体外加腔内照射治疗食管癌与单纯体外照射的疗效探讨

目的 探讨食管癌体外加腔内照射与单纯外照射治疗的疗效及副作用。材料 本文收集１９９３年１２月－１９９５年５月收治经病理证实的１００例食管癌病人。方法 病变长度不超过８ｃｍ，分体外加腔内照射（腔内组）和单纯体外照射（对照组）两组。腔内组先给外照射肿瘤量６００ｃＧｙ，体外照射治疗结束的下一周开始腔内治疗。每周一次剂量５００－７００ｃＧｙ，共给２次。     

放射治疗后诱发恶性肿瘤26例分析

回顾性分析20年放射治疗后诱发的26例恶性肿患者临床资料．其中首发肿瘤包括食管癌3例、鼻咽癌13例、鼻腔癌1例、宫颈癌9例。放射源用^60Co及深部X射线。取用常规的分割照射，照射剂量为DT40～90Gy。26例放射治疗后在3～20年在原照射部位出现了继发恶性肿瘤．其中3例食管癌继发了纵膈肿瘤。13例鼻咽癌被继发硬腭鳞癌、扁桃体癌、软腭低分化腺癌。1例鼻腔癌继发恶性坏死性肉芽肿，9例宫颈癌继发了膀胱癌、前列腺癌、直肠癌。     

超分割放射治疗食管癌的长期疗效

目的 评价超分割放射治疗食管癌的长期疗效及放射反应和并发症。方法 ９２例食管癌随机分为２组：常规分割放射治疗组４６例,１次／ｄ,２．００Ｇｙ／次,５次／周,总剂量７０．０Ｇｙ,３５次,４７～５６ｄ;超分割放射治疗组４６例,２次／ｄ,１．１５Ｇｙ／次,间隔４～６ｈ,５ｄ／周,总剂量８０．５Ｇｙ,７０次,４９～５３ｄ。全部商例均采用＾６０Ｃｏ照射。结果 ２个组急性和晚期放射反应差异无显著意义（Ｐ〉０．     

192 Ir腔内加体外放射治疗宫颈癌118例分析

目的：研究^192Ir高剂量率腔内加体外放射治疗宫颈癌的疗效和放射反应。方法：118例宫颈癌患者采用^192Ir高剂量率腔内加体外放射治疗，开始体外全盆腔照射，5次／周，2Gy/次，盆腔平面中心剂量26－40Gy,2.5-4.0周完成；然后中间挡铅，4个野照射，4次／周，2Gy/次，宫旁剂量20－25Gy；同时腔内治疗，1次／周，6Gy/次，剂量为36－42Gy。结果：全组3、5年生存率分别为83．1％和72．0％，Ⅱ，Ⅲ期5年生存率分别为80．6％和58．7％（P＞0．05）。早期放射性直肠反应发生率为13．6％，膀胱反应发生率为5．9％；晚期放射性直肠炎发生率为15．3％，膀胱炎为4．2％，直肠阴道瘘为0．9％。结论：^192Ir高剂量率腔内加体外照射治疗宫颈癌疗效肯定，应用方便，副作用少。     

局部晚期子宫颈残端癌体外调强放疗加三维适形腔内近距离放疗

子宫次全切除术后,残留子宫颈发生的癌称子宫颈残端癌.可分为隐性残端癌和真性残端癌.由于次全子宫切除术后残留的子宫颈管较短,近距离放疗受很大限制,子宫旁及盆腔组织的照射剂量较一般放疗量减低.为了提高子宫颈残端癌的疗效,降低并发症,本院2012年采用体外调强放疗配合子宫颈管插植后置管行三维适形腔内近距离放疗3例,现将结果报告如下.     

前列腺癌三维适形和调强放疗的初步结果

目的 分析三维适形放疗（3DCRT）和调强放疗（IMRT）前列腺癌的初步疗效和早晚期副反应.方法 36例无远处转移的前列腺癌接受了3DCRT和IMRT,其中35例同时接受内分泌治疗.23例临床靶区包括前列腺或前列腺加精囊,13例先接受盆腔照射然后包括前列腺和精囊.临床靶区的中位剂量为76.0 Gy（52.5～83.0Gy）,盆腔预防性照射中位剂量为45.0Gy（40～50Gy）.结果 3、5年总生存率分别为91%、84%.3、5年癌症相关生存率均为91%.全组早期胃肠道反应≤2级35例,3级1例,无4级反应;早期泌尿系统副反应≤2级34例,3级2例,无4级反应.全组分别有4例1级和3例2级晚期胃肠道反应,无≥3级晚期胃肠道反应;晚期泌尿系统反应发生率低,6例1级,2级1例,3级1例.结论 应用三维适形放疗和调强放疗技术治疗前列腺癌,高剂量放疗是安全的,早期和晚期副反应可接受,未发现严重晚期副反应.     

