Comparative Study between Patients Treated with Conventional Radiotherapy and IMRT with Chemotherapy for Stage III - IVA Nasopharyngeal Carcinoma: A Single Institution Retrospective Report

Introduction: Nasopharyngeal carcinomas are the most radiation-sensitive tumours, and radiotherapy alone provides better local control. Objectives: To evaluate the clinical efficacy and acute and late toxicities of two different treatment regimens for locally advanced nasopharyngeal carcinoma. Methods: From 2014 to 2017, 150 cases of stage III and 68 cases of stage IVA nasopharyngeal carcinoma were treated. Of these, 137 received conventional radiotherapy plus chemotherapy, and 81 received intensity-modulated radiotherapy plus chemotherapy. Chemotherapy was given either as induction, concurrent or adjuvant therapy. Survival rates were calculated according to Kaplan Meier and compared with the Log-rank test. The RTOG or EORTC criteria were used to assess acute and late toxicities. Results: The median follow-up time was 21.5 months, and the 2-year locoregional relapse-free survival, distant metastases-free survival, and overall survival rates in the conventional radiotherapy plus chemotherapy group were 76%, 71% and 77%, respectively;in the intensity-modulated radiotherapy plus chemotherapy group, they were 97%, 84%, and 100%, respectively. The difference in survival between the two groups was significant (χ2 = 5.06, P = 0.028). The incidence of grade 2 and 3 xerostomia one year after radiotherapy was 45.1% and 30.9% versus 33.3% and 0%. Conclusion: Compared with conventional radiotherapy plus chemotherapy, intensity-modulated radiotherapy plus chemotherapy offers better locoregional relapse-free survival and overall survival in patients with stage III and IVA nasopharyngeal carcinoma, and may significantly reduce the occurrence of radiation-induced xerostomia.

Fat clearance and conventional fixation identified ypN0 rectal cancers following intermediate neoadjuvant radiotherapy have similar long-term outcomes

BACKGROUND As a prognostic factor for colorectal cancer,lymph node(LN)status,particularly the number of LN harvested,has been demonstrated to be essential in the evaluation of quality control in terms of surgical specimen.Neoadjuvant chemoradiation,however,decreases the LN harvest.Therefore,certain approaches(such as fat clearance or methylene blue)has drawn significant attention in order to raise LN yield.AIM To compare the long-term oncologic outcome of ypN0 rectal cancer identified using fat clearance(FC)or conventional fixation(CF)following 30 Gy in 10 fractions(30 Gy/10f)of neoadjuvant radiotherapy(nRT).METHODS Three hundred and eighty-two patients with resectable and locally advanced rectal cancer were treated by 30 Gy/10f intermediate nRT(biologically equivalent dose of 36 Gy)plus total mesorectal excision.Two specimen fixation methods(FC or CF)were non-randomly used.The ypN0 status was identified in 124 and 101 patients in the FL and CF groups,respectively.Primary endpoints were local recurrence-free survival(LRFS)and cancer-specific survival(CSS).RESULTS The median follow-up of patients was 5.1 years.The median numbers of retrieved LNs in the FC and CF groups were 19.5(range,4-47)and 12(range,0-44),respectively,with a significant difference(P=0.000).The percentages of patients with 12 or more retrieved nodes were 82.3%and 50.5%(101/159)in the FC and CF groups,respectively,with a significant difference(P=0.000).The LRFS at 5 years were 95.7%and 94.6%in the FC and CF groups,respectively,without statistical difference(P=0.819).The CSS at 5 years were 92.0%and 87.2%in the FC and CF groups,respectively,without statistical difference(P=0.482).CONCLUSION For patients with ypN0 rectal cancer who underwent 30 Gy/10f preoperative radiotherapy,the increased retrieval of LNs using fat clearance is not associated with survival benefit.This time-consuming fixation method has a low efficacy as a routine practice.

