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Objective To determine the maximum tolerated dose ( MTD) and dose?limiting toxicity ( DLT) of weekly PTX and DDP concurrent postoperative radiotherapy in Chinese women with high?and intermediate?risk early cervical cancer. Methods Women with high risks postoperative cervical carcinoma, ECOG≤2 were eligible. Pelvis RT (6/10 MV X?ray,3DCRT 40 Gy/20f,para?metrial boost 10?20 Gy/5?10f) was followed by 2?4f brachytherapy applications ( 192 Ir,5 Gy/f) . Concurrent weekly chemotherapy was started at DDP 20 mg/m2 and PTX 10 mg/m2 weekly,and escalated in three?patient cohorts according to 3+3 methods. Results 25 patients were enrolled and treated over seven doses levels until dose?limiting toxicity (DLT) was reached. Median age was 48 years (range,34?66).All of patients finished RT in 7 weeks. Grade 3,4 non?hematologic toxicities were diarrhea and observed in two patients (4 cycles,DLT) at level 7.Grade 3,4 hematologic,principally leukopenia and neutropenia,and occurs late cycles. One grade 4 leukopenia and neutropenia was observed at dose level 6 but not seen in three additional patients. No one was delayed treatment time by concurrent chemotherapy.22 patients finished 6 cycles. Median follow?up is 59. 5 months. Three patients have died of cancer metastasis and recurrence. One patient has died of respiratory failure. Conclusions Combination PTX and DDP administered concurrently with pelvic EBRT can be safely administered at the MTD of DDP 35 mg/m2 and PTX 30 mg/m2 weekly for six cycles in Chinese women with postoperative cervical cancer.
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Objective To evaluate the safety of helical tomotherapy (HT) for hepatocellular carcinoma confined to the liver,and to investigate the efficacy of HT by comparison with three-dimensional conformal radiotherapy (3DCRT).Methods In June 2011,hypofractionated HT was performed in 35 patients with unresectable hepatocellular carcinoma confined to the liver who had no distant metastasis or tumor thrombosis.The dose in each fraction increased from 2.4 Gy to 5.0 Gy with a median dose of 3.2 Gy.The median dose for the total treatment was 50.0 Gy.Within the same period,45 patients received conventionally fractionated 3DCRT with a median dose of 54.0 Gy.The adverse reactions,clinical outcomes,and survival time were compared between the two groups.The survival rate was calculated with Kaplan-Meier method,and log-rank test was used to estimate statistical significance of survival differences.Multivariate analysis of survival was carried out with Cox' s regression model.Results There were no significant differences in adversc reactions between the two groups.The objective response rate was significantly higher in the HT group than in the 3DCRT group (60％ vs.33％,P=0.024).There was no significant difference in the disease control rate between the two groups (94％ vs.89％,P=0.459).The HT group showed significantly higher 1-,2-,and 3-year overall survival rates than the 3DCRT group (97％ vs.80％,P=0.025;81％ vs.55％,P =0.008;67％ vs.50％,P =0.048).The multivariate analysis indicated that tumor smaller than 8 cm,transarterial chemoembolization before radiotherapy,and HT were associated with improved survival (P=0.005;P =0.000;P=0.002).Conclusions HT shows an advantage in precise treatment of hepatocellular carcinoma confined to the liver.With acceptable toxicity,hypofractionated HT shortens the treatment duration and improves the survival in patients.
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Objective To evaluate the safety and feasibility of three-dimensional conformal radiation therapy combined with tegafur in treating locally recurrent rectal cancer. Methods A total of 32 patients with locally recurrent rectal cancer were treated with chemoradiotherapy ( CRT) . Radiotherapy was delivered to a total of 45 Gy in 25 fractions followed by a boost of 18 Gy in 10 fractions using three dimensional radiotherapy planning. Tegafur was given orally[80 mg·(m2)-1·d-1] on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40, and 43-47 during radiotherapy. Results Most of the adverse effects were mild. Grade 3-4 toxic effects occurred in 12. 5% of patients. Thirty-one patients completed full course of CRT, while one patient discontinued chemotherapy due to Grade 4 thrombocytopenia. There were 3 cases (9. 4%) with complete response, 21 cases (65. 6%) with partial response, and the overall response rate was 75. 0%. Overall pain response (complete and partial pain relief) was achieved in 96. 9% of patients. The 1- and 2-year overall survival rate was 71. 0% and 56. 5%, respectively. Conclusion 3D-CRT combined with tegafur for locally recurrent rectal cancer is feasible with high patient compliance and tolerable toxicities.
