The Department of Radiation Oncology of the Cancer Hospital of Fudan University has evolved from the Section of Radiotherapy of the former Sino Belgium Radium Institute.After Liberation it became the Shanghai Radium Institute,and then later the Cancer Hospital of Shanghai First Medical College. From simple superficial X ray machines, rapid development has occruued,and now we have Linac accelerators, and even the most recent techniques, such as intensity modulated radiotherapy (IMRT). The clinical results obtained in the Department are some of the best, many of them leading in their respective fields.

The management of recurrence in irradiated field of carcinoma of the breast after mastectomy remains a difficult and a challenging problem for the radiation oncologists. Locol regional control may lead to an improvement in survival quality. We analyzed retrospectively the response rate of combined treatment during radiation therapy with hyperthermia in 15 patients with chest wall or regional recurrence in irradiated fields. The complete regression rate for all 15 fields as 73% (11/15) and partial regression rate, 27% (4/15).Our clinical information indicated that radiation plus hyperthermia for recurrence in previously irradiated fields is safe and valuable. The ideal clinical schedule should be determined by randomized clinical trials.

Purpose: The long term results and radiation sequelae of nasopharyngeal carcinoma treated by 60 Co external irradiation plus the high dose rate afterloading intracavity radiation (AIR) were analysed.Materials and Methods:From June 1981 to December 1988, 64 patients with nasopharyngeal cacinoma were treated by 60 Co external irradiation plus the high dose rate AIR. The AIR was given as a routine boost or for residual disease. The external irradiation dose varied from 55 to 70 Gy, whereas AIR dose ranged from 10 to 45 Gy. Results: All patients were followed up for mored than 5 years. The 5-year local control rate was 82.8%. The 5-year actuarial survival and disease free rates were 75.0%,68.8% respectively . 8 cases developed distant metastases, 6 cases recurred in the nasopharynx and/or neibouring structures and 1 case ocurred bone sarcoma of hard palate. The late radiation sequelae occured in 4 cases, 1 radiation necrosis of the bone in nasal cavity and 3 radiation perforations in hard and soft palate.Conclusion: We think that AIR for nasopharyngeal carcinoma is indicated for boosting the dose to the nasopharyngeal cavity with appropriated reduction in external irradiation dose ,and for residual disease after primary external radiotherpy. To reduce radiation sequelae applicator should be improved.

Objective To compare the efficacy after conventional radiotherapy and late course accelerated fractionation radiotherapy for nasopharyngeal carcinoma (NPC).Methods A total of 200 NPC patients were enrolled and randomly assigned to conventional radiotherapy (CF) group with 99 cases or late course accelerated fractionation radiotherapy (LCAF) group with 101 cases,who received irradiation to 60Co γ or 6 MV X-rays.In the CF group,the total dose of nasopharynx was 70 Gy/35 fractions at 2 Gy daily.In the LCAF group,for the first two-thirds of the treatment,two daily fractions of 1.2 Gy were given to the primary lesion and the total dose was 48 Gy/40 fractions.For the last one third of the treatment,the dose per fraction was increased to 1.5 Gy and the total dose was 30 Gy/20 fractions.Results There were 25,16,25 in CF group and 16,13,18 patients in LCAF group who had recurrence of nasophaynx,cervical lymph nodes,and distant metastasis,respectively.The 5-year nasopharyngeal control and overall survival rates was 75.9％ and 87.6％ in CFgroup (x2 =4.066,P＜0.05),58.0％ and 74.1％(x2 =5.076,P ＜ 0.05) in LCAF group,respectively.Cervical lymph nodes local rates and distant metastasesfree rates at 5 years were 8 1.5％ and 90.0％ in CF group (P ＞ 0.05),74.1％ and 83.3％ (P ＞ 0.05) in LCAF group,respectively.Conclusions Compared with CF,LCAF can improve nasopharyngeal control and overall survival rates,but there are no significant difference in the recurrence rates of cervical lymph nodes and distant metastasis.

Objective To summarize our experience and treatment results of nasopharyngeal carcinoma treated in a single institution. Methods From Jan. 2000 to Dec.2003,1837 patients with histologically proven nasopharyngeal carcinoma(NPC) were retrospectively analyzed. The disease was staged according to the Fuzhou stage classification. 885 patients received cisplatin (DDP) based chemotherapy. All patients received radiotherapy to the nasopharynx and neck. The dose was 30.6-74.0 Gy, 1.8-2.0 Gy per fraction over 3.5-8.0 weeks to the primary site with 60Co γ rays or 6 MV X-rays. The dose to lymph nodes was 60-68 Gy. The residual disease was boosted by 192Ir afterloading brachytherapy,small external beam fields, conformal radiotherapy,or X-knife. Results The median follow-up time was 54(3-90) months. The 5-year overall survival(OS), disease-free survival (DFS), relapse-free survival (RFS) and distant metastasis free survival(DMSF) rates were 67.42% ,63.25% ,86.47% and 80.31% ,respectively. Clinical stage was the most significant prognostic factor,and OS was 88% ,74.8% ,65.9% ,52.4% and 20% for stage Ⅰ ,stage Ⅱ,stage Ⅲ,stage ⅣA and stage ⅣB,respectively. Gender,T,N and TNM stage were the significant prognostic factors of OS in multivariate analysis. Conclusions For NPC patients,the 5-year OS of 67.4% is achieved by conventional radiotherapy technique in our institution. Both univariate and multivariate analysis shows that gender and clinical stage are the significant prognostic factors of OS.