Three-dimensional conformal intensity-modulated radiation therapy of left femur foci does not damage the sciatic nerve

During radiotherapy to kill femoral hydatid tapeworms, the sciatic nerve surrounding the focus can be easily damaged by the treatment. Thus, it is very important to evaluate the effects of ra- diotherapy on the surrounding nervous tissue. In the present study, we used three-dimensional, conformal, intensity-modulated radiation therapy to treat bilateral femoral hydatid disease in Meriones meridiani. The focus of the hydatid disease on the left femur was subiected to radio- therapy （40 Gy） for 14 days, and the right femur received sham irradiation. Hematoxylin-eosin staining, electron microscopy, and terminal deoxynucleotidyl transferase-dUTP nick end labeling assays on the left femurs showed that the left sciatic nerve cell structure was normal, with no ob- vious apoptosis after radiation. Trypan blue staining demonstrated that the overall protoscolex structure in bone parasitized with Echinococcus granulosus disappeared in the left femur of the animals after treatment. The mortality of the protoscolex was higher in the left side than in the right side. The succinate dehydrogenase activity in the protoscolex in bone parasitized with Echi- nococcus granulosus was lower in the left femur than in the right femur. These results suggest that three-dimensional conformal intensity-modulated radiation therapy achieves good therapeutic effects on the secondary bone in hydatid disease in Meriones meridiani without damaging the morphology or function of the sciatic nerve.

Clinical observation of gemcitabine and concomitant three-dimensional conformal radiotherapy in the treatment of locally advanced non-small cell lung cancer

Objective: To evaluate the clinical effect of gemcitabine and concurrent three-dimensional conformal radiation therapy (3D-CRT) for locally advanced non-small cell lung cancer (NSCLC) . Methods: From April 2002 to June 2005, 38 pa-tients with inoperable stage III NSCLC were treated with gemcitabine and 3D-CRT simultaneously. Chemotherapy consisted of intravenously gemcitabine 350 mg/m2 on days 1, 8, 15, 22, 29, 36. 3D-CRT was delivered up to a total dose of 60–64 Gy with a 2.0 Gy dose fraction per day, 5 days per week. Results: The overall response rates of primary tumor and mediastinum metastatic node were 86.8% (33/38) and 90.6% (29/32) respectively, and 91.7% (22/24) and 78.6% (11/14) for squamous cell carcinoma and adenocarcinoma respectively. The acute side effects of patients were mostly myelosuppression, nausea, vomiting, radiation-induced esophagitis and pneumonitis (RTOG I/II), however, all of them were cured. Conclusion: Con-current application of gemcitabine and 3D-CRT can improve the overall response rate for locally advanced NSCLC without aggravating the side effects.

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.

Influences of Motion Artifacts on Three-Dimensional Reconstruction Volume and Conformal Radiotherapy Planning

Objective:To investigate the influences of motion artifacts on three-dimensional (3D) reconstruction volume and conformal radiotherapy planning. Methods:A phantom which can mimic the clip motion of lung tumor along the cranial-caudal direction is constructed by step motor, small ball of polyethylene and potato. Ten different scan protocols were set and CT data of the phantom were acquired by using a commercial GE LightSpeed16 CT scanner. The 3D reconstruction of the CT data was implemented by adopting volume-rendering technology of GE AdvantageSim 6.0 system. The reconstructed volumes of each target in different scan protocols were measured through 3D measuring tools. Thus, relative deviations of the reconstruction volumes between moving targets and static ones were determined. The three-dimensional conformal radiation therapy (3D-CRT) plans and conformal fields were created and compared for a static/moving target with the WiMRT treatment planning system (TPS). Results:For a static target, there was no obvious difference among the 3D reconstruction volumes when the CT data were acquired with different pitches and slices. The appearance of 3D reconstruction volume and 3D conformal field of a moving target was quite different from that of static one. The maximum relative deviation is nearly 90% for a moving target scanned with different scan protocols. The relative deviations are variable among the different targets, about from -39.8% to 89.5% for a smaller target and from -18.4% to 20.5% for a larger one. Conclusion:The motion artifacts have great effects on 3D-CRT planning and reconstruction volume, which will greatly induce distorted conformal radiation fields and false DVHs for a moving target.

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.

