目的 对一种矩形孔准直器伽玛刀的射野形状、大小、半影等剂量学参数进行测量,并对射野聚焦形成的剂量分布、静态和动态拉弧的剂量分布进行分析,以归纳矩形孔准直器的伽玛刀剂量学特征.方法 在Luna-260型伽玛刀上,用EBT3剂量胶片测量不同射野的剂量分布,通过胶片分析软件得到矩形孔准直器的剂量学参数,选取3号和6号准直器在放射治疗计划系统中进行不同角度拉弧聚焦,分析不同截面上形成的剂量线.结果 矩形孔准直器形成的矩形野大小、半影测量结果均符合国标WS 582-2017《X、γ射线立体定向放射治疗系统质量控制检测规范》的要求.1～6号准直器尺寸偏差均在1 mm内,静态聚焦野半影最大为4.3 mm.3种截面(横断面、冠状面、矢状面)的剂量分布形状与拉弧角度大小相关.对于50％剂量线大小,在Z方向上,两种准直器50％剂量线大小均为14mm左右,在X、Y方向上,两种准直器50％剂量线大小变化幅度不同,其中3号准直器变化幅度较大,6号准直器变化幅度较小.结论 矩形准直器射野尺寸及半影大小均符合国标要求,矩形孔准直器拉弧角度影响剂量分布,其剂量学特性能够为临床应用提供参考.

目的 比较3种自动勾画图像分割软件(rtStation、AccuContour、RT-Mind)与手动勾画对胸部肿瘤危及器官(Organs at Risk,OARs)的勾画效果.方法 选取解放军总医院第五医学中心放疗科行胸部肿瘤放疗患者15例,由肿瘤放疗医生手动勾画OARs,经确认后以此勾画结果作为参考标准,再分别应用3种图像分割软件勾画OARs,比较手动勾画与自动勾画的时间、Dice相似性系数(Dice Similarity Coefficient,DSC)和Hausdroff距离(Hausdorff Distance,HD).结果 3种自动勾画软件勾画速度比较:AccuContour>RT-Mind>rtStation,勾画时间均在3 min内完成,而人工勾画需30 min左右.3种自动勾画软件对心脏、左肺、右肺、脊髓的勾画效果较好,DSC均在0.85以上,但对食管和气管的勾画效果较差,且AccuContour、RT-Mind软件在勾画心脏、脊髓的DSC显著高于rtStation软件(P<0.05);在勾画左肺和右肺的DSC方面,AccuContour软件显著优于rtStation、RT-Mind软件(P<0.05).3种自动勾画软件脊髓HD值最小,气管HD值最大,但AccuContour、RT-Mind软件的脊髓HD均显著低于rtStation软件(P<0.05);rtStation软件的心脏HD显著高于AccuContour、RT-Mind软件(P<0.05);3种自动勾画软件的食管HD均低于2 cm,且AccuContour软件显著优于rtStation、RT-Mind软件(P<0.05);对于左、右肺,RT-Mind软件HD均超过2 cm,显著高于rtStation、AccuContour(P<0.05),勾画效果较差.结论 3种图像分割软件在胸部OARs自动勾画时,食管和气管勾画效果基本满意,但需要医师手动修改,软件有待进一步提高;心脏、肺和脊髓勾画效果理想,图像分割软件能够提高医师工作效率.

