扇贝提取物对荷瘤小鼠放射损伤的恢复作用

目的 观察用＾１９２Ｉｒ核素照射联合扇贝提取物对荷瘤小鼠免疫和抗氧化功能的影响。了解扇贝提取物对放射损伤的恢复作用。方法 选用２Ｌ６１５皮下荷瘤小鼠模型作照射,＾１９２Ｉｒ核素照射联合扇贝提取物组实验期间每天均以一定量的扇贝提取物灌胃,接种瘤株后第１４天,＾１９２Ｉｒ核素照射,共３次,末次照射后的次日,进行免疫和抗氧化功能指标测定。结果 荷瘤鼠因＾１９２Ｉｒ核素照射而下降的免疫指标明显回升,包括脾脏ＮＫ细胞杀伤活性,丝裂原诱发的淋巴细胞转化强度,外周血白细胞总数及脾脏重量;并且,因照射而下降的抗氧化物酶谷胱甘肽过氧化物酶（ＧＳＨ－Ｐｘ）和超氧化物歧化酶（ＳＯＤ）活性显著增高,脂质过氧化产物丙二醛（ＭＤＡ）含量显著下降。结论 ＾１９２Ｉｒ核素照射联合扇贝提取物可有效提高机体抗氧化能力,增强免疫活性,对放射损伤具有     

脑胶质瘤瘤旁近距离放疗临床研究

目的探讨复发性脑恶性胶质瘤再次手术后瘤旁近距离放疗的方法、疗效与安全性。方法回顾性分析本科近8年来376例复发性脑胶质瘤再次手术后瘤腔内置入放疗囊术后行131I近距离放疗316例,余60例术后行动脉化疗。随访观察两组病例肿瘤再次复发率及生存率、死亡率。结果瘤旁近距离放疗组再次复发率及死亡率均低于术后动脉化疗组。结论复发性脑恶性胶质瘤再次手术时瘤内置入放疗囊。术后注入131I行瘤旁近距离放疗可以显著提高患者的疗效和生存率。     

脑肿瘤的组织间近距离放射治疗

组织间近距离放射治疗可提升脑肿瘤局部照射剂量,对于经过选择的原发和复发恶性脑胶质瘤及单发脑转移瘤患者,能提高局部控制率,延长生存期,且无严重的放射并发症,是一种安全、有效的辅助性治疗方法。     

X-刀治疗大鼠胶质瘤的磁共振灌注成像

目的 :观察X 刀对大鼠脑胶质瘤的治疗作用 ,探讨MR灌注成像 (PWI)对X 刀治疗疗效的早期评价。方法 :2 0只SD雄性大鼠右尾状核接种C6胶质瘤细胞复制大鼠脑胶质瘤模型。治疗组 10只接种胶质瘤细胞后第 15天行X 刀治疗 ,10只对照组未行治疗 ,分别第 15天 (治疗组X 刀治疗前 )和第 17天行PWI ,计算肿瘤的相对局部脑血容量(rrCBV) ,观察治疗后肿瘤rrCBV的变化率 ,并与荷瘤鼠存活期进行回归分析。结果 :肿瘤接种成功率为 10 0 %。治疗组治疗后 48h肿瘤的rrCBV明显减小 ,其下降百分比平均为 3 5 .8%。对照组和治疗组大鼠生存期分别为 2 2 .8和 3 0 .5d ,两组间差异有显著意义。X 刀治疗后肿瘤rrCBV的下降百分比与大鼠生存期密切相关 (r =0 .82 ,P <0 .0 5 )。结论 :X 刀治疗能延长荷胶质瘤大鼠生存期 ,PWI能在治疗后早期判断愈后     

