体外结合腔内放射治疗局部晚期直肠癌

目的 回顾性分析体外结合腔仙高剂量放射治疗局部晚期直肠癌的近期疗效和毒副反应。方法 以体外照射和腔内高剂量后装治疗局部晚期直肠癌，体外照射用^60Co或10MV－X线，三野等中心照射，盆腔总剂量50－60Gy/5-6周，腔内高剂量率后装治疗与体外照射同期进行，按肠腔狭窄程度选用不同外径的施源器。结果 全组64例病人经治疗肿瘤完全消失（CR）7例,肿瘤部分消退（PR）37例，1年生存率60．9％（39／64），疼痛缓解94．7％，止血率100％。近期毒副反应主要为腹泻（I－Ⅱ度）82．8％（53／64），（Ⅲ-Ⅳ度）12．5％（8／64）。结论 体外结合腔内放射治疗局部晚期直肠癌，可达到缓解症状，提高病人生活质量，延长生存时间的姑息目的。     

直肠癌腔内放射治疗

1989至1990年用高剂量率腔内放疗125例下段直肠癌。术前照射83例,照射超过病变上下缘各2cm,导管处1cm为剂量参考点,5Gy/f.2f/WK.DT30Gy～40Gy。放疗后3周手术。术后照长度超过吻合口上下各1.5处为剂量参考点,10Gy/f 1f/wk DT30Gy,局部淋巴结转移者用下腹穿野外照射DT38Gy。术前放疗中有4例改为单纯放疗,均于1年内死亡。3年生存率术前放疗为69.6％(55/79),术后放疗66.7％(28/42)。     

局部晚期直肠癌的术前同步放射治疗和化疗

目的 观察１５例局部晚期直肠癌术前放射治疗和化疗（术前放化组）后外科手术的结果，以同期２７例直肠癌术前放射治疗加手术治疗作为对照组，分析其疗效及毒副反应。方法 １５例局部晚期直肠癌予术前放射治疗（ＤＴ４０～４６Ｇｙ，２０～２３次，４～５周完成）加同步化疗（氟尿嘧啶加甲酰甲氢叶酸钙静脉滴注和脱氧氟尿苷口服），对照组为同期２７例局部晚期直肠癌，予术前放射治疗，ＤＴ４０～５０Ｇｙ，２０～２５次，４～５周     

晚期直肠癌姑息性放射治疗

本文收集我科1995年7月～1998年8月姑息放射治疗晚期直肠癌患者33例,取得满意疗效,报告如下。1　临床资料1.1　一般资料晚期直肠癌33例,男19例、女14例,平均年龄51岁。腺癌28例、粘液腺癌5例。其中直肠癌根治术后复发20例,术后复发间隔时间均超过半年。无手术切除指征患者13例,其中2例行乙状结肠造口术。临床表现为骶尾部疼痛32例,大便带血11例,会阴部结节、溃疡7例。ＣＴ检查主要表现为盆腔不规则软组织影,部分和膀胱、前列腺或骶尾骨前粘连。1.2　治疗方法全部病人均采用60Ｃｏγ或6ＭＶＸ线照射。常规全盆腔野照射,剂量为40Ｇｙ/(10～15…     

高剂量率后装放射治疗原发性阴道癌40例临床分析

目的分析高剂量率后装治疗原发性阴道癌的疗效。材料与方法1984年1月~1994年4月，共收治原发性阴道癌40例，全部采用外照射加腔内放疗，外照射采用60CO－γ线或直线加速器8MV－X线，腔内照射采用Buchler后装机的中间振荡源。结果所有病例均随访3年以上，40例病人Ⅱ、Ⅲ、Ⅳ期的3年生存率分别为71．4％、55．6％、0．0％，5年生存率分别为57．6％、46．6％、0．0％。轻度放射性直肠炎8例，轻度放射性膀胱炎6例，重度直肠炎1例。结论高剂量率后装安全方便，疗效可靠，适应于更多病例，注意保护，可维持患者正常功能。     

腔内放射治疗局部晚期直肠癌

我科1989年6月至1990年2月用高剂量率近距离腔内照射和体外照射治疗局部晚期直肠癌14例,现将治疗方法及近期疗效报告如下。 性别与年龄:男性9例,女性5例。年龄30—78岁。病变情况:不能手术切除者7例,病变累及     

