高剂量率192Ir组织间插植放射治疗口腔口咽癌

目的　探讨外照射加组织间插植超分割放射治疗口腔、口咽癌的疗效。方法　初治口腔、口咽癌 48例 ,外照射DT30～ 6 5Gy (T1 、T2 期 30～ 5 0Gy,T3 、T4期 5 0～ 6 5Gy) ,加1 92 Ir高剂量率组织间照射DT15～ 35Gy(T1 、T2 期 30～ 35Gy ,T3 、T4期 15～ 30Gy)。结果　原发灶全消率 :T1 期 5 5 ,T2 期 2 3 2 7,T3 期 6 13,T4期 0 3;部分消退率T2 期 4 2 7,T3 期 7 13,T4期 3 3。 3年总生存率和无瘤生存率分别为79 .4%和 5 5 .8%。影响预后的多因素分析结果显示仅与TNM分期、病理类型有关。结论　口腔、口咽癌外照射配合组织间插植近距离照射是早期病例的根治手段 ,对拒绝手术、有手术禁忌证和失去手术指征晚期患者是一种有效的姑息治疗手段     

Intracavitary radiation treatment of nasopharyngeal carcinoma by the high dose rate afterloading technique

Sixty-four patients with nasopharyngeal carcinoma were treated by various combinations of external irradiation with intracavitary radiotherapy using the high dose rate afterloading technique. The afterloading intracavitary radiation (AIR) was given as a routine boost or for residual or recurrent disease. The external irradiation dose varied from 45 to 70 Gy, whereas the AIR dose ranged from 10-50 Gy, depending on the nature of the primary nasopharyngeal lesion. The results were quite encouraging, although the longest follow-up so far has only been just over 4 years. Of 13 such cases that received external radiotherapy plus AIR as primary treatment, 12 have survived. However, of the 9 cases who received AIR for local recurrence after external radiotherapy, only 5 survived. Of the total of 64 cases treated by AIR from June 1981 to May 1986, 54 are alive. No serious radiation sequelae have been observed. It can be concluded that AIR for nasopharyngeal carcinoma is indicated for boosting the dose to the nasopharyngeal cavity with appropriate reduction in external irradiation dose, and for residual or recurrent disease after primary external radiotherapy.     

The role of radiation therapy in carcinoma of the extrahepatic bile ducts

Carcinoma of the extrahepatic bile ducts is uncommon, and the primary management has been largely surgical. Radiotherapy for this disease has received minimal attention, although recent innovations have prompted increased interest. We report a retrospective review of 34 patients treated with radiotherapy between 1967 and 1982. The five-year survival rate was 6%, and the median survival was 11 months. Patient characteristics, treatment techniques, and outcome for the entire group, as well as selected subgroups are discussed. Two patients treated by interventional radiographic techniques, external irradiation, and transcatheter intracavitary brachytherapy are presented in detail. The current surgical, radiotherapeutic, and chemotherapeutic literature is reviewed.     

Intracavitary brachytherapy in the treatment of gynecologic neoplasms

Modern intracavitary brachytherapy carefully combined with megavoltage external beam radiotherapy is responsible for the high cure rates achieved with radiation treatment of invasive cervical cancers. Pelvic disease recurrence is rare after treatment of patients with tumors <5 cm in diameter, and even patients with massive tumors 8–10 cm in diameter are cured in 30–50% of cases. Inoperable adenocarcinomas of the endometrium and superficial cancers of the vagina are also effectively treated with intracavitary irradiation. The relative radioresistance of the uterus and vagina, physical advantages resulting from exploitation of the inverse square law, and the radiobiological advantages of low dose rate radiation have combined to make intracavitary irradiation a critical tool in the management of many gynecologic neoplasms. J. Surg. Oncol. 1997;66:141–147. © 1997 Wiley-Liss, Inc.     

