Results of interstitial radiotherapy using I-125 seeds in the treatment of prostatic cancer

30 patients with localized adenocarcinoma of the prostate were treated with pelvic lymphadenectomy and I-125 interstitial implantation from 1980 to 1985 (21/30 T3-tumors and 14/30 with poor differentiation). The mean follow-up is 59.5 months (range 18 to 88 months). The crude, progression-free and local progression-free survival rates (Kaplan-Meier) for all patients are 68%, 61% and 71% respectively. But, the progression-free survival is 39% in patients with G3-tumors after five years and only 25% in patients with T3 G3-tumors after four years. The local progression rate was 33% in patients with T3-tumors. We did not observe any late intestinal side-effects, but 11/30 (37%) patients suffered from later urinary flow problems caused mainly by local tumor progression. Therefore, we regard interstitial implantation with I-125-seeds as an alternative treatment to radical prostatectomy in patients with T1, 2 G1, 2-tumors but as insufficient in patients with T3 G3-tumors.     

Conformation radiotherapy of carcinoma of the prostate]

During the period from 1975 to 1989, 84 patients with carcinoma of the prostate were treated with conformation radiotherapy at Tokyo Metropolitan Komagome Hospital. The radiation field encompassed only the area of the prostate gland; it did not include the pelvic lymph nodes. The clinical stage of the 84 tumors was 22 in Stage A, 31 in Stage B, 15 in Stage C and 16 in Stage D. The average age of patients was 73.4 years, with range of 54 to 88 years. The average dose to the tumor was 65.7 Gy, with range of 60 Gy to 70 Gy. Hormone therapy was applied to 42 cases. The 5- and 10-year cumulative survival rates were 90.7% and 70.5% for Stage A, 41.7% and 26.7% for Stage B, 48.9% and 48.9% for Stage C, and 32.6% and 0% for Stage D, respectively. The 5-year cause-specific cumulative survival rates were 100% for Stage A, 92.3% for Stage B, 65.0% for Stage C and 40.3% for Stage D, respectively. Patients with poorly differentiated adenocarcinomas or undifferentiated carcinomas showed poorer survival than those with well-differentiated carcinoma. Only 7 cases suffered in-field recurrence, and 2 cases suffered recurrence at pelvic lymph nodes. Acute reactions were noted in 13 cases. Late complications following treatment were acceptable. Mild to moderate complications were recognized in 2 cases, but neither patient required surgery. In conclusion, our data suggest the advantage of the conformation technique applied to radiation therapy for carcinoma of the prostate.     

^125 I粒子植入联合化疗对不可手术切除Ⅲ期非小细胞肺癌的临床疗效

目的观察^125 I粒子植入联合吉西他滨和顺铂（简称GP）方案治疗不可手术切除Ⅲ期NSCLC的临床疗效。方法2005年1月至2008年6月的不可手术切除Ⅲ期NSCLC患者39例,给予^125 I粒子植入联合GP方案（按体表面积吉西他滨1000mg／m2,顺铂75mg／m2）化疗（联合组）。采用TPS制定”I粒子植入数量和布源方法,在CT引导下经皮穿刺组织间植人^125 I粒子,处方剂量为110—130Gy,术后应用TPS进行剂量验证。植入术后1周开始化疗。另设同时期39例不可手术切除Ⅲ期NSCLC患者为对照组,行3D—CRT序贯GP方案化疗。所有患者均经病理学检查确诊,化疗后每3个月复查胸部CT,随访24个月。比较2组患者的近期（即治疗开始后3个月）有效率、生存率、生存时间差异,数据分析采用x2检验、Kaplan—Meier法、Log-rank法。结果联合组近期有效率为71．8％（28／39）,与对照组（61．5％,24／39）相比差异无统计学意义（x2=0．93,P〉0．05）,但肿瘤CR率与对照组相比差异有统计学意义（x2=4．48,P〈0．05）;联合组和对照组的1年生存率分别为79．5％（31／39）和66．7％（26／39）,差异无统计学意义（x2=1．57,P〉0．05）,2年生存率分别为41．0％（16／39）和23．1％（9／39）,差异有统计学意义（x2=4．07,P〈0．05）。联合组和对照组的中位生存时间分别为（18．9±2．7）个月和（14．2±0．7）个月,差异有统计学意义（x2=4．63,P〈0．05）。联合组Ⅲ～Ⅳ级放射性肺炎、放射性食管炎及骨髓抑制总发生率和对照组差异有统计学意义（x2=13．94,P〈0．05）。^125I粒子植入术中发生轻度气胸2例,出现术后少量咳血痰2例,无粒子局部脱落者。结论^125I粒子植入联合GP方案化疗治疗不可手术切除Ⅲ期NSCLC有很好的肿瘤CR率及2年生存率;^125I粒子植入是有效的、安全的微创介入治疗方法。     

