术中大剂量放疗对宫颈癌Ⅱb患者免疫系统的影响

背景与目的:探讨宫颈癌Ⅱb患者术中大剂量放疗前后外周血T淋巴细胞亚群和白细胞介素-2(Interleukin-2,IL-2)水平的变化。材料与方法:对61例宫颈癌Ⅱb患者(其中28例行术中放疗,33例行单纯放疗)在放疗前后,分别用流式细胞技术和放射免疫分析法检测患者T淋巴细胞亚群水平(包括CD4、CD8、CD4/CD8)和白细胞介素-2(IL-2)水平的变化。并与20例正常人作对照。结果:放疗后,单纯放疗组和术中放疗组间CD4、CD4/CD8、IL-2差异有统计学意义,单纯放疗组明显低于术中放疗组。结论:术中大剂量放疗对宫颈癌Ⅱb患者免疫系统的影响较轻,有利于机体的恢复。7     

儿童视网膜母细胞瘤51例临床分析

目的　分析儿童视网膜母细胞瘤的发病特点。方法　对 5 1例儿童视网膜母细胞瘤患者的性别、眼别、就诊年龄与视神经的受累率、遗传史、居住地、治疗情况进行回顾性分析。结果　男性多于女性 ,单侧发病居多数 ,平均就诊年龄 3 6 4± 1 92岁 ,总视神经受累率 37 2 5 % ,城区儿童多于农村儿童 ,以外科手术为主要治疗方法。结论　应加强对 5岁以下儿童的眼部检查 ,尤其警惕有肿瘤家族史的患者 ,争取早期发现和早期治疗。     

182例局部晚期宫颈癌根治性子宫切除术加术前新辅助治疗预后分析

目的 观察局部晚期宫颈癌根治性子宫切除术加术前同期放化疗(CRCT)、单纯放疗(RT)的疗效,并分析影响预后的因素。方法 回顾分析2006—2011年收治的 182例Ⅰ_B2~Ⅲ_B期宫颈癌患者资料,其中 59例RT,123例术前每周顺铂40 mg/m²同期RT,放疗剂量 40~50 Gy分 20~25次。新辅助治疗后 2~3周行全子宫、双附件及盆腔淋巴结切除术。采用Cox法行多因素预后分析。结果 随访时间满 3年者为 69例。肿瘤直径≥4.5 cm时术前CRCT与RT的 3年无进展生存(PFS)、总生存(OS)率均相似(χ²=1.84、1.56,P=0.176、0.221),<4.5 cm时术前CRCT比RT的PFS、OS率高(χ²=5.22、4.81,P=0.022、0.018)。全组 3年PFS、OS率分别为92.0%、93.8%。Cox分析显示肿瘤直径(<6 cm与≥6 cm)是PFS、OS的影响因素(χ²=2.56、4.06,P=0.011、0.007),年龄(<48岁与≥48岁)是OS的影响因素(χ²=4.86,P=0.046),术后淋巴结状况(是否转移)是PFS的影响因素(χ²=1.04,P=0.010)。     

243例ⅡB期宫颈癌术前同期放化疗加根治术与根治性放疗同期化疗预后比较

目的 比较宫颈癌术前同期放化疗加根治术与根治性放疗同期化疗的临床疗效及远期不良反应。方法 回顾分析2004—2011年收治的243例Ⅱ_B期宫颈癌患者,121例术前同期放化疗加根治术(放化疗手术组),122例根治性放疗同期化疗(放化疗组),化疗方案为顺铂40 mg/m²·周。Kaplan-Meier法计算生存率等并Logrank法检验,Cox法多因素预后分析。结果 放化疗手术组、放化疗组随访率均为100%,随访时间满3年样本数分别为34、33例。放化疗手术组与放化疗组3年无进展生存率(PFS)为91.5%与82.0%(P=0.013),总生存率(OS)为95.5%与89.2%(P=0.085),局控率为96.7%与93.4%(P=0.375)。肿瘤直径(≥6 cm)、年龄(≤35岁)为放化疗手术组PFS预后因素(P=0.033、0.037)。病理类型(非鳞癌)、肿瘤直径(≥6 cm)为放化疗组PFS预后因素(P=0.013、0.002),其中肿瘤直径(≥6 cm)也是OS预后因素(P=0.007)。放化疗手术组下肢水肿发生率较高(P=0.000),放化疗组放射性肠炎发生率较高(P=0.000)。结论 初步结果表明术前同期放化疗加根治术能获得较好预后,肿瘤直径为两个组共同的PFS预后因素。     

