INTRABEAM实施乳腺癌术中放疗系统临床应用观察(附20例报告)

目的:评价INTRABEAM术中放射治疗系统临床应用的安全性和优势.方法:INTRABEAM对20例保乳手术患者实施术中瘤床放疗,均为单次照射每次20Gy,施用器规格为4.5cm(范围1.5-5.0cm),治疗持续时间35.5-51分钟.结果:术中照射治疗后有3例发生治疗区局部积液,经抽吸并加压包扎后愈合,乳房水肿1例.结论:INTRABEAM术中放射治疗系统近期无明显毒副作用,INTRABEAM术中放射治疗系统是一项安全良好耐受性技术,病人乐于接受.     

高强度聚焦超声联合立体定向放疗治疗晚期结肠癌肝转移的疗效观察

目的:对比观察高强度聚焦超声与立体定向放疗治疗晚期结肠癌肝转移的临床效果.方法:2013年2月到2015年8月选择在我院诊治的晚期结肠癌肝转移患者78例,根据平行分组的原则分为观察组与对照组各39例,对照组给予立体定向放射治疗,观察组给予高强度聚焦超声与立体定向放射治疗,都治疗观察4周,记录与随访预后情况.结果:观察组与对照组的治疗有效率分别为69.2%和38.5%,观察组的治疗有效率明显高于对照组(P<0.05).治疗期间两组的粒细胞减少、贫血、胃肠道反应、手足综合征等毒副反应发生情况对比无明显差异(P>0.05).观察组与对照组治疗后的NK细胞含量分别为(25.10±3.49)%和(20.14±4.67)%,都明显高于治疗前的(12.45±2.01)%和(12.24±2.20)%(P<0.05),治疗后观察组的NK细胞含量明显多于对照组(P<0.05).随访至今,观察组与对照组的无进展生存时间为(18.23±4.19)个月和(14.89±3.82)个月,观察组明显长于对照组(t=3.491,P<0.05).结论:高强度聚焦超声与立体定向放疗治疗晚期结肠癌肝转移的合用能提高近期疗效,不会增加毒副反应的发生,延长患者的生存时间,且作用机制可能与有效改善外周血免疫功能有关.     

培门冬酶治疗结外NK/T细胞淋巴瘤的临床疗效

目的：分析结外 NK/ T 细胞淋巴瘤行培门冬酶与左旋门冬酰胺酶治疗的临床疗效。方法：以2009年6月至2014年12月病理诊断为结外 NK/ T 细胞淋巴瘤的患者为研究对象。将患者随机分为2组,培门冬酶组和左旋门冬酰胺酶组,两组均采用放疗以及以铂类为基础的两联方案化疗。在治疗结束后评价并对比患者的近期、远期疗效以及毒副反应。结果：共搜集结外 NK/ T 细胞淋巴瘤患者171例,其中培门冬酶组86例,左旋门冬酰胺酶组85例,近期疗效比较,P <0.05,差异有统计学意义,3个月、6个月、1年生存率比较,经Logrank 检验,P =0.000<0.05,培门冬酶组的3个月、6个月、1年生存率显著高于左旋门冬酰胺酶组;两组患者均出现了不同程度的血液学毒性及恶心、呕吐等反应,恶心、呕吐、过敏、高血糖等发生率比较,P <0.05,差异有统计学意义;白细胞、血小板下降、肝功能损害的发生率比较,P >0.05。结论：培门冬酶较左旋门冬酰胺酶可明显提高结外 NK/ T 细胞淋巴瘤的近期疗效。不良反应少,安全性高。     

肿瘤患者术后长时间皮下积液淋巴漏的放疗疗效分析

目的探讨肿瘤患者术后长时间皮下积液淋巴漏放疗疗效。方法 18例肿瘤患者手术后出现皮下积液淋巴漏,置管时间长达7天以上,每天引流量为15～92 ml,实行皮下清扫区域、引流区域的局部小剂量放疗。结果 18例患者放疗剂量为Dm 4.5～26.4 Gy,放疗2～11次后拔管,拔管后均未再出现皮下积液等,取得良好效果。结论小剂量放射治疗可以有效地治疗肿瘤患者术后长时间不愈的皮下积液淋巴漏。     