目的 研究碳纤维体位固定板的透射系数及对椎体转移瘤放射治疗剂量的影响.方法 CT定位机下扫描碳纤维体位固定板,计算体位固定板在不同角度下的衰减系数,并与相同条件下的实测体位固定板衰减系数比较,分析放射治疗计划系统的准确性;另选择10例椎体转移瘤患者,其中男性5例,女性5例;年龄50～76岁,中位年龄65岁;病灶均位于双肾之间椎体上.在不勾画体位固定板的CT图像上设计无板计划,无板计划完成后将此计划移植到勾画体位固定板的CT图像上,并进行剂量计算,比较无板计划、有板计划靶区和危及器官(OAR)的剂量学差异.结果 体位固定板在不同机架角度下的实际衰减系数为0.966～0.995,放射治疗计划系统计算得到的体位固定板的衰减系数与实际测量得到的衰减系数偏差在0.62％以内;对于椎体转移瘤计划,体位固定板勾画参与剂量计算后,靶区的受照剂量明显降低,平均降低2％左右.对于靶区的适形性指数(CI)、均匀性指数(HI),体位固定板的勾画会导致靶区的CI显著降低,差异有统计学意义(0.849±0.051vs0.760±0.037.P＜0.05),而对HI影响不大,差异无统计学意义(P＞0.05).对OAR,有板计划的剂量体积(V10、V20、V30)、Dmean、Dmax均比无板计划偏低,其中小肠、左肾、右肾的剂量体积减少百分点均在 1％以内;脊髓 Dmax 减少了0.87 cGy(2.3％),且差异均有统计学意义[(38.85±0.89)cGy vs(37.99±0.77)cGy.P＜0.05].结论 碳纤维体位固定板对椎体转移瘤患者的放射治疗剂量有一定的影响,为确保靶区剂量准确性,建议在治疗计划设计时考虑体位固定板,使其参与剂量计算.

目的 利用4种测量手段确定Luna-260型全身伽马刀各个准直器的输出因子,为伽马刀质量控制提供合理的测量方式和参考依据.方法 采用PTW微型宝石探测器60019、PTW指形电离室31010、IBA指形电离室cc04和EBT3胶片分别进行测量.在相同温度、气压测量条件下,使用不同的测量方式在伽马刀等中心位置处进行相同时间照射,归一化后得出输出因子并与计划系统中的输出因子进行比较.结果 测量大于3号准直器射野(14 mm×14 mm)的准直器输出因子时,各种测量方法得到的结果差异较小,最大误差为-0.9％;但测量小于3号准直器射野(14 mm×14 mm)的准直器输出因子时,不同测量工具的测量结果有着明显的差别,尤其射野尺寸最小的1号准直器(6 mm×6 mm)最大偏差达到-72％.结论 Luna-260型全身型伽马刀因准直器的特殊性,射野输出因子的测量选择EBT3胶片或者灵敏体积较小的宝石探测器60019等方式能得到准确的结果.

目的 分析脑转移瘤患者行立体定向放疗后发生颅内新发转移的危险因素.方法 选取2016年13月至2020年10月在解放军总医院第五医学中心放射治疗科治疗的98例脑转移瘤患者.根据患者经立体定向放疗后是否发生颅内新发转移,将患者分为转移组(65例)和未转移组(33例),并分析患者的原发肿瘤类型以及立体定向放疗疗效.采用Logistic多因素回归分析影响患者发生颅内新发转移的独立危险因素,建立列线图预测模型并验证.结果 原发肿瘤的类型中肺癌患者最多(50例,51.02％),其次是乳腺癌患者(48例,48.98％).患者经立体定向放疗,其中放疗有效者有81例(82.65％),放疗无效者有17例(17.35％);治疗后复发者有13例(13.27％),无复发者有85例(86.73％).Logistic多因素回归分析发现,KPS70、多发脑转移灶、脑转移瘤体积4 cm3以及体部肿瘤(体部肿瘤)进展,均为患者发生颅内新发转移的独立危险因素(P＜0.05).校准图表明,列线图预测模型与标准曲线有良好的拟合度,该模型预测患者行立体定向放疗后发生颅内新发转移的概率与实际发生颅内新发转移的概率具有良好的一致性.DCA曲线表明,该预测模型对于患者发生颅内新发转移风险有良好的临床应用价值.结论 KPS70、多发脑转移灶、脑转移瘤体积4 cm3以及体部肿瘤进展,均为患者发生颅内新发转移的危险因素.本研究旨在为临床上提高脑转移瘤患者经立体定向放疗的治疗效果提供依据,改善患者预后.

