三维适形放疗联合射频热疗治疗食管上段癌的临床观察

目的 分析三维适形放疗联合射频热疗治疗食管上段癌的疗效,与单纯放疗作对比.方法 48例食管上段癌随机分2组,每组24例.单纯放疗组:DT 60～70 Gy/30～35次/6～7周;综合治疗组:DT 60～70 Gy/30～35次/6～7周,放疗期间加用SR-1000型射频热疗,每周两次,功率500～800 W,每次加热1 h,共6次.结果 综合治疗组的近期疗效(CR+PR)为95.8%,明显高于单纯放疗组的70.8%,差异有统计学意义(P<0.05).结论 联合方法即三维适形放疗+射频热疗能提高食管癌的近期治疗效果.     

射频电容加热深部肿瘤——加热放射治疗的研究

采用上文同样的射频电容加热方式再与放射治疗配合,对40名晚期深部肿瘤患者进行临床应用的评价。热疗为每周1～2次,每次热疗在放疗后进行,总共4～13次。对其中33名患者采用每次170～200cGy的放疗,每周5次,总剂量为30～70Gy,有2名肝癌少于40Gy,2名直肠癌达70Gy。其余7名接受每次400cGy、每周2次的放疗,总剂量为28～60Gy,大多在40～48Gy。在接受加热加放疗的40名患者中,6名完全有效(100%消退),6名大部分有效(80～     

放疗联合热疗治疗颈部淋巴结转移癌的临床疗效观察

目的:观察颈部淋巴结转移癌放射治疗加热疗的临床疗效.方法:100例颈部转移癌患者,随机分成2组,热疗加放疗组(H+R),单纯放疗组(R),两组病例放射治疗均采用8MV-X射线照射,DT:2Gy/次,1日1次,1周5次,H+R组病人1周配合2次热疗,共进行10次.结果:治疗剂量达50Gy时,放疗+热疗组CR+PR:92%,单纯放疗组CR+PR:76%,二者有显著性差异;放疗+热疗组,剂量达56-60Gy时,CR:72%,单纯放疗组,剂量达66-70Gy时,CR:44%,二者有显著性差异.结论:放疗联合热疗治疗可减少放射治疗剂量,减轻局部放射负损伤,提高病灶消退率,使颈部淋巴结转移癌疗效明显提高.     

立体定向体部放射治疗联合射频热疗治疗非小细胞肺癌的近期疗效观察

目的:观察立体定向体部放射治疗联合射频热疗治疗非小细胞肺癌的近期疗效和毒副反应。方法:21 例患者均采用少分次、大分割的立体定向放射治疗。肿瘤直径＜3cm者,70%～80% 等剂量线覆盖靶区,单次周边剂量7～9Gy,总剂量36～42Gy,分5～6次;肿瘤直径3～5cm者,60%～70%等剂量线覆盖靶区,单次周边剂量5～8Gy,总剂量40Gy,分5～8次;肿瘤直径＞5cm者,50%～60%等剂量线覆盖靶区,单次周边剂量4～6Gy,总剂量40～42Gy,分7～10次。隔日治疗,总时间不超过2周。疗程中同步行射频热疗,在放疗前或后45min内实施,时间为60min,每周1～2次,次间间隔72h以上,共6～8次。结果:治疗后2～3个月所有患者得到随访。其中完全缓解率为19.0%（4/21）,部分缓解率为71.4%（15/21）,总有效率为90.5%（19/21）。骨髓抑制为主要并发症,发生率为61.9%（13/21）。结论:立体定向体部放射治疗联合射频热疗治疗非小细胞肺癌近期疗效好,毒副反应轻可耐受,值得临床推广。     

放疗联合热疗治疗颈部淋巴结转移癌的临床疗效观察

目的：观察颈部淋巴结转移癌放射治疗加热疗的临床疗效。方法：100例颈部转移癌患者,随机分成2组,热疗加放疗组（H＋R）,单纯放疗组（R）,两组病例放射治疗均采用8MV-X射线照射,DT：2Gy/次,1日1次,1周5次,H＋R组病人1周配合2次热疗,共进行10次。结果：治疗剂量达50Gy时,放疗＋热疗组CR＋PR：92%,单纯放疗组CR＋PR：76%,二者有显著性差异;放疗＋热疗组,剂量达56-60Gy时,CR：72%,单纯放疗组,剂量达66-70Gy时,CR：44%,二者有显著性差异。结论：放疗联合热疗治疗可减少放射治疗剂量,减轻局部放射负损伤,提高病灶消退率,使颈部淋巴结转移癌疗效明显提高。     

