前列腺癌半程调强放疗后调整计划对靶区和危及器官的影响

目的探讨后半程调整计划对前列腺癌肿瘤靶区和危及器官受照剂量的影响。方法前列腺癌患者30例,放疗前制定38次全程调强放疗计划（计划1）,放疗20次后重新定位勾画靶区继续照射18次（计划2）,比较2种计划中大体肿瘤靶区体积、直肠和膀胱受照剂量体积。结果计划1和计划2勾画的大体肿瘤靶区平均体积分别为71.82cm3、52.47cm3;2种计划中直肠50Gy剂量照射体积占总体积百分比（V50）、70Gy剂量照射体积占总体积百分比（V70）、平均剂量及膀胱V70、最大剂量比较差异有统计学意义（P〈0.05）。结论半程调强放疗后重新制定融合计划可缩小受较高剂量照射的直肠体积,降低膀胱最高受照剂量。     

网络成瘾患者父母教养方式及护理干预措施研究

目的：探讨三维调强适形放射治疗宫颈癌的护理方法。方法：对37例中晚期宫颈癌患者采用高能直线加速器实施全程三维调强适形放疗，2Gy／次，5次／周，总剂量50Gy。在放疗前后进行精心的病情观察及护理。结果：本组均顺利完成放射治疗，不良反应小，治疗有效率为100％。结论：对宫颈癌患者行三维调强适形放射治疗过程中做好相应护理，能提高疗效，降低并发症发生率。     

三维调强适形放射治疗宫颈癌37例观察及护理

目的:探讨三维调强适形放射治疗宫颈癌的护理方法.方法:对37例中晚期宫颈癌患者采用高能直线加速器实施全程三维调强适形放疗,2Gy/次,5次/周,总剂量50Gy.在放疗前后进行精心的病情观察及护理.结果:本组均顺利完成放射治疗,不良反应小,治疗有效率为100%.结论:对宫颈癌患者行三维调强适形放射治疗过程中做好相应护理,能提高疗效,降低并发症发生率.     

替吉奥联合同步放疗治疗老年局部晚期食管癌的临床观察

目的观察替吉奥联合三维适形放射治疗老年局部晚期食管癌的近期疗效和毒性反应。方法 49例不能或不愿手术的老年食管癌患者,随机分为联合组（替吉奥联合三维适形放射治疗）25例,对照组（单纯三维适形放射治疗）24例。两组均采用三维调强适形放疗,每周5次,每次2.0 Gy,总剂量为60～66 Gy。联合组在放疗第1天开始口服替吉奥胶囊40 mg/m^2,2次/d,14 d为1个疗程,休息1周后继续口服第2个疗程。结果联合组和对照组放疗结束时获得有效率分别为88.0%和54.2%,两组有效率差异有统计学意义（P〈0.05）。毒副作用主要为放射性食管炎、骨髓抑制、胃肠道反应、肝功能损伤等,联合组发生率略高于对照组,但两组差别无统计学意义（P均〉0.05）。结论替吉奥联合三维调强适形放射治疗提高了老年局部晚期食管癌近期疗效,毒副作用轻,可耐受。     

全脑放疗加三维适形放疗对脑转移瘤疗效的临床分析

目的评价脑转移瘤三维适形放射治疗的临床意义。方法对64例脑转移瘤患者,32例采用单纯全脑放疗,1．8～2．0Cy／次,每周5次,总剂量36～40Gy;另32例采用全脑放疗后局部加三维适形放射治疗。结果采用全脑放疗肿瘤治疗组,局部控制率为40．62％;全脑放疗加三维适形放射治疗组,局部控制率为78．13％。结论脑转移肿瘤放射治疗有效,可以延长患者生存时间,改善生活质量。全脑放疗加三维适形放射治疗的效果明显优于全脑放疗。     

