The clinical observation of three-dimensional conformal radiotherapy combined with FOLFOX chemotherapy for rectal cancer of postoperative local recurrence

Objective The aim of this study was to explore the three-dimensional conformal radiotherapy combined with FOLFOX scheme chemotherapy in the treatment of postoperative recurrence of rectal cancer.

Three-dimensional conformal radiotherapy combined with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer

AIM： To investigate the effect of three-dimensional conformal radiotherapy （3-DCRT） in combination with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer. METHODS： Forty-eight patients with unresectable recurrent rectal cancer were randomized and treated by 3-DCRT or 3-DCRT combined with FOLFOX4 chemotherapy between September 2001 and October 2003. For the patients without prior radiation history, the initial radiation was given to the whole pelvis by traditional methods with tumor dose of 40 Gy, followed by 3-DCRT for the recurrent lesions to the median total cumulative tumor dose of 60 Gy （range 56-66 Gy）; for the post-radiation recurrent patients, 3-DCRT was directly given for the recurrent lesions to the median tumor dose of 40 Gy （36-46 Gy）. For patients in the study group, two cycles chemotherapy with FOLFOX4 regimen were given concurrently with radiotherapy, with the first cycle given simultaneously with the initiation of radiation and the second cycle given in the fifth week for patients receiving conventional pelvis radiation or given in the last week of 3-DCRT for patients receiving 3-DCRT directly. Another 2-4 cycles （average 3.6 cycles） sequential FOLFOX4 regimen chemotherapy were given to the patients in the study group, beginning at 2-3 wk after chemoradiation. The outcomes of symptoms relieve, tumor response, survival and toxicity were recorded and compared between the study group and the control group. RESULTS： For the study group and the control group, the pain-alleviation rates were 95.2% and 91.3%（P〉 0.05）; the overall response rates were 56.5% and 40.0% （P〉0.05）; the 1-year and 2-year survival rates were 86.9%, 50.2% and 80.0%, 23.9%, with median survival time of 25 mo and 16 mo （P〈 0.05）; the 2-year distant metastasis rates were 39.1% and 56.0% （P= 0.054）, respectively. The side effects, except peripheral neuropathy which was relatively severer in the study group, were similar in the the two groups and well tolerated. CONCLUSION： Three-dimensional conformal radiotherapy combined with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer is a feasible and effective therapeutic approach, and can reduce distant metastasis rate and improve the survival rate.

Dosimetric study of five-field intensity-modulated radiotherapy compared with conventional three-dimensional conformal radiotherapy for rectal cancer

Objective： The aim of the study was to compare the difference of dose distribution in clinical target volume and organ at risk （OAR） between five-field intensity-modulated radiotherapy （IMRT） and conventional three-dimensional conformal radiotherapy （3DCRT） in the radiotherapy of rectal cancer. Methods： Fifteen patients with rectal cancer treated with radio- therapy （RT） were retrospectively analyzed. Among the patients, seven received RT preoperatively and 8 postoperatively. The target volume and the OARs such as the small bowel, bladder and femoral heads were contoured for each patient. 3DCRT-plan and IMRT-plan were performed for each patient respectively, with the prescribed dose covering at least 95% of the planning target volume （PTV）. The conformity index （CI） and homogeneity index （HI） were used for evaluation of the dose distribution in the target volume, and the Dx% （the lowest dose to the x% volume of the OARs that received the highest dose of irradiation） and the mean dose were used for evaluation of the dose to OARs. Paired-T test was used for companson of the difference between the two plans. Results： In the IMRT-plan and 3DCRT-plan, the CI were 0.94 and 0.87 （P = 0.000） and the HI were 1.13 and 1.17, respectively （P = 0.001）. For small bowel, the D30%, D50% and the mean dose were 19.67 Gy, 15.13 Gy and 18.81 Gy in the IMRT-plan and 25.20 Gy, 22.20 Gy and 22.89 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For bladder, the D30%, D50%, and the mean dose were 24.80 Gy, 34.20 Gy and 28.70 Gy in the IMRT- plan, and 35.07 Gy, 44.67 Gy and 35.68 Gy in the 3DCRT-plan, respectively （P 〈 0.001 for all pairs of parameters）. For femoral heads, the D5% in the IMRT-plan and 3DCRT-plan were 40.6 Gy and 40.47 Gy, respectively （P = 0.936）, and the mean dose were 30.14 Gy and 25.57 Gy, respectively （P = 0.001）. Conclusion： Five-field IMRT-plan is better than 3DCRT-plan in the conformity and the dose homogeneity within target volume and also better in sparing the small bowel and bladder.

