用Lyman NTCP模型分析原发性肝癌三维适形放疗引起的放射性肝病

目的建立原发性肝癌三维大分割适形放疗Lyman NTCP模型的参数和探讨放射性肝病的影响因素。方法109例患者进行大分割三维适形放疗,其中93例患者肝硬化Child-Pugh分级A级,16例为B级。患者每星期治疗3次,每次间隔48h,(4．8±0．5)Gy/次,平均剂量(53．5±5．5)Gy。用最大拟然比方法分别得到Child-A和Child-B患者Lyman模型中的NTCP参数。结果共有17例发生放射性肝病,发生在Child-A组8例,Child-B组9例。多因数分析表明,肝硬化分级程度是与放射性肝病相关的独立因素(P=0．000)。所有患者的NTCP参数为n=1．1,m=0．35,TD_(50) (1)=38．5Gy；Child-A级为n=1．1,m=0．28,TD_(50)(1)=40．5Gy；Child-B级为n=0．7,m=0．43,TD_(50)(1)=23Gy。结论肝硬化分级是预测放射性肝病发生的危险因子。Child-B患者进行适形放疗易引起放射性肝病。     

主动呼吸控制技术(ABC)在肺癌放射治疗中的应用

目的：使用主动呼吸控制技术（aetive brething control,ABC）治疗非小细胞肺癌患者，评价呼吸运动时肺部肿瘤动度的影响及ABC技术的优势和可行性，并评价近期疗效和急性放射反应。方法：选择9例使用ABC技术联合三维造型放疗技术治疗的非小细胞系癌患者进行分析。CT定位扫描时分别采集ABC和自由呼吸（free breath.FB）状态下的图像，评价呼吸运动对肺部肿瘤动度和PTV边界的影响唾弃；并比较两种计划的DVH，放疗剂量为54-60Gy/18-20次。3Gy/次，1次/天，5天/周，定期随访，评价近期疗效及急性放射反应。结果：应用ABC技术后，隔肌的平均位移从FB时的43.5mm（20.0-32.0mm）降低为3.6mm（0.5-72.mm）,胸壁的侧方位移从FB时的3.2mm（2.8-4.0mm）降低为1.2mm（0.5-1.6mm）.PTV边界可以从FB时的1.5mm减少为0.75cm;肺的V20从21.8%降低为15.0%,减少了30.6%.中位随访6个月时,9例患者中有6例CR,3例PR.急性放射副反应都很轻微,仅为I-II.结论：在肺癌的精确放射治疗中,呼吸动度的影响不可忽视.而ABC系统可以有效的降低呼吸运动时治疗的影响,提高放疗的精确性,减少副反应.,但该系统使用较为复杂,延长了治疗的时间,个别患者不能忍受.     

Predictors of long-term survival in patients with gallbladder cancer

The aim of this study was to examine the predictors of long-term survival (>24 months) in patients with gall bladder cancer. A retrospective review of 117 cases of gall bladder cancer resected between 1989 and 2000. The resections included 80 simple cholecystectomies and 37 extended procedures. Patients with survival >24 months (n=44) were compared with those having survival <24 months (n=73) for 17 prognostic factors. Overall median survival was 16 months with a 5-year survival of 27%. T status (P=.000) and adjuvant chemoradiotherapy (P=.001) were independent predictors of long-term survival. Survival advantage was seen in T3N+ve disease (P=.007) with extended procedures. Complete (R0) resection was attained in 30 patients with a 5-year survival advantage of 30% as compared with incomplete (R1) resection (P=.0002). Adjuvant chemoradiotherapy improved survival in simple cholecystectomy group (P=.0008) but no advantage was seen after extended procedures. Stage III (P=.001) and node-positive disease (P=.0005) had significant benefit with adjuvant therapy. Poor differentiation and vascular invasion were associated with poor long-term survival. R0 resection was associated with prolonged survival. Extended procedures improved survival in patients with T3N+ve disease. Addition of chemoradiotherapy made significant improvement in long-term survival in stage III and node-positive lesions and in patients undergoing simple cholecystectomy. R0 resection predicted long-term survival in gall bladder cancer. T3 N+ve disease had better survival after extended procedures. Adjuvant chemoradiotherapy improved survival in stage III and node-positive disease. Poor differentiation and vascular invasion were adverse predictors of survival.     

