电离辐射致甲状腺疾病的临床观察

作者对202例头颈部肿瘤放疗患者及678例甲状腺机能亢进症服¹³¹I治疗想者的甲状腺疾病的临床资料进行了统计分析,分析表明,放射性甲状腺机能减退症是电离辐射诱发的主要的甲状腺疾病。其发牛率为6%～12%:外照射诱发甲状腺机能减退症的生物效应是¹³¹I内照射的3.6倍；多见于照后3～8年。对放射性甲状腺疾病的类型,放射性甲状腺机能减退症的发生率,潜伏期.内外照射生物效应的差剐,剂量阀值以及各类甲状腺疾病的关系等问题进行了简要的讨论。     

外放疗联合个体化导板辅助 125I放射性粒子植入治疗晚期头颈部鳞癌

目的：探讨外放疗联合个体化导板辅助¹²⁵I放射性粒子植入治疗无法手术的头颈部鳞癌的可行性及不良反应。 方法：对17例因全身系统疾病而无法手术的头颈部鳞癌患者进行常规分割放疗联合个体化导板辅助¹²⁵I放射性粒子植入增量放疗。外放疗总照射剂量为50 Gy,放射性粒子匹配周缘剂量（matched peripheral dose, MPD）为80~120 Gy。 结果：通过肿瘤体积变化情况和临床表现评价治疗标准,17例患者治疗总有效率达到82.4%（14/17）,1例死于大出血。主要的不良反应包括：软组织坏死、局部出血及放射性黏膜炎和皮炎等,治疗过程未发生急性并发症与严重的放射性损伤。 结论：外放疗联合个体化导板辅助¹²⁵I放射性粒子植入治疗晚期头颈部鳞癌,是一种微创、有效、安全性高的治疗方案。     

恶性肿瘤放疗对甲状腺功能损伤的研究

放射治疗是当前治疗头颈部肿瘤的主要手段之一,甲状腺受电离辐射照射后可引起功能和形态改变,乃至发生癌变的严重后果,这些越来越受到人们的关注。     

一例放射性甲状腺功能减退

一例放射性甲状腺功能减退邓惠静，马力文上胸部、头颈部肿瘤患者进行放射治疗或甲状腺机能亢进患者应用同位素治疗后易引起医源性甲状腺功能减退（以下简称甲减）。Ｘ；文作者报道一例乳腺癌术后，由于锁骨上淋巴作者单位：北京医科大学第三临床医院职业病中心１０００８...     

放射性龋齿相关因素研究

随着综合治疗在头颈部肿瘤放疗中的应用和病人长期生存率的提高,需要对相关并发症的治疗及病人的生存质量给予越来越多的关注.放射性龋齿是头颈部肿瘤放疗后最常见的远期损伤.对放射性龋齿形成原因、影响因素、治疗方法及预防措施进行综述,并探寻降低放射性龋齿发生率的有效方法.     

头颈部肿瘤涎腺放射性损伤的防治研究进展

放射性涎腺损伤是头颈部肿瘤患者放射治疗后最常见的并发症之一,表现为口腔疼痛,说话、吞咽困难等症状,严重影响患者的生存质量。因此,涎腺放射性损伤的防治十分重要。本文从放疗保护药物、放疗技术、分子生物学等方面,针对头颈部肿瘤涎腺放射性损伤的预防与治疗予以综述。     

放射性龋齿相关因素研究

随着综合治疗在头颈部肿瘤放疗中的应用和病人长期生存率的提高，需要对相关并发症的治疗及病人的生存质量给予越来越多的关注。放射性龋齿是头颈部肿瘤放疗后最常见的远期损伤。对放射性龋齿形成原因、影响因素、治疗方法及预防措施进行综述，并探寻降低放射性龋齿发生率的有效方法。     

大鼠脑照射后学习记忆力下降及脑损伤修复的研究

放射性脑病(Radiation encephalopathy REP)是头颈部恶性肿瘤患者放射治疗后经过一段潜伏期产生神经系统损害的疾病，是肿瘤放疗后的严重并发症。本研究通过建立放射性脑损伤动物模型，Morris水迷宫检测其学习记忆能力，观察大鼠全脑照射后学习记忆能力的改变，并给予GM1进行干预治疗，以观察GM1对脑照射后大鼠学习记忆能力的影响，为放射性脑病的临床治疗提供依据。     

