益脾养肝方联合TACE、3DCRT治疗原发性肝癌的临床观察

目的探讨益脾养肝方联合TACE、3DCRT治疗原发性肝癌的临床观察。方法将2019年1月—2020年6月在医院治疗的102例原发性肝癌患者随机分为两组,对照组使用肝动脉化疗栓塞术(TACE)及三维适形放疗(3DCRT)治疗,在此基础上,观察组使用益脾养肝方治疗,对比两组的近期疗效、中医证候积分、T淋巴细胞亚群、肝功能指标、肿瘤大小及AFP水平、1年生存率及复发率。结果观察组治疗有效率为47.06%、临床控制率为80.39%,明显高于对照组的23.53%、62.75%(P<0.05);观察组治疗后胁痛、脘闷、腹胀、神疲乏力、纳差等中医证候积分明显低于对照组(P<0.05),但在发热、痞块等中医证候积分上无明显差异(P>0.05);观察组治疗后CD_(3)^(+)、CD_(3)^(+)CD_(4)^(+)明显高于对照组(P<0.05),而CD_(3)^(+)CD_(8)^(+)相比无明显差异(P>0.05);观察组治疗后ALT、AST水平明显低于对照组,ALB水平明显高于对照组(P<0.05),而TBIL水平无明显差异(P>0.05);观察组治疗后肿瘤直径、AFP明显低于对照组(P<0.05);观察组1年生存率明显高于对照组,复发率明显低于对照组(P<0.05)。结论益脾养肝方联合TACE、3DCRT治疗原发性肝癌的临床疗效显著,能明显减轻中医证候,改善免疫功能及肝功能,降低AFP水平,缩小瘤体,在一定程度上提高1年生存率,降低复发率,具有积极的临床意义。

益脾养肝方联合TACE、3DCRT治疗原发性肝癌疗效观察

目的:观察和评价益脾养肝方联合TACE和3DCRT治疗原发性肝癌的临床疗效。方法:51例原发性肝癌患者随机分为治疗组(26例),给予中药益脾养肝方联合TACE及3DCRT治疗;对照组(25例),给予TACE和3DCRT治疗。两组疗程35~42 d(根据3DCRT治疗时间而变化)。观察和比较两组病例在治疗前后中医证候、实体瘤大小、细胞免疫功能、肝功能、生存率等方面的相关指标并进行统计分析。结果:经治疗后,治疗组中医疗效总有效率88.0%,对照组中医疗效总有效率32.0%,两组比较有显著性差异(P<0.05)。治疗组在中医证候改善,CD3+、CD3+CD4+变化,降低ALT、AST等方面优于对照组,差异有统计学意义(P<0.05)。治疗组在实体瘤大小改变、生存率等方面均优于对照组,但差异无统计学意义(P>0.05﹚。结论:益脾养肝方联合TACE和3DCRT治疗原发性肝癌,可以明显改善患者临床症状、改善生化指标、提高患者生活质量,且安全可靠。

胰腺癌3DCRT联合化疗的疗效分析

目的:观察三维适形放射治疗(3 dimensional conformal radiotherapy,3DCRT)联合化疗治疗胰腺癌的临床疗效。方法:回顾分析我院自2006年1月至2011年6月收治的60例胰腺癌患者。治疗组28例,于化疗第1天行3DCRT,每周期第1、8、21、29天静滴吉西他滨(GEM)1000mg/m2,草酸铂130mg/m2,静脉滴注。对照组32例,给予每周期第1、8、21、29天静滴GEM 1 000mg/m2,草酸铂130mg/m2,静脉滴注。比较两组治疗完成情况、临床疗效、毒副反应及生存情况。结果:治疗组治疗完成率89.29%,对照组治疗完成率93.75%,两组在统计学上差异无显著性意义(P>0.05);两组总有效率分别为25.0%与3.1%(P<0.05)。两组毒副反应主要为血小板减少(28.6%,21.9%),白细胞下降(39.3%,31.3%),胃肠道反应(82.1%,75.0%)以及肝功能变化(10.7%,9.4%),两组毒副反应发生率比较,差异无统计学意义(P>0.05);治疗组与对照组在6个月生存率(82.1%,53.1%)、12个月生存率(46.4%,21.9%)及中位生存期(11.2个月,7.6个月)比较,差异具有统计学显著性意义(P<0.05)。结论:3DCRT+吉西他宾+草酸铂治疗胰腺癌疗效确切,可减轻临床症状。

