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1.
目的:观察并探讨奥利沙铂(Oxaliplatin,L-OHP)与多西紫杉醇(Docetaxel,DXL)化疗方案联合同步三维适形放疗(three dimensional conformal radiotherapy,3DCRT)治疗晚期局限性非小细胞肺癌(non-small cell lung cancer,NSCLC)的近期临床效果并安全性。方法:将2010年1月-2012年2月间入选的94例局限性NSCLC患者随机单盲分为观察组(48例)与对照组(46例),观察组给予L-OHP、DXL化疗方案并联合同步3DCRT治疗方案,对照组予3DCRT治疗方案,对比两组治疗后临床疗效、生命质量改善情况及治疗期间毒副反应。结果:①两组患者疗效构成不同,观察组完全缓解率(12.5%)与总有效率(81.3%)均高于对照组(6.5%、58.7%),且后者差异具有统计学意义(X2=5.713,P=0.017);②观察组、对照组治疗后生活质量改善比例分别为56.6%、33.3%,两组生活质量具有显著性差异(Z=-2.101,P=0.036);③治疗期间观察组、对照组分别死亡2例(4.2%)、1例(2.2%),观察组骨髓抑制、胃肠道反应、末梢神经损害、放射性肺损伤发生率高于对照组(P0.05)。结论:L-OHP与DXL化疗联合同步3DCRT放疗治疗NSCLC可提高后者对原发病灶的近期控制率、改善患者生活质量,但也应注意对联合放化疗期间出现毒副反应的对症处置。  相似文献   

2.
目的:评估交替放化疗(CRT)对晚期鼻咽癌(NPC)患者的疗效与影响因素。方法:选取在我院耳鼻喉科治疗的102例鼻咽癌患者。交替使用放疗,化疗进行治疗。在102例患者中,83例接受顺铂(50 mg/m2/d,d1-2)和5-氟尿嘧啶(5-Fu;800 mg/m2/d,d1-5),而19例患者接受卡铂(20 mg/m2/d,d6)和5-FU。结果:72(70.6%)例患者完成全部3个化疗疗程。交替放化疗的总时间为92(82-102)天。中位随访时间54个月,5年无进展生存期(PFS)为70.5%。多因素分析显示,体重减轻和化疗疗程数对PFS有显著影响。结论:化疗与放疗交替治疗的NPC患者依从性好,适应性强,值得临床推广。  相似文献   

3.
目的:观察调强适形放疗(intensity modulated radiation therapy,IMRT)联合多西他赛、奈达铂方案化疗同步治疗局部晚期食管癌的疗效及安全性。方法:选择66例局部晚期食管癌患者为研究对象,将其随机分为2组,其中常规放疗组(A组)共30例,采用常规照射方法,6/8 MV高能X线,2.0 Gy/次,5次/周;40 Gy/20次后再次定位剂量达60~66 Gy,强调放疗组(B组)共36例,采用强调适应性放疗,6/8MV-X射线照射,以95%等剂量线包绕PTV(计划靶区),处方剂量GTV(肿瘤区)66 Gy/30次,CTV(临床靶区)60 Gy/30次,PTV 60 Gy/30次,每天1次,每周5次。强调放疗组同期接受IMRT和多西他赛、柰达伯化疗,21天1个周期,连续2个周期。治疗结束后根据实体瘤疗效评价标准(RECIST)评定临床疗效;参照WHO毒性反应分度标准评价毒副反应。结果:常规放疗组和强调放疗组的总有效率分别为46.66%和91.67%(x2=17.26,P0.05);常规放疗组的毒副反应发生率显著高于强调放疗组,包括骨髓抑制、放射性食管炎和消化道反应的发生率存在显著差异(P0.05)。结论:调强适形放疗联合多西他赛、奈达铂化疗同步治疗局部晚期食管癌疗效较好,毒副反应可耐受,具有潜在的推广应用价值,值得临床进一步研究。  相似文献   

