Objective To evaluate the effect and patient 's tolerance on late-course high-dose radiotherapy (LCHDRT) combined with concurrent chemotherapy for locally advanced non-small cell lung cancer (NSCLC).Methods 73 NSCLC patients were entered into this study from May 2000 to May 2006.The treatment regime consisted of conventional radiotherapy first (40 Gy,20 f,4 w),followed by LCHDRT (24-30 Gy,6 f,2 w,tumor α/β =10 Gy,BED =81.6-93 Gy) combined with concurrent chemotherapy.Conventional irradiation field encompassed the primary lesion,hilum of lung and mediastinal lymph drainage region.LCHDRT focused on the primary lesion only,with ≥95 ％ isodose curve covering the planning target volume (PTV) and the target dose was prescribed to PTV.Supraclavicular metastases lymph node was treated by 6 MV X-ray and electron beam to a total dose of 65-70 Gy.Chemotherapy regime consisted of vinorelbine (25 mg/m2,d1,8 iv) and cisplatin (30 mg/d,d1-3,iv gtt) in the lst and 5th weeks.Results Leukopenia and radiation-induced pneumonitis,as shown by the WHO staging system were the most common acute toxicities.In V20≤25 ％,17.2 ％ (5/29) patients happened radiation-induced pneumonitis only.But in V20 ＞ 25 ％ and ≤ 30 ％,65.9 ％ (29/44) happened radiation-induced pneumonitis (x2 =16.63,P ＜ 0.01).It showed that patients accompany increment of V20,the happening rate of radiation-induced pneumonits probability was increased.The other acute toxicities such as nausea,fever,radiation-induced esophagitis,hemoglobin decrease and thrombocytopenia were mainly grade 1 or 2.After symptomatic treatment,all patients completed the planned treatment without interruption except 4 patients above 70 old years of grade 3 radiation-induced pneumonitis.Late lung radio-fibrosis was 34.3 ％ (25/73).Before the end of the second month after treatment,the complete response (CR) and partial response (PR) rates were 17.8 ％ (13/73) and 69.9 ％ (51/73),respectively,with CR+PR rate of 87.7 ％.The 1-,3-,5-year local control and overall survival rates as monitored by the x2 test method were 82.2 ％,60.3 ％,50.7 ％ and 57.5 ％,23.3 ％,13.7 ％,respectively.Conclusion LCHDRT combined with concurrent chemotherapy shows a promising results,but the rational time-dose-fraction model still need further observation.

Objective To compare the treatment effects and toxicity of late co urse accelerated hyperfractionation radiotherapy (LCAFR), LCAFR plus concurren t chemotherapy (LCAFR+C) and conventional fractionation radiotherapy(CFR) on esop hageal cancer. Methods 150 patients with squamous carcinoma of thoracic esophag us were divided randomly into three groups: 1.CFR group, patients were irradiate d 2.0?Gy/f, 5 times a week, to a total does of 60?Gy. 2. LCAFR group, patients wer e first irradiated with CFR to 30?Gy, then followed by 1.5?Gy/f bid, at more t han 6 hours' interval, to the total dose of 60?Gy. 3.LCAFR+C group: The radiotherap y technique was the same as the LCAFR group, but weekly 20 mg DDP and 500 mg 5-Fu wer e added simultaneously for 5 weeks. Results All three groups completed their tre atment course. Of CFR, LCAFR and LCAFR+C groups, the 1-,2-,3- and 4-year sur viva l rates were 54%, 30%, 18%, 18%; 76%, 56%, 44%, 42% and 82%, 62%, 50%, 44%. The 1-,2-,3- and 4-year local control rates were 40%, 32%, 26%, 24%; 72%, 60%, 5 6%, 54% and 78%, 66%, 60%, 56%, with obvious better results in the latter two groups (P0.05). The acute toxic effect was severer in the LCAFR+C g roup than in the other two, with the difference significant between the LCAFR+C and CFR group, bu t not between the LCAFR and CFR group. The tolerance of the patients to LCAFR wa s better than that of LCAFR+C group. There were no significant differences in la te complications and causes of death between the three groups. The main cause of death was local recurrence and uncontrolled primary disease, which were signifi cantly lower in the LCAFR and LCAFR+C groups than in the CFR group. Conclusions Both late course accelerated hyperfractionation radiotherapy and late course acc elera ted hyperfractionation radiotherapy plus chemotherapy can significantly improve the local control and survival of esophageal cancer, but the latter has increase d toxicity. Concurrent small dose chemotherapy can not lowered the remote metas tatic rate.

