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Objective@#To study the related factors of radiation induced lung injury(RILI) after three-dimensional conformal radiotherapy(3D-CRT) in the elderly patients with advance esophageal cancer, thus to provide reference for radiotherapy planning.@*Methods@#The clinical data and physical parameters of 72 elderly patients with advance esophageal cancer were analyzed, including gender, age, performance status scoring, smoking history, tumor location, T staging, underlying disease of the lung, radiation dose, the whole lung accepted 5 Gy exposure volume(V5), V10, V15, V20, V25, V30, V40 and mean lung dose(MLD).@*Results@#Among 72 patients, 15 cases developed RILI.It was revealed by univariate analysis that there were statistically significant differences in advanced age, underlying disease of the lung, V5, V10, V15, V20, V25, MLD with RILI(χ2=5.098, P=0.026; χ2=3.598, P=0.030; t=3.854, P=0.034; t=4.901, P=0.022, t=4.638, P=0.029, t=5.122, P=0.015, t=3.652, P=0.041, t=5.760, P=0.010).@*Conclusion@#It should be payed more attention to factors such as advanced age, underlying disease of the lung, V5, V10, V15, V20, V25 and MLD when elderly patients with advance esophageal cancer patients were treated with 3D-CRT in order to prevent and decrease the risks of RILI.
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Objective To perform an exploratory investigation on confocal laser endomicroscopy (CLE) in the diagnosis of malignant bladder tumour.Methods From June 10 to July 11,2017,6 male bladder cancer patients underwent white light cystoscopy (WLC) + CLE examination,aging 64-86 years (median 72 years).All patients received TURBT on suspected lesions.WLC and CLE imaging results were recorded and validated by pathologic specimens.Results Lesions confirmed by histopathology were 3 low grade non-invasive papillary urothelial carcinomas,1 high grade non-invasive papillary urothelial carcinoma,1 low grade invasive urothelial carcinoma,1 high grade invasive urothelial carcinoma,1 carcinoma in situ (CIS),1 high grade dysplasia,1 cystitis glandularis,1 chronic inflammation,and 1 scar tissue.For CLE images in the normal urothelium,three layers of cells with different presentation were observed,namely,the superficial umbrella cells,the intermediate cells smaller in size and uniformly shaped,and the capillary network in the lamina propria.For non-invasive urothelial carcinoma,tumour cells appeared as papillary lesions growing from fibrovascular cores,with low grade cells appearing monomorphic and more cohesively arranged,and high grade cells relatively pleomorphic,more disorganised and with tortuous blood vessels in the fibrovascular core.For invasive urothelial carcinoma,tumour cells invaded the lamina propria,with uniform appearances,poor cohesion and indistinct cellular borders,and high grade ones were more pleomorphic.CIS and inflammation both appeared as erythematous patch-like flat lesions under WLC and sometimes difficult to differentiate.Under CLE,the former appeared as dysplastic and disorganised cells with indistinct cellular borders,with intact lamina propria,and inflammatory cells were discovered as infiltrative clusters in the lamina propria that were uniformly shaped and loosely connected.Dysplasia appeared somewhat similar compared with CIS under WLC,but with lower cellular irregularity as confirmed with pathology.Cellular appearance and structure in scar tissue was similar to that in the normal urothelium,but superficial umbrella cells were more likely absent,with thinner cell layers,and inflammatory infiltration was sometimes discovered in the lamina propria.Conclusions CLE provides real-time cellular imaging of the urothelium,and shows promising potential for clinical diagnosis,especially in differentiating fiat urothelial lesions.Large prospective studies are required for further validation.
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Objective To investigate the diagnostic value of narrow-band imaging for flat bladder lesions.Methods Forty-nine patients with flat bladder lesions diagnosed by white light cystoscopy + narrow-band imaging followed by transurethral resection were included.The diagnostic value of narrow-band imaging was evaluated based on postoperative pathological results.Results A total of 59 flat lesions were identified,in which 8 were normal urothelium,3 were chronic inflammation,1 was papillary urothelial neoplasm of low malignant potential,1 were mild dysplasia,1 was moderate dysplasia,1 were severe dysplasia,3 were carcinoma in situ,16 were low-grade papillary urothelial carcinoma,16 were high-grade papillary urothelial carcinoma,and 8 were invasive papillary urothelial carcinoma.For narrow-band imaging,the sensitivity was 86.7 ％ (39/45),specificity was 57.1％ (8/14),diagnostic accuracy was 79.7 ％ (47/ 59),false-positive rate was 42.9％ (6/14),positive predictive value was 86.7％ (39/45),negative predictive value was 57.1％ (8/14),area under ROC curve was 0.719.Among these lesions,the sensitivity and specificity for postoperative recurrent lesions were 100％ (3/3) and 40％ (2/5),respectively,and those for erythematous patch-like lesions were 90％ (9/10) and 100％ (4/4),respectively.Conclusion Narrow-band imaging can improve the detection rate for flat bladder tumor lesions,and reduce the risk for missed diagnosis under white light cystoscopy,especially for otherwise indistinguishable erythematous patch-like lesions.
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OBJECTIVE:To observe clinical efficacy and safety of tegafur gimeracil oteracil potassium combined with 3D-CRT and microwave hyperthermia in the treatment of elderly patients with local advance esophageal cancer. METHODS:48 cases of local advance esophageal cancer were divided into group A,B and C according to random number table method,with 16 cases in each group according to random number table method. Group A was given 3D-CRT with total dose of 60-66 Gy totnlly for 6-7 weeks;group B was additionally given tegafur gimeracil oteracil potassium 60 mg/(m2·d),bid,on the basis of group A 3 weeks for a course of treatment,until the end of radvotherapy;group C was additionally given thermotherapy on the basis of group B 3 weeks for a course of treatment,until the end of radvotherapy. Clinical efficacy,1-year survival rate,dysphagia,weight and KPS score were compared among 3 groups,and the occurrence of toxic reactions(radioactive esophagitis,radioactive pneumonia, bone marrow suppression and gastrointestinal reaction) were observed in 3 groups. RESULTS:Total effective rate,1-year survival rate and the remission rate of dysphagia of group C were 93.75%,87.50% and 93.75%,which were significantly higher than those of group A(50.00%,50.00% and 56.25%)and B(68.75%,68.75% and 68.75%),with statistical significance(P0.05). The incidence of radioactive esophagitis and radioactive pneumonia in group C were significantly lower than in group A and B,with statistical significance(P0.05). CONCLUSIONS:Tegafur gimeracil oteracil potassium combined with 3D-CRT and microwave hyperthermia in the treat-ment of elderly patients with local advance esophageal cancer further improves clinical efficacy and survival rate,but shows low inci-dence of toxic reaction.