目的:比较ⅢC期宫颈癌采用淋巴结清扫术和延伸野根治性放疗的近期疗效和副作用.方法:回顾性分析我院2017年1月至2020年10月收治的ⅢC期宫颈癌患者56例,26例行腹主动脉旁淋巴结清扫术+宫颈病灶根治性放射治疗;30例直接采用延伸野根治性放射治疗,分析比较两组的近期疗效,放射性并发症.结果:采用淋巴结清扫术组的患者近期疗效较好,对比延伸野放疗组差异有统计学意义(P<0.05).放射性肠炎的发生率也明显低于延伸野放疗组(P<0.05).放射性膀胱炎、骨髓抑制和延伸野放疗比较,差异无统计学意义(P>0.05).结论:对于ⅢC期宫颈癌患者,采用淋巴结清扫联合宫颈病灶根治性放射治疗近期临床疗效好,并发症少.

目的 探讨采用3D打印技术制作的阴道多通道个体化模型塞插植治疗宫颈癌的近期疗效.方法 2013年11月至2015年8月收治的30例宫颈癌患者接受常规腔内治疗(ICBT),作为ICBT组,2015年9月至2016年10月收治的26例宫颈癌患者接受3D打印插植治疗(3DP-ISBT),作为3DP-ISBT组.比较两组患者的剂量学结果[高危临床靶体积(HR-CTV)D90和膀胱、直肠、乙状结肠D2cc],并评价近期疗效.结果 肿瘤直径5～6 cm、肿瘤直径≥7 cm、阴道侵犯﹥2/3及有宫旁侵犯的3DP-ISBT组宫颈癌患者HR-CTV D90均明显高于ICBT组患者,差异均有统计学意义(P﹤0.01).3DP-ISBT组患者直肠、乙状结肠的D2cc均低于ICBT组,差异均有统计学意义(P﹤0.05).3DP-ISBT组患者1年肿瘤局部控制率为86.2％,高于ICBT组的58.3％,差异有统计学意义(P﹤0.05).治疗期间无严重不良反应.结论 与传统腔内治疗相比,3D打印多通道个体化阴道模型塞插植治疗宫颈癌具有更好的剂量学优势,且近期疗效较好,但长期疗效及不良反应还需要进一步评估.

目的:观察中药阴道冲洗治疗放射性阴道炎的临床疗效.方法:选取2016年2月-2018年8月于甘肃省肿瘤医院行根治性放射治疗的宫颈癌患者300例,按随机数字表法分为观察组(中药煎剂冲洗组)和对照组Ⅰ(1/90洁尔阴洗液冲洗组),对照组Ⅱ(1/5000～8000)高锰酸钾溶液冲洗组),各100例.观察比较三组防治放射性阴道炎的临床疗效.结果:观察组治愈率、总有效率均高于对照组Ⅰ、对照组Ⅱ,差异有统计学意义(P<0.05).结论:中药汤剂阴道冲洗治疗放射性阴道炎疗效显著,值得推广应用.

目的 比较分析Ⅱb～Ⅲb期宫颈癌腔内联合宫旁插植近距离治疗计划中的3种优化方法的剂量学差异.方法 选取Ⅱb～Ⅲb期宫颈癌患者33例,对每例患者制订3种计划,分别为手动优化组、模拟退火逆向计划优化算法(IPSA)组、混合逆向计划优化算法(HIPO)组.比较3组计划中高危临床靶区(HR-CTV)的体积剂量参数V150、V100、D100、D90、均匀性指数(HI),以及危及器官(直肠、膀胱、乙状结肠)的剂量参数D0.1 cm3、D1 cm3、D2 cm3.结果 IPSA组和HIPO组的V150、V100均低于手动优化组,HI均高于手动优化组,HIPO组的V100高于IPSA组,差异均有统计学意义(P﹤0.05).IPSA组和HIPO组直肠、膀胱、乙状结肠的D0.1 cm3、D1 cm3和D2 cm3均低于手动计划组,差异均有统计学意义(P﹤0.05);HIPO组直肠、膀胱的D0.1 cm3、D1 cm3和D2 cm3均低于IPSA组,差异均有统计学意义(P﹤0.05).结论 对于局部晚期宫颈癌腔内联合宫旁插植技术,基于3组优化方法的计划均能满足临床需求.HIPO计划和IPSA计划能提高靶区剂量覆盖;HIPO计划较IPSA计划可以进一步提高靶区的V100和HI指数,同时减少膀胱和直肠的受量.

