胰腺癌平扫或强化氟脱氧葡萄糖PET-CT图像靶区勾画研究

目的 探讨平扫或强化氟脱氧葡萄糖(FDG) PET-CT图像在胰腺癌靶区勾画中的作用。方法 回顾分析本院 2008—2009年间 21例局部晚期不可切除及术后复发胰腺癌患者资料,以相同固定体位分别行平扫CT、PET,其中 11例之后行强化CT。将扫描数据输入治疗计划系统,行平扫或强化CT、PET图像融合,分别依据强化CT、平扫CT、平扫PET及平扫或强化PET-CT融合图像勾画大体肿瘤体积(GTV),并用配对或成组t检验比较不同图像GTV大小。结果 21例患者平扫 GTV_CT、平扫 GTV_PET、平扫或强化 GTV_PET-CT平均值分别为76.9、47.0、44.5 cm³,平扫 GTV_PET-CT平均体积明显小于平扫GTV_CT (z=－3.91,P=0.000)。11例强化 GTV_CT、强化 GTV_PET、强化 GTV_PET-CT平均体积分别为64.1、45.1、49.3 cm³,强化 GTV_PET-CT平均体积明显小于强化GTV_CT (z=－2.13,P=0.033),强化 GTV_PET-CT平均体积与平扫 GTV_PET-CT相似(z=－0.80,P=0.424)。结论 PET和强化或平扫CT的融合图像能提高不可切除胰腺癌靶区勾画准确性,有望降低放疗不良反应。     

全脑放疗联合厄洛替尼治疗肺腺癌多发脑转移的理论基础和研究进展

全脑放疗(标准治疗)和(或)立体定向放疗(局部补量或<3个转移灶的可选手段)是当前肺癌多发脑转移的主要治疗手段^\[1\]。然而,当前多发脑转移的治疗规范未注意肺癌病理类型、甚至病种的差别。当前,TKI治疗肺腺癌脑转移显示了令人鼓舞的疗效^\[2-3\],但多数TKI治疗肺癌脑转移的研究将放疗和靶向治疗隔离开来,并未重视放疗在脑转移中的重要地位。当前少有两者联合治疗肺腺癌脑转移的大样本报道,更未见前瞻性对照研究。肺腺癌易发生脑转移特点和靶向治疗应用现状都要求临床研究为厄洛替尼联合全脑放疗治疗肺腺癌脑转移特别是多发脑转移提供依据。     

放疗中呼吸运动对不同形状射野剂量分布的影响

Objective To evaluate the influence of respiration on the radiation dose distribution within target volume in radiotherapy with film dosimetry. Methods Radiation of 50 MU was delivered by a square, round, ellipse, dumb bell, or female shaped filed to the films within a moving or motionless Respiration Motion Phantom respectively, the dose distributions for the two motion status were measured and compared. In order to further verify the impact of respiration, a plank phantom was used on different shifting value: 0, 0.5, 1.0, 1.5 and 2.0 cm, respectively. A square, round, or eUipse-shaped filed was used for irradiation and the distributions in different status were measured and compared with film dosimetry. Iso-dose line comparison, NAT(Normalized Agreement Tests) and γ comparison were used for the comparison of dose distributions. Fs can be an index to reflect the variability of the areas that surrounded by iso-dose lines. (FS90, FS50, FS25 delegates the ratio of the areas that surrounded by 90 %,50 %,25 % iso-dose hne in different situation respectively). Results (1) Compared with motionless situation, the FS90 in horizontal movement situation became small and the FS25 became large. As the displacement became larger, the FS90 became larger and the FS25 became smaller. FS in vertical movement situation, square and dumb bell fields changed while the others didn't have a change. (2)γ and NAT comparison: In the horizontal movement situation, compared with the static phantom, Pγ < 60 % and PNAT < 75 %. Under vertical movement situation, Pγ were less than 85 % for the square, round, dumb bell and female shaped fileds. In the plank phantom verification, Pγ and PNAT became smaller as the movement became larger. Conclusions The respiration can impact on the dose distribution within the target volume in radiotherapy, leading to a smaller area of higher dose level and an expanded area of lower dose level. The influence will become more significant with larger movement of the target.     

