Role of radiation therapy in the treatment of melanoma

Melanoma has been widely described as radioresistant but this should not be construed as meaning that melanoma is radioincurable. Many melanoma cell lines are as radiosensitive as other tumors commonly treated successfully with radiotherapy (RT). The use of RT requires careful planning resulting in the administration of a tumoricidal dose to the tumor cells with adequate sparing of normal tissues. RT has been used for primary therapy, postresection adjuvant therapy and palliation of symptomatic melanoma. Curative RT has been given for uveal melanoma yielding patient survival equivalent to enucleation. RT has been administered to patients with unresectable disease yielding relatively favorable results. As an adjuvant therapy postoperatively, RT has been used selectively to improve local disease control. Finally, RT is used successfully as a palliative maneuver for symptoms related to distant metastatic melanoma in patients with incurable disease.     

Comparison of optimized single and multifield irradiation plans of antiproton, proton and carbon ion beams

Background and purpose

Antiprotons have been suggested as a possibly superior modality for radiotherapy, due to the energy released when antiprotons annihilate, which enhances the Bragg peak and introduces a high-LET component to the dose. However, concerns are expressed about the inferior lateral dose distribution caused by the annihilation products.

Methods

We use the Monte Carlo code FLUKA to generate depth-dose kernels for protons, antiprotons, and carbon ions. Using these we then build virtual treatment plans optimized according to ICRU recommendations for the different beam modalities, which then are recalculated with FLUKA. Dose-volume histograms generated from these plans can be used to compare the different irradiations.

Results

The enhancement in physical and possibly biological dose from annihilating antiprotons can significantly lower the dose in the entrance channel; but only at the expense of a diffuse low dose background from long-range secondary particles. Lateral dose distributions are improved using active beam delivery methods, instead of flat fields.

Conclusions

Dose-volume histograms for different treatment scenarios show that antiprotons have the potential to reduce the volume of normal tissue receiving medium to high dose, however, in the low dose region antiprotons are inferior to both protons and carbon ions. This limits the potential usage to situations where dose to normal tissue must be reduced as much as possible.     

Successful treatment of metastatic androgen-independent prostate carcinoma in a transsexual patient

The occurrence of prostate carcinoma in transsexual patients has rarely been reported. These cases present a unique challenge in that such patients are effectively receiving androgen deprivation therapy. By definition, their disease is androgen-independent prostate cancer, and the role of local therapy is undefined. We report on a male-to-female transsexual patient with metastatic prostate cancer treated successfully with combination chemotherapy after previous standard therapy failed.     

A randomized phase III study of neoadjuvant hormonal therapy in patients with localized prostate cancer

The primary objective of this randomized trial is to evaluate the benefit of the addition of neoadjuvant hormonal therapy to escalated-dose external-beam radiation therapy in the treatment of patients with intermediate-risk carcinoma of the prostate. A secondary objective of this study is to determine prognostic factors for radiation response. All patients will have tissue oxygenation measured and biopsies taken before treatment at the time of fiducial marker insertion for radiation treatment planning and daily monitoring. In addition, patients randomized to the neoadjuvant bicalutamide arm will be asked to consider having these studies repeated before initiation of radiation therapy (after 3 months of hormonal therapy).     

泰索帝联合吡柔比星治疗晚期乳腺癌的疗效观察

目的：观察泰索帝联合吡柔比星治疗晚期乳腺癌临床疗效及不良反应。方法：26例均有组织病理学细胞学诊断及可评价客观指标。采用泰索帝75mg/m^2 dl,静脉滴注1小时，用泰索帝前1天口服地塞米松10mg，连续3天。吡柔比星40mg/m^2 d2化疗。21天为1周期，2个周期评价疗效。结果：26例可评价疗效和不良反应。CR3例，PR 16例，NC5例，PD2例，有效率73．1％。不良反应主要为白细胞减少Ⅲ度占34．6％，Ⅳ度占26．9％，脱发Ⅱ度占46．2％，Ⅲ度占23．1％，腹泻Ⅱ度占34．6％Ⅲ度占23．1％。结论：泰索帝联合吡柔比星治疗晚期乳腺癌有效率较高，不良反应可以耐受。     

