Equivalent prognosis with no lymph node metastasis to pathological complete remission in patients with localized advanced esophageal cancer after neoadjuvant triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by curative surgery: a single-center retrospective cohort study.

Background: Adjuvant nivolumab therapy has become the standard therapy for patients with localized advanced esophageal cancer with non-pathological complete response after neoadjuvant chemoradiotherapy followed by curative surgery. However, the necessity of this therapy for patients after neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin, and 5-fluorouracil (DCF) regimen followed by surgery is unclear, and the prognosis of grouping based on the presence or absence of pathological tumor and lymph node findings has not been analyzed. Therefore, our study aimed to address these questions. Methods: This retrospective cohort study included patients with cT1N1-3M0 and cT2-3N0-3M0 esophageal cancer according to the Japanese Classification of Esophageal Cancer, 11th edition, who received NAC with DCF followed by curative surgery between 2008 and 2020 at Jichi Medical University Hospital. We divided patients with ypT0-3N0-3M0 into four histological groups, namely ypT0N0, ypT+N0, ypT0N+, and ypT+N+, and we evaluated overall survival as the primary outcome and the prognostic relationship of lymph node metastasis as the secondary outcome. Results: A total of 101 patients were included in this study. Kaplan-Meier analysis showed that the curves of the ypT0N0 and ypT+N0 groups were almost identical, while they differed from the other two groups. The hazard ratio of ypN+ was 4.44 (95% confidence interval: 2.03-9.71; P<0.001). Conclusions: The prognosis of the ypT+N0 group after NAC with DCF followed by surgery was similar to that of pathological complete remission. Grouping patients according to pathological lymph node status is a reasonable predictor of prognosis.

Totally Robotic Esophagectomy.

Totally robotic esophagectomy is performed using a robotic technique without additional thoracoscopy or laparoscopy. However, most robotic esophagectomies are currently performed in a hybrid form combining robotic and other endoscopic techniques. Laparoscopic stomach mobilization and thoracoscopic esophagogastric anastomosis are commonly used methods in robotic esophagectomy. In this paper, totally robotic esophagectomy without thoracoscopic or laparoscopic assistance is presented.

Evaluation of combination of multiple MRI sequences in the differential diagnosis of esophagus cancer / 中华放射学杂志

Objective@#To evaluate the role of combination of multiple MRI sequences in the differential diagnosis of esophagus cancer and to assess the accordance among radiologists with different experience.@*Methods@#Thirty-fifty patients underwent conventional MRI including T2 weighted (T2) sequences, gadolinium fat-suppressed T1 weighted sequences (post-contrast T1), and DWI sequences. Three radiologists with different experience determined the possibility of local recurrence (LR) on T2, T2+post-contrast T1, T2+DWI, and T2+post-contrast T1+DWI. ROC and Kappa were used.@*Results@#In total, 13 patients had LR. On T2WI, the ROC curve (AUC) achieved by the senior,intermediate and junior groups were 0.701,0.407,and 0.584, respectively.Compared with simple T2WI sequences, DWI and T1 Gd significantly improved the AUC value for the intermediate radiologist. The great difference was observed between radiologists of different experience (Kappa coefficient was from 0.227 to 0.884). Combination of multiple sequences significantly reduced the diagnostic differences between radiologists with different experience for the senior radiologists particularly.@*Conclusions@#The addition of DWI and T1 post-contrast MRI increased diagnostic ability for LR of esophagus cancer and reduced the diagnostic differences between radiologists with different experience compared to T2WI.

Evaluation of combination of multiple MRI sequences in the differential diagnosis of esophagus cancer / 中华放射学杂志

Objective To evaluate the role of combination of multiple MRI sequences in the differential diagnosis of esophagus cancer and to assess the accordance among radiologists with different experience. Methods Thirty?fifty patients underwent conventional MRI including T2 weighted (T2) sequences, gadolinium fat?suppressed T1 weighted sequences (post?contrast T1), and DWI sequences. Three radiologists with different experience determined the possibility of local recurrence (LR) on T2, T2+post?contrast T1, T2+DWI, and T2+post?contrast T1+DWI. ROC and Kappa were used. Results In total, 13 patients had LR. On T2WI, the ROC curve (AUC) achieved by the senior,intermediate and junior groups were 0.701, 0.407, and 0.584, respectively. Compared with simple T2WI sequences, DWI and T1 Gd significantly improved the AUC value for the intermediate radiologist. The great difference was observed between radiologists of different experience (Kappa coefficient was from 0.227 to 0.884). Combination of multiple sequences significantly reduced the diagnostic differences between radiologists with different experience for the senior radiologists particularly. Conclusions The addition of DWI and T1 post?contrast MRI increased diagnostic ability for LR of esophagus cancer and reduced the diagnostic differences between radiologists with different experience compared to T2WI.

