Stereotactic body radiotherapy in pancreatic adenocarcinoma

Background:Stereotactic body radiotherapy(SBRT)in pancreatic cancer allows high delivery of radiation doses on tumors without affecting surrounding tissue.This review aimed at the SBRT application in the treatment of pancreatic cancer.Data sources:We retrieved articles published in MEDLINE/PubMed from January 2017 to December 2022.Keywords used in the search included:“pancreatic adenocarcinoma”OR“pancreatic cancer”AND“stereotactic ablative radiotherapy(SABR)”OR“stereotactic body radiotherapy(SBRT)”OR“chemoradiotherapy(CRT)”.English language articles with information on technical characteristics,doses and fractionation,indications,recurrence patterns,local control and toxicities of SBRT in pancreatic tumors were included.All articles were assessed for validity and relevant content.Results:Optimal doses and fractionation have not yet been defined.However,SBRT could be the standard treatment in patients with pancreatic adenocarcinoma in addition to CRT.Furthermore,the combination of SBRT with chemotherapy may have additive or synergic effect on pancreatic adenocarcinoma.Conclusions:SBRT is an effective modality for patients with pancreatic cancer,supported by clinical practice guidelines as it has demonstrated good tolerance and good disease control.SBRT opens a possibility of improving outcomes for these patients,both in neoadjuvant treatment and with radical intent.

Treatment for paraganglioma with stereotactic radiotherapy

BACKGROUND Paragangliomas(PG)are rare neoplasms of neuroendocrine origin that tend to be highly vascularized,slow-growing,and usually sporadic.To date,common treatment options are surgical resection(SR),with or without radiation therapy(RT),and a watch-and-wait approach.AIM To evaluate the local control and effectiveness of exclusive fractionated stereotactic RT(FSRT)treatment in unresectable PG(uPG).METHODS We retrospectively evaluated patients with uPG(medically inoperable or refused SR)treated with FSRT with a Cyberknife System(Accuray Incorporated,Sunnyvale,California).Toxicity and initial efficacy were evaluated.RESULTS From May 2009 to January 2023,6 patients with a median age of 68(range 20-84)were treated with FSRT.The median delivered dose was 21 Gy(range 20-30 Gy)at a median isodose line of 75.5%(range 70%-76%)in 4 fractions(range 3-5 fractions).The median volume was 13.6 mL(range 12.4-65.24 mL).The median cumulative biological effective dose and equivalent dose in 2-Gy fractions were 70 Gy and 37.10 Gy respectively.Site of origin involved were the timpa-nojugular glomus(4/6),temporal bone,and cervical spine.In 1 of the 6 patients,the follow-up was insufficient;5 of 6 patients showed a 5-year overall survival and 5-year progression-free survival of 100%.We observed negligible toxicities during and after RT.The majority of patients showed stable symptoms during follow-up.Only 1 patient developed spine metastases.CONCLUSION Our preliminary results on this small cohort of patients suggest that FSRT could be an effective and safe alternative to SR.

Stereotactic body radiotherapy combined with sintilimab in patients with recurrent or oligometastatic hepatocellular carcinoma: A phase Ⅱ clinical trial

BACKGROUND Stereotactic body radiotherapy(SBRT)and programmed cell death 1 inhibitors have shown potential in treating hepatocellular carcinoma(HCC)in retrospective studies.AIM To evaluate the efficacy of combining SBRT with sintilimab for patients with recurrent or oligometastatic HCC.METHODS This trial involved patients with recurrent or oligometastatic HCC intravenously treated with SBRT plus sintilimab every 3 wk for 12 mo or until disease progression.The primary endpoint was progression-free survival(PFS).RESULTS Twenty-five patients were enrolled from August 14,2019,to August 23,2021.The median treatment duration was 10.2(range,0.7-14.6)months.SBRT was delivered at a median dose of 54(range,48-60)Gy in 6(range,6-10)fractions.The median follow-up time was 21.9(range,10.3-39.7)mo,and 32 targeted lesions among 25 patients were evaluated for treatment response according to the Response Evaluation Criteria in Solid Tumors version 1.1.The median PFS was 19.7 mo[95%confidence interval(CI):16.9-NA],with PFS rates of 68%(95%CI:52-89)and 45.3%(95%CI:28-73.4)at 12 and 24 mo,respectively.The median overall survival(OS)was not reached,with OS rates of 91.5%(95%CI:80.8-100.0)and 83.2%(95%CI:66.5-100.0)at 12 and 24 mo,respectively.The 1-and 2-year local control rate were 100%and 90.9%(95%CI:75.4%-100.0%),respectively.The confirmed objective response rate and disease control rate was 96%,and 96%,respectively.Most adverse events were graded as 1 or 2,and grade 3 adverse events were observed in three patients.CONCLUSION SBRT plus sintilimab is an effective,well-tolerated treatment regimen for patients with recurrent or oligometastatic HCC.

