早期非小细胞肺癌大分割放射治疗临床研究

目的：探讨三维适形放疗（3-dimensional conformal radiotherapy，3D．CRT）大分割放射治疗早期非小细胞肺癌的疗效和毒性反应。方法：11例早期非小细胞肺癌（I期8例，HB期3例；中位年龄72岁）三维适形大分割放射治疗（hypofractionation radiotherapy，HORT）全程或后程推量，肿瘤剂量60Gy～76Gy，3Gy～8Gy／次，1次／天，3次～5次／周。生物等效剂量76．8Gy～105．6Gy。中位随访时间54个月。根据WHO标准评价近期疗效，RTOG标准评价毒性反应。结果：完全缓解（CR）9．09％（1／11），部分缓解（PR）81．8％（9／i1），稳定（NC）9．09％（1／11）。中位生存时间39个月。1，3及5年总生存率分别为81．8％，58．4％和18％，1，3及5年肿瘤相关生存率分别为91％，91％和18％。放射性食管炎27．3％（2级2例，3级1例），急性放射性肺炎（2级1例）9．09％。结论：三维适形大分割放射治疗早期非小细胞肺癌近期疗效和生存率优于常规分割放疗，放疗毒性未见明显增加，耐受性好，是一种有效安全的局部治疗手段。     

急诊短程放疗联合唑来膦酸治疗转移性脊髓压迫症的疗效观察

目的 探讨急诊短程放射治疗联合唑来膦酸治疗转移性脊髓压迫症的近期疗效.方法 对 38 例转移性脊髓压迫症采用直线加速器照射,6 MV-X 或10 MV-X,3.0 Gy/次,5次/周,总剂量 DT 30～36 Gy/10～12次,同时加强脱水治疗,唑来膦酸 4 mg 静滴抑制骨破坏.结果 疼痛缓解有效率86.8%,运动功能改善有效率81.6%.结论 转移性脊髓压迫症急诊放疗联合唑来膦酸治疗能迅速缓解压迫,改善症状,有较好的近期疗效.     

螺旋断层放疗治疗髓母细胞瘤的疗效观察

目的 探讨螺旋断层放疗技术治疗髓母细胞瘤的剂量学优势、不良反应及疗效。方法 2011年2月至2011年10月,4例髓母细胞瘤患者接受螺旋断层放射治疗。术后瘤床临床靶区（CTV1）剂量：50.4Gy／28f,每次18Gy,5次／周;全脑全脊髓临床靶区（CTV2）剂量：30.6Gy／17f,每次1.8Gy,5次／周。结果 4例患者接受照射的均匀性和适形性较好,重要器官的照射剂量低,治疗时间均小于15min。4例患者均获随访,中位随访9个月（4～15个月）,至随访截止时间无1例复发。主要不良反应为骨髓抑制和恶心呕吐,4例患者均可耐受。结论 螺旋断层放疗治疗髓母细胞瘤的疗效和剂量分布较好,为治疗髓母细胞瘤开辟了一个新的治疗平台。     

短程冲击放射治疗肿瘤转移性脊髓压迫症

[目的]探讨短程冲击放射疗法治疗肿瘤转移性脊髓压迫症的临床疗效.[方法]对32例肿瘤转移性脊髓压迫症患者(肺癌14例,乳腺癌10例,前列腺癌4例,鼻咽癌3例,食管癌1例).采用直线加速器照射,6MV-X DT3Gy/次,1次/日,5次/周,总剂量DT36Gy～42Gy/12～14次/2.5～3周.[结果]疼痛缓解、运动功能改善有效率分别为87.5%(28/32)和78.1%(25/32),截瘫者有效率0(0/3),持续导尿者有效率33.3%(2/6).[结论]短程冲击放射治疗转移性脊髓压迫症能迅速缓解疼痛、恢复和保留神经功能,但对神经损伤严重者疗效不佳.     