头颈部肿瘤放射治疗新进展

临床肿瘤放射治疗进展 晚期头颈部肿瘤目前治疗上仍然存在着局部控制率低,疗后局部复发率高的缺点,因此如何进一步提高晚期头颈部肿瘤的局部控制率就成为改善预后的关键因素。通过超分割或加速分割技术,或通过化学治疗与放射治疗的配合,以及一些放疗新技术、新方法的应用,可望克服常规分割放疗的缺陷,从而相应改进头颈部肿瘤常规分割放疗的局部控制率。１　　非常规分割照射的研究 主要分为以下几种：（１）加速分割,治疗总时间中度缩短至３３～４０天,而总剂量不变;（２）加速超分割,治疗总时间缩短至１７～３３天,但总剂量相应…     

探讨食管癌外照射加腔内放疗与单纯外照射的疗效

目的比较食管癌外照射加腔内放射与单纯外照射治疗的生存率及副作用。材料与方法１９８９年２月～１９９２年７月１１０例经病理证实的食管中段癌，病变长度均小于７ｃｍ的放疗病例平均分成两组，Ａ组为单纯外照射组（对照组），Ｂ组为外照射加腔内放疗组（治疗组）。病例均无远处转移及锁骨上淋巴结转移。结果两组远期生存率无明显差别，近期副反应无明显差别，远期副反应及局部复发率Ａ组明显高于Ｂ组。结论两种治疗方法远期疗效无差别，外照射加腔内放疗，不仅减少局部复发率，还可减少全身反应，缩短治疗时间，不失为一种治疗食管癌的可行方法     

71例扁桃体癌放射治疗分析

目的：探讨扁桃体癌放射治疗方法、疗效和影响预后的因素。方法：回顾性分析我科1971年8月至1995年10月收治的经病检证实的扁桃体癌71例，外照射＋腔内治疗组15例，单纯外照射组39例，外照射＋化疗组17例。结果：外照射＋腔内治疗组局部控制率为82．1％，单纯外照射组局部控制率为68．4％，外照射＋化疗组局部控制率为64．2％。外照射＋腔内治疗组局部控制率与单纯外照射和外照射＋化疗组相比，差异有显著性意义（χ^2=4.65,P=0.030;χ^2=5.65,P=0.018)。外照射＋腔内治疗组3、5、10年生存率分别为76．3％、53．2％和31．2％，单纯外照射组3、5、10年生存率分别为74．0％、45．2％和33．5％，外照射＋化疗组3、5、10年生存率分别为75．2％、47．1％和25．3％，3个组3、5、10年生存率相互比较，差异均无显著性意义（P＞0．05）。结论：腔内治疗作为原发灶推量手段，能提高局部控制率，但不能提高生存率。     

IE期鼻腔非霍奇金淋巴瘤预后的多因素分析

目的　探讨影响IE 期鼻腔非霍奇金淋巴瘤患者预后的因素。方法　 71例原发于鼻腔非霍奇金淋巴瘤IE 期患者 ,其中 37例病灶局限于鼻腔 (IE 局限组 ) ,34例有鼻腔外侵犯 (IE 超腔组 )。44例为单纯放疗 ,2 7例为放疗加化疗。生存统计采用Kaplan Meier法 ,组间比较采用Log rank检验。多因素分析采用Cox模型。结果　放疗后肿瘤完全消失者 5 ,10年生存率分别为 71.9%和 5 9.7% ,放疗后残留者均为 13.9% (P =0 .0 0 0 4)。IE 局限组 5 ,10年生存率分别为 6 9.8%和 5 6 .7% ,IE超腔组分别为 40 .7%和 35 .6 % ,二者差异有显著性 (P =0 .0 0 47)。年龄≤ 44岁患者的预后明显好于年龄 >44岁者 (P =0 .0 0 0 3)。IE 局限放疗加化疗组和单纯放疗组的 10年生存率分别为 75 .0 %和 5 2 .0 % ,IE 超腔组则分别为 45 .0 %和 37.6 % (P =0 .0 6 44 )。有无B症状对生存率无显著影响 (P =0 .792 )。Cox多因素分析显示 ,放疗近期疗效、肿瘤超腔和年龄是影响预后的独立因素。结论　鼻腔IE 期淋巴瘤的治疗以放疗为主 ,加上化疗能提高远期生存率。放疗近期疗效、临床分期和年龄对预后有显著影响。     

