[Analysis of internal quality control data of complete blood count from laboratories participating in national external quality assessment].

Objective: To investigate current status and problems of internal quality control (IQC) of complete blood count in China so as to perform IQC normally. Methods: The IQC data of complete blood count for five parameters were collected from laboratories participating in national external quality assessment during 2012-2017 (totally 12 times), including WBC, RBC, Hb, Hct and PLT. After confirmation of all data, data for the 12 times were analyzed as follows.The proportions of using different levels of quality control materials were calculated.The 25th, 50th, 75th, 90th percentiles CV of data collected for the 12 times were calculated respectively and the trends of CV were observed over time.The difference of CV among laboratories running three control levels was compared.The CV of each parameter in 2017 was compared with precision requirements based on biological variation, health standards and German Medical Association Directive; The proportions of laboratories using different control rules were calculated. Results: After invalid data was excluded from those IQC data of laboratories for the 12 times external quality assessment (up to 2 402, as low as 1 449) from 2012 to 2017, the residual data (up to 2 332, as low as 1 431, accounting for 96.0%-99.2%) was used for analysis. 61.9%-66.1%, 18.2%-23.6% and 14.3%-17.3% of laboratories ran one, two and three control levels respectively, and the proportions of laboratories running more than two control levels increased from 33.9% to 38.1%. The decrease trend of the 75th, 90th percentiles CV of WBC, RBC, Hb, Hct for three levels, PLT for normal level and the 90th percentiles CV of PLT low level had statistically significance over time (P<0.05); the decrease trend of the 75th percentiles CV of PLT low level and 75th, 90th percentiles CV of PLT high level had no statistically significance over time. The CV had significant difference between low and normal, low and high control level for WBC and PLT, while there were no difference between normal and high control levels. There were no significant difference of CV among three control levels for RBC, Hb, and Hct. Except for the CV of Hct low, normal level and PLT low level, 85% of laboratories for the other parameters could meet the minimum precision requirements based on biological variation; more than 85% laboratories met the requirements of health standards; except for the CV of PLT low level, more than 80% laboratories met the requirements of German Medical Association Directive. The proportion of laboratories using 1(3s)/2(2s) quality control rules increased from 59.2% to 76.0%. Conclusions: During the past 6 years, the CV for IQC has shown a decrease trend over time. However, the control level and quality control rules used by some laboratories do not meet management requirements. The CV of Hct and PLT in a few laboratories do not meet the minimum requirements of the health standards, and need to implement quality improvements fatherly.

Interleukin-10 polymorphisms associated with susceptibility to acute myeloid leukemia.

We investigated the association between polymorphisms in interleukin-10 (IL-10) -1082G/A (rs1800896), -819T/C (rs1800871), and -592A/C (rs1800872) and the risk of acute myeloid leukemia (AML) in a Chinese population. A total of 167 primary AML cases and 328 healthy control subjects were recruited at the First People's Hospital of Yunnan Province between March 2009 and January 2012. The polymorphisms rs1800896, rs1800871, and rs1800872 were genotyped by polymerase chain reaction-restriction fragment length polymorphism. Multivariate regression analyses showed that subjects carrying the rs1800871 CC genotype and C allele had a significantly increased risk of AML, with adjusted odds ratios (95% confidence intervals) of 1.72 (1.01-2.97) and 1.38 (1.04-1.81), respectively. Those carrying the rs1800872 G allele had a slightly increased risk of AML, with an adjusted odds ratio (95% confidence interval) of 1.30 (1.01-1.72). Moreover, genotyping results demonstrated that subjects carrying both the rs1800871 C allele and rs1800872 G allele had a moderately increased risk of AML, indicating that the 2 genotypes had a synergistic effect on AML risk (odds ratio = 2.03, 95% confidence interval = 1.24- 3.15). Our results demonstrated that polymorphisms in rs1800871 and rs1800872 enhance the risk of AML, and these 2 single nucleotide polymorphisms have a synergistic effect on AML risk.

Therapeutic effects of chimeric antigen receptor T cells (CAR-T) on relapse/refractory diffuse large B-cell lymphoma (R/R DLBCL): a meta-analysis.

