High Dose Rate Cobalt-60 Afterloading Intracavitary Therapy for Cervical Carcinoma in Srinagarind Hospital - Analysis of Survival

Objective: To evaluate the actuarial survival rates in uterine cervical cancer patients treated with teletherapycombined with high dose rate (HDR) cobalt-60 brachytherapy. Materials and Methods: A retrospective studyof uterine cervical cancer patients, stages IB-IVB (International Federation of Gynecologists and Obstetriciansrecommendations or FIGO), treated by radiotherapy alone between April 1986 and December 1988 wasconducted. The patients were treated with teletherapy 50Gy/25 fractions, five fractions per week to the wholepelvis, together with HDR cobalt-60 afterloading brachytherapy of 850 cGy/ fraction, weekly to point A for 2fractions. Results:The study analysed the records of 141 patients with uterine cervical cancer with a mean ageof 50.0 years (range 30-78). The mean tumor size was 4.1 cm in diameter (range 1-8). Mean follow-up time was2.94 years (range 1 month - 6.92 years). The 5 year actuarial survival rates for patients with small size tumorsless than 2 cm in diameter and tumor sizes larger than 2 cm in diameter were 100% and 63.2%. The overall 5year survival rate was 63.3%. For cancer stages IB, IIB, IIIA and IIIB they were 100%, 80.3%, 100% and 54.8%and for squamous cell carcinoma and adenocarcinoma were 58.3% and 31.2%. Conclusion: Combined HDRcobalt-60 brachytherapy and external beam radiotherapy provide a useful modality in the treatment of uterinecervical cancer, feasible for developing countries. The approach demonstrated a slightly elevated radiationmorbidity but was most effective in early stages and with small tumor sizes less than 2 cm in diameter.     

~(125)Ⅰ植入治疗源的剂量学参数的Monte Carlo模拟

放射性粒子源125I已被广泛用于前列腺和眼睛的植入治疗中。本文采用EGS5蒙特卡罗代码计算了美国医用物理学协会（AAPM）TG-43U1报告中推荐的型号为6711125I近距治疗源（活性区长取0.28cm）的剂量学参数,如剂量率常数、径向剂量函数和各向异性函数。剂量率常数为0.959cGy/h/U,与TG-43U1推荐值和Dolan等已发表的值相差在2.0%以内 径向剂量函数数值与二者均符合较好 随着角度和距离的增加,各向异性函数值数值与二者的复合程度趋佳。并给出了实用性较强的径向剂量函数的拟合公式。     

HDR brachytherapy decreases proliferation rate and cellular progression of a radioresistant human squamous cell carcinoma in vitro

Purpose: To investigate the effects of high dose rate (HDR) brachytherapy on cellular progression of a radioresistant human squamous cell carcinoma in vitro, based on clinical parameters.

Materials and methods: An acrylic platform was designed to attach tissue culture flasks and assure source positioning during irradiation. At exponential phase, A431cells, a human squamous cell carcinoma, were irradiated twice up to 1100 cGy. Cellular proliferation was assessed by Trypan blue exclusion assay and survival fraction was calculated by clonogenic assay. DNA content analysis and cell cycle phases were assessed by flow cytometry and gel electrophoresis, respectively. Cellular death patterns were measured by HOPI double-staining method.

Results: Significant decreasing cellular proliferation rate (p?<?0.05) as well as reduced survival fraction (p?<?0.001) in irradiated cells were observed. Moreover, increased percentage of cells arrested in the G₂/M phase (32.3?±?1.5%) in the irradiated group as compared with untreated cells (8.22?±?1.2%) was detected. Also, a significant (p?<?0.0001) nuclei shrinking in irradiated cells without evidence of necrosis or apoptosis was found.

Conclusion: HDR brachytherapy led to a decreased proliferation rate and cell survival and also hampered cellular progression to mitosis suggesting that tumor cell death mainly occurred due to mitotic death and G₂/M cell cycle arrest.     

