局部复发鼻咽癌旋转容积调强与固定野动态调强放疗技术的剂量学比较

目的比较旋转容积调强放疗(VMAT)技术与固定野动态调强放疗(IMRT)技术在复发鼻咽癌应用中的剂量学差异。方法选取11例局部复发鼻咽癌患者,分别设计双弧VMAT与七野IMRT两组计划,比较两组计划的靶区(PTV)剂量参数、适形指数(CI)和均匀指数(HI),以及危及器官(OAR)剂量参数、机器监测跳数(MU)、投照时间。结果 VMAT的PTV D98%略低于IMRT(P0.05),CI高于IMRT(P0.05),HI与IMRT无显著差异(P0.05)。VMAT中双侧颞叶的Dmean与周围正常组织的Dmean均比IMRT低(P0.05),脑干的Dmean略高于IMRT(P0.05),在其他危及器官两者无显著差异(P0.05)。VMAT的MV(672±112)明显少于IMRT(917±206),幅度约(25±13)%(P0.05),VMAT投照时间〔(2.3±0.1)min〕比IMRT〔(5.1±0.4)min〕减少(54±3)%。结论局部复发鼻咽癌VMAT计划可以达到或略优于IMRT计划的靶区剂量分布,能更好地保护双侧颞叶,有效减少MU和投照时间。     

调强放疗治疗老年鼻咽癌的疗效观察

目的观察调强放疗(IMRT)治疗老年鼻咽癌患者的疗效及不良反应。方法收集30例经病理组织学确诊的老年鼻咽癌患者,所有患者均接受根治性调强放疗,26例患者接受了同期化疗。观察疗效和毒副反应。结果全组患者完全缓解(CR)率及部分缓解(PR)率分别93.3%(30/32)和6.7%(2/30),有效率为100%。全组无局部及区域复发,局部控制率100%。1年总生存率及2年总生存率分别为96.0%及85.3%。1年及2年无病生存率分别为92.7%及76.5%。全组毒副反应轻,主要为放射性口腔黏膜炎及放射性皮肤反应。结论调强放疗治疗老年鼻咽癌疗效确切,毒副反应发生率低,耐受性好。     

调强适形放疗治疗老年鼻咽癌的近期疗效观察

目前鼻咽癌治疗以放疗为首选,但常规放疗放射线在杀灭肿瘤同时正常组织或器官也不可避免受到损伤.近年来研究表明,调强适形放疗(Intensity Modulated Radiation Therapy,IMRT)可使鼻咽癌肿瘤靶区剂量提高的同时,降低周围正常组织及重要器官的受量[1].本文旨在探讨两种放疗技术治疗鼻咽癌的近期疗效及毒副作用.     

鼻咽癌放疗后局部复发的术式选择

对鼻咽癌放疗后局部复发者采用手术治疗,可切除其对放疗不敏感的病灶,提高患者生存率,甚至达到根治目的。但由于患者首次接受放疗后局部软组织纤维化,血运差,解剖层次不清,故给手术治疗带来一定困难,且患者伤口愈合及鼻咽功能也受到影响。１９８５～１９９７年,我们根据鼻咽癌的病变部位和范围,对６１例鼻咽癌放疗后局部复发患者采用不同的术式清除病灶,尽可能保留正常组织及功能,现将治疗结果报告如下。１ 临床资料 本文男４３例,女１８例;年龄２３～６１岁;放疗后复发时间３个月至１２年,平均３年。其中鼻咽癌原发灶及其毗…     

局部晚期鼻咽癌不同调强技术的剂量学比较

目的 研究局部晚期鼻咽癌常规固定野调强(IMRT)、单弧容积旋转调强(SA-VMAT)及双弧容积旋转调强(DA-VMAT)3种调强放疗技术的剂量学差异.方法 30例局部晚期鼻咽癌患者,以相同处方剂量和目标进行9野IMRT、SA-VMAT及DA-VMAT计划设计.比较3种计划靶区(PTV)剂量参数、适形度指数(CI)和均匀性指数(HI)及危及器官(OAR)剂量参数、机器跳数(MU)、治疗时间.结果 3种计划均能满足临床剂量学要求.在鼻咽部原发癌及颈转移淋巴结计划靶区(PGTV)靶区,DA-VMAT和IMRT的CI优于SA-VMAT(P<0.05).在PTV1靶区,DA-VMAT的D98值高于SA-VMAT(P<0.05);DA-VMAT和IMRT的HI优于SA-VMAT(P<0.05).其余数值均无差异.危及器官方面,DA-VMAT脊髓最大剂量较IMRT及SA-VMAT剂量明显低(P<0.05);DA-VMAT及IMRT腮腺平均剂量均较SA-VMAT明显低(P<0.05).IMRT的MU明显多于SA-VMAT及DA-VMAT(P<0.05).IMRT的治疗时间明显长于SA-VMAT及DA-VMAT(P<0.05).结论 在局部晚期鼻咽癌放疗中,3种计划在靶区覆盖和危及器官保护上都可以达到临床要求.DA-VMAT计划可以达到或略优于IMRT计划的靶区剂量分布,并能更好地保护脊髓,减少治疗时间.     