Comprehensive Treatment Uncertainty Analysis and PTV Margin Estimation for Fiducial Tracking in Robotic Liver Stereotactic Body Radiation Therapy

Objective This study aims to quantify the uncertainties of CyberKnife Synchrony fiducial tracking for liver stereotactic body radiation therapy(SBRT)cases,and evaluate the required planning target volume(PTV)margins.Methods A total of 11 liver tumor patients with a total of 57 fractions,who underwent SBRT with synchronous fiducial tracking,were enrolled for the present study.The correlation/prediction model error,geometric error,and beam targeting error were quantified to determine the patient-level and fraction-level individual composite treatment uncertainties.The composite uncertainties and multiple margin recipes were compared for scenarios with and without rotation correction during treatment.Results The correlation model error-related uncertainty was 4.3±1.8,1.4±0.5 and 1.8±0.7 mm in the superior-inferior(SI),left-right,and anterior-posterior directions,respectively.These were the primary contributors among all uncertainty sources.The geometric error significantly increased for treatments without rotation correction.The fraction-level composite uncertainties had a long tail distribution.Furthermore,the generally used 5-mm isotropic margin covered all uncertainties in the left-right and anterior-posterior directions,and only 75%of uncertainties in the SI direction.In order to cover 90%of uncertainties in the SI direction,an 8-mm margin would be needed.For scenarios without rotation correction,additional safety margins should be added,especially in the superior-inferior and anterior-posterior directions.Conclusion The present study revealed that the correlation model error contributes to most of the uncertainties in the results.Most patients/fractions can be covered by a 5-mm margin.Patients with large treatment uncertainties might need a patient-specific margin.

Effect of Stereotactic Body Radiation Therapy on Diverse Organ Lesions in Advanced Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors

Objective The combination of stereotactic body radiation therapy(SBRT)and immune checkpoint inhibitors(ICIs)is actively being explored in advanced non-small-cell lung cancer(NSCLC)patients.However,little is known about the optimal fractionation and radiotherapy target lesions in this scenario.This study investigated the effect of SBRT on diverse organ lesions and radiotherapy dose fractionation regimens on the prognosis of advanced NSCLC patients receiving ICIs.Methods The medical records of advanced NSCLC patients consecutively treated with ICIs and SBRT were retrospectively reviewed at our institution from Dec.2015 to Sep.2021.Patients were grouped according to radiation sites.Progression-free survival(PFS)and overall survival(OS)were recorded using the Kaplan-Meier method and compared between different treatment groups using the log-rank(Mantel-Cox)test.Results A total of 124 advanced NSCLC patients receiving ICIs combined with SBRT were identified in this study.Radiation sites included lung lesions(lung group,n=43),bone metastases(bone group,n=24),and brain metastases(brain group,n=57).Compared with the brain group,the mean PFS(mPFS)in the lung group was significantly prolonged by 13.3 months(8.5 months vs.21.8 months,HR=0.51,95%CI:0.28–0.92,P=0.0195),and that in the bone group prolonged by 9.5 months with a 43%reduction in the risk of disease progression(8.5 months vs.18.0 months,HR=0.57,95%CI:0.29–1.13,P=0.1095).The mPFS in the lung group was prolonged by 3.8 months as compared with that in the bone group.The mean OS(mOS)in the lung and bone groups was longer than that of the brain group,and the risk of death decreased by up to 60%in the lung and bone groups as compared with that of the brain group.When SBRT was concurrently given with ICIs,the mPFS in the lung and brain groups were significantly longer than that of the bone group(29.6 months vs.16.5 months vs.12.1 months).When SBRT with 8–12 Gy per fraction was combined with ICIs,the mPFS in the lung group was significantly prolonged as compared with that of the bone and brain groups(25.4 months vs.15.2 months vs.12.0 months).Among patients receiving SBRT on lung lesions and brain metastases,the mPFS in the concurrent group was longer than that of the SBRT→ICIs group(29.6 months vs.11.4 months,P=0.0003 and 12.1 months vs.8.9 months,P=0.2559).Among patients receiving SBRT with<8 Gy and 8–12 Gy per fraction,the mPFS in the concurrent group was also longer than that of the SBRT→ICIs group(20.1 months vs.5.3 months,P=0.0033 and 24.0 months vs.13.4 months,P=0.1311).The disease control rates of the lung,bone,and brain groups were 90.7%,83.3%,and 70.1%,respectively.Conclusion The study demonstrated that the addition of SBRT on lung lesions versus bone and brain metastases to ICIs improved the prognosis in advanced NSCLC patients.This improvement was related to the sequence of radiotherapy combined with ICIs and the radiotherapy fractionation regimens.Dose fractionation regimens of 8–12 Gy per fraction and lung lesions as radiotherapy targets might be the appropriate choice for advanced NSCLC patients receiving ICIs combined with SBRT.

伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素

目的:分析伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素。方法:回顾性分析2022年1月至2023年1月在该院接受伽马刀立体定向放射治疗的121例肺癌脑转移瘤患者的临床资料。统计伽玛刀立体定向放射治疗肺癌脑转移瘤患者的预后情况,采用Logistic回归分析伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素。结果:121例伽马刀立体定向放射治疗肺癌脑转移瘤患者预后不良40例,设为预后不良组,预后良好81例,设为预后良好组;预后不良组脑转移瘤最大直径≥3 cm、血清鳞状细胞癌抗原(SCC-Ag)≥3.80 ng/mL、血清细胞角蛋白19片段(CYFRA21-1)≥7.52 ng/mL、血清神经元特异性烯醇化酶(NSE)≥50.81μg/L占比均高于预后良好组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,血清SCC-Ag≥3.80 ng/mL、血清NSE≥50.81μg/L均为伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的危险因素(OR>1,P<0.05)。结论:血清SCC-Ag≥3.80 ng/mL、血清NSE≥50.81μg/L均为伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的危险因素。

醒脑静注射液联合立体定向微创治疗对高血压脑出血患者的应用效果

目的探讨醒脑静注射液联合立体定向微创治疗对高血压脑出血患者的应用效果。方法选取2018年1月至2023年1月九江市第一人民医院神经外科收治的80例高血压脑出血患者作为研究对象,根据随机数字表法将患者分为对照组和观察组,每组各40例。对照组采用小骨窗开颅术治疗,观察组采用醒脑静注射液联合立体定向微创治疗。比较两组患者的手术时间、血肿清除率、并发症(包括肺部感染、消化道出血、二次出血)发生率及术后生活自理能力情况。结果观察组的手术时间短于对照组,血肿清除率>80%的比例高于对照组,差异有统计学意义(P<0.05)。观察组术后1个月的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。观察组的术后生活自理能力评分高于对照组,差异有统计学意义(P<0.05)。结论醒脑静注射液联合立体定向微创治疗高血压脑出血患者,可以缩短手术时间,提高血肿清除率,且其并发症相对较少,同时术后患者日常生活自理水平提高明显,值得临床推广应用。

