Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis. 相似文献
: Accelerated fractionation was used to shorten overall treatment time to increase locoregional control and cause-specific survival.
: Eighty-eight patients with cancer of the esophagus ineligible for surgery were entered in the study between 1986 and 1993. Neoadjuvant chemotherapy was given to 64% of patients. Accelerated radiotherapy using the concomitant boost technique delivered a median dose of 65 Gy in a median overall treatment time of 32 days.
: The 3-year acturial local control rate in patients with T1, T2, and T3 tumors was 71%, 42%,and 33%, respectively. The 3-year cause-specific survival rates were 40%, 22%, and 6%, respectively. Sixteen percent of patients experienced Grafe 3 esophagitis. Late toxicity included esophageal stenosis and pulmonary fibrosis in 8% and 9% of the patients, respectively. Multivariate analysis demonstrated that T stage and overall treatment time were prognostic factors for cause-specific survival. T stage and neoadjuvant chemotherapy were independent prognostic factors for locoregional control.
: These findings suggest that accelerated giben in an overall treatment time of <35 days might be beneficial for easy-stage cancer of the esophagus. Neoadjuvant chemotherapy is not recommended, as it was a significant adverse prognostic factor in the multivariate analysis for local control. Accelerated fractionation can be carried out with modeate acure and late toxicity. 相似文献
The authors studied the true “dynamic” distance between the esophageal stumps in type I atresia in order to perform the delayed
anastomosis at the most favorable time. The position of the inferior pouch was fluoroscopically evaluated in four patients,
inserting a Hegar dilator through the gastrostomy. The superior esophageal pouch was delineated by a Replogle tube. No anesthesia
was required. In all cases the procedure was simple, safe, fast, and accurate. No complications occurred, and patients could
be operated upon at the optimal time.
Accepted: 16 May 1997 相似文献
Objective: To study the pattern of lymphnode metastasis in carcinoma of esophagus. Methods: 200 cases of resected esophageal
cancer specimens were carefully examined pathologically. Lymphnode metastasis, its pathway and extent in relation to pathological
changes were analyzed. Results: Lymphnode metastasis was mainly regional and extended vertically in both directions. Leaping-over
metastasis was another feature. The deeper invasion by the tumor, the higher frequencies of metastasis development, and vice
versa. However, leaping-over metastasis was more likely to occur where tumor invasion was less severe. Conclusion: Owing to
the high frequency of lymphnode metastasis in the superior mediastinum and the widely spanned leaping-over metastasis, an
operative approach by three incisions through right thoracotomy with excision of the whole segment of esophagus and anastomosis
at cervical region was recommended, in order to dissect lymphnodes in the cervical, thoracic and abdominal regions and to
leave less or no metastatic lymphnodes behind. 相似文献