OBJECTIVETraditional detection approaches for non-O157 STEC are both time and labour consuming in diseases surveillance. Virulence genes detection based on multiplex PCR could not only improve the detection efficiency but also increase the accuracy.

METHODSSix virulence genes of non-O157:H7 (stx1, stx2, eae, hly, etpD, katP6) were detected by two groups of trebling PCRs. The multiplex PCRs were optimized by melting curve analysis in SYBR Green I real-time PCR. Testing result of multiplex PCR was consistent with serological testing.

RESULTSThe sensitivity limits of the multiplex PCR for stx1, stx2, eaeP, etpD, katP, and hly were 10 ng/ml, 120 ng/ml, 110 ng/ml,165 ng/ml, 85 ng/ml, and 15 ng/ml, respectively, which is similar with that of single PCR. When the multiplex PCR was applied in 120 adults and 90 children diarrhea samples detection, 13 cases were detected for non-O157 positive.

CONCLUSIONThe method we established can be used for non-O157 STEC virulence genes detection and screening with high efficiency and accuracy.

Escherichia coli Infections ; diagnosis ; microbiology ; Escherichia coli Proteins ; genetics ; Humans ; Multiplex Polymerase Chain Reaction ; methods ; Shiga-Toxigenic Escherichia coli ; genetics ; isolation & purification ; Virulence Factors ; genetics

OBJECTIVETo analyze the relation between pathologic tumor response in preoperative radiotherapy and long-term survival in patients with esophageal carcinoma and the significance of radiosensitivity in the treatment of esophageal carcinoma.

METHODS176 esophageal cancer patients received preoperative radiotherapy and tumor resection from 1977 to 1989. The radio-response was classified into severe, moderate and mild according to the tumor pathologic response to radiotherapy. 191 patients treated by surgery alone served as control. The relation between radiation response of tumor and long-term survival and disease free survival was analyzed.

RESULTSThe 5-year survival rates of severe, moderate, mild and control groups were 60.7%, 46.4%, 21.1% and 38.8%. The survival was significantly improved in severe than moderate one (P = 0.029), moderate than mild group (P = 0.013) and severe than the control group (P = 0.000). It was only slightly improved in the moderate than control group (P = 0.295), but decreased in mild than the control group (P = 0.034). The 5-year disease-free survival (DFS) rates were 55.7%, 40.7%, 18.7% and 33.3% in severe, moderate, mild and control groups. The DFS was significantly improved in severe than moderate group (P = 0.029), moderate than mild group (P = 0.018), severe than the control group (P = 0.000 4). It was only slightly improved in moderate than the control group (P = 0.23), but decreased in the mild than the control group (P = 0.096). In the severe group, the proportion of stage T4, N1 lesion, TNM stage I-II and number of radical resection were 9.8%, 18%, 90.2%, and 90.2%. In the moderate group, they were 20.3%, 15.9%, 79.7% and 82.6%. In the mild group, they were 42.2%, 37.8%, 53.3% and 46.7%. In the control group, they were 50.3%, 40.8%, 37.7% and 77.5%. The rates of downstaging and surgical resection were improved only in severe and moderate groups (P < 0.01).

CONCLUSIONThe fact that only patients in whom severe radiation response are observed would appreciably benefit from preoperative radiotherapy whereas the others do not, illustrates that there might be no benefit of radiotherapy for radioresistant esophageal carcinoma. Radiosensitivity measurement before preoperative radiotherapy would be valuable for individualized treatment.

Adult ; Aged ; Combined Modality Therapy ; Esophageal Neoplasms ; mortality ; pathology ; radiotherapy ; surgery ; Female ; Humans ; Male ; Middle Aged ; Prognosis

OBJECTIVETo evaluate the feasibility, therapeutic effects and complications of three-dimensional conformal radiotherapy (3DCRT) for small-cell lung cancer (SCLC).

