紫杉醇对人腺样囊性癌细胞株ACC-2体外辐射增敏作用

目的 评价紫杉醇对人腺样囊性癌细胞株ACC-2的辐射增敏作用。方法 用克隆形成法检测不同时间-浓度条件紫杉醇和／或放射作用后的人腺样囊性癌细胞株ACC-2细胞存活分数，计算辐射增敏率(SER)。结果 紫杉醇对ACC-2细胞具有体外增殖抑制作用。人腺样囊性癌细胞株ACC-2的平均效应剂量(Do)=1．43Gy，Dq=3．6Gy，10，100，1000nmol紫杉醇作用24h后SER分别为1．29，1．66和1．23。结论 人腺样囊性癌细胞株ACC-2具有一定的辐射抗性。紫杉醇对其体外增殖抑制作用表现为时间．浓度依赖性效应。一定条件下紫杉醇对人腺样囊性癌细胞株ACC-2具有辐射增敏作用。     

Ⅱ级胶质瘤术后调强放射治疗疗效分析

目的分析Ⅱ级胶质瘤术后调强放射治疗的疗效及预后影响因素。方法对2010年1月至2018年12月期间收治的接受术后调强放射治疗的109例Ⅱ级胶质瘤患者进行回顾性分析。主要研究终点为无复发生存率、次要研究终点为总生存率。分析年龄、性别、手术切除状态、病灶最大径、肿瘤跨中线、含星形细胞瘤成份、同步放化疗、辅助化疗等因素对无复发生存的影响。结果全组随访率91.75%,随访期间10例死亡,27例复发。照射野内复发24例,占88.9%;照射野外复发3例,占11.1%。其中,肿瘤全切组81例复发14例,占17.3%;部分切除组28例复发13例,占46.4%。部分切除组复发率明显高于全切组(χ^2=9.484,P<0.05)。全组患者1、2、3、4、5年无复发生存率分别为92.5%、86.0%、80.6%、77.5%、66.8%,2、3、4、5年总生存率分别为97.2%、90.8%、87.7%、84.5%。多因素分析显示,手术部分切除(HR=3.608,P<0.05)、肿瘤跨中线(HR=3.183,P<0.05)患者更容易复发进展。结论Ⅱ级胶质瘤行术后调强放射治疗,可获得较好的无复发生存。照射野内复发为主要的治疗失败模式,手术切除状态、肿瘤是否跨中线是影响无复发生存的重要因素。     

小细胞肺癌化疗后肿瘤体积变化规律及影响因素

目的：通过分析小细胞肺癌（SCLC）化疗后肿瘤体积的变化规律及可能影响其变化的相关因素,为诱导化疗的最佳周期数选择及放射治疗的最佳介入时机提供理论依据。方法回顾性分析行多周期诱导化疗的首诊 SCLC 患者的疗效。使用治疗计划系统自带体积测量软件及 Image J 图像处理软件测量肿瘤体积,分析诱导化疗不同周期后的体积变化情况,并分析可能的影响因素（性别、年龄、大体类型、患者 ECOG 评分、化疗前肿瘤体积、T 分期）对其的影响。结果（1）共有34例 SCLC 患者入组,化疗前和化疗1、2、3、4、5、6个周期后的肿瘤绝对体积分别为63002．89（18488．99,130598．54）、40523．12（12083．03,77139．65）、12145．31（2758．06,67560．39）、18141．67（4498．78,70062．25）、13864．67（2940．28,71071．43）、20964．56（1854．63,85806．55）和19600．00（5698．36,151165．90）mm 3。（2）化疗前和化疗1个周期后绝对体积之间差异有统计学意义（t ＝3．157,P ＝0．004）,两组的相对体积（假定化疗前肿瘤体积为1）差异也有统计学意义（t ＝3．312,P ＝0．003）,第3周期较第2周期化疗无效例数明显升高（P ＝0．025）,其他各相邻周期间差异无统计学意义。（3）logistic 回归分析发现,T 分期（χ2＝5．512,P ＝0．019,OR ＝0．099）是 SCLC 化疗1个周期后肿瘤消退率的独立影响因素。结论SCLC 患者多周期化疗后体积变化呈现一定的规律。化疗1个周期后 SCLC 平均原发灶肿瘤体积明显下降,化疗3个周期后可能出现反弹。若采用诱导化疗,1个周期即可。 T3～4期较 T1～2期的第1周期肿瘤退缩效果相对较好。     

