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直腸癌手術前放射治療之探討

Preoperative Radiotherapy for Rectal Cancer: Comparison between Conventional Radiotherapy and Conformal Radiotherapy

摘要


本文目的在於針對直腸癌手術前的傳統放射治療和順形放射治療的方式做比較。針對37位直腸癌術前放射治療的患者,接受傳統放射治療(conventional radiotherapy)以及順形放射治療(three-dimensional conformal radiotherapy)。分析不同治療技術的劑量分佈情形,並記錄其中31位病人在接受手術後其腫瘤縮小的比例。放射治療計劃之結果可以用劑量體積直方圖(dose-volume histogram, DVH)來計算均質性指標(homogeneity index)與順形指標(conformal index),另外等劑量曲線(isodose curve)對腫瘤的包覆情形可以用來評估治療時的腫瘤給予劑量以及對正常組織的影響。 由結果可知:順形放射治療的均值指標較傳統放射治療為佳;選取90%或95%等劑量曲線時順形指標亦以順形放射治療結果較佳;對50%腫瘤體積造成的平均劑量相近,但是傳統治療所造成的50%膀胱體積劑量則比順形治療高了約40.557cGy。另外,直腸癌患者以術前放射治療方式,對於腫瘤期別降低是有意義的,可使手術時更容易進行完全摘除。經術前放射治療的31位患者,其開刀後,16位腫瘤期別降低,23位可以保留肛門。順形放射治療可以較完整的包覆腫瘤,避開正常組織,使膀胱的劑量降低。此外,直腸癌術前放射治療確實可以有效降低腫瘤期別,並保留肛門(sphincter preservation)。

並列摘要


From January 1999 to August 2002, 35 patients with hepatocellular carcinoma (HCC) under three-dimensional conformal radiation therapy (3DCRT). The purpose of this study is to analyse patient tumor and treatment characteristics determining outcome. Stage of HCC, including AJCC OKUDA and CLIP staging systems, child-pugh classification of cirrhosis of liver, tumor volume, volume of the normal liver, laboratory data before and after 3DCRT including a-fetoprotein, albumin, silirabin, GOT, OPT, prothrombin time, alkaline phosphotase, were analysed. Survival time was computed. The mean survival time were 47.13 months, 22.84 months and 5.21 months when tumor volume were<100 cm^3, 300 cm^3 and>400 cm^3, respectively. Survival time is inversely proportional to tumor size. Three-dimensional radiation therapy is an important treatment modality which can provide survival benefit for unresectable hepatocellular carcinoma.

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