Value of perioperative brachytherapy in the management of non-oat cell carcinoma of the lung

Nearly one-half of all patients with non-oat cell carcinoma of the lung are found to have mediastinal lymph node metastases at the time of initial presentation. There is no consensus today on what constitutes best treatment in patients whose disease is confined to the chest and in whom mediastinal lymph node metastases are the only evident site of tumor spread. The overall survival of these patients is so low that the majority have been either excluded from therapy or have been treated palliatively by external radiation therapy. In an attempt to improve the control of mediastinal lymph node metastases in the operable patients, we began a pilot study in 1977 at Memorial Hospital to determine the value of perioperative brachytherapy (permanent Iodine-125 implantation of primary lung and a temporary Iridium-192 implantation of the mediastinum) with or without resection followed by a moderate dose of postoperative external beam irradiation.Eighty-eight patients with disease limited to one hemithorax (N2 MO) were treated with this combined method during the period 1977 through 1980.Locoregional control was observed in 76% of the 88 patients. The median survival is 26 months and the 2 year actuarial survival is 51%. There was no post-operative mortality.This pilot study has demonstrated that the combination of surgery, perioperative brachytherapy and external beam irradiation in non-oat cell carcinoma of the lung, metastatic to mediastinal lymph nodes, can improve the locoregional control and prolong survival with minimal early or late morbidity.     

Radiation therapy of esophageal cancer: role of high dose rate brachytherapy.

Fifty untreated cases of squamous cell carcinoma arising from the middle one-third of the esophagus, with no apparent extraesophageal spread on a computed tomography (CT) scan and with a Karnofsky performance status of over 70, were treated by external beam irradiation to a dose of 3500 cGy/15 fractions/3 weeks. Twenty-five patients (Group A) received treatment with further external beam irradiation to a dose of 2000 cGy/10 fractions/2 weeks. Another group of 25 patients (Group B) received treatment with high dose rate intracavitary irradiation to a dose of 1200 cGy delivered in two sessions of 600 cGy each a week apart. All patients were assessed symptomatically, endoscopically, and radiologically every 3 months. There was marked difference at the end of 1 year in relief of dysphagia (37.5% in Group A vs. 70.6% in Group B), local control (25% in group A vs. 70.6% in group B) although the results were statistically insignificant (p greater than 0.05) and actuarial survival (44% in group A vs. 78% in group B) which was, however, significant statistically (z = 2.83). The cumulative radiation effect (CRE) by external beam irradiation was 1729 reu and by external beam and intracavitary irradiation 1741 reu, but the biological dose effect was better with external beam and intracavitary irradiation. Eight percent of patients treated by external beam and intracavitary irradiation had strictures in contrast to 4% treated by external beam irradiation alone. Moderate doses of external beam and intracavitary irradiation can give a better local response than external beam irradiation alone for the same biological dose in the treatment of esophageal carcinoma.     

Results and complications of high dose rate and low dose rate brachytherapy in carcinoma of the cervix: Cerrahpa?a experience.

PURPOSE: To evaluate the results and complications of treatment with high dose rate (HDR) compared to low dose rate (LDR) brachytherapy in cervical carcinoma. METHODS: Three hundred and seventy patients who were treated with external irradiation and intracavitary brachytherapy and followed for more than 2 years between 1978 and 1998 have been recently updated. The low dose rate group consisted of 77 cases treated between 1978 and 1982 and HDR group consisted of 293 cases treated between 1982 and 1998. All patients first received external irradiation with 60Co or 9-18 MV photons and a median dose of 54 Gy was given in 6 weeks. In the LDR group, intracavitary treatment was given with Manchester applicators loaded with radium (30 mg) in an intrauterine tube and 20 mg in vaginal ovoids. The dose delivered to point A was on average 32 Gy in one application. In the HDR group, a total dose of 24 Gy was given to point A in three insertions 1 week apart. The dose rate was 0.62 Gy at point A. RESULTS: The 5-year pelvic control rate was found to be 73% in the HDR group, compared with 86% in the radium group for stage I cases. In stage IIB and IIIB cases, the rates were 68% and 45% for HDR and 65% and 53% for LDR, respectively. In all stages, there was no statistical difference in pelvic control and survival rates between the two groups. Overall incidence of late complications was found as 31.1% and 31.9% in HDR and LDR groups, respectively. The grade 2-4 late complication rate was 14% in the HDR group compared to 19% in the LDR group (P>0.05). CONCLUSION: HDR brachytherapy in the management of the cervix appears to be a safe and efficacious approach. Pelvic control, survival and complications rates are quite similar when compared with LDR.     

