鼻咽癌双侧茎突后区受侵放疗计划改进

针对常规方案为茎突后区补量不合理之处,提出改进方案,探讨如何在脊髓、晶体等敏感器官不超过耐受剂量的同时,满足茎突后区的剂量要求,以期提高鼻咽癌的局部控制率.选择双侧茎突后区受侵的局部晚期鼻咽低分化鳞癌病人1例,在常规方案照射至50Gy后.施行三维适形放射治疗,着重讨论在后程三维推量阶段如何设置照射野及分配剩余的20Gy;计划评价工具为剂量-体积直方图统计表并考察茎突后区剂量.鼻咽层面、颅底及以上层面剂量分布满意,90%以上等剂量曲线包绕大部分靶区,茎突后区剂量考察点所受剂量为6405cGv,正常组织剂量没有超过最大限值.该方案可以提高靶区覆盖度,对茎突后区剂量有明显改善.     

CT/MRI影像融合对鼻咽癌肿瘤靶区及三维适形治疗影响

背景与目的：精确地勾画鼻咽癌肿瘤靶区是制定最佳治疗计划、降低肿瘤的局部复发率和保护周围正常重要器官的首要条件．本研究的目的是比较CT和MRI来源的鼻咽癌肿瘤靶区，评价CT—MRI融合靶区容积应用于三维适形放射治疗时，对治疗剂量的影响．方法：收集8位患者的CT模拟定位和MRI扫描的图像，然后在CT、MRI和CT／MRI融合网像上分别勾画肿瘤靶区和周围重要的器官每个病例都做2个治疗计划：①用CT图像上的靶区做1个三维适形放射治疗计划；②用CT／MRI融合图像上的靶区做1个三维适形放射治疗计划。肿瘤的处方剂量为70Gy。然后，比较2个治疗计划中肿瘤靶区的95％容积（1395）受照平均剂量、周围正常组织的5％容积（D5）受照平均剂量。结果：MRI上的肿瘤靶区比CT上的肿瘤靶区大53．5％。但并不一定包括CT上的肿瘤靶区。用CT上勾画的靶区做三维适形放射治疗计划，剂量分布是满意的，但以上治疗计划应用于CT／MRI融合图像上的靶区，D95的剂量分布较低（59．78Gy）。用CT／MRI融合图像上勾画的靶区做三维适形放射治疗计划，则D95剂量分布较好，但在有些治疗计划上周围重要器官的剂量分布较高：结论：CT／MRI融合图像有助于鼻咽癌靶区的确定，但也造成GTV扩大，在三维适形放射治疗计划上的肿瘤靶区剂量分布足够，但周围重要器官的受照剂量提高。鼻咽癌的治疗方案有待于进一步改进。     

鼻咽癌三维适形放疗30例疗效分析

目的：探讨三维适形放疗治疗鼻咽癌的疗效。方法：选择自2005年收治的30例鼻咽癌患者,其中初次治疗18例,不规则面颈联合等中心照射50Gy/25F/35d＋颈部锁骨上野50Gy/25F/35d,体部真空垫、头部U形面膜固定后CT扫描,靶区勾画及计划设计,三维适形放射治疗,鼻咽部肿瘤靶区剂量为。复发癌12例,肿瘤复发区域三维适形放射治疗,靶区剂量60-70Gy/24-28F/35-40d。结果：初次治疗患者1、2、3年局控率分别为88.89%、83.33%、77.78%。1、2、3年生存率分别为94.44%、88.89%、83.33%。出现口干、咽痛等早期放射反应,都能耐受,未观察到明显的张口困难或后组颅神经损伤。复发癌患者再程放疗2年局控率为75.0%,2年生存率为83.33%。放射损伤包括听力丧失8.33%（1/12,张口困难16.67%（2/12）,吞咽困难8.33%（1/12）。结论：三维适形放射治疗能改善鼻咽癌治疗靶区的剂量分布,提高靶区照射剂量,进而提高肿瘤的局部控制率,同时减少靶区周围正常组织的受照剂量,减少放射并发症。     

