放射治疗计算机信息管理系统的开发与应用

目的　开发放射治疗信息管理系统计算机软件。方法　采用局域网、客户机 服务器模式 ,以SQL SERVERA为数据库服务器 ,使用VisualFoxpro 5 .0为编程语言进行开发。结果　该系统包括放射治疗计划系统和放射治疗科数据管理系统。结论　该系统运行稳定 ,数据安全可靠 ,操作简单 ,易于临床推广使用。     

三维适形低分割放射治疗老年非小细胞肺癌疗效观察

目的　探讨三维适形低分割放射治疗老年非小细胞肺癌的疗效。方法　 4 5例患者均采用低分割治疗 ,处方剂量为 4～ 5Gy,隔日 1次 ,总量 4 8～ 5 5Gy。结果　CR 2 3例 ( 5 1.1% ) ,PR 15例( 33.3% ) ,NC 5例 ( 11.1% ) ,PD 2例 ( 4 .4 % ) ,RR 38例 ( 84 .4 % )。 1、2、3年生存率分别为 6 6 .7%、4 8.9%、39.1%。结论　三维适形放射治疗对于老年非小细胞肺癌是一种反应较小 ,痛苦较轻 ,安全有效的治疗措施     

艾本与放疗联合治疗恶性肿瘤骨转移的临床疗效

目的:探讨艾本(伊班膦酸钠)全身用药与局部放疗相结合治疗恶性肿瘤局限性骨转移的临床疗效.方法:80例恶性肿瘤局限性骨转移患者随机分为两组,艾本静脉滴注加局部放疗40例(治疗组);单放组40例,只采用局部放疗(对照组).结果:治疗组疼痛缓解率为92.5%,对照组疼痛缓解率为82.5%,两组间比较无明显差异(P＞0.05);溶骨病灶再钙化的有效率治疗组为76.7%,而对照组仅为27.8%,两组比较有显著性差异(P＜0.001);治疗组出现第二部位骨转移的机率明显低于对照组(P＜0.05);1年生存率治疗组明显高于对照组(P＜0.05).两组患者不良反应的发生率相似,无显著性差异(P＞0.05).结论:艾本联合放疗治疗局限性骨转移,具有止痛快、疗效确切、高效修复溶骨病灶,并能防止新转移灶的发生及较高的生存率等优点.     

63例宫颈腺癌临床治疗和预后分析

目的:了解影响宫颈腺癌预后的相关因素,探讨宫颈腺癌比较理想的治疗方法.方法:对天津医科大学附属肿瘤医院1980年1月至2000年1月间收治的63例宫颈腺癌进行分析,占同期宫颈癌的4.65%,并随机选取同期治疗的80例宫颈鳞癌作为对照进行比较.患者平均发病年龄53.7岁,绝经后患者占55.6%.主要症状为阴道不规则出血和/或白带增多.其中Ⅰ期17例,Ⅱ期33例,Ⅲ期13例.20例采用单纯放射治疗,43例采用放射治疗与手术相结合的综合治疗.结果:收治的宫颈腺癌占宫颈癌的比例从80年代的3.5%(38/1087)上升至90年代的7.36%(34/462),其5年总的生存率为56.9%(33/63-5),低于同期宫颈鳞癌5年生存率.单纯放疗组5年生存率50%;手术放疗组5年生存率为60.5%,两组间无统计学差异.行根治性手术的Ⅰ、Ⅱ期患者5年生存率为80%,而行全宫切除的同期患者5年生存率仅为39.3%,但二者差异尚无统计学意义.宫颈肿瘤≥4cm和＜4cm者5年生存率分别为34.3%(12/35)和60.7%(17/28)具有明显差异(P＜0.05).Ⅰ、Ⅱ期5年生存率62%(31/50),而Ⅲ期5年生存率为7.7%(1/13),二者差异显著(P＜0.01).结论:宫颈腺癌的发病比例呈上升趋势,宫颈腺癌的预后与临床分期、肿瘤大小、治疗方式关系密切.以根治性手术为主的综合治疗是宫颈腺癌的主要治疗方法.     