Analysis of endoscopic screening for upper digestive tract cancer in Danzhou from 2015 to 2017

Objective: To analyze and evaluate the results of endoscopic screening for upper digestive cancer in Danzhou city of Hainan, China. Methods: Totally 300 8 subjects aged from 40 to 69 years old were selected by cluster sampling method for screening of upper digestive tract cancer in Danzhou from 2015 to 2017. Results: In total, 13 cases (0.43%) of high grade intraepithelial neoplasia and cancer were detected. The detection rate of esophageal cancer, cardia cancer and gastric cancer was 0.07% (2 cases), 0.07% (2 cases) and 0.30% (9 cases), respectively. The diagnosis rate of early cancer was 92.31% (12 cases) and the treatment rate was 46.15% (6 cases). Conclusion: Endoscopic Screening is an effective way to detect precancerous lesions and early cancer. The detection rate in Danzhou is lower than the national average. Improving the professional and management ability of screening project team, mastering the incidence and mortality trend of upper digestive tract cancer, is key to the implementation and evaluation of the project of early diagnosis and treatment of upper digestive tract cancer.

Clinical sensitization effect of celecoxib in the radiotherapy and chemotherapy of patients with esophagus neoplasms / 中国基层医药

Objective To discuss the sensitization effect of celecoxib in the radiotherapy and chemotherapy of patients with esophageal cancer,and its clinical application value.Methods According to the digital table,60 patients with esophageal cancer were randomly divided into observation group and control group,30 cases in ecah group.The control group was given conventional radiation and chemotherapy,the observation group received combination with celecoxib for radiotherapy sensitization.The clinical effect was compared between the two groups.Results The total effective rate of the observation group was 46.67％ (14/30),which was higher than 20.00％ (6/30) of the control group,the difference between the two groups was statistically significant (x2 =4.343,P ＜ 0.05).In the observation group,radioactive pneumonia occurred in 1 case,radioactive esophagitis in 2 cases,radioactive myocarditis in 1 case.In the control group,radioactive pneumonia occurred in 2 cases,radioactive esophagitis in 1 case,radioactive myocarditis in 2 cases,the differences between the two groups were statistically significant (x2 =0.350,0.350,0.350,all P ＞0.05).In the observation group,7 cases occurred nausea and vomiting,diarrhea in 1 case,bone marrow suppression in 5 cases,renal toxicity in 2 cases.In the control group,8 cases had nausea and vomiting,diarrhea happened in 2 cases,bone marrow suppression in 3 cases,renal toxicity in 1 case,there were no statistically significant differences between the two groups (x2 =0.088,0.350,0.576,0.350,all P ＞ 0.05).Conclusion Application of celecoxib in patients with esophageal cancer during the process of radiation and chemotherapy has sensitization effect,it can promote the esophageal cancer treatment effect,without increase in adverse reactions,it is worthy of popularization and application in clinic.

[Comparison of the effect of lymph node dissection performed by Ivor-Lewis or left-sided thoracic esophagogastrectomy for Siewert type â ¡ adenocarcinoma of the esophagogastric junction].