Hypofractionated versus Conventionally Fractionated Radiotherapy in Post-Mastectomy Breast Cancer Patients

Background & Objective: Hypofractionation has been used in curative setting in breast conservative surgery, but still no adequate information about its application in the adjuvant setting after mastectomy in breast cancer patients. The aim of this trial was to assess the efficacy and toxicity of hypofractionation radiotherapy (40 Gy in 15 fractions) in post mastectomy breast cancer patients and to compare these results with those of post mastectomy patients treated retrospectively by conventional radiotherapy (50 Gy in 25 fractions) as regard overall survival (OS), disease free survival (DFS), locoregional disease free survival (LDFS), and toxicities. Patients & Methods: One hundred post mastectomy breast cancer patients were included into this study, they were divided into 2 groups, the 1st included 50 patients treated prospectively with hypofractionated radiotherapy regimen (40 Gy in 15 fractions), and the 2nd (control group) included 50 patients treated retrospectively with conventionally fractionated radiotherapy regimen (50 Gy in 25 fractions). Results: The 2 year overall survival were 96% & 94% respectively (p = 0.7), while the disease free survival were 91% & 89.8%, respectively (p = 0.9), and the LDFS were 95.8% & 93.3%, respectively (p = 0.9), G1 acute dermatitis was observed in 22 (44%) & 25 (50%) patients in group I & II respectively, G2 in 8 (16%) & 10 (20%) patients respectively, no G4 skin toxicity was detected. Radiation pneumonitis was observed in 2 patients (4%) only in group II. Conclusion: post-mastectomy hypofractionated radiation therapy achieved comparable survival and toxicity to the conventionally fractionated radiotherapy with the advantage of reducing overall treatment time, treatment burden & cost.

Analysis of the efficacy and safety of conventional radiotherapy of chest wall and clavicular field and three-dimensional conformal radiotherapy in patients after modified radical mastectomy

Objective:To explore the efficacy and safety of conventional radiotherapy of chest wall and clavicular field and three-dimensional conformal radiotherapy in patients after modified radical mastectomy.Methods: A total of 84 patients who were admitted in our hospital after modified radical mastectomy were included in the study and divided into the conventional radiotherapy group (n=42) and the three-dimensional conformal radiotherapy group (n=42) according to different radiotherapy methods. The patients in the conventional radiotherapy group were given conventional radiotherapy of chest wall and clavicular field, while the patients in the three-dimensional conformal radiotherapy group were given three-dimensional conformal radiotherapy. The serum tumor markers and peripheral blood T lymphocyte subsets 6-8 weeks after treatment in the two groups were detected. The clinical efficacy, and toxic and side effects in the two groups were evaluated.Results: The serum CA15-3, CA125, CEA, and CK19 levels after treatment in the two groups were significantly reduced when compared with before treatment, CD3+,CD4+, and CD4+/CD8+ were significantly elevated, while CD8+ was significantly reduced when compared with before treatment, but the comparison of the above indicators between the two groups was not statistically significant. The occurrence rate of radioactive skin damage and pneumonia after treatment in the conventional radiotherapy group was significantly higher than that in the three-dimensional conformal radiotherapy group. Conclusions:The two kinds of radiotherapy schemes have an equal efficacy, but the toxic and side effects of three-dimensional conformal radiotherapy are significantly lower than those by the conventional radiotherapy, with a certain advantage.

Recent advances in breast cancer radiotherapy:Evolution or revolution,or how to decrease cardiac toxicity?

Radiation therapy has a major role in the management of breast cancers.However,there is no consensus on how to irradiate and on volume definitions,and there are strong differences in strategies according to different centers and physicians.New treatment protocols and techniques have been used with the principal purpose of decreasing lung and heart toxicity and adapting radiation treatment to patients' anatomy.There is evidence that indicates internal mammary chain radiotherapy should be used carefully and that high quality techniques should be used for decreasing the dose delivered to the heart.This review of the literature presents the state of the art on breast cancer radiotherapy,with special focus on the indications,techniques,and potential toxicity.

ALTERNATING CHEMOTHERAPY AND FRACTIONATED RADIOTHERAPY AS A MODALITY FOR THE TREATMENT OF PRIMARY LIVER CANCER

Alternating chemotherapy and fractionated radiotherapy were carried out in 32 patients with surgically proven unresectable primary liver cancer (PLC).After initial surgical intervention of hepatic artery ligation and cannulation,the tumor war localized with silver clips.The cisplatin 20 mg was infused via a hepatic artery catheter per day on the first 3 consecutive days.Fractionated radiation(18MV straight linear accelerator)of 250 cGy,twice a day with an interval of 6 hours,was then followed on the 8th,9th and 10th days.The cycle was repeated 3 or 4 times.The shrinkage of tumors and decrease of AFP level were observed in 100%(32/32)and 5% (19/21)of the patients respectively.A second-stage resection was done in 37.5%(12/32)of the patients.The 1-,3- and 5-year survival rates after resection were 96.7% ,67.5% and 67. 5 % respectively.It is suggested that this modality is a choice of therapies which can convert some unresectable large PLC to resectable ones.

