Objective:To evaluate the efficacy and safety of simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) for rectal cancer with lateral lymph node metastasis (LLNM).Methods:From January 2016 to December 2022, 103 rectal cancer patients with LLNM were enrolled. The patients were divided into SIB-IMRT group (52 cases) and conventional chemoradiotherapy (CRT) group (51 cases) using the random number table method. The dose was 50 Gy for the pelvis with 60 Gy of SIB-IMRT for the LLNM in the SIB-IMRT group. The dose was 50 Gy for the pelvis in the CRT group. The primary endpoint was the lateral recurrence rate. The efficacy and adverse reactions of the two groups were compared.Results:The adverse reactions and surgical complications after neoadjuvant radiotherapy were comparable between the two groups. The response rates of LLNM treatment were 76.9% and 56.9%, respectively, in the two groups ( χ2=4.69, P=0.03). The SIB-IMRT group and CRT group had a local recurrence rate of 7.7% and 25.5% ( χ2=5.92, P=0.015), respectively, and a lateral recurrence rate of 3.8% and 23.5% ( χ2=8.49, P=0.004), respectively. Univariate analysis showed that the SIB-IMRT, short axis of lateral lymph nodes <5 mm after radiotherapy, and negative result in the postoperative lymph node pathological examination were factors associated with lateral recurrence. Multivariable regression analysis demonstrated that the SIB-IMRT ( HR=6.42, 95% CI: 1.40-29.49) and short axis of lateral lymph nodes <5 mm after radiotherapy ( HR=0.17, 95% CI: 0.04-0.66) were independent factors associated with lateral recurrence. The two groups had a 3-year disease-free survival of 73.25% and 62.6% ( P>0.05), respectively, and a 3-year overall survival of 87% and 82.5% ( P>0.05), respectively. Conclusions:The SIB-IMRT is safe and effective for rectal cancer with LLNM. The short axis of lateral lymph nodes <5 mm after neoadjuvant radiotherapy and SIB-IMRT is an independent risk factor for lateral recurrence.

目的 观察结直肠癌患者外周血和癌组织中Vδ1 T和Vδ2 T细胞比例和功能的变化,探讨其在结直肠癌发生、发展中的作用.方法 收集衢州市人民医院20例健康体检者(对照组)外周血,以及20例结直肠癌患者(癌症组)外周血和癌组织,通过流式细胞术检测对照组外周血,以及癌症组外周血、癌旁组织和癌组织Vδ1 T和Vδ2 T细胞的比例;通过抗体扩增能力检测对照组外周血,以及癌症组外周血、癌旁组织和癌组织Vδ1 T和Vδ2 T细胞的增殖能力;通过增殖实验检测对照组外周血,以及癌症组外周血、癌旁组织和癌组织Vδ1 T细胞的免疫抑制能力.结果 对照组外周血Vδ1 T细胞比例为(1.1±0.5)％,癌症组外周血Vδ1 T细胞比例为(3.2±0.9)％,两者比较,差异有统计学意义(P<0.05),癌症组外周血Vδ1 T细胞比例高于对照组;对照组外周血Vδ2 T细胞比例为(4.5±1.5)％,癌症组外周血Vδ2 T细胞比例为(2.2±0.7)％,两者比较,差异有统计学意义(P<0.05),癌症组外周血Vδ2 T细胞比例低于对照组.癌症组癌旁组织γδT细胞经抗体扩增后,总γδT细胞比例为(85.3±18.3)％,Vδ1 T细胞比例为(24.5±12.8)％,Vδ2 T细胞比例为(55.3±15.2)％;癌症组癌组织 γδT细胞经抗体扩增后,总 γδT细胞比例为(84.9±12.6)％,Vδ1 T细胞比例为(60.6±13.7)％,Vδ2 T细胞比例为(21.8±12.6)％.癌症组外周血和癌组织Vδ1 T细胞的免疫抑制功能增强(P<0.05),癌旁组织Vδ1 T细胞的免疫抑制功能亦增强(P<0.05),但仍低于癌症组外周血和癌组织的Vδ1 T细胞免疫抑制能力.结论 癌症组外周血和肿瘤组织中Vδ1和Vδ2 T细胞比例失衡和功能的改变可能与肿瘤逃逸相关.

