Comparison of effectiveness and safety of different treatment modes for limited-stage small cell lung / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare the effectiveness and safety of different treatment modes for limited-stage small cell lung cancer(SCLC).</p><p><b>METHODS</b>The clinical data of 171 SCLC patients who had received different therapies were retrospectively analyzed.</p><p><b>RESULTS</b>Of these 171 patients,55 had received concurrent radiochemotherapy,66 received sequential radiochemotherapy,and 50 received chemotherapy alone. For these 171 patients,the overall response rate(ORR)was 73.1%,overall survival(OS)and progression-free survival(PFS)were 23.5 months and 15.2 months,respectively,and the 1-,3-,and 5-year survival rates were 76.2%,30.4%,and 16.3%,respectively. For the concurrent group,sequential group,chemotherapy alone group,the median OS were 30.6,23.1,and 19.1 months,the median PFS were 19.7,13.3,and 11.5 months,and the 5-year survival rate was 28.7%,13.6%,and 9.4%,respectively(all P<0.05). The main toxic effects were myelosuppression,radiation pneumonia,and radiation esophagitis. The incidences of 1-2 grade myelosuppression were 92.7%,89.4%,and 92% in the concurrent group,sequential group,and chemotherapy alone group(P=0.25). For concurrent group and sequential group,the incidence of 1 grade radiation pneumonia were 47.2% and 50%,respectively(P=0.61),whereas the incidence of 1-2 grade radiation esophagitis were 94.5% and 75.8%(P=0.02). Multivariate analysis showed that gender,ECOG score,TNM stage,and thoracic radiation therapy were the independent prognostic factors for SCLC.</p><p><b>CONCLUSION</b>Concurrent radiochemotherapy is the treatment of choice for SCLC patients because it can improve the survival with tolerable toxicities.</p>

Therapeutic efficacy of three-dimensional conformal radiation therapy for patients with locally advanced non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the treatment results of three-dimensional conformal radiotherapy (3D-CRT) and conventional radiotherapy (2D) for patients with locally advanced non-small-cell lung cancer (NSCLC).</p><p><b>METHODS</b>Five hundred and twenty seven patients with stage III NSCLC treated between Jan 2000 and Dec 2006 were included in this study. Among them, 253 cases were treated with 3D-CRT, and 274 with conventional radiotherapy. In the 3D group, 159 (62.8%) patients received chemoradiotherapy, 77 with total radiotherapy dose of > 60 Gy, 49 with 50 - 60 Gy. In the 2D group, 127 (46.4%) patients received chemoradiotherapy, 48 with total radiotherapy dose of > 60 Gy, 75 with 50 - 60 Gy.</p><p><b>RESULTS</b>The 1-, 3-, 5-year overall survival rates (OS) and median survival time for patients treated with 3D-CRT were 73.3%, 26.1%, 14.4% and 20.1 months, respectively, and that of patients treated with 2D radiotherapy were 61.0%, 13.8%, 8.0% and 15.6 months, respectively (P = 0.002). The 1-, 3-, 5-year cause-specific survival rates (CSS) were 79.0%, 33.3%, and 20.8% for the 3D group and 65.1%, 16.7%, 11.2%, respectively, for the 2D group (P = 0.000). The 1-, 3-, and 5-year locoregional control rates were 71.6%, 34.3% and 31.0% for patients treated with 3D radiotherapy and 57.3%, 22.1% and 19.2%, respectively, for patients treated with 2D treatment (P = 0.002). The results of multivariate analysis showed that 3D-CRT, KPS, clinical tumor response and pretreatment hemoglobin level were independently associated with increased OS and CSS. No statistically significant differences were found between the radiation complications in the two groups.</p><p><b>CONCLUSIONS</b>The results of our study demonstrate that 3D-conformal radiotherapy improves the survival rate in patients with stage III NSCLC compared with that of 2D radiation therapy.</p>

