鼻咽癌调强放疗与常规放疗患者生存质量的初步观察

目的 比较鼻咽癌患者调强放疗与常规放疗的急慢性反应和生存质量。方法 系统分析2008年8月至2010年9月在宁波市李惠利医院行常规放疗及调强放射治疗(IMRT)的初治鼻咽癌患者91例,分为IMRT组(35例)和常规放疗组(56例)。常规放疗采用面颈联合野+颈切线野及耳前野+颈部电子线野,靶区剂量2.0 Gy/次,35次,共70 Gy;调强放疗设定9个共面野,靶区剂量2.12 Gy/次,33次,共69.96 Gy。比较IMRT和常规放疗患者的急性不良反应如口干、吞咽疼痛、吞咽困难、皮肤和黏膜反应等;晚期放射损伤如吞咽困难、张口困难、甲状腺功能低下、视力及听力下降、皮肤损伤、皮下组织纤维化、脊髓炎、脑损伤等方面。结果 与常规组相比,IMRT组的急性不良反应有不同程度的减轻,口干、吞咽疼痛、吞咽困难、皮肤反应和黏膜反应等的发生率较低(χ²=85.73、 56.03、 26.58、69.28和55.99,P<0.05);晚期损伤中口干、吞咽困难、味觉改变、张口困难、皮肤损伤等方面显著减轻(χ²=37.95、7.48、9.49、9.49和11.87, P<0.05),而听力下降程度、视力损伤、脑损伤等的发生率差异无统计学意义,可能与随访时间较短有关。结论 相对于常规放疗,IMRT技术能够减轻急性不良反应,并减少晚期损伤发生率,改善患者的生存质量。     

鼻咽癌常规和超分割后加速放疗的疗效分析

目的 比较鼻咽癌常规和超分割后加速放疗的局部控制率和生存率。 方法 200例初治鼻咽癌患者根据计算机产生的随机数入常规组和超分割后加速放疗组,鼻咽原发灶采用⁶⁰Co γ射线或6 MV X射线外照射,常规组70 Gy/35次/7周,超分割后加速放疗组前4周采用超分割1.2 Gy/次,剂量为48 Gy/40次,后2周加速超分割1.5 Gy/次,剂量为30 Gy/20次,均为2次/d,间隔≥6 h,5 d/周。结果 常规组99例中,远处转移25例、鼻咽复发25例、颈部复发16例;超分割后加速放疗组101例中,远处转移18例、鼻咽复发16例、颈部复发13例。常规组和超分割后加速组5年鼻咽局部控制率分别为75.9%、87.6% (χ²=4.066, P<0.05),总生存率分别为58.0%、74.1%(χ²=5.076, P<0.05),5年无远处转移率分别为74.1%、83.3%(P> 0.05),颈部局部控制率分别为81.5%、90.0%(P> 0.05)。结论 与常规分割相比,超分割后加速放疗组提高了鼻咽局部控制率和总生存率,未减少颈部复发和远处转移率。     

144例鼻咽癌常规放疗后鼻窦炎发生的因素分析

目的 探讨鼻咽癌患者常规放疗后鼻窦炎的发生情况及其影响因素。方法 回顾分析本院2000—2005年收治的放疗前无鼻窦炎而放疗后发生鼻窦炎的144例鼻咽癌患者资料,并就其影响因素进行分析。鼻窦炎的诊断用MRI法。T₁+T₂期82例,T₃+T₄期62例。鼻腔受侵58例,无鼻腔受侵86例。鼻咽灶为面颈联合野6 MV X线常规分割照射68~78 Gy, 6~8周,其中>70 Gy 55例、≤70 Gy 89例。颈部为6 MV X线+高能电子线照射,淋巴结阳性者64~74 Gy, 6~8周;阴性者50~54 Gy, 4~5周。结果 全组患者放疗后鼻窦炎总的发生率为86.8%(125例),其中T₃+T₄期的高于T₁+T₂期的,分别为94%(58例)和82%(67例),差异有统计学意义(χ²=4.32, P<0.05);鼻咽灶剂量>70 Gy的高于≤70 Gy的,分别为95%(52例)和82%(73例),差异有统计学意义(χ²=4.65, P<0.05) ;鼻腔受侵的高于未受侵的,分别为95%(55例)和81%(70例),差异有统计学意义(χ²=5.46, P<0.05)。鼻窦炎发生在放疗后3、6、12、>12个月的比例不同,分别占13.6%(17例)、31.2%(39例)、48.8%(61例)及6.4%(8例),差异有统计学意义(χ²=70.48, P<0.01)。结论 鼻咽癌患者常规放疗后鼻窦炎的发生率较高,并在1年内达最高峰;鼻腔有无侵犯、鼻咽照射剂量和T分期与放疗后鼻窦炎的发生有关。     

