CT引导下~(125)I粒子植入治疗鼻咽癌放疗后残留病灶的疗效

目的:评价CT引导下~(125)I粒子植入治疗鼻咽癌放疗后残留肿瘤病灶的疗效.方法:2007年1月-2008年1月本院25例放疗后有残留肿瘤病灶的鼻咽癌患者接受了~(125)I粒子植入治疗.采用三维治疗计划系统(treatment planning system, TPS)计算植入~(125)I粒子数量和总剂量.CT引导下将~(125)I放射性粒子植入残留肿瘤病灶中,并对植入的~(125)I放射性粒子剂量分布进行验证.术后3、6和12个月定期进行鼻咽内窥镜和CT检查,并评价近期疗效和不良反应.结果:术后12个月时,25例患者中完全缓解20例、部分缓解2例、无变化2例、疾病进展1例,总有效率(完全缓解+部分缓解)为88.0%.所有患者于术中和术后均未发生严重并发症.结论:CT引导下~(125)I粒子植入治疗鼻咽癌放疗后残留肿瘤病灶是一种安全而有效的治疗方法.     

碘125粒子植入联合体外高频热疗治疗盆腔复发转移妇科肿瘤的近期疗效观察

目的:评价放射性碘125粒子联合高频热疗治疗伴有大肿块的晚期妇科肿瘤患者的疗效和疼痛缓解情况.方法:回顾性分析20例术后或放化疗后复发的晚期妇科肿瘤患者,采用CT引导下放射性碘125粒子植入,术后辅以体外高频热疗.观察患者的近期疗效和生活质量改善情况.结果:20例患者的近期有效率为80%,疼痛缓解率为75%,患者生活质量较治疗前改善(P<0.05).结论:采用放射性碘125粒子植入联合高频热疗治疗伴有盆腔大肿块的晚期妇科肿瘤患者疗效较好,值得进一步研究.     

COX模型对术中125I粒子植入治疗中晚期食管鳞癌预后因素的分析

目的:探讨术中联合125I粒子植入治疗中晚期食管鳞癌的安全性、疗效及影响患者生存率的因素。方法:我院收集2001年-2006年间100例术中联合125I粒子植入治疗食管鳞癌患者(根据术前CT分期标准:II-III期)临床资料,剔除姑息性切除及转流术患者5例,最终入组95例食管鳞癌根治性切除联合125I粒子植入患者,并对其进行分析。患者均依据TPS所制定的剂量,在术中直视下125I粒子组织间植入。选用0.3-0.7mCi的125I粒子10-40粒,总活度在7-28mCi,肿瘤匹配周边剂量40-80Gy。通过单因素及多因素分析影响患者术后生存率的因素。结果:截止2011年6月30日,95例患者均获随访,40例仍存活。患者术后粒子验证质量评估满意,无严重并发症发生,无患者死于手术或粒子植入治疗,局部复发率11.6%,远处转移率41.1%。1、3、5年患者总体生存率分别为90.5%、58.9%、42.1%,中位生存期38个月(95%CI:25-51个月)。单因素生存分析显示年龄组(P=0.0006)、肿瘤分段(P=0.0013)、术前CT分期(P=0.0003)、粒子活度(P=0.0026)和肿瘤匹配周边剂量(P=0.0021)以及术后病理分期(P=0.0001),均影响术中联合125I粒子植入治疗患者的长期生存率。COX回归多因素分析后显示与预后有关的因素为粒子活度(P=0.017)和肿瘤匹配周边剂量(P=0.000)以及术后病理分期(P=0.0000)。结论:术中联合125I粒子植入治疗中晚期食管鳞癌简单、安全、有效,可降低局部复发率、提高患者生存率。其中粒子活度、MPD和术后病理分期是影响患者预后的主要因素。125I粒子单粒活度0.5-0.7mCi,肿瘤匹配周边剂量60-70Gy合理可行。     

