盆腔外照射、高剂量率后装联合5-FU、DDP治疗IIB—IVA期宫颈癌疗效比较

【目的】比较盆腔外照射、高剂量率后装联合5-氟尿嘧啶(5-fluorouracil,5-FU)、顺铂(Cisplatin,DDP)月疗或DDP周疗治疗IIB—IVA期宫颈癌的近期疗效及不良反应,探讨治疗晚期无远处转移宫颈癌的优化方案。【方法】80例符合纳入标准的宫颈癌患者被随机分为A、B组,每组40例。两组患者均行DT 30 Gy全盆腔野照射,随后中央挡铅板照射,DT 20 Gy。腔内照射A点总剂量42 Gy。A组给予5-FU 1 000 mg/m2/day,DDP 20 mg/m2/day,静滴5 d,28 d为1疗程,共3疗程。B组每周给予DDP 30 mg/m2静滴,共6疗程。观察两组肿瘤消退、并发症及治疗依从性。【结果】B组完成化疗及放疗人数均显著大于A组(P<0.05)。完成放化疗剂量≥80%的人数显著大于A组(P<0.05)。A组III度以上骨髓抑制及III级以上恶心呕吐反应率显著大于B组(P<0.05)。治疗后3个月两组患者完全缓解率无统计学差异(P>0.05)。【结论】两组方案治疗晚期无远处转移宫颈癌的疗效相似,但DDP周疗毒性反应低,依从性好,可行性强。     

CT引导下125I粒子植入治疗鼻咽癌放疗后颈部淋巴结转移

目的 介绍CT引导下125I粒子永久植入治疗鼻咽癌放疗后颈部淋巴结转移的技术方法并评价其临床价值.方法 16例鼻咽癌根治性放疗后颈部转移淋巴结行CT引导下125I粒子植入,依据植入前1周内CT图像应用计算机治疗计划系统制定粒子植入计划,按计划在CT引导下穿刺植入125I粒子,术后4～6个月内复查CT观察粒子分布、不良反应及疗效.结果 16例共植入粒子128粒.根据疗效评价标准判定,完全缓解（CR）31.25%（5/16） 部分缓解（PR）43.75%（7/16） 无恶化（AC）18.75%（3/16） 恶化（PD）6.25%（1/16）.总有效率（CR＋PR）为75.00%（12/16）,未见急性并发症和治疗相关的放射损伤.结论 CT引导下125I粒子永久植入治疗鼻咽癌放疗后颈部转移淋巴结是一种安全、可靠,疗效显著的治疗方法.     

Early time course of neointima formation and vascular remodelling following percutaneous coronary intervention and vascular brachytherapy of in-stent restenotic lesions as assessed by intravascular ultrasound analysis

Summary In-stent restenosis (ISR) represents the major limitation of stent implantation. Treatment, although of relative technical ease, is unsatisfactory due to a high incidence of recurrent restenosis. Vascular brachytherapy (VBT) has emerged as a powerful adjunct therapeutic modality to treat ISR. Inhibition of neointima formation has been regarded as the relevant mechanism of action. Yet, positive remodelling has been suspected as another contributing factor. Since only very few precise analyses of the extent, distribution and time course of the respective mechanims exist, the goal of the present study was to describe the changes of the vessel geometry at the target lesion and at the reference site following angioplasty and VBT of ISR in 42 patients by means of quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) before and after the index procedure and at the 3 and 6 month follow-up.By QCA the acute lumen gain measured 2.2±0.8 mm, the late lumen loss at 3 months was 0.1±0.5 mm and at 6 months 0.4±0.7 mm. By IVUS luminal cross-sectional area increased from 1.5±1.2 mm² to 7.9±1.9 mm² (p<0.001). The intima hyperplasia cross-sectional area at 3 months was only 0.2±1.0 mm² (p=0.191), but increased to 0.7±0.6 mm² (p<0.001) at 6 months resulting in a lumen cross-sectional area of 7.1±1.7 mm². Stent dimensions did not show any significant changes over time. The external elastic membrane cross-sectional area at 3 months increased by 1.3±1.9 mm² (p<0.001), and showed a further increase by 0.7±2.9 mm² at 6 months. Positive remodelling could be demonstrated also at the reference segment.In conclusion the absolute amount of intima hyperplasia during a 6-month follow-up period after VBT of ISR is low and most pronounced between the third and sixth month. Besides this, predominantly within the first 3 months of follow-up, significant positive remodelling could be demonstrated at the target lesion and at the reference site. Both observed effects may contribute to the preservation of the vessel lumen.Diese Publikation enthält die Ergebnisse der Promotionsarbeit von Frau Andrea Zimmermann     

