【摘要】 目的 评价大分割适形放射治疗对腹膜后软组织肿瘤术后患者的治疗作用。 方法 对1998年10月-2003年4月收治的16例腹膜后软组织急性肿瘤术后患者行大分割适形放射治疗，设计临床靶区等效生物剂量为55～62 Gy，观察放疗后2、5年局部控制率、生存率和无病生存情况。 结果 2、5年局部控制率较未行放疗患者明显提高并和其他放射治疗方式达到较高治疗剂量者近似；远期生存无改善，无病生存率较未行放疗患者有提高。 结论 大分割适形放射治疗方式对腹膜后软组织急性肿瘤术后患者有较好的局部控制作用，无瘤生存率有提高，远期生存无改善，无严重的远期放疗后遗症。【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.
【摘要】 目的 探讨后程适形放射治疗（3 dimensional comformal radiation therapy，3D-CRT）同步化学疗法治疗Ⅲ期非小细胞肺癌（non-small-cell lung cancer，NSCLC）的近期疗效。 方法 搜集2005年1月-2008年6月NSCLC患者共115例，其中53例行单纯后程3D-CRT（单放组），62例行后程3D-CRT联合同步化学疗法（联合组），所有患者均经病理证实为Ⅲ期NSCLC。两组放射治疗方案均采用常规分割治疗加后程3D-CRT，DT 62～72 Gy。联合组化学疗法采用TP（紫杉醇 + 顺铂）方案。 结果 单放组和联合组近期疗效（完全缓解+部分缓解）分别为75.47%、91.94%，差异有统计学意义（Plt;0.05）。单放组和联合组的治疗不良反应主要有白细胞、血小板减少，放射性食管炎，放射性气管炎，恶心、呕吐等胃肠道反应。骨髓抑制和消化道反应，联合组稍高于单放组。经对症治疗后，所有患者均可耐受。 结论 后程3D-CRT联合TP方案化学疗法较单纯后程适形放射治疗明显提高Ⅲ期NSCLC近期疗效。患者耐受性尚可。【Abstract】 Objective To observe the recent therapeutic effect of late course 3 dimensional conformal therapy concomitant with chemotherapy on locally advanced stage Ⅲ non-small-cell lung cancer (NSCLC). Methods From January 2005 to June 2008, 115 patients with stage Ⅲ NSCLC were confirmed by pathology, in whom 53 only underwent late course conformal therapy (radiotherapy group), and another 62 underwent late course conformal therapy concomitant with chemotherapy (combined group). The radiotherapy schema of the two groups was routine division plus late course conformal therapy (with DT 62-72 Gy). The chemotherapy schema in the combined group was performed with TP (paclitaxel and DDP). Results The recent curative effect (complete remission plus partial remission) in radiotherapy group and combined group was 75.47% and 91.94%, respectively (Plt;0.05). The frequent adverse reactions in the two groups included leucocytopenia, thrombocytopenia, radioactive esophagitis, radioactive tracheitis, nauseated, and emesia. The rate of bone marrow depression and alimentary canal reaction in combined group was higher than that in the radiotherapy group. In the two groups, all patients could tolerance the treatments. Conclusion Late course 3 dimensional conformal therapy concomitant with TP schema chemotherapy for NSCLC could raise the recent curative effect. The patients could tolerance the treatments.
【摘要】 目的 探讨三维适形放疗(3DCRT)联合介入栓塞化疗(TACE)治疗Ⅲ、Ⅳ期原发性肝癌的方法和临床价值。 方法 回顾性总结2006年6月-2008年12月采用3DCRT联合TACE治疗原发性肝癌的临床资料40例。 结果 3DCRT联合TACE治疗Ⅲ、Ⅳ期原发性肝癌有效率为85%。0.5、1、2年局部控制率分别为92%、70%、52%。0.5、1、2年生存率分别为75%、46%、30%，治疗不良反应轻微。 结论 3DCRT联合TACE能提高原发性肝癌患者生活质量，延长生存期,是治疗中晚期原发性肝癌的有效治疗方法之一。【Abstract】 Objective To investigate the application and clinical value of three-dimensional conformal radiation therapy (3DCRT) combined with transcatheter arterial chemoembolization (TACE) on stage Ⅲ and Ⅳ primary hepatic carcinoma. Methods A Total of 40 cases of stage Ⅲ and Ⅳ primary hepatic carcinoma treated by 3DCRT combined with TACE from June 2006 to December 2008 were analyzed retrospectively. Results The response rate was 85%. The 0.5-, 1-, and 2-year local response rates were 92%, 70%, and 52%, and the 0.5-, 1-, and 2-year survival rates were 75%, 46%, and 30%, respectively. The adverse reactions of radiotherapy were tolerable. Conclusion 3DCRT combined with TACE could improve prognosis of stage Ⅲ and Ⅳprimary hepatic carcinoma.
