肺癌的放射线疗法增强检查点阻断免疫疗法的效果

联合使用放射疗法和免疫疗法(CTLA-4阻断)在针对黑色素瘤的治疗中有较好的效果,但是对于其他的癌症是否有效,还有待进一步的验证。尤其是目前检査点阻断(如CTLA-4阻断)疗法对于肺癌等实体瘤疗效有限,如果使用联合疗法治疗有效,对于实体瘤患者有很大益处。本文作者发现使用化疗和CTLA-4阻断抗体易普利姆玛(Ipilimumab)联合应用,可以通过增强患者本身的免疫应答延长患者的生存期。

恶性胶质瘤化学放射线同步化治疗(附18例病例分析)

恶性胶质瘤32例,18例术后应用化学、放射线同步化治疗;14例行单纯放射线治疗作为对照组。结果证明,同步化治疗的近期疗效及1a、2a 生存率高于对照组。说明对恶性胶质瘤术后行同步化治疗有较好的疗效,是目前首选的治疗方案。

伽马刀放射手术对颅内疾病的治疗

本文简单介绍了伽马刀的基本结构和伽马刀放射手术的概念,并对放射手术中应注意的辐射效应与辐射容积的关系、各组颅神经和脑干对γ射线的耐受剂量等作了扼要的叙述。并详述了伽马刀放射手术的适应证。

头颈部放射治疗后拔牙与放射性颌骨骨髓炎关系的临床分析

目的探讨牙拔除术对头颈部放射治疗后患者发生放射性颌骨骨髓炎（osteoradionecrosis，ORN）的影响。方法收集83例头颈部恶性肿瘤放疗后经x线诊断ORN的需拔牙患者，拔牙前给予口服抗生素2d，微创拔牙，术后继续口服抗生素5d，3个月拔牙创不愈合者诊断为ORN。结果83例患者放疗后因智齿冠周炎、急性牙髓炎、残根残冠、根尖周炎等，共拔除182颗患牙，其中8例出现ORN。放疗剂量不同导致放疗后拔牙发生ORN的差异有统计学意义（x^2=5．004，P=0．025），高剂量患者（70～80Gy）拔牙后ORN炎发生率25．00％，明显高于低剂量患者（50—70Gy）的发生率4．76％。放疗后拔牙时间（X2=0，P=I．000）、一次性拔牙总数目（x2=0，P=1．000）对放疗后拔牙发生ORN的差异无统计学意义。结论放射剂量是诱发ORN的主要原因，放疗前拔除患牙、放疗后定期检查口腔，防治牙周、牙体疾病是预防ORN的主要手段。

凋亡素2配体对放射线诱导95-D细胞凋亡的影响的研究

目的:探讨凋亡素2配体(Apo-2L)对放射线诱导肺癌95-D细胞凋亡的影响。方法:MTT法检测不同浓度凋亡素2配体在体外对肺癌95-D细胞的抑制率,将细胞分为4组,对照组、凋亡素2配体组、单纯照射组、凋亡素2配体+放射照射组,流式细胞仪检测各组凋亡率及细胞周期。结果:凋亡素2配体对95-D细胞的体外抑制作用明显,随着药物浓度的增大及时间的延长,抑制率明显增高(P<0.05)。流式细胞术显示凋亡素2配体与放射线联用能够使95-D细胞的凋亡率提高,与单用凋亡素2配体组及单纯放疗组相比,凋亡率差异显著(P<0.05)。结论:凋亡素2配体在体外具有抑制95-D细胞增殖的作用并能够促进细胞的凋亡,同时凋亡素2配体联合放射线可以明显提高肺癌95-D细胞的凋亡率。

增生性瘢痕的激光治疗进展

手术、创伤、烧伤及炎症反应等多种因素都可以导致增生性瘢痕形成，其治疗包括手术与非手术方法。非手术方法有多种，如：瘢痕内注射皮质类固醇、局部使用维A酸、冷冻疗法、放射线疗法、压迫疗法、硅凝胶敷贴等，其中有些方法因为疼痛、疗程长等原因很难为患者所接受，而且疗效不佳，复发率高，且会带来诸如萎缩性瘢痕、色素异常、皮肤坏死等副作用^[1]。