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Objective To investigate the long-term survival of esophageal squamous cell carcinoma (ESCC) patients of different ages after three-dimensional conformal radiotherapy (3 DCRT).Methods From July 2003 to September 2008,769 patients with stage Ⅰ-Ⅲ ESCC were eligible for the analysis.All patients were treated with 3DCRT.The prescribed dose was 50-70 Gy (median,60 Gy),1.8-2.0 Gy per fraction,5 fractions per week.The Kaplan-Meier method was used to calculate overall survival (OS) and local control (LC) rates; the log-rank test was used for survival difference analysis and univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis.Results The follow-up rate was 98.3％.For all patients,the 1-,3-,and 5-year LC rates were 76.3％,52.8％,and 48.5％,respectively,and the 1-,3-,and 5-year OS rates were 70.1％,36.2％,and 23.0％,respectively.The 1-,3-,and 5-year OS rates were 71.2％,38.8％,and 24.9％,respectively,for patients aged 45-74 years,versus 69.6％,26.6％,and 15.4％ for patients aged 75-89 years (P =0.008).Multivariate prognostic analysis showed that age was also a prognostic factor in ESCC patients after 3DCRT.A total of 620 patients died.Patients aged 45-74 years had a significantly higher proportion of individuals that died of distant metastasis (23.9％ vs.14.2％,P =0.009),while patients aged 75-89 years had a significantly higher proportion of individuals that died of non-cancer diseases (14.1％ vs.4.9％,P=0.000).Conclusions Survival varies between ESCC patients of different ages after 3DCRT.The survival of elderly ESCC patients is poor,and the relatively high mortality from non-cancer diseases may be an important reason for poor survival.
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Objective To evaluate the role of thoracic three-dimensional conformal radiotherapy (3DCRT) in patients with extensive-stage small cell lung cancer (ES-SCLC).Methods A total of 171 patients with ES-SCLC admitted from 2004 to 2009 were included in the study.Eighty-six patients received thoracic 3DCRT and systemic chemotherapy (CT),while 85 patients received systemic CT alone.3DCRT was delivered at 1.5 Gy/fraction twice daily or 2.0 Gy/fraction once daily,with a total dose ranging from 40 to 62 Gy.The CT regimen consisted of carboplatin/cisplatin and etoposide.The survival time and survival rate were calculated by the Kaplan-Meier method,and the log-rank test was used for univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis.Results The follow-up rate was 100％.The median overall survival (OS) time and the 2-and 5-year OS rates were 15 months,31.5％,and 2.4％,respectively,for all patients;they were 18 months,35.3％,and 2.4％,respectively,for the CT/3DCRT group,versus 12 months,14.5％,and 2.4％ for the CT group (P =0.023).The median progression-free survival (PFS) time and the 1-and 2-year PFS rates were 8 months,27.5％,and 2.4％,respectively,for all patients;they were 9 months,35.4％,and 6.0％,respectively,for the CT/3DCRT group,versus 6 months,20.5％,and 6.0％ for the CT group (P =0.004).In the CT/3DCRT group,the 22 patients who received 45 Gy at 1.5 Gy/fraction twice daily had a median PFS time of 11 months,versus 9 months for the 26 patients who received 60 Gy at 2.0 Gy/fraction once daily (P =0.037).Multivariate analysis revealed that receiving ≥ 4 cycles of CT (P =0.001) and 3DCRT (P =0.008) were favorable prognostic factors for OS.Conclusions Thoracic 3DCRT can improve the OS and PFS in patients with EDSCLC,and it has good efficacy when delivered with a total dose of 45 Gy at 1.5 Gy/fraction twice daily.Thoracic 3DCRT and receiving ≥4 cycles of CT are independent favorable prognostic factors for OS.
