Adenosine deaminase (ADA) activity in pleural fluid from 81 patients was measured by colorime-tric method. Of these cases, 55 cases were tuberculous pleural effusion, 22 cases were malignant pleura! effusion and 4 cases were transudate pleural effusion.The mean ADA, activity in pleural fluid of tuberculous group was 188.3?58.2u and that of malignant group was 52. 2?15. 4u. Statistically the difference is highly significant (p0.05). In tuberculous group, pleural fluid ADA levels higher than 110u were found in 53. cases (96.3%), and those above 120u were found in 52 cases (94.5%), while no case in malignat group had the ADA level higher than 90u, and in 20 cases it is lower than 70u (20/22 cases, 90.9%). These data suggest that pleural fluid ADA activity may be a useful index in the differential diagnosis of tuberculous and malignant pleural effusions.

ObjectiveThis study evaluates the feasibility of intensity-modulated radiation therapy (IMRT) to treat patients with 1 -5 brain metastases from non-small cell lung cancer (NSCLC).Methods 30 IMRT patients with brain metastases for NSCLC studied retrospectively.Whole brain radiotherapy plus three-dimensional conformal radiotherapy (WBRT + 3DCRT) and WBRT plus stereotactic radiotherapy ( WBRT + SRT) plans were generated.Planning target volume ( PTV ) and organs at risk dose were measured and compared by dose volume histogram.Differences were analyzed in the three techniques by Wilcoxon Z -test.Results D99％ of the shoulder ( D99％-D90％ ) from IMRT were higher than from WBRT +3DCRT and WBRT+SRT in all cases.From D15％ of slope (D90％-D10％) to D5％ of tail (D10％ -D1％ ),IMRT were lower than WBRT + 3DCRT and WBRT + SRT ( Z =- 4.72,P =0.000 and Z =- 4.72,P =0.000).D10％ and D5％ of IMRT were (35.1 ±1.42) Gy and (37.7 ±2.91) Gy,WBRT +3DCRT were (36.5±2.86) Gy and ( 39.1 ± 3.56) Gy ;WBRT + SRT were (36.2 ± 2.57) Gy and ( 38.7 ± 3.67) Gy.IMRT vs WBRT+ 3DCRT and WBRT + SRT were significant ( Z=-3.18,-3.18,P=0.001,0.001 and Z=- 4.11,- 3.02,P =0.000,0.002) in 13 patients with 3 - 5 brain metastases.The total mean monitor units were 14756.3,9614.8 and 9043.2 for IMRT,WBRT +3DCRT and WBRT + SRT plans,respectively,with a 38.7％ reduction from IMRT to WBRT + SRT (Z =-4.78,-4.78,P =0.000,0.000).The brain doses around metastases were similar in the three techniques with 1 -2 metastases,but IMRT was the best with 3 -5 metastases.ConclusionsIMRT can advance brain metastases dose and improve the planning target minimum dose and spare the dose around brain metastases.Only IMRT is the best choice for just sparing the dose around brain metastases among 3 -5 brain metastases.

ObjectiveTo prospectively investigate the impact of short-time response on survival of concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT) for stage Ⅳ non-small cell lung cancer (NSCLC). Methods From Jan.2003 to Oct.2010,201 patients with pathologically or cytologically proven stage Ⅳ NSCLC were included.All patients received platinum-based chemotherapy.Of the 167 patients eligible for analysis,the median number of chemotherapy were 4 cycles.The median dose for planning target volume (PTV) of thoracic primary tumor was 63 Gy.Response was scored according to WHO criteria. Survival was calculated by Kaplan-Meier method and compared using the Logrank. Cox regression model were used to examine the effect of response on overall survival.ResultsThe follow-up rate of 201 patients was 97.5％.with 201,170 and 134 patients finished ＜ 1,1 -2 and ≥3 years' follow-up.For the 167 patients eligible for analysis,the CR,PR,NC and PD rate of primary tumor was 5.4％,65.9％,21.0％ and 7.7％,respectively.The effective group ( CR + PR) and ineffective group ( NC + PD) was 71.3％ and 28.7％,respectively.The median survival time (MST) for patients with CR,PR,NC and PD was 22.6,13.4,8.8 and 4.8 months,respectively ( χ2 =44.79,P =0.000).The MST for effective and ineffective group was 13.9 and 7.6 months,respectively in the whole group ( χ2 =8.3 0,P =0.004 ),12.1months and 7.3 months in those treated with 2 - 3 cycles chemotherapy ( χ2 =7.71,P =0.007 ),and 13.9months and 7.9 months in those treated with 2 -5 cycles chemotherapy and radiation dose to PTV ≥36 Gy ( χ2 =4.00,P =0.045 ).No significant MST difference was detected between patients of effective group and ineffective group treated with 4 -5 cycles chemotherapy ( χ2 =0.67,P =0.413),or those treated with 4 -5 cycles of chemotherapy and radiation dose to primary lesion ≥36 Gy (χ2 =0.00,P =0.956).Multivariate analysis showed that 4-5 cycles of chemotherapy and CR and PR achieved in primary tumor (β =0.182,P=0.041 ) were independent favorable factors for survival. Conclusion CCTTRT can improve local control,and prolong the survival time for Stage Ⅳ NSCLC.

