松果体生殖细胞瘤放射治疗分析

目的　探讨立体定向放射治疗技术联合常规放疗在松果体生殖细胞瘤治疗中的应用及治疗效果。方法　 1996年4月— 1997年 9月 7例松果体生殖细胞瘤患者接受放射治疗 ,其中 2例应用γ 刀立体定向单次大剂量放射治疗加全脑全脊髓放射治疗 ,3例应用X 刀立体定向分次放射治疗加全脑全脊髓放射治疗 ,2例应用常规放疗加全脑全脊髓放射治疗。结果　 5例患者行γ 刀、X 刀立体定向放射治疗联合全脑全脊髓放射治疗 ,治疗结束后 4例患者肿瘤消失 ,1例肿瘤明显缩小 ;2例行常规放疗联合全脑全脊髓放射治疗者 ,治疗结束后肿瘤均明显缩小 ;所有患者在治疗过程中均有轻度恶心呕吐 ,白细胞下降 ,治疗结束后临床症状均明显减轻。 1例患者因严重消化道反应及白细胞下降终止治疗 ,于 5个月后出现脊髓转移。 2例随访 2 6个月 ,1例随访 18个月 ,2例随访 12个月 ,均无肿瘤复发。结论　应用立体定向放射治疗技术联合常规放疗能有效控制肿瘤 ,不良反应小 ,安全可靠 ,可能成为松果体生殖细胞瘤首选治疗方法。     

立体定向放射治疗体部肿瘤(附96例随访分析)

目的:通过临床随访观察,确定用立体定向分次放射治疗(Fractionted Stereotactic Radiotherapy,FSRT)体部肿瘤的近期疗效。对象与方法:96例体部肿瘤患者,其中38例肺癌、12例肝癌、11例胰腺癌、6例纵隔恶性肿瘤、6例食管癌、5例胃癌、5例胆管癌、6例直肠癌、3例宫颈癌和卵巢癌、4例椎骨转移瘤,继确诊和/或手术后,均经x线立体定向分次放射治疗。全部病例中67例(70％)经术前经皮穿刺针吸活组织检查或术后病理组织学检查证实,其余病例由临床、CT和/或磁共振等影像资料证实。用体箱、负压袋固定患者后CT扫描定位,X线立体定向放射治疗计划系统设计并优化治疗计划,加速器旋转照射。部分病人结合常规放射治疗。结果:X线立体定向放射治疗后1～3周内,90例(近94％)表现出临床症状明显改善,而且在此期间未发现1例严重并发症或死亡。肺癌患者随访CT检查32例,其中29例于FSRT后1～6个月肿瘤消失,2例肿瘤体积缩小50％以上,只有1例肿瘤大小无变化,有效率近97％。FSRT对其他肿瘤也有明显疗效,不仅可使原发癌灶缩小或消失,而且可使有癌转移的淋巴结消失。结论:FSRT是一种安全、无痛苦的、且能保持器官原有形态、结构及功能的治疗体部肿瘤的方法,它不仅适合于早期肿瘤患者,而且尤其适合于那些年老体弱,不能耐受手术的或术后残     

X-刀治疗颅内病变的CT定位

目的 :探讨 X-刀治疗颅内病变 CT定位的方法。方法 :CT定位 X-刀治疗颅内肿瘤及动静脉畸形 337例 ,采用 FN-89或 Fischer立体定向仪 ,Somatom- DR CT机扫描定位 ,X-刀治疗软件根据 CT系列图像自动优化计划治疗。结果 :所有 X-刀治疗的病灶均采用 CT定位 ,靶点确定均一次到位。结论 :CT定位行 X-刀治疗颅内肿瘤及动静脉畸形是一种安全有效的方法     

