Reirradiation for locally recurrent lung cancer previously treated with radiation therapy

PURPOSE: Local recurrence of lung cancer after previous external beam irradiation poses some problems for subsequent management. We retrospectively reviewed our series of patients with local recurrence of lung cancer to evaluate the efficacy and safety of reirradiation. PATIENTS AND METHODS: Between 1979 and 2000, 34 patients with local recurrence of lung cancer were retreated with external radiation. There were 29 males and 5 females ranging in age from 38 to 85 years (median: 69 years). At the time of reirradiation, the clinical stage was I or II in 2 patients, IIIa in 5 patients, IIIb in 14 patients, and IV in 13 patients. Reirradiation was performed in 18 patients with the aim of achieving a cure or prolongation of survival (radical treatment), while 16 patients were treated for improvement of their symptoms (symptomatic treatment). RESULTS: The median interval between the initial radiation therapy and reirradiation was 23 months, with a range of 5 to 87 months. The dose of initial irradiation delivered to the tumor ranged from 30 to 80 Gy (median: 60 Gy) in 1.5--2.0-Gy fractions per day. During reirradiation, it ranged from 10 to 70 Gy (median: 50 Gy) in 1.8--3.0-Gy fractions per day. The cumulative dose delivered to the tumor by treatments of both initial and second irradiation ranged from 56.5 to 150 Gy (median: 110 Gy). A response was observed in 14 out of 18 patients given radical treatment (complete response, 6; partial response, 8). Twelve of the 16 patients (75%) given symptomatic treatment also showed a symptomatic benefit. The overall survival rate after reirradiation was 43% at 1 year and 27% at 2 years, with a median survival time of 8 months. The median survival time after radical treatment was 15 months, with a range of 3 to 58 months, whereas that after symptomatic treatment was 3 months, with a range of 1 to 14 months. Six long-term survivors lived for more than 20 months. Reirradiation-induced toxicity included symptomatic radiation pneumonitis in 19 patients and symptomatic radiation esophagitis in 6 patients. These toxicities were not fatal, and radiation myelopathy was not caused by reirradiation. CONCLUSION: Based on this study, external beam reirradiation can achieve satisfactory results for local recurrence of lung cancer provided that attention is paid to the possible hazards.     

Is there a dose-effect relationship for the treatment of symptomatic vertebral hemangioma?

PURPOSE: Symptomatic vertebral hemangiomas are rare vascular lesions. Radiotherapy is the most common treatment. Because of a lack of information in the literature, uncertainty exists about the total radiation dose to be applied. METHODS AND MATERIALS: Individual data from our own and published patients with symptomatic vertebral hemangioma treated with radiotherapy alone were obtained. The data were pooled, and the impact of the total dose on complete pain relief was evaluated using the chi-square test. Because different single-fraction doses were used, the equivalent dose in 2-Gy fractions (EQD(2)) was used for the analysis. RESULTS: Complete data could be obtained from 117 patients. Patients were categorized according to total dose (EQD(2)) into two groups of similar size (Group A: 20-34 Gy, n = 62; and Group B: 36-44 Gy, n = 55). Radiation-induced complete pain relief was achieved in 39% (24/62) of the patients in Group A and in 82% (45/55) of the patients in Group B. The difference was statistically significant (p = 0.003). CONCLUSIONS: The data suggest a dose-effect relationship in the radiotherapy of symptomatic vertebral hemangiomas. We recommend a total radiation dose 36-40 Gy with a dose per fraction of 2.0 Gy.     

Radiotherapy for patients with metastatic brain tumor

Fourty-one patients with a metastatic brain tumor were analyzed to evaluate the usefulness of irradiation. The radiation was given conventionally 3 to 5 times a week with a fractional dose of 1.5 to 2 Gy. The mean survival times was 5.0 months in all cases. The survival times did not change in a dose of 20 to 60 Gy, and symptomatic response was also not perceived in this dose of 20 to 60 Gy. The condition of the primary disease seems to be deeply related to the survival time. It is considered that radiation therapy for brain metastasis is particularly useful in a patients with well-controlled, primary tumors and dose of more than 20 Gy should be given at least.     

