VMAT联合XELOX方案术前治疗局部

[目的]观察VMAT联合XELOX方案术前治疗局部晚期直肠腺癌的早期临床疗效及治疗不良反应,明确其在临床实践中的可行性.[方法]入组2012年3月至2014年9月符合入组条件的局部进展期直肠腺癌患者86例,予以术前放化疗.全组放疗采用VMAT技术,靶区剂量为:计划大体肿瘤靶体积(PGTV):50Gy/25次,计划靶区(PTV):45Gy/25次,1次/d,5次/周.同步化疗采用XELOX方案,具体如下:卡培他滨1600mg/m2/d,分两次口服,d1～14,22～25,奥沙利铂100mg/m2,d1,22).术后继续行XELOX方案化疗4个周期.[结果]全组86例患者均完成放疗.放化疗期间3～4级急性不良反应发生情况:血液学毒性:3～4级白细胞减少5例(5.8％);3～4级血小板减少2例(2.3％).非血液学毒性:3～4级腹泻13例(15.1％).全组共85例患者完成手术,其中Dixon手术57例,Miles'手术26例,Hartmann手术1例,其他1例.低位直肠癌保肛率为50％(23/46).82例(96.5％)患者RO切除.全组病理完全缓解率(pCR)20.0％(17/85).局部T分期、N分期及临床分期降期率分别为82.4％、52.9％和76.5％.术后60天内无死亡病例.[结论] VMAT联合XELOX方案术前治疗局部进展期直肠腺癌可获得良好的pCR率及肿瘤降期率,不良反应可耐受,值得临床推广.     

Ⅱ期和Ⅲ期直肠癌根治术后卡培他滨同期放化疗疗效及失败原因分析

目的 分析Ⅱ、Ⅲ期直肠癌根治术后卡培他滨同期放化疗Ⅱ期临床研究结果.方法 2005-2007年间共131例病理诊断明确的Ⅱ、Ⅲ期直肠癌患者纳入研究,所有患者均接受根治术后同期化放疗和辅助化疗.治疗方案为全盆腔放疗50 Gy分25次,放疗期间同期应用卡培他滨1600mg/m2,每天分2次服用,连用2周停l周.结果 同期放化疗期间3+4级不良反应发生率为28.2％.随访率为93.9％,3年总生存率、无局部区域复发生存率和无远处转移生存率分别为85.1％、96.7％和79.5％.共31例出现复发,包括5例局部区域复发和28例远处转移.单因素分析提示病理低分化或中低分化、未接受辅助化疗、ⅢC期和淋巴结阳性率＞30％是影响总生存的因素(x2=15.49、15.85、8.80和9.76,P=0.000、0.000、0.011和0.002),ⅢC期、未接受辅助化疗和淋巴结阳性率＞30％是影响无远处转移生存的因素(x2 =6.51、11.57和9.70,P=0.034、0.001和0.002).但未接受辅助化疗者中病理为低分化或T4期的患者更多(x2 =7.20、6.48,P=0.027、0.039).结论 Ⅱ、Ⅲ期直肠癌根治术及卡培他滨同期放化疗后局部区域控制率高,远处转移是主要失败原因.     

简化调强放疗同步卡培他滨治疗直肠癌术后复发临床观察

目的:观察直肠癌术后复发患者简化调强放疗(sIMRT)同步卡培他滨化疗的近期疗效和不良反应.方法:33例直肠癌术后复发患者均行sIMRT[先行盆腔淋巴引流区及直肠周围放疗(45～50) Gy/(25 f·5 w),复发病灶局部加量18～20 Gy,(1.8～2.0) Gy/次,5次/周,总剂量达63～70 Gy],并同步卡培他滨化疗(1 000 mg/m2,从放疗第1天开始,连服14 d,休息7d为1个周期,放疗期间口服2个周期).放疗结束后行同方案巩固化疗2个周期.结果:全部患者均完成治疗,33例患者中CR 5例(15.2％),PR 20例(60.6％),NC 6例(18.2％),PD 2例(6.1％),总有效率75.8％.血清CEA下降50％并维持≥1个月者21例(84.0％).治疗后临床症状改善和明显好转29例(87.9％).主要不良反应是血液学毒性、消化道反应、急性膀胱炎和手足综合征等,均可耐受.结论:调强放疗联合卡培他滨同步化疗治疗直肠癌术后复发患者,不良反应轻,近期疗效确切,值得在临床上进一步探讨应用.     