COX模型对术中125Ⅰ粒子植入治疗中晚期食管鳞癌预后因素的分析

目的:探讨术中联合125I粒子植入治疗中晚期食管鳞癌的安全性、疗效及影响患者生存率的因素.方法:我院收集2001年-2006年间100例术中联合125I粒子植入治疗食管鳞癌患者(根据术前CT分期标准:Ⅱ-Ⅲ期)临床资料,剔除姑息性切除及转流术患者5例,最终入组95例食管鳞癌根治性切除联合125I粒子植入患者,并对其进行分析.患者均依据TPS所制定的剂量,在术中直视下125I粒子组织间植入.选用0.3-0.7mCi的125I粒子10-40粒,总活度在7-28mCi,肿瘤匹配周边剂量40-80Gy.通过单因素及多因素分析影响患者术后生存率的因素.结果:截止2011年6月30日,95例患者均获随访,40例仍存活.患者术后粒子验证质量评估满意,无严重并发症发生,无患者死于手术或粒子植入治疗,局部复发率11.6％,远处转移率41.1％.1、3、5年患者总体生存率分别为90.5％、58.9％、42.1％,中位生存期38个月(95％ CI:25-51个月).单因素生存分析显示年龄组(P =0.0006)、肿瘤分段(P =0.0013)、术前CT分期(P=0.0003)、粒子活度(P＝0.0026)和肿瘤匹配周边剂量(P =0.0021)以及术后病理分期(P=0.0001),均影响术中联合125I粒子植入治疗患者的长期生存率.COX回归多因素分析后显示与预后有关的因素为粒子活度(P=0.017)和肿瘤匹配周边剂量(P=0.000)以及术后病理分期(P =0.0000).结论:术中联合125I粒子植入治疗中晚期食管鳞癌简单、安全、有效,可降低局部复发率、提高患者生存率.其中粒子活度、MPD和术后病理分期是影响患者预后的主要因素.125I粒子单粒活度0.5-0.7mCi,肿瘤匹配周边剂量60-70Gy合理可行.     

CT引导下125I 粒子植入联合化疗治疗复发性卵巢癌

目的:探讨CT引导下125I 粒子植入联合化疗治疗复发性卵巢癌患者的临床疗效及安全性。方法:回顾性分析采用125I粒子植入联合化疗治疗的21例复发性卵巢癌患者资料。共29处可评价病灶,其中25处适合125I 粒子植入治疗。应用治疗计划系统制定125I 粒子植入计划,在CT引导下植入粒子。粒子植入术后3 d 内行紫杉醇脂质体静脉化疗,次日经肿瘤供血动脉灌注卡铂,每3 周重复1 次,随访观察治疗效果及并发症。结果:2 个疗程化疗结束后125I 粒子植入治疗的25处病灶中完全缓解（CR）为16%（4/25）、部分缓解（PR）为56%（14/25）、疾病稳定（SD）为12%（3/25）、疾病进展（PD）为16%（4/25）,总有效率（CR+PR）为72%（18/25）,疼痛缓解率为82.4%（14/17）,KPS 评分较治疗前升高（P=0.019）。 中位无进展生存时间（PFS）为6.8 个月,中位生存时间（OS）为14.2 个月,1 年生存率为42.9%（9/21）,主要为血液学及消化道不良反应,所有患者未发生严重的放射性损伤并发症。结论:125I粒子植入治疗联合化疗能够提高复发性卵巢癌患者的临床缓解率,改善临床症状,并且耐受性良好。      

姑息手术^125I粒子植入联合热疗及化疗治疗晚期肺癌

目的评价姑息性手术125I粒子植入联合热疗及化疗综合治疗晚期肺癌的方法和疗效.方法 28例肺癌中原发性非小细胞肺癌(NSCLC)15例(ⅢA期9例,ⅢB期6例),NSCLC手术后局部复发6例,转移性肺癌7例(其中结肠癌肺转移3例,乳癌肺转移4例).采用开胸姑息切除 125I粒子植入 体外高频透热治疗(HFDT) 化疗17例,胸腔镜附加小切口行局部肿块(楔形)切除 125I粒子植入 HFDT 化疗6例,肿瘤内射频消融(RFA) 125I粒子植入 化疗5例.结果全组随访12～32个月(平均16.9个月).CR 21例,PR 6例,NR 1例.1年后局部复发4例,2例经再次植入125I又得到控制.5例患者死亡,1例因局部复发,4例因远处转移.所有患者植入125I粒子后无白细胞、血小板降低,无肝肾功能损害,均能较好耐受同时化疗.结论本治疗方法安全可行,有较高的肿瘤局部控制率,患者生活质量高,生存期延长.     

~(125)I粒子植入联合支气管动脉灌注化疗栓塞治疗肺鳞癌的临床应用

目的探讨125I粒子植入联合支气管动脉灌注化疗栓塞治疗肺鳞癌的临床价值。方法选取2010年1月至2012年4月间收治的30例肺鳞癌患者,先行支气管动脉灌注化疗栓塞术,2⁴d之后行125I粒子植入术,术前采用计算机治疗计划系统(TPS)模拟布源,计算术中所需125I粒子的总活度及粒子数量。在CT引导下,将125I粒子植入瘤体区。术后1、2、4个月时行CT扫描,参照世界卫生组织(WHO)实体肿瘤疗效评价标准进行评价。结果125I粒子植入联合支气管动脉灌注化疗栓塞治疗后1、2、4个月的有效率分别为63.3%、93.3%和96.7%。全组30例患者均全部完成治疗,所有患者未出现严重并发症,化疗不良反应轻。结论125I粒子植入联合支气管动脉灌注化疗栓塞术作为治疗肺鳞癌患者的一种重要方法,临床疗效较为确切,治愈率较高,比较安全,值得推广应用。     

