立体定向适形放疗治疗原发性肝癌的近期疗效分析

目的 观察立体定向适形放疗治疗原发性肝癌的近期疗效.方法 28例原发性肝癌患者经Elscint twin flash 螺旋CT机定位后,用Leibinger三维放疗计划系统拟制放疗计划,在Varian直线加速器上实施治疗.平均随访时间为12个月.分析肿瘤反应率、放疗后无肝内肿瘤进展率及放疗后12个月生存率,观察治疗毒副作用.结果 放疗后肿瘤体积反应率为85.7%,放疗后12个月无肝内肿瘤进展率为38.4%,放疗后12个月生存率为70.5%.存活患者无晚期肝损伤.结论 立体定向适形放疗治疗肝癌的毒性较小,对提高肝内肿瘤的局部控制率有一定意义.     

两株人肝癌细胞QSG-7701和HepG2放射敏感性的体外研究

在研究肿瘤的辐射效应之初就有人发现 [1], 各种肿瘤细胞对辐射的敏感性有明显差异 , 因而在接受放射治疗时效果也不一样 . 体外培养细胞株的存活分数 (surviving fractionm,SF)在受到 2 Gy照射后 (简称 SF2)可以在 0.01～ 0.90之间变动 , 即使是同一肿瘤的不同细胞株 , SF2也可以相差数十倍 [1]. 放射诱发细胞凋亡现象是近年放射生物学研究的一个热点 . 有人在研究鼠的肿瘤时发现 [2], 细胞放射反应与照射后凋亡水平具有相关性 .     

108例老年人晚期非小细胞肺癌三维适形放射治疗的疗效分析

目的分析三维适形放射治疗（3D-CRT）在老年人非小细胞肺癌（NSCLC）的临床应用效果和放射损伤情况。方法接受3D-CRT的108例老年人晚期NSCLC中,男性102例,女性6例,中位年龄72岁。适形放疗单次剂量5～8Gy,隔日1次,总剂量68～82Gy。结果108例全部完成了放射治疗计划,完全缓解21例（19.4%）,部分缓解73例（67.6%）,无变化12例（11.1%）,恶化2例（1.9%）,总有效率87.0%。1、2、3年总生存率分别为65%、33%、28%。急性放射性肺炎2级8例,3级2例;晚期放射性肺炎2级11例,3级5例。结论采用3D-CRT技术治疗老年人晚期NSCLC有比较好的近期疗效,无严重的不良反应,有助于提高肿瘤的局部控制率,改善患者生存质量,减少并发症。     

131I-Herceptin放射免疫显像用于Herceptin相关心脏毒性机制的实验研究

目的探讨Herceptin相关心脏毒性的机制。方法^131I-Herceptin采用Iodogen法制备。取家兔5只,注射^131I-Herceptin 3h～5d,以放射免疫显像观察Herceptin的分布,以肌肉为参照,计算并比较各组织、器官的计数与肌肉计数的比值（O/M）。于注射后第5天处死家兔,取心、肺等组织,称重并测定放射性计数,计算并比较每克组织摄取分数（%ID/g）。以免疫组化测定并比较家兔各脏器HER2表达。结果注射后3h心脏O/M比值显著高于肺（P=0.032）和肝（P=0.019）,但24h后显著降低（P=0.001）。各组织器官的每克组织的摄取分数以血液最高,为12.6%ID/g;其次为肝,为8.6%ID/g;心肌、肺和脾的摄取分数相近;肌肉最低,为1.6%ID/g。血液的摄取分数与其它脏器比较,除肝脏外（P=0.098）,其它均显著低于血液。心肌摄取仅高于肌肉（P=0.041）和小肠（P=0.034）,数值上甚至低于肝、肾、脾。心肌、肺和脾的摄取分数相近。心肌HER2表达水平与肝、肺、肾等组织未见显著差异（H=3.236,P=0.172）。结论心肌属于HER2低表达组织,对Herceptin的摄取量并不高于其它组织器官。     

