目的 对贵州省宫颈癌后装治疗基本情况进行摸底调查,分析该项技术全省现状,发现存在问题并提出相应对策,为卫生行政部门规范宫颈癌后装治疗提供参考.方法 网络问卷结合现场调研.结果 截至2019年4月,贵州省有5家医疗机构,在3个州(市)开展宫颈癌后装治疗,全省在运营后装治疗机5台,百万人口拥有率0.14,均采用三维后装治疗技术;全省没有专职后装医师、物理师和治疗师;2018年全省宫颈癌后装治疗比49.30％.结论 设备不足、区域分布不均;医疗机构之间技术水平参差不齐;缺乏专职后装治疗专业队伍;病人对治疗信息获取不全等是贵州省宫颈癌后装治疗存在的主要问题.政策引导加快后装治疗机配置步伐;通过医联体建设,努力实现资源共享;充分发挥专业社团桥梁、纽带作用,促进专业队伍建设,推动后装治疗同质化发展;建立有效的质控指标体系等是解决目前贵州省宫颈癌后装治疗中存在问题的有效措施.

目的 探讨将放疗流程的中期评估作为临床质量保证(QA)和质量控制(QC)环节的必要性.方法111例同期放化疗Ⅲ期局部晚期非小细胞肺癌患者,放射治疗36～40Gy时进行中期评估,根据评估结果分为修改靶区组(78例,重新定位、融合图像)和未修改靶区组(33例,执行原放疗计划);采用同期放化疗,化疗以铂类为基础的两药联合方案,放疗为调强放疗技术,初始和中期评估均采用相同的增强CT定位扫描、靶区勾画、计划设计和评估原则;观察2组剂量体积参数[双肺平均肺剂量(MLD)、全肺接收5Gy或以上辐射剂量的体积百分比(V5)、平均心脏剂量(MHD)]、放射性肺炎(RP)及放射性食管炎(RE);随访两组局部复发(LR)及局部无进展生存(LRPFS)情况.结果放疗疗程中期评估时,修改靶区组较未修改靶区组,在剂量体积参数中正常组织MLD、V5和MHD有降低,差异有统计学意义(P<0.05),表明在放疗流程中进行中期评估并及时调整放疗计划,可以降低正常肺、心脏受照射的剂量体积,从而保护正常组织器官;2组病例RE、RP发生率、局部复发、局部无进展生存比较,差异无统计学意义(P>0.05),结果表明放射治疗流程中重新调整放疗计划的中期评估,对放射性肺炎、放射性食管炎及局部控制率无影响,修改靶区安全可行.结论放疗流程中期进行中期评估并对肿瘤缩小明显患者调整放疗计划不影响疗效,可作为放射治疗临床QA/QC质控环节.

目的 比较宫颈癌三维近距离放疗前诊断性MRI图像与定位CT图像勾画肿瘤靶区的差异性,以探讨CT定位进行宫颈癌三维近距离放疗的可行性.方法 回顾性分析2017年至2019年我院收治的符合纳入和排除标准的100例宫颈癌患者,比较MRI和CT图像勾画的靶区差异,探讨CT定位放疗计划的靶区和危及器官剂量及毒副反应发生率.绘制受试者工作特征(ROC)曲线,获得MRI图像勾画靶区体积的最佳截断值.靶区体积剂量的比较采用配对样本t检验,毒副反应发生率的比较采用卡方检验或Fisher精确概率法.结果 根据三维近距离放疗前诊断性MRI图像上勾画的临床大体肿瘤体积(GTV)的最佳截断值,将患者分为两组:小体积组(GTVMRI≤3.48 cm3)和大体积组(GTVMRI>3.48 cm3).定位CT图像在小体积组勾画的GTV体积、宽度、厚度及高度与诊断性MRI图像上的差异均无统计学意义(P>0.05);诊断性MRI图像在大体积组勾画的GTV体积、宽度、厚度、高度均小于定位CT图像,差异有统计学意义(P<0.001).CT定位放疗计划在靶区和危及器官剂量及毒副反应发生率方面,小体积组与大体积组的差异均无统计学意义(P>0.05),均满足GEC-ESTRO在靶区覆盖和危及器官剂量限制方面的推荐标准.结论 对于小体积患者,靶区和危及器官剂量限制均达GEC-ESTRO推荐标准,可用CT定位代替MRI定位;对于大体积患者,建议优先选择MRI定位,但无法行MRI定位时,CT定位也是可行的.