早期鼻咽癌容积弧形调强放疗与固定野调强放疗剂量学比较

目的比较容积弧形调强放疗(VMAT)与固定野调强放疗(IMRT)技术在早期鼻咽癌应用中的剂量学差异。方法选取10例早期鼻咽癌患者,分别制定双弧VMAT与九野IMRT两组放疗计划。比较靶区覆盖、适形指数(CI)、均匀指数(HI)、危及器官保护、计划设计时间、机器跳数(MU)和投照(delivery)时间。结果 PTVnx:VMAT的CI及HI与IMRT相似(P>0.05)。PTVnd:VMAT的CI优于IMRT(P<0.05),HI差于IMRT(P<0.05)。PTV60:VMAT的CI优于IMRT(P<0.05),HI与IMRT相似(P>0.05)。VMAT的脊髓、口腔、正常组织区的剂量低于IMRT(P<0.05),而脑干计划区、喉、腮腺的剂量高于IMRT(P<0.05),脊髓计划区、脑干、晶体、视神经、视交叉剂量与IMRT相似(P>0.05)。计划设计时间:VMAT[(181.6±36.0)min]较IMRT[(68.1±7.6)min]增多171%(P<0.05)。MU:VMAT(609±43)较IMRT(2 071±262)减少70%(P<0.05)。投照时间:VMAT[(2.2±0.1)min]较IMRT[(6.6±0.4)min]减少66%(P<0.05)。结论早期鼻咽癌VMAT能达到略优于IMRT的靶区剂量分布,而危及器官保护方面不具明显优势,能大幅度减少MU和投照时间。     

前程适形＋后程IMRT治疗局部晚期鼻咽癌临床分析

目的探讨前程适形＋后程放射治疗（IMRT）治疗局部晚期鼻咽癌的临床价值。方法对42例局部晚期鼻咽癌患者行1—2个周期顺铂＋5．氟尿嘧啶诱导化疗后,分别行前程适形＋后程IMRT（A组）及全程IMRT（B组）;比较两组临床疗效、肿瘤靶体积（GTV）、临床靶体积、危及器官计划体积（PRV）剂量。结果两组1a肿瘤局控者比较无统计学差异。A组枕部0—1度不良反应轻于B组。A组颈部淋巴结靶区平均GIN明显低于治疗前,PRV剂量（小脑）明显低于B组（P均〈0．05）;前程行10次适形放疗的适形度指数好于行16次放疗者,CTV1、CTV2比较有统计学差异（P均〈0．05）。结论局部晚期鼻咽癌前程适形＋后程IMRT的疗效优于全程TMRI,且以10次适形放疗最佳。     

非小细胞肺癌再程放疗89例疗效观察

一般认为,非小细胞肺癌（NSCLC）首次放疗失败者局部病灶常常对放射线抗拒。1993年12月2003年12月,我们对放疗后局部复发的89例NSCLC患者行再程放疗,取得满意效果。现报告如下。     

适形调强放射治疗对鼻咽癌局部晚期患者颅神经损伤及生活质量的影响分析

目的 探讨适形调强放射治疗对鼻咽癌局部晚期(T3、T4)患者颅神经损伤及生活质量的影响.方法 回顾性分析2009年3月至2015年4月我院收治的64例鼻咽癌局部晚期患者的临床资料,比较适形调强放射治疗(IM RT)患者(3 4例)和常规放疗(RT)患者(3 0例)的颅神经损伤情况、毒副反应发生情况和生活质量.结果 放疗...     

