前列腺癌放射治疗及PSA监测价值的探讨

目的 探讨前列腺癌放射治疗及放疗前后PSA测定的预后判断价值。方法 10例前列腺癌分别行单纯前列腺切除及双侧睾丸去势术，术后均给予8MV—X线放射治疗及放疗前后PSA测定。结果 放疗后前列腺肿瘤及盆腔转移灶全部缩小及消退。化疗后PSA下降生存期长，升高生存期短。结论 前列腺癌根治术、放射治疗及内分泌治疗等综合治疗是前列腺癌有效的治疗方法。术后放疗能提高生存率。PSA测定可作为治疗失败或复发及远处转移的指标。     

前列腺癌放射治疗及PSA监测价值的探讨

目的探讨前列腺癌放射治疗及放疗前后PSA测定的预后判断价值.方法 10例前列腺癌分别行单纯前列腺切除及双侧睾丸去势术,术后均给予8MV-X线放射治疗及放疗前后PSA测定.结果疗后前列腺肿瘤及盆腔转移灶全部缩小及消退.化疗后PSA下降者生存期长,升高者生存期短.结论前列腺癌根治术、放射治疗及内分泌治疗等综合治疗是前列腺癌有效的治疗方法.术后放疗能提高生存率.PSA测定可作为治疗失败或复发及远处转移的指标.     

术中放疗治疗脑膜瘤和星状细胞瘤

在北美放射学会年会上,哈佛大学放疗科主任Glodson 报告了术中放疗治疗脑瘤病人,共102例.例脑膜瘤病人已分别存活到术后17个月和30个月.8例星状细胞瘤病人现存活4例,分别为术后1—11个月.术中放疗操作起来毫无困难,也不增加术后的不良反应。术后仍可进行其它常规治疗而无副作用。放疗剂量为1500拉德,对脑膜瘤病人可再增加4000拉德。脑组织完全耐受这个剂量,CT 扫描未发现脑组织坏死。但术中放疗对脑的深部病灶无效,这种情况下无法将主要病灶切除.     

早期宫颈癌术后腔内近距离治疗的研究进展

宫颈癌是世界上最常见的妇科恶性肿瘤之一，每年新增病例和死亡人数绝大多数来自发展中国家，且近年来宫颈癌发病呈现出年轻化趋势，严重威胁女性健康和生命。手术治疗是早期宫颈癌的首选治疗方法之一。近距离放射治疗是宫颈癌放射治疗重要组成之一。术后病理显示存在阴道切缘阳性、近切缘因素等患者需要补充近距离放射治疗，但目前对于早期宫颈癌术后腔内近距离放射治疗适应症及具体实施方案尚未完全明确。故本文将对早期宫颈癌术后腔内近距离放射治疗适应症、放疗技术、施源器选择等方面进行综述。     

高分级脑胶质瘤术后放射治疗

放射治疗是高分级脑胶质瘤重要治疗手段之一,但疗效不理想,而术后适时放疗、精确勾画靶区,放疗总量＞60 Gy、适形调强放疗及联合化疗、靶向治疗是提高其放疗疗效的重要因素.     

脑恶性胶质瘤放射治疗临床研究进展

脑恶性胶质瘤是成人最常见的颅内原发恶性肿瘤,其致残率和病死率均很高。术后辅助放疗是恶性胶质瘤的标准治疗手段之一,可延长患者的生存期。近年来,随着放疗技术和方法的不断发展,恶性胶质瘤的术后放疗发生了很大的变化。本文将对恶性胶质瘤的放射治疗临床研究进展进行复习。     

食管癌的放射治疗

食管癌的放射治疗王凤明，朱晓代食管癌的放射治疗可分为单纯放疗和与手术配合的放疗。前者又分为根治性放疗和姑息性放疗；后者包括术前放疗、术后放疗和术中放疗。本文根据近１０余年文献，对各种放疗方法及结果加以综述。一、根治性放疗凡病变本身尚有手术切除指征，但...     

