诱导化疗对局部晚期鼻咽癌放疗远期疗效的影响

目的:探讨诱导化疗对局部晚期鼻咽癌放疗远期疗效的影响.方法:回顾性分析120例Ⅲ、Ⅳa期鼻咽痛患者按治疗方法分为两组(化放组及单放组).放疗采用直线加速器照射鼻咽及颈部,鼻咽剂量DT 70-76 Gy,7-7.5周,颈部剂量DT 50-70 Gy,5-7周.诱导化疗采用DDP+5-Fu方案.结果:化放疗组1、3、5年生存率分别为98%、76%、20%;单放组分别为96%、60%、18%,无显著性差异(P>0.05).化放组远处转移率为20.9%,单放组为41.7%,两组比较有显著性差异(P<0.05).结论:诱导化疗能降低局部晚期鼻咽癌放疗的远处转移率,但没有提高生存率.     

放疗加诱导化疗治疗中晚期鼻咽癌疗效分析

目的　探讨化疗对中晚期鼻咽癌生存率的影响。方法　将 10 0例初次治疗被确诊为中晚期鼻咽癌 (Ⅲ、Ⅳ期 )的患者随机分为两组 :单纯放疗组 (单放组 )与诱导化疗加放疗组 (放化组 ) ,每组各 5 0例。单放组鼻咽平均剂量 70Gy 7周 (6 6～ 76Gy) ,颈部平均剂量 6 5Gy 6 .5周 (5 0～ 74Gy) ;放化组在照射前行顺铂 (DDP)加氟尿嘧啶 (5 Fu)化疗 2～ 3个疗程 ,1周后行放疗 ,鼻咽平均剂量 70 .4Gy 7.5周 (6 8～ 74Gy) ,颈部平均剂量 6 6Gy 7周 (5 0～ 72Gy)。结果　单放组与放化组 1,2 ,3年生存率分别为 88.0 %和 90 .0 %、6 0 .0 %和 78.0 %、4 4 .0 %和 6 8.0 % ,两组比较差异有显著性。单放组与放化组 1,2 ,3年局控率分别为 78.0 %和 86 .0 %、4 6 .0 %和 6 8.0 %、4 0 .0 %和 6 2 .0 % ,两组比较差异有显著性。单放组与放化组Ⅰ、Ⅱ级白细胞下降发生率分别为 10 .0 %、2 8.0 %、2 .0 %和 16 .0 % ;单放组与放化组Ⅰ、Ⅱ、Ⅲ级咽黏膜反应发生率分别为 8.0 %和 4 .0 %、82 .0 %和 76 .0 %、10 .0 %和 2 0 .0 %。无因毒副作用而延迟或中断治疗者。结论　放疗前行 2～ 3疗程诱导化疗能提高中晚期鼻咽癌生存率和局控率。     

根治性放疗后食管癌复发的手术切除和再程放疗的比较

目的 :分析比较食管癌根治性放疗 (DT6 0～ 70 Gy/ 6～ 7周 )后复发的患者经手术切除和再程放疗的疗效。材料与方法 :1984年 1月～ 1990年 1月间将前瞻性随机分组的 78例患者随机分为手术切除组和再程放疗组进行对比治疗。手术切除组 39例 ,再程放疗组 39例 ,放疗剂量 DT4 0～ 6 0 Gy/ 4～ 6周。结果 :手术切除率为 89.7% ,手术切除组术后并发症为 2 5 .7% ,手术死亡率达 11.4 %。 1,3,5年生存率分别为 82 .8%、34.5 %和 2 7.6 % ;再程放疗组 1,3,5年生存率分别为 4 0 .5 %、8.1%和 2 .7% ,两组比较(P<0 .0 1)。结论 :手术切除组的疗效明显好于再程放疗组 ,手术是根治性放疗后复发患者首选的治疗手段。     

联合化疗与放射相伴治疗240例食管癌

采用随机分组对 1 2 0例食管癌放化相伴治疗与 1 2 0例单纯放射治疗进行对比研究 ,两组照射方法相同 ,DT5 0～ 70Gy/5～ 7周 ,1 ,2 ,3,4年生存率 ,放化组为 6 8.3%、4 9.5 %、2 7.1 %、1 5 .6 % ,单纯放射组为 4 4.1 %、2 8.4 %、2 2 .9%、1 5 .6 % ,其中 1 ,2年生存率对比有显著差异 (P <0 .0 5 ) ,中位生存期 ,放化组明显高于单放组。     