Objective To explore the curative effect and patient's tolerance combined transcatheter arterial chemoembolization(TACE) and three dimensional conformal radiotherapy(3DCRT) for primary hepatocellular carcinoma.Methods 38 patients were treated by combined TACE and 3DCRT.The treatment regimen consisted of TACE first,it took TACE of Doxombicin 50 mg/m2,Fluorouracil 600 mg/m2,Cisplatin 60 mg and iodine Oil 10～15 ml.repeated every four weeks.thlee times totally.After resting one or two months,followed by 3DCRT(44～56 Gy/7～11f/3～4w),the planning target volume(PTV)was covered by the 80%～90% isodose curve and the target dose was prescribed to PTV.Resuits All patients completed the planned treatment without interruption.Hematological and radiation-induced toxicities as shown by the WHO staging system were 52.6% of grade 1～2 acute gastrointestinal tract reaction and 47.4% of grade 1～2 bone marrow inhibition but they were tolerable.The complete response(CR)and partial response(PR)rates were 23.7% and 63.2%.respectively,with a CR+PR rate of 86.8%.The median survival was 18.5 months.The 1-,2-and 3-year survival rates were 73.7%,57.9% and 34.2% respectively. Conclusion Combined TACE and 3DCRT iS better to short-term curative effect,it has lesser toxicities and it is a satisfactory therapy for unreseetable primary hepatocellular carcinoma.Long-tem survival and late toxicities need further observation.

Objective To evaluate the effect and tolerance of late-course three dimensional conformal radiotherapy(LC3DCRT) combined with concurrent chemotherapy for stage Ⅲ non-small cell lung cancer(NSCLC).Methods From May 2000 to May 2003,48 such patients were entered into this study.The patient's characteristics were: 38 male and 10 female,with median age of 62 years(range 40 to 74);Karnovsky performance score ≥70;stage ⅢA 16 and ⅢB 32,squamous cell carcinoma 38 and adenocarcinoma 10.The treatment regimen consisted of conventional radiotherapy first(40Gy/20f/4W),followed by 3DCRT(24-30Gy/4-5f/2W) combined with concurrent chemotherapy.Conventional irradiation field encompassed the primary lesion,ipsilateral hilum and mediastinal lymph drainage region.LC3DCRT focused on the primary lesion only,with the 80%-90% isodose curve covering the planning target volume(PTV) and the target dose was prescribed to PTV.Supraclavicular metastatic lymph node was treated by mixed 6MV X-ray and electron beam to a total dose of 65-70Gy.Chemotherapy treatment regimen consisted of isophosfomide(25mg/m~2,d1、8,iv) and cisplatin(30mg/d,d1-3,iv) in the 1st and 5th week.Results Before the end of the second month after treatment,the complete response(CR)and partial response(PR) rate was 16.7% and 75.0%,respectively,with a CR+PR rate of 91.7%.The 1-,2-and 3-year local control and overall survival rates as monitored by the Kaplan-Meier method was 87.5%,50.0%,35.7% and 87.5%,46.7%,28.6%,respectively.All patients completed the planned treatment without interruption.Hematological toxicity and radiation-induced pneumonitis as shown by the WHO staging system were the most common acute toxicities but they were tolerable,with 8.3% of grade 3 leukopenia and 4.2% of grade 3 radiation-induced pneumonitis.The severity of the other acute toxicities such as nausea,fever,hemoglobin decrease,and radiation-induced esophagitis were mainly grade 1 or grade 2.Conclusions Late course three dimensional radiotherapy combined with concurrent chemotherapy shows a promising results with tolerable acute toxicities.Long-term survival and late toxicities need further observation.

Objective To analyze the difference of irradiation dose and volume of organs at risk (OAR) particularly in small intestine between supine position and prone position on intensity-roodulated radiotherapy(IMRT) for cervical cancer. Methods 11 patients with Ⅱ_B-Ⅲ_B cervical cancer were scanned with supine position and prone position by CT.The CT images were transported to TPS,then target volumes were delineated and the IMRT plans were designed respectively.The prescribed dose was 95%PTV receiving 45 Gy in 23 fractions of 2 Gy.The exposure volumes of the OAR at different position and different dose levels in the dose volume histograms (DVH) were compared and analyzed.Results When tlle dose di8tributions met to the clinic request,the exposure volumes of small intestine at prone position were redueed than that at supine position in dose range 46-30 Gy(P<0.05),but this phenomenon Was not distinct in low dose range(< 20 Gy)(P>0.05).The exposure volumes of bladder, rectum, femur head and spine cord were no obviously differences at dissimilar position. Conclusion IMRT of cervical cancer should adopt prone position.because their small intestine will be protected better.