Radiation therapy alone or combined with misonidazole in the treatment of locally advanced non-oat cell lung cancer: report of an RTOG prospective randomized trial

From September 1979 to February 1983, 268 patients with unresectable, locally advanced (RTOG Stage III), non-small cell lung cancer were randomized to receive radiation therapy alone (RT) (50 Gy large field and 10 Gy boost), or combined with misonidazole (400 mg/m2 2-4 hr prior to RT daily for 5-6 weeks to a maximum dose of 12 g/m2 or until tumor progression). One hundred twenty-three patients who received irradiation alone and 116 given RT + misonidazole were evaluable for toxicity, time to tumor progression, and survival as of April 1987. The distribution of patient characteristics was similar in both treatment groups; 59% of the patients had a Karnofsky score of 90 or better, 53% had adenocarcinoma or large cell tumors, and 47% had Stage T3 tumors. Complete tumor regression was reported for 33 (27%) patients treated with radiation therapy alone and 24 (21%) who received misonidazole + RT. Median survival was 8 months with RT alone and 7.4 months with misonidazole + RT. Ninety-five percent of the patients have died. Seventy percent of the patients treated with radiation alone and 77% of those treated with misonidazole + RT died of progressive disease. Three patients treated with radiation alone and two with RT + misonidazole died subsequent to radiotherapy-related pneumonitis or pulmonary fibrosis. There was no significant improvement in response rates, local control, or survival for patients who received daily misonidazole along with irradiation compared with patients treated by irradiation alone.     

"Instant-mix" whole brain photon with neutron boost radiotherapy for malignant gliomas

From July 1985 through March 1987, 44 consecutive patients with supratentorial, nonmetastatic anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM) were treated with whole brain photon irradiation with concomitant neutron boost at the University of Chicago. All patients had biopsy proven disease and surgery ranged from biopsy to total gross excision. Whole brain photon radiation was given at 1.5 Gy per fraction, 5 days weekly for a total dose of 45 Gy in 6 weeks. Neutron boost radiation was prescribed to a target minimum dose that included the pre-surgical CT tumor volume plus 1 cm margin. Neutrons were administered 5-20 minutes prior to photon radiation twice weekly and a total dose of 5.2 Gyn gamma was administered over 6 weeks. Median follow-up was 36 months. The median survival was 40.3 months for anaplastic astrocytoma (10 patients) and 11 months for glioblastoma multiforme (34 patients) and 12 months for the overall group. Variables that predicted longer median survival included histology (AA vs. GBM), age (less than or equal to 39 years vs. older), and extent of surgery (total gross or partial excision vs. biopsy) whereas tumor size and Karnofsky performance status did not have a significant influence. The median survival of the anaplastic astrocytoma group was better than expected compared to the RTOG 80-07 study (a dose-finding study of similar design to this study) and historical data. Reasons for this are discussed.     

时辰化疗联合放疗治疗晚期食管癌

目的探讨时辰化疗联合放疗治疗晚期食管癌的疗效。方法晚期食管癌患者80例,随机分为单纯放疗组（单放组）和时辰化疗联合放疗组（综合组）,两组各40例。时辰化疗方法：顺铂（DDP）联合5-氟尿嘧啶（5-Fu）静脉滴注,DDP20mg／m^2,每日10时至22时给药,5-Fu 500mg／m^2,每日22时至次日10时给药,5d为1个疗程,第29天重复。放疗：综合组肿瘤剂量56～60Gy,照射5～6周;单放组肿瘤剂量64—70Gy,照射6～7周,观察患者治疗的效果及影像改善情况,随访6～20个月。结果综合组和单放组总有效率分别为92．5％（37／40）及75．0％（30／40）,两组差异有统计学意义（P〈0．05）;综合组和单放组患者1年生存率分别为75．0％（30／40）和52．5％（21／40）,差异有统计学意义（P〈0．05）;2年生存率分别为47．5％（19／40）和30．0％（12／40）,差异有统计学意义（P〉0．05）。结论时辰化疗联合放疗是一种治疗晚期食管癌的有效方法。     

Long-term results of a pilot study of low dose cranial-spinal irradiation for cerebellar medulloblastoma

