腔内放疗与体外放疗结合全身化疗治疗中晚期中央型肺癌的研究

目的探讨全身化疗结合支气管腔内放疗治疗不能手术的中晚期中央型肺癌的安全性、近期疗效、毒副反应和适应证。方法选用铂类为主的全身化疗方案同时经纤维支气管镜置入施源管、模拟定位机定位后用192铱后装治疗机行腔内局部放疗3~5次(1次/周),单次剂量5Gy~7Gy,参考点在0.5cm~1.0cm。化疗每3~4周一周期,3~4个周期为一疗程,一个疗程后评估近期疗效、毒副反应。结果腔内放疗组52例全部有效,完全缓解46例(88.46%)、部分缓解6例(11.54%);阻塞症状和咳嗽在首次腔内放疗后能明显缓解。体外放疗组64例中,有效者59例(92.2%),完全缓解45例(70.3%)、部分缓解14例(21.87%),无变化者5例;32例阻塞症状和咳嗽在体外放疗后2周左右开始减轻,两者近期客观疗效比较无显著性差异。毒副作用白细胞减少腔内放疗组1级、2级、3级白细胞降低为21/52、19/52、3/52;体外放疗组分别为6/64、26/64和32/64;两者比较有显著性差异。放射性肺炎腔内放疗组无放射性肺炎发生,体外放疗组64例中有63例发生(98.4%);放射性食道炎腔内治疗组52例有2例发生;体外治疗组全部出现了放射性食道炎,两者比较有显著性差异。结论全身化疗结合腔内放疗治疗中晚期中央型肺癌安全,近期疗效明显,减少体外放疗所导致的放射性肺炎、放射性食道炎的发生和减低白细胞的下降程度,改善病人生活质量。     

支气管动脉灌注化疗药物联合放疗治疗小细胞肺癌的临床分析

目的　观察支气管动脉灌注化疗药物联合放疗对治疗小细胞肺癌的近期疗效及全身副作用。方法　 2 0 0 0年 5月～ 2 0 0 1年 5月 5 0例小细胞肺癌进入该研究。治疗组 2 5例 ,中央型 16例 ,周围型 9例 ,采用支气管动脉灌注丝裂霉素 +托马克 +顺铂 ,联合放疗。对照组 2 5例 ,中央型 14例 ,周围型 11例 ,采用丝裂霉素 +托马克 +顺铂单纯全身化疗。结果　治疗组有效率 92 %明显高于对照组的有效率 80 % ,但统计学上无显著性差异。治疗组中央型和周围型有效率分别为 94%和 89% ,全身副反应方面 ,如胃肠道反应、骨髓抑制 ,治疗组和对照组发生率分别为 16%、2 0 %和 72 %、64 % ,有显著差异性。结论　支气管动脉灌注化疗联合放疗治疗小细胞肺癌疗效较高 ,全身毒副反应少。     

脑生殖细胞瘤体外放疗及近距离放射治疗配合体外放疗的临床分析

目的　比较常规体外放疗及近距离放疗配合体外放疗对脑生殖细胞瘤的疗效及预后。方法　 1993年 4月至 1997年12月对 2 1例脑生殖细胞瘤采取放射治疗 ,其中 11例采用单纯体外放疗 ,10例采用近距离放疗配合体外放疗 ;对有脑室侵犯者给予全脊髓放疗。结果　 2 1例放疗结束后 3个月行CT或MRI检查示病灶基本消失。单纯体外放疗组 3年生存率为 87.5 % ,近距离放疗配合体外放疗组为 10 0 .0 %。随诊期内未出现严重并发症。结论　近距离放疗配合体外放疗的疗效与单纯体外放疗相比无显著性差异。随诊期内未见严重放射性并发症。     