内外同步放射治疗Ⅱ～Ⅲ期宫颈癌的远期疗效

目的:探讨内外同步放射治疗Ⅱ～Ⅲ期宫颈癌的临床疗效和放射副反应。方法:选择1991年6月至2000年5月我院收治的Ⅱ～Ⅲ期宫颈鳞癌患者166例进行192Ir高剂量率腔内加60Co体外同步放射治疗,全盆腔外照射4次/周,2Gy/次,总剂量46～50Gy;腔内放疗5～8Gy/次,1次/周,A点的总剂量35～42Gy。治疗总疗程6～7周。结果:全组总5年生存率为63.9%,其中Ⅱ期72.3%,Ⅲ期58.4%(P>0.05)。晚期放射性直肠反应发生率1+2级9.6%(16/166),3+4级4.2%(7/166);晚期放射性膀胱反应发生率1+2级3.6%(6/166),3+4级1.2%(2/166)。结论:内外同步放射治疗Ⅱ～Ⅲ期宫颈鳞癌疗效肯定,耐受性好;如何降低晚期放射反应有待进一步研究。     

适行放射治疗前列腺癌剂量学疗效比较及对生活质量的影响

目的:应用三维适形放射治疗计划系统评价前列腺癌不同的照射方法,以明确前列腺癌三维适形放射治疗(3D-sCRT)改善生活质量的优势。方法:选用2000-09/2004-09复旦大学附属中山医院45例T1,T2,T3前列腺癌病例,随机分3组,每组15例,分别用常规四野、四野适形、六野适形3个不同放射治疗技术,适行放疗采用CMS公司FOCUS2.6.1三维适形放射治疗计划系统设计治疗计划,计划的总剂量均为70Gy。用剂量体积直方图(DVH)比较靶区剂量和正常组织的受照射剂量差异。结果:3种治疗计划均能满足靶区剂量要求,但六野适形放射治疗计划靶区剂量明显优于常规放射治疗(P<0.05),而六野适形放射治疗计划与四野适形放射治疗之间差异无显著性意义(P>0.05)。常规四野、四野适形、六野适形放射治疗计划适形指数分别为0.33,0.55,0.56;50%直肠的受照射剂量为47.48,39.15,38.45Gy,50%膀胱受照射剂量为49.32,9.42,3.11Gy,股骨头最大剂量为49.84,34.00,26.24Gy。常规放射治疗组患者生活质量评分为(15.2±2.90)分,而四野适形、六野适形组为(18.30±3.90),(19.10±4.30)分,明显优于常规放射(P<0.05)。结论:前列腺癌的常规设野方法基本能满足靶区剂量学要求,然而正常组织的受照射剂量明显高于其他两种计划。3D-CRT的主要优势在于减少正常组织的受照     

食道癌三维调强适形放疗的护理

目的探讨三维调强适形放疗治疗食道癌的护理措施。方法采用高能直线加速器6mV-x线,实施全程三维调强适形放疗,2～3Gy/次,5次/周,总剂量60Gy。结果42例患者除1例合并食道气管瘘停止放疗,1例并发肺炎中断治疗,其余均顺利完成治疗,不良反应小,总有效率92%。结论护士在治疗过程中做好相应的护理,能提高患者对此新技术的认知程度。     

食道癌三维调强适形放疗的护理

目的 探讨三维调强适形放疗治疗食道癌的护理措施.方法 采用高能直线加速器6 mV-x线,实施全程三维调强适形放疗,2～3 Gy/次,5次/周,总剂量60 Gy.结果 42例患者除1例合并食道气管瘘停止放疗,1例并发肺炎中断治疗,其余均顺利完成治疗,不良反应小,总有效率92%.结论 护士在治疗过程中做好相应的护理,能提高患者对此新技术的认知程度.     