Evaluation of 3D-CRT and VMAT Radiotherapy Plans for Left Breast Cancer with Regional Lymph Nodes Irradiation

Introduction: Radiation therapy after breast surgery is an integral part of the treatment of early breast cancer. The goal of radiation therapy is to achieve the best possible coverage of the planning target volume (PTV), while reducing the dose to organs at risk (OARs) which are normal tissues whose sensitivity to irradiation could cause damage that can lead to modification of the treatment plan. In the last decade, radiation oncologist started to use the Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for irradiating the breast, in order to achieve better dose distribution and target dose to the PTV and OAR. The aim of this study is to compare 2 external radiotherapy techniques (VMAT vs 3D) for patients with node-positive left breast cancer. Patients and Methods: We randomly selected 10 cases of postoperative radiotherapy for breast cancer in our hospital. The patients are all female, the average age was 45.4 years old, and the primary lesions are left breast. The ANOVA test was used to compare the mean difference between subgroups, and the p value Results: Dose volume histogram (DVH) was used to analyze each evaluation dose of clinical target volume (CTV) and organs at risk (OARs). Compared to 3DCRT plans, VMAT provided more uniform coverage to the breast and regional lymph nodes. The max point dose for tVMAT was lower on average (106.4% for VMAT versus 109% for 3DCRT). OAR sparing was improved with tVMAT, with a lower average V17Gy for the left lung (27.91% for VMAT versus 30.04% for 3DCRT, p and lower for V28Gy (13.75% for VMAT versus 22.34% for 3DCRT, p = 0.01). We also found a lower V35Gy for the heart on VMAT plan (p = 0.02). On the contrary, dose of contralateral breast was lower in 3DCRT than VMAT (0.59 Gy vs 3.65 Gy, p = 0.00). Conclusion: The both types of plans can meet the clinical dosimetry demands of postoperative radiotherapy for left breast cancer. The VMAT plan has a better conformity, but 3CDRT can provide a lower dose to the contralateral organs (breast and lung) to avoid the risk of secondary cancers.

Role of radiation therapy in gastric adenocarcinoma

在有在美国的胃的癌症的病人的结果仍然保持令人失望，与约 23% 的五年的全面幸存率。本地人地区性的控制追随者外科的给定的高率，一个强壮的基本原理为辅助放射治疗的使用存在。使随机化的审判与辅助放射疗法显示出优异本地控制并且与辅助 chemoradiation 改进全面幸存。在由一位富有经验的外科医生经历了 D2 淋巴节点解剖的病人的辅助 chemoradiation 的利益不被知道，并且除了辅助化疗的辅助放射治疗的利益继续定义。在 unresectable 疾病， chemoradiation 在病人的一个小数字允许长期的幸存并且提供有效减轻。大多数试用独自与化疗或放射治疗相比显示出一个好处到联合形式治疗。使用外科手术前， intra 起作用， 3D 保角，并且在胃的癌症的调制放射治疗进一步正在答应，但是要求的紧张学习。当前的文章在能的将切除的治疗考察放射治疗的角色，集中于在美国的当前的建议并且 unresectable 胃的癌。

Simultaneous modulated accelerated radiation therapy for esophageal cancer:A feasibility study

