子宫颈癌四野照射屏蔽铅块设计探讨

目的探讨子宫颈癌四野照射合理铅块设计配合腔内治疗的更佳方法。方法对39例各期子宫颈癌患者四野照射时超声测量子宫颈管至肿瘤外缘距离及妇科检查了解子宫旁情况,TPS计算四野照射时用固定铅块的放射治疗方法的子宫旁剂量,关注子宫旁的低剂量区。结果四野照射时用固定铅块的放射治疗方法可能导致子宫旁的低剂量区,且肿瘤可能落在低剂量区内。39例患者中仍有29例见子宫旁不良改变,即肿瘤可能落在低剂量区内。结论使用等中心技术个体化设计四野照射时的中线屏蔽铅块,能更好地消除子宫旁的低剂量区。     

动脉化疗在中晚期膀胱癌治疗中应用的初步报告

自1996年1月至今，我科为12例晚期膀胱癌患者施行了髂内动脉灌注化疗。结果：1例T4期降至T2期后给予膀胱部分切除；7例经手术＋动脉化疗，2年复查未发现复发现象；4例带瘤生存，病灶无进展。动脉化疗毒性反应较轻，疗效是肯定的，为中晚期膀胱癌开辟了一条新的治疗途径。     

宫颈癌根治术后三维适形放疗的临床价值

目的:观察宫颈癌根治术后三维适形放疗(three d im ensional conform al rad iation therapy,3D-CRT)临床应用的价值,以探讨宫颈癌根治术后理想的放疗技术。方法:155例Ⅰ~Ⅲa期宫颈癌根治术后患者,随机分两组,其中三维适形放疗组81例,常规放疗组74例。按FIGO分期,Ⅰ期45例、Ⅱa期77例、Ⅱb期31例、Ⅲa期2例,均经病理证实,其中鳞癌148例、腺癌7例。靶区范围:包括阴道上部、宫颈残端、宫旁组织、髂总、髂内外、闭孔、骶前区及盆腔淋巴引流区。照射方式:三维适形放疗设计4个野轮照或两个野轮照(即前后野与左右野轮照);常规放疗为前后两野对穿照射。剂量48~50 Gy,Ⅱb期术后残端"Boos"t剂量8~10 Gy。结果:三维适形放疗组与常规放疗组的0.5年、1年、1.5年、2年的肿瘤局部控制率相比,差异无统计学意义,而三维适形放疗组的并发症少于常规放疗组,两组的早晚期胃肠道反应及泌尿系统反应差异有统计学意义(P<0.05)。在宫颈癌根治术后放射治疗模式中,采用三维适形放疗优于常规放疗两野前后对穿照射。结论:宫颈癌根治术后三维适形放疗是优于常规放疗的放疗技术,三维适形放疗4个野轮照不但具有剂量集中、均匀、副作用小及并发症少的优点,而且还明显体现了侧野及残端"Boost"优势。     

Survival prediction using artificial neural networks in patients with uterine cervical cancer treated by radiation therapy alone

Background: We evaluated the usefulness of artificial neural networks (ANNs) for survival prediction in patients with uterine cervical cancer treated by radiotherapy. Methods: We used data from 134 patients with uterine cervical cancer treated by combined external and high-dose-rate remote afterloading intracavitary radiotherapy between 1978 and 1993. The ANNs were trained using the data from 67 randomly selected patients. Using the trained ANNs, we predicted the 5-year survival in the remaining 67 patients, and compared it with the known 5-year survival. The performance of the ANNs was evaluated using a receiver operating characteristic (ROC) curve and was compared using the area under the ROC curve (Az). Results: When fundamental factors, such as age, performance status, hemoglobin, total protein, International Federation of Gynecology and Obstetrics (FIGO) stage, and histological type were used as inputs in the ANNs, Az was 0.5483 ± 0.0145 (mean ± SD). When the histological grading of radiation effect determined by periodic biopsy examination was used in addition to the fundamental factors, Az was highest (0.7782 ± 0.0105). When the cytological grading of radiation effect by the periodic smear was used in addition to the fundamental factors, Az was 0.5523 ± 0.0135, which was not significantly different from that when only the fundamental factors were used. Conclusion: ANNs allow us to evaluate the importance of prognostic factors, and make it possible to predict the survival of each patient. Using ANNs, the combination of histological grading of radiation effect determined by periodic biopsy examination, in addition to the fundamental factors, is the most effective for prediction of survival in patients with uterine cervical cancer. Received: November 8, 2001 / Accepted: June 7, 2002 Acknowledgments The authors are grateful to Masaji Takahashi, M.D. (Professor Emeritus, Kyoto University), Masahiro Hiraoka, M.D. (Professor, Department of Therapeutic Radiology and Oncology, Kyoto University), and Masaaki Kataoka, M.D. (Shikoku Cancer Center Hospital), for their valuable discussions and advice in carrying out this study. This work was presented, in part, at the 86th RSNA meeting in Chicago, USA, November 26 to December 1, 2000. Correspondence to:T. Ochi     

