鼻咽癌放疗后继发性皮肤晚期放射损伤

目的 通过分析皮肤早期放射反应对皮肤晚期放射反应的影响,探讨皮肤的继发性晚期放射损伤。方法 对门诊随访的放疗后生存5年以上的335例鼻咽癌患者进行调查研究,其中放疗时中位年龄41岁(12～67岁),240例伴颈部淋巴结转移。鼻咽原发灶首程放疗中位剂量为70Gy(55～86Gy),以面颈野为主野放疗71例,以耳前野为主野放疗264例。颈部根治性放疗中位剂量为64Gy(46～72Gy),预防照射中位剂量为55Gy(21～67Gy)。48例合并化疗。根据1995年SOMA标准评价皮肤晚期放射反应。结果 随访间隔中位时间为14年(5～38年)。63例无皮肤晚期反应,1、2、3、4级皮肤晚期反应发生率分别为43.9%(147例)、20.9%(70例)、13.7%(46例)、2.7%(9例)。44例放疗中出现湿性脱皮反应,其中1、2、3、4级皮肤晚期反应发生率分别为41%(18例)、23%(10例)、30%(13例)和5%(2例);无湿性脱皮患者的相应发生率分别为44.3%(129例)、20.6%(60例)、11.3%(33例)和2.4%(7例),两者差异有统计学意义(χ²=17.42,P=0.002)。分层分析结果显示初诊时是否伴颈部淋巴结转移、放疗野及颈部淋巴结放疗剂量均对皮肤晚期反应发生有关,而性别、年龄及是否联合使用化疗与皮肤晚期反应的发生无关。 结论 严重的皮肤早期放射反应可能增加皮肤晚期放射反应,可能存在继发性皮肤晚期放射损伤。     

局部复发直肠癌超常规大分割同步放化疗疗效分析

目的 分析局部复发不能手术切除的直肠癌患者,采用超常规大分割放疗同步口服卡培他滨化疗的疗效、影响因素及不良反应。方法 选取2006年1月至2013年1月,本院收治的52例直肠腺癌术后局部复发的患者,均采用调强放疗(IMRT)技术,照射复发肿瘤区,肿瘤中位剂量63.4 Gy(61.6~64.4 Gy),2.2~2.3 Gy/次,5次/周;13例进行盆腔淋巴结预防照射采用同步补量IMRT技术,剂量45~50.4 Gy,1.8~2.0 Gy/次。全部患者均接受同步化疗,每天口服卡培他滨1 650 mg/m²,连续5 d/周。分析局部控制率(LC)、总生存率(OS)及不良反应。结果 全部患者完全缓解(CR)、部分缓解(PR)、稳定(SD)及局部进展(PD)分别为23.1%、38.5%、32.7%和5.8%。既往盆腔放疗与未放疗的有效率(CR+PR)分别为37.1%和71.1%(χ²=5.40,P<0.05); 单一区域复发疗效优于两个及以上区域复发者,有效率分别为81.8%和46.7%(χ²=6.63,P<0.05)。早期严重不良反应包括:3级皮肤反应19例(36.5%),3级血液学不良反应1例(1.9%)。4例患者晚期发生重度吻合口狭窄行横结肠造瘘。5年LC和OS分别为49.1%和23.1%。结论 局部复发直肠癌单纯局部大分割高剂量放疗同步口服卡培他滨化疗是可行的,早晚期不良反应可耐受,有较好的近期疗效和长期控制率。     

