目的评估大分割放疗或立体定向放射治疗(stereotactic body radiotherapy,SBRT)后联合免疫治疗对肺转移瘤患者生存的影响,并分析该联合治疗方案的疗效和安全性。方法回顾性纳入2021年1月至2023年1月在广州医科大学附属第一医院接受大分...目的评估大分割放疗或立体定向放射治疗(stereotactic body radiotherapy,SBRT)后联合免疫治疗对肺转移瘤患者生存的影响,并分析该联合治疗方案的疗效和安全性。方法回顾性纳入2021年1月至2023年1月在广州医科大学附属第一医院接受大分割放疗或SBRT治疗的56例不同病理类型肺转移瘤患者(共104个病灶)的临床资料。根据治疗策略,将患者分为大分割放疗或SBRT后联合免疫治疗组(n=24)和大分割放疗或SBRT后未联合免疫治疗组(n=32)。主要研究目的为总生存时间(overall survival,OS),次要研究目的包括无进展生存时间(progression-free survival,PFS),局部控制率(local control rate,LCR)和安全性。通过Kaplan-Meier和Cox回归模型进行生存分析,并探索伴有肺外转移在不同治疗策略下的预后价值。结果纳入患者原发肿瘤以肺癌(35/56,62.5%),消化系统(8/56,14.3%)和头颈肿瘤(6/56,10.7%)为主。至数据分析截止日(2025年7月31日),放疗后联合免疫治疗组的2年和3年OS高于未联合免疫治疗组,呈现生存获益趋势,但差异无统计学意义(2年OS:83.3%vs.65.6%;3年OS:59.8%vs.55.8%,P=0.337)。探索性分析发现,在未联合免疫治疗组中,伴有肺外转移患者较仅肺转移瘤患者的生存期明显缩短,中位OS为16个月vs.未达到(HR=3.343,95%CI:1.005~11.120,P=0.049),中位PFS为8个月vs.26个月(HR=3.136,95%CI:1.042~9.437,P=0.042)。而在联合免疫治疗组中,是否伴有肺外转移对OS(HR=1.099,95%CI:0.268~4.496,P=0.891)与PFS(HR=1.525,95%CI:0.558~4.167,P=0.46)均无显著影响。联合治疗组2年和3年LCR在数值上高于未联合免疫治疗组(2年:95%vs.91.2%;3年:91.9%vs.79.7%,P=0.089)。治疗安全性良好,≥2级急性放射性肺炎(acute radiation pneumonitis,ARP)发生率为15.4%,无4级及以上ARP事件。结论大分割放疗或SBRT后联合免疫治疗显示出改善肺转移瘤患者生存的趋势,虽未达到统计学显著性,但是对伴有肺外转移的患者,采用该治疗模式能够获得与仅肺转移患者相当的生存预后。这一发现具有一定的临床启发意义,为晚期肺转移瘤的治疗策略优化提供了新思路。展开更多
背景与目的:乳腺癌保乳术后单周超大分割全乳放疗能在保证疗效和安全性的同时缩短疗程,是目前可选的全乳放疗方案。超大分割放疗要求患者每日接受图像引导,但其对位置误差的影响尚不明确。在每日锥形束计算机断层扫描(cone-beam compute...背景与目的:乳腺癌保乳术后单周超大分割全乳放疗能在保证疗效和安全性的同时缩短疗程,是目前可选的全乳放疗方案。超大分割放疗要求患者每日接受图像引导,但其对位置误差的影响尚不明确。在每日锥形束计算机断层扫描(cone-beam computed tomography,CBCT)引导下,本研究旨在探索单周超大分割全乳放疗的位置误差及其影响因素,并计算临床靶体积(clinical target volume,CTV)外扩至计划靶体积(planning target volume,PTV)的三维边界。方法:纳入2021年2月-10月于上海瑞金医院入组乳腺癌术后单周超大分割全乳放疗前瞻性研究(NCT04926766)连续入组的患者的临床资料[(2020)临伦审第(352)号]。所有患者每日治疗前摆位后行CBCT1,根据CBCT1纠正误差后再行CBCT2,当次治疗结束后行CBCT3。CBCT1、CBCT2与定位CT的三维位置误差分别为初始、残余分次间误差。CBCT2与CBCT3间的三维位置误差为分次内误差。根据每次治疗的分次间及分次内误差,基于van Herk公式计算CTV外扩至PTV三维边界。结果:本研究共入组患者34例,收集CBCT图像510例次。每日治疗前CBCT在线位置纠正显著减少三维位置误差(初始分次间误差vs残余分次间误差:前后2.8 mm vs 0.4 mm;头脚1.6 mm vs 0.5 mm;左右1.8 mm vs 0.3 mm;P均<0.001)。对于残余分次间误差,CTV体积较大患者(>402.5 cm^(3)vs≤402.5 cm^(3))在前后方向(0.5 mm vs 0.3 mm,P=0.023)和头脚方向(0.6 mm vs 0.5 mm,P=0.037)更大。对于分次内误差,CTV较大患者(>402.5 cm^(3)vs≤402.5 cm^(3))在前后方向更大(0.5 mm vs 0.2 mm,P=0.001);身体质量指数(body mass index,BMI)较高患者(>23.2 kg/m^(2)vs≤23.2 kg/m^(2))在前后方向更大(0.7 mm vs 0.2 mm,P<0.001);体重更大患者(> 60.0 kg vs≤60.0 kg)在前后方向更大(0.5 mm vs 0.2 mm,P=0.033)。每日CBCT引导下CTV外扩至PTV边界推荐为:前后2.3 mm,头脚2.8 mm,左右2.0mm。但CTV>402.5 cm^(3)和BMI>23.2 kg/m^(2)的患者需要更大的头脚方向外扩边界,分别为3.1和3.4 mm。结论:每日CBCT图像引导下,对大部分患者将全乳放疗CTV外扩至PTV的三维边界限制在3 mm内是可行的,而BMI较高和CTV较大患者需在头脚方向适度增大外扩边界。展开更多
Background:Lung metastases often occur after orthotopic liver transplantation(OLT)for hepatocellular carcinoma(HCC).This study aimed to evaluate the safety and efficacy of combining hypofractionated radiotherapy(HFRT)...Background:Lung metastases often occur after orthotopic liver transplantation(OLT)for hepatocellular carcinoma(HCC).This study aimed to evaluate the safety and efficacy of combining hypofractionated radiotherapy(HFRT)with tyrosine kinase inhibitors(TKIs)in