4.
目的:对比晚期非小细胞肺癌患者经三维适形放疗(3D-CRT)与调强放疗(IMRT)后,其血清肿瘤标志物及剂量学参数的变化。方法:选择2015年1月-2016年12月期间我院收治的非小细胞肺癌患者120例,根据放疗方案将其分为IMRT组60例与3D-CRT组60例。比较两组临床疗效、药物毒副反应、1年内的生存率、放射剂量参数,以及治疗前与治疗后血清肿瘤标志物的变化。结果:IMRT组治疗的总有效率与3D-CRT组对比差异无统计学意义(P0.05)。IMRT组血小板减少、Ⅲ度放射性食管炎、Ⅲ度消化道反应、Ⅲ度放射性肺炎、Ⅲ度白细胞减少的发生率均低于3D-CRT组(P0.05)。IMRT组1年内的生存率90.00%,高于3D-CRT组的75.00%(P0.05)。IMRT组CI值与HI值均高于3D-CRT组(P0.05),IMRT组与3D-CRT组平均剂量对比差异无统计学意义(P0.05)。治疗后两组鳞状细胞癌抗原(SCC)、细胞角蛋白19片段抗原21-1(CYFRA21-1)与肿瘤特异性生长因子(TSGF)水平均显著降低,且IMRT组低于3D-CRT组(P0.05)。结论:IMRT与3D-CRT对于晚期非小细胞肺癌患者的临床疗效相当,但IMRT药物毒副反应少、放射剂量低,可能通过控制肿瘤来降低肿瘤标志物水平。  相似文献   

5.
目的:探讨新辅助化疗对局部晚期非小细胞肺癌患者术后生存质量的影响。方法:选取2011年5月至2012年5月于本院胸腔外科接受治疗的ⅢA~ⅢB期非小细胞肺癌患者240例并将其随机分成2组,即新辅助化疗组(A组)和单纯手术组(B组),每组120例。A组患者在临床确诊后接受2个周期的新辅助化疗,化疗结束2~3周后接受手术治疗;对照组患者临床确诊后直接行手术治疗。术后,两组患者均给予4周期常规放化疗。采用QLQ-C30量表对两组患者术前与术后第1、3、6个月的生存质量进行评估,并比较两组患者生存质量评分的差异。结果:术后1、3、6个月时,两组患者的各项功能分值均较术前显著升高(P0.05);术后第3、6个月,患者的总体健康状况得分较术前显著升高(P0.05);术后1个月时,A组患者的呼吸困难评分较术前明显增加(P0.05),术后第3个月后,该分值与术前比较无显著性差异;术后第1、3个月时,两组患者的疼痛评分均较术前明显升高(P0.05),但第6个月时,该评分与术前无显著性差异;术后第6个月时,两组患者的疲乏得分较术前明显降低(P0.05);术后第1、3、6个月时,两组患者的经济困难评分明显较术前升高(P0.05)。术后1、3、6个月时,A组患者的总体状况得分均显著高于B组(P0.05),呼吸困难评分和疲乏评分明显低于B组(P0.05),经济困难评分均显著高于B组(P0.05)。结论:新辅助化疗可以提高局部晚期非小细胞肺癌患者术后半年内的生存质量。  相似文献   

6.
目的:研究胸部肿瘤患者放疗中肺功能指标的变化并分析放射性肺炎的影响因素。方法:将2018年3月至2019年3月于我院接受放疗的胸部肿瘤患者100例记为观察对象,按照是否发生放射性肺炎分为肺炎组28例与无肺炎组72例。分别比较两组的临床资料、放疗前后肺功能及放疗参数,并采用多因素Logistic回归分析放射性肺炎的影响因素。结果:放疗后两组第1秒用力呼气容积(FEV_1)、FEV_1/用力肺活量(FVC)、一氧化碳弥散量(DLCO)均高于放疗前,且肺炎组放疗前、后FEV_1、FEV_1/FVC、DLCO均低于无肺炎组(均P0.05)。两组年龄、肿瘤类型、化疗史、美国东部肿瘤合作组(ECOG)评分、放疗靶区比较差异有统计学意义(均P0.05)。肺炎组计划靶区(PTV)、受到一定剂量以上照射的肺体积占全肺总体积的百分数(V_(dose))、平均肺计量(MLD)、正常组织并发症概率(NTCP)、总射野数高于无肺炎组(均P0.05)。经多因素Logistic回归分析可得:胸部肿瘤放疗患者放射性肺炎的独立危险因素有肺癌、化疗史、ECOG评分为2分、放疗靶区以肺野为主、PTV、MLD、V_(dose)、NTCP、总射野数、FEV_1、FEV_1/FVC(均P0.05)。结论:放疗可有效改善胸部肿瘤患者的肺功能,其中肺癌、化疗史、ECOG评分为2分、放疗靶区以肺野为主以及PTV、MLD、V_(dose)、NTCP、总射野数、FEV_1、FEV_1/FVC是放射性肺炎的影响因素。  相似文献   

