目的 系統(tǒng)評(píng)價(jià)唑來膦酸聯(lián)合放射治療(放療)治療惡性腫瘤骨轉(zhuǎn)移的療效和安全性。方法 計(jì)算機(jī)檢索PubMed、EMbase、The Cochrane Library(2012年第10期)和CBM、CNKI、VIP、WanFang Data,收集唑來膦酸聯(lián)合放療治療惡性腫瘤骨轉(zhuǎn)移的隨機(jī)對(duì)照試驗(yàn),檢索時(shí)限均為建庫至2012年10月,并追溯納入研究的參考文獻(xiàn)。由兩位研究者按照納入與排除標(biāo)準(zhǔn)獨(dú)立篩選文獻(xiàn)、提取資料和評(píng)價(jià)質(zhì)量后,采用RevMan 5.1軟件進(jìn)行Meta分析。結(jié)果 納入29個(gè)RCT,共2 061例患者。Meta分析結(jié)果顯示:與單純放療組比較,唑來膦酸聯(lián)合放療組可改善治療結(jié)束時(shí)控制疼痛有效率[OR=3.08,95%CI(2.30,4.12),Plt;0.000 01]、治療結(jié)束2周后控制疼痛有效率[OR=3.39, 95%CI(2.52,4.56),Plt;0.000 01]、患者生活質(zhì)量[OR=2.74,95%CI(1.66,4.52),Plt;0.000 01]和活動(dòng)能力[OR=2.96, 95%CI(2.16,4.05),Plt;0.000 01],并降低新生骨轉(zhuǎn)移瘤發(fā)生率[OR=0.21,95%CI(0.10,0.45),Plt;0.000 1]和骨相關(guān)事件發(fā)生率[OR=0.17,95%CI(0.03,0.92),P=0.04]。在不良反應(yīng)方面,唑來膦酸聯(lián)合放療組的發(fā)熱[OR=11.92, 95%CI(6.31,22.48),Plt;0.000 01]和低鈣血癥[OR=8.82,95%CI(1.61,48.36),P=0.01]發(fā)生率明顯增多。結(jié)論 與單純放療相比,唑來膦酸聯(lián)合放療能明顯緩解骨轉(zhuǎn)移性疼痛,有效提高腫瘤患者的活動(dòng)能力并改善生活質(zhì)量,同時(shí)能有效減少新發(fā)骨轉(zhuǎn)移及骨相關(guān)事件發(fā)生。
目的 探討碘131(131I)治療后Graves眼病(GO)預(yù)后與血清促甲狀腺激素受體抗體(TRAb)水平變化之間的關(guān)系。 方法 選擇2011年5月-12月初發(fā)Graves病患者238例,分為GO組124 例和非GO組114 例,分別檢測(cè)131I治療前及131I治療后2、3、6個(gè)月甲狀腺功能和TRAb,GO患者131I治療前和治療后6 個(gè)月進(jìn)行臨床活動(dòng)度評(píng)分(CAS)。 結(jié)果 131I治療前各組TRAb水平差異無統(tǒng)計(jì)學(xué)意義(P>0.05),TRAb水平與GO CAS評(píng)分之間無相關(guān);131I治療后6個(gè)月所有患者TRAb水平顯著增加;非GO組有5例新發(fā)GO,新發(fā)GO組與其他患者的TRAb水平分別為(58.7 ± 77.9)、(61.9 ± 81.1)U/L,差異無統(tǒng)計(jì)學(xué)意義(P>0.05);GO組又分為GO無變化29例,GO加重17例,GO緩解78例,三組患者TRAb水平分別為(53.5 ± 77.6)、(66.2 ± 89.9)、(66.8 ± 42.2)U/L,差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。 結(jié)論 131I治療后患者TRAb水平顯著增加,但TRAb水平的變化和GO預(yù)后無關(guān),TRAb與GO的關(guān)系還需要進(jìn)一步研究。
【摘要】 目的 分析重力因素對(duì)二維探測(cè)器陣列驗(yàn)證靜態(tài)調(diào)強(qiáng)計(jì)劃的影響,判斷機(jī)架角度歸為0°的測(cè)量方法是否安全可靠。 方法 在0°機(jī)架角和實(shí)際治療機(jī)架角分別測(cè)量靜態(tài)調(diào)強(qiáng)計(jì)劃的劑量分布,以3 mm范圍內(nèi)偏差lt;3%(3% 3 mm)標(biāo)準(zhǔn)進(jìn)行γ分析,獲得相對(duì)于參考劑量分布的通過率,分析通過率變化規(guī)律。分析兩種方法測(cè)量的等中心點(diǎn)絕對(duì)劑量的差異?!〗Y(jié)果 通過率的變化呈隨機(jī)分布,96.9%的照射野偏差lt;2.5%。所有計(jì)劃的85.7%絕對(duì)劑量偏差lt;2%,最大偏差為4.75%。 結(jié)論 使用二維探測(cè)器陣列在0°角進(jìn)行調(diào)強(qiáng)計(jì)劃的日常驗(yàn)證是安全可靠的。【Abstract】 Objective To analyze impacts of gravity on the verification of IMRT plans with 2-Dimensional detector arrays and to evaluate the reliability of the measurements in vertical direction (gantry angle=0). Methods The dose distributions for each beam in IMRT plans were measured with 0 degree gantry angle and actual gantry angle respectively. The γ percentage pass rate (according to 3% 3 mm) for each beam under each angle condition was obtained by the comparison between the measured dose distribution and the calculated dose map from the treatment planning system which was treated as the reference distribution. Then the absolute dose at the isocenter for each plan was measured at each angle condition and was analyzed. Results The variations of γ percentage pass rates between the two types of measurements were randomly distributed, and the deviations for 96.9% beams were less than±2.5%. The differences between absolute doses for 85.7% beams were less than±2% and the biggest deviation was -4.75%. Conclusion Verification of IMRT plans for the radiotherapy quality assurance using 2-Dimensional detector arrays in 0 degree gantry angle is safe and reliable.
