Objective To evaluate the curative effect of nasal non-Hodgkin lymphoma(N-NHL) by four types of therapy such as pure chemotherapy, pure radiotherapy, chemotherapy combined with radiotherapy, and APBSCT combined with TBI. Methods One hundred and thirty five patients with nasal NHL were treated between 1980 and 2000. All patients received radiotherapy alone or chemotherapy alone or radiotherapy combined with radiotherapy or TBI combined with APBSCT. The median radiation dose to the nasal cavity was 56.0 Gy with a range of 35.2 to 75.5 Gy. Six patients received TBI combined APBSCT. The TBI dose was 8 Gy. Two patients received 30 Gy in nasal of the six patients. The chemotherapy regimen consisted of 2-6 cycles of COP, COPP, COMP, CHOP, COBDP. Results The local control rate and 5-year survival rate of the four groups of pure chemotherapy, pure radiotherapy, combined chemotherapy and radiotherapy and APBSCT combined with TBI were 12 %, 69 %, 76 %, 83 % and 9 %, 52 %, 63 %, 83 %. For the four groups, the best is APBSCT, then combined chemotherapy and radiotherapy group ,then pure radiotherapy, the last is pure chemotherapy. There is significant difference between the four groups(P

Objective To study whether post-operative radiotherapy is necessary for patients with early breast cancer after radical mastectomy. Methods In 1998, 270 early breast cancer patients with 0 -3 pathologically confirmed positive axillary lymph nodes after radical mastectomy were retrospectively ana-lyzed. There were 156 patients with negative lymph node and 114 with 1 -3 positive lymph nodes. The prog-nostic index (PI) was defined as the sum of scores of the tumor size, number of positive axillary lymph nodes, receptor status, surgical margin status, lymphatic thrombi status, pathological grading and age. The PI≥ 4 was considered as high-risk, and PI <4 as the low-risk. Numerical variables were compared using t test and categorical variables were compared using chi-square test. Kaplan-Meier method was used to calcu-late the survival rates, and the Log-rank test was used for the comparison of the survival curves between dif-ferent groups. Results Of the patients with lymph node negative and 1 - 3 positive, the survival rates were 75.0% and 63.2% (χ~2 = 4.40 ,P =0.036), respectively. The corresponding disease-free survival rate, lo-cal recurrence rate, distant metastasis rate were 71.2% and 9.6% (χ~2 = 3.90, P = 0.048), 7.7% and 16.7%(χ~2 =5.22,P=0.022),12.8% and 21.1%(χ~2=3.27,P=0.070), respectively. The mean dis-ease-free survival time of the two groups was 97.03 ± 2.53 months and 87.01 ± 3.80 months, respectively. In the high-risk group, the 10-year survival rates of patients with and without radiotherapy were 72% and 56% (χ~2 = 4.07, P = 0.044), the local recurrence rates were 5% and 24% (χ~2= 11.16, P = 0. 001), and the distant metastasis rates were 16% and 26% (χ~2= 2.18 ,P = 0. 140). In the low-risk group, the survival rate of patients with and without radiotherapy were 81% and 71% (χ~2 = 1.57 ,P = 0.210), the local recur-rence rates were both 11% (χ~2=0.01 ,P=0.975), and the distant metastasis rates were both 13% (χ~2 = 0.00,P = 1. 000). Conclusions Early breast cancer patients with 1 -3 positive axiilary lymph nodes should receive post-operative radiotherapy after radical mastectomy. The prognostic index may decrease the chance of unnecessary radiation by distinguishing the patients under low risk of recurrence from those under high risk.