目的:观察比较调强放疗与三维适形放疗治疗宫颈癌的临床效果及安全性.方法:选择某医院收治的宫颈癌90例,根据辅助放疗方式不同,随机分为调强放疗组与三维适形放疗组各45例.两组均采用定位CT扫描,扫描后将图像数据传送至治疗计划系统.根据获得的CT图像勾画靶区,宫颈癌术后瘤床区为临床靶区,临床靶区在三维上均匀外扩1 cm为计划靶区;同时,勾画危及器官.三维适形放疗组采用4野盒式照射技术,通过剂量体积直方图评估治疗计划,要求95％的处方剂量包绕计划靶区;调强放疗组采用5野共面调强技术,危及器官剂量体积按照相关标准限定.观察比较两组治疗后生活质量、不良反应发生情况;随访2年,观察比较两组复发、转移及生存情况.结果:调强放疗组治疗后功能状态(KPS)评分分值为(84.67±6.25)分,非常显著高于三维适形放疗组的(78.22±7.16)分(P＜0.01);调强放疗组放射性肠炎、放射性膀胱炎、白细胞计数降低以及恶心、呕吐的发生率,均显著低于三维适形放疗组(P＜0.05);随访2年,两组局部复发率、远处转移率和生存率比较,均差异不显著(P＞0.05).结论:调强放疗与三维适形放疗治疗宫颈癌远期效果相当,但调强放疗更安全,可显著减少不良反应,减轻患者痛苦,进而提高患者生活质量.

目的:探讨使用4种不同体位固定方式用于乳腺癌放疗定位,并对4种不同的固定方式的摆位精度分析和比较,为临床应用提供参考.方法:选取2018年11月至2019年1月我院收治的乳腺癌放疗患者34例,其中乳腺癌保乳术后患者20例,乳腺癌根治术后(锁骨上下区放疗)患者14例.将乳腺癌保乳术后患者20例分为A、B两组,分别采用负压垫加头膜固定和乳腺托架固定;将乳腺癌根治术后患者14例分为C、D两组,采用颈肩膜固定(C组双手置于体侧)(D组患侧手抓耳).用Philips Bigbore大孔径CT模拟机进行定位扫描,图像传输到Varian Ecplipse治疗计划系统进行重建,计划设计.对所有参与研究的患者首次治疗完成后,进行CT下复位验证,并将验证图像与计划图像配准,测量治疗中心坐标误差,用SPSS 18.0统计软件对数据进行统计分析,给出摆位误差.结果:A组在X、Y、Z方向上的摆位误差分别为(1.7±1.9)mm、(2.1±2.9)mm、(2.0±1.2)mm;B组在X、Y、Z方向上的摆位误差分别为(2.8±1.1)mm、(3.7±1.1)mm、(4.8±1.3)mm;C组在X、Y、Z方向上的摆位误差分别为(2.1±1.6)mm、(2.1±1.5)mm、(3.6±3.1)mm;D组在X、Y、Z方向上的摆位误差分别为(1.0±0.5)mm、(1.9±1.5)mm、(3.6±1.9)mm.A组在Y、Z方向的摆位误差小于B组(P=0.048、0.038),A、B两组在X方向的摆位误差比较,差异无统计学意义(P>0.05);C、D两组在X、Y、Z方向的摆位误差比较,差异无统计学意义(P>0.05).结论:乳腺癌保乳术后患者的放疗,全乳加锁骨上的一体化的调强技术,用负压垫加头膜固定技术比用乳腺托架固定技术减少了摆位误差;乳腺癌根治术后患者放疗,用颈肩膜固定技术的两种体位对摆位误差无太大差异,为了减少相邻野衔接问题引起的剂量误差建议采用手抓耳体位.

针对后装治疗用192 IF放射源的参考空气比释动能率的量值急需进行溯源.参考国际通例,由指型电离室(PTW-30013)在60Coγ射线和250 kV X射线下的空气比释动能校准因子推导得出192Ir γ射线的空气比释动能校准因子,从而测定192Ir放射源参考空气比释动能率标准值,进而完成对井型电离室的参考空气比释动能率校准.通过不确定度评定得出:192Ir放射源的参考空气比释动能率的不确定度为3.6％,井型电离室校准因子的不确定度为3.8％.

