鼻咽癌放疗后舌骨及喉室的运动学变化特征

目的 利用视频造影吞咽检查(VFSS)分析鼻咽癌患者放疗后舌骨运动学变化特征。方法 本试验为前瞻性临床研究,收集2014年10月至2015年5月在本院初治的25例鼻咽癌患者为研究对象,在放疗前后使用普通X射线模拟机采集吞咽视频,通过视频分析软件进行连续快速截图,对比放疗前后吞咽时间、舌骨移动度及平均移动速度。结果 25例受试者放疗后平均吞咽时间较放疗前延长[(1.38±0.23)s vs.(1.12±0.26)s,t=-9.53,P<0.05),舌骨水平方向移动度(HHD) 较放疗前降低［(0.78±0.24)cm vs.(1.01±0.25)cm,t=5.82,P<0.05),舌骨垂直方向移动度(HVD) 也较放疗前降低［(0.78±0.18)cm vs.(1.01±0.25)cm,t=2.56,P<0.05],舌骨平均移动速度放疗后明显降低[(0.83±0.19)cm/s vs.(1.31±0.45)cm/s,t=6.46,P<0.05]。喉室移动度放疗前后比较,差异无统计学意义(P>0.05)。结论 鼻咽癌患者放疗后吞咽时间较前延长,舌骨移动度及平均移动速度较前降低。临床试验注册 中国临床试验注册中心,ChiCTR-OOC-16007913。     

18F-FDG PET/CT在鼻咽癌颈部淋巴结转移分期中的作用

目的 探讨18F-FDG PET/CT在鼻咽癌患者颈部淋巴结转移分期中的作用.方法 按前瞻性设计研究方案,纳入2009年3月至2010年11月病理确诊为鼻咽癌的初治患者62例,其中男48例,女14例,中位年龄43岁.患者放疗前1周内行CT或MRI检查并进行AJCC分期,然后行18FFDG PET/CT检查后再次分期.以治疗后随访6个月以上结果为标准,评价2种检查方法进行N分期的准确性.分析PET/CT N分期对治疗方案的影响,并计算Kappa值,进行一致性检验,率的比较采用x2检验.结果 62例患者中,N0 9例,N1 16例,N2 24例,N3 13例.18F-FDG PET/CT N分期准确性为96.8％(60/62),与实际N分期一致性检验Kappa值为0.955;CT或MRI N分期准确性为72.7％(45/62),Kappa值为0.607.30.6％(19/62)患者PET/CT与CT或MRI N分期不一致,随访证实PET/CT正确改变了27.4％(17/62)患者的N分期;其中l例从N0提高至N2,由根治性放疗改为放化疗综合治疗,另16例改变了转移淋巴结GTV的勾画和照射剂量.PET/CT咽后淋巴结检出率为54.8％(34/62),其灵敏度、特异性和准确性分别为80.0％ (20/25)、94.4％(17/18)和86.0％(37/43).比较43例同时有MRI和PET/CT检查结果的患者资料,两者对咽后淋巴结的检出率分别为60.5％(26/43)和55.8％ (24/43),差异无统计学意义(x2=2.000,P＞0.05).结论 18F-FDGPET/CT较常规CT或MRI对鼻咽癌N分期的准确性高,且能较好地显示咽后淋巴结,在定性较小淋巴结方面有一定优势.     