Clinical Research on Three-Dimensional Conformal Radiotherapy of Non-Small Cell Lung Cancer

OBJECTIVE To investigate the clinical efficacy and toxic effect of the 3-dimensional conformal radiation therapy(3DCRT)for non- small cell lung cancer(NSCLC). METHODS Fifty-two patients with the Stage-I and IV NSCLC were treated with 3DCRT.Cross analysis of the clinical data was conducted in the comparison between the 52 cases with 3DCRT and the other 50 cases with the conventional radiation therapy (CRT).In the 3DCRT group,only the primary tumor and positive lymph-node draining area were included in the clinical target area,setting 4 to 6 coplanar or non-coplanar irradiation fields,with 2 Gy or 3 Gy/fraction,1 fraction a day and 5 fractions per week. The total dose ranged from a test dose(DT)of 66 Gy to 72 Gy.In the CRT group,the field area contained the primary tumor plus the homolateral hilum of the lung,the mediastinum superior or hol-mediastinum,and opposed anteroposterior irradiation.When the dosage reached DT 36～40 Gy,an oblique portal administered radiation was conducted in order to avoid injuring the spinal cord. The DT was 1.8～2.0 Gy/fraction,1 fraction a day,5 fractions per week,with a total dose of 60 Gy to 70 Gy. RESULTS The therapeutic effect(CR+PR)was 90.4% in the 3DCRT group,and was 72% in the CRT group.There was statistically significant difference between the two groups,P<0.01. There was a clinical symptom improvement attained by 96.5% and 86.4% respectively in the two groups,and there was a statistically significant difference between the groups,P<0.01.The 6-month, 1 and 2-year overall survival rates were 92.3%,75.0% and 42.3% in the 3DCRT group,and 76%,60% and 30% in the CRT group, respectively.There was a significant difference in the 6-month overall survival rate between the groups,P<0.05.There was no obvious significant difference in the 1 and 2-year overall survival rates between the two groups,P>0.05.The toxic reaction was 12.5% and 23.7% respectively in the 3DCRT and CRT groups. Acute radioactive esophagitis and leucopenia were markedly lower in the 3DCRT group than in the CRT group.There was a statistically significant difference between the groups,P<0.05.No toxic reaction of Stage-Ⅲand over was found in the 3DCRT group during radiation therapy. CONCLUSION The 3DCRT method has a satisfactory short- term efficacy and improvement of clinical symptoms in treating NSCLC,with a mild toxic reaction and good tolerance in patients. It can be used for enhancing the tumor-control rate and bettering the quality of life.

Observation of the therapeutic efficacy of stereotactic radiotherapy in 44 cases of retroperitoneal metastatic tumor

Objective: To investigate the therapeutic effects of stereotactic radiotherapy for retroperitoneal metastatic tumor. Methods: From August 1997 to October 2004, 44 patients with retroperitoneal metastatic tumors were treated with stereotactic radiotherapy. The planning target volume was encompassed by 90%–95% isodose line. Fractional dose was from 6 Gy to 8 Gy, and they were treated 2–3 times per-week and 4–8 times in all. The total radiation doses of PTV were from 32 Gy to 48 Gy. Re- sults: After the radiotherapy, the pain was obviously relieved in 81.8% patients. Three months after completion of radiotherapy passed and then, abdominal CT was performed to evaluate the results. The whole effective rate was 81.8% [CR 27.7% (12/44) and PR 54.5% (24/44)], and six months after radiotherapy, CR was 27.7% (12/44) and PR was 59.1% (26/44). The middle survival time was 12 months. Conclusion: It is suggested that stereotactic radiotherapy for retroperitoneal metastatic tumor is a safe and effective method.

