放射治疗124例原发性脑瘤临床分析

本文回顾124例原发性脑瘤的单纯放疗和术后放疗的5年生存情况。材料与方法：分析经术后病理或CT、MRI证实的124原发性脑瘤。8mv－x线或60Co常规分割全脑照射，中线剂量30～40Gy，局部追加照射DT10－20Gy。全脊髓预防照射DT25～30Gy。结果：5年生存率：全部切除者和部分切除者分别是7／13（53．4％）、8／23（34.8％）；放射剂量50～60Gy者好于低剂量组；胶质瘤、髓母细胞瘤、室管膜瘤分别为10/32（31.2％）、2／6（33．3％）、1／2。结论：病人生存期长短取决于手术切除程度、放射剂量与肿瘤组织学类型。     

鼻咽癌局部复发分次立体定向放射治疗

目的　探讨分次立体定向放射治疗技术 ,在局部复发晚期鼻咽癌再程放疗中的应用。方法　 1997年 7月到 2 0 0 0年12月 ,采用分次立体定向放射治疗局部复发鼻咽癌 2 3例。所有病例均采用 6MVX线照射 ,设 1～ 3个中心 ,80 %剂量曲线将靶区完全包含。总剂量DT2 4～ 64Gy(中位剂量 5 2 .2Gy) ,单次剂量DT4～ 8Gy(中位剂量 6.4Gy)。 结果　局部复发鼻咽癌经分次立体定向放射治疗后 ,1年生存率为 78.3 % (18/2 3 )、2年生存率为 69.6% (16/2 3 )。 3 9.1% (9/2 3 )的患者随访期内死亡 ,其中死于局部复发 1例 ,死于远处转移 5例 ,鼻咽大出血 3例。结论　分次立体定向放射治疗用于局部复发鼻咽癌的治疗是安全有效的 ,但单次剂量和总剂量值得进一步研究。     

69例局部复发鼻咽癌调强放疗疗效及预后分析

目的回顾性分析局部复发鼻咽癌调强放疗的疗效及影响预后的相关因素。方法 69例局部复发鼻咽癌患者均行调强放疗,再程放疗pGTV总剂量为49.5～77.4Gy(中位剂量为66Gy),每次分割剂量1.86～2.5Gy(中位2.1Gy)。48例接受1～6个周期以铂类为基础的化疗。结果全组患者的中位随访时间为20个月,截止末次随访日期,死亡24例(34.8%)。1、2年局部无进展生存率、无远处转移生存率及总生存率分别为92.9%、81.8%、81.8%和88.8%、65.5%、65.5%。单因素分析结果显示,首程放疗方式(P=0.004)和再程放疗总剂量(P=0.011)与生存期相关;多因素分析发现影响局部复发鼻咽癌的独立预后因素有首程放疗方式(P=0.004)和再程放疗总剂量(P=0.004)。放疗期间的急性毒副反应均可耐受。结论 IMRT是局部复发鼻咽癌的有效治疗手段,可提高患者的生存率。首程放疗方式和再程放疗总剂量是影响患者生存时间的独立预后因素。     

胆管支架联合3D—CRT治疗晚期肝门部胆管癌的疗效评价

目的：分析胆管支架置入术联合三维适形放疗（3D-CRT）对晚期肝门部胆管癌的临床疗效。方法：对25例肝门部晚期胆管癌行金属支架置入联合3D—CRT治疗（治疗组），分析肿瘤局部控制率、生存率，并与同期16例单纯支架治疗患者（对照组）进行对比研究。结果：两组患者支架置入术后胆红素均逐渐下降，治疗组获得了60．0％的肿瘤局部缓解率，中位生存期为14个月，对照组为7．5个月，两组生存率差异有显著性（P〈0．01）。结论：胆道支架置入联合3D—CRT明显提高了晚期肝门部胆管癌患者的生存率，是晚期肝门部胆管癌一种有效的治疗方法。     