儿童急性淋巴细胞性白血病并发中枢神经系统白血病的临床治疗研究

目的：探讨儿童中枢神经系统白血病复发再治疗的安全有效方法。方法：应用国产^60Co，对27例曾接受全颅、全脊髓放射治疗和(或)鞘内注射后CNSL复发的儿童急性淋巴细胞性白血病进行全颅、全脊髓间歇性放射治疗，并联合鞘内注射。治疗方案为：全颅1.5Gy／次 全脊髓0．75Gy／次，1次／d照射3d。第1天鞘内注射甲氨蝶呤(MTX)8～12mg/m^2，阿糖胞苷(Ara—C)25mg/m^2．地塞米松(DXM)2～5mg/次，以后每8周全颅1．5Gy 全脊髓0．75Gy照射1次，当天鞘内注射，用药剂量同前。总疗程为2年2个月。结果：27例患者中，3年内死于骨髓复发4例、CNSL复发2例；3～5年内死于骨髓复发5例、CNSL复发8例．3、5年生存率分别为77．8％(21/27)、25．9％(7/27)。间歇性放射治疗过程中未发现明显急性毒副反应。随访期间发现5例记忆力差、注意力不易集中现象。结论：间歇性放射治疗联合鞘内注药对于曾接受全中枢神经系统放射治疗和(或)鞘内注射后CNSL复发的儿童急性淋巴细胞性白血病安全而有效。     

直肠癌术后复发组织间插植放射治疗探讨

目的：探讨直肠癌术后复发的组织间插植放射治疗技术及疗效。方法：1996年2月～1998年10月本院治疗直肠癌Mile’s术后会阴部局部复发10例,其中伴阴道受侵3例。体外照射40～50Gy后行组织间插植高剂量率^192Ir后装治疗,施源管5～25根,剂量3～10Gy／次,总量26～30Gy。结果：CR3例,PR5例,PD2例。2例在治疗后出现局部复发,2例出现会阴部放射性溃疡,均为10Gy／次的患者。3年生存率60％（6／10）,其中2例带瘤生存。结论：组织问插植放射治疗是直肠癌术后复发的有效治疗方法,高剂量率放射治疗的分次剂量不宜过高,尤其是会阴皮肤及阴道受侵者。     

立体定向适形放射治疗体部恶性肿瘤的临床分析

目的：对62例体部恶性肿瘤实体定向适形放射治疗，并作临床分析。方法：自1997年5月至2001年5月治疗62例颅外肿瘤（89个病变部位），并进行了随访。肿瘤的临床靶体积（CTV）为0.2-254.2cm^3(平均为28.7cm^3)，计划靶体积处方剂量为3-12Gy(平均5.38Gy)，分3-10次照射。结果：治疗过程中无1例死亡。患者一般状况评分（KPS评分）：治疗前10-90分（平均60分），治疗后20-100分（平均82分）。近期疗效按实体瘤疗效标准：完全缓解（CR）6例，部分缓解(PR)34例，无变化（NC）15例，进展（PD）7例，肿瘤控制有效率为64.5%。结论：立体定向适形放射治疗颅外肿瘤有较好疗效。     

每周7次连续加速分割放射治疗头颈部鳞癌临床分析

目的观察每周7次连续加速分割放射治疗（7次／周，常规分割）治疗头颈部鳞癌的近期疗效及毒副作用。方法30例头颈部鳞癌，采用面颈联合野7次／周连续加速分割放射治疗（CAIR），总剂量同常规分割放射治疗（CF），分割剂量为1．8Gy／次或2Gy／次，并与同期CF组（32例）对比分析毒副作用。结果两组病例均能顺利完成治疗，头颈部鳞癌放疗后完全缓解率（CR）为93％和72％，两组差异有统计学意义（P〈0．05），两组放射治疗急性毒副作用差别无统计学意义。结论头颈部鳞癌CAIR有较好的近期疗效．患者能耐受CAIR治疗，急性放射毒副作用与CF组比较差异无统计学意义。     

35例胰腺癌立体适形放射治疗

目的：应用立体适形放射治疗技术治疗胰腺癌，评价其疗效和并发症。方法：35例胰腺癌患者给予立体适形放射治疗，每天1次，每次2Gy～3Gy，每周共5次，共计20次-35次；5个～8个共面或非共面适形固定野，总剂量60Gy～70Gy。结果：83．33％患者胸背部疼痛明显缓解；放疗后2个月～6个月复查CT，肿瘤缩小25％以上者60．00％；1年、2年生存率分别为77．14％、29．16％。结论：立体适形放射治疗胰腺癌，疗效较好，并发症少，是不能手术的患者的较好的治疗方式。     