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Objective To evaluate the effect of GTV volume on response of esophageal carcinoma.Methods From Jan.2004 to Dec.2008,72 cases newly diagnosed N0 stage thoracic esophageal carcinomas were included in this retrospective study.All treatment plans were set up and designed by CT simulator and 3D TPS.They received dose 56-70 Gy/27-33F/6-7w with 6MV X-ray.The GTV,the tumor length and maximum diameters were measured on the treatment planning system with the X-ray.RECIST standard was applied to evaluate the radiotherapy response of esophageal carcinoma.The effectiveness of related prognostic factors on survival was evaluated by univariate analyses.Results The short-term response with CR were 79％ with length ＜ 5 cm,48％ with 5-7 cm and 26％ with length ＞7 cm(P =0.003).The 1-,2-,3-and 5-year survival rates were 93％,79％,69％,69％ ; 91％,61％,46％,46％ and 80％,46％,28％,22％ (P =0.037).The short-term response with CR were 56％ with maximum diameters ≤3 cm and 33％ with maximum diameters ＞ 3 cm(P =0.033).The 1-,2-,3-and 5-year survival rates were 91％,72％,55％,37％ and 80％,45％,30％,30％ (P =0.037).The short-term response with CR were 52％ with GTV volume≤40 cm3 and 30％ with GTV volume ＞40 cm3(P =0.059).The 1-,2-,3-and 5-year survival rates were 91％,67％,51％,41％ and 80％,43％,27％,27％ (P =0.047).In the multivariate analysis,the length of GTV was likely to be the most important factor for the short-term response(P =0.005,0.014).Conclusions GTV volume,the tumor length and maximum diameters are factors for short-term response of N0 stage esophageal carcinoma.The GTV length is independent prognostic factor.The GTV length is the worse the prognosis will be.
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ObjectiveTo determine the maximal tolerated dose and the dose-limiting toxicity of hydroxycamptothecin (HCPT)concurrently combined with three-dimensional conformal radiotherapy (3DCRT) for unresectable or locally relapsed rectal cancer.Methods Twenty-two patients with rectal cancer were enrolled into phase Ⅰstudy between 2004 -2007. HCPT was intravenously administered concurrently with 3DCRT weekly,dose given from 6,8,10 mg/m2 or twice a week,dose given from 4,6,8,10 mg/m2,respectively.Total radiation dose of 50 Gy was delivered to the whole pelvis at a fraction of 2 Gy per day for 5 weeks,with 10 - 16 Gy subsequent boost to tumor area.Dose-limiting toxicities (DLT) were defined as grade 3 or higher non-hematologic toxicity or grade 4 hematologic toxicity.ResultsIn the twice a week group,DLTs of grade 3 diarrhea were observed in 2 patient treated at dose of 6 mg/m2.In the weekly group,DLTs of grade 3 diarrhea and radiation-induced dermatitis were observed in Ⅰ patient at dose of 8mg/m2,and were not observed in the next 3 patients at the same dose level.However,at dose of 10 mg/m2,2 patients had grade 3 diarrhea or nausea.The 5-year overall survival rate was 23％ and the median survival time was 18 months.ConclusionsHCPT given concurrently with 3DCRT is safe and tolerable for patients with unresectable or locally relapsed rectal cancer.Either 8 mg/m2 weekly or 4 mg/m2 twice a week can be recommended for further study.The dose-limiting toxicities are grade 3 diarrhea,nausea and radiation-induced dermatitis.
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ObjectiveThe study is to investigate the predictive values of dosimetric parameters and patient related factors in severe acute radiation pneumonitis (SARP) after concurrent chemoradiotherapy in non-small cell lung cancer (NSCLC).Methods In all,147 NSCLC patients treated with concurrent chemotherapy and 3DCRT between 2006 and 2010 was collected.Independent sample t test was used to compare parameter values between patients with SARP and those without SARP.Logistic regression was used to identify significant determined factor.Predictive value of each parameter was tested by ROC analysis.Pearson correlation was used to analyze correlations between parameters.Represent factors were identified by factor analysis.ResultsThe incidence of SARP was 9.5％ ( 14/147 ).The means lung dose (MLD),V20,V30,V40,and V50 ( x2 =4.87 -6.84,P =0.009 -0.025,respectively ) were determining factors for SARP.Our datasets shows that for SARP ＜5％,MLD,V20,V30,V40 and V50 should be ≤16.77 Gy,V20≤34.15％,.V30 ≤23.62％,.V40 ≤ 18.57％,V50 ≤ 13.02％.ROC analysis show that areas under MLD,V20,V30,V40 and V50 curves was corresponding to 0.678,0.661,0.667,0.677,and 0.651,respectively.In addition,the sensitivity and specificity of each parameter at cutoff values are:78.0％ and 48.1％ for MLD;42.9％ and 82.0％ for V2o ;78.6％ and 52.9％ for V30 ;71.4％ and 61.7％ for V40,and 57.1％ and 67.7％ for V50.Factor analysis suggest that we can choose 1 or 2 parameters from MLD,V20,or V30,and another from V40 or V50 for predicting.The incidence of SARP was greater in patients with tumorsin right lower lung than other locations ( 22.2％ vs 6.7％,x2 =6.19,P =0.0 2 3 ).Conclusions The MLD,V20,V30,V40 and V50 are determining factors for SARP.As predictive value of each parameter alone is relatively week,using two or more parameters to predict SARP is recommended.
