~(153)Sm-EDTMP治疗骨转移癌的临床观察

目的　评价１５３Ｓｍ － 乙二胺四亚甲基膦酸（ＥＤＴＭＰ） 治疗骨转移癌的临床价值。方法　４５ 例临床上确诊为恶性肿瘤伴多发性骨转移患者,其中男１６ 例,女２９ 例,年龄３１ ～７６ 岁,均有显著骨痛。采用两次给药法静脉注射１５３Ｓｍ － ＥＤＴＭＰ。结果　治疗后骨痛完全缓解者２０ 例（４４．４ ％ ） ,骨痛部分缓解者２２ 例（４８．９ ％ ） ,无效者３ 例（６．７ ％ ）,止痛总有效率为９３．３％ 。转移灶缩小或消失总有效率为２６．７ ％ 。结论　１５３Ｓｍ － ＥＤＴＭＰ治疗骨转移癌有一定的临床价值。     

Radiotherapy dose compensation for lung patients

The purpose of the present paper is to provide a more homogeneous dose distribution in the target volume from compensated anterior and posterior fields while the healthy lung is spared by de-weighting the lateral fields. A compensation computation which used linear iterations to compute the most homogeneous dose distribution across the target volume was applied to produce optimum compensator designs. The equivalent tissue–air ratio (E-TAR) inhomogeneity correction was applied for the computations using a GE target series II planning computer. The compensators designed were tested for accuracy in a modified water/lung phantom using a scanning diode and an anthropomorphic phantom using thermoluminescent dosimeters. A comparison has been made between the compensated and uncompensated plans for the first nine patients who we have treated with this technique. The dose profiles produced by the computation agreed with the prediction of the computed isodose plans to within ± 2% at the target depth. The thermoluminescent dosimeter (TLD)-measured results in the anthropomorphic phantom agreed with the planning computer within ± 3%. A comparison of nine compensated plans of radiotherapy patients for large-volume targets in the lung region showed a maximum variation in the target to be 19% uncompensated versus 10% compensated. By providing compensated treatment fields from anterior and posterior treatment portals, a homogeneous dose that conforms well to the target volume is provided. As an added bonus, this enables the lateral lung fields to be significantly de-weighted and the healthy lung is spared considerable dose.     

Treatment of advanced head and neck cancer by means of radiation therapy plus chemotherapy — a randomised trial

Fifty-eight patients with advanced head and neck cancer were entered into a randomised trial comparing radical radiation therapy to the primary tumour and associated lymph node areas with a combination of radiation therapy plus chemotherapy. The distribution of tumour types and stages was similar in the two treatment groups. The response rates to radiation therapy alone (50% complete plus partial response) and to radiation therapy plus chemotherapy (60% complete plus partial response) were not significantly different. However, a significant difference in survival was found between the two groups. The median duration of survival for the patients treated by means of radiation therapy alone was 18 weeks; that for the combined therapy was 36 weeks. The combination of radical radiation therapy plus intermittent high-dose chemotherapy was well tolerated and appears to be an approach that warrants further trial.     

Comparison of the clinical course of hodgkin's disease in children and adolescents

In this study the clinical features and response to therapy of 34 children, 4–10 years of age, and 54 adolescents, 11–20 years of age, were compared. The therapeutic response in patients in this series entered on a formal protocol was compared with nonstudy patients. The 2 age groups had similar sex ratios, characterized by male predominance, and age was not a determining factor in the extent of disease at diagnosis. By contrast, the distribution of histopathology varied between children and adolescents: mixed cellularity was most prevalent in the 4–10-year group (14/34), while nodular sclerosis predominated in the older patients (23/55). Remission induction and duration were not age dependent, but remission duration did differ between study and nonstudy patients. Forty-five of 57 patients in the former group remain in continuous complete remission compared to 7 of 31 in the latter group. From these results we conclude that the clinical course of Hodgkin's disease is similar in children and adolescents and that the aggressive therapy combined with careful staging used so successfully in adults should be adhered to in younger patients.     

