纤维支气管镜下大剂量腔内放疗治疗癌性支气管阻塞

目的 应用后装设备在支以气管镜引导下将＾１９２Ｉｒ导入支气管内进行腔内放疗,治疗癌性支气管阻塞。方法 常规纤维支气管镜检后,将施源器导管经活检孔导入病变部位,接后装机进行放疗,每次６￣８Ｇｙ,每周１次,连续３周为１疗程。疗程结束后第１、４周复查。结果 胸部Ｘ线检查示：ＣＲ１５例（２３．０８％）,ＰＲ２８例（４３．０８％）,ＭＲ１２例（１８．４６％）,总有效率（ＣＲ＋ＰＲ＋ＭＲ）为８４．６２％。纤支     

三维适形放疗配合化疗治疗放疗后局部复发的非小细胞肺癌的疗效观察

目的探讨三维适形放疗+化疗治疗放疗后局部复发的非小细胞肺癌(NSCLC)的疗效。方法28例NSCLC常规外照射后局部复发患者,采用三维适形放疗(3DCRT)加全身化疗(NP方案化疗2周期)。结果28例患者全部完成治疗,4例完全缓解(CR),17例部分缓解(PR),5例稳定(NC),2例进展(PD)。总有效率(CR+PR)75.0%(21/28)。1、2年生存率分别为53.6%(15/28)、10.7%(3/28)。结论放疗后局部复发的NSCLC采用3DCRT合并NP方案化疗近期疗效满意,局部疗效好,远期疗效及晚期并发症有待观察。     

重组人血管内皮抑制素(恩度)联合放疗同步治疗中晚期宫颈癌48例的近期疗效

目的:观察重组人血管内皮抑制素(恩度)同步放疗对中晚期宫颈癌的近期疗效。方法:将48例中晚期(Ⅱb-Ⅳa期)宫颈癌患者随机分为两组:单纯放疗组(RT组)24例,恩度联合放疗组(RT+E组)24例。两组放疗方法相同。RT+E组在放疗开始每天一次恩度7.5mg/m2 iv drop,共4周。结果:近期临床疗效:RT+E组CR 18例(75.0%),PR 5例(20.8%),NC 1例(4.2%),有效率(CR+PR)95.8%;RT组CR 8例(33.3%),PR 10例(41.7%),NC 6例(25.0%),有效率(CR+PR)75.0%,RT+E组的CR及有效率均高于RT组,差异有显著性。结论:重组人血管内皮抑制素(恩度)同步放疗可提高中晚期宫颈癌的近期疗效,毒性反应没有增加。     

38例癌性上腔静脉综合征放疗疗效分析

目的探讨放疗配合低剂量化疗对38例癌性上腔静脉综合征病人的治疗方法及疗效.方法采用6MV X线照射,28例行常规放疗,前后对穿照射,10例行立体定向适形放疗.总剂量40～72GY.低剂量化疗采用顺铂20mg放疗第一天开始静输,连续5天.结果38例病人CR23例(60.5%);PR10例(26.3%);其中常规放疗组CR15/28(53.6%);PR8/28(28.6%);立体定向适形放疗CR8/10(80%);1/10(10%),放射性肺炎发生率:常规放疗6/28(21.4%);立体定向适形放疗0/10,总有效率(CR+PR)为86.8(33/38),平均缓解期为19.6个月.结论放射治疗并低剂量化疗可使造成上腔静脉综合征的瘤体迅速缩小,受压症状很快消失,较以往单独化疗或单独放疗比,疗效好,缓解期长.立体定向适形放疗的近期并发症要明显低于常规放射治疗,不失为上腔静脉压迫综合征临床有效治疗手段.     