放化疗同时治疗食管癌

目的　探讨放化疗同时治疗食管癌的价值。方法　将 6 8例食管癌患者随机分为 2组 ,一组 35例放疗同时合并 5 Fu、PDD方案化疗 (放化组 )。另一组 33例单纯放疗 (单放组 )。放疗采用 6MV或 15MV X线照射 ,中平面DT 5 5～6 5GY ;化疗共 4个周期 ,与放疗同时进行 2个周期 ,放疗结束后 2个周期。结果　随访 3年 ,放化组和单放组近期疗效CR分别为 80 %和 5 1.5 %(P <0 .0 5 )、1、2、3年生存率分别为 74.3%、5 1.4%、34.3%和 48.5 %、30 .3%、2 1.2 %。放化组生存率明显高于单放组 (P <0 .0 5 )。但骨髓抑制及胃肠道反应放化组高于单放组 (P <0 .0 5 )。结论　放化疗同时对食管癌治疗有协同作用 ,值得临床进一步探讨。     

颈段食管癌治疗方法的探讨

分析 1 70例颈段食管癌 ,以探讨颈段食管癌的治疗方案。术前放疗加手术综合治疗 30例 ,单纯手术 2 7例 ,单纯放疗 1 1 3例 ,术前放疗剂量为DT4 0Gy/4周 ,疗后 3个月内行手术 ,单纯放疗剂量为DT5 0Gy/5周以上 ,综合治疗、单纯手术与单纯放疗其 5年生存率分别为 4 0 .0 %、1 5 .3%与 2 8%。综合治疗与单纯手术间有统计学差别 (P <0 .0 5 ) ,且并发症发生率、手术有关死亡率相似。颈淋巴结转移是影响单纯放疗预后的重要因素 ,单纯放疗主要失败原因为局部未控复发 ( 71 .0 % ) ,综合治疗主要失败原因为淋巴结转移 ( 81 .0 % )。我们认为综合治疗能提高颈段食管癌的生存率 ,而根治性单纯放疗也是主要的治疗方法之一。术前放疗剂量 ,在食管局部为DT4 0Gy/4周 ,双下颈锁骨上预防时为DM4 5～5 0Gy ,有淋巴结转移时应给予DM5 0Gy以上 ,同时行淋巴结转移侧颈清扫术。     

放疗加诱导化疗治疗晚期鼻咽癌的临床观察

 目的　评价诱导化疗对晚期鼻咽癌放疗疗效的影响。方法　 1 993年 2月至 1 995年 1 2月 ,1 1 8例 、 期鼻咽癌患者随机分为两组 (化放组及单放组 ) ,每组 59例。放疗采用60 Co机或直线加速器照射。鼻咽癌原发灶 DT66～ 76Gy/6.5～ 7.5w,颈部 DT50～ 66Gy/5～ 6.5w。化疗组在放疗前采用 DDP+5- Fu方案诱导化疗。结果　 5年生存率化放组为 57.6% ,单放组为 35.6% ,差别有统计学意义 (P<0 .0 5)。化放组远处转移率为 2 8.9% ,单放组为 40 .7% ,差别有统计学意义 (P<0 .0 5)。结论　放疗加诱导化疗能提高晚期鼻咽癌的生存率并可降低远外转移率。     

后期加速超分割术前放疗经腹会阴手术治疗局部晚期直肠癌

 目的　探讨后期加速超分割术前放疗经腹会阴手术治疗局部晚期直肠癌的疗效。方法　 4 6例局部晚期直肠癌随机分为加速后期超分割术前放疗经腹会阴手术组 2 2例 ,单纯腹会阴手术组 2 4例。术前放疗组先行盆腔前后野常规照射 36Gy/ 4周 ,后行盆腔两侧野超分割照射 ,2 4～ 2 6Gy/ 2周 ,总DT为 6 0～6 2Gy ,休息 4～ 5周后手术。单独手术组术前不放疗。 结果　术前放疗组淋巴结转移率、局部复发率显著低于单纯手术组。手术切除率、3年、5年生存率显著高于单纯手术组。结论　后期超分割术前放疗对可手术的局部晚期直肠癌是有意义的     

