Dosimetric Comparative Analysis of Volumetric Modulated Arc Therapy and Intensity-Modulated Radiation Therapy in Cervical Cancer

Objective:To carry out dosimetric comparison between volumetric modulated arc therapy(VMAT)and intensity-modulated radiation therapy(IMRT)in cervical cancer.Methods:50 postoperative cervical cancer patients were included in this study.The patients were admitted for treatment from January 2021 to January 2022.VMAT and IMRT plans were designed for each patient to analyze the dose distribution in the target area of the two treatment techniques.Results:Comparing the monitor unit for single treatment(638.21±116.21 MU)and time of single treatment(143.21±23.14 s)in the observation group and the monitor unit for single treatment(932.14±74.11 MU)and time of single treatment(223.14±17.26 s)in the control group,there was significant difference(P<0.05);there was also significant difference(P<0.05)between the normal tissue(bladder and rectum)of the observation group and that(bladder and rectum)of the control group.Conclusion:VMAT is more effective in cervical cancer,and it has a certain protective effect on normal tissues in patients and can reduce the radiation dose.

Significant value of 18F-FDG-PET/CT in diagnosing small cervical lymph node metastases in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy

Background: Little is known about the nature of metaistasis to small cervical lymph nodes(SCLNS) in the patients with nasopharyngeal carcinoma(NPC)examined by using 18-fluoro-2-deoxy-glucose(^(18)F-FDG) positron emission tomography/computed tomography(PET/CT).The present study aimed to evaluate the diagnostic values of PET/CT in identifying metastasis in SCLNs in NPC patients.Methods: Magnetic resonance images(MRI) and PET/CT scans for 470 patients with newly diagnosed, non-distant metastatic NPC were analyzed. Metastatic rates of SCLNs were defined by the positive number of SCLNs on PET/CT scans and total number of SCLNs on MRI scans. Receiver operating characteristic curve was applied to compare PET/CT-determined stage with MRI-determined stage.Results: In total, 2082 SCLNs were identified, with 808(38.8%) ≥ 5 and < 6 mm in diameter(group A), 526(25.3%)≥ 6 and < 7 mm in diameter(group B),374(18.0%)≥ 7 and < 8 mm in diameter(group C), 237(11.4%) ≥8 and<9 mm in diameter(group D),and 137(6.5%) ≥ 9 and <10 mm in diameter(group E).The overall metastatic rates examined by using PET/CT for groups A, B,C,D, and E were 3.5%, 8.0%, 31.3%, 60.0%, and 83.9%, respectively(P< 0.001). In level IV/Vb, the metastatic rate for nodes ≥ 8 mm was 84.6%. PET/CT examination resulted in modification of N category and overall stage for 135(28.7%) and 46(9.8%) patients, respectively. The areas under curve of MRIdetermined and PET/CT-determined overall stage were 0.659 and 0.704 for predicting overall survival, 0.661 and 0.711 for predicting distant metastasis-free survival, and 0.636 and 0.663 for predicting disease-free survival.Conclusions: PET/CT was more effective than MRI in identifying metastatic SCLNs, and the radiologic diagnostic criteria for metastatic lymph nodes in level IV/Vb should be re-defined.

Bone marrow-sparing intensity-modulated radiotherapy for postoperative treatment of cervical cancer

Objective： The aim of this study was to compare bone marrow-sparing intensity-modulated radiotherapy （IMRT） with IMRT without entering pelvic bone marrow as a planning constraint in the treatment of cervical cancer after hysterectomy. Methods： For a cohort of 10 patients, bone marrow-sparing IMRT and routine IMRT planning were designed. The prescribed dose was 45 Gy/1.8 Gy/25f, 95% of the planning target volume received this dose. Doses were computed with a commercially available treatment planning system （TPS） using convolution/superimposition （CS） algorithm. Plans were compared according to dose-volume histogram （DVH） analysis in terms of planning target volume （PTV） homogeneity and conformity indices （HI and CI） as well as organs at risk （OARs） dose and volume parameters. Results： Bone marrow-sparing IMRT had an vantages over routine IMRT in terms of CI, but inferior to the latter for HI. Compared with routine IMRT, V5, Vl0, V20, V30, V40 of pelvic bone marrow of bone marrow-sparing IMRT reduced by 1.81%, 8.61%, 31.81%, 29.50%, 28.29%, respectively. No statistically significant differences were observed between bone marrow-sparing IMRT and routine IMRT in terms of small bowel, bladder and rectum. Conclusion： For patients with cervical cancer after hysterectomy, bone marrowsparing IMRT reduced the pelvic bone marrow volume irradiated at all dose levels and might be conducive to preventing the occurrence of acute bone marrow toxicity.