康复新液联合美皮康泡沫敷料治疗头颈部肿瘤放疗后的皮肤损伤

头颈部肿瘤由于放疗时间长、剂量大,引起放射性皮肤损伤发生率高,轻者皮肤脱屑、渗液,3~4级放射性皮肤损伤属于较重的皮肤损伤^[1],既增加患者痛苦,又影响疗效。因此,及时有效地治疗3级以上放射性皮肤损伤是首要问题。对头颈部肿瘤放疗致皮肤损伤采用康复新液、美皮康泡沫敷料治疗,取得满意效果,现报道如下。     

头颈部肿瘤放疗相关口腔并发症和治疗

放疗是头颈部肿瘤患者常见的治疗方式。头颈部放疗常会导致口腔颌面部并发症, 因该部位组织结构复杂, 发病机制多样, 现有的治疗方案和研究进展较为局限。本文重点对最常见的放射性口腔黏膜炎、放射性唾液腺损伤及放射性龋齿进行系统总结, 回顾了现有发病机制假说、治疗及研究进展, 以期为深入研究相关病理机制和新的预防、治疗手段提供一定的参考。     

CT-Guided Core Needle Biopsy of Deep Suprahyoid Head and Neck Lesions

Objective

To evaluate the efficacy of computer tomography (CT)-guided core needle biopsy (CNB) in the diagnosis of deep suprahyoid lesions in patients with treated head and neck cancers.

Materials and Methods

Between December, 2003 and May, 2011, 28 CT-guided CNBs were performed in 28 patients with deep suprahyoid head and neck lesions. All patients had undergone treatment for head and neck cancers. Subzygomatic, paramaxillary, and retromandibular approaches were used. The surgical results, response to treatment, and clinical follow-up were used as the diagnostic reference standards.

Results

All biopsies yielded adequate specimens for definitive histological diagnoses. A specimen from a right parapharyngeal lesion showed atypia, which was deemed a false negative diagnosis. Diagnostic accuracy was 27/28 (96.4%). Two minor complications were encountered: a local hematoma and transient facial palsy. Between the 18 or 20 gauge biopsy needles, there was no statistical difference in the diagnostic results.

Conclusion

CT-guided core needle biopsy, with infrequent and minor complications, is an accurate and efficient method for the histological diagnosis of deep suprahyoid lesions in post-treated head and neck cancer patients. This procedure can preclude an unnecessary surgical intervention, especially in patients with head and neck cancers.     

Reirradiation for recurrent head and neck carcinoma using high-dose-rate brachytherapy: A multi-institutional study

AIMThis study presents multi-institutional individual data of reirradiation (ReRT) for head and neck cancer using brachytherapy (ReRT-BT) collected by national surveillance in Japan.METHODS AND MATERIALSWe distributed an e-mail-based questionnaire to 153 institutions equipped with high-dose-rate (HDR) brachytherapy facilities and received responses from 76 institutions (49.7%). Of these 76 institutions, only four (5.2%) performed ReRT-BT for head and neck cancers, and three provided individual patient's data.RESULTSSix ReRT-BT cases of patients with recurrent head and neck cancer, treated with HDR brachytherapy in seven ReRT sessions, were identified from three institutions. Three patients (two cases of lips and one case of gingiva) who underwent curative-intent treatment achieved complete response at the treated area. Three patients who received palliative treatment (one case of tongue and two cases of maxillary sinus) had sustained tumor growth at the treated site, but with improvement in symptoms. No grade ≥3 toxicity was found after HDR ReRT-BT.CONCLUSIONSReRT-BT for head and neck cancer using HDR brachytherapy is a safe and useful approach to treat recurrent cancer after initial radiotherapy with curative and palliative intent. However, the scarce availability of ReRT-BT is a barrier to the wider utility of this effective procedure.     

