目的:通过比较联合应用红外定位系统(optical positioning system,OPS)、锥形束计算机断层扫描(cone beam computed tomography,CBCT)和单纯应用CBCT在颈胸膜固定方式下在食管中下段癌放射治疗中的摆位误差,探讨OPS的临床应用价值.方法:选择病理及影像学明确诊断食管中下段癌患者20例,分为单纯CBCT验证(对照组)及联合OPS、CBCT验证(观察组).对每例患者在首次放射治疗时通过加速器上的激光灯进行摆位,先行千伏级CBCT扫描,后在同一体位下,通过调整患者体位使红外激光十字线与体表标记线对齐且使机房内OPS实时监控数据均在3 mm以内再行CBCT扫描,从而采集和比较每例患者在OPS和CBCT不同引导技术下摆位误差数据,采用SPSS 26.0软件进行统计处理.结果:对照组和观察组患者在X、Y、Z轴方向上的摆位线性误差分别为(0.21±0.03)、(0.39±0.05)、(0.18±0.04)cm和(0.09±0.91)、(0.17±0.03)、(0.15±0.02)cm.两种验证方式在Z(腹背方向)方向摆位误差差异无统计学意义(P>0.05),在X(左右方向)及Y(头脚方向)方向摆位误差差异有统计学意义(P<0.05).结论:食管中下段癌患者使用颈胸热塑膜配合OPS技术可有效提高患者放疗中左右方向及头脚方向的摆位精确性,对于提高食管中下段癌颈胸膜摆位的精度及放射治疗工作效率具有较高的临床应用价值.

Objective To retrospectively study the short-term efficacy of bevacizumab in the treatment of patients with refractory cerebral edema. Methods The clinical data of 16 patients with refractory cerebral edema treated with bevacizumab from November 2020 to November 2022 in the head and neck radiotherapy department of Nantong Tumor Hospital were analyzed. including 5 cases of lung cancer brain metastasis, 9 cases of glioblastoma and 2 cases of rectal cancer. All patients were insensitive to conventional osmotic diuretics, diuretics, corticosteroids and other treatments. Bevacizumab was administered at a dose of 5 mg/kg Repeating every 3 to 4 weeks, receiving at least one treatment. The edema around the tumor and the tumor volume were measured before the first drug, two months after the drug, and four months after the drug, and the edema index was calculated. The clinical symptoms and adverse reactions of patients before and after treatment were recorded. Results After treatment, the increased intracranial pressure in all patients was improved compared with that before the treatment. The edema index of all patients at 2 months and 4 months after treatment were significantly lower than that before the treatment (P ＜ 0.05). There were no obvious serious adverse reactions during the treatment. Conclusion Bevacizumab can effectively control intractable peritumoral edema, relieve clinical symptoms, and improve the quality of life of patients, providing a new idea for the treatment of brain malignant tumors accompanied by peritumoral brain edema.

Importance Most older patients with esophageal cancer cannot complete the standard concurrent chemoradiotherapy (CCRT). An effective and tolerable chemoradiotherapy regimen for older patients is needed. Objective To evaluate the efficacy and toxic effects of CCRT with S-1 vs radiotherapy (RT) alone in older patients with esophageal cancer. Design, Setting, and Participants A randomized, open-label, phase 3 clinical trial was conducted at 23 Chinese centers between June 1, 2016, and August 31, 2018. The study enrolled 298 patients aged 70 to 85 years. Eligible participants had histologically confirmed esophageal cancer, stage IB to IVB disease based on the 6th edition of the American Joint Committee on Cancer (stage IVB: only metastasis to the supraclavicular/celiac lymph nodes) and an Eastern Cooperative Oncology Group performance status of 0 to 1. Data analysis was performed from August 1, 2020, to March 10, 2021. Interventions Patients were stratified according to age (<80 vs ≥80 years) and tumor length (<5 vs ≥5 cm) and randomly assigned (1:1) to receive either CCRT with S-1 or RT alone. Main Outcomes and Measures The primary end point was the 2-year overall survival rate using intention-to-treat analysis. Results Of the 298 patients enrolled, 180 (60.4%) were men. The median age was 77 (interquartile range, 74-79) years in the CCRT group and 77 (interquartile range, 74-80) years in the RT alone group. A total of 151 patients (50.7%) had stage III or IV disease. The CCRT group had a significantly higher complete response rate than the RT group (41.6% vs 26.8%; P = .007). Surviving patients had a median follow-up of 33.9 months (interquartile range: 28.5-38.2 months), and the CCRT group had a significantly higher 2-year overall survival rate (53.2% vs 35.8%; hazard ratio, 0.63; 95% CI, 0.47-0.85; P = .002). There were no significant differences in the incidence of grade 3 or higher toxic effects between the CCRT and RT groups except that grade 3 or higher leukopenia occurred in more patients in the CCRT group (9.5% vs 2.7%; P = .01). Treatment-related deaths were observed in 3 patients (2.0%) in the CCRT group and 4 patients (2.7%) in the RT group. Conclusions and Relevance In this phase 3 randomized clinical trial, CCRT with S-1 was tolerable and provided significant benefits over RT alone in older patients with esophageal cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02813967.

