Purpose To study the influence of Monaco 5.4 treatment planning system (TPS) on the dosimetry of radiotherapy for nasopharynx carcinoma (NPC) under the condition of different segment shape optimization (SSO) times. Methods Fifteen patients with T 3-4 N 0-2 M 0 stage nasopharyngeal carcinoma were enrolled, and each case was designed with SSO of 3, 5, 7 and 10 times respectively. The dose results of the target area and the major organs at risk (OAR) were statistically analyzed by DVH statistics; moreover, the isodose lines of 70Gy, 60Gy and 54Gy were intercepted at the same plane in the transverse, coronal and sagittal views and the segment shapes were compared at the angle of 30°, 120°, 240° and 330° in beam eye view (BEV); In addition, optimization time (OT), delivery time (DT), segments# and MU# were obtained and analyzed by optimization console; the plans were verified and analyzed by using ArcCheck phantom. Results For target area D 2 , the results of the SSO7 group and the SSO10 group were similar and both better than those of SSO3 and SSO5 groups, and the D 2 results of the SSO3 group were notable higher than those of the other three groups; for the major OARs, the results of the maximum dose of spinal cord, brain stem, and lens and the mean dose and V 30 of parotid glands showed the same trend. It showed that SSO7 and SSO10 share similar dose results, too which are notable better than the similar dose results shared by SSO3 and SSO5; in the dose deprogram distribution of 70Gy, 60Gy and 54Gy, partial 70Gy dose spillover occurred in both groups SSO3 and SSO5 and it was more obvious in group SSO3. While there was a no significant dose spillover in group SSO7 and group SSO10; in the sub-field alignment comparison under the same angle, the alignment became more complicated and the sub-fields were smaller as the number of SSO increased; the results of segment#, MU# and plan delivery time between different SSO groups were slightly different, while the plan optimization time changed significantly. The difference between group SSO3 and group SSO10 was more than 500s; the results were compared in ArcCheck, there was no significant difference between the groups. Conclusions The user-defined SSO function of Monaco 5.4 TPS effectively balances the relationship between plan design efficiency and plan quality. When SSO is 7, it is better value for efficiency and quality in clinical radiotherapy for nasopharyngeal carcinoma.

目的:比较术中消融联合化疗和单纯化疗在Ⅳ期胰腺癌治疗中的效果,并初步探讨消融联合化疗的潜在细胞学机制.方法:入选南京医科大学第二附属医院收治的Ⅳ期胰腺癌患者,分为单纯化疗组(化疗组,n=13)与术中消融联合化疗组(消融组,n=14),分析患者临床资料,对比肿瘤指标、血常规指标及术后生存期等.同时,采用Boyden小室建立人胰腺癌细胞渗透性实验模型,探究超低温冷冻对人胰腺癌细胞渗透性的影响.结果:消融组治疗后总胆红素(total bilirubin,TB)显著低于化疗组,而白蛋白(albumin,ALB)显著高于化疗组(P＜0.01).两组CA19-9在治疗前后均没有显著差异.消融组治疗前后的白细胞数和中性粒细胞百分比均低于化疗组(P＜0.05).消融组治疗前血小板数高于化疗组(P＜0.05).化疗组治疗后的红细胞数显著低于治疗前(P＜0.01).消融组治疗后的中性粒细胞百分比显著高于治疗前(P＜0.01).消融组术后的生存期显著优于化疗组(P=0.019).经过超低温冷冻的胰腺癌细胞渗透性显著增强(P＜0.01).结论:术中消融联合化疗较单纯化疗对Ⅳ期胰腺癌的治疗效果更好,患者生存期延长.

