunoreactive score (IRS) and comprehensive IRS were associated with poor overall survival. In multivariate analysis, tumor cell differentiation and comprehensive IRS were independent prognostic factors for overall survival. Among the high-risk group of patients, those who had received chemotherapy seemed to have a higher overall survival rate and a lower distant metastasis rate in this study, but the difference was not statistically significant.</p><p><b>CONCLUSION</b>For stage I NSCLC patients, tumor cell differentiation and comprehensive IRS are independent prognostic factors for overall survival. Adjuvant chemotherapy might somehow improve the survival for the patients with high-risk factors.</p>

Comparative study on prognostic factors in young and old lung cancer patients under chemo-radiotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the differences in prognostic factors between the young and old lung cancer patients treated by chemo-radiotherapy.</p><p><b>METHODS</b>The clinical data were collected from 70 young patients (< 40 years old, the study group) and 82 randomly selected old patients (> or = 40 years old, the control group) treated by chemo-radiotherapy. Survival analysis was done by the Kaplan-Meier method, univariate analysis by Log rank test and multivariate analysis by Cox proportional hazard model, respectively.</p><p><b>RESULTS</b>Median survival time was 10 months in the study group and 12 months in the control group. The 2-year survival rate was 11.1% versus 23.1% and the 5-year survival was 3.1% versus 5.4%, respectively. Univariate analyses demonstrated that symptom duration time, mis-diagnosis duration time, clinical stage, chemo-radiation regimen, radiation dose, DDP dose, weight loss and Karnofsky performance status were associated with the prognosis of the study group, and symptom duration time, clinical stage, radiation dose, DDP dose, weight loss and Karnofsky performance status were associated with that of the control group. Multivariate analyses showed that clinical stage, weight loss and Karnofsky performance status were independent prognostic factors for both groups, but DDP dose only for the study group.</p><p><b>CONCLUSION</b>The overall survival was similar in young and old patient groups; There was some difference in prognostic factors between the two groups; DDP dose was an independent prognostic factor for young lung cancer patients which might bear dose-response relationship.</p>

Treatment of 40 patients with primary tracheal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the efficacy of treatment in 40 patients with primary tracheal carcinoma.</p><p><b>METHODS</b>From 1970 to 2001, 40 patients with primary tracheal carcinoma treated in our hospital were retrospectively reviewed. Twenty-eight were male and 12 were female with median age of 47 years. The median interval from onset of symptoms to diagnosis was 10 months (1 - 60 months). Fifteen patients had adenoid cystic carcinoma, 14 squamous cell carcinoma, 8 adenocarcinoma, 2 small-cell carcinoma and 1 mucoepidermoid carcinoma. Thirty-two patients received operation plus adjuvant radiotherapy, 6 received radiotherapy alone and 2 received operation alone.</p><p><b>RESULTS</b>The median survival time for all patients was 40 months. The 1-, 5-, and 10-year survival rate was 86%, 59% and 29%, respectively. The 1-, 5-, and 10-year local control rate was 84%, 60% and 50%, respectively. Distant metastasis rate in 1, 5, and 10 years was 17%, 51% and 84%, respectively.</p><p><b>CONCLUSION</b>Surgical resection plus adjuvant radiotherapy is a reasonable mode of treatment. Despite late local recurrence after initial treatment, its intrinsic feature, excellent long-term palliation can be achieved after treatment.</p>

Clinico-pathologic and prognostic studies on lung adenocarcinoma patients under 40 years of age / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study whether the clinico-pathologic characteristics and survival of young lung cancer patients < 40 years of age differ from those of lung cancer patients >or= 40 years of age.</p><p><b>METHODS</b>Retrospective analysis was carried out to compare the clinico-pathologic features and survival of 129 young patients (young group) with those of 140 randomly selected older ones (elderly group).</p><p><b>RESULTS</b>The young group, when compared with the older group, had more female (P = 0.037), longer mean duration of symptoms (4.7 m vs 2.5 m, P < 0.001), higher misdiagnostic rate (65.1% vs 24.3%, P < 0.001) with longer mean duration of misdiagnosis for the misdiagnosed patients (5.6 m vs 2.5 m, P < 0.001), more adenocarcinoma (54.3% vs 42.1%, P < 0.001), higher pathologic grade (69.5% vs 36.0%, P < 0.001), more advanced-stage diseases at diagnosis (74.4% vs 45.7%, P < 0.001), more patients receiving combined-modality treatment (94.6% vs 62.1%, P < 0.001) and more distant failures as initial relapse (64.7% vs 50.6%, P = 0.02). The median survivals and 5-year survival rates were better in patients with stage I-II disease in the young group than the older group (54 m vs 33 m and 46.2% vs 25.0%, P = 0.0495), even though the overall median survivals and 5-year survival rates were similar in either group (11 m vs 14 m and 8.3% vs 11.9%, P = 0.2889). There was no difference in family or smoking history (P = 0.227 and 0.171).</p><p><b>CONCLUSION</b>Younger patients with lung cancer present difference in clinico-pathologic features from the older ones, but the survivals of the two groups are similar. To define younger lung cancer as "the younger type of lung cancer" may have a practical clinical significance.</p>

PhaseⅢstudy on late course accelerated fractionated irradiation combined with concurrent chemotherapy for esophagus squamous cell carcinoma / 中华放射肿瘤学杂志

Objective To evaluate the role of late course accelerated fractions.ted irradiation(LCAF) combined with concurrent chemotherapy in the management of esophageal carcinoma.Methods From March 1998 to July 2000,111 eligible patients were randomized into LCAF alone group(LCAF,57 patients)or LCAF plus concurrent chemotherapy group(LACF-CT,54 patients).The radiotherapy regimen was identical in the two groups,consisting of conventional fractionation in the first 2/3 course and accelerated fractionation in the second 1/ 3 course to a total dose of 68.4 Gy/41 Fx/44 d.Chemotherapy regimen consisted of four eycles of cisplatin 25 mg/ (m~2?d)plus fluorouracil 600 mg/(m~2?d)on day 1 to 3 every 4 weeks and was delivered on the first day of radiotherapy.Results The median follow-up time was 67.1 months(range 47.6-76.4 months).The 1-,3-,5- year survival rate was 67%,44% ,40% and 77%,39% 28% in LACF-CF and LEAF group,respectively(P =0.310).Grade 3+4 acute side-effact was 42% and 25% in LCAF-CT and LCAF group,respectively(P＜0. 05),with 3 treatment-related deaths in the LCAF-CT group.Conclusions Late course accelerated fractionated irradiation combined with concurrent chemotherapy has a trend towards improving the survival,at the cost of increasing acute side-effect.Its role needs further confirmation by larger sample studied in randomization.