Objective To investigate the feasibility of dose verification of helical tomotherapy (HT) using the PTW Seven29 2D-ARRAY with Octavius phantom.Methods The 12 patients HT plan were verified with the PTW Seven29 2D-ARRAY combining Octavius phantom.The detector array was guided and registered by MVCT imaging,and measured dose distributions on the corresponding planes were compared with those calculated by the treatment planning system (TPS).Based on several different Gamma criteria,the Gamma analysis method was utilized to evaluate the dose verification.Results According to the different acceptance criteria combination of dose difference/distance to agreement at different threshold level including 3％/2 mm,3％/3 mm,3％/4 mm,3％/5 mm at TH5,TH10,TH20,TH30,the mean passing rates with γparameter ≤ 1 were all above 91.7％ and 93.9％ when PTW Seven29 2D-ARRAY was horizontal and vertical.The dose distribution measured by the 2D-ARRAY combining Octavius phantom was well consistent with that calculated by the TPS.Conclusions 2D-ARRAY with Octavius phantom can get satisfying results when used in HT plan dose verification and is a viable tool to replace traditional film dosimetry system in clinical quality assurance work.

Total 52 patients with breast lesions underwent dynamic contrast-enhanced breast MRI; and the breast vascularization was scored on the MRI vascular maps with a range of 0 to 3. The mean number of vessels per ipsilateral breast in malignant cases was higher than that of benign cases (3.8±2.0 vs. 1.3± 1.0; P=0.000). When the breast vascularity score 0-1 was defined as benign and 2-3 was defined as malignant, the sensitivity and specificity was 79% and 83%, respectively. Results indicate that dynamic contrast-enhanced breast MRI is of value in diagnosis of malignant breast lesions.

Objective To analyze the response rate and prognostic factors for patients with locally recurrent rectal cancer treated with hypofractionated chemoradiotherapy without reresection.Methods Totally 52 patients with locally recurrent rectal cancer received hypofractionated irradiation and concurrent chemotherapy from January 2006 to January 2013 were enrolled.All patients received intensity-modulated radiotherapy (IMRT).The median dose was 63.4 Gy (61.6-64.4 Gy) at 2.2-2.3 Gy/f,5 f/week.Thirteen patients underwent prophylactic irradiation at lymph nodes region,the total dose of 45-50.4 Gy with conventional fraction and a simultaneous integrated boost was used.All patients received concurrent chemotherapy,capecitabine at 1 650 mg·m-2 ·d-1,divided into 2 times,5 d/week.The variables were compared by the chi-square test or Fisher's exact test.Local control (LC) and overall survival (OS) were calculated with using the Kaplan-Meier method.Results For all patients,the clinical complete response (CR),partial response (PR),stable disease (SD) and progressive disease (PD) was 23.1％,38.5％,32.7％ and 5.8％,respectively.The response rate (CR + PR) for patients with previous irradiation to pelvis and without were 37.1％ and 71.1％,respectively (x2 =5.40,P ＜ 0.05);for patients with 1 and 2 or more recurrent subsites were 81.8％ and 46.7％,respectively (x2 =6.63,P ＜ 0.05).Acute grade 3 skin and hematologic toxicities occurred in 19 patients (36.5％) and 1 patient (1.9％),respectively.None occurred grade 4 toxicity and none occurred grade 3 or more gastrointestinal and urologic toxicities.Four patients showed severe late toxicity of anastomotic stricture and performed a stoma at transverse colon.No other severe late toxicities were observed.The LC at 5 years was 49.1％ and the OS was 23.1％.Conclusions For patients with locally recurrent rectal cancer,hypofractionated chemoradiotherapy without resection is an acceptable and effective regimen,the response rate and long-term outcomes are promising.

Objective To investigate the feasibility of dose verification of intensity modulated planning of helical tomotherapy (HT) using three-dimensional semiconductor array (Delta4) and find a more time-consuming and accurate method to validate the delivery dose.Methods Delta4 detector array was used to verify the HT plan dose distribution of 10 patients.The precise setup of detector array was guided and registered by MVCT imaging.After the implementation of delivery,the measured dose distributions on the corresponding planes were compared with those calculated by the treatment planning system (TPS).According to the different acceptance criteria combination of dose difference or distance to agreement at different threshold level including 3％/2 mm,3％/3 mm,3％/4 mm,3％/5 mm at TH5,TH10,TH20,TH30,TH70,TH90,the γ analysis method was utilized to evaluate the dose verification.Results The dose distribution measured by the Delta4 was well consistent with that calculated by the TPS.The mean γpassing rates were all above 94.89％.Conclusions Delta4 detector array can get satisfying results when used in HT plan dose verification and is a viable tool to replace traditional film dosimetry system in clinical quality assurance work.

