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Objective To compare the efficacy after conventional radiotherapy and late course accelerated fractionation radiotherapy for nasopharyngeal carcinoma (NPC).Methods A total of 200 NPC patients were enrolled and randomly assigned to conventional radiotherapy (CF) group with 99 cases or late course accelerated fractionation radiotherapy (LCAF) group with 101 cases,who received irradiation to 60Co γ or 6 MV X-rays.In the CF group,the total dose of nasopharynx was 70 Gy/35 fractions at 2 Gy daily.In the LCAF group,for the first two-thirds of the treatment,two daily fractions of 1.2 Gy were given to the primary lesion and the total dose was 48 Gy/40 fractions.For the last one third of the treatment,the dose per fraction was increased to 1.5 Gy and the total dose was 30 Gy/20 fractions.Results There were 25,16,25 in CF group and 16,13,18 patients in LCAF group who had recurrence of nasophaynx,cervical lymph nodes,and distant metastasis,respectively.The 5-year nasopharyngeal control and overall survival rates was 75.9％ and 87.6％ in CFgroup (x2 =4.066,P＜0.05),58.0％ and 74.1％(x2 =5.076,P ＜ 0.05) in LCAF group,respectively.Cervical lymph nodes local rates and distant metastasesfree rates at 5 years were 8 1.5％ and 90.0％ in CF group (P ＞ 0.05),74.1％ and 83.3％ (P ＞ 0.05) in LCAF group,respectively.Conclusions Compared with CF,LCAF can improve nasopharyngeal control and overall survival rates,but there are no significant difference in the recurrence rates of cervical lymph nodes and distant metastasis.
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Objective To assess the impact of respiratory motion on the displacement of target area and to analyze the discrimination between free breathing and active breathing control (ABC) in patients with gastric cancer treated with post-operative radiotherapy. Methods From January 2005 to November 2006, 22 patients with post-operatively confirmed gastric cancer were enrolled in this study. All diseases were T_3/ N +, staging Ⅱ - Ⅳ. Patients were CT scanned and treated by radiation with the use of ABC. Image J software was used in image processing, motion measurement and data analysis. Surgical clips were implanted as fiducial marks in the tumor bed and lymphatic drainage area. The motion range of each clip was measured in the resultant-projection image. Motions of the clips in superior-inferior (S-I), right-left (R-L) and anterior-posterior (A-P) directions were determined from fluoroscopy movies obtained in the treatment position. Results The motion ranges in S-I, R-L and A-P directions were 11.1 mam, 1.9 mm and 2.5 mm (F = 85.15, P = 0. 000) under free breathing, with 2.2 mm, 1.1 mm and 1.7 nun under ABC (F = 17.64, P = 0. 000), and the reduction of motion ranges was significant in both S-I and A-P directions (t = 4.36, P = 0. 000;t = 3.73,P = 0.000). When compared with under free-breathing, the motion ranges under ABC were kept unchanged in the same breathing phase of the same treatment fraction, while significant increased in different breathing phase in all three directions (t = - 4.36, P = 0. 000; t = - 3.52, P = 0.000; t =-3.79, P = 0. 000), with a numerical value of 3.7 mm, 1.6 mm and 2.8 mm, respectively (F = 19.46, P = 0. 000) . With ABC between different treatment fractions , the maximum displacements were 2.7 mm, 1.7 mm and 2.5 mm for the centre of the clip cluster (F =4.07,P =0. 019), and were 4.6 mm, 3.1 mm and 4.2 mm for the clips (F =5.17 ,P =0.007). The motion ranges were significant increased in all the three directions (t = - 4.09, P=0.000 ; t =-4.46, P = 0.000 ; t = - 3.45, P =0.000). Conclusions In the irradiation of post-operative gastric cancer, the maximum displacement of organ motions induced by respiration is in S-1 direction and the minimum in R-L direction under free breathing. The use of ABC can reduce the motions significantly in S-I and A-P directions, and the same changes exist in both inter-and intra-fraction treatment.
