三维适形放疗结合252锎中子腔内后装照射治疗中晚期食管癌的临床研究

目的:探讨三维适形放疗结合锎(252Cf)中子腔内后装照射治疗中晚期食管癌的疗效、不良反应及晚期并发症。方法:92例中晚期食管癌患者全部采用三维适形放疗结合锎(252Cf)中子腔内后装照射治疗。三维适形放疗总剂量为45Gy-54Gy,分25-30次,5-6周完成;腔内照射3-4Gy/次,1次/周,共2-4次,总吸收剂量10Gy-16Gy。结果:治疗结束3个月进食梗阻缓解率为95%。近期疗效:完全缓解(CR)27%,部分缓解(PR)69.6%。1、2、3年局部控制率分别为82%、51%、32%;1、2、3年生存率分别为:78%、35%、18%;急性放射性食管炎发生率为54%;晚期食管狭窄发生率9%;食管穿孔发生率2%。结论:中晚期食管癌采用三维适形放疗结合锎(252Cf)中子腔内后装照射能够迅速而持久地缓解进食梗阻症状,提高局部控制率及生活质量,近期疗效显著,放疗不良反应未见明显增加。     

外照射配合^252锎中子射线腔内照射治疗食管癌的临床观察

目的观察外照射与252锎中子射线内照射结合治疗食管癌的疗效及不良反应。方法对50例局部中晚期食管癌初治患者进行前瞻性随机分组研究。大分割组：外照射40 Gy后,开始内外照射同期进行,每周六加一次内照射,内照射5 Gy/次,1次/周,共10 Gy/2次;小分割组：外照射30 Gy后,即开始内外照射同期进行,每次3.5 Gy,1次/周,共10.5 Gy/3次。两组外照射总量均为50 Gy,均采用常规分割照射,2 Gy/次,1次/日,5次/周。结果大、小分割组1、3、5年局控率分别为72.73%、58.18%、48.48%和77.52%、46.96%、41.74%（P=0.622）,1、3、5年生存率分别为81.82%、40.91%、27.27%和75.00%、32.14%、28.57%（P=0.92）;大、小分割组急性放射性食管炎发生率分别为90.90%和92.90%（P=0.80）,晚期放射性食管炎发生率分别为81.80%和50.00%（P=0.02）。结论两组局控率及生存率相当,但大分割组晚期放射性食管炎发生率明显高于小分割组。     

252Cf中子腔内后装加体外照射治疗食管癌的临床研究

目的 比较锎(252Cf)中子腔内后装加体外照射与单纯体外照射治疗食管癌的疗效、副反应及晚期并发症.方法 将86例患者随机均分成252Cf中子腔内后装加体外照射(腔内组)与单纯体外照射(外照组)组.外照组采用医科达医用直线加速器三维适形或常规体外照射,总剂量DT70Gy分35次7.0周完成.腔内组外照射方式、方法同外照组,但总剂量DT60 Gy分30次6.5周完成另加腔内照射.腔内照射方法是经口置特制带水囊的食管施源器于食管病变部位,以距离源10 mm处为剂量计算参考点,病变上下两端外放1～2 cm;4 Gy/次,1次/周,共3～4次.先中子治疗,第2天开始外照射,腔内与外照射同步,腔内治疗之日不进行外照射.结果 治疗后进食阻挡改善者腔内组明显早于外照组,腔内组中6例进水困难者经1次食管球囊扩张、252Cf中子腔内治疗加外照射5～6 d即可进流食,2周后进软食.结束后3个月完全缓解率、部分缓解率和无改变率腔内组分别为33%、67%和0%,外照组分别为19%、76%和5%,两组近期有效率分别为100%和95%(χ2=4.32,P＜0.05).腔内组和外照组1年局部控制率分别为84%和70%(χ2=4.57,P＜0.05);1年生存率分别为81%和61%(χ2=4.17,P＜0.05);急性放射性食管炎发生率61%、51%;(χ2=1.75,P＞0.05)和晚期食管狭窄发生率5%、7%;(χ2=0.35,P＞0.05)相似.结论 食管癌采用252Cf中子腔内后装加体外照射治疗的疗效优于单纯体外照射,且未明显增加放疗副反应.     

