目的 探讨新辅助化疗结合同步放化疗治疗中晚期宫颈癌的临床疗效及对患者预后的影响.方法 选取2014年3月至2019年3月间收诊的80例中晚期宫颈癌患者,根据治疗方式的不同展开分组,其中对照组40例采用同步放化疗治疗方式,观察组40例在进行1至2疗程新辅助化疗后结合同步放化疗治疗,观察两组治疗结束后临床疗效、不良反应、生活质量评分.结果 接受新辅助化疗后同步放化疗的观察组,治疗后总有效率高于对照组,两组间比较差异显著(P<0.05);不良反应比较中,两组骨髓抑制、消化道反应、发热、脱发等不良反应率无差异(P>0.05);血清指标HPV-E6值水平较对照组更低,差异显著(P<0.05);生活质量比较中,观察组患者行干预后生理机能、躯体功能、社会功能、情感职能显著提升,较对照组差异明显(P<0.05).结论 为中晚期宫颈癌患者实施新辅助化疗与同步放化疗结合,可改善中晚期宫颈癌患者血清指标水平,且未明显增加不良反应,提高临床疗效及生活质量,应用效果较好,值得推广.

Objective To investigate the clinical characteristics and risk factors for various radiation pneumonitis after three-dimensional radiotherapy in esophageal carcinoma patients. Methods A total of 229 esophageal carcinoma cases with radiation pneumonitis after three-dimensional radiotherapy were included in this retrospective analysis. Then a comparative study was carried out to compare the differences between the clinical symptoms, treatment model and dosage in the patients with various radiation pneumonitis. Results 89 cases showed radiation pneumonitis, among which the number of cases with grade 1, 2 and 3 radiation pneumonitis was 52, 32 and 5, respectively. No cases showed grade 4 or 5 radiation pneumonitis. No statistical differences were noticed in the age, sex, T stage, N stage, TNM stage and GTV between the cases with various radiation pneumonitis (P＞0.05). Statistical differences were observed in the grade of radiation pneumonitis in the cases received radiochemotherapy compared with those only received radiotherapy (P＝0.006). The radiation dosage and three dimensional technique showed no effects on the severity of radiation pneumonitis (P＞0.05). Significant differences were observed in the mean lung volume, V5, V10, V15, V20 and V30 in those of various radiation pneumonitis (P＜0.05). Conclusion The severity of radiation pneumonitis in the esophageal cancer patients is correlated with the concomitant chemotherapy and radiation dosage.

Objective To investigate the adverse effects and clinical efficacy of the intensive modulated radiotherapy (IMRT)and intravaginal brachytherapy combined with versus without chemotherapy in elderly patients with cervical cancer,and to analyze its prognostic factors.Methods Clinical data and follow-up results of 214 patients with cervical cancer aged ≥60 years undergoing IMRT and intravaginal brachytherapy combined with or without chemotherapy were retrospectively analyzed.The overall survival(OS) rate was calculated by using the Kaplan-Meier method.Prognostic factors were analyzed by Log-rank single factor test and Cox multivariate analysis.Results The rates of myelosuppression(≥grade 3)was higher in the concurrent chemo-radiotherapy group than in simple radiotherapy group(48.6％％ vs.15.8 ％,x2 =27.372,P ＜ 0.05).The complete response (CR)rate was higher in the concurrent chemo-radiotherapy group than in the simple radiotherapy group (83.0％ vs.68.3％,x 2=5.993,P=0.014).The 1-,3-and 5-year OS rate were 92.2 ％,79.3 ％ and 65.6 ％,respectively in all patients.Univariate analysis showed that the staging,lymph node metastasis status,pathological type and short-term efficacy of cervical cancer (based on FIGO guideline)were influencing factors for the prognosis (x2 =4.321-30.316,all P ＜ 0.05).Multivariate analysis showed that the FIGO staging,lymph node metastasis status and short-term efficacy were independent influencing factors for the prognosis(x2 =5.284-14.261,all P＜0.05).Conclusions The intensive modulated radiotherapy and intravaginal brachytherapy combined with chemotherapy have a good efficacy and favorable long-term survival rate for the treatment of cervical cancer in elderly patients,and its major adverse effects can be tolerated.The FIGO staging,lymph node metastasis status and short-term efficacy are independent influencing factors for the prognosis in elderly patients with cervical cancer.