食管癌是常见的消化道肿瘤,而患食管癌患者的营养不良发生率在所有肿瘤中偏高,多数食管癌患者在病程中存在不同程度的营养不良[1],发生率为所有恶性肿瘤的第一位.本研究通过对同步放疗食管癌患者采用肠内或肠外不同营养方式,研究分析不同组患者体质量、营养变化以及对放化疗是否存在积极的影响作用.

目的 探讨胃镜下钛夹标记在食管癌放射治疗靶区勾画中的应用.方法 将94例食管癌患者作为研究对象,以胃镜下钛夹标记食管癌勾画放疗靶区作为胃镜钛夹组,同期以食管钡餐标记食管癌勾画放疗靶区作为钡餐标记组.比较两组食管癌长度、肿瘤区(GTV)、临床靶区(CTV)体积的差异,并分析GTV上下边界勾画误差的相关因素.结果 胃镜钛夹组检出和勾画食管病灶总长度、各胸段病灶长度均高于钡餐标记组(均P＜ 0.05),胃镜钛夹组勾画食管癌GTV、CTV体积均高于钡餐标记组(均P＜ 0.05),胃镜钛夹组肺、心脏、脊髓危及剂量均高于钡餐标记组(均P＜ 0.05),病灶位置、病灶胃镜分型、支气管哮喘是独立影响因素(均P＜0.05),94例食管癌钛夹植入后,出现Ⅰ度出血7例,无钛夹植入相关性的穿孔、肠道梗阻等并发症;放疗期间仅有12例放射性食管炎,无放射性食管溃疡、放射性肺炎发生.结论 胃镜下钛夹标记有助于精确定位食管癌病灶,优化放疗靶区的剂量,减少靶区勾画误差,值得临床选择.

Objective To investigate the efficacy of involved field irradiation (IFI) and elective nodal irradiation (ENI) in treating elderly esophageal cancer patients and identification of associated prognostic factors. Methods A total of 87 elderly esophageal cancer patients who underwent three dimensional (3D) conformal radiation therapy at the Quzhou People's Hospital between July 2011 and August 2013 were enrolled in this study. The patients were divided into IFI (n=45) and ENI groups (n=42). Within the IFI group, the gross tumor volume (GTV) included primary esophageal tumors and enlarged lymph nodes, while within the ENI group, the GTV included primary esophageal tumors and lymphatic drainage area of the corresponding esophageal segments. The radiation dosage in both groups was 50-60 Gy/time,5-6 times/week, and continued for 5-6 weeks. The patients were followed by telephone until December 2016. The 1-, 2-, and 3-year overall survival (OS) rate, as well as adverse reactions in the two groups, were compared. The potential factors influencing patient prognosis were also analyzed. Results There were no significant differences in the 1-, 2-, and 3-year OS between the two groups (P>0.05). The incidence of radiation pneumonitis in both groups was not significantly different (P>0.05). The incidence of radiation esophagitis in the IFI group was lower than the ENI group (P<0.05). Tumor site, KPS score, and radiotherapy approach did not significantly affect the 3-year OS (P>0.05), while the 3-year OS differed significantly among patients as a function of gender, age, T stage, and N stage (P<0.05). Multivariate Cox regression analysis suggested that age〔RR=2.334,95%CI (1.144, 4.759)〕 and T stage 〔RR=0.361,95%CI (0.179, 0.729)〕were independent prognostic factors for elderly patients with esophageal cancer (P<0.05). Conclusion IFI and ENI were shown to have comparable efficacy; however, IFI has the advantage of reducing the severity of radiation esophagitis compared with ENI. Age and T stage were shown to be independent prognostic factors for elderly patients with esophageal cancer.