Objective:To explore the significance of the clinical target volume (CTV) dose optimization in the upper and middle neck in protecting the laryngopharynx, anterior and posterior rings during intensity-modulated radiotherapy (IMRT) and multimodal imaging system for nasopharyngeal carcinoma.Methods:Clinical data of 298 nasopharyngeal carcinoma patients admitted to Jiangsu Cancer Hospital from 2016 to 2018 were retrospectively analyzed. According to the following five strategies of CTV dose optimization in the upper and middle neck: group A, complete optimization of bilateral cervical lymph nodes (CLNs), that is, the CTV doses of bilateral CLNs were 50.4 Gy; group B, complete optimization of unilateral CLNs, that is, the CTV dose of unilateral CLNs was 50.4 Gy and the contralateral CLNs was 60 Gy; group C, incomplete optimization of bilateral CLNs, that is, the CTV doses of bilateral CLNs were 50.4 Gy, while the suspicious positive CLNs were selectively boosted to 60 Gy; group D, incomplete optimization of unilateral CLNs, that is, the CTV dose of unilateral CLNs was 50.4 Gy and the suspicious positive CLNs were selectively boosted to 60 Gy, and the CTV dose of contralateral side was 60 Gy; group E: no optimization, that is, the CTV doses of bilateral CLNs were 60 Gy.Results:Among 298 patients, 215 patients received dose optimization and 83 cases did not receive dose optimization. In the dose optimization schemes, 114 cases were assigned in group A, 36 cases in group B, 60 cases in group C and 5 cases in group D. The median (range) follow-up time was 28.5(6.0-46.3) months. The overall survival rate was 95.6%, the progression-free survival rate was 84.2% and the locoregional control rate of CLNs was 98.0%. Local relapse of CLNs occurred in six patients, including 1 case of retropharyngeal lymph node, 4 cases of Ⅱ area and 1 case of Ⅳ area. The P values of average dose of laryngopharynx in group A, group B, group C and group D compared with that in group E were<0.001, 0.016, 0.001 and 0.572, respectively. The P values of the average dose of the anterior ring in group A, group B, group C and group D compared with that in group E were<0.001, 0.011, <0.001 and 0.805, respectively. The P values of the average dose of the posterior ring in group A, group B, group C and group D compared with that in group E were<0.001, 0.004, <0.001 and 0.252, respectively.Conclusions:Combined with the metastatic rules of CLNs and multimodal imaging system, it is safe to optimize the CTV dose of the upper and middle neck during IMRT in nasopharyngeal carcinoma patients, which can significantly reduce the doses of laryngopharynx, anterior and posterior rings, thereby providing evidence for reducing the CTV dose in the upper and middle neck.

目的 观察胃癌根治术后采用替吉奥联合奥沙利铂辅助化疗的疗效.方法 回顾性分析我院胃癌根治术患者66例(2014年1月～2017年4月),分为奥沙利铂辅助化疗的对照组(33例)与替吉奥联合奥沙利铂辅助化疗的观察组(33例),观察患者化疗不良反应发生率、生活质量及转移情况.结果 不良反应发生率:观察组(27.27％)与对照组(30.30％)相比,P＞0.05;治疗前,两组生活质量对比,P＞0.05,治疗后,观察组心理功能(76.38±4.51)分,物质生活(78.36±4.47)分,躯体功能(77.51±4.76)分,社会功能(75.37±3.97)分,高于对照组,P＜0.05;观察组淋巴结转移率6.06％,腹膜转移率3.03％,没有出现肝脏转移,低于对照组,P＜0.05.结论 胃癌根治术后采用替吉奥联合奥沙利铂辅助化疗,不会增加患者化疗不良反应,且转移发生率低,值得借鉴.

目的 分析维持化疗对于局部晚期胃癌术后患者的生存期影响,探讨提高局部晚期胃癌术后患者预后的辅助治疗模式.方法 回顾分析2013年1月-2014年12月在兴化市人民医院肿瘤科收治的根治术后、病理分期为T3-4N0-3M0、TxN2-3M0期术后接受联合化疗的102例患者,统计并分析其临床资料.结果 102例局部晚期胃癌术后接受1-3周期联合化疗、4-6周期联合化疗、4-6周期联合化疗后并序贯单药维持化疗患者3年无瘤生存率分别为28.1%、57.1%和78.6%,差异具有统计学意义(P＜0.05),3年的总生存率分别为37.5%、64.3%和78.6%,差异具有统计学意义(P＜0.05).结论 局部晚期胃癌患者预后不良,接受4-6周期联合化疗后并序贯单药短期维持治疗能够改善患者预后.

