目的:观察顺铂周方案化疗联合大分割适形放疗治疗复发鼻咽癌的相关放化疗不良反应、生活质量及疗效.方法:2008年10月至2013年2月我科收治鼻咽癌复发患者101例,倾向性得分匹配法分成鼻咽癌单纯放疗组(对照组:全部采用三维适形放疗,大分割,每次3 Gy,每周5次,共17 ～ 20次,总量51～ 60 Gy/4周)和鼻咽癌同步放化疗组(研究组:在对照组的基础上,采取顺铂周方案化疗,顺铂30 mg/m2,第1天,1次/周,共4周).观察放化疗不良反应、生活质量影响、近远期疗效等.结果:两组患者近期放射损伤反应如口干、口腔黏膜损伤、颌面部皮肤损伤、乏力等,远期反应如口干、耳聋、张口困难、颌面部肌肉纤维化、放射性脑病等比较均无统计学差异(P＞0.05),两组患者生活质量评价(KPS评分、体重变化)治疗前与治疗结束时及治疗结束时与治疗后3个月对比,均无统计学差异(P＞0.05),对照组3个月后、6个月后、9个月后、12个月后有效率分别为52.9％、60.8％、64.7％、66.7％,而研究组有效率分别为70.0％、78.0％、84.0％、88.0％,9个月后、12个月后有效率对比两组有统计学差异(P＜0.05),对照组1年、2年、3年、4年、5年生存率分别为94.1％、74.5％、58.8％、43.1％、33.3％,研究组1年、2年、3年、4年、5年生存率分别为96.0％、84.0％、74.0％、64.0％、54.0％,两组4年生存率、5年生存率对比有统计学差异(P＜0.05).结论:顺铂周方案化疗联合大分割适形放疗治疗复发鼻咽癌,有较好的近期疗效与远期疗效,可明显提高肿瘤的局部控制率,且不良反应可耐受,安全性较好.

目的 研究大分割三维适形放疗鼻咽癌的放射损伤及疗效.方法 采用倾向性得分匹配法,把105例鼻咽癌患者分成全程常规分割适形放疗组(对照组)和前程常规分割后程大分割三维适形放疗组(研究组),观察放射损伤、近期疗效、远期疗效等.结果 两组急性放射损伤、远期放射损伤差异均无统计学意义(P>0.05),治疗后3个月完全缓解率研究组(88.5％)与对照组(67.9％)对比差异有显著性(χ2=6.471,P<0.05),5年生存率研究组(78.8％)、对照组(60.4％)亦有明显优势(χ2=4.225,P<0.05).结论 前程常规分割联合后程大分割适形放疗用于鼻咽癌患者的近期疗效、远期疗效较好,且放射损伤反应与全程常规分割适形放疗并无明显差异,安全性较好.

Objective To investigate the efficacy and adverse reactions of palonosetron and dexamethasone in preventing cisplatin-induced nausea and vomiting. Methods From September 2015 to August 2017, a total of 217 nasopharyngeal carcinoma patients in the 163rd Hospital of PLA were randomly divided into two groups according to the digital table.The control group (n=108) was given palonosetron when used cisplatin treatment, the study group(n=109) was given palonosetron combined with dexamethasone.The clinical efficacy and adverse reactions in the two groups were observed. Results After treatment of 1-6 weeks, the incidence rates of headache, dizziness and fatigue in the study group were 7.2%, 2.9% and 3.4% respectively, which were significantly lower than those in the control group(12.7%, 6.0% and 6.3%), the differences between the two groups were statistically significant(χ2=10.902, 7.412, 6.207, all P<0.05). The prevention rate of nausea and vomiting in the control group was 75.5%, which in the study group was 80.9%, and at delay period, the prevention rate of nausea and vomiting in the control group was 85.5%, which in the study group was 91.0%, the differences between the two groups were statistically significant(χ2=5.615, 9.442, all P<0.05). Conclusion Palonosetron and dexamethasone are effective in the treatment of nasopharyngeal carcinoma with cisplatin-induced nausea and vomiting, and can reduce the side effects of palonosetron. Key words: Palonosetron; Dexamethasone; Nausea; Vomiting; Nasopharyngeal neoplasms

