甘氨双唑钠对肺鳞癌放射增敏的临床前瞻性研究

目的 通过对肺鳞癌放射增敏的临床研究，探讨甘氨双唑钠（CMNa)放射增敏的治疗效果。方法 402例肺鳞癌患者随机分为放射增敏组和对照观察组，放射增敏组病人在放疗过程中，分别给予CMNa 1200mg/m^2静脉滴注0.5h，同步给予对照组病人生理盐水250ml静脉滴注，观察两组患者不同的近期疗效。结果 肿瘤原发病灶CR率与CR PR率在两组之间差异有显著性，原发病灶达CR时吸收剂量明显低于对照组。两组患者治疗前后血常规和肝肾功能的检查结果，治疗中和治疗后不良反应及严重程度的比较无统计学意义。结论 CMNa可提高肺鳞癌的CR率和总有效率，并可降低肿瘤达到CR和PR时所需的吸收剂量。     

三氧化二砷对鼻咽癌放射增敏的临床研究

目的探讨三氧化二砷对鼻咽癌放射增敏作用临床应用的价值。方法将61例T1-4 N0-1期鼻咽癌病人随机分入单纯放疗组和三氧化二砷放射增敏组，观察两组病人鼻咽肿瘤和颈部肿瘤消退情况及毒副作用。结果放射治疗40Gy时三氧化二砷增敏组和单纯放疗组的鼻咽肿瘤消退率分别为53．13％（17／32）和17．24％（5／29），χ^2=8．495，P=0．004，差异有统计学意义；两组的颈部肿块消退速度无差别；三氧化二砷增敏组的白细胞降低和恶心呕吐较单纯放疗组发生频率高，但多为Ⅰ～Ⅱ度反应，未见Ⅳ度反应。其他的不良反应在两组间差异无统计学意义。结论与单纯放疗相比，放疗加三氧化二砷使鼻咽肿瘤消退较快，无严重毒副作用。     

放射增敏药物研究的现状及其趋向

放射增敏药物研究的现状及其趋向胡璧肿瘤临床治疗中，放疗是一个非常重要的措施，在总的治疗中占７０％、然而肿瘤放疗效果不尽理想，如果采用正常组织可耐受的照射剂量进行治疗，肿瘤的平均治愈率仅４０％，用放射增敏药，可以提高射线对肿瘤细胞的敏感性。因此，国内外...     

甘氨双唑钠对肺癌体内外放射增敏作用研究

目的研究甘氨双唑钠对肺癌细胞株照射敏感性及配合肺癌患者应用γ刀治疗的放射增敏作用。方法肺癌细胞系NCl—H446和NCl—H596用^60Coγ射线照射，同时用或不用甘氨双唑钠配合，台盼蓝拒染法检测存活细胞存活率；绘制细胞生存曲线；应用γ刀治疗的临床各期肺癌患者，治疗前静脉滴注甘氨双唑钠，同时随机选择单纯γ刀治疗未使用甘氨双唑钠者作为对照。1个疗程结束后6周评价疗效。结果甘氨双唑钠可以显著增加肺癌细胞株对γ射线的敏感性，提高γ射线对肺癌细胞系的杀伤作用；甘氨双唑钠配合γ刀治疗肺癌可显著增加疗效，两组总有效率（CR＋PR）分别为47．22％和37．67％，抑瘤率分别为55．42％和44．15％，差异有统计学意义（P〈0．05），且与临床分期及病理类型无关（P〉0．05）。结论甘氨双唑钠对肺癌细胞株及肺癌患者的放射治疗有增敏作用，能显著提高放疗疗效，是一种良好的放射增敏剂。     

放射增敏剂在肿瘤治疗中的应用

放射治疗是治疗恶性肿瘤的重要手段之一。临床上常因正常组织耐受剂量的限制而不能给予肿瘤足够的照射剂量,而造成治疗失败,因此,如何提高肿瘤对射线的敏感性是临床肿瘤放疗面临的突出问题。放射增敏剂作为一种增强肿瘤放疗敏感性、提高放疗疗效的药物,通过增加辐射诱导的氧自由基及DNA损伤、调控放疗关键分子靶点以达到放射增敏目的。本文结合放射增敏剂在放射治疗中的应用,概述了放射增敏剂的发展现状及相关领域的研究进展,并对多种放射增敏剂的作用机制进行了简要综述,以期为进一步研究放射增敏调控的分子机制、促进放射增敏剂的研发,以及设计新的策略改善放射治疗结果提供帮助。     

放射性肺炎27例临床诊断分析

放射性肺炎多发生在肺癌、乳腺癌等胸部肿瘤放疗后，是较常见的并发症，我科从１９９５年８月至１９９７年６月，共收治肺癌和乳腺癌病人１１２例，放疗结束后３个月内有２７人发生放射性肺炎，发生率为２４．１％，现报告如下。材料与方法：本组病人男５７例，女５５例，...     

磁共振扩散成像在肺癌并肺不张放疗中的应用研究

目的探讨肺癌并肺不张在放疗中应用磁共振扩散成像(diffusion weighted imaging,DWI)技术确定精确靶区应用价值。方法 56例非小细胞肺癌并肺不张患者根据放疗前是否应用DWI技术确定靶区随机分成两组,观察组29例,对照组27例。观察组在强化CT下勾画肿瘤靶区为GTV-ct,应用DWI技术确定肿瘤靶区为GTV-mri。对照组仅在强化CT下勾画靶区。两组计划放疗剂量均为56~60Gy。观察两组患者放疗后肺复张情况、放疗疗效、放疗完成情况、生活质量变化、放射性肺炎、放射性食管炎情况。结果观察组在CT和DWI下勾画肿瘤体积存在差异,GTV-ct和GTV-mri平均体积分别为138.28和104.59cm3,F=33.63,P0.01。放疗结束后观察组和对照组肺复张分别为23例(79.31%)和14例(51.85%),差异有统计学意义(P0.05)。观察组4例CR,21例PR,总有效率(CR+PR)86.20%,对照组2例CR,15例PR,总有效率62.96%,差异无统计学意义(P=0.065)。观察组26例(89.66%)完成放疗,对照组完成17例(62.96%)完成放疗,差距有统计学意义(P0.05)。观察组与对照组治疗后karnofsky评分总提高率分别为72.41%(21/29)与40.74%(11/27),差异有统计学意义(P0.05)。观察组发生放射性肺炎4例,对照组发生放射性肺炎组11例,差异有统计学意义(P0.05)。观察组12例放射性食管炎,对照组17例放射性食管炎,差异无统计学意义(P=0.119)。结论 DWI与CT所显示的大体肿瘤体积有差异,应用DWI技术确定肺癌并肺不张放疗靶区安全、可靠,有利于降低放射性并发症发生率。     

高效表达的NO对肺腺癌细胞A549放射敏感性的影响

目的 研究同步、高效表达的一氧化氮（NO）对肺腺癌细胞A549放射敏感性的影响,探寻增强肿瘤放射敏感性的新途径.方法 利用前期构建的可调控目的 基因高效表达的载体pfos-iNOS/GFP转染肺腺癌细胞A549,将阳性转染细胞和未转染细胞给予2 Gy X线照射后,检测细胞照射前后不同时相点NO的产量;给予不同剂量的X线照射后,检测照射后各组细胞的存活率,根据细胞存活率分别绘制各组细胞的辐射剂量-存活曲线,并进一步通过计算Do值及放射增敏比（SER）分析各组细胞放疗敏感性的变化.结果 转染载体pfos-iNOS/GFP的细胞照射后,NO浓度较照射前明显增高,其中照射后16 h较照射前增强10倍.转染治疗载体组Do值（1.16 Gy）明显低于未转染组（3.93 Gy）,治疗载体组的放疗敏感性是对照组的3.5倍.结论 高效表达的NO使体外肺腺癌细胞的放射敏感性明显增强,为肿瘤放疗增敏提供了新的模式.     