【摘要】 目的 調(diào)強(qiáng)放射治療(IMRT)能較好的保護(hù)危及器官并給予腫瘤足夠的致死劑量,基于多葉準(zhǔn)直器(MLC)分步照射的IMRT技術(shù)對(duì)復(fù)雜病例需要更多子野。研究對(duì)直腸癌術(shù)后放射治療使用不同子野數(shù)目的IMRT計(jì)劃進(jìn)行比對(duì),選擇合理的子野數(shù)?!》椒ā∵x取2010年4-8月入院的直腸癌術(shù)后患者10例,保持射野入射角度及優(yōu)化目標(biāo)參數(shù)相同,僅改變MLC子野數(shù)目,設(shè)計(jì)不同IMRT對(duì)每一患者治療計(jì)劃的靶區(qū)適形指數(shù)(CI)、均勻性指數(shù)、最大劑量、最小劑量、平均劑量,危及器官關(guān)注體積的受照劑量,機(jī)器跳數(shù)及治療時(shí)間進(jìn)行分析。 結(jié)果 所有治療計(jì)劃中靶區(qū)及危及器官的劑量學(xué)評(píng)估指標(biāo)無統(tǒng)計(jì)學(xué)意義(Pgt;0.05),只有亞臨床計(jì)劃靶區(qū)(PTV)CI在15個(gè)子野的方案中(0.74±0.06)明顯差于25個(gè)子野方案(0.82±0.03)、40個(gè)子野方案(0.81±0.06)及60個(gè)子野方案(0.84±0.03),有統(tǒng)計(jì)學(xué)意義(Plt;0.05);治療機(jī)器跳數(shù)(MU)隨子野數(shù)目增多明顯增大,15、20、40及60個(gè)子野方案所需MU分別為(458±56)、(559±62)、(614±74)、(622±82),有統(tǒng)計(jì)學(xué)意義(Plt;0.05),但40個(gè)子野方案與60個(gè)子野方案間無統(tǒng)計(jì)學(xué)意義。治療時(shí)間明顯隨子野數(shù)增加而增大?!〗Y(jié)論 直腸癌術(shù)后IMRT計(jì)劃使用25個(gè)子野能滿足臨床劑量要求,同時(shí)能有效降低治療時(shí)間,可作為臨床應(yīng)用參考值。【Abstract】 Objective The intensity modulated radiotherapy (IMRT) can deliver tumor enough doses and protect risk organs as much as possible at the same time. The MLC-based step and shoot IMRT(sIMRT) plan needs much more segment member to meet clinical aims. In this study, several sIMRT plans using different segment number for postoperative rectal cancer were compared to find out the most reasonable segment number setting. Methods Ten patients with rectal carcinoma underwent postoperative adjuvant radiotherapy for rectal cancer from April to August 2010 were selected. For each patient, the angle of field, the prescription expected and the physical parameters optimized were kept the same, while only the number of segments was changed in sIMRT plans. The dose volume histogram-based parameters [conformity index (CI) and homogeneous index (HI)] and other parameters concerned were compared and analyzed. Results The indexes of dosimetry associated with the targets and risk organs showed no significant statistical difference among the 4 sIMRT plans with different segment numbers. The index CI of PTV in the sIMRT plan with 15 segments (CI 0.74±0.06) was less than that in the sIMRT plan with 25 segments (CI 0.82±0.03), the sIMRT plan with 40 segments plan (CI 0.81±0.06), and the sIMRT plan with 60 segments (CI 0.84±0.03) (Plt;0.05). There were significant differences in MU among the sIMRT plans with 15 segments (average MU: 458±56) , with 25 segments (average MU: 559±62 ), and with 40 segments (average MU: 614±74)or with the 60 segments (average MU: 622±82 (Plt;0.05). The more segments meant more MU and more irradiation time. Conclusion The sIMRT plan for patients of rectal cancer to receive postoperative adjuvant radiotherapy may require at least 25 segments to balance the accepted dose results and efficient delivering.