METHODSThe data of 19 SCLC patients treated between June 2001 and August 2003, with 3DCRT were reviewed and analyzed. Eighteen patients were treated by radiotherapy plus chemotherapy while only 1 patient by radiotherapy alone. Radiotherapy was delivered at 2 Gy/fraction, 5 fractions per week with a median total dose of 54 Gy. Chemotherapy consisted of 4 - 6 cycles of etoposide and cisplatin or carboplatin. The median follow-up time was 24 months.

RESULTS(1) The overall response rate after 3DCRT was 79.0%, with a complete remission rate of 31.6% (6/19), partial remission rate of 47.4% (9/19). The 1- and 2-year overall survival (OS) was 71.7% and 35.8% respectively, with a median survival time (MST) of 19 months, and both the 1- and 2-year local progression free survival (LPFS) were 94.7%. (2) Of these 19 patients, grade 2 acute radiation pneumonitis developed in 5.3%, grade 2 late radiation pneumofibrosis in 5.3%, grade 2 acute radiation esophagitis in 10.5% and grade 2 acute hematologic toxicity in 10.5%.

CONCLUSIONThree-dimensional conformal radiotherapy is feasible in the treatment of SCLC with high response rate and acceptable complications. Further observation, more patients treated by 3DCRT and prolonged follow-up are needed to evaluate remote survival.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Small Cell ; drug therapy ; radiotherapy ; Combined Modality Therapy ; Female ; Humans ; Lung Neoplasms ; drug therapy ; radiotherapy ; Male ; Middle Aged ; Radiotherapy Dosage ; Radiotherapy, Conformal ; methods

OBJECTIVETo retrospectively analyze the effects of different chemotherapy regimens for concurrent chemoradiation on locally advanced non-small cell lung cancer (NSCLC).

METHODSThe data from 106 patients diagnosed as locally advanced NSCLC (IIIa: 29, IIIb: 77), who received various chemotherapy regimens for concurrent chemoradiotherapy, were retrospectively analyzed. Paclitaxel-based chemotherapy regimen was administered in 55 patients, topotecan regimen in 21 patients, PE (cisplatin and etopside) regimen in 26 patients, and other regimens in the remaining 4 patients. The effect of different chemotherapy regimens on overall survival and toxicity was analyzed.

RESULTSThe median survival time was 18.6 months, and the overall 1- and 3-year survival rates were 72.2% and 27.5%, respectively. The median survival time of 102 patients treated with paclitaxel-containing, topotecan-containing or PE regimens was 16.3, 27.3 and 29.1 months, respectively. The overall survival times of topotecan and PE groups were superior to that of paclitaxol-based group, but not significantly different (P = 0.32). Both univariate and multivariate analysis showed that paclitaxol-based chemotherapy regimen was significantly associated with a poorer survival (P < 0.05). N stage was another significant prognostic factor determined by COX multivariate regression model. Compared with the other regimens (10.6%), paclitaxel-based regimen (27.3%) had more acute radiation pneumonitis (grade >or= 2, P = 0.03), but no significant differences were observed in blood toxicity and esophagitis.

CONCLUSIONThere is a correlation between different chemotherapy regimens for concurrent chemoradiotherapy and the overall survival and acute radiation pneumonitis in patients with locally advanced NSCLC.

Adult ; Aged ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Agents, Phytogenic ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; pathology ; radiotherapy ; Cisplatin ; therapeutic use ; Combined Modality Therapy ; Etoposide ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; drug therapy ; pathology ; radiotherapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Paclitaxel ; therapeutic use ; Proportional Hazards Models ; Radiation Pneumonitis ; etiology ; Radiotherapy, Conformal ; Retrospective Studies ; Survival Rate ; Topotecan ; therapeutic use

OBJECTIVETo evaluate the effect of thoracic radiation therapy (TRT) on patients with extensive stage small-cell lung cancer (SCLC).

