单克隆抗体标载的~(131)Ⅰ脑胶质瘤瘤内放免治疗

目的探讨131I-chTNT(131I-肿瘤细胞核人鼠嵌合单抗)通过局部化疗囊注入胶质瘤瘤腔内,行瘤内放免治疗的价值。方法选择全部经手术病理证实的脑胶质瘤56例,其中胶质母细胞瘤34例,星形细胞瘤22例。第1次手术者20例,余为复发性手术。术中瘤腔内置入化疗囊,手术后7d囊内注131I-chTNT1.1×103Bq,15d后重复注入1次。结果于末次注药后2个月复查CT或MRI,随访期6个月～2年2个月,完全缓解21例(37.5%),部分缓解24例(42.8%),临床症状减轻,病情稳定7例(12.5%),病情恶化4例(7.1%)。结论单克隆抗体与131I交联后靶向于肿瘤细胞核,与瘤体特异性结合,并将其荷载的放射性核素输送到肿瘤细胞内,由内向外摧毁肿瘤。临床疗效满意,优于其他类型的瘤内近距离放疗。     

调强放疗联合替莫唑胺同期化疗治疗恶性脑胶质瘤术后残留病灶的近期疗效

目的观察调强放疗联合替莫唑胺同期化疗治疗恶性脑胶质瘤术后残留病灶的近期疗效及毒副反应。方法将32例恶性脑胶质瘤术后有残留病灶的患者随机分为对照组17例和试验组15例．对照组术后行调强放疗,试验组行术后调强放疗的同时FI服替莫唑胺化疗（75mg·m^-2·d-1）,疗程结束后评价两组患者的近期疗效及毒副反应。结果试验组总有效率为73．3％（11／15）,对照组总有效率为23．5％（4／17）,两组比较差异有统计学意义（P=0．047）。两组毒副反应比较无统计学意义。结论调强放疗联合替莫唑胺同期化疗治疗恶性脑胶质瘤术后残留病灶有较好的近期疗效。     

颅内恶性肿瘤选择性动脉灌注化疗

目前 ,无论颅内原发恶性胶质瘤或是继发转移瘤 ,都缺乏有效治疗措施 ,手术、放疗和全身化疗对提高生存质量和延长生存期均不理想。寻找有效治疗方法 ,改善病人预后 ,人们做了大量努力 ,我们对手术后复发性颅内恶性胶质瘤和无法手术切除的转移瘤试行超选择性动脉灌注化疗 ,明显提高了病人生存期和生存质量 ,认为这是一种值得推广的新技术。1　材料与方法1.1　一般材料　 14例病人 ,男 9例女 5例 ,年龄 12～ 6 2岁 ,平均 49.6岁。 4例术后复发性胶质瘤位于大脑半球 ,2例无法手术切除的脑干胶质瘤 ;6例肺腺癌脑转移 (4例肺癌术后 ,2例与肺癌共…     

脑胶质瘤放射治疗实验及临床研究进展

立体定向放射治疗、近距离放疗、放疗加化疗等综合治疗是提高恶性脑胶质瘤控制率的有效途径.而立体定向放射加常规放疗治疗胶质瘤既发挥了放射物理剂量分布的优点,又符合放射生物学原则,较以往治疗提高了患者的生存机会. 手术力争全切除,术后内照射、术后应用肿瘤敏感药物超选择颈内动脉介入化疗、术后敏感药物间质化疗联合增敏放疗,序贯自体免疫治疗,是一种个体综合治疗脑胶质瘤的安全有效方法 .     

