32P持续低剂量率辐射敷贴治疗的胶片剂量验证

目的:对32P的敷贴治疗进行胶片剂量验证.方法: 直线加速器建立25-575cGy的胶片辐射剂量曲线.放射性核素32P溶液4.14MBq吸附在 1.1cm×1.2cm 的长方形滤纸上制成放射性敷贴器.将20张1.5cm×1.5cm的辐射直接显色(RC)胶片(胶片厚0.225mm)重叠放置(总厚度4.5mm),把放射性敷贴器放置在最顶端,辐射0.5小时.通过辐射剂量曲线计算每张胶片辐射剂量,根据胶片厚度推算距离敷贴器不同距离处的辐射剂量,并绘制相应的剂量-距离曲线.结果: 距离敷贴器 0、 0.225、 0.45、0.675、0.9、1.125、1.35、1.8、2.025、2.25、2.475mm处的0.5小时辐射测量吸收剂量为265、175、120、98、68、55、39、25、19、16、12、5cGy,拟合曲线为Y=257.28e-1.4521X.结论: 放射性核素32P敷贴器的辐射剂量随距离增加呈指数方式衰减,敷贴器表面和2.5mm处的辐射剂量相差约53倍.     

Radiobiology of low-dose-rate radiation relevant to radioimmunotherapy

Systemically delivered targeted radioisotopes are being used ever-increasingly for cancer therapy. Compared with conventional external beam radiation therapy, the radiation dose-rate associated with these novel systemic therapies is approximately two orders of magnitude lower in intensity (dose-rate). Hence it is referred to as low dose-rate (LDR) radiotherapy. An awareness of the unique radiobiology associated with LDR-based therapy provides a basis for cautious enthusiasm as these new therapies are explored.     

Intraoperative MR-guided instillation of phosphorus-32 for cystic craniopharyngiomas: case report

Intraoperative magnetic resonance imaging has been applied to a number of neurosurgical disease processes since the late 1990's. The ability to visualize the operative site in near-real time has added a significant degree of safety to the treatment of lesions such as a cystic craniopharyngioma which can be located in regions of the brain where an untoward consequence can result in significant neurological morbidity. Previous surgical techniques, although often successful, did not allow the neurosurgeon to directly visualize whether the goals of surgery had been met or whether there was an inadvertent complication associated with the surgical approach until after the event had occurred. The safe and accurate instillation of radioactive phosphorus into this cystic tumor resulted in clinical improvement and the maintenance of normal pituitary function for this patient. The extreme accuracy and safety of this surgical technique is demonstrated by the imaging examples provided.     

Radioactive-induced tumors by phosphorus-32 as colloidal compound

Chromic colloidal phosphate labeled with 32P, which has been proposed for the treatment of several articular diseases, was injected intra-articularly in the knee joint of adult Wistar rats. After a 270 days minimum latent period, tumors began to appear in the injected zone, to a 70% frequency. Ten lung metastases were detected. In five cases, squamous cell carcinomas were induced in the injected area. The relevance of a sound evaluation of the risk involved in treatments with radioactive isotopes, is discussed.     

^32P玻璃微球经肝动脉栓塞内照射治疗中晚期肝癌

目的探讨32P玻璃微球行经肝动脉栓塞内照射的安全性和有效性。方法原发性肝癌26例,经肝动脉选择性插管后,用32P玻璃微球与超液化碘油混合后作栓塞。治疗放射剂量为75～150Gy。结果术后均有肝功能一过性异常,2周后逐渐恢复至术前水平,血象及肾功能无异常改变。术后无严重并发症。微球主要分布于肝内,癌／肝放射比为3.5:1。随访3～19个月23例（88.4％）。病灶有缩小,体积缩小50％以上11例（42．3％）。9例（75．0％）生存期＞1年,中位生存时间为8．1月。结论32P玻璃微球作为一种新型栓塞内放射材料,具有半衰期适中,射程适宜的优势。初步临床应用表明为行肝动脉栓塞内照射安全、有效。     