Objective:To study the related factors of severe acute radiation-induced lung injury (SAR) caused by IMRT and concurrent chemotherapy for non-small cell lung cancer. Methods:We retrospectively analyzed the data of 2 323 non-small cell lung cancer pa-tients who underwent IMRT radiotherapy and concurrent chemotherapy at the Department of Radiotherapy of Tianjin Medical Univer-sity Cancer Institute and Hospital from January 2010 to January 2014. We analyzed the clinical factors and parameters that affect dose by univariate and multivariate analysis. Results:A total of 2 323 patients enrolled and 1 241 cases suffering from acute radiation-in-duced lung injury with the rate of 53.4%. Only 185 cases suffered from SARP with a rate of 7.96%. Univariate analysis showed that the gender, histopathological type, total radiation dose, V5 (%), and average dose rate are not related to SARP (P>0.05). By contrast an age of>60 years, 1%predicted FEV, docetaxel+carboplatin/cisplatin chemotherapy, V20 (%), V30 (%), and mean lung dose (MLD) are sig-nificantly related to SARP (P<0.05). Multivariate analysis showed that a patient age of>60 years, docetaxel+carboplatin/cisplatin che-motherapy, V20 (%), and V30 (%) are the independent risk factors of SARP. Conclusion:Among the non-small cell lung cancer patients undergoing IMRT radiotherapy and concurrent chemotherapy, further attention should be given to elderly patients, patients receiving docetaxel and platinum chemotherapy, as well as V20 and V30 with high doses. The necessary preventive treatment should be given to reduce the incidence of SARP, improve the quality of life of patients, and reduce the incidence of respiratory failure and mortality.

Objective To investigate clinical efficacy of simultaneous integrate boost for glioblastoma with intensity?modulated radiotherapy ( SIB?IMRT). Methods A total of 46 patients with glioblastoma who underwents SIB?IMRT from January 2013 to August 2014,were retrospectively analyzed. Toxicity after completion of SIB?IMRT were assessed. Kaplan?Meier method was used to analyze survival and progression?free survival. Multivariate analyses were performed to determine significant prognostic factors. Results There was no patients delayed by more than grade 3 radiation toxicity. The median overall survival and 1?year survival rates was 69 weeks and 73%,respectively. The progression free survival and 1?year progression?free survival rate were 43 weeks and 39%,respectively. The pattern of failure was identical (9 Local, 7 distant and 0 marginal recurrence). Multivariate analyses show that temozolomide concurrent chemoradiotherapy were independent factors correlated to prognosis. Conclusions The preliminary results demonstrate that SIB?IMRT for glioblastoma appear to be effective and safe. With the limted number of patients in this group,SIB?IMRT could be used for treating glioblastoma with caution,which deserves further study.

Objective To evaluate the role of 18F fluorodeoxyglucose positron emission tomography computed tomography (PET-CT) in nasopharyngeal carcinoma (NPC) after radiotherapy. Methods A total of 27 NPC patients received 18FDG PET-CT 8-32 weeks after radiotherapy. All the patients were followed up for about 12 months after the examination. Metastasis and residual were evaluated by PET-CT. The correlation between SUV and prognosis was analyzed. Results Of these 27 patients, metastasis was found in 2 patients by PET-CT. Local persistence was diagnosed as for SUV≥2. 5 by PET-CT in 20 patients, among whom 18 were confirmed by biopsy and then received brachytherapy or conformal radiotherapy. One year local control and survival rates were 70% and 81%. Based on SUV, the patients were divided into group one for SUV between 2. 5 and 5(9 patients) or group two for SUV≥5 (11 patients). In group one and group two, the one year local control rate, survival rate and metastasis rate were 67% , 55% (P=0.670) , 64% ,89%(P=0.319), and 22% , 82% (P =0. 022) , respectively. Conclusions PET-CT is valuable for the identification of residual nasopharyngeal carcinoma. SUV of residual tumor is related to metastasis.

Objective:To evaluate the radiotherapeutic strategy for the treatment of recurrent esophageal cancer after radical re-section and determine relevant prognostic factors. Methods:A total of 66 patients with esophageal carcinoma and exhibited recurrence after radical surgery were retrospectively reviewed from Jan 2007 to Jun 2010. The median interval of recurrence from the initial sur-gery was 10.6 months. Among the 66 patients, 50 suffered from loco-regional recurrences alone, and 16 developed distant metastases in addition to loco-regional recurrences. Among the 66 patients, 10 were treated with radiotherapy after recurrence, 23 were treated with chemotherapy alone, and 33 were treated with radiotherapy combined with chemotherapy. Among the 33 patients, 22 were initially treat-ed with chemotherapy and 11 were initially treated with radiotherapy. The median total dose of the external radiotherapy was 60 Gy with 6 MV X-ray of a linear accelerator. Results:The median survival period after recurrence was 14.3 months (95%CI=12.4~16.2 months). The 1-, 2-, and 3-year survival rates were 61.9%, 25.9%, and 16.5%, respectively. The median survival period after recurrence in the patients who were treated with chemotherapy alone, radiotherapy alone, and radiotherapy combined with chemotherapy were 11.4, 25.5, and 14.3 months, respectively. The patients who developed distant metastases treated with chemotherapy initially showed better survival outcome than those treated with radiotherapy (P=0.032). Univariate analysis results showed the following prognostic factors:tumor location before surgery;operation mode;whether or not recurrence was detected with distant metastases;and therapy af-ter recurrence. Multivariate analysis results showed that tumor location before surgery was an independent prognostic factor. Conclu-sion:Tumor location may indicate prognosis after recurrence. Patients with recurrent esophageal carcinoma and developed distant me-tastases treated with chemotherapy may initially benefit from a longer survival rate.