目的:研究固定铅门8野调强技术(8F-SJT)应用于左侧乳腺癌保乳术后的剂量优势,并与常规6野调强技术(6F-IMRT)进行剂量参数比较.方法:对10例左侧乳腺癌保乳术后患者分别制定固定铅门8野调强放疗计划和常规6野调强放疗计划,在保证靶区(PTV)处方剂量前提下,尽量降低危及器官受量,比较两组治疗计划的剂量-体积直方图(DVH),评估靶区及危及器官剂量参数.结果:2种调强技术计划之间比较,8F-SJT改善了靶区适形指数(CI),差异具有统计学意义(P<0.05),8F-SJT靶区最小剂量(Dmin)、最大剂量(Dmax)、平均剂量(Dmean)以及剂量均匀指数(HI)与6F-IMRT相比,差异无统计学意义(P>0.05);8F-SJT左肺V20、V30及Dmean明显低于6F-IMRT(P<0.05),8F-SJT左肺V5、V10与6F-IMRT相比,差异无统计学意义(P>0.05);8F-SJT心脏V5、V10、V20、V30及Dmean均明显低于6F-IMRT(P<0.05);8F-SJT右侧乳腺和冠状动脉左前降支(LAD)的Dmax、Dmean均明显低于6F-IMRT(P<0.05).结论:左侧乳腺癌保乳术后固定铅门8野调强计划要优于常规6野调强计划,可以考虑临床实践.

目的 利用四维CT(4DCT)测量肝脏八段内病灶随呼吸运动产生的位移,用以确定体部伽玛刀肝脏各段病灶放射治疗所需的内靶区(ITV).方法 选择2014年3月至2018年10月在解放军总医院第五医疗中心医院行伽玛刀治疗肝癌患者30例,其中男性13例,女性17例;年龄32～76岁,中位年龄60岁.分别行非门控扫描(计划图像)和4DCT扫描,在4DCT得到的10个呼吸时相的图像上分别勾画肝内占位性病灶并测量靶区体积(GTV)中心在三维(3D)方向的位移大小,得到呼吸动度值,此动度值作为计划图像上GTV需要外扩的范围,得到ITV.结果 共有75个肝内占位性病灶,Ⅰ段内病灶9个,Ⅱ段12个,Ⅲ段10个,Ⅳ段11个,Ⅴ段9个,Ⅵ段7个,Ⅶ段7个,Ⅷ段10个.肝脏八段内病灶的呼吸动度不同,其中Ⅰ段内病灶3D方向呼吸动度最小,病灶中心点在左右、前后、头脚方向的位移分别为(0.14±0.06)cm、(0.19±0.05)cm、(0.70±0.19)cm;Ⅱ段内病灶3D方向呼吸动度最大,病灶中心点在左右、前后、头脚方向的位移分别为(0.22±0.09)cm、(0.31±0.15)cm、(1.05±0.22)cm;病灶在头脚方向的呼吸动度大于左右方向、前后方向,差异均有统计学意义(P均＜0.05).病灶在前后方向的呼吸动度大于左右方向,但差异无统计学意义(P＞0.05).结论 应用4DCT得到的肝脏八段内的病灶动度,可以准确确定肝脏各段病灶ITV.在体部伽玛刀治疗肝脏肿瘤时应用4DCT扫描能够保证治疗的精度,提高疗效.

Objective:To explore the dosimetric characteristics of whole brain radiotherapy (WBRT) and CyberKnife stereotactic radiotherapy (SRT) in breast cancer patients with 4-9 brain metastases.Methods:The clinical and imaging data of 10 breast cancer patients with 4-9 brain metastases in the Fifth Medical Centre, Chinese PLA General Hospital between March 2015 and November 2015 were retrospectively analyzed. CT and magnetic resonance imaging (MRI) images were imported into the treatment planning system to achieve the fused images for delineating. A radiotherapy treatment plan was designed after delineating the target area. WBRT was administered with two fields, and the prescription dose was 30 Gy in 10 fractions. SRT was administered by the CyberKnife with the prescription dose of 16-18 Gy in one fraction. The volume and dose of the tumor target area, optic nerve, optic chiasm, brain stem, hippocampus and other critical organs were calculated; and radiotherapy dose indexes of WBRT and SRT were compared after conversion to a biological effective dose (BED).Results:The maximum dose (BED 4) in the SRT group was higher than that in the WBRT group [(191.0±41.3) Gy vs. (52.5±0.0) Gy, t = 10.596, P < 0.01]. The brain tissue and tumor in the target area of WBRT received the same uniform dose of 120.0 Gy. The median maximum dose of BED 1 of partial organs at risk in the SRT group was lower than that in the WBRT group [(left optic nerve: 3.9 Gy (0.1-11.2 Gy), right optic nerve: 3.9 Gy (0.2-8.9 Gy), optic chiasm: 5.1 Gy (3.8-19.4 Gy); all P < 0.05]. The median volume dose of BED 1 in the SRT group were lower than that in the WBRT group (brain stem V 1/3: 4.5 Gy (1.9-5.7 Gy), normal brain tissue V 2/3: 3.1 Gy (1.3-4.3 Gy), left optic nerve 0.2 cm 3: 2.7 Gy (0.0-8.8 Gy), right optic nerve 0.2 cm 3: 3.0 Gy (0.0-6.7 Gy), optic chiasm 0.2 cm 3: 3.6 Gy (2.5-14.8 Gy), left hippocampus V 1/3: 5.4 Gy (2.1-10.4 Gy), right hippocampus V 1/3: 4.6 Gy(2.4-12.5 Gy); all P < 0.05). Conclusion:The dosimetric simulation results show that SRT for breast cancer patients with 4-9 brain metastases result in a significantly higher dose of the tumor target area and a significantly lower dose of some organs at risk compared with WBRT; and organs at risk meet the requirement of the dose constraints.

