59例脊椎血管瘤放射治疗疗效分析

目的　探讨脊椎血管瘤放射治疗的适应证、剂量、疗效。方法　脊椎血管瘤 5 9例 ,女 36例 ,男 2 3例。 5 7例有脊椎局部疼痛和 (或 )肢体感觉和 (或 )运动功能障碍。 6例曾在外院接受手术治疗 ,其中 4例为椎板减压加部分肿瘤切除术后复发。采用深部X线、电子线、60 Coγ线、6～ 8MVX线等照射 ,总剂量 2 8～ 90Gy ,中位剂量 4 0Gy。结果　 5 4例可评价疗效 ,总有效率为 87.0 % ;其中剂量30～ 4 0Gy和剂量 >4 0Gy组的有效率分别为 90 .2 %和 83.3% (χ2 =0 .4 1,P =0 .6 0 8)。 9例不完全截瘫者中 ,治愈和显效各 4例 ,1例无效。结论　 (1)放射治疗对有症状的脊椎血管瘤是安全有效的方法 ,有效剂量在 30～ 4 0Gy;而无症状或症状轻微无神经压迫症状者可暂不治疗 ;(2 )放射治疗起效慢 ,大多数病例在疗后 3个月至 7年内 (中位时间 1.5年 )症状逐步减轻或消失 ;(3)放射治疗后影像检查多无明显改变。     

脊椎血管瘤32例放射治疗效果分析

 目的　探讨脊椎血管瘤放射治疗的适应证、剂量、疗效。方法　脊椎血管瘤患者32例，男21例，女11例。32例均有脊椎局部疼痛、肢体感觉和（或）运动功能障碍。采用6～8 MV X线照射，总剂量30～80 Gy，中位剂量40 Gy。7例有明显脊髓压迫症状者采用手术加术后放疗的综合治疗方法，其中3例由于瘤体范围大，术前行介入法栓塞病变椎体供血动脉。结果　32例患者总有效率为90.6 %（29／32），其中剂量30～40 Gy组和剂量＞40 Gy组的有效率分别为92.6 %（25／27）和80.0 %（4／5）（χ2＝2.05，P＝0.221）。均无明显的并发症及恶性变。结论　对脊椎血管瘤采用术前介入法栓塞供血动脉并椎体减压术结合术后放疗的综合治疗方法具有快速缓解压迫、减少术中出血、疗效确切的优势。     

放射治疗脊椎血管瘤截瘫1例报告

1　病例报告患者男性 ,2 5岁。因患脊椎血管瘤 ,于 1993年 5月 11日在我院行 (T12 ～L1)椎体切除术 ;1994年 9月 2 0日因脊椎血管瘤复发并引起左下肢麻木 ,再次行手术治疗。术后病理检查证实为毛细血管瘤。右下肢完全丧失感觉 ,腰背部及左下肢疼痛进行性加重 ,生活不能自理 ,发生截瘫。体检 :T10～ 12 、L2～ 4 椎骨明显隆起。MRI检查提示 :椎骨内 10cm× 4cm大小的略低信号影 ,病灶内散在小点状细条状信号 ,肿块压迫椎体 ,引起骨质缺损 ,下胸段脊髓见藕节状虾虫样信号。下腰段椎管内见数条纡曲血管影。临床诊断 :脊椎血管瘤 (T12 ～L2 …     