69例复发鼻咽癌近距离超分割放疗远期疗效分析

背景与目的:局部复发是鼻咽癌治疗失败的原因之一.复发鼻咽痛再治疗有放疗、手术、化疗及靶向治疗等,其中放疗是最主要的方法.再放疗有多种方式,包括常规外照射、近距离治疗、三维适形及调强放疗等.本研究通过回顾性分析局部复发再分期为早期的鼻咽痛采用单纯腔内近距离超分割放疗或联合常规外照射的远期疗效及晚期放射性损伤,评估近距离超分割放疗在复发鼻咽癌中的应用价值.方法:鼻咽癌首程放疗后局部复发再分期为T1和T2的69例患者,其中rT1 51例,rT2 18例.20例接受单纯腔内近距离超分割放疗,每次2.5～3.0 Gy,每天2次,间隔超过6 h,连续治疗5 d,休息1周后再连续治疗5 d.照射剂量为40~50 Gy,中位剂量50 Gy.49例在常规外照射剂量达30~65 Gy,中位剂量50 Gy,休息1～4 d后加用腔内近距离推量8～48 Gy,中位剂量20 Gy,近距离照射方式同前.结果:全组再程放疗后3年和5年生存率分别为59.66%和39.66%:3年和5年局部摔制率分别为86.3%和77.2%;晚期并发症中鼻咽溃疡发生率26.1%;张口受限39.1%;后组颅神经损伤30.4%;放射性脑病13.0%.再放疗后单纯近距离治疗组及联合治疗组张口受限分别为4例和23例(P=0.038),鼻咽溃疡分别为6例和12例(P=0.636).结论:鼻咽癌复发再分期为早期者采用腔内近距离超分割放疗临床实施可行,值得推荐.     

鼻咽癌体外加腔内放疗临床观察

本资料观察分析了本院1997年正月至12月收治的31例鼻咽癌采用体外加腔内高剂量率近距离放疗。与97年以前30例鼻咽癌肿瘤消失慢或足量未控而单纯体外加量的病例进行临床比较，体外加腔内高剂量率近距离放疗，肿瘤消退较单纯体外常规放疗快，鼻咽腔粘膜反应二组差异不大，而口腔粘膜反应前组较后组轻。     

90例晚期非小细胞肺癌调强放疗同步化疗治疗疗效

摘 要：［目的］探讨调强放疗同步化疗治疗晚期非小细胞肺癌的疗效。［方法］ 180例晚期非小细胞肺癌患者,随机分成对照组和治疗组,每组90例,两组都给予同步放化疗,化疗方案均为多西他赛单药化疗,对照组采用三维适行放疗,治疗组采用调强放疗,治疗周期为8周。［结果］治疗组与对照组的靶区平均剂量分别为（65.32±4.12）Gy和（62.34±5.13）Gy;靶区最高剂量分别为（69.42±5.31）Gy和（66.33±4.09）Gy,治疗组的靶区平均剂量和最高剂量均比对照组高（P<0.05）。对照组和治疗组治疗有效率分别为66.7%、83.3%,治疗组明显高于对照组（P<0.05）。治疗组的皮肤反应、消化道反应、血液毒性等不良反应发生情况明显少于对照组(P<0.05)。随访结果显示,治疗组的总生存时间、无疾病进展生存时间和1年生存率都明显高于对照组(P<0.05)。［结论］相对于三维适行放疗,调强放疗同步化疗方案治疗晚期非小细胞肺癌能获得更为理想的靶区剂量,能促进治疗疗效的提高,减少不良反应的发生,从而延长患者的生存时间。     

局部晚期食管癌体外放射联合腔内放疗同期化疗的随机研究

目的　分析体外放射联合腔内放疗加同期化疗治疗局部晚期食管癌的疗效。方法　 1995年 12月至 1997年 12月 ,88例局部晚期食管癌随机分为两组 :44例用60 Co γ射线或 6MV X射线外放射DT=5 5 2 0～ 6 0 0 0CG/4 6～ 5 0次 /2 3～ 2 5天 ;平均 3天后用192 Ir源HDR腔内放疗DT=5 0 0～ 10 0 0CGY/2～ 4次。DF方案化疗于放疗前一周开始 ,共化疗两周期 (综合组 ) ;对照组 44例单用放疗。结果　综合组 1、2、3年生存率分别为 79.2 %、33 .4%、15 .6 % ,对照组 77.3 %、36 .4%、12 .5 %。两组局部未控、复发和转移率相似 (P >0 .0 5 ) ,非癌死亡率综合组明显高于对照组 (P <0 .0 5 )。结论　体外放射联合腔内放疗加同期化疗不能进一步提高局部晚期食管癌 3年生存率。     

