Clinical observation of three-dimensional conformal radiotherapy(3D-CRT) with concurrent chemotherapy in treatment of recurrent cervical cancers

Objective： The aim of the study was to explore the efficacy of three-dimensional conformal radiotherapy （3D- CRT） combined with TP concurrent chemotherapy in treatment of recurrent cervical cancers. Methods： From May 2005 to May 2009, 36 patients with recurrent cervical cancer were treated by 3D-CRT of 60-66 Gy and TP （docetaxel 70 mg/m^2, d1; cisplatin 20 mg/m^2, dl-d3; 21 days per cycle, totally 2 cycles） concurrent chemotherapy. Results： All of the patients had finished the 3D-CRT, the total response rate, complete response rate and partial response rate were 80.0% （28/35）, 45.7% （16/35）, and 34.3% （12/35）, respectively. The pain-alleviation rate was 91.4% （32/35）. The hemorrhage control rate was 94.3% （33/35）. The median overall survival was 21.2 months. The 1-, 2- and 3-year survival rates were 54.3%, 37.1% and 22.8%, respectively. The life qualities of the patients were improved, without any treatment related death. Conclusion： Radiotherapy is effective and well-tolerated for recurrent cervical cancers, and it can promote regional control of the disease and prolong survival time.

Clinical observation in three-dimensional conformal radiotherapy (3D-CRT) with concurrent chemotherapy in treatment of postoperative cerebral gliomas

Objective:The aim of the study was to investigate the efficacy of three-dimensional conformal radiotherapy (3D-CRT) combined with Temozolomide (TMZ) concurrent chemotherapy in treatment of postoperative cerebral gliomas by prospective randomized controlled trials. Methods: Sixty-two patients with cerebral glioma who had residual tumor were divided into 3D-CRT group (radiotherapy group, n=31) and 3D-CRT with concurrent chemotherapy group (chemoradiotherapy group, n=31) prospectively. All patients received a dose of 50-60 Gy/25-30 F/5-6 weeks by 6 MV-X ray, three-dimensional conformal radiotherapy, 1 f/d, 5 times a week. Chemotherapy regimen was Temozolomide:75 mg/m2/d, concomitantly with radiotherapy, followed by 150-200 mg/m2/d, 5 days, 28 days per cycle, totally 3-6 cycles. Results: The total response rate was 35.3% (11/31) in radiotherapy group. The response rate was 61.3% (19/31) in chemoradiotherapy group. There was significant difference in curative effect (P=0.042). There was no significant difference in survival comparison of two groups (P=0.263). Stratified analysis showed the patients with grade Ⅲ gliomas of chemoradiotherapy group had better prognosis than ones of radiotherapy group (P=0.043). Conclusion: The 3D-CRT with concurrent chemotherapy can improve the survival of cerebral gliomas with pathological grade Ⅲ.

Dosimetric study of five-field intensity-modulated radiotherapy compared with conventional three-dimensional conformal radiotherapy for rectal cancer

Objective： The aim of the study was to compare the difference of dose distribution in clinical target volume and organ at risk （OAR） between five-field intensity-modulated radiotherapy （IMRT） and conventional three-dimensional conformal radiotherapy （3DCRT） in the radiotherapy of rectal cancer. Methods： Fifteen patients with rectal cancer treated with radio- therapy （RT） were retrospectively analyzed. Among the patients, seven received RT preoperatively and 8 postoperatively. The target volume and the OARs such as the small bowel, bladder and femoral heads were contoured for each patient. 3DCRT-plan and IMRT-plan were performed for each patient respectively, with the prescribed dose covering at least 95% of the planning target volume （PTV）. The conformity index （CI） and homogeneity index （HI） were used for evaluation of the dose distribution in the target volume, and the Dx% （the lowest dose to the x% volume of the OARs that received the highest dose of irradiation） and the mean dose were used for evaluation of the dose to OARs. Paired-T test was used for companson of the difference between the two plans. Results： In the IMRT-plan and 3DCRT-plan, the CI were 0.94 and 0.87 （P = 0.000） and the HI were 1.13 and 1.17, respectively （P = 0.001）. For small bowel, the D30%, D50% and the mean dose were 19.67 Gy, 15.13 Gy and 18.81 Gy in the IMRT-plan and 25.20 Gy, 22.20 Gy and 22.89 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For bladder, the D30%, D50%, and the mean dose were 24.80 Gy, 34.20 Gy and 28.70 Gy in the IMRT- plan, and 35.07 Gy, 44.67 Gy and 35.68 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For femoral heads, the D5% in the IMRT-plan and 3DCRT-plan were 40.6 Gy and 40.47 Gy, respectively （P = 0.936）, and the mean dose were 30.14 Gy and 25.57 Gy, respectively （P = 0.001）. Conclusion： Five-field IMRT-plan is better than 3DCRT-plan in the conformity and the dose homogeneity within target volume and also better in sparing the small bowel and bladder.

