DWI在前列腺癌放疗疗效评估中的价值

目的：观察前列腺癌放疗前后ADC值的变化特点,探讨扩散加权成像（DwI）在前列腺癌疗效评估中的价值。方法：41例经直肠腔内超声导引下穿刺证实为前列腺外周带腺癌的患者在放疗前1个月和放疗后3个月内行DWI检查。放疗前后分别测量外周带肿瘤阳性侧和阴性侧的ADC值。所有患者均进行随访。对复发组及控制组放疗前及放疗后的ADC值、腺癌阳性侧与阴性侧放疗前及放疗后的ADC值进行t检验。结果：肿瘤阳性侧放疗前ADC值为（1.26±0．19）×10^-3mm2／s,放疗后为（1．43±0．13）×10^-3mm2／s;阴性侧放疗前ADC值为（1．54±0．20）×10^-3mm2／s,放疗后为（1．46±0．12）×10^-3mm2／s。阳性侧与阴性侧放疗前差异有统计学意义（P〈0．001）,放疗后差异无统计学意义（P=0．14）。6例患者复发（复发组）,35例控制良好（控制组）。放疗前复发组ADC值为（1．23±0．22）×10^-3mm2／s,控制组为（1．27±0．18）×10^-3mm2／s,两者差异无统计学意义（P=0．30）;放疗后复发组ADc值为（1．35±0．10）×10^-3 mm2／s,控制组为（1.45±0．12）×10^-3mm2／s,两者差异有统计学意义（P〈0．001）。结论：前列腺癌放疗后ADC呈升高趋势,控制组ADC值增高程度明显高于复发组,提示DWI在监测前列腺癌放疗效果、早期评估预后方面有潜在应用价值。     

放疗在前列腺癌治疗中的应用

随着放疗技术的进步,前列腺癌的放疗研究不断深入。本文介绍了三维适形放疗,强适形放疗以及配合粒植入、热疗、内分泌治疗等提高局部控制率和生存率的研究进展。另外,对前列腺癌的放射治疗原则与适应证也作了简要讨论。     

磁共振DWI在前列腺癌诊断中的应用价值

<正> 前列腺癌在西方国家男性恶性肿瘤的发病率和病死率均居于前列,既往认为国内发病率较低,近年来随着我国老龄人群的增加和生活方式的改变,其发病率呈明显增高趋势,其预后及治疗主要取决于早期诊断和准确的术前分期,正确处理的情况下前列腺癌的死亡率相对较低。临床对前列腺癌的筛查主要靠直肠指诊和血清前列腺特异性抗原,对癌的确诊需经超声引导下穿刺活检。临床检查尤其是     

MR扩散加权成像在评价前列腺癌内分泌治疗中的应用价值

目的探讨内分泌治疗前后前列腺外周带癌区和非癌区的表观扩散系数（ADC）值的变化情况。方法对经手术病理或穿刺活检证实的14例前列腺癌和18例内分泌治疗6个月以上的前列腺癌患者行MR扩散加权成像（DWI）。依病理结果，将前列腺6分区归类为癌区和非癌区，测量每个分区的ADC值，同时测量每例膀胱、闭孔内肌的ADC值，对2组的结果进行比较。结果未治疗组14例癌区和非癌区的ADC值分别为（1．22±0．25）×10^-3、（1．59±0．19）×10^-3mm^2／s，差异有统计学意义（t=7．03，P〈0．01）。经内分泌治疗后的18例癌区的ADC值升高至（1．46±0．30）×10^-3mm^2／s，非癌区的ADC值为（1．59±0．24）×10^-3mm^2／s，癌区和非癌区之间ADC值差异有统计学意义（t=2．46，P〈0．05）。两组癌区之间ADC值差异有统计学意义（t=4．66，P〈0．01），非癌区、膀胱、闭孔内肌的ADC值差异无统计学意义（t值分别为0．06、0．48、1．64，P值均〉0．05）。结论ADC值用于判断前列腺癌内分泌治疗效果有应用前景。     