Dosimetric analysis of tomotherapy-based intensity-modulated radiotherapy with and without bone marrow sparing for the treatment of cervical cancer

Objective The aim of the study was to compare tomotherapy-based bone marrow-sparing intensity-mod- ulated radiotherapy （BMS-IMRT） with intensity-modulated radiotherapy （IMRT） without entering the pelvic bone marrow as a planning constraint in the treatment of cervical cancer after hysterectomy. Methods BMS-IMRT and IMRT plans were designed for a cohort of nine patients. The prescribed dose was 45 Gy in 1.8 Gy daily fractions, and 95% of the planned target volume received this dose. The doses were computed using a commercially available treatment planning system with the convolution/superposition algorithm. Plans were compared according to dose-volume histogram analysis in terms of planning target volume homogeneity and conformity indices （HI and CI） as well as organ at risk dose and volume parameters. Results BMS-IMRT had advantages over IMRT in terms of CI, but was equivalent to the latter in H1. V5, V10, V20, V30, and V40 of pelvic bone marrow in BMS-IMRT decreased by 0.06%, 17.33%, 22.19%, 13.85%, and 16.46%, respectively, compared with IMRT. Except for V30 of the small bowel and V30 and V40 of the bladder, no statistically significant differences were found between BMS-IMRT and IMRT in the small bowel, bladder, and rectum. Conclusion For cervical cancer patients receiving tomotherapy-based radiotherapy after hysterectomy, BMS-IMRT reduced pelvic bone marrow volume receiving low-dose radiation, and it may be conducive to preventing acute hematologic toxicity.

Establishment of a prediction model for severe acute radiation enteritis associated with cervical cancer radiotherapy

BACKGROUND Cervical cancer is one of the most common gynecological malignant tumors.Radiation enteritis(RE)leads to radiotherapy intolerance or termination of radiotherapy,which negatively impacts the therapeutic effect and seriously affects the quality of life of patients.If the incidence of RE in patients can be predicted in advance,and targeted clinical preventive treatment can be carried out,the side effects of radiotherapy in cervical cancer patients can be significantly reduced.Furthermore,accurate prediction of RE is essential for the selection of individualized radiation dose and the optimization of the radiotherapy plan.AIM To analyze the relationships between severe acute RE(SARE)of cervical cancer radiotherapy and clinical factors and dose-volume parameters retrospectively.METHODS We included 50 cervical cancer patients who received volumetric modulated arc therapy(VMAT)from September 2017 to June 2018 in the Department of Radiotherapy at The First Affiliated Hospital Soochow University.Clinical and dose-volume histogram factors of patients were collected.Logistic regression analysis was used to evaluate the predictive value of each factor for SARE.A nomogram to predict SARE was developed(SARE scoring system≥3 points)based on the multiple regression coefficients;validity was verified by an internal verification method.RESULTS Gastrointestinal and hematological toxicity of cervical cancer VMAT gradually increased with radiotherapy and reached the peak at the end of radiotherapy.The main adverse reactions were diarrhea,abdominal pain,colitis,anal swelling,and blood in the stool.There was no significant difference in the incidence of gastrointestinal toxicity between the radical and postoperative adjuvant radiotherapy groups(P>0.05).There were significant differences in the small intestine V_(20),V_(30),V_(40),and rectal V40 between adjuvant radiotherapy and radical radiotherapy after surgery(P<0.05).Univariate and multivariate analyses revealed anal bulge rating(OR:14.779,95%CI:1.281-170.547,P=0.031)and disease activity index(DAI)score(OR:53.928,95%CI:3.822-760.948,P=0.003)as independent predictors of SARE.CONCLUSION Anal bulge rating(>0.500 grade)and DAI score(>2.165 points)can predict SARE.The nomogram shows potential value in clinical practice.

