The follow-up of 34 children with medulloblastoma who received 3-dimensional conformal radiation therapy

Objective:In our investigation,we studied the patients with medulloblastoma who received 3-dimensional conformal radiation therapy(3DCRT) and recorded their effects,side effects and failure reasons.Methods:From August 2001 to August 2007,34 children with medulloblastoma were treated in our hospital.The age at diagnosis was 3-16 years old,and the mean age at diagnosis was 9.5 years old.Among all the patients,16 cases were included in the high risk group and 18 cases were included in the low risk group.All the patients were performed total resection or subtotal resection and no patients received radiotherapy or chemotherapy before operation.All patients received 3DCRT within 3 weeks after resection.The dose of 30 Gy were given to the whole brain and whole spine,followed by 20-25 Gy boosted to the posterior brain fossa.The median fraction dose was 180 cGy.Every patient received the chemotherapy scheme of the Lomustine,Cisplatinum and Vincristine.Nobody received intrathecal chemotherapy.The tests of the complete blood count,blood biochemistry,hepatic and renal functions were required before every cycle of chemotherapy.Results:5-year overall survival(OS) and 5-year disease free survival(DFS) were 71% and 62% respectively.The median follow-up time was 36.5 months.The 5-year OS of the high risk group was 71% compared to 62% of the low risk group.There were significant difference between the two groups(P = 0.01).There were 13 failure cases in all the patients.Of these 13 patients,10 were dead and the other 3 were alive with tumor.The complete remission(CR) rate was 70.5% and the partial remission(PR) rate was 14%.Among the failure patients,there were 3 patients(8.8%) with the recurrences located in the brain of cribriform region.The 5-year OS of the patients with preoperative metastases was 12.5%(1/8),and which of the patients with residual tumor volume > 1.5 cm3 was 0%(0/5).Through the statistic analysis,it was found that both whether or not the metastases were found before surgery and residual tumor volume have the significant impacts on the prognosis of the children with medulloblastoma(P < 0.05).The major adverse reactions were hematological toxicity(7/34,20.6%) and gastrointestinal reaction(4/34,11.8%).Conclusion:Through the using of 3DCRT for the children with medulloblastoma,the severe side effects rate was not high.The prognosis of the patients in low risk group was satisfied which was opposite to that of the patients in high risk group.And the patients with residual tumor volume > 1.5 cm3 and preoperative metastases also had poor prognosis.It is needed to pay attention to the possible low dose of the brain of cribriform region.

Preliminary analysis of a clinical trial for three-dimensional conformal radiation therapy after conservative surgery

Objective The aim of this study was to evaluate the efficacy, complications and cosmetic results of three-dimensional conformal radiation therapy for early breast cancer after conservative surgery.

Clinical observation of three-dimensional conformal radiotherapy(3D-CRT) with concurrent chemotherapy in treatment of recurrent cervical cancers

Objective： The aim of the study was to explore the efficacy of three-dimensional conformal radiotherapy （3D- CRT） combined with TP concurrent chemotherapy in treatment of recurrent cervical cancers. Methods： From May 2005 to May 2009, 36 patients with recurrent cervical cancer were treated by 3D-CRT of 60-66 Gy and TP （docetaxel 70 mg/m^2, d1; cisplatin 20 mg/m^2, dl-d3; 21 days per cycle, totally 2 cycles） concurrent chemotherapy. Results： All of the patients had finished the 3D-CRT, the total response rate, complete response rate and partial response rate were 80.0% （28/35）, 45.7% （16/35）, and 34.3% （12/35）, respectively. The pain-alleviation rate was 91.4% （32/35）. The hemorrhage control rate was 94.3% （33/35）. The median overall survival was 21.2 months. The 1-, 2- and 3-year survival rates were 54.3%, 37.1% and 22.8%, respectively. The life qualities of the patients were improved, without any treatment related death. Conclusion： Radiotherapy is effective and well-tolerated for recurrent cervical cancers, and it can promote regional control of the disease and prolong survival time.

