复方苦参注射液联合三维适形放疗治疗骨转移癌疼痛46例疗效观察

目的探讨复方苦参注射液联合三维适形放疗治疗骨转移癌疼痛的临床疗效。方法选择骨转移癌患者92例,随机分为复方苦参注射液联合三维适形放疗组（治疗组）、单纯三维适形放疗组（对照组）,每组46例。对照组仅给予局部三维适形放疗,治疗组在对照组基础上,加用复方苦参注射液20 ml溶于生理盐水250 ml静滴、1次/d,10 d为1个疗程,共治疗2～4个疗程。2个疗程结束后比较两组止痛效果及不良反应情况。结果治疗组总有效率为87.0%,对照组为67.4%,两组比较P〈0.05。治疗后治疗组KPS评分增加38例,对照组26例,两组比较P〈0.01。止痛起效时间对照组为（6.91±1.04）d,治疗组为（3.18±0.86）d,两组比较P〈0.05。两组治疗后均未出现严重不良反应。结论复方苦参注射液联合三维适形放疗治疗骨转移癌疼痛的疗效优于单纯放疗。     

三维适形放疗联合复方苦参注射液治疗转移性骨肿瘤疗效观察

目的观察三维适形放疗联合复方苦参注射液治疗转移性骨肿瘤的疗效与安全性。方法将48例转移性骨肿瘤患者分成两组,联合组给予三维适形放疗＋复方苦参注射液静滴,放疗组给予单纯三维适形放疗。比较两组治疗前后的疼痛缓解、生活质量改善及免疫功能变化情况。结果联合组疼痛缓解总有效率为80．8％,生活质量改善有效率为92．3％;放疗组分别为68．2％、77．3％,两组比较均有统计学差异（P均〈0．05）。放疗组白细胞明显减少,与联合组比较有统计学差异;联合组NK细胞活性增高,CD4／CD8升高,与对照组比较有统计学差异（P均〈0．05）。结论三维适形放疗联合复方苦参注射液可明显缓解转移性骨肿瘤引起的疼痛,减少并发症的发生,提高患者的生活质量,减少放疗相关性白细胞减少的发生率,提高机体免疫功能。     

鼻咽癌常规放疗与适形调强放疗复发率及疗效比较

随机选择80例鼻咽癌患者，按单纯随机法分为常规放疗组与适形调强放疗组各40例进行放射治疗，治疗后随访10～24个月。结果：①近期疗效：常规放疗组和适形调强放疗组患者肿瘤消退率分别为60％和90％，明显缩小率分别为40％和10％；②早期反应：常规放疗组和适形调强放疗组患者急性黏膜反应和口干发生率分别为100％和80％；③晚期反应：常规放疗组患者有3例出现颞叶坏死，18例出现中耳炎；适形调强放疗组患者无一发生颞叶坏死及中耳炎；④复发率：2a内复发率常规放疗组为21％，适形调强放疗组为8％；两组近期疗效、早期反应、晚期反应、复发率比较差异均有统计学意义（P均〈0．05）。认为鼻咽癌适形调强放疗优于常规放疗。     

复方苦参注射液联合放疗治疗骨转移癌疼痛患者疗效观察

目的观察复方苦参注射液联合放疗治疗骨转移癌疼痛的疗效。方法选择89例骨转移癌疼痛患者,随机分为单独放疗组44例、联合治疗组（化疗＋复方苦参注射液）45例,参照NRS疼痛分级标准,治疗8周后观察两组患者的疼痛改善情况。结果联合治疗组的止痛效果与单用放疗组无明显差异,在改善生存质量方面两组有明显差异（P〈0.05或〈0.01）。结论复方苦参注射液联合放疗可改善骨转移癌疼痛患者的生存质量。     