目的 在宫颈癌同步放化疗(concurrent radiochemotherapy,CRT)过程中MR可以发现实体肿瘤大小的影像学改变,鳞状细胞癌相关抗原(squamous cell carcinoma antigen,SSCA)血清学水平可近似评估患者放化疗后肿瘤负荷.本研究旨在明确MR检查联合SSCA血清水平检测的早期治疗应答能否评估局部晚期宫颈癌患者的生存预后.方法 回顾性分析2011-01-01-2014-12-31在衢州市人民医院肿瘤放疗科接受CRT序贯腔内放疗的187例宫颈癌患者放化疗前后MR图像,评估放化疗前后肿瘤FIGO分期.收集包括1年内肿瘤复发率和无复发生存时间、腹主动脉旁淋巴结复发率和局部复发率、3年内癌症死亡率和生存时间等数据.所有患者接受外照射的治疗剂量中位数为48.6 Gy,同期给予4个周期顺铂化疗.根据治疗前后FIGO分期及SCCA变化水平将患者分为早期应答阳性组(56例)和阴性组(100例).采用χ2检验比较两组的死亡率和复发率,Kaplan-Meier法描绘生存曲线,Log-rank检验比较两组间生存曲线差异,Cox多因素回归模型分析影响生存期的独立危险因素.结果 早期应答阳性组1年内死亡率(10.7％)和阴性组(21.0％)比较,差异无统计学意义,χ2=0.429,P=0.512,但阳性组3年内癌症死亡率、1年内局部复发率和腹主动脉旁淋巴结转移复发率(25.0％、12.5％ 和8.9％)低于阴性组(59.0％、47.0％ 和39.0％),χ2=6.721、11.314和7.184,均P<0.05.Log-rank分析提示阳性组1年内无肿瘤复发中位生存期、3年内中位生存期〔(11.91±0.05)个月和(32.84±1.05)个月〕长于阴性组〔(10.9±0.20)个月和(29.16±0.85)个月〕,χ2=4.65、4.98,均P<0.05,但两组间1年内无癌症死亡生存期差异无统计学意义,χ2=0.78,P=0.475.经Cox多因素风险比例回归模型校正后,初始FIGO分期(HR=5.228,95％CI:2.605～10.491)和早期治疗学应答(HR=0.419,95％CI:0.209～0.843)为影响1年内肿瘤复发事件风险的独立危险因素.结论 早期治疗应答是局部晚期宫颈癌患者3年癌症相关死亡的独立危险因素.利用MR联合血清SC-CA水平检测可以评估和预测局部晚期宫颈癌患者的疾病预后.

Objective To investigate the clinical value of radiotherapy combined with xeloda monotherapy in the treatment of elderly patients with rectal cancer.Methods 80 elderly patients with rectal cancer were retrospectively collected.The patients were assigned into study group (n=43) or control group (n=37) according to the treatment way.The study group adopted radiotherapy combined with xeloda,while the control group only treated with radiotherapy.The main indicators included major clinical outcomes (3-year survival rate,recurrence rate,progression free survival),and postoperative health related quality of life and major complications of the two groups were observed.Results Compared with the control group,the 3-year recurrence rate of the study group decreased significantly (25.58% vs.48.65%,x2=4.579,P=0.032);the progression free survival was significantly prolonged [(42.58±7.63)months vs.(34.95±6.30)months,t=7.495,P=0.000];the quality of health related life after 1 year increased significantly [(75.50±8.11) vs.(69.76±9.58),t=3.295,P=0.002].There were no significant differences in postoperative major complications (granulocyte reduction,diarrhea,nausea,vomiting,hand foot syndrome and sensory neuropathy) and 3-year survival rate between the two groups (all P>0.05).ConclusionRadiotherapy combined with xeloda chemotherapy helps improve progression free survival and recurrence rate in elderly patients with rectal cancer.