声动力疗法促脑胶质瘤凋亡的实验研究

目的探讨声动力疗法对荷瘤鼠脑胶质瘤组织的促凋亡作用及其治疗机制。材料与方法 74只Wistar大鼠于右侧尾状核处接种C6胶质瘤细胞,制作颅内胶质瘤模型,行增强MRI筛选荷瘤鼠。依MRI结果分为对照组、血卟啉甲醚组(HMME组)、超声组和声动力组(SDT组),每组16只。声动力参数为1.0MHz、1.0W/cm2、60s超声辐照和5mg/kg血卟啉甲醚。治疗后24h行TUNEL染色检测胶质瘤细胞凋亡率,电镜检测凋亡形态学改变,免疫组化检测蛋白GFAP、S-100、Bcl-2/Bax、Caspase-3、Caspase-9、Fas/Fas-L表达和Cytc释放,并记录4组大鼠生存期。结果 74只Wistar大鼠共68只成瘤,成瘤率为91.89%。与对照组[(3.20±0.72)%]比较,SDT组[(30.60±1.60)%]及超声组([14.50±0.80)%]凋亡率显著提高(P<0.05),HMME组([3.60±0.51)%]无明显凋亡发生(P>0.05);SDT组荷瘤鼠生存期长达(46.3±3.1)d,较对照组[(31.1±2.1)d]显著延长(P<0.05),超声组[(32.4±2.3)d]、HMME组[(30.1±3.0)d]生存期较对照组无明显变化(P>0.05)。电镜检测到SDT组、超声组胶质瘤细胞核固缩,染色质边集,线粒体肿胀;免疫组化显示GFAP、S-100、Bax、Caspase-3、Caspase-9呈高表达,Bcl-2、Fas-L呈低表达和Cytc释放,Fas表达无明显变化。结论声动力疗法对荷瘤鼠胶质瘤有促凋亡治疗作用,并与线粒体内源性凋亡途径密切相关。     

脑肿瘤的组织间近距离放射治疗

组织间近距离放射治疗可提升脑肿瘤局部照射剂量,对于经过选择的原发和复发恶性脑胶质瘤及单发脑转移瘤患者,能提高局部控制率,延长生存期,且无严重的放射并发症,是一种安全、有效的辅助性治疗方法.     

脑肿瘤的组织间近距离放射治疗

组织间近距离放射治疗可提升脑肿瘤局部照射剂量，对于经过选择的原发和复发恶性脑胶质瘤及单发脑转移瘤患，能提高局部控制率，延长生存期，且无严重的放射并发症，是一种安全、有效的辅助性治疗方法。     

导管基础上放疗防止冠状动脉再狭窄的两年随访

尽管早期的试验表明放射治疗再狭窄是安全又有效的，但作为一项新技术，人们对诸如动脉瘤的形成、穿孔以及进行性血管疾患等远期并发症发生的可能性极为关注，放疗疗效是否持久以及其对再狭窄的发生是否仅起延缓的作用也有待于进一步观察，为此作了随访研究。方法：将５５例行冠状动脉血管成形术后的患者随机分为１９２　Ｉｒ源治疗组（１９２　Ｉｒ组，２６例）和安慰剂组（对照组，２９例），把１９２　Ｉｒ和安慰剂分别置于一个０．７６ｍｍ（０．０３－ｉｎ）长的带状物内，导入患者靶血管内照射２０～４５分钟，剂量在８００～３０００…     

罂粟碱开放血脑屏障与卡氮芥治疗恶性胶质瘤的研究

本文报告了1988年9月～1991年4月,对12例胶质瘤病人测定瘤内氨甲喋呤(MTX)含量,并经颈动脉穿刺注入罂粟碱开放血脑屏障及卡氮芥(BCNU)治疗恶性胶质瘤31例的临床研究。在12例胶质瘤病人中,经颈动脉注入罂粟碱可逆性开放血脑屏障后注入MTX,瘤内MTX含量增高,为1854±51ng/g瘤;颈动脉单纯注入MTX后为1020±51.28ng/g瘤;静脉注入MTX后瘤内含量为174±31.5ng/g瘤。31例中胶质母细胞21例,间变性星形细胞瘤10例,平均治疗2.1次,每次注入卡氮芥250mg。平均生存期101.6±32.7周,中位生存期104周。作者认为本疗法简便、安全、有效、并发症少,能延长病人生存期。     

