Cancer of the pelvis: definitive three-dimensional conformal radiotherapy for patients with isolated recurrence in the para-aortic lymph nodes

The purpose of this study was to evaluate the outcome of definitive three-dimensional conformal radiotherapy (RT) for isolated para-aortic lymph node (LN) recurrence in patients with controlled primary cancer of the pelvis. Twenty-four consecutive patients with isolated para-aortic LN recurrence were retrospectively analyzed. The patients were included in this study if they were eligible to receive definitive RT for abdominal para-aortic LN recurrence with controlled primary cancer of the pelvis without other distant/recurrent diseases. The median time between the front-line therapy and RT for isolated para-aortic LN metastases was 21 months. Nineteen (79%) patients had an objective tumor response. In-field failure occurred in four patients (17%), while failure outside of the irradiated field was recognized in 12 patients (50%). The overall survival, progression-free survival and local control rates at 5 years were 56%, 29% and 72%, respectively. Statistically significant prognostic factors of the overall survival rate in the univariate analyses were an objective tumor response (P = 0.0098) and the time between front-line therapy and RT (P = 0.033). The maximum tumor size was a significant prognostic factor of the overall survival rates in the multivariate analyses (P = 0.046). The toxicities were mild; leukopenia of Grade 3 was detected in one patient, and no Grade 3 or higher non-hematological toxicity was observed. In conclusion, definitive three-dimensional RT for isolated abdominal para-aortic LN recurrence in patients with controlled primary cancer of the pelvis may be feasible, and can provide a relatively longer-term survival. The results justify further investigation of higher dose RT using modern RT planning techniques.     

分析食管癌根治性放疗后复发模式确定是否选择性淋巴结照射

目的研究胸段食管癌放射治疗选择性淋巴结照射(ENI)的有效性。方法回顾分析我院2006年4月至2009年2月期间新就诊的胸段食管鳞癌患者,80例患者均进行选择性淋巴结照射,选择性淋巴结照射剂量50Gy,原发肿瘤区照射剂量60～70 Gy。结果 80例患者均耐受放射治疗,未出现严重毒副反应,60例患者达到完全缓解,获得完全缓解的患者,仅一例出现选择性淋巴结照射失败而没有其他部位复发。结论胸段食管鳞癌放射治疗的患者,淋巴结预防照射是预防淋巴结失败的有效手段,远期生存有待于进一步评估。     

Treatment outcomes of patients with FIGO Stage I/II uterine cervical cancer treated with definitive radiotherapy: a multi-institutional retrospective research study

The purpose of this study was to analyze the patterns of care and outcomes of patients with FIGO Stage I/II cervical cancer who underwent definitive radiotherapy (RT) at multiple Japanese institutions. The Japanese Radiation Oncology Study Group (JROSG) performed a questionnaire-based survey of their cervical cancer patients who were treated with definitive RT between January 2000 and December 2005. A total of 667 patients were entered in this study. Although half of the patients were considered suitable for definitive RT based on the clinical features of the tumor, about one-third of the patients were prescribed RT instead of surgery because of poor medical status. The RT schedule most frequently utilized was whole-pelvic field irradiation (WP) of 30 Gy/15 fractions followed by WP with midline block of 20 Gy/10 fractions, and high-dose-rate intracavitary brachytherapy (HDR-ICBT) of 24 Gy/4 fractions prescribed at point A. Chemotherapy was administered to 306 patients (46%). The most frequent regimen contained cisplatin (CDDP). The median follow-up time for all patients was 65 months (range, 2–135 months). The 5-year overall survival (OS), pelvic control (PC) and disease-free survival (DFS) rates for all patients were 78%, 90% and 69%, respectively. Tumor diameter and nodal status were significant prognostic indicators for OS, PC and DFS. Chemotherapy has potential for improving the OS and DFS of patients with bulky tumors, but not for non-bulky tumors. This study found that definitive RT for patients with Stage I/II cervical cancer achieved good survival outcomes.     