目的 食管癌是我国常见恶性肿瘤,临床工作中不少老年患者不能耐受手术和化疗而选择单纯放疗作为其根治方式.本研究通过观察老年食管癌患者放疗的毒副作用和长期疗效,探讨高血压或糖尿病对放射性食管和肺损伤的影响,分析其预后影响因素.方法 收集2008-01-04-2017-11-30苏州大学附属第一医院放疗科、江阴市人民医院放疗中心、泰州市人民医院肿瘤科和常州市第二人民医院放疗科4个中心收治的接受单纯放疗≥70岁食管鳞癌患者359例,其中伴2型糖尿病患者59例,高血压147例.分析糖尿病或高血压与放射性食管和肺损伤的关系,Kaplan-Meier法计算生存率(overall survival,OS),Log-rank法行预后单因素分析和Cox法行预后多因素分析.结果 糖尿病和无糖尿病患者≥3级放射性食管炎和放射性肺炎的发生率分别为15.3％和5.7％、16.9％和1.7％,差异均有统计学意义,χ2值分别为6.746和28.761,均P<0.05.高血压和无高血压患者≥3级放射性食管炎和放射性肺炎发生率分别为10.9％和4.7％、8.2％和1.4％,差异均有统计学意义,χ2值分别为4.915和9.873,均P<0.05.全组患者完全缓解率(complete response,CR)和部分缓解率(partial remission,PR)分别为63.0％和32.6％,总有效率(CR+PR)为95.6％.全组1、3、5年生存率分别为76.7％、42.1％和25.3％,中位生存时间26.9个月(95％CI:22.2～31.7个月).选择性淋巴结照射野(elective node irradiation,ENI)和累及野(involved field irradiation,IFI)照射总复发率、野外复发率分别为18.07％、1.20％和16.66％、3.26％,两组差异均无统计学意义,χ2值分别为0.089和0.991,均P>0.05.单因素分析显示,影响老年食管癌三维技术放疗预后的因素有肿瘤T分期、N分期、TNM分期、PS评分、近期疗效、肿瘤部位和放疗剂量.Cox多因素分析显示,TNM分期、近期疗效、PS评分和肿瘤部位是影响生存期的独立预后因素.结论 老年食管癌伴糖尿病或高血压为患者发生≥3级放射性食管和肺损伤的易感因素.老年患者进行IFI放疗不影响预后,TNM分期、近期疗效、PS评分和肿瘤部位是影响生存期的独立预后因素.

Objective To observe the long-term prognosis and analyze the predictive factors of esophageal cancer patients treated with three-dimensional radiotherapy.Methods A total of 373 patients with esophageal squamous carcinoma who received three-dimensional radiotherapy were retrospectively enrolled in this study.Among these,231 cases received three dimensional conformal radiotherapy (3D-CRT) and the other 142 received intensity modulated radiotherapy (IMRT);202 cases received radiotherapy alone,and the other 171 received chemoradiotherapy;249 cases received involved-field irradiation(IFI),and the other 124 received elective nodal irradiation(ENI);60 cases received a total radiation dose of 50-60 Gy,and the other 313 received 60-70 Gy.Kaplan-Meier method was used to calculate the overall survival (OS) and progression-free survival (PFS).The Logrank single factor analysis and Cox multivariate analysis were used to evaluate predictive factors of PFS and OS.Results The 1-,3-,5-year OS and PFS were 69.4％,33.7％,22.9％ and 63.8％,32.8％,22.4％,respectively.The median OS and PFS were 22.7 months (95％ CI 18.6-25.4 months) and 19.2 months (95％ CI 16.7-21.3 months) respectively.Univariate analysis showed that age,gender,tumor location,three-dimensional technology (3D-CRT vs.IMRT),chemotherapy,prophylactic irradiation to lymphatic drainage area and irradiation dose did not influence OS and PFS (P ＞ 0.05).T-stage,N-stage,TNM-stage and gross tumor volume (GTV) were significantly correlated to OS and PFS (x2 =5.836-14.526,P ＜ 0.05).The multivariate analysis showed that N-stage and GTV were independent predictive factors of OS and PFS (x2 =5.345-12.216,P ＜0.05).The OS and PFS of patients with two fields of lymph node metastases were worse than those with only one lymph node field metastasis (x2 =4.467,4.169,P ＜ 0.05).Conclusions The long-term efficacy for esophageal cancer patients could be significantly improved through 3D-CRT technology.N-stage and tumor volume were independent prognostic factors of OS and DFS.The number of lymph node metastasis field is significantly related to prognosis.