OBJECTIVE: Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma (NHL). This study aimed to systematically evaluate the efficacy of chimeric antigen receptor T cells (CAR-T) in treating relapse/refractory DLBCL (R/R DLBCL) and associated complete-remission rate (CR). MATERIALS AND METHODS: PubMed, Cochrane Library, CNKI, VIP, CBM, and Wanfang databases were searched, and literature was collected up to January 2019. According to inclusion criteria and exclusion criteria, two researchers independently reviewed and screened literature, extracted required data and crossly checked them. This meta-analysis was conducted using RevMan 5.3 software. RESULTS: This study finally included 13 English literatures and 263 cases. There was no heterogeneity among all these studies, therefore, fixed effect model was used. Meta-analysis findings showed that total CR rate of R/R DLBCL treated with CAR-T was 46.8% (95% CI: 0.408-0.533). Subgroup analysis showed that CR rate of CD28 group was slightly higher [52.5%, with 95% confidence interval (CI): 0.441-0.602] compared to that of 4-1BB group (41.5%, with 95% CI: 0.324-0.510). CR rate of CD19 group was slightly higher (49.2%, with 95% CI: 0.429-0.556) compared to that of CD20 group (42.2%, with 95% CI: 0.231-0.639). Funnel chart of total CR rate, co-stimulatory factor, and target antigen demonstrated fundamental symmetry. Moreover, age, HSCT administration, CAR-T cell counts, and drug pre-treatment also affected immunotherapy on CAR-T on R/R DLBCL. CONCLUSIONS: CAR-T treatment for R/R DLBCL demonstrated evident curative effect and high complete remission rate. CAR-T cell immunotherapy would be expected to become mainstream therapy for hematolymph system tumors.

MicroRNA-338-3p inhibits the progression of bladder cancer through regulating ETS1 expression.

OBJECTIVE: MicroRNA-338-3p (miR-338-3p) was reported to influence the metastasis and development of several human cancers. However, in bladder cancer (BC), the special function of miR-338-3p remains unknown. Here, we aimed at exploring the miR-338-3p function in the progression of BC. PATIENTS AND METHODS: miR-338-3p and ETS1 expressions were examined by quantitative Real-time polymerase chain reaction (qRT-PCR) in BC samples. Following that, transwell assays for cell migration and invasion were performed. And MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay for cell proliferation was conducted as well. Western blot was employed to examine the epithelial-mesenchymal transition (EMT) marker expressions. Finally, the relationship between miR-338-3p and E26 transformation specific-1 (ETS1) was verified by luciferase reporter assay. RESULTS: The decreased miR-338-3p expression was examined in BC cells. Moreover, miR-338-3p upregulation repressed cell proliferation ability in BC. Next, miR-338-3p upregulation also depressed cell metastasis and EMT in BC cells. Furthermore, ETS1 was a direct target of miR-338-3p and inversely associated with its expression. And upregulation of ETS1 partially rescued the suppression of miR-338-3p for cell proliferation and metastasis in BC. CONCLUSIONS: Upregulation of miR-338-3p inhibited the proliferation, metastasis and EMT in BC by suppressing ETS, showing that miR-338-3p might block the development of BC through regulating ETS1 expression.

Cylindroma of the nasopharynx: a chronic disease.

From March 1958 to October 1984, 10 patients with cylindroma (cystic adenoid epithelioma) arising in the nasopharynx were treated in our hospital. The presenting symptoms of these patients ranged in duration for 2 weeks to 8 years, with an average of 25 months. Eighty percent of the patients had destruction of the base of skull and 60% had cranial nerve involvement. Of these 10 patients, two had Stage II disease, two had Stage III, and six had Stage IV. Response was seen in this tumor at tissue doses between 5000-8000 rad. Of the seven patients at risk for 5 years, 86% survived, yet 36% of the patients died of tumor between the fifth to tenth year. Fifty percent of the patients lived beyond 10 years. Based on this experience, a dose of more than 8000 rad is advised for the primary lesion. For the neck region, radiation is indicated only when there are lymph node metastases; prophylactic radiation of the neck is not necessary. Local recurrence or single distant metastasis is amenable to radiation therapy. Among the six patients who failed in the course of follow-up, three had local recurrences, two had pulmonary metastases, and one died of cerebral vascular accident.

Establishment, characteristics, and utilization of a new in vivo-in vitro system.

Radiotherapy and chemotherapy are two important methods for malignant tumor treatment. To research radiobiological response in therapy, we have established a better experimental method in contrast to the traditional ones such as TCD50, regrowth delay, cell survival curve, etc, all with their limitations. A new mouse tumor in vivo-in vitro system LA795 Vv-Vt has been developed for studies on radiobiology. Such a system could be used to study the in vivo response of a solid tumor by the in vitro cloning assay. For the purpose of increasing the PE in vitro, LA795 Vv-Vt tumor line was purified through culturing the cells as a clonogenic spheroid. The spheroids were then injected into the flank of mouse subcutaneously for tumor growth. The in vivo-in vitro system LA795 Vv-Vt is an excellent model dissecting and analyzing the various factors which affect tumor development and determine the response of tumor to specific agent and regimens.