中晚期非手术治疗肺癌患者应用卡瑞利珠单抗联合立体定向体部放疗的有效性研究

目的评估卡瑞利珠单抗联合立体定向体部放疗(SBRT)在中晚期非手术治疗肺癌中对生存期及治疗安全性的影响价值。方法采用回顾性分析,选择2020年4月—2022年10月赤峰市医院放疗科收治的中晚期非手术治疗肺癌患者300例,根据临床治疗方式不同,分为对照组(150例,SBRT治疗)与研究组(150例,SBRT治疗基础上静脉注射卡瑞利珠单抗,3周/次,共计4次)。两组均治疗3个疗程(21 d为1个疗程)。收集两组临床信息对比治疗效果、治疗前后炎症因子(IL-6、IL-10)、肿瘤坏死因子(TNF-a)、血管内皮因子(bFGF、Ang-2、VEGF、MMP-9)变化情况、机体免疫状况(CD4+、CD8+、NK)及治疗期间不良反应。结果研究组治疗有效率高于对照组,IL-6、IL-10水平低于对照组,TNF-a水平高于对照组(P<0.05);研究组bFGF、Ang-2、VEGF、MMP-9均低于对照组(P<0.05);研究组干预后机体免疫T细胞亚群CD4+、CD8+、NK高于对照组(P<0.05);两组治疗不良反应比较,差异无统计学意义(P>0.05)。结论卡瑞利珠单抗联合立体定向体部放疗(SBRT)在中晚期非手术治疗肺癌中展现了较好的生存期延长和治疗安全性,可通过调节炎症因子、肿瘤坏死因子和血管内皮因子的水平,以及增强机体的免疫功能,达到更好的治疗效果和较低的不良反应,临床应用价值高。

Therapeutic Effects of Stereotactic Radiotherapy on 389 Cases of Brain Glioma

Objective： To investigate the treatment effectiveness and side effects of stereotactic radiotherapy for brain glioma. Methods： From Jun. 1995 to Dec. 1998, 389 cases of brain gliomas were treated by stereotactic radiotherapy, among which 151 cases were treated by stereotactic radiosurgery （SRS） and the other 238 cases, by fractionated stereotactic radiotherapy （FSRT）. In the SRS group, the marginal tumor dose was 20 to 30 Gy （median, 2.6 Gy）. One to 6 isocenters （median, 2.48） and 5 to 21 irradiation arcs （median, 8.45） were applied. In the FSRT group, the per-fraction marginal tumor dose was 8 to 12 Gy with 1 to 6 isocenters （median, 2.53）, 6 to 20 irradiation arcs （median, 8.25） and 2-5 fractions delivered everyday or every other day. Results： Three months after treatment, the complete and partial response rates were 13.9% and 45.7% in SRS group respectively. The stable disease rate was 17.2%. The total effective rate was 76.8%. In FSRT group, the complete and partial remission rates were 19.7% and 47.9% respectively. The stable disease rate was 20.6%. The total effective rate was 88.2%. The total effective rate of FSRT group was higher than that in SRS group （X^2=9.874, P=0.020）. The 1-year, 3-year and 5-year survival rate of all patients was 54.3%, 29.3%, 16.5% respectively. The 1-year, 3-year and 5-year survival rate in SRS group and FSRT group was 52.3% vs 26.5%, 11.9% vs 55.5%, and 31.1 vs 19.3% respectively. There was no significant difference between the two groups （X^2=2.16, P=0.1417）. The brain edema caused by the main radiation was more severe in the SRS group than in FSRT group （X^2=4.916, P=0.027）. Conclusion： It is effective for brain glioma to be treated by stereotactic radiotherapy. Compared with SRS, the FSRT has the advantage of good effect and less side response.

Magnetic resonance-guided focused ultrasound for essential tremor:a prospective,single center,single-arm study

The safety and effectiveness of magnetic resonance-guided focused ultrasound thalamotomy has been broadly established and validated for the treatment of essential tremor.In 2018,the first magnetic resonance-guided focused ultrasound system in Chinese mainland was installed at the First Medical Center of the PLA General Hospital.This prospective,single center,open-label,single-arm study was part of a worldwide prospective multicenter clinical trial(ClinicalTrials.gov Identifier:NCT03253991)conducted to confirm the safety and efficacy of magnetic resonance-guided focused ultrasound for treating essential tremor in the local population.From 2019 to 2020,10 patients with medication refractory essential tremor were recruited into this open-label,single arm study.The treatment efficacy was determined using the Clinical Rating Scale for Tremor.Safety was evaluated according to the incidence and severity of adverse events.All of the subjects underwent a unilateral thalamotomy targeting the ventral intermediate nucleus.At the baseline assessment,the estimated marginal mean of the Clinical Rating Scale for Tremor total score was 58.3±3.6,and this improved after treatment to 23.1±6.4 at a 12-month follow-up assessment.A total of 50 adverse events were recorded,and 2 were defined as serious.The most common intraoperative adverse events were nausea and headache.The most frequent postoperative adverse events were paresthesia and equilibrium disorder.Most of the adverse events were mild and usually disappeared within a few days.Our findings suggest that magnetic resonance-guided focused ultrasound for the treatment of essential tremor is effective,with a good safety profile,for patients in Chinese mainland.