鼻咽癌体外加腔内放疗临床观察

 本资料观察分析了本院1997年正月至12月收治的31例鼻咽癌采用体外加腔内高剂量率近距离放疗。与97年以前30例鼻咽癌肿瘤消失慢或足量未控而单纯体外加量的病例进行临床比较,体外加腔内高剂量率近距离放疗,肿瘤消退较单纯体外常规放疗快,鼻咽腔粘膜反应二组差异不大,而口腔粘膜反应前组较后组轻。     

放疗联合化疗治疗晚期宫颈癌的临床观察

目的:观察放化疗同步治疗晚期宫颈癌的近期疗效及急性不良反应.方法:初次治疗的Ⅲb期宫颈癌患者60例,随机分为单放组和放化组各30例.放疗采用加速器体外照射+192Ir腔内后装治疗,体外剂量50Gy/25f/5w(36Gy时中央挡铅),腔内照射A点总剂量42Gy/6f.化疗方案,顺铂20-30mg/m2,静脉滴注,第1-4天,5-FU 500mg/m2,d1-5,静脉滴注,共2周期.结果:单放组CR 40.0%,PR 23.3%;放化同步组CR 67.7%,PR 23.3%(P<0.05).两组总有效率单放组63.3%,放化组90.0%(P<0.05).放化疗期间的不良反应,单放组骨髓抑制和胃肠道反应都较轻,而放化同步组较单放组重.结论:放化疗联合应用能提高晚期宫颈癌局部控制率,同时放化疗的不良反应也有增加,但患者均能耐受.     

中央型肺癌的介入化疗加放疗效果分析

目的　分析中央型肺癌经供血动脉灌注化疗加6 0 Co放疗的疗效。方法　中晚期中央型肺癌 48例 ,均经病理证实 ,行支气管动脉及其它供血动脉灌注化疗 ,一周后行6 0 Co外照射放疗。结果　 48例治疗后有效率 (CR +PR) 66 7% ,6例获得手术根治机会 ,随访13～ 36个月 ,1、2、3年生存率分别为 10 0 % ,75 % ,60 %。结论　介入化疗加6 0 Co放疗是治疗中央型肺癌的有效方法     

外放射结合腔内照射治疗气管癌和支气管肺癌的疗效观察

目的 探讨气管癌、支气管肺癌腔内放射治疗的价值。方法 4例原发气管癌和22例原发支气管肺癌及14例(18处病变)支气管肺癌术后复发者，外放射采用6MV X射线，剂量为DT30～77Gy(平均52Gy)；腔内照射采用低剂量率^192Ir小线源(1．48BGq)，支气管黏膜参考点剂量为4～6Gy／次，总剂量10～53Gy(中位值28Gy)。结果 37例肿瘤完全消退(CR)，2例部分消退(PR)，1例轻微变化(MR)，3、5年局部控制率分别为75％和65％。23例生存时间≥3年，3年生存率为57．5％。并发症较少见。结论 外放射结合腔内照射治疗对于早期支气管肺癌、局限性气管癌和支气管肺癌术后复发者是有效的治疗手段．长期生存是可能的。     

Treatment of recurrent disease in lung cancer

Recurrence is a common event after treatment of lung cancer. Retreatment options depend on previous therapies, location of recurrence, and physical condition of the patient. Locoregional relapse can be treated the same way as initial lung cancer, including surgery, radiotherapy (RT), and chemotherapy (CHT), or combined treatment. Approximately 1% to 2% of all recurrent lung cancer is treated with curative reoperation, with somewhat dismal results. RT has been used for either postsurgical or post-RT locoregional recurrences. In the former case, external beam RT was particularly effective in isolated bronchial stump recurrences, with median survival time of approximately 28.5 months and a 5-year survival of approximately 31.5%. In the latter case, reirradiation, generally with endobronchial brachytherapy, was successful in palliation of intrathoracic symptoms (in at least two-thirds of cases), carrying a low incidence of radiation pneumonitis (up to 5%) although cumulative doses went up to 120-150 Gy. Besides external beam RT, endobronchial RT was used to treat symptomatic intraluminal recurrences, with the vast majority of studies using high-dose rate brachytherapy. Finally, CHT has been used in relapsed/refractory advanced or metastatic non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) with the major emphasis on the third-generation drugs that show good response after previously used platinum-based CHT.     