Results of definitive radiotherapy with concurrent chemotherapy for maxillary sinus carcinomas with neck lymph node metastasis

The purpose of this study was to describe the results of definitive radiotherapy (RT) with concurrent chemotherapy for maxillary sinus carcinomas (MSCs) with neck lymph node metastasis to clarify its limitation. Local control (LC), progression-free survival (PFS) and overall survival (OS) rates were calculated using the Kaplan–Meier method and were compared between subgroups using the log rank test. Toxicity was classified using common terminology criteria of adverse events version 5.0. Eighteen patients with inoperable MSC with neck lymph node metastasis including 12 men and 6 women with a median age of 67 years were analyzed. The histologic diagnoses were as follows: 16 patients had squamous cell carcinomas and 2 had other histology. Four patients had stage T3 MSC, 6 had T4a and 8 had T4b. Among 18 patients, 7 received concurrent systemic chemotherapy and 11 received selective arterial chemo-infusion. The median follow-up period was 17 months. The 2-year LC, PFS and OS rates for the entire cohort were 34, 31 and 46%, respectively. No significant differences were observed for LC, PFS and OS rates between systemic chemotherapy and selective arterial chemo-infusion cohorts. Grade 3 or higher acute toxicity, including both non-hematological and hematological, was observed in nine patients (50%), while no grade 3 or higher late toxicity was observed. In conclusion, we described the results of definitive RT for MSCs with neck lymph node metastasis. Local recurrence of primary tumor was a frequent pattern of failure and it should be addressed in future study.     

Overall response of both intrahepatic tumor and portal vein tumor thrombosis is a good prognostic factor for hepatocellular carcinoma patients receiving concurrent chemoradiotherapy

This study investigated the prognostic significance of portal vein tumor thrombosis (PVTT) response in hepatocellular carcinoma (HCC) patients treated with localized concurrent chemoradiotherapy (CCRT). We retrospectively analyzed 100 patients treated with CCRT for UICC Stage T2–4N0M0 HCC with PVTT between 2002 and 2011. The radiotherapy (RT) volume included both primary tumor and PVTT, and the median radiation dose was 45 Gy. Treatment response was evaluated for up to 6 months after RT. With respect to PVTT response to treatment, complete response (CR) and partial response (PR) were achieved in 14% and 48% of patients, respectively, yielding an objective response (OR) rate of 62%. PVTT size (≤3cm diameter) was associated with a higher rate of a CR (P = 0.001). The median overall survival (OS) was 11.6 months. Independent prognostic factors for OS were OR of the tumor to RT and a CR of the PVTT. Achieving an OR in both the tumor and the PVTT demonstrated a significant correlation with improved survival (P = 0.002). Progression of intrahepatic metastasis was affected not by CCRT but by the clinical features of the PVTT, particularly the initial PVTT site. PVTT response following CCRT seems prognostically significant. CR of the PVTT was associated with improved survival. Achieving an OR in both the tumor and PVTT was also associated with improved survival.     

Prognostic factors,patterns of recurrence and toxicity for patients with esophageal cancer undergoing definitive radiotherapy or chemo-radiotherapy