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ObjectiveTo analyze the prognosis of 784 patients according with clinical staging of esophageal carcinoma treated with non-surgical methods,investigate the predictive value and deficiency of the clinical staging.MethodsFrom July 2003 to January 2009,784 patients with esophageal carcinoma received 3DCRT treatment.The prescribed doses ranged from 50 Gy-70 Gy with median dose of 60 Gy,1.8-2.0 Gy/fraction,1 fraction/day,5 fractions/week.65 patients received prescription dose of＜60 Gy and all the others'≥60 Gy.All the patients were divided into subgroups according to different T,N and TNM stages.Therapeutic effect was evaluated.ResultsThe follow up rate was 97.1％,503 patients were followed up for more than 3 years and 122 were followed up for more than 5 years.The 1-,3-,5-year local control rates and overall survival rates were 77.2％,54.2％,46.5％ and 69.5％,34.9％,23.9％,respectively,with median survival time of 21 months.There were significant differences of survival curves for different T stages,N stages and TNM stages.For the groups of stage Ⅰ,Ⅱ and Ⅲ,the 1-,3-,5-year survival rates were 86.4％,47.6％,45.1％ ;84.7％,46.3％,36.4％ and 64.0％,30.9％,19.1％,respectively ( x2 =29.34,P =0.000).There were 752 patients with squamous cell carcinoma ( 95.9％ )and 32 patients with non-squamous cell carcinoma (4.1％ ),the median survival time were 21 and 16 months,respectively ( x2 =4.44,P =0.035 ).There were significant difference of survival rates for the subgroups whose GTV volume ≤20 cm3,20 -40 cm3,40 -60 cm3 and ＞60 cm3 (54 months,29 months,21months and 14months,x2 =68.71,P =0.000).ConclusionsThe clinical staging of esophageal carcinoma treated with non-surgical methods could predict the prognosis accurately,for patients with different pathology and GTV volumes,there were variance in the prognosis,so we advised the complement of the two factors in the draft of clinical stages.
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ObjectiveThis study evaluates the feasibility of intensity-modulated radiation therapy (IMRT) to treat patients with 1 -5 brain metastases from non-small cell lung cancer (NSCLC).Methods 30 IMRT patients with brain metastases for NSCLC studied retrospectively.Whole brain radiotherapy plus three-dimensional conformal radiotherapy (WBRT + 3DCRT) and WBRT plus stereotactic radiotherapy ( WBRT + SRT) plans were generated.Planning target volume ( PTV ) and organs at risk dose were measured and compared by dose volume histogram.Differences were analyzed in the three techniques by Wilcoxon Z -test.Results D99％ of the shoulder ( D99％-D90％ ) from IMRT were higher than from WBRT +3DCRT and WBRT+SRT in all cases.From D15％ of slope (D90％-D10％) to D5％ of tail (D10％ -D1％ ),IMRT were lower than WBRT + 3DCRT and WBRT + SRT ( Z =- 4.72,P =0.000 and Z =- 4.72,P =0.000).D10％ and D5％ of IMRT were (35.1 ±1.42) Gy and (37.7 ±2.91) Gy,WBRT +3DCRT were (36.5±2.86) Gy and ( 39.1 ± 3.56) Gy ;WBRT + SRT were (36.2 ± 2.57) Gy and ( 38.7 ± 3.67) Gy.IMRT vs WBRT+ 3DCRT and WBRT + SRT were significant ( Z=-3.18,-3.18,P=0.001,0.001 and Z=- 4.11,- 3.02,P =0.000,0.002) in 13 patients with 3 - 5 brain metastases.The total mean monitor units were 14756.3,9614.8 and 9043.2 for IMRT,WBRT +3DCRT and WBRT + SRT plans,respectively,with a 38.7％ reduction from IMRT to WBRT + SRT (Z =-4.78,-4.78,P =0.000,0.000).The brain doses around metastases were similar in the three techniques with 1 -2 metastases,but IMRT was the best with 3 -5 metastases.ConclusionsIMRT can advance brain metastases dose and improve the planning target minimum dose and spare the dose around brain metastases.Only IMRT is the best choice for just sparing the dose around brain metastases among 3 -5 brain metastases.
