兔髂动脉腔内照射预防血管成形术后再狭窄实验研究初报

目的 评价兔髂动脉内近距离治疗预防经皮经腔血管成形术（ＰＴＡ）后再狭窄的可行性及作用。方法 ２９只兔髂动脉进行ＰＴＡ后制成动脉狭窄模型,４周后将狭窄病灶分为３个组：（１）８只作为对照组,仅作ＰＴＡ;（２）９只ＰＴＡ后＾１９２Ｉｒ腔内照射１０Ｇｙ;（３）１２只ＰＴＡ后＾１９２Ｉｒ腔内照射１８Ｇｙ。全部兔饲养４周后活杀,取病理组织学标本进行分析。结果 新内膜面积１￣３组分别为（１３．８５±６．９２）μ     

鼻咽癌原发灶复发联合外照射和腔内后装治疗

从１９９１年１月至１９９２年１２月，收集我院鼻咽癌首程放疗后鼻咽原发灶复发，再分期Ｔ１和Ｔ２的８０例，随机分为外照射加腔内后装治疗组（综合放疗组）和单纯外照射组（对照组）各４０例。综合放疗组外照射鼻咽剂量３０￣６０Ｇｙ／１５￣３０次，３￣６周（中位剂量４４Ｇｙ），腔内后装鼻咽顶粘膜下０．３ｃｍ剂量１０￣３６Ｇｙ／２￣６次，１￣３周（中位剂量３０Ｇｙ）；对照组外照射鼻咽剂量６０￣７０Ｇｙ／３０￣３６     

Ⅰ、Ⅱ期鼻咽癌外照射联合高剂量率腔内后装治疗

目的探讨高剂量率腔内后装治疗在鼻咽癌放疗中的作用。材料与方法从１９９２年１月至１９９３年６月，１１０例Ⅰ、Ⅱ期鼻咽癌患者随机分为外照射加高剂量率腔内后装治疗组（综合放疗组）和单纯外照射组（对照组）。综合放疗组外照射鼻咽剂量５６～６０Ｇｙ／２８～３０次／５、６～６周，腔内治疗鼻咽顶壁粘膜下０．３ｃｍ给量８Ｇｙ３次／１．５～２周。对照组外照射鼻咽剂量６６～７２Ｇｙ／３３～３６次／６．６～７．２周。结果治疗后３６个月局部控制率综合放疗组优于对照组（９８，２％对８５．５％，Ｐ＜０．０５）；张口困难发生率，综合放疗组低于对照组（７．３％对４７．３％，Ｐ＜０．００５）。结论外照射加高剂量率腔内后装治疗可提高早期（Ⅰ、Ⅱ期）鼻咽癌的局部控制率。     

直肠癌手术前后辅助入疗疗较比较

「目的」探讨比较术前单次、术前４０Ｇｙ放疗及术后放疗对直肠癌疗效的影响。「方法」１２７例病理证实的直肠癌患者，于１９９０年４月至１９９４年１２月随机分为３组，分别为术前单次组３９例，术前４０Ｇｙ组４３例和术后放疗组４５例。术前放疗组中病理若属Ｔ３期以上，则加用术后放疗。术前单次组产疗剂量为５Ｇｙ～６Ｇｙ／次，放疗后４８小时内手术。术前４０Ｇｙ组中位剂量为４０Ｇｙ／２０次（２０Ｇｙ～４０Ｇｙ），放疗     

直肠癌手术前后辅助放疗疗效比较

［目的］探讨比较术前单次、术前４０Ｇｙ放疗及术后放疗对直肠癌疗效的影响。〔方法）１２７例病理证实的直肠癌患者, 于１９９０年 ４月至 １９９４年 １２月随机分为 ３组,分别为术前单次组 ３９例,术前４０Ｇｙ组 ４３例和术后放疗组 ４５例。术前放疗组中病理 若属Ｔ_３期以上,则加用术后放疗。术前单次组放疗剂量为５Ｇｙ－６Ｇｙ／次,放疗后４８ 小时内手术。术前４０Ｇｙ组中位剂量为４０Ｇｙ／２０ 次（２０Ｇｙ－ ４０Ｇｙ）,放疗后休息 ４周手术。术后放疗组中位剂量为 ５５．１Ｇ ｙ／２９次（３０Ｇｙ－ ６３Ｇｙ／１５次～ ３５次）,手术放疗间隔为 ３～ ４ 周。［结果］全部病例中位随访７８个月,３组中位生存期分别为５５、５８、４７个月,Ｋａｐｌａｎ Ｍｅｉｅｒ法计算３年及５年生存率分别为 ７４．３％、４８７％,６７．４％、４８９％和６２２％、４２２％。局部复发率分别为１２．８％、２３．１％,１４．０％、２３．３％和２２．２％、２８．９％。单因素Ｌｏｇ ｒａｎｋ检验术前放疗２组３年局部复发率低于术后放疗（Ｐ＜０．０５）。５年局部复发率和生存率无差别。［结论］适当剂量的术前放 疗较术后放疗具有更高的局控率和较低的副反应。     

