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.

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.

Effect of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy on clinical outcomes in patients with glioblastoma multiforme

Background Few studies were reported on the comparison of clinical outcomes between intensity-modulated radiotherapy （IMRT） and three-dimensional conformal radiotherapy （3D-CRT） in the treatment of glioblastoma multiforme （GBM）.This study aimed to determine whether IMRT improves clinical outcomes compared with 3D-CRT in patients with GBM.Methods The records of 54 patients with newly-diagnosed GBM from July 2009 to December 2010 were reviewed.The patients underwent postoperative IMRT or 3D-CRT with concurrent and adjuvant temozolomide.Kaplan-Meier method and log rank test were used to estimate differences of patients＇ survival.Results The median follow-up was 13 months.Of the 54 patients,fifty （92.6%） completed the combined modality treatment.The 1-year overall survival rate （OS） was 79.6%.The pattern of failure was predominantly local.A comparative analysis revealed that no statistical difference was observed between the IMRT group （n=21） and the 3D-CRT group （n=33） for 1-year OS （89.6% vs.75.8%,P=0.795）,or 1-year progression-free survival （PFS） （61.0% vs.45.5%,P=0.867）.In dosimetric comparison,IMRT seemed to allow better sparing of organs at risk than 3D-CRT did （P=0.050,P=0.055）.However,there was no significant difference for toxicities of irradiation between the IMRT group and the 3D-CRT group.Conclusions Our preliminary results suggested that delivering standard radiation doses by IMRT is unlikely to improve local control or overall survival for GBM compared with 3D-CRT.Given this lack of survival benefit and increased costs of IMRT,the utilization of IMRT treatment for GBM needs to be carefully rationalized.

Adjuvant radiotherapy in central hepatocellular carcinoma after narrow-margin hepatectomy:A 10-year real-world evidence

Objective:A prospective randomized control study investigated the feasibility and efficacy of adjuvant radiotherapy on patients with central hepatocellular carcinoma(HCC)after narrow-margin hepatectomy(<1 cm).This study presents an updated 10-year real-world evidence to further characterize the role of adjuvant radiotherapy.Methods:Patients with central HCC after narrow-margin hepatectomy(<1 cm)were prospectively assigned to adjuvant radiotherapy group and control group.Patients'outcome,adverse events,long-term recurrence and survival rates were investigated.Results:The 1-,5-,and 10-year recurrence-free survival(RFS)rates were 81.0%,43.9%,and 38.7%,respectively in adjuvant radiotherapy group and 71.7%,35.8%,and 24.2%,respectively in control group(log-rank test,P=0.09).The 1-,5-,and 10-year overall survival(OS)rates were 96.6%,54.7%,and 42.8%,respectively in adjuvant radiotherapy group and 90.2%,55.1%,and 30.0%,respectively in control group(log-rank test,P=0.20).The 1-,5-,and 10-year RFS rates for patients with small HCC(≤5 cm)were 91.1%,51.6%,and 48.4%,respectively in adjuvant radiotherapy group and 80.0%,36.6%,and 26.6%,respectively in control group(log-rank test,P=0.03).Landmark analysis demonstrated that patients with small HCC in adjuvant radiotherapy group had a significantly improved OS in second five years after treatment in comparison to patients in control group(log-rank test,P=0.05).Conclusions:Our updated results showed a sustained clinical benefit on reducing recurrence,improving longterm survival for small central HCC by adjuvant radiotherapy after narrow-margin hepatectomy.Long-term survival data also indicated that hepatectomy is an optimal treatment for selected patients with central HCC.

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.

