早期乳腺癌根治术后不同剂量分割方案的放射治疗

目的 探讨早期乳腺癌根治术后或改良根治术后不同剂量分割放射方案的疗效。方法 367例早期乳腺癌根治术后放疗患者,根据术后放射治疗的不同剂量分割方案分为3组;常规分割组149例,2Gy／次,每日1次,每周5次,总DT50Gy;隔日照射组177例,3Gy／次,每周3次,总DT45Gy;快速照射组41例,第1天和第3天DT5Gy／次,第15天和第17天DT6．5Gy／次,总DT23Gy。共有257例接受了化疗和(或)内分泌治疗。结果 全组5年总生存率和无病生存率分别为87．4％和89．6％。常规分割组、隔日照射组和快速照射组的5年无病生存率分别为90．8％、86．5％和84．6％(P=0．16);局部区域复发率分别为2．7％、2．8％和2．4％,差异无显著性。结论 隔日照射可取得和常规分割照射同样的疗效;快速照射缩短了疗程时间,其疗效和毒副作用值得进一步研究。     

85例低发区鼻咽癌放射治疗分析

目的：评价低发区鼻咽癌放射治疗疗效及影响预后的因素,方法：放疗采用常规分割剂量连续放疗（每次DT200cGy,每周5次）,鼻咽放疗总剂量DT40－80Gy,平均65．62Gy。颈部N0DT40－50Gy,N1－3DT60－80Gy,随访至5年,生存率统计采用Kaplan-Meier法。结果85例总的1、2、3、4、5年累积生存率分别为75．3％、58．6％、40．7％、38％、363％。生存率随期别降低（P＝0．002）,女性较男性预后好（P＝0．06）。死亡52,死亡原因主要为鼻咽原发生或（和）颈部转移淋巴结复发或未控（22例,占42．3％）及远处转移（21例,占40．4％（）。结论①85例低发区鼻咽癌总的放射治疗疗效略差。②女性病人预后相对较。③鼻咽癌原发灶或（和）颈部转移淋巴结复发或（和）未控及远处转移均是死亡的主要原因。     

放射治疗50例骨转移癌疼痛的临床观察

[目的]探讨放射治疗不同分割方式对恶性肿瘤骨转移的止痛效果。[方法]50例骨转移癌患者，28例采用低分割照射，DT3Gy／次，4～5次／周．总DT30Gy：22例采用常规分割照射，DT2Gy／次，5次／周，总DT40Gy。[结果]68处骨转移灶放疗后止痛总有效率为94．1％（64／68），大剂量低分割组有效率为94．8％（37／39），常规分割剂量组有效率为93．1％（27／29）．两组止痛有效率比较差异无显著性（P〉0．05）。[结论]放射治疗对骨转移癌疼痛是一种好的止痛方法，大剂量低分割方式与常规分割方式放射治疗止痛疗效相近。     

不规则剂量分割放射治疗食管癌疗效分析

目的 评价不规则剂量分割放射治疗食管癌疗效。方法 80例食管癌随机分成二组，不规则剂量分割放射治疗组40例，周一2次，2．5Gy／次，间隔6小时以上，周二至周五，每天1次，1.5Gy／次。总剂量66Gy／36次，42-45天。常规分割放射治疗组，每周五次，2Gy／次。总剂量66Gy／33次，45—48天。全部病例均采用6MV—X线外照射。结果 两组近期疗效基本相似，1、2、3年生存率不规则剂量分割治疗组分别为71.1％、50.0％、36．8％，常规分割放射治疗组分别为47．4％、26．3％、15．8％。两者生存率的差异均有显著意义。结论 不规则剂量分割放射治疗组的生存率明显高于常规分割放射治疗组，表明不规则剂量分割放射治疗是食管癌治疗的一种有效的方法。     