Intracavitary brachytherapy using stereotactically applied phosphorus-32 colloid for treatment of cystic craniopharyngiomas in 53 patients

This paper summarizes outcomes of a single-center study of intracavitary brachytherapy (IBT) with stereotactically applied phosphorus-32 ((32)P) colloid for treatment of cystic craniopharyngiomas. We assessed its efficacy and safety, on the basis of clinical and radiological outcomes in one of the largest reported patient series. Between 1992 and 2011, 53 patients were treated with IBT, 14 without previous treatment and 39 who had previously been treated for recurrent cysts. Intervention was performed by applying 200?Gy to the internal cyst wall (median volume 6.1?ml). Median clinical and radiological follow-up were 60.2 and 53.0?months, respectively. Actuarial tumor cyst control was 86.0?±?5.3?% at 12, 24, and 60?months. Actuarial out-of-field control (development of new cysts or progression of solid tumor parts) was 90.9?±?4.3, 84.0?±?5.6, and 54.5?±?8.8?% after 12, 24, and 60?months, respectively. Corresponding actuarial overall progression-free survival was 79.4?±?6.1, 72.4?±?6.8, and 45.6?±?8.7?% at 12, 24, and 60?months, respectively. Visual function improved for 12 patients (23.5?%), remained unchanged for 34 patients (66.7?%), and worsened for five patients (9.8?%), correlating with tumor progression in each case. Endocrinological deterioration occurred for ten patients (19.6?%); for nine patients this was a result of tumor progression or after tumor resection and for one it was attributed to irradiation. Within six months of IBT seven patients (13.7?%) experienced transient neurological deficits and two patients (3.9?%) deteriorated permanently (hemiparesis and third nerve palsy). Stereotactically applied (32)P is highly efficacious for control of cystic components of craniopharyngiomas and is associated with a low risk of permanent morbidity. The procedure does not, however affect the development of new cysts or the progression of solid tumor parts.     

婴幼儿皮肤血管瘤P-32放射治疗的临床观察

目的：探讨P-32放射治疗婴幼儿皮肤血管瘤的临床效果及不良反应。方法：观察38例婴幼儿P-32放射治疗后的治疗效果及不良反应。结果：P-32放射治疗婴幼儿血管瘤一次治愈率76.3%,有效率100%。治疗中要及时注意皮肤局部损伤情况。结论：P-32放射治疗婴幼儿皮肤血管瘤方法有效,不良反应。     

Combined low-dose-rate brachytherapy and external beam radiation for cervical cancer: experience over ten years

Cervical cancer was treated with a combination of external beam and intracavitary radiation during a 10-year period at Wayne State University. Data were collected for 216 patients treated radically with external beam radiation (EBRT) and low-dose-rate brachytherapy for cervical cancer between 1980 and 1991 at Wayne State University. Patient distribution by stage was IB, 20.8%; IIA, 7.4%; IIB, 26.9%; IIIA, 1.8%; IIIB, 40.7%; and IVA, 2.3 %. Survival curves were constructed using Kaplan-Meier methods and differences between groups were tested for significance using the log-rank test. Multivariate analysis was done using the Cox proportional hazards model. With a median follow-up of 114 months, actuarial disease-free survival for all patients was 60% at 5 years and 55% at 10 years. Actuarial 5-year survival for Stage IB was 79%; for Stage II, 59%; and for Stage III, 53%. There were 14/216 (6%) of patients with severe late complications. On univariate analysis, race was found to be statistically significant, with Caucasian patients having better survival than African American (P = 0.03). The survival for patients treated in shorter overall times was significantly higher (P<0.001), especially with treatment completion in under 58 days. The stepwise Cox multivariate analysis provided the following significant results: race (African American vs. Caucasian; P = 0.04, RR = 1.6), Stage (II vs. I, P = 0.004, RR = 2.6), Stage (III vs. I; P = 0.004, RR = 2.5), and overall treatment time (P = 0.006, RR = 1.62). Rates of local control, survival, and complications among women treated with combined external beam and intracavitary radiation for cervix cancer were similar to those of prior retrospective studies.     

