Radiochemotherapy combined with regional pelvic hyperthermia induces high response and resectability rates in patients with nonresectable cervical cancer > or =FIGO IIB "bulky"

PURPOSE: To evaluate preoperative radiochemotherapy combined with regional pelvic hyperthermia in patients with nonresectable cervical cancer >/= International Federation of Gynecology and Obstetrics (FIGO) IIB "bulky" in a Phase II study. METHODS AND MATERIALS: Thirty-two patients with nonresectable FIGO IIB-IVA cervical cancer confined to the pelvis were treated with radiochemotherapy (5 x 1.8 Gy/wk, 45-50.4 Gy; cisplatin, 40 mg/m2/wk) and weekly regional pelvic hyperthermia (SIGMA-60 applicator, system BSD-2000; BSD Medical Corp., Salt Lake City, UT). Responders underwent hysterectomy if possible, whereas patients still unresectable received definitive hyperthermic radiochemotherapy. Feasibility, toxicity, as well as response and resectability, local progression free- and overall survival rates, were evaluated. RESULTS: Thirty of 32 patients completed treatment. Grade III/IV toxicities (National Cancer Institute-Common Toxicity Criteria) were diarrhea (n = 5), weight loss >10 kg (n = 4), and nausea (n = 2). Twenty-four of 32 patients (75%) achieved a partial remission after 45-50 Gy, and 20 patients underwent hysterectomy (18 patients, R0; 8 patients pCR). Three-year overall survival was 60%, with moderate (13%) rates of severe late toxicity. R0-resected patients had a favorable chronic toxicity profile and an excellent prognosis (3-year survival rate: 93%). Response depended on thermal parameters (vaginal reference point), whereas response, R0-resection, and FIGO stage are significant prognostic factors for survival. CONCLUSION: Preoperative hyperthermic radiochemotherapy (45-50 Gy) induces high response rates and enables curative surgery in a high proportion of patients with nonresectable cervical cancer. Therefore, the use of hyperthermia in conjunction with standard chemo-/radiotherapy +/- surgery may allow for more effective tumor treatment while decreasing the risk of complications in patients with locally advanced cervical cancer.     

Intraoperative radiation therapy for patients with recurrent rectal and sigmoid colon cancer in previously irradiated fields.

A retrospective study evaluated 15 patients with pelvic recurrence of colorectal cancer in a previously irradiated region who received intraoperative radiation therapy (IORT) as part of salvage therapy. Total prior external beam radiation therapy (EBRT) doses ranged from 45 to 79.2 Gy. Tumor resection was accomplished in 14 patients, with an exenteration performed in seven. IORT dose was 15-20 Gy. Three patients received additional EBRT as a post-operative course of 25.2 Gy in 14 fractions. Actuarial 3-year local control rate was 25%. The 3-year overall survival rate was 29%. Patients with fixed and/or bulky pelvic tumors had a local control rate of 19% at 12 months and median overall survival of 9 months. Patients with less extensive clinical presentations of anastomotic non-fixed transmural recurrence, isolated pelvic node metastasis and rectal recurrence following local excision had a local control rate of 42% at 36 months and median survival of 43 months. We conclude that clinical presentation of recurrent disease is an important prognostic factor. The value of IORT may be limited to patients with less extensive clinical presentations.     

Split course pelvic irradiation and a boost for carcinoma of the prostate

Fifty nine patients with prostatic cancer treated by definitive external irradiation were retrospectively evaluated. The true pelvis and prostate gland were irradiated by a split course technique for 48-50 Gy and 68-70 Gy in 7 weeks with a booster dose of 20 Gy delivered in the rest period (after 24-26 Gy) to the prostate via small ports. The overall 3 and 5 year actuarial survival was 83% and 75%, respectively. Only four patients had persistent local disease and two of these (Stage D) died with local disease and distant metastases. Acute mild diarrhea or mild cystitis occurred in 26 patients whereas two patients developed chronic diarrhea lasting for 2 and 12 months after therapy. There were no long-term complications requiring interventional surgery. Sexual potency did not seem to be affected. These results indicate that carefully performed external radiotherapy with a booster dose delivered half-way through whole pelvic radiation is very well tolerated without affecting the local control rate.     