46例首诊伴远处转移鼻咽癌的预后分析

Objective To retrospectively analyze the therapeutic results of patients with initially di-agnosed metastatic nasopharyngeal carcinoma (NPC). Methods From January 1995 to December 1998, 46 NPC patients with distant metastases were treated in Fujian provincial cancer hospital. Among these pa-tients, 43 were single site metastasis and 3 were multiple sites metastases;The site of metastasis were 19 pa-tients in the liver, 11 in the bone, 7 in the lung, 1 in the brain, 6 in mediastinal nodes and 6 in axillary lymph nodes. All patients received standard radiotherapy to the primary site and cervical node region with a median dose of 72 Gy. Forty-one patients (89%) received 1-5 cycles chemotherapy (cisplatin and 5-flu-orouracil), and 23 (50%) received palliative irradiation to the metastatic site. Results The median surviv-al time was 20 months. The 1-, 2-, 3-year and 5-year overall survival rates were 66%, 47%, 30% and 19%, respectively. Irradiation to the metastatic sites and KPS were the significant prognostic factors. Pa-tients with palliative irradiation to the metastatic site had longer survival than those without (39 months vs. 13 months, X2=8.63, P=0.012). Patients with good performance status (KPS≥80) had better outcomes thanthose with poor performance status (26 months vs. 12 months, X2= 3.95, P=0.035) . Conclusions Active therapy may prolong the survival of patients with initially diagnosed metastatic NPC, especially for those who have good performance status. Under systematic chemotherapy, radiotherapy to the primary site and supportive care, the palliative irradiation to the metastatic site may also yield a good result.     

胃癌术后IMRT与常规对穿及适形照射剂量学的比较

目的比较胃癌术后常规放射治疗与适形及调强（IMRT）治疗技术在同一处方剂量（45 Gy）时的剂量分布特点,为临床提供参考。方法选取9例胃癌术后患者,在CT图像序列上勾画出临床靶区（CTV）,CTV外放1 cm定义为计划靶区PTV,对PTV分别用常规两野对穿、适形5野及5野调强照射技术进行计划设计。所有方案处方剂量均为45 Gy,要求95%体积PTV接受45 Gy剂量,IMRT与适形计划采用优化以保证≥95%的PTV接受45 Gy的处方剂量,99%的PTV接受42.75 Gy。根据剂量体积直方图（DVH）比较PTV受量和正常器官的受量差异和剂量分布,并计算正常组织并发症概率（NTCP）。结果IMRT能够产生优于常规及适形的靶区剂量分布,均匀性及适形度明显优于常规对穿照射。IMRT的左肾受23 Gy剂量的体积百分比（V23）明显低于常规及适形技术,从脊髓剂量来看,IMRT的脊髓最大剂量为（39.3＋2.3）,小于40 Gy,明显优于常规前后对穿及适形照射技术,并相应减少脊髓的NTCP值。结论IMRT相对于常规对穿照射及适形照射具有明显的靶区剂量分布优势,可以减少肾脏、脊髓等正常组织器官的照射体积百分比及NTCP值。     

食管癌患者首次摆位行锥形束CT验证的误差分析

目的:探讨食管癌患者首次摆位行锥形束CT验证的重要性.方法:对接受图像引导放射治疗(IGRT)的92例食管癌患者,首次摆位采用锥形束CT影像技术(CBCT),获得图像与计划CT图像进行匹配校正,获得X、Y、Z轴及矢状轴旋转摆位误差共368个数据.结果:X轴误差为(0.22±0.19)cm,其中胸下段组为(0.34±0.26) cm.Y轴误差为(0.40±0.28)cm,其中颈段和胸上段组为(0.45±0.34)cm.Z轴误差为(0.34±0.26)cm,其中胸中段组为(0.38±0.27) cm.矢状轴旋转误差为(0.11±0.12)°.结论:CBCT可减少食管癌首次摆位误差.建议根据肿瘤生长位置外放计划靶体积(PTV).     