目的:探讨注射聚乙二醇重组人粒细胞集落刺激因子(PEG-rhG-CSF)治疗宫颈癌化疗所致中性粒细胞减少症的有效性和安全性.方法:筛选2016年1月-2018年12月来甘肃省肿瘤医院进行宫颈癌治疗的女性患者162例,随机分成对照组和治疗组.对照组79例,平均年龄为(38.7±3.6)岁;治疗组83例,平均年龄为(41.2±4.3岁).2组皆进行同步放化疗,对照组患者化疗24 h注射重组人粒细胞集落刺激因子(rhG-CSF),治疗组患者化疗24 h后注射聚乙二醇重组人粒细胞集落刺激因子(PEG-rhG-CSF);2组患者化疗后定期复查血常规,检查骨髓抑制差异、中性粒细胞绝对值随时间变化差异、化疗延迟率及不良反应发生率.结果:治疗组给药后12～144 h中性粒细胞数与增殖率,化疗第一周期中性粒细胞数减少、白细胞减少方面均有显著差异(P＜0.05);治疗组中性粒细胞数绝对值在不同时间点高于对照组,在给药第5、10天有显著性差异(P＜0.05);另外治疗组的化疗延迟人数少于对照组(P＜0.05);2组不良反应无显著差异(P＞0.05).结论:PEG-rhG-CSF在治疗宫颈癌同步放化疗中有较好的疗效和安全性.

目的 探讨腔内联合宫旁插植治疗(IC/ISBT)和腔内后装治疗(ICBT)对局部晚期宫颈癌的临床疗效.方法 选取经体外照射放疗(50 Gy/25 f)后肿瘤消退不明显且宫旁受侵的局部晚期(ⅡB～ⅢB期)宫颈癌患者100例.采用随机数字表法将患者分为ICBT组和IC/ISBT组,每组50例.然后进行CT,将图像传至Oncentra Brachy Therapy计划系统,行靶区勾画,采用模拟退火逆向优化方式进行计划设计,比较ICBT组和IC/ISBT组患者的近期疗效、肿瘤复发或转移率、并发症发生率.结果 IC/ISBT组患者的完全缓解(CR)率为96.0％,高于ICBT组的88.0％,差异有统计学意义(P﹤0.05);IC/ISBT组患者的客观缓解率(ORR)为98.0％,高于ICBT组的92.0％,差异有统计学意义(P﹤0.05).IC/ISBT组患者的肿瘤复发或转移率为4.0％,低于ICBT组的16.0％,差异有统计学意义(P﹤0.05).IC/ISBT组患者放射性皮炎的发生率为38.0％,与ICBT组的42.0％比较,差异无统计学意义(P﹥0.05);IC/ISBT组患者放射性直肠炎的发生率为14.0％,低于ICBT组的32.0％,差异有统计学意义(P﹤0.05);IC/ISBT组患者放射性膀胱炎的发生率为30.0％,与ICBT组的28.0％比较,差异无统计学意义(P﹥0.05).结论 对外照射后肿瘤消退不明显、宫旁受侵的局部晚期宫颈癌患者采用IC/ISBT治疗方式,可取得较好的宫旁控制率和近期疗效,且能够降低放射性直肠炎的发生率,值得临床推广应用.