Combined modality treatment in unresectable extrahepatic biliary carcinoma

PURPOSE: Cancers of the extrahepatic biliary tract are rare. Surgical resection is considered the standard treatment, but is rarely feasible. Several reports of combined modality therapy, including external beam radiation, often combined with chemotherapy and intraluminal brachytherapy, have been published. The purpose of this study was to evaluate the effect of chemoradiation plus intraluminal brachytherapy on response, local control, survival, and symptom relief in patients with unresectable or residual extrahepatic biliary carcinoma. METHODS AND MATERIALS: From February 1991 to December 1997, 20 patients (14 male, 6 female; mean age 61 +/- 12 years; median follow-up 71 months) with unresectable (16 patients) or residual (4 patients), nonmetastatic extrahepatic bile tumors (common bile duct, 8; gallbladder, 1; Klatskin, 11) received external beam radiation (39.6-50.4 Gy); in 19 patients, 5-fluorouracil (96-h continuous infusion, days 1-4 at 1,000 mg/m(2)/day) was also administered. Twelve patients received a boost by intraluminal brachytherapy using (192)Ir wires of 30-50 Gy, prescribed 1 cm from the source axis. RESULTS: During external beam radiotherapy, 8 patients (40%) developed grade 1-2 gastrointestinal toxicity. Four patients treated with external-beam plus intraluminal brachytherapy had a clinical response (2 partial, 2 complete) after treatment. For the total patient group, the median survival and time to local progression was 21.2 and 33.1 months, respectively. Distant metastasis occurred in 10 (50%) patients. Two patients who received external beam radiation plus intraluminal brachytherapy developed late duodenal ulceration. Two patients with unresectable disease survived more than 5 years. CONCLUSION: Our data suggest that chemoradiation plus intraluminal brachytherapy was relatively well-tolerated, and resulted in reasonable local control and median survival. Further follow-up and additional research is needed to determine the ultimate efficacy of this regimen. New chemoradiation combinations and/or new treatment strategies (neoadjuvant chemoradiation) may contribute, in the future, to improve these results.     

Treatment of roentgenographically occult endobronchial carcinoma with external beam radiotherapy and intraluminal low-dose-rate brachytherapy: second report

PURPOSE: To evaluate the efficacy and toxicity of treatment with external beam radiotherapy and intraluminal low-dose-rate brachytherapy for roentgenographically occult endobronchial carcinoma (ROEC). METHOD AND MATERIALS: A total of 79 lesions (71 cases) of ROEC were treated with external beam radiotherapy and intraluminal low-dose-rate brachytherapy from July 1991 to December 1998. Of these lesions, 68 (64 cases) were treated with our standard dose (external beam radiotherapy of 40 Gy and intraluminal low-dose-rate brachytherapy of 25 Gy) and are the subject of this report. All 64 patients were males, and their ages ranged from 55 to 80 (median, 68) years. The histologic diagnosis was squamous cell carcinoma in all patients. RESULTS: In all cases, the scheduled treatment was carried out within 2 months. Follow-up period ranged from 4 to 91 (median, 44) months from the beginning of this treatment. Acute toxicity was tolerable. Grade 2 radiation pneumonitis was observed in 4 cases, and there was no case of greater than Grade 2 radiation fibrosis. Nineteen cases of bronchial stenosis and 23 cases of bronchial obstruction were observed on follow-up bronchoscopy. However, no Grade 2 or greater deterioration of respiratory function due to radiotherapy, prolonged symptoms, or fatal toxicity was observed. Nine patients suffered recurrence, 5 of whom were rescued by surgery and external beam radiotherapy, and 4 of whom died of disease. The 5-year cause-specific survival, overall-survival, and disease-free rate were 96.1%, 72.3%, and 87.3%, respectively. CONCLUSION: Combined treatment with external beam radiotherapy and intraluminal low-dose-rate brachytherapy is effective and results in acceptable complications for ROEC.     

