保乳治疗已成为早期乳腺癌的治疗选择方式之一，而放射治疗则是保乳治疗的重要组成部分。尽管目前全乳照射（whole breast irradiation，WBI）仍然是保乳术后放疗的主导模式，但以照射靶区范围及剂量分割模式改变为特征的加速部分乳腺...保乳治疗已成为早期乳腺癌的治疗选择方式之一，而放射治疗则是保乳治疗的重要组成部分。尽管目前全乳照射（whole breast irradiation，WBI）仍然是保乳术后放疗的主导模式，但以照射靶区范围及剂量分割模式改变为特征的加速部分乳腺照射（accelerated partial breast irradiation，APBI）近年来备受关注，现已替代WBI成为部分具有特定临床病理特征保乳患者的放疗选择。展开更多
Background: Gross target volume of primary tumor(GTV?P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma(NPC), but it is unknown whether the same is true for locally advanced NP...Background: Gross target volume of primary tumor(GTV?P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma(NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity?modulated radiotherapy(IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to ind a suitable cut?of value of GTV?P for prognosis prediction.Methods: Clinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver oper?ating characteristic(ROC) curves were used to identify the cut?of values of GTV?P for the prediction of diferent end?points [overall survival(OS), local relapse?free survival(LRFS), distant metastasis?free survival(DMFS), and disease?free survival(DFS)] and to test the prognostic value of GTV?P when compared with that of the American Joint Committee on Cancer T staging system.Results: The 358 patients with locally advanced NPC were divided into two groups by the cut?of value of GTV?P as determined using ROC curves: 219(61.2%) patients with GTV?P ≤46.4 mL and 139(38.8%) with GTV?P >46.4 mL. The 3?year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV?P ≤46.4 mL than in those with GTV?P > 46.4 mL(all P < 0.05). Multivariate analysis indicated that GTV?P >46.4 mL was an independent unfavorable prognostic factor for patient survival. The ROC curve veriied that the predictive ability of GTV?P was superior to that of T category(P < 0.001). The cut?of values of GTV?P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4 mL, respectively.Conclusion: In patients with locally advanced NPC, GTV?P >46.4 mL is an independent unfavorable prognostic indi?cator for survival after IMRT, with a prognostic value superior to that of T category.展开更多
基金北京市医院管理局临床医学发展专项，吴阶平医学基金会资助项目(WKJ055-3-006)Special Funding Support in Clinical Medicine Development of Beijing Municipal Administration of Hospitals，Wu Jieping Medical Foundation
文摘目的比较基于4DCT呼气末时相、18F-FDG PET-CT及T2加权(T2W)MRI所勾画胸段食管癌大体肿瘤体积(GTV)、位置及长度差异,探讨食管癌原发肿瘤GTV勾画时PET-CT与MRI图像结合的必要性。方法26例拟行同步放化疗的胸段食管癌患者序贯完成增强3DCT、增强4DCT、PET-CT、增强MRI胸部定位扫描,基于3DCT图像形变配准。分别基于3DCT、4DCT的呼气末时相、PET-CT SUV 2.5、T2W-MRI和DWI图像勾画GTV获得GTVCT、GTV50%、GTVPET2.5、GTVMRI和GTVDWI。结果GTVPET2.5大于GTV50%(P<0.001)和GTVMRI(P=0.008),而GTVMRI与GTV50%接近(P=0.439)。GTVMRI与GTV50%、GTVCT的适形指数(CI)大于GTVPET2.5与GTV50%、GTVCT的(P=0.004、P=0.039),GTVMRI与GTVPET2.5的CI明显小于GTVMRI、GTVPET2.5与GTV50%、GTVCT的(P=0.000~0.021)。镜检长度与GTVPET、GTVDWI长度相近(P>0.05),且GTVPET2.5与GTVDWI长度接近(P=0.072)。结论基于PET-CT SUV2.5与呼吸门控状态下T2W-MRI所勾画食管癌GTV和空间位置差异明显,PET-CT与MRI结合进行食管癌靶区勾画的必要性尚需探讨,但MRI-DWI可以代替PET-CT帮助基于CT图像勾画GTV时上下界的确定。
文摘保乳治疗已成为早期乳腺癌的治疗选择方式之一，而放射治疗则是保乳治疗的重要组成部分。尽管目前全乳照射（whole breast irradiation，WBI）仍然是保乳术后放疗的主导模式，但以照射靶区范围及剂量分割模式改变为特征的加速部分乳腺照射（accelerated partial breast irradiation，APBI）近年来备受关注，现已替代WBI成为部分具有特定临床病理特征保乳患者的放疗选择。
基金supported by the National Natural Science Foundation of China (No.81372792)
文摘Background: Gross target volume of primary tumor(GTV?P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma(NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity?modulated radiotherapy(IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to ind a suitable cut?of value of GTV?P for prognosis prediction.Methods: Clinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver oper?ating characteristic(ROC) curves were used to identify the cut?of values of GTV?P for the prediction of diferent end?points [overall survival(OS), local relapse?free survival(LRFS), distant metastasis?free survival(DMFS), and disease?free survival(DFS)] and to test the prognostic value of GTV?P when compared with that of the American Joint Committee on Cancer T staging system.Results: The 358 patients with locally advanced NPC were divided into two groups by the cut?of value of GTV?P as determined using ROC curves: 219(61.2%) patients with GTV?P ≤46.4 mL and 139(38.8%) with GTV?P >46.4 mL. The 3?year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV?P ≤46.4 mL than in those with GTV?P > 46.4 mL(all P < 0.05). Multivariate analysis indicated that GTV?P >46.4 mL was an independent unfavorable prognostic factor for patient survival. The ROC curve veriied that the predictive ability of GTV?P was superior to that of T category(P < 0.001). The cut?of values of GTV?P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4 mL, respectively.Conclusion: In patients with locally advanced NPC, GTV?P >46.4 mL is an independent unfavorable prognostic indi?cator for survival after IMRT, with a prognostic value superior to that of T category.
