鼻咽癌放射治疗后感音神经性耳聋的临床分析

目的观察鼻咽癌患者放射治疗后感音神经性耳聋的发生率及探讨影响其发生的因素。方法对放射治疗后随访期满1年以上的25例鼻咽癌患者分别进行纯音听阈和声阻抗一导纳测试，并且收集相关的临床资料予以回顾性分析。结果所有患者随访期为12—94月(中位53月)。低频段和高频段感音神经性耳聋的发生率分别为8％和42％。对影响高频段感音神经性耳聋的单因素分析后发现，患者确诊时的年龄和随访时间有统计学意义(t=2．051，P=0．0458；t=2．978，P=0．0045)；而性别、确诊时是否主诉有听力下降和(或)耳鸣、鼻咽部照射剂量和是否联合应用含顺铂的化疗则均无统计学意义。采用Binary Logistic回归法多因素分析显示，患者确诊时的年龄和随访时间有统计学意义(P=0．02；P=0．009)。结论鼻咽癌放射治疗后高频段感音神经性耳聋的发生率明显高于低频段，影响高频段感音神经性耳聋发生的主要因素是患者确诊时的年龄和随访时间，而治疗前的听力水平、放疗剂量与是否联合应用含顺铂的化疗对其发生率的影响尚不明确。     

^99Tc^m-双半胱氨酸-甲硝唑SPECT显像预测鼻咽癌乏氧的初步研究

目的初步探讨^99Tc^m-EC-MN（99锝-双半胱氨酸-甲硝唑）SPECT显像对预测鼻咽癌乏氧状况的可行性及临床价值。方法在放疗前对15例鼻咽癌初治病例进行^99Tc^m-EC-MN SPECT显像,测定鼻咽原发病灶肿瘤T/N值（放射性计数/正常组织放射性计数比值）,并随访治疗疗效。结果15例鼻咽原发病灶的T/N值为0.91-3.51（平均值为2.14）,放疗后15例中,CR 8例,PR 7例;其3年总生存率、局部控制率和无远地转移率分别为53.3%、79.0%和86.2%。T/N值≤2.14和〉2.14组的治疗反应率、总生存率、局部控制率和无远地转移率差异均无统计学意义（P〉0.05）。结论^99Tc^m-EC-MN SPECT显像能安全地用于鼻咽癌乏氧的检测;肿瘤之间不同的T/N值提示鼻咽原发灶均存在不同程度的乏氧现象,但其临床应用价值不能肯定。     

食管癌分次放疗期间靶区不确定性初步研究

Objective To investigate the changes of target during fractionated radiotherapy for e-sophageal cancer, and to assess their impact on the implementation of radiotherapy. Methods Fourteen pa-tients with unresectable esophageal cancer were enrolled to receive full course conformal radiotherapy. CT scans were performed after every ten fractions. New targets (GTV) were delineated on repeated CT scans. Then the pretreatment radiotherapy plans were copied to the new targets to investigate the conformity between the new GTV and the plans. Results The majority of the GTVs decreased with the increasing fractions dur-ing radiotherapy. However, GTVs of 35.7% (5/14) patients increased by 2.0%-37.7% at the tenth frac-tion. The PTVs covered by 95% isodose curve at the time of pretreatment,tenth fraction,twentieth fraction and thirtieth fraction were 97.81%±1.53%, 91.95%±5.25%, 94.27%±4.23% and 94.03%±6.45%, respectively. Moreover, at tenth, twentieth and thirtieth fraction, there were 6,5, and 4 patients whose PTVs covered by 95% isodose curve were below 95%, respectively. Conclusions There are signifi-cant target changes during fractionated radiotherapy for esophageal cancer, which may result in uncertainties of radiotherapy implementation.     

肿瘤微环境乏氧对化疗敏感性的影响

肿瘤微环境乏氧不仅使肿瘤自身更具侵袭性，容易发生远处转移，而且能使肿瘤对放化疗的抗拒性增加，从而降低其疗效。肿瘤微环境乏氧影响化疗敏感性的机制可分为直接耐药和间接耐药两种，现简要综述此方面的研究进展。     

放射治疗增敏的新靶点ATM的研究进展

临床发现患遗传性共济失调-毛细血管扩张(ataxia-telangiectasia，A-T)综合征的患者对电离辐射具有高敏感性：通过研究表明其高放射敏感性可能归因于ATM(ataxia-telangiectasia mutated)基因，其中起关键作用的部分是ATM蛋白激酶：为此，人们开发了ATM激酶的阻滞剂，如咖啡因、己酮可可碱、甲基黄嘌呤和UCN-01(7-hydroxystaurosporine)等，并在基础和临床研究中获得了一些可喜的结果：     

