局部刮除肿瘤联合放疗治疗骨巨细胞瘤的临床研究

目的：探讨局部刮除肿瘤联合术中适形固定施源器模型插植放疗和术后外照射治疗骨巨细胞瘤（GCTB）的临床疗效和毒副反应。方法：将2006年2月．2008年2月在湖南省肿瘤医院初次治疗的长骨GCTB患者30例随机分为单纯局部刮除手术组和局部刮除手术联合放疗组,两组患者均行局部肿瘤刮除术,局部刮除手术联合放疗组在此基础上给予术中适形固定施源器模型插植放疗和术后外照射,治疗后比较两组的临床疗效和毒副反应。结果：局部刮除手术联合放疗组1、3、5年均未复发,而单纯局部刮除手术组的1、3、5年复发率分别为9．1％、27．3％、45．5％,3年和5年复发率均显著高于局部刮除手术联合放疗组（P〈0．05）。局部刮除手术联合放疗组中未见严重相关性毒性和死亡,术后两组的关节功能评分比较无明显差剐（P〉0．05）。结论：局部手术刮除病灶结合术中和术后放疗治疗骨巨细胞瘤可显著降低患者的复发率,且不影响关节功能,是一种较为安全的治疗方法。     

自固化磷酸钙人工骨修复小儿局部骨缺损的临床应用

目的：研讨自固化磷酸钙人工骨（Calcium Phosphate Cement,CPC)填充修复小儿局部骨缺损的临床意义,方法：选用CPC修复小儿骨缺损18例,年龄最小8个月,最大12岁,平均8岁,骨缺损部位：肱骨9例,胫骨6例,胫骨3例,病因,单纯性骨囊肿8例,骨纤维异常增生症5例,动脉瘤样骨囊肿4例,嗜酸性肉芽肿1例,骨缺损大小,最大7cm,最小2cm,平均5cm,CPC填充方式：单纯粉末7例,粉末＋松质骨粒6例,粉末＋条形骨块5例。CPC初步固化时间,最短15分钟,最长30分钟,平均20分钟,随访时间：13－27个月,平均18．5个月。结果：全组18例应用CPC后未见明显局部和全身不良反应。手术前后血PH值钙磷代谢无异常改变。X线片显示：CPC与宿主骨接触紧密,无脱落,术后3个月出现降解,新生骨形成。结论：CPC安全无毒,使用方便,易塑形,生物相容性好,能在体内降解,可以替代自体骨材料在小儿局部骨缺损应用。     

5例腹膜后异位嗜铬细胞瘤的CT表现并文献复习

目的：分析腹膜后异位嗜铬细胞瘤的CT影像学结果,探讨其特异性的CT表现。方法：回顾性分析5例经病理证实为腹膜后异位嗜铬细胞瘤患者的临床、手术及CT资料。结果：5例均为单发肿块,位于腹主动脉周围,CT平扫表现为境界清楚的圆形或椭圆形肿块,肿块直径3CM-7CM,平均4．5CM,瘤体密度较均匀,无囊变和坏死,增强后呈明显较均匀强化。结论：腹膜后异住嗜铬细胞瘤常位于腹主动脉旁,CT增强显示腹主动脉旁类圆形富血供软组织肿块,若t临床合并高血压,应高度警惕嗜铬细胞瘤的可能。     

老年慢性嗜酸性粒细胞肺炎一例

目的:总结1例高龄患有慢性嗜酸性粒细胞肺炎(CEP)的诊断和治疗的临床过程,探讨最佳的治愈方法。方法:对1例患有慢性嗜酸性粒细胞肺炎的患者进行详细检查、诊治,并结合文献资料进行分析,对其病症的临床症状和诊断治疗予以讨论。结果:CEP的病因不是很明确,患者多以以往有过敏病史的临床特点,同时也比较容易复发;但是经过治疗,有效地减少了复发,治愈效果良好。结论:CEP具有其特有的典型症状,经过给予激素维持治疗可明显改善病症,控制病情的发展变化。     