肝硬化Child-Pugh A 级原发性肝癌患者大分割3DCRT后放射性肝病发生的剂量因素的预测

在中国和其他亚洲国家，原发性肝癌（primary livercarcinoma，PLC）是一种很常见的肿瘤，然而大多数PLC患者在确诊时已失去了手术治疗机会。白上世纪中期以来，放射治疗作为一种姑息性的治疗手段在PLC的治疗中逐渐得到广泛应用，特别是近20年，随着三维适形放射治疗（three-dimensional conformal radiotherapy，3DCRT）的应用，PLC治疗的疗效显著提高，2年生存率可达33％～41％，已逐渐成为不能手术的中晚期PLC首选治疗方式。

3DCRT联合紫杉醇加顺铂同步化疗治疗Ⅲ期NSCLC的临床疗效及安全性分析

目的分析3DCRT联合紫杉醇加顺铂同步放化疗治疗Ⅲ期NSCLC的临床疗效及安全性。方法选取Ⅲ期NSCLC患者65例分为2组:试验组33例,对照组32例。对照组单纯进行放疗,放疗总量为60~70 Gy,1.8~2.5Gy·d-1,每周5次,疗程为6~7周。试验组在对照组的治疗基础上给予紫杉醇注射液135 mg/m2配比500 m L质量浓度为0.045 g/m L的生理盐水加顺铂75 mg/m2配比质量浓度为0.008 g/m L的氯化钠静脉滴注,在化疗第1周、第4周静脉滴注,治疗后按实体瘤的疗效评价标准对疗效进行客观评价,再依据抗癌药物毒副作用标准对患者安全性进行分析。结果试验组治疗总有效率为88.6%,显著高于对照组的72.3%,差异有统计学意义(P<0.05)。2组均出现白细胞、血小板和血红蛋白减少,恶心呕吐,关节疼痛等不良反应,试验组Ⅲ~Ⅳ级不良反应的发生率高于对照组,2组差异有统计学意义(P<0.05)。3年内试验组生存率显著高于对照组(P<0.05)。结论 3DCRT联合紫杉醇加顺铂同步放化疗治疗Ⅲ期NSCLC相对比单纯放疗,有效率更高,但其不良反应情况更严重,选取治疗方案时应该充分考虑患者的安全性。

基于3DCRT、IMRT、VMAT三种放疗技术的宫颈癌剂量分布比较

目的:对比三维适形放疗(3DCRT)、不同射野数目调强适形放疗(IMRT)、容积弧形调强放疗(VMAT)三种不同放疗技术在宫颈癌根治术后计划靶体积(PTV)以及危及器官(OAR)保护方面的差异。方法:取宫颈癌根治术的60例患者,所有患者均拟行术后盆腔外照射治疗,分别制定4野3DCRT、5野7野9野IMRT、5野VMAT放疗计划,处方剂量为50Gy,对比不同放疗计划靶区分布均匀度以及适形度、危及器官受照体积等指标。结果:5F-IMRT、7F-IMRT、9F-IMRT PTV剂量分布均匀性明显优于3DCRT(P<0.05),但与VMAT比较无显著差异(P>0.05);不同放疗计划比较中7F-IMRT与9F-IMRT的适形度最理想,其次为5F-IMRT、VMAT、3DCRT;IMRT、VMAT高剂量区对直肠、膀胱、小肠的保护作用明显强于3DCRT,而VMAT在20Gy条件下对小肠的保护作用略次于7F-IMRT、9F-IMRT,但VMAT对直肠、膀胱的保护作用与IMRT比较无显著差异(P>0.05);VMAT在机器跳数、治疗时间中较IMRT、VMAT具有显著优势(P<0.05)。结论:在不同放疗技术的宫颈癌剂量分布中发现,VMAT、IMRT具有良好的适形度以及危及器官保护能力,并且PTV分布均匀度也较为理,同时VMAT还可有效减少机器跳数以及缩短治疗时间,可作为一种宫颈癌术后放疗的良好放疗技术。