Objective: To compare the extent of lymphadenectomy and postoperative complications between Ivor-Lewis procedure and left sided thoracotomy in patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG). Methods: The clinical data of 101 patients with Siewert type Ⅱ EG who received surgical treatment between January 2014 and September 2015 in the Department of Esophageal Cancer, Tianjin Medical University Cancer Hospital were analyzed retrospectively. These patients were divided into Ivor-Lewis group (IL, n=38) and left- sided thoracotomy group (LT, n=63) according to the operation mode. The number and extent of dissected lymph nodes and postoperative complications were compared between the two groups. Results: The surgical blood loss, length of postoperative stay, anastomotic leakage, pulmonary infection, respiratory failure and complications of incision of the two groups showed no significant differences (P>0.05 of all). The operation time of IL group was 200 min, significantly longer than the LT group (120 min, P<0.05). The number of resected lymph nodes in the IL and LT groups were (20±9) and (13±7), respectively, with a statistically significant difference (P<0.001). Significantly more thoracic lymph nodes (7±5) were harvested in the IL group than in the LT group (2±2, P<0.001), and the number of resected abdominal lymph nodes in the IL and LT groups were (13±8) and (11±7), with a non-significant difference (P=0.157). As regarding the lymph node dissection rate, the IL approach was obviously better than the LT approach in the following lymph node stations: superior mediastinal nodes, subcarinal nodes, left hilar nodes, right hilar nodes, middle thoracic paraesophageal nodes, lower thoracic paraesophageal nodes, lymph nodes along the common hepatic artery, and lymph nodes along the splenic artery(P<0.05 for all). Conclusions: The Ivor-Lewis procedure achieves better thoracic and abdominal lymph node dissection, and does not cause more postoperative complications than the left-sided thoracotomy in patients with Siewert type Ⅱ AEG. However, these findings need to be confirmed by large-scale randomized clinical trial in the future.

Comparison of the effect of lymph node dissection performed by Ivor-Lewis or left-sided thoracic esophagogastrectomy for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction / 中华肿瘤杂志

Objective@#To compare the extent of lymphadenectomy and postoperative complications between Ivor-Lewis procedure and left sided thoracotomy in patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG).@*Methods@#The clinical data of 101 patients with Siewert type Ⅱ EG who received surgical treatment between January 2014 and September 2015 in the Department of Esophageal Cancer, Tianjin Medical University Cancer Hospital were analyzed retrospectively. These patients were divided into Ivor-Lewis group (IL, n=38) and left- sided thoracotomy group (LT, n=63) according to the operation mode. The number and extent of dissected lymph nodes and postoperative complications were compared between the two groups.@*Results@#The surgical blood loss, length of postoperative stay, anastomotic leakage, pulmonary infection, respiratory failure and complications of incision of the two groups showed no significant differences (P>0.05 of all). The operation time of IL group was 200 min, significantly longer than the LT group (120 min, P<0.05). The number of resected lymph nodes in the IL and LT groups were (20±9) and (13±7), respectively, with a statistically significant difference (P<0.001). Significantly more thoracic lymph nodes (7±5) were harvested in the IL group than in the LT group (2±2, P<0.001), and the number of resected abdominal lymph nodes in the IL and LT groups were (13±8) and (11±7), with a non-significant difference (P=0.157). As regarding the lymph node dissection rate, the IL approach was obviously better than the LT approach in the following lymph node stations: superior mediastinal nodes, subcarinal nodes, left hilar nodes, right hilar nodes, middle thoracic paraesophageal nodes, lower thoracic paraesophageal nodes, lymph nodes along the common hepatic artery, and lymph nodes along the splenic artery(P<0.05 for all).@*Conclusions@#The Ivor-Lewis procedure achieves better thoracic and abdominal lymph node dissection, and does not cause more postoperative complications than the left-sided thoracotomy in patients with Siewert type Ⅱ AEG. However, these findings need to be confirmed by large-scale randomized clinical trial in the future.

MicroRNA let-7 and esophagus cancer / 国际肿瘤学杂志

The discovery of microRNA (miRNA) has opened up a new train of thought for the diagnosis and treatment of esophagus cancer.let-7 is one of the most widely research of miRNA.In a variety of tumors,the expression of let-7 is down-regulated.let-7 can play the role of tumor suppressor gene by targeting to high mobility group A2 (HMGA2) and inhibit the cell proliferation.Recent studies have shown that the lower the degree of differentiation of cells,let-7 expression level is lower.It is expected as a symbol of poorly differentiated tumors.In addition,let-7 and esophagus cancer's radiation and chemotherapy sensitivity are closely related.

[Definition of accurate planning target volume margins for esophageal cancer radiotherapy]. / Détermination des marges du volume cible anatomoclinique au volume cible prévisionnel pour la radiothérapie conformationnelle des cancers de l'œsophage.