嗜铬细胞瘤围手术期的临床护理效应

目的：探讨嗜铬细胞瘤囤手术期的护理方法。方法：对10例嗜铬细胞瘤手术治疗的病人围手术期护理进行回顾性分析。结果：10例病人均达到临床治愈,顺利出院。结论：术前充分的术前准备,配合术中术后血压的观察和调整是手术治疗嗜铬细胞瘤成功的重要保证,良好的心理状态是治疗和护理嗜铬细胞瘤病人取得手术成功的关键。     

早期乳腺癌保乳术后放射治疗的临床研究

目的:通过对早期乳腺癌保乳术后放射治疗的研究,探讨其远期疗效及瘤床加量照射和放化疗顺序等问题。方法:84例早期乳腺癌患者行保乳手术,术后行三维适形放疗,50Gy/25次,1次/天,5次/周,瘤床局部加量10～16Gy/5～8次。化疗采用蒽环类为主的方案,65例肿瘤直径>1cm者先化疗3个周期后放疗,然后再化疗1～3周期,13例肿瘤直径≤1cm者在术后3～6周放疗,然后化疗4～6个周期。ER/PR阳性者均行内分泌治疗。结果:全组病人5年生存率100%,5年无瘤生存率91.4%。3例乳腺局部复发,3例分别出现肺、肝和骨转移,其中2例死于肿瘤转移。总复发率7.1%。瘤床加量组局部复发率低于未加量组(P=0.04)。放化疗顺序对肿瘤复发率无影响(P=0.15)。美容效果优良率94%,一般者3.6%,差者2.4%。结论:放射治疗是早期乳腺癌保乳治疗的重要组成部分,瘤床加量照射可降低局部复发率。放化疗顺序对于局部复发率影响不大。     

新生儿Ⅰ期胃代食管术治疗Ⅲa型食管闭锁的疗效观察

目的:探讨Ⅰ期胃代食管术治疗Ⅲa型食管闭锁的疗效。方法:对2008年3月至2013年6月我院采用Ⅰ期胃代食管术治疗的8例Ⅲa型食管闭锁进行回顾性分析。其中男6例,女2例,食管两盲端距离均大于3 cm。结果:所有患儿均顺利完成手术。6例治愈出院,1例死亡,1例家长放弃治疗。术后5例有严重肺炎,近期吻合口瘘2例。随访6个月至5年,吻合口狭窄2例,均行食管扩张术治愈,轻度胃食管反流4例,均未行抗反流手术,采用少量多餐及体味喂养治疗后症状缓解。结论:新生儿期采用Ⅰ期胃代食管术治疗Ⅲa型食管闭锁临床可行,避免了分期手术,缩短了治疗周期,有助于提高治愈率。     

茎点霉致泛发性嗜酸性脓疱性毛囊炎1例及实验分析

目的报道1例顽固性嗜酸性脓疱性毛囊炎,并对其病因、诊断及治疗方法进行研究讨论。方法患者男性,47岁,头面部丘疱疹1年伴瘙痒,泛发,并出现血嗜酸性粒细胞增多3个月就诊。取皮损组织和骨髓进行组织分别进行HE、PAS、PASM、钙荧光白染色;同时进行组织真菌培养;真菌特异性引物ITS4/ITS5、NL1/NL5、T1/TUB4Rd测序。结果组织病理可见以毛囊为中心的嗜酸性毛囊化脓性炎,PAS染色和钙荧光白染色可见真皮、皮下组织大量不规则菌丝和孢子,毛囊及毛囊周围显著;骨髓PASM染色可见大量芽生孢子,组织及骨髓组织培养见绒毛状菌落,初期为粉红色,渐变为黑褐色,培养4周见黑色子囊形成;序列鉴定为茎点霉属;抗真菌治疗后痊愈。结论嗜酸性脓疱性毛囊炎可由真菌感染诱发;作为植物致病菌的茎点霉属感染可导致严重的变态反应,并可诱发嗜酸性脓疱性毛囊炎。     