肺癌骨转移放疗止痛效果临床分析

目的 分析骨转移癌放疗止痛疗效。方法 将189例原发灶为肺癌的骨转移癌计221个病灶的放疗结果进行回顾性分析。放疗方案分为2种剂量分割组:(1)常规分割组:2Gy/次,5次/周,总剂量30～50Gy,共163个病灶;(2)中～低分割组:3～5Gy/次,2～3次/周,总剂量20～40Gy,共58个病灶。对不同病理类型和原发灶控制情况下的放疗结果进行分层分析。结果 常规分割、中-低分割组有效率分别为90.7%和87.9%(χ²=1.229,P>0.05),总有效率为90.0%。小细胞癌、非小细胞肺癌的有效率分别为92.4%和89.0%(χ²=0.668,P>0.05)。原发灶控制与未控制的有效率为88.4%和91.7%(χ²=0.787,P>0.05)。结论 放疗是一种有效止痛方式,可作为骨转移癌首选治疗方法。不同分割剂量放疗对骨转移疼痛的缓解程度无影响,放疗疗效与原发灶病理类型及原发灶控制与否关系不明显。     

急性期放射性脑损伤磁共振扩散张量成像的定量研究

目的 利用磁共振扩散张量成像(DTI)定量分析,探讨正常脑组织不同部位急性期放射损伤的敏感性。方法 44例欲行全颅放疗的颅内肿瘤患者,在放疗前及放疗后3周行磁共振常规扫描、增强扫描及扩散张量成像,测量非肿瘤侧大脑半球接受总放射剂量为27 Gy时的等剂量区域内脑回灰质、脑回白质、深部灰质、深部白质的表观扩散系数(ADC)、部分各向异性(FA)、相对各向异性(RA)、容积比率(VR)等指标,并进行对比分析。 结果 所有患者常规及增强磁共振扫描非肿瘤侧大脑半球均未发现异常信号,而放疗后脑回灰质ADC值升高(t=-3.819,P<0.05),脑深部灰质核团ADC、容积比率值升高(t=-3.31、-2.810,P<0.05),脑深部灰质核团FA、RA值降低(t=2.906、2.349,P<0.05),其余部位放疗前后DTI各指标差异无统计学意义。结论 在急性期脑灰质较白质对放疗损伤敏感,DTI能从组织细胞功能水平对放射性脑损伤急性反应进行评价。     

甘氨双唑钠对恶性肿瘤放射增敏的临床研究

目的 评价甘氨双唑钠(sodium glycididazole, CMNa)在恶性肿瘤的放射增敏作用及安全性。方法 对符合CMNa Ⅳ期临床研究的80例诊断明确的实体瘤患者采用三维适形放疗(three dimensional conformal radiotherapy, 3D-CRT)或常规放疗,2 Gy/次,5次/周,中位照射剂量60Gy,同期应用CMNa 800 mg/m²,每周3次;观察肿瘤近期疗效和毒性作用。结果 宫颈癌的近期疗效最好,有效率91.7%,其后依次是鼻咽癌85.7%、食管癌66.7%、肺癌54.5%、肝胆癌40%,全部有效率(CR+PR)62.6%,疾病控制率(CR+PR+SD)达到100%;黏膜、皮肤的不良反应最常见,但多为1～2级轻度反应,分别为51.3%和46.3%;血液毒性白细胞下降最明显,但与治疗前相比差异无统计学意义(χ²=3.329,P=0.061),对肝肾功能、心电图变化均无明显影响。结论 放疗结合CMNa治疗恶性肿瘤有满意的近期疗效,无明显毒性反应。     

