放射治疗骨转移癌患者生活质量的影响

骨转移癌的主要症状是顽固性骨疼痛难以缓解，长期应用止痛药易引起严重的不良反应，导致癌症患者生活质量明显下降。放射治疗骨转移癌目的就是控制肿瘤对骨的破坏，从根本上消除或减轻骨疼痛，减少对止痛药的依赖和需要量，提高患者的生存质量。我院于1999年6月至2000年8月对40例骨转移癌进行局部放疗，观察其止痛疗效及对患者生活质量的影响情况，现报道如下。     

89Sr治疗老年患者前列腺癌骨转移骨痛的临床观察

目的 评价89^SrCl2对老年患者前列腺癌骨转移伴骨痛的临床疗效及不良反应.方法 对外科去势治疗术后的老年患者前列腺癌骨转移伴有不同程度骨痛患者48例,使用89^SrCl2静脉注射治疗,观察其镇痛效果、骨转移灶的变化、前列腺特异性抗原（PSA）及不良反应等.结果 48例患者接受89^Sr治疗后,止痛的总有效率达89.6%,无效10.4%,骨转移灶有明显减少.对PSA有不同程度的下降.所有治疗者均未发现严重的不良反应和毒副作用.结论 89^SrCl2对去势治疗术后的老年患者前列腺癌骨转移骨痛的临床止痛疗效明显,特别是对多发骨转移癌伴骨痛患者是一种有效的治疗方法.     

原发性肝癌骨转移患者预后相关影响因素分析

 目的 分析原发性肝癌(primary hepatic carcinoma,PHC)骨转移患者预后相关影响因素。方法 回顾性分析福建省立医院收治的112例PHC骨转移患者行外照射治疗的临床效果,对PHC骨转移的疼痛进行分级,分别记录1、2、3年生存率,及放疗后疼痛改善情况,对性别、骨转移病灶、肝内病灶、骨转移时AFP水平、r-GT水平、骨转移是否伴有骨旁软组织或其他脏器转移,以及肝内灶是否手术治疗和肝内灶控制情况等影响PHC骨转移患者远期生存率的相关因素进行分析。运用Kaplan-Meier法进行生存分析,单因素分析采用Logrank法,多因素分析采用Cox回归模型。结果 112例PHC骨转移部位多见于腰椎(25.89%)、骶髂骨(19.64%)和胸肋骨(17.86%);肝癌确诊后3年生存率为15.18%,骨转移确诊后3年生存率为9.82%;肝内病灶数量、骨转移诊断时r-GT水平、骨转移是否伴其他脏器(组织)转移、肝内灶是否行手术治疗以及肝内病灶控制情况均为影响PHC骨转移患者3年生存率的独立危险因素(P<0.05),其余因素与生存率无明显相关。结论 外照射治疗可明显改善PHC骨转移患者疼痛症状,但远期生存率较低,肝内病灶数量、骨转移诊断时r-GT水平、骨转移是否伴其他脏器(组织)转移、肝内灶是否行手术治疗,以及肝内病灶控制情况均为影响患者远期生存率独立危险因素。
     

核素治疗转移性骨癌骨痛的展望

就目前临床上常用的几种治疗骨痛用核素药物的特点进行比较,并介绍一种被寄予厚望的、可由核素发生器生产的、188Re标记的药物188Re-HEDP,同时,就建立全国可行的核素治疗骨转移癌骨痛疗效的评定标准,提出了建议。     

晚期前列腺癌患者26例骨痛的综合治疗

观察晚期前列腺癌患者骨痛的治疗效果。方法：回顾性分析2005-09～2010-09的26例晚期前列腺癌骨痛患者临床资料，所有患者均已在8～32个月前行双侧睾丸切除术及内分泌治疗。针对患者骨痛，采用联合化疗（8例）、局部放疗（6例）、同位素治疗（4例）和帕米膦酸二钠（8例）等综合治疗。结果：26例经随访3个月-5年，平均30个月。完全缓解和明显缓解21例，轻度缓解和无缓解5例，有效率81％。缓解期为3-15个月，平均8个月。结论：积极的综合治疗能缓解晚期前列腺癌患者骨痛的临床症状，提高其生活质量。     

125I粒子植入术治疗转移性骨痛的临床应用

目的 初步探讨放射性粒子植入术治疗骨转移瘤所致骨痛的疗效.方法 诊治52例骨转移瘤患者,在CT引导下行125I放射性粒子植入治疗.结果 125I放射性粒子植入后,第2天患者疼痛感明显减轻;第5～7天患者胀痛感加重;术后10～ 30 d患者疼痛逐渐缓解.术后1个月疗效评估:Ⅰ级疼痛缓解率100％,Ⅱ级疼痛缓解率88.9％,Ⅲ级疼痛缓解率92.3％,总有效率93.7％ (P＜0.05).对不同疼痛程度患者局部疼痛缓解有效率高,但Ⅱ、Ⅲ级疼痛缓解率无明显差异(P=0.369).结论 125I放射性粒子植入治疗骨转移瘤所致骨痛,治疗时间短、短期内缓解疼痛疗效明显且并发症少.特别对于溶骨型骨转移瘤,其治疗效果较好,在临床保守治疗疼痛控制不理想时,125I放射性粒子植入可作为一种有效的治疗方法.     

呼吸运动对肝癌放疗靶区的影响

随着放疗技术和放射生物学的发展,放射治疗在肝癌的综合治疗中占据了越来越重要的地位.然而,呼吸运动仍然是影响肝癌放疗疗效的重要因素.呼吸门控放疗、主动控制放疗、图像跟踪放疗、四维放疗等技术的应用,有效地减少了肿瘤周围正常组织的受照射体积,提高了放疗的疗效.     

头颈部癌患者生活质量及相关因素分析

 头颈部癌是一种临床常见的恶性肿瘤,患者不仅面临肿瘤对生命的威胁,而且还受到疾病本身及其治疗所带来的外观改变和诸如饮食、吞咽、呼吸和交流等重要器官功能减退的影响。由于以上原因,头颈部癌患者生活质量的下降有其自身特点。为研究该类患者生活质量现状,本研究于2007-02至2009-07对我院收治的109例头颈部癌患者的生活质量进行调查分析,分析影响其生活质量的主要因素。     

Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

Objective

The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC).

Materials and methods

Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance.Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); the second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12.Analgesic medication use was translated into a morphine-equivalent dose.

Results

The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1.CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed.

Conclusion

RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.     

原发性肝癌患者介入治疗期间生命质量评价的应用

目的　从生命质量的角度对经介入治疗的原发性肝癌患者进行评价 ,探讨其临床应用价值。方法　采用万祟华等编制的肝癌特异性生命质量评定量表对广东省 3家医院 1 75例经介入治疗的原发性肝癌患者进行生命质量评定 ,统计介入术前、术后 1个月及 3个月的生命质量总分及各维度得分 ,分析其影响因素 ,归纳介入期间生命质量变化曲线。结果　生命质量总分平均值在介入术后出现明显提高 ,术前、术后 1个月及 3个月的分值分别为 :1 1 5 4± 45 1、1 2 8 1± 2 8 3、1 2 9 8± 46 4(P <0 0 1 )。多因素逐步回归分析示肝癌分期、肝功能分级、有否超选、有否栓塞及介入次数是影响患者生命质量得分的主要因素 (P <0 0 5)。生命质量变化曲线可分为 3种类型 ,术前得分高于 1 50分者为Ⅰ型 ,其生命质量变化曲线为下降恢复型 ;位于 89和 1 4 3分之间者为Ⅱ型 ,变化曲线为持续上升型 ;术前得分低于 83分者为Ⅲ型 ,变化曲线为上升下降型。结论　总体上介入治疗能够提高中晚期肝癌患者的生命质量。提高程度与肝癌分期、肝功分级和介入治疗方法等密切相关 ,生命质量分型对于肝癌患者介入治疗的生命质量趋向的预测和指导临床选择介入治疗方式有一定的意义     

骨转移癌放射止痛治疗的临床效果研究

目的观察两种姑息放射治疗方法对骨转移的晚期肿瘤患者骨转移病灶的临床疗效、副反应。方法 72例患者92处骨转移灶根据患者的预计生存期与病灶部位的不同分为两组,对于估计寿命超过1a的患者给予照射剂量为2GY分割,总剂量为40GY/20 F,共42例44处,均为每周5次;对预计生存期不足1a的患者给予每次剂量为3GY,总剂量30GY/10F,共30例48处。结果常规组有效率86.8%,大分割组有效率91.6%,2组总有效率89.1%,但两组不同分割方式的有效率无统计学差异,P>0.05,两组放疗副反应的发生率相近,且症状较轻。结论放射治疗对骨转移癌疼痛是一种较好的止痛治疗方法,常规放疗、大分割2组放疗方法疗效和副反应相近。     

An investigation into the incidence of pain flare in patients undergoing radiotherapy for symptomatic bone metastases

IntroductionExternal Beam Radiotherapy (EBRT) is a recognised intervention for symptomatic pain relief from bone metastases. Pain flare is a reported EBRT toxicity, described in 16–41% of steroid-naïve patients. This study aimed to determine incidence and duration of pain flare amongst patients within one Oncology Centre.MethodsPatients receiving EBRT for bone metastases were recruited to a prospective cohort study. Baseline pain scores and a daily pain/analgesia diary were recorded during EBRT and for 14 days thereafter. Pain flare was defined as a two-point increase on a pain scale or 25% increase in analgesia intake, with a return to baseline.ResultsOf the thirty-two participants, 69% (n = 22) completed the diary. 41% (n = 9) patients experienced pain flare, the median duration being 3 days. Of the evaluable patients, 55% (n = 12) were male, 45% (n = 9) female. The median age was 73 years (range 40–83). The common primary sites of disease were Breast (32%) and Prostate (32%), with other sites making up the remaining 36%. The most frequent EBRT site was the spine (63%), with other treatment sites including pelvis (23%) and extremities (14%). EBRT regimes were restricted to 20 Gy in 5 treatments, received by 32% (n = 7) of patients and 8 Gy in 1 treatment (68% (n = 14)). Of these two regimes, pain flare was reported by 29% and 47% respectively.ConclusionPain flare is a common toxicity of EBRT for bone metastases. Taking the small sample size into consideration, the incidence and duration of pain flare in patients within this single-centre study are comparable with those found in international studies.     

Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy

PURPOSE: The importance of the quality of life (QOL) and mental condition of patients being treated for cancer is now recognized. In this study, we evaluated QOL and mental condition in patients with cancer before and after radiotherapy. MATERIALS AND METHODS: The subjects were 170 patients who had undergone radiotherapy. The examination of QOL was performed using the quality of life questionnaire for cancer patients treated with anticancer drugs (QOL-ACD), and mental condition (anxiety and depression) was examined using the hospital anxiety and depression scale (HADS). These examinations were performed at the start of radiotherapy and immediately after radiotherapy. RESULTS: The QOL score was slightly higher in all patients after the completion of radiotherapy than before the start of radiotherapy. In the palliative radiotherapy group, QOL score was significantly improved by treatment. Anxiety and depression were improved after radiotherapy. There was a correlation between the degrees of improvement of the HADS and QOL score. CONCLUSION: We could treat cancer patients by radiotherapy without reducing their QOL, and improvement in QOL was significant in the palliative radiotherapy group. Mental condition was also improved after radiotherapy.     

鼻咽癌放疗后舌骨及喉室的运动学变化特征

目的 利用视频造影吞咽检查(VFSS)分析鼻咽癌患者放疗后舌骨运动学变化特征。方法 本试验为前瞻性临床研究,收集2014年10月至2015年5月在本院初治的25例鼻咽癌患者为研究对象,在放疗前后使用普通X射线模拟机采集吞咽视频,通过视频分析软件进行连续快速截图,对比放疗前后吞咽时间、舌骨移动度及平均移动速度。结果 25例受试者放疗后平均吞咽时间较放疗前延长[(1.38±0.23)s vs.(1.12±0.26)s,t=-9.53,P<0.05),舌骨水平方向移动度(HHD) 较放疗前降低［(0.78±0.24)cm vs.(1.01±0.25)cm,t=5.82,P<0.05),舌骨垂直方向移动度(HVD) 也较放疗前降低［(0.78±0.18)cm vs.(1.01±0.25)cm,t=2.56,P<0.05],舌骨平均移动速度放疗后明显降低[(0.83±0.19)cm/s vs.(1.31±0.45)cm/s,t=6.46,P<0.05]。喉室移动度放疗前后比较,差异无统计学意义(P>0.05)。结论 鼻咽癌患者放疗后吞咽时间较前延长,舌骨移动度及平均移动速度较前降低。临床试验注册 中国临床试验注册中心,ChiCTR-OOC-16007913。     

Differentiation of adrenal tumors in patients with hepatocellular carcinoma: Adrenal adenoma versus metastasis

Objective

To investigate whether computed tomography (CT) attenuation test for differential diagnosis of adrenal nodule is applicable in patients with hepatocellular carcinoma (HCC) which shows similar image characteristics to adrenal adenoma.

Materials and methods

This retrospective study was approved by our institutional review board, and the requirement for informed consent from study patients was waived. Searching picture archiving and communication system, we identified 3678 patients with HCC who underwent upper abdominal unenhanced CT scans between April 2002 and March 2010, and 114 adrenal nodules (39 adenomas and 75 metastases) were included for analysis. Ten nodules were confirmed pathologically while 104 had imaging diagnosis (enlarged or emerged during the study period). Size, CT number, and the internal characteristics of the lesions were recorded.

Results

Mean CT numbers of adrenal adenomas were significantly lower than those of metastases (P < 0.0001, t-test) on unenhanced CT. Thresholds of 17 and 33 Hounsfield units (HU) provided the following sensitivity, specificity, and accuracy: 46.2%, 100%, and 81.6% at 17 HU, and 94.9%, 89.3%, and 91.2% at 33 HU, respectively. The area under receiver operating characteristic curve for the CT number test was 0.96. Metastases were significantly larger than adrenal adenoma (P = 0.009, t-test). However, the accuracy of testing using mass size was 64.0% at most. All adenomas and metastases were depicted as homogeneous masses with the exception of two metastases that presented as heterogeneous masses (necrotic or lipomatous).

Conclusion

Adrenal adenomas can be differentiated from HCC metastases using CT number on unenhanced CT.     

4D-CT和形变配准技术对肝癌放疗中累加剂量的评估

目的 应用4D-CT和形变配准技术,研究呼吸运动对原发性肝癌(HCC)肿瘤靶区及正常肝脏放疗剂量累加的影响.方法 选择19例已行肝动脉化疗栓塞术并准备接受放疗的HCC患者,依次接受自由呼吸下3D-及4D-CT模拟定位,将4D-CT图像依呼吸周期分为10个时相.在3D-CT图像上进行治疗计划设计,获得3D剂量(Dose_-3D),将其在4D-CT的10个序列图像中重新计算得到10个时相的相应剂量,其中吸气末(EI)及呼气末(EE)图像上的剂量分别命名为Dose_-EI及Dose_-EE.将4D-CT的10个时相的剂量以呼气末时相为参考,经形变累加得到4D剂量(Dose_-4D).比较靶区及正常肝脏在Dose_-3D、Dose_-EI、Dose_-EE及Dose_-4D间的剂量学差异.结果 Dose_-3D中计划靶区D₉₉和D₉₅均高于Dose_-4D、Dose_-EI及Dose_-EE(χ²=32.75、26.31,P<0.05),但Dose_-3D的适形指数(CI)和均匀指数(HI)较另外3种剂量分布为优,其中CI由0.78分别降至0.63、0.60、0.57,HI由0.08增至0.15、0.16、0.19(χ²=37.80、31.86, P<0.05);而计划靶区各剂量-体积指标在Dose_-4D与Dose_-EI、Dose_-EE间,以及Dose_-EI与Dose_-EE间的差异并无统计学意义(P>0.05).正常肝脏平均剂量(D_mean)、V₅、V₁₀、V₂₀、V₃₀和V₄₀在4种剂量分布间的差异均无统计学意义(P>0.05).结论 4D-CT结合形变配准技术可较准确反映原发性肝癌患者放疗时靶区及正常肝脏的受量,利于对放射性肝损伤相关剂量-体积指标准确预测,可为靶区剂量的安全提升提供基础.     

Dynamic contrast-enhanced MR imaging findings of bone metastasis in patients with prostate cancer

AIM:To evaluate the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) findings of bone metastasis in prostate cancer patients.METHODS:Sixteen men with a diagnosis of metastatic prostate cancer to bones were examined with DCE-MRI at 1.5 Tesla.The mean contrast agent concentration vs time curves for bone metastasis and normal bone were calculated and K trans and ve values were estimated and compared.RESULTS:An early significant enhancement (wash-out:n=6,plateau:n=8 and persistent:n=2) was detected in all bone metastases (n=16).Bone metastasis from prostate cancer showed significant enhancementand high K trans and ve values compared to normal bone which does not enhance in the elderly population.The mean K trans was 0.101/mmiinn and 0.0051/mmiinn (P < 0.001),the mean ve was 0.141 and 0.0038 (P < 0.001),for bone metastases and normal bone,respectively.     

局部放疗联合89Sr治疗骨转移癌的疗效观察

目的评价局部放疗配合放射性核素^89Sr治疗骨转移癌的疗放，分析单纯放疗单纯核素^89Sr治疗及联合治疗的副作用。方法观察60例确诊为骨转移癌的患者，分为3组，每组20例。局部放疗（A组），采用6MV直线加速器外照射给予吸收剂量30—60Gy，2—4周，局部放疗＋^89Sr治疗（B组），单纯^89Sr治疗（C组）放射性核素^89Sr静脉内注射3—4mCi。结果治疗后B组骨痛缓解，原发灶改善明显好于A、C组；新增疼痛部位及转移灶均少于A、C组（P〈0．05）。治疗后血液学的毒性3组差异统计学意义（P〉0．05）。结论局部放疗配合^89Sr治疗骨转移癌有较好的疗效，提示对单发性骨转移患者的压痛明显部位给予局部外照射止痛效果明显，对多发骨转移且病灶相距较近的给予放疗联合^89Sr治疗效果安全可靠，对全身性多发性骨转移者采用单纯放射性核素^89Sr治疗对于止痛和控制骨转移有一定疗效。