宫颈癌术后低剂量盆腔放疗的长期疗效

[目的]探讨宫颈癌术后低剂量盆腔放疗的可行性。[方法]回顾性分析91例患者宫颈癌根治患者,术后用常规盆腔预防性放射治疗剂量治疗(40～50 Gy,20～25次,4～5 w),其中44 Gy为低剂量组(A组,78例),≥44Gy为常规剂量组(B组,13例)。生存率计算采用Kaplan-Meier法,生存率比较采用Logrank检验。[结果]低剂量组5年生存率为92.2%,常规剂量组为84.6%,两组类似。放射性肠炎:低剂量组0级33例、1级35例、2级10例;常规剂量组为0级0例、1级7例、2级6例,低剂量组发生较少。白细胞计数、下肢淋巴水肿、放射性膀胱炎、肠穿孔和肠梗阻的发生率类似。[结论]宫颈癌术后盆腔预防性放射治疗剂量40～44 Gy是可行的。     

食管癌三种放疗技术的剂量学比较

目的比较分析调强适形放疗（IMRT）与三维适形放疗（3D-CRT）、常规二野照射（2D-RT）在食管癌照射中的剂量学优势,为IMRT在食管癌的临床应用提供参考。方法应用三维治疗计划系统（3-DTPS）在10例食管鳞癌患者的CT虚拟图像上分别设计2D-RT、3D-CRT和IMRT 3种放疗计划,应用剂量体积直方图比较3种计划PTV靶区各项参数及肺、脊髓、心脏等正常组织受照射体积和剂量、正常组织并发症发生概率（NTCP）。结果①3种计划的CI有显著性差异：IMRT最大,3D-CRT次之,2D-RT最差（P〈0.001）。IMRT计划HI低于3D-CRT和2D-RT（P〈0.05）。②IMRT脊髓最大剂量、心脏平均剂量和V40及双肺10 Gy以上的受照射体积均低于3D-CRT和2D-RT（P〈0.05）。③颈段及胸上段食管癌IMRT计划CI及双肺V5高于3D-CRT和2D-RT（P〈0.05）,HI和脊髓最大剂量低于3D-CRT和2D-RT（P〈0.05）。④胸中下段食管IMRT计划CI及双肺V5高于3D-CRT和2D-RT（P〈0.05）,HI、双肺10 Gy以上的受照射体积及心脏V40小于3D-CRT和2D-RT（P〈0.05）。结论无论是颈段、胸上段食管癌还是胸中下段食管癌采用IMRT计划在靶区剂量分布、靶区适形度、正常组织保护方面均优于2D-RT和3D-CRT。     

335例鼻咽癌根治性放疗后晚期反应分析

目的 分析我院鼻咽癌患者根治性常规放疗后长期生存情况和晚期反应.方法 我院335例经病理证实为鼻咽癌的初治患者均接受根治性常规放疗,57.0％的患者接受顺铂+氟尿嘧啶为主的化疗.观察并记录患者的长期生存情况和晚期反应.结果 随访率92.2％,中位随访时间55(1～104)个月.全组5年总生存率、无进展生存率、无复发生存...     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

放射治疗骨转移癌疼痛47例临床分析

目的 观察骨转移癌疼痛放射治疗方法对疼痛的缓解效果。方法47例患者60处骨转移灶均采用6 MV X线放射治疗。剂量方案采用两种方法:A方案:30—51 Gy/10～17f/2～4周,B方案:25～30 Gy/5—6f/1～2周。结果分次方案对疼痛缓解率无明显影响,总有效率均为91.5％,但常规分次放疗3～4次后疼痛缓解,而低分割放疗1—2次后疼痛即缓解。结论 骨转移癌放射治疗止痛效果确切、迅速,副作用小,对大部分病例可采用低分割方案。     