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Objective Adenoid cystic carcinoma (ACC), a rare malignancy in head and neck region, is predominately found in the salivary glands. Our study is to retrospectively analyze the treatment outcomes and prognostic factors of ACC originated from the major salivary glands. Methods A total of 54 patients diagnosed as ACC were treated in our institution, including 24 cases originated from the parotid gland and 30 from the submandibular or sublingual gland. According to the records, 26 patients received surgery alone and 28 were treated with surgery followed by radiotherapy with a median dose of 58 Gy (range, 50 -65 Gy). Results The Follow-up rate was 94%, and 15 patients from postoperative radiotherapy group and 20 from surgery alone group were followed up more then 5 years. The 5-year overall survival rate, local-regional control rate, distant metastasis rate, and disease-free survival rate were 97%, 71%, 13% and 69%, respectively. Lung metastasis, occurred in 7 patients, was the most common distant failure. Fifteen recurrences were observed, including 13 in surgery alone group and 2 in postoperative radiotherapy group. The 5-year local-regional control and disease-free survival rates were 90% and 85% for patients treated with postoperative radiotherapy, 54% and 55% for those treated with surgery alone. Univariate and multivariate analyses showed that postoperative radiotherapy was the only prognostic factor of local-regional control and survival rates. Other parameters such as nerve involvement did not significantly influence the treatment results. Conclusions Postoperative radiotherapy can improve the prognosis of ACC originate from the major salivary glands compared with surgery alone. Distant metastasis is an obstacle in curing the disease, which indicates the value of systemic treatment.
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Objective To study the effect of different fraction interval with same total radiation dose on tumor growth delay and survival in C57BL mice implanted with lewis lung cancer,and to determine whether prolonged fraction interval will decrease the tumor response to radiation. Methods Forty-eight mice were implanted with lewis lung cancer in the back legs.When the diameter of transplanted tumor reached 0.8 to 1 cm,the mice were randomized into 6 groups:normal control group,single fraction of 18 Gy group,18 Gy in 2 fractions of 9 Gy at 30 min interval group,18 Gy in 7 fractions of 2.57 Gy at 5 min inter val group,18 Gy in 2 fractions of 9 Gy at 60 min interval group and 18 Gy in 7 fractions of 2.57 Gy at 10 rain interval group.The maximal and minimal diameters of the tumor were measured and record every other day to study the tumor growth tendency,the tumor growth delay and the mice survival time. Results The tumor growth delay of groups at prolonged fraction interval was shorter than the group with single fraction of 18 Gy (P < 0.05).The tumor growth delay of groups at fraction interval of 30 rain was longer than that of groups at interval of 60 rain (P < 0.05).There was no significant difference of the tumor growth delay be tween the groups with same delivery time (P >0.05).The mice survival time of the groups with prolonged fraction interval was shortened when omparing to the group with single fraction of 18 Gy.While the difference was not significant between the groups at fraction interval of 30 min and 60 min. Conclusions The pro longed fraction interval but same total radiation dose shortens the tumor growth delay and survival time in the mice implanted with Lewis lung cancer.The longer fraction interval impairs the tumor control more signifi candy.However the difference of the effect on mice survival time is not significant between the groups at fraction interval of 30 min and 60 min.
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Background and purpose:Studies have shown that some molecular markers could serve as prognostic factors for nasopharynx carcinoma, but the predictive role of catenins and cyclin D1 remains uncertain for the disease. Our paper is to investigate the expression of catenins(?-,?- and ?-) and cyclin D1 in nasopharyngeal carcinoma as well as to analysis their relation to clinic factors and prognosis. Methods:We retrieved 38 paraffin-embedded specimens of nasopharynx carcinoma, immunohistochemistry was used to examine the expression of ?-,?- and ?-catenin , cyclin D1 and tumor proliferation activity marker ki-67.Results:Reduced expression of ?-,?- ,?-catenin and cyclin D1 was observed in most of the tumors. Our preliminary study demonstrated that there was no significant correlation between their expression with T-stage, N-stage, clinical stage and primary tumor volume, as well as with ki-67 stain. In unviarance analysis, patients with reduced expression of ?-catenin had poorer prognosis than those with high expression, 5 year overall survival and disease free survival rates of these two groups were 53.2%, 29.0% and 81.9%, 76.0%, respectively(P
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Some problems of defining target volumes and normal organs are issueds in nasopharyngeal carcinoma. The factors that affect gross target volume,clinical target volume,planning target volume,normal tissues and cervical lymph node target in necks are analyzed ,and some suggestions for defining target and normal tissues are discussed in this article.
