锎-252中子腔内后装治疗子宫内膜癌21例临床观察

目的观察锎-252腔内后装治疗子宫内膜癌的近期疗效及并发症情况,并对该治疗方案进行初步评价。方法选择21例未接受过任何治疗,按照国际妇产科联盟（FIGO）临床分期为Ⅰ～Ⅳ期的子宫内膜癌患者作为研究对象。治疗方案：锎-252中子后装治疗,共进行3～4次。A点总剂量：35-45Gy;F点总剂量：35-50Gy。该治疗间歇穿插全盆腔外照射,前后对穿野,200cGy／次,4次／周,外照射20-30Gy后,盆腔野中央屏蔽挡铅4cm,四野外照射治疗,200cGy／次,4次／周,使总剂量达到45-50Gy,总疗程5～6周。结果21例患者中随访5年者7例,随访4年者3例,随访3年者3例,随访2年者1例,随访1年者7例。局部控制率为90％以上,放射性膀胱炎和放射性直肠炎发生率低。结论锎-252中子腔内加高能x线外照射治疗子宫内膜癌患者具有局部控制率高、治疗时间短、治疗后并发症发生率低等特点,具有一定的临床应用前景。     

外照射加腔内照射治疗食管癌的前瞻性研究

目的观察一定剂量的外照射后不同时期加腔内放射治疗的疗效及副作用，以探讨较适当的腔内照射时机。方法100例食管癌患者随机分2组，A组：35Gy外照射后，即开始内外照射同期进行。B组：50Gy外照射后开始腔内照射。两组外照射总吸收剂量均为50Gy，采用常规分割照射，1.8—2Gy，次，5次，周。腔内照射5Gy，次，每周1次，共2次。结果A组的1、3和5年局控率分别为60．2％、39．8％和36．2％，B组的1、3和5年局控率分别为54．1％、32．8％和29．2％；P=0．5118。两组的1、3和5年生存率分别为52．0％、26．0％、21．8％和54．0％、23．4％、16．7％，P=0．8159。A组和B组急性放射性食管炎的发生率分别为70％（35/50）和48％（24/50），P=0．038，但严重的食管炎（Ⅲ级及以上）的发生率相当，均为4％。A组和B组食管瘘的发生率分别为8％（4／50）和10％（5／50）。结论于35Gy外照射后同期加腔内照射及外照射50Gy结束后即局部补加腔内照射均是可行的。两种治疗方案相比，前者急性放射性食管炎的发生率高于后者，但晚期并发症无增加。     

CT三维数字化导航穿刺技术在经皮肺穿刺活检中的应用

目的 探讨CT三维数字化导航穿刺技术在肺局限性病变活检中的临床应用价值.方法 将2013年1月-2015年6月收治的212例需穿刺活检的肺部占位患者,按随机化原则分为对照组和研究组,研究组106例患者采用三维立体定位与三维导航穿刺仪活检;对照组106例患者采用CT横断面引导下常规穿刺针活检;统计分析两组的一次性穿刺成功率,并发症发生率,手术时间,诊断正确率.结果 病灶体积≤3 cm×3 cm×3 cm的患者中研究组一次穿刺成功率69.8％(37/53),对照组一次穿刺成功率22.7％(12/53)(=21.8,P＜0.01),差异有统计学意义;研究组并发症发生率18.9％(10/53),对照组并发症发生率48.9％(26/53) (x2=6.01,P＜0.05),差异有统计学意义;研究组诊断正确率96.2％(51/53),对照组诊断正确率81.1％(43/53),(x2=11.84,P＜0.05)两组比较差异有统计学意义.病灶体积＞3 cm×3 cm×3 cm的患者中研究组诊断正确率94.3％ (50/53),对照组诊断正确率79.2％ (42/53),(x2=5.27,P＜0.05)两组比较差异有统计学意义.研究组患者穿刺时间(11.6±2.8) min,对照组患者穿刺时间(22.2±6.3) min(t=-1 1.698,P＜0.01),差异有统计学意义.结论 CT三维数字化导航穿刺技术显著提高了肺部病变活检的一次穿刺成功率和诊断正确率,是一种简便、准确、安全的数字化穿刺导航新方法.     