高剂量率^192Ir后装近距离放疗中晚期直肠癌

目的：分析高剂量率＾１９２Ｉｒ后装近距离放疗在中晚期直肠癌中的价值。方法：３８例中晚期直肠癌,综合组高剂量＾１９２Ｉｒ后装近距离放疗结合外照射放疗２０例,对照组单纯外照射１８例。高剂量率＾１９２Ｉｒ后装近距离放疗根据肿瘤形态采用组织间插植术和腔内放疗,２周４次完成,总剂量２４Ｇｙ－２８Ｇｙ。１周后外加 照射。对照组外照射盆腔野总剂量４５Ｇｙ－５０Ｇｙ,２次／ｄ。结果：临床证状改善,局部肿瘤消退情况     

鼻咽癌放疗后的颈动脉狭窄

ＣｈｅｎｇＳＷＫ等回顾性分析了９６例鼻咽癌患者放疗后颈动脉狭窄的状况。９６例均无颈动脉手术史 ,放疗为主要治疗或术后辅助治疗。原发灶放疗量为６４Ｇｙ～７２Ｇｙ,若颈部淋巴结阴性 ,颈部放疗量为４５Ｇｙ～５０Ｇｙ,若颈部淋巴结阳性 ,颈部放疗量为６０Ｇｙ～６６Ｇｙ。放疗结束时间至少１２个月以上。所有患者的双侧颈总、颈内和颈外动脉均行彩色多普勒超声检查。颈动脉狭窄程度≥７０ %为有临床意义。对年龄、性别、吸烟史、糖尿病、缺血性心脏病、脑血管病、放疗后时间间隔等因素作单独分析。以９６例健康人作为对照组。所得数据…     

~(137)Cs后装腔内放射治疗Ⅱ、Ⅲ期宫颈癌远期疗效

［目的］评估布克勒（Ｂｕｃｈｌｅｒ）１３７Ｃｓ后装腔内放疗机治疗Ⅱ、Ⅲ期宫颈癌的远期疗效。［方法］总结１９８６年１０月至 １９８７年 １２月间应用“Ｂｕｃｈｌｅｒ”后装机合并６０ＣＯ或８ＭｅＶ直线加速器对Ⅱ、 Ⅲ期的宫颈癌 １４０例进行根治性放射治疗。放疗剂量：腔内放疗Ⅱ期Ａ点６０Ｇｙ～７２Ｇｙ,阴道与宫腔剂量比为４：３或１：１,随后外照射Ｂ点则采用盆腔四野照射,剂量４４Ｇｙ～５６Ｇｙ。Ⅲ期先采用盆腔全盆大野外照射Ｂ点２０Ｇｙ～２９Ｇｙ,随后盆腔四野外照射,Ｂ点补至４５６ｙ～５５Ｇｙ。盆腔四野照射期间配合腔内放疗Ａ点５０Ｇｙ～６０Ｇｙ,阴道与宫腔剂量比为３：２或１：１。［结果］全组患者随访１０年,其中７人失访,随访率为９５％（１３３／１４０）。Ⅱ、 Ⅲ期宫颈癌的１０年生存率分别为５９％（３６／６１）、３１．６４％（２５／７９）,总的１０年生存率为４３．５７％（６１／１４０）。［结论］布克勒后装腔内治疗机对宫颈癌的远期疗效比国内报道低,治疗合并症放射性直肠炎、膀胱炎、阴道炎均较高。     

