早期乳腺癌术后靶区勾画共识

背景与目的：国际上乳腺癌术后辅助放疗的临床靶体积（clinical target volume，CTV）勾画存在明显差异，有必要在单中心形成靶区勾画共识。方法：选取复旦大学附属肿瘤医院收治的2例乳腺癌患者，1例为保乳术后，另1例为乳房改良根治术后。分别进行模拟CT扫描。结果：复习了美国和欧洲的靶区勾画共识，结合已经发表的临床研究对靶区的定义以及自己的临床实践，经多次专家讨论，分别就保乳术后的瘤床、乳腺及改良根治术后的胸壁、区域淋巴结CTV进行了详细的定义。由1名医生在模拟CT上勾画，并将勾画好的靶区再送给各专家进行修改。结论：形成了一致的早期乳腺癌术后靶区勾画共识，有利于临床实践、教学及科研工作。     

如何在放化疗同期进行肿瘤患者的营养干预

肿瘤患者的营养不良是指由摄取不足和炎症反应引起人体肌肉、脂肪含量减少,进而导致体力、认知能力以及免疫功能下降的亚急性或者慢性营养损耗状态（Soeters PB,Reijven PL,Schols JM,etal.2008）。     

清胃汤治疗慢性浅表性胃炎临床研究

目的：观察清胃汤治疗慢性浅表性胃炎脾胃湿热证的临床疗效。方法：将80例慢性浅表性胃炎脾胃湿热证患者随机分为对照组和治疗组,每组各40例。对照组给予奥美拉唑肠溶片及马来酸曲美布汀片口服,幽门螺杆菌（Hp）阳性者加服克拉霉素分散片及阿莫西林胶囊;治疗组口服清胃汤,疗程均为4周。观察治疗后两组患者胃镜检查情况、中医证候积分、临床症状改善情况及幽门螺杆菌（Hp）清除率,随访复发率。结果：治疗组胃黏膜疗效评定的有效率为95%,优于对照组的80%（P〈0.05）;胃黏膜组织学疗效评定的有效率为90%,优于对照组的75%（P〈0.05）;治疗组中医证候疗效的有效率为97.5%,优于对照组的72.5%（P〈0.05）;治疗后治疗组脾胃湿热证积分为（5.28±1.97）分,低于对照组的（8.95±3.26）分（P〈0.05）,治疗组餐后饱胀不适、早饱感和上腹部疼痛等主要症状改善明显,有效率分别为96.77%、100.00%、97.14%,对照组分别为78.13%、83.33%、82.35%,差异均具有统计学意义（P〈0.05）;治疗组Hp清除率为57.14%,对照组为60.00%,两组Hp清除率比较,差异无统计学意义（P〉0.05）;治疗组复发率为30.43%,低于对照组的56.26%（P〈0.05）。结论：清胃汤治疗慢性浅表性胃炎脾胃湿热证临床疗效好,并能杀灭Hp,降低复发率,不良反应少。     

复发性鼻咽癌的自发及放疗后凋亡观察

目的：观察24例复发性鼻咽癌的自发与放疗后凋亡及分裂指数。方法：第一病例均观察放疗前和复发后的病理切片,光镜下计数凋亡指数和分裂指数。结果：结果表明,鼻咽癌的自发凋亡指数为0．55％,分裂指数为0．36％。放疗后复发时凋亡指数为0．63％,分裂指数为0．40％。结论：与其它肿瘤相比,．鼻咽癌属于低凋亡指数肿瘤,复发时凋亡指数和分裂指数与治疗前相比无明显差别。凋亡指数在鼻咽癌预后因素中的作用尚需进一步研究。     

兆伏级锥形束CT影像质量定量分析

Objective To quantitatively analyze the image quality of megavoltage cone-beam CT (MVCBCT) under different scanning conditions to provide reference in clinical applications. Methods Si-emens ONCOR linear accelerator with MVCBCT was used to scan the phantom under different conditions. The image quality was evaluated in terms of image noise, uniformity, spatial resolution, contrast resolution, the number of Monitor Units(MUs) used in imaging,and the size of the reconstruction matrix. The comparison of the image quality between MVCBCT and conventional simulator CT was also analyzed. Results The image noise was decreased with the increase of the number of MUs. The uniformity index showed that the system u-niformity was weakly dependent on MU numbers or the size of the reconstruction matrix. Except for the ima-ges with 5 MUs,all other images had the spatial resolution of 0.4 lp/mm with a reconstruction matrix of 256 ×256. Better low contrast resolution was achieved by using more MUs. For typical pelvis and head-and-neck patients,the imaging dose at the center was 0.8 cGy/MU and 0.7 cGy/MU, respectively,and the maxi-mum dose was about 1.2 cGy/MU. For typical abdomen patients,the image maximum dose and center dose was 1.3 cGy/MU and 0.7 cGy/MU,respectively. Conclusions The image quality of MVCBCT is inferior to the conventional kilo-voltage CT. However,with the optimization of the parameters in imaging,we can a-chieve sufficient image contrast in the bone,air and some soft-tissue structures with low imaging dose to pa-tients. Such images can be used for IGRT.     

肠癌的放射治疗

放射治疗已经经历了一个多世纪的发展历史，在伦琴发现X线，居里夫人发现镭之后，很快用临床治疗恶性肿瘸。日前，大约70％的癌症患者在治疗中需要用放射治疗。可见，放射治疗已成为治疗恶性肿瘤的主要手段之一。放疗究竟会起多少作用？射线对人体会造成怎样的伤害？     

局部进展期直肠癌新辅助治疗——精准医疗时代的思考

术前新辅助放化疗已成为局部晚期直肠癌的标准治疗方案,目前的研究热点集中在如何预测新辅助治疗的疗效,富集优势人群,避免不敏感患者的过度治疗,减少不必要的医疗开支?近两年随着基因测序技术的迅速发展,依据基因表达对结直肠癌进行分子分型并判断患者的药物敏感性及预后,对于不同基因表达的患者给予个体化精准治疗成为目前治疗的重点,本文将对以上方面进行综述?     

兆伏级锥形束CT影像质量定量分析

Objective To quantitatively analyze the image quality of megavoltage cone-beam CT (MVCBCT) under different scanning conditions to provide reference in clinical applications. Methods Si-emens ONCOR linear accelerator with MVCBCT was used to scan the phantom under different conditions. The image quality was evaluated in terms of image noise, uniformity, spatial resolution, contrast resolution, the number of Monitor Units(MUs) used in imaging,and the size of the reconstruction matrix. The comparison of the image quality between MVCBCT and conventional simulator CT was also analyzed. Results The image noise was decreased with the increase of the number of MUs. The uniformity index showed that the system u-niformity was weakly dependent on MU numbers or the size of the reconstruction matrix. Except for the ima-ges with 5 MUs,all other images had the spatial resolution of 0.4 lp/mm with a reconstruction matrix of 256 ×256. Better low contrast resolution was achieved by using more MUs. For typical pelvis and head-and-neck patients,the imaging dose at the center was 0.8 cGy/MU and 0.7 cGy/MU, respectively,and the maxi-mum dose was about 1.2 cGy/MU. For typical abdomen patients,the image maximum dose and center dose was 1.3 cGy/MU and 0.7 cGy/MU,respectively. Conclusions The image quality of MVCBCT is inferior to the conventional kilo-voltage CT. However,with the optimization of the parameters in imaging,we can a-chieve sufficient image contrast in the bone,air and some soft-tissue structures with low imaging dose to pa-tients. Such images can be used for IGRT.