后程加速超分割三维适形放疗治疗食管癌的疗效分析

目的探讨后程加速超分割三维适形放疗治疗食管癌的疗效和不良反应。方法将110例食管癌患者随机分为后程加速超分割三维适形放疗组(试验组)和单纯三维适形放疗组(对照组),每组55例,均采用6MV X线外照射。试验组患者前2/3疗程采用三维适形放疗,总剂量38Gy分19次,后1/3疗程采用后程加速超分割三维适形放疗,每次1.4 Gy,每天2次,间隔6h以上,补量总剂量28Gy,至总剂量66Gy结束疗程。对照组采用单纯三维适形放疗,总剂量66Gy分33次。比较两组患者的治疗效果。结果试验组患者的1年、3年和5年生存率分别为78.2%、52.7%和32.7%,对照组患者分别为69.1%、43.6%和25.5%,两组差异无统计学意义(P>0.05)。结论后程加速超分割三维适形放射治疗食管癌具有提高生存率的趋势。     

后程加速超分割放射治疗食管癌结果分析

目的评价后程加速超分割放射治疗食管癌疗效及毒副作用.方法96例食管癌随机分常规分割放疗组(简称常规组)47例,常规分割每次2.0GY,每日1次,每周5日,总量70GY/35f/7w左右;后程加速超分割组(简称后超组)49例,先常规分割即每次2.0GY,每日1次,每周5日,40GY后改为每次1.5GY,每日2次相隔时间6小时,每周5日,总量70GY/40f/6w左右.结果后超组1、3、5年生存率分别为75.51%、46.94%、28.57%,明显高于常规组55.32%、21.28%、10.64%.后超组急性放射性食管炎、气管炎的发生率高于常规组,两组后期损伤无显著差异.结论食管癌患者后程加速超分割放射治疗,疗效优于常规分割.食管癌死因以复发加未控及远处转移为主,但两组的死亡因素主要是复发加未控及远处转移,这值得进一步研究.     

后程加速超分割适形放射治疗食管癌48例观察

[目的]评价食管癌常规放疗结合后程加速超分割三维适形放射治疗的临床价值.[方法]96例食管癌患者随机分为适形组与对照组(普通后程加速超分割放射治疗).放疗采用6/15MV-X线外照射,前程常规放射治疗2Gy/次,共40Gy,后程改用后程加速超分割适形放射治疗或普通超分割放疗,2次/天,1.5 Gy/次,全疗程总剂量为70 Gy.[结果]适形组与对照组的1、2年生存率分别为87.5%、66.7%和77.1%、54.2%(X2=1.79,1.57,P>0.05),局部控制率分别为93.8%、89.6%和87.5%、79.2%(Y2=1.10,1.98,P>0.05).Ⅰ～Ⅲ级放射性肺炎发生率适形组与对照组分别为6.3%和20.8%(X2=4.36,P<0.05).[结论]后程加速超分割适形放射治疗食管癌虽然未能显著提高患者的近期疗效及局部控制率,但对肺有较好的保护作用.     

三维适形放射治疗颈段、胸上段食管鳞癌

 目的 评价颈段、胸上段食管鳞癌三维适形放射治疗的疗效。方法 82例颈段、胸上段食管鳞癌病例，随机分为三维适形后程加速超分割（后加速组）和常规分割（常规组）两组。常规组总剂量64 ~ 66 Gy，6.5周完成。后加速组为前3周采用常规分割，后2周采用超分割方法。结果 两组近期疗效比较无明显差异，后加速组1，2，3年局部控制率分别为68.3 %，45.0 %，45.0 %，常规组分别为52.6 %，30.1 %，27.4 %，两组比较差异无统计学意义（χ2 = 3.01，P = 0.08）；后加速组1，2，3年生存率分别为73.2 %，42.2 %，39.4 %，常规组分别为61.0 %，31.7 %，26.8 %，两组比较差异无统计学意义（χ2 = 1.46，P = 0.22）。 结论　三维适形放疗剂量分布均匀，周围正常组织受量减少，后程加速超分割放射治疗有望提高食管癌的疗效，局部肿瘤复发和未控仍是失败的主要原因，是否需要提高放射治疗剂量有待于临床进一步研究。     