术前区域动脉灌注化疗对结肠癌组织学疗效及预后的影响

目的:总结结肠癌术前区域动脉灌注化疗的经验,观察其组织学疗效与预后的关系。方法:对56例术前经肠系膜动脉灌注化疗的结肠癌患者及47例未经术前灌注化疗的结肠癌患者随访资料进行回顾性分析。结果:56例经术前灌注化疗的结肠癌患者肿瘤组织学疗效0级2例,Ⅰ级24例,Ⅱ级28例,Ⅲ级2例,总有效率96.4%。经术后5年随访,术前灌注化疗的结肠癌患者5年生存率明显高于未经术前灌注化疗的结肠癌患者(P<0.01)。结论:术前区域动脉灌注化疗可显著提高结肠癌组织学疗效,改善预后效果,提高生存率。     

同步放疗联合介入化疗治疗中晚期子宫颈癌的临床观察

 目的　比较吡柔比星（THP）、5-氟尿嘧啶（5-Fu）联合顺铂（DDP）介入化疗联合放疗与单纯放疗治疗中晚期子宫颈癌的疗效和不良反应。方法　将48例经病理确诊的ⅡB～Ⅳ期子宫颈癌患者按随机数字表法分为同步放疗及介入化疗组（25例）和单纯放疗组（23例）,两组放疗剂量相同,同步放化疗组在放疗前后予以髂内动脉局部介入灌注化疗,THP 30～40 mg、5-Fu 0.50～0.75 g、DDP 40～ 60 mg,28 d为1个周期,共 3～4个周期 。对比两组的治疗效果及相关不良反应。结果　同步放疗及介入化疗组有效率为92.0 %（23／25）,3年生存率80.0 %（20／25）。单纯放疗组有效率为69.6 %（16／23）, 3年生存率为52.2 %（12／23）,两组差异有统计学意义（均P＜0.05）。两组相关不良反应发生率之间差异无统计学意义（均P＞0.05）,经对症处理后可耐受,为可逆的。结论　同步放疗联合介入化疗治疗中、晚期子宫颈癌可显著提高患者有效率及生存率,不良反应与单纯放疗相比无明显增加。     

子宫颈癌俯卧位调强放射治疗摆位误差分析

目的研究子宫颈癌俯卧位调强放射治疗的摆位误差大小,为子宫颈癌调强放疗计划设计临床靶区体积（CTV）外放计划靶区体积（PTV）时提供参考数据。方法选取行俯卧位调强放射治疗的子宫颈癌患者6例,所有病例治疗时身下垫有孔泡沫板,热塑成形固定膜固定。连续5d治疗时用电子射野影像装置（EPID）拍射正侧位验证片各1张,共60张验证片,通过配准数字化重建图像（DRR）和EPID拍摄的验证片的骨性解剖结构,计算平移和旋转误差。结果平移误差：左右方向为（3．1±1．8）mm、头脚方向为（3．9±3．3）mm、腹背方向为（4．2±2．6）mm;旋转误差冠状面为（0．8±0．9）°、矢状面为（1．2±1）°。结论对于子宫颈癌俯卧位调强放射治疗,CTV到PTV的外放应为左右7．1mm、腹背10．8mm、头脚10.4mm,在患者身体上做摆位的标记线有助于减少摆位误差。     