目的 比较局部晚期宫颈癌三维近距离治疗3D打印阴道多通道个体化施源管与常规施源器剂量学差异,观察疗效及毒副反应.方法 50例初治局部晚期宫颈癌行近距离根治性放射治疗,其中25例患者行3D打印多通道施源器(3DP-ISBT组),25例患者采用传统施源管(ICBT组).比较2组患者的HR-CTV剂量分布,评价危及器官的剂量分布、近期疗效与毒副反应.结果 3DP-ISBT、ICBT组近距离HR-CTV D90分别为(87±7)、(76±16)Gy.组间比较,3D打印多通道个体化施源管较常规施源器剂量分布更合理,且差异有统计学意义(P＜0.05).膀胱D2cc3DP-ISBT组为(81±8)Gy,ICBT组为(86±17)Gy;直肠D2cc3DP-ISBT组为(72±10)Gy,ICBT组为(79±14)Gy.组间比较,3D打印多通道个体化施源管患者放射性膀胱炎及放射性直肠炎发生率均低于常规施源器,且差异均有统计学意义(P＜0.05).结论 3D打印个体化施源管与传统常规施源器行腔内放射治疗相比剂量分布更加合理,降低正常组织受量有明显优势,具有疗效好、毒副反应轻的特点.

目的:分析EBT3胶片对X射线的响应特性,研究一种应用EBT3胶片的剂量校准新方法,并探讨使用剂量校准新方法完成调强放射治疗剂量验证的方法及过程.方法:胶片剂量校准时,引入净光密度,将胶片扫描后的像素值转化为净光密度,再由净光密度转换为剂量值的校准.运用该方法验证了1例用于测试治疗计划系统计算精度的调强放射治疗计划.结果:EBT3胶片对MV级X射线的剂量响应呈非线性关系.通过引入净光密度这一新的剂量校准方法可以很好地去除由胶片和扫描过程引入的误差.使用这一新的胶片剂量校准方法进行剂量验证,结果显示在3 mm/3％条件下,Gamma通过率大于98％.结论:使用EBT3胶片剂量校准新方法能更精确地得到胶片测量的剂量分布,使胶片测量更为方便,该方法可以在临床推广使用.

通过锥形束计算机断层扫描(Cone beam computed tomography,CBCT)在线校准与非在线校准所得误差数据,推导出两个不同的计划靶区(Planning target volume,PTV)外放边界,分别设计计划,分析不同外放边界对靶区及危及器官的剂量学差异.推导计算可知,未行CBCT在线校准PTV的外放边界X、Y、Z方向分别为5.50、9.89、5.83 mm,行CBCT在线校准PTV的外放边界X、Y、Z方向分别为3.73、5.16、4.36 mm;两种不同外放所得膀胱及直肠的V30、V40、V50、Dmean,小肠的V20、V30、V40、V50、Dmean,盆骨髓的V10、V20、V30、V40、V50、Dmean,左右股骨头的V50、Dmean均有显著的统计学差异(p<0.05);临床靶区(Clinical target volume,CTV)的D2、D5、D50、Dmean及均匀性指数(IH)、适形度指数(IC)均有显著的统计学差异(p<0.05);行CBCT在线校准若PTV外放过大,危及器官的受量将明显偏高,未行CBCT在线校准若PTV外放过小,靶区受量将明显欠量.使用CBCT在线校准技术可以大幅度减小摆位误差,提高摆位精度,同时PTV外放边界应需和行CBCT在线校准与否密切联动,以避免靶区欠量及危及器官受量偏高的现象,保证治疗质量.