^(18)F-FDG PET-CT显像评估大鼠C6胶质瘤放疗早期疗效实验研究

目的了解大鼠C6胶质瘤放疗前后18F-脱氧葡萄糖正电子发射体层显像-X线计算机断层成像(18F-FDG PETCT)显像特点,探讨18F-FDG PET-CT评估大鼠C6胶质瘤早期放疗疗效价值。方法建立荷C6胶质瘤SD大鼠模型,按随机数字表法分成对照组及放疗组,两组分别于放疗前及放疗后24 h、7 d行18F-FDG PET-CT显像,采集不同时期大鼠肿瘤最大标准摄取值(SUVmax-T)、对侧脊柱旁肌肉最大标准摄取值(SUVmax-M),计算两者比值(T/M)并观察肿瘤体积变化。放疗结束,取两组肿瘤,常规HE染色,免疫组织化学法测定肿瘤细胞增殖指数Ki-67及微血管密度(MVD)表达情况。结果 1放疗24 h T/M值较放疗前降低(t=5.991,P<0.01)。对照组24 h T/M值较首次显像增高(t=5.196,P<0.01)。2放疗7 d T/M值较放疗后24 h(t=3.082,P<0.05)、放疗前(t=4.822,P<0.01)显著降低(F=5.902,P<0.01)。对照组7 d T/M值较24 h明显增高(t=3.621,P<0.05)。3 HE染色示放疗组较对照组坏死明显,放疗组Ki-67与MVD表达水平较对照组明显减低(t=7.201、2.986,P<0.01)。4 T/M值与Ki-67表达呈明显正相关(r=0.824,r2=0.679,P<0.05);T/M值与MVD表达呈正相关(r=0.779,r2=0.606,P<0.05)。结论18FFDG PET-CT可评估大鼠C6胶质瘤放疗早期疗效,并可反映胶质瘤的增殖活性和血管生成情况。

伽玛刀临床应用中的几个问题

伽玛刀临床应用中的几个问题解放军１５０医院（４７１０３１）许川伽玛刀［１］（ＧａｍｍａＫｎｉｆｅ，即γ刀）是当今世界神经外科最先进的治疗仪器之一。γ刀在我国的开展具有某些特殊性，有几个问题需要认真思考，取得共识，以便γ刀在我国能够健康地开展下去。本文...

浅层X线治疗家族性良性慢性天疱疮

目的:评价浅层X线治疗5例家族性良性慢性天疱疮(HHD)患者的疗效。方法:对5例HHD患者的腋窝或腹股沟等部位行浅层X线治疗,每周1次,共3～4次,累积放射量9～12 Gy。结果:5例患者随访4～35个月后,3例皮疹完全消退,2例部分改善,不良反应主要为色素沉着。结论:浅层X线放射疗法治疗家族性良性慢性天疱疮安全有效。

Therapeutic effects and prognostic factors in three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma

AIM: To evaluate the therapeutic efficacy of threedimensional conformal radiotherapy (3D-CRT) combined with transcatheter arterial chernoembolization (TACE) on the patients with hepatocellular carcinoma (HCC).METHODS: Between 1998 and 2001, 94 patients with HCC received 3D-CRT combined with TACE. A total 63 patients had a Okuda stage Ⅰ lesion and 31 patients had stage Ⅱ. The median tumor size was 10.7 cm (range 3.0-18 cm), and liver drrhosis was present in all the patients. There were 43 cases of class A and 51 dass B. TACE was performed using lipiodol,5-fluorouracil, cisplatin, doxorubicin hydrochloride and mitomycin, followed by gelatin sponge cubes. Fifty-nine patients received TACE only one time, while the others 2 to 3 times. 3D-CRT was started 3-4 wk after TACE. All patients were irradiated with a stereotactic body frame and received 4-8 Gy single high-dose radiation for 8-12 times at the isocenter during a period of 17-26 d (median 22 d).RESULTS: The median follow-up was 37 mo (range 10-48 mo) after diagnosis. The response rate was 90.5%. The overallsurvival rate at 1-, 2-, and 3- year was 93.6%, 53.8% and 26.0% respectively, with the median survival of 25 too. On univariate analysis, age (P=-0.026), Child-Pugh classification for cirrhosis of liver (P=0.010), Okuda stage (P=-0.026),tumor size (P=0.000), tumor type (P=0.029), albuminemia (P=0.035), and radiation dose (P=0.000) proved to be significant factors for survival. On multivariate analysis,age (P=-0.024), radiation dose(P=-0.001), and tumor size (P=0.000) were the significant factors.CONCLUSION: 3D-CRT combined with TACE is an effective and feasible approach for HCC. Age, radiation dose and tumor size were found to be significant prognostic factors for survival of patients with HCC treated by 3D-CRT combined with TACE. Further study for HCC is needed to improve the treatment efficacy.