低剂量每周一次多西他赛同步放疗治疗食管癌的临床疗效

目的探讨低剂量多西他赛每周一次同步放射治疗食管癌的临床疗效。方法86例食管癌患者随机分为放化组45例和单放组41例。两组均行前程普通放疗加后程适形放疗。前程普通放疗采用三野等中心照射,剂量DT40Gy/20次,后程适形放疗剂量DT26～30Gy/13～15次,总剂量DT66～70Gy/33～35次,6.5～7周完成。放化组在放疗同期行多西他赛化疗,20mg/次,1次/周,总量为120～140mg/6～7次;同时给一定的对症支持治疗等。治疗前及治疗后行上消化道造影、胸部CT,腹部B超等检查,以评价疗效。结果放化组总有效率（CR＋PR）为86.7%,单放组总有效率为68.3%,两组差异具有统计学意义（P〈0.05）;放化组骨髓抑制毒副反应较单放组增加,但经处理后均能顺利完成治疗;两组1年总生存率分别为88.9%和65.8%（P〈0.05）。结论低剂量每周一次多西他赛联合放疗能提高食管癌的近期疗效,毒副反应患者均能耐受。     

诱导化疗对局部晚期鼻咽癌放疗远期疗效的影响

目的：探讨诱导化疗对局部晚期鼻咽癌放疗远期疗效的影响。方法：回顾性分析120例Ⅲ、1Va期鼻咽癌患者按治疗方法分为两组（化放组及单放组）。放疗采用直线加速器照射鼻咽及颈部,鼻咽剂量DT70—76Gy,7—7．5周,颈部剂量DT50—70Gy,5—7周。诱导化疗采用DDP＋5-Fu方案。结果：化放疗组1、3、5年生存率分别为98％、76％、20％;单放组分别为96％、60％、18％,无显著性差异（P〉0．05）。化放组远处转移率为20．9％,单放组为41．7％,两组比较有显著性差异（P〈0．05）。结论：诱导化疗能降低局部晚期鼻咽癌放疗的远处转移率,但没有提高生存率。     

Organ motion in image-guided radiotherapy: lessons from real-time tumor-tracking radiotherapy

External radiotherapy using imaging technology for patient setup is often called image-guided radiotherapy (IGRT). The most important problem to solve in IGRT is organ motion. Four-dimensional radiotherapy (4DRT), in which the accuracy of localization is improved – not only in space but also in time – in comparison to 3DRT, is required in IGRT. Real-time tumor-tracking radiotherapy (RTRT) has been shown to be feasible for performing 4DRT with the aid of a fiducial marker near the tumor. Lung, liver, prostate, spinal/paraspinal, gynecological, head and neck, esophagus, and pancreas tumors are now ready for dose escalation studies using RTRT.     

国产威达（WD－H·D·R18）后装腔内治疗机的临床应用（附380例疗效观察）

我院自１９９２年６月至１９９３年６月使用广东威达（ＷＤ·Ｈ·Ｄ·Ｒ·１８型）后装腔内治疗机，施行腔内放疗、组织间插植、术中置管和表面敷贴放疗等方法，治疗各种癌瘤共３８０例，其近期疗效为：完全消失７９．７４％（３０３／３８０）部分消失：１４．７４％（５６／３８０）无效：５．５３％（２１／３８０）；总有效率：９４．４８％（３５９／３８０）。全组随诊时间为１－１２个月。结合临床应用的若干问题对该机作出初步评价。     