Influence of biopsy on the prognosis of nasopharyngeal carcinoma--a critical study of biopsy from the nasopharynx and cervical lymph node of 649 patients.

Most of the nasopharyngeal carcinomas (NPC) are histopathologically either poorly differentiated or undifferentiated. After radiotherapy, hematogenous spread is the chief cause of failure for these patients. Biopsies taken from the nasopharynx or the enlarged neck nodes should be performed to establish diagnosis before radiotherapy. The present study was done to ascertain whether the biopsy procedure would affect the final outcome of this malignancy, and to establish certain criteria for clinicians as they endeavor to correctly diagnose and prepare the patients for treatment. Six hundred and forty-nine of 702 NPC patients treated in our hospital from March 1958 through 1972 were analyzed for this purpose and the results are as follows: For patients with fixed and partially fixed neck nodes, the interval between the first biopsy and radiotherapy, the number of times or frequency of biopsy either taken from the nasopharynx or the lymph node and the type of biopsy done on the lymph node did not influence the prognosis. For patients with or without only movable neck nodes, the interval between the first biopsy from the nasopharynx and radiotherapy influenced the final outcome. Patients who received radiotherapy within 14 days after biopsy had a five year survival of 61% (42/69), which is better than that of the patients who started their treatment beyond the 15th day (47.5%-58/122). This is statistically significant (p less than 0.05). The number of times or frequency of biopsy taken from the nasopharynx before radiotherapy did not influence the result of treatment. The interval, therefore, and not the frequency, is important in the biopsy from the nasopharynx. For patients with movable lymph nodes, partial excision of the node gave a poorer five year survival (22%-2/9) than that of patients on whom complete excision was done (50%-9/18). Therefore, complete excision of the node is advised for patients with movable neck node metastasis.

Disappearance of local tumor of esophageal carcinoma after irradiation.

The range of doses which may lead to disappearance of local tumor after radiation treatment of esophageal carcinoma is extensive. Its possibility may reach 33% if the dose exceeds 5000 rad. However, the sensitivity of this cancer varies greatly in different patients. In clinical practice, the total dose should be decided according to the response of the tumor. Disappearance of local tumor signified better prognosis than otherwise. Radiation ulcer can be easily mistaken as local recurrence. Based upon clinical symptoms and X ray film, the possibility of misdiagnosing ulceration as local recurrence after radiotherapy of more than 6000 rad was as high as 29% (12/42) in our experience. The pathogenesis and management of radiation ulcer in the esophagus are discussed.

High dose rate radiosensitization: a clinical pilot study of 27 cancer patients.

In laboratory experiments, it was reported by some authors that radiation response increases with the dose rate, although other workers have reported that this relationship does not exist. Up to the present, this problem has remained controversial. The present clinical pilot study was designed with the aim of comparing the effect of high and low dose rates. The study was carried out on 27 patients who suffered from various types of malignancy. Twelve patients with advanced but relatively comparable bilateral metastases in the neck region, and 15 patients with multiple pulmonary metastatic foci were studied. Radiation was given at a high dose rate (1112 rad/min) when irradiating one side of the neck or one of the metastatic lesions in the lung, while radiation was given at a low dose rate (400 rad/min) on the opposite side of the neck or a separate lesion in the lung. All other aspects of radiation, however, were identical for all lesions. The total dose varied from 4000-7000 rad/4-7 wk. Five fractions per week and a daily dose of 200-300 rad was given. It was observed that the high dose rate gave rise to a higher radiosensitivity than the low dose rate. Tumor regression rates were calculated by measuring the dimensions of the lesions. The tumor regression rate in the high dose rate group was universally higher than that in the low dose rate group. The radiation response in the high dose rate group was about 5.2-37.6%, averaging 18%, higher than that in the low dose rate group. In conclusion, a high dose rate of radiation elicits a higher radiosensitivity, and hence, a possible higher cancericidal effect.

Radiation therapy of giant cell tumor of bone: analysis of 35 patients.

