Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy

BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent recurrence after liver cancer resection.However,there are multiple RT techniques available,and the differ-ential effects of these techniques in preventing postoperative liver cancer re-currence require further investigation.AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival(OS)and disease-free survival(DFS)and to determine the optimal strategy.METHODS This study involved network meta-analyses and followed the PRISMA guidelines.The data of qualified studies published before July 10,2023,were collected from PubMed,Embase,the Web of Science,and the Cochrane Library.We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints.The magnitudes of the effects were determined using risk ratios with 95%confidential intervals.The results were analyzed using R software and STATA software.RESULTS A total of 12 studies,including 1265 patients with hepatocellular carcinoma(HCC)after liver resection,were included in this study.There was no significant heterogeneity in the direct paired comparisons,and there were no significant differences in the inclusion or exclusion criteria,intervention measures,or outcome indicators,meeting the assumptions of heterogeneity and transitivity.OS analysis revealed that patients who underwent stereotactic body radiotherapy(SBRT)after resection had longer OS than those who underwent intensity modulated radiotherapy(IMRT)or 3-dimensional conformal RT(3D-CRT).DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS.Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT.IMRT,a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT,may be a preferred option.

Dose escalation of external beam radiotherapy for high-risk prostate cancerdImpact of multiple high-risk factor

Objective:To retrospectively investigate the treatment outcomes of external beam radiotherapy with androgen deprivation therapy(ADT)in high-risk prostate cancer in three radiotherapy dose groups.Methods:Between 1998 and 2013,patients with high-risk prostate cancer underwent threedimensional conformal radiotherapy or intensity-modulated radiotherapy of 66 Gy,72 Gy,or 78 Gy with ADT.Prostate-specific antigen(PSA)relapse was defined using the Phoenix definition.PSA relapse-free survival(PRFS)was evaluated in each radiotherapy dose group.Moreover,high-risk patients were divided into H-1(patients with multiple high-risk factors)and H-2(patients with a single high-risk factor)as risk subgroups.Results:Two hundred and eighty-nine patients with a median follow-up period of 77.3 months were analyzed in this study.The median duration of ADT was 10.1 months.Age,Gleason score,T stage,and radiotherapy dose influenced PRFS with statistical significance both in univariate and multivariate analyses.The 4-year PRFS rates in Group-66 Gy,Group-72 Gy and Group-78 Gy were 72.7%,81.6%and 90.3%,respectively.PRFS rates in the H-1 subgroup differed with statistical significance with an increasing radiotherapy dose having a more favorable PRFS,while PRFS rates in H-2 subgroup did not differ with increase in radiotherapy dose.Conclusion:Dose escalation for high-risk prostate cancer in combination with ADT improved PRFS.PRFS for patients in the H-1 subgroup was poor,but dose escalation in those patients was beneficial,while dose escalation in the H-2 subgroup was not proven to be effective for improving PRFS.

Adjuvant External Beam Radiotherapy ±Brachytherapy in Endometrial Cancer: A Retrospective Study from Faculty of Medicine, Chiang Mai University

Purpose: To report the retrospective study of external beam radiotherapy (EBRT) ± intravaginal brachytherapy (IVBT) as adjuvant treatment for endometrial cancer. Materials and Methods: From 2001-2009, 152 patients received complete surgical staging for endometrial carcinoma and were designed by a multidisciplinary team to receive EBRT ± IVBT. The treatment results and late toxicities were evaluated and recorded. Results: At the median follow-up time of 43 months, the disease-free survival, metastasis-free survival and overall survival rates were 96.9%, 96.9% and 96.9%, respectively. Stage and age showed the statistical significance with the p-value of less than 0.001. From five to ten percent of patients developed Grades 1-2 late gastrointestinal and genitourinary toxicities, respectively. Conclusion: The using of adjuvant EBRT ± IVBT for endometrial?carcinoma yielded treatment results and acceptable toxicities.