7.
78 例肺癌脑转移患者临床分析   总被引:1,自引:0,他引:1       下载免费PDF全文
目的:探讨与肺癌脑转移预后相关的影响因素,为更好的治疗肺癌脑转移提供参考依据。方法:回顾性分析2002年~2009年唐都医院收治的78例肺癌脑转移的临床资料。结果:患者年龄、性别、病理类型、脑转移灶数目、颅外有无转移性病灶、患者的行为状态(PS评分)对患者生存期无显著影响(P>0.05)。但放疗+化疗治疗组疗效显著优于单纯放疗组及单纯化疗组(P<0.05),症状消失者(CR)或明显缓解者(PR)生存较无明显改善者(SD)或加重者(PD)生存期显著延长。结论:对肺癌脑转移患者应采取放疗联合化疗综合方案治疗,同时,应及时关注其症状缓解情况并指导治疗。  相似文献   

8.
目的:探讨周剂量多西紫杉醇联合三维适形放疗(3DCRT)治疗进展期贲门癌患者的疗效。方法:2007年10月到2009年5月38例不能手术的贲门癌患者行3DCRT,处方剂量62Gy,1.8Gy/次,5次/周;同时联合多西紫杉醇75mg/m2,每周1次,连续6周。用Kaplan-Meier法分析患者的中位无进展生存时间。结果:完全缓解12例,部分缓解18例,30名患者缓解(78.9%),中位无进展生存时间16.4个月。治疗过程中的毒副作用轻,患者可以耐受。结论:周剂量多西紫杉醇化疗联合适形放疗对进展期贲门癌患者是安全、有效的。  相似文献   

9.
目的:探讨宫颈癌放疗患者生活质量的影响因素及与应对方式的关系。方法:选取2018年7月2019年11月期间我院收治的宫颈癌放疗患者139例,收集患者临床资料,采用癌症治疗功能评价系统中的宫颈癌量表(FACT-Cx)对宫颈癌患者的生活质量进行评分,采用Jalowiec的应对量表(JCS)记录并评估所有患者的应对方式,并采用Pearson相关性分析生活质量与应对方式的关系。采用单因素及多因素Logistic回归分析宫颈癌放疗患者生活质量的影响因素。结果:宫颈癌放疗患者的FACT-Cx总分与面对、乐观、姑息、依靠自我应对方式评分呈正相关(P<0.05),与情感宣泄、宿命应对方式评分呈负相关(P<0.05),与逃避、支持应对方式评分无相关性(P>0.05)。不同文化程度、年龄、化疗、肿瘤病理类型情况患者之间FACT-Cx总分比较无统计学差异(P>0.05);不同家庭月收入、肿瘤分期、下肢水肿情况、婚姻状况患者之间FACT-Cx总分比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,家庭月收入、肿瘤分期、下肢水肿情况、婚姻状况均是宫颈癌放疗患者生活质量的影响因素(P<0.05)。结论:宫颈癌放疗患者生活质量与应对方式存在密切联系,且家庭月收入、肿瘤分期、下肢水肿情况、婚姻状况均是其生活质量的影响因素,临床工作者应结合以上因素对患者放疗方案给予针对性调整。  相似文献   