基于MRI的前列腺癌放疗中标志物手动辨识与定位评价

目的 评价基于MRI的前列腺癌放疗中黄金基准标志物（GFM）手动辨识和定位方法的效能。 方法 纳入2019年6月至2021年6月于唐山市人民医院接受治疗的16例前列腺癌患者进行前瞻性研究,年龄（58.5±4.1）岁,每例患者均置入了3枚GFM后接受放疗定位CT扫描,然后采用单独序列（SS）法和组合序列（CS）法对所有患者进行MRI检查。由5名放疗医师分别对2种序列法获得的所有图像进行GFM手动辨识和定位。计算单个GFM中心（CsGFM）坐标均值和3枚GFM空间质心（CmGFM）坐标均值,并采用Bland-Altman分析法分别评价2种序列法定位的一致性。通过与CT定位比较并计算GFM的标志物间距（IMD）,评价2种序列法定位的准确度,组间比较采用配对样本t检验。 结果 SS法GFM辨识阳性率为79.17%（38/48）,CS法为93.75%（45/48）。（1）一致性结果。SS法中,每名放疗医师计算的GFM中心坐标同所有GFM的CsGFM坐标均值在左右、头脚、腹背3个方向上的95%一致性界限（LoA）范围分别为−1.46~0.97 mm、−1.06~1.73 mm、−1.96~1.12 mm;CS法中分别为−0.79~1.09 mm、0.10~1.47 mm、−0.87~1.40 mm。SS法中,每名放疗医师计算的3枚GFM空间质心坐标同所有患者的CmGFM坐标均值在左右、头脚、腹背3个方向上的95%LoA范围分别为−1.38~0.94 mm、−1.60~1.07 mm、−1.07~1.75 mm;CS法中分别为−0.57~0.76 mm、−0.71~0.98 mm、−1.16~0.76 mm。（2）准确度结果。与CT定位比较,SS法中IMD为（0.59±0.39） mm,显著大于CS法中的（0.32±0.17） mm,且差异有统计学意义（t=−1.89,P=0.027）。 结论 基于MRI的2种GFM手动辨识和定位方法的效能均可满足临床要求,其中CS法GFM手动辨识的阳性率、定位一致性和准确度均优于SS法。     

扩散峰度成像在前列腺癌诊断中的应用价值

【摘要】目的:探讨扩散峰度成像( DKI)在鉴别前列腺癌与非癌组织（包括良性前列腺增生和正常组织）中的价值。方法：搜集经病理证实的61例前列腺疾病患者的病例资料,包括前列腺癌患者37例（均行前列腺根治切除术）和前列腺增生患者24例（均行经直肠12针穿刺活检）。所有患者均行3.0T常规MRI及10个b值（0、50、100、250、500、750、1000、1500、2000、2500s/mm2）的单次激发EPI扫描,通过DKI模型计算平均扩散系数(MD)和平均峰度(MK)参数图,分别测量前列腺癌组织、中央叶及移行带非癌组织、外周带非癌组织的MD、MK值,比较各组织间的差异,并进行ROC曲线分析,计算MD、MK值诊断前列腺癌的敏感度及特异度。结果：前列腺癌患者的癌组织、中央叶和移行带非癌组织、外周带非癌组织三者之间的MD值、MK值差异均有统计学意义（P<0.001）;MD值、MK值在鉴别诊断前列腺癌与非癌组织中具有较高的敏感度和特异度,当MD、MK界值分别为1.617×10-3mm2/s、0.736×10-3mm2/s时,诊断前列腺癌的敏感度和特异度分别为96.8％、91.6%和95.8％、99.1%,曲线下面积分别为0.993和0.983。结论：DKI模型能较好地反映前列腺癌与非癌组织结构的差异,在前列腺癌诊断中具有较高的临床应用价值。     

高剂量率近距离放射治疗前列腺癌

高剂量率近距离放射治疗是根治前列腺癌的重要治疗手段之一，是近年来前列腺癌治疗领域的研究热点。着重介绍了高剂量率近距离放射治疗前列腺癌的原理，目前所采用的治疗技术，临床应用研究及其未来发展方向。     

评价MRI在前列腺癌包膜外侵犯诊断中的应用价值

目的探讨常规MRI对于前列腺癌包膜外侵犯（ECE）的诊断价值。方法搜集经前列腺癌根治手术病理证实的29例前列腺癌患者的术前MRI资料，通过与病理结果对照，回顾性分析常规MRI对于前列腺癌ECE诊断的准确性。结果29例手术病理证实的前列腺癌中9例有ECE（31．0％）。MRI诊断ECE的敏感性为3／9，特异性为90％（18／20），阳性预测值为3／5，阴性预测值为75％（18／24），总的诊断符合率为72．4％（21／29）。结论常规MRI诊断前列腺癌ECE的特异性较高，但敏感性低。     