放射治疗肺癌脑转移临床疗效观察

目的探讨不同放射治疗方法对肺癌脑转移的疗效.方法对65例肺癌脑转移患者进行放射治疗,分为全脑放疗(WBRT)组、三维适形放射治疗(3D-CRT)组和全脑放疗加三维适形放射治疗(WBRT+3D-CRT)组.WBRT组2～3 Gy/次,总剂量30～40 Gy/3～4周;3D-CRT组治疗单次靶区周边剂量3～8 Gy,总剂量40～60 Gy;WBRT+3D-CRT组,WBRT 2～3 Gy/次,总剂量30～40 Gy/3～4周,之后3D-CRT治疗单次靶区周边剂量3～8 Gy,总剂量16～32 Gy.结果三组病例局部控制率分别为42.3%、84.3%和85.0%,中位生存期分别为5,11,12.5个月.在死亡原因中,WBRT组死于脑转移比率为53.8%,较后两组高.结论对于肺癌脑转移,全脑放疗加三维适形放射治疗(WBRT+3D-CRT)组及单纯三维适形放射治疗(3D-CRT)组在肿瘤局部控制率及生存率方面均优于全脑放疗(WBRT)组.     

140例局部复发鼻咽癌患者三维适形放疗的疗效分析

背景与目的:局部复发鼻咽癌再次放疗的方式很多,但常规放疗后良反应大,目前关于三维适形放疗(three dimensional conformal radiation therapy,3D-CRT)治疗复发鼻咽癌的报道较少,本研究旨在分析3D-CRT对140例局部复发鼻咽癌患者的疗效及其不良反应.方法:本院于1997年5月-2009年6月对140例经病理活检和(或)通过CT/MRI证实颅底病变或颅神经症状进展而确诊为局部复发的鼻咽癌患者采用3D-CRT治疗.患者中位复发时间为27.5个月(1～156个月),50.7％患者的复发为T3-4期,患者3D-CRT治疗的最小计划放疗剂量是GTV-P为DT 59.4 Gy/1.8～2 Gy(联合或不联合化疗).结果:复发后中位照射剂量是62 Gy (39～82 Gy);中位随访时间25.5个月(3～135个月),随访率100％.3、5年的总生存率(overall survival,OS),无瘤生存率(disease-free survival,DFS),局部控制率(locoregional recurrence-free survival,LRRFS)分别为44.53％ vs 31％,42.82％ vs 29.13％,44.19％ vs 30.76％.48例患者(34.3％)出现中重度并发症,其中鼻咽溃疡13例(9.29％),颅神经损伤21例(15％),张口困难20例(14.3％),听力下降16例(11.4％).多因素分析显示年龄是独立的预后不良因素.结论:采用3D-CRT对局部复发鼻咽癌安全、有效,不良反应可以耐受.     

早期乳腺癌根治术后不同剂量分割方案的放射治疗

目的 探讨早期乳腺癌根治术后或改良根治术后不同剂量分割放射方案的疗效。方法 367例早期乳腺癌根治术后放疗患者,根据术后放射治疗的不同剂量分割方案分为3组;常规分割组149例,2Gy／次,每日1次,每周5次,总DT50Gy;隔日照射组177例,3Gy／次,每周3次,总DT45Gy;快速照射组41例,第1天和第3天DT5Gy／次,第15天和第17天DT6．5Gy／次,总DT23Gy。共有257例接受了化疗和(或)内分泌治疗。结果 全组5年总生存率和无病生存率分别为87．4％和89．6％。常规分割组、隔日照射组和快速照射组的5年无病生存率分别为90．8％、86．5％和84．6％(P=0．16);局部区域复发率分别为2．7％、2．8％和2．4％,差异无显著性。结论 隔日照射可取得和常规分割照射同样的疗效;快速照射缩短了疗程时间,其疗效和毒副作用值得进一步研究。     