Chemotherapy in the treatment of advanced or recurrent olfactory neuroblastoma

Background: Olfactory neuroblastoma is a rare sino‐nasal tumor arising from the olfactory epithelium and is often characterized by local invasion or metastasis. The role of chemotherapy in the treatment of this tumor is unclear. The purpose of this study was to review our institution’s experience of chemotherapy for advanced or recurrent olfactory neuroblastoma. Methods: Twenty‐one patients with histologically proven olfactory neuroblastoma were treated at our institution between 1992 and 2002. Twelve of these patients received chemotherapy in the setting of unresectable or recurrent disease and were retrospectively reviewed for clinical characteristics, treatment outcome or survival. Results: Eight patients of the 12 patients received cisplatin‐based chemotherapy and the remaining four patients received chemotherapy consisting of docetaxel plus irinotecan (three patients) or cyclophosphamide, doxorubicin, and vincristine (1 patient). A partial response was achieved in five patients, with an overall response rate of 42%, although the chemotherapeutic regimens were heterogeneous. Two partial responses were obtained among the three patients who received docetaxel plus irinotecan. The response rate to chemotherapy was 83% in the younger age group (<40 years), as opposed to 0% in the older age group (≥40 years), and the difference between the two groups was statistically significant (P = 0.02). Conclusion: Our study indicated that olfactory neuroblastoma would be sensitive to chemotherapy, especially with young patients. Docetaxel plus irinotecan has the possibility of showing favorable response, and warrants further investigation.     

CT模拟与三维计划对减低鼻咽癌放疗并发症的价值

目的了解引起鼻咽癌放射治疗并发症的影响因素,通过观察CT模拟及三维计划与X线模拟二维计划比较分析对鼻咽癌放射并发症的影响.方法临床观察从1995年～2005收治的并且能够随诊到的161例鼻咽癌病人放疗后出现的并发症.临床从张口受限、急性皮肤反应、颈部组织纤维化、口干症以及鼻腔粘连等并发症来观察结果.结果颈部组织纤维化中、重度,三维计划分别为8/108(7.4%)和1/108(0.9%);二维计划分别为8/53(15.1%)和4/53(7.5%).口干症中、重度三维计划分别为10/108(9.3%)和3/108(2.8%);二维计划分别为17/53(32.1%)和9/53(17.0%).急性皮肤反应中、重度三维计划分别为18/108(16.7%)和8/108(7.4%);二维计划分别为19/53(35.8%)和11/53(20.8%).张口受限三维计划为7/108(6.5%);二维计划为12/53(22.6%).鼻腔粘连三维计划为12/108(11.1%),二维计划为13/53(24.5%).结论CT模拟与三维计划可明显降低放疗并发症的发生.     

单钉-棒固定在胸腰椎结核前路手术中的应用

目的探讨脊柱结核手术内固定的有效方式。方法2002年6月~2004年6月,在手术前有效抗结核化疗的基础上,采用前路病灶清除、植骨融合及单钉-棒内固定的手术方式治疗胸、腰椎结核患者54例。术中在保证彻底清创的基础上注意保留病椎有血供的部分和无明显破坏的椎间盘,以减少切除范围和融合的节段,有神经症状者注意行椎管前侧减压。骨缺损采用自体髂骨、异体髂骨 自体碎骨、或钛网 自体碎骨的方法修复,安置单钉-棒时注意对移植骨块适当加压。患者术后卧床10d左右,然后在支具的保护下下床活动。本组共有41例患者获得随访,手术后随访的时间7~31个月,平均18个月。结果患者所有的结核病灶均顺利愈合,植骨稳定,无明显移位和塌陷,内固定器无松脱和折断,其中37例达到骨性愈合标准;脊柱后凸角平均矫正达23°,患者术前伴有的神经症状也大部分消失,绝大部分患者恢复日常生活、工作。结论前路单钉-棒内固定不仅能够维持胸、腰椎结核手术后脊柱的稳定,防止移植骨块的脱位、塌陷和骨不愈合的发生,而且可以最大范围地减少融合节段,减少术中创伤,故是手术治疗胸、腰椎结核的可靠固定方式。     

Symptomatic osteoradionecrosis of pelvic bones in patients with gynecological malignancies—result of a long-term follow-up

The aim of this study was to assess the incidence and risk factors of pelvic fractures as a result of radiation therapy in women with gynecological cancer. We retrospectively reviewed 3530 female patients treated at our institute between 1980 and 1998 with megavoltage radiation with or without brachytherapy for cancer in the pelvic area. Eligible were patients with vulvar, vaginal, cervical, endometrial, and fallopian tube cancer. Median follow-up was 88 months (range 0-240). Emphasis was put on treatment-related and patient-related risk factors. Of the eligible 3155 patients, 15 developed symptomatic bone fracture caused by osteoradionecrosis, which makes an overall incidence of 0.44% The diagnosis was based on anamnesis, clinical course, and X-ray or computed tomography images. Median time of onset was 44 months (range 6-197). All patients had pain as the first symptom. The only independent predictive factor for developing osteoradionecrosis seemed to be preexistent osteoporosis. Other risk factors that are related to osteoporosis include higher age, postmenopausal status, or steroid treatment. We did not find any significant treatment-related predictive factor for pelvic osteoradionecrosis. Patients with osteoporosis are probably at the highest risk for developing osteoradionecrotic fractures after pelvic radiotherapy. More studies are needed to find out other endogenous predictive factors.     