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ObjectiveTo study the feasibility of RapidArc (RA) associated with active breath coordinator (ABC)for hepatocelluar carcinoma (HCC)radiotherapy comparing of three-dimensional conformal radiotherapy (3DCRT),intensity modulated radiotherapy (IMRT),RA treatment plans in different breath status.Methods12 HCC cases were selected.Three series CT scanning were completed in Free Breathing (FB),End Inspiration Hold (EIH) and End Expiration Hold (EEH) associated with ABC device.3DCRT,IMRT and RA (three 135° arcs) treatment plans were respectively designed on planning target volume (PTV) in different breath status.The dosimetric differences among 3 DCRT,IMRT and RA,among RA plans under different breath status were compared.ResultsThe PTV in FB was larger than in EEHand EIH (160.8 cm3,89.5 cm3,83.1 cm3,F=6.63,P=0.004). The conformity index and homogeneity index of RA plans were better than IMRT and 3DCRT ( 0.92,0.90,0.77,F =72.55,P =0.000 ;0.90,0.89,0.84,F =125.49,P =0.000 ) ;the V20,V30,V40 of normal liver in 3DCRT were higher than IMRT and RA (24％,20％,19％,F=3.56,P =0.032;13％,10％,10％,F=5.74,P =0.004;8％,5％,6％,F =3.72,P =0.027).The normal liver mean dose,V10,V20,V30,V40 of RA plans in FB were higher than in EEH and EIH ( 13.46 Gy,10.25 Gy,9.48 Gy,F =3.627,P =0.038 ;46％,35％,32％,F =2.96,P=0.066;24％,16％,16％,F=3.69,P=0.036;13％,8％,8％,F=4.28,P=0.022;8％,5％,5％,F =2.39,P =0.108 ).The duodenum D5 cm3 of RA in EEH was lower than in FB and EIH (8.78 Gy,19.35 Gy and 11.67 Gy,F =1.56,P =0.224 ).The mean monitor units for 3 DCRT,IMRT,RA was 254.06 MU,626.33 MU and 550.28 MU ( F =147.35,P =0.000 ),while the mean treatment time was 135 s,540 s and 130 s respectively (F =62.83,P =0.000).ConclusionsThe RapidArc applying three 135°arcs with ABC in HCC radiotherapy can achieve better PTV coverage than IMRT with fewer monitor units,shorter treatment time and sparing more normal liver.
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ObjectiveTo explore the feasibility,efficacy and cosmetic effect of three-dimensional conformal external beam partial breast irradiation (EB-PBI) after breast-conserving surgery for the selected Chinese early stage breast cancer patients.MethodsFrom June 2003 to December 2010,Forty-four early stage breast cancer patients underwent EB-PBI after breast-conserving surgery.Twenty patients had CT simulation scan in moderate deep inspiration breathing hold,and twenty-four patients in free breathing.EB-PBI was planned and delivered by three-dimensional conformal radiotherapy (3DCRT)with four noncoplanar beams.The prescribed dose was 3.40 Gy per fraction in thirty-nine patients and 3.85 Gy per fraction in five patients,twice per day at an interval of at least six hours,in five consecutive days.Results The number of patients with follow up time of 2,3 and 5 years were 39,31 and 16.Grade 1 acute radiationinduced dermatitis was observed in 17 patients (39％) at three months.Cosmesis was good or excellent in all cases at six months after radiotherapy and in 95％ cases at two years after radiotherapy.The 2-,3-and 5-year local control rates were 100％,99％ and 94％,respectively.The 2-,3-,and 5-year survival rates were all 100％ and no metastases occurred.Conclusions EB-PBI delivered by 3DCRT is feasible for selected Chinese early stage breast cancer patients after breast-conserving surgery.The cosmetic effect,local control rate and long-term survival rate are satisfactory,and acute radiation toxicity is very low.
