Objective The purpose of this study was to investigate the clinical significance of serum vascular endothelial growth factor(S-VEGF)in patients of esophageal squamous cell carcinoma with the end-point of progress-free survival rate.Methods Sera from 89 patients with esophageal squamous carcinoma,who presented and treated with concurrent chemoradiotherapy or surgical resection in Cancer Center d Sun Yat-Sen University from December 2002 to May 2004,were sampled at the time of pre-treatment.30 cases of health individuals without any evidence of disease were selected as control group.For patients with surgical resection were performed with esophagectomy and extended lymphadenectomy.For patients with concurrent chemoradiotherapy comprised of cisplatin and 5-fluorouracil.The radiotherapy dose of 2 Gy per day was initiated on Day 1 of chemotherapy and continued daily for 5 days per week for 6 weeks,for a total close of 60 Gy.Two courses of chemotherapy were given during radiotherapy at 6-week intervals.The serum vascular endothelial growth factor(S- VEGF)levels were measured with a solid phase enzyme Human VEGF Immunoassay ELISA kit.The end point of this study was progress-free survival,and time was calculated from the date of diagnosis to date of relapse or last follow evaluation.Results S-VEGF level of patients with esophageal squamous cell carcinoma was significantly higher than that of heahhy controls(475.93?44.76 pg/ml vs.294.20?23.40 pg/ml;P=0.020).S-VEGF levels in patients with StageⅢand StageⅣdisease were significantly higher than those in patients with Stage I and StageⅡdisease.The 1-year progress-free survival rate d high S-VEGF group(≥475 pg/ml)was significantly lower than that of the low S-VEGF group(＜475 pg/ml)(24% vs.66%;P=0.0004).The 1-year progress-free survival rate of the patients with StageⅠand StageⅡdisease was significantly higher than that of patients with StageⅢand StageⅣdisease(71% vs.29%;P=0.0015).The variables were assessed by multivariate analysis using the Cox proportional hazards model,and the results revealed that the clinical stage and the S-VEGF were first and second independent prognosis factor,respectively.Conclusions In the current study,a high S-VEGF was found to be associated with tumor progression,poor treatment response,and poor survival in patients with squamous cell carcinoma of the esophagus.

Objective To compare three kinds of irradiation treatment plans for cervical and upper thoracic esophageal cancer,in order to arrived at proper decision for the patient.Methods From February 2001 to June 2004,43 such patients were studied with three different simulated treatment plans made including conformal plan,conventional four-field plan and conventional two-field plan for every one.All plans were evaluated with iso- dose curve and dose-volume histogram.Results GTV on 95% isodose curve was 99.5%,98.2% and 87.4% in conforaml plan,conventional four-field plan and conventional two-field plan,respectively;PTV_1 and PTV_2 on 95% isodose with 97.8%,97.2%,94.8% and 95.8%,86.6%,73.7%.The volume of＞20 Gy dose of left lung accepted was 18.6%,17.2% and 32.3%,in conformal plan,conventional four-field plan and conventional two-field plan,respectively;the right lung received 20.5%,19.9% and 35.5%.Conclusions Conformal plan is the best in radiotherapy,as it can provide ideal dose distribution of irradiated target with adequate protection of the normal tissues.Conventional four-field plan,being easy to carry out,can replace the conformal plan in most situations.Conventional two-field has the most uneven dose distribution and largest lung volume irradiated.

OBJECTIVETo explore the relationship between germ cell apoptosis and the expression as well as the distribution of Sertoli cell vimentin induced by local exposure to heat.

METHODSLocal short-term exposure of prepubertal male rats testis to heat (43 degrees C for 15 min). Histochemical method was used to observe morphological characteristics of seminiferous tubule. The distribution and expression of Sertoli cell cytoskeletons were analyzed by immunohistochemistry and germ cell apoptosis was evaluated by TUNEL technique at different hour-intervals.