目的:探讨乳腺浸润性导管癌的临床病理特征与体质量指数(BMI)的相关性.方法:收集809例经病理检查确诊为乳腺浸润性导管癌女性患者的年龄、身高、体质量、月经婚育史、免疫组化、分子分型、临床分期、空腹静脉血糖及生存随访等资料,计算BMI;根据BMI数值将其分为BMI正常组、中间组及肥胖组,分析临床病理特征与BMI的相关性.结果:纳入患者的中位年龄46岁,中位随访时间69个月,单因素χ2检验分析结果显示乳腺癌患者分子分型及治疗前空腹静脉血糖与BMI有关(χ2=4.935,P=0.046;χ2=7.228,P=0.038),肥胖组乳腺癌患者中三阴型乳腺癌比例较高,且患者空腹静脉血糖高于正常组及中间组,差异具有统计学意义(P<0.05);年龄、月经状态、肿瘤大小、临床分期、淋巴结状态与BMI无关(P>0.05).结论:乳腺浸润性导管癌的临床病理特征与BMI具有一定的关系,表现为肥胖的女性乳腺浸润性导管癌患者具有更差的分子分型,且其空腹静脉血糖水平高于正常.

目的 分析ⅡB期宫颈癌CT引导下三维近距离治疗患者的预后相关因素及探讨不同的靶区勾画体积对局部控制率的影响.方法 回顾贵州省肿瘤医院2014年1月至2016年12月的120例ⅡB期宫颈癌患者的临床资料,按三维近距离治疗时高危临床靶区(the high-risk clinical target volume,VHR CTV)以29.46 cm3(中位数)为界,VHR CTV≤29.46 cm3者为小体积组,VHR CTV＞ 29.46 cm3者为大体积组,分析预后因素及临床疗效、放疗副反应.结果 ①总体患者3年无进展生存时间(PFS):77.1％,总生存期(OS):78.7％,无局部区域复发生存率(LRRFS):92.1％.大小体积组3年OS、PFS和LRRFS差异无统计学意义(P＞0.05);②117例治疗有效的患者中2组疗效相当;③两组患者直肠、膀胱受量差异无统计学意义(P＞0.05);④两组患者放射副反应差异无统计学意义(P＞0.05).结论 ①本组患者中未发现影响ⅡB期宫颈癌患者的独立生存预后因素;②本组患者局部控制率与VHR CTV大小无相关性;③两组患者膀胱、直肠受量和放射性副反应发生率差异无统计学意义(P＞0.05).

目的 新辅助化疗越来越被广泛用于可手术乳腺癌患者.探讨改良Neo-Bioscore评分系统作为一种新的方法对我国乳腺癌新辅助化疗后生存预测作用.方法 收集贵州省肿瘤医院乳腺妇瘤科2007-07-08-2013-12-01行新辅助化疗的乳腺癌患者495例,每例患者根据CPS+EG评分系统(clinical-pathologic scoring system+estrogen receptor-negative disease and nuclear grade 3 tumor pathology)及改良Neo-Bioscore评分系统(clinical-pathologic scoring system+estrogen receptor-negative disease and nuclear grade 3 tumor pathology+HER2 positive)分别评分,采用Kaplan-Meier法对不同临床分期、不同病理分期、不同CPS+EG评分分值及不同改良Neo-Bioscore评分分值进行乳腺癌特异性生存(disease-specific survival,DSS)分析.结果 中位随访71个月,全组5年DSS为81％,95％CI为77.08％ ～84.92％.改良Neo-Bioscore评分系统计算每位患者所得分值,其DSS均随着分值增加而下降,差异有统计学意义,χ2=34.618,P<0.05;对于临床Ⅲ期、病理Ⅲ期、新辅助化疗后未达到病理完全缓解(pathological complete responses,pCR)的乳腺癌患者,随着改良Neo-Bioscore分值增加,其DSS明显降低,差异有统计学意义,χ2=33.018,P<0.05;对于HER2阳性及阴性的患者,随着改良Neo-Bioscore分值增加,其DSS明显降低,差异有统计学意义,χ2=29.233,P<0.05.根据所得分值的中位值分为高分值组(>3分)和低分值组(≤3分),改良Neo-Bioscore评分系统,高分值组DSS明显低于低分值组,差异有统计学意义,χ2=43.201,P<0.05;对于临床Ⅲ期、病理Ⅲ期、新辅助化疗后未达到pCR的乳腺癌患者,高分值组DSS明显低于低分值组,差异有统计学意义,χ2=25.675,P<0.05;对于HER2阴性的患者,改良Neo-Bioscore高分值组患者的DSS明显低于低分值组患者的DSS,差异有统计学意义,χ2=18.784,P<0.05.结论 改良Neo-Bioscore评估系统优化了接受新辅助化疗患者的分期和预后评估,有助于个体化设计患者的后续强化辅助治疗,以期改善生存、有效避免过度治疗及治疗不足,为乳腺癌个体化治疗提供参考.