The aim of this study was to evaluate the effectiveness and tolerability of definitive chemo-radiation or radiotherapy alone in patients with esophageal cancer. We retrospectively analyzed the medical records of n = 238 patients with squamous cell carcinoma or adenocarcinoma of the esophagus treated with definitive radiotherapy with or without concomitant chemotherapy at our institution between 2000 and 2012. Patients of all stages were included to represent actual clinical routine. We performed univariate and multivariate analysis to identify prognostic factors for overall survival (OS) and progression-free survival (PFS). Moreover, treatment-related toxicity and patterns of recurrence were assessed. Patients recieved either chemo-radiation (64%), radiotherapy plus cetuximab (10%) or radiotherapy alone (26%). In 69%, a boost was applied, resulting in a median cumulative dose of 55.8 Gy; the remaining 31% received a median total dose of 50 Gy. For the entire cohort, the median OS and PFS were 15.0 and 11.0 months, respectively. In multivariate analysis, important prognostic factors for OS and PFS were T stage (OS: P = 0.005; PFS: P = 0.006), M stage (OS: P = 0.015; PFS: P = 0.003), concomitant chemotherapy (P < 0.001) and radiation doses of >55 Gy (OS: P = 0.019; PFS: P = 0.022). Recurrences occurred predominantly as local in-field relapse or distant metastases. Toxicity was dominated by nutritional impairment (12.6% with G3/4 dysphagia) and chemo-associated side effects. Definitive chemo-radiation in patients with esophageal cancer results in survival rates comparable with surgical treatment approaches. However, local and distant recurrence considerably restrict prognosis. Further advances in radio-oncological treatment strategies are necessary for improving outcome.     

同步加速调强放疗在早期乳腺癌保乳术后放疗中的临床研究

目的：观察同步加速调强放疗在早期乳腺癌保乳术后放疗的临床疗效和不良反应。方法：选择本院45例于2010年1月-2012年12月接受保留乳房手术切除的早期乳腺癌患者,按照随机数字表法分成研究组和对照组,研究组23例采用全乳放疗并同期加量放疗,1.8~2.4 Gy/d,每周5次。全乳腺照射45 Gy/25F,瘤床区总剂量60 Gy/25 F;对照组22例采用全乳放疗后局部瘤床加量,2 Gy/d,每周5次,全乳腺照射50 Gy/25 F,瘤床区局部加量10 Gy/5 F,总剂量60 Gy/30 F。按RTOG标准评估放疗反应,复发转移率的比较采用χ2检验。结果：两组患者中位随访18个月,研究组23例患者中,1例患者出现同侧锁骨上淋巴结转移,1例出现骨转移,复发转移率为8.70%。患者的放疗反应为1~2级,中位住院放疗时间为30 d。对组照22例患者中1例肝转移,其余均未出现复发和远处转移,复发转移率为4.55%。放疗反应为1~2级,中位住院放疗时间37 d。两组复发转移率比较差异无统计学意义（P=0.968）。结论：同步加速调放疗治疗早期乳腺癌保乳术后患者,缩短了治疗时间,临床疗效良好,放疗反应轻微,值得进一步临床研究及应用。     

从我院卵巢癌收治情况看卵巢癌诊治现状

目的探讨近10年来本地区卵巢癌诊断和治疗现况。方法收集1998年1月-2008年1月我院所有拟诊为卵巢癌患者的基本信息和治疗情况,并作统计分析。结果我院收治的471例卵巢癌患者中,433例接受了手术治疗并获得明确病理组织学分型,71．62％就诊时已是Ⅲ～Ⅳ期,324例行初次手术。436例接受了化疗,出现明确化疗副反应的有314人次。146例患者复发,在随访到的患者中,3年生存率和5年生存率只有29．14％和9．27％。结论近10年来卵巢癌就诊人数明显增加,但有限的治疗手段使得晚期癌生存状况仍不容乐观。     

Radiotherapy for Stage I or II hypopharyngeal carcinoma

Hypopharyngeal squamous cell carcinoma (HPSCC) is usually diagnosed at an advanced stage, and early-stage HPSCC is relatively rare. Because of the rarity of early-stage HPSCC, few reports have been published on the efficacy of radiotherapy (RT) in its treatment. We retrospectively reviewed the clinical records of 45 consecutive patients with Stage I and II HPSCC from May 1991 to June 2010. Patient characteristics were as follows: median age, 66 years (range, 44–90 years); male/female, 39/6; and T1/T2, 27/18. The irradiation dose ranged from 60 to 72 Gy (median: 70 Gy). Of the 45 patients, 21 underwent concurrent chemotherapy. With a median follow-up period of 62 months, the 5-year overall survival rate was 81%. Local failure occurred in 5 patients, and the 5-year local control rate was 83%. All local recurrences were successfully salvaged by surgery. The 5-year functional larynx preservation rate was 92%. Acute toxicity was manageable. Grade 3 laryngeal edema and Grade 3 hypothyroidism occurred in 1 patient each. No other late adverse events of Grade 3 or greater were observed. Based on these results, RT seemed to be an effective treatment modality for early HPSCC, with favorable organ preservation and acceptable adverse events. Early detection and accurate management of local recurrence and second malignancy was deemed to be critical.     