Concurrent 5-fluorouracil, mitomycin C and radiation with or without brachytherapy in recurrent cervical cancer: a scoring system to predict clinical response and outcome

AIMS AND PURPOSE: This is a prospective, phase II study aimed to evaluate the effect of concurrent 5-fluorouracil, mitomycin C, and radiation with or without brachytherapy on the clinical outcome of a series of recurrent cervical cancer patients and to determine the prognostic impact of a subset of factors. METHODS: Thirty-three patients with locally recurrent, non-metastatic cervical cancer received external beam radiation (4-week split course: 23.4 + 23.4 Gy) plus two courses of concomitant chemotherapy (5-fluorouracil, 96-h continuous infusion, days 1-4, 1 g/m2/day; mitomycin C, 10 mg/m2, bolus i.v., day 1). Twelve patients with vaginal recurrence (36.4%) underwent endocavitary low-dose rate brachytherapy boost (20-25 Gy); 11 patients with lateral pelvic recurrence (33.3%) received external beam radiation boost (14-20 Gy). RESULTS: Fourteen complete responses (42.4%), 7 partial responses (21.2%), 5 disease stabilizations (15.1%) and 7 progressions (21.2%) were obtained. After a median follow-up of 34 months (range, 6-127), overall actuarial 3-year survival, progression-free survival and local progression-free survival were 59.7%, 48.1% and 51.7%, respectively. Patients with vaginal recurrence of less than 4 cm and negative lymph nodes proved to respond best to the treatment. Two patients (6.1%) experienced hematologic grade 3 toxicity. One patient had grade 3 intestinal toxicity (3.0%). No patient had major skin or urological acute toxicity. Severe late toxicity was infrequent. Three patients had prolonged leukopenia (9.0%). Four patients showed severe vaginal stenosis (12.1%). A clinical score of 0 to 1 was assigned to each patient on the basis of the absence (score = 0) or presence (score = 1) of any of the following prognostic factors: time between surgery and recurrence shorter than 12 months, pelvic wall site of recurrence, positive lymph nodes, hemoglobin < 11 g/dL. Using this system, it was clear that patients with a low total score had a significantly better outcome (clinical remission, 51% of patients with a score < or = 2 vs 12% of patients with a score > 2, P = 0.06), local control of the disease (65% vs 20% after 3 years, P = 0.001,) and overall survival (75% vs 30% after 3 years, P = 0.032). CONCLUSIONS: Our data suggest that this combined modality therapy was relatively well tolerated and resulted in reasonable local control and survival. The scoring system proved to be helpful to identify patients with the greatest chance of benefiting from the treatment. Further studies are probably needed to salvage the other patients, whose prognosis remains severe.     

Chimioradiothérapie de rattrapage à visée curative de rechutes pelviennes isolées de cancers du col utérin

PurposeEvaluation of the results of salvage radiation therapy with curative intent in the treatment of recurrent cervical carcinoma.Patients and methodsFourteen patients with a recurrence of a cervical cancer were treated in our department between 1982 and 2009. Five patients had a pelvic relapse, four a vaginal relapse and five a pelvic lymph node relapse. Four patients had first a surgical resection of the relapse, which was incomplete in two patients. All patients had pelvic radiotherapy with a median dose of 55 Gy in conventional fractionation. Concurrent chemotherapy was administered to 12 patients. A vaginal brachytherapy with a median dose of 20 Gy was performed in addition in 3 patients. The median follow-up was 39 months.ResultsSafety of radiation therapy was correct with 29% of grade 3 acute or intestinal toxicity. Tumor control was observed in 10 patients (71%). Four patients presented a locoregional tumor progression. At the time of analysis, three patients had died from their cancer. From the date of relapse, the rate of overall survival at 2 and 5 year was respectively 84% and 74%. Three patients (21%) had severe late effects.ConclusionIn our experience, chemoradiotherapy can achieve a high rate of remission in patients with isolated pelvic recurrence of cervical cancer. This treatment is feasible only if the patient had not received radiation therapy before or if the relapse is out of the previously irradiated volume.     