Objective To investigate the factors associated with radiation-induced lung damage in non-small cell lung cancer (NSCLC) treated with radical three-dimensional conformal radiotherapy (3DCRT). Methods Eighty-six patients with NSCLC were treated by radical 3DCRT (total dose 60-66 Gy, 1.8-2.0 Gy/f, 5 d/w). Several clinical and dosimetric factors were analyzed retrospectively, inclu-ding sex, age, smoking history, heart disease history, pulmonary function, tumor location, clinical stage,pathological diagnosis, chemotherapy, total dose, numbers of fields, mean lung dose (MLD), V_5, V_(10),V_(15), V_(20), V_(25), V_(30), V_(35), V_(40), V_(45), V_50, V_55, V_(60) and V_(65). Radiation-induced lung damage was graded ac-cording to the Common Terminology Criteria for Adverse Events version 3.0. Univariate and multivariate an-alyses were performed to identify the predictive factors. Results The median follow-up was 12 months (range, 1-36 months). The incidence of≥ grade 3 radiation-induced lung damage was 13.9%. In univari-ate analysis, V_5, V_(10),V_(15), V_(20), V_(25), V_(30), V_(35)and MLD were all significantly associated with radiation-induced lung damage, while the clinical factors, total dose, numbers of fields, V_(40), V_(45), V_50, V_55, V_(60)and V_(65) were not. In Logistic regression analysis, Vs was the only factor significantly associated with radiation-induced lung damage (χ~2=5.15,P=0.023). The incidence of ≥ grade 3 radiation-induced lung damage in the group with V_5≤45% and V_5 > 45% were 2.3% and 26.2%, respectively (χ~2= 10.24, P = 0.001). Conclu-sions The lung damage may dependent on the irradiated volume more than the radiation dose. A number of doaimetric factors are significantly associated with radiation-induced lung damage. However , V_5 should be considered in radical 3DCRT for NSCLC patients to reduce the incidence of radiation-induced lung damage.

Objective To investigate the prognostic significance of postoperative radiotherapy (PORT) for locally advanced pulmonary adenocarcinoma with micropapillary pattern(MPPAC).Methods A total of 45 completely resected pN2-3 cases that occured from January 2012 to December 2014 at Tianjin Medical University Cancer Hospital were retrospectively analyzed.All of them were diagnosed with MPPAC by pathological diagnosis.Based on whether receiving PORT, patients were divided into radiotherapy and non-radiotherapy groups.General characteristics, overall survival and disease-free survival characteristics of the two groups were compared, respectively.Results The median overall survival (OS) of patients was 19.8 months, 1-year and 2-year overall survival rate was 79.4％ and 30.3％ , respectively.The median disease free survival (DFS) of patients was 13 months, 1-year and 2-year, and the disease free survival rate was 59.3％ and 28.9％ , respectively.The radiotherapy and non-radiotherapy groups exhibited median OS of 22.3 and 11.4 months,respectively (x2=13.329, P＜ 0.05) , and corresponding D FS of 16.2 and 10.4 months(x2 =7.972 ,P ＜0.05).The epidermal growth factor receptor gene (EGFR) mutation rate of patients was 57.14％ (20/35), In the subgroup analysis, for patients with EGFR mutation, the radiotherapy and non-radiotherapy groups showed median OS of 25.6 and 18.4 months, respectively(x2 =9.268,P ＜ 0.05) , and corresponding DFS of 21.6 and 12.6 months (P ＞ 0.05).For patients with wildtype EGFR, the radiotherapy and non-radiotherapy groups showed median OS of 21.8 and 10.6 months,respectively(x2 =9.595,P ＜ 0.05) , and corresponding DFS of 15.2 and 6.6 months(x2 =4.538,P ＜0.05).Conclusions PORT could improve survival of patients with pN2.3 MPPAC.For patients with locally advanced MPPAC after curative resection, PORT is still an integral part of treatment.