18F-FLT PET/CT与18F-FDG PET/CT在鼻咽癌诊断和分期中的应用比较

目的 通过与18F-FDG PET/CT显像对比,探讨18 F-FLT PET/CT检测鼻咽癌原发灶和颈部淋巴结转移灶的可行性.方法 12例初治且经病理确诊的鼻咽癌患者(年龄22～62岁)自愿进入该前瞻性临床研究.每位患者先行18F-FDG PET/CT检查,次日行18F-FLF PET/CT检查.至少有2位核医学科和放射科医师阅片,比较18F-FDG PET/CT和18F-FLT PET/CT图像,采用ROI技术计算鼻咽肿瘤、颈部淋巴结转移灶、正常组织对18F-FDG、18F-FLT的SUVmax、SUVmean和MTV.采用非参数Wilcoxon秩和检验比较组间摄取和MTV差异.结果 12例鼻咽癌患者病灶均明显摄取18F-FLT.18F-FLT PET/CT和18F-FDG PET/CT均可准确诊断该组病例,二者对原发灶和淋巴结转移灶的检测结果无明显差别.鼻咽癌病灶的18F-FDG和18F-FLT SUVmax分别为10.7±5.8和6.0±2.4,SUVmean分别为5.8±3.0和3.6±1.5;SUVmax和SUVmean组间差异均有统计学意义(Z=-2.589和-2.353,P均＜0.05),而 MTV在18F-FDG和8F-FLT PET/CT 2种显像方法之问的差异无统计学意义(15.9±9.2和18.1±11.1;Z=-0.786,P＞0.05).6例有颈部淋巴结转移灶患者的SUVmax、SUVmean和MTV在2种显像方法间差异均无统计学意义(8.5±6.2比6.4±2.5、5.3±4.2比3.8±1.4、6.5 ±4.8比6.0±4.4;Z=-0.734、-0.734和-0.674,P均＞0.05).18F-FLT在颞叶摄取(SUVmax 0.7±0.3)明显低于18F-FDG(SUVmax 8.3±2.7;Z=-3.062,P＜0.01),其对于原发灶颅内浸润显示较18F-FDG更清晰.结论 18F-FLT PET/CT在鼻咽癌原发灶和淋巴结转移灶的诊断效能与18F-FDG PET/CT相当,对于显示原发灶的颅底附近侵犯更有利,其临床应用值得进一步研究.     

46例首诊伴远处转移鼻咽癌的预后分析

Objective To retrospectively analyze the therapeutic results of patients with initially di-agnosed metastatic nasopharyngeal carcinoma (NPC). Methods From January 1995 to December 1998, 46 NPC patients with distant metastases were treated in Fujian provincial cancer hospital. Among these pa-tients, 43 were single site metastasis and 3 were multiple sites metastases;The site of metastasis were 19 pa-tients in the liver, 11 in the bone, 7 in the lung, 1 in the brain, 6 in mediastinal nodes and 6 in axillary lymph nodes. All patients received standard radiotherapy to the primary site and cervical node region with a median dose of 72 Gy. Forty-one patients (89%) received 1-5 cycles chemotherapy (cisplatin and 5-flu-orouracil), and 23 (50%) received palliative irradiation to the metastatic site. Results The median surviv-al time was 20 months. The 1-, 2-, 3-year and 5-year overall survival rates were 66%, 47%, 30% and 19%, respectively. Irradiation to the metastatic sites and KPS were the significant prognostic factors. Pa-tients with palliative irradiation to the metastatic site had longer survival than those without (39 months vs. 13 months, X2=8.63, P=0.012). Patients with good performance status (KPS≥80) had better outcomes thanthose with poor performance status (26 months vs. 12 months, X2= 3.95, P=0.035) . Conclusions Active therapy may prolong the survival of patients with initially diagnosed metastatic NPC, especially for those who have good performance status. Under systematic chemotherapy, radiotherapy to the primary site and supportive care, the palliative irradiation to the metastatic site may also yield a good result.     

智齿未拔除的鼻咽癌患者放疗后下颌骨坏死2例报告

鼻咽癌的常规放射治疗中,下颌骨常常会受到高剂量照射,部分患者因此出现严重的晚期放射性并发症--放射性骨坏死(osteoradionecrosis,ORN).该并发症的发生可能与智齿有关.本文报告我院近年发现的2例未拔除智齿行鼻咽癌化疗而发生ORN的病例,并对该病的发生发展及与智齿拔除是否有关进行文献复习,以期对肿瘤放射治疗工作有所帮助.     

PET/CT在食管癌放射治疗中的应用进展

食管癌是最常见的恶性肿瘤之一,放射治疗是其治疗的重要手段.然而,目前的CT、食管内镜超声(EUS)等影像检查手段只能从肿瘤的解剖形态信息上来进行食管癌的放射治疗模拟定位及分期、疗效评价.18F-FDG PET/CT作为集功能和解剖信息于一身的一种新的检查方式,在食管癌的诊断分期及放化疗预后的监测中已经得到了日益广泛的应用.笔者就18F-FDG PET/CT在食管癌的诊断分期及放射治疗方面的应用进展进行综述.