门冬氨酸鸟氨酸在原发性肝癌X-刀治疗中的保肝作用

目的：观察门冬氨酸对原发性肝癌X-刀治疗所造成的肝功能损害的作用。方法：对接受X-刀治疗的31例原发性肝癌病人给予门冬氨酸鸟氨酸保肝。并设30例对照组。2组病人均于X-刀治疗当天开始给予常规保肝治疗。检测两组疗前和疗后胆红素（BIL）丙氨酸氨基转氨酶（ALT）。门冬氨酸氨基转氨酶（AST）和血氨（BA）水平。结果：对照组X-刀治疗后BIL、ALT、AST明显升高。治疗组则未出现上述现象与对照组相比差异有统计学意义，P〈0．05。治疗组术后血氨低于对照组P〉0．05差异无统计学意义。结论：门冬氨酸鸟氨酸用于原发性肝癌X-刀治疗，可减轻肝细胞损害，保护肝脏功能。增强病人对X-刀治疗的耐受性。     

门冬氨酸鸟氨酸与异甘草酸镁在肝癌伽玛刀治疗中护肝作用的比较

目的 探讨门冬氨酸鸟氨酸与异甘草酸镁在原发性肝癌伽玛刀治疗中的护肝作用.方法 选择经B超、CT、MRI及AFP等明确诊断为肝癌并且已为中晚期而不宜手术治疗的患者为研究对象,在对其进行伽玛刀治疗前后给予门冬氨酸鸟氨酸或异甘草酸镁治疗.实验分3组:A组92例给予门冬氨酸鸟氨酸,B组90例给予异甘草酸镁,C组86例为对照组并给予甘草酸二铵、肌苷等,3组均于伽玛刀治疗前3 d给药.检测3组伽玛刀治疗前后总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)和血氨(BA)水平.结果 A组和B组对伽玛刀治疗患者的肝功能有明显的保护作用,患者伽玛刀治疗后TBIL、ALT及AST均有所升高,但能较快恢复正常,与C组比较有统计学差异(P＜0.05);A组伽玛刀治疗后血氨明显下降,而B组伽玛刀治疗后血氨无下降,差异有统计学意义(P＜0.05).结论 门冬氨酸鸟氨酸与异甘草酸镁均可防治伽玛刀治疗所致肝损伤,保护和促进肝功能恢复,减少并发症,增加患者对伽玛刀治疗的耐受性,且门冬氨酸鸟氨酸与异甘草酸镁比较,能更有效降低血氨,预防肝性脑病的发生.     

门冬氨酸鸟氨酸在肝动脉栓塞化疗中的保肝作用

目的：观察门冬氨酸乌氨酸对肝动脉栓塞化疗所造成的肝功能损害的作用。方法：对接受肝动脉栓塞化疗的31例原发性肝癌病人给予门冬氨酸乌氨酸保肝，并设30例为对照组。2组病人均于肝动脉栓塞化疗后当天开始给予常规护肝治疗。检测两组疗前和疗后胆红素（BIL）、丙氨酸氧基转移酶（ALT）、门冬氨酸氨基转移酶（AST）和血氨（BA）水平。结果：对照组肝动脉栓塞化疗后BIL、ALT、AST明显升高，治疗组则未出现上述现象，与对照组相比差异有统计学意义，P〈0．05。治疗组术后血氧亦低于对照组，但P〉0．05，差异无统计学意义。结论：门冬氨酸乌氨酸用于肝动脉栓塞化疗，可减轻肝细胞损害，保护肝脏功能，增强病人对栓塞化疗的耐受性。     

原发性肝癌介入性化疗栓塞的风险预测

目的对原发性肝癌患者行介入性化疗栓塞进行风险预测.方法将116例行介入栓塞治疗的原发性肝癌患者根据术后的肝功能分为良好组、轻度损害组、重度损害组,对3组病例之间术前的肝功能和储备功能进行单因素分析(秩和检验)和多因素分析(有序多项分类Logistic回归),对肝癌患者行介入性化疗栓塞后的肝功能损害进行预测.结果 3组之间术前丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转肽酶、碱性磷酸酶差异均无显著性意义(P>0.05),而吲哚靛青绿负荷实验15 min 潴留率和Child分级差异有显著性意义(P<0.05),Logicits回归推导出3个预测术后分组的方程式,实际符合率为82.76%.结论 ICGR15和Child分级是评估行介入栓塞治疗肝癌患者的肝储备功能的较好的指标,预测方程为肝癌的介入栓塞治疗提供了1个安全评估依据.     

