Objective To evaluate the optimized simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) plans in cervical esophageal carcinoma underwent prophylactic lymphatic irradiation.MethodsSix patients with cervical esophageal carcinoma were studied.The gross tumor volume (GTV) and clinical target volume (CTV) (including bilateral mid-lower neck and supraclavicular lymph drainage regions,upper mediastinal lymph drainage regions) were delineated on sim-CT images,GTV and CTV were uniformly expanded by 5 mm to create PGTV and PTV.Five fields(5F) ,7F and 9F SIB-IMRT plans were designed.The prescribed doses to PGTV and PTV were 66 Gy and 60 Gy in 30 fractions respectively.The parameters of dose-volume histograms in three groups planning were compared.Results The values of conformity index(CI) of PGTV were 0.56,0.62 and 0.69 (F =6.22,P ＜0.01 ),the V66 with 88.24% ,95.03% and 94.91% ( F = 4.39,P ＜ 0.05 ) and D95 with 6539.67,6601.83 and 6602.00 cGy (F=4.46,P ＜0.05) in 5F,7F and 9F SIB-IMRT plans.The values of CI,V66 and D95 of PTV were 0.80,0.85 and 0.87 (F=11.29,P＜0.01),with 91.64%,94.05% and 95.06% (F=4.10,P＜0.05) and with 5934.00,5987.17 and 6006.33 cGy (F =4.01,P ＜0.05).The values of maximal dose of spinal cord were 4707.17,4497.83 and 4357.00 cGy( F = 11.26 ,P ＜0.011 ) in 5F ,7F and 9F SIB-IMRT plans.The values of all dosimetic parameters about PGTV and PTV were same in 7F and 9F SIB-IMRT plans ( all P ＞ 0.05 ).Conclusion 7F-SIB-IMRT plan is best one scheme for cervical esophageal carcinoma underwent prophylactic lymphatic irradiation.

Objective To investigate the epidemic characteristics and trends of incidence and mortality of prostate cancer in cancer registration areas in Zhejiang province from 2000 to 2009.Methods Clinical data incidence and mortality of prostate cancer were collected from 6 cancer registration areas in Zhejiang province,including Hangzhou,Jiaxing,Jiashan,Haining,Shangyu and Xianju.Crude rates,standardized rate and change trend,age-specific rates and annual percent change (APC,95％ CI) of prostate cancer were checked,sorted and analyzed in Zhejiang Cancer Center.Results The prostate cancer incidence rate from 2000 to 2009 was 9.79/100 000,age-standardized incidence rates by world standard population (ASIRW) was 6.39/100 000,and the incidence cumulative risk of males aged 0-74 was 0.72％ ; while the mortality rate was 2.73/100 000,age-standardized mortality rates by world standard population was 1.74/100 000,and the mortality cumulative risk of males aged 0-74 was 0.14％.Age-specific incidence of prostate cancer remained low before 50,years old and peaked at over 85-year-old group (130.30/100 000).Age-specific mortality of prostate cancer increased after 55,and also peaked at over 85-year-old group (81.19/100 000).The annual prostate cancer incidence rate generally grew from 1.39/100 000 (2000) to 13.89/100 000 (2009),and the APC was 14.18％ (95％ CI,9.68％-18.98％).Meanwhile,the prostate cancer mortality rate also increased from 1.52/100 000 (2000) to 3.58/100 000 (2009),and the APC was 11.83％ (95％ CI,5.69％-18.33％).Conclusion Prostate cancer incidence and mortality in Zhejiang cancer registration areas increased sharply,and the prevention and treatment of prostate cancer should be strengthened.

In April 10, 2010, an earthquake measuring magnitude 7.1 shocked Yushu County,Qinghai province. For medical rescue, the National Earthquake Disaster Emergency Rescue Team was sent to Yushu right away. Rescue work in Yushu was faced with such difficulties as short preparative time, heavy workload, high exposure to various acute high altitude diseases (AHAD), and a number of other diseases frequently found on the cold plateau. To ensure the rescue work a success, the team took a series of measures including efficient preparative procedure, scientific and logical procedure in the emergency medical aid operations, reliable and effective handling of AHADs, along with sufficient self protection for team members.

