食管癌外照射加高剂量腔内治疗疗效分析

目的 研究外照射加腔内放射治疗食管癌疗效。方法 1995年1月－1996年6月收治60例食管癌随机分为两组：30例用8MV直线加速器X线外照射DT66－70Gy;30例用8MV直线加速器X线外照射DT60Gy，结束后2周视残留病灶情况给予腔内放疗5－10Gy/1-2次。结果 吞咽症状改善单放组70％，外照射加腔内放疗组90％。1、3、5年生存率单放组分别为43．3％、16．7％、6．7％，外照射加腔内放疗组分别为83．3％、40％、26．7％，生存率对比有显性差异。结论 外照射加腔内放疗较单纯外照射生存率明显提高（P＜0．05）。但要适当掌握剂量，选择好适应证尤为重要。     

内外照射结合治疗食管癌60例疗效观察

目的　探讨外照射加腔内放疗治疗食管癌的临床价值。方法　 1999年 1月～ 12月 12 0例经病理证实的食管癌患者 ,随机分为外照射加腔内放疗 (综合组 )、单纯外照射组 (对照组 )各 6 0例。 6MVX线外照射 ,综合组外照射剂量 5 5Gy 6周 ,补充腔内治疗 2次 ,剂量 10～ 12Gy ;对照组外照射剂量 6 5～ 70Gy 6～ 7周。结果　综合组的 1、2、3年生存率分别为 71.7%,42 .3%,2 8.1%,对照组的1、2、3年生存率分别为 5 1.7%、34.5 %、2 1.1%,仅 1年生存率差异有显著性 (P <0 .0 5 ) ;因局部复发或未控而死亡者综合组为48.3%,对照组为 70 .0 %,差异有显著性 (P <0 .0 5 ) ;食管溃疡、瘘和狭窄的发生率两组差异无显著性 (P >0 .0 5 )。结论　外照射结合腔内放疗可提高食管癌的局部控制率和 1年生存率。     

外照射结合腔内放疗中晚期食管癌102例疗效观察

探讨食管癌外照射加腔内放疗的临床价值。1995年1－1995年12月将102例经病理证实的食管癌患者，随机分为外照射加腔内放疗组（综合组）、单纯外照射组（对照组），各51例。6MV X线外照射，综合组外照射剂量60Gy 6周，补充腔内治疗2次，剂量10－12Gy；对照组外照射剂量65－70Gy 6－7周。结果：综合组的1、2、3、4、5年生存率分别为72．5％、42．0％、28．5％、20．4％、14．2％，对照组的1、2、3、4、5年生存率分别为52．9％、33．3％、21．5％、15．6％、11．7％，仅1年生存率差异有显著性（P＜0．05）；因局部复发或未控而死者综合组为50．9％，对照组为68．6％，差异有显著性（P＜0．05）；食管溃疡、瘘和狭窄的发生率两组差异无显著性（P＞0．05）。初步研究结果提示，外照射结合腔内放疗可提高食管癌的局部控制率和1年生存率。     

外照射结合腔内放疗中晚期食管癌102例疗效观察

探讨食管癌外照射加腔内放疗的临床价值。 1995年 1～ 1995年 12月将 10 2例经病理证实的食管癌患者 ,随机分为外照射加腔内放疗组 (综合组 )、单纯外照射组 (对照组 ) ,各 5 1例。 6MVX线外照射 ,综合组外照射剂量 6 0Gy 6周 ,补充腔内治疗 2次 ,剂量 10～ 12Gy ;对照组外照射剂量 6 5～ 70Gy 6～ 7周。结果 :综合组的 1、2、3、4、5年生存率分别为 72 5 %、42 0 %、2 8 5 %、2 0 4%、14 2 % ,对照组的 1、2、3、4、5年生存率分别为 5 2 9%、33 3%、2 1 5 %、15 6 %、11 7% ,仅 1年生存率差异有显著性 (P <0 0 5 ) ;因局部复发或未控而死者综合组为 5 0 9% ,对照组为 6 8 6 % ,差异有显著性 (P <0 0 5 ) ;食管溃疡、瘘和狭窄的发生率两组差异无显著性 (P >0 0 5 )。初步研究结果提示 ,外照射结合腔内放疗可提高食管癌的局部控制率和 1年生存率     

