Definitive concurrent chemoradiotherapy (dCCRT) is suggested as the standard treatment for cervical esophageal squamous cell carcinoma (CESCC). This retrospective propensity study compared the 8-year survival outcomes and acute treatment toxicities of these patients treated with elective nodal irradiation (ENI) versus involved-field irradiation (IFI). Patients with stage II–IV CESCC treated with dCCRT at the Fourth Hospital of Hebei Medical University between January 1, 2007 and December 31, 2020 were enrolled in the study. All the patients were restaged according to the American Joint Commission 8th edition criteria. The propensity score matching (PSM) was used to minimize the effects of treatment selection bias and potential confounding factors including sex, age, ECOG score, clinical T stage, clinical N stage, clinical TNM stage and radiation dose between the ENI group and IFI group. Survival and the prognostic factors were evaluated. The 131 eligible patients underwent ENI (60 patients, 45.8

Objectives Clinical studies on immune checkpoint inhibitors (ICIs) combined with neoadjuvant chemotherapy (nCT) have been carried out for the resectable esophageal squamous cell carcinoma (ESCC). So far, few studies have compared the survival outcomes of nCT plus ICIs and nCT alone. This study aimed to compare the efficacy and safety of neoadjuvant ICIs combined with nCT versus nCT followed by esophagectomy for patients with resectable locally advanced ESCC. Methods A retrospective analysis of ESCC patients underwent nCT or nCT combined with ICIs followed by esophagectomy (from March 2013 to April 2021) was performed. A 1:1 propensity score matching (PSM) with a caliper 0.01 was conducted to balance potential bias. Results A total of 47 comparable pairs of ESCC patients receiving nCT and nCT combined with ICIs were selected for the final analysis. The tumor regression grade (TRG) 0 and pathologic complete response (pCR) rates in the nCT+ICIs group were significantly higher than those of the nCT group (21.7% vs. 4.5%, P=0.016; and 17.0% vs. 2.1%, P=0.035, respectively). The rate of nerve invasion was 4.3% in the nCT+ICIs group, significantly lower than 23.4% of the nCT group (P=0.007). The incidences of adverse events in the nCT+ICIs group were similar compared with the nCT group and there was no grade 5 toxicity in either group. The 1-, 2-year disease-free survival rates (DFS) were 95.7%, 80.7% and 76.1%, 63.8% in the two groups (P=0.001, and P=0.046, respectively). The 1-year OS was improved in the nCT+ICIs group, which was close to a statistical difference (95.7% vs. 84.8%, P=0.074). Local recurrence rate in the nCT+ICIs group was 6.4%, significantly lower than 21.3% of the nCT group (P=0.036), while there was no significant difference in the distant metastasis. Conclusions Compared with nCT alone, neoadjuvant immunotherapy plus nCT for patients with locally advanced ESCC has an advantage in pathological response, and could improve DFS with a good safety and feasibility, while long term survival validation is still needed further.

In recent years, the incidence of adenocarcinomas of the esophagogastric junction (AEG), with a poor prognosis, is increasing. Surgical resection is the primary curative paradigm in the treatment of AEG patients, while the prognosis remains woeful. A number of randomized clinical trials has shown that neoadjuvant chemoradiotherapy or neoadjuvant chemotherapy is more beneficial than surgery alone. From May 2018 to May 2019, 31 AEG patients with HER2 (-) AEG enrolled in a phase II clinical trial were treated with apatinib combined with neoadjuvant chemoradiotherapy, of which 18 (60.0%) were ORR, and 29 (96.7%) were DCR. The pathological complete remission rate was 33.3% and R0 resection rate was 93.3%. Based on the results of this trial, we plan to expand the sample size to further explore the efficacy and safety of apatinib combined with simultaneous neoadjuvant chemoradiotherapy in the treatment of AEG. This is a prospective, randomized, controlled, multicenter phase III clinical trial, which is planned to enroll 180 patients. The patients were randomly divided into two groups: Group A: two cycles of apatinib (orally, 250 mg/day on day 1-28) and two cycles of capecitabine (orally, 1,000 mg/m2 twice daily on day 1-14) plus oxaliplatin (intravenously, 130 mg/m2 on day 1); concurrent radiotherapy (a total dose of 45 Gy in 25 fractions) started on day 1 of chemotherapy; Group B: two cycles of capecitabine (orally, 1,000 mg/m2 twice daily on day 1-14) plus oxaliplatin (intravenously, 130 mg/m2 on day 1); concurrent radiotherapy (a total dose of 45 Gy in 25 fractions) started on day 1 of chemotherapy. The operation was performed during 8-12 weeks after the neoadjuvant therapy, and both groups were treated with capecitabine (1000mg/m2 bid d1-14) for 6 cycles after operation. The main inclusion criteria were as follows: 18-70 year-old operable patients with locally advanced AEG; patients with negative HER-2 by IHC or FISH test; patients with Siewert Ⅱ or Ⅲ AEG diagnosed by gastroscopy; patients with clinical stage Ⅲ (according to the eighth edition AJCC stage); patients with 0-2 of ECOG performance status; measurable focus (according to RECIST1.1 standard) and organ function under the normal range. The primary endpoint was pCR rate, while the secondary endpoints included ORR, DCR, R0 resection rate and toxicity. Enrollment is currently ongoing. Clinical trial information: NCT03986385. Clinical trial information: NCT03986385. This study has been listed as a key project by Fourth Hospital of Hebei Medical University, and has given support and assistance. Thanks to all the staff involved in this study for their efforts. The authors. Has not received any funding.