目的:探讨两种不同体位固定技术对胸腹部肿瘤放疗重复摆位精度的影响.方法:60例需行放疗的胸腹部肿瘤患者按随机数字法分为对照组:翼形板+真空垫固定体位(30例);观察组:改良式体位固定技术即热塑体膜联合体板+真空垫组(30例).所有患者首次放疗前行CBCT扫描,以后每周扫描一次,比较两组X轴(左右)、Y轴(头脚)和Z轴(腹背)方向的摆位误差值.结果:对照组X轴、Y轴和Z轴方向上摆位误差分别为(4.03±0.15)mm、(3.62±0.23)mm和(3.74±0.31)mm.观察组X轴、Y轴和Z轴方向上摆位误差分别为(3.91±0.29)mm、(3.54±0.34)mm和(2.86±0.20)mm.两组在Z轴方向的摆位误差比较差异具有统计学意义(P<0.05).结论:改良式体位固定技术可以改善胸腹部肿瘤患者放疗时摆位的舒适度,利于体位的固定,提高患者治疗时摆位的重复性和精度.

目的:探讨EB病毒编码的小mRNA(EBV-encoded small RNAs,EBER)、Ki67、B淋巴细胞瘤-2(B cell lymphoma-2,Bcl2)在鼻腔NK/T淋巴瘤中的表达、与临床病理特征及放疗敏感性的关系.方法:选取鼻腔NK/T淋巴瘤患者45例作为研究对象,采用原位杂交法检测放疗前EBER表达情况,免疫组化法检测Ki67、Bcl2的表达情况,并分析EBER、Ki67、Bcl2的表达与病理特征及放疗敏感性的关系.结果:45例鼻腔NK/T淋巴瘤组织中EBER、Ki67及Bcl2阳性表达34例(75.6％)、39例(86.7％)和38例(84.4％),且3者之间两两呈正相关关系(P<0.05).EBER、Ki67及Bcl2在不同性别、年龄患者之间表达差异无统计学意义(P>0.05),在不同临床分期、有无B症状和颈淋巴结侵犯的患者中表达差异有统计学意义(P<0.05).EBER、Ki67及Bcl2阳性表达患者的放疗疗效均低于阴性表达者(均P<0.05).结论:EBER、Ki67、Bcl2可作为鼻腔NK/T淋巴瘤患者放射治疗敏感性和预后的评价指标,为患者采取针对性的放疗方法提供理论基础.

目的:研究鼻咽癌放疗后发生远处转移的规律,并分析其影响因素,以指导临床治疗方案的制定.方法:回顾性分析2012年1月—2017年12月南通市肿瘤医院收治的初治无远处转移鼻咽癌371例患者的临床资料,根据鼻咽癌第8版UICC/AJCC临床分期标准进行分期,采用Kaplan-Meier法计算无远处转移生存率,Logrank对生存率进行差异性检验,采用Cox模型进行单因素和多因素分析.结果:Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分别为24例(6.47％)、115例(31.0％)、184例(49.6％)、48例(12.9％);远处转移56例(15.1％),其中Ⅱ期转移6例(5.22％),Ⅲ期转移38例(20.7％),Ⅳ期转移12例(25.0％);单因素分析及多因素分析结果显示T、N分期、淋巴结包膜侵犯、咽后淋巴结转移是无远处转移生存率的影响因素.结论:T、N分期越晚、咽后淋巴结转移及出现淋巴结包膜侵犯是鼻咽癌患者放疗后发生远处转移的高危因素,需要探讨更有效的干预治疗模式.