Objective To investigate the expression of MnSOD and E-cadhefin in nasopharyngeal carcinoma(NPC) tissue and its relationship with clinicopathological features and prognosis. Methods The expression of MnSOD and E-cadherin were detected by immunohistochemistry method in 60 NPC patients. Results Of the whole group,lymph node positive group and lymph node negative group,the strong positive rate of MnSOD protein was 47% (28/60) ,49% (25/51 patients) and 33% (3/9) (x2 =0.76,P =0.382), respectively.The corresponding strong positive rate of E-cadherin protein was 47% (28/60) ,43% (22/51) and 78% (7/9) (x2 =3.69,P =0.047) ,respectively.The expression of MnSOD increased with T stage and N stage.The higher expression of MnSOD was significantly associated with the larger size of metastatic lymph node(r =0.46 ,P =0.002) ,more radioresistance and poorer prognosis,but not with the region of lymph node metastasis(r =0.223,P = 0.116).The lower expression of E-cadherin was closely relevant with higher N stage and the smaller region of lymph node metastasis(r =-0.33,P = 0.020),but not with T stage,lymph node size or radiosensitivity(r =-2.19,P=0.093;r=-0.07,P=0.623;r=-0.18,P=0.170).Multi variate analysis showed that MnSOD and E-canherin were independent prognostic factors (x2= 4.45,P = 0.035;x2 =5.12,P=0.024). Conclusions High expression of MnSOD may stimulate tumor growth and reduce radiosensitivity.High expression of E-cadherin may inhibit lymphatic metastasis,while has no rela tionship with tumor growth and invasion.MnSOD and E-cadherin could affect the prognosis of NPC patients.

Objective To explore the efficacy of neoadjuvant chemoradiotherapy (CRT) followed by surgery for locally advanced esophageal squamous cell carcinoma (ESCC),and to investigate the correlation between a clinical complete response (cCR) and a pathologic complete response (pCR).Methods One hundred and fifty-eight patients with locally advanced thoracic ESCC from 2001 to 2013 were retrospectively analyzed.All patients received concurrent chemoradiotherapy followed by surgery.Platinumbased chemotherapy regimens were adopted in chemotherapy and a prescribed dose of 40 Gy in 20 fractions,5 fractions per week,was used in radiotherapy.The overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method,and pairwise comparisons and univariate prognostic analyses were performed using the log-rank test.Multivariable prognostic analyses were performed using the Cox regression model.Results The pCR rate was 41.1％ in all patients.After the treatment with neoadjuvant CRT,32(72.7％) out of 44 patients with a cCR had a pCR,but only 33(28.9％) out of 114 patients with a non-cCR had a pCR (P =0.000).The sensitivity,specificity,positive predictive value,and negative predictive value of a cCR in predicting a pCR were 49.2％,87.1％,72.7％,and 71.1％,respectively.The 3-year sample size was 91.The 3-year OS and DFS rates in all patients were 53.9％ and 48.6％,respectively.Patients with a cCR had significantly higher 3-year OS and DFS rates than those with a non-cCR (P =0.012;P =0.026),while patients with a pCR had significantly higher 3-year OS and DFS rates than those with a non-pCR (P =0.000;P =0.000).The multivariate analyses demonstrated that the pathologic response after CRT and chemotherapy regimen were the influencing factors for OS.The most common grade ≥3 acute adverse reaction was leucopenia (34.2％).Conclusions With a high pCR rate and tolerable adverse reactions,neoadjuvant CRT followed by surgery is a safe and effective option for locally advanced ESCC.The cCR rate after CRT is closely correlated with the pCR and OS rates.

ObjectiveTo evaluate correlation factors of cervical lymph nodes metastasis in thoracic esophageal carcinoma.MethodsLocal-regional metastasis of lymph node for 126 cases with esophageal squamous cell cancer after surgery from 2004 to 2009 were reviewed.Risk factors of cervical lymph nodes metastasis were examined by multiple Logistic regression analysis.ResultsIn 126 cases,supraclavicular lymph node metastasis rate was 43.7％ (55/126).By logistic regression,none of the primary site,T stage,N stage,histological grade,lymph node metastasis rate,lymph node metastasis degree and number of lymph nodes metastatic field was not the high risk of cervical lymph nodes metastasis.In addition,multivariate analysis found that lymph node metastasis in mediastinum region 1 was high risk factor for lymph node metastasis of region 1 ( x2 =12.14,9.27,P =0.000,0.002),lymph node metastasis in region Ⅲ and region 2 were high risk factors for lymph node metastasis of region Ⅱa ( x2 =14.56,8.27,8.02,3.93,P =0.000,0.004,0.005,0.047 ).ConclusionMediastinal para-recurrent nerve lymph node metastasis is a significant predictor for cervical lymph nodes metastasis.

