保乳术后放疗中钛夹动度与乳腺大小及钛夹位置的相关性

【摘要】目的:分析保乳术后放疗患者钛夹动度，并探讨其与乳腺大小、钛夹位置的相关性。方法:随机选取保乳术后放疗患者15例，每周两次锥形束CT。测量乳腺基底面直径（D）和乳高轴（H），以瘤床质心为原点将临床靶区分4个象限。记录各象限内钛夹在左右、腹背、头脚方向动度（MLR、MAP、MSI）以及其与临床靶区最内、最前、最上的距离（DSLR、DSAP、DSSI）。结果:MLR、MAP、MSI分别为（2.2±3.0）、（-1.1±3.6）、（0.8±4.7） mm；系统误差Σ在左、右、腹、背、头、脚分别为1.7、2.2、2.0、2.4、2.9、3.0 mm，随机误差σ分别为2.4、4.0、3.2、4.0、4.7、4.7 mm；靶区对应外放5.9、8.3、7.2、8.8、10.5、10.9 mm。一象限内，当D×H<99.89 cm2，MAP和D×H强相关（r=0.805），MLR、MAP均和DSLR、DSAP、DSSI强正相关（r=0.94, 0.94, 0.91；0.87, 0.91, 0.92），MSI和DSLR、DSAP强正相关（r=0.91, 0.94）；四象限内，当D×H<90.71 cm2，MAP和DSLR，MSI和DSAP均强负相关（r=-0.96；-0.95），MLR和DSLR强正相关（r=0.91）。结论:钛夹动度有各向异性，以SI方向外扩最大，并易受乳腺大小、钛夹位置影响。     

Lateral Lymph Nodes in Rectal Cancer: Do we all Think the Same? A Review of Multidisciplinary Obstacles and Treatment Recommendations

Lateral lymph nodes in low, locally advanced, rectal cancer have proven implications for local recurrence rates, which increase drastically in the presence of persistently enlarged lateral lymph nodes. These clinical implications warrant a thorough understanding of lateral nodal disease with awareness and knowledge from all three specialties involved – radiology, radiation oncology, and surgery – to ensure proper treatment. Relevant literature for each specialty, including all current guidelines and perspectives, were examined. Variations in definitions and treatment paradigms were evaluated. There is still no consensus for the standardized treatment of lateral nodal disease. Each discipline works according to their own available evidence, but relevant data are scarce. Current international guidelines and standard recommendations for the diagnostics and treatment of lateral lymph nodes are lacking. This results in differing perspectives and interpretations between the disciplines which can lead to challenging communication in an area where multidisciplinary collaboration is essential. This review addresses this by presenting the current evidence, perspectives and practices of each specialty and makes suggestions for each phase of the diagnostic and treatment process for patients with lateral nodal disease. By doing this, steps are taken toward achieving international consensus, and multidisciplinary collaboration.     

External Beam Radiotherapy in Western Africa: 1969–2019

AimsWe describe the absolute and per capita numbers of megavoltage radiotherapy machines (MVMs) in Western Africa from 1969 to 2019.Materials and methodsWestern Africa was defined in accordance with the United Nations' delineation and inclusive of 16 countries. A literature search for publications detailing the number of cobalt-60 machines (COs) and linear accelerators (LINACs) in radiotherapy centres was carried out. Population data from the World Bank Group and crude cancer rates from the International Agency for Research on Cancer were used to calculate ratios of million persons per MVM and MVMs per 1000 cancer cases.ResultsThe numbers of MVMs in Western Africa in 1969, 1979, 1989, 1999 and 2009 were zero, two, three, six and nine, respectively. In 2019 there were 22 MVMs distributed across Ghana (five), Côte d’Ivoire (two), Mali (one), Mauritania (two), Nigeria (nine) and Senegal (three). Nine countries (56.3%) had no history of external beam radiotherapy (EBRT). The largest increase in absolute EBRT capacity occurred from 2017 to 2019, during which 13 MVMs were commissioned. The largest decrease in EBRT capacity occurred from 2015 to 2017, during which four LINACs and three COs were rendered non-operational. The ratio of million persons per MVM improved from 67.0 in 1979 to 17.8 in 2019. As of 2019, there was 0.09 MVM per 1000 cancer cases.ConclusionsWestern African nations have experienced an increase in the absolute number of MVMs and per capita radiotherapy capacity during the last 50 years, especially in the last decade. As non-functional LINACs contributed to a temporary decline in the EBRT infrastructure, dual use of CO/LINAC technologies may act to promote the availability of EBRT treatment in centres with capacity for multiple MVMs.     