Objective:To observe the therapeutic effect of large dose fraction radiotherapy on locally advanced non-small cell lung cancer (NSCLC),and to explore the changes of serum levels of EGFR and TGF-α before and after radiotherapy and its clinical significance.Methods:Seventy patients with locally advanced NSCLC were selected in the Department of Radiotherapy in the hospital from July 2011 to July 2016.They were divided into conventional frac-tion radiotherapy group (prescription dose PTV 60 Gy/30 f,a single dose 2 Gy)and large dose fraction radiotherapy group (prescription dose of PTV 50 Gy /10 f,a single dose of 5 Gy).The efficacy was observed in two groups after the treatment,and the expression levels of epidermal growth factor receptor (EGFR)and transforming growth factor-α (TGF-α)of patients were analysed by radioimmunoassay and enzyme-linked assay.Results:The effective rate and stability rate of thoracic lesions in large dose fraction radiotherapy group were 75.00% and 85.00%,respective-ly,which were significantly higher than those in conventional fraction radiotherapy group (68.00% and 80.00%,P＜0.05).Hypo-fractionated radiotherapy group and conventional radiotherapy group before treatment of serum EGFR,TGF-α content was respectively (24.31 ± 4.06)μg/L,(26.30 ± 2.16)μg/L and (24.42 ± 4.04)μg/L,(25.96 ± 2.24)μg/L,the two groups had no significant difference (P＞0.05),two groups after treatment of serum EGFR,TGF-α content was respectively (12.11 ± 3.58)μg/L,(14.13 ± 1.72)μg/L and (14.31 ± 3.64)μg/L,(18.25 ± 1.65)μg/L,there were statistically significant difference (P＜0.05).Conclusion:In the large dose fraction ra-diotherapy group,there was a higher control rate than the conventional radiotherapy group without increasing the side effects,which might be associated with the down regulation of EGFR and TGF-α levels in patients＇serum.Therefore,large-segment radiotherapy is expected to be a new choice for radiation dose partitioning in patients with locally ad-vanced NSCLC.

Objective To study the relationship between epidermal growth factor receptor (EGFR), transforming growth factor-α (TGF-α) and different fractional doses of radiotherapy in lung cancer cells and its possible mechanism. Methods Lung cancer cell line A549 cells were irradiated with conventional fractionation (2Gy/day) and large fractionation (4, 8 Gy/day), DT = 8 Gy. Realtime fluorescence quantitative PCR (QPCR), enzyme-linked immunosorbent assay (ELISA) and Western blotting were used to detect EGFR, TGF-α gene and protein expression in A549 cells, respectively. In addition, the expression of γ-H2 AX was determined by immunofluorescence assay. Results The expression levels of EGFR mRNA and TGF-α mRNA in A549 cells of 4 Gy/day and 8 Gy/day fractionation groups were significantly lower than those of 2 Gy/day fractionation group (P＜0. 05). The expressions of EGFR and TGF-α proteins in A549 cells of 4 Gy/day and 8 Gy/day fractionation groups were significantly lower than those of 2 Gy/day fractionation group (P＜0. 05). Immunofluorescence assay showed that the expression ofγ-H2 AX in A549 cells in 4 Gy/day and 8 Gy/day fractionation groups was significantly higher than that in control group and 2 Gy/day fractionation group. Conclusion The expression of EGFR and TGF-α decreased significantly after high dose fractionated radiotherapy, which increased the sensitivity of A549 cells to radiation.The mechanism may be related to the up-regulation of the expression of histone γ-H2 AX in DNA damage repair.

目的:探讨放疗联合替吉奥同步化疗对老年食管癌的近期效果.方法:老年食管癌患者47例,随机分为单纯放疗组23例和同步放化疗组24例.两组均采用调强放疗,同步放化疗组放疗处方剂量为54 Gy/30次,同时口服替吉奥胶囊70 mg/m2,d1～d14,共2个周期.单纯放疗组放疗处方剂量为60 Gy/30次.结果:同步放化疗组总有效率87.5％,高于单纯放疗组的60.9％,差异有统计学意义(P=0.044).两组毒副反应主要表现为放射性肺炎、放射性食管炎、血液学毒性、胃肠道反应,两组比较差异无统计学意义(P>0.05).结论:放疗联合替吉奥同步化疗治疗老年食管癌患者的近期临床疗效较好,毒副反应可控制.