Objective To compare the clinical effects, side effects and cosmetic effects of two radiotherapy techniques sequential boost radiotherapy and simultaneous integrated boost radiotherapy after breast conserving surgery for early breast cancer. Methods From January 2014 to May 2017 in Jiangyin People's Hospital, 96 patients with early breast cancer after breast conserving surgery were included in this study. The patients were randomly divided into sequential boost radiotherapy group (49 cases) and simultaneous integrated boost radiotherapy group (47 cases). In sequential boost radiotherapy group, 49 patients received 25 fractions of 2.0 Gy for the total breast during 5 weeks following 5～8 fractions of 2.0 Gy for local tumor bed in 1～1.5 weeks. In simultaneous integrated boost radiotherapy group, 47 patients received 25 fractions of 2.0 Gy for the total breast and 2.4 Gy for local tumor bed during 5 weeks. We investigated the side effects, cosmetic effects and long-term survival. Results The incidence rates of acute skin reaction, late skin reaction, bone marrow suppression and radiation pneumonia were not statistically significant between the sequential boost radiotherapy group and simultaneous integrated boost radiotherapy group (P＞0.05). No significant differences were observed in terms of cosmetic effect between the sequential boost radiotherapy group and simultaneous integrated boost radiotherapy group before, after and 1 year after radiotherapy (P＞0.05). Patients were followed up for 12 to 50 months. The median follow-up time was 29 months and the follow-up rate was 100%. All patients were healthy and survived during the follow-up period. Conclusion The efficacy of sequential boost radiotherapy was similar to that of simultaneous integrated boost radiotherapy after breast conserving surgery for early breast cancer. The simultaneous integrated boost radiotherapy is acceptable with similar cosmetic effect from that sequential boost radiotherapy for early patients after breast conserving surgery, and the treatment time and cost can be significantly reduced.

Objective To investigate the risk factors for acute radiation esophagitis andpneumonitis after radiation therapy in esophageal cancer (EC) patients with diabetes or hypertension.Methods A total of 373 EC patients receiving three dimensional conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) were included in this study.Among these patients,42 showed concurrent with diabetes and 99 with hypertension.Radiation esophagitis or pneumonitis in patients with or without diabetes,and with or without hypertension were monitored in the 1-year follow up,respectively.Results The prevalence of grade 1,2,3 and 4 radiation esophagitis in diabetes and non-diabetes patients was 40.5％,38.1％,14.3％,4.8％ and 66.2％,27.8％,2.7％,1.8％,respectively,while that of the grade 1,2 and 3 radiation pneumonitis in diabetes and non-diabetes patients was 31.0％,16.7％,9.5％ and 30.8％,15.7％,1.2％,respectively.The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with diabetes and was significantly higher than those with non-diabetes (x2 =13.573,12.279,P ＜ 0.05).The prevalence of grade 1,2,3 and 4 radiation esophagitis in hypertension and non-hypertension patients was 49.5％,38.4％,8.1％,3.0％ and 68.2％,25.5％,2.6％,1.8％,respectively,while that of the grade 1,2 and 3 radiation pneumonitis in hypertension and non-hypertension patients were 30.3％,18.2％,5.1％ and 31.0％,15.0％,1.1％,respectively.The prevalence of grade 3 or above radiation esophagitis and pneumonitis in patients with hypertension was significantly higher than those with non-hypertension (x2 =5.695、5.422,P ＜ 0.05).Diabetes is an independent risk factor for grade 3 or above acute radiation esophagitis and pneumonitis.Conclusions Diabetes or hypertension might be risk factors for severe radiation esophagitis and pneumonitis in EC patients receiving radiation therapy.