前列腺癌的三维适形放射治疗和调强放射治疗的剂量学比较

目的比较前列腺癌放射治疗(以下简称"放疗")中三维适形放疗和调强放疗的剂量学差异。方法分别对12例前列腺癌患者运用Oncentra MasterPlan治疗计划系统进行三维适形放疗和调强放疗计划的设计,处方剂量均为7 200cGy。在保证95%计划靶区体积达到处方剂量要求前提下,比较两种方法靶区和周围危及器官的剂量分布。结果三维适形放疗与调强放疗都可达到处方剂量95%体积计划靶区的要求。调强放疗和三维适形放疗计划的适形度指数(CI)分别为0.75±0.04、0.67±0.03,均匀性指数(HI)分别为1.06±0.02,1.08±0.02。调强放疗的CI和HI均优于三维适形放疗,差异均有统计学意义(P0.05)。调强放疗中,直肠V40、V50、V70、靶区平均受量(Dmean)均低于三维适形放疗,差异均有统计学意义(P0.05)。调强放疗中,双侧股骨头的Dmax低于三维适形放疗,差异有统计学意义(P0.05)。结论前列腺癌放疗中,调强放疗的靶区适形度和剂量均匀性优于三维适形放疗,具有明显的剂量学优势。     

直肠癌术前容积调强与固定野调强的剂量学研究

目的 　比较对直肠癌术前患者应用固定野调强(fixed-field intensity-modulated radiotherapy,FF-IMRT)和容积调强(volumetric modulated arc therapy,VMAT)两种计划方式进行术前放射治疗的剂量学差异。 方法 　选择15例直肠癌术前进行调强放疗的患者行CT模拟定位,勾画靶区及危及器官,对同一CT图像设计FF-IMRT计划和VMAT计划。评估靶区及危及器官的剂量分布。 结果 　VMAT计划组和FF-IMRT计划组靶区覆盖度均能满足处方剂量要求。与FF-IMRT计划组相比,VMAT计划组计划靶区（planning target volume,PTV）105%覆盖度、Dmean及Dmax均增加（P=0.011,P=0.017,P=0.006）,适形度指数减低（P=0.008）,而均匀性指数差异无统计学意义（P=0.193）。与FF-IMRT计划组相比,VMAT计划组膀胱V50增加约15%（P=0.009）,Dmax平均值增加0.7 Gy（P=0.003）;小肠V30降低10%（P=0.004）,Dmax平均值增加0.9 Gy（P=0.000）;骨髓V10、V30、V40分别降低2%、10%、10%（P=0.000,P=0.000,P=0.000）,Dmean平均值降低1.7 Gy（P=0.000）;左右股骨头D5分别降低3.2 Gy、2.4 Gy（P=0.000,P=0.000）;全身V10、V20、V30、V40也明显降低（P=0.003,P=0.000,P=0.000,P=0.004）。VMAT计划组较FF-IMRT计划组机器跳数（monitor units,MU）平均值减少50%（P=0.000）。 结论 　直肠癌术前患者采用VMAT技术,可以获得等同于或优于FF-IMRT计划的剂量分布,患者治疗时间明显缩短,MU明显降低。     

乳腺癌改良根治术后大分割放疗的临床研究

目的研究局部晚期乳腺癌改良根治术后大分割放疗与常规分割放疗的疗效、副反应。方法 100例局部晚期乳腺癌病例,病人均接受乳腺癌改良根治术和术后6~8周期化疗,随机分为大分割放疗和常规分割放疗2组:大分割放射治疗组2.9 Gy/次,每周5次,总剂量43.5 Gy;常规分割治疗组2 Gy/次,每周5次,总剂量50 Gy。结果大分割放射治疗组和常规分割放射治疗组的3年总生存率分别为82.4%和85.7%,局部区域复发率分别为7.8%和6.1%,急性2~3级放射性皮肤损伤发生率分别为7.8%和6.1%(P>0.05),两组均无严重的后期反应发生(臂丛损伤、皮肤溃疡形成、放射性肺炎等),心电图所示两组心肌缺血性改变也无明显差别。结论大分割放射治疗缩短了治疗时间,其总生存率及局部复发率、疗后毒副作用与常规分割放射治疗无明显差异,可作为局部晚期乳腺癌改良根治术后常规辅助放疗的替代放疗方案。     