晚期胰腺癌患者三维适形放疗联合热疗的疗效观察

目的探讨晚期胰腺癌患者三维适形放射疗法联合热疗的临床疗效。方法采用三维适形放疗联合热疗技术对50例晚期胰腺癌患者进行治疗。对于直径〈5cm的肿瘤,每周放疗3次,每次3．8～4．5Gy,4周总剂量为45～54Gy;对于直径〉5cm的肿瘤,每周放疗5次,每次2Gy,6周总剂量为60—65Cy。对全部患者在放疗后1h内进行热疗。结果患者在治疗后2～3个月进行CT检测复查,治疗后总有效率达70．0％,腹痛总缓解率为100％,黄疸总消退率84．6％。治疗后两年随访结果表明,生存率为60．0％。结论采用三维适形放疗与热疗联合治疗晚期胰腺癌的疗效好,不良反应小,止痛效果好,值得临床推广。     

28例恶性肿瘤颈部淋巴结转移热放疗临床分析

  目的 探讨28例恶性肿瘤颈部淋巴结转移热放疗与单纯性放疗的疗效对比。方法 患者随机分为热疗加放疗组和单纯放疗组。每组14例。热疗加放疗组采用微波加温合并加速器放疗，热疗结束后30 ~ 40 min进行放疗。放射治疗每周外照射5次，每次1.8 ~ 2 Gy；肿瘤照射剂量鳞癌60 ~ 65 Gy，腺癌60 ~ 70 Gy，其他55 ~ 60 Gy；单纯放疗组只进行相应剂量的放射治疗。结果 热疗加放疗组总有效率为85.71 ％，单纯性放疗组总有效率为：64.2 ％，两组比较差异有统计学意义（P＜0.01）。结论 热疗加放疗可以通过影响多个肿瘤发生的相关因素来达到杀伤肿瘤细胞的目的，具有明显的互补和增效作用热疗。     

立体聚集热疗加放射治疗盆腔恶性肿瘤的临床研究

目的　探讨BSD2 0 0 0型热疗机深部立体聚焦热疗结合放射治疗盆腔恶性肿瘤的疗效。方法　自 1995年8月至 1997年 12月我们将 6 1例盆腔复发或转移的恶性肿瘤病人随机分为热疗加放疗组 ( 3 1例 )和单纯放疗组 ( 3 0例 )。热疗采用立体聚焦的BSD2 0 0 0型热疗机 ,Sigma6 0辐射器 ,每周热疗两次 ,每次均于同日放疗后 3 0分钟内进行 ,每次 40～ 6 0分钟。平均每例热疗 3 .5次。采用高电阻铅测温针肿瘤内测温。放疗用 6MV或 15MVx线 ,每周 5次 ,每次 1.8～ 2 .0Gy ,三野或四野照射 ,均用缩野技术。热疗加放疗组平均照射 5 6Gy ,单纯放疗组 6 0 .5Gy。 结果　治疗结束后热疗加放疗组CR率为 6 4 .5 % ;单纯放疗组为 3 3 .3 3 % (P <0 .0 5 )。放疗至 2 0Gy时两组的CR PR率即显示有明显的意义(P <0 .0 5 )。当放疗至 40Gy时热疗加放疗组的CR率即达 5 5 .2 % ,明显高于单纯放疗组 ( 2 3 .3 % )P <0 .0 5。热疗加放疗组的副作用包括加热区域疼痛 ,股外侧烧灼样感 ,脉搏增快 ,血压升高 ,皮肤水疱。两组皮肤反应均低于Ⅱ°。发生率两组无明显差异 (分别为 2 2 .6 % ,16 .7% )。结论　采用BSD2 0 0 0型深部立体聚焦热疗机热疗结合放疗可以明显提高盆腔复发或转移恶性肿瘤的疗效 ,减少放疗的并发症。     

