IV期肿瘤患者的放疗.ppt

* Radiation Therapy Oncology Group (RTOG 74-02).27 Ninety percent of patients experienced some relief of pain and 54% achieved eventual complete pain relief. The conclusion was that protracted dose-fractionation schedules were more effective than short-course schedules * Radiation Therapy Oncology Group (RTOG 74-02).27 Ninety percent of patients experienced some relief of pain and 54% achieved eventual complete pain relief. The conclusion was that protracted dose-fractionation schedules were more effective than short-course schedules * The fields for upper HBI cover the thorax and abdomen from the neck to the top of the iliac crests. For midbody HBI, the fields include the abdomen and pelvis from the diaphragm to the ischial tuberosities, and for lower HBI treatment, the field borders are from the top of the pelvis to the inferior portion of the femurs. * Several conclusions are clear from these studies: a. Single dose treatments of 8 Gy provide similar pain relief to longer treatment regimens (30 Gy in 10 fractions or 20 to 24 Gy in five to eight treatments). b. The retreatment rates are higher after short course treatment, by a factor of 2 to 3. c. Response rates are lower when scored by the patient instead of by the treating physician. d. Response rates are better when the initial pain scores are lower, that is, when the patients are treated for moderate pain rather than severe pain. e. There is no consistent dose response relationship for palliation of bone metastases. 多次分割的随机临床研究比较 作者 病例数 剂量(Gy/Fx) 完全缓解(%) 总缓解(%) 病理骨折(%) Tong et al.,1982 美国 （单发病灶） 266(146) 20/5 40/15 53 61 82 85 4 18 Tong et al.,1982 美国 （多发病灶） 750（613） 15/5 .20/5 25/5 30/10 49 56 49 57 87 85 83 78 5 7 9 8 Hirokawa et al., 1989 日本 128（128） 25/5 30/10 NA 75 75 NA Rasmusson et al., 1995 丹麦 217（127） 15/3 30/10 NA 69 66 NA Niewald et al, 1996 德国 100（100） 20/5 30/15 33 31 77 86 8 13 单次与多次分割的随机临床研究 作者 病例数 剂量(Gy/Fx) 中位生存 完全缓解 总缓解 复治率 病理骨折 Kaasa et al.,2006 376 8/1 vs. 30/10 9.6 7.1 NA 无差异