Definitive radical radiotherapy in tumors of the prostate. Analysis of statistics

The records were analyzed of 50 patients treated by definitive external beam irradiation for carcinoma of the prostate in the Oncologic Radiotherapy Department of the "Ospedali Riuniti" of Bergamo, Italy, from January 1981 to December 1985. Our series of patients included 22 cases of stage B and 28 cases of stage C tumors. The actuarial 5-year survival rates, according to the Kaplan-Meier method, were for the whole group 69.9%; 79.5% and 54.9% for stage B and stage C tumors respectively. Relationships were also analyzed of tumor control and survival to stage, grading, and total dose of radiations. The recent increasing interest is explained in the use of radiation therapy in the treatment of this kind of patients. A special emphasis is put on the role of CT in determining both field size and dose distribution, and on the use of high-voltage energy in order to make treatment more technically reliable and reduce its morbidity.     

Intraoperative I-125 seed implantation for extensive recurrent head and neck carcinomas

From 1978 to 1988, 41 patients with extensive recurrent carcinomas of the head and neck were treated with surgical resection plus intraoperative iodine-125 seed implantation. Surgery was performed to resect the tumors and to expose the tumor beds for implantation. I-125 seeds were implanted intraoperatively, with a spacing of 0.75-1 cm between adjacent seeds, either into the soft tissue in the tumor bed or onto small patches of gelatin sponges to cover the bone, nerve, or blood vessel involved with disease. Reconstructive flaps were used in 18 patients. The average I-125 dose delivered by the implanted seeds was 8,263 cGy. The determinate 5-year actuarial survival rate for the entire group was 40%. The 5-year local disease control rate was 44%. Major complications were transient wound infection (32%), flap necrosis (24%), fistula formation (10%), and carotid blowout (5%). These results indicate that surgical resection plus I-125 seed implantation provides a potentially curative treatment for patients with extensive recurrent head and neck carcinomas that would be considered traditionally unresectable and that would be treated only with palliative therapy.     

621例原发性肝癌介入治疗的疗效分析

本文对６２１例原发性肝癌的疗效进行了分析。根据不同的治疗方法分为三组：Ａ组为单纯动脉内药物灌注；Ｂ组为药物与碘化油混合栓塞；Ｃ组为在Ｂ组治疗后加用明胶海绵栓塞。Ａ、Ｂ、Ｃ、三组１、３年生存率分别为２７．９４％，０％；５９．５２％，１４．３４％和６６．６２％，１２．４２％；中位生存期为８．３３，１５．０５和１７．３７月。总的１、３、５年生存率为６２．８８％，１２．８５％和７．４５％，中位生存　１６．２３月。并对ＡＦＰ的变化、肿瘤大小、门脉癌栓、治疗方法和次数进行了分析讨论。研究结果提示ＬｐＧｓＴＡＣＥ的疗效较好。     

Tumorectomy and radiation therapy in early breast cancer: a report on 392 patients

