Effects of dosimetric inadequacy on local control and toxicities in the patients with T4 nasopharyngeal carcinoma extending into the intracranial space and treated with intensity.modulated radiotherapy plus chemotherapy

Background:To protect neurological tissues,underdosing occurs in most cases of T4 nasopharyngeal carcinoma(NPC) with intracranial extension.In this study,we aimed to evaluate the effect of dosimetric inadequacy on local control and late neurological toxicities for patients treated with intensity-modulated radiotherapy(IMRT) plus chemotherapy.Methods:We prospectively enrolled patients who had non-metastaticT4 NPC with intracranial extension treated between January 2009 and November 2013.The prescribed dose was 66.0-70.4 Gy to the primary planning target volume(primary gross tumor volume [GTVp;i.e.,the nasopharyngeal tumor] +5.0 mm).Dose-volume histogram parameters were calculated,including minimum point dose(D_(min)) and dose to 95% of the target volume(D95).All patients received chemotherapy with the cisplatin,5-fluorouracil,and docetaxel regimen.Survivals were estimated using the Kaplan-Meier method and compared using the log-rank test.Results:In total,41 patients were enrolled.The local partial response rate was 87.8% after induction chemotherapy.With a median follow-up of 51 months,7 patients experienced failure in the nasopharynx;the 3-year local failure-free survival and overall survival rates of the 41 patients were 87.4% and 90.2%,respectively.The actual mean D_(min) to the GTVp was 55.2 Gy(range 48.3-67.3 Gy),and D95 was 61.6 Gy(range 52.6-69.0 Gy).All doses received by neurological organs remained well within their dose constraints.No patients developed temporal lobe necrosis or other neurological dysfunctions.Conclusions:With relative underdosed IMRT plus effective chemotherapy,the patients achieved satisfactory local control with few late toxicities of the central nervous system.Determining the acceptable extent of dosimetric inadequacy requires further exploration.

Neoadjuvant chemotherapy plus intensity-modulated radiotherapy versus concurrent chemoradiotherapy plus adjuvant chemotherapy for the treatment of locoregionally advanced nasopharyngeal carcinoma:a retrospective controlled study

Background:In the era of intensity-modulated radiotherapy(IMRT),the role of neoadjuvant chemotherapy(NAC)for locoregionally advanced nasopharyngeal carcinoma(NPC)is under-evaluated.The aim of this study was to compare the efficacy of NAC plus IMRT and concurrent chemoradiotherapy(CCRT)plus adjuvant chemotherapy(AC)on locoregionally advanced NPC.Methods:Between January 2004 and December 2008,240 cases of locoregionally advanced NPC confirmed by pathologic assessment in Sun Yat-sen University Cancer Center were reviewed.Of the 240 patients,117 received NAC followed by IMRT,and 123 were treated with CCRT plus AC.The NAC+IMRT group received a regimen that included cisplatin and 5-fluorouracil(5-FU).The CCRT+AC group received cisplatin concurrently with radiotherapy,and subsequently received adjuvant cisplatin and 5-FU.The survival rates were assessed by Kaplan-Meier analysis,and the survival curves were compared using a log-rank test.Multivariate analysis was conducted using the Cox proportional hazard regression model.Results:The 5-year overall survival(OS),locoregional relapse-free survival(LRRFS),distant metastasis-free survival(DMFS),and disease-free survival(DFS)were 78.0,87.9,79.0,and 69.8%,respectively,for the NAC+IMRT group and78.7,84.8,76.2,and 65.6%,respectively,for the CCRT+AC group.There were no significant differences in survival between the two groups.In multivariate analysis,age(<50 years vs.>50 years)and overall stage(Ⅲvs.Ⅳ)were found to be independent predictors for OS and DFS;furthermore,the overall stage was a significant prognostic factor for DMFS.Compared with the CCRT+AC protocol,the NAC+IMRT protocol significantly reduced the occurrence rates of grade 3-4 nausea-vomiting(6.5 vs.1.5%,P=0.023)and leukopenia(9.7 vs.0.8%,P=0.006).Conclusions:The treatment outcomes of the NAC+IMRT and CCRT+AC groups were similar.Distant metastasis remained the predominant mode of treatment failure.

Impact of Postoperative Radiotherapy and Chemotherapy on Survival for Patients with Node Positive Oral Cancer

Purpose: The aim of the present study is to compare between the use of post-operative concurrent chemotherapy and radiotherapy alone on survival for patients with high risk oral cavity tumors at the National cancer Institute of Egypt, undergoing surgery and receiving adjuvant treatment. Patients and Methods: This is a retrospective study, which was carried out at the National Cancer Institute (Cairo University) on patients with node positive oral cavity cancer diagnosed between the year 2000 and 2008. The study included 60 patients (45 males and 15 females) with median age 57 years old. The patients underwent surgery, followed by postoperative radiotherapy 60 Gy/6 weeks versus postoperative radiotherapy 60 Gy/6 weeks with concurrent cisplatin 100 mg/m2 at day 1, day 22 and day 43. Results: Regarding use of concurrent chemotherapy, there was a significant difference in overall survival rate and locoregional control favoring patients who received concurrent chemotherapy and radiotherapy, 3 years and 5 years overall survival rates respectively were 53.8% and 40.4% compared to 37.5% and 26.3% for patients who didn’t receive any chemotherapy with (p 0.038) for 5 years. Regarding age, there was a significant difference in overall survival rate favoring patients ≤57 years in both arm groups, 3 years and 5 years overall survival rates respectively were 51.6% and 38.9% compared to 28.3% and 18.9% for patients >57 years with (p 0.028) for 5 years. Conclusion: We recommend for oral cavity tumor patients at the NCI of Egypt who have positive neck nodes to be treated with concurrent chemo-radiotherapy rather than radiotherapy alone especially by using the new techniques as intensity modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT).

Comparative Study between Patients Treated with Conventional Radiotherapy and IMRT with Chemotherapy for Stage III - IVA Nasopharyngeal Carcinoma: A Single Institution Retrospective Report

Introduction: Nasopharyngeal carcinomas are the most radiation-sensitive tumours, and radiotherapy alone provides better local control. Objectives: To evaluate the clinical efficacy and acute and late toxicities of two different treatment regimens for locally advanced nasopharyngeal carcinoma. Methods: From 2014 to 2017, 150 cases of stage III and 68 cases of stage IVA nasopharyngeal carcinoma were treated. Of these, 137 received conventional radiotherapy plus chemotherapy, and 81 received intensity-modulated radiotherapy plus chemotherapy. Chemotherapy was given either as induction, concurrent or adjuvant therapy. Survival rates were calculated according to Kaplan Meier and compared with the Log-rank test. The RTOG or EORTC criteria were used to assess acute and late toxicities. Results: The median follow-up time was 21.5 months, and the 2-year locoregional relapse-free survival, distant metastases-free survival, and overall survival rates in the conventional radiotherapy plus chemotherapy group were 76%, 71% and 77%, respectively;in the intensity-modulated radiotherapy plus chemotherapy group, they were 97%, 84%, and 100%, respectively. The difference in survival between the two groups was significant (χ2 = 5.06, P = 0.028). The incidence of grade 2 and 3 xerostomia one year after radiotherapy was 45.1% and 30.9% versus 33.3% and 0%. Conclusion: Compared with conventional radiotherapy plus chemotherapy, intensity-modulated radiotherapy plus chemotherapy offers better locoregional relapse-free survival and overall survival in patients with stage III and IVA nasopharyngeal carcinoma, and may significantly reduce the occurrence of radiation-induced xerostomia.

Induction chemotherapy with docetaxel,cisplatin and fluorouracil followed by concurrent chemoradiotherapy for unresectable sinonasal undifferentiated carcinoma: Two cases of report

BACKGROUND Sinonasal undifferentiated carcinoma(SNUC) is a rare aggressive tumor that is often unresectable. Optimal treatment for patients with unresectable,locally advanced SNUC(LA-SNUC) has not been established,and the patient outcome remains poor. We report two cases of unresectable LA-SNUC in which induction chemotherapy with docetaxel,cisplatin and fluorouracil(TPF) followed by radiotherapy with concurrent cisplatin(CCRT),a standard treatment option for locally advanced head and neck cancer,demonstrated promising outcomes.CASE SUMMARY A 39-year-old man presented with tearing and pain in the right eye. A biopsy of the tumor invading the sinonasal cavities,right orbit and cranial base confirmed the diagnosis of LA-SNUC. Induction TPF chemotherapy induced remarkable tumor shrinkage and rapidly improved the symptoms. He subsequently received CCRT and achieved complete remission of the disease. The other case is a 21-year-old man who presented with worsening vision. The unresectable tumor involving the nasal septum and cranial base was pathologically diagnosed as SNUC. TPF chemotherapy followed by CCRT yielded complete remission of the disease with preserved visual function. Both patients have been disease-free for44 mo.CONCLUSION Induction TPF chemotherapy followed by CCRT may remarkably improve the outcomes in LA-SNUC patients.

三维适形调强放疗在局部晚期头颈部鳞状细胞癌患者中的应用效果

目的:探讨三维适形调强放疗在局部晚期头颈部鳞状细胞癌(HNSCC)中的应用效果.方法:选取2021年1月—2022年8月滨州市中心医院收治的HNSCC患者100例为研究对象,随机分为对照组和观察组,各50例.对照组予以常规化疗,观察组在对照组基础上加用三维适形调强放疗.比较两组治疗效果及安全性.结果:观察组疾病控制率高于对照组,差异有统计学意义(P=0.037);治疗后,两组细胞角质蛋白19片段抗原21-1、胸苷激酶1、鳞状细胞癌相关抗原水平均下降,观察组低于对照组,差异有统计学意义(P<0.05);治疗后,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于治疗前,CD8^(+)低于治疗前,观察组优于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05).结论:三维适形调强放疗可提高局部晚期HNSCC患者治疗效果,降低肿瘤标志物水平,加快免疫功能恢复,且不会增加不良反应.

不同加量方式调强放疗治疗盆腹腔淋巴结转移宫颈癌患者的疗效及安全性

目的探讨不同加量方式调强放疗治疗盆腹腔淋巴结转移宫颈癌患者的疗效及安全性。方法根据调强放疗加量方式的不同将82例盆腹腔淋巴结转移宫颈癌患者分为对照组(n=41,后程加量调强放疗)和研究组(n=41,同步加量调强放疗)。比较两组患者的临床疗效、危及器官照射剂量、治疗时间及不良反应发生情况。结果放疗完成时、放疗3个月后,研究组患者的客观缓解率(ORR)分别为92.68%、90.24%,分别高于对照组患者的73.17%、68.29%,差异均有统计学意义(P﹤0.05)。研究组患者直肠最大剂量(D_(max))、小肠D_(max)、膀胱D2cc均明显低于对照组(P﹤0.01)。研究组患者外照射时间和整体治疗完成时间均明显短于对照组(P﹤0.01)。研究组患者骨髓抑制发生率为34.15%,明显低于对照组患者的65.85%,差异有统计学意义(P﹤0.01)。结论与后程加量调强放疗相比,同步加量调强放疗治疗盆腹腔淋巴结转移的宫颈癌患者,可提高临床疗效,缩短治疗时间,减少危及器官照射剂量,降低骨髓抑制发生率。

调强放疗联合化疗在肝癌合并静脉/下腔静脉癌栓中的应用

目的探讨在肝癌合并静脉/下腔静脉癌栓患者治疗中使用调强放疗联合化疗的临床治疗效果。方法选取100例肝癌合并静脉/下腔静脉癌栓患者作为研究样本,以随机数字表的方式分为实验组及对照组,各50例。实验组采用调强放疗联合化疗进行治疗,对照组给予调强放疗进行治疗。比较两组患者的临床治疗效果,不良反应发生情况,治疗前后的生活质量评分及心理状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)]评分。结果实验组有效率60.00%高于对照组的30.00%(P<0.05)。两组患者不良反应发生率比较,无统计学差异(P>0.05)。治疗后,实验组社会功能、情绪功能、角色功能、躯体功能评分分别为(90.08±4.21)、(91.27±3.16)、(91.68±5.23)、(92.89±6.19)分,均显著高于对照组的(79.61±3.42)、(78.12±6.15)、(77.26±6.12)、(78.46±5.13)分(P<0.05)。治疗后,对照组SDS及SAS评分分别为(51.72±5.51)、(53.01±4.36)分,实验组分别为(40.21±3.53)、(40.01±5.32)分,实验组均低于对照组(P<0.05)。结论肝癌合并静脉/下腔静脉癌栓患者应用调强放疗联合化疗效果明显,不仅能够改善患者的生存质量,缓解不良心理,同时不会增加不良反应,建议临床大力推广。

Ⅲ期非小细胞肺癌患者行调强放疗和立体定向体部放疗同步化疗的效果对比

目的比较Ⅲ期非小细胞肺癌患者行调强放疗和立体定向体部放疗同步化疗的效果。方法选取2020年1月—2023年1月淄博市妇幼保健院收治的50例Ⅲ期非小细胞肺癌患者为研究对象,所有患者均开展化疗(吉西他滨+顺铂方案),按治疗方法不同分为两组,各25例。对照组实施立体定向体部放疗,观察组实施调强放疗。对比两组临床疗效、免疫功能指标、血清细胞因子。结果两组客观缓解率与疾病控制率对比,差异无统计学意义(P均>0.05)。治疗后,研究组的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于对照组,CD8+低于对照组,差异有统计学意义(P均<0.05)。治疗后,研究组的白细胞介素-2为(231.92±14.44)μg/L,白细胞介素-6为(131.25±9.87)μg/L,肿瘤坏死因子-α为(4.59±1.09)μg/L,均低于对照组的(278.03±15.35)μg/L、(173.97±10.91)μg/L、(5.21±1.05)μg/L,差异有统计学意义(t=10.940、14.519、2.048,P均<0.05)。结论Ⅲ期非小细胞肺癌患者在化疗基础上联合调强放疗或者立体定向体部放疗具有显著疗效,且调强放疗对患者免疫功能的影响更小,可以更好地改善血清细胞因子水平。

适形调强放疗联合同步化疗在宫颈癌患者中的应用价值

目的探讨适形调强放疗联合同步化疗在宫颈癌患者中的应用价值。方法选择122例宫颈癌患者为研究对象,根据随机数字表法分为观察组和对照组,每组61例。对照组使用紫杉醇+顺铂进行化疗,观察组在对照组化疗基础上实施适形调强放疗技术,比较两组治疗效果及不良反应发生率。结果观察组客观缓解率、疾病控制率均高于对照组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论宫颈癌患者采用适形调强放疗联合化疗的方案有助于提升整体治疗效果,未增加不良反应,值得临床推广与应用。

安罗替尼辅助适形调强放疗同步化疗在肺癌脑转移患者临床治疗中的应用效果

目的探讨肺癌脑转移患者采用安罗替尼辅助适形调强放疗同步化疗的效果。方法回顾性分析2021年1月—2022年11月在山东国欣颐养集团枣庄医院接受治疗的100例肺癌脑转移患者的临床资料,根据治疗方案不同将其分为对照组及观察组。将行适形调强放疗同步化疗的50例作为对照组,将行安罗替尼辅助适形调强放疗同步化疗的50例作为观察组,均治疗2个周期。比较两组患者的疗效、肿瘤标志物水平、不良反应发生情况及预后情况。结果观察组的疾病控制率为92.00%,高于对照组的70.00%,差异有统计学意义(P<0.05)。治疗后,观察组的血清癌胚抗原、鳞状上皮细胞癌抗原水平均低于对照组,组间差异有统计学意义(P<0.05)。两组的不良反应发生率比较,差异无统计学意义(P>0.05)。观察组的总生存期、无进展生存期均长于对照组,组间差异有统计学意义(P<0.05)。结论肺癌脑转移患者采用安罗替尼辅助适形调强放疗同步化疗的效果满意,可降低肿瘤标志物水平,改善预后。

调强放疗同步化疗对中晚期食管癌患者血清肿瘤标志物水平、生活质量的影响

目的探讨调强放疗同步化疗在中晚期食管癌患者中的应用效果。方法选取新泰市人民医院2020年6月—2023年6月收治的64例中晚期食管癌患者为研究对象,按随机数字表法将其分为对照组和观察组,每组32例。两组均行化疗,在此基础上,对照组进行常规放疗,观察组进行调强放疗。比较两组患者的临床效果及安全性。结果观察组的临床疗效为93.75%,高于对照组的75.00%,差异有统计学意义(P<0.05)。治疗后,观察组的癌胚抗原、细胞角化素蛋白片段19、鳞状上皮细胞癌相关抗原水平分别为(1.61±0.27)μg/mL、(1.42±0.25)ng/mL、(1.04±0.22)μg/mL,均低于对照组的(1.91±0.32)μg/mL、(1.78±0.28)ng/mL、(1.38±0.25)μg/mL,组间差异有统计学意义(P<0.05)。治疗后,观察组的世界卫生组织生活质量评定量表简表中的心理、生理、环境、社会关系领域评分分别为(86.41±6.12)分、(87.56±6.23)分、(89.47±5.81)分、(86.87±6.25)分,均高于对照组的(80.34±5.87)分、(80.87±6.11)分、(82.06±5.39)分、(80.76±6.14)分,组间差异有统计学意义(P<0.05)。两组的不良反应发生率比较,差异无统计学意义(P>0.05)。结论调强放疗同步化疗可提高中晚期食管癌的控制效果,降低患者血清肿瘤标志物水平,更好地改善其生活质量,安全可行。

三维适形调强放疗同步化疗在直肠癌术前的应用价值研究

分析直肠癌术前应用三维适形调强放疗同步化疗的效果。选取2022年2月—2022年10月行常规术后辅助化疗的40例患者作为对比组,选取2022年11月—2023年5月行三维适形调强放疗同步化疗的40例患者作为试验组,观察两组患者的血清肿瘤标志物、近期疗效、不良反应发生率、局部复发率与远处转移率。结果显示,试验组患者的血清肿瘤标志物数值、近期疗效均优于对比组,局部复发率、远期转移率以及不良反应发生率均低于对比组(P<0.05)。研究发现,直肠癌患者在术前进行科学合理的三维适形调强放疗同步化疗,可以有效提升其临床疗效,降低疾病的远处转移率以及局部复发率。

时辰诱导化疗序贯同步放化疗治疗局部晚期鼻咽癌的Ⅱ期临床研究

目的：研究TPF（多西他赛＋顺铂＋5-氟尿嘧啶）方案时辰诱导化疗联合调强放疗治疗局部晚期鼻咽癌的毒性反应和近期疗效。方法：初治的局部晚期鼻咽癌患者，接受诱导化疗TPF方案，多西紫杉醇75mg／m^2，静滴，d1。顺铂75mg／m^2，分5d完成静滴给药，每天10：00～22：00。5-氟尿嘧啶750mg／m^2／d d1—d5，持续静滴，每天22：00～10：00。21d／周期，共3个周期。随后行三维适形调强放疗（IMRT），放疗同期行紫杉醇单药增敏化疗（紫杉醇135mg／m^2，静滴，21天／周期，共2个周期）。不良反应按CTCAEv3．0评价分级，临床疗效参照2000年实体瘤治疗疗效评价标准（RECIST）进行评价，有效率为CR＋PR。结果：3个周期诱导化疗后CR为23．8％，PR为68．6％。诱导化疗序贯同步放化疗后CR为64．8％，PR为31．4％。2年总生存率91．4％，2年无进展生存率87．0％，2年无远处转移生存率88．4％。诱导化疗主要不良反应为骨髓毒性，3级以上粒细胞下降为28．6％，无3级以上肾功能损害。同期放化疗期间口腔黏膜反应最多见为81．0％，其中16．2％出现3～4级反应。整组患者无治疗相关死亡。结论：TPF方案时辰诱导化疗联合紫杉醇同期调强放化疗治疗局部晚期鼻咽癌安全、近期疗效好，远期疗效及不良反应尚需扩大病例数及继续随访.

长疗程尼妥珠单抗联合放化疗治疗局部晚期鼻咽癌的可行性

目的：评价长疗程尼妥珠单抗（nimotuzumab）联合调强放疗和化疗治疗局部晚期鼻咽癌有效性和安全性。方法：分析从2008年11月至2014年3月在浙江省肿瘤医院39例确诊为Ⅲ-Ⅳ期鼻咽癌患者，其中男性29例，女性10例；Ⅲ期20例，Ⅳa期14例，Ⅳb期5例。患者接受长疗程尼妥珠单抗联合调强放、化疗，尼妥珠单抗200 mg/次，1次/周，所有患者治疗9～18周。观察长疗程尼妥珠单抗联合调强放、化疗的疗效及毒副作用，参考RTOG标准分析患者急、慢性毒副作用；采用Kaplan-Meier方法、Log-rank法检验分析生存情况。结果： 所有患者接受9周期以上尼妥珠单抗联合调强放、化疗的治疗后，中位随访时间46月（22～86个月），3年无局部复发生存率（LRFS）、无区域复发生存率（RRFS）、无远处转移生存率（DMFS）、PFS和OS分别为92.1%、 89.7%、 82.5%、 77.6%和86.8%。单因素分析显示临床分期和新辅助化疗周期对生存率重要影响（3年DMFS Ⅲ、Ⅳ期分别为 100.0%和63.2%（P〈0.01）; 3年LRFS 1～2周期、3～4周期分别为75.0%和96.8%（P〈005）。结论：长疗程尼妥珠单抗联合调强放疗、化疗提高局部晚期鼻咽癌的疗效，并不增加毒、副作用，其远期疗效有待于长期随访结果。

初治鼻咽癌调强适形放疗近期临床观察

目的 研究调强放射治疗（IMRT）对初治鼻咽癌的疗效以及对正常组织的保护和毒性反应。方法 对24例鼻咽癌初治患者鼻咽和全颈及锁骨上全程实施IMRT，肿瘤靶区授予处方剂量68～70Gy。对于Ⅲ和Ⅳ期患者，在IMRT同时，结合患者淋巴结转移及一般情况给予PDD＋5-Fu±THP-ADM方案化疗1～2周期。结果 治疗计划结果显示，覆盖鼻咽GTV1D95的平均剂量为70．48Gy，GTvlV95的平均体积为98．46％；靶区内GTV1、GTV2、CTV1和CTV2的平均剂量分别为70．48Gy、66．98Gy、60．10Gy和51．18Gy。本组有2例、16例、5例和1例患者分别出现0、1、2和3级的皮肤急性放射性反应；有4例、6例、13例和1例患者分别出现1、2、3和4级的口腔粘膜急性放射性反应；其中1例合并联合化疗患者因严重口腔粘膜炎中断放疗1周。其他合并化疗患者在化疗后均出现不同程度的骨髓抑制，经对症处理均未影响正常放射治疗。本组患者中位随访期13个月。无1例出现局部复发或远处转移。结论 IMRT在初治早期或晚期鼻咽癌病例均可获得理想的剂量分布，正常组织得到很好的保护，毒副反应可以耐受，临床疗效令人满意。

调强或三维适形放疗联合TP方案化疗治疗局部中晚期食管癌的临床研究

目的观察评价调强或三维适形放疗联合多西他赛与顺铂治疗局部中晚期食管癌的疗效及不良反应。方法局部中晚期的60例食管癌患者随机分为两组:A:30例调强放疗联合TP(多西他赛及顺铂)方案化疗组,B:30例三维适形放疗联合TP(多西他赛及顺铂)方案化疗组。放射剂量为64Gy/30次/6周。结果近期疗效,总有效率(CR+PR)调强化疗组的90%好于适形放疗组的80%,但两组比较差异没有统计学意义(P>0.05)。1、2、3年生存率分别为调强化疗组86.7%、70.0%、66.7%及适形化疗组的70.0%、63.3%、63.3%,两组比较差异没有统计学意义(P>0.05)。比较两组肺V20、V30,调强化疗组有优势(P<0.05),两组急性放射性食管炎比较差异不大,无统计学意义(P>0.05)。结论调强放疗联合TP(多西他赛及顺铂)方案化疗治疗局部中晚期食管癌在目前是一种较有效的方法。

