Clinical role of ^(18)F-FDG PET/CT-based simultaneous modulated accelerated radiotherapy treatment planning for locally advanced nasopharyngeal carcinoma

Objective The aim of this study was to compare the long-term local control, overall survival, and late toxicities of positron emission tomography/computed tomography （PET/CT）-guided dose escalation radio- therapy versus conventional radiotherapy in the concurrent chemoradiotherapy treatment of locally ad- vanced nasopharyngeal carcinoma （NPC）. Methods Atotal of 48 patients with stage IIl-IVa NPC were recruited and randomly administered PET/CT- guided dose escalation chemoradiotherapy （group A） or conventional chemoradiotherapy （group B）. The dose-escalation radiotherapy was performed using the simultaneous modulated accelerated radiotherapy technique at prescribed doses of 77 gray （Gy） in 32 fractions （f） to the gross target volume （GTV）： planning target volume （PTV） 1 received 64 Gy/32 f, while PTV2 received 54.4 Gy/32 f. Patients in group B received uniform-dose intensity-modulated radiotherapy, PTV1 received 70 Gy/35 f and PTV2 received 58 Gy/29 f. Concurrent chemotherapy consisted of cisplatin [20 mg/m2 intravenous （IV） on days 1-4] and docetaxel （75 mg/m2 IV on days 1 and 8） administered during treatment weeks 1 and 4. All patients received 2-4 cycles of adjuvant chemotherapy of the same dose and drug regimen. Results The use of fluorine-18-fluorodeoxyglucose （18F-FDG） PET/CT significantly reduced the treat- ment volume delineation of the GTV in 83.3% （20/24） of patients. The 5-year local recurrence-free survival rates of the two groups were 100% and 79.2%, respectively （P = 0.019）. The 5-year disease free survival （DFS） rates were 95.8% and 75.0%, respectively （P = 0.018）. The 5-year local progression-free survival and DFS rates were significantly different. The 5-year overall survival （OS） rates were 95.8% and 79.2%, re- spectively. Differences in OS improvement were insignificant （P = 0.079）. Late toxicities were similar in the two groups. The most common late toxicities of the two arms were grade 1-2 skin dystrophy, xerostomia, subcutaneous fibrosis, and hearing loss. There were no cases of grade 4 late toxicity. Conclusion The use of 18F-FDG PET/CT-guided dose escalation radiotherapy is well tolerated and can reduce local recurrence rates for patients with locally advanced NPC compared to conventional chemora- diotherapy.

THE IMPACT OF RADIOTHERAPY COURSE LENGTH ON THE TREATMENT RESULTS OF NASOPHARYNGEAL CARCINOMA(NPC)

Analyses made among four radiotherapy schedules for NPC in order to determine whether there is an impact of radiotherapy course length on treatment results.A series of 320 NPC patients were divided into four radiation treatment branches each with a schedule, this clinical trial was non-randomized.Radiotherapy course length factor was considered with a derivative LQ model formula that biological effective dose(BED)=nd[1 +d/(α/β)]-(T-28).The four branches were:1.split-course 103 cases, with an intermediary rest of 3-4 weeks,mean total dose 70Gy/35fx,73d, BED 51.6 Gy; 2.continuous 115 cases, 72Gy/36fx, 61d, BED 62.6 Gy;3.hyperfractionation I 52 cases, 1.5 Gy b.i.d.,time interval(Ti)≥6 hr, 75Gy/49fx,57d,BED 65.5Gy;4. hyperfractionation Ⅱ 50 cases, 1.2 Gy b.i.d., Ti≥6hr,76Gy/60fx,59d,BED 63.0 Gy.Treatment results were compared with 1-, and 3-year loco-regional recurrent rates,and 1-,and 3-year survival rates, and these rates were of a negative interrelation with prolonged course duration, but of a positive one with BED valas.Continuous branch was of a course mean 12 days shorter than the spilt-course one, its treatment results were nearly 10% higher in some subgroups;and hyperfractionation branches were slightly better than continuous one.