十年来国人原发性肝癌TACE联合3DCRT与单纯TACE疗效的系统评价

目的系统评价十年来国人原发性肝癌肝动脉介入栓塞化疗(transcatheter arterial chemoembolization,TACE)联合三维适形放疗(three dimensional conformal radiotherapy,3DCRT)治疗与单纯使用TACE治疗的总有效率与生存率。方法计算机检索Pub Med、CBM、CNKI、万方数据库,查找比较国人原发性肝癌TACE联合3DCRT治疗与单纯TACE治疗近期疗效和1年、2年、3年生存率的随机对照试验(RCT),检索时限均为2004年1月至2014年2月,并追溯纳入文献的参考文献。同时,手工检索已发表的资料、会议论文及学位论文。由2位研究者根据纳入与排除标准进行文献筛选、资料提取和质量评价后,采用Rev Man 5.1软件进行Meta分析。结果最终纳入20个随机对照试验,包括1511例患者。Meta分析结果显示:TACE联合3DCRT组与单纯TACE组总有效率比较[RR=2.90,95%CI(2.31,3.64),P<0.00001],1年生存率比较[RR=2.54,95%CI(2.02,3.19),P<0.00001],2年生存率比较[RR=2.75,95%CI(2.22,3.40),P<0.00001],3年生存率比较[RR=3.00,95%CI(2.33,3.87),P<0.00001]。结论 TACE联合3DCRT较单纯TACE治疗原发性肝癌总有效率提高;1年、2年、3年生存率明显增加,提示临床上TACE联合3DCRT治疗原发性肝癌较单纯使用TACE疗效好。

PTBD联合3DCRT治疗肝门部胆管癌患者的护理

目的探讨PTBD联合3DCRT治疗肝门部胆管癌患者的护理技巧。方法对我科12例PTBD术联合3DCRT治疗肝门部胆管癌患者的临床护理作回顾分析。结果经治疗症状缓解明显,近期疗效显著,生存质量改善,未发生与护理相关的并发症。结论PTBD术联合3DCRT治疗肝门部胆管癌是行之有效的疗法,结合精心的护理可提高患者的生存质量,延长生存期。

复方苦参注射液联合3DCRT治疗骨转移癌痛的临床观察

目的:探讨复方苦参注射液联合三维适形放疗(3DCRT)治疗骨转移癌痛的临床疗效。方法:将52例骨转移瘤患者随机分为联合治疗组和单纯放疗组,联合治疗组(n=26)采用复方苦参注射液和3DCRT联合治疗,单纯治疗组(n=26)采用3DCRT治疗,治疗结束后观察两组患者的止痛效果,中性粒细胞减少及生活质量改善情况。结果:两组患者疼痛的缓解率比较联合治疗组明显优于单纯放疗组,差异显著(P<0.05),在中性粒细胞减少及生活质量改善方面联合治疗组均优于单纯放疗组。结论:复方苦参注射液联合3DCRT治疗骨转移癌痛疗效显著,值得临床推广。

