论文部分内容阅读
目的:探讨立体定向伽玛刀放射治疗中晚期贲门癌的近期疗效及可行性。方法:对2005年1月至2008年1月我院收治的43例中晚期贲门癌患者,进行立体定向伽玛刀放射治疗。患者均以仰卧位用负压袋固定、经CT扫描定位,将定位图像输入γ-TPS系统,由医师确定精确的靶区,由物理师设计靶点,调整剂量分布,尽量避开肝脏和胰腺、肾脏等正常组织,以50%-85%的剂量曲线包绕靶区,肿瘤边缘剂量DT2.5-3.2Gy/f,3f/W,总量DT20-32Gy/8-10f。CT定位及每次治疗前,患者均定量充盈胃腔。比较患者放疗前、后的钡餐及CT片中病灶的大小、临床症状,统计生存率并观察放疗反应。结果:伽玛刀放射治疗后,43例患者均有不同程度的症状改善(上腹疼痛不适减轻23例,呕血黑便停止2例,进食改善17例,体重增加20例);3月时复查钡餐或CT,总有效率为72.09%,其中病灶完全缓解4.65%(2/43),部分缓解67.44%(29/43),无变化27.91%(12/43),恶化0。治疗后1年、2年总体生存率分别为51.16%(22/43),25.58%(11/43),中位生存期为18.2月。放疗反应:腹痛腹胀55.8%(15例出现,9例加重,24/43),骨髓抑制18.6%(8/43),放射性胃炎4.7%(2/43)。全部患者配合对症支持治疗后,放疗反应逐渐恢复,肝肾功能基本正常,并均按计划完成放疗。结论:伽玛刀治疗中晚期贲门癌有显著的近期疗效,放疗反应较轻,是中晚期贲门癌姑息治疗的可行方案之一。
Objective: To investigate the short-term curative effect and feasibility of stereotactic gamma knife radiotherapy for advanced cardiac cancer. Methods: From January 2005 to January 2008 in our hospital, 43 cases of patients with advanced cardia cancer, stereotactic gamma knife radiotherapy. The patients were all placed in a supine position with a vacuum bag. The CT images were taken and placed into the gamma-TPS system. The physicians determined the precise target area. The physicians designed the target to adjust the dose distribution and try to avoid the liver and pancreas , Kidney and other normal tissues, with dose curve of 50% -85% around the target area, the tumor marginal dose DT2.5-3.2Gy / f, 3f / W, the total amount of DT20-32Gy / 8-10f. CT positioning and before each treatment, patients were fully filled gastric cavity. Compare the size, clinical symptoms, statistical survival rate and radiotherapy response of patients with barium meal and CT before and after radiotherapy. Results: After gamma knife radiotherapy, 43 patients had different degrees of symptom improvement (23 cases of upper abdominal pain discomfort, 2 cases of hematemesis stopped, 17 cases of eating improvement, 20 cases of weight gain); The total effective rate was 72.09% with barium meal or CT. The complete remission rate was 4.65% (2/43), partial response rate was 67.44% (29/43), no change was 27.91% (12/43), and the rate was 0. One year after treatment, the overall 2-year survival rates were 51.16% (22/43) and 25.58% (11/43), respectively. The median survival time was 18.2 months. Radiotherapy response: abdominal distension 55.8% (15 cases, 9 cases aggravated, 24/43), bone marrow suppression 18.6% (8/43), 4.7% of radioactive gastritis (2/43). All patients with symptomatic and supportive treatment, radiotherapy response gradually restored, liver and kidney function was normal, and completed radiotherapy according to plan. Conclusion: Gamma knife treatment of cardiac cancer in the late have a significant short-term efficacy, radiation response is light, is the palliative treatment of cardia cancer in the late one of the possible options.