This paper reports 35 patients treated for giant cell tumor of bone. Ten patients were treated by surgery followed by postoperative irradiation. All 10 were cured; eight have survived for more than 5 years and four for more than 10 years without recurrence. Twenty-five patients were treated by radiation alone. All patients were followed for 2 to 17 years. For those who received more than 3500 rad, the local control rate was 82% (14/17); for those who received more than 4000 rad, the local control rate was 85% (11/13). Thirteen have lived for more than 5 years and nine have lived for more than 10. Our experience reveals that surgery and postoperative radiation produce the best results, and that these results are better than those reported in the literature. The results of radiation alone are comparable to that of surgery. For lesions not amenable to surgery, or those which would become crippling if surgery is attempted, radiation should be used either alone or in combination with conservative surgery. The dose for radiation alone should be 5000 to 6000 rad and for postoperative radiation, 3000 to 4000 rad. Supervoltage X rays (60Co or 8 Mv X ray), but not orthovoltage X rays, are indicated. A single radiation course with higher dose is preferred to multiple courses with lower doses. In 62% (15/24) of patients, pain relief begins before treatment is completed. In 74% (14/19) of patients, the tumor mass will not resolve until the sixth month after radiation.

Value of computed tomography in staging the primary lesion (T-staging) of nasopharyngeal carcinoma (NPC): an analysis of 54 patients with special reference to the parapharyngeal space.

CT scans of the nasopharynx and the base of skull were performed in 54 patients with histologically proven NPC. The CT findings are compared to those obtained by routine clinical examination. In this series, involvement of the parapharyngeal spaces was found by CT scan in 61% (33/54) of patients, which is impossible to assess by clinical means. Intracranial invasion was demonstrated by CT scan with intravenous contrast enhancement in five patients. CT is more sensitive in showing the erosion of skull base than X ray film. CT scans demonstrated 17% (5/30) of bony invasion in X ray negative patients. Clinical examination showed one involved wall in nine patients; CT scan discovered involvement of two or more walls in five (55%) of these nine. Routine clinical examination discovered extra-nasopharyngeal extensions in 34 locations, whereas CT scans discovered 106, a ratio of 1:3.1. The common sites of extra-nasopharyngeal extension detected by CT scan are: parapharyngeal space, intracranial invasion, sphenoidal sinus, orbit, ethmoidal sinus, maxillary antrum, oropharynx and the nasal cavity. In T-staging of NPC, 55% (6/11) of clinical T2 lesions are up-staged by CT. Thirty-six percent (4/11) of clinical T3 lesions were also up-staged. However, 94% (17/18) of clinical T4 lesions remained unchanged. Only 6% (1/18) of clinical T4 lesions were down-staged.

Management of local residual primary lesion of nasopharyngeal carcinoma: II. Results of prospective randomized trial on booster dose.

Although the question of booster dose for residual primary lesion arises in only 5% of nasopharyngeal carcinoma patients receiving radiotherapy, it poses a difficult problem for clinicians and should be followed. Hence, to test the validity of booster dose for residual primary lesion of nasopharyngeal carcinoma, a prospective randomized trial has been designed and carried out since January 1980. All patients who had a residual lesion in the nasopharynx at 70 Gy were biopsied. Those pathologically positive for cancer were randomized into two groups: (a) positive radiation group (PRG): patients were given further irradiation to a total dose of 90 Gy by the cone-down and assault technique, and (b) positive observation group (POG): patients were given no more irradiation but were followed periodically together with those who were pathology negative (NOG). A total of 78 patients were entered. The validity of booster dose was shown by the 5-year survival rates of the PRG, POG and NOG groups: 75% (3/4), 33% (1/3), and 58% (14/24), respectively. The total local recurrence rates of these groups were 6% (1/16), 36% (5/14), and 4% (2/48), respectively. The authors believe that booster dose for pathology positive residual lesion in the nasopharynx is necessary. The four factors leading to the development of a local recurrence are: (a) residual primary lesion proved positive by pathology but left unboosted, (b) well differentiated squamous cell carcinoma in the original primary lesion, (c) mild radio-response in the cancer parenchyma, and (d) mild radio-response in the interstitial tissue.

Management of local residual primary lesion of nasopharyngeal carcinoma (NPC): are higher doses beneficial?

