三维适形放射治疗脑胶质瘤术后残存灶近期疗效分析

目的 :探讨增大分割剂量三维适形放射治疗 (3D CRT)脑胶质瘤术后残存灶的近期疗效及早期并发症的发生率。方法 :15例脑胶质瘤进入三维放射治疗组 ,其中星形细胞瘤Ⅰ～Ⅱ级 5例 ,Ⅲ级 7例 ,Ⅳ级 3例。 2～ 3Gy 次 ,1次 d ,5次 周 ,总剂量 5 1～ 6 0Gy。结果 :除 1例生存 10个月死于局部复发外 ,其余全部生存 6个月以上。其中 5例接受 3Gy分割量 ,17次照射的患者生存 11个月以上 ,无放射性脑损伤发生。结论 :大分割三维适形放射治疗脑胶质瘤残存灶患者有较好的近期疗效 ,无早期并发症 ,晚期并发症和远期疗效有待进一步观察     

三维适形放射治疗脑胶质瘤术后残存灶近期疗效分析

目的：探讨增大分割剂量三维适形放射治疗(3D-CRT)脑胶质瘤术后残存灶的近期疗效及早期并发症的发生率。方法：15例脑胶质瘤进入三维放射治疗组，其中星形细胞瘤Ⅰ～Ⅱ级5例，Ⅲ级7例，Ⅳ级3例。2～3Gy／次，1次／d，5次／周，总剂量51～60Gy。结果：除1例生存10个月死于局部复发外，其余全部生存6个月以上。其中5例接受3Gy分割量，17次照射的患者生存11个月以上，无放射性脑损伤发生。结论：大分割三维适形放射治疗脑胶质瘤残存灶患者有较好的近期疗效，无早期并发症，晚期并发症和远期疗效有待进一步观察。     

肺癌脑转移的治疗及预后分析

为探讨提高肺癌脑转移疗效的方法及影响预后的因素 ,1995年 5月 -2 0 0 0年 5月收治的 64例肺癌脑转移患者行手术加放疗、放疗加化疗和单纯放疗。放疗采用6 0 Coγ线或 6MV X线全脑照射 ,多发灶全脑照射 40～ 5 0Gy 4～ 5周 ,2Gy 次 ,5次 周 ;单发灶全脑照射 40Gy后局部野增加 10～ 2 0Gy。化疗采用威猛 (Vm 2 6) 10 0mg ,静脉滴入d1 ～d3;顺铂 (DDP) 5 0mg ,d1 ～d3;CCNU 12 0mg ,口服 ,d1 或CAP(环磷酰胺、多柔比星、顺铂 ) +CCNU方案 ,3～ 4周重复。手术加放疗的中位生存期和 1年生存率分别为 13个月和 71 4% ,明显放疗加化疗的 8个月和 40 % ,而放疗加化疗又明显高于单纯放疗的 5个月和 15 6% ,三者比较差异有显著意义 ,P <0 0 1。手术加放疗和放疗加化疗的综合治疗对肺癌脑转移有较好的疗效     

加速超分割放射治疗脑星形细胞瘤

目的评价加速超分割放射治疗对脑星形细胞瘤的疗效.方法92例脑星形细胞瘤不全切除的放疗患者分为4个组,常规放射治疗剂量每次1.8Gy～2.0Gy,每周5次,总剂量55～70Gy.超分割放射治疗剂量每次1.1Gy～1.2Gy,每天2次,间隔6小时,每周5次,总剂量60～70Gy.结果92例随访5年,Ⅰ～Ⅱ级1,3,5年局控率超分割组优于常规组,Ⅰ～Ⅱ级1,3,5年局控率高于Ⅲ～Ⅳ级局控率.结论加速超分割放疗方式可明显提高Ⅰ～Ⅱ级星形细胞瘤的局控率.但对于Ⅲ～Ⅳ级星形细胞瘤效果不够明显.同时肿瘤病理类型是影响脑星型细胞瘤预后的重要因素,超分割放疗效果亦与病理类型关系密切.     