宫颈癌术后放疗与同步放、化疗的临床分析

为了探讨同步放、化疗的效果和不良反应,笔者对2006年5月至2007年10月收治的宫颈癌术后有复发危险的患者进行了术后放疗与同步放、化疗的研究.现将其不良反应及其耐受性报道如下.     

三维放疗联合顺铂同期化疗局部晚期宫颈癌疗效分析

Objective To analyze the therapeutic efficacy and treatment related toxicities for patients with locally advanced cervical cancer treated with three-dimensional conformal radiotherapy (3DCRT) combined with concurrent chemotherapy. Methods From January 2007 to February 2008, 181 patients with stage ⅡA-ⅣA cervical cancer were retrospectively analyzed. All patients were treated with CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent weekly cisplatin-based chemotherapy. The median age was 50 years (range, 32 to 82 years). The overall survival ( OS), disease-free survival (DFS) and local control (LC) rates were calcalated by Kaplan-Meier method and the difference was compared using Log-rank test. The treatment related toxicities were evaluated according to Radiotherapy Oncology Group (RTOG) criteria. Results With a median follow-up time of 34 months and following rate of 92. 2%, the 3-year OS, DFS and LC rates were 73.4%, 70. 4% and 91.3%,respectively. The 3-year OS rate was 66. 9% for patients with tumor diameter ≥4 cm and 86. 4% for those with tumor diameter ＜4 cm( χ2 =6. 29 ,P =0. 012). The incidences of grade 1 and grade 2 acute toxicities of the lower gastrointestinal tract and the genitourinary system were 40. 0% ,45.0% and 19. 9% ,4. 4%,retrospectively. There were no grade 3 or more acute toxicities. The incidence of grades 3 or 4 late toxicities of the lower gastrointestinal tract was 4. 9%. Conclusions CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent chemotherapy can achieve good therapeutic effects for locally advanced cervical cancer. The acute and late toxicities are significantly reduced compared with historic controls as a result of incorporation of 3DCRT technique.     

三维放疗联合顺铂同期化疗局部晚期宫颈癌疗效分析

目的 分析CT图像为基础三维适形放疗联合顺铂同期化疗对晚期宫颈癌患者疗效及副反应情况.方法 回顾分析2007-2008年本科收治的181例Ⅱa～Ⅳa期宫颈癌患者资料,其中年龄32～82岁(中位数50岁).放疗采用以CT图像为基础的三维适形放疗和三维192Ir后装照射技术,同期联合顺铂单药每周化疗方案.结果 随访中位数34个月,随访率为92.2%.全组患者3年总生存率为73.4%、无瘤生存率为70.4%、盆腔控制率为91.3%.肿瘤直径≥4 cm和＜4 cm者总生存率分别为66.9%和86.4%(χ2=6.29,P=0.012).RTOG分级急性胃肠道副反应1、2级发生率分别为40.0%、45.0%,泌尿系副反应l、2级发生率分别为19.9%、4.4%.RTOG分级晚期下消化道副反应3+4级发生率为4.9%.结论 以CT图像为基础三维适形放疗和三维192Ir后装照射技术联合顺铂同期化疗对局部晚期宫颈癌患者疗效较好,并对降低晚期严重副反应的发生有益.