Objective To prospectively evaluate the survival of different metastasis organs with concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT) for stage Ⅳ non-small cell lung cancer (NSCLC).Methods Two hundred and one patients of stage Ⅳ NSCLC were enrolled from January,2003 to July,2010.Of the 182 patients eligible for analysis,The number of patients with single-organ metastasis or multiple-organ metastasis was 107 and 75,respectively.Patients were treated by platinum-based chemotherapy,the median number of cycle was 4.The median dose to planning target volume of primary tumor (DTPTv) was 63 Gy.Survival was calculated by Kaplan-Meier method and compared using the Logrank.Results The follow-up rate of 201 patients was 97.5％.with 201,170 and 134 patients finished ＜ 1,1 -2 and ≥3 years'follow up.Of 182 patients,the 1-,2-,and 3-year overall survival (OS) rate and median survival time (MST) was 41.0％,17.0％,10.0％ and 10.5 months,respectively ;with single-organ metastasis and multi-organ metastasis were 50％,20％,14％ and 13 months and 29％,12％,0％ and 8.5 months ( x2 =10.10,P =0.001 ),respectively; compared with multi-organ metastasis,the 1-,2-,and 3-year OS arte and MST of patients with bone,lung metastasis only was 58％,25％,16％ and 14 months (x2 =10.42,P=0.001 ) and 49％,21％,21％ and 11 months (x2 =6.39,P=0.011 ) respectively;patients with brain metastasis only did not show advantage of survival comparing with patients with multi-organ metastasis (49％,8％,0％ and 12 months and 29％,12％,0％ and 8 months,respectively;x2 =0.71,P =0.401 ) ;the 1-,2-,and 3-year OS rate and MST was 63％,23％,19％ and 15 months and 42％,15％,0％ and 10 months,respectively for patients with single-organ metastasis and multi-organ metastasis patients who accepted 4 - 5 cycles of chemotherapy ( x2 =6.47,P =0.011 ) ; for patients under the same metastasis and 4 - 5 cycles of chemotherapy,no matter whether single-organ or multiple-organ metastases,the 1 -,2-,3-year OS rate and MST of patients with enough radiotherapy on DTPTV ≥63 Gy were better than patients without enough radiotherapy ( DTPTV ＜ 63 Gy ) ( 71％,25 ％,25％ and 16.8 months and 33％,17％,0％ and 10.5 months,respectively;x2 ＝4.73,P =0.030 ;54％,21％,0％ and 14.3 months and 29％,10％,0％ and 7.6 months,respectively,x2 =8.16,P =0.004).The MST of liver metastases was 6 months,there was significantly difference when comparing with non liver matastasis ( x2 =17.21,P =0.000).Conclusions It is very important to treat stage Ⅳ NSCLC with CCTTRT,especially patients with single-organ metastasis.Liver metastases is a unfavorable prognostic factor.

