Objective To evaluate the relation between lung dosimetric parameters and the risk of symptomatic radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) who had re-ceived postoperative radiotherapy. Methods From November 2002 to March 2006, 90 patients with NSCLC who had received postoperative 3-dimentinal conformal radiotherapy (3DCRT) were retrospectively analyzed, including 53 with stage ⅢA disease, 25 with stafe ⅢB disease and 12 with stage Ⅰ-Ⅱ disease but positive margins. Seventy (78%) patients underwent lobectomy, 20 ( 22% ) underwent pneumonectomy, and 38 ( 46% ) received adjuvant chemotherapy. The median radiation dose was 60 Gy given in 30 fractions of 2 Gy using 6 MV X-ray. The percentage of the whole lung volume ( Vx ) and the ipsilateral absolute lung volume ( Vipsi-dosewhich received more than a certain dose were calculated. The endpoint was grade 2 and above RP based on CTC AE 3.0. The relation between the dosimetric factors and RP was also analyzed with receiver operating characteristic (ROC) curves. Results Nine patients ( 10% ) developed symptomatic RP ( grade 2 in 7 and grade 3 in 2), and all of them were in the lobectomy group. No RP was observed in patients who received pneumonectomy. Both V30 and V35 were higher in patients with RP than those without ( 19% vs 14% ,U= -2.16,P=0.030, and 15% vs 11%,U= -2.65,P =0.007, respectively). The area under curve in receiver operating characteristic curves based on the relation between incidence of RP and the value of Vipsi-dose was 0. 757. Using Vipsi-30 of 340 cm3 as a cut-off to predict RP, the sensitivity and specificity were 88% and 70%, respectively. The incidence of RP was 3% in patients with Vipsi-30< 340 cm3 compared with 29% in those with Vipsi-30>340cm3 ( X2 = 9.75 , P = 0.003 ) . Conclusions More than340 cm3 of the ipsilateral lung receiving 30 Gy is significantly related to the risk of RP in patients undergoing lobectomy. It is safe for patients who undergo pneumonectomy to receive postoperative 3DCRT if lung V20 is less than 10%.

Objective To study the value of image-guided radiotherapy (IGRT) in lung cancer. Methods From Mar. 2007 to Dec. 2007,58 patients with lung cancer were treated with IGRT. Set-up er-rors in each axial direction was calculated based on IGRT images of each patient. The change of GTV was e-valuated on both cone-beam CT and CT simulator images. Results Twenty-two patients with left lung cane-er,30 with right lung cancer,5 with mediastinal lymphanode metastasis and one with vertebra metastasis were included. The set-up error in x,y and z axes was (0.02±0.26) cm, (0.14±0.49) cm and ( -0. 13± 0.27) cm, respectively,while the rotary set-up error in each axis was -0.15°± 1.59°, -0.01°± 1.50° and 0.12°±1.08°, respectively. The set-up errors were siguifieantly decreased by using of IGRT. GTV movement was observed in 15 patients (25.9%) ,including 5 with left upper lung cancer. GTV moving to the anterior direction was observed in 9 patients,including 4 with]eft upper lung cancer. GTV reduced in 23 (44.2%) patients during treatment. Asymmetric GTV reduction of 22 lesions was observed,with a mean re-ductive volume of 4.9 cm3. When GTV began to shrink,the irradiation dose was 4 -46 Gy,with 20 -30 Gy in 9 patients. Conclusions The use of IGRT can significantly reduce set-up errors. GTV movement and reduction are observed in some cases. The time to modify the target volume needs to be further studied.

Objective To evaluate the efficacy of three-dimensional conformal radiation therapy (3DCRT) for esophageal carcinoma and identify prognostic factors in this patient group.Methods From May 2002 to Jun 2005,132 patients with unresectable or inoperable esophageal cancer were treated with 3DCRT in our hospital.Their chnical data were analyzed retrospectively.ResultsThe 1-and 2-year local control rates was 65.4% and 52.1% in the whole group,respectively.The overall 1-and 2-year survival rate was 50.7% and 32.2% ,respectively.The median survival time was 13 months.The 1-and 2-year survival rate was 56.7%and 36.7% in stageⅠ + Ⅲ ,respectively,with 35.2% and 14.7% in stage IV.The median survival time were 15 months and 9 months for stage Ⅰ +Ⅲ and Ⅳ,respectively(x2 = 8.17,P = 0.004). Of patients with stage Ⅰ + Ⅲ disease who were absent of perforation sign before radiotherapy,with lesion length less than 8.0 cm and whole course given by 3DCRT,the 1-and 2-year survival rate was 73.0% and 49.9%,respectively.Univariate analysis revealed that condition of alimentation,absence of perforation sign, short lesion length,early TNM stage were associated with good survival.Multivariate analysis confirmed that absence of perforation sign and lesion length were independent prognostic factors for survival. Conclusions 3DCRT is effective for esophageal carcinomas in terms of survival and local control.Further improvement could be achieved with muhi-modality treatment.Absence of perforation sign and lesion length are independ ent prognostic factors for survival.

Objective To investigate the value of interleukin(IL)-6 and kidney injury molecule(Kim)-1 in the early prediction of contrast-induced pnephropathy(CIN)after percutaneous coronary intervention(PCI)in patients with coronary heart disease.Methods A total of 730 patients with coronary heart disease who underwent PCI were retrospectively collected,divided into CIN group(n=46)and non-CIN group(n=684),and the medical records of the two groups were compared,and the relationship between Kim-1 and IL-6 of renal injury and CIN was analyzed by binary regression,and the receiver operating characteristic(ROC)curve was used to explore the predictive value of these two markers on CIN after PCI for coronary heart disease.Results There was no significant difference between two groups in terms of preoperative IL-6(P=0.467)and Kim-1(P=0.643),and 48h and 72h after PCI,IL-6 and Kim-1 in CIN group was higher than that in non-CIN group(P＜0.001),and IL-6 and Kim-1 in CIN group was higher than that in before surgery(P＜0.001).48h postoperative IL-6(OR=1.884,P=0.002),48h postoperative Kim-1(OR=1.409,P＜0.001)and 72h postoperative IL-6(OR=1.377,P＜0.001)and 72 hours postoperative Kim-1(OR=1.092,P=0.004)were independent risk factors for CIN.The ROC curve showed that when used as a diagnostic marker for CIN,the area under the curve(AUC)of IL-6(48h),IL-6(72h)were 0.837,0.782,AUC of 48h Kim-1 and 72h Kim-1 were 0.820 and 0.827,respectively.Conclusion IL-6 and Kim-1 are independent risk factors for CIN after PCI for coronary heart disease.IL-6 and Kim-1 were positively correlated with the occurrence of CIN after PCI for coronary heart disease.IL-6 and Kim-1 have good diagnostic sensitivity and specificity for CIN after PCI for coronary heart disease.