特殊体模及膀胱充盈状态对直肠癌术后辅助放疗的影响

目的 比较特殊体模及膀胱充盈状态对直肠癌术后放疗剂量分布及正常组织受照射体积的影响,探讨直肠癌术后适形放疗较理想的治疗模式。方法 共有23例直肠癌患者入选。8例和15例患者分别采用膀胱充盈条件下常规或特殊体模固定的俯卧位3野照射,处方剂量50 Gy。15例患者CT定位同时还扫描膀胱排空状态下的图像。运用三维计划系统比较3种照射方式的靶区和正常组织体积-剂量关系、适形指数(CI_PTV)、特殊体模及膀胱充盈状态对不同剂量水平(5~52.5 Gy)小肠受照射体积影响以及小肠急性放射性反应与受照射体积的关系。结果 3种照射模式中靶区和股骨头体积-剂量分布及适形指数均无明显差异(P>0.05)。但采用特殊体模照射时,小肠在高剂量区内体积(V₂₀~V_52.5)均显著减少(P<0.01),且在膀胱充盈时更加明显,而低剂量区受照射体积(V₅~V₁₅)则减少不明显(P>0.05);膀胱充盈状态下使用特殊体模还可显著降低不同剂量水平(20~52.5 Gy)膀胱受照射体积(P<0.01)。照射过程中患者腹泻程度(RTOG 0~1和≥2)与低剂量区内(5~30 Gy)小肠受照射体积均显著相关(P<0.05)。结论 膀胱充盈状态下特殊体模固定的俯卧位照射方式明显降低了小肠和膀胱的受照射剂量,减少了小肠急性放射反应的发生。     

Raf激酶抑制蛋白预测鼻咽癌放疗敏感性

目的 探讨鼻咽癌(NPC)肿瘤组织中Raf激酶抑制蛋白(RKIP)表达与 NPC放疗敏感性的关系,评估其预测NPC患者放疗敏感性的价值。方法 采用回顾性研究,收集病理确诊为NPC且初治时无远处转移及只接受根治性调强放疗的180例患者。以放疗开始5年内鼻咽原发灶和(或)颈部转移灶的照射野内出现复发为放疗抗拒组,均有病理活检证实,且与放疗前病理类型相同;放疗开始5年内鼻咽原发灶和颈部转移灶射野内均未出现复发的NPC患者为放疗敏感组。两组患者以放疗敏感性密切相关的重要因素进行配对。免疫组织化学法检测所有入组患者在接受放疗前肿瘤组织的RKIP,分析其与放疗敏感性的关系。结果 放疗敏感组及放疗抗拒组RKIP阳性表达率(80.0%与26.7%)及表达强度差异均有统计学意义(χ²=12.498、51.429,P<0.01),且均与放疗抵抗呈负相关(r=-0.535、-0.344,P<0.01)。RKIP判别放疗抵抗的指标敏感性80.0%,特异性73.3%,准确率77.2%,阳性预测值75.0%,阴性预测值78.6%,假阳性率26.7%,假阴性率20.0%。结论 RKIP与NPC放疗抵抗呈负相关,可作为一种NPC患者内在放射敏感性的初筛分子标记物,有待前瞻性研究进一步证实。     

53例颈椎受侵鼻咽癌的常规和调强放疗疗效分析

目的 比较颈椎受侵局部晚期鼻咽癌患者使用调强放疗（IMRT）和常规放疗的临床疗效及不良反应。方法 收集2006年1月至2012年12月颈椎受侵无远处转移的初治鼻咽癌患者53例,其中调强放疗24例,肿瘤靶区剂量72~74 Gy/33次。常规放疗29例,靶区剂量68~74 Gy /34~37次。全部患者接受顺铂+氟尿嘧啶方案的同步化疗及放疗后4~6周期的辅助化疗。结果 调强组和常规组3年总生存率为87.7%和65.5%,5年总生存率为45.5%和9.1%（χ²=6.89,P<0.05）;两组间的局部无进展3 年生存率分别为87.4%和69.9%,5年生存率为49.4%和9.4%（χ²=13.26,P<0.05）。但两组间的无远处转移3年生存率为94.4%和40.8%,5年生存率为 79.8%和30.4%,差异无统计学意义。N分期（χ²=8.53,P<0.05）和调强放疗（χ²=8.02,P<0.05）为患者总生存率及无进展生存率的相关因素。调强组放疗后口干的发生率显著低于常规组（Z=-2.67,P<0.05）,两组患者急性口咽黏膜炎和骨髓不良反应的发生率差异无统计学意义。结论 与常规放疗相比,颈椎受侵局部晚期鼻咽癌患者行调强放疗能明显提高局部控制率和总生存率,但未能降低远处转移率;同时,调强放疗可以降低口干等不良反应发生率。     