脑恶性胶质瘤放射治疗临床研究进展

脑恶性胶质瘤是成人最常见的颅内原发恶性肿瘤，其致残率和病死率均很高。术后辅助放疗是恶性胶质瘤的标准治疗手段之一，可延长患者的生存期。近年来，随着放疗技术和方法的不断发展，恶性胶质瘤的术后放疗发生了很大的变化。本文将对恶性胶质瘤的放射治疗临床研究进展进行复习。     

食管癌术后放射治疗的研究进展

手术治疗是食管癌的主要治疗手段之一,但即使是早期食管癌,其术后局部复发率仍然较高,因此食管癌术后的放射治疗已引起临床重视。回顾食管癌术后放疗四十多年的历史,尽管已经取得了一些进展,但是仍然有一些热点问题值得探讨,例如术后放疗的适应证、靶区范围、照射剂量等等。随着三维适形调强放疗技术广泛应用,食管癌术后放疗正在进入个体化、精确化、综合化的时代。     

视神经胶质瘤术后颅内胶质瘤与脑膜瘤并存一例

患者男,26岁,主因"颅内脑膜瘤、星形细胞瘤术后"于2008年1月来我院就诊。患者2007年12月因"间断头疼1个月,加重1周"在外院就诊,头颅核磁发现蝶骨嵴及鞍区占位。既往14岁时曾因"右眶内视神经胶质瘤"接受手术治疗及术后放射治疗(DT:60 Gy/30 f/6 W),放疗后右眼视力逐步丧失。术前查体:精神可,神清语利;右眼无光感,左眼     

Adjuvant radiotherapy for atypical and malignant meningiomas: a systematic review

Atypical meningiomas (AMs) and malignant meningiomas (MMs) are tumors with a lower incidence and poorer prognosis than benign meningiomas. The role of radiotherapy as an adjuvant to surgical resection, especially for AMs, is incompletely defined. In this study, the English-language literature was systematically reviewed for studies that reported tumor characteristics, treatment parameters, and clinical outcomes after adjuvant radiotherapy for AM and MM, including overall survival, progression-free survival, and/or time to recurrence or mortality. Clinical outcomes were further assessed in the context of resection status, timing of administration, and radiation dose. Outcomes after stereotactic radiosurgery were also examined. Treatment toxicity and other potential prognostic or confounding factors were appraised. Ten and 11 studies for AM and MM, respectively, met the inclusion criteria. The median 5-year progression-free survival and overall survival after adjuvant radiotherapy were 54.2% and 67.5%, respectively, for AM and 48% and 55.6% for MM. The complication rates were 11.1% for AM and 5.1% for MM. Incomplete resection and radiation dose <50 Gy conferred significantly poorer 5-year progression-free survival. Most studies were unable to demonstrate a statistically significant prognostic benefit for adjuvant radiotherapy in AM. In conclusion, adjuvant radiotherapy significantly improved local control of AMs and MMs, especially after subtotal resection. Study limitations, including inadequate statistical power, may underlie the studies'' inability to demonstrate a statistically significant benefit for adjuvant radiotherapy in AM. Because these tumors preferentially recur within 5 years of surgical resection, future studies should define whether early adjuvant therapy should become part of the standard treatment paradigm for completely excised tumors.     

Radiotherapy for meningiomas

Because of a substantial overall recurrence rate of meningiomas, the role of surgery as the sole treatment for every case must be evaluated. Also, occasionally, the patient's age and/or the location of the tumor precludes considering him/her as a candidate for surgery. In these instances, radiotherapy or radiosurgery may be advisable. The article presents two cases treated at M. D. Anderson Cancer Center, those of a 65-year-old male with a tumor in the left temporal lobe and 74-year-old female with a tumor in the right petroclival region. It also reviews the roles that radiotherapy plays in treating patients with meningiomas. Retrospective analyses of outcomes provide ample evidence that conventional radiation after incomplete resection reduces the incidence of progression of tumor over a long period. Information on patients who have had only external radiation is meager, since most patients have at least a partial resection. Complete resection for benign meningiomas is sufficient. For malignant meningiomas, adjuvant radiation should be administered, regardless of the extent of surgical excision. When surgery poses a high risk of morbidity or mortality, radiation therapy and radiosurgery are promising alternatives.     

Clinical features and long-term outcomes of pediatric spinal meningiomas

Pediatric spinal meningiomas are very rare. Most studies on pediatric spinal meningiomas are case reports with literature reviews. This study presented a surgical series of 14 pediatric patients with histologically proven sporadic spinal meningiomas, including 5 WHO grade II tumors. In this series, there were 9 male and 5 female patients with a mean age of 11.1 years. Seven tumors were located in the cervical spine, 5 in the thoracic spine, and 2 in the lumbar spine. Gross total resection (GTR) of the tumor with a well-demarcated dissection plane was achieved in 11 cases, subtotal resection was achieved in 2 cases, and partial resection was performed in 1 case. The symptoms were improved in 10 cases at the last follow-up and the current status of 2 patients worsened and 1 patient had no change compared to the preoperative presentation. One patient died of progressive tumor regrowth after partial resection and adjuvant radiotherapy. The postoperative follow-up magnetic resonance imaging showed tumor recurrence in one of the 11 GTR cases during the mean follow-up period of 72.5 months. Recurrence/regrowth of the residual tumors was observed in both the 2 STR cases. Although pediatric spinal meningiomas have a higher incidence of WHO grade II meningiomas, they are amenable to surgery if it is possible to achieve GTR. A good clinical outcome after GTR can be expected, even for WHO grade II meningiomas. Effect of adjuvant radiochemotherapy for controlling the tumors is still unclear and requires further investigation.     