局部晚期鼻咽癌容积弧形调强与固定野调强放疗的剂量学比较

目的探讨局部晚期的鼻咽癌患者放射治疗时分别采取调强放疗(IMRT)与快速旋转调强放疗(Rapid Arc)技术的剂量学差异。方法选取2013年2月至2014年8月收治的36例初诊为局部晚期的鼻咽癌患者,应用Eclipse 10.0计划系统分别对靶区设计强放疗计划及旋转调强治疗计划,均采用同步加量的治疗模式。在保证计划满足临床要求的前提下,比较两种计划方案的靶区剂量分布及危及器官受照剂量。结果 Rapid Arc及IMRT计划在局部晚期鼻咽癌放射治疗的靶区剂量学上基本无明显差异,其中p GTVnx及计划靶区(PTV)1的靶区适形度Rapid Arc较高。两种计划各危及器官的受照射剂量基本无差异,其中腮腺平均剂量和V30及颞颌关节的平均剂量Rapid Arc计划较低。Rapid Arc计划较IMRT计划的机器跳数减少57%,总治疗时间减少63%。结论对于局部晚期鼻咽癌的根治性放射治疗,IMRT技术和Rapid Arc技术的剂量分布基本一致,均能满足临床要求。Rapid Arc技术的总机器跳数更低,治疗时间更短。     

Multimodality treatment with intensity modulated radiation therapy for esophageal cancer

The objective of this study is to determine the feasibility and report the outcome of patients with locally advanced esophageal cancer treated with preoperative or definitive chemoradiotherapy (CRT) using intensity‐modulated radiation therapy (IMRT). Between 2003 and 2007, 30 patients with non‐cervical esophageal cancer received concurrent chemotherapy and IMRT at Stanford University. Eighteen patients were planned for definitive CRT and 12 were planned for preoperative CRT. All patients had computed tomography‐based treatment planning and received IMRT. The median dose delivered was 50.4 Gy. Patients planned for preoperative CRT underwent surgery 4–13 weeks (median 8.3 weeks) following completion of CRT. Median follow‐up of surviving patients from start of RT was 24.2 months (range 8.2–38.3 months). The majority of tumors were adenocarcinomas (67%) and poorly differentiated (57%). Tumor location was 7% upper, 20% mid, 47% lower, and 27% gastroesophageal junction. Actuarial 2‐year local‐regional control (LRC) was 64%. High tumor grade was an adverse prognostic factor for LRC and overall survival (OS) (P= 0.015 and 0.012, respectively). The 2‐year LRC was 83% vs. 51% for patients treated preoperatively vs. definitively (P= 0.32). The 2‐year disease‐free and OS were 38% and 56%, respectively. Twelve patients (40%) required feeding tube placement, and the average weight loss from baseline was 4.8%. Twelve (40%) patients experienced grade 3+ acute complications and one patient died of complications following feeding tube placement. Three patients (10%) required a treatment break. Eight patients (27%) experienced grade 3 late complications. No grade 4 complications were seen. IMRT was effective and well tolerated. Disease recurrence remains a challenge and further investigation with dose escalation to improve LRC and OS is warranted.     

固定铅门技术在鼻咽癌容积旋转调强中的剂量学研究

目的研究VMAT技术与固定铅门VMAT技术(FJT-VMAT)在鼻咽癌放疗计划中的剂量学差异。方法选取15例鼻咽癌患者在Eclipse 10.0治疗计划系统上分别制定VMAT和FJT-VMAT两种计划,比较两种计划靶区、危及器官(OAR)和正常组织低剂量区(B-P)的剂量学参数,机器跳数(MU)及治疗时间(TT)。结果两者均能满足临床治疗需求,FJT-VMAT计划中PGTVnd、PTV1和PTV2的Dmean显著低于VMAT计划,差异有统计学意义(均P0.05),PGTVnd和PTV1的Dmax FJT-VMAT计划较VMAT计划明显减低,PTV1的Dmin FJT-VMAT计划较VMAT计划明显增高(P0.01,P0.05)。而PGTVnx剂量分布两者差异无统计学意义(P0.05);FJT-VMAT计划中Bstem计划区(Dmax)、SC计划区(Dmax)、双侧腮腺(Dmean、V30)和B-P(V20、V30)较VMAT计划明显减低,差异有统计学意义(P0.01,P0.05),其余OAR剂量差异无统计学意义(P0.05)。FJT-VMAT计划的MU(683±87)较VMAT计划的MU(559±62)增加了22%(P0.05),单次平均治疗时间均约为2 min。结论 FJT-VMAT计划较VMAT计划提供了更优的部分靶区剂量分布,且对部分OAR和B-P的保护有明显优势,其MU略高但TT两者间无明显差异。     

