TOMO、射波刀、伽玛刀等放疗技术比较及实际使用交流贴

对于肺部，适用的有这么几种 氩氦刀属于冷冻方式，射频消融属于热疗方式，还有个粒子植入。
; ?/ g& e3 V2 t5 @0 g. {* E0 U现在考虑能否对我家人肺部原发病灶进行下微创。
' @1 w; S" B  a* I& f# b北京可选的医院：潘家园肿瘤医院，301,302，海总，空总，北医三院，宣武医院等。
# L( p# l! @$ p+ ~$ C$ j8 Q准备去挂号问诊一下，有信息再和大家来交流、

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ESTRO 2013: Commonly used drug can limit radiation damage to lungs and heart for cancer patients
21 Apr 2013
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Unavoidable damage caused to the heart and lungs by radiotherapy treatment of tumours in the chest region can be limited by the administration of an ACE inhibitor, a drug commonly used in the treatment of cardiovascular disease, a group of Dutch researchers have found.
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Common cancers such as breast, oesophagus, lung, and Hodgkin’s lymphoma are frequently treated with radiotherapy, but the radiation dose that can be given safely is limited by the sensitivity of the health lung tissue which is also irradiated.

The lung is a particularly complex and sensitive organ and strategies for protecting it from radiotherapy damage, apart from limiting the dose given and, therefore, the efficacy of the treatment, are few.
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/ W7 M) F! d7 p$ b( [1 UPresenting the research to the 2nd Forum of the European Society for Radiotherapy and Oncology (ESTRO), Dr Sonja Van der Veen, MSc, from the University Medical Centre, Groningen, The Netherlands, said that she had set out with colleagues to see whether the use of an ACE inhibitor could protect against early radiation-induced lung toxicity (RILT).

) B: z2 w' a* y  s1 s- wPrevious studies had shown that damage to blood vessels can play an important role in the development of RILT, so the researchers irradiated the lungs, heart, or heart and lungs of rats and administered the ACE inhibiter captopril immediately after treatment.

: @- H) |( x4 T- AThe rats’ lung functions were then measured at two-weekly intervals.
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“After eight weeks, when early lung toxicity is usually at its height, we found that captopril improved the rats’ heart and lung functions, but we were surprised to find that this only occurred when the heart was included in the irradiation field,” said Dr Van der Veen. “This was not due to protection of the lung blood vessels, which were equally damaged with or without captopril. So we investigated further and found that the captopril treatment improved the heart’s function and decreased the level of fibrosis in the heart soon after irradiation. So these new findings show that ACE inhibition decreases RILT by reducing direct acute heart damage.”

Irradiating the heart leads to the development of fibrosis, which stiffens it, and this in turn leads to problems in the relaxation of the left ventricle. Due to this, blood flow from the lungs into the heart is hindered, and this can cause pulmonary damage. However, after treatment with captopril, the researchers observed an improvement in ventricular relaxation in the irradiated hearts.

1 U6 c: ~  @% f9 x3 \Dr Van der Veen and her colleagues are now collaborating with a research group from the Mayo Clinic, Rochester, Minnesota (USA), in order to design a randomised clinical trial where patients who are treated with radiation to the thoracic area including the heart will be treated with either an ACE inhibitor or a placebo after irradiation.

9 p0 e4 C" G5 G" [& k9 z: aMuch progress has been made in radiation treatment over recent years, but in breast cancer, for example, most women still receive high doses to the heart, and this is known to increase the risk of heart disease. A recent study has shown that for each Gray (Gy) of radiation, there is a 7.4% increase in the occurrence of a subsequent major coronary event.
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“Given that most women will receive a dose of between 1 and 5 Gray, and that the dangers are even greater for women with existing cardiac risk factors or coronary disease, this is still a big problem,” said Dr Van der Veen.

, r6 E# l) C' u8 }, F9 B1 f3 vRats were chosen for the study because, unlike mice, they are big enough for researchers to be able to irradiate different part of the lungs and heart. The researchers believe that the way in which ACE inhibition works in both animals and humans is similar.
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7 e9 e+ V* d9 n4 z  g0 ~( P“We are confident that our clinical trial will see the same protective effect in humans as that which we have seen in rats,” said Dr Van der Veen. “We will also now begin to study the late effects of ACE inhibition on RILT to see whether it affords similar protection. We believe that our results suggest a promising strategy for shielding patients from radiation damage and improving their quality of life, while at the same time allowing them to receive a high enough dose to ensure the effective treatment of their cancer.”
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% [) Z0 Z0 p( l7 |) \" OPresident of ESTRO, Professor Vincenzo Valentini, a radiation oncologist at the Policlinico Universitario A. Gemelli, Rome, Italy, said: “This study underlines the importance of translational research. The understanding of anti-cancer mechanisms, as well as of protective opportunities discovered in the experimental environment, is of upmost importance in the era of personalised medicine. This research provides further evidence of the importance of testing experimental theories in the clinical environment to the ultimate benefit of patients.”