提高肺SBRT精度的多窗位动态组合诊疗手段

目的研究不同窗位描绘肿瘤真实范围的能力以寻找最佳窗位组合。方法本研究提出三个指标(目标肿瘤可偏移空间、目标肿瘤体积一致性,目标肿瘤图像置信度)对115例肺立体定向放射治疗患者的MVCT图像进行评估。结果对于存在边缘晕征的肿瘤,调整窗位可以获得目标肿瘤更真实的范围,窗位值达到-612HU效果最佳;对于局部密度变化单一边缘清晰的病灶,窗位的调整带来的图像引导精度提高不明显;对于存在瘤周弥漫性炎症的病灶,窗位调整不适用,无法提高图像引导精度。结论多窗位动态组合可以获取更真实的肿瘤范围,有助于降低图像引导误差,提高肺立体定向放射治疗精度。

Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy

BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent recurrence after liver cancer resection.However,there are multiple RT techniques available,and the differ-ential effects of these techniques in preventing postoperative liver cancer re-currence require further investigation.AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival(OS)and disease-free survival(DFS)and to determine the optimal strategy.METHODS This study involved network meta-analyses and followed the PRISMA guidelines.The data of qualified studies published before July 10,2023,were collected from PubMed,Embase,the Web of Science,and the Cochrane Library.We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints.The magnitudes of the effects were determined using risk ratios with 95%confidential intervals.The results were analyzed using R software and STATA software.RESULTS A total of 12 studies,including 1265 patients with hepatocellular carcinoma(HCC)after liver resection,were included in this study.There was no significant heterogeneity in the direct paired comparisons,and there were no significant differences in the inclusion or exclusion criteria,intervention measures,or outcome indicators,meeting the assumptions of heterogeneity and transitivity.OS analysis revealed that patients who underwent stereotactic body radiotherapy(SBRT)after resection had longer OS than those who underwent intensity modulated radiotherapy(IMRT)or 3-dimensional conformal RT(3D-CRT).DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS.Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT.IMRT,a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT,may be a preferred option.

立体定向脑电图引导下电刺激引起微笑与欢笑2例

欢笑和微笑在大脑中的产生和传播网络尚未完全清楚。本文报告2例行立体定向脑电图植入的药物难治性癫痫患者,通过电刺激分别在左侧中央前回、右侧岛短回反复诱发出微笑(不带有愉悦情绪及运动意识)及欢笑(带有与情景不相符的愉悦情绪)。该现象反映了笑的情绪及行为网络存在区别与联系。

难治性精神疾病立体定向神经调控治疗的伦理风险及其防治

难治性精神疾病立体定向神经调控治疗技术的伦理风险主要包括精神疾病的病因理论不确定性风险、多元的行动主体责任归属风险、主体权利认定风险适应证、禁忌证范围认定及知情同意权的认定风险以及分配公平公正风险。临床实践中病因理论的确定性不断被证实、临床实践诊疗程序逐步规范、知情同意权日益明确,难治性精神疾病立体定向神经调控治疗技术伦理风险逐步得到改善。提出通过政府加大宣传力度,增强公众的认知水平;明确各级组织的管理职责,分工协作调配资源,完善服务模式;加强相关领域制度建设与落实等防治路径来规避难治性精神疾病立体定向神经调控治疗技术的伦理风险。

