不能手术食管癌三维放疗与同期放化疗生存比较

目的 不能手术食管癌采用三维放疗技术单纯放疗(RT)与同期放化疗(CCRT)的生存比较。方法 搜集2002—2012年间本院行根治性3DRT和CCRT食管鳞癌480例患者资料,采用倾向配比评分法配对后共296例患者入组,分析比较两组患者生存情况。结果 3DRT和CCRT组3、5年样本数分别为58、48例和58、52例。3DRT和CCRT组3、5年OS分别为32.6%、22.1%和35.1%、26.5%(P=0.463);PFS分别为27.8%、19.8%和30.7%、25.8%(P=0.637)。60~70 Gy亚组3DRT和CCRT的5年OS相近(25.6%和25.3%,P=0.833)、PFS相近(22.7%和25.2%,P=0.999),血道转移率相近(23.4%和24.1%,P=0.899)。50.0~59.9 Gy亚组CCRT 的5年OS和PFS高于3DRT (32.3%∶12.0%,P=0.030和24.1%∶10.6%,P=0.087);3DRT组中60~70 Gy亚组5年OS和PFS明显好于50.0~59.9 Gy亚组(P=0.024和0.041);CCRT组中2个亚组的OS和PFS相近(P=0.791和0.984)。CCRT组不良反应大于3DRT组(主要为食管炎和白细胞下降,P=0.000、0.005),但患者均能耐受。结论 不能手术食管癌患者采用3D放疗技术根治性同期放化疗时建议适当降低放疗剂量, 不能同期放化疗患者给予60~70 Gy放疗也能获得较好生存,但仍需要随机研究的结果证实。     

HCC术中放疗的安全性研究

目的 采用队列研究方法探讨IOERT在Ⅰ期HCC治疗中的安全性。方法 2010—2012年间初次病理诊断为Ⅰ期HCC的16例患者接受了IOERT。采用队列研究方法筛选同期行单纯根治术的87例Ⅰ期HCC患者,根据肿瘤大小(>5 cm与≤5 cm)及切缘情况(近切缘与切缘阴性)进行1∶2配对,共32例为对照组。评价两组患者术中、术后不良事件,反映肝功能的生化、凝血象及血常规等指标变化,以及与IOERT相关的不良反应。独立样本t检验组间差异。结果 IOERT组与对照组相比,手术时间明显延长[(275.4±71.55) min和(184.7±64.74) min,P=0.000],术中不良事件发生率稍高(18.75%和6.25%,P=1.000),手术并发症发生率稍低(12.50%和28.12%,P=0.460),围手术期死亡率分别为0和6%(P=0.440)。反映肝功能的实验室指标两组均相近(P>0.05),术后均降至1级或恢复正常。中位术后住院时间、外科住院时间、切口愈合时间及切口愈合级别两组也相似(P>0.05)。IOERT组无放射性肝炎发生。结论 IOERT作为早期HCC术后的辅助治疗,对术后康复及肝功能等无影响,IORT剂量15~16 Gy是安全可行的。     

218例食管癌根治术后复发再治疗的疗效分析

目的 分析食管癌根治术后复发挽救治疗的疗效,为综合治疗提供依据。 方法 回顾分析2004—2014年间食管癌R₀术后复发转移行挽救治疗的218患者资料。采用Kaplan-Meier法计算生存率并Logrank法检验和单因素预后分析,Cox模型多因素预后分析。 结果 全组患者复发后中位随访时间53个月。复发后1、3年OS率分别为57.2%、24.4%。163例局部区域复发患者复发后放化疗(40例),单纯放疗(106例),支持治疗(13例)的1、3年OS率分别为70%、42%,55%、24%,23%、8%(放化疗比单纯放疗 P=0.045,单纯放疗比支持治疗 P=0.004,单纯化疗无 1年生存)。单因素分析显示术后病理N分期、TNM分期、复发后治疗方式影响预后(P均=0.001),多因素分析中只有复发后治疗方式是影响生存的独立预后因素(P=0.013)。 结论 食管癌根治术后复发转移后采用放化疗或放疗挽救治疗有明显生存获益,特别是局部区域复发患者。     