Three hundred ninety-two breast cancer patients (231 with stage I and 161 with stage II disease) were treated with tumorectomy followed by radiation therapy. The overall actuarial survival rate was 86.5% at 5 years and 78.0% at 10 years. The 5-year disease-free survival rate was 70.2%. Survival rates depended on locoregional tumor extension. Patients with stage I tumors had a survival rate of 92.0% at 5 years and 84.0% at 10 years; patients with stage II tumors had a survival rate of 82.0% at 5 years and 75.0% at 10 years. The percentage of patients with local recurrences was 13.0% for all patients (10.8% for stage I and 16.1% for stage II patients). The percentage of patients with lymph node recurrences was 1.5% for all patients (1.3% for stage I and 1.9% for stage II patients). The percentage of patients with distant metastases was 11.2% for all patients (7.8% for stage I and 16.1% for stage II patients). Locoregional control rates compared favorably with those in the literature. Breast preservation rates at 5 years were 85.0% for stage I and 80.9% for stage II patients. Cosmetic results were judged good by physicians in 80% of patients and by 90% of the patients themselves. Complication rates were very low.     

Conformal proton beam therapy of prostate cancer — update on the loma linda university medical center experience

Background

The ability to eradicate localized prostate cancer is dependent upon the radiation dose which can be delivered to the prostate. This dose is often limited by the tolerance of normal organs (rectum, bladder). Conformal beam therapy takes advantage of the unique depth dose characteristics of heavy charged particles (the Bragg Peak) to escalate the radiation dose delivered to the prostate while minimizing treatment-related toxicity.

Method

643 patients with localized prostate cancer were treated with protons alone or a combination of protons and photons. All treatment was planned on a 3-D planning system and all received doses between 74–75 CGE (Cobalt Gray Equivalent) at 1.8–2.0 CGE/day. Patients were evaluated for toxicity and response to treatment.

Results

Five-year actuarial clinical and biochemical disease-free survival rates for the entire group are 89 and 79% respectively. A statistically significant difference in biochemical disease-free survival was seen between patients in the “early” (T1b-2b, PSA<15) and “advanced” (T1b-2b, PSA>15 or T2c-T4, PSA<50) subgroups (89% vs. 68% at 4.5 years, p<0.001). A PSA nadir of less than 0.51 ng/ml predicted for the highest chance of freedom from biochemical recurrence. Minimal radiation proctitis was seen in 21% of patients; toxicity of greater serverity was seen in less than 1%.

Conclusion s

Conformal proton beamt therapy produced high rates of response and minimal toxicity. A phase III dose escalation trial is in progress to help define the optimum radiation dose for the treatment of early stage prostate cancer.

     

Primary radiotherapy of prostatic carcinoma--the results at Essen with 173 patients

173 patients suffering from prostate carcinomas of stages A to C received percutaneous irradiations. The five-year survival is 100% in stage A (n = 6), 79% in stage B (n = 41), and 68% in stage C (n = 126). 116 patients received only percutaneous irradiation after needle biopsy, 30 patients were irradiated subsequently to surgical intervention, and 27 were treated by hormones during primary therapy. An analysis was made about survival, recurrence rate, metastasis-free interval, and incidence of metastases in dependence on stage, grading, and different forms of primary treatment. The importance of stage and grading as prognostic factors is confirmed by the results of this study. Extended primary therapy (surgery and/or hormones) seems to bring no benefit as compared to radiotherapy alone. Transurethral resection of the prostate as a surgical/diagnostic intervention has an unfavorable influence on the prognosis.     

