59例子宫内膜癌单纯放射治疗

目的 评价子宫内膜癌单纯放射治疗的效果,分析影响治疗效果的因素。方法 对５９例子宫内膜癌病例病进行回顾性分析,其中Ｉ期１７例,Ⅱ期２６例,Ⅲ期１４例,Ⅳ期２例。休外照射应用６或８ＭＶＸ射线直线加速器,后装治疗应用ＷＤ－ＨＤＲ１８及（或）Ｂｕｃｈｌｅｒ）后装治疗机。结果 该组患者５年生存率为５年生存率为６４．３％,其中Ｉ期为７９．２％,Ⅱ期为７５．３％,Ⅲ期为３１．４％,Ⅳ期为０．０％。期别、病理组     

子宫内膜癌放射治疗疗效分析

为了观察放疗对子宫内膜癌的影响。对我院1987年～1990年72例接受放疗的子宫内膜癌患者进行分析。根据1971年FIGO标准，Ⅰ期24例、Ⅱ期41例、Ⅲ期7例。病理分类：腺癌58例、腺鳞癌6例、透明细胞癌2例。年龄：35～76岁，平均年龄57．96岁。治疗方法：全盆大野照射，盆腔中平面剂量为DT40GY～50GY，腔内治疗X点剂量20～40GY，A点剂量20GY～30GY。5例单纯体外照射、14例单纯腔内、53例体外加腔内。38例患者放疗后行全子宫及双侧附件切除，术后病理证实，部分病例无肿瘤残存。腔内放疗作为全盆外照后的补充放疗能有效地控制子宫内膜肿瘤。总五年存活率为52．6％，Ⅰ～Ⅱ期五年存活率为：Ⅰ期58％、Ⅱ期51．14％、Ⅲ期28．77％。单纯放疗可适用于Ⅰ、Ⅱ期子宫内膜癌不宜手术的患者。对病期较晚、手术不能切除干净的晚期患可行全量放疗，然后争取行子宫及双侧附件切除。为了提高单纯放疗疗效，在放射治疗前临床医生应尽可能全面的掌握肿瘤的信息。     

子宫内膜癌放射治疗进展

子宫内膜癌放射治疗进展中国医学科学院肿瘤医院（１０００２１）孙建衡子宫内膜癌放射治疗的进展，可以概括于以下几个方面。一、腔内放射治疗目前放射治疗已确认为是一种根治子宫内膜癌的方法，４０年代初，Ｈｅｙｍａｎ倡导将多数含有镭的金属小囊填满宫腔的宫腔填充法...     

子宫内膜癌放射治疗进展

摘 要：近年来,放射治疗技术在子宫内膜癌治疗中的应用愈加广泛,包括用于无法手术治疗患者的单纯放疗,以及作为术前、术中、术后的辅助放疗。文章对这些放疗方法在子宫内膜癌治疗中的应用指征、具体应用方法及疗效进行综述。     

术后放射治疗Ⅰ期子宫内膜癌患者预后影响因素的分析

目的探讨放射治疗Ⅰ期子宫内膜癌术后患者的生存状况和预后的影响。方法选取2010年1月至2011年1月间进行术后放疗的164例Ⅰ期子宫内膜癌患者,采用门诊随访的形式对患者随访,对随访结果进行分析。结果 1、2、3、4和5年生存率分别为94.5%、91.5%、87.8%、82.3%和76.8%,中位生存时间为54个月。年龄、放疗前贫血、子宫下段受累和内分泌治疗对患者的生存期有影响(均P<0.05)。年龄、放疗前贫血、子宫下段受累和内分泌治疗是预后的独立影响因素(均P<0.05)。结论Ⅰ期子宫内膜癌患者手术后放射治疗的5年生存率高,年龄、放疗前贫血、子宫下段受累和内分泌治疗是预后的独立影响因素。     

