Brachytherapy was the earliest technique of radiotherapy for the treatment of cancer and still is an important part of modern radiation oncology.It has been widely used as one of the modalities for gynecological cancer as well as head and neck cancer.In recent years,radioactive seed implantation has been proved to be one of the standard treatments for early stage prostate cancer,and brachytherapy alone is emerging as the major treatment for early stage breast cancer after lumpectomy.This article reviewed the current status of brachytherapy in clinical application as reported during the 2005' annual ASTRO meeting and its prospected for future development.

Ideal tumor marker should have potential clinical values in early diagnosis, monitoring of the residual, recurrence and distant metastasis of the disease. It also plays a role in the prediction of prognosis of the disease and evaluation of its sensitivity to radiotherapy and chemoradiotherapy. The article reviewed the current status of research about the tumor marker related to nasopharyngeal carcinoma.

Objective To evaluate the long term local control and survival of nasopharyngeal carcinoma using radiotherapy combined with different chemotherapy regimens. Methods From July 1987 to October 1989, 300 patients pathologically confirmed nasopharyngeal carcinoma were randomized into three groups: radiotherapy alone (114 patients), neoadjuvant chemotherapy plus radiotherapy (93) and concurrent chemotherapy and radiotherapy (93). The primary tumor received a total dose of 70 Gy with 2?Gy per day. Patients who had cervical lymph node metastasis received 65～70?Gy to the neck whereas patients who did not have cervical lymph node metastasis received a prophylactic radiation of 50?Gy. The regimen of neoadjuvant chemotherapy consisted of 5 Fu (1?000?mg, 3 times per week) and Cisplatin (100?mg,once a week) alternatively for 4 weeks. Concurrent chemotherapy consisted of Cisplatin (20?mg, twice a week) and 5 Fu (500?mg, twice a week) alternatively to 6 weeks. Results The overall 5 year survival rate (OS), disease free survival rate (DFS), distant metastasis free rate(DMF)and local regional free rate (LRF) were 57.1%, 52.9%, 61.0% and 83.3%, respectively. For all patients, there was not a significant difference in the 5 year OS, DFS, DMF, LRF (P= 0.23, 0.65, 0.54, 0.83) and toxicity between these three groups. Cox regression analysis showed that only N stage was a prognostic factor, while treatment modalities was not. Conclusions Radiotherapy combined with neoadjuvant chemotherapy or concurrent chemotherapy did not significantly improve the survival rate and local control rate as compared to conventional radiotherapy. Therefore, radiotherapy plus chemotherapy, and chemotherapy regimens need to be further studied.

Objective To analyze the treatment results of intracavitary hyperfractionated brachytherapy for nasopharyngeal carcinoma and to determine the optimal dose of external radiation. Methods From February 1996 to June 1998, 128 patients with T1 2 nasopharyngeal carcinoma were treated with external radiotherapy followed by intracavitary brachytherapy. The majority of them had residual tumor less than 10 mm after external radiotherapy. The external radiation doses were divided into 3 groups: 56 Gy, 60 Gy and 66 Gy. Brachytherapy was delivered with 2.5 3.0 Gy per fraction, 2 fractions a day with an interval of 6 hours. The total doses ranged from 12 to 24 Gy with a median of 18 Gy. Results The disease free survival rates at 3 and 4 years for all patients were 84.2% and 74.9%, respectively. The corresponding local relapse free survival rates were 97.1% and 92.7%, respectively. The 3 year disease free survival rates and local relapse free survival rates were 83.6% and 100% for 56 Gy group, 88.4% and 90.9% for 60 Gy group, and 84.6% and 93.3% for 66 Gy group, respectively,all with differences in significant. Radiation complications were rare. Conclusions We suggest that patients with residual tumor less than 10 mm after external radiotherapy should receive intracavitary brachytherapy as a boost. The dose of external radiotherapy for T1 2 stage NPC can be decreased to 56 Gy.