症状性脊椎血管瘤合并脊髓功能损害的治疗进展

脊椎血管瘤是一种脊柱良性病变,表现为脊椎内血管组织异常增生。尸检结果显示,脊椎血管瘤发生率为10%~12%,通过影像学手段筛查脊椎血管瘤的发病率为10%~27%,可见脊椎血管瘤在人群中的发生率很高[1-3]。有研究根据患者临床表现,将脊椎血管瘤分为无症状性脊椎血管瘤、疼痛性脊椎血管瘤和合并脊髓功能损害的脊椎血管瘤[4]。目前,临床所说的症状性脊椎血管瘤即为后两种类型总称,仅占脊椎血管瘤的0.9%~1.2%。近40年间,84例症状性血管瘤仅有28.6%的患者出现脊髓受压引起的神经功能障碍或截瘫[5]。因此,合并脊髓功能损害的症状性脊椎血管瘤在临床中较少见,且目前关于其手术治疗方面的国内外报道较少。由于脊椎血管瘤为富血供病变,术中出血汹涌,手术难度及危险系数极高,因此对脊髓或神经根减压方式和病变椎体的处理方法尚无一致观点[6-10]。笔者对合并脊髓功能损害的脊椎血管瘤治疗现状综述如下,为临床医生选择合适的治疗方法提供参考。     

脊椎血管瘤的放射治疗(20例分析)

 脊椎血管瘤是常见的脊椎良性瘤。常压迫脊髓产生局部疼痛、肢体麻木,甚至截瘫。故严重地影响病人的劳动力和生活。因此对本病及时确诊和积极治疗是十分重要的。我院从1960年10月至1975年6月经放射治疗并随诊五年以上者共20例,治疗结果表明放射治疗可使症状明显改善;生理功能恢复。本文进行临床分析以助于今后的治疗。     

有症状脊椎血管瘤的放射治疗效果

本组收治的15例脊椎血管瘤都具有症状,除患病部位、下肢疼痛及麻木外,伴双下肢瘫痪者7例,多数为中晚期病人。因其解剖部位及病变弥散的关系,仅单纯手术治疗远期效果不佳。我们采用单纯放疗或椎板切除减压合并放疗,使疗效明显提高,经放疗后14例中有13例症状消失或基本消失。即使出现脊髓压迫而发生双下肢瘫痪者,经及时放疗或椎板切除减压后立即放疗,都能收到满意疗效。     

放射治疗致气管软化一例

患者男，47岁，农民。因患胸上段（T（2-3））食管癌于2000年1月在我院门诊行放射治疗，6MV X线照射，每次2Gy，共28次、总剂量56Gy左右，前后野垂直照射40Gy，等中心照射16Gy，之后症状缓解，患者能从事正常体力活动。至2005年1月患者出现吞咽困难，在某县级医院诊断为食管癌局部复发，并在该院行放射治疗共25次，射线种类不详，估计剂量约50Gy，治疗后症状减轻，能进半流质饮食。     

三维适形放射治疗肺癌脑转移临床疗效观察

目的：通过观察脑转移三维适形放射治疗的结果，探讨三维适形放射治疗对非小细胞肺癌脑转移的临床意义。方法：1998年5月-2006年2月41例确诊肺癌脑转移患者，其中合并颅外转移18例，非颅外转移23例。所有患者首先经全脑放疗，2—3Gy／次，5次／周，DT30Gy-40Gy，然后行三维适形放射治疗局部加量，90％的等剂量曲线包括靶区，DT4—6Gy／次，总剂量12Gy-24Gy。结果：治疗有效率90．2％（37／41），中位生存期18月，半年生存率79．9％，1年生存率66．7％。结论：全脑放射治疗＋三维适形放射治疗可以提高脑转移的靶区剂量，并提高局部控制率，减少脑部复发的机会，同时颅外转移灶及原发灶的治疗也非常重要。     

有症状的椎骨血管瘤

椎骨血管瘤是从血管发生的生长缓慢的良性肿瘤,大多无症状,系在脊柱和胸部照片或尸检时偶然发现。椎骨血管瘤罕有脊髓压迫。本文报告近10年中12例具有症状的椎骨血管瘤。女性10例,男性2例,年龄10～45岁,多数在120岁及30岁,最年轻的1例患者是10岁女孩。12例中8例有截瘫,但均无外伤史。多数病人开初诊断为波特氏(Pott′s)截瘫。5例截瘫系急性发作,3例呈慢性进行性。5例突发性截瘫的脊柱为压缩性骨折。其它征象为局部疼痛、麻木以及下肢刺痛感。     