三维适形放疗结合252锎中子腔内后装照射治疗中晚期食管癌的临床研究

目的：探讨三维适形放疗结合锎（252Cf）中子腔内后装照射治疗中晚期食管癌的疗效、不良反应及晚期并发症。方法：92例中晚期食管癌患者全部采用三维适形放疗结合锎（252Cf）中子腔内后装照射治疗。三维适形放疗总剂量为45Gy-54Gy,分25-30次,5-6周完成;腔内照射3-4Gy/次,1次/周,共2-4次,总吸收剂量10Gy-16Gy。结果：治疗结束3个月进食梗阻缓解率为95%。近期疗效：完全缓解（CR）27%,部分缓解（PR）69.6%。1、2、3年局部控制率分别为82%、51%、32%;1、2、3年生存率分别为：78%、35%、18%;急性放射性食管炎发生率为54%;晚期食管狭窄发生率9%;食管穿孔发生率2%。结论：中晚期食管癌采用三维适形放疗结合锎（252Cf）中子腔内后装照射能够迅速而持久地缓解进食梗阻症状,提高局部控制率及生活质量,近期疗效显著,放疗不良反应未见明显增加。     

体外照射联合^252Cf中子后装治疗T1、T2期鼻咽癌的临床研究

目的比较单纯常规体外照射与体外照射联合^252Cf中子后装治疗T1、T2期鼻咽癌原发灶的局部控制疗效和并发症。方法对30例初治的T1期和部分T2期鼻咽癌病例进行体外照射联合^252Cf中子后装治疗。结果全部病例随访2年,鼻咽局部复发2例,2年局部控制率93．3％,远处转移4例,张口困难2例,无一例患者发生软腭穿孔。结论体外照射联合^252Cf中子后装治疗鼻咽癌,增加了鼻咽腔内照射剂量,提高了局部控制率,减少了鼻咽癌外照射剂量,有利于降低张口困难的发生率。     

Predictive value of specimen histology after preoperative radiotherapy in the treatment of bulky/barrel carcinoma of the cervix.

One hundred thirty-four patients with bulky and barrel-shaped cervix cancers were treated with preoperative radiation to 40-45 Gy, intracavitary therapy using Cs-137 or Cf-252 and extrafascial total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) 4-6 weeks after radiotherapy. Outcome of therapy was traced for patients with residual tumor (positive) in the hysterectomy specimen and those who had no residual tumor (negative) in the specimens. All specimens were studied by a set protocol to carefully evaluate the TAHBSO specimen for gross or residual tumor. Ninety-two percent of the patients with negative specimens survived 5 years, but this dropped to 71% if the specimen was positive. These findings were observed in both the Cs-137- and Cf-252-treated patients. Patients with negative specimens failed mainly in distant sites, whereas those with positive specimens failed locally and distantly. Patient survival was less in patients with positive specimens. There was no difference in outcomes for adenocarcinoma and squamous cell carcinomas. The specimen histological findings have predictive value in patients treated with preoperative radiation and surgery.     

A contribution to the comparison of the efficacy of radiotherapeutic procedures in cervical carcinoma.

This paper presents a new method in which the regression velocity of cervical carcinoma is measured by computer tomography and the results evaluated by two statistical methods: non-linear regression analysis and survival analysis. By means of this approach it was possible to compare the early effect of therapy in patients treated with intracavitary application of 226Ra plus external radiotherapy with those treated with 252Cf, 226Ra and extended radiotherapy. In the latter group a higher efficacy of the therapy was demonstrated by both statistical methods. As the timing between external and intracavitary radiotherapy was different in the two groups and as 252Cf contributed to a rather small part of the total radiation dose it could not be concluded that the difference in efficacy really was due to 252Cf. Of essential interest was, however, that an obvious difference in efficacy could be found between two slightly different treatment techniques. The statistical procedure called survival analysis, used here parallelly with weighed regression analysis seemed to give better results than a classical regression analysis and can thus be recommended for processing of clinical data of the type which is discussed in this paper.     