目的 探讨端对端(E2E)测试在直线加速器放射治疗质量控制中的应用,验证其可行性,为加速器质量控制提供一种新方法.方法 采用放射治疗专用Philips Brilliance 16排大孔径CT模拟定位机获取Lucy头颈部模体影像,传输到Eclipse v.7.6(Varian Medical Systems)治疗计划系统进行图像重建,按照E2E测试计划要求设计调强计划.将装有EBT3胶片的Lucy头颈部模体分别置于Varian 23EX、Varian iX、Varian 600CD 3台直线加速器上,模拟执行计划.计划执行完毕后取出照射胶片,利用扫描仪扫描胶片,通过E2E软件分析扫描胶片给出测试结果.结果 Varian 23EX在左右方向偏差(△x)、前后方向偏差(△y)、头脚方向偏差(△z)分别为(-0.41±0.25)mm、(-0.50±0.31)mm、(0.85±0.31) mm;Varian iX在△x、△y、△z分别为(-0.35±0.69)mm、(0.09±0.26) mm、(1.14±0.44) mm;Varian 600CD在△x、△y、△z分别为(0.00±0.61) mm、(-1.00±0.68)mm、(0.12±1.30) mm,Varian 23EX、Varian iX、Varian 600CD 3台直线加速器治疗总偏差分别为(1.13±0.22) mm、(1.39±0.13) mm、(1.64±0.28) mm,均满足加速器治疗偏差≤2 mm的要求.结论 E2E测试应用于直线加速器放射治疗质量控制是可行的,测试结果是可信的,对于加速器综合质量控制具有非常高的使用价值.

BackgroundPrevious studies have documented a high incidence of toxicity in patients with ultra‐central non‐small cell lung cancer (UC‐NSCLC) treated with stereotactic body radiation therapy (SBRT). However, these studies mainly focused on early stage patients and included small sample populations. We reviewed the outcomes and toxicity of SBRT in patients with advanced stage UC‐NSCLC treated at our institution.MethodsFifty‐one consecutive patients with advanced UC‐NSCLC treated with SBRT using a regular regimen of 35 Gy administered in five fractions between December 2014 and August 2017 were reviewed. UC was defined as tumors abutting or overlapping the trachea or the proximal bronchial tree. We included locally advanced patients who were unfit or unwilling to receive conventional chemoradiotherapy and patients with metastatic or postoperative recurrent disease. Clinical outcomes, dosimetric parameters, and SBRT toxicity were analyzed.ResultsThe median age was 63 years (range: 35–82), and the median tumor diameter was 6.8 cm (range: 2.1–12.4). The overall median follow‐up duration was 17 months (25.5 months for surviving patients). The median local control was 17 months for stage III patients and 11 months for stage IV or recurrent patients. Grade 3 or higher toxicity was observed in 9.8% of patients: G3 radiation pneumonitis (5.9%) and possible treatment‐related death (3.9%).ConclusionSBRT with a moderate dose in 4–6 fractions is effective and tolerable for patients with advanced stage UC‐NSCLC. However, caution should be taken considering possible treatment‐related death. Further studies are warranted.