Application of three dimensional conformal radiation therapy combined with high-intensity focused ultrasound for prostate cancer

Objective:Prostate cancer is a form of cancer that develops in the prostate,a gland in the male reproductive system.Prostate cancer tends to develop in men over the age of fifty;it is one of the most prevalent types of cancer in men.This article introduced a new method of prostate cancer treatment with the combination of three dimensional conformal radiation therapy (3D-CRT) and high-intensity focused ultrasound (HIFU),its efficacy was evaluated.Methods:From January 2004 to December 2009,95 patients were diagnosed with prostate cancer,among them,48 patients were received combined therapy with total irradiation of TD 60 Gy/30 Fx and 5 fractions of HIFU treatment,while 47 patients were received with pure 3D-CRT with total irradiation of TD (66-72) Gy/(33-36) Fx.Various indicators were evaluated,such as the local control rate and distant metastasis rate,the changes in blood PSA and fPSA,changes in T-lymphocyte subsets and NK cells,as well as acute adverse reaction of normal tissue.Results:The local response rate difference between the two groups had statistical significance (P < 0.05);the changes in blood PSA and fPSA were significant (P < 0.05);CD3+,CD4+,CD8+,CD4+/CD8+ and NK cells of the combined group increased obviously (P < 0.01),while the latter group had no increase (P > 0.05);the combined group had lower blood cells reduction and II-level acute adverse reaction of rectum,bladder and caput humeri than the pure group,but the II-level acute adverse reaction of urogenital canal in the combined group was higher (P < 0.05).Conclusion:The combined therapy with 3D-CRT and HIFU is a good way for the treatment of aged-related prostate cancer.It can ease the symptoms,control the disease and lengthen the survival time.

Influences of Motion Artifacts on Three-Dimensional Reconstruction Volume and Conformal Radiotherapy Planning

Objective ：To investigate the influences of motion artifacts on three-dimensional （3D） reconstruction volume and conformal radiotherapy planning. Methods： A phantom which can mimic the clip motion of lung tumor along the cranial-caudal direction is constructed by step motor, small ball of polyethylene and potato. Ten different scan protocols were set and CT data of the phantom were acquired by using a commercial GE LightSpeedl6 CT scanner. The 3D reconstruction of the CT data was implemented by adopting volume-rendering technology of GE AdvantageSim 6.0 system. The reconstructed volumes of each target in different scan protocols were measured through 3D measuring tools. Thus, relative deviations of the reconstruction volumes between moving targets and static ones were determined. The three-dimensional conformal radiation therapy （3D- CRT） plans and conformal fields were created and compared for a static/moving target with the WiMRT treatment planning system （TPS）. Results：For a static target, there was no obvious difference among the 3D reconstruction volumes when the CT data were acquired with different pitches and slices. The appearance of 3D reconstruction volume and 3D conformal field of a moving target was quite different from that of static one. The maximum relative deviation is nearly 90% for a moving target scanned with different scan protocols. The relative deviations are variable among the different targets, about from -39.8% to 89.5% for a smaller target and from - 18.4% to 20.5% for a larger one. Conclusion ：The motion artifacts have great effects on 3 D-CRT planning and reconstruction volume, which will greatly induce distorted conformal radiation fields and false DVHs for a moving target.

A dosimetric comparative study between conformal and intensity modulated radiation therapy in the treatment of primary nasopharyngeal carcinomas: the Egyptian experience

Objective: The study is a comparative study, the aim of which is to compare 3D conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) in treating nasopharyngeal carcinomas; dosimetrically evaluating and comparing both techniques as regard target coverage and doses to organs at risk (OAR). Methods: Twenty patients with nasopharyngeal carcinoma were treated by 3D-CRT technique and another 20 patients were treated by IMRT. A dosimetric comparison was done by performing two plans for the same patient using Eclipse planning system (version 8.6). Results: IMRT had a better tumor coverage and conformity index compared to 3D-CRT plans (P value of 0.001 and 0.004), respectively. As for the dose homogeneity it was also better in the IMRT plans and the reason for this was attributed to the dose inhomogeneity at the photon/electron junction in the 3D-CRT plans (P value 0.032). Also, doses received by the risk structures, particularly parotids, was significantly less in the IMRT plans than those of 3D-CRT (P value 0.001). Conclusion: IMRT technique was clearly able to increase the dose delivery to the target volume, improve conformity and homogeneity index and spare the parotid glands in comparison to 3D-CRT technique.

