Soft tissue sarcomas (STS) consist of a heterogeneous group of rare malignancies with mesenchymal origin. Surgical resec-tion is the primary treatment for STS, but radiation therapy (RT) also plays an important role in the treatment. Radiotherapy for STS has advanced significantly over the past 50 years. Both preoperative and postoperative radiotherapies are equivalent in local control but are associated with different toxicity profiles. Boost techniques for STS include brachytherapy, intraoperative radiation therapy (IORT), and external beam. Long-term toxicities of RT to normal tissues have been reduced because of improvements in image guid-ance and intensity-modulated radiotherapy, which significantly increase the precision and delivery of RT. This review discusses RT tech-nologies and their acceptable treatment principles.

Objective We investigate the possible effect of inflammative indicator C reactive protein(CRP) ,interleukin‐6(IL‐6) and procalcitonin(PCT) on the outcome of HBV infection .Methods The clinical data and peripheral serum of 48 patients with HBV related hepatocellular carcinoma and 48 patients with decompensated cirrhosis were collected ,HBV copy numbers ,PCT ,IL‐6 , CRP ,ALT ,AST ,prothrombin time(PT ) and other indicators were tested for comparison and correlative analysis .Results HBV copy numbers ,PCT ,CRP ,lymphocytes and mononuclear cells showed no significant difference between primary hepatocellular car‐cinoma and decompensated cirrhosis group;however ,IL‐6 level was significantly higher in decompensated liver cirrhosis than in hep‐atocellular carcinoma ,as opposed to the absolute number of neutrophils .Conclusion IL‐6 increase may be related to final outcome of HBV infection ,dynamic monitoring IL‐6 is helpful to evaluate the prognosis of HBV infection .

Hybridomas producing monoclonal antibodies (McAb) directed against Trichomonas vaginalis have been produced by fusing NSI myeloma cells with spleen cells of BALB/c mice immunized with Trichomonas vaginalis.IFA technique was used to test the binding activity of four McAbs produced.The McAb belonged to the IgG subtypes IgGl(2A2,2A4 McAb),IgG3 (2H9 McAb) and IgG 2b (2A12 McAb).Three McAbs,designated 2A2,2A4,2A12,reacted with a surface membrane component of live Trichomonas vaginalis.One (2A12) of them produced com-plement-dependent cytolysis of the parasites.Others (2A2.2A4) produced complement-independent cytotoxicity of the parasites.2H9 McAb which reacted with the nucleus of the organisms did not agglutinate the parasites.The four McAbs which did not have cross reaction with some protozoa of Zoomastigophorea species were specific antibodies against Trichomonas vaginalis.(Figs.1-3)

Objective To identify high-risk group among gastric cancer patients treated with curative resection and more than D1 dissection, and investigate the indications for proper adjuvant therapy.Methods 297 patients who met the following enrolled criteria were retrospectively analyzed:treated between January 2002 and December 2004, primary gastric or gastroesophageal cancer, underwent curative gastrectomy and more than D1 lymphadenectomy, pathologically staged as T3-4N0-1M0,or TxN2-3M0.The overall survival (OS), disease-free survival (DFS), local-regional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) were calculated, and possible prognostic factors were analyzed.Results The median follow-up time was 61 months.The follow-up rate was 92.3%.The 5-year OS, DFS, LRFS and DMFS were 57.9%, 52.2%, 70.6% and 71.7%, respectively.Four independent prognostic variables identified for OS, DFS, LRFS and DMFS using multivariate analysis were Borrmann type (Ⅰ+Ⅱ/Ⅲ+Ⅳ), total number of dissected lymph nodes (>18/≤18), number of positive lymph nodes (0-3/≥4), and 6th AJCC TNM stage (Ⅱ+Ⅲ a/Ⅲ b+ⅣM0)(χ2=3.94-16.34,P<0.05).If one unfavorable prognostic factor was scored as 1, according to the total scores of the four prognostic factors, four risk groups were generated as low (score:0), low-intermediate (score:1), high-intermediate (score:2) and high risk group (score:3 or 4).The 5-year OS, DFS, LRFS and DMFS were 85.7%, 61.0%, 58.6% and 38.6%(χ2=31.20,P<0.01) in low risk group, 85.2%, 61.3%, 48.1% and 31.8%(χ2=31.88,P<0.01) in low-intermediate risk group, 94.4%, 77.8%, 64.4% and 57.2%(χ2=18.36,P<0.01) in high-intermediate risk group and 87.9%, 75.0%, 74.2% and 55.5%(χ2=19.30,P<0.01) in high risk group.Conclusions Even with R0 resection and more than D1 lymphadenectomy, the outcome was poor for gastric cancer patients with two or more unfavorable prognostic factors.Prospective study is warranted to evaluate the efficacy of adjuvant concurrent chemoradiotherapy for this group of patients.

