Objective To investigate the rationality and prognostic value of the Criteria for clinical staging of esophageal cancer treated by non-surgical methods (Draft) by comparison with the criteria for postoperative pathological staging.Methods A retrospective analysis was performed on the clinical data of 162 patients with esophageal cancer who underwent radical resection at the Second Hospital of Soochow University from December 2008 to July 2012.Preoperative clinical staging and postoperative pathological staging were performed,and the Kappa statistic was used to evaluate the agreement between the two staging systems.The Kaplan-Meier method was used to calculate overall survival (OS) rates,and the log-rank test was used for survival difference analysis and univariate analysis.Results The coincidence rates of T,N,and TNM stages were 67.9％,57.4％,and 67.9％,respectively,and the agreements were moderate,poor,and moderate,with Kappa values of 0.544,0.302,and 0.509.The follow-up rate was 93.2％.The 1-,2-,and 3-year sample sizes were 127,66 and 27,respectively.The 1-,2-,and 3-year OS rates were 82.6％,56.2％,and 37.7％,respectively.There were no significant differences in OS between patients with preoperative T1 and T2 stages and between patients with preoperative N0 and N1 stages (P =0.086,0.101),but significant differences were observed between patients with different T stages,N stages,or TNM stages (P =0.000-0.028).This was in line with the prognostic results based on the postoperative pathological staging.Conclusions The clinical staging criteria (draft) have moderate agreement with the criteria for postoperative pathological staging and have good prognostic value,but they require further refinement and improvement.

More than 20 studies published during the past 10 years concerning preoperative radiotherapy in rectal cancer were reviewed carefully. And we evaluated the role of IMRT being routinely used in preoperative treatment of rectal cancer.

The delineation of clinical target volume (CTV) is a critical step in planning conformal radiotherapy for rectal cancer.Several guidelines suggest different subvolumes and anatomical boundaries in radiotherapy for rectal cancer, potentially leading to a misunderstanding of CTV definition.This article reviews recent advances in the delineation of CTV in radiotherapy for rectal cancer.

Objective To systematically evaluate the risk factors for upper extremity lymphedema after breast cancer treatment and the strength of their associations.Methods PubMed,Ovid,EMbase,and the Cochrane Library were searched to identify clinical trials published up to December 2012.The quality of included studies was assessed by the Newcastle-Ottawa Scale;data analysis was performed by Stata 10.0 and RevMan 5.2;the strength of associations between risk factors and breast cancer-related upper extremity lymphedema was described as odds ratio (OR) and 95％ confidence intervals (CI).Results Twenty-two studies involving 10106 patients were included in the meta-analysis.The risk factors for upper extremity lymphedema after breast cancer treatment mainly included axillary lymph node dissection (OR =2.72,95％ CI=1.06-6.99,P=0.038),hypertension (OR=1.84,95％ CI=1.38-2.44,P=0.000),body mass index (OR =1.68,95％ CI=1.22-2.32,P =0.001),and radiotherapy (OR =1.65,95％ CI =1.20-2.25,P =0.002),while no significant associations were found for such factors as chemotherapy,age,number of positive lymph nodes,and number of dissected lymph nodes.Conclusions The incidence of upper extremity lymphedema is high among patients with breast cancer after treatment,and axillary lymph node dissection,hypertension,body mass index,and radiotherapy are the main risk factors for lymphedema after breast cancer treatment.