Neutron therapy of endometrial cancer using californium-252 sources of high activity

Endometrial cancer patients received intracavitary irradiation from the Anet-B installation using a high-energy 252-Cf source. Radical complex radiotherapy was given to 30 patients and radical-dose intracavitary irradiation--to 14 only. Incomplete palliative radiotherapy was carried out in 6 cases. Intracavitary radiation treatment preceded extirpation of the uterus and appendages in 10 cases. The complex radiotherapy proved effective in 93% of patients with stage I, II and III endometrial tumors.     

Study of acute 60Co, low dose rate CF-252 and CS-137 radiation on LSA ascites lymphoma in vivo

Dose response curves were determined for the LSA lymphoma for acute 60Co, low dose rate Cs-137 and Cf-252 radiations using in vivo survival time bioassay. Mean survival times increased with dose with a prominent oxygen effect noted for acute 60Co and Cs-137. OER was lowest for Cf-252 where it was approximately 1.4. The RBEn for oxic LSA cells to Cf-252 neutrons was 3.1 for acute 60Co and 4.2 for Cs-137. It was larger for hypoxic tumor and RBE was 5.3 for 60Co and 5.8 for Cs-137. Survival curves based on survival data used a multitarget dose-response model for photon radiation and exponential dose-response for Cf-252 radiation. When LSA was irradiated in advanced tumor stages in vivo, Cf-252 was much more effective than acute 60Co or LDR Cs-137 for increasing survival time. Tumor response in vivo matched the in vitro irradiated tumor data. No schedule dependence was observed for mixing of 60Co and Cf-252 radiations.     

Feasibility study: Results of treatment of primary and recurrent adenocarcinoma of the corpus uteri with Californium-252

A trial of Cf-252 for the radiotherapy of primary or recurrent corpus adenocarcinoma was carried out at the University of Kentucky. The patients with primary tumors were of advanced age, poor general medical condition, and had multiple chronic medical illnesses, poorly differentiated tumors and/or metastatic Stage IVB disease. Fourteen patients with primary tumors were treated and all achieved complete local tumor control. The five year actuarial disease-free survival rate by the Kaplan-Meier method was 100% for Stage I-III disease, although 36% died of other, usually medical, causes. For eight patients treated with recurrent tumors, long term tumor control was 40% four year actuarial disease survival. Local control was 100% for vault recurrences of 3 cm diameter size, but only 6/8 (75%) cleared their pelvic tumors completely. Those that did not had tumors of massive size, distant metastatic disease and adenosquamous or poorly-differentiated (G3) pattern. One additional cut across, infected tumor was controlled for 26 months. Corpus carcinoma was highly sensitive to Cf-252 neutron radiation therapy.     

早中期鼻咽癌外照射联合腔内放疗长期疗效的前瞻性研究

[目的]探讨Ⅰ、Ⅱ期鼻咽癌患者采用单纯外照射放疗与外照射加腔内联合放疗的长期疗效。[方法]前瞻性研究453例Ⅰ、Ⅱ期鼻咽癌患者,随机分为单纯外照射组297例,联合照射组156例;单纯外照射组采用低熔点铅挡块不规则野照射,常规照射,常规分割,总剂量为66～74Gy;联合照射组采用同样的外照射方法,总剂量给予58～62Gy,并给予15～20Gy腔内近距离放疗。[结果]单纯外照射组和联合照射组的5年鼻咽局控率分别为Ⅰ期92.86%、96.43%（P=0.35）,Ⅱ期89.02%、94.53%（P=0.01）;5年总生存率分别为Ⅰ期88.10%、92.86%（P=0.27）,Ⅱ期81.18%、90.63%（P=0.03）。口干和张口困难的毒副反应联合照射组比单纯外照射组轻。[结论]Ⅰ、Ⅱ期鼻咽癌患者采用常规外照射联合腔内放疗相对单纯常规放疗有较好的疗效,并可减轻毒副反应。     

Specimen histology after one or two preoperative CF-252 implants for bulky stage IB cervical cancer

Using hysterectomy specimens obtained 1 month after Cf-252 neutron brachytherapy plus fractionated radiotherapy, we determined the fraction of positive and negative specimens with neutron dose for bulky Stage IB cervical cancers. The specimens obtained and studied after an initial Cf-252 insertion when the sources were newer and less decayed were more frequently negative for histological evidence of cancer than after the sources had decayed and 2 insertions were needed. After two insertions to deliver a therapeutic dose preoperatively the specimens were more frequently positive. When a larger initial dose was delivered to the tumor a larger proportion of negative specimens was noted. The size of neutron dose fraction was important to local tumor clearance and to rendering the specimens negative as well as schedule in use.     

