Purpose: Lung toxicity is a primary side effect in stereotactic radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). We aimed to use a set of radiobiological models to evaluate and compare modern IM...Purpose: Lung toxicity is a primary side effect in stereotactic radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). We aimed to use a set of radiobiological models to evaluate and compare modern IMRT delivery techniques with three-dimensional conformal techniques for SBRT treatment of NSCLC in terms of lung toxicity, and aimed to compare the results from different radiobiologcal models. Methods: Ten early-stage NSCLC patients treated with SBRT were retrospectively selected. Five treatment plans were generated to deliver 50 Gy in five fractions to the planning target volume for each case: a helical tomotherapy (HT) plan, two three-dimensional cofnromal radiotherapy (3D-CRT) plans using 6-MV and 10-MV photon beams respectively, and two volumetric modulated arc therapy (VMAT) plans using one and two arc fields respectively. The lung RDV was calculated with three parallel functional sub-unit (FSU) models and two normal tissue complication probability (NTCP) models. Results: Both the HT and VMAT plans showed significantly higher contralateral mean lung dose and lower ipsilateral mean lung dose compared to the 3D-CRT plans. There was no statistically significant difference in terms of lung toxicities between the IMRT and 3D-CRT techniques using either the FSU models or the NTCP models. Based on both the FSU and the NTCP models, there was strong correlation between lung toxicity and the mean lung dose in SBRT treatment plans. Conclusions: Based on both the NTCP and parallel FSU models, both IMRT and traditional 3D-CRT delivery techniques could achieve comparable lung sparing inn SBRT treatment of early-stage lung cancer. However, the validity of the radiobiological model results should be checked by clinical data.展开更多
目的:探讨立体定向体部放射治疗(stereotactic body radiotherapy,SBRT)在原发性肝癌(Primary he-patic carcinoma,PHC)放疗中的剂量学特点和临床价值,证实SBRT是PHC放射治疗的发展方向。方法:2009年1月至8月,可行放疗的PHC患者50例,CT...目的:探讨立体定向体部放射治疗(stereotactic body radiotherapy,SBRT)在原发性肝癌(Primary he-patic carcinoma,PHC)放疗中的剂量学特点和临床价值,证实SBRT是PHC放射治疗的发展方向。方法:2009年1月至8月,可行放疗的PHC患者50例,CT薄层定位扫描,将图像分别输入SBRT和三维适形放射治疗(3DCRT)计划系统,同一病例做两个治疗计划,对靶区内剂量分布、危及器官(OARs)受量、适形度等进行对比。结果:SBRT计划中靶区剂量显著高于3DCRT,正常肝脏和邻近OARs的重要剂量学指标均显著性低于3DCRT,两计划中适形指数(CI)和病灶覆盖率(Coverage)无统计学差异(P>0.05),均匀指数(HI)对比差异有显著性(P<0.05)。SBRT治疗后3个月左右复查CT,观察疗效。50例患者均完成治疗和接受随访复查,局部控制率为88%,半年、1年生存率分别为86%、70%。不良反应少且轻,经处理可缓解消失。结论:SBRT在肝癌放疗中具有明显的剂量学优势,值得推广运用。展开更多