【摘要】蒙特卡羅劑量計(jì)算法一直被公認(rèn)為是最精確的輻射輸運(yùn)計(jì)算工具,因此很早就成為模擬輻射治療粒子輸運(yùn)的重要方法之一。但真正能應(yīng)用于腫瘤放射治療臨床工作的基于蒙特卡羅算法的放射治療計(jì)劃系統(tǒng)的推出卻經(jīng)歷了一個(gè)漫長(zhǎng)的時(shí)間過程,目前仍在進(jìn)一步開發(fā)和優(yōu)化中。現(xiàn)就通用蒙特卡羅應(yīng)用程序的發(fā)展歷史,介紹基于蒙特卡羅算法的放射治療計(jì)劃系統(tǒng)的研究基礎(chǔ);描述放射治療過程中完整的輻射輸運(yùn)的組成部分;總結(jié)此類系統(tǒng)的優(yōu)勢(shì)、研發(fā)難點(diǎn)和特有的限制條件;介紹能使蒙特卡羅算法應(yīng)用于臨床的主要途徑;并指出仍需要努力研究從而充分發(fā)揮其潛力的領(lǐng)域。
【摘要】 目的 評(píng)價(jià)大分割適形放射治療對(duì)腹膜后軟組織腫瘤術(shù)后患者的治療作用。 方法 對(duì)1998年10月-2003年4月收治的16例腹膜后軟組織急性腫瘤術(shù)后患者行大分割適形放射治療,設(shè)計(jì)臨床靶區(qū)等效生物劑量為55~62 Gy,觀察放療后2、5年局部控制率、生存率和無病生存情況?!〗Y(jié)果 2、5年局部控制率較未行放療患者明顯提高并和其他放射治療方式達(dá)到較高治療劑量者近似;遠(yuǎn)期生存無改善,無病生存率較未行放療患者有提高?!〗Y(jié)論 大分割適形放射治療方式對(duì)腹膜后軟組織急性腫瘤術(shù)后患者有較好的局部控制作用,無瘤生存率有提高,遠(yuǎn)期生存無改善,無嚴(yán)重的遠(yuǎn)期放療后遺癥。【Abstract】 Objective To observe the effect of high-dose three-dimensional conformal radiotherapy combined with surgery on primary retroperitoneal soft tissue sarcoma. Methods A total of 16 patients with primary retroperitoneal soft tissue sarcoma underwent high-dose three-dimensional conformal radiotherapy after sarcoma excision from October 1998 to April 2003. The biologically effective dose was 55-62 Gy for CTV. The local control rate and long-term survival rate and disease free survival after 2 and 5 years were observed. Results The local control rate obviously raised in these patients after 2 and 5 years; but the long-term survival rate didn’t improve and the disease free survival improved in these patients compared with those wasn’t radiated. Conclusion High-dose three-dinensional comfomal radiotherapy is effective on the patients with retroperitoneal soft tissue sarcoma in local control rate and disease free survival, but long-term survival rate is not improved and the side-effect is not serious.
