放射治疗

文摘:背景:我们进行了一项多国随机研究，比较单独放疗与放疗加西妥昔单抗(一种对抗表皮生长因子受体的单克隆抗体)治疗局部晚期头颈部鳞状细胞癌的疗效。方法局部晚期头颈癌患者随机分为单独大剂量放疗(213例)和每周大剂量放疗加西妥昔单抗(211例)两组，初始剂量为每平方米体表面积400 mg，随后在放疗期间每周服用250 mg /平方米。主要终点是局部疾病控制的持续时间;次要终点为总生存率、无进展生存率、有效率和安全性。西妥昔单抗联合放疗患者局部区域控制的中位持续时间为24.4个月，单独放疗患者局部区域进展或死亡的风险比为14.9个月(局部进展或死亡的风险比为0.68;P = 0.005)。中位随访时间为54.0个月，联合治疗患者的中位总生存期为49.0个月，单独放疗患者的中位总生存期为29.3个月(死亡危险比为0.74;P = 0.03)。放疗加西妥昔单抗显著延长无进展生存期(疾病进展或死亡的危险比，0.70;P = 0.006)。 With the exception of acneiform rash and infusion reactions, the incidence of grade 3 or greater toxic effects, including mucositis, did not differ significantly between the two groups. CONCLUSIONS Treatment of locoregionally advanced head and neck cancer with concomitant highdose radiotherapy plus cetuximab improves locoregional control and reduces mortality without increasing the common toxic effects associated with radiotherapy to the head and neck. (ClinicalTrials.gov number, NCT00004227.)

文摘:背景:在早期乳腺癌中，局部治疗的差异在很大程度上影响局部复发的风险，也可能影响乳腺癌的长期死亡率。为了检验这种关系，基于1995年开始的相关随机试验的个体患者数据，进行了协作元分析。方法在78个随机治疗比较(放疗与不放疗，23500;多手术vs少手术，9300人;更多的手术vs放射治疗，9300)。共确定24种局部处理比较。为了帮助将局部(即局部)复发的影响与乳腺癌死亡率的影响联系起来，根据5年局部复发风险是否超过10%(- 10%，17000名妇女;10%， 2.5万名女性)。大约四分之三的最终局部复发风险发生在前5年。在5年局部复发风险差异很小(- 10%)的比较中，15年乳腺癌死亡率差异很小。 Among the 25 000 women in the comparisons that involved substantial (�10%) differences, however, 5-year local recurrence risks were 7% active versus 26% control (absolute reduction 19%), and 15-year breast cancer mortality risks were 44·6% versus 49·5% (absolute reduction 5·0%, SE 0·8, 2p�0·00001). These 25 000 women included 7300 with breast-conserving surgery (BCS) in trials of radiotherapy (generally just to the conserved breast), with 5-year local recurrence risks (mainly in the conserved breast, as most had axillary clearance and node-negative disease) 7% versus 26% (reduction 19%), and 15-year breast cancer mortality risks 30·5% versus 35·9% (reduction 5·4%, SE 1·7, 2p=0·0002; overall mortality reduction 5·3%, SE 1·8, 2p=0·005). They also included 8500 with mastectomy, axillary clearance, and node-positive disease in trials of radiotherapy (generally to the chest wall and regional lymph nodes), with similar absolute gains from radiotherapy; 5-year local recurrence risks (mainly at these sites) 6% versus 23% (reduction 17%), and 15-year breast cancer mortality risks 54·7% versus 60·1% (reduction 5·4%, SE 1·3, 2p=0·0002; overall mortality reduction 4·4%, SE 1·2, 2p=0·0009). Radiotherapy produced similar proportional reductions in local recurrence in all women (irrespective of age or tumour characteristics) and in all major trials of radiotherapy versus not (recent or older; with or without systemic therapy), so large absolute reductions in local recurrence were seen only if the control risk was large. To help assess the life-threatening side-effects of radiotherapy, the trials of radiotherapy versus not were combined with those of radiotherapy versus more surgery. There was, at least with some of the older radiotherapy regimens, a significant excess incidence of contralateral breast cancer (rate ratio 1·18, SE 0·06, 2p=0·002) and a significant excess of non-breast-cancer mortality in irradiated women (rate ratio 1·12, SE 0·04, 2p=0·001). Both were slight during the first 5years, but continued after year 15. The excess mortality was mainly from heart disease (rate ratio 1·27, SE 0·07, 2p=0·0001) and lung cancer (rate ratio 1·78, SE 0·22, 2p=0·0004). Interpretation In these trials, avoidance of a local recurrence in the conserved breast after BCS and avoidance of a local recurrence elsewhere (eg, the chest wall or regional nodes) after mastectomy were of comparable relevance to 15-year breast cancer mortality. Differences in local treatment that substantially affect local recurrence rates would, in the hypothetical absence of any other causes of death, avoid about one breast cancer death over the next 15years for every four local recurrences avoided, and should reduce 15-year overall mortality.