This study aimed to investigate the efficacy and safety of concurrent neoadjuvant chemoradiotherapy (CRT) plus apatinib in treating locally advanced, HER2-negative, Siewert's type II-III adenocarcinoma of esophagogastric junction (AEG) patients. Thirty eligible patients were analyzed in this single-arm, open-label, phase II trial. Patients received neoadjuvant regimen as follows: two cycles of apatinib (orally, 250 mg/day on day 1-28), two cycles of capecitabine (orally, 1,000 mg/m2 twice daily on day 1-14), oxaliplatin (intravenously, 130 mg/m2 on day 1), and concurrent radiotherapy (a total dose of 45 Gy in 25 fractions) started on day 1 of chemotherapy. Then, surgery was performed within 8-12 weeks after the completion of neoadjuvant therapy. This trial was registered on the ClinicalTrials.gov website (access number: NCT03349866). After neoadjuvant CRT plus apatinib treatment, 18 (60.0%) patients achieved objective response, 29 (96.7%) patients achieved disease control, and 20 (66.7%) patients achieved down-staging. Encouragingly, tumor regression grade (TRG) 0, TRG 1, TRG 2 and TRG 3 were observed in 33.3%, 20.0%, 30.0% and 10.0% patients, respectively; the pathological complete response rate was 33.3%, and the R0 resection rate was 93.3%. Regarding survivals, the 1-year and 2-year progression-free survival rates were 96.7% and 88.1%, respectively. Meanwhile, the 1-year and 2-year overall survival rates were 100.0% and 96.6%, respectively. As to safety, the majority of the adverse events were of mild grade, and the post-operative complications were manageable. In conclusion, neoadjuvant CRT plus apatinib exhibits high efficacy and acceptable tolerance in patients with locally advanced, HER2-negative, Siewert's type II-III AEG.

OBJECTIVE:Nasopharyngeal carcinoma (NPC) is a common malignant tumour in Southeast Asia, especially in southern China. ABO blood groups have been proven to play an important role in many cancers. However, it is still controversial whether the ABO blood group has a definite relationship to susceptibility to NPC and the prognosis of NPC patients. This meta-analysis was performed to elucidate the correlation between ABO blood group and NPC to provide more data for clinical practice.METHODS:A systematic search was performed of the Chinese National Knowledge Infrastructure (CNKI), Wanfang, Web of Science, EMBASE, and PubMed databases up to December 31, 2020. Stata 11.0 statistical software was used for this meta-analysis.RESULTS:According to the inclusion and exclusion criteria, a total of 6 studies including 6938 patients with NPC were selected. Blood group O was relevant to Chinese NPC patients, and patients with blood group O had a significantly lower incidence of NPC, while blood group A had no correlation with susceptibility to NPC. There was no difference in the 3-year overall survival (OS), locoregional relapse-free survival (LRRFS) or distant metastasis-free survival (DMFS) rates between patients with blood group O and those with non-O blood groups; worse 5-year OS, LRRFS and DMFS rates were found in patients with blood group O, whereas blood group A was not related to prognosis.CONCLUSION:Blood group O in Chinese patients with NPC seems to be a protective factor for morbidity. However, once patients with blood group O are diagnosed with NPC, this blood group often indicates unfavourable OS, LRRFS and DMFS rates. It is recommended that more attention should be paid to the influence of blood group factor on patients in the treatment of NPC.