Between May 1974 and March 1983, 44 children with histologically verified cerebellar medulloblastoma were seen for post-operative cranial-spinal irradiation following attempted total tumor removal. Six patients were excluded from review because they received all or part of their treatment at another institution (3 patients) or did not complete the planned course of irradiation (3 patients). All of the 38 remaining patients were treated by a previously described technique on a 4 MeV Linear Accelerator with 55 Gy delivered to the primary tumor site. Prior to December 1978, 19 consecutive children (Group A) had spinal prophylactic doses of 30-40 Gy and brain prophylactic doses of 40-50 Gy. After the date, 25 Gy was given to the cranial-spinal axis of 19 consecutive children (Group B). This lower dose was arbitrarily selected with the hope of reducing morbidity in treated survivors and achieving the same tumor control. Risk factors that define good and poor prognosis were evaluated for each group, and there were no differences noted. Myelography and CSF cytology were not routinely performed. Follow-up for the 38 patients ranges from 20 months to 124 months. For the low risk patients, survival (12/15 or 80%) was independent of cranial-spinal radiation dose (Group A 6/8, Group B 6/7). For the high risk patients survival was poor (9/23 or 39%), not dependent on cranial-spinal radiation dose (Group A 5/11, Group B 4/12), and associated with failure at the primary site (10/14), often with CSF seeding (8/10). The other 4 failures include 2 who had moved outside the United States (details of failure are unknown), 1 with supratentorial, CSF seeding and distant metastases, and 1 with distant metastasis only. There were no isolated spinal failures. This pilot study shows that the prophylactic radiation dose to the cranial-spinal axis can be decreased to 25 Gy without jeopardizing control rate and survival in patients with medulloblastoma.     

射波刀治疗脑转移瘤临床疗效分析

目的 回顾性分析射波刀(Cyberknife)治疗脑转移瘤临床疗效.方法 搜集2007年前1年天津肿瘤医院资料完整、射波刀治疗的脑转移病例40例,其中原发灶为肺癌27例、乳腺癌4例、消化道肿瘤4例、肾癌1例、原发灶不明4例.脑转移病灶共计68个,最大直径0.4～7.5 cm,平均1.9cm.在脑转移发现时,35例患者原发病经手术或化疗达到部分缓解或者稳定状态.射波刀治疗以计划靶体积几何中心为射野等中心及剂量归一点,通过数百个方向的射线束照射,使得80%等剂量面必须包括95%以上计划靶体积.采用低分割照射5～25Gy/次,1～5次,总剂量18～36Gy.结果 失访2例,随访率为95%.射波刀治疗后1周评价临床症状改善有效率为90%(36例),3个月后复查颅脑强化CT或MRI后的病灶治疗有效(CR+PR+SD)率为94%(64/68).3个月局部控制率、1年生存率分别为78%(53/68)、68%(27例).在原病灶范围以外出现新发病灶14例(35%);新发病灶与年龄、是否行全脑放疗、肿瘤数目、肿瘤最大直径、射波刀单次治疗剂量、治疗次数和总治疗剂量等因素无关.结论 单纯射波刀作为脑转移首程治疗临床效果较好.     

Concurrent chemoradiotherapy combined with intraoperative radiotherapy for locally advanced pancreatic cancer: a feasibility study

Initial clinical results of concurrent chemoradiotherapy combined with high-dose intraoperative radiotherapy (IOR) for locally advanced pancreatic cancer were analyzed. Between June 1996 and May 1999, 6 patients with locally advanced pancreatic cancer without distant metastasis were treated with preoperative concurrent chemoradiotherapy followed by IOR. Preoperative radiation therapy was given by the dynamic arc conformal technique with a daily fraction of 1.8 Gy to a total dose of 45 Gy in 5 weeks. Cisplatin (5 mg/day for 4 weeks) and 5-fluorouracil (250 mg/day for 5 weeks) were administered continuously during preoperative radiation therapy. IOR as a single dose of 28 or 30 Gy was given to the gross tumor volume using electron beams of 15- to 22-MeV. Concurrent chemoradiotherapy was well tolerated, although all of the patients complained of nausea and fatigue. Two patients developed grade III leukopenia. No other serious acute toxicity was noted. The median survival time of the 6 patients was 17.5 months, which was significantly longer than that of our historical control treated with external radiation therapy with IOR (8 months), although the difference in survival was borderline significant (p=0.068). Concurrent chemoradiotherapy followed by high-dose IOR was well tolerated in patients with locally advanced pancreatic cancer, and the initial clinical results appeared promising.     