130例脑转移瘤常规放疗和调强放疗的疗效分析

目的 评价调强放射治疗在脑转移瘤治疗中的疗效.方法 将130例脑转移瘤患者随机分成常规放疗组和调强放射治疗组.常规放疗组64例,先行全脑放射治疗(WBRT)36～40 Gy后,局部缩野加量,总剂量到50～60 Gy,每次2 Gy,5次/周.调强放射治疗组66例,全脑放射治疗剂量39.2～39.6Gy,脑转移灶剂量54～60 Gy,5次周,共23次.结果 治疗结束后3月、6月复查,对1～3个脑转移灶患者,常规放疗组和调强放疗组的中位生存期、有效率(CR+ PR)和1年生存率分别为13月、82％、59％和14月、88％、61％.对于脑转移灶数目大于3个的患者,常规放疗组和调强放疗组的中位生存期、有效率(CR+ PR)和1年生存率分别为9月、73％、47％和13月、87.5％、59％.结论 调强放射治疗可能是多发脑转移瘤患者的一种较常规全脑放疗更有效的治疗手段.     

热疗配合放射治疗不能手术的食管癌疗效分析

探讨不能手术的食管癌热疗配合放射治疗的效果。方法　回顾性分析 5 0例不能手术的食管癌热疗配合放射治疗的临床资料。 5 0例中男性 43例 ,女性 7例 ;鳞癌 46例 ,腺癌 1例 ,小细胞癌 3例。热疗采用 8MHz深部射频热疗机 ,在放射后 10～ 6 0min内进行加温 ,每次治疗 5 0min ,每周 1～ 2次。放射治疗采用 8MVX射线或6 0 Coγ射线 ,常规分割照射 ,总剂量 6 0～ 70Gy ,6～ 7周者 42例 ,72～ 76Gy ,7～ 8周者 4例 ,5 0Gy以下者 4例 ,治疗效果均以食管钡餐检查为评价手段。采用Kaplan Meier法进行生存率分析、Logrank法检验 ,分析不同的热疗参数对疗效的影响。 结果　热疗次数达 3次以上者 1、2年生存率均高于 3次以下者 ,分别为 42 .5 %、17.5 %及 10 .0 %、0 .0 % (P<0 .0 1) ;热疗有效功率 80 0W以上的 1、2年生存率比 80 0W以下高 ,分别为 46 .9%、18.8%及16 .7%、5 .6 % (P <0 .0 5 )。结论　热疗配合放射治疗食管癌亦应注意有效功率及热疗次数。     

三维适形放疗联合微波热疗治疗颈部淋巴结转移癌的疗效观察

目的：观察三维适形放疗配合微波热疗对颈部淋巴结转移性癌的治疗效果。方法：对55例来源于鼻咽癌、喉癌、食管癌及肺癌的颈部淋巴结转移性癌,分为微波热疗＋三维适形放疗组30例及单纯三维适形放疗组25例,放疗总量60-70Gy/30-35次;6次/周;微波热疗3次/周,随访3个月,观察疗效。结果：两组患者全部完成治疗计划。微波热疗＋三维适形放疗组患者在治疗结束时颈部肿块完全消退23例（76.7%）,单纯三维适形放疗组患者为7例（35.0%）,两组比较差异有统计学意义（P〈0.05）。随访结束时微波热疗＋三维适形放疗组患者颈部肿块完全消退25例（83.3%）,单纯三维适形放疗组为15例（60.0%）,两组比较差异有统计学意义（P〈0.05）。无明显不良反应。结论：三维适形放疗联合微波热疗对治疗颈部淋巴结转移性癌疗效良好。     

Hyperthermia in combination with definitive radiation therapy: results of a Phase I/II RTOG Study