软组织恶性纤维组织细胞瘤术后辅助放化疗预后因素分析

、68.0%、53.0%和62个月.单因素分析显示肿瘤大小、分期及术后放疗等均和预后明显相关,而性别、年龄、肿瘤部位、术后化疗对总生存率无影响,多因素回归分析显示术后放疗为独立预后因素.单纯化疗、单纯放疗及化疗+放疗组疗效相似,但它们均优于无放化疗组.结论 体积较小、术后无转移的肿瘤预后较好,而术后治疗以术后辅助放疗者预后最好.     

放疗中呼吸运动对不同形状射野剂量分布的影响

Objective To evaluate the influence of respiration on the radiation dose distribution within target volume in radiotherapy with film dosimetry. Methods Radiation of 50 MU was delivered by a square, round, ellipse, dumb bell, or female shaped filed to the films within a moving or motionless Respiration Motion Phantom respectively, the dose distributions for the two motion status were measured and compared. In order to further verify the impact of respiration, a plank phantom was used on different shifting value: 0, 0.5, 1.0, 1.5 and 2.0 cm, respectively. A square, round, or eUipse-shaped filed was used for irradiation and the distributions in different status were measured and compared with film dosimetry. Iso-dose line comparison, NAT(Normalized Agreement Tests) and γ comparison were used for the comparison of dose distributions. Fs can be an index to reflect the variability of the areas that surrounded by iso-dose lines. (FS90, FS50, FS25 delegates the ratio of the areas that surrounded by 90 %,50 %,25 % iso-dose hne in different situation respectively). Results (1) Compared with motionless situation, the FS90 in horizontal movement situation became small and the FS25 became large. As the displacement became larger, the FS90 became larger and the FS25 became smaller. FS in vertical movement situation, square and dumb bell fields changed while the others didn't have a change. (2)γ and NAT comparison: In the horizontal movement situation, compared with the static phantom, Pγ < 60 % and PNAT < 75 %. Under vertical movement situation, Pγ were less than 85 % for the square, round, dumb bell and female shaped fileds. In the plank phantom verification, Pγ and PNAT became smaller as the movement became larger. Conclusions The respiration can impact on the dose distribution within the target volume in radiotherapy, leading to a smaller area of higher dose level and an expanded area of lower dose level. The influence will become more significant with larger movement of the target.     

鼻咽癌照射野的探讨

鼻咽癌照射野的探讨崔书祥，王迎选，赵路军，孙洪森，吴佃久，陈国雄我院１９９０年１月～１９９１年６月收治鼻咽癌２２例，经ＣＴ或ＭＲＩ检查咽旁间隙受侵率为７７．１８％。将患者ＣＴ或ＭＲＴ图像输入放疗计划系统进行照射野分析，结果表明以往的常规耳前野仅对少数...     