96例青年鼻咽癌放射治疗疗效分析

目的：分析青年鼻咽癌放射治疗疗效。方法：从1986年1月到1990年10月，使用60COγ线治疗青年鼻咽癌96例。鼻咽部Dt64～80Gy～8周。颈部转移淋巴结DT60～70Gy／6～8周，预防剂量45Gy以上。结果：本组5年生存率为39．6％（38／96），Ⅱ、Ⅲ、Ⅳ期5年生存率分别为84．6％（11／13）47．4％（18／38）、20．0％（9／45）。结论：青年鼻咽癌病情进展快，颈淋巴结转移率高（86．4％），分次照射DT1．9～2Gy／次5年生存率高；淋巴结N3患者预后差。     

肺癌脑转移81例放射治疗的临床观察

目的：回顾性分析81例肺癌脑转移放射治疗效果和有关预后因素与生存的关系。方法：81例脑部转移灶照射DT19．8－65．0Gy,同时进行肺部原发灶照射12例DT35－60Gy。结果：本组肺癌脑转移患放射治疗后0．5、1和2年生存率分别为71．6％、25．9％和4．9％。结论：肺癌脑转移一旦确诊应进行以放射治疗为主的综合治疗,可以改善临床症状和延长生存时间。     

常规分割三维适形放疗结合介入治疗肝细胞癌伴门静脉癌栓的疗效

目的肝细胞癌伴门静脉癌栓预后极差,本研究的目的是评价常规分割三维适形放射治疗结合经皮介入肝动脉化疗栓塞治疗肝细胞癌伴门静脉癌栓的疗效.方法对32例不能手术切除的肝细胞癌伴门静脉癌栓患者采用三维适形放射治疗结合经皮介入肝动脉化疗栓塞治疗,三维适形放射治疗采用DT2 Gy/次,5次/周;根据肿瘤体积大小,给予DT45 Gy～60 Gy/23～30次,对于肿瘤体积比较大,不能耐受高剂量放射治疗的病人,在肝细胞癌伴门静脉癌栓达到处方剂量后,缩野针对门静脉癌栓加量至DT60 Gy/30次.观察近期疗效,用Kaplan-Meier法进行生存分析,采用COX比例风险模型作多因素分析.结果原发灶肿瘤缓解率68.8%,门静脉癌栓缓解率87.5%,1、2、3年累积生存率分别是56.3%、31.3%、21.9%,中位生存期15个月.多因素分析显示卡氏评分、Child分级是影响预后的主要因素(P＜0.05).血清转氨酶升高和放射性肝损伤是常见的并发症.结论常规分割三维适形放射治疗结合经皮介入肝动脉化疗栓塞治疗肝细胞癌伴门静脉癌栓有较好的疗效,肝功能Child分级、卡氏评分是影响预后的主要因素.     

局部复发性软组织肉瘤的疗效及预后

目的评价局部复发性软组织肉瘤的治疗效果并探讨其预后因素。方法采用单因素和多因素分析方法,对９６例局部复发性软组织肉瘤的临床、病理特征、治疗方法及其对预后的影响进行研究。肿瘤组织学分级为低分级者（Ｇ１）２０例,占２０．８％;高分级者（Ｇ２,３）７６例,占７９．２％。手术方式为广泛切除６６例,局部切除６例,截肢２４例。辅助放疗２４例,辅助化疗３６例。结果本院再次手术后５年局部控制率为７０．１％,５年生存率为５９．１％。多因素分析显示：肿瘤的分级、部位、大小,是影响生存率的独立的预后因素。结论强调对软组织肉瘤的首次合理治疗。广泛切除术的切缘应＞２ｃｍ。局部复发肿瘤经积极治疗仍可获得较满意效果。较有效的综合治疗方案有待进一步探索。     