Objective To compare the influence of two different position fixation techniques on the setup error of radiotherapy towards breast cancer patients after modified radical mastectomy.Methods Fifty breast cancer patients,who had taken modified radical mastectomy and were receiving adjuvant radiotherapy,were included in the study.Patients were randomly divided into two groups:25 cases in the wing plate and vacuum cushion fixed position group,and 25 cases in the head and neck shoulder thermoplastic membrane fixed position group.In the course of treatment,5 setup errors were measured by cone beam CT (CBCT) for each patient and 250 sets of CT data were obtained.CBCT scan images and planning CT images were automatically bone marked by X-ray volume image (XVI) software,and the setup error values in the threedimensional translation direction (X,Y,Z) and rotational direction (ROLL,PITCH,YAW) were compared.Results For the wing plate and vacuum cushion fixed position group,the setup errors in the center of the X-axis (left-right),Y-axis (cranial-caudal) and Z-axis (anterior-posterior) directions were (2.20 ± 1.65) mm,(2.95 ± 2.10) mm and (2.37 ± 2.14)mm,respectively.The set up errors in ROLL,PITCH and YAW directions were(1.25 ± 0.96)°,(0.45 ± 0.53) ° and(0.61 ± 0.52) °,respectively.For the head and neck shoulder thermoplastic membrane fixed position group,the setup error in the center of the X-axis (left-right),Y-axis (cranial-caudal) and Z-axis (anterior-posterior) directions were (2.29±1.89)mm,(2.49±l.79)mm and (1.67 + 0.95)mm,respectively.The set up errors in ROLL,PITCH and YAW directions were (0.81 ± 0.92) °,(0.43 ± 0.51) ° and (0.53 ± 0.64) °,respectively.Statistically significant differences were found for the setup errors of the two groups in both the Z-axis and ROLL direction (P ＜ 0.05).Conclusion For breast cancer patients after modified radical mastectomy,position fixation with head and neck shoulder thermoplastic membrane can improve the setup repeatability,reduce the setup error,and enhance the setup accuracy during radiotherapy.

Objective:To evaluate the accuracy of different body immobilization methods of radiotherapy for esophageal carcinoma was studied by using the cone-beam CT(CBCT) method.Methods:A total number of 30 esophageal cancer patients were randomly assigned into 2 groups(vacuum pad group,wing panels+vacuum pads group) for immobilization,cone beam CT(CBCT) scan was adopted in each patients.XVI software to CBCT scan images and CT images were automatically registered.Setup errors of CBCT were calculated according to its matched and planned CT images in left-right(X),superior-inferior(Y) and anterior-posterior(Z) directions.Paired t-test was used to evaluate the differences.Results:In the vacuum pad group,the set-up errors of CBCT in the X,Y,Z axis were X(2.19±1.62) mm,Y(2.92±2.13) mm and Z(2.83±2.17) mm,respectively.In the wing panels + vacuum pads group,the set-up errors of CBCT in the X,Y,Z axis were X(1.89±0.83) mm,Y(2.33±1.29) mm and Z(1.54±0.93) mm,respectively.The difference between the two groups was statistically significant(P<0.05).Conclusion:The combination of the wing plate and the vacuum pad immobilization technique can further reduce the position error of esophageal carcinoma,and better reflect "three fine" radiotherapy.

Objective To investigate the value of PET?CT image fusion to delineate the target of intensity modulated radiation therapy( IMRT) in locally advanced non?small cell lung cancer( NSCLC) , and the impact on target volume and dose of normal lung tis?sue. Methods Thirty NSCLC patients of clinical stageⅢA andⅢB were randomly selected. Target and organ at risk were delineated on the same fixed position according to enhanced CT images and fusion images of PET/CT and CT, respectively. Then the volume of gross tumor volume( GTV) and planning target volume( PTV) under these two status were compared. Moreover, the percent of the total lung volume exceeding 5 Gy( V5 ) , percent of the total lung volume exceeding 20 Gy( V20 ) , mean dose of lung irradiated( MLD) in two different conformal IMRT plans were observed when the dosage of PTV was up to 60 Gy/30 f. Results The GTV volume on fusion im?ages of PET?CT/CT was (248?39±94?80)cm3, less than (311?22±99?16)cm3 on the enhanced CT images in 30 cases. The difference was statistically significant(P<0?05). PTV, extended from GTV, in fusion images of PET?CT/CT was (356?68±92?73) cm3, while in the enhanced CT images were (433?58±107?89 cm3) with significant difference(P<0?01). The V5, V20 and MLD of whole lung in the two plans were compared. In fusion images of PET?CT/CT program, V5, V20 and MLD was (51?26±10?50)%, (25?71±5?17)% and (1595?27±148?24) cGy, remarkly less than (56?41±9?55)%, (29?09±4?10)% and (1693?59±100?60) cGy in the enhanced CT program with significant difference( P<0?05) . Conclusion Application of PET?CT/CT fusion image to delin?eate the targets of IMRT can improve the accuracy of target delineation volume and reduce the dose of normal lung tissues.