Low dose rate brachytherapy in the treatment of cervical carcinoma.

The use of ICRT is a critical component in the successful treatment of cervical carcinoma with radiation therapy. Low dose rate ICRT allows optimization of the therapeutic ratio by utilizing physical and radiobiological principles. An optimal geometric relationship among the intracavitary applicators, the tumor, and other pelvic tissues is critically important in maximizing tumor control rates while simultaneously minimizing normal tissue complication rates. Treatment policies that have judiciously combined EBRT and LDR ICRT have achieved very high tumor control rates while maintaining acceptable complication rates. The use of HDR ICRT forfeits some of the radiobiological advantage of LDR ICRT. It remains to be determined whether this difference will have significant clinical consequences.     

The role of afterloading iridium (Ir192) implant in the management of carcinoma of the tongue

A total of 86 patients with carcinoma of the tongue were treated between May 1, 1974 and June, 1978, at the Los Angeles County-University of Southern California Medical Center and California Hospital Medical Center, Los Angeles, California. Fifty-five of these patients were treated for primary tumors and 31 of the 86 patients were re-irradiated with interstitial Ir¹⁹² implants for recurrent or persistent tumors after “radical” external irradiation and/or surgery. Primary treatment consisted of a combination of external irradiation and an interstitial after loading Ir¹⁹² implant. In the primary treatment group, patients with T₁ and T₂ lesions showed control rates of 69% for the anterior two-thirds of the tongue (9 of the 13 patients) and 75 % for the posterior one-third of the tongue (3 of the 4 patients). For patients with T₃ and T₄ lesions, the control rates were 46 % (6 of the 13 patients) and 68 % (17 of the 25 patients) for the anterior two-thirds of the tongue and the base of the tongue respectively. In the re-irradiation group, 4 of the 13 patients (30 % ) with lesions of the anterior two-thirds of the tongue and 8 of the 18 patients (44 %) with lesions of the base of the tongue achieved local control. The follow-up period for all these patients was a minimum of 24 months.     

Sequential comparison of low dose rate and hyperfractionated high dose rate endobronchial radiation for malignant airway occlusion.

A pilot trial (S2) was conducted at the University of Wisconsin to determine the feasibility, efficacy, and toxicity of hyperfractionated high dose rate endobronchial radiation. To avoid multiple bronchoscopies, an optimized hyperfractionated schema was derived from the linear-quadratic model. Utilizing a single bronchoscopy, 31 patients with malignant airway occlusion received 4 Gy x 4 fractions over 2 days at 2 cm from source center using a high dose rate remote afterloader. Response and morbidity were compared to a previous trial (S1) in which 66 patients were treated with conventional low dose rate endobronchial radiation. Response was assessed by change in performance status, symptom resolution, percent of lifetime rendered symptom-free or improved, and radiographic reaeration. These parameters were highly comparable between the two groups. The mean ECOG performance status improved from 2.2 to 1.8 for S1 and 2.1 to 1.6 for S2; symptom improvement or resolution was noted in 78% for S1 and 79% for S2; lifetime rendered symptom-free or improved was 54% for S1 and 57% for S2; and the overall radiographic response rate was 78% for S1 and 85% for S2. The overall incidence of fistulae was 7/101. We conclude that endobronchial radiation is an effective and safe modality for palliation, and hyperfractionated high dose rate endobronchial radiation achieves responses similar to low dose rate endobronchial radiation with a similar complication rate.     

External beam radiotherapy plus single-fraction high dose rate brachytherapy in the treatment of locally advanced prostate cancer

Purpose

To evaluate the efficacy and toxicity of external beam radiation therapy (EBRT) plus high-dose-rate brachytherapy (HDRB) as a boost in patients (pts) with intermediate or high-risk prostate cancer.