One hundred and eighty-two nasopharyngeal carcinoma (NPC) patients, treated from March 1958 through 1978, received 70 Gy or more and were left with gross residual lesion in the nasopharynx, were retrospectively analyzed. Ninety-two patients were given a boost by reduced portals to a total of 90-120 Gy (boost group) whereas for the other non-randomized 90 patients, the treatment was stopped at 70 Gy (observation group). The local recurrence, distant metastasis and 5-year survival rates of the two groups are: 35% (32/92) vs. 58% (52/90), 20% (18/92) vs. 43% (39/90), and 54% (50/92) vs. 21% (19/90), respectively. The benefit of boost is more apparent in patients with T1-2 than T3-4 lesions (p less than 0.001), at increased risk of radiation encephalo-myelitis from 5.5% to 17%. The authors believe that boost be given to patients with early Stage T or small residual lesion at the primary site of NPC.

Chinese herb "destagnation" series I: Combination of radiation with destagnation in the treatment of nasopharyngeal carcinoma (NPC): a prospective randomized trial on 188 cases.

The results of a prospective randomized trial on 188 patients with NPC is reported to evaluate the validity of Chinese herbal medicine-Destagnation combined with radiotherapy. Ninety patients were allotted to the Destagnation group (radiation plus Destagnation) and 98, to the control group (radiation only). The 5-year success rate (number surviving minus number recurred but salvaged by re-treatment) of the Destagnation group is 53% (48/90) in comparison to 37% (36/98) of the control group (p less than 0.05). Minor complications of Destagnation included occasional anorexia and frequency of bowel movement. The reduced rate of local recurrence at the primary site in the Destagnation group (14%-13/90) as compared to that of the control group (29%-28/98) (p less than 0.05) suggests that Destagnation may be a radiosensitizer. The similar metastatic rates in both groups; 21% (19/90) in the Destagnation group and 21% (21/98) in the control group may refute the belief that Destagnation enhances hematogenous spread.

Randomized clinical trial on the combination of preoperative irradiation and surgery in the treatment of esophageal carcinoma: report on 206 patients.

From June 1977 to May 1985, a prospective randomized clinical trial on pre-operative radiation for esophageal carcinoma was carried out in 206 patients. Lesions under 8 cm in length and patients younger than 65 years, at least on semi-liquid diet and not contra-indicated for surgery were randomized into a combined group (104 patients) or a surgery alone group (102 patients). Eight MV X ray units were used for the pre-operative radiation using A-P portals to deliver 4,000 cGy to the whole mediastinum and the left gastroepiploic lymphatic chain. Surgery was carried out after 2 to 4 week's rest. The immediate results of the combined group and the surgery alone group were: resection rate 93% and 85%, operative mortality 5% and 6%, intra-thoracic anastomotic leak 0% and 1%, positive pathology at the esophageal stump 0% and 2%, and lymph nodes metastasis 27% and 35% respectively. The 5-year survival rates of the combined group and the surgery alone group were 35% and 30%. We have noticed that those patients with lesions showing radiation reaction of grade III gave a 5-year survival of 50% (12/24). Because intra- and extra-thoracic lymphnode metastasis caused failures (41% and 34% of these two groups), increasing the preoperative tumor dose to 60 Gy or designing post-operative irradiation to cover the bilateral supraclavicular areas was necessary. The whole mediastinum and the left gastroepiploic lymphatics could further improve the results of surgery. Further studies are needed.

Serologic diagnosis of nasopharyngeal carcinoma. A double-blind study of four EB virus antibodies with evaluation by sequential discrimination.

It is generally known that a close relationship exists between Epstein-Barr Virus (EBV) and nasopharyngeal carcinoma (NPC). Recently, patients with early lesions of NPC have been detected in the general population by use of serologic mass survey. Using the double-blind method, we have studied the diagnostic value of the four EBV antibody titers, VCA-IgA, VCA-IgG, EA-IgA and EA-IgG, in four groups of subjects, each consisting of 50 persons: patients with nasopharyngeal carcinoma (NPC group), patients with cancers other than NPC in the head and neck regions (HNC group), patients with cancers outside of head and neck regions (OC group) and normal individuals (NS group). The results of these four antibodies were evaluated both singularly and together by multivariate sequential discrimination. Taking 1:10 as the criterion of being positive, in the NPC group, the positive rate of VCA-IgA is 88%, the VCA-IgG rate is 100%, the EA-IgA rate is 48% and the EA-IgG rate is 74%. In the non-NPC group, the positive rates of VCA-IgA are as high as 86%-92%, but those of the other antibodies are as low as 0-42%. The positive rates and the geometric mean titers of these four antibodies were all elevated as compared with those in the three non-NPC groups. These differences are statistically significant. VCA-IgG is unimportant in the diagnosis of NPC because of its low specificity. By treating the antibody titers of VCA-IgA, VCA-IgG, EA-IgA and EA-IgG with sequential discrimination, the correlation rate between the serology and pathology of NPC is 88% and the false positive rate is 7.3%.