Proposal of human spinal cord reirradiation dose based on collection of data from 40 patients

PURPOSE: Driven by numerous reports on recovery of occult radiation injury, reirradiation of the spinal cord today is considered a realistic option. In rodents, long-term recovery was observed to start at approximately 8 weeks. However, prospective clinical studies are lacking. Therefore, a combined analysis of all published clinical data might provide a valuable basis for future trials. METHODS AND MATERIALS: We collected data from 40 individual patients published in eight different reports after a comprehensive MEDLINE search. These represent all patients with data available for dose per fraction and total dose of each of both treatment courses. We recalculated the biologically effective dose (BED) according to the linear-quadratic model using an alpha/beta value of 2 Gy for the cervical and thoracic cord and 4 Gy for the lumbar cord. In this model, a dose of 50 Gy given in single daily fractions of 2 Gy is equivalent to a BED of 100 Gy(2) or 75 Gy(4). For treatment with two daily fractions, a correction term was introduced to take incomplete repair of sublethal damage into account. RESULTS: The cumulative doses ranged from 108 to 205 Gy(2) (median dose, 135 Gy(2)). The median interval between both series was 20 months. Three patients were treated to the lumbar segments only. The median follow-up was 17 months for patients without myelopathy. Eleven patients developed myelopathy after 4-25 months (median, 11 months). Myelopathy was seen only in patients who had received one course to a dose of > or =102 Gy(2) (n = 9) or were retreated after 2 months (n = 2). In the absence of these two risk factors, no myelopathy developed in 19 patients treated with < or =135.5 Gy(2) or 7 patients treated with 136-150 Gy(2). A risk score based on the cumulative BED, the greatest BED for all treatment series in a particular individual, and interval was developed. Low-risk patients remained free of myelopathy and 33% of intermediate-risk patients and 90% of high-risk patients developed myelopathy. CONCLUSION: On the basis of these literature data (and with due caution), the risk of myelopathy appears small after < or =135.5 Gy(2) when the interval is not shorter than 6 months and the dose of each course is < or =98 Gy(2). We would recommend limiting the dose to this level, whenever technically feasible. However, it appears prudent to propose the collection of prospective data from a greater number of patients receiving doses in the range of 136-150 Gy(2) to assess the safety of higher retreatment doses for those patients in whom limited doses might compromise tumor control.     

伽玛刀治疗22例原发视神经鞘脑膜瘤的疗效分析

目的 探讨采用伽玛刀进行低分割、高剂量的分次立体定向放射治疗（FSRT）治疗原发性视神经鞘脑膜瘤的疗效。方法2004年8月至2010年3月收治原发性视神经鞘脑膜瘤22例患者,均采用Hyper SGSI型立体定向体部伽玛射线放射治疗系统进行FSRT治疗,1例进行常规分割,单次剂量2Gy;21例行低分割、高剂量的FSRT治疗,单次剂量3～5Gy靶区累积剂量为36～40Gy。治疗后6个月随访1次,中位随访时间25个月,观察患者的临床症状改善情况、视力保全率及肿瘤控制情况。 结果 截止于末次随访,全组患者的视力控制率为77.3％（17／22）,其中视力改善4例,稳定13例,下降3例,失明2例。视力控制率随时间变化略有下降,1年视力控制率为95.0％（19／20）,2年视力控制率为75.0％（9／12）,但差异无统计学意义（P＞0.05）。肿瘤控制率为100.0％,最大径缩小＞50％的8例（36.4％）,缩小25％～50％的11例（50.0％）,缩小＜10％～25％的3例（13.6％）。突眼症状改善率为100.0％,治疗前突眼度为（17.3±2.7）mm,治疗后突眼度为（14.9±1.5）mm（P＜0.05）。有10例患者出现治疗相关反应,对症治疗可恢复。 结论 采用低分割、高剂量的FSRT治疗原发视神经鞘脑膜瘤的疗效确切,但视力改善不明显,对于确切分割模式及剂量尚需进一步探讨。     

Radiation therapy combined with radiosensitizing agents for cerebral glioblastoma in adults

