[Curative Effect of Jiedu Shengji Recipe in Preventing and Treating Acute Radiation Esophagitis in Radiotherapy Induced Esophageal Carcinoma Patients].

OBJECTIVE: To observe the curative effect of Jiedu Shengji Recipe (JSR) in preventing and treating acute radiation esophagitis in radiotherapy induced esophageal carcinoma patients. METHODS: Totally 86 mid-late stage esophageal carcinoma patients were assigned to the treatment group and the control group according to random digit table, 43 in each group. All patients received concurrent radiochemotherapy. Patients in the treatment group took JSR from starting the radiotherapy, one dose per day for 8 successive weeks, while those in the control group took mixture of dexamethasone, lido- caine, and gentamicin, 10 mL each time, taken before radiation and within 30 min after radiation, discontinued till the end of radiation. The occurrence time of acute radiation esophagitis and, duration of symptoms, esophageal radioactive damage degree, curative effect, improvement rate of Karnofsky performance scale (KPS) , and the incidence of adverse reactions were observed in the two groups. RESULTS: Compared with the control group, the occurrence time of acute radiation esophagitis was prolonged (15. 46±3. 37 days vs 10.23±2.46 days) , and duration of symptoms was shortened (20.18±4.56 days vs 26. 17±3. 26 days) in the treatment group, with statistical difference (P <0. 01). In the treatment group the occurrence rate of mid and high level (degree II to degree IV) acute radiation esophagitis was lower than that of the control group (Z =3. 34, P <0. 01). The total effective rate was 95. 35% (41/43) in the treatment group and 67. 44% (29/43) in the control group, with statistical difference between the two groups (X² =11.06, P<0.01 ). The improvement rate of KPS were higher in the treatment group than in the control group [65. 12% (28/43) vs 27.91% (12/43) ; X² =11.97, P <0. 01]. The incidence of adverse reactions were lower in the treatment group than in the control group with statistical difference [9.30% (4/43) vs 34. 88% (15/43) ; X²=8.17, P <0. 01]. CONCLUSION: JSR had better effect for preventing and treating moderate and severe acute radiation esophagitis in concurrent chemoradiotherapy induced esophageal carcinoma patients.

[Effect of Qingfei Quyu Decoction in Prevention of Radiation Pneumonitis Induced by Concurrent Chemoradiotherapy for Esophageal Carcinoma Patients].

OBJECTIVE: To assess the effect of Qingfei Quyu Decoction (QQD) in preventing radiation pneumonitis in esophageal carcinoma patients by concurrent using it with chemoradiotherapy. METHODS: A total of 120 patients with mid-late stage esophageal carcinoma were randomly assigned to the treatment group (60 cases) and the control group (60 cases). All patients received concurrent radiochemotherapy. Patients in the treatment group additionally took QQD, one dose per day for 8 successive weeks. The incidence of radiation pneunonitis was compared between the two groups. The improvement rates of short-term benefit rate, Karnofsky performance scale (KPS), and body weight (BW) improvement rate were calculated between the two groups. The 1-and 2-year overall survival rates were compared between the two groups. RESULTS: The incidence of radiation pneunonitis was 8.93% (15/56) in the treatment group and 18.64% (11/59) in the control group (P < 0.05). The short-term benefit rate was 92.86% (52/56) in the treatment group and 69.49% (41/59) in the control group (P < 0.05). Besides, the KPS and BW improvement rate were higher in the treatment group [89.29% (50/56) and 83.05% (49/59) ] than in the control group [80.36% (45/56) and 66.10% (39/59)] (P < 0.05). The 1-and 2-year overall survival rate were 66.07% and 35.71% in the treatment group, higher than those of the control group (61.02% and 30.51%; P > 0.05). CONCLUSION: Concurrent using QQD with chemoradiotherapy for treating esophageal carcinoma patients could lower the incidence of radiation pneumonitis, attenuate the degree of radiation induced lung injury, improve clinical benefit rate, and elevate their QOL.

Patterns of failure after involved field radiotherapy for locally advanced esophageal squamous cell carcinoma.

PURPOSE: To retrospectively analyze the patterns of failure and the treatment effects of involved-field irradiation (IFI) on patients treated with locally advanced esophageal squamous cell carcinoma (ESCC) and to determine whether IFI is practicable in these patients. METHODS: A total of 79 patients with locally advanced ESCC underwent three dimensional conformal (3D)CRT) or intensity modulated radiotherapy (IMRT) using IFI or elective nodal irradiation (ENI) according to the target volume. The patterns of failure were defined as local/regional, in-field, out)of)field regional lymph node (LN) and distant failure. With a median follow)up of 32.0 months, failures were observed in 66 (83.6%) patients. RESULTS: The cumulative incidence of local/regional failure (55.8 vs 52.8%) and in)field regional lymph node failure (25.6 vs 19.4%) showed no statistically significant difference between the IFI and the ENI group (p=0.526 and 0.215, respectively). Out)of)field nodal relapse rate of only 7.0% was seen in the IFI group. Three)year survival rates for the ENI and IFI group were 22.2 and 18.6%, respectively (p=0.240), and 3)year distant metastasis rates were 27.8 and 32.6%, respectively (p=0.180). The lung V10, V20, V30 and mean lung dose of the ENI group were greater than those of the IFI group, while the mean lung dose and V10 had statistically significant difference. CONCLUSIONS: The patterns of failure and survival rates in the IFI group were similar as in the ENI group; the regional recurrence and distant metastasis are the main cause of treatment failure. IFI is feasible for locally advanced ESCC. Further investigation is needed to increase local control and decrease distant metastasis in these patients.