高压氧与肿瘤放射治疗

高压氧可抑制肿瘤生长和转移，提高肿瘤组织氧合，并诱导肿瘤细胞周期同步化，是一种安全、有效的放射增敏措施，与放疗联合应用可提高疗效。同时，高压氧也是治疗晚期放射性损伤的主要方法之一，但对放射并发症的预防作用尚需进一步研究。     

生脉注射液对放射性肺损伤防治作用的临床研究

目的　通过观察生脉注射液对恶性胸部肿瘤患者放疗后放射性肺炎、肺纤维化的临床疗效,探讨生脉注射液对放射性肺损伤的防治作用。方法　130例患者随机分为治疗组和对照组,对照组患者给予根治性放疗,治疗组患者给予根治性放疗加生脉注射液治疗,6 0ml加入5 %葡萄糖注射液2 5 0ml中,iv ,qd ,针对放疗中出现的不良反应给予相同的对症治疗,观察2组患者放射性肺炎和肺纤维化的发生率,以及生活质量评价。结果　治疗组放射性肺炎的发生率(12 .31% )与对照组(2 7.6 9% )相比有显著性差异(P <0 .0 5 ) ,治疗组肺纤维化发生率(33.85 % )与对照组(5 2 .31% )相比有显著性差异(P <0 .0 5 ) ,治疗组患者的生活质量评价明显高于对照组,与对照组相比有显著性差异(P <0 .0 1)。结论　中药制剂生脉注射液可以降低放疗后放射性肺炎及肺纤维化的发生率,对放射性肺损伤具有防治作用。     

低强度He-Ne激光血管内照射配合放疗治疗鼻咽癌的临床研究

目的探讨低强度He-Ne激光血管内照射(intravascularlowlevellaserirradiation,ILLLI)配合放疗治疗鼻咽癌的放射反应及远期疗效。方法将122例接受放疗的鼻咽癌患者随机分为单纯放疗组(对照组)和放疗+ILLLI组(治疗组),比较两组患者的急性放射反应发生率,出现急性放射反应的放疗剂量,局部复发率,远处转移率及5年生存率。结果治疗组与对照组比较,中重度急性放射反应及并发症发生率明显减少(P<0.01),出现急性放射反应的剂量明显提高(P<0.01),局部复发率,远处转移率及5年生存率两组差异无显著意义(P>0.05)。结论ILLLI可提高鼻咽癌患者放疗耐受性,降低急性放射反应及并发症发生率,不增加远处转移,可作为鼻咽癌患者放疗的有效辅助治疗措施。     

Results of radiotherapy of esophageal cancer

From 1972 to 1987, sixty-seven patients with esophageal cancer were treated with radiotherapy over 50 Gy. The actuarial survival at 5 years and the median survival in all patients were 5.3% and 7 months, respectively. Survival was analyzed according to the intent of radiotherapy and the tumor response. The 5 year survival and the median survival were 5.6% and 8 months for the group of radiotherapy with curative intent, whereas they were 0% and 7 months for the group of non-curative radiotherapy (p less than 0.02). The median survivals of absolutely curable, relatively curable, relatively non-curable and absolutely non-curable group were 13, 9, 5 and 3 months, respectively. And survivals of the first two groups were significantly longer than those of the last two groups. The survival in patients with distant metastasis was worse than in those who had no distant metastasis (p less than 0.05). In the fifty-five patients with no distant metastasis, the significant prognostic factors were performance status and radiation dose (TDF).     

^18F-FDGPET／CT评估鼻咽癌远处间隔转移、复发及效能分析

目的：对经^18F-FDGPET／CT扫描的鼻咽癌患者远处转移及PET／CT诊断效能进行分析。方法：73例鼻咽癌分为原发未经治疗组和治疗组,分析鼻咽癌各组远处转移部位、发生率。采用5级分类诊断法,选取不同分级点作为截止点绘制ROC曲线,寻找最佳截止点评价诊断效能。结果：22例原发未经治疗组远间隔转移发生率为59．1％,51例治疗组远处间隔转移发生率为68．6％,两组比较有差异（P〈0．01）。远处间隔转移最常见的部位依次是远处淋巴结（38．67％）、骨骼（36％）及肝脏（25．33％）。ROC曲线示以3级为最佳截止点PET／CT诊断效能较高。原发灶与复发灶SUV比较有统计学意义（P〈0．01）。结论：鼻咽癌远处间隔转移发生率较高,最常见部位是远处间隔淋巴结,PET／CT诊断鼻咽癌远处转移的效能较高。     

Comparison of thin-section CT and pathological findings in small solid-density type pulmonary adenocarcinoma: Prognostic factors from CT findings

Objective

We divided pulmonary adenocarcinoma of ≤20 mm into air-containing and solid-density types based on a percentage reduction of the maximum tumor diameter in the mediastinal window image compared to the area in the lung window image on thin-section (TS) CT of ≥50% (air-containing type) and <50% (solid-density type). No relapse occurred in patients with air-containing type. The prognosis of solid-density type may be poor even when the tumor size is 20 mm or smaller. We investigated whether CT findings for these tumors could serve as prognostic factors.