早期鼻咽癌18F-FDG摄取与葡萄糖转运蛋白1及已糖激酶-Ⅱ过度表达的关系

目的 测定并分析早期鼻咽癌18F-脱氧葡萄糖（FDG）摄取与肿瘤组织葡萄糖转运蛋白1（Glut1）及己糖激酶-Ⅱ（HK-Ⅱ）的表达,以探讨鼻咽癌组织摄取FDG的分子机制及其与肿瘤病理类型和分期的相关性.方法 40例早期鼻咽癌患者（T1期12例,T2期28例）行PET检查,测定病灶最大标准摄取值（SUVmax）及平均标准摄取值（SUVmean） 行鼻咽部肿瘤活组织检查,并采用免疫组织化学法测定其Glut1及HK-Ⅱ表达,计算阳性细胞百分率.T1与T2期患者SUVmax或SUVmean间的差异采用t检验,Glut1及HK-Ⅱ表达阳性率差异采用x2检验,SUVmax与Glut1和HK-Ⅱ表达间的关系采用Pearson相关分析.结果 40例患者SUVmax与SUVmean分别为9.45±1.87和6.04±1.09.T1期分别为8.95±1.91和5.61±1.08,T2期分别为11.55±1.70和7.98±1.10,T1期与T2期相比原发灶SUVmax（t=4.46,P＜0.001）及SUVmean（t=6.76,P＜0.001）差异均有统计学意义.40例早期鼻咽癌患者Glut1及HK-Ⅱ染色均为阳性,阳性细胞率分别为（45.2±10.9）%与（68.3±9.5）%.其中Glut1阳性细胞率在T1期和T2期分别为（38.4±8.1）%与（49.7±12.6）%,两者差异无统计学意义（x2=40.58,P＞0.05）,而HK-Ⅱ阳性细胞率在T1期与T2期分别为（60.1±11.1）%与（77.9±14.7）%,差异有统计学意义（x2=58.71,P＜0.05））.SUVmax与Glut1表达阳性细胞率呈低度正相关（r=0.369,P=0.019）,与HK-Ⅱ表达阳性细胞率呈中度正相关（r=0.549,P=0.001）.结论 早期鼻咽癌组织FDG摄取与Glut1过度表达相关.     

131I-Herceptin的血液存在方式及体内外稳定性研究

目的 探讨131I-Herceptin的稳定性与生物学特性.方法 131I-H-Herceptin采用Iodogen法制备,其基础放射化学纯度(RCP)为(94.9+2.7)%.4℃冰箱内放置3、24、48、72、96 h,取各时间样品测RCP.取家兔5只,静脉注射131I-Herceptin后1 h、3 h、6h、24 h、2 d、3 d,4 d、5 d取血,分离血清及血细胞,测血清131I-Herceptin的RCP,并测定血清或血细胞放射性计数百分比.各组样品RCP的差异分析采用One-way Anova检验.结果 4℃放置72 h以内,RCP未见显著下降(F=15.985,P＜0.001);72 h后显著(t=9.971,P＜0.001)下降至(82.6±2.8)%.注射后1～96 h,131I-Herceptin主要存在于血清,其放射性所占比例稳定在81%～87%.注射体内后1 h,血清内131I-Herceptin的RCP为(90.9±8.5)%.未见显著差异(t=1.753,P＞0.05).24 h后为(75.4±3.9)%,提示开始显著降低(t=6.564,P＜0.001).结论 采用Iodogen法标记的131I-Herceptin,体外放置72h内,放射化学纯度基本稳定,注入体内后主要存在于血清,24h以内放射化学纯度稳定,24h后降解明显.     