局部晚期直肠癌两组术前放疗剂量方案短期疗效分析

目的 评估局部晚期直肠癌新辅助放化疗不同放疗剂量短期疗效差异及耐受性。方法 回顾性分析2010年8月至2015年5月在本院接受新辅助放化疗的局部晚期直肠癌患者。根据放疗剂量分为46和50 Gy两组,同步化疗方案以卡培他滨为基础,<75岁且一般情况较好的患者联合奥沙利铂,所有患者完成新辅助放化疗和直肠癌根治术。结果 共有213例患者纳入研究,其中2010年8月至2013年8月接受46 Gy放疗剂量治疗61例,2013年9月至2015年5月接受50 Gy放疗剂量治疗152例,其中男性145例,女性68例;T₂期22例,T₃期180例,T₄期11例;下、中、上段直肠癌分别为82、115和16例。两组患者年龄、性别、治疗前T分期及N分期差异无统计学意义（P>0.05）,临床特征匹配。50和46 Gy组病理完全缓解（PCR）率分别为24.3%和18.0%（P>0.05）;病理缓解良好（GR）率分别为75.0%和67.2%（P>0.05）;T降期率分别为46.7%和39.3%（P>0.05）。T₃N₂/T₄亚组分析：50和46 Gy组CR率分别为23.3%和6.3%（P>0.05）;GR （病理消退分级3+4）率分别为72.1%和50.0%,差异无统计学意义（P>0.05）。T降期率为46.5%和31.3%,差异无统计学意义（P>0.05）。结论 50 Gy较46 Gy放疗剂量治疗局部晚期直肠癌未能提高肿瘤病理缓解率及T降期率,对T₃N₂/T₄期患者,两组差异也无统计学意义,远期疗效有待进一步随访验证。     

局部晚期直肠癌新辅助治疗同期加量调强与三维适形放疗随机对照研究

目的 评估局部晚期直肠癌新辅助治疗同期加量调强放疗对比三维适形放疗疗效及安全性。方法 前瞻性研究自2010年5月至2015年5月,临床分期为T₃/T₄或淋巴结阳性且肿瘤下缘距肛门10 cm以内初治直肠腺癌患者共130例。采用随机数字表法分为调强放疗组和三维适形放疗组,调强放疗组66例,三维适形放疗组64例。调强放疗方案为盆腔放疗剂量45 Gy,1.8 Gy/次,共5周,同步原发病灶及转移淋巴结外放1 cm加量放疗剂量至55 Gy。三维适形放疗为盆腔放疗45 Gy,1.8 Gy/次,共5周,两组于放疗第1~14天及第22~35天接受卡培他滨1 650 mg·m^-2·d^-1口服化疗。手术于放化疗结束后6~8周进行。结果 两组患者性别、年龄、肿瘤位置、病理分化程度以及临床分期基线指标差异均无统计学意义(P>0.05)。2例患者出现放疗终止情况,分别为调强放疗组1例3级腹泻与三维适形放疗组1例3级乏力。两组血液及非血液不良反应差异均无统计学意义,无4级及以上不良反应出现。手术类型及术后并发症两组差异均无统计学意义。术后4级病理降期(病理完全缓解)率调强放疗组为22.7%,三维适形放疗组为15.6%,两组比较差异无统计学意义(P>0.05),3级与4级病理降期率两组比例分别为42.4%和25.0%,两组比较差异有统计学意义(χ²=4.406, P=0.036)。结论 局部晚期直肠癌新辅助同期加量调强放疗为可行治疗方案,与三维适形放疗相比可进一步提高病理降期。临床试验注册 中国临床试验注册中心,ChiCTR-INR-16008004。     

直肠癌新辅助同步加量调强放疗对侧方淋巴结转移的影响

目的 在侧方淋巴结转移的直肠癌中,评估侧方淋巴结加量放疗的疗效及安全性。方法 2016年1月至2022年12月入组103例合并侧方淋巴结转移的直肠癌患者,按随机数表法分为加量放疗组52例和常规放疗组51例。加量放疗组在盆腔放疗50 Gy的基础上,侧方淋巴结同步加量放疗至60 Gy。常规放疗仅盆腔放疗剂量50 Gy。研究首要终点为侧方复发率,比较两组的疗效及不良反应。结果 加量放疗组和常规放疗组新辅助放疗的不良反应及手术并发症相仿,侧方淋巴结治疗有效率分别为76.9%和56.9%(χ²=4.69,P=0.03),局部复发率分别为7.7%和25.5%(χ²= 5.92,P = 0.015),侧方复发率分别为3.8%和23.5%(χ²= 8.49,P = 0.004)。单因素分析显示,同步加量放疗、放疗后侧方淋巴结短径< 5 mm以及术后淋巴结病理阴性为侧方复发相关因素;多因素回归分析显示,加量放疗(HR=6.42, 95% CI: 1.40~29.49)及放疗后侧方淋巴结短径<5 mm(HR=0.17, 95%CI: 0.04~0.66)为侧方复发的独立相关因素。两组3年无病生存率(DFS)分别为73.25%和62.6%(P＞0.05),3年总生存率(OS)分别为87%和82.5%(P＞0.05)。结论 侧方淋巴结转移直肠癌同步加量放疗安全有效,加量放疗和新辅助治疗后侧方淋巴结短径<5 mm是侧方复发的独立影响因素。     