Vaginal stenosis in patients treated with radiotherapy for carcinoma of the cervix

The aim of our study was to determine the incidence, timing, and severity of vaginal stenosis in patients with carcinoma of the cervix who had received pelvic and/or vaginal radiotherapy as part of their treatment. We also sought to determine if there were any predisposing factors for the development of stenosis. A retrospective chart review was undertaken for all the patients diagnosed with carcinoma of the cervix between January 1, 1990, and December 31, 2000 and treated with pelvic and/or vaginal radiation at Westmead Hospital. Since January 1, 1990, data regarding vaginal stenosis has been prospectively recorded on all the patients. Data collected included patient demographics, stage of disease, treatments administered, and incidence, timing, and severity of vaginal stenosis. One hundred and eighty-eight patients were treated. Mean age was 58.6 years. Thirteen percent of patients had stage IB disease, 45% had stage II disease, 39.5% had stage III disease, and 1.5% had stage IV disease. One hundred and seventy-nine patients returned for follow-up, and data regarding vaginal toxicity were available in 98%. Twenty-seven percent had grade 1 toxicity (partial stenosis or shortening but not complete occlusion), and 11% had grade 2 (complete occlusion). Stenosis of any grade was noted at a mean of 9.6 months and median of 7.5 months (range, 26 days-5.6 years) from completion of treatment. The only prognostic factor associated with increased risk of stenosis was age greater than 50 years (odds ratio 2.26). Vaginal stenosis is a common complication of pelvic and vaginal radiotherapy, occurring in 38% of patients. Stenosis occurs most often in the first year after treatment. Patients over the age of 50 are most at risk.     

The in vitro pharmacological profile of KR31080, a nonpeptide AT1 receptor antagonist

Summary— KR31080 (2-butyl-5-methyl-6-(1-oxopyridin-2-yl)-3-[[2'-(1H-tetrazol-5-yl) biphenyl-4-yl]methyl]-3H-imidazo[4,5-b] pyridine) is a potent inhibitor of angiotensin type 1 (AT₁) receptors in rabbit aorta and human recombinant AT₁ receptors. In the isolated rabbit thoracic aorta, KR31080 caused a nonparallel shift to the right of the concentration-response curves to angiotensin II (All) with decreased maximal response (pD'₂ = 10.1 ± 0.1), but had no effect on the contractile response induced by norepinephrine. KR31080 inhibited specific [¹²⁵I]AII binding to rabbit aortic membranes (AT, receptors) and [¹²⁵I][Sar¹, Ile⁸]AII binding to human recombinant AT₁ receptors in a concentration-dependent manner with IC₅₀ values of 0.84 ± 0.08 nM and 1.92 ± 0.15 nM, respectively, but did not inhibit specific [¹²⁵I)AII binding to bovine cerebellum membranes (ÀT₂ receptors). In the Scatchard analysis, KR31080 interacted with rabbit aortic AT₁ receptors in a competitive manner, similar to losartan. These results demonstrate that KR31080 is a potent and AT₁ selective angiotensin receptor antagonist which exerts a competitive antagonism in the [¹²⁵I]AII binding assay and insurmountable AT₁ receptor antagonism in the functional study.     

综合治疗晚期原发性肝癌72例疗效观察

目的 探讨腹腔化疗或联合其他方法综合治疗晚期原发性肝癌的治疗效果.方法 72例不能手术切除的、合并门静脉癌栓、腹腔内转移或淋巴结转移的晚期肝癌,采取腹腔化疗或者联合TACE等其他方法治疗.5-氟尿嘧啶(5-FU)0.5～0.75 g,腹腔内注入1/日,连用10～15天,总量5.0～12.5 g,最后一天腹腔内注入丝裂霉素(MMC)10 mg或卡铂100 mg.7例胆管细胞癌联合使用健择800～1000 mg.结果 全组平均生存时间13.97±6.27月.累积1年、2年生存率分别为59.7%和30.6%.肝功能Child A级平均生存时间15.91±5.49月,B级8.55±5.09月,有显著性差别.结论 腹腔化疗或联合其他综合治疗方法是肝癌并腹腔内转移的有效治疗方法,可延长部分晚期肝癌患者的生存时间,改善生活质量.