Combining surgery with 125I brachytherapy for recurrent mediastinal dedifferentiated liposarcoma: A case report and review of literature

BACKGROUND Dedifferentiated liposarcoma in the mediastinum is an extremely rare malignant neoplasm.A few previous case reports indicate that surgical resection is the major treatment,but frequent recurrence occurs locally.Due to its rarity,its clinical characteristics,optimal treatment and clinical outcomes remain unclear.Here,we report a case of multifocal recurrent dedifferentiated liposarcoma in the posterior mediastinum treated by combining surgery with 125I brachytherapy,and summarize its clinical features,treatment and prognosis.CASE SUMMARY A 75-year-old man was admitted to our hospital with a history of gradual dysphagia for one year and aggravated dysphagia for 3 mo.Contrast-enhanced computed tomography(CT)revealed several large cystic-solid masses with lipomatous density,and calcification in the posterior-inferior mediastinum.The patient received a wide excision by video-assisted thoracoscopic surgery.Pathological analysis confirmed the tumors were dedifferentiated liposarcomas.The tumor locally relapsed 24 mo later,and another operation was performed by video-assisted thoracoscopic surgery.Fifteen months after the second surgery,the tumor recurred again,and the patient received CT-guided radioactive seeds 125I implantation.After 8 mo,follow-up chest CT showed an enlarged tumor.Finally,his condition exacerbated with severe dysphagia and dyspnea,and he died of respiratory failure in July 2018.CONCLUSION We reviewed the literature,and suggest that surgical resection provides beneficial effects for dedifferentiated liposarcoma in the mediastinum,even in cases with local recurrence.125I brachytherapy may be beneficial for recurrent unresectable patients.     

Clinical Application of Iodine-125 Seed Brachytherapy Combined with Anti–PD-1 Antibodies in the Treatment of Lung Cancer

PurposeThe purpose of this case report was to investigate the clinical efficacy and tolerability of anti–programmed cell death protein (PD)-1 antibody combined with iodine (I)-125 seed brachytherapy in lung cancer treatment.MethodsThree patients with advanced PD-L1–positive non–small-cell lung cancer were treated first with I-125 seed brachytherapy and then with anti–PD-1 antibody. Clinical efficacy was evaluated with Response Evaluation Criteria in Solid Tumors.FindingsAll 3 patients had complete response or partial response. None of the 3 patients had reported obvious adverse events.ImplicationsEncouraging preliminary results provide important support for further clinical treatment of lung cancer using anti–PD-1 antibody combined with I-125 seed brachytherapy.     

Episcleral plaque brachytherapy using 'BARC I-125 Ocu-Prosta seeds' in the treatment of intraocular tumors: a single-institution experience in India

Context:

To analyze the results of episcleral plaque brachytherapy using indigenous Bhabha Atomic Research Centre (BARC) Iodine-125 Ocu-Prosta seeds for the management of intraocular tumors from a single institute.

AIM:

To report our initial experience and learning curve on the use of ‘BARC I-125 Ocu-Prosta seeds’ for the management of intraocular tumors such as choroidal melanomas, retinoblastomas and vasoproliferative tumors (VPT).

Materials and Methods:

We retrospectively reviewed 13 eyes of 13 patients who underwent ophthalmic brachytherapy between May 2008 to March 2012. Nine cases had choroidal melanomas; three had retinoblastomas while one case had VPT.