膀胱癌术后放疗与第二原发直肠恶性肿瘤的关联性研究:一项基于大队列的回顾性研究

目的 探讨膀胱癌术后放疗与发生第二原发肿瘤直肠癌风险的关系。方法 从美国国立癌症研究所肿瘤监测、流行病学和结果数据库(SEER)(1975—2017)中纳入符合标准的膀胱癌患者75 120例。第二原发肿瘤定义为膀胱癌治疗后5年以上发生的直肠癌,第二原发肿瘤直肠癌的累积发病率通过Fine-Gray竞争风险回归进行估计。用泊松回归评估放疗患者与未放疗患者中直肠癌的相对风险。结果 在75 120例患者中,70 045例(92.4%)为白人,中位年龄65.8岁(54~74岁)。2 236例(3%)接受了术后放疗,72 884例(97%)仅接受了手术治疗。在放疗和非放疗患者中,30年随访期间直肠癌的累积发生率分别为0.93%和0.43%(P=0.004)。在竞争风险回归分析中,接受放疗与发生直肠癌明显相关(HR=1.86;95%CI 1.26~2.74,P=0.009)。直肠癌放疗相对风险(RR)随着直肠癌诊断时间越早增加越显著(1975—1985 v.s.1985—1994:RR=2.59;95%CI 1.20~4.86,P＜0.001),放疗时年龄越小发生第二原发肿瘤的概率越大(≤50岁vs.＞50岁:RR=7.89;95%CI 2.97~21.30,P＜0.001);使用泊松分布计算放疗患者直肠第二肿瘤相对风险均更高(RR=2.20;95%CI 1.45~3.18,P＜0.001),诊断日期调整后,放疗患者直肠第二肿瘤风险仍更高(RR=1.77;95%CI 1.17~2.57,P=0.009)。结论 膀胱癌放疗后发生直肠癌的风险增加,应积极随诊检查尽早发现膀胱癌放疗后相关的第二原发肿瘤直肠癌。     

非小细胞肺癌三维适形放射治疗后急性放射性肺损伤分析

目的 探讨非小细胞肺癌(NSCLC)三维适形放射治疗后放射性肺损伤发生的相关因素,为提高NSCLC局部控制率和改善生存质量提供参考。方法 收集2000年8月至2004年12月符合入组条件接受三维适形放疗的非小细胞肺癌患者107例,其中全程三维适形放疗48例,59例前程行传统常规放疗,后程行三维适形放疗。全组患者均为根治性放疗,处方剂量60~78Gy,中位剂量66Gy。结果 全组患者放射性肺损伤发生率为62.6%,≥2级放射性肺损伤的发生率为38.3%,其中2级23例占21.5%,3级14例占13.1%,4级4例占3.7%。单因素分析显示,慢性阻塞性肺病、照射野个数、双肺接受的平均剂量、双肺V₅~V₄₀对≥2级放射性肺损伤的发生均有显著性影响,其中双肺平均剂量、双肺V₂₀、疗前伴慢性阻塞性肺病为影响放射性肺损伤发生的独立性因素。 结论 NSCLC接受三维适形放疗者,应严格限制双肺接受的平均剂量和双肺V₂₀,尤其对放疗前伴有慢性阻塞性肺病者更应高度重视避免严重放射性肺损伤的发生。     