AIM:To establish the feasibility of simultaneous modulated accelerated radiation therapy(SMART) in esophageal cancer(EC).METHODS:Computed tomography(CT)datasets of 10patients with upper or middle thoracic squamous cell EC undergoing chemoradiotherapy were used to generate SMART,conventionally-fractionated three-dimensional conformal radiotherapy(3DCRT)and intensity-modulated radiation therapy(cf-IMRT)plans,respectively.The gross target volume(GTV)of the esophagus,positive regional lymph nodes(LN),and suspected lymph nodes(LN±)were contoured for each patient.The clinical target volume(CTV)was delineated with 2-cm longitudinal and 0.5-to 1.0-cm radial margins with respect to the GTV and with 0.5-cm uniform margins for LN and LN(±).For the SMART plans,there were two planning target volumes(PTVs):PTV66=(GTV+LN)+0.5 cm and PTV54=CTV+0.5 cm.For the 3DCRT and cfIMRT plans,there was only a single PTV:PTV60=CTV+0.5 cm.The prescribed dose for the SMART plans was 66 Gy/30 F to PTV66 and 54 Gy/30 F to PTV54.The dose prescription to the PTV60 for both the 3DCRT and cf-IMRT plans was set to 60 Gy/30 F.All the plans were generated on the Eclipse 10.0 treatment planning system.Fulfillment of the dose criteria for the PTVs received the highest priority,followed by the spinal cord,heart,and lungs.The dose-volume histograms were compared.RESULTS:Clinically acceptable plans were achieved for all the SMART,cf-IMRT,and 3DCRT plans.Compared with the 3DCRT plans,the SMART plans increased the dose delivered to the primary tumor(66Gy vs 60 Gy),with improved sparing of normal tissues in all patients.The Dmax of the spinal cord,V20 of the lungs,and Dmean and V50 of the heart for the SMART and 3DCRT plans were as follows:38.5±2.0 vs 44.7±0.8(P=0.002),17.1±4.0 vs 25.8±5.0(P=0.000),14.4±7.5 vs 21.4±11.1(P=0.000),and 4.9±3.4vs 12.9±7.6(P=0.000),respectively.In contrast to the cf-IMRT plans,the SMART plans permitted a simultaneous dose escalation(6 Gy)to the primary tumor while demonstrating a significant trend of a lower irradiation dose to all organs at risk except the spinal cord,for which no significant difference was found.CONCLUSION:SMART offers the potential for a 6Gy simultaneous escalation in the irradiation dose delivered to the primary tumor of EC and improves the sparing of normal tissues.

Comparison of Dosiology between Three Dimensional Conformal and Intensity-modulated Radiotherapies (5 and 7 fields) in Gastric Cancer Post-surgery

The purpose of this study was to compare the dose distribution of intensity-modulated ra- diotherapy （IMRT） in 7 and 5 fields as well as 3-D conformal radiotherapy （3D-CRT） plans for gastric cancer using dosimetric analysis. In 15 patients with gastric cancer after D1 resection, dosimetric pa- rameters for IMRT （7 and 5 fields） and 3D-CRT were calculated with a total dose of 45 Gy （1.8 Gy/day） These parameters included the conformal index （CI）, homogeneity index （HI）, maximum dose spot for the planned target volume （PTV）, dose-volume histogram （DVH） and dose distribution in the organs at risk （OAR）, mean dose （Dmean）, maximal dose （Dmax） in the spinal cord, percentage of the normal liver volume receiving more than 30 Gy （V30） and percentage of the normal kidney volume receiving more than 20 Gy （V20）. IMRT （7 and 5 fields） and 3D-CRT achieved the PTV coverage. However, IMRT presented significantly higher CI and HI values and lower maximum dose spot distribution than 3D-CRT （P=0.001）. For dose distribution of OAR, IMRT had a significantly lower Dmean and Dmax in spinal cord than 3D-CRT （P=-0.009）. There was no obvious difference in V30 of liver and V20 of kidney between IMRT and 3D-CRT, but 5-field IMRT showed lower Dmean in the normal liver than other two plans （P=0.001）. IMRT revealed favorable tumor coverage as compared to 3D-CRT and IMRT plans. Specifically, 5-field IMRT plan was superior to 3D-CRT in protecting the spinal cord and liver, but this superiority was not observed in the kidney. Further studies are needed to compare differences among the three approaches.

The Effect of Absorbed Dose to Organs at Risk Following Craniospinal Irradiation Using Different Radiotherapy Techniques