MR扩散张量成像在前列腺癌诊断中的价值

目的 探讨MR DTI在前列腺癌诊断中的价值.方法 回顾性分析2009年10月至2010年12月期间,临床怀疑为前列腺癌且行MR常规检查及DTI扫描的44例患者的资料.病理证实为前列腺癌16例、良性前列腺增生28例.采用t检验比较前列腺癌、良性前列腺增生患者间各向异性分数(FA)值及ADC值的差异,采用ROC曲线分析FA值及ADC值对前列腺癌诊断效能,并初步确定前列腺癌FA值及ADC值诊断阈值.结果 前列腺癌区和良性前列腺增生的FA值分别为0.308±0.084和0.203±0.029,ADC值分别为(0.883±0.192)×10-3和( 1.408±0.130)×10-3mm2/s,差异均有统计学意义(￡值分别为4.833和10.779,P值均＜0.01).ROC曲线上,ADC曲线下面积为0.996(95％可信区间为0.984～1.007),FA值曲线下面积为0.904(95％可信区间为0.812～0.996),FA值联合ADC值的曲线下面积为0.996(95％可信区间为0.984～1.007).ADC值阈值为0.725×10-3mm2/s,敏感度为100.0％,特异度为96.0％;FA值阈值为0.311,敏感度为100.0％,特异度为68.7％.结论 DTI成像能为前列腺癌诊断及鉴别诊断提供有价值的信息,有助于提高对前列腺癌的诊断能力.     

放射性核素标记铃蟾肽在前列腺癌诊治中的研究进展

前列腺癌等多种肿瘤细胞表面能过度表达铃蟾肽受体,因此,铃蟾肽及其受体可以作为靶点进行放射性核素受体显像及靶向治疗肿瘤,并成为近年来诊治前列腺癌的研究热点.该文综述了放射性核素标记铃蟾肽在前列腺癌显像及治疗方面的研究进展.     

鼻咽癌放射治疗后脑干放射性损伤的MRI表现

目的探讨鼻咽癌放射治疗后脑干放射性损伤的ＭＲＩ表现。方法分析５１例鼻咽癌经放射治疗后，脑干放射性损伤的ＭＲＩ自旋回波Ｔ１ＷＩ及超快速自旋回波Ｔ２ＷＩ和增强后Ｔ１ＷＩ表现及临床表现。结果脑干放射性损伤的临床表现为肢体麻木、无力或瘫痪及颅神经损伤症状。ＭＲＩ显示中脑、脑桥和延髓内呈斑片状改变分别为２、７及３例；脑桥基底部广泛受累９例；脑桥基底部下份及延髓前上份者３０例。自旋回波Ｔ１ＷＩ病灶均呈低或等信号改变；超快速自旋回波Ｔ２ＷＩ呈等、高信号混杂改变，脑桥水平病灶内高信号呈横行条纹状。增强后扫描显示病灶区无强化者９例，斑点状强化者３例及不规则花环状强化者３９例。占位效应与病灶的大小不相称。１４例经治疗后ＭＲＩ复查，４例病灶消失，８例病灶形态及位置无变化，２例病灶增大。结论ＭＲＩ可显示脑干放射性脑病特征；临床症状与ＭＲＩ追踪表现可不完全一致     

前列腺癌放射治疗进展

现代计算机技术推动医学影像技术高速发展,高水平的图像技术又推动放射治疗计划系统进入到更复杂、更高水平。放射治疗计划的设计由原来的二维图像和人工计算发展到了X射线图像和复杂的计算机运算。在治疗过程中,由于肿瘤代谢、抗原的差别,已经考虑到其与正常组织不同的生物学变量,使执行治疗计划时更加精确,如摆位误差、器官运动等已被全面系统地考虑,故又称四维放射治疗。     

Localized prostate cancer with intermediate- or high-risk features treated with combined external beam radiotherapy and iodine-125 seed brachytherapy