立体定向放疗联合FOLFOX4化疗治疗无法手术的复发性直肠癌的近期疗效观察

目的探讨立体定向放疗联合FOLFOX4化疗治疗无法手术的复发性直肠癌的临床疗效。方法无法手术的复发性直肠癌48例接受立体定向放疗：既往未接受盆腔放疗病例，常规盆腔前后野或三野外照射DT40Gy，然后针对复发病灶行立体定向放疗总剂量DT56-66Gy（中位剂量60Gy）；曾接受盆腔放疗病例，直接针对复发病灶行立体定向放疗DT36～46Gy（中位剂量40Gy）。治疗组联合FOLFOX4方案化疗：其中接受全盆腔照射者，在放射治疗开始第1周和第5周予FOLFOX4化疗2周期；直接行适形放疗者，于放疗第1周和最后1周予FOLFOX4化疗2周期。放疗结束后2～3周开始序贯FOLFOX4化疗2～4周期（平均3．6周期）。记录两组症状缓解情况、近期疗效、远期疗效和毒副反应。结果治疗组和对照组疼痛缓解率分别为95．2（20／21）％和91．3％（21／23）（P〉0．05）；治疗组和对照组总有效率分别为56．5％和40．0％（P〉0．05）；1、2年生存率分别为86．9％、50．2％和80．0％、23．9％，中位生存期分别为25个月和16个月（P〈0．05）；2年远处转移率分别为39．1％和56．0％（P=0．054）。两组患者的毒副反应除外周神经毒性外无明显差异，毒副反应较轻，基本可以耐受。结论立体定向放疗联合FOLFOX4化疗治疗无法手术的复发性直肠癌安全可行，可望减少远处转移的发生和改善生存率。     

Ⅱ/Ⅲ期直肠癌术后辅助放疗

背景与目的：直肠癌是常见的肿瘤，手术是其主要的治疗方法，辅助放疗能提高Ⅱ／Ⅲ期直肠癌的局控率。但放疗剂量的增加是否能进一步提高局控率并对生存率有所改善尚不明确。本研究观察Ⅱ／Ⅲ期直肠癌根治术后辅助放疗的疗效，探讨是否存在肿瘤局控与剂量效应关系。方法：回顾性分析1993年7月至2001年12月间Ⅱ／Ⅲ期直肠癌接受术后放射治疗的病例74例。Ⅱ期32例，Ⅲ期42例。放射治疗常规分割1．8～2．0Gy／次，总剂量40—70Gy，中位剂量54Gy。全组中有62例患者接受了以氟尿嘧啶为基础的辅助化疗1～10疗程。应用SPSS11．5统计软件，Kaplan—Meier法进行生存分析。结果：全组中位随访时间44．6个月（7．3～119．9个月），全组5年生存率和无瘤生存率分别为58％和60％。局部复发14例，远处转移17例。将全组按剂量分为≤50Gy，51-60Gy，〉60Gy3组，5年局控率分别为92％，71％和87％（P=0．9194）；5年生存率分别为68％，62％和53％（P=0．4194），3组间未显示有统计学差异。共有5例因并发症而死亡，接受的放疗剂量均大于50Gy。结论：Ⅱ、Ⅲ直肠癌根治术后辅助放疗未显示有剂量效应，剂量增加未提高局控率和生存率。常规分割放疔时以50Gy为宜，过高的剂量有增加并发症发牛的危险。     

肺癌脑转移不同放射治疗方法的疗效分析

［目的］探讨不同放射治疗方法对肺癌脑转移的疗效。［方法］１７６例有病理学证实的肺癌脑转移患者分为４组：单纯全脑放疗组(WBRT)、全脑放疗加立体定向放射外科(WBRT＋SRS)，单纯立体定向放射治疗(SRT)，全脑放疗加立体定向放射治疗(WBRT＋SRT)。SRS治疗组，单次靶区平均周边剂量８Gy～２０Gy，总剂量２０Gy～３２Gy；SRT治疗组，单次靶区平均周边剂量２Gy～５Gy，总剂量２５Gy～６０Gy；WBRT组，１．８Gy～２Gy／次，总剂量３０Gy～４０Gy。［结果］４组的局部控制率分别为４７．１％、８７．７％、８６．５％、７８％；中位生存期分别为５．０、１１．０、１１．５、１０．０个月；局部无进展生存期分别为３．３３、８．３３、９．３３、７．６７个月；颅脑无新病灶生存期分别为４．１１、８．５７、９．０３、６．１２个月。单纯全脑放疗组死于脑转移的占５７．６％，较其他３组高。而全脑放疗加立体定向放射外科组的晚期放射反应的发生率为１２．２％，较其它组高。［结论］肺癌单发脑转移瘤患者的最佳治疗方式是单纯立体定向放射治疗。多发脑转移，全脑放疗加立体定向放射治疗(WBRT＋SRT)在提高生存率以及减少并发症方面优于其他治疗方法。     

Limitations of conventional doses of chemoradiation for unresectable biliary cancer