三维适形放射治疗肺癌脑转移临床疗效观察

目的：通过观察脑转移三维适形放射治疗的结果，探讨三维适形放射治疗对非小细胞肺癌脑转移的临床意义。方法：1998年5月-2006年2月41例确诊肺癌脑转移患者，其中合并颅外转移18例，非颅外转移23例。所有患者首先经全脑放疗，2—3Gy／次，5次／周，DT30Gy-40Gy，然后行三维适形放射治疗局部加量，90％的等剂量曲线包括靶区，DT4—6Gy／次，总剂量12Gy-24Gy。结果：治疗有效率90．2％（37／41），中位生存期18月，半年生存率79．9％，1年生存率66．7％。结论：全脑放射治疗＋三维适形放射治疗可以提高脑转移的靶区剂量，并提高局部控制率，减少脑部复发的机会，同时颅外转移灶及原发灶的治疗也非常重要。     

食管癌全程三维适形后程加速超分割放疗的临床观察

目的：探讨全程三维适形后程加速超分割放疗治疗食管癌的疗效。方法：对24例食管癌患者进行三维适形放疗,2Gy／次,5次／周,至DT40Gy／20次／4周后改为1．5Gy／次,2次／日,行10次,总剂量DT70Gy／6周。结果：1、2、3年局控率为70．8％、62．5％、58．3％;1、2．3年生存率为79．1％、54．2％、41．6％。结论：食管癌患者采用三维适形后程加速超分割放疗可提高局控率和生存率,减轻正常组织损伤,不良反应可耐受。     

Organ motion in image-guided radiotherapy: lessons from real-time tumor-tracking radiotherapy

External radiotherapy using imaging technology for patient setup is often called image-guided radiotherapy (IGRT). The most important problem to solve in IGRT is organ motion. Four-dimensional radiotherapy (4DRT), in which the accuracy of localization is improved – not only in space but also in time – in comparison to 3DRT, is required in IGRT. Real-time tumor-tracking radiotherapy (RTRT) has been shown to be feasible for performing 4DRT with the aid of a fiducial marker near the tumor. Lung, liver, prostate, spinal/paraspinal, gynecological, head and neck, esophagus, and pancreas tumors are now ready for dose escalation studies using RTRT.     

国产威达（WD－H·D·R18）后装腔内治疗机的临床应用（附380例疗效观察）

我院自１９９２年６月至１９９３年６月使用广东威达（ＷＤ·Ｈ·Ｄ·Ｒ·１８型）后装腔内治疗机，施行腔内放疗、组织间插植、术中置管和表面敷贴放疗等方法，治疗各种癌瘤共３８０例，其近期疗效为：完全消失７９．７４％（３０３／３８０）部分消失：１４．７４％（５６／３８０）无效：５．５３％（２１／３８０）；总有效率：９４．４８％（３５９／３８０）。全组随诊时间为１－１２个月。结合临床应用的若干问题对该机作出初步评价。     

2019年中国大陆地区放疗人员和设备基本情况调查研究

[目的]了解我国大陆地区放疗人才及设备情况。[方法]2019年4月10日至9月20日期间,中华医学会放射肿瘤治疗学分会通过线上问卷的形式进行了全国第九次行业调查,调查2018年度全国各个医院从事放疗的人员、设备、技术、年放疗人次以及主要放疗病种等数据。[结果]本次问卷回收率100%,所有放疗单位数据通过各省医学会再次确认。中国大陆地区放疗单位1463家。从事放疗的工作人员共29096人,其中放疗医师14575人、物理师4172人、技师8940人、维修师1409人。共有直线加速器2021台(含进口和国产),钴60远距离治疗机66台,近距离治疗机339台,质子重离子机5台,常规模拟机1453台,CT模拟机355台。能开展二维放疗1002家,三维适形放疗1272家,静态调强放疗1121家,Rapid Arc145家,容积旋转调强放疗279家,立体定向放射治疗297家,近距离治疗273家,全身X线治疗75家,全身电子线治疗73家,Tomo治疗38家,质子/重离子治疗5家。病床数97836张(含综合医院肿瘤科病床),放疗年治疗人数1259602人。[结论]中国大陆地区放疗单位数目缓慢增长,放疗从业人员较前稍减少,开展放疗新技术单位逐年增加,全国每百万人口放疗设备(加速器+钴60)仅1.5,仍低于WHO的要求。     