立体定向适形放射治疗颅外中晚期恶性肿瘤的护理

我院肿瘤科 ,于 1 998年 6月～ 1 999年 5月应用立体定向适形放射治疗(体部Ｘ -刀)前程或后程结合常规放疗对 1 90例中晚期颅外恶性肿瘤患者进行了临床观察和分析 ,取得了较好的疗效 ,现结合临床护理体会报告如下。1　临床资料患者 1 90例 ,其中男 1 2 7例 ,女 63例 ,年龄 4 0～82岁 ,随机分成两组进行前瞻性分析 ,1 0 0例前程或后程结合常规放疗实施立体定向适形放疗为对照组。2　结果立体定向适形放射治疗具有定位准确、计划精确、剂量精确的特点 ,本组资料共有 1 0 0例接受立体定向放射联合治疗 ,结果表明 ,在常规放疗基础上追加立体定向…     

立体定向放射治疗技术的进展

立体定向放射治疗包括立体定向放射外科(sterotacic ra-diosurgery,SRS)和立体定向放射治疗(sterotaetie radiotherapy,SRT),其共同特点是借助立体定向装置和影像设备准确定出靶区的空间位置,经计算机优化后通过γ线(γ-刀)或X线(X-刀)集束照射,使靶接受高剂量均匀照射而周围组织受量很低以达到控制或根除病变的目的[1]。SRS治疗对象初期     

超级伽玛刀治疗肿瘤536例近期疗效分析

γ射线立体定向全身放射治疗系统(简称:全身γ刀)是由我国首创,具有完全自主知识产权,国际领先的立体定向放射治疗设备,通过近10年的临床应用,目前我国已有近100台不同类型的γ刀治疗了各类癌症患者10万余例,已成为我国重要的立体定向放射治疗手段之一[1].我院自2007年3月～2008年5月应用超级γ刀(SGS-I型)治疗肿瘤患者536例,效果良好.     

立体定向放射治疗在鼻咽癌初治中的推量应用效果观察

目的探讨立体定向放射治疗在鼻咽癌初治患者放射治疗中的推量应用对局控率和近期疗效的影响。方法常规放射治疗＋立体定向放射治疗鼻咽癌36例。肿瘤体积3～76cm3,应用BJ-6B6MV-X射线进行常规放射治疗,剂量达60～70GY后,应用SGI-TPS拟制立体定向放射治疗计划,BEV方向4～8个非共面照射野,计划靶区体积（PTV）一次治疗量4～5GY,3/周,总剂量12～20GY。结果本组患者1、2、3年的鼻咽局部控制率分别达到97.2%、91.6%和86.1%。除1例患者在治疗后13个月死于远处广泛转移外,无其他特殊并发症发生。结论鼻咽癌初治患者在常规外照射后给予立体定向加量照射,能够取得较好的局部控制。     

CT立体定向术在内放射治疗囊性颅咽管瘤的应用

目的：探讨治疗囊性颅咽管瘤最佳方法。方法：对20例囊性颅咽管瘤行CT立体定向囊内置管同位素（胶体磷酸铬）放射治疗。结果：全部病例经排除囊液后临床症状迅速改善,经囊内放射治疗后,2－5年随访,CT扫描显示,肿瘤均较治疗前明显缩小。结论：CT立体定向囊腔内放射治疗囊性颅因咽管瘤十分安全、有效,应作为治疗囊性颅咽管瘤首选的方法。     

肺癌的X刀放疗及CT随访观察

目的　探讨X刀立体定向在放射治疗肺癌中的价值。方法　 5 2例肺癌患者行X刀治疗 ,治疗前后均行常规放疗 ,放疗结束后 2～ 3月行CT复查 ,比较治疗前后临床及肿瘤大小的变化情况 ,根据临床表现和CT检查结果综合判断疗效。结果　完全缓解 6例 (11.5 % ) ;部分缓解 2 9例 (5 5 .8% ) ;无变化或肿块缩小 ,缩小不足 5 0 % 13例 (2 5 % ) ;进展 4例 (7.7% )。总有效率为 92 .3 %。结论　X刀治疗肺癌可以使肿瘤局部得到准确的高剂量照射 ,近期疗效显著 ,安全可行。     