奈达铂联合氟尿嘧啶诱导化疗治疗局部晚期鼻咽癌的疗效及安全性分析

目的 探讨治疗局部晚期鼻咽癌时奈达铂联合氟尿嘧啶诱导化疗的近期疗效和不良反应,并对其安全性进行分析.方法 选自120例局部晚期鼻咽癌患者;以患者入院时间先后顺序进行随机分组,实验组60例、对照组60例.实验组:静脉滴注奈达铂(80 mg/m2),d1;持续微泵输入氟尿嘧啶(500 mg/m2/d),d1~d5;每21天为1个疗程,连用2个疗程.对照组:静脉滴注卡铂(300 mg/m2),d1;持续微泵输入氟尿嘧啶(500 mg/m2/d),d1~d5;每21天为1个疗程,连用2个疗程.两组诱导化疗2个周期完成后14 d开始序贯适型调强放疗.序贯适型调强放疗:直线加速器适型调强放疗,每次2.18 Gy,每周5次.序贯放疗结束后进行MRI检查.结果 2个周期诱导化疗后,实验组鼻咽部CR+PR 48例,总有效率为80.00%,淋巴结总有效率为73.34%,对照组鼻咽部CR+PR 46例,总有效率为76.67%,淋巴结总有效率为71.43%,两组治疗疗效比较无显著差异(P>0.05);诱导化疗序贯放疗后,实验组鼻咽部和淋巴结总有效率分别为96.67%和100.00%,对照组鼻咽部和淋巴结总有效率分别为96.67%和100.0%,两组间疗效对比无显著差异(P>0.05),但两组诱导化疗后,疗效均显著提高;诱导化疗序贯放疗后总疗效对比,实验组CR率为83.33%;对照组CR率为70.00%.两组近期总疗效比较无显著差异(P>0.05);实验组血小板减少发生率为16.67%,明显低于对照组46.67%,两组比较差异显著(P<0.05);特别在Ⅲ、Ⅳ度,实验组发生率(1.67%)显著低于对照组(16.67%),两组比较有明显差异(P<0.05).实验组恶心呕吐发生率(76.67%)与对照组(83.33%)比较差异不大,无显著差异性.结论 在治疗局部晚期鼻咽癌时奈达铂联合氟尿嘧啶具有疗效好,不良反应轻的特点,值得在鼻咽癌诱导化疗中推广应用.     

立体定向放射治疗中晚期肺癌近期疗效观察

目的　比较立体定向放谢治疗与普遍放疗对不能手术的中晚期肺癌的近期疗效。方法　 49例立体定向放疗组 (适形组 ) ,采用CT模拟定位技术和立体适形放疗技术 8MVX线 ,单次剂量 5 0 0～80 0cGY ,隔日照射 ,共 8～ 10次 ,疗程 14～ 2 1天 ,总量 80 0 0cGY ,对照组 49例 8MVX线 ,常规照射 ,每日2 0 0cGY ,疗程 40～ 45天 ,总量 6 0 0 0cGY。结果　治疗结束后 4～ 8周观察疗效。适形组 :完全缓解率CR44 9% ,CR +PR(总有效率 ) 89 8% ,对照组 :完全缓解率CR2 4 5 % ,CR +PR(总有效率 ) 6 9 4%。 1年后的局控率 :适形组 5 3 1% ,对照组 30 6 %。结论　立体定向放射治疗能有效提高中晚期肺癌的局部控制率 ,改善临床症状。提高生存质量 ,近期疗效满意。     

紫杉醇同期放疗化疗与PF方案诱导化疗加局部放疗治疗晚期鼻咽癌近期疗效比较

目的　比较紫杉醇同期放疗、化疗与 PF方案诱导化疗 +局部放疗治疗晚期鼻咽癌的临床疗效和毒副作用。方法　 72例局部晚期鼻咽癌患者随机分为两组 ,一组 36例为紫杉醇同期放疗 +化疗 (紫杉醇组 ) ,另一组 36例为 PF(DDP,5 - FU )方案诱导化疗 1～ 2个疗程后加放疗 (PF组 )。结果　两组在半量 (40 Gy)放疗结束时鼻咽病灶有效率 (PR+CR)分别为 72 .2 %和 6 9.4 % (P >0 .0 5 ) ;颈部转移灶有效率 (PR+CR)分别为 72 .2 %和 75 .0 %(P>0 .0 5 ) ;全量放疗结束时鼻咽病灶有效率 (PR+CR)分别为 97.2 %和 94 .4 % (P>0 .0 5 ) ;颈部转移灶有效率(PR+CR)分别为 97.2 %和 97.4 % (P>0 .0 5 ) ;放疗毒副作用所致恶心呕吐、口腔黏膜反应和骨髓抑制等差异有显著性 (P<0 .0 5 )。结论　紫杉醇同期放疗、化疗与 PF方案诱导化疗 +局部放疗晚期鼻咽癌局部控制率相近 ,但前者毒副作用较轻。     