成人脑恶性胶质瘤术后放疗同步替尼泊甙联合 司莫司汀化疗疗效分析

目的前瞻性研究成人脑恶性胶质瘤患者术后同步放化疗的疗效。方法1999年9月至2003年5月收治50例成人脑恶性胶质瘤术后患者，随机分成两组，各25例。①单纯放疗组，给予术后单纯放疗，DT54～60Gy；②同步放化疗组，给予单纯放疗组相同的放疗方法，同时于DT20Gy后行同步替尼泊甙（VM-26）联合司莫司汀（Me-CCNU）化疗。结果成人恶性胶质瘤术后单纯放疗组1、3、5年生存率分别为56％、24％、6％，中位生存期为16个月；术后同步放化疗组1、3、5年生存率分别为72％、48％、20．11％，中位生存期为36个月。同步放化疗组生存率明显优于单纯放疗组（χ^2=4．05，P=0．044）。结论成人恶性胶质瘤患者在手术后适当时机进行同步放化疗可以提高生存率；VM-26联合Me-CCNU是有效的化疗方案。     

恶性胶质瘤:对放疗反应的时间

作者回顾性分析了71例脑恶性胶质瘤术后、放疗后、化疗前的CT征象,以期对恶性胶质瘤放疗反应的时间进行评价。均经活检证实,位于幕上的恶性胶质瘤患者,术后3周行放疗,44Gy/22次/4.5周全脑照射后局部追加14Gy/8次/1.5周,放疗后8周行BCNU或diaziquone(AZQ)化疗。术后、放疗后、化疗前后各行一次CT扫描。71例中男性45例,女性26例,年龄18～74岁。48例胶质母细胞瘤,23例间变胶质瘤,位于左侧31例,右侧36     

192Ir核素脑胶质瘤间质内放疗的研究及其临床应用

为观察用＾１９２Ｉｒ后装治疗脑胶质瘤间后内放疗的有效性及其并发症,用皮荷瘤鼠和脑荷瘤鼠模型行间质内放疗实验,证明在内照射后可抑制肿瘤生长及延长鼠的生存期的可靠基础上,对７２例脑胶质瘤采用＾１９２Ｉｒ后装机行瘤间后内近距离照射,取得良好疗效。手术无何严重并发症,无死亡。术后随访１－５年,生存率分别为９２％、８２％、７２％、５６％及３２％,表明生存期显著延长。结论脑深部胶质瘤用＾１９２Ｉｒ核素瘤间持     

术中125I粒子植入治疗复发性脑胶质瘤的临床研究

目的探讨复发性脑胶质瘤术中mI粒子植入治疗的近期治疗效果及并发症。方法回顾性分析58例复发性脑胶质瘤患者资料,其中,23例患者行单纯手术,另外35例利用计算机三维治疗计划系统于术前或术中制定治疗计划,术中依据所制定的剂量,在肿瘤切除后的瘤床上植入mI粒子,处方剂量为140～188Gy。术后每2个月复查CT或MRI进行验证和质量评估,随访8～32个月,比较分析两组患者的肿瘤复发率、生存期及放射性并发症。结果单纯手术组中有20例复发,复发率为87．0％;有3例死于术后并发症。术中mI粒子植入治疗组中有23例复发,复发率为65．7％;有5例死于术后并发症,4例发生顽固性脑水肿,3例发生放射性脑坏死。术中“I粒子植入治疗组肿瘤复发时间f（97．5±15．3）周】明显长于单纯手术组【（62．5±13．6）周]（t=9．21,P〈0．05）,生存期[（60．3±7．1）周】亦明显长于单纯手术组[（43．1±5．5）周1（t=13．03,P〈0．05）。单因素变量分析结果显示,世界卫生组织肿瘤病理分级与肿瘤切除程度是影响患者生存率的独立因素。结论术中125I粒子植入治疗可降低脑胶质瘤的复发率,有效增加复发性脑胶质瘤患者的生存时间。     

