独立准直器调强放疗系统的验收测试

目的 建立IC_IMRT系统的验收测试方法并完成该系统的验收测试.方法 采用NE2571电离室和2570剂量仪测量加速器的启动特性和下咽、肺及宫颈癌3个病例的等中心和其他剂量特征点的绝对剂量.采用Mapcheck2二维半导体矩阵验证基本测试例和3个病例的二维平面剂量分布.基本测试例由矩形或方形射野组成,分别为2 cm×2 cm、5 cm×5 cm、10 cm×10 cm、20 cm×20 cm、2 cm×10 cm、10 cm×2 cm、5 cm×20 cm和20 cm×5 cm的对称射野,2 cm×2 cm(x1=4cm、y1=10 cm,χ2=-2 cm、y2=-8 cm)和5 cm×5 cm(x1=-2 cm、y1=-5 cm,χ2=7 cm、y2=10cm)的非对称射野及由5个20 cm ×4 cm的射野合成的20 cm×20 cm的条状叠加野.采用γ分析法比较测量和计算的剂量分布,通过率标准为3 mm/3%≥90%.结果 当加速器输出跳数达到4即可保证2%的剂量精确性;对所有测试例等中心及特征点的绝对剂量误差最大为-3.67%;在全部11个基本测试野和3个病例的24个照射野中只有条状叠加野和下咽癌病例2个野的通过率稍低于90%,分别是83.6%、88.3%和89.7%.3个计划的实施时间依次是15、14、27 min.结论 测试结果总体满足临床要求,系统可用于患者治疗.

Abstract：

Objective To perform an acceptance test for the IMRT system with independent collimator. Methods An ion chamber dosimeter were used to measure the startup characteristics of the accelerator and the absolute dose at isocenter and given characteristic points for three clinical cases ( a lower nasopharyngeal carcinoma, a lung cancer and a cervical cancer). The characteristic points represented the organs at risk or the target. A Mapeheck2 was used to measure dose maps of basic test fields and the treatment fields for the clinical cases. The basic test fields were as follows: 1 ). Symmetric fields in size of 2 cm ×2 cm, 5 cm ×5 cm, 10 cm× 10 cm, 20 cm ×20 cm, 2 cm × 10 cm, 10 cm ×2 cm, 5 cm ×20 cm and 20 cm ×5 cm;2). Asymmetric fields in size of 2 cm ×2 cm (x1 =4 cm, y1 = 10 cm;x2 = -2 cm, y2 = -8cm) and 5 cm ×5 cm (x1 = -2 cm, y1 = -5 cm;x2 =7 cm, y2 = 10 cm) ;3) A 20 cm ×20 cm composite field composed of five 20 cm× 4 cm narrow bar fields side by side. Gamma Index was used to compare calculated and corresponding measured dose distributions. When the criterion was 3% dose difference or 3 mm distance-to-agreement, the pass rate was required to be more than 90%. Results The accuracy of machine output was better than 2% when machine monitor units increased to 4. Among all basic test fields and all the treatment fields of three clinical cases, the maximal absolute dose error was -3.67%, and only the composite test field and two treatment fields of the lower nasopharyngeal carcinoma case had a pass rate slightly less than 90%, which were 83.6%, 88. 3% and 89. 7% ,respectively. For the three clinical cases the treatment delivery times were 15, 14, and 27 minutes, respectively. Conclusions The overall commissioning results are acceptable, and the system can be used in clinic.     