Objective To study the spatial distribution of set-up errors for cervical cancer with intensity modulated radiation therapy (IMRT) and to provide referential safety margin out of clinical tumor volume (CTV) during treatment plan design. Methods Six patients with cervical cancer were treated with IMRT in prone position, belly board and thermoplastic cast was used for immobilization. Measurement were made on a daily basis setup under five consecutive treatments with electron portal images device (EPID).Portal films from two projection (one anter-posterior and one opposite lateral)were taken. Sixty portal films were analyzed. The translational and rotational deviations were analyzed by registering and comparing the bony structures of EPID and digitally reconstructed radiographs (DRR). Results The translational deviations were (3.1 ±1.8) mm, (3.9 ±3.3) mm, (4.2 ±2.6) mm in medi-lateral, cranio-caudal and anterior-posterior directions, the rotational deviations were in coronal plane (0.8±0.9)° and sagittal plane (1.2±1)°. Conclusion For the patients with cervical cancer undergoing IMRT, the margins between the CTV and PTV should be 7.1 mm in lateral direction, 10.4 mm in cranio-caudal and 10.8 mm in anterior-posterior directions. The sign on patients body can help to reduce the setup errors.

Objective To seek the curative effect of stereotactic radiation therapy (SRT) combined with gemcitabine for unresectable advanced pancreatic carcinoma.Methods 24 patients were treated by SRT of 6MV X-ray.Patients were fixed with the rack of stereotactic localization and heated plastics mould.The CT scanning results were put into the treatment planning system.According to the target area of tumor,sensitive organs and moving error drew GTV,CTV and PTV.The best plan was selected by the dose-volume histogram (DVH).5 to 7 beams of non-coplanar radiation ray were chosen.PTV was surrounded by ≥95 ％ isodose curves.Conventional fraction,5 fractions per week,1.8-2 Gy per fraction was used.All patients received a total dose of 50-60 Gy.Gemcitabine was performed 1000 mg/m2,once a week,iv gtt,in the 1st,2nd and 4th,5 th weeks.Results In chemo-radiotherapy,50.0 ％ (12/24) patients showed light nausea,41.7 ％ (10/24) patients showed leucopenia or thrombocytopenia of grade 1 or 2,after symptomatic treatment,all patients completed the planned treatment.In a period of one month to three months,after SRT combined with chemotherapy,appetite improvement was 83.3 ％ (20/24),jaundice disappeared in 6 of 6 patients (100.0 ％),abdominal pain was relieved in 21 of 24 patients (87.5 ％),3 patients were relieved completely among them.The complete remission (CR) rate was 16.7 ％ (4/24) and partial remission (PR) rate was 66.7 ％ (16/24),with CR+PR rate of 83.4 ％ (20/24).One-year survival rate was 70.8 ％ (17/24).As a consequence of cachexia,intestinal obstruction or bleeding,7 patients died within one year.Nobody survived more than 2 years.Conclusions SRT combined with gemcitabine for advanced pancreatic carcinoma may relieve symptoms.It is an effective approach to improve life quality and prolong survival time for advanced pancreatic carcinoma,especially lod and weak patients are more suitable to select SRT combined with gemcitabine.

Objective To investigate the way to accurately delineate gross tumor volume (GTV) of high grade gliomas(HGG) for intensity modulated radiation therapy (IMRT) by using computed tomography (CT) and magnetic resonance imaging (MRI) image fusion technique. Methods CT and MRI images were fused from 19 patients. The GTV of each patient were independently delineated by one chief doctor and one resident doctor on CT and MRI image. The GTV contoured on CT (GTVCT), MRI (GTVMRI) were measured, and composite volumes (GTVCT+MRI) were the sum of CT-defined GTV and MRI-defined GTV. The differences of these volumes were compared. Results Whether chief or resident doctors delineated, all were GTVMRI ＞GTVCT(P ＜0.050). The percentages of GTVMRI on GTVCT+MRI were (98.57±7.00)% by chief doctors, and (97.84±10.00)% by resident doctors. Compared the difference between GTVCT and GTVMRI in postoperative patients and preoperative patients, P =0.046, and the difference between chief doctors and resident doctors was statistically significant for GTV defined by CT (P =0.020), but not by MRI and composite image (P ＞0.050).Conclusion The GTV of HGG patients must be delineated on both CT image and MRI image, including using CT and MRI image fusion. But the composite volumes(GTVCT+MRI) should be the sum of CT-defined GTV and MRI-defined GTV. Especially for the postoperative patients,delineating GTV should be taken more attention. And the GTV should be delineated by doctors with full experiences.