Objective To analyze and compare dosimetric differences between pencil beam convolution (PBC) algorithm and anisotropic analytical algorithm (AAA) in designing intensity-modulated radiotherapy plans for postoperative patients with cervical cancer. Methods Based on Eclipse treatment planning system, PBC algorithm and AAA were separately used to design intensity-modulated radiotherapy plans for 30 postoperative patients with cervical cancer, and the corresponding verification plans were also generated. The dosimetric parameters of target areas and organs-at-risk were compared. Results Statistical differences were found in the dosimetric parameters of target areas calculated with two different algorithms, including the D5％, D50％, D95％, D98％, Dmean of target areas, and the homogeneity index of planning target volume and conformity index of clinical target volume (P<0.05). The comparison of calculated organs-at-risk dose revealed that differences in V30, V40, Dmean of rectum and bladder, the V10, V20, V30, Dmean of small intestine, the V10, V20, V30, V40, V50, Dmean of marrow, the V20, V30, V40, V50, Dmean of the right femoral head and the V20, V30, V50, Dmean of the left femoral head were statistical significant (P<0.05), and that except for the V40 of the right and the left femoral head and the V50 of rectum, the other reference indexes calculated with PBC were lower than those calculated with AAA. The comparison of verification plans of two algorithms didn't showed any statistical differences. Conclusion Although both AAA and PBC algorithm are conformed to the clinical requirement, some significant dosimetric differences between PBC and AAA are existed. Compared with AAA, PBC algorithm overestimates the dose of target area which is in high-dose region, and underestimates the dose of organs-at-risk which is in low-dose region.

目的:探讨微小RNA-126(miR-126)增强胃癌细胞放射敏感性的分子生物学机制.方法:体外培养胃癌SGC-7901细胞,通过转染miR-126模拟序列上调细胞内的miR-126水平,使用RT-qPCR及Western blot检测miR-126上调后zeste基因增强子同源物2(EZH2)的mRNA及蛋白水平的变化.双萤光素酶报告基因实验确认miR-126与EZH2的靶向结合关系.在上调miR-126水平的同时,通过共转染pcDNA3.1-EZH2真核表达质粒提高细胞内的EZH2表达,CCK-8法及流式细胞术分析照射后胃癌细胞的活力及凋亡率的变化,从而评估EZH2过表达对miR-126放射增敏作用的影响.结果:上调胃癌SGC-7901细胞中的miR-126水平可以显著抑制EZH2的mRNA及蛋白水平(P<0.05).双萤光素酶报告基因实验提示miR-126与EZH2的mRNA间存在直接靶向关系.与仅上调miR-126的细胞相比,上调miR-126水平的同时过表达EZH2水平,将导致照射后SGC-7901细胞的活力增加,凋亡率减少(P<0.05).结论:对EZH2靶向抑制是miR-126增强胃癌SGC-7901细胞放射敏感性的机制之一.

目的:探讨组织间插植在宫颈残端癌、阴道残端复发癌放疗中的近期疗效.方法:对35例诊断明确的宫颈残端癌、阴道残端复发癌行组织间插植放疗联合经典的体外照射及近距离腔内照射的模式,观察近期疗效及不良反应.结果:35例宫颈残端癌、阴道残端复发癌放疗结束评价疗效,达到完全缓解30例患者(85.7％),部分缓解5例患者(14.3％),治疗有效率可达100％.观察不良反应:35例患者均出现了不同程度的骨髓抑制,其中30例患者(85.7％)出现1～3级骨髓抑制,5例患者(14.3％)出现3～4级骨髓抑制.22例患者(62.9％)出现1～3级急性放射性直肠炎症状,15例患者(42.9％)出现1～3级急性放射性膀胱炎症状,但未出现3级以上的急性放射性副反应.结论:组织间插植对于宫颈残端癌、阴道残端复发癌是一种有效的治疗方式,可明显提高局部控制率高、完全缓解率、部分缓解率,且无严重的近期不良反应发生,具有很好的治疗可行性,相对安全可靠.

目的:探讨局部中晚期宫颈癌放射治疗前后的MRI表现,评价MRI在宫颈癌放疗前后的临床价值.方法:对122例局部中晚期宫颈癌分别进行放射治疗前后MRI检查,对肿瘤大小、信号,宫旁受侵、盆腔淋巴结等进行对比.结果:122例患者中,肿瘤明显缩小或消失106例,轻度缩小16例,肿瘤总体信号降低109例,信号不均匀13例,淋巴结缩小或消失48例.宫颈癌放射治疗前后与宫旁组织对比,观察内容均清晰.结论:MRI检查对宫颈癌放射治疗疗效及预后评价具有重要意义.