patients with lung metastases from HCC following OLT.Methods:We retrospectively analyzed forty-eight patients with lung metastases post-OLT for HCC,who underwent concurrent HFRT and TKIs between July 2011 and August 2022.The primary endpoint was progression-free survival(PFS),and secondary endpoints included overall survival(OS),local control rate(LCR),in-field objective response rate(ORR),and treatment-related side effects.Results:The median follow-up duration was 42.3 months,with median PFS and OS of 9.9 and 32.7 months,respectively.PFS rates at 1,2,and 3 years were 33.3%,20.8%,and 12.5%,respectively,whereas corresponding OS rates were 91.7%,70.8%,and 33.3%,respectively.Independent adverse factors for PFS included the presence of>3 lung metastases,interval time from OLT to lung metastasis<1 year,and post-HFRT lymphocyte nadir<0.8×10^(9)/L.For OS,independent adverse factors included shorter PFS time,shorter intervals from OLT to lung metastasis,and post-HFRT lymphocyte nadirs<0.8×10^(9)/L.The 1-and 2-year LCRs for lung metastases were 100%and 85.3%,respectively.The best in-field ORR was 95.5%,with no adverse events exceeding grade 2.Radiation pneumonitis occurred in 32 patients(66.7%),with grade 1 in 28 patients(58.3%)and grade 2 in 4 patients(8.3%).Conclusions:The combination of HFRT with TKIs is a feasible,safe,and promising approach for treating lung metastases from HCC post-OLT.展开更多
BACKGROUND Radiation therapy is an important treatment for esophageal tumors.However,there is still controversy regarding the total dose and fraction dose.The optimal dose and fractionation schedule have not yet been ...BACKGROUND Radiation therapy is an important treatment for esophageal tumors.However,there is still controversy regarding the total dose and fraction dose.The optimal dose and fractionation schedule have not yet been clearly established.Hypofractionated radiotherapy is becoming more popular,but it is unknown whether this is the optimal choice for esophageal tumors.In addition,the appropriate dose per fraction is uncertain.We performed a retrospective study to address these issues.AIM To report the cumulative survival and toxicity associated with the delivered dose escalation and hypofractionation schedule of radiation therapy for esophageal squamous cell carcinoma.METHODS Forty-seven patients treated for inoperable locally advanced thoracic esophageal squamous cell carcinoma with helical tomotherapy using different total doses and doses per fraction were enrolled.Toxicity and adverse events were evaluated in all patients to determine the acute and long-term effects according to the Toxicity Criteria of The Radiation Therapy Oncology Group.Overall survival was calculated using the Kaplan-Meier method.Logistic analysis was used to identify the correlation between dose delivered to the primary tumor and the degree of toxicity.In multivariate analysis,all variables were entered in a single step using the method of backward stepwise regression.RESULTS Six patients died of bleeding