Objective To evaluate the role of postmastectomy radiotherapy in four subgroups of high-risk breast cancer patients, who were grouped by the status of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (Her-2). Methods A total of 437 invasive breast cancer patients with T3-4N1 or N2-3 and available immunohistochemistry results of ER, PR and Her-2 were retrospectively analyzed. Patients were classified into 4 subgroups according to hormone receptors (ER or PR, Rec) and Her-2 status:Rec-/Her-2-(triple negative), Rec-/Her-2 +, Rec +/Her-2 + and Rec +/Her-2-. Rec-was defined as ER-and PR-. Rec + was defined as ER + and/or PR +. Her-2 positive was defined as Her-2 + + or Her-2 + + +. End points were isolated locoregional recurrence (LRR), distant metastasis (DM), disease-free survival (DFS) and overall survival (OS). Results The median follow up time was 48 months. Sixty-nine (15. 8%) patients were Rec-/Her-2-, 62 (14. 2%) Rec-/Her-2 +, 89 (20.4%) Rec +/Her-2 + and 217 (49.7%) Rec +/Her-2-. 480(93.4%) patients received chemotherapy and 352(80. 5%) received radiotherapy. Radiotherapy significantly reduced the 5-year LRR rates of all the four subgroups (Rec-/Her-2-: 13.1% vs. 33. 3%, Rec-/Her-2 + :9. 3% vs. 21.2%, Rec + /Her-2 + :9. 7% vs. 47.0%, Rec +/Her-2-:3. 2% vs. 15.4%). Radiotherapy significantly lowered the 5-year DM rates (26. 7% vs. 49.4%, 27.6% vs. 67. 5%, 18.4% vs. 100%) and improved the 5-year DFS rate (66. 7% vs. 33. 3% , 67.7% vs. 33. 3% , 72. 6% vs. 0%) as well as OS (73.9% vs. 25.2% ,69. 8% vs.41.5%, 91.0% vs. 32. 8%) of patients with Rec-/Her-2-, Rec-/Her-2 + and Rec +/Her-2 +. Conclusions In high-risk breast cancer patients, all subgroups of patients grouped by ER, PR and Her-2 status can benefit from postmastectomy radiotherapy.

Objective To evaluate the risk of locoregional recurrence ( LRR ) and role of radiotherapy for patients with estrogen receptor?negative and human epidermal growth factor receptor 2?overexpressed ( Rec?/HER?2+) locally advanced breast cancer ( LABC ) . Methods A retrospective analysis was performed on the clinical data of 294 patients with Rec?/HER?2+LABC from 1999 to 2011. All patients were treated with modified radical mastectomy ( MRM ) . Of them, 239 patients received postmastectomy radiotherapy and 55 patients did not. Locoregional recurrence?free survival ( LRRFS) and overall survival ( OS) , as well as LRR, were compared between the two groups. The Kaplan?Meier method was used to estimate survival and recurrence rates, and the log?rank test was used for survival difference analysis and univariate prognostic analysis. Multivariate prognostic analysis was performed using the Cox regression model. Results The 5?year sample size was 162. Fifty?six patients developed LRR. The 5?year LRRFS and OS rates were 79. 7% and 70. 0%, respectively. Postmastectomy radiotherapy significantly increased the 5?year LRRFS rate ( 85. 1% vs. 56. 0%, P=0. 000) , but did not significantly increase the 5?year OS rate ( 71. 3% vs. 64. 2%, P= 0. 441 ) . Multivariate analysis indicated that postmastectomy radiotherapy was the only independent prognostic factor associated with increased LRRFS ( RR=0. 303, 95% CI:0. 166?0. 554, P=0. 000). Conclusions Patients with Rec?/HER?2+ LABC treated with MRM alone appear to be at a significantly increased risk of LRR compared with those treated with MRM followed by radiotherapy.