144例鼻咽癌常规放疗后鼻窦炎发生的因素分析

目的 探讨鼻咽癌患者常规放疗后鼻窦炎的发生情况及其影响因素。方法 回顾分析本院2000—2005年收治的放疗前无鼻窦炎而放疗后发生鼻窦炎的144例鼻咽癌患者资料,并就其影响因素进行分析。鼻窦炎的诊断用MRI法。T₁+T₂期82例,T₃+T₄期62例。鼻腔受侵58例,无鼻腔受侵86例。鼻咽灶为面颈联合野6 MV X线常规分割照射68~78 Gy, 6~8周,其中>70 Gy 55例、≤70 Gy 89例。颈部为6 MV X线+高能电子线照射,淋巴结阳性者64~74 Gy, 6~8周;阴性者50~54 Gy, 4~5周。结果 全组患者放疗后鼻窦炎总的发生率为86.8%(125例),其中T₃+T₄期的高于T₁+T₂期的,分别为94%(58例)和82%(67例),差异有统计学意义(χ²=4.32, P<0.05);鼻咽灶剂量>70 Gy的高于≤70 Gy的,分别为95%(52例)和82%(73例),差异有统计学意义(χ²=4.65, P<0.05) ;鼻腔受侵的高于未受侵的,分别为95%(55例)和81%(70例),差异有统计学意义(χ²=5.46, P<0.05)。鼻窦炎发生在放疗后3、6、12、>12个月的比例不同,分别占13.6%(17例)、31.2%(39例)、48.8%(61例)及6.4%(8例),差异有统计学意义(χ²=70.48, P<0.01)。结论 鼻咽癌患者常规放疗后鼻窦炎的发生率较高,并在1年内达最高峰;鼻腔有无侵犯、鼻咽照射剂量和T分期与放疗后鼻窦炎的发生有关。     

31例颅内室管膜瘤术后放射治疗的预后分析

目的 讨论颅内室管膜瘤的临床特点、治疗转归和预后因素。方法 回顾性分析2009年1月-2012年6月收治的31例颅内室管膜瘤术后放射治疗患者的临床资料,男22例,女9例,平均年龄18岁(3~60岁);17例患者行手术全切,14例患者行次全切除;平均放疗剂量53.9 Gy(48.6~60 Gy);观察疗效,分析患者3和5年的疾病无进展时间,总生存时间。对年龄、性别、肿瘤部位、手术切除情况、病理分级、放疗方式、放疗剂量、辅助治疗8个因素进行单因素分析,Cox比例风险模型分析影响预后的因素。结果 中位随访51个月。7例患者术后放疗后复发,5例为原位复发,2例发生全中枢播散。死亡患者6例,其中4例为儿童第Ⅳ脑室间变性室管膜瘤患者。3和5年的无进展生存率(PFS) 分别为80.6% 和75.9%,3和5年的总生存率(OS)分别为 83.9%和76.2%。手术全切组(17/31)和次全切除组(14/31)的3年和5年PFS分别为94.1%和64.3%,90.9%和57.1%,差异均有统计学意义(χ²=4.685、6.311, P<0.05);手术全切组和次全切除组的5年OS分别为83.3%和64.3%,差异有统计学意义(χ²=4.238, P<0.05)。放疗剂量≤55 Gy和>55 Gy两组患者的5年PFS分别为64.2%和100.0%,差异有统计学意义(χ²=4.210, P<0.05)。未观察到严重的不良反应。结论 手术是室管膜瘤的首选治疗方法,部分切除和间变性室管膜瘤患者,术后放疗是最重要的辅助手段。手术切除程度和放疗剂量影响室管膜瘤患者预后。     