Conformal Invariant Asymptotic Expansion Approach for Solving （3＋1）-Dimensional JM Equation

The （3＋1）-dimensional Jimbo-Miwa （JM） equation is solved approximately by using the conformal invariant asymptotic expansion approach presented by Ruan. By solving the new （3＋1）-dimensional integrable models, which are conformal invariant and possess Painlevé property, the approximate solutions are obtained for the JM equation, containing not only one-soliton solutions but also periodic solutions and multi-soliton solutions. Some approximate solutions happen to be exact and some approximate solutions can become exact by choosing relations between the parameters properly.

Evaluation of whole-course three-dimensional conformal radiotherapy combined with late-course accelerated hyperfractionated radiotherapy for esophageal carcinoma patients

Objective： The aim of the study was to evaluate the therapeutic effect and safety of whole-course three-dimensional conformal radiotherapy （3DCRT） combined with late-course accelerated hyperfractionated radiotherapy （LCAFR） on patients with esophageal carcinoma. Methods： one hundred and one patients with esophageal carcinoma were divided into two groups. Observing group （49 cases） were treated by whole-course 3DCRT. Patients in control group （52 cases） were treated by conventional radiotherapy. Clinical efficiencies and radiation toxicities were compared between two groups. Results： The side effects including radiation esophagitis （63.2%） and tracheitis （49.0%） decreased in observing group, but there was no significant difference between two groups （69.2% and 55.7% in controls）. The 1-, 2-and 3-year tumor local control rates and overall survival rates in the observing group were significantly improved compared with the control group, being respectively 87.8%, 75.5%, 63.3% vs 71.2%, 55.8%, 42.3% and 85.7%, 71.4%, 46.7% vs 69.2%, 51.9%, 26.9% （all P 0.05）. Conclusion： The therapeutic effect of whole-course 3DCRT combined with LCAFR for esophageal carcinomas is superior to conventional radiotherapy.

The follow-up of 34 children with medulloblastoma who received 3-dimensional conformal radiation therapy