PURPOSE: To determine, in a retrospective review, the limitations of definitive chemoradiation in the treatment of patients with unresectable extrahepatic cholangiocarcinoma and generate testable hypotheses for future prospective clinical trials. METHODS AND MATERIALS: Between 1957 and 2000, 52 patients with localized, unresectable cholangiocarcinoma were treated with radiotherapy (RT) with or without concurrent chemotherapy. Unresectable disease was defined, by evidence on imaging studies or at surgical exploration, as localized tumor abutting or involving the main portal vein, tumor involvement of secondary biliary radicals, or evidence of nodal metastases. Patients were grouped according to the RT dose: 27 patients received a total dose of 30 Gy (Group 1), 14 patients received 36-50.4 Gy (Group 2), and 11 patients received 54-85 Gy (Group 3). 192Ir intracavitary boosts (median 20 Gy) were delivered in 3 patients, and an intraoperative boost (20 Gy) was used in 1 patient. Of the 52 patients, 38 (73%) received concomitant protracted venous infusion of 5-fluorouracil (200-300 mg/m2 daily, Monday through Friday). Kaplan-Meier analysis was used to calculate the actuarial 1-year and median overall survival (OS), radiographic local progression, symptomatic progression, and distant failure. Treatment-related variables and prognostic factors were evaluated using the log-rank test. RESULTS: The first site of disease progression was local in 72% of cases. The actuarial local progression rate at 12 months for all patients was 59%. The median time to radiographic local progression was 9, 11, and 15 months in Groups 1, 2, and 3, respectively (p = 0.48). Fifteen percent of all patients developed metastatic disease (1-year OS rate 18%). The median survival rate for all patients was 10 months (1-year OS rate 44%). The RT dose, use of concurrent chemotherapy, histologic grade, initial extent of liver involvement, and extent of vascular involvement had no influence on radiographic local progression or OS. Grade 3 or greater toxicity was similar in all dose groups (22% vs. 14% vs. 27%, p = 0.718). CONCLUSION: The primary limitation of definitive chemoradiation was local progression. Although the small patient numbers limited the statistical power of this study, a suggestion of improved local control was found with the use of higher RT doses. To address this pattern of failure, future prospective investigation using high-dose conformal RT with novel cytotoxic and/or biologic agents with radiosensitizing properties is warranted.     

Radiation dose considerations in the palliative treatment of locally advanced adenocarcinoma of the pancreas

Treatment of locally advanced pancreatic cancer with high-dose radiotherapy has not been curative, and can be difficult to tolerate. We decided to compare retrospectively the outcomes of patients treated concurrently with 5-fluorouracil and either 30 Gy or more than 30 Gy of radiation. From December 1993 through May 2001, 107 patients with locally advanced adenocarcinoma of the pancreas had been treated with palliative chemoradiation. Eighty-six patients had received a prescribed dose of 30 Gy and 50.4 Gy had been prescribed in 18 patients. Two of these patients were unable to complete the full dose of radiotherapy due to toxicity, and 3 received intraoperative radiotherapy boost (20 Gy). Three additional patients received a prescribed dose of 33 Gy, 36 Gy, and 52.2 Gy, respectively. These patients were grouped together (n = 21, median 50.4 Gy). All patients had received concurrent protracted venous infusions of 5-fluorouracil (300 mg/m Monday through Friday). The median survival time was not affected significantly by a higher radiotherapy dose (8 months for the 30 Gy group versus 9 months for the group receiving higher doses; P = 0.64). The 6-month actuarial progression rates were 45% versus 50% (P = 0.90) for local disease progression, and 54% versus 50% (P = 0.94) for distant metastasis for the 30 Gy and the higher dose groups, respectively. Ten of the 86 patients (12%) who had received 30 Gy were hospitalized for treatment-related gastrointestinal toxicity (grade 3) versus 6 of the 21 (29%) patients given higher doses (P = 0.05). Compared with higher doses given over 5 to 6 weeks, chemoradiation (30 Gy in 10 fractions in 2 weeks with concurrent infusional 5-FU) results in a similar median survival, and local disease progression rates in patients with locally advanced pancreatic cancer apparently do not substantially improve local disease control or median survival time. Because higher doses of radiotherapy can lead to increased acute treatment-related morbidity, we recommend using 30 Gy in 10 fractions unless the patient is part of a prospective study evaluating novel biologic or cytotoxic radiosensitizers.     

