131例颈部转移癌热疗加放疗和单纯放疗近期疗效观察

我科1992年6月～1998年7月,对68例颈部转移癌灶行热疗加放疗(ＨＴ ＲＴ),并与我科同期63例颈部转移癌单纯放疗(ＲＴ)临床效果进行比较,以探索加热放射治疗颈部转移癌的价值。1　临床资料11　病例选择全组病例均经病理组织学证实为颈部转移癌,肿瘤直径0.8～1.0ｃｍ,未用或停用化疗、内分泌治疗及其他抗肿瘤药(针对颈部转移癌)达4周以上,治疗期间仅行升白支持治疗,预期生存期2～3个月以上,年龄11～84岁,中位年龄48岁,随机分组,加热放射组原发癌包括鼻咽癌24例,肺癌19例,喉癌17例,甲状腺癌6例,下咽癌2例;单纯放射组原发癌包括鼻咽癌23例,肺癌19…     

热疗加放疗治疗盆腔恶性肿瘤的临床热剂量学研究

目的采用温度当量分(TEM42．5℃)作为热剂量单位,评价其与肿瘤缓解率之间的关系,找出适合临床应用的热剂量单位。方法对49例复发或转移的盆腔恶性肿瘤患者采用热疗(放疗后30min热疗,每次热疗40～60min,2次／周)联合放疗(1．8～2．OGy／次,1次／d,5次／周),并用高电阻铅测温针在肿瘤中心部位单点连续测温。以TEM42．5℃作为热剂量单位。结果49例患者中,完全缓解(CR)14例,部分缓解(PR)21例,无缓解(NR)14例。肿瘤缓解(CR PR)率和TEM42．5℃,放疗剂量呈明显正相关;肿瘤体积和热疗次数,与肿瘤缓解率无相关性。结论TEM42．5℃和放疗剂量,与肿瘤缓解率呈明显正相关,可作为肿瘤热疗联合放疗时的热剂量单位。     

恶性肿瘤患者超声热疗护理

超声热疗合并放疗、化疗是目前临床治疗恶性肿瘤的新方法之一。据文献报导 ,放疗、化疗半小时内配合超声热疗可提高肿瘤对放、化疗的敏感性和肿瘤的控制率 ［１］。我院自１９９６年至今已治疗恶性肿瘤３７例 ,总有效率达９６．２% ,现将护理体会作如下介绍。１临床资料和护理方法１．１一般资料本组患者３７例 ,男２０例 ,女１７例 ,年龄１８岁～７８岁 ,平均年龄５１．１岁。头颈部肿瘤／或转移癌２１例 ,四肢皮肤肿瘤６例 ,胸部体表肿瘤和／或转移癌４例 ,直肠肛管肿瘤３例 ,神经内分泌瘤２例 ,膀胱瘤１例。肿瘤大小为２．５ｃｍ～１３ｃ…     

248例恶性肿瘤微波热疗近期疗效报告

为观察微波热疗对恶性肿瘤的疗效，１９９１年９月至１９９４年１２月，对２４８例晚期恶性肿瘤进行微波加热配合放疗和化疗或单独热疗的临床观察。加温是采用９１５ＭＨｚ微波治疗机进行。全组近期总有效率６８．１％（１６９／２４８），单纯热疗有效率６４．５％（６０／９３），放疗加热疗有效率６９．１％（９４／１３６），化疗加热疗有效率６０．０％（３／５），热疗加放疗加化疗有效率８５．７％（１２／１４）。     

放疗联合热疗治疗难治性复发性盆腔恶性肿瘤的疗效及安全性

目的 探讨放疗联合热疗治疗难治性复发性盆腔恶性肿瘤的疗效及安全性.方法 选取66例难治性复发性盆腔恶性肿瘤,根据治疗方式分为观察组(n=34)和对照组(n=32),对照组患者给予放疗,观察组患者给予放疗联合盆腔部位热疗.比较两组患者的临床疗效、生活质量[肿瘤患者生活质量量表(QOL)]、不良反应和远期生存率.结果 观察...     

恶性肿瘤患者超声热疗护理

超声热疗合并放疗、化疗是目前临床治疗恶性肿瘤的新方法之一.据文献报导,放疗、化疗半小时内配合超声热疗可提高肿瘤对放、化疗的敏感性和肿瘤的控制率[1].我院自1996年至今已治疗恶性肿瘤37例,总有效率达96.2%,现将护理体会作如下介绍.     