三维适形放疗治疗复发子宫颈癌的剂量学研究

目的 比较常规放疗和三维适形放疗(3DCRT)治疗复发子宫颈癌靶区(PTV)和危及器官(OAR)的剂量分布,为3DCRT在复发子宫颈癌中的应用提供依据.方法 选取2007年5月至8月间就诊于山西省肿瘤医院的13例复发的子宫颈癌患者,CT模拟定位后,影像资料输入拓能(Topslane)三维治疗计划系统,由同一物理师对每一患者分别进行传统前后对穿野和五野三维适形计划设计,处方剂量均为50 Gy,比较二者PTV和OAR的剂量分布.结果 在相同的处方剂量(50 Gy),普通放疗(CRT)(AP/PA)和3DCRT的OAR(直肠、膀胱、小肠)最大受照剂量间差异无统计学意义(P>0.05),而二者PTV的最大受照剂量间差异有统计学意义(P<0.001),比较PTV的平均剂量则无统计学意义(P>0.05).表明CRT(AP/PA)和3DCRT二者有着同样的PTV覆盖.经比较PTV的均匀性,在CRT(AP/PA)和3DCRT间差异有统计学意义(P<0.001).比较CRT(AP/PA)和3DCRT的各OAR高剂量区(>40 Gv)的受照体积(V40)后,二者各OAR的V40间差异有统计学意义(P<0.01),3DCRT的V40在直肠、膀胱、小肠比CRT(AP/PA)分别平均减少53.31 ml(90.69%)、124.00 ml(79.47%)、655.16 ml(92.22%).结论 3DCRT治疗的PTV剂量均匀性劣于CRT,而OAR的受照体积明显少于CRT,从而有望减少OAR放疗并发症发生率(NTCP).     

28例宫颈癌放疗后主动脉旁淋巴结转移的调强放射治疗

目的：探讨调强放射治疗（intensity modulated radiation therapy，IMRT）用于宫颈癌放疗后主动脉旁淋巴结转移患者的治疗效果、减少并发症的价值。方法：28例宫颈癌放疗后主动脉旁淋巴结转移患者（KPS≥70）放疗前均行1～3个周期化疗，然后给予全程IMRT，1．8～2．3Gy／次，1次／日，5次／周，总处方剂量58～68Gy，中位剂量63．5Gy，同时设计28例患者的普通主动脉旁2野照射计划，拟给予相同的处方剂量，比较危险器宫（organs at risk，OAR）受照射剂量。随机选择32例接受普通放疗的病例，比较IMRT和普通放疗的急慢性毒副反应及近期疗效。结果：28例患者均完成全程IMRT，照射靶区内计划靶区体积（planning target volume，PTV）的平均剂量为67．5Gy，90％的等剂量曲线（中位剂量63．5Gy）可以覆盖99％以上的肉眼肿瘤靶区体积（grosstumor volume，GTV）。IMRT与普通主动脉旁两野比较，肾、脊髓、小肠的受照射剂量明显减小（P均〈0．05），急、慢性毒副反应明显减少。两组完全缓解率和有效率比较均有统计学意义（P〈0．05）。1、2年生存率IMRT组较普通放疗组明显提高（P〈0．05），但3年生存率比较无统计学意义（P〉0．05）。结论：IMRT技术用于治疗宫颈癌放疗后主动脉旁淋巴结转移，可获得理想的剂量分布，靶区可以获得根治性剂量，临近危险器宫得到很好的保护，临床近期疗效满意，毒副反应可以耐受。     

新辅助介入化疗对巨块型子宫颈癌的疗效观察

 目的 观察新辅助介入化疗对巨块型子宫颈癌的作用。方法 对1999年1月至2004年12月收治的126例巨块型宫颈癌患者，随机分为2组，介入组74例，采用Seldinger技术髂内动脉插管注药。鳞癌采用顺铂+博来霉素加长春新碱（VBP）方案，腺癌采用顺铂+阿霉素+长春新碱（AVP）方案。放疗组52例，按照宫颈癌放疗常规用6 Mev加速器行全盆腔体外照射，总剂量24 Gy，中间档野后继续照25 Gy，穿插Ir192后装腔内放疗，每周2次，每次A点剂量5 Gy，总剂量40 Gy。两组患者术后2周决定下一步治疗。结果 介入化疗组肿块消退（CR）12例（12／74），占16.21 %，肿块缩小≥50 %（PR）57例（57／74），占77.02 %。适宜2期手术67例（67／74），占90.54 %；放疗组CR6例（6／52），占11.53 %；PR31例（31／52），占59.61 %。适宜2期手术37例，占71.15 %（37／52）。两组比较，PR、2期手术率差异有统计学意义。介入化疗2年复发率6 %，3年复发率8 %；放疗组2年复发率8 %，3年复发率23 %；介入组3年总生存率79 %，放疗组3年总生存率71 %。两组2年复发率与3年总生存率比较，无统计学意义（P＞0.05）；3年复发率差异有统计学意义（P＜0.05）。结论 新辅助介入化疗可有效缩小肿瘤，增加2期手术率，减少3年复发率，能否减低5年复发率、增加5年生存率，有待进一步随访。     