RESULTSAfter 2 h and 4 h heat exposure, the disattachment phenomenon between Sertoli cell and spermatogonia occurred. Spermatogonia arranged in disorder and displaced away from the basement membrane of seminiferous tubules. Immunohistochemical staining showed that vimentin positive staining was seen radiating from the Sertoli cell perinuclear region with apical "spoke-like" pattern in controls. There was an intense vimentin immunoreactivity surrounding Sertoli cell nuclei along with the collapse of the apical extensions in 2 h group, but no significant difference compared with the controls. The expressions of vimentin in 12 h and 24 h groups were higher than those of the controls (P <0.01), respectively. TUNEL showed that incidence of apoptosis was observed to increases markedly in 12 h and 24 h groups, but it was found that the incidences of apoptotic events were decreased in these two groups compared with the controls.

CONCLUSIONThe changes of expression and distribution of Sertoli cell vimentin filaments correlate with the increased germ cell apoptosis. Local heat may disrupt spermatogenesis by injuring Sertoli cell directly.

Animals ; Apoptosis ; Hot Temperature ; In Situ Nick-End Labeling ; Male ; Rats ; Rats, Sprague-Dawley ; Sertoli Cells ; metabolism ; Spermatozoa ; pathology ; Vimentin ; biosynthesis

Objective To analyze the local control rate and the desimetric patterns of local recurrence in nasopharyngeal carcinoma(NPC)patients having been treated with standardized conventional radiotherapy and to evaluate the delineation of rational target volume.Methods From Jan.2000 to Dec.2000,476 patients with untreated NPC were treated by standardized conventional radiotherapy alone at the Sun Yat-sen University Cancer Center.The radiation ports were designed on a X-ray simulator.The nasopharyngeal lesion demonstrated by CT scan and the subclinical spread regions adjacent to the nasopharynx were defined as the target volume.Kaplan- Meier method was used to calculate the cumulative local recurrence rate.For patients with locad recurrence,the primary and recurrent local tumor volumes(V_(nx),V_(recur))were delineated with three-dimensional treatment planning system(3DTPS),and the dataset of radiation ports and delivered prescription dose to the 3DTPS were transferred according to the first treatment.The dose of radiation received by V_(recur)was calculated and analyzed with dose- volume histogram(DVH).Local recurrence was classified as:1.“in-port”with 95% or mere of the recurrence volume((recur)_V_(95))was within the 95% isedase;2.“marginal”with 20% to95% of _(recur)V_(95)within the 95% isedese; 3.“outside”with only less than 20% of _(recur)_V_(95)within the 95% isodose curve.Results With the median follow- up of 42.5 months(range 8～54 months),52 patients developed local recurrence.The 1-,2-,3 and 4-year cumulative local failure rate was 0.6%,3.9%,8.7% and 11.5%,respectively.Among the 42 local recurrent patients who could be analyzed by 3DTPS,52% were in-port,40% were marginal and 7% were outside.For most of the marginal recurrence and all the outside recurrence patients,the main reason of recurrence were related to the unreasonable design of the radiation port and inaccuracy in the interpretation image findings.Conclusions The outcome of better local control rate and the dosimetric pattern of local recurrence show that the target volume is reasonable for NPC in Sun Yat-sen University Cancer Center.Enhancing the capability of correct interpretation of images,accurate design of the radiation pouts and making most useful molecular or functional imaging techniques to escalate the local radiation dose are promising ways to improve the local control further and better.

Objective：A retrospective study was conducted to evaluate the efficiency of postoperative radiotherapy for completely resected, pathologically Stage Ⅲ a (N2) non-small cell lung cancer (NSCLC). Methods：From January 1989 to December 1993, among the patients with NSCLC who underwent radical surgery in the authors’hospital, there were 119 patients with completely resected, pathologically Stage Ⅲ a(N2)NSCLC. A total of 55 cases of these patients received postoperative radiotherapy with dose of 46-62 gray in mediastinum and hilus (S＋ RT group), except other 64 cases (S group). The survival rates and local control rates were analyzed and compared by the life table and Log-rank. Results：The clinical characters of patients such as age, sex, pathologic type were similar between two groups. The 1,3,5-year survival rates were 80.0％ , 32.7％ , 25.5％ respectively in S＋ RT group and 76.4％ , 36.4％ , 23.0％ respectively in S group, with no significant difference between two groups（ P >0.05） . The median time of local recurrence was 21 months in S＋ RT group and 12 months in S group, with significant difference between two groups(P<0.05） . The 1,3,5-year local control rates were 94.0％ , 78.5％ , 69.0％ respectively in S＋ RT group in contrast to 83.1％ , 58.3％ , 50.6％ respectively in S group(P< 0.05). The metastasis rates were similar in two groups （ P>0.05） . Conclusion：Postoperative radiotherapy can increase the local control rates and prolong the time of local recurrence for the patients with completely resected, pathologically Stage Ⅲ a (N2) NSCLC, but the survival rate can not be improved.