立体定向放射治疗肺癌脑转移疗效分析

目的探讨不同放射治疗方法对肺癌脑转移的疗效.方法176例由病理学证实的肺癌脑转移患者分为4组:单纯全脑放疗(WBRT)组、全脑放疗加立体定向放射外科(WBRT SRS)组、单纯立体定向放射治疗(SRT)组、全脑放疗加立体定向放射治疗(WBRT SRT)组.SRS治疗单次靶区平均周边剂量8～20Gy,总剂量20～32Gy;SRT治疗单次靶区平均周边剂量2～5Gy,总剂量25～60Gy;WBRT1.8～2Gy/次,总剂量30～40Gy.结果四组的局部控制率分别为47.0%、87.7%、86.5%和78.0%;中位生存期分别为5.0,11.0,11.5和10.0个月;局部无进展生存期分别为3.33,8.33,9.33和7.67个月;颅脑无新病灶生存期分别为4.11,8.57,9.03和6.12个月.在死因分析中,WBRT组死于脑转移的比率为57.6%,较其他三组高.而WBRT SRS组的晚期放射反应的发生率为12.2%,较其他组高.结论肺癌单发脑转移瘤患者的最佳治疗方式是单纯立体定向放射治疗,治疗失败后再行挽救性全脑照射或立体定向放疗.对于多发脑转移,全脑放疗加立体定向放射治疗(WBRT SRT)在提高生存率以及减少并发症方面优于其他治疗方法.     

恶性脑胶质瘤的化疗以及与放疗的相互作用

脑恶性胶质瘤的治疗是一直困扰着医学界的一大难题,在所有的原发脑部恶性肿瘤,大约一半是胶质细胞瘤,按照WHO的分级标准,Ⅰ和Ⅱ级为低分级胶质瘤,III和IV级为高分级胶质瘤。高分级的胶质瘤大约占胶质瘤总数的75%,而且恶性程度极高,侵袭性很强,如果不治疗,往往在数周内导致死亡[1]。标准的脑原发肿瘤治疗包括手术、术后放疗,尽管放射治疗的一些新方法、新技术已经广泛应用于临床,并提高了局控率和生存时间,但相对于单纯手术后的4～5个月而言,手术加放射治疗的总的中位生存时间仍然只有9～12个月。近30年来的研究表明,辅助化疗的效果并不…     

治疗135例脑恶性星形细胞瘤的探讨

目的 :分析脑恶性星形细胞瘤手术后采用单纯放射治疗及放疗加颈动脉化疗的疗效。材料与方法 :1987年 8月～ 1992年 11月收治 135例脑恶性星形细胞瘤。分两组治疗 ,单放组 71例 ,综合组 6 4例。两组放疗剂量 DT5 5～ 70 Gy。综合组术后 4～ 15天行颈动脉化疗 ,10～ 15天后行放疗 ,放疗结束再化疗 1～ 3次。结果 :单放组中位生存期 17.5个月 ,综合组为 31.9个月。其中效果最好的是多形性胶质母细胞瘤。33例中 2 ,3,5年生存率分别 70 %、36 %、15 %。结论 :脑恶性星形细胞瘤术后采用综合组治疗方案疗效满意     

23例脑恶性胶质细胞瘤术后残留病灶三维适形放射治疗

[目的]探讨三维适形放射治疗脑恶性胶质细胞瘤(BMG)疗效.[方法]47例经CT或MRI证实术后病灶残留的BMG随机分为单纯常规放射治疗组(单放组)和X线三维适形放射治疗组(三维适形组).单放组24例,模拟机定位2Gy/次,1次/天,大野加缩野总剂量50Gy～54Gy,6周内结束照射;三维适形组23例,先共面或非共面多野照射常规剂量分割,5次/周,1.8Gy/次～2Gy/次,总剂量为40Gy～45Gy后缩野采用共面或非共面多野照射或非共面弧形旋转照射,PTV边缘剂量15Gy～20Gy(85%～90%等剂量曲线),中位平均剂量17.75Gy,4～5次分割.[结果]治疗结束后3个月进行CT或MRI检查,三维适形组的肿瘤消退率为78.2%,明显高于单放组45.8%,三维适形组1年生存率(91.3%)也明显高于单放组(58.3%).单放组治疗结束时达到CR的病人1年肿瘤复发率为50%,明显高于三维适形组的20%.后者恶心呕吐等颅内高压及对地塞米松依赖性的急性放射反应未见高于单放组.[结论]X线三维适形放射治疗可以提高BMG的局部肿瘤消退率、局部肿瘤控制率和病人的1年生存率,同时没有明显增加病人的急性毒性反应,长期生存率有待进一步观察.     

