奈达铂联合调强放疗对局部晚期鼻咽癌的疗效的作用分析 *

摘要 目的： 分析奈达铂联合强调放疗在局部晚期鼻咽癌患者中的疗效。方法： 选择我院局部晚期鼻咽癌患者 87 例, 随机分为两 个组, 分别是奈达铂组 （ A 组） 和顺铂组 （B 组 ） ,对两组患者接受治疗后的近期疗效、 远期疗效以及毒性反应进行比较分析。结果： A、 B 两组患者鼻咽原发灶完全缓解 （CR ） 率分别为 91.8%、 86.8% （ P=0.632>0.05 ）, 颈部淋巴结转移灶的完全缓解 （CR ） 率分别为 87.8%、 84.2% （ P=0.864>0.05 ）, 均不存在统计学显著性差异。A、 B 两组患者 3 年的总生存率 （ OS ） 分别为： 81.6%、 78.9%, P=0.762; 局部控制率 （ LC ） 分别为： 93.9%、 94.7%, P=0.890; 两组患者 3 年的区域控制率 （RC ） 分别为： 98.0%、 97.3%, P=0.849; 两组患者 3 年 的无远处转移生存率 （DMFS ） 分别为： 79.6%、 76.3%, P= 0.724。A 组患者 Plt 下降发生率为 46.9%显著高于 B 组发生率 34.2% （ P<0.05 ）, 具有统计学显著性差异; A 组患者恶心呕吐的发生率 36.7%显著低于 B 组患者的发生率 76.3% （ P<0.05 ）, 具有统计学显 著性差异; 其余毒性反应的发生率均不存在统计学显著性差异 （P>0.05 ）。结论： 奈达铂联合强调放疗治疗局部晚期鼻咽癌的近期 疗效与远期疗效与顺铂相当, 但是奈达铂胃肠道不良反应发生率较顺铂低, 血小板的降低程度比顺铂更加严重。     

Institutional experience with a rotational total skin electron irradiation (RTSEI) technique—A three decade review (1981–2012)

Total skin electron irradiation (TSEI) for patients with cutaneous lymphomas is technically challenging, and numerous approaches have been developed to overcome the many field matching problems associated with such a large and complex treatment volume. Since 1981 we have delivered TSEI using a rotational total skin electron irradiation (RTSEI) technique in conjunction with patch, treat and boost fields in order to provide complete skin and dose coverage. Initially we used a 6 MeV electron beam at an extended source-skin distance (SSD) on a modified linear accelerator. More recently we began using a high dose rate electron mode on a commercially available linear accelerator. The RTSEI technique allows the delivery of a seamless surface dose to the majority of the patient''s skin surface in a single treatment. In this review paper we present our three-decade experience with the technical development, dosimetry, treatment delivery and clinical outcomes of our RTSEI technique.     

Micronuclei and other nuclear anomalies in normal human buccal mucosa cells of oral cancer patients undergoing radiotherapy: a field effect

We evaluated micronuclei and other nuclear anomalies in exfoliated epithelial cells of the oral cavity on the side opposite the lesion targeted by radiotherapy and correlated them with radiation doses. Buccal smears were obtained from oral cancer patients undergoing radiotherapy with a cumulative dose of at least 1000 rad for 3 weeks and from controls matched for age, gender and habits. The exfoliated cells from the mucosa were collected using a cytobrush; smears were prepared, fixed in 80% methanol and stained using the Feulgen plus fast green method. The mean number of micronuclei and other nuclear anomalies/1000 cells was significantly greater in patients undergoing radiotherapy treatment, but the differences were not significant compared to radiation doses. It appears that radiotherapy has a potent clastogenic effect on buccal mucosal cells of oral cancer patients.     

In silico simulation of the effect of hypoxia on MCF-7 cell cycle kinetics under fractionated radiotherapy

The treatment outcome of a given fractionated radiotherapy scheme is affected by oxygen tension and cell cycle kinetics of the tumor population. Numerous experimental studies have supported the variability of radiosensitivity with cell cycle phase. Oxygen modulates the radiosensitivity through hypoxia-inducible factor (HIF) stabilization and oxygen fixation hypothesis (OFH) mechanism. In this study, an existing mathematical model describing cell cycle kinetics was modified to include the oxygen-dependent G1/S transition rate and radiation inactivation rate. The radiation inactivation rate used was derived from the linear-quadratic (LQ) model with dependence on oxygen enhancement ratio (OER), while the oxygen-dependent correction for the G1/S phase transition was obtained from numerically solving the ODE system of cyclin D-HIF dynamics at different oxygen tensions. The corresponding cell cycle phase fractions of aerated MCF-7 tumor population, and the resulting growth curve obtained from numerically solving the developed mathematical model were found to be comparable to experimental data. Two breast radiotherapy fractionation schemes were investigated using the mathematical model. Results show that hypoxia causes the tumor to be more predominated by the tumor subpopulation in the G1 phase and decrease the fractional contribution of the more radioresistant tumor cells in the S phase. However, the advantage provided by hypoxia in terms of cell cycle phase distribution is largely offset by the radioresistance developed through OFH. The delayed proliferation caused by severe hypoxia slightly improves the radiotherapy efficacy compared to that with mild hypoxia for a high overall treatment duration as demonstrated in the 40-Gy fractionation scheme.     