Methods and materials

From 2002 to July 2012, 377 pts with a diagnosis of intermediate or high-risk prostate cancer were treated with EBRT plus HDRB. Median patient age was 66 years (range, 41–86). Most patients (347 pts; 92%) were classified as high-risk (stage T2c–T3, or PSA > 20 ng/mL, or GS ? 8), with 30 patients (8%) considered intermediate risk. All patients underwent EBRT at a prescribed dose of 60.0 Gy (range, 45–70 Gy) to the prostate and seminal vesicles. A total of 120 pts (31%) received a dose of 46 Gy (45–50 Gy) to the true pelvis. All pts received a single-fraction 9 Gy (9–15 Gy) HDR boost. Most patients (353; 94%) were prescribed complete androgen deprivation therapy (ADT). Overall survival (OS), cause-specific survival (CSS), and biochemical relapse-free survival (BRFS) rates were calculated. In the case of BRFS, patients with <26 months of follow-up (n = 106) were excluded to minimize the impact of ADT.

Results

The median follow-up for the entire sample was 50 months (range, 12–126), with 5-year actuarial OS and CSS, respectively, of 88% (95% confidence interval [CI]: 84–92) and 98% (95% CI: 97–99). The 5-year BRFS was 91% (95% CI: 87–95) in the 271 pts with ?26 months (median, 60 months) of follow-up. Late toxicity included grade 2 and 3 gastrointestinal toxicity in 17 (4.6%) and 6 pts (1.6%), respectively, as well as grades 2 and 3 genitourinary toxicity in 46 (12.2%) and 3 pts (0.8%), respectively.

Conclusion

These long-term outcomes confirm that EBRT plus a single-fraction HDRB boost provides good results in treatment-related toxicity and biochemical control. In addition to the excellent clinical results, this fractionation schedule reduces physician workload, treatment-related expenses, patient discomfort and risks associated with anaesthesia. We believe these findings support the use of single-fractionation boost techniques.     

外照射加锎-252中子腔内照射治疗70例食管癌

目的:观察外照射加锎-252(252Cf)中子腔内照射治疗食管癌的疗效。方法:70例食管癌患者每周接受一次252Cf中子腔内照射,4Gy/次,总剂量16Gy/4周;中子治疗开始后第二天接受60Co外照射,4次/周,总剂量50~56Gy。结果:①近期疗效:CR87.1%,PR11.5%,NR1.4%;②1年生存率75.7%,2年生存率51.4%,3年生存率22.9%;③并发症发生率:放射性食管炎48.6%,食管溃疡7.1%,食管狭窄25.7%,食管瘘2.9%。结论:外照射加252Cf中子腔内照射治疗食管癌的近期疗效及1年、3年生存率与外照射结合192Ir腔内放疗相近,可能具有一定的应用前景。     

非根治剂量的体外照射配合腔内放疗加根治术治疗宫颈癌

目的 总结分析外照射配合腔内放疗加根治术治疗Ⅰb-Ⅲa期宫期癌的5年生存率和晚期并发症。方法 106例宫颈癌均行广泛性子宫切除和盆腔淋巴结清除术,其中78例行术前放疗（体外加腔内放疗,下同）,16例采用腔内放疗＋手术,12例术后放疗。外照射采用^60Co治疗机,给予合盆或盆腔四野照射,B点剂量术前放疗者为25－30Gy,术后放疗者为40－50Gy;腔内放疗采用^192Ir高剂量率后装机,A点剂量6－18Gy。结果 （1）5年生存率：Ⅰb-Ⅲa期术前放疗组为78.2%（61／78）,腔内＋手术组为68.8%（11／16）,术后放疗组为33.3%（4／12）。术前放疗组与术后放疗组相比,差异有显著性（P＜0.05）。术前放疗组中,Ⅱ期患者的5年生存率(77.6%,45／58）高于术后放疗组（1／4,P＜0.05）。（2）主要并发症：多为放射性直肠炎和膀胱炎。术前放疗组、腔内放疗＋手术组和术后放疗组的并发症发生率分别为34.6%(27/78）、31.3%（5／16）和33.3%(4/12),差异无显著性（P＞0.05）。结论 非根治量的体外照射配合腔内放疗加根治术治疗宫颈癌,可提高Ⅰb-Ⅲa期患者总的5年生存率和Ⅱ期患者的5年生存率,晚期并发症发生率差异无显著性。     