同时推量加速调强放疗治疗头颈部恶性肿瘤的临床研究

应用同时推量加速调强放疗技术（SIB－IMART）治疗15例头颈部恶性肿瘤，肉眼靶区（GTV）的平均剂量为70Gy，临床靶区（CTV）的平均剂量为54Gy，脑干、脊髓及腮腺等正常组织的受量均在允许范围之内。结果 13例38天内完成治疗，2例因副作用而中断放疗；皮肤反应I级12例、Ⅱ级3例；粘膜反应Ⅱ级9例、Ⅲ级4例、Ⅳ级2例，咽部及食管I级10例、Ⅱ级3例、Ⅲ级2例；唾液腺副作用明显较传统放疗技术轻，15例中0级3例、I级10例、Ⅱ级2例；口干0级3例、I级9例、Ⅱ级3例，无重度或完全口干病例。放疗结束后疗效达CR者13例，PR者2例，无一例出现病情进展。认为SIB－IMART治疗头颈部恶性肿瘤安全可行，特别是肋腺可受到较好保护，且不同的靶区可以同时实现不同的剂量水平，缩短了治疗时间。     

Long-term survivors after preoperative pelvic radiation therapy for locally unresectable rectal and sigmoid carcinoma

From 1972 to 1976, 11 patients received moderate-dose pelvic preoperative radiation therapy (4500–4600 rad ±500 rad boost) for initially unresectable rectal or sigmoid carcinoma. Of six patients subsequently explored, five had radical surgery and are alive without disease at least five years later. Comparison of the present long-term follow-up series with prior (short-term follow-up) series suggests that moderate-dose preoperative pelvic radiation therapy can convert many of these lesions to being resectable ones for which long-term survival-without-disease can be achieved. Attention to irradiation dose and field size is stressed, and a suggestion is made that patients whose tumors at final pathology still demonstrate extrarectal extension receive postoperative small-field boost irradiation.     

调强适形放射治疗非小细胞肺癌的初步研究

目的　观察非小细胞肺癌 (NSCL C)调强适形放射治疗 (IMRT)的疗效和毒副反应。方法　 13例NSCL C采用 IMRT技术。每周 3～ 5次 ,每次 2～ 6 Gy,与 2 8例常规放射治疗进行对照。结果　 IMRT组有效率 (CR PR)为 92 .3% ,对照组为 5 3.6 % ,两组差异有显著性意义 (P<0 .0 5 ) ,两组急性放射性食管炎发生率分别为 2 3.0 %和 4 6 .4 % ;放射性肺炎发生率分别为 2 3.0 %和 4 2 .9% ,两组差异不显著 (P>0 .0 5 )。结论　 NSCL C调强适形放射治疗效果较满意 ,可提高局部控制率 ,远期疗效有待进一步观察。     

126例胸部肿瘤患者调强放疗后动态心电图改变的临床分析

目的 探讨不同时间段、不同类型肿瘤、不同治疗方法下,胸部肿瘤患者接受调强放射治疗对动态心电图（AECG）的影响.方法 选取在我院临床肿瘤中心接受调强放射治疗的胸部肿瘤患者126例,按照肿瘤类型分为左肺癌组43例,左乳癌组39例,食管癌组44例;按照治疗方法分为单纯放疗组36例,同步放化组46例,序贯放化组44例.分别于治疗前、治疗后和治疗结束半年后进行24 h Holter监测,比较这3个时间段的AECG异常发生率,以及在2种分类方法下各组治疗后新增AECG异常发生率.结果 偶发房（室）性心律失常、ST-T改变在治疗后较治疗前明显增加,差异有统计学意义（P＜0.05）;两者在治疗前与治疗结束半年后比较,差异无统计学意义（P＞0.05）.分别比较不同类型胸部肿瘤、接受不同治疗方法的各3组患者治疗后新增AECG异常发生率,差异均无统计学意义（P＞0.05）.结论 调强放射治疗后胸部肿瘤患者的AECG改变多在治疗早期出现,是可逆性的.由于调强放射治疗的精确性,不同类型胸部肿瘤放疗后的AECG改变无显著性差异.紫杉醇＋铂类化疗方案对AECG影响较小,其心脏毒性相对较低.     