Multivariate prognostic analysis of stage I(E) primary non-Hodgkin's lymphomas of the nasal cavity

From January 1968 to December 1997, a total of 71 patients with stage I(E) (Ann Arbor staging system, 1971) primary non-Hodgkin's lymphomas of the nasal cavity received treatment in the Cancer Center of Sun Yat-Sen University of Medical Sciences. Thirty-seven lesions were limited to the nasal cavity (limited I(E)), whereas the other 34 were extended to the structure out of the nasal cavity (extended I(E)). Forty-four patients were treated with radiochemotherapy and 27 with radiotherapy alone. Kaplan-Meier methods were used in the survival analysis. Multivariate analysis was carried out using the Cox proportional hazard model. The 5- and 10-year survival rates were 71.85% and 59.67% for the patients with a complete response to irradiation, and both were 13.89% for the patients with residue lesions (p = 0.0004). The 5- and 10-year survival rates were 69.81% and 56.72% for limited I(E), and 40.65% and 35.57% for extended I(E) (p = 0.0047). The prognosis was better for those younger than 44 years (p = 0.0003). The 10-year survival rates for radiotherapy alone and combined radiochemotherapy are 52% and 75% for limited I(E) versus 37.58% and 45% for extended I(E) (p = 0.0644). B symptoms did not significantly affect clinical outcome (p = 0.729). Multivariate analysis showed that complete response of local lesion after radiotherapy, invasion of the primary tumor to adjacent structures, and patients' age were independent prognostic factors. Our study showed that radiotherapy is the main treatment method for the primary non-Hodgkin's lymphomas of the nasal cavity; the addition of chemotherapy may improve long-term survival. The local tumor response to radiotherapy, whether the extranasal structures were invaded, and patients' age were independent prognostic factors.     

鼻腔非霍奇金淋巴瘤的化学治疗及放射治疗

目的 探讨不同治疗方法对鼻腔非霍奇金淋巴瘤(NHL)患者的预后影响。方法 在59例原发于鼻腔NHLIE期患者中,化疗 放疗33例,放疗 化疗8例,单纯化疗10例,单纯放疗8例,化疗方案为CHOP.结果 全组患者的l,3,5年生存率分别为71．2％、42．0％和38．5％,不同治疗方法的生存率差异无显著性(P=0．3943),但生存曲线显示,放化组优于其他组。临床分期显示,Ig局限组患者l,3,5年生存率为84．2c／／,67．7％和62．0%,,Ig超腔组患者为50．0％、14．3％和14．3％,差异有显著性(P=0．0012)。首程化疗≥3个周期24例,首程放疗≥40 Gy16例,CR率分别为25．0v／／,和75．0％,筹异有显著性(P=0．002)。首程化疗2,3～4,5～6个周期的CR率分别为10．5％、25．0％和25．0％,差异无显著性(P=0．48)。并发症发生率及治疗相关死亡率均以化放组为高(39．4％,15．2％),但差异无显著性(P=0．202,P=0．693)。结论 Ⅰ期鼻腔NHL患者首选放疗,以尽早达到局部控制,再根据临床分期及恶性程度或国际预后指数(IPI)酌情给予更有效的化疗方案。     

Primary lymphomas of the nasal cavity and paranasal sinuses

Extranodal lymphomas which present in the nasal cavity and/or the paranasal sinuses are rare. Thirty-eight patients with disease that was clinically limited to the head and neck (Ann Arbor Stages IE-IIE) were admitted between 1947 and 1983. Twenty-eight patients were treated with radiotherapy alone and 10 received combination chemotherapy in addition. The overall 5-year survival figure was 56%. The corresponding result for Stage IE was 67%. No patient with Stage IIE disease survived 5 years. Extent of the extranodal disease also influenced results for Stage IE patients who were treated with radiotherapy only. When the extranodal disease was staged using the American Joint Committee TNM system, the 5-year disease-free survival for T1 and T2 patients was 78% as compared with 19% for patients with T3 and T4 disease. The addition of combination chemotherapy improved results for patients with T3 and T4 lesions.     