Radiotherapy is widely used in the treatment of nasopharyngeal carcinoma (NPC), whereas its effects on the NPC growth, survival, and metastases have not been completely evaluated. Here, we compared the detected metastatic NPC tissues after radiotherapy (m-NPC) to the resected primary NPC tissues prior to radiotherapy (p-NPC). We detected higher levels of Snail2 protein, but not mRNA in m-NPC, compared to p-NPC. In vitro, a modest irradiation on NPC cells resulted in significant cell death, but increased Snail2 protein, but mRNA levels in the surviving NPC cells. Bioinformatics analyses showed that miR-613, which was significantly decreased in NPC cells after irradiation, targeted the 3′-UTR of Snail2 mRNA to inhibit its translation. Moreover, miR-613 overexpression inhibited Snail2-mediated cell invasiveness, while miR-613 depletion increased Snail2-mediated cell invasiveness in NPC cells. Finally, we detected significantly lower levels of miR-613 in m-NPC, compared to p-NPC. Together our data suggest that although radiotherapy induced NPC cell death, it may increase Snail2-mediated NPC cell invasiveness through downregulating miR-613.

Radiotherapy is widely used in the treatment of nasopharyngeal carcinoma (NPC), whereas its effects on the NPC growth, survival, and metastases have not been completely evaluated. Here, we compared the detected metastatic NPC tissues after radiotherapy (m-NPC) to the resected primary NPC tissues prior to radiotherapy (p-NPC). We detected higher levels of Snail2 protein, but not mRNA in m-NPC, compared to p-NPC. In vitro, a modest irradiation on NPC cells resulted in significant cell death, but increased Snail2 protein, but mRNA levels in the surviving NPC cells. Bioinformatics analyses showed that miR-613, which was significantly decreased in NPC cells after irradiation, targeted the 3'-UTR of Snail2 mRNA to inhibit its translation. Moreover, miR-613 overexpression inhibited Snail2-mediated cell invasiveness, while miR-613 depletion increased Snail2-mediated cell invasiveness in NPC cells. Finally, we detected significantly lower levels of miR-613 in m-NPC, compared to p-NPC. Together our data suggest that although radiotherapy induced NPC cell death, it may increase Snail2-mediated NPC cell invasiveness through downregulating miR-613.

目的:探讨正电子发射计算机断层显像(PET-CT)在经导管肝动脉化疗栓塞术(TACE)治疗原发性肝癌(HCC)患者预后判断中的价值,及与中医虚实证候的相关性.方法:纳入HCC患者70例,行TACE治疗,于治疗前进行PET-CT检测,根据最大标准摄取值(SUVmax)分为高代谢组和低代谢组,分析SUVmax与中医虚实证候相关性,并随访患者的生存率.结果:两组患者共随访了6～59个月,平均随访24个月,1、3、5年生存率低代谢组患者分别为89.47％(17/19)、55.56％(10/18)和44.44％(8/18),高代谢组患者分别为74.00％(37/50)、27.08％(13/48)和22.22％(10/45),两组患者生存率差异有显著性意义(Log-rank x2=13.564,P＜0.001).虚证组SUVmax值显著高于实证组(6.98±1.86 vs 4.23±1.96).而1、3、5年生存率虚证组患者分别为70.27％(26/37)、36.11％(13/36)和17.14％(6/35),实证组患者分别为87.50％(28/32)、58.62％(17/29)和42.85％(12/28).肿瘤SUVmax值、肿瘤大小以及中医证型虚实不同是影响HCC患者预后的独立因素.结论:PET-CT检查能较好地预测TACE治疗前HCC患者的预后,低代谢的患者其预后更好,同时实证患者的预后较虚证者更好.

放射治疗是治疗宫颈癌、直肠癌等盆腔恶性肿瘤的主要手段之一，而放射性直肠炎是治疗后的常见并发症。随着放射治疗在盆腔恶性肿瘤治疗中应用的增加，放射性直肠炎的发病率有增加的趋势[1]，但目前尚无公认有效的治疗药物和治疗手段。近几年随着越来越多的细胞因子被发现，以及对其研究的深入，有些细胞因子在辐射损伤的预防和治疗中取得了令人瞩目的成就，如IL-11对受照射小鼠肠隐窝干细胞及上皮组织具有保护作用，能减轻辐射对肠黏膜造成的损伤[2-4]。为探索放射性直肠炎较优治疗方案，我们采用重组人IL-11联合蒙脱石散（商品名：思密达）、地塞米松保留灌肠治疗重度放射性直肠炎，并与单纯思密达加激素保留灌肠方案进行对比，现将结果报道如下。