106例子宫内膜癌术后联合放射治疗疗效及预后因素分析

[目的]探讨子宫内膜癌手术后辅助放射治疗的疗效及其预后因素。[方法]接受术后辅助放疗的子宫内膜癌患者106例，直线加速器盆腔野体外照射，24例加阴道施源器HDR腔内后装治疗。按患者年龄、手术病理分期、肌层浸润、病理类型、病理分级、淋巴结转移6个观察指标分析与5年生存率的关系。[结果]全组5年生存率53．6％。年龄、手术病理分期、肌层浸润、病理类型、淋巴结转移与术后生存率显著相关（P〈0．05），病理分级与生存率无明显相关（P〉0．05）。[结论]子宫内膜癌手术后辅助放射治疗的疗效肯定，年龄、手术病理分期、肌层浸润、病理类型、淋巴结转移是影响子宫内膜癌生存率的预后因素。     

I / II 期子宫内膜癌术后放射治疗疗效分析

目的:评价I/II期子宫内膜癌术后放疗的疗效和并发症.方法:2001年9 月-2008年8月收治45例I/II期子宫内膜癌术后患者.采用常规4野等中心适形照射技术,全盆腔6-10MV-X,DT46-50Gy/23-25f/31-35d,2Gy/f,5f/w.结果:中位随访50个月, 1年、3年和5年总生存率分别为100%、 96.9%和88.9%,1年、3年和5年无病生存率分别为93.2%、84.2%和84.2%.1年、3年和5年局部控制率分别为97.8%、94.6%和94.6%.1年、3年和5年远处转移率分别为6.7%、12.3%和12.3%.45例患者的急性反应主要是1例4°WBC减少症,3例3°腹泻.14例行盆腔淋巴结清扫术患者出现晚期并发症,其中3例为肠梗阻,2例3°,1例5°.结论:术后放疗可以降低有高危因素的早期子宫内膜癌的局部控制率,但晚期放射损伤发病率相对较高.     

术后补充放射治疗对Ⅱ期子宫内膜癌预后的影响

目的　探讨不同治疗方法对II期子宫内膜癌生存率及复发的影响。方法　对 1988年 1月至 1998年 12月在本院收治的 84例Ⅱ期子宫内膜癌患者根据治疗方法不同将其分为A、B两组。A组 3 3例行次广泛子宫切除加盆腔淋巴结清扫术。B组 5 1例手术范围与A组相同术后加阴道残端区盆腔外照射。分析两组的生存率及复发情况。结果　全部病例 5年生存率为 79,7% ( 67/ 84) ,A ,B组 5年生存率分别为 78 7% ( 2 6/ 3 3 )和 84 3 % ( 4 3 / 5 1)。B组 5年生存率比A组高 ,统计学上无显著差异 (P >0 0 5 )。A、B两组盆腔复发率分别为 18 1% ( 6/ 3 3 ) ,5 8% ( 3 / 5 1) ,差异有显著性 (P <0 0 5 )。A、B俩组远处转移率分别为 12 1% ( 4 / 3 3 ) ,11 8% ( 6/ 5 1)。统计学无显著意义。结论　Ⅱ期子宫内膜癌患者经过系统的手术后补充阴道残端区盆腔外照射能明显减少局部复发但不能控制远处转移 ,对 5年生存率无明显影响。     

子宫内膜癌合并卵巢恶性肿瘤

１７例同时发生子宫内膜及卵巢恶性肿瘤的病例，根据肿瘤的组织学类型分为二组：Ａ组：７例患者子宫和卵巢均为子宫内膜样腺癌；Ｂ组；１０例为子宫内膜腺癌合并卵巢其他类型的恶性肿瘤（如浆液性乳头状腺癌、粘液腺癌、中胚叶混合瘤等），Ａ、Ｂ二组的生存率无显著性差别（分别为７１％、５０％，平均随诊２２个月），然而，深肌层受侵者预后较差。     