Objective:In our investigation,we studied the patients with medulloblastoma who received 3-dimensional conformal radiation therapy(3DCRT) and recorded their effects,side effects and failure reasons.Methods:From August 2001 to August 2007,34 children with medulloblastoma were treated in our hospital.The age at diagnosis was 3-16 years old,and the mean age at diagnosis was 9.5 years old.Among all the patients,16 cases were included in the high risk group and 18 cases were included in the low risk group.All the patients were performed total resection or subtotal resection and no patients received radiotherapy or chemotherapy before operation.All patients received 3DCRT within 3 weeks after resection.The dose of 30 Gy were given to the whole brain and whole spine,followed by 20-25 Gy boosted to the posterior brain fossa.The median fraction dose was 180 cGy.Every patient received the chemotherapy scheme of the Lomustine,Cisplatinum and Vincristine.Nobody received intrathecal chemotherapy.The tests of the complete blood count,blood biochemistry,hepatic and renal functions were required before every cycle of chemotherapy.Results:5-year overall survival(OS) and 5-year disease free survival(DFS) were 71% and 62% respectively.The median follow-up time was 36.5 months.The 5-year OS of the high risk group was 71% compared to 62% of the low risk group.There were significant difference between the two groups(P = 0.01).There were 13 failure cases in all the patients.Of these 13 patients,10 were dead and the other 3 were alive with tumor.The complete remission(CR) rate was 70.5% and the partial remission(PR) rate was 14%.Among the failure patients,there were 3 patients(8.8%) with the recurrences located in the brain of cribriform region.The 5-year OS of the patients with preoperative metastases was 12.5%(1/8),and which of the patients with residual tumor volume > 1.5 cm3 was 0%(0/5).Through the statistic analysis,it was found that both whether or not the metastases were found before surgery and residual tumor volume have the significant impacts on the prognosis of the children with medulloblastoma(P < 0.05).The major adverse reactions were hematological toxicity(7/34,20.6%) and gastrointestinal reaction(4/34,11.8%).Conclusion:Through the using of 3DCRT for the children with medulloblastoma,the severe side effects rate was not high.The prognosis of the patients in low risk group was satisfied which was opposite to that of the patients in high risk group.And the patients with residual tumor volume > 1.5 cm3 and preoperative metastases also had poor prognosis.It is needed to pay attention to the possible low dose of the brain of cribriform region.

Three-Tesla Magnetic Resonance and Computed Tomography Imaging in Three-Dimensional Conformal Radiotherapy for Localized Prostate Cancer

Aims and background: we evaluate CT-3Tesla MRI fusion in conformal radiotherapy for localized prostate cancer.Methods: 18 consecutive patients underwent a 3T MRI scan under radiotherapy planning conditions, after the CT scan. Bowel and bladder preparation were prescribed. CT and MR images were automatically fused;prostate and seminal vesicles were contoured on CT and on MRI, organs at risk were defined on CT-MRI fusion. Late rectal and sexual toxicity, differences in target volume between MRI and CT and differences in rectal and penile bulb dose distribution based on CT only or on CT-MRI fusion were evaluated.Results: one patient experienced a late rectal toxicity;no patient had sexual toxicity. The difference between the mean MRI and CT target volumes was statistically significant (p = 0.0001 paired Student's t-test). The dose-volume histogram (DVH) analysis shows a significant reduction of the dose received by the rectum and the penile bulb in MRI-plans compared to CT-plans.Conclusions: 3 Tesla MRI scan under radiotherapy planning conditions along with bowel preparation significantly improves the definition of the target volume sparing normal tissue irradiation.

Management of Hepatocellular Carcinoma Patients with Portal Vein Thrombosis Using Three-Dimensional Conformal Radiotherapy

Objective: To determine the possible therapeutic gain of using three-dimensional conformal radiotherapy (3D-CRT) as a treatment option for portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma (HCC) and to evaluate the tolerance and toxicity of using such treatment. Materials and methods: Sixty two patients were enrolled in this prospective study between June 2013 and August 2015. The clinical target volume (CTV) was the PVTT and the prescribed dose was 50 Gy/25 fractions. The median follow-up time was 7.4 months. Results: The thrombus crude response rate was 40.4% and the only significant prognostic factor for response was the thrombus size. Responders had significant better survival compared to non-responders with a median survival of 12.5 and 8 months respectively (P Conclusions: The results of this study suggest that radiotherapy should be considered as a safe treatment option for HCC patients with PVTT. It is effective not only for PVTT local control but also for survival, although prospective randomized trials are needed to confirm these results.