Linear Accelerator Based External Beam Radiotherapy in Glomus Jugulare Tumour: A Retrospective Review from a Tertiary Cancer Hospital in Kenya

Objective: Tumours originating from jugular bulb, carotid bifurcation, Vagus nerve are collectively called Paragangliomas. They are slow growing, essentially benign tumours, but can be detrimental if untreated. There is limited evidence on the effectiveness of fractionated radiotherapy in the management ofs Glomus jugulare tumours. The aim of this study is to determine the efficacy of Linear accelerator based fractionated external beam radiotherapy on unilateral inoperable Glomus jugulare paragangliomas. Method: This is a retrospective analysis of all the 12 cases of inoperable, unilateral Glomus jugulare tumours treated during the period 2011-2016 at a tertiary cancer centre in Kenya. Minimum follow up duration was 3 years. Patient characteristics, disease staging, immediate complications and therapeutic efficacy were analysed from the case files. Results: The 12 patients diagnosed with inoperable Glomus jugulare tumours reported in this period were treated with external beam radiotherapy to a tumour dose of 54 Gy in 30 fractions over a period of 6 weeks using IMRT technique in 6 MV Linear accelerator. 2/3rd of the patients were females in 5th and 6th decade of life. Onset of first symptom to initiation of treatment was found to be 1.7 years. Headache, earache, and tinnitus were the main complaints. No major side effects were recorded during therapy. Mean length of the tumour in its maximum dimension at the time of diagnosis was 4.5 cm. At the end of one-year post therapy, a mean reduction of 6.5 mm in the tumour length was observed, (Range: 0 - 15 mm). Tumour size remained static for a year and thereafter a slow growth pattern of 1mm per year was observed. Conclusion: Fractionated external beam radiotherapy is an effective and non-invasive treatment for advanced, inoperable Glomus jugulare paragangliomas. Clinical stability through tumour control was observed. Though newer radiation techniques like Cyberknife, Proton therapy offer better tumour control, conventional external beam radiotherapy is an effective tool in disease containment in resource limited countries.

Californium-252 neutron brachytherapy combined with external pelvic radiotherapy plus concurrent chemotherapy for cervical cancer: a retrospective clinical study

Background:Cervical cancer is the sixth most common cancer in Chinese women.A standard treatment modal?ity for cervical cancer is the combination of surgery,chemotherapy,external?beam radiotherapy and intracavitary brachytherapy.The aim of this study was to retrospectively assess the long?term treatment outcomes of patients with cervical cancer who were treated with californium?252 neutron brachytherapy combined with external?beam radio?therapy plus concurrent chemotherapy.Methods:We retrospectively analyzed the medical records of 150 patients with primary stages IB?IVB cervical cancer who received neutron brachytherapy combined with external?beam radiotherapy concurrently with cisplatin chemo?therapy.All patients were followed up.Using an actuarial analysis,patient outcomes and treatment?related adverse effects were evaluated and compared.Results:The median overall survival(OS)was 33.2 months.The 3?year progression?free survival rates for patients with stages I–II,III,and IV diseases were 81.0%(68/84),65.0%(39/60),and 0%(0/6),respectively;the 3?year OS rates were 90.5%(76/84),85.0%(51/60),and 16.7%(1/6),respectively.Vaginal bleeding was controlled within the median time of4.0 days.One month after treatment,97.3%of patients achieved short?term local control.The local recurrence rates for patients with stages I–II,III,and IV disease were 4.8%(4/84),11.7%(7/60),and 33.3%(2/6),respectively,and the occurrence rates of distant metastasis were 16.7%(14/84),25.0%(15/60),and 100.0%(6/6),respectively.Cancer stage,tumor size,and lymph node metastasis were identified as prognostic risk factors,but only lymph node metastasis was found to be an independent prognostic factor.The most common adverse effects during treatment were grades 1 and 2 irradiation?related proctitis and radiocystitis.Conclusion:For patients with cervical cancer,neutron brachytherapy combined with external?beam radiotherapy plus concurrent chemotherapy produces a rapid response and greatly improves local control and long?term survival rates with tolerable adverse effects.