卡培他滨联合调强放疗治疗食管癌术后纵隔淋巴结转移的近期疗效观察

目的：观察卡培他滨联合调强放疗治疗食管癌术后纵隔淋巴结转移的近期疗效及不良反应。方法62例食管癌术后纵隔淋巴结转移的患者按随机数字表法随机分为2组,单纯调强放疗组（A 组）31例,卡培他滨联合调强放疗组（B 组）31例。A 组仅采用调强放疗,B 组采用调强放疗联合口服卡培他滨化疗。两组放疗方案、计划相同：总剂量60~66 Gy,（30~33）次/（6~6.5）周,卡培他滨1250 mg/ m2,每日2次,连续14 d,21 d 为1周期,共应用2疗程。治疗期间观察放化疗相关不良反应,放疗结束后1个月复查胸部 CT 评价疗效。结果 A 组：完全缓解（CR）7例,部分缓解（PR）12例,无效（SD）10例,进展（PD）2例,有效率为61.3%（19/31）;B 组：CR 10例,PR 16例,SD 4例,PD 1例,有效率为83.9%（26/31）,两组有效率差异有统计学意义（χ2=3.971,P <0.05）。A、B 组的骨髓抑制发生率分别为29.0%、38.7%（χ2=0.648,P =0.421）,放射性肺炎发生率分别为19.4%、25.8%（χ2=0.369,P =0.544）,差异无统计学意义。结论卡培他滨联合调强放疗治疗食管癌术后纵隔淋巴结转移近期疗效满意,未增加放化疗相关不良反应。     

加速分割放疗同步卡培他滨化疗治疗晚期鼻咽癌

背景与目的:目前,常规分割放疗治疗晚期鼻咽癌疗效不甚理想,5年生存率仅在23%～40%之间。为此,本研究探讨加速分割放疗同步卡培他滨化疗治疗晚期鼻咽癌的疗效和毒副反应。方法:82例晚期鼻咽癌患者,采用抽签法随机分为加速分割放疗同步卡培他滨化疗组和常规分割放疗组。同步放化疗组每周照射6d,每天照射1次,每次照射剂量为1.8～1.9Gy,总剂量为72～76Gy,且在放疗同时给予卡培他滨化疗;常规分割放疗组每周照射5d,每天照射1次,每次照射剂量为2Gy,总剂量亦为72～76Gy。结果:同步放化疗组的完全缓解率为92.7%,显著高于常规分割放疗组的71.0%(P<0.05)。同步放化疗组的局部复发率(17.1%)显著低于常规分割放疗组(36.5%)(P<0.05),而其远处转移率(19.5%)亦显著低于常规分割放疗组(41.5%)(P<0.05)。两组的5年生存率分别为63.5%和41.3%,同步放化疗组显著优于常规分割放疗组(P<0.05)。而同步放化疗组的骨髓抑制及急性放射反应发生率则显著高于常规分割放疗组(P<0.05)。结论:加速分割放疗同步卡培他滨化疗对晚期鼻咽癌有较好的疗效,且其毒副反应能耐受。     