图像引导对宫颈癌治疗的作用

目的:分析宫颈癌根治性图像引导放疗(IGRT)对靶区剂量的影响,探讨其合理应用模式。方法:选取2012—2016年于中国人民解放军总医院第七医学中心行螺旋断层放疗(HT)的20例宫颈癌患者,应用兆伏级CT(MVCT)图像在HT自适应模块上进行重建及模拟,分别得到有/无图像引导下的受照剂量参数;将各单次剂量分布和对应的融...     

Long-term follow-up of neoadjuvant intraarterial chemotherapy using an original four-lumen double-balloon (4L-DB) catheter for locally advanced uterine cervical cancer

Background  We report the therapeutic potential, longterm survival, and toxicity of neoadjuvant intraarterial chemotherapy (NAIC) using an original four-lumen double-balloon (4L-DB) catheter followed by radical hysterectomy and/or radiotherapy in patients with locally advanced cervical cancer. Methods  Sixty patients with stage IIB-IVA cervical squamous cell cancer were treated with NAIC which included cisplatin (60–70 mg/m², day 1), mitomycin-C (10–20 mg/m², day 1), and pirarubicin hydrochloride (THP; 10–20 mg/m², day 1) for two courses every 21 days. Results  The median follow up among surviving patients was 93.7 months. Among 60 eligible patients, 22 had a complete response (CR; 36.7%) including 12 with a pathologic CR (20.0%). Thirty-six patients had a partial response (60.0%), and stable disease was observed in only 2 patients (3.3%). Moreover, we found that the platinum concentration in the cervix was correlated with the clinical response (P < 0.001). The 10-year progression-free survival (PFS) and 10-year survival were 90.9% and 90.9%, respectively, in patients with stage IIB disease and 66.0% and 70.7%, respectively, in patients with stage III disease. Leukopenia occurred in 86.7% of patients, but it was not very severe (grade 3, 4 in 13.3% of patients). Conclusion  Our results with NAIC using the 4L-DB catheter in locally advanced cervical cancer demonstrate that a high platinum concentration has beneficial effects on primary lesions and improves long-term progression-free and overall survival.     

宫颈癌根治术后骶前淋巴结区域是否需要预防性治疗的临床研究

目的:研究早期(ⅠB期～ⅡA期)宫颈癌患者术后放疗靶区勾画是否应包括骶前组淋巴结.方法:46例早期宫颈癌患者行根治术1个月后开始进行三维适形放射治疗.患者随机分为2组,治疗组为放疗靶区勾画不包括骶前淋巴结,对照组为放疗靶区勾画包括骶前淋巴结.所有患者均经检查示无放疗禁忌证,并对其治疗知情同意.随访比较2组患者的局部控制率和放射性直肠炎的发生率及程度.结果: 2组患者的局控率差异无统计学意义(χ~2=0.000, P=1.000);5%和95%体积的直肠(V_5,V_(95))接受剂量及整个直肠接受平均剂量、最小剂量经比较,差异有统计学意义(V_5:t=2.169, P=0.041;V_(95):t=4.036, P=0.001; 平均剂量:t=2.236, P=0.036; 最小剂量:t=2.265, P=0.034),而直肠接受的最大剂量则差异无统计学意义(t=0.518, P=0.610);放射性直肠炎的发生率差异有统计学意义(P<0.05).结论:宫颈癌根治术后有复发危险因素的早期宫颈癌患者,在三维适形放疗靶区勾画时可不包括骶前组淋巴结,以减少放射性直肠炎的发生.     