X线立体定向放射治疗脑恶性胶质细胞瘤的研究

目的　探讨X线立体定向放射治疗在脑恶性胶质细胞瘤 (BMG)治疗中的作用。方法　 1996年 10月～ 1998年 10月 ,112例CT或MRI证实术后病灶残瘤的BMG随机分为单纯常规放射治疗组 (单放组 )和常规放射治疗 +X线立体定向放射治疗 (立体定向放疗组 )。单放组 5 8例 ,男 40例 ,女 18例 ,年龄 16～ 76岁 (中位 40 .5岁 ) ,KPS6 0～ 70者 12例 ,>70者 46例 ;放疗前增强CT或MRI显示 ,肿瘤体积 1.0 0cm3 ～ 2 14 .78cm3 ,中位体积 2 1.0 0cm3 ;常规剂量分割照射 ,5次 /周 ,1.8～ 2Gy/次 ,总剂量 46 .2 0～ 6 5 .95Gy ,中位剂量 5 7.81Gy。立体定向放疗组共 5 4例 ,男 39例 ,女 15例 ,年龄 16～ 78岁 (中位年龄 44.5岁 ) ;KPS6 0～ 70者 8例 ,>70者 76例 ;肿瘤体积 1.76cm3 ～ 132 .0 0cm3 ,中位体积 2 2 .32cm3 ;先行常规照射 ,其照射野设计及其剂量分割与单放组相同 ,总剂量 45 .80～ 6 2 .45Gy ,中位剂量 5 5 .2 6Gy ;于常规放疗结束后 1周行立体定向放疗 ,采用非共面弧形旋转照射 ,PTV边缘剂量 8Gy～ 5 0Gy( 6 0 %～ 90 %等剂量曲线 ) ,中位 2 7.75Gy ;单次治疗 2 2例 ,分两次治疗者 2 8例 ,三次分割治疗者 6例 ,分次治疗的时间间隔为 1周 ;单次剂量 8Gy～ 5 0Gy ,中位单次剂量 15Gy。结果　治疗结束后 3个月CT     

放疗加诱导化疗治疗中晚期鼻咽癌疗效分析

目的　探讨化疗对中晚期鼻咽癌生存率的影响。方法　将 10 0例初次治疗被确诊为中晚期鼻咽癌 (Ⅲ、Ⅳ期 )的患者随机分为两组 :单纯放疗组 (单放组 )与诱导化疗加放疗组 (放化组 ) ,每组各 5 0例。单放组鼻咽平均剂量 70Gy 7周 (6 6～ 76Gy) ,颈部平均剂量 6 5Gy 6 .5周 (5 0～ 74Gy) ;放化组在照射前行顺铂 (DDP)加氟尿嘧啶 (5 Fu)化疗 2～ 3个疗程 ,1周后行放疗 ,鼻咽平均剂量 70 .4Gy 7.5周 (6 8～ 74Gy) ,颈部平均剂量 6 6Gy 7周 (5 0～ 72Gy)。结果　单放组与放化组 1,2 ,3年生存率分别为 88.0 %和 90 .0 %、6 0 .0 %和 78.0 %、4 4 .0 %和 6 8.0 % ,两组比较差异有显著性。单放组与放化组 1,2 ,3年局控率分别为 78.0 %和 86 .0 %、4 6 .0 %和 6 8.0 %、4 0 .0 %和 6 2 .0 % ,两组比较差异有显著性。单放组与放化组Ⅰ、Ⅱ级白细胞下降发生率分别为 10 .0 %、2 8.0 %、2 .0 %和 16 .0 % ;单放组与放化组Ⅰ、Ⅱ、Ⅲ级咽黏膜反应发生率分别为 8.0 %和 4 .0 %、82 .0 %和 76 .0 %、10 .0 %和 2 0 .0 %。无因毒副作用而延迟或中断治疗者。结论　放疗前行 2～ 3疗程诱导化疗能提高中晚期鼻咽癌生存率和局控率。     

Clinical and dosimetric study of radiotherapy for glioblastoma: three-dimensional conformal radiotherapy versus intensity-modulated radiotherapy

Journal of Neuro-Oncology - We aimed to compare three-dimensional conformal radiotherapy (3D-CRT) with intensity-modulated radiotherapy (IMRT) for the treatment of glioblastoma. Retrospective study...     