Objective:To investigate the value of radiotherapy in patients with stage Ⅳ B thoracic esophageal squamous cell carcinoma (ESCC) at initial diagnosis. Methods:A total of 199 patients with stage Ⅳ B thoracic ESCC at initial diagnosis (according to UICC/AJCC Eighth Edition Esophageal and Esophagogastric Junction Cancer TNM Staging) who were treated in the Fourth Hospital of Hebei Medical University between January 2010 to December 2016 were recruited. Winthin the whole group, 130 patients (65.3%) had distant lymph node metastases alone, 51 cases (25.6%) of solid organ metastases alone and 18 cases (9.0%) of solid organ complicated with distant lymph node metastases. Among them, 16 patients (8.0%) were treated with chemotherapy alone, 50 cases (25.1%) of radiotherapy alone, 133 cases (66.8%) of radiochemotherapy (81 patients treated with concurrent radiochemotherapy and 52 patients treated with sequential radiochemotherapy). The survival rate was calculated by Kaplan-Meier method and the difference was analyzed by log-rank test. Clinical prognosis was assessed by multivariate Cox regression model. Results:The median overall survival (OS) of the entire cohort was 12.3 months (95% CI: 10.6-15.4m), and the 1-, 2-, 3-and 5-year OS rates were 52.1%, 25.2%, 19.1%, and 11.5%, respectively. Multivariate analysis showed that tumor length, the number of metastatic organs, and treatment modalities were the independent prognostic factors for OS. There was no significant difference in OS between concurrent radiochemotherapy and sequential radiochemotherapy ( P=0.955). The OS of patients in the radiotherapy dose of ≥6000 cGy group was significantly longer than that of their counterparts in the 4500-5039 cGy and 5040-6000 cGy groups (both P<0.001). Conclusions:For stage Ⅳ B thoracic ESCC patients at initial diagnosis, tumor length ≤3cm, single organ metastasis, and radiochemotherapy strategy are significantly correlated with longer OS. For stage Ⅳ ESCC patients with good physical status, radiotherapy can be supplemented on the basis of systemic chemotherapy. Concurrent or sequential radiochemotherapy needs to be individualized. If patients are tolerable, radiochemotherapy is recommended to the primary tumor or non-regional metastatic lymph nodes, aiming to prolong the OS of patients.

Abstract Background Brain metastases (BM) from esophageal carcinoma (EC) is clinically rare and has not yet been reported in elderly patients. This study aimed to investigate the clinicopathological characteristics, outcomes and prognostic factors of BM in elderly patients with EC, in order to provide guidance for clinical practice. Methods A total of 20 EC patients older than 65 years who were diagnosed with BM were identified from the fourth Hospital of Hebei Medical University between January 1, 2009 and December 31, 2018. Survival was evaluated by the Kaplan–Meier method and Cox proportional hazards models. Results The median time from diagnosis of EC to BM was 11.8 months (0–249.2 months). The median overall survival (OS) was 4.8 months (1.13–23.3 months), with 20% of patients achieving the 1‐year survival rate. Patients with KPS score of ≥70 had a significantly better OS than those with KPS score<70 (8.4 vs. 3.9 months, p = 0.033). Compared to patients without brain radiotherapy, patients with brain radiotherapy showed better outcomes in both median OS (8.4 vs. 2.9 months) and 1‐year survival rate (23.1% vs. 14.3%, p = 0.043). The median OS of patients with radiotherapy combined with chemotherapy and/or targeted therapy and radiotherapy alone was 9.7 months (3.4–23.3 months) and 7.2 months (1.7–18.4 months), respectively, with no significant difference between the two groups (p = 0.215). Conclusions Brain radiotherapy provided clinically meaningful survival benefit for elderly patients with BM from EC. Thus, active treatments for those patients might be required.

Background: To investigate the effects and safety profile of radiation dose escalation utilizing computerized tomography (CT) based radiotherapy techniques (including 3-Dimensional conformal radiotherapy, intensity-modulated radiotherapy and proton therapy) in the definitive treatment of patients with esophageal carcinoma (EC) with definitive concurrent chemoradiotherapy (dCCRT). Methods: All relevant studies utilizing CT-based radiation planning, comparing high-dose (≥ 60 Gy) versus standard-dose (50.4 Gy) radiation for patients with EC were analyzed for this meta-analysis. Results: Eleven studies including 4946 patients met the inclusion criteria, with 96.5% of patients diagnosed with esophageal squamous cell carcinoma (ESCC). The high-dose group demonstrated a significant improvement in local-regional failure (LRF) (OR 2.199, 95% CI 1.487-3.253; P<0.001), two-year local-regional control (LRC) (OR 0.478, 95% CI 0.309-0.740; P=0.001), two-year overall survival (OS) (HR 0.744, 95% CI 0.657-0.843; P<0.001) and five-year OS (HR 0.683, 95% CI 0.561-0.831; P<0.001) rates relative to the standard-dose group. In addition, there was no difference in grade ≥ 3 radiation-related toxicities and treatment-related deaths between the groups. Conclusion: Under the premise of controlling the rate of toxicities, doses of ≥ 60 Gy in CT-based dCCRT of ESCC patients might improve locoregional control and ultimate survival compared to the standard-dose dCCRT. While our review supports a dose-escalation approach in these patients, multiple ongoing randomized trial initial and final reports are awaited to evaluate the effectiveness of this strategy.