Role of high dose rate brachytherapy in the treatment of prostate cancer

High dose rate (HDR) brachytherapy in intermediate and high-risk prostate cancer patients has started in the late eighties in Europe and the United States, as a boost combined with external beam radiation therapy, as an attractive method for dose escalation. The results of the first dose-escalation study performed at William Beaumont Hospital has established the safety and efficacy of this combined treatment approach. Likewise, this landmark study enabled a paradigm shift in the radiobiology of prostate cancer, demonstrating that the alpha/beta of prostate cancer was much lower than previously believed to be and therefore the sensitivity of this tumor model to higher-than-conventional doses per fraction led to a dramatic increase of hypofractionated treatment regimens, the object of significant clinical research efforts, currently under way. The excellent toxicity profile and clinical outcome of HDR boost combined treatment prompted investigators to expand HDR brachytherapy indications to low/intermediate prostate cancer patients as the sole treatment modality. The results, toxicity and a brief review of the literature for both HDR boost and HDR monotherapy will be presented.     

铱~(192)高剂量率后装加外照射治疗宫颈癌105例分析

目的　研究铱192 高剂量率后装加外照射治疗宫颈癌的疗效 ,并发症等。方法　前瞻性治疗 ,全盆腔外照射DT 2 5～ 3 0Gy/3周后 ,再行腔内铱192 后装治疗和盆腔四野垂直照射 :腔内每周 1次 ,A点剂量每次 5～ 7Gy ,总剂量3 0～ 3 5Gy ,盆腔四野照射 ,宫旁剂量 15～ 2 0Gy/1.5～ 2周。 结果　CR PR 10 0 % ,3年生存率Ⅱ期 89.5 % ,Ⅲ期 80 .4% ,全组 83 .8%。结论　本疗法疗效可靠 ,放射性直肠炎、膀胱炎发生率与传统方法相似 ,放射性阴道损伤略高 ,放疗中、放疗后坚持阴道冲洗非常重要。     

A comparison between low dose rate radiotherapy and conventionally fractionated irradiation in moderately extensive cancers of the oropharynx

We report the comparative results for local tumor control between two groups of patients treated by radiotherapy fractionated in a conventional manner at normal high dose rate (29 patients with 2 years minimum follow-up and 24 patients with 3 years minimum follow-up) and by low dose rate radiotherapy (19 patients with 2 years minimum follow-up, 14 patients with 3 years minimum follow-up) with moderately extensive cancers of the oropharynx (T2b-T3a, 3-5 cm in diameter). At 2 and 3 years follow-up, the number of local recurrences in the patients treated with low dose rate radiotherapy is half (26 and 21%) that for those treated with conventionally fractionated radiation at normal high dose rates (52 and 54%). These results require more rigorous confirmation.     

食管癌放射治疗设定照射野范围的分析研究

目的:分析照射野与预后的关系,为模拟定位时更好地确定照射范围提供参考。方法:回顾分析2000年4月~2001年4月在河北医科大学第四医院放疗科进行后程加速超分割放疗的符合入组条件的食管癌患者102例,计算常规设野时野长和野宽外扩的范围,分析与生存率的关系。结果:常规模拟定位设野长度外扩的范围按照中位值分为≤4·2cm和>4·2cm两组,≤4·2cm组1、2、3和4年生存率分别为76·0%、50·0%、28·3%和21·2%;>4·2cm组分别为69·0%、55·4%、48·2%和38·0%。两组总体生存率差异无统计学意义,χ2=2·15,P=0·14。设野宽度外扩的范围按照中位值分为≤1·8cm和>1·8cm两组,≤1·8cm组1、2、3和4年生存率为64·0%、46·0%、36·0%和29·3%;>1·8cm组为76·9%、53·9%、42·3%和31·5%。两组总体生存率差异无统计学意义,χ2=0·62,P=0·73。结论:设野长度外扩的范围对总体生存率的影响差异无统计学意义,但>4·2cm组在生存方面显示了一定的优越性。设野宽度外扩的范围对总体生存率的影响差异无统计学意义,但>1·8cm组在生存方面显示了一定的优越性。