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.

目的 比较头颈肩热塑膜和真空垫在食管中上段癌放疗中的摆位误差,优化固定方式.方法 2017年7月—2019年6月江阴市人民医院符合入组条件的食管中上段癌患者60例,随机分为两组:头颈肩热塑膜组(n=30)和真空垫组(n=30).所有患者均行定位CT扫描、三维治疗计划.放疗中每周对患者行CT扫描图像验证,比较验证CT和定位CT中X(左右)、Y(头脚)、Z(胸背)方向的摆位误差,比较两组患者摆位误差.结果 头颈肩热塑膜组和真空垫组X方向的摆位误差分别为(2.2±1.2)mm和(2.7±1.4)mm,头颈肩热塑膜组小于真空垫组,差异有统计学意义(P=0.001);两组患者Y方向摆位误差分别为(2.3±1.2)mm和(3.1±1.4)mm,头颈肩热塑膜组小于真空垫组,差异有统计学意义(P<0.001);两组患者Z方向摆位误差分别为(2.2±1.3)mm和(2.3±1.3)mm,差异无统计学意义(P=0.494).结论 食管中上段癌接受放疗时采用头颈肩热塑膜固定误差较小,精度优于真空垫固定.

目的 探讨宫颈癌术后三维适形放疗和调强放疗的剂量学差异,观察其急性放射反应发生情况.方法 选取我院收治的宫颈癌术后接受外照射治疗患者60例,其中三维适形放疗28例,调强放疗32例.所有患者均针对同一计划靶区(PTV)设计调强与三维适形两套计划,进行计划评价和急性毒性反应评价.结果 适形指数(CI)调强计划优于三维适形计划(P<0.05),调强计划放疗组小肠的V50、膀胱和直肠的V40、V50均低于三维适形放疗组(P<0.05).调强放疗组1、2级恶心呕吐、腹泻和泌尿系反应的发生率均低于三维适形放疗组(P<0.05),两组均极少出现3级急性反应,骨髓抑制发生率比较差异无统计学意义(P>0.05).结论 宫颈癌术后调强放疗较三维适形放疗有明显的剂量学优势,可有效减少急性不良反应发生.

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 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:探讨小靶区调强放疗技术(IMRT)治疗早期鼻咽癌的近期疗效.方法:以2010年5月至2012年3月确诊鼻咽癌的早期患者26例,随机分成两组,实验组采用小靶区调强放疗技术;对照组采用常规调强放疗技术.结果:26例鼻咽癌患者,其中实验组13例,对照组13例.实验组与对照组放疗比较,实验组放疗反应(口干、放射性口腔黏膜反应)较对照组轻,两者比较差异有统计学意义(P<0.05).局控率统计学无明显差异.结论:小靶区调强放疗技术与常规调强放疗技术比较,在保证肿瘤局部控制率基础上,小靶区调强放疗技术改善了患者口干、口腔黏膜反应、提高了生活质量.

Objective To explore the value of three-dimensional conformal radiotherapy for advanced esophageal carcinoma by comparing the efficacy and toxicity between three-dimensional conformal radiotherapy(3D-CRT) combined with concurrent chemotherapy and conventional radiotherapy combined with concurrent chemotherapy in the treatment of advanced esophageal cancer.Methods A total of 100 patients with advanced esophageal cancer were divided into conventional group(conventional radiotherapy combined with chemotherapy) and conformal group(three-dimensional conformal radiotherapy combined with chemotherapy).The efficacy and toxicity,1-,2-and 3-year local control rates and survival rates of the two groups were compared.Results The total efficacy rate of the conformal group was 92.0% which was significantly higher than the 72.0% of the conventional group(P<0.05).The 3-year local control rate and survival rate of the conformal groups were significantly higher than those of the conventional group(P<0.05).Incidence rate of toxicity showed no significant difference between the two groups.Conclusion Three-dimensional conformal radiotherapy combined with chemotherapy compared with conventional technology radiotherapy can significantly improve the survival rate of patients with advanced esophageal with tolerable toxic side effects.

目的探讨三维适形放疗技术在中晚期食管癌中的应用价值。方法中晚期食管癌患者80例随机分为适形组（三维适形放疗联合化疗）40例和对照组（常规技术放疗联合化疗）40例。比较2组的近期疗效、远期疗效以及毒副反应发生情况。结果适形组治疗总有效率（90.0%）明显高于对照组（72.5%）;适形组1a生存率（82.5%）明显高于对照组（62.5%）;2组毒副反应发生情况无差异。结论三维适形放疗联合化疗治疗中晚期食管癌近期疗效及1a生存率较好,毒副反应略增加,但患者基本可耐受。

目的观察三维适形放疗联合复方苦参注射液治疗转移性骨肿瘤的疗效与安全性。方法将48例转移性骨肿瘤患者分成两组,联合组给予三维适形放疗+复方苦参注射液静滴,放疗组给予单纯三维适形放疗。比较两组治疗前后的疼痛缓解、生活质量改善及免疫功能变化情况。结果联合组疼痛缓解总有效率为80.8%,生活质量改善有效率为92.3%;放疗组分别为68.2%、77.3%,两组比较均有统计学差异(P均<0.05)。放疗组白细胞明显减少,与联合组比较有统计学差异;联合组NK细胞活性增高,CD4/CD8升高,与对照组比较有统计学差异(P均<0.05)。结论三维适形放疗联合复方苦参注射液可明显缓解转移性骨肿瘤引起的疼痛,减少并发症的发生,提高患者的生活质量,减少放疗相关性白细胞减少的发生率,提高机体免疫功能。

目的 探讨放疗联合射频热疗治疗腹膜后转移淋巴结近期疗效.方法 腹膜后淋巴结转移的患者23例,放射治疗采用6 MV-X射线体外照射,三维适形放疗技术,90%-95%PTV 50-55 Gy/25-28次.射频热疗每周2次,60 min/次,共6-8次,每次热疗1h后行放疗.结果 结果表明,近期疗效评价有效率(CR+PR)为82.6%.结论 放疗联合射频热疗治疗后转淋巴结,能提高局部控制率,患者耐受性好.

<正>食管癌是我国常见肿瘤之一,发患者数约占全世界50%以上,死亡率居我国恶性肿瘤的第4位。食管癌确诊患者中,多数已为中晚期,可行根治性手术的患者仅为25%左右,因此,同步放化疗己成为不能或不宜行手术患者的标准治疗方案。三维适形放疗(3D-CRT)较传统放疗而言,在靶区定位

Objective To evaluate the differences in contouring of gross tumor volumes(GTV) between different physicians and analyze causes.Methods CT images from patients with nasopharyngeal neoplasms and lung neoplasms were reviewed by 3 radio-therapists and 3 radio-diagnosticians with more than 10 years experience.The variability of GTV volume,the maximum value of X axle of layer and coronal section were calculated.The differences of GTV between the two departments were analyzed.Results The volume of GTV by radio-diagnosticians were smaller than that by radiotherapists.The radio-diagnosticians were found more accurate in GTV delineation than radiotherapists,but the variability in GTV delineation of layers and coronal sections of lung neoplasms was not statistically significant.Conclusion More attention should be paid to the variability of GTV delineation by physicians from different departments to improve the level of image-diagnose in radio-therapists.Advanced image examination approaches and cooperation of radiation oncologists should be introduced to enhance the accuracy of target region delineation.