MRI用于立体定向放射治疗定位的精确性分析

目的：研究MRI用于立体定向放射治疗（SRT）定位时误差的大小，明确MRI能否单独用于SRT定位。方法：模拟对病人的扫描方法，对特制体模进行固定和MRI扫描。在治疗计划系统上，测量x、y、z3个方向靶点距离，并将结果与实际距离做比较，差别的绝对值即为该定位系统的误差。结果：相邻点x方向，误差0.2～1.4mm，平均0．9mm；y方向误差0.5～1.5mm，平均0．9mm。相对点x方向，误差0.3～1．7mm，平均0.9mm；y方向，误差0.4～1．8mm，平均0．9mm。各标记层面之间误差无显著性差别（P〉0．05）。z方向误差0．3～1.9mm，平均1．0mm。结论：本研究采用的立体定向定位系统和MRI扫描方法，用MRI进行影像采集制定SRT计划，对多数颅内和头颈部肿瘤的定位精度符合临床要求，但在将MRI进行SRT定位扫描时，必须作全面的检查和验证。     

Effects of irradiation on nasal mucociliary clearance in head and neck cancer patients

A prospective longitudinal study was conducted on fifty patients of histopathologically confirmed head and neck cancer with the main aim to assess the nasal mucociliary clearance, pre-and post-irradiation; and to compare the findings with the healthy non-irradiated age and sex-matched controls. All the patients underwent saccharin particle test for nasal mucociliary clearance before commencement of radiation therapy and again within 6 months of completion of radiation therapy. The difference between the saccharin perception times of nasal mucosa in the healthy non-irradiated controls and the pre-irradiated head and neck cancer patients were statistically inssignificant (P>0.05). But, the difference between the saccharin perception times of nasal mucosa in the pre-and post-irradiated head and neck cancer patients was found to be statistically significant (P=0). It is concluded that even indirect irradiation of nasal mucosa in head and neck cancer patients significantly affect its ciliary activity. Significance of total radiation dosage along with chemotherapy in some cases was also studied.     

Radioquimioterapia de la enfermedad limitada del carcinoma pulmonar de célula pequeña. ¿Tratamiento concomitante en protocolos asistenciales?

Purpose We retrospectively reviewed our institution’s database to investigate the outcome and impact of combined radiochemotherapy (RT/CT; concomitant or in sequence) in localised small-cell lung cancer (L-SCLC). Material and methods Between January 1995 to November 1999, 79 patients with L-SCLC received combined RT/CT at our Institution. RT was delivered concurrently or sequentially following the CT. Patients with treatment response received additional prophylactic cranial irradiation (PCI). Results Of the patients treated, 54% had received concurrent CT/RT compared to 46% receiving RT following the CT. PCI was administered to 80% of the patients. Complete response was observed in 66% of patients. With a median follow up of 30 months, median overall survival was 15.9 months; 14.3 months for patients who received RT following CT and 21.6 months for those receiving concurrent CT/RT. The type of schedule of combined radiochemotherapy was an independent prognostic factor for survival free of local recurrence, as was additional PCI for distant metastasis-free survival. Conclusions Our results are similar to those reported previously in the literature. The main point of interest is that our patients were non-selected. We strongly support the use of concurrent CT/RT so as to achieve results comparable to the best in the literature.

     

Changes in practice of breast cancer radiotherapy 1998–2002: An Australasian survey

In order to assess the impact on radiation oncology practice of the publication of evidence-based guidelines for technical aspects of therapeutic radiation for breast cancer, the Radiation Oncology Expert Advisory Group of the National Breast Cancer Centre conducted two postal surveys of radiation oncologists practising in Australia and New Zealand. Results from a survey conducted in 1998, prior to distribution of the guidelines, have been published previously. This article reports on results from a survey undertaken in 2002 and contains data from 102 respondents who manage women with breast cancer. The results show several important changes in practice since 1998, including increased use of CT scanning in breast cancer treatment planning and increased use of immobilization devices for patient treatment. There is also evidence of increased attention to technical aspects of treatment planning that reduce the potential risk of treatment toxicity. The influence of the guidelines, the wider availability of modern equipment and results from landmark clinical trials on change in radiation therapy practice is discussed.     

放射治疗肺癌脊椎转移的临床研究

为探讨肺癌脊柱转移放射治疗的时间剂量分割方法及其疗效,将肺癌脊柱转移64例患者随机分为治疗组和对照组,治疗组每次3Gy,每周5次,共30Gy;对照组每次2Gy,每周5次,共50Gy;两组均使用6mVX线照射.分别比较疼痛缓解率、止痛起效时间、及脊髓压迫缓解率.结果显示治疗组和对照组的疼痛缓解率分别为87.5%和81.3%,无显著性差异(P＞0.05);平均止痛起效时间分别为8±2.2天和15±3.2天,差异性显著(P＜0.01);脊髓压迫缓解率分别为85.0%和81.8%,无显著性差异(P＞0.05).结果表明放射治疗肺癌脊柱转移疗效好,起效快,建议使用30Gy/10f/2W的时间剂量分割模式.     