重组干扰素α—2b治疗晚期恶性肿瘤的作用

目的为验证干扰素α－２ｂ治疗晚期恶性肿瘤的疗效和毒性,用重组干扰素α－２ｂ（ｒ－ＩＦＮα－２ｂ）治疗恶性肿瘤１０２例。方法采用ｒ－ＩＮＦα－２ｂ肌肉注射,每周２次,第１周３×１０６ＩＵ／次;第２周６×１０６ＩＵ／次;第３～８周９×１０６ＩＵ／次。结果９０例可评价疗效的患者中,总有效率为１６．７％（１５／９０）,其中肾癌的有效率为１０．８％（４／３７,２例ＣＲ,２例ＰＲ）,恶性黑色素瘤的有效率为１４．３％（４／２８,４例ＰＲ）,恶性淋巴瘤的有效率为４／８（４例ＰＲ）,乳腺癌的有效率为３／１５（３例ＰＲ）,２例多发性骨髓瘤均无效。ＣＲ患者的中位缓解期为４０个月,而ＰＲ患者的中位缓解期只有４．８个月。主要不良反应为流感样症状,胃肠道反应和较轻微骨髓抑制。结论ｒ－ＩＦＮα－２ｂ具有一定抗肿瘤活性,可以将其作为第二线药物治疗肾癌、黑色素瘤及恶性淋巴瘤。     

The early history of radiotherapy: 1895–1939

The years 1895–1939 covered a period extending from the discovery of X rays to the end of the pre-atomic era. The events leading to Roentgen's discovery and the claims made for priority in the use of therapeutic X rays are discussed. Early X ray equipment and the attempts at dosage estimation are reviewed and a brief account is given of the development of curietherapy in its various forms, with particular reference to telecurietherapy.     

胰腺癌新辅助治疗和辅助治疗

胰腺癌的新辅助治疗和辅助治疗是目前胰腺癌研究的热点问题。新辅助治疗因为缺乏前瞻性随机对照研究,目前除进行临床研究外,仍不能被推荐为标准治疗方法。根据大宗病例的临床试验研究结果,胰腺癌术后化疗可以降低死亡风险,而放疗的作用仍有待进一步研究。     

Advances in combined radiation therapy for the management of rectal cancer

Significant advances have been made in the use of adjuvant radiation for patients with localized rectal cancer. Recent progress in adjuvant postoperative radiation regimens relates to the integration of systemic therapy into radiation, as well as redefining the techniques and sequences for both modalities. The adjuvant radiation management approach in both North America and Europe has been shifting towards preoperative adjuvant therapy to promote sphincter-preserving surgery and to decrease acute and late toxicity. Although 5-fluorouracil-based chemotherapy in combination with radiation remains the standard adjuvant therapy for rectal cancer, the integration of novel chemotherapeutic agents and biologic modulators remains an active area of investigation.     

胰腺癌经动脉介入治疗的研究现状

胰腺癌是一类恶性程度高、病情进展迅速、手术切除率低且预后极差的消化系统恶性肿瘤。患者常由于早期诊断困难而失去手术根治性切除的机会,且放、化疗等治疗效果不尽如人意。近年来,随介入技术的不断发展,微创性介入治疗已成为提高生存质量、延长生存期的重点研究方向之一。其中,经动脉灌注的介入联合化疗以其相对高效、安全、简便、并发症和不良反应较低等优点,成为无法手术切除的患者延长存活期,提高生活质量的重要治疗手段之一;而以动脉介入为主的新辅助治疗对提高患者的手术切除率以及生存率具有显著意义。在基因治疗成为肿瘤治疗研究热点的现况下,靶向治疗与介入治疗的结合将成为临床胰腺癌治疗的一个具有广阔发展前景的方向。     

Ad-p53与Ad-p16联合对人肺腺癌GLC-82细胞作用的体外实验研究 *

探讨腺病毒介导的p53与p16基因的联合对人肺腺病GLC-82疗效提高的可能性。方法：将分别携有p53基因、p16基因重组腺病毒(Ad-p53与Ad-p16)联合使用,通过细胞生长和存活实验、克隆形成实验、流式细胞分析、TUNEL检测、RT-PCR分析、免疫组织化学实验,观察其对人肺腺癌GLC-82细胞的作用。结果：在总感染强度相同的前提下,Ad-p53与Ad-p16联合导入GLC-82细胞,对细胞生长存活及克隆形成能力的抑制、以及所造成的凋亡效果比施用单种基因的效果强,表明p53基因与p16基因在体外疗效上互为协同。结论： Ad-p53与Ad-p16联合,可以提高对人肺腺癌GLC-82细胞的疗效。     

Improved control of bulky prostate carcinoma with sequential estrogen and radiation therapy