129例原发鼻腔非霍奇金淋巴瘤的预后分析

背景与目的：原发鼻腔非霍奇金淋巴瘤（non-Hodgkin’s lymphoma,NHL）预后较差．远处转移和局部复发率均较高．目前本病尚无标准治疗原则。本研究主要探讨影响原发鼻腔NHL的预后因素。方法：1996年1月至2002年12月共收治129例经病理证实的原发鼻腔NHL。116例经病理形态学诊断为鼻腔NK／T细胞淋巴瘤。根据Ann Arbor分期,ⅠE期102例,ⅡE期22例,ⅣE期5例。124例ⅠE／ⅡE期患者单纯放疗22例,单纯化疗7例,45例放疗后化疗,50例化疗后放疗。5例ⅣE期以化疗为主。结果：全组5年总生存率（overall survival,OS）和无病生存率（disease-freely survival,DFS）分别是68．0％和55．8％。ⅠE期和ⅡE期患者的5年OS分别是71．7％和70．6％（P=0．77）,DFS分别是60．9％和47．0％（P=0．09）。首程治疗后完全缓解（complete response,CR）的患者5年OS为83．1％,而未达CR患者的5年OS为18．0％（P〈0．01）,相应5年DFS分别为68．0％和15．5％（P〈0．01）。国际预后指数（international prognostic index,IPl）评分为0,1和≥2的5年OS分别为81．1％、60．1％和14．3％（P〈0．01）,DFS分别为68．8％、44．6％和22．5％（P〈0．01）。38例患者治疗中进展或疗后复发,远处结外器官复发占78．9％,是治疗失败主要原因。单因素分析显示,首程治疗后的CR率、一般状态评分（performance status,PS）、IPI和修订后IPI与预后相关。多因素分析显示仅治疗后的CR率是独立预后因素。结论：治疗后的CR率是影响原发鼻腔NHL的重要预后因素,原因以远处病灶治疗失败为主。     

Primary non-Hodgkin's lymphoma of bone: a rare disorder with high frequency of T-cell phenotype in southern Taiwan

Primary non-Hodgkin's lymphoma of bone (PLB) is a rare disorder representing less than 1% of all non-Hodgkin's lymphomas and has rarely been reported in Taiwan. A retrospective clinicopathological study was performed according to the 2002 World Health Organization criteria and identified 14 cases during a 13-year period in 2 medical centers in southern Taiwan. There was male predominance (M:F = 6:1) with a median age of 42 and bone pain (6 patients, 43%) as the most common symptom. Half of the patients had monostotic and the other half polyostotic lesions. Axial skeletons (10 cases, 71%) were the most frequent sites of involvement. The staging results were stage I (9 patients, 64%), stage II (2, 14%) and stage IV (3, 21%). Eight cases (57%) were of B-cell phenotype and the remaining 6 (43%), T-cell. Histologically, 7 (50%) were diffuse large B-cell lymphomas (DLBCLs) and 5 (36%) anaplastic large cell lymphomas. Seven patients received chemotherapy and radiotherapy; 4 chemotherapy and 3 radiotherapy alone. Of the 11 patients with follow-up information, 6 (55%) died of disease within 1 year including 5 with T-cell lymphomas, while all the 5 patients surviving over 1 year were of B-cell phenotype. The overall 1-year survival rate was 45%. The survival of B-cell lymphomas was significantly better than T-cell tumors (p = 0.016, log-rank test). In summary, this study reported the largest series of PBL in Taiwan and confirmed that the majority was DLBCL and B-cell tumors had more favorable prognosis. As compared to the Western series, the cases showed a striking male predominance, higher percentage of axial skeleton involvement, higher relative frequency of T-lineage tumors and poorer prognosis.     

Clinical stage IEA-IIEA orbital lymphomas: outcomes in the era of modern staging and treatment.