文摘:电离辐射的治疗应用是基于保留正常组织的影响，同时试图达到对肿瘤细胞的致命作用。在放射治疗的历史上，很明显，正常组织的整体效果存在显著差异。虽然在正常组织中有一些晚期影响的早期评价，通常不能通过急性反应预测，但只有在最近几年才有关于晚期损害严重程度缓慢和进行性增加的完整文件。目前，急性和晚期辐射效应的病理生理机制已经得到了更好的理解(2)，但其他模式与放疗的相互作用需要持续监测，以识别和减轻不良后遗症。Stone(3)的工作是一个未预料到的后期效应的经典例子，它是由“快中子”辐照引起的。急性反应是温和和可容忍的，但晚期后遗症是如此明显，以至于在近三十年的时间里，人们对使用快中子进行治疗几乎没有兴趣。晚期发病率评分标准是由对快中子治疗重新感兴趣的医生和放射治疗肿瘤组(RTOG)工作人员共同努力制定的。在20世纪70年代末，中子/粒子委员会是RTOG的几个模态委员会之一。认识到Stone的结果，由Lawrence Davis领导的这个委员会与RTOG的工作人员一起建立了快中子放射治疗可能的后期影响的标准和评分。来自欧洲癌症研究和治疗组织(EORTC)的研究人员，由爱丁堡西部总医院的威廉·邓肯领导，希望有共同betway亚洲的毒性标准，以期待联合研究。 RTOG Protocol 7929, an international registry of patients treated with heavy particles, was started in 1980. At the annual meetings of the international participants in particle studies, there were attempts to monitor interobserver variations in scoring effects in normal tissues and to seek consistency in reporting toxicity, but no publications document these efforts. The first prospective trial to use the Late Morbidity Scoring Criteria was RTOG Protocol 8001, a study of fast neutron therapy for malignant tumors arising in salivary glands. Although the RTOG began to use these criteria in reporting toxicity in patients enrolled in all studies from 198 1 (beginning with RTOG Protocol 8 115), the criteria only became a published part of protocols in 1983. At that time, statistical methods began to be used, which presented time-adjusted estimates of late effects, the rationale for which was described by Cox (1). It is now considered standard to represent cumulative probabilities of late effects with methods similar to those for estimating local control and survival. The Acute Radiation Morbidity Scoring Criteria were developed in 1985 as complimentary to the Late Effects Scoring Criteria. The National Cancer Institute promulgated standard toxicity criteria in 1990, but late effects were not considered. An abbreviated version of the RTOG/EORTC toxicity criteria was published by Winchester and Cox in 1992 as part of the Standard for Breast Conservation Treatment. The current RTOG Acute Radiation Morbidity Scoring Criteria are presented in Table 1. The RTOG/EORTC Late Radiation Morbidity Scoring Scheme is detailed in Table 2. In both tables, 0 means an absence of radiation effects and 5 means the effects led to death. The severity

文摘:上下文。-间质放射(植入)治疗用于临床局限性前列腺腺癌，但与其他治疗方法相比如何尚不清楚。-评价临床局限性前列腺癌患者根治性前列腺切除术(RP)、体外放射(RT)或植入伴或不伴新辅助雄激素剥夺治疗后前列腺特异性抗原(PSA)的控制情况。-采用Cox回归多变量分析比较结果资料的回顾性队列研究。设置和病人。在1989年1月至1997年10月期间，共有1872名男性在宾夕法尼亚大学费城医院接受了RP (n=888)或植入治疗，其中包括或不包括新辅助雄激素剥夺疗法(n=218)，或在波士顿放射治疗联合中心接受了RT (n=766)。主要结果测量。- PSA失败的精算自由(定义为PSA结果)。-与RP治疗的低风险患者(T1c期、T2a期、PSA水平≤10 ng/mL、Gleason评分≤6)相比，采用RT、种植体+雄激素抑制治疗或种植体治疗的患者PSA失效的相对风险(RR)分别为1.1(95%可信区间[CI]， 0.5-2.7)、0.5 (95% CI, 0.1-1.9)和1.1 (95% CI, 0.3-3.6)。种植体治疗的中危患者(T2b期或Gleason评分为7或PSA水平>10及≤20 ng/mL)和高危患者(T2c期或PSA水平>20 ng/mL或Gleason评分≥8)与RP相比，PSA失败的RRs分别为3.1 (95% CI, 1.5 ~ 6.1)和3.0 (95% CI, 1.8 ~ 5.0)。在植入治疗中加入雄激素剥夺并不能改善高危患者的PSA结果，但与中危患者的RP或RT相比，PSA结果无统计学差异。当使用传统的活检Gleason评分(2到4 vs 5到6 vs 7 vs 8到10)对患者进行分层时，这些结果没有变化。-低风险患者在RP、RT或植入物治疗后的5年PSA预后评估(伴或不伴新辅助雄激素剥夺)无统计学差异，而采用RP或RT治疗的中高危患者优于植入物治疗的患者。 Prospective randomized trials are needed to verify these findings.