国产奥沙利铂为主的联合化疗结合同期放射治疗晚期直肠癌

目的：了解和评价国产奥沙利铂联合氟尿嘧啶、亚叶酸钙联合同期放射治疗晚期直肠癌的有效性和安全性。方法：国产奥沙利铂(L-OHP)130mg/m^2静脉滴注2小时，第l天；氟尿嘧啶(5-Fu)300mg/m^2静脉滴注，第l～5天；亚叶酸钙(CF)200mg／m^2静脉滴注，第l～5天，2l天为l周期。治疗3周期。与化疗同步进行全盆腔放疗，体外照射DT50～60GY／25～30次(5～6周)。结果：共治疗52例，近期疗效完全缓解(CR)2例；部分缓解(PR)27例；总有效率55．7％。一年生存率为79．0％(4l／30)，2年生存率为48．0％(25／52)。主要毒副反应是消化道反应、神经毒性和放射性直肠炎，而骨髓抑制轻微。结论：国产奥沙利铂为主的联合化疗结合同期放疗治疗晚期直肠癌的效果好，其毒性患可以耐受.     

晚期直肠癌11例放射治疗疗效分析

我院1995年12月到1997年6月放射治疗晚期直肠癌11例(Duke C期3例,DukeD期8例)。随访6~25月,客观有效率10/11,症状改善率11/11。因此,放射治疗对晚期直肠癌的姑息治疗可取得较好的效果。     

宫颈癌高低剂量率^137铯腔内后装放疗的比较

回顾性分析高剂量率（HDR）和低剂量率（LDR）腔内后装治疗宫颈癌。LDR组采用我院1979年6月～1984年12月137铯腔内后装放射治疗子宫颈癌862例。HDR组采用我院1986年12月至1987年7月137铯腔内后装治疗宫颈癌135例。结果：5年存活率HDR组低於LDR组；Ⅱ级放射性直肠炎HDR组为13．0％，低於LDR组22．6％（P＜0．01）。两组Ⅱ、Ⅲ期患者中无癌存活5年以上者宫旁A点吸收剂量比值（HDR／LDR）为0．53～0．54。结论：此剂量率转换系数对指导临床实践有参考价值。     

Phase I Study of Lenvatinib and Capecitabine with External Radiation Therapy in Locally Advanced Rectal Adenocarcinoma

BackgroundNeoadjuvant chemoradiation with fluoropyrimidine followed by surgery and adjuvant chemotherapy has been the standard treatment of locally advanced stages II and III rectal cancer for many years. There is a high risk for disease recurrence; therefore, optimizing chemoradiation strategies remains an unmet need. Based on a few studies, there is evidence of the synergistic effect of VEGF/PDGFR blockade with radiation.MethodsIn this phase I, dose-escalation and dose-expansion study, we studied 3 different dose levels of lenvatinib in combination with capecitabine-based chemoradiation for locally advanced rectal cancer.ResultsA total of 20 patients were enrolled, and 19 were eligible for assessment of efficacy. The combination was well tolerated, with an MTD of 24 mg lenvatinib. The downstaging rate for the cohort and the pCR was 84.2% and 37.8%, respectively. Blood-based protein biomarkers TSP-2, VEGF-R3, and VEGF correlated with NAR score and were also differentially expressed between response categories. The NAR, or neoadjuvant rectal score, encompasses cT clinical tumor stage, pT pathological tumor stage, and pN pathological nodal stage and provides a continuous variable for evaluating clinical trial outcomes.ConclusionThe combination of lenvatinib with capecitabine and radiation in locally advanced rectal cancer was found to be safe and tolerable, and potential blood-based biomarkers were identified.Clinical Trial Registration {"type":"clinical-trial","attrs":{"text":"NCT02935309","term_id":"NCT02935309"}}NCT02935309     