Objective To investigate the treatment outcome and failure in patients with primary mediastinal large B-cell lymphoma(PMBL). Methods Between Jan. 1992 and Oct. 2006, a total of 46 patients with pathologically confirmed PMBL were reviewed, including 14 with Ann Arbor Stage I disease, 23 with Stage Ⅱ disease,3 with Stage Ⅲ disease and 6 with Stage Ⅳ disease. Stage Ⅰ+Ⅱ disease was present in 80% of the patients. All patients were treated with chemotherapy ,and 29 also received radiotherapy. Twenty-seven patients(59%) were treated with first generation regimen(CHOP),9(20%) with third generation regimens (MACOP-B, ProMACE/CytaBOM, m-BACOD, or ProMACE-MOPP), and 10(22%) with high-dose chemotherapy (HDCT/APBSCT). Rituximab was administered to 16 patients (35%). For most patients who received radiotherapy,an involved field was used with a median dose of 45 Gy in 23 fractions.Results The rate of complete remission, partial remission and progression disease was 41%, 30% and 24% ,respectively. The 5-year overall survival rate(OS) for all patients was 35%. The 2- and 5-year OS was 79% and 63% for stage Ⅰ+Ⅱ and 51% and 0 for stage Ⅲ+Ⅳ ,respectively(X2=4.35 ,P=0. 037).The 2-year progression free survival rate was 63 % and 11%, respectively (X2=17.77, P=0.1300). The 5-year OS was 80% for the patients with CR,50% for those with PR,and 0 for those with progression disease(X2= 19.58 ,P=0.003 ). With a median follow-up of 22 months, progression disease and relapse occurred in 19 patients. Conclusions Survival of patients with advanced stage PMBL is poor. Further studies areneeded to confirm the optimal treatment. Radiotherapy often plays a pivotal role in local control.

Objective A phase Ⅰ study was conducted to determine the maximal tolerated dose (MTD) and the dose-limiting toxicity(DLT) of chemotherapy of oral doxifluridine(5-dFUR) and leucovorin with concurrent standard radiotherapy(RT) as adjuvant treatment in patients with rectal cancer. Methods Patients aged 18-75 years old, Karnofsky scored ≥70%, stage Ⅱ/Ⅲ rectal cancer after curative surgery were eligible. Total RT dose was delivered as DT 50 Gy in the fraction of 2.0 Gy per day for 5 weeks to the pelvic area. 5-dFUR was administered concurrently with radiotherapy in escalating doses, and oral leucovorin was The DLTs included grade 3 or grade 4 hematologic and nonhematologic toxicity. Results From Aug. 2005 the most common side effects although all neutropenia was less grade 3. The DLT was observed in 1 patient of RT. In the following 3 enrolled patients, one suffered grade 3 abdominal cramp pain, diarrhea, fatigue, nausea/vomit and grade 2 neutropinea and fever. Grade 3 diarrhea was also observed in all the additional 3 papatients didn't complete the scheduled concurrent chemoradiotherapy due to severe side effects,including 1 at grade 3 abdominal cramp pain,fatigue and nausea/vomit. Conclusions Diarrhea is the most common and severe side effect in this phase Ⅰ study. The MTD of doxifluridine, concurrently with RT and fixed dose of oral cramp pain is often accompanied with diarrhea and nauser/vomit when the dose of doxifluridine exceeds 550 mg/( m2 · d) or 900 mg/d,patients need to be observed carefully.