Objective To observe the efficacy and adverse reactions of ubenimex combined with radiotherapy for the treatment of early nasopharyngeal carcinoma. Methods A total of 129 patients with early nasopharyngeal carcinoma who were admitted to the 163th Hospital of PLA, the Second Affiliated Hospital of Hunan Normal University from October 2013 to September 2016 were retrospectively analyzed. Three-dimensional conformal radiotherapy was used in the control group and ubenimex combined with three-dimensional conformal radiotherapy was taken in the study group. Radiation injury response, quality of life and therapeutic effects of patients in both groups were observed respectively. Results The fatigue incidence of the study group was lower than that of the control group (57.8 % vs. 75.4 %, χ2= 4.481, P= 0.034). Karnofsky score (χ2=6.345, P=0.042; χ2=6.382, P=0.041, respectively) and weight change (χ2=6.014, P= 0.049; χ2= 6.351, P= 0.042, respectively) had statistical differences in both groups in the end of radiotherapy and 3 months after radiotherapy. 1-year non-distant metastasis survival rate (92.2 %, 59/64) in the study group was significantly higher than that in the control group (80.0 %, 52/65) (χ2=3.989, P=0.046). Conclusion Ubenimex combined with radiotherapy for early nasopharyngeal carcinoma can improve the patients' quality of life, reduce the radiation injury response and increase the metastasis-free survival rate.

目的:探讨肺腺癌患者胸苷酸合成酶(TS)不同表达水平与放射敏感性的关系.方法:对经病理确诊的94例局部晚期肺腺癌患者,根据TS不同表达水平,将患者分为高表达组(40例)和低表达组(54例).对患者的肺部原发病灶行体部伽玛刀立体定向适形放射治疗,放疗结束后1个月复查胸部CT评价近期疗效.结果:全部患者均按计划完成治疗,两组近期疗效:高表达组:CR 3例,PR 27例,SD 7例,PD 3例,近期总有效率为75.0％[(CR+PR)/总病例数 ×100％];低表达组:CR 8例,PR 41例,SD 3例,PD 2例,近期总有效率为90.7％.两组近期疗效比较差异有统计学意义(P<0.05).结论:肺腺癌TS低表达组的放疗后近期疗效好,提示TS表达水平可能作为肺腺癌放射敏感性的标志物之一.

Objective:To evaluate the clinical efficacy and side reactions of TACE combined with body gamma knife radiotherapy for patients with huge hepatocellular carcinoma.Methods:38 cases of non-surgical treatment of huge hepatocellular carcinoma patients were treatment by TACE combined with body gamma knife radiotherapy.4 weeks after gamma knife treatment,hepatic CT or MRI examinations were performed to evaluate the efficacy.All patients were followed up and reexamined regularly.Results:Short-term effictive:complete remission in 0 cases,partial remission in 23 cases,stable disease in 12 cases,progress disease in 3 cases,and the short-term effective rate was 92.1％.The 1,3 and 5 years survival rate was 81.6％,10.5％ and 5.3％ respectively.The main adverse events were digestive tract reaction,myelosuppression and radioactive hepatitis.All of the patients were tolerable.Conclusion:TACE combined with body gamma knife radiotherapy for the treatment of patients with huge hepatocellular carcinoma has good effect with mild side reactions.

[目的]比较体部伽马刀和调强适形放射治疗(IMRT)技术对周围型非小细胞肺癌(NSCLC)实施放疗计划的剂量学特点.[方法]对11例NSCLC同时应用体部伽马刀和IMRT制定放射治疗计划,总剂量为66 Gy.计划标准为处方剂量至少覆盖95％的计划靶体积(PTV),各危及器官剂量均要求在耐受剂量范围内.通过靶区的等剂量分布、剂量体积直方图(DVH)以及适形指数(CI)和均匀指数(HI)等比较肿瘤靶区剂量和正常组织受照射剂量的差异.[结果]IMRT计划的CI和HI均优于伽马刀计划;伽马刀计划周围正常组织的剂量全肺的V5、V10、V20、V30均显著低于IMRT计划(P<0.05).伽马刀PTV最大剂量(Dmax)、平均剂量(Dmean)、最小剂量(Dmin)优于相应的IMRT指标,靶区剂量比IMRT计划要高(P<0.05).[结论]伽马刀治疗周围型的NSCLC可显著提高靶区剂量,同时很好地保护周围正常组织,在综合治疗中更有提高治疗增益比潜能.

[目的]比较肝动脉介入化疗栓塞(TACE)联合体部伽玛刀放疗与手术治疗大肠癌肝转移的疗效.[方法]本院70例可手术治疗的大肠癌肝转移患者,其中30例行TACE联合体部伽玛刀放疗(联合组),40例行手术治疗(手术组),比较两组患者的总生存期、复发转移率及副反应发生情况等.[结果]联合组与手术组3年总生存率,总复发转移率分别为86.7%,50.0%和87.5%,52.5%,两组相比较差异均无显著性(P>0.05).联合组与手术组C级以上严重并发症发生率分别为16.67%和25%,两组相比较差异均无显著性(P>0.05).[结论]TACE联合体部伽玛刀治疗大肠癌肝转移安全有效,效果不逊于手术治疗.

目的:检测miR-129成熟体miR-129-5p在人脑胶质瘤组织中的表达特点,探讨人脑胶质瘤组织中miR-129-2表达异常是否与miR-129-2启动子甲基化有关。方法:收集湘雅医院神经外科2013年10-12月收治的胶质瘤患者肿瘤组织21例、脑外伤患者非肿瘤脑组织标本21例。Real-time PCR检测脑胶质瘤组织和非肿瘤脑组织、脑胶质瘤细胞株和正常脑胶质细胞株中miR-129-5p的表达;甲基化特异性PCR（methylation-specific PCR,MSP）检测胶质瘤组织中miR-129-2基因启动子甲基化的情况;亚硫酸氢盐硫化测序PCR（bisulfite-sequencing PCR,BSP）分析经甲基化转移酶抑制剂5-氮杂-2’-脱氧胞苷（5-aza-2’-deoxycitydine,5-Aza-d C）处理后的胶质瘤细胞miR-129-2基因启动子甲基化水平的变化,同时Real-time PCR检测miR-129-5p的表达变化。结果:miR-129-5p在人脑胶质瘤组织和细胞中表达显著低于非肿瘤脑组织和正常脑胶质细胞（P＜0.05）,胶质瘤组织中miR-129-2基因的启动子甲基化率显著高于正常脑组织（P＜0.05）,使用5-Aza-d C去甲基化处理脑胶质瘤细胞后miR-129-2基因的启动子甲基化程度降低、miR-129-5p表达显著升高（P＜0.05）。结论:miR-129-5p在脑胶质瘤中显著低表达,miR-129-2启动子甲基化是导致其低表达的机制之一。

[目的]探讨替吉奥同步放疗并维持化疗治疗局部晚期胰腺的有效性和安全性.[方法]收集28例经病理证实或符合临床诊断标准的局部晚期胰腺癌患者.放疗方案为应用10MV-X,肿瘤大体靶区(GTV)为肿瘤组织和转移淋巴结,放疗剂量(DT)为50 Gy/25次(5周内),1次/日,同时予以替吉奥胶囊40～60 mg/d,1次/日(根据患者体表面积计算:＜1.25 m2,40 mg/d;≥1.25～1.5 m2,50 mg/d;≥1.5 m2,60 mg/d),共35 d,放化疗结束后2周开始予以替吉奥单药化疗80～120 mg/d,分2次服用(根据患者体表面积计算:＜1.25 m2,80 mg/d;≥1.25～1.5 m2,100mg/d;≥1.5 m2,120 mg/d),连续14 d,休息7d为1周期,口服化疗直至病情进展或不能耐受其毒性.用实体瘤疗效反应评价标准评价治疗效果,用美国国立癌症研究所的常规毒性判定标准评价毒副反应.[结果]共入组病例28例,其中26例患者按计划治疗直至病情进展,近期治疗有效率(CR+PR)为38.4％(10/26),肿瘤控制率(CR+PR+SD)为80.8％(21/26),临床获益率53.9％(14/26).随访提示中位无进展生存期和中位生存期分别为6.3个月和12.8个月,1年生存率为46.3％.治疗过程中最常见的毒副反应为1～2度血液学毒性,非血液毒副反应主要为恶心、食欲减退.[结论]替吉奥同步放疗并维持化疗治疗局部晚期胰腺癌安全,毒副反应轻,患者临床症状可得到改善,生存改善,是一种安全有效的治疗模式,但长期治疗效果及毒副反应有待进一步研究.

[目的]评价全脑放疗(WBRT)联合吉非替尼治疗表皮生长因子受体(EGFR)突变阳性肺腺癌脑转移的疗效.[方法]回顾性分析70例EGFR突变阳性肺腺癌脑转移患者的临床资料,根据经济情况及意愿分为观察组40例和对照组30例.观察组行WBRT同时口服吉非替尼250 mg,1次/天.对照组行WBRT同时口服替莫唑胺:150 mg/m2,d1～5,28 d重复,连续4个周期.分析比较两组患者近期疗效、无进展生存期、总生存期及治疗的毒副反应情况.[结果]治疗后第12周观察组和对照组的近期有效率分别为92.5％和70.0％,差异有统计学意义(x2 =6.110,P=0.013).观察组的中位无进展生存期和总生存期分别为16和27个月,对照组分别为7和13个月,差异均有统计学意义(均P=0.000).两组的Ⅲ～Ⅳ级毒副反应:观察组痤疮样皮疹6例,对照组为0例,差异有统计学意义.两组乏力、恶心呕吐、腹泻、骨髓抑制等发生率差异均无统计学意义.[结论]WBRT联合吉非替尼治疗EGFR突变阳性肺腺癌脑转移患者的近、远期疗效显著,副反应可以耐受.

Lung cancer is one of the most common but serious cancers in the world. Both the X-ray repair cross-complementing group 1 (XRCC1) gene and the human multidrug resistance 1 (MDR1) gene are important candidate genes influencing the susceptibility to various diseases, including lung cancer. This study aimed to assess the correlation of genetic polymorphisms in XRCC1 and MDR1 with the susceptibility to lung cancer. In this study, a total of 320 lung cancer patients and 346 cancer-free controls in Chinese population were enrolled in this study. Data about the clinical characteristics and related risk factors of lung cancer were collected by questionnaires. The single-nucleotide polymorphisms (SNPs) of XRCC1 and MDR1 genes were genotyped by created restriction site-polymerase chain reaction method. Our data showed that the risk for lung cancer increased significantly among the variant Arg194Trp (C > T, rs1799782) and Arg399Gln (G > A, rs25487) of XRCC1, but there are no significant differences in the allelic and genotypic frequencies of c.1564A > T and c.3073A > C of MDR1 between lung cancer patients and cancer-free controls. In conclusion, these preliminary results suggest that the C > T, rs1799782 and C > T, rs25487 of XRCC1 genetic variants might be used as molecular markers for detecting lung cancer susceptibility.

[Obj ective]To explore the relationship between epidermal growth factor receptor tyrosine kinase domain (EGFR-TKD)mutation and radiosensitivity in patients with lung adenocarcinoma.[Methods]A total of 3 6 lung adeno-carcinoma patients with EGFR-TKD mutation were selected as the observation group.A total of 24 patients without EG-FR-TKD mutation were selected as the control group.Three-dimensional conformal radiotherapy was performed in prima-ry lung lesions of patients in 2 groups.Chest CT reexamination was performed 1 month after radiotherapy and used to e-valuate the short-term efficacy.[Results]All patients completed the treatment smoothly.In the observation group,1 0 patients were complete remission(CR),and 24 patients were partial remission(PR),and 2 patients were stable,and no one was developed,and the short-term total effective rate(CR+PR)was 94.4%.In the control group,7 patients were complete remission(CR),and 1 0 patients were partial remission(PR),and 6 patients were stable,and 1 patient was de-veloped,and the total short-term effective rate was 70.8%.There was significant difference in the short-term efficacy be-tween two groups(P<0.05).[Conclusion]Lung adenocarcinoma patients with EGFR-TKD mutation have better short-term efficacy.It suggests that EGFR-TKD mutation is an important indicator of predicting radiosensitivity.

[Objective]To evaluate the clinical efficacy and side reactions of three-dimensional conformal radiotherapy combined with S-1 for elderly patients with locally advanced rectal cancer .[Methods]Thirty eld-erly patients with locally advanced rectal cancer receiving nonsurgical therapy were treated by three-dimensional conformal radiotherapy combined with S-1 sequential chemotherapy orally for 4 weeks .Three-dimensional con-formal radiotherapy scheme was 90% ~95% prescribe dose 3~4Gy once for 5 times per week ,the total dose of 36~40Gy and biological effective dose of 46 .8~50 .4Gy .S-1 scheme was S-1 40mg/m2 twice a day for 4 successive weeks and rest for 2 week as a cycle .Colonoscopy and other examinations 4 weeks after chemother-apy were used for evaluating the efficacy .All patients were followed up and reexamined regularly .[Results]Among all patients ,10 patients were complete remission ,and 17 patients were partial remission ,and 2 pa-tients were stable ,and 1 patient was progressive ,and the short-term effective rate was 90 .0% .The 1 ,2 and 3-year survival rate was 100% ,86 .7% and 63 .3% ,respectively .The main side reaction was lower digestive tract response .Grade III toxicities occurred in 2 patients ,and grade I~II toxicities occurred in other patients .[Conclusion]Three-dimensional conformal radiotherapy combined with S-1 sequential chemotherapy for the treatment of elderly patients with locally advanced rectal cancer has good effect with mild side reactions .

Objective:To study the effect of body gamma knife synchronous assistance chemotherapy for locally advanced non-small cell lung cancer(NSCLC).Methods:All 60 patients with NSCLC were treated with gamma knife.Results:All 60 patients completed the planned dose therapy.CR was 28.3%,PR 60%,the total effective rate(CR+PR) 88.3%,1-year survival(OS) 56.7%.The main adverse reactions were myelosuppression and gastrointestinal reactions.Conclusion:Sequential chemotherapy with body gamma knife treatment on locally advanced non-small cell lung cancer is effective,toxicity can be tolerated.

Objective:To observe the short-term effects and adverse effects of induced chemotherapy and concurrent chemotherapy and radiotherapy in patients with local advanced nasopharyngeal carcinoma.Methods:Sixty-two cases treated by chemotherapy plus concurrent chemotherapy and radiotherapy were retrospectively analyzed.Results:All 62 patients completed the planned dose therapy.After induction chemotherapy the improvement response rate was 77.4%.Nasopharyngeal,cervical lymph node improvement response rate was 92.8%.3 months after treatment improvement response rate was 100%.Cervical lymph node improvement response rate was 100%.Over the concurrent chemotherapy treatment period,37.1% of patients had grade III mucositis.After 1-year the survival rate was 90.3%.Conclusion:Induction chemotherapy plus concurrent radiotherapy and chemotherapy was effective for patients of locally advanced nasopharyngeal carcinoma in the short term.Acute toxicity during treatment was significantly decreased when patients completed a full treatment.

[目的]探讨替莫唑胺联合三维适形术后放疗治疗高级别脑胶质细胞瘤(HGG)的疗效及安全性.[方法]回顾性分析46例经手术病理证实的HGG的临床资料,其中间变型星形细胞瘤26例,多形性胶质细胞瘤20例.使用6MV-X线进行局部扩大野照射,放疗范围包括原瘤体及周围水肿区域,并外放2～3 cm,DT 60 Gy/30F,每日1次,每周5次,连续6周,放疗期间每日口服替莫唑胺75 mg/(m2·d).放疗结束4周后,继续给予替莫唑胺标准5d方案辅助化疗6个周期,每周期28 d.第1周期用量150 mg/ (m2·d),连用5d,无明显血液毒性后,从第2周期起剂量增至200 mg/(m2·d).Kaplan-meier方法计算生存率.[结果]46例患者的中位疾病无进展生存时间为7.8个月(95％CI,6.0～9.6个月),中位生存时间为14.3个月(95％CI,8.4～20.2个月),6个月、1年的疾病无进展生存率分别为80.4％和52.2％.1年、2年的总生存率分别为60.9％和21.7％.替莫唑胺不良反应发生率低,以轻度血液毒性为主.[结论]替莫唑胺联合三维适形术后放疗治疗加后续单药辅助化疗治疗HGG较单纯放疗临床疗效好,且安全、治疗耐受性好.

目的观察替莫唑胺联合全脑放疗治疗非小细胞肺癌及脑转移的疗效、生存时间及不良反应。方法回顾分析32例非小细胞肺癌脑转移患者,全脑放疗剂量DT 40 Gy,常规分割,1次/d,每周5次,放疗期间口服替莫唑胺75mg/(m2.d),放疗结束后4周,继续给予替莫唑胺标准5d方案辅助化疗,最多6个周期,每周期28d。第1周期用量150mg/(m2.d),连用5d,无明显血液毒性后,从第2周期起剂量增至200mg/(m2.d)。Kaplan-Meier方法计算生存率。结果近期治疗有效率90.6%,其中完全缓解率28.1%(9/32),部分缓解率62.5%(20/32),中位总生存时间为9.2个月,中位无疾病进展时间为6个月,1年生存率为21.0%,治疗的不良反应轻,患者能耐受。结论替莫唑胺联合全脑放疗治疗非小细胞肺癌脑转移有较好的临床疗效,患者对治疗可耐受。

Objective To study the prevalence of lung cancer in patients with solitary pulmonary nodule and to analyze the related factors of lung cancer .Methods One hundred and seventeen patients with solitary pulmona-ry nodules have been diagnosed by surgery ,biopsy and sputum pathology .CT scans of the patients were analyzed retrospectively .Related data was analyzed by using Logistic regression analysis .Results The number of lung cancer in these patients was 91 (77.8% ) .The relevant factors of lung cancer were age ,male ,smoking history , history of malignancy ,spiculation ,lobulation ,pleural indentation ,vascular convergence sign ,air bronchogram , vacuole sign ,nodular intrinsic and spinous sign .Conclusion Solitary pulmonary nodule is benign or malignant . Relevant factors of images is related to lung cancer .

目的 观察体部伽玛刀序贯化疗治疗局部晚期非小细胞肺癌的近期疗效及不良反应.方法 回顾性分析2007年12月—2009年1月我科收治的60例局部晚期非小细胞肺癌行体部伽玛刀序贯化疗治疗的临床资料.结果 60例患者全部完成了计划剂量治疗,治疗结束后3个月完全缓解(CR)者占28.3％,部分缓解(PR)者占60％,总有效者(CR+PR)占88.3％,1年生存率(OS)为56.7％.主要不良反应为骨髓抑制和消化道反应.结论 体部伽玛刀序贯化疗治疗局部晚期非小细胞肺癌近期疗效高,毒副反应小.