立体定向适形放疗剂量对晚期胆管癌治疗疗效的影响

目的：探讨立体定向适形放疗(3D-CRT)剂量对不可切除的胆管癌治疗疗效的影响。方法：对48例不能手术切除的局部晚期胆管癌患者采用3D-CRT技术，根据放疗剂量分为3组，低剂量组12例，DT33～39Gy，中等剂量组23例，DT40—58Gy，高剂量组13例，DT59．4—68Gy。低剂量组3Gy／次，中等剂量组及高剂量组1．8—2．0Gy／次，5次／周。结果：所有患者局部复发的中位时间是10月，中位总生存期是12月。影像学显示24例(50％)疾病进展，其中21例(87．5％)以局部复发作为疾病进展的第一影像学证据，其余3例出现远处转移。3组间局部复发时间(P=0．220)及中位生存时间(P=0．232)差异无显著性。急性胃肠道反应发生率在各放疗剂量组差异无显著性(P=0．485)。结论：局部进展是本组胆管癌治疗失败的主要原因。虽然因本研究病例数较少不足以进到统计处理，但高放疗剂量组具有局部控制率较高、总生存期较长的趋势。     

Radiotherapy of Vertebral Hemangiomas

Between 1975 and 1996, 14 patients (11 females, 3 males) with vertebral hemangioma received treatment with radiotherapy. Thirteen patients had a history of back pain or lumbago and 2 patients had neurological symptoms such as sensory impairment or paraplegia. The standard dose administered was 36 Gy in 18 fractions (five treatments per week). In the 13 patients with pain, this was completely or partially relieved. The condition of a man with hypesthesia of the legs deteriorated and a woman with paraplegia who was treated with decompressive laminectomy followed by radiotherapy recovered completely after irradiation. CT scan before irradiation showed thickened trabeculae as small punctate areas of sclerosis in all patients. At MR imaging before irradiation, T2-weighted MR images showed areas of high intensity in all patients and MR images demonstrated lesion enhancement. However, none of the patients who were treated successfully with radiation demonstrated any changes of the affected vertebra in the conventional radiographic films, CT scan or MR imaging, even 5 years after irradiation. Radiological imaging is indispensable for the diagnosis of vertebral hemangiomas but does not appear to be useful for evaluating the effects of radiotherapy.     

Is there a dose-effect relationship for the treatment of symptomatic vertebral hemangioma?

PURPOSE: Symptomatic vertebral hemangiomas are rare vascular lesions. Radiotherapy is the most common treatment. Because of a lack of information in the literature, uncertainty exists about the total radiation dose to be applied. METHODS AND MATERIALS: Individual data from our own and published patients with symptomatic vertebral hemangioma treated with radiotherapy alone were obtained. The data were pooled, and the impact of the total dose on complete pain relief was evaluated using the chi-square test. Because different single-fraction doses were used, the equivalent dose in 2-Gy fractions (EQD(2)) was used for the analysis. RESULTS: Complete data could be obtained from 117 patients. Patients were categorized according to total dose (EQD(2)) into two groups of similar size (Group A: 20-34 Gy, n = 62; and Group B: 36-44 Gy, n = 55). Radiation-induced complete pain relief was achieved in 39% (24/62) of the patients in Group A and in 82% (45/55) of the patients in Group B. The difference was statistically significant (p = 0.003). CONCLUSIONS: The data suggest a dose-effect relationship in the radiotherapy of symptomatic vertebral hemangiomas. We recommend a total radiation dose 36-40 Gy with a dose per fraction of 2.0 Gy.     