Objective To evaluate the effect of GTV volume on response of esophageal carcinoma.Methods From Jan.2004 to Dec.2008,72 cases newly diagnosed N0 stage thoracic esophageal carcinomas were included in this retrospective study.All treatment plans were set up and designed by CT simulator and 3D TPS.They received dose 56-70 Gy/27-33F/6-7w with 6MV X-ray.The GTV,the tumor length and maximum diameters were measured on the treatment planning system with the X-ray.RECIST standard was applied to evaluate the radiotherapy response of esophageal carcinoma.The effectiveness of related prognostic factors on survival was evaluated by univariate analyses.Results The short-term response with CR were 79％ with length ＜ 5 cm,48％ with 5-7 cm and 26％ with length ＞7 cm(P =0.003).The 1-,2-,3-and 5-year survival rates were 93％,79％,69％,69％ ; 91％,61％,46％,46％ and 80％,46％,28％,22％ (P =0.037).The short-term response with CR were 56％ with maximum diameters ≤3 cm and 33％ with maximum diameters ＞ 3 cm(P =0.033).The 1-,2-,3-and 5-year survival rates were 91％,72％,55％,37％ and 80％,45％,30％,30％ (P =0.037).The short-term response with CR were 52％ with GTV volume≤40 cm3 and 30％ with GTV volume ＞40 cm3(P =0.059).The 1-,2-,3-and 5-year survival rates were 91％,67％,51％,41％ and 80％,43％,27％,27％ (P =0.047).In the multivariate analysis,the length of GTV was likely to be the most important factor for the short-term response(P =0.005,0.014).Conclusions GTV volume,the tumor length and maximum diameters are factors for short-term response of N0 stage esophageal carcinoma.The GTV length is independent prognostic factor.The GTV length is the worse the prognosis will be.

OBJECTIVE: To observe the clinical efficacy of highly agglutinative staphylococcin (HAS) combined with cisplatin in the treatment of malignant hydrothorax after straining and inserting central venous catheter in thoracic cavity. METHODS: 90 patients with malignant hydrothorax combined with lung cancer were randomly divided into A、B、C 3 groups. Central venous catheter was inserted in thoracic cavity for strainage. Group A were intrapleural injected with 5 000 U HAS, group B 40 mg?m-2 cisplatin and group C 5 000 U HAS combined with 40 mg?m-2 cisplatin once a week. Clinical efficacies of 3 groups were evaluated after 3 weeks of treatment. RESULTS: The total effective rate of group A, B and C were 43.0%, 46.7% and 80.0% respectively. There was obvious difference between group C and A as well as group B(P

Objective To compare acute toxicity for stage Ⅱ-Ⅲ patients with rectal cancer irradiated with helical tomotherapy (HT) and conventional five-field intensity-modulated radiotherapy (5-IMRT).Methods The data of 84 stage Ⅱ-Ⅲ patients with rectal adenocarcinoma treated with concurrent chemoradiotherapy (CRT) were retrospectively analyzed.19 patients underwent postoperative CRT,and 65 patients underwent preoperative CRT.43 patients received radiotherapy with HT and 41 patients with 5-IMRT.The delineation on clinical target volume (CTV) and gross tumor target (GTV) was similar for two groups.The CTV to plan tumor volume (PTV) margins were 1.0 cm for patients with 5-1MRT and 0.5 cm for patients with HT.For all patients,a dose of 45.0-50.4 Gy,in daily fractions of 1.8 Gy,was delivered to PTV.For 45 patients with high risk factors,simultaneous integrated boost (SIB) was given to the tumor or tumor bed of a total dose of 55.0-60.0 Gy,in daily fractions of 2.1-2.3 Gy.Before treatment,the patients treated with HT underwent scanning by the tomotherapy-integrated megavoltage computed tomography (MVCT) scan modality and were positioned by co-registration of these images to the original kilovoltage planning CT image set.Concurrent capecitabine every day 1 600 mg/m2,twice daily on every day in the week.Results The rates of grade ≥ 2 acute cystitis were 7.0 ％ (3 cases) in HT group and 2.4 ％ (1 case) in 5-IMRT group (P =0.616),and ≥3 grade acute diarrhea were 4.7 ％ (2 cases) and 12.2 ％ (5 cases),respectively (P =0.259).≥2 grade leukopenia were 48.8 ％ (21 cases) and 19.5 ％ (8 cases),respectively (P =0.005),≥1 grade anemia were 34.9 ％ (15 cases) and 14.6 ％ (6 cases),respectively (P =0.032),and ≥1 grade thrombocytopenia were 23.3 ％ (10 cases) and 14.6 ％ (6 cases),respectively (P =0.314).Conclusions There is no significant difference in acute diarrhea and cystitis for patients treated with HT and 5-IMRT.Leukopenia and anemia in patients treated with HT are worse than those in patients with 5-IMRT,and thrombocytopenia is similar in the two groups.