改良三维适形放疗治疗巨块型局部晚期非小细胞肺癌的临床观察

 目的　探讨改良的三维适形放疗（3D-CRT）计划对巨块型非小细胞肺癌（NSCLC）的靶区剂量的影响,并观察近期及远期疗效和毒副作用。方法　回顾性分析临床确诊为局部晚期NSCLC的81例患者临床资料;肿瘤直径均≥5 cm;鳞状细胞癌52例,腺癌24例,腺鳞癌5例;ⅢA 63例,ⅢB 18例;分为改良前3D-CRT组（简称T1模式组）39例和改良后3D-CRT组（简称T2模式组）42例。T1模式组接受放化疗综合治疗者31例（79.5 %）,放疗剂量2 Gy／次,26～30次,总剂量52～60 Gy;T2模式组接受放化疗综合治疗者31例（73.8 %）,放疗剂量2 Gy／次,30～35次,总剂量60～70 Gy。结果　T1模式组患者的1、2、3年总生存率分别为56.4 %、33.3 %、28.4 %,1、2、3年局部控制率分别为38.4 %、28.2 %、20.5 %,中位生存期为17个月;T2模式组患者的1、2、3年总生存率分别为61.9 %、35.7 %、28.5 %,1、2、3年局部控制率分别为47.6 %、40.4 %、30.9 %,中位生存期19个月;两组之间局部控制率差异有统计学意义（P＜0.05）,总生存率及中位生存期差异无统计学意义（P＞0.05）。结论　改良后的3D-CRT技术能够提高巨块型局部晚期NSCLC患者的局部控制率及生存质量,患者1年生存率有提高,远期生存率无提高。     

Three-dimensional conformal radiotherapy versus intracavitary brachytherapy for salvage treatment of locally persistent nasopharyngeal carcinoma

PURPOSE: To compare the outcomes of three-dimensional conformal radiotherapy (3D-CRT) and intracavitary brachytherapy (ICBT) as salvage treatment for locally persistent nasopharyngeal carcinoma. METHODS AND MATERIALS: Between March 1994 and November 2001, a total of 117 patients with locally persistent nasopharyngeal carcinoma received salvage treatment for 2-8 weeks (median, 4 weeks) after a full course of conventional external beam RT. Of the 117 patients, 54 were salvaged with 3D-CRT (3D group) and 63 with ICBT (BT group). No statistically significant differences were found in the patient characteristics between the two groups (p >0.05). In the 3D group, the planning target volume for 3D-CRT was defined as the persistent disease plus a 5-mm margin; three to seven static conformal coplanar or noncoplanar portals were delivered for each fraction. The median salvage dose was 24 Gy (range, 18-38 Gy), with fraction size of 2.0 Gy/d. In the BT group, a median salvage dose of 20 Gy (range, 15-30 Gy) was delivered with a (192)Ir source, at 5 Gy/fraction, twice weekly. The brachytherapy dose was prescribed at a distance of 1 cm from the center of the surface as defined by the sources, irrespective of the extent of persistent disease. The actuarial rates of survival were estimated using the Kaplan-Meier method. Potential differences in the actuarial outcomes between groups were evaluated using the Mantel log-rank test. Multivariate analyses were performed with the Cox regression proportional hazards model. RESULTS: The 5-year actuarial rates of overall survival, disease-specific survival, and local failure-free survival for the 3D group and BT group were 64.50% vs. 55.78% (p = 0.33), 70.03% vs. 59.56% (p = 0.11), and 88.93% vs. 76.28% (p = 0.07), respectively. Subgroup analysis showed that the 5-year actuarial local failure-free survival rate of patients with initially diagnosed T3-T4 disease for the 3D group and BT group was 84.01% vs. 60.50% (p = 0.03). The incidence of Grade 3-4 late complications was comparable between the two groups. Multivariate analyses performed in the whole group showed that T stage at initial diagnosis and the salvage technique (3D-CRT or ICBT) were the statistically significant, independent prognostic factors for local failure-free survival (p = 0.00 and p = 0.02, respectively). CONCLUSION: 3D-CRT seemed to provide better local control than ICBT as a salvage treatment for locally persistent nasopharyngeal carcinoma, especially in patients with initially diagnosed T3-T4 disease. CT/MRI evaluation of the extent of persistent disease is recommended for technique selection of salvage RT. Patients should be cautioned about the potentially increased complications. The optional time for salvage treatment remains controversial.     

