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Objective To evaluate the tolerance of preoperative neoadjuvant chemoradiotherapy (neoCRT) plus esophagectomy, as well as the short-term outcome, tumor resection rate, incidence of postoperative complications, and perioperative mortality, in patients with locally advanced esophageal cancer.Methods This study included 74 patients with thoracic esophageal cancer who were admitted to our hospital from May 2011 to June 2015.Chemotherapy and radiotherapy were performed concurrently.The chemotherapy consisted of vinorelbine (25 mg/m2 on days 1, 8, 22, and 29) and cisplatin (25 mg/m2 on days 1-4 and 22-25).The radiotherapy was conventionally fractionated with a total dose of 40 Gy (2.0 Gy/d).At 4-8 weeks after chemoradiotherapy, esophagectomy was performed (neoCRT+surgery group);definitive chemoradiotherapy (DCRT) was performed in the patients who refused surgery (DCRT group);follow-up was performed in the patients who refused any anti-cancer therapies after neoCRT (neoCRT group).Results Forty-four patients underwent neoCRT+surgery, with a radical resection (R0) rate of 100% and a pathological complete response (pCR) rate of 43%;17 patients received DCRT;13 patients received neoCRT alone.For the neoCRT+surgery group, DCRT group, and neoCRT group, the 2-year overall survival (OS) rates were 79%, 75%, and 17%, respectively, and the 2-year disease-free survival (DSF) rates were 75%, 55%, and 17%, respectively.There were significant differences in OS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.001), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.415).There were significant differences in DFS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.002), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.416).The rate of clinical response to preoperative neoCRT was 87% for all patients.Fifty-six patients (76%) developed grade ≥3 myelosuppression due to preoperative neoCRT.The incidence rates of postoperative pulmonary infection, anastomotic leakage, and anastomotic stenosis were 21%, 12%, and 7%, respectively, and the perioperative mortality rate was 2%.Conclusions For patients with locally advanced esophageal cancer, preoperative neoCRT plus surgery can increase the clinical response rate and pCR rate, reduce the tumor stage, and improve the survival, but chemoradiotherapy toxicities and perioperative complications cannot be ignored.
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Objective To observe the effect of different periodontal therapies on serum levels of tumor necrosis factor-alpha (TNF-α),interleukin-6(IL-6)and C-reactive protein (CRP)in elderly patients with coronary.Methods Totally 90 elderly patients with severe periodontitis were divided into three groups,the control group performed the treatment of coronary heart disease;the periodontal treatment group performed the treatment of coronary heart disease and periodontal treatment;the combine group per-formed periodontal therapy and flap surgery on the basis of the treatment of coronary heart disease.The obvervational index were compared among three groups.Results All patients′clinical indexes of periodontitis of combination group and basic group has im-proved after treatment,the levels of PD,SBI,CAL,PLI,the percentage of bleeding on probing and probing depth were significantly decreased (P <0.05),and had significant adhesion(P <0.05);the contrast between combination group and basic group,the levels of PD,SBI,CAL,the percentage of bleeding on probing and probing depth had notable difference(P <0.05).All patients′clinical indexes of periodontitis of combination group and basic group had improved after treatment,serum levels of TNF-α,IL-6 and CRP were significantly decreased (P <0.05);the contrast between combination group and basic group,serum levels of TNF-α,IL-6 and CRP have notable difference (P <0.05).Conclusion The periodontal basic therapy and periodontal flap therapy can reduce the ser-um levels of TNF-α,IL-6 and CRP of elderly coronary heart disease (CHD),but compared to the routine medicine maintenance therapy,the effect of periodontal flap therapy is better.