10.
摘要 目的:探讨血清微小核糖核酸(miRNA)-141-3p、miR-150-5p与鼻咽癌(NPC)患者临床病理特征和放疗敏感性的关系。方法:收集2019年1月~2022年7月在我院接受放疗的92例NPC患者为NPC组,根据放疗疗效分为抵抗组和敏感组,另选取同期80名在我院体检的健康志愿者为对照组。比较对照组、NPC组血清miR-141-3p、miR-150-5p表达。分析NPC患者血清miR-141-3p、miR-150-5p表达与临床病理特征的关系。利用单因素和多因素Logistic回归分析NPC患者放疗抵抗的影响因素。结果:与对照组比较,NPC组血清miR-141-3p表达升高,miR-150-5p表达降低(P<0.05)。NPC患者血清miR-141-3p、miR-150-5p表达在不同分化程度、TNM分期和淋巴结转移中比较有差异(P<0.05)。92例NPC患者放疗抵抗发生率为22.83%(21/92)。单因素分析显示,抵抗组TNM分期Ⅲ~Ⅳa期和miR-141-3p ≥ 2.60比例高于敏感组,miR-150-5p ≥ 0.80比例低于敏感组(P<0.05)。多因素Logistic回归分析显示,miR-141-3p ≥ 2.60为NPC患者放疗抵抗的独立危险因素,miR-150-5p ≥ 0.80为独立保护因素(P<0.05)。结论:NPC患者血清miR-141-3p高表达,miR-150-5p低表达,与分化程度、TNM分期、淋巴结转移和放疗敏感性有关,有望成为NPC患者放疗抵抗的评价指标。  相似文献   

11.

Objective

To evaluate concurrent chemotherapy for T4 classification nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT).

Methods

From July 2004 to June 2011, 180 non-metastatic T4 classification NPC patients were retrospectively analyzed. Of these patients, 117 patients were treated by concurrent chemoradiotherapy (CCRT) using IMRT and 63 cases were treated by IMRT alone.

Results

The median follow-up time was 58.97 months (range, 2.79–114.92) months. For all the patients, the 1, 3 and 5-year local failure-free survival (LFFS) rates were 97.7%, 89.2% and 85.9%, regional failure free survival (RFFS) rates were 98.9%, 94.4% and 94.4%, distant failure-free survival (DFFS) rates were 89.7%, 79.9% and 76.2%, and overall survival (OS) rates were 92.7%, 78.9% and 65.3%, respectively. No statistically significant difference was observed in LFFS, RFFS, DFFS and OS between the CCRT group and the IMRT alone group. No statistically significant difference was observed in acute toxicity except leukopenia (p = 0.000) during IMRT between the CCRT group and the IMRT alone group.

Conclusion

IMRT alone for T4 classification NPC achieved similar treatment outcomes in terms of disease local control and overall survival as compared to concurrent chemotherapy plus IMRT. However, this is a retrospective study with a limited number of patients, such results need further investigation in a prospective randomized clinical trial.  相似文献   

12.
IntroductionThere are no adequate data to determine whether intensity-modulated radiotherapy (IMRT) is superior to three-dimensional conformal radiotherapy (3DCRT) in the treatment of non-small cell lung cancer (NSCLC). This meta-analysis was conducted to compare the clinical outcomes of IMRT and 3DCRT in the treatment of NSCLC.MethodsNo exclusions were made based on types of study design. We performed a literature search in PubMed, EMBASE and the Cochrane library databases from their inceptions to April 30, 2015. The overall survival (OS) and relative risk (RR) of radiation pneumonitis and radiation oesophagitis were evaluated. Two authors independently assessed the methodological quality and extracted data. Publication bias was evaluated by funnel plot using Egger’s test results.ResultsFrom the literature search, 10 retrospective studies were collected, and of those, 5 (12,896 patients) were selected for OS analysis, 4 (981 patients) were selected for radiation pneumonitis analysis, and 4 (1339 patients) were selected for radiation oesophagitis analysis. Cox multivariate proportional hazards models revealed that 3DCRT and IMRT had similar OS (HR = 0.96, P = 0.477) but that IMRT reduced the incidence of grade 2 radiation pneumonitis (RR = 0.74, P = 0.009) and increased the incidence of grade 3 radiation oesophagitis (RR = 2.47, P = 0.000).ConclusionsOS of IMRT for NSCLC is not inferior to that of 3DCRT, but IMRT significantly reduces the risk of radiation pneumonitis and increases the risk of radiation oesophagitis compared to 3DCRT.  相似文献   