Objective To investigate the value of lung adenocarcinoma classification developed by International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society ( IASLC/ATS/ERS) in predicting the effect of three-dimensional radiotherapy ( 3DRT) after surgery for locally advanced lung adenocarcinoma.Methods The clinical data of 150 patients with invasive lung adenocarcinoma who underwent radical resection and systematic lymph node dissection in Tianjin Medical University from 2010 to 2013 were analyzed, and according to the IASLC/ATS/ERS classification, they were divided into lepidic predominant group (LEP group), acinar predominant group (ACN group), papillary predominant group (PAP group), micropapillary predominant group (MIP group), and solid predominant group (SOL group), and further divided into LEP group, CAN/PAP group, and MIP/SOL group.The overall survival ( OS) and disease-free survival ( DFS) rates were compared between groups.The Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for survival difference analysis and univariate prognostic analysis, and the Cox proportional hazards model was used for multivariate prognostic analysis.Results Among all the patients, the median OS and DFS rates were 30.8 and 25.8 months, respectively.For the patients in the LEP group, ACN/PAP group, and MIP/SOL group, the median OS rates were 40.0, 32.2, and 28.4 months, respectively ( P=0.005) , and the median DFS rates were 29.2, 25.8, and 24.2 months, respectively ( P=0.011) .For the ACN/PAP group, the patients who received or did not receive radiotherapy had a median OS rate of 37.4 or 25.3 months ( P=0.000) and a DFS rate of 31.1 or 25.2 months (P=0.000).For the MIP/SOL group, the patients who received or did
not receive radiotherapy had a median OS rate of 28.3 or 27.4 months ( P=0.783) and a DFS rate of 25.3 or 24.0 months ( P=0.732 ) .Conclusions The IASLC/ATS/ERS classification helps to predict the prognosis of patients with locally advanced invasive lung adenocarcinoma who receive postoperative radiotherapy.Postoperative radiotherapy can be performed for ACN and PAP patients, while there is no need to perform radiotherapy for MIP and SOL patients .

Objective:To investigate the inhibitory effects of halofuginone on radiation-induced pulmonary injury and to explore the therapeutic mechanism of this drug. Methods:A total of 72 healthy female C57BL/6 mice were randomized into 4 groups, namely, control, irradiation, halofuginone, and irradiation plus halofuginone groups, with 18 mice in each group. No treatment was performed in the control group. In the halofuginone group, the halofuginone lavage was conducted once a day, with a continuous course treatment for a month or until sacrifice of the mice. In the therapeutic alliance group, the treatment mode was the same as that in the halofuginone group. Then, a 6MV-X ray single fraction irradiation was performed after the completion of a 15-day intragastric administration. At 24 h, 1 week, 2 weeks, 4 weeks, 12 weeks, and 20 weeks after the irradiation, 3 mice from each group were randomly sacrificed, and total lung tissues were harvested. The lung was dissected to prepare pathological sections. The sections were stained with hematoxylin and eosin staining (H&E) to explore morphologic changes. The protein and mRNA expression levels of TGF-β1 were analyzed by a combi-nation of immunohistochemistry and polymerase chain reaction. The level of hydroxyproline was also measured. Results: The out-comes of H&E staining showed that halofuginone markedly ameliorated the acute pulmonary inflammation and fibrosis induced by irra-diation. The combination group had a lower level of hydroxyproline than the irradiation group, with statistically significant differences at 20 weeks after irradiation (P=0.037). The protein and mRNA expression levels of TGF-β1 were higher in the irradiation and combi-nation groups than in the control group and (or) halofuginone group at different time points (P<0.05). The combination group had lower TGF-β1 protein expression than the irradiation group at different time points, with statistically significant differences at 2, 4, 12, and 20 weeks after the irradiation (P<0.05). Meanwhile, TGF-β1 mRNA level was lower in the combination group than in the irradiation group only at 4 and 12 weeks after the irradiation (P<0.05). Conclusion:Halofuginone can ameliorate the irradiation-induced lung inflamma-tion and fibrosis probably by inhibiting the radiation-induced TGF-β1 expression. Therefore, halofugione is expected to be a therapeu-tic drug for preventing irradiation injury of the lung.