目的：分析食管癌放疗后食管瘘形成因素，探讨减少放疗后食管瘘形成的措施。方法：对32例放疗后食管瘘形成病例予以回归性分析。结果：单因素分析表明：溃疡型病灶、营养状况差、病灶外侵者，肿瘤残留、联合化疗、单独较大高剂量体积的患者放疗后易形成食管瘘。多因素分析显示放疗后食管瘘形成的高危因素依次为：肿瘤大体类型、肿瘤外侵范围、是否联合化疗、高剂量体积、肿瘤残留、营养状况。结论：溃疡型、髓质型、肿瘤外侵范围广、联合化疗、单独高剂量体积较大、肿瘤残留、营养状况差与放疗后食管瘘形成关系密切，可采取相关措施减少放疗后食管瘘发生。

Objective To compare the short_term effects of Paclitaxel∕ Nedaplatin and Cisplatin∕ 5_Fu on weekly concomitant chemoradiotherapy of advanced esophageal cancer. Methods Thirty_six patients with advanced esophageal cancer were divided into TN group(radiation with weekly concurrent chemotherapy of Paclitaxel∕ Nedaplatin)and PF group(radiation with weekly concurrent chemotherapy of Cisplatin∕ 5_Fu). The short_term effects at the end of the radiotherapy and 3 months after radiotherapy were observed. Results ①At the end of radiotherapy,the overall response rate in TN group and in PF group was 88. 89% and 86. 11% . At 3 months after the end of radiotherapy,the overall response rate of the group and the PF group was 91. 67% and 69. 44% . The complete remisson rate of TN group and in PF group was 38. 88% and 25. 00% . The complete remission rate of two groups was 69. 44% and 44. 44%(p ﹦ 0. 032). ②Incidences of peripheral nerves toxicities and leucopenia in TN group were higher than those in PF group,while the patients’physical function,role function,emotional function,social function,general health status were better than those in PF group,and treatment symptoms such as fatigue,nausea,vomiting,anorexia and consti_pation in TN group were less frequent in TN group than in PF group. Conclusion At 3 months after radiotherapy,radiation with weekly concurrent chemotherapy of Paclitaxel∕ Nedaplatin significantly improves the overall responses and the complete remis_sions,and reduces the impacts on quality of life at the same time.

目的 观察经皮肝胆管穿刺引流术(PTCD)联合调强放疗(IMRT)治疗恶性梗阻性黄疸(MOJ)的疗效.方法 采用TCD联合IMRT治疗MOJ对照既往实施常规PTCD的患者,观察并比较二者疗效.结果 观察组36例血清总胆红素(T-BiL)在PTCD治疗后1周明显下降,IMRT治疗结束1个月后持续下降;经IMRT治疗后肿瘤总有效率72.22％;PTCD联合IMRT组6个月、1年、2年累积生存率分别是77.78％、55.56％和11.11％,明显高于既往单纯行PTCD的生存率(57.14％、23.81％、0％)(P＜0.05).2组的中位生存时间分别为18个月和9.2个月(P＜0.05).结论 PTCD联合IMRT治疗MOJ安全有效,明显缓解黄疸和疼痛症状,从而提高患者的生活质量.

Objective To investigate the impact of three-dimensional conformai radiotherapy using two-process plan on V20 and the incidence of radioactive pneumonia (RP) in patients with locally advanced esophageal cancer. Methods Forty patients with locally advanced esophageal cancer undergoing three-dimensional conformai radiotherapy were randomly assigned to use one-process plan (group A, n - 20) or two-process plan (group B, n = 20). First CT positioning was performed before inducth e chemotherapy in all patients. For patients in group A an entire dose of 66 Gy was given. For patients in group B, when the dose reached 46 Gy, the second row CT positioning was performed and the two CT images were fused; the late course conformai planning was formed and 20 Gy dose was prescribed with a total dose of 66 Gy. The V20 was calculated and the incidence of RP over three months was documented in two groups. Results The overall incidence of RP was 22.5% (9/40), including 7 cases in group A (35.0%) and 2 cases in group B (10. 0%). There was significant difference in bilateral lung V20 between two positionings (P <0.05), but no difference in bilateral lung average illuminated dose (P >0.05). Conclusion Adoption of two-process plan for conformai radiotherapy can reduce lung V20 and incidence of radiation-induced lung injury for patients with locally advanced esophageal cancer.