In vitro radiosensitization of breast cancer with hypoxia‐activated prodrugs

KP167 is a novel hypoxia‐activated prodrug (HAP), targeting cancer cells via DNA intercalating and alkylating properties. The single agent and radiosensitizing efficacy of KP167 and its parental comparator, AQ4N, were evaluated in 2D and 3D cultures of luminal and triple negative breast cancer (TNBC) cell lines and compared against DNA damage repair inhibitors. 2D normoxic treatment with the DNA repair inhibitors, Olaparib or KU‐55933 caused, as expected, substantial radiosensitization (sensitiser enhancement ratio, SER_0.01 of 1.60–3.42). KP167 induced greater radiosensitization in TNBC (SER_0.01 2.53 in MDAMB‐231, 2.28 in MDAMB‐468, 4.55 in MDAMB‐436) and luminal spheroids (SER_0.01 1.46 in MCF‐7 and 1.76 in T47D cells) compared with AQ4N. Significant radiosensitization was also obtained using KP167 and AQ4N in 2D normoxia. Although hypoxia induced radioresistance, radiosensitization by KP167 was still greater under 2D hypoxia, yielding SER_0.01 of 1.56–2.37 compared with AQ4N SER_0.01 of 1.13–1.94. Such data show KP167 as a promising single agent and potent radiosensitiser of both normoxic and hypoxic breast cancer cells, with greater efficacy in TNBCs.     

生物超微弱发光的两维探测

本文介绍了自行研制的二套系统及其应用。1．高灵敏荧光显微镜系统,该系统探测灵敏度达到10－6lx量级,比普通CCD系统提高了104倍,系统用宽量程照度计对微弱光成象性能进行了标定,在给出细胞荧光图象的同时,可以给出每一象元的发光强度,并可给出视觉更易分辨的光强的三维显示和伪彩色图象。在该系统上得到了分红菌甲素在Hela细胞中的分布图象,Hela细胞加入竹红菌甲素后的光照损伤及抗氧化剂维生素E等对细胞的保护图象。2．光子计数成象系统,该系统灵敏度达10-8lx量级,可探测到单个光子及其分布,在其上得到了绿豆芽,树叶,昆明鼠,人手及手指的超微弱发光的光子图象,并用统计理论进行了信号检验。     

血管内皮抑制素联合调强放疗对老年中晚期非小细胞肺癌的临床应用价值研究

目的探讨血管内皮抑制素联合调强放疗在老年中晚期非小细胞肺癌(NSCLC)中的放疗增敏作用及对T细胞、NK细胞的影响。方法选取2015年3月至2016年8月新疆维吾尔自治区人民医院NSCLC患者106例,依据简单随机数字表法分为对照组(采取调强放疗)与研究组(在对照组基础上使用血管内皮抑制素),每组53例。分析两组临床疗效、治疗前后NK细胞、T细胞水平、血清肿瘤标志物水平、EPO mRNA、EPO-R mRNA水平、毒副反应,随访3年后统计两组生存情况[中位总生存期(OS)、中位无进展生存期(PFS)]。两组比较采用独立样本t检验,组内治疗前后比较采用配对t检验,临床疗效、毒副反应发生率等采用c2检验。结果对照组肿瘤控制率低于研究组(69.81%比86.79%)(P<0.05);与治疗前比较,两组治疗后NK细胞、CD3±、CD4^+、CD4^+/CD8^+水平,血清CA199、CA125、CEA、CY211水平,EPO mRNA,EPO-R mRNA水平均降低,CD8^+水平增高,差异有统计学意义(P均<0.05);与对照组治疗后比较,研究组治疗后NK细胞[(8.01±1.64)%比(10.44±2.13)%]、CD3±[(53.51±6.02)%比(59.33±5.15)%],CD4^+[(32.31±4.01)%比(36.40±3.86)%]、CD4^+/CD8^+[(0.94±0.28)%比(1.23±0.30)%],中位PFS(5个月比8个月)、中位OS(18个月比23个月)升高,CD8^+[(34.22±3.08)%比(29.56±2.50)%],CA199[(35.20±4.46)kU/L比(30.15±4.14)kU/L]、CA125[(34.91±6.03)kU/L比(29.77±5.30)kU/L]、CEA[(22.50±3.97)μg/L比(17.97±4.10)μg/L]、CY211[(7.19±2.01)μg/L比(4.56±1.34)μg/L],EPO mRNA水平(0.85±0.08比0.80±0.06)、EPO-RmRNA水平(0.88±0.09比0.81±0.08)降低,差异具有统计学意义(P均<0.05);与对照组比较,研究组血红蛋白减少、肝肾功能损伤、恶心呕吐、中性粒细胞减少发生率之间比较差异无统计学意义(P>0.05)。结论联合采取调强放疗及血管内皮抑制素治疗老年中晚期NSCLC,可有效提高肿瘤控制率,改善患者生存状况,可能是因其能降低血清肿瘤标志物水平,减轻对免疫功能的影响,调节EPO mRNA、EPO-R mRNA,且具有安全性。     

