【摘要】 目的 研究Monaco治疗计划系统中不同参数设置对容积旋转调强放射治疗(VMAT)计划质量的影响，得出更合理的治疗计划参数设置以提高VMAT治疗质量。 方法 2010年1-5月间治疗3例患者，为食管癌、宫颈癌和鼻咽癌各1例，分别设置不同的计划参数进行容积旋转调强计划优化，通过多种评估指标比较各VMAT计划质量的差异，得出临床所需的MSC、MSS、SSF、Sm、MMS和MDR共6个治疗计划参数对VMAT治疗质量的影响。 结果 MSC、MSS和SSF的3个参数对VMAT治疗质量不产生影响，有影响的Sm、MMS和MDR参数中，随着Sm和MMS值的增大，VMAT计划的剂量分布逐渐变差，但控制点数、机器跳数和照射时间均逐渐减小；随着MDR值增大，VMAT治疗的剂量分布先逐渐变差后不变，控制点数和机器跳数均是先增大后不变，而照射时间是先减小后不变。 结论 Sm、MMS和MDR 3个参数对VMAT计划质量有较大影响，对不同的患者，设置合适的Sm、MMS和MDR值对提高计划质量非常重要。【Abstract】 Objective To investigate the impacts of parameter settings on the quality of plans for the volumetric modulated arc therapy (VMAT) with Monaco treatment planning system. Methods Three patients who underwent VMAT from January to May 2010 were selected. The planning optimizations were processed by setting different planning parameters, including MSC, MSS, SSF, Sm, MMS and MDR, respectively. Then the quality of each plan with a certain set of parameters was evaluated by various evaluation indexes. The differences of quality among different plans were analyzed by comparing these indexes. Results There was no influence on the quality of VMAT planning for the parameter MSC, MSS and SSF to be set with different values. However, the other three parameters, MSC, MSS and SSF , affected the quality of VMAT planning with different values. Along with the aggrandizement of Sm and MMS value, the dose distribution of VMAT plans gradually became bad, while the number of control points, machine monitor units and irradiation time were gradually reduced. And along with the aggrandizement of MDR value, the dose distribution of VMAT plans became bad gradually until a constant state was reached, and both the number of control points and machine monitor units increased at first and then kept constant, while irradiation time decreased at first and then kept constant. Conclusion The selections of parameter Sm, MMS and MDR impact the quality of VMAT planning greatly. It is very important to set the suitable value of Sm, MMS and MDR to get the best planning quality for patients with different complexity.
摘要:目的：探讨超声引导下组织间插植内照射治疗中晚期宫颈癌的意义和效果。方法:回顾性分析32例中晚期宫颈癌患者,采用超声引导下肿瘤组织间插植内照射+外照射。结果：有23例肿瘤脱落,宫颈原形出现,其余7例肿瘤缩小50%以上,持续时间均≥1个月,另有2例肿块缩小＜50%,即CR为719%,PR为218%,NC为63%,PD为0%。结论：超声引导下插植内照射是一种治疗中晚期宫颈癌的安全有效的近距离放疗技术。Abstract: Objective: To evaluate the efficacies of interstitial implant brachytherapy by ultrasoundguided for moderately advanced and advanced cervical carcinoma. Methods: Thirytwo patients with cervical cancer ⅡbⅣ who received interstitial implant brachytherapy by ultrasoundguided and routine irradiation. Results: 719% cases achieved complete remission (CR), 219% cases partial remission (PR), 63% cases no change(NC),0% case progressed disease（PD）. Conclusion: Interstitial implant brachytherapy by ultrasoundguided is an effective method for cervical tumor.