三维适形放射治疗结合同步化疗治疗局部晚期非小细胞肺癌

目的评价和比较三维适形放射治疗结合同步化疗与序贯治疗局部晚期非小细胞肺癌(NSCLC)近期疗效和患者耐受性。方法42例局部晚期NSCLC患者随机分入同步治疗组和序贯治疗组。同步组放疗第1和第4周及放疗结束后行EP方案化疗(Vp16100mg,dl~5,DDP30mg/m2,dl~3),共6周期。序贯组予2周期EP方案化疗后常规放疗,放疗结束后继续完成4周期化疗。结果同步组和序贯组总有效率分别为85.7%和57.1%,有显著性差异。同步组局部控制率高于序贯组(P>0.05)。两组不良反应除骨髓抑制外无显著性差异。结论三维适形放射治疗结合同步化疗治疗局部晚期NSCLC近期疗效较好,毒性也有所增加,但能为绝大多数患者耐受。远期疗效有待进一步随访。     

Biliary tree malignancies: The University of Minnesota experience

Because of its slow-growing natural history, most patients with extrahepatic biliary tree malignancies present with inoperable disease. For the minority of patients with operable disease, surgical resection remains the treatment of choice and offers the patient the best chance for long-term local control. The role of chemotherapy and radiotherapy in the management of these patients in the definitive, adjuvant, and palliative setting is expanding, although unsettled. Response rates with chemotherapy have been low and will most likely find a place in a combined multimodality setting. Radiotherapy (external beam, intraoperative, and intraluminal brachytherapy using ¹⁹²Ir) has played a major role in the treatment of these cancers. The close proximity of bowel, kidney, and liver limits the external beam radiotherapy doses that can be safely delivered. Since most patients require placement of percutaneous transhepatic biliary catheters to relieve jaundice, this route has been utilized to deliver higher doses of radiation to the tumor area with intraluminal ¹⁹²Ir ribbons. The University of Minnesota has treated 15 patients with extrahepatic bile duct cancers. Most were located at the bifurcation of the common bile duct and were treated with intraluminal brachytherapy alone or with external beam radiotherapy. Our results are comparable to previously reported retrospective data with a median survival of 8 months and three long-term survivors. J. Surg. Oncol. 1997;65:298–305. © 1997 Wiley-Liss, Inc.     

The treatment results of 40 patients with localized endobronchial cancer with external beam irradiation and intraluminal irradiation using low dose rate (192)Ir thin wires with a new catheter.

BACKGROUND AND PURPOSE: While bronchial intraluminal irradiation is valued highly as a useful palliative treatment for lung cancer, its role as a curative treatment is unclear. The treatment results of 40 localized enbobronchial tumors (including tracheal cancer) who underwent external beam irradiation (EBR) and intraluminal irradiation (IR) as a curative treatment is reported, and the role of combined EBR and IR as a curative potential treatment is examined. MATERIALS AND METHODS: Forty patients, including 22 with roentgenographically occult lung cancer (ROLC), 14 (18 lesions) with postoperative recurrent lung cancer (PORLC) and four with tracheal cancer, who underwent EBR and IR from February 1987 to August 1996, were studied. IR was conducted using low dose rate (1.48 GBq) (192)Ir thin wires at a bronchial mucosal dose of 4-6 Gy per fraction, with a total dose of 10-57 Gy (median 28 Gy). All patients were also given combined external Linac X-ray irradiation for a total dose of 30-77 Gy (median 52 Gy). RESULTS: As for the primary effect, complete response (CR) was obtained in all 22 ROLC cases; CR was obtained in 12 (16 lesions), partial response (PR) in one and minor response (MR) in one of the PORLC cases; and CR was obtained in three and PR in one of the tracheal cancer cases. The 3-year and 5-year local control rate by Kaplan-Meier method was 75 and 65%, respectively. Twenty-two patients survived for 3 years or longer. Complications included one case each of fatal tracheal hemorrhage, bronchial mucosal ulcer and bronchial stenosis. CONCLUSIONS: Combined EBR and IR is useful as a curative potential treatment, and long-term survival can be expected in ROLC, tracheal cancer and a portion of PORLC cases.     

Multi-institutional randomized trial of external radiotherapy with and without intraluminal brachytherapy for esophageal cancer in Japan. Japanese Society of Therapeutic Radiology and Oncology (JASTRO) Study Group.

