Objective To investigate the application of accelerators in primary hospitals, and to explore the advantages and disadvantages of domestic accelerators. Methods Twenty-six primary hospitals that used domestic accelerators and an equal number of primary hospitals that used imported accelerators were enrolled in the study. Comparison was made by group t test. Results (1) The mean numbers of patients treated every day were 28.08 for the 26 hospitals with imported accelerators and 39.23 for the 26 hospitals with domestic accelerators (P=0.45).(2) There was no significant relationship of hospital level with equipment brand, the number of treated patients, or treatment technology.(3) The proportions of hospitals that need to employ radiotherapy doctors, physical therapists, and technicians were 87.8%, 77.6%, and 87.8%, respectively.(4) The purchasing and maintenance costs were significantly higher for the imported accelerators than for the domestic ones (P=0.00, 0.04);there were no significant differences in product service, applicability, convenience, or stability between imported and domestic accelerators (P=0.21-1.00,0.15-0.52,0.07-1.00).(5) For the domestic accelerators, the repeatability was poor in the low-dose treatment, and the remote diagnosis of equipment failure was not yet achieved. Conclusions Domestic accelerators can meet the basic requirements of primary hospitals. Compared with imported ones, domestic accelerators have lower total costs but comparable indices in most investigations and tests. In terms of repeatability of the low-dose treatment, remote diagnosis, and planning system, however, domestic accelerators still have a long way to go.

Objective To compare the efficacy of neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant chemotherapy (NCT) in treating locally advanced esophageal squamous cell carcinoma. Methods We retrospectively analyzed a total of 177 patients who received NCRT (72 patients) or NCT (105 patients) combined with surgery for esophageal squamous cell carcinoma from January 2009 to October 2015 in the Affiliated Cancer Hospital of Zhengzhou University. The survival rate was analyzed using the Kaplan-Meier method. Results Among the 177 patients (clinical stage cT_2-4N_0-1M₀), the 2-and 3-year sample sizes were 44 and 26 in the NCRT group, and 47 and 28 in the NCT group. The pathological complete response (pCR) rate was significantly higher in the NCRT group than in the NCT group (22% vs. 10%, P=0.019). There were no significant differences in the incidence of postoperative complications, mortality, and recurrence rate between the two groups (all P>0.05). The 2-and 3-year overall survival rates for the NCRT group were 74% and 51%, versus 64% and 51% for the NCT group (P=0.527);the 2-and 3-year disease-free survival rates for the NCRT group were 54% and 50%, versus 54% and 46% for the NCT group (P=0.379). Conclusions Compared with NCT, NCRT significantly increases the pCR rate without increasing postoperative complications and mortality in esophageal squamous cell carcinoma patients. However, since the survival rate is similar between the two groups, the efficacy of NCRT and NCT remains to be verified by further prospective, multi-centered, and large-sample studies.

Objective To determine the prognostic factors in patients with stage yp0-I rectal cancer following preoperative concurrent chemoradiotherapy. Methods Eighty-seven patients who received preoperative concurrent chemoradiotherapy and total mesorectal excision (TME) for stage yp0-I rectal cancer from January 2008 to December 2013 were enrolled into the present study. TME was performed 4-8 weeks after the concurrent chemoradiotherapy (CRT). Whole pelvic radiotherapy was given at a dose of 45.0-50.4 Gy, along with concurrent chemotherapy using capecitabine or capecitabine combined with oxaliplatin. Local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were calculated using the Kaplan-Meier method, and compared by the Logrank test. Univariate and multivariate prognostic analyses were performed using the Logrank test and the Cox model, respectively. Results The median interval between preoperative CRT and TME surgery was 51 days. Approximately 45% of the patients received adjuvant chemotherapy following TME. The 3-year LRFS, DMFS, DFS, and OS were 98%, 93%, 93%, and 96%, respectively. The multivariate prognostic analysis showed that the downstaging depth score (DDS), which is based on the pre-treatment clinical stage and postoperative pathological stage, was correlated with DMFS and DFS (P=0.020 and 0.005, respectively). The area under the receiver operating characteristic curve of DDS for predicting 3-year DFS was 0.803 at a cut-off value of 5 points. Conclusions Satisfactory long-term survival is achieved in patients with yp0-I stage rectal cancer after preoperative CRT, and DDS can be used as a prognostic factor for long-term survival.

Objective To investigate the feasibility, safety, and short-term efficacy of preoperative capecitabine and simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) followed byone cycle of neoadjuvant capecitabine in patients with locally advanced rectal cancer (LARC). MethodsFrom March 2015 to April 2016, a total of 37 patients with LARC were enrolled in this study. They received capecitabine (825 mg/m² orally twice daily for 5 weeks, days 1-5 weekly) and SIB-IMRT (58.75 Gy in 25 fractions for rectal lesion and positive lymph nodes and 50.00 Gy in 25 fractions for pelvic lymphatic drainage area). After the concurrent chemoradiotherapy, they were allowed to rest for one week. And then they received one cycle of induction chemotherapy with capecitabine (1250 mg/m² orally twice daily for 14 days). And total mesorectal excision (TME) was scheduled at 6-8 weeks after the concurrent chemoradiotherapy. The primary endpoint was pathologic complete response (pCR) rate, and the secondary endpoints included tumor and nodal (TN) downstaging rate, the rate of sphincter-preserving surgery, and adverse events. Results All the 37 patients successfully received the preoperative concurrent chemoradiotherapy. Only 32 patients underwent the surgical resection, 4 patients refused surgery due to symptom relief, and 1 patient delayed surgery due to perianal edema after radiotherapy. The pCR rate was 34%(11/32);the TN downstaging rate was 91%(29/32);the R₀ resection rate was 100%;24 patients (75%) underwent the sphincter-preserving surgery. During the period of chemoradiotherapy, most of the patients experienced grade 1/2 acute adverse events and grade 3/4 adverse events occurred in 3 patients. The postoperative complications included ureteral injury (1 patient) and intestinal obstruction (1 patient), and no death occurred in the perioperative period. Conclusions For patients with LARC, preoperative SIB-IMRT combined with one cycle of capecitabine followed by TME is safe and feasible, and has good short-term efficacy and mild acute adverse events.