手术切除联合放射与化疗治疗脑胶质瘤

目的：探讨手术切除联合放射治疗脑胶质瘤的疗效和安全性。方法：回顾分析2005-01～2008-01间我院收治的63例脑胶质瘤患者的临床资料,其中31例患者手术切除后给予放射治疗联合化疗（观察组）,32例患者术后行普通化疗（对照组）,比较两组患者生存率和复发等。结果：手术切除联合放射治疗脑胶质瘤,患者复发率低于对照组,生存时间长于对照组（P〈0.05）。结论：手术切除肿瘤的基础上联合放疗和化疗,可以延长患者的生存时间,提高治疗效果,值得临床推广应用。     

磁共振引导~(125)I粒子植入挽救性治疗恶性脑胶质瘤1年预后相关因素分析

目的探讨磁共振引导~(125)I粒子植入挽救性治疗恶性脑胶质瘤1年预后相关因素分析。方法回顾性分析磁共振引导~(125)I粒子植入治疗的31例手术后放疗后复发、放疗后复发的恶性脑胶质瘤患者,其中Ⅲ级15例,IV级16例。选取性别、年龄、KPS评分、瘤体最长径、手术切除程度、病理分级、靶区剂量D90、肿瘤位置(小脑幕为界)8个因素,应用Kaplan-Meier进行生存分析,Cox比例风险回归模型进行预后的单因素和多因素分析。结果单因素分析显示年龄、KPS评分、手术切除程度、病理分级及靶区剂量D90是预后相关因素,组间差异均有统计学意义(P0.05)。而性别、瘤体最长径、肿瘤位置组间差异无统计学意义(P0.05)。Cox比例风险回归表明年龄≤50、KPS评分≥80分、手术切除完全、靶区剂量D90(90~100Gy)的患者~(125)I粒子植入治疗预后效果较好。结论年龄、KPS评分、手术切除程度、靶区剂量D90是影响~(125)I粒子植入治疗恶性脑胶质瘤的预后独立危险因素。     

Tumor resection cavity administered iodine-131-labeled antitenascin 81C6 radioimmunotherapy in patients with malignant glioma: neuropathology aspects

INTRODUCTION: The neurohistological findings in patients treated with targeted beta emitters such as (131)I are poorly described. We report a histopathologic analysis from patients treated with combined external beam therapy and a brachytherapy consisting of a (131)I-labeled monoclonal antibody (mAb) injected into surgically created resection cavities during brain tumor resections. METHODS: Directed tissue samples of the cavity walls were obtained because of suspected tumor recurrence from 28 patients. Samples and clinical follow-up were evaluated on all patients (Group A) based on total radiation dose received and a subset of these (n=18; Group B, proximal therapy subset) who had received external beam therapy within 相似文献   

Cs-131 brachytherapy for patients with recurrent glioblastoma combined with bevacizumab avoids radiation necrosis while maintaining local control

PurposeRe-irradiation of recurrent glioblastoma (GBM) may delay further recurrence but re-irradiation increases the risk of radionecrosis (RN). Salvage therapy should focus on balancing local control (LC) and toxicity. We report the results of using intraoperative Cesium-131 (Cs-131) brachytherapy for recurrent GBM in a population of patients who also received bevacizumab.Methods and MaterialsTwenty patients with recurrent GBM underwent maximally safe neurosurgical resection with Cs-131 brachytherapy between 2010 and 2015. Eighty Gy was prescribed to 0.5 cm from the surface of the resection cavity. All patients previously received adjuvant radiotherapy and temozolomide, and received bevacizumab before or after salvage brachytherapy. Seven of 20 (35%) tumors were multiply recurrent and had been previously salvaged with external beam radiotherapy. Patients received MRI scans every 2 months monitored for recurrence, progression, and RN.ResultsMedian tumor diameter was 4.65 cm (range, 1.2–6.3 cm). Median number of seeds pace was 41 (range, 20–74) with total seed activity 96.8U (range, 41.08–201.3U). At a median followup of 19 months, crude LC was 85% and median overall survival was 9 months (range, 5–26 months). There were two postoperative wound infections (10%), three seizures (15%), and 0% incidence of RN.ConclusionsOur study demonstrates that while LC and survival are similar to other studies of postoperative external beam radiotherapy, no RN occurred in any of these patients, including 7 multiply re-irradiated patients. Of interest, there were patients with multiple recurrences whose survival extended beyond 20 months. These findings suggest that the use of highly conformal Cs-131 brachytherapy is a promising treatment for patients with recurrent GBM with minimal risk of development of RN.     