Subgroups of peripheral immune effector cells in cervical cancer patients are more sensitive to radiation therapy than chemotherapy

Background:CD8 positive T lymphocytes and natural killer(NK)cells in the peripheral blood of cervical cancer patients exhibit varying sensitivities to radiotherapy and chemotherapy.Methods:A total of 50 healthy peoples and 60 cervical cancer patients were recruited.The patients with cervical cancer were separated into two groups:radiation and chemotherapy,and blood sample were collected before and after treatment.Data on the proportion of CD8 positive T lymphocytes and NK cells were gathered for analytical evaluation.Results:Compared to healthy individuals,patients with cervical cancer exhibit a reduced proportion of CD8 positive T cells within their peripheral blood.And for patients with cervical cancer,radiation therapy has been found to be more effective than chemotherapy in increasing the proportion of CD8 positive T lymphocytes and NK cells.Conclusions:These results suggest that radiation therapy increases the levels of CD8 positive T lymphocytes and NK cells within the peripheral blood of patients with cervical cancer.The study hypothesis that the changes in the percentage of CD8 positive T lymphocytes may serve as a potential indicator for predicting treatment efficacy.

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.

早期宫颈癌根治术后放化疗预后影响因素的研究进展

早期宫颈癌患者在行根治术后一旦出现复发,需要协助放化疗等辅助治疗,但接受辅助治疗患者预后相对较差,且生存情况也不理想,给患者日常生活带来严重影响。因此,明确早期宫颈癌术后放化疗预后的影响因素对改善患者生活质量尤为重要。影响早期宫颈癌术后放化疗预后的影响因素较多,包括术后放化疗方案、放疗技术、早期宫颈癌根治术后放化疗的时间段以及盆腔淋巴结转移等,现阶段临床尚无统一意见,还有诸多可能的影响因素有待临床大量研究证实。

3D打印技术在宫颈癌近距离放射治疗中的应用

近距离放射治疗是宫颈癌患者根治性放射治疗中必不可少的一部分,然而传统近距离放射治疗的施源器对部分术后残端复发或偏心性或大体积宫颈癌患者存在置入困难、不能适应个体化的局部病灶、剂量分布不理想等问题,继而影响疗效及预后。3D打印技术可以为患者设计个体化的施源器。3D打印技术与近距离放射治疗相结合,可以提高放射治疗的准确性。目前3D打印技术在宫颈癌近距离放射治疗中的应用主要包括构建宫颈癌模型,进行术前规划,显示肿瘤形状以及肿瘤与周围组织的解剖关系。同时还包括制作个性化施源器,减少空气间隙发生,以实现精确剂量分布。此外还包括设计平行/斜行插植针道施源器,优化针道和靶区剂量分布。综述宫颈癌近距离放射治疗中3D打印技术在上述领域的应用现状,讨论开发3D打印所需材料、系统建立及图像引导所面临的挑战。

宫颈癌外照射对肠道菌群的影响

目的研究外照射对宫颈癌患者肠道菌群的影响。方法收集宫颈癌患者67例外照射调强放射治疗前后粪便样本。利用Illumina NovaSeq高通量测序菌群,通过自身对照,将患者分为治疗前组(T0组)与治疗后组(T1组),分析肠道菌群的变化;再根据放射性肠炎程度分为无放射性肠炎组(E0组)及放射性肠炎组(E1组);根据肿瘤消退率分有效组(R1组)及效果欠佳组(R0组),分析患者肠道菌群变化。结果T0组和T1组肠道菌群的α多样性指数差异均无统计学意义(P>0.05);β多样性Bray-Curtis指数差异有统计学意义(P<0.05)。E0与E1组治疗前后α多样性指数、β多样性指数差异均无统计学意义(P>0.05),在菌群组成上,发现在外照射后E0组中放线菌目、微球菌科、罗氏菌属,E1组中乳杆菌科、拟杆菌门、拟杆菌目S24_7、Bulleidia增高;R0与R1组治疗前后α多样性指数、β多样性指数差异均无统计学意义(P>0.05);在R1组肠道中拟杆菌、毛螺菌科-Lactonifactor、巴斯德菌科、丹毒丝菌的相对丰度增高。结论宫颈癌患者外照射前后肠道菌群结构和组成均有显著改变,此变化可能与增加放射性肠炎的发生有关,并可能对近期治疗效果产生一定影响。

Effects of Moxibustion on Hemoglobin and Immunoglobulin in Cervical Cancer Patients Undergoing Radiotherapy

Objective： To observe the effects of moxibustion on hemoglobin and immunoglobulin in cervical cancer patients on radiotherapy. Methods： Sixty-six patients with cervical cancer were randomized into a moxibustion group （n=36） and a control group （n=30）, and underwent the same radiotherapy; during the radiotherapy period, the moxibustion group was given moxibustion at Shenque （CV 8） and Sanyinjiao （SP 6）, and the control group was given no other treatment. Agar diffusion method was employed to detect the concentrations of hemoglobin and immunoglobulin in peripheral blood before and after treatment. Results： After eight-week treatment, the concentrations of hemoglobin and immunoglobulin were higher in the moxibustion group than those in the control group, with a significant difference in the concentration of IgG between the two groups （P〈0.01）. Conclusion： Moxibustion can increase the concentrations of hemoglobin and immunoglobulin in cervical cancer patients on radiotherapy to improve the immunity.