应用放射治疗模拟机对二次复形真空袋体位固定精度的验证研究

目的:探讨半软状态二次复形真空袋体位固定误差,为立体定向放射治疗中能否使用其提供依据。方法:抽取无漏气真空袋120例为对照组,抽取半软状态二次抽真空复形真空袋45例为实验组,应用模拟定位机对照射前、后测量灯光野与照射野X、Y、Z方向的移动情况进行比较,并进行统计学处理。结果:无漏气真空袋体位固定患者的X、Y、Z坐标的偏差率为5.83%,而半软状态二次复形真空袋体位固定患者X、Y、Z坐标的偏差率为35.65%,二者比较差异有显著性意义(P<0.01),故提示不能使用二次复形真空袋作为立体定向放射治疗的体位固定。结论:本研究结果表明在X-刀治疗中,使用真空袋体位偏差率及偏差幅度低,具有较好的体位固定效果,能保证良好的体位重复性。半软状态二次复形真空袋则有较大偏差率及偏差幅度,不宜在立体定向放射治疗中继续应用,应当重新制作真空袋进行CT定位。     

全身伽玛刀适形放疗非小细胞肺癌169例临床分析

目的 分析非小细胞肺癌(NSCLC)全身伽玛刀适形放疗的疗效及并发症.方法 采用全身伽玛刀治疗的NSCLC 169例,根据病程、肿瘤部位、性质、体积确定放射总剂量、分割次数、时间.小靶区(肿瘤＜3cm),5～10Gy/次,40～50Gy/4～10次;中靶区(肿瘤3～5cm),4～8Gy/次,48～56Gy/4～16次;大靶区(肿瘤≥5cm),3～4Gy/次, 40Gy/10～14次后缩野,追加剂量10～30Gy.结果 完全缓解率(CR)41.6%,部分缓解率(PR)42.8%,无变化率(NC)13.8%,总有效率(CR PR)84.4%.1年局部控制率92.3%,1、2年生存率75.1%、46.2%,放射性肺炎发生率Ⅰ～Ⅱ级为15.4%,Ⅲ级为3.1%.结论 全身伽玛刀治疗NSCLC近期疗效好,副作用轻微,能显著提高肿瘤的局部控制率.     

立体定向放射外科治疗作用于正常脑组织的放射生物学研究进展

立体定向放射外科(SRS)治疗主要包括伽玛刀和X-刀等治疗手段,通过利用高能射线以立体定向的方法照射颅内靶病灶,使之发生放射性毁损。由于靶区与周围正常脑组织间有非常陡峭的剂量梯度,因此在治疗疾病的同时,周围正常脑组织受到的损伤很小,并可使患者免受开颅的痛苦,因此较手术治疗更安全。但是,SRS治疗对靶区周围及脑内正常脑组织并非全然没有影响,在治疗靶灶的同时,仍会引起正常脑组织产生放射生物学反应。本文就SRS治疗对正常脑组织的放射生物学效应进行综述。     

Natural history of intracranial meningioma after radiotherapy]

The author examined the natural history of intracranial meningioma after radiotherapy using CT or MR imaging. Twenty patients with intracranial meningioma received radiotherapy from a high-energy linear accelerator (4-10 MV X rays) from 1980 to 1996. The total doses were 50 Gy to the tumor bed in single doses of 2 Gy in 5 weekly fractions. Meningiomas in 10 of 20 patients were reduced within 1 to 38 months after radiotherapy, the average being 11 months. The tumors were controlled for a median of 60 months after radiotherapy (range 19-126 months). Four other patients have shown no change in tumor size after radiotherapy. The tumors were controlled for a median of 70 months after radiotherapy (range 37-127 months). The other six patients have shown tumor growth within 3 to 25 months after radiotherapy, after which the tumors stopped growing for a median of 71 months (range 2-181 months). Neither tumor size nor histological type was related to response. The growth of tumors was controlled by radiotherapy for a median duration of 43 months in the meningothelial type, 52 months in the fibroblastic type, and 61 months in the transitional type. The median duration for all benign tumors was 52 months. A moderate correlation was noted between tumor response and functional outcome after radiotherapy in 9 patients with neurological deficits. The natural histories of intracranial meningiomas after radiotherapy were grouped into three categories. Some tumors showed no change in size over a long period. This was a characteristic response after radiotherapy that differed from that of other brain tumors. The results of this study provide important information for the follow-up of intracranial meningiomas after radiotherapy.     