奈达铂与调强适形同步放化疗治疗中晚期食管癌疗效分析

目的观察调强适形放疗＋奈达铂同步化疗治疗中晚期食道癌的疗效及不良反应。方法将60例中晚期食道癌患者随机分为单纯调强放疗组（单纯放疗组）30例和调强放疗同步奈达铂（放化疗组）30例。2组患者均采用8MV-X线全程实施调强适形放疗,放疗剂量为95%GTV 68～70 Gy/28～30次,95%PTV 56～60 Gy/28～30次;放化疗组在放疗期间每周给予NDP 40 mg/m2静脉滴注化疗,共5.5～6星期。结果放化疗组总有效率及2年生存率高于单纯放疗组;2组白细胞减少、血小板减少、Ⅱ度放射性食道炎发生率无差异。结论同步放化疗治疗中晚期食管癌的疗效较单纯放疗明显提高,不良反应较单纯放疗无明显差异。     

Hyaluronic acid rectal spacer in EBRT: Usability,safety and symmetry related to user experience

ObjectivesTo report on the usability, safety, symmetry, and effectiveness of hyaluronic acid (HA) injected between the prostate and the rectum for patients undergoing treatment for prostate cancer with external beam radiotherapy (EBRT), and present a novel definition of rectal spacer symmetry that is reproducible and independent of patient anatomy.Patients and Methods102 consecutive patients with clinical stage of T1c-3b prostate cancer underwent general anaesthesia for fiducial marker insertion and injection of HA into the perirectal space before EBRT. HA safety, symmetry, separation, and usability based on user experience were assessed.ResultsHA insertion was completed with a 100% success rate independent of user experience, rated as ‘easy’ or ‘very easy’ in all cases. There were no postoperative complications reported. The mean (SD) recto-prostatic separation for all patients at the base, midgland and apex were 12 (±2) mm, 11 (±2) mm, and 9 (±1) mm respectively. The mean sagittal length of the implant was 43 (±5) mm. The implant was rated as symmetrical in 98% of cases. The mean rV70Gy was 1.6% (IQR 0.8-3.3%) for patients receiving 78-80Gy. The mean rV53Gy was 2.8% (IQR 1.2-4.8%) for patients receiving 60-62Gy. The median prostate size was 43.5 cc (IQR 32-57).ConclusionInjection of HA was able to achieve highly symmetrical recto-prostatic separation, with new users able to produce excellent separation, particularly at the apex, achieving similar dosimetry outcomes as competent and experienced users. HA is safe, easy to use, and significantly reduced mean rV70Gy and rV53Gy compared to non-spacer patients.     

Constrained non-rigid registration for use in image-guided adaptive radiotherapy

A constrained non-rigid registration (CNRR) algorithm for use in prostate image-guided adaptive radiotherapy is presented in a coherent mathematical framework. The registration algorithm is based on a global rigid transformation combined with a series of local injective non-rigid multi-resolution cubic B-spline Free Form Deformation (FFD) transformations. The control points of the FFD are used to non-rigidly constrain the transformation to the prostate, rectum, and bladder. As well, the control points are used to rigidly constrain the transformation to the estimated position of the pelvis, left femur, and right femur. The algorithm was tested with both 3D conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) dose plan data sets. The 3DCRT dose plan set consisted of 10 fan-beam CT (FBCT) treatment-day images acquired from four different patients. The IMRT dose plan set consisted of 32 cone-beam CT (CBCT) treatment-day images acquired from 4 different patients. The CNRR was tested with different combinations of anatomical constraints and each test significantly outperformed both rigid and non-rigid registration at aligning constrained bones and critical organs. The CNRR results were used to adapt the dose plans to account for patient positioning errors as well as inter-day bone motion and intrinsic organ deformation. Each adapted dose plan improved performance by lowering radiation distribution to the rectum and bladder while increasing or maintaining radiation distribution to the prostate.     