热疗加放疗治疗局部复发乳腺癌的疗效分析

目的评价热疗加放疗治疗局部复发乳腺癌的疗效.方法回顾性分析热疗加放疗治疗的85处病灶,其中39处病灶曾接受过放疗,未曾放疗的部位给予59.5±6.8 Gy(40～70 Gy)照射,曾放疗的病灶实施43.0±12.4 Gy(12～74.4 Gy)照射;热疗每周1次或1周2次,平均每例患者的热疗次数为4.5(2～9)次.结果治疗1个月后CR率为92.0%,过去未曾放疗的病灶CR率为47.1%(16/34),曾放疗过病灶的CR率为56.1%(23/41),虽然曾放疗组的剂量(43.0±12.4 Gy)明显低于未放疗组的剂量(59.5±6.8 Gy),但两组间CR率差异无显著性(P=0.40).治疗后4周时弥散/多发型病变较肿块/结节型病变的CR率高,而6个月后弥散/多发型的局部控制率却明显降低.结论局部热疗配合放疗可以提高复发乳腺癌的局部控制率,特别是对曾经接受过放疗的区域可以降低放疗的剂量.弥散/多发型肿块较肿块/结节型的病灶对治疗的反应较早,但是很容易在短时期内复发.     

热疗并用放疗治疗鼻咽癌110例的近期疗效

热疗并用放疗治疗鼻咽癌１１０例的近期疗效广西玉林地区红十字会医院张奕敬，庞伟，柒斌加温有杀伤肿瘤细胞的作用，合并放射治疗具有协同杀灭肿瘤细胞的互补作用。１９９０年１１月至１９９２年１２月，我院采用热疗并用放疗的综合治疗方法，治疗鼻咽癌１１０例，取得了...     

超声引导下射频热疗联合适形放疗治疗肝癌的近远期疗效

目的：探讨超声引导下射频热疗联合适形放疗治疗肝癌的近远期疗效。方法：连续收集我院2012年3月至2014年3月收治的80例肝癌患者的临床资料,患者均经临床表现、影像、生化检查及病理确诊为原发性肝癌。该研究取得我院伦理委员会通过及患者、家属的知情同意权后,依据随机数字表法将患者分为对照组和观察组,每组40例。对照组给予单纯适形放疗,观察组在对照组的基础上联合使用超声引导下射频热疗,对两组患者近期及远期疗效进行比较和分析。结果：两组患者治疗前胆红素、白蛋白、ALT 和 PT 水平比较,差异均无统计学意义（P ＞0．05）;治疗后两组患者的胆红素、ALT 和 PT 水平均降低,且试验组降低的更明显,白蛋白水平均升高,且试验组升高的更明显,差异均有统计学意义（P ＜0．05）。观察组患者的总有效率显著高于对照组,差异有统计学意义（P ＜0．05）。随访发现,观察组患者6个月和1年的肿瘤复发率及患者的病死率均显著低于对照组,差异均有统计学意义（P ＜0．05）。结论：超声引导下射频热疗联合适形放疗治疗肝癌近远期效果显著,有效降低了放疗对肝脏的损害,患者耐受度较高,提高了患者远期生存率。     

Treatment of malignant brain tumors with focused ultrasound hyperthermia and radiation: results of a phase I trial

Summary Hyperthermia delivered by scanned focused ultrasound was combined with external beam radiation to treat 15 patients with primary malignant tumors of the brain. A preliminary craniectomy was performed to avoid attenuation of the ultrasound beam by the skull, and multiple thermal sensors were employed to ascertain intratumoral temperatures. The target temperature was 42.5°C at the tumor boundary. This was attained at more than one point during every complete treatment, while a mean temperature in excess of 42°C was achieved within the scanned tumor volume during at least 1 treatment in 11 patients. Technical problems and toxicities are described.     