Objective To evaluate the overall survival and safety among patients for stage Ⅳ non-small cell lung cancer (NSCLC) treated with concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT).Methods From Jan.2003 to July 2010,201 patients with stage Ⅳ NSCLC were included.All patients were treated with CCTTRT.Those patients who received only one cycle chemotherapy were not included in survival analysis,but analysis of toxicity.One hundred and eighty-two patients were eligible for survival analysis.All patients received platinum-based two-drug chemotherapy.The median number of cycles was 4.The median dose to planning target volume of primary tumor ( DTPTV ) was 63 Gy.Treatment-related gastrointestinal and hematological toxicity were scored according to WHO criteria.Radiation-related pneumonitis and esophagitis were evaluated according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTC) version 3.0.Survival was calculated by Kaplan-Meier method and compared using the Logrank.Cox regression model was used to examine the effect of CCTTRT on overall survival.Results The follow-up rate of 201 patients was 97.5％.with 201,170 and 134 patients finished ＜ 1,1 -2 and ≥3 years' follow-up,respectively.Of the 182 patients eligible for survival analysis,further stratified analysis showed that the 1-,2-and 3-year overall survival rate and median survival time (MST) was 54％,20％,13％ and 14.3 months,respectively for patients treated with concurrent 4 -5 cycles chemotherapy and CCTTRT,and 66％,23％,19％ and 16.1 months,respectively for those treated with 4 -5 cycles chemotherapy and DTPTV ≥ 63 Gy.Under similar chemoradiotherapy intensity,the MST of patients with single organ metastasis was significantly longer than that with multiple organ metastases ( 13.0 months versus 8.5 months,x2 =10.10,P =0.001 ).For patients eligible for survival analysis and received 4 - 5 cycles of systemic chemotherapy,MST of patients treated with DTPTV≥63 Gy was significantly longer than those treated with DTPTV ＜63 Gy[14.9 months vs.8.4 months (x2 ＝20.48,P =0.000) and 16.1 months vs.8.8 months ( x2 =11.75,P =0.001 )].For patients with single organ metastasis,MST was 16 months for those treated with DTPTV ≥63 Gy and 9 months for those with DTPTV ＜63 Gy (x2 =10.51,P=0.000) ;for patients with multiple organ metastasis,it was 11 months and 7 months,respectively ( x2 =7.90,P =0.005 ).Multivariate analysis showed that concurrent 4 - 5 cycles chemotherapy and DTPTV ≥63 Gy (β =0.243,P=0.019) and improved KPS (β =1.268,P=0.000) were independent factors for survival.For the whole group,45％ patients had Grade 2 -3 gastrointestinal toxicity,35.0％ grade 3- 4 leukopenia,18％ grade 3- 4 thrombocytopenia.15.0％ grade 3- 4 anemia,9.5％ Grade 2 - 3 radiation pneumonia and 13.4％ radiation esophagitis,respectively.Conclusions For stage Ⅳ NSCLC,CCTTRT can prolong survival time with acceptable toxicity.Radiotherapy to thoracic primary tumor should be under consideration.

Objective To evaluate the importance of three-dimensional radiotherapy for elderly patients of stage Ⅳ non-small cell lung cancer (NSCLC).Methods Comparing with treatment outcome of ≥65 years 67 patients and ＜ 65 years 134 patients using concurrent chemotherapy and thoracic threedimensional radiotherapy during 2003 to 2010 years.Survival analysis was taken by Kaplan-Meier method.The multivariate prognosis was analyzed by Cox model.Results The follow-up was 97.8％.The percentage of ≥65 years and ＜ 65 years patients accepted with concurrent 4-5 cycles chemotherapy were 30％ and 55％,and with 42％ and 49％ patients with radiotherapy ≥63 Gy.The median survival time (MST) were 17 months and 14 months (x2 =0.76,P =0.384) for ≥65 years and ＜ 65 years patients accepted with concurrent 4-5 cycles chemotherapy concurrent ≥63 Gy radiotherapy respectively.The MST and 1-,2-,3year overall survival rate were 17 months and 8 months,65％ and 23％,30％ and 13％,24％ and 9％(x2 =7.90,P =0.005) for whole groups patients treated with chemotherapy concurrent ≥63 Gy and ＜ 63 Gy radiotherapy.And the MST of patients ≥ 63 Gy was significantly longer than those with ＜ 63 Gy either concurrent chemotherapy any cycles (x2 =9.54,P =0.023).The MST were 14 months and 8 months (x2 =1.82,P=0.178),17 months and 17 months (x2 =0.47,P=0.492) for ≥ 65 years and ≥ 63 Gy radiotherapy patients accepted with concurrent 4-5 cycles and 2-3 cycles chemotherapy concurrent respectively.Multivariate analysis showed local response (β =0.600,P =0.003) and numbers of tumor metastasis (β =0.670,P =0.040) were independent factors for survival.Conclusions For a part of elderly patients of stage Ⅳ NSCLC,concurrent chemotherapy and thoracic three-dimensional radiotherapy can prolong survival time with acceptable toxicity.Perhaps radiotherapy is more important.