METHODSOne hundred and fifty-four patients with extensive stage SCLC treated in our department between January 2003 and December 2006 were enrolled in this study. Eighty nine patients received chemotherapy and thoracic radiation therapy (ChT/TRT), and 65 patients were treated with chemotherapy alone (ChT without TRT). The chemotherapy was CE (carboplatin and etoposide), PE (cisplatin and etoposide) or CAO (CTX, ADM and VCR) regimens. The total dose of thoracic irradiation was 40-60 Gy with 1.8 - 2.0 Gy per fraction.

RESULTSFor the whole group, the median survival time (MST) was 13.7 months, the 2-year and 5-year overall survival rates were 27.9% and 8.1%, respectively. The MST, overall survival rates at 2 years and 5 years in the ChT/TRT group and ChT without TRT group were 17.2 months, 36.0%, 10.1% and 9.3 months, 16.9%, 4.6%, respectively (P = 0.001). The median progression-free survival (PFS) for all patients was 8.0 months, the 2-year and 5-year PFS were 13.6% and 8.2%, respectively. The median PFS, 2-year and 5-year PFS in the ChT/TRT group and ChT without TRT group were 10.0 months, 17.4%, 10.5% and 6.2 months, 9.8%, 4.9%, respectively (P < 0.001). The incidence of intra-thoracic local failure was 29.6% in the ChT/TRT group and 70.0% in the ChT/without TRT group (P = 0.000).

CONCLUSIONSChemotherapy plus thoracic radiation therapy can improve the overall survival, progress free survival and reduce local regional failure rate in patients with extensive stage SCLC compared with that by chemotherapy alone.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carboplatin ; therapeutic use ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Disease-Free Survival ; Etoposide ; administration & dosage ; Humans ; Lung Neoplasms ; drug therapy ; radiotherapy ; Prognosis ; Small Cell Lung Carcinoma ; drug therapy ; radiotherapy ; Survival Rate

OBJECTIVETo evaluate the effects of a solitary megadose protocol of ionizing radiation (IR) to parotid gland on the structured and function changes of bilateral parotid glands in miniature pig.

METHODSFourteen minipigs were subjected to either 15 or 20 Gy to one parotid gland with a linear accelerator, while another four minipigs served as non-IR controls. Salivary flow rates and salivary chemistries were measured pre-IR, and 4 and 16 weeks post-IR. A quantitative assessment of gland weight and acinar area, and detailed serum chemistry and hematological analyses, were also performed.

RESULTSParotid gland weights were significantly decreased in the 15 and 20 Gy groups at 4 and 16 weeks post-IR. The acinar cell area in glands of both IR groups was significantly reduced. Parotid flow rates decreased by 60% with 15 Gy at 16 weeks post-IR. In the 20 Gy group, salivary flow rates were reduced by 80% at 16 weeks post-IR. Additionally, parotid flow rates significantly reduced in contralateral glands with 20 Gy at 16 weeks, while structure and weight did not changes in parotid glands.

CONCLUSIONStructural changes in salivary gland parenchyma occurred relatively early after IR, while the alterations in salivary output were relatively delayed. Further, reductions in salivary flow were not proportional to acinar cell area loss. There isn't a significant structured change of contralateral glands, but significant reduction of parotid flow rate at this time.

Animals ; Parotid Gland ; radiation effects ; Swine ; Swine, Miniature

OBJECTIVETo investigate the association between survival and postoperative three-dimensional conformal radiotherapy (3DCRT) in patients with resected non-small cell lung cancer (NSCLC).

METHODSEighty-four patients were treated with surgery and postoperative 3DCRT for NSCLC. Sixty-five (77.4%) patients received lobectomy, and 19 (22.6%) received pneumonectomy. Fifty-four (64.3%) patients achieved R0 resection and 30 cases (35.8%) received R1/R2 resection. Fifty-two patients were of stage IIIA and 24 patients were of stage IIIB. Photon energy of 6 MV was used for all the patients. The median 3DCRT dose was 60 Gy (40 - 70 Gy) with a fraction size of 2 Gy. Thirty-seven patients received median 3 cycles of adjuvant chemotherapy. The median follow-up was 35.5 months for survivors.