射线能量对子宫内膜癌调强放疗计划质量的影响

目的 研究射线能量对子宫内膜癌术后全盆腔调强放射治疗计划质量的影响。方法 选择10例子宫内膜癌术后患者,对每例患者分别设计6和18 MV的全盆腔调强放射治疗计划。所有计划均使用相同的布野方案和剂量体积约束。比较两组计划的靶区、危及器官和正常组织的剂量分布。结果 6和18 MV计划的平均PTV₁₀₀分别是95.6%和95.3% (检验值P=0.26), D_mean分别是52.55 Gy和52.60 Gy(P=0.54),适形指数分别是0.87 和 0.88 (P=0.03),均匀性指数均为1.10 (P=0.38)。18 MV计划较6 MV计划正常组织的平均积分剂量下降了2.4% (P=0.001),小肠和结肠的平均V₃₀和V₅₀分别下降了4.2% (P=0.006)和3.3% (P=0.046),其他危及器官的剂量分布间差异无统计学意义。结论 对于子宫内膜癌的术后全盆腔调强放射治疗,18 MV计划比6 MV计划剂量分布的适形度更好,能够更好地保护正常组织、小肠和结肠。两组计划靶区的覆盖度和剂量分布的均匀性,以及直肠、膀胱和盆腔骨的保护相当。     

Moist Skin Care Can Diminish Acute Radiation-Induced Skin Toxicity

BACKGROUND: Radiation treatment may induce acute skin reactions. There are several methods of managing them. Validity of these methods, however, is not sufficiently studied. We therefore investigated, whether moist skin care with 3% urea lotion will reduce acute radiation skin toxicity. PATIENTS AND METHODS: 88 patients with carcinomas of the head and neck undergoing radiotherapy with curative intent (mean total dose 60 Gy, range: 50-74 Gy) were evaluated weekly for acute skin reactions according to the RTOG-CTC score. In 63 patients, moist skin care with 3% urea lotion was performed. The control group consisted of 25 patients receiving conventional dry skin care. The incidence of grade I, II, and III reactions and the radiation dose at occurrence of a particular reaction were determined and statistically analyzed using the log-rank test. The dose-time relations of individual skin reactions are described. RESULTS: At some point of time during radiotherapy, all patients suffered from acute skin reactions grade I, > 90% from grade II reactions. 50% of patients receiving moist skin care experienced grade I reactions at 26 Gy as compared to 22 Gy in control patients (p = 0.03). Grade II reactions occurred at 51 Gy versus 34 Gy (p = 0.006). Further, 22% of the patients treated with moist skin care suffered from acute skin toxicity grade III as compared to 56% of the controls (p = 0.0007). CONCLUSION: Moist skin care with 3% urea lotion delays the occurrence and reduces the grade of acute skin reactions in percutaneously irradiated patients with head and neck tumors.     

Proton Therapy for Head and Neck Malignancies at Tsukuba

PURPOSE: To evaluate the effectiveness and feasibility of proton therapy for head and neck cancers. PATIENTS AND METHODS: From 1983 to 2000, 33 patients with head and neck malignancies but no history of surgical resection were treated with 250-MeV protons with or without X-ray irradiation. This study retrospectively evaluated local control, survival, and treatment sequelae of these patients. The median total target dose using protons with or without X-rays was 76 Gy (range: 42-99 Gy) and the median proton dose per fraction 2.8 Gy (range: 1.5-6.0 Gy). RESULTS: Overall 5-year survival and local control rates were 44% and 74%, respectively. One (3%) and six patients (18%) suffered from treatment-related acute and late toxicity > grade 3 (RTOG/EORTC acute and late radiation morbidity scoring criteria). One patient with a history of radiotherapy suffered from acute toxicity > grade 3. CONCLUSION: Proton therapy appeared to offer high local control rates with few toxicities relative to conventional radiotherapy. However, late toxicity was seen in areas where large radiation doses had been given.     