宫颈癌根治性放疗中三维适形调强放疗技术的应用

目的:探讨三维适形调强技术在宫颈癌放射治疗中的应用.方法:应用PubMed检索系统,以"宫颈癌、调强放疗"为关键词,检索2000-01-2009-10相关宫颈癌调强治疗文献.进一步筛选有关调强放疗在宫颈癌根治性放疗中降低胃肠道及骨髓毒性、靶区的勾画原则及调强放疗在后程推量中的应用的文献有26篇.结果:盆腔、盆腔延伸野适形调强放疗可以降低小肠、骨髓、直肠、膀胱和肾脏在高剂量区的受照射体积,降低严重急性毒性的发生率.膀胱、直肠充盈状态及肿瘤体积的变化,导致子宫体、子宫颈位移.每周进行CT或MR定位扫描并进行靶区勾画及计划设计可以减少危及器官在计划靶体积(PTV)中的受照射体积.在宫颈癌根治性放疗中建议使用调强技术与腔内技术结合进行后程推量治疗.结论:三维适形调强放射治疗在宫颈癌根治性治疗中具有重要的意义,临床治疗结果仍在观察中.     

Comparison of conventional radiotherapy and intensity-modulated radiotherapy for post-operative radiotherapy for primary extremity soft tissue sarcoma

Introduction

Doses in conventional radiotherapy for extremity soft tissue sarcoma (STS) potentially exceed normal tissue tolerances. This study compares 3D-conformal radiotherapy (3D-CRT) with intensity-modulated radiotherapy (IMRT) in optimising target volume coverage and minimising integral dose to organs-at-risk (OAR).

Methods and materials

Ten patients undergoing post-operative radiotherapy for extremity STS were assessed. PTV₁ was defined as tumour bed plus 5 cm superiorly/inferiorly and 3 cm circumferentially, PTV₂ was defined as 2 cm isotropically. OAR were defined as whole femur, neurovascular bundle, tissue corridor and normal tissue outside PTV₁. For each patient 2-phase 3D-CRT was compared to 2/3 field (2/3f) and 4/5 field (4/5f) IMRT with simultaneous integrated boost (SIB). The primary planning objective was to minimise femur and skin corridor dose. Volumetric analysis and conformity and heterogeneity indices were used for plan comparison.

Results

A planning protocol containing dose/volume constraints for target and OAR was defined. 4/5f IMRT showed greatest conformity and homogeneity. IMRT resulted in significantly lower femur V45 using 2/3f (p = 0.01) and 4/5f (p = 0.0009) than 3D-CRT. 4/5f IMRT resulted in significantly lower normal tissue V55 (p = 0.004) and maximum dose (p = 0.04) than 3D-CRT.

Conclusions

A reproducible set of planning guidelines and dose-volume constraints for 3D-CRT and IMRT planning for extremity sarcomas was devised. 4/5f IMRT with SIB resulted in better target coverage and significantly decreased OAR dose. Further evaluation of this technique within a clinical trial is recommended to demonstrate that the technical benefit of the more complex technique translates into patient-derived benefit by reducing late toxicity.     

Optimization of radiotherapy

Carcinoma of the nasal pharynx, Spinal cord, Optimization of therapy, Treatment characteristic (TC), Radiotherapeutic operating characteristic (ROC).     

Costs of radiotherapy

A systematic assessment of radiotherapy for cancer was conducted by The Swedish Council on Technology Assessment in Health Care (SBU) in 2001. The assessment included an overview of the capacity for radiotherapy in terms of infrastructure of cancer care and an estimation of the costs of radiotherapy in Sweden. A postal questionnaire distributed to all 16 centres of radiotherapy in Sweden showed the following results: In 2000 there were 57 accelerators with complementary equipment in operation, 24 of which had been installed 10 or more years ago earlier. The total cost of external radiation therapy was estimated at SEK 427 million in the year 2000, or approximately 5% of the estimated total cost of oncology care in Sweden. The total cost of brachytherapy was estimated at SEK 43 million or about one-tenth of that of external radiotherapy. The total cost of external radiotherapy has increased since the last inquiry (1991) by about 16% more than the general inflation in Sweden, but at the same time the volume of fractions has increased by about 37%. Thus, an increase in the efficiency of external radiotherapy, calculated per fraction, was achieved in the 1990s. At the department level, there was a clear correlation between cost of salaries and output of fractions of external radiotherapy, thus indicating the adaptation of manpower to the volume of patients. There was an even higher correlation between the number of accelerators and the volume of fractions of radiotherapy, which suggests the occurrence of certain economies of scale in Swedish external radiotherapy.     