血管内近程放疗与序贯三维适形放疗治疗门静脉主干癌栓的疗效对比

目的 比较血管内近程放疗(EVBT)与序贯三维适形放疗(3-DCRT)治疗门静脉主干癌栓(MPVTT)的安全性和疗效.方法 对2012年5月至2014年6月接受支架植入和TACE治疗的176例肝细胞肝癌合并MPVTT患者的病历资料进行回顾性分析,其中123例(A组)同期在门脉主干内植入125I粒子条,余53例行序贯3-DCRT(B组).比较两组患者的生存期、疾病无进展生存期、支架通畅期及治疗相关不良事件的发生率.结果无严重治疗相关不良事件发生.平均随访(11.7±8.3)个月,A组及B组的平均生存期分别为(11.7±1.2)和(9.5±1.8)个月(P=0.002),平均疾病无进展生存期分别为(5.3±0.7)和(4.4±0.4)个月(P=0.010),平均支架通畅期分别为(10.3±1.1)及(8.7±0.7)个月(P=0.003).结论 相对序贯3-DCRT,EVBT联合支架植入和TACE能显著延长HCC伴MPVTT患者的生存期.     

MRI引导下的宫颈癌三维后装治疗进展

宫颈癌是造成全球女性肿瘤患者死亡的主要原因之一,放疗是宫颈癌的主要治疗手段,而后装治疗是宫颈癌放疗不可缺少的组成部分,外照射联合后装治疗适用于无远处转移的各期初治或复发宫颈癌患者。MRI具有良好的软组织分辨率,在精确靶区范围、保护OAR以及改善患者临床结局等方面有着独特优势;近来许多研究证实了MRI引导下的宫颈癌三维后装的可行性及优越性。本文主要从相关MR成像技术、施源器选择、靶区勾画与评估以及MRI引导下的三维后装治疗所带来的临床效应等方面进行阐述。     

CT引导下局部晚期宫颈癌组织间插植近距离治疗剂量学分析

目的 探讨CT引导下组织间插植近距离治疗对局部晚期宫颈癌靶区及周围正常组织剂量学优势,提供一种简单、有效的临床治疗方式。方法 共纳入52例经体外放疗后肿瘤消退不明显、剩余肿瘤仍>5 cm的局部晚期宫颈癌患者。应用宫腔管和自由金属针组成的“混合”施源器对患者进行CT引导下组织间插植近距离治疗。勾画高危CTV (HR-CTV)、中危CTV (IR-CTV)及OAR。将体外照射与近距离治疗的EQD₂相加。评价HR-CTV和IR-CTV的D₉₀、D₁₀₀及膀胱、直肠及乙状结肠的D_{2 cc}值。结果 HR-CTV的D₉₀平均值为(88.4±3.5) Gy。膀胱、直肠、乙状结肠的D_{2 cc}分别为(81.1±5.6)、(65.7±5.1)、(63.1±5.4) Gy。100%患者膀胱、乙状结肠的D_{2 cc}≤90、≤70 Gy,89%患者直肠的D_{2 cc}≤70 Gy。结论 CT引导下组织间插植近距离治疗对局部晚期宫颈癌有明显剂量学优势,临床或许可行,但远期疗效及不良反应尚待进一步观察。     