婴幼儿皮肤血管瘤P-32放射治疗的临床观察

目的:探讨P-32放射治疗婴幼儿皮肤血管瘤的临床效果及不良反应.方法:观察38例婴幼儿P-32放射治疗后的治疗效果及不良反应.结果:P-32放射治疗婴幼儿血管瘤一次治愈率76.3%,有效率100%.治疗中要及时注意皮肤局部损伤情况.结论:P-32放射治疗婴幼儿皮肤血管瘤方法有效,不良反应.     

Review of low-dose-rate radiobiology for clinicians

The use of therapeutic modalities that employ low-dose-rate (LDR) radiation is becoming increasingly prevalent in the clinic (eg, systemic targeted radiation therapy and brachytherapy). A natural tendency for radiation oncologists as they become familiar with these new therapies is to make predictions regarding efficacy and toxicity based on extrapolations from high-dose-rate radiobiology. If unfounded, these extrapolations could be misleading. This article discusses general principles of LDR radiobiology applicable to radioimmunotherapy.     

Effects of methylxanthines on cell-cycle redistribution and sensitization to killing by low-dose-rate radiation

The effects of two methylxanthines, caffeine and isobutylmethylxanthine (IBMX), on the response to radiation given at two low dose rates were studied in a human hepatoma cell line, HepG2. These dose rates are in the range to which tumor cells are exposed in radiolabeled immunoglobulin therapy of primary hepatoma. At the higher dose rate (0.3 Gy/hr for 24 hr), the radiation completely inhibited growth, and cells accumulated in the G2 phase of the cell cycle. Caffeine (1 mM), given either continuously or during the last 4 hours of the radiation exposure, counteracted the growth inhibition and G2 accumulation and enhanced cell killing. The 0.5-mM dose of IBMX had little effect on cells. For a lower dose rate and longer exposure period (0.06 Gy/hr for 3 days), the radiation partially inhibited growth and the accumulation of cells in G2 was small. Continuous, but not short, exposure to caffeine enhanced killing at this dose rate and counteracted the G2 accumulation. At the lower dose rate, IBMX enhanced the growth inhibition, G2 accumulation, and killing above that with radiation alone.     

Mortality in a cohort of radiation treated childhood skin hemangiomas

Mortality was studied in 18,357 patients (33% males and 67% females) with skin hemangioma admitted to Radiumhemmet between 1920 and 1959. The treatments of the hemangiomas were performed by radium-226 sources (13,094 patients) or x-ray therapy (2,540 patients). In 2,723 patients no radiotherapy was given. The median age was 6 months for the treated patients and 8 months for the patients not receiving radiotherapy. Between 1920 and 1951 a total of 154 patients were reported dead. The cohort was matched with the Swedish Cause of Death Register between 1952 and 1985. During that period 504 died, in 146 patients the cause of death was cancer or leukemia. The total number of person-years at risk was 587,426. In patients treated with radium-226 or orthovoltage x-rays, 410 deaths occurred (standardized mortality ratio (SMR) = 1.07; ns). In patients given contact therapy 34 deaths occurred (SMR = 0.82; ns) and in the not irradiated group 60 deaths occurred (SMR = 0.78; ns). Patients treated with radium-226 or orthovoltage x-rays had an SMR of 1.34 for all cancers combined (p less than 0.05). For patients treated between 1920 and 1939 the SMR for cancer was 1.53 (p less than 0.05) as compared to an SMR of 1.16 (ns) for those treated between 1940 and 1959.     

