后装腔内插植放疗与三维后装腔内放疗治疗局部晚期宫颈癌的疗效与剂量学比较

目的探讨后装腔内插植放疗与三维后装腔内放疗治疗局部晚期宫颈癌的疗效与剂量学差异。方法将212例局部晚期宫颈癌患者,按照治疗方法的不同分为A组(106例)和B组(106例)。在体外三维适形调强放疗的基础上,A组采用后装腔内插植放疗,B组采用三维后装腔内放疗。对比两组近期疗效、并发症发生率以及剂量学差异。结果B组患者高危临床靶区D100、D90和中危临床靶区D100、D90均明显低于A组,膀胱、直肠、乙状结肠的D2cm3均明显高于A组,差异均有统计学意义(P﹤0.01)。A组患者总有效率明显高于B组,放射性直肠炎、放射性膀胱炎发生率均明显低于B组,差异均有统计学意义(P﹤0.01)。结论后装腔内插植放疗能够在提升肿瘤组织受照剂量的同时,降低危及器官的受照剂量,提升近期缓解率、控制率,减少不良反应。     

局部晚期喉癌3DCRT与IMRT放疗计划的剂量学对比

目的 利用ECLIPSE计划系统对局部晚期喉癌适形放疗(3DCRT)和逆向调强适形放疗(IMRT)计划作剂量学比较,评估不同照射方法的优缺点。方法 选择6例病理证实的局部晚期喉癌患者,用ECLIPSE对每例患者分别作出3DCRT和IMRT计划。根据靶区V95%、D5%、D95%、靶区最大值、最小值及平均值和正常组织受量D50、D33、D5、Dmax和Dmean来比较这两种计划剂量学的差异。结果 两种不同计划中的靶区分布中,GTV和GTVnd差别不大,但对于亚临床区CTV和某些正常组织有统计学差异。结论 对局部晚期喉癌原发灶及阳性淋巴结,3DCRT和IMRT计划均有较好覆盖。但在亚临床病灶方面,IMRT比3DCRT包含靶区更好一些,且IMRT减少了腮腺正常组织的照射剂量。     

腔内联合组织间插植放疗与三维后装腔内放疗治疗局部晚期宫颈癌的疗效及剂量学参数比较

目的:对比腔内联合组织间插植放疗(intracavitary/interstitial brachytherapy, IC-ISBT)与三维后装腔内放疗(intracavitary brachytherapy, ICBT)两种方式在宫颈癌近距离治疗中的疗效与剂量学差异。方法:回顾性分析2019年01月至2021年12月于我院接受根治性放疗的61例宫颈癌患者的资料，按照治疗方法不同分为IC-ISBT组和ICBT组，对比两组近期疗效、不良反应发生率以及剂量学差异。结果:IC-ISBT组的HR-CTV D_90%高于ICBT组，且差异有统计学意义(P=0.026);IC-ISBT组的直肠■、■和膀胱■、■显著低于ICBT组，差异有统计学意义(P<0.05);IC-ISBT组完全缓解率明显高于ICBT组，差异有统计学意义(P<0.05);IC-ISBT组放射性肠炎发生率明显低于ICBT组，差异有统计学意义(P<0.05)。结论:IC-ISBT治疗能显著提高靶区剂量的同时降低直肠、膀胱的受量，提高肿瘤客观缓解率，降低不良反应发生率。     

奈达铂联合放疗治疗局部晚期宫颈癌临床观察

目的探讨奈达铂联合放疗治疗局部晚期宫颈癌的临床疗效和毒副反应。方法 58例局部晚期宫颈癌患者随机分为2组,每组29例,分别接受奈达铂联合放疗(治疗组)和顺铂联合放疗(对照组)。结果2组有效率、生存率比较差异均无统计学意义(P均>0.05);治疗组胃肠道反应和血小板减少与对照组比较差异有统计学意义(P<0.05)。结论奈达铂联合放疗治疗局部晚期宫颈癌具有与顺铂联合放疗相似的疗效,且毒副反应更轻。     

调强适形放疗治疗晚期宫颈癌患者的疗效观察

目的:探究调强适形放疗(IMRT)治疗晚期宫颈癌患者的疗效观察.方法:回顾性选取2014年04月至2016年05月我院收治的符合纳排研究标准的79例接受放疗的中晚期宫颈癌患者.根据治疗期选取放疗方式不同,将43例行常规普通放疗的患者纳为常规放疗组,将36例行调强放疗的患者纳为IMRT组.观察两组近期临床疗效、放疗毒性反...     

