全中枢系统合并局部加量照射治疗颅内生殖细胞瘤

目的 回顾分析46例生殖细胞瘤患者行全中枢系统合并局部照射治疗的效果。方法 对1995年至2006年我科治疗的诊断明确的生殖细胞瘤患者,放疔后长期随访,分析预后。结果 46例生殖细胞瘤患者放疔后,5年、10年生存率分别为93.8%、82.6%,未发现有意义的预后因素。结论 全中枢系统照射治疗应为颅内生殖细胞瘤必要的治疗方法。治疗结果满意,远期放射损伤很少。     

Risk factors for early failure after thermal capsulorrhaphy.

Thermal capsular shrinkage has rapidly become a common procedure for a variety of shoulder conditions usually associated with instability, although clinical data on outcomes are limited. The objective of this study was to identify risk factors for poor outcome after thermal capsulorrhaphy. Of 106 patients who underwent thermal shrinkage, 15 patients with treatment failures were identified. The mean time to failure after the procedure was 6.3 months (range, 1 to 16). Previous operations and multiple recurrent dislocations were associated with poor outcome at a highly significant level. Multidirectional instability and participation in contact sports did not attain statistical significance as risk factors. However, statistical power in these two comparisons was insufficient to exclude them as potential risk factors. A concomitant procedure at the time of thermal capsulorrhaphy was not associated with poor outcome. The data from early treatment failures can be useful in guiding patient selection for thermal capsulorrhaphy. This procedure may be of limited value for patients who have had prior operations or have a history of multiple dislocations. The data also suggest that thermal capsulorrhaphy should be used cautiously in patients with multidirectional instability or in those who are involved in contact sports.     

颅脑肿瘤放射治疗时射野外器官吸收剂量体模法测量与分析

目的 在是否使用楔形板和照射野面积不同的情况下,测量和分析颅脑肿瘤放射治疗时射野外器官的吸收剂量。 方法 使用中国成人男性仿真人体模型,模拟颅脑肿瘤放射治疗,采用不使用楔形板的普通方野照射技术组和使用楔形板的三维适形照射技术（3D-CRT）组,普通方野照射技术组分别用2 cm×2 cm野和4 cm×4 cm野进行照射,3D-CRT组分别按等效方野面积分为2 cm×2 cm野和4 cm×4 cm野进行照射;使用热释光剂量计测量射野外器官的吸收剂量并进行分析。 结果 颅脑肿瘤靶区处方剂量为100 cGy时,射野外各器官吸收剂量范围为0.13~2.83 mGy。头颈部器官4 cm×4 cm野照射时的吸收剂量与2 cm×2 cm野比较,差异有统计学意义（t=-5.023,P=0.004）;胸腹部器官4 cm×4 cm野照射时的吸收剂量与2 cm×2 cm野比较,差异无统计学意义（t=-1.438,P=0.171）。普通方野照射组头颈部器官、腹部器官的吸收剂量与3D-CRT组比较,差异均有统计学意义（t头=-2.805,P=0.038;t腹=-11.966,P=0.000）。 结论 接受颅脑肿瘤放射治疗的患者,射野外器官吸收剂量的大小与照射野面积、是否采用楔形板照射技术有关。接受大野照射的患者,靶区邻近器官吸收剂量越大;照射野面积和处方剂量相同时,使用楔形板的照射技术相对于不使用楔形板的射野外器官的吸收剂量增大。     

Simplified estimation method for dose distributions around field junctions in proton craniospinal irradiation

In radiotherapy involving craniospinal irradiation (CSI), field junctions of therapeutic beams are necessary, because a CSI target is generally several times larger than the maximum field size of the beams. The purpose of this study was to develop a simplified method for estimating dose uniformity around the field junctions in proton CSI. We estimated the dose profiles around the field junctions of proton beams using a simplified field-junction model, in which partial lateral dose distributions around the field edge were assumed to be approximated using the error function. We measured the lateral dose distributions of the proton beams planned for the CSI treatment using a two-dimensional (2D) ionization chamber array. Although dose hot spots and cold spots tend to be underestimated by a chamber array because of the partial volume effect of the sensitive volume and discrete chamber positions, the model estimation results were fairly consistent with the measurements obtained using a 2D chamber array subjected to CSI-simulated serial irradiation. The simplified junction model enabled us to estimate the dose distributions and dependence of the setup position gap on the dose uniformity around the field junctions on the basis of the field-by-field dose profiles measured using the 2D chamber array.     