We analyzed our treatment results of 71 operated patients with cerebral glioblastoma treated by conventional external radiation therapy (mean dose 60.2 Gy) combined with radiosensitizing agents. More than 50% reduction of tumor volume was obtained in 20 patients (28.2%). A response rate of at least 40% was obtained in patients treated with combined ACNU-vincristine-nicardipine, ACNU-5FU-hydroxyurea, or cisplatin alone. The combination of ACNU and vincristine with or without nicardipine resulted in significantly longer survival. The median survival in this group was 101.1 weeks and the two-year survival rate was 45.9%; these results were significantly better than those achieved with other ACNU combinations or other combinations without ACNU. In the analysis of survival, factors correlated to longer survival were a patient age of younger than 45 years, wide resection of the tumor, a good postoperative performance status (KS 70%), a radiation dose of 68–72 Gy, small postoperative tumor remnants (< 20 cm³), no visible tumor after radiation therapy, and the administration of adjuvant chemotherapy. Maximum resection of the tumor and localized irradiation with a dose of 70 Gy combined with ACNU and vincristine appears to be the most effective treatment at present.     

Dose-response relationship in locoregional control for patients with stage II-III esophageal cancer treated with concurrent chemotherapy and radiotherapy

PURPOSE: To evaluate the correlation between radiation dose and locoregional control (LRC) for patients with Stage II-III unresectable esophageal cancer treated with concurrent chemotherapy and radiotherapy. METHODS AND MATERIALS: The medical records of 69 consecutive patients with clinical Stage II or III esophageal cancer treated with definitive chemoradiotherapy at the University of Texas M. D. Anderson Cancer Center between 1990 and 1998 were retrospectively reviewed. Of the 69 patients, 43 had received < or =51 Gy (lower dose group) and 26 >51 Gy (higher dose group). The median dose in the lower and higher dose groups was 30 Gy (range, 30-51 Gy) and 59.4 Gy (range, 54-64.8 Gy), respectively. Two fractionation schedules were used: rapid fractionation, delivering 30 Gy at 3 Gy/fraction within 2 weeks, and standard fractionation, delivering > or =45 Gy at 1.8-2 Gy/fraction daily. Total doses of <50 Gy were usually given with rapid fractionation. Cisplatin and 5-fluorouracil were administrated to 93% of the patients. RESULTS: The patient characteristic that differed between the two groups was that patients in the lower dose group were more likely to have had weight loss >5% (46.2% vs. 23.3%). The lower dose group had more N1 tumors, but the tumor classification and stage grouping were similar in the two groups. The median follow-up time for all patients was 22 months (range, 2-56 months). Patients in the higher dose group had a statistically significant better 3-year local control rate (36% vs. 19%, p = 0.011), disease-free survival rate (25% vs. 10%, p = 0.004), and overall survival rate (13% vs. 3%, p = 0.054). A trend toward a better distant-metastasis-free survival rate was noted in the higher dose group (72% vs. 59%, p = 0.12). The complete clinical response rate was significantly greater in the higher dose group (46% vs. 23%, p = 0.048). In both groups, the most common type of first failure was persistence of the primary tumor. Significantly fewer patients in the higher dose group had tumor persistence after treatment (p = 0.02). No statistically significant difference was found between the two groups in the pattern of locoregional or distant failure. The long-term side effects of chemoradiotherapy were similar in the two groups, although it was difficult to assess the side effects accurately in a retrospective fashion. On multivariate analysis, Stage II (vs. III) disease and radiation dose >51 Gy were independent predictors of improved LRC, and locoregional failure was an independent predictor of worse overall survival. CONCLUSION: Our data suggested a positive correlation between radiation dose and LRC in the population studied. A higher radiation dose was associated with increased LRC and survival in the dose range studied. The data also suggested that better LRC was associated with a lower rate of distant metastasis. A threshold of tumor response to radiation dose might be present, as suggested by the flattened slope in the high-dose area on the dose-response curve. A carefully designed dose-escalation study is required to confirm this assumption.     