Objective To evaluate the feasibility and efficacy of chemoradiotherapy for locally advanced (inoperable) rectal cancer. Methods Seventy-six patients with locally advanced (T_4) or recurrent rectal cancer were randomized into two groups of concurrent chemoradiotherapy with either oxaliplatin plus 5-FU (oxaliplatin 130 mg/m~2, day 1,5-FU 350 mg/m~2, day 1 -5 ,LV 200 mg/m~2, day 1 -5, 4 weeks per cycle) or capecitabine (1650 mg/m~2, day 1 -14, 3 weeks per cycle) alone. All patients received pelvic three-dimensional conforrnal radiotherapy (3 DCRT) of 46 -50 Gy in 23 -25 fractions, with a boost of 14 -18 Gy in 7 -9 fractions. Results The median follow-up time was 19 months. The overall response rate was 64% in the oxaliplatin/5-FU group comparing with 58% in the capecitabine group (χ~2 = 0. 08 ,P =0. 772), with the median survival time of 22 months and 18 months (u = 17.71, P = 0. 077), respectively. The overall survival in the two groups was 68% and 63% at 1 year, and 21% and 19% at 2 years, respectively (χ~2 = 0. 97, P = 0. 326). There were no treatment-related deaths or grade 4 toxicities. Neutrocytopenia (39. 5% vs 77.7%, z = -3.97,P =0. 0001), diarrhea (47.4% vs 88.9%, z = -4. 78, P = 0. 0001), nausea and vomiting (68.4% vs 97.2%, z = -3. 17, P = 0. 0001), and neurotoxicity (5.3% vs 66.7%, z= -6.56, P= 0.0001) were more common in the oxaliplatin/5-FU group. Conclusions Concurrent chemoradiotherapy is well-tolerated and effective in patients with locally advanced (inoperable) rectal cancer.

Objective To explore the efficacy and prognostic factors of postoperative intensity?modulated radiotherapy ( IMRT) with or without chemotherapy in rectal cancer. Methods A retrospective analysis was performed on the clinical data of 218 patients with rectal cancer, who underwent postoperative IMRT in our hospital from January 2009 to December 2013. The Kaplan?Meier method was used to calculate survival rate;the log?rank test was used for survival difference analysis and univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis. Results The follow?up rate was 97. 7%. The 1?and 3?year overall survival rates were 90. 8% and 75. 2%, respectively, the 1?and 3?year disease?free survival rates were 85. 3% and 70. 5%, respectively, and the 1?and 3?year locoregional recurrence?free survival rates were 96. 7% and 88. 1%, respectively. The incidence of grade 3?4 acute adverse reactions was 28. 4%, mainly manifested as leukopenia ( 13. 8%) and diarrhea ( 11. 0%) . Univariate prognostic analysis showed that preoperative carcinoembryonic antigen ( CEA) and CA199 levels, maximum tumor diameter, tumor location, degree of differentiation, depth of tumor invasion, number of lymph node metastases, TNM stage, perineural invasion, surgical procedure, total mesorectal excision, preoperative bowel obstruction, and preoperative anemia were the predictors of survival ( P=0. 006, 0. 000, 0. 000, 0. 017, 0. 000, 0. 016, 0. 000,0. 011,0. 001,0. 006,0. 037 and 0. 010) . Multivariate prognostic analysis showed that preoperative CEA level, tumor location, TNM stage, preoperative bowel obstruction, and preoperative anemia were the predictors of survival ( P=0. 000,0. 000,0. 000,0. 001 and 0. 001) . Conclusions Postoperative IMRT with or without chemotherapy is an effective method for rectal cancer with mild adverse reactions and high compliance. Preoperative CEA level, tumor position, TNM stage, preoperative bowel obstruction, and preoperative anemia are independent prognostic factors for the overall survival.

Objective MicroRNAs (miRNAs) play important roles in the chemoradiotherapy efficacy of rectal cancer (RC).This study aimed to screen the chemoradiotherapy-associated microRNAs and their target genes of RC through bioinformatics approaches in order to promote the fundamental study of RC chemoradiotherapy.Methods The chemoradiotherapy-associated microRNAs were manually searched through the published papers via PubMed and its target genes were identified by comprehensively analyzing these public data of microRNA-mRNA and gene expression profiles.Both gene ontology (GO) and pathway analysis of the target genes were performed by DAVID and IPA programs,respectively.Results A total of 38 microRNAs were collected from PubMed,and 3 545 putative target genes were inferred from the integrated microRNA-mRNA associations,among them,131 were differentially expressed (DE) (P ＜ 0.05) in the selected gene expression profile (GSE35452).The GO and pathway enrichment analyses indicated that the DE genes were closely involved in the responses of chemoradiotherapy of RC.Conclusions These microRNAs and their regulated DE genes may contribute to the molecular mechanism of the differential efficacy of RC chemoradiotherapy,which may provide a theoretical reference for predicting the response of RC to chemoradiotherapy.