微球联合碘油栓塞治疗肝癌的初步经验

目的 研究采用微球联合碘油作为栓塞剂治疗肝癌的安全性及疗效.方法 对肝癌患者行经动脉化疗栓塞(TACE)治疗时除使用化疗药物外,选用直径300～500μm的微球1～2ml及碘油10～20 ml作为栓塞剂.分别观察患者术前、术后肝功能、血清甲胎蛋白(AFP)水平、肿瘤的改变情况及栓塞相关并发症.结果 36例原发性肝癌患者入选本组研究.TACE术后患者黄疸指数、丙氨酸转氨酶和碱性磷酸酶均有不同程度升高,血清白蛋白、AFP水平明显降低;肿瘤不同程度坏死、缩小明显(P＜0.05).结论 在肝癌介入治疗中,使用微球联合碘油作为栓塞剂,疗效明显;但可造成一定程度的肝功能损害,应注意栓塞剂的用量及肝功能保护.     

立体定向适形放疗治疗原发性肝癌的近期疗效分析

目的 观察立体定向适形放疗治疗原发性肝癌的近期疗效.方法 28例原发性肝癌患者经Elscint twin flash 螺旋CT机定位后,用Leibinger三维放疗计划系统拟制放疗计划,在Varian直线加速器上实施治疗.平均随访时间为12个月.分析肿瘤反应率、放疗后无肝内肿瘤进展率及放疗后12个月生存率,观察治疗毒副作用.结果 放疗后肿瘤体积反应率为85.7%,放疗后12个月无肝内肿瘤进展率为38.4%,放疗后12个月生存率为70.5%.存活患者无晚期肝损伤.结论 立体定向适形放疗治疗肝癌的毒性较小,对提高肝内肿瘤的局部控制率有一定意义.     

还原型谷胱甘肽在原发性肝癌介入治疗后保肝作用中的临床应用

目的 探讨还原型谷胱甘肽在原发性肝癌介入治疗后的保肝作用.方法 回顾性分析2010年1月-2013年6月收治的原发性肝癌患者110例,按照随机数字表法分为对照组50例和治疗组60例,均给予肝动脉化学性栓塞和灌注治疗.对照组,静脉滴注维生素C 2.0g,维生素B6 0.2 9,肌苷2.0 g,以及支链氨基酸250 ml,每日1次,术后连续使用l周;治疗组,在前述基础用药上加用还原型谷胱甘肽1.8 9,以5％葡萄糖溶液250 ml配伍静脉滴注.同时检测术前和术后1周各项肝功能指标,进行两组间比较.结果 治疗前两组肝功能、病情无明显差异.介入治疗1周后,治疗组和对照组转氨酶(ALT、AST)、总胆红素(TBIL)均明显升高(P＜0.05),血清前白蛋白(PA)均明显降低(P＜0.05);治疗组各项指标变化明显优于对照组(P＜0.05).结论 还原型谷胱甘肽能明显改善原发性肝癌介入治疗引起的肝功能损害,有很好的临床应用价值.     