125I放射性粒子植入联合化疗治疗复发鼻咽癌的临床观察

[目的]观察125Ⅰ粒子植入联合化疗治疗复发鼻咽癌的临床疗效.[方法]对60例患者分别行125Ⅰ粒子植入联合化疗和单纯化疗,观察其治疗前后复发病灶和EB病毒抗体滴度、血沉(ESR)、不良反应变化情况.[结果]125Ⅰ粒子植入联合化疗后的复发病灶CR 15例,PR 12例,SD 3例;对照组复发病灶CR 3例,PR 9例,SD 15例,PD 3例.125Ⅰ粒子植入联合化疗组EB病毒抗体滴度下降27例,稳定3例;对照组下降12例,稳定15例,上升3例.125Ⅰ粒子植入联合化疗组治疗前后ESR比较有显著性差异(P=0.029).两组患者治疗前后不良反应无显著性差异.[结论]125Ⅰ粒子植入联合化疗对复发鼻咽癌的局部控制率高,不良反应小,值得临床进一步推广.     

手术联合^125I粒子及缓释化疗粒子靶向治疗胶质瘤的临床研究

目的探讨术中应用^125I粒子及化疗粒子联合植入法治疗胶质瘤的可行性和疗效。方法南阳医专附院自2003年12月至2007年12月,应用术中放、化疗粒子联合植入法治疗胶质瘤41例。治疗中交替植入卡莫司汀（BCNU）缓释化疗粒子和放射性^125I粒子。放射性粒子的肿瘤匹配周边剂量（MPD）为90～100Gy。结果41例患者均顺利完成治疗,术后3—6个月CT复查肿瘤变化,显示瘤体不同程度缩小,其中6例完全缓解,24例部分缓解,8例稳定,局部控制率为73％。随访6—28个月,最长1例随访时间为术后4年,现仍存活。1例术后6个月死于胶质瘤复发。结论手术联合放射性^125I粒子和BCNU缓释化疗粒子联合应用局部植入技术安全、副作用小、费用低及并发症发生率低,是综合治疗胶质瘤的有效手段之一。     

超声引导下~125I放射性粒子植入治疗原发性肝癌的临床观察

目的:探讨超声引导下经皮穿刺植入125I放射性粒子治疗原发性肝癌的应用价值。方法:采用三维治疗计划系统(3D-TPS)计算48例肝癌患者51个病灶125I植入剂量,在超声显示肝脏病灶后,将125I粒子按外周密植、中间疏植的原则经皮穿刺植入肿瘤内。术后2周行超声检查,观察有无腹腔出血等并发症,术后2个月行AFP检测、彩超、CT或MR检查评价治疗效果。结果:125I放射性粒子治疗48例原发性肝癌后,12周内31例患者AFP降至正常,12例患者较术前下降一半,5例无变化,有效率为89.58%;51个病灶完全缓解23个,部分缓解21个,无变化6个,进展1个,总有效率为86.27%,无严重并发症。结论:超声引导下经皮穿刺植入125I放射性粒子治疗肝癌创伤小,布源合理,疗效肯定,并发症少,操作简单,实用性强。     

Interstitial high dose-rate brachytherapy: principle, practice and first clinical experiences with a new remote-controlled afterloading system using Ir-192

In our newly developed remote-controlled afterloading system, a single Ir-192-source is moved within hollow stainless steel needles, which are arranged strictly parallel and are uniformly spaced. Dose calculation is performed by an especially designed computer program using geometrical bodies (ellipsoid, cylinder and plane parallel body) as idealized tumor shapes. Reference points for calculation are defined on the surface of the chosen geometrical body. Theoretical base, principles of dosage, handling and first clinical experiences after treatment of 28 patients are presented.     

乳腺癌的新辅助全身治疗

 乳腺癌新辅助全身治疗,是指对某些乳腺癌患者在术前给予其全身性的治疗。术前综合运用化疗、内分泌治疗和靶向治疗可起到降期和提高保乳手术率的独特作用。新辅助化疗已经成为局部晚期乳腺癌的标准治疗方式之一。新辅助条件下,对于特定患者使用芳香化酶抑制剂和曲妥珠单抗治疗的研究也取得了长足进步。     

Neoadjuvant therapy in pancreatic cancer

Pancreatic cancer is the fourth leading cause of cancer deaths in the United States. Surgical resection offers the only hope of cure, though the addition of chemoradiation in the adjuvant setting has been shown to improve survival over surgery alone. Many patients are unable to receive adjuvant therapy due to prolonged postoperative recovery. For this reason, administration of chemoradiation preoperatively (neoadjuvant) has been proposed as an alternative to postoperative treatment. In patients with resectable disease, neoadjuvant therapy results in similar survivals compared to postoperative therapy, with a greater proportion of patients able to complete treatment. For selected patients with borderline or unresectable disease, neoadjuvant therapy offers the potential for tumor downstaging and increasing the likelihood of a margin-negative resection. This article reviews the use of neoadjuvant therapy in the treatment of pancreatic cancer.     