目的:观察阴道扩张术预防局部晚期宫颈癌患者行放化疗后阴道狭窄的效果.方法:108例行同步放化疗后的局部晚期宫颈癌患者,分为阴道扩张组(n=57)和未扩张组(n=51),在治疗结束后6个月内,阴道扩张组定期到医院进行阴道扩张及冲洗,未扩张组自行冲洗阴道(1次/d),2组患者均随访5年,比较2组患者的阴道狭窄率、阴道粘连率、性生活正常率及患者1、3、5年生存率和阴道感染率.结果:阴道扩张组患者阴道狭窄、粘连的发生率明显低于未扩张组(P＜0.05),性生活正常率明显高于未扩张组(P＜0.05);两组患者阴道感染率及1、3、5年生存率比较,差异无统计学意义(P＞0.05).结论:阴道扩张可以明显降低局部晚期宫颈癌患者放化疗后的阴道狭窄.

目的 分析宫颈癌术后调强放射治疗(intensity modulated radiation therapy,IMRT)髂骨骨髓受照剂量、体积与血液学毒性的关系,探讨IMRT中髂骨骨髓的剂量限制.方法 选择2007 07-01 2011-07 31贵州省肿瘤医院收治的宫颈癌根治术后辅助放疗的56例患者为研究对象.放疗采用IMRT联合阴道残端近距离治疗,并行紫杉醇+顺铂同期和(或)同步化疗2～4个周期.髂骨骨髓勾画在定位CT上进行,包括股骨头水平以上的全部髂骨,仅画骨髓腔而不包括骨皮质,勾画时窗宽为500 HU,窗位为200 HU.治疗期间每周复查血常规.血液学毒性按CTC 3.0标准评估,以放疗过程中白细胞、中性粒细胞绝对值、血红蛋白和血小板计数中最低1次作为分级评估记录.将Ⅰ～Ⅱ级血液学毒性定为阴性,Ⅲ～Ⅳ级血液学毒性定为阳性.分别比较血液学毒性的程度(阴性或阳性)与髂骨骨髓受照体积(V10、V20、V30、V40和V50分别表示10、20、30、40和50 Gy照射体积占整个体积的百分比)之间的关系.结果 56例患者髂骨骨髓体积为(138.31～184.43) cm3,中位体积164.41 cm3.血液学毒性Ⅰ级11例(19.6％),Ⅱ级12例(21.4％),Ⅲ级26例(46.4％),Ⅳ级7例(12.5％).阴性血液学毒性患者占总患者的41.1％(23/56),阳性患者则占58.9％(33/56).血液学毒性阳性发生率在V30(P=0.004)、V40(P=0.031)、V50(P-0.037)组间差异有统计学意义.单因素Logistic回归分析显示,仅髂骨骨髓V30(P=0.018)和V40、(P=0.039)差异有统计学意义.多因素分析显示,髂骨骨髓V30、V40及化疗周期数均为影响血液学毒性发生率的独立因素.V40＞22.5％血液学毒性阳性发生率为78.6％,而V40≤22.5％时则仅为39.3％,P=0.003.同时化疗1～2个周期(同期化疗)患者血液学毒性阳性发生率为44.7％,3～4个周期(同期化疗+同步化疗)的患者则为72.5％,P=0.009 4.结论 宫颈癌术后IMRT中髂骨骨髓V40与血液学毒性的阳性(Ⅲ～Ⅳ级)发生相关,提示限制V40≤22.5％对于保护髂骨骨髓功能具有一定意义.而化疗周期的累加也是影响血液学毒性发生的关键因素.