三维适形放疗协同化疗治疗食管癌术后纵隔转移临床观察

目的 观察三维适形放疗协同化疗治疗食管癌术后纵隔淋巴结转移的临床疗效和毒副反应.方法 将56例食管癌术后发生纵隔淋巴结转移者分为两组:观察组30例,对照组26例.观察组采用FD方案化疗,放疗第1天开始,5-氟脲嘧啶500 mg/m2+顺铂20 mg/m2,d1～5,28 d为1个周期,共4个周期;同时给予三维适形放射治疗,2～3 Gy/次,5次/周,照射总量为60～68 Gy.对照组采用单纯三维适形放疗,放疗方法与剂量同观察组.结果 治疗后6个月复查,观察组完全缓解(CR)20例,部分缓解(PR)9例,总有效率(CR+PR)96.7%;对照组CR 11例,PR 8例,有效率(CR+PR)73.1%.观察组与对照组1、2、3年生存率分别为86.7%、56.7%、23.3%和80.8%、34.6%、15.4%.结论 食管癌术后纵隔转移行三维适形放疗协同化疗疗效优于单纯放疗,可以提高生存率.     

博宁加化疗治疗乳腺癌骨转移疼痛的疗效观察

目的观察博宁对乳腺癌骨转移的止痛效果.方法应用博宁加化疗和单用化疗两组对照研究.结果治疗组30例博宁加化疗止痛效果CR 16例(53.3%),PR11例(36.7%),止痛总有效率CR+PR 27例(90.0%).对照组28例单用化疗,止痛效果CR 4例(14.3%),PR6例(21.4%),止痛总有效率CR+PR 10例(35.7%).两组差异显著(P＜0.05),博宁应用中除少数出现骨痛加重外,余无异常.结论博宁是一种安全有效,毒副作用小,作用时间长的新一代双膦酸盐制剂,与化疗并用于乳腺癌骨转移,止痛效果更好.     

体部伽玛刀治疗肝门区肿瘤临床观察

目的:探讨体部立体定向放疗(stereotactic body radiotherapy,SBRT)治疗无法手术的肝门区肿瘤的疗效及毒副作用。方法:2006年10月至2010年6月,对63例肝门区无法手术肿瘤进行SBRT,每次分割剂量(3-6)Gy,照射次数6-15次,肿瘤剂量(39-60)Gy每周2-5次。治疗后1月、3月评价疗效,1年、2年评价患者的生存率。结果:1月CR 15例(23.8%)、PR 34例(54.0%)、SD 11例(17.5%)、PD 3例(4.8%),总有效率78.8%。总胆红素和直接胆红素均较治疗前下降,36例(36/48,75%)患者转为正常,门脉癌栓有效率40.9%。6例患者在治疗3个月内死亡,未能进行以后的疗效评价,3月CR 22例(34.9%)、PR 32例(50.8%)、SD 3例(4.8%),总有效率85.7%(54/63)。总胆红素和直接胆红素全部转为正常为40例(40/48,83.3%),其余5例也接近正常。门脉癌栓有效率63.6%。≤5cm肿瘤CR 72.2%(13/18),CR+PR 94.4%(17/18),>5cm CR 20%(9/45),CR+PR 82.2%(37/45)。患者1年生存率79.4%(50/63)、2年生存率42.9%(27/63)。结论:肝门区肿瘤SBRT是一种安全、有效的治疗方法。     

Endobronchial brachytherapy: a preliminary experience.