Real-time dosimetry in external beam radiation therapy

With growing complexity in radiotherapy treatment delivery,it has become mandatory to check each and every treatment plan before implementing clinically.This process is currently administered by an independent secondary check of all treatment parameters and as a pre-treatment quality assurance (QA) check for intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy treatment plans.Although pre-treatment IMRT QA is aimed to ensure the correct dose is delivered to the patient,it does not necessarily predict the clinically relevant patient dose errors.During radiotherapy,treatment uncertainties can affect tumor control and may increase complications to surrounding normal tissues.To combat this,image guided radiotherapy is employed to help ensure the plan conditions are mimicked on the treatment machine.However,it does not provide information on actual delivered dose to the tumor volume.Knowledge of actual dose delivered during treatment aid in confirming the prescribed dose and also to replan/reassess the treatment in situations where the planned dose is not delivered as expected by the treating physician.Major accidents in radiotherapy would have been averted if real time dosimetry is incorporated as part of the routine radiotherapy procedure.Of late real-time dosimetry is becoming popular with complex treatments in radiotherapy.Realtime dosimetry can be either in the form of point doses or planar doses or projected on to a 3D image dataset to obtain volumetric dose.They either provide entrance dose or exit dose or dose inside the natural cavities of a patient.In external beam radiotherapy,there are four different established platforms whereby the delivered dose information can be obtained:(1)Collimator;(2)Patient;(3)Couch;and(4)Electronic Portal Imaging Device.Current real-time dosimetric techniques available in radiotherapy have their own advantages and disadvantages and a combination of one or more of these methods provide vital information about the actual dose delivered to radiotherapy patients.

Efficacy and safety of intraoperative radiotherapy in rectal cancer:A systematic review and meta-analysis

BACKGROUND In recent years,intraoperative radiotherapy(IORT)has been increasingly used for the treatment of rectal cancer.However,the efficacy and safety of IORT for the treatment of rectal cancer are still controversial.AIM To evaluate the value of IORT for patients with rectal cancer.METHODS We searched PubMed,Embase,Cochrane Library,Web of Science databases,and conference abstracts and included randomized controlled trials and observational studies on IORT vs non-IORT for rectal cancer.Dichotomous variables were evaluated by odds ratio(OR)and 95%confidence interval(CI),hazard ratio(HR)and 95%CI was used as a summary statistic of survival outcomes.Statistical analyses were performed using Stata V.15.0 and Review Manager 5.3 software.RESULTS In this study,3 randomized controlled studies and 12 observational studies were included with a total of 1460 patients,who are mainly residents of Europe,the United States,and Asia.Our results did not show significant differences in 5-year overall survival(HR=0.80,95%CI=0.60-1.06;P=0.126);5-year disease-free survival(HR=0.94,95%CI=0.73-1.22;P=0.650);abscess(OR=1.10,95%CI=0.67-1.80;P=0.713),fistulae(OR=0.79,95%CI=0.33-1.89;P=0.600);wound complication(OR=1.21,95%CI=0.62-2.36;P=0.575);anastomotic leakage(OR=1.09,95%CI=0.59-2.02;P=0.775);and neurogenic bladder dysfunction(OR=0.69,95%CI=0.31-1.55;P=0.369).However,the meta-analysis of 5-year local control was significantly different(OR=3.07,95%CI=1.66-5.66;P=0.000).CONCLUSION The advantage of IORT is mainly reflected in 5-year local control,but it is not statistically significant for 5-year overall survival,5-year disease-free survival,and complications.

Current role of spacers for prostate cancer radiotherapy

Radiotherapy is an established curative treatment method for prostate cancer. Optimal tumor control rates can only be achieved with high local doses,associated with a considerable risk of rectal toxicity. Apart from already widely adapted technical advances,as intensitymodulated radiation therapy,the application of spacers placed between the prostate and rectum has been increasingly used in the last years. Biodegradable spacers,including hydrogel,hyaluronic acid,collagen or an implantable balloon,can be injected or inserted in a short procedure under transrectal ultrasound guidance via a transperineal approach. A distance of about 1.0-1.5 cm is usually achieved between the rectum and prostate,excluding the rectal wall from the high isodoses. Several studies have shown well tolerated injection procedures and treatments. Apart from considerable reduction of rectal irradiation,a prospective randomized trial demonstrated a reduction of rectal toxicity after hydrogel injection in men undergoing prostate image-guided intensity-modulated radiation therapy. The results are encouraging for continuing evaluation in dose escalation,hypofractionation,stereotactic radiotherapy or re-irradiation trials in the future.