RESULTSThe overall 3-year survival rate was 58.6%, and the 4-year overall survival rate was 43.9%. Of the 43 patients who had treatment failure, only 8 (9.9%) patients showed intrathoracic recurrence, but 38 (46.9%) patients had distant metastasis. The univariate analysis for all patients showed that sex, age, weight loss, tumor size, pathology and stage were not correlated with prognosis. R1/R2 resection was associated with a significantly worse survival. Toxicities were acceptable, with 9 (11.1%) patients appeared higher than NCI CTC grade 2 radiation pneumonitis.

CONCLUSIONIn a population-based cohort, postoperative 3DCRT for NSCLC provides a good prognosis, and the radiation-related pneumonitis is acceptable.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; pathology ; radiotherapy ; surgery ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Humans ; Imaging, Three-Dimensional ; Lung Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Pneumonectomy ; methods ; Radiation Pneumonitis ; etiology ; Radiotherapy Dosage ; Radiotherapy, Conformal ; adverse effects ; methods ; Radiotherapy, High-Energy ; adverse effects ; Survival Rate

OBJECTIVETo evaluate single photon emission computed tomography (SPECT) lung perfusion in predicting radiation pneumonitis in lung cancer patients.

METHODSFrom April 2003 to March 2004, 31 lung cancer patients treated with radical radiotherapy received SPECT lung perfusion scans, among whom, 23 had had perfusion scans both before and at the time of 40 Gy irradiation. The perfusion changes in the region of interest (ROI) after irradiation were obtained through comparing post-radiotherapy with pre-radiotherapy average proportion of SPECT counts within the ROI relative to average counts of the whole lung. Endpoint was defined as grade 2 and above radiation pneumonitis according to RTOG criteria.

RESULTSLung perfusion defect was observed in all the patients at baseline. > or = grade 2 lung perfusion defect was found in 68.2% (15/22) of patients with central lesion and in 22.2% (2/9) of patients with peripheral lesions (P = 0.04). Seventy percent of the patients (16/23) experienced improved perfusion at 40 - 50 Gy. > or = grade 2 radiation pneumonitis was observed in 12 patients (38.7%) in the whole group, with 6 in those with grade 1 perfusion defects and another 6 in > or = grade 2 group, respectively; Of the 23 patients who had had both pre- and post-radiotherapy SPECT perfusion scan, 5 > or = grade 2 radiation pneumonitis occurred in the 16 perfusion-improved patients and 3 in the 7 unimproved patients.

CONCLUSIONThere is no significant correlation between radiation pneumonitis and the extent of perfusion defect either before or after 40 - 50 Gy irradiation based on our limited data analysis in this series.

Adult ; Aged ; Carcinoma, Small Cell ; radiotherapy ; Carcinoma, Squamous Cell ; radiotherapy ; Female ; Follow-Up Studies ; Humans ; Lung ; physiopathology ; radiation effects ; Lung Neoplasms ; radiotherapy ; Male ; Middle Aged ; Perfusion ; Pneumonia ; diagnostic imaging ; etiology ; Radiation Injuries ; diagnostic imaging ; etiology ; Radiotherapy, Conformal ; adverse effects ; Tomography, Emission-Computed, Single-Photon ; methods

OBJECTIVETo summarize our experience and evaluate the prognostic factors of locally advanced non small cell lung cancer (LA-NSCLC) treated with three dimentional conformal radiotherapy (3D-CRT).

METHODS118 patients with stage IIImA/IIIB non small cell lung cancer were treated with 3D-CRT from Nov. 2001 to Mar. 2005. 113 patients with complete clinical data were eligible for analysis, 45 of them received radiotherapy alone; 39 were treated by concurrent chemoradiation with paclitaxol plus carboplatin in 32 patients and topotecan in 7 patients, and 29 by sequential chemoradiation with platinum-based regiment in most of them. The dose of radiation for the thoracic field ranged from 26 Gy to 75 Gy with a median dose of 60 Gy. GTV and PTV were collected from the 3D treatment plans in 79 and 101 patients, respectively. Overall survival (OS) was calculated using the Kaplan-Meier method. Comparisons among the curves were made using a two-tailed long-rank test. The Cox model was used for multivariate analysis.