局部晚期食管癌体外放射联合腔内放疗同期化疗的随机研究

目的　分析体外放射联合腔内放疗加同期化疗治疗局部晚期食管癌的疗效。方法　 1995年 12月至 1997年 12月 ,88例局部晚期食管癌随机分为两组 :44例用60 Co γ射线或 6MV X射线外放射DT=5 5 2 0～ 6 0 0 0CG/4 6～ 5 0次 /2 3～ 2 5天 ;平均 3天后用192 Ir源HDR腔内放疗DT=5 0 0～ 10 0 0CGY/2～ 4次。DF方案化疗于放疗前一周开始 ,共化疗两周期 (综合组 ) ;对照组 44例单用放疗。结果　综合组 1、2、3年生存率分别为 79.2 %、33 .4%、15 .6 % ,对照组 77.3 %、36 .4%、12 .5 %。两组局部未控、复发和转移率相似 (P >0 .0 5 ) ,非癌死亡率综合组明显高于对照组 (P <0 .0 5 )。结论　体外放射联合腔内放疗加同期化疗不能进一步提高局部晚期食管癌 3年生存率。     

肺癌脑转移的放射治疗

目的　分析放射治疗肺癌转移的疗效及与化疗比较。材料与方法　 1980年 1月至 1996年 12月 ,对肺癌脑转移 12 6例进行回顾性研究。化疗采用CCNU ,BCNU ,CTX ,MTX ,DDP ,VP -16。放疗采用60 Co或 6MV X直线加速器 ,全脑DT30～ 40Gy ,并局部追加DT10～ 2 0Gy ,局部放疗DT35～ 5 5Gy。结果　全组 1、2年生存率分别为 16 7% (2 1/12 6 )、3 2 (4/12 6 ) ,中位生存时间为 7 9个月。单纯放疗组 1年生存率为 5 4% (3/86 ) ,中位生存时间为 7 0个月。放疗加化疗综合组 1、2年生存率分别为 2 5 7% (18/70 )、5 7% (4/70 ) ,中位生存时间为 8 6个月。结论　肺癌脑转移化疗加放疗综合治疗为主要治疗手段能提高疗效     

腔内放射治疗食管癌疗效分析

目的　食管癌腔内放射治疗与单纯外照射的疗效分析 ,探讨食管癌腔内高剂量率、时间、剂量、分割因素 ,提高局部控制率和生存率。方法　对 2 0 0例食管癌患者随机分为腔内加体外照射A、B两组 ,各 6 0例 ,单纯外照射C组 80例 ,治疗方法 :A组先腔内 70 0cGy× 3次 / 3周 ,后外照 5 0Gy/ 5周。B组外照射 6 0Gy/ 6 2周 ,40Gy后加腔内 5 0 0cGy× 2次同时进行。C组单纯外照射 70Gy/ 7周。结果　 1、3、5年生存率A组为 46 7%、2 1 7%、6 7%,B组 73 3%、38 3%、2 1 7%,C组 5 6 3%、2 6 3%、16 3%,1年生存率B组高于A、C两组 ,有显著差异 (P <0 0 5 )。结论　A组放射反应重 ,疗效差 ,不易采用。B组较为理想 ,远期疗效有所提高 ,是腔内加体外照射目前可行的一种治疗方法。     

外照射加89Sr内照射治疗多发性骨转移瘤疗效分析

目的　探讨外照射加89Sr内照射治疗多发性骨转移瘤的效果。方法　 42例多发性骨转移瘤患者进行放射治疗。直线加速器 6MV X线外照射 ,2～ 3Gy/次 ,DT30～ 5 4Gy。其中 18例在外照射结束 1～ 2周后行89Sr内照射 ,剂量为2 .2 2MBq/kg。结果　外照射加89Sr内照射组 (综合组 )疼痛缓解率为 94.4% ,单纯外照射组 (单放组 )缓解率为 83.3% (X2=1.2 1,P >0 .2 5 ) ,疼痛平均缓解时间综合组为 6个月 ,单放组 4.5个月。结论　外照射加89Sr内照射治疗多发性骨转移瘤为较有效的治疗方法。     

高剂量率~(192)Ir后装腔内加外照射治疗宫颈癌的远期疗效分析

目的　分析高剂量率192 Ir后装腔内加外照射治疗宫颈癌的远期疗效及并发症。方法　对12 8例Ⅱ、Ⅲ期放疗后宫颈癌进行了回顾分析。其中Ⅱ期 47例 ,Ⅲ期 81例。全盆腔外照射DT2 0Gy/ 10次 ,全盆中间挡铅 4cmDT2 0Gy～ 30Gy/ 10次～ 15次 ;后装A点剂量 48Gy～ 5 6Gy/ 6次～ 7次。 结果　 1、3、5年生存率分别为 91 6 1%、81 8%和 6 7 36 % ;Ⅱ、Ⅲ期 1、3、5年生存率无统计学差异 (P >0 .0 5 ) ;远期严重并发症的发生率 7 0 3% (9/ 12 8)。结论　高剂量率192 Ir后装腔内加外照射治疗宫颈癌疗效肯定 ,并发症少。盆腔局部复发仍是放疗失败的主要原因。     