局部晚期宫颈癌术前同步放化疗疗效及安全性评价

目的：探讨术前同步放化疗在局部晚期宫颈癌治疗中的疗效及安全性。方法2007年1月至2010年12月对70例Ⅰb2期及Ⅱa2期宫颈癌患者行PVB或TP或TC方案化疗结合腔内后装放疗后再行根治性子宫切除术,观察宫颈局部肿瘤变化及同步放化疗毒副反应,分析术前同步放化疗对局部晚期宫颈癌患者的疗效及安全性。结果70例患者中完全缓解和部分缓解分别为14例和45例,总有效率为84．3％。3年局部复发率为31．3％,3年远处转移率为25．4％,3年总生存率为79．1％。毒副反应发生情况,骨髓抑制30．0％（21/70）,周围神经毒性10．0％（7/70）,胃肠道反应80．0％（56/70）,肌肉关节痛12．9％（9/70）,脱发87．1％（61/70）。手术平均出血量410 mL,手术平均时间160min。术后输尿管尿瘘2例,尿潴留12例,盆腔淋巴囊肿合并感染1例,均对症治疗后痊愈。结论局部晚期宫颈癌术前同步放化疗能够获得较为理想的治疗效果,毒副反应可耐受,不影响后续的手术治疗,术后并发症轻微,具有良好的临床应用前景。     

局部晚期宫颈癌放疗结合免疫治疗的相关研究进展

局部晚期宫颈癌患者标准治疗方案为同步放化疗,短期疗效较好,但远期预后较差,易局部复发和远处转移,严重影响患者的生活质量及总生存期.近年来,免疫治疗成为国内外学者研究的热点,其可以激活机体自身的免疫系统,通过增强体内免疫细胞的数量及功能,从而特异性、持续地识别并消灭肿瘤细胞.放疗主要是对照射野内的肿瘤组织采用高能射线的方式精确杀死局部肿瘤组织,死亡后的肿瘤组织最终作为一种新抗原激活体内的抗肿瘤免疫反应.基于局部放疗与免疫系统的内在协同作用使放疗结合免疫治疗成为可能.本文就国内外在局部晚期宫颈癌放疗结合免疫治疗的广阔前景及面临的相关挑战进行综述.     

新辅助化疗联合手术或放疗治疗局部晚期宫颈癌的临床观察

宫颈癌是常见的妇科恶性肿瘤之一,由于手术和放射治疗的应用,早期宫颈癌有较高的生存率,Ⅰb期、Ⅱa期患5年生存率约75％～90％。但局部晚期宫颈癌（宫颈肿瘤中〉4cm）因宫颈浸润深度、淋巴结转移率及肿瘤对放疗的抗拒性增加,使得复发率高而生存率低。为了改善局部晚期宫颈癌患的预后,国内外学进行了不懈的努力,尤其随着肿瘤化学治疗的基础与临床研究的迅速发展,宫颈癌的化疗也越来越受到重视。本报道了我院自1990～1993年间收治的58例局部晚期宫颈癌病例,先予以新辅助静脉化疗再联合根治性手术或放射治疗,效果满意。现报告如下：     

IMRT和CRT在宫颈癌术后放疗中的剂量学对比及临床应用

目的：比较IMRT（intensity modulated radiation therapy,调强适形放射治疗）和CRT（conventional ra-diotherapy,常规放疗）在宫颈癌术后放疗中,对危及器官保护方面的差异。方法：选取我院2007年1月-2010年1月30例宫颈癌术后放疗患者,均行CT模拟定位扫描并勾画靶区及危及器官,临床靶区（CTV）包括子宫、宫颈、阴道等原发肿瘤区域及髂总、髂外、髂内、闭孔、骶前淋巴结等区域和其周围组织,计划靶区（PTV）为CTV外放1cm,处方剂量为45Gy/1.8Gy/25次,95%PTV达到处方剂量要求。30例患者均做IMRT及CRT两种计划设计,对比两种照射方式下骨髓、小肠、直肠及膀胱的剂量分布、剂量、体积直方图（ova）中的多个指标。随后按患者自主意愿选取15例入IMRT组,另15例入CRT组进行放疗,对比两组副反应发生率。结果：与CRT相比,IMRT降低了30-40Gy范围内骨盆骨髓、小肠、膀胱、直肠的受照体积,有显著统计学意义。IM-RT组膀胱、肠道副反应发生率明显低于CRT组,有显著统计学意义。两组在骨髓抑制方面无统计学差异。结论：对于宫颈癌术后放疗的患者,IMRT较CRT能明显降低危及器官的受量,降低并发症发生率,具有明显优势,值得临床推广应用。     