非小细胞肺癌患者体部伽玛刀治疗后局部复发的多因素分析

目的 分析非小细胞肺癌患者体部伽玛刀治疗后局部复发的影响因素,探讨规范化治疗方案.方法 332例非小细胞肺癌患者行体部伽玛刀治疗,并定期随访,对患者的性别、年龄、卡氏评分、临床分期、病理类型、肿瘤分化程度、肿瘤体积、肿瘤部位、靶区勾画、分次剂量、等效生物剂量、化疗方案等进行单因素分析(采用χ2检验或t检验),对单因素分析有意义的临床因素应用COX模型进行多因素分析.结果 在定期随访过程中,332例患者有22例出现局部复发.多因素分析结果显示年龄大、等效生物剂量低与局部复发有关.结论 非小细胞肺癌患者体部伽玛刀治疗的等效生物剂量低是导致局部复发的重要原因.行根治性治疗的患者局部宜给予大于80Gy的等效生物剂量.     

χ刀治疗颅内外疾病CT影像学初步评价

目的：探讨χ刀治疗颅内外疾病的效果及ＣＴ表现。方法：对颅内外病变１０５例共１２０个病灶施行χ刀治疗，３６例于χ刀术后２～９个月进行ＣＴ随访，其中胶质瘤１６例，转移瘤７例，脑膜瘤５例，鼻咽癌１例，听神经瘤２例，垂体瘤３例，脑血管畸形２例。３例χ刀治疗后又行外科手术。结果：在ＣＴ随访的３６例中１０例缩小、明显缩小以致消失。８例与治疗前相比无改变。其余各例均发生形态变化。３例χ刀治疗后又进行外科手术，病理结果显示有大量凝固性坏死组织存在，检见或未检见瘤细胞。结论：我们的经验及短期随访结果表明，χ刀对控制肿瘤是一种有效的治疗手段。     

膀胱非上皮性肿瘤的诊断与治疗（附11例临床分析）

目的：总结膀胱非上皮性肿瘤的诊治特点,探讨治疗方法与预后的关系。方法：回顾性分析11例膀胱非上皮肿瘤临床资料。男7例。女4例。年龄32—65岁。其中血尿6例,尿频2例,排尿困难1例,排尿晕厥2例。超声及CT检查发现11例膀胱占位病变,均行膀胱镜检查及活检。结果：9例良性肿瘤行单纯肿瘤剜除术或膀胱部分切除术;2例恶性肿瘤均行膀胱全切术。恶性肿瘤术后辅助化疗、放疗。随访3个月-3年。良性肿瘤均无复发,恶性肿瘤2例死于术后3年内,平均存活13个月。结论：膀胱非上皮性肿瘤临床上少见,病理类型复杂,恶性居多,预后较差。误诊率高,深部活检可提高其诊断率。膀胱部分切除术或膀胱全切术是本病的主要治疗方法．良性肿瘤应完整切除．恶性肿瘤应争取广泛切除．结合其病理特点辅助放化疗可提高疗效。     

