非小细胞肺癌低分割放疗研究进展

肺癌是全球发病率和死亡率第一的恶性肿瘤,虽然放疗在NSCLC的治疗中具有可观的局部疗效,但临床上仍有部分患者出现治疗失败。放疗失败的主要原因是局部未控、复发或远处转移。与常规分割相比,大分割放疗可在不增加放疗次数的情况下提高总的放疗剂量;对于接受相同BED照射的NSCLC患者,大分割放疗除了能带来局部控制率上的增加外,还可减少治疗次数,节省治疗时间和费用,增加病人的便捷,提高医用加速器的使用效率。L-Q模型的数据在预测大分割放疗疗效时存在许多局限。除经典L-Q模型所模拟的机制外,还可能有其他机制的参与。分子影像是无创性评价放疗疗效的可靠手段,利用不同分子显像剂结合胞内特定靶分子,能够对恶性肿瘤的代谢水平、乏氧状态、增殖能力等情况进行较为准确的评估,为大分割放疗提供良好的疗效评估手段并成为研究其特殊放射生物效应的有力工具。     

Evaluation of combining bony anatomy and soft tissue position correction strategies for IMRT prostate cancer patients

Background

Radiotherapy treatment requires delivering high homogenous dose to target volume while sparing organs at risk. That is why accurate patient positioning is one of the most important steps during the treatment process. It reduces set-up errors which have a strong influence on the doses given to the target and surrounding tissues.

Aim

The aim of this study was to investigate the efficiency of combining bony anatomy and soft tissue imaging position correction strategies for patients with prostate cancer.

Materials and methods

The study based on pre-treatment position verification results determined for 10 patients using kV images and CBCT match. At the same patients’ position, two orthogonal kV images and set of CT scans were acquired. Both verification methods gave the information about patients’ position changes in vertical, longitudinal and lateral directions.

Results

For 93 verifications, the mean values of kV shifts in vertical, longitudinal and lateral directions equaled: −0.11 ± 0.54 cm, 0.26 ± 0.38 cm and −0.06 ± 0.47 cm, respectively. The same values achieved for CBCT matching equaled: 0.07 ± 0.62 cm, 0.22 ± 0.36 cm and −0.02 ± 0.45 cm. Statistically significant changes between the values of shifts received during the first week of treatment and the rest time of the irradiation process were found for 2 patients in the lateral direction and 2 patients in vertical direction among kV results and for 3 patients in the longitudinal direction among CBCT results. A significant difference between kV and CBCT match results was found in the vertical direction.

Conclusions

In clinical practice, CBCT combined with kV or even portal imaging improves precision and effectiveness of prostate cancer treatment accuracy.     

I131内放射治疗对成人恶性脑胶质瘤癫痫发作的影响

目的：探讨内放射治疗对胶质瘤引起的癫痫的影响。方法：回顾性分析2004年后利用I131内放射治疗的成人幕上恶性脑胶质瘤合并有癫痫发作的患者23例,统计其在治疗前1月及治疗后1月、2月时的癫痫发作频率和类型,并分析肿瘤体积变化与发作频率变化的关系。结果：治疗后1月癫痫发作无明显改变,治疗后2个月癫痫发作明显减少,13例无癫痫发作,另外10例有发作患者频率也明显下降,其中肿瘤缩小超过1／2者78％无癫痫发作。结论：I131内放射治疗的成人幕上恶性脑胶质瘤可以明显减少患者的癫痫发作。     

PET-CT图象融合技术对肺癌靶区定义的研究

目的:目前作为靶区定义依据,CT,MRI等影像主要反映人体解剖结构,而以PET.SPECT.MRS为代表的影像技术可以获得肿瘤内部生物学特性的影像,将对于肿瘤放射治疗靶区定义提供新的靶区范围。结果:本文针对2例典型病例,4名有经验医师分别采取目前常用CT影像和我们所得到的融合图像对肿瘤靶区定义,对比他们的定义差异。结论:利用融合技术将多种影像同时显示,对靶区的定义,尤其了解肿瘤的功能区域有重要的临床意义,可以提高靶区定义准确性,为进一步调强放射治疗以及将来的生物学靶区定义带来重要的实验和临床依据。     

Acute toxicity and quality of life in high risk prostate cancer patients: Updated results of randomized hypofractionation trial

Purpose

The aim of our study was to perform the final analysis of acute toxicity and quality of life data obtained from 221 consecutive patients who suffered from intermediate-to-high risk prostate cancer.