颈部放疗对甲状腺功能的影响

目的 探讨颈部放疗对甲状腺功能的影响。方法 １９８７年１２月至１９９７年１２月在我院治疗的３２例患者,放疗前和放疗后测定甲状腺功能（血清况Ｔ３、Ｔ４浓度）。结果 放疗后血清总Ｔ３、Ｔ４浓度明显降低（Ｐ〈０．０５）。按照甲状腺受照射的剂量不同,甲状腺减退的发生率分别为３５￣４５Ｇｙ组２２．２％（４／８）;４６￣５５Ｇｙ组３７．５％（３／８）;５６￣７０Ｇｙ组５０．０％（３／６）。结论 放射治疗颈部癌     

颈部放疗对甲状腺功能的影响

目的　探讨颈部放疗对甲状腺功能的影响。方法　１９８７ 年１２ 月至１９９７ 年１２ 月在我院治疗的３２ 例患者,放疗前和放疗后测定甲状腺功能（血清总Ｔ３ 、Ｔ４ 浓度） 。结果　放疗后血清总Ｔ３ 、Ｔ４ 浓度明显降低（ Ｐ＜ ０．０５） 。按照甲状腺受照射的剂量不同,甲状腺功能减退的发生率分别为３５ ～４５Ｇｙ 组２２－２ ％ （４／８） ;４６～５５Ｇｙ 组３７－５ ％ （３／８） ;５６ ～７０Ｇｙ 组５０－０ ％ （３／６） 。结论　放射治疗颈部癌症时应保护甲状腺组织以减少对甲状腺功能的损伤。     

高剂量率~(192)Ir后装腔内加外照射治疗宫颈癌的远期疗效分析

目的　分析高剂量率192 Ir后装腔内加外照射治疗宫颈癌的远期疗效及并发症。方法　对12 8例Ⅱ、Ⅲ期放疗后宫颈癌进行了回顾分析。其中Ⅱ期 47例 ,Ⅲ期 81例。全盆腔外照射DT2 0Gy/ 10次 ,全盆中间挡铅 4cmDT2 0Gy～ 30Gy/ 10次～ 15次 ;后装A点剂量 48Gy～ 5 6Gy/ 6次～ 7次。 结果　 1、3、5年生存率分别为 91 6 1%、81 8%和 6 7 36 % ;Ⅱ、Ⅲ期 1、3、5年生存率无统计学差异 (P >0 .0 5 ) ;远期严重并发症的发生率 7 0 3% (9/ 12 8)。结论　高剂量率192 Ir后装腔内加外照射治疗宫颈癌疗效肯定 ,并发症少。盆腔局部复发仍是放疗失败的主要原因。     

Relative biological effectiveness of 125I sources in a murine brachytherapy model

The relative biological effectiveness of 125I and 192Ir has been determined in a murine brachytherapy model that uses a clonogenic cell assay as the end point. Removable 125I or 192Ir sources were implanted at right angles to the surface of RIF-1 tumors grown in the flanks of C3H/He mice. After irradiation for 1-5 days, mice were sacrificed and isodosed annuli of irradiated tumor tissue were sampled for the clonogenic cell assay. The slopes and intercepts of the two radiation survival curves for implanted sources with activities of 10 to 50 Gy for 125I (dose rate = 39.8 +/- 4.3 cGy/hr) and 192Ir (dose rate = 42.3 +/- 2.7 cGy/hr) were identical; the relative biological effectiveness was 1.     

Interstitial irradiation by 192Ir seed assemblies in fixed cervical lymph node metastases

Eleven patients with fixed cervical lymph node metastases were treated using external irradiation followed by interstitial implants, 137Cs needles were used for one patient and 192Ir seed-assemblies for 10 patients. The local tumor responses were 4 CR, 6 PR and 1 NC. Acute tolerance was good, and there were no major late injuries except for one case of severe subcutaneous fibrosis. No morbidities such as local infection, bleeding or pulmonary injuries were encountered. Clear-cut dose control relationships were demonstrated; the local control of the nodes treated with intervals of more than one month between external and interstitial irradiation was poor. It is considered that adequate treatment is to give 40 Gy over 4 weeks by external irradiation first, then, after an interval of 2 weeks, to give 40-50 Gy over 4-5 days using 192Ir interstitial implants. The interstitial implants appeared to provide an improvement in local control and in the therapeutic ratio of fixed cervical lymph node metastases.     