立体适形放射治疗前列腺癌29例临床分析

目的:分析立体适形放射治疗(3D-CRT)前列腺癌的疗效.方法:采用3D-CRT治疗前列腺癌29例,26例放疗前行双侧睾丸切除,22例同时服用内分泌治疗药物.采用3D-CRT技术,5次/周,1.8～2Gy/次,DT 60～72Gy,中位剂量68Gy.结果:中位随访18个月,生存率82.8%,肿瘤特异生存率93.1%.1、2、3级急性胃肠道不良反应发生率分别为44.8%,6.9%,3.4%,1、2级急性泌尿生殖系统不良反应发生率分别为34.5%,6.9%.结论:3D-CRT治疗前列腺癌疗效满意,不良反应小.     

Ⅲb期宫颈癌的放射治疗并化疗疗效观察

目的:观察放射治疗并同期化疗Ⅲb期宫颈癌的疗效及不良反应.方法:对59例Ⅲb期宫颈癌患者随机分为放射治疗 化疗组(放、化组)和单纯放射治疗组(单放组).两组放疗方案相同,化疗与放疗同时进行.结果:近期有效率放、化组为100%,单放组为92.3%,两组无明显差异(P＞0.05);5年生存率放、化组为69.7%,单放组为42.3%,两组有显著差异(P＜0.05);恶心、呕吐消化道反应和白细胞降低率放、化组较单放组明显高(P＜0.01 P＜0.05),放射性直肠炎、膀胱炎两组无差异(P＞0.05);远处转移率单放组明显高(P＜0.05).结论:放射治疗同时化疗可提高局部控制率及5年生存率,减少远处转移率.不良反应经对症治疗后,症状减轻或消失.     

鼻咽癌骨转移的发生及预后因素分析

目的分析鼻咽癌骨转移的发生和治疗因素.方法回顾性分析我院1990～1999年间初治的935例鼻咽癌患者骨转移的发生、疗效及对预后的影响.结果本组骨转移的发生率为10%.应用单因素分析发现1992年福州分期Ⅲ～Ⅳ期、T4、N2-3、AKP＞70为影响骨转移增加的因素,多因素分析发现仅N2-3、AKP＞70为影响骨转移增加的独立因素.通过生存率分析治疗手段对预后影响发现放疗 化疗组比单纯放疗组或单纯化疗组的中位生存期延长.结论N分期增高是鼻咽癌骨转移的高危因素,放射治疗加化疗有可能改善鼻咽癌骨转移的预后.     

血红蛋白浓度对非小细胞肺癌放疗疗效的影响

目的:探讨分析血红蛋白浓度与非小细胞肺癌放射治疗后的生存率及局部肿瘤控制率之间的关系。方法:1993年3月—1999年1月,选择收治非小细胞肺癌(Ⅰ期~Ⅲ期,T1~4N0~3M0)218例,于放射治疗前根据血红蛋白(Hb)浓度分3组(贫血组、正常组和高血红蛋白组)。根据放射治疗中血红蛋白浓度的变化分为2组(Hb升高组及Hb降低组)。全部病例均予以根治性放射治疗,常规分割。对其生存率及局部肿瘤控制率予以观察、对比分析。结果:放射治疗前升高血红蛋白量可提高非小细胞肺癌患者的局部肿瘤控制率及生存率;放射治疗中血红蛋白量的升高及降低对非小细胞肺癌患者的生存率有影响。结论:升高血红蛋白量可提高非小细胞肺癌患者的生存率及局部肿瘤控制率。     

Significance of plasma transforming growth factor-β levels in radiotherapy for non–small-cell lung cancer