Locally recurrent breast carcinoma: the effect of adjuvant chemotherapy on prognosis

A group of 72 patients who had received radiotherapy between 1972 and 1980 for isolated local-regional recurrence of breast cancer was studied; 38 had received adjuvant chemotherapy and 34 had not. The two groups were comparable except for the initial nodal status and median time from mastectomy to recurrence. Outcome was not significantly different for the two groups in terms of response to radiotherapy, incidence of re-recurrence, distant metastases, and three-year survival. The length of the disease-free interval and the response to radiotherapy were the only factors studied that were significantly related to survival.     

Novel human IgG2b/murine chimeric antitenascin monoclonal antibody construct radiolabeled with 131I and administered into the surgically created resection cavity of patients with malignant glioma: phase I trial results.

Results from animal experiments have shown that human IgG2/mouse chimeric antitenascin 81C6 (ch81C6) monoclonal antibody exhibited higher tumor accumulation and enhanced stability compared with its murine parent. Our objective was to determine the effect of these differences on the maximum tolerated dose (MTD), pharmacokinetics, dosimetry, and antitumor activity of (131)I-ch81C6 administered into the surgically created resection cavity (SCRC) of malignant glioma patients. METHODS: In this phase I trial, eligible patients received a single injection of (131)I-ch81C6 administered through a Rickham catheter into the SCRC. Patients were stratified as newly diagnosed and untreated (stratum A), newly diagnosed after external beam radiotherapy (XRT) (stratum B), and recurrent (stratum C). (131)I-ch81C6 was administered either before (stratum A) or after (stratum B) conventional XRT for newly diagnosed patients. In addition, chemotherapy was prescribed for all patients after (131)I-ch81C6 administration. Dose escalation was performed independently for each stratum. Patients were observed for toxicity and response until death or progressive disease. RESULTS: We treated 47 patients with (131)I-ch81C6 doses up to 4.44 GBq (120 mCi), including 35 with newly diagnosed tumors (strata A and B) and 12 with recurrent disease (stratum C). Dose-limiting hematologic toxicity defined the MTD to be 2.96 GBq (80 mCi) for all patients, regardless of treatment strata. Neurologic dose-limiting toxicity developed in 3 patients; however, none required further surgery to debulk radiation necrosis. Median survival was 88.6 wk and 65.0 wk for newly diagnosed and recurrent patients, respectively. CONCLUSION: The MTD of (131)I-ch81C6 is 2.96 GBq (80 mCi) because of dose-limiting hematologic toxicity. Although encouraging survival was observed, (131)I-ch81C6 was associated with greater hematologic toxicity, probably due to the enhanced stability of the IgG2 construct, than previously observed with (131)I-murine 81C6.     

Intra-arterial regional chemotherapy and intensive loco-regional radiotherapy in the treatment of locally advanced cancer of the breast

A multimodal treatment combining intra-arterial chemotherapy and intensive loco-regional radiotherapy was administered to 55 patients with locally advanced breast cancer. Adjuvant polychemotherapy followed, and eventually endocrino-therapy. Combined intra-arterial chemotherapy and intensive radiotherapy gave excellent results in both primary and lymph node lesions, with 90.9% and 92.2% complete/partial response rates. Three-year and 5-year actuarial survival rates were 69% and 59%, respectively. Patients showing better local responses to combined intra-arterial chemotherapy and intensive radiotherapy had longer survival and less frequent local recurrences. Combined intra-arterial chemotherapy and intensive loco-regional radiotherapy seems to be an effective modality for the treatment of locally advanced breast cancer.     