放射治疗联合免疫疗法治疗恶性肿瘤的相关机制与研究进展

放射治疗能通过诱导 DNA 损伤杀伤照射野内的肿瘤细胞,也能激活机体免疫系统。放疗可促进肿瘤相关抗原释放、激活树突状细胞并促进肿瘤相关抗原的呈递、增加肿瘤浸润淋巴细胞,刺激免疫系统阻止肿瘤的复发和（或）转移。一些研究已证实放疗与免疫治疗联合可发挥协同抗肿瘤效应。本文就放疗与免疫治疗联合应用抗肿瘤的相关机制及最新研究进展做一综述。     

三维适形放疗联合微波热疗治疗颈部淋巴结转移癌的疗效观察

目的：观察三维适形放疗配合微波热疗对颈部淋巴结转移性癌的治疗效果。方法：对55例来源于鼻咽癌、喉癌、食管癌及肺癌的颈部淋巴结转移性癌,分为微波热疗＋三维适形放疗组30例及单纯三维适形放疗组25例,放疗总量60-70Gy/30-35次;6次/周;微波热疗3次/周,随访3个月,观察疗效。结果：两组患者全部完成治疗计划。微波热疗＋三维适形放疗组患者在治疗结束时颈部肿块完全消退23例（76.7%）,单纯三维适形放疗组患者为7例（35.0%）,两组比较差异有统计学意义（P〈0.05）。随访结束时微波热疗＋三维适形放疗组患者颈部肿块完全消退25例（83.3%）,单纯三维适形放疗组为15例（60.0%）,两组比较差异有统计学意义（P〈0.05）。无明显不良反应。结论：三维适形放疗联合微波热疗对治疗颈部淋巴结转移性癌疗效良好。     

三维适形放疗联合微波热疗治疗颈部淋巴结转移癌的疗效观察

目的:观察三维适形放疗配合微波热疗对颈部淋巴结转移性癌的治疗效果。方法:对55例来源于鼻咽癌、喉癌、食管癌及肺癌的颈部淋巴结转移性癌,分为微波热疗+三维适形放疗组30例及单纯三维适形放疗组25例,放疗总量60-70Gy/30-35次;6次/周;微波热疗3次/周,随访3个月,观察疗效。结果:两组患者全部完成治疗计划。微波热疗+三维适形放疗组患者在治疗结束时颈部肿块完全消退23例(76.7%),单纯三维适形放疗组患者为7例(35.0%),两组比较差异有统计学意义(P<0.05)。随访结束时微波热疗+三维适形放疗组患者颈部肿块完全消退25例(83.3%),单纯三维适形放疗组为15例(60.0%),两组比较差异有统计学意义(P<0.05)。无明显不良反应。结论:三维适形放疗联合微波热疗对治疗颈部淋巴结转移性癌疗效良好。     

三维适形放疗联合内生场热疗治疗腹部肿瘤的临床观察

目的探讨三维适形放疗联合内生场热疗治疗腹部肿瘤的临床疗效及不良反应。方法 42例腹部肿瘤患者,随机分为对照组和实验组,对照组给予局部三维适形放疗D_T(50～60)Gy/(25～30)次;实验组在放疗的同时,给予内生场热疗,每周2次,共治疗6～12次。观察疗效及不良反应。结果全组42例患者均顺利完成治疗,近期疗效:对照组总有效率(CR+PR)为61.9%,实验组总有效率(CR+PR)为90.5%,两组间统计学差异显著(P0.05)。远期疗效:对照组的1、2、3年生存率分别为76.2%、39.6%和14.2%,中位生存时间(OS)为21.810个月,中位无进展生存时间(PFS)为17.286个月;实验组的1、2、3年生存率分别为90.5%、61.9%和23.8%,中位OS为26.810个月,中位PFS为21.587个月。实验组的生存率及无进展生存时间均高于对照组,但两组间差异无统计学意义(P0.05)。两组间不良反应无明显差异。结论三维适形放疗联合内生场热疗能提高腹部肿瘤的局部控制率,且显示较单纯放疗能延长OS及PFS的优势,同时不良反应轻微,值得临床推广应用。     

Determination of the temperature artifact during ultrasound hyperthermia

Temperature artifacts produced by very small uncoated thermocouples during ultrasonic heating are evaluated by backward extrapolation of the linear portion of the temperature rise curve or by backward extrapolation of the exponential portion of the temperature decay curve. The accuracy of these techniques for larger clinically used thermocouples is investigated by use of a two-dimensional model of the bioheat equation which simulates the transfer of heat radially from a probe 1 mm in diameter. The accuracy of these techniques is found to depend upon the perfusion rate. In the absence of perfusion, both extrapolation techniques underestimate the artifact by nearly 40%. Extrapolation of the temperature rise curve is very sensitive to the perfusion rate and this technique results in errors exceeding 100% when the perfusion rate is high. Extrapolation of the temperature decay curve produces more consistent results. Over a blood flow range of 0–100 ml/100 g per min, the artifact is underestimated by an amount that varies from approximately 40% to 30% respectively. Thus, the artifact can be determined to within 5% by this technique by increasing the extrapolated value by 35%.     

