Hypofractionated radiation therapy for invasive breast cancer: From moderate to extreme protocols

Adjuvant irradiation is the standard treatment after breast conservative surgery. Normofractionated regimen with an overall treatment time of 5 to 6 weeks is often considered as a limiting factor for irradiation compliance. In order to answer this issue, moderate and more recently extreme hypofractionated protocols appeared. We report here oncological outcomes and toxicity of hypofractionated breast irradiation. After defining the frame of moderate and extreme hypofractionated breast irradiations based on overall treatment time, patient selection criteria were listed. According to their levels of proof, the results of moderate and extreme hypofractionated breast irradiation were analysed. Overall treatment time for moderate hypofractionated breast irradiation ranged from 3 to 4 weeks, while for extreme hypofractionated breast irradiation, it was less than 1 week. For moderate hypofractionated breast irradiation, whole breast irradiation was currently performed with or without lymph node irradiation. Moderate hypofractionated breast irradiation has proven to be as safe and as efficient as normofractionated breast irradiation with level IA evidence. For extreme hypofractionated breast irradiation, phase III randomized trials confirmed that accelerated partial breast irradiation was non-inferior in terms of local control compared to normofractionated whole breast irradiation (with external beam radiation therapy and multicatheter brachytherapy), with similar acute and late toxicity. While the use of intraoperative breast irradiation remains under debate, new very accelerated partial breast irradiation (overall treatment time not exceeding 2 days) protocols emerged with encouraging results. Accelerated partial breast irradiation is warranted for extreme hypofractionated breast irradiation and is indicated for low-risk breast cancers. Moderate and extreme hypofractionated breast irradiation regimens are validated and can be routinely proposed according to patient selection criteria.     

高剂量CT辐射致家兔脾组织病理变化的初步实验研究

目的初步探讨CT腹部模式常规和非常规扫描次数、高曝光剂量扫描对家兔急性脾组织病理变化的影响。方法将46只大白兔随机分成3组：（1）高曝光剂量CT扫描组36只。采用约为常规剂量2倍的腹部CT扫描模式,对大白兔进行全身扫描,再将其分两大亚组,每组18只。①腹部模式一次性扫描组（一次性扫描组）：CT扫描层厚为2.5mm分别连续扫描3、6、9、12、15和18次,48h后剖杀;②腹部模式重复扫描组（重复扫描组）：CT扫描层厚以5mm分别连续扫描2、4、6、8、10和12次,24h后重复上述扫描,24h后剖杀。（2）常规CT扫描组：5只,采用常规次数和曝光剂量对大白兔进行全身扫描,48h后剖杀。（3）健康对照组：5只。所有实验动物取脾组织作病理分析。结果光镜病理结果：①一次性扫描组：连续扫描6次时出现红髓髓窦略扩张、淤血;连续9-18次扫描后,脾脏出现红髓髓窦扩张、淤血,可见网状组织细胞增生和吞噬含铁血黄素。②重复扫描组：共8次扫描时出现红髓髓窦轻度扩张、淤血,散在中性粒细胞浸润;16-24次扫描后,脾脏出现红髓髓窦扩张、淤血,散在中性粒细胞浸润,间或有组织细胞增生。结论常规脾脏CT扫描是非常安全的;在非常规扫描次数和高曝光剂量下,CT辐射可能会引起家兔急性脾组织的异常病理变化。     

低能量血管内激光照射治疗脑损伤的免疫功能变化与研究

本文对49例接受低能全血管内激光照射治（ILIB）的脑损伤病人的免疫功能改变进行研究．研究显示，低能量血管内激光照射疗法可明显改善免疫状态和免疫反应水平，增强免疫功能和机体抗感染能力．     

照射与免疫的时间间隔对抗体形成的影响及其辐射剂量效应

本实验观察了0. 25、0. 5、1. 0、2. 0、3. 0和4. 0Gy全身照射后3至6 h羊红细胞(SRBC)免疫对小鼠脾脏抗体形成细胞(PFC)的影响。结果发现,各剂量照射后,免疫与照射的时间间隔较长者,辐射对PFC反应的抑制显著加深。照射后3及6h免疫,脾脏PFC反应均随照射剂量的增加而降低。照射后3h免疫时,PFC反应的D_(37)值为4. 13Gy;照射后6h免疫时,PFC反应的D_(37)值为1. 74Gy。     

