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Radioiodine Therapy for WellDifferentiated Thyroid Carcinoma

卵巢甲状腺肿腹腔种植1例报道

目的总结1例卵巢甲状腺肿腹腔种植病例的诊治过程。方法回顾性分析2023年7月笔者所在医院收治的1例卵巢甲状腺肿腹腔种植患者的临床资料和病理结果。结果患者系55岁女性，因“腹痛4+ 年，盆腔包块切除术后4年” 入院。完善CT检查提示心膈角区、肝肾间隙包膜、腹膜、腹盆腔多发结节，既往于外院行子宫、右侧附件及部分腹腔结节切除术，术后病理提示为结节性甲状腺肿样的良性组织学表现。经笔者所在医院疑难病例讨论后，患者接受了甲状腺全切除手术，术中出血约为5ｍL，术后恢复良好、未见明显并发症。术后33 ｄ于核医学科接受131I放射治疗。出院后1个月于当地医院复查甲状腺功能正常，目前已随访5个月，甲状腺功能控制正常，颈部及腹部无不适，继续随访。结论卵巢甲状腺肿腹腔种植病例罕见，临床表现无特异性，诊断主要依据病理学证据，生物学行为具有惰性，临床干预首选完整切除卵巢肿物及腹膜结节，若不能完整切除或者随诊结节复发，可以行甲状腺全切除后131I放射治疗，但该治疗方案仍需更多研究进一步探讨。

Initial Approach of Applying Intraoperative Radiotherapy with Electrons after Conservative Surgery for Patients with Early Breast Cancer

【摘要】目的探讨早期乳腺癌保乳术中电子线放射治疗(intraoperative radiotherapy with electron,ELIOT)的可行性,评价术后并发症和术后乳房外观。方法2007年6月2009年6月期间,共有26例早期乳腺癌(肿瘤直径不超过25 cm)患者接受乳腺癌保乳手术及ELIOT,放疗剂量为21 Gy(分割照射58～60 Gy)。术后1年内第1、2、3个月,第6、9、12个月,1年后每6个月评估一次,主要评估切口愈合状况、并发症、乳房外观及肿瘤复发情况。结果术后切口愈合时间14～22 d,平均17 d。随访2～25个月,平均12个月,有2例切口脂肪液化,11例切口水肿伴引流液较多,全组无切口感染或血肿。随访期间内,未发现局部复发、远处转移或对侧乳腺癌。手术切口愈合后、术后6个月,1、2年对乳房外观评价结果:优秀者分别依次为577%、667%、727%及100%;好者分别依次为346%、222%、182%及0;一般者分别依次为77%、111%、91%及0。结论乳腺癌保乳术后行ELIOT 疗效确切、安全,对早期乳腺癌患者是一种方法简便,疗效确切、安全的选择。

胸下段食管癌术后放射治疗的范围

食管癌恶性程度高，全球范围内食管癌死亡率居恶性肿瘤的第 6 位。大多数食管癌的治疗首选手术切除，但根治术后复发率仍较高，局部复发是治疗失败的主要原因，术后预防性放射治疗可提高局部控制率。然而，放射治疗靶区的范围仍存在争议，尤其是胸下段食管癌术后患者行放射治疗时是否需包含锁骨上区淋巴结照射。部分学者认为增加双侧锁骨上区淋巴结照射无意义，但有更多的研究显示增加锁骨上区淋巴结照射可以减少锁骨上区复发率，术后放射治疗时需重点考虑。

MRI Findings in Brain Radiation Necrosis Following Radiotherapy for Brain Neoplasm by γknife

摘要:目的:探讨伽玛刀治疗颅内肿瘤并发放射性脑损伤的MRI影像表现及其组织病理学基础。方法:回顾性分析8例经手术及病理证实的放射性脑损伤的MRI表现;其中,星形胶质细胞瘤4例,转移性腺癌2例,血管母细胞瘤1例,鼻咽癌1例。结果:病变位于小脑半球、额叶、颞叶及顶叶,8例9个病灶共有2种MRI表现:5例6个病灶平扫T1WI呈低、等信号,T2WI呈稍高、高信号,增强扫描呈“结节状”、“花环状”强化;3个病灶平扫为类圆形,T1WI呈均匀低信号,T2WI呈高信号,边界清楚,增强扫描囊腔无强化,囊壁轻度均匀强化。所有病例均有占位效应。结论:伽玛刀所致放射性脑损伤具有一定的特征性,特别是囊状坏死。

视网膜母细胞瘤诊疗进展

视网膜母细胞瘤是最常见于小儿的恶性肿瘤，它的早期诊断与合理治疗一直以来都备受医学领域相关学者的关注与重视，随着当代国内外医学诊疗技术的精进及理论的完善，相较于传统的诊疗方法，尽可能保眼治疗已然成为相关学者共同追求的目标。该文主要就当前早期诊断和保眼治疗的观点和方法进行了综述。