Objective To summarize the current advancement of preoperative radiotherapy for rectal cancer. Methods Relevant literatures about current advancement of preoperative radiotherapy for rectal cancer published domesticly and abroad recently were collected and reviewed. Results The lower local recurrence rate and longer disease-free survival time were observed in preoperative radiotherapy， compared with postoperative radiotherapy for rectal cancer. The recurrence rate was higher in short-course radiotherapy， compared with conventionally radiotherapy for stageⅢrectal cancer， but there was no significant difference for stageⅡrectal cancer. The biology molecular such as p53， CEA， Cox-2， EGFR， and VEGF had shown to be radiosensitive. Conclusions The proposal of preoperative radiotherapy for rectal cancer， could be prone to conventionally radiotherapy. There are more screening targets for preoperative radiotherapy in extensive exploration of diverse radiosensitivity. Biology molecular， developed gene expression profiling， and gene chips for rectal cancer may contribute to the individualization treatment.
Objective To observe the effect of cisplatin in bletilla hyacinthine particle chemotherapy combined with 125I brachytherapy on short-and long-term outcomes and the toxic and side effects in advanced gastric cancer. Methods One hundred seventy-six patients with stage Ⅱ or stage Ⅲ advanced gastric cancer underwent curative surgical resection were included in this study. They were randomly divided into brachytherapy and chemotherapy group (n=48), intraperitoneal chemotherapy group (n=32) and intravenous chemotherapy group (n=48), and other patients who abandoned radiotherapy and chemotherapy and signed informed consent form by themselves were considered as control group (n=48). The short-and long-term outcomes and the toxic and side effects were observed and the survival of all patients was analyzed by Kaplan-Meier method and Log-Rank test. Results For short-term outcomes, the total effective rate in 4 groups were 95.83%, 71.88%, 64.58% and 52.08% respectively, and the difference was significant (Plt;0.05). For long-term outcomes, the 3 -and 5-year mortality rate was 37.50% and 56.30%, and 5-year median survival time was (14±4.51) months (95%CI: 14.419-4.512) in brachytherapy and chemotherapy group patients. The 3- and 5-year mortality rate was 78.12%and 93.75%and 5year median survival time was (10.6±1.13) months (95%CI: 10.620-1.163) in intraperitoneal chemotherapy group patients. The 3-and 5-year mortality rate was 79.21%and 95.80%and 5-year median survival time was (11±3.10) months (95%CI: 11.130-3.162) in intravenous chemotherapy group patients. The 3-and 5-year mortality rate was 87.50%and 95.83% and 5-year median survival time was (9±2.30) months (95%CI: 10.024-1.180) in control group patients. Compared with the vein chemotherapy group, the short distance puts the chemotherapy group disgusting vomit, the marrow to suppress, the liver function harm, the kidney function harm formation rate to reduce obviously (Plt;0.05). Conclusion Cisplatin in bletilla hyacinthine particle chemotherapy combined with 125I brachytherapy can reduce the toxic and side effects of drugs and prolong survival time of patients with advanced gastric cancer.
Objective To evaluate the clinical efficacy and safety of hyperthermia combined with radiotherapy and chemotherapy (HRCT) for non-small cell lung cancer (NSCLC), so as to provide references for further clinical practice and research. Methods The databases such as The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched on computer from the date of their establishment to May 1st of 2011, and other sources as supplied were also retrieved to collect all the relevant randomized controlled trials (RCTs) on comparing HRCT with non-HRCT. The quality of the included trials was assessed according to the Cochrane Handbook 5.1 for Systematic Review and the features of this study as well. Meta-analyses were conducted by using RevMan 5.1 software. Results A total of eight RCTs involving 546 patients were included. The results of meta-analyses showed that: a) Total effective rate: The total effective rate of HRCT was higher than other non-HRCT therapies, and there were significant differences in HRCT compared with radio-chemotherapy, hyperthermia plus chemotherapy, and pure chemotherapy, the OR and 95%CI were 2.05 (1.18, 3.56), 3.41 (1.12, 10.38), and 6.11 (1.20, 31.16), respectively; and b) Safety evaluation: The incidence rates of radiation pneumonitis, radiation esophagitis and granulocytopenia were all lower in the HRCT group than that in the radio-chemotherapy group, but the significant differences were only found in the incidence rate of granulocytopenia (OR=0.34 (0.19, 0.59). Conclusion Compared with other therapies, HRCT tends to improve the clinical efficacy and safety for NSCLC, but this result needs to be proved by more clinical trials. HRCT is superior to the routine radio-chemotherapy in both efficacy and safety, but the relevant evidence for proving its long-term efficacy and safety is still required.