食管癌分次放疗期间靶区不确定性初步研究

Objective To investigate the changes of target during fractionated radiotherapy for e-sophageal cancer, and to assess their impact on the implementation of radiotherapy. Methods Fourteen pa-tients with unresectable esophageal cancer were enrolled to receive full course conformal radiotherapy. CT scans were performed after every ten fractions. New targets (GTV) were delineated on repeated CT scans. Then the pretreatment radiotherapy plans were copied to the new targets to investigate the conformity between the new GTV and the plans. Results The majority of the GTVs decreased with the increasing fractions dur-ing radiotherapy. However, GTVs of 35.7% (5/14) patients increased by 2.0%-37.7% at the tenth frac-tion. The PTVs covered by 95% isodose curve at the time of pretreatment,tenth fraction,twentieth fraction and thirtieth fraction were 97.81%±1.53%, 91.95%±5.25%, 94.27%±4.23% and 94.03%±6.45%, respectively. Moreover, at tenth, twentieth and thirtieth fraction, there were 6,5, and 4 patients whose PTVs covered by 95% isodose curve were below 95%, respectively. Conclusions There are signifi-cant target changes during fractionated radiotherapy for esophageal cancer, which may result in uncertainties of radiotherapy implementation.     

荧光原位杂交法预测肿瘤放射敏感性的初步研究

目的 研究应用荧光原位杂交（FISH）方法预测人肿瘤细胞放射敏感性及其应用的可行性。方法 用3种放射敏感性不同的人肿瘤细胞株[鼻咽鳞癌（CNE）、肺腺癌（SPC）和乳腺癌（MCF-7）]，常规克隆形成方法测定不同剂量照射后的存活分数和照射后24h经秋水仙素阻断细胞分裂周期，低渗、固定、常规染色体制片后，采用8号染色体涂染探针和FISH方法测定肿瘤细胞8号染色体诱导的畸变量。结果 2、4、6Gy照射后24h、CNE、SPC和MCF-7细胞诱导生成的残存染色体畸变能够反映细胞 的放射敏感性，所有细胞株诱导染色体畸变与细胞存活分数分别存在良好相关性（r=0.98），3种细胞株SF2和相应残存染色体畸变也存在良好相关性（r=0.96）。结论 采用FISH方法计数照射诱导的残存染色体畸变，可以预测肿瘤细胞的放射敏感性差异并具有重要的临床意义。     

食管癌分次放疗期间靶区不确定性初步研究

目的 观察食管癌分次放疗期间靶区变化情况,探讨这些变化对放疗计划实施影响程度.方法 选取14例未手术并拟接受全程三维适行放疗食管癌患者.在放疗期间每照射10次重新行定位CT扫描,并且再次勾画靶区(GTV).随后将放疗前制定放疗计划复制到新CT图像上,观察分次放疗期间新勾画靶区与放疗前治疗计划符合程度.结果 放疗过程中GTV总体呈递减趋势,14例中5例在照射至第10次时出现CTV增大为初始2.0%～37.7%.95%等剂量曲线包括计划靶体积(PTV)初始计划时为97.81%±1.53%、第10次时为91.95%±5.25%、第20次时为94.27%±4.23%和第30次时为94.03%±6.45%,且在照射后第10、20和30次分别有6、5和4例出现95%等剂量曲线包括PTV降至95%以下.结论 食管癌分次放疗期间靶区出现明显变化而使放疗实施存在不确定性.     

复发头颈部癌再程放疗研究

近50%的头颈部癌病例在接受首程放疗后会出现放射野内复发。挽救性手术是首选的治疗手段。临床研究表明复发头颈部癌接受挽救性手术+术后再程放疗或者再程放疗 ±化疗或靶向药物治疗后能使一小部分病例获益,得到肿瘤控制和长期生存。但总体疗效不尽如人意,且伴发严重的急性和晚期,甚至致死性的治疗相关不良反应。因此要求在实施再程放疗时需要充分考虑复发肿瘤情况、首次放疗相关因素和病人自身状态。随着放疗技术和综合治疗模式的发展,包括质子和重离子以及免疫治疗的临床应用,为提高复发头颈部癌治疗疗效,降低治疗相关不良反应提供了可能性。     

45例前列腺癌放射治疗的临床分析

目的分析前列腺癌放射治疗的疗效及预后因素.方法回顾分析本院常规放射治疗前列腺癌45例,41例放射治疗前接受双侧睾丸切除,29例同时服用内分泌治疗药物.采用常规放射治疗技术,5次/周,1.8～2.0*!Gy/次,肿瘤剂量最低50.4*!Gy,最高75.9*!Gy,中位68.3*!Gy.结果中位随访28个月(范围1～111个月),随访率91.1%.5年总生存率为76.4%,肿瘤特异生存率为76.5%.1、2、3级急性胃肠道反应发生率分别为53.5%、7.0%、9.3%,1、2级急性泌尿生殖系统反应发生率分别为41.9%、4.7%;1、2级胃肠道晚期反应发生率分别为16.7%、7.1%,1、2、3级泌尿生殖系统晚期反应发生率分别为23.8%、4.8%、2.4%.结论前列腺癌的放射治疗结果较为满意,治疗的副反应尚能承受.