2019年中国大陆地区放疗人员和设备基本情况调查研究

[目的]了解我国大陆地区放疗人才及设备情况。[方法]2019年4月10日至9月20日期间,中华医学会放射肿瘤治疗学分会通过线上问卷的形式进行了全国第九次行业调查,调查2018年度全国各个医院从事放疗的人员、设备、技术、年放疗人次以及主要放疗病种等数据。[结果]本次问卷回收率100%,所有放疗单位数据通过各省医学会再次确认。中国大陆地区放疗单位1463家。从事放疗的工作人员共29096人,其中放疗医师14575人、物理师4172人、技师8940人、维修师1409人。共有直线加速器2021台(含进口和国产),钴60远距离治疗机66台,近距离治疗机339台,质子重离子机5台,常规模拟机1453台,CT模拟机355台。能开展二维放疗1002家,三维适形放疗1272家,静态调强放疗1121家,Rapid Arc145家,容积旋转调强放疗279家,立体定向放射治疗297家,近距离治疗273家,全身X线治疗75家,全身电子线治疗73家,Tomo治疗38家,质子/重离子治疗5家。病床数97836张(含综合医院肿瘤科病床),放疗年治疗人数1259602人。[结论]中国大陆地区放疗单位数目缓慢增长,放疗从业人员较前稍减少,开展放疗新技术单位逐年增加,全国每百万人口放疗设备(加速器+钴60)仅1.5,仍低于WHO的要求。     

Clinician's guide to prostate IMRT plan assessment and optimisation

Intensity-modulated radiotherapy (IMRT) offers dosimetric benefit for irregularly shaped treatment volumes compared to three-dimensional conformal approaches. Some groups advocate IMRT as the standard of care for prostate radiotherapy. For clinicians, assessment of an IMRT plan can introduce new opportunities and challenges. Although a standard IMRT plan may be deemed acceptable by meeting pre-set dose constraints, further optimisation may yield a superior treatment plan by further reducing dose to critical structures or improving target volume homogeneity. The aim of this article is to present aspects of IMRT planning relevant to clinicians to aid in plan critiquing.     

Evaluation of a Novel Field-placement Algorithm for Locoregional Breast Cancer Radiotherapy Including the Internal Mammary Chain

Aims

Irradiation of the internal mammary chain (IMC) is increasing following recently published data, but the need for formal delineation of lymph node volumes is slowing implementation in some healthcare settings. A field-placement algorithm for irradiating locoregional lymph nodes including the IMC could reduce the resource impact of introducing irradiation of the IMC. This study describes the development and evaluation of such an algorithm.

Radiothérapie adaptative : stratégies et bénéfices selon les localisations tumorales

Adaptive radiotherapy (ART) is a complexe image-guided radiotherapy modality that comprises multiple planning to account for anatomical variations occurring during irradiation. Schematically, two strategies of RTA can be distinguished and combined according to tumor locations. One or more replanning can be proposed to correct systematic variations such as tumor shrinkage. A library of treatment plans with day-to-day plan selection from cone-beam CT imaging can also be proposed to correct random variations such as uterine motion or bladder/rectum volume changes. Because of strong anatomical variations occurring during irradiation, RTA appears therefore particularly justified in head and neck, lung, bladder, cervical and rectum and pancreas tumors, and to a lesser extent for prostate tumors and other digestive tumors. For these tumor locations, ART provides a fairly clear dosimetric benefit but a clinical benefit not yet formally demonstrated. ART cannot be proposed in a routine practice but must be evaluated medico-economically in the context of prospective trials. A rigorous quality control must be associated.     

非小细胞肺癌3D-CRT与IMRT立体定向放疗剂量学比较

目的:研究三维适形(3D-CRT)和逆向调强(IMRT)两种计划方式在进行早期非小细胞肺癌(NSCLC)立体定向放射治疗(SBRT)的剂量学差异。方法:选取接受放射治疗的早期NSCLC患者12例,分别采用3D-CRT和IMRT技术设计SBRT治疗计划。比较两种计划方式下PTV的相关剂量学参数(CI、HI、D1%、D99%),肺、胸壁、心脏及脊髓的剂量学参数(Vx、Dmean、Dmax),以及加速器的机器跳数、治疗时间等差异。结果:在PTV相关参数比较中,3D-CRT计划的CI、HI以及D1%均差于IMRT,差异有统计学意义,P<0.05;但是两者的D99%差异无统计学意义,P>0.05。在危及器官受量的比较中,3D-CRT与IMRT计划的患侧肺V5～V40、健侧肺V5～V15、双侧肺V5～V40、胸壁V5～V40、Dmean、心脏V20～V40、Dmean及脊髓Dmax的差异均无统计学意义,P>0.05。3D-CRT计划的机器跳数及治疗时间较IMRT计划分别减少了53%和78%,P<0.05。在绝对剂量体积比较中,3D-CRT的V60～V75及V45～V60均大于IMRT,V20～V45小于IMRT,差异均无统计学意义,P>0.05。结论:IMRT计划在早期NSCLC行SBRT治疗中不具有明显的剂量学优势。考虑到IMRT实施过程的复杂性和不确定性,早期NSCLC行SBRT治疗时3D-CRT可作为首选。     