Randomized clinical trial on the combination of preoperative irradiation and surgery in the treatment of adenocarcinoma of gastric cardia (AGC)--report on 370 patients.

PURPOSE: An attempt was made to define the role of radiotherapy before operation for AGC. METHODS AND MATERIALS: From January 1978 to May 1989, a prospective randomized trial on preoperative radiotherapy (R+S) vs. surgery alone (S) for AGC was carried out in 370 patients. Patients were randomized into a combined group (R+S, 171 patients) or a surgery alone group (S, 199 patients) by the envelope method. 8-MV photon or telecobalt was used for the preoperative radiation therapy, using anterior-posterior opposing parallel fields to deliver 40 Gy to the cardia, lower segment of the esophagus, fundus, lesser curvature, and hepatogastric ligament. Surgery was performed after 2 to 4 weeks rest. RESULTS: The 5- and 10-year survival rates of the R+S Group and the S Alone Group were 30.10% and 19.75%, 20.26% and 13.30%, respectively. The survival curves of these two groups diverged right from the beginning after the operation over the ninth year. Statistics by Kaplan-Meier log rank test proves that the difference is significant (chi2 = 6.74, p = 0.0094). The immediate results were: resection rate 89.5% and 79.4% (p < 0.01); pathologic stage after resection T2 12.9% and 4.5% (p < 0.01), T4 40.3% and 51.3% (p < 0.05), lymph node metastasis rates 64.3% and 84.9% (p < 0.001); operative mortality rates 0.6% and 2.5%; intrathoracic leak rates 1.8% and 4.0%, respectively. The causes of failure were: local uncontrol and recurrence 38.6% vs. 51.7% (p < 0.025), regional lymph node metastasis 38.6% vs. 54.6% (p < 0.005), distant metastasis 24.3% vs. 24.7%. CONCLUSION: Preoperative radiation therapy is able to improve the results of surgery for adenocarcinoma of the gastric cardia.

Long term survival of radiotherapy for esophageal cancer: analysis of 1136 patients surviving for more than 5 years.

One thousand one hundred and thirty-six patients surviving for more than five years after radiotherapy were studied. The important prognostic factors are: lesion less than 5 cm in length, lesion located in the upper-third segment and lesion that is radiosensitive. The radiation dose given to long term survivors varies greatly, i.e., 2700 to 9300 rad. Yet, for the sensitive type of lesion, doses lower than 5000 rad could also effect a cure. The delivery of an optimum dose determined by serial examinations during radiotherapy could improve the result of treatment. For local recurrent lesions, the value of a second course of radiation is extremely limited and surgery is the only means to offer a cure. For metastasis in the lymph nodes, radiation offers some hope of cure, although the long term outcome may not be satisfactory. For second primary cancer of the esophagus, aggressive radiation still gives encouraging results.

Comparison of pre- and postoperative radiation in the combined treatment of carcinoma of maxillary sinus.

A series of 50 patients with cancer of the maxillary sinus treated by either preoperative or postoperative radiation from February, 1958 to June, 1974 is presented. In the postoperative group the patients were either free from recurrence, of if there was recurrence, the tumor was less than 0.5 cm in diameter. In the preoperative group, 23 of 36 patients survived for more than five years (64%). In the postoperative group, 4 of 14 patients survived for more than five years (26%). There is an obvious superiority in the preoperative radiation group. The surgical complication rate in the preoperative group was 29% as compared to 14% in the postoperative group. Although the incidence of complications in the preoperative group is higher, we believe it is worth attempting in clinical practice because of the more favourable survival rates.

Non-cancerous ulcer in the esophagus after radiotherapy for esophageal carcinoma--a report of 27 patients.

Twenty-seven patients with non-cancerous ulcers (NCU) (radiation ulcer) after radiotherapy for esophageal carcinoma are presented. Two-thirds of them had been misdiagnosed as uncontrolled or recurrent cancers, leading to improper management. Patients with NCU in the esophagus are characterized by having severe pain in the chest or back, especially on swallowing. On X-ray films, the lesions appear as superficial ulcerations with a line of demarcation above and below the ulcer margin. The wall opposite the ulcer is not usually involved and the ulcer infrequently invades the nearby organs. On conservative treatment, they usually heal and the symptoms are relieved. Seven out of 27 patients have survived from 20 months to 13 years without any evidence of disease.