宫颈癌放疗后骨盆不全骨折误诊分析

目的 探讨宫颈癌放疗后骨盆不全骨折(PIF)的诊治措施及误诊原因、防范措施。方法 回顾性分析2020年1月—2022年12月收治的误诊为骨转移癌的宫颈癌放疗后PIF 3例的临床资料。结果 本组3例均因宫颈癌放疗后出现腰骶部疼痛就诊,MRI和SPET/CT等影像学检查提示骨转移癌,建议行局部放疗,1例1个月后经术后病理检查确诊PIF,经相应治疗症状缓解;2例经对症治疗症状缓解,随访1年影像学复查未见进展诊断为PIF。结论 临床和影像学表现缺乏特异性和接诊医生诊断经验不足是导致宫颈癌放疗后PIF误诊的主要原因。对宫颈癌放疗后出现骨盆疼痛患者需综合临床表现及多种影像学检查结果进行诊断,特别要注意与骨转移癌鉴别,以避免误诊。

宫颈癌热放化随机分组治疗疗效

目的：研究热、放、化疗三种因素对宫颈癌治疗的疗效。方法：1993年10月～1994年8月对120例宫颈癌患者随机分为单纯放疗组（A）、热放疗组（B）、放化疗组（C）、热放化疗组（D），治疗结束时评价近期疗效，随访5年生存情况。结果：治疗结束时完全缓解率（CR）从高到低依次为热放化疗组（D）83．3％、热放疗组（B）60．0％、放化疗组（C）50．0％、单纯放疗组（A）46．7％。近期疗效热放化疗组（D）明显好于其它3组（P＜0．05）。A、B、C 3组疗效相近（P＞0．05）。5年生存率从高到低依次为：热放疗组（B）和热放化疗组（D）均为76．7％、单纯放疗组（A）70．0％、放化疗组（C）66．7％。5年生存率4组之间无明显差异（P＞0．05）。结论：热放化疗治疗宫颈癌近期疗效好，但未能延长生存期。

同步放化疗和单纯放疗治疗ⅡB～ⅢB期宫颈癌的疗效比较

背景与目的:同步放化疗已成为局部晚期宫颈癌的标准治疗模式,但对于放疗联合何种方案的化疗效果最佳,目前尚无一致意见。本研究中我们比较同步放化疗与单纯放疗,以及同步放化疗不同化疗方案的疗效及毒副反应。方法:2003年1月至2004年12月江西省妇幼保健院收治的符合入组标准的ⅡB～ⅢB期宫颈癌患者285例,按住院序号随机分为单纯放疗组142例,同步放化疗组143例。同步放化疗组又按化疗方案不同分为:BP(博来霉素+顺铂)方案同步放化疗51例,TP(紫杉醇+卡铂)方案同步放化疗47例,FP(氟尿嘧啶+顺铂)方案同步放化疗45例。比较单纯放疗组与同步放化疗组患者的3年生存率和不良反应,同时对同步放化疗三种不同化疗方案组的3年生存率及不良反应进行比较。结果:全组中位随访时间为42个月,单纯放疗组与同步放化疗组的3年生存率分别为65%和75%,两组比较差异有统计学意义(P=0.042)。单纯放疗组Ⅲ～Ⅳ度急性毒副反应低于同步放化疗组(P<0.001),迟发性毒副反应两组差异无统计学意义(P=0.613)。同步放化疗组BP方案、TP方案、FP方案的3年生存率分别为74%、80%和71%,三组间比较差异无统计学意义(P=0.792)。三组Ⅲ～Ⅳ度急性及迟发性毒副反应发生率相似。结论:与单纯放疗相比,同步放化疗可明显提高ⅡB～ⅢB期宫颈癌患者的疗效。在同步放化疗三种不同的化疗方案中,紫杉醇联合卡铂方案组患者3年生存率略高于其他两种化疗方案,毒副反应可耐受,值得进一步研究。