食管癌同步放化疗奈达铂加氟脲苷方案剂量递增试验

目的:探讨奈达铂(NDP)加氟脲苷(FUDR)方案应用于食管癌同步放化疗时的最大耐受剂量(MTD)并观察其毒副反应.方法:共入选13例初治食管鳞癌患者.放射治疗采用常规分割方法,照射剂量为60Gy/30次,6周.同步化疗采用剂量递增方法,起始剂量为NDP 20 mg·m-2,FUDR 300 mg·m-2,d 1用药,以后每周用药1次,共6次.递增剂量为NDP 5 mg·m-2,FUDR 50 mg·m-2.DLT定义为3级或3级以上毒性反应.每剂量组至少5例,如无剂量限制毒性(DLT)出现则进入下一剂量组,直到出现DLT.出现DLT的前一剂量即为MTD.结果:DLT为3级放射性食管炎,发生于NDP 30 mg·m-2,FUDR 400 mg·m-2剂量水平,共有2例患者发生;其前一剂量水平NDP 25 mg·m-2,FUDR 350 mg·m-2即为MTD.主要毒性反应为放射性食管炎、放射性肺炎、厌食、呕吐、白细胞减少、血小板下降和肝功能损害.结论:食管癌同步放化疗奈达铂加氟脲苷每周方案的最大耐受量为NDP 25 mg·m-2,FUDR 350 mg·m-2.     

48例脑转移瘤放射治疗疗效分析

目的探讨放射治疗对脑转移瘤的疗效及应用价值。方法将48例脑转移瘤患者采用直线加速器6MVX线全脑照射DT30～40Gy/15～20次/3～4周,大部分病人缩野局部追加10～20Gy/5～10次/1～2周。结果36例显效,11例好转,总有效率97.9%,平均生存期6.3月。结论脑转移瘤放射治疗能明显缓解症状,提高生存质量,延长生存期。     

脑转移瘤调强放射治疗疗效观察

目的 探讨调强放射治疗脑转移瘤的疗效及毒副反应.方法 实施5野调强放射治疗脑转移肿瘤18例.根据预后分级评分(GPA)分级,Ⅲ级11例,Ⅳ级7例.全脑剂量(PTV-CTV)1.9～2.4 Gy/次,DT 36～42 Gy;脑转移灶(PTV-GTV)2.2～3.0 Gy/次,DT 40～56 Gy;均为5次/周;同步加量结束.95%的等剂量曲线包括靶区.放疗结束后行脑部MRI评价疗效.结果 CR 4例(22.2%),PR 12例(66.7%),SD 1例(5.6%),PD 1例(5.6%),有效率88.9%.1年生存率71.2%.主要毒副反应为骨髓抑制、恶心呕吐、脑水肿等.结论 调强放射治疗脑转移瘤有较好的疗效,毒副反应轻.     

26例非小细胞肺癌调强放疗的近期疗效和毒副反应

目的 分析应用调强放疗( IMRT)技术治疗非小细胞肺癌( NSCLC)患者的近期疗效和毒副反应.方法 应用IMRT技术治疗26例不能手术或不愿手术的NSCLC.肿瘤GTV的中位体积为280.2(46.2~689.3) cm3,所有患者均接受2.0~2.5 Gy/次的分割;1次/d;5次/周;4 ~7周完成治疗,中位总剂量为55.2(33~70) Gy,均采用5野的调强放疗.结果 26例患者均完成了放疗计划.中位随访时间为8.2(4~21)个月,1年生存率65.4%.放疗结束后3个月时的肿瘤局控情况:CR 1例 (3.8%);PR 19例 (73.2%);SD 3例 (11.5%) ;PD 3例 (11.5%),其中死亡1例 (3.8%).最常见的毒副反应为放射性肺炎和放射性食管炎.结论 应用5野IMRT技术治疗NSCLC可行、有效,毒副反应可耐受.     

胸段食管癌三维适形放疗摆位误差研究

目的 应用电子射野影像装置(EPID)测量胸段食管癌三维适形放疗(3DCRT)的摆位误差,推算PTV与CTV之间的间隙.方法 对41例胸段食管癌患者每周拍摄1次正侧位EPI,通过比较EPI和数字重建影像(DRR)的差异来测量摆位误差.根据公式计算出PTV与CTV之间的间隙.采用自身配对设计对22例接受根治性放疗患者应用不同PTV与CTV的间隙值分别设计两套模拟治疗计划,A组x、y和z轴均为10 mm,B组采用本研究结果 的间隙值.应用配对t检验或Wilcoxon符号秩检验来比较两套计划间的差异.结果 x、y、z轴的PTV与CTV的间隙值分别为8.72、10.50、5.62 mm.两套模拟计划间的脊髓最高照射剂量不同,A计划为(4638.7±1449.6)cGy,B计划为(4310.2±1528.7)cGy(t=5.48,P=0.000);脊髓并发症概率也不同,A计划为4.82%±5.99%,B计划为3.64%±4.70%(Z=-2.70,P=0.007).结论 笔者单位胸段食管癌接受3DCRT时在x,y和z轴上的PTV与CTV之间的间隙值分别为8.72、10.50、5.62 mm;与3个轴均为10 mm的间隙值相比应用本研究结果 制定治疗计划可更有效地保护脊髓.     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.     

胸段食管癌三维适形放疗摆位误差研究

Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.