三维适形加量放射治疗非小细胞肺癌

目的：探讨三维适形加量放射治疗非小细胞肺癌（NSCLC）的优势。方法：21例非小细胞肺癌，CT模拟机定位，输入TPS（Pinnacle^3 7．4／7．6），勾画GTV1，先常规或三维适形放疗30Gy／15F～50Gy／25F，第2次CT定位，勾画GTV2，予三维适形放射治疗至66Gy／33F～70Gy／35F。结果：GTV2与GTVl相比，平均缩小比例39．5％，13例大于40％。近期疗效：CR19．0％，PR71．4％，NC9．5％，总有效率（CR＋PR）90．5％，1年生存率85．7％。早期放射性肺损伤：1级13例（61．9％），2级6例（28．6％），3级2例（9．5％）。放射性食管炎：1级15例（71．4％），2级6例（28．6％）。后期放射肺纤维化：0级2例（9．5％），1级15例（71．4％），2级4例（19．0％）。结论：三维适形加量放射治疗NSCLC过程中，肿瘤平均退缩比例为39．5％，再次重新勾画GTV并加量，可以有效地减少治疗范围，提高靶区剂量，降低放射治疗副反应。     

三维适形放疗联合多西紫杉醇化疗治疗食管癌的临床观察

目的：评价三维适形放疗联合多西紫杉醇化疗治疗食管癌的临床疗效和安全性。方法：32例不能手术或拒绝手术的中晚期食管癌患者根据入选标准随机分成同期放化疗（治疗组）和单纯三维适形放疗（对照组）,每组16例,治疗组在放疗的同时给予多西紫杉醇20-30mg/m2静脉滴注,每周1次,连续6周,在放疗第一天同时进行。两组放疗方法相同,均采用直线加速器6MVX线,2Gy/次,5次/每周。照射总剂量54-64Gy,采用X线和CT检查比较两组近期疗效,并且比较两组间不良反应的差别。结果：同期放化疗组与单纯放疗组完全缓解率（CR）分别为56.3%和37.5%,有效率（CR＋PR）分别为87.5%和56.3%。同期放化疗组不良反应尤其是放射性食管炎,及Ⅰ、Ⅱ度骨髓抑制较对照组大,但经处理后均能顺利完成治疗。结论：三维适形放疗联合多西紫杉醇化疗较单纯放疗组疗效好,可提高中晚期食管癌的近期有效率,不良反应患者能耐受。     

A prospective randomised trial of 4 Gy or 8 Gy single doses in the treatment of metastatic bone pain.

270 patients with painful bone metastases requiring palliative radiotherapy were randomised to receive single fractions of 4 Gy or 8 Gy in a randomised trial. Pain scores and analgesic usage were recorded before treatment and at 2, 4, 8 and 12 weeks. Pain was assessed by patients on a 4 point graded scale using pain charts administered by a central trials office. Response was defined as an improved rating compared to the pretreatment value. Compliance with the pain chart was 72% at 4 weeks. At 4 weeks, the actual response rates were 69% for 8 Gy and 44% for 4 Gy (p less than 0.001), but there was no difference in complete response (no pain) rates at 4 weeks or duration of response between the two arms. It is concluded that 8 Gy gives a higher probability of pain relief than 4 Gy, but that 4 Gy can be an effective alternative in situations of reduced tolerance.     

放疗联合周剂量紫杉醇治疗老年食管癌的临床研究

目的探讨放疗联合周剂量紫杉醇治疗老年食管癌的疗效及毒副反应。方法 49例老年食管癌患者随机分为同步放化疗组（24例）和单纯放疗组（25例）,2组放疗均采用常规分割,照射剂量60~66 Gy。同步放化疗组紫杉醇60 mg,每周1次,连续6周。结果同步放化疗组有效率87.5%,高于单纯放疗组的60.0%（P〈0.05）。同步放化疗组Ⅱ、Ⅲ度白细胞减少占54.2%,明显高于单纯放疗组的20.0%（P〈0.05）。结论放疗联合周剂量紫杉醇治疗老年食管癌近期疗效较好,毒副反应相对加重但可耐受。     

Phase II evaluation of high dose accelerated radiotherapy for anaplastic thyroid carcinoma.

