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題名:EARLY EXPERIENCE OF STEREOTACTIC BODY RADIOTHERAPY IN PATIENTS WITH PRIMARY AND METASTATIC LUNG TUMORS     (28點)
使用立體定位體部放射治療於原發性和轉移性肺腫瘤病患之早期經驗
著者:Hsin-Lun Lee(李欣倫) ;Jo-Ting Tsai(蔡若婷) ;Shang-Wen Chen(陳尚文) ;Jia-Wei Lin(林家瑋) ;Wilson Tiu Lao(留偉順) ;Kum-Min Wang(王孔民) ;Chiu-Ping Chen(陳秋萍) ;Jeng-Fong Chiu(邱仲峰) ;Tao-Sang Chung(鍾道生)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:電腦刀 ; 立體定位體部放射治療 ; 肺腫瘤 ; 放射性肺炎 ; CyberKnife® ; Stereotactic body radiotherapy ; Lung tumor ; Radiation pneumonitis
刊名:Therapeutic Radiology and Oncology
頁碼:111-124
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

目的:探討使用電腦刀立體定位體部放射治療(SBRT)於原發性和轉移性肺腫瘤病患之臨床結果。 方法:回溯性探討自 2005 年 11 月至 2008 年 6 月間於萬芳醫院接受 SBRT 之 19 位病患的醫療記錄。SBRT 是運用電腦刀之腫瘤追蹤系統來實行治療。治療後腫瘤反應和相關之副作用是以追蹤影像進行評估。治療相關副作用則以 Common Terminology Criteria for Adverse Eventsversion 3.0 分級來記錄副作用之嚴重程度。 結果:於接受電腦刀 SBRT 之 19 位肺腫瘤病患(共 47 顆肺腫瘤)中,8 位(11 顆腫瘤)為原發,11 位(36 顆腫瘤)為轉移。9 顆腫瘤位於中央,其餘位於週邊。腫瘤體積介於 1.1 至110.5 毫升(中位數,9.5 毫升)。放射治療之劑量介於 22 至 60 Gy ,歸一化於 76% 至 85% 之等劑量曲線,分 2 至 4 次給予。於 12 個月之中位追蹤時間中,共有 3 位病患發生 2 級放射性肺炎,另有 2 位病患發生 3 級放射性肺炎。分析其風險因子,女性(p = 0.038)和中央型肺腫瘤(p = 0.042)於單變項分析中有統計學上之差異。在兩位為復發中央型肺腫瘤且先前己接受過肺部體外放射治療之病患中,觀察到氣管食道瘺管及支氣管壞死之治療相關副作用。於 16位可供分析局部控制率的病患中,4 位(25%)為 complete response ,7 位(43.8%)為 partialresponse,2 位(12.5%)為 stable disease,3 位(18.7%)為 progressive disease。病人一年之整體存活率為 63% ,一年之局部無病存活率為 84.2% 。比較原發性和轉移性肺癌之一年局部無病存活率(87.5% vs. 81.8%, p = 0.87),以及中央型和週邊型肺腫瘤之一年局部無病存活率(80%vs. 85.7%, p = 0.63),並無統計學上之差異。 結論:於我們的早期經驗中,電腦刀立體定位體部放射治療能有效局部控制原發性和轉移性肺腫瘤,然而,治療中央型或先前己照射過放射線之復發肺腫瘤時,應特別謹慎以避免較嚴重之副作用。
Purpose : To investigate the clinical outcomes of patients with primary and metastatic lung tumors treated by CyberKnife® (CK) stereotactic body radiotherapy (SBRT). Methods : Between November 2005 and June 2008, we treated 19 patients with SBRT at Taipei Medical University-Wan Fang Hospital. The SBRT was delivered by CK tumor tracking system. Tumor response and treatment-related toxicity were evaluated by follow-up image study. Treatment-related toxicities were scored by Common Terminology Criteria for Adverse Events version 3.0. In this study, we reviewed their medical records retrospectively. Results : We treated 47 lung tumors in 19 patients using CK SBRT. Eleven tumors in 8 patients were primary lung cancer, and 36 tumors in 11 patients were metastatic lung cancer. The locations of 9 tumors were central, whereas the others were peripheral. The tumor volumes were ranged from 1.1 to 110.5 ml (median, 9.5 ml). The radiation doses were ranged from 22 to 60 Gy, given in 2 to 4 fractions. The prescribed doses were normalized at 76% to 85% of the planned isodose. With a median follow-up interval of 12 months, we observed that grade 2 radiation pneumonitis (RP) occurred in 3 patients (1 central; 2 peripheral), whereas we found that grade 3 RP occurred in 2 patients with central lesions. According to the univariate analysis, female (p = 0.038) and central lesion (p = 0.042) were two predictive factors to the occurrence of grade ≥ 2 RP. One grade 4 tracheal complication (tracheoesophageal fistula) and one grade 5 bronchial complication (bronchial necrosis) were observed in two patients who had centrally located recurrent tumors and had been previous treated with external beam radiotherapy. Four of the evaluable patients (16 patients) had responded completely (25%), seven exhibited partial response to treatment (43.8%), and two had stable disease (12.5%). Three patients had tumor progression after SBRT (18.7%). The 1-year overall survival (OS) was 63%, and the 1-year local progression-free survival (PFS) was 84.2%. The 1-year local PFS was 87.5% for primary lung cancer and 81.8% for metastatic lung cancer (p = 0.87). The 1-year local PFS for central and peripheral lesions was 80% and 85.7%, respectively (p = 0.63). Conclusion : Our study showed that SBRT using the CK system was effective for treating primary and metastatic lung tumors, providing better local control and shorter treatment course compared with those treated with conventional fractionated radiotherapy. Our study also showed two predicting factors for RP. Finally, using SBRT to treat centrally located tumor or re-irradiate recurrent tumor require additional caution due to higher risk of having complication. Thus, we suggest that more studies are needed in the future to confirm those findings in this study.