改良Papineau植骨术与抗生素磷酸钙骨水泥局部应用治疗牵张成骨并发Ceirny III型骨髓炎的比较研究

摘要 目的：探讨改良Papineau植骨术与抗生素磷酸钙骨水泥局部填塞治疗牵张成骨技术使用中并发Ceirny III型骨髓炎的疗效。方法：回顾性分析自2013年1月到2015年4月采用改良Papineau植骨术与抗生素磷酸钙骨水泥局部填塞治疗牵张成骨技术并发Ceirny III型骨髓炎17例。A组6例，采用清创后磷酸钙骨水泥5 mL混合0.5 g万古霉素粉剂清创后填塞治疗。B组11例，采用改良Papineau植骨术，即清创后，按5 mL体积松质骨混合0.5 g万古霉素粉剂，清创后植入缺损部位。两组病例术后均行封闭负压吸引(VAC)治疗7天。随访病人局部疼痛缓解情况，皮肤红肿表现、窦道愈合情况、骨缺损部位骨愈合情况以及术后复发情况来判定疗效并比较分析。结果：17例病人术后随访12~20个月。A组全部病例术后2~3周局部炎症消退，创口愈合，定期检测血白细胞计数（WBC）、血沉（ESR）和C反应蛋白（CRP）均下降至正常，2例再未出现感染征象，4例病人于术后3 ~10周再次出现渗液，局部皮肤发红，ESR、CRP进行性升高表现。再次给与清创，换药治疗后逐渐愈合，随访再无渗液出现。B组病人11例，创口2~3周内全部愈合，定期检测WBC、ESR和CRP均下降至正常。随访未见复发。结论：抗生素负荷磷酸钙骨水泥在牵张成骨技术治疗后并发Ceirny III型骨髓炎时，虽有效果，但复发率较高，改良Papineau植骨术疗效更好。     

皮瓣移植结合骨牵张技术修复感染性胫骨复合皮肤组织缺损的临床效果观察

目的：观察皮瓣移植结合骨牵张技术修复感染性胫骨复合皮肤组织缺损的临床效果。方法：自2008年6月至2012年6月,共收治了胫骨感染性复合组织缺损16例,采用一期彻底去除病变坏死组织和病变的胫骨断端,切取同侧腓肠肌皮瓣、腓肠神经营养血管皮瓣转位、对侧小腿内侧皮瓣和游离皮瓣移植修复小腿皮肤缺损,二期行骨牵张延长术进行治疗。结果：所有16例胫骨复合组织缺损病例感染均得到了控制,移植的皮瓣顺利成活,胫骨截骨延长区成骨良好,断端骨愈合,其中2例出现针道感染,无血管神经并发症发生。骨延长2～9cm,平均延长5．5cm。外同定延长支架在停止骨延长8-20个月后拆除,双下肢等长,膝关节和踝关节功能良好。术后细菌培养＋药敏结果：金黄色葡萄球菌感染8例,表皮葡萄球菌感染4例,大肠杆菌感染1例,阴沟肠杆菌感染l例,肠球菌感染l例。结论：伤口彻底清创,胫骨断端坏死骨切除后一期行皮瓣移植,二期行骨牵张延长术是一种治疗感染性胫骨复合组织缺损的有效方法。     