早期鼻咽癌血管内皮细胞生长因子表达与肿瘤组织18F-FDG摄取的关系

目的 研究早期鼻咽癌组织血管内皮细胞生长因子(VEGF)表达及肿瘤组织~(18)F-FDG摄取的情况,并探讨早期鼻咽癌组织VEGF表达与~(18)F-FDG摄取的关系.方法 对40例I,II期鼻咽癌患者进行正电子发射体层显像检查,测定鼻咽原发灶肿瘤组织的~(18)F-FDG最大摄取值和标准摄取值(SUV_(max)和SUV_(mean)),应用标准链霉菌抗生物素蛋白-过氧化物酶亲和免疫组化法检测40例患者肿瘤组织VEGF的表达.结果 40例早期鼻咽癌组织的SUV_(max)>与SUV_(mean)分别为9.45±1.87和6.04±1.09,T_1期肿瘤原发灶SUV_(max)与SUV_(mean)分别为8.95±1.91和5.61±1.08,T_2期的原发灶SUV_(max)与SUV_(mean)分别为11.55±1.70和7.98±1.1,T_2期原发灶SUV_(max)和SUV_(mean)高于T_1期(t=4.46,P<0.001;t=6.763,P<0.001).非角化分化型肿瘤原发灶SUV_(max)与SUV_(mean)分别为9.74±1.82和6.82±1.23,非角化未分化型肿瘤原发灶SUV_(max)与SUV_(mean)分别为10.44±2.16和6.68±1.35,非角化分化型和非角化未分化型肿瘤原发灶SUV_(max)和SUV_(mean)无差别(t=1.230,P>0.05;t=0.346,P>0.05).40例鼻明癌组织VEGF染色阳性细胞率为60.8%;鼻咽癌组织FDG摄取(SUV_(max))和VEGF表达的细胞阳性率相关(r=0.460,P=0.03).结论 早期鼻咽癌组织FDG摄取与肿瘤组织VEGF过度表达相关,其SUV值反映了鼻咽癌组织的葡萄糖代谢情况,同时也在一定程度上反映了肿瘤组织乏氧的程度.

Abstract：

Objective To study the overexpression of vascular endothelial growth factor (VEGF) and fluorine-18 fluorodeoxyglucose (FDG) uptake in early-stage nasopharyngeal carcinoma (NPC) and evaluate their relationship. Methods FDG positron emission tomography (PET) was performed in forty patients with stage I and stage II NPC. The maximum and mean standard uptake values (SUV_(max) and SUV_(mean) ,respectively) were measured in each patient, and the expression of VEGF was measured on paraffin sections using immunohistochemistry. Results The FDG uptake in the patients were 9.45±1.87 (SUV_(max)) and 6.04±1.09 (SUV_(mean)), 8.95±1.91 (SUV_(max)) and 6.04±1.09 (SUV_(mean)) in stage I patients, and 11.55±1.70 (SUV_(max)) and 7.98±1.1 (SUV_(mean)) in stage II patients. The FDG uptake of stage II patients was higher than that of stage I patients. The FDG uptake of non-keratinizing differentiated carcinoma was 9.74±1.82 (SUV_(max)) and 6.82±1.23 (SUV_(mean)) and 10.44±2.16 (SUV_(max)) and 6.68±1.35 (SUV_(mean)) in non-keratinizing undifferentiated carcinoma, showing no significant differences between them (SUV_(max): t=1.230, P>0.05; SUV_(mean): t=0.346, P>0.05). The VEGF-positive cells were 60.80% in the tumor. A correlation between VEGF expression and FDG uptake in he tumor was noted (r=0.460, P=0.03). Conclusion VEGF overexpression is correlated to FDG uptake in patients with early-stage NPC. The SUV value reflects the glucose metabolism of NPC, and also shows the degree of oxygen insufficiency in the tumor tissue.     