局部晚期食管癌三维适形放疗疗效观察

放射治疗是中晚期食管癌的主要治疗手段,但常规分割放疗的5年生存率多在10%左右[1]。三维适形放疗（3DCRT）可通过减少周围正常组织和器官的损伤来提高肿瘤患者生存率[2]。2000年9月至2002年9月我院对82例常规照射和全程适形放疗食管鳞癌患者,进行常规分割并后程加速超分割照射对比研究,旨在探讨适形放疗并后程加速超分割对局部晚期食管癌患者疗效的影响。[第一段]     

同步化疗加后程加速超分割适形放射治疗食管癌

 目的 评价同步化疗加后程加速超分割适形放射治疗食管癌的疗效和并发症。方法 54例食管癌患者随机分为二组（适形组与对照组），每组27例，放疗采用6／15MVX线外照射，前2／3疗程常规放射治疗DT40Gy，后1／3疗程分为后程加速超分割适形放射治疗和超分割放疗，2次／天，1．4Gy／次，全疗程总剂量为68Gy，化疗采用LEP方案（四氢叶酸钙，5-氟脲嘧啶和顺铂）。结果 适形组与对照组的1、2年生存率分别为85．2%、63．0％和78．0％、59．3%（x²=0．49、0．08，P〉0．05）。结论 同步化疗加后程加速超分割适形放射治疗食管癌有提高生存率的趋势，并发症少。     

前程超分割加后程加速超分割放射治疗食管癌的临床观察

目的观察前程超分割、后程加速超分割放射治疗食管癌的临床效果.方法前程超分割每次DT 110 cGy,2次/d,5 d/周,30～40 Gy/2.5～3.5周;后程加速超分割DT 145～150 cGy/次,2次/d,5 d/周,至总量DT 60～70 Gy/4.5～5周,两次照射间隔时间≥6 h.行常规分割放疗者设为对照组.结果前程超分割加后程加速超分割组与常规分割组的有效率及1年生存率分别为83.8%、70.9%和70.0%、46.7%,两组比较差异有显著性(P＜0.05).前程超分割加后程加速超分割组放射性食管炎较对照组重,但能耐受.结论前程超分割加后程加速超分割放射治疗食管癌,与常规放疗相比,疗程短、疗效高,可显著提高食管癌局部控制率和1年生存率.     

可手术食管癌采用手术与放射治疗的随机对照研究

目的探讨对可手术治疗的食管癌患者,采用后程加速超分割适形放射治疗与手术治疗的疗效。方法对269例可手术的胸段食管癌患者进行随机分组,手术组135例,放疗组134例。手术组距肿瘤上下缘各5cm以上切除食管及其周围的淋巴脂肪组织,常规摘检≥5mm的区域淋巴结。放疗组临床靶区（CTV）前程设野原则：胸上段食管癌包括双侧锁骨上区及病变下缘以下4cm,胸中段食管癌上下缘各外放4cm,胸下段食管癌包括上缘以上4cm及胃左淋巴引流区,食管处宽度5～6cm,以90％的等剂量曲线包绕CTV,设3～5个照射野,常规分割,每次1．8～2．0Gy,照射50．0～50．4Gy,然后缩野（病变上下缘各外放2cm）加速超分割（1．5Gy／次,2次／d,间隔≥6h）照射18～21Gy,总剂量为68．4～71．0Gy。结果放疗组1、3、5年总生存率分别为88．6％、56．2％和34．7％,手术组分别为93．3％、61．5％和36．9％,两组间差异无统计学意义。手术组1、3、5年无进展生存率,分别为75．9％、43．7％和23．1％,放疗组分别为73．3％、39．7％和20．6％,两者间差异亦无统计学意义。结论可手术的食管癌采用后程加速超分割适形放射治疗,其疗效与手术治疗相当。     

