Objective:To analyze the clinical prognosis of patients with cervical and upper thoracic esophageal squamous cell carcinoma treated with radical intensity-modulated radiotherapy (IMRT) with or without chemotherapy, and to explore the significance of elective lymph node irradiation (ENI).Methods:A retrospective analysis was performed on 309 patients with cervical and upper thoracic esophageal squamous cell carcinoma who underwent IMRT with or without chemotherapy in the Department of Radiology, the Fourth Hospital of Hebei Medical University. The prognostic factors were analyzed and patients receiving different irradiation methods were assigned into different group. The curative effect, toxicity and side effects were analyzed among different groups.Results:The 1-, 3-and 5-year overall survival (OS) and progression-free survival (PFS) were 76.7%, 37.4%, 19.3% and 59.7%, 27.4% and 14.4%, respectively, with median values of 26.8 and 15.5 months. Multivariate analysis showed that gender, cTNM staging and chemotherapy were the prognostic factors affecting the OS ( P=0.003, P<0.001, P=0.022), and gender, cTNM stage and radiation mode were the prognostic factors affecting the PFS ( P=0.016, P<0.001, P=0.008). After propensity score matching (PSM), the 1-, 3-, and 5-year OS and PFS were 77.2%, 39.3%, 20.0%, and 62.0%, 29.3%, and 15.4%, respectively, with median values of 27.1 and 18.2 months. Multivariate analysis showed that gender, cTNM staging and chemotherapy were the prognostic factors affecting the OS ( P=0.026, P<0.001, P=0.017); cTNM staging and irradiation mode were the prognostic factors affecting the PFS ( P<0.001, P=0.008). A subgroup analysis of chemotherapy showed that patients receiving 3-4 cycles of chemotherapy were preferred. The side effects of the patients were mainly grade 0 to 2, which could be tolerated. Conclusions:IMRT combined with or without chemotherapy is an efficacious treatment for patients with cervical and upper thoracic esophageal squamous cell carcinoma; ENI can improve the PFS of patients.

Objective To compare the long-term efficacy and complications of peroral endoscopic circular myotomy and full-thickness myotomy for patients with achalasia of cardia. Methods A retrospective analysis was performed on the data of 53 patients with achalasia of cardia, who underwent peroral endoscopic myotomy in the First Affiliated Hospital of Zhengzhou University from June 2012 to December 2014 and were followed-up regularly.Twenty-one patients underwent circular myotomy, and the other 32 patients underwent full-thickness myotomy. The postoperative long-term efficacy and gastroesophageal reflux complications of the two groups were compared. Results The effective rate of the circular myotomy group and the full-thickness myotomy group was 90. 5%( 19/21) and 100. 0%( 32/32), respectively ( P＝ 0. 152). There were no significant differences between the two groups on postoperative Eckardt scores, lower esophageal sphincter pressure and 4 s integrated relaxation pressure ( P ＞ 0. 05 ). The incidence of clinically relevant gastroesophageal reflux of full-thickness myotomy group was higher than that of circular myotomy group (40. 6% VS 14. 3%, χ2＝4. 174, P＝0. 041). Conclusion The long-term efficacy of circular myotomy is similar to that of full-thickness myotomy, but the incidence of clinically relevant gastroesophageal reflux is higher in full-thickness myotomy.

Objective: To evaluate the effect of different irradiation methods on the long-term prognosis of patients with clinical T_2-3N₀M₀ esophageal squamous cell carcinoma, aiming to select the optimal treatment for these patients. Methods: A total of 268 eligible patients admitted to our hospital from January 2007 to December 2012 were enrolled in this study. All patients were divided into the involved-field irradiation (IFI) and elective node irradiation (ENI) groups. The composition ratio, prognostic factors and adverse events were analyzed between two groups. Results: The median overall survival (OS) time was 35.5 months (95%CI : 30.12-40.88) and the median disease-free survival (DFS) time was 23.5 months (95%CI: 19.00-28.00). According to the multivariate analysis results, all patients were assigned into two groups at a ratio of 1 vs.1(n=86 in each group). Multivariate analysis after propensity score matching (PSM) demonstrated that irradiation method was the independent factor of OS (P=0.038), and T stage and radiotherapy were the independent factors affecting DFS (P=0.002, 0.032). The incidence of ≥grade Ⅱ adverse events did not significantly differ between two groups (P=0.819, 0.756). However, patients with combined chemotherapy experienced more adverse events. Conclusion ENI can prolong the OS and DFS of patients with clinical T_2-3N₀M₀ esophageal squamous cell carcinoma, and does not increase the incidence of severe adverse events.