Between August 1981 and April 1986, 133 patients with superficial malignant tumors not previously treated with radiotherapy were entered on a Phase I/II RTOG study evaluating hyperthermia plus definitive radiotherapy. Eligible patients included those with superficial epithelial or mesenchymal tumors less than 4 cm in depth. Protocol radiotherapy specified a tumor dose of 60 Gy delivered in 1.8-2.0 Gy fractions 5 times/week with a boost of 5-10 Gy through reduced portals to residual tumor. Protocol hyperthermia, delivered twice weekly, was to start within 15 minutes following irradiation and to consist of 60 minutes of heat to a tumor temperature of 43 degrees C. Sixteen patients were excluded. Of the 117 eligible patients, the treated lesions had site/histologies which were 35% head & neck/squamous, 46% breast/adenocarcinoma, and 19% other site/histologies. Lesions were 3 cm or larger for 77% of patients. Of the 41 patients with head & neck/squamous lesions, skin or subcutaneous necrosis occurred within 6 months for 2% of the patients; 12% experienced thermal blisters. Fourteen patients were followed for 6 months or more following start of treatment; none of these experienced late toxicities more severe than telangiectasis. Complete responses were observed in 51% of these patients. Of the 54 patients with breast/adenocarcinoma lesions, skin or subcutaneous necrosis occurred within 6 months for 13% of the patients; 17% experienced thermal blisters. Thirty-seven patients were followed for 6 months or more following start of treatment; complications observed during this period included 13% with ulceration and one case of skin necrosis. Complete responses were observed in 85% of these patients. Local control was maintained at nearly this level for at least 2 years. Logistic regression analyses showed site/histology, greatest tumor diameter and average tumor temperature to be significantly related to response. Based on these promising findings, the RTOG has instituted a randomized Phase III study evaluating radiation therapy with or without hyperthermia in this patient population.     

Microwave-induced hyperthermia and radiotherapy in human superficial tumours: clinical results with a comparative study of combined treatment versus radiotherapy alone

Eighty-five evaluable superficial recurrent malignant tumours, mainly adenocarcinomas (78 per cent), in 38 patients were treated with either combined local hyperthermia (41-45 degrees C for four sessions) and low dose radiotherapy (30.0 Gy) or the same low dose radiotherapy alone. The treatment was given for two weeks. Hyperthermia was induced externally with 2450 MHz or 915 MHz microwaves. Totally 57 tumours were given combined treatment with a complete and partial response rate of 46 and 30 per cent, respectively (duration 1-38 months). In 18 patients with 2-10 superficial tumours each, 56 tumours were used in a comparative study, comparing the effect of combined hyperthermia and low dose radiotherapy versus the same low dose radiotherapy alone, the patients acting as their own controls. The total response rates were 89 and 50 per cent, respectively, in the two treatment modality groups. The difference in response rates is significant (p = 0.0039) in favour of the combined treatment, and this is also found when comparing complete remissions only (p = 0.0027). Local pain and normal tissue reactions presented problems during and after 2450 MHz microwave-induced hyperthermia treatment, performed without a coupling water bag system. Introduction of 915 MHz microwave-induced hyperthermia with a coupling deionized water bag system and refinement of microwave applicators, as well as the temperature control system considerably reduced these problems.     

Hyperthermia combined with radiation therapy for primarily unresectable and recurrent colorectal cancer.

The value of adjuvant hyperthermia to radiotherapy in the treatment of locally advanced colorectal cancers was investigated. Between 1981 and 1989, 71 primarily unresectable or recurrent colorectal tumors were treated with radiotherapy at the Department of Radiology, Kyoto University Hospital. Of the 71 tumors, 35 were treated with radiotherapy plus hyperthermia (group I), while 36 tumors (group II) were unsuitable for hyperthermia mainly because of difficulties with the insertion of temperature probes or the thickness of the patient's subcutaneous fat (greater than 2 cm). The mean total radiation dose was 58 Gy and 57 Gy for groups I and II, respectively. Thirty deep-seated pelvic tumors were treated with an 8 MHz radiofrequency capacitive heating device, and five subsurface tumors were treated with a 430 MHz microwave hyperthermia system. Hyperthermia was given following radiotherapy for 30-60 min for a total of 2-14 sessions (mean 5.7). In 32 of the 35 tumors heated, direct measurement of tumor temperature was performed. For the five tumors treated with the microwave heating device, the means of the mean maximum, average, and minimum measured intratumoral temperatures were 45.4 degrees C, 43.3 degrees C, and 40.6 degrees C, respectively. The corresponding values were 42.2 degrees C, 41.3 degrees C, and 40.3 degrees C for the 27 tumors treated with the capacitive heating device. Effective heating of deep-seated pelvic tumors was more difficult than heating of abdominal wall or perineal tumors. The local control rate at 6 months after the treatment, which was defined as absence of local progression of the tumors, was 59% (17/29) and 37% (11/30) for groups I and II, respectively. The objective tumor response rate (complete regression plus partial response) evaluated by computed tomography was 54% (19/35) in group I, whereas it was 36% (10/28) in group II. A better response rate of 67% was obtained in the 15 tumors with a mean average tumor temperature of greater than 42 degrees C. Although limitation of our current heating devices exist, the combination of hyperthermia with radiotherapy is a promising treatment modality in the treatment of locally advanced colorectal cancer.     