The Long and the Short of it: the Role of Short-course Radiotherapy in the Neoadjuvant Management of Rectal Cancer

Total mesorectal excision is the cornerstone of treatment for rectal cancer. Multiple randomised trials have shown a reduction in local recurrence rates with the addition of preoperative radiotherapy, either as a 1-week hypofractionated short-course (SCRT) or a conventionally fractionated long-course (LCRT) schedule with concurrent chemotherapy. There is also increasing interest in the addition of neoadjuvant chemotherapy to radiotherapy with the aim of improving disease-free survival. The relative use of SCRT and LCRT varies considerably across the world. This is reflected in, and is probably driven in part by, disparity between international guideline recommendations. In addition, different approaches to treatment may exist both between and within countries, with variation related to patient, disease and treatment centre and financial factors. In this review, we will specifically focus on the use of SCRT for the treatment of rectal cancer. We will discuss the literature base and current guidelines, highlighting the challenges and controversies in clinical application of this evidence. We will also discuss potential future applications of SCRT, including its role in optimisation and intensification of treatment for rectal cancer.     

A Randomised Phase II Clinical Trial Comparing the Deliverability and Acute Toxicity of Wide Tangent versus Volumetric Modulated Arc Therapy to the Breast and Internal Mammary Chain

AimsInclusion of the internal mammary chain in the radiotherapy target volume (IMC-RT) improves disease-free and overall survival in higher risk breast cancer patients, but increases radiation doses to heart and lungs. Dosimetric data show that either modified wide-tangential fields (WT) or volumetric modulated arc therapy (VMAT) together with [AQ1]voluntary deep inspiration breath hold (vDIBH) keep mean heart doses below 4 Gy in most patients. However, the impact on departmental resources has not yet been documented. This phase II clinical trial compared the time taken to deliver IMC-RT using either WT and vDIBH or VMAT and vDIBH, together with planning time, dosimetry, set-up reproducibility and toxicity.Materials and methodsLeft-sided breast cancer patients requiring IMC-RT were randomised to receive either WT(vDIBH) or VMAT radiotherapy. The primary outcome was treatment time, powered to detect a minimum difference of 75 min (5 min/fraction) between techniques. The population mean displacement, systematic error and random error for cone beam computed tomography chest wall matches in three directions of movement were calculated. Target volume and organ at risk doses were compared between groups. Side-effects, including skin (Radiation Therapy Oncology Group), lung and oesophageal toxicity (Common Terminology Criteria for Adverse Events v 4.03) rates, were compared between the groups over 3 months. Patient-reported outcome measures, including shoulder toxicity at baseline, 6 months and 1 year, were compared.ResultsTwenty-one patients were recruited from a single UK centre between February 2017 and January 2018. The mean (standard deviation) total treatment time per fraction for VMAT treatments was 13.2 min (1.7 min) compared with 28.1 min (3.3 min) for WT(vDIBH). There were no statistically significant differences in patient set-up errors in between groups. The average mean heart dose for WT(vDIBH) was 2.6 Gy compared with 3.4 Gy for VMAT(vDIBH) (P = 0.13). The mean ipsilateral lung V_17Gy was 32.8% in the WT(vDIBH) group versus 34.4% in the VMAT group (P = 0.2). The humeral head (mean dose 16.8 Gy versus 2.8 Gy), oesophagus (maximum dose 37.3 Gy versus 20.1 Gy) and thyroid (mean dose 22.0 Gy versus 11.2 Gy) all received a statistically significantly higher dose in the VMAT group. There were no statistically significant differences in skin, lung or oesophageal toxicity within 3 months of treatment. Patient-reported outcomes of shoulder toxicity, pain, fatigue, breathlessness and breast symptoms were similar between groups at 1 year.ConclusionVMAT(vDIBH) and WT(vDIBH) are feasible options for locoregional breast radiotherapy including the IMC. VMAT improves nodal coverage and delivers treatment more quickly, resulting in less breath holds for the patient. This is at the cost of increased dose to some non-target tissues. The latter does not appear to translate into increased toxicity in this small study.