Successful treatment of metastatic androgen-independent prostate carcinoma in a transsexual patient

The occurrence of prostate carcinoma in transsexual patients has rarely been reported. These cases present a unique challenge in that such patients are effectively receiving androgen deprivation therapy. By definition, their disease is androgen-independent prostate cancer, and the role of local therapy is undefined. We report on a male-to-female transsexual patient with metastatic prostate cancer treated successfully with combination chemotherapy after previous standard therapy failed.     

Role of radiation therapy in the treatment of melanoma

Melanoma has been widely described as radioresistant but this should not be construed as meaning that melanoma is radioincurable. Many melanoma cell lines are as radiosensitive as other tumors commonly treated successfully with radiotherapy (RT). The use of RT requires careful planning resulting in the administration of a tumoricidal dose to the tumor cells with adequate sparing of normal tissues. RT has been used for primary therapy, postresection adjuvant therapy and palliation of symptomatic melanoma. Curative RT has been given for uveal melanoma yielding patient survival equivalent to enucleation. RT has been administered to patients with unresectable disease yielding relatively favorable results. As an adjuvant therapy postoperatively, RT has been used selectively to improve local disease control. Finally, RT is used successfully as a palliative maneuver for symptoms related to distant metastatic melanoma in patients with incurable disease.     

A randomized phase III study of neoadjuvant hormonal therapy in patients with localized prostate cancer

The primary objective of this randomized trial is to evaluate the benefit of the addition of neoadjuvant hormonal therapy to escalated-dose external-beam radiation therapy in the treatment of patients with intermediate-risk carcinoma of the prostate. A secondary objective of this study is to determine prognostic factors for radiation response. All patients will have tissue oxygenation measured and biopsies taken before treatment at the time of fiducial marker insertion for radiation treatment planning and daily monitoring. In addition, patients randomized to the neoadjuvant bicalutamide arm will be asked to consider having these studies repeated before initiation of radiation therapy (after 3 months of hormonal therapy).     

Comparison of optimized single and multifield irradiation plans of antiproton, proton and carbon ion beams

Background and purpose

Antiprotons have been suggested as a possibly superior modality for radiotherapy, due to the energy released when antiprotons annihilate, which enhances the Bragg peak and introduces a high-LET component to the dose. However, concerns are expressed about the inferior lateral dose distribution caused by the annihilation products.

Methods

We use the Monte Carlo code FLUKA to generate depth-dose kernels for protons, antiprotons, and carbon ions. Using these we then build virtual treatment plans optimized according to ICRU recommendations for the different beam modalities, which then are recalculated with FLUKA. Dose-volume histograms generated from these plans can be used to compare the different irradiations.

Results

The enhancement in physical and possibly biological dose from annihilating antiprotons can significantly lower the dose in the entrance channel; but only at the expense of a diffuse low dose background from long-range secondary particles. Lateral dose distributions are improved using active beam delivery methods, instead of flat fields.

Conclusions

Dose-volume histograms for different treatment scenarios show that antiprotons have the potential to reduce the volume of normal tissue receiving medium to high dose, however, in the low dose region antiprotons are inferior to both protons and carbon ions. This limits the potential usage to situations where dose to normal tissue must be reduced as much as possible.     

Radiation therapy (RT) after prostatectomy: The case for salvage therapy as opposed to adjuvant therapy

Patients with pathologic stage T3 or T4 prostate cancer who have undetectable PSA levels following radical retropubic prostatectomy (RRP) have a substantial risk of recurrence. Radiotherapy (RT) can be administered immediately following the RRP (immediate adjuvant RT) or may be postponed until the PSA level has risen to a level that is indicative of residual or recurrent prostate cancer (salvage RT). Immediate adjuvant RT can significantly reduce the risk of relapse, but does not appear to increase the rate of survival. Approximately two-thirds of patients with rising PSA levels after RRP can be salvaged with RT alone. This result was achieved in patients treated with an adequate dose of radiation before the PSA rose to > 1.1 ng/ml. While no one can be certain which approach (adjuvant or salvage RT) is better, future studies should examine this issue. Whether immediate postoperative adjuvant RT is of value to patients is the subject of two randomized prospective studies. The benefit of adjuvant RT is a matter of controversy. Salvage RT treats only those patients with proven residual prostate cancer. The salvage RT approach has several advantages. This approach spares approximately 40% of patients who have had an RRP for T3 or T4 prostate cancer and eliminates the risks and costs associated with adjuvant RT. Additionally, it appears that the results of immediate adjuvant RT are similar to those achieved with early salvage RT.