192Ir高剂量率近距离放疗在结直肠癌术后复发肺内寡转移治疗的初步应用

目的 初步探讨运用近距离放射治疗结直肠癌术后复发肺内寡转移患者的临床疗效,评估其可行性。方法 回顾性收集河北省沧州中西医结合医院自2013年5月至2017年10月入院的结直肠癌术后肺内寡转移患者的病例,10例患者共15个病灶,采用CT引导下¹⁹²Ir高剂量率近距离放射治疗肺部转移病灶。应用定位CT扫描图像,将插植针置入肿瘤,在CT引导下调整插植针至合适位置,将插植完成后图像传至计划系统,勾画靶区和危及器官,进行三维重建,制定放疗计划,计划通过后实施治疗,采用单次放疗,剂量20 Gy。结果 10例患者均顺利完成治疗,1级不良事件发生率30%,其中1例为轻度咳嗽,2例为痰中带血,无严重不良事件发生。治疗后1年肿瘤局部控制率（LC）为93.3%,其中1例患者治疗6个月后局部进展,再次实施近距离放射治疗,中位无进展生存期（PFS）为8.5个月,中位总生存（OS）为14.7个月。结论 对于无法手术的结直肠癌术后复发肺内寡转移患者来说,近距离放射治疗是一种可选择的安全可行的治疗方式,短期内可重复治疗,不良反应小,肿瘤局部控制率佳。     

Hepatic Arterial Infusion Chemotherapy Using Fluorouracil Followed by Systemic Therapy Using Oxaliplatin Plus Fluorouracil and Leucovorin for Patients with Unresectable Liver Metastases from Colorectal Cancer

The purpose of this study was to assess retrospectively the sequential treatment of hepatic arterial infusion (HAI) chemotherapy followed by systemic therapy using oxaliplatin plus 5-flourouracil (5-FU) and leucovorin, namely, FOLFOX, for patients with liver metastases from colorectal cancer. We reviewed 20 patients with unresectable liver metastases from colorectal cancer. Patients were initially treated with HAI chemotherapy until disease progression (5-fluorouracil, 1000 mg/m² intra-arterial infusion, weekly) and then with FOLFOX thereafter (FOLFOX4, n = 13; modified FOLFOX6, n = 7). Adverse events, tumor response, and time to progression for each therapy were evaluated retrospectively, and overall survival was estimated. Toxicity of HAI chemotherapy was generally mild. Of 20 patients, adverse events leading to treatment discontinuation occurred in only 1 patient (5%) during initial therapy using HAI chemotherapy, while 9 patients (45%) exhibited adverse events during subsequent FOLFOX therapy. For HAI chemotherapy and FOLFOX, objective response rates were 85.0% and 35.0%, respectively, and median time to progression was 11.6 and 5.1 months, respectively. Median overall survival was 30.1 months. In conclusion, the sequence of HAI chemotherapy followed by FOLFOX is a promising treatment strategy for the long-term use of active chemotherapeutic agents, leading to a superior tumor response and fewer toxic effects in patients with unresectable liver metastases from colorectal cancer.     

选择性动脉化疗药物灌注及栓塞治疗结肠直肠癌肝转移

目的：探讨选择性动脉２化疗药物灌注及栓塞治疗结直肠癌肝转移的价值。材料与方法：对２７例失去手术机会的结直肠癌肝转移患者,采用经股动脉穿刺,选择性肝动脉插管灌注化疗药物（ＡＤＭ,ＣＢＰ,ＦＵＤＲ）,并用ＡＤＭ及磺化油乳化后栓塞肝动脉。结果：在第１疗程结束后,１９例患者肝内肿瘤有缩小,２５例ＣＥＡ降低,２３例上腹疼痛减轻或消失。１、２、３年生存率辊７０．４％、５１．９％、２２．２％。结论：经肝动脉化疗     

Clinical outcomes and dosimetric predictors of toxicity for re-irradiation of vaginal recurrence of endometrial cancer