脾动脉栓塞在肝癌介入治疗中的应用

目的：探讨脾动脉栓塞在肝癌介入治疗中的应用价值。方法：对11例中晚期肝癌病人在进行肝动脉化疗栓塞的同时进行脾动脉栓塞治疗，观察病人血液白细胞、血小板计数及肝功能的变化情况和术后反应，判断治疗效果。结果：所有病人治疗后血液白细胞和血小板计数升高，肝功能恢复快，无严重并发症发生。结论：脾动脉栓塞应用于治疗肝癌可改善病人肝功能，控制脾功能亢进，促进血液白细胞、血小板升高，有助于病人的恢复。     

脾动脉部分栓塞在肝癌介入治疗中临床应用研究

目的：研究脾动脉部分栓塞在肝癌介入治疗中的临床应用价值。方法：对62例肝癌病人在肝动脉灌注化疗栓塞过程中进行脾动脉部分栓塞治疗，观察病人血液中自细胞、血小板计数及肝功能的变化，判断疗效。结果：治疗后所有病人白细胞、血小板计数升高，恢复正常的时间为术后2—4周，49例肝功能改善，原有牙龈出血和鼻衄等症状大多消失，伴门脉癌栓76％（16／21）术后近期腹水减少或消失，肝功能恢复较快，无严重并发症。结论：肝癌介入化疗栓塞同时行脾动脉部分栓塞可以有效改善肝功能，缓解脾功能亢进，促进血液中自细胞、血小板升高，减轻门脉压力增高，提高免疫力，对肝癌预后有积极作用。     

健脾疏肝汤联合肝脾双栓治疗原发性肝癌合并脾功能亢进临床研究

目的:探讨中药健脾疏肝汤联合肝脾动脉双栓塞法治疗原发性肝癌合并脾功能亢进的临床疗效。方法:将60例原发性肝癌合并脾功能亢进患者随机分为治疗组和对照组,两组均行肝脾动脉双栓塞术及肝动脉灌注化疗术。治疗组同时给予中药健脾疏肝汤口服,观察患者肝功能、血常规、AFP测量门静脉、脾静脉直径及肿瘤大小。结果:治疗组患者肝功能恢复明显优于对照组(P<0.05)、AFP低于对照组(P<0.05)、门静脉及脾静脉直径明显低于对照组(P<0.05),且并发症发生率低于对照组。结论:中药健脾疏肝汤联合肝脾动脉双栓塞法治疗原发性肝癌合并脾功能亢进能改善肝功能,降低门脉压力,延缓肿瘤进展,降低并发症发生率。     

原发性肝癌患者肝动脉化疗栓塞治疗后T细胞亚群改变及临床意义

目的：了解原发性肝癌患者经肝动脉化疗栓塞术（ＴＡＣＥ）后免疫功能状态。方法：我们应用流式细胞仪检测了１６例原发性肝癌患者ＴＡＣＥ术前后Ｔ细胞表面抗原标志（ＣＤ３、ＣＤ４、ＣＤ８）,并与良性病变患者进行对比分析。结果：原发性肝癌患者术前ＣＤ３＋、ＣＤ４＋、ＣＤ４＋／ＣＤ８＋均低于对照组,ＣＤ８＋高于对照组,ＴＡＣＥ术后ＣＤ８＋降低,ＣＤ３＋、ＣＤ４＋、ＣＤ４＋／ＣＤ８＋均升高。结论：原发性肝癌患者治     

晚期肺癌三维适形放疗31例临床分析

目的探讨晚期肺癌三维适形放疗方式及预后。方法对31例晚期肺癌患者资料进行回顾性分析。根据放疗方法的不同分为普通放疗(RT)+三维适形放疗(3DCRT)组10例、单纯三维适形放疗组21例,分析不同放疗方法的生存质量和生存率。结果 RT+3DCRT组、单纯3DCRT组的治疗有效率分别为90%,95.2%;1年生存率分别为20%、12.9%;相互比较均无显著性差异,但生存质量均有明显提高。结论 3DCRT可使晚期肺癌患者局部控制率提高,生活质量改善。     