Stereotactic radiosurgery for WHO grade I meningiomas

Meningiomas represent a common intracranial tumor in the adult population. Although extirpation to achieve a gross total resection or at least decrease mass effect has been the mainstay of treatment, stereotactic radiosurgery has come to play an increasingly important role in the management of patients with meningiomas. Radiosurgery utilizes highly focused, beams of ionizing radiation to inactivate tumor cells. Image guidance and a steep dose fall off are critical features of this approach. The radiobiology of radiosurgery differs in certain advantageous ways from conventional radiotherapy. Radiosurgery initially was utilized to treat recurrent or residual skull base meningiomas. As success was observed in this setting, radiosurgery has gradually expanded its role so as to treat convexity meningiomas; it is also used as an upfront treatment for patients for whom clinical and neuro-imaging findings are consistent with a meningioma. Most large series demonstrate tumor control rates for patients with grade I meningiomas in excess of 85%. Neurological function is generally preserved or improved for patients with meningiomas. However, complications can occur. Longitudinal follow-up including neurologic and radiologic assessment is required. Single and multisession stereotactic radiosurgery will likely play an expanded role in the treatment of patients with meningiomas.     

High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results.

PURPOSE: Large skull-base meningiomas are difficult to treat due to their proximity or adherence to critical structures. We analyzed the long-term results of patients with skull-base meningiomas treated by a new approach with high-precision fractionated stereotactic radiotherapy. PATIENTS AND METHODS: One hundred eighty-nine patients with benign meningiomas were treated with conformal fractionated stereotactic radiotherapy between 1985 and 1998. Patients were undergoing a course of radiotherapy either as primary treatment, following subtotal resection, or for recurrent disease. The median target volume was 52.5 mL (range, 5.2 to 370 mL). The mean radiation dose was 56.8 Gy (+/- 4.4 Gy). Follow-up examinations, including magnetic resonance imaging, were performed at 6-month intervals thereafter. RESULTS: The median follow-up period was 35 months (range, 3 months to 12 years). Overall actuarial survival for patients with World Health Organization (WHO) grade I meningiomas was 97% after 5 years and 96% after 10 years. Local tumor failure was observed in three of 180 patients with WHO grade I tumors and was significantly higher in two of nine patients with WHO grade II tumors. A volume reduction of more than 50% was observed in 26 patients (14%). Preexisting cranial nerve symptoms resolved completely in 28% of the patients. Clinically significant treatment-induced toxicity was seen in 1.6% of the patients. No treatment-related deaths occurred. CONCLUSION: The results of this study demonstrate that fractionated stereotactic radiotherapy is safe and effective in the therapy of subtotally resected or unresectable meningiomas. The overall morbidity and incidence subacute and late side effects of this conformal radiotherapy approach were low.     

The value of radiation therapy as an adjuvant to surgery in intracranial meningiomas

Our experience with benign and malignant intracranial meningiomas between 1970 and 1983 is reported. Fourteen cases were treated after surgery, 10 benign and four malignant, following complete or incomplete resection or recurrence after resection. Two of 10 benign meningiomas have recurred and one of the two has been controlled by reoperation. None of the malignant meningiomas have been cured, but disease-free intervals up to 4 years were noted. The mean radiation dose was 5,400 rad, given with complex fields and shrinking field technique with no major complications. Adjuvant radiation after resection of meningiomas results in frequent cure of benign meningioma and may extend the interval of recurrence in malignant variants.     

Chemotherapy,hormonal therapy,and immunotherapy for recurrent meningiomas

Meningioma is a common intracranial tumor, originating from the meninges of the skull or spinal canal. Most meningiomas are benign tumors, however atypical or anaplastic tumors can be found in 6% of cases. Patients with asymptomatic small benign meningiomas can be followed without therapy, but in symptomatic patients complete surgical resection should be performed. For recurrent previously resected tumors re-resection is recommended followed by radiotherapy in selected cases. Antiprogesterone treatment can also be considered in recurrent benign meningiomas. Immunotherapy with interferon-alpha and chemotherapy should be reserved for all cases of recurrent meningiomas (benign, atypical, and malignant) when all the standard therapies have failed or contraindicated.     