Objective To compare the prognostic factors and adverse effects of elderly patients with esophageal cancer between radiotherapy alone and concurrent chemoradiotherapy. Methods A total of 479 patients with esophageal squamous cell carcinoma aged 70 years or older were analyzed retrospectively at our institute, from January 2008 to December 2017. The patients were divided into radiotherapy alone group ( 359 cases ) and concurrent chemoradiotherapy group ( 120 cases ) . After Propensity Score Matching ( PSM) , data from matched patients with 102 cases in each group was analyzed. The overall survival (OS) rates, the prognostic factors and adverse effects were assessed. Results The 1, 3, 5-year of OS in radiotherapy alone group after PSM were 77. 4％, 40. 1％, 22. 7％, respectively, and median overall survival time (mOS) was 26. 9 months (95％ CI:18. 7 - 35. 2 months). The chemoradiotherapy group after PSM were 79. 5％, 47. 6％, 35. 7％ and 35. 6 months (95％ CI:23. 2-48.0 months), respectively, while there was no significant difference between the groups (P >0. 05). Subgroup analysis showed that the 1, 3, 5-year of OS and mOS of the patients aged 70 -75 years in radiotherapy alone group were 79. 4％, 41. 0％, 26. 2％ and 29. 2 months, respectively. The patients aged 70-75 years in chemoradiotherapy group were 86. 5％, 56. 1％, 47. 6％ and 48. 9 months, respectively. There was statistically significance between the groups after PSM(χ2 =4. 746, P<0. 05). The univariate prognostic analysis showed that the age, T stage, N stage, clinical stage, short-term efficacy and performance status were influencing factors for OS (χ2 =6. 714-42. 900, P<0. 05). The clinical stage and short-term efficacy were independent prognostic factors for OS (χ2 =5. 007 -9. 181, P<0. 05). In addition , the risk of non-tumor related death of the patients aged 75 years or older in the chemoradiotherapy group was higher than those in the radiotherapy alone group(χ2 =5. 630, P<0. 05). The prevalence of toxicities (≥grade 3) including bone marrow suppression, radiation esophagitis and radiation pneumonia in the chemoradiotherapy group were higher than that in the radiotherapy alone group (χ2 =4. 701 -28. 318, P<0. 05). Conclusions Concurrent chemoradiotherapy, compared with radiotherapy alone, may improve the prognosis of patients aged 70-75 years with esophageal squamous cell carcinoma.

Objective To assess the long-term efficacy and adverse effects of three-dimensional radiotherapy (3-DCRT) for elderly patients with esophageal cancer,to investigate the effects of diabetes and hypertension on radiation esophagitis and pneumonitis and to analyze the prognostic factors.Methods A total of 233 patients aged 70 or over with esophageal squamous cell carcinoma were treated with 3-DCRT,and 27 of the patients had type-2 diabetes and 63 had hypertension.Radiation esophagitis and pneumonitis were monitored in patients with or without diabetes and in patients with or without hypertension.Potential prognostic factors were analyzed by Logrank single factor analysis and Cox multivariate analysis.Results The incidences of radiation esophagitis and pneumonitis in grade 3 or over were significantly higher in patients with diabetes than in those without diabetes (Z =-3.762,-2.972;P ＜0.001,0.003).The incidences of radiation esophagitis and pneumonitis in grade 3 or over in patients with hypertension were significantly higher than in those without hypertension (Z =-2.610,-2.209;P =0.009,0.027).The 1-,3 and 5-year overall survival (OS) rates were 70.6％,35.8％ and 23.9％,respectively.The median OS was 23.0 months (95％CI:18.6-27.5).Univariate analysis showed that age (x2 =4.274,P =0.039),T stage (x2=9.376,P 0.025),N-stage (x2=8.504,P=0.014),TNM stage (x2=7.806,P=0.020),gross tumor volume (GTV) (x2 =5.209,P =0.022) and short-term therapeutic efficacy (x2 =25.276,P＜0.001) had influenced OS.Multivariate analysis showed that T-stage (P =0.001),N-stage (P =0.007),TNM stage (P =0.002) and short term therapeutic efficacy (P ＜ 0.001) were independent prognostic factors for OS.Conclusions 3-DCRT achieves favorable long-term efficacy in elderly patients with esophageal cancer.Diabetes and hypertension are potential risk factors for radiation esophagitis and pneumonitis.T-stage,N-stage,TNM stage,and short term therapeutic efficacy are independent prognostic factors.