Feeding the Data Monster: Data Science in Head and Neck Cancer for Personalized Therapy

ObjectiveHead and neck carcinomas are clinically challenging malignancies because of tumor heterogeneities and resilient tumor subvolumes that require individualized treatment planning and delivery for an improved outcome. Although current approaches to diagnosis and therapy have boosted locoregional control, the long-term survival in this patient group remains unchanged over the last decades. A new approach to head and neck cancer management is therefore needed to better identify patient subgroups that are responsive to specific therapies. The aim of this article is to review the current status of knowledge and practice utilizing big data toward personalized therapy in head and neck cancers based on CT and PET imaging modalities.MethodsLiterature published in English since 2000 was searched using Medline. Additional articles were retrieved via pearling of identified literature. Publications were reviewed and summarized in tabulated format.ResultsStudies based on big data in head and neck cancer are limited; however, the field of radiomics is under continuous development and provides valuable input for personalized treatment. Using PET/PET CT biomarkers for patient treatment individualization and response prediction seems promising, especially in regard to detection of hypoxia and clonogenic cancer stem cells. Literature shows that macroscopic changes in medical images (whether structural or functional) are correlated with biologic and biochemical changes within a tumor.ConclusionCurrent trends in data science suggest that the ideal model for decision support in head and neck cancers should be based on human-machine collaboration, namely, on (1) software-based algorithms, (2) physician innovation collaboratives, and (3) clinician mix optimization.     

Experience of high-dose-rate brachytherapy for head and neck cancer treated by a customized intraoral mold technique

Radiotherapy of head and neck cancer has become more successful with the advances in treatment modalities and use of a multidisciplinary approach. Higher quality treatment and a team approach to radiotherapy have thus been required for head and neck cancer. This study presents the clinical experience of high-dose-rate (HDR) brachytherapy for head and neck cancer treated by a customized intraoral mold technique. Two patients are reported for whom we created dental prostheses as the radiation carriers for HDR brachytherapy of their head and neck cancers. HDR brachytherapy with the dental prostheses reported here was feasible and effective for eradicating the head and neck cancer. It has been demonstrated that HDR brachytherapy using a customized intraoral technique can be a treatment option for patients who are not candidates for surgery or external irradiation. It is strongly suggested that specialized dentists are needed who are familiar with not only the anatomy and function of the head and neck region but also radiotherapy. Dental radiologists should take responsibility for constructing irradiation prostheses. If they do, they have the potential to improve the quality of life of patients who undergo radiotherapy for head and neck cancer.     

Use of diffusion-weighted imaging (DWI) in PET/MRI for head and neck cancer evaluation

Objective

The purpose of this study was to analyze whether diffusion-weighted imaging (DWI) adds significant information to positron emission tomography/magnetic resonance imaging (PET/MRI) on lesion detection and characterization in head and neck cancers.

Methods

Seventy patients with different head and neck cancers were enrolled in this prospective study. All patients underwent sequential contrast-enhanced (ce) PET/computed tomography (CT) and cePET/MRI using a tri-modality PET/CT-MR setup either for staging or re-staging. First, the DWI alone was evaluated, followed by the PET/MRI with conventional sequences, and in a third step, the PET/MRI with DWI was evaluated. McNemar’s test was used to evaluate differences in the accuracy of PET/MRI with and without DWI compared to the standard of reference.

Results

One hundred eighty-eight (188) lesions were found, and of those, 118 (62.8 %) were malignant and 70 (37.2 %) were benign. PET/MRI without DWI had a higher accuracy in detecting malignant lesions than DWI alone (86.8 % vs. 60.6 %, p?Conclusion The use of DWI as part of PET/MRI to evaluate head and neck cancers does not provide remarkable information. Thus, the use of DWI might not be needed in clinical PET/MRI protocols for the staging or restaging of head and neck cancers.     