食管癌体外加HDR腔内放疗疗效分析

1992年5月～1994年12月体外放疗50～60Gy／5～6周加高剂量率（HDR）腔内放疗10～15Gy／4～6；k／5～9天，2.5Gy／次，Bid治疗食管鳞癌56例（综合组），与同期单纯体外放疗60～70Gy／6．5～7周52例（对照组）比较。综合组1、2年生存率和2年局控率分别为76．8％、51．8％和63．5％。明显高于对照组的42．3％、28．8％和32．6％。食管X线片示病变长度≤7cm和无食管轴向异常者，综合组3年生存率分别42．3％和40．9％，明显高于对照组的14．8％和14．3％。综合组食管瘘发生率为3．6％，晚期食管良性狭窄率为7．4％。     

Comparisons between the KKU-Model and Conventional Rectal Tubes as Markers for Checking Rectal Doses during Intracavitary Brachytherapy of Cervical Cancer

Background: To compare the KKU-model rectal tube (KKU-tube) and the conventional rectal tube (CRT) for checking rectal doses during high-dose-rate intracavitary brachytherapy (HDR-ICBT) of cervical cancer. Materials and Methods: Between February 2010 and January 2011, thirty -two patients with cervical cancer were enrolled and treated with external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT). The KKU-tube and CRT were applied intrarectally in the same patients at alternate sessions as references forcalculation of rectal doses during ICBT. The gold standard references of rectum anatomical markers which are most proximal to radiation sources were anterior rectal walls (ARW) adjacent to the uterine cervix demonstrated by barium sulfate suspension enema. The calculated rectal doses derived from actual anterior rectal walls, CRT and the anterior surfaces of the KKU-tubes were compared by using the paired t-test. The pain caused by insertion of each type of rectal tube was assessed by the visual analogue scale (VAS). Results: The mean dose of CRT was lower than the mean dose of ARW (Dmean0-Dmean1) by 80.55±47.33 cGy (p-value <0.05). The mean dose of the KKU-tube was lower than the mean dose of ARW (Dmean0-Dmean2) by 30.82±24.20 cGy (p-value <0.05). The mean dose difference [(Dmean0-Dmean1)-(Dmean0-Dmean2)] was 49.72±51.60 cGy, which was statistically significant between 42.32 cGy -57.13 cGy with the t-value of 13.24 (p-value <0.05). The maximum rectal dose by using CRT was higher than the KKU-tube as much as 75.26 cGy and statistically significant with the t-score of 7.55 (p-value <0.05). The mean doses at the anterior rectal wall while using the CRTs and the KKU-tubes were not significantly different (p-value=0.09). The mean pain score during insertion of the CRT was significantly higher than the KKU-tube by a t-score of 6.15 (p-value <0.05) Conclusions: The KKU-model rectal tube was found to be an easily producible, applicable and reliable instrument as a reference for evaluating the rectal dose during ICBT of cervical cancer without negative effects on the patients.     

High-dose-rate stereotactic brachytherapy for patients with newly diagnosed glioblastoma multiformes

Purpose: To evaluate high-dose-rate (HDR) stereotactic brachytherapy (STBT) for glioblastoma multiforme (GBM). Materials and methods: Between August 1994 and December 1998, 28 patients with newly diagnosed GBM underwent surgery, external-beam radiotherapy (EBRT) and HDR STBT. STBT eligibility criteria included unifocal lesions, residual tumor <6cm in maximum diameter, supratentorial lesions, tumors not crossing the midline, tumors without subependymal spread and Karnofsky performance status (KPS) >60. STBT was delivered over five consecutive days with two fractions per day for a total median dose of 30Gy. Twenty-eight STBT eligible GBM patients treated with surgery and EBRT only over the same period were matched controls. Results: Median survival times for the STBT group and controls were 19.5 versus 12.5 months; one and two year survival rates were 89% versus 42% and 61% versus 28%, respectively (p=0.12). Using multivariate analysis, age, KPS and HDR STBT were significant factors predicting survival. By RPA class, 2-year survival rates for STBT and controls were: III – 78% versus 50%; IV – 40% versus 0%; V – 21% versus 15%, respectively. Corresponding median survival times in months were: 41.6 versus 21.2 (p = 0.39); 16.7 versus 12.1 (p = 0.36); 18.7 versus 10.6 (p = 0.02). No major complications were found in the STBT arm. Conclusions: Because of small patient numbers, median survival time increases were only statistically significant in the RPA Class V patients, but a strong survival time trend emerged favoring patients undergoing HDR STBT. Further prospective study is warranted to fully assess the merits of this technique for GBM management.     

