512例鼻咽癌颈淋巴结转移规律的研究

背景与目的:合理定义鼻咽癌颈部靶区在临床上显得越来越重要,本研究旨在探讨鼻咽癌颈淋巴结转移的规律,以指导三维适形放射治疗颈部靶区的勾画.方法:收集2003年1月～2004年6月在中山大学肿瘤防治中心初治的鼻咽癌病例512例,所有病例均经病理证实、并行增强CT模拟扫描.淋巴结分区标准采用2003年RTOG推荐的颈部淋巴结分区标准.结果:512例病例中,328例(64.1%)诊断为有淋巴结转移.淋巴结阳性的病例中61.3%为单侧淋巴结转移,38.7%为双侧淋巴结转移.咽后淋巴结的发生率为64.1%,其中单侧占50.9%,双侧占49.1%.淋巴结阳性的病例中Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ和咽后区的转移率分别为3.0%、97.9%、46.0%、9.5%、13.7%、0%和74.4%.跳跃性转移率仅为4.6%～6.5%.25.3%的N1-3病例出现了推荐标准以外区域的侵犯.结论:鼻咽癌的颈部淋巴结转移是由上而下循序性的;跳跃性转移发生率低;咽后淋巴结为鼻咽癌转移的首站淋巴结.咽后、Ⅱ区和Ⅲ区最容易受累及;Ⅰa和Ⅵ区从未受累.有部分阳性淋巴结超出了RTOG推荐用于N0的颈部CTV范围.以上结果有助于鼻咽癌的三维适形放疗和调强放疗颈部靶区的勾画.     

脑胶质瘤的调强放射治疗：附7例临床分析

背景与目的：脑胶质瘤的治疗手段主要是手术和放射治疗，其中放射治疗在综合治疗中的地位越来越受到重视。本文介绍适形调强放射治疗(Intensity modulated radiation therapy，IMRT)技术在脑胶质瘤中的应用及可行性分析。方法：对7例接受IMRT的脑胶质瘤术后患者的治疗计划进行评估，根据ICRU50号和62号报告要求勾画肿瘤靶区，通过Corvus3．0逆向计划计算系统分别得出肿瘤靶区的剂量分布情况以及肿瘤周围重要器官的所照射剂量。结果：肿瘤靶区最小、最大、平均剂量分别为63．17Gy、73．03Gy、69．93Gy，平均D95为67．25Gy，平均V95为99．99％。各重要器官所接受的照射量明显低于常规放疗技术中的最小耐受剂量。结论：从剂量学和放射生物学角度来看，IMRT技术在脑胶质瘤放疗方面应有一定的优势。     

Training specificity, graft development and graft-mediated functional recovery in a rodent model of Huntington's disease

Neuronal function and morphology are affected by the environment and the behavioral experience. Here we report on the effects of differential training protocols on the development and the functional recovery mediated by intrastriatal striatal grafts. Rats were trained exclusively on the left or the right paw to perform on the skilled staircase task before being lesioned unilaterally in the dorsal striatum with quinolinic acid. E15 whole ganglionic eminence suspension grafts were implanted into the lesioned striatum. Subsequent testing probed unilateral performance of the affected contralateral paw, as well as bilateral performance. The grafted animals were initially as impaired as the lesioned, but partially recovered their performance with additional training. Grafted animals with appropriate previous experience initially performed better on the staircase test, but the advantage was transient. Furthermore, the grafted animals performed better with their affected paw under forced choice than under conditions when both paws were simultaneously probed. Improvements of the grafted animals were also observed on tests of forelimb akinesia and asymmetry. Morphological data suggest that the training conditions influenced the development specifically of striatal-like, but not of non-striatal like, neurones within the grafts. The grafts were smaller containing less striatal-like neurones in animals that were trained on the contralateral side prior to lesioning and grafting. The results support the hypothesis that unilateral training sensitizes the striatum that subserves the motor learning, leading to exacerbated excitotoxic lesions and to an environment less conducive for graft development.     