Thoracic radiation therapy improves the prognosis for patients with extensive stage small-cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the effect of thoracic radiation therapy (TRT) on patients with extensive stage small-cell lung cancer (SCLC).</p><p><b>METHODS</b>One hundred and fifty-four patients with extensive stage SCLC treated in our department between January 2003 and December 2006 were enrolled in this study. Eighty nine patients received chemotherapy and thoracic radiation therapy (ChT/TRT), and 65 patients were treated with chemotherapy alone (ChT without TRT). The chemotherapy was CE (carboplatin and etoposide), PE (cisplatin and etoposide) or CAO (CTX, ADM and VCR) regimens. The total dose of thoracic irradiation was 40-60 Gy with 1.8 - 2.0 Gy per fraction.</p><p><b>RESULTS</b>For the whole group, the median survival time (MST) was 13.7 months, the 2-year and 5-year overall survival rates were 27.9% and 8.1%, respectively. The MST, overall survival rates at 2 years and 5 years in the ChT/TRT group and ChT without TRT group were 17.2 months, 36.0%, 10.1% and 9.3 months, 16.9%, 4.6%, respectively (P = 0.001). The median progression-free survival (PFS) for all patients was 8.0 months, the 2-year and 5-year PFS were 13.6% and 8.2%, respectively. The median PFS, 2-year and 5-year PFS in the ChT/TRT group and ChT without TRT group were 10.0 months, 17.4%, 10.5% and 6.2 months, 9.8%, 4.9%, respectively (P < 0.001). The incidence of intra-thoracic local failure was 29.6% in the ChT/TRT group and 70.0% in the ChT/without TRT group (P = 0.000).</p><p><b>CONCLUSIONS</b>Chemotherapy plus thoracic radiation therapy can improve the overall survival, progress free survival and reduce local regional failure rate in patients with extensive stage SCLC compared with that by chemotherapy alone.</p>

Treatment and prognosis of extrapulmonary small cell carcinoma of 243 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The extrapulmonary small cell carcinoma (EPSCC), a uncommon malignant tumor, has seldom been reported. The aim of this study was to analyze the clinical characteristics, treatment and prognosis of EPSCC.</p><p><b>METHODS</b>The clinical data of 243 patients admitted in our hospital from 1977 to 2007 were reviewed. The survival rate was calculated by the Kaplan-Meier method and log-rank test.</p><p><b>RESULTS</b>The median age of the patients was 58 years and the male-to-female ratio was 2.47:1. According to VALSG criteria, 209 patients had limited disease (LD) and 34 had extensive disease (ED). 170 patients received chemotherapy-based multimodal therapy, 73 received surgery, and/or radiotherapy. The 6, 12, 24, 36 and 60-month survival rates of these patients were 88.9%, 67.2%, 36.8%, 27.3% and 18.3%, respectively. The clinical stage, vessel involvement and regional lymph node metastases were independent prognostic factors of EPSCC. Patients with LD had a median overall survival of 18.6 months compared with 14.0 months in patients with ED (P = 0.030). The median survival was 19.2 months for the patients without vessel involvement and 14.4 months with vessel involvement (P = 0.026). The median survival of the patients with regional lymph node metastases was 13.9 months, while 39.5 months without regional lymph node metastases (P = 0.000). Among different primary sites, patients with gynecologic small cell cancer had a median survival of 28.0 months, head and neck 20.1 months and gastrointestinal tract 14.3 months. Brain metastasis was observed in a lower number of patients with EPSCC compared with that in patients with SCLC. There were no statistically significant differences in overall survival between patients with pure and mixed EPSCC (P = 0.396).</p><p><b>CONCLUSION</b>EPSCC is an uncommon malignant tumor with early metastasis and poor prognosis. The clinical characteristics of EPSCC and SCLC were similar in some aspects, however, there are some differences in etiology, clinic course, survival and frequency of brain metastases. These differences may influence the choice of therapeutic strategy. Multimodal therapy, combination of chemo- and radio-therapy after surgical resection may improve the outcome of EPSCC.</p>