The evidence of combining neoadjuvant chemoradiotherapy (CRT) and targeted therapy for adenocarcinoma of esophagogastric junction (AEG) is inadequate. The objective of this study was to investigate the efficacy and safety of neoadjuvant CRT with apatinib for HER-2 negative, Siewert type II and III AEG. Patients with resectable, locally advanced, HER-2 negative and Siewert type II or III AEG were enrolled. Patients received two cycles of apatinib (250 mg/day on days 1-28) and two cycles of capecitabine (1,000 mg/m2 twice daily on days 1-14) plus oxaliplatin (130 mg/m2 on day 1). Radiotherapy (45 Gy in 25 fractions) started on day 1 of chemotherapy. Surgery was performed within 8-12 weeks after completion of CRT. The primary endpoint was the pathological complete response rate (pCR). Clinical effects were assessed using the objective response rate (ORR), disease control rate (DCR), and R0 resection rate. (NCT03349866). Thirty-one patients were enrolled and 28 received surgery. One withdrew during the treatment and 2 developed metastases (1 hepatic and 1 peritoneal) after completing the neoadjuvant therapy. The ORR, DCR, R0 resection, pCR, near pCR were 60.0% (18/30), 96.7% (29/30), 93.3% (28/30), 33.3% (10/30), and 20.0% (6/30), respectively. The most common grade 3 events were leukopenia (16.7%), neutropenia (6.7%), nausea (6.7%), and vomiting (6.7%). There have been no grade 4 or 5 events. Neoadjuvant concurrent CRT and apatinib results in high R0 resection and pCR rates in patients with resectable HER-2 negative AEG with manageable safety. A randomized controlled trial in locally advanced AEG is ongoing (NCT03986385).

Target delineation of postoperative radiotherapy for the adenocarcinoma of the esophagogastric junction (AEG) is based on guidelines of esophageal carcinoma and gastric cancer, but there is still controversy. Some studies have demonstrated that AEG has a unique rule of lymph node metastasis and different clinical characteristics from esophageal and gastric cancer, the main basis of delineating of the target is typically on accordance with the drainage of the lymph node reported by surgical specimens. However, many factors can affect the recurrence pattern. It may be reasonable to design the clinical target volume (CTV) according to the rules of postoperative recurrence. This study aimed to investigate the patterns of local /regional recurrence and/or distant metastasis after radical surgery and its implication for the target delineation of prophylactic postoperative irradiation for locally advanced AEG patients. From January 2006 to December 2016, 157 AEG patients with local /regional recurrence and/or distant metastasis after R0 resection were analyzed retrospectively, including 66 (42.0%) and 91 (58%) with Siewert type II and III. There were 10, 51, 85 and 11 patients with pathological stage IIA, IIB, IIIA and IIIB, retrospectively. Surgery only was the treatment for 46 patients (29.3%), whereas 111 patients underwent adjuvant chemotherapy (70.7%). The most frequent treatment failure was the recurrence of local/regional lymph nodes site (52.2%, 82/157), then the distant metastasis outside abdomen (22.3%, 35/157). Peritoneum failure, liver metastasis, recurrence of anastomosis and remnant stomach accounted for 12.7% (20/157), 10.8% (17/157), 7.6% (12/157) and 5.7% (9/157), retrospectively. Among the patients with abdominal lymph nodes recurrence, the main locations were different from surgical specimen showing. It was more common in No.16a2 (52.2%), No.16b1 (37.3%), No.9 (23.9%), and No.16b2 (16.4%) areas compared to lymph node metastasis of original specimens, which were major located in areas of No.7 (76.9%), No.1/2 (75.2%), and No.3 (38.5%). The failure patterns of mediastinal lymph node were also different from postoperative pathological specimens. The main mediastinal recurrences after the surgery were located in No.2 (53.3%), No.4 (38.5%), and No.1 (20%) areas, which lymph node dissection did not need to be carry out ordinarily or were difficult to be operated. Local and regional lymph node recurrences in AEG patients after the surgery are different from the fields of high-risk lymph node metastasis suggested by postoperative pathology specimens. It occurs commonly outside the lymph node dissection areas due to unnecessary lymphadenectomy or difficulty in clearance. We suppose that the field of prophylactic postoperative radiotherapy design should refer to the high-risk area of postoperative recurrence appropriately, not lymph node drainage fields suggested from current NCCN guidelines.

Aim: To compare the clinical efficacy of neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) for esophageal cancer. Methods: Randomized controlled trials reporting on the comparison of nCRT and nCT for esophageal cancer were identified. Results: Three eligible randomized controlled trials were identified and included with a total of 375 patients (189 nCRT, 186 nCT). Outcomes showed that compared with nCT group, R0 resection and pathologic complete response (pCR) rates were significantly increased in nCRT group. However, no significant difference was seen in 3- and 5-year progression-free survival or 3- and 5-year overall survival. Conclusion: The addition of radiotherapy to neoadjuvant chemotherapy results in higher R0 resection rate and pCR rate, without significantly impacting survival.

