MR加速器在肺癌放疗中的应用及基本应用流程北大核心CSCD

放疗是肿瘤治疗的重要手段之一。图像引导放疗是目前实现肿瘤精准放疗的主流技术。MR加速器能在放疗过程中对肿瘤进行MRI, 实现肿瘤的实时追踪与监控, 完成MR引导的自适应放疗。本文将综述MR加速器在肺癌中的相关研究与应用。     

复发头颈部癌再程放疗研究

近50%的头颈部癌病例在接受首程放疗后会出现放射野内复发。挽救性手术是首选的治疗手段。临床研究表明复发头颈部癌接受挽救性手术+术后再程放疗或者再程放疗 ±化疗或靶向药物治疗后能使一小部分病例获益,得到肿瘤控制和长期生存。但总体疗效不尽如人意,且伴发严重的急性和晚期,甚至致死性的治疗相关不良反应。因此要求在实施再程放疗时需要充分考虑复发肿瘤情况、首次放疗相关因素和病人自身状态。随着放疗技术和综合治疗模式的发展,包括质子和重离子以及免疫治疗的临床应用,为提高复发头颈部癌治疗疗效,降低治疗相关不良反应提供了可能性。     

头颈部肿瘤放射治疗新进展

临床肿瘤放射治疗进展 晚期头颈部肿瘤目前治疗上仍然存在着局部控制率低,疗后局部复发率高的缺点,因此如何进一步提高晚期头颈部肿瘤的局部控制率就成为改善预后的关键因素。通过超分割或加速分割技术,或通过化学治疗与放射治疗的配合,以及一些放疗新技术、新方法的应用,可望克服常规分割放疗的缺陷,从而相应改进头颈部肿瘤常规分割放疗的局部控制率。１　　非常规分割照射的研究 主要分为以下几种：（１）加速分割,治疗总时间中度缩短至３３～４０天,而总剂量不变;（２）加速超分割,治疗总时间缩短至１７～３３天,但总剂量相应…     

头颈部恶性肿瘤的质子、重离子治疗实践

放疗在头颈部肿瘤治疗中占重要地位,但因头颈部集中了人体许多重要功能,放疗可能导致严重后遗症。质子、重离子治疗具有优于常规光子射线放射物理学和生物学特性,有利于肿瘤控制和正常组织保护。质子、重离子技术已在头颈部软组织肿瘤(尤其颅底脊索瘤、软骨肉瘤)、恶性黑色素瘤、腺样囊性癌等常规光子抵抗肿瘤中显出优势,在复发性肿瘤再程放疗中的安全性也得到了验证。     

影像组学在头颈部肿瘤放疗的研究进展

头颈部肿瘤具有复杂的解剖和高度的异质性,放疗是主要的治疗手段之一,治疗策略和预后评估往往依据TNM分期,缺乏个体化的参考信息。影像组学高通量的提取与肿瘤生物学有关的图像特征,用于无创定量评价整体肿瘤的异质性,为实现精准放疗开拓了新的途径。本文将介绍影像组学近年来在头颈部肿瘤放疗的应用和挑战。     

基于MR引导放疗系统肺癌SBRT初步临床应用

目的:初步观察MR引导下非小细胞肺癌体部立体定向放疗(SBRT)的可行性,并对有无磁场环境下剂量学差异进行分析。方法:前瞻性的入组3例SBRT的非小细胞肺癌患者,均应用MR引导加速器放疗。治疗计划分别应用有磁场模型和无磁场模型进行优化和剂量计算,同时在常规加速器进行患者备用计划的制备。比较有无磁场模型剂量的分布差异。同...     

