目的 探讨淋巴瘤化疗致弥漫性肺损伤的临床特点、诊断、治疗，加强对该病早期诊断、早期治疗的认识。 方法 对6例化疗后急性弥漫性肺损伤的淋巴瘤患者临床资料进行分析，并复习国内外相关文献。 结果 化疗药物可引起急性弥漫性肺损伤，在化疗1~7个周期时出现，6例患者均以发热为首发症状，2例同时出现干咳，5例在发热后出现气促，肺部CT表现为双肺弥漫性磨玻璃样影，激素治疗效果好，甲基泼尼松龙40~120 mg治疗有效。 结论 化疗药物相关的弥漫性肺损伤早期诊断十分重要，发热为常见首发症状，早期使用糖皮质激素是治疗的关键。

目的：探讨中枢神经系统血管周细胞瘤的临床特点及其治疗方法。方法回顾分析14例中枢神经系统血管周细胞瘤患者的临床资料，随访5～100个月，并进行文献复习。结果14例患者均行手术，术后病理明确诊断。肿瘤全切除8例，大部切除3例，部分切除3例。肿瘤复发7例（50％，4例为全切除，1例大部切除，2例为部分切除，术后均未曾放疗），中位复发时间39个月，全切术后中位复发时间41．5个月，未全切除中位复发时间17个月。复发后再次手术及术后放疗仍可获得较长时间生存。结论血管周细胞瘤诊断依赖于病理，目前手术及术后放疗是较好的治疗办法，手术切除的完整性尤为重要。

Objective To analyze the effect of intensity-modulated radiotherapy(IMRT) on nasopharyngeal carcinoma.Methods Eighty-nine patients with nasopharyngeal carcinoma(14 at stage Ⅰ,46 at stage Ⅱ,28 at stage Ⅲ,and 1 at stage Ⅳ a) admitted to our hospital from October 2007 to October 2010 underwent IMRT at the dose of 60-65Gy for the gross tumor volume(PTV) of nasopharyngeal carcinoma,which was increased to 70-75Gy according to the reduced PTV of nasopharyngeal carcinoma.The dose of IMRT was 65-70Gy,52Gy,36.5Gy,47.2Gy or 43.4Gy,40.1Gy or 39.6Gy,and 30Gy,respectively,for nasopharyngeal carcinoma at middle and low neck,supraclavicular area,brainstem and spinal cord,left or right optic nerve,left or right parotid,and 50% of parotid.Results The median follow-up time of patients was 34 months.Local or lymph nasopharyngeal carcinoma reoccurred in 7 patients.The 1-and 2-year local recurrent rate of nasopharyngeal carcinoma was 2.2% and 6.7%,respectively.The 1-,2-and 3-year survival rate of the patients was 98.9%,96.6% and 93.2%,respectively.The main acute reactions in the patients were radiation injury of oral mucosa,bone marrow suppression and xerostomia.Radiation injury of oral mucosa at gradesⅠ,Ⅱ and Ⅲ accounted for 19.1%,49.4% and 31.4%,respectively.Bone marrow suppression at gradesⅠ,Ⅱ and Ⅲ was 47.2%,16.9% and 20.2%,respectively.No sequel of radiation cerebral injury was observed in all patients.Conclusion IMRT can achieve satisfactory dose distribution in different areas of nasopharyngeal carcinoma and improve its local control rate and 2-and 3-year survival rate,and is thus a standard treatment modality for nasopharyngeal carcinoma.

目的:比较常规分割放疗方案与大分割放疗方案治疗骨转移癌疼痛的疗效。方法:选择骨转移癌60例,随机分为观察组32例和对照组28例。观察组采用常规分割放疗方案,每次2 Gy,每周5次,总照射剂量40 Gy;对照组采用大分割放疗方案,每次3 Gy,每周3次,总照射剂量30 Gy。比较两组疗效。结果:观察组完全缓解(CR)率75.0%,部分缓解(PR)率18.8%,总有效率93.8%;对照组CR率67.9%,PR率21.4%,总有效率89.3%。两组总有效率比较,差异不显著(P>0.05)。结论:常规分割与大分割放疗方案治疗骨转移癌疼痛疗效相近。