ObjectiveThe aim of the study is to compare the results of the combined external beam radiotherapy (EBRT) with iodine-125 seed brachytherapy vs. brachytherapy alone for prostate cancer treatment in patients with intermediate and high risk of disease recurrence.Methods and MaterialsNinety-six patients were treated from January 1998 to December 2006. Twenty-four patients received combined treatment and 72 patients received brachytherapy alone. Patients were classified into intermediate or high risk of recurrence according to the D’Amico’s classification. The prescribed dose for brachytherapy was 145 Gy as monotherapy and 110 Gy for combined treatment. The dose of EBRT was 45 Gy over 5 weeks, with 1.8 Gy daily fractions. Results were analyzed based on Phoenix definition of biochemical recurrence, that is, nadir plus 2 ng/mL.ResultsBiochemical control was achieved by 96% (23 of 24) of patients receiving combined treatment and by 72% (52 of 72) in the group treated by brachytherapy alone (p < 0.015). The addition of EBRT resulted in a 94% biochemical disease-free survival at 5 years; and in brachytherapy alone group, the rate was 54% (p < 0.011). Mean followup was 96 months (24–132 months; confidence interval 95%: 90–102).ConclusionThis study shows that in patients with localized prostate cancer, with intermediate and high risk of biochemical recurrence, the addition of EBRT can confer a significant biochemical control advantage when added to brachytherapy.     

Declining use of brachytherapy for the treatment of prostate cancer

PurposeTo analyze the recent trends in the utilization of external beam radiation therapy (EBRT) and brachytherapy (BT) for the treatment of prostate cancer.Methods and MaterialsUsing the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all patients diagnosed with localized prostate adenocarcinoma between 2004 and 2009 who were treated with radiation as local therapy. We evaluated the utilization of BT, EBRT, and combination BT + EBRT by the year of diagnosis and performed a multivariable analysis to determine the predictors of BT as treatment choice.ResultsBetween 2004 and 2009, EBRT monotherapy use increased from 55.8% to 62.0%, whereas all BT use correspondingly decreased from 44.2% to 38.0% (BT-only use decreased from 30.4% to 25.6%, whereas BT + EBRT use decreased from 13.8% to 12.3%). The decline of BT utilization differed by patient race, SEER registry, median county income, and National Comprehensive Cancer Network risk categorization (all p < 0.001), but not by patient age (p = 0.763) or marital status (p = 0.193). Multivariable analysis found that age, race, marital status, SEER registry, median county income, and National Comprehensive Cancer Network risk category were independent predictors of BT as treatment choice (all p < 0.001). Moreover, after controlling for all available patient and tumor characteristics, there was decreasing utilization of BT with increasing year of diagnosis (odds ratio for BT = 0.920, 95% confidence interval: 0.911–0.929, p < 0.001).ConclusionsOur analysis reveals decreasing utilization of BT for prostate cancer. This finding has significant implications in terms of national health care expenditure.     

Patient-reported health-related quality of life outcomes after HDR brachytherapy between small (<60 cc) and large (≥60 cc) prostate glands

PURPOSE

Patients with large prostate glands are underrepresented in clinical trials incorporating brachytherapy due to concerns for excessive toxicity. We sought to compare health-related quality of life (HRQOL) outcomes between small (<60 cc) and large (≥60 cc) prostates treated with high-dose-rate brachytherapy (HDR-B).

Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy

PURPOSE: The importance of the quality of life (QOL) and mental condition of patients being treated for cancer is now recognized. In this study, we evaluated QOL and mental condition in patients with cancer before and after radiotherapy. MATERIALS AND METHODS: The subjects were 170 patients who had undergone radiotherapy. The examination of QOL was performed using the quality of life questionnaire for cancer patients treated with anticancer drugs (QOL-ACD), and mental condition (anxiety and depression) was examined using the hospital anxiety and depression scale (HADS). These examinations were performed at the start of radiotherapy and immediately after radiotherapy. RESULTS: The QOL score was slightly higher in all patients after the completion of radiotherapy than before the start of radiotherapy. In the palliative radiotherapy group, QOL score was significantly improved by treatment. Anxiety and depression were improved after radiotherapy. There was a correlation between the degrees of improvement of the HADS and QOL score. CONCLUSION: We could treat cancer patients by radiotherapy without reducing their QOL, and improvement in QOL was significant in the palliative radiotherapy group. Mental condition was also improved after radiotherapy.     