Role of radiation therapy in gastric adenocarcinoma

Outcomes in patients with gastric cancer in the United States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong rationale exists for the use of adjuvant radiation therapy. Randomized trials have shown superior local control with adjuvant radiotherapy and improved overall survival with adjuvant chemoradiation. The benefit of adjuvant chemoradiation in patients who have undergone D2 lymph node dissection by an experienced surgeon is not known, and the benefit of adjuvant radiation therapy in addition to adjuvant chemotherapy continues to be defined. In unresectable disease, chemoradiation allows long-term survival in a small number of patients and provides effective palliation. Most trials show a benefit to combined modality therapy compared to chemotherapy or radiation therapy alone. The use of pre-operative, intra-operative, 3D conformal, and intensity modulated radiation therapy in gastric cancer is promising but requires further study. The current article reviews the role of radiation therapy in the treatment of resectable and unresectable gastric carcinoma, focusing on current recommendations in the United States.

The Effect of Absorbed Dose to Organs at Risk Following Craniospinal Irradiation Using Different Radiotherapy Techniques

Introduction: In medulloblastoma patients craniospinal irradiation is an important element the treatment. Our study aimed to evaluate the effect of absorbed dose to organs at risk using the hybrid intensity-modulated radiation therapy (IMRT) versus three-dimensional conformal radiotherapy (3DCRT) for craniospinal irradiation (CSI) in average risk medulloblastoma patients. Materials and Methods: In this study, thirteen medulloblastoma patients were included. The prescribed total dose to the planning target volume (PTV) was 23, 40 Gy in 13 fractions. Two radiotherapy techniques, three dimensional conformal radiotherapy (3DCRT) and hybrid intensity modulated radiotherapy (IMRT) were used to treat these patients. The coverage of the Target was evaluated using the D mean, D95%, D2%, D98% and V95%. Other parameters were also compared such as Integral dose (ID), Homogeneity index (HI) and doses to the organs at risk (OARs). Results: There was no significant difference in the mean dose received by the PTV-Brain or the dose received by 95% and 98% of PTV volume using the two techniques. For PTV-Spine, the percentage volume receiving 95% of the total dose increased significantly in the hybrid IMRT technique compared to the conformal technique. So, hybrid IMRT plan achieved the best coverage for PTV spine. Lower dose for OAR was delivered by 3DCRT, except the heart and thyroid, hybrid IMRT achieved better sparing. All plans resulted in the same dose homogeneity index (DHI) for PTV-Brain. For PTV-Spine, hybrid IMRT technique achieved better dose homogeneity compared to 3DCRT technique (1.09 vs. 1.12;p > 0.05). Conclusions: hybrid IMRT technique can be realized on conformal technique because it achieved better dose coverage for the (PTV) and organ at risk (OAR). 3DCRT reduced mean dose to most OARS, except the heart and thyroid. Therefore, the hybrid IMRT technique may be a CSI treatment alternative to 3DCRT.

3D-CRT和VMAT对头颈部肿瘤患者甲状腺功能的影响

目的:研究三维适形放疗(3D-CRT)和容积调强放疗(VMAT)对头颈部肿瘤患者甲状腺功能的影响。方法:将2011年1月至2014年6月在重庆三峡中心医院肿瘤分院行放射治疗的14头颈部肿瘤患者随机分为3D-CRT组和VMAT组,各70例,3D-CRT组行3D-CRT治疗,VMATVMAT治疗,所有患者均完成放射治疗,随访24个月。观察放疗后临床疗效,分别检测放疗前、放束时、放疗后3、6、12、18、24个月血清促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)和游离甲状素(FT4)水平,采用QLQ-H&N35量表评分评价患者放疗前、放疗1个月、放疗后及放疗后6个月质量,记录随访期间甲状腺功能减退发生情况。结果:两组放疗后总有效率差异无统计学意义(05);放疗后6、12、18、24个月甲状腺功能减退情况,VMAT组TSH均显著低于3D-CRT组(P<0.0)疗后12、18、24个月,VMAT组FT3、FT4均显著高于3D-CRT组(P<0.05);放疗后6个月,VMAT组-H&N35量表评分显著低于3D-CRT组(P<0.05);随访24个月内两组甲状腺功能减退发生率差异统计学意义(P>0.05)。结论:3D-CRT和VMAT均是治疗头颈部肿瘤的有效放疗方法,但VMAT护患者甲状腺功能及改善治疗后生活质量方面优于3D-CRT。