立体定向放射治疗:提高鼻咽癌局部控制的有效方法

放射治疗是鼻咽癌首选和主要的治疗方法,其控制率与放疗剂量呈正相关。鼻咽癌放疗后局部复发是失败原因之一。立体定向放射治疗(stereotactic radiotherapy,SRT)具有高精度、高剂量体积适形于靶区、高治疗增益比以及靶周正常组织照射少的特点,适合作为鼻咽癌残留病灶推量照射。尽管各家报道的SRT推量分割方案不一,但结果均显示对有病灶残存的患者给予高剂量照射能提高局部控制率。肿瘤侵及颈鞘血管、海绵窦以及瘤体大伴有坏死是推量照射的禁忌证;老年患者和合并高血压、糖尿病、鼻咽部严重感染者是推量照射的相对禁忌证。对紧邻血管神经的靶区采用SRT比立体定向放射外科(stereotactic radiosurgery,SRS)更有利降低晚期损伤。采用SRT作为鼻咽癌残留病灶推量照射有肯定的临床价值。选择合适病例、个体化的剂量分割方案、综合把握肿瘤消退和正常组织修复的平衡关系,能使患者获得满意的疗效和较高的生存质量并能提高晚期患者生存率。     

肺癌不同放射治疗技术剂量学比较研究

目的：应用三维治疗计划系统评价肺癌不同的照射方法，以明确肺癌三维适形放射治疗的优势。方法：选用13例ⅢA、ⅢB期非小细胞肺癌病例，采用Cadplan 6.0.8三维治疗计划系统设计放射治疗计划，每例均做3个计划，分别为常规、常规加适形和适形放射治疗计划，计划的总剂量均为66Gy。用剂量体积直方图（DVH）比较靶区剂量和正常组织的受照射剂量的差异。结果：3种治疗计划均能满足靶区剂量要求，剂量变化差异无显著性意义。常规、常规加适形和适形放射治疗计划的照射适形指数分别为0．13、0．24和0．35；全肺接受≥20Gy照射的体积百分比的均数分别为32％、26％、34％和22％；心脏平均剂量的均数分别为18．15和12Gy。结论：肺癌常规放射治疗设野方法基本能满足靶区的剂量学要求，然而正常组织的受照剂量明显高于其他2种治疗计划。三维适形放射治疗的主要优势在于减少正常组织的受照剂量。     

鼻咽癌局部复发三维适形放射治疗的临床研究

随着电子计算机技术和医学影像技术的快速发展,放射治疗已由常规放疗发展成为三维适形放疗.三维适形放疗技术大大改善了肿瘤靶区与周围正常组织和器官之间的剂量关系,且定位准确.我们应用三维适形放疗技术治疗局部复发性鼻咽癌25例,以探讨三维适形放射治疗的价值.     

肝癌三维适形放疗设野方法的研究

目的：探讨肝癌三维适形放射治疗照射野的设计方法。方法：利用上海拓能（Topslane）公司的三维治疗计划系统对112例肝癌患者，根据医生要求的CTV和周围的敏感器官限制受量，进行三维适形放射治疗计划设计，结合剂量曲线分布情况和剂量体积直方图（DVH）选择最佳治疗方案。结果：以肿瘤中心点为剂量归一点，80％～90％的剂量线均能包绕靶区体积，而周围正常组织受量都在理想的范围内。结论：对肝癌的三维治疗计划设计时，要根据病人不同的病变部位采取不同的设野方法，这样能使靶区剂量分布均匀，适形度好，同时也有效地保护了敏感器官，从而提高肿瘤剂量及肿瘤局部控制率。     

鼻咽癌后程三维适形放疗正向计划的设计及优化

目的：探讨鼻咽癌后程三维适形放射治疗正向计划的设计及优化方法。方法：随机选取20例鼻咽癌后程加量的患者,在PROWESS PANTHER计划系统上进行三维适形放射治疗正向计划的设计及优化,通过射野数目、射野方向、射野权重因子的合理设定及选择,结合DVH图和剂量曲线分布情况选择最优方案。结果：分析患者的DVH图,显示各靶区均能达到较好的剂量曲线分布,在给予靶区致死剂量的同时,周围危及器官受量都在其耐受剂量范围内。结论：在没有开展调强放疗技术的单位,根据鼻咽癌患者病变侵犯情况,选择合适的射野进行三维适形放疗正向计划设计及优化,也能得到符合临床要求的较佳的治疗计划,从而可提高鼻咽癌局部控制率,有效保护危及器官,提高病人的生存质量。     