Asymptomatic radiation-induced telangiectasia in children after cranial irradiation: frequency, latency, and dose relation

PURPOSE: To determine the frequency, dose relation, and latency of radiation-induced telangiectasias in children after cranial irradiation. MATERIALS AND METHODS: The authors identified 90 children who had undergone cranial irradiation between 1981 and 2001 and undergone magnetic resonance (MR) imaging with follow-up for at least 6 months. Patients were assigned to low-dose (LD) and high-dose (HD) groups. All 24 children in the LD group received a radiation dose of 18.0 or 19.8 Gy. The 66 patients in the HD group received a dose of 32.0 Gy or greater. Telangiectasias were defined as small low-signal-intensity foci on intermediate- or T2-weighted MR images. For the patients who underwent serial MR imaging, the first depicted appearance of each telangiectatic lesion was recorded. Statistical analyses were performed. RESULTS: Telangiectasias in at least one area were observed in 18 (20%) patients. The frequency of telangiectasia was 13% (three of 24 patients) in the LD group as compared with 23% (15 of 66 patients) in the HD group; this difference was not significant (P =.22, Fisher exact test). In 12 patients (one from LD and 11 from HD group) who underwent serial MR imaging follow-up for up to 10 years (mean, 8.1 years), a total of 31 lesions were detected. Twelve (39%) of these lesions were detected by the 3rd year, and 21 (68%) were evident by the 5th year. Six (50%) of the 12 patients who underwent serial MR imaging had telangiectatic foci after 5 years. CONCLUSION: Radiation-induced telangiectasia appears to occur in at least 20% of children who undergo cranial irradiation. In this small series, higher radiation dose was not significantly associated with higher frequency of telangiectasia, although there was a trend in this direction.     

Low dose irradiation in advanced tumours of head and neck.

A material of 19 patients with T3 and T4 tumours of the mouth and pharynx was treated by fractionated low dose rate irradiation. Regression occurred in a large proportion of tumours but at the expense of a high rate of necrosis.     

CT analysis of mucosal surface dose in intraluminal irradiation for esophageal cancer

PURPOSE: Balloon applicators are generally used in intraluminal irradiation for esophageal cancer. CT exhibits a distortion of the applicator during treatment. Because little attention has been paid to dose non-uniformity in the esophageal mucosa, we analyzed mucosal surface dose using CT. MATERIALS AND METHODS: Eleven patients with esophageal cancer treated with a double-lumen balloon applicator (balloon length: 15 cm, diameter: 20 mm) were evaluated. Reference dose was prescribed at 5 mm under the mucosal surface. Mucosal surface points were determined from CT images, and relative surface dose to reference dose was calculated. Hot and cold spots were defined respectively, as dose points receiving at least 200% and less than 100% of the reference dose. RESULTS: The mean mucosal dose ranged from 138% to 174%. Mucosal dose was distributed widely from 100% to 199% in 94% of all patients. Hot and cold spots accounted for 5.3% and 0.7% of mucosal dose points, respectively. CONCLUSION: 1) CT analysis exhibited the inhomogeneity of esophageal mucosal dose in intraluminal irradiation. 2) At present, it is acceptable to prescribe the reference dose at 5 mm under the esophageal surface. 3) Balloon applicators should be improved to achieve dose uniformity in the esophageal mucosa.     

TBI后颅内感染的发生情况和危险因素

目的探讨颅脑损伤(TBI)术后颅内感染的发生率及发生颅内感染的危险因素。方法 2012年1月—2015年12月川北医学院附属医院神经外科收治1 349例TBI患者,道路交通伤542例,高处跌落332例,重物砸伤291例,其他原因184例。其中47例在术后出现颅内感染(感染组),男性31例,女性16例;年龄21~65岁,平均42.0岁;按照年龄、性别进行1∶2匹配的原则选取94例术后未发生颅内感染的TBI患者作为对照组,男性58例,女性36例;年龄20~65岁,平均40.7岁。分析TBI患者发生颅内感染的危险因素。结果 TBI患者手术后并发颅内感染主要与开放性创伤、受伤至手术时间、脑室外引流时间、术后白蛋白水平有关(OR=1.629、95%CI:1.284~4.429,OR=1.531、95%CI:1.227~4.302,OR=1.776、95%CI:1.363~5.728,OR=0.601、95%CI:0.275~0.930,P0.05),与患者入院时的GCS评分关系不显著(OR=0.581、95%CI:0.241~0.836,P0.05)。结论 TBI患者术后容易并发颅内感染,开放性创伤、受伤至手术时间、脑室外引流时间是TBI患者术后并发颅内感染的危险因素,术后白蛋白水平是患者并发颅内感染的保护性因素。     

Formation of neoplasms in dogs after chronic gamma irradiation at a low-intensity dose

In order to estimate end effects of chronic prolonged gammairradiation of dogs, an exposure of 80 animals to irradiation was terminated and they were followed up closely. Out of 80 animals 30 dogs (1st series) were irradiated for 3 years and 50 dogs (II series) for 6 years. The dogs were exposed to irradiation at doses of 21 to 190 rad per year. Out of the total number of animals 22 dogs died. Post-mortem examinations showed neoformations in 13 animals (7 malignant and 12 benign neoformations). The highest number of tumors developed in dogs of the II series (10 out of 11) one-two years after irradiation (6 malignant tumors--malignant pheochromocytoma of adrenals; malignant adenoma of the hypophysis: polymorphocellular sarcoma of the liver; leucomyosarcoma of the uterus; bladder cancer; breast cancer; and 10 benign tumors--pancreatic adenoma; liver angioma; 2 papillary adenomas of the prostate; 3 renal adenomas; lipoma; polyps of the gall-bladder). Animals of the 1st series displayed 3 neoformations (1 malignant tumor--bladder tumor and 2 benign tumorsliver hepatoma and spleen angioma) 4--5 years after irradiation.     

