卡培他滨联合放疗与单纯放疗治疗消化道恶性肿瘤的临床可行性

目的分析卡培他滨联合放疗与单纯放疗治疗消化道恶性肿瘤临床可行性和疗效,为临床治疗提供参考。方法选取消化道恶性肿瘤患者72例为研究对象,采取抽签法随机分为观察组和对照组,对照组患者实施单纯放疗,观察组患者实施卡培他滨联合放疗,依照WHO制定实体肿瘤评价标准判断治疗效果,并采用WHO抗癌药物剂型反应分度标准评价不良反应。结果观察组总有效率(75.0%)显著高于对照组(52.8%)(P<0.05)。两组患者1年生存率差异不明显(P>0.05),观察组患者2年生存率(47.2%)显著高于对照组(16.7%)(P<0.05)。在治疗中,观察组患者主要不良反应为血液毒性白细胞毒性、手足综合征等,经对症处理后缓解,患者均耐受,没有出现退出试验者。观察组患者不良反应发生率显著低于对照组(P<0.05)。结论消化道恶性肿瘤患者实施卡培他滨联合放疗能够提高疗效,提高生存率,同时能够减少不良反应的出现,具有使用价值。     

Radiotherapy for mesothelioma

Three to four thousand cases of malignant pleural mesothelioma will occur in the United States this year. Single-modality therapy with radiation plays a role for palliation. Radiation can prevent tumor recurrence at drain/instrumentation sites and provide symptomatic relief of pain and other complaints. Combinations of surgery and radiation also have been attempted with curative intent. The best local control has been found--EPP followed by radiotherapy. Locoregional tumor recurrence can be dramatically reduced with combinations of extrapleural pneumonectomy and radiation therapy. Survival in aggressively treated early-stage patients is excellent. However, the preponderance of death from distant metastases makes the development of better systemic therapy essential. Better therapy also must be developed for patients who are not candidates for extrapleural pneumonectomy.     

Radiotherapy for meningiomas

Because of a substantial overall recurrence rate of meningiomas, the role of surgery as the sole treatment for every case must be evaluated. Also, occasionally, the patient's age and/or the location of the tumor precludes considering him/her as a candidate for surgery. In these instances, radiotherapy or radiosurgery may be advisable. The article presents two cases treated at M. D. Anderson Cancer Center, those of a 65-year-old male with a tumor in the left temporal lobe and 74-year-old female with a tumor in the right petroclival region. It also reviews the roles that radiotherapy plays in treating patients with meningiomas. Retrospective analyses of outcomes provide ample evidence that conventional radiation after incomplete resection reduces the incidence of progression of tumor over a long period. Information on patients who have had only external radiation is meager, since most patients have at least a partial resection. Complete resection for benign meningiomas is sufficient. For malignant meningiomas, adjuvant radiation should be administered, regardless of the extent of surgical excision. When surgery poses a high risk of morbidity or mortality, radiation therapy and radiosurgery are promising alternatives.     

PACS in Radiotherapy

In recent years, the use of the Picture Archiving and Communications System (PACS) has become widespread in the area of diagnostic radiology for archival, review and reporting of patient data. However, the adoption of PACS within the field of radiotherapy is still very limited, despite the fact that most radiotherapy systems now use Digital Imaging and Communications in Medicine (DICOM) for both storage and communication. This paper discusses the challenges of integrating PACS into a radiotherapy department as a long-term archive of patient treatments. A possible solution based on a large English department is used as an example.     

Radiotherapy after prostatectomy

AIMS AND BACKGROUND: The role of radiotherapy after prostatectomy is controversial. This paper tries to give some guidelines for everyday practice through an analysis of literature data. METHODS: The potential role of radiotherapy in the adjuvant and salvage setting is discussed. We also report and interpret available literature data for both settings. RESULTS: As regards an increase in or detectable prostate-specific antigen (PSA) after radical prostatectomy, about 40-50% of patients are rendered bNED with local salvage radiotherapy, but only 10-50% are long-term (5 years) biochemically controlled. A timely salvage treatment is crucial to optimize control probability. As regards adjuvant radiotherapy for undetectable postoperative PSA in patients at high risk of failure as judged on pathology, results are more encouraging. Recent data report bNED rates > 70% at 5 years. CONCLUSIONS: Although results are far from satisfactory, salvage radiotherapy should be considered for every patient with an increased or detectable PSA after surgery. Adjuvant radiotherapy seems preferable to salvage radiotherapy for patients at high (> 30%) risk of failure.     

Radiotherapy for outpatients

Radiotherapy can be done on an outpatient basis depending on the patient's cancer stage, radiation method, concurrent therapy, treatment purpose and general condition. Daily treatment time takes only about 1 minute, but the patient has to come 5 times a week for about 6 weeks for radical treatment and about 3 weeks for palliative treatment. If treated with radiotherapy alone, most patients suffer no severe adverse effects in their daily life. Therefore, radiotherapy can be done on an outpatient basis only if the patient is able to come frequently to the clinic for several weeks. Breast cancer patients commonly undergo radiotherapy in the outpatient clinic, such as breast conserving therapy, postoperative therapy and radiotherapy for local recurrence after mastectomy. Prostate cancer is also commonly treated with radical radiotherapy, postoperative therapy and radiotherapy for local recurrence after prostatectomy. Usually, postoperative irradiation for other cancers and radiotherapy for bone metastases are also undergone on an outpatient basis. During outpatient treatment, it is important to predict and avoid severe normal tissue reactions to radiotherapy, such as myelosuppression and/or pneumonitis, before they are apparent by watching the patient carefully.