目的观察术后放疗加小剂量奈达铂节律化疗治疗中晚期术后喉癌的疗效及不良反应。方法 70例中晚期术后喉癌患者随机分成两组,治疗组行术后放疗加奈达铂节律化疗,对照组行单纯术后放疗。对比两组患者的CR、PR百分率、不良反应发生率以及治疗效果。结果治疗组CR、PR百分率分别为54.29%、31.43%,对照组分别为20.00%、57.14%,两组CR比较差异有统计学意义（P＜0.05）。两组不良反应发生率无统计学差异。结论近期疗效CR（完全缓解率）:节律化疗加术后放疗组高于单纯术后放疗组,且不良反应无明显增加。

Objective To study and compare the local control rate of the primary location and lymph node metastasis for nasopharyngeal carcinoma between intensitymodulated radiation therapy (IMRT) and conventional radiation therapy (CRT).Methods Thirty nasopharyngeal carcinoma patients in stage T3N1M0 planned with CMS system in IMRT and CRT,calculated the dose to tumor and normal tissues respectively.The 2-year and 3-year control rate was summarized.Results There was no significant difference about the dose to tumor between IMRT and CRT,but the dose to the normal tissuew was lower in IMRT than in CRT.The 2-year and 3-year control rate were 95%,93% with IMRT and 83%,75% with CRT.Conclusion The dose distribution to tumor target area is more creditable with IMRT than with CRT.The dose to the normal tissues is controlles effectively with IMRT,IMRT is more advantageous than CRT.

2007年3月～2008年8月,我院采用小剂量顺铂(DDP)联合放疗治疗局部晚期鼻咽癌,取得较满意疗效.现报告如下.

Objective To study and compare the dose difference of intensity modulated radiation therapy (IMRT) and conventional radiation therapy(CRT) affecting tumor and normal tissues. Methods Thirty nasopharyngeal carcinoma patients in stage T3N1M0 received IMRT and CRT with CMS system. The dose affecting tumor and normal tissues was calculated respectively. Results There was no significant difference of the dose between IMRT and CRT, but the dose affecting the normal tissue was lower in IMRT than that in CRT. Conclusions The dose distribution to tumor target area is more precise with IMRT than that with CRT. The dose to the normal tissues is controlled more effectively with IMRT than that with CRT.

Objective To investigate the radiobiological effects of two irradiation protocols on human hepatocarcinoma cells BEL-7402 and hepatic cells QSG-7701.Methods BEL-7402 cells were irradiated by total doses of 0 Gy,1 Gy,2 Gy,3 Gy,5 Gy,7 Gy,9 Gy,10Gy at a dose rate of 3Gy/min.Two different delivery patterns were acute irradiation model with the fraction-delivery-time was 0～4 min;and 3-Dimensional conformal radiation therapy(3DCRT) model with the fraction-delivery-time was lasted 13～15 min.The surviving fractions were determined by classical colony forming assay.The radiobiological parameters were calculated,and cell survival curves were plotted according to "the single-hit multi-target model".The survivability,apoptosis and cell cycles of BEL-7402 and QSG-7701 cells irradiated by 6MV X-ray with a single dose of 5 Gy,were assessed by methyl thiazole tetrazolium(MTT) assay and flow cytometry(FCM).Results The values of D0,Dq,SF2 of BEL-7402 cell line in acute irradiation pattern and 3DCRT irradiation pattern were 1.69 and 1.78,1.45 and 1.54,0.625 and 0.654 respectively.The number of apoptotic BEL-7402 cells reached a peak(32%) and showed a lowest survival(65%) at the 12h after irradiation,while irradiated apoptotic rate in QSG-7701 cells showed highest(18%) at the 24h.Apoptosis and survival between the two cell lines at 12h induced by radiation were significant different(P<0.01).Conclusion The radiobiological effectiveness were able to be influenced by prolonged fraction-delivery-time for 3DCRT.Radiosensitivity was markedly various from cancer and normal cellular line.

目的观察根治性放疗加低剂量节律化疗治疗恶性肿瘤的疗效及其不良反应。方法54例恶性肿瘤患者随机分成两组,对照组行单纯根治性放疗,治疗组行根治性放疗加低剂量节律化疗。放疗肿瘤临床病灶剂量为65~70 Gy/6.5~7周,亚临床病灶剂量为45~50 Gy/4.5~5周。化疗顺铂(DDP)10 mg/次,3次/周,每周1、3、5进行化疗,共6~7周。结果治疗组CR、PR百分率分别为53.57%、32.14%,对照组分别为38.46%、19.23%,两组比较差异有统计学意义(P<0.05)。两组不良反应发生率无统计学差异。结论节律化疗加根治性放疗比单纯根治性放疗疗效好,且不良反应无明显增加。

Objective To evaluate the expression and clinical significance of survivin protein and proliferation cell nuclear antigen(PCNA)in nasopharyngeal carcinoma(NPC). Methods The immunohistochemistry was used to test the expression of survivin and PCNA in 68 cases of NPC tissues. Results The positive rate of survivin and PCNA expression was 72.1% and 73.5% respectively.The positive expression rates of survivin increased significant with higer T stage and neck lymph node metastasis (P<0.05).The patient with tumor residual after radiation,relaps,and metastesis had higer expression of survivin,but without significance.The positive rate of survivin expression in NPC patients with lese than 5-year survival rate was higher than that in NPC patients with over 5-year survival rate.The expressions of survivin and PCNA showed a significant correlation(P<0.05). Conclusion The expression of survivin is closely associated with prognosis.