Efficacy and Prognostic Analysis of 315 Stage I-IVa Esophageal Cancer Patients Treated with Simultaneous Integrated Boost-Intensity-Modulated Radiation Therapy.

PURPOSE: Use of simulated integrated boost-intensity-modulated radiation therapy (SIB-IMRT) is rarely reported in the treatment of esophageal cancer. This study was performed to observe the curative effect and prognostic factors associated with concurrent chemoradiotherapy for esophageal cancer using modern radiotherapy (RT) techniques. PATIENTS AND METHODS: In total, 315 patients with esophageal squamous cell carcinoma who received SIB-IMRT between 2015 and 2018 were included in this retrospective study. Median doses were planning target volume (PTV) 5400 cGy, 30 times (180cGy/fraction); planning gross tumor volume (PGTV) 6000 cGy, 30 times (200 cGy/fraction), once a day and 5 times a week. The entire period of RT was 6 weeks. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse reactions were observed. Univariate analysis was performed, and factors with P<0.15 were included in multivariate analysis. Cox regression analysis was used for multivariate prognostic analysis. P<0.05 was considered statistically significant. The incidence of adverse reactions under single chemotherapy concurrent chemoradiotherapy (sCCRT) and double chemotherapy concurrent chemoradiotherapy (dCCRT) was analyzed. RESULTS: Two-year, 3-year OS and PFS of the entire group were 49.5%, 40.2% and 40.3%, 34.0%, and the median survival time was 23.5 months. Univariate and multivariate analyses showed that T-stage (P=0.049), N-stage (P=0.024), clinical stage (P=0.041), short-term efficacy (P<0.001), and use of concurrent chemotherapy (P<0.001) were the influencing factors for OS. ORR was 87.6%. Adverse reactions were significantly increased with increasing chemotherapy dose. CONCLUSION: The adverse reactions of SIB-IMRT in esophageal cancer can be tolerated. T-stage, N-stage, clinical stage, short-term curative effect, and concurrent chemotherapy are the prognostic factors affecting survival. Because it has lower toxicity and is as effective as dCCRT, sCCRT should be considered in the management of esophageal cancer.

[Bioaccumulation and Translocation Characteristics of Heavy Metals in a Soil-Maize System in Reclaimed Land and Surrounding Areas of Typical Vanadium-Titanium Magnetite Tailings].

A total of 86 soil samples, 86 corn kernel samples, 50 tailings samples, and 33 ore rock samples were collected in reclaimed land and surrounding areas of typical vanadium-titanium magnetite tailings located in the Chengde Central Region and analyzed for 14 elements (P, Fe, Cu, Ni, Cd, Cr, Pb, Zn, Hg, Ti, Mn, and Mo) and speciation of heavy metals. This study investigated the bioaccumulation and translocation characteristics of heavy metals in a soil-maize system based on a descriptive statistical analysis, a geological accumulative index, bioconcentration factors, and a redundancy analysis. The results showed that the average accumulation index of surface soil followed an order of P > Cu > Fe2O3 > Cr > Ti > V > Ni > Mn > Cd > Zn > Mo > As > Pb > Hg, while the accumulation level of heavy metals was generally categorized as either no accumulation or moderate accumulation. Compared to China's soil environmental quality standard risk screening values (GB15618-2018), the over-standard rates of Cr and Cu were 2.32% and 1.16%, respectively. The content of Fe, Ti, As, Pb, and Mn in the corn kernels of the tailings and surrounding areas was relatively high, and the content of Mo, Ni, Cu, Zn, Cd, and Cr in the control area was relatively high. The over-standard rates of Ni, Zn, and Cu in the corn kernels were 13.61%, 13.23%, and 5.17% respectively, according to China's national food safety standard limits for contaminants in food (GB 2762-2017). The bioconcentration factors of Fe, Ti, As, Pb, and Mn in the corn kernels of the tailings and the surrounding areas were relatively higher, while the bioconcentration factors of Mo, Ni, Cu, Zn, Cd, and Cr were lower than in control area. The bioactive components of Cd accounted for 50.17%, which was the highest, followed by Ni, Zn, and Cu with average ratios of 13.61%, 13.23%, and 5.17%, respectively. Compared to the control area, the Pb, As and Hg elements in the soil samples of the reclaimed land showed a lower total amount but a higher bioavailability content and soil pH value, while the Cu and Hg elements showed a higher total amount but lower bioavailability content and soil pH value. These differences in total heavy metal concentrations, bioavailability amounts, and soil pH values made the bioconcentration intensity of As and Pb in the tailings reservoir and surrounding area relatively higher. When studying the ecological risk of heavy metal pollution or determining the remediation target value of reclaimed land in a mine tailings reservoir and the soil around the mine area, the bioavailable state limit of heavy metals should be should be taken into account as the evaluation standard.