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Objective To analyze the efficacy,complications and prognostic factors of three-dimensional conformal radiotherapy(3 DCRT)for locally advanced non-small cell lung cancer(NSCLC).Methods 56 patients who were treated either by radiotherapy alone(14 patients)or radiotherapy plus chemotherapy(42 patients)from Jan.2005 to Feb.2008 were enrolled.The patient cohort consisted of 36 men and 20 women,median age 62,median total dose 60 Gy.Results The following-up rate was 96%.The number of patients completed follow-up were 14 and 10,respectively at 3-year and 5-year.The response rate of 3DCRT was 70%.with complete mmission 9%and partial remission 61%.The 1-、3-、and 5-.year survival rates were 62%、25% and 17%,respectively,and the median survival time(MST)was 20 months.By logrank test,clinical stage,KPS perfomance,tumor volume,radiation dose,treatment regimen and response to treatment showed statistically dramatic impact on overall survival.By Cox muhivariable regression,the independent adverse prognostic factors by both univariate analysis and multivariate analysis were clinical stage,treatment type,and response to treatment.Grade 2 acute radiation pneumonitis was observed in 1 patient and grade 3 in 1 patient.Late grade 2 lung injury developed in 1 patient,and grade 3 in 1 patient.Acute grade 1 radiation esophagitis were observed in 20 patients.and above Grade 2 in 5patients.Acute grade 1+2 hematologic toxicity developed in 15 patients,and above Grade 2 developed in 4 patients.Conclusions 3 DCRT was feasible in the treatment of locally advanced NSCLC with acceptable normal tissue toxicity.Relative early stage.radio-chemotherapy with total radiation dosage≥60 Gy and good immediate tumor response are favorable prognostic factors for overall survival.
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Objective To study the short-term curative effects and side effects of the three-dimensional conformal radiotherapy combined with chemotherapy in advanced esophageal cancer in Xinjiang provenience.Methods One hundred and twelve cases were divided into Kazak and Han nationality group according to the different nations.Chemotherapy was DF regime:5-Fu 1000 ms/m2+DDP 20 mg/m2,d1-4,21 days as a cycle,total 4-6 cycles.For both groups,3DCRT was carried out by conventional fractionation with total dose of 60-66 Gy/30-33frin 6-7w.Results The following-up rate was 100%.The number of pailents followed up at two years wero 23 and 27 in Kazak and Han nationality group,respectively.The immediate effective rates(CR(complete remission)+PR(partial remission))were 77%(34/44)and 85%(58/68)in ban and kazak group,respectively(X2=4.89,P=0.180).The 1-and 2-year survival rate were 75%,59%and 52%,40%(X2=1.71,P=0.191)in Kazak and Han group,respectively.The 3-4grade radioesophagitis were 5%(2/44)and 7%(5/68)in kazak group and han group,respectively(X2=1.66,P=0.435).The 3-4 grade radiopneumonia were 2%(1/44)and 1%(1/68)in kazak group and ban group,respectively(X2=0.99,P=0.608).The 3-4 grade haematolosical toxicity were9%(4/44) and 29%(20/68 in kazak and in han group,respectively(X2=6.57,P=0.037).Conclusions There was no significant difference in short-term curative effects between patients from han and kazak nationality with advanced carcinoma of esophagus who received the three-dimensional conformal radiotherapy combined with chemotherapy.but Kazak people showed better tolerance.
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Objective To analyze the therapeutic efficacy and treatment related toxicities for patients with locally advanced cervical cancer treated with three-dimensional conformal radiotherapy (3DCRT) combined with concurrent chemotherapy. Methods From January 2007 to February 2008, 181 patients with stage ⅡA-ⅣA cervical cancer were retrospectively analyzed. All patients were treated with CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent weekly cisplatin-based chemotherapy. The median age was 50 years (range, 32 to 82 years). The overall survival ( OS), disease-free survival (DFS) and local control (LC) rates were calcalated by Kaplan-Meier method and the difference was compared using Log-rank test. The treatment related toxicities were evaluated according to Radiotherapy Oncology Group (RTOG) criteria. Results With a median follow-up time of 34 months and following rate of 92. 2%, the 3-year OS, DFS and LC rates were 73.4%, 70. 4% and 91.3%,respectively. The 3-year OS rate was 66. 9% for patients with tumor diameter ≥4 cm and 86. 4% for those with tumor diameter ＜4 cm( χ2 =6. 29 ,P =0. 012). The incidences of grade 1 and grade 2 acute toxicities of the lower gastrointestinal tract and the genitourinary system were 40. 0% ,45.0% and 19. 9% ,4. 4%,retrospectively. There were no grade 3 or more acute toxicities. The incidence of grades 3 or 4 late toxicities of the lower gastrointestinal tract was 4. 9%. Conclusions CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent chemotherapy can achieve good therapeutic effects for locally advanced cervical cancer. The acute and late toxicities are significantly reduced compared with historic controls as a result of incorporation of 3DCRT technique.