目的 观察去氧氟尿苷联合华蟾素节拍化疗老年晚期胃肠癌的临床疗效和安全性.方法 2012年3月至2015年3月兴化市人民医院肿瘤科收治47例老年晚期胃肠癌患者,使用小剂量去氧氟尿苷联合华蟾素持续短间歇口服给药,直至病情进展或出现不能耐受的毒性反应.结果 47例可评价疗效,12例部分缓解,13例病情稳定,没有完全缓解病例,总疾病控制率53.2％,中位疾病进展TTP时间为4.6个月,Ⅲ～Ⅳ度不良反应5例(10.6％).结论 去氧氟尿苷联合华蟾素节拍化疗老年晚期胃结肠癌有效,不良反应轻,可减少患者住院时间,减少家庭护理压力.

目的 观察GP方案联合化疗治疗晚期食管癌的疗效及毒副反应.方法 经病理组织学明确诊断的46例食管鳞癌.所有患者均为经过一线TP或DP、PF等方案化疗后出现复发或转移的晚期食管癌病人,以吉西他滨1.0 g/m2静脉滴注30 min,第1、8 d;顺铂25 mg/m2静脉滴注,第1-3 d,每3周重复一次.每治疗2周期评价疗效.结果 46例食管鳞癌患者中完全缓解0例,部分缓解12例,稳定10例,总有效率47.8%.不良反应主要为胃肠道反应及骨髓抑制.结论 GP方案作为治疗晚期食管癌二、三线用药疗效确切.而且毒副作用小,可以作为治疗晚期复发及转移性食管癌患者的化疗方案.

Objective:To analyze the efficacy of esophageal carcinoma treated with two ways of radiotherapy.Methods: From 2005 to 2008,95 patients with esophageal carcinoma treated with conventional fraction radiotherapy(CFRT) and three-dimensional conformal radiotherapy(3DCRT) were retrospectively analyzed.The local control rates,the survival rates and the toxicity were evaluated.Results: The follow-up rates of CFRT and 3DCRT were 93.6% and 97.9% by December 2008.The 1-year local control rates were 53.5% and 81.6%,the 2-year local control rates were 29.8% and 50.2%.The 1-year overall survival rates were 70.6% and 87.1%,the 2-year overall survival rates were 30.4% and 51.5%.Toxicity in the two groups was similar.Conclusion: Three-dimensional conformal radiotherapy is effective and feasible in the treatment of esophageal cancer,and the toxicities can be tolerated.It can improve the efficacy of esophageal carcinoma.

Objective To evaluate the effect and toxicity of three dimensional conformal radiation therapy(3DCRT) combined with chemotherapy using docetaxel and cisplatin for patients with unresected locally advanced non-small cell lung cancer(LA-NSCLC).Methods A total of 52 patients with LA-NSCLC were equally randomized to two groups.Those in radiotherapy group were given 3DCRT,2 Gy/single dose/day,totalling 60-64 Gy;those in the chemoradiotherapy group were administrated with docetaxel 30 mg/m2 and cisplatin 20 mg/m2 on day 1,8,22 and 29 before radiation same as that of the radiotherapy group.ResultsThe effective rates of chemoradiotherapy group and radiotherapy group were 92.3% and 76.9%,respectively,with a significant difference between the two groups(χ2=10.8,P0.05).No significant difference was noted between the two groups in terms of acute toxicity(P0.05).Conclusion 3DCRT combined with chemotherapy using docetaxel and cisplatin is effective for LA-NSCLC and well tolerated by patients.

为探讨FP方案同步化疗联合放射治疗食管癌的近期疗效和急性毒性反应,作者2005年9月～2 008年12月将82例食管癌患者的随机分组进行对比研究;一组41例采用放射治疗同时配合顺铂(PDD)加氟脲嘧啶(5-Fu)全身化疗(化放组); 另一组41例采用单纯放射治疗(单放组).现报道如下.