独立准直器调强放疗系统的验收测试

Objective To perform an acceptance test for the IMRT system with independent collimator. Methods An ion chamber dosimeter were used to measure the startup characteristics of the accelerator and the absolute dose at isocenter and given characteristic points for three clinical cases ( a lower nasopharyngeal carcinoma, a lung cancer and a cervical cancer). The characteristic points represented the organs at risk or the target. A Mapeheck2 was used to measure dose maps of basic test fields and the treatment fields for the clinical cases. The basic test fields were as follows: 1 ). Symmetric fields in size of 2 cm ×2 cm, 5 cm ×5 cm, 10 cm× 10 cm, 20 cm ×20 cm, 2 cm × 10 cm, 10 cm ×2 cm, 5 cm ×20 cm and 20 cm ×5 cm;2). Asymmetric fields in size of 2 cm ×2 cm (x1 =4 cm, y1 = 10 cm;x2 = -2 cm, y2 = -8cm) and 5 cm ×5 cm (x1 = -2 cm, y1 = -5 cm;x2 =7 cm, y2 = 10 cm) ;3) A 20 cm ×20 cm composite field composed of five 20 cm× 4 cm narrow bar fields side by side. Gamma Index was used to compare calculated and corresponding measured dose distributions. When the criterion was 3% dose difference or 3 mm distance-to-agreement, the pass rate was required to be more than 90%. Results The accuracy of machine output was better than 2% when machine monitor units increased to 4. Among all basic test fields and all the treatment fields of three clinical cases, the maximal absolute dose error was -3.67%, and only the composite test field and two treatment fields of the lower nasopharyngeal carcinoma case had a pass rate slightly less than 90%, which were 83.6%, 88. 3% and 89. 7% ,respectively. For the three clinical cases the treatment delivery times were 15, 14, and 27 minutes, respectively. Conclusions The overall commissioning results are acceptable, and the system can be used in clinic.     

30例脑胶质瘤的术后调强适形放射治疗

目的探讨术后脑胶质瘤调强适形放疗的临床疗效。方法30例脑胶质瘤予术后调强适形放疗,以90%~95%等剂量线包绕计划靶体积（PTV）。肿瘤靶体积（GTV）照射(58~70) Gy/(28~33)f,临床靶体积（CTV）照射(56~66) Gy/(28~33)f ,PTV照射(50.4~60) Gy/(28~33)f,1次/天,5f/w。结果完全缓解率（CR）23.3%（7/30）,部分缓解率（PR）66.7%（20/30）,稳定率为10%（3/30）。1、2、3年总生存率分别为93.3%、76.7%、60%。Ⅰ~Ⅱ级1、2、3年生存率分别为100%、94.1%、76.5%;Ⅲ~Ⅳ级1、2、3年生存率分别为84.6%、53.8%、38.5%。Ⅰ~Ⅱ级组与Ⅲ~Ⅳ级组相比差异有统计学意义（P=0.0153）。患者对治疗的耐受性良好,不良反应主要为颅高压症状,放射性脑水肿。结论脑胶质瘤术后调强适形放疗疗效好,无严重不良反应。     

多叶准直器透射对调强放疗剂量计算准确性影响观察

目的 探讨多叶准直器透射及其对调强放疗剂量计算准确性的影响。方法 使用电离室分别测量瓦里安Trilogy直线加速器多叶准直器(MLC)叶片平均透射和叶片剂量学间距(DLG),并使用电子射野影像装置测量MLC叶片内透射和叶片间透射。通过 10例肿瘤调强放疗患者资料评价计划系统使用实际测量结果模拟MLC透射计算剂量准确性。结果 6、10 MV X射线MLC叶片平均透射值分别为1.6%、1.8%,透射值随射野增大而增加、随深度增加而增加、离轴位置稍低于中心轴;叶片内透射值分别为 0.8%~1.2%、1.1%~1.6%;叶片间透射值分别为 1.3%~1.9%、1.6%~2.5%。计划系统使用实际测量结果模拟MLC的透射值具有很好一致性。3%3 mmγ通过率 2例鼻咽癌患者分别为93.6%和94.5%,其余 8例患者均>95%。结论 调强放疗中MLC透射直接影响靶区剂量准确性,MLC叶片透射与测量深度、射野大小和离轴位置有关。     

调强适形放疗联合替莫唑胺治疗恶性脑胶质瘤的临床观察

[目的]观察调强适形放疗(IMRT)联合替莫唑胺(TMZ)治疗恶性脑胶质瘤的临床疗效。[方法]28例术后病理诊断为高级别胶质瘤(WHOⅢ～Ⅳ)的患者,术后放射治疗为全脑左、右对穿野常规照射(WBRT)并后程调强加量照射。常规放射治疗剂量为40Gy/20f/4w,调强放射治疗剂量为20Gy/4f/2w;放疗同步口服替莫唑胺(TMZ)治疗6个周期,之后再接受至少2个周期的常规TMZ治疗。[结果]中位生存时间及无进展生存时间分别为11.5个月和7.2个月;1年总生存率为53.57%,2年总生存率为25.00%。常见的不良反应为恶心、呕吐,血液学毒性是白细胞和血小板下降,但仅限于Ⅰ～Ⅱ度。[结论]IMRT同步TMZ治疗恶性脑胶质瘤,安全有效,不良反应轻微。     