A Longitudinal Study of Clinical Benefits with Implementation of the Deep Inspiration Breath-Hold Technique in Post-Operative Radiotherapy for Left-Sided Breast Cancer

Purpose/Objectives: We aimed to report clinical effects on critical organ dose and cardiac toxicity from implementation of the deep inspiration breath-hold (DIBH) technique in post-operative extern-beam radiotherapy of patients with left-sided breast cancer, using longitudinal clinical data. Materials/Methods: We retrieved three groups of patients who received post-operative radiotherapy of left-sided breast cancer in our institution in recent years: Groups A and B consist of patients whose treatment did not include internal mammary nodes (IMN) and who were treated with the free breathing technique and with the DIBH technique, respectively, and Group C consists of patients whose radiotherapy included internal mammary nodes with the DIBH technique. Dose parameters for the heart and left lung were retrieved from the treatment plans. Radiation-induced cardiac risks were estimated using existing risk models. Results: The average heart dose was 2.65 ± 0.98 Gy, 1.10 ± 0.29 Gy, and 1.26 ± 0.25 Gy in Groups A, B, and C, respectively. The average heart volumes receiving at least 25 Gy were 7.10 ± 9.79 cc in Group A, 0.07 ± 0.22 cc in Group B, and 0.03 ± 0.08 cc in Group C. On average, the excessive risk of having ischemic heart disease was estimated to be 19.6%, 8.1%, and 9.3% in Groups A, B, and C, respectively. The mean left lung doses were 5.73 ± 1.86 Gy, 5.93 ± 1.55 Gy, and 9.13 ± 1.57 Gy in Groups A, B, and C, respectively. Conclusion: Implementation of the DIBH technique significantly lowered heart dose and decreased the ischemic heart disease risk in patients receiving post-operative radiotherapy for left-sided breast cancer, without significant increase in left lung dose.

放疗计划定量评估在宫颈癌外照射精准放疗流程管理中的应用

目的通过对宫颈癌外照射放射治疗计划的量化评估,探究放疗计划中存在的问题以指导临床,降低出错几率,提高放疗计划质量,完善放疗流程。方法选取2019年5月~2022年1月在中山大学肿瘤防治中心进行放射治疗的227例宫颈癌患者,将经临床批准且实施的放疗计划通过计划系统至Plan IQ^(TM)工作站。根据ICRU83号报告、GEC-ESTRO工作组的推荐指南及本中心临床要求制定评估指标,经高资历临床医生批准后对计划进行量化评估。总结记录放疗计划中存在的问题,同时,对评分较低的计划重新再计划,分析再计划前后的差异性。结果通过对277例宫颈癌放疗计划分析得出:(1)靶区得分不及格主要是大体肿瘤GTV、计划靶区PGTV(CI、V_(66Gy)),分别为10.6%、65.2%、1%。得分0的有:计划靶区PGTV(CI)、大体肿瘤GTV、计划靶区PCTV(D_(98%)、HI),分别为0.4%、10.1%、0.4%、0.4%。OARs中不及格的主要是肠道(直肠、小肠、结肠),比例≥20.7%。且直肠、小肠、结肠、肾、股骨头存在得分为0的情况;(2)资深剂量师在PGTV(V_(60 Gy)、D_(98%))、PCTV(CI)、CTV(D_(98%))上优于初级剂量师(P≤0.046),且在脊髓和小肠的保护方面一致性优于初级剂量师(P≤0.034);(3)俯卧位组计划在满足靶区要求的情况下,肠道的剂量明显低于仰卧位组计划(P<0.05)。选择得分低的20例放疗计划进行再计划,结果再计划靶区的GTV(Dmin)、PTV(V_(45 Gy)、D_(98%))高于原计划(P<0.05)。在OARs中,小肠(V_(40 Gy)和V_(30 Gy))、结肠(V_(40 Gy)和V_(30 Gy))、膀胱(D35%)的剂量均明显低于原计划(P<0.05)。结论放疗计划的量化评估在提高放疗计划质量的同时,可实现放疗计划质量及放疗流程的风险管理。