康复新防治头颈部肿瘤同步放化疗引起的口腔黏膜炎

 目的　观察康复新对头颈部肿瘤放化疗期间口腔黏膜的保护作用,以提高放疗的远期疗效。方法　78例患者在接受直线加速器3D常规分割剂量照射时,同期应用氟尿嘧啶缓慢静脉滴注。放疗期间治疗组及对照组分别漱口后口服康复新口服液及蒙脱石散（思密达）悬浊液,2次／d,并对口腔黏膜进行观察及记录损伤分级。结果　治疗组口腔黏膜炎发生率94.87 %,对照组发生率为100.00 %。口腔黏膜炎大部分发生于放疗第3周至第4周,第5周后发生难免性口腔黏膜炎,但对照组发生时间明显早于治疗组,同时,治疗组口腔黏膜炎大部分为1～2级。结论　康复新能很好防治头颈部肿瘤放化疗引起的口腔黏膜炎,降低口腔黏膜炎级别,提高治疗依从性,并未见严重不良反应。     

中药参芪放后方防治头颈部肿瘤放射毒副反应疗效观察

目的观察中药参芪放后方在防治头颈部肿瘤放射反应及放射毒副反应方面的功效.方法将83例头颈部肿瘤(鼻咽癌、扁桃体癌、舌癌)随机分为中药加放疗组(观察组,42例)和单纯放疗组(对照组,41例).观察组在放疗期间结合服用参芪放后方加减.观察两组患者放疗过程中放射反应及放射毒副反应情况.结果观察组在放疗期间口咽黏膜反应、口干程度、颈部放射性皮炎程度均较轻,晚期放射后遗症如张口度较好,颈部肌肉硬化程度较轻,与对照组对比,差异有显著性(P<0.05).结论参芪放后方有防治头颈部肿瘤放射反应及放射毒副反应的功效.     

MR加速器在乳腺癌放疗中的临床应用北大核心CSCD

目的介绍MR加速器应用于乳腺癌术前放疗的应用流程和注意事项, 并报告不良反应。方法中国医学科学院肿瘤医院拟开展一项单臂、Ⅱ期临床研究, 入组患者实施MR加速器下术前瘤床补量, 2周内进行保乳手术, 术后6周内接受辅助全乳照射, 研究终点为≥2级急性不良反应。首例应用MR加速器术前放疗乳腺癌患者43岁, 为右乳外象限浸润性癌, cT_(2)N_(0)M_(0)期, AJCC第8版ⅡA期。患者接受CT和MR定位、MR指导下靶区勾画、Monaco系统计划设计, MR加速器下摆位并基于位移适应调整, 单次8 Gy照射。患者的剂量计算考虑了1.5 T磁场存在下的电子回旋效应(ERE)及电子束效应(ESE)。结果首例患者治疗顺利, 计划的正常器官满足限量要求, 因ERE及ESE导致的皮肤剂量增加幅度不大(D_(max) 8.44 Gy), 下颌及右上臂受量均很低(D_(max) 28.5、17.8 cGy), 无>1级急性不良反应。患者放疗后第7天接受保乳术, 未出现严重手术并发症, 伤口愈合及时。结论 1.5 T磁场对皮肤、下颌和手臂的剂量影响较小, 放疗及放疗后手术均无明显并发症增加。MR加速器下乳腺癌的放疗尚需更大样本的经验积累, 以不断优化治疗流程。     

MR加速器在肝脏肿瘤放疗中的临床应用北大核心CSCD

目的初步探讨MR加速器在肝脏肿瘤中的应用流程、疗效及安全性。方法回顾性分析2019—2021年15例采用MR加速器治疗的肝脏肿瘤患者的临床数据, 探讨肝脏肿瘤采用MR加速器治疗的流程, 分析患者肿瘤的图像识别率、疗效及不良反应。结果全组15例患者中肝细胞癌6例、结直肠癌肝转移8例、乳腺癌肝转移1例;肝内1个病灶10例、2个病灶4例、3个病灶1例;中位肿瘤最长径2.4 cm (0.8~9.8 cm)。MR加速器大体肿瘤体积(GTV)识别率达13/15, 2例患者GTV显示不清, 采用肿瘤周边大血管或胆管识别辅助仍可达精准配准。全组患者均接受体部立体定向放疗。肝细胞癌患者中位分割次数9次(5~10次), GTV或计划靶体积(PGTV)中位单次剂量6 Gy (5~10 Gy), 中位总剂量52 Gy (50~54 Gy), α/β=10的中位2 Gy等效剂量(EQD2Gy)为72 Gy (62.5~83.3 Gy)。肝转移瘤患者中位分割次数10次(5~10次), GTV或PGTV的中位单次剂量5 Gy (5~10 Gy), 中位总剂量50 Gy (40~50 Gy), α/β=5的中位EQD2Gy为71.4 Gy (71.4~107.1 Gy)。放疗后1个月野内总有效率8/13, 疾病控制率13/13, 放疗后3~6个月野内总有效率6/6。全组患者中位随访4.0个月(0.3~11.6个月), 4个月局部无进展生存、无进展生存和总生存分别为15/15、11/15和15/15。放疗不良反应轻微, 未见≥3级不良反应。结论 MR加速器对肝内肿瘤显示率高, 且可通过周边大血管或胆管的显示辅助精准配准, 在肝脏肿瘤的精准治疗上初步展现优势, 局部疗效肯定, 耐受性好。     

