Purpose: Whether craniospinal irradiation (CSI) could be replaced by limited-field radiation in non-metastatic bifocal germinoma remains controversial. We addressed the issue based on the data from our series and the literature. Methods: Data from 49 patients diagnosed with non-metastatic bifocal germinoma at our hospital during the last 10 years were collected. The Pediatric Quality of Life Inventory 4.0 was used to evaluate health-related quality of life (HRQOL). Additionally, 81 patients identified from the literature were also analyzed independently. Results: In our cohort, 34 patients had tumors in the sellar/suprasellar (S/SS) plus pineal gland (PG) regions and 15 in the S/SS plus basal ganglia/thalamus (BG/T) regions. The median follow-up period was 52 months (range, 10 to 134 months). Our survival analysis showed that patients treated with CSI (n=12) or whole-brain radiotherapy (WBRT; n=34) had comparable disease-free survival (DFS; p=0.540), but better DFS than those treated with focal radiotherapy (FR; n=3, p=0.016). All 81 patients from the literature had tumors in the S/SS+PG regions. Relapses were documented in 4/45 patients treated with FR, 2/17 treated with whole-ventricle irradiation, 0/4 treated with WBRT, and 1/15 treated with CSI. Survival analysis did not reveal DFS differences between the types of radiation field (p=0.785). HRQOL analysis (n=44) in our cohort found that, compared with S/SS+PG germinoma, patients with BG/T involvement had significantly lower scores in social and school domains. However, HRQOL difference between patients treated with CSI and those not treated with CSI was not significant. Conclusion In patients with non-metastatic bifocal germinoma, it is rational that CSI could be replaced by limited-field radiation. HRQOL in patients with BG/T involvement was poorer.

Objective To investigate the imaging features of giant cell tumors (GCTs) of the skull and review of the literatures.Methods CT and MR features of 16 histologically proven GCTs of the skull were analyzed retrospectively.The imaging features of GCTs of the skull were summarized based on literature.Results 16 patients (male=9,female=7) with GCTs of the skull were enrolled in the study.Most of the lesions were originated from sphenoid and temporal bone.On CT scan,the lesions showed slightly hyperdense with cystic formation.Those of the sphenoid bone in sellar region usually showed osteolytic bone destruction;those of the temporal bone usually showed expansive bone destruction,foci calcification in the lesion and discontinuous "bony shell" sign could be seen at the edge.On MR images,the lesion showed isointense on T1 WI and iso-or hypointense on T2 WI with cystic formation.After contrast medium injection,the lesions demonstrated heterogeneous and apparent enhancement,and the enhancement of the adjacent meninges could be detected in some cases.Conclusion GCTs of the skull mainly originate from sphenoid and temporal bone,and the bone changes are different between the two sites on CT scan.The imaging features of GCTs are various on MR images and mainly show isointense or hypointense on T2 WI.

Objective To explore the application value of near infrared spectrum (NIRS) in the detection of epidural and subdural hematoma in clinic.Methods Thirty-four patients with subdural and epidural hematomas (study group) confirmed by CT or MRI and 14 healthy volunteers (contrast group) were selected.The NIRS equipment which was produced by Institute of Automation of Chinese Academy of Sciences were used to assess the intracranial hematomas.Taking CT or MRI results as the golden standard,the diagnostic efficiency of NIRS for subdural and epidural hematomas were evaluated.Results For the diagnosis of subdural and epidural hematomas,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 91.18％(31/34),71.43％ (10/14),85.42％(41/48),88.57％(31/35) and 76.92％ (10/13),respectively.Conclusion NIRS is a good device to predict intracranial subdural and epidural hematomas with high sensitivity and positive predictive value,which is helpful for early diagnosis and therapy in clinic.