Patients with bulky prostate cancer have usually been treated by palliative measures because the likelihood of tumor control with definitive irradiation has been low and the development of distant metastases high. The addition of estrogen to irradiation has not been shown to be of value. However, we believe the method of estrogen administration may have been the cause for the apparent lack of benefit. Estrogen had been started either concurrent with irradiation or had been used for palliation and was given for long and unscheduled time periods prior to irradiation. We have used estrogen for two months prior to and concurrent with irradiation. We postulated that in those patients with estrogen responsive cancer, the reduced tumor burden prior to irradiation could enhance tumor control and survival. Between 1975 and 1980, 25 patients with bulky prostate cancer received sequential estrogen and irradiation, 12 patients irradiation alone and six patients irradiation after having become refractory to longterm estrogen use. One patient was lost to follow-up. Eighteen of 25 (72%) treated by sequential estrogen and irradiation, 14/17 (82%) with estrogen responsive cancer and 4/8 (50%) with estrogen resistant cancer had a complete tumor response. Six of 11 (55%) patients treated by irradiation alone and 2/6 (33%) treated by irradiation for estrogen refractory cancer had a complete tumor response. Disease-free survival was observed in 13/25 (52%) treated by sequential estrogen and irradiation, and 8/17 patients (47%) with irradiation. It is also possible the improved survival in the estrogen responsive group was a direct result of improved local control. Persistent local disease can act as a source for distant metastases. Distant metastases was observed in 15% of patients when the primary tumor was controlled and 30% when there was persistent or recurrent local disease. Also, progressive local disease can be an important cause of death. This was most evident in our patients with estrogen refractory cancer. Almost all patients in this group had progressive local disease that caused serious urinary bleeding and urinary infection that were considered the major cause of death. Our results suggest bulky prostate cancer should be aggressively treated when first diagnosed. The value of adjunct estrogen is unproven. Our results with the use of estrogen prior to and concurrent with irradiation is encouraging. Estrogen may shrink the cancer and allow for a more favorable geometry for external irradiation. Tumor control and survival may be thereby improved. The lower frequency of tumor control and survival of patients with estrogen resistant cancer indicates the need to explore other therapeutic approaches for this group of patients. A higher dose of external irradiation or the addition of chemotherapy prior to irradiation may be of value.     

睾丸生殖细胞肿瘤综合治疗的长期疗效

目的 分析睾丸生殖细胞肿瘤(TGCTs)患者的临床特征、综合治疗疗效、生存率以及与预后有关的因素。方法 对107例行高位睾丸切除 精索静脉结扎术、术后均行化疗的TGCTs患者进行回顾性分析。近期疗效比较采用χ^2检验;生存率的计算采用Kaplan-Meiel生存曲线;生存率的比较采用Log rank检验。结果 107例患者中位年龄32岁。精原细胞瘤33例(30．8％),其中Ⅰ期14例,占42．4％;非精原细胞瘤74例(69．2％),其中I期21例,占28．4％。临床分期和病理类型是影响患者预后的主要因素。患者总的3,5,10年生存率分别为75．8％、73．5％和73．5％。精原细胞瘤患者3,5,10年生存率分别为100％、96．8％和96．8％;非精原细胞瘤患者3,5,10年生存率分别为63、5％、61．7％和61．7％。64例患者可评价疗效,单用化疗的患者中,17例(26,6％)达CR,另有8例(12．5％)化疗加放疗或解救手术后达CR。获CR与未获CR者5年生存率分别为91．7％和26．2％。结论 Ⅰ期TGCTs预后好。采用以化疗为主的综合治疗可明显提高转移性TGCTs患者的疗效和生存率。     

妊娠恶性滋养细胞肿瘤34例诊治分析

为了分析恶性滋养细胞肿瘤的发病、诊断及治疗后转归,探讨妊娠恶性滋养细胞肿瘤临床分期的特点及最佳治疗手段,对34例妊娠恶性滋养细胞肿瘤患者采用5-氟尿嘧啶（5-FU）、放线菌素D静脉联合化疗和（或）顺铂（DDP）、5-FU、多柔比星介入化疗及栓塞治疗,甲氨蝶呤、5-FU局部化疗或联合手术治疗等手段。结果：Ⅰ、Ⅱ期侵蚀性葡萄胎（IM）和绒癌（CC）患者,经采用联合化疗、介入治疗兼手术治疗治愈率100％,Ⅲ、Ⅳ期患者采用联合化疗、手术治疗亦可获得较满意的效果。初步研究结果提示,恶性滋养细胞肿瘤应早诊断早治疗,采取以化疗为主、手术治疗为辅的综合治疗手段,多数患者可以获得相对满意的治疗效果。     