Clinical analysis of 126 patients with primary small cell carcinoma of the esophagus / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the prognostic factors and the principles of treatment of primary esophageal small cell carcinoma (SCEC) retrospectively.</p><p><b>METHODS</b>The data of 126 patients with histologically confirmed SCEC treated in our department between May 1985 and June 2005 were retrospectively analyzed. 85 patients were in limited disease stage (LD) and 41 patients as extensive disease stage (ED) according to the Veterans Administration Lung Study Group staging system. Among the 84 patients treated with esophagectomy, 8 cases were in stage I, 16 in stage IIa, 10 in stage IIb, 40 in stage III, 4 in stage IVa and 6 in stage IVb, according to the TNM system (6(th) edition, AJCC). Cox's hazard regression model was used to identify the prognostic factors, and Chi-square test to detect the difference of frequencies among different groups. Kaplan-Meier and log-rank methods were used to estimate and compare the survival rates.</p><p><b>RESULTS</b>The median follow-up duration of this series was 13 months. One hundred and eight patients died of the disease during the follow-up, 10 were still alive and 8 were lost to follow-up. The 1-, 3-, and 5-year overall survival rates (OS) were 52.2%, 15.9%, and 12.2%, respectively, with a median survival time (MST) of 12.5 months. The 1-, 2-, and 3-year OS were 62.1%, 30.8%, and 22.4% with a MST of 14.0 months for LD, and 29.3%, 13.6% and 2.7% with a MST of 7.0 months for ED, respectively. There was a statistically significant difference in OS between LD and ED (P = 0.0001). The MST of the patients treated with chemotherapy was 14.5 months, significantly longer than the 5.2 months of the patients without (P = 0.0001). Multivariate analysis showed that stage (HR 1.91, 95% CI 1.26 approximately 2.91, P = 0.002), length of the primary lesion (HR 1.75, 95% CI 1.17 approximately 2.63, P = 0.007), and chemotherapy (HR 0.42, 95% CI 0.28 approximately 0.65, P = 0.000) were independent prognostic factors.</p><p><b>CONCLUSION</b>Esophageal small cell carcinoma is a systemic disease. The tumor stage (LD or ED), length of the primary lesion and chemotherapy are independent prognostic factors. Therefore, a systemic therapy based on chemotherapy should be recommended.</p>

Effect of different chemotherapy regimens for concurrent chemoradiotherapy on locally advanced non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To retrospectively analyze the effects of different chemotherapy regimens for concurrent chemoradiation on locally advanced non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>The data from 106 patients diagnosed as locally advanced NSCLC (IIIa: 29, IIIb: 77), who received various chemotherapy regimens for concurrent chemoradiotherapy, were retrospectively analyzed. Paclitaxel-based chemotherapy regimen was administered in 55 patients, topotecan regimen in 21 patients, PE (cisplatin and etopside) regimen in 26 patients, and other regimens in the remaining 4 patients. The effect of different chemotherapy regimens on overall survival and toxicity was analyzed.</p><p><b>RESULTS</b>The median survival time was 18.6 months, and the overall 1- and 3-year survival rates were 72.2% and 27.5%, respectively. The median survival time of 102 patients treated with paclitaxel-containing, topotecan-containing or PE regimens was 16.3, 27.3 and 29.1 months, respectively. The overall survival times of topotecan and PE groups were superior to that of paclitaxol-based group, but not significantly different (P = 0.32). Both univariate and multivariate analysis showed that paclitaxol-based chemotherapy regimen was significantly associated with a poorer survival (P < 0.05). N stage was another significant prognostic factor determined by COX multivariate regression model. Compared with the other regimens (10.6%), paclitaxel-based regimen (27.3%) had more acute radiation pneumonitis (grade >or= 2, P = 0.03), but no significant differences were observed in blood toxicity and esophagitis.</p><p><b>CONCLUSION</b>There is a correlation between different chemotherapy regimens for concurrent chemoradiotherapy and the overall survival and acute radiation pneumonitis in patients with locally advanced NSCLC.</p>

Postoperative three-dimensional conformal radiotherapy for resected non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the association between survival and postoperative three-dimensional conformal radiotherapy (3DCRT) in patients with resected non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Eighty-four patients were treated with surgery and postoperative 3DCRT for NSCLC. Sixty-five (77.4%) patients received lobectomy, and 19 (22.6%) received pneumonectomy. Fifty-four (64.3%) patients achieved R0 resection and 30 cases (35.8%) received R1/R2 resection. Fifty-two patients were of stage IIIA and 24 patients were of stage IIIB. Photon energy of 6 MV was used for all the patients. The median 3DCRT dose was 60 Gy (40 - 70 Gy) with a fraction size of 2 Gy. Thirty-seven patients received median 3 cycles of adjuvant chemotherapy. The median follow-up was 35.5 months for survivors.</p><p><b>RESULTS</b>The overall 3-year survival rate was 58.6%, and the 4-year overall survival rate was 43.9%. Of the 43 patients who had treatment failure, only 8 (9.9%) patients showed intrathoracic recurrence, but 38 (46.9%) patients had distant metastasis. The univariate analysis for all patients showed that sex, age, weight loss, tumor size, pathology and stage were not correlated with prognosis. R1/R2 resection was associated with a significantly worse survival. Toxicities were acceptable, with 9 (11.1%) patients appeared higher than NCI CTC grade 2 radiation pneumonitis.</p><p><b>CONCLUSION</b>In a population-based cohort, postoperative 3DCRT for NSCLC provides a good prognosis, and the radiation-related pneumonitis is acceptable.</p>