Objective To systematically compare the efficacy of three-dimensional conformal radiotherapy (3D-CRT) versus intensity-modulated radiotherapy (IMRT) in the treatment of prostate cancer (PCa).Methods Clinical comparative studies of IMRT and 3D-CRT in the treatment of PCa were collected from PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), and Wanfang Data after two independent researchers developed the strategy and inclusion and exclusion criteria for the literature search.Articles published up to February 2017 were searched for, and the languages of publications were restricted to English and Chinese.Clinical meta-analysis of the data from the relevant studies was performed using the RevMan5.3 software.Results A total of 15 relevant retrospective cohort studies were collected from the databases in strict accordance to the search strategy and inclusion and excluding criteria.There were 4608 PCa patients, including 2229 in the IMRT group and 2379 in the 3D-CRT group.IMRT and 3D-CRT had similar adverse effects in terms of early-stage (odds ratio[OR]=0.77, 95% confidence interval[CI]:0.43-1.40, P=0.390) and late-stage (OR=0.75, 95%CI:0.55-1.04, P=0.080) urinary tract injury.However, IMRT led to reduced early-stage (OR=0.47, 95%CI:0.27-0.82, P=0.008) and late-stage (OR=0.52, 95%CI:0.35-0.78, P=0.001) intestinal injury compared with 3D-CRT.Meanwhile, the biochemical recurrence-free survival rate was also significantly higher in the IMRT group than in the 3D-CRT group (OR=1.87, 95%CI:1.51-2.32, P=0.000).Conclusions IMRT is more protective against intestinal injury with a higher biochemical recurrence-free survival rate compared with 3D-CRT during the treatment of PCa.

Objective To observe efficiency and toxicity of whole brain simultaneous integrated boost intensity-modulated radiotherapy in patients with 3 or more multiple brain metastases tumor.Method Total of 56 patients with 3 or more multiple brain metastases tumor were randomly divided into therapy group and control group,The therapy group was treated with whole brain simultaneous integrated boost intensity-modulated radiotherapy; the control group was treated with whole-brain radiotherapy (WBRT).Result The efficiency in therapy group and control group came to 89.29% and 60.71% respectively (P=0.031); 3 months local control in therapy group and control group came to 96.43% and 89.29% respectively, without showing significant difference between the two groups; For 6~12 months local control, the therapy group (92.86% and 78.58%) was significantly higher than the control group (60.71% and 21.43%); For acute side effects, there was no statistically significant difference between the two groups.Conclusion For patients with 3 or more multiple brain metastases tumor, whole brain simultaneous integrated boost intensity-modulated radiotherapy can improve the therapeutic efficiency and the local control of 6~12 months, and the patients toleraated, it should be popularized in clinic.