子宫移位宫颈癌盆腔四野外照射采用两种挡铅治疗方式的疗效比较

目的 探讨盆腔四野外照射时采用沿子宫中轴平面挡铅法治疗子宫移位宫颈癌患者的疗效和安全性。方法2009年1月至2013年3月广西壮族自治区南溪山医院收治ⅡB～ⅣA期的中晚期子宫颈癌初治患者108例,行同期放化疗。放疗采用盆腔外照射加192Ir高剂量率腔内后装治疗,化疗采用PF方案（顺铂+5-FU）。当外照射盆腔平面中心剂量达34～40 Gy／17～20 f时改行盆腔四野外照射,在模拟机下定位并测量子宫移位程度;将发生子宫移位的70例患者随机分为对照组（n=35）和观察组（n=35）,对照组采用沿盆腔中央挡铅法,观察组采用沿子宫中轴平面挡铅法,均追加宫旁剂量15～20 Gy／8～10 f。评价两组患者的近期疗效、生存率、局部复发率及毒副反应。结果 观察组和对照组的完全缓解率分别为94.29％、74.29％,局部复发率分别为5.71％、22.86％,差异均有统计学意义（P＜0.05）。观察组和对照组患者的1、2 年生存率分别为94.29％、82.86％和85.71％、71.43％,差异无统计学意义（P＞0.05）。两组的毒副反应主要为骨髓抑制、胃肠道反应、放射性膀胱炎和放射性直肠炎,多为1～2级,差异无统计学意义（P＞0.05）。结论 沿子宫中轴平面挡铅法可以减少剂量学“冷点”,弥补宫旁低剂量区的弊端,提高了因子宫移位治疗时造成的子宫旁低剂量,可明显提高肿瘤的完全缓解率及近期生存率,降低肿瘤的局部复发率。     

Paclitaxel and carboplatin concurrent with radiotherapy for primary cervical cancer

BACKGROUND: Concurrent radiochemotherapy is currently considered the new standard treatment in locally advanced cervical cancer. PATIENTS AND METHODS: Eight women with cervical cancer stage IB2-IVA were treated with standard radiation therapy in combination with standard carboplatin (AUC=2, once weekly, x 6) and escalating doses of paclitaxel (60 mg/m2, once weekly, x 4, then x 5 and x 6). RESULTS: At the lowest dose level, four weekly paclitaxel cycles in six patients, three developed grade III diarrhoea and one severe radiation enteritis several weeks after radiotherapy. Two patients did not achieve complete remission and underwent additive salvage hysterectomy. All patients remained free of local recurrence, but one patient had distant metastases after 13 months. The median disease-free survival was 25 months with a median follow-up of 26 months. CONCLUSION: Standard pelvic radiotherapy in combination with weekly carboplatin and paclitaxel is poorly tolerated due to dose-limiting diarrhoea.     

Effect of concurrent intra-arterial infusion of platinum drugs for patients with stage III or IV uterine cervical cancer treated with radical radiation therapy