Fourteen patients with malignant airway obstruction were treated with a placement of a flexible nylon catheter for low dose rate manual afterloading Iridium 192 endobronchial brachytherapy using a flexible fibreoptic bronchoscope. Eight patients had obstructive pneumonitis at initial presentation, while 6 cases were recurrences after previous external irradiation. Six evaluable patients of the former group had complete or partial reinflation of lung and were followed by external radiotherapy. Of the latter group, 3 were evaluable and had moderate to good palliation of their symptoms. No complication was observed. The technique is simple and safe with good patient compliance. Further evaluation is indicated to assess its role in the locoregional management of lung cancer.     

三维适形放疗治疗恶性梗阻性黄疸35例

目的：观察三维适形放疗治疗恶性梗阻性黄疸的疗效。方法：2000年10月-2007年12月,对35例恶性梗阻性黄疸患者行三维适形放疗,每次3Gy,每周5次,总共15—19次（剂量45—57Gy）。结果：所有病例均完成治疗,病灶完全缓解率（cR）8例,占22．9％;部分缓解（PR）22例,占62．9％;无变化5例,占14．3％,总有效率85．8％,29例黄疸均有不同程度消退,没有严重的并发症发生。一年生存率为60％。结论：三维适形放疗对恶性梗阻性黄疸有较好的疗效,绝大多数患者能耐受,是治疗恶性梗阻性黄疸的一种有效方法。     

Hybrid 3D visualization of the chest and virtual endoscopy of the tracheobronchial system: possibilities and limitations of clinical application

OBJECTIVE: A hybrid rendering method which combines a color-coded surface rendering method and a volume rendering method is described, which enables virtual endoscopic examinations using different representation models. MATERIALS AND METHODS: 14 patients with malignancies of the lung and mediastinum (n=11) and lung transplantation (n=3) underwent thin-section spiral computed tomography. The tracheobronchial system and anatomical and pathological features of the chest were segmented using an interactive threshold interval volume-growing segmentation algorithm and visualized with a color-coded surface rendering method. The structures of interest were then superimposed on a volume rendering of the other thoracic structures. For the virtual endoscopy of the tracheobronchial system, a shaded-surface model without color coding, a transparent color-coded shaded-surface model and a triangle-surface model were tested and compared. RESULTS: The hybrid rendering technique exploit the advantages of both rendering methods, provides an excellent overview of the tracheobronchial system and allows a clear depiction of the complex spatial relationships of anatomical and pathological features. Virtual bronchoscopy with a transparent color-coded shaded-surface model allows both a simultaneous visualization of an airway, an airway lesion and mediastinal structures and a quantitative assessment of the spatial relationship between these structures, thus improving confidence in the diagnosis of endotracheal and endobronchial diseases. CONCLUSIONS: Hybrid rendering and virtual endoscopy obviate the need for time consuming detailed analysis and presentation of axial source images. Virtual bronchoscopy with a transparent color-coded shaded-surface model offers a practical alternative to fiberoptic bronchoscopy and is particularly promising for patients in whom fiberoptic bronchoscopy is not feasible, contraindicated or refused. Furthermore, it can be used as a complementary procedure to fiberoptic bronchoscopy in evaluating airway stenosis and guiding bronchoscopic biopsy, surgical intervention and palliative therapy and is likely to be increasingly accepted as a screening method for people with suspected endobronchial malignancy and as control examination in the aftercare of patients with malignant diseases.     

三维适形放疗治疗35例恶性梗阻性黄疸

目的：观察三维适形放射治疗恶性梗阻性黄疸的疗效，探讨其更有效的治疗方法。方法：1998年10月—2000年12月，对35例恶性梗阻性黄疸患者行三维适形放疗，每次3—4Gy，每周5次，总共10—12次。结果：所有病例均完成治疗，病灶完全缓解率(CR)8例，占24％，部份缓解(PR)22例，占63％，无变化5例，占13％，总有效率87％。29例黄疸均有不同程度消退，没有严重的并发症发生。一、二年生存率分别为70％、21％。结论：三维适形放疗对恶性梗阻性黄疸有较好的疗效，绝大多数患者均能耐受，是治疗恶性梗阻性黄疸的一种有效方法。     