目的 研究甘氨双唑钠(CMNa)联合小剂量顺铂(cisplatinum)对Ⅲ期非小细胞肺癌( NSCLC )放射治疗的疗效和不良反应.方法 75例病理确诊的Ⅲ期NSCLC患者经化疗一个疗程后随机分为三组,均采用三维适形放疗,分别辅以甘氨双唑钠联合小剂量顺铂、单纯甘氨双唑钠以及单纯小剂量顺铂.治疗完成后评价近期疗效、生存期及毒副反应.结果 甘氨双唑钠+顺铂组的总有效率(CR+PR)和完全缓解率(CR)明显高于甘氨双唑钠组和顺铂组.而三组的平均生存期、1/2年生存率及主要毒副反应均无统计学差异(P＞0.05).结论 甘氨双唑钠联合顺铂合并放疗可明显提高Ⅲ期NSCLC患者的近期疗效,远期疗效有升高趋势,但不明显.毒副作用可耐受,无明显增加.

目的 观察多西他赛联合顺铂化疗同步放疗对Ⅲ期非小细胞肺癌的疗效,研究治疗对血清中血管内皮生长因子(VEGF)的影响.方法 收集122例Ⅲ期非小细胞肺癌的患者,随机分为两组,对照组(61例)应用多西他赛、顺铂同步化疗;观察组(61例)应用多西他赛、顺铂同步化疗联合放疗,观察两组的疗效及对血清中VEGF的影响.结果 观察组近期和远期疗效均明显优于对照组,治疗后观察组血清中VEGF的表达明显低于对照组.结论 多西他赛、顺铂同步化疗联合放疗对Ⅲ期非小细胞肺癌的治疗效果理想,且能有效下调血清中VEGF的表达.

[目的]探讨Survivin、BRCA1及class Ⅲ β-tubulin蛋白在非小细胞肺癌(NSCLC)中的表达及与紫杉醇耐药的关系.[方法]应用免疫组织化学法检测64例NSCLC患者Survivin、BRCA1及class Ⅲ β-tubulin蛋白的表达;给予紫杉醇为基础的化疗方案,分析上述蛋白表达与紫杉醇化疗敏感性的关系.[结果]Survivin阳性与class Ⅲβ-tubulin阳性患者对紫杉醇方案治疗的有效率(RR)分别低于Survivin阴性患者(27.8％vs 71.4％,P＜0.05)与class Ⅲ β-tubulin阴性患者(23.5％ vs 73.3％,P＜O.01);而BRCA1阳性患者对紫杉醇方案治疗的RR高于BRCA1阴性患者(60.0％ vs 31.0％,P＜O.05).多因素分析表明class Ⅲ β-tubulin是NSCLC紫杉醇治疗无进展生存期(PFS)的独立影响因素(x2=4.852,P=0.027),分期是与总生存期(OS)相关的独立影响因素(x2=4.105,P=0.035).[结论]NSCLC患者Survivin、class Ⅲ β-tubulin蛋白表达阳性及BRCA1蛋白表达阴性预示对紫杉醇治疗相对不敏感.

目的:观察塞来昔布在晚期肺癌同步放化疗中的增敏作用。方法:35例晚期非小细胞肺癌患者随机分为观察组和对照组,两组均接受相同的同步放化疗,观察组放化疗期间每周2次口服塞来昔布400 mg,比较两组疗效及不良反应。结果:第3周期化疗结束后,观察组有效率较对照组明显提高(61.11%和23.53%,P<0.05),不良反应两组差异无统计学意义。结论:塞来昔布能够增加晚期肺癌放化疗的敏感性,患者耐受性良好。