目的:探討甲亢合并周期性麻痹(TPP)的發(fā)病情況、臨床特點(diǎn)及131碘治療后的療效分析。方法:回顧性分析36例甲亢合并TPP患者與43例甲亢不伴TPP患者的臨床資料及131碘治療后療效。結(jié)果:甲亢合并TPP患者男性明顯多于女性,其中尤以30~40歲的青壯年多見;甲亢合并TPP患者平均131碘治療劑量明顯低于對(duì)照組(Plt;0.01);經(jīng)131碘治療后,甲亢合并TPP患者與對(duì)照組在甲亢治愈率、甲減發(fā)生率上無顯著性差異(Pgt;0.05)。結(jié)論:甲亢合并TPP發(fā)病男性明顯多于女性,與Graves病有明顯區(qū)別。早期、正確診斷甲亢合并TPP,可避免延誤對(duì)以周癱為主要癥狀的甲亢患者診治。131碘治療是一種非常有效的治療甲亢合并TPP的方法。
目的:探討松果體區(qū)腫瘤的治療策略。方法:我院自2003年12月至2007年12月收治的58例松果體區(qū)腫瘤,按腫瘤標(biāo)志物甲胎蛋白(AFP)和人β促絨膜性腺激素(hCG-β)將其分為標(biāo)志物增高組和正常組,回顧分析兩組臨床資料和治療體會(huì)。結(jié)果:腫瘤標(biāo)志物正常組36例,其中27例行手術(shù)切除腫瘤,9例行伽馬刀治療(其中5例行伽馬刀加腦室腹腔分流治療)。術(shù)后4例因病理報(bào)告示生殖細(xì)胞瘤行伽馬刀補(bǔ)充治療,3例因梗阻性腦積水行腦室腹腔分流。增高組22例,均選用伽馬刀治療(其中17例合并梗阻性腦積水者行伽馬刀加腦室腹腔分流)。治療后3例因癥狀緩解不佳行手術(shù)切除腫瘤術(shù)。手術(shù)病例中24例采用經(jīng)胼胝體入路,4例經(jīng)枕部小腦幕入路,2例經(jīng)幕下小腦上入路。手術(shù)全切24例,次全切5例,部分切除1例,術(shù)后住院期內(nèi)死亡者1例。病理診斷:生殖細(xì)胞瘤14例,畸胎瘤5例,中樞神經(jīng)細(xì)胞瘤4例,室管膜瘤2例,表皮樣囊腫2例,腦膜瘤1例,膠質(zhì)瘤1例,皮樣囊腫1例。放射外科治療病例中28例術(shù)后3個(gè)月臨床癥狀明顯改善,4例隨訪期內(nèi)腫瘤無明顯變化,3例腫瘤增大。2例放療后出現(xiàn)鞍區(qū)轉(zhuǎn)移。結(jié)論:松果體區(qū)腫瘤組織類型多樣,應(yīng)盡可能先明確腫瘤性質(zhì)后選擇合理治療策略。
摘要:目的:探討同期放化療治療中晚期鼻咽癌的療效。方法: 我院2003年6月至2006年10月中晚期鼻咽癌患者95例回顧分析, 兩組放射治療相同, 用6 MV-X線外照射和6~12 MeV電子線, 觀察組放療始PF方案同步化療。結(jié)果:兩組治療結(jié)束后3個(gè)月觀察組鼻咽癌原發(fā)病灶療效有效率高于對(duì)照組(Plt;0.05), 頸部淋巴結(jié)療效有效率高于對(duì)照組(Plt;0.05), 兩組患者不良反應(yīng)主要為急性黏膜反應(yīng)、骨髓抑制、胃腸道反應(yīng)等。觀察組的毒副作用發(fā)生率明顯高于對(duì)照組(Plt;0.05)。結(jié)論:同期放化療治療中晚期(Ⅲ或Ⅳa期)鼻咽癌是目前較為理想的治療方案, 其毒性反應(yīng)可以耐受。
目的:研究小鼠頭頸鱗癌細(xì)胞株SCCⅦ體外放射敏感性,并探討其與細(xì)胞周期阻滯的可能關(guān)系。方法:利用細(xì)胞克隆形成試驗(yàn)及MTT法檢測(cè)SCCⅦ細(xì)胞受X射線照射后細(xì)胞存活能力及細(xì)胞生長(zhǎng)趨勢(shì)的變化,通過流式細(xì)胞學(xué)檢測(cè)X射線照射后細(xì)胞周期分布的變化。結(jié)果:相同劑量照射后的SCCⅦ細(xì)胞存活分?jǐn)?shù)高于Hela細(xì)胞(Plt;0.05);4 Gy照射后的SCCⅦ細(xì)胞在96 h內(nèi)細(xì)胞生長(zhǎng)速度仍高于Hela細(xì)胞(Plt;0.05);4 Gy照射后SCCⅦ細(xì)胞G1期和G2期細(xì)胞比例明顯升高(Plt;0.05)。結(jié)論:SCCⅦ細(xì)胞對(duì)放射線不敏感性,放射線導(dǎo)致的細(xì)胞周期阻滯是SCCⅦ細(xì)胞放射抵抗的可能原因之一