Multiple myeloma: past, present and future--editorial / 中国实验血液学杂志

Multiple myeloma is a neoplasm of mature and immature plasma cells, it remains an incurable disease using conventional chemotherapy and increasing aggressive approaches. In recent years, due to the better understanding of myeloma biology, genetics and tumor formation, there are lots of new active drugs or combinational chemotherapy regimens having been developed, such as proteasome inhibitors, immunomodulatory agents etc, they are more effective than conventional chemotherapy. This article summarizes the recent advances with the new options for the treatment of multiple myeloma.

Prognosis of locally advanced non small cell lung cancer treated with three dimentional conformal radiotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To summarize our experience and evaluate the prognostic factors of locally advanced non small cell lung cancer (LA-NSCLC) treated with three dimentional conformal radiotherapy (3D-CRT).</p><p><b>METHODS</b>118 patients with stage IIImA/IIIB non small cell lung cancer were treated with 3D-CRT from Nov. 2001 to Mar. 2005. 113 patients with complete clinical data were eligible for analysis, 45 of them received radiotherapy alone; 39 were treated by concurrent chemoradiation with paclitaxol plus carboplatin in 32 patients and topotecan in 7 patients, and 29 by sequential chemoradiation with platinum-based regiment in most of them. The dose of radiation for the thoracic field ranged from 26 Gy to 75 Gy with a median dose of 60 Gy. GTV and PTV were collected from the 3D treatment plans in 79 and 101 patients, respectively. Overall survival (OS) was calculated using the Kaplan-Meier method. Comparisons among the curves were made using a two-tailed long-rank test. The Cox model was used for multivariate analysis.</p><p><b>RESULTS</b>The 1-, 2- and 3-year overall survival rate was 60.7%, 31.6% and 22.4%, respectively, with a median survival time of 17 months. In univariate analysis, the following characteristics were significantly associated with longer survival: absence of chest pain, good karnofsky performance status (KPS), albumin > 4.2 g/L, hemoglobin > or = 140 g/L (male) or 130 g/L (female), response to radiotherapy and GTV < 100 cm3. However, multivariate analysis revealed that only good KPS was an independent risk factor predicting the survival.</p><p><b>CONCLUSION</b>Three-dimensional conformal radiotherapy is effective in the treatment of locally advanced non-small cell lung cancer with acceptable complications. Karnofsky performance status is the only independent prognositic factor.</p>

SPECT lung perfusion scans in predicting radiation pneumonitis in lung cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate single photon emission computed tomography (SPECT) lung perfusion in predicting radiation pneumonitis in lung cancer patients.</p><p><b>METHODS</b>From April 2003 to March 2004, 31 lung cancer patients treated with radical radiotherapy received SPECT lung perfusion scans, among whom, 23 had had perfusion scans both before and at the time of 40 Gy irradiation. The perfusion changes in the region of interest (ROI) after irradiation were obtained through comparing post-radiotherapy with pre-radiotherapy average proportion of SPECT counts within the ROI relative to average counts of the whole lung. Endpoint was defined as grade 2 and above radiation pneumonitis according to RTOG criteria.</p><p><b>RESULTS</b>Lung perfusion defect was observed in all the patients at baseline. > or = grade 2 lung perfusion defect was found in 68.2% (15/22) of patients with central lesion and in 22.2% (2/9) of patients with peripheral lesions (P = 0.04). Seventy percent of the patients (16/23) experienced improved perfusion at 40 - 50 Gy. > or = grade 2 radiation pneumonitis was observed in 12 patients (38.7%) in the whole group, with 6 in those with grade 1 perfusion defects and another 6 in > or = grade 2 group, respectively; Of the 23 patients who had had both pre- and post-radiotherapy SPECT perfusion scan, 5 > or = grade 2 radiation pneumonitis occurred in the 16 perfusion-improved patients and 3 in the 7 unimproved patients.</p><p><b>CONCLUSION</b>There is no significant correlation between radiation pneumonitis and the extent of perfusion defect either before or after 40 - 50 Gy irradiation based on our limited data analysis in this series.</p>