Effect of intraoperative radiotherapy combined with external beam radiotherapy following internal drainage for advanced pancreatic carcinoma

AIM: To determine the survival of advanced pancreatic cancer patients treated with intraoperative radiotherapy (IORT) combined with external beam radiation therapy (EBRT) following internal drainage (cholecystojejunostomy or choledochojejunostomy). METHODS: Eighty-one patients with advanced pancreatic cancer who received IORT combined with EBRT following internal drainage (ID) between 1996 and 2001 were retrospectively analyzed. Among the 81 patients, 18 underwent ID+IORT, 25 ID+IORT+EBRT (meanwhile, given 5-Fu 300 mg/m^2 iv drip, 2f/w), 16 EBRT, 22 had undergone simple internal drainage. The IORT dose was 15-25Gy in a single fraction. The usual EBRT dose was 30-40Gy with a daily fraction of 1.8-2.0 Gy. RESULTS: The complete remission rate, partial remission rate of patients with backache and abdominal pain treated with ID+IORT were 55.5%, 33.3% respectively. Alleviation of pain was observed 2 or 3 wk after IORT. The median survival time (MST) of ID+IORT group was 10.7 mo. The pain remission rate of patients treated with ID+IORT+EBRT was 92%, and their MST was 12.2 mo. The MST of patients treated with EBRT and simple internal drainage was 5.1 mo and 7.0 mo, respectively. The survival curve of ID+IORT group and ID+IORT+EBRT group was significantly better than that of EBRT group (P<0.05). The difference between the ID+IORT+EBRT group and ID group was significant (P<0.05). CONCLUSION: IORT combined with EBRT following internal drainage can alleviate pain, improve quality of life and prolong survival time of patients with advanced pancreatic cancer.

Adjuvant therapies for colorectal cancer

The management of colon and rectal cancer has changed dramatically over the last 25 years. The use of adjuvant therapies has become standard practice in locally advanced (stage Ⅲ and selected stage Ⅱ) colorectal cancer. Improved surgical techniques, chemotherapeutics and radiotherapy are resulting in higher cure rates and the development of agents targeting proliferative and angiogenic pathways offer further promise. Here we explore risk factors for local and distant recurrence after resection of colon and rectal cancer, and the role of adjuvant treatments. Discussion will focus on the evidence base for adjuvant therapies utilised in colorectal cancer, and the treatment of sub-groups such as the elderly and stage Ⅱ disease. The role of adjuvant radiotherapy in rectal cancer in reduction of recurrence will be explored and the role and optimal methods for surveillance post-curative resection with or without adjuvant therapy will also be addressed.

Anti-tumor effect of pEgr-IFNγgene-radiotherapy in B16 melanoma-bearing mice

AIM: To construct a pEgr-IFNγ Plasmid and to investigate its expression properties of interferon-γ (INF-γ) induced by irradiation and the effect of gene-radiotherapy on the growth of melanoma. METHODS: A recombined plasmid, pEgr-IFNγ, was constructed and transfected into B16 cell line with lipofectamine. The expression properties of pEgr-IFNγ were investigated by ELISA. Then, a B16 melanoma-bearing model was established in mice, and the plasmid wasinjected into the tumor tissue. The tumor received 20 Gy X-ray irradiation 36 h after injection, and IFN-γ expression was detected from the tumor tissue. A tumor growth curve at different time points was determined. RESULTS: The eukaryotic expression vector, pEgr-IFNγ, was successfully constructed and transfected into B16 cells. IFN-γ expression was significantly increased in transfected cells after X-ray irradiation in comparison with 0 Gy group (77.73-94.60 pg/mL, P<0.05-0.001), and was significantly higher at 4 h and 6 h than that of control group after 2 Gy X-ray irradiation (78.90-90.00 pg/mL, P<0.01-0.001).When the transfected cells were given 2 Gy irradiation 5 times at an interval of 24 h, IFN-y expression decreased in a time-dependent manner. From d 3 to d 15 after IFNγ generadiotherapy, the tumor growth was significantly slower than that after irradiation or gene therapy alone. CONCLUSION: The anti-tumor effect of pEgr-IFNγ generadiotherapy is better than that of genebherapy or radiotherapy alone for melanoma. These results may establish an important experimental basis for gene-radiotherapy of cancer.