复发晚期直肠癌的姑息性放疗：（附14例临床分析）

报告北京协和医院放疗科１９８１年至１９９０年对１４例晚期复发的直肠癌患者放疗的效果。本组病人年龄３１～６０岁，男女各７例。放疗结束时病人会阴区疼痛症状完全及部分缓解达１００％，２例便血症状得到控制。经随诊，无症状生存达３个月者１０例，无症状生存达半年者４例，全组病人平均生存达１４个月。作者分析并认为对晚期复发的直肠癌患者的放疗，意在姑息减症，放疗剂量不宜过高。放疗安全无明显并发症，对提高病人生存质量，是一种有效的治疗姑息手段。     

食管癌放疗后复发三维适形放疗的临床观察

目的探讨三维适形放疗(3DCRT)在食管癌首程放疗后局部复发患者中应用的疗效、放射性损伤及影响因素。方法 38例首程放疗后局部复发的食管癌患者,采用3DCRT技术进行二程放疗。放疗处方剂量中位值56Gy(50～64Gy),1.8～2.0Gy/次,5次/周。结果随访截至2009年12月31日,随访率为100.0%。38例患者中完全缓解8例,部分缓解27例,无进展或恶化3例。全组患者1、2、3年总生存率分别为68.4%、23.7%、15.8%。全组≥2级放射性食管炎14例,≥2级放射性肺炎9例,≥2级血液学副反应4例。本组共死亡32例,其中死于局部复发15例、远处转移6例、食管瘘2例、食管狭窄1例、全身衰竭4例、其他疾病2例、死因不详2例。结论食管癌首程放疗后局部复发采用3DCRT二程放疗是可行的,有较好临床症状缓解率和即时疗效,部分患者可延长生存期,但再程放疗并发症较高,临床应用时应严格掌握其适应证。     

Radiation therapy in the treatment of giant cell tumor of bone

Purpose: To assess the local control rate and potential complications of radiotherapy, and the factors influencing response to radiotherapy for primary and locally recurrent giant cell tumor of bone.Methods and Materials: Twenty patients were irradiated for giant cell tumor of bone between 1983 and 1993. Fourteen patients received radiotherapy at the time of primary diagnosis (10 had biopsy and 4 partial surgery) and 6 patients at the time of local recurrence (following additional surgery in 2). Fourteen patients had tumors of the extremity and six of the vertebral column. The radiotherapy dose ranged from 40–60 Gy in 15–30 fractions over 3–6 weeks. The response to radiotherapy was assessed by clinical and radiological criteria and the probable factors influencing response were analyzed.Results: The median follow-up period was 48 months (range, 4 months to 13 years). Local control was obtained in 18/20 patients. The two local failures were salvaged, one by reirradiation and the other by surgery. Only one patient died of giant cell tumor, following extensive bone marrow infiltration. There was no serious late toxicity or malignant transformation. The response to radiotherapy was not influenced by disease status at presentation, tumor site, radiotherapy schedule, or presence of soft tissue extension.Conclusions: Radiotherapy is effective in producing local control in primary as well as recurrent giant cell tumor of bone. There are no major complications and no significant risk of malignant transformation. Radiotherapy could be considered as the primary treatment modality in patients where surgery would produce functional deficits.     

Radiotherapy in the treatment of vertebral hemangiomas

Symptomatic vertebral hemangiomas are not common. Although radiotherapy has been used as treatment, the data are sparse concerning total dose, fractionation and results. We report nine patients with vertebral hemangioma treated with 3000-4000 rad, 200 rad/day, 5 fractions per week, followed from 6 to 62 months. Seventy-seven percent had complete or almost complete disappearance of the symptoms. Radiotherapy schedules are discussed.     