脑胶质瘤的调强放射治疗：附7例临床分析

背景与目的：脑胶质瘤的治疗手段主要是手术和放射治疗，其中放射治疗在综合治疗中的地位越来越受到重视。本文介绍适形调强放射治疗(Intensity modulated radiation therapy，IMRT)技术在脑胶质瘤中的应用及可行性分析。方法：对7例接受IMRT的脑胶质瘤术后患者的治疗计划进行评估，根据ICRU50号和62号报告要求勾画肿瘤靶区，通过Corvus3．0逆向计划计算系统分别得出肿瘤靶区的剂量分布情况以及肿瘤周围重要器官的所照射剂量。结果：肿瘤靶区最小、最大、平均剂量分别为63．17Gy、73．03Gy、69．93Gy，平均D95为67．25Gy，平均V95为99．99％。各重要器官所接受的照射量明显低于常规放疗技术中的最小耐受剂量。结论：从剂量学和放射生物学角度来看，IMRT技术在脑胶质瘤放疗方面应有一定的优势。     

直线加速器二级准直器在全段食管癌术后调强计划中的应用

目的:探讨全段食管癌术后放疗患者调强计划中限制二级准直器位置对靶区和危及器官受照剂量的影响。方法:选择13例全段食管癌术后放疗患者,设计两种逆向调强放疗（IMRT）计划。第一种是二级准直器限制位置的IMRT（Jaw Fixed-IMRT,F-IMRT）:以心脏上下界为界,F-IMRT计划的靶区分为上、中、下三个分区,通过固定二级准直器来实现,三个分区分别设计射野数量及角度,两两分区之间二级准直器头脚方向重叠(overlap,OL)的距离定为0、1、2、3、4 cm,共生成5个F-IMRT计划（命名为F-IMRT-OL0.1.2.3.4）;第二种是常规IMRT(conventional-IMRT,C-IMRT):患者靶区为一个整体,不限制二级准直器,射野设置为9野共面均分。两种计划靶区及危及器官优化参数相同,对比分析两种计划的剂量学差异及加速器跳数（MU）。结果:F-IMRT计划中,二级准直器需要重叠以保证靶区足量,但随重叠距离增加危及器官受量呈递增趋势,本研究中F-IMRT-OL1为最优计划。F-IMRT-OL1与C-IMRT计划的适形指数（CI）和均匀性指数（HI）差异无统计学差异（P＞0.05）;F-IMRT-OL1肺的V5 Gy、V10 Gy、V20 Gy及Dmean低于C-IMRT,具有统计学差异（P＜0.05）,而对于肺的高剂量体积V30 Gy,无明显差异（P＞0.05）;F-IMRT-OL1计划心脏的V30 Gy和V40 Gy及Dmean均低于C-IMRT,具有统计学差异（P＜0.05）;F-IMRT-OL1肝脏、肾脏的Dmean低于C-IMRT（P＜0.05）;两种计划的脊髓和MU无明显差异（P＞0.05）。结论:对于全段食管癌术后患者的调强放疗计划设计, F-IMRT-OL1计划能在保持靶区剂量充分和剂量均匀性的同时,可以有效地减小肺和心脏剂量的照射体积及平均剂量。     