微生物在放射性口腔黏膜炎中作用的研究进展

放射性口腔黏膜炎(ROM)是头颈部肿瘤放疗后最常见不良反应之一。ROM会引起患者口腔疼痛、进食困难、营养不良,甚至导致治疗中断。近年来,口腔微生物在ROM中作用逐渐受到重视。故针对ROM临床表现、发病机制,及微生物在ROM中的研究进展、机制通路和益生菌治疗进行综述。     

头颈部肿瘤放疗者营养与支持治疗专家共识

放疗是头颈部肿瘤最常用的治疗手段。恶性肿瘤本身代谢异常及治疗过程中伴随的急性和晚期毒性等极易导致患者发生营养不良,其发生率高达44%~88%,其中重度营养不良的发生率为20%~40%。患者一旦发生营养不良,其治疗耐受性和敏感性会降低,治疗并发症会进一步增高,从而延长住院时间增加治疗费用,最终影响患者疗效。因此,营养与支持治疗是头颈肿瘤患者治疗的重要组成部分。为了使这部分患者得到合理、有效的营养与支持治疗,根据我国目前的肿瘤放疗和肿瘤营养治疗现状,参考国内外相关指南,制定适合我国情况的头颈部肿瘤放疗患者营养与支持治疗专家共识非常必要。     

放射性口腔黏膜炎防治策略专家共识(2019)

放射性口腔黏膜炎(RTOM)是放疗导致的口腔黏膜炎症,是头颈部肿瘤患者放疗中最常见的并发症,重度RTOM可导致治疗中断,影响疗效。近年来,针对RTOM的防治研究不断有报道,但国内尚缺乏规范和指南。本共识参考国外相关临床实践指南,对国内外RTOM的防治药物和方法进行回顾、总结,为RTOM的预防与治疗提供推荐和建议。     

Radiothérapie postopératoire avec cétuximab pour les carcinomes épidermoïdes de la tête et du cou à haut risque de récidive non éligibles au cisplatine : expérience d’un centre et revue de la littérature

PurposeThe use of concurrent cetuximab with postoperative radiotherapy for patients with head and neck cancer has been scarcely discussed in the literature. The main aim of this study was to report clinical outcomes of high-risk head and neck cancer patients treated by postoperative radiotherapy with cetuximab.Patients and methodsBetween January 2013 and December 2016, all medical records of patients operated for head and neck cancer who underwent postoperative radiochemotherapy were retrospectively analyzed. Patients who received cisplatin were excluded; only patients who received cetuximab were included in the analysis.ResultsAmong 52 patients with head and neck cancer treated with postoperative radiochemotherapy, 18 patients received cetuximab potentiation due to ineligibility for cisplatin. Median overall survival (OS) and progression-free survival (PFS) were 23 and 19,5 months and 3-year OS and PFS were 30,5% and 25,9%, respectively. There was a 22% treatment discontinuation rate.ConclusionIn our single-center retrospective analysis, postoperative radiotherapy with cetuximab for patients with high-risk head and neck cancer ineligible for cisplatin showed similar outcomes to the literature data for exclusive postoperative radiotherapy, with a high discontinuation rate. These low-power data support the lack of indication for cetuximab in combination with postoperative radiotherapy.     