高压氧联合化疗对卵巢上皮性癌疗效研究

目的 探讨高压氧联合PC方案化疗对卵巢上皮性癌初治患者的疗效.方法 将58例卵巢上皮性癌术后患者采用随机数字表法分为研究组(30例)和对照组(28例),对照组给予环磷酰胺1000 mg/m2+顺铂75 mg/m2,21 d为1个疗程,至少6个疗程.研究组在高压氧2个标准大气压下暴露60 min,出舱25～30 min给予对照组方法化疗.比较两组的近期疗效和3年存活率、无进展生存时间以及不良反应等.结果 研究组近期总有效率、未控率、复发率、复发时间、3年存活率分别为83.3%(25/30)、6.7%(2/30)、33.3%(10/30)、(21.0±0.8)个月、43.3%(13/30),明显优于对照组的67.9%(19/28)、17.9%(5/28)、46.4%(13/28)、(18.0±0.6)个月、17.9%(5/28)(P＜0.05).研究组无进展生存时间和总生存时间明显长于对照组(P＜0.05),且不良反应发生率明显低于对照组(P＜0.05).结论 卵巢上皮性癌的辅助化疗中,高压氧联合PC方案疗效优于单纯PC方案,且高压氧能明显减少PC方案不良反应.     

Paclitaxel and carboplatin as outpatient therapy for stage III and IV epithelial ovarian cancer.

BACKGROUND: To determine the toxicity and the response rate of a three-hour paclitaxel infusion and carboplatin administered as outpatient treatment for stage III and IV epithelial ovarian cancer. METHODS: Forty-three patients with stage III/IV epithelial ovarian cancer underwent cytoreductive surgery and then received paclitaxel 175 mg/m2 over 3-hr infusion and carboplatin AUC5 every 21 days for six cycles. Elegible patients had adequate bone marrow, renal and hepatic function; G-CSF was recommended if white cell count fell under 3,000/mm3. RESULTS: No patients had hypersensivity reactions; 15 out of 43 patients (35%) required colony-stimulating factors, 39 patients (91%) had general alopecia, three patients (7%) had severe emesis, 20 patients (46%) had mild emesis, four patients (9%) had severe myalgias, eight patients (18%) had moderate myalgias, one patient (2%) had grade 3 neurotoxicity. Three patients experienced grade 3 thrombocytopenia (7%). At a median follow-up of 29 months, 32 of 43 patients are alive (74%). Median progression-free survival is 14 months. Median overall survival has not been reached. CONCLUSIONS: Three-hour infusion paclitaxel and carboplatin is an effective and safe outpatient therapy for epithelial ovarian cancer.     

Treatment outcomes of definitive chemoradiotherapy for patients with hypopharyngeal cancer