Objective To retrospectively analyze the effect of three-dimensional radiotherapy on the survival of patients with stage Ⅳ squamous cell lung cancer.Methods Of the 101 patients collected from two prospective phase Ⅱ studies, 88 were part of the per-protocol set.All patients received platinum-doublet chemotherapy with concurrent radiation to the primary tumor.Primary endpoints were overall survival (OS) and progression-free survival (PFS).Survival was calculated using the Kaplan-Meier estimator, and univariate and multivariate analyses were performed using the log-rank test and Cox model, respectively.Results The 1-, 2-, 3-, and 5-year OS rates of the 88 patients were 42.2%, 13.6%, 8.7%, and 3.1%, respectively, and the median survival time (MST) was 10 months.The 1-, 2-, 3-, and 5-year OS and MST at PTV dose ≥63 Gy were 45.7%, 25.7%, 17.1%, 7.1%, and 11 months, respectively, whereas the 1-, 2-, 3-, and 5-year OS and MST at PTV dose<63 Gy were 39.6%, 4.5%, 2.8%, 0%, and 10 months, respectively (P=0.007).The median PFS at ≥63 Gy and<63 Gy were 9 months and 7 months, respectively (P=0.032).The 1-, 2-, 3-, and 5-year OS and PFS of patients who received 4 cycles of chemotherapy at a PTV dose of ≥63 Gy were 51.9%, 29.6%, 18.5%, 9.9%, and 9 months, respectively (P=0.001 and P=0.012), which were significantly prolonged compared with other treatment modalities.Multivariate analysis showed that PTV ≥63 Gy may be influence the OS of patients (P=0.080).Conclusions Three-dimensional radiotherapy can prolong the survival of patients with stage ⅠV squamous cell lung cancer, as demonstrated by the gradual improvement in OS and PFS following the increase in the intensity of concurrent chemotherapy and radiation therapy.A PTV dose of ≥63 Gy may be influence the OS.

ObjectiveTo explore the effect of radiation dose on survival for stage Ⅳ non-small cell lung cancer (NSCLC) treated with concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT).Methods From Jan.2003 to Jul.2010,201 Stage Ⅳ NSCLC patients were enrolled.Nineteen patients who received only one cycle chemotherapy were not included in survival analysis.Of the 182 patients eligible for survival analysis,all patients received platinum-based chemotherapy of two drugs.The median number of cycles was 4.The median dose to planning target volume of primary tumor ( DTPTV )was 63 Gy. Survival was calculated by Kaplan-Meier method and compared using the Logrank. Cox regression models were used to examine the effect of DTPTV on overall survival.ResultsThe follow-up rate of 201 patients was 97.5％.with 201,170 and 134 patients finished ＜ 1,1 -2 and ≥3 years' follow-up.The 1-,2-,3-year overall survival rate and median survival time was 20％,14％,0％ and 7.1 months;27％,10％,3％ and 9.6 months;and 59％,22％,16％ and 14.9 months,respectively for patients treated with DTPTV ＜ 45.0 Gy,45.0 - 62.1 Gy and ≥63.0 Gy,respectively ( χ2 =27.88,P =0.000 ) ;43％,19％,0％and 1 1 months and 2 0 ％,1 1％,5 ％ and 8 months,respectively for those received 2 - 3 cycles of chemotherapy and radiation dose ≥63 Gy and ＜ 63 Gy,respectively (χ2 =2.99,P =0.084) ;66％,23％,19％ and 16 months and 29％,12％,0％ and 8.8 months,respectively for those received 4 - 5 cycles chemotherapy and radiation dose ≥ 63 Gy and ＜ 63 Gy,respectively (χ2=15.87,P=0.000).No significant difference was found for patients received 2 - 3 cycles chemotherapy concurrently with DTP,Tv ≥63 Gy and 4 -5 cycles chemotherapy concurrently with DTPTV ＜63 Gy,respectively (χ2 =1.93,P =0.165).Multivariate analysis showed that 4 -5 cycles chemotherapy concurrently with DTPTv ≥63 Gy ( β =0.243,P =0.019),and improved KPS after treatment ( β =1.268,P =0.000) were independent favorable factors for survival.ConclusionChemotherapy concurrent with CCTTRT can prolong survival time of patients with stage Ⅳ NSCLC,especially for those treated with DTPTV ≥63 Gy.