体部伽玛刀治疗晚期胰腺癌的临床分析

目的:探讨体部伽玛刀治疗晚期胰腺癌的安全性和有效性。方法:采用SGS-Ⅰ型立体定向伽玛射线体部治疗系统(体部伽玛刀)治疗79例晚期胰腺癌患者。伽玛刀治疗采用三维立体定向治疗计划系统给予患者精确定位。在临床靶区(CTV)边缘外放5mm-10mm形成计划靶区(PTV);等剂量线为50%-60%,肿瘤≤5cm的单次周边剂量3.5-4.5Gy,肿瘤>5 cm的单次周边剂量3.0-4.0Gy;治疗总剂量为35-48Gy;治疗次数9-11次,大多数患者为每周5次治疗。观察病人的有效率、生存时间和临床受益率(CBR)。结果:伽玛刀治疗过程中88.9%患者上腹部及腰背部疼痛明显减轻;66.7%患者黄疸指数下降。CBR 69.6%。伽玛刀治疗3个月复查CT,病变部位达到CR 1例,PR 25例;总有效率(CR+PR)32.9%。主要不良反应为:恶心,呕吐,骨髓抑制。结论:伽玛刀是治疗晚期胰腺癌的安全、有效的治疗方法。为临床肿瘤医师提供了一个新的治疗手段。     

Randomized Pilot Study of 20 Gy in 5 Fractions versus 27 Gy in 3 Fractions Radiotherapy for Treating Painful Bone Metastases: A Single Institution Experience

Purpose: Radiotherapy is a very effective tool in the treatment of painful bone metastases. The aim of this study was to compare the palliative effect of radiotherapy between the standard fractionation schedule 20 Gy over 5 fractions (20Gy/5fr) and the high biological dose schedule 27 Gy over 3 fractions (27Gy/3fr) which is frequently used in Stereotactic body radio-surgery (SBRT). Methods: Patients were randomized to receive (20Gy/5fr)or (27Gy/3fr). The primary aim of the study was pain relief using the numeric rating scale (NRS), after three months of radiation therapy. Secondary end points include pain relief immediately after finishing radiation therapy (within one week), and narcotic relief after three months of radiation therapy. Results: Twenty-two patients with painful bone metastases were included. 12 patients received (20Gy/5fr) and 10 patients received (27Gy/3fr). Male patients were predominant on both arms (81.8%) with a mean age of 58 years [ranging between 19-72 years]. For pain relief after three months of radiation therapy, partial pain relief was documented in 9 patients (75%) with (20Gy/5fr) and in 8 patients (80%) with (27Gy/3fr) with a p- value of 0.6. Additionally, narcotic relief after three months was equal for both groups. For immediate pain relief, partial pain relief was seen in one patient (8%) with (20Gy/5fr) versus seven patients (70%) with (27Gy/3fr) with a p value of 0.06. The increase in immediate pain relief in the 27Gy arm was numerically but not statistically significant. Conclusion: SBRT and standard fractionation radiation therapy had equal effectiveness for pain relief, when the assessment was done after three months of radiation therapy. Interestingly, SBRT had a better immediate pain relief.     

Dose-response relationship in local radiotherapy for hepatocellular carcinoma

PURPOSE: Dose escalation using three-dimensional conformal radiotherapy (3D-CRT) is based on the hypothesis that increasing the dose can enhance tumor control. This study aimed to determine whether a dose-response relationship exists in local radiotherapy for primary hepatocellular carcinoma (HCC). METHODS AND MATERIALS: One hundred fifty-eight patients were enrolled in the present study between January 1992 and March 2000. The exclusion criteria included the presence of an extrahepatic metastasis, liver cirrhosis of Child class C, tumors occupying more than two-thirds of the entire liver, and a performance status on the Eastern Cooperative Oncology Group scale of more than 3. Radiotherapy was given to the field, including the tumor, with generous margin using 6- or 10-MV X-rays. The mean radiation dose was 48.2 +/- 7.9 Gy in daily 1.8-Gy fractions. The tumor response was assessed based on diagnostic radiologic examinations, including a computed tomography scan, magnetic resonance imaging, and hepatic artery angiography 4-8 weeks after the completion of treatment. Liver toxicity and gastrointestinal complications were evaluated. RESULTS: An objective response was observed in 106 of 158 (67.1%) patients. Statistical analysis revealed that the total dose was the most significant factor associated with the tumor response. The response rates in patients treated with doses <40 Gy, 40-50 Gy, and >50 Gy were 29.2%, 68.6%, and 77.1%, respectively. Survivals at 1 and 2 years after radiotherapy were 41.8% and 19.9%, respectively, with a median survival time of 10 months. The rate of liver toxicity according to the doses <40 Gy, 40-50 Gy, and >50 Gy was 4.2%, 5.9%, and 8.4%, respectively, and the rate of gastrointestinal complications was 4.2%, 9.9%, and 13.2%, respectively. CONCLUSIONS: The present study showed the existence of a dose-response relationship in local radiotherapy for primary HCC. Only the radiation dose was a significant factor for predicting an objective response. The results of this study showed that 3D-CRT can theoretically be used for treating primary HCC.     