宫颈癌术后保护骨髓的调强放疗剂量学研究

背景与目的:同步放化疗已成为有高危因素的宫颈癌术后患者的标准治疗,与单纯放疗相比,同步放化疗确实提高了疗效,但同时也增加了血液学不良反应。本研究通过比较对骨髓进行限量的调强放疗(bone marrow-sparing intensity-modulated radiotherapy,BMS-IMRT)与未对骨髓进行限量的调强放疗(conventional intensity-modulated radiotherapy,IMRT)、三维适形放疗(three-dimension conformalradiation therapy,3D-CRT)在宫颈癌根治术后患者靶体积覆盖及危及器官(organ at risk,OAR)保护方面的差异,确定BMS-IMRT的剂量学优势。方法:对10例宫颈癌根治术后患者分别设计出3D-CRT(四野盒式)、IMRT和BMS-IMRT的3种治疗计划并比较靶区及危及器官剂量分布。靶区处方剂量均为45 Gy,危及器官包括骨髓、小肠、膀胱、直肠和股骨头。所有计划在Pinnacle3(Version 9.2 f)治疗计划系统上完成,最终的剂量计算采用串筒卷积迭加算法进行。结果:3组的靶区覆盖率相似(P>0.05)。BMS-IMRT组的骨髓V5、V10、V20、V30及V40均低于3D-CRT组(P<0.05),且V20、V30、V40低于IMRT组(P<0.05),而BMS-IMRT组与IMRT组小肠、膀胱、直肠的受量差异无统计学意义(P>0.05)。结论:对于宫颈癌术后患者,BMS-IMRT计划在降低骨髓剂量方面优于IMRT和3D-CRT。宫颈癌术后放疗计划设计中增加骨髓的限量有助于降低急性骨髓抑制的发生率。

宫颈癌术后三维适形放疗和共面等分设野调强放疗计划的对比分析

目的探讨宫颈癌术后三维适形放射治疗(3D-CRT)和共面等分设野调强放射治疗(IMRT)计划靶区及其周围危及器官受照剂量的差异。方法随机选择10例宫颈癌术后患者,进行CT扫描、靶区和危及器官的勾画,处方剂量50 Gy。分别进行3D-CRT和共面等分设野IMRT计划设计,计算靶区剂量均匀度指数(HI)、适形度指数(CI)、最大受照剂量、最小受照剂量、平均受照剂量和危及器官照射体积等并对结果进行比较分析。结果 5F-IMRT、7F-IMRT和9F-IMRT在靶区适形度方面明显优于3D-CRT;在危及器官(膀胱V30、V40、V50,小肠V50和直肠V30、V40、V50)保护方面,5F-IMRT、7F-IMRT和9F-IMRT明显优于3D-CRT,P<0.05。而各IMRT计划之间差异无统计学意义,P>0.05。结论宫颈癌术后辅助放疗共面等分IMRT计划无论在靶区适形度还是正常组织保护方面均优于3D-CRT,同时也证实7野或9野IMRT未必较5野获益更多。5野与7、9野的IMRT相比,在治疗时间及费用方面有独特的优势,值得在临床上推广。

多西他赛联合卡铂同步放化疗门诊治疗中晚期宫颈癌的近期疗效观察

目的观察多西他赛联合卡铂同步放化疗门诊治疗中晚期宫颈癌患者的近期疗效及毒副作用。方法选择81例中晚期宫颈癌患者,给予多西他赛75 mg/m2+卡铂300 mg/m2,静脉滴注,21 d为1个周期。所有患者完成3～4个周期化疗;同步行宫颈放疗(体外照射加192Ir腔内照射)。观察治疗的近期疗效及毒副作用。结果 81例患者中完全缓解79例、部分缓解2例、稳定0例、进展0例,有效率100.0%。主要毒副作用为胃肠道反应、骨髓抑制、放射性肠炎、放射性膀胱炎,其发生率分别为58.0%、40.7%、16.0%、11.1%。无放化疗相关死亡病例。结论多西他赛联合卡铂同步放化疗治疗中晚期宫颈癌,近期疗效确切、耐受性好,可用于门诊治疗。