The effect of Captopril on benign and malignant reactions in irradiated rat skin

The effect of the angiotensin converting enzyme inhibitor Captopril on the severity of radiation-induced epilation and moist desquamation and the incidence of skin tumours was determined for up to 52 weeks in male rats. The irradiation consisted of a range of single doses (0, 10, 20, 30 Gy) of 60Co gamma rays to a 3.5 cm2 right hemithorax port. Half of each radiation dose group consumed control powdered chow, and half consumed chow containing Captopril (50 mg/kg/day) continuously after irradiation. There were time- and radiation-dose-dependent increases in all three skin reactions. Rats exposed to 10 Gy exhibited a mild and transient epilation, but no moist desquamation or neoplasia in the radiation port. In animals exposed to 30 Gy, however, epilation began at 2 weeks after irradiation, reached a peak at approximately 7 weeks, then persisted essentially unchanged through 52 weeks. Captopril had no significant effect on the epilation reaction. Two waves of moist desquamation were observed after 30 Gy. The first appeared at 3 weeks after irradiation, reached a peak from 6-10 weeks, then subsided partially but significantly from 12-26 weeks. The second wave of moist desquamation began at 26-28 weeks, often was ulcerative, and occasionally was accompanied by the appearance of tumours in the irradiated volume. Captopril significantly (p less than 0.05) reduced the severity of both phases of the moist desquamation reaction after 30 Gy, and reduced the percentage of animals exhibiting the most severe desquamation score (involving 50% of the radiation port). Of particular interest was the observation that Captopril also reduced the incidence of tumours. Of the 14 tumours detected, all were malignant (fibrosarcomas, squamous cell carcinomas), and only three (p less than 0.05) occurred in rats receiving Captopril. Multiple tumours (three cases), tumours induced by 20 Gy (three cases), and tumours appearing before 6 months (one case) were observed only in rats consuming control diet, never in Captopril-treated animals. Animals which developed tumours in the second 6 months post-irradiation exhibited significantly more severe moist desquamation during the first 6 months than did the tumour-free members of their treatment group. Thus Captopril, known to ameliorate acute lung damage in irradiated rats, also reduces chronic benign and malignant skin reactions in the radiation treatment field.     

Evidence for humoral effects on the radiation response of rat foot skin.

The influence of perturbation of the physiologic state of the whole body on the outcome of radiation exposure has been examined in a rat foot model. Irradiation was carried out using 60Co gamma-rays. Moist desquamation was used as an endpoint. Rats were given a priming dose of 2 Gy, 4 Gy or 7 Gy to their whole body except their hind feet (partial body priming dose). After a variable time period both hind feet of these animals were irradiated with graded doses of 60Co gamma-rays. The incidence of moist desquamation in the irradiated feet of these animals was compared with the incidence of moist desquamation in animals that had not received the initial partial body priming dose. It was noticed that the incidence of moist desquamation in the rat foot skin of animals that received 7 Gy partial body priming dose 4 h prior to irradiation of their hind feet was significantly less than moist desquamation in control animals. The ED(50) value of 22.53+/-0.16 Gy for moist desquamation of the foot skin of control animals was significantly lower (p<0.01) than the value of 25.25+/-0.29 Gy obtained for animals that received a partial body priming dose of 7 Gy 4 h prior to irradiation of their hind feet. It was concluded that the response of rat foot skin to radiation was not purely the result of epidermal stem cell kill and that it can be modified by alterations in the overall physiological state of the animal's body brought about by a priming dose to the whole of the animal's body except the hind feet.     