对食管癌放疗并用化疗的一次性效果的探讨

作者对22例食管癌放疗并用化疗的一次性效果作了分析。单纯外照射者15例,其中10例照射剂量为60Gy以上,外照射十腔内照射7例。一般外照射剂量为10MV X线,2.0～2.5Gy/次,4次/周。并用腔内照射者给予50～55Gy照射后再追加10～20Gy腔内照射。化疗应用Cisplatin(CDDP),Methotrexate(MTX)及Replomycin(PEP),于放疗前、40Gy前后及放疗后分别给药。只服药1次者13例,2次者8例,3次者1例。治疗结束时     

腔内近距离放射治疗食管癌的特点和作用

食管癌腔内近距离放疗是将放射源置于食管腔内进行放射治疗的一种方法,它可以作为表浅性食管癌或复发性食管癌的主要治疗手段,但更多的是将其作为局限性中晚期食管癌外照射后追加剂量照射的方法,这样可以提高肿瘤控制率和患者的生存率,对病变长度小于5cm或肿瘤局限于肌层的患者疗效更为明显。只要降低单次剂量、控制总剂量,腔内近距离放疗的早期反应可以耐受,后期并发症也可以得到控制。     

判断食管癌预后的X线所见

作者研究了1965年以来千叶大学的食管癌病例,探讨了X 线表现与预后的关系。依肿瘤浸润范围分为Ⅰ(小于1/2管径),Ⅱ(大于1/2管径但未及全周)和Ⅲ度(全周径)。在179例中,三度的五年存活率分别为33%、41%、80%。依x 线所见病变长度分为L≤4cm;4>L≤6cm;6>L≤8cm;810cm 五组。179例中,五年存活率依次为26%、12%、9%,4%及0。依病变的深度分为早期、浅表、中间及深达四型.五年存活率依次为50%、26%、11%、2%。依食管狭窄部的直径与正常管径之比分为     

化疗并后程加速超分割放疗中晚期食管癌

目的观察同期化疗并后程加速超分割放疗(后超组)和同期化疗并常规分割放疗治疗食管癌(常规组)的疗效和毒性,寻找更有效的局部控制率和降低远处转移率并提高生存率的治疗方法.方法选择病变长度≤12 cm、无远处转移证据的中晚期食管癌分后超组和常规组各40例.两组化疗方案相同.后超组放疗第1～28天,为常规分割放疗,缩野后行加速超分割放疗,总剂量为67 Gy/38次,共42 d.常规组放疗为全程常规分割放疗,总剂量为70 Gy/35次,共49 d.结果近期疗效后超组Ⅰ+Ⅱ级31例占77.5%,Ⅲ+Ⅳ级9例占22.5%,常规组Ⅰ+Ⅱ级22例占55.0%,Ⅲ+Ⅳ级18例占45.0%(P＜0.05).后超组和常规组1,2年局部控制率分别为77.14%、51.86%和55.21%、31.28%(P=0.049);后超组和常规组1,2年生存率分别为72.22%、48.64%和54.09%、27.33%(P=0.041).急性放射性食管炎后超组明显重于常规组,且持续时间长.白细胞下降、胃肠道不良反应及放射性肺炎两组比较,其差异无显著性(P＞0.05).结论(1)同期化疗并后程加速超分割放疗的放射性食管炎虽有所增加,但多数患者能耐受;(2)同期化疗并后程加速超分割放疗较同期化疗并常规分割放射治疗提高了近期疗效、局控率及生存率.     

