MRI in medical practice and its future use in radiation oncology. Resume of XXV GOCO Congress (Montpellier) 2017

This publication is a resume of the GOCO Congress (Montpellier 2017). A part of this congress was about the use of MRI in clinical practice, focused on the oncology field. The role of this tool was described in diagnosis, staging of tumors, evaluation of treatment response and the future use in prognostic and investigation (radiomics). After that, in the context of the present and future uses of MRI in radiation oncology, MRI guided radiotherapy was explained, as a method that allows an increased precision in image guided treatments. This publication is a resume of the GOCO Congress (Montpellier 2017). A part of this congress was about the use of MRI in clinical practice, focused on the oncology field. The role of this tool was described in diagnosis, staging of tumors, evaluation of treatment response and the future use in prognostic and investigation (radiomics).     

Analysis of a volumetric-modulated arc therapy (VMAT) single phase prostate template as a class solution

AimTo assess a class solution template for volumetric-modulated arc therapy (VMAT) for prostate cancer using plan analysis software.BackgroundVMAT is a development of intensity-modulated radiotherapy (IMRT) with potential advantages for the delivery of radiotherapy (RT) in prostate cancer. Class solutions are increasingly used for facilitating RT planning. Plan analysis software provides an objective tool for evaluating class solutions.Materials and methodsThe class solution for VMAT was based on the current static field IMRT template. The plans of 77 prostate cancer patients were evaluated using a set of in-house plan quality metrics (scores) (PlanIQ™, Sun Nuclear Corporation). The metrics compared the class solution for VMAT planning with the IMRT template and the delivered clinical plan (CP). Eight metrics were associated with target coverage and ten with organs-at-risk (OAR). Individual metrics were summed and the combined scores were subjected to non-parametric analysis. The low-dose wash for both static IMRT and VMAT plans were evaluated using 40 Gy and 25 Gy isodose volumes.ResultsVMAT plans were of equal or better quality than the IMRT template and CP for target coverage (combined score) and OAR combined score. The 40 Gy isodose volume was marginally higher with VMAT than IMRT (4.9%) but lower than CP (−6.6%)(P = 0.0074). The 25 Gy volume was significantly lower with VMAT than both IMRT (−32.7%) and CP (−34.4%)(P < 0.00001).ConclusionsAutomated VMAT planning for prostate cancer is feasible and the plans are equal to or better than the current IMRT class solution and the delivered clinical plan.     

11例恶性肿瘤继发性骨髓增生异常综合征病例分析

目的：分析恶性肿瘤继发骨髓增生异常综合征（MyelodysplasticSyndrome,MDS）病例资料,寻找肿瘤继发MDS关键致病因素,并为原发病治疗风险评估提供参考依据。方法：采用回顾性研究方法,查阅北京中医药大学东直门医院肿瘤血液科2007年1月．2012年4月MDS患者住院病例,区分原发、继发两种类型,并对继发性MDS病例资料进行综合分析。结果：按照MDS诊断标准,在明确诊断的75例患者中,原发性64例,肿瘤继发11例,占14．67％。11例患者均为中老年人群,其中,65岁以上老龄患者7例,占63．6％;70岁以上老龄患者5例,占45．45％。肿瘤继发MDS,尤其是老龄患者特征为严重合并症多,生存质量差,生存期短。致病原因有多方面因素,其中,放化疗联合应用可增加肿瘤继发MDS的风险性。结论：恶性肿瘤及其相关治疗易继发MDS,放化疗联合应用可增加其风险性;老龄患者继发MDS的机会明显增加,且预后不良。因此,对于老龄肿瘤患者要认真评估治疗受益和相关风险。     

利可君防治恶性肿瘤放疗所致骨髓抑制的疗效观察

目的：观察利可君片防治恶性肿瘤放疗所致骨髓抑制的疗效。方法：选择我院2010年6月至2012年6月收治的60例接受放疗的恶性肿瘤患者,将其随机分为对照组和观察组,每组各30例,对照组在出现骨髓抑制前对照组不服用任何升血药物,在出现骨髓抑制后给予吉赛欣静脉或皮下注射2～5μg/kg,1次每日;观察组患者放疗前1周开始口服利可君片20mg,3次每日,至放疗结束后2周。比较两组的疗效,骨髓抑制发生时间和发生率,血小板和白细胞水平。结果：两组的疾病控制率和有效率比较无明显差别（P〉0．05）;对照组和观察组骨髓抑制的发生率分别为60．0％和16．7％,观察组显著低于对照组（P〈0．05）;治疗后,观察组血小板和白细胞无明显改变,对照组与治疗前相比明显下降（P〈0．05）,且显著低于观察组（P〈0．05）。结论：利可君防治恶性肿瘤放疗所致骨髓抑制的疗效显著,值得临床推广。     