BACKGROUND AND PURPOSE: Anaplastic thyroid cancer responds poorly to conventional radiotherapy and prognosis in the absence of effective chemotherapy is dismal. The median survival following diagnosis is only 4 months and the majority of patients die with uncontrolled local disease. This study describes the use of accelerated radiotherapy aiming to improve local response in patients with anaplastic thyroid carcinoma. Toxicity was assessed prospectively. PATIENTS AND METHODS: Seventeen patients with anaplastic thyroid carcinoma were treated and assessed for both outcome and treatment toxicity. Eight further patients with primary carcinomas arising in the neck were also treated with this protocol but were assessed for treatment toxicity only. Patients were treated twice daily, 5 days a week, to a total dose of 60.8 Gy in 32 fractions over 20-24 days in two or three phases. RESULTS: Three patients with anaplastic carcinoma demonstrated a complete clinical response and seven patients achieved a partial response. Five patients had stable disease and two patients died before radiotherapy was completed. Toxicity from oesophagitis and dysphagia was high with 10 patients requiring intravenous fluids or nasogastric tube feeding. CONCLUSION: This approach improved the response rate to radiotherapy but toxicity was unacceptable. A modified accelerated radiotherapy protocol is being explored.     

立体定向放射治疗肝门部胆管癌疗效分析

目的探讨肝门部胆管癌立体定向放射治疗的疗效.方法 17例因内科或外科原因不能手术或患者不同意手术的肝门部胆管癌采用立体定向放射治疗,单次剂量4～8 Gy(中位剂量5.6 Gy),总剂量40～60 Gy(中位剂量48 Gy).结果 CR 8例,PR 9例,总有效率为100.0%;1年生存率为94.1%(16/17).结论立体定向放疗是肝门部胆管癌的有效治疗方法.     

不同剂量分割模式的三维适形放疗对局部进展期胰腺癌的疗效分析

目的探讨局部进展期胰腺癌三维适形放疗最佳时间剂量分割模式。方法30例进展期胰腺癌患者随机分为两组,常规组15例,接受常规剂量分割(1.8~2 Gy/次,5次/周),低分割组15例,剂量分割(3~5 Gy/次,3~5次/周)。两组患者等效生物剂量相同(56 Gy)。结果常规组和低分割组有效率分别为46.7%和53.3%,1年生存率分别为20.0%和26.7%,差异无显著性。常规组和低分割组临床受益反应率分别为86.6%和53.3%,两组比较差异有显著性(P<0.05)。常规组疼痛缓解率86.6%,低分割组60.0%(P>0.05)。结论常规剂量分割的三维适形放疗治疗局部进展期胰腺癌急性放射反应轻,能有效改善临床症状,提高生活质量,延长生存期。     

Treatment of portal vein tumor thrombosis of hepatoma patients with either stereotactic radiotherapy or three-dimensional conformal radiotherapy

BACKGROUND: Patients with hepatocellular carcinoma (HCC) often have unresectable tumors. Transcatheter arterial chemoembolization (TACE) is one of the limited alternative treatments that can prolong these patients' survival. However, the presence of portal vein tumor thrombosis (PVTT) is a contraindication for TACE and, therefore, HCC patients with PVTT would be depleted of the advantage of TACE. The purpose of this study was to analyze the recanalization rate of thrombosed portal vein and treatment toxicities after stereotactic radiotherapy (SRT) or three-dimensional conformal radiotherapy (3DCRT). METHODS: From March 2002 to November 2004, 43 patients were enrolled in this prospective study. Twenty-two patients were in the SRT group and 21 in the 3DCRT group. For SRT, 3 Gy per fraction, 3 fractions per week, was given to a total dose of 45 Gy. For 3DCRT, a daily dose of 1.8 Gy, 5 fractions per week, was given to a total dose of 45 Gy. RESULTS: Of the 43 patients, 16 completed the planned radiotherapy. Eventually, 14 patients received evaluation for portal vein recanalization, 8 in the SRT and 6 in the 3DCRT group, respectively. For all patients, the crude response rate was 26%. For 14 evaluable patients, the crude response rate was 79%. It was 75% in the SRT group and 83% in the 3DCRT group (P = 0.71). The median survival time was 6.0 and 6.7 months for the SRT and 3DCRT group, respectively (P = 0.911). CONCLUSIONS: Image-based radiotherapy, either SRT or 3DCRT, can recanalize the PVTT in unresectable HCC patients. Responders also had better 1 year and 2 year survivals. A more strict patient selection criterion may maximize the potential benefits of radiotherapy for hepatoma patients with PVTT.     