Phase II trial of clarithromycin and pamidronate therapy in myeloma

A phase II study to further evaluate any possible antimyeloma activity of clarithromycin was conducted following a report of possible clinical efficacy. Twenty patients, 11 male and 9 female with a median age of 73 yr, received clarithromycin 500 mg twice daily with monthly intravenous infusions of disodium pamidronate. None of the study patients received concomitant cytotoxic or steroid therapy. Ten patients had relapsed disease, five had refractory disease, four were previously untreated, and one patient was unsuitable for cytotoxic therapy. The median number of previous treatment modalities was 1.5. Serum M protein levels and urinary M protein excretion were monitored along with other parameters to assess response. Median duration of therapy was 16 wk and six patients had dose escalation. A significant decrease in M protein production occurred in one patient at wk 12 of therapy, which maximized following dose escalation to a 47% decrease from baseline. Two patients had incremental but unsustained M protein reductions. Serum/urine M protein levels remained static in six patients and rose in the remaining six evaluable patients. The M protein response rates in this study are much lower than those previously reported and do not confirm efficacy. In addition, the recently postulated antimyeloma activity of pamidronate may explain some of the M protein decreases.     

时辰化疗在晚期食管癌治疗中的疗效观察

目的:观察时辰化疗在晚期食管癌治疗中的疗效。方法:对85例晚期食管癌患者按信封法随机分为时辰化疗组(42例)和常规化疗组(43例)。时辰化疗组采用在放疗第1、8天分别行紫杉醇(PTX)时辰化疗,给予PTX60mg/m2,静脉滴入3h,每次用药于当天凌晨4∶00开始;顺铂(DDP)20mg/m2,d1～d5,于当天10∶00～22∶00给药,每3～4周为1个周期。常规化疗组PTX和DDP的用量同时辰化疗组,按常规输液时间10∶00左右进行,普通滴速,两组患者每化疗2个周期的间隔时间相同。两组患者化疗的同时给予放射治疗,单次剂量1.8～2Gy,靶区总剂量60～66Gy,6～7周照射。观察两组患者的治疗效果及影像学改善情况。结果:时辰化疗组总有效率为83.3%(35/42),明显高于常规化疗组60.5%(26/43),P<0.05。时辰化疗组毒副反应明显比常规化疗组低,主要为Ⅰ～Ⅱ度。结论:时辰化疗与常规化疗相比是一种高效低毒的治疗晚期食管癌的方法。     

Interstitial high dose-rate brachytherapy: principle, practice and first clinical experiences with a new remote-controlled afterloading system using Ir-192

In our newly developed remote-controlled afterloading system, a single Ir-192-source is moved within hollow stainless steel needles, which are arranged strictly parallel and are uniformly spaced. Dose calculation is performed by an especially designed computer program using geometrical bodies (ellipsoid, cylinder and plane parallel body) as idealized tumor shapes. Reference points for calculation are defined on the surface of the chosen geometrical body. Theoretical base, principles of dosage, handling and first clinical experiences after treatment of 28 patients are presented.     

Treatment outcomes of particle radiotherapy using protons or carbon ions as a single-modality therapy for adenoid cystic carcinoma of the head and neck

Background and purposeThe aim of this study was to retrospectively analyse the outcomes of cases of adenoid cystic carcinomas (ACCs) of the head and neck that were treated at a single institution with particle therapy consisting of either protons or carbon ions.Methods and materialsBetween February 2002 and March 2012, 80 patients were treated with proton therapy (PT) or carbon ion therapy (CIT) alone. PT and CIT were employed in 40 (50%) patients each, and more than half of the patients received 65.0 GyE in 26 fractions (n = 47, 59%).ResultsThe median duration of follow-up was 38 months (range, 6–115 months). For all patients, the 5-year for overall survival (OS) rate, progression-free survival (PFS) rate, and local control (LC) rate were 63%, 39%, and 75%, respectively. No significant differences between PT and CIT were observed. The 5-year LC rates for T4 and inoperable cases were 66% and 68%, respectively. Twenty-one patients (26%) experienced grade 3 or greater late toxicities, including three patients who developed grade 5 bleeding from nasopharyngeal ulcers.ConclusionsParticle radiotherapy for ACC achieves favourable LC, and its efficacy in inoperable or T4 cases is promising. There were no significant differences between PT and CIT in terms of OS, PFS and LC.