CT模拟定位在食管癌放射治疗中的临床应用

目的：探讨CT模拟定位在食管癌放射治疗的临床应用价值。方法：45例食管癌病例行CT模拟定位,全部病例以肿瘤中心为照射野的等中心点,照射野长度为肿瘤上、下缘放大3.5 cm,野宽为肿瘤边缘外放1.0 cm,总剂量为DT 60 Gy～70 Gy,2 Gy/次,5次/周。结果：CT模拟定位可以和X线模拟定位一样完成从定位到做体表标记的全过程。45例病例近期疗效显示完全缓解率达60.00%（27/45）,部分缓解率为40.00%（18/45）。结论：CT模拟定位可以准确提供食管癌病变情况,利用CT模拟定位,可提供更多的原始信息和提高模拟精度。     

腔内近距离放射治疗食管癌的特点和作用

食管癌腔内近距离放疗是将放射源置于食管腔内进行放射治疗的一种方法，它可以作为表浅性食管癌或复发性食管癌的主要治疗手段，但更多的是将其作为局限性中晚期食管癌外照射后追加剂量照射的方法，这样可以提高肿瘤控制率和患的生存率，对病变长度小于5cm或肿瘤局限于肌层的患疗效更为明显。只要降低单次剂量、控制总剂量，腔内近距离放疗的早期反应可以耐受，后期并发症也可以得到控制。     

沙利度胺联合放疗治疗食管癌的临床观察

目的 前瞻性研究沙利度胺干预下食管癌患者放疗过程中血清血管内皮生长因子(VEGF)水平的动态变化及近期疗效和耐受性.方法 采集86例食管癌患者放疗前、中、后的血清,应用酶联免疫吸附法( ELISA)测定血清VEGF水平,根据患者放疗中VEGF水平的变化给予沙利度胺干预,将83例(另外3例因不耐受放疗而中断治疗)患者分成服药组32例(放疗中VEGF水平升高或不变的患者给予口服沙利度胺至放疗结束)和未服药组51例(VEGF水平降低的患者不服用沙利度胺放疗至结束),观察沙利度胺干预下食管癌放疗的疗效及服用药物的安全性.另设30例健康对照组.结果 86例食管癌患者放疗前血清VEGF表达水平较30例健康对照者升高,差异有统计学意义(t=5.07,P＜0.01),且与原发肿瘤大小(t=4.55,P＜0.01)、淋巴结转移(t=7.50,P ＜0.01)、组织病理类型(F=3.40,P＜0.01)及临床分期均有关(t=2.52,P＜0.01),而与病变部位、远处转移、X射线分型、患者性别、年龄均无关(P均＞0.05).服药组患者放疗后较放疗中血清VEGF的表达水平降低(t=2.37,P＜0.05),放疗有效率为71.88％;未服药组患者放疗中、后血清VEGF的表达水平差异无统计学意义(t=0.18,P＞0.05),服药组与未服药组的患者比较,头晕、倦怠反应的发生率分别为62.50％和15.69％(x2=19.28,P=0.000),嗜睡的发生率分别为18.75％和1.96％(x2=5.168,P=0.023),Ⅲ-Ⅳ度食管炎发生率分别为12.50％和11.76％(x2=0.061,P=0.806),Ⅲ-Ⅳ度白细胞下降发生率分别为6.25％和9.80％(x2=0.026,P=0.872),Ⅲ～Ⅳ度血小板下降发生率分别为3.13％和5.88％(x2=0.002,P=0.965),Ⅲ～Ⅳ度恶心呕吐发生率分别为9.38％和27.45％(x2=2.913,P=0.088),过敏反应的发生率均为0.结论 沙利度胺能够降低食管癌患者血清VEGF的表达水平,患者服用沙利度胺后耐受性较好.     