立体定向适形多靶点置管引流术治疗脑出血的临床研究

【目的】寻找一种治疗高血压脑出血的有效方法。【方法】96例高血压脑出血病人,局麻下病人安装CRW型定位头架,行CT扫描,将CT图像转输到Radionic X-刀工作站进行血肿的三维重建和计算血肿量。根据血肿的形状和量选择靶点数目。原则上对于规整长柱型血肿量在20 mL以内的血肿,靶点选择在血肿中下1/3下1～2 cm处;对于形状不规则且量较大的血肿,行三维重建时,尽可能在此血肿腔内建成2～3个较规整长柱状“亚血肿形图像”,在每一“亚血肿形图像”内均设一靶点。手术钻孔部位根据血肿的形状而定。原则上按长轴方向入路。一般选择在额纹中部,行横切口。常规钻孔后通过导向仪将1～3根硅胶管送至预定的靶点,先抽出液化的陈旧血,然后用生理盐水1 mL加尿激酶2万单位每天1次注入血肿腔内,夹闭硅胶管2 h后,行闭式引流,1～3 d后复查CT,血肿消失后拔管。【结果】89例病人（92.7%）手术后1～3 d拔管,且血肿排空量约占总量的90%～95%。前20例病死率为30%（6例死亡）,后76例病死率为3.95%（3例死亡）。近期优良率为62%,远期优良率为85.2%。【结论】该手术方式除适合神经外科脑出血手术适应证外,尤其适用于不同部位的不规则形的且量较大的脑出血病人。

宫颈癌根治性放疗中三维适形调强放疗技术的应用

目的:探讨宫颈癌根治性放疗中三维适形调强放疗技术的临床应用疗效。方法:采用常规放疗患者39例为对照组,采用三维适形调强放疗患者39例为观察组,放疗结束后患者随访1年或至死亡,比较两组患者的临床疗效、生存质量、安全性指标、1年生存率等情况。结果:观察组有效率和疾病控制率均明显高于对照组,观察组躯体功能、认知功能、情绪功能、角色功能、社会功能等生存质量评分均明显低于对照组,观察组直肠反应、骨髓抑制等不良反应发生率均明显低于对照组(P<0.05);观察组皮肤损伤、膀胱反应等不良反应发生率均低于对照组,观察组1年生存率高于对照组(P>0.05)。结论:三维适形调强放疗技术在宫颈癌根治性放疗中具有显著的临床疗效,值得临床推广使用。

直肠癌术后盆腔三维适形放疗、简化调强技术和适形调强放疗的三维剂量学比较分析

目的比较三维适形放疗、简化调强放疗和适形调强放疗在直肠癌术后放疗中的三维剂量学差异。方法选择2008年1月-2013年1月在本院进行直肠癌术后放疗且无放疗禁忌证患者342例,分别使用三维适形放疗、简化调强放疗以及适形调强放疗方案,按照国际标准评价方法比较3种放疗方案的靶区平均剂量、靶区适形指数、剂量不均性指数及子野机器跳数。结果靶区平均剂量：三维适形放疗比简化调强放疗、适形调强放疗剂量要高,差异有统计学意义（P〈0.05）,简化调强放疗与适形调强放疗差异无统计学意义（P〉0.05）。靶区适形指数：三维适形放疗指数最低（P〈0.05）,简化调强放疗与适形调强放疗差异无统计学意义（P〉0.05）。剂量不均性指数：适形调强放疗最高,简化调强放疗最低,3种方案差异有统计学意义（P〈0.05）。适形调强放疗的子野机器跳数明显高于三维适形放疗、简化调强放疗,差异有统计学意义（P〈0.05）,三维适形放疗与简化调强放疗差异无统计学意义（P〉0.05）。结论 3种化疗方案中,简化调强技术性价比最好,值得临床推广应用。

TACE联合三维适形放疗治疗肝癌合并门静脉癌栓的疗效观察

目的探讨肝动脉化疗栓塞术(TACE)联合三维适形放疗技术(3DCRT)治疗原发性肝癌(PHC)合并门静脉癌栓(PVTT)的临床疗效和安全性。方法 60例经病理组织学确诊的PHC伴PVTT患者分为治疗组和对照组。治疗组采用TACE联合3DCRT治疗,对照组单纯采用TACE治疗。疗程结束后评价近期疗效、观察不良反应,随访1年评价客观疗效和生存率。结果治疗组近期疗效有效率为80.0%,高于对照组(43.3%),相比较差异有统计学意义,P<0.05;治疗组患者随访期内有18例死亡,对照组患者随访期内有24例死亡,治疗组中位疾病进展时间、1年生存率显著高于对照组,相比较差异有统计学意义,P<0.05。两组患者对毒性反应均可耐受。结论 TACE联合3DCRT治疗PHC合并PVTT患者临床疗效肯定,不良反应小,值得临床推广应用。

鼻咽癌二维适形放疗中下颌下腺保护技术的可行性探索

目的:探索鼻咽癌二维适形照射中对下颌下腺进行保护的可行性及对局部控制率的影响。方法:2002年5月～2004年7月,对60例N0及颈部淋巴结<2cm的N1期鼻咽癌患者,用面膜固定,个体化二维适形常规或超分割方式照射,根据颈淋巴结大小进行下颌下腺部分或全部保护。结果:60例鼻咽癌患者全组5年生存率86.4%,5年无病生存率81.7%,5年局部控制率93.2%,无下颌区或颏下区肿瘤复发。口干程度有所减轻,无口干症状(G1)3例(5%);轻度口干(G2)39例(65%);中度口干(G3)17例(28%);重度口干(G4)1例(2%)。结论:N0及部分N1期鼻咽癌患者可对下颌下腺区域进行保护,避免照射,可减轻口干程度而不影响局部控制率。

乳腺癌放射治疗对心脏损伤及防护的研究进展

乳腺癌是所有患癌群体中5年生存率较高群体,早期患者生存率可达到近90%。其中80%的乳腺癌患者术后需要接受放射治疗,目前的研究表明乳腺癌患者放疗后10至20年期患放射性心血管疾病的风险较未接受放射治疗患者风险明显升高。随着现代放疗技术的日渐成熟,从最初二维时代进入到如今逆向调强适型时代,明显减少了射线对心血管疾病的损伤,本文对乳腺癌放射治疗时心脏防护的研究进展进行综述。

DMLC-01型多叶光栅三维适形联合半束照射技术在下咽癌放射治疗的应用

目的:探讨DMLC-01型外挂电动多叶光栅三维适形放射治疗(3D-CRT)联合下颈半束照射治疗局部中晚期下咽癌的疗效观察。方法:选取医院收治的32例局部中晚期下咽癌放射治疗患者,将采用环状软骨以上平面给予DMLC-01型光栅进行3D-CRT的患者纳入观察组(18例),使用传统二维常规放射治疗的患者纳入对照组(14例),两组放射治疗的下颈均采用前切线野半束照射。全部放射治疗计划均进行验证,比较两组患者近期疗效以及放射性损伤反应发生情况。结果:对两组患者近6个月疗效评估比较,观察组治疗客观缓解率为88.9%,对照组为71.4%,两组比较差异有统计学意义(x^2=3.11,P<0.05);两组治疗中急性皮肤损伤、吞咽困难、口腔黏膜炎和口干症等放射性损伤反应发生情况比较,观察组Ⅰ~Ⅱ级发生率依次为16.7%、27.7%、33.3%和16.7%;对照组Ⅰ~Ⅱ级发生率依次为21.4%、28.5%、35.7%和21.4%,两组间差异无统计学意义(x^2=2.12,x^2=2.43,x^2=2.27,x^2=2.15;P>0.05)。结论:利用DMLC-01型外挂多叶光栅三维适形联合下颈半束照射局部中晚期下咽癌安全有效,对于经济欠发达地区开展放射治疗工作是一种较好的选择。

Graves 眼病三种放疗技术的剂量学对比研究

目的比较三种放疗技术,对Graves眼病(Graves'ophthalmopathy,GO)的靶区剂量与危及器官的保护情况。方法选取2016年7月—2018年6月在我院接受放疗的20例GO患者进行研究,分别制定三种放疗计划,包括三维适形放疗(Threedimensional conformal radiation therapy,3DCRT)、调强放疗(Intensity-modulated radiation therapy,IMRT)、容积旋转调强放疗(Volumetric modulated arc therapy,VMAT)。比较靶区覆盖与危及器官所受剂量。结果在靶区剂量方面,VMAT有最好的均匀度和适形性,IMRT略微次之,3DCRT表现最差,差异具有统计学意义(P<0.05)。在器官保护方面,IMRT对于泪腺、视网膜和眼球,都具有最低的平均剂量,对晶体有最低的最大剂量;而3DCRT在最大剂量和平均剂量方面,除了晶体外,其他器官的表现都最差,差异具有统计学意义(P<0.05)。结论IMRT技术对于GO患者的危及器官保护最好,并且靶区覆盖情况也令人满意,可推荐为治疗GO的理想放疗技术。