子宫动脉灌注新辅助化疗在Ⅱ期子宫颈癌临床治疗中的应用

目的探讨针对Ⅱ期子宫颈癌患者采用子宫动脉灌注新辅助化疗的临床应用效果。方法选取本院2010年7月至2012年7月收治的63例Ⅱ期子宫颈癌患者作为研究组,所有患者均在手术与放疗前给予子宫动脉灌注新辅助化疗,同期选择仅行常规手术的50例患者作为对照组,观察两组患者的预后效果,并综合比较研究组中Ⅱa期与Ⅱb期病例的治疗效果。结果研究组患者治疗后总有效率为68．3％,对照组总有效率为48．0％,组间比较具有统计学意义（P〈0．05）,但研究组中Ⅱa期与Ⅱb期病例的治疗结果比较无统计学意义（P〉0．05）。两组患者的深部间质浸润率比较存在统计学意义（P〈0．05）,但Ⅱa期与Ⅱb期患者的预后影响因素比较无统计学意义（P〉0．05）。化疗后毒副反应较为轻微,未对持续治疗产生影响。结论针对Ⅱ期子宫颈癌患者采用子宫动脉灌注新辅助化疗能够提高临床治疗效果,保证手术实施的可行性,提高肿瘤组织清除率。     

双侧髂内动脉灌注化疗对宫颈癌根治术后患者恢复的影响

目的探讨在宫颈癌手术治疗中，术中髂内动脉灌注化疗的可行性。方法随机抽取2001年1月～2004年6月期间行宫颈癌根治术30例行术中髂内动脉灌注DDP化疗(A组)，与同期30例未接受术中髂内动脉灌注化疗的患者(B组)对照，分析术后恢复情况。结果两组体温、尿量、消化道反应、肛门排气、骨髓抑制、盆腔引流量、膀胱功能恢复情况等均无明显差异，预防性用药能控制恶心、呕吐等消化道反应。结论双侧髂内动脉术中灌注化疗辅助治疗早期宫颈癌操作简单，副作用小，是一种简单、安全、可行的方法。     

Comparison of chemoradiation with radiation as postoperative adjuvant therapy in cervical cancer patients with intermediate-risk factors

Aims

In cervical cancer patients with intermediate-risk factors, the optimal adjuvant therapy is still controversial. We retrospectively compared the treatment outcome of chemoradiation with that of radiation.

Methods

From 1997 to 2005, 79 consecutive cervical cancer patients received postoperative adjuvant therapy indicated by intermediate-risk factors. Fifty-five women received chemoradiation and 24 women received radiation. Risk factors, recurrence-free survival (RFS), adverse events, and recurrence pattern were investigated and were compared between the chemoradiation and radiation groups. RFS was calculated by the Kaplan–Meier method and was compared by the log-rank test.

Results

Risk factors were well-balanced between the two groups. Four patients recurred in the chemoradiation group and eight patients recurred in the radiation group. RFS rate of the chemoradiation group was significantly higher than that of the radiation group (P = 0.01). Hematologic toxicity was more common in the chemoradiation group than in the radiation group (P < 0.01). However, non-hematologic toxicity was similar between the two groups and most of the patients (97%) completed postoperative adjuvant therapy. Recurrence pattern was similar between the two groups.

Conclusion

In cervical cancer patients with intermediate-risk factors, chemoradiation was well-tolerated and more effective than radiation as a postoperative adjuvant therapy.     

手术前新辅助化疗联合放射治疗治疗局部晚期宫颈癌的临床分析

目的探讨手术前新辅助化疗联合放射治疗治疗局部晚期宫颈癌的疗效。方法分析35例Ⅰb2期～Ⅱb2期术前新辅助化疗联合放射治疗（观察组）与32例单纯手术（对照组）的局部晚期宫颈癌患者的临床资料,评价观察组和对照组患者的近期疗效,并比较两组患者术中出血量、手术时间、术后病理特征与疗效。结果观察组患者治疗总有效率为80.9%,高于对照组的9.3%（P〈0.05）。两组患者手术时间、术中出血量、脉管受侵以及阴道切缘癌残留率比较,差异无统计学意义（P〉0.05）,观察组患者宫旁浸润率及淋巴结转移率低于手术组（P〈0.05）。结论手术前新辅助化疗联合放射治疗可以缩小局部肿瘤,使宫旁浸润消退,可提高局部晚期宫颈癌的疗效。     