A clinical trial for advanced cervico-vaginal pelvic carcinomas using Californium Cf-252 fast neutron therapy: report of early responses

This report summarizes clinical experiences with Californium (Cf) 252 for the radiotherapy of advanced cervicovaginal carcinomas at the University of Kentucky Medical Center from November 1976 to April 1979. Fifty-nine patients were treated with Cf-252 during this period. After pilot studies, a treatment schedule was developed which appeared to offer improved local control and clearance of these tumors in ～90% of treated patients. However, a longer follow-up period is essential to determine whether local tumor control is sustained or whether local tumor recurrence remains as great a problem as for patients who receive conventional radio-nuclide therapy. Ultimate long term survival and outcome will depend upon the frequency of control of local-regional disease and the frequency of appearance of more disseminated and metastatic disease. Cf-252 neutron brachytherapy was combined with 4500–5500 rad of Cobalt 60 or linear accelerator external beam fractionated radiotherapy for 4–6 weeks. Neutron treated patients whose disease was in appropriate clinical stages were also treated with combined radiotherapy-surgery without problems. Stage dependent regression was noted; low stage tumors responded distinctly better and more rapidly than higher stage tumors. All histological patterns responded, and no unusual severe or unanticipated early side effects or toxic tissue reactions were observed.     

A tumor/normal tissue advantage for low dose rate neutron brachytherapy

Reports on clinical study of Cf-252 pelvic brachytherapy are reviewed and show that complication frequency is low. Low dose rate (LDR) neutron brachytherapy has been shown to be effective against cervical and advanced pelvic cancers; and produces 5 year cures without a high frequency of normal tissue complications. This is attributed to a high relative biological effectiveness (RBE) for the bulky, hypoxic tumor which along with an oxygen enhancement ratio (OER) advantage and dose-rate independent effects, produces rapid tumor regression and good local tumor control. Adjacent normal tissues which are oxygenated have lower RBE values than that of hypoxic tumors. Cf-252 brachytherapy increases the dose differential, therapeutic gain and the probability of local tumor control, since the high RBE of Cf-252 for hypoxic tumor is much less in normal tissues. Cf-252 radiation concentrated in the tumor, and for this reason, has had much fewer attendant normal tissue complications compared to neutron beam therapy.     

鼻咽癌放疗完全缓解后腔内照射补量

目的研究鼻咽癌放疗完全缓解后腔内照射补量的剂量效应关系。方法1992年2月~1999年12月92例根治性放疗65~70Gy后完全缓解T1、T2患者行近距离腔内补量照射,1975年11月~2000年12月收治的根治性放疗后完全缓解未进一步治疗的T1、T2患者206例为对照。结果T1、T2根治性放疗后完全缓解未加量组、根治性放疗后完全缓解腔内补量组5年生存率分别为78.28%、85.14%。根治性放疗后完全缓解腔内补量<80Gy者与≥80Gy者5年生存率分别为78.2%、85.9%。结论早期鼻咽癌传统根治性放疗后相对抗拒肿瘤腔内补量提高了局部控制,可进一步改善生存。     

The tolerance dose of the urinary bladder

The tolerance dose of the urinary bladder was estimated by studying the late injury of the urinary bladder in 79 cases of the carcinoma of the urinary bladder treated by external irradiation, in 253 cases of the uterine cervix treated by conformation radiotherapy technique or two-axes arc therapy combined with low-dose rate intracavitary irradiation of small doses, and 55 cases of the carcinoma of the uterine cervix treated by low-dose rate intracavitary irradiation combined with whole pelvic irradiation with the center splitter. As a result, the tolerance dose in case of radiotherapy of the carcinoma of the urinary bladder was revealed to be as low as TDF 100. The tolerance dose in case of radiotherapy of the carcinoma of the uterine cervix treated mainly by conformation radiotherapy technique or two-axes arc therapy was proved to be TDF 110-120, and treated mainly by intracavitary irradiation 120 or over.     