[ABSTRACT]Objective:To study the effect of radiotherapy on serum SCC,CEA,CRFRA21-1,TAG72,CA1 99 and lymphocyte subsets in patients with esophageal squamous cell carcinoma.Methods:A total of 60 patients with esophageal squa-mous cell carcinoma in our hospital from January 2013 to January 201 6 were selected as experiment group and 40 healthy sub-jects were selected as control group.Patients in experiment group were treated with 6MV X-ray radiation therapy.Serum SCC, CEA,CRFRA21-1,TAG72,CA1 99 and the cell percentage of peripheral blood CD4 + ,CD8 + were compared in control group and the experimental group before and after 1 month radiotherapy.Results:Before treatment,the levels of serum SCC,CEA and CRFRA21-1 in the experimental group were significantly higher than those in the control group (P <0.05 );After treat-ment,the levels of serum SCC,CEA and CRFRA21-1 in the experimental group were significantly lower than those before treatment,but the experimental group patients were significantly higher than those in the control group (P <0.05);There was no significant difference between the experimental group and the control group in the level of serum TAG72 and CA1 99 before treatment,and there was no significant difference in the serum levels of TAG72 and CA1 99 before and after radiotherapy in the experimental group (P >0.05).Before treatment,the cell percentage of peripheral blood CD4 + ,CD8 + and the ratio of CD4 +/CD8 + in experimental group was significantly lower than that of the control group,the percentage of peripheral blood CD8 + in the experimental group was significantly higher than that in the control group (P <0.05 );Compared with before treatment, there was no statistically significant difference after treatment in the cell percentage of peripheral blood CD4 + ,CD8 + and the ratio of CD4 +/CD8 + in experimental group (P >0.05),and in the experimental group,the proportion of CD4 + cells and the tatio of CD4 +/CD8 + in peripheral blood was significantly lower than that of the control group,the proportion of CD8 + was significantly higher than that of the control group (P <0.05 ).Conclusions:Radiotherapy can significantly reduce the serum SCC,CEA,CRFRA21-1,TAG72 and CA1 99 levels of the patients with esophageal squamous cell carcinoma,but have less in-fluence on the T lymphocyte subsets.

Objective:To evaluate the influence of general chemotherapy combined with local radiotherapy in the treatment of patients with extensive stage small cell lung cancer (ES-SCLC).Methods:Retrospective analysis the clinical data of 46 patients with ES-SCLC,and their clinical characters and survival outcomes were compared according to whether they received local treatment for me-tastases,radiotherapy for primary nidi and prophylactic cranial irradiation (PCI).Results:The median survival time (MST)in patients with single and multiple local radiotherapy and those without local radiotherapy for metastases was 12.1 months,18.5 months and 9.5 months respectively.The MST in patients with local treatment in limited time and selective time and those without local radiotherapy for metastases was 10.7 months,15.8 months and 9.1 months respectively,and it was significant difference when compared with the overall survival (OS)(P<0.01).MST in patients with radiochemotherapy and single chemotherapy was 13.7 months and 8.7 months respec-tively.MST in patients with and without PCI was 18.4 months and 10.1 months respectively,and there was significant difference in the comparison with overall survival (OS)(P<0.01).Cox multivariate regression analysis showed that local treatment for metastases,ra-diotherapy for primary nidi and application of PCI were protective independent prognostic factors for patients with ES-SCLC (P<0. 01).Conclusion:On the basis of systemic chemotherapy,the local treatment of chemotherapy,primary radiotherapy and PCI can pro-long the survival of patients with ES-SCLC.

目的：观察并比较早期乳腺癌患者保乳术后行调强放疗与常规放疗的临床效果。方法回顾性分析2010年12月—2013年12月来我院进行诊治的62例Ⅰ期、Ⅱ期乳腺癌患者的临床资料，分为对照组和观察组。观察组34例，于保乳术后行调强放射治疗；对照组28例，于保乳术后行常规放射治疗，治疗后随访2年，观察并统计2组患者的急性放射性皮肤反应发生率、局部控制率、无瘤生存率以及远处转移率。结果观察组1级急性皮肤反应发生率为91.2%，2级为8.8%；对照组1级急性皮肤反应发生率为67.9%，2级为32.1%，2组比较差异均有统计学意义（P<0.05）。对照组患者的局部控制率为96.4%、无瘤生存率96.4%、远处转移率0%，观察组患者的局部控制率为97.1%、无瘤生存率97.1%、远处转移率2.9%，2组比较差异均无统计学意义（P>0.05）。结论与常规放疗相比，对早期乳腺癌患者行保乳术后使用调强放疗，局部控制率、无瘤生存率、远处转移率均无明显差异，但2级急性放射性皮肤反应发生率显著降低。