Late recurrence or radiation induced cancer of the larynx

Twenty five patients with squamous carcinoma of the glottis (T_1a, and T_1b) had undergone successful irradiation. Many years later they developed a so-called late recurrence. The following evidence shows that these ‘late recurrences’ are radiation induced: –the interval of 5–18 years (mean 9.9 years) between the first and the second cancer correlates with the interval seen usually in radiation induced malignancy –recurrences generally appear during the first 2 years after irradiation –all the second cancers were found in the previously irradiated area –in patients treated by surgery only, late recurrences are extremely rare –histological examination clearly shows that the second carcinoma originates from the squamous epithelium and not from dormant nests in the deeper layers of the vocal cord. These factors should be taken into consideration when deciding between surgical or radiation therapy in younger patients with high life expectation.     

骨髓细胞-80℃保存及其程序移植的实验研究

目的：提供简便有效的骨髓细胞(BMC)保存方法,以便进一步提高骨髓移植效果。方法：以昆明种小鼠急性放射病为模型,进行了-80℃冷冻保存BMC及其程序移植的研究。结果：-80℃保存的BMC其有核细胞回收率为(89.0±3.5)％,锥虫蓝拒染率为(85.0±3.6)％;产率(每105个BMC)：单核巨噬细胞克隆形成单位(CFU-GM)为108±10,脾细胞克隆形成单位(CFU-S)为12±3。昆明种小鼠程序移植-80℃保存的同种异基因BMC 4×105,其活存率与一次移植同条件冻存的BMC 1×107相同(30％);程序移植4×106时,活存率显著提高(60％)。经性染色体检查各组均有植入证据。结论：-80℃保存BMC是一种行之有效的方法;骨髓程序移植可能充分利用了每次腾出的“龛位”,减少了移植细胞数,却增加了干细胞植入,提高了移植效果,是一种“种子与土壤”并重的移植新方法。     

三维水箱测量系统

本文对在医院放疗设备 ,特别是医用直线加速器和X刀的质量保证和质量控制中越来越广泛使用的三维水箱测量系统的构造及性能作了介绍和论述。     

Statement of Madrid

ABSTRACT

Increased incidences of childhood acute leukaemia were noted among survivors of the atomic bombings of Hiroshima and Nagasaki. In Western societies, Childhood Acute Lymphoblastic Leukaemia has a distinct epidemiology peaking at 3 years old. Exposure to ionising radiation is an established hazard but it is difficult to gauge the precise risk of less than 100 mSv. Since 1983 significant leukaemia incidences have been reported among families residing near nuclear installations. The target cells (naïve neonatal lymphocytes) get exposed to multiple xenobiotic challenges and undergo extraordinary proliferation and physiological somatic genetic change. Population movements and ionising radiation are considered taking account of updated understanding of radiation biology, cancer cytogenetics and immunological diversity. Double Strand Breaks in DNA arise through metabolic generation of Reactive Oxygen Species, and nearly always are repaired; but mis-repairs can be oncogenic. Recombinant Activating Gene enzymes in rapidly dividing perinatal pre-B lymphocytes being primed for antibody diversity are targeted to Signal Sequences in the Immunoglobulin genes. off target pseudo-sequences may allow RAG enzymes to create autosomal DSBs which, when mis-repaired, become translocated oncogenes. Immunogens acting by chance at crucial stages may facilitate this. In such circumstances, oncogenic DSBs from ionising radiation are less likely to be significant.     

Decreased DNA repair activity in bone marrow due to low expression of DNA damage repair proteins

The bone marrow (BM) is one of the organs that is sensitive to acute exposure of ionizing radiation (IR); however, the mechanism of its high sensitivity to IR remains to be elucidated. BM is differentiated into dendritic cells (DC) with granulocyte macrophage-colony stimulating factor (GM-CSF). Using this in vitro model, we studied whether radiosensitivity is distinctly regulated in undifferentiated and differentiated BM. We discovered that levels of DNA damage repair (DDR) proteins are extremely low in BM, and they are markedly increased upon differentiation to DC. Efficiency of both homologous recombination (HR)- and non-homologous end joining (NHEJ)-mediated repair of DNA double strand breaks (DSBs) is much lower in BM compared with that of DC. Consistent with this, immunofluorescent γH2AX is highly detected in BM after IR. These results indicate that increased radiosensitivity of BM is at least due to low expression of the DNA repair machinery.