Objective To investigate the effects of three-dimensional conformal radiotherapy for local recurrence of esophageal carcinoma.Methods Clinical data about 52 patients with local recurrence of esophageal carcinoma were retrospectively analyzed.Of the 52 patients,12 had local recurrence of esophageal carcinoma in anastomosis,35 had local recurrence of esophageal carcinoma accompanying mediastinal lymphatic metasrasis,and 5 local recurrence of esophageal carcinoma accompanying supraclavicular lymphatic metastasis.The patients were received three-dimensional conformal radiotherapy with a total radiation dose of 55-66Gy.Results The total effective rate of three-dimensional conformal radiotherapy was 73.1% for local recurrence of esophageal carcinoma.The 1-and 2-year survival rate was 51.9% and 25%,respectively.The symptom-ameliorated rate was 88.6%.Conclusion Three-dimensional conformal radiotherapy is effective against local recurrence of esophageal carcinoma after operation and can prolong the survival time of esophageal carcinoma patients.

瘢痕疙瘩是皮肤在创伤愈合过程中产生的过度结缔组织,范围常超出原创面,若不积极治疗,病灶不断扩大,给患者生理和心理均带来极大的困扰.我院2005年1月-2009年12月对67例瘢痕疙瘩患者采用手术联合放射治疗(放疗)方法进行治疗,并与44例单纯放疗的疗效进行比较,报告如下.

Objective: Several prospective multicenter studies have demonstrated high safety efficacy for mesial temporal lobe epilepsy (TLE) with Gamma Knife radiosurgery using 24 Gy at the margin. In this paper we reported the long-term outcome of 7 patients with TLE treated with very low-dose linear accelerator (LINAC) based fractionated stereotactic radiotherapy (FSRT). We also discussed the feasibility of LINAC for TLE.Methods: To record the treatment process, outcomes and side effects for 7 patients with TLE treated with low-dose LINAC, whose marginal dose of all cases was 12 Gy at the 85% isodose line, and post-FSRT seizure frequencies were compared with those of patients pre-FSRT. One special case (case 6) was reported in detail.Results: Reduction of seizure frequency post-FSRT was 50% in 2 cases, 30% in 1 case, and 0% in 2 cases, and seizure frequency increased more than 100% in 2 cases. No patient was seizure free at the last follow up. 2 cases presented transitory complications and 2 cases showed an obvious drop in IQ, memory decline and permanent neurologic complications, including partial aphasia and mild hemiplegia in 1 case, progressive ataxia and cognition decline in another case.Conclusion: Outcome of TLE treated by very low-dose LINAC based FSRT was poor because of mild reduction in seizure attack frequency and serious complications. (C) 2010 Elsevier B.V. All rights reserved.

目的 观察原发性颞叶癫痫经定向适形放射治疗后的近期疗效和长期随访结果,探讨适形放射治疗是否适用于原发性颞叶癫痫.方法 自2003年4月～2004年12月间收治了11例原发性颞叶癫痫病人,以64-v-EEG的检查确定癫痫灶区域;同时经过MRI、脑磁图(MEG)、PET-CT等调整癫痫灶靶区的范围,用Win-MRT-TPS优化治疗方案,以85%～90%等剂量计算,立体定向适形放疗隔日治疗1次,每次600cGY,共2次,总量1200 cGY.病人随访3～5年,每次检查MRI、64-V-EEG,部分病人加查脑磁图(MEG)和PET-CT以评定疗效.结果 治疗后患者症状逐渐缓解,6个月缓解5例,6～12个月缓解4例,2例未见效果.治疗后1年效果满意、显著改善、良好者9例,总有效率81.8%(9/11),3年77.8%(7/9),5年83.3%(5/6).治疗后5例病人出现脑水肿,2例病人轻微头疼、恶心.7例病人局灶性脱发.结论 适形放射治疗原发性颞叶癫痫患者后部分疗效良好,随访期内未发现明显不良反应,提示该方法是一种微刨、有效的治疗方法.

病例介绍 患者,女,66岁.入院前一周感胸背部疼痛,束带感,同时伴左下肢无力,麻木,踏棉花感,不能站立,于2006年月12月19日收治入院.查体:脊柱后凸畸形,T8棘突压痛明显,伴叩击痛,活动明显受限;T8平面以下感觉迟钝,触觉、位置觉存在;腹壁反射,膝腱反射,跟腱反射未引出.

