Ⅱ期和Ⅲ期直肠癌根治术后卡培他滨同期放化疗疗效及失败原因分析

目的 分析Ⅱ、Ⅲ期直肠癌根治术后卡培他滨同期放化疗Ⅱ期临床研究结果.方法 2005-2007年间共131例病理诊断明确的Ⅱ、Ⅲ期直肠癌患者纳入研究,所有患者均接受根治术后同期化放疗和辅助化疗.治疗方案为全盆腔放疗50 Gy分25次,放疗期间同期应用卡培他滨1600mg/m2,每天分2次服用,连用2周停l周.结果 同期放化疗期间3+4级不良反应发生率为28.2％.随访率为93.9％,3年总生存率、无局部区域复发生存率和无远处转移生存率分别为85.1％、96.7％和79.5％.共31例出现复发,包括5例局部区域复发和28例远处转移.单因素分析提示病理低分化或中低分化、未接受辅助化疗、ⅢC期和淋巴结阳性率＞30％是影响总生存的因素(x2=15.49、15.85、8.80和9.76,P=0.000、0.000、0.011和0.002),ⅢC期、未接受辅助化疗和淋巴结阳性率＞30％是影响无远处转移生存的因素(x2 =6.51、11.57和9.70,P=0.034、0.001和0.002).但未接受辅助化疗者中病理为低分化或T4期的患者更多(x2 =7.20、6.48,P=0.027、0.039).结论 Ⅱ、Ⅲ期直肠癌根治术及卡培他滨同期放化疗后局部区域控制率高,远处转移是主要失败原因.     

早期乳腺癌保乳术后大分割三维放疗Ⅱ期临床观察

目的 观察早期乳腺癌保乳术后大分割三维放疗的疗效、美容效果和不良反应。
方法 2009-2010年45例pT is~2N 0~1M 0期乳腺癌患者保乳术后行三维适形或简化调强放疗,全乳43.5 Gy,瘤床补量8.7Gy,2.9Gy/次, 总疗程24 d。33例接受了化疗,其中新辅助化疗2例、术后化疗31例。局部区域控制率和总生存率用Kaplan Meier法计算。
结果 随访率100%。2年局部区域控制率、生存率均为100%;1例单发骨转移。2级乳房水肿1例,2级乳房纤维化6例,2级上肢水肿1例。2级放射性皮炎4例,1、2级放射性肺炎分别为5、2例。与同期保乳术后常规分割放疗相比,放疗次数由30次降至18次,疗程由40 d缩短至24 d,费用由30450元降至19770元。
结论 乳腺癌保乳术后全乳大分割放疗的疗效和美容效果较好,不良反应可接受,且能显著降低治疗时间和费用。     

肝癌术后放疗锥形束CT配准方法研究

目的 比较肝癌术后辅助性放疗锥形束CT (CBCT)不同配准方法结果。
方法 12例患者在瘤床放置金属标记,放疗前后共行214次CBCT。对CBCT图像分别用标记配准、常规骨性配准、常规灰度配准、椎体配准、膈顶配准方法进行配准,并以标记配准作为金标准与其他配准结果行配对t检验和Pearson相关分析。
结果 214次CBCT数据分析结果显示4种配准方法的左右(x)、上下(y)、前后(z) 方向中仅常规骨性配准y方向和椎体配准x方向的与标记配准结果相似(t=0.75、－0.97,P=0.452、0.333),其余各方向与标记配准结果间均不同(t=－13.48~14.56,P均<0.05)。4种配准结果与标记配准结果仅在常规灰度配准的y方向与标记配准相关性较好 (r=0.852,P=0.000),其余的相关性均较差(r=0.367~0.777,P均=0.000)。4种配准结果与标记配准结果的绝对差值在 x、y、z方向上至少有1次>2 mm的比例占 84.1%~93.0%,至少有1次>3 mm的比例占 65.9%~79.9%。
结论 肝癌术后放疗CBCT在线校位时靶区内有标记者应以金属标记为配准目标,无金属标记者用其他配准方法均存在一定误差故应适当增加计划靶体积外放边界。     