Concurrent gemcitabine and cisplatin combined with 3D conformal radiotherapy for stage III non-small cell lung cancer

Objective： To study the toxicities and efficacy of concurrent gemcitabine plus cisplatin combined with three-dimensional conformal radiotherapy for stage Ⅲ non-small cell lung cancer （NSCLC）. Methods： Thirty-six patients with pathologically diagnosed NSCLC received radiotherapy and concurrent chemotherapy. There were 22 patients with stage Ilia and 14 patients with IIIb. Radiotherapy was given a total of 60-70 Gy in conventional fractionation. Chemotherapy included gemcitabine （600 mg/m^2） and cisplatin （20 mg/m^2）, once per week. Results： Thirty-two patients received a total dose of 60-72 Gy. Two patients received 56 Gy and another two patients received 58 Gy. Thirty-four patients received 4-6 weeks of chemotherapy, while two patients received only 2 weeks of chemotherapy. The overall response rate （CR ＋ PR）, complete response rate （CR）, partially response rate （PR） were 83.3% （30/36）, 11.1% （4/36） and 72.2% （26/36） respectively. The median follow-up duration was 18.4 months. The 1- and 2-year overall survival rates were 77.8% （28/36） and 55.6% （20/36）, respectively. Conclusion： Concurrent gemcitabine and cisplatin combined with three-dimensional conformal radiotherapy for stage III non-small cell lung cancer is effective and well tolerated. Lone-term results need further study.

THREE-DIMENSIONAL CONFORMAL RADIATION THERAPY FOR LOCALLY RECURRENT NASOPHARYNGEAL CARCINOMA

Objective: To investigate the safety and effectiveness of three-dimensional conformal radiation therapy (3-D CRT) for locally recurrent nasopharyngeal carcinoma (NPC). Methods: From April 1998 to March 2000, 34 patients who had undergone previous external beam radiation therapy were retreated with 3-D CRT for locally recurrent NPC (33 poorly differentiated squamous cell carcinomas, 1 adenoma). The patients were re-staged according to Huaqing staging system with the following distribution: T1N0M0 in 5 cases, T2N0M0 in 11 cases, T3N0M0 in 12 cases, T4N0M0 in 6 cases. The maximal dimension of the gross tumor volume (GTV) ranged from 1.0 cm to 5.0 cm (median: 2.9 cm). CT simulation and 3-D planning were used to ensure full and conformal coverage of the planning target volume (PTV) by treated volume, while minimizing the absorbed dose of the adjacent normal tissue. 5–7 static conformal coplanar or noncoplanar portals were delivered for each fraction irradiation. The total dose delivered ranged from 65–70 Gy, with 2.5 Gy per fractionation, one fractionation per day, 5 days a week. Median follow-up time from 3-D CRT was 25 months (range: 12–36 months). Results: Over the follow-up period, local recurrence was observed in 3 patients, regional failure in 3, distant metastasis in 3, and six patients died; 88.2% (30/34) of the patient maintained local control, 82.4% (28/34) survived, and 76.5% (26/34) survived with no evidence of tumor. Acute complications were minor and few. The overall incidence of late complication was 20.6% (7/34), and severe complication was 14.7% (5/34), after re-irradiation with 3-D CRT. Conclusion: 3-D CRT is safety and effectiveness for most of the patients with locally recurrent NPC. Our preliminary results indicate a high local control rate and a low complication rate. The long-term curative effect and sequelae await further study.

Curative 3D Conformal Radiotherapy of Non-Operated Prostate Adenocarcinoma at Pointe-a-Pitre University Hospital (Guadeloupe): About 29 Cases