Objective To investigate the treatment effects of low dose sterotactic radiotherapy for primary temporal lobe epilepsy.Methods 13 patients of primary temporal lobe epilepsy were treated two times(once every two days) by sterotactic radiotherapy with a total dose of 12Gy according to WinMRT-TPS treatment method.All patients had a follow-up period of 3-5 years.Results 6 patients had reduced seizure freguency in 6 months after treatment 5 patients had reduced seizure freguency in 6-12 months and 2 patients had no efficacy.The efficient rate was 84.6%(11/13) one year after treatment,80.0%(8/13) 3 years after treatment,71.4%(5/7) 5 years after treatment,respectively.After treatment 7 patients had transient brain edema,3 patients had slight headache and nausea,and 9 patients had local lose hair.Conclusion Low dose sterotactic radiotherapy is safe and effective for primary temporal lobe epilepsy.This modality is minimal invasive and effective.

Objective To study stereotaxic photon knife with low doses for the therapy of primary epilepsy and evaluate its efficacy. Methods Patients with primary epilepsy, who did not want to take anti-epilepsy drugs continuously and regularly, were included in therapeutic group. After the epileptic focus was located through video electroencephalography, radiation with a total dose of 12 Gy was applied to the epileptic region by the stereotaxie photon knife. The general condition matched patients who received regular valproate therapy from out-patient department were selected as controls, and the controlled patients vs. the therapeutic ones were pair-matched (1:1). Results All of the patients were followed up for 12-37 months. No abnormal reaction to radiotherapy or other complication was documented. As for the outcome, one case got to Engel Class I after radiation, two to Class II, six to Class III, and two to Class IV. There existed a statistical difference when they were compared with those of the control group. Conclusion The effectiveness of non-destroyed and local radiation on epilepsy focus is satisfactory in part of the patients. No obvious side effect was found during the follow-up period. That is to say, this modality is minimally invasive and effective.

Objective To explore low-dose stereotaxic radiotherapy for primary epilepsy originally and evaluate the efficacy of this modality. Methods The patients with primary epilepsy who do not want to continuously and regularly take the anti-epilepsy drugs were included in therapeutic group. After the epileptic focus was located through video electroencephalography, the total dose of 12Gy radiation was applied by the stereotaxic photon knife on the epileptic region. The general condition matched patients from out-patient department were selected as control, and the controlled patients vs, the therapeutic one is 2:1. Results All of the patients were followed up for 12~37 months. During this period, no any abnormal reactions to radiotherapy or other complications was documented. One case was in Engel Class Ⅰafter radiation, two were in Engel Class Ⅱ, six were in Engel Class Ⅲ,and two were in Engel Class Ⅳ.There exists a statistical difference compared with the control group. Conclusions The effectiveness of non-destroyed and regional radiation on epilepsy focus is satisfactory in part of the patients. No obvious side effect was found during the follow-up period. That is to say, this modality is minimal invasive and effective.

BACKGROUND Three dimensional conformal radiotherapy is one of the important treatment methods for patients aged 65 and older with inoperable non-small cell lung cancer (NSCLC). The aim of this study is to evaluate the efficacy of three dimensional conformal radiotherapy in elderly patients with inoperable NSCLC. METHODS Thirty-one patients aged 65 and older with stage II and III NSCLC were treated by three dimensional conformal radiotherapy. Clinical effects, survival rates and pulmonary toxicity were analyzed. RESULTS The overall response rate (CR+PR) was 87.1% (27/31). The 1, 2 and 3-year survival rates were 83.9% (26/31), 51.6% (16/31), and 25.8% (8/31) respectively. The relation of treatment efficacy and tumor size was observed. Acute radiation pneumonitis occurred in 3.2% (1/31) of the patients. Radiation pulmonary fibrosis occurred in 19.4% (6/31) of the patients. CONCLUSIONS Three dimensional conformal radiotherapy is a safe and effective treatment for elderly patients with inoperable NSCLC and has a high survival rate.

皮肌炎的发生、发展、转归和恶性肿瘤有一定的相关性。现就皮肌炎的发生、与肿瘤消长的关系、诊断及预后作一综述。