放射性脑脊髓损伤的诊断和治疗

放射性脑脊髓病足肿瘤放疗后期较严重的损伤之一。本文介绍了近年来放射性脑脊髓病的发病机制、诊断、治疗研究进展，并对分子生物学存该领域的研究前景作一阐述。     

地龙,复方丹参,野木瓜对鼻咽癌放射增敏的前瞻性研究：附557例…

收集５５７例鼻咽癌以随机分组联合应用地龙、复方丹麦、野木瓜进行放射增敏的前瞻性研究。     

地龙、复方丹参、野木瓜对鼻咽癌放射增敏的前瞻性研究（附557例近期疗效分析）

收集５５７例鼻咽癌以随机分组联合应用地龙、复方丹参、野木瓜进行放射增敏的前瞻性研究。近期疗效结果显示，不管放疗结束时原发灶的全消中还是放疗后３个月鼻咽ＣＴ扫描复查原发灶的全消率，中药放疗组均优于对照组，Ｐ＜０．００５。但颈淋巴结转移灶的全消率两组之间无明显差异，Ｐ＞０．５。同时还讨论了以上３种中药放射增敏的机理。     

Environmental enrichment affects striatal graft morphology and functional recovery

Environmental conditions and behavioural experience can affect neuronal function and morphology. It is less well known whether such factors also influence the growth, integration and functional recovery provided by neural grafts placed within the damaged brain. Here we report on the effects of differential housing conditions on striatal graft morphology and functional recovery after striatal lesions. Rats were pretrained on a skilled bilateral forelimb task, the staircase test, and lesioned unilaterally in the lateral dorsal striatum with quinolinic acid. One group of lesioned animals was given suspension grafts of E15 whole ganglionic eminence implanted into the lesioned striatum. Following transplantation, the animals were housed either in standard cages (four per cage) or in enriched environment housing conditions (10 per cage) with tunnels, ladders and increased living space available for exploration, social interaction and play. The differentially housed animals were retested on the skilled staircase test at two separate time points. Repeated testing, environmental enrichment and transplantation positively influenced behavioural recovery. Partial recovery was observed bilaterally amongst the grafted animals in both housing conditions. Nevertheless, the grafted animals housed in the enriched environment performed significantly better in the final test compared with all of the other experimental groups. The grafts survived equally well under both housing conditions but the grafts of animals housed in the enriched environment contained larger projection neurons and were somewhat better reinnervated by dopaminergic afferents. An increased level of striatal brain-derived neurotrophic factor was observed in the control animals housed under the enriched compared with the standard conditions. The results indicate that an enriched environment can affect both graft function and graft morphology through as yet unknown mechanisms.     

调强放射治疗的临床应用

适形调强放射治疗(Intensity Modulated RadiationTherapy,IMRT)是近十年在三维适形放射治疗的基础上发展起来的一种崭新的放射技术,IMRT的设计主要致力于受常规放疗的限制部分,同时又要对肿瘤组织的照射不能限制。理论上讲,如果肿瘤能作放射治疗,那么IMRT将对许多肿瘤的治疗都会产生深远的影响,它可以根据肿瘤的形状给予致死剂量的照射,而对肿瘤邻近的正常组织器官接受较低的剂量照射。     

放疗联合人参多糖注射液治疗鼻咽癌的临床观察

目的：观察放射治疗联合人参多糖注射液治疗鼻咽癌的疗铲和对免疫功能的影响。方法：将131例初治鼻咽癌患者随机分为放疗联合人参多糖组（64例）和常规放疗组（６７例），观察两组局部消退率，１年总生存率，无瘤生存率有主无远外转移生存率，观察两组治疗前后Ｔ细胞亚群、自然镣伤（ＮＫ）细胞活性及淋巴因子－激活杀伤（LAK）细胞活性的变化。结果：两组治疗后3个月临床检查，放疗联合人参多糖组和常规放疗组鼻咽肿瘤完全消退率分别为96.6％和93.3%，颈淋巴结转移灶完全消退率分别为85.7％和78.0％，鼻咽肿瘤CT消退率分别为60.3％和51.7％；放疗后1年总生存率分别为100.0％及96.5%，放疗后1年无瘤生存率分别为84.4％及74.6％，放疗后无远处转移生存率分别为93.8％及88.1%。放疗联合人参多糖组外周血NK细胞及LAK细胞活性增高，T3、T4值增高（均P＜0.05），常规放陪组治疗前后外周血T3、T4值降低（P＜0.05），NK细胞、LNK细胞活性差异无是生，未发现人参多糖有毒副作用。结论：人参多糖在放疗中对改善鼻咽癌患者机体免疫功能有一定的作用，并减轻放疗反应和改善患者一般状况。