Context: Technological advances have improved the toxicities of radiotherapy. We are evaluating the 3D technique in prostate cancer. Materials and Methods: Retrospective study from January 2015 to December 2015 with 29 files. Survival was calculated by Kaplan-Meier method. Results: We collected 29 patient records over the study period. The median age was 75 years with the following extremes: 54 years and 83 years. The median PSA level was 12 ng/ml with a range of 3.05 to 79 ng/ml. Gleason score analysis showed 6 patients (20.69%) with a score of 6 (3 + 3), 23 patients (79.31%) with a score of 7 including 12 patients (41.38%) with grade 3 and 11 patients (37.93%) with grade 4. The median dose delivered was 74 Gy, with a mean dose of 73.79 Gy and extremes of 70 Gy for the minimum and 76 Gy for the maximum. Hormone therapy was combined with radiotherapy in 17 patients (58.62%). Seven patients (24.14%) had grade 1 acute bladder toxicity and one patient (3.45%) had grade 2 acute toxicity. Late bladder toxicity was grade 1 in 5 patients (17.24%), grade 2 in 3 patients (10.34%) and grade 3 in 1 patient (3.45%). Late rectal toxicity, grade 2 in 3 patients (10.34%), grade 3 in 1 patient, was noted. Overall survival at 2 years was 100% and 89.65% at 5 years. Relapse-free survival at 2 years was 82.76% and 62.07% at 5 years. There were 3 deaths (10.34%) of which only one was related to prostate cancer. Conclusion: Radiotherapy, like surgery, is a fundamental option for the treatment of prostate cancers, particularly those that are locally advanced. It is gaining in importance with the improvement of techniques (IMRT, VMAT…) and new fractionations which contribute to the reduction of toxicities and the comfort of patients (shorter spread).

非小细胞肺癌患者血清sTim-3和SPINK1水平与三维适形放疗效果及预后的关系

目的探讨非小细胞肺癌患者血清可溶性T细胞免疫球蛋白黏蛋白分子3(sTim-3)、丝氨酸蛋白酶抑制剂Kazal1型(SPINK1)水平与三维适形放疗效果及预后的关系。方法选取102例肺癌患者作为研究对象,收集患者的一般临床资料(包括年龄、性别、吸烟史、饮酒史、肿瘤直径、TNM分期、分化程度以及病理类型),抽取入院第2日空腹外周静脉血,采用酶联免疫吸附法(ELISA)检测血清sTim-3、SPINK1水平并据中位数大小将患者分为sTim-3低和高水平组、SPINK1低和高水平组;患者均进行三维适形放疗,随访12个月,观察并记录患者疗效,采用Kaplan-Meier生存曲线和log-rank检验研究血清sTim-3、SPINK1与患者预后的关系,采用COX回归研究非小细胞肺癌患者预后的影响因素。结果肿瘤直径>3.0 cm、肿瘤淋巴结转移(TNM)分期为Ⅲ~Ⅳ期、分化程度为低分化的非小细胞肺癌患者血清sTim-3、SPINK1表达水平高于肿瘤直径≤3.0 cm、TNM分期为Ⅰ~Ⅱ期、分化程度为中高分化的非小细胞肺癌患者(P<0.05);接受三维适形放疗后,血清sTim-3、SPINK1低水平组非小细胞肺癌患者总有效率高于高水平组(P<0.05);sTim-3、SPINK1高水平组非小细胞肺癌患者生存率分别低于对应的低水平组(P<0.05);sTim-3、SPINK1、TNM分期、分化程度是影响非小细胞肺癌患者预后的危险因素(P<0.05)。结论非小细胞肺癌患者血清sTim-3、SPINK1高表达与三维适形放疗疗效以及预后有关。

3D-CRT与IMRT两种放疗技术在原发性肝癌患者中的应用效果

目的:分析原发性肝癌患者实施三维适形放射治疗(3D-CRT)与强度调控放射治疗(IMRT)的效果。方法:回顾性分析2019年7月—2021年7月于漳州市医院收治的86例原发性肝癌患者的临床资料,根据治疗方法不同分为3D-CRT组(3D-CRT放射治疗)及IMRT组(IMRT放射治疗),各43例。比较两组剂量学参数、放疗照射时间、子野数、总子野跳数及危及器官受量;比较两组放疗后不良反应发生率。结果:IMRT组靶区平均剂量(PTVDmean)、靶区最小剂量(PTVDmin)、靶区最大剂量(PTVDmax)、靶区适形指数(CI)及靶区均匀指数(HI)均高于3D-CRT组,差异有统计学意义(P<0.05)。IMRT组的放疗照射时间长于3D-CRT组,子野数、总子野跳数少于3D-CRT组,差异有统计学意义(P<0.05)。IMRT组脊髓、左肾、右肾、胃受量低于3D-CRT组,差异有统计学意义(P<0.05)。IMRT组放疗后不良反应发生率低于3D-CRT组,差异有统计学意义(P<0.05)。结论:IMRT技术在原发性肝癌放射治疗中可有效提升靶区的照射剂量,并可降低放疗期间对危及器官的损伤程度。

