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躯干和肢体软组织肉瘤的围手术期化疗与放疗 预览
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作者 Lee D.Cranmer Edward Y.Kim 《中国临床医学》 2019年第3期340-359,共20页
虽然手术是肢体和躯干原发软组织肉瘤的根治性治疗手段,但对于高危患者单纯手术常难以获得疾病的长期控制。治疗失败的主要原因为远处转移,其次为局部复发。一些局部进展期的患者可能面临无法手术切除,或仅边缘可切除,因此预后很差。围... 虽然手术是肢体和躯干原发软组织肉瘤的根治性治疗手段,但对于高危患者单纯手术常难以获得疾病的长期控制。治疗失败的主要原因为远处转移,其次为局部复发。一些局部进展期的患者可能面临无法手术切除,或仅边缘可切除,因此预后很差。围手术期的系统治疗和放疗可提高手术疗效。如何确立围手术期系统治疗的价值颇具挑战。系统治疗可以缩小肿瘤。但要证明其对局部控制的价值从而促进实施更为保守的外科手术的证据仍不充分。对于那些原发肿瘤被认定为难以或不可能切除的患者,新辅助化疗可能为疾病的局部控制提供一种选择。围手术期的系统治疗也可以避免远处转移的发生。近期的研究表明,以蒽环类药物/异环磷酰胺为基础的辅助治疗能够使患者获益,虽然证据来自于对一项大型研究的再次分析。一项新辅助化疗的随机研究提示,对某些经过选择的肉瘤组织学亚型,以蒽环类药物/异环磷酰胺为基础的系统化疗可能改善患者无病生存和总生存期。其疗效的获得主要是通过改善远处无转移生存而不是局控率的提高。这两项研究所采用的方法均存在一定的局限性,因此需要进一步探索。尽管如此,我们相信这些结果支持在局部进展期、肢体和躯干原发的软组织肉瘤患者中进行新辅助化疗。放疗与手术结合在软组织肉瘤的治疗中有确切的疗效。虽然预后并不因放疗和手术的先后顺序而异,但不良反应却存在差异。辅助放疗较新辅助放疗有更低的围手术期伤口并发症,但相对于新辅助放疗而言,辅助放疗需要更高的放射剂量,对长期功能的预后差于新辅助放疗。因此,我们相信围手术期放疗与化疗一样,在可能的情况下,应尽可能在术前进行。 展开更多
关键词 软组织肉瘤 躯干 肢体 化疗 放疗
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Strategies to tackle the challenges of external beam radiotherapy for liver tumors 预览
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作者 Michael I Lock Jonathan Klein +5 位作者 Hans T Chung Joseph M Herman Edward Y Kim William Small Nina A Mayr Simon S Lo 《世界肝病学杂志:英文版(电子版)》 2017年第14期645-656,共12页
Primary and metastatic liver cancer is an increasingly common and difficult to control disease entity.Radiation offers a non-invasive treatment alternative for these patients who often have few options and a poor prog... Primary and metastatic liver cancer is an increasingly common and difficult to control disease entity.Radiation offers a non-invasive treatment alternative for these patients who often have few options and a poor prognosis.However,the anatomy and aggressiveness of liver cancer poses significant challenges such as accurate localization at simulation and treatment,management of motion and appropriate selection of dose regimen.This article aims to review the options available and provide information for the practical implementation and/or improvement of liver cancer radiation programs within the context of stereotactic body radiotherapy and image-guided radiotherapy guidelines.Specific patient inclusion and exclusion criteria are presented given the significant toxicity found in certain sub-populations treated with radiation.Indeed,certain sub-populations,such as those with tumor thrombosis or those with larger lesions treated with transarterial chemoembolization,have been shown to have significant improvements in outcome with the addition of radiation and merit special consideration.Implementing a liver radiation programrequires three primary challenges to be addressed:(1) immobilization and motion management;(2) localization;and(3) dose regimen and constraint selection.Strategies to deal with motion include simple internal target volume(ITV) expansions,non-gated ITV reduction strategies,breath hold methods,and surrogate marker methods to enable gating or tracking.Localization of the tumor and organs-at-risk are addressed using contrast infusion techniques to take advantage of different normal liver and cancer vascular anatomy,imaging modalities,and margin management.Finally,a dose response has been demonstrated and dose regimens appear to be converging.A more uniform approach to treatment in terms of technique,dose selection and patient selection will allow us to study liver radiation in larger and,hopefully,multicenter randomized studies. 展开更多
关键词 Hepatocellular 肝转移 4DCT 指导图象的放射疗法 Stereotactic 身体放射治疗
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