Objective To analyze the clinical efficacy,toxicity and survival prognosis of patients diagnosed with Siewert type Ⅱ and Ⅲ locally advanced adenocarcinoma of esophagogastric junction (AEG) undergoing preoperative involved-field irradiation with concurrent chemotherapy. Methods A total of 45 cases were recruited in this prospective clinical trial. Prior to surgery, patients received 2 cycles of chemotherapy with XELOX and concurrent radiotherapy ( a total of 45 Gy in 25 fractions,5 times weekly). After 6-8 weeks,they underwent surgical resection. After the surgery,patients received 6 cycles of adjuvant chemotherapy. The completion of preoperative neoadjuvant chemoradiotherapy, postoperative pathological status,TNM down-staging effect and adverse reactions were observed. Kaplan-Meier method was applied to estimate survival analysis. Results All 45 patients completed preoperative neoadjuvant chemoradiotherapy. Among them, 39 patients completed 2 cycles of chemotherapy, and 6 patients completed 1 cycle of chemotherapy. The median time of surgical interval was 6 weeks. The R0resection rate was 96%.The pathological complete response (pCR) rate was 22%. The TNM down-staging rate was 69%.The incidence of acute radiation-induced esophagitis or gastritis was 44% and the incidence of radiation-induced pneumonitis was 7%. The incidence of grade 1-3 leukocytopenia,thrombocytopenia and neutropenia was 78%,47% and 44%,respectively. In terms of gastrointestinal reactions,the incidence of nausea,vomiting and loss of appetite was 62%,24% and 71%,respectively. No hematologic or nonhematologic adverse effects was observed at grade 4 or 5.The median follow-up time was 30 months. 11 patients died of cancer,1 patient was treatment-related death in the perioperative period and 1 patient died of pneumonia. The 1-,2-and 3-year progression-free survival (PFS) rates were 90%,70% and 67%,respectively. The 1-,2-and 3-year overall survival rates were 95%,80% and 75%,respectively. The 1-,2-and 3-year local control rates were 95%,84% and 84%, respectively. The 1-, 2-and 3-year distant metastasis rates were 7%, 25% and 25%, respectively. Conclusions Preoperative involved-field irradiation with concurrent chemotherapy yields relatively high clinical efficacy and is well tolerated by patients with Siewert typeⅡandⅢlocally advanced AEG.Patients are recommended to receive 4 cycles of adjuvant chemotherapy following neoadjuvant chemoradiotherapy and surgery.

Background Although a clinical complete response (cCR) after chemoradiotherapy (CRT) could lead to a better prognosis, the choice of a following strategy, such as surgical or non-surgical approach, remains controversial. Methods All articles relevant to a comparison of surgical and non-surgical treatment (including further definitive chemoradiotherapy or active surveillance) for esophageal carcinoma patients with a cCR after CRT were retrieved for meta-analysis. The final date for data retrieval was 30 June 2018. Results Four retrospective studies including 648 patients met the inclusion criteria: 620 with squamous cell carcinoma and 28 with adenocarcinoma. The CRT + surgery group had an advantage over the non-surgery group in regard to two-year disease-free survival (DFS); however, the two groups showed similar results in five-year DFS. The CRT + surgery group had an advantage over the non-surgery group in two-year overall survival (OS); nevertheless, the two groups showed similar results in five-year OS. Conclusions Based on the available evidence, the addition of surgery to thoracic locally advanced esophageal carcinoma patients with a cCR after neoadjuvant CRT provided no advantage to long-term survival. As an exception, the two-year DFS and OS could be improved. This research conclusion might be more suitable to patients with squamous cell carcinoma.

目的 程序性凋亡受体配体1(programmed death ligand-1,PD-L1)在多种肿瘤组织中存在过表达,然而关于其与食管鳞癌的研究尚不多见,本研究通过观察其在食管鳞癌石蜡组织中的表达情况,探讨其临床意义.方法 收集河北医科大学第四医院2011-01-01-2011-08-31行根治性手术切除且淋巴结清除≥12枚的90例食管鳞癌石蜡组织标本,采用免疫组化方法检测PD-L1阳性表达.分析PD-L1阳性表达与临床病理特征和预后的关系,并进行多因素分析.结果 PD-L1阳性表达率为30.0％(27/90),＜60岁组PD-L1阳性表达率为46.3％,高于≥60岁组16.3％,x2=9.576,P=0.002;淋巴结转移组PD-L1阳性表达率为41.3％,高于淋巴结阴性组26.1％,x2=5.726,P=0.017;Ⅰ期PD-L1阳性表达率为3.7％,Ⅱ期为29.6％,Ⅲ期为65.7％,组间差异有统计学意义,x2 =7.891,P=0.019.全组患者中位总生存时间(overall survival,OS)为49.7个月,中位无进展生存期(progression-free-surviva,PFS)为27.5个月.PD-L1阳性表达组1、3、5年OS为68.0％、36.0％和32.0％,PFS为57.7％、30.8％和30.8％;阴性表达组1、3、5年OS为89.3％、62.5％和53.6％,PFS为85.7％、53.6％和50.0％.二者差异有统计学意义,x2值分别为5.579和5.565,均P=0.018.PD-L1阳性表达与患者性别、病变位置、病变长度、T分期、肿瘤分化程度及脉管瘤栓情况均无相关.多因素分析显示,术后化疗为影响患者术后OS的独立影响因素(P=0.015),而淋巴结转移为影响患者术后OS(P＜0.001)及PFS(P=0.001)的独立危险因素.结论 食管鳞癌患者PD-L1阳性表达与年龄呈负相关,淋巴结阳性及pTNM分期较晚者PD-L1阳性表达率高.PD-L1阳性表达者预后差,术后化疗为影响患者术后OS的独立危险因素,而淋巴结转移是影响食管鳞癌患者术后OS和PFS的独立危险因素.