BACKGROUND AND PURPOSE: The present study examines outcomes in patients with primary orbital lymphomas who underwent complete staging. MATERIALS AND METHODS: From 1978 to 1997, 21 adult patients at the M.D. Anderson Cancer Center had stage IEA-IIEA orbital non-Hodgkin's lymphomas based on staging that included computed tomography scans. Sixteen (76%) patients had working formulation low-grade lymphomas, and five (24%) had aggressive lymphomas. Fourteen of 16 (88%) patients with low-grade lymphomas were treated with radiotherapy alone, and four of five (80%) patients with aggressive lymphomas were treated using combination chemotherapy with or without radiotherapy. Total radiotherapy doses ranged from 30.0 to 40.0 Gy using daily 1.5-2.0 Gy fractions. RESULTS: The median follow-up was 84 months. For the low-grade lymphomas, the 5-year local control, progression-free survival, and overall survival rates were 100, 100, and 92%, respectively. For the seven low-grade lymphomas treated with radiotherapy alone to 30.0 Gy in 20 fractions, the 5-year local control, progression-free, and overall survival rates were 100, 100, and 75%, respectively. The 5-year incidence of complications, which were typically mild, in eyes irradiated to 30 Gy in 20 fractions versus higher biologically effective doses were 25 and 38%, respectively (P = 0.62). Of the five patients with aggressive lymphomas, none of the four who underwent chemotherapy with or without radiotherapy relapsed (all four remain alive), whereas the one treated with radiotherapy alone for stage IEA disease experienced a distant relapse. CONCLUSIONS: In patients with low-grade lymphomas, a good therapeutic ratio was obtained with low-dose radiotherapy alone. In patients with aggressive lymphomas, chemotherapy with or without radiotherapy resulted in excellent local control, progression-free survival, and overall survival; however, the statistical power was limited.     

Extranodal non-Hodgkin's lymphoma of the head and neck. A clinicopathologic study in the Kyoto-Nara area of Japan

The clinicopathologic features of 114 Japanese patients with extranodal non-Hodgkin's lymphoma of the head and neck region were analyzed. The median age was 60.5 years and the male:female ratio was 1.5:1. The most common site of involvement was Waldeyer's ring, followed by the oral cavity, thyroid gland, paranasal sinuses, nasal cavity, and larynx. Seventy-five percent of the patients were in Stage I or Stage II at admission. Histologically, diffuse lymphoma accounted for 94% and follicular lymphoma for 6% of cases. The histologic grade according to the Working Formulation System of the National Cancer Institute was low in 11%, intermediate in 75%, and high in 14% of cases. Immunohistochemical study showed that the majority of the cases were of B-cell type and only 13 cases (11%) were of the T-cell type. Peripheral T-cell lymphomas (eight cases) mainly occurred in the nasopharynx and nasal cavity, whereas four of five thymic T-cell lymphomas were found in the palatine tonsil. The over-all 5-year survival rate was 54%, and the factors affecting survival were sex, histologic grade, T/B phenotype, clinical stage, and the site of initial presentation. Five-year survival with nasal cavity and Waldeyer's ring lymphoma was 24% and 46%, respectively. The poor prognosis of lymphomas at these sites might result from the predominance of T-cell lymphoma, the paucity of low grade lymphoma, and the relatively high incidence of cases that were in an advanced stage at presentation. In Stage II, patients treated with combined therapy tended to have a better 5-year survival rate than those treated with radiotherapy alone.     

Thyroid lymphomas stages IE and IIE: comparative results for radiotherapy only, combination chemotherapy only, and multimodality treatment

This study was undertaken to ascertain the influence of both more precise staging and more intensive treatment on results in 38 patients with Stage IE and IIE lymphomas of the thyroid. These patients were admitted between 1947 and 1984. Using the modified Rappaport system, the disease was classified as diffuse large cell in 32 patients. The initial investigation included lymphangiography in 25 patients, five of which had a staging laparotomy. The assigned stages were IEA--11, IEB--1, and IIEA--26. Treatment consisted of definitive radiotherapy alone in 15; combination chemotherapy and radiotherapy in 14; and chemotherapy alone in 6 patients. The remaining three patients were treated with surgery alone. In general, combination chemotherapy consisted of cyclophosphamide, Adriamycin, vincristine, and prednisone, with or without bleomycin (CHOP +/- Bleo). The overall 5-year survival and disease-free survival were 72 and 64%, respectively. For patients treated with radiotherapy only, results depended on stage. For Stage IE, the survival and disease-free survival were 100 and 83%, respectively. The corresponding Stage IIE results were 88 and 75%. Within this group, results were better for a subset of patients where disease did not involve the mediastinum. Survival and disease-free survival for combined modality treatment were both 77% (10 of these 17 patients had Stage IIE disease). Survival and disease-free survival for combination chemotherapy were 53 and 30% (all had Stage IIE disease). In conclusion, radiotherapy alone is excellent treatment for disease limited to the thyroid with or without cervical adenopathy. Results for patients with mediastinal extensions was unsatisfactory and the addition of combination chemotherapy is indicated.