脑转移瘤的放射治疗进展

脑转移瘤是肿瘤最常见的神经系统并发症,发病率呈上升趋势。治疗方案已经从传统的全脑放射治疗发展到个体化治疗阶段。放疗仍是当前的主要治疗手段之一。随着放疗技术的不断发展,脑转移瘤患者的生活质量明显改善,生存期明显延长。全脑放疗、立体定向放射外科以及两者联合是目前的主要治疗方法,但在最佳联合方式及患者的选择等方面尚待进一步明确。笔者将对脑转移瘤的放射治疗进展进行综述。     

192Ir三维近距离联合调强放疗在晚期肝外胆管癌的临床应用

目的探讨¹⁹²Ir三维近距离联合调强放射治疗在不可手术切除的晚期梗阻性肝外胆管癌患者的临床疗效及安全性。方法回顾性分析2014年1月1日至2018年1月1日河北省沧州中西医结合医院收治的18例不可手术切除的晚期恶性梗阻性肝外胆管癌患者,经病理证实且接受胆道支架植入,继而序贯调强放射治疗及¹⁹²Ir三维近距离放射治疗。收集患者的临床资料,包括性别、年龄、临床分期、近距离放射治疗剂量-体积参数等,评价临床疗效及不良反应、治疗前后的胆红素变化水平、局部控制率及生存率。结果所有患者均顺利完成治疗。¹⁹²Ir三维近距离联合调强放射治疗后1个月复查,18例患者中,部分缓解(PR)16例,稳定(SD)2例,其中14例患者在接受近距离放射治疗后肿瘤较调强放射治疗后缩小,4例肿瘤无明显变化。6个月局部控制率(LC)为94.4%(17/18)。1年和2年生存率分别为55.6%(10/18)和38.9%(7/18)。治疗后患者总胆红素、直接胆红素均降低,黄疸症状明显缓解。整个治疗过程中,患者不良反应为恶心、呕吐,发热,胆道感染等,但无3级及以上不良反应。结论¹⁹²Ir三维近距离放射治疗联合调强放射治疗在不可手术切除的晚期肝外胆管癌患者中,局部控制率良好,不良反应可耐受,但对长期生存的影响尚需大样本的对照研究。     

High-Dose-Rate Brachytherapy for Small-Sized Peripherally Located Lung Cancer

BACKGROUND: The demand for minimally invasive therapies is increasing in the treatment of small peripheral non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Twelve patients with T1-2 N0 M0 peripheral NSCLC were treated by high-dose-rate brachytherapy with (192)Ir radioactive source. RESULTS: A (192)Ir source was introduced into the tumors percutaneously in five patients (percutaneous brachytherapy) or transbronchially in seven patients (transbronchial brachytherapy). Whereas irradiation was performed with a single fraction of 20 Gy in percutaneous brachytherapy, it was hypofractionated from 5 x 5 Gy to 2 x 12.5 Gy in transbronchial brachytherapy. Complications were generally mild in all patients, although focal radiation pneumonitis was observed in most patients. Primary recurrence occurred in three patients, including one with a T2 tumor and one treated by brachytherapy as a salvage treatment for recurrence after conformal radiotherapy. When brachytherapy is evaluated as a primary treatment for T1 N0 M0 NSCLC, local control rate is 88.9% and estimated 5-year survival rate is between 60% and 70%. CONCLUSION: Brachytherapy has a potential to be a method to treat peripheral T1 N0 M0 NSCLC.     

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。     

Paediatric brachytherapy. II. Brain implantation

The case histories of four children with brain tumours, for whom stereotactic brachytherapy was indicated, are presented from the St Bartholomew's Hospital intracranial brachytherapy programme. The recent evolution of the computed-tomography-directed stereotactic technique is described and the uses of different radionuclides (198Au, 192Ir) are discussed. The future of brachytherapy for paediatric brain tumours is debated.     