A dosimetric comparative study between conformal and intensity modulated radiation therapy in the treatment of primary nasopharyngeal carcinomas: the Egyptian experience

Objective: The study is a comparative study, the aim of which is to compare 3D conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) in treating nasopharyngeal carcinomas; dosimetrically evaluating and comparing both techniques as regard target coverage and doses to organs at risk (OAR). Methods: Twenty patients with nasopharyngeal carcinoma were treated by 3D-CRT technique and another 20 patients were treated by IMRT. A dosimetric comparison was done by performing two plans for the same patient using Eclipse planning system (version 8.6). Results: IMRT had a better tumor coverage and conformity index compared to 3D-CRT plans (P value of 0.001 and 0.004), respectively. As for the dose homogeneity it was also better in the IMRT plans and the reason for this was attributed to the dose inhomogeneity at the photon/electron junction in the 3D-CRT plans (P value 0.032). Also, doses received by the risk structures, particularly parotids, was significantly less in the IMRT plans than those of 3D-CRT (P value 0.001). Conclusion: IMRT technique was clearly able to increase the dose delivery to the target volume, improve conformity and homogeneity index and spare the parotid glands in comparison to 3D-CRT technique.

Application of three dimensional conformal radiation therapy combined with high-intensity focused ultrasound for prostate cancer

Objective:Prostate cancer is a form of cancer that develops in the prostate,a gland in the male reproductive system.Prostate cancer tends to develop in men over the age of fifty;it is one of the most prevalent types of cancer in men.This article introduced a new method of prostate cancer treatment with the combination of three dimensional conformal radiation therapy (3D-CRT) and high-intensity focused ultrasound (HIFU),its efficacy was evaluated.Methods:From January 2004 to December 2009,95 patients were diagnosed with prostate cancer,among them,48 patients were received combined therapy with total irradiation of TD 60 Gy/30 Fx and 5 fractions of HIFU treatment,while 47 patients were received with pure 3D-CRT with total irradiation of TD (66-72) Gy/(33-36) Fx.Various indicators were evaluated,such as the local control rate and distant metastasis rate,the changes in blood PSA and fPSA,changes in T-lymphocyte subsets and NK cells,as well as acute adverse reaction of normal tissue.Results:The local response rate difference between the two groups had statistical significance (P < 0.05);the changes in blood PSA and fPSA were significant (P < 0.05);CD3+,CD4+,CD8+,CD4+/CD8+ and NK cells of the combined group increased obviously (P < 0.01),while the latter group had no increase (P > 0.05);the combined group had lower blood cells reduction and II-level acute adverse reaction of rectum,bladder and caput humeri than the pure group,but the II-level acute adverse reaction of urogenital canal in the combined group was higher (P < 0.05).Conclusion:The combined therapy with 3D-CRT and HIFU is a good way for the treatment of aged-related prostate cancer.It can ease the symptoms,control the disease and lengthen the survival time.

Feasibility and acute toxicity of 3-dimensional conformal external-beam accelerated partial-breast irradiation for early-stage breast cancer after breast-conserving surgery in Chinese female patients

