Objective To investigate the general characteristics and treatment processes of patients with advanced esophageal cancer (EC) treated in county- or prefecture-level hospitals in high-incidence areas of EC in China. Methods In this retrospective observational study, electronic medical records of patients with advanced EC were collected from six medical centers in high-incidence areas. Eligible patients had advanced EC and whose first medical contact was documented between January 1, 2022, and June 1, 2024. Descriptive statistical analyses were conducted to evaluate patient characteristics and treatment plans. Results A total of 322 EC patients were included, of whom 230 were male (71.4%). The median age was 69 years. Among the 270 patients with available tumor diagnosis information, 264 patients (97.8%) presented with EC-specific symptoms. Of the 281 patients with pathological data, esophageal squamous cell carcinoma was the predominant type, accounting for 254 cases (90.4%). Among 235 patients with information on the initial diagnostic method, 220 (93.6%) were diagnosed through endoscopy. A total of 216 patients (67.1%) with advanced disease progressed from early or locally advanced stages. Surgical treatment was performed in 126 patients (39.1%), of whom 123 (97.6%) achieved R0 resection, and 71 (56.3%) of them received perioperative treatment. Definitive chemoradiotherapy was administered to 116 patients (36.0%). The median disease-free survival for patients undergoing radical surgery was 13.9 months, while that for patients treated with definitive chemoradiotherapy was 10.6 months. At the advanced stage, lymph node metastasis was observed in 250 patients (77.6%), with mediastinal lymph node metastasis being the most common type. Organ metastasis occurred in 176 patients (54.7%), most frequently involving the lungs, liver, and bones. Most patients (79.8%, 229/287) were from the county or city where the hospoital was loacted, 77.9% (232/298) were covered by resident basic medical insurance, and 88.7% (274/309) of patients initiated advanced treatment at the participating hospitals. Conclusion This study reveals the unique epidemiological, clinical, and pathological characteristics of patients with EC in high-incidence areas of China. The results provide an important reference for further exploration of this disease and its management.

Objective:To investigate the dosimetric differences between non-coplanar volumetric modulated arc therapy (VMAT) and non-coplanar fixed-field intensity-modulated radiotherapy (IMRT) of Monaco treatment planning system (TPS) in hippocampus-avoidance whole-brain radiation therapy with simultaneous integrated boost(HA-WBRT+SIB) for brain metastases,so as to provide a practical and feasible treatment plan for clinical work. Methods:A total of 22 patients with brain metastases were retrospectively selected. Two radiotherapy plans,which included non-coplanar VMAT and non-coplanar fixed field IMRT of HA-WBRT+SIB,were designed for each patient. The dose distribution,the machine units (MU) of plan,and verification of pre-treatment plan in target area and organs at risk (OARs) between two plans were compared under meeting the prescribed dose requirements of target volume. Results:There were no significant differences in covered volumes (V50 and V55) of 50 and 55 Gy dose,maximum dose (Dmax),heterogeneity index(HI) and conformity index(CI) of planning gross tumor volume(PGTV) between the two plans (P>0.05). For whole-brain planning target volume (PTV-brain-SIB),there was no significant difference in the dose that was covered by 98％ volume (D98％) between IMRT and VMAT (P<0.05). VMAT plan could significantly improve the covered volume of 30 Gy dose (V30) of PTV-brain-SIB,and decrease HI value and increase CI value,and the differences of them between VMAT and IMRT were significant (t=-6.366,3.289,-8.343,P<0.05),respectively. The Dmax values of left and right eyes of VMAT plan were significantly lower than those of IMRT plan,and the differences were significant (t=5.784,5.351,P<0.05),respectively. The Dmax value of right inner ear of VMAT plan was higher than that of IMRT plan,and the difference was significant (t=-2.848,P<0.05). VMAT could significantly increase D100％ value of left and right hippocampus,which was higher than that of IMRT plan,and the differences of them between two plans were significant (t=-2.564,-6.578,P<0.05),respectively. The MU of IMRT plan was significantly lower than that of VMAT plan,and the difference was significant (t=-6.249,P<0.05). The treatment time of VMAT plan was (294.1±16.4) s,which was significantly less than that of IMRT plan,and the difference of that between two plans was significant (t=-7.400,P<0.001). Under the standards of 3％/2 mm and 2％/2 mm of γ analysis,the γ pass rates of IMRT plan were respectively (99.1±0.6)％ and (97.6％±1.0)％,which were significantly higher than those of VMAT plan,and the differences of them were significant (t=-2.733,t=-5.780,P<0.001),respectively. Conclusion:The non-coplanar VMAT and non-coplanar fixed field IMRT based on the Monaco TPS can produce clinically acceptable results for HA-WBRT+SIB in patients with brain metastases. Compared with IMRT,VMAT has better advantage in dose distribution of target volume,and higher treatment efficiency,but IMRT can better protect the hippocampus and reduce the number of MU.