OBJECTIVETo report clinical outcomes and dosimetric predictors of late toxicity for patients with vaginal recurrence of endometrial cancer treated with brachytherapy in the re-irradiation setting.METHODSOn retrospective review, 32 patients with vaginal recurrence of endometrial cancer received salvage brachytherapy with or without pelvic radiotherapy (RT) from 06/2003–12/2017. Prior RT modalities were vaginal brachytherapy (19, 59%), pelvic RT (7, 22%) or both (6, 19%). Image-guided brachytherapy was performed with CT- (25, 78%) or MR-guidance (7, 22%). Vaginal control, recurrence-free survival (RFS) and overall survival (OS) were estimated by Kaplan-Meier method. Late toxicity was graded by Common Toxicity Criteria for Adverse Events.RESULTSMedian time from prior RT to re-irradiation was 22 months (range, 4–140). Salvage RT modalities were pelvic RT and brachytherapy (25, 78%) or brachytherapy alone (7, 22%). With median follow-up of 47 months, 3/5-year vaginal control, RFS and OS rates were 64/56%, 47/41% and 68/42%, respectively. Six patients (19%) had no evidence of disease at 85–155 months. Late grade 2/3 GI, GU and vaginal toxicity rates were 13%/16%, 19%/13%, and 9%/16%. Cumulative D2cc rectum (sum of prior and salvage RT courses) was predictive of grade 2+ and grade 3 GI toxicity. Cumulative D2cc rectum for an estimated 10% risk of late grade 2+ and 3 GI toxicity was 86 Gy and 92 Gy, respectively.CONCLUSIONSSalvage image-guided brachytherapy in the re-irradiation setting results in modest local control and increased late toxicity for localized recurrent endometrial cancer. With long-term disease control, cumulative D2cc rectum may be used to reduce late GI complication risk.     

Results of whole lung irradiation and chemotherapy in comparison with partial lung irradiation in metastasizing, undifferentiated soft tissue sarcomas

The poor prognosis of patients with unresectable pulmonary metastases of soft tissue sarcoma is well known. In order to evaluate the beneficial effect of radiotherapy, we have treated 44 patients with pulmonary metastases of grade 3 soft tissue sarcoma from 1980 to 1986. In 36 patients the treatment volume was restricted to the single metastases up to a dose of 50 to 60 (9 to 10 Gy/week). The survival rate at one year was 18% and at two years 6%. Eight patients were treated with a combined regimen, consisting of cisplatin and ifosfamide with simultaneous whole lung irradiation. Irradiation was performed with 8 or 16 MV photons at a hyperfractionation of 2 x 0.8 Gy/day (8 Gy/week). After a dose of 12 Gy, the single metastases were boosted up to 50 to 60 Gy, with a second course of chemotherapy. In six of eight patients complete remissions were achieved, one patient showed a partial remission. The survival rate at 27 months was 50%. The patients with partial remission died from pulmonary progression at 23 months. One patient died after twelve months from a loco-regional recurrence in the tonsillar fossa without evidence of pulmonary disease. Side effects included alopecia and moderate bone marrow suppression approximately twelve days after each chemotherapy cycle. Pulmonary fibrosis was observed only at the high dose volume without impairment of respiratory function. From these observations the conclusion is drawn that whole lung irradiation simultaneously with cisplatin and ifosfamide chemotherapy provides good palliative results without relevant morbidity in patients with high grade unresectable pulmonary metastases of soft tissue sarcomas.     

Hepatic Arterial Infusion Chemotherapy through a Port-Catheter System as Preoperative Initial Therapy in Patients with Advanced Liver Dysfunction due to Synchronous and Unresectable Liver Metastases from Colorectal Cancer

Purpose We retrospectively evaluated the safety and efficacy of preoperative initial hepatic arterial infusion chemotherapy (HAIC) through a port-catheter system in patients with liver dysfunction due to synchronous and unresectable liver metastases. The aim of HAIC was to improve patients’ clinical condition for later surgical removal of primary colorectal cancer. Methods Port-catheter systems were placed radiologically in 21 patients (mean age 58.6 ± 8.1 years) with liver dysfunction due to synchronous liver metastases from colorectal cancer. Initial HAIC of 1,000 mg/m² 5-fluorouracil was administered weekly as a 5 hr continuous infusion through this system. Surgical removal of the primary lesion was planned after HAIC improved the liver function. Results Port-catheter system placement was successful in all patients without severe complications. Patients were followed up for a median of 309 days (range 51–998 days). After starting HAIC, no severe adverse events that caused drug loss and treatment postponement or suspension were observed in any of the patients. HAIC was performed a mean of 4.5 ± 3.0 times and the liver function improved in all patients. Curative (n = 18) or palliative (n = 1) surgical removal of the primary lesion was performed. The remaining 2 patients died because extrahepatic metastases developed and their performance status worsened; thus, surgery could not be performed. The median survival times of all patients and the operated patients were 309 and 386 days, respectively. Conclusion Initial HAIC administration is a safe and efficacious method for improving liver function prior to operative resection of primary colorectal cancer in patients with liver dysfunction due to synchronous and unresectable liver metastases.     