准直器角度优化对胃癌调强放疗计划影响

目的 探讨4种准直器角度优化技术对胃癌调强放疗计划靶区(PTV)及危及器官(OAR)剂量学的影响。方法 选取2015-2016年间武汉大学中南医院接受调强放疗的10例胃癌患者,调强放疗计划均采用常规5个野(330°、10°、45°、90°、180°),其他优化参数一致。在Eclipse计划系统中分别用4种不同的准直器角度优化技术设计调强放疗计划。准直器角度优化技术包括准直器角度设为默认0°(CL0)、与0°垂直的90°(CL90)、采用Eclipse自动角度优化(CLA)以及将准直器角度设为X-Jaws围绕靶区PTV距离最短时的角度(CLX)。主要剂量学参数包括PTV适形指数(CI)、均匀指数(HI)、平均剂量(Dmean)及OAR受量,并且考虑治疗时间(Time)、治疗跳数(MU)、控制点(CP)、分野数(SF)及适形距离(Fx)等参数。结果 以CL0优化为对照,4种准直器角度优化技术PTV的CI、HI及Dmean比较差异无统计学意义(P>0.05),然而CLX能显著增加靶区PTV的Dmean(P<0.05);CLX优化能够减少肝(V30减少1.54%)、左肾(V12减少1.46%)等受量,但会轻微增加小肠和脊髓的最大剂量(<1%),而CL90与CLA优化会导致增加胃受量。4种不同的准直器角度优化中,CLX优化能够减少MU (减少25.02%)、CP (减少26.03%)、Fx (减少20.27%)及SF (平均减少1.3个分野)。对于Time,CLX相对减少10.03%;CL90与CLA能够减少MU、CP、Fx和SF,且CL90在减少Time方面有一定的优势,而CLA会相对增加Time (增加5.04%)。结论 在胃癌的调强放疗计划中,采用CL90、CLA和CLX 3种准直器角度优化技术能够获得与常规CL0的准直器角度优化相当的剂量分布,且能减少MU,从而减少漏射和照射时间,提高治疗效率。     

宫颈癌放疗中多叶准直器角度改变对放疗过程的影响

目的:探讨设计宫颈癌调强计划时,调整多叶准直器对放疗过程的影响。方法:随机抽取12例宫颈癌患者,在其他各项参数设置一样的情况下,采用系统默认的0度角为对照组,调整角度为观察组,据此两种方案制定放疗计划。在满足临床靶区要求的条件下,比较小肠、膀胱、直肠等重要危及器官受量和治疗时长。结果:对照组靶区适形指数、不均匀指数、子野数目、机器跳数分别为:1.05±0.01、0.76±0.03、246±17、1 472±130,观察组靶区适形指数、不均匀指数、子野数目、机器跳数分别为:1.05±0.01、0.77±0.02、236±8、1 447±114,靶区适形指数比较没有统计学意义（P>0.05）,观察组子野数目和机器跳数较对照组减少,且比较具有统计学意义（P<0.05）;调整多叶准直器时与多叶准直器为0度时对比,直肠V30、V40、V50的受照体积平均减少（4.3±1.2）%、（5.1±1.5）%、（2.6±1.1）%,膀胱V30、V40、V50的受照体积平均减少（3.6±1.6）%、（5.3±2.0）%、（1.8±0.8）%;观察组治疗时长较对照组平均减少（51±14）s,治疗时长降低且比较有统计学意义（P<0.05）。结论:设计宫颈癌调强计划时,在满足靶区剂量的前提下,适当调整多叶准直器角度可以在一定程度上降低重要危及器官的受量,同时可以减少治疗时长,降低机器的损耗。     

不同机架角时多叶准直器叶片对不同调强放疗剂量影响

目的 研究加速器多叶准直器角度为0°和不同机架角时多叶准直器叶片对不同调强放疗剂量的影响.方法 用30 cm×30 cm×3 cm固体水模体预选静态调强和动态调强中大小合适的30个单方向野和机架角为0°、45°、90°、270°、315°,用Mapcheck二维半导体矩阵测量和其剂量分析系统的γ分析方法(3%/3 mm、5%/3 mm)对相应通过率进行定量分析.以治疗靶区由小到大预选30例患者的静态调强和动态调强计划用上述同样方法测量和分析.结果 加速器多叶准直器角度为0°和机架角分别为0°、45°、90°、270°、315°时静态调强和动态调强30个单方向野实测的3%/3 mm平均通过率分别为97.71%和96.25%(t=1.70,P=0.389)、96.34%和93.72%(t=2.95,P=0.002)、96.65%和92.98%(t=2.87,P=0.005)、95.87%和93.15%(t=2.71,P=0.006)、96.09%和93.51%(t=2.89,P=0.004),5%/3 mm的平均通过率也无差别,分别为99.31%～99.73%和98.89～99.68%(t=0.57～1.90,P=0.913～0.725);30例患者计划的3%/3 mm平均通过率分别为96.11%～96.76%和94.88～95.78%(t=1.02～1.61,P=0.317～0.235).结论 当加速器多叶准直器角度为0°和不同机架角度时多叶准直器叶片对调强放疗剂量相比0°时确有影响,但其面剂量分布误差都在可接受的5%内.