More than 4000 cases of esophagus neoplasms are diagnosed every year in France. Radiotherapy, which can be delivered in preoperative or exclusive with a concomitant chemotherapy, plays a central role in treatment of esophagus cancer. Even if efficacy of radiotherapy no longer has to be proved, the prognosis of esophagus cancer remains unfortunately poor with a high recurrence rate. Toxicity of esophageal radiotherapy is correlated with the irradiation volume, and limits dose escalation and local control. Esophagus is a deep thoracic organ, which undergoes cardiac and respiratory motion, making the radiotherapy delivery more difficult and increasing the planning target volume margins. Definition of accurate planning target volume margins, taking into account the esophagus' intrafraction motion and set up margins is very important to be sure to cover the clinical target volume and restrains acute and late radiotoxicity. In this article, based on a review of the literature, we propose planning target volume margins adapted to esophageal radiotherapy.

A clinical study of salvage radiotherapy for supraclavicular lymph node metastasis in patients with esophageal cancer / 中华放射肿瘤学杂志

Objective To evaluate the efficacy of salvage radiotherapy for supraclavicular lymph node metastasis ( SLNM) after initial treatment in patients with esophageal cancer. Methods A total of 117 patients with SLNM after radical resection for esophageal cancer were enrolled as subjects from 2006 to 2012. All patients received three?dimensional radiotherapy with 1. 8?2. 0 Gy per cycle, 5 cycles a week. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The Cox model was used for multivariate analysis. Results The follow?up rate was 100%. In all the patients, the 1?and 3?year overall survival (OS) rates were 38. 5% and 14. 1%, respectively. The 1?and 3?year OS rates were significantly higher in patients treated with salvage radiotherapy or radiochemotherapy ( n=100) than in patients without any salvage treatment (n=17)(42% vs. 18%,P=0. 008;17% vs. 0%, P=0. 008). The patients treated with radiochemotherapy ( n=32) had significantly higher 1?and 3?year OS rates than those treated with radiotherapy alone (n=68)(59% vs. 34%, 36% vs. 11%, P=0. 002) or without any salvage treatment (n=17)(59% vs. 18%, 36% vs. 0%, P=0. 002). Patients without visceral metastasis (n=80) had significantly higher 1?and 3?year OS rates than those with visceral metastasis ( n=37) ( 44% vs. 27%, P=0. 002;22% vs. 0%,P=0. 002) . Patients with supraclavicular doses of ≥60 Gy in salvage radiotherapy ( n=75) had significantly higher 1?and 3?year OS rates than those with supraclavicular doses of<60 Gy in salvage radiotherapy ( n=25) ( 75% vs. 25%,P=0. 000;24% vs. 8%,P=0. 000) . The multivariate analysis using the Cox model showed that supraclavicular doses of ≥60 Gy, mediastinal metastasis, visceral metastasis, and salvage treatment method were independent factors for survival ( P=0. 001,0. 015,0. 009, 0. 025) . Conclusions Salvage radiotherapy can improve the survival of patients with SLNM in esophageal cancer. Salvage radiotherapy or radiochemotherapy is highly recommended for patients with SLNM alone. A radiation dose of ≥60 Gy in salvage radiotherapy improves survival in patients.

Clinical study on postoperative recurrence in patients with pN1 esophageal squamous cell carcinoma.

BACKGROUND: The 7th edition Union for International Cancer Control esophageal cancer staging system has changed the pathological N stage from N0, N1 (the existence state of regional lymph node metastasis) to N0, N1, N2, and N3 (number of regional lymph node metastasis). This study was designed to analyze the influencing factors of early recurrence in patients with pathological N1 stage (pN1 stage) esophageal squamous cell carcinoma (ESCC) after radical esophagectomy. METHOD: A retrospective study of 95 consecutive pN1 stage ESCC patients was conducted. The Cox proportional hazards model was used to determine the independent risk factors for recurrence. RESULTS: Recurrence was recognized in 52 patients (54.7%) within three years after surgery. The median time to tumor recurrence was 14.2 months. Locoregional recurrence was found in 42 patients (44.2%) and hematogenous metastasis in 10 patients (10.5%). Recurrence closely correlated with pT stage, positive lymph node metastasis (LNM) in 2-station and/or 2-field, pathologic stage, intramural metastasis, lymph-vascular invasion, and postoperative adjuvant chemotherapy (χ(2) = 8.853∼65.695, P < 0.05). Cox multivariate analysis showed that pT3-4a stage (odds ratio [OR] = 3.604, P = 0.027), positive LNM in 2-station (OR = 4.834, P = 0.009) or 2-field (OR = 5.689, P = 0.003) and no adjuvant chemotherapy (OR = 1.594, p = 0.048) were independent risk factors for postoperative recurrence. CONCLUSION: Adjuvant chemotherapy might be helpful to reduce the recurrence rate of pN1 patients with thoracic ESCC. Induction therapy could further improve the therapeutic effect of pN1 ESCC with suspected multi-station and/or multi-field LNM.