ObjectiveTo verify the safety and feasibility of retroperitoneal laparoendoscopic singlesite surgery (LESS) adrenalectomy in the treatment of adrenal gland tumors or cyst.MethodsFrom Oct.2009 to Jan.2012,7 patients underwent retroperitoneal LESS adrenalectomy with Quadport technology by one surgeon.The mean patient age was 46 ( 39 - 55 ) years.The mean largest tumor diameter was 2.3 (1.8-3.6) cm.All procedures were performed through retroperitoneal approach by using Quadport,tip flexible laparoscope with 0° lens and conventional laparoscopic instruments.This technique was evaluated in respects of operative time,estimated blood loss,intraoperative complications,drainage time,visual analog pain scale (VAPS) score,post-operative hospital stay and pathological results.ResultsSeven cases of LESS adrenalectomy were completed successfully.There was no additional trocar added,no conversion to conventional laparoscopic or open approach.The mean operative time was 106 (70 - 180) min,and the mean estimated blood loss was 59 (5 -200) ml.The mean first day post-operative VAPS score was 2 (1 -3),drainage time was 2 (2 -3) d.Post-operative hospital stay was 5 (3 -6) d.No perioperative complication was observed.Pathological results showed 1 case of adrenal pheochromocytoma,5 cases of adrenal cortical adenoma and 1 case of adrenal cyst.ConclusionRetroperitoneal LESS adrenalectomy is a safe and feasible option for the treatment of adrenal tumors and cyst.

Objective To evaluate the capability of 18 F-FLT uptake and investigate the early radiation response of human colorectal cancer cells HCT116 exposed to 6 MV X-rays.Methods 3.7 kBq 18F-FLT was added to HCT116 cells with different cell numbers (1.0 × 105-1.5 × 106) and cultured with different times (36,60,84 h).The 18F-FLT uptake rate was measured with a γ-counter after exposed to different does of 6 MV X-rays (0,2,4,6,8 Gy) after 24,48,and 72 h of irradiation.Then the cell uptake inhibition rate,cell proliferation,and cell cycle phase were measured.Results The uptake rate of 18F-FLT in HCT116 was (18.97 ± 1.16)％.The 18F-FLT uptake inhibition rates at 24 h after different does of irradiation (2,4,6,8 Gy) were (32.10±0.02)％,(54.46 ±0.04)％,(62.74 ±0.04)％,and (65.81 ±4.81)％,respectively,which was positively correlated with radiation dose.Conclusions The 18F-FLT uptake rate of human colorectal cancer HCT116 cells could be used to evaluate the early radiation response.

Objective To verify the safety and feasibility of applying laparoendoscopic singlesite radical prostatectomy (LESS-LRP) in the treatment of prostate cancer. Methods From Sept. to Dec. 2010, LESS-LRP was used to treat 2 early stage prostate cancer patients. The LESS-LRP was preformed through extra-peritoneal approach by using standard laparoscopic instruments and a 5 mm flexible laparoscope. This technique were evaluated in respects of operative time, estimated blood loss, intraoperative complications, drainage time, post-operative pain score (VAPS), post-operative hospital stay, pathological results and post-operative PSA levels. Results All procedures of the 2cases were completed with LESS-LRP without conversion to standard laparoscopic or open radical prostatectomy. The operative times for LESS-LRP were 280 and 285 min, estimated blood loss were 400 and 200 ml, respectively. There was no severe intraoperative complication. The drainage times were 2 and 6 d, the VAPS in the first post-operative day were 1 and 0, and post-operative hospital stay were 14 and 7 d. There was no secondary bleeding or wound infection. The 2 prostate cancer cases were all in pathological stage pT2c N0 M0. Surgical margins of the specimens were negative. The first case showed PSA of 0. 033 ng/ml 1 month after the surgery. Conclusion LESS-LRP can be an exploratory option in clinical for the treatment of prostate cancer.