Comparison of intensity-modulated radiotherapy, adaptive radiotherapy, proton radiotherapy, and adaptive proton radiotherapy for treatment of locally advanced head and neck cancer

Background and purpose

Various radiotherapy planning methods for locally advanced squamous cell carcinoma of the head and neck (SCCHN) have been proposed to decrease normal tissue toxicity. We compare IMRT, adaptive IMRT, proton therapy (IMPT), and adaptive IMPT for SCCHN.

Materials and methods

Initial and re-simulation CT images from 10 consecutive patients with SCCHN were used to quantify dosimetric differences between photon and proton therapy. Contouring was performed on both CTs, and plans (n = 40 plans) and dose-volume histograms were generated.

Results

The mean GTV volume decreased 53.4% with re-simulation. All plans provided comparable PTV coverage. Compared with IMRT, adaptive IMRT significantly reduced the maximum dose to the mandible (p = 0.020) and mean doses to the contralateral parotid gland (p = 0.049) and larynx (p = 0.049). Compared with IMRT and adaptive IMRT, IMPT significantly lowered the maximum doses to the spinal cord (p < 0.002 for both) and brainstem (p < 0.002 for both) and mean doses to the larynx (p < 0.002 for both) and ipsilateral (p = 0.004 IMRT, p = 0.050 adaptive) and contralateral (p < 0.002 IMRT, p = 0.010 adaptive) parotid glands. Adaptive IMPT significantly reduced doses to all critical structures compared with IMRT and adaptive IMRT and several critical structures compared with non-adaptive IMPT.

Conclusions

Although adaptive IMRT reduced dose to several normal structures compared with standard IMRT, non-adaptive proton therapy had a more favorable dosimetric profile than IMRT or adaptive IMRT and may obviate the need for adaptive planning. Protons allowed significant sparing of the spinal cord, parotid glands, larynx, and brainstem and should be considered for SCCHN to decrease normal tissue toxicity while still providing optimal tumor coverage.     

放疗技师独立模拟定位的可行性分析

目的:探讨放疗技师独立模拟定位的可行性和意义。方法:根据医师填写的模拟定位申请单,应用模拟定位机独立完成照射野设计,医师审核计划并确定治疗剂量和分割方式后实施治疗。结果:技师独立完成603例各种肿瘤患者的模拟定位,二次定位率5.3%(32/603)。结论:技师独立模拟定位具有可行性。     

Flash放疗

Flash放疗是利用超高剂量率超快辐射所产生的对正常组织有保护作用的Flash效应进行的放疗。由于其独特的放射生物学优势,Flash放疗正受到学术界和工业界越来越多的关注,成为了当前放疗领域的前沿热点。本文总结了目前已开展及计划开展Flash照射实验报道,对各类细胞和动物实验、实验条件及实验结果等进行了归纳;同时介绍了Flash效应可能的生物学机理和分析了Flash放疗面临的挑战,对潜在的临床应用进行了展望。     

鼻咽癌常规放疗与调强放疗的临床研究

目的:比较鼻咽癌不同放疗方式的远期并发症发生情况及远期疗效.方法:采用门诊随访、电话随访、随访信等方式,调查2003-01-01-2006-07-31在我院行放射治疗的145例鼻咽癌患者临床资料,分析不同放疗方式远期并发症发生率及远期疗效.其中常规放疗68例,调强放疗77例.随访的远期并发症包括口干、张口受限、放射性龋齿、听力下降、颈部纤维化等.所有的远期并发症均视为二分类变量.结果:常规放疗组和调强放疗组口干、颈部纤维化的发生率分别为94.1％和61.0％(x2=22 012,P＜0.01)、41.2％和15.6％(x2=11.839,P=0.001),张口受限、放射性龋齿、听力下降的发生率分别为35.3％和26 0％(x2 =1.484,P=0.223)、35.3％和28.6％(x2=0.753,P=0.385)、52.9％和40.0％,x2 =2.846,P=0.092.常规放疗组和调强放疗组5年生存率分别为60.5％和77.4％,x2=4.320,P=0.038.结论:鼻咽癌调强放疗远期并发症的发生率低于常规放疔,远期疗效明显优于常规放疔,但调强放疔仍存在部分远期并发症,影响患者的生存质量.