Objective:To investigate the diagnosis and treatment of gastrointestinal fistula after radical gastrectomy .Methods:The clinical data of 15 patients ,who underwent radical gastrectomy and suffered post‐surgery gastrointestinal fistula at Depart‐ment of Gastric Cancer and Soft Tissue Sarcoma ,Shanghai Cancer Center ,Fudan University from Jan 2013 to Dec 2014 ,were retrospectively analyzed .Results:Four of the fifteen patients received reoperative procedures for peritoneal drainage .And the other 11 patients were cured after B ultrasound or CT imaging guided percutaneous catheter drainage and treatments such as fasting ,gastrointestinal decompression ,and enteral nutrition via needle catheter jejunostomy .No patient died .There was no statistically significant difference regarding length of hospital stay ,leukocytes abnormal days in peripheral blood and fever days after the diagnosis of gastrointestinal fistula between the reoperation group and the non‐reoperation group(P>0 .05) .Conclu‐sions:Early diagnosis ,as well as adequate and effective drainage is the key to cure for gastrointestinal fistula after radical gas‐trectomy .If operation indication is properly managed and nonsurgical treatment such as percutaneous catheter drainage is effec‐tive ,then reoperation can be avoided .

This paper is about the clinical trials of preoperative concurrent chemoradiotherapy for advanced adenocarcinoma of the stomach or gastroesophageal junction reported in recent years. The radiation dose of most trials is 45 Gy. Chemotherapy drugs such as 5-fluorouracil, cisplatin and taxol are concurrently used as sensitizers. A number of trials have induction chemotherapy prior to chemoradiotherpy. The validity is evaluated by R0 resection rate, pathological complete response rate and overall survival rate. The safety is assessed by the adverse reaction, treatment related mortality, and its effect on postoperative complications and mortality. The results showed that preoperative chemoradiotherapy can significantly improve the R0 resection rate and benefit the prognosis of the patients. Meanwhile, the security and impact on operations of preoperative chemoradiotherapy is controllable. The recent researches are mostly in phase II, and more randomized controlled studies are needed. To fully accept the preoperative chemoradiotherapy as a standard treatment, more evidence and long-term efficacy index are indispensible.

Total gastrectomy is a very important mode of therapy for gastric cancer.Many different types of reconstruction have been proposed,but there is no definitive conclusions as to which procedure is the best because of the postoperative complications,such as dumping syndrome,regurgitant esophagitis,malnutrition and so on.In this review,the author summarized recent clinical studies addressing gastrointestinal reconstruction following total gastrectomy.There is still some debate on preserving duodenal passage and the pouch reconstruction can provide improvement of the quality of life in patients receiving total gastrectomy.

Objective To study the clinicopathological characteristics of hereditary nonpolyposis colorectal cancer (HNPCC) in Chinese population with different criteria and guidelines. Methods Twenty four families fulfilling Amsterdam Criteria (AC), 15 additional families fulfilling Japanese Criteria (JC) and the remaining 19 patients fitting Bethesda Guidelines (BG) were analyzed. Results In the 24 AC families there were 116 malignant tumor patients including 90 colorectal cancer (CRC) subjects and in the 15 JC families there were 54 malignant tumor patients including 33 CRC cases. The two groups displayed similar clinical features. Mean age of first CRC at diagnosis was 46.1 and 51.4 years old, respectively. The proximal colonic cancers accounted for 55.4% versus 44.8%. Synchronous and metachronous multiple CRCs occurred in 25.6% and 18.2% of patients respectively. Totally there were 55 extracolonic tumors in the two groups. Gastric and endometrial carcinomas were two most common extracolonic tumor types in our series. The tumors of the 34 probands showed more frequent exophytic growth pattern, higher occurance of poorly differentiated carcinoma, A / B Dukes stage and more Crohn's like lymphoid reaction ( P

Purpose: To study the clinical treatment and prognosis of gastric cancer in elderly patients. Methods: From 1984 to 1995, 110 old patients with malignant tumor in stomach were treated in this hospital. All 110 patients received surgery with radical resections in 60 cases, palliative resections in 22 cases, laparotomy in 24 cases, and gastrojejunostomy in 4 cases. Results: Postoperative complication was 16. 36%, mortality was 1. 8%. The overall 3- and 5- year survivals for radical resections were 68. 4%, 55. 08%, respectively. Multivariate analyses showed that the favorable factors for prognoses were stage and radical resection. Conclusions: It is recommended that radical resection should be performed for malignant tumors of stomach in old patients. Although the risks of complication morbidity and surgery mortality are more likely to be higher after surgery for the elderly, the outcome would be better if more attention were paid, to improve patients general condition, and correct management after surgery.\;