辐照油菜花粉自由基测定

本文采用电子顺磁共振技术测定经Ｃｏ~（６０）γ射线８ＫＧｙ辐照后的油菜花粉中自由基的含量水平。测定结果表明Ｃｏ~（６０）γ射线辐照引起油菜花粉中自由基含量明显升高，但在室温下存放，很快下降至正常水平。     

头部X线照射后大鼠血清中皮质酮含量和脾细胞中糖皮质激素受体变化及其相互关系的研究

给Wistar大鼠以10Gy X射线头部照射后不同时间测定血清皮质酮含量和脾细胞中糖皮质激素受体,结果表明:头照后24h受体数已降到对照组的25％,以后逐渐回升,至第9天恢复到接近正常水平。头照后受体的最大结合容量有降低趋势,但差异不显著,而Kd值显著增大,亲和力降低。皮质酮含量的变化呈双峰曲线,第1天即显著增高,至第9天仍显著增高,皮质酮含量和受体的变化规律不一致。体外实验还证实了1～10倍血清浓度的皮质酮在短时间内不会引起所测定的GCR改变。证明皮质酮的变化虽然可能是引起受体变化的一个原因,但不是主要原因。     

辐射诱发淋巴细胞凋亡生成与抑制作用研究

研究了辐射诱发的人外周血淋巴细胞凋亡生成，以及水溶性维生素Ｅ类似物－Ｔｒｏｌｏｘ对辐射诱导人外周血淋巴细胞凋亡的抑制作用。照后３０分钟内Ｔｒｏｌｏｘ能有效地阻抑ＤＮＡ片段形成，而在照前或受照中加入Ｔｒｏｌｏｘ均不能抑制ＤＮＡ片段形成，揭示Ｔｒｏｌｏｘ并不是通过清除照射过程中产生的自由基而起作用。照后３０分钟内加Ｔｒｏｌｏｘ，２小时后撤去，同样能抑制ＤＮＡ片段形成，表明Ｔｒｏｌｏｘ能不可逆地阻抑细胞凋亡早期的＂关键＂事件。     

丝裂素活化蛋白激酶介导~(60)Coγ射线抑制血管平滑肌细胞增生的机制

目的研究60 Coγ射线对平滑肌细胞增殖的影响及机制。方法采用同位素技术 ,测定3 H TdR掺入和丝裂素活化蛋白激酶 (MAPK)活性。结果 1 4、2 8Gy60 Coγ射线明显抑制平滑肌细胞增殖 ,同时MAPK活性明显下降。结论 60　Coγ射线抑制平滑肌细胞增殖可能是通过降低MAPK活性途径实现的。     

Biological activity of tissue flaps in the treatment of complicated irradiation wounds

Within the last ten years, 79 patients were treated for 114 chronically contaminated, intractable irradiation wounds using various methods of the modern plastic surgery. Radical excision of the devitalised contaminated tissue has been impracticable in 25 cases due to the risk of life-threatening complications or significant functional loss. Different types of flaps such as cutaneous, fasciocutaneous, musculocutaneous, split muscle, isolated vascularised fascia and greater omentum have been used. Despite the incomplete excision, 84% of wounds healed primarily. The essential factor for good wound healing seems to be the biologic activity (BA) of the flap's deep tissue layer that directly contacts the wound bed. BA includes density of the vascular net, ability of neovascularisation, plasticity and specific immunological capacities. It seems to be possible to classify the flaps according to the BA level. Tissue defects in which the chances for radical debridement are poor need the highest BA level in the flap reconstruction.Presented to the European Congress on Wound Healing and Skin Physiology, Bochum, Germany, 1992     

小鼠骨髓巨噬细胞培养液的造血抑制活性研究

观察了小鼠骨髓型正常巨噬细胞株经６Ｇｙ＾６０Ｃｏ照射后细胞培养上对ＣＦＵ－Ｅ和ＣＦＵ－Ｇ同期怕影响,结果未照射和照射后Ａｎａ－１细胞培养３上清对ＣＦＵ－Ｅ和ＣＦＵ－ＧＭ的形成均垢抑制活性,但照射后抑制活性更强,上清经灭活后抑制活性减弱,结论;小鼠骨髓巨噬 培养上清对ＣＦＵ－＝Ｅ和ＣＦＵ－ＧＭ均的抑制活性,这种抑制活性可能是抑制因子和细胞毒共同作用的结果。