青少年或儿童原发系统性间变大细胞淋巴瘤CHOP为主化疗±放疗的远期疗效

目的 分析青少年儿童原发系统性间变大细胞淋巴瘤(ALCL)患者接受CHOP方案化疗 ±受累野放疗的疗效。方法 回顾分析本院1998—2010年收治的 28例青少年、儿童ALCL患者资料。Ⅰ、Ⅱ期 12例中单纯化疗 2例、综合治疗 10例,Ⅲ、Ⅳ期 16例中单纯化疗 14例、综合治疗 2例。CHOP方案 15例、CHOP联合其他高强度化疗 13例。化疗周期数 3~17个(中位数6个)。放疗多为受累野照射,剂量 39.6~50.0 Gy (中位数45 Gy)。结果 全组患者首程疗后达CR者 25例(89%),3例病变进展。中位随访时间45.3个月。全组 5年无事件生存率为80%,5年OS为93%。疗终达CR者 5年OS为100%,而未达CR者无 5年OS (P=0.000)。≥2个结外器官受侵者 5年无事件生存率为38%,而<2个结外器官受侵者的为85%(P=0.010)。结论 青少年、儿童原发系统性ALCL按成人方案治疗效果满意,但还需要长期随访。     

表观扩散系数预测直肠癌术前放化疗疗效分析

目的 探讨表观扩散系数(ADC)预测局部晚期直肠癌术前放化疗疗效的作用。方法 2007 —2011年间前瞻性纳入病理证实的临床Ⅱ、Ⅲ期直肠腺癌患者 70例。均行术前同期放化疗,盆腔放疗 44.0~50.4 Gy分 22~28次,同期化疗卡培他滨每天1650 mg/m²第 1~35天+奥沙利铂50 mg/m²每周1次共5次,放化疗后 4~8周行根治性手术。疗前常规行盆腔MRI及扩散加权成像检查,测量ADC值并行术后病理反应评级。Mann-Whitney U检验法分析组间ADC值差异,Kaplan-Meier法计算生存率并Logrank法检验。结果 70例患者中7例(10%) pCR、38例(54%)降期。中位随访34个月, 22例(31%)复发。疗前、疗中、疗后平均ADC值分别为(1.09±0.19)×10^－3、(1.28±0.19)×10^－3、(1.47±0.24)×10^－3 mm²/s。预后较好组(pCR、降期、无复发)疗前平均ADC值低于预后不良组(P=0.049、0.001、0.029)。取疗前ADC值1.06×10^－3mm²/s为界值预测降期,ROC曲线下面积为0.737(95% CI=0.618~0.856)。疗前ADC值<1.06×10^－3mm²/s组3年DFS和DMFS均高于≥1.06×10^－3 mm²/s组,分别为86%比58%(P=0.01)和90%比60%(P=0.01)。 结论 疗前ADC值与局部晚期直肠癌术前同期放化疗疗效有一定相关性,对预测直肠癌术前放化疗疗效有一定意义。     

软组织肿瘤的放射治疗

20世纪70年代初期,肢体软组织肉瘤的生存率仅为25%～30%,而近10年超过70%的患者接受了手术 放射治疗(简称为放疗) 化疗的综合治疗,以广泛切除术辅以放疗为基本治疗模式的5年局部控制率可达80%～90%,5年的生存率亦提高到了60%～80%,可见放疗在软组织肉瘤的治疗中有着显著的疗效。根据放疗与手术的不同组合和先后顺序,可以将放疗区分为术前放疗、术后放疗和术中放疗。     