Integrinβ_3与鼻咽癌CNE细胞放疗敏感性的关系研究

目的探讨黏附分子integrinβ3对人鼻咽癌细胞系CNE的放疗敏感性的作用,进而初步探讨其可能机制。方法采用三维培养方法获得CNE细胞团簇(multicellular spheroids,MCS);血球计数器计数法比较阻断integrinβ3作用前后CNE MCS的放射敏感性;流式细胞术检测integrinβ3表达和细胞凋亡。结果 (1)成功建立CNE MCS;(2)在一定辐射剂量范围内,CNE MCS中integrinβ3表达量随着辐射剂量的增加而增加;(3)阻断integrinβ3的作用后,CNE MCS的放疗敏感性增加,细胞凋亡率上调。结论黏附分子integrinβ3的表达水平影响CNE MCS的放射敏感性,这可能与integrinβ3抑制凋亡相关。     

PBL教学法在肿瘤放射治疗教学中的价值

目的 探析以问题为基础（PBL）教学法在肿瘤放射治疗教学中的应用价值。方法 选取2019年8月—2021年8月期间在我院肿瘤放射治疗科参加教学200名的实习生作为研究对象,按计算机分组法将以上人员随机分为试验组和对照组,每组100名,对照组实施传统教学,试验组实施PBL教学,对比两组人员经不同方式教学后的理论考核成绩、技能操作成绩,统计其教学结果的优良率,并对所有参与本次教学调查的实习生进行满意度调查。结果 试验组在PBL教学法下的理论成绩略低于对照组,经对比差异无统计学意义（P> 0.05）;该组人员的技能操作考核成绩高于对照组、教学结果优良率92.00%(92/100)高于对照组82.00%(82/100)、教学满意率95.00%(95/100)高于对照组80.00%(80/100),以上数据经对比差异有统计学意义（P<0.05）。结论 将PBL教学法用于肿瘤放射治疗科的临床教学中可在保证实习生掌握扎实理论知识基础上更好的提升其临床实践能力,此教学方法对保证实习生的教学结果、提高其对的教学方法的满意率均有着重要价值。     

Empyème thoracique postpneumonectomie et scanographie dosimétrique. À propos de deux observations et revue de la littérature

Following a pneumonectomy for cancer, the patients are classically observed by clinical examination and standard chest X-ray. However, torpid empyemas can be missed when they occur after the period of hospitalization and when they are not accompanied by a fever. At the time of postoperative radiotherapy, the dosimetric CT scan constitutes the first examination providing objective information of the endothoracic content. It is therefore necessary on this occasion to assure the normality of the postpneumonectomy pleural space while checking that the substituted liquid is homogeneous and above all that the internal mediastinal part of the cavity has a concave appearance. If that is not the case, an empyema should be suspected. The diagnosis, confirmed by a cytobacteriological examination of the pleural fluid, constitutes a counterindication of the radiotherapy. We present two cases of postpneumonectomy paucisymptomatic empyema which were diagnosed during the course of postoperative radiotherapy when the initial dosimetric CT scan was pathologic and could have allowed an earlier diagnosis.     

Cutaneous squamous cell carcinoma of the head and neck metastasizing to the parotid gland--a review of current recommendations

Cutaneous squamous cell carcinoma (SCC) of the head and neck may metastasize in up to 5% of patients, with the parotid lymph nodes the most frequent site for spread. Metastases frequently show delayed presentation after the primary cancer had been treated. The optimum treatment should be surgery followed by adjuvant radiotherapy, with an appropriate parotidectomy, and preservation of the facial nerve if not involved by tumor and treatment to the neck. In a clinically N0 neck, levels I to III should be cleared for facial primaries, levels II to III for anterior scalp and external ear primaries, and levels II to V for posterior scalp primaries. Approximate 5-year disease-specific survival (DSS) after treatment was 70% to 75%. Patients with immunosuppression, in particular transplant recipients, are at high risk of developing aggressive metastatic cutaneous SCC. Modifications of the staging systems have demonstrated the prognostic benefits of accurately staging parotid and/or neck nodal disease.     

Malignant tumours of the cervical oesophagus

Forty-seven patients with malignancy of the cervical oesophagus are described and compared with a group of 647 patients with hypopharyngeal malignancy. There was a higher proportion of non-squamous malignancy in cervical oesophageal cancer compared with hypopharyngeal cancer. Cervical oesophageal malignancy tended to present earlier with significantly lower T stage and neck node metastases were relatively unusual at presentation. Patients with cervical oesophageal malignancy were frequently incurable at the time they are first seen and 21 had palliative treatment only, 26 patients had curative treatment, 12 underwent radical radiotherapy and 14 had surgery. Cervical oesophageal malignancy had a significantly worse prognosis than hypopharyngeal malignancy with an 18% 3 year survival compared with a 33% 3 year survival (χ²₁=7.1089, P <0.01). Those patients with oesophageal malignancy who were treated fared considerably better than the whole group with 30% being alive at 3 years (χ²₁=10.5185, P <0.01).