Ⅲ期食管癌后程加速超分割三维适形放射治疗协同化疗的疗效分析

目的　分析临床Ⅲ期食管癌常规放射治疗后进行后程加速超分割三维适形放射治疗协同化疗的疗效、副反应及失败原因。方法　将食管鳞癌 98例随机均分至 2个组 :( 1)单纯放射治疗组前 2 / 3疗程常规设野放射治疗 4 0Gy左右 ,后 1/ 3疗程改为CT模拟定位三维计划系统设野后程加速超分割适形放射治疗 ,1.5Gy/次 ,2次 /d ,共 15～ 2 4Gy左右 ;总剂量为 5 5～ 6 4Gy ,30～ 36分次 ,全疗程35～ 4 0d。 ( 2 )协同化疗组在上述放射治疗的同时加用顺铂 2 0mg(第 1～ 5天 )、亚叶酸钙 2 0 0mg(第 6～ 10天 )、氟尿嘧啶 5 0 0mg(第 6～ 10天 ) ,2 8d为 1个周期 ,共 5个周期。结果　随访 8～ 4 8个月 ,单纯放射治疗组和协同化疗组的 1、2、3年生存率分别为 73%、5 3%、35 %和 76 %、73%、5 5 % ,协同化疗组高于单纯放射治疗组 ( χ2 =4 .12 ,P <0 .0 5 ) ;1、2、3年局部控制率分别为 76 %、5 9%、4 9%和 82 %、76 %、6 9 % ,协同化疗组高于单纯放射治疗组 ( χ2 =4 .2 2 ,P <0 .0 5 )。Cox回归分析显示病变部位是独立的预后因素 ,颈段、胸上段食管癌预后明显优于胸中段食管癌。结论　常规放射治疗后进行后程加速超分割三维适形放射治疗可作为颈段、胸上段Ⅲ期食管癌的首选方法之一 ,协同化疗可以提高局部控制率和生存率     

后程加速超分割三维适形放疗同步化疗治疗中晚期食管癌的临床研究

目的 探讨后程加速超分割三维适形放疗同步化疗治疗中晚期食管癌的疗效和不良反应。方法 将122例食管癌患者随机分为后程加速超分割三维适形放疗同步化疗组（观察组）60例和三维适形同步放化疗组（对照组）62例。两组前程放疗均行直线加速器三维适形照射至剂量46 Gy/23次,对照组后程放疗继续行常规分割照射至总剂量62 Gy,观察组后程改用加速超分割放疗,分次剂量1.4 Gy/次,2次/d,2次间隔时间＞6 h,至总剂量62.8 Gy。两组均于放疗同期采用紫杉醇联合顺铂2个周期方案化疗,放疗结束继续行1～２个周期巩固化疗,28 d为1个周期。结果 观察组和对照组有效率分别为88.3%和64.5%,观察组1年、2年局部控制率分别为 74.3% 、58.7%,对照组分别为53.6%、32.6%,两组比较差异有统计学意义（P＜0.05）。观察组1年、2年生存率分别为66.7%、55.0%,对照组分别为 53.2%、43.5%,差异均无统计学意义（P＞0.05）。两组急性不良反应和晚期放射反应以Ⅰ～Ⅱ级为主,两组比较差异无统计学意义（P＞0.05）。结论 后程加速超分割三维适形放疗同步化疗治疗中晚期食管癌较三维适形同步放化疗可提高近期疗效及局部控制率,不良反应较轻,患者均能耐受。     

Organ motion in image-guided radiotherapy: lessons from real-time tumor-tracking radiotherapy

External radiotherapy using imaging technology for patient setup is often called image-guided radiotherapy (IGRT). The most important problem to solve in IGRT is organ motion. Four-dimensional radiotherapy (4DRT), in which the accuracy of localization is improved – not only in space but also in time – in comparison to 3DRT, is required in IGRT. Real-time tumor-tracking radiotherapy (RTRT) has been shown to be feasible for performing 4DRT with the aid of a fiducial marker near the tumor. Lung, liver, prostate, spinal/paraspinal, gynecological, head and neck, esophagus, and pancreas tumors are now ready for dose escalation studies using RTRT.     

国产威达（WD－H·D·R18）后装腔内治疗机的临床应用（附380例疗效观察）

我院自１９９２年６月至１９９３年６月使用广东威达（ＷＤ·Ｈ·Ｄ·Ｒ·１８型）后装腔内治疗机，施行腔内放疗、组织间插植、术中置管和表面敷贴放疗等方法，治疗各种癌瘤共３８０例，其近期疗效为：完全消失７９．７４％（３０３／３８０）部分消失：１４．７４％（５６／３８０）无效：５．５３％（２１／３８０）；总有效率：９４．４８％（３５９／３８０）。全组随诊时间为１－１２个月。结合临床应用的若干问题对该机作出初步评价。     