Objective To study the results of external beam radiotherapy plus 192 Ir hyperfractionated high dose rate interstitial brachytherapy (HHDR-IBT) for cancer of the oral cavity and oropharynx. Methods Fourty-eight patients with cancer of the oral cavity and oropharynx were treated by external beam radiotherapy (T 1,T 2 30～50 Gy,T 3,T 4 50～60 Gy) followed by 192 Ir HHDR-IBT delivering 15～35 Gy (30～35 Gy for T 1,T 2 and 15～30 Gy for T 3,T 4 in 250～350 cGy per fraction,two fractions per day). Over 3～5 days. Results The complete response rates at 3 months were T 1100% (5/5),T 2 85%(23/27),T 3 46%(6/13),T 4 0%(0/3) and the partial reponse rates:T 2 15% (4/27), T 3 54%(7/13), T 4 100%(3/3). The 3-year survival and disease-free survival rates were 79.4% and 55.8%,respectively.Multivariate analysis showed that TNM stage and pathalogic type were prognostic factors.Conclusions Carcinoma of the oral cavity and oropharynx treated with external beam radiotherapy combined with 192 Ir hyperfractionated high dose rate interstitial brachytherapy ia able to give a good local control for T 1,T 2 lesions with good functional preservation. For T 3,T 4 lesions,this method is able to offer a high palliation.

margin from CTV to PTV.

ObjectiveTo evaluate the outcomes and toxicities of elderly nasopharyngeal carcinoma (NPC) treated with conventional radiotherapy alone.MethodsFrom January 1995 to December 1998,95 newly diagnosed nasopharyngeai carcinoma with age ≥65 years treated in our hospital.The clinical data were analyzed retrospectively.Kaplan-Meier method was used for analysis of local-regional control survival and distant metastasis-free survival. The Logrank test was used for univariate prognostic analysis and Cox regression was used for multivariable prognostic analysis.ResultsThe follow-up rate was 98％.The 3-,5- and 8-year local-regional control (LRC) and distant metastasis-free survival (DMFS) rates were 89％,87％,84％ and 85％,79％,79％,respectively. The most common acute toxicities were grade1-2 leukopenia (36％),skin reaction (64％) and mucositis (66％).The most frequent late toxicities were hearing impairment (8％),trismus ( 10％ ) and radiation-induced cranial neuropathy (5％).In univariate analysis,interruption of radiotherapy ( χ2 =7.45,P =0.006 ) and regional neck lymph nodes response (χ2 =4.17,P=0.041 ) was the prognostic factors for LRC,T stage (χ2 =4.16,P=0.032),N stage ( χ2 =4.66,P =0.031 ) and interruption of radiotherapy ( χ2 =9.42,P =0.002 ) was the prognostic factors for DMFS. In multivariable analysis,interruption of radiotherapy and the regional neck lymph nodes response were the prognostic factors for LRC (χ2=6.19,P=0.013 and χ2=12.16,P=0.002;respectively),N stage and radiotherapy interruption were prognostic factors for DMFS.(χ2=15.06,P =0.000 and χ2 =21.62,P =0.000 ; respectively ).ConclusionsConventional radiotherapy alone for elder NPC can produce satisfactory results with acceptable treatment-relative toxicities.Our experience showed that the early N stage,without radiotherapy interruption and good regional lymph nodes response had a good longterm prognosis.