Objective To explore the radiosensitization of sodium glycididazole(CM-Na) combined with low-dose cisplatin in radiotherapy for advanced esophageal carcinoma and to evaluate its effects.Methods A total of 62 patients with advanced esophageal carcinoma received three-dimesional conformal radiation therapy at a dose of60 ~70 Gy,and all patients were randomly divided into twogroups. Group A received continuous intravenous drip of cisplatin 10 mg from Monday to Friday and intravenous drip of CM-Na 700mg/m2at1 hour before irradiation three times weekly. Group B were only given intravenous drip of CM-Na 700 mg/m2at1 hour beforeirradiation three times weekly.Results One month after treatment,the response rate in Group Awas 93.3%,in Group B was 70.0%.There were significant differences between the two groups(P0.05).Conclusion Radiosensitization of cisplatin combined with CM-Na could enhance the response rate of the patients with advanced esophageal carcinoma and could get better effct than by administering CM-Na only.

[目的]研究MRI-CT图像融合技术对提高脑胶质瘤术后放疗患者靶区勾画的准确性和稳定性的作用.[方法]比较两位医师对11例脑胶质瘤术后患者分别采用直接勾画方法和MRI-CT图像融合的方法勾画的临床靶体积(CTV),通过比较勾画的CTV和适形度来比较两种方法勾画靶区的准确性和稳定性.[结果]采用MRI-CT方法勾画的CTV的体积小于用常规方法勾画的CTV的体积(t=2.49, P=0.032),而两位医师采用MRI-CT图像融合勾画的CTV适形度高于常规方法勾画CTV的适形度(t=4.21, P=0.002).[结论]MRI-CT图像融合是脑胶质术后准确勾画靶区的有效方法.

Objective To evaluate the therapeutic efficacy and adverse effects of three dimensional conformal radiotherapy(3-DCRT) for patients with primary hepatocellular carcinoma after transcatheter arterial chemoembolization(TACE) treatment.Methods From November 2005 to November 2007,48 patients with primary hepatocellular carcinoma entered this trial.Among those patients,24 cases in combined group were treated by TACE plus 3-DCRT;other 24 cases were treated by TACE alone as control group.TACE was administered via hepatic arterial infusion of 5-FU,DDP,ADM and iodized oil,while 3-DCRT applied 6MV X-ray for PTV 40~66 Gy/20~33 F with a single dose of 2 Gy.Results The early response rate(CR+PR) for combined group was 82.6%,significantly higher than that of control group(54.5%,P=0.042).The one-year and three-year survival rates were 74.0% and 30.0% for combined group,50.0% and 14.0% for control group,respectively(P=0.036).There were no significant differences in adverse effects between two groups.Conclusion TACE combined with 3-DCRT is a safe and effective strategy for treatment of patients with primary hepatocellular carcinoma.

Objective To retrospectively analyze the incidence of the radiation pneumonia(RP)complicated with the radiotherapy of esophagus cancer and lung cancer,and to investigate the correlation between them.Methods The 260 in-patients diagnosed with esophagus cancer and lung cancer in total,from Jan,2003 to April,2007 were proceeded with radiotherapy by the 6-15 MV X Linearity Accelerator through routine segmentation,DT4 600 CGY-7000 CGY/23-25F.The irradiation field area in 185 cases is over 120 cm2,the irradiation doses in 220 cases are higher than 5000 CGY.Results The incidence of RP in all cases is 19.2%, in the cases which the doses are over 5000CGY is 21.4%,in the cases which the radiation field area is over 120 cm2 is 24.3%.Conclusion The radiation-induced pulmonary injury should be more taken care.the wilder the radiation field area and the higher the dose are taken,the more the incidence of the RP takes place.

同步放化疗是治疗局部晚期非小细胞肺癌(NSCLC)的首选方法,但化疗方式有多种.为比较日低剂量顺铂同步放疗和周期性化疗同步放疗的近期疗效和远期生存率及毒副反应,笔者对1999年2月至2001年10月间收治的68例局部晚期非小细胞肺癌随机分组进行比较研究,现将结果报道如下.