目的 目前临床治疗中利用调强放射治疗(IMRT)联合化疗治疗非小细胞癌(NSCLC)的研究较少.文中旨在分析化疗联合IMRT治疗局部进展期NSCLC患者的疗效及对生存质量的影响. 方法 选择2012年1月至2014年12月苏州大学附属第一医院放疗科收治的160例局部进展期NSCLC患者,根据治疗方式不同分为IMRT组(紫杉醇或吉西他滨联合顺铂化疗,调强放射治疗)和对照组(仅紫杉醇或吉西他滨联合顺铂化疗),每组80例.比较2组患者治疗效果及对患者生存质量的影响. 结果 IMRT组治疗有效率高于对照组(78.75％ vs 47.50％,P＜0.05).IMRT组患者1年、2年、3年生存率(70.00％、52.50％、36.25％)明显高于对照组(52.50％、36.25％、21.25％),差异有统计学意义(P＜0.05).IMRT组患者中位疾病进展时间、中位生存期明显大于对照组[8.9 vs 6.3个月,14.2 vs 11.1个月],差异均有统计学意义(P＜0.05).IMRT组不良反应发生率与对照组比较差异无统计学意义(P＞0.05). 结论 局部进展期NSCLC者采用化疗联合IMRT能显著提高治疗效果,不良反应较少,安全性高,明显延长患者生存期,值得临床推广使用.

Objective To assess the effects of bladder filling and emptying state on the dose distribution to normal tissue in intracavitary brachytherapy of cervical cancer.Methods We searched databases including PubMed,EMBASE,Cochrane Library,Ongoing Controlled Trial,Chinese Biomedical Literature Database,Chinese Journal FullText Database and Chinese Scientific Journals FullText Database.Quality assessment and data extract was performed for clinical research that met qualifying criteria,then we performed Meta-analysis by StatAl 2.0 software.Results Six studies were involved and 135 patients were included.The Meta-analysis showed that the median dose D50 to the bladder in filling state was significantly lower than in emptying state (SMD=-2.48,95％ CI:-4.37--0.59,P=0.000).D1cm3 and D2cm3 showed no significant difference (P=0.000,0.000).D2cm3 to the rectum in filling state was greater than in emptying state (SMD=0.39,95％ CI:0.06-0.72,P=0.257).D50 and D1cm3 showed no significant difference (P=0.105,0.005).D2cm3 to the sigmoid colon in filling state was greater than in emptying state (SMD=0.81,95％ CI:0.50-1.12,P=0.648).D50 and D1cm3 showed no significant difference (P=0.039,0.000).D1cm3and D2cm3 to the small bowel in filling state was lower than in emptying state (SMD=-3.28,95％ CI:-5.61--0.95,P=0.000 and SMD=-2.98,95％ CI:-4.68--1.28,P=0.000).D50 showed no significant difference (P=0.008).When sensitivity analyses were performed by the sequential dropping of a single study,differences were observed when the study of Patra et al was excluded.Conclusions In intracavitary brachytherapy of cervical cancer,the dose distribution to the bladder and small bowel in filling bladder state were lower than those in emptying bladder state,the results of sigmoid colon and rectum were just opposite.Confined by article quality and quantity,further evaluations in adequately powered large control trail are needed to confirm these findings.

目的：应用千伏级锥形束CT（kV-CBCT）探讨鼻咽癌调强放疗过程中摆位误差。方法对23例接受调强放疗的鼻咽癌患者在首次放疗前行锥形束CT（CBCT）扫描，以后每周扫描1次，连续扫描6周，重建后获取断层图像，使其与计划定位图像行匹配比较，得出3个方向左右（X）、头脚（Y）、腹背（Z）线性误差和Z轴向旋转误差（RTN）的平均摆位误差数据。结果23例患者共做CBCT 138次，在腹背、头脚、左右3个方向和水平面旋转的摆位误差均值分别为-1.82 mm、-0.31 mm、0.95 mm和-0.82°。结论使用kV-CBCT扫描系统能较准确地检测和修正摆位误差。

Objective Objective To evaluate the set-up errors of intensity-modulated radiotherapy ( IMRT) in nasopha-ryngeal carcinoma ( NPC) and analyze its effects on dose distribution of targets and peripheral organs at risk ( OAR) using kilo-volt cone-beam CT ( KV-CBCT) .Methods 15 NPC patients who received IMRT were selected .They were set up by 3 points on thermoplastic film ,and scanned by KV-CBCT once a week .Sectional images were acquired after reconstruction and compared with the planning CT images ,the variations of three dimensional and horizontal rotation could be achieved .Transplanting the offset cen-tral point of three dimensional and horizontal rotation to the primary positioning images ,the other parameters were invariant .The dose distributions were simulated on the primary treatment planning CT images and the dose distributions betweem them were compared.Results The mean values of set-up errors on anteroposterior,craniocaudal,lateral position and rotation was -1.833 mm,-0.32 mm,0.96 mm,-0.8333 degree,respectively.The dose variations for GTVnxD95,GTVndD95,CTV2D95,PTV2D95,and PTVnd D95 were -1.28%~-0.32%,-3.31%~-0.63%,-2.33%~-1.30%,-2.51%~-0.45%,and -2.53%~-0.48%,respectively.Dmax of brainstem,spinal cord,and the optic chiasm were -3.14%~12.58%,-22.91%~21.21%,-7.25%~14.77%,respectively.The D50 and Dmean of parotid were -13.87%~18.21%and -6.84%~9.21%.Conclusion Due to the presences of set-up errors,dose distribution of nasopharyngeal carcinoma ( NPC) undergoing IMRT is affected ,and dose distribution of OAR increased significantly .KV-CBCT can reduce the treatment errors and improve the accuracy of IMRT .

Objective To investigate the clinical value of CT positioning combined with the simulator in accurate radiotherapy of esophageal cancer.Methods Between Jan. 2009 and Feb. 2012,167 patients with local advanced esophageal cancer received both CT and simulator localization at the same body position fixed by vacuum pad.Through the comparative advantages and disadvantages of the two positioning methods,we explored the clinical value between CT and simulator positioning in accurate radiotherapy of esophageal cancer. Results Compared with simulator,CT positioning had advantages such as in the display with the tumor luminal invasion,the mediastinal lymph node involvement and the radiation dose distribution.At the same time,simulator positioning had advantages over CT positioning in the lesion length and the esophageal tracheal or mediastinal fistula.Conclusion CT positioning combined with the simulator is useful in accurate radiotherapy of esophageal cancer.

Objective To study the effect of dose conformal lead block sheilding on adjacent area outside radiation field. Mehtods Metal oxide-sillicon semiconductor field effect transistor (MOSFET) probes were laid vertically on the edge of the radiation field intensively. Low melting-point alloy conformal lead blocks of different thickness were used to shield the adjacent area of the radiation field. MOSFET probes were individually measured under different conditions. Results Comparing shielding conformal lead blocks, with no lead block shielding the surface dose decreased 15%～20%, within 0～2 mm out of the radiation field. There was significant difference (P0.01). However, there was no significant dose change exceeding 2mm (from 2 to 10 mm) out of the radiation field (P0.05), comparing shielding conformal lead blocks with no lead block used. Conclusion Conformal lead block decreases the surface dose out of the edge of radiation field and can protect the adjacent normal tissues.

通过对34例头颈部肿瘤患者面罩固定,运用X线模拟定位机对其进行校正,发现鼻咽癌9%,颅脑肿瘤(术后)7%超出误差允许范围.对其造成误差的原因进行分析讨论,寻求减少误差的方法.