Introduction: In medulloblastoma patients craniospinal irradiation is an important element the treatment. Our study aimed to evaluate the effect of absorbed dose to organs at risk using the hybrid intensity-modulated radiation therapy (IMRT) versus three-dimensional conformal radiotherapy (3DCRT) for craniospinal irradiation (CSI) in average risk medulloblastoma patients. Materials and Methods: In this study, thirteen medulloblastoma patients were included. The prescribed total dose to the planning target volume (PTV) was 23, 40 Gy in 13 fractions. Two radiotherapy techniques, three dimensional conformal radiotherapy (3DCRT) and hybrid intensity modulated radiotherapy (IMRT) were used to treat these patients. The coverage of the Target was evaluated using the D mean, D95%, D2%, D98% and V95%. Other parameters were also compared such as Integral dose (ID), Homogeneity index (HI) and doses to the organs at risk (OARs). Results: There was no significant difference in the mean dose received by the PTV-Brain or the dose received by 95% and 98% of PTV volume using the two techniques. For PTV-Spine, the percentage volume receiving 95% of the total dose increased significantly in the hybrid IMRT technique compared to the conformal technique. So, hybrid IMRT plan achieved the best coverage for PTV spine. Lower dose for OAR was delivered by 3DCRT, except the heart and thyroid, hybrid IMRT achieved better sparing. All plans resulted in the same dose homogeneity index (DHI) for PTV-Brain. For PTV-Spine, hybrid IMRT technique achieved better dose homogeneity compared to 3DCRT technique (1.09 vs. 1.12;p > 0.05). Conclusions: hybrid IMRT technique can be realized on conformal technique because it achieved better dose coverage for the (PTV) and organ at risk (OAR). 3DCRT reduced mean dose to most OARS, except the heart and thyroid. Therefore, the hybrid IMRT technique may be a CSI treatment alternative to 3DCRT.

Evaluation of endocrine therapy combined with intensity modulated radiation therapy in patients with advanced prostate cancer

Objective The aim of this study was to study the effect of endocrine therapy combined with intensity-modulated radiation therapy in patients with advanced prostate cancer.Methods The clinical data of 231 patients with advanced prostate cancer treated with radiotherapy in our hospital from May 2010 to March 2018 were collected.A total of 135 patients were treated with endocrine therapy combined with intensity-modulated radiotherapy,and 96 patients were treated with intensity-modulated radiotherapy only because of drug allergy,serious adverse reactions,and economic reasons.Two months after the end of the treatment,the short-term curative effect was evaluated using imaging reexamination.The total prostate-specific antigen(TPSA)and free prostate-specific antigen(FPSA)were detected before and 2 months after the end of the treatment.All patients were followed up for at least 3 years,and the metastasis-free survival rate and cumulative survival rate of the two groups were calculated.Results The remission rates(RRs)of the observation and control groups were 64.45%and 46.87%,respectively;the difference was not statistically significant(P>0.05);however,the efficacy distribution of the endocrine therapy combined with intensity-modulated radiotherapy group was significantly better than that of the intensity-modulated radiotherapy group(P<0.05).There was no significant difference in clinical efficacy between the two groups in different TNM stages and Gleason grades.After treatment,the levels of TPSA and FPSA were significantly decreased compared with those before treatment;however,the decrease in the endocrine therapy combined with the intensity-modulated radiation therapy(IMRT)group was significantly higher than that in the IMRT group(P<0.05).Although there were no significant differences in the 1-year and 3-year cumulative survival rates between the two groups,the 1-year and 3-year metastasis-free survival rates of the endocrine therapy combined with the IMRT group were 60%and 38.17%,respectively,which were significantly higher than those of the IMRT group(37.5%and 20.83%,P<0.05).Conclusion Endocrine therapy combined with IMRT significantly improved the clinical efficacy of advanced prostate cancer,reduced PSA(prostate specific antigen)levels,and improved the metastasis-free survival rates.

三维适形放疗治疗原发性肝癌患者疗效及发生放射性肝损伤影响因素分析

目的分析采用三维适形放疗(3DCRT)治疗原发性肝癌(PLC)患者的疗效和放射性肝损伤(RILI)发生的影响因素。方法2019年4月~2022年4月我院诊治的PLC患者85例,均接受3DCRT治疗。按照实体瘤疗效评价标准考核疗效,根据报道的标准诊断RILI。应用Logistic回归模型分析影响PLC患者接受3D-CRT治疗疗效和RILI发生的因素。结果经3D-CRT治疗,本组获得客观缓解50例(58.8%);客观缓解组TNMⅣ期和Child-Pugh B级占比分别为36.0%和14.0%,均显著低于非客观缓解组的60.0%和48.6%(P<0.05),而单次剂量为3~4 Gy和总剂量为50~60 Gy占比分别为52.0%和68.0%,均显著高于非客观缓解组的28.6%和45.7%(P<0.05);本组发生RILI者15例(17.7%);RILI组TNMⅣ期和Child-Pugh B级、单次剂量为3~4 Gy和总剂量50~60 Gy占比分别为80.0%、93.0%、73.3%和86.7%,均显著高于无RILI组(分别为38.6%、14.3%、35.7%和52.9%,P<0.05);多因素Logistic回归分析发现,TNM分期、Child-Pugh分级、单次剂量和总剂量均为影响3DCRT治疗的疗效和发生RILI的因素(OR=5.078、4.988、4.600、4.850、4.963、5.043、5.150、4.740,P<0.05)。结论PLC患者接受3DCRT治疗的疗效和RILI的发生受TNM分期、Child-Pugh分级、单次剂量和总剂量的影响,临床在制定放疗计划时,要充分考虑以上敏感因素,以保证提高疗效并显著降低RILI的发生。