Biomarkers for enhancing the radiosensitivity of nasopharyngeal carcinoma

Nasopharyngeal carcinoma(NPC) is a common head and neck malignancy. The incidence of NPC is higher in Southern China and Southeast Asia compared with Western countries. Given its high radiosensitivity, the standard treatment for NPC is radiotherapy. However, radioresistance remains a serious obstacle to successful treatment. Radioresistance can cause local recurrence and distant metastases in some patients after treatment by radiation. Thus, special emphasis has been given to the discovery of effective radiosensitizers. This review aims to discuss the biomarkers, classified according to the main mechanisms of radiosensitization, which can enhance the sensitivity of NPC cells to ionizing radiation.

The clinical effects of concurrent radiochemotherapy in cases suffered from stages III to IVa nasopharyngeal carcinoma

Objective： The aim of the study was to investigate the clinical effects of concurrent radiochemotherapy in treating locally advanced （Stages III-IVa） nasopharyngeal carcinomas （NPCs）. Methods： A total of 95 patients who suffered from nasopharyngeal carcinoma （Stages III-IVa） was divided into two groups： Group concurrent radiochemotherapy （Group CCRT, n = 49） and Group radiotherapy （Group RT, n = 46）. The two groups were both delivered conventional fractionated radiotherapy, while Group CCRT was delivered three cycles chemotherapy of PF （DDP ＋ 5-Fu） regimen or PLF （DDP ＋ 5-Fu ＋ CF） regimen. Results： The complete remission rate and total remission rate of Group CCRT were higher than those of Group RT, and the differences were of statistical importance （X2 = 4.72-7.19, P 〈 0.05）. The one-year overall survival （OS） rate was calculated by life table method, in Group CCRT, it was higher than that of Group RT and the difference was of statistical importance （X2 = 4.24, P 〈 0.05）. The 3-year overall survival （OS） rate, nasopharyngeal control rate and cervical lymph nodes＇ control rate of Group CCRT were all higher than those of Group RT and the differences were of statistical importance （X2 = 4.28-4.40, P 〈 0.05）. The 5-year overall survival （OS） rate and metastasis-free rate of Group CCRT were higher than those of Group RT and the differences were of statistical importance （X2 = 3.96-8.26, P 〈 0.05）. The incidence rates of acute toxicities in Group CCRT were obviously higher than those in Group RT, and the difference of gastrointestinal reaction was of statistical importance （X2 = 11.70, P 〈 0.05）. Conclusion： This study has demonstrated that concurrent radiochemotherapy can improve the remission rate, overall survival rate and locally control rate. The toxicities of concurrent radiochemotherapy can be tolerated by the patients.

Radiation therapy concurrent with weekly cisplatin therapy for loco-regionally advanced nasopharyngeal carcinoma:outcomes of a clinical trial

Objective:The purpose of this study was to define the maximum tolerated dose(MTD) by describing the doselimiting toxicity(DLT) of weekly cisplatin concurrently with conventional plus 3-dimensional conformal radiotherapy(CT + 3DCRT) in patients with loco-regionally advanced nasopharyngeal carcinoma(NPC).Methods:Patients with loco-regionally advanced NPC(III/IVa stage) were enrolled into a dose-escalating study.Toxicity was graded according to Common Terminology Criteria for Adverse Events version 3.0(CTCAE v3.0).MTD was defined when 2 of 6 patients developed DLT.The starting dose of cisplatin was 15 mg/m2/w,with a subsequent dose escalation of 5 mg/m2/w in cohorts of 3 new patients.CT + 3DCRT was given to the nasopharynx and the upper neck;the lower neck was treated by a single anterior field irradiation.The prescription dose was 70-80 Gy by 35-40 fractions to the nasopharynx gross tumor,and 66-70 Gy by 33-35 fractions to the positive neck lymph nodes.Results:From Jun.2008 to Sep.2009,24 patients received complete chemoradiotherapy,and all of them were eligible for toxicity evaluation.On the first five dose levels of 15 mg/m2/w and 35 mg/m2/w,no patient experienced DLT.On the next dose level of 40 mg/m2/w,1 patient experienced DLT of grade 3 myelosuppression for 1.4 weeks,and among the additional 3 patients,no one developed DLT.On the seventh dose level of 45 mg/m2/w,all the patients developed grade 3 myelosuppression for more than 1 weeks,and the dose-escalating trial stopped.The 23(95.8%) patients achieved clinical complete remission(CR) in the local site;22(91.7%) achieved CR in the regional site,and all patients got CR 3 months later.After a median follow-up of 16.4 months,1 patient developed liver metastases 2 months later,1 patient developed bone metastases 10 months later and 22 kept disease-free survival.Conclusion:The MTD of cisplatin weekly with concurrent CT + 3DCRT for local advanced NPC is 40 mg/m2/w,with myelosuppression as DLT.