Application of fluorodeoxyglucose positron emission tomography in the management of head and neck cancers

The use of fluorodeoxyglucose positron emission tomography (FDG PET) scan technology in the management of head and neck cancers continues to increase. We discuss the biology of FDG uptake in malignant lesions and also discuss the physics of PET imaging. The various parameters described to quantify FDG uptake in cancers including standardized uptake value, metabolic tumor volume and total lesion glycolysis are presented. PET scans have found a significant role in the diagnosis and staging of head and neck cancers. They are also being increasingly used in radiation therapy treatment planning. Many groups have also used PET derived values to serve as prognostic indicators of outcomes including loco-regional control and overall survival. FDG PET scans are also proving very useful in assessing the efficacy of treatment and management and follow-up of head and neck cancer patients. This review article focuses on the role of FDG-PET computed tomography scans in these areas for squamous cell carcinoma of the head and neck. We present the current state of the art and speculate on the future applications of this technology including protocol development, newer imaging methods such as combined magnetic resonance and PET imaging and novel radiopharmaceuticals that can be used to further study tumor biology.     

High-dose-rate and pulsed-dose-rate brachytherapy in palliative treatment of head and neck cancers

PurposeThe main purpose of the study was to assess the results of high-dose-rate brachytherapy (HDRBT) and pulsed-dose-rate brachytherapy (PDRBT) in the palliative treatment of patients with locally or regionally recurrent head and neck cancers. The detailed aims concerned the evaluation of these methods in the context of local control, survival, and complications rates in patients subgrouped by different parameters such as age, gender, primary and recurrent tumor localization, tumor size, treatment method (HDR/PDR), primary treatment method, and radiation dose applied.Methods and MaterialsPDRBT and HDRBT were used in 106 and 50 patients, respectively. In 8 patients, BT procedures were performed in combination with simultaneous chemotherapy. Sixteen patients were additionally treated with interstitial hyperthermia. All patients were regularly followed up within 6 months. Local control, complications, and survival were assessed. Materials included 156 patients with head and neck cancers treated palliatively with HDRBT and PDRBT in the Department of Otolaryngology of Poznań University of Medical Sciences and in the Department of Brachytherapy of Greater Poland Cancer Center from January 2002 to November 2008.ResultsComplete and partial remissions 6 months after finishing the treatment were achieved in 37.7% of patients, whereas survival rates 12 and 24 months after brachytherapy were estimated for 40% and 17%, respectively. The overall complications rate was 35%.ConclusionsOur results suggest that HDRBT and PDRBT constitute a safe alternative in the palliative treatment of patients with locally or regionally recurrent head and neck cancers with a relapse in a previously irradiated area, which were not qualified or rejected surgery. It gives a good palliative effect with acceptable complication rate.     

Helical tomotherapy with simultaneous integrated boost dose painting for the treatment of synchronous primary cancers involving the head and neck

Objective:

To demonstrate the feasibility of helical tomotherapy (HT)-based intensity-modulated radiotherapy (IMRT) for the treatment of synchronous primary cancers arising from the head and neck.

Methods:

14 consecutive patients with histologically proven squamous cell carcinoma of the head and neck were determined to have a second primary cancer in the upper aerodigestive tract on further evaluation and were treated with HT using simultaneous integrated boost IMRT. Megavoltage CT scans were acquired daily as part of an image-guided registration protocol. Concurrent platinum-based systemic therapy was given to nine patients (64%).

Results:

HT resulted in durable local control in 21 of the 28 primary disease sites irradiated, including a complete clinical and radiographic response initially observed at 17 of the 20 sites with gross tumour. The mean displacements to account for interfraction motion were 2.44 ± 1.25, 2.92 ± 1.09 and 2.31 ± 1.70 mm for the medial–lateral (ML), superior–inferior (SI) and anteroposterior (AP) directions, respectively. Table shifts of >3 mm occurred in 19%, 20% and 22% of the ML, SI and AP directions, respectively. The 2-year estimates of overall survival, local-regional control and progression-free survival were 58%, 73% and 60%, respectively.

Conclusion:

The effectiveness of HT for the treatment of synchronous primary cancers of the head and neck was demonstrated.