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$ d) }+ D/ M0 i- H9 h) qASCO2013:肺癌患者放疗同时不宜使用ACEI
+ V/ V$ B# l. A5 E' y6 K　　我国学者的一项研究显示，使用血管紧张素转化酶抑制剂（ACEI）与非小细胞肺癌（NSCLC）患者的局部恶化(LRP)风险增加相关，提示如果有前瞻性研究证实有效，再在放疗患者中持续这种治疗。

5 O% y% o) e+ V　　该回顾性研究纳入673例接受根治性放化疗的III 期NSCLC患者，用Cox比例风险模型来决定使用ACEI与局部无进展生存率（LRPFS）、无远处转移生存率(DMFS), 无病生存率(DFS), 和总体生存率(OS)之间的关系。

! }6 p$ |0 N  {$ C* C6 U1 l/ C　　结果显示，单因素分析提示使用ACEI的患者肿瘤局部恶化风险增加，在校正多变量因素后，ACEI的这种作用依然显著。而使用ACEI与DMFS、DFS或OS 之间无显著联系。
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& f" P0 I6 w3 g+ i$ a! b2 k　　原文标题：Examining the influence of incidentally using ACEI on survival outcomes in stage III non-small cell lung cancer patients treated with definitive radiotherapy

老马 发表于 2013-6-7 02:29

                               
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1 V9 B7 ?+ r; x: ]2 ~, Y治疗高血压药CAPTOPRIL ( Capoten ，卡特普 ) ，能减轻肺部放疗副作用。

好消息！多谢马哥！有具体如何使用的建议吗？

感谢老马的信息

贝优芬（医用皮肤保护凝胶)
【性状】本品为凝胶剂
3 n  \: J# p" H3 L$ j【主要结构】本品由聚氨基葡萄糖、甘油、辅料等组成。
【适用范围】适用于放疗患者放疗过程中的皮肤保护。
【使用方法】
3 P5 d; l; D! {) `! n( K  N1、放疗后立即使用贝优芬，涂抹1-2毫米厚，直到透过凝胶看不到皮肤为止，每日3次，间隔相等时间，可能的情况下，可以轻轻按摩片刻，以便皮肤吸收。
4 M- V( b/ e6 H2、涂抹贝优芬时，涂抹面积周边应大于照射面积边缘1厘米左右。
【注意事项】
( \8 \8 O6 j$ P  o% z4 y* f$ S, |0 B1、本品仅供外用，禁止内服。
2、轻涂于皮肤表面，不得反复用力涂抹。
& w" j3 g& I' U# h3、若发现皮肤刺激及不适应，应停止使用。
' p/ A0 R* g% h5 J1 a2 }0 ?4、每日放疗前4小时，停止使用贝优芬，并及时用干纱布或毛巾擦净剩余药物或在护士的帮助下，清洗掉药物。
( x1 ~( I- y8 R【执行标准】YZN/鲁潍0039-2006
【生产许可】鲁食药监生产许20060027号
【注册号】鲁潍食药监械（准）字2006第1640055号
, \% F7 R! ^8 M8 W* P( [【贮藏条件】避光、密封、在阴凉干燥处保存。
1 a+ z  h4 d, e/ a9 s【规格】40克/支

三乙醇乳膏(比亚芬）

啊风。。 发表于 2013-3-22 12:39

. k9 R" S3 Y( ]6 _2 o                               
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4 H# f2 z& w" ~1 C" `- }* F  L' j  \我刚做了伽马刀不久现状况还好

肺部伽马刀还是脑部呀，脑部注意脑水肿

老马 发表于 2013-7-5 08:46

5 O1 C" B% r1 V- C7 W! K; A                               
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贝优芬（医用皮肤保护凝胶)
" z% c' y4 S8 L4 o9 ^1 v【性状】本品为凝胶剂
【主要结构】本品由聚氨基葡萄糖、甘油、辅料等组成。
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谢谢马哥, 收藏备用了.

     我做过射波刀，效果好，副作用低，肺腺癌左小脑单发转移3.8*3.5CM,三次射波刀后就剩一点大了，副作用是，胃口差点，口干点，头发掉点，钱贵点（3次4.2W）其他无，当时连续3天每天1次，第4天吊了250毫升甘露醇，第5天就上班了。
     我想了解一下，伽马刀的效果和价格，有做过的说一下，谢谢！