磁共振成像增强扫描判定鼻咽癌根治性放射治疗后的疗效研究

目的:探讨磁共振成像(MRI)增强扫描在判定鼻咽癌(NPC)根治性放射治疗后疗效的研究。方法:选取医院收治的83例NPC患者,所有患者均接受放射治疗,且分别在放射治疗前后进行MRI增强扫描,分析并记录其影像学结果。结果:接受放射治疗前MRI影像学检查的83例患者肿瘤病灶T2加权成像(T2WI)出现不均匀的高信号等表现,T1加权成像(T1WI)表现出较低的信号,而在增强MRI扫描之后对肿瘤病灶的形状、形态以及周围部位进行观察,其中54例患者病灶侵犯到翼内肌,15例患者病灶侵犯到翼外肌,14例患者病灶侵犯到口咽部;同时有67例患者的颈部淋巴结出现不同程度的肿大。83例患者在接受1~6个疗程的放射治疗后,再次接受MRI增强扫描,其中78例患者的肿瘤病灶范围明显缩小,肿瘤病灶的边界相对较为清晰,对周围组织侵犯的范围也逐渐缩小,已经出现肿大的淋巴结开始有所缩小,放射治疗前与放射治疗后相比,其余5例患者放射治疗前后实施MRI检查并未发现明显的改变。83例患者经过放射治疗前后的肿瘤病灶以及淋巴结MRI检查结果显示,放射治疗后与放射治疗前相比,肿瘤病灶以及淋巴结直径、弥散系数(ADC)值均缩短,且随着放射治疗剂量的增加,肿瘤病灶以及淋巴结直径、ADC值不断缩短,经过重复测量方差分析可见,放射治疗前(0 Gy)和放射治疗时(30 Gy、50 Gy及70 Gy)不同剂量下肿瘤病灶及淋巴结直径比较,差异均有统计学意义(F=284.094,F=51.313;P<0.001);放射治疗前(0 Gy)和放射治疗时(30 Gy、50 Gy及70 Gy)不同剂量下肿瘤病灶及淋巴结直径的ADC值比较,差异均有统计学意义(F=3.361,F=15.108;P<0.05)。83例患者实施放射治疗后行MRI增强扫描可见,病灶边界、侵犯口咽、侵犯翼内肌、侵犯翼外肌以及淋巴结肿大的病灶周围侵犯发生率分别为6.02%、12.05%、24.10%、12.05%和3.61%。结论:对NPC患者实施MRI增强扫描能够充分的将其放射治疗前后的变化显示出来,能够用于对NPC放射治疗疗效的评价,具有较高的临床应用价值。

鼻咽癌放疗后口干燥症的临床分析

背景与目的:口干燥症是鼻咽癌放疗后最常见的后遗症之一,严重影响患者的生存质量。本研究旨在探讨鼻咽癌放疗后口干燥症的严重程度及其对日常生活的影响。方法:在中山大学肿瘤防治中心鼻咽科门诊选择放疗后满1年以上复查的鼻咽癌患者136例,复查时进行面对面访谈式的口干问卷调查,根据调查结果分析口干燥症的严重程度及对生存质量的影响。结果:136例患者均有不同程度的口干,其中73.5%的患者有中度至重度的口干。82.4%的患者因口干经常要喝水来帮助讲话;92.6%的患者因口干经常要喝汤水来帮助吞咽;91.2%的患者饮食习惯有明显改变,只能吃半流质食物、软食或干饭加汤水;61.3%的患者在夜间因口干而醒来需喝水;75.0%的患者诉放疗后牙齿有不同程度病变。结论:73.5%行常规放疗的鼻咽癌患者有中度至重度的口干。鼻咽癌放疗后口干燥症对患者的讲话、吞咽、睡眠有严重影响,患牙病的几率增加。