Objective To evaluate the curative effect between conventional fraction radiotherapy (CFRT) and intensity modulated radiation therapy (IMRT) combined with concurrent chemotherapy for unresectable esophageal carcinoma.Methods 144 patients were enrolled into this study.They were divided into CFRT group and IMRT group.CFRT group (60 cases):irradiation field encompassed primary lesion and mediastinal lymph drainage regin.Neck and thoracic upper segment cases were made front thorax T field irradiation first,DT 36 Gy/18 f,followed by two front oblique field made Iso-central irradiation,field width was 4.5-5.0 cm,gantry angle 50°-60°,wedge filter 30°,DT added to 66 Gy.For thorax middle or lower segment patients,field width was 6.0-6.5 cm,field length was that the tumor upper and lower each extended 3.0-5.0 cm,vertically irradiated in thoracic front and at the back,after DT 36 Gy/18 f,changed to two back ablique field,made Iso-central irradiation,DT added to 66 Gy.IMRT group (84 cases):GTV was esophageal primary lesion and metastasis lymph node (GTVnd);CTV included GTV,GTVnd and mediastinal lymph drainage region,at GTV around all was widened 0.8-1.0 cm,its upper and lower each extended 3.0-5.0 cm;PTV were in the basis of CTV,all were widened 0.5 cm again.With ≥95 ％ isodose curve covering the PTV and the target dose was prescribed to PTV 60-64 Gy/30-32 f.Organ at risk (OAR):both lungs V20≤30 ％,spinal cord ≤45 Gy/6 weeks,heart V30≤40 ％.Chemotherapy of two groups was same,DDP 25-30 mg/m2 × 3-5 days,5-Fu 450-500 mg/m2 × 5 days civ,28 days were one period,total 2 period,after 1-3 months,strengthen chemotherapy 3-4 period.Results Leucopenia and radiation-induced esophagitis as shown by the WHO staging system were the most common acute toxicities,but were mainly grade 1 or 2.The incidence rate of leucopenia and radiation-induced esophagitis in CFRT group were 78.3 ％ (47/60) and 83.3 ％ (50/60),IMRT group were 82.1％ (69/84) and 79.8 ％ (67/84).After symptomatic treatment,all patients completed the planner treatment.During radiotherapy and after treatment,the patients showed grade 1-2 radiation-induced pneumonitis,CFRT group were 36.7 ％ (22/60),but IMRT group were only 9.5 ％ (8/84) (x2 =9.99,P ＜ 0.01).In CFRT group and IMRT group,the 1-,3-,5-year survival rates were 75.0 ％ (45/60),36.7 ％ (22/60),20.0 ％ (17/84) and 79.8 ％ (67/84),35.7 ％ (30/84),21.4 ％ (18/84),respectively.Conclusion The overall response and 5-year survival rates of CFRT and IMRT combined with concurrent chemotherapy are similar,however,the incidence of grade 1-2 radiation-induced pneumonitis of IMRT is low,which indicates that IMRT can reduce the lungs irradiational volume and dose.

Objective To provide a reference to the clinical application by comparing the posology difference of 3DCRT(three-dimensional conformal radiation therapy) and IMRT(intensity modulated radiation therapy) for lung cancer with mediastinum lymphonode metastasis. Methods From Aug.2007 to Feb.2008,11 patients of lung cancer with mediastinum lymphonode metastasis were treated by IMRT. IMRT plan and 3DCRT plan were designed by CT-simulator image. The conformity index, PTV uniformity and the organs at risk were compared by the target isodose curve and dose volume histogram(DVH) in two plans. The prescribe dose was 66 Gy/33 fracinations in 6 weeks, and 95 % dose curve covered 95 % target volume. The data were analyzed by t-test in SPSS 14.0. Results The conformity index in IMRT was superior than 3DCRT (P＜0.05).PTV above 110 % volume in IMRT was reduced than 3DCRT. On the protection of lung tissue,the volumes of V20,V30,V40 in IMRT were obviously less than 3DCRT (P＜0.05). Conclusion IMRT is a better selection to larger volume and irregular shape of CTV for lung cancer with mediastinum lymphonode metastasis.