Consistency of Organ Geometries during Prostate Radiotherapy with Two Different Bladder and Bowel Regimens

BackgroundThe majority of Ontario cancer centres incorporate bladder and bowel preparation protocols for the treatment of prostate cancer with radical radiotherapy. Differing methods are used to achieve a full bladder and empty rectum for planning and treatment. We compared the effects of two different bladder and bowel preparation regimens on bladder, rectum, and prostate +/− seminal vesicle geometries through a course of radiotherapy. An optimal preparation would achieve reliable spatial arrangements and a high therapeutic ratio.MethodsThis prospective longitudinal study involved 59 prostate cancer patients treated with radical radiotherapy, of which half followed cohort 1 (laxative cohort) and the other cohort 2 (consistent timing cohort) bladder and bowel preparation regimen. Participants were asked to maintain an empty rectum for both planning and daily treatment appointments in cohort 1 through a fleet enema the morning of the planning appointment, and intake milk of magnesium during daily treatments. No specific bowel preparation was provided to cohort 2 patients. Instead, their appointment times were aligned with their natural bowel habits. This information was collected through a prescreening tool before treatment booking. All cohort 1 and 2 participants were asked to drink 250 mL of water 1 hour before planning and daily treatment appointments. Cohort 2 participants who identified no pre-existing urinary conditions were also asked to drink 2 L of water within 24 hours before the planning session and to continue this during treatment trajectory unless unable to do so because of treatment-induced bladder toxicities later in the treatment. A total of 1,335 structures (bladder, rectum +/− gas, and prostate +/− seminal vesicles) were contoured on the cone beam computerized tomography scans by three radiotherapists. A stringent quality assurance process was performed to assure quality and consistency of contours. Organ volumes were measured and evaluated for consistency over time from planning to completion of radiotherapy. Data analysis included the Fischer exact test and mixed effect modelling for total and subvolumes for bladder, rectum, rectal gas, and prostate +/− seminal vesicles.ResultsBaseline total volumes for bladder ranged from 132 mL to 501 mL with means of 325 mL and 315 mL in cohorts 1 and 2, respectively. Bladder volume declined 3.6 mL per fraction and 2.4 mL per fraction in cohorts 1 and 2, respectively. The volume of the bladder structure inside the planning target volume (PTV) on simulation showed no difference by cohort (P = .095) but there was an effect of time (linear P < .0005). Baseline total volumes for rectum ranged from 19.2 mL to 106.3 mL with means of 52.0 mL and 54.7 mL in cohorts 1 and 2, respectively. The volume of the rectum inside the PTV on simulation showed no difference by cohort (P = .12) or time (P = .30) during the treatment course. Volume of gas in the rectum did not vary by cohort (P = .6) or time (P = .08). Baseline total volumes for the clinical prostate +/− seminal vesicles target ranged from 37.1 mL to 167.5 mL with means of 76.2 mL and 66.0 mL in cohorts 1 and 2, respectively. The clinical target decreased by 3% in total volume during the course of radiotherapy in both cohorts, with similar rates of the target falling outside the planned PTV structure.ConclusionsNo significant difference was found between cohorts for rectal volume, gas volume, target coverage, and rectal and bladder volumes in the PTV. Hence, patients should be offered a choice between cohort 1 and 2 bowel preparation regimens to allow for patient preference customization. Cohort 2 bladder preparation regimen was shown to be superior for consistency with slightly larger volume over time.     