Single dose irradiation response of pig skin: a comparison of brachytherapy using a single, high dose rate iridium-192 stepping source with 200 kV X-rays

An experimental brachytherapy model has been developed to study acute and late normal tissue reactions as a tool to examine the effects of clinically relevant multifractionation schedules. Pig skin was used as a model since its morphology, structure, cell kinetics and radiation-induced responses are similar to human skin. Brachytherapy was performed using a microSelectron high dose rate (HDR) afterloading machine with a single stepping source and a custom-made template. In this study the acute epidermal reactions of erythema and moist desquamation and the late dermal reactions of dusky mauve erythema and necrosis were evaluated after single doses of irradiation over a follow-up period of 16 weeks. The major aims of this work were: (a) to compare the effects of iridium-192 (192Ir) irradiation with effects after X-irradiation; (b) to compare the skin reactions in Yorkshire and Large White pigs; and (c) to standardize the methodology. For 192Ir irradiation with 100% isodose at the skin surface, the 95% isodose was estimated at the basal membrane, while the 80% isodose covered the dermal fat layers. After HDR 192Ir irradiation of Yorkshire pig skin the ED50 values (95% isodose) for moderate/severe erythema and moist desquamation were 24.8 Gy and 31.9 Gy, respectively. The associated mean latent period (+/- SD) was 39 +/- 7 days for both skin reactions. Late skin responses of dusky mauve erythema and dermal necrosis were characterized by ED50 values (80% isodose) of 16.3 Gy and 19.5 Gy, with latent periods of 58 +/- 7 days and 76 +/- 12 days, respectively. After X-irradiation, the incidence of the various skin reactions and their latent periods were similar. Acute and late reactions were well separated in time. The occurrence of skin reactions and the incidence of effects were comparable in Yorkshire and Large White pigs for both X-irradiation and HDR 192Ir brachytherapy. This pig skin model is feasible for future studies on clinically relevant multifractionation schedules in a brachytherapy setting.     

Effects of Lipochromin and Levosinum in the modulation of radiation-induced injury to pig skin

Pig skin was used as a model to study the effectiveness of two topically applied creams, Lipochromin and Levosinum, in modifying the development of both early and late radiation damage to pig skin. Irradiated skin sites that received daily topical application of Levosinum or Lipochromin after exposure were compared with sites on the contralateral flank of the same animal that received irradiation only. Irradiation was with graded doses of 90Sr/90Y beta-rays. Incidence of moist desquamation (acute) and ischaemic dermal necrosis (late) were used as end-points. The latency period for the development of moist desquamation and its healing time was also assessed. The latency period for the development of moist desquamation in this model ranged from 4.00-6.75 weeks. There was no significant difference between the cream treatment and control sites. Application of Levosinum shortened the healing time of moist desquamation at each dose level by 5-10 days. In three out of four dose levels used, this shortening of the healing time was statistically significant (p < 0.03). Treatment with these topical applications also reduced the incidence of late dermal necrosis and increased the ED50 values for the incidence of dermal necrosis. This increase in ED50 values was equivalent to a dose modification factor of 1.11-1.13.     

Toxicity and outcome of pelvic IMRT for node-positive prostate cancer

Background and purpose

This study reports on the treatment techniques, toxicity, and outcome of pelvic intensity-modulated radiotherapy (IMRT) for lymph node-positive prostate cancer (LNPPC, T1-4, c/pN1 cM0).

Patients and methods

Pelvic IMRT to 45–50.4?Gy was applied in 39?cases either after previous surgery of involved lymph nodes (n?=?18) or with a radiation boost to suspicious nodes (n?=?21) with doses of 60–70?Gy, usually combined with androgen deprivation (n?=?37). The prostate and seminal vesicles received 70–74?Gy. In cases of previous prostatectomy, prostatic fossa and remnants of seminal vesicles were given 66–70?Gy. Treatment-related acute and late toxicity was graded according to the RTOG criteria.

Results

Acute radiation-related toxicity higher than ?grade?2 occurred in 2?patients (with the need for urinary catheter/subileus related to adhesions after surgery). Late toxicity was mild (grade 1–2) after a median follow-up of 70?months. Over 50% of the patients reported no late morbidity (grade 0). PSA control and cancer-specific survival reached 67% and 97% at over ?5?years.

Conclusion

Pelvic IMRT after the removal of affected nodes or with a radiation boost to clinically positive nodes led to an acceptable late toxicity (no grade 3/4 events), thus justifying further evaluation of this approach in a larger cohort.     