Treatment of Radioresistant Cancers–Proceedings of the International Symposium on the Prospects for Treatment of Radioresistant Cancers Held in Kyto (Japan), May 21st 1979

Summary

Using autoradiographic methods it was noted that S phase cells at the bottom of the crypts in the small intestine were the most efficient scavengers of exogenous injected thymidine. The efficiency of the incorporation of ³H-TdR (salvage pathway of DNA synthesis) by cells at the crypt base (stem cell zone) was twice as high as for the S phase cells at the top of the crypt (maturing proliferative cells). There were no such position-dependent differences in incorporation of ³H-UdR (de novo pathway of DNA synthesis). Radiation (0·75–5·0 Gy ¹³⁷Cs γ-rays) inhibited the incorporation of ³H-TdR very rapidly and this was also cell-position dependent. The cells at the bottom of the crypt were the most affected. The injection of cold thymidine before ³H-TdR changed the pattern of the incorporation of ³H-TdR along the side of the crypt in a very similar way to radiation, and the grain number was decreased predominantly in the cells at lower positions.

The possibility of the existence of a regional gradient of endogenous thymidine (reutilization from intestinal sources), and the influence of irradiation on the gradient of thymidine incorporation resulting from direct and abscopal effects of whole body exposure, are discussed.     

Impact of Nonosseous Findings on 18F-NaF PET/CT in a Patient with Ductal Breast Carcinoma

¹⁸F-NaF was used as a bone-seeking PET tracer for skeletal imaging until the introduction of the widely available ^99mTc-labeled bone agents. However, there is renewed clinical interest in ¹⁸F-NaF since prior technical and logistic limitations to its routine use are no longer present, and, as a consequence, it is likely that uptake unrelated to bone and non-osseous findings will be encountered more frequently. As a result of tumoral necrosis, soft tissue metastases may demonstrate ¹⁸F-NaF avidity due to dystrophic calcification. On the other hand, all non-osseous findings, whether ¹⁸F-NaF avid or not, may provide important diagnostic information that may alter the course of the disease, including treatment options. Herein we present a patient with ductal carcinoma of the breast in whom findings unrelated to the skeletal system in ¹⁸F-NaF PET/CT altered the treatment strategy.     

Production of large quantities of 90Y by ion-exchange chromatography using an organic resin and a chelating agent

The performance of a system composed of an organic cation exchanger (Dowex 50Wx8) and a chelating agent (EDTA) previously described for the successful production of (90)Y via a (90)Sr/(90)Y generator is assessed under dynamic conditions. In an attempt to overcome the established limitation of ion-exchange resins for the separation of subcurie quantities of activity, (90)Y is repeatedly isolated from an 11.8-GBq (320 mCi) (90)Sr cow using a three-column tandem arrangement. The high recovery and radionuclidic purity obtained for (90)Y and the parameters of the separation (time, eluant concentration, pH and flow rate range) strongly suggest that Ci quantities of (90)Y can be handled satisfactorily by the ion-exchange method. No replacement or treatment of the cow, low waste generation and (90)Sr losses less than 0.1% after each run were observed during the present study which, in combination with the low cost of this resin, may result in an attractive alternate method for the production of large quantities of (90)Y.     

Rapid determination of Sr impurities in freshly “generator eluted” Y for radiopharmaceutical preparation

⁹⁰Y is one of the most useful radionuclides for radioimmunotherapeutic applications and has a half-life (t_1/2=64.14 h) suitable for most therapeutic applications, beta particles of high energy and decays to a stable daughter. It is significant that ⁹⁰Y is available conveniently and inexpensively from a radionuclide “generator” by decay of its parent, ⁹⁰Sr. Nevertheless, current and planned clinical applications with [⁹⁰Y] labelled compounds employ activity levels that cannot be readily obtained from an in-house generator, but from commercial sources. We have evaluated Eichrom's Sr-resin, either as an “in-house” generator or as a fast QC method for analysis of ⁹⁰Y solutions.In particular, for the development as a generator, we investigated the percentage of the radio-Sr in the first 8 M HNO₃ eluate: in this fraction the concentration of ⁹⁰Sr must be smaller than 10⁻⁵% (recommendations of the International Commission on Radiological Protection). For evaluation as a rapid QC method, we analyzed the concentration of ⁹⁰Y in all the fractions containing “only” radio-Sr: ⁹⁰Y should not be present in these eluates. After the collection of β⁻ and γ spectra and analysis of them, we concluded that commercial Sr-resin minicolumn cannot give us the results expected; we developed an in-house system loaded with 4 mL of Sr-resin which gave better results as a generator and a rapid QC method.     