非小细胞肺癌放疗后有症状放射性肺损伤临床特点分析

目的 分析非小细胞肺癌(NSCLC)患者放疗后发生有症状放射性肺损伤(SRILI)的临床特点。方法 回顾分析2000—2007年放疗的NSCLC患者治疗期间或随访中发生并在本院治疗的SRILI临床症状、体征、影像及血液学改变等。SRILI经2名放疗科和1名影像科医生根据不良反应常见术语标准3.0版进行诊断和分级。结果 81例SRILI患者纳入分析,其中2级 35例、3级 42例、4级 0例、5级 4例。自放疗开始SRILI症状出现时间中位数8.3周。SRILI症状主要为咳嗽(95%)、气短(69%)、发热(48%),最高体温中位数38.3℃。临床体征相对较少,常见为呼吸音粗糙(50%)。影像表现为放射野内肺实变、通气支气管征、斑片和条索影,少数出现在放射野外。血象改变为中性粒细胞比例稍高(中位数77.4%)。结论 SRILI出现在放疗开始后平均8.3周,临床特点表现为咳嗽、气短、发热、呼吸音粗糙,放射野内或少数野外实变、斑片、条索影,中性粒细胞比例稍高。     

154例广泛期小细胞肺癌治疗结果预后因素分析

Objective To investigate independent prognostic factors for overall survival (OS) in extensive disease small cell lung cancer (EDSCLC). Methods Between January 2003 and December 2006, 154 patients diagnosed with extensive stage small cell lung cancer were enrolled in this study.Prognostic factors such as gender, age, performance status, smoking history, weight loss, distant metastasis, the number of matastasis, brain metastasis, the cycle of chemotherapy and thoracic radiation therapy (TRT) for EDSCLC patients were evaluated by univariate and multivariate analysis. Results The median following-up time was 40. 5 months. The rate of follow-up was 92. 2%. The MST and overall survival rates at 3-year in smoking group and no-smoking group were 13 months, 11.8% and 17 months,22. 8%,respectively (χ2=3.40,P =0. 064);in ChT/TRT group and ChT group, they were 17. 2 months, 17.9%and 9.3 months,13.9%, respectively(χ2=10.47,P=0.001);and in the cycle of chemotherapy ≥4 group and ＜ 4 group, they were 16 months, 20. 1% and 9.3 months, 2. 9%, respectively (χ2=17.79,P=0. 000). By multivariate analysis, smoking history was a statistically significant unfavorable factor for OS in EDSCLC patients (versus no-smoking, hazard ratio (HR)=1.462, χ2=4.40, P=0.036). In addition, ≥4 cycles of chemotherapy and TRT were favorable prognostic factors ( ≥4 cycles vs ＜4 cycles, HR =0. 420,χ2 = 17. 17, P = 0. 000; ChT/TRT vs ChT, HR = 0. 634, χ2 = 6. 20, P = 0. 013). Conclusions Smoking is a independent unfavorable prognostic factor and ≥ 4 cycles of chemotherapy And TRT are independent favorable prognostic factors for OS in EDSCLC.     

肺癌锥形束CT图像不同配准方式的误差分析

Objective To analyze the influencing factors of cone-beam CT (CBCT) imagine registration in lung cancer. Methods From Mar. 2007 to Dec. 2007, 20 patients with lung cancer were treated with IGRT. The imagines of CBCT were collected from 6 to 19 fractions during the patients' radiotherapy. To compare the difference of set-up errors between the two groups according to the distance from the lesion in lung to the centrum. At the same time, CBCT imagines from the first, middle and the last fraction of these patients' radiotherapy were registrated in bone and grey methods by four doctors. The difference of set-up errors between different doctors and registrated methods were compared. Results The mean values of set-up errors were ＜2 mm in the two groups without significant difference (x:-1.31mm vs 0. 10 mm (t=0. 07,P=0.554);y:1.24 mm vs 1.37 mm (t=0. 05,P=0. 652);z: - 1.88mm vs -1.26mm (t= -0. 12,P=0.321)). The mean values of set-up errors were ＜ 1.3 mm in four doctors and registrated methods without significant difference, for bone registration,x: -0. 05 mm, -0. 01 mm,0. 05 mm, -0.12 mm and -1.31 mm ( F=-0.01,P=0.887) ;y:0.56 mm,0.35 mm,0.51 mm and 0.43 mm (F= -0.01,P=0.880);z: -1.16 mm, -1.20 mm, -0.88 mm and -1.03 mm (F= -0.04,P=0. 555 ), for grey registration ,x: -0.32 mm, -0.341 mm, -0.395 mm and - 0.37 mm(F=-0.01, P=0.874);y:0.34 mm,0.54 mm, -0.04 mm and 0.27 mm (F= -0.03,P=0.622);x:-1.12 mm,- 1.15 mm, - 1.13 mm and - 1.04 mm (F=0. 00,P=0. 812). Conclusions With the same registrated box and imagine quality, the location of the lesions in lung, registred methods and different doctors are not the influencing factors for CBCT imagine registration.     

