原名「台灣學術線上」
包含TAO期刊庫 + TAO書籍庫 + 論文 + 史料文獻
首頁 | 關於TAO | 瀏覽 | 進階查詢 | 參考工具 | 會員服務 | 已購專書 | RSS服務 | 電子報 | FAQ  
查詢範圍:
   
查詢模式:
熱門查詢詞:
   
   
   
     
   
 
項次 書目
1
題名:Mycosis Fungoides: A Case Report     (20點)
蕈樣黴菌病:病例報告
著者:Chung-Ching Hsieh(謝忠志) ;Meng-Hao Wu(吳孟浩) ;Yuen-Liang Lai(賴允亮) ;Hung-Cheng Chen(陳弘政) ;Cheng-I Hsi(奚正義) ;Kou-Hwa Chang(張國華) ;Chang-Hung Chung(鐘昌宏) ;Hung-Chi Dai(戴宏旗)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:蕈樣黴菌病 ; 表皮T-細胞淋巴癌 ; 全身皮膚電子束放射治療 ; 六對照野法 ; Mycosis fungoides ; Cutaneous T-cell lymphoma ; Total skin electron beam radiation therapy ; Six-dual-field technique
刊名:Therapeutic Radiology and Oncology
頁碼:131-140
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

葷樣徽菌病是一罕見的T以來放射線被用於治療這個甚真輻射敏感性之疾病'不過相當比例的病人有廣泛的皮膚病變,或是病姓在先前照射過的範閻以外甚或之中復發,因此數十年來放射治療工作者,一直探尋能夠使皮膚(“圓柱"狀的人體之表層)接受較大範聞與較高劑量照射且又能接受其毒性的技術。使用現代直線加速器所產生的低能量電子,在有限深度內釋出能量,得以避免較深部的組織受到輻射,加以三十多年前史丹佛大學發展一種“六對照野法" , 能在符合上述要求下達到較佳的劑量分佈﹒自此接受全身皮膚電子東放射治療的病人,有較好的臨床反應與較小的毒性。 我們採用這種“六對照野法"治療一位有廣泛皮膚病變的4 9歲男性病患。射源至表面的距離拉長為3 2 3 公分,並架設一塊壓克力板以發散射東及衰減電子能量。從直線加速器所產生6MeV 初能量的電子將變為2 . 6 2 MeV 。加速器的輸出減為0 . 0 6 4 8 cGyjMU (在最高劑量深度處) , 準直儀全開至4 0 乘以4 0 平方公分, 且不加錐孔。每一成對照野的射束各與水平軸成上或下2 0度之夾角,倍率係數( multiplication fact or ) 經測量為2 . 68 ' 腫瘤劑量定於皮膚表面下5毫米處( 位於9 0 % 等劑量曲線) , 總計每單一照野的照射必須1 2 1 2 MU 。射東平坦度在垂直及水平方向分別爵士5%與± 1 0 % 之內, 使用熱發光劑量計( TLD ) 的測量值來評估體表4 5 個部位的劑量均勻度,是否追加照射或屏蔽則依個別情況而定。每週治療4個連續日, 每2 日為一週期,每1天治療半數的成對照野,單次劑量是2 G y ﹒ 共照射18 個週期, 達到36 G y 的總劑量,但在療程的正中段休息1 0天。皮膚病社對此療法反應良好,搔癢在前半療程結束前已完全緩解, 副作用( 手掌和腳掌的皮膚炎和頭髮完全脫落) 亦可接受,然而該病人拒絕後續的輔助治療。 儘管全身皮膚電子束放射治療可以達到良好的初期臨床效果,至今對於葷樣徽菌病病人的處理依然是個挑戰。此疾病有極高的復發傾向,目前要完全治癒病變已超越局部範間的病人,機會依然渺茫。除了放射治療,尚有許多療法已在臨床應用或研究中,我們建議對這額病人採敢複合式治療以提昇長期療效。
Mycosis fungoides is a rare T-cell lymphoma , but it accounts for about half of all cases of cutaneous T-cell lymphoma. Radiation has long been used to treat patients with this radiosensitive disease. However, a signif icant proport ion of patients present with generalized plaques or recurrence of lesions outside or even within the previously irradiated area, it challenged radiotherapists for decades how to irradiate skin (the superficial layer of a somewhat "cylinder-like" human body) with not only larger field and higher dose but also tolerable toxicity. Radiation with low energy electrons generated by modern linear accelerators, depositing their energy within limited depth could spare deeper tissues. The six-dual-field technique, which provide more satisfying dose distribution for these requirements was developed at Stanford University three decades ago. Since then, the patients treated with total skin electron beam radiation would have better clinical response and minor toxicity. We adopted the six-dual-field technique to treat a 49-year-old male with generalized plaques. The source-to-surface distance was extended to be 323 ern, and an acrylic beam spoiler was installed to scatter the beam and attenuate the electron energy. The resulting electron energy was 2.62 MeV, generated by a 6 MeV Linac, the output of which was degraded to deliver 0.0648 cGy/MU (at the depth of maximum dose, dmax) . The collimator was fully opened to 40 x 40 ern" without a cone. The hinge angle of the dual-field was determ ined to be 20 degrees. The measured multiplicat ion factor was 2.68. We prescribed a tumor dose at 5 mm depth beneath the skin surface (90% isodose profile). Overall, 1212 MU were required for each field. Beam flatness was within ± 5% and ± 10% in the vertical and horizontal dimensions, respectively. Thermoluminescent dosimeters (TLD) were used to evaluate dose homogeneity at 45 sites. Individualized boost or shielding was used at appropriate sites. Radiation therapy was administered for 4 consecutive days per week, with 2 days constituting a treatment cycle. On the first day of a cycle, half of the 6 dual-fields were irradiated, with the other half treated the other day. A total dose of 36 Gy over 18 cycles was given with a fraction dose of 2 Gy. A 10day midway break was given. The skin lesions responded well to this regimen, and itching was completely relieved prior to completion of the first half of the treatment course. Side effects (marked dermatitis of palms and soles and total hair loss) were acceptable. The patient refused subsequent adjuvant therapy. Despite total skin radiation can achieve good initial clinical outcome, the management of patients with mycosis fungoides is still challenging. This disease has a predispo- sition to relapse, and the chance is dismal to cure patients with the disease beyond limited plaque stage for the time being. In addition to radiation therapy, a variety of modalities have been in clinical use or in investigation. We suppose combination treatment should be administered in these patients to improve long-term control.