闪光放射治疗对比常规放射治疗在放射性肺损伤中的机制探索

放射治疗是治疗肺癌的重要手段,但容易造成肺部损伤并降低患者生活质量。闪光放射治疗(Flash-RT)因其极短的辐射时间和高剂量率备受关注,其在保证肿瘤治疗强度的同时,能够减少正常组织毒性反应。Flash-RT能否减少放射性肺损伤成为近年重点研究课题。本综述基于文献分析方法,通过检索国内外相关文献,系统评估Flash-RT与常规剂量率放射治疗对肺损伤的影响及其机制。通过综述Flash-RT与常规剂量率放射治疗对肺损伤的影响及其机制对比,为肺癌患者的治疗提供科学依据。Flash-RT与常规剂量率放射治疗相比,可以显著减少肺损伤并提高患者生活质量。未来仍需深入探索Flash-RT的机制,开发适用于不同肿瘤的Flash-RT装置和开展大规模临床研究。

小剂量分次放疗增敏化疗在转移性结直肠癌治疗中的临床研究

目的:探究小剂量分次放疗增敏化疗在转移性结直肠癌(mCRC)治疗中的疗效及安全性。方法:根据治疗方式不同将72例一线化疗失败的mCRC患者分为观察组(n=37)和对照组(n=35)。对照组采用贝伐珠单抗^(+)化疗二线治疗。随访两年,比较两组患者的临床疗效、不良反应发生情况(白细胞、血小板)、治疗前后的血清肿瘤标志物水平[癌胚抗原(CEA)、糖类抗原199(CA199)]、免疫功能(CD3^(+)、CD4^(+)、CD8^(+))和生存情况[总生存期(OS)、无进展生存期(PFS)]。结果:观察组治疗后总有效率高于对照组(20.00%vs.43.24%,P<0.05);治疗后,两组CEA、CA199水平低于治疗前,且观察组低于对照组(P<0.05);两组CD3^(+)、CD4^(+)水平上升,且观察组高于对照组(P<0.05);CD8^(+)下降,且观察组低于对照组(P<0.05);两组白细胞下降、血小板减少等不良反应发生情况比较,差异无统计学意义(P>0.05);观察组两年OS、PFS分别为62.16%、40.54%,均高于对照组的37.14%、17.14%(P<0.05)。结论:小剂量分次放疗增敏化疗联合贝伐珠单抗^(+)化疗二线治疗mCRC具有较好的临床疗效,能改善患者的血清肿瘤标志物水平,提高其免疫功能,延长患者生存期,且具有一定安全性。

A review of the impact of FLASH radiotherapy on the central nervous system and glioma

Glioma has received considerable attention because of its potential of inducing high rates of morbidity,disability,and mortality.FLASH radiotherapy(FLASH-RT)has emerged as a popular topic in current research because of its ability to protect normal tissues.The present review summarized the current development of FLASH-RT in both the central nervous system and glioblastomas,explored the potential mechanisms underlying FLASH-RT-mediated protective effects on the central nervous system,and revealed the advantages of this new technique for glioma therapy.This study highlights the benefits and challenges of the present research and provides a reference for future research.