125I粒子持续低剂量率照射对前列腺癌PC-3细胞移植瘤的抑制作用

目的:探讨125I粒子持续低剂量率照射对前列腺癌PC-3移植瘤体内抑制作用的疗效,为前列癌治疗提供理论依据.方法: 利用体内粒子植入模型研究125I粒子持续低剂量率照射对前列腺癌PC-3移植瘤抑制作用.两颗粒子,线性排列,中间无间隔.每颗粒子活度1mCi.粒子植入后不同时间观察前列腺癌PC-3移植瘤体积变化和距离源中心层面不同垂直距离组织病理学变化.结果: 125I粒子组与假源粒子植入后不同时间测量肿瘤体积.125I粒子组均有不同程度的抑制作用,其中粒子植入后96h实验组肿瘤抑制作用差异有统计学意义(P<0.05).组织病理学研究显示125I粒子持续低剂量率照射不同时间后,距离粒子中心1.7mm处均有不同程度肿瘤细胞变性坏死,2.8mm处坏死区域明显减少,间质纤维化,增生明显.而空白对照组肿瘤细胞未见明显的变性坏死,周围亦无明显的纤维化.结论: 125I粒子持续低剂量率照射对前列腺癌PC-3移植瘤具有明显抑制作用,引起肿瘤组织变性坏死.     

^32磷玻璃微球肝动脉栓塞治疗肝癌的临床疗效观察

目的国产32磷玻璃微球（32P－GMS）治疗肝癌疗效观察。方法经度股动脉穿刺,导管选择性插管至肝动脉灌注32P－GMS超液化碘油混悬液,治疗原发性肝癌32例;转移性肝癌14例;随机对照组原发性肝癌18例用肝动脉栓塞化疗。结果治疗后3月观察原发性肝癌32P－GMS治疗组病灶缩小＞50％6例,50％～25％11例,＜25％～10％12例,有效率为90．63％（29／32）,对照组18例中14例有效（77．78％）,经Ridit分析和X2检验,二组无显著差异。转移性肝癌14例中11例有效。32P－GMS治疗肝癌总有效率86．96％（40／46）。32P－GMS治疗组未出现明显血液毒性。结论32P－GMS肝动脉栓塞是治疗肝癌的有效手段之一。     

Complete remission of nonresectable pancreatic cancer after infusional colloidal phosphorus-32 brachytherapy, external beam radiation therapy, and 5-fluorouracil: a preliminary report.

This is a preliminary report of five patients diagnosed with locally advanced nonresectable pancreatic cancer who achieved improved quality of life, delay of local progression, and reduction of biomarker CA 19-9 after infusion of colloidal phosphorus 32 (32P) and administration of combined chemoradiotherapy. A phase II trial using intratumoral colloidal 32P delivery for nonresectable pancreatic cancer without metastases is in progress. Patients initially were given infusions of decadron followed by macroaggregated albumin and 30 mCi colloidal 32P to the interstitial space of the tumor by two infusions 1 week apart. Through this method, doses ranging from 750,000 to 1,800,000 cGy were delivered. After administration of colloidal 32P, external radiation to a dose of 6000 cGy minimum tumor dose, including regional lymph nodes, was given concomitantly with four intravenous infusions of 500 mg bolus 5-fluorouracil on alternating days within the first 2 weeks after initiation of external radiation. All five of these patients demonstrated cessation of local tumor growth or regression of disease on serial computed tomography scans for a minimum of 10 months from completion of therapy. Three of these patients have survived without local disease progression over 24 months from initiation of therapy, with one patient approaching 36 months. CA 19-9 values for all patients declined within weeks after completion of therapy. This new method of isotope delivery has resulted in reduction of tumor volume, normalization of the biomarker CA 19-9, and improved performance status in those patients who have localized nonresectable disease without dissemination.     