Radiotherapy for large symptomatic hemangiomas

Between 1974 and 1988, 13 patients presented with large (3 to greater than 20 cm) symptomatic unresectable or partially resected hemangiomas. Tumor sites were extremities (five cases), vertebral bodies (three cases), face (two cases), pituitary fossa (one case), pelvic bones (one case), and bladder (one case). Symptoms included severe pain in eight patients, inability to use an extremity in five, vision problems in three, weakness in two, and hematuria with decreased urinary stream in one. Many patients had more than one symptom. Two of the cases were associated with life-threatening consumptive coagulopathies (Kasabach-Merritt syndrome). Therapy was delivered with both orthovoltage and megavoltage photons. Doses ranged from 6.25 to 40.0 Gy in 1.6- to 2.5-Gy fractions. Follow-up ranged from 2 to 15 years (median, 13 years). Tumor shrinkage was noted in 9 (82%) of the 11 cases in which tumor size data were collected before and after therapy. Complete response of tumor mass occurred in 4 (36%) of 11, partial response occurred in 5 (45%), and no response occurred in 2 (18%). No tumor grew after radiotherapy. Some relief in symptoms occurred in all 13 patients; 10 (77%) had complete resolution of symptoms. In both patients with life-threatening cytopenias, hematologic values returned to normal after treatment. Because the majority of the patients responded to all dose levels administered, no firm dose-response relationship was evident. However, objective (measurable) complete responses occurred in two (50%) of the four patients receiving doses of 30 Gy or greater compared with only two (29%) of the seven patients who received lesser doses. No long-term morbidity occurred. Radiotherapy of large unresectable and partially resected hemangiomas yields long-term relief of symptoms and tumor shrinkage in the majority of patients treated.     

经皮椎体成形术联合放疗治疗脊椎骨转移瘤的临床观察

目的:探讨经皮成形术(PVP)联合放疗治疗脊椎骨转移瘤的方法及疗效.方法:对26例经病理学证实的42个病变椎体行PVP.骨水泥按粉、液、对比剂3:2:1比例配制.胸腰骶椎区均采用经椎弓根或椎体后外侧穿刺,在确定穿刺到位并无椎管内渗漏后,将骨水泥快速灌注至椎体内.灌注量为胸椎平均4.6ml,腰椎平均5.4ml,骶椎平均5.5ml.术后观察患者疼痛缓解程度,并于当日、1个月CT检查注射椎体.放疗在PVP后第3～4天开始,采用60C0照射,2～3Gy/次,总量35～45Gy/3～4周.结果:穿刺成功率100%本组26例单侧穿刺32个椎体,双侧穿刺10个椎体.CT检查骨水泥周围组织渗漏2例,但均未出现临床症状.26例放疗过程顺利.PVP后止痛有效率为80.8%(21/26),联合放疗后,止痛有效率上升至96.2%(25/26).随访4～10个月,止痛有效率在10个月内为88.5%(23/26).结论:PVP有靶区硬度压强和快速缓解疼痛的作用,放疗能强化对肿瘤的抑制,从而达到提高疗效的目的.     

Radiotherapy and conservative surgery in the management of musculo-aponeurotic fibromatosis

Fifty-four patients with musculo-aponeurotic fibromatosis treated with surgery, surgery and planned post-operative radiotherapy, or radiotherapy alone between 1936 and 1982 have been retrospectively reviewed. Twenty-seven patients had a previous excision before definitive treatment. All patients in whom surgery was known to be incomplete and who had no further treatment relapsed. Nine patients had a complete surgical excision alone and 1 relapsed. Twenty-nine patients were treated with surgery and post-operative radiotherapy and 7 relapsed. Relapse was associated with small field size, orthovoltage irradiation, and doses less than 50 Gy. Radiotherapy was effective in preventing relapse in 6 of 8 cases incompletely excised and in all of these cases the total dose was more than 50 Gy. In 13 assessable patients with clinically evident disease, 14 fields were treated with radiotherapy. Complete response was achieved in 9 fields (although one subsequently relapsed and 2 had a marginal relapse), partial response in 4, and disease stasis in one. Complete resolution took up to 21 months and total doses ranged from 35.2 Gy to 64 Gy. Radiotherapy is indicated in cases of incomplete excision and inoperable disease. Doses should be radical and fields should be sufficiently generous to encompass the anatomical limits of the infiltrated tissues.