乳腺癌保乳术后大分割放疗与常规分割放疗的疗效及其安全性比较

目的比较早期乳腺癌保乳术后大分割放疗(HyRt)与常规分割放疗的疗效及其安全性。方法本研究为单中心、前瞻性、随机对照研究,纳入2017年5月-2019年5月唐山市人民医院收治的83例pTis-T2N0M0乳腺癌患者,接受保乳术+前哨淋巴结活检(SLNB),术后采用逆向调强放射治疗(IMRT)技术,采用随机数字表法分为大分割放疗组(n=41)与常规分割放疗组(n=42)。分析两组危及器官受量、治疗疗效、治疗失败模式及放疗相关不良反应。根据NCI CTC AE 3.0标准评估放疗相关不良反应,包括放射性皮炎、放射性肺炎、乳腺/皮肤纤维化、肺纤维化等。结果最终纳入83例乳腺癌患者,中位年龄44(26~67)岁。两组患者的年龄(P=0.443)、TNM分期(P=0.335)、分子分型(P=0.333)、分化程度(P=0.617)、病理类型(P=0.127)等临床参数比较,差异无统计学意义。与常规分割放疗组比较,大分割放疗组患者的患侧肺V5(25.6%vs.33.8%,P=0.015)、患侧肺V20(13.3%vs.17.2%,P=0.042)及患侧肺平均照射剂量(MLD;7.4 Gy vs.10.4 Gy,P=0.020)均明显降低。本组仅3例患者出现远处转移,未观察到区域淋巴结转移及局部复发。大分割放疗组与常规分割放疗组2年无进展生存(PFS)率无明显差异(94.4%vs.85.2%,P=0.818)。与常规分割放疗组比较,大分割放疗组≥Ⅱ级放射性皮炎发生率明显降低(2.4%vs.21.4%,P=0.015);大分割放疗组与常规分割放疗组Ⅰ级乳腺/皮肤纤维化发生率无明显差异(19.5%vs.14.3%,P=0.570),两组均未观察到≥Ⅲ级放疗相关不良反应。结论相较全乳常规放疗同期瘤床加量照射,早期乳腺癌保乳术后患者行HyRt耐受性好,不良反应发生率低,可作为首选的放射治疗模式。

大体积脑转移瘤大分割后程缩野放疗的剂量学及临床疗效分析

目的探讨大分割后程缩野放疗对大体积脑转移瘤患者的剂量学及其临床疗效分析。方法收集20例病灶体积6~20 cm^(3)、病灶数目1~4个且行大分割后程缩野放疗的脑转移瘤患者资料。脑部病灶处方剂量为52.5 Gy/3.5 Gy/15 f。治疗10次后复查颅脑增强MRI评估疗效、若肿瘤退缩明显重新勾画靶区完成后程放疗。评估不缩野放疗计划(Plan1)和后程缩野放疗计划下(Plan2)脑组织及其他危及器官剂量学参数变化、后程计划缩瘤率、近期疗效(疗后2~3个月评估近期疗效)。结果后程缩野放疗中脑组织及危及器官的辐射剂量都有下降。且后程缩野时平均缩瘤率为41.76%,3个月ORR为90.5%,6个月LCR为100%。结论大分割后程缩野放疗缩瘤率高,能有效减少正常组织剂量学参数值,对大体积病灶局部控制率好,近期疗效佳。

前列腺癌大分割与常规分割图像引导放疗中注入水凝胶后的直肠毒性比较研究

目的比较前列腺癌(prostate cancer,PCa)大分割和常规分割放疗中注入水凝胶后的直肠毒性。方法筛选2022-10/2023-10月作者医院放疗科PCa患者130例,收集其临床资料用于前瞻性研究。采用简单随机分配法将患者分为注入水凝胶的大分割放疗组(n=50)和常规分割放疗组(n=80)。采用美国肿瘤放射治疗协作组织(radiation therapy oncology group,RTOG)急性不良反应评价标准和常见不良事件评价标准(common adverse event evaluation criteria,CTCAE)5.0版评价和比较两组PCa患者急性和晚期放射性直肠炎(radiation proctitis,RP)发生率。结果两组PCa患者基线资料比较差异均无统计学意义(P>0.05)。大分割放疗组、常规分割放疗组PCa患者发生急性Ⅰ级RP的发生率为12.00%和17.50%,发生晚期Ⅰ级RP的发生率为4.00%和5.00%,均无患者发生急性或晚期Ⅰ级以上RP,两组PCa患者急性和晚期Ⅰ级RP发生率比较差异均无统计学意义(P>0.05)。结论两种放射疗法中注入水凝胶后直肠毒性较为接近,水凝胶的应用具有一定的普适性。

基于LQ模型的原发性肝癌立体定向放射治疗剂量学实验

目的:探讨肝癌立体定向放射治疗(SBRT)的剂量学效应是否符合线性二次(LQ)模型。方法:选取体外培养的人肝癌细胞株HepG2和Hep3B,给予生物有效剂量(BED)照射(6、8、10、12、14 Gy)。照射分割方式包括单次照射(模拟SBRT)和分次照射3次、5次(模拟IMRT)。检测辐照后存活分数反应不同分割方式的损伤效应;绘制生存曲线,观察不同分割方式对细胞增殖的影响;辐照后细胞划痕实验,观察不同分割方式对细胞侵袭和迁移能力的影响。结果:LQ模型在肝癌SBRT放疗的应用体外验证中出现明显的分离效应。对于HepG2细胞和Hep3B细胞,当BED<12 Gy(α/β=10 Gy)时,不同分割方式在损伤效应、增殖能力、侵袭能力上未显示出明显差异,SBRT符合LQ模型;当BED≥12 Gy时,单次分割相对于多次分割,显示出更高的损伤效应,即SBRT损伤效应高于IMRT。结论:SBRT在肝癌中适用LQ模型具有一定的剂量区间,超过该区间损伤效应高于LQ模型预测结果。