彩色多普勒超声对原发性肝癌肝固有动脉血流动力学的研究

目的：利用彩色多普勒超声,研究原发性肝癌（PHC）患者肝固有动脉（HA）的血流动力学特点,并与肝硬化患者和正常人对照分析,为PHC的早期诊断和鉴别诊断提供血流参数依据。方法：应用彩色多普勒超声检测原发性肝癌和肝硬化患者及正常人肝固有动脉内径（PHA—D）和肝固有动脉多普勒血流频谱参数。结果：PHC患者肝固有动脉内径宽于肝硬化患者和正常人（P〈0．05）,收缩期峰值流速高于肝硬化患者和正常人（P〈0．05）,阻力指数低于肝硬化患者和正常人（P〈0．05）。结论：PHC患者与肝硬化患者及正常人相比,肝固有动脉收缩期峰值流速明显增加,管径增宽,阻力指数降低,差别有统计学意义,通过彩色多普勒超声对PHC患者肝固有动脉内径和肝固有动脉多普勒血流频谱参数的检测,有助于原发性肝癌的早期诊断和鉴别诊断。     

肝动脉化疗栓塞与三维立体定向放疗配合治疗原发性肝癌

目的 探讨肝动脉化疗栓塞(TACE)与三维立体定向放疗(3DCRT)配合治疗HCC的效果.方法 对131例HCC患者,采用TACE结合3DCRT进行治疗,89例先行TACE,15例先行3DCRT,27例3DCRT前后接受TACE.根据肿瘤的大小部位,3DCRT以50%～90%的等剂量线包绕计划靶区,单次剂量3～5 GY,治疗8～12次,肿瘤边缘总放射剂量36～50 GY.结果治疗后近期有效率为83.2%.1、2.年生存率为85.5%、52.6%,无严重并发症.结论 TACE与3DCRT配合是治疗HCC安全、有效的方法.     

Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy

Background and purpose

Intensity-modulated radiotherapy (IMRT) has rapidly become standard of care in the management of locally advanced head and neck squamous cell carcinoma (HNSCC). In this study, our aim was to retrospectively investigate the effect of the introducing IMRT on outcome and treatment-related toxicity compared to parotid-sparing 3D conformal radiotherapy (3DCRT).

Material and methods

A total of 245 patients with stage III and IV HNSCC treated with primary radiotherapy between January 2003 and December 2010 were included in this analysis: 135 patients were treated with 3DCRT, 110 patients with IMRT. Groups were compared for acute and late toxicity, locoregional control (LRC), and overall survival (OS). Oncologic outcomes were estimated using Kaplan–Meier analysis and compared using a log-rank test. Acute toxicity was analyzed according to the Common Terminology Criteria for Adverse Events v3.0 and late toxicity was scored using the RTOG/EORTC late toxicity scoring system.

Results

Median follow-up was 35 months in the IMRT group and 68 months in the 3DCRT group. No significant differences were found in 3-year LRC and OS rates between the IMRT group and 3DCRT group. Significantly less acute mucositis ≥ grade 3 was observed in the IMRT group (32% vs. 44%, p?=?0.03). There was significantly less late xerostomia ≥ grade 2 in the IMRT group than in the 3DCRT group (23% vs. 68%, p?<?0.001). After 24 months, there was less dysphagia ≥ grade 2 in the IMRT group although differences failed to reach statistical significance.

Conclusion

The introduction of IMRT in the radiotherapeutic management of locally advanced head and neck cancer significantly improved late toxicity without compromising tumor control compared to a parotid-sparing 3D conformal radiotherapy technique.     

Radiation-induced acute toxicities after image-guided intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for patients with spinal metastases (IRON-1 trial)

Purpose

Radiation therapy (RT) provides an important treatment approach in the palliative care of vertebral metastases, but radiation-induced toxicities in patients with advanced disease and low performance status can have substantial implications for quality of life. Herein, we prospectively compared toxicity profiles of intensity-modulated radiotherapy (IMRT) vs. conventional three-dimensional conformal radiotherapy (3DCRT).

Methods

This was a prospective randomized monocentric explorative pilot trial to compare radiation-induced toxicity between IMRT and 3DCRT for patients with spinal metastases. A total of 60 patients were randomized between November 2016 and May 2017. In both cohorts, RT was delivered in 10 fractions of 3?Gy each. The primary endpoint was radiation-induced toxicity at 3 months.