后程X-刀治疗DP方案化疗后无进展局部晚期非小细胞肺癌的疗效

目的探讨序贯后程X刀治疗多烯紫杉醇加顺铂(DP方案)4周期化疗后无进展局部晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)的疗效及不良反应。方法57例4周期DP方案化疗后无进展患者随机分为两组,常规组行常规分割照射,2Gy/次、1次/日,5次/周,总量64Gy;后程X刀组前四周治疗同常规组,4周后改用X刀,6Gy/次,3次/周,共6次,总量76Gy。比较两组的疗效及副作用。结果后程X刀组完全缓解率38.7%,高于常规组15.4%(P=0.047),后程X刀组三年生存率35.5%高于常规组15.4%(P=0.035),两组不良反应差异均无显著性。结论与常规放射治疗相比,序贯后程X刀治疗可提高化疗后无进展局部晚期NSCLC患者的完全缓解率及三年生存率,不良反应未增加,可作为化疗后无进展NSCLC患者的主要治疗手段。     

Study of local three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for patients with stage III hepatocellular carcinoma

The purpose of this study was to evaluate treatment-related toxicity, outcome, patterns of failure, and prognostic factors for patients with stage III unresectable hepatocellular carcinoma (HCC) treated with a combination of local 3-dimensional conformal radiotherapy (3D-CRT) and transcatheter arterial chemoembolization (TACE) under the support of G-CSF. From October 1997 to August 2001, 45 patients with stage III unresectable hepatocellular carcinoma underwent transcatheter arterial chemoembolization with local 3D-CRT. Twenty-seven patients were classified as having stage IIIA disease according to the American Joint Committee on Cancer (AJCC) staging system and 18 were classified as stage IIIB. The mean diameter of the treated hepatic tumor was 8.5 cm. Before 3D-CRT, 2 cycles of transcatheter arterial chemoembolization were prescribed. Forty-eight hours later, the G-CSF was prescribed for 5 days after the completion of every TACE. With the interval of 10 to 14 days after the second cycle of TACE, 3D-CRT was prescribed to all patients with a total dose of 50.4 Gy at 1.8 Gy per fraction 5 days per week. After the completion of 3D-CRT, the additional 2 cycles of TACE were given. All patients were monitored for treatment-related toxicity, outcome, patterns of failure, causes of death, and prognostic factors. Forty-two of 45 patients were treated smoothly with the primary schedule. In a median follow-up period of 27 months, 22 patients were alive and 23 were dead. Progressive disease occurred in 28 patients, including local recurrence alone (4 patients), distant metastases with local recurrence (8 patients), and distant metastases alone (16 patients). Nine patients developed radiation-induced liver disease (RILD). Three patients had treatment-related gastrointestinal bleeding. There were 2 treatment-related deaths, including 1 from RILD and 1 from gastrointestinal bleeding. Complete regression (CR) was observed in 6 patients, partial regression (PR) in 35 patients, and stable disease (SD) in 4 patients. The median overall survival duration from treatment was 23.5 months with a 1-year overall survival rate of 68.5%, a 2-year survival rate of 48.3%, and a 3-year survival rate of 22.6%. The median freedom from progressive disease survival duration from treatment was 25 months with 1-year, 2-year, and 3-year progression-free survival rates of 76.2%, 56.8%, and 42.4%, respectively. The stage of HCC, regional lymph node status, portal vein thrombosis, pretreatment alpha-fetoprotein level (AFP), and tumor size affected the treatment outcomes significantly. Therefore, for patients with stage III unresectable hepatocellular carcinoma, combined local 3D conformal radiotherapy with transcatheter arterial chemoembolization under the support of G-CSF is an effective treatment protocol. Further research is required to decrease distant metastases and to determine the safe irradiation dose-volume.     