从鼻咽癌放疗后复发部位探讨放疗设野范围

背景与目的:自上世纪90年代,中山大学肿瘤医院鼻咽癌常规外照射采用面颈联合野、耳前野和低熔点挡铅技术,本研究通过分析部分常规放疗后局部区域复发患者的资料探讨常规鼻咽癌面颈联合野和耳前野照射范围的合理性。方法:收集1999年在中山大学肿瘤医院按常规面颈联合野和耳前野设野治疗的,放疗后局部区域出现复发,有放疗前后和复发CT检查的鼻咽癌患者资料,分析复发灶所侵犯的部位。对于有照射野设置资料患者,在三维治疗计划系统(3DTPS)下进一步行局部复发灶和照射野模拟剂量学分析,观察复发灶与95%等剂量线的关系,若复发灶95%以上(包括95%)的体积在95%等剂量线内,判断为野内复发,20%以上(包括20%)～95%以下体积在95%等剂量线内,边缘复发,20%以下体积在95%等剂量线内,野外复发。结果:共收集了40例可供分析的患者,其中15例患者材料完整可供局部复发灶和照射野模拟剂量学分析。局部复发的主要部位为鼻咽腔、颅底骨质;局部复发灶和照射野模拟剂量学分析发现野内复发9例,边缘复发4例,野外复发2例。6例边缘和野外复发的患者,经过进一步分析发现复发与未严格遵循常规设野原则或对病灶范围判断失误造成不适当的照射野边界导致靶区出现低剂量区有关。结论:常规鼻咽癌面颈联合野和耳前野照射范围基本是合理的。

外放疗联合碘-125粒子植入治疗头颈癌的临床应用

目的:初步评价外放疗联合碘-125(125I)粒子植入治疗头颈癌患者的局部控制率和放射性损伤的有关结果。方法:选择2008年2月至2010年7月在北京大学口腔医院口腔颌面外科就诊的头颈癌患者10例,其中鳞状细胞癌8例,低分化腺癌2例,均因全身疾病或局部晚期而不能手术治疗。所有患者均先接受常规分割外放疗,然后再行125I粒子植入增量放疗。外放疗总照射剂量(total dose,DT)为50 Gy(鳞癌)或70 Gy(低分化腺癌);125I粒子植入治疗的匹配周缘剂量(matched peripheral dose,MPD)为60 Gy(TNM分期为Ⅰ~Ⅱ)或80 Gy(TNM分期为Ⅲ~Ⅳ)。125I粒子活度为25.9~29.6 MBq/个。对患者进行随访,分析急性放射性损伤、晚期放射性损伤、局部控制和生存情况。结果:平均随访12个月(2~28个月),有1例出现软组织坏死,1例出现吞咽困难和局部大出血,余未见其他严重副作用。所有病灶均在6个月内完全消退,1例出现颈淋巴结转移,1例出现远处转移,余未见复发和转移。10例患者中有7例存活。结论:外放疗联合125I粒子植入是治疗不能根治手术头颈癌患者的一种安全、有效的选择方法。

高强度聚焦超声联合低剂量放疗作为进展期前列腺癌内分泌治疗后补充治疗的有效性和安全性分析

The aim of this study was to investigate the feasibility and safety of high-intensity focused ultrasound （HIFU） combined with （＋） low-dose external beam radiotherapy （LRT） as supplemental therapy for advanced prostate cancer （PCa） following hormonal therapy （HT）. Our definition of HIFU＋LRT refers to treating primary tumour lesions with HIFU in place of reduced field boost irradiation to the prostate, while retaining four-field box irradiation to the pelvis in conventional-dose external beam radiotherapy （CRT）. We performed a prospective, controlled and non-randomized study on 120 patients with advanced PCa after HT who received HIFU, CRT, HIFU＋LRT and HT alone, respectively. CT/MR imaging showed the primary tumours and pelvic lymph node metastases visibly shrank or even disappeared after HIFU ＋LRT treatment. There were significant differences among four groups with regard to overall survival （OS） and disease-specific survival （DSS） curves （P=0.018 and 0.015）. Further comparison between each pair of groups suggested that the long-term DSS of the H IFU ＋ LRT group was higher than those of the other three groups, but there was no significant difference between the HIFU＋LRT group and the CRT group. Multivariable Cox＇s proportional hazard model showed that both HIFU＋LRT and CRT were independently associated with DSS （P=0.001 and 0.035） and had protective effects with regard to the risk of death. Compared with CRT, HIFU ＋LRT significantly decreased incidences of radiation-related late gastrointestinal （GI） and genitourinary （GU） toxicity grade ≥ II. In conclusion, long-term survival of patients with advanced PCa benefited from strengthening local control of primary tumour and reRional lymph node metastases after HT. As an alternative to CRT, HIFU＋LRT showed Rood efficacy and better safety.