卡瑞利珠单抗联合调强适形放疗用于非小细胞肺癌患者的效果

目的:观察卡瑞利珠单抗联合调强适形放疗用于非小细胞肺癌(NSCLC)患者的效果。方法:选取2021年1月至2023年2月该院收治的80例NSCLC患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各40例。对照组采用调强适形放疗,观察组在对照组基础上联合卡瑞利珠单抗治疗。比较两组临床疗效,治疗前后肿瘤标志物[糖类抗原125(CA125)、蛋白激酶B(PKB)、脂肪酸合成酶(FAS)]水平、血清学指标[肿瘤特异性生长因子(TSGF)、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(b-FGF)]水平,以及不良反应发生率。结果:观察组客观缓解率(ORR)为72.50%(29/40),高于对照组的50.00%(20/40),差异有统计学意义(P<0.05);治疗后,观察组CA125、PKB、FAS水平均低于对照组,差异有统计学意义(P<0.05);治疗后,观察组TSGF、VEGF、b-FGF水平均低于对照组,差异有统计学意义(P<0.05);两组白细胞减少、贫血、血小板减少、放射性肺炎、恶心呕吐等不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:卡瑞利珠单抗联合调强适形放疗用于NSCLC患者可提高ORR,降低肿瘤标志物、血清学指标水平,效果优于单纯调强适形放疗。

Helical tomotherapy and volumetric modulated arc therapy:New therapeutic arms in the breast cancer radiotherapy

AIM To analyse clinical and dosimetric results of helical tomotherapy(HT) and volumetric modulated arc therapy(VMAT) in complex adjuvant breast and nodes irradiation.METHODS Seventy-three patients were included(31 HT and 42 VMAT). Dose were 63.8 Gy(HT) and 63.2 Gy(VMAT) in the tumour bed, 52.2 Gy in the breast, 50.4 Gy in supraclavicular nodes(SCN) and internal mammary chain(IMC) with HT and 52.2 Gy and 49.3 Gy in IMC and SCN with VMAT in 29 fractions. Margins to particle tracking velocimetry were greater in the VMAT cohort(7 mm vs 5 mm).RESULTS For the HT cohort, the coverage of clinical target volumes was as follows: Tumour bed: 99.4% ± 2.4%; breast: 98.4% ± 4.3%; SCN: 99.5% ± 1.2%; IMC:96.5% ± 13.9%. For the VMAT cohort, the coverage was as follows: Tumour bed: 99.7% ± 0.5%, breast: 99.3% ± 0.7%; SCN: 99.6% ± 1.4%; IMC: 99.3% ± 3%. For ipsilateral lung, Dmean and V20 were 13.6 ± 1.2 Gy, 21.1% ± 5%(HT) and 13.6 ± 1.4 Gy, 20.1% ± 3.2%(VMAT). Dmean and V30 of the heart were 7.4 ± 1.4 Gy, 1% ± 1%(HT) and 10.3 ± 4.2 Gy, 2.5% ± 3.9%(VMAT). For controlateral breast Dmean was 3.6 ± 0.2 Gy(HT) and 4.6 ± 0.9 Gy(VMAT). Acute skin toxicity grade 3 was 5% in the two cohorts.CONCLUSION HT and VMAT in complex adjuvant breast irradiation allow a good coverage of target volumes with an acceptable acute tolerance. A longer follow-up is needed to assess the impact of low doses to healthy tissues.