Objective To investigate the clinical efficacy of postoperative temozolomide combined with three dimensional conformal radiation therapy(3DCRT) in high grade gliomas.MethodsData of 30 cases with high grade gliomas were retrospectively analyzed,who after operation were divided into two groups of A(20 cases,treated with temozolomide combined with 3DCRT) and B(10 cases,treated with 3DCRT alone).The short-term clinical efficacy and survival rate were compared.Results The short-term complete remission rate and 1-and 2-year survival rates in group A were 75%(15/20),70%(14/20) and 45%(9/20),respectively,which were higher than 40%(4/10),40%(4/10)and 20%(2/10) in group B(P0.05).Conclusion Temozolomide combined with 3DCRT is better than 3DCRT alone in treating human high grade gliomas after surgery.

Objective To observe the curative effect of three dimensional conformal radiation therapy(3DCRT) plus TP regimen chemotherapy in the treatment of mediastinal lymph node metastasis after operation of esophagus cancer.Methods Eighty four cases with mediastinal lymph node metastasis after operation of esophagus cancer were divided randomly into two groups:42 cases were treated with 3DCRT(named A group) ;another 42 cases with 3DCRT combined with TP regimen chemotherapy(named B group).The curative effect and toxicities of the two groups were evaluated respectively.Results The 1-,2-,3-year survival rates of A group and B group were 28.6%,19.0%,7.1% and 50.0%,26.2%,9.5% respectively.The overall response rates of A group and B group were 76.2% and 92.8%(P < 0.05).The toxicities of B group which could be tolerated were higher than those of A group.Conclusion 3DCRT combined with TP regimen chemotherapy can improve the survival rate and overall response rate of patients with mediastinal lymph node metastasis after operation of esophagus cancer.

目的探讨三维适形放疗(3D-CRT)联合多西他赛同步化疗在中晚期食管癌患者治疗中的疗效和毒副作用。方法 96例患者根据入选标准进入研究,48例进入化疗+放疗组(放化组),48例进入单纯放疗组(单放组)。放化组:单药多西他赛25mg/m2化疗,1次/周,放疗第一天开始应用。采用三维适形放疗,95%PTV64～70Gy/33～35Fr/6～7W。单放疗组:放射治疗方案同综合组。结果放化组的3年生存率及局控率分别为63.35%、58.35%,单放组的3年总生存率及局控率分别为36.62%、25.36%,两组显示出显著统计学差异。放化组及单放疗组的毒性反应经对症处理后患者均能耐受。结论三维适形放疗联合多西他赛同步化疗对食管癌近期疗效较好。虽毒性反应增加,但病人可以耐受。

Objective To find and depict the maximal tolerance dose of 3 dimensional conformal radiation therapy(3DCRT) for esophageal cancinoma,and investigate its efficacies and toxicities.Methods Fifty esophageal carcinoma received conventional fractionation irradiation through anterioposterior fields,DT 44 Gy/22fx,4-5 weeks,3DCRT was started as a boost.The scheduled dose escalation ranged from 74 Gy to 80 Gy.The boost doses were delivered with 3 Gy per fraction,once a day,5 fractions a week.The criteria for cessation of further dose escalation was more than or equal to 15% of patients developed grade ≥3 radiation pneumonitis(RTOG).Results The 1-and 2-year local control rates were 68%,56% in the whole group,respectively.The overall 1-and 2-year survival rates were 58%,35%.Acute radiation esophagitis was: grade 0-2 30 cases,grade 3-4 14 cases.Acute radiation pneumonitis was: grade 0-2 13 cases,grade 3-4 8 cases.The skin and the heart have not acute radiation inflammation.Conclusion Three dimensional conformal radiation therapy dose escalation for esophageal carcinoma is tolerable with an excellent short term local control.Remote local control rate and survival rate await further follow-up.