放疗联合肝动脉栓塞化疗治疗原发性肝癌的研究进展

放疗和介入是目前不能切除的晚期原发性肝癌(PHC)患者的主要治疗方法,但由于各自适应证的限制影响其有效率.放疗技术的进步,特别是放疗联合肝动脉栓塞化疗(TACE)在肝癌治疗中的应用,为患者提供了更佳的治疗手段.     

原发性肝癌42例三维适形精确放疗联合介入治疗临床观察

 目的 探讨三维适形精确放疗联合介入治疗原发性肝癌的疗效。方法 将84例原发性肝癌患者随机分为介入组（A组）和联合组（B组）。A组应用肝功能化疗栓塞治疗3次，B组在肝动脉化疗栓塞治疗3 d后，应用三维适形精确放疗使总剂量达48～55 Gy。结果 A组和B组有效率分别为73.0 ％和90.5 %，1、2、3年生存率分别为：62.3 %、40.1 %、20.5 ％和71.1 ％、45.2 %、30.3 %。结论 三维适形精确放疗联合介入治疗能显著提高原发性肝癌疗效。     

原发性肝癌的三维适形放射治疗

近年来三维适形放疗得到很大发展,已单独或与其他方法联合治疗原发性肝癌。放射诱导性肝病是其最严重的并发症,Lyman公式可用来预测原发性肝癌三维适形放疗的肝脏耐受剂量。     

原发性肝癌的三维适形放射治疗

近年来三维适形放疗得到很大发展,已单独或与其他方法联合治疗原发性肝癌。放射诱导性肝病是其最严重的并发症,Lyman公式可用来预测原发性肝癌三维适形放疗的肝脏耐受剂量。     

三维适形放疗联合动脉化疗栓塞治疗原发性肝癌的疗效观察

目的探讨三维适形放疗联合经导管肝动脉化疗栓塞治疗原发性肝癌的临床疗效。方法随机将2008年11月至2011年11月住院治疗的130例原发性肝癌患者分为对照组和观察组,每组各65例。对照组患者行经导管肝动脉化疗栓塞治疗,观察组患者在三维适形放疗后再行经导管肝动脉化疗栓塞治疗,比较两组患者临床疗效和药物不良反应情况。结果观察组患者总有效率（78．5％）明显高于对照组的（61．5％）,差异有统计学意义（P〈0．05）;而对照组和观察组不良反应发生率差异无统计学意义（P〉0．05）。结论三维适形放疗联合经导管肝动脉化疗栓塞治疗原发性肝癌疗效确切,安全高效,不良反应少。     

国人精确放疗联合经肝动脉化疗栓塞术治疗原发性肝癌疗效的Meta分析

目的:比较精确放疗联合经肝动脉灌注化疗栓塞治疗原发性肝癌与单纯经肝动脉灌注化疗栓塞治疗的疗效。方法:通过计算机和手工检索全面收集国内关于精确放疗联合经肝动脉灌注化疗栓塞与单纯经肝动脉灌注化疗栓塞治疗原发性肝癌的临床对照研究文献,并按Cochrane协作网推荐的方法进行Meta分析。采用RevMan 5.0软件,应用固定效应模式分析,对符合纳入标准的12个研究进行Meta分析。结果:与单纯经肝动脉灌注化疗栓塞相比,精确放疗联合经肝动脉灌注化疗栓塞治疗原发性肝癌,肿瘤有效率与控制率均有明显提高,远期生存率亦有明显提高,两者间差异有显著性。结论:精确放疗联合经肝动脉灌注化疗栓塞治疗原发性肝癌疗效好,安全性高,值得推广。     

希罗达联合三维适形放疗在肝癌中的应用

 原发性肝癌是我国常见的恶性肿瘤之一，首选的治疗手段是手术切除病灶，但大多数患者就诊时已经属于中晚期，丧失手术切除机会。非手术治疗当中，三维适形放疗已广泛应用于治疗中晚期肝癌。肝癌单纯适形放疗疗效较差，我院从2003年1月~2005年6月始用希罗达联合适形放疗治疗35例原发性肝癌患者，现将治疗疗效报告如下：     

索拉菲尼联合放疗治疗原发性肝癌的研究进展

 适形放疗是原发性肝癌局部治疗的重要手段之一,但放疗后肝内、肝外转移率较高。索拉菲尼是目前肝癌治疗中惟一被证实有效的药物,可提高晚期肝癌患者的总生存期。索拉菲尼联合放疗,可提高肿瘤细胞辐射敏感性、抑制血管生成、缓解肿瘤乏氧状态、使细胞周期同步化。索拉菲尼联合放疗,已进行了大量生物学研究,Ⅰ、Ⅱ期临床试验也正在开展。     

热疗联合三维适形放疗治疗原发性肝癌 TACE 术后局部复发的临床研究

目的：探讨热疗联合三维适形放疗（3D—CRT）治疗原发性肝癌TACE后局部复发病例的疗效及不良反应。方法：40例接受TACE术后局部复发的原发性肝癌患者，随机分为实验组与对照组，实验组20例，行热疗联合三维适形放疗；对照组20例，仅采用三维适形放疗。结果：实验组与对照组近期有效率（CR＋PR）分别为85％、55％。不良反应发生上，实验组局部皮肤损伤显著。而在胃肠道反应、肝功能损害、骨髓毒性上与对照组无差异。结论：热疗联合三维适形放疗，能提高三维适形放疗治疗原发性肝癌TACE术后局部复发病例的近期疗效，且不良反应相似。     

2016年原发性肝癌放疗共识

随着技术进步,放疗对原发性肝癌的有效性和安全性都在不断提高,但国内至今仍无相关共识。因此,肝癌放疗的相关协会,包括中华医学会放射肿瘤学分会、中国生物医学工程学会精确放疗分会肝癌学组与消化系统肿瘤专家委员会、中国研究型医院学会放射肿瘤学分会肝癌学组共同讨论,最终形成原发性肝癌放疗共识。主要内容包括:对早中期肝癌患者,如不能进行手术切除或射频消融可考虑局部放疗,特别是SBRT;对中晚期肝癌患者,放疗可以和TACE或肝动脉灌注化疗或全身药物治疗联合,以提高治疗效果;对于晚期伴有远处转移的肝癌患者,放疗可以作为姑息减征手段,提高患者生活质量,延长生存期。虽然放疗是肝癌有效治疗手段之一,但仍需前瞻、随机、对照的Ⅲ期研究,以获得更高级别的临床证据,进一步确立放疗在肝癌治疗中的地位。     

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。     

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.     

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。     

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.