外照射联合锎－252腔内放疗在食管癌放疗后复发患者中的应用

目的：分析食管癌放疗后复发患者应用再程外照射放疗联合锎－252腔内放疗的价值。方法：选择2011年5月至2014年5月符合纳入标准的食管癌放疗后复发患者60例,分为实验组（外照射＋腔内）30例和对照组（单纯外照射）30例。比较两组患者近期缓解率、前2年生存率和不良反应。结果：实验组与对照组治疗结束后,患者近期缓解率分别为86．2％（25／29）和75．0％（21／28）,有统计学差异（P＜0．05）;治疗组第1、2年生存率分别为24．1％和21．4％,无明显统计学差异（P＞0．05）;两组患者不良反应发生情况比较实验组的不良反应主要表现为放射性食管炎和食管穿孔,对照组表现为放射性肺炎的发生率提高。结论：外照射联合锎－252腔内放疗可以提高食管癌放疗后局部复发患者的局控率,同时食管穿孔的风险增大。     

Five-year cure of cervical cancer treated using californium-252 neutron brachytherapy

Female pelvic carcinoma is one of the common malignancies seen at the University of Kentucky Medical Center and often presents in an advanced stage. In 1976, we began to test californium-252 neutron brachytherapy (NT) for its efficacy for control of primary and recurrent advanced uterine, cervix, and vaginal cancers. The first protocol used was 5000-5500 rad of whole pelvis irradiation followed by 1-2 Cf-252 insertions using a single tandem placed in the utero-cervico-vaginal region. Of 27 patients with primary carcinomas treated, 10 are alive and well 5 years later (37%). Two of two recurrent tumors were locally controlled but failed later. These patients had advanced cervical, vaginal, or endometrial carcinomas. In 1977, a transitional year, treatment of only unfavorable stages and presentations with NT was initiated. Similar results were obtained with NT as compared to conventional photon therapy (PT). Further improvement in treatment results can be anticipated as NT brachytherapy is used for advanced cancer therapy by more effective treatment schedules and radiation doses. Cf-252 can be used as a radium substitute and achieved similar rates of tumor control and 5-year survivals.     

放射治疗结合热疗治疗宫颈癌的疗效观察

目的:观察放射治疗加热疗治疗宫颈癌的临床效果。方法:将66例经病理确诊的宫颈癌患者随机分为两组:放射治疗 热疗组(热放组)33例和单纯放射治疗组(单放组)33例。两组的放射治疗方法一样:全盆照射 盆腔四野照射 腔内后装放疗。热放组采用了射频深部热疗和微波腔内热疗,热疗每周1次至2次,直至放疗结束。每次热疗均在放疗后30分钟内开始。结果:热放组和单放组的局部控制率(CR)分别为84．8％和 60．6％,有显著性差异(P<0．05)。1年、2年的生存率两组无显著差异(P>0．05),但3年生存率分别为84．8％和 63．6％,有着显著性差异(P<0．05)。结论:放射治疗结合热疗可提高宫颈癌患者的局部控制率和生存率。     

Results of stage III carcinoma of the uterine cervix treated by conformation radiotherapy

From 1967 through 1982, 206 patients with stage III carcinoma of the uterine cervix were treated by conformation radiotherapy. In the first half of the period (group A), external irradiation alone was used, while in the second half (group B), intracavitary irradiation with a low dose-rate was applied in combination with external irradiation. The two-year local control rate was 56.9% in group A and 81.5% in group B. With the combined use of intracavitary irradiation, the five-year actuarial survival rate was also improved from 45.5% in group A to 59.7% in group B. At the same time, the frequency of late injury of the rectum, sigmoid colon and the urinary bladder was also decreased with the use of small sources. It can be concluded that the combined application of intracavitary irradiation and external irradiation is important to improve the treatment results of stage III carcinoma of the uterine cervix.