87例扁桃腺癌放射治疗分析

本文收集从1980年3月～1990年3月车院行单纯放射治疗的扁桃腺癌87例，对其疗效及预后进行分析。     

影响食管癌单纯放疗后一年生存率的因素

目的：分析影响食管癌单纯放疗一年生存的因素,为个体化治疗方案制定和准确评估预后提供参考标准。方法：回顾分析71例食管癌单纯放疗患者的临床资料,分析其一年生存率及影响因素。结果：所有患者在放疗结束后均随访一年以上。影响因素有X线所显示病变之长度、放疗剂量、CT所示肿瘤最大直径、食管病变部位、血红蛋白水平以及是否合并淋巴结转移。而性别、年龄与预后无关。结论：食管癌X线所示病变越长,近期疗效越差;照射剂量≥50Gy者疗效优于〈50Gy,〉70Gy并不能提高疗效;CT最大直径越大预后越差;胸上中段疗效好于胸下段癌;血红蛋白正常者疗效优于血红蛋白低者;无淋巴结转移患者预后优于合并淋巴结转移患者。     

影响食管癌单纯放疗后一年生存率的因素

目的:分析影响食管癌单纯放疗一年生存的因素,为个体化治疗方案制定和准确评估预后提供参考标准。方法:回顾分析71例食管癌单纯放疗患者的临床资料,分析其一年生存率及影响因素。结果:所有患者在放疗结束后均随访一年以上。影响因素有X线所显示病变之长度、放疗剂量、CT所示肿瘤最大直径、食管病变部位、血红蛋白水平以及是否合并淋巴结转移。而性别、年龄与预后无关。结论:食管癌X线所示病变越长,近期疗效越差;照射剂量≥50Gy者疗效优于<50Gy,>70Gy并不能提高疗效;CT最大直径越大预后越差;胸上中段疗效好于胸下段癌;血红蛋白正常者疗效优于血红蛋白低者;无淋巴结转移患者预后优于合并淋巴结转移患者。     

500例中晚期食管癌单纯放疗的多因素分析

目的分析中晚期食管癌单纯放疗的预后因素,为个体化治疗方案制定和准确评估预后提供参考标准。方法单纯放疗的中晚期胸段食管癌500例中,男318例,女182例,中位年龄56.5岁。胸上段癌195例,胸中段癌277例,胸下段癌28例。X线片病变长度≤3.0cm者36例,3.1～7.0cm者318例,7.1～10.0cm者132例,>10.0cm者14例。胸部CT扫描显示病变长度≤3.0cm者14例,3.1～7.0cm者130例,7.1～10.0cm者298例,>10.0cm者58例。病变最大层面上测量肿瘤最大直径≤2.0cm者87例,2.1～3.0cm者153例,>3.0cm者260例。应用加速器6MVX线给予一前、两后斜野等中心或源皮距照射,常规分割或后程加速超分割,总剂量60～66Gy,30～39分次,6.0～6.3周完成。结果全组1、3、5年生存率分别为71.1%、32.6%、20.8%。单因素分析显示传统预后因素性别、声哑、病变部位、病变长度、软组织阴影、溃疡和食管腔扭曲成角均明显影响预后;CT扫描相关因素如病变长度、最大外侵深度、最大直径、气管支气管受侵、降主动脉受侵、椎前三角消失和淋巴结转移也显著影响长期生存;治疗相关因素如前垂直野宽、野长、后斜野宽、野长、总剂量、总疗程时间、即时疗效和近期疗效对生存也有显著影响。Cox多因素分析显示淋巴结转移、CT显示的病变最大直径、声哑、CT显示病变长度、病变部位、病变最大外侵程度、后斜野宽度、总疗程时间、即时疗效和近期疗效均为独立性预后因素。综合多种因素的预后指数PI值越低,预后越好。结论中晚期食管癌单纯放疗后,除传统预后因素外,胸部CT扫描能提供更准确的评估预后的指标,预后指数模型能够更敏感地预测疗后生存。     