Abstract：

Objective To analyze the therapeutic efficacy and treatment related toxicities for patients with locally advanced cervical cancer treated with three-dimensional conformal radiotherapy (3DCRT) combined with concurrent chemotherapy. Methods From January 2007 to February 2008, 181 patients with stage ⅡA-ⅣA cervical cancer were retrospectively analyzed. All patients were treated with CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent weekly cisplatin-based chemotherapy. The median age was 50 years (range, 32 to 82 years). The overall survival ( OS), disease-free survival (DFS) and local control (LC) rates were calcalated by Kaplan-Meier method and the difference was compared using Log-rank test. The treatment related toxicities were evaluated according to Radiotherapy Oncology Group (RTOG) criteria. Results With a median follow-up time of 34 months and following rate of 92. 2%, the 3-year OS, DFS and LC rates were 73.4%, 70. 4% and 91.3%,respectively. The 3-year OS rate was 66. 9% for patients with tumor diameter ≥4 cm and 86. 4% for those with tumor diameter ＜4 cm( χ2 =6. 29 ,P =0. 012). The incidences of grade 1 and grade 2 acute toxicities of the lower gastrointestinal tract and the genitourinary system were 40. 0% ,45.0% and 19. 9% ,4. 4%,retrospectively. There were no grade 3 or more acute toxicities. The incidence of grades 3 or 4 late toxicities of the lower gastrointestinal tract was 4. 9%. Conclusions CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent chemotherapy can achieve good therapeutic effects for locally advanced cervical cancer. The acute and late toxicities are significantly reduced compared with historic controls as a result of incorporation of 3DCRT technique.     

局部晚期宫颈癌CT图像引导下192Ir三维腔内后装治疗剂量体积参数与疗效关系

目的 观察CT图像引导下192Ir三维腔内后装治疗的肿瘤靶区及危及器官受照射体积剂量参数与肿瘤局部控制率及晚期副反应之间关系.方法 10例局部晚期宫颈癌患者在完成盆腔外照射40 Gy及同期化疗后开始每周1次的CT图像引导下192Ir三维腔内后装治疗,每次治疗前进行CT扫描定位,勾画肿瘤靶区(GTV、CTV)和危及器官,利用PLATO治疗计划系统进行逆向治疗计划设计及优化,CTV单次处方剂量为6 Gy,治疗5～7次.结果 1年盆腔控制率为90%,1～2级放射性肠炎发生率为50%,无≥3级副反应.90%CTV等效生物剂量(BED)和相当于2 Gy分次的等效剂量(EQD2)分别为(95.50±7.81)Gy和(79.73±6.57)Gy(α/β=10).90%GTV的BED和EQD2分别为(101.86±7.27)Gy和(84.95±6.1)Gy(α/β=10).90%处方剂量对GTV、CTV的覆盖率分别为92%±4%、87%±7%.直肠、乙状结肠2 cm3体积受到的最小照射剂量分别为(74.97±1.64)、(67.93±4.30)Gy(EQD2,α/β=3).与二维治疗计划相比,三维治疗计划在没有改变A点剂量、直肠参考点剂量情况下提高了GTV、CTV的90%体积受照射剂量及90%处方剂量对GTV、CTV的覆盖率.结论 CT图像引导下192Ir三维腔内后装治疗提高了处方剂量对肿瘤靶区的覆盖率,1年盆腔控制率为90%且无严重副反应,远期疗效观察中.

