头颈部肿瘤放疗对甲状腺功能的损伤

头颈部肿瘤放疗后会引起不同程度的甲状腺功能减退.引起甲状腺功能减退的机制包括射线对甲状腺及垂体细胞的直接损伤、对相关血管的损伤以及自身免疫反应等.影响头颈部肿瘤放疗后甲状腺功能的因素主要有:放疗剂量、放疗技术、是否联合手术化疗等.通过对这些影响因素的研究可为防治甲状腺功能减退提供依据,从而提高患者生活质量.     

脑膜转移癌诊疗现状

脑膜转移癌(CM)近年来发病率有所提升.其诊断为腰穿脑脊液及以核磁共振成像为主的影像学检查.治疗方法包括鞘内化疗、放射治疗、手术及对症支持,但具体治疗方案存在争议.目前推荐个体化治疗及综合治疗,靶向药物在本病中的应用有望取得较好的治疗效果.     

PET/CT在评价及观察大鼠肺癌放疗效果中的应用

Objective The aim of this study was to understand the role of PET/CT in monitoring the therapeutic effect of radiotherapy (RT) on lung cancer with Wistar rats. Methods Thirty Wistar in-bred strain rats (6-8 weeks, weighed 180-280 g, female, ordinary) were made into Lewis pulmonary tumor model rats. 18F-fluorodeoxyglucose (FDG) PET/CT was performed when tumor reached 1.5-2.0 cm in greatest diameter (4-6 weeks) as a baseline. In order to get the optimal time point of PET/CT for moni-toring RT effect in rat cancer model, PET/CT was performed at the 3rd day, 1st, 2nd, 3rd, and 4th week after giving single dose of 5 Gy to each rat. Standardized uptake values (SUV) from FDG PET were measured and rats were sacrificed at different time point for validation. Besides, the expressions of glucose transport1 (Glut1) in tumor tissue were studied using immunohistochemistry. The level of tumor cell apoptosis, degra-dation, and necrosis were observed. SPSS 11.0 software was used for data analyses. Results A negative correlation of SUV uptake and time after RT and negative correlation of Glut1 expression and time after RT were observed in rat tumors, respectively. Positive correlation of SUV uptake and Glut1 expression in rat tumors was observed (Spearman rank correlation test, rs = 0.97, P < 0.01). Before RT, the SUV in rat tumor was 1.28 ± 0.31 and was decrease to 1. 00 ± 0.23 at the 3rd day and 0.18 ± 0. 10 at the 4th week after RT (F=15. 126, P<0.05). Before RT, the Glut1 in rat tumor was 0.2558 ±0.03 and was decrease to 0. 2320 ± 0. 01 at the 3rd day and 0. 1320±0.04 at the 4th week after RT. The amounts of tumor cell apopto-sis, degradation, and necrosis increased with time after RT. Conclusion Though FDG PET could monitor the therapeutic effect at the 3rd day after giving single dose of RT to rat lung tumor model, the optimal time was the the 4th week after treatment.     

hTERT启动子调控hNIS基因介导肺癌细胞碘摄取和131I治疗的实验研究

目的 构建含人端粒酶反转录酶(hTERT)核心启动子调控的人钠/碘同向转运体(hNIS)基因重组腺病毒,并靶向转染至肺癌A549细胞中特异性表达.探讨hTERT启动子调控的hNIS基因介导放射性碘治疗肿瘤的可能性.方法 应用AdEasy系统构建重组腺病毒Ad-hTERT-hNIS,同时构建巨细胞病毒(CMV)启动子调控的hNIS重组腺病毒Ad-CMV.hNIS作为阳性对照,不含hNIS的重组腺病毒Ad-CMV作为阴性对照.应用反转录.聚合酶链反应(RT-PCR)方法验证hTERT在转染肿瘤细胞中的转录活性,摄碘实验检测表达的hNIS蛋白功能,细胞克隆形成实验评价131I对转染肿瘤细胞的毒性作用.结果 成功构建重组腺病毒Ad-hTERT-hNIS、Ad-CMV-hNIS及Ad-CMV,并经PCR验证正确.RT-PCR证实hNIS cDNA能从Ad-hTERT-hNIS转染的细胞中扩增出来.Ad-hTERT-hNIS和Ad-CMV-hNIS转染的肺癌A549细胞摄碘能力比阴性对照组Ad-CMV转染的细胞分别提高了23和31倍,且摄碘能力可以被NaClO4抑制.Ad-hTERT-hNIS和Ad-CMV-hNIS转染的肺癌A549细胞均可被131I杀死,2组细胞成活率分别为(31.2±1.45)%和(23.6±4.08)%,而阴性对照组和未转染病毒组分别为(89.0 ±2.99)%和(91.2 ±4.63)%.结论 hTERT启动子调控的hNIS重组腺病毒转染肿瘤细胞后,应用131I治疗有望成为一种新的基因靶向治疗手段.     