Analysis of postoperative radiotherapy for non-metastatic head and neck adenoid cystic carcinoma based on SEER data

ObjectiveThe postoperative role of adjuvant radiotherapy in non-metastatic head and neck adenoid cystic carcinoma (ACC) remains controversial. We analyzed adjuvant radiotherapy’s effect on surgical patient survival.MethodsPatients diagnosed with ACC from 2004 to 2015 in the Surveillance, Epidemiology, and End Results database were analyzed. The overall survival (OS) and disease-specific survival (DSS) of patients after adjuvant radiotherapy were assessed using the Kaplan–Meier and multivariate Cox methods. Propensity score matching (PSM) was performed to adjust confounders between patients with or without adjuvant radiotherapy; a forest plot was generated by subgroup analysis.ResultsThe study included 742 patients. In the PSM cohort, adjuvant radiotherapy did not improve OS or DSS. Radiotherapy was not a protective factor for OS or DSS in the univariate and multivariate Cox proportional hazard models. In the subgroup analysis, postoperative radiotherapy improved the OS of female and N1-stage patients and those with oropharyngeal tumors or over 79 years and the DSS of N1-stage patients.ConclusionsPostoperative radiotherapy showed different benefits in ACC patients, and postoperative radiotherapy recommendations should be individualized. Female and N1-stage ACC patients and those with oropharyngeal tumors or patients over 79 years without distant metastases postoperatively could benefit from adjuvant radiotherapy.     

失效模式与效应分析在低能X线术中放疗的应用

目的:探讨失效模式与效应分析(FMEA)在低能X线术中放疗(IORT)中的应用,分析其在IORT中的潜在风险,初步探讨FMEA优化IORT管理、减少潜在风险发生的可行性。方法:由IORT团队(1名放疗科医生、1名放疗科物理师、2名外科医生、2名护士)成立FMEA工作小组,应用FMEA方法开展系统风险评估。确立流程模块,...     

鼻咽癌肝肺转移的放疗加中药治疗探讨

目的 :观察放疗加中药治疗鼻咽癌肝肺转移的疗效。方法 :90例患者随机分成对照组 45例和治疗组 45例。治疗组采用放疗加中药法 ,对照组采用单纯放疗法。结果 :治疗组鼻咽癌肝肺转移有效率为 82 .2 % ,肝转移的平均生存期12 .0 5月 ,肺转移为 14 .2 6月 ,肝肺均转移为 5 .96月。对照组有效率为 5 7.8% ,肝转移的平均生存期 8.38月 ,肺转移为 9.30月 ,肝肺均转移为 5 .5 3月。结论 :对鼻咽癌肝肺转移的放疗配合应用中药治疗能更好缓解症状 ,控制肿瘤 ,减轻反应 ,延长患者生存期。     

N064A (Alliance): Phase II Study of Panitumumab,Chemotherapy, and External Beam Radiation in Patients with Locally Advanced Pancreatic Adenocarcinoma

BackgroundThis North Central Cancer Treatment Group (NCCTG) N064A (Alliance) phase II trial evaluated upfront chemoradiotherapy incorporating the EGFR inhibitor panitumumab, followed by gemcitabine and panitumumab for unresectable, non-metastatic pancreatic cancer.MethodsThe treatment consisted of fluoropyrimidine and panitumumab given concurrently with radiotherapy followed by gemcitabine and panitumumab for 3 cycles followed by maintenance panitumumab. The primary endpoint was the 12-month overall survival (OS) rate and secondary endpoints included confirmed response rate (RR), OS, progression-free survival (PFS), and adverse events. Enrollment of 50 patients was planned and the study fully accrued.ResultsFifty-two patients were enrolled, but only 51 were treated and included in the analysis. The median age of patients was 65 years and 54.9% were women. Twenty-two patients received at least 1 cycle of systemic therapy following radiotherapy, but 29 patients received chemoradiotherapy only without receiving subsequent chemotherapy after completion of chemoradiotherapy. The overall RR was 5.9% (95% CI: 1.2%-16.2%). The 12-month OS rate was 50% (95% CI: 38%-67%) which fell short of the per-protocol goal for success (51.1%). The median PFS was 7.4 months (95% CI: 4.5-8.6) and the median OS was 12.1 months (95% CI 7.9-15.9). Grade 3 or higher adverse events were reported by 88%.ConclusionThe combination of panitumumab, chemotherapy, and external beam radiation therapy was associated with very high rates of grades 3-4 toxicities and survival results did not meet the trial’s goal for success. This regimen is not recommended for further study (ClinicalTrials.gov Identifier {"type":"clinical-trial","attrs":{"text":"NCT00601627","term_id":"NCT00601627"}}NCT00601627).     

Pembrolizumab-related Immune Thrombocytopenia in a Patient with Lung Adenocarcinoma Treated by Radiotherapy: Potential Immune-related Adverse Event Elicited by Radiation Therapy

The effect of radiotherapy during immunotherapy on immune-related adverse events (irAEs) is not fully understood. We herein report a 74-year-old woman diagnosed with lung adenocarcinoma with programmed death ligand 1 expression ≥50% and treated with pembrolizumab. She developed fatal immune thrombocytopenia associated with pembrolizumab immediately following radiotherapy. A flow cytometry analysis of peripheral blood detected an increased expression of programmed death-1 (PD-1) and Ki-67 in CD4^＋ and CD8^＋ T cells after radiotherapy, compared with pre-irradiation measurements. This case suggests that radiotherapy may evoke irAEs during treatment with anti-PD-1 antibodies, which physicians should consider when using radiotherapy in patients treated with these drugs.