    

本卷期目次
Therapeutic Radiology and Oncology
5-氟尿嘧啶單獨或併用遊離輻射治療人類結腸直腸癌細胞之效果/ 黃正仲陳柏元鄧文炳黃家瑜林冠如吳國海傅秉三林芳仁
Mycosis Fungoides: A Case Report/ Chung-Ching HsiehMeng-Hao WuYuen-Liang LaiHung-Cheng ChenCheng-I HsiKou-Hwa ChangChang-Hung ChungHung-Chi Dai
Preliminary Experience of Reducing Bowel Irradiation Volume in the Treatment of Rectal Cancer: Two Cases Study/ Jui-Tsan LiuFang-Jen LinShang-Wen ChenHsieh-Ting WuJi-An LiangShin-Neng Yang
核醫藥物放射性核種治療製劑錸-188-錫-1,1氫氧亞乙基二磷酸鹽之特性研究/ 丁慧枝曾誠齊丁幹謝柏蒼黃英峰李全孝劉怡慶
The Combined Effect of Colchicine and Radiation of Human Hepatoma HA22T/VGH Cells/ Yu-Jen ChenShyh-Dar ShyurAnita ChangHung-Cheng ChenKou-Hwa ChangYuen-Liang LaiPai-Gene Chen
以立體定位放射手術治療腦動靜脈畸型/ 郭萬祐
網眼技術對電子放射治療的皮膚免除效應研究/ 林桂華朱鐵吉林招膨劉慕台林芳仁
加馬刀單一射束劑量分佈模擬研究/ 陳俊丞蕭正英江祥輝李宗其
Siemens PRIMUS直線加速器之中子量測研究/ 林松彥謝明崇林招膨朱鐵吉劉慕台張東浩
以立體定位放射手術治療腦動靜脈畸形:高雄長庚紀念醫院之初步結果/ 黃英彥陳翰容王重榮梁雲陳惠君孫立民方富民葉世安許軒之熊敬業吳嘉明陳春志
局部放射治療對腦幹部位不成熟畸胎瘤之治療效果-病例報告/ 陳虹汶賴允亮張國華鍾昌宏吳孟浩王銘志陳裕仁黃福昭呂衍達
核醫藥物放射性核種治療製劑錸-188-錫-1,1氫氧亞乙基二磷酸鹽之特性研究/ 丁慧枝曾誠齊丁幹謝柏蒼黃英峰李全孝劉怡慶
Siemens PRIMUS直線加速器之中子量測研究/ 林松彥謝明崇林招膨朱鐵吉劉幕台張東浩
網眼技術對電子放射治療的皮膚免除效應研究/ 林桂華朱鐵吉林招膨劉幕台林芳仁
Mycosis Fungoides: A Case Report/ Chung-Ching HsiehMeng-Hao WuYuen-Liang LaiHung-Cheng ChenCheng-I HsiKou-Hwa ChangChang-Hung ChungHung-Chi Dai
Preliminary Experience of Reducing Bowel Irradiation Volume in the Treatment of Rectal Cancer: Two Cases Study/ Jui-Tsan LiuFang-Jen LinShang-Wen ChenHsieh-Ting WuJi-An LiangShin-Neng Yang
局部放射治療對腦幹部位不成熟畸胎瘤之治療效果--病例報告/ 陳虹汶賴允亮張國華鍾昌宏吳孟浩王銘志陳裕仁黃福昭呂衍達
以立體定位放射手術治療腦動靜脈畸型/ 郭萬祐
5-氟尿嘧啶單獨或併用遊離輻射治療人類結腸直腸癌細胞之效果/ 黃正仲陳柏元鄧文炳黃家瑜林冠如吳國海傅秉三林芳仁
The Combined Effect of Colchicine and Radiation of Human Hepatoma HA22T/VGH Cells/ Yu-Jen ChenShyh-Dar ShyurAnita ChangHung-Cheng ChenKou-Hwa ChangYuen-Liang LaiPai-Gene Chen
以立體定位放射手術治療腦動靜脈畸形:高雄長庚紀念醫院之初步結果/ 黃英彥陳翰容王重榮梁雲陳惠君孫立民方富民葉世安許軒之熊敬業吳嘉明陳春志
加馬刀單一射束劑量分佈模擬研究/ 陳俊丞蕭正英江祥輝李宗其
 
   
 
   

與TAO合作 | 隱私與版權聲明 | 聯絡方式 | 下載Adobe Reader
地址:台北市中正區(100)北平東路30-12號3樓
電話:(02)2393-6968 傳真:(02)2393-6877
Email: service@wordpedia.com
Wordpedia Family: 學校、企業版入口 | 遠流影音館
Copyright©2011 Wordpedia Co., Ltd. All Rights Reserved.