Enhancement of CD4^+ T cell activities and modulation of Th1/Th2 lineage development in radiated tumor-bearing rats treated with male zooid of Antheraea pernyi extracts

AIM: To investigate whether supplementation of male zooid of Antheraea pernyi extracts (MZAPE) could enhance immune function of radiated tumor-bearing rats. METHODS: Eighty male Wistar rats were randomly divided into a control group, a simple radiation group, a MZAPE group, and a radiation plus MZAPE group. With the tumor model established by implanting Walker-256 ascites tumor cells, tumor weight and tumor control rate were calculated. The rats in the simple radiation and radiation plus MZAPE groups were underwent to radiation at 10 Gy within 2 d. In the MZAPE and radiation plus MZAPE groups, the MZAPE was gavaged at a dose of 16.53 mg/kg once a day for 7 d. T cell subsets in peripheral blood were determined by flow cytometry and the expression of IL-2, IFN-γ, IL-4 and IL-10 in sera were determined by ELISA on the 8th d. RESULTS: The tumor weight of simple radiation group, MZAPE group and radiation plus MZAPE group was lower than that of control group (P < 0.01) and tumor control rates were 63.08% ± 6.43%, 69.86% ± 7.12% and 35.30% ± 7.67%, respectively. CD4+ T and CD8+ T cells in the peripheral blood of the simple radiation group were fewer than in control group. In the MZAPE and radiation plus MZAPE groups, the number of CD4+ T cells was higher while CD8+ T cells was lower than in the control and simple radiation groups. Expression of IL-2 and INF-γ in the radiation group was lower than in control group, and significantly enhanced during MZAPE therapy (P < 0.05). Expression of IL-4 and IL-10 in the radiation group had no significant changes compared with the control group, and decreased significantly after MZAPE treatment (P < 0.01). CONCLUSION: MZAPE administration may help improve the immune function of the radiated tumor-bearing rats and reverse the radiation-induced immune inhibition by promoting the proliferation of T helper cells and inducing the transdifferentiation from Th2 to Th1.

A study of transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy for local advanced pancreatic cancer

Objective: To evaluate the clinical effect of transarterial infusion chemotherapy of gemcitabine plus three dimen- sional conformal radiotherapy on patients with local advanced pancreatic cancer. Methods: Fifty-one patients with local ad- vanced pancreatic cancer from June 2002 to February 2004 were enrolled, twenty-four patients of combined group were treat- ed with transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy, while twenty-seven patients of control group were treated only with transarterial infusion chemotherapy of gemcitabine. Results: There were significant statistical differences between two groups in clinical benefit response (91.7% versus 74.1%, P < 0.01) and overall remission rate (70.8% versus 33.3%, P < 0.01). The 6-month survival rate, 12-month survival rate and 24-month survival rate of combined group were 83.3%, 62.5% and 37.5% respectively, while that of control group were 55.6%, 33.3% and 11.1% respectively. This showed significant difference between the two groups. Conclusion: Transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy may be better than single transarterial infusion chemotherapy of gemcitabine in improving survival rates and elongating survival time of patients with local advanced pancreatic cancer.

The Radiotherapy Effect of 512 Cases of Carcinoma of Cervix Uteri

To report treatment results of 512 cases of carcinoma of uteri and investigate the way to improve treatment effects. Methods: The 5-year survival rate and the factors influencing the prognosis of 512 cases of uteri were analyzed retrospectively. Results: The 5-year survival rate after radiotherapy was as follows: stage I: 100%; stage Ⅱ: 74.5%; stage Ⅲ: 56.5%; stage IV: 28.6%. Overall 5-year survival rate was 65.4%, which was almost the same as traditional intracavitary injection (65.7%). The 5-year survival rate in cervix lesions more than 4 cm and those less than or equal to 4 cm in stage Ⅱ was 63.9% and 79.3%, respectively, with statistically significant difference (P<0.05). The 5-year survival rate of the patients with squamous carcinoma in stage Ⅱ was 77.0% and that with low differentiated squamous carcinoma was 64.0% respectively. Twenty-three (4.5%) out of 512 suffered from post-radiotherapy rectitis, 18 (3.5%) cystitis. Conclusion: the survival rate of the patients with cervix carcinoma subject to radiotherapy is stabilized to 65%. The diameter and pathological classes affect survival rate, respectively. Low radiotherapy dose decrease complications.

理疗方法及设备在临床的应用

物理疗法简称理疗,是临床治疗手段之一,它具有操作简便、治疗费用低廉、疗效好、无副作用,多无痛苦、无创伤等优点。理疗的基本原理是:用人工的方法将物理能源直接或间接的施加在人体的某一部位,通过物理能源的作用或人体的神经反射作用及体液作用,影响人体的神经系统和体液系统,加强和改善这些系统的功能,从而达到特定的治疗目的。药物治疗配合理疗,可以缩短病程,加速康复,因此,理疗越来越多的受到临床医生及患者的青睐。掌握和选择适当的理疗方法也就显得尤为重要。 临床治疗可见的理疗方法有:电疗法,光线疗法,磁疗法,冷冻疗法,高压氧仓疗法,超声波疗法,运动疗法,生物反馈疗法,放射线疗法,水疗法,温热疗法等。下面介绍几种临床常用的理方法。