Radiotherapy for intracranial and spinal ependymomas

BACKGROUND: The low incidence of ependymomas results in limited treatment experience. While standard therapy consists of surgery and postoperative radiotherapy, irradiation techniques are still subject to discussion. We report the experience from Münster over the last 35 years. PATIENTS AND METHODS: Since 1961, 25 evaluable patients with ependymoma were irradiated in Münster: 17 intracranial and 8 spinal tumors. Fourteen of 25 patients underwent subtotal resection. Fifteen of 25 patients were treated by local irradiation, 10 of 25 with large-field techniques (whole-brain/cranio-spinal irradiation) and an additional tumor boost. The median tumor dose amounted to 50 Gy (16 to 65 Gy). Sites of recurrence were analyzed and correlated with the irradiated region. RESULTS: Twelve recurrences were observed. Six of 12 could be exactly related to the irradiation portals and were found well inside the local or boost fields. The remaining 6 tumors also recurred locally; whether they were in-field or field margin recurrences was not to be discerned by the imaging available at the time. No out-field recurrences or spinal seeding were observed. For 8 of 17 locally irradiated patients with intracranial ependymomas, 5 local recurrences were recorded. In 9 of 17 patients receiving whole-brain or cranio-spinal irradiation, 6 local recurrences were found. Two of 8 spinal tumors recurred locally. CONCLUSIONS: All tumors recurred within the former tumor bed. In the remaining cranio-spinal axis no recurrences or metastases were found. Similar results are reported from current literature. The value of large-field techniques (whole brain/spinal irradiation) is to be questioned. Modern methods like IORT or stereotactic radiotherapy might be able to deliver a higher tumor dose without increasing toxicity.     

Radiation Therapy in the Multimodal Treatment Approach of Pituitary Adenoma

BACKGROUND: Pituitary tumors are relatively uncommon, comprising 10-12% of all intracranial tumors. The treatment consisting of surgery, radiotherapy and drug therapy or a combination of these modalities is aimed at the control of tumor cell proliferation and--in endocrine active tumors--the reduction of hormone secretion. However, the slow proliferation characteristics of pituitary tumors necessitate long-term studies for the evaluation of the treatment results. In the last decade there has been continuous improvement in surgical procedures, radiotherapy techniques and drug generation. In this paper, literature will be reviewed to assess the role of modern radiotherapy and radiosurgery in the management of pituitary adenomas. MATERIAL AND METHODS: Nowadays, magnetic resonance imaging for the definition of the target volume and a real three-dimensional (3-D) treatment planning with field conformation and the possibility for non-coplanar irradiation has to be recommended. Most groups irradiate these benign tumors with single doses of 1.8-2.0 Gy up to a total dose of 45 Gy or 50.4 Gy in extensive parasellar adenomas. Adenomas are mostly small, well circumscribed lesions, and have, therefore, attracted the use of stereotactically guided high-precision irradiation techniques which allow extreme focussing and provide steep dose gradients with selective treatment of the target and optimal protection of the surrounding brain tissue. RESULTS: Radiation therapy controls tumor growth in 80-98% of patients with non-secreting adenomas and 67-89% for endocrine active tumors. Reviewing the recent literature including endocrine active and non-secreting adenomas, irradiated postoperatively or in case of recurrence the 5-, 10- and 15-year local control rates amount 92%, 89% and 79%. In cases of microprolactinoma primary therapy consists of dopamine agonists. Irradiation should be preferred in patients with macroprolactinomas, when drug therapy and/or surgery failed or for patients medically unsuitable for surgery. Reduction and control of prolactin secretion can be achieved in 44-70% of patients. After radiotherapy in acromegaly patients somatomedin-C and growth hormone concentrations decrease to normal levels in 70-90%, with a decrease rate of 10-30% per year. Hypercortisolism is controlled in 50-83% of adults and 80% of children with Cushing's disease, generally in less than 9 months. Hypopituitarism is the most common side effect of pituitary irradiation with an incidence of 13-56%. Long-term overall risk for brain necrosis in a total of 1,388 analyzed patients was estimated to be 0.2%. Other side effects are rare too, and do also depend on the damage produced by tumor itself or preceding surgery. They include deterioration of vision in 1.7% of all cases, vascular changes in 6.3%, neuropsychological disorders such as dementia in 0.7% and secondary malignancies in 0.8%, if single doses of 2.0 Gy and total doses of 50 Gy are not exceeded. CONCLUSION: Conventional radiation therapy of pituitary adenoma is highly effective. It is recommended after subtotal resection of primary tumors such as macroadenomas, after gross total resection from endocrine active adenomas with postsurgical hormone secretion and for recurrent tumors. Radiosurgery seems to be a possible treatment alternative in experienced centers, and only in patients with adenomas smaller than 25-30 mm with a minimum distance of 2-3 mm to the chiasm.