Abstract：

Objective To investigate the impact of accelerator′s multi-leaf collimator (MLC) on the radiotherapy dose with different gantry angles.Methods Measured with Mapcheck 2D diode array and 30 cm×30 cm×3 cm solid water, Pre-selecting the 30 appropriate single fields and 0°,45°,90°,270°,315° gantry angles of static and dynamic intensity modulated radiation therapy (IMRT), quantification analysis of the passing rate with MapCheck γ(3%/3 mm) and (5%/3 mm) analysis methods, and the same method to 30 examples static and dynamic IMRT plans.Results When the accelerator collimator angle is 0°,the 30 appropriate single fields′ passing rate of between 0°gantry angle and 45°,90°,270°,315°gantry angles of static and dynamic IMRT accordingly is 97.71% and 96.25%(t=1.70, P=0.389), 96.34% and 93.72%(t=2.95, P=0.002), 96.65% and 92.98%(t=2.87, P=0.005), 95.87% and 93.15%(t=2.71, P=0.006), 96.09% and 93.51%(t=2.89, P=0.004) with MapCheck γ(3%/3 mm) analysis methods, however, the passing rate also does not have the difference, respectively is 99.31%-99.73% and 98.89-99.68%(t=0.57-1.90, P=0.913-0.725) with MapCheck γ(5%/3 mm) analysis methods;the passing rate of 30 examples static and dynamic IMRT plans accordingly is 96.11%-96.76% and 94.88%-95.78%(t=1.02-1.61, P=0.317-0.235).Conclusions When the accelerator collimator angle is 0°, at different gantry angles, MLC leaves due to gravity, friction, inertia, etc caused by errors in place, the physical penumbra and leakage radiation will indeed affect the IMRT dose, however, the deviation of dose distribution is within acceptable 5%.     

影响人脑恶性胶质瘤预后因素的研究

背景与目的:影响人脑恶性胶质瘤预后的因素众多,本文通过总结我们的临床病例,分析影响人脑恶性胶质瘤预后的因素。方法:收集自2003年10月至2004年4月在南方医科大学附属南方医院神经外科手术治疗的67例恶性胶质瘤患者的资料。生存分析单因素使用Kaplan-Meier法计算生存率并采用对数秩(log-rank)检验;多因素分析使用Cox比例风险模型,采用逐步回归分析。结果:单因素分析结果显示术前癫痫、肿瘤分化程度、肿瘤范围、术中病理标示肿瘤向周边侵袭性生长程度、手术切除程度及术后个体化综合治疗等因素与患者预后有关(P<0.05);多因素分析示手术切除范围、术后个体化综合治疗、肿瘤侵袭性生长程度、肿瘤的分化程度则是影响无瘤生存的独立因素。年龄、性别、KPS评分、肿瘤体积等因素两种分析均未发现与预后有关。结论:手术切除范围、术后个体化综合治疗、肿瘤侵袭性生长程度、肿瘤的分化程度对预后影响较大;而术前癫痫、肿瘤范围对判断预后价值有限;患者的年龄、性别、KPS评分、肿瘤体积与预后无关。     

恶性胶质瘤术后应用替莫唑胺化疗联合放疗的临床观察

目的比较替莫唑胺联合放疗和单纯放疗对恶性胶质瘤术后治疗的疗效和安全性。方法选择2002~2003年收治的38例术后病理证实为恶性胶质瘤的病人,随机分为2组。实验组(22例)在放疗的同时采用替莫唑胺化疗,随后进行6个周期的化疗;对照组(16例)仅行放疗。长期随访,观察病人的无进展生存时间和总的生存时间以及药物的安全性。结果实验组的平均无进展生存时间为(10.97±6.14)月,对照组为(6.20±3.68)个月(P<0.05)。实验组总的生存时间为(14.89±10.08)个月,对照组为(8.26±4.80)个月(P<0.05)。常见的副作用为恶心、呕吐和乏力等,仅有两个病人表现为白细胞减少,经过对症处理和药物减量后病情好转。结论替莫唑胺和放疗联合治疗胶质瘤的效果要好于单纯放疗,病人可以较好的耐受联合治疗。     