2019年中国大陆地区放疗人员和设备基本情况调查研究

[目的]了解我国大陆地区放疗人才及设备情况。[方法]2019年4月10日至9月20日期间,中华医学会放射肿瘤治疗学分会通过线上问卷的形式进行了全国第九次行业调查,调查2018年度全国各个医院从事放疗的人员、设备、技术、年放疗人次以及主要放疗病种等数据。[结果]本次问卷回收率100%,所有放疗单位数据通过各省医学会再次确认。中国大陆地区放疗单位1463家。从事放疗的工作人员共29096人,其中放疗医师14575人、物理师4172人、技师8940人、维修师1409人。共有直线加速器2021台(含进口和国产),钴60远距离治疗机66台,近距离治疗机339台,质子重离子机5台,常规模拟机1453台,CT模拟机355台。能开展二维放疗1002家,三维适形放疗1272家,静态调强放疗1121家,Rapid Arc145家,容积旋转调强放疗279家,立体定向放射治疗297家,近距离治疗273家,全身X线治疗75家,全身电子线治疗73家,Tomo治疗38家,质子/重离子治疗5家。病床数97836张(含综合医院肿瘤科病床),放疗年治疗人数1259602人。[结论]中国大陆地区放疗单位数目缓慢增长,放疗从业人员较前稍减少,开展放疗新技术单位逐年增加,全国每百万人口放疗设备(加速器+钴60)仅1.5,仍低于WHO的要求。     

Clinician's guide to prostate IMRT plan assessment and optimisation

Intensity-modulated radiotherapy (IMRT) offers dosimetric benefit for irregularly shaped treatment volumes compared to three-dimensional conformal approaches. Some groups advocate IMRT as the standard of care for prostate radiotherapy. For clinicians, assessment of an IMRT plan can introduce new opportunities and challenges. Although a standard IMRT plan may be deemed acceptable by meeting pre-set dose constraints, further optimisation may yield a superior treatment plan by further reducing dose to critical structures or improving target volume homogeneity. The aim of this article is to present aspects of IMRT planning relevant to clinicians to aid in plan critiquing.     

Evaluation of a Novel Field-placement Algorithm for Locoregional Breast Cancer Radiotherapy Including the Internal Mammary Chain

Aims

Irradiation of the internal mammary chain (IMC) is increasing following recently published data, but the need for formal delineation of lymph node volumes is slowing implementation in some healthcare settings. A field-placement algorithm for irradiating locoregional lymph nodes including the IMC could reduce the resource impact of introducing irradiation of the IMC. This study describes the development and evaluation of such an algorithm.

非小细胞肺癌3D-CRT与IMRT立体定向放疗剂量学比较

目的:研究三维适形(3D-CRT)和逆向调强(IMRT)两种计划方式在进行早期非小细胞肺癌(NSCLC)立体定向放射治疗(SBRT)的剂量学差异。方法:选取接受放射治疗的早期NSCLC患者12例,分别采用3D-CRT和IMRT技术设计SBRT治疗计划。比较两种计划方式下PTV的相关剂量学参数(CI、HI、D1%、D99%),肺、胸壁、心脏及脊髓的剂量学参数(Vx、Dmean、Dmax),以及加速器的机器跳数、治疗时间等差异。结果:在PTV相关参数比较中,3D-CRT计划的CI、HI以及D1%均差于IMRT,差异有统计学意义,P<0.05;但是两者的D99%差异无统计学意义,P>0.05。在危及器官受量的比较中,3D-CRT与IMRT计划的患侧肺V5～V40、健侧肺V5～V15、双侧肺V5～V40、胸壁V5～V40、Dmean、心脏V20～V40、Dmean及脊髓Dmax的差异均无统计学意义,P>0.05。3D-CRT计划的机器跳数及治疗时间较IMRT计划分别减少了53%和78%,P<0.05。在绝对剂量体积比较中,3D-CRT的V60～V75及V45～V60均大于IMRT,V20～V45小于IMRT,差异均无统计学意义,P>0.05。结论:IMRT计划在早期NSCLC行SBRT治疗中不具有明显的剂量学优势。考虑到IMRT实施过程的复杂性和不确定性,早期NSCLC行SBRT治疗时3D-CRT可作为首选。     

Radiothérapie adaptative : stratégies et bénéfices selon les localisations tumorales

Adaptive radiotherapy (ART) is a complexe image-guided radiotherapy modality that comprises multiple planning to account for anatomical variations occurring during irradiation. Schematically, two strategies of RTA can be distinguished and combined according to tumor locations. One or more replanning can be proposed to correct systematic variations such as tumor shrinkage. A library of treatment plans with day-to-day plan selection from cone-beam CT imaging can also be proposed to correct random variations such as uterine motion or bladder/rectum volume changes. Because of strong anatomical variations occurring during irradiation, RTA appears therefore particularly justified in head and neck, lung, bladder, cervical and rectum and pancreas tumors, and to a lesser extent for prostate tumors and other digestive tumors. For these tumor locations, ART provides a fairly clear dosimetric benefit but a clinical benefit not yet formally demonstrated. ART cannot be proposed in a routine practice but must be evaluated medico-economically in the context of prospective trials. A rigorous quality control must be associated.     