改良髂内动脉化疗联合放疗治疗Ⅲ～Ⅳa期子宫颈癌32例

目的探讨改良髂内动脉化疗联合放疗治疗Ⅲ～Ⅳa期宫颈癌的疗效。方法回顾分析2005年5月至2009年8月在广东省茂名农垦医院妇产科、肿瘤放疗科住院治疗70例Ⅲ～Ⅳa期子宫颈癌患者的完整资料,其中行改良髂内动脉化疗术联合放疗（介入+放疗,A组）患者32例,单纯放疗（B组）患者38例。A组患者采用Seldinger技术穿刺右股动脉,先行右子宫动脉化疗栓塞术;再超选至左髂内动脉化疗,保留导管连续化疗3 d;化疗药有顺铂、氟尿嘧啶。放疗用直线加速器远距离外照射+¹⁹²Ir高剂量率腔内放疗。B组只进行外照射和腔内放疗,剂量稍增减。结果 1年生存率比较,A组为78.1%,高于B组（55.3%,P<0.05）;3年生存率比较,A组为59.4%,高于B组34.2%（P<0.05）;两组1、3年生存率比较差异有统计学意义;5年生存率两组比较差异无统计学意义（P>0.05）。两组放疗并发症发生率比较,差异无统计学意义（P>0.05）。结论改良髂内动脉化疗术联合放疗对Ⅲ～Ⅳa期宫颈癌的近期疗效较单纯放疗为好,生存质量较高;两组5年生存率比较则差异无统计学意义。     

国产血管内~(192)Ir线源的放射剂量测定

目的　对国产血管内192 Ir线源的剂量分布进行评价 ,为动物实验和临床应用提供依据。方法　采用KodakX omatV慢感光胶片 ,从平行和垂直于放射源长轴方向进行测量 ,径向测量时间为 2 5、45、6 5和 82s ,轴向测定时间为 2 5s,同时进行标准剂量的标定 ,通过胶片自动分析测量系统分析剂量分布和吸收剂量。参考AAPMTGNo.6 0报告 ,采用MonteCarlo方法对放射源的辐射剂量进行理论计算 ,同时与采用AAPMTGNo.43报告计算方法进行比较。结果　国产血管内192 Ir线源具有良好的剂量分布。AAPMTGNo .43报告计算方法比MonteCarlo方法高估 32 %的辐射剂量。结论国产192 Ir线源作为血管内放射源是可行的 ,采用慢感光胶片测定放射源的剂量分布是一种有效手段。     

Brachytherapy and percutaneous stenting in the treatment of cholangiocarcinoma: a prospective randomised study

PURPOSE: To evaluate the effect of radiation therapy including intraluminal brachytherapy with iridium-192 on survival of patients with malignant biliary strictures (cholangiocarcinoma, histologically improved) treated with metallic stent in a prospective randomised study. METHOD AND MATERIALS: In the prospective randomised study, 21 patients with cholangiocarcinoma were treated with implantation of percutaneous stents followed with intraluminal Ir-192 brachytherapy (mean dose 30 Gy) and external radiotherapy (mean dose 50 Gy) and 21 patients were treated only with stents insertion. We did not find any statistically significant differences in age and tumor localization between these two groups of patients. RESULTS: All the patients died. In the group of patients treated with brachytherapy and with stent implantation, the mean survival time was 387.9 days. In the group of patients treated only with stent insertion the mean survival was 298 days. In effort to eliminate possible effect of external radiotherapy we treated the control group of eight patients with cholangiocarcinoma by stent insertion and brachytherapy only. CONCLUSION: Our results show that combined radiation therapy could extend the survival in the patients with cholangiocarcinoma obstruction.     

Retrospective dosimetric comparison of low-dose-rate and pulsed-dose-rate intracavitary brachytherapy using a tandem and mini-ovoids.