Modified simultaneous integrated boost radiotherapy for an unresectable huge refractory pelvic tumor diagnosed as a rectal adenocarcinoma

A clinical trial of radiotherapy with modified simultaneous integrated boost(SIB)technique against huge tumors was conducted.A 58-year-old male patient who had a huge pelvic tumor diagnosed as a rectal adenocarcinoma due to familial adenomatous polyposis was enrolled in this trial.The total dose of 77 Gy(equivalent dose in 2Gy/fraction)and 64.5 Gy was delivered to the center of the tumor and the surrounding area respectively,andapproximately 20%dose escalation was achieved with the modified SIB technique.The tumor with an initial maximum size of 15 cm disappeared 120 d after the start of the radiotherapy.Performance status of the patient improved from 4 to 0.Radiotherapy with modified SIB may be effective for patients with a huge tumor in terms of tumor shrinkage/disappearance,improvement of QOL,and prolongation of survival.

Role of dynamic perfusion magnetic resonance imaging in patients with local advanced rectal cancer

BACKGROUND The management of rectal cancer patients is mainly based on the use of the magnetic resonance imaging(MRI)technique as a diagnostic tool for both staging and restaging.After treatment,to date,the evaluation of complete response is based on the histopathology assessment by using different tumor regression grade(TRG)features(e.g.,Dworak or Mandard classifications).While from the radiological point of view,the main attention for the prediction of a complete response after chemotherapy treatment focuses on MRI and the potential role of diffusion-weighted images and perfusion imaging represented by dynamiccontrast enhanced MRI.The main aim is to find a reliable tool to predict tumor response in comparison to histopathologic findings.AIM To investigate the value of dynamic contrast-enhanced perfusion-MRI parameters in the evaluation of the healthy rectal wall and tumor response to chemo-radiation therapy in patients with local advanced rectal cancer with histopathologic correlation.METHODS Twenty-eight patients with biopsy-proven rectal adenocarcinoma who underwent a dynamic contrast-enhanced MR study performed on a 1.5 T MRI system(Achieva,Philips),before(MR1)and after chemoradiation therapy(MR2),were enrolled in this study.The protocol included T1 gadolinium enhanced THRIVE sequences acquired on axial planes.A dedicated workstation was used to generate color permeability maps.Region of interest was manually drawn on tumor tissue and normal rectal wall,hence the following parameters were calculated and statistically analyzed:Relative arterial enhancement(RAE),relative venous enhancement(RVE),relative late enhancement(RLE),maximum enhancement(ME),time to peak and area under the curve(AUC).Perfusion parameters were related to pathologic TRG(Mandard’s criteria;TRG1=complete regression,TRG5=no regression).RESULTS Ten tumors(36%)showed complete or subtotal regression(TRG1-2)at histology and classified as responders;18 tumors(64%)were classified as non-responders(TRG3-5).Perfusion MRI parameters were significantly higher in the tumor tissue than in the healthy tissue in MR1(P<0.05).At baseline(MR1),no significant difference in perfusion parameters was found between responders and nonresponders.After chemo-radiation therapy,at MR2,responders showed significantly(P<0.05)lower perfusion values[RAE(%)54±20;RVE(%)73±24;RLE(%):82±29;ME(%):904±429]compared to non-responders[RAE(%):129±45;RVE(%):154±39;RLE(%):164±35;ME(%):1714±427].Moreover,in responders group perfusion values decreased significantly at MR2[RAE(%):54±20;RVE(%):73±24;RLE(%):82±29;ME(%):904±429]compared to the corresponding perfusion values at MR1[RAE(%):115±21;RVE(%):119±21;RLE(%):111±74;ME(%):1060±325];(P<0.05).Concerning the time-intensity curves,the AUC at MR2 showed significant difference(P=0.03)between responders and non-responders[AUC(mm2×10-3)121±50 vs 258±86],with lower AUC values of the tumor tissue in responders compared to nonresponders.In non-responders,there were no significant differences between perfusion values at MR1 and MR2.CONCLUSION Dynamic contrast perfusion-MRI analysis represents a complementary diagnostic tool for identifying vascularity characteristics of tumor tissue in local advanced rectal cancer,useful in the assessment of treatment response.