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Objective To observe the incidence of RP in NSCLC and esophageal carcinoma treated with 3DCRT and investigate the relationship between acute RP and lung function and dosimetric parameters.Methods From October 2006 to August 2008, 3DCRT plus concurrent chemotherapy of NP or LFP were applied to 64 patients with locally advanced NSCLC or esophageal carcinoma. twenty-three patients suffered form NSCLC and 41 patients from esophageal carcinoma, the prescription doses were 60 Gy/30fx and 58 -64 Gy/29 -32fx, respectively. Results For patients with esophageal carcinoma, 34% developed RP(9 grade 1,3 grade 2 and 2 grade 3). For patients with NSCLC, 96% developed RP(9 grade 1, 8 grade 2 and 5 grade 3). There was significant difference between the two groups(t =5. 55,P=0. 000). The FEV1.0/FVC and DLCO of patients with NSCLC were significantly lower than those of esophageal carcinoma, the ratio were 75.6%:82.7%(t=2.75,P=0.008)and 71.7%:81.0%(t=2.50, P=0.015),respectively. For patients whose FEV1.0, FEV1.0/FVC%, DLCO ＜80% and ≥80% before irradiation,the incidence of ≥2grade ARP were 35% vs 25% ,31% vs 26% and 35% vs 19%, respectively(x2 = 1.81,0.15,2. 13,P =0.179,0.697,0.144). While for patients whose FEV1.0 ＜ 70% and ≥70%, the incidence of severe ARP were 67% and 22% ,respectively(x2 =5.64, P =0.018). Spearman correlated analysis indicated that all the dosimetric parameters had relation with ≥ 2 grade ARP . The V20 of lung and MLD were found independently associated with RP according to multivariate analysis(x2 = 4.61,6.97, P = 0.032,0.008).Conclusions Parameters of basic lung function can predict the incidence of ≥2 grade RP to some extent,especially when the value of FEV1.0, FEV1.0/FVC%, and DLCO was lower. However, the V20 of lung and MLD may be the most valuable predictors.
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ObjectiveTo investigate prognostic factors in Stage Ⅲ non-small cell lung cancer (NSCLC)treated with definitive radiation therapy (RT) with PET-CT-based radiotherapy planning. MethodsFifty nine patients with Stage Ⅲ NSCLC treated with radiation therapy of 60 Gy or more were enrolled into this study.The impact of prognostic factors on survival was evaluated by univariate and multivariate analyses. Results The following-up rate was 98％.Nineteen patients completed 2 years' followed-up. The overall l-year and 2-year survival rate was 66％ and 37％, respectively, with a median survival time of 17 months. At a univariate analysis, cigarette smoking status, T stage, radiation dose, the standardized uptake value, the gross tumor volume and clinical stage were significant prognostic factors ( x2 =7.46,7. 52,8.37,4. 97,5.82,4. 37, P =0. 006,0. 006,0. 004,0. 026,0. 016,0. 037, respectively ).At multivariate analyses, cigarette smoking status, radiation dose, gross tumor volume and clinical stage were significant prognostic factors ( x2 =6. 20, 9. 69, 6. 39, 10. 09, P =0. 013,0. 002, 0. 011,0. 001,respectively). Conclusions Cigarette smoking status, radiation dose, gross tumor volume and clinical stage are significant prognostic factors on survival in patients with Stage Ⅲ NSCLC treated with RT based on PET-CT radiotherapy planning.