调强放射治疗未分化型鼻咽癌的疗效及治疗前后血清sE-cad与PDGF水平变化探讨

目的探究调强放射治疗(IMRT)未分化型鼻咽癌(NPC)的临床疗效及患者治疗前后血清上皮型钙黏蛋白(sE-cad)、血小板源性生长因子(PDGF)水平变化。方法选取2019年6月—2021年6月收治的84例未分化型NPC患者作为研究对象,按照随机数字表法按1∶1比例分为观察组和对照组,每组各42例,对照组采用三维适形放射治疗(3DCRT),观察组采用IMRT治疗。治疗7周后比较两组患者临床疗效,治疗前与治疗7周后肿瘤标志物水平[癌胚抗原(CEA)、鳞状细胞癌相关抗原(SCC-Ag)、角蛋白19片段21-1(CYFRA21-1)],生活质量核心量表(QLQ-C30)评分,纤维化指标[透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原(PCⅢ)],血清sE-cad、PDGF水平及治疗期间并发症发生率。结果治疗7周后,观察组疾病控制率95.24%,显著高于对照组的80.95%(P<0.05);观察组血清CEA、SCC-Ag、CYFRA21-1水平较对照组低(P<0.05);观察组QLQ-C30评分较对照组低(P<0.05);观察组血清HA、LN、PCⅢ水平较对照组低(P<0.05);观察组血清sE-cad、PDGF水平较对照组低(P<0.05);观察组并发症发生率较对照组低(P<0.05)。结论与3DCRT相比,采用IMRT治疗未分化型NPC可有效降低肿瘤标志物及血清sE-cad、PDGF水平,提高生活质量,疗效显著,且对正常组织影响更小,安全性高。

术前三维适形放射治疗对结肠癌的疗效及其对血小板参数的影响

目的:分析术前三维适形放射治疗(3DCRT)对结肠癌的疗效及对血小板(PLT)参数的影响。方法:选取医院收治的110例结肠癌患者,根据治疗方式不同将其分为对照组(62例)和观察组(58例),对照组给予常规放射治疗,观察组给予术前3DCRT治疗,对比两组放射治疗前后PLT参数指标,统计随访放射治疗后1~3年的局部控制率、生存率及治疗期间并发症发生率。结果:放射治疗后,两组患者PLT及其平均体积(MPV)均低于治疗前,差异有统计学意义(t观察组=7.407,t=5.733;t对照组=4.977,t=2.589;P<0.05)。放射治疗后,观察组PLT、MPV及降钙素原(PCT)值低于对照组,差异有统计学意义(t=2.256,t=4.165,t=2.737;P<0.05)。观察组随访1年、2年及3年的局部控制率及生存率均高于对照组,差异均有统计学意义(χ^(2)局部控制率=4.359,χ^(2)=3.944,χ^(2)=3.910;χ^(2)生存率=3.986,χ^(2)=4.270,χ^(2)=0.011;P<0.05)。两组患者治疗期间白细胞减少率、晚期并发症发生率及全身反应发生率比较,差异均无统计学意义(χ^(2)=0.187,χ^(2)=0.006,χ^(2)=0.011;P>0.05)。结论:术前3DCRT治疗结肠癌可获得更高的肿瘤切除率,可有效调节血小板参数,并明显改善局部控制率及生存率,放射治疗相关不良反应发生率较低,患者可耐受。

对比常规放疗与三维适形放射治疗(3D-CRT)乳腺癌的临床疗效、毒副作用

目的对比常规放疗与三维适形放射治疗(3D-CRT)乳腺癌的临床疗效、毒副作用。方法选定本院2018年1月至2021年1月住院的90例乳腺癌患者,以随机法将其分组(每组n=45),对比组给予常规放疗治疗,观察组给予3D-CRT治疗,对比两组局部复发率、血清肿瘤标志物、毒副反应总发生率,统计危及器官照射剂量。结果观察组局部复发率(2.22%)低于对比组(22.22%),P<0.05(差异有统计学意义)。观察组治疗后血清糖类抗原199(CA199)、糖类抗原125(CA125)、癌胚抗原(CEA)均低于对比组,P<0.05(差异均具有统计学意义)。观察组毒副反应总发生率(8.89%)低于对比组(28.89%),P<0.05(差异具有统计学意义)。患侧肺V20、患侧肺V30、患侧肺V40、患侧肺V50、左侧心脏V30、左侧心脏V40、左侧心脏V50、分别是(15.28±2.62)cm^(3)、(10.15±3.96)cm^(3)、(1.85±0.62)cm^(3)、(0.54±0.26)cm^(3)、(2.52±1.25)cm^(3)、(2.24±0.99)cm^(3)、(0.45±0.13)cm^(3)。结论3D-CRT可有效抑制乳腺癌患者肿瘤病灶生长,降低局部复发率、血清肿瘤标志物浓度,同时可减少危及器官照射剂量,减轻毒副反应。