高剂置率近距离放射治疗鼻咽癌的近期临床观察

本文报告48例采用外照射加腔内后装治疗鼻咽癌患者.其中计划性内、外照射29例,外照射未控补加腔内治疗9例,外照射放疗后鼻咽局部复发10例、腔内治疗使用~192Lr放射源,外照射总量5000~8500cGy.腔内治疗每次参考点剂量500~l000cG,总量1500~2500cGy.总鼻咽局部控制率91.7%.高于单纯外照射.为顽固性鼻咽癌的治疗提供了新方法.     

High beta and electron dose from 192Ir: implications for "gamma" intravascular brachytherapy

PURPOSE: Trains of multiple 192Ir seeds are used in many clinical trials for intravascular brachytherapy. 192Ir source is commonly considered as a gamma emitter, despite the understanding that this radionuclide also emits a wide range of electron and beta energies, with a similar range of energy. The high dose from betas and electrons in the submillimeter range due to unsealed ends of seed sources should be precisely quantified to fully understand the backdrop for complications associated with 192Ir coronary artery brachytherapy. METHODS AND MATERIALS: Monte Carlo simulations (MCNP4C code) were performed for a model 5-seed 192Ir train used in SCRIPPS, GAMMA, and the Washington Radiation for In-Stent Restenosis (WRIST) randomized clinical trials. A stack of radiochromic films was also used to measure the dose distributions for an actual 6-seed train. RESULTS: In the submillimeter range very close to the source, Monte Carlo results show that betas and electrons deposit a higher dose than 192Ir photons (gamma and X-rays) over the interseed gap. A high luminal dose from the combined effects of betas, electrons, and photons emitted from 192Ir can be deposited, particularly between seeds. When prescribing 15 Gy at 2 mm, the combined dose can be as high as 160 Gy at 0.5 mm. Different peak doses near the interseed gaps were noted, which may be due to variability of seed-end surfaces and nonuniformity of seed activity within a real multiseed train. Dose-volume histograms (DVH) of lumen surfaces were evaluated for an eccentric seed train. The DVH parameters indicating the extent of hot spots in the lumen wall, DV(10), DV(5), DV(2), and DV(1) (dose received by 10, 5, 2, 1% respectively of the total lumen surface), can be as high as 55, 76, 81, and 155 Gy for a lumen with 3-mm diameter, and 75, 80, 110, and 158 Gy for a narrow 2-mm lumen. CONCLUSION: 192Ir multiple seed trains used in the SCRIPPS, GAMMA, and WRIST trials can deposit a very high dose to the luminal wall. A particularly high electron and beta dose can be delivered near the interseed gap if the source is not centered in the catheter and lumen. The dose from 192Ir betas and electrons may partially explain adverse outcomes reported from 192Ir multiseed clinical trials. Improvement of the encapsulation design to filter out the betas and electrons should be seriously considered.     

192Ir腔内放疗预防男性尿道内切开术后再狭窄临床分析

目的 探讨和评价尿道内切开或(和)瘢痕电切术后,192Ir腔内放疗预防男性尿道再狭窄的安全性和临床疗效.方法 2年余内共治疗48例,其中年龄18～81岁,狭窄长度为0.5～5.5cm,90%狭窄长度在3.0 cm以内.外伤性狭窄23例、前列腺增生术后狭窄19例、不明原因狭窄6例.经尿道造影或内窥镜检查确诊.26例首次治疗,22例再次治疗(首次治疗属非放疗疗法).放疗处方剂量为14～18 Gy.结果 48例平均随访10个月,有效率98%.治疗后无复发,无明显副作用.47例排尿均通畅,最大尿流率13.9～36.4(19.2±10.3)ml/s;1例出现轻度尿失禁,可能与多次扩张损伤尿道括约肌有关.结论 尿道内切开或(和)瘢痕电切术后腔内放疗有助于预防尿道再狭窄,明显优于现有其他治疗方法,且副作用小、简便易行.     

Brachytherapy: Results of two different therapy strategies for patients with primary glioblastoma multiforme