鼻咽癌组织放疗前后细胞增殖凋亡的变化

目的 研究鼻咽癌组织放疗前后细胞增殖凋亡的变化。方法 采用TdT酶介导的生物素化dutp缺口末端标记技术 (terminaloxynucleotidyltransferasemediateddUTPbiotinnickendlabeling,TUNEL)和免疫组化S P法 ,分别检测 6 0例鼻咽癌患者在放疗前、放疗第 2周、第 4周时细胞凋亡率(apoptosisrate,AR)和增殖细胞核抗原 (proliferationcellnuclearantigen ,PCNA)的表达。结果 鼻咽癌组织放疗后的AR明显高于放疗前 ;常规分割放疗组放疗第 4周后的AR较放疗第 2周时下降 ,而PCNA增殖指数升高 (P <0 0 1) ;加速超分割放疗组放疗第 2周和放疗第 4周的AR、PCNA增殖指数均无显著差异 (P >0 0 5 )。结论 放射治疗鼻咽癌可以加速癌细胞的凋亡 ,鼻咽癌自发性细胞凋亡与放疗诱发的凋亡呈正相关。常规分割放疗过程中存在肿瘤细胞加速再增殖和细胞凋亡率下降 ,而采用超分割放疗可以减少鼻咽癌细胞加速再增殖 ,提高凋亡率。

一种新型可调充气式鼻咽后装施源器的研制和应用

背景与目的:鼻咽腔内近距离放疗施源器(以下简称施源器)在鼻咽腔内近距离放疗中起重要作用,直接影响治疗的效果。我们研制了一种新型施源器。方法:新型施源器用医用乳胶材料制成,在距施源器前端15mm处置一气囊,气囊边缘与管轴相切,紧贴于管壁一侧,令充气时管轴反向拱形隆起贴近治疗部位。使用时经中鼻道达后壁,通过旋转施源器可调节施源器方向和位置,经注气孔注入空气并固定。治疗前需复核定位证实。结果:共治疗221例鼻咽癌,初治病例中鼻咽肿物消退率92.6%,复发病例鼻咽肿物全部消退,鼻咽前壁或后壁粘膜坏死5例,鼻甲水肿及后鼻道粘连8例。结论:本施源器具有安全可靠,操作方便,患者无痛苦,剂量分布理想,固定性较好等优点。在治疗中出现鼻咽粘膜坏死可能与初期使用时单次剂量过高有关。

428例鼻咽癌患者颈部及Ⅴ区后缘转移淋巴结位置分布规律研究

目的:分析鼻咽癌患者颈部及Ⅴ区后缘淋巴结的转移规律,指导鼻咽癌颈部放疗靶区的勾画。方法:回顾性分析2013年2月至2016年4月就诊于成都军区总医院428例经病理确诊为鼻咽癌的患者,所有患者均行颅底至锁骨下缘的增强CT模拟扫描。淋巴结分区采用RTOG等推荐的分区指南(2013版),由两位医师共同阅片对颈部及Ⅴ区后缘的转移淋巴结进行分析,并选取1例N0期的鼻咽癌患者作为标准,参照Ⅴ区后缘正常解剖结构位置及比例,将428例患者中有Ⅴ区后缘转移淋巴结的中心点勾画于标准病例的定位CT图像上,采用SPSS 19.0软件分析Ⅴ区后缘淋巴结转移与其余各区淋巴结之间的相关性,并分析Ⅴ区后缘转移淋巴结的位置及特点。结果:428例患者中381例(89.0%)出现淋巴结转移,转移概率最高的前4位淋巴结区依次为Ⅱb(75.2%)、Ⅶa(60.3%)、Ⅱa(59.6%)、Ⅲ(42.0%);21例(4.9%)出现Ⅴ区后缘淋巴结转移,共统计Ⅴ区后缘转移淋巴结32枚,各枚淋巴结中心点在标准患者上距斜方肌前缘的垂直距离均值为16 mm。相关性分析提示Ⅴ区后缘淋巴结转移与同侧Ⅴa区相关(P=0.001)。结论:鼻咽癌颈部淋巴结按照从上到下,由近及远的顺序转移,跳跃性转移的发生率低;Ⅴ区后缘淋巴结转移与同侧Va区阳性相关;Va区淋巴结转移时,同侧V区后界的勾画应适当后移至斜方肌前缘后25 mm。