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Objective To investigate the positioning errors of head and neck during intensity-modulated radiation therapy of nasopharyngeal carcinoma.Methods Nineteen patients with middle-advanced nasopharyngeal carcinoma (T2-4N1-3M0), treated by intensity-modulated radiation therapy, underwent repeated CT during their 6-week treatment course.All the patients were immobilized by head-neck-shoulder thermoplastic mask.We evaluated their anatomic landmark coordinated in a total of 66 repeated CT data sets and respective x, y, z shifts relative to their position in the planning CT.ResultsThe positioning error of the neck was 2.44 mm±2.24 mm,2.05 mm±1.42 mm,1.83 mm±1.53 mm in x, y, z respectively.And that of the head was 1.05 mm±0.87 mm,1.23 mm±1.05 mm,1.17 mm±1.55 mm respectively.The positioning error between neck and head have respectively statistical difference (t=-6.58,-5.28,-3.42,P=0.000,0.000,0.001).The system error of the neck was 2.33,1.67 and 1.56 higher than that of the head, respectively in left-right, vertical and head-foot directions;and the random error of neck was 2.57,1.34 and 0.99 higher than that of head respectively.Conclusions In the process of the intensity-modulated radiation therapy of nasopharyngeal carcinoma, with the immobilization by head-neck-shoulder thermoplastic mask, the positioning error of neck is higher than that of head.
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Objective To investigate the result and side effect of late course accelerated three-di-mensional conformal radiotherapy (3DCRT) for esophageal carcinoma. Methods From July 2003 to March 2006, 55 patients with esophageal carcinoma receiving 3DCRT were randomly divided into late course accel-erated radiation group (group A, 27 patients) and conventional fractionation group (group B, 28 patients). The prescribed dose in group B was 64 -66 Gy, 2 Gy per fraction, 1 fraction per day, 5 fractions per week for about 6.5 weeks. Patients in group A received conventional fractionation irradiation for the first 4 weeks. Then the dose was increased to 3 Gy per fraction to a total dose of 67 -70 Gy. The treatment course in group A was about 6 weeks. The treatment response, acute site effects, 1-, 3-and 5-year local control rates and o-verall survival rates of the two groups were observed. Results In group A, 23 patients (85%) achievedcomplete response (CR) and 4(15%) achieved partial response (PR). While in group B, 16 patients (57%) achieved CR and 12(43%) achieved PR. The CR rate was significant higher in group A (χ~2 = 5.24,P=0.022). The 1-, 3-, 5-year local control rates were 85%, 54%, 54% in group A, and 70%, 56%, 33 % in group B (χ~2 = 0.68, P = 0.409), respectively. The 1 -,3-,5-year overall survival rates of the two groups were 81%, 37%, 29% and 61%, 39%, 23% (χ~2 = 0.06, P = O. 804), respectively. Both lo-cal control and overall survival were similar between the two groups. The incidences of acute radiation esoph-agitis in the two groups were similar (85% vs. 89% ;χ~2 =0. 00,P=0. 959), and the incidence of radiation pneumonitis was slightly higher in group A than in group B (67% vs 43% ;χ~2 =3.14,P =0.076). By the last follow up, 19 patients in group A and 21 in group B died. Among them, 10 in group A and 15 in group B died of local failure, while 7 in group A and 5 in group B died of metastasis. Conclusions When com-pared with conventional fractionation 3DCRT, late course accelerated 3DCRT for esophageal carcinoma can achieve better results in clinical response, though not in long-term local control or survival. The incidence of acute radiation esophagitis and pneumonitis is clinically acceptable.
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Objective To evaluate the feasibility, therapeutic effects and normal tissue complications of three-dimensional conformal radiotherapy (3DCRT) for loco-regionally recurrent esophageal cancer after initial radiotherapy. Methods Between March 2001 and May 2007, 42 patients with loco-reigonal recurrent esophageal cancer after initial radiotherapy were treated with 3DCRT, including 27 male and 15 female with a median age of 67.5 years. Radiotherapy was delivered at 1.8 -2.0 Gy per fraction, 5 fractions per week, with a median total dose of 54 Gy. Treatment outcomes and normal tissue complications were assessed with WHO and RTOG/EORTC criteria. Results By December 31,2008, the follow-up rate was 100%. Twenty patients had follow-up time of 1 year and the remaining 22 had 2 years. The clinical symptom relief rate was 60%, and the response rate was 90.5% with a complete remission rate of 17% and partial remission rate of 74%. The overall 1- and 2-year survival (OS) rates were 60% and 24%. Grade 2 and grade 3 acute radiation esophagitis developed in 31% and 5% of the patients, respectively. Grade 2 and grade 3 acute radiation pneumonitis developed in 19% and 2% , respectively. Grade 2 and grade 3 acute radiation hematology toxicities developed in 5% and 2%, respectively. Conclusions For patients with loco-regional recurrences of esophageal cancer after initial radiotherapy, 3DCRT is feasible, with a good clinical symptom relief rate and immediate tumor response. However,the complication rate was high and the clinical indications should be strictly controlled.