OBJECTIVE Esophageal adenoid cystic carcinoma is rare in clinic,and literatures are mostly case report or small sample cases,so far is still lack of systematic understanding of the disease.This study retrospectively analyzed the clinicopathological characteristics and diagnosis strategy of 22 esophageal adenoid cystic carcinoma,in order to provide a reference for clinical.METHODS The clinicopathological characteristics of esophageal adenoid cystic carcinoma,confirmed by surgical pathology specimens in the the fourth hospital of Hebei medical university from January 1,2004 to December 31,2013,were retrospectively analyzed.RESULTS The incidence rate of male with esophageal adenoid cystic carcinoma was more than that of female,and the ratio was 4.5 ∶ 1.Of which 4 cases were upper thoracic,Fourteen cases of middle and 4 cases were lower.Nineteen cases were in stage Ⅰ,2 cases in Ⅱ,1 case in Ⅲ.Preoperative endoscopic diagnosis rate was only 27.3％ (6/22),of which 11 cases were misdiagnosed as squamous cell carcinoma,4 cases as adenocarcinoma,1 case as adenosquamous carcinoma.The lymph node metastasis rate,degree of lymph node metastasis and incidence of lung metastasis were 9.1％ (2/22),0.9％ (2/229) and 27.3 (6/22),respectively.The 1,3 and 5 year survival rates in all cases were 90.9 ％,81.3 ％ and 65.1％.There was no significant difference in survival rate between comprehensive treatment after surgery and surgery alone (x2 =0.054,P=0.816).CONCLUSIONS The incidence rate of male with esophageal adenoid cystic carcinoma is higher than that of female.Most of whose locations are middle thoracic.Adenoid cystic carcinoma of the esophagus has a good prognosis,and the most treatment failure is pulmonary metastasis,postoperative comprehensive treatment still need to be studied further.

Objective To examine the effects of different pre-treatment nutritional status and inflammatory markers on acute adverse reactions in esophageal cancer patients during concurrent intensity-modulated radiation therapy (IMRT) and chemotherapy.Methods The acute adverse reactions of 338 eligible esophageal cancer patients who received concurrent IMRT and chemotherapy in our hospital from 2006 to 2014 were reviewed.The effects of different pre-treatment nutritional status, such as body mass index level (BMI), albumin level (ALB), total lymphocyte count (TLC), the presence or absence of anemia, and inflammatory indicators including neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR), on acute adverse reactions in the patients were examined.Data were analyzed using the chi-square test with continuity correction and logistic regression analysis.Results The incidence rate of malnutrition in the patients based on their nutritional status was 5.62%-54.14%.The incidence rate of grade≥2 acute radiation esophagitis (RE) was significantly higher in the low ALB group than in the normal ALB group (P=0.000).The incidence rate of adverse reactions in the hematologic system increased as TLC decreased (P=0.006), but the incidence rate of acute radiation pneumonitis (RP) was reduced as TLC decreased (P=0.001).In addition, the incidence rate of grade ≥2 acute RE was significantly higher in the anemia group than in the non-anemia group.Inflammatory marker analysis demonstrated that the incidence rate of acute RE was significantly higher in the high NLR group and high PLR group than in the low NLR group and low PLR group (P=0.000 and P=0.024, respectively).Logistic regression analysis of nutritional status and inflammatory markers showed that TLC was an independent risk factor for acute adverse reactions in the hematologic system (P=0.001), and ALB and PLR were independent risk factors for acute RE (P=0.017 and P=0.011,respectively).Conclusions Nutritional status and inflammatory markers are associated with concurrent chemoradiotherapy-induced acute adverse reactions in esophageal carcinoma patients, and hence may be valuable indicators of acute adverse reactions during treatment.In addition, nutritional treatment and support care should be actively provided to the patients to prevent the development of acute adverse reactions during treatment.