Objective To assess the efficacy and toxicity of the maintenance radiotherapy for epithelial ovarian cancer. Methods We searched MEDLINE (1950 to 2009), EMbase (1966 to 2009), The Cochrane Library (Issue 1, 2009), CBMdisc (1978 to 2009), CNKI (1979 to 2009), VIP (1989 to 2009) and relevant internet websites to identify randomized controlled trials (RCTs) of maintenance radiotherapy for epithelial ovarian cancer. The quality of the included trials was assessed by Cochrane Systematic Review Handbook. Meta-analyses were conducted by RevMan 5.0 and SPSS 10.0 software. Results A total of 5 RCTs involving 529 patients were identified. The result of meta-analyses showed that the whole-abdominal radiation increased the 5-year progression-free survival (PFS) at RR1.76 and 95%CI 1.13 to 2.73, while it showed no effect on the 5-year overall survival (OS) at RR1.30 and 95%CI 0.96 to 1.76. The main adverse reactions of maintenance radiotherapy for epithelial ovarian cancer included diarrhea and abdominal pains, whose severity was related to radiation dose. Conclusion The whole-abdominal radiation can increase the 5-year PFS while its effect on the 5-year OS needs to be further studied.
Objective To assess the clinical effectiveness, safety and cost-effectiveness of adjuvant radiotherapy(RT) for endometrial cancer compared to other treatmen. Method The following electronic databases were searched: MEDLINE, EMBAS, CancerLit, CBMdisc, CNKI. The Cochrane Library (Issue 3, 2007). Correlative websites, such as ‘google’, were searched by hand. The studies included in the references of eligible studies were additionally searched RCTs of adjuvant radiotherapy before March, 2007 comparing adjuvant radiotherapy with other treatment for endometrial cancer were included. Eligible RCTs were assessed for quality by two reviewers independently: criteria of concealment of treatment, blinding, standard validity and reliability of outcome measures, withdraw rate, intention-to-treat analysis and homogeneity between centers were analyzed for each study. All data were performed by a meta-analysis. Result Seven RCTs met the inclusion criteria/ Methodological quality was level B. Five RCTs were compared adjuvant radiotherapy (external beam radiotherapy (EBRT) and /or intracavitary radiotherapy (ICRT) with other treatment, Two RCTs including one RCT was compared two different fractionation schedules for postoperative vagina high-dose-rate(HDR) irradiation in endometrial carcinoma the other RCT was compared two different radiotherapy method (pelvic radiotherapy and vagina radiotherapy vs vagina radiotherapy) for endometrial carcinoma. No survival different were identified; none of the studies was powered enough to show a survival benefit. But who received RT had fewer local (pelvic and/or vagina) recurrences compared to women not receiving RT. Adverse effects is found more often in RT than in not RT, there is less localrecurrences in combined radiotherapy (pelvic radiotherapy and vagina radiotherapy) than in vagina radiotherapy. lowdose vagina radiotherapy had few vagina shortening than high-dose radiotherapy, there are the same 5-overall surviva, local recurrences and distant recurrences. Conclusions Adjuvant radiotherapy for endometrial can cer can better control local recurrences than observation for postoperative endometrial cancer. Effects about overall survival, distant recurrences and disease-free survival are similar; low-dose vagina radiotherapy has few vagina shortening than high-dose radiotherapy, there are the same 5-years overall survival, local recurrences and distant recurrences for endometrial cancer, there is less local recurrences in combined radiotherapy (pelvic radiotherapy plus vagina radiotherapy) than in vagina radiotherapy for endometrial cancer; postoperative high-dose brachytherapy can get good cost-effectiveness; Effect of adjuvant radiotherapy for overall survival and disease-free survival of endometrial carcinoma are needed to further assessed by rigorously designs, randomized, double-blind, placebo-controlled trials adjuvant radiotherapy for endometrial carcinoma.