鼻内镜手术治疗慢性鼻窦炎54 例临床疗效分析

目的:研究鼻内镜手术治疗慢性鼻窦炎的疗效。方法:选取在2008年10月至2010年1月之间来本院进行手术治疗的慢性鼻窦炎患者54例,使用鼻内镜手术进行治疗,作为此次研究的治疗组;而同时选取在同一时期来到本院的38例患者,作为此次研究的对照组采用一般的鼻外径手术治疗。在手术结束以后每位患者均需随访1年,根据患者的恢复情况比较两种手术方法对鼻窦炎的疗效,以上手术方式均根据患者意愿。结果:使用鼻内镜手术进行治疗的患者中治愈的有31例,有效的有18例,而无效的则有5例,总的有效率为90.7%;而采用一般手术的患者中治愈的患者为17例,有效的患者为12例,无效的则有9例,其总的有效率为76.3%;且应用鼻内镜手术的治疗组的并发症发生率小于使用一般手术的对照组,两组患者疗效比较差异有统计学意义(P<0.05)。结论:鼻内镜手术治疗慢性鼻赛炎的疗效确切,安全可靠,值得广大医务工作者在临床上大力推广。     

食管癌患者放射治疗中照射体积和时间与外周血淋巴细胞绝对值的相关性研究

摘要 目的：探究照射体积和时间与食管癌患者外周血淋巴细胞绝对值的相关性。方法：本研究方案将纳入2019年1月~2019年12月蚌埠医学院第一附属医院放疗科收治的放疗或同步放化疗食管癌患者84例,其中单独放疗患者24例,同步放化疗患者60例,采用血液细胞分析仪测定患者放疗期间每周复查外周血白细胞（WBC）、中性粒细胞（N）、淋巴细胞（L）、血红蛋白（HB）及血小板（PLT）计数等指标。Pearson相关性分析照射时间、剂量及体积与外周血指标之间的相关性。结果：食管癌放疗患者,包括同步放化疗及单纯放疗亚组,在治疗1-6周,照射时间与外周血指标均无相关性（P>0.05）。但在放疗第5-6周,患者放疗剂量与WBC、N、L、HB呈负相关（P<0.05）,同步放化疗亚组患者照射剂量与WBC、N、L、HB呈负相关（P<0.05）。在治疗1-4周,不同照射剂量下各梯度照射剂量对应照射体积与外周血指标均无相关性（P>0.05）。但在第5-6周时,患者不同梯度照射剂量下各照射体积与WBC、N呈负相关（P<0.05）,同时在20Gy-60Gy照射剂量,尤其20Gy和30Gy照射剂量下照射体积与L呈负相关（P<0.05）。同步放化疗亚组患者不同照射剂量下各照射体积与WBC、N呈负相关（P<0.05）,同时在20Gy-60Gy照射剂量下照射体积与L呈负相关（P<0.05）,而且在60Gy照射剂量下照射体积与HB呈负相关（P<0.05）。结论：放疗患者特别是同步放化疗亚组患者照射体积、照射剂量与食管癌患者外周血淋巴细胞计数成负相关,基线淋巴细胞与食管癌患者外周血淋巴细胞计数成正相关,而照射时间与食管癌患者外周血淋巴细胞计数无相关性。     

Experiences in the treatment of tumour of base of the tongue with high dose rate interstitial radiotherapy on the basis of a retrospective analysis

PURPOSE: To describe the role, the execution and the importance of interstitial radiotherapy in the irradiation of the base of tongue cancer. MATERIAL AND METHODS: Between January, 1993 and December, 1998 nineteen patients with primary squamous cell cancer of the base of tongue (1 T1N0, 3 T2N0, 2 T3N0, 2 T3N2, 3 T4N0, 6 T4N1, 2 T4N2) were managed with brachytherapy partly with definitive intention combined with teletherapy (60-66 Gy) as a boost, partly as a single postoperative treatment. Irradiation was carried out by HDR after-loading (Ir-192) unit, using rigid needle or flexible plastic catheter. The treatment plan was made by PLATO 3D brachytherapy planning system. In case of boost the mean total dose of brachyherapy was 22 Gy (12-30 Gy), in postoperative treatment it was 27 Gy (24-30 Gy). RESULTS: 6-8 weeks after the definitive radiotherapy the CT/MR showed complete remission in 67% and partial remission in 33% of the patients. Of all treated patients during the mean follow-up period (30 months) the local tumour control was 42%. Five patients (26%) died in local failure. Six patients (32%) are alive with tumour. Osteoradionecrosis and fistula did not occur. CONCLUSIONS: In the oncological treatment of the advanced base of tongue tumour the combination of percutan and interstitial radiotherapy seems to be very advantageous,because it improves not only the curability, but the patients' quality of life as well.     