调强放射治疗的临床应用现状与存在的问题

随着计算机技术和放射治疗计划系统的飞速发展，放射治疗技术日新月异，相继出现了三维适形放射治疗(threedimensional radiotherapy，3D-CRT)和调强放射治疗(intensity modulated radiotherapy，IMRT)。3D-CRT的目的是使放射治疗的三维高剂量分布与靶区的三维形状一致，以保护靶区周围的正常组织。然而，对于形状特殊的肿瘤，传统的3D-CRT无法实现三维高剂量分布与靶区的三维形状一致，     

复发期鼻咽癌的再程治疗:调强放射治疗技术的实施及展望

外放射治疗是局部复发性鼻咽癌再程治疗的主要手段.不同的放疗技术,如常规放疗、立体定向放疗、近距离治疗、三维适形放疗、调强适形放疗各有其特点.调强适形放疗作为革命性的新技术,在复发鼻咽癌的治疗中发挥其独特的优势,既能提高肿瘤靶区的剂量同时又能减少鼻咽周围正常组织的照射剂量,从而提高治疗增益比,值得大力推广和应用.     

Oncogénétique et psycho-oncologie, une collaboration recommandée...

Résumé: La possibilité depuis 1994, de connaître la probabilité individuelle de développer certains cancers a permis de proposer de nouvelles modalités de prévention, de traitements et contribué au développement actuel de loncogénétique. Une meilleure connaissance des répercussions psychologiques tant pour les patients que pour les apparentés est désormais possible et limplication des psycho-oncologues dans ce cadre de la réalisation des tests prédictifs, recommandée. La mission de «messager» qui incombe au «cas-index» doit faire lobjet dune attention particulière. La complexité de linformation et la dimension paradoxale que peut avoir parfois la communication à propos des choix, rend difficile lévaluation de la qualité du consentement. La situation particulièrement délicate dune aide à la décision à légard de la chirurgie prophylactique, exige une collaboration étroite des généticiens et des psycho-oncologues.Les soins de support en oncologie     

The role of papillomaviruses in human cancers

This review comprehensively evaluates the influence of gene-gene, gene-environment and multiple interactions on the risk of colorectal cancer (CRC). Methods of studying these interactions and their limitations have been discussed herein. There is a need to develop biomarkers of exposure and of risk that are sensitive, specific, present in the pathway of the disease, and that have been clinically tested for routine use. The influence of inherited variation (polymorphism) in several genes has been discussed in this review; however, due to study limitations and confounders, it is difficult to conclude which ones are associated with the highest risk (either individually or in combination with environmental factors) to CRC. The majority of the sporadic cancer is believed to be due to modification of mutation risk by other genetic and/or environmental factors. Micronutrient deficiency may explain the association between low consumption of fruit/vegetables and CRC in human studies. Mitochondrial modulation by dietary factors influences the balance between cell renewal and death critical in colon mucosal homeostasis. Both genetic and epigenetic interactions are intricately dependent on each other, and collectively influence the process of colorectal tumorigenesis. The genetic and environmental interactions present a good prospect and a challenge for prevention strategies for CRC because they support the view that this highly prevalent cancer is preventable.     

Antifungal combination therapy in localized candidosis

A mouse model of localized candidosis in air-filled subcutaneous cysts imitating thrush has been developed. We have now tested various antifungal combinations in this animal model. Flucytosine (5-FC) + amphotericin B (Amph B) showed the highest efficacy, a clear additive or even synergistic effect was seen. The combination of 5-FC + imidazole or triazole derivative was less efficacious, an additive effect was rare. The combination of 5-FC + Amph B was also tested against Candida albicans strains showing various degrees of 5-FC-resistance. A significant reduction in 5-FC-resistant mutants was seen after the treatment with the combination.     

Les génériques en cancérologie: à molécule identique, médicaments identiques? Les biosimilaires, des super-génériques?

Résumé: Les biosimilaires vont bientôt voir leur apparition en Europe. Comment un laboratoire peut-il aborder le développement de son dossier dAMM? Quelles sont les bases légales et les recommandations officielles? Comment la similarité et/ou le caractère générique peuvent-ils être démontrés? Les règles sont-elles identiques à celles des produits chimiques conventionnels pour lesquels, notamment en cancérologie, il existe des médicaments génériques? Comment faire pour que la sécurité et lefficacité des médicaments biosimilaires soient assurées pour les patients?     

