不同分割方式放射治疗脑转移癌的临床观察

目的:探讨不同分割方式放射治疗脑转移癌引起头痛的止痛效果。方法:48例脑转移癌患者,24例采用低分割照射(治疗组),肿瘤吸收剂量3Gy/次,5次/周,总剂量30Gy;24例采用常规分割照射(对照组),肿瘤吸收剂量 2Gy/次,5次/周,总剂量40Gy。结果:48例脑转移癌止痛总有效率为94%,治疗组为96%(23/24),对照组为92%(22/24),两组止痛有效率比较差异无显著性(P>0.05)。结论:放射治疗对脑转移癌疼痛治疗效果肯定,大剂量低分割与常规分割两种放疗方式疗效相似。     

50例骨转移癌的放射治疗止痛效果分析

目的：分析骨转移癌的放射治疗止痛效果。方法：对50例骨转移癌病人常规分割治疗。选用钴^60—外照射，射野：椎体骨转移上、下界包括各一个正常椎体，左、右界包括椎体及椎旁受浸组织，其它骨转移据病情局部照射或整骨照射。照射方法、剂量：常规分割，DT200cGy／次，总DT4000cGy。结果：显效41例，有效6例，总有效率(41 6)／50。一年生存率85％。结论：放射治疗可作为骨转移癌首选治疗方法。     

三维适形放射治疗局限性骨转移癌的止痛效果

目的:分析三维适形放射治疗对局限性骨转移癌的止痛作用方法:全组52例,年龄48~75岁。非小细胞肺癌17例、乳腺癌15例、前列腺癌和肾癌各6例,直肠癌5例和3例为甲状腺癌转移。采用三维适形放疗,根据CT显示病变范围设定临床靶区,设5~6个共面照射野,根据剂量分布决定每个照射野的权重。中位剂量40Gy/8次,(平均35Gy-45Gy/7-10次)。治疗期间配合适量激素。结果:止痛效果明显,总有效率达100%。截止2007年2月,有随访结果的38例,其中18例生存1年,9例存活2年,6例存活3年,有5例存活4年健在。结论:三维适形照射技术对局限性骨转移癌不仅有肯定的止痛效果,而且对控制病变的发展同样是一种较为理想的治疗方法。     

骨转移癌放疗止痛的疗效分析

目的探讨放射治疗对骨转移癌的止痛效果。方法对1998年1月—2003年1月收治的46例原发灶均病理或细胞学证实，对经X线、ECT、CT或MRI明确诊断的骨转移癌患者行放射治疗，观察其止痛效果。放疗采用模拟机、CT定位，用Co^60外照射。总剂量为30～50Gy。结果全部病例均获得不同程度的缓解，显效率43．5％(20/46)，有效率56．5％(26／46)。结论放射治疗是骨转移患者止痛的有效方法。     

三维适形放射治疗局部晚期非小细胞肺癌的近期疗效观察

目的评价三维适形放射治疗局部晚期非小细胞肺癌(NSCLC)的局部控制率和副作用。方法37例局部非小细胞肺癌患者均先行大野常规照射DT40Gy，1．8—2．0Gy，5次／周，后缩野采用三维适形放疗加量DT20-30Gy，3次／周，照射累计剂量DT60～70Gy。结果CR16例(43．2％)，PR18例(48．6％)。副作用以放射性食管炎为主，但均可耐受。结论三维适形放疗可提高患者局部控制率，减轻放疗的毒副作用。     

骨水泥成形辅以放射治疗应用于恶性肿瘤骨转移癌:可为临床首选方案?

背景:骨水泥成形具有即刻止痛和稳定骨折的作用,可明显提高肿瘤患者的生活质量,但其用于临床时间尚短,许多学者认为这种技术缺乏远期随访资料和更多病例验证,对复杂部位转移灶的治疗仍值得深入分析.目的:回顾性分析单纯放射治疗及骨水泥成形辅以放射治疗恶性肿瘤骨转移癌患者的效果.方法:2006-09/2009-02上海市第六人民医院收治的60例恶性肿瘤骨转移癌患者,随机分成2组,单纯放射治疗组30例,采用6 MV X射线,照射剂量2 Gy/次,5次/周,照射4周,总照射剂量40 Gy;联合组30例,采用骨水泥成形治疗,并辅以放射治疗.采用VRS法疼痛程度分级和目测类比评分法相结合的方式进行骨痛评分,测定起效时间.结果与结论:治疗前两组患者骨痛评分基本相似(P>0.05);治疗后与单纯放射治疗组比较,联合组痛程度显著缓解,骨痛评分明显降低(P<0.05).单纯放射治疗组共13例患者治疗无效,联合组共8例患者治疗无效,单纯放射治疗组患者的起效时间迟于联合组.在10个月的随访期内,单纯放射治疗组共有25例患者死亡,联合组共有21例患者死亡,不同随访时间段内联合组生存患者多于单纯放射治疗组.全部死亡病例中均未发现与骨水泥有关的证据,提示应用骨水泥成形辅以放射治疗骨转移瘤比单纯行放射疗法对疼痛的缓解更为有效,可作为骨转移癌首选的治疗方式.     