磁共振扩散峰度成像预测鼻咽癌放疗近期疗效研究

背景与目的:磁共振(magnetic resonance imaging,MRI)扩散峰度成像(diffusion kurtosis imaging,DKI)是非侵入性新型功能成像技术,是扩散张量成像(diffusion tensor imaging,DTI)技术的延伸和发展,该研究运用MRI-DKI技术的相关参数前瞻性分析该技术在预测鼻咽癌放疗近期疗效中的作用。方法:收集2014年11月—2017年8月在海南省人民医院就诊的60例鼻咽癌患者,所有患者在治疗前、后分别行MRI扫描及DKI扫描,治疗后3个月的MRI检查按RECIST 1.1标准评估疗效,分为治疗反应组(response group,RG)和无反应组(no-response group,NRG)。结果:治疗前肿瘤最大层面直径在两组间差异无统计学意义(P=0.057)。治疗前DKI扫描测得参数轴向扩散系数(axis diffusion coefficient,D_(ax))、平均扩散系数(mean diffusion coefficient,D_(mean))和横向扩散系数(radius diffusion coefficient,D_(rad))在RG组明显高于NRG组(P=0.02、0.03和0.03),部分各向异性(fractional anisotropy,FA)、轴向峰度系数(axis kurtosis coefficient,K_(ax))、峰度部分各向异性(kurtosis fractional anisotropy,KFA)、平均峰度系数(mean kurtosis coefficient,K_(mean))、横向峰度系数(radius kurtosis coefficient,K_(rad))和平均峰度张量(mean kurtosis tensor,Mkt)在RG组明显低于NRG组(P=0.03、0.02、0.01、0.00、0.00和0.00)。K_(rad)(临界值=0.76)是最好的预测放疗敏感性的参数。用受试者工作特征(receiver operating characteristic,ROC)曲线分析参数K_(rad)显示,灵敏度为77.8%,特异度为93.7%[曲线下面积(area under curve,AUC)=0.913,95%CI:0.811~1.000]。多因素分析显示,DKI的参数是鼻咽癌放疗敏感性的独立预测因素。结论:MRI-DKI技术可用于预测鼻咽癌放疗的近期疗效。

早期干预在减缓鼻咽癌放疗后分泌性中耳炎中的作用

目的探讨鼻咽癌患者放疗早期经鼓室注入曲安奈德及氨溴索溶液在减缓放疗后分泌性中耳炎中的作用。方法收集在放疗前无分泌性中耳炎症状的鼻咽癌患者40例,共有64耳在放射野内,分为实验组和对照组各32耳。实验组于放疗量达30Gy开始每周鼓室注射曲安奈德及氨溴索混合液,对照组不进行任何预防性处理,直到放疗结束,两组病人均观察至放疗结束后6个月,比较分析两组病人在放疗结束,放疗后第3个月末及第6个月末患分泌性中耳炎的概率。结果放疗结束时实验组1人1耳出现分泌性中耳炎(1/32),对照组有4人6耳出现分泌性中耳炎(6/32),两者差异有统计学意义(X2=18.19,p<0.01)。放疗后第3个月末实验组有2人2耳出现分泌性中耳炎(2/32),对照组中有6人共9耳出现分泌性中耳炎(9/32),两者差异有统计学意义(X2=20.75,p<0.01)。第6个月末时实验组有4人共6耳出现分泌性中耳炎(6/32),对照组共有13人共18耳出现分泌性中耳炎(18/32),两者差异有统计学意义(X2=30.47,p<0.01)。结论在鼻咽癌放疗早期经鼓室注入曲安奈德及氨溴索,能减缓鼻咽癌患者放疗后分泌性中耳炎进程。