3DCRT+TP/FP对腹腔淋巴结转移癌疗效分析

目的分析研究三维适形放射治疗结合多西紫杉醇(或氟脲嘧啶)+顺铂(3DCRT+TP/FP)对恶性肿瘤腹腔淋巴结转移的疗效。方法采用3DCRT+TP/FP对50恶性肿瘤腹腔淋巴结转移患者综合治疗,观察统计患者近期疗效、毒副作用反应、及生活质量等临床表现。结果按Karnofsky评分标准,治疗后评分中位数提高20.7。治疗结束后3个月,腹部CT复查显示,共60个靶区,完全缓解(CR)24个靶区,占40%(24/60),部分缓解(PR)32个靶区,占53.3%(32/60),稳定(SD)4个靶区,占6.7%(4/60),总有效率(PR+CR)为93.3%(56/60)。毒副作用降低,1年生存率为74%(37/50),2年生存率为26%(13/50)。结论 DCRT+TP/FP对腹腔淋巴结转移癌具有较好的近期疗效,而且具有降低毒副和提高生活质量的作用。

三维适形放疗(3DCRT)治疗复发性食管癌

目的：研究三维适形放疗（3DCRT）治疗复发性食管癌的临床效果。方法：采用WIMRT计划系统设计5-6个照射野,处方剂量为PTV2Gy/次,总剂量50Gy/25d,评价近期疗效。结果：本组15例患者放疗结束后复查食管钡餐片：Ⅰ级1例、Ⅱ级9例、Ⅲ级5例。9例患者在治疗3周后出现放射性食管炎、气管炎,经对症处理后均缓解。结论：三维适形放射治疗可有效控制食管癌,避免放射性脊髓炎的发生,提高患者的生活质量。

Dosimetric Comparison between Three Dimensional Conformal Radiation Therapy (3DCRT) &Intensity Modulated Radiation Therapy (IMRT) in Mid-Lower Oesophageal Carcinoma

Purpose: To investigate if intensity modulated radiation therapy (IMRT) offers a better planning target volume (PTV) coverage and/or lower dose to normal thoracic structures in comparison to three dimensional conformal radiation therapy (3DCRT) in the treatment of mid and lower oesophageal carcinoma patients. Materials and Methods: A prospective study in the period from 2014 till 2015 was held in the radiation therapy department of the National Cancer Institute, Cairo University, in which 20 locally advanced or inoperable mid and lower oesophageal cancer patients were treated by chemo-radiation using 3DCRT technique. IMRT plans were generated for those 20 patients. The 3DCRT and IMRT plans were compared as regards PTV coverage and doses to critical organs at risk. Results: All plans had produced satisfactory PTV coverage with no significant differences noted. The lung V20 for both lungs in 3DCRT was 16.94% ± 4.2% which was increased to 21.42% ± 3.6% in IMRT (p = 0.017). The mean dose to the heart and V30 were higher in IMRT plans while the mean dose to the spinal cord was higher with 3DCRT plans, yet that didn’t reach a statistically significant level (p = 0.156). The dose delivered to the liver didn’t pose any difference between both techniques. Conclusion: 3DCRT remains to be a feasible cost effective treatment delivery option for mid and lower oesophageal cancer cases with a lower optimization and delivery time than that for IMRT. Moreover, that calls for further dosimetric studies and clinical trials to assess IMRT technique. In our study, IMRT using nine fields didn’t prove to be superior to 3DCRT.

颈段及胸上段食管癌IMRT与3DCRT剂量比较

颈段及胸上段食管癌在临床中较为少见，由于其生物学特性及复杂的解剖关系使颈段食管癌手术难度大，手术治疗时切除范围较广，甚或需切除喉等重要器官，而仅有少数患者通过手术治愈。

谈3DCRT在CT扫描定位及影像获取方面的体会

本文主要总结了在做三维适形放射治疗(3DCRT)时,关于CT定位及影像获取方面的几点注意事项和经验参考。

从工程物理方面谈做3DCRT疗效保证的体会

作者根据本单位的具体情况,从工程技术和物理质控二大方面,分三个阶段即CT扫描定位阶段、治疗计划阶段、治疗实施阶段,分别对三维适形放射治疗(3DCRT)的疗效保证,总结了一些经验方法,以供同行交流参考。