Abstract：

Objective To investigate the correlation between dose volume histogram(DVH)of tumor targets and organs at risk(OAR)at CT-image based 192Ir brachytherapy and effects and complications for patients with locally advanced cervical cancer. Methods Ten patients with FIGO stage ⅢB cervical cancer received CT image-based 192Ir intracavitary brachytherapy after 54 Gy of three-dimentional four-field pelvic external beam radiotherapy and concurrent weekly cisplatin chemotherapy. Before each brachytherapy,CT images were acquired with applicators in place. Gross tumor volume(GTV), clinical target volume (CTV)and OAR were contoured and inverse treatment planning was designed and optimized by using PLATO treatment planning system. Conventional two-dimensional plans were also designed for comparison.The total intracavitary brachytherapy dose was 30 -42 Gy in 5 -7 fractions. The patients were followed, and the local control and complications were analyzed. The biologically equivalent dose(BED)and biologically equivalent dose in 2 Gy fractions(BED2)for GTV, CTV and OAR were calculated. The minimum dose in the most irradiated tissue volume 2 cm3(D2 cm3)adjacent to the applicator of the sigmoid colon, rectum,bladder and small bowel was determined from the DVH. Results The 1-year local pelvic control rate was 90% and grade 1-2 late complication of sigmoid colon and rectum was 50%. No grade 3 or more complications developed. On CT-image based planning, the BED and BED2 to 90% of the CTV(D90)were 95.50 Gy ± 7. 81 Gy and 79. 73 Gy ± 6. 57 Gy. The BED and BED2 to 90% of the GTV(D90)were 101.86 Gy ± 7.27 Gy and 84. 95 Gy ± 6. 1 Gy. The volume enclosed by 90% of prescribed dose(V90)for GTV and CTV were 92% ±4% and 87% ±7% respectively. The D2cm3 for rectum and sigmoid colon were 74. 97 Gy ±1.64 Gy and 67. 93 Gy ± 4. 30 Gy(EQD2, α/β = 3). Comparing with 2D brachytherapy plans , CT - image based planning has improved D90 and V90 for GTV and CTV with similar dose at point A and rectum reference point. Conclusions Computer tomography-image based 192Ir brachytherapy has resulted in the better dose distribution to the tumor targets with excellent tumor control and acceptable toxicity.     

宫颈癌调强放疗膀胱受照剂量的评价

目的:研究宫颈癌调强放疗计划设计中膀胱壁与膀胱受照剂量的差别,从而在计划设计中正确设置和评价膀胱的限制剂量。方法:随机选取19例宫颈癌病例,为其设计调强计划。为了便于比较,分别给19例患者设计第一程全盆照射计划,处方剂量50 Gy/25次,利用DVH图分别评价膀胱和膀胱壁的受量。结果:调强计划中膀胱、膀胱壁的最小剂量、最大剂量差异均无统计学意义。膀胱平均剂量、D70、D50、D40和D30分别为38.45、30.07、38.68、43.90和47.54 Gy,膀胱壁平均剂量、D70、D50、D40和D30分别为40.97、32.80、45.83、49.16和50.24 Gy。用膀胱所受剂量评价膀胱壁剂量,膀胱壁平均剂量、D70、D50、D40和D30分别被低估6.55%、9.08%、18.49%、11.98%和5.68%。结论:在宫颈癌调强计划设计中,简单的用整个膀胱受量评价膀胱壁受量,将会低估膀胱壁的真正受量,从而加大膀胱并发症的概率,对膀胱造成不必要的损伤。     

宫颈癌术后放射治疗232例回顾性临床分析

目的:探讨宫颈癌患者术后放疗的疗效、并发症以及预后影响因素。方法:回顾性分析2006-01-01-2009-09-30在我科接受术后放疗的ⅠA～ⅡB期具有预后不良因素的232例宫颈癌患者。结果:3年总生存率、无瘤生存率和盆腔控制率分别为92.5%、89.2%和93.3%。无盆腔淋巴结转移者3年总生存率为93.2%,有盆腔淋巴结转移者为77.2%,差异有统计学意义,P=0.036。在外照射结束后接受腔内后装治疗和未接受后装治疗患者总生存率分别为96.6%和92.8%,盆腔控制率均为95.9%,差异无统计学意义,P值分别为0.183和0.519。结论:具有不良预后因素的宫颈癌患者接受术后放疗,可获得满意的总生存率、无瘤生存率和盆腔控制率,肿瘤远处转移为治疗失败主要原因。