Objective To compare the dosimetric differences between helical tomotherapy (HT) and volume-modulated arc therapy (VMAT) in the treatment of upper thoracic esophageal carcinoma (UTEC).Methods A total of 10 patients with UTEC were randomly selected.HT plan and double-arc VMAT plan were designed and optimized for each patient.The prescription dose was 50 Gy/30 fractions for gross target volume (GTV), 66 Gy/30 fractions for planned target volume (PTV).The dose distribution and conformal index (CI), homogeneity index (HI) of target volume, the D1％, D5％, Dg5％, D99％, and dose of organ at risk (OAR) were analyzed by using the dose volume histogram (DVH).The monitor units and delivery time were also evaluated.Results For GTV and PTV, the D99％ of HT plans were slightly higher than those of VMAT plans (t =4.476, 3.756, P ＜ 0.05) , but no significant differences in D1％ , D5％ , D95％ , HI and CI (P ＞ 0.05) were found.The V10, V15, V20 and mean lung dose (MLD) to the total-lung of HT plans were all significantly lower than those of VMAT plans (t =-3.369,-4.824, -4.869,-3.657, P ＜ 0.05).There were no significant differences for V5, V30 and Dmax of cord (P ＞ 0.05).The monitor units and delivery time of VMAT plans were significantly lower than those of HT plans (t =13.970, 7.982, P ＜ 0.05).Conclusions Both HT and VMAT are appropriate for esophageal cancer radiotherapy.HT significantly reduces the radiation dose of the total-lung, while VMAT has obvious advantages in efficiency.

Objective To evaluate the dosimetric characteristics of helical tomotherapy (HT),intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiation therapy (3D-CRT) for postoperative radiotherapy of rectal cancer.Methods Ten male patients with stage Ⅱ or Ⅲ middle or low position rectal cancer were selected retrospectively.All of the 10 patients underwent Dixon surgery and CT simulation orientation.The target volumes and normal organs were drawn in the CT images and the plans for HT,IMRT and 3D-CRT were designed.The prescribed dose was given 50 Gy in 25 fractions,covering at least 95％ of the planning target volume.Results All plans met the needs of the prescribed doses.The HT and IMRT plans met the needs of dose limit to organs at risk,however,the 3D-CRT plans failed to do that.The conformity indexes of HT,IMRT and 3D-CRT plans were 0.86,0.82 and 0.62,respectively (F =206.81,P ＜ 0.001),and the homogeneity indexes were 0.001,0.157,and 0.205,respectively (x2 =15.8,P ＜ 0.001).The 3D-CRT plans had larger volumes than the HT plans and IMRT plans in the high-dose regions such as pelvic V50,bladder V40,bowel V50 and femoral head D5 (P ＜ 0.05),but the differences between the HT plans and IMRT plans were not statistically significant (P ＞0.05).The V15 value of bowel of HT plans were higher than those of the IMRT and 3D-CRT plans (71.1％ vs.63.3％ and 67.7％,respectively).However,there was no significantly difference.Conclusions All of the HT,IMRT and 3D-CRT plans are able to meet the prescription dose requirement of the target regions of rectal cancer.The HT plans show the best dose homogeneity and target conformity,followed by the IMRT plans,and then the 3D-CRT plans.The HT plans meet the needs of all OARs slightly better than the IMRT plans.3D-CRT plans are simple and practical with poor protective ability toward the OARs.

Background and purpose: The incidence of breast cancer increases as patients age, elderly patients account for a large proportion. Due to the insufifcient systemic therapy, more complications and poorly physical condition, the prognosis of elderly patients is often worse than the younger. The aim of this study was to investigate the safety and tolerance with non-anthracyclin regimen as adjuvant chemotherapy in elderly breast cancer patients. Methods:From Nov. 2008 to Jan. 2012, 56 patients (≥65 years) after surgical excision were enrolled into this study. The patients were divided into two groups:TC and PC groups. Each patient received 4 or 6 cycles of chemotherapy of PC (175 and 600 mg/m2, respectively;n=21) or TC (75 and 600 mg/m2, respectively;n=35), administered intravenously every 3 weeks, as adjuvant chemotherapy. Radiation therapy (as indicated) and endocrine therapy, for patients with hormone receptor-positive disease, were administered after completion of chemotherapy. Results: In this study, 50 patients completed chemotherapy as plan, the proportion of two groups were above 90%. After a median follow-up of 33 months, the median disease-free survival(DFS) and overall survival(OS) were not reached. The relapse-free rate and survival rate were 89.5%and 100%in the PC regime group, which were 90.3%and 96.8%in the TC regime group. Major toxicities included:neutropenia, leucopenia, alopecia, nausea, vomiting and various degree of peripheral neuropathy. The incidence of gradeⅢ-Ⅳneutropenia was 76.2%in PC group vs 48.6%in TC group (P=0.044). The most common cause for withdrawing from treatment was to be unable to tolerate the adverse effects. Conclusion:Adjuvant chemotherapy with paclitaxel and cyclophosphamide is safe, tolerable and promising for elderly breast cancer patients.