放射与放射合并卡莫氟治疗局部晚期贲门癌的临床对照研究

目的 比较卡莫氟联合放射治疗与单纯放射治疗局部晚期贲门癌的局部疗效和毒副反应,探讨其临床治疗的可行性。方法 57例局部晚期贲门癌病人,采用信封法随机分为卡莫氟联合放射治疗组(研究组)27例,单纯放射治疗组(对照组)30例。放射治疗用6～8 MV X线照射,每周照射5次,每次1.8～2.0 Gy,总剂量55～65 Gy/5～6周。研究组于放疗治疗前1周开始口服卡莫氟片,每次200 mg,每日3次,日剂量600 mg,至放射治疗结束。结果 卡莫氟联合放射治疗组总有效率(CR+PR)为62.9％,其中CR 18.5％(5/27),PR 44.4％(12/27),单纯放射治疗组总有效率为36.7％,其中CR 10％(3/30),PR 26.7％(8/30)。两组吞咽困难缓解开始时间平均为(24.5±4.5)d和(29.7±3.2)d,两组之间差异有显著性(P<0.05和P<0.01)。两组毒副反应主要表现为胃肠道反应和轻度骨髓抑制,差异无显著性(P>0.05)。结论 卡莫氟联合放射治疗可提高局部晚期贲门癌的局部控制率,缩短吞咽困难持续时间,而毒副反应无明显增加,可在临床上选择使用。     

934例鼻咽癌单纯放疗远期疗效分析

目的 分析鼻咽癌患者单纯根治性放疗的远期疗效.方法 回顾分析1999年全年934例鼻咽癌初治患者临床资料及其主要预后影响因素.934例中男676例,女258例.按1992年福州分期标准分期,Ⅰ、Ⅱ、Ⅲ、Ⅳ.期分别为35、215、488和196例.全组病例均采用低熔点铅挡块而颈联合野等中心照射技术给予单纯常规分割放疗,原发灶总剂量66～88 Gy,颈淋巴结转移灶总剂量60～70 Gy,颈预防照射剂量50～56 Gy.结果 随访3.0～94.2个月,中位随访期67.1个月.全组病例5和8年总生存率、无瘤牛存率、无复发牛存率、无转移牛存率分别为68.3%、67.3%、64.4%、72.4%和48.0%、66.6%、50.8%、68.0%(χ2=49.74,P=0.000).无论是5和8年总牛存率、无瘤牛存率、无复发生存率或无转移生存率,N1期患者均显著低于N0期患者[66.0%:77.4%和50.3%:59.8%(χ2=33.34.P=0.000)、66.8%:76.1%和66.1%:76.1%(χ2=29.08,P=0.000)、63.4%:72.9%和48.9%:58.7%(χ2=27.65,P=0.000)、71.0%:80.8%和63.4%:68.0%(χ2=26.13,P=0.000)],N1与N2期的相似,N1～2期的显著高于N3期的.多因素分析表明性别、年龄、T分期及N分期是影响总牛存的独立预后因素.结论 早期鼻咽癌患者单纯根治性放疗可取得较好远期疗效,但局部晚期患者的总牛存率则仍未理想,主要火败丁局部区域复发和远处转移.临床分期及N期不同期别是影响顶后的主要因素.     

32例食管癌放射治疗后死亡的尸检分析

目的：分析放射治疗后食管癌的死亡原因,提高对非肿瘤性穿孔的认识及治疗。方法回顾性分析本钎放射的食管癌死亡并有完整尸检资料病例32例,一程放射疗32例。一程放射治疗26例,二程放射治疗6例,放射治疗总剂量6－200Gy。结果：局部无癌占28．1％,肿瘤残存占71．95,总剂量量41－59、60－80Gy局部无癌分别占5／9、3／9,肿瘤残存分别占13．0％、47．8％,次剂量＜180、180－210、＞210cGy无肿瘤残存分别占2／9、3／9、4／9,肿瘤残存分别占52．2％、39．1％、8．7％。穿孔周围组织中有大量的急慢性炎性细胞浸润,甚至有脓腔的形成及纤维素的段裂。淋巴结转移占46．95。上段食管癌隔下淋巴结转移占50．0％。下段食管癌隔下淋巴结转移占12．5％。全身脏器转移率为37．5％,以穿孔死亡为主要原因占75．0％。,其中无肿瘤穿孔死亡占33．33％,以食管主动脉瘘为主占62．5％,全组5年生存。1、3年生存率分别为15．65（5／32）、3．1％（1／32）,结论食管癌放射治疗后以局部复发造成的食管穿孔死亡为主,但要警惕有一部分病例,因局部无癌造成非癌性穿孔死亡。     