Objective： A prospective randomized trial was performed to evaluate the contribution of neoadjuvant chemotherapy in the patients with locoregionally advanced nasopharyngeal carcinoma. Methods： The patients with locoregionally advanced nasopharyngeal carcinoma were treated with either radiotherapy alone (RT group) or neoadjuvant chemotherapy plus radiotherapy (CT/RT group). Neoadjuvant chemotherapy consisting of 2-3 cycles of cisplatin (20 mg/m2 on Day 1 to Day 5), bleomycin (7 mg/m2 on Day 1 and Day 5), and 5-FU (500 mg/m2 on Day 1 to Day 5) followed by radiotherapy was given to CT/RT group. All patients were treated in a uniform definitive-intent radiation therapy in two groups. Results： From 1992 to 1993, 457 patients were enrolled and 440 patients (221 in RT group, 219 in CT/RT group) were assessable. The 5-year overall survival (OS) rates were 62％ for CT/RT group and 55％ for RT group (P=0.1335)； The 5-year relapse free survival rate was 48％ versus 58％ , respectively (P=0.0539). The 5-year free local recurrence (FLR) rate was 82％ for CT/RT group, 74％ for RT group (P=0.0412). There was no significant difference in free distant metastasis (FDM) between two treatment groups (CT/RT group, 79％ ; RT group, 75％ ; P=0.4177). Subgroup analyses showed that neoadjuvant chemotherapy improved local control in patients with T3-4 disease, and had no effect in preventing distant metastases in patients with N2-3 disease. Conclusion： Despite improving FLR and RFS, neoadjuvant chemotherapy and radiatherapy failed to gain other survival benefit or reduce distant metastases in patients with locoregionally advanced nasopharyngeal carcinoma. The indication for neoadjuvant chemotherapy is proposed.

OBJECTIVETo analyze treatment and prognostic factors of 74 patients with dermatofibro-sarcoma protuberans (DFSP).

METHODSFrom August 1990 to November 1999, 74 patients with DFSP confirmed pathologically were treated. There were 52 males and 22 females with a median age of 37 years (range 4 to 80 years) on diagnosis. Seventeen patients were treated by extensive excision and 2 by limited excision. Fifty-two patients had surgical resection alone (S), and 22 postoperative radiotherapy (S + R) of 50-70 Gy. The multivariate parameters were analyzed using Cox model. Kaplan-Meier and Log-Rank test were used to evaluate the results of the recurrence-free survival.

RESULTSThe rate of recurrence was 28.4% for all patients. The 5-year recurrence-free survival rate (RFSR) was 66.6% and the 10-year RFSR was 52.5%. The 5-year and 10-year in the S group were 58.4% and 41.2%, compared with 90.0% and 83.3% in the S + R group (P < 0.05). The 5-year and 10-year RFSR in the pathologically positive margin group were 57.5% and 41.4% respectively, compared with the 75.0% and 56.6% in the pathologically negative group (P < 0.05). Multivariate analysis suggested radiotherapy and negative pathological margins were favorable prognostic factors.

CONCLUSIONPost-operation radiotherapy and pathological margin are the independent prognostic factors.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Combined Modality Therapy ; Dermatofibrosarcoma ; mortality ; radiotherapy ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Postoperative Care ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Skin Neoplasms ; mortality ; radiotherapy ; surgery

AIMTo study the chemical structure of SC3, an acidic polysaccharide from Salvia chinesis.

METHODSBased on chemical (including sugar composition analysis, methylation analysis, uronic acid reduction and partial acid hydrolysis) and spectral analysis (IR, NMR, ESI-MS), the structural characterization of SC3 was investigated.

RESULTSSC3 was composed Rha, Ara, Gal and GalA, with its mean molecular weight of 7.7 x 10(4). By means of methylation analysis, partial acid hydrolysis, NMR and ESI-MS spectrum, the linkages and sequence information of SC3 were obtained.