胸部肿瘤放射治疗的研究进展

随着物理学、计算机技术、影像学的发展,放射治疗方法在最近几十年也有了显著的进步与发展,而放疗技术是治疗癌症行之有效的方法。本文主要综述了胸部肿瘤的放射治疗最新的进展,其中包括乳腺癌、肺癌、食道癌和纵膈肿瘤的放射治疗。细胞对放射线的敏感性在分裂期最高,在DNA合成期其敏感性最低。放射疗法既不损伤周围正常组织,仅仅对异常增殖的癌肿给予大量的杀伤,同时机体又再次尽可能发挥最大的调节功能。伴随胸部肿瘤放疗技术的进步,对治疗这些肿瘤有非常重要的临床意义。     

Case presentation – A five-year survival of the patient with glioblastoma brain tumor

This paper presents an atypical case of a patient with brain tumor of the glioblastoma multiforme (GBM) type who achieved a 5-year survival. Some general information is provided including epidemiology, diagnostic and treatment procedures (surgery and radio-chemo-therapy), and prognosis of survival related to GBM. The course of the disease, including its main symptoms, individual reasons for the delay of adjuvant treatment, after the primary surgical treatment, 37-month period of the decease free survival, as well as comprehensive management after the tumor recurrence are also presented. Histopathology confirming the clinical diagnosis is discussed in a separate chapter.     

Analysis of the EBT3 Gafchromic film irradiated with 6 MV photons and 6 MeV electrons using reflective mode scanners

We explore in our study the effects of electrons and X-rays irradiations on the newest version of the Gafchromic EBT3 film. Experiments are performed using the Varian “TrueBeam 1.6” medical accelerator delivering 6 MV X-ray photons and 6 MeV electron beams as desired. The main interest is to compare the responses of EBT3 films exposed to two separate beams of electrons and photons, for radiation doses ranging up to 500 cGy. The analysis is done on a flatbed EPSON 10000 XL scanner and cross checked on a HP Scanjet 4850 scanner. Both scanners are used in reflection mode taking into account landscape and portrait scanning positions. After thorough verifications, the reflective scanning method can be used on EBT3 as an economic alternative to the transmission method which was also one of the goals of this study. A comparison is also done between single scan configuration including all samples in a single A4 (HP) or A3 (EPSON) format area and multiple scan procedure where each sample is scanned separately on its own. The images analyses are done using the ImageJ software. Results show significant influence of the scanning configuration but no significant differences between electron and photon irradiations for both single and multiple scan configurations. In conclusion, the film provides a reliable relative dose measurement method for electrons and photons irradiations in the medical field applications.     

放射加博宁治疗骨转移癌的病例分析

目的:观察放疗和博宁对骨转移癌的止痛效果。方法:对100例骨转移癌患者进行回顾性分析,单纯放疗30例,博宁加放疗14例,博宁加放化疗56例。结果:全组总有效率为89%,显效率达51%。各组有效率:单放组为83-3%,博宁加放疗组为92.9%,博宁加放化组为91.1%。三组间止痛效果无显著性差异(P>0.05)。在应用博宁治疗组中有一例出现类似过敏反应症状,其他无明显毒副反应发生。结论:放射治疗骨转移癌止痛迅速而有效。博宁治疗骨转移癌止痛效果明显,尤其适合应用于多发性骨转移癌患者。二者联合应用效果更加。     

乳腺癌术后放疗联合复方苦参注射液的临床效果观察

目的:分析乳腺癌术后放疗联合复方苦参注射液的临床治疗效果。方法:选取2013年3月至2016年3月我院收治的乳腺癌患者83例,本次治疗前均接受保乳及前哨淋巴结活检术以及5周期的辅助化疗。将患者随机分为对照组42例和观察组41例,对照组患者给予单纯术后放疗治疗,观察组给予患者术后放疗联合复方苦参注射液治疗。比较两组患者治疗前后的血清CA125、CA153及CA724,及CD3~+、CD4~+、CD8~+、CD4~+/CD8~+及NK细胞水平,以及不良反应的发生情况。结果:治疗后,两组的血清CA125、CA153及CA724水平均明显降低,且观察组显著低于对照组,差异具有统计学意义(P0.05)。观察组的CD3~+、CD4~+、CD8~+、CD4~+/CD8~+及NK细胞数较治疗前明显改善,观察组的CD3~+、CD4~+、CD4~+/CD8~+及NK细胞数显著高于对照组,CD8~+显著低于对照组,差异具有统计学意义(P0.05)。治疗期间,观察组患者的II度以上皮肤反应、骨髓抑制的发生率均显著低于对照组,差异具有统计学意义(P0.05)。结论:乳腺癌术后放疗联合复方苦参注射液治疗可显著增强机体的细胞免疫功能,且安全性更高。