经支气管镜高频电技术治疗肿瘤性中央气道狭窄的临床价值

目的 探讨经支气管镜高频电技术治疗肿瘤性中央气道狭窄的临床价值。方法 对比分析38例中央气道良性及恶性肿瘤并气道狭窄患者,治疗前后临床表现、不张肺复张、气道再通及肺功能等变化情况。结果 反复咯痰、发热及呼吸困难均于治疗后100%缓解、消失,刺激性咳嗽94.4%改善、咯血87.5%改善,不张肺的肺复张率92%。治疗结束时中央气道狭窄再通即时疗效无论良性、恶性组疗效均为100%,治疗结束后3月中央气道狭窄再通总有效率94.7%。气促评分、肺功能（肺通气功能、换气功能及气道阻力）改善情况,治疗前后比较差异均具有统计学意义（P<0.001）。并发症少,复发率低。结论 经支气管镜高频电技术治疗肿瘤性中央气道狭窄是一项安全、有效的治疗手段,比较适合我国国情。     

高温射频消融治疗周围型肺部恶性肿瘤

目的CT引导经皮肺穿刺高温射频消融治疗89例周围型肺部恶性肿瘤的近期疗效观察.方法集束聚能刀高温射频消融治疗89例周围型肺部恶性肿瘤,包括原发性周围型肺癌65例,肺转移癌24例,共计226个肿瘤.结果胸部CT或X线平片复查,肿瘤经射频消融治疗后绝大多数病例的肿瘤在3个月左右明显缩小(CR+PR,82.0%).术后并发症包括气胸32例、少量血胸3例和局部疼痛15例.结论高温射频消融治疗周围型肺部恶性肿瘤,近期疗效确切,严重并发症少,是一种较为安全有效的治疗方法.     

High-dose-rate endobronchial brachytherapy for recurrent airway obstruction from hyperplastic granulation tissue

PURPOSE: Benign endobronchial granulation tissue causes airway obstruction in up to 20% of patients after lung transplantation or stent placement. High-dose-rate endobronchial brachytherapy (HDR-EB) has been successful in some cases refractory to standard bronchoscopic interventions. METHODS AND MATERIALS: Between September 2004 and May 2005, 8 patients with refractory benign airway obstruction were treated with HDR-EB, using one to two fractions of Ir-192 prescribed to 7.1 Gy at a radius of 1 cm. Charts were retrospectively reviewed to evaluate subjective clinical response, forced expiratory volume in 1 second (FEV(1)), and frequency of therapeutic bronchoscopies over 6-month periods before and after HDR-EB. RESULTS: The median follow-up was 14.6 months, and median survival was 10.5 months. The mean number of bronchoscopic interventions improved from 3.1 procedures in the 6-month pretreatment period to 1.8 after HDR-EB. Mean FEV(1) improved from 36% predicted to 46% predicted. Six patients had a good-to-excellent subjective early response, but only one maintained this response beyond 6 months, and this was the only patient treated with HDR-EB within 24 h from the most recent bronchoscopic intervention. Five patients have expired from causes related to their chronic pulmonary disease, including one from hemoptysis resulting from a bronchoarterial fistula. CONCLUSION: High-dose-rate-EB may be an effective treatment for select patients with refractory hyperplastic granulation tissue causing recurrent airway stenosis. Performing HDR-EB within 24-48 h after excision of obstructive granulation tissue could further improve outcomes. Careful patient selection is important to maximize therapeutic benefit and minimize toxicity. The optimal patient population, dose, and timing of HDR-EB should be investigated prospectively.     

Photodynamic therapy for patients with advanced non-small-cell carcinoma of the lung