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60 cm 3). Primary tumor volume was found to be an independent prognostic factor of local control in multivariant analysis without any statistical significance to predict the disease-free survival or distant relapse-free survival rates. Conclusion The greater volume disparity with the same T stage and the data extension overlap with different T stages are demonstrated and the primary tumor volume may be considered as a prognostic factor in the treatment of nasopharyngeal carcinoma.
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Purpose: To evaluate the effect of radiotherapy and to detect the prognostic factors for residual and recurrent foci after surgery of thyroid gland cancers. Materials and Methods: 109 patients with residual or recurrent foci of thyroid cancers after surgery were treated with radiotherapy. Results:The overall 5-,10-, 15-, 20- and 25- year survival rates were 93.6%, 91.7% , 88.7%, 87.6% and 87.6% and the 5-, 10-, 15-, 20- and 25- year survival rates with no evidence of disease were 90.8%, 89.8% ,85.6%, 84.1% and 84.1%, respectively. The clinical stage was the main factor and patient's age at diagnosis, patient's sex, histopathological types and radiation dose were also the prognostic factors. Conclusion:Radiotherapy is beneficial to residual and recurrent foci after surgery of thyroid cancer. The optimum radiation dose is 45～65 Gy.
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6hrs, followed by concomitant boost to a total dose of 74 Gy within 6 weeks. In lung cancer, the program was 1.15～1.25 Gy per fraction, two fractions per day for a total dose of 70 Gy with overall treatment time about 6 to 7 weeks. Esophageal cancer, conventional fractionation was given to total dose about 41 Gy followed by a boost for an additional 28 Gy by 1.5 Gy per fraction twice daily with overall treatment time about 6.3 weeks.Our preliminary treatment data showed that the local tumor control rates were higher in these study groups than the conventional groups and the acute reactions were increased as expected but tolerable. The main points of altered fractionation radiation schedules are also discussed.
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Objective To evaluate treatment effects and to determine the prognostic factors of primary orbital lymphoma. Methods From March 1984 to October 2000, 44 primary orbital lymphoma patients were admitted into our hospital, with 27 males and 17 females. Twenty-seven patients had eyelid or conjunctiva primary, and 17 patients orbit primary. Patient's age ranged from 14 to 86 years (median, 50.5years). According to the Ann Arbor Staging System, there were 40 ⅠEA, 4 ⅡEA lesions. Cobolt-60 ?ray was given first to the whole orbit to 30-35?Gy followed by 180 kv X-rays or 9 Mev ?-beam to the focus to a total dose of 41.0-51.5?Gy (median, 46.5?Gy). Kaplan-Meier method was used to analyze the survival. Log-rank test was used to detect the difference between groups.Results Only 1 patient failed from primary site and 5 patients from distant metastasis after radiotherapy. The 5-year and 10-year cause-specific survival rate were 90.9% and 84.5%, respectively. On univariate and multivariate analyses, eyelid or conjunctiva localization and Ann Arbor stage ⅠEA were independent favorable prognostic factors for survival. The 5-year survival was much higher in eyelid or conjunctiva patients than in orbital ones (96.3% vs 70.6%, P=0.013). The survival time was longer in stage Ⅰ than in stage Ⅱ (P=0.000). Neither the RT dose nor the age or sex influenced the outcome.Conclusions Localized orbital lymphoma can be well controlled with low-dose RT alone. Patients with eyelid or conjunctival localization and stage Ⅰ have better cause-specific survival.