复发、转移子宫颈癌调强放疗和三维适形放疗的比较

 目的　比较调强放疗（IMRT）和三维适形放疗（3DCRT）治疗复发、转移子宫颈癌的疗效、剂量学及毒副作用。方法　回顾性分析治疗后复发转移子宫颈癌62例,其中IMRT组29例,3DCRT组33例,均行直线加速器6 MV X线放疗,单次剂量1.8～2.2 Gy,每周5次,共18～33次,处方剂量40～60 Gy,中位剂量52.8 Gy。同时对IMRT组的患者设计行3DCRT,给予相同的处方剂量,比较危及器官（OAR）受照射剂量。结果　IMRT组膀胱和小肠的最高剂量分别为（4642.71±805.53）cGy和（4240.36±572.51）cGy,低于3DCRT组的（5057.53±1998.03） cGy和（5953.99±1180.81）cGy（P＜0.05);IMRT计划中PTV的最高剂量（5245.68±365.26）cGy高于3DCRT的最高剂量（4801.27±346.25）cGy,差异具有统计学意义（P＜0.05）。IMRT组1、2、3年生存率分别为65.5 %(19／29)、42.1 %(8／19)、25.0 %（2／8）,中位生存时间为19个月,28例死亡病例中,21例死于肿瘤进展,7例死于远处转移;3DCRT组：1、2、3年生存率分别为60.6 %（20／33）、35.0 %（7／20）、14.3 %(1／7),中位生存时间为17个月,32例死亡病例中,24例死于肿瘤进展,8例死于远处转移。IMRT组和3DCRT组比较,1、2、3年生存率差异无统计学意义（均P＞0.05）。IMRT组的不良反应的发生率明显低于3DCRT组,尤其是Ⅰ级和Ⅱ级,IMRT组为24.1 %（7／29）,3DCRT组为33.5 %（11／33）。结论　IMRI对于复发转移子宫颈癌疗效较3DCRT更好,可以在提高肿瘤剂量的同时减少正常组织的受照体积和剂量,减少不良反应的发生。     

Combined intensity-modulated radiation therapy and brachytherapy in the treatment of cervical cancer

PURPOSE: This treatment planning study compared pseudo-step-wedge intensity modulation (PSWIM), intensity-modulated radiation therapy (IMRT), and conventional external irradiation, all combined with brachytherapy, for treatment of patients with cervical cancer. METHODS AND MATERIALS: This was a prospective study of 10 patients treated with PSWIM delivering 50.4 Gy to the pelvic lymph nodes and 20 Gy to the cervical tumor. This treatment was compared with a conventional treatment plan with a four-field box to 45 Gy and to an IMRT plan delivering 45 Gy. In each case, brachytherapy was prescribed to a total Point A low-dose-rate equivalent dose of 85 Gy. Total doses to Points A, Point P, the bladder point, and the rectal point were calculated. Acute toxicity and treatment response were prospectively recorded. RESULTS: The mean PSWIM total low-dose-rate equivalent dose to Points A and P (97.3 Gy and 65.1 Gy, respectively) was significantly higher, the mean rectal dose was the same, and the mean bladder dose was higher than with IMRT or four-field box. No acute toxicity of greater Grade 2, as defined by the than Radiation Therapy Oncology Group, was experienced. The positron emission tomography-based treatment response compared favorably with our institutional experience. CONCLUSIONS: Use of PSWIM and brachytherapy delivers significantly more dose to the tumor and lymph nodes than do competing techniques. Rectal doses are comparable. Maximum bladder point doses are higher. Toxicity and tumor response are acceptable.     

肝动脉灌注在结直肠癌肝转移治疗中的应用现状及前景

结直肠癌（colorectal cancer ,CRC ）是中国最常见的恶性肿瘤之一,肝转移是其主要的转移模式及治疗关键。相对于全身化疗,肝动脉灌注（hepatic arterial infusion,HAI）给药方式可使肝脏局部药物浓度升高,而外周血液中药物浓度较低,全身不良反应相对较低。HAI 化疗在肠癌肝转移的转化化疗、肝切除术后辅助化疗以及肠癌根治性切除术后的肝转移预防方面显示出一定的应用前景。本文就HAI 在肠癌肝转移的治疗现状及前景做一综述。