调强放疗联合西妥昔单抗及顺铂治疗晚期鼻咽癌

目的:EGFR与鼻咽癌关系密切,西妥昔单抗是一种特异性阻断EGFR的单克隆抗体。观察调强适型放射治疗联合西妥昔单抗(cetuximab)及顺铂(cisplatin,又称DDP)方案治疗晚期鼻咽癌的有效性和安全性。方法:2007年7月至2007年12月共8例入组,其中初治鼻咽癌7例,复发鼻咽癌1例,所有病例均为Ⅲ、Ⅳ期;所有患者都签署知情同意书,研究报伦理委员会批准。治疗方法包括调强放疗、顺铂、西妥昔单抗(400mg/m2,放射治疗前1周;250mg/m2,每周1次,放疗期间维持)。结果:8例均完成调强放疗。8例完成西妥昔单抗治疗4～8疗程,平均6个疗程;3例因肝功异常未行同期化疗,3例完成DDP30mg/m2化疗4～7疗程,1例完成DDP100mg/m2化疗2疗程,1例完成DDP100mg/m2化疗1疗程。8例均出现皮肤痤疮样皮疹,主要急性毒性反应为黏膜炎和骨髓抑制;黏膜炎8例;白细胞下降3例;3个月后所有反应为0～1级。8例均达完全缓解(completeremission,CR),1例患者综合治疗后3个月出现肋骨转移。结论:调强放疗联合西妥昔单抗及顺铂方案治疗晚期鼻咽癌的不良反应主要为口咽黏膜炎和疼痛较重,有2例不可耐受,建议降低西妥昔单抗的剂量。近期疗效令人满意,远期疗效尚需观察。

NP方案联合同步调强放疗治疗局部晚期非小细胞肺癌的临床观察

目的:探讨NP方案联合调强放疗治疗局部晚期非小细胞肺癌的临床疗效和不良作用。方法:72例Ⅲ期非小细胞肺癌患者随机分为2组,治疗组36例给予NP方案化疗,长春瑞滨25 mg/m^2,d1,d8;DDP 75mg/m^2,d1,21d为1个周期,至少2个周期。化疗同时给予调强常规分割放疗,照射剂量为60～64Gy。对照组36例仅给予相同方法的放疗。治疗完成4周后评价疗效及不良反应。结果:治疗组与对照组的有效率(RR)分别为72.2%和41.7%(P<0.05),中位疾病进展时间(TTP)分别为7.2个月和5.8个月。治疗组与对照组的主要不良反应:Ⅲ～Ⅳ度骨髓抑制分别为20例和5例,Ⅲ～Ⅳ度胃肠道反应为6例和0例,Ⅲ～Ⅳ度放射性食管炎和放射性肺炎为4例和3例、5例和2例。结论:NP方案化疗联合同步调强放疗对局部晚期非小细胞肺癌有较好的近期疗效,不良反应可以耐受。

简单调强放射治疗与同期化疗治疗颈及胸上段食管癌可行性研究及近期疗效分析

背景与目的:对于颈及胸上段食管癌,三维适形放疗(3-dimensional conformal radiation therapy,3D-CRT)并不一定都能满足临床要求,而适形调强放射治疗(intensity modulation radiation therapy,IMRT)又会占用大量的人力物力。中国医学科学院肿瘤医院定义了一种简单调强放疗技术(simplified IMRT,sIMRT)。本研究中我们应用sIMRT联合同期化疗治疗颈及胸上段食管癌,并分析急性放射反应和近期疗效。方法:对30例颈及胸上段食管癌的原发灶和预防照射区进行sIMRT计划设计。定义2个靶区:PTV1,给予64Gy(2.13Gy×30次)的照射;PTV2,给予54Gy(1.8Gy×30次)的剂量,设计等角度5野sIMRT计划。在开始放疗的第1～5天和第29～33天给予顺铂(DDP)+氟尿嘧啶(5-FU)方案同期化疗2个周期,放疗结束后28天原方案重复2个疗程。结果:患者可在6周内完成治疗计划,5野sIMRT获得了满意的剂量分布,剂量分布和IMRT相似,但明显优于3D-CRT。所有患者完成了治疗计划,治疗中仅1例发生Ⅲ级放射性气管炎,无因放疗反应而中断治疗的患者。食管病灶达完全缓解(complete remission,CR)者27例(90%),部分缓解(partial remission,PR)3例(10%),总有效率达100%;淋巴结病灶达CR者13例,PR4例。毒性反应主要为Ⅰ～Ⅱ级白细胞下降。结论:sIMRT较复杂调强计划治疗颈胸上段食管癌剂量分布相似,明显优于3D-CRT,近期疗效满意,急性放射反应可耐受,远期疗效及组织损伤尚有待长期随访观察。