PURPOSE: The purpose of this study was to explore the effect of concurrent intra-arterial infusion of platinum drugs in patients with stage III or IV uterine cervical cancer treated with radical radiation therapy. PATIENTS AND METHODS: Thirty-three patients with advanced (stage IIIA, 2; IIIB, 28; IVA, 3) uterine cervical squamous cell carcinoma were randomized into a concurrent intra-arterial infusion of platinum drugs with radiation therapy (IAPRT) group (18 patients) and a radiation therapy alone group (15 patients). After altering intrapelvic blood flow by embolization of the superior and inferior gluteal arteries under pelvic angiography, intra-arterial infusion of platinum drug through catheters inserted into both internal iliac arteries was performed concurrently with radiation therapy. One-shot infusion of cisplatin (100 mg/m2) twice with a 2- to 3-week interval was performed in eight patients, weekly infusion of carboplatin (100 mg/m2) via a reservoir five to six times was performed in four patients, and daily shot of cisplatin (10 mg/body) or 21 days via a reservoir was performed in six patients. Radiation therapy consisted of external-beam irradiation of 50 Gy/25 fractions/5 weeks for the whole pelvis with midline block after 30 Gy and intracavitary high-dose-rate brachytherapy using tandem and ovoids of 24 Gy/4 fractions/4 weeks to point A. RESULTS: The local complete response rate of the IAPRT group was 94% and was significantly higher than that of the radiation therapy group (67%). There were no significant differences in local response in the three drug delivery methods. Two- and 5-year overall survival rates were 54.5% and 44.4% in the IAPRT group, and 74.5% and 50.0% in the radiation therapy group, respectively. There was no significant difference between the two groups. In the IAPRT group, grade 3 or 4 acute bowel complications were seen in 33% of patients, grade 3 or 4 late bowel complications were seen 44%, and grade 3 or 4 myelosuppression was seen in 33%, and these complications were seen more in the IAPRT group than in the radiation therapy group and caused death in some patients. CONCLUSIONS: IAPRT had a better local response than radiation therapy but showed no proof of control over recurrence and had a poorer survival than radiation therapy. There were many local recurrences and distant metastases, contrary to the better first response of the IAPRT group over the radiation therapy group. Complications of the IAPRT group were very severe and made the patient's performance status and prognosis worse than in the radiation therapy group. We need to design some methods to decrease these complications to make use of the good local response acquired with IAPRT. Furthermore, we should re-examine the indication of IAPRT in patients with a large tumor because local recurrence and distant metastasis would be inevitable.     

Epidermoid carcinoma of the uterine cervix at operable bulky stages IB and II treated with combined primary radiation therapy and surgery]

PURPOSE: To identify prognostic factors and treatment toxicity in a series of operable bulky stages I and II cervical carcinomas treated with a therapeutic modality combining primary irradiation and surgery. PATIENTS AND METHODS: Between July 1982 and May 1996, 66 patients with bulky squamous-cell cervical carcinomas (stage IB2, IIA, and IIB with 1/3 proximal parametrial invasion) underwent primary external beam pelvic radiation therapy (37.40 Gy to 40 Gy over 4.5 weeks) and low-dose-rate uterovaginal brachytherapy (20 Gy) followed, 5 to 6 weeks later, by class II modified radical hysterectomy with bilateral pelvic lymphadenectomy. The four last patients received concomitant chemotherapy during the first and the fourth radiation week combining 5-FU and cisplatin. A clinical pelvic lymph node involvement had been observed in 7 patients. The clinical median tumor size was 5 cm in diameter (range: 4.5-8 cm). The median follow-up was 97 months. RESULTS: Pathologic complete tumor response in specimen of hysterectomy were observed in 46 patients. Six patients had pathologic unilateral iliac lymph node involvement. The 5- and 10-year specific survival rates were 79 and 74%, respectively. The 5- and 10-year disease-free survival rates were 76% and 71%, respectively. The 10-year local control rate was 85%. The 10-year probability for pelvic recurrence was significantly influenced by the pathologic tumor response: 26% in the residual group vs 5% in the complete tumor response group, P = 0.024). After multivariate analysis, the independent factors decreasing the probability of disease-free survival were: pathologic pelvic lymph node involvement (P = 0.029), and parametrial invasion (P = 0.031). Five late severe complications requiring surgical intervention were observed: 2 bowel obstructions, 1 ureteral stenosis, 1 vesicovaginal fistula, and 1 radiation induced unilateral femoral necrosis. CONCLUSION: A good local control is obtained after combined primary radiation therapy and surgery for bulky stages I and II cervical carcinomas. In our more recent practice, the treatment combines primary concomitant chemoradiation followed by surgery including pelvic and para-aortic lymphadenectomy.     