鼻咽癌局部复发适形放疗近期疗效分析

目的:采用适形放疗提高鼻咽癌局部复发的治疗效果,探讨最佳剂量分割方法。方法:1997年9月至2000年2月对41例鼻咽癌局部复发病人行适形放疗。27例常规外照射39Gy,在3周内分30次完成后进行低分割适形放疗,80%等剂量线4～7Gy/次,总量20～24Gy,分4次在2周内完成;14例全程超分割适形放疗,90%等剂量线59.8Gy4.6周内分46次完成。结果:适形放疗的等剂量线分布在三维方向上与靶区适形。急性放射性粘膜炎、后组颅神经损伤、张口困难两组相似,低分割组22%鼻咽粘膜坏死,3.7%视神经损伤。超分割组无鼻咽粘膜坏死、视神经损伤。两组治疗有效率均达93%。结论:鼻咽癌局部复发病人采用超分割适形放疗取得满意的近期效果,低分割适形放疗不宜采用。

放射治疗联合奥沙利铂与卡培他滨治疗局部晚期直肠癌的疗效观察

目的:评价术前放射治疗联合奥沙利铂与卡培他滨的方法治疗局部晚期(T3-4)直肠癌的临床疗效和安全性。方法:54例局部晚期直肠癌患者接受术前盆腔放射治疗(50Gy/25次),同步接受奥沙利铂联合卡培他滨的化疗方案(奥沙利铂100mg/m2,静脉滴注第1天和第22天;卡培他滨825mg/m2,口服2次/d,第1～14天以及第22～35天)。结果:54例患者中有51例接受了手术治疗,其中10例(19.7%)患者获得了病理完全缓解(pathologic complete response,pCR),R0切除率为100%,保肛率为51.0%。1年和2年生存率分别为91.0%和83.8%。最常见的不良反应是血液学不良反应,3度以上的不良反应主要是贫血(1.9%)、白细胞减少(11.2%)和血小板减少(1.9%);最常见的非血液学不良反应是腹泻。结论:术前放射治疗联合卡培他滨与奥沙利铂的治疗方案对局部晚期直肠癌有一定的疗效,且不良反应率较低,是一种有效及较为安全的综合治疗方法。

食管癌三维适形放疗疗效和靶区勾画与局部复发关系的探讨

目的:通过分析三维适形放疗的临床结果,初步探讨食管癌靶体积勾画的合理性。方法:共46例行三维适形放疗的食管癌患者进入研究。将靶体积分为大体肿瘤体积(GTV)、临床靶体积(CTV)和计划靶体积(PTV)。处方剂量PTV60~70Gy。采用Kaplan-Meier计算局部区域无进展生存率和总生存率。对比疗前和疗后CT,判断肿瘤复发或未控位于野内、野外或边缘。复发的部位在90%剂量曲线内定义为野内复发,在90%和50%剂量曲线内定义为边缘复发,50%剂量曲线外定义为野外复发。结果:1和2年局部区域无进展生存率分别为67.4%和49.9%,总生存率分别为和76.1%和58.7%。野内、边缘、野外复发或未控分别为50.0%、18.7%和31.3%。结论:该靶体积划定方法是比较合理的,但仍需进一步研究。

5-氟尿嘧啶对直肠癌术后骶前手术间隙灌注化疗的临床研究

目的 探索预防直肠癌术后盆内局部复发的新途径。方法 对 12 6例直肠癌切除术后患者采用盆内骶前手术间隙灌注式化疗新方法 ,术中盆内骶前手术间隙置管 ,术后连续 3天经该管生理盐水冲洗 ,术后 7天灌注 5 氟尿嘧啶进行盆内手术间隙化疗。结果 12 6例无手术死亡。术后随访 5年 ,局部复发 11例 (8 7% ) ,肝转移 16例 (12 7% ) ,腹膜后淋巴转移 8例(6 3% ) ,5年生存率为 74 7%。治疗副作用及术后并发症包括 :白细胞减少 1例 ,恶心呕吐 5例 ,吻合口瘘 1例 ,腹部伤口感染2例、会阴伤口感染 3例 ,拖出肠段坏死 1例。无盆内大出血、盆内感染等严重局部并发症。结论 所用方法操作简单 ,应用方便 ,具有高选择性区域化疗特点 ,全身毒副作用小 ,无严重局部并发症 ,局部复发率低 ,5年生存率较高 ,具有较好的预防局部复发效果 。

局部复发鼻咽癌三维适形放疗初步观察

目的:探索三维适形放疗(3demensionalconformalradiationtherapy3DCRT)技术在局部复发鼻咽癌再程放疗中的应用。方法:1998年4月～1999年10月,采用3DCRT技术治疗局部复发鼻咽癌26例。其中低分化鳞癌25例,低分化腺癌1例。按92’福州分期标准再分期:T1N0M04例,T2N0M08例,T3N0M09例,T4N0M05例。密集肿瘤区(grosstumorvolumeGTV)最大径1.0～5.0cm(平均3.1cm)。全组病例均采用每次5～7个固定适形野照射,计划靶区(planningtargetvolumePTV)平均最大剂量、最小剂量、平均剂量分别为104.1±1.3%、92.1±2.8%、99.2.±1.7%。时间-剂量-分次处方:65～70Gy/26～28次,共5～5.5周。随访8～26个月,中位随访时间17个月。结果:再程放疗后随访期内靶区边缘复发2例,颈淋巴结复发3例,远处转移2例,死亡4例。随访期内肿瘤局部控制率88.5%(23/26),84.6%(22/26)患者生存,76.9%(20/26)无瘤生存。再程放疗所致急性放射反应少而轻。累计后遗症发生率19.2%(5/26),放射性功能损害发生率15.4%4/26。结论:三维适形放疗技术用于局部复发鼻咽癌具有明显的剂量分布优势。初步临床观察结果表明,这一放疗新技术用于局部复发鼻咽癌肿瘤局部控制率高、放射反应和后遗症较少,远期疗效和后遗症尚有待观察。

后程三维适形放射治疗配合化疗治疗直肠癌术后复发临床观察

目的探讨后程三维适形放射治疗结合化疗治疗直肠癌术后复发的疗效。方法49例术后复发直肠癌随机分为适形放疗加化疗组（适形组）25例，常规放疗加化疗组（常规组）24例。适形组前程采用6MVX线全盆腔放疗46Gy后改作三维适形放射治疗推量至70Gy，常规组采用6MVX线全盆腔放疗46Oy；后采用两后斜野成角照射推量至66Gy，两组均于放疗第一周及最后一周化疗，予5-氟尿嘧啶500mg／m^2，甲酰四氢叶酸钙200mg，d1～5，静脉滴注。生存分析采用Kaplan-Meier法。结果适形组和常规组1、2、3年生存率分别为88．0％、64．0％、48．0％和66．7％、45．8％、37．5％（P=0．08），中住生存期分别为35和22月；3年肿瘤局部控制率分别为68．0％、41．7％（P〈0．05），毒副反应两组差异无统计学意义。结论三维适形放射治疗结合化疗是治疗直肠癌术后复发的有效治疗方法，能明显地提高患者的近期生存率。

新辅助同步放化疗联合全系膜切除对局部进展期中低位直肠癌的治疗价值

目的探讨新辅助同步放化疗联合直肠全系膜切除术(total mesorectal excision,TME)用于局部进展期中低位直肠癌治疗的可行性与临床价值。方法 111例局部进展期(T3～4 N0～2 M0)中低位直肠癌术前接受同步放化疗,放疗剂量50 Gy,化疗包括奥沙利铂+卡培他滨的联合化疗方案及不含铂类药物的单药化疗方案。共105例患者同步放化疗结束后2～10周内完成了肿瘤根治性(R0)手术,可进行疗效的病理学评价。结果 105例患者获得根治性切除,切缘均阴性,42例(37.8%,42/111)患者成功实施保肛手术;18例临床-影像分期为T4期患者中,15例(83.3%)新辅助放化疗后获得根治性切除(R0)。所有患者手术及术后恢复顺利,无严重手术并发症;术后病理示肿瘤完全消退15例(14.3%),重度消退26例(24.8%),中度消退40例(38.1%),轻度及无消退24例(22.8%)。结论新辅助同步放化疗联合TME手术安全可行,可提高局部进展期中低位直肠癌的根治性切除率与保肛率,不增加手术并发症,是局部进展期中低位直肠癌的优选治疗模式。

直肠癌五野调强放疗与传统适形放疗剂量学研究

目的:研究五野调强技术(IMRT)与三维适形(3DCRT)技术治疗直肠癌肿瘤靶区和危及器官照射剂量的区别。方法:回顾性分析15例直肠癌患者的放疗资料,其中7例为术前放疗,8例为术后放疗。在每位患者的模拟定位CT上分别勾画肿瘤靶区及小肠、膀胱、股骨头等危及器官(OAR),并分别进行3DCRT和IMRT计划设计,要求处方剂量至少覆盖95%的计划靶体积。应用适形指数(CI)和均匀指数(HI)评价肿瘤靶区剂量的分布,应用Dx%(接受高量照射的x%的体积所受到的最低剂量)和平均剂量评价OAR受照射剂量。两个计划剂量分布的差别采用配对t检验比较。结果:在IMRT和3DCRT计划中,CI分别为0.94和0.87(P=0.000);HI分别为1.13和1.17(P=0.001);小肠D30%分别为19.67Gy和25.20Gy,D50%分别为15.13Gy和22.20Gy,平均剂量分别为18.81Gy和22.89Gy(P均为0.000);膀胱的D30%分别为34.20Gy和44.67Gy,D50%分别为24.80Gy和35.07Gy,平均剂量分别为28.70Gy和35.68Gy(P均为0.000);股骨头D5%分别为40.60Gy和40.47Gy(P=0.936),平均剂量分别为30.14Gy和25.57Gy(P=0.001)。结论:IMRT在靶区剂量均匀性和适形度方面均优于3DCRT计划,对正常组织的保护也存在明显的优势。

Ⅲ、Ⅳa期鼻咽癌调强放疗联合三种含铂方案同期化疗的比较

目的:比较调强适形放疗(IMRT)联合顺铂+氟尿嘧啶(PF)、紫杉醇+顺铂(TP)、每周顺铂(DDP)方案同期治疗Ⅲ、Ⅳa期鼻咽癌的临床疗效和毒副反应。方法:采用前瞻、随机对照研究,138例Ⅲ、Ⅳa期初治鼻咽癌患者分别行PF、TP、每周顺铂方案同期放化疗。均采用IMRT放疗技术。结果:中位随访28(5～37)个月,三组无瘤生存曲线和生存曲线差异有统计学意义(P<0.05)。两两比较,DDP组与PF组优于TP组。三组Ⅲ～Ⅳ度粒细胞减少、胃肠道反应、口腔黏膜炎分别为34.78%vs30.43%vs8.70%(P<0.05)、23.91%vs21.74%vs34.78%(P<0.05)、60.87%vs65.22%vs52.17%(P>0.05)。结论:IMRT同期联合PF、TP、DDP方案治疗Ⅲ、Ⅳa期鼻咽癌,综合近期疗效与毒副反应,DDP方案最优,PF方案次之,远期疗效仍有待进一步随访观察比较。

同步化疗加三维适形放射治疗食管癌术后纵隔淋巴结转移

目的探讨胸段食管癌根治术后纵隔淋巴结转移同步化疗加三维适形放射治疗的疗效和并发症。方法 60例食管癌术后发生纵隔转移的患者,随机分为两组(适形组与对照组),每组30例,放疗采用6/15MVX线外照射,前2/3疗程常规放射治疗DT(38～40)Gy,后1/3疗程采用后程加速超分割适形放射治疗和超分割放疗,2次/天,(1.4～1.5)Gy/次,全疗程总剂量DT(65～68)Gy,采用FP方案化疗(5-Fu+DDP)。结果治疗后3月内复查CT,适形组与对照组的CR、PR分别为53.5%、36.7%和43.3%、36.7%,无进展病例,有效率(CR+PR)分别为90.0%、80.0%(χ2=1.17,P>0.05),1、3、5年生存率分别为80.0%、33.3%、13.3%和73.3%、20.0%、6.7%(χ2=0.80、1.36、0.91,P>0.05)。结论同步化疗加三维适形放射治疗食管癌术后纵隔淋巴结转移可提高局部控制率和生存率,不良反应小。

调强适形放疗同步化疗联合内生场热疗治疗复发和局部晚期直肠癌的近期疗效

目的探讨调强适形放疗(IMRT)联合同步化疗及内生场热疗治疗复发和局部晚期直肠癌的近期疗效及安全性。方法 60例均为经病理证实的复发或局部晚期直肠癌随机分为同步放化疗联合热疗治疗的A组(n=30)和同步放化疗治疗的B组(n=30)。两组放疗方式和化疗方法均相同,A组于放疗后1 h内加用NRL-004型内生场肿瘤热疗系统热疗。治疗结束后3个月评估近期疗效和近期不良反应,随访评估远期疗效。结果A组总有效率(90.0%)高于B组(66.7%),差异有统计学意义(2=4.812,P<0.05)。两组疾病控制率均为100%。KPS评分、局部疼痛缓解率及各类不良反应比较差异均无统计学意义(P>0.05)。结论 IMRT同步Cape OX化疗联合内生场热疗治疗复发和局部晚期直肠癌可有效提高近期疗效、改善生活质量,且不增加不良反应,值得进一步研究。

图像引导调强放疗同步化疗治疗局部晚期宫颈癌的初步临床观察

目的 探讨盆腔调强放疗（IMRT）与三维适形治疗（3-DCRT）分别同步化疗在局部晚期宫颈癌治疗中的近期临床疗效及急性毒副作用.方法 将2012年1月～2013年10月潍坊市人民医院收治的106例局部晚期宫颈癌患者,按患者意愿分为IMRT组（55例）和3-DCRT组（51例）,两组均同步顺铂40 mg/m2每周方案化疗.比较两组患者的近期临床疗效及急性毒副作用.结果 IMRT组和3-DCRT组近期疗效比较,差异无统计学意义（P＞0.05）.两组主要不良反应为血白细胞数减少和消化道反应.与3-DCRT组比较,IMRT组Ⅰ～Ⅲ度的白细胞明显减少（P＜0.05）,直肠炎发生率明显降低（P＜ 0.05）.结论 调强放疗同步化疗治疗局部晚期宫颈癌,虽未提高近期疗效,但急性毒副作用发生率降低.