早期鼻咽癌单纯调强放疗的远期疗效评价

目的 评价早期鼻咽癌各亚组根治性调强放疗(IMRT)的远期疗效和副反应.方法 回顾分析2001-2008年在本中心初诊接受IMRT的198例按UICC/AJCC2002分期的早期鼻咽癌的5年生存率、治疗失败因素和急性副反应.Kaplan-Meier法计算生存率并Logrank检验.结果 中位随访时间为50.9个月(12～104个月),随访率为96%,随访满1、3、5年者分别为198、139、72例.全组病例5年的肿瘤相关生存率、鼻咽局部无复发生存率及无远处转移生存率分别为97.3%、97.7%及97.8%.T1、T2期患者5年鼻咽局部无复发生存率分别为100%、96.7%(x2=2.24,P=0.135).T1N0、T2N0、T1N1和T2N1期的5年无远处转移生存率分别为100%、98.8%、100%和93.8%(x2=2.35,P=0.125).全组治疗5年总失败率仪为6.1%(12例)且全部为Ⅱb期患者.急性副反应主要是1、2级黏膜炎及咽喉炎,未发现放射性脑、脊髓病和脑神经损伤的晚期副反应.结论 IMRT早期鼻咽癌能取得较好疗效且治疗副反应轻微;但T2b和T2bN1期患者有相对较高的局部复发和远处转移趋势,也许对这些患者放化疗能进一步获益.

Abstract：

Objective To evaluate the outcomes and toxicities of early stage nasopharyngeal carcinoma(NPC)patients treated with intensity-modulated radiotherapy(IMRT)alone. Methods From February 2001 to January 2008, 198 early stage NPC patients according to AJCC/UICC 2002 staging system were treated by radical radiotherapy with IMRT technique in our institute, the clinical data were analyzed retrospectively. Results The 5-year disease-specific survival, local recurrence-free survival(LRFS)and distant metastasis-free survival(DMFS)were 97.3%, 97.7% and 97. 8% respectively. The 5-year LRFS for T1, T2 patients were 100%, 96. 7%(x2 = 2. 24 ,P = 0. 135)respectively. The 5-year DMFS for T1 N0,T2N0, T1N1, and T2N1 patients were 100%, 98. 8%, 100% and 93. 8%(x2= 2. 35, P= 0. 125)respectively. Grade 1 and 2 mucositis and pharyngitis were most common acute toxicities. Radiation encephalopathy and cranial nerve injury were not observed in all patients. Conclusions IMRT alone for early stage NPC patients can produce satisfactory results and acceptable treatment-relative toxicities. Patients with T2b and T2bN1 had a relatively higher incidence of local recurrence and distant metastasis, which suggested that combination of IMRT and chemotherapy may improve clinical results in those patients.     

Nasopharyngeal carcinoma treated by radical radiotherapy alone: Ten-year experience of a single institution

PURPOSE: To report on our experience in the treatment of nasopharyngeal carcinoma (NPC) by radical radiotherapy alone in our institution during the last decade. METHODS AND MATERIALS: From January 1990 to May 1999, 905 NPC patients were treated and were studied retrospectively. Radical radiotherapy was given to this cohort by conventional technique in a routine dose of 70-72 Gy to the primary tumor and metastatic lymph nodes. In case of residual primary lesion, a boost dose of 8-24 Gy was delivered by either 192Ir afterloading brachytherapy, fractionated stereotactic radiotherapy, conformal radiotherapy, or small external-beam fields. RESULTS: The 5-year and 10-year local-regional control, overall survival, and disease-free survival rates were 81.7% and 76.7%, 76.1% and 66.5%, 58.4% and 52.1%, respectively. In case of residual primary lesions after a dose of 70-72 Gy of conventional external-beam radiotherapy (EBRT), an additional boost was able to achieve a local control of 80.8%, similar to that obtained with primary lesions that completely disappeared at 70-72 Gy (82.6%, p = 0.892). CONCLUSIONS: The treatment results of radical EBRT followed by a boost dose to the residual primary tumor for nasopharyngeal carcinoma in our institution are promising.     

Endometrial adenocarcinoma treated with combined radiotherapy and surgery: 437 cases]

PURPOSE: To identify prognostic factors and treatment toxicity in a series of operable endometrial adenocarcinomas. PATIENTS AND METHODS: Between November 1971 and October 1992, 437 patients (pts) with endometrial carcinoma, staged according to the 1988 FIGO staging system, underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy without (n = 140) or with (n = 297) pelvic lymph node dissection. The chronology of RT was not randomized and depended on the usual practices of the surgical teams. Group I: 79 pts received preoperative uterovaginal brachytherapy (mean total dose [MD]: 57 Gy). Group II: 358 pts received postoperative RT (196 pts received vaginal brachytherapy alone [MD: 50 Gy], 158 pts had external beam pelvis RT [EPRT] [MD: 46 Gy over 5 weeks] followed by vaginal brachytherapy [MD: 17 Gy], and 4 pts had EPRT alone [MD: 46 Gy over 5 weeks]). The mean follow-up was 128 months. RESULTS: The 10-year disease-free survival rate was 86%. From 57 recurrences, 12 were isolated locoregionally. Multivariate analysis showed that independent factors decreasing the probability of disease-free survival were: histologic type (clear cell carcinoma, p = 0.038), largest histologic tumor diameter > 3 cm (p = 0.015), histologic grade (p = 0.008), myometrial invasion > 1/2 (p = 0.0055), and 1988 FIGO staging system (p = 9.10(-8)). In group II, the addition of EPRT did not seem to improve locoregional control. The postoperative complication rate was 7%. The independent factors increasing the risk of postoperative complications were FIGO stage (p = 0.02) and pelvic lymph node dissection (p = 0.011). The 10-year rate for grade 3 and 4 late radiation complications according to the LENT-SOMA scoring system was 3.1%. EPRT independently increased the 10-year rate for grade 3 and 4 late radiation complications (R.R.: 5.6, p = 0.0096). CONCLUSION: EPRT increases the risk of late radiation complications. After surgical and histopathologic staging with pelvic lymph node dissection, in a subgroup of intermediate risk patients (stage IA grade 3, IB-C and II), postoperative vaginal brachytherapy alone is probably sufficient to obtain a good therapeutic index. Results for patients with stage III tumor are not satisfactory.     

Risk stratification of patients with advanced squamous cell carcinoma of cervix treated by radiotherapy alone

PURPOSE: To identify prognostic factors for local and distant relapse and perform risk stratification for patients with advanced cervical cancer treated with radiotherapy (RT) alone. METHODS AND MATERIALS: A total of 1031 patients with Stage IB-IVA squamous cell carcinoma of the cervix treated with full-course RT but without any chemotherapy were included for analysis. Of these, 311 patients with nonbulky Stage IB-IIA disease were designated the reference group and the other 720 patients were the study group. The associations of stage, squamous cell carcinoma antigen (SCC-ag) level, hemoglobin level, age, cell differentiation, and pelvic lymph node status with treatment failure were evaluated. The independent prognostic factors were identified by multivariate analysis. The study group was further stratified into subgroups using combinations of these risk factors. RESULTS: In the study group, independent risk factors for local relapse were advanced stage and age <45 years. The 5-year local relapse-free survival rate was 86% for patients > or =45 years with bulky Stage IB-IIA or IIB disease, and was even greater, up to 90% if the SCC-ag level was <2. In contrast, it was 65% for patients with Stage IIIB who were <45 years old. The independent risk factors for distant failure were advanced stage, SCC-ag level >2, and positive pelvic lymph nodes. The 5-year distant relapse-free survival rate was 83% for patients with bulky Stage IB-IIA and IIB disease, SCC-ag level <2, and negative lymph nodes and 43% for patients with Stage III, SCC-ag level >2, and positive lymph nodes. CONCLUSION: The risk of treatment failure in advanced-stage cervical cancer patients treated by RT alone can be more precisely predicted by risk stratification. A certain subgroup of patients had better control than the others. The benefit of treating these relatively low-risk patients with additional treatment such as concurrent chemotherapy should be further evaluated in prospective studies or meta-analyses.