Objective:To analyze the risk factors of first-episode hematogenous metastasis in patients with thoracic esophageal squamous cell carcinoma (ESCC) who received non-surgical treatment after radiotherapy and chemotherapy, and its impact on survival and prognosis.Methods:The clinical data of 230 ESCC patients who met the inclusion criteria and received radical radiotherapy in Tengzhou Central People′s Hospital and Affiliated Hospital of Xuzhou Medical University from January 2011 to October 2018 were retrospectively analyzed.Logistic regression analysis and survival were used to analyze the risk factors and prognosis of blood group metastasis after treatment.Results:In 230 patients with thoracic esophageal cancer, 70 cases (30.4%) developed hematogenous metastasis for the first time.Compared with patients without hematogenous metastasis, the median overall survival was 15 months and 20 months (χ 2=7.249, P=0.007), and the median progression free survival was 9 months and 13 months (95% CI was 7.2-10.8 months and 10.8-15.2 months, respectively χ 2=21.664, P<0.001). Logistic multivariate analysis showed that there was significant difference in the occurrence of hematogenous metastasis among different N stages (χ 2=30.764, P<0.001). N stage was an independent factor for judging hematogenous metastasis, and the increased N stage increased the risk of hematogenous metastasis (OR value were 6.000, 12.629 and 48.167, respectively; 95% CI were 1.712-21.025, 3.546-44.976 and 10.848-213.858, respectively; all P<0.05). The overall survival time of patients with concurrent chemoradiotherapy before hematogenous metastasis was longer than that of patients with sequential chemoradiotherapy and radiotherapy alone (χ 2=10.002, P=0.007). Stratified analysis showed that adjuvant chemotherapy after concurrent chemoradiotherapy could prolong the overall survival of patients with N2 and N3 (χ 2=11.025, P=0.001). Conclusion:N staging is an independent factor to judge the hematogenous metastasis.ESCC patients with hematogenous metastasis after chemoradiotherapy have poor prognosis.N2, N3 patients with concurrent chemoradiotherapy after adjuvant chemotherapy have clinical benefits.

Objective To compare the dose distribution of postoperative plans with preoperative plans for 3D printing coplanar template assisted radioactive seed implantation,and to explore the accuracy of the technique in seed implantation.Methods From November 2015 to December 2016 a total of 32 patients were selected and underwent 3D printing coplanar template assisted radioactive seed implantation in Tengzhou Central People's Hospital of Shandong province.There were 36 implanted lesions,including l0 in the lungs,5 in neck lymphs,3 in pelvic cavities,3 in vertebral body,2 in pancreas,2 in abdominal lymph nodes,2 in portal veins,and 9 in the other parts.All patients were given preoperative planning and guided by the coplanar templates.Compared with the preoperative plan,all levels needles inserted at the same time.According to preoperative planning the implantation surgery was completed accurately.The postoperative dosimetry was evaluated.The preoperative and postoperative dosimetry parameters were compared,including Dg0,D100,V90,V100.V150,V200 and conformal index (CI),external index (EI),and homogeneity index(HI).The paired t test was used to perform the statistical analysis.Result There was no significant differences in Dg0,D100,V90,V100,V150,V200,CI,EI and HI between before and after operation(P ＞ 0.05).Conclusions The dose parameters in postplan showed no difference compared with preplan in this study.For fixed and moving organ tumors,3D printing coplanar template assisted radioactive seed implantation has good therapeutic accuracy,and may be a standardized surgicalmethod for seed implantation in the future.

Objective:To investigate the technical method and clinical efficacy of CT-guided radioactive 125I seed implantation (RISI) assisted by 3D-printed coplanar template(3D-PCT) in the treatment of metastatic tumors of chest wall, and analyze the influence of dosimetric parameters on the treatment efficacy. Methods:A retrospective analysis was conducted for 55 patients with metastatic tumors of chest wall treated with 3D-PCT-assisted 125I radioactive seed implantation in Tengzhou Central People′s Hospital from January 2014 to March 2021.Preoperative plans were made using a brachytherapy treatment planning system, and dosimetric parameters were assessed at 3d after surgery. During regular CT reexaminations after surgery, the local control rate and overall survival (OS) rate were calculated and the pain relief degree and complications were assessed. The Logrank test and Cox regression were used for univariate and multivariate analyses of local control time (LCT). Meanwhile, receiver operating characteristic (ROC) curves were plotted to analyze the critical values of dosimetric parameters and to predict the LCT. Results:The 1-, 2-, and 3-year OS rates ofthe 55 patients were 72.7% (40/55), 21.8% (12/55), and 16.4% (9/55), respectively.The local control rates of 3, 6, 12, and 24 months were 96.4%(53/55), 86.5%(45/52), 85.0%(34/40), and 91.7%(11/12), respectively. There was no statistically significant difference between postoperative and postoperative dosimetric parameters of GTV, particle number, D90, D100, V100, V150, V200, CI, EI, and HI ( P> 0.05). Compared with postoperative V90, the postoperative V90 decreased with a statistically significant difference( P=0.006). As indicated by the univariate Cox regression analysis, the pathological grade, D90, D100, V90, and V200had significant effects on the LCT( P<0.05). Among them, the pathological grade and D90 were independent influencing factors of the LCT, while the other factors showed no statistically significant difference according to the multivariate Cox regression analysis.The LCT of patients with D90≥127 Gy was significantly longer than that of patients with D90<127 Gy (χ 2=16.61, P=0.000). The pain relief rate was 80.8%(21/26) after three months. Five cases suffered from grade Ⅰ-Ⅱ radioactive dermatitis and one case experienced grade Ⅲ radioactive dermatitis. Conclusions:The 3D-PCT-assisted CT-guided 125I radioactive seed implementation can achieve precise and controllable dose and definite efficacy in the treatment of metastatic tumors of chest wall, with few complications.The LCT was remarkably prolonged in the case of D90≥127 Gy, and D90 is an independent influencing factor of the LCT.