Objective To analyze the low dose-volume associated with radiation-induced lung injury (RILI) in patients with advanced non-small cell lung cancer (NSCLC) treated by three-dimensional confor-real radiation therapy (3DCRT). Methods Data of 100 patients with histologically proved NSCLC treated with 3DCRT or IMRT between November 2006 and January 2009 were collected. Nine patients treated with radiotherapy alone and 91 with radiotherapy combined with chemotherapy. A median dose of 70 Gy (range,60-80 Gy) was delivered with late-course accelerated hyperfractionated radiotherapy (LAHRT). Twenty-four patients received dose of 61-69 Gy and 76 received more than 70 Gy. The V_5 ,V_(10) ,V_(20) ,V_(30)and mean lung dose (MLD) were calculated from the dose volume histogram system. The RILI was evaluated according to Common Toxicity Criteria 3.0(CTC 3.0). Results The range of V_5 ,V_(10) ,V_(20) ,V_(30) was 37%-98%,27%-78%, 17%-54% and 9%-31%, respectively, with a median value of 65%, 47.5%, 31% and 24%, respectively. The acute RILI of grade 1, 2, 3, 4 and 5 was observed in 34, 27, 8, 1 and 1 patients,respectively. The chronic RILI of grade 1, 2 and 3 was observed in 46, 14 and 2 patients, respectively. V_5 ,V_(10) ,V_(20) and MLD were significantly correlated with acute RILI of ≥ grade 1. V_5 ,V_(20) ,V_(30) and MLD were significantly correlated with acute RILI of ≥ grade 2. The acute RILI of ≥ grade 2 was significantly in-creased when V_5, V_(20) and V_(30) were more than 65%, 31% and 24%, respectively. The acute RILI of ≥ grade 3 was significantly increased when V_5 was more than 65%. The acute RILI of ≥ grade 1 was signifi-candy increased when V_(20)was more than 31%. The gross tumor volume and planning target volume were sig-nificantly correlated with the acute RILI of ≥ grade 1 and chronic RILI of ≥ grade 2. Conclusions The dose-volume V_5 and V_(10) are effective in predicting RILI.

Objective To analyze the clinical outcome of concurrent ehemo-radiotherapy in stage Ⅳ non-small cell lung cancer(NSCLC).Methods From Jan.1997 to Dec.2006,214 patients with patho logically or cytologically proven stage Ⅳ NSCLC were included in this analysis.Of those patients,98 re ceived radiotherapy concurrently with 3-week cycle chemotherapy(group A),18 received radiotherapy con currently with weekly chemotherapy(group B) ,44 received chemotherapy alone,37 received radiotherapy a lone and 13 received sequential chemo-radiotherapy.The primary tumor was treated by three-dimensional conformal radiotherapy(3DCRT) or conventional radiotherapy with conventional fraefionation or late-course accelerated hyperfraction (LA H RT).Group A received 21-28 days cycle cisplatin-based chemotherapy (cis platin combined with PTX,DTY,NVB or Vp-16) ,and group B received weekly DDP combined with PTX or topteeon for 4-6 weeks.Results The follow-up rate was 99%.The 1-and 2-year overall survival rates of group A,group B,chemotherapy alone,radiotherapy alone and sequential chemo-radiotherapy were 41% and 11% ,16% and 0,31% and 7% ,34% and 10% ,26% and 3% ,respectively(x2 = 11.18,P=0.025).The patients with concurrent 3DCRT,LAHRT and radiotherapy dose≥70 Gy had better survival in group A than those in chemotherapy alone group.Patients who received≥2 cycles chemotherapy with concurrent radio therapy had longer survival time than those who had ≥2 cycles chemotherapy alone. Conclusions Con current chemotherapy and 3DCRT,LAHRT with the dose ≥70 Gy can improve the overall survival of patients with stage Ⅳ non-small cell lung cancer.