Chest?regional recurrence and metastasis are the main modes of treatment failure after surgery for patients with esophageal cancer. As one of the primary approaches for local therapy, radiotherapy has a satisfactory efficacy in the reduction of postoperative chest?regional recurrence in patients with esophageal cancer. Right now, the value of postoperative adjuvant therapy for patients with positive lymph nodes has been widely recognized by clinicians. Postoperative adjuvant chemoradiotherapy has become a standard treatment mode. However, there is no consensus on whether adjuvant radiotherapy should be performed in patients with negative lymph nodes. To determine whether patients with stage pN0 esophageal cancer should receive postoperative adjuvant therapy, this paper reviews the current research advances in possible evidence for the necessity of postoperative adjuvant radiotherapy for patients with stage pN0 esophageal cancer, current related reports, and the effects of different surgical methods on treatment outcomes of postoperative adjuvant therapy.

Objective To study the correlation between dose-volummetrics and changes of pulmona- ry function tests(PFTs), and to study the ability of standard dose-volummetrics to predict these changes after radiotherapy. Methods Pulmonary function was measured in 39 patients with inoperable lung cancer one week before and 2-4 months after radiotherapy. The pulmonary function parameters were the forced vital ca- pacity(FVC), forced expiratory volume in ls (FEV 1.0) and diffusion capacity of carbon monoxide(DL- CO). Dose-volumrnetrics were V_(10), V_(15), V_(20), V_(25), V_(30), V_(35), V_(40), CTV_(100), CTV_(95), CTV_(90), CTV_(80), lung D_(mean), V_(eff) and NTCP. Pearson and line regression analysis was performed to determine whether the correlation exis- ted between the metrics and the changes of PFTs. Results No correlation was found between the dose- volummetrics and the changes in PFTs. Excluding patients(n=15) with pretreatment atelectasis, signifi- cant correlation was found between the dose-volummetrics (V_(20), V_(25), V_(30), V_(35), V_(40), GTV, V_(eff) and D_(mean)) and the PFTs changes(r=0.469-0.695, P≤0.05). Therefore, the re-expansion may have jesperdized the proper data to the present record. Multivariate analysis showed that V_(30) was the risk factor to affect the chan- ges of FEV 1.0 and DLCO(P=0.046、0.041). The pulmonary function of patients with V_(30)≥18% was worse than patients with V_(30)

Objective To study the expression of proliferating cell nuclear antigen (PCNA), metastasis-related gene nm23-H1 in supratentorial astrocytomas, and analyze the prognostic factors and the relationship between PCNA expression, nm23-H1 expression and clinical, MRI features.Methods From November 1994 to December 1998, 52 pathologically proved astrocytoma patients with complete clinical data were analyzed. The expressions of PCNA and nm23-H1 were detected by streptabitin peroxidase (SP) immunohistochemical method. Clinical and MRI data were collected and analyzed by Cox proportional hazard model .Results There was a significant difference in the expressions of PCNA and nm23-H1 in the lesion and their adjacent tissues (P

Objective To investigate the effect of antisense VEGF on radiation sensitivity of esophageal cancer cells in vivo.Methods Sixteen male BLBA/C/nu nude mice were randomly divided into 4 groups and prepared cells were injected subcutaneously on paw pat of mice(2?106/100 ?L/mice): The size of the subcutaneous tumors was measured before and after irradiation and transfection.The effect of treatment was evaluated by speed of tumor growth. The expression level of VEGF was examined in different groups by RT-PCR,western blotting respectively.Results The absolute growth delay (AGD)for antisene group, irradiation group and antisene plus irradiation group was 3.0?2.6, 10.1?5.4 and 27.4?3.1 days,and nominal growth delay (NGD) was 24.4?3.1 days. The enhancement factor of antisense VEGF for radiotherapy was 2.41. A decreased expression level of endogenous VEGF mRNA and protein were found in antisene group by RT-PCR and western blotting analysis.Conclusion Antisense VEGF and radiotherapy may enhance radiotherapic effect for esophageal cancer xenografts.