放疗同步TNF方案治疗鼻咽癌的临床疗效观察

目的:观察放疗同期紫杉醇+奈达伯+氟尿嘧啶化疗治疗鼻咽癌的疗效及毒副反应。方法:81例确诊为鼻咽癌的患者随机分为治疗组(放疗同期TNF方案化疗组)41例和对照组(单纯放疗组)40例。治疗组在放射治疗的第1、4周给予TNF方案化疗及放疗后2个周期紫杉醇+奈达伯+氟尿嘧啶方案化疗。结果:治疗组1、3年生存率分别为100%(41/41)、82.9%(34/41)。对照组1、3年生存率分别为87.5%(35/40)、62.5%(25/40)(P>0.05)。放化组3年生存率及局控率、远处转移控制率明显高于单纯放疗组,治疗组虽消化道反应及骨髓功能抑制明显较对照组发生率高,但与对照组相比无统计学差异。结论:放疗同期TNF化疗治疗鼻咽癌疗效好,毒副反应可耐受。

我国鼻咽癌放射治疗研究热点及趋势分析

运用文献计量学方法及CiteSpace等软件对中国知网数据库1988-2018年收录的鼻咽癌放射治疗相关文献进行可视化研究,通过分析地区发文量、重要作者以及关键词热点变化了解该领域研究现状和未来发展方向。

鼻咽癌放疗期患者的口腔反应及口腔念珠菌负荷状况和生物分型

目的:探讨鼻咽癌(NPC)放疗期患者口腔反应及念珠菌负荷状况及生物分型.方法:同期观察NPC放疗期患者48例(实验组)和健康对照者42例(对照组)的口腔反应,并采取漱口法进行口腔念珠菌的定量检测,利用革兰染色法、厚壁孢子生成实验、CHROMagar显色培养和API 20 CAUX鉴定系统对分离株进行生物型鉴定.结果:实验组中有30例主诉口干、疼痛,其中10例伴有味觉障碍; 8例有放射性口炎;7例为口腔念珠菌病,与对照组比较差异有统计学意义(P<0.05或P<0.01);实验组口腔念珠菌的检出率为50.00%,高负荷检出均来自有口干主诉的患者,而对照组仅为16.67%,负荷均低于500 CFU/ml,两组比较差异有统计学意义(P=0.001,OR值=3.000,95% CI 1.44～6.24); 24个分离株中白色念珠菌15株,近平滑念珠菌2株,高里念珠菌2株,法氏念珠菌2株,其它3株.结论:NPC放疗期患者口腔健康状况受损,主要表现为口干和放射性口炎,口腔念珠菌病发生率增高.口腔念珠菌的检出率增加,除白色念珠菌外,其它菌型亦可能成为NPC放疗患者口腔念珠菌的病原菌.

模拟摆位训练对鼻咽癌调强放疗首次摆位误差的影响研究

目的:研究治疗前模拟摆位训练对鼻咽癌调强放疗首次摆位误差的影响,为提高治疗摆位精度提供临床参考。方法:实验入组100例鼻咽癌调强放疗患者,随机分为常规组(50例)与训练组(50例)。常规组按常规过程治疗摆位,训练组在治疗前一天进行一次模拟摆位训练。相同条件下,首次治疗摆位时利用EPID给患者拍摄MVDR验证片,通过灰度配准+人工配准得到摆位误差,并记录满足临床要求所需调整的摆位次数n。采用独立t检验进行统计分析。结果:与常规组相比,训练组中患者首次摆位的旋转误差无论在调整前还是在调整后都要明显变小,差别具有统计学意义(P<0.05)。调整前和调整后的常规组与训练组的旋转角度Rtn分别为(0.25°±0.75°)vs(-0.01°±0.22°)(P=0.026)和(0.03°±0.15°)vs(-0.12°±0.10°)(P=0.027)。另外,训练组在首次摆位过程中调整次数要明显少于常规组(P<0.05),调整次数分别为(0.14±0.40)次vs(0.80±1.26)次(P=0.001)。结论:鼻咽癌调强放射治疗前进行模拟摆位训练可以明显减少旋转角度误差和调整摆位次数,提高了放射治疗摆位精度和效率。

