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Objective:To explore the efficacy and prognostic factors of intensity-modulated radiotherapy (IMRT) in elderly patients with locally advanced esophageal cancer.Methods:The clinical data of 87 elderly patients with locally advanced esophageal cancer who received IMRT and 79 elderly patients with locally advanced esophageal cancer who received three-dimensional conformal radiotherapy (3DCRT) from January 2005 to December 2015 in Changzhou Cancer Hospital Affiliated to Soochow University were retrospectively analyzed, and their efficacy and adverse reactions were observed. The log-rank test and Cox proportional hazards model were used for univariate and multivariate analyses to analyze the prognostic factors of patients receiving IMRT.Results:In the IMRT group, 27 cases (31.0%) achieved complete remission, and 60 cases (69.0%) achieved partial remission; in the 3DCRT group, 18 cases (22.8%) achieved complete remission, and 61 cases (77.2%) achieved partial remission. There was no statistical difference in the short-term efficacy (CR+PR) between the two groups ( χ2 = 1.43, P = 0.232). The 1-, 3-, and 5-year overall survival rates in the IMRT group were 77.0%, 46.0% and 23.0%, respectively, and the 3DCRT group were 70.1%, 40.5% and 10.1%, respectively. There was a statistical difference in the overall survival between the two groups ( χ2 = 4.89, P = 0.027). For elderly patients with locally advanced esophageal cancer who received IMRT, univariate analysis showed that gender, lesion location, T stage, gross tumor volume, and short-term efficacy were prognostic factors (all P < 0.05); multivariate analysis showed that lesion location, T stage, gross tumor volume, and short-term efficacy were independent prognostic factors (all P < 0.05). In the IMRT group, the incidence rate of ≥ grade 2 radiation pneumonitis was 10.3% (9/87), the incidence rate of ≥ grade 2 radiation esophagitis was 32.2% (28/87), the incidence rate of leukopenia was 18.4% (16/87), and the incidence rate of hemoglobin reduction was 7.0% (6/87), and there was no statistical difference in the incidence of acute adverse reactions between the IMRT group and the 3DCRT group (all P > 0.05). Conclusions:IMRT has more advantages than 3DCRT in the treatment of elderly patients with locally advanced esophageal cancer, especially those with upper cervical and thoracic lesion, T 1-3 stage, gross tumor volume ≤40 cm 3, and complete remission in a short term can benefit from it, and the adverse reactions are mild.
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Objective@#To analyze the clinical features of inpatients infected with influenza A virus, and then to provide evidence for the diagnosis, treatment and prevention of influenza A in primary hospital.@*Methods@#The clinical data of inpatients with influenza A in one district hospital from Dec 2016 to Mar 2017 were collected to analyze retrospectively.@*Results@#A total of 21 665 patients were admitted to hospital from Dec 2016 to Mar 2017. Among them 647 flu-like cases accepted influenza A nucleic acid detection, and 203 cases were positive, the positive rate was 31.4%. The median age of influenza A positive patients was 64.25 years, and 20.2% were 0 to 4 years, 49.26% were 65 years of age or older. 58.13% patients had at least one underlying medical condition. Fever, Cough and Sputum were the most symptoms of patients infected with influenza A. Compared with the patients under 60 years old, non-fever symptoms were more common in those 60 years or older, the difference was statistically significant (χ2=15.43, P<0.001). Laboratory examination indicated that lymphocytopenia were detected in 54.27% of patients, and increased level of C-reactive protein and procalcitonin (PCT) in 74.83% and 11.76% of patients respectively. Moreover, 75.58% of patients had high erythrocyte sedimentation rate (ESR), 8 patients (97.3%) had findings consistent with pneumonia. 78.33% of patients received anti-viral treatment with oseltamivir, the rate of antibiotic utilization was as high as 85.22%. The median of hospitalization expense of patients infected with influenza A was 4 280 (interquartile range 2 792-9 565) yuan, and the cost of inpatients who had combined underlying diseases were higher than that in inpatients who had no coexisting medical conditions, the difference was statistically significant (Z=7.106, P<0.01). No death occurred in this study.@*Conclusions@#Children and old people were at high risk for influenza A infection. Fever, cough and lymphocytopenia were the common clinical features of patients infected with influenza A. It is especially noteworthy for the patients who were 60 years of age or older with flu-like symptoms but without fever, or the patients who had one or more underlying medical conditions, and such patients should receive influenza virus nucleic acid tests as early as possible.