Re-irradiation combined with capecitabine in locally recurrent squamous cell carcinoma of the head and neck

Background

We performed a prospective phase II trial to investigate the safety and efficacy of radiotherapy combined with capecitabine in patients suffering from a recurrence of a squamous cell carcinoma of the head and neck (SCCHN) within a previously irradiated field.

Patients and methods

A total of 31 evaluable patients with recurrent SCCHN received re-irradiation with a total dose of 50?Gy (25 fractions over 5?weeks) up to a maximum of 60?Gy combined with 900?mg/m²/day capecitabine given on the days of radiotherapy.

Results

The median time to relapse after the first course of radiotherapy was 15?months. The overall response rate in our study was 68% including 6?patients with a complete response. The median overall survival was 8.4?months. Grade 3 or 4 mucositis occurred in 4?patients and 1?patient, respectively. No grade 4 hematological toxicities were observed; 1?patient had grade 3 anemia. The cumulative median lifetime dose was 116?Gy.

Conclusion

Capecitabine combined with re-irradiation is a well-tolerated treatment in patients with recurrent SCCHN. In light of its good tolerability, it appears to be a potential option for patients with a reduced performance status and may also serve as a basis for novel treatment concepts, such as in combination with targeted therapies.     

Image-guided interstitial high-dose-rate brachytherapy for dose escalation in the radiotherapy treatment of locally advanced lung cancer: A single-institute experience

PurposeTo evaluate the clinical outcome after CT-guided interstitial high-dose-rate (HDR) brachytherapy for dose escalation in the radiotherapy treatment of inoperable locally advanced non–small-cell lung cancer (NSCLC).Methods and MaterialsFrom 2005 to 2015, 16 patients with unresectable NSCLC were treated. Median age was 65.7 years (range, 52–86). The median tumor volume was 95.3 cm³ (range, 20.0–2000.0). The median prescribed HDR was 15.0 Gy (range, 7.0–32.0) delivered in twice-daily fractions of 6.0–8.0 Gy in 4 patients and in once-daily fractions of 7.0–15.0 Gy in 12 patients, respectively.ResultsAfter a median followup of 12.5 months, median overall survival and local control was 12.9 and 24.9 months, respectively. The corresponding median overall survival and local control rates at 1, 2, and 3 years were 56.2%, 37.5%, and 12.5% as well as 68.9%, 57.4%, and 43%, respectively. Apart from one Grade 1 cough episode persisting for 1 week and one patient developing a minor hemopneumothorax requiring no postprocedural drainage, no other adverse events were recorded.ConclusionsCT-guided interstitial HDR brachytherapy is a safe modality for radiation dose escalation which may play a role in the definitive radiotherapy treatment of locally advanced NSCLC.     

食管癌连续7天常规分割加速放射治疗的远期疗效分析

目的连续7d常规分割加速放射治疗方案和后程加速超分割放射治疗方案治疗食管癌的疗效比较。方法57例食管鳞癌患者随机分为两组，连续7d常规分割加速放射治疗组（连续组）29例和后程加速超分割放射治疗组（后超组）28例。连续组治疗方法1次，d，2Gy／次，7d，周，吸收剂量60Gy，30次，30d；后超组前半程为常规分割（5次，周，2Gy／次），照射至30Gy时改加速超分割（2次，d，1．5Gy／次，5d，周），吸收剂量60Gy，共35次，33～35d。结果连续组和后超组1年、2年、3年总生存率分别为62．07％、37．93％、25．60％和64．29％、35．71％、25．00％。1年、2年、3年局部控制率连续组和后超组分别为82．93％、70．59％、52．94％和70．38％、45．95％、40．84％，3年疾病特异性生存率连续组为28．72％，后超组为25．00％。两组间晚期反应差异未见统计学意义。结论连续组3年生存率与后超组相当，局部复发、未控和转移仍是食管癌放射治疗失败的主要原因。     