Objective:To observe the effect of adjuvant chemoradiation in breast cancer with stageⅠ~Ⅱ after breast conservative surgery( BCS ). Methods:Sixty-five patients of breast cancer(Ⅰ~Ⅱ)received treatment of breast conservative surgery and the combination chemotherapy of anthracy-cline or taxane were adopted in postoperative therapy. The intensity modulated radiotherapy( ImRT) was used for the whole breast irradiation in adjuvant radiotherapy. The toxicity and side reactions, breast cosmetic result,local recurrence,distant metastasis and overall survival situation were ob-served. Results:After follow-up of 12 to 78 months,it was observed that 4-year survival rate was 100%,of which 3 cases appeared distant metastasis(3/65,4. 6%). In radiotherapy the major acute toxicity and side reactions wereⅠ~Ⅱdegree skin reactions(87. 7%)andⅠdegree myelo suppres-sion(46. 1%). The main side effects of chemotherapy wereⅠ~II degree myelo suppression(86. 4%),Ⅰ~Ⅱdegree gastrointestinal reactions(88. 1%)andⅡ~ Ⅲdegree hair loss(74. 6%). In breast cos-metic result,57 cases were excellent,accounting for 88%. 8 cases were unsatisfactory,accounting for 12%. Conclusions:The curative effect is certain forⅠ~Ⅱstage breast cancer treated with BCS plus adjuvant chemoradiation. The toxic and side effects are mild and the breast cosmetic result is satisfac-tory.

Objective:To observe the effect of different radiotheraPy methods for skin reactions,cosmetic effect, lung function,heart damage and survival after breast conserving surgery for early breast cancer. Methods:Collected 121 cases of breast cancer Patients receiving radiotheraPy in different ways after breast conserving surgery from 1998 to 2010. 37 Patients received conventional 2-D radiotheraPy,80 Patients received three dimensional radiotheraPy. Ra-diotheraPy with 6 MV-X-ray whole breast radiotheraPy of 50Gy,electronic wire external irradiation dosage of 10Gy or synchronous added to 6 0 Gy to tumor bed ,estradiol or Progesterone recePtor Positive with endocrine theraPy. Results:3-year survival rate was 97. 0%,5-year survival rate was 95. 0%,5-year disease free survival rate was 95. 0%,the local recurrence rate was 0%. The radiation-induced lung injury rate of conventional radiotheraPy was significantly higher than that of 3-DCRT(P=0. 010). Radiation induced heart injury rate of the left breast cancer was slightly higher than the right,but had no obvious statistical difference(P=0. 21). Two-dimensional radia-tion radioactive heart injury was significantly higher than that in three dimensional radiotheraPy,the difference was statistically significant(P=0. 007). Radioactive skin injury incidence of two dimensional radiation was significantly higher than that of the three-dimensional radiotheraPy,the difference was statistically significant(P=0. 003). Cos-metic effect was associated with radiation skin reaction,cosmetic effect of II° and above skin reaction of breast was worse than I°(P=0. 030). After breast conserving surgery received local radiotheraPy 3 - year survival rate was 98. 0%,5-year survival rate was 98. 0%,the survival rate of T1 and T2 were 100% and 97%,100% and 94%, 100% and 94%,the difference was statistically significant(P=0. 014). Conclusion:The local radiotheraPy after breast conserving theraPy significantly Prolonged survival,comPared conventional radiotheraPy,the 5 -year survival adwantage of 3-DCRT was not reflected,but in the Protection of lung,heart,skin and cosmetic result is better than conventional radiotheraPy.

乳腺癌保乳术后放疗常用的治疗体位有仰卧位和俯卧位，前者是常规治疗体位，后者近年来才逐步采用。本研究通过比较早期乳腺癌保乳术后仰卧位及俯卧位的全乳调强放射治疗（IM RT ）计划，旨在获取乳腺癌保乳术后俯卧位放疗的剂量学特征，支持临床放疗工作的开展。