We analyzed the efficacy of definitive chemoradiotherapy (CRT) for patients with hypopharyngeal cancer (HPC). Subjects comprised 97 patients who were treated with definitive CRT from 1990 to 2006. Sixty-one patients (62.9%) with resectable disease who aimed to preserve the larynx received induction chemotherapy (ICT), whereas 36 patients (37.1%) with resectable disease who refused an operation or who had unresectable disease received primary alternating CRT or concurrent CRT (non-ICT). The median dose to the primary lesion was 66 Gy. The median follow-up time was 77 months. The 5-year rates of overall survival (OS), progression-free survival (PFS), local control (LC), and laryngeal preservation were 68.7%, 57.5%, 79.1%, and 70.3%, respectively. The T-stage was a significant prognostic factor in terms of OS, PFS and LC in both univariate and multivariate analyses. The 5-year rates of PFS were 45.4% for the ICT group and 81.9% for the non-ICT group. The difference between these groups was significant with univariate analysis (P = 0.006). Acute toxicity of Grade 3 to 4 was observed in 34 patients (35.1%). Grade 3 dysphagia occurred in 20 patients (20.6%). Twenty-nine (29.8%) of 44 patients with second primary cancer had esophageal cancer. Seventeen of 29 patients had manageable superficial esophageal cancer. The clinical efficacy of definitive CRT for HPC is thought to be promising in terms of not only organ preservation but also disease control. Second primary cancer may have a clinical impact on the outcome for HPC patients, and special care should be taken when screening at follow-up.     

Permanent interstitial re-irradiation with Au-198 seeds in patients with post-radiation locally recurrent uterine carcinoma

This study sought to analyze the outcome of patients with post-treatment locally recurrent uterine carcinoma treated with Au-198 seed permanent interstitial re-irradiation (Au-198 IRI). A retrospective review of the data of 15 patients with post-treatment locally recurrent uterine carcinoma treated with Au-198 IRI between 1991 and 2009 was performed to evaluate the disease response, local control, overall survival and complication rates. All the patients had received definitive radiation therapy or surgery as the initial treatment. None were judged as being suitable candidates for surgical treatment, and were referred for Au-198 IRI. Au-198 IRI was performed for the vaginal wall in 8 patients, vaginal stump in 4 patients, vulva in 2 patients, and cervix in 1 patient. The median tumor volume was 1.3 cm³(range, 0.4–6.9), the median treated volume was 6.3 cm³(range, 1.8–11), and the median prescribed dose was 76 Gy (range, 68–90). At a median follow-up duration of 19 months (range, 4.3–146.9), 13 of 15 patients (87%) showed complete responses after Au-198 IRI, although 10 of these 13 patients (77%) developed repeat central recurrence again between 2.5 and 49.7 months after the Au-198 IRI (median, 12.5 months). The overall 2-year local control rate and 2-year overall survival rate in the 15 patients were 33% and 64%, respectively. Two (13%) of the 15 patients experienced late complications that were more severe than Grade III. As a result, Au-198 IRI is considered to be one of the salvage treatment modalities with tolerable complications for inoperable centrally recurrent uterine carcinoma.     

复发性上皮性卵巢癌41例临床分析

目的:探讨复发性上皮性卵巢癌的综合治疗方法、再次肿瘤细胞减灭术的临床价值及影响再次肿瘤细胞减灭术治疗效果的因素。方法:回顾性分析41例复发性上皮性卵巢癌的临床资料。结果;复发后行再次肿瘤细胞减灭术联合术后化疗的患者和单纯化疗的患者比较复发后生存时间明显延长(P<0.05);复发后进行再次肿瘤细胞减灭术联合术后化疗的22例患者中初次治疗后的临床缓解时间(DFI)≤12个月的患者复发后中位生存时间较DFI>12个月的患者明显缩短(P<0.01);再次肿瘤细胞减灭术基本切净或残余灶≤2cm的患者和残余灶>2cm的患者比较,复发后中位生存时间明显延长(P<0.05);再次术后化疗疗程数>3次的患者和≤3次的患者比较,复发后中位生存时间明显延长(P<0.01)。结论:在严格选取手术适应症的前提下,再次肿瘤细胞减灭术辅以术后规律、足疗程的化疗可以延长复发患者的生存时间。     

Radiotherapy with fraction size of 2.25 Gy in T1-2 laryngeal and hypopharyngeal cancer