立体定向放射治疗小射野探测器研究进展

由于侧向带电粒子平衡的缺失、主光子源的遮挡,以及在小射野测量中可以选择的探测器有限,对现代放射治疗技术进行小野剂量学测定提出诸多挑战,这些挑战极大影响了剂量学的准确性。过量辐射事故表明对小野剂量学测定的适当方法了解不足。本综述介绍了目前适合在小野剂量学测量中应用的各类型探测器,包括微型电离室、半导体探测器、金刚石探测器、塑料闪烁体探测器、放射变色胶片、热释光探测器、放射光致发光玻璃探测器、光受激发光探测器、聚合物凝胶剂量计,为物理师在选择小野探测器时提供参考。

安宫牛黄丸联合立体定向穿刺治疗急性脑出血患者疗效观察

目的探讨安宫牛黄丸联合立体定向穿刺治疗急性脑出血的疗效。方法选取2022年7月至2023年2月急性脑出血患者40例,随机分为2组,对照组患者给予立体定向穿刺抽吸术,观察组在此基础上联合安宫牛黄丸治疗,比较治疗后第1天及2周时神经功能缺损评分(NIHSS)、日常生活能力量表评分(ADL)、改良Rankin量表评分(mRS)及相关并发症等情况。结果治疗后两组患者NHISS评分、GCS评分和ADL评分与治疗前比较,差异有统计学意义(P<0.05),且观察组NHISS评分比对照组改善更显著(P<0.05)。观察组患者颅内感染发生率比对照组低(P<0.05),观察组总有效率高于对照组(P<0.05)。结论立体定向穿刺术后应用安宫牛黄丸治疗急性脑出血,能促进神经功能恢复,减少术后并发症的发生,从而改善患者预后。

立体定向微创手术治疗对老年脑胶质瘤患者免疫水平及日常生活能力的影响

目的 探究立体定向微创手术治疗对老年脑胶质瘤患者免疫水平及日常生活能力的影响。方法 选取哈尔滨医科大学附属第一医院2020年3月—2022年2月收治的老年胶质瘤患者90例作为研究对象,按照随机数字表法分为两组,各45例。对照组采取常规开颅术瘤切除治疗,观察组采取立体定向微创手术治疗。比较两组的临床疗效、日常生活活动能力量表(ADL)评分、美国国立卫生研究院卒中量表(NIHSS)评分、外周血免疫指标辅助性T细胞(Th)1、Th2以及Th17水平。结果 观察组临床总有效率高于对照组,术后1年复发率低于对照组,治疗后观察组ADL评分高于对照组,NIHSS评分低于对照组,Th1水平高于对照组,Th2及Th17水平低于对照组,差异均有统计学意义(P<0.05)。结论 立体定向微创手术治疗老年脑胶质瘤疗效确切,不仅改善了免疫功能指标及神经功能缺损情况,还有助于提高日常生活能力,降低短期复发率。

立体定向微创手术对脑胶质瘤患者神经功能的影响

目的探讨立体定向微创手术对脑胶质瘤患者神经功能的影响。方法将100例脑胶质瘤患者根据治疗方法的不同分为传统组和微创组,每组50例,传统组行传统开颅肿瘤切除术,微创组行立体定向微创手术。比较两组患者的手术指标、临床疗效、神经肽水平、美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分、日常生活能力(ADL)评分以及术后并发症发生情况。结果微创组患者手术时间、住院时间均短于传统组,差异均有统计学意义(P﹤0.05)。微创组患者的总有效率为80.00%,高于传统组患者的62.00%,差异有统计学意义(P﹤0.05)。术后1年,两组患者的精氨酸升压素、β-内啡肽水平均低于本组术前,但微创组患者的精氨酸升压素、β-内啡肽水平均高于传统组,差异均有统计学意义(P﹤0.05)。术后3个月,两组患者的NIHSS评分均低于本组术前,且微创组患者的NIHSS评分低于传统组,两组患者的GCS、ADL评分均高于本组术前,且微创组患者的GCS、ADL评分均高于传统组,差异均有统计学意义(P﹤0.05)。微创组患者的并发症总发生率为8.00%,低于传统组患者的24.00%,差异有统计学意义(P﹤0.05)。结论立体定向微创手术应用于脑胶质瘤患者的治疗中,可缩短手术时间与住院时间,提高临床疗效,减轻对患者神经系统的损伤,改善神经缺损状况,从而有助于提高患者的日常生活能力,降低并发症发生率。