Évaluation d’un score prédictif de dénutrition chez les patients pris en charge par irradiation pour un cancer des voies aérodigestives supérieures : étude rétrospective chez 127 patients

PurposeThe purpose of this study was to establish a pre-therapeutic score that could predict which patients would be at high risk of enteral tube feeding during (chemo)-radiotherapy for head and neck cancer.Patients and methodsA monocentric study was conducted retrospectively on patients receiving a radiotherapy or concurrent chemoradiotherapy for a head and neck cancer. A logistic model was performed in order to assess clinical or therapeutic risk factors for required artificial nutrition during treatment. Significant parameters, issued from multivariate analysis, were summed and weighted in a score aiming at estimating a malnutrition risk during radiotherapy.ResultsAmong the 127 evaluated patients, 59 patients required artificial nutrition during radiotherapy. In multivariate analysis, predictive factors for malnutrition were weight loss superior to 5% in the 3 months before radiotherapy, advanced tumor stage (III–IV vs. I–II), and pain requiring strong analgesics (step II–III vs. I). Concurrent chemotherapy was identified as a significant risk factor also, but it was strongly correlated with the tumor stage. The score, estimated from these previous factors, allowed a prediction of a risk of enteral feeding with a sensitivity of 90% and a specificity of 85%.ConclusionA predictive score of enteral nutrition before radiotherapy of head and neck cancer should be a useful clinical tool to target the patients who would need a prophylactic gastrostomy. Our study evidenced some risk factors of malnutrition requiring artificial feeding. However, we need a prospective study to confirm the validity of this score.     

放射性口腔黏膜炎影响因素研究进展

放射性口腔黏膜炎(RIOM)是头颈癌放疗患者常见的不良反应,RIOM不仅显著影响患者口腔功能,还影响近远期生活质量,重者可降低肿瘤控制率从而影响患者生存期。关于放射性口腔黏膜炎影响因素的研究较多,部分研究结论并不一致,本文综合近年来关于RIOM影响因素的研究进展,为RIOM的预防和管理提供依据。     

头颈肿瘤功能性颈淋巴结清扫术的适应证及临床根治效果

背景与目的：功能性颈淋巴结清扫术自1967年Bocca提出后,在头颈外科临床中已被推广应用,但对其临床应用适应证及其临床根治效果,国内外头颈外科专家特有不同观点,本研究旨在探索功能性颈淋巴结清扫术临床应用适应证和临床根治效果。方法：对152例次功能性颈淋巴结清扫术病例,利用手术标本病理检查及随诊资料进行分析讨论。结果：152例次功能性颈清扫术,舌鳞癌20例次,喉鳞癌23例次,甲状腺乳头状癌96例次,滤泡状腺癌9例次,髓样癌4例次,舌,喉鳞癌N0,N1,N2病例术后5年复发率分别为12．5％,14．3％,40．0％和20％,16．7％,50．0％,甲状腺乳头状腺癌N1a,N1b病例术后5年复发率分别为：6．5％,7．1％。结论：功能性颈淋巴结清扫术适用于较早期及低度恶性的头颈肿瘤手术治疗,且可获得良好的临床根治效果。     

Research progress on influencing factors of radiation-induced oral mucositis

Radiation-induced oral mucositis (RIOM) is a common toxicity in patients receiving radiotherapy for head and neck cancer. RIOM not only significantly affects the oral function of patients, but also affects the short-term and long-term quality of life. In severe cases, it can reduce the tumor control rate and thus impact the survival of patients. The influencing factors of RIOM has been intensively studied, whereas the conclusions of some studies are inconsistent. In this article, the research progresses on the influencing factors of RIOM in recent years were summarized, aiming to provide the basis for the prevention and management of RIOM.     

Clinical application of intensity-modulated radiotherapy for head and neck cancer

Intensity-modulated radiotherapy (IMRT) is a modern treatment technique that allows one to shape the dose to the target volume and to reduce the dose delivered to healthy tissue. Over the last decade, IMRT has been implemented for head and neck cancer treatment, with the aim of reducing the dose delivered to the parotid glands and improving the dose coverage of complex target volumes located close to critical structures. The potential benefits of IMRT in terms of salivary function preservation and better local control have contributed to the rapid diffusion of this new technology. However, it should not be overlooked that IMRT is a novel treatment technique and that its clinical application represents a paradigm shift in the practice of radiation oncology. The purpose of this article is to review the clinical experience with IMRT for head and neck cancer treatment and to discuss some important issues related to its implementation.