ABSTRACT
SUMMARY: The aim of this study was to assess if the entire mediastinum (M), the bilateral supraclavicular area (S), and the left gastric area (L) should be all included in the irradiation volume. The clinical data of 204 patients with thoracic esophageal squamous cell carcinoma who had undergone prophylactic postoperative radiotherapy after radical surgery were retrospectively reviewed. They were classified into four groups: group A, 26 patients with irradiated M alone; group B, 139 patients with irradiated M + S; group C, 10 patients with irradiated M + L; and group D, 29 patients with irradiated M + S + L. The 5-year disease-free survival rates were 36% in group A, 31% in group B, 40% in group C and 44% in group D (chi2=3.05, P =0.39), respectively. Multivariate analysis revealed that the irradiated extent was not a significant influential factor (hazard ratio=0.84, 95% confidence interval, 0.69-1.03, P =0.10). None of 43 patients without the L irradiated and with disease in the upper and middle upper thirds (defined in middle third but with upper third invaded), and one of 83 patients without the L irradiated and with disease in the middle third only thoracic esophagus were shown to have abdominal lymph node metastasis. Supraclavicular lymph node metastasis in patients in the lower and middle lower thirds (defined in middle third but with lower third invaded) were, respectively, 1/43 and 1/18 whether the S was irradiated or not. It seems unnecessary that the L be irradiated when the primary site is in the upper, middle, and middle upper thirds of the thoracic esophagus after radical surgery. Similarly, S may be unnecessarily irradiated in the lower and middle lower thirds.
Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Esophageal Neoplasms/radiotherapy , Esophagectomy/methods , Adult , Aged , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/secondary , Carcinoma, Squamous Cell/surgery , Cohort Studies , Confidence Intervals , Disease-Free Survival , Esophageal Neoplasms/mortality , Esophageal Neoplasms/pathology , Esophageal Neoplasms/surgery , Female , Humans , Immunohistochemistry , Lymphatic Metastasis , Male , Middle Aged , Multivariate Analysis , Neoplasm Recurrence, Local/prevention & control , Neoplasm Staging , Postoperative Care/methods , Primary Prevention/methods , Probability , Prognosis , Proportional Hazards Models , Radiotherapy Dosage , Radiotherapy, Adjuvant , Retrospective Studies , Risk Assessment , Survival Rate , ThoraxABSTRACT
Perinatal asphyxia is one of the major causes of cerebral injury in neonates. It may be due to the increased endogenous opioid-like substances (OLS) in the body. The levels of three OLS, namely leucine-enkephalin (LEK), beta-endorphin (beta-EP) and dynorphin A1-13 (DynoA1-13) of 44 cases with neonatal asphyxia were studied by radioimmunoassay. The OLS level in plasma and cerebral spinal fluid (CSF) were higher in asphyxiated group than those in the control group, especially in asphyxiated cases with fetal distress. The OLS levels of CSF were also higher in cases with cerebral injury than in those without cerebral injury, while the levels of OLS in plasma had no difference in these two groups. The relationship between OLS levels and asphyxia and cerebral injury is also discussed.