腹部肿瘤术中电子线放疗安全性和急性副反应观察

目的 观察腹部肿瘤术中电子线放疗的安全性和急性副反应.方法 2008-2009年间行术中放疗的腹部肿瘤患者52例,其中乳腺癌14例,胰腺癌19例,宫颈癌3例,卵巢癌4例,肉瘤6例,其他肿瘤6种各1例.初治者37例,复发者15例.29例行根治手术,4例行姑息切除,19例行探查术.术中放疗采用Mobetron移动式术中电子线加速器,照射剂量9～18 Gy.观察术中及术后6个月内副反应,参照CTC3.0进行分级评估.结果 全组中位手术时间190 min,术后中位住院时间12 d,术后死亡2例.术后感染3例经处理后好转.中位拆线时间为术后13 d,53%创口达1级甲愈合.全组中位随访183 d,>3级副反应发生率为20%,其中最常见为血液系统,其次为腹痛.与术中放疗相关副反应发生率为1级28%,2级4%.结论 腹部肿瘤患者术中放疗略延长了拆线时间,但可承受;术中放疗安全性好,值得进一步推广.     

289例局部晚期非小细胞肺癌放疗和放化综合治疗结果

目的回顾性分析局部晚期非小细胞肺癌放疗和放化综合治疗结果。方法对随诊资料完整的289例局部晚期非小细胞肺癌患者纳入分析。其中鳞癌152例,腺癌74例,腺鳞癌2例,其他类型2例,分类不明癌24例,临床诊断35例;分期ⅢA 74例、ⅢB 215例;治疗方法包括单纯放疗(168例)、综合治疗(121例),综合治疗中同步放化疗24例、序贯化放疗78例(序贯或同步放化疗后巩固化疗38例)、放疗后化疗19例。结果1、3、5年总生存率、中位生存时间全组为45%、16%、8%、16.2个月,ⅢA期为57%、27%、11%、21.7个月,ⅢB期为41%、12%、7%、15.3个月。Logrank检验显示临床分期、KPS评分、肿瘤总体积、疗前血红蛋白水平、巩固化疗、放疗剂量、近期疗效等显著影响5年生存率和中位生存时间;放化综合组疗效略好于单纯放疗组,但差别无统计学意义。Cox多因素回归分析显示分期、巩固化疗为独立预后因素,KPS评分、近期疗效和放疗剂量对预后的影响处于统计学边沿水平。2级以上放射性食管炎和放射性肺炎发生率分别为24%和8%。失败原因包括胸腔内占41%、胸腔外占48%、胸内 胸外占11%,不同治疗组之间无差别。结论分期为ⅢA期、KPS>80、巩固化疗、较小肿瘤总体积、近期疗效(CR PR)的患者生存率较好。放化疗联合诱导治疗后巩固化疗的治疗模式可能是进一步改善疗效的方向。     