两种全中枢神经系统放疗技术患者有效剂量的比较

目的比较螺旋断层放疗（helical tomotherapy,HT）和多等中心放疗（multi-ISO radiotherapy,M-ISO）两种技术在全中枢神经系统放疗（craniospinal irradiation,CSI）过程中患者的有效剂量。方法选取在本院已接受全中枢神经系统放射治疗的9例儿童患者,分别运用螺旋断层放疗和多等中心放疗两种技术对此9例患者重新进行治疗计划设计。对9例患者共18个治疗计划的患者有效剂量进行计算,运用配对t检验比较两种放疗技术过程中患者有效剂量的差异。结果HT和M-ISO计划均满足临床要求,两组计划靶区剂量D_95%差异无统计学意义（P>0.05）;HT组的D_98%、D_2%、均匀性指数（HI）优于M-ISO计划（t=2.762、2.413、4.563,P<0.05）;M-ISO组的D_50%、D_mean和适形指数（CI）优于HT计划（t=5.259、3.685、7.815,P<0.05）。两种计划方法对危及器官的保护各有优势;9例患者全身有效剂量HT计划高于M-ISO计划,差异有统计学意义（t=5.921,P<0.01）。结论 HT与M-ISO两种技术在全中枢神经系统放疗中各有优势,HT组计划低剂量区域范围对于患者有效剂量影响较大,全中枢放疗计划设计时应关注低剂量辐射范围。     

颅内损伤住院患者结局的多因素分析

目的；分析影响颅内损伤住院患者结局的各种因素，计算其效应大小并拟合死亡要领模型，为提高颅内损伤救治水平提供有用信息。方法：选择包括以国际疾病分类（ICD－9CM）编码为分类标准的创伤病种，并考虑其年龄，性别等若干相关因素，以颅内损伤病死率为反应变量拟合logistic回归模型，分析各因素对病死率影响的统计学意义及影响作用的大小。结果：除“创伤病种”外，“年龄”和“入院时病况”进入logistic模型，“性别”和“身份”未进入。拟合的死亡概率模型具有统计学意义。结论：“创伤”是病死的主要影响因素，“年龄”和“入院时病况”与颅内损伤的结局也具有相关性。年龄越大，病死率越高，入院时病况越危急，病死率越高。     

Single dose and fractionated palliative irradiation for osseous metastases.

A retrospective review of a series of cases of osseous metastases from carcinoma of the female breast treated either with single dose or ten fraction irradiation is reported. Equally reliable palliation was achieved by either method, unaffected by concomitant hormone therapy. The morbidity is assessed and the implications discussed. A prospective study is advocated.     

Appropriate treatment planning method for field joint dose in total body irradiation using helical tomotherapy

Total body irradiation (TBI) using helical tomotherapy (HT) has advantages over the standard linear accelerator-based approach to the conditioning regimen for hematopoietic cell transplantation. However, the radiation field has to be divided into two independent irradiation plans to deliver a homogeneous dose to the whole body. A clinical target volume near the skin increases the skin surface dose; therefore, high- or low-dose regions arise depending on the set-up position accuracy because the two radiation fields are somewhat overlapped or separated. We aimed to determine an adequate treatment planning method robust to the set-up accuracy for the field joint dose distribution using HT-TBI. We calculated treatment plans reducing target volumes at the interface between the upper and lower body irradiations and evaluated these joint dose distributions via simulation and experimental studies. Target volumes used for the optimization calculation were reduced by 0, 0.5, 1.0, 2.0, 2.5, and 3.0 cm from the boundary surface on the upper and lower sides. Combined dose distributions with set-up error simulated by modifying coordinate positions were investigated to find the optimal planning method. In the ideal set-up position, the target volume without a gap area caused field junctional doses of up to approximately 200%; therefore, target volumes reduced by 2.0–3.0 cm could suppress the maximum dose to within 150%. However, with set-up error, high-dose areas exceeding 150% and low-dose areas below 100% were found with 2.0 and 3.0 cm target volume reduction. Using the dynamic jaw (DJ) system, dose deviations caused by set-up error reached approximately 20%, which is not suitable for HT-TBI. Moreover, these dose distributions can be easily adjusted when combined with the intensity modulation technique for field boundary regions. The results of a simulation and experimental study using a film dosimetry were almost identical, which indicated that reducing the target volume at the field boundary surface by 2.5 cm produces the most appropriate target definition.