Clinical Observation of Three Dimensional Conformal Radiotherapy with Tamoxifen in Treatment of Postoperative Malignant Glioma

Objective: To evaluate the efficacy and adverse effects of three dimensional conformal radiotherapy (3D-CRT)with tamoxifen in treating patients with postoperative malignant glioma. Patients and Methods: 60 patients ofpostoperative malignant glioma were randomly assigned into two groups, 30 patients were treated with 3D-CRTplus tamoxifen (treatment group), and the other 30 patients with 3D-CRT plus temozolomide (control group).All patients were radiated by 6MV X-ray, 2.0Gy per fraction, once daily, with a total dose (DT) of 56~60Gy.Tamoxifen was delivered at 60mg /m2/d, temozolomide was given at 75mg/m2/d. All patients were treated withconcurrent radiotherapy. Results: One, 2, 3 year survival rates of treatment and control group were 63.3%,30.0%, 23.0% and 70.0%, 33.3%, 26.7%, respectively (χ2=0.01, 0.23, 0.09, P>0.05). The rate of thromboembolismin treatment group was 6.7%. Conclusion: Therapeutic efficacy of two groups was similar, but it was more costeffectivein treatment group, and toxicity did not increase.     

MicroRNAs在胶质瘤治疗中的作用及研究进展

越来越多证据表明microRNAs在神经肿瘤的发生发展中扮演着重要角色。随着组织和血浆中提取和测定microRNAs技术的改进．某些特定的胶质母细胞瘤或其他恶性肿瘤的microRNAs作为临床生物标志物已为时不远,但应用microRNAs治疗恶性胶质瘤仍有较大困难。本文通过microRNAs在恶性胶质瘤的表达、分子靶向治疗及microRNAs的给药途径三个方面对microRNAs治疗恶性胶质瘤的研究进展做一综述。     

恶性胶质瘤术后治疗疗效及预后因素分析

目的观察恶性胶质瘤术后治疗的疗效,并分析其预后影响因素。方法恶性胶质瘤59例,其中Ⅲ级24例,Ⅳ级35例,术后给予三维适形放疗,肿瘤剂量50～60 Gy/5～6周。13例患者行同步化疗,替莫唑胺75 mg/m2.d。按照WHO实体瘤疗效评价标准评估疗效。采用Kaplan-Meier法计算生存率,Cox模型进行多因素分析。结果近期有效率（CR＋PR）为75.5%。全组病例1、3、5年生存率分别为52.5%（31/59）、27.1%（16/59）、10.1%（6/59）。单因素分析显示预后相关因素有年龄、病理分级、病变个数、手术切除程度、放疗前ECOG评分、手术至放疗开始的时间、同步化疗（P〈0.05）。多因素分析显示手术切除程度、同步化疗是独立预后因素（P〈0.05）。放疗期间23.7%的患者脑水肿加重。结论恶性胶质瘤术后放化疗疗效较好,手术切除程度和同步化疗是重要的预后影响因素。     

恶性胶质瘤外照射加X-刀推量的治疗模式的探讨

背景与目的:恶性胶质瘤是预后极差的常见颅内恶性肿瘤,治愈很困难。本研究报告恶性胶质瘤外照射加X刀推量的治疗模式的疗效。方法:对15例确诊为恶性胶质瘤的患者进行了外照射加X-刀推量的治疗。外照射50Gy/25F/5W后,紧接着用X-刀推量7～10Gy。结果:治疗后近期效果满意,无严重神经功能障碍并发症。3例患者分别死于X刀后4、5、11个月,余均健在。全组仅1例在疗后3个月出现脑水肿,给以对症治疗后缓解。余患者无严重的放射反应。结论:恶性胶质瘤外照射加X-刀推量的治疗模式是可行的。     