Quality of life up to 10 years after external beam radiotherapy and/or brachytherapy for prostate cancer

PurposeThe aim of this study was to evaluate quality-of-life changes up to 10 years following three different radiotherapy concepts.Methods and MaterialsIn the years 2000–2003, 295 patients were treated with external beam radiotherapy (EBRT; n = 135; 70.2 Gy in 1.8 Gy fractions), low-dose-rate brachytherapy (LDR-BT with I-125; n = 94; 145 Gy), and high-dose-rate brachytherapy (HDR-BT with Ir-192; n = 66; 18 Gy in two fractions using 4–6 needles) as a boost to EBRT (50.4 Gy in 1.8 Gy fractions). Quality of life was assessed using the Expanded Prostate Cancer Index Composite at median time of 2, 6, and 10 years after treatment.ResultsThe urinary function score 2 years after EBRT (mean 93 points) was significantly higher in comparison to HDR-BT + EBRT (80 points, higher doses to the urethra relevant) and LDR-BT (88 points). After 10 years, only HDR-BT + EBRT (75 points) remained worse (LDR-BT 92 points; EBRT 91 points). Urinary incontinence score decreased from 83 to 76 points in the HDR-BT + EBRT group. No significant differences or changes resulted in the bowel domain. The mean sexual function score (i.e., sexuality score) was significantly higher after LDR-BT versus HDR-BT + EBRT and EBRT (30 vs. 19 and 24 points after 2 years and 25 vs. 13 and 15 points after 10 years, respectively)—a lower patient age and a lower percentage with hormonal treatment need to be considered.ConclusionApart from decreasing sexual function for all patients, decreasing urinary scores were found in the HDR-BT + EBRT group predominantly as a result of increasing incontinence. This study demonstrates the need for optimum BT treatment planning.     

鼻咽癌放疗后放射性脑病及生活质量研究

目的分析广东地区鼻咽癌放疗后放射性脑病（radiation encephalopathy，RE）的临床和影像学特点，并对放射性脑病患者生存质量的变化及其影响因素进行研究。方法分析89例RE患者的临床资料，采用世界卫生组织生存质量量表简表（WHOQOL-BREF）、LENT／SOMA放射性损伤评估量表对33例RE患者（病例组）和34例疗程匹配的鼻咽癌放疗后无放射性脑病患者（对照组）进行评定，系统分析放射性脑病患者生存质量的变化、影响因素及与神经系统症状的相关性。结果二程放疗后6个月内RE的发生率较一程放疗者差异有统计学意义；首发症状以球麻痹症状（33例，37．07％）最常见；病例组在社会关系、总的健康和总的生活评分方面低于对照组（P〈0．05）；二程放疗者较一程放疗者在总的健康评分、总的生活评分、生理因素和心理因素评分低（P〈0．05）。球麻痹症状与生活质量心理因素、总的生活和健康评分呈负相关（P〈0．05），头痛、神经功能障碍也分别与生活质量等的评分呈负相关。结论再程放疗后放射性脑损伤出现的潜伏期明显缩短。除环境因素外，放射性脑病对生命质量的其他方面存在一定的负性影响。球麻痹症状的存在对生存质量产生了较大的负性影响。     

Magnetic resonance imaging (MRI) anatomy of the prostate and application of MRI in radiotherapy planning

Radiotherapy planning for prostate carcinoma has traditionally been performed on computed tomography (CT)-images, on which both the high dose areas (prostate with or without seminal vesicles) as well as the low dose areas (surrounding structures, such as the rectum and bladder) are anatomically delineated. However, magnetic resonance imaging (MRI) provides much more information than CT; it can superbly demonstrate the internal prostatic anatomy, prostatic margins and the extent of prostatic tumours. Hence, MRI becomes a powerful tool to improve the accuracy of planning delineations in radiotherapy for prostate carcinoma and is rapidly gaining popularity in the radiotherapy community. The present paper reviews some important anatomical landmarks and acquisition protocols relevant to radiotherapy planning and explains the rationale and importance of close collaboration between radiotherapists and radiologists in optimizing radiotherapy for patients with prostate carcinoma.