Background A growing number of studies worldwide have advocated the replacement of whole-breast irradiation with accelerated partial breast irradiation using three-dimensional conformal external-beam radiation （APBI-3DCRr） for early-stage breast cancer. But APBI can be only used in selected population of patients with early-staged breast cancer. It is not replacing the whole breast radiotherapy. This study aimed to examine the feasibility and acute normal tissue toxicity of the APBI-3DCRT technique in Chinese female patients who generally have smaller breasts compared to their Western counterparts.Methods From May 2006 to December 2009, a total of 48 Chinese female patients （with early-stage breast cancer who met the inclusion criteria） received APBI-3DCRT after breast-conserving surgery at Sun Yat-sen University Cancer Center. The total dosage from APBI-3DCRT was 34 Gy, delivered in 3.4 Gy per fractions, twice per day at intervals of at least six hours. The radiation dose, volume of the target area and volume of irradiated normal tissues were calculated.Acute toxicity was evaluated according to the Common Toxicity Criteria （CTC） 3.0.Results Among the 48 patients, the planning target volume for evaluation （PTVE） was （90.42±9.26） cm3, the ipsilateral breast volume （IBV） was （421.74±28.53） cm3, and the ratio between the two was （20.74±5.86）%. Evaluation of the dosimetric characteristics of the PTVE revealed excellent dosimetric results in 14 patients and acceptable results in 34 patients. The dose delivered to the PTVE ranged from 93% to 110% of the prescribed dose. The average ratio of the volume of PTVE receiving 95% of the prescription dose （V95） was （99.26±0.37）%. The habituation index （HI） and the conformity index （CI） were 1.08±0.01 and 0.72±0.02, respectively, suggesting good homogeneity and conformity of the dose delivered to the target field. The radiation dose to normal tissues and organs was within the dose limitation.Subjects experienced mild acute toxicity. The main manifestations were breast edema in 22 patients, breast pain in 7,skin erythema in 25, general malaise in 22 and cytopenia in 8. No acute radiological cardiac or pulmonary injury was found.Conclusions The results of our short-term follow-up showed that it is feasible to perform APBI-3DCRT for early-stage breast cancer after breast-conserving surgery in Chinese female patients with smaller breasts. However, further studies are required to elucidate its efficacy and long-term side effects.

三维适形放疗同步卡培他滨联合吉西他滨治疗32例局部晚期胰腺癌的临床观察

目的探讨同步放化疗(CCRT)治疗局部晚期胰腺癌的疗效和毒性反应。方法2003年1月至2006年2月共收治局部晚期胰腺癌患者32例,采用三维适形放疗(3DCRT),总量45～54Gy;同步化疗方案为:卡培他滨1500mg/m2,分2次口服,第1～14天;吉西他滨1000mg/m2,静脉滴注第1、8、15天。21天为1周期,与放疗同时开始,CCRT结束后1个月巩固化疗2～4周期。结果所有患者均完成CCRT治疗,其中21例完成4个周期巩固化疗,7例3个周期,4例2个周期。有效率为56.2%,中位生存期为18.8个月,1、2年生存率分别为46.8%和22.5%;疼痛缓解率65.6%(21/32),生活质量明显改善,无治疗相关性死亡。结论三维适形放疗同步卡培他滨联合吉西他滨治疗局部晚期胰腺癌疗效显著,能提高局部控制率,延长生存期,缓解疼痛,提高生活质量,且毒副反应能够耐受。