ObjectiveTo compare the role of AJCC 6th and 7th TNM staging systems in predicting the long term survival of locally advanced gastric cancer patients after curative surgery. Methods All patients who met the following criteria were included for analyses: treated between January 2002 and December 2004, primary gastric or gastroesophageal cancer, underwent curative gastrectomy ( UICC R0 ) and at least more than D1 lymphadenectomy, pathologically staged as T3-4N0-1 M0, or any T, N2-3M0. Overall survival (OS), disease-free survival ( DFS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) were calculated and compared according to N and TNM stage of the two TNM staging systems (T stage were not analyzed due to its extremely unbalanced distribution). The N and TNM stage and other significant variables in univariate analyses were evaluated further for both OS and DFS by Cox regression. ResultsThe median follow-up time was 61 months. The follow-up rate was 92. 3％.Among the 297 enrolled patients, 56. 9％ of the patients had a stage migration between the two staging systems. According to 6th, no difference in DMFS was detected between different N and TNM stages (x2 =6. 65, P =0. 084 ; x2 =6. 61, P =0. 108 ). When using 7th, statistically significant difference was found in DMFS between different N stages ( x2 =9. 035,P =0. 029), and TNM stage also tended to have an influence on DMFS ( x2 =7.27,P =0. 064). The N and TNM stage had similar significant influence on OS, DFS and LRFS based on both staging systems ( x2 =9. 23 - 19. 00,P =0. 000 -0. 026 and x2 =11.67 - 19. 11 ,P =0. 000 -0. 009).In Cox regression, TNM stage was an independent prognostic variable for both OS and DFS based on these two staging systems (x2=9.05-25.51, P=0.000-0.003 ), but the 7thappeared to be a better predictor than the 6 th ( OS : RR =1.6 1 8 vs 1.4 9 6 ; DFS : RR =1.5 9 4 vs 1. 5 6 4 ).ConclusionsThe N and TNM stage in 7th TNM staging system are more predictive for DMFS than in 6th TNM staging system for locally advanced gastric cancer patients. The 7th TNM staging system provides a better prognostic estimation of both OS and DFS.

Objective The benefit of adjuvant chemoradiotherapy remains controversial for gastric cancer patients treated with more than D1 dissection. This retrospective analysis is to distinguish the first site of recurrence in patients treated with curative resection and more than D1 dissection and to find any feasible adjuvant concurrent chemoradiotherapy recommendation for them. Methods All patients treated between January 2002 and December 2004 who met the following criteria were analyzed: primary gastric or gastroesophageal cancer, underwent curative gastrectomy ( UICC R0 ) and more than D1 lymphadenectomy,pathologically staged as T3-4N0-1 M0, or any Tx N2-3M0. There were 297 patients analyzed and 19.5%,52. 2%, 17. 8% , 10. 4% of patients had stage Ⅱ ( T3 N0 M0, T1 N2 M0 ), Ⅲa, Ⅲb and Ⅳ ( M0 ) diseases,respectively. 76. 1% of patients received adjuvant chemotherapy, while Only 2 patients underwent adjuvant radiotherapy. Failure patterns and the prognostic factors for locoregional recurrence were analyzed. Results The median follow-up time was 61 months and the follow-up rate was 92. 3%. 145 patients developed recurrence with a median recurrent time of 26 months. Locoregional recurrence was observed in 82 patients and distant metastasis in 79 patients. Gastric stump, anastomosis, intra-abdominal lymph nodes were the most common sites of locoregional recurrence. Liver and lung were the most frequent sites of distant metastasis. Prognostic variables for locoregional recurrence were identified after univariate analysis,including pathologic type ( χ2 = 11.50, P = 0. 009 ), total number of dissected lymph nodes ( χ2 = 6. 65,P =0. 010), the number of positive lymph node ( χ2 =5. 80,P =0. 016), lymph node capsular invasion ( χ2 =pathologic type, total number of dissected lymph nodes, lymph node capsular invation, AJCC TNM stage and Borrmann type were independent prognostic factors for locoregional recurrence ( χ2 = 6. 77,19. 33,17. 84 and 6. 02,P =0. 009,0. 000,0. 000 and 0. 014). ConclusionsLocoregional recurrence remains the main cause of failure for locally advanced gastric or gastroesophageal cancer patients even though the patients have had more than D1 lymphadenectomy. The role of adjuvant concurrent hemoradiotheray for those patients is warranted.