子宫颈癌同步放化疗的疗效与副反应

目的研究同步放化疗治疗子宫颈癌的疗效及副反应。方法158例Ⅰb2～Ⅳ期子宫颈癌患者接受同步放化疗。盆腔体外放射治疗DT 45 Gy/25f,腔内后装放疗7～9次,宫颈黏膜下0.5 cm,大块肿瘤消除量为10～30 Gy,A点(42±7)Gy。同步化疗用药为5-氟尿嘧啶(5-Fu) 2400 mg、m2,96 h持续泵入,第1天和第29天;顺铂(DDP)60 mg/m2,分1～4 d静脉滴入,第1～4天和第29～32天。结果全组总5年生存率为66.3%。宫颈局部未控率为4.4%(7/158),盆腔复发率为3.2%(5/158),远处转移率为17.1%(27/158)。毒副反应中,Ⅲ、Ⅳ级白细胞下降为12.7%(20/158),血小板下降为1.3%(3/158),中、重度贫血为3.2%(5/158),胃肠道反应腹泻为17.8%(28/158),心脏毒性为10.1%(16/158),放射性直肠炎为13.3%(21/158),放射性膀胱炎为0.6%(1/158)。结论采用含5-Fu和DDP的药物同步放化疗治疗子宫颈癌,总治疗时间没有延长,5年生存率亦未见提高。治疗中,相关毒副反应增加,但可以接受。     

调强适形放疗联合化疗及射频热疗对局部晚期非小细胞肺癌的疗效研究

目的研究调强适形放疗联合化疗及射频热疗,治疗局部晚期非小细胞肺癌的疗效及不良反应。方法将84例NSCLC患者随机分成两组（治疗组与对照组）,每组42例。治疗组采用调强适形放疗,常规分割2 Gy/次,每周5次,总剂量60 Gy/30次;化疗采用NP方案,与放疗同步进行,并同时行射频热疗,每周2次。对照组单纯采用NP方案化疗。结果治疗组放射性肺炎发生率为2.4%,放射性食管炎发生率为26.2%,Ⅰ～Ⅱ度白细胞下降发生率为47.6%,Ⅲ度白细胞下降发生率为14.3%,中位生存期为17.6个月,1、2、3年生存率分别为63.5%、38.5%、29.5%,而对照组Ⅰ～Ⅱ度、Ⅲ度白细胞下降发生率分别为42.9%、11.9%,中位生存期为11.3个月,1、2、3年生存率分别为41.0%1、2.4%4、.0%。结论调强适形放疗联合同期化疗及射频热疗治疗局部晚期非小细胞肺癌,可明显提高患者局部控制率及1、2、3生存率,且不良反应小。     

分次立体定向伽玛刀配合盆腔放疗治疗宫颈癌的临床观察

目的：探讨全盆腔常规放疗加分次立体定向伽玛刀治疗宫颈癌的疗效。方法：60例中晚期宫颈癌患者采用全盆腔常规放疗46-50Gy,加分次立体定向伽玛刀治疗,伽玛刀DT 16-20Gy,2Gy/次,1次/日。结果：近期疗效CR 40%,PR 51.67%,SD 8.33%,无PD病例。总有效率91.67%。1、2、3年生存率96.67%、70%、28.33%。近期毒副反应及远期并发症低。结论：全盆腔常规放疗加分次立体定向伽玛刀治疗中晚期宫颈癌疗效好,不良反应小,方法简便,易被患者接受。     

The Feasibility and Safety of Induction Chemotherapy Followed by Definitive Chemoradiation in Patients with Locally Advanced Cervical Cancer: A Single-Arm Phase II Clinical Trial

Background: The present study aimed at investigating the feasibility and safety of induction chemotherapy followed by definitive chemoradiation (dCRT) in patients with locally advanced cervical cancer. Materials and Methods: In this single-arm clinical trial, patients with cervical cancer (stages IB3-IVA) received a median four cycles of induction chemotherapy (paclitaxel and carboplatin, every three weeks) followed by dCRT (which consisted of the whole pelvis at the dose of 45-50 Gy along with weekly cisplatin (40 mg/m2) followed by intracavitary brachytherapy at the total dose of 80-90 Gy). Primary end point was local control at three months, which was assessed by gynecologic examination and pelvic MRI. The secondary outcome of the study was treatment-related toxicity. Results: Seventy-four patients with the mean age of 51.6 ± 9.5 years were included. The most frequent (51.4%) disease stage was IIB. Complete and partial clinical responses were observed in 60.8% and 14.9% of patients, respectively. The frequency of progressive disease and stable disease were 14.9% and 9.5%, respectively. Grade II and III neutropenia (during neoadjuvant chemotherapy were 13.5% and 2.7%, respectively; these figures during chemoradiation were 29.7% and 13.5%, respectively. A treatment interruption was observed for 60.8% (45 cases) of patients during chemoradiation and 31.1% during  induction chemotherapy. Discussion and conclusion: Induction chemotherapy followed by chemoradiation is feasible in patients with locally advanced cervical cancer; however, the toxicity should be managed properly to avoid delayed e treatment. More than three quarters of the patients achieved complete or partial clinical response within a three-month follow-up.     