三维适形放疗同步奥沙利铂加卡培他滨术前治疗Ⅱ～Ⅲ期直肠癌的疗效观察

目的 探讨Ⅱ～Ⅲ期直肠癌应用奥沙利铂联合卡培他滨术前同步放化疗的临床疗效及毒副反应。方法 收集大连医科大学附属第二医院放疗科2008年至2012年收治的经病理组织学证实的Ⅱ～Ⅲ期直肠癌患者104例,术前均行同步放化疗。三维适形放疗：1.8 Gy／次,DT 50.4 Gy／28次。同步化疗方案：奥沙利铂50 mg／m2,每周1次,共5次;卡培他滨1650 mg／（m2·d）,d1～d35。同步放化疗结束后8周进行手术,术后完成6个月的FOLFOX 6方案全身化疗。观察并随访术前同步放化疗后疗效及不良反应。结果 同步放化疗后肿瘤降期率为55.8％（58／104）,术后完全缓解（CR）22例,部分缓解（PR） 67例,稳定（SD） 15例,有效率（RR）为85.6％（89／104）。总体保肛率为78.8％（82／104）。不良反应主要为腹泻、恶心、呕吐、骨髓抑制及口腔炎等,仅1例4级不良反应发生,无放化疗相关死亡。3年生存率、无病生存率、远处转移率及局部复发率分别为90.3％、74.0％、24.0％和3.9％。结论 Ⅱ～Ⅲ期直肠癌奥沙利铂联合卡培他滨术前同步放化疗能降低肿瘤分期,提高肿瘤病理完全缓解率,且不良反应可耐受,局部控制可,但并未明显降低远处转移率,其结果仍需长期随访。     

三维适形放疗同步卡培他滨化疗治疗直肠癌术后复发的临床观察

目的 观察直肠癌术后复发三维适形放疗同步口服卡培他滨的疗效及不良反应.方法 选择64例直肠癌术后复发患者,随机分为三维适形放疗同步口服卡培他滨组(32例,治疗组)和二维适形放疗组(32例,对照组).卡培他滨1250mg/m2,每天2次口服,从放疗开始的第1天口服,连续服用14d,休息1周,21 d为1个周期.同步进行的三维适形放疗,DT60～70Gy,2Gy/次,5次/周,放疗结束后3个月复查盆腔CT.结果 治疗组总有效(CR+PR)率为87.6%,对照组总有效率为65.6%.结论 三维适形放疗同步口服卡培他滨治疗直肠癌术后复发的患者,疗效确切,不良反应小.     

三维适形放疗同步卡培他滨化疗治疗直肠癌术后复发的临床观察

目的 观察直肠癌术后复发三维适形放疗同步口服卡培他滨的疗效及不良反应.方法 选择64例直肠癌术后复发患者,随机分为三维适形放疗同步口服卡培他滨组(32例,治疗组)和二维适形放疗组(32例,对照组).卡培他滨1250mg/m2,每天2次口服,从放疗开始的第1天口服,连续服用14d,休息1周,21 d为1个周期.同步进行的三维适形放疗,DT60～70Gy,2Gy/次,5次/周,放疗结束后3个月复查盆腔CT.结果 治疗组总有效(CR+PR)率为87.6%,对照组总有效率为65.6%.结论 三维适形放疗同步口服卡培他滨治疗直肠癌术后复发的患者,疗效确切,不良反应小.     

26例低位局部进展期直肠癌术前加量IMRT临床观察

目的 探讨低位直肠癌患者行术前同期加量IMRT联合卡培他滨化疗方案的可行性及治疗效果。方法 选取2015-2016年301医院26例局部晚期直肠癌患者,肠镜下肿瘤下缘距肛缘5 cm内。放疗剂量分割模式:直肠肿瘤及转移淋巴结为58.75 Gy分25次(2.35 Gy/次),盆腔淋巴引流区为50 Gy分25次,同步卡培他滨化疗(825 mg/m²,2 次/d,5天/周)5周。同步放化疗结束后休息1周,继续辅以1个周期卡培他滨化疗(1250 mg/m²,2 次/d,连续14 d)。同步放化疗结束后6~8周行直肠TME。研究主要终点为获得ypCR及保肛手术率,次要终点为急性放化疗反应、TN降期率及术后并发症。结果 26例患者均完成新辅助放化疗,其中25例患者已行手术治疗,1例患者因肛周水肿无法手术。术后ypCR率达32%(8/25),保肛手术率为60%(15/25);TN总降期率为92%(23/25),R0切除率为100%。放化疗期间24例患者发生1、2级不良反应,2例患者发生3级放射性皮炎,未见≥4级急性不良反应。术后输尿管损伤1例,肠梗阻1例。结论 低位直肠癌患者行术前同期加量IMRT联合卡培他滨化疗方案安全可行,ypCR、R0切除率及保肛手术率达到了预期效果,长期生存是否获益有待今后进一步研究。临床试验注册 中国临床试验注册中心,注册号:ChiCTR-ONC-12002387。     