Scientific Developments in Imaging and Dosimetry for Molecular Radiotherapy

Molecular radiotherapy is a rapidly developing field with new vector and isotope combinations continually added to market. As with any radiotherapy treatment, it is vital that the absorbed dose and toxicity profile are adequately characterised. Methodologies for absorbed dose calculations for radiopharmaceuticals were generally developed to characterise stochastic effects and not suited to calculations on a patient-specific basis. There has been substantial scientific and technological development within the field of molecular radiotherapy dosimetry to answer this challenge. The development of imaging systems and advanced processing techniques enable the acquisition of accurate measurements of radioactivity within the body. Activity assessment combined with dosimetric models and radiation transport algorithms make individualised absorbed dose calculations not only feasible, but commonplace in a variety of commercially available software packages. The development of dosimetric parameters beyond the absorbed dose has also allowed the possibility to characterise the effect of irradiation by including biological parameters that account for radiation absorbed dose rates, gradients and spatial and temporal energy distribution heterogeneities. Molecular radiotherapy is in an exciting time of its development and the application of dosimetry in this field can only have a positive influence on its continued progression.     

药物选择 剂量 分割 顺序对放疗联合免疫治疗晚期非小细胞肺癌疗效的影响

非小细胞肺癌(non-small cell lung cancer，NSCLC)约占肺癌总数的85%，53%的患者在确诊时即为晚期。近年来，免疫检查点抑制剂(immune checkpoint inhibitors，ICIs)在晚期肿瘤治疗中效果显著。放疗在晚期NSCLC主要用于局部姑息治疗。研究显示免疫治疗协同放疗治疗晚期NSCLC与单独放疗或免疫治疗相比，可改善患者的无进展生存(progression-free survival，PFS)和总生存(overall survival，OS)，且不增加3级以上不良反应发生率。但ICIs的选择、放疗剂量、分割方式及联合治疗顺序仍未完全阐明。本文就免疫治疗联合放疗在晚期NSCLC中的临床研究进展作一综述，为临床选择提供参考。      

MR引导放疗在胰腺癌中的应用

放疗是治疗胰腺癌的重要手段。但受胰腺运动等因素影响,放疗疗效难以充分发挥。更高效的胰腺癌放疗有赖于运动管理方式的改进与高质量的图像引导。新兴的MR引导放疗技术软组织分辨率高、无额外辐射、能进行功能成像,经过大量研究评估与验证,其在靶区与危及器官的精准勾画、辅助运动管理和自适应放疗等方面有着巨大优势,有望更好地发挥放疗在胰腺癌治疗中的作用。本文就MR引导放疗在胰腺癌治疗中的应用作一综述和展望。     

A Phase II Study of Biodegradable Stents Plus Palliative Radiotherapy in Oesophageal Cancer

AimsSelf-expanding metal stents provide rapid improvement of dysphagia in oesophageal cancer but are associated with complications. The aim of the present study was to test the effectiveness of an alternative treatment of combining biodegradable stents with radiotherapy.Materials and methodsA Simon two-stage single-arm prospective phase II trial design was used to determine the efficacy of biodegradable stents plus radiotherapy in patients with dysphagia caused by oesophagus cancer who were unsuitable for radical treatment. Fourteen patients were recruited and data from 12 were included in the final analyses.ResultsFive of 12 patients met the primary end point: one stent-related patient death; four further interventions for dysphagia within 16 weeks of stenting (41.7%, 95% confidence interval 15.2–72.3%). The median time to a 10-point deterioration of quality of life was 2.7 weeks. Nine patients died within 52 weeks of registration. The median time to death from any cause was 15.0 weeks (95% confidence interval 9.6–not reached).ConclusionThe high re-intervention observed, which met the pre-defined early stopping criteria, meant that the suggested alternative treatment was not sufficiently effective to be considered for a larger scale trial design. Further work is needed to define the place of biodegradable stents in the management of malignant oesophageal strictures.     

HSG、Ki67组织表达与宫颈癌新辅助化疗治疗效果的相关分析

目的探讨细胞增殖抑制基因(HSG)、增殖细胞核抗原(Ki67)组织表达与宫颈癌新辅助化疗治疗效果的相关性。方法选取2017年1月至2019年7月广东省第二人民医院收治的180例经临床确诊的宫颈癌患者作为研究对象,采用随机数字表法分为观察组和对照组,每组90例。对照组采用传统手术治疗和放疗;观察组实施收治治疗、放疗及新辅助化疗。统计比较两组治疗前后HSG、Ki67水平变化、临床疗效及不良反应发生率情况。结果观察组术后3周及术后6周HSG阳性表达率高于对照组,而Ki67阳性表达率低于对照组(P<0.05)。观察组疾病控制率(DCR)高于对照组(P<0.05)。结论宫颈患部HSG表达率与宫颈癌患者的康复情况呈正相关,而Ki67表达水平与宫颈癌患者DCR呈负相关。评估HSG及Ki67指标变化对宫颈癌新辅助化疗结果的评价具有重要的指导价值。