脑恶性胶质瘤术后会师化疗同步适形放疗的临床观察

目的 探讨脑恶性胶质瘤显微手术全切后间质内尼莫司汀（ACNU）与替莫唑胺（TMZ）会师化疗同步适形放疗的临床疗效和安全性。方法 选取临床影像诊断为脑恶性胶质瘤的患者99例,均行开颅显微手术全切肿瘤和组织病理证实,术后采用单纯适形放疗( RT) 21 例,采用尼莫司汀间质化疗同步适形放疗( ACNU + RT) 24例,采用替莫唑胺化疗同步适形放疗( TMZ + RT) 23例,ACNU间质内化疗与口服TMZ会师化疗同步适形放疗(ACNU + TMZ + RT) 31例,比较四组的疗效和安全性。结果 脑恶性胶质瘤显微手术全切术后ACNU + TMZ +RT组患者1、2、3年存活率分别为80.6%(25/31)、48.4%(15 /31)、25.8%(8 /31),中位生存时间为29.0（39.8～18.6）月。术后1、2、3年ACNU +TMZ + RT组中位生存时间明显长于RT组、ACNU + RT 组和TMZ + RT 组(χ_L²=21.045和22.385,P=0.043和0.045);脑恶性胶质瘤显微手术全切术后ACNU + TMZ +RT组患者1、2、3年Karnofsky≥60所占比率分别为77.4%(24 /31)、48.4%(15 /31)、22.8%(8 /31)。术后1、2年ACNU+TMZ+RT组生存质量明显优于RT组、ACNU+RT 组及TMZ+RT组(χ²=8.199,P=0.042)、(χ²=7.864,P=0.049)。结论 脑恶性胶质瘤显微手术力争全切除,术后间质内ACNU与TMZ会师化疗同步适形放疗是脑恶性胶质瘤较优化的综合治疗方案,可显著延长患者的生存时间,提高患者的生存质量。     

替莫唑胺联合放射治疗复发性恶性脑胶质瘤的临床疗效

目的探讨替莫唑胺联合放射治疗复发性恶性脑胶质瘤的临床疗效。方法选取52例复发性恶性脑胶质瘤患者为研究对象,随机将患者分为对照组和实验组,每组26例,给予对照组患者三维适形放射治疗,实验组在对照组的基础上给予口服150 mg/(m^2·d)替莫唑胺治疗,分析比较2组患者的临床疗效及不良反应,并对2组患者进行为期1年的随访,记录患者生存状态。结果实验组患者临床治疗有效率为73.08%,明显高于对照组的46.15%(P<0.05)。治疗后实验组患者的卡氏评分及生活质量改善率明显高于对照组(P<0.05)。2组临床均未见治疗性死亡患者,主要临床不良反应表现为中轻度白细胞计数减少、放射性脑水肿、恶心呕吐、发热、骨髓抑制及贫血等症状(P>0.05)。实验组患者1年随访生存率为92.31%,明显高于对照组的84.62%;复发率(3.85%)明显低于对照组的15.38%(P<0.05)。结论替莫唑胺联合放射治疗是复发性恶性脑胶质瘤较为理想的治疗方式,对于改善患者生活质量、提高患者生存率有积极作用,值得临床推广应用。     

Reduction of End-stage Malignant Glioma by Injection with Autologous Cytotoxic T Lymphocytes

Autologous cytotoxic T lymphocytes (CTL) against primary-cultured malignant gliomas were generated from peripheral blood mononuclear cells in vitro in 4 patients. Activities of the CTL were highly specific to the corresponding autologous glioma and were inhibited, in one patient, with antibodies against CD3, CD8 and MHC-class I molecules. When the CTL were injected 3 times into the primary-tumor-resected cavity via an Ommaya tube, reduction of the recurrent tumors with magnetic resonance imaging (MRI)-measured volumes exceeding 45 cm³ was observed in 3 patients. In a patient with glioblastoma multiforme (GBM), the tumor volume (estimated, 130 cm³) was rapidly reduced to 1/3, although re-recurrence of the tumor followed 40 days later. A slight but distinct rapid reduction of the tumor volume was observed in another GBM patient and in an anaplastic astrocytoma patient; essentially no change was observed in a further GBM patient. These results suggest that adoptive immunotherapy with autologous CTL will be clinically effective against end-stage malignant gliomas.