后程加速超分割放射治疗食管癌的疗效观察

目的：探讨后程加速超分割放射治疗食管癌的临床疗效。方法：60例经病理证实食管癌患者随机分为两组：A组和B组，每组各30例。A组采用常规分割放射治疗，1次／d，2．0Gy／次，5次／周，总剂量60Gy，共30次，6周；B组采用后程加速超分割放射治疗，放疗前4周采用常规分割，共40Gy，后9个治疗日采用超分割方法，即根据病变长度适当缩短照射野，1．5Gy／次，2次／d，间隔4h以上，每周照5d，照射27．0Gy，总剂量67．0Gy／5．6周。采用^60Coγ线或直线加速器6MVX线，三野外照射。结果：随访时间4～65个月，中位23个月。随访率为91．6％；B组近期有效率100％优于A组的88．5％（P〈0．05），两组患者均无Ⅲ度放射性食管炎或气管炎。B组与A组1、3、5年生存率分别为66．6％、33．3％、22．2％及57．6％、25．5％、18．2％，两组比较，无显著性差异（P〉0．05），中位生存时间分别为22及20个月。结论：食管癌后程加速超分割放射治疗急性反应能耐受，其疗效优于常规分割放射治疗。     

放射治疗骨转移癌68例临床观察

目的回顾分析骨转移癌放射治疗疗效及影响因素。方法68例骨转移癌患者，采用6MVX15MVX线或不同能量电子线外照射，根据转移灶GTV的大小PTV外放2cm，或采用TPS优化后3D适形治疗。给予常规分割放疗和低分割放疗。结果疼痛症状明最缓解，无症状靶区无疼痛出现。结论放射治疗止痛作用见效快，并可获得较持久的止痛效果，放射治疗剂量分割对疗效无影响。放射治疗骨转移无症状靶区预防疼痛的疗效值得期待。     

鼻咽癌后程三维适形放射治疗初步观察

目的分析鼻咽癌后程三维适形放射治疗（3DCRT）近期疗效。方法32例初治元远处转移的鼻咽癌患者，采用分三阶段对原发灶放射治疗。第一段用面颈联合野常规放疗DT36Gy，第二段用耳前野放疗DT14Gy，第三段用3DCRT DT 20-25Gy。总照射剂量DT70-75Gy。颈部用切线野／或者加电子线野作常规分割照射，设野上界保持与主野下界衔接，对颈淋巴结阴性照射DT50Gy，淋巴结阳性照射DT66—70Gy。结果局部肿瘤消退率（有效率）100％，完全缓解率93．75％，1年生存率100％。元严重并发症。结论鼻咽癌后程三维适形放射治疗（3DCRT）可以获得比较理想的剂量分布，近期疗效满意。     

转移性黑色素瘤的姑息性放疔

目的：根据恶性黑色素瘤的放射生物学特性，设计了短疗程的放射治疗，以评价其在转移性患者中的姑息疗效。方法：21例(27个部位)转移性恶性黑色素瘤接受姑息性放疗，照射部位包括骨转移15个，淋巴结和皮下转移7个，脑转移5个。结合黑色素瘤生物特点和患者一般情况而制定时间-剂量模式，主要包括30Gy／10次／2周(10例，占37％)和20Gy／5次／1．5周(8例，占30％)。结果：总的姑息有效率为89％(24／27)，其中，骨和软组织转移的有效率为90％(20／22)，脑转移有效率为80％(4／5)。有效患者的中位缓解持续时间为60d，占剩余生存时问的67％。结论：短程放射治疗作为姑息治疗的手段，可以在大多数晚期转移性黑色素瘤患者中达到有效的减症作用。在高于常规分割剂量的基础上，可以视正常组织耐受性而适当降低分次剂量。总剂量的生物效应需达到相当于常规分割36Gy以获得较满意的姑息疗效。     

The impact of bisphosphonate therapy on the survival time of patients undergoing radiotherapy for bone metastases