PURPOSE: With the aim of improving the results of treatment of esophageal cancer, we designed this multi-institutional, randomized trial to establish the optimal irradiation method in radical radiation therapy for esophageal cancer by clinically evaluating external irradiation alone and in combination with intraluminal brachytherapy. METHODS AND MATERIALS: The study population consisted of patients with squamous cell carcinoma who were expected to be successfully treated with radical radiation therapy. The patients who could be given intraluminal brachytherapy at the end of external irradiation of 60 Gy were stratified into 2 groups. Patients assigned to receive external irradiation alone received boost irradiation of 10 Gy/week on a schedule similar to the previous one, and with the same or smaller irradiation field. Intraluminal brachytherapy was performed, as a rule, with the reference dose point set at a depth of 5 mm of the esophageal submucosa, and a total of 10 Gy was irradiated at a daily dose of 5 Gy, on a once-weekly schedule with low-dose-rate or high-dose-rate brachytherapy equipment. RESULTS: A total of 103 patients were registered, 94 of whom were analyzable, with 8 ineligible, and 1 for whom complete information was unavailable. The overall cumulative survival rate was 20.3% at 5 years. The cause-specific survival rate was 31.8% at 5 years. The cause-specific survival rate at 5 years was 27% in the external irradiation alone group and 38% in intraluminal brachytherapy combined group. There was no significant difference between the 2 groups (p = 0.385). However, in the patients with 5 cm or less tumor length, the cause-specific survival rate was 64% at 5 years in the intraluminal brachytherapy combined group, which showed a significant improvement over 31.5% in the external irradiation alone group (p = 0.025). In the patients with Stage T1 and T2 disease, cause-specific survival rates tended to be better in the intraluminal brachytherapy combined group than in the external irradiation alone group (p = 0.088). In the patients with more than 5 cm tumor length or Stage T3-4 disease, there were no significant differences between the two groups by treatment methods (p = 0.290). The incidence of early and late complications did not differ according to whether intraluminal brachytherapy was used. CONCLUSION: For the purpose of establishing the usefulness of intraluminal brachytherapy, further prospective randomized studies are necessary to evaluate the efficacy in tumors with short length and those with shallow invasion, or to assess the usefulness of intraluminal brachytherapy, as additional irradiation in large advanced tumors have been shown to have disappeared by diagnostic imaging after chemoradiotherapy with 60 Gy/6w external irradiation.     

High dose rate endobronchial brachytherapy in combination with external beam radiotherapy for stage III non-small cell lung cancer.

INTRODUCTION: A phase-II study was planned to test the effect of external beam radiotherapy in combination with endobronchial brachytherapy on the local control and survival of stage-III non-small cell lung cancer patients. MATERIALS AND METHODS: Thirty patients with stage-III non-small cell lung cancer have been treated with 60 Gy external beam radiotherapy and 3 x 5 Gy HDR endobronchial brachytherapy to control tumor and to prolong survival. RESULTS: Therapy regimen was found to be very effective for the palliation of major symptoms, palliation rates were 42.8% for cough, 95.2% for hemoptysis, 88.2% for chest pain and 80.0% for dyspnea. There was a 76.7% tumor response (53.3% complete, 23.3% partial) verified by chest CT scans and bronchoscopy. However, median locoregional disease free survival was 9+/-4 months (95% CI: 1-17) and it was only 9.6% at 5 years. Major side effects were radiation bronchitis (70.0%), esophagitis (6.6%) in the acute period and bronchial fibrosis (25%), esophagial fibrosis (12.5%) and fatal hemoptysis (10.5%) in the late period. Median survival was 11+/-4 months (95% CI: 4-18),and 5-year actuarial survival was 10%. Locoregional disease free survival (P=0.008) and the overall survival was longer (P<0.001) in the patients younger than 60, survival was also improved in the patients with complete response (P=0.019). There were no major complications during catheterisation; early side effects were quite tolerable but severe late complications were around 10%. CONCLUSIONS: It is concluded that endobronchial brachytherapy in combination with external irradiation provides a good rate of response, however does not eradicate locoregional disease and does not prolong survival except for some subgroups such as younger patients.