Research progress on predicting radiation pneumonia based on four-dimensional computed tomography ventilation imaging in lung cancer radiotherapy

Lung cancer is the leading cause of cancer-related deaths worldwide. Radiation pneumonitis is a major complication in lung cancer radiotherapy. Four-dimensional computed tomography (4DCT) imaging provides dynamic ventilation information, which is valuable for lung function assessment and radiation pneumonitis prevention. Many methods have been developed to calculate lung ventilation from 4DCT, but a systematic comparison is lacking. Prediction of radiation pneumonitis using 4DCT-based ventilation is still in an early stage, and no comprehensive review exists. This paper presented the first systematic comparison of functional lung ventilation algorithms based on 4DCT over the past 15 years, highlighting their clinical value and limitations. It then reviewed multimodal approaches combining 4DCT ventilation imaging, dose metrics, and clinical data for radiation pneumonitis prediction. Finally, it summarized current research and future directions of 4DCT in lung cancer radiotherapy, offering insights for clinical practice and further studies.

Controversy over surgical modalities for early non-small cell lung cancer

Lobectomy and systematic nodules resection has been the standard surgical procedure for non-small cell lung cancer (NSCLC). However, increased small-size lung cancer has been identified with the widespread implementation of low-dose computed tomography (LDCT) screening, and it is controversial whether it is proper to choose lobar resection for the pulmonary nodules. Numerous retrospective researches and randomized clinical trials, such as JCOG0201, JCOG0804/WJOG4507L, JCOG0802 and CALGB/Alliance 140503, revealed that the sublobar resection was safe and effective for NSCLC with maximum tumor diameter≤2 cm and with consolidation tumor ratio (CTR)≤0.25, and that segmentectomy was superior to lobectomy with significant differences in 5-year overall survival rate and respiratory function for patients with small-size (≤2 cm, CTR>0.5) NSCLC and should be the standard surgical procedure. It is the principle for multiple primary lung cancer that priority should be given to primary lesions with secondary lesions considered, and it is feasible to handle the multiple lung nodules based on the patients' individual characteristics.

Clinical and dosimetric factors of radiation pneumonitis in patients with locally advanced non-small cell lung cancer

Objective To investigate the clinical factors and dosimetric parameters associated with grade≥2 radiation pneumonitis (RP) after thoracic radiotherapy in patients with locally advanced non-small cell lung cancer (NSCLC). Methods The clinical factors and dosimetric parameters in patients with locally advanced NSCLC who received thoracic radiotherapy at West China Hospital of Sichuan University between January 2016 and January 2018 were retrospectively analyzed. The potential factors associated with the occurrence of grade≥2 RP were analyzed with logistic regression analysis. Results A total of 104 patients were included, and the incidence rate of grade≥2 RP was 19.2%. Multivariate logistic regression analysis showed that the percentage of the heart volume that received more than 20 Gy (V20) [odds ratio (OR)=1.068, 95% confidence interval (CI) (1.004, 1.137), P=0.036], lung mean dose (Dmean) [OR=1.003, 95%CI (1.000, 1.006), P=0.031] and superior vena cava Dmean [OR=1.001, 95%CI (1.000, 1.001), P=0.041] were associated with grade≥2 RP. Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve combined with heart V20, lung Dmean and superior vena cava Dmean to predict grade≥2 RP was 0.839 [95%CI (0.752, 0.926)]. In addition, the optimal critical values for heart V20, lung Dmean and superior vena cava Dmean to predict grade≥2 RP were 20%, 13 Gy and 38 Gy, respectively. Conclusions Heart V20, lung Dmean and superior vena cava Dmean are associated with grade≥2 RP after thoracic radiotherapy in patients with locally advanced NSCLC. In addition, taking heart V20<20%, lung Dmean<13 Gy and superior vena cava Dmean<38 Gy as normal organ dose limits may reduce the risk of grade≥2 RP after thoracic radiotherapy for locally advanced NSCLC patients.

Clinical Research on Submandibular Gland Transposition Intervening Acute Radiation Induced Oral Mucosal Reaction and Xerostomia

【摘要】目的探讨颌下腺移位术对预防急性放射性口腔黏膜反应及口干燥症的临床效果。方法2007年7月2009年6月间选择40例患者进行前瞻性临床对照研究。治疗组20例,在放疗前将颌下腺移位至颊下区。对照组20例不行颌下腺移位术。观察放疗中两组急性口腔黏膜反应,测定放疗前后唾液分泌量的变化,放疗后3个月进行口干燥程度问卷调查。结果治疗组急性口腔黏膜反应明显轻于对照组(Plt;0.05)。治疗组放疗后3个月移位术侧颌下腺摄取、排泌功能均明显较对照好,两组比较有统计学意义(Plt;0.05)。结论颌下腺移位术预防鼻咽癌放疗后口干燥症的临床近期疗效较好,可改善鼻咽癌患者放疗后的生活质量。