Radiotherapy for Stage I–III Nodal Low-Grade Non-Hodgkin’s Lymphoma

BACKGROUND: To evaluate retrospectively long-term results and patterns of recurrence in patients with low-grade non-Hodgkin's lymphoma (NHL) Ann Arbor stage I-II and limited stage III. PATIENTS AND METHODS: 58 patients, who had been treated between 1980 and 1996, were analyzed. Median follow-up period was 8.75 years. 48 patients (83%) presented with follicular lymphoma (stage I: 23 patients, stage II and III: 15 and ten patients, respectively). Median age was 51 years. Irradiation was applied with a median total dose of 40 Gy. 13 patients (22%) additionally received chemotherapy. End points of the investigation were remission rate, overall- and disease-free survival, and patterns of recurrence, as well as the prognostic impact of age, B-symptoms, chemotherapy, irradiation dose, treatment volume, and Ann Arbor stage. RESULTS: 6 weeks after treatment 91% of the patients had complete, 7% partial response. One patient (2%) was classified as progressive disease. Overall survival rate was 86% and 69% at 5 and 10 years, respectively. Corresponding disease-free survival rates were 73% and 63%. Regarding overall survival, multivariate analysis identified age (p = 0.001) as independent prognostic factor. In the subgroup of patients with follicular lymphoma 92% were found in complete, 6% in partial remission, one patient (2%) with progressive disease. Overall survival rates at 5 und 10 years were 87% and 70%, disease-free survival rates 75% and 64%, respectively. Out-of-field recurrence rate for all 58 patients was 34% and the proportion of relapses at nodal or lymphatic sites outside the treated areas in relation to all registered recurrences was 77%. CONCLUSIONS: Our results maintain external radiotherapy as a curative concept in the treatment of limited stage low-grade lymphoma, especially in younger patients. Patterns of recurrence would favor total nodal irradiation (TNI) as an appropriate approach for these patients.     

Perioperative image-adapted brachytherapy for the treatment of paranasal sinus and nasal cavity malignancies

PurposeSinonasal malignancies are a rare group of cancers often associated with late presentation and poor prognosis. In the past, there was little progress regarding survival rate, and often, multimodal treatment regimens are required. The aim of this study was to evaluate the clinical outcome of perioperative image-adapted brachytherapy (IABT) as part of a multidisciplinary treatment regimen for the therapy of sinonasal cancer.Methods and MaterialsSince 2006, patients with sinonasal cancer at the University Hospital of Schleswig-Holstein Campus Luebeck, Germany, were offered a multimodal treatment concept including head and neck surgery, perioperative IABT with or without external beam radiation therapy, and chemotherapy. In a retrospective study, such patients were analyzed for survival rate, tumor control, and toxicity of the interdisciplinary treatment.ResultsThirty-five consecutive patients were analyzed. The majority of patients (63%) were treated for a primary tumor and 62% presented with tumor Stages III–IV. The mean follow-up time with IABT was 28 months. Overall survival estimate was 72% after 3 years. Disease-specific survival, disease-free survival, and local control rates were 83%, 63%, and 67%, respectively. On univariate analysis, a significant better disease-free survival rate was found in patients treated for primary, but not recurrent, sinonasal cancer (p = 0.006). The overall treatment toxicities were mainly classified Grade I.ConclusionsInterdisciplinary perioperative IABT is associated with excellent locoregional control and survival rates. IABT is well tolerated and shows low toxicity. Furthermore, visual acuity can be preserved in advanced cases. The implementation of perioperative IABT into multimodal treatment regimens improves the oncologic outcome.     

I-125 or Pd-103 for brachytherapy boost in men with high-risk prostate cancer: A comparison of survival and morbidity outcomes