Three-dimensional conformal radiotherapy for locoregionally recurrent non-small cell lung cancer after initial radiotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, therapeutic effects and normal tissue complications of three-dimensional conformal radiotherapy (3DCRT) for locoregionally recurrent non-small cell lung cancer after initial radiotherapy.</p><p><b>METHODS</b>Between August 1999 and August 2003, 27 such patients were treated with 3DCRT after initial radiotherapy. This series consisted of 25 men and 2 women with a median age of 64 years. Radiotherapy was delivered at 2 Gy per fraction, 5 fractions per week, to a median dose of 50 Gy. Treatment results and normal tissue complications were assessed with WHO and RTOG/EORTC criteria.</p><p><b>RESULTS</b>Based upon a median follow-up time of 20.6 months, 25 patients (92.6%) completed the planned 3DCRT treatment. Their clinical symptom relief rate was 79.1%, and the response rate was 59.3% with a complete remission rate of 14.8% (4/27), partial remission rate of 44.4% (12/27). The overall 1- and 2-year survival (OS) rates were 73.8% and 25.4% with a median survival time (MST) of 20 months. The 1- and 2-year local progression free survival (LPFS) rates were both 88.8%. Grade 2 and grade 3 acute radiation pneumonitis developed in 7.4% (2/27) and 11.1% (3/27). Grade 2 late radiation pneumonitis developed in 11.1% (3/27).</p><p><b>CONCLUSION</b>3DCRT is feasible and advisable for locoregionally recurrent non-small-cell lung cancer, giving a good immediate tumor response and acceptable normal tissue complications.</p>

Preliminary results of three-dimensional conformal radiotherapy for small-cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, therapeutic effects and complications of three-dimensional conformal radiotherapy (3DCRT) for small-cell lung cancer (SCLC).</p><p><b>METHODS</b>The data of 19 SCLC patients treated between June 2001 and August 2003, with 3DCRT were reviewed and analyzed. Eighteen patients were treated by radiotherapy plus chemotherapy while only 1 patient by radiotherapy alone. Radiotherapy was delivered at 2 Gy/fraction, 5 fractions per week with a median total dose of 54 Gy. Chemotherapy consisted of 4 - 6 cycles of etoposide and cisplatin or carboplatin. The median follow-up time was 24 months.</p><p><b>RESULTS</b>(1) The overall response rate after 3DCRT was 79.0%, with a complete remission rate of 31.6% (6/19), partial remission rate of 47.4% (9/19). The 1- and 2-year overall survival (OS) was 71.7% and 35.8% respectively, with a median survival time (MST) of 19 months, and both the 1- and 2-year local progression free survival (LPFS) were 94.7%. (2) Of these 19 patients, grade 2 acute radiation pneumonitis developed in 5.3%, grade 2 late radiation pneumofibrosis in 5.3%, grade 2 acute radiation esophagitis in 10.5% and grade 2 acute hematologic toxicity in 10.5%.</p><p><b>CONCLUSION</b>Three-dimensional conformal radiotherapy is feasible in the treatment of SCLC with high response rate and acceptable complications. Further observation, more patients treated by 3DCRT and prolonged follow-up are needed to evaluate remote survival.</p>