宫颈癌术后盆腔螺旋断层调强和固定野调强技术的剂量学比较

  目的  比较对宫颈癌术后患者应用螺旋断层调强放疗(helical tomotherapy, HT)和固定野调强放疗(fixed-field intensity-modulated radiotherapy, FF-IMRT)两种计划方式进行放射治疗的剂量学差异。  方法  选择10例宫颈癌术后进行调强放疗的患者行CT模拟定位, 勾画靶区及危及器官, 对同一CT图像设计HT计划和FF-IMRT计划。评估靶区及危及器官的剂量分布。  结果  HT计划组和FF-IMRT计划组靶区覆盖度均满足临床处方剂量要求。与FF-IMRT计划组相比, HT组的计划靶区(planning target volume, PTV)95%、PTV100%覆盖度增加, PTV105%覆盖度降低、Dmean及Dmax均明显降低(P=0.000), 适形度指数和均匀性指数均优于FF-IMRT计划组(P=0.000)。与FF-IMRT计划组相比, HT计划组的膀胱V₄₀降低约7%(P=0.000), Dmax平均值降低1.7 Gy(P=0.000);直肠V₄₀降低约8%(P=0.000);小肠V₃₀、V₄₀分别降低4%、3%(P=0.002, P=0.000), Dmax平均值降低2 Gy(P=0.000);骨髓V₃₀增加约5%(P=0.001), 左右股骨头D₅差异无统计学意义; 马尾神经Dmax的平均值降低约2 Gy(P=0.030)。全身V₂₀、V₃₀、V₄₀分别降低2%、1.3%、0.6%(P < 0.01)。  结论  宫颈癌患者采用HT技术, 靶区均匀性指数及适形度指数均较FF-IMRT技术明显提高, 膀胱、直肠、小肠中高剂量区的体积进一步降低。HT技术在宫颈癌术后的临床应用中具有可行性, 可作为一种新的照射方式推广。     

A Retrospective Planning Analysis Comparing Volumetric-Modulated Arc Therapy (VMAT) to Intensity-Modulated Radiation Therapy (IMRT) for Radiotherapy Treatment of Prostate Cancer

PurposeThis study aims to compare intensity-modulated radiation therapy (IMRT) to volumetric-modulated arc therapy (VMAT) for the treatment of prostate cancer. Particular focus was placed on the impact IMRT and VMAT have on departmental planning and treatment resources.Materials and MethodsTwenty prostate cancer cases were retrospectively planned to compare 5-field IMRT to VMAT using a single arc (VMAT-1A) and 2 arcs (VMAT-2A). The impact on departmental resources was assessed by comparing the time needed to generate the dose distributions and to deliver the treatment plan. A comparison of plan quality was also performed by comparing homogeneity, conformity, the number of monitor units (MUs), and dose to the organs at risk.ResultsIMRT and VMAT-2A were able to produce adequate plans for all cases. Using VMAT-1A, planning guidelines were achieved in 8 of the 20 cases. IMRT provided an improved dose distribution and the best homogeneity to the planning target volume. Also, the IMRT plans were generated significantly faster than both VMAT techniques. VMAT planning provided significantly improved conformity and used significantly fewer monitor units than IMRT. VMAT-1A treatments were significantly faster than both IMRT and VMAT-2A. VMAT plans delivered lower dose to the bladder and heads of femur, and an increased dose to the rectum in the low dose region.ConclusionIMRT may have an advantage over VMAT for the treatment of prostate cancers. This is primarily due to the uncertainty of achieving planning guidelines using VMAT and the extended time needed to generate the VMAT plans.     

图像引导放射治疗在宫颈癌患者治疗中的应用

目的探讨中晚期宫颈癌患者应用图像引导放射治疗(IGRT)技术,在提高靶区剂量与减少正常组织受量方面的价值。方法 30例中晚期宫颈癌患者,均给予全程IGRT放疗同步化疗。治疗结束后3个月评价近期疗效,随访评价毒副反应发生情况。观察直肠、小肠和膀胱的受照射剂量和体积。结果 30例患者均完成全程的IGRT,近期疗效显示:CR 26例,PR 4例。1至2年生存率为100%。放疗靶区较精确,OAR的受照剂量为:小肠31.68 Gy;直肠37.19 Gy;膀胱30.13 Gy。毒副反应主要为急、慢性消化道反应和急、慢性血液系统反应。结论在宫颈癌治疗中,IGRT放疗技术可以提高肿瘤放疗的精准性,达到最大程度杀灭肿瘤和保护正常组织器官功能,毒副反应可耐受。