Advances in External Beam Radiation Therapy and Brachytherapy for Cervical Cancer

The standard of care for the definitive treatment of locoregionally advanced cervical cancer is external beam radiation therapy (EBRT) with concurrent chemotherapy followed by a brachytherapy boost. Historically, EBRT was delivered via a two-dimensional technique based primarily on bony landmarks. This gave way to three-dimensional conformal radiation therapy, which allows for dose calculation and adjustment based on individual tumour and patient anatomy. Further technological advances have established intensity-modulated radiation therapy (IMRT) as a standard treatment modality, given the ability to maintain tumoricidal doses to target volumes while reducing unwanted radiation dose to nearby critical structures, thereby reducing toxicity. Routine image guidance allows for increased confidence in patient alignment prior to treatment, and the ability to visualise the daily position of the targets and organs at risk has been instrumental in allowing safe reductions in treated volumes. Additional EBRT technologies, including proton therapy and stereotactic body radiation therapy, may further improve the therapeutic index. In the realm of brachytherapy, a shift from point-based dose planning to image-guided brachytherapy has been associated with improved local control and reduced toxicity, with additional refinement ongoing. Here we will discuss these advances, the supporting data and future directions.     

区域动脉化疗加60Co外照射治疗晚期直肠癌

１９８５年至１９９５年采用区域动脉插管化疗加６０Ｃｏ外照射的方法治疗晚期直肠癌２５例，其中术后复发１３例，单纯造瘘９例，部分切除３例。化疗每次用顺铂２０ｍｇ，５－Ｆｕ５００ｍｇ，二者交替，１２天为１周期，２周期为１个疗程，化疗后行６０Ｃｏ外照射，肿瘤量５０～６０Ｇｙ／６～７周。全组１年、２年、３年生存率分别为５３．８％、３４．６％、８．０％，而单纯造瘘组２年生存率（３８．５％）高于术后复发组（３０．８％）。结果提示，对不能切除的晚期直肠癌较适宜采用这种治疗方法，而区域动脉化疗加放疗能有效地改善晚期直肠癌的预后。     

Contact X-Ray Brachytherapy for Early Rectal Cancer: A Review of Outcomes From a Single UK Centre

AimsColorectal cancer is the fourth most prevalent cancer in the UK. Fortunately, with modern surveillance programmes, more patients are being diagnosed at an earlier stage. Although surgical excision remains the gold standard, many patients have co-morbidities that preclude them from having radical surgery. Additionally, a number of patients do not wish to live with a permanent colostomy. Radiotherapy has an established role in the non-surgical treatment of patients with rectal cancer. Increasing the radiation dose to the tumour increases the chance of local control. Using contact X-ray brachytherapy (CXB) it is possible to escalate the dose to the tumour and minimise the dose received by surrounding normal tissues. The aim of this study was to evaluate the outcomes of patients from our centre who have undergone CXB with or without external beam radiotherapy.Materials and methodsA prospectively maintained and locally managed colorectal database was used to collect clinical details and outcomes for colorectal cancer patients. All patients who were treated with CXB at our institution from the commencement of the service in April 2014 to the end of December 2019 were analysed. There was a minimum of 18 months of follow-up.ResultsOne hundred and ninety-three patients received at least one fraction of CXB. The median age at first treatment was 72 years (range 33–103 years). Seventy-three per cent of patients were male. Of the operable or high surgical risk patients, 105 were treated radically with radiotherapy, 28 were treated radically with radiotherapy after local resection and 22 patients were medically unfit for surgery. Most patients received external beam radiotherapy 45 Gy/25 fractions (87/146) or 25 Gy in five fractions (35/146). Forty-seven patients received CXB as sole treatment (51% had previous radiotherapy). Of those with a response assessment, with a median follow-up of 35 months, 78% of all patients achieved a clinical complete response (cCR) or a near cCR, 6% had a partial response and 16% had persistent disease. Of 154 radically treated patients with a response assessment, 84% achieved cCR or near cCR, 19% (24/129) of these subsequently relapsed.ConclusionThis series shows that CXB is a well-tolerated and effective treatment in a diverse cohort of patients with rectal cancer. Comparable favourable oncological outcomes were seen, in keeping with previously published work.