复方苦参注射液联合放化疗治疗晚期非小细胞肺癌的疗效与安全性

目的观察复方苦参注射液联合放化疗对晚期非小细胞肺癌（NSCLC）的疗效与安全性。方法将62例晚期NSCLC患者随机分成两组,对照组采用紫杉醇＋卡铂或顺铂方案化疗;治疗组化疗方案同上,同时给予复方苦参注射液治疗。对两组中有适应证者均适时加用放疗。治疗2个周期后评价两组的近期疗效、生存质量及毒副反应,比较两组的1年生存率。结果治疗组近期疗效优于对照组,但无统计学差异（P〉0．05）;毒副反应较对照组明显减轻,生存质量明显改善（P均〈0．05）;随访1年生存率明显升高（P〈0．05）。结论复方苦参注射液联合放化疗能提高临床疗效,减轻化疔不良反应,改善患者生存质量,延长生存期。     

岩舒注射液在118例直肠癌术后放化疗中的应用

目的观察岩舒(复方苦参)注射液在直肠癌术后放化疗中的作用。方法 118例直肠癌术后患者按随机数字表法分为放化疗组(对照组)和放化疗联合岩舒组(治疗组)。治疗组60例应用常规放疗+化疗+岩舒注射液方案,对照组58例应用常规放疗+化疗,观察两组临床症候、放射性直肠反应,生存质量、肝功能和白细胞的变化。结果治疗组临床症候和放射性直肠反应生存质量的改善明显优于对照组(P0.01),肝功能异常和白细胞降低较对照组明显减少(P0.01)。结论放化疗联合岩舒注射液可显著减轻直肠癌术后放化疗的不良反应,改善患者生活质量。     

中药复方苦参注射液联合放化疗治疗局部晚期鼻咽癌的疗效观察

目的观察复方苦参注射液联合放化疗治疗局部晚期鼻咽癌的疗效。方法选取2013年1月~2014年1月我院收治的局部晚期鼻咽癌患者54例,将其随机分为观察组和对照组,各27例。两组同步放化疗均采用相同的常规分割放疗和单药顺铂同步化疗,观察组在此基础上采用复方苦参注射液治疗。观察两组患者疗效。结果观察组总有效率为85.2%,与对照组的81.5%比较,差异无统计学意义(P0.05);观察组胃肠道反应0级1例、Ⅰ级14例、Ⅱ级12例,对照组胃肠道反应0级1例、Ⅰ级10例、Ⅱ级9例、Ⅲ级7例;观察组骨髓抑制0级3例、Ⅰ级14例、Ⅱ级10例,对照组骨髓抑制0级2例、Ⅰ级12例、Ⅱ级8例、Ⅲ级5例;观察组黏膜反应Ⅰ级10例、Ⅱ级17例;对照组黏膜反应Ⅰ级9例、Ⅱ级12例、Ⅲ级6例,两组各毒性反应分级上比较,差异有统计学意义(P0.05)。结论采用复方苦参注射液联合放化疗治疗局部晚期鼻咽癌安全有效,值得临床应用。     

苦参注射液联合化疗治疗中晚期恶性肿瘤临床观察

将126例中晚期肿瘤患者随机分为两组,对照组给予单纯化疗,治疗组在化疗基础上联用复方苦参注射液.发现治疗组近期有效率明显高于对照组,治疗组Ⅲ～Ⅳ度白细胞下降、恶心、呕吐发生率均明显低于对照组,治疗组卡氏评分升高率明显高于对照组.提示复方苦参注射液联合化疗治疗中晚期恶性肿瘤能减轻毒副反应、提高近期疗效和患者生存质量,值得临床推广使用.     

复方苦参注射液、IL-2及α-干扰素治疗肺癌伴恶性胸腔积液疗效

目的观察复方苦参注射液、IL-2及干扰素辅助治疗肺癌伴恶性胸腔积液疗效和不良反应。方法 150例肺癌伴胸腔积液患者随机分治疗组和对照组。治疗组分为a、b、c三组,分别在胸腔内注入复方苦参注射液+IL-2、复方苦参注射液+α-干扰素、IL-2+α-干扰素。对照组分为d、e、f组,分别在胸腔内注入复方苦参注射液、IL-2、α-干扰素。4周后观察两组疗效及不良反应。结果复方苦参注射液、IL-2及α-干扰素两两联合治疗肺癌伴胸腔积液的有效率明显优于单用一种药物治疗;复方苦参注射液联合α-干扰素的有效率最高.不良反应中,治疗组中发热、胸痛及胃肠道反应等毒副反应的发生率均明显少于对照组。结论复方苦参注射液、IL-2及α-干扰素两两联合辅助治疗肺癌胸腔积液效果肯定,其中以复方苦参注射液联合IL-2或α-干扰素效果最佳。     

复方苦参注射液静滴联合药物介入治疗中晚期原发性肝癌临床观察

目的探讨复方苦参注射液联合介入治疗中晚期原发性肝癌患者的临床疗效。方法 50例肝癌患者随机分成两组,治疗组27例采用复方苦参注射液＋介入治疗,对照组23例单用介入治疗。治疗1个周期后分别以RECIST标准和NCICTC标准观察和评价其疗效和不良反应。结果两组均无CR病例。治疗组总有效率63.0%（17/27）,对照组总有效率56.5%（13/23）;两组比较,P〉0.05。治疗组不良反应发生率低于对照组,生活质量改善总有效率高于对照组,差异具有统计学意义（P均〈0.05）。结论复方苦参注射液联合介入治疗中晚期原发性肝癌虽然不能明显增加疗效,但能明显减轻介入治疗的不良反应。     

The case for dose escalation versus adjuvant androgen deprivation therapy for intermediate risk prostate cancer

Patients with intermediate-risk prostate cancer have a significant risk of biochemical failure after treatment with external beam radiation therapy. Two strategies to improve outcomes are radiation dose escalation and androgen deprivation therapy (ADT). This article discusses the evidence in favor of dose escalation. The case for radiation dose escalation has been established by several randomized studies, which show improved biochemical control (bNED) rates. Although late toxicity was also increased, it remains at clinically acceptable levels. The use of more focal methods of radiation, such as proton therapy and intensity modulated radiation therapy (IMRT), allows safe dose escalation to 80 Gy. The role of adjuvant ADT is most clearly established in high-risk disease. Advantages in the intermediate-risk group are less pronounced. It is probable that therapeutic gain seen from dose escalation in intermediate-risk patients might allow them to be spared the toxicity of ADT and yet achieve good PSA and clinical control rates. Further randomized trials comparing and or combining the two treatment strategies are required.     

直肠癌放疗的标准流程

因特异性症状的缺乏,大多数直肠癌患者就诊时已处于晚期或局部晚期。对于局部晚期直肠癌（II/III期）患者,放射治疗联合根治性的全直肠系膜切除TME手术能显著的提高患者的局部控制率并延长总的生存时间。目前,调强放射治疗技术已广泛开展。然而,各医疗中心在直肠癌放疗实施过程,治疗流程中存在显著差异。本文现对我院直肠癌的放疗标准流程做一简单介绍以供参考。     

Omission of Chemotherapy in Early Stage Nasopharyngeal Carcinoma Treated with IMRT: A Paired Cohort Study

The objective of this study was to evaluate the necessity of concurrent chemotherapy in T1-2N1 nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT).The retrospective analysis was conducted using the paired comparison method. We matched cases to controls using the greedy matching algorithm with 1:1 control to case ratio. Controls were matched to cases by factors including age, gender, T stage, and duration of RT. The control group included patients received IMRT alone. In another group, concurrent chemotherapy (DDP 40 mg/m²/w) was administrated to each paired patient.From Jan 2009 to Dec 2011, a total of 86 well-balanced T1-2N1 (2002 UICC staging system) NPC patients were retrospectively analyzed. Half of them (43 patients) received radical IMRT alone and another 43 received concurrent chemotherapy with IMRT (CCRT). Median follow-up is 37.4 months (4.8–66.2 months). All patients received a radiation dose of 66Gy/30Fx. In the CCRT group, all patients received a cumulative dose of ≥200 mg/m². The differences of 3-year overall survival (OS), 3-year progression-free survival (PFS), 3-year relapse-free survival (RFS), and 3-year metastasis-free survival (MFS) between 2 groups were not significant (P > 0.05). The most frequently increased toxicities related to chemotherapy were mild to moderate leukopenia (P = 0.003) and mild anemia (P = 0.008).Omission of weekly cisplatin chemotherapy resulted in comparable survival outcomes to CCRT in IMRT populations. More data from future randomized trials are warranted to further confirm it.     

Comparative outcomes for three‐dimensional conformal versus intensity‐modulated radiation therapy for esophageal cancer

Emerging data suggests a benefit for using intensity modulated radiation therapy (IMRT) for the management of esophageal cancer. We retrospectively reviewed patients treated at our institution who received definitive or preoperative chemoradiation with either IMRT or 3D conformal radiation therapy (3DCRT) between October 2000 and January 2012. Kaplan Meier analysis and the Cox proportional hazard model were used to evaluate survival outcomes. We evaluated a total of 232 patients (138 IMRT, 94 3DCRT) who received a median dose of 50.4 Gy (range, 44–64.8) to gross disease. Median follow up for all patients, IMRT patients alone, and 3DCRT patients alone was 18.5 (range, 2.5–124.2), 16.5 (range, 3–59), and 25.9 months (range, 2.5–124.2), respectively. We observed no significant difference based on radiation technique (3DCRT vs. IMRT) with respect to median overall survival (OS) (median 29 vs. 32 months; P = 0.74) or median relapse free survival (median 20 vs. 25 months; P = 0.66). On multivariable analysis (MVA), surgical resection resulted in improved OS (HR 0.444; P < 0.0001). Superior OS was also associated on MVA with stage I/II disease (HR 0.523; P = 0.010) and tumor length ≤5 cm (HR 0.567; P = 0.006). IMRT was also associated on univariate analysis with a significant decrease in acute weight loss (mean 6% + 4.3% vs 9% + 7.4%, P = 0.012) and on MVA with a decrease in objective grade ≥3 toxicity, defined as any hospitalization, feeding tube, or >20% weight loss (OR 0.51; P = 0.050). Our data suggest that while IMRT‐based chemoradiation for esophageal cancer does not impact survival there was significantly less toxicity. In the IMRT group there was significant decrease in weight loss and grade ≥3 toxicity compared to 3DCRT.     

肿瘤放射治疗技术进展

20世纪90年代以来,随着放射物理技术、计算机技术和医学影像技术的迅猛发展,放射治疗技术已取得了长足进展。三维适形放疗、调强放疗、容积旋转调强放疗和螺旋断层放疗等先进放射治疗技术层出不穷,大幅提高了肿瘤靶区的物理适形度和治疗效率。但在肿瘤的放射治疗临床实践中仍然存在若干急需解决的问题。近年来,以生物引导放射治疗、图像引导放射治疗、剂量引导放射治疗和放射影像组学为代表的新技术,推动着放射治疗向以"精确定位"、"精确计划"和"精确治疗"为终极目标的"三精放疗"时代迈进。     

体外局部高频热疗联合放疗治疗进展期肝细胞癌患者临床疗效研究

目的 研究体外局部高频热疗辅助放疗治疗进展期肝细胞癌(HCC)患者的临床疗效.方法 采用随机数字表法将66例进展期HCC患者分为对照组33例和观察组33例,分别采取放疗或在放疗的基础上联合体外局部高频热疗治疗,随访12个月.结果 观察组客观缓解率(ORR)为63.6％,显著高于对照组的35.5％(P<0.05);治疗后...     

Outcomes of induction chemotherapy followed by chemoradiation using intensity‐modulated radiation therapy for esophageal adenocarcinoma

This study looks at toxicity and survival data when chemoradiation (CRT) is delivered using intensity‐modulated radiation therapy (IMRT) after induction chemotherapy. Forty‐one patients with esophageal adenocarcinoma treated with IMRT from March 2007 to May 2009 at Memorial Sloan‐Kettering Cancer Center were analyzed. All patients received induction chemotherapy prior to CRT. Thirty‐nine percent (n = 16) of patients underwent surgical resection less than 4 months after completing CRT. Patients were predominantly male (78%), with a median age of 68 years (range 32–85 years). The majority of acute treatment‐related toxicity was hematologic or gastrointestinal, with 17% of patients having grade 3+ hematologic toxicity and 12% of patients having grade 3+ gastrointestinal toxicity. Only two patients developed grade 2–3 pneumonitis (5%) and 5 patients experienced post‐operative pulmonary complications (29%). Eight patients (20%) required a treatment break. With a median follow up of 41 months for surviving patients, 2‐year overall survival was 61%, and the cumulative incidences of local failure (LF) and distant metastases were 40% and 51%, respectively. This rate of LF was reduced to 13% in patients who underwent surgical resection. Surgery and younger age were significant predictors of decreased time to LF on univariate analysis. Induction chemotherapy followed by CRT using IMRT in the treatment of esophageal cancer is well tolerated and is not associated with an elevated risk of postoperative pulmonary complications. The use of IMRT may allow for integration of more intensified systemic therapy or radiation dose escalation for esophageal adenocarcinoma, ultimately improving outcomes for patients with this aggressive disease.     

原发性肝癌放射治疗进展

原发性肝癌（PLC）是常见的恶性肿瘤之一，以往主要的治疗方法是手术切除。随着新的放疗技术，如三维适形放射治疗、立体定向放射治疗、束流调强放射治疗等的发展，放射治疗在PLC综合治疗中的作用日益突出。本文对PLC放射治疗的进展，包括PLC放疗的理论基础、放疗技术的发展、放疗与其他方法的联合应用、放疗并发症的发生和处理作一概述。     

Multimodality treatment with intensity modulated radiation therapy for esophageal cancer

The objective of this study is to determine the feasibility and report the outcome of patients with locally advanced esophageal cancer treated with preoperative or definitive chemoradiotherapy (CRT) using intensity‐modulated radiation therapy (IMRT). Between 2003 and 2007, 30 patients with non‐cervical esophageal cancer received concurrent chemotherapy and IMRT at Stanford University. Eighteen patients were planned for definitive CRT and 12 were planned for preoperative CRT. All patients had computed tomography‐based treatment planning and received IMRT. The median dose delivered was 50.4 Gy. Patients planned for preoperative CRT underwent surgery 4–13 weeks (median 8.3 weeks) following completion of CRT. Median follow‐up of surviving patients from start of RT was 24.2 months (range 8.2–38.3 months). The majority of tumors were adenocarcinomas (67%) and poorly differentiated (57%). Tumor location was 7% upper, 20% mid, 47% lower, and 27% gastroesophageal junction. Actuarial 2‐year local‐regional control (LRC) was 64%. High tumor grade was an adverse prognostic factor for LRC and overall survival (OS) (P= 0.015 and 0.012, respectively). The 2‐year LRC was 83% vs. 51% for patients treated preoperatively vs. definitively (P= 0.32). The 2‐year disease‐free and OS were 38% and 56%, respectively. Twelve patients (40%) required feeding tube placement, and the average weight loss from baseline was 4.8%. Twelve (40%) patients experienced grade 3+ acute complications and one patient died of complications following feeding tube placement. Three patients (10%) required a treatment break. Eight patients (27%) experienced grade 3 late complications. No grade 4 complications were seen. IMRT was effective and well tolerated. Disease recurrence remains a challenge and further investigation with dose escalation to improve LRC and OS is warranted.     

Complete response to radiation therapy of orbital metastasis from hepatocellular carcinoma

The incidence of hepatocellular carcinoma (HCC) is increasing in the United States, and 50%-75% of patients with HCC will develop metastatic disease.Orbital metastases from HCC are extremely rare. We report the case of a 52-year-old male with known metastatic HCC, who presented with severe proptosis and diplopia. An orbital mass was identified on magnetic resonance imaging (MRI) and confirmed to have hypermetabolic activity on positron emission tomography/computed tomography. He received a palliative course of external beam radiation therapy to the right orbit. Intensity modulated radiation therapy (IMRT) was used to allow sparing of critical normal tissues in close proximity to the tumor. One month after completion of IMRT to 58 Gray in 30 fractions delivered over 6 wk, the patient had a complete clinical, radiologic (MRI) and symptomatic response.The patient continues to have local control in the orbit 1.7 years after therapy completion. All critical normal structures were kept below the tolerance dose using IMRT, and no toxicities were observed.