Objective To evaluate the efficacy and safety of trastuzumab plus different chemotherapy regimens in treatment of patients with HER-2-positive advanced breast cancer .Methods 132 patients with advanced HER-2-positive breast cancer were treated with trastuzumab plus different regimens . The clinical characteristics, efficacy and toxicity of the 132 patients were retrospectively analyzed.Results Five patients had complete response ( CR ) , 61 patients had partial response ( PR ) , 39 patients had stable disease (SD), and 27 patients had progressive disease (PD).The objective response rate was 50.0%and the disease control rate was 79.5%.The median progression-free survival was 9.3 months.The median overall survival time was 46.2 months.The 1-, 2-, 5-year survival rates were 98.3%, 81.9% and 40.2%, respectively.Trastuzumab combined with chemotherapy is superior to trastuzumab monotherapy (51.2%vs.33.3%).The number of metastatic sites , efficacy, different previous treatment lines were independent prognostic factors of PFS (P=0.002, P<0.0001 and P<0.0001, respectively).Visceral metastases, pathological grade, and PFS were independent prognostic factors of OS (P=0.041, P=0.001, P=0.025, P<0.001, P<0.0001 and P<0.0001, respectively).Regarding the toxicities, one case discontinued treatment due to the decrease of left ventricular ejection fraction to 47%, two cases had heartbeat tachycardia , 6 cases had palpitation , 17 cases had a fever during first input trastuzumab .No other serious cardiac toxicity was observed .The most common toxicities were chemotherapy-related hematological and non-hematological toxicities .Conclusions Trastuzumab combined with chemotherapy is superior to trastuzumab monotherapy . Patients may get benefits for early use of trastuzumab . Trastuzumab plus chemotherapy is effective and well tolerated in patients with advanced HER-2 positive breast cancer .No heart failure occurred in this series of patients , and cardiac safety seems better than that in Caucasians because of younger age at the onset in Chinese advanced breast cancer patients .

Objective To evaluate the efficacy and safety of trastuzumab plus different chemotherapy regimens in treatment of patients with HER-2-positive advanced breast cancer .Methods 132 patients with advanced HER-2-positive breast cancer were treated with trastuzumab plus different regimens . The clinical characteristics, efficacy and toxicity of the 132 patients were retrospectively analyzed.Results Five patients had complete response ( CR ) , 61 patients had partial response ( PR ) , 39 patients had stable disease (SD), and 27 patients had progressive disease (PD).The objective response rate was 50.0%and the disease control rate was 79.5%.The median progression-free survival was 9.3 months.The median overall survival time was 46.2 months.The 1-, 2-, 5-year survival rates were 98.3%, 81.9% and 40.2%, respectively.Trastuzumab combined with chemotherapy is superior to trastuzumab monotherapy (51.2%vs.33.3%).The number of metastatic sites , efficacy, different previous treatment lines were independent prognostic factors of PFS (P=0.002, P<0.0001 and P<0.0001, respectively).Visceral metastases, pathological grade, and PFS were independent prognostic factors of OS (P=0.041, P=0.001, P=0.025, P<0.001, P<0.0001 and P<0.0001, respectively).Regarding the toxicities, one case discontinued treatment due to the decrease of left ventricular ejection fraction to 47%, two cases had heartbeat tachycardia , 6 cases had palpitation , 17 cases had a fever during first input trastuzumab .No other serious cardiac toxicity was observed .The most common toxicities were chemotherapy-related hematological and non-hematological toxicities .Conclusions Trastuzumab combined with chemotherapy is superior to trastuzumab monotherapy . Patients may get benefits for early use of trastuzumab . Trastuzumab plus chemotherapy is effective and well tolerated in patients with advanced HER-2 positive breast cancer .No heart failure occurred in this series of patients , and cardiac safety seems better than that in Caucasians because of younger age at the onset in Chinese advanced breast cancer patients .