凋亡及凋亡相关蛋白BaX在局部晚期宫颈癌同步放化疗中的表达

目的：研究局部晚期宫颈鳞癌细胞对同步放化疗应答的分子机制,探讨凋亡及Bax、Bcl-2的表达。方法：49例局部晚期宫颈鳞癌患者随机分为两组：单纯放疗（RT）组25例接受盆腔外照射和后装治疗;同步放化疗（CRT）组24例除接受放疗外,还接受3个周期的化疗（DDP＋5-FU）。在治疗前和治疗过程中（RT组：放疗10Gy后;CRT组：放疗10Gy＋（DDP＋5-FU）×1个周期）分别活检留取标本,用TUNEL法及免疫组化检测凋亡及Bax、Bcl-2的表达。结果：RT组和CRT组完全缓解率分别为52.0%和79.2.0%（P=0.044）。在治疗前和治疗过程中,RT组和CRT组凋亡阳性率均增加,分别由24%上升到60.0%（P=0.01）和20.8%增加到87.5%（P=0.000）,差异显著;治疗中CRT组较RT组增加更加明显（P=0.03）。Bax的表达亦增加,分别由24.0%上升到52.0%（P=0.021）和25.0%增加到79.2%（P=0.000）,差异显著;CRT组较RT组增加的更显著（P=0.044）。两组在治疗中,凋亡的阳性率和Bax的阳性表达密切相关,CRT组较RT组相关性更强（P=0.015,r=0.827：P=0.027,r=0.523）,但两组Bcl-2的表达无变化（P〉0.05）。结论：局部晚期宫颈鳞癌,CRT比RT有更好的缓解率,其机制可能是化疗和放疗有协同作用,通过上调Bax通路诱导了肿瘤细胞的凋亡。 基金 广西壮族自治区卫生厅科研基金资助（编号：Z2005023）     

调强放疗与三维适形放疗治疗局部晚期鼻咽癌的疗效及毒副作用对比

目的 探讨调强放疗(IMRT)与三维适形放疗(3D-CRT)治疗局部晚期鼻咽癌的毒副作用及治疗效果.方法 将120例局部晚期鼻咽癌患者随机分为观察组与对照组,每组60例.观察组采用调强适形放疗,对照组采用三维适形放疗.结果 2组随访时间、生存率及复发率差异无统计学意义(P>0.05).随着时间延长,对照组中耳炎发生率增高速度明显高于观察组(P<0.05);观察组口腔毒副作用占46.67%,消化系统毒副作用占36.67%,血液系统毒副作用占10.00%,皮肤毒副作用占70.00%.对照组口腔毒副作用占56.67%,消化系统毒副作用占46.67%,血液系统毒副作用占16.67%,皮肤毒副作用占90.00%.由于样本量限制,2组未见统计学差异(P>0.05).结论 IMRT与3D-CRT相比,效果相当,但毒副作用相对较小,需要进一步大样本验证.     

N064A (Alliance): Phase II Study of Panitumumab,Chemotherapy, and External Beam Radiation in Patients with Locally Advanced Pancreatic Adenocarcinoma

BackgroundThis North Central Cancer Treatment Group (NCCTG) N064A (Alliance) phase II trial evaluated upfront chemoradiotherapy incorporating the EGFR inhibitor panitumumab, followed by gemcitabine and panitumumab for unresectable, non-metastatic pancreatic cancer.MethodsThe treatment consisted of fluoropyrimidine and panitumumab given concurrently with radiotherapy followed by gemcitabine and panitumumab for 3 cycles followed by maintenance panitumumab. The primary endpoint was the 12-month overall survival (OS) rate and secondary endpoints included confirmed response rate (RR), OS, progression-free survival (PFS), and adverse events. Enrollment of 50 patients was planned and the study fully accrued.ResultsFifty-two patients were enrolled, but only 51 were treated and included in the analysis. The median age of patients was 65 years and 54.9% were women. Twenty-two patients received at least 1 cycle of systemic therapy following radiotherapy, but 29 patients received chemoradiotherapy only without receiving subsequent chemotherapy after completion of chemoradiotherapy. The overall RR was 5.9% (95% CI: 1.2%-16.2%). The 12-month OS rate was 50% (95% CI: 38%-67%) which fell short of the per-protocol goal for success (51.1%). The median PFS was 7.4 months (95% CI: 4.5-8.6) and the median OS was 12.1 months (95% CI 7.9-15.9). Grade 3 or higher adverse events were reported by 88%.ConclusionThe combination of panitumumab, chemotherapy, and external beam radiation therapy was associated with very high rates of grades 3-4 toxicities and survival results did not meet the trial’s goal for success. This regimen is not recommended for further study (ClinicalTrials.gov Identifier {"type":"clinical-trial","attrs":{"text":"NCT00601627","term_id":"NCT00601627"}}NCT00601627).     