上段食管癌累及野照射CRT、3D-CRT与IMRT计划的剂量学对比研究

目的比较颈段、胸上段食管癌常规放疗(CRT)、三维适形放疗(3D-CRT)、调强放疗(IMRT)累及野放疗中靶区和危及器官(OAR)的剂量学差异,进而为临床治疗选择最优放射治疗方案;比较不同大小肿瘤(直径<3 cm及>5 cm)不同放疗计划对危及器官的影响,进而选择较优的放疗计划。方法选择12例颈段及胸上段食管癌患者,应用三维治疗计划系统(TPS)分别为每位患者设计三种治疗计划(A.常规放疗;B三维适形放疗;C调强适形放疗),在规定CTV至少达到95%处方剂量前提下根据剂量体积直方图(DVH)、等剂量曲线比较三种计划靶区剂量分布及脊髓、气管、肺正常组织受量的差异;同时比较不同大小的肿瘤三种放疗计划对脊髓的剂量学影响。结果三种计划的靶区的平均剂量以IMRT计划为好,IMRT同时减少了脊髓及气管的剂量,差异有统计学意义(P<0.05);不管肿瘤直径大小,以IMRT计划最好。结论颈段及胸上段食管癌采用调强适形放疗,能在提高靶区剂量的同时更好的保护周围正常组织及器官,较三维适形放疗有剂量学优势,是目前较好的一种放疗方法。

3D-CRT与静态IMRT在局部晚期非小细胞肺癌治疗中的效果及安全性分析

目的:探讨三维适形放疗(3-dimensional conformal radiation therapy,3D-CRT)与静态调强放疗(intensity modulated radiation therapy,IMRT)在局部晚期非小细胞肺癌(locally advanced non-small cell lung cancer,LANSCLC)治疗中的效果及安全性。方法:选取2017年1月-2019年6月就诊于本院的82例LANSCLC患者,按随机数字表法将其分为A、B组,各41例。A组行静态IMRT,B组行3D-CRT。比较两组治疗效果、计划靶区剂量及治疗安全性。结果:两组治疗总有效率与平均剂量比较,差异均无统计学意义(P>0.05)。A组不均匀性指数(HI)高于B组,而适形指数(CI)水平低于对照组(P<0.05)。A组>Ⅲ度放射性食管炎、血小板减少、>Ⅲ度白细胞减少、>Ⅲ度放射性肺炎及>Ⅲ度消化道反应发生率均低于B组(P<0.05)。结论:3D-CRT与静态IMRT在LANSCLC治疗中的效果相似,但静态IMRT靶区剂量分布更优,能减少放疗毒副反应发生,而其低剂量区照射体积增大,需加以注意。

TACE序贯3D-CRT治疗原发性肝癌的疗效及安全性观察

目的观察肝动脉化疗栓塞(TACE)序贯三维适形放疗(3D-CRT)治疗原发性肝癌的临床效果和安全性。方法 78例原发性肝癌患者,按随机数字表法分为对照组与观察组,各39例。对照组患者给予TACE序贯治疗;观察组患者在此基础上同时给予3D-CRT治疗。观察两组治疗效果,并记录治疗期间不良反应发生情况。结果观察组治疗总有效率82.1%高于对照组的61.5%(P<0.05),骨髓抑制发生率48.7%低于对照组的71.8%(P<0.05)。结论 TACE序贯3D-CRT治疗原发性肝癌能有效控制病情,不良反应少,疗效安全可靠。