目的:观察中药热奄包在局部中晚期宫颈癌同步放化疗中的临床疗效.方法:将我院2015年4月至2016年3月住院宫颈癌患者100例随机分为观察组(同步放化疗联合中药热奄包组)54例,对照组(单纯同步放化疗组)46例,观察两组治疗前后下消化道毒性反应及生活质量状况.结果:观察组治疗后毒性反应发生率(59.3％)低于对照组(100.00％),差异具有统计学意义(P＜0.05);观察组治疗后卡氏评分高于治疗前,差异有统计学意义(P＜0.05);对照组治疗前后卡氏评分差异无统计学意义(P＞0.05);观察组治疗后卡式评分明显高于对照组,差异有统计学意义(P＜0.05).结论:中药热奄包可以明显减轻中晚期宫颈癌患者同步放化疗后下消化道毒性反应,提高患者生存质量,值得临床推广应用.

目的:探讨高能电子线治疗瘢痕瘤的疗效及其影响因素.方法:选取2000年至2014年间甘肃省肿瘤医院及甘肃省人民医院放疗科收治的可随访瘢痕瘤患者206例,均采用6MeV或9MeV电子线源皮距照射技术放射治疗,分析其临床疗效及影响因素.结果:206处瘢痕瘤患者电子线治疗有效率为90.3％,瘢痕长度、瘢痕面积、术后开始放疗时间、术后放疗方式、瘢痕部位与电子线疗效有关;多因素分析显示瘢痕部位、术后开始放疗时间为影响电子线疗效的因素.结论:高能电子线是治疗瘢痕瘤的有效手段,术后开始治疗时间,瘢痕治疗面平坦是该法治疗效果的重要影响因素.

目的:分析局部晚期直肠癌单药卡培他滨与XELOX方案术前新辅助同步放化疗的疗效及不良反应.方法:对2008年至2012年经病理诊断Ⅱ-Ⅲ期直肠腺癌患者进行研究,共计60例.A组术前采用单药卡培他滨同步放化疗治疗,B组采用双药奥沙利铂联合卡培他滨同步放化疗治疗,比较两组治疗效果.结果:A组术后有16例患者降期,B组18例降低分期;经新辅助治疗后病理学检测显示,A组pCR率为26.7%,B组30%;随访20个月,两组OS率分别为91.2%,92.4%,DFS率分别为69.5%和63.3%;以上差异均无统计学差异(P>0.05).A组腹泻11例低于B组18例;A组胃肠道反应10例低于B组22例;A组血液学毒性6例低于B组15例,以上差异均具有统计学意义(P<0.05).结论:局部晚期直肠癌同步放化疗单药卡培他滨化疗疗效良好.

AIM: To investigate the influences of microRNA-126 on the curative effect of chemoradiotherapy and radiosensitivity of SGC-7901 cells.METHODS: The patients of gastric cancer (n=60) were selected in this study including 32 males and 28 females with the average age of (51±7) years.All patients received similar chemoradiotherapy strategy.The tissue and blood samples were collected during treatment.The short-term curative effect was evaluated by the Response Evaluation Criteria in Solid Tumors (RECIST), and the patients were divided into sensitive group and insensitive group.The microRNA-126 levels were detected by RT-qPCR.The SGC-7901 cells were maintained in vitro and transfected with microRNA-126 mimic.The plate colony formation assay was used to determine the enhancement effect of microRNA-126 on radiosensitivity of the SGC-7901 cells.The apoptotic rate of the SGC-7901 cells induced by microRNA-126 was analyzed by flow cytometry.RESULTS: According to the RECIST, 28 cases were defined as sensitive patients and 32 cases were the insensitive patients.Compared with the sensitive patients, the microRNA-126 levels both in blood and tissue samples were lowered in the insensitive patients, and the relative fold changes were 0.72±0.04 and 0.48±0.03, respectively (P<0.05).After transfection with microRNA-126 minic, the SF2 and D0 in the SGC-7901 cells were decreased with the SER of 1.74.Furthermore, microRNA-126 induced apoptosis of SGC-7901 cells and enhanced their radiosensitivity.CONCLUSION: The patients with low microRNA-126 level may suffer a poor curative effect of chemoradiotherapy on the gastric cancer.MicroRNA-126 has an enhancement effect on the radiosensitivity to the SGC-7901 cells.