Comparison of linac-based fractionated stereotactic radiotherapy and tomotherapy treatment plans for intra-cranial tumors

This study compares and analyzes stereotactic radiotherapy using tomotherapy and linac-based fractionated stereotactic radiotherapy in the treatment of intra-cranial tumors,according to some cases.In this study,linac-based fractionated stereotactic radiotherapy and tomotherapy treatment were administered to five patients diagnosed with intra-cranial cancer in which the dose of 18–20 Gy was applied on 3–5 separate occasions.The tumor dosing was decided by evaluating the inhomogeneous index （II） and conformity index （CI）.Also,the radiation-sensitive tissue was evaluated using low dose factors V1,V2,V3,V4,V5,and V10,as well as the non-irradiation ratio volume （NIV）.The values of the II for each prescription dose in the linacbased non-coplanar radiotherapy plan and tomotherapy treatment plan were （0.125±0.113） and （0.090±0.180）,respectively,and the values of the CI were （0.899±0.149） and （0.917±0.114）,respectively.The low dose areas,V1,V2,V3,V4,V5,and V10,in radiation-sensitive tissues in the linac-based non-coplanar radiotherapy plan fell into the ranges 0.3%–95.6%,0.1%–87.6%,0.1%–78.8%,38.8%–69.9%,26.6%–65.2%,and 4.2%–39.7%,respectively,and the tomotherapy treatment plan had ranges of 13.6%–100%,3.5%–100%,0.4%–94.9%,0.2%– 82.2%,0.1%–78.5%,and 0.3%–46.3%,respectively.Regarding the NIV for each organ,it is possible to obtain similar values except for the irradiation area of the brain stem.The percentages of NIV10%,NIV20%,and NIV30%for the brain stem in each patient were 15%–99.8%,33.4%–100%,and 39.8%–100%,respectively,in the fractionated stereotactic treatment plan and 44.2%–96.5%,77.7%–99.8%,and 87.8%–100%,respectively,in the tomotherapy treatment plan.In order to achieve higher-quality treatment of intra-cranial tumors,treatment plans should be tailored according to the isodose target volume,inhomogeneous index,conformity index,position of the tumor upon fractionated stereotactic radiosurgery,and radiation dosage for radiation-sensitive tissues.

分次立体定向放疗联合全脑放疗治疗乳腺癌脑转移患者的临床疗效

目的探讨分次立体定向放疗(FSRT)联合全脑放疗治疗乳腺癌脑转移患者的临床疗效。方法采用随机数字表法将140例乳腺癌脑转移患者分为观察组和对照组,每组70例,对照组患者采取全脑放疗,观察组患者采取FSRT联合全脑放疗。比较两组患者的近期疗效、生活质量[卡氏功能状态(KPS)评分]、血清学指标[CC趋化因子配体20(CCL20)、单核细胞趋化因子-1(MCP-1)、血管内皮生长因子(VEGF)]、不良反应发生情况及生存情况。结果观察组患者的总有效率为88.57%,明显高于对照组患者的68.57%,差异有统计学意义(P﹤0.01)。治疗后,两组患者KPS评分均高于本组治疗前,观察组患者KPS评分高于对照组,差异均有统计学意义(P﹤0.05)。治疗后,两组患者血清CCL20、MCP-1、VEGF水平均低于本组治疗前,观察组患者血清CCL20、MCP-1、VEGF水平均低于对照组,差异均有统计学意义(P﹤0.05)。观察组患者的不良反应总发生率为5.71%,低于对照组患者的18.57%,差异有统计学意义(P﹤0.05)。观察组患者的1年生存率为94.29%,高于对照组患者的80.00%,差异有统计学意义(P﹤0.05)。结论FSRT联合全脑放疗治疗乳腺癌脑转移患者可提高近期和远期疗效,改善生活质量,降低血清CCL20、MCP-1、VEGF水平,且安全性较好。