13.
Little is known about the value of adding concurrent chemotherapy (CC) to radiotherapy for stage II nasopharyngeal carcinoma (NPC) with undetectable (0 copies/mL) pretreatment Epstein-Barr Virus (EBV) DNA in the intensity-modulated radiotherapy (IMRT) era. To address this question, the present study retrospectively reviewed 514 patients with newly diagnosed stage II NPC and undetectable pretreatment EBV DNA from Sun Yat-sen University Cancer Center between March 2008 and October 2016. Clinical characteristics and survival outcomes between concurrent chemoradiotherapy (CCRT) and IMRT alone groups were compared. Propensity score matching analysis was conducted to control for confounding factors. Although CCRT group had significantly higher proportions of stage N1 disease than IMRT alone group before matching (85% vs. 61%, p < 0.001), no statistically significant differences were noted for OS (97.8% vs. 98.1%, p = 0.700), DFS (93.4% vs. 94.5%, p = 0.846), DMFS (96.0% vs. 96.9%, p = 0.762), and LRFS (97.3% vs. 98.1%, p = 0.701). After 1:1 propensity-score matching, 177 pairs were identified. Patients in each group were found to be well balanced in baseline characteristics and risk factors (all P > 0.05). The five-year OS (96.9% vs. 98.2%, p = 0.302), DFS (92.0% vs. 95.2%, p = 0.777), DMFS (95.2% vs. 97.6%, p = 0.896), and LRFS (97.3% vs. 97.6%, p = 0.328) rates remain comparable for both CCRT and RT alone groups. Additionally, subgroup analysis still failed to observe any significant survival benefit for the addition of CC to IMRT for N1 disease (P>0.05 for all). Our results indicated that IMRT alone appeared to achieve comparable survival to CCRT for stage II NPC with undetectable pretreatment EBV DNA.Keyword: Nasopharyngeal carcinoma, Epstein–Barr virus DNA, Survival, Intensity-modulated radiotherapy, Concurrent chemotherapy, Effect  相似文献   

14.

Purpose

To report the incidence of and risk factors for mastoiditis after intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC).

Patients and Methods

Retrospective analysis of pretreatment and follow-up magnetic resonance imaging (MRI) data for 451 patients with NPC treated with IMRT at a single institution. The diagnosis of mastoiditis was based on MRI; otomastoid opacification was rated as Grade 0 (none), 1 (mild), 2 (moderate) or 3 (severe) by radiologists blinded to clinical outcome. This study mainly focused on severe mastoiditis; patients were divided into three groups: the G0M (Grade 0 mastoiditis before treatment) group, G1-2M (Grade 1 to 2 mastoiditis before treatment) group and G3M (Grade 3 mastoiditis before treatment) group. The software SAS9.3 program was used to analyze the data.

Results

For the entire cohort, the incidence of Grade 3 mastoiditis was 20% before treatment and 31%, 19% and 17% at 3, 12 and 24 months after radiotherapy, respectively. In the G0M group, the incidence of severe mastoiditis was 0% before treatment and 23%, 15% and 13% at 3, 12 and 24 months after radiotherapy, respectively. Multivariate analysis revealed T category (OR=0.68, 95% CI = 0.469 to 0.984), time (OR=0.668, 95% CI = 0.59 to 0.757) and chemotherapy (OR=0.598, 95% CI = 0.343 to 0.934) were independent factors associated with severe mastoiditis in the G0M group after treatment.

Conclusions

Mastoiditis, as diagnosed by MRI, occurs as a progressive process that regresses and resolves over time in patients with NPC treated using IMRT.  相似文献   

15.

Purpose/Objective(s)

To determine if intensity modulated radiation therapy (IMRT) in the post-operative setting for gastric cancer was associated with reduced toxicity compared to 3D conformal radiation therapy (3DCRT).

Materials/Methods

This retrospective study includes 24 patients with stage IB-IIIB gastric cancer consecutively treated from 2001–2010. All underwent surgery followed by adjuvant chemoradiation. Concurrent chemotherapy consisted of 5-FU/leucovorin (n = 21), epirubicin/cisplatin/5FU (n = 1), or none (n = 2). IMRT was utilized in 12 patients and 3DCRT in 12 patients. For both groups, the target volume included the tumor bed, anastomosis, gastric stump, and regional lymphatics.

