100 patients suffering from cancer of the tonsil were treated by radiation therapy from May 1972 through 1988. All were proved by pathology as: anaplastic carcinoma 31(31%), poorly differentiated carcinoma 33(33%),squamous cell carcinoma 31(31%), adenocarcinoma 1(1%), papilloma with malignant change 1 and unclassifiable 3. Cliniral staging (1987,UICC) stage Ⅰ4(4%), stage Ⅱ6(5%), stage Ⅲ 21(21%) and stage Ⅳ 69(69%). N 0 18(18%),N 1～3 82(82%).Telecobalt was given to 50～70 Gy/6～8wk in 88% of patients. It was

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.

BACKGROUNDTo observe the effects of MVP chemotherapy combined with concurrent radiotherapy for stage IIIB-IV non-small cell lung cancer.

METHODSSixty-two patients with stage IIIB-IV non-small cell lung cancer were randomized into two groups, concurrent radiochemotherapy group and MVP che-motherapy group. All patients in two groups were treated with MVP regimen (mitomycin C 6 mg/m² on day 1, vindesine 2 mg/m² on days 1, 8, and cisplatin 80-100 mg/m²). Patients in concurrent radiochemotherapy group received concurrent radiotherapy (46-56 Gy in 5-6 weeks).

RESULTSAll patients received 2-4 cycles of MVP chemotherapy. The response rate was 48.4% and 19.4% in concurrent radiochemotherapy group and MVP group respectively (P < 0.05), the 1-year survival rate was 54.8% and 22.6% respectively (P < 0.05), median time to progression was 8 months and 4 months respectively (P < 0.05), and median survival duration was 10 months and 6 months respectively (P < 0.05). Incidence of grade II-III leukopenia in concurrent radiochemotherapy group was remarkably higher than those in MVP group..

CONCLUSIONSThe results show that efficacy of MVP chemotherapy combined with concurrent radiotherapy is significantly higher than that of MVP chemotherapy alone for advanced non-small cell lung cancer.

BACKGROUNDTo study the apoptosis inducing effect of preoperative hyperfractionated accelerated radiation therapy (HART) and expression of Bcl-2, Bax proteins in non-small cell lung cancer.

METHODSFrom October 1999 to March 2001, 81 patients with non-small cell lung cancer were prospectively divided into preoperative HART group (20 patients) and surgical group (61 patients). The patients in preoperative HART group were given preoperative irradiation with 2.5 Gy/fraction, twice a day to a total dose of 25 Gy/10 fractions/5-7 days using anterior-posterior opposing parallel fields, then operation would be performed within 2 weeks. The patients in surgical group only received surgical treatment. Apoptotic index (AI), cell cycle distribution and expression of Bcl-2, Bax proteins were quantitatively analyzed by indirect-immunofluorescene and flow cytometry.

RESULTSAI was 4.6%±2.3% in surgical group and 12.8%±4.3% in preoperative HART group, respectively ( P < 0.001). There was no difference in S phase fraction (SPF) between the two groups ( P > 0.05). The fluorescence index (FI) for Bcl-2, Bax proteins and the ratio of Bcl-2/Bax were 1.33±0.21, 1.05±0.13 and 1.29±0.23 in surgical group, and 1.14±0.26, 1.19±0.16 and 0.96±0.23 in preoperative HART group respectively ( P < 0.01, P < 0.001 and P < 0.001 respectively). AI showed a positive correlation to Bax protein ( P < 0.001) and a negative correlation to the ratio of Bcl-2/Bax ( P < 0.01).

CONCLUSIONSPreoperative HART may induce a high-level apoptosis by decreasing the expression of Bcl-2 protein and increasing the expression of Bax protein. However, it is still necessary to further observe whether it can improve the long-term survival of patients with NSCLC.

BACKGROUNDConcurrent chemotherapy plus radiotherapy is a trend in treatment of non-small cell lung cancer (NSCLC), but the treatment program is rather complicated and the toxicity is more severe than chemotherapy or radiotherapy alone. The aim of this study is to evaluate the early response and toxicity of concurrent chemoradiotherapy.

METHODSEighty unresectable stage IIIA-IIIB NSCLC patients pathologically proved were randomly divided into 2 groups. Group A: patients were treated with concurrent chemotherapy of vinorelbine (12.5mg/m², on days 1, 8, 29, 36) and cisplatin (40mg/m², on days 1, 8, 29, 36) (NP regimen) plus conventional radiotherapy. Patients were irradiated at 1.8-2.0Gy/Fx daily, 5 days per week. The total dose was 60Gy/30-33 Fx. After the radiation, 3 cycles of NP regimen were performed, but the dose of vinorelbine was 25mg/m². Group B: patients received sequential chemoradiotherapy. At first radiation was performed as same as group A. Then chemotherapy of NP (NVB 25mg/m², on days 1 and 8, DDP 80mg/m², on day 1) was followed for 4-5 cycles.

RESULTSThe overall response rate in concurrent and sequential groups was 80.0% and 57.5% respectively (Chi-Square=4.71, P < 0.05). Incidences of grade III-IV acute radiation esophagitis and leukopenia were 47.5% and 65.0% in group A, and 25.0% and 42.5% in group B respectively (P < 0.05). The acute radiation pneumonitis rate was 32.5% in group A and 20.0% in group B (P > 0.1).

CONCLUSIONSConcurrent chemoradiotherapy is well tolerated in most unresectable stage IIIA-IIIB NSCLC patients. Its early response is better than sequential chemoradiotherapy.