多通道施源器用于晚期宫颈癌三维腔内放疗的剂量学研究

目的 探讨中晚期宫颈癌三维后装腔内放疗中三通道施源器的通道设计与OAR、靶区剂量间关系。方法 调取2015—2016年我院三维腔内治疗的15例中晚期宫颈癌数据,其中30次“阴道卵形两半球+宫腔管”的三通道施源器剂量参数纳入研究。在原靶区和OAR勾画、处方剂量不变基础上保留宫腔管单通道施源器,重新进行三维腔内照射设计的剂量参数作为对照组,配对t检验两组OAR剂量参数。结果 三通道、单通道施源器组直肠D_2cc分别为(387.8±96.8)、(340.8±88.1) cGy;两组膀胱和乙状结肠D_2cc分别为(443.2±87.5)、(719.4±243.0) cGy和(330.3±88.8)、(383.1±105.6) cGy。三通道组满足直肠(D_2cc≤500 cGy)、膀胱(D_2cc≤550 cGy)和乙状结肠(D_2cc≤500 cGy)计划限量,单通道组膀胱和乙状结肠D_2cc受量分别为大于和部分大于计划限量。单通道组膀胱和乙状结肠D_2cc受量高于三通道组(P均<0.05)。结论 宫颈癌三维腔内放疗中“阴道卵形两半球+宫腔管”三通道施源器比宫腔管单通道可有效降低膀胱和乙状结肠受量,有利于计划优化和剂量实施。     

Californium-252 neutron brachytherapy combined with external pelvic radiotherapy plus concurrent chemotherapy for cervicalcancer: a retrospective clinical study

Background: Cervical cancer is the sixth most common cancer in Chinese women. A standard treatment modality for cervical cancer is the combination of surgery, chemotherapy, external-beam radiotherapy and intracavitary brachytherapy. The aim of this study was to retrospectively assess the long-term treatment outcomes of patients with cervical cancer who were treated with californium-252 neutron brachytherapy combined with external-beam radiotherapy plus concurrent chemotherapy.Methods: We retrospectively analyzed the medical records of 150 patients with primary stages IB-IVB cervical cancer who received neutron brachytherapy combined with external-beam radiotherapy concurrently with cisplatin chemotherapy.All patients were followed up. Using an actuarial analysis, patient outcomes and treatment-related adverse effects were evaluated and compared.Results: The median overall survival (OS) was 33.2 months. The 3-year progression-free survival rates for patients with stages Ⅰ—Ⅱ, Ⅲ, and Ⅳ diseases were 81.0% (68/84), 65.0% (39/60), and 0% (0/6), respectively; the 3-year OS rates were 90.5% (76/84), 85.0% (51/60), and 16.7% (1/6), respectively. Vaginal bleeding was controlled within the median time of 4.0 days. One month after treatment, 97.3% of patients achieved short-term local control. The local recurrence rates for patients with stages Ⅰ—Ⅱ, Ⅲ, and Ⅳ disease were 4.8% (4/84), 11.7% (7/60), and 33.3% (2/6), respectively, and the occurrence rates of distant metastasis were 16.7% (14/84), 25.0% (15/60), and 100.0% (6/6), respectively. Cancer stage,tumor size, and lymph node metastasis were identified as prognostic risk factors, but only lymph node metastasis was found to be an independent prognostic factor. The most common adverse effects during treatment were grades 1 and 2 irradiation-related proctitis and radiocystitis.Conclusion: For patients with cervical cancer, neutron brachytherapy combined with external-beam radiotherapy plus concurrent chemotherapy produces a rapid response and greatly improves local control and long-term survival rates with tolerable adverse effects.     

外照射联合锎－252腔内放疗在食管癌放疗后复发患者中的应用

目的：分析食管癌放疗后复发患者应用再程外照射放疗联合锎－252腔内放疗的价值。方法：选择2011年5月至2014年5月符合纳入标准的食管癌放疗后复发患者60例,分为实验组（外照射＋腔内）30例和对照组（单纯外照射）30例。比较两组患者近期缓解率、前2年生存率和不良反应。结果：实验组与对照组治疗结束后,患者近期缓解率分别为86．2％（25／29）和75．0％（21／28）,有统计学差异（P＜0．05）;治疗组第1、2年生存率分别为24．1％和21．4％,无明显统计学差异（P＞0．05）;两组患者不良反应发生情况比较实验组的不良反应主要表现为放射性食管炎和食管穿孔,对照组表现为放射性肺炎的发生率提高。结论：外照射联合锎－252腔内放疗可以提高食管癌放疗后局部复发患者的局控率,同时食管穿孔的风险增大。