头颈部肿瘤放疗后口腔粘膜反应护理

1 临床资料 2007年1月～2007年12月统计科室共收治头颈部肿瘤11例,其中鼻咽癌3例,恶性淋巴瘤3例,腮腺癌2例,上颌窦癌1例,舌下腺癌1例,颊粘膜癌1例.男性8例,女性3例,年龄在31～78岁之间,平均年龄50岁.均采用直线加速器6MVX线照射,200cGy/次,5次/周,原发灶、颈部转移灶DT(60～70)Gy/(6～7)周,颈部预防量DT45～50Gy/4.5～5周.     

放射增敏剂醚醇硝唑在肿瘤病人放疗中的应用

大量实验材料证明,使用放射增敏剂醚醇硝唑(misonidazole)可以增加乏氧肿瘤细胞对射线的敏感性,从而提高对肿瘤治疗的效果。本文报告将此药用于12例中晚期癌症病人(肺鳞癌8例,转移性肺鳞癌1例,小细胞未分化肺癌1例,恶性黑色素瘤2例)的观察结果。患者一般情况中等,无神经系统疾患。给药方法:口服醚醇硝唑1.2g,装于胶囊内,每周二次,共5周。黑色素瘤病人加用10～20%醚醇硝唑溶液10～20ml局部涂布3次。临床应用结果:对肺鳞癌病人有一定效益,特别是对肺不张的复张所需的累积照射剂量明显减少,与对照组比较P<0.01。一例黑色素瘤病人的疗效显著。醚醇硝唑的毒性作用不明显,有轻微的恶心,一过性的食欲减退,占服药病人的5/11,未见神经系统并发症。病人服药后采耳血,用高效液相色谱法测定血中醚醇硝唑浓度(平均高峰值39μg/ml,峰时2.5h),据此来调整病人的照射时间,以期取得最佳放射增敏效果。     

根治性放疗后复发再放疗的放射耐受性

临床工作中经常会遇到照射野内肿瘤复发、第 2原发或邻近照射野的第 2原发肿瘤的根治性放疗问题 ,这需要了解根治性放疗后较长时间内组织器官的放射性损伤的修复和对再放射的耐受性问题。同一部位的再放疗 ,特别是根治性放疗后的再放疗通常认为会带来不可逆转的放射损伤而被认为是禁忌的 ,但近来越来越多的实验研究和临床资料表明许多正常组织对放射损伤是能够修复的 ,因而对“禁忌论”提出了挑战。尽管如此 ,放射肿瘤学家仍心有余悸 ,这主要是因为缺乏第一程放疗的确切数据如放疗的时间、剂量、组织照射后修复放射损伤的时间等等。是否要进…     

胸部肿瘤放疗致放射损伤的防治

近年来 ,肿瘤的发病率逐年升高 ,约 6 5 %～ 75 %的病人需要放射治疗[1 ] 。由于综合治疗的应用 ,患者生存期延长 ,放疗所致胸部病变也相应增加 ,临床上出现了一些误诊误治现象[2 ] 。笔者收集和分析了 116 5例胸部肿瘤病人的资料 ,现报道如下。一、材料和方法1 临床资料 :收集了 1994年 1月～ 2 0 0 2年 12月有完整的影像学资料的胸部肿瘤病人 116 5例。其中肺癌 30 5例、食管癌 2 99例、乳癌 4 0 8例、鼻咽癌 10 2例、淋巴瘤 4 0例、淋巴结转移癌 11例。男性 6 6 4例 ,女性 5 0 1例。年龄 2 3～ 78岁 ,平均 5 8岁。所有病例都接受了化疗。…     

一例从事放疗工作人员放射反应的处理

某女,39岁,于1997年3月从事60Ｃｏ机放疗工作,日工作量较大。半年后自感乏力,易感冒,关节酸痛,消瘦。1997年5月13日经本院查血常规:白细胞29×109/Ｌ,红细胞464×1012/Ｌ,血红蛋白126ｇ/Ｌ。1个月后再次复查白细胞30×109/Ｌ～38×109/Ｌ,骨髓象大致正常,于1998年4月16日住本院内科诊治。住院期间无发热、恶心、呕吐、气短现象。既往史,家庭史无特殊记载。住院后经用升血等药物综合治疗1个月,白细胞43×109/Ｌ～44×109/Ｌ,患者于1998年5月17日出院,诊断为白细胞减少症。并建议避免接触放射性物质。患者于1998年6月14日脱离放射性岗位,调高…     