Objective:To observe the short-term efficacy and side effects of three kinds of nedaplatin-based chemotherapy for non-small cell lung cancer(NSCLC).Methods: A total of 20 patients with NSCLC were treated with nedaplatin-based chemotherapies for two treatment cycles,then the efficacy and toxicity were evaluated in accordance with WHO criteria. Results: There were 2 CR pts,7 PR pts,12 SD pts and 1PD respectively.The total response rate was 45.0%.The major adverse event marrow suppression was observed mainly to I or II degrees,with grade Ⅲ,Ⅳ toxicity of neutropenia in 7 pts(35.0%) and thrombocytopenia in 5 pts(25.0 %).After processing,previous adverse reactions were found disappeared and didn′t affect further step of chemotherapy.No serious hepatorenal damage was found.Gastro-intestinal tract toxicities were relatively mild and usually at grade Ⅱ or below.Conclusion:It′s beneficial for the patients with NSCLC to be given nedaplatin-based chemotherapies,while long follow-up will be necessary to determine the influence of those therapies on NSCLC.

Objective:Docetaxel was used in a phase Ⅱ trial in the combination with cisplatin for esophageal cancer.The anti-tumor response,toxicity and suevival of the treated patients were evaluated.Methods:Thirty patients with advanced unresectable or complicated with metastasis were allotted,twenty patients were primary chemotherapy while ten patients received adjuvant chemotherapy after operation.Patrents were given docetaxel 75 mg/m2 by 1-hour infusion on the first day,and cisplatin 40 mg/m2 daily on the second day and the third day.Treatment was recycled every 21 days.Results:Thirty patients completed a median of 2 cycles and 28 patients were evaluable for response.Major objective responses were observed in 16 patients(57.1%),including 4 complete response(14.2%),and 12 partial response(42.8%).The median time to tumor progression was 5.2 months.The median actuarial survival was 9.5 months.Twenty-eight patients were assessable for toxicity.The most common nonhematologic toxicity was alopecia.Grade 3 to 4 nentropenia was observed in 13.3﹪ of the pantients.Conclusion:The combination of docetaxel and cisplatin can be considered as a main regimen in the treatment of advanced esophageal cancer.

Objective To evaluate the efficacy and toxicity of gemcitabine plus 5-fluorouracil/leucovorin in the treatment of advanced breast cancer resistant to anthracyclines and/or taxanes.Methods Thirty eight cases of advanced breast cancer pretreated with anthracyclines and/or taxanes were enrolled into this study,Gemcitabine 1200mg/m2 iv,combined with leucovorin 200mg/m2 iv,then 10 minutes,intravenous bolus of 5-Fu 325mg/m2 fol-lowed by 48 hours infusion of 5-Fu 2.8g/m2 using an ambulatory pump.The regimen was given per 14 days.One cycle consisted of twice chemotherapy regimens.All enrolled patients received at least two cycle of treatment.Results CR 2 casesP、R 14 casesN、C 13 cases;PD 9 cases an overall respons rate of 42.1%.The main side effect included grade Ⅲ～Ⅳ leckopenia 18.4%,grade Ⅲ thrombocytopenia 5.9%.Conclusion Gemcitabine plus 5-fluorouracil/leucovorin GLF regimen is effective for advanced breast cancer resistant to anthracyclines and/ or taxcines.

骨转移癌是恶性肿瘤常见的并发症,肺癌、乳腺癌和前列腺癌患者约半数最终会发生骨转移.骨转移可引起疼痛、病理性骨折、高钙血症、继发性神经功能不全和功能障碍,严重影响患者的生存质量.放射治疗和双膦酸盐类药物均是治疗骨转移的有效方法.我院于2002年9月～2004年1月应用帕米膦酸钠(博宁),并用放射治疗骨转移癌,取得较满意的疗效,现报道如下: