36例儿童肾母细胞瘤综合治疗的临床探讨

目的:回顾本院近年儿童肾母细胞瘤的综合治疗方法并分析疗效。方法:对本院1998年4月至2003年5月收治的36例肾母细胞瘤患儿参照国际肾母细胞瘤研究协作组(NWTSG)标准判断分期和组织分化程度进行分组,依照分组分治的综合治疗原则,Ⅰ、Ⅱ期FH组采取手术加低剂量化疗,Ⅲ、Ⅳ期及所有组织分化不良型组采取加强化疗并加行局部放疗。对随访结果进行统计学分析。结果:所有患者治疗后3年总生存率和3年无病生存率分别为86.10%和75.0%。按不同分期计算生存率分别为Ⅰ期100%和100%,Ⅱ期93.3%和86.7%,Ⅲ期88.9%和77.8%,Ⅳ期60.0%和20.0%。按不同组织分化程度计算生存率分别为FH组94.7%和89.5%,UFH+CCSK+RTK组76.5%和58.8%。结论:多学科协作的放、化疗联合的分组分治综合治疗模式治疗儿童肾母细胞瘤安全且疗效显著。

Observation of Intensity-Modulated Radiotherapy with Different Fractionated Doses Used in 58 Cases with Astrocytoma

OBJECTIVE To analyze the therapeutic effects and side effects of intensity-modulated radiotherapy （IMRT） with different fractionated doses in treating astrocytoma.METHODS During a period from October 2001 to December 2006, 58 patients with astrocytoma were treated using IMRT. Based on the World Health Organization （WHO） classification, 32 of the 58 cases were grade-Ⅱ, 20 grade-Ⅲ and 6 grade-IV （glioblastoma multiforme, GBM）. Thirty-two of the 58 patients （3 with grade IV, 11 with grade Ⅲ, and the other 18 with grade II who were over 40 years） were treated with hyperfractionated IMRT （Hyper Fr IMRT）, and the other 26 patients were treated with standard fractionated IMRT （St Fr IMRT）.RESULTS The 1-, 3- and 5-year overall survival （OS） rates were respectively 86%, 52%, and 45%, and the 1-, 3- and 5-year progression-free survival （PFS） rates were respectively 77%, 38%, and 25%. Using an analytical hierarchy process it was shown that concerning the patients with grade II astrocytoma classified based on WHO grading, the therapeutic effect was much better in the group of Hyper Fr IMRT than in the St Fr IMRT group. There was no statistical significance of the differences in the OS and PFS rates between the 2 groups （P = 0.049 and P = 0.006）. The OS and PFS rates of the patients with grade-III astrocytoma were both higher in the group with Hyper Fr IMRT than in the St Fr IMRT group. However, there was no statistical significance of the differences between the 2 groups. Advanced RTOG grade-Ⅲ（radiation therapy oncology group, RTOG） neurotoxicity occurred only in 1 of the cases.CONCLUSION Compared with the St Fr IMRT, the Hyper Fr IMRT may help to prolong the survival of patients with astrocytoma.

Solution procedure of residue harmonic balance method and its applications

This paper presents a simple and rigorous solution procedure of residue harmonic balance for predicting the accurate approximation of certain autonomous ordinary differential systems.In this solution procedure,no small parameter is assumed.The harmonic residue of balance equation is separated in two parts at each step.The first part has the same number of Fourier terms as the present order of approximation and the remaining part is used in the subsequent improvement.The corrections are governed by linear ordinary differential equation so that they can be solved easily by means of harmonic balance method again.Three kinds of different differential equations involving general,fractional and delay ordinary differential systems are given as numerical examples respectively.Highly accurate limited cycle frequency and amplitude are captured.The results match well with the exact solutions or numerical solutions for a wide range of control parameters.Comparison with those available shows that the residue harmonic balance solution procedure is very effective for these autonomous differential systems.Moreover,the present method works not only in predicting the amplitude but also the frequency of bifurcated period solution for delay ordinary differential equation.