前列腺癌大分割调强放疗副反应初步分析

Objective To analyze the acute and late toxicities in patients with prostate cancer trea-ted with hypofractionated intensity-modulated radiotherapy (IMRT). Methods Between June 2006 and June 2008, 37 patients with prostate cancer were treated with hypofractionated IMRT. The clinical target vol-ume (CTV) was the prostate, seminal vesicles and pelvic lymph nodes in 24 patients, the prostate and semi-hal vesicles in 12, and only the tumor bed in 1. The dose per fraction was 2.3 - 2.8 Gy, with 2.7 Gy in 26 patients. The minimal dose was 62.5-75.0 Gy to the prostate and seminal vesicles, and 50 Gy to the pelvic lymph nodes. Results The median follow-up was 14 months. None of the patients experienced grade 4 a-cute gastro-intestinal (GI) toxicity. Grade 1, 2 and 3 acute GI toxicity occurred in 24.3%, 35.1% and 2.7% of the patients, respectively. The rectal V50>27% and V55>20% were highly significantly associat-ed with grade ≥1 acute GI toxicity. Grade 1,2 and 3 acute genitourinary (GU) toxicity occurred in 68%, 0% and 3% of the patients, respectively. The bladder V50> 10% was significantly associated with grade ≥1 acute GU toxicity. The incidence of late GI toxicity was low. No grade ≥3 late GI toxicity was observed. The incidence of late grade 1 and 2 GI toxicity was 24% and 5%, respectively. The rectal V65> 10% was highly significantly associated with grade ≥1 late GI toxicity. No late grade 4 GU toxicity was observed. The incidence of grade 1, 2 and 3 late GU toxicity was 49%, 11% and 3%, respectively. Grade ≥2 late GU toxicity was correlated with V40, V50 and mean dose of the bladder. Conclusions Acute and late toxicity of hypofractionated IMRT is acceptable in patients with prostate cancer.     

早期结外鼻型NK/T细胞淋巴瘤放化疗疗效与不良反应分析

目的 探讨早期结外鼻型NK/T细胞淋巴瘤放化疗综合治疗的疗效及不良反应。方法 回顾性分析本院收治的174例经病理证实的结外鼻型NK/T细胞淋巴瘤患者资料。生存分析及组间比较采用Kaplan-Meier法和Log-rank检验。结果 全组Ⅰ期患者102例,Ⅱ期患者72例。2例患者接受单纯放疗,172例患者接受放化疗综合治疗。全组总有效率为94.2%（164/174）,其中完全缓解（CR）患者153例（87.9%）。5年总生存率（OS）为87.3%,5年无进展生存率（PFS）为83.1%,5年局部区域控制率为91.9%。放化疗期间最常见不良反应为骨髓抑制和口腔黏膜炎,≥ 3级骨髓抑制占62.1%,≥ 3级口腔黏膜炎占10.9%。多因素分析结果显示,高龄、B症状及Ann Arbor分期Ⅱ期是OS的独立预后不良因素,而高龄和Ann Arbor分期Ⅱ期是PFS的独立预后不良因素。放疗剂量≥ 50 Gy较低剂量组可显著提高总PFS,两组5年PFS分别为83.5%和76.5%（HR 0.374,95%CI 0.169~0.826,P=0.015）。结论 早期NK/T细胞淋巴瘤经过放化疗综合治疗可达到较好疗效,不良反应可以耐受。     

影响脑干胶质瘤的预后因素分析

目的 通过脑干胶质瘤（brainstem gliomas,BSG）调强放疗单中心回顾性分析研究,探讨脑干胶质瘤调强放疗后的总生存（OS）及影响预后的因素。方法 收集北京大学肿瘤医院放疗科2012年1月至2019年9月接受调强放疗资料完整的脑干胶质瘤病例,回顾性分析患者的总生存及影响因素,预后因素分析包括：性别、年龄、手术方式、影像学分型、发病部位、世界卫生组织（WHO）分级、是否化疗、放疗方式、症状至首次治疗时间、放疗剂量。结果 共收集21例患者,随访时间≥3个月的脑干胶质瘤患者有18例,中位随访时间15.5（5.3~25.6）个月,中位生存时间（mOS） 20（14.1~25.8）个月,1年和2年总生存率分别为86.2%和34.5%。影响脑干胶质瘤患者放疗疗效的因素包括手术方式、影像学分型、发病部位、WHO分级、放疗方式（χ²=4.829~20.261,P<0.05）。结论 肿瘤大部分及以上手术切除、局灶内生型/外生型、发病部位在中脑、低级别肿瘤、肿瘤切除术后放疗的患者预后较好,对指导临床具有一定参考价值。     

Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.