BACKGROUND: In the current study, the authors describe and compare two different strategies of brachytherapy for the treatment of patients with primary glioblastoma multiforme (GBM). METHODS: The study was comprised of 84 patients. Forty-five patients were implanted with permanent or temporary low activity iodine-125 ((125)I) seeds in Cologne and 21 patients were implanted with temporary iridium-192 ((192)Ir) wires in Amsterdam. Both groups received external beam radiation therapy (EBRT); the (125)I group received 10-30 grays (Gy) with the implant in situ and the (192)Ir group received 60 Gy before implantation. In Cologne, implantation was performed after a diagnostic stereotactic biopsy whereas in Amsterdam implantation took place after cytoreductive diagnostic surgery. In addition, 18 patients in Amsterdam served as a control group. This group received only EBRT after cytoreductive surgery. RESULTS: In both groups the mean age of the patients was between 50-55 years, with 80% of the patients age > 45 years. The mean implantation volume encompassed by the referenced isodose was 23 cm(3) for (125)I and 48 cm(3) for (192)Ir. Initial dose rates were 2. 5-2.9 centigrays (cGy)/hour for permanent (125)I, 4.6 cGy/hour for temporary (125)I, and 44-100 cGy/hour (mean, 61 cGy) for (192)Ir. A total dose of 50-60 Gy, 60-80 Gy, and 40 Gy, respectively, was administered at the outer margins of the tumor. The median survival was approximately 16 months for both the (125)I group and the (192)Ir group. This was 6 months longer than the median survival in the control group. Reoperations were performed in 4 patients in the (125)I group (9%) versus 7 patients in the (192)Ir group (33%). No complications or late reactions were reported in the (125)I group, whereas one case of hemorrhage and three cases of delayed stroke were observed in the (192)Ir group. CONCLUSIONS: The equal median survival times in these two brachytherapy groups with such different dose rate radiation schedules support the hypothesis that dose rate does not play a major role in the survival of patients with primary GBM.     

Brachytherapy boost to the tumour bed in high risk patients after limited surgery for breast cancer

The results of treatment for 174 patients at high risk of local recurrence, referred for radiotherapy after conservative surgery for early breast cancer, are evaluated. Microscopic margin involvement, extensive carcinoma in situ, and vascular/lymphatic invasion were the main risk factors for local recurrence. Whole-breast irradiation (40 Gy in 15 fractions over 3 weeks) followed with a brachytherapy boost (Ir192 wire implant or PDR Ir192) of 25 Gy was applied. Median follow-up was 80 months. The actuarial 6-year overall survival rate was 91% and the within breast recurrence-free survival was 88%. The most common risk factor among those recurring within the breast was involved surgical margins (13 out of 17). Cosmesis was reported to be good or excellent in 79% of cases. In patients at high risk for local recurrence, tumour-bed boost with brachytherapy can provide satisfactory local control after limited surgery and external radiotherapy.     

Long-term outcomes after external beam irradiation and brachytherapy boost for base-of-tongue cancers

PURPOSE: To assess long-term efficacy and toxicity associated with external beam irradiation (EBRT) and interstitial (192)Ir implantation for the treatment of squamous carcinoma of the base of tongue. METHODS AND MATERIALS: Between April 1975 and December 1993, 41 patients with base-of-tongue carcinomas were treated with (192)Ir interstitial implants after EBRT at Stanford University. One patient had Stage I, 6 had Stage II, 7 had Stage III, and 27 had Stage IV tumors. Twenty-eight patients had cervical lymph node involvement at diagnosis. All received EBRT to a median dose of 50 Gy (range 48.9-68 Gy) to the primary tumor and regional lymph nodes before brachytherapy. Interstitial implant was performed 2-4 weeks after EBRT. Intraoperatively, nylon catheters were placed via steel trocars into the base of tongue, glossotonsillar groove, and pharyngo-epiglottic fold using a catheter looping technique. Twenty-three of 28 node-positive patients also underwent simultaneous neck dissections. Postoperatively, the (192)Ir seeds were inserted and allowed to remain in place for approximately 35 h to achieve a median tumor dose of 26 Gy (range 20-34 Gy) to a median volume of 73 cc. Survival, local control, and complications were assessed. RESULTS: With a median follow-up of 62 months (range 9-215) for all patients and 90 months for alive patients, the 5-year Kaplan-Meier survival estimate was 66%. The 5-year local control rate was 82%, with 7 patients recurring locally, 2 of whom were salvaged with surgery. Nodal control was achieved in 93% of patients with either EBRT alone or in combination with neck dissection. The 5-year freedom from distant metastasis rate was 83%. Acute complications included transient bleeding (5%) and infection (8%). Late complication included soft-tissue necrosis/ulceration (7%), osteoradionecrosis (5%), and xerostomia. CONCLUSION: Base-of-tongue carcinoma can be effectively treated with EBRT and (192)Ir implant boost. Local control is excellent and complication rates are acceptable.