Clinical efficacy of submucosal tunnel endoscopic resection for upper gastrointestinal muscularis propria submucosal tumors / 中华消化外科杂志

Objective To evaluate the clinical efficacy of submucosal tunnel endoscopic resection (STER) for upper gastrointestinal muscularis propria submucosal tumors (SMTs) with diameter ≥3.5 cm.Methods The clinical data of 14 patients with SMTs≥3.5 cm who were admitted to the Second Xiangya Hospital of Central South University between October 2011 and July 2014 were retrospectively analyzed, including 13 patients with tumor at esophagus and 1 patient with tumor at cardia.All patients underwent STER and the observed indexes included operation tine, tumor location and diameter, results of pathological examination and occurrence of postoperative complications.All patients were followed up regularly at the out-patient department including reexamination of gastroscopy, endoscopic ultrasonography (EUS) and computed tomography (CT) till August 2014.Measurement data with normal distribution were presented as average (range).Results All the 14 patients underwent STER successfully with mean operation time of 83 minutes (range, 60-160 minutes).Fourteen tumors were exited, with 13 located at esophagus and 1 at gastric cardia.En bloc resection was achieved in 13 patients and the tumors were extracted through the tunnel.The tumor in the remaining 1 patient was large with a diameter of 5.3 cm and close to trachea, it was extracted by 2 pieces.The average diameter of 14 tumors extracted was 4.1 cm and postoperative pathological examination confirmed the tumors as leiomyomas.Three patients had postoperative complications, subcutaneous emphysema occurred in 1 patient and retrosternal pain in 1 patient.One patient suffered mucosal laceration and recovered after a metal stent was inserted for 2 weeks.The average duration of postoperative hospital stay was 6.4 days (range, 4.0-8.0 days).All patients were followed up for a median time of 11.5 months (range, 1.0-24.0 months) with no recurrence.Conclusion STER is a safe and effective method for SMTs with diameter≥3.5 cm.

Role of MHC class Ⅰ-related molecules A on NK cells immunotherapy in esophageal cancer patients after operation / 肿瘤研究与临床

Objective To explore the relevance of expression of MHC class Ⅰ-related molecules A (MICA) molecule and NK cells immunotherapy in esophageal cancer patients after operation.To analyze the significance of MICA expression in NK cell immunotherapy.Methods 100 patients of esophageal cancer were divided into 3 group,surgical alone group,MICA negative with NK therapy group (MICA-group) and MICA positive with NK therapy group (MICA+ group).The immunity indicators and tumor markers including the levels of CD3+,CD4+ T cells,ratio of CD4+/CD8+, NK cells,Treg cells,the levels of Th1/Th2/Th17 cytokine,the antibody IgA,IgM,IgG and the tumor markers of CEA,SCC,CA199,CYFRA21-1 were detected before treatment and after treatment 60 days.Results The positives rates of CD3+,CD4+ T cells,NK cells and the ratio of CD4+/CD8+ in peripheral blood from MICA+ patients group were higher than those of before treatment [(68.3±7.6) ％ vs (56.2±4.1) ％,(39.8±8.2) ％ vs (30.8±4.7) ％,(22.2±4.7) ％ vs (18.7±5.5) ％,(1.49±0.30) vs (1.15±0.61),P ＜ 0.05],meanwhile the levels of Treg cells was lower than those of before treatment [(8.1± 4.0) ％ vs (13.4±4.5) ％,P ＜ 0.05].There was no statistical significant difference of positive rate of CD8+ T cells [(26.9±6.2) ％ vs (27.8±7.1) ％,P ＞ 0.05].The levels of Th1 cytokin (IL-2,IFN-γand TNF-α) increased and Th2 cytokin (IL-4,IL-6 and IL-10) decreased after treatment.The level of Th17 cytokine was not different significantly (P ＞ 0.05).The content of IgA,IgM,IgG in MICA+ group were effectively improved after treatment.The tumor markers CEA,SCC,CA199,CYFRA21-1 had no statistically change before and after treatment.Conclusion The results indicate that NK cells immunotherapy can enhance the cellular immunity and humoral immunity of MICA positive esophageal cancer patients after operation.