The purpose of this study was to compare the dose distribution of Iridium-192 ((192)Ir) pulsed-dose-rate (PDR) brachytherapy to that of Cesium-137 ((137)Cs) low-dose-rate (LDR) brachytherapy around mini-ovoids and an intrauterine tandem. Ten patient treatment plans were selected from our clinical database, all of which used mini-ovoids and an intrauterine tandem. A commercial treatment planning system using AAPM TG43 formalism was used to calculate the dose in water for both the (137)Cs and (192)Ir sources. For equivalent system loadings, we compared the dose distributions in relevant clinical planes, points A and B, and to the ICRU bladder and rectal reference points. The mean PDR doses to points A and B were 3% +/- 1% and 6% +/- 1% higher than the LDR doses, respectively. For the rectum point, the PDR dose was 4% +/- 3% lower than the LDR dose, mainly because of the (192)Ir PDR source anisotropy. For the bladder point, the PDR dose was 1% +/- 4% higher than the LDR dose. We conclude that the PDR and LDR dose distributions are equivalent for intracavitary brachytherapy with a tandem and mini-ovoids. These findings will aid in the transfer from the current practice of LDR intracavitary brachytherapy to PDR for the treatment of gynecologic cancers.     

Radiation recall reaction with docetaxel administration after accelerated partial breast irradiation with electronic brachytherapy

PurposeAccelerated partial breast irradiation (APBI) offers several advantages over whole breast irradiation. Electronic brachytherapy may further reduce barriers to breast conserving therapy by making APBI more available. However, its toxicity profile is not well characterized.Methods and MaterialsA 60-year-old woman was treated with APBI using Axxent (Xoft, Sunnyvale, CA) electronic brachytherapy. One month after APBI, a cycle of docetaxel and cyclophosphamide was given. Within 3 weeks, the patient developed an ulcerative radiation recall reaction in the skin overlying the lumpectomy cavity. To investigate this toxicity, the skin dose from electronic brachytherapy was compared with the dose that would have been delivered by an iridium-192 (¹⁹²Ir) source. Additionally, a dose equivalent was estimated by adjusting for the increased relative biologic effectiveness (RBE) of low energy photons generated by the electronic source.ResultsUsing electronic brachytherapy, the skin dose was 537 cGy per fraction compared with 470 cGy for an ¹⁹²Ir source. Given an RBE for a 40 kV source of 1.28 compared with ¹⁹²Ir, the equivalent dose at the skin for an electronic source was 687 cGy-equivalents, a 46% increase.ConclusionsWe present a case of an ulcerative radiation recall reaction in a patient receiving APBI with electronic brachytherapy followed by chemotherapy. Our analysis shows that the use of electronic brachytherapy resulted in the deposition of significantly higher equivalent dose at the skin compared with ¹⁹²Ir. These findings suggest that standard guidelines (e.g., surface-to-skin distance) that apply to ¹⁹²Ir-based balloon brachytherapy may not be applicable to electronic brachytherapy.     

CT-Guided Interstitial Brachytherapy of Primary and Secondary Lung Malignancies

BACKGROUND AND PURPOSE: CT-guided interstitial brachytherapy of primary lung malignancies and pulmonary metastases represents a novel interventional technique, combining conventional high-dose-rate (HDR) iridium-192 ((192)Ir) brachytherapy with modern CT guidance for applicator positioning and computer-aided 3-D radiation treatment planning. The purpose of this study was to assess safety and efficacy of this technique. PATIENTS AND METHODS: 30 patients with 83 primary or secondary lung malignancies were recruited in a prospective nonrandomized trial (Table 1). After catheter positioning under CT fluoroscopy, a spiral CT was acquired for treatment planning (Figure 1). All but two patients received a defined single dose (coverage > 99%) of at least 20 Gy from a (192)Ir source in HDR technique. RESULTS: Adverse effects were nausea (n = 3, 6%), minor (n = 6, 12%) and one major pneumothorax (2%). Post intervention, no changes of vital capacity and forced expiratory volume could be detected. The median follow-up period was 9 months (1-21 months) with a local tumor control of 91% at 12 months (Figure 2). CONCLUSION: CT-guided interstitial brachytherapy proved to be safe and effective for the treatment of primary and secondary lung malignancies.