大型嗅沟脑膜瘤外科治疗：附18例报告

背景与目的：目前对嗅沟脑膜瘤的治疗方法已较成熟,但对大型肿瘤患者的手术处理仍存在一定难度。本文拟探讨手术治疗大型嗅沟脑膜瘤的操作技术与经验。方法：回顾性总结2000年1月至2009年1月间在本科经手术治疗的18例大型（肿瘤最大径〉5cm）嗅沟脑膜瘤患者的临床资料并进行分析。所有患者术前常规行头颅X线平片、CT及MRI检查,有10例患者同时进行了肿瘤CT血管成像扫描检查,4例患者行DSA检查。全部患者均行手术治疗,采用双额骨瓣开颅,矢状窦前部结扎经前纵裂入路,8例患者术中行腰池置管,术中使用双频射频器行肿瘤内分块切除,同时辅以神经导航系统帮助术者动态了解操作部位与肿瘤周边重要组织结构的位置关系。结果：18例患者中手术切除肿瘤达到SimpsonⅠ级10例,Ⅱ级8例。无死亡及新的神经功能缺损发生,1例术后发生脑脊液鼻漏,2例发生明显皮下积液,其中1例继发硬膜外感染,3例经处理后均治愈。14例得到1～8年随访,1例在随访期间MRI显示肿瘤有复发而行放射治疗,其余患者均未见肿瘤复发。结论：双额骨瓣前纵裂入路仍是治疗大型嗅沟脑膜瘤理想的手术入路。术前行肿瘤CT血管成像检查以及术中辅以神经导航技术对重要的血管神经及脑组织的保护具有良好的帮助作用。     

Radiothérapie stéréotaxique des méningiomes intracrâniens

Meningiomas are the most common non-malignant tumours of the brain. Gross-total resection remains the preferred treatment, if achievable without morbidity. Radiation therapy is advocated for inoperable, incompletely resected, or recurrent grade 1 tumours, if there is a progressive, symptomatic lesion, or in case of functional impairment. Postoperative radiation therapy is recommended for grade 2 or 3 lesions. Fractionated stereotactic radiotherapy and stereotactic radiosurgery are high precision techniques, allowing good sparing of surrounding tissues. Fractionated stereotactic radiotherapy and stereotactic radiosurgery give comparable results, with excellent 5-year tumour control rates of more than 90% for benign meningiomas. Toxicity is low and seems equivalent, despite a biased use of fractionated stereotactic radiotherapy for larger meningiomas, close to critical structures. Fractionated stereotactic radiotherapy seems to be of special interest in the treatment of cavernous sinus or optic pathways meningiomas. The different therapeutic modalities should be discussed by a multidisciplinary team.     

Malignant meningioma: An indication for initial aggressive surgery and adjuvant radiotherapy

Malignant meningiomas constitute a rare subset of meningiomas and display a marked propensity for post-surgical recurrence. This retrospective study evaluates the various parameters which alter the recurrence rate. The records of all malignant meningioma patients treated from 1984 through 1992 were reviewed, and the time to recurrence or current patient status was determined, and the influence of various patient and disease parameters were analyzed. Thirty-eight patients were treated with 48 malignant meningioma resections performed (28 total and 20 subtotal), 25 at initial presentation and 23 for recurrent disease; 19 patients received postoperative radiotherapy. Subtypes included 32 anaplastic meningioma, 11 hemangiopericytoma, 2 meningiosarcoma, and 3 papillary meningioma. Followup ranged from 3 to 144 months, with five patients excluded from analysis. Actuarial disease free/progression free survival (DFS) at 5 years was 39% following total resection versus 0% after subtotal resection (p=0.001). For all totally excised lesions, the 5-yr DFS was improved from 28% for surgery alone to 57% with adjuvant radiotherapy (p=NS). Adjuvant irradiation following initial resection increased the 5-yr DFS rates from 15% to 80% (p=0.002). When administered for recurrent lesions, adjuvant radiotherapy improved the 2-yr DFS from 50% to 89% (p=0.015), but had no impact on 5-yr DFS. Multivariate analysis indicates extent of resection, adjuvant radiotherapy, and recurrence status are independent prognostic factors. Malignant meningiomas display a tendency for post surgical recurrence, with recurrence significantly increased for multicentric and recurrent disease. Complete surgical resection and the administration of adjuvant irradiation following initial resection are crucial to long-term control.