The Long and the Short of it: the Role of Short-course Radiotherapy in the Neoadjuvant Management of Rectal Cancer

Total mesorectal excision is the cornerstone of treatment for rectal cancer. Multiple randomised trials have shown a reduction in local recurrence rates with the addition of preoperative radiotherapy, either as a 1-week hypofractionated short-course (SCRT) or a conventionally fractionated long-course (LCRT) schedule with concurrent chemotherapy. There is also increasing interest in the addition of neoadjuvant chemotherapy to radiotherapy with the aim of improving disease-free survival. The relative use of SCRT and LCRT varies considerably across the world. This is reflected in, and is probably driven in part by, disparity between international guideline recommendations. In addition, different approaches to treatment may exist both between and within countries, with variation related to patient, disease and treatment centre and financial factors. In this review, we will specifically focus on the use of SCRT for the treatment of rectal cancer. We will discuss the literature base and current guidelines, highlighting the challenges and controversies in clinical application of this evidence. We will also discuss potential future applications of SCRT, including its role in optimisation and intensification of treatment for rectal cancer.     

A Randomised Phase II Clinical Trial Comparing the Deliverability and Acute Toxicity of Wide Tangent versus Volumetric Modulated Arc Therapy to the Breast and Internal Mammary Chain

AimsInclusion of the internal mammary chain in the radiotherapy target volume (IMC-RT) improves disease-free and overall survival in higher risk breast cancer patients, but increases radiation doses to heart and lungs. Dosimetric data show that either modified wide-tangential fields (WT) or volumetric modulated arc therapy (VMAT) together with [AQ1]voluntary deep inspiration breath hold (vDIBH) keep mean heart doses below 4 Gy in most patients. However, the impact on departmental resources has not yet been documented. This phase II clinical trial compared the time taken to deliver IMC-RT using either WT and vDIBH or VMAT and vDIBH, together with planning time, dosimetry, set-up reproducibility and toxicity.Materials and methodsLeft-sided breast cancer patients requiring IMC-RT were randomised to receive either WT(vDIBH) or VMAT radiotherapy. The primary outcome was treatment time, powered to detect a minimum difference of 75 min (5 min/fraction) between techniques. The population mean displacement, systematic error and random error for cone beam computed tomography chest wall matches in three directions of movement were calculated. Target volume and organ at risk doses were compared between groups. Side-effects, including skin (Radiation Therapy Oncology Group), lung and oesophageal toxicity (Common Terminology Criteria for Adverse Events v 4.03) rates, were compared between the groups over 3 months. Patient-reported outcome measures, including shoulder toxicity at baseline, 6 months and 1 year, were compared.ResultsTwenty-one patients were recruited from a single UK centre between February 2017 and January 2018. The mean (standard deviation) total treatment time per fraction for VMAT treatments was 13.2 min (1.7 min) compared with 28.1 min (3.3 min) for WT(vDIBH). There were no statistically significant differences in patient set-up errors in between groups. The average mean heart dose for WT(vDIBH) was 2.6 Gy compared with 3.4 Gy for VMAT(vDIBH) (P = 0.13). The mean ipsilateral lung V_17Gy was 32.8% in the WT(vDIBH) group versus 34.4% in the VMAT group (P = 0.2). The humeral head (mean dose 16.8 Gy versus 2.8 Gy), oesophagus (maximum dose 37.3 Gy versus 20.1 Gy) and thyroid (mean dose 22.0 Gy versus 11.2 Gy) all received a statistically significantly higher dose in the VMAT group. There were no statistically significant differences in skin, lung or oesophageal toxicity within 3 months of treatment. Patient-reported outcomes of shoulder toxicity, pain, fatigue, breathlessness and breast symptoms were similar between groups at 1 year.ConclusionVMAT(vDIBH) and WT(vDIBH) are feasible options for locoregional breast radiotherapy including the IMC. VMAT improves nodal coverage and delivers treatment more quickly, resulting in less breath holds for the patient. This is at the cost of increased dose to some non-target tissues. The latter does not appear to translate into increased toxicity in this small study.