早期乳腺癌保乳术后瘤床不同补量放疗模式的疗效及安全性

目的 比较早期乳腺癌保乳术后全乳大分割放疗序贯瘤床大分割补量与瘤床常规分割补量的疗效及安全性。方法 按照瘤床补量放疗模式的不同将120例早期乳腺癌保乳术后全乳大分割放疗患者分为瘤床大分割组(n=30,序贯瘤床大分割补量870 cGy/3 f)和瘤床常规分割组(n=90,序贯瘤床常规分割补量1000 cGy/5 f)。比较两组患者的乳房美容效果、不良反应发生率、住院时间及预后。结果 放疗后1、6个月,两组患者的乳房美容效果优良率比较,差异均无统计学意义(P>0.05)。两组患者骨髓抑制、急性皮肤不良反应、晚期皮肤不良反应、放射性肺炎发生率比较,差异均无统计学意义(P>0.05)。两组患者的住院时间比较,差异无统计学意义(P>0.05)。两组患者的2年局部控制率和生存率均为100%。结论 早期乳腺癌保乳术后全乳大分割放疗已成为目前放疗的主流模式,序贯瘤床大分割补量与序贯瘤床常规分割补量的乳房美容效果和不良反应均无明显差异,患者的2年局部控制率及生存率均较高。在瘤床区域有钛夹标记的前提下,可优先选择更精准的三维适形调强放疗技术进行大分割瘤床补量放疗。

低剂量分次放疗增敏化疗治疗晚期结直肠癌的临床效果

目的:探讨对晚期结直肠癌患者采取低剂量分次放疗增敏化疗(LDFRT)治疗的有效性及可行性。方法:选取2017年3月—2019年3月广西科技大学第一附属医院肿瘤科经病理学或组织学确诊的40例晚期结直肠癌患者为研究对象,按照随机数字表法分为对照组和试验组,各20例。对照组给予常规化疗治疗,试验组在对照组基础上联合LDFRT治疗。比较两组近期疗效、不良反应、总生存期(OS)和无进展生存期(PFS)、免疫功能。结果:试验组客观缓解率高于对照组,差异有统计学意义(P=0.038);试验组中位OS、PFS长于对照组,差异有统计学意义(P<0.05);试验组、对照组不良反应发生率比较,差异无统计学意义(P>0.05);治疗后,试验组CD8+低于对照组,CD4+、CD4+/CD8+、中性粒细胞计数、淋巴细胞计数水平均高于对照组,差异有统计学意义(P<0.05)。结论:LDFRT治疗晚期结直肠癌患者效果较好,能延长患者无进展生存时间,增加患者免疫功能,不会增加不良反应。

不同分割模式调强放疗NSCLC脑部寡转移的疗效及放射性脑损伤发生情况分析

目的研究不同分割模式调强放疗对NSCLC脑部寡转移的疗效及放射性脑损伤发生情况及预后分析。方法选取收治的82例非小细胞肺癌(NSCLC)脑部寡转移患者作为研究对象,根据患者的分割模式分为大分割组(n=38)和对照组(n=44)。对比两组患者放疗后的临床疗效以及放射性脑损伤发生率;对比两组患者治疗期间不良反应发生率和1年生存率。结果相比于对照组临床有效率[65.91%(29/44)],大分割组[78.95%(30/38)]显著更高(P<0.05);大分割组患者放射性脑损伤发生率[7.89%(3/38)]与对照组[4.55%(2/44)]相比,差异无统计学意义(P>0.05);大分割组患者不良反应发生率[10.53%(4/38)]与对照组[11.36%(5/44)]相比,差异无统计学意义(P>0.05);大分割组患者1年内生存率[63.16%(24/38)]与对照组患者[59.09%(26/44)]相比,差异无统计学意义(P>0.05)。结论与常规分割模式调强放疗相比,大分割模式调强放疗治疗NSCLC脑部寡转移疗效更高,但放射性脑损伤、不良反应发生率以及1年内生存率并不具有差异性。