From 1970 to 1984,100 patients with esophageal cancer survived over 10 years after radiotherapy alone. In theis group 58 male, 42 female; section of upper thoracic 53, section of middle thoracic 47; medullary type 82, fungoid type 14; tumor length ≤5cm 49, 5.1～7.0cm 34, 7.1～9.0cm 17. They were teated by three or four intersecting radiation, total doses were 50～70Gy. 9 patients received second radiotherapy for local relapse. In 100 patients, 58 patients still survived , 42 patients died of local relapse 18, bleeding 6 and fistula 4. 5 patients suffered from radiation myelitis and 3 patients fracture of rib in 58 living patients. Conclusion: the result of treatment is better in group of young people. Patients with supraclavicular metastasis have received seccond radiotherapy after first raditherapy could still survive for a long time. Local relapse is the important factor for death yet. We think total dose is adapted between 50～70Gy. The spinal received dose

Purpose: At present ,the local control of esophageal carcinoma have been improved by using intra-cavitary irradiation, but the complications a much more than before. It is necessary to study the real condition of these complications.Materials and Methods: From August 1993 to May 1994,38 patients with esophageal carcinoma were treated with external beam combined with intra-cavitary radiotherapy in our hospital. Conventional radiotherapy was used 200cGy/F,5F/W.When the dose of external beam reached 3800cGy/19F,intra-cavitary radiotherapy was added with the dose of 500cGy/F/W(patient did not receive the external beam at the same day). The total dose of external and intra-cavitary radiotherapy were 5000cGy/25F/5W and 1500cGy/3F/3W at end of the course respectively.Results: ① 68.4%(26/38) patients had esophagitis.②25 patients suffered from the non-carcinoma esophagostenosis, which was related to the length of tumor before treatment, the shade of soft tissue around lesion, the esophagitis, the diameter of esophagus cavitary and stiff of esophagus wall before intracavitary radiotherapy.③10 of 38 cases had non-carcimoma ulcer. All patients had received 1500cGy/3F/3W intracavitary radiotherapy and occured serious esophagitis, 7 of 10 suffered from the non-carcinoma stricture and ulcer before or later.④ 6 of 38 cases had the fistula and 5 patients had been exposed 1500cGy/3F/3W intracavitary radiotherapy.Conclusion: Esophageal carcinoma treated by afterloading techniques may improve the serious obstruction immediately, but it is not sure the long-term survial yet. We also find the increasing serious complications and the decreasing life quality by using this treatment.We suggests that this method only can be used as an auxilliary way with the external beam radiotherapy.

Objective To study the dose distribution of intra-cavitary NiTi metal-stent for correction in radiotherapy of esophageal carcinoma.Methods Thermoluminescence Dosimeter(TLD) with LiF dose units was used to simulate the dose variation in wax phantom with or without Chinese and Japanese metal stents in esophageal lumen on 60Co, 4 MV X-ray and 6 MV X-ray machines. The dose distribution on the stent fringe (i.e.,on the esophageal mucosa) was compared with that at the center of esophagus without metal stent.Results When a single anterior field was used to irradiate the esophageal carcinoma, the dose enhancement on the anterior and posterior point of the Chinese metal stent was 16.2% and 7.8% by 60Co,15.4% and 6.8% by 4 MV X-ray and 12.8% and 5.8% by 6 MV X-ray. With the same set-up, the dose enhancement of Japanese stent was 13.0% by 6 MV X-ray. When anterioposterior and posterioanterior (AP/PA) opposing fields were used ,the dose enhancement ratio was 11.7%～24.0%. When three fields from three different directions were used ,the dose were increased by 3.2～16.2%.Conclusions When irradiating esophageal carcinoma with intra-cavitary metal stent,we suggest the fraction dose be below 1.7 Gy when one field is used and not exceed 1.5 Gy when AP/PA fields are used. It is advisable to use the three field technique with the diameter of the stent limited to 1.5 cm.

Objective To evaluate the possibility of using preoperative conventional lung function tests and impulse oscilloresistometry system (IOS) to predict the development of postoperative respiratory failure after radical lung cancer surgery in patients with poor pulmonary function. Methods Fifty-two male patients with lung cancer between 51-63 yrs undergoing radical lung cancer surgery were included in this study. Preoperative pulmonary function was assessed by conventional lung function tests ( FEV1.0 , VC, MVV) and impulse oscilloresistometry system (IOS) (peripheral airway resistance R5-R20; elastic resistance ( X5 ) and Fres. Postoperative respiratory failure was defined as short of breath (SOB) , cyanosis, SpO2 45 mm Hg.Results Nine patients developed postoperative respiratory failure (17.3%). There was significant difference in FEV1.0 , R5-R20, X5 and Fres between patients who developed postoperative respiratory failure and those who did not. Logistic regression analysis showed that Fres is an independent factor predicting respiratory failure. Conclusion Fres is an important parameter of impulse oscilloresistometry system (IOS) for prediction of postoperative respiratory failure after lung cancer surgery in patients with poor pulmonary function.