Patients with advanced non-small-cell lung carcinoma (NSCLC) have poor prognoses and experience negative sequelae of disease. Patients often suffer from dyspnea and/or hemoptysis, with overall pulmonary compromise. Patients with advanced, inoperable disease have limited options for treatment. This study summarizes our early experience and findings using photodynamic therapy (PDT) as an effective modality in the palliation of hemoptysis, dyspnea, and physical airway obstruction in cases of inoperable lung cancer. A retrospective review was conducted for the first 10 patients diagnosed with stage III/IV obstructive NSCLC who underwent PDT at our institution. Endobronchial lesions were identified by bronchoscopy. Treatments were initiated 48 hours after intravenous injection of 2 mg/kg of the photosensitizing agent porfimer sodium (Photofrin, QLT PhotoTherapeutics, Vancouver, BC). The porfimer sodium was then activated by illumination with a 630 nm wavelength light using a Coherent argon ion laser through a flexible bronchoscope. Repeated bronchoscopies were performed 1-3 days following initial PDT for evaluation and airway debridement. In 8 cases, a second treatment of PDT was administered within 72 hours of the first injection. One patient received a third treatment several months later. Three patients also received endobronchial stents after PDT. Overall, all 10 patients responded to PDT. Physical airway obstruction was reduced in all patients, with a noted improvement in bronchoscopic luminal diameter. Acute hemoptysis resolved in all 7 symptomatic patients. Median survival was 5.5 months post-PDT, while median survival postdiagnosis was 10.5 months. Three patients are alive at the time of this review at 5-21 months following therapy. Patients with unresectable late-stage NSCLC have few options for treatment. Our early experience with PDT indicates effective relief of hemoptysis, dyspnea, and airway obstruction and improves their quality of life.     

Endobronchial radiation therapy (EBRT) in the management of lung cancer.

Between October 1987 and November 1988, 19 endobronchial Iridium-192 line source placements were attempted in 17 patients with advanced incurable lung cancer. Approximately 30 Gy was delivered to the endobronchus using a low dose rate (LDR) afterloading technique delivering a mean dose of 70 cGy/hr at 5 mm. Improvement in subjective symptoms was noted in 67% of evaluable patients whereas objective responses defined by chest X ray and bronchoscopy were noted in 26% and 60%, respectively. No significant morbidity was observed. The radiation exposure to health care workers was low ranging from 10 to 40 mRem per treatment course with most of the staff receiving less than 10 mRem per treatment course (minimal detectable level 10 mRem). The results of this series are compared with selected series using low dose rate as well as intermediate dose rate (IDR) and high dose rate (HDR) endobronchial radiation therapy (EBRT). Based on bronchoscopic responses from the selected series reviewed, both HDR low total dose per treatment (range 7.5-10 Gy) and LDR high total dose per treatment (range 30-50 Gy) are effective in palliating the vast majority of patients with endobronchial lesions. Intermediate dose rate is also effective using fractions similar to high dose rate but total dose similar to low dose rate. The efficacy of endobronchial radiation therapy in the palliative setting suggest a possible role for endobronchial radiation therapy combined with external beam irradiation with or without chemotherapy in the initial management of localized lung cancer. Defining the optimal total dose, dose rate, and the exact role of endobronchial radiation therapy in the management of lung cancer will require large cooperative trials with standardization of techniques and definitions.     

Predicting the response of obstructive endobronchial tumors to photodynamic therapy

To investigate the usefulness of bronchoscopic examination, computerized tomography (CT), and radionuclide quantitative ventilation-perfusion lung scan to determine the response of patients with obstructive endobronchial tumors to photodynamic therapy (PDT), the findings in 24 patients treated with PDT were analyzed. PDT was found to be most effective when the tumor was bronchoscopically polypoid in appearance, with little or no submucosal invasion or peribronchial extension seen on CT scans. With increasing submucosal and/or peribronchial extension, the immediate response to treatment was poorer. Patients who had 50% or more of the airway obstruction due to mucosal tumor had no evidence of local tumor recurrence for a median interval of 22 weeks after treatment. In patients with predominant submucosal and/or peribronchial tumor, the duration of response was 7 weeks. Response to treatment did not correlate with the degree of airway obstruction. CT provided valuable information regarding the extent of the peribronchial involvement and airway distortion, which was often underestimated by bronchoscopy alone. Absent perfusion or reduction of regional perfusion out of proportion to ventilation on scintigraphy in the involved lung zone was found to be associated with extensive peribronchial involvement and a poor outcome. The authors conclude that the addition of CT and radionuclide quantitative ventilation-perfusion lung scan to bronchoscopic examination is useful in predicting the response of patients with obstructive endobronchial tumors to PDT.