乳腺癌术后放射治疗

<正>乳腺癌的发病率持续上升,但近年来美、英、加拿大等西方国家乳腺癌死亡呈明显下降趋势[1,3,6,15],这可能与多因素有关,但其主要原因为:①医疗设备与技术的提高,使早期确诊病人增多。②乳腺癌的治疗疗效有了明显的提高。对于乳腺的治疗目前的共识是:乳腺癌作为一个全身性疾病,治疗应以手术、化疗、放疗和内分泌治疗的综合性治     

原发性肝癌介入治疗结合三维适形放疗与单纯介入治疗的疗效比较

目的：比较肝动脉化疗栓塞（TACE）结合三维适形放射治疗（3DCRT）与单纯介入肝动脉化疗栓塞（TACE）对原发性肝癌（PHC）的疗效。方法：56例PHC患者分为2个组，A组28例（3DcRT加TACE，先TACE1次～3次，3DCRT45Gy-60Gy），B组28例（TACE2次～3次）。介入化疗选用顺铂60mg～100mg、阿霉素40mg、丝裂霉素20mg或5-FU1000mg～1500mg，顺铂60mg-80mg，ADM40mg（或MMC10mg-20mg）。结果：A组CR＋PR27例，总有效率为96％；B组CR＋PR17例，总有效率有60．7％（P〈0．01）。癌灶体积与疗效有关，PTV（计划靶体积）≤216cm^3者CR7／8，HV〉216cm^3者CR1／8（P〈0．01）。结论：PHC疗效3DCRT加TACE组优于单纯TACE绢。     

鼻咽癌常规放疗靶体积合理性的初步探讨

目的分析鼻咽癌常规放疗的局部控制情况和局部复发的剂量学模式,初步探讨照射靶体积确定的合理性.方法共476例初治鼻咽癌患者接受规范化单纯常规根治性放疗.全部病例均采用常规模拟定位,鼻咽靶体积为CT检查所见的原发病灶范围以及可能侵犯的亚临床病灶区域.利用Kaplan-Meier方法计算局部累积复发率;将鼻咽局部复发患者疗前和复发时局部病灶范围（Vnx和Vrecur）勾画于三维治疗计划系统,复制首程放疗的射野并按原处方剂量进行计算,根据剂量体积直方图进行剂量学评价：recurV95（95%处方剂量曲线包括的Vrecur）≥95%定义为野内复发,95%＞recurV95≥20%定义为野边缘复发,20%＞recurV95定义为野外复发.结果局部复发共52例,全组1、2、3、4年局部累积复发率分别为0.6%、3.9%、8.7%、11.5%.对42例局部复发的剂量学分析显示野内复发占多数（52%）,而大部分野边缘复发和全部野外复发均与射野设置不当、影像学阅片能力欠缺使首程放疗剂量不足有关.结论较好的局部控制率、复发的剂量学模式的分析结果提示该靶体积的设置比较合理.提高影像阅片能力,准确的射野设计,充分利用生物影像学工具,有针对性地提高照射剂量,有望进一步提高局部控制率.     

CT导向下125I种子源植入治疗恶性肿瘤

目的:探讨CT导向下125I种子源植入治疗恶性肿瘤的安全性及临床疗效。方法:11例患者14个病灶行CT导向下125I种子源植入,其中原发肿瘤5例,转移瘤6例(9个病灶)。根据治疗计划系统(TPS)计算布源,在CT导向下将18.5~29.6MBq活度的125I种子源相隔1.0~1.5cm多层面植入肿瘤内。术后1~10个月复查CT观察种子源在瘤体内的分布、疗效及有无并发症。结果:随诊CT复查,14个病灶完全缓解(CR)5个;明显缓解(OR)7个;部分缓解(PR)2个;无效(P)0。治疗前后病灶平均大小分别为4.23cm和2.07cm(t=5.018,P<0.01)。未见急性并发症和治疗相关的放射损伤。结论:CT导向下125I种子源植入治疗恶性肿瘤是一种安全、有效的方法,近期疗效肯定。     

手术^125I粒子植入联合热疗治疗中晚期肿瘤

目的探讨手术^125I粒子植入联合热疗治疗中晚期肿瘤的临床价值。方法回顾性分析总结29例中晚期肿瘤患者^125I粒子植入联合热疗的方法和经验。采用手术或B超、CT引导下植入0．4～0．7mCi^125I粒子，41处病灶共710个粒子。术后进行热疗，随访观察血象、免疫学指标、肿瘤学指标、影像学改变等，评价近期疗效。结果术后3个月复查肿瘤学指标显著下降。全组患者完全缓解（CR）7例，部分缓解（PR）15例，无变化（NC）3例，疾病进展（PD）4例，客观有效率为75．9％（22／29），局部病灶控制率93．1％（27／29）。1例肺癌植入粒子过程中出现气胸。2例出现粒子移位（肺内）。未见其他严重并发症。结论^125I放射性粒子植入联合化疗、热疗治疗中晚期肿瘤近期临床效果好，并发症发生率低，是综合治疗中晚期肿瘤的一种简单、安全、有效的方法。     

后程三维适形放疗治疗Ⅲ期非小细胞肺癌临床研究

OBJECTIVE: To evaluate the therapeutic efficacy and radiation complications of late course three-dimensional conformal radiotherapy (3DCRT) in patients with stage III non-small cell lung cancer (NSCLC). METHODS: Eighty-six patients with stage III NSCLC were randomly divided into group A (n=42) receiving conventional radiotherapy at the total dose of 66 to 70 Gy in 33 to 35 fractions completed in 6 to 7 weeks and group B (n=44) with late course 3DCRT at the dose of 24-30 Gy in 6 fractions (400-500 cGy per fraction every other day) after 40 Gy conventional radiotherapy, completed in 5 to 6 weeks. RESULTS: The efficacy rates in groups A and B were 55.0% and 82.9%, and the complete remission rates were 7.5% and 31.7% respectively, showing significant difference between the two groups (P<0.05). The 1- and 2-year survival rates of the patients in group A and B were 62.5% vs 78.0%, and 40.0% vs 53.7% respectively, without significant difference (P>0.05). The median survival time in groups A and B were 11.4 months and 19.8 months respectively. The major radiation complications observed in the two groups were grade I to II acute radiation esophagitis and hematopoietic toxicity. The later stage radiation complications in the two groups were grade I to II radiation lung fibrosis, occurring at a similar rate between the two groups. CONCLUSION: Late course 3DCRT produces better therapeutic effects than conventional radiotherapy in patients with stage III NSCLC.