Results

Median follow-up was 4.3 months. Two patients suffered from grade 3 acute toxicities in the IMRT arm, along with 1 patient in the 3DCRT group. At 12 weeks after treatment (t2), 1 patient reported grade 3 toxicity in the IMRT arm vs. 4 patients in the 3DCRT group. No grade 4 or 5 adverse events occurred in either group. In the IMRT arm, the most common side effects by the end of irradiation (t1) were grade 1–2 xerostomia and nausea in 8 patients each (29.6%), and dyspnea in 7 patients (25.9%). In the 3DCRT group, the most frequent adverse events (t1) were similar: grade 1–2 xerostomia (n?=?10, 35.7%), esophagitis (n?=?10, 35.8%), nausea (n?=?10, 35.8%), and dyspnea (n?=?5, 17.9%).

Conclusion

This is the first randomized trial to evaluate radiation-induced toxicities after IMRT versus 3DCRT in patients with vertebral metastases. This trial demonstrated an additional improvement for IMRT in terms of acute side effects, although longer follow-up is required to further ascertain other endpoints.

     

Sucralfate versus Mesalazine versus Hydrocortisone in the Prevention of Acute Radiation Proctitis during Conformal Radiotherapy for Prostate Carcinoma

PURPOSE: To assess whether the topical use of steroids or 5-aminosalicylic acid (5-ASA) is superior to sucralfate in preventing acute rectal toxicity during three-dimensional conformal radiotherapy (3DCRT) to 76 Gy. PATIENTS AND METHODS: Patients undergoing 3DCRT for prostate carcinoma at our institution were offered to be randomized to sucralfate 3 g in 15 ml suspension enema (Antepsin, mesalazine 4 g gel enema (Enterasyn, or hydrocortisone 100 mg foam enema (Colifoam. Randomization was blind to the treating physician but not to the patient. Sucralfate was chosen as control arm. Topical treatment had to be performed once daily, starting on day 1 of 3DCRT. Acute rectal toxicity was scored weekly according to RTOG criteria. Time to occurrence of grade 2+ acute rectal toxicity was taken as endpoint. RESULTS: The trial was opened in August 1999, and after the first 24 patients had been treated, arm 2 was discontinued because of eight patients receiving mesalazine, seven actually developed acute rectal toxicity (five patients grade 3 and two patients grade 2).Until May 2001, 134 consecutive patients were randomly assigned to sucralfate (63 patients), mesalazine (eight patients) or hydrocortisone (63 patients). The cumulative incidence of acute rectal toxicity at the end of treatment by arm is 61.9 +/- 6.1%, 87.5 +/- 11.7%, and 52.4 +/- 6.2% for arms 1, 2, and 3, respectively. The difference between the mesalazine group and the sucralfate group is highly significant (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.1-5.7; p = 0.03). At both uni- and multivariate analysis taking into account several patients and treatment covariates, the difference between hydrocortisone and sucralfate is not significant (HR 0.7, 95% CI 0.5-1.2; p = 0.2). CONCLUSION: Topical mesalazine is contraindicated during radiotherapy. Hydrocortisone enema is not superior to sucralfate in preventing acute rectal toxicity.     

Combined therapy of transcatheter arterial chemoembolisation and three-dimensional conformal radiotherapy for hepatocellular carcinoma