三维适形放疗治疗食管鳞癌的近期疗效、生存率及预后的影响因素分析

目的:观察三维适形放疗治疗食管鳞癌的近期疗效、生存率并分析其预后的影响因素。方法:纳入我院从2010年11月～2016年10月收治的食管鳞癌患者150例进行研究,按治疗方式的不同分成研究组(n=84,三维适形放疗治疗)和常规组(n=66,常规放疗治疗)。随访3年,比较两组近期疗效、毒副反应发生情况以及3年生存情况。单因素分析研究组患者3年生存情况与性别、年龄、病变长度、病变部位、大体肿瘤体积(GTV)的关系,多因素Logistic回归分析三维适形放疗食管鳞癌患者预后的影响因素。结果:研究组治疗总有效率显著优于常规组(P0.05)。研究组放射性食管损伤、血液毒性反应发生率均显著低于常规组(均P0.05)。研究组1、2、3年存活率均显著高于常规组(均P0.05)。单因素Logistic分析结果显示:不同年龄、病变长度、病变部位以及GTV的食管鳞癌患者三年生存率比较差异有统计学意义(均P0.05)。多因素Logistic回归分析发现年龄≥70岁、病变长度≥50 mm、病变部位为胸下段、GTV≥40 cm3均是三维适形放疗食管鳞癌患者3年内死亡的危险因素。结论:三维适形放疗治疗食管鳞癌患者的近期疗效优于常规放疗,可降低毒副反应发生率,提高生存率。年龄≥70岁、病变长度≥50 mm、病变部位为胸下段、GTV≥40 cm~3均是三维适形放疗食管鳞癌患者3年内死亡的危险因素,值得临床重点关注。     

食管癌三维适形放疗前后肺功能、生活质量的变化及放射性肺炎的影响因素分析

目的:探讨食管癌三维适形放疗前后肺功能、生活质量的变化及放射性肺炎的影响因素.方法:收集2017年11月～2019年11月在我院进行三维适形放疗的食管癌患者102例,对患者放疗前后的肺功能进行检测对比,并采用生活质量评价简袁(QLQ-C30)对患者放疗前后的生活质量进行评估对比.统计患者放疗后放射性肺炎的发生率,根据患...     

Validation of Monte Carlo multithreading TOpas 3.6 software in order to simulate the 6 MV Elekta Synergy MLCi2 platform linac

BackgroundMonte Carlo simulation is generally appreciated as an extraordinary technique to investigate particle physics processes and interactions in nuclear medicine and Radiation Therapy. The present task validates a new methodology of Monte Carlo simulation based on the Multithreading technique to reduce CPU time to simulate a 6 MV photon beam provided by the Elekta Synergy MLCi2 platform medical linear accelerator treatment head utilizing TOpas version 3.6 Monte Carlo software and the Slurm Marwan cluster.Materials and methodsThe simulation includes the linear accelerator (LINAC) major components. Calculations are performed for the photon beam with several treatment field sizes varying from 3 × 3 to 10 × 10 cm² at a 100 cm of distance from the source to the surface of the IBA dosimetry water box. The simulation was wholly approved by comparison with experimental distributions. To evaluate simulation accuracy, gamma index formalism for (2%/2mm) and (3%/2mm) criteria, Distance To Agreement DTA, and the estimator standard error ɛ and ɛ_max are used.ResultsGood agreement between simulations and measurements was observed for depth doses and lateral dose profiles, respectively. The gamma index comparisons also highlighted this agreement; more than 97% of the points for all simulations satisfy the quality assurance criteria of (2%/2mm). Regarding calculation performance, the event processing speed is faster using Gate-[mp] compared to TOpas-[mt] mode when running the identical simulation code for both.ConclusionsConsequently, according to the achieved results, the proposed methodology shows the first validation of TOpas in radiotherapy linacs simulations and a reduction in calculation time, capping simulation accuracy as much as possible. For this reason, this software is recommended to be serviceable for Treatment Planning Systems (TPS) purposes.