Neck Lymph Node Metastases from an Unknown Primary Tumor

Background and Purpose: Up to 10% of all neck lymph node metastases present without a known primary site. The optimal treatment strategy for these patients is still undefined. The purpose of this retrospective analysis is to assess the outcome in patients with neck metastases from an unknown primary tumor (CUP). Furthermore, prognostic factors and treatment modalities are discussed. Patients and Methods: From 1984 to 2003, 28 patients with squamous cell neck metastases from a CUP were treated at the authors institution. In 17 patients, neck dissection (twelve radical, five modified radical) was performed. In that case, adjuvant radiotherapy was carried out with a mean of 56.7 Gy. In eleven patients, only biopsies were done. These patients received definitive radiotherapy with a mean of 66.8 Gy. In summary, 25 patients received extended radiotherapy including both sides of the neck and potential mucosal primary sites. Additional chemotherapy was administered to five patients. Results: The duration of follow-up was 4.1–189.5 months (median 45.1 months). After this period of time, ten patients (36%) remained alive. 5-year overall survival was 40.1%, neck control rate 72.7%. No subsequent primary could be detected. Extracapsular extension and surgery had significant influence on prognosis. Grade 3 toxicity (mucositis or skin reactions) was seen in three patients; no hematologic toxicity > grade 2 was observed. 19 patients suffered from grade 2 xerostomia. Conclusion: With radical surgery followed by radiotherapy good survival rates in patients with neck metastases from a CUP can be obtained. Whether limited radiotherapy might be equal to extended irradiation and can reduce side effects, must be shown in ongoing clinical trials.     

伽玛刀立体定向放疗结合全脑照射治疗脑转移瘤临床效果分析

目的 分析立体定向放疗结合全脑照射治疗脑转移瘤的疗效和预后,同时观察服用替莫唑胺(TMZ)与放疗结合对患者生存率的影响。方法 脑转移瘤患者52例,按照治疗方法不同分为2组,一组为全脑照射(WBRT)+立体定向放疗(SRT,伽玛刀),共35例,一组为单纯SRT,共17例。全脑放疗分次剂量为1.8~3.0 Gy/次,1 次/d,5 次/周,总剂量D_T30~40 Gy,WBRT+SRT组全脑后伽玛刀补量采用45%~75%等剂量曲线包绕PTV,边缘剂量12~15 Gy,中心剂量20~30 Gy。单纯SRT组分次立体定向放疗采用45%~75%等剂量曲线包绕PTV,边缘剂量36~40 Gy,中心剂量70~80 Gy。随访1~2年。所选52例患者中有20例患者放疗期间及放疗后服用替莫唑胺胶囊,同步化疗组化疗方案为:口服替莫唑胺75 mg/m²,1次/d,直至放疗结束,放疗结束后再服用3~6个月,剂量改为150 mg/m²。结果 放射治疗后1~3个月,复查CT/MRI显示总有效率(CR+PR)为84.62%,WBRT+SRT组有效率为88.57%,SRT组有效率为76.47%;肿瘤的6个月及1年的局部控制率分别为92.10%和85.20%。WBRT+SRT组的平均生存期13.2个月,中位生存期11个月;6个月生存率为71.40%,12个月生存率为54.30%,18个月生存率为14.30%。SRT组的平均生存期10.2个月,中位生存期9个月;6个月生存率为41.20%,12个月生存率为23.50%,18个月生存率为5.88%。替莫唑胺+放疗与单纯放疗的6个月、12个月及18个月生存率分别为80.00%和56.30%、60.00%和37.50%、10.00%和12.50%。结论 WBRT+SRT治疗脑转移瘤总体上优于单纯SRT治疗。放疗+TMZ联合治疗与单纯放疗相比,替莫唑胺在放疗过程中服用可提高患者生存率,不良反应无显著增加。