Aim: To analyze the efficacy and toxicity of stereotactic body radiotherapy (SBRT) versus intensity-modulated radiotherapy (IMRT) in stage III patients with ultra-central squamous non-small-cell lung cancer (sqNSCLC). Methods: Forty-four stage III patients with ultra-central sqNSCLC receiving SBRT (n = 15) or IMRT (n = 29) between December 2014 and August 2017 were reviewed. Results: At a median follow-up of 16.5 months, the 1-year local control rate of SBRT and IMRT was 60.8 and 37.5%, respectively (p = 0.23); the median overall survival was 17 versus 18 months (p = 0.48); ≥3 grade toxicity was 20 versus 24.1% (p = 0.83). Conclusion: SBRT is effective and patient friendly for stage III patients with ultra-central sqNSCLC. Toxicity might be tolerable with a moderate dose five to six fraction regimen. However, more prospective studies are warranted.

目的:比较左侧乳腺癌保乳术后自由呼吸、吸气末屏气两种呼吸模式下放射治疗计划的靶区、心脏、冠状动脉左前降支、左肺以及右侧乳腺等危及器官的剂量参数,探索在左侧乳腺癌保乳放疗中能最大程度减少靶区周围重要组织器官受照体积和剂量的呼吸模式.方法:选取左侧乳腺癌保乳术后的患者10例,年龄38 ～ 65岁,采用乳腺托架进行体位固定.用Philips Brilliance 16排大孔径CT定位机进行图像扫描,扫描层厚3 mm,分别采集自由呼吸(free breath,FB)、吸气末屏气(inspiration breath hold,IBH)两种呼吸模式下的CT图像.将CT图像传输到Varian Eclipse治疗计划系统进行图像重建,勾画靶区及危及器官,分别设计两种呼吸模式下的6野调强计划,比较两种呼吸模式下的靶区和危及器官剂量学参数.结果:FB、IBH两种呼吸模式下,靶区的最大剂量、平均剂量、均匀指数及体积差异均无统计学意义(P＞0.05).FB、IBH两种呼吸模式下危及器官受量对于心脏:D max分别为(46.61±1.68) Gy、(39.29±8.40) Gy,Dmean分别为(6.74±4.00)Gy、(5.39 ±4.12)Gy,差异均有统计学意义(P＜0.05);V5、V10、V20、V30的差异也均有统计学意义(P＜0.05).冠状动脉左前降支(LAD):Dmax分别为(39.64 ±4.31)Gy、(30.54 ±9.08) Gy,Dmean分别为(31.21 ±7.70) Gy、(22.72 ±9.36) Gy,差异均有统计学意义(P＜0.05).左肺:Dmean分别为(9.11 ±2.61) Gy、(8.74 ±2.01)Gy,差异无统计学意义(P＞0.05);V5、V10、V20、V30的差异也均无统计学意义(P＞0.05).右侧乳腺:Dmax分别为(4.76±1.94) Gy、(5.06 ±2.15)Gy,Dmean分别为(1.32±1.01)Gy、(1.30 ±0.94) Gy,差异均无统计学意义(P＞0.05).结论:左侧乳腺癌保乳术后两种呼吸模式计划比较,靶区受照剂量、左肺受照剂量及右侧乳腺受照剂量均无明显差异.吸气末屏气技术明显降低了心脏、LAD的受照剂量.

A 75-y-old Chinese female patient diagnosed with lung adenocarcinoma with brain metastasis suffered severe nausea and vomiting, and these symptoms were contraindications for CyberKnife treatment. Neither mannitol, nor dexamethasone, relieved the symptoms. However, after the patient received a single dose of bevacizumab (200 mg, 2.9 mg/kg), the patient's symptoms were significantly relieved. The patient subsequently completed a successful CyberKnife treatment. In addition, the patient received an oral treatment of gefitinib. At 15 months post treatment, the patient's brain tumor was controlled. Thus, administration of bevacizumab at a low dose (2.9 mg/kg) may significantly alleviate peri-tumoral brain edema and its symptoms, thereby facilitating radiosurgery treatment.