This study was carried out to evaluate the influence of fraction size 2.25 Gy on local control of T1 and T2 laryngeal and hypopharyngeal cancers. Between August 2002 and December 2010, 80 patients with T1 and T2 laryngeal or hypopharyngeal cancers were treated with definitive radiotherapy with a fraction size of 2.25 Gy. Primary sites were the larynx in 69 and the hypopharynx in 11. Fifty-three patients were T1 and 27 were T2. All patients'' pathology was squamous cell carcinoma except one carcinosarcoma. Radiotherapy was delivered 5 days/week with a 4-MV photon beam up to a total dose of 63.0 Gy. Median treatment time was 41 days. Statistical analysis of survival was calculated using the Kaplan–Meier method. No acute toxicity greater than grade 2 (CTCAE ver. 3.0.) including mucositis and dermatitis was observed. All but one patient had a complete response. The partial response patient received salvage surgery. The median follow-up period was 47 months (ranging from 4 to 108 months). No late toxicity greater than 1 was observed. Nine patients developed recurrence, seven local and two neck lymph nodes. Three patients died, one from laryngeal cancer and two from intercurrent diseases. The 5-year local control rates (LCRs) in the entire group, larynx T1, larynx T2 and hypopharynx T1 were 85.8%, 97.6%, 70.1% and 85.7%, respectively. The LCRs of T1 improved compared with our historical control, but not those of T2. The 2.25-Gy fraction size is safe and may have the potential to achieve good LCR in T1 lesions.     

Clinical results of stereotactic body radiotherapy for Stage I small-cell lung cancer: a single institutional experience

The purpose of this study was to evaluate the treatment outcomes of stereotactic body radiotherapy (SBRT) for Stage I small-cell lung cancer (SCLC). From April 2003 to September 2009, a total of eight patients with Stage I SCLC were treated with SBRT in our institution. In all patients, the lung tumors were proven as SCLC pathologically. The patients'' ages were 58–84 years (median: 74). The T-stage of the primary tumor was T1a in two, T1b in two and T2a in four patients. Six of the patients were inoperable because of poor cardiac and/or pulmonary function, and two patients refused surgery. SBRT was given using 7–8 non-coplanar beams with 48 Gy in four fractions. Six of the eight patients received 3–4 cycles of chemotherapy using carboplatin (CBDCA) + etoposide (VP-16) or cisplatin (CDDP) + irinotecan (CPT-11). The follow-up period for all patients was 6–60 months (median: 32). Six patients were still alive without any recurrence. One patient died from this disease and one died from another disease. The overall and disease-specific survival rate at three years was 72% and 86%, respectively. There were no patients with local progression of the lesion targeted by SBRT. Only one patient had nodal recurrence in the mediastinum at 12 months after treatment. The progression-free survival rate was 71%. No Grade 2 or higher SBRT-related toxicities were observed. SBRT plus chemotherapy could be an alternative to surgery with chemotherapy for inoperable patients with Stage I small-cell lung cancer. However, further investigation is needed using a large series of patients.     

幼女及青春期少女卵巢肿瘤临床分析

目的探讨幼女及青春期少女卵巢肿瘤的临床特点及治疗方法。方法回顾性分析1999年2月～2009年4月收治的全部4～19岁卵巢肿瘤患者64例。结果患者平均年龄16.4岁,其中4～9岁3例(4.7%),10～14岁13例(20.3%),15～19岁48例(75%)。性索间质细胞瘤3例,上皮性肿瘤22例,生殖细胞肿瘤39例;交界性肿瘤2例,恶性肿瘤6例。所有患者均行手术治疗,4例生殖细胞恶性肿瘤患者行保留生育功能手术,2例上皮癌患者实施肿瘤细胞减灭术。4例接受了4～6疗程以顺铂为主的化疗。随访期间,6例恶性肿瘤患者中有3例死亡;余病例无复发。结论幼女及青春期少女卵巢肿瘤以生殖细胞肿瘤为主,随着年龄增长,上皮性肿瘤所占比例增高。生殖细胞恶性肿瘤可以采取保留生育功能的手术。     