CONCLUSIONSC3 is an complicated acidic polysaccharide, obtained for the first time from the plant.

Arabinose ; chemistry ; isolation & purification ; Galactose ; chemistry ; isolation & purification ; Molecular Structure ; Molecular Weight ; Plants, Medicinal ; chemistry ; Polysaccharides ; chemistry ; isolation & purification ; Rhamnose ; chemistry ; isolation & purification ; Salvia ; chemistry

Objective To analyse the preliminary clinical results of intensity modulated radiation therapy (IMRT) for 122 untreated nasopharyngeal carcinoma (NPC)pafients.Methods 122 NPC pa- tients received IMRT alone from Feb.2001 to Jun.2004,with 31 females and 91 males,and a median age of 45 years(range 25-66).According to the Fuzhou Stage Classification,there were StageⅠ11 patients, StageⅡ34,StageⅢ62,and StageⅣa 15.IMRT was carried out using an inverse planning system (COR- VUS 5.0,Peacock plan) developed by the NOMOS Corp.The treatment was given with the Multi-leaf Inten- sity Modulating Collimator (MIMIC) using a slice-by-slice arc rotation approach.The prescription dose was 68 Gy/30f to the nasopharynx gross tumor volume (GTV_(nx)),60-66 Gy/30f to positive neck lymph nodes (GTV_(nd)),60 Gy/30f to the first clinical target volume (CTV_1) and 54 Gy/30f to the second clinical target volume (CTV_2).Kaplan-Meier method was used to calculate the overall survival rate (OS),distant metas- tasis-free survival rates (DMFS),and local-regional control rates from the last date of therapy.Log-rank test was used to detect the difference between groups.Results The median follow-up time was 20 months ( range 6 to46 months).The 1-,2-,and 3-year OS was 95.2%,91.4%,85.1%,DMFS was 91.9%, 88.6%,85.6%,and the local-regional control rates was 96.5%,93.2%,93.2%,respectively.Statistics of the local control rate was insignificant either for advanced T(T3+T4) stage or early T(T1+T2) stage diseases(P=0.148).The 2-year regional control rate was insignificant either for patients with N(+) or N (-),but the 2-year DMFS was significant both for patients with N(+) and N(-)lesions(P=0.004).For 17 patients who failed,there were two with residual disease and one with recurrence at the primary site (17.6%),three patients in the neck (17.6%),twelve patients (70.6%) in distant metastases.Conclu- sions Intensity modulated radiation therapy does provide excellent local-regional control for untreated NPC, especially in patients with advanced T stage or N(+) lesion.Distant metastasis is the main cause of failure. N (+) is significantly correlated with distant metastasis.

Objective This study is to investigate the set-up accuracy of thermoplastic mask used for immobilization of nasopharyngeal carcinoma (NPC) patients being treated by Intensity Modulated Radia- tion Therapy (IMRT).Methods Nineteen patients with early stage nasopharyngeal carcinoma (T1- T2N0M0),treated by fractionated intensity-modulated radiation therapy,underwent repeated CTs during their 6-week treatment course.We evaluated their anatomic landmark coordinates in a total of 85 repeated CT data sets and respective x,y and z shifts relative to their position in the 19 treatment-planning reference CTs.Results The translation in x,y,and z-axes with their mean value derived from both positive and negative set-up errors was-0.84 mm(x-axis),+0.65 mm(y-axis) and +0.01 mm(z-axis).Mean target isocenter translation was (0.89?0.69) mm,(0.82?0.79) mm,(0.95?1.24) mm in x,y and z-direc- tions,respectively.The mean total magnitude vector and 95% CI of isocenter motion were 1.87 mm and 4.65 mm.The data measured over the 6-week fractionated course of treatment revealed a slight deterioration of isocenter accuracy.The 95% CI,considered by us to be a valuable parameter for characterizing the sys- tem,of 4.17 mm for measurement within the first 3 weeks increased to 5.12 mm in the last 3 weeks of treat- ment.Conclusions The sequential CT scanning is a pronounced valuable method of evaluating the quality of departmental specific patient positioning procedures.The thermoplastic mask is eyed as well suited tool for immobilization and repositioning of NPC patients receiving intensity-modulated radiation therapy.