Objective:To explore the effect of injection of triglyceride content in coix seed on 3D-CRT combined with gemcitabine of locally advanced pancreatic carcinoma.Methods:The patients with locally advanced pancreatic carcinoma were randomly divided into treatment group and control group,treated with gemcitabine(800mg/m2,iv,d1,d8,d15,28 days as a cycle,for 2 cycles) and concurrent 3D-CRT[45-50Gy/(25f·5weeks)].The treatment group were also treated with injection of triglyceride in coix seed(100ml/d,iv,d1-21,28 days as cycle,for 2 cycles).Results:The break time of treatment in treatment group was(1.52±0.48) days,significantly lower than(3.42±1.02) days in control group(P=0.000).The chemotherapy completion rate in treatment group was 56.5%,significantly higher than 25.0% in control group(P=0.028).The improvement of symptoms in treatment group was 82.6% significantly higher than 54.1%in control group(P=0.037).For 1-year and 2-year survival rate,there was no statistically significant difference between the two groups.The median overall survival and median progress free survival in treatment group were 17.2 months and 8.6 months,significantly higher than 12.4months and 5.2months in control group(P=0.047,P=0.040).Conclusion:The injection of triglyceride content in coix seed can improve 3D-CRT combined with gemcitabine concurrently tolerance of locally advanced pancreatic carcinoma.

食管癌在我国发生率和死亡率居第4位,病理90%以上为鳞状细胞癌,对放射线较敏感.放射治疗是目前治疗食管癌主要的、有效的手段之一,三维适形放疗技术(3DCRT)能够提高肿瘤靶区剂量,并使周围正常组织得到保护.本组33例食管癌选择3DCRT后取得较好的疗效.

目的 空肠内营养支持配合三维适形放疗治疗恶性肿瘤幽门梗阻的疗效.方法 将31例晚期各种恶性肿瘤引起的幽门梗阻患者随机分组,分为治疗组及对照组,治疗组予以在胃镜下经鼻空肠喂养管置入术行空肠内营养支持;对照组予以肠外营养,两组均针对幽门部病变行适形放疗,95％PTV 45-50Gy/25-28Fx;观察营养状况及生活质量、生存期.结果 治疗组:营养状况及生活质量较支持前提高,患者依从性高.对照组:营养状况及生活质量较支持前下降,不良反应发生率高,患者依从性低.两组生存期有差异(P＜0.05).结论 恶性肿瘤幽门梗阻患者在胃镜下三腔鼻空肠喂养管置入术后行空肠内营养支持配合三维适形放疗治疗能改善患者营养状况及生活质量,依从性高,生存期延长.

目的观察尼妥珠单抗联合顺铂同步放化疗治疗中晚期鼻咽癌的近期疗效及不良反应。方法选取26例初治病理确诊局部晚期鼻咽癌患者,均采用调强适形放射治疗,同时给予尼妥珠单抗联合顺铂同步化疗。放疗之日起给予尼妥珠单抗200 mg,静脉滴注,每周1次,共6次;同时给予顺铂40 mg/m2,静脉滴注,每周1次,共6次。参照实体瘤疗效评价标准(RECIST)评价近期疗效,参照CTC 3.0标准评价不良反应。结果 26例患者均可评价疗效,治疗后完全缓解(CR)23例(88.5%),部分缓解(PR)2例(7.7%),肿瘤稳定1例(3.8%),总有效率(CR+PR)96.2%。急性不良反应主要为白细胞减低,其次为皮肤、黏膜反应及消化道反应,患者均可耐受,未影响后继治疗。结论尼妥珠单抗联合顺铂同步放化疗治疗局部晚期鼻咽癌患者,近期疗效确切,不良反应轻微,患者可耐受。

目的 探讨胆管支架置入联合放疗治疗恶性梗阻性黄疸(阻黄)的临床效果.方法 回顾2009年8月至2010年12月我院收治的已失去手术机会并成功接受PTCD治疗的恶性阻黄患者45例,单纯放置胆管支架25例(对照组),联合放疗20例(观察组).观察两组黄疸改善、复发、生存及并发症情况.结果 两组治疗1 w和2 w时TB和DB水平均较治疗前显著下降(P＜0.05),两组比较差异无统计学意义(P＞0.05)；观察组支架堵塞时间、复发时间及生存时间均明显晚于对照组,差异有统计学意义(P＜0.05)；观察组未发生并发症,对照组出现3例.结论 相比单纯胆管支架置入,胆管支架置人联合放疗治疗恶性阻黄能有效延缓支架堵塞时间和黄疸复发时间,减少并发症,延长生存时间,值得临床推广应用.