复发及转移性甲状腺癌外照射的临床结果分析

目的:分析外照射在复发及转移性甲状腺癌患者中的临床疗效及毒副反应。方法:回顾分析2008年1月至2018年1月北京协和医院放疗科收治的复发及转移性甲状腺癌患者64例,转移性甲状腺癌29例,复发性甲状腺癌35例。外照射采用三维适形、调强放疗或立体定向放疗技术。评价全组患者生存、疗效及毒副反应。疗效评估参照VRS主诉疼痛分级法和RECIST1.1实体瘤疗效评价标准。采用Kaplan-Meier法计算生存率,Cox模型进行预后因素分析。结果:中位随访时间38个月,2年和3年的总生存率分别为67.2%(95%CI=0.556~0.787)和51.6%(95%CI=0.394~0.638)。病理类型是影响总生存率的预后因素(HR=0.32,95%CI=0.163~0.629,P=0.001)。40例可测量病灶外照射1个月后和2年的DCR分别为92.5%和60.94%。全组患者均未出现RTOG-3级及以上毒副反应。结论:对于复发及转移性甲状腺癌患者,外照射治疗可明显改善症状、控制局部病灶。

两种放疗技术治疗难治性瘢痕疙瘩的剂量学比较

目的本文比较了6 MeV电子线和铱192(192Ir)高剂量率(High Dose Rate,HDR)表面敷贴近距离放疗两种技术治疗难治性瘢痕疙瘩的剂量学差异。方法在头颈部仿真模体和固体水模体上,标注出常见难治性瘢痕疙瘩位置(下颌区瘢痕切口及长度大于25 cm的瘢痕切口),在表面敷贴与不敷贴Flap管状施源器两种情况下,进行CT扫描,获得4套CT图像,之后应用计划系统模拟6 MeV电子线外照射及192Ir HDR表面敷贴近距离放疗两种技术的剂量分布。结果表面敷贴近距离治疗,在剂量学上优势明显:更集中照射需要照射的区域;减少对周围健康皮肤的辐射;凹凸不平的表面,仍能保持参考平面的剂量分布一致;较长切口,外照射需要分野照射的病例中,采用近距离治疗避免分野处剂量衔接不佳等问题。结论瘢痕表面敷贴近距离治疗,在治疗较长及表面不平的难治性瘢痕时,与电子线外照射比较,剂量优势更加明显。

^(125)I粒子与放疗分别联合化疗治疗Ⅲ_b期NSCLC的比较

目的比较^(125)I粒子组织间植入和外放疗分别联合化疗治疗局部晚期非小胞肺癌(non-small cell lung cancer,NSCLC)的疗效与安全性。方法76例Ⅲ_b期NSCLC患者,观察组37例接受^(125)I放射性粒子植入后联合同步NP方案化疗,对照组39例接受外放疗同步NP方案化疗。结果观察组和对照组总有效率、局部控制率分别为78.4%和56.4%、91.9%和74.4%,均有显著性差异(P<0.05);两组1年生存率分别为67.6%和66.7%,无显著性差异(P>0.05);两组治疗相关死亡率分别为0%和10.3%,有显著性差异(P<0.05)。对照组发生Ⅲ、Ⅳ度放射性食管炎、Ⅲ、Ⅳ度放射性肺炎和Ⅲ、Ⅳ度白细胞减少分别为15.4%、10.3%和41.0%,观察组所有病例未出现Ⅲ-Ⅳ放射性肺炎及食管炎,Ⅲ-Ⅳ度白细胞发生率为18.9%,差异均有统计学意义(P<0.05)。结论放射线^(125)I粒子组织间植入联合同步化疗治疗局部晚期NSCLC具有较好的疗效和安全性。