Background. Bisphosphonates are form of medical therapy for bone metastases. Morbidity from bone metastases including hypercalcemia episodes, pain, pathological fractures and appearance of new metastases in skeletal system is decreased by bisphosphonate therapy. The aim of this article is to determine the influence of bisphosphonate therapy on survival time of patients irradiated due to bone metastases.
Material and methods. 305 patients irradiated due to bone metastases were assessed in this retrospective study. 94 of them were additional treated by bisphosphonates. Median survival time counted from the end of radiotherapy to the death of patients was assessed. Using U Mann Whitney test the influence of bisphosphonates therapy on survival time was determined. The significance level of p = 0,05 was accepted.
Results. The median survival time of patients irradiated due to bone metastases and treated by bisphosphonates was 8,1 month and 5,24 month in the group treated only by radiotherapy. Median survival time of pts with breast cancer and with unknown primary site of cancer who were treated by radiotherapy and bisphosphonates was significantly longer (respectively p = 0,001 and p = 0,016) as compared with the group with irradiated bone metastases only.
Conclusions. 1. Bisphosphonates therapy improved the median survival time in the whole group of patients irradiated due to bone metastases. 2. Statisticaly significant prolonged survival time was observed in groups of patients with breast cancer and with unknown primary site of cancer. Median survival time was prolonged in these groups about 5 months and 3,5 months respectively.     

Palliative radiotherapy in the treatment of skeletal metastases.

Two-third of patients with metastatic cancer suffer from pain. Pain originating from skeletal metastases is the most common form of cancer pain. Bone pain, often exacerbated by pressure or movement, limits the patient's autonomy and social life. Pathological fracture and spinal cord compression are additional complications caused by bone metastases.Radiotherapy is effective in treating bone pain not adequately controlled by analgesics. Seventy percent of patients benefit from radiotherapy. Single and multifraction regimens are equally effective in relieving pain. Retreatment is needed somewhat more often following single fraction therapy. Most patients benefit from retreatment irrespectively of previous fractionation schedule. Hemibody irradiation and radioisotopes, e.g., strontium-89 and samarium-153 are used in treating scattered painful bone metastases.Radiotherapy is used for preventing pathological fracture by treating osteolytic lesions especially in the weight-bearing bones such as the spinal column and long bones.Radiotherapy is the treatment of choice in spinal cord compression, which is the most serious complication caused by bone secondaries.Radiotherapy provides efficient, well-tolerated and cost-effective palliative care.     

大分割与常规分割放疗对恶性肿瘤骨转移癌痛的疗效观察

目的观察大分割及常规分割放疗对骨转移癌痛的疗效。方法 43例恶性肿瘤骨转移患者被随机分为两组,大分割放疗组21例,300 cGy/次,每周5次,DT:3 000 cGy,常规分割放疗组22例,200 cGy/次,每周5次,DT:4 000cGy。结果全组放疗止痛总有效率为81.4%,大分割放疗组止痛有效率为80.95%,常规分割放疗组止痛有效率为81.82%,两者疗效无显著性差异(P>0.05)。放疗1周内上痛起效率大分割组为71.43%,常规分割组为72.73%,两组比较无显著差异(P>0.05)。结论放疗是治疗骨转移癌痛的有效方法,不同的放疗分割方式有效率和放疗1周内止痛起效率无显著差异,可以根据患者的情况,如病情、预后及经济情况等来选择。     

ACR Appropriateness Criteria® non-spine bone metastases

Bone is one of the most common sites of metastatic spread of malignancy, with possible deleterious effects including pain, hypercalcemia, and pathologic fracture. External beam radiotherapy (EBRT) remains the mainstay for treatment of painful bone metastases. EBRT may be combined with other local therapies like surgery or with systemic treatments like chemotherapy, hormonal therapy, osteoclast inhibitors, or radiopharmaceuticals. EBRT is not commonly recommended for patients with asymptomatic bone metastases unless they are associated with a risk of pathologic fracture. For those who do receive EBRT, appropriate fractionation schemes include 30?Gy in 10 fractions, 24?Gy in 6 fractions, 20?Gy in 5 fractions, or a single 8?Gy fraction. Single fraction treatment maximizes convenience, while fractionated treatment courses are associated with a lower incidence of retreatment. The appropriate postoperative dose fractionation following surgical stabilization is uncertain. Reirradiation with EBRT may be safe and provide pain relief, though retreatment might create side effect risks which warrant its use as part of a clinical trial. All patients with bone metastases should be considered for concurrent management by a palliative care team, with patients whose life expectancy is less than six months appropriate for hospice evaluation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.     

Six gray single dose radiotherapy in the treatment of metastatic bone pain

Bone metastases are observed in approximately 50% of patients with cancer and these are essential to influence the quality of life. As one of the most effective means of therapy for patients with bone metastases, radiotherapy can be applied as fractional and single dose. In this prospective study, we analyzed the pain relief after 6 Gy single dose irradiation in 62 patients with painful bone metastases. This was assessed by an 11-point scale questionnaire. In 88.7% of the treatments response was obtained after the single-dose radiotherapy (37.1% complete response, 51.6% partial response, 11.3% no response). In approximately 53% of the treatments the response initiated within one week. We concluded that a single dose of 6 Gy was very effective in the palliation of painful bone metastases.     