试点研究：卡培他滨联合顺铂治疗食管癌

我们的目标是评估卡培他滨联合顺铂用于食管鳞状细胞癌同步放化疗（CRT）的可行性。18例食管癌患者进入本次研究。同步放化疗方案为：静脉滴注顺铂60mg／m^2,d1,口服卡培他滨825mg／m^2,2次,d,d1-14,间隔3wk后重复1次;对原发部位及区域淋巴结放疗每日2Gy至总剂量60Gy。同步放化疗后,进行2周期的化疗,     

中医药参与肿瘤综合治疗模式现状与分析

中医药在肿瘤综合治疗中有独特的地位和优势,中医、西医诊疗理念与评价内容的日趋一致性为中医药参与肿瘤综合治疗奠定了有利的理论基础。中医药参与肿瘤不同阶段的治疗形成了维持治疗、巩固治疗、强化治疗以及序贯治疗等不同模式。全文针对中医药参与综合治疗肿瘤的模式进行探讨,以期为今后临床研究提供一定的理论基础。     

Radiation therapy with charged particles

Charged particle beams can offer an improved dose conformation to the target volume as compared with photon radiotherapy, with better sparing of normal tissue structures close to the target. In addition, beams of ions heavier than (4)He exhibit a strong increase of the linear energy transfer in the Bragg peak as compared with the entrance region. These physical and biological properties are much more favorable than in photon radiotherapy. As a consequence, particle therapy with protons and heavy ions has gained increasing interest worldwide, and many clinical centers are considering introducing radiation therapy with charged particles. This contribution summarizes the physical and technical principles of charged particle therapy with protons and heavy ions. It briefly reviews the clinical experience gathered so far with proton therapy and gives a more detailed summary of the recent results in carbon ion therapy of skull base tumors, head and neck tumors, non-small-cell lung cancer, hepatocellular carcinomas, bone and soft-tissue sarcomas, and prostate cancer.     

A randomized phase III study of neoadjuvant hormonal therapy in patients with localized prostate cancer

The primary objective of this randomized trial is to evaluate the benefit of the addition of neoadjuvant hormonal therapy to escalated-dose external-beam radiation therapy in the treatment of patients with intermediate-risk carcinoma of the prostate. A secondary objective of this study is to determine prognostic factors for radiation response. All patients will have tissue oxygenation measured and biopsies taken before treatment at the time of fiducial marker insertion for radiation treatment planning and daily monitoring. In addition, patients randomized to the neoadjuvant bicalutamide arm will be asked to consider having these studies repeated before initiation of radiation therapy (after 3 months of hormonal therapy).     

放疗同时多因子介入治疗60例晚期癌症的随机研究

目的探索晚期癌症的治疗方法。方法１９９６年１月～１９９７年３月,将６０例预期生存仅３～６个月的晚期癌症患者随机分成两组：（１）综合治疗组：放疗的同时用化疗药物、免疫反应修饰剂和中药制剂等多因子介入治疗;（２）对照组：单用放疗。两组放疗方法相同,腹腔肿块照射ＤＴ５０Ｇｙ,２５次／３５天,其他肿块照射ＤＴ６０Ｇｙ,３０次／４２天。结果综合治疗组有效率、平均缓解期、中位生存期和１年生存率分别为９３．３％、７．４个月、１１个月和４６．７％,对照组分别为６３．３％、４．７个月、６．５个月和６．７％,两组差异均有显著性（Ｐ＜０．０１）。结论综合治疗可有效延长晚期癌症患者生存期,并明显改善其生存质量。     

Improved control of bulky prostate carcinoma with sequential estrogen and radiation therapy