不同剂量顺铂周化疗治疗ⅡB期～ⅣA期宫颈癌的疗效评价

目的:观察放疗联合不同剂量顺铂周疗方案治疗中晚期宫颈癌的治疗效果,探寻宫颈癌最佳的治疗方案。方法:收集2007年1月—2008年6月本院收治的符合入组标准的ⅡB～ⅣA期宫颈癌患者135例,按住院序号随机分为单纯放疗45例(单纯放疗组);同步放化疗90例(同步放化疗组),其中顺铂周疗20mg.m-2低剂量组45例及40mg.m-2标准剂量组45例。比较单纯放疗组与同步放化疗组患者的3年生存率及相关毒性反应发生率。同时对同步放化疗组中的2种不同剂量顺铂周疗方案组患者的3年生存率及相关毒性反应发生率进行比较。结果:全组中位随访时间42(6～51)个月。单纯放疗组患者与同步放化疗组患者3年生存率分别是68.9%和83.3%,2组比较差异有统计学意义(χ2=3.858,P<0.05)。单纯放疗组Ⅲ-Ⅳ级急性毒性反应发生率低于同步放化疗组(χ2=4.072,P<0.05)。同步放化疗组中,20mg.m-2低剂量组及40mg.m-2标准剂量组患者的3年生存率分别为82.2%和84.4%,2组比较差异无统计学意义(χ2=0.090,P>0.05)。20mg.m-2低剂量组急性毒性反应发生率明显低于40mg.m-2标准剂量组患者(χ2=3.920,P<0.05)。结论:与单纯放疗比较,同步放化疗可明显提高ⅡB期～ⅣA期宫颈癌的疗效。在同步放化疗中,与40mg.m-2标准剂量顺铂比较,20mg.m-2低剂量顺铂可以在不降低患者疗效的同时,降低患者Ⅲ-Ⅳ级急性毒性反应的发生率。

鼻咽癌低熔点铅挡块面颈联合野设野方法的探讨

目的：探讨鼻咽癌等中心放疗低熔点铅挡块面颈联合野的设野方法。方法：利用鼻咽＋上颈部 CT/MRI扫描，采用等中心体位固定方法模拟定位并拍摄面颈部 X线照片，根据鼻咽病灶侵犯的范围描画照射靶区，制作低熔点铅挡块。结果：（ 1）常规第一段面颈联合野前上界与眼眶缘的距离 15～ 20 mm；前下界与上颌窦底壁的距离 5 mm；上界平筛窦顶壁；后上界与上 1/3斜坡距离 5 mm；后下界与下 1/3斜坡距离 10～ 15 mm。第二段面颈分野的后下界向前移 5～ 10 mm；下界上移至下颌角水平。口咽受累时，两段均用面颈联合野，但后界前移至颈椎体后缘，其颈后三角区用 8～ 12 MeV电子线照射。（ 2）根据鼻咽癌侵犯的范围相应扩展局部照射野。结论：（ 1）等中心面颈联合野设野原则可根据鼻咽癌侵犯的范围做个体化放疗设计。（ 2）通过精确的适形设野，可使照射靶区设计更合理 ,并更有效地遮挡邻近重要器官。

奈达铂同步调强放疗治疗局部晚期宫颈癌的临床研究

目的比较奈达铂或顺铂同步调强放化疗治疗局部晚期宫颈癌的近期疗效及不良反应。方法协和医院肿瘤中心2009年8月至2011年8月收治的经病理证实的ⅡB至ⅣA期宫颈癌患者86例,分为奈达铂组和顺铂组。均采用盆腔调强放射治疗联合后装治疗,盆腔放疗大体肿瘤靶区(GTV)剂量56Gy/28f,盆腔淋巴结引流区(CTV)剂量50Gy/28f,后装剂量25～30Gy。奈达铂组:放疗第1天起予奈达铂25mg/m2静滴,每周1次,5～6次;顺铂组:放疗第1天起予顺铂25mg/m2静滴,每周1次,5～6次。结果两组有效率均达100.0%,奈达铂组的完全缓解率为89.1%,顺铂组为87.5%,差异无统计学意义。奈达铂组食欲减退、恶心、呕吐及体重下降的发生率明显低于顺铂组(P<0.05),奈达铂组白细胞减少、血小板减少的发生率略高于顺铂组,但差异无统计学意义。两组急性放射性膀胱炎及2级以上放射性直肠炎的发生率均较低。结论奈达铂或顺铂联合同步调强放疗治疗局部晚期宫颈癌疗效相似,但奈达铂的恶心、呕吐反应较轻,耐受性优于顺铂。