Objective To investigate the dosimetric influence of pure carbon fiber treatment tabletop of Elekta Precise new linear accelerator in radiotherapy.Methods Surface-axis distance (SAD) technology was employed for the measurement.Two groups of fields were set and both of them were SAD opposed portals ( one of them went through the tabletop,while the other did not).A PTW electrometer and a 0.6 cm3 Farmer ionization chamber were utilized for comparison measurement.Then dose attenuation of the main table board,extended body board,the extended board for head,neck and shoulders,and the joints of these boards were calculated.Results Under the energy of 6 MV,the dose attenuations of the following locations were:1.4％ - 7.2％ at the main treatment table board; 2.8％ - 38.7％,1.4％ -30.1％,1.5％ -20.8％ and 1.4％ - 11.2％,respectively at distances of 1,4,7 and 8 cm from the joint of the main table board ;0.5％ - 5.0％ at the extended body board; 4.7％ - 15.4％ at distance of 1cm from the joint of the extended body board; 0.5％ -3.3％ at the neck position of the extended board for head,neck and shoulders; 5.3％ - 16.7％ at the shoulder positions; and 6.8％ -30.4％ at the joint between the extended boards and the main table board.Conclusions The dose attenuations of the new linear accelerator pure carbon fiber treatment tabletop vary at different locations. Considerable higher attenuations are observed at the table board joints than other locations.

三维治疗计划系统(treatment planning system,TPS)是采用三维水箱和均匀水模体测量机器数据并按一定数学模型拟合而成的参数进行剂量计算,但患者解剖部位是非均匀组织,TPS模型算法对不均匀组织能否进行准确的密度修正呢?为此探索非均质模体验证和分析Pinnacle3 TPS光子线数学模型进行剂量计算的精度。

Objective This study evaluates the feasibility of intensity-modulated radiation therapy (IMRT) to treat patients with 1 -5 brain metastases from non-small cell lung cancer (NSCLC).Methods 30 IMRT patients with brain metastases for NSCLC studied retrospectively.Whole brain radiotherapy plus three-dimensional conformal radiotherapy (WBRT + 3DCRT) and WBRT plus stereotactic radiotherapy ( WBRT + SRT) plans were generated.Planning target volume ( PTV ) and organs at risk dose were measured and compared by dose volume histogram.Differences were analyzed in the three techniques by Wilcoxon Z -test.Results D99％ of the shoulder ( D99％-D90％ ) from IMRT were higher than from WBRT +3DCRT and WBRT+SRT in all cases.From D15％ of slope (D90％-D10％) to D5％ of tail (D10％ -D1％ ),IMRT were lower than WBRT + 3DCRT and WBRT + SRT ( Z =- 4.72,P =0.000 and Z =- 4.72,P =0.000).D10％ and D5％ of IMRT were (35.1 ±1.42) Gy and (37.7 ±2.91) Gy,WBRT +3DCRT were (36.5±2.86) Gy and ( 39.1 ± 3.56) Gy ;WBRT + SRT were (36.2 ± 2.57) Gy and ( 38.7 ± 3.67) Gy.IMRT vs WBRT+ 3DCRT and WBRT + SRT were significant ( Z=-3.18,-3.18,P=0.001,0.001 and Z=- 4.11,- 3.02,P =0.000,0.002) in 13 patients with 3 - 5 brain metastases.The total mean monitor units were 14756.3,9614.8 and 9043.2 for IMRT,WBRT +3DCRT and WBRT + SRT plans,respectively,with a 38.7％ reduction from IMRT to WBRT + SRT (Z =-4.78,-4.78,P =0.000,0.000).The brain doses around metastases were similar in the three techniques with 1 -2 metastases,but IMRT was the best with 3 -5 metastases.Conclusions IMRT can advance brain metastases dose and improve the planning target minimum dose and spare the dose around brain metastases.Only IMRT is the best choice for just sparing the dose around brain metastases among 3 -5 brain metastases.

目的:测量施源器位置及外照射摆位的误差,评估自行设计的后装CT定位治疗床对施源器的固定效果;确定外照射调强治疗靶区外放产生计划靶区(PTV)的间距.方法:接受三维后装与外照射调强融合放疗的患者50人次,每位患者在每次布放施源器前均采用热塑成型膜固定在自行设计的后装CT定位治疗床上,而后植入并固定施源器,作定位螺旋CT扫描.在每次治疗前进行锥形束CT扫描获取三维CT图像,将此图像和计划设计所用的螺旋CT图像进行配准,得到施源器位置及外照射摆位误差的数值.误差由X(左右)、Y(头脚)、Z(腹背)方向的平移分量和围绕3个轴线的旋转角度分量(Rx、Ry、Rz)构成.统计分析误差数据,用二参数法计算产生计划靶区的间距.结果:灰度配准的平移误差为X(0.18±0.15)cm、Y(0.22±0.12 )cm、Z(0.17±0.13)cm,旋转角度误差为RX(1.71°±1.09°)、RY(1.31°±1.04°)、RZ(0.73°±0.44°);施源器作为配准标志手动配准的平移误差为X(0.11±0.09)cm、Y(0.12±0.05)cm、Z(0.16±0.10)cm,旋转角度误差为RX(0.51°±0.16°)、RY(0.15°±0.08° )、RZ(0.23°±0.21°);计划靶区的X、Y、Z外放间距分别为0.47、0.58、0.43cm.结论:应用锥形束CT技术可准确测量自行设计的后装定位治疗床对施源器的固定摆位误差,确定产生计划靶区所需的外放间距能有效地保证三维后装放疗的精确实施;