Objective To analyze the prognosis of 225 patients according with clinical staging of esophageal carcinoma treated with non-surgical methods, and investigate the practicality and predictive value of the clinical staging. Methods From March 2001 to July 2007, 225 patients with esophageal carcinoma received 3DCRT treatment. The prescribed doses were ranged from 5000 -7000 cGy with the median dose of 6400 cGy, 25 patients received accelerative radiation of 300 cGy per fraction after conventional radiotherapy of 3000 -4000 cGy, 57 patients received concurrent chemotherapy with or without consolidation chemotherapy. All the patients were divided into subgroups of different T stages, different N stages and different TNM stages. Local control rates, survival rates were observed and Cox regression analysis were performed to search valuable prognostic factors. Results The following-up rate was 99. 6%. The 3-and 5-years following-up number were 116 and 33 patients, respectively. The 1 -,3-,and 5-year local control rates were 77. 2% ,48.2% and 34. 5%, respectively. The 1-,3-,and 5-year overall survival rates were 68.4% ,33.7% and 20. 8%, respectively. The median survival time was 20 months. There were significant difference between survival curves for T1-4 stages, N0-2 stages and Ⅰ - Ⅲ stages with x2 value of 13.07,20. 49 and 17.16, with P value of 0. 004,0. 000 and 0. 000, respectively. For the group of stage Ⅰ, Ⅱ and Ⅲ, the 1-,3-,and 5-year survival rates were 89.4% ,56. 1% ,and 37.8% ;69.6% ,32. 4% ,and 18.0%and 47. 2%, 19. 5%, and 13. 0%, respectively. According to the result of Cox regression analysis, the tumor length of CT scan, clinical N stage, short term restlt were most valuable predictive factors.Conclusions The clinical staging of esophageal carcinoma treated with non-surgical methods could predict the prognosis accurately, clinical N stage may have more closely association with prognosis, however, some details of the staging program need more consummate.

Objective To evaluate the prognostic significance of 3 clinical stage system in 3-dimensional conformal radiotherapy (3DCRT) for esophageal squamous cell carcinoma. Methods From January 2004 to August 2007, 179 cases of esophageal squamous cell carcinoma were treated with 3DCRT.Before radiation, each patient was staged with UICC 2003 TNM stage, stage of Chinese esophageal cancer cooperation group (cooperation group' stage), and Zhu's clinical stage respectively. Concordance of each clinical stage and prognosis was analyzed with SPSS 11.5. Results In 179 cases of esophageal cancer,Concordance was better in T stage ( Kappa = 0. 271 ) than in TNM stage ( Kappa = 0. 167 ) between cooperation group' stage and Zhu's stage. Among them, 98 cases was staged with UICC stage, concordance of T stage was better between UICC-T and cooperation group' T stage (Kappa =0. 261 ) than between UICCT and Zhu's T stage (Kappa = 0. 045 ) ;concordance of TNM stage was better between UICC-TNM and Zhu's TNM stage ( Kappa = 0. 597 ) than between UICC-TNM and cooperation group' TNM stage ( Kappa =0. 299 ). With multivariate analysis, T ( χ2 value is 11.58, 26. 00 and 51.05, all P ＜ 0. 01 ), N ( χ2 value is 15.28, 16. 10 and 16. 10,all P＜0. 01), M (χ2 value is 5.59, 27.78 and 27.78,all P＜0. 01), and TNM (χ2 value is 15.77, 34,35 and 51. 10,all P＜0. 01 ) stage in 3 kinds of clinical stage were independent prognostic factors. In UICC stage, T1-T3 was difficult to definite and the prognosis was not significantly different in T1 -T3 stage. Conclusions In this study, 3 kinds of clinical stage could evaluate prognosis of esophageal cancer after radiotherapy;cooperation group' stage and Zhu's stage need further application, with further accuracy needed.