Clinical observation on three-dimensional conformal radiotherapy combined with concurrent chemotherapy in the treatment of multiple primary carcinoma of esophagus / 肿瘤研究与临床

Objective To analysis of the efficacy and toxicity of multiple primary cancer of esophagus in three-dimensional conformal radiotherapy and concomitant chemotherapy.Methods Fifteen cases of multiple primary carcinoma of esophagus who refused the operation were collected.The Elekta linac 6 MV/10 MV X ray was used to conformal irradiation in three-four coplanar wild,2 Gy/time,1 time/day,5 times/week.The dose to the target area,CTV 40-50 Gy/4-5 weeks,GTV 60 Gy/6 weeks.TP scheme (paclitaxel+cisplatin) was used in the first day and 29th day,three-dimensional conformal radiation therapy initiated in the second day after chemotherapy.Results 1,3 year local control and overall survival were 86.7 ％ (13/15),33.4 ％ (5/15) and 73.3 ％ (11/15),26.6 ％ (4/15).Class 1-2 and class 3-4 acute radiation esophagitis and leukopenia occurred rates were 86.7 ％ (13/15),13.3 ％ (2/15) and 80 ％ (12/15),20 ％ (3/15).Conclusion Radiation therapy is the better treatment method for multiple primary carcinoma of esophagus when proximal lesions located in upper thoracic and cervical high.Toxic and side-effects can be tolerated of three dimensional conformal radiation therapy combined with chemotherapy in the treatment of multiple esophageal cancer.

Comparison of infrared mrker-based positioning system and electronic portal imaging device for the measurement of setup errors / 中华放射肿瘤学杂志

ObjectiveTo measure the setup errors with infrared marker-based positioning system (IM-BPS) and electronic portal imaging device (EPID) for patients with esophageal carcinoma and lung cancer and investigate the accuracy and practicality of IM-BPS. MethodsFrom January 2007 to January 2008, 40 patients with esophageal carcinoma and 27 patients with lung cancer received three-dimensional conformal radiotherapy or intensity-modulated radiotherapy, setup errors during the treatment were measured with IM-BPS and EPID, and the data of setup errors were compared with paired t-test and agreement with x2-test. ResultsIt takes 10 - 12 mins to complete the validating for each patient by EPID) system, while IMBPS system only needs 2 -5 mins. The mean setup errors along x, y and z-axis for patients with esophageal carcinoma measured by IM-BPS and EPID were 3.49 mm, 3. 19 mm, 3.31 mm and 4. 03 mm, 3.41 mm, 3.43 mm, respectively. For the patients with lung cancer, the setup errors were 4. 23 mm, 3.51 mm, 3. 39mm and 4. 85 mm, 3. 53 mm, 3.74 mm, respectively. The difference of setup errors meanured by the two systems was within 1 mm for 65％ esophageal carcinoma patients ( x2 =51.09, P =0. 000), and 55％ lung cancer patients ( x2 =53. 35, P =0. 000).Conclusions The measurement results of setup errors for patients with esophageal carcinoma and lung cancer show that IM-BPS is mostly better than EPID. Though validating for patients can be measured accurately and be well quality controlled, IM-BPS is used easily because of macroscopic, homely,spare time and real-time monitoring.

The predictive value of basic lung function and dosimetric parameters of acute radiation pneumonitis during the treatment of concurrent chemoradiotherapy / 中华放射肿瘤学杂志

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.

Low dose volume of the lung in prediction of acute radiation pneumonitis / 中华放射肿瘤学杂志