Objective To analyze the prognosis of advanced esophageal carcinoma treated with paclitaxel and different platinum?based chemotherapy regimens plus intensity?modulated radiotherapy ( IMRT) , and to explore an optimal chemotherapy regimen. Methods A total of 242 patients with advanced esophageal carcinoma who were admitted to our hospital and treated with paclitaxel and cisplatin ( 68 patients), nedaplatin (85 patients), lobaplatin (58 patients), or oxaliplatin (31 patients) plus IMRT from 2008 to 2014 were enrolled as subjects. The prognosis of the four groups was analyzed after 2, 3, and ≥4 cycles of chemotherapy. The survival rates were calculated by the Kaplan?Meier method and analyzed by the log?rank test. The Cox model was used for the multivariate prognostic analysis. Results The sample number of 3 years was 168 cases. In all the 242 patients, the medium survival time was 31. 1 months and the 3?year overall survival ( OS) rate was 47. 4%. There was no significant difference in the 3?year OS rate between the cispaltin, nedaplatin, lobaplatin, and oxaliplatin groups ( 46. 2% vs. 56. 4% vs. 45. 7% vs. 29. 0%, P=0. 090) . The stratified analysis showed that the cisplatin, nedaplatin, and lobaplatin groups had a significantly higher OS rate than the oxaliplatin group ( 50. 1% vs. 29. 0%, P=0. 021 ) . There was no significant difference in the 3?year OS rate between patients receiving 2, 3, and≥4 cycles of chemotherapy ( 40. 1% vs. 49. 5% vs. 50. 8%, P=0. 264) . The multivariate analysis showed that esophageal tumor volume and the maximal size of metastatic lymph node were independent prognostic factors. Conclusions Combined with IMRT, paclitaxel plus cisplatin, nedaplatin, or lobaplatin?based chemotherapy achieves improved survival rates than paclitaxel plus oxaliplatin?based chemotherapy. Esophageal tumor volume and the maximal size of metastatic lymph node are independent prognostic factors.

Objective To retrospectively analyze the therapeutic results of patients with initially di-agnosed metastatic nasopharyngeal carcinoma (NPC). Methods From January 1995 to December 1998, 46 NPC patients with distant metastases were treated in Fujian provincial cancer hospital. Among these pa-tients, 43 were single site metastasis and 3 were multiple sites metastases;The site of metastasis were 19 pa-tients in the liver, 11 in the bone, 7 in the lung, 1 in the brain, 6 in mediastinal nodes and 6 in axillary lymph nodes. All patients received standard radiotherapy to the primary site and cervical node region with a median dose of 72 Gy. Forty-one patients (89%) received 1-5 cycles chemotherapy (cisplatin and 5-flu-orouracil), and 23 (50%) received palliative irradiation to the metastatic site. Results The median surviv-al time was 20 months. The 1-, 2-, 3-year and 5-year overall survival rates were 66%, 47%, 30% and 19%, respectively. Irradiation to the metastatic sites and KPS were the significant prognostic factors. Pa-tients with palliative irradiation to the metastatic site had longer survival than those without (39 months vs. 13 months, X2=8.63, P=0.012). Patients with good performance status (KPS≥80) had better outcomes thanthose with poor performance status (26 months vs. 12 months, X2= 3.95, P=0.035) . Conclusions Active therapy may prolong the survival of patients with initially diagnosed metastatic NPC, especially for those who have good performance status. Under systematic chemotherapy, radiotherapy to the primary site and supportive care, the palliative irradiation to the metastatic site may also yield a good result.

Objective To determine the diagnostic value of diffusion weighted imaging(DWI) for primary nasopharyngeal carcinoma(NPC) and metastatic lymph nodes,and to establish the diagnostic thresh-old of apparent diffusion coefficients(ADCs). Methods Conventional MR scans and DWI scans were con-tinuously performed in 56 patients with newly diagnosed NPC and 55 healthy volunteers. All patients re-ceived primary tumor biopsy and MR image-guided cervical lymph node fine-needle biopsy. ADC and eADC values of both primary lesions and lymph nodes were calculated and compared. Results According to the pathological diagnosis,all the 56 patients had non-keratinizing carcinoma and 51 had lymph node metastasis. In the control group,75 cervical lymph nodes were found. ADC values of both primary NPC and metastatic lymph nodes were significantly lower, while eADC values were higher than those of normal controls. Setting the ADC value threshold at 0.809 ×10-3 mm2/s, the sensitivity and specificity for primary NPC detection were 80.4% and 74.5%, respectively. The negative and positive predictive values were 79.2% and 77.6% ,respectively. The accuracy was 78.4%. Setting the ADC value threshold at 0. 708×10-3 mm2/s, the sensitivity and specificity in the detection of metastatic cervical lymph nodes were 43.1% and 93.3%, respectively. The negative and positive predictive values were 70.7% and 81.5% ,respectively. The accura-cy was 73.0%. Conclusions DWI might be a new diagnostic approach in the detection of primary NPC as well as metastatic lymph nodes.