Investigation of Hot-Spots in TomoDirect 3DCRT Breast Treatment

Background: Conventional tomotherapy platforms only allow for the delivery of helical IMRT. However the use of IMRT and helical delivery in breast cancer treatment is non-standard. Newer tomotherapy units are equipped with a static-beam mode with 3DCRT capabilities. During the clinical use, we frequently observe hot-spots in the plan that renders the plan clinically unacceptable. The purpose of this study is to investigate the underlying cause of the hot-spots in tomotherapy static-beam breast treatment and possible solutions. Materials/Methods: Theories about the formation of the hot-spot were developed. Eight lumpectomy patients contoured according to RTOG-1005 specifications were also used to illustrate the magnitude of hot-spots under various planning strategies. Two tangential beams were used for the whole breast irradiation plan with prescription dose of 40 Gy in 15 fractions. Results: The hot-spot was identified as the behavior of the optimization engine when part of the target region was blocked. With the current design of tomotherapy’s 3DCRT planning where user adjustment was greatly limited, none of the planning strategies were able to reduce the hot-spots to acceptable levels in the eight patients studied. The best strategy still produced an average of 48.5 Gy (121% of prescription dose) hot-spot dose and 30.4 cc hot-spot volume (volume receiving > 110% prescription dose). It is also shown that the hot-spot was not a result of energy or other physical limitation of the radiation device. By manually adjusting the plan sinogram, the maximum hot-spot dose drops from 121% to 111% and the hot-spot volume drops from 30 cc to 6 cc on average. Conclusions: While TomoDirect 3DCRT showed great promise in breast treatment, treatment planning software improvements may be needed in order to improve the clinical acceptability by reducing hot-spots in normal tissue.

Radiotherapy to the Left Breast with 3DCRT, IMRT or VMAT: International Medical Center Experience

Radiation therapy after conservative breast surgery is an integral part of the treatment of early breast cancer. The aim of radiotherapy is to achieve the best coverage of the Planning Target Volume (PTV), while reducing the dose to the Organs at Risk (OAR). Such goals are not always achievable with the conformal three dimensions plans (3DCRT). Recently, radiation oncologist uses Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for irradiating the breast. In this study, we compared 3DCRT, IMRT and VMAT for left breast cancer patients in terms of PTV coverage, OAR. We also revised the different dose distribution in 1) different breast volume categories, 2) nodal irradiation versus breast only, and 3) boost versus no boost. Results: The routinely reported dose constrains for the ipsilateral lung and for the heart were not significantly different on comparing the three techniques. While for the contralateral lung, the difference in mean dose was in favor of 3DCRT. In large breast volume, 3DCRT provided a lower Max dose to the contralateral lung and the lowest mean dose to the contralateral breast when compared to IMRT p < 0. 046. In case of no nodal irradiation, the contralateral breast mean dose was lower in 3DCRT in comparison to IMRT and VMAT p < 0.037. When boost dose was given, 3DCRT plans had produced a lower Max dose to the contralateral lung p < 0.017. Conclusion: The three techniques (3DCRT, IMRT, and VMAT) can meet the clinical dosimetry demands of radiotherapy for left breast cancer after conservative surgery, as long as the routinely OARs only (heart and ipsilateral lung) are reported. Our study showed that 3CDRT can provide a lower dose to the contralateral organs (breast and lung), specially, in case of large breast volumes, no nodal irradiation and when a boost is given.