Methods

The subjects were 105 patients with solid-density type pulmonary adenocarcinoma that was identified on TSCT and found to have a diameter of 20 mm or smaller after surgical resection during the period from April 1997 to November 2004. Notches, air bronchogram, pleural retraction, spiculation, venous involvement, and ground glass opacity were examined on TSCT, and their associations with pathological findings (i.e., pleural invasion, lymphatic permeation, vascular invasion, lymph node metastasis, and Noguchi's classification) and relapse were investigated using chi-square test and Cox proportional hazards model.

Results

The incidence of relapse was significantly higher in cases with notches. The incidence of notches increased with tumor growth and notches were frequent in Noguchi type D tumors, reflecting poorly differentiated adenocarcinoma. Lymphatic permeation and type D cases were independent factors associated with a poor prognosis using Cox proportional hazards model.

Conclusions

TSCT findings may be useful for prediction of the prognosis of solid-density type pulmonary adenocarcinoma.     

Subtle Pleural Metastasis without Large Effusion in Lung Cancer Patients: Preoperative Detection on CT

Objective

We wanted to describe the retrospective CT features of subtle pleural metastasis without large effusion that would suggest inoperable lung cancer.

Materials and Methods

We enrolled 14 patients who had open thoracotomy attempted for lung cancer, but they were proven to be inoperable due to pleural metastasis. Our study also included 20 control patients who were proven as having no pleural metastasis. We retrospectively evaluated the nodularity and thickening of the pleura and the associated pleural effusion on the preoperative chest CT scans. We reviewed the histologic cancer types, the size, shape and location of the lung cancer and the associated mediastinal lymphadenopathy.

Results

Subtle pleural nodularity or focal thickening was noted in seven patients (50%) having pleural metastasis and also in three patients (15%) of control group who were without pleural metastasis. More than one of the pleural changes such as subtle pleural nodularity, focal thickening or effusion was identified in eight (57%) patients having pleural metastasis and also in three patients (15%) of the control group, and these findings were significantly less frequent in the control group patients than for the patients with pleural metastasis (p = 0.02). The histologic types of primary lung cancer in patients with pleural metastasis revealed as adenocarcinoma in 10 patients (71%) and squamous cell carcinoma in four patients (29%). The location, size and shape of the primary lung cancer and the associated mediastinal lymphadenopathy showed no significant correlation with pleural metastasis.

Conclusion

If any subtle pleural nodularity or thickening is found on preoperative chest CT scans of patients with lung cancer, the possibility of pleural metastasis should be considered.     

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。     

周围型肺腺癌CT征象与CD147、VEGF表达的关系

目的 分析周围型肺腺癌在CT上的一些典型征象,并探讨这些征象与CD147、VEGF表达的关系。方法 收集2006-01至2012-12周围型肺腺癌73例可作免疫组化的蜡块及术前CT检查资料。采用免疫组化SP法分别测定肺腺癌组织中CD147及VEGF的表达结果,对阳性结果根据染色面积及染色强度进行等级划分。将CD147、VEGF的表达结果与术前CT检查的各特异性征象进行对比,观察两种基因表达结果与CT征象之间是否相关。结果 CD147表达与CT征象中的空泡征、肿块大小、棘突征、深分叶征、纵隔淋巴结转移之间有相关性（P〈0.05）,与毛刺征、胸膜凹陷征无相关性（P〉0.05）;VEGF表达与毛刺征、棘突征、深分叶征、纵隔淋巴结转移之间有相关性（P〈0.05）,与肿块大小、空泡征、胸膜凹陷征无相关性（P〉0.05）。结论 肺腺癌的某些CT特异性征象与CD147、VEGF表达有相关性,可为判断肺腺癌的预后提供依据。     

Percutaneous radiofrequency thermal ablation of lung VX2 tumors in a rabbit model using a cooled tip-electrode: feasibility,safety, and effectiveness