西妥昔单抗联合调强放疗及TP方案化疗治疗局部晚期鼻咽癌初步研究

[目的]研究西妥昔单抗联合调强放疗及TP方案化疗治疗局部晚期鼻咽癌的近期疗效及不良反应.[方法] 21例局部区域晚期鼻咽癌患者接受调强放射治疗及TP方案同步化疗2个周期,同时接受每周1次的西妥昔单抗治疗.采用CTCAE 3.0记录治疗期间的最大不良反应;观察局部区域控制及远处转移情况.[结果] 21例患者都完成预定调强放射治疗计划,20例(95.2％)患者完成了预定的西妥昔单抗治疗,19例(90.5％)患者完成了2个周期的TP方案化疗.无治疗相关性死亡发生,4级不良反应包括白细胞减少(7例,33.4％),中性粒细胞减少(3例,14.3％),血小板减少(1例,4.8％)及4级唑疮样皮疹(1例,4.8％).口腔及口咽黏膜炎、骨髓抑制、放射性皮炎、呕吐为常见的3级毒性.中位随访13个月,21例患者1年局部控制率、区域控制率及无远处转移生存率为100.0％、100.0％及95.2％.[结论]西妥昔单抗联合调强放疗及TP方案化疗治疗局部晚期鼻咽癌近期疗效令人鼓舞,不良反应可控可逆.     

Transcatheter Arterial Chemo-Embolization (TAC-E) for Patients with Locally Advanced Breast Cancer

Preoperative transcatheter arterial chemo-embolization (TAC-E)was used for 19 patients with locally advanced breast cancer,to eradicate the extensive loco-regional areas prior to surgeryand hopefully to reduce the postoperative recurrence rate. Theresults were as follows: (1) Each primary tumor showed markedregression within 2 weeks after TAC-E. (2) Surgicopathologyconfirmed the excellent efficacy of TAC-E against both primarytumors and metastatic lymph node tumors. (3) Side effects dueto this treatment were few, compared with other forms of cancerchemotherapy. (4) The prognosis of each patient was good. We conclude that preoperative TAC-E has a great potential forthe treatment of locally advanced breast cancer.     

Effects of EGFR,CK19, CK20 and Survinin Gene Expression on Radiotherapy Results in Patients with Locally Advanced Head and Neck Cancer

Purpose: To investigate the effects of epidermal growth factor receptor (EGFR), cytokeratin 19 (CK19),cytokeratin 20 (CK20) and survinin gene expression on local control (LC) and overall survival (OS) in patientswith locally advanced head and neck cancer (LAHNC) who were administered radiotherapy (RT). Materialsand Methods: Twenty-six patients who were admitted to Uludag University Medical Faculty Department ofRadiation Oncology with a diagnosis of LAHNC (GIII-GIV) were included in this study. Gene expression wasevaluated in tumor tissues and peripheral blood. RNA isolation was performed on paraffinized tumor tissuesand peripheral blood samples obtained before RT (BR). The densities of the obtained RNAs were analyzed at260/280 nm. cDNA samples obtained from total RNA,EGFR, CK19, CK20 and survinin gene expression levelswere assessed via the Sybr Green method and data were analyzed with the ΔΔCt method. The same process wasrepeated for peripheral blood samples taken after RT (AR). Results: The female/male ratio was 3:23 and themean age was 56.5 years (38-75years). After radiotherapy, CK19 and CK20 levels in the peripheral blood werefound to be correlated according to Pearson correlation analysis(p=0.049). This result indicates a possibility ofremaining positive for CK19 and CK20 in the peripheral blood even after RT in patients with CK19, CK20,and EGFR positive tumors before RT. There was a statistically significant correlation between survinin levelsmeasured BR and AR (p=0.028). Conclusions: In this study, we found that patients with any EGFR, CK19, CK20or survinin positivity in their peripheral blood obtain less benefit from radiotherapy. A wider patient populationand advanced protein analyses are necessary in order to increase the reliability of our findings.