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.     

三维适形放疗与调强放疗在不同肺叶非小细胞肺癌中的刘量学研究

目的比较不同肺叶非小细胞肺癌（NSCLC）的调强放疗（IMRT）和三维适形放疗（3DCRT）的剂量学特点。方法以肿瘤位于上叶（上叶组）及下叶（下叶组）的各10例接受根治性放疗的NSCLC患者为研究对象,分别制定5野IMRT计划及3—5野3DCRT计划,应用剂量体积直方图评估两组治疗计划,分别比较上叶组、下叶组IMRT与3DCRT计划之间的剂量学参数。结果1）上叶组、下叶组的IMRT计划的以下指标优于相应的3DCRT计划,差异均有统计学意义（P〈0．05）：PTV参数、适形指数、异质性指数、平均肺剂量及肺V10～V65、食管Dmean及V55、心脏V40、食管的早晚期正常组织并发症发生率;2）IMRT计划比3DCRT计划平均降低了上叶组约2．7％的肺V5值及下叶组约1．1％的V5值,但差异无统计学意义（P〉0．05）;3）与3DCRT计划比较,上叶组、下叶组的IMRT计划的食管V35、心脏Dmean均较低,在上叶组的差异有统计学意义（P〈0．05）,在下叶组的差异无统计学意义（P〉0．05）。结论在NSCLC的根治性放疗中,5野IMRT较3DCRT更能提高靶区的剂量分布均匀性,在保护正常组织器官方面也显示出较明显的优势;且IMRT应用于上叶NSCLC的优势有可能大于下叶者。     

三维适形放疗与调强放疗在不同肺叶非小细胞肺癌中的剂量学研究

目的 比较不同肺叶非小细胞肺癌(NSCLC)的调强放疗(IMRT)和三维适形放疗(3DCRT)的剂量学特点.方法 以肿瘤位于上叶(上叶组)及下叶(下叶组)的各10例接受根治性放疗的NSCLC患者为研究对象,分别制定5野IMRT计划及3～5野3DCRT计划,应用剂量体积直方图评估两组治疗计划,分别比较上叶组、下叶组IMR...     

鼻咽癌患者心理状态与免疫功能的关系

目的 探讨鼻咽癌患者在放疗期间的心理状态与免疫功能的关系.方法 分别应用焦虑自评量表(SAS)和抑郁自评量表(SDS)调查60例首诊鼻咽癌患者在放疗开始和放疗结束时的焦虑和抑郁状况,同时测定患者的血液白细胞及总淋巴细胞水平.结果 治疗前后患者焦虑状况、抑郁状况、白细胞水平及总淋巴细胞水平比较差异均有统计学意义(P＜0....     

盐酸氨溴索防治早期放射性肺损伤的实验研究

目的探讨盐酸氨溴索对小鼠早期放射性肺损伤的防治作用。方法成年雄性昆明种小鼠36只,随机分成对照组,模型组和盐酸氨溴索组,每组12只。对照组小鼠无照射无给药,模型组灌胃生理盐水10 ml/(kg·d),盐酸氨溴索组灌胃盐酸氨溴索口服溶液40 mg/(kg·d),连续5 d。第5天给药后1 h,模型组和盐酸氨溴索组小鼠全肺单次照射18 Gy X射线,照射后继续给药3周。于照射后2周、6周,进行小鼠肺部螺旋CT扫描及图像分析,获得小鼠全肺的平均灰度值;采用HE染色,制作肺组织病理切片,在光镜下观察肺组织的变化。结果盐酸氨溴索组小鼠全肺平均灰度值明显低于模型组(P<0.05);模型组小鼠在照射后存在明显的病理组织学上的改变,表现为肺充血、水肿、肺间质增厚,盐酸氨溴索组上述所见明显减轻。结论盐酸氨溴索对放射性肺损伤有一定的防治作用。     

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.     

B10细胞在放射性肺纤维化进程中的动态变化

目的:探究B10细胞放射性肺纤维化进程中的动态变化.方法:将30只6～8周C57BL/6小鼠随机分为未照射对照组、照射后2 d组(IR2d组)、照射后14 d组(IR14d组)、照射后3个月组(IR3m组)、照射后5个月组(IR5m组),应用电离辐射建立放射性肺纤维化的动物模型,通过HE染色法、Masson染色观察肺组...     

鼻咽癌、肺腺癌和乳腺腺癌细胞XRCC4基因保守性研究

目的：研究不同人类肿瘤细胞XRCC4基因的保守性，探讨其与肿瘤放射敏感性的关系。方法：常规集落形成方法测定人类肿瘤鼻咽鳞癌（CNE）、肺腺癌（SPC-A1）和乳腺腺癌（MCF-7）不同剂量照射后的细胞存活率，采用聚合酶链式反应和克隆技术测定三种细胞XRCC4基因序列，分析它们的保守性变化和突变对基因产物亲疏水性的影响。结果：三种细胞存活参数比较存在较大差异，CNE细胞较SPC-A1和MCF-7细胞显示出较高的放射敏感性。CNE、SPC-A1和MCF-7细胞XRCC4基因同源性分别为：99.94％、99.97％和99％，存在包括碱基插入、缺失和颠换等突变形式。其中，CNE和MCF-7细胞6bp的TTCTAG插入突变导致的氨基酸序列变化影响该基因产物的亲疏水结构。结论：XRCC4基因产物在非同源性末端连接途径中起重要的协调作用，CNE和MCF-7细胞该基因的同源性低于SPC-A1细胞，两者的6bp插入突变是影响肿瘤细胞DNA双链断裂损伤修复能力和肿瘤放射敏感性的因素之一。     

头颈部肿瘤患者放射治疗期间营养状况动态分析

[目的]探讨头颈部肿瘤患者放射治疗期间营养状态动态变化,分析影响的因素。[方法]每周跟踪调查患者的营养状况并观察急性毒性反应。采用体重、转铁蛋白、血清前白蛋白等指标评价营养状态,采用非条件logistic回归法对影响患者营养不良的因素进行多因素分析。[结果]患者放疗期间,体重持续下降,每隔2周平均下降0.7 kg、1.29 kg、1.19 kg和0.6 kg,以放疗的第2~4周下降最显著,各营养指标也呈下降趋势。分析提示,口咽部急性毒性反应和患鼻咽癌是影响营养不良的主要因素。[结论]头颈部肿瘤患者放疗期间普遍存在不同程度营养不良,应正确识别和预防影响营养不良的主要因素,寻找最佳营养支持的时机,最大限度减少营养不良的发生。