[Source of Groundwater Nitrate in Luanping Basin Based on Multi-environment Media Nitrogen Cycle and Isotopes].

The multi-environment media of water, surface soil and vadose zone soil samples were collected in the upstream of Miyun Reservoir, in the Luanping Basin of Chengde City, Hebei Province. The aim was to identify the pollution source, ratio, spatial distribution, migration, and transformation characteristics of nitrogen in groundwater. Hydrogeochemistry, soil total nitrogen, and dissolved nitrate nitrogen of vadose zone soil analysis and a multi isotope tracer technique of δ15 N-NO3 and δ18O-NO3, δ34S-SO4 and δ18O-SO4, δ14 C, combined with land-use type analysis and geostatistics, were used in the study. The results showed that nitrate was the main form of nitrogen in the groundwater of the Luanping Basin. The NO3- concentration of groundwater was significantly correlated with the land-use types of residential land and cultivated land where the nitrate pollution of shallow groundwater was mainly distributed. Of the groundwater samples, 13.79% exceeded the National Standard Ⅲ for Groundwater (GB/T 14848-2017) of NO3- concentration value, while the excess multiple was 1.04-3.86, and 37.93% of the groundwater samples exceeded the World Health Organization NO3- concentration standard value. The excess multiple was 1.08-6.83. The spatial variation of groundwater NO3- concentration, soil total nitrogen and surface soil dissolved nitrate nitrogen of vadose zone was affected by the combination of natural structural factors and anthropogenic factors. The source of groundwater nitrate was mainly from livestock manure and domestic sewage, followed by chemical fertilizer leaching. The nitrogen cycle in the aeration zone-groundwater-dominated nitrogen circulation in the groundwater runoff area of the piedmont basin was nitrification. These findings are highly significant for the prevention and remediation of groundwater pollution when viewing the basin system as an independent unit, and for studying the sources and fate of nitrate pollution in the water environment.

Progress of clinical study on hypofractionated radiotherapy after breast-conserving surgery.

Whole-breast radiotherapy after breast-conserving surgery (BCS) can improve patient survival while reducing local tumor recurrence. Although standard breast radiotherapy can achieve good tumor control and cosmetic effects with low toxicity, the 5- to 7-week treatment time is relatively long for patients and can result in wasted medical resources. Therefore, there is a growing trend toward hypofractionated radiotherapy (HFRT), which accelerates partial-breast irradiation. Both short-course radiotherapy and conventional fractionated radiotherapy are safe and effective treatment modes, with similar survival and local tumor control effects as those of conventional radiotherapy (CRT), and adverse reactions can be tolerated. Compared with conventional fractionated radiotherapy, short-course radiotherapy saves medical resources and has a shorter total treatment time, reduced treatment costs, and an improved quality of life for patients.

Randomised phase III trial of concurrent chemoradiotherapy with extended nodal irradiation and erlotinib in patients with inoperable oesophageal squamous cell cancer.

BACKGROUND: This randomised phase III study was conducted to investigate the efficacy of extended nodal irradiation (ENI) and/or erlotinib in inoperable oesophageal squamous cell cancer (ESCC). PATIENTS AND METHODS: Patients with histologically confirmed locally advanced ESCC or medically inoperable disease were randomly assigned (ratio 1:1:1:1) to one of four treatment groups: group A, radiotherapy adoption of ENI with two cycles of concurrent TP chemotherapy (paclitaxel 135 mg/m2 day 1 and cisplatin 20 mg/m2 days 1-3, every 4 weeks) plus erlotinib (150 mg per day during chemoradiotherapy); group B, radiotherapy adoption of ENI with two cycles of concurrent TP; group C, radiotherapy adoption of conventional field irradiation (CFI) with two cycles of concurrent TP plus erlotinib; group D, radiotherapy adoption of CFI with two cycles of concurrent TP. RESULTS: A total of 352 patients (88 assigned to each treatment group) were enrolled. The 2-year overall survival rates of group A, B, C and D were 57.8%, 49.9%, 44.9% and 38.7%, respectively (P = 0.015). Group A significantly improved 2-year overall survival compared with group D. The ENI significantly improved overall survival in patients with inoperable ESCC (P = 0.014). The addition of erlotinib significantly decreased loco-regional recurrence (P = 0.042). Aside from rash and radiation oesophagitis, the incidence of grade 3 or greater toxicities did not differ among 4 groups. CONCLUSION: Chemoradiotherapy with ENI and erlotinib might represent a substantial improvement on the standard of care for inoperable ESCC. ENI alone should be adopted in concurrent chemoradiotherapy for ESCC patients.