Interstitial hyperthermia (MINERVE) for perineal local recurrence of rectal cancer

Interstitial hyperthermia (MINERVE) was performed for 2 patients with perineal local recurrence of rectal cancer. The MINERVE was a 20 W generator of 550-610 kHz with 4 pairs of probes creating an electromagnetic field (Odam Co., France). The basic regimen was five irradiation treatments of 2 Gy per week, with two hyperthermia treatments (for 60 minutes at more than 43.5 degrees C) a week, 500 mg of 5-FU or 25 mg of CDDP per hyperthermia treatment, and 3 g/day of PSK. The radiation therapy was performed prior to hyperthermia, the chemotherapy at the same time. Perineal tumors and symptoms disappeared completely in 1 patient and were reduced in 1 patient. This treatment is expected to be clinically as a part of multidisciplinary treatment for superficial malignant tumors.     

三维适形放疗联合微波热疗治疗颈部淋巴结转移癌的疗效观察

目的:观察三维适形放疗配合微波热疗对颈部淋巴结转移性癌的治疗效果。方法:对55例来源于鼻咽癌、喉癌、食管癌及肺癌的颈部淋巴结转移性癌,分为微波热疗+三维适形放疗组30例及单纯三维适形放疗组25例,放疗总量60-70Gy/30-35次;6次/周;微波热疗3次/周,随访3个月,观察疗效。结果:两组患者全部完成治疗计划。微波热疗+三维适形放疗组患者在治疗结束时颈部肿块完全消退23例(76.7%),单纯三维适形放疗组患者为7例(35.0%),两组比较差异有统计学意义(P<0.05)。随访结束时微波热疗+三维适形放疗组患者颈部肿块完全消退25例(83.3%),单纯三维适形放疗组为15例(60.0%),两组比较差异有统计学意义(P<0.05)。无明显不良反应。结论:三维适形放疗联合微波热疗对治疗颈部淋巴结转移性癌疗效良好。     

Retrospective analysis of the response of tumours in patients treated with a combination of radiotherapy and hyperthermia

One hundred and twelve patients with various carcinomas were treated on 112 fields with radiotherapy and hyperthermia, using non-invasive techniques. Radiotherapy dose ranged from 13-70 Gy (except for one patient receiving hyperthermia alone) with a mean of 28.6 Gy. The combined treatment was primarily aimed at giving palliation; 79 per cent of the patients had received previous irradiation on the same area. Hyperthermia was given twice weekly following radiotherapy. From the temperature data collected, 12 different parameters expressing the hyperthermia 'dose' were derived. The various parameters for both treatment modalities, i.e. radiotherapy and hyperthermia, and some of the tumour parameters were statistically evaluated with respect to their influence on tumour response. The overall response rate was 87 per cent including 33 per cent complete response. The complete response rate increased with increasing radiotherapy total dose, i.e. from 23 per cent (14-25 Gy) and 38 per cent (28-36 Gy) to 60 per cent (greater than 38 Gy). A positive correlation between the tumour temperature parameter representative of the coldest spot in the tumour, and the level of response was found. Achievement of complete response appeared also to be determined to a considerable extent by radiotherapy total dose as well as tumour volume. The correlation between response level and the minimum hyperthermia dose parameters persisted, however, after correction for the influence of tumour volume and radiotherapy total dose. These results support the opinion that higher tumour response rates can be achieved by increasing the hyperthermia treatment level at the coldest spot in the tumour.     

恶性滋养细胞肿瘤脑转移的放射治疗

From 1982 to 1985, 26 patients with malignant trophoblastic tumor were treated. Of them, 8 patients developed brain metastasis. Seven out of these 8 patients were treated with 60Co whole brain radiotherapy. The total dose on the longitudinal mid-plane of brain was 3300 cGy/2-3 weeks. Four patients were cured, 3 of them have survived without recurrence or sequelae for 6.5, 6 and 4.5 years, respectively; the other one died of liver metastasis 1 year after radiotherapy. Radiotherapy is an effective method in the combined treatment for brain metastasis of malignant trophoblastic tumors.