rhES结合3D-CRT治疗对食管癌患者症状改善、血清sMICA及组织相关蛋白表达的影响

目的将重组人血管内皮抑制素(rhES)联合三维适形放射(3D-CRT)治疗用于食管癌患者,观察其临床疗效,以及对Stathmin、细胞间质上皮转换因子(c-met)及组织相容性复合体Ⅰ类链相关蛋白A(sMICA)表达的影响。方法选择2013年7月至2014年8月在泰州市人民医院接受治疗的112例食管癌患者为研究对象,采用随机数字法分为对照组和研究组,每组56例。对照组采用单独3D-CRT治疗方案,研究组采用rhES联合3D-CRT治疗方案。随访60个月,比较两组患者的临床疗效、生存质量、生存率、病灶远处转移率和局部复发率、不良反应发生率及血清中Stathmin、c-met、sMICA、血管内皮细胞生长因子(VEGF)表达。结果治疗后,研究组的病情缓解率(69.64%)高于对照组(50.00%),差异有统计学意义(χ^2=4.495,P=0.034);研究组的5年病灶远处转移率(21.43%)、局部复发率(30.36%)均低于对照组(39.29%、50.00%),差异有统计学意义(χ^2=4.223、4.495,P<0.05),研究组5年生存率(55.36%)明显高于对照组(35.71%),差异有统计学意义(χ^2=5.467,P=0.019)。治疗后,研究组社会功能[(92.52±2.21)分]、躯体功能[(89.24±2.16)分]、角色功能[(94.12±1.67)分]、情绪功能[(93.56±2.21)分]、认知功能[(91.78±2.01)分]等生存质量维度评分均明显高于对照组的社会功能[(86.97±1.45)分]、躯体功能[(85.84±1.12)分]、角色功能[(89.22±2.04)分]、情绪功能[(92.18±1.16)分]、认知功能[(88.87±2.13)分]评分,研究组总体症状评分[(41.11±1.14)分]低于对照组[(48.79±1.06)分],差异有统计学意义(P<0.05)。治疗后研究组组织中的Stathmin、c-met、VEGF表达水平及阳性率明显低于对照组,差异有统计学意义(P<0.05)。治疗期间两组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论rhES联合3D-CRT治疗能有效降低食管癌患者Stathmin、c-met、sMICA、VEGF的表达,抑制肿瘤细胞的生长、转移,改善患者的生存质量,且不良反应发生率低,安全性高,有望在临床上推广应用。

3D-CRT与IMRT两种放疗技术在原发性肝癌患者中的应用效果

目的:分析原发性肝癌患者实施三维适形放射治疗(3D-CRT)与强度调控放射治疗(IMRT)的效果。方法:回顾性分析2019年7月—2021年7月于漳州市医院收治的86例原发性肝癌患者的临床资料,根据治疗方法不同分为3D-CRT组(3D-CRT放射治疗)及IMRT组(IMRT放射治疗),各43例。比较两组剂量学参数、放疗照射时间、子野数、总子野跳数及危及器官受量;比较两组放疗后不良反应发生率。结果:IMRT组靶区平均剂量(PTVDmean)、靶区最小剂量(PTVDmin)、靶区最大剂量(PTVDmax)、靶区适形指数(CI)及靶区均匀指数(HI)均高于3D-CRT组,差异有统计学意义(P<0.05)。IMRT组的放疗照射时间长于3D-CRT组,子野数、总子野跳数少于3D-CRT组,差异有统计学意义(P<0.05)。IMRT组脊髓、左肾、右肾、胃受量低于3D-CRT组,差异有统计学意义(P<0.05)。IMRT组放疗后不良反应发生率低于3D-CRT组,差异有统计学意义(P<0.05)。结论:IMRT技术在原发性肝癌放射治疗中可有效提升靶区的照射剂量,并可降低放疗期间对危及器官的损伤程度。