Clinician's guide to prostate IMRT plan assessment and optimisation

Intensity-modulated radiotherapy (IMRT) offers dosimetric benefit for irregularly shaped treatment volumes compared to three-dimensional conformal approaches. Some groups advocate IMRT as the standard of care for prostate radiotherapy. For clinicians, assessment of an IMRT plan can introduce new opportunities and challenges. Although a standard IMRT plan may be deemed acceptable by meeting pre-set dose constraints, further optimisation may yield a superior treatment plan by further reducing dose to critical structures or improving target volume homogeneity. The aim of this article is to present aspects of IMRT planning relevant to clinicians to aid in plan critiquing.     

Evaluation of a Novel Field-placement Algorithm for Locoregional Breast Cancer Radiotherapy Including the Internal Mammary Chain

Aims

Irradiation of the internal mammary chain (IMC) is increasing following recently published data, but the need for formal delineation of lymph node volumes is slowing implementation in some healthcare settings. A field-placement algorithm for irradiating locoregional lymph nodes including the IMC could reduce the resource impact of introducing irradiation of the IMC. This study describes the development and evaluation of such an algorithm.

非小细胞肺癌3D-CRT与IMRT立体定向放疗剂量学比较

目的:研究三维适形(3D-CRT)和逆向调强(IMRT)两种计划方式在进行早期非小细胞肺癌(NSCLC)立体定向放射治疗(SBRT)的剂量学差异。方法:选取接受放射治疗的早期NSCLC患者12例,分别采用3D-CRT和IMRT技术设计SBRT治疗计划。比较两种计划方式下PTV的相关剂量学参数(CI、HI、D1%、D99%),肺、胸壁、心脏及脊髓的剂量学参数(Vx、Dmean、Dmax),以及加速器的机器跳数、治疗时间等差异。结果:在PTV相关参数比较中,3D-CRT计划的CI、HI以及D1%均差于IMRT,差异有统计学意义,P<0.05;但是两者的D99%差异无统计学意义,P>0.05。在危及器官受量的比较中,3D-CRT与IMRT计划的患侧肺V5～V40、健侧肺V5～V15、双侧肺V5～V40、胸壁V5～V40、Dmean、心脏V20～V40、Dmean及脊髓Dmax的差异均无统计学意义,P>0.05。3D-CRT计划的机器跳数及治疗时间较IMRT计划分别减少了53%和78%,P<0.05。在绝对剂量体积比较中,3D-CRT的V60～V75及V45～V60均大于IMRT,V20～V45小于IMRT,差异均无统计学意义,P>0.05。结论:IMRT计划在早期NSCLC行SBRT治疗中不具有明显的剂量学优势。考虑到IMRT实施过程的复杂性和不确定性,早期NSCLC行SBRT治疗时3D-CRT可作为首选。     

The Long and the Short of it: the Role of Short-course Radiotherapy in the Neoadjuvant Management of Rectal Cancer

Total mesorectal excision is the cornerstone of treatment for rectal cancer. Multiple randomised trials have shown a reduction in local recurrence rates with the addition of preoperative radiotherapy, either as a 1-week hypofractionated short-course (SCRT) or a conventionally fractionated long-course (LCRT) schedule with concurrent chemotherapy. There is also increasing interest in the addition of neoadjuvant chemotherapy to radiotherapy with the aim of improving disease-free survival. The relative use of SCRT and LCRT varies considerably across the world. This is reflected in, and is probably driven in part by, disparity between international guideline recommendations. In addition, different approaches to treatment may exist both between and within countries, with variation related to patient, disease and treatment centre and financial factors. In this review, we will specifically focus on the use of SCRT for the treatment of rectal cancer. We will discuss the literature base and current guidelines, highlighting the challenges and controversies in clinical application of this evidence. We will also discuss potential future applications of SCRT, including its role in optimisation and intensification of treatment for rectal cancer.     