碳纤维腹板在直肠癌术后放疗中的临床应用

目的：研究碳纤维腹板在直肠癌术后放疗中对小肠和膀胱的保护作用及放疗摆位的重复性。方法：选择直肠癌术后患者45例，其中应用腹板放疗组20例（A组），未应用腹板放疗（对照）组25例（B组），均采用三维适形放疗（three-dimen-sional conformal radiation therapy，3D-CRT）技术，95％的计划靶体积（planning target volume，PTV）处方剂量为50Gy／25次。A组患者采取单纯俯卧位（A1组）或加用腹板（A2组）进行2次CT定位扫描，通过剂量体积直方图观察PTV及小肠和膀胱受照射的剂量和体积。随机抽取A组和B组各10例患者，通过双曝光射野验证系统测量2组患者的摆位误差。同时，观察和记录所有患者在治疗过程中的急性放疗反应。结果：A1、A2组总PTV、总小肠体积、总膀胱体积及PTV平均受照射剂量差异均无统计学意义（P〉0.05）；A2组小肠平均受照射剂量、10％-100％各等剂量曲线包绕的小肠体积、膀胱平均受照射剂量和30％-100％各等剂量曲线包绕的膀胱体积均显著减少，差异有统计学意义（P〈0.05）。与B组相比，A组患者左-右和头-脚方向摆位误差减小，差异有统计学意义（P〈0.05）；前-后方向摆位误差也减小，但差异无统计学意义（P=0.705）。A组患者中≥3级不良反应的发生率为15％（3／20），无治疗中断或终止；B组患者中≥3级不良反应的发生率为24％（6／25），因严重急性反应有2例患者中断治疗，1例患者终止治疗。结论：碳纤维腹板可显著减少直肠癌术后放疗中小肠和膀胱的受照射体积和剂量，且摆位重复性好，患者放疗反应减轻，值得临床推广应用。

局部进展期胃癌根治术后三维适形放疗联合同期化疗与单纯化疗的对比研究

目的：比较局部进展期胃癌根治术后三维适形放疗联合同期化疗与单纯化疗的疗效及安全性。方法将76例拟行胃癌根治术的病理诊断为Ⅱ～Ⅳ期的患者随机分为2组，观察组38例术后给予三维适形放疗联合S－LOX方案化疗，对照组38例仅给予S－LOX方案化疗。化疗方案为奥沙利铂130 mg／㎡静滴第1，8天，替吉奥胶囊40 mg／m^22次／d口服第1—14天，3周为1个周期，共6个周期。 R0术后总放疗剂量45 Gy／25次，R1术后残存区瘤床局部加量6～10 Gy。结果76例患者均完成治疗。观察组1，2，3年累积总体生存率分别为92％，82％和55％，中位生存时间33．1个月；对照组分别为82％，63％和45％，中位生存时间27．6个月。2组总体生存曲线比较差异无统计学意义（P＞0．05）。观察组1，2，3年无疾病进展生存率分别是74％，63％和29％，中位无进展生存时间26．6个月；对照组分别是55％，34％和5％，中位无进展生存时间19．3个月。2组无进展生存曲线比较差异有统计学意义（P＜0．05）。2组Ⅲ～Ⅳ度骨髓抑制和消化道反应发生率比较差异均无统计学意义。结论局部进展期胃癌根治术后同步放化疗可提高近期疗效，延长患者的疾病无进展生存时间，不良反应患者可以耐受，值得推广应用。

18FDG PET/CT定位三维适形放疗联合化疗对复发性直肠癌的疗效和预后分析

目的对比研究术后复发性直肠癌经18FDG PET/CT定位适形放疗联合化疗的疗效、副反应及失败原因。方法对64例术后局部复发性直肠癌患者随机分为18FDG PET/CT定位适形放疗组(PET/CT组)和普通CT定位适形放疗组(普通CT组)。PET/CT组用PET/CT扫描定位,将扫描数据输入三维治疗计划系统,将PET图像和CT图像融合后进行靶区(GTV与PTV)和重要脏器勾画、三维重建,制定计划后常规分割适形放疗40Gy左右,然后缩野放疗至总剂量60Gy～66Gy;普通CT组用普通CT定位设野,三维适形放疗至相同剂量;全组均辅助化疗4～6周期。结果放疗后全组CEA值平均为11.9ng/ml,较放疗前的16.4ng/ml显著下降,放疗前后差异有显著性统计学意义(P<0.01);PET/CT组的中位复发时间10.2个月,普通CT组的中位复发时间9.0个月,两者差异有显著性统计学意义(P<0.01);疗前GTV≤80cm3者预后好,是独立的预后因子(P<0.01)。结论 PET/CT定位三维适形放疗术后复发性直肠癌可以优化放疗计划,联合化疗可以延长中位复发时间,分期早的病变预后好。