RATIONALE AND OBJECTIVE: To evaluate the feasibility, safety, and effectiveness of percutaneous CT-guided transthoracic radiofrequency ablation (RFA) of lung VX2 tumors implanted in rabbits. MATERIALS AND METHODS: Thirty-five rabbits with implanted lung VX2 tumors were divided into two groups, an RFA group (n = 28) and a control group (n = 7). In the RFA group, RFA was performed on VX2 tumors using a 17-gauge internally cooled-tip electrode. Contrast-enhanced CT was performed before the RFA and on the same day, day 3, weeks 1, 2, 3, and months 1, 2, 6, and 9, after the RFA. The therapeutic efficacy was evaluated by CT and pathologic findings. RESULTS: RFA of lung tumors was technically successful in each instance. Complete tumor ablation was achieved in 19 of the 28 rabbits (67.9%) in the RFA group. Nine rabbits (32.1%) showed local tumor relapse and mediastinal lymph nodal or pleural metastasis. The animals in the control group died of end-stage malignancies with diffuse tumor spread and malignant pleural effusion (mean 26 +/- 2.7 days). There were 17 (60.7%) complications related to the procedure, ie, pneumothorax (n = 12), obstructive pneumonia (n = 3), hemothorax (n = 1), and burn (n = 1). RFA of centrally located VX2 tumors (in inner 2/3 of the lung) was more frequently associated with complications than RFA of peripherally located VX2 tumors ( P= 0.02). CONCLUSION: This experimental study demonstrates the feasibility of RFA therapy for treating lung VX2 tumors in rabbits, although RFA for central tumors carries the potential for major complications, including large pneumothorax or obstructive pneumonia.     

Modification of spontaneous lung metastasis by local radiation combined with or without immunomodifier

This study was carried out to determine the effect of local irradiation of the NFSa tumors on the incidence of lung metastases. The spontaneous lung metastases were found in those animals whose tumors had grown in size bigger than 10 mm in diameter. The incidence of metastases and the number of lung nodules were increased in those animals of irradiated group when compared to those of control group with the same size. This is probably because the irradiation of tumors resulted some retardation in their growth and thus, the irradiated tumors took a longer time to reach a given size than those unirradiated control tumors. The incidence of spontaneous lung metastases was significantly reduced by subcutaneous administration of OK-432 (2.5KE/mouse) locally into the surroundings of the tumor immediately after irradiation. The administration of OK-432 after the metastasis development was no longer effective. Both of intraperitoneal and subcutaneous administrations of OK-432 into opposite side of unirradiated thigh showed no suppression of metastasis. These results suggest that an appropriate immunostimulation combined with radiotherapy may be important for the suppression of tumor metastases.     

立体定向放射治疗对晚期肺腺癌患者血清CEA、CA125、CA153禾口TSGF表达的影响分析

目的 探讨立体定向放射治疗对晚期肺腺癌患者血清癌胚抗原（CEA）、糖链抗原125（CA125）、糖链抗原125（CA153）和肿瘤特异生长因子（TSGF）表达的影响。 方法 将烟台市烟台山区院2015年1月至2017年5月收治的92例晚期肺腺癌患者随机分为对照组（46例）和观察组（46例）。对照组:男性28例、女性18例,年龄（57.6±7.4）岁,采用紫杉醇联合顺铂化疗;观察组:男性30例、女性16例,年龄（58.2±8.1）岁,在对照组的基础上另给予立体定位放射治疗。对比2组患者的治疗效果、血清CEA、CA125、CA153和TSGF表达水平、并发症及预后。组间比较采用t检验和χ2检验,采用Kaplan-Meier生存曲线对生存率进行分析。 结果 治疗后,观察组的治疗有效率为37.0%（17/46）,对照组为17.4%（8/46）,2组之间的差异有统计学意义（χ2=4.449,P=0.035）;观察组患者的血清CEA、CA125、CA153和TSGF表达水平均明显低于对照组,差异有统计学意义（t=6.987~13.575,均P=0.000）;2组并发症的发生率的差异无统计学意义（χ2=0.562,P=0.337）;观察组的中位生存时间为13.6个月,对照组为10.2个月,差异有统计学意义（U=126.0,P<0.01）。 结论 立体定向放射治疗能够促进肺腺癌的治疗效果,降低患者的血清肿瘤标志物水平,延长患者的生存时间,值得临床借鉴应用。