宫颈癌术前或放疗中辅助介入治疗的临床应用

目的评价宫颈癌患者于放疗前或放疗过程中,以及部分Ⅱa期以前患者术前采用动脉灌注化疗和介入栓塞治疗进行新辅助化疗的效果。方法回顾性分析2000年4月—2006年12月来我科进行介入化疗的Ⅰb～Ⅲa宫颈癌患者31例,评价介入效果,观察并发症并定期随访。结果31例治疗的患者中,Ⅰb～Ⅱb期15例,经1～2次介入治疗后,行广泛性子宫切除4例,次广泛子宫切除11例;Ⅲ期宫颈癌16例,放疗过程中出血7例,治疗后放疗得以继续进行,其余9例于治疗后常规进行放疗,效果较好。结论介入化疗及栓塞治疗可作为宫颈癌患者术前及放疗过程中的新辅助化疗手段,应用前景好,值得临床推广。     

Concurrent end-phase boost high-dose radiation therapy for non-small-cell lung cancer with or without cisplatin chemotherapy

The aim of this study was to audit the results of a high-dose, combined-modality prospective protocol for non-small-cell lung cancer in terms of survival, disease-specific survival and toxicity. One hundred and twenty-one patients with non-small-cell lung cancer were treated with a concurrent, end-phase, boost, high-dose radiotherapy protocol with 65 Gy in 35 fractions for more than 5 weeks. Sixty-six patients received radiotherapy alone (group 1), 29 received concurrent chemoradiation (group 2) and 26 received neoadjuvant and concurrent chemotherapy (group 3). Thirty-four patients had stage I disease, six had stage II and 81 had stage III. Overall median survival was 23 months: 75% at 1 year and 23% at 5 years. Median survivals for patients with stage I and stages II and III disease were 43 and 19 months, respectively. For stages II and III patients by groups 1-3, median survivals were 18, 25 and 18 months, respectively, and 2-year survivals were 36, 52 and 38%, respectively. Toxicity was acceptable. Overall, 9% had symptomatic pneumonitis and 7% had grades 3 and 4 oesophagitis. For those who had the mediastinum included in the volume, grade > or = 3 oesophagitis occurred in 0, 11 and 22% (n = 110, P = 0.001), respectively, for treatment groups 1-3. Overall treatment-related mortality was 3%, consisting of two septic deaths, one pneumonitis and possibly one late cardiac event, all occurring in patients who had chemotherapy (7% of 55 patients). Treatment-related mortality declined over the study period. Accelerated radiotherapy was well tolerated, with only moderate increased acute toxicity when combined with concurrent platinum chemotherapy. Toxicity was enhanced by induction chemotherapy. Overall survival outcomes were excellent for this condition. Continued use of this radiotherapy schedule is recommended as the platform for assessment of other chemotherapy schedules.     

髂内动脉化疗辅助经尿道电切治疗浸润性膀胱癌的临床研究

目的评价动脉介入化疗辅助经尿道电切治疗浸润性膀胱癌的效果。方法对13例病理证实为肌层浸润性的膀胱移行细胞癌（T2-T3）的患者行经尿道电切术＋辅助动脉介入化疗。经骼内动脉灌注的化疗药物为顺铂80mg、表柔比星50mg,氟尿嘧啶1g或喜树碱30mg。经辅助动脉介入化疗后,所有病例定期随访,观察其生存期、无病生存期以及化疗副作用等。结果13例患者完成治疗,年龄68.3±7.4岁,平均随访26.46个月,肿瘤复发5例（38.46%）,对复发肿瘤行再次经尿道切除,1例远处转移行全身化疗。2例患者因癌死亡。结论选择辅助介入化疗结合经尿道切除的治疗对部分肌层浸润性的膀胱移行细胞癌（T2-T3）的患者具有一定的疗效,并具有保留膀胱功能、较好生活质量的优点。