鼻咽癌放射治疗相邻照射野间的连接方法

目的 探讨鼻咽癌放射治疗中一种新的面颈野或耳前野与颈切线野连接方法的可行性。方法 用带独立准直器的直线加速器治疗鼻咽癌患者，前半程以半束照射方式连接面颈联合野与下颈前切线野，后半程用耳前野(X线)-上颈电子线野-下颈前切线野(X线)相连接的方法进行照射。结果 根据治疗计划系统显示，靶区剂量分布理想，相邻野间未发现明显的“冷点”和“热点”，初步临床观察结果满意。结论 本照射野间的连接方法是一种可行的照射方式。     

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.     

序贯放化疗后辅助化疗治疗局部晚期鼻咽癌的疗效分析

目的 评价新辅助化疗(NACT)序贯调强放疗(IMRT)之后的辅助化疗(AC)对局部晚期鼻咽癌的临床疗效. 方法 收集初治的局部晚期鼻咽癌172例,其中NACT+ IMRT组94例、NACT+ IMRT+ AC组78例.应用Kaplan-Meier法评估患者的生存率,Cox回归模型进行多因素分析. 结果 NACT+ IMRT组与NACT+IMRT+AC组的3年总生存率(0S)、无进展生存率(PFS)、无复发生存率(RFS)、无远处转移生存率(DMFS)分别为86.66％ vs.84.47％,77.38％ vs.75.31％,92.65％ vs.86.00％,83.20％ vs.88.64％,2组比较差别均无统计学意义(P＞0.05).对于N3及ⅣA期患者,AC延长了无远处转移生存,但是增加了3～4级骨髓抑制及听力下降的发生率(P＜0.05).N分期是DMFS的独立预后因素(P＜0.05). 结论 NACT+ IMRT治疗后的AC对局部晚期鼻咽癌患者并没有增加生存获益,反而增加了毒副反应,但它可能有助于降低N3及ⅣA期患者的远处转移风险.     

食管癌三维适形放疗靶区界定

食管癌三维适形放疗是新开展的一项精确放疗技术,靶区的准确界定是适形放疗中首要和基础的工作,为了更准确地勾画靶区,本文对食管癌三维适形放疗中大体肿瘤区或肉眼肿瘤区、临床靶区、计划靶区的界定问题进行综述。其中,正电子发射体层成像对于食管癌三维适形放疗中大体肿瘤区的准确界定具有重大价值。至于食管癌三维适形放疗临床靶区和计划靶区的外放边界大小,各治疗中心报道的数据不一致,仍有待进一步探讨。     

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.     

基于磁共振指导靶区勾画的高级别胶质瘤术后调强放射治疗的疗效分析

目的 回顾性分析基于磁共振（MRI）指导靶区勾画的高级别胶质瘤术后行调强放射治疗联合替莫唑胺化疗的疗效及预后影响因素。方法 回顾性分析本院放疗科2010年10月至2015年12月收治的111例高级别胶质瘤术后患者。通过MRI-CT融合技术,在手术前、术后 （＜72 h）及放疗前,MRI指导下勾画靶区,行调强放射治疗联合替莫唑胺化疗。用K-M法计算生存率,分别采用Log-Rank检验和COX回归分析进行单因素和多因素统计分析,分析患者的年龄、性别、病理分级、病灶数量、是否累及多个脑叶、是否跨中线、伴有癫痫发作、病灶最大径、辅助化疗等因素对预后的影响。结果 全组111例符合入组条件的患者随访率为94.6%。全组患者1、2、3、4、5年生存率分别为81.6%、54.2%、39.1%、25.4%、15.5%,中位生存期为38个月。单因素分析结果显示,病理分级、年龄、术前肿瘤最大径、辅助化疗对生存率有影响（χ²=5.549、6.393、4.555、4.965, P<0.05）;多因素分析提示,病理低分级、年轻、术前肿瘤最大径较小有较好预后（Wald=4.784、4.560、5.859, P<0.05）。结论 高级别胶质瘤术后,通过MRI-CT融合技术,在术前、术后 （＜72 h）及放疗前MRI指导下制定放疗靶区,行调强放射治疗联合替莫唑胺化疗,可取得较好疗效,其中Ⅲ级胶质瘤、<50岁、肿瘤最大径<6 cm、接受辅助化疗者预后较好。     