related to aorto-esophageal fistulization.Four patients died of tracheo-esophageal fistulas,and 7 patients died of local recurrence.The remaining 20 patients died of metastases and multi-organ failure due to organ metastases.The dose of radiation and the dose level were positively correlated with esophageal toxicity,which was much greater with dose escalation and dose level per fraction increase.CONCLUSION Esophageal toxicity can be tolerated below a prescribed radiation dose of 60 Gy and less than 2.3 Gy per fraction.展开更多
文摘目的评估大分割放疗或立体定向放射治疗(stereotactic body radiotherapy,SBRT)后联合免疫治疗对肺转移瘤患者生存的影响,并分析该联合治疗方案的疗效和安全性。方法回顾性纳入2021年1月至2023年1月在广州医科大学附属第一医院接受大分割放疗或SBRT治疗的56例不同病理类型肺转移瘤患者(共104个病灶)的临床资料。根据治疗策略,将患者分为大分割放疗或SBRT后联合免疫治疗组(n=24)和大分割放疗或SBRT后未联合免疫治疗组(n=32)。主要研究目的为总生存时间(overall survival,OS),次要研究目的包括无进展生存时间(progression-free survival,PFS),局部控制率(local control rate,LCR)和安全性。通过Kaplan-Meier和Cox回归模型进行生存分析,并探索伴有肺外转移在不同治疗策略下的预后价值。结果纳入患者原发肿瘤以肺癌(35/56,62.5%),消化系统(8/56,14.3%)和头颈肿瘤(6/56,10.7%)为主。至数据分析截止日(2025年7月31日),放疗后联合免疫治疗组的2年和3年OS高于未联合免疫治疗组,呈现生存获益趋势,但差异无统计学意义(2年OS:83.3%vs.65.6%;3年OS:59.8%vs.55.8%,P=0.337)。探索性分析发现,在未联合免疫治疗组中,伴有肺外转移患者较仅肺转移瘤患者的生存期明显缩短,中位OS为16个月vs.未达到(HR=3.343,95%CI:1.005~11.120,P=0.049),中位PFS为8个月vs.26个月(HR=3.136,95%CI:1.042~9.437,P=0.042)。而在联合免疫治疗组中,是否伴有肺外转移对OS(HR=1.099,95%CI:0.268~4.496,P=0.891)与PFS(HR=1.525,95%CI:0.558~4.167,P=0.46)均无显著影响。联合治疗组2年和3年LCR在数值上高于未联合免疫治疗组(2年:95%vs.91.2%;3年:91.9%vs.79.7%,P=0.089)。治疗安全性良好,≥2级急性放射性肺炎(acute radiation pneumonitis,ARP)发生率为15.4%,无4级及以上ARP事件。结论大分割放疗或SBRT后联合免疫治疗显示出改善肺转移瘤患者生存的趋势,虽未达到统计学显著性,但是对伴有肺外转移的患者,采用该治疗模式能够获得与仅肺转移患者相当的生存预后。这一发现具有一定的临床启发意义,为晚期肺转移瘤的治疗策略优化提供了新思路。
文摘背景与目的:乳腺癌保乳术后单周超大分割全乳放疗能在保证疗效和安全性的同时缩短疗程,是目前可选的全乳放疗方案。超大分割放疗要求患者每日接受图像引导,但其对位置误差的影响尚不明确。在每日锥形束计算机断层扫描(cone-beam computed tomography,CBCT)引导下,本研究旨在探索单周超大分割全乳放疗的位置误差及其影响因素,并计算临床靶体积(clinical target volume,CTV)外扩至计划靶体积(planning target volume,PTV)的三维边界。方法:纳入2021年2月-10月于上海瑞金医院入组乳腺癌术后单周超大分割全乳放疗前瞻性研究(NCT04926766)连续入组的患者的临床资料[(2020)临伦审第(352)号]。所有患者每日治疗前摆位后行CBCT1,根据CBCT1纠正误差后再行CBCT2,当次治疗结束后行CBCT3。CBCT1、CBCT2与定位CT的三维位置误差分别为初始、残余分次间误差。CBCT2与CBCT3间的三维位置误差为分次内误差。根据每次治疗的分次间及分次内误差,基于van Herk公式计算CTV外扩至PTV三维边界。结果:本研究共入组患者34例,收集CBCT图像510例次。每日治疗前CBCT在线位置纠正显著减少三维位置误差(初始分次间误差vs残余分次间误差:前后2.8 mm vs 0.4 mm;头脚1.6 mm vs 0.5 mm;左右1.8 mm vs 0.3 mm;P均<0.001)。对于残余分次间误差,CTV体积较大患者(>402.5 cm^(3)vs≤402.5 cm^(3))在前后方向(0.5 mm vs 0.3 mm,P=0.023)和头脚方向(0.6 mm vs 0.5 mm,P=0.037)更大。对于分次内误差,CTV较大患者(>402.5 cm^(3)vs≤402.5 cm^(3))在前后方向更大(0.5 mm vs 0.2 mm,P=0.001);身体质量指数(body mass index,BMI)较高患者(>23.2 kg/m^(2)vs≤23.2 kg/m^(2))在前后方向更大(0.7 mm vs 0.2 mm,P<0.001);体重更大患者(> 60.0 kg vs≤60.0 kg)在前后方向更大(0.5 mm vs 0.2 mm,P=0.033)。每日CBCT引导下CTV外扩至PTV边界推荐为:前后2.3 mm,头脚2.8 mm,左右2.0mm。但CTV>402.5 cm^(3)和BMI>23.2 kg/m^(2)的患者需要更大的头脚方向外扩边界,分别为3.1和3.4 mm。结论:每日CBCT图像引导下,对大部分患者将全乳放疗CTV外扩至PTV的三维边界限制在3 mm内是可行的,而BMI较高和CTV较大患者需在头脚方向适度增大外扩边界。
基金supported by grants from the National Natu-ral Science Foundation of China(82102913 and 82102823)the Special Clinical Research Program of the Health Industry,Shanghai Municipal Health Commission(202340179).