Relationship between fluorodeoxyglucose uptake and overexpression of glucose transport protein 1 and hexokinase-Ⅱ in early-stage nasopharyngeal carcinoma

Objective To discuss the molecular mechanism of 18F-fluorodeoxyglucose (FDG) uptake in tumor and to assess its value to identify pathologic type and cancer staging in patients with earlystage nasopharyngeal carcinoma.Methods Forty patients with nasopharyngeal carcinoma of early-stage,including 12 cases with T1 stage and 28 cases with T2 stage, underwent FDG PET imaging.The maximum standardized uptake value ( SUVmax ) and mean standardized uptake value ( SUVmean ) of FDG uptake of each patient were measured and compared between T1 and T2 stage by t-test.The expression of glucose transport protein 1 ( Glut1 ) and hexokinase- Ⅱ ( HK- Ⅱ ) of each case was measured in paraffin sections by streptavidin-perosidase (SP) immunohistochemistry.The positive expression rate of Glut1 and HK- Ⅱ was calculated and compared between T1 and T2 by x2 test.Meanwhile, the correlation between the expression of Glut1 or HK-Ⅱ and the SUVmax was tested by Pearson analysis.Results The SUVmax and SUVmean in 40 patients were 9.45 ± 1.87 and 6.04 ± 1.09, respectively.The SUVmax of patients with T1 stage (8.95 ± 1.91 ) was significantly lower (t =4.46, P＜0.001 ) than that of patients with T2 stage (11.55 ± 1.70), and the SUVmean of patients with T1 stage (5.61 ± 1.08) was significantly lower ( t = 6.76, P ＜ 0.001 ) than that of patients with T2 stage (7.98 ± 1.10) too.Among 40 patients, all patients showed positive expression of Glut1 and HK-Ⅱ , and the positive expression rate of Glut1 and HK-Ⅱ was ( 45.2 ± 10.9 )% and ( 68.3 ±9.5)%, respectively.The positive expression rate of Glut1 was (38.4 ±8.1)% in T1 stage and (49.7 ±12.6)% in T2 stage, which displayed no difference (x2 =40.58, P＞0.05), but the HK-Ⅱ positive expression rate showed significant difference (x2 =58.71, P＜0.05) between T1 stage (60.1 ±11.1)% and T2 stage (77.9 ± 14.7 )%.The correlation analysis indicated that there was low-degree positive correlation (r =0.369, P=0.019) between the SUVmax and Glut1 expression, and there was medium-degree positive correlation (r = 0.549, P = 0.001 ) between the SUVmax and HK-Ⅱ expression.Conclusion Expression of Glut1 and HK-Ⅱ was positively correlated with FDG uptake in patients with early-stage nasopharyngeal carcinoma.     

鼻咽癌HK-Ⅱ和VEGF表达与PET/CT 显像18F-FDG摄取的关系

 目的 探讨鼻咽癌的18F-FDG摄取与肿瘤组织己糖激酶-Ⅱ(hexokinase-Ⅱ, HK-Ⅱ)及血管内皮细胞生长因子（VEGF）表达的关系。方法 对2005年3月至2006年8月收治的40例鼻咽癌患者进行正电子发射体层显像（PET）检查,测定肿瘤最大和标准摄取值（SUVmax和SUVmean）;应用标准链霉菌抗生物素蛋白 过氧化物酶亲和（SP）免疫组织化学法检测40例患者肿瘤组织己糖激酶-Ⅱ 和血管内皮细胞生长因子（VEGF）的表达。结果 40例鼻咽癌组织的SUVmax与 SUVmean分别为（9.45±1.87）和（6.04±1.09）;40例鼻咽癌组织HK-Ⅱ阳性细胞率为68.33%,VEGF染色阳性细胞率为60.8%;鼻咽癌组织FDG摄取（SUVmax）和HK-Ⅱ表达的细胞阳性率呈显著相关（r=0.493,P＝0.001）,鼻咽癌组织FDG摄取（SUVmax）和VEGF表达的细胞阳性率相关（r=0.460,P＝0.03）。结论 鼻咽癌组织FDG摄取与HK-Ⅱ和VEGF过度表达相关。