To evaluate the influence on acute toxicity with different nutrition status and inflammatory indexes ofthe patients after concurrent chemoradiotherapy in esophageal carcinoma. A total of 338 cases of esophageal carcinoma who underwent intensity modulated radiation therapy (IMRT)with concurrent chemotherapy were eligible for retrospectively analysis. The influence on acute toxicity with different nutrition status such as body mass index level (BMI), albumin level (ALB), total lymphocyte count level (TLC), anemia and inflammatory indexes including neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were observed after the treatment. The incidence rate of malnutrition according to different nutrition status was ranging from 5.62% to 54.14%. The incidence of acute radiation esophagitis of grade 2 and above in low ALB group were higher than that in normal ALB group (χ2=75.677，P=0.000). The incidence of hematologic toxicity among different TLC levels had statistical difference significantly. With the decline of TLC level, the incidence of hematologic system toxicity was increased (χ2=12.891，P=0.006), but the rate of acute radiation pneumonitis was decreased (χ2=19.775，P=0.001). The incidences of acute radiation esophagitis of grade 2 and above in anemia group were much higher than that in normal group (χ2=37.774, P=0.000). An higher incidence of acute radiation esophagitis was shown in NLR and PLR high level groups than in lower NLR and PLR groups (χ2=64.207, P=0.000; χ2=11.260, P=0.004). Accompanied by NLR and PLR levels elevate,the rate of acute radiation esophagitis is ascendant, where as the rate is decendant with ALB and Hb levels decline. The occurrence of hematologic system toxicity will increases and acute radiation pneumonitis decreases when TLC levels goes down.

postoperative pathological examination results and radiotherapy toxicities. Results All the 45 patients completed preoperative concurrent chemoradiotherapy and surgery, with two cycles of chemotherapy in 39 patients and one cycle in 6 patients. The rates of R0resection and pathological complete response(pCR) were 95.6%(43/45)and 22.2%(10/45), respectively. There were 10(22.2%), 17(37.8%), 15 (33.3%),and 3(6.7%)patients with tumor regression grades 0,1,2,3,respectively. The rate of lymph node metastasis was 37.8%(17/45),and the lymph node ratio was 4.33%(46/1 062). The postoperative pathological examination showed that T and N downstaging after surgery was observed in 24 and 26 patients, respectively;the proportions of patients with T3-T4tumors and positive lymph nodes after surgery declined by 51.1%(P=0.000)and 42.2%(P=0.000), respectively. The overall incidence of radiation esophagitis/gastritis was 44.4%(20/45), and the incidence rates of grade 1, 2, and 3 radiation esophagitis/gastritis were 18%,22%,and 4%,respectively. The incidence of acute radiation pneumonitis was 6.7%(3/45), all in grades 1 and 2. There was one perioperative treatment-related death. Conclusions Two cycles of XELOX chemotherapy combined with concurrent 45 Gy radiotherapy before surgery in patients with locally advanced Siewert type Ⅱ and Ⅲ AEG can achieve a relatively high pCR rate,effectively reduce the lymph node metastasis rate, achieve downstaging, and increase R0resection rate. This regimen has many good advantages,including low incidence of acute toxicities,good tolerability,and acceptable rate of perioperative treatment-related deaths. The target volume delineation involving metastatic lymph nodes is feasible.