目的:探讨立体定向放疗(stereotactic body radiotherapy,SBRT)对不可手术切除的肝转移癌患者的临床疗效。方法:回顾性分析2018年3月至2019年11月同济大学附属东方医院收治的28例肝转移癌患者的临床资料。予4D-CT或呼吸门控技术进行CT...目的:探讨立体定向放疗(stereotactic body radiotherapy,SBRT)对不可手术切除的肝转移癌患者的临床疗效。方法:回顾性分析2018年3月至2019年11月同济大学附属东方医院收治的28例肝转移癌患者的临床资料。予4D-CT或呼吸门控技术进行CT模拟定位,予肝转移病灶50Gy/10f的剂量分割模式。结果:所有患者均顺利完成全程放疗。半年和1年的总生存率(overall survival,OS)为95.0%和70.1%。1年的局部控制率(local control,LC)为92.2%。常见的不良反应为Ⅰ~Ⅱ级的恶心、纳差、腹痛等,无Ⅲ级以上的不良反应发生。结论:以50Gy/10f分割模式的立体定向放射治疗技术治疗肝转移癌安全有效。展开更多
随着恶性肿瘤综合治疗的发展,发生脊柱转移的患者预期寿命延长,提高脊柱转移瘤的局部控制率成为临床关注的热点。立体定向放射治疗(stereotactic body radiotherapy,SBRT)是利用高度适形的放疗计划和图像引导技术,将根治性的放射剂量通...随着恶性肿瘤综合治疗的发展,发生脊柱转移的患者预期寿命延长,提高脊柱转移瘤的局部控制率成为临床关注的热点。立体定向放射治疗(stereotactic body radiotherapy,SBRT)是利用高度适形的放疗计划和图像引导技术,将根治性的放射剂量通过外照射的方式聚焦到肿瘤部位,达到消灭肿瘤的目的。目前越来越多SBRT技术用于脊柱转移瘤的治疗。为更好地治疗脊柱转移瘤,NOMS(neurologic,oncologic,mechanical,and systemic)决策框架的概念被引入临床实践中,它将立体定向放射治疗、分离手术、脊柱的稳定和常规分割放疗联合起来,为脊柱转移瘤提供最佳治疗策略。脊柱转移瘤SBRT,局控率高,副作用小,但是需要注意危及器官剂量的限制。该文对NOMS中关于脊柱转移瘤SBRT的一些建议进行解读,为临床肿瘤放射医师提供参考。展开更多
文摘Purpose: Lung toxicity is a primary side effect in stereotactic radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). We aimed to use a set of radiobiological models to evaluate and compare modern IMRT delivery techniques with three-dimensional conformal techniques for SBRT treatment of NSCLC in terms of lung toxicity, and aimed to compare the results from different radiobiologcal models. Methods: Ten early-stage NSCLC patients treated with SBRT were retrospectively selected. Five treatment plans were generated to deliver 50 Gy in five fractions to the planning target volume for each case: a helical tomotherapy (HT) plan, two three-dimensional cofnromal radiotherapy (3D-CRT) plans using 6-MV and 10-MV photon beams respectively, and two volumetric modulated arc therapy (VMAT) plans using one and two arc fields respectively. The lung RDV was calculated with three parallel functional sub-unit (FSU) models and two normal tissue complication probability (NTCP) models. Results: Both the HT and VMAT plans showed significantly higher contralateral mean lung dose and lower ipsilateral mean lung dose compared to the 3D-CRT plans. There was no statistically significant difference in terms of lung toxicities between the IMRT and 3D-CRT techniques using either the FSU models or the NTCP models. Based on both the FSU and the NTCP models, there was strong correlation between lung toxicity and the mean lung dose in SBRT treatment plans. Conclusions: Based on both the NTCP and parallel FSU models, both IMRT and traditional 3D-CRT delivery techniques could achieve comparable lung sparing inn SBRT treatment of early-stage lung cancer. However, the validity of the radiobiological model results should be checked by clinical data.