广泛期小细胞肺癌化疗后脑预防照射及颅外病变放疗的Ⅱ期临床研究

Objective To investigate the efficacy and safety of thoracic radiotherapy (TR) and prophylactic cranial irradiation (PCI) in patients with extensive small cell lung cancer (SCLC) who show response to chemotherapy. Methods From July 2010 to March 2012, 30 patients with a pathological or cytological diagnosis of extensive SCLC who showed response to 4-6 cycles of chemotherapy with carboplatin plus etoposide or chemotherapy with cisplatin plus etoposide were included in the study. The median age of patients was 57 years (range, 40-71 years). All the patients received TR (50-60 Gy) and PCI (25 Gy). The short-term efficacy was assessed by RECIST 1.1, and the toxicities were evaluated according to CTCAE 3.0 and RTOG radiation morbidity scoring criteria. Results Twenty-nine of the 30 patients completed the TR and PCI. Of these patients, 13% showed complete remission, 27% showed partial remission, and 60% showed stable disease, and the disease control rate was 100%. Progression was seen in 16 patients after effective treatment, including 1 patients with locoregional failure (LRF) alone and 15 patients with distant failure (DF)(9 patients with DF alone and 6 patients with locoregional and distant metastases, 4 patients with brain metastasis). The follow-up rate was 100%. The 1-year LRF rate and DF rate were 24% and 51%, respectively. The 1-year overall survival rate and disease-free survival rate were 71% and 37%, respectively. The acute toxicities included grade ≥2 hematological toxicity and grade ≥2 radiation esophagitis, which occurred in 33% and 13% of all patients. Conclusions TR and PCI have good short-term efficacy and safety in extensive SCLC patients with response to chemotherapy and can reduceDOI:10.3760/cma.j.issn.1004-4221.2013.05.007基金项目:北京希望马拉松专项基金(N2010-8)作者单位:100021 北京协和医学院中国医学科学院肿瘤医院肿瘤研究所放疗科(张文珏、周宗玫、陈东福、梁军、冯勤付、张红星、王小震、惠周光、肖泽芬、吕纪马、王绿化),内科(李峻岭)通信作者:周宗玫,Email:zhouzongmei2013@163.combrain metastases and local recurrence. However, further study is needed with a larger sample.     

胸段食管癌放疗四种体位固定方式对锁骨上区域动度的比较研究

目的：胸段食管癌放疗过程中,多数情况下使用胸腹平架进行体位固定。在放疗实施过程中,还要考虑到 手臂位置对射野设计的影响,以及手臂本身所受的辐射剂量。本研究意在探讨对胸段食管癌需要锁骨上联合纵隔 放疗时,不同体位固定方式对锁骨上区域动度和重复性的影响。方法：前瞻性入组 ８０例胸段食管癌患者,放疗野包 括纵隔和锁骨上区域。在 ＣＴ定位时,分别使用如下 ４种不同的固定方式,即胸腹平架固定上肢置于体侧、胸腹平架 固定双手上举、颈胸一体架固定手臂置于体侧和颈胸一体架固定双手上举。放疗期间第一周行 ５次锥形束 ＣＴ （ｃｏｎｅｂｅａｍＣＴ,ＣＢＣＴ）验证体位,之后每周行一次 ＣＢＣＴ验证。根据 ＣＢＣＴ图像评价四种体位固定方式的系统误差 和随机误差,以及胸锁关节和肩锁关节的位移误差。结果：ＣＢＣＴ数据结果显示四种固定方式对整体靶区（医生勾画 靶区）系统误差∑（个体病例误差平均值的标准差）和随机误差 σ（个体病例误差标准差的均方根）都小于 ０．５ｃｍ。 颈胸一体架上举组在 Ｚ、Ｒｘ、Ｒｚ方向的摆放误差小于胸腹平架上举组,在 Ｘ、Ｒｘ方向的摆放误差小于胸腹一体架体侧 组,在 Ｚ方向的摆放误差小于颈胸一体架体侧组,差异均有统计学意义（Ｐ＜０．０５）。对于肩锁关节空间位移,颈胸一 体架上举组（０．２１±０．１３）ｃｍ的肩锁关节动度的误差都小于胸腹平架体侧组（０．２４±０．１７）ｃｍ、胸腹平架上举组 （０．２８±０．１６）ｃｍ及颈胸一体架体侧组（０．２３±０．１３）ｃｍ。结论：对于胸段食管癌,采用颈胸一体架固定双臂上举置 于臂托架的体位,锁骨上区域摆位误差最小、重复性最优。