Objective To explore the changes and the tendency of breast cancer radiotherapy in China within the past decade.Methods A survey on breast cancer radiotherapy in 1 999 and 2006 was conducted in 4 hospitals located within the southeast coastal region of China,including patients'clinical characteristics,the purpose of radiotherapy and its techniques.Results The percentage of breast conservative treatment(BCT)increased from 3%in 1999 to 13%in 2006.For radiotherapy techniques in 2006 compared with 1999,the growth trend was found in use of breast immobilization devices(80% vs.46%),treatment planning system(70% vs.23%),and CT simulation(14%vs.0).The frequency was increased in the chest wall irradiation after masteetomy(90%vs.67%),but decreased in internal mammary region(30%vs.76%)and axilla(37%vs.69%)treatment.There were no differences in total dose and fractionation prescription.Conclusions BCT was performed more frequently,but postmastectomy radiotherapy was still essential option in China at present.Although some advanced techniques were applied frequently in clinical practice.Simulation,treatment planning,and irradiation target design were urgent for improvement and standardization.

Abnormalities, Drug-Induced ; etiology ; Abnormalities, Radiation-Induced ; etiology ; Antineoplastic Agents ; adverse effects ; Breast Neoplasms ; diagnosis ; therapy ; Contraindications ; Female ; Humans ; Mastectomy ; Neoplasm Staging ; Pregnancy ; Pregnancy Complications, Neoplastic ; diagnosis ; therapy ; Prognosis ; Radiotherapy ; adverse effects ; Risk Assessment ; Risk Factors ; Sentinel Lymph Node Biopsy

Objective To evaluate the high?risk factors for brain metastases after prophylactic cranial irradiation ( PCI), and to provide a basis for personalized treatment. Methods A retrospective analysis was performed in 188 patients with limited?stage small?cell lung cancer who received PCI in our hospital from 2005 to 2010. The Kaplan?Meier method was used to calculate the cumulative rate of brain metastases. The log?rank test and the Cox model were used for the univariate and multivariate analyses of the potential factors for the cumulative incidence of brain metastases, respectively. Results In the 188 patients, 31 ( 16?5%) had brain metastases. The 1?, 2?, and 3?year cumulative incidence rates of brain metastases were 4%, 15%, and 20%, respectively. The univariate analysis showed that staged Ⅲ disease before treatment, elevated levels of tumor markers, incomplete remission after chemoradiotherapy, and local?regional relapse were risk factors for high incidence of brain metastases ( P= 0?044, 0?037, 0?005, 0?007) . The multivariate analysis revealed that incomplete remission after chemoradiotherapy and local?regional relapse after chemoradiotherapy were risk factors for high incidence of brain metastases after PCI ( P= 0?003, 0?040 ) . Conclusions Patients with incomplete remission or local?regional relapse after chemoradiotherapy have high incidence of brain metastases after PCI. For those patients, a frequent follow?up of the central nervous system plus salvage cranial irradiation might provide an alternative to PCI.

Objective To investigate the differences of measurement of gross target volume (GTV)between endoscopic ultrasonography ( EUS )-based ( GTVEUS ) and computed tomography ( CT ) -based (GTVCT) method for thoracic esophageal squamous cell carcinoma. Methods EUS was performed on 36consecutive patients with thoracic squamous cell carcinoma, and the superior and inferior boarders of the tumor defined by EUS were marked with hemoclips. The CT planning scan was then performed with the patient in supine position, and the GTVCT and GTVEUS were contoured respectively. The lengths ( LCT and LEUS) and spatial locations of longitudinal GTVCT and GTVEUS were compared. Results The mean LCT and LEUS were (7. 79 ± 3. 15 ) cm and (7. 42 ± 2. 72) cm, respectively ( t = 0. 82, P ＞ 0. 05 ), with a correlation coefficient of 0. 61 (P ＜0. 001 ). Locations of longitudinal GTVCT and GTVEUS were compared in 34cases, with 2 excluded for invisualization on CT. The mean conformal index (CI) was (0. 79 ± 0. 18 ), and spatial variations were found in 71% patients, with 8 patients at proximal end and 21 others at distal end.There was no clip placement associated complication. Conclusion Endoscopic hemoclips placement is safe and reliable. EUS can provide additional information to CT in defining longitudinal GTV in thoracic esophageal squamous cell carcinoma, especially in superficial and submucosal carcinomas.