Advances in knowledge:

HT is a feasible option for synchronous primary cancers of the head and neck and can result in long-term disease control with acceptable toxicity in appropriately selected patients.The proportion of patients with newly diagnosed head and neck cancer who are found to have a synchronous second primary tumour has been estimated to range from 5% to 15%.^1–3 Slaughter et al⁴ described the concept of field cancerization as the most logical explanation for the development of multiple cancers in the upper aerodigestive tract. With the routine adoption of panendoscopy and the widespread utilization of positron emission tomography (PET) as a component of the initial staging evaluation, the number of patients diagnosed with synchronous cancers involving the head and neck appears to be increasing.⁵ Despite the increased prevalence, uncertainty exists regarding the optimal manner in which patients with synchronous primary cancers of the head and neck should be managed. For patients receiving radiotherapy, the large areas at risk for tumour recurrence make treatment delivery a therapeutic and technical challenge.Intensity-modulated radiotherapy (IMRT) reduces radiation to critical structures while maintaining desired doses to user-defined targets through a computer-derived optimization process (i.e. inverse planning) and non-uniform beam intensities. Because of its ability to achieve conformal dose distributions to convex and concave targets, IMRT represents the standard in the radiotherapeutic management of head and neck cancer. Helical tomotherapy (HT) is a specialized form of IMRT, which is also based on inverse planning but relies on a rotational gantry and a binary multileaf collimator system rather than a fixed number of beam angles for radiation delivery. We report here our experience with HT for the treatment of synchronous primary cancers involving the head and neck.     

A survey of techniques to reduce and manage external beam radiation-induced xerostomia in British oncology and radiotherapy departments

Xerostomia is the most common side effect of external beam radiotherapy to the head and neck [Anand A, Jain J, Negi P, Chaudhoory A, Sinha S, Choudhury P, et-al. Can dose reduction to one parotid gland prevent xerostomia? – A feasibility study for locally advanced head and neck cancer patients treated with intensity-modulated radiotherapy. Clinical Oncology 2006;18(6):497–504.]. A survey was carried out in British oncology departments to determine what treatment regimes, to minimise xerostomia, are used for patients with head-and-neck cancers treated with external beam radiotherapy.A semi-structured questionnaire consisting of both quantitative and qualitative questions was designed that asked departments which of the identified methods they used, why a method might not be currently employed, and whether its use had ever been considered.The study found that there are wide disparities between the techniques employed by oncology departments to avoid and reduce xerostomia in patients with cancers of the head and neck. The National Institute of Clinical Health and Excellence, [National Institute for Clinical Health and Excellence (NICE). Improving outcomes in head and neck cancers: the manual. London: Office of Public Sector Information; 2004.] for example, recommends that patients are given dental care and dietary advice but some departments did not appear to be doing this. Less than half of departments stated that they offer complementary therapies and less than 40% prescribed pilocarpine, a saliva-stimulant. Only two respondents stated that they use amifostine, a radioprotector, during radiotherapy treatment to the head and neck.The results also suggested a move toward using Intensity Modulated Radiotherapy (IMRT) for treating head-and-neck cancers which offers better normal tissue sparing than three-dimensional conformal radiotherapy. [Anand A, Jain J, Negi P, Chaudhoory A, Sinha S, Choudhury P, et al. Can dose reduction to one parotid gland prevent xerostomia? – A feasibility study for locally advanced head and neck cancer patients treated with intensity-modulated radiotherapy. Clinical Oncology 2006;18(6):497–504, Braam P, Terhaard C, Roesnink J, Cornelis P, Raaijmakers C. Intensity-modulated radiotherapy significantly reduces xerostomia compared with conventional radiotherapy. International Journal of Radiation Oncology, Biology and Physics 2006, Wendt TG, Abbasi-Senger N, Salz H, Pinquart I, Koscelny S, Przetak S, et al. 3D-conformal-intensity modulated radiotherapy with compensators for head and neck cancer: clinical results of normal tissue sparing. Radiation Oncology 2006;1:18. Available from: http://www.ro-journal.com/content/1/1/18 [accessed on 21.11.06].]. This, in turn, offers increased normal tissue sparing than conventional radiotherapy [Ng M, Porceddu S, Milner A, Corry J, Hornby C, Hope G, et al. Parotid-sparing radiotherapy: does it really reduce xerostomia? Clinical Oncology 2005;17(8):610–7.]. The survey indicated that all three techniques, however, are still in use in oncology and radiotherapy departments, and several departments stated that financial considerations were hindering their move toward providing IMRT.