Influence of the number of lymph node metastasis on survival and significance of postoperative radiotherapy for esophageal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the influence of the number of lymph node metastasis on survival and prophylactic postoperative radiotherapy after radical resection of thoracic esophageal carcinoma.</p><p><b>METHODS</b>Four hundred and ninety-five patients with thoracic esophageal squamous cell cancer who had undergone radical resection were randomly divided into surgery group alone (S, 275) and surgery plus radiotherapy group (S + R, 220). The patients were classified into three groups: Group A: 234 patients (47.2%) without lymph node involvement; Group B: 146 patients (29.5%) with 1 to 2 involved lymph nodes and Group C: 115 patients (23.2%) with >or= 3 involved lymph nodes.</p><p><b>RESULTS</b>1. The 5-year survival rate in Groups A, B and C for the same T stage (T3) was 52.6%, 28.8% and 10.9%, respectively (P = 0.0000); the 5-year survival rate in group C was 0% in S group and 19.3% in S + R group (P = 0.0336); 2. In the positive lymph node group, the metastatic rate of intra-thoracic and supraclavicular lymph node was 35.9% and 21.2% in S group and 19.7% and 4.4% in S+R group (P = 0.014 and P = 0.000). In the negative lymph node group, the metastatic rates of intra-thoracic lymph node was 27.8% in S group and 10.3% in S + R group (P = 0.003). The metastatic rate of intra-abdominal lymph node in Groups A, B and C was 3.9%, 9.4% and 17.5%, respectively (P = 0.0000). The occurrence of hematogenous metastasis was most frequent in group C (27.8%) with >or= 3 positive lymph nodes.</p><p><b>CONCLUSION</b>1. The number of metastatic lymph node is one of the important factors which affects the survival of thoracic esophageal carcinoma. 2. Chemotherapy might be given to the patients with three or more lymph nodes involved who have the possibility of developing hematogenous metastasis. Postoperative radiotherapy can reduce the occurrence of intra-thoracic and supraclavicular lymph node metastasis and improve the survival of patients with three or more lymph nodes involvement.</p>

Relation between pathologic tumor response to preoperative radiotherapy and the prognosis in patients with esophageal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the relation between pathologic tumor response in preoperative radiotherapy and long-term survival in patients with esophageal carcinoma and the significance of radiosensitivity in the treatment of esophageal carcinoma.</p><p><b>METHODS</b>176 esophageal cancer patients received preoperative radiotherapy and tumor resection from 1977 to 1989. The radio-response was classified into severe, moderate and mild according to the tumor pathologic response to radiotherapy. 191 patients treated by surgery alone served as control. The relation between radiation response of tumor and long-term survival and disease free survival was analyzed.</p><p><b>RESULTS</b>The 5-year survival rates of severe, moderate, mild and control groups were 60.7%, 46.4%, 21.1% and 38.8%. The survival was significantly improved in severe than moderate one (P = 0.029), moderate than mild group (P = 0.013) and severe than the control group (P = 0.000). It was only slightly improved in the moderate than control group (P = 0.295), but decreased in mild than the control group (P = 0.034). The 5-year disease-free survival (DFS) rates were 55.7%, 40.7%, 18.7% and 33.3% in severe, moderate, mild and control groups. The DFS was significantly improved in severe than moderate group (P = 0.029), moderate than mild group (P = 0.018), severe than the control group (P = 0.000 4). It was only slightly improved in moderate than the control group (P = 0.23), but decreased in the mild than the control group (P = 0.096). In the severe group, the proportion of stage T4, N1 lesion, TNM stage I-II and number of radical resection were 9.8%, 18%, 90.2%, and 90.2%. In the moderate group, they were 20.3%, 15.9%, 79.7% and 82.6%. In the mild group, they were 42.2%, 37.8%, 53.3% and 46.7%. In the control group, they were 50.3%, 40.8%, 37.7% and 77.5%. The rates of downstaging and surgical resection were improved only in severe and moderate groups (P < 0.01).</p><p><b>CONCLUSION</b>The fact that only patients in whom severe radiation response are observed would appreciably benefit from preoperative radiotherapy whereas the others do not, illustrates that there might be no benefit of radiotherapy for radioresistant esophageal carcinoma. Radiosensitivity measurement before preoperative radiotherapy would be valuable for individualized treatment.</p>

Evidence-based clinical practice of radiotherapy of small-cell lung cancer / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the effects of radiotherapy in the treatment of small-cell lung cancer and the optimal radiation doses, irradiation volume and fractionations.</p><p><b>METHODS</b>Using evidence-based principles to search and evaluate clinical evidence on radiotherapy of small-cell lung cancer and giving grades of recommendation in clinical practice.</p><p><b>RESULTS AND CONCLUSION</b>The combination of chemotherapy and thoracic irradiation were the treatment strategy in limited stage small-cell lung cancer (LD SCLC). There were no clear answers on optimal irradiation dose and volume. Early thoracic irradiations were better than later ones. Radiotherapy should be started at the first or second cycle of chemotherapy. Hyperfractionated irradiation may have therapeutic benefit compared with conventional irradiation. Prophylactic cranial irradiation could improve survival for patients with complete response after chemotherapy and radiotherapy.</p>