Results

Median follow-up for the entire cohort was 19 months (range 0.4–8.5 years), and 49 months (0.5–8.5 years) in surviving patients. The 3DCRT group received a median dose of 45 Gy, and the IMRT group received a median dose of 50.4 Gy (p = 0.0004). For the entire cohort, 3-year overall survival (OS) was 40% and 3-year disease free survival (DFS) was 41%. OS and DFS did not differ significantly between the groups. Acute toxicity was similar. Between 3DCRT and IMRT groups, during radiotherapy, median weight lost (3.2 vs. 3.3 kg, respectively; p = 0.47) and median percent weight loss were similar (5.0% vs. 4.3%, respectively; p = 0.43). Acute grade 2 toxicity was experienced by 8 patients receiving 3DCRT and 11 receiving IMRT (p = 0.32); acute grade 3 toxicity occurred in 1 patient receiving 3DCRT and none receiving IMRT (p = 1.0). No patients in either cohort experienced late grade 3 toxicity, including renal or gastrointestinal toxicity. At last follow up, the median increase in creatinine was 0.1 mg/dL in the IMRT group and 0.1 mg/dL in the 3DCRT group (p = 0.78).

Conclusion

This study demonstrates that adjuvant chemoradiation for gastric cancer with IMRT to 50.4 Gy was well-tolerated and compared similarly in toxicity with 3DCRT to 45 Gy.  相似文献   

16.
The maximum tolerated dose (MTD) of lobaplatin as a single agent chemotherapy concurrent with intensity-modulated radiotherapy (IMRT) in Asian population with nasopharyngeal carcinoma (NPC) remains unclear. From June 2016 to December 2017, 17 patients diagnosed with stage III-IVb NPC from an Asian population were prospectively enrolled. Patients were administered lobaplatin with 25-50?mg/m2 escalation of dosage on day 1. Every 21?days (days 1, 22, and 43) during radiotherapy, cycles were repeated. We administered radiotherapy as 2.12-2.27 Gy per fraction with five daily fractions each week for 6 to 7 weeks. The evaluation of lobaplatin-related toxic effects was based on the Common Terminology Criteria for Adverse Events version 4.0. During the weekly treatment period, complete blood counts and biochemistry were performed. Dose-limiting toxicities (DLTs) were determined by the following events during any cycle in which lobaplatin was administered. Each dose group consisted of at least three cases. We proceeded to the subsequent dose group in the absence of DLT with a dose increment of 5 mg/m2 until DLT occurred. Periods from 1 week prior to the chemotherapy initiation to 3 weeks after the last chemotherapy were defined as DLT observation periods. MTD was determined by the dose that was immediately below the dose that produced DLT. After analysis, DLT occurred in three patients, including a group with two of three patients in 45 mg/m2 lobaplatin and another group with one of five patients in 40 mg/m2 lobaplatin. No grade 3-4 toxicity was observed in patients treated with lobaplatin <40 mg/m2. The tumor response rate at 12?weeks after treatment was 100%. In summary, lobaplatin concurrent with IMRT was active in stage III-IVb NPC, and the MTD for the lobaplatin as single-agent chemotherapy was 40 mg/m2 when combined with IMRT in an Asian population. This trial is registered with ClinicalTrials.gov, number NCT03188497.  相似文献   

17.
目的:探讨康莱特注射液联合放化疗对中晚期宫颈癌患者的疗效及对放化疗引起的毒副反应的影响。方法:选取2009年6月—2012年3月间笔者所在医院收治的经病理组织学确诊的62例局部晚期宫颈鳞癌患者,随机平均分成实验组(n=31)和对照组(n=31),分别接受康莱特注射液+放化疗联用和单纯放化疗的治疗,考察两组受试者的临床有效率、生活质量及毒副反应。结果:实验组和对照组受试者的总有效率分别为93.6%和83.9%,无显著差异(P>0.05);生活质量稳定和改善的比率分别为93.5%和71.0%,有显著差异(P<0.05);实验组受试者的主要毒副反应发生率明显低于对照组(P<0.05)。结论:康莱特注射液联合放化疗能有效用于中晚期宫颈癌患者的治疗,并显著提高患者生活质量,明显减轻放化疗所致不良反应。  相似文献   

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