分次大剂量全身照射后骨髓及胎肝移植治疗急性白血病

白血病经大剂量全身照射(以下简称TBI)后骨髓与胎肝移植(以下简称BMT、FLT)治疗技术发展很快,以往国内开展BMT与FLT均采用单次大剂量全身照射     

63例脑膜转移瘤临床分析

目的 探讨脑膜转移瘤(CM)的临床表现和治疗方法及其与预后关系.方法 回顾本院1998-2008年确诊的63例CM患者病历资料,分析其临床表现及不同治疗方式与预后关系.63例CM患者中原发灶以肺癌(65%)及乳腺癌(13%)多见.所有患者均经增强MRI检查,29例患者同时行腰穿检查.51例患者接受了全脑放疗、全身化疗和(或)鞘内化疗,其余12例患者单纯对症支持治疗.采用Kaplan-Meier法进行生存分析.结果 所有患者在随访期内全部死亡,随访率为95%,其中随访满1、2年者分别为59、56例.全组患者中位总生存期为2.2个月(0.1～24.4个月).确诊CM前临床分期(x2=6.68,P=0.036)及原发灶控制情况(x2=7.04,P=0.008)与生存明显相关.放疗剂量≥30 Gy者与未放疗者中位生存期分别为3.0个月(1.0～24.4个月)和1.8个月(0.1～14.2个月)(x2=5.54,P=0.019);放疗±化疗组、单纯化疗组及单纯对症治疗组中位生存期分别为3.0个月(0.5～24.4个月)、2.2个月(0.3～14.2个月)和1.2个月(0.1～4.5个月)(x2=9.32,P=0.009).结论 CM预后较差,CM前临床分期及原发灶控制情况与生存明显相关,足量放疗有望延长患者生存期,但尚需大样本临床研究证实.

Abstract：

Objective To analyze the clinical characteristics and the prognostic factors of carcinomatous meningitis(CM). Methods 63 patients with CM treated in Tianjin Medical University Cancer Institute and Hospital from 1998 to 2008 were reviewed retrospectively. The correlations between clinical characteristics, treatment modalities and the prognosis of CM were analyzed. The common primary site was lung cancer(65%)and breast cancer(13%). All the patients were underwent MRI scan and 29 of the patients received lumbar puncture. Fifty-one patients received whole brain radiotherapy, systemic and/or intrathecal chemotherapy. The other 12 patients only received supportive care. Kaplan-Meier method and Log-rank test were used for survival analysis. Results All patients died by the end of follow-up. The follow-up rate was 95%. The number of patients who undergone 1-,2 years follow-up were 59 and 56. The median survival time was 2. 2 months(range :0. 1 -24. 4 months)for the entire group. The clinical stage and the control status of the primary disease were strongly correlated with survival(x2 = 6. 68, P = 0. 036)and(x2 = 7.04, P = 0. 008). The median survival time was 3.0 months(range: 1.0 - 24. 4 months)in patients who received ≥30 Gy whole brain irradiation, while only 1.8 months(range:0. 1-14. 2 months)in those who did not receive radiotherapy(x2 =5.54,P =0. 019). The median survival time of radiotherapy ± chemotherapy group, chemotherapy only group and supportive treatment only group were 3.0 months (range :0. 5 - 24. 4 months), 2. 2 months(range :0. 3 - 14. 2 months)and 1. 2 months(range :0. 1 - 4.5 months), respectively(x2 = 9. 32, P = 0. 009). Conclusions The prognosis of CM is very poor. The clinical stage before the diagnosis of CM and the control status of primary disease and were significantly correlated with survival. Sufficient whole brain irradiation dose may prolong survival and worth further study in a large sample study.     

食管癌根治术后复发的治疗策略

  目的  探讨食管癌根治性切除术后复发患者的放射治疗策略和预后因素。  方法  回顾性分析病理确诊为食管癌且经R0切除后出现复发转移的66例患者,肿瘤中位复发时间10.6个月;50例患者局部区域复发,16例患者复发合并远处转移;全组患者中,单纯放疗10例,单纯化疗23例,放化联合治疗33例;联合放化疗组:先行化疗者22例,先行放疗者11例。放疗采用6MV-X线,中位放疗剂量60 Gy。  结果  全组患者1、2、3年生存率和中位生存时间分别为61.9%、25.9%、16.5%和14.3个月（95% CI=2.4~16.2个月）。三种治疗模式中单纯化疗、单纯放疗和联合放化疗的患者中位生存时间分别为11.4、25.5和14.3个月（P= 0.037）。复发合并远处转移的联合放化疗患者,先行化疗较先行放疗生存有获益（P=0.032）。单因素分析显示患者初治时的肿瘤分段、术式、复发是否合并转移、复发后治疗方式以及复发后是否放疗与患者预后相关（P < 0.05）。多因素分析显示患者初始治疗时的肿瘤分段为影响患者预后的独立因素（P < 0.01）。  结论  术前食管癌分段或许能提示复发的预后;对于有远处转移的患者,先行化疗后再放疗,对延长生存更有益。