Neck Lymph Node Metastases from an Unknown Primary Tumor

Background and Purpose: Up to 10% of all neck lymph node metastases present without a known primary site. The optimal treatment strategy for these patients is still undefined. The purpose of this retrospective analysis is to assess the outcome in patients with neck metastases from an unknown primary tumor (CUP). Furthermore, prognostic factors and treatment modalities are discussed. Patients and Methods: From 1984 to 2003, 28 patients with squamous cell neck metastases from a CUP were treated at the authors institution. In 17 patients, neck dissection (twelve radical, five modified radical) was performed. In that case, adjuvant radiotherapy was carried out with a mean of 56.7 Gy. In eleven patients, only biopsies were done. These patients received definitive radiotherapy with a mean of 66.8 Gy. In summary, 25 patients received extended radiotherapy including both sides of the neck and potential mucosal primary sites. Additional chemotherapy was administered to five patients. Results: The duration of follow-up was 4.1–189.5 months (median 45.1 months). After this period of time, ten patients (36%) remained alive. 5-year overall survival was 40.1%, neck control rate 72.7%. No subsequent primary could be detected. Extracapsular extension and surgery had significant influence on prognosis. Grade 3 toxicity (mucositis or skin reactions) was seen in three patients; no hematologic toxicity > grade 2 was observed. 19 patients suffered from grade 2 xerostomia. Conclusion: With radical surgery followed by radiotherapy good survival rates in patients with neck metastases from a CUP can be obtained. Whether limited radiotherapy might be equal to extended irradiation and can reduce side effects, must be shown in ongoing clinical trials.     

早期乳腺癌保乳术后低分割瘤床同步加量放疗方法的前瞻性临床研究

目的 研究早期乳腺癌保乳术后低分割模式的同步加量调强放疗的近期疗效不良反应及美容效果。方法 前瞻性纳入76例分期为TisT_1~2N₀M₀早期乳腺癌保乳术后行低分割同步加量调强适形放疗（IMRT）/容积旋转调强放疗（VMAT）的患者,放疗剂量分割方式为患侧全乳2.65 Gy/次,42.4 Gy/16次,共22 d,瘤床区给予同步加量3.1 Gy/次,49.6 Gy/16次,共22 d。乳房美容效果评估依据哈弗系统,不良反应评估采用常见不良反应事件评价标准（CTCAE）3.0标准。logistic回归分析检验发生2级及以上放射性皮肤反应的相关因素。结果 中位随访29（16~40）个月,随访率为100%。1、2、3年的生存率均为100％,无患者出现复发或转移。1、2级急性皮肤反应发生率分别为52/76（68.4%）和6/76（7.9%）。放疗后晚期1、2级皮肤及皮下组织晚期反应发生率为10/76（13.1%）和2/76（2.6%）。美容优良率为61/74（82.4%）。瘤床的平均剂量与2级及以上放射性皮肤反应相关。结论 早期乳腺癌保乳术后大分割全乳同步瘤床加量调强放疗的近期疗效、美容效果及急性/晚期不良反应均可接受,需要更长时间的随访来进一步证实其安全性。     

Radiotherapy for Orbital Lymphoma

PURPOSE: To analyze the effectiveness of radiotherapy in the management of orbital non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: 42 patients (median age 64.5 years) were reviewed retrospectively. The median follow-up period was 58 months. 26 patients had stage IE orbital lymphoma (22 indolent, four aggressive NHLs). 16 patients had advanced NHLs in stages II-IV with orbital involvement (eleven indolent, five aggressive NHLs). The median radiation dose was 40 Gy (20-46 Gy) for indolent lymphoma and 44 Gy (20-48 Gy) for aggressive lymphoma. Patients with stage IE were treated with at least 30 Gy. RESULTS: The 5-year local control rate for patients with stage I was 100%, the 5-year overall survival 91%. Two distant relapses were found, but no lymphoma-related death was detected. The 5-year local control rate for patients in stages II, III, and IV was 80%. Two local failures were detected. The 5-year overall survival for the advanced stages was 47%, nine patients with stages III and IV died due to systemic progression of lymphoma. Acute, radiotherapy-related complications grade 3/4 were not observed. Late effects grade 1/2 were documented in 45%. Six patients, treated with doses of > 36 Gy, developed grade 3 complications (four cataract, two dryness). CONCLUSION: Radiotherapy alone yields excellent local control and overall survival rates in orbital lymphoma stage IE. Local irradiation is also well tolerated and effective in advanced NHL stages with orbital infiltration. Doses of > 36 Gy resulted in an increase of late complications.