消化道肿瘤腹膜后淋巴结转移行介入化疗加立体定向放疗的价值

目的 探讨消化道肿瘤术后腹膜后淋巴结转移行介入化疗加立体定向放疗的价值。方法 自 1997年 8月至 2 0 0 1年 2月 ,在我院采用立体定向加介入治疗腹腔转移瘤 46例 ,采用先腹腔动脉化疗 (TAI) ,Seldinger技术穿刺股动脉 ,插入 1 2 2～ 1 83m长的导管 ,行腹腔动脉肿瘤供血支插管药物灌注化疗 ,鳞癌给予顺铂 60～ 80mg、丝裂霉素 10～ 2 0mg、阿霉素 60～ 80mg ,腺癌给予甲酰四氢叶酸钙 3 0 0mg、氟尿嘧啶 10 0 0～ 15 0 0mg、顺铂 60～ 80mg、阿霉素 60～ 80mg(或丝裂霉素 10～2 0mg)。TAI后或 2次TAI间歇期给予立体定向放疗 ,根据病变大小和部位选用不同大小的准直器 ,80 %以上的等剂量线包绕靶区 ,边缘剂量 2～ 6Gy/次不等 ,隔日 1次 ,常规外照射后补量 4～ 6次 ;未行外照射者行 8～ 15次。疗效评价采用国际抗癌联盟制定的标准 :(1)完全缓解 (completeresponse,CR) ,所见肿瘤病变完全消失并至少维持 4周以上 ;(2 )部分缓解 (partialresponse ,PR) ,肿瘤病灶的最大径及其最大垂直径的乘积减少 5 0 %以上 ,并维持 4周以上 ,无新的病变出现 ;(3 )无变化 (nochange,NC) ,肿瘤病灶的两径乘积缩小 5 0 %以下或增大 2 5 %以下 ,无新的病变出现 ;(4)进展 (progressivedisease,PD) ,肿瘤病灶的两径乘积增大

颅脑肿瘤放射治疗时射野外器官吸收剂量体模法测量与分析

目的：在是否使用楔形板和照射野面积不同的情况下，测量和分析颅脑肿瘤放射治疗时射野外器官的吸收剂量。方法使用中国成人男性仿真人体模型，模拟颅脑肿瘤放射治疗，采用不使用楔形板的普通方野照射技术组和使用楔形板的三维适形照射技术（3D-CRT）组，普通方野照射技术组分别用2 cm×2 cm野和4 cm×4 cm野进行照射，3D-CRT组分别按等效方野面积分为2 cm×2 cm野和4 cm×4 cm野进行照射；使用热释光剂量计测量射野外器官的吸收剂量并进行分析。结果颅脑肿瘤靶区处方剂量为100 cGy时，射野外各器官吸收剂量范围为0．13-2．83 mGy。头颈部器官4 cm×4 cm野照射时的吸收剂量与2 cm×2 cm野比较，差异有统计学意义（t=-5．023， P=0．004）；胸腹部器官4 cm×4 cm野照射时的吸收剂量与2 cm×2 cm野比较，差异无统计学意义（t=-1．438， P=0．171）。普通方野照射组头颈部器官、腹部器官的吸收剂量与3D-CRT组比较，差异均有统计学意义（t 头=-2．805， P=0．038；t腹=-11．966，P=0．000）。结论接受颅脑肿瘤放射治疗的患者，射野外器官吸收剂量的大小与照射野面积、是否采用楔形板照射技术有关。接受大野照射的患者，靶区邻近器官吸收剂量越大；照射野面积和处方剂量相同时，使用楔形板的照射技术相对于不使用楔形板的射野外器官的吸收剂量增大。