RESULTSThe 1-, 2- and 3-year overall survival rate was 60.7%, 31.6% and 22.4%, respectively, with a median survival time of 17 months. In univariate analysis, the following characteristics were significantly associated with longer survival: absence of chest pain, good karnofsky performance status (KPS), albumin > 4.2 g/L, hemoglobin > or = 140 g/L (male) or 130 g/L (female), response to radiotherapy and GTV < 100 cm3. However, multivariate analysis revealed that only good KPS was an independent risk factor predicting the survival.

CONCLUSIONThree-dimensional conformal radiotherapy is effective in the treatment of locally advanced non-small cell lung cancer with acceptable complications. Karnofsky performance status is the only independent prognositic factor.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bone Neoplasms ; secondary ; Brain Neoplasms ; secondary ; Carboplatin ; administration & dosage ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; pathology ; radiotherapy ; secondary ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Karnofsky Performance Status ; Lung Neoplasms ; drug therapy ; pathology ; radiotherapy ; Male ; Middle Aged ; Neoplasm Staging ; Paclitaxel ; administration & dosage ; Particle Accelerators ; Proportional Hazards Models ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Conformal ; methods ; Remission Induction ; Survival Rate

OBJECTIVETo compare the treatment results of three-dimensional conformal radiotherapy (3D-CRT) and conventional radiotherapy (2D) for patients with locally advanced non-small-cell lung cancer (NSCLC).

METHODSFive hundred and twenty seven patients with stage III NSCLC treated between Jan 2000 and Dec 2006 were included in this study. Among them, 253 cases were treated with 3D-CRT, and 274 with conventional radiotherapy. In the 3D group, 159 (62.8%) patients received chemoradiotherapy, 77 with total radiotherapy dose of > 60 Gy, 49 with 50 - 60 Gy. In the 2D group, 127 (46.4%) patients received chemoradiotherapy, 48 with total radiotherapy dose of > 60 Gy, 75 with 50 - 60 Gy.

RESULTSThe 1-, 3-, 5-year overall survival rates (OS) and median survival time for patients treated with 3D-CRT were 73.3%, 26.1%, 14.4% and 20.1 months, respectively, and that of patients treated with 2D radiotherapy were 61.0%, 13.8%, 8.0% and 15.6 months, respectively (P = 0.002). The 1-, 3-, 5-year cause-specific survival rates (CSS) were 79.0%, 33.3%, and 20.8% for the 3D group and 65.1%, 16.7%, 11.2%, respectively, for the 2D group (P = 0.000). The 1-, 3-, and 5-year locoregional control rates were 71.6%, 34.3% and 31.0% for patients treated with 3D radiotherapy and 57.3%, 22.1% and 19.2%, respectively, for patients treated with 2D treatment (P = 0.002). The results of multivariate analysis showed that 3D-CRT, KPS, clinical tumor response and pretreatment hemoglobin level were independently associated with increased OS and CSS. No statistically significant differences were found between the radiation complications in the two groups.

CONCLUSIONSThe results of our study demonstrate that 3D-conformal radiotherapy improves the survival rate in patients with stage III NSCLC compared with that of 2D radiation therapy.

Aged ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; pathology ; radiotherapy ; Chemoradiotherapy ; Female ; Follow-Up Studies ; Hemoglobins ; metabolism ; Humans ; Lung Neoplasms ; drug therapy ; pathology ; radiotherapy ; Male ; Neoplasm Staging ; Radiation Pneumonitis ; etiology ; Radiotherapy Dosage ; Radiotherapy, Conformal ; adverse effects ; methods ; Survival Rate