PURPOSE: In dose-escalation studies of radiotherapy (RT) for non-small-cell lung cancer (NSCLC), radiation pneumonitis (RP) is the most important dose-limiting complication. Transforming growth factor-beta1 (TGF-beta1) has been reported to be associated with the incidence of RP. It has been proposed that serial measurements of plasma TGF-beta1 can be valuable to estimate the risk of RP and to decide whether additional dose-escalation can be safely applied. The aim of this study was to evaluate prospectively the time course of TGF-beta1 levels in patients irradiated for NSCLC in relation to the development of RP and dose-volume parameters. METHODS AND MATERIALS: Plasma samples were obtained in 68 patients irradiated for medically inoperable or locally advanced NSCLC (dose range, 60.8-94.5 Gy) before and 4, 6, and 18 weeks after the start of RT. Plasma TGF-beta1 levels were determined using a bioassay on the basis of TGF-beta1-induced plasminogen activator inhibitor-1 expression in mink lung cells. All patients underwent chest computed tomography scans before RT that were repeated at 18 weeks after RT. The computed tomography data were used to calculate the mean lung dose (MLD) and to score the radiation-induced radiologic changes. RP was defined on the basis of the presence of either radiographic changes or clinical symptoms. Symptomatic RP was scored according to the Common Toxicity Criteria (Grade 1 or worse) and the Southwestern Oncology Group criteria (Grade 2 or worse). Multivariate analyses were performed to investigate which factors (pre- or posttreatment TGF-beta1 level, MLD) were associated with the incidence of RP. To improve our understanding of the time course of TGF-beta1 levels, we performed a multivariate analysis to investigate which factors (pre-RT TGF-beta1 level, MLD, RP) were independently associated with the posttreatment TGF-beta1 levels. RESULTS: The pre-RT TGF-beta1 levels were increased in patients with NSCLC (median 21 ng/mL, range, 5-103 ng/mL) compared with healthy individuals (range, 4-12 ng/mL). On average, the TGF-beta1 levels normalized toward the end of treatment and remained stable until 18 weeks after RT. In 29 patients, however, TGF-beta1 was increased at the end of RT with respect to the pre-RT value. The multivariate analyses revealed that the MLD was the only variable that correlated significantly with the risk of both radiographic RP (p = 0.05) and symptomatic RP, independent of the scoring system used (p = 0.05 and 0.03 for Southwestern Oncology Group and Common Toxicity Criteria systems, respectively). The TGF-beta1 level at the end of RT was significantly associated with the MLD (p <0.001) and pre-RT TGF-beta1 level (p = 0.001). CONCLUSION: The MLD correlated significantly with the incidence of both radiographic and symptomatic RP. The results of our study did not confirm the reports that increased levels of TGF-beta1 at the end of RT are an independent additional risk factor for developing symptomatic RP. However, the TGF-beta1 level at the end of a RT was significantly associated with the MLD and the pre-RT level.     

Serious adverse effects of amifostine during radiotherapy in head and neck cancer patients

Background and purpose: Amifostine has been shown to protect against xerostomia induced by radiotherapy for head and neck cancer, but its impact on the therapeutic index is unknown. This is the first report focusing on amifostine related adverse effects leading to discontinuation of amifostine treatment.

Patients and methods: Thirty-nine patients from two centers irradiated for head and neck cancer received i.v.-infusions of amifostine prior to each radiation fraction. In a phase III study, two daily amifostine doses, 200 mg/m² (n=21) and 340 mg/m² (n=18), were compared for protection against radiation induced toxicity. Total radiation dose was 60–70 Gy (2 Gy per fraction), nine patients received concurrent chemotherapy with cisplatin/5-FU. amifostine was usually discontinued after >1 episode of serious toxicity during subsequent treatment sessions.

Results: In 16/39 patients (41%) amifostine was discontinued due to severe adverse effects, which led to discontinuation of the phase III study. In four of 16 patients radiotherapy was delayed due to amifostine related adverse effects for 1–3 days. Discontinuation occurred more often in patients receiving chemotherapy. The results led to a literature review for amifostine treatment during radiotherapy in head and neck cancer patients. Regarding our series and published series using an amifostine schedule comparable to ours, total discontinuation rate was 27% (57/214). Discontinuation was significantly influenced by chemotherapy (P=0.007), but not by amifostine dose (P=0.156).

Conclusion: Daily i.v. administration of amifostine during radiotherapy in head and neck cancer is associated with a high rate of serious adverse effects leading to discontinuation of amifostine treatment and sometimes delay of radiotherapy.