OBJECTIVE Polyethylene glycol recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF) has a long half-life in vivo,which can effectively prevent and cure neutropenia caused by concurrent chemoradiotherapy and has more advantages than rhG-CSF in curative effect.However,due to the short clinical time of the application of PEG-rhG-CSF,there are very rare studies on whether rhG-CSF can further reduce the severity of bone marrow suppression and shorten the recovery time.To compare the effectiveness of Pegylated recombinant human granulocyte-colony stimulating factor (PEG-rhG-CSF) combining with rhG-CSF and simple application of PEG-rhG-CSF on the treatment of Grade Ⅲ-Ⅳ neutropenia after concurrent radiochemotherapy of malignant tumor,providing the basis for clinical rational application.METHODS A total of 52 malignant tumor patients with concurrent chemoradiotherapy-induced neutropenia treated in the Fourth Hospital of Hebei Medical University from April 1,2014 to June 31,2016 were retrospectively analyzed.52 cases were divided into monotherapy group (n=9) and combination therapy group (n=43).Among those 34 cases who had Grade Ⅲ neutropenia,4 of them accepted one-time subcutaneous injection of 3 mg PEG-rhG-CSF,while the remaining 30 cases accepted subcutaneous injection of 3 mg PEG-rhG-CSF combining with subcutaneous injection of rhG-CSF once a day.Among those 18 cases who had Grade Ⅳ neutropenia,5 of them accepted one-time subcutaneous injection of 3 mg PEG-rhG-CSF,while the remaining 13 cases accepted subcutaneous injection of 3 mg PEG-rhG-CSF combining with subcutaneous injection of rhG-CSF once a day.For the combination group,daily subcutaneous infection of rhG-CSF continued for until the absolute neutrophil count (ANC) recover to ≥2.0 × 109 L-1.The absolute counting of neutrophils,proliferation rate of neutrophils,and the time required for neutrophils to recover to ≥2.0 × 109 L-1 were analyzed at different time period (24-48 h,72-96 h after medication) after rescuing treatment for patients in each group.METHODS Retrospective analysis was conducted on 52 malignant tumor patients with Grade-Ⅳ neutropenia caused by concurrent radiochemotherapy.Among those 34 cases who had Grade Ⅲ neutropenia,4 of them accepted one-time subcutaneous injection of 3mg PEG-rhG-CSF,while the remaining 30 cases accepted subcutaneous injection of 3 mg PEG-rhG-CSF combining with subcutaneous injection of rhG-CSF once a day.Among those 18 cases who had Grade Ⅳ neutropenia,5 of them accepted one-time subcutaneous injection of 3mg PEG-rhG-CSF,while the remaining 13 cases accepted subcutaneous injection of 3mg PEG-rhG-CSF combining with subcutaneous injection of rhG-CSF once a day.For the combination group,daily subcutaneous infection of rhG-CSF continued for until the absolute neutrophil count (ANC) recover to≥2.0× 109 L-1.The absolute counting of neutrophils,proliferation rate of neutrophils and the time required for neutrophils to recover to ≥2.0 × 109 L-1 were analyzed at different time period(24-48 h,72-96 h after medication) after rescuing treatment for patients in each group.RESULTS The absolute counting of neutrophils at 24-48 hours after salvage treatment in each group was (5.86±8.31) × 109 L-1 and (4.99±5.80) × 109 L-1,respectively (P=0.94).While the absolute counting of neutrophils at 72-96 hours after salvage treatment in each group was (7.05±6.19) × 109 L-1 and (9.29±8.07) × 109 L-1,respectively (P=0.52).The neutrophil proliferation rate in each group was (125.00±162.10) × 109 L-1 and (260.50±391.13) × 109 L-1 respectively (P=0.42).For the recovering time,there was no difference between the monotherapy treatment group and combination treatment group [(69.33 ± 51.54) h vs (63.07±42.88) h,P=0.71].Subgroup analysis showed that there was no significant difference between patients with Grade Ⅲ neutropenia and Grade Ⅳ neutropenia in the absolute counting of neutrophils,proliferation rate of neutrophils and the recovering time (P＞0.05).CONCLUSION Signal application of PEG-rhG-CSF can effectively alleviate Grade Ⅲ -Ⅳ neutropenia induced by concurrent radiochemotherapy,and ensure the patients can be treated with a full dose of antitumor therapy,while reducing the supplemental dose of rhG-CSF.

To analyze the feasibility of involved-field irradiation (IFI) in patients with locally advanced adenocarcinoma of gastroesophageal junction (AEG) in Siewert's type II and III underwent preoperative concurrent chemoradiotherapy. A total of 45 cases were involved into this study. Patients received two cycles of chemotherapy with XELOX and concurrent radiotherapy (45Gy/25f, five fractions per week). After 6 to 8 weeks, they underwent operation. Patients were filled with 800 to 1000 ml water before CT simulation, and more than 5mm of stomach wall on the CT images was delineated as GTV-primary, with the reference of upper gastrointestinal barium meal, esophagus endoscopy, and MRI simultaneously. CTV provided a proximal margin of 2.0cm and distal margin of 1.5 to 2.0cm and radial of 0.8cm around the GTV-primary. GTV-nd was drawn on each relevant slice of the planning CT, and we just regarded GTV-nd and its involved area of metastasis (IFI) as CTV-nd. PTV was defined as 0.8 to 1.0cm of external expansion. The feasibility of IFI was analyzed via the postoperative pathology response and toxicity of chemoradiotherapy. Of the 45 patients, 39 completed preoperative concurrent chemoradiotherapy (CCRT), 6 underwent one cycle of chemotherapy with irradiotherapy. The R0 resection rate was 93.3% (42/45). The rate of pathological complete response (pCR) was 22.2% (10/45). The patients with tumor regression grade 0 to grade 3 were 10 (22.2%), 17 (37.8%), 15 (33.3%), 3 (6.7%), respectively. The lymph node metastasis rate and ratio were 37.8% (17/45) and 4.3% (46/1062). After neoadjuvant chemoradiotherapy, down-staging of T and N were observed in 24 and 26 patients, respectively. The proportion of pathological of stage T3∼4 had a decline by 51.1%, N positive by 42.2%, and stage III-IV by 37.8% (c2=30.896, P=0.000, c2=16.568, P=0.000, c2=17.822, P=0.000). The incidence of esophagitis/gastritis was 44.4% (20/45), and grade 1-3 were 17.8%, 22.2%, 4.4%, respectively. The rate of grade 1-2 pneumonitis was 6.6% (3/45). One patient died of treatment toxicity. A total dose of 45Gy irradiation with concurrent 2 cycles of XELOX regiment before surgery for locally advanced AEG with Siewert's type II and III could achieve a preferable pCR and higher R0 resection. The rate of lymph node metastasis is decreased obviously, as well as T and N stage. In addition to mild toxicity, concurrent chemotherapy with IFI is worthy to be studied further.