区域注射磷—32玻璃微球对裸鼠移植性人肝细胞癌的形态学影响

目的：研究－３２玻璃微球（３２Ｐ－ＧＭＳ）区域注射对裸鼠移植性人肝细胞癌的形态学影响及其意义。方法：应用光镜、免疫组织化学及电镜观察对照组及治疗组的肿瘤组织学和超微结构特征。结果：对照组中，瘤体长径约３ｃｍ，瘤细胞排列紧密，呈小梁状，富于血窦，约５％瘤细胞坏死。治疗组中，瘤体长径为０．４～２ｃｍ，其中少部分瘤体边缘细胞排列紧密，大部分瘤细胞排列松散，呈网状或假腺样且被纤维血管束分割成巢。４０％～８０％的瘤细胞呈凝固性坏死。７５％以上排列紧密的瘤细胞ＰＣＮＡ阳性，而排列松散的ＰＣＮＡ阳性瘤细胞不足２５％。松散排列的瘤细胞较紧密排列的瘤细胞，桥粒显著减少、细胞变性坏死增多。结论：本研究提示局部内放射３２Ｐ－ＧＭＳ明显具有杀伤癌细胞和抑制肿瘤生长的作用。这为３２Ｐ－ＧＭＳ对肝癌治疗的实验研究和临床应用提供形态学依据。     

放射治疗诱发恶性肿瘤32例分析

研究恶性肿瘤放射治疗后诱发恶性肿瘤的发生因素。方法　回顾性分析 2 9年中放射诱发的 32例恶性肿瘤 ,其中原发肿瘤是宫颈癌的 2 4例、鼻咽癌的 6例、上颌窦癌的 2例。放射源为6 0 Co或 8MVX射线 ,常规分割照射 ,照射剂量为 40～ 12 0Gy。 结果　 32例放射治疗后 3～ 2 6年在原照射部位出现了肿瘤 ,其中 2 4例宫颈癌被诱发了直肠腺癌、臀部纤维肉瘤、膀胱移行细胞癌 ;6例鼻咽癌被诱发了硬腭鳞癌、软腭低分化腺癌、上颌窦骨肉瘤 ;2例上颌窦鳞癌被诱发了上颌骨骨肉瘤。结论　放射治疗可以诱发恶性肿瘤 ,主要与照射剂量、照射时年龄、照射部位有关。     

Subclinical thyroid disease after radiation therapy detected by radionuclide scanning

PURPOSE: The actuarial risk for developing benign or malignant thyroid disease following radiation therapy (RT) is controversial, but may be as high as 50% at 20 years. An effective screening modality should be specific but not overly sensitive, a limitation of ultrasound. We questioned whether Technetium-99 m pertechnetate ((99m)Tc TcO(4)(-)) scanning could detect clinically significant disease in ostensibly disease-free cancer survivors. METHODS AND MATERIALS: Eligibility criteria included an interval of at least 5 years after RT to the cervical region, a thyroid gland that was normal to palpation, euthyroid status determined by clinical examination, free T4 and TSH. The 34 patients scanned included 16 children (<18 years old) and 18 adults at the time of RT, 16 females and 18 males. The mean age at RT was 20 years (range, 2.1-50.3 years), and the mean age at (99m)Tc TcO(4)-scanning was 33 years (range, 13.6-58 years), providing a mean interval of 13 years (range, 5.3-26.6 years). The mean RT dose to the thyroid was 36.4 Gy (range, 19.5-52.5). Thyroid scanning was performed with a 5 mCi dose of (99m)Tc TcO(4)(-) obtaining flow, immediate and delayed static, and pinhole collimator images. RESULTS: Seven patients (21.6%) had abnormal scans, and the percentage was higher among children (25%) and females (25%) compared to adults (16.7%) and males (16.7%), respectively. Two of 34 patients (5.9%) were discovered to have a thyroid cancer; histopathologies were papillary and follicular carcinoma. CONCLUSION: In this population of clinically normal cancer survivors who had been irradiated to the cervical region, subclinical thyroid disease, of potential clinical significance, was detected by (99m)Tc TcO(4)(-) in about 20%. Children may be more commonly affected. Although the cost effectiveness of screening will require a larger sample number, we propose a surveillance schema for this patient population.