放疗后发生急性放射性肺炎1例

放射性肺炎在临床工作中经常遇到,治疗方法各异,现将我院治疗的一例报道如下。 患者,男,68岁,诊断右肺中上叶肺癌并肺气肿,纵瞒淋巴结转移,于1993年8月30日在全麻下行肺癌根治术,病理报告:鳞状细胞癌、两端切线、淋巴结1/2查见癌。     

鼻咽癌放疗后继发性皮肤晚期放射损伤

目的 通过分析皮肤早期放射反应对皮肤晚期放射反应的影响,探讨皮肤的继发性晚期放射损伤。方法 对门诊随访的放疗后生存5年以上的335例鼻咽癌患者进行调查研究,其中放疗时中位年龄41岁(12～67岁),240例伴颈部淋巴结转移。鼻咽原发灶首程放疗中位剂量为70Gy(55～86Gy),以面颈野为主野放疗71例,以耳前野为主野放疗264例。颈部根治性放疗中位剂量为64Gy(46～72Gy),预防照射中位剂量为55Gy(21～67Gy)。48例合并化疗。根据1995年SOMA标准评价皮肤晚期放射反应。结果 随访间隔中位时间为14年(5～38年)。63例无皮肤晚期反应,1、2、3、4级皮肤晚期反应发生率分别为43.9%(147例)、20.9%(70例)、13.7%(46例)、2.7%(9例)。44例放疗中出现湿性脱皮反应,其中1、2、3、4级皮肤晚期反应发生率分别为41%(18例)、23%(10例)、30%(13例)和5%(2例);无湿性脱皮患者的相应发生率分别为44.3%(129例)、20.6%(60例)、11.3%(33例)和2.4%(7例),两者差异有统计学意义(χ²=17.42,P=0.002)。分层分析结果显示初诊时是否伴颈部淋巴结转移、放疗野及颈部淋巴结放疗剂量均对皮肤晚期反应发生有关,而性别、年龄及是否联合使用化疗与皮肤晚期反应的发生无关。 结论 严重的皮肤早期放射反应可能增加皮肤晚期放射反应,可能存在继发性皮肤晚期放射损伤。     

Radiation Induced Lung Reactions in Breast Cancer Therapy

BACKGROUND AND PURPOSE: Radiologic reactions in lung, usually subclinical, are a frequent side effect of radiotherapy for breast cancer. This study was initiated to identify effects of age and tamoxifen on radiation pneumonitis and consequent fibrosis. PATIENTS AND METHODS: Retrospectively, 451 patients irradiated postoperatively between 1992 and 1995 at the Department of Radiotherapy of Carl-Thiem-Klinikum (Cottbus, Germany) were analyzed. The median age was 58 years. After mastectomy (n = 296), 25 x 2.0 Gy were applied; breast-conserving surgery (n = 155) was followed by 30 x 2.0 Gy. In 221 patients, adjuvant tamoxifen was given. Follow-up included thorax radiography after 15 weeks and 1 year. In patients with reversible observations in standard chest radiography from 15 weeks to 1 year, CT or high-resolution (HR-)CT scans were analyzed after 4-7 years. RESULTS: Clinical symptoms of pneumonitis were seen in 25 patients (5.5%), all with radiologic changes. Early radiologic changes were detected in 134 patients (29.7%). Age (> 58 years; p = 0.0127) and tamoxifen (p = 0.0001) were found as significant parameters of early pneumopathy. Late radiologic changes were seen in 94/425 patients (22.1%), all after a positive early reaction (p = 0.001). CONCLUSION: A low incidence of clinically symptomatic pneumonitis was observed, while the vast majority of patients presented with early radiologic changes. Higher age and tamoxifen treatment significantly increased the incidence of early pneumopathy. Local fibrotic responses must be expected in all patients with early reactions, indicating a strong consequential component of the late reaction.     