体部伽玛刀治疗晚期胰腺癌的临床分析

目的：探讨体部伽玛刀治疗晚期胰腺癌的安全性和有效性。方法：采用SGS-Ⅰ型立体定向伽玛射线体部治疗系统（体部伽玛刀）治疗79例晚期胰腺癌患者。伽玛刀治疗采用三维立体定向治疗计划系统给予患者精确定位。在临床靶区（CTV）边缘外放5mm-10mm形成计划靶区（PTV）;等剂量线为50%-60%,肿瘤≤5cm的单次周边剂量3.5-4.5Gy,肿瘤〉5 cm的单次周边剂量3.0-4.0Gy;治疗总剂量为35-48Gy;治疗次数9-11次,大多数患者为每周5次治疗。观察病人的有效率、生存时间和临床受益率（CBR）。结果：伽玛刀治疗过程中88.9%患者上腹部及腰背部疼痛明显减轻;66.7%患者黄疸指数下降。CBR 69.6%。伽玛刀治疗3个月复查CT,病变部位达到CR 1例,PR 25例;总有效率（CR＋PR）32.9%。主要不良反应为：恶心,呕吐,骨髓抑制。结论：伽玛刀是治疗晚期胰腺癌的安全、有效的治疗方法。为临床肿瘤医师提供了一个新的治疗手段。     

Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05

PURPOSE: To determine the maximum tolerated dose of single fraction radiosurgery in patients with recurrent previously irradiated primary brain tumors and brain metastases. METHODS AND MATERIALS: Adults with cerebral or cerebellar solitary non-brainstem tumors 相似文献   

热疗加放疗治疗局部复发乳腺癌的疗效分析

目的评价热疗加放疗治疗局部复发乳腺癌的疗效.方法回顾性分析热疗加放疗治疗的85处病灶,其中39处病灶曾接受过放疗,未曾放疗的部位给予59.5±6.8 Gy(40～70 Gy)照射,曾放疗的病灶实施43.0±12.4 Gy(12～74.4 Gy)照射;热疗每周1次或1周2次,平均每例患者的热疗次数为4.5(2～9)次.结果治疗1个月后CR率为92.0%,过去未曾放疗的病灶CR率为47.1%(16/34),曾放疗过病灶的CR率为56.1%(23/41),虽然曾放疗组的剂量(43.0±12.4 Gy)明显低于未放疗组的剂量(59.5±6.8 Gy),但两组间CR率差异无显著性(P=0.40).治疗后4周时弥散/多发型病变较肿块/结节型病变的CR率高,而6个月后弥散/多发型的局部控制率却明显降低.结论局部热疗配合放疗可以提高复发乳腺癌的局部控制率,特别是对曾经接受过放疗的区域可以降低放疗的剂量.弥散/多发型肿块较肿块/结节型的病灶对治疗的反应较早,但是很容易在短时期内复发.     

Chemotherapy with low doses of radiation followed by definitive radiotherapy for advanced unresectable carcinoma of the head and neck

Thirty-six patients with advanced unresectable carcinoma of the head and neck were treated with a combination of three courses of chemotherapy and low doses of radiation, followed after 3 weeks by definitive irradiation. Each course was repeated every 3 weeks with the following sequence. Cisplatin (20 mg/m2) was given in a 20-minute infusion, followed by a 2-hour infusion of 5-fluorouracil (400mg/m2), on days 1,2,5, and 6. Low doses of radiation were given on days 3 and 4, followed by a 2-hour infusion of 5-fluorouracil (400 mg/m2) with a dose of 3 Gy on the target volume. For definitive irradiation, a total dose of 60 Gy was delivered in 30 fractions within 6 weeks. The complete response rate reached 30%, and the partial response rate was 30%. With a median follow-up of 11 months, median overall survival was 10 months; median survival was 21 months for patients with complete response, 9 months for patients with partial response, and 6 months for those with no response (P=.02).