目的：探讨ⅢA-N2期非小细胞肺癌（NSCLC）完全切除术后三维适形放疗联合辅助化疗疗效。方法:对48例ⅢA-N2期NSCLC完全切除术后患者，术后病理为腺癌18例、鳞癌27例、腺鳞癌3例，按信封法随机分为放疗组（24例）与非放疗组（24例）。放疗组采用术后三维适形放疗，4～5个非共面野，以90%～95%等剂量曲线包绕PTV，每次2 Gy，1次/日，5次/周，共照射25次，总剂量DT 50 Gy，放疗后予TP方案化疗3~4周期；非放疗组术后予TP方案化疗3~4周期。结果：放疗组1、2、3年生存率分别为95.8%、79.2%、62.5%，非放疗组分别为91.7%、58.3%、37.5%；放疗组1、2、3年无病生存率分别75.0%、58.3%、45.8%，非放疗组分别为54.2%、41.7%、25.0%；放疗组与非放疗组3年胸腔内复发分别12.5%和37.5%；放疗组与非放疗组中位生存时间分别为28个月和18个月；放疗组白细胞减少、急性放射性肺炎、气管炎发生率分别为25.0%、8.3%、12.5%，均为Ⅰ或Ⅱ级；Ⅰ级急性放射性食管炎发生率为20.8%。结论：ⅢA-N2期非小细胞肺癌完全切除术后三维适形放疗联合辅助化疗，可以降低患者胸腔内肿瘤复发、提高术后生存率。
目的:评价70岁以上老年非小细胞肺癌患者大分割放疗的长期疗效和并发症。方法:对1997年8月至2003年2月收治的38例70岁以上非小细胞肺癌实施大分割三维适形放疗(3D-CRT),年龄70～85岁,中位年龄74岁。全组卡氏评分均≥70。其中Ⅰ期8例, Ⅱ期20例, Ⅲ期8例,Ⅳ期2例。结果:全组有效率(CR+PR)92.1%;1,2,3,5年生存率分别为94.7%、65.7%、38.9% 和 28.0%。1,2 级急性放射性食管炎发生率 47.4%(18/38);未出现急性症状性放射性肺炎,未发现严重心脏、食管、脊髓放射性反应。晚期局部肺放射性纤维化表现(CT和/或胸片)为34.2%(13/38).结论:不能手术的老年非小细胞肺癌患者大分割适形放射治疗,安全有效,副作用可以耐受。
目的:探讨经导管肝动脉灌注化疗栓塞(TACE)与TACE联合三维适形放射治疗(TACE + 3DCRT)原发性肝细胞癌(HCC)的疗效.方法:随机分成两组的HCC患者,均不能手术、门脉无癌栓、无远处脏器转移。50例患者行单纯TACE 2次(TACE组)。40例患者在TACE 2次后第四周再行三维适形放射治疗(TACE + 3DCRT组),放疗采用6MVX射线,4～6 Gy/次,隔日一次,3次/周,总剂量45～60 Gy。TACE采用碘化油、顺铂、5氟尿嘧啶、表阿霉素及明胶海绵。结果:TACE组与TACE+3DCRT组近期疗效有效率(完全缓解+部分缓解)分别为68.0%(34/50)、87.5%(35/40),1年生存率分别为78.0%(39/50)、95.0%(38/40),两组差异均有统计学意义(Plt;0.05)。TACE的治疗反应主要为栓塞综合征,3DCRT有7.5%(3/40)发生急性放射性肝炎,经对症、保肝处理后缓解。两组患者均能耐受。结论:TACE + 3DCRT治疗不能手术、门脉无癌栓、无远处脏器转移的HCC的疗效较单纯TACE治疗HCC的疗效好。
ObjectiveTo compare the dosimetric differences among the double-arc volumetric-modulated arc therapy (VMAT), 7 field intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3D-CRT) techniques in treatment planning for cervical cancer as adjuvant radiotherapy. MethodFifteen patients who underwent adjuvant chemotherapy for cervical cancer between March 1st and September 30th, 2013 were chosen to be our study subjects through random sampling. Under Pinnacle 9.2 planning system, the same CT image was designed through three different techniques:VMAT, IMRT and 3D-CRT. We then compared target zone fitness index, evenness index, D98%, D2%, D50% among those different techniques. Monitor unit (MU) and treatment time were also analyzed. ResultsThree techniques showed similar target dose coverage. The IMRT and VMAT plans achieved better target dose conformity, which reduced the V20 of the pelvic, the V50 of the rectum and bladder, as well as the V40/50 of the small intestine (P<0.05). The VMAT technique showed few dosimetric advantages over the IMRT technique. VMAT technique had the advantages of less MU (P>0.05) and shorter overall treatment time (P<0.01) compared with IMRT technique. ConclusionsThe IMRT and VMAT plans achieve similar dose distribution to the target, and are superior to the 3D-CRT plans, in adjuvant radiotherapy for cervical cancer. VMAT technique has the advantages of less MU and shorter overall treatment time.