非小细胞肺癌肿瘤体积大小对调强放射治疗肺剂量体积参数的影响

目的：探索非小细胞肺癌(non-small cell lung cancer,NSCLC)肿瘤体积大小对调强放射治疗(intensity modulated radiation therapy,IMRT)肺剂量学参数的影响,为制定IMRT计划时限定肺剂量参数提供参考依据。方法： 回顾性分析2009年6月至2013年10月行IMRT的NSCLC共204例,将原发灶的计划靶区(planning target volume,PTV)处 方剂量设定为60~66 Gy(2.00~2.25 Gy/次,共27~33次)。分析正常肺组织接受放射剂量高于5或20 Gy照射的体积百分 比(fractional volume percent of the lung receiving a dose >5 or 20 Gy,V5,V20)、正常肺组织接受放射剂量低于5 Gy的绝对体 积(absolute volume of lung spared from receiving a dose <5 Gy,AVS5)、平均肺剂量(mean lung dose,MLD),并采用回归模 型进行曲线拟合来分析它们随原发灶肿瘤体积大小的变化所呈现的变化规律。结果：V5,V20和MLD随肿瘤体积的 变化呈二次方程的曲线变化规律,而AVS5呈对数方程曲线变化规律。当肿瘤体积分别低于某一数值(依次为294.6, 283.2,304.9 cm3)时,肺V5,V20和MLD随肿瘤体积增大而呈二次曲线性增大;而当肿瘤体积分别高于某一数值(依次 为294.6,283.2,304.9 cm3)时,肺V5,V20和MLD随肿瘤体积增大而呈二次曲线性下降。肺AVS5随肿瘤体积的增大呈对 数曲线下降。结论：随着肺肿瘤体积的的不断增大,V5,V20和MLD和AVS5的变化规律有所不同;当肿瘤体积超过一 定界值(大约为300 cm3时,相对应的肿瘤直径为7~8 cm)后,制定NSCLC调强放射治疗计划时除关注肺V5,V20和MLD 外,还应更加重视AVS5的限制。     

放射治疗中碳纤维头颈肩架剂量影响研究

目的：探讨全碳头颈肩架对三维治疗计划（TPS）剂量分布的影响。方法：分析35例应用头颈肩架的三维适形放疗计划,比较在移除和不移除头颈肩架的情况下TPS计算的PTV内最低剂量（Dmin）、最高剂量（Dmax）、最高剂量与最低剂量之差（Dmax—Dmin）、平均剂量（Dmean）及100％等剂量曲线包绕PTV的体积百分比（P100％）,用配对t检验或Wilcoxon符号秩检验来比较组间差异,并统计TPS在2种条件下计算出的剂量偏差率。结果：移除头颈肩架组与不移除头颈肩架组间在TPS中计算的Dmin、Dmax、Dmax-Dmin、Dmean的差异有统计学意义（P=0．028,0．000,0．009,0．042）,P100％的差异无统计学意义（P=0．342）;剂量偏差率｜△Dmin｜／Dose、｜△Dmax｜／Dose、｜△Dmean｜／Dose分别为1．116％、2．058％、2．142％。结论：设计TPS时,移除头颈肩架对剂量计算与评估有偏差。     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

CNE、SPC-A1 和 MCF-7 人类肿瘤细胞 Ku80 基因同源性研究

目的研究人鼻咽鳞癌(CNE)、肺腺癌(SPC-A1)和乳腺腺癌(MCF-7)细胞 Ku80 基因功能区的保守性,探讨该基因突变与肿瘤放射和化学治疗疗效的关系.方法采用聚合酶链式反应和克隆技术测定 3 种肿瘤细胞内与 DNA 损伤修复有关的 Ku80 基因序列,分析他们的功能区保守性变化,模拟和比较突变产物亲疏水性差异.结果人 CNE、SPC-A1 和 MCF-7 肿瘤细胞 Ku80 基因同源性分别为99.95%、99.5%和99.7%,包括碱基转换和颠换突变.部分突变碱基导致产物氨基酸替代并影响他们的亲疏水结构.SPC-A1 细胞发生150aa Ile→Val、 470aa Asp→Gly、553aa Phe→Ile 替代和 570aa Gln→0 缺失;MCF-7 细胞发生 209aa Lys→Glu、231aa Leu→Arg 和 297aa →Ser 替代;而 CNE 细胞功能区高度保守.结论SPC-A1 和 MCF-7 细胞 Ku80p 功能区存在氨基酸替代,影响其结构和活性变化,与肿瘤细胞 DNA 双链断裂损伤修复能力和肿瘤放化疗疗效直接相关.     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.