Objective To observe the incidence of radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) or esophageal carcinoma treated by three-dimensional conformal radiation therapy (3DCRT), and investigate the predictive value of low dose volume of the lung on RP.Methods From Mar 2005 to Aug 2008, 161 patients with locally advanced NSCLC or esophageal carcinoma received 3DCRT. Fifty-three patients with NSCLC received radiotherapy of 60 Gy/30 -34 fx and concurrent chemotherapy of navelbine plus cisplatin (NP). Among the 108 patients with esophageal carcinoma with prescription doses ranging from 58 Gy/29 fx to 70 Gy/35 fx, 46 and 62 received 3DCRT alone or 3DCRT with concurrent chemotherapy of calcium folinate, 5-Fu and cisplatin (LFP), respectively. Univariate and multivariate analysis and receiver operating characteristics (ROC) curves were performed to assess the correlated factors of RP. Results The follow-up rate was 100%. The rate of RP was 57. 8% (93/161) for all patients, 94% (50/53,including 1 with Grade 4 and 1 with Grade 5) for patients with NSCLC, and 39.8% (43/108, none with Grade 4 and 5) for patients with esophageal carcinoma. The correlative factors included the sex, volume of gross tumor volume (GTV), mean lung dose (MLD), V5, V10, V15, V20, V25 and V30 of normal lung according to Spearman correlative analysis. Univariate analysis showed that all the 9 factors could predict RP. Only V5 and the volume of GTV were found independently associated with Grade 2 or more RP in multivariate analysis. ROC analysis indicated that the cut-off point of the curve was 55% with the area under ROC curve of 0. 684 (P = 0. 000). For the patients with lung V5 ≥ 55% and < 55% ,43% (36/84) and 18% (14/77) developed RP of Grade 2 or more, respectively. Conclusions Dosimetric parameters including MLD, normal tissue complication probability, and V5-V30 could predict RP. V5 may be the most valuable predictor. When V5 exceeds 55%, the probability of RP of grade 2 or more may increase notably. Besides the limitation of MLD, V20 and V30, the volume of low dose region should be also limited to a lower range during treatment planning.

A comparative study on the risks of esophagus-cancer patients among factors as blood relatives,paternal line,matriarchal and different sex / 中华流行病学杂志

Objective In order to provide new clues on the cause of esophagus-cancer through seeking for information among the relatives of esophagus-cancer-patients at high-risk,contrast analysis was carried out to compare the ORs between esophagus-cancer cases and the relatives of the patients.Methods Case-control study was adopted on 720 cases and 720 controls who were kin relatives of the patients.Results (1) Risk of the relatives to the esophagus-cancer-patient group ( 1.34%-2.24% ) was obviously higher than the control group (0.78%-1.21%) (P＜0.01).In 1st grade relatives,the risk of parent' s to the esophagus-cancer patients (6.11% ) was obviously higher than the control group (2.97%) (P＜0.01 ).(2) According to the cascade analysis to the cases of both paternal and matriarchal,lines,results showed that the risks of both the paternal line (0.87%-1.01%) and the matriarchal line (0.50%-0.79%) in the group of esophagus-cancer cases were all obviously higher than the lines in the control groups (0.53%-0.65%) and (0.38%-0.47%).Data also showed that the risk among the male relatives of paternal line (eg:grandfathers',father' s,uncles' etc.) in the group of cases was 2.68% while the matriarchal (eg:grandmother's,mother' s,aunts' etc.) was 1.91%.Both figures were obviously higher than that in the control group (1.50% and 0.92%,P＜0.01 ).Conclusion The risk factor of esophagus cancer of the next generation seemed higher if the father and his brothers or mother and her sisters having had esophagus-cancers.

Single nucleotide polymorphisms in XRCC1 and outcome in esophagus cancer receiving cisplatin based concurrent chemoradiotherapy / 肿瘤研究与临床

Objective To investigate whether the single nucleotide polymorphisms (SNP) in DNA repair gene XRCC1(X-ray repair cross-complementing 1) were associated with the survival of cisplatin based combination concurrent chemoradiotherapy in esophagus cancer. Methods Overall 286 esophagus cancer patients receiving cisplatinum based chemotherapy were investigated. 5' nuclease allelic discrimination assay (TaqMan) and real-time PCR were taken to assess XRCC1 genotypes. Efficacies and adverse-effects were analyzed individually according to their genotype. Results Short-time effects showed the RR rate in patients with Arg/Arg and Arg/GIn genotypes(A group) was 93.56 %, significantly higher than 69.81% (P<0.05) in patients with GIn/GIn genotype (B group). The 1-year and 3-year survival rates were 82.8 %, 41.2 % in A group, significantly (P<0.05) different from 58.5 %, 26.4 % in B group, respectively. No statistically differences were found on adverse effects. Conclusion Significant relationships are found between single nucleotide polymorphisms in XRCC1 and outcome in esophagus cancer receiving cisplatin based concurrent chemoradiotherapy.