Patients with bulky prostate cancer have usually been treated by palliative measures because the likelihood of tumor control with definitive irradiation has been low and the development of distant metastases high. The addition of estrogen to irradiation has not been shown to be of value. However, we believe the method of estrogen administration may have been the cause for the apparent lack of benefit. Estrogen had been started either concurrent with irradiation or had been used for palliation and was given for long and unscheduled time periods prior to irradiation. We have used estrogen for two months prior to and concurrent with irradiation. We postulated that in those patients with estrogen responsive cancer, the reduced tumor burden prior to irradiation could enhance tumor control and survival. Between 1975 and 1980, 25 patients with bulky prostate cancer received sequential estrogen and irradiation, 12 patients irradiation alone and six patients irradiation after having become refractory to longterm estrogen use. One patient was lost to follow-up. Eighteen of 25 (72%) treated by sequential estrogen and irradiation, 14/17 (82%) with estrogen responsive cancer and 4/8 (50%) with estrogen resistant cancer had a complete tumor response. Six of 11 (55%) patients treated by irradiation alone and 2/6 (33%) treated by irradiation for estrogen refractory cancer had a complete tumor response. Disease-free survival was observed in 13/25 (52%) treated by sequential estrogen and irradiation, and 8/17 patients (47%) with irradiation. It is also possible the improved survival in the estrogen responsive group was a direct result of improved local control. Persistent local disease can act as a source for distant metastases. Distant metastases was observed in 15% of patients when the primary tumor was controlled and 30% when there was persistent or recurrent local disease. Also, progressive local disease can be an important cause of death. This was most evident in our patients with estrogen refractory cancer. Almost all patients in this group had progressive local disease that caused serious urinary bleeding and urinary infection that were considered the major cause of death. Our results suggest bulky prostate cancer should be aggressively treated when first diagnosed. The value of adjunct estrogen is unproven. Our results with the use of estrogen prior to and concurrent with irradiation is encouraging. Estrogen may shrink the cancer and allow for a more favorable geometry for external irradiation. Tumor control and survival may be thereby improved. The lower frequency of tumor control and survival of patients with estrogen resistant cancer indicates the need to explore other therapeutic approaches for this group of patients. A higher dose of external irradiation or the addition of chemotherapy prior to irradiation may be of value.     

局部晚期食管癌的围手术期治疗策略

我国是食管癌的高发地区之一,目前手术仍是局部晚期食管癌治疗的主要手段。为降低手术患者复发、转移的几率,延长其生存期,寻求最佳的治疗方法,已有多个临床研究对围手术期联合化、放疗的综合治疗方法进行了探索。本文对近年来针对围手术期治疗的主要临床研究做一综述。      

早期乳腺癌保守性手术后放射治疗进展

保守性手术已成为早期乳腺的主要治疗方式，而放射治疗是乳腺癌保乳综合治疗中一个不可缺少的组成部分，是防止局部复发的根本保证。因此，术后放射治疗很关键。     

Interstitial high dose-rate brachytherapy: principle, practice and first clinical experiences with a new remote-controlled afterloading system using Ir-192

In our newly developed remote-controlled afterloading system, a single Ir-192-source is moved within hollow stainless steel needles, which are arranged strictly parallel and are uniformly spaced. Dose calculation is performed by an especially designed computer program using geometrical bodies (ellipsoid, cylinder and plane parallel body) as idealized tumor shapes. Reference points for calculation are defined on the surface of the chosen geometrical body. Theoretical base, principles of dosage, handling and first clinical experiences after treatment of 28 patients are presented.     

拓扑替康治疗小细胞肺癌的临床疗效观察

目的探讨以拓扑替康(Topotecan)为主联合方案治疗小细胞肺癌(SCLC)的疗效及安全性.方法初治和复治患者30例,拓扑替康1.20 mg/(m2*d),静脉滴入30 min,1次/d,连用5 d,21 d为1个周期.2个周期评价疗效,1个周期可评价不良反应.结果在30例患者中,CR 4例,PR 15例,有效率63.3%.主要不良反应为骨髓抑制,非血液学毒性较轻微,一般均可耐受.结论以拓扑替康为主联合化疗方案治疗SCLC有效,可作为SCLC一线或二线用药,局限期疗效优于广泛期.