Diagnostic Performance of 68Ga-DOTATATE PET/CT, 18F-FDG PET/CT and 131I-MIBG Scintigraphy in Mapping Metastatic Pheochromocytoma and Paraganglioma

Purpose

To evaluate the diagnostic performance of ⁶⁸Ga-DOTATATE ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography (CT), ¹⁸F-FDG PET/CT and ¹³¹I-MIBG scintigraphy in the mapping of metastatic pheochromocytoma and paraganglioma.

Materials and Methods

Seventeen patients (male = 8, female = 9; age range, 13–68 years) with clinically proven or suspicious metastatic pheochromocytoma or paraganglioma were included in this prospective study. Twelve patients underwent all three modalities, whereas five patients underwent ⁶⁸Ga-DOTATATE and ¹³¹I-MIBG without ¹⁸F-FDG. A composite reference standard derived from anatomical and functional imaging findings, along with histopathological information, was used to validate the findings. Results were analysed on a per-patient and on per-lesion basis. Sensitivity and accuracy were assessed using McNemar’s test.

Results

On a per-patient basis, 14/17 patients were detected in ⁶⁸Ga-DOTATATE, 7/17 patients in ¹³¹I-MIBG, and 10/12 patients in ¹⁸F-FDG. The sensitivity and accuracy of ⁶⁸Ga-DOTATATE, ¹³¹I-MIBG and ¹⁸F-FDG were (93.3 %, 94.1 %), (46.7 %, 52.9 %) and (90.9 %, 91.7 %) respectively. On a per-lesion basis, an overall of 472 positive lesions were detected; of which 432/472 were identified by ⁶⁸Ga-DOTATATE, 74/472 by ¹³¹I-MIBG, and 154/300 (patient, n = 12) by ¹⁸F-FDG. The sensitivity and accuracy of ⁶⁸Ga-DOTATATE, ¹³¹I-MIBG and ¹⁸F-FDG were (91.5 %, 92.6 % p < 0.0001), (15.7 %, 26.0 % p < 0.0001) and (51.3 %, 57.8 % p < 0.0001) respectively. Discordant lesions were demonstrated on ⁶⁸Ga-DOTATATE, ¹³¹I-MIBG and ¹⁸F-FDG.

Conclusions

Ga-DOTATATE PET/CT shows high diagnostic accuracy than ¹³¹I-MIBG scintigraphy and ¹⁸F-FDG PET/ CT in mapping metastatic pheochromocytoma and paraganglioma.     

Variability of lesion detectability and standardized uptake value according to the acquisition procedure and reconstruction among five PET scanners