Clinical outcomes of helical tomotherapy for super-elderly patients with localized and locally advanced prostate cancer: comparison with patients under 80 years of age

We investigated the clinical outcomes of helical tomotherapy in 23 patients aged ≥80 years with localized and locally advanced prostate cancer and compared the results with data from 171 patients under 80 years. All patients received helical tomotherapy in our hospital between September 2009 and October 2012. The median follow-up periods were 35 months in the aged group and 34 months in the younger group. The median prescribed dose in helical tomotherapy was 78 Gy in 39 fractions (range, 72–78 Gy). The 3-year overall survival and biochemical relapse-free rates were 92% and 96% in the aged group and 99.4% and 97.3% in the younger group, respectively. There was no significant difference between the two groups in the biochemical relapse-free rates. The 3-year cumulative incidences of late Grade 2 or higher rectal toxicity and urinary toxicity were 13% and 4.8% in the aged group and 7.0% and 1.2% in the younger group, respectively. There was no significant difference between the aged group and the younger group in the cumulative incidence rates of rectal toxicity or urinary toxicity. No patients exhibited Grade 4 or higher toxicity, and all patients improved with conservative therapy. Helical tomotherapy in super-elderly patients with localized and locally advanced prostate cancer had good biochemical control rates without severe late toxicity. Definitive helical tomotherapy may be the treatment of choice for patients with localized and locally advanced prostate cancer, even in those older than 80 years of age.     

Preliminary results of magnetic resonance imaging-aided high-dose-rate interstitial brachytherapy for recurrent uterine carcinoma after curative surgery

This report presents initial experience with imaging-aided high-dose-rate interstitial brachytherapy (HDR-ISBT) for post-operative recurrence of uterine carcinoma. Fourteen patients presenting with post-operative recurrence of uterine carcinoma (nine cervix and five corpus) between July 2005 and October 2008 were enrolled in this study (median follow-up: 37 months, range: 6-59 months). We implanted magnetic resonance imaging (MRI)-compatible plastic applicators using our own ambulatory technique. HDR-ISBT treatment consisted of twice-a-day irradiation of 6 Gy each with at least a six-hour interval to provide the total prescribed dose. Treatment was based on treatment planning-computed tomography with MRI as a reference. Seven patients were treated with a combination of ISBT (median 30 Gy/5 fractions; range: 27-33 Gy) and external beam radiation therapy (EBRT), and the other seven with brachytherapy only (median 54 Gy/9 fractions; range: 48-54 Gy), one of whom had previously received pelvic EBRT. The three-year estimates of local control and overall survival rates were 77.9% (95% confidence interval (CI): 55.8-100%) and 77.1% (95% CI: 54.2-100%), respectively. Two patients, who had received combined treatment with EBRT showed untoward reactions, including a grade 3 subileus and grade 2 constipation. Another patient, who had been treated with ISBT alone, developed grade 2 urinary constriction. Our imaging-aided HDR-ISBT for post-operative recurrence of uterine carcinoma was found to be practical with promising preliminary results.     

体部伽玛刀治疗门静脉主干癌栓疗效观察

目的：探讨体部伽玛刀治疗原发性肝癌伴门静脉癌栓（PVTT）的疗效。方法：对52例原发性肝癌伴门静脉癌栓患者实行伽玛刀治疗。采用50％～700／0等剂量曲线覆盖计划靶区（PTV）,单次处方剂量为3．0～4．5Gy,照射总剂量在30～49．5Gy之间,并观察PVTT近期疗效及生存率。结果：伽玛刀治疗结束3个月后,门静脉癌栓完全缓解18例（占34．62％）,部分缓解23例（占44．23％）,稳定4例（占7．69％）,进展7例（占13．46％）,总有效率为78．85％。生存6个月48例（占92．31％）,生存12个月38例（占73．08％）,24个月29例（占55．77％）,中位生存期为14．04-月。结论：伽玛刀治疗门静脉癌栓疗效确切,能够延长患者的生存期。