结直肠癌术后放疗后局部复发或转移的三维适形放疗

目的:评价三维适形放疗对术后放疗后局部复发或转移的结直肠癌患者的局部控制率、生存率以及治疗的安全性。方法:26例术后放疗后局部复发或转移的结直肠癌患者采用三维适形放疗,3Gy~4.5Gy/次/日,每周5次,总剂量DT42Gy~48Gy。结果:完全缓解19.23%(5/26),部分缓解53.84%(14/26),进展15.37%(4/26),1、2、3年生存率分别为80.75%、53.84%、30.76%。副作用主要为腹痛,腹泻。结论:三维适形放疗是安全的,能在一定程度上缓解病人的症状,治疗有一定的效果。     

T4 rectal cancer treated with preoperative chemoradiation to the posterior pelvis followed by multivisceral resection: patterns of failure and limitations of treatment

PURPOSE: To analyze the overall pattern of treatment failure and sites of pelvic disease recurrence relative to the radiation fields used in treating patients with clinically staged T4 rectal cancer with preoperative chemoradiation followed by multivisceral resection. METHODS AND MATERIALS: Between 1990 and 1998, 45 patients with T4 rectal cancer were treated with preoperative chemoradiation. Clinical staging was according to the system of the American Joint Cancer Committee and was based on endoscopic ultrasonography, chemotherapy (CT), and physical examination. A diagnosis of T4 disease required evidence of invasion of a contiguous structure on CT (n = 31) or endorectal ultrasonography (n = 6), vaginal mucosal involvement on pelvic examination (n = 6), or a combination of these findings (n = 2). Chemoradiation was delivered with 18 MV photons using a 3-field belly-board technique. The median total dose was 45 Gy in all patients (range 45-63). Nine patients received a boost with external beam radiotherapy (EBRT) (n = 5, 1.8-18 Gy), intraoperative RT (n = 3, 10-20 Gy), or interstitial brachytherapy (n = 1, 20 Gy). All patients received concurrent chemotherapy consisting of protracted venous infusion 5-fluorouracil (300 mg/m(2), 5 d/wk). Resection was not performed in 13 (29%) of the 45 patients because of metastases detected before resection or patient refusal. Multivisceral resection and pelvic exenteration was required in 21 (66%) and 11 (34%) of 32 patients, respectively. We compared the location of pelvic disease recurrence with the RT simulation films. The Kaplan-Meier method was used to calculate the 4-year actuarial pelvic and distant recurrent rates and the overall survival rate. RESULTS: The median length of follow-up was 31.0 months for all patients and 40.0 months for patients alive at last follow-up. When only the resected cases were considered, the local recurrence rate was 20%. Distant metastases occurred in 44% of cases; the overall survival rate was 69%. When all patients were considered, the local recurrence rate was similar (24%), but the rate of distant recurrence (51%) was higher and the overall survival rate lower (50%). Pelvic disease was controlled in all 8 patients whose disease responded well to chemoradiation (either a histologically complete response or microscopic residual disease). Three of 4 patients with close or positive margins had pelvic recurrences despite intraoperative RT and brachytherapy. Nine of the 10 pelvic recurrences occurred in the radiation field. Elective external iliac nodal irradiation was not used, and nodal metastases were not seen in that region. In 1 case, marginal recurrence occurred in a common iliac node at the superior edge of the treatment field. CONCLUSIONS: Despite aggressive multimodality therapy including multivisceral resection, a high rate of pelvic and distant disease recurrence occurred in patients with clinically staged T4 disease. Regional disease recurred almost exclusively in the radiation field. The intraoperative RT and interstitial brachytherapy doses used did not prevent pelvic disease recurrence in patients with close or positive margins. Novel strategies such as higher preoperative doses of RT with or without altered fractionation or more effective radiosensitizers are needed to improve locoregional control in patients with T4 disease. Future strategies must also include more effective systemic therapy.     