Objective To investigate the influence of two different prone positions with belly-board on target motions and their dose distributions in pelvic 3-Dimension intensity-modulated radiation radiotherapy of cervical cancer.Methods The motion ranges of GTV under two different prone positions with belly-board(The first prone position: the lower end of belly-board hole opening near the upper end of lumbosacral junction;the second prone position: the lower end of belly-board hole opening near the lower end of the sacroiliac joints) and the dose-volume histograms of GTV,CTV and PTVwere measured for all 10 cervical cancer patients received pelvic radiotherapy,and the relationship of them was compared.Results The target motions under two different prone positions with belly-board are existed in the abdomen-back' directions(1~1.5cm),and have statistical significance(P<0.05),while there is no statistical significance in the head-feet' directions and left-right' directions(P>0.05);But the dose-volume histogram changes of GTV,CTV and PTV under two different prone positions with belly-board are no Statistical significance(P>0.05).Conclusion The target motions under two different prone positions with belly-board are existed,but they have no influence on dose-volume histograms of themselves.

Objective To identify the best technique of postmastectomy radiation therapy (PMRT).Methods Twenty-eight patients with stage Ⅱ or Ⅲ invasive breast cancer were treated with modified radical mastectomy and radiotherapy sequaciously involving the supraclavicular region and the chest wall.Three different techniques were developed for each patient:two tangential conformal fields ( half field) in the chest wall plus supraclavicular intensity modulated radiotherapy (3D-CRT + IMRT),integrated chest wall and supraclavicular IMRT(IMRT),and two tangential conformal fields (half field) in the chest wall plus single field electron beam radiotherapy in the supraclavicular region( 3D-CRT + E).The dose distributions of the target areas and the irradiated volumes of the ipsilateral lung ( V5,V10,V20,and V45)were estimated with the dosage volume histogram (DVH).The dosage prescription was 50.4 Gy (1.8 Gy × 28 f).Results The conformity index (CI) of the 3D-CRT + IMRT group was (0.61 ± 0.03),not different from that of the IMRT [ (0.62 ±0.03),q =2.16,P ＞0.05],and the CI levels of these 2 groups were both higher than that of the 3D-CRT + E group [ (0.44 ± 0.02 ),q =20.50,22.66,P ＜0.01 ].The heterogeneity index (HI) of the 3D-CRT + IMRT group was ( 1.17 ±0.02),not different from that of the IMRT [ (1.15 ±0.02),q =1.66,P ＞0.05],and the HI levels of these 2 groups were both lower than that of the 3D-CRT + E group[ ( 1.24 ±0.04),q =3.91,5.58,P ＜0.01 ].The levels of V5 and V10 of the ipsilateral lungs of the 3D-CRT + E group(48.70％ ±3.24％,38％.56％ ±3.70％ ) and 3D-CRT + IMRT group (49.12％ ±3.03％,38.38％ ± 3.56％ ) were all significantly lower than those of the IMRTgroup [(77.18％ ±8.01％,53.07％ ±6.85％),V5,q =20.35,20.05,P＜0.01; V10,q=12.10,12.24,P ＜0.01 ] and there were not significant differences in the V5 and V10 levels between the 3D-CRT + E and 3D-CRT + IMRT groups ( q =0.30,0.14,P ＞ 0.05 ).The levels of V20 of the ipsilateral lungs of the 3D-CRT + IMRT group (26.57％ ±2.51％ )and IMRT group (25.22％ ±2.77％) were all significantly lower that those of the 3D-CRT + E group [ (31.79％ ± 3.00％ ),q =5.27,8.21,P ＜ 0.01 ]and there were not significant differences in the V20 level between the 3D-CRT + IMRT and IMRT groups (q=2.76,P ＞ 0.05 ).There were not significant differences in the V45 levels among these 3 groups (F =0.69,P ＞ 0.05).Conclusions The 3D-CRT + IMRT technique in PMRT effectively reduces the radiated dose on the ipsilateral lung.