A Randomised Phase II Clinical Trial Comparing the Deliverability and Acute Toxicity of Wide Tangent versus Volumetric Modulated Arc Therapy to the Breast and Internal Mammary Chain

AimsInclusion of the internal mammary chain in the radiotherapy target volume (IMC-RT) improves disease-free and overall survival in higher risk breast cancer patients, but increases radiation doses to heart and lungs. Dosimetric data show that either modified wide-tangential fields (WT) or volumetric modulated arc therapy (VMAT) together with [AQ1]voluntary deep inspiration breath hold (vDIBH) keep mean heart doses below 4 Gy in most patients. However, the impact on departmental resources has not yet been documented. This phase II clinical trial compared the time taken to deliver IMC-RT using either WT and vDIBH or VMAT and vDIBH, together with planning time, dosimetry, set-up reproducibility and toxicity.Materials and methodsLeft-sided breast cancer patients requiring IMC-RT were randomised to receive either WT(vDIBH) or VMAT radiotherapy. The primary outcome was treatment time, powered to detect a minimum difference of 75 min (5 min/fraction) between techniques. The population mean displacement, systematic error and random error for cone beam computed tomography chest wall matches in three directions of movement were calculated. Target volume and organ at risk doses were compared between groups. Side-effects, including skin (Radiation Therapy Oncology Group), lung and oesophageal toxicity (Common Terminology Criteria for Adverse Events v 4.03) rates, were compared between the groups over 3 months. Patient-reported outcome measures, including shoulder toxicity at baseline, 6 months and 1 year, were compared.ResultsTwenty-one patients were recruited from a single UK centre between February 2017 and January 2018. The mean (standard deviation) total treatment time per fraction for VMAT treatments was 13.2 min (1.7 min) compared with 28.1 min (3.3 min) for WT(vDIBH). There were no statistically significant differences in patient set-up errors in between groups. The average mean heart dose for WT(vDIBH) was 2.6 Gy compared with 3.4 Gy for VMAT(vDIBH) (P = 0.13). The mean ipsilateral lung V_17Gy was 32.8% in the WT(vDIBH) group versus 34.4% in the VMAT group (P = 0.2). The humeral head (mean dose 16.8 Gy versus 2.8 Gy), oesophagus (maximum dose 37.3 Gy versus 20.1 Gy) and thyroid (mean dose 22.0 Gy versus 11.2 Gy) all received a statistically significantly higher dose in the VMAT group. There were no statistically significant differences in skin, lung or oesophageal toxicity within 3 months of treatment. Patient-reported outcomes of shoulder toxicity, pain, fatigue, breathlessness and breast symptoms were similar between groups at 1 year.ConclusionVMAT(vDIBH) and WT(vDIBH) are feasible options for locoregional breast radiotherapy including the IMC. VMAT improves nodal coverage and delivers treatment more quickly, resulting in less breath holds for the patient. This is at the cost of increased dose to some non-target tissues. The latter does not appear to translate into increased toxicity in this small study.     

Radiothérapie adaptative : stratégies et bénéfices selon les localisations tumorales

Adaptive radiotherapy (ART) is a complexe image-guided radiotherapy modality that comprises multiple planning to account for anatomical variations occurring during irradiation. Schematically, two strategies of RTA can be distinguished and combined according to tumor locations. One or more replanning can be proposed to correct systematic variations such as tumor shrinkage. A library of treatment plans with day-to-day plan selection from cone-beam CT imaging can also be proposed to correct random variations such as uterine motion or bladder/rectum volume changes. Because of strong anatomical variations occurring during irradiation, RTA appears therefore particularly justified in head and neck, lung, bladder, cervical and rectum and pancreas tumors, and to a lesser extent for prostate tumors and other digestive tumors. For these tumor locations, ART provides a fairly clear dosimetric benefit but a clinical benefit not yet formally demonstrated. ART cannot be proposed in a routine practice but must be evaluated medico-economically in the context of prospective trials. A rigorous quality control must be associated.