32例妇科恶性肿瘤术后调强适形放射治疗分析

目的 探讨调强适形放射治疗（IMRT）在妇科恶性肿瘤患者术后治疗中的效果及价值。方法 32例子宫颈癌、子宫内膜癌术后患者（KPS≥70）在放疗前均行1～3个周期的化疗,而后给予全程IMRT。其中17例为术后、化疗后预防性照射,15例为术后、放疗和（或）化疗后腹膜后淋巴结转移和（或）盆腔壁复发的放疗。结果 32例患者均完成全程放射治疗,预防性照射的计划靶区（PTV）中位剂量为56．8Gy;腹膜后淋巴结转移、盆壁复发的胛V中位剂量为60．6Gy,90％的等剂量曲线可以覆盖99％以上的肉眼肿瘤靶区（GTV）体积。小肠、膀胱、直肠、肾脏和脊髓的中位剂量分别为21．3Gy、37．8Gy、35．3Gy、8．5Gy和22．1Gy。14例患者出现Ⅰ～Ⅱ级消化道反应,其中Ⅱ级反应者3例,I级反应者11例;5例出现Ⅰ～Ⅱ度骨髓抑制;12例出现Ⅰ级皮肤反应。1年生存率为100％。预防性照射的2、3年生存率均为100％;腹膜后淋巴结转移和（或）盆腔壁复发患者的2、3年生存分别为5／7和3／6。结论 IMRT对妇科恶性肿瘤术后患者的预防性照射和复发患者的放疗均可获得理想的剂量分布,邻近危险器官得到保护,临床近期疗效满意。     

Regional hyperthermia for deep-seated malignancies using the BSD annular array

Forty-four patients were treated using the BSD-1000 Annular Phased Array between April 1983 and December 1986. There were 32 pelvic, nine abdominal, two extremity, and one thoracic sites treated. Mean tumour volume was 646 cc. Thirty-nine patients had concurrent radiation therapy, receiving a mean dose of 38 Gy. Mean average temperature was 41.0 +/- 1.4 degrees C. Most patients experienced local or systemic toxicity, requiring temporary treatment interruption in 33 patients, and termination of treatment in eight. Chronic complications were seen in four, but these were in patients receiving high total radiation doses as well. There were six complete and five partial responses. Among the 32 patients with pelvic tumours, mean tumour volume was 317 cc, mean radiation dose was 42 Gy, and mean average temperature was 41.3 +/- 1.2 degrees C. There were five complete and four partial responses. Achieving tumour temperatures greater than or equal to 42 degrees C with the annular array is difficult, due to both systemic and local toxicity. To improve clinical hyperthermia for thoracic, abdominal, and pelvic tumours, new technologies such as steerable phased array microwave systems; scanned, focused ultrasound; and permanently implantable thermoregulating ferromagnetic seeds, or new approaches such as using drugs to alter blood flow, or combining hyperthermia with antineoplastic drugs or biological agents, will be necessary.     