左乳癌根治术后胸壁3DCRT与3DCRT加电子线混合照射的剂量学研究

目的:探讨左乳癌改良根治术后胸壁三维适形照射和三维适形加电子线照射的剂量学特点。方法:选取左乳癌改良根治术后10例患者,采用pinnacle3 9.10计划系统分别设计胸壁三维适形照射和三维适形加电子线照射计划,比较两种计划的剂量学参数。结果:Dmax、Dmix、Dmean、V90、3DCRT较3DCRT+E升高,差异均有统计学意义(P<0.05);V95、V100、3DCRT略低于3DCRT+E,差异无统计学意义(P>0.05);V105、V110、3DCRT较3DCRT+E高,其中V105差异有统计学意义(P<0.05);CI和D53DCRT+E较3DCRT高,3DCRT+E优于3DCRT,差异有统计学意义(P<0.05);HI和D95差异无统计学意义(P>0.05)。危及器官左肺V5、V10、V15、V20、V30、V40和Dmean3DCRT+E较3DCRT总体升高,除V40差异无统计学意义外(P>0.05),其余参数差异均有统计学意义(P<0.05),右肺Dmean3DCRT+E稍高,差异无统计学意义(P>0.05);心脏受照剂量3DCRT+E总体呈升高趋势,其中V5、V10、V15和V40差异均有统计学意义(P<0.05)。结论:总体上靶区剂量分布3DCRT优于3DCRT+E,但3DCRT+E适形度、靶区高剂量D5和高剂量体积V105和V110优于3DCRT;3DCRT+E对危及器官剂量左肺和心脏的保护并不优于3DCRT。可能是0.5 cm厚的等效填充物不能有效的降低9Me V电子线等对左肺和心脏表面剂量所致。因此、建议每一个患者在治疗前应该选择最佳厚度等效填充物和电子线能量、混合射线的剂量比例等,并通过放射治疗计划系统下制定个体化的治疗方案。

3DCRT联合TP方案同步放化疗治疗Ⅲ期非小细胞肺癌的临床疗效

目的:分析3DCRT联合TP方案同步放化疗治疗Ⅲ期非小细胞肺癌的临床疗效分析。方法:选取2010年1月-2013年10月期间在我院初治的86例Ⅲ期NSCLC患者分为试验组与对照组各43例。试验组采用TP方案同步放化疗,对照组单纯放疗;两组患者放疗结束后继续序贯化疗;评价两组患者的近、远期疗效和不良反应。结果:整理分析后发现,试验组的有效率为81.40%,显著高于对照组58.14%,差异有统计学意义(P=0.019);试验组2年生存率51.16%,高于对照组27.91%,差异有统计学意义(P=0.027);不良反应骨髓毒性反应显著高于对照组,但经对症治疗后未出现不可逆重大并发症。结论:3DCRT联合TP方案同步放化疗治疗Ⅲ期非小细胞肺癌的近、远期临床疗效是显著的,毒副反应不影响治疗计划。

利用3DCRT技术提升分次量的探讨

目的探讨利用3D C R T技术治疗颅外肿瘤时大幅度提高分次量的可能性。方法回顾性分析总结300例颅外肿瘤的治疗计划。其中胸部肿瘤143例,腹部肿瘤157例。计划靶区体积7.0￣1478cm3,多数计划以90%的等剂量线包围PTV,少数以80%的等剂量线包围PTV的95%。以参考点剂量的90%为处方剂量,分次剂量多为5￣10G y,众数剂量为6￣8G y,疗程一般为5￣15d,间隔0￣1d,总剂量视情况给到常规治疗的根治量或姑息量,生物效应则增加10%￣40%。结果所有治疗计划均顺利完成,患者未出现影响生存质量的并发症。结论由于f因子的作用,3D C R T使得较大幅度增加分次量,缩短总疗程,提高放射的生物效应成为可能;对于体积较大的肿瘤在治疗开始时应积极考虑使用3D C R T技术;由于认知水平有限,使用3D C R T技术不宜过分追求精确计划、精确设计、精确治疗;使用3D C R T技术治疗颅外肿瘤时视治疗目的的不同,给予常规放疗2￣3倍的分次量是安全、可靠、有效的。