中晚期食管癌患者3D-CRT同步化疗的临床效果

目的探讨中晚期食管癌患者三维适形放疗(3D-CRT)同步化疗的临床效果。方法 60例中晚期食管癌患者,按照不同的治疗方式将其分为对照组与观察组,每组30例。对照组患者给予3DCRT,观察组给予3D-CRT同步联合TP方案化疗。对比两组患者的临床效果、随访后的生存率以及毒副反应发生情况。结果经治疗,观察组临床有效率为86.7%(26/30),高于对照组的63.3%(19/30),差异具有统计学意义(P<0.05)。观察组患者1、2、3年的生存率分别为83.3%(25/30)、66.7%(20/30)、56.7%(17/30);对照组患者1、2、3年的生存率分别为60.0%(18/30)、40.0%(12/30)、30.0%(9/30);观察组1、2、3年的生存率均高于对照组,差异均具有统计学意义(P<0.05)。两组患者均出现毒副反应,但经过积极对症治疗后均可完成治疗,耐受性良好。结论 3D-CRT同步联合TP方案化疗治疗中晚期食管癌患者近期疗效显著,且可提高患者的远期生存率,毒副反应患者可以承受,具有良好的临床应用效果,是性价比较高的治疗方案。

对比常规放疗与三维适形放射治疗(3D-CRT)乳腺癌的临床疗效、毒副作用

目的对比常规放疗与三维适形放射治疗(3D-CRT)乳腺癌的临床疗效、毒副作用。方法选定本院2018年1月至2021年1月住院的90例乳腺癌患者,以随机法将其分组(每组n=45),对比组给予常规放疗治疗,观察组给予3D-CRT治疗,对比两组局部复发率、血清肿瘤标志物、毒副反应总发生率,统计危及器官照射剂量。结果观察组局部复发率(2.22%)低于对比组(22.22%),P<0.05(差异有统计学意义)。观察组治疗后血清糖类抗原199(CA199)、糖类抗原125(CA125)、癌胚抗原(CEA)均低于对比组,P<0.05(差异均具有统计学意义)。观察组毒副反应总发生率(8.89%)低于对比组(28.89%),P<0.05(差异具有统计学意义)。患侧肺V20、患侧肺V30、患侧肺V40、患侧肺V50、左侧心脏V30、左侧心脏V40、左侧心脏V50、分别是(15.28±2.62)cm^(3)、(10.15±3.96)cm^(3)、(1.85±0.62)cm^(3)、(0.54±0.26)cm^(3)、(2.52±1.25)cm^(3)、(2.24±0.99)cm^(3)、(0.45±0.13)cm^(3)。结论3D-CRT可有效抑制乳腺癌患者肿瘤病灶生长,降低局部复发率、血清肿瘤标志物浓度,同时可减少危及器官照射剂量,减轻毒副反应。

食管癌3种放疗方式的疗效比较

目的探讨常规放疗、三维适形放疗(3DCRT)、调强放疗(IMRT)治疗食管癌的疗效差异。方法 117例食管癌中,38例采用常规放疗,32例采用3DCRT,47例采用IMRT。并对疗效和毒副反应进行比较分析。结果常规放疗组、3DCRT组和IMRT组的有效率分别为92.1%、96.9%、91.5%,差异无统计学意义(P=0.617)。3组1年生存率分别为77.9%、87.5%、86.7%(P=0.193);2年生存率分别为38.6%、55.1%、57.7%(P=0.211)。3DCRT组+IMRT组总疼痛缓解率为90.9%,常规放疗组为84.6%,差异无统计学意义(P=0.642)。放射性食管炎发生率3DCRT组+IMRT组较常规放疗组高(P=0.012),放射性肺炎发生率常规放疗组较3DCRT组+IMRT组高(P<0.001),放射性气管炎常规放疗组较3DCRT组+IMRT组高(P=0.028),骨髓抑制常规放疗组较3DCRT组+IMRT组高(P=0.010)。结论 3DCRT和IMRT能提高食管癌的临床疗效,并减轻患者的放射性损伤。