Objective To assess the efficacy of vinorelbine ( NVB)?based regimens in patients with metastatic triple negative breast cancer (mTNBC) pretreated with anthracyclines and taxanes. Methods Clinical data of 48 patients diagnosed and treated for mTNBC between 2004 and 2012 at the Cancer Hospital, Chinese Academy of Medical Sciences ( CAMS) were retrospectively analyzed. All patients were pretreated with anthracyclines and at least one taxane in neo?adjuvant, adjuvant or chemotherapy for mTNBC and patients should be having at least one measurable metastatic lesion. Totally, 48 patients were included in this study, of which 21 cases received first?line chemotherapy and 27 cases received second?line chemotherapy. Based on the regimen they received, 22 patients were treated with NVB plus platinum ( NP ) , and 26 patients with NVB plus capecitabine ( NX ) . Results After 70 months follow?up, in the total group of patients, the objective response rate was 20.8%, clinical benefit rate was 43.8%, median progression free survival (PFS) was 4.4 months and median overall survival (OS) was 15.5 months. In addition, the ORR was significantly better in the NP arm versus NX arm (33.8% vs.7.7%, P=0.029) as well as PFS was statistically improved in the NP arm than NX arm (5.3 m vs. 3.0 m, P=0.023). Similar trend was observed in the OS, although the difference was not statistically significant (27.7 m vs. 14.8 m, P=0.077). In all, the most frequently reported adverse events were G1/2 gastrointestinal toxicity ( 68. 8%) and neutropenia (62.5%) . No significant difference was observed between the NP arm and NX arm ( P>0. 05). The percentage of patients who delayed chemotherapy administration in the NP arm and NX arm was 9.1% ( n=
2), and 3.8% (n=1), respectively. Conclusions NVB?based combination chemotherapy demonstrates moderate efficacy in mTNBC patients pretreated with anthracyclines and one taxane with manageable toxicity. NP regimen shows potential superiority over NX regimen, and should be further verified in randomized phaseⅢ clinical trial in larger cohort.

Objective: We aimed to examine the feasibility and toxicity of EC-T dose-dense regimen and to demonstrate the suitable dose of epirubicin in a Chinese early-stage breast cancer population with high recurrence risk. Methods: 370 patients with early-stage breast cancer at high risk of recurrence were treated with EC-T dose-dense adjuvant chemotherapy and prophylactic administration of recombinant human granulocyte stimulating factor (G-CSF). The incidence of delayed chemotherapy, drug reduction and adverse reactions were retrospectively analyzed. Results: 370 patients completed the planned eight cycles of chemotherapy, 50 patients experienced chemotherapy delay, and 90 had chemotherapy dose reductions. Overall, 61.1% of the patients experienced grade 3 or 4 hematology toxicities, 4.1% of the patients experienced grade 3 gastrointestinal toxicity, 16.3% experienced grade 3 or 4 liver malfunction, and 1.9% experienced grade 3 alopecia. In the multivariate analysis, pretreatment epirubicin levels were associated with comprehensive and hematology toxicity risk (OR=1.268, P=0.046; OR=1.244, P=0.036). With G-CSF support, the probability of grade 3-4 dose limiting toxicity, i. e. neutropenia, abnormal liver function, and gastrointestinal adverse effects did not increase as the epirubicin dose level increased(P>0.05). However, there were no statistically significant associations between epirubicin grade and treatment delay (P=0.814) or dose reduction (P=0.282). Conclusions EC-T dose-dense chemotherapy shows tolerable toxicity. High dose level is not a limiting factor for this regimen. With G-CSF support, epirubicin 85-90 mg/m² is appropriate tolerance dose for Chinese early breast cancer patients with high recurrence risk.