Results:

For choroidal melanomas the average apical diameter before brachytherapy was 7.6 mm and average largest basal diameter was 12.1 mm, respectively, which reduced to 4.2 mm and 7.7 mm after the procedure at an average follow-up of 24 months (range 10-43 months). Retinoblastoma and VPT also showed good regression after brachytherapy.

Conclusion:

Plaque radiotherapy using ¹²⁵I seeds can be performed under peribulbar anesthesia and provides a viable option for the management of intraocular cancer with minimal invasiveness and surgical complications. Patients in our studies experienced excellent local tumor control. With the availability of indigenous ‘BARC I-125 Ocu-Prosta seeds’ locally, cost effective ophthalmic brachytherapy can be performed in India.     

Technical acquisition and dosimetric assessment of iodine-125 permanent brachytherapy in localized prostate cancer: Our first series of 100 patients

Objectives:   To assess our initial experience in the treatment of localized prostate cancer using low-dose-rate brachytherapy (LDR-brachytherapy) with iodine-125.
Methods:   One-hundred consecutive patients received LDR-brachytherapy between July 2004 and October 2006. Seventy-six patients were treated with seed implantation alone, whereas 24 patients were treated with a combination of brachytherapy and external beam radiotherapy. The minimal percentage of the dose received by 90% of the prostate gland (%D90), the percentage prostate volume receiving 100% of the prescribed minimal peripheral dose (V100), and the operation time were compared among every 10 consecutive patients.
Results:   The means of %D90 and V100 were 109.6% and 93.4%, respectively. When compared with the first 10 patients, both D90 and V100 showed significant improvement in the following 10 consecutive patients. Similarly, the mean operation time decreased significantly according to the accumulated number of patients.
Conclusions:   Our initial experience with the first 100 cases suggests that LDR-brachytherapy needs accumulation of many more patients to obtain high-quality post-implant dosimetric outcomes.     

Salvage permanent perineal radioactive‐seed implantation for treating recurrence of localized prostate adenocarcinoma after external beam radiotherapy

OBJECTIVE

To assess our experience with salvage permanent perineal radioactive‐seed implantation (SPPI) as a possible therapeutic option for recurrent prostate adenocarcinoma, as salvage therapies for recurrences after definitive external beam radiotherapy (EBRT) for localized adenocarcinoma of the prostate are associated with significant morbidity and biochemical failure.

PATIENTS AND METHODS

We retrospectively analysed on patients who had SPPI for localized recurrent prostate adenocarcinoma from 1996 to 2007 after primary treatment with EBRT. Excluded were patients who had other primary treatment or had no follow‐up. Primary outcomes were time to biochemical relapse‐free survival, using the Phoenix definition of a prostate‐specific antigen (PSA) nadir +2 ng/mL, and cancer‐specific survival. Secondary outcomes were the International Prostate Symptom Score (IPSS), the International Index of Erectile Function‐5 score (IIEF‐5), and complications based on Common Terminology Criteria for Adverse Events (version 3).

RESULTS

In all, 37 patients had SPPI during this period; after applying inclusion and exclusion criteria, 24 remained for analysis. At the time of salvage therapy, the median time to the diagnosis of local recurrence was 49 months, the median PSA level was 3.36 ng/mL, the median PSA doubling time was 20 months, and all patients were clinically re‐staged at ≤T2 with negative transrectal ultrasonography and/or magnetic resonance spectroscopy. The original Gleason score was ≤6 in nine patients, 7 in eight and ≥8 in three (not recorded in two). The median follow‐up after SPPI was 30 months; the cancer‐free survival was 96% (one death) and biochemical relapse‐free survival was 88% (three patients). The PSA level was higher than the levels before SPPI at 3 months in all three failures, but lower in all 21 patients considered relapse‐free. Complications included one urethral stricture, one grade 3 rectal haemorrhage and five grade 2 gross haematuria that resolved with conservative management. Insufficient data were available to assess the IPSS or IIEF‐5 scores.

CONCLUSION

With a short‐term follow‐up SPPI appears to provide excellent prostate cancer control with an acceptable rate of complications for patients with local recurrence of prostate cancer after EBRT. An extended follow‐up is necessary to determine the long‐term durability and safety of SPPI.