影响早期宫颈癌术后放疗的预后因素及生存质量分析

目的 回顾性分析早期宫颈癌手术后调强放疗(IMRT)和三维适形放疗(3D-CRT)治疗的预后及生存质量情况,探讨IMRT能否提高早期宫颈癌术后患者的治疗增益比. 方法 收集148例国际妇产科联盟(FIGO)分期为Ⅰ B～ⅡA期具有不良预后因素的宫颈癌术后患者的临床资料,其中IMRT组100例,3D-CRT组48例.采用单因素及多因素COX回归分析各种影响预后因素;Kaplan-Meier法计算总生存率及无复发生存率;非参数-秩和检验、卡方检验和成组t检验比较2组患者生存质量情况. 结果 IMRT组与3D-CRT组5年总生存率分别为85％和68％(P=0.005,P=0.012);3年无复发生存率分别为85％和70％ (P=0.042,P=0.039).而盆腔淋巴结转移0,1,≥2个5年生存率分别为90％,68％和43％ (P=0.000,P=0.000);3年无复发生存率分别为83％,71％和57％(P=0.003,P=0.013).IMRT组在躯体功能、角色功能及1,3,5年的总体生存质量评分优于3D-CRT组(P＜0.05). 结论 早期宫颈癌手术后患者辅助IMRT可降低复发率,提高生存率,提高患者的生存质量.盆腔淋巴结转移是影响预后的独立因素.     

191例鼻咽癌颈部半束与全束照射的结果分析

目的 探讨与全束照射比较,半束照射技术能否提高鼻咽癌患者的区域淋巴结控制率和减少放射性后组脑神经损伤(RILCN)发生率.方法 191例以连续接受根治性放疗的鼻咽癌患者为研究对象,常规分割照射,采用同期非随机对照研究的方法,将患者分为半束照射组(80例)和全束照射组(111例);以Kaplan-Meier法计算生存率、Log-rank检验进行差异检验、Cox比例风险模型和Logistic回归模型进行多因素分析.结果 全组5年总生存率为67.3%,半束组与全束组5年总生存率分别为62.3%和67.4%,差别无统计学意义(X2=0.244,P=0.621);性别和临床分期为预后因素.5年区域淋巴结控制率分别为80.6%和83.1%,差别无统计学意义(X2=1.425,P=0.237);N分期为其预后因素.半束照射组和全束照射组的RILCN发生率分别为8.8%(7/80)和9.0%(10/111),两组间差别无统计学意义(X2=0.004,P=0.951).结论 与全束照射相比,半束照射技术未能提高鼻咽癌患者的区域淋巴结控制率和减少放射性后组脑神经损伤发生率.     

脑转移瘤三维适形放疗与调强放疗的剂量学比较研究

目的 通过对脑转移瘤三维适形放疗(3D-CRT)和调强放疗(IMRT)计划对比研究,探讨两种放疗方式的剂量学分布特点,为脑转移瘤临床治疗方案制定提供指导.方法对入组10例脑转移瘤患者进行放疗计划剂量学比较.在三维治疗计划系统上对每例患者分别进行3D-CRT及IMRT计划设计,评价靶区覆盖指数(CI)、异质系数(IC)、...     

头颈部肿瘤患者营养综合状况与急性放射毒性反应的关系

[目的]分析头颈部肿瘤患者放疗前的营养综合状况和急性放射毒性反应的关系。[方法]调查130例头颈部肿瘤患者放疗前的营养状况,分别在放疗前和放疗2周末、4周末、放疗结束时评价放射毒性反应。采用因子分析,建立营养评价综合模型;采用广义加性模型分析患者营养综合状况和急性放射毒性的关系。[结果]根据营养综合指标判断,入院时营养不良88例（67.7%）,其中轻度47例（36.2%）、中度32例（24.6%）、重度9例（6.9%）。患者营养状况与放射性皮炎（t=-4.65,P〈0.001）,口腔干燥（t=-5.67,P〈0.001）,咽/咽喉炎（t=-2.67,P=0.008）,疲劳（t=-4.01,P〈0.001）,厌食（t=-3.13,P=0.002）间存在线性关系,与吞咽困难（χ2=16.80,P〈0.001）,黏膜炎（χ2=3.65,P=0.037）存在某种曲线关系。[结论]头颈部肿瘤患者的营养综合状况与急性放射毒性反应之间存在着一定的相关性,营养不良的患者在放疗前应给予营养支持。