中晚期恶性肿瘤患者的血尿酸水平观察

目的：观察中晚期癌症患者的血尿酸水平,通过与传统的营养评估指标如血白蛋白,IBW%（实际体重/理想体重）,前白蛋白,淋巴细胞总数,转铁蛋白等进行对比,旨在了解血尿酸水平的变化能否反映中晚期恶性肿瘤患者的营养状况的变化。方法：对近1年我院住院的78例中晚期肿瘤患者进行身高,体重,血尿酸,血白蛋白,IBW%（实际体重/理想体重）,前白蛋白,淋巴细胞总数,转铁蛋白的测定,并进行比较。结果：通过传统的营养评估指标,观察到78例中晚期肿瘤患者中营养不良有58例,发生率74.2%,低尿酸血症有67例,发生率85.7%。结论：尿酸降低能反映中晚期肿瘤患者的营养不良状况、尿酸水平能够作为肿瘤营养不良的一个评估指标,并且与血白蛋白、IBW%等指标相比,能更早期的反映患者的营养不良状况。     

Percutaneous Placement of Peritoneal Port-Catheter in Patients with Malignant Ascites

We report our experience with a radiologically placed peritoneal port-catheter in palliation of malignant ascites. Port-catheters were successfully placed under ultrasonographic and fluoroscopic guidance in seven patients (five women, two men) who had symptomatic malignant ascites. The long-term primary patency rate was 100%. The mean duration of catheter function was 148 days. Seven patients had a total of 1040 port-days. Two patients received intraperitoneal chemotherapy via the port-catheter. There were no procedure-related mortality and major complications. Minor complications such as ascitic fluid leakage from the peritoneal entry site, migration of the catheter tip to the right upper quadrant, and reversal of the port reservoir occurred in four patients. None of these complications affected the drainage and required port explantation. In patients with symptomatic malignant ascites, a peritoneal port-catheter can provide palliation and eliminate multiple hospital visits for repeated paracentesis with high patency and low complication rates.     

恶性肿瘤病人医院内感染回顾性调查分析

目的了解医院恶性肿瘤病人医院内感染率,顺位及相关因素,为降低医院感染率提供可靠依据。方法对南充市中心医院2008～2011年住院3天以上的恶性肿瘤病人进行回顾性调查分析。结果 4年中住院3天以上的恶性肿瘤病人1832人,发生院内感染372例,感染部位以下呼吸道为主。年龄大,住院时间长,抗生素滥用,有手术史的恶性肿瘤病人发生率高。结论恶性肿瘤病人医院内感染与病人年龄,住院天数,侵入性治疗,抗生素使用有相关性。     

Radiation Effects on K+-activated Metabolic Reactions

Abstract

Purpose: The aim of this study was the evaluation of induced DNA damages of human prostate cancer cells, DU-145, treated with a combination of radiofrequency capacitive hyperthermia (HT) and teletherapy (EBRT) compared to a combination of teletherapy with high-dose rate brachytherapy (BR).

Materials and methods: DU-145 cells were cultured as spheroids in 300 micron diameter. Then the following treatments were conducted: (a) EBRT at doses of either 2?Gy or 4?Gy of photon 15?MV, (b) HT for 0, 30, 60, and 90?minutes duration at 43?°C from a 13.56?MHz radiofrequency capacitive heating device (Celsius TCS), (c) BR with Ir-192 seed at doses of either 2?Gy or 5.5?Gy, (d) The mentioned HT followed by EBRT (HT?+?EBRT) and (e) EBRT followed by BR (EBRT?+?BR). Alkaline comet assay was performed to measure tail moment.

Results: The induced DNA damages of DU-145 cells treated by adding HT to EBRT compared with EBRT alone, showed a significant enhancement; 3.28 and 5.14 times respectively for 30 and 60?minutes HT. By plotting dose-response curves, we could find a range of doses, which create radiobiological iso-effect in HT?+?EBRT and EBRT?+?BR treatments.

Conclusions: This study suggests that about DNA damages of DU-145 cells, HT?+?EBRT could partly be considered as an alternative to EBRT?+?BR.     

Radiation Emission from Patients Treated with Holmium-166 Radioembolization

PurposeTo assess the radiation exposure to individuals coming from patients after treatment with holmium-166 (¹⁶⁶Ho) microspheres.Materials and MethodsHolmium-166 radioembolization (RE) with escalating whole-liver doses of 20 Gy, 40 Gy, 60 Gy, and 80 Gy was administered to 15 patients. Exposure rates (μSv/h) from patients were measured at 1.0 m distance from a lateral and frontal position at 0, 3, 6, 24, and 48 hours after infusion. The total effective dose equivalent (TEDE) to a maximally exposed contact was calculated in accordance with guidelines of the U.S. Nuclear Regulatory Commission (NRC). Results were extrapolated to a whole-liver dose of 60 Gy used in future treatments.ResultsThe median exposure rate at discharge, 48 hours after infusion, measured from a lateral position was 26 μSv/h (range, 7–45 μSv/h). Extrapolated to a whole-liver dose of 60 Gy, none of the exposure rates for the NRC contact scenario, at any time, frontal or lateral, would lead to a TEDE > 5 mSv; all patients may be released directly after treatment. Release after 6 hours is possible without contact restrictions for patients who received up to 7 GBq.ConclusionsThe TEDE to a contact of patients treated with ¹⁶⁶Ho RE would not exceed the NRC limit of 5 mSv. Contact restrictions 6 hours after treatment are unnecessary for infused activities < 7 GBq.     