OBJECTIVE: The objective of this study was to assess differences in the semiquantitative values of 18F-fluorodeoxyglucose (18F-FDG) uptake among different positron emission tomographic (PET) systems. METHODS: A phantom study was performed to compare standardized uptake value (SUV) in five PET scanners including a dedicated PET scanner and four PET/computed tomography (CT) scanners. Radioactivity simulating the SUV of 2.5 was filled in the hot spheres (8 mm, 11 mm, 14 mm, 18 mm, 22 mm, and 27 mm) that were set in the cylindrical phantom with the background SUV of 1.0. Data acquisition and reconstruction were performed according to routine and standardized conditions. The standardized condition was as follows: CT acquisition (120 kVp, 50 mA) and PET acquisition (2-min acquisition with a slice thickness of 2 mm); reconstruction was performed by ordered subsets expectation maximization + Fourier rebinning. Detectability of hot spheres and SUV was compared between routine condition and standardized condition with five PET scanners. RESULTS: On routine condition, two cameras could detect a 14-mm sphere clearly. On the other hand, the visualization of hot spheres by the standardized condition was remarkably variable. Semiquantitative evaluation revealed that a maximum of 45.7% error was recognized with the 27-mm sphere by the routine condition, although the standardized condition could reduce the error to 22.6%. CONCLUSIONS: Detectability depends not only on the PET machine but also on the imaging protocol. The results indicate that SUV is variable with PET machines under routine conditions of data acquisition and reconstruction. Standardization of the reconditions can reduce variability and maximum difference in the SUV by half.     

Repeated 0.5-Gy γ-ray irradiation attenuates autoimmune manifestations in MRL-lpr/lpr mice

Purpose: MRL-lpr/lpr mice, a model for various autoimmune diseases, were repeatedly irradiated with 0.5 Gy of γ-rays, and changes in their autoimmune manifestations were investigated.

Materials and methods: MRL-lpr/lpr mice at 13 weeks of age were maintained in plastic cages and exposed whole-body to 0.5 Gy γ-ray irradiation from a ¹³⁷Cs source 5 times per week for 4 weeks, from the time they were 13 weeks old until they reached 17 weeks old. Changes of autoimmune manifestations were examined 3 weeks later at the 20th week.

Results: Splenomegaly, lymphadenopathy, and proteinuria in MRL-lpr/lpr mice were clearly ameliorated by a total dose of 10 Gy (0.5 Gy/day×5 days/week for 4 weeks). Histologically severe disease-specific damage to the kidney and the salivary gland, i.e., glomerulonephritis and sialoadenitis, was also improved after irradiation. CD3⁺ CD4^? CD8^? CD45R/B220⁺ T cell numbers, which proliferate abnormally in MRL-lpr/lpr mice, were significantly decreased by the irradiation, possibly through induction of apoptosis. The elevated NO₂^? and NO₃^? (NO_x^?) production by macrophages of MRL-lpr/lpr mice was lowered by the irradiation. The irradiation also prolonged the life span of MRL-lpr/lpr mice. These phenomena may contribute to the amelioration of autoimmune manifestations in MRL-lpr/lpr mice exposed to repeated small-doses of γ-rays.

Conclusions: Repeated small-dose γ-ray exposure ameliorates the autoimmune manifestations in MRL-lpr/lpr model mice.     

222Rn-220Rn累积探测器参加日本组织的国际比对结果分析

目的 通过参加国际比对,提高²²²Rn和²²⁰Rn累积测量的水平,保证测量的质量。方法 将本实验室的LD-P型²²²Rn-²²⁰Rn探测器寄往日本放射线医学综合研究所(National Institute of Radiological Science,NIRS),参加²²²Rn-²²⁰Rn累积探测器的国际比对。²²²Rn比对在NIRS的标准²²²Rn室进行,按暴露量分低、中、高3个水平;²²⁰Rn比对在NIRS的²²⁰Rn室进行,也分低、中、高3个水平。暴露结束后将探测器寄回本实验室进行蚀刻、分析,然后把测量结果报给NIRS,最后NIRS将暴露的参考值反馈回本实验室。结果 LD-P探测器²²²Rn比对测量低、中、高3个暴露水平的测量值与参考值的相对偏差(RPD)分别为-13.8%、-14.4% 和-17.1%;²²⁰Rn比对测量低、中、高3个暴露水平的测量值与参考值的RPD分别为-14.4%、 8.9%和-3.2%。结论 本次比对LD-P探测器²²²Rn和²²⁰Rn的测量结果均在NIRS规定的RPD为20%的一级标准范围内。