252Cf中子腔内后装加体外照射治疗食管癌的临床研究

目的 比较锎(252Cf)中子腔内后装加体外照射与单纯体外照射治疗食管癌的疗效、副反应及晚期并发症.方法 将86例患者随机均分成252Cf中子腔内后装加体外照射(腔内组)与单纯体外照射(外照组)组.外照组采用医科达医用直线加速器三维适形或常规体外照射,总剂量DT70Gy分35次7.0周完成.腔内组外照射方式、方法同外照组,但总剂量DT60 Gy分30次6.5周完成另加腔内照射.腔内照射方法是经口置特制带水囊的食管施源器于食管病变部位,以距离源10 mm处为剂量计算参考点,病变上下两端外放1～2 cm;4 Gy/次,1次/周,共3～4次.先中子治疗,第2天开始外照射,腔内与外照射同步,腔内治疗之日不进行外照射.结果 治疗后进食阻挡改善者腔内组明显早于外照组,腔内组中6例进水困难者经1次食管球囊扩张、252Cf中子腔内治疗加外照射5～6 d即可进流食,2周后进软食.结束后3个月完全缓解率、部分缓解率和无改变率腔内组分别为33%、67%和0%,外照组分别为19%、76%和5%,两组近期有效率分别为100%和95%(χ2=4.32,P＜0.05).腔内组和外照组1年局部控制率分别为84%和70%(χ2=4.57,P＜0.05);1年生存率分别为81%和61%(χ2=4.17,P＜0.05);急性放射性食管炎发生率61%、51%;(χ2=1.75,P＞0.05)和晚期食管狭窄发生率5%、7%;(χ2=0.35,P＞0.05)相似.结论 食管癌采用252Cf中子腔内后装加体外照射治疗的疗效优于单纯体外照射,且未明显增加放疗副反应.     

鼻咽癌超分割放疗临床研究

１９９２年５月至１９９３年１０月将６２例鼻咽癌病人随机分为常规放疗组和超分割放疗组。常规放疗组每日１次，１．８～２．０Ｇｙ／次，每周五次，总量６８～７０Ｇｙ／３４～３７次／７～７．４周。超分割放疗组１．１Ｇｙ／次，每日２次，间隔≥６～８小时，总量７４～７７Ｇｙ／６６～７０次／７周。急性粘膜反应超分割放疗组重于常规放疗组（Ｐ＜０．０５），经系统口咽处理病人可以耐受，放疗结束后６个月，临床与ＣＴ检查鼻咽肿瘤退缩率两组基本相同。两年生存率和无瘤生存率，常规放疗组分别为８３．９％和７４．２％。超分割放疗组分别为９０．３％和８３．９％（Ｐ＞０．０５），近期疗效超分割组略优于常规放疗组，放疗后主要后遗症（张口困难、口干、放射性龋齿等）超分割组明显轻于常规放疗组（Ｐ＜０．０５）。     

Half body irradiation (HBI) in advanced cancer

From Feb. 1981 to Oct. 1983, 31 patients with advanced cancer of lung, nasopharynx, uterine cervix, breast, malignant lymphoma and others, with extensive metastasis and severe pain, were treated by HBI. The routine therapy would not have relieved the patients of such pain. 60Co was used (SSD 180 cm, dose rate 23-25 rad/min, single mid plane dose 800 rad). Six patients received a second radiation after the first one, 37 courses of HBI were performed in 31 patients (5 times for the upper half and 32 for the lower half). In 32 out of 37 courses of HBI, the pain was partially or completely relieved with a relief rate of 86% and a complete relief rate of 46%. The authors believe that HBI for advanced cancer is superior to any other means. A dose of 800 rad can shrink the tumor or render it subsided temporarily even though not curing it. The side effects on the digestive tract and blood picture were tolerable.     

Linac-based intensity modulated total marrow irradiation (IM-TMI)

Total body irradiation (TBI) has been used as a form of systemic therapy for the treatment of hematological malignancies and as a pre-conditioning regimen prior to bone marrow transplant. However, standard techniques are associated with both acute and chronic toxicities due to the large volumes of normal tissue irradiated. Intensity modulated radiation therapy (IMRT), with its ability to conform the high dose region to the shape of the target, offers a method to reduce radiation related sequelae and potentially allow for the delivery of higher than conventional doses. The goal of this study is to investigate the feasibility of a linac-based approach to intensity modulated total marrow irradiation (IM-TMI) and to discuss the challenges associated with its clinical implementation. The successful development of linac-based IM-TMI would represent advancement in the field of radiotherapy and potentially reduce the incidence and severity of complications associated with current TBI techniques.     