Cancer immunotherapy

Unprecedented progress has seen made in the last decade in the field of cancer immunotherapy. The recent approval of nivolumab （Opdivo）, the first anti-programmed cell death-1 （PD-1） antibody, for metastatic melanoma in Japan, marked a milestone in the rapidly advancing field of cancer immunotherapy. Nivolumab together with ipilimumab （Yervoy）, the anti-cytotoxic T-lymphocyte-associated antigen-4 （CTLA-4） antibody, are the first 2 drugs in the class of ＂immune checkpoint inhibitors＂ that have delivered impressive responses in patients with metastatic melanoma and renal cell cancer （RCC） as well as a variety of solid tumors.     

Effect of tumor therapeutic irradiation on the mechanical properties of teeth tissue

Tumor irradiation of the head-neck area is accompanied by the development of a so-called radiation caries in the treated patients. In spite of conservative therapeutic measures, the process results in tooth destruction. The present study investigated the effects of irradiation on the demineralization and remineralization of the dental tissue. For this purpose, retained third molars were prepared and assigned either to a test group, which was exposed to fractional irradiation up to 60 Gy, or to a non-irradiated control group. Irradiated and non-irradiated teeth were then demineralized using acidic hydroxyl-cellulose gel; afterwards the teeth were remineralized using either Bifluorid12 or elmex gelee. The nanoindentation technique was used to measure the mechanical properties, hardness and elasticity, of the teeth in each of the conditions. The values were compared to the non-irradiated control group. Irradiation decreased dramatically the mechanical parameters of enamel and dentine. In nonirradiated teeth, demineralization had nearly the same effects of irradiation on the mechanical properties. In irradiated teeth, the effects of demineralization were negligible in comparison to non-irradiated teeth. Remineralization with Bifluorid12 or elmex gelee led to a partial improvement of the mechanical properties of the teeth. The enamel was more positively affected by remineralization than the dentine.     

Consultation multidisciplinaire pour les patients atteints d’une pathologie tumorale (carcinome infiltrant ou lésion précancéreuse) liée à HPV : la consultation multidisciplinaire papillomavirus

Given the recent increase in the number of human papillomavirus (HPV)-induced cancers in other locations than gynaecological, the number of patients with two cancers at distinct sites, and because of the lack of exhaustive data, we decided to create a multidisciplinary network around an HPV consultation at the Georges-Pompidou European Hospital (HEGP). This network aims to set up the best tools for detecting HPV-associated “multisite” precancerous lesions in order to determine the possible impact of dedicated care for this at-risk population. This monthly consultation was created at the HEGP in June 2014. It is currently organized around five consultations: gynaecological, ENT, urological, digestive and immunological. Every patient who has been diagnosed with HPV-related cancer and whose care is provided at the HEGP is offered this particular follow-up: systematically, once the initial lesion has been treated, the patient is convened annually for a day during which it benefits from the consultations mentioned above. A consultation with a psychologist is systematically proposed. Local samples are taken at each site: a cytological examination, the analysis of known predictive and prognostic virological markers are carried out. This study fits more broadly in a theme of clinical and fundamental research around cancers related to HPV.     

Differentiation state and invasiveness of human breast cancer cell lines

Summary Eighteen breast cancer cell lines were examined for expression of markers of epithelial and fibroblastic differentiation: E-cadherin, desmoplakins, ZO-1, vimentin, keratin and ₁ and ₄ integrins. The cell lines were distributed along a spectrum of differentiation from epithelial to fibroblastic phenotypes. The most well-differentiated, epithelioid cell lines contained proteins characteristic of desmosomal, adherens and tight junctions, were adherent to one another on plastic and in the basement membrane matrix Matrigel and were keratin-positive and vimentin-negative. These cell lines were all weakly invasive in anin vitro chemoinvasion assay. The most poorly-differentiated, fibroblastic cell lines were E-cadherin-, desmoplakin- and ZO-1-negative and formed branching structures in Matrigel. They were vimentin-positive, contained only low levels of keratins and were highly invasive in thein vitro chemoinvasion assay. Of all of the markers analyzed, vimentin expression correlated best within vitro invasive ability and fibroblastic differentiation. In a cell line with unstable expression of vimentin, T47D_CO, the cells that were invasive were of the fibroblastic type. The differentiation markers described here may be useful for analysis of clinical specimens and could potentially provide a more precise measure of differentiation grade yielding more power for predicting prognosis.