3DCRT技术治疗原发性肝癌的临床剂量学研究

目的探讨3DCRT技术治疗原发性肝癌的方法、处方剂量与疗效的关系。方法27例有随访结果的肝癌患者,对其肿瘤体积大小、位置、处方剂量及生存期作回顾性总结。结果治疗后肿瘤局部控制率为85.2%(23/27),1年生存率为70.4%(19/27),2年生存率为55.6%(15/27),3年生存率为33.3%(9/27)。所有病人无放射性肝炎等严重副反应发生。结论3DCRT技术治疗不宜手术的肝癌是一种无创而有效的治疗方法,可提高肝癌的局部控制率,不良反应轻微,病人生存质量得到提高。

奥沙利铂联合3DCRT与单用3DCRT、奥沙利铂治疗晚期直肠癌近期疗效比较

目的比较奥沙利铂联合3DCRT与单用3DCRT、奥沙利铂应用于晚期直肠癌患者的近期疗效。方法选择72例晚期直肠癌患者,按随机数字表法分为观察组36例和对照组36例(对照组再均分为对照组A和对照组B,每组18例)。对照组A采用单纯3DCRT方法,对照组B采用单纯奥沙利铂治疗,观察组采用奥沙利铂联合3DCRT方法。对3组患者放疗后的近期疗效、1年生存率、2年生存率、及不良反应(骨髓抑制反应、胃肠道反应、神经毒性及放射性直肠炎)发生率进行比较。结果观察组总有效率为94.4%,对照组A总有效率为72.2%,对照组B总有效率为66.7%,观察组的总有效率明显优于对照组A和对照组B(均P<0.05);对照组A与对照组B总有效率比较,差异无统计学意义(P>0.05)。观察组的1年生存率(88.9%)和2年生存率(72.2%)均明显高于对照组A(66.7%、38.9%)和对照组B(61.1%、38.9%)(均P<0.05);对照组A与对照组B 2组患者的生存率相比较,差异无统计学意义(P>0.05)。观察组患者发生的不良反应中骨髓抑制反应、胃肠道反应及神经毒性,比对照组A明显(P<0.05),但在放射性直肠炎方面,2组比较差异无统计学意义(P>0.05);观察组患者发生的不良反应中骨髓抑制反应、胃肠道反应及神经毒性,与对照组B相比,差异无统计学意义(P>0.05),在放射性直肠炎方面,2组患者比较差异有统计学意义(P<0.05)。结论奥沙利铂联合3DCRT治疗晚期直肠癌患者可提高放疗疗效,在改善临床症状、提高生活质量等方面有较好的临床效果。

胰腺癌3DCRT计划设计中BAO和BAF两种优化的比较

目的：探讨胰腺癌射野角度优化（Beam Angle OptimizationBAO）方法对三维适形治疗（3DCRT）的计划质量及计划设计效率的影响。方法：对8例胰腺癌患者以相同的处方剂量，但分别采用BAO和固定射野角度（Beam Angle Fixed BAF）方法设计4野的三维适形治疗（3DCRT）计划，BAO计划组初始角度为0°、90°、180°、270°，最终射野角度由系统自动优化得到：BAF计划组射野角度基于物理师临床经验，采用试错方法（Trial-and-erro）得到。比较两组计划在剂量分布、靶区适形指数（CI）与均匀性指数（HI），不同危及器官（OAR）的照射剂量以及计划设计效率的差异性。结果：两组计划均能满足临床剂量要求，与BAF相比，BAO计划组靶区PTv适形指数CI较优（p=0．037），靶区PTV中位剂量Dso＊略高（p=0．011）；BAO计划组危及器官照射剂量均比BAF组低（P=O．叭2～0．525），其中肝脏和双肾的平均剂量D-有显著性差异（p=0．030，0．012）；BAO和BAF计划组总计划时间和总机器跳数（Mu）分别为5．0（±0．5）min、360（±32）MU和10（±1．0）min、365（±38）MU（P=0．000、0．981），BAO组在计划设计效率方面提高了100％。结论：相比于固定射野角度方法，使用射野角度优化（BAO）可得到更优的胰腺癌三维适形计划，且可提高计划设计的效率，可以在临床上开展广泛应用。