肺癌脑转移放化疗63例预后分析

背景和目的：肿瘤脑转移最常见于肺癌患者。放射治疗是其有效的常规治疗手段。目前的治疗以姑息止痛和减轻症状为目的,方法差异较大,对肺癌脑转移预后的认识也不尽相同,本研究通过回顾性分析肺癌脑转移患者放射治疗的疗效,以探讨其对预后影响的相关因素。材料和方法：对我院1994年1月至2000年12月资料完整的63例肺癌脑转移患者临床资料进行回顾性研究,所有患者接受放射治疗,其中42例合并使用化疗,放疗中位剂量为40Gy(24-62.4Gy)。t检验分析不同因素对平均生存期的差异。生存分析采用Kaplan-Meier法,Cox比例风险模型对预后因素进行分析。结果：放疗合并化疗者生存时间平均为9.5个月。单纯放疗者平均为6.3个月（P=0.043);治疗结束时有效和无效者的生存时间分别为9.3个月及5.0个月（P=0.042);放疗总剂量大于50Gy者为10.8个月,小于50Gy者6.7个月（P=0.028);单次剂量大于1.8Gy者为9.0个月,小于1.8Gy者4.8个月（P=0.015)。差别均有统计学差异。生存分析发现放疗合并化疗及治疗结束时有效的患者预后较好。结论：放疗合并化疗与否和治疗结束时是否有效是肺癌脑转移放射治疗的独立预后因素。     

Hypofractionated radiotherapy for the palliation of advanced head and neck cancer in patients unsuitable for curative treatment--"Hypo Trial".

BACKGROUND AND PURPOSE: The primary purpose of the trial was to assess rate of tumour response to a hypofractionated course of radiotherapy in patients with incurable squamous cell carcinoma of the head and neck (HNSCC). Secondary objectives included radiation toxicity, symptom control, quality of life (QoL) and progression-free and overall survival. PATIENTS AND METHODS: Patients were planned to receive 30 Gy in 5 fractions at 2/week, at least 3 days apart, with an additional boost of 6 Gy for small volume disease (< or =3 cm) in suitable patients. Thirty-seven patients were enrolled between August 2004 and March 2006. Median age was 68 (43-87) years, 81% were male and the predominant primary site was oropharynx (32%). The majority (73%) presented with Stage III-IV disease. RESULTS: Thirty-five patients received radiotherapy, 1 died prior to treatment and one refused treatment. Of the 35 patients receiving radiotherapy, 31 (88%) received > or =30 Gy. Of the 35 patients who received treatment the overall objective response was 80%. Grade 3 mucositis and dysphagia were experienced in 9/35 (26%) and 4/35 (11%), respectively. QoL and symptom control were assessable in 21 patients. Thirteen (62%) reported an overall improvement in QoL and 14 (67%) experienced an improvement in pain. The median time to progression and death was 3.9 and 6.1 months, respectively. CONCLUSION: The "Hypo Trial" regimen provided effective palliative treatment in HNSCC unsuitable for curative treatment. Compliance was excellent and resulted in high response rates, symptom control and improvement in QoL with acceptable toxicity. However, progression free and overall survival was short.     

晚期胰腺癌患者三维适形放疗联合热疗的疗效观察

目的探讨晚期胰腺癌患者三维适形放射疗法联合热疗的临床疗效。方法采用三维适形放疗联合热疗技术对50例晚期胰腺癌患者进行治疗。对于直径〈5cm的肿瘤,每周放疗3次,每次3．8～4．5Gy,4周总剂量为45～54Gy;对于直径〉5cm的肿瘤,每周放疗5次,每次2Gy,6周总剂量为60—65Cy。对全部患者在放疗后1h内进行热疗。结果患者在治疗后2～3个月进行CT检测复查,治疗后总有效率达70．0％,腹痛总缓解率为100％,黄疸总消退率84．6％。治疗后两年随访结果表明,生存率为60．0％。结论采用三维适形放疗与热疗联合治疗晚期胰腺癌的疗效好,不良反应小,止痛效果好,值得临床推广。