Intensity modulated radiation therapy(IMRT),as one of precise technique, can improve the target volume coverage and escalate the total dose of tumor, while decrease the dose of surrouding critical organs at the same time. So IMRT results in good local-regional control and better quality of life. This article reviews the advantage of IMRT used in treatment of nasopharyngeal carcinoma(NPC) from the aspect of radiophysics、radiobiology and clinlcal application, and also proposes some controversial issues.

Objective To study the radiosensitizing effect and the side effect of Celecoxib in radiotherapy of head and neck cancers.Methods Sixty-eight patients with head and neck cancers from June 2005 to May 2007 were randomized to two groups,routine group in which patients were given definitive radiotherapy only and Cox-2 group in which patients were given definitive radiotherapy combined with Celecoxib 200mg bid orally from the beginning to the end of the radiotherapy course.Results In the Cox2 group and routine group,the CR+PR for local lesion was 91.7% and 81.3% respectively,and for lymph node was 91.7% and 80.0% respectively.The remote metastasis in the two groups was 8.0% and 17.4%.Conclusions Celecoxib could increase the radiosensitivity and there was significant difference between the two groups.It had little side effect.However,its long-term effect needs further study in the future.

Objective: To compare DDP and CMNa in radiosensitivity and side-effect in patients with nasopharyngeal carcinoma.Methods: Sixty-two patients were randomized into two groups,DDP group and CMNa group.CMNa was used venously with 800 mg/m2 in 30 minutes and radiotherapy was performed in 60 minutes in Monday,Wednesday and Friday for every week from the beginning to the end of the radiotherapy.DDP was used venously with 10mg daily from Monday to Friday in first two weeks and in the fourth and fifth week.Facial-neck field was given with 38GY,then facial-jugular field and anterior-nasal field were given with 30-34GY. Results: In the two groups the CR+PR for local lesion was 93.3% and 84.38% respectively,90.9% and 84.38% respectively for lymph node,and the remote metastasis for the two groups was 16.67% and 18.75%. Conclusion: There was no significant difference in radiosensitivity(P0.05) in two groups but the side-effect in the DDP group was more severe than in CMNa group,And the long term effect needs further study in the future.

TPA文献报道较多,但作为非特异性肿瘤标志物,对临床判断有一定局限性[1], 本院从2004年起,联合检测TPA, 以期能达到更准确的判断肿瘤及其预后,具体资料如下.

Objective To analyse relativity of serum VEGF and TPA with stage in patients with nasopharyngeal carcinoma(NPC) for the reference of the prognosis.Methods 70 patients with NPC in different stages were sampled with serum VEGF and TPA,patients in T_1 stages 18 cases,T_2 stages 42 cases,T_3 stages 5 cases,T_4 stages 5 cases,N_0 stages 21 cases,N_1 stages 26 cases,N_2 stages 16 case s,N_3 stages 7 cases.Results 42 patients were positive with TPA,28 patients were negtive with TPA,40 patients were positive with VEGF and 30 patients negtive with VEGF.Conclusions [WT5BZ]There is some relation between VEGF/TPA and stages in patients with NPC,which is significant in prognosis.

膀胱癌是泌尿系统的常见肿瘤,1990年12月至1998年12月共收治膀胱癌229例,大部为浅表性膀胱癌行局部肿瘤切除术加膀胱灌注化疗,其中32例晚期膀胱癌因肿瘤较大行手术+放射综合治疗.

目的:探讨头颈部肿瘤放疗对脑组织的影响.方法:通过对11例鼻咽癌患者放疗后临床表现和影像学的观察,分析放射性脑损伤的特点.结果:放射性脑损伤的主要表现为精神症状、癫痫和颅内高压,CT平扫为不规则的低密度区,增强扫描10例表现为边缘增强的囊变区.MRI平扫表现为不均匀的稍长T1和长T2,增强扫描为边缘明显增强的低信号区.结论:放射性脑损伤有其特殊临床特点,重在预防.

Objective To observe the effect of residual tumor after radiotherapy on survival rate of patients with nasopharyngeal carcinoma (NPC). Methods From Jan. 1989 to Dec. 1998, 108 of 304 NPC patients pathologically confirmed, had residual tumor after radical radiotherapy, of whom, 26, 68, 14 had residual lesion in the nasopharyngeal cavity alone, cervical lymph node alone, and nasopharyngeal cavity plus cervical lymph node. Results The overall 1 , 3 , 5 , and 10 year survival rates (OS) significantly decreased in the residual group. The highest OS was in the group with nasopharynx residual alone, and the lowest in nasopharynx plus residual lymph node group. The bigger the residual lesion, the lower the OS. Conclusions The overall survival rate decreases in patients with residual lesion after radiotherapy, especially in patients with both nasophrynx and regional lymph node residual. Tumor residual after radiotherapy can be a prognostic indicator for patients with NPC.