Morphologic and morphometric studies on tumor necrosis produced by radiotherapy, and hyperthermia singly and in combination

The purpose of the present study was to evaluate the therapeutic effects of hyperthermia associated with radiotherapy on neoplasia. Two transplanted experimental tumors (undifferentiated carcinoma of mouse breast and sarcoma 37) were used. A protocol was followed that included, for both models, four groups of animals: 1) control group; 2) radiotherapy group; 3) hyperthermia group; 4) radiotherapy associated with hyperthermia group. The animals were sacrificed after therapy according to a different schedule for each type of tumor. The morphology of the neoplasia in every group of treated tumors was compared with that of the control group. For quantitative evaluation of the necrosis, we studied the ratio of the tumor necrotic areas (N) to a tumor standard area (T). From the results obtained, the following conclusions were made: 1) Necrosis produced by combined treatment was significantly greater than that obtained by using one only; 2) necrosis appeared early after treatment and remained relatively unchanged; 3) The damaging effect of the hyperthermia occurred earlier than that produced by radiotherapy when these methods were used separately, thus suggesting distinct mechanisms of tumor necrosis.     

Non-invasive estimation of hyperthermia temperatures with ultrasound

Ultrasound is an attractive modality for temperature monitoring because it is non-ionizing, convenient, inexpensive and has relatively simple signal processing requirements. This modality may be useful for temperature estimation if a temperature-dependent ultrasonic parameter can be identified, measured and calibrated. The most prominent methods for using ultrasound as a non-invasive thermometer exploit either (1) echo shifts due to changes in tissue thermal expansion and speed of sound (SOS), (2) variation in the attenuation coefficient or (3) change in backscattered energy from tissue inhomogeneities. The use of echo shifts has received the most attention in the last decade. By tracking scattering volumes and measuring the time shift of received echoes, investigators have been able to predict the temperature from a region of interest both theoretically and experimentally in phantoms, in isolated tissue regions in vitro and preliminary in vivo studies. A limitation of this method for general temperature monitoring is that prior knowledge of both SOS and thermal-expansion coefficients is necessary. Acoustic attenuation is dependent on temperature, but with significant changes occurring only at temperatures above 50°C, which may lead to its use in thermal ablation therapies. Minimal change in attenuation, however, below this temperature range reduces its attractiveness for use in clinical hyperthermia. Models and measurements of the change in backscattered energy suggest that, over the clinical hyperthermia temperature range, changes in backscattered energy are dependent on the properties of individual scatterers or scattering regions. Calibration of the backscattered energy from different tissue regions is an important goal of this approach. All methods must be able to cope with motion of the image features on which temperature estimates are based. A crucial step in identifying a viable ultrasonic approach to temperature estimation is its performance during in vivo tests.     

微波深部热疗加同步放化疗治疗中晚期宫颈癌的临床效果

目的:评价微波深部热疗在中晚期巨块型宫颈癌治疗中的疗效及安全性。方法:将经放化疗和放化热疗治疗的100例Ⅱb-Ⅲb期、肿瘤直径大于4cm的巨块型宫颈癌患者各50例,分为对照组和实验组。对照组放化疗:外照射均采用6MV-X加速器调强放射治疗+192铱高剂量率后装腔内照射,同步顺铂40mg/m2,静点,每周1次,与外照射同步结束。实验组:放化疗与对照组相同,另加局部体外热疗,温度为(40±1)℃,60分/次,2次/周,共10次。治疗结束后1个月复查相关检查,进行疗效评价。结果:实验组达到CR者92%(46/50),对照组达到CR者仅78%(39/50),肿瘤缩小率实验组明显高于对照组,差异有统计学意义(χ2=4.201, P＜0.039)。结论:深部热疗联合同步放化疗是治疗中晚期宫颈癌、特别是巨块型宫颈癌的一种安全有效的方法,具有临床推广价值。