Prognostic nomogram to predict the distant metastasis after intensity-modulated radiation therapy for patients with nasopharyngeal carcinoma

Distant metastasis-free survival (DMFS) significantly differs among individuals with nasopharyngeal carcinoma (NPC). This analysis was carried out to find prognostic risk factors of DMFS and create a nomogram to predict DMFS for NPC patients who received Intensity-Modulated Radiation Therapy (IMRT).During March 2008 to January 2010, 437 patients with confirmed NPC from First Affiliated Hospital of Guangxi Medical University were recruited into this study. We developed a nomogram for predicting DMFS according to Cox regression analysis. Nomogram performance was assessed by concordance index (C-index), bootstrap validation method, and operating characteristics curves (ROC), respectively.Four independent prognostic factors for distant metastasis were identified, including age, chemotherapy, N-stage and residual tumor. C-index of the nomogram for prediction of DMFS was 0.807 (95% confidence interval, 0.726 to 0.738), which was confirmed using bootstrap validation, indicating satisfactory predictive accuracy. The calibration curves also showed adequate agreement in predicting the 3 and 5-year DMFS. The 3 and 5-year area under the curve (AUC) of ROC for nomogram and TMN stage were 0.828 and 0.612, 0.809, and 0.571, respectively. Classifying risk subgroups based on optimal cut-off value contributes to the effective discrimination of distant metastasis.The nomogram developed for this study is useful for oncologists to accurately predict DMFS and facilitates individualized treatment for patients with NPC.     

Preoperative radiation therapy for locally advanced carcinoma of the rectum

During a three-year period, 27 patients with the diagnosis of adenocarcinoma of the rectum were referred to the Department of Radiation Oncology and accepted for preoperative radiation therapy. The referral was based solely on endoluminal ultrasound staging (ELUS) of an unfavorable lesion (n=12) or ultrasound staging with the clinical impression of a fixed (n=9) or tethered (n=6) lesion. High-dose (4,500–5,600 cGy) preoperative radiation was followed by definitive surgery in four to seven weeks. The gross and microscopic pathology observed in 23 specimens of this group of patients formed the basis of this report. The microscopic findings that persist after radiation allow an accurate determination of the tumor stage existing prior to radiation. Correlations are made between the original evaluation of the tumor, including ELUS, and the microscopic findings. ELUS accurately predicted the depth of tumor penetration in 20 to 23 of 23 specimens and the lymph node status in 16 of 23 specimens. In the context of the pathologic findings as described, downstaging was not demonstrated. Following this radiation protocol, a marked reduction in tumor mass was demonstrated, as well as evidence of tumor destruction in the remaining mass, varying from minimal to total elimination of viable tumor. The concept that radiation fibrosis exists only as it approximates or replaces neoplasm is offered. In the context of this pathologic finding, improved resectability occurred for certain tumors. It is recommended that ELUS be added to the clinical evaluation of rectal adenocarcinoma. It is also recommended that the pathologic findings described be used when reporting the stage of rectal tumors that have received high-dose preoperative radiation therapy.Supported in part by a grant from the Catherine McAuley Research Fund.     

Hearing loss in patients with nasopharyngeal carcinoma after chemotherapy and radiation

In light of the possible adverse effects of radiation on hearing, we conducted a study to evaluate the long-term sensorineural hearing status following radiotherapy (RT) in patients suffering from nasopharyngeal carcinoma. Audiologic examinations were performed at regular intervals before and after RT. We also analyzed the effects of age, chemotherapy, pre-RT hearing status, and post-RT otitis media with effusion (OME) on post-RT hearing change. A total of 150 patients (261 ears) were enrolled in this study and followed up for a mean of 43.8 months. After RT, 8.9-28.8% of ears had at least a 10 dB loss in bone conduction threshold at speech frequency, which was defined as an average of hearing threshold at 0.5 kHz, 1 kHz, and 2 kHz, while the percentage was 18-34.2% at 4 kHz. Patient age was related to these changes at speech frequency, and the presence of post-RT OME was related to significant loss at both speech frequency and 4 kHz. Pre-RT hearing status and chemotherapy did not influence hearing change. To sum up, sensorineural hearing loss began as early as after completion of RT. Early changes may be transient, but the effect of radiation on hearing tended to be chronic and progressive.