Comparative 60Co total body irradiation (220 cm SAD) and 25 MV total body irradiation (370 cm SAD) dosimetry

Adults with acute leukemia and malignant lymphoma in relapse after conventional therapy are treated with cyclophosphamide and total body irradiation (TBI) followed by autologous bone marrow transplants. For cobalt TBI, patients seated in a stand angled 45° above the floor are treated in a single fraction with sequential right and left lateral 87 cm ×87 cm fields at 220 cm source-axis distance (SAD) using a 5000 Ci cobalt unit. Typical lateral diameters, mid-plane dose rates, mid-plane doses, and maximum doses are: Hips, 34 cm, 8 rad/min, 900 rad, and 1050 rad; and shoulders, 38 cm, 7.7 rad/min, 800 rad, 1080 rad. The estimated lung dose is 1000 to 1100 rad. A compensator limits the dose to the head to 1000 rad. Estimated organ doses are: small intestine, liver and kidneys-1100 rad, and heart-1200 rad. Phantom dosimetry and dosimetry on patients treated reveals that these doses are delivered within 5 % accuracy. Patient tolerance of treatment, and some biological considerations of low dose rate therapy are reviewed. Certain dosimetry features of an alternate treatment at 370 cm SAD, using 25 MV photons are also presented.     

Once-a-week lower hemibody irradiation (HBI) for metastatic cancers

Hemibody irradiation (HBI) of 8 Gy has been shown to produce pain relief in widespread metastatic disease. The major problems occurred with high dose (over 6 Gy) to the upper hemibody. Because 8 Gy lower HBI was well tolerated, we decided to study the efficacy and tolerance of even higher radiation doses given to the lower hemibody. Nineteen patients with widespread metastatic cancers in the lower hemibody were treated from 1982 to 1984 with 16 Gy (8 Gy one week apart) to the lower hemibody (from top of iliac crest to knee joint) after premedication with an antiemetic. All the patients tolerated this high dose, lower HBI well, except for two patients who had slight nausea and vomiting, and one patient who had moist reaction in the perineum. There was no significant bone marrow depression. All patients had improvement in performance status and had prompt pain relief, ten (53%) with complete pain relief and nine (47%) with partial pain relief. The median duration of pain relief was 5 months. Ten of the 15 patients who died were pain-free at the time of death. The four patients still living are free of pain. The median survival was 7 months, and five patients survived 1 year. High dose (8 Gy X 2 spaced one week apart), lower HBI produces prolonged, prompt and effective palliation of pain with minimal morbidity and is well tolerated. It probably does not prolong survival. Because it requires only two treatments spaced one week apart, it is a very convenient and cost effective regimen for the sick and elderly patient.     

The association of adult respiratory distress syndrome (ARDS) with thoracic irradiation (RT)

The authors report two cases of apparent adult respiratory distress syndrome (ARDS) following limited thoracic irradiation for lung cancer. Respiratory failure followed rapidly after irradiation with diffuse bilateral infiltrates, both in and out of the irradiated volume along with progressive hypoxemia unresponsive to oxygen management. Other potential causes of lung injury such as lymphangitic tumor, cardiac failure, and infections were excluded by both premortem and postmortem examination. Autopsy findings in both irradiated and unirradiated volumes of lung were consistent with hyaline membrane changes. The possible relationship between radiation therapy to limited lung volumes and the development of adult respiratory distress syndrome is discussed.     

CNS relapse despite prophylactic cranial irradiation (PCI) in small cell lung cancer (SCLC)

CNS relapse after PCI may reflect either suboptimal radiation dose schedules or reseeding from other sites of active disease. A retrospective study has been undertaken to investigate these alternative mechanisms of treatment failure. Between August 1981 and December 1983, 30 patients with SCLC treated by induction chemotherapy, followed by high-dose cyclophosphamide (7 Gm/m2), were selected for PCI on the basis of clinical, radiological, and bronchoscopic CR. Pretreatment CT brain scans were normal in all patients, and 20 Gy mid-plane dose in 5 daily fractions were delivered by lateral fields to whole brain using megavoltage X rays and localizing check films. Progressive focal neurological signs of cranial metastases developed in 7/30 (23%) patients 3-11 months after PCI, confirmed on CT scanning in 4 patients. Relapse at other sites, predominantly the thorax, occurred in all seven patients at intervals of 1-6 months prior to CNS relapse. Published clinical data of tumor volume doubling times in SCLC predict longer CNS relapse-free intervals after PCI than those observed in our patients if reseeding was responsible for relapse. This suggests that incomplete eradication of intracranial disease is the main cause of CNS relapse after PCI. Higher equivalent radiation doses may improve the results of PCI.