Low-dose Taxol radiosensitization in locally advanced head and neck cancers

INTRODUCTION: Combined modality treatment with chemotherapy and radiotherapy in locally advanced head and neck cancers is an effective and often the only treatment with a chance of cure. An alternative is to use chemotherapeutic agents at low doses as radiosensitizers. In this study we examined the radiosensitizing effect of low dose Taxol in locally advanced head and neck cancer. Patients and methods: 26 patients with locally advanced squamous cell carcinoma of the oral cavity and the oropharynx were treated with external beam radiotherapy up to doses of 66-70 Gy and received concomitantly 2 mg/m(2) Taxol intravenously three times a week. Response rates according to WHO criteria, side effects according to the National Cancer Institute Common Toxicity Criteria, overall and progression-free survival were evaluated. RESULTS: All patients completed the therapy. Median radiation dose was 66 Gy, Taxol dose 40 mg/m(2) and treatment duration 54 days. 8 weeks after completion of therapy complete response was 30.8%, partial response 34.6%, stable disease 11.5% and progressive disease 23.1%. The median follow-up time was 25 months (9-36). At the cloes- out date 12 (46,1%) of the patients were alive, 9 without evidence of disease. The estimated median overall survival was 22 months (CI 14.2-34.6), the median progression-free survival 12 months (CI 5.2-18.8). We observed four grade 4, fourteen grade 3 and numerous grade 1-2 side effects. There was no treatment related death. DISCUSSION: Our regimen resulted in a worse response rate than the aggressive chemoradiation protocols treating the same disease. However, the two-year survival was comparable with the results of other studies. The advantages of our schedule are that it is well tolerated, easy to perform on an outpatient basis, resource effective and does not deteriorate the general condition of the patients, therefore successive therapy can be carried out immediately if necessary. We intend to evaluate the effectivity of this treatment in a study comparing radiotherapy with Taxol sensitization versus radiotherapy alone.     

Radiotherapy applications of patients with malignant mesothelioma: A single center experience

Background

In the management of malignant pleural mesothelioma, radiotherapy has been used for the purpose of prophylaxis to reduce the incidence of recurrence at surgical insertion sites or palliate the symptoms.

Aim

The purpose of the study was to evaluate the techniques and effectiveness of radiotherapy in malignant pleural mesothelioma.

Materials and methods

Forty-four (18 female, 26 male) patients diagnosed with malignant pleural mesothelioma were retrospectively evaluated. All patients had surgery or thoracoscopic biopsy for diagnosis, staging or treatment and all received palliative or prophylactic radiotherapy. Fifty-seven percent of the patients received chemotherapy.

Results

Prophylactic radiation was applied to 27 patients with 4–15 MeV electron energies. The median radiotherapy dose was 30 Gy with 3 Gy daily fraction dose. During treatment, 12 patients had grade 1 erythema according to the RTOG scale. In 3 (12%) patients, a local failure at treatment field was observed. Palliative radiotherapy was applied to 17 patients for pain palliation. The median radiation dose was 40 Gy with 2 Gy daily fraction dose by using 6–18 MV photon and/or 4–12 MeV electron energies. Two patients had grade 1 erythema and one patient had grade 2 odynophagy according to the RTOG scale. For 10 (59%) patients, palliation of chest pain was delivered. No late toxicity was observed for all cases.