新辅助化疗联合放疗治疗中晚期鼻咽癌的疗效观察

目的：研究新辅助化疗在治疗中晚期鼻咽癌（NPC）中的疗效。方法：63例中晚期NPC病人随机分为单纯放疗组30例、新辅助化疗联合放疗组33例。化疗方案：PFL方案（DDP80mg／m^2～100mg／m^2，d1；5-FU3．5／m^248h；CF0．3，d1），共2～3疗程；化疗后2周常规放射治疗：鼻咽癌原发灶DT68．0Gy／7周，颈转移灶DT65．0Gy／6周，颈预防剂量55．0Gy。结果：新辅助化疗联合放疗组原发灶及颈转移灶完全缓解率优于单纯放疗组，毒性反应与单纯放疗组相比无明显差异。结论：新辅助化疗联合放疗可提高中晚期NPC患者近期肿瘤缓解率，毒性反应可耐受，但远期生存率需进一步观察。

三氧治疗对鼻咽癌放疗患者血清HIF-1α和VEGF水平的影响

目的探讨三氧治疗对鼻咽癌放疗患者血清HIF-1α和VEGF水平的影响。方法 40例鼻咽癌患者随机分为三氧联合调强放疗组(实验组)和调强放疗组(对照组),每组20例。应用ELISA法检测两组治疗前、中、后的HIF-1α和VEGF水平。结果实验组治疗后HIF-1α与治疗前相比差异无统计学意义(p>0.05),治疗后VEGF低于治疗前水平(p<0.05)。对照组治疗后HIF-1α和VEGF均高于治疗前,具有显著统计学差异(p<0.01)。实验组治疗后HIF-1α和VEGF均低于对照组,且具有显著统计学差异(p<0.01)。结论三氧治疗可降低鼻咽癌放疗患者血清HIF-1α和VEGF水平。

调强放疗对鼻咽癌患者甲状腺功能的影响

目的探讨鼻咽癌患者调强放射治疗后早期甲状腺功能的变化情况,为甲状腺功能保护提供依据。方法收集经病理证实、排除基础甲状腺疾病且接受IMRT治疗的鼻咽癌患者。分析对比放疗前后TT3和TT4水平。结果全组患者治疗前、后TT3水平分别为1.83 IU/L、1.69 IU/L,治疗前、后TT4水平分别为124.66 IU/L、127.23 IU/L。其中150例(59.8%)治疗后TT3水平下降,变化具有统计学差异(P=0.001)。N3患者放疗后血清TT3及TT4水平均明显降低(P值分别为0.043、0.032)。结论 IMRT模式下,鼻咽癌患者放疗结束时甲状腺激素降低,N3患者尤为明显。N3患者可运用VMAT/Tomotherapy等技术降低甲状腺照射剂量,且应早期监测甲状腺激素水平,发现问题及早干预。

五色灵芝对减轻鼻咽癌患者放疗反应及提高免疫功能的临床试验

观察由香港维特健灵健康产品公司提供的“五色灵芝胶囊”对减轻患者放疗反应及提高免疫功能的作用。方法：将确诊鼻咽癌进行单纯放疗的７２例患者，随机分成试验组及对照组，每组各３６例。在放疗期间试验组服五色灵芝胶囊２粒ｔｉｄ，而对照组服Ｖｉｔｃ２粒ｔｉｄ。两组分别在放疗前、中、放疗后检测外周血淋巴细胞３Ｈ－ＴＤＲ转化率，自然杀伤淋巴细胞，Ｈｂ、ＲＢＣ、ＷＢＣ及观察口干、胃纳、口腔粘膜反应。结果：试验组患者外周血３Ｈ－ＴＤＲ淋巴细胞转化率白细胞的升高程度大于对照组，有显著性差异；其它指标两组间无差异。结论：“五色灵芝胶囊”对提高放疗患者的免疫功能有效，对减轻放疗副作用无效。