Outcomes of Metallic Biliary Stent Insertion in Patients with Malignant Bilobar Obstruction

PurposeTo assess clinical outcomes of metal stent insertion in patients with bilobar bile duct obstruction by malignant tumors.Materials and MethodsRecords of 120 consecutive patients who underwent placement of metallic stents for palliation of malignant bilobar biliary obstruction between 1995 and 2010 were retrospectively reviewed. Single-duct stent insertion was performed in 44 patients with one liver lobe that accounted for more than 70% of total liver volume or only one patent lobar portal vein (group 1). Bilobar stent insertion was performed in 60 patients with approximately equal lobe sizes, patent lobar portal veins, or cholangitis at presentation (group 2). In 16 patients with discontiguous right anterior and posterior segmental ducts (group 3), three stents were deployed in the left lobar and right anterior and posterior segmental ducts. Overall survival, primary patency, and patient morbidity rates following stent insertion were assessed.ResultsNo significant differences in mean overall survival (group 1, 7.3 mo; group 2, 10.3 mo; group 3, 6.5 mo; P = .21) or mean primary stent patency (group 1, 4.2 mo; group 2, 5.9 mo; group 3, 3.5 mo; P = .17) were demonstrated. However, patients in group 3 were significantly more likely to require hospitalizations for cholangitis and additional invasive procedures for recurrent biliary obstruction than patients in groups 1 and 2.ConclusionsUnilobar and bilobar metal stent insertion led to similar outcomes when treatment decision was based on relative liver lobe volumes, lobar portal vein patency, and presence of cholangitis on presentation.     

Double-Layered PTFE-Covered Nitinol Stents: Experience in 32 Patients with Malignant Esophageal Strictures

We evaluated the effectiveness of a double-layered polytetrafluoroethylene (PTFE)-covered nitinol stent in the palliative treatment of malignant esophageal strictures. A double-layered PTFE-covered nitinol stent was designed to reduce the propensity to migration of conventional covered stent. The stent consists of an inner PTFE-covered stent and an outer uncovered nitinol stent tube. With fluoroscopic guidance, the stent was placed in 32 consecutive patients with malignant esophageal strictures. During the follow-up period, the technical and clinical success rates, complications, and cumulative patient survival and stent patency were evaluated. Stent placement was technically successful in all patients, and no procedural complications occurred. After stent placement, the symptoms of 30 patients (94%) showed improvement. During the mean follow-up of 103 days (range, 9–348 days), 11 (34%) of 32 patients developed recurrent symptoms due to tumor overgrowth in five patients (16%), tumor ingrowth owing to detachment of the covering material (PTFE) apart from the stent wire in 3 (9%), mucosal hyperplasia in 2 (6%), and stent migration in 1 (3%). Ten of these 11 patients were treated by means of placing a second covered stent. Thirty patients died, 29 as a result of disease progression and 1 from aspiration pneumonia. The median survival period was 92 days. The median period of primary stent patency was 190 days. The double-layered PTFE-covered nitinol stent seems to be effective for the palliative treatment of malignant esophageal strictures. We believe that the double-layer configuration of this stent can contribute to decreasing the stent’s migration rate.     

消化道恶性肿瘤患者外周血象的变化及意义

目的探讨消化道恶性肿瘤患者外周血象的变化及意义。方法将我院2003年1月—2006年12月内科收治的173例消化道恶性肿瘤患者治疗前的血常规指标,与同期来我院进行健康体检的企事业单位健康人群9 766例进行比较。结果消化道恶性肿瘤患者的红细胞计数、血红蛋白、红细胞压积均减少,平均红细胞体积、平均红细胞血红蛋白量增高,均表现为巨幼细胞性贫血,骨髓象呈增生性贫血改变,而白细胞总数的变化较小,白细胞分类,中性粒细胞百分比超过正常范围与淋巴细胞百分比低于正常范围者多见,血小板数异常远较血红蛋白与白细胞为少,但36例肝癌患者中28例出现血小板减少。结论临床上应重视消化道肿瘤高危因素人群外周血象的变化,尤其是良恶性贫血的鉴别,以免漏诊、误诊。