目的 通过对基于旋转拉弧调强的立体定向放疗(RapidArc-SBRT)与调强放疗(IMRT)的治疗计划的比较、分析,从物理剂量上评估了RapidArc-SBRT与IMRT各自的优势,并指出临床应用中应注意的问题.方法 选取20例非小细胞肺癌(NSCLC)患者进行研究,要求患者靶区比较规则,最大直径不超过5 cm,距脊髓的间隙至少大于1 cm.RapidArc-SBRT计划采用旋转拉弧适形技术,IMRT采用固定野动态调强技术,所有计划的处方剂量均为60 Gy,选取合适的方案作为最终的比较计划.结果 RapidArc-SBRT计划肺的V5、V10明显高于IMRT计划,但V15、V20、V30、V40低于IMRT计划;脊髓、食管受量与距计划靶区(PTV)的距离大小有关,心脏的RapidArc-SBRT计划有降低的趋势;2种计划靶区的适形指数(CI)相差较小,RapidArc-SBRT计划的靶区均匀性优于IMRT计划;RapidArc-SBRT计划在治疗总跳数和治疗时间上有明显优势.结论 对于合适的NSCLC患者,RapidArc-SBRT计划具有一定的优势,靶区剂量更均匀,总治疗跳数少,治疗时间短.

The outcome of recurrent brain metastasis is dismal. This study aims to assess the clinical outcomes and toxicity of reirradiation as a salvage treatment for progressive brain metastasis in patients with advanced breast cancer. Between July 2005 and September 2014, the medical records of 56 patients with brain metastasis from breast cancer were retrospectively reviewed. Of these patients, 39 received whole-brain radiotherapy (WBRT) followed by stereotactic radiosurgery (SRS) reirradiation (Group 1), and 17 received SRS followed by WBRT reirradiation (Group 2). Overall survival (OS) and brain progression-free survival rates/times were calculated using the Kaplan-Meier method. Prognostic factors were evaluated using the Cox proportional hazards model. Change in neurologic function was also assessed. The median OS was 10.8 months (range, 1.3-56.8 months). In Group 1, the median PFS time (PFS-1) was 6.5 months and the OS time was 11.4 months. Multivariate analysis revealed that longer OS was significantly associated with a high Karnofsky performance score (KPS) (P = 0.004), controlled extracranial metastasis (P = 0.001) and a good response to reirradiation (P = 0.034). In Group 2, the median PFS time (PFS-2) after reirradiation was 8.5 months and the OS time was 10.8 months. Multivariate analysis revealed that longer OS was significantly associated with a high KPS (P = 0.018). The majority of the patients had improved or stable neurological function. Reirradiation is an effective and a safe treatment for patients with brain metastases from breast cancer. It might delay the progression of intracranial disease and improve neurological function. A suitable patient selection for reirradiation was suggested.

碘造影剂是为增强影像效果观察而注入人体组织或器官的化学制品,是放疗CT定位常用的药品之一.为预防造影剂外渗,临床护理可通过提高穿刺技术、血管的合理选择、患者的健康教育及CT定位时的体位配合等多个方面进行干预,但由于患者不适当活动和碘造影剂注入的速度要求对血管造成的较大压力都会导致造影剂外渗.本文介绍的是我科使用舒康博治疗碘造影剂外渗致皮肤水疱1例的护理体会.舒康博(水凝胶敷料,生产商地址:德国,规格:10 cm×10 cm)为透明的聚氨酯水凝胶敷料,用半透明的聚氨酯膜覆盖,含有聚氨酯凝胶、水、丙二醇和氯化钠的聚合物,可阻止细菌透过,可为伤口提供湿润的愈合环境,适用于肉芽组织生长过程不理想的慢性伤口的覆盖,如下肢溃疡、褥疮,还可用于Ⅱ度烧伤,凝胶冰凉舒适的作用可减轻伤口的疼痛.

A 40-year-old Chinese female patient, with radiation-induced brain necrosis after radiosurgery, was treated 6times with a single dose of 200mg (3.27mg/kg) bevacizumab each time, and with an interval of 12-16weeks between each treatment. Neurological symptoms such as dizziness, fatigue, and headache disappeared after each administration of bevacizumab. The results suggest that repeated bevacizumab treatment using a low-dose and long-dosing interval may significantly alleviate radiation necrosis and its symptoms.