Objective To analysis the status of interstitial brachytherapy(ISBT) treatment of cervical cancer and compare the application of different ISBT modes.Methods The databases of PubMed,EMBASE,Web of Science,Cochrane Library(2015.Issue 12),Chinese Biomedical Literature Database (CBM),China National Knowledge Infrastructure (CNKI) and Wanfang were searched from the starting to December 31st,2015.The clinical studies on ISBT were comprehensively collected.Articles were screened by two reviewers and the process of extraction was done by pre-designed table including general characteristic and radiation-related clinical features.Results A total of 85 studies were included,35 in English and 50 in Chinese.24.7％(21/85) were clinical controlled studies.The first authors in English studies were mainly from America (13/35) and India (6/35),while those in the Chinese articles were mainly from Guangzhou (10/50)and Jiangsu(7/50) of China.Chinese articles were from 43 journals and only 18.0％(9/50) were included by CSCD.The reporting of follow-up time,feature of ISBT and treatment guided methods was incomplete.Most studies (60/68) used high dose rate (HDR) brachytherapy,and 11 modes were applied.The mode of 5.5-6Gy per fraction and 5-6 fractions twice a day were used by transperineal ISBT in 32％(8/25) of English studies,but 53.1％(17/32) of Chinese studies used 6-12Gy per fraction and 1-3 fractions weekly by barehanded ISBT.Conclusion The reporting of ISBT on cervical cancer is still incomplete,especially in Chinese studies.The number of controlled trial is small.The modes of ISBT are various and non-standard.It has significant differences in ISBT dose,template and anesthesia.

Objective:To evaluate the clinical value of oncoplastic technique in breast conservation surgery.Meth-ods:Clinical data of 87 breast cancer patients who received oncoplastic surgery from January 2010 to June 2011 were retrospectively analyzed.The breast incision was disigned based on the diameter and the location of tumor.Many meth-ods were used to repair breast defects,one was volume displacement procedure,the other was volume replacement pro-cedure.Objective evaluation and subjective satisfaction survey were assessed 1 year after operation.Results:The me-dian age of the patients was 47 years(range 29 to 66 years).The average diameter of tumors was 2.4 cm(range 1.0 to 5.0cm).Choice of operation method:11 were batwing mammaplasty,8 were peri -areolar mammaplasty,18 were inferior pedicle inverted -T mammaplasty,12 were upper pedicle inverted -T mammaplasty,8 were medial mamma-plasty,13 were lateral mammaplasty,2 were J -mammaplasty,9 were lateral thoracoaxillar fat tissue flap and 6 were inframammary adipofascial flap.The rate of positive surgical margin was 8.0%.The rate of complication was 4.6%. Cosmetic outcome:The objective satisfaction rate was 86.2%,subjective satisfaction rate was 88.5%.The mean fol-low -up period was 54 months(range 38 to 60 months).The local recurrence rate was 5.7%.5 -year overall survival rate was 94.3%.Conclusion:Breast oncoplastic techniques can get a satisfactory cosmetic appearance.

[目的]研究血清S100B蛋白在诊断颅内恶性肿瘤患者放射性脑损伤中的作用.[方法]计算机检索中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库、PubMed、Embase和The Cochrane Library,纳入S100B蛋白与放射性脑损伤关系的研究,并用RevMan5.2软件进行统计分析.[结果]共纳入5篇研究,Meta分析结果显示:接受放疗患者的S100B水平均高于脑胶质瘤患者和脑转移瘤患者的S100B水平(P＜0.05);接受放疗总剂量5000cGy患者S100B阳性人数少于接受放疗总剂量7000cGy患者S100B阳性人数(P＜0.05);普通放疗患者的S100B水平高于三维适形或调强放疗,差异有统计学意义(P＜0.05).[结论]血清S100B蛋白可作为颅内恶性肿瘤放射性脑损伤诊断的较早期监测指标.