Conclusion

Our experience showed that prophylactic and palliative radiotherapy are effective and safe therapy modalities in malignant pleural mesothelioma in preventing seeding metastasis at intervention sites or relieving pain. Prospective randomized studies are still needed to determine the benefits of radiotherapy application and to indicate optimum dose schemes.     

Radiation therapy for the management of painful bone metastases: Results from a randomized trial

AimThe aim of this study was to compare the effectiveness of two radiotherapy schedules in patients with bone metastases.BackgroundWe analyzed the need for re-irradiation, rates of pain control, pathological fractures, and functionality in patients randomized to single-fraction (8 Gy 1×) or multiple-fraction radiotherapy (3 Gy 10×) with at least 12 months follow-up, during five years. The hypothesis was that the two radiotherapy schedules are equally effective.Materials and methodsNinety patients with painful skeletal metastases were randomized to receive single fraction (8 Gy) or multiple fraction (3 Gy 10×) radiotherapy.ResultsIn the single-fraction group, seven pathological fractures occurred (15.5%) versus two (4.4%) in the multiple-fraction group. There was no statistically significant difference between the time it took to suffer a pathological fracture in both groups (p = 0.099). Patients in the single-fraction group received twelve re-irradiations (26.6%), four in the multiple-fraction group (8.8%), with no significant difference between time elapsed before the first re-irradiation (p = 0.438).ConclusionThis study shows no difference between the two groups for the majority of patients with painful bone metastases. Patients were followed up during five years, and the trial showed no disadvantage for 8 Gy 1× compared to 3 Gy 10×. Despite the fact that the pathological fracture rate is 3.75 times higher in the single-fraction group, this schedule is considered more convenient for patients and more cost-effective for radiotherapy departments.     

The impact of the time factor on the outcome of a combined treatment of patients with laryngeal cancer

PurposeTo investigate the impact of the time factor on the locoregional control in combined treatment (surgery and postoperative radiotherapy) in patients with advanced laryngeal cancer.Materials and MethodsBetween January 1993 and December 1996, 254 patients with pT3 or pT4 and pN0-pN2 laryngeal cancer were treated by surgery and postoperative radiotherapy (RT). The median age of patients was 56.3 years (range: 30–70 years). The analyzed group consisted of 236 males (92%) and 18 females (8%). In all cases total laryngectomy was performed. 196 out of 254 patients underwent homolateral neck dissection and 58 out of 254 bilateral neck dissection. RT began 45 days postoperatively (range: 22 to 78 days) and continued for 47 days (range: 40–74 days). The primary tumour bed was irradiated to the median total dose of 61.2 Gy (range: 57 – 64 Gy) and all regional lymph nodes were treated in all patients to a dose of 50 Gy. Postoperative RT was indicated in case of close postoperative margins at the tumour site or pathological status of lymph nodes described as pN1 or pN2. Univariate and multivariate analyses were used to determine the predictors for locoregional failure. The following factors were studied for their prognostic importance of locoregional outcome: the overall treatment time (OTT), radiotherapy treatment time (RTT), the interval between surgery and the beginning of radiotherapy, age, sex, pT and pN categories.Results: The actuarial 5-year overall survival rate was 49%, the actuarial loco regional control rate was 70%. The univariate analysis, using a log-rank test indicated that prolongation of the overall treatment time (OTT), the time of radiotherapy (RTT), the interval time between surgery and radiotherapy, and the pN status were predicted for the loco regional control of postoperative radiotherapy. The multivariate analysis using Cox proportional hazard model indicated that only RTT, OTT, and the pathological status of lymph nodes were independent prognostic factors for the loco regional control.Conclusions: The analysis showed that the prolongation of the overall treatment time of the combined modality (OTT) and the time of radiotherapy course (RTT) were independent prognostic time factors correlated with lower loco regional control.     