文摘目的 :采用循证医学的方法评价体部立体定向放疗联合化疗治疗晚期胰腺癌的临床效果。方法:通过检索中国知网、万方、维普、Pub Med、Embase数据库,收集有关体部立体定向放疗联合化疗治疗晚期胰腺癌相临床研究,检索时限均从建库至2021年6月。依据事先设置的文献纳入与排除标准,筛选出符合要求的临床研究,应用Rev Man 5.3软件进行Meta分析。结果:共纳入21项临床研究,总计1738例患者。Meta分析结果显示,对于晚期胰腺癌患者,使用立体定向放疗联合化疗与单独化疗比较,有较好的客观有效率(Z=9.59,P<0.001,OR=4.71,95%CI:3.43~6.46)、1年生存率(Z=5.00,P<0.001,OR=2.36,95%CI:1.69~3.31)、2年生存率(Z=3.61,P<0.001,OR=2.76,95%CI:1.59~4.79),骨髓抑制发生率(Z=0.07,P=0.95,OR=0.98,95%CI:0.51~1.87)和消化道反应发生率(Z=0.01,P=0.99,OR=1.0,95%CI:0.58~1.72)差异无统计学意义;使用立体定向放疗联合化疗与单独体部立体定向放疗比较,有较高的客观有效率(Z=4.97,P<0.001,OR=2.68,95%CI:1.82~3.95)、2年生存率(Z=4.40,P<0.001,OR=3.86,95%CI:2.11~7.04)和骨髓抑制发生率(Z=2.49,P=0.01,OR=4.51,95%CI:1.38~14.72),1年生存率Z=0.84,P=0.40,OR=1.46,95%CI:0.60~3.54)和消化道反应发生率(Z=0.84,P=0.40,OR=1.68,95%CI:0.50~5.57)差异无统计学意义。结论:立体定向放疗联合化疗治疗晚期胰腺癌有较好的临床效果,这些结果还需要未来在大样本、高质量的随机对照试验中进行评估。
文摘目的:探讨立体定向体部放射治疗(stereotactic body radiotherapy,SBRT)在原发性肝癌(Primary he-patic carcinoma,PHC)放疗中的剂量学特点和临床价值,证实SBRT是PHC放射治疗的发展方向。方法:2009年1月至8月,可行放疗的PHC患者50例,CT薄层定位扫描,将图像分别输入SBRT和三维适形放射治疗(3DCRT)计划系统,同一病例做两个治疗计划,对靶区内剂量分布、危及器官(OARs)受量、适形度等进行对比。结果:SBRT计划中靶区剂量显著高于3DCRT,正常肝脏和邻近OARs的重要剂量学指标均显著性低于3DCRT,两计划中适形指数(CI)和病灶覆盖率(Coverage)无统计学差异(P>0.05),均匀指数(HI)对比差异有显著性(P<0.05)。SBRT治疗后3个月左右复查CT,观察疗效。50例患者均完成治疗和接受随访复查,局部控制率为88%,半年、1年生存率分别为86%、70%。不良反应少且轻,经处理可缓解消失。结论:SBRT在肝癌放疗中具有明显的剂量学优势,值得推广运用。
文摘目的:探讨立体定向放疗(stereotactic body radiotherapy,SBRT)对不可手术切除的肝转移癌患者的临床疗效。方法:回顾性分析2018年3月至2019年11月同济大学附属东方医院收治的28例肝转移癌患者的临床资料。予4D-CT或呼吸门控技术进行CT模拟定位,予肝转移病灶50Gy/10f的剂量分割模式。结果:所有患者均顺利完成全程放疗。半年和1年的总生存率(overall survival,OS)为95.0%和70.1%。1年的局部控制率(local control,LC)为92.2%。常见的不良反应为Ⅰ~Ⅱ级的恶心、纳差、腹痛等,无Ⅲ级以上的不良反应发生。结论:以50Gy/10f分割模式的立体定向放射治疗技术治疗肝转移癌安全有效。
文摘随着恶性肿瘤综合治疗的发展,发生脊柱转移的患者预期寿命延长,提高脊柱转移瘤的局部控制率成为临床关注的热点。立体定向放射治疗(stereotactic body radiotherapy,SBRT)是利用高度适形的放疗计划和图像引导技术,将根治性的放射剂量通过外照射的方式聚焦到肿瘤部位,达到消灭肿瘤的目的。目前越来越多SBRT技术用于脊柱转移瘤的治疗。为更好地治疗脊柱转移瘤,NOMS(neurologic,oncologic,mechanical,and systemic)决策框架的概念被引入临床实践中,它将立体定向放射治疗、分离手术、脊柱的稳定和常规分割放疗联合起来,为脊柱转移瘤提供最佳治疗策略。脊柱转移瘤SBRT,局控率高,副作用小,但是需要注意危及器官剂量的限制。该文对NOMS中关于脊柱转移瘤SBRT的一些建议进行解读,为临床肿瘤放射医师提供参考。