磁共振成像影像导航及靶区选择在经颅磁刺激治疗中的应用

背景:在经颅磁刺激临床实际应用中,是否能准确瞄准刺激脑区可影响经颅磁刺激的实际治疗效果。近年来,随着神经导航系统、移动式增强现实技术的发展,以及多种不同模态磁共振成像数据分析方法的出现,刺激靶区定位的准确性和靶区选择的优化有望得到进一步的提高。目的:综述基于磁共振成像的影像导航定位原理及在经颅磁刺激中的应用,归纳不同模态磁共振成像数据分析在指导经颅磁刺激靶区选择上的作用。方法:应用计算机在PubMed、中国知网和万方数据库检索相关文献,以“transcranial magnetic stimulation,coil positioning,neuronavigation,augmented reality,magnetic resonance imaging,经颅磁刺激,线圈定位,神经导航,增强现实,核磁共振成像,原理”为主要检索词,最终纳入63篇文献进行分析。结果与结论:①传统经颅磁刺激线圈放置方法中,“5 cm规则”、国际脑电10-20定位法最为常用,这些方法具有简便、经济的优点,但过于依赖操作者的经验,存在不同操作者的技术差异。②基于立体定向技术发展而来的神经导航系统是目前可视化程度及准确度最高的辅助经颅磁刺激线圈放置的引导方式,它通过MRI数据采集、脑三维重建、头模配准及立体几何定位等步骤来实现可视化定位,具有较高的临床治疗及科研应用价值,但因其设备较为昂贵,目前在医疗机构中尚未普及。③对于不同层次的医疗单位,移动式移动式增强现实技术不失为一种经济、高效的神经导航系统替代方案,它通过磁共振成像数据采集、构建二维/三维图像、虚拟图像与真实脑图像叠加来实现头皮下脑组织可视化定位,具有直观性强、成本低廉的优势,可在基层医疗单位推广应用。④尽管相对脑电10-20定位策略,可视化定位的临床疗效优越性目前尚未充分体现,但随着研究者对人脑多种不同模态磁共振成像扫描数据的挖掘,有望进一步优化经颅磁刺激治疗靶区选择的策略,提高经颅磁刺激治疗应答率和个性化程度,这在将来是极具潜力和挑战的研究方向。

放疗联合帕博利珠单抗治疗晚期非小细胞肺癌的临床效果

目的 探究立体定向体放射治疗(SBRT)联合帕博利珠单抗对晚期非小细胞肺癌(NSCLC)患者生存和肿瘤反应影响。方法 对2019—2020年期间在攀枝花市中西医结合医院接受一线帕博利珠单抗化疗的NSCLC患者病历进行回顾性分析,共纳入符合标准的患者116例,共有32.8%(38/116)的患者接受了SBRT,纳入联合组,其余患者纳入单用组。使用Kaplan-Meier模型评估2组中位无进展生存期(PFS)和总生存期(OS)。记录比较2组的不良反应发生情况。结果 整个队列的中位PFS为12.00个月(95%CI:10.17~13.83),和中位OS为23.43个月(95%CI:20.04~26.82)。多变量分析显示,SBRT治疗是PFS(HR:0.45,95%CI:0.65~0.93,P=0.020)和OS(HR:0.32,95%CI:0.53~0.87,P=0.013)的独立预测因素。联合组的中位PFS为13.97个月(95%CI:12.04~15.89),而单用组为10.08个月(95%CI:7.90~12.27)(P=0.016)。联合组的中位OS为30.67个月(95%CI:22.20~39.14),而单用组为21.97个月(95%CI:18.64~25.30)(P=0.011)。2组间总体不良事件发生率比较差异无统计学意义(P>0.05),联合组3级或3级以上肺炎的发生率略高于单用组(7.89%vs 3.87%),但差异无统计学意义(P=0.350)。结论 在一线帕博利珠单抗治疗期间,联合SBRT可改善晚期NSCLC患者的PFS和OS,且不增加治疗毒性。