Evaluation of efectiveness of palliative radiotherapy alone or combined with surgery in patients with bone metastases

Material and methods. The retrospective analysis results of palliative radiotherapy alone or combined with surgery of 200 patients with bone metastases are presented. All patient were irradiatated, 47 of them were operated before or after radiotherapy. General performance status, pain relief, movement efficiency, analgetic drugs and bisphosphonates administration, disease progress and bone reossification were assesed 1, 2, 3, 6, 12 months after the treatment and durning the last examination.
Results. The complete or partial pain relief were observed in 47% of patients 1 month, 56% two months 41% in 3, 38% 6 months after the treatment. 26% reported pain relief 1 year after irradiation and 33% at the last visit
The Kaplan Maier survival analysis shows ststistically significant longer survival for patient treated by combined treatment, women, patients with multiple bone metastases and patients with metastases located in long bones and patients without symptoms of spine compression. Spearman analysis reveals correlation beetween performance status and follow up. There are no correlations between radiation dose, bisphosphonates administration and pain relief, pathology of tumor and follow up.
Conclusions. The obtained results suggests that radiotherapy is effective method of analgetic treatment in bone metastases and that radiotherapy associated with surgery improves survival.     

Single Fraction External Beam Radiation Therapy in the Treatment of Localized Metastatic Bone Pain. A Review.

Bone metastases are a frequent complication of cancer, and frequently cause pain. Indications for radiotherapy for bone metastases include pain, risk for pathologic fracture, and neurological complications arising from spinal cord compression, nerve root pain or cranial nerve involvement. There are numerous fractionation patterns of external beam radiation therapy for painful bone metastasis, both fractionated schedules and single fraction regimens. All prospective randomized trials that evaluated differences in the outcomes associated with various fractionated regimens versus single fraction regimens unequivocally showed that single fraction regimens (mostly 8 Gy) are at least equal with various fractionated regimens. The single fraction regimens have an additional advantage of being more convenient to both patients and hospitals. However, there are still numerous questions that are left unanswered in these trials, such as the “optimal” single fraction that should be used, the possibility for retreatment, and prognostic factors that may help identify those patients more likely to respond to a single fraction radiation therapy in the treatment of painful bone metastasis.     

Review of patterns of practice and patients’ preferences in the treatment of bone metastases with palliative radiotherapy

Introduction Since the 1980s, randomized clinical trials showed that single fraction radiotherapy (RT) provided equal pain relief as multiple fractions of RT in the treatment of bone metastases. Materials and methods Using Medline, a literature search was conducted on patterns of practice among radiation oncologists and patients’ preferences of dose fractionations for the treatment of bone metastases. Results and discussion Fifteen studies on international patterns of practice published between 1966 and May 2006 were identified. Surveys of Canadian radiation oncologists indicated approximately 85% preferred multiple fractions, most often as 20 Gray in five fractions (20 Gy/5). Surveys in the United States indicated that 30 Gy/10 was most commonly used, and 90–100% of these oncologists preferred multiple over single fraction RT. Multiple fractions were most commonly used in the United Kingdom, Western Europe, Australia and New Zealand, and India; however, more radiation oncologists in these countries would prescribe a single fraction than in North America. Three studies investigated patients’ preferences of dose fractionations. In the Australian study, most patients favored single fraction RT as long as long-term outcomes were not compromised. Durability of pain relief was considered more important than short-term convenience factors. In the Singapore study, 85% of patients would choose extended courses of RT (24 Gy/6) compared to a single 8 Gy. In the Canadian study, most patients (76%) would choose a single 8 Gy over 20 Gy/5 of palliative RT due to greater convenience. Conclusion Despite strong evidence supporting the use of single fraction RT, current practices and preferences favor multiple fractions for the treatment of bone metastases. This has significant implications for the overall quality of life, RT department workload, costs to healthcare systems, and patient convenience.     

131I治疗分化型甲状腺癌骨转移疗效及其影响因素

¹³¹I治疗分化型甲状腺癌（DTC）骨转移疗效较好,可有效减轻骨痛、稳定或缩小骨转移灶,显著改善远期疗效,提高患者生存率。影响¹³¹I治疗DTC骨转移疗效的主要因素包括骨转移灶是否摄碘、¹³¹I累积剂量、年龄、病理类型、是否合并骨外器官转移、¹³¹I联合其他治疗手段、发现骨转移癌时间、是否存在临床骨相关事件及骨转移灶大小及数量。本文对¹³¹I治疗DTC骨转移效果及其影响因素进行综述。