容积旋转调强放疗治疗宫颈癌患者的效果及对其生存期及卵巢功能的影响

目的探讨容积旋转调强放疗治疗宫颈癌术后患者对卵巢功能、生存期的影响。方法选取2019年2月至2021年1月梁山县人民医院妇科收治的74例宫颈癌患者作为研究对象,经随机数字表法分为两组,每组各37例。参照组行三维适形调强放疗,研究组行容积旋转调强放疗。评估两组的促卵泡激素(FSH)水平、生存期、卵巢功能情况。结果研究组的FSH水平低于参照组,差异有统计学意义(P<0.05);研究组的卵巢功能正常、下降、丧失占比为35.14%、37.84%、27.03%,参照组为13.51%、29.73%、56.76%,研究组的卵巢功能优于参照组,差异有统计学意义(P<0.05);两组的生存期比较,差异无统计学意义(P>0.05)。结论在宫颈癌术后患者中容积旋转调强放疗辅助治疗,相比于三维适形调强放疗对卵巢功能的影响更低,具有较高的临床应用价值。

DP化疗方案联合三维适形调强放疗用于食管癌患者的效果

目的:观察DP化疗方案联合三维适形调强放疗用于食管癌患者的效果。方法:回顾性分析2019年10月至2021年12月该院收治的96例食管癌患者的临床资料,按照治疗方式不同将其分为对照组和研究组各48例。对照组实施三维适形调强放疗,研究组在对照组基础上联合DP化疗方案治疗,比较两组客观缓解率、治疗前后血清学指标[血管内皮生长因子(VEGF)、胸苷激酶1(TK1)、表皮生长因子受体(EGFR)]水平、肿瘤标志物[鳞状上皮细胞癌抗原(SCCA)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)]水平和生命质量[欧洲癌症患者生命质量测定量表(EORTC QLQ-C30)]评分。结果:两组客观缓解率比较,差异无统计学意义(P>0.05);治疗后,两组VEGF、TK1、EGFR、CA19-9、CEA、SCCA水平均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05);治疗后,两组EORTC QLQ-C30评分均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05)。结论:DP化疗方案联合三维适形调强放疗用于食管癌患者可提高生命质量评分,降低肿瘤标志物和血清学指标水平,效果优于单纯三维适形调强放疗。

食管癌三维适形放射治疗剂量学与放射性肺炎发生相互关系的研究

目的:通过食管癌常规放射治疗与三维适形放射治疗的技术对比研究,比较应用不同外照射技术时肿瘤靶区适形指数的差异,以及肺等正常组织受照射容积剂量与放射性肺炎并发症发生概率(NTCP)的关系。方法:应用三维治疗计划系统,对28例胸中段EPC分别设计三种照射技术(A:常规3野;B:适形3野;C:适形5野)。比较在同一处方剂量(66Gy)时肿瘤靶区的适形指数,全肺受照射剂量与肺的NTCP的差异。结果:A、B、C三种照射技术比较:1)靶区的适形指数从0.55±0.09提高至0.76±0.04和0.78±0.06。2)肺平均剂量从(16.54±2.35)Gy降低至(13.26±1.93)Gy和(3.38±1.61)Gy;肺的V20从(32.95±6.43)%降低至(23.01±6.25)%和(24.8±4.47)%;肺的V30从(17.25±4.96)%降低至(12.18±3.66)%和(6.75±2.93)%。3)肺的NTCP从(6.9±6.86)%降低至(1.14±1.11)%和(1±1.02)%。A、B和C三种照射技术比较差异均有统计学意义,P=0.000。结论:三维适形放射治疗技术的靶区剂量分布较理想,显著降低正常肺的照射体积和剂量,减少放射性肺炎NTCP。