本卷期目次
Therapeutic Radiology and Oncology
EARLY EXPERIENCE OF STEREOTACTIC BODY RADIOTHERAPY IN PATIENTS WITH PRIMARY AND METASTATIC LUNG TUMORS/ Hsin-Lun LeeJo-Ting TsaiShang-Wen ChenJia-Wei LinWilson Tiu LaoKum-Min WangChiu-Ping ChenJeng-Fong ChiuTao-Sang Chung
DOSIMETRIC ANALYSIS FOR SPARING THE OBTURATOR NERVES USING IMRT TECHNIQUE FOR CERVICAL CANCER/ Wun-Ke ChenChao-Hsing WangMeng-Hao WuK. S. Clifford ChaoDavid HuangYu-Jen Chen
設計一套特殊針板及平行定位量角器做為攝護腺插種治療輔助工具的研究/ 吳嘉明葉世安蕭光吟郭忠民陳清江趙敏吳敬次
4D CT影像於肺部腫瘤放射治療的應用/ 林俊彥謝敏文程言鼎陳柏元陳臣苑吳卉蓁白冰清王俊傑
18F-FDG PET/CT IMAGES PRODUCED STUNNINGLY FALSE-NEGATIVE RESULTS AFTER DEFINITIVE CHEMORADIOTHERAPY IN NASOPHARYNGEAL CARICINOMA-A CASE REPORT/ Yung-Hsiang LinYuh-Feng WangTa-Wen HsuWen-Yen ChiouMoon-Sing LeeHon-Yi LinTzyy-Ling ChungShih-Kai Hung
INTRACRANIAL HEMANGIOPERICYTOMA: A CASE REPORT AND LITERATURES REVIEW/ Tzu-Wen HsuYu-Chang HuWei-Ming LaiChien-Hsun ChenChung-Man LeungKuo-Chen ChangChing-Hsiung Chang
PROGNOSTIC FACTOR AFFECTING THE OUTCOME OF BONE METASTASIS FROM HEPATOCELLULAR CARCINOMA/ Cheng-Hong LiouMu-Tai LiuWen-Tau HuangAi-Yih WangChao-Yuan HuangChu-Ping PiTung-Hao ChangChih-Chieh HsuChia-Chun Huang
THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY FOR UNRESECTABLE OR POST-OPERATIVE RESIDUAL BILIARY TRACT CARCINOMA/ Chun-chieh HuangEng-Yen HuangFu-Min FangChong-Jong WangHui-Chun ChenChang-Yu WangYu-Ming WangHsuan-Chih Hsu
 
   
 
   

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