晚期喉癌在喉癌病例中所占比率很高,国内报道为36%～82%,国外为74%～83%[1].喉癌的主要治疗手段是手术和放疗及二者的结合,根据病变部位、范围及病期选择不同的方法.喉癌对放射治疗较为敏感,放疗能保留喉部正常结构和发音功能,提高患者的生存质量.如果放疗后复发,患者还可以通过半喉或全喉切除术获得第二次治疗机会.Ⅲ～Ⅳ期喉鳞癌的疗效和预后尚不能令人满意,治疗方法争议也较多.目前以手术为主的综合治疗仍是最主要的治疗方式,提高喉功能保留率的研究报告较多.国外多组随机试验显示,同步放化疗优于单纯根治放疗和术后辅助放疗[2],但同步放化疗也使急性不良反应明显增加.已有众多试验证实,采用肿瘤时间治疗学方式,可以提高抗肿瘤药的耐受性和有效性[3].本研究旨在观察调强放射治疗联合化疗治疗晚期喉癌的近期疗效及治疗的不良反应.

Objective: To observe the efficacy and safty of intensity-modulated radiation therapy (IMRT) plus concomitant and adjuvant chemotherapy of temozolomide (TMZ) for glioma patients with postoperative residual. The target dose distribution and the dose to organs at risk were analyzed by dosiology of radiotherapy. Methods: Twenty-one glioma patients with postoperative tumor residual were enrolled between April 2008 and June 2009, including 10 cases of gradeⅡand 11 cases of grade Ⅲ-Ⅳ within the WHO 2000 classification. All patients received IMRT with a total dosage of 59.92-64.20 Gy/ 28-30 fx and concomitant chemotherapy (oral TMZ 50-75 mg·m-1·d-1), followed by 6 cycles of adjuvant TMZ (150-200 mg·m-1·d-1, in a 28-d cycle) 4 weeks after IMRT. Results: There were 2 cases of complete response (CR), 17cases of partial response (PR), and 2 cases of stable disease (SD), and the overall response rate (CR+PR) was 90.5%. The overall response rates of patients with grade Ⅱ and Ⅲ-Ⅳ were 100% (10/10) and 81.8% (9/11), respectively. The one-year progression-free survival rate was 80.9% and the overall survival rate was 85.7%, which were both 100% in grade Ⅱ, whereas 72.7% and 81.8% in grade Ⅲ-Ⅳ, respectively. The dose of each critical organ in IMRT was obviously lower than the minimum tolerance dose in conventional radiation therapy, and the radiation-related toxicities were mild. All patients in this study could tolerate the regimen. Conclusion: IMRT combined with concomitant and adjuvant TMZ chemotherapy for gliomas has a higher short-term efficacy with less side effects, meanwhile the IMRT for protection of vital organs around the target has certain advantages. DOI:10.3781/j.issn.1000-7431.2011.05.009

BACKGROUND & OBJECTIVE: Radiotherapy is a mainstay in the management of glioma.In this study,we investigated the change of congnitive function and activities of daily living after treatment of intensity-modulated radiation therapy(IMRT) plus concomitant temozolomide in patients with glioma.METHODS: From Feb 2008 to Feb 2010,twenty-eight postoperative patients with pathologically confirmed glioma were treated with IMRT plus concomitant oral temozolomide of 50-75 mg/㎡·d.Among the 28 patients,fifteen cases were diagnosed with astrocytoma grade Ⅱ and 13 cases with grade Ⅲ-Ⅳ,respectively.The short-term efficacy of radiation therapy was eveluated with RECIST criteria and the cognitive function and activities of daily living were evaluated with the Mini-Mental State Examination(MMSE) and Activity of Daily Living Scale(ADL).RESULTS: The overall response rate(CR+PR) was achieved in 85.1%(4 complete response,19 partial response) of patients,with 100% in patients with grade Ⅱ glioma(15/15) and 61.5%(8/13) in patients with grade Ⅲ-Ⅳ glioma.The MMSE score of patients was 21.80±6.74 before treatment,25.13 ± 3.87 during treatment and 25.45 ± 3.62 afer treatment(P < 0.05).CONCLUSION: The intensity-modulated radiation therapy combined with concurrent temozolomide chemotherapy treatment of brain gliomas can improve cognitive function and activities of daily living.