PurposeBrachytherapy boost improves biochemical recurrence rates in men with high-risk prostate cancer (HRPC). Few data are available on whether one isotope is superior to another. We compared the oncologic and morbidity outcomes of I-125 and Pd-103 in men with HRPC receiving brachytherapy.Methods and MaterialsOf 797 patients with HRPC, 190 (23.8%) received I-125 or 607 received Pd-103 with a median of 45 Gy of external beam irradiation. Freedom from biochemical failure (FFBF), freedom from metastases (FFMs), cause-specific survival (CSS), and morbidity were compared for the two isotopes by the ANOVA and the χ² test with survival determined by the Kaplan–Meier method and Cox regression.ResultsMen treated with I-125 had a higher stage (p < 0.001), biological equivalent dose (BED) (p < 0.001), and longer hormone therapy (neoadjuvant hormone therapy, p < 0.001), where men treated with Pd-103 had a higher Gleason score (GS, p < 0.001) and longer followup (median 8.3 vs. 5.3 years, p < 0.001). Ten-year FFBF, FFM, and CSS for I-125 vs. Pd-103 were 77.5 vs. 80.2% (p = 0.897), 94.7 vs. 91.9% (p = 0.017), and 95.4 vs. 91.8% (p = 0.346), respectively. Men with T3 had superior CSS (94.1 vs. 79.5%, p = 0.001) with I-125. Significant covariates by Cox regression for FFBF were prostate specific antigen (PSA), the GS, and the BED (p < 0.001), for FFM PSA (p < 0.001) and GS (p = 0.029), and for CSS PSA, the GS (p < 0.001) and the BED (p = 0.022). Prostate cancer mortality was 7/62 (15.6%) for BED ≤ 150 Gy, 18/229 (7.9%) for BED >150–200 Gy, and 20/470 (5.9%) for BED >200 Gy (p = 0.029). Long-term morbidity was not different for the two isotopes.ConclusionsBrachytherapy boost with I-125 and Pd-103 appears equally effective yielding 10-year CSS of over 90%. I-125 may have an advantage in T3 disease. Higher doses yield the most favorable survival.     

Classical and anaplastic seminoma: difference in survival

Classical and anaplastic seminoma are traditionally treated with radiation therapy and are said to have the same prognosis. A retrospective study was undertaken of 90 seminoma patients treated with radiation therapy between 1961 and 1985. The classical group consisted of 71 patients of whom 50 had stage I and 21 had stage II disease. The anaplastic group consisted of 19 patients of whom ten had stage I and nine had stage II disease. The median follow-up time was 64 months for the entire group. The 10-year relapse-free survival rate for the classical group was 94% and for the anaplastic group was 70% (P less than .05). For patients with classical stage I disease, the relapse-free actuarial survival rate was 98%; for patients with anaplastic stage I disease, it was 64% (P less than .02). For the classical stage II disease group, the relapse-free actuarial survival rate was 84% and for the anaplastic stage II disease group, 75% (P less than .70). Four patients in the classical group (6%) had relapses; of these, one patient had local recurrence of tumor, and three had distant metastases. In the anaplastic group, four patients (21%) had relapses; two patients had local recurrence of tumor, and two had distant metastases. Therefore the data suggest a difference in survival and relapse rates between classical and anaplastic seminoma.     

Locally advanced nasopharyngeal cancer: long-term outcomes of radiation therapy

PURPOSE: To investigate the clinical manifestations and treatment outcomes in patients with stage T4M0 nasopharyngeal carcinoma. MATERIALS AND METHODS: Findings in 179 patients (age range, 13-78 years) with American Joint Committee on Cancer stage T4M0 nasopharyngeal carcinoma treated from January 1983 to February 1992 with a minimum follow-up of at least 5 years were reviewed. Of the 179 patients, 166 (92.7%) had World Health Organization type II or III disease. Forty-one patients (22.9%) had no lymph nodal involvement; 138 patients (77.1%) had metastatic nodal involvement in the neck. All patients underwent radiation therapy; 39 patients also received different forms of chemotherapy. The radiation therapy doses were usually 70-74 Gy administered to the primary tumor over 7 or 8 weeks, 70-74 Gy to the neck region in patients with nodal involvement, or 50-60 Gy administered to the neck region over 5 or 6 weeks in patients without neck nodal involvement. RESULTS: In 100 patients, radiation therapy failed in the primary tumor alone (n = 28), neck nodes alone (n = 5), and distant metastases alone (n = 43) or at a combination of sites (n = 24). The cumulative failure rates for the primary tumor, neck metastases, and distant metastases were 25.1% (n = 45), 14.0% (n = 25), and 33.0% (n = 59), respectively. The 5-year primary disease-free, distant disease-free, and overall survival rates were 68.7%, 56.5%, and 28.6%, respectively. Results of salvage treatment for relapse were unsatisfactory. CONCLUSION: In about three-tenths of patients, T4M0 nasopharyngeal carcinoma can be cured with conventional high-dose radiation therapy.     

Radiotherapy of carcinoma of the nasopharynx. Results and analysis of prognostic factors

Radiation therapy of the patients with nasopharyngeal carcinoma results in permanent loco-regional control in 55-100% of cases according to stage of disease. Five-year overall survival rates range 30-55% and 5-year disease-free survival 30-40%. Factors affecting survival are: sex, age, overall patient conditions, Epstein-Barr associated antibodies, histology, T and N stages, cranial nerve and neck nodes involvement, staging method, dose and fractionation of radiation therapy, and adjuvant treatment. Our results in 94 patients can be summarized as follows: 78.4% local control, 89.8% control of lymph nodes clinically palpable at diagnosis, 40% overall 5-year survival, and 38% 5-year disease-free survival. Significant prognostic factors in our series of patients were T and N stages and histology.     

Prostate preservation by combined external beam and HDR brachytherapy in nodal negative prostate cancer

Purpose

The combined external beam- and high-dose rate brachytherapy (HDR-BT) of localized prostate cancer was introduced at Kiel University in 1986. The aim of this intermediate analysis was to judge the Kiel method of localized prostate cancer radiation treatment after ten years experience.

Patients and Methods

In the past ten years 174 patients with histological proven localized prostate cancer were subjected to combined tele-/HDR-brachytherapy. Local staging in all of the cases by transrectal ultrasound, nodal staging in the majority of the cases by CT or MRI. Average age of the patients was 68.2 years (44–84). According to AJCC/UICC staging T1B, T2, T3 was found in 2, 113 and 59 cases, respectively. Highly differentiated tumors (G1) were found in 27, moderately differentited (G2) in 87, poorly differentiated (G3) in 60 cases. The mean follow-up was 47.1 months with the median of 51.7 months. Total prescribed dose 50 Gy on the small pelvis and 70 Gy on the prostate capsule due to the integration of two, 15 Gy each, HDR-brachytherapy fractions in 6 weeks.

Results

Ten patients died of prostate cancer and 18 of intercurrent diseases resulting in a 5 years overall survival rate of 83% and tumor specific survival rate of 94%. Twenty-one patients showed a clinical progression, of these 14 systemic, 5 local and 2 both systemic and local. Additional 16 patients had PSA elevation only. The 5-years biochemical and/or clinical progression-free survival in the cohort was 79% and 73% for the T3 tumors. Side effects were 27 cases of proctitis/colitis and 20 cases of dysuria/cystitis.

Conclusion

The integrated HDR-BT combined with external beam radiation treatment is a method with excellent tumor control rates at five years superior to those of external beam treatment alone or external beam combined with iodine-125 implants. This form of radiotherapy would appear to be particularly well-suited to treatment of advanced localized (T3) tumors.

     

Physikalische Grundlagen und klinische Durchführung der interstitiellen Brachytherapie der Prostata mit Jod-125

BACKGROUND: Interstitial brachytherapy with I-125 seeds can be used for successful treatment of early stage prostate cancer. There is presented the technique of permanent transperineal implantation of I-125 seeds with intraoperative treatment planning which is suited for the treatment of prostate cancer up to the clinical stage of T2a. MATERIAL AND METHODS: Some weeks before the implantation of the seeds the prostate volume is determined using transrectal ultrasound (TRUS) so as to estimate the required number of I-125 seeds. At the outset of the treatment the prostate is stabilized by two perineally inserted needles. Subsequently there is carried out an ultrasound guided treatment planning that allows to optimize the distribution of the seeds within the prostate. In interstitial brachytherapy we use RAPID STRANDS((R)), i. e. the I-125 seeds are embedded in vicryl suture at distances of 1 cm. During implantation of the I-125 seeds the transversal placement of the applicator needles is controlled by TRUS and the cranio-caudal placement of the applicator needles is controlled using the fluoroscopic unit as well as TRUS. About 4 weeks after the implantation of the seeds there is carried out a postoperative computation of the dose distribution of the implant using CT imaging. RESULTS: The procedure possesses the advantage that ultrasound imaging, treatment planning and seed implantation are carried out with the prostate remaining in an unaltered position. During implantation the combined imaging of TRUS and fluoroscopy allows a safe placement of the seeds with in the prostate. CONCLUSION: The methods for the calculation of the actually attained dose distribution must still be optimized, because the postoperative examination of the individual results has so far been possible only with difficulties resulting from methodological inconveniences.     