非小细胞肺癌脑部转移瘤适形与调强放疗的剂量研究

为探讨NSCLC脑部转移瘤调强放疗与适形放疗的剂量特点,本研究选取57例非小细胞肺癌脑转移瘤患者,其中单个脑转移灶患者5例,多个脑转移灶患者52例,分别设计全脑放疗+适形放疗与调强放疗计划,用均匀指数(HI)和适形指数(CI)评价靶区剂量,危及器官(OAR)剂量用近似最大剂量D_2%(串联)和中位剂量D_50%(并联)进行评价。研究发现,单个脑转移灶IMRT与WBRT+CRT比较中,CI为(PTV,(0.80±0.15) cGy,(0.34±0.19) cGy, p=0.00),HI为(PTV,(0.52±0.03) c Gy,(0.71±0.12) cGy, p=0.24),两者OARs剂量比较:脑干为((4 348±236) cGy,(4 593±149) cGy, p=0.01),脑垂体为((4 258±166) cGy,(4 581±123) cGy, p=0.02);在多个脑转移灶中,IMRT与WBRT+CRT比,较CI为(PTV,(0.59±0.33) cGy,(0.49±0.27) cGy, p=0.03),HI为(PTV,(0.93±0.01) cGy,(0.58±0.03) cGy, p=0.19),两者OARs剂量比较:脑干为((4 946±132) cGy,(4 843±196) cGy, p=0.51),脑垂体为((4 597±180) cGy,(4 705±149) cGy, p=0.70)。本研究的结果说明,单个脑转移灶患者,IMRT较WBRT+CRT有更好的靶区适形性、稍差的靶区异质性,脑干和垂体的IMRT剂量低于WBRT+CRT,而眼球、晶体的剂量两者差别不明显。多个脑转移灶患者,IMRT较WBRT+CRT有更好的靶区适形性、稍差的靶区异质性,而OARs剂量,IMRT较WBRT+CRT差异不明显。在临床实践过程中,应当根据患者不同的病灶情况选择合适的放疗方案,以获取更优的临床治疗效果。     

Modelling the correlation between EGFr expression and tumour cell radiosensitivity, and combined treatments of radiation and monoclonal antibody EGFr inhibitors

ABSTRACT: Purpose To estimate the effects of heterogeneity on tumour cell sensitivity to radiotherapy combined with radiosensitizing agents attributable to differences in expression levels of Epidermal Growth Factor Receptor (EGFr). Materials and methods Differences in radiosensitivity are not limited to cells of different cancer histotypes but also occur within the same cancer, or appear during radiotherapy if radiosensitizing drugs are combined with ionizing radiation. A modified biologically effective dose (MBED), has been introduced to account for changes in radiosensitivity parameters (alpha and alpha/beta) rather than changes in dose/fraction or total dose as normally done with standard biologically effective dose (BED). The MBED approach was applied to cases of EGFr over-expression and cases where EGFr inhibitors were combined with radiation. Representative examples in clinical practice were considered. RESULTS: Assuming membrane EGFr over-expression corresponds to reduced radiosensitivity (alphaH = 0.15 Gy-1 and alphaH/betaH = 7.5 Gy) relative to normal radiosensitivity (alpha = 0.2 Gy-1 and alpha/beta = 10 Gy), an increased dose per fraction of 2.42 Gy was obtained through the application of MBED, which is equivalent to the effect of a reference schedule with 30 fractions of 2 Gy. An equivalent hypo-fractionated regime with a dose per fraction of 2.80 Gy is obtained if 25 fractions are set. Dose fractionations modulated according to drug pharmacokinetics are estimated for combined treatments with biological drugs. Soft and strong modulated equivalent hypo-fractionations result from subtraction of 5 or 10 fractions, respectively. CONCLUSIONS: During this computational study, a new radiobiological tool has been introduced. The MBED allows the required dose per fraction to be estimated when tumour radiosensitivity is reduced because EGFr is over-expressed. If radiotherapy treatment is combined with EGFr inhibitors, MBED suggests new treatment strategies, with schedules modulated according to drug pharmacokinetics.