介入化疗加三维适形放疗治疗胰腺癌的疗效

目的:观察手术不能切除的晚期胰腺癌动脉灌注化疗(TAC)结合三维适形放疗(3D-CRT)的疗效。方法:32例病人先行TAC治疗1～3次,化疗药物为健择1600mg～1800mg,顺铂80mg～100mg。TAC后1～2周行3-DCRT,单次量为2.0Gy,1次/天,肿瘤量55～60Gy。结果:CR1例、PR12例、NC4例、PD4例,有效率(CR PR)为40.6%;1、2年生存率分别为46.87%(15/32)、28.1%(9/32);患者疼痛完全缓解29例,缓解率90.6%(29/32)。结论:对不能切除的胰腺癌行3DCRT与动脉灌注化疗结合是治疗局部进展期胰腺癌的一种有效方法。     

Treatment of portal vein tumor thrombosis of hepatoma patients with either stereotactic radiotherapy or three-dimensional conformal radiotherapy

BACKGROUND: Patients with hepatocellular carcinoma (HCC) often have unresectable tumors. Transcatheter arterial chemoembolization (TACE) is one of the limited alternative treatments that can prolong these patients' survival. However, the presence of portal vein tumor thrombosis (PVTT) is a contraindication for TACE and, therefore, HCC patients with PVTT would be depleted of the advantage of TACE. The purpose of this study was to analyze the recanalization rate of thrombosed portal vein and treatment toxicities after stereotactic radiotherapy (SRT) or three-dimensional conformal radiotherapy (3DCRT). METHODS: From March 2002 to November 2004, 43 patients were enrolled in this prospective study. Twenty-two patients were in the SRT group and 21 in the 3DCRT group. For SRT, 3 Gy per fraction, 3 fractions per week, was given to a total dose of 45 Gy. For 3DCRT, a daily dose of 1.8 Gy, 5 fractions per week, was given to a total dose of 45 Gy. RESULTS: Of the 43 patients, 16 completed the planned radiotherapy. Eventually, 14 patients received evaluation for portal vein recanalization, 8 in the SRT and 6 in the 3DCRT group, respectively. For all patients, the crude response rate was 26%. For 14 evaluable patients, the crude response rate was 79%. It was 75% in the SRT group and 83% in the 3DCRT group (P = 0.71). The median survival time was 6.0 and 6.7 months for the SRT and 3DCRT group, respectively (P = 0.911). CONCLUSIONS: Image-based radiotherapy, either SRT or 3DCRT, can recanalize the PVTT in unresectable HCC patients. Responders also had better 1 year and 2 year survivals. A more strict patient selection criterion may maximize the potential benefits of radiotherapy for hepatoma patients with PVTT.     

中晚期胰腺癌三维适形放疗辅助高强度聚焦超声的临床观察

目的观察高强度聚焦超声（HIFU）与三维适形放疗（3D-CRT）联合治疗中晚期胰腺癌的近期疗效及价值。方法 48例中晚期胰腺癌患者（Karnofsky评分60~85分）随机分为两组,每组24例,A组行HIFU＋3D-CRT;B组单纯放疗。两组均采用三维适形放疗,常规分割（2.0 Gy/次,每周5次）,DT40~50 Gy/20~25 Fx。A组患者均予4~8次高强度聚焦超声治疗。结果 A组近期有效率37.5%,B组20.8%,A组临床受益率52.2%,B组为21.7%。两组比较差异有显著性（P〈0.05）。主要毒性反应为白细胞减少和红细胞减少。结论 HIFU＋3D-CRT联合治疗中晚期胰腺癌有较好的疗效,且耐受性较好。     

放疗加化疗治疗直肠癌术后复发58例临床观察

目的探讨后程适形放疗加化疗治疗术后复发直肠癌的疗效.方法 58例术后复发直肠癌随机分为后程适形放疗加化疗组（适形组）29例,普放加化疗组（对照组）29例.前程采用三野等中心照射40GY,后予适形推量至65～70GY,对照组后程用两斜野照射推量至DT55～60GY,两组均于放疗第一周予FP方案（5-Fu 500mg/m2 d1～5;DDP 30mg/m2 d1～3）化疗一周期,放疗结束后再化疗3～5周期.结果适形组和对照组3年局部控制率分别为65.5%、48.3%（P〈0.05）,适形组和对照组1、3年生存率分别为89.3%、58.6%和82.8%、41.3%（P〈0.05）,中位生存时间分别为30和21个月.毒副反应两组无统计学差异,患者均可耐受.结论后程适形放疗加化疗治疗术后复发直肠癌有较好疗效,毒副反应可耐受,值得推广使用.