颈段、胸上段食管癌3DCRT/IMRT剂量学比较

目的通过对颈段、胸上段食管癌三维适形(3DCRT)和调强(IMRT)放疗计划的剂量学比较,选择符合临床要求的最优方案。方法 14例颈段、胸上段食管癌患者模拟定位后参考食管钡餐和内镜检查结果勾画GTV,按照统一标准确定CTV、PTV,分别设计3DCRT、5野均匀分布IMRT-A和5野非均匀分布IMRT-B共3套放疗计划,以95%PTV获得100%处方剂量进行归一,分析各计划靶区剂量分布及危及器官受量的差异。结果本组病例所有的IMRT计划均能满足治疗要求,而4例3DCRT计划不能满足要求,本研究仅对10组可行计划进行进一步的剂量学比较。预防照射区(PTV1):3DCRT计划的剂量参数Dmean、D100、D95分别为(5725±54.96)cGy、(4703±25.26)cGy、(5203±71.70)cGy,明显高于IMRT-A的(5348±27.14)cGy、(4158±27.36)cGy、(4996±54.74)cGy和IMRT-B的(5232±26.85)cGy、(4286±12.13)cGy、(4979±31.78)cGy(P<0.05);3DCRT V105为(82.95±3.02)%,高于IMRT-A的(71.07±6.68)%和IMRT-B的(69.55±4.56)%(P<0.05),V100、V95无明显差异(P>0.05)。肿瘤区(PTV2):3套放疗计划的Dmean、D100、D95、V105、V95无明显差异(P>0.05),而IMRT-A和IMRT-B的V100分别为(95.21±1.78)%和(96.12±2.55)%,均高于3DCRT的(88.69±1.84)%(P<0.05);IMRT-A和IMRT-B HI分别为1.08±0.01和1.02±0.01,低于3DCRT的1.18±0.03,差异有统计学意义(P<0.05)。除肺V5外,IMRT-A和IMRT-B脊髓Dmax、肺V20、V30、MLD分别为(3641±23.41)cGy、(22.08±0.31)%、(11.07±0.51)%、(1034±37.51)cGy和(3303±75.39)cGy、(19.82±1.74)%、(10.14±1.20)%、(981±38.16)cGy,均小于3DCRT的(4113±38.28)cGy、(28.07±6.30)%、(19.72±5.26)%、(1356±38.91)cGy,差异具有统计学意义(P<0.05)。IMRT计划剂量参数、体积参数、剂量分布均匀性无明显差别(P>0.05);IMRT-B肺MLD和脊髓Dmax较IMRT-A低,差异具有统计学意义(P<0.05)。结论颈段、胸上段食管癌放疗采用IMRT优于3DCRT,根据靶区形状非均匀布野IMRT可进一步降低肺和脊髓受照剂量。

3D-CRT联合DC-CIK细胞治疗高原地区复发性小细胞肺癌的疗效观察

目的探讨三维适型放疗(3D-CRT)联合树突状细胞-细胞因子诱导的杀伤细胞(DC-CIK)回输治疗高原地区复发性小细胞肺癌(SCLC)的临床疗效,以及对血管内皮生长因子(VEGF)、神经元特异性烯醇化酶(NSE)的影响。方法选取2012年5月至2014年4月青海省第五人民医院肿瘤放疗科收治的复发性SCLC患者85例,按随机数字表法分为对照组(41例)与观察组(44例),分别给予单纯3D-CRT治疗,3D-CRT联合DC-CIK细胞治疗,比较两组的疗效、不良反应发生率、治疗前后VEGF及NSE水平,并观察治疗前后两组各项肝、肾功能指标变化。结果观察组的有效率(65.9%)及疾病控制率(79.5%)均高于对照组,差异均有统计学意义(P<0.05)。两组治疗4、8周后,血清VEGF、NSE水平及疼痛评分均下降,差异均有统计学意义(P<0.05);治疗8周后,观察组VEGF、NSE水平及疼痛评分均低于对照组,差异均有统计学意义(P<0.05)。两组各项不良反应发生率比较,差异均无统计学意义(P>0.05)。两组治疗前及治疗后各项肝、肾功能指标水平比较,差异均无统计学意义(P>0.05)。结论 3D-CRT联合DC-CIK细胞生物治疗高原地区复发性SCLC的疗效更明显,且对放(化)疗不良反应及肝、肾功能无明显影响。

晚期肺癌三维适形放疗31例临床分析

目的探讨晚期肺癌三维适形放疗方式及预后。方法对31例晚期肺癌患者资料进行回顾性分析。根据放疗方法的不同分为普通放疗(RT)+三维适形放疗(3DCRT)组10例、单纯三维适形放疗组21例,分析不同放疗方法的生存质量和生存率。结果 RT+3DCRT组、单纯3DCRT组的治疗有效率分别为90%,95.2%;1年生存率分别为20%、12.9%;相互比较均无显著性差异,但生存质量均有明显提高。结论 3DCRT可使晚期肺癌患者局部控制率提高,生活质量改善。