Cine 4DCT imaging artifacts: Quantification and correlations with scanning parameters and target kinetics

To study temporal resolved computed tomography imaging (4-Dimensional Computed Tomography: 4DCT) artifacts correlations with scanning parameters and target kinetics and to assess uncertainty introduced by 4DCT in radiotherapy treatment planning.In this work we classified 4DCT artifacts as finite gantry rotation speed related (FGS) and finite sampling frequency related (FSF). We studied FGS artifacts using a respiratory phantom and FSF artifacts using a Monte Carlo simulation of acquisition timing.From our analysis FGS localization error is comparable with image resolution determined by voxel dimensions. Remaining FGS artifacts are correlated with gantry rotation time (Trot), target velocity (v) and their interaction.FSF artifacts occurrence is correlated with sampling ratio (SR), i.e. the ratio of patient respiratory period (Tresp) and sampling time (Ts).In the studied velocity range (0–2 cm/s), using a Trot of 0,5s and a SR higher than 15, FGS and FSF artifacts became comparable with other sources of uncertainty.Our considerations are valid for “ideal” breathing pattern only. When variations from periodical breathing, high target velocity (more than 2 cm/s) or high peak to peak amplitude (more than 2 cm) are present, patient specific images artifacts analysis is recommended.     

Cardiac surgery in patients irradiated for Hodgkin’s lymphoma

Background/Objectives. Therapy for Hodgkin’s lymphoma is disease specific and cannot be compared with treatment for other diseases. It often includes more extensive radiotherapy on the mediastinum than for other malignancies. Cardiac morbidity is known to occur in patients previously irradiated. This study describes the postoperative course after cardiac surgery of patients previously irradiated for Hodgkin’s lymphoma. Methods. From January 1990 until June 2008, 12 patients underwent cardiac surgery in the University Medical Center Utrecht after previous irradiation for Hodgkin’s lymphoma. Data on radiotherapy, surgery and follow-up were collected retrospectively. The postoperative functional status was assessed by a telephone questionnaire. Results. Atrial fibrillation (33%) and pleural effusion (25%) were the most common postoperative complications. After a mean followup of 2.6±2.9 years four patients had died. The remaining patients were all in a favourable New York Heart Association and Canadian Cardiothoracic Society class. The estimated one-, two- and four-year survival rates were 83, 69 and 46% respectively. Conclusion. The early postoperative outcome of cardiac surgery in this population is reasonably good. The long-term results may prove to be disappointing, but the cohort is small. (Neth Heart J 2010;18:61–5.)     

Rhythms in human gastrointestinal mucosa and skin

Rhythmicity in cell proliferation is well established in the gastrointestinal tract and skin, both in rodents and humans. This is the basis for studies on the timing of both chemotherapy and radiotherapy. More recently, circadian rhythm studies of cell-cycle proteins have confirmed earlier findings based on thymidine labeling and flow cytometry. The genetic control of circadian rhythms has been elucidated recently and a possible connection between the circadian clock and the timing of cell-cycle events has been suggested. The data for gastrointestinal mucosa and skin are reviewed and the potential clinical implications of these results are discussed.     

Therapeutic effect of gene-therapy in combination with local X-irradiation in a mouse malignant melanoma model

Plasmid containing mIL-18 and B7.1 genes downstream of Egr-1 promoter was constructed and used in gene-radiotherapy on malignant melanoma in C57BL/6J mice implanted with B16 cells followed by exploration of the immunologic mechanism of the therapeutic effect. The treatment with plasmid pEgr-IL-18-B7.1 plus local X-irradiation showed more effective suppression of tumor growth than the treatment with radiation alone, pEgr-IL-18-B7.1 alone, or single gene pEgr-IL-18 (or pEgr-B7.1) combined with local X-irradiation. Anticancer immunity was found to be significantly upregulated in tumor-bearing mice treated with pEgr-IL-18-B7.1 plus local X-irradiation. IL-18 showed no direct killing effect on malignant melanoma cells in vitro, and the mechanism of the combined therapy with pEgr-IL-18-B7.1 and local X-irradiation was apparently related with the stimulation of host anticancer immunity by increased secretion of IL-18 and upregulated immunogenicity of the tumor cells by increased expression of B7.1 on their surface in addition to the direct effect of local X-irradiation on the tumor cells.     

放疗与吉西他滨治疗对肺癌A549细胞自噬相关基因Beclin1表达的影响

目的:探讨放疗与吉西他滨(Gemcitabine,GEM)治疗对人肺腺癌A549细胞中自噬相关基因Beclin1表达的影响。方法:使用60Coγ照射(6Gy)人肺腺癌A549细胞,细胞继续培养6、12和24h。使用人剂量吉西他滨处理人肺腺癌A549细胞,细胞继续培养24 h后,以未处理的A549细胞为对照,用RT-PCR和Western blotting法检测A549细胞中Beclin1 m RNA和蛋白的表达。结果:经过放射线照射后,三组A549细胞内Beclin1 m RNA和蛋白的表达量均增加,且在24小时末表达量达到最大。经过吉西他滨处理后,吉西他滨处理组A549细胞内Beclin1 m RNA和蛋白的表达量均增加。结论:放射治疗与吉西他滨治疗均可导致A549细胞内自噬相关基因Beclin1表达上调。