热疗加放疗治疗局部复发乳腺癌的疗效分析

目的评价热疗加放疗治疗局部复发乳腺癌的疗效.方法回顾性分析热疗加放疗治疗的85处病灶,其中39处病灶曾接受过放疗,未曾放疗的部位给予59.5±6.8 Gy(40～70 Gy)照射,曾放疗的病灶实施43.0±12.4 Gy(12～74.4 Gy)照射;热疗每周1次或1周2次,平均每例患者的热疗次数为4.5(2～9)次.结果治疗1个月后CR率为92.0%,过去未曾放疗的病灶CR率为47.1%(16/34),曾放疗过病灶的CR率为56.1%(23/41),虽然曾放疗组的剂量(43.0±12.4 Gy)明显低于未放疗组的剂量(59.5±6.8 Gy),但两组间CR率差异无显著性(P=0.40).治疗后4周时弥散/多发型病变较肿块/结节型病变的CR率高,而6个月后弥散/多发型的局部控制率却明显降低.结论局部热疗配合放疗可以提高复发乳腺癌的局部控制率,特别是对曾经接受过放疗的区域可以降低放疗的剂量.弥散/多发型肿块较肿块/结节型的病灶对治疗的反应较早,但是很容易在短时期内复发.     

Recurrence Patterns after Radical Hysterectomy in Stage IB1-IIA Cervical

Objectives: The purpose of this study was to evaluate the patterns of recurrence and its associated factorsin stage IB1-IIA cervical cancer cases after radical hysterectomy. Methods: We retrospectively reviewed the655 medical records of patients with cervical cancer who underwent radical surgery at Chiang Mai UniversityHospital between January 2003 and December 2006. All patients had a type III radical hysterectomy andcomplete systematic bilateral pelvic lymphadenectomy. Post-operative adjuvant pelvic radiation therapy wasgiven concurrently with weekly cisplatin 40 mg/m2 for 6 cycles to patients with at least one major risk or twointermediate-risk factors. Sites of disease recurrence, time to relapse of disease, and postoperative overall survivalwere analyzed and all possible clinicopathological factors related to the risk of recurrence were determined.Results: The median time to recurrence was 11.5 months (range, 2-45 months). There was no significantdifferences in the mean time to recurrence between local and distant recurrence groups (14.6 ±3.9 months vs.16.2±5.3 months; p=0.632). The 3-year survival rates of patients with local and distant recurrences were 67.6%(95%CI=45.6 to 89.6%) and 39.8% (95%CI=11.8 to 67.8%), respectively (p=0.602). Tumor size was the onlyclinicopathological prognostic factor associated with overall survival. Conclusion: Patients with stage IB1-IIAcervical cancer should have close surveillance during the first two years of radical surgery. Tumor size of greaterthan 2 cm at the time of primary surgery appears to be significantly related to the prognosis of patients withrecurrence. With an understanding of the natural history of cervical cancer recurrence, an optimal methodof follow-up and prospective clinical trial for markers of metastatic potential to detect recurrence need to beconducted in the future.     

Feasibility and morbidity of combined hyperthermia and radiochemotherapy in recurrent rectal cancer--preliminary results

BACKGROUND: The local recurrence rate of colorectal cancer has been significantly reduced due to the use of combined radiochemotherapy. Despite this improvement regarding locally advanced tumour recurrences, the treatment strategy for pre-treated patients remains difficult and unresolved. PATIENTS AND METHODS: We analysed treatment and follow-up data of 14 patients with local recurrence of rectal cancer who were treated with radiation therapy (RT), chemotherapy (CT) and regional hyperthermia (RHT) from November 1997 to December 2001. Nine of these patients had received irradiation and CT (= pre-treated patients) in the past. For this group, 30.6-39.6 Gy RT, 5-fluorouracil (5-FU) as a continuous infusion over 5 days per week (350 mg/m(2)/24 h) combined with RHT twice a week was given. The 5 remaining patients (= not pre-treated) received conformal irradiation of 45 Gy with a boost between 9 and 14.4 Gy, combined with continuous infusion of 5-FU on days 1-4, and 29-33 (500 mg/m(2)/ 24 h), and RHT twice a week. Response to therapy was evaluated by means of computed tomography (CT) or magnetic resonance imaging (MRI) and by clinical follow-up. RESULTS: Among 13 evaluated cases, the overall objective response rate was 54% (5 complete responses, 2 partial responses). At mean follow-up of 13.9 months (range 5-32 months) 7 patients were alive. CONCLUSION: The therapeutic regimen appears to be active in the treatment of local recurrences of rectal cancer. Larger-scaled studies are needed to evaluate the potency of hyperthermia in this therapeutic strategy.