Objective To assess the efficacy of vinorelbine ( NVB)?based regimens in patients with metastatic triple negative breast cancer (mTNBC) pretreated with anthracyclines and taxanes. Methods Clinical data of 48 patients diagnosed and treated for mTNBC between 2004 and 2012 at the Cancer Hospital, Chinese Academy of Medical Sciences ( CAMS) were retrospectively analyzed. All patients were pretreated with anthracyclines and at least one taxane in neo?adjuvant, adjuvant or chemotherapy for mTNBC and patients should be having at least one measurable metastatic lesion. Totally, 48 patients were included in this study, of which 21 cases received first?line chemotherapy and 27 cases received second?line chemotherapy. Based on the regimen they received, 22 patients were treated with NVB plus platinum ( NP ) , and 26 patients with NVB plus capecitabine ( NX ) . Results After 70 months follow?up, in the total group of patients, the objective response rate was 20.8%, clinical benefit rate was 43.8%, median progression free survival (PFS) was 4.4 months and median overall survival (OS) was 15.5 months. In addition, the ORR was significantly better in the NP arm versus NX arm (33.8% vs.7.7%, P=0.029) as well as PFS was statistically improved in the NP arm than NX arm (5.3 m vs. 3.0 m, P=0.023). Similar trend was observed in the OS, although the difference was not statistically significant (27.7 m vs. 14.8 m, P=0.077). In all, the most frequently reported adverse events were G1/2 gastrointestinal toxicity ( 68. 8%) and neutropenia (62.5%) . No significant difference was observed between the NP arm and NX arm ( P>0. 05). The percentage of patients who delayed chemotherapy administration in the NP arm and NX arm was 9.1% ( n=
2), and 3.8% (n=1), respectively. Conclusions NVB?based combination chemotherapy demonstrates moderate efficacy in mTNBC patients pretreated with anthracyclines and one taxane with manageable toxicity. NP regimen shows potential superiority over NX regimen, and should be further verified in randomized phaseⅢ clinical trial in larger cohort.

Objective:The 6th edition American Joint Committee on Cancer (AJCC) staging system for breast cancer classifies ipsilateral supraclavicular lymph node metastasis (ISLM) downing stage from M1 to N3, suggesting more patients might receive radical treatment. The aim of this study was to analyze the effect of ISLM on the prognosis of N3 breast cancer and verify the rationality of modified staging.Methods:A total of 321 breast cancer patients with N3 according to the 6th edition AJCC staging system were retrospectively analyzed. Propensity Score Matching (PSM) was used to pair the different subgroups of N3. The primary end point was disease-free survival (DFS), the secondary end point was overall survival (OS). Kaplan-Meier method was used to calculate the DFS and OS. The differences between two groups were analyzed by the Log-rank test.Results:After PSM pairing twice, 78 patients with none-ISLM and 78 patients with ISLM were enrolled in the first group; 51 patients with none-ISLM was compared patients with isolated ISLM in the second group. The results of the two groups showed that patients with none-ISLM have a prolonged DFS (the first group: 58.9 months vs 32.1 months, P=0.101; the second group: 59.0 months vs 44.0 months, P=0.533), while the OS was opposite (the first group: 87.4 months vs 140.4 months, P=0.289; the second group: 87.4 months vs 137.1 months, P=0.289). Conclusions:The prognosis of breast cancer patients with ISLM is similar to that of patients with none-ISLM in stage N3. It is reasonable to include ISLM in N3 in the 6th edition AJCC staging system. Yet, prospective studies with larger sample size are needed to further confirmation.

Objective:The 6th edition American Joint Committee on Cancer (AJCC) staging system for breast cancer classifies ipsilateral supraclavicular lymph node metastasis (ISLM) downing stage from M1 to N3, suggesting more patients might receive radical treatment. The aim of this study was to analyze the effect of ISLM on the prognosis of N3 breast cancer and verify the rationality of modified staging.Methods:A total of 321 breast cancer patients with N3 according to the 6th edition AJCC staging system were retrospectively analyzed. Propensity Score Matching (PSM) was used to pair the different subgroups of N3. The primary end point was disease-free survival (DFS), the secondary end point was overall survival (OS). Kaplan-Meier method was used to calculate the DFS and OS. The differences between two groups were analyzed by the Log-rank test.Results:After PSM pairing twice, 78 patients with none-ISLM and 78 patients with ISLM were enrolled in the first group; 51 patients with none-ISLM was compared patients with isolated ISLM in the second group. The results of the two groups showed that patients with none-ISLM have a prolonged DFS (the first group: 58.9 months vs 32.1 months, P=0.101; the second group: 59.0 months vs 44.0 months, P=0.533), while the OS was opposite (the first group: 87.4 months vs 140.4 months, P=0.289; the second group: 87.4 months vs 137.1 months, P=0.289). Conclusions:The prognosis of breast cancer patients with ISLM is similar to that of patients with none-ISLM in stage N3. It is reasonable to include ISLM in N3 in the 6th edition AJCC staging system. Yet, prospective studies with larger sample size are needed to further confirmation.