To evaluate the toxicity and efficacy of combined therapy of three-dimensional conformal radiotherapy (3DCRT) and transcatheter arterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC). 50 HCC patients treated by combined TACE and 3DCRT were selected from a patient database. Sequence of treatments was that TACE was performed first, followed by 3DCRT with an interval of about 4 weeks between. TACE was administered by 5-Fu 500-600 mg m(-2), cis-platinum 30-40 mg m(-2), epi-adriamycin 40-60 mg m(-2) mixed with iodized oil and Gelfoam embolisation. A median of two courses of TACE was given. 3DCRT was delivered by 4-6 coplanar or non-coplanar fields. The mean tumour dose was 43.0+/-6.3 Gy by conventional fractionation (2 Gy per fraction, five fractions a week), and mean dose to normal liver, 19.1+/-6.3 Gy. Acute hepatic toxicities were notable in five patients (10%) with Common Toxicity Criteria (CTC) grade 1 in two cases and grade 3 in three patients, but all recovered eventually. Two patients developed radiation-induced liver disease (RILD) and died soon after the onset of RILD. Four patients had Radiation Therapy Oncology Group (RTOG) grade 1 acute gastrointestinal complication and one patient had acute gastrointestinal bleeding. Five patients experienced RTOG Grade 1 leukopenia and Grade 2 in five cases. Nine patients achieved have partial response, and 37 patients were in stable disease. Four patients were observed to have progressive disease. The overall survival rates at 1 year, 2 years and 3 years were 60%, 38% and 28%, respectively, with a median survival period of 17 months. Irradiation dose, T-stage and hepatic cirrhosis were identified as independent predictors for overall survival by Cox proportional regression analysis. The 1 year, 2 years and 3 years local progression-free rates were 74%, 57% and 38%, and the 1 year, 2 years and 3 years distant metastasis rates were 15%, 21% and 40%, respectively. The combined modality of TACE and 3DCRT was tolerable for the majority of HCC patients, resulted in good outcome and warrants for further prospective trial.     

原发性肝癌动脉化疗栓塞术少见严重并发症分析

目的：对原发性肝癌（primary hepatic carcinoma ,PHC）动脉化疗栓塞术（transcatheter arterial chemoemboli-zation ,TACE）术后发生的少见严重并发症发生原因做相关分析。方法分析2010年1月～2013年10月间351例PHC患者行TACE治疗患者资料,对发生少见严重并发症的患者影像及临床相关资料做相应分析,以期得出不同严重并发症的发生原因及预防措施。结果少见严重并发症包括肝破裂出血3例,1例经保守治疗后好转,2例死亡;肝脓肿2例,1例经抗感染及脓肿穿刺引流治愈,1例发生感染性休克而死亡;1例食管胃底静脉曲张破裂大出血,经内科止血处理好转;1例并发急性胆囊炎经对症处理后好转;余3例分别死于碘油脑栓塞（cerebral lipiodol embolism ,CLE）、肺栓塞和股动脉延迟出血。结论原发性肝癌T ACE治疗严重并发症临床少见,一旦发生可能危及患者生命,因此严格遵循PHC诊疗规范,把握适应证,合理控制化疗药物剂量技术及栓塞程度。     

直肠癌术后盆腔不同放疗技术的剂量学研究

目的 比较直肠癌术后盆腔三维适形放疗(3DCRT)、适形调强放疗(IMRT)和简化调强(sIMRT)技术的三维剂量学特点,为直肠癌术后辅助放疗照射方法的优选提供依据。方法 选择Ⅱ～Ⅲ期直肠癌经腹前切除(Dixon手术)术后盆腔放疗的10例患者分别行3DCRT、sIMRT和IMRT3种计划设计,利用剂量体积直方图评价不同照射技术对靶区和正常组织照射剂量和靶区适形指数(CI)及剂量不均匀性指数(HI)。结果 不同放疗技术的剂量学研究:1CI为IMRT＞sIMRT＞3DCRT(t=7.48、9.13,P＜0.05)。23种治疗计划PTV靶区剂量分布的均匀度3DCRT最好,IMRT和sIMRT相似,但两者差异无统计学意义。3对膀胱的保护,IMRT明显优于3DCRT,sIMRT稍低于IMRT;对小肠的保护,sIMRT优于3DCRT,但IMRT并不比sIMRT具有更多优势;对结肠的保护,3种计划差异无统计学意义;对股骨头的保护,IMRT及sIMRT均明显好于3DCRT。IMRT、sIMRT对上述危及器官的保护优势主要体现在高剂量区。43种不同放疗技术的机器子野跳数sIMRT的子野跳数(543.0±69.8)与3DCRT技术(569.7±48.7)相当,但显著低于IMRT计划(770.3±73.1)。结论 在直肠癌术后放疗中sIMRT放疗技术具有最优性价比。