Objective To study the characteristics of lymph node metastases of thoracic esophageal carcinoma and its influence on patient's prognosis and to find postoperative combined modality therapy for esophageal cancer. Methods To analyze retrospectively the clinical meterials of 97 patients who had undergone resection of thoracic esophageal carcinoma. Results Lymph node metastases was found in 36 of the 97 treated patients (37.1%) .In 561 lymph nodes dissected,metastases existed in 400(14.4% ),tumor differentiation was the factors influencing lymph node metastases, but the length of tumor and depth of tumor invasion were not. the 3 - year surivival rate of the patients with lymph node metastases was 36% , much lower than that of patients with no lymph node metastases (54% ). Conclusions Postoperative combined modality therapy for esophageal cancer is a valuable procedure

自1997年1月～1999年6月,本院共收治经病理确诊的鼻咽癌144例,全部病例采用病人仰卧位,面膜固定一个体位照射法,在模拟机下定位,用等中心多野照射,原发灶用6 MV-X线外照射,采用3种不同的分割方法进行放射治疗.

目的:探讨鼻咽癌放射治疗后放射性脑病的临床特点、治疗及预后.方法:对我院收治的469例鼻咽癌患者中,采用面颈联合野36～40Gy后缩野改耳前野加鼻前野或耳后野,常规放疗406例,中位剂量70(66～74)Gy,后程加速超分割32例,中位剂量76(70～80)Gy,超分割31例,剂量76.8Gy.结果:18例发生放射性脑病病变部位:颞叶15例,双侧4例,单侧11例,脑桥3例.潜伏期:单程放射治疗中位潜伏期33(22～77)个月;再程放射治疗中位潜伏期8.5(6～28)个月.全组随访率100%,16例仍存活,2例死于放射性脑病.结论:鼻咽癌放射性脑病与剂量及照射野设计有关.MRI为其重要的诊断方法,PET可作为鉴别诊断的方法之一.尽早进行激素、脱水、扩血管和脑细胞营养药等治疗可有一定效果,但对病情反复,且有手术指征的患者尽早切除病灶可获良效.

Objective To determine the influence of peripheral blood hemoglobin concentration on the radiotherapy result of nasopharyngeal carcinoma (NPC) . Methods From January 1989 to December 1998, 304 patients with pathologically confirmed NPC received radical radiation. There were 209 males and 95 females. The ages ranged from 16 to 77 years with a median of 42. All patients were irradiated by 60 Co or 6 ?MV external beam with a total dose of 64～76?Gy for the primary tumor and 46～77?Gy for the cervical lymph nodes. The peripheral blood hemoglobin concentration for all patients was measured before, during and after radiotherapy. These patients were divided into three groups according to the peripheral blood hemoglobin concentration before radiotherapy: anemia (120?g/L), normal (120～160?g/L) and high hemoglobin groups (160?g/L), and into two groups according to the change in the peripheral blood hemoglobin concentration during radiotherapy as increased and decreased groups. Results All patients were followed with a follow-up rate of 90.5%. The peripheral blood hemoglobin concentration had a significant effect on the survival of NPC patients. Its decrease or increase during radiotherapy affected the survival and local control rates of NPC patients. Conclusions The change of peripheral hemoglobin concentration affecting the oxygen content in the blood, can influence the local control and survival rates of NPC patients. Increase results in higher survival.

目的 分析放疗 +射频热疗 +免疫治疗对晚期食管癌的疗效 ,与单纯放疗作对比 .方法 60例晚期食管癌患者随机分 3组 ,各 2 0例 .单纯放疗组 :DT 66～ 70Gy/33～ 35次 /6.5～ 7周 ;放疗 +免疫治疗组 :DT 66～ 70Gy/33～ 35次 /6.5～ 7周 ,放疗期间加免疫治疗 ,白介素 Ⅱ 5 0万单位 ,每周两次 ,共 10次 ,或干扰素 10 0万单位 ,每周两次 ,共 10次 ;放疗 +射频热疗 +免疫治疗组 :DT 62～ 66Gy/31～ 33次 /6～ 6.5周 ,放疗期间加用SR 10 0 0型射频热疗 ,每周两次 ,功率 5 0 0～80 0W ,每次加热 1h ,共 4～ 10次 ,并加免疫治疗 ,方法同上 .每组 10例病人放疗前后检测T细胞亚群 .结果 放疗 +射频热疗 +免疫治疗组的近期疗效 （CR +PR）为 90 % ,明显高于单纯放疗组的 65 %及放疗 +免疫治疗组的 75 % ,有统计学意义 （P ＜0 .0 5 ） .结论 联合方法即放疗 +射频热疗 +免疫治疗能提高食管癌的近期治疗效果 .