Objective To evaluate the safety and clinical efficacy of stereotactic body radiation therapy (SBRT) for lung cancer.Methods A retrospective analysis was performed on 200 patients with primary non-small cell lung cancer (NSCLC)(118 patients) or solitary pulmonary metastasis (82 patients) who underwent SBRT in Zhejiang Cancer Hospital from January 2012 to September 2015.The 80% isodose line covered 95% of the planning target volume,and the 100% isodose line covered 100% of the internal gross tumor volume.The fractional dose was 4.0-18.0 Gy daily or every other day,and the biologically equivalent dose ranged from 40.0 to 151.2 Gy (median 100 Gy).Results All patients completed treatment.The follow-up rate was 96.0%.The complete response and partial response rates were 14.8%(17/115) and 65.2%(75/115) for the primary tumor group,versus 25%(19/77) and 38%(29/77) for the metastasis group.The incidence rates of grade Ⅱ and Ⅲ acute radiation pneumonitis were 4.7% and 3.1%,respectively.The median follow-up was 14.9 months.The 1-and 2-year local control rates were 95.7% and 84.3% for the primary tumor group,versus 92% and 73% for the metastasis group.The 1-and 2-year overall survival rates were 94.5% and 92.0% for the primary tumor group,versus 85% and 62% for the metastasis group.Conclusions SBRT is a safe and effective treatment for early primary NSCLC and solitary pulmonary metastasis,resulting in high 1-and 2-year local control and overall survival rates and low rate of complications.

Objective:To summarize the incidence of acute radiation pneumonitis (ARP) after gemcitabine induction chemotherapy for non-small cell lung cancer (NSCLC) and identify the high risk factors and dosimetric limitations of ARP after gemcitabine induction chemotherapy.Methods:We retrospectively analyzed 191 NSCLC cases who were received gemcitabine induction chemotherapy and chest radiotherapy in radiotherapy department of Zhejiang Cancer Hospital between January 2010 and December 2010. Base line data, treatment information and the incidence of ARP after treatment were collected. The risk factors of ARP were analyzed with univariate and multivariate Logistic regression method.Results:A total of 49 patients developed ≥ grade Ⅱ ARP, accounting for 25.7% of all cases. Univariate analysis indicated that the probability of ARP in patients who received the cumulative dose of gemcitabine ≥ 9.0 g was 3.45 times higher than that in those treated at a dose of < 9.0 g ( P=0.015). Radiation dose ≥ 50 Gy was significantly correlated with the occurrence of ARP ( P=0.008). The risk of ARP was increased by 7.69 times if the time interval between radiotherapy and chemotherapy was within 10 weeks ( P=0.047). Among the dosimetric parameters, V 5Gy, V 20Gy, V 30Gy and mean lung dose (MLD) of bilateral lungs were 45%, 22%, 16%, and 1 200 cGy respectively. All of them could effectively predict the occurrence of ARP (all P≤0.001). Multivariate analysis indicated that only radiotherapy dose ( P=0.044) and V 5Gy( P=0.02) were the independent predictors of ARP. Conclusions:For NSCLC patients who receive gemcitabine induction chemotherapy, the cumulative dose of gemcitabine, the interval time between chemotherapy and radiotherapy and the radiation dose are associated with the occurrence of ARP. We should strictly limit the total lung dosimetric parameters, such as V 5Gy, V 20Gy, V 30Gy and MLD to reduce the incidence of ARP.

Objective To investigate the incidence and mortality of brain tumor in Zhejiang cancer registration areas from 2000 to 2009.Methods Data from 6 Cancer registration areas of Zhejiang province were collected.Number of cases,crude rates,proportions,age standardized rates,cumulate rates,cut rates,age-specific rates and annual percentage change (APC,95％ CI) of brain tumor incidence and mortality were analyzed.Results There were 5 123 new diagnosed brain tumor cases in Zhejiang cancer registration areas,accounting for 3.14％ of all the new cancer cases.The incidence rate of brain tumor was 8.53/100 000,and the standardized incidence rate by Chinese population was 5.72/100 000,ranking the 7th in cancer incidence spectrum of anatomic sites.Agespecific incidence of brain tumor increased along with age,and peaked among 70-74 age groups (24.09/100 000).The annual incidence rate of brain tumor increased from 2000 (6.87/100 000) to 2009 (8.35/ 100 000),with APC as 1.58％ (95 ％ CI:-2.17％-5.47％,no statistical significance).A total of 2 357 deaths caused by brain tunor were reported from 2000-2009,accounting for 2.47％ of all the cancer death cases.Mortality rate on brain tumor appeared to be 3.92/100 000,with the standardized mortality rate by Chinese population as 2.45/100 000,ranking the 7th in cancer mortality spectrum of anatomic sites.The age-specific mortality of brain tumor remained low among 0-39 year-olds,and reached the peak at 80-84 age groups (17.64/100 000).The annual mortality rate of brain tumor decreased from 2000 (4.30/100 000) to 2009 (3.83/100 000) with minor fluctuation,and the APC was-0.65％ (95％CI:-3.35％-2.12％,no statistical significance).Conclusion Brain tumors incidence and mortality in Zhejiang cancer registration areas were at a relatively high level.People who were at middle-age,especially above 70 years old should be the key targets for protection on this disease.Brain tumor incidence rates increased annually in Zhejiang,which should be called for attention.