Objective:To investigate the dosimetric differences between non-coplanar volumetric modulated arc therapy (VMAT) and non-coplanar fixed-field intensity-modulated radiotherapy (IMRT) of Monaco treatment planning system (TPS) in hippocampus-avoidance whole-brain radiation therapy with simultaneous integrated boost(HA-WBRT+SIB) for brain metastases,so as to provide a practical and feasible treatment plan for clinical work. Methods:A total of 22 patients with brain metastases were retrospectively selected. Two radiotherapy plans,which included non-coplanar VMAT and non-coplanar fixed field IMRT of HA-WBRT+SIB,were designed for each patient. The dose distribution,the machine units (MU) of plan,and verification of pre-treatment plan in target area and organs at risk (OARs) between two plans were compared under meeting the prescribed dose requirements of target volume. Results:There were no significant differences in covered volumes (V50 and V55) of 50 and 55 Gy dose,maximum dose (Dmax),heterogeneity index(HI) and conformity index(CI) of planning gross tumor volume(PGTV) between the two plans (P>0.05). For whole-brain planning target volume (PTV-brain-SIB),there was no significant difference in the dose that was covered by 98％ volume (D98％) between IMRT and VMAT (P<0.05). VMAT plan could significantly improve the covered volume of 30 Gy dose (V30) of PTV-brain-SIB,and decrease HI value and increase CI value,and the differences of them between VMAT and IMRT were significant (t=-6.366,3.289,-8.343,P<0.05),respectively. The Dmax values of left and right eyes of VMAT plan were significantly lower than those of IMRT plan,and the differences were significant (t=5.784,5.351,P<0.05),respectively. The Dmax value of right inner ear of VMAT plan was higher than that of IMRT plan,and the difference was significant (t=-2.848,P<0.05). VMAT could significantly increase D100％ value of left and right hippocampus,which was higher than that of IMRT plan,and the differences of them between two plans were significant (t=-2.564,-6.578,P<0.05),respectively. The MU of IMRT plan was significantly lower than that of VMAT plan,and the difference was significant (t=-6.249,P<0.05). The treatment time of VMAT plan was (294.1±16.4) s,which was significantly less than that of IMRT plan,and the difference of that between two plans was significant (t=-7.400,P<0.001). Under the standards of 3％/2 mm and 2％/2 mm of γ analysis,the γ pass rates of IMRT plan were respectively (99.1±0.6)％ and (97.6％±1.0)％,which were significantly higher than those of VMAT plan,and the differences of them were significant (t=-2.733,t=-5.780,P<0.001),respectively. Conclusion:The non-coplanar VMAT and non-coplanar fixed field IMRT based on the Monaco TPS can produce clinically acceptable results for HA-WBRT+SIB in patients with brain metastases. Compared with IMRT,VMAT has better advantage in dose distribution of target volume,and higher treatment efficiency,but IMRT can better protect the hippocampus and reduce the number of MU.

Objective    To investigate the short-term therapeutic effect of neoadjuvant immunotherapy combined with chemotherapy in the locally advanced esophageal squamous cell carcinoma. Methods    The clinical data of patients with esophageal squamous cell carcinoma treated with neoadjuvant treatment in Gaozhou People's Hospital from August 2019 to October 2020 were retrospectively analyzed. According to the different treatments, the patients were divided into two groups: a neoadjuvant immunotherapy combined with chemotherapy group (NIC group) and a neoadjuvant chemoradiotherapy group (NC group). The baseline data, incidence of adverse events during treatment, perioperative indicators, postoperative pathological remission rate and incidence of postoperative complications were compared between the two groups. Results    Totally 33 patients were enrolled, including 15 males and 18 females, with an average age of 62.37±7.99 years. There were 17 patients in the NIC group and 16 patients in the NC group. In the NIC group, the carcinoma was mainly located in the middle and lower esophagus, with 5 paitents in stage Ⅱ, 9 patients in stage Ⅲ, and 3 patients in stage Ⅳa. In the NC group, the carcinoma was mainly located in the upper-middle esophagus, with 1 patient in stage Ⅱ and 15 patients in stage Ⅲ. During the neoadjuvant treatment, there was no significant difference in the occurrence of bone marrow suppression or gastrointestinal reactions between the two groups (P>0.05). There were 4 immune-related rashes in the NIC group and 1 esophageal perforation in the NC group. Fourteen (82.35%) patients in the NIC group and 12 (75.00%) patients in the NC group completed the operation on schedule. The postoperative ICU stay time and chest tube indwelling time in the NIC group were shorter than those in the NC group (P<0.05). There were 5 patients of complete remission in the NIC group, and 6 patients in the NC group. There was no significant difference in the pathological regression grade or residual tumor cells between the two groups (P>0.05). There was no significant difference in the incidence of anastomotic fistula, thoracic gastric fistula, bronchial mediastinal fistula, abdominal distension, pulmonary infection, stroke, or hoarseness during the perioperative period between the two groups of patients who completed the operation (P>0.05). In the NC group, 2 patients died during the perioperative period because of thoracic gastric fistula complicated by severe infection. Conclusion    Neoadjuvant immunotherapy combined with chemotherapy dose not significantly increase the occurrence of adverse events and shows a good rate of pathological remission, which indicates that the neoadjuvant immunotherapy combined with chemotherapy is a safe, feasible and potential new treatment model.

Objective To illustrate the basic operational principle of the control software item Part and value ( IPV) of Elekta digital medical linac and specifically explain that the control software monitors and controls the subsystems in a real-time manner by using three types of items and Parts. Methods Firstly, the composition of the control system of Elekta digital medical linac was introduced. Then, the definition and category of the items and Parts of the control software and the basic principle of different types of items were illustrated. Finally, the application of control software items and Parts in real-time monitoring and controlling the operation of subsystems was evaluated by analyzing the motion control of high-power ( HP) phase shifter. Results By analyzing the principle and citing a classical example to specifically illustrate the operational principle and application of control software IPVs, the users, especially the maintenance personnel, could master relevant theoretical knowledge, rapidly and accurately find the operational parameters during daily use and maintenance, besides analyze and resolve the problems based on the control principle of relevant subsystem. Conclusion Users, especially the maintenance personnel who master the working principle of these subprojects and their project sub-items can quickly and accurately check, calibrate the operating parameters via the control software, resolve equipment failure and avoid accidents caused by inappropriate operation in the daily use or maintenance.