文摘Background:Lung metastases often occur after orthotopic liver transplantation(OLT)for hepatocellular carcinoma(HCC).This study aimed to evaluate the safety and efficacy of combining hypofractionated radiotherapy(HFRT)with tyrosine kinase inhibitors(TKIs)in patients with lung metastases from HCC following OLT.Methods:We retrospectively analyzed forty-eight patients with lung metastases post-OLT for HCC,who underwent concurrent HFRT and TKIs between July 2011 and August 2022.The primary endpoint was progression-free survival(PFS),and secondary endpoints included overall survival(OS),local control rate(LCR),in-field objective response rate(ORR),and treatment-related side effects.Results:The median follow-up duration was 42.3 months,with median PFS and OS of 9.9 and 32.7 months,respectively.PFS rates at 1,2,and 3 years were 33.3%,20.8%,and 12.5%,respectively,whereas corresponding OS rates were 91.7%,70.8%,and 33.3%,respectively.Independent adverse factors for PFS included the presence of>3 lung metastases,interval time from OLT to lung metastasis<1 year,and post-HFRT lymphocyte nadir<0.8×10^(9)/L.For OS,independent adverse factors included shorter PFS time,shorter intervals from OLT to lung metastasis,and post-HFRT lymphocyte nadirs<0.8×10^(9)/L.The 1-and 2-year LCRs for lung metastases were 100%and 85.3%,respectively.The best in-field ORR was 95.5%,with no adverse events exceeding grade 2.Radiation pneumonitis occurred in 32 patients(66.7%),with grade 1 in 28 patients(58.3%)and grade 2 in 4 patients(8.3%).Conclusions:The combination of HFRT with TKIs is a feasible,safe,and promising approach for treating lung metastases from HCC post-OLT.
文摘BACKGROUND Radiation therapy is an important treatment for esophageal tumors.However,there is still controversy regarding the total dose and fraction dose.The optimal dose and fractionation schedule have not yet been clearly established.Hypofractionated radiotherapy is becoming more popular,but it is unknown whether this is the optimal choice for esophageal tumors.In addition,the appropriate dose per fraction is uncertain.We performed a retrospective study to address these issues.AIM To report the cumulative survival and toxicity associated with the delivered dose escalation and hypofractionation schedule of radiation therapy for esophageal squamous cell carcinoma.METHODS Forty-seven patients treated for inoperable locally advanced thoracic esophageal squamous cell carcinoma with helical tomotherapy using different total doses and doses per fraction were enrolled.Toxicity and adverse events were evaluated in all patients to determine the acute and long-term effects according to the Toxicity Criteria of The Radiation Therapy Oncology Group.Overall survival was calculated using the Kaplan-Meier method.Logistic analysis was used to identify the correlation between dose delivered to the primary tumor and the degree of toxicity.In multivariate analysis,all variables were entered in a single step using the method of backward stepwise regression.RESULTS Six patients died of bleeding related to aorto-esophageal fistulization.Four patients died of tracheo-esophageal fistulas,and 7 patients died of local recurrence.The remaining 20 patients died of metastases and multi-organ failure due to organ metastases.The dose of radiation and the dose level were positively correlated with esophageal toxicity,which was much greater with dose escalation and dose level per fraction increase.CONCLUSION Esophageal toxicity can be tolerated below a prescribed radiation dose of 60 Gy and less than 2.3 Gy per fraction.