ObjectiveTo compare the radiation dose distribution in irradiated target area and organs at risk among conventional radiotherapy, conformal radiotherapy and semi-field conformal radiotherapy in Graves' ophthalmopathy patients. MethodsThirty patients with Grave's ophthalmopathy treated between January 2010 and December 2012 were included in this study.CT scan was performed to obtain images of each patients; three-dimensional planning system (3D-TPS) was done to design conventional radiotherapy, conformal radiotherapy and semi-field conformal radiotherapy for each patient.Then, we counted the standard deviation of study parameters for each radiotherapy technique, and the results were compared among the three groups. ResultsAverage irradiation dose in target area of patients accepting conventional irradiation, conformal irradiation and semi-field conformal irradiation therapy was not significantly different (P > 0.05).V95 and the conformity index values of conformal irradiation and semi-field conformal irradiation therapy were better than those of the conventional irradiation therapy (P < 0.001), while no significant difference between conformal irradiation and semi-field conformal irradiation therapy was detected (P > 0.05).Patients accepting conventional irradiation got the highest cumulative irradiation dose in eye lens, while patients accepting semi-field conformal irradiation therapy got the lowest irradiation dose in eye lens, and the differences were significant (P < 0.05).Patients accepting conventional irradiation got the highest cumulative irradiation dose in pituitary, while cumulative irradiation dose in pituitary in patients accepting conformal irradiation and semi-field conformal irradiation therapy was not significantly different (P > 0.05). ConclusionsConformal irradiation and semi-field conformal irradiation techniques are superior to conventional irradiation technique, with a better target conformal degree and higher does distribution in target area, as well as a lower radiation dose in normal tissues surrounding target area.Semi-field conformal irradiation technique has a better performance than conformal irradiation therapy in eye lens protection.
ObjectiveTo systematically review efficacy and safety of docetaxel chemotherapy combine with 3-dimensional conformal radiation therapy (3D-CRT) in treatment of esophageal cancer.MethodsDatabases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI and WanFang Data were searched from inception to February 2017 to collect randomized controlled trials (RCTs) and quasi-randomized control trials (qRCTs) about docetaxel chemotherapy combine with 3D-CRT in treatment of esophageal cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Stata 12.0 software.ResultsA total of 17 RCTs involving 1 353 patients were included. The results of meta-analysis showed that, compared with the radiotherapy alone, the docetaxel chemotherapy combine with 3D-CRT could improve effective rate (OR=1.25, 95%CI 1.07 to 1.47, P=0.003), 3-year survival rate (OR=1.91, 95%CI 1.19 to 3.06, P=0.006), but there were no significant differences in 1-year survival rate (OR=1.28, 95%CI 0.95 to 1.72, P=0.105), hematologic toxicities (OR=1.13, 95%CI 0.85 to 1.49, P=0.389) and gastrointestinal reactions (OR=1.19, 95%CI 0.90 to 1.57, P=0.181).ConclusionsCompared with radiotherapy alone, docetaxel chemotherapy combine with 3D-CRT can improve the effective rate, 3-year survival rate, but not increase the incidences of adverse effects. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.