Prognostic implication of thyroglobulin and quantified whole body scan after initial radioiodine therapy on early prediction of ablation and clinical response for the patients with differentiated thyroid cancer

Objective

To investigate predictors for successful ablation and disease-free status after high-dose radioiodine therapy in patients with differentiated thyroid cancer.

Methods

We enrolled 173 consecutive patients with differentiated thyroid cancer between November 2001 and December 2004 retrospectively (female 145, 46?±?12?years). All patients underwent total thyroidectomy and I-131 ablative therapy (IAT) (3.7?C5.4?GBq). The success or failure of ablation was assessed 6?C9?months after the IAT with reference to undetectable thyroglobulin (Tg) and negative I-131 whole body scan (WBS). Afterward, the decision for disease-free status was evaluated using Tg and WBS (follow-up period after 1st IAT 7?C81?months, median 43?months, criteria of disease-free: less than 10?ng/ml TSH-stimulated Tg or less than 2?ng/ml TSH-unstimulated Tg and/or negative WBS). Clinical and tumoral factors such as sex, age, pathologic type, the size of tumor, quantified cervical uptake in WBS1, pattern in WBS1, ablative therapy dose, AJCC stage, lymph node (LN) stage, Tg just before IAT (Tg1), and ablation status were assessed using logistic regression analyses.

Results

There were 93 successful ablations (54?%). Significant predictors for the ablation failure were Tg1 (OR?=?8.42; 95?% CI?=?2.76?C25.69; p?<?0.0001), LN metastasis (OR?=?3.05; 95?% CI?=?1.11?C8.37; p?=?0.031), and quantified cervical uptake in WBS1 (OR?=?4.95; 95?% CI?=?1.07?C22.88; p?=?0.041). One hundred fifty-five patients were determined as disease-free after follow-up. All the eighteen patients with persistent disease were identified as ablation failure after first IAT. Significant predictors for the disease-free status were Tg1 (OR?=?0.98; 95?% CI?=?0.97?C0.99; p?=?0.028), tumor size (OR?=?0.53; 95?% CI?=?0.28?C0.96; p?=?0.044), and quantified cervical uptake in WBS1 (OR?=?0.87; 95?% CI?=?0.76?C0.98; p?=?0.024).

Conclusions

The thyroglobulin and quantified cervical uptake in whole body scan are significant predictors for the successful ablation and disease-free status after follow-up.     

儿童视网膜母细胞瘤个体化综合治疗的临床分析

 目的 分析儿童视网膜母细胞瘤(retinoblastoma, RB)个体化综合治疗的疗效和存在的问题。方法 依据患儿全身情况和临床分期,对59例(75只患眼)RB患儿采取个体化综合治疗,对其疗效和存在问题进行临床分析。结果 RB患儿常见的首发症状为白瞳症35例(60%),斜视12例(20%),结膜充血6例(10%),视力下降3例(5%),眼突3例(5%)。59例RB患儿眼内期3年生存率为90%(43/48),眼外期3年生存率为45%(5/11),总3年生存率为81%(48/59)。75只患眼总的保眼率为41.3%(31/75),其中A～C期的保眼率为100%,D期的保眼率为68%(17/25),E期的保眼率为13.8%(4/29);2例眼外期RB患儿因肿瘤巨大无法行手术治疗,9例眼外期手术成功切除肿瘤,手术切除率为82%。结论 RB 的个体化综合治疗可以提高患儿的3年生存率及保眼率,但E期患儿的眼球摘除率仍然很高,眼外期RB患儿的管理是今后工作中的重点和难点。