肝动脉化疗栓塞联合体外放疗治疗肝细胞癌合并门静脉癌栓的安全性和有效性

目的评估肝细胞肝癌合并门静脉癌栓患者经肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE）联合体外放疗（external-beam radiation therapy,EBRT）的安全性和有效性。方法收集我院肿瘤中心2011-01至2013-12行TACE联合门静脉癌栓放疗的肝细胞肝癌53例。放疗方式包括三维适形放疗、伽马刀放疗及调强适形放疗,放疗剂量分割主要包括60 Gy/30F、60 Gy/20F和60 Gy/12F。收集患者性别、年龄、ECOG评分、肝炎病毒感染情况、Child-Pugh分级、治疗前AFP水平、门脉癌栓位置、TACE与EBRT先后顺序、放疗的等效生物学剂量、癌栓疗效、患者1年生存情况及治疗相关毒副反应。结果门静脉癌栓患者经治疗CR 6例,PR 22例,SD 20例,PD 5例,总体有效率（CR＋PR）为52.8%（28/53）,总生存时间为3.5~27.1个月,中位生存时间为11.4个月,平均生存时间为17.5个月。ECOG评分、癌栓是否累及门静脉主干,以及癌栓经过联合治疗后的疗效影响患者的1年生存率。当患者首先行肝动脉化疗栓塞治疗时,腹痛、腹泻、消化道出血及转氨酶升高等不良反应发生率较高。结论 TACE联合门静脉癌栓放射治疗是肝癌合并门脉癌栓的有效治疗手段。首先行癌栓放疗,可以减轻不良反应。

乳腺癌的术中放疗

乳腺癌是全球女性最高发的恶性肿瘤,不仅威胁患者生命,同时也影响患者的生存质量和生理功能。因此,采用优化的综合治疗策略,延长患者生命,改善患者生存质量,是目前乳腺癌治疗的趋势。放射治疗是乳腺癌综合治疗的重要组成部分,近年来,乳腺癌放射治疗具有照射范围缩小,分割次数减少两大趋势。术中放疗(intraoperative radiotherapy,IORT)由于在手术中直视下给予单次大剂量照射,具有缩短疗程,有效保护正常组织的优势。目前IORT对接受保乳术的乳腺癌患者可作为外照射的局部剂量追加技术方法,或作为替代术后外照射的技术方法。现就IORT技术的优缺点及其临床适应证、疗效和不良反应进行系统回顾,为指导临床开展IORT提供依据。

80例鼻咽癌应用新型施源器腔内后装治疗的疗效分析

目的:探讨鼻咽癌外照射联合新型施源器后装治疗与单纯外照射的疗效和并发症。方法:将80例初治鼻咽癌患者按治疗方法分为外照射联合腔内后装(综合治疗组)及单纯外照射(对照组)两组,综合治疗组外照射剂量DT60～65Gy,腔内后装在外照射后期进行,剂量DT6～20Gy,中位剂量12Gy。对照组外照射剂量DT70～75Gy。结果:全部病例随访至2006年5月,随访率97.5%,综合治疗组和对照组的近期有效率分别为92.5%、75.3%(P<0.05),3、5年生存率分别为87.5%、65.0%(P<0.05)及74.2%、55.6%(P>0.05);3、5年无瘤生存率分别为72.5%、60.0%及64.5%、52.8%(P>0.05)。两组并发症发生率有显著性差异。结论:鼻咽癌外照射联合新型施源器后装治疗提高肿瘤近期有效率和3、5年生存率,降低口咽干燥等放疗并发症发生,提高生活质量。

^(89)SrCl_2联合局部外放疗治疗骨转移癌的疗效观察

目的:观察单独使用89SrCl2及89SrCl2联合局部外放疗对骨转移癌的疗效。方法:将121例患者随机分为89SrCl2(对照)组57例,89SrCl2联合局部外放疗(实验)组64例。结果:89SrCl2对照组、89SrCl2联合局部外照射实验组止痛有效率分别为78%、95%(P<0.05);骨病灶好转有效率分别为21%、53%(P<0.01);一般状况改善有效率为69%、92%(P<0.01),试验组比对照组有效率明显提高,而毒副反应试验组没有明显叠加和增强。结论:89SrCl2联合局部外放疗能显著提高骨转移癌的治疗效果。