目的 研究核磁共振（MR）引导的海马保护技术应用于小细胞肺癌全脑放射治疗（放疗）的效果。方法 对确定行全脑放疗的30例小细胞肺癌脑转移患者,行常规放疗CT定位后以定位体位行全头颅MR平扫,将计算机断层扫描（CT）和MR的T1加权像在Monaco 5.1计划系统上进行精准融合,勾画全脑放疗及海马区域,在海马区域三维方向上分别外扩5、15 mm作为海马与计划靶区之间的剂量跌落,每一例患者在Monaco 5.1计划系统上按照不保护海马组织以及外扩5、15 mm进行保护设计3个容积旋转调强技术（VMAT）放疗计划,观察海马组织的平均及最大放疗剂量。结果 增加保护海马组织之后,3个放疗计划的D100均≥95%,每例的3个放疗计划间D100比较差异无统计学意义（P>0.05）;设置外扩5、15 mm的剂量跌落区后,左、右海马的平均剂量、最大剂量均明显降低,而且3个放疗计划的海马平均剂量、最大剂量之间对比差异有统计学意义。结论 小细胞肺癌脑转移患者进行全脑放疗时,利用MR引导的海马保护技术并设置外扩15 mm的剂量跌落区,能够显著降低海马的剂量,达到保护目的。

Objective To explore the application of MR guided hippocampal avoidant whole brain radiotherapy（WBRT）for small cell lung cancer（SCLC）．Methods Thirty SCLC patients with brain metastases who underwent WBRT were enrdled．After routine CT localization was performed,and a head MR was performed in a the same position．T1 weighted images of MR and CT images were accurately fused on the Monaco 5.1 planning system．The entire brain tissue and hippocampus region were delineated． The dose drop areas between the hippocampus and the planned target area were expanded 5mm and 15mm in the three-dimensional direction of the hippocampus,respectively．Three volumetric modulated arc therapy（VMAT）radiotherapy plans were designed for each patient on the Monaco 5.1 planning system based on whether the hippocampal tissue was avoid．The average and maximum doses of hippocampal tissue were observed．Results After the avoidance of hippocampal tissue,the D100 of the three radiotherapy plans reached ≥95%,and there was no significant difference in D100 between the three radiotherapy plans in each case．After setting dose drop areas of 5mm and 15mm for external expansion,the average and maximum doses of the left and right hippocampus were significantly reduced,and there was a significant difference in the comparison between the average and maximum doses in the hippocampus of the three radiotherapy plans．Conclusions MR guided hippocampal avoidant technology and the setting of a 15 mm dose drop area can significantly reduce the dose to the hippocampus in patients with SCLC undergo whole brain radiotherapy．

弥漫性大B细胞淋巴瘤（DLBCL）是最常见的高度异质性非霍奇金淋巴瘤（NHL）,不同的疾病阶段或临床亚型预后不尽相同。放射治疗作为无交叉耐药的理想局部治疗技术,应用于DLBCL可有效改善患者预后。初治DLBCL通过放射治疗联合化学治疗、免疫治疗等综合治疗可使约60%~70%患者疾病缓解。对于不同预后影响因素,如年龄、肿瘤体积、淋巴结外侵犯等,联合放射治疗也可取得更佳疗效。在复发性/难治性DLBCL的治疗中,自体造血干细胞移植（ASCT）和嵌合抗原受体T细胞免疫治疗（CAR-T）是目前的研究热点,而放射治疗无论是作为ASCT与CAR-T术前的桥接治疗或失败后的挽救性治疗均有助改善患者预后。随着放射治疗技术的日益优化,放射治疗在综合治疗方案中扮演着越来越重要的角色。

Diffuse large B-cell lymphoma（DLBCL）is a highly heterogeneous type of non-Hodgkin lymphoma（NHL）and its prognosis is different for different disease stages or clinical subtypes．Radiation therapy（RT）is a local treatment technique that does not cause cross-resistance and can effectively improve the prognosis of patients with DLBCL．When combined with chemotherapy and immunotherapy,RT can alleviate the disease in more than 60% of patients．Furthermore,RT can achieve better results for different prognostic factors such as age,tumor volume and external nodal invasion．For treating relapsed / refractory DLBCL,autologous stem cell transplantation（ASCT）and chimeric antigen receptor T cell immunotherapy（CAR-T）are currently being researched,while RT can help as bridging therapy before ASCT and CAR-T or salvage therapy after failure．With the increasing optimization of technology,radiotherapy plays an increasingly important role in combined treatment options．

目的 检测外周血循环肿瘤细胞(circulating tumor cell, CTC)在原发性肝癌患者中的表达情况,并探讨CTC动态变化及其相对于甲胎蛋白(Alpha fetoprotein AFP)对原发性癌患者术后复发转移的预测作用。方法 收集原发性肝癌患者134例,肝脏良性病变患者72例,检测外周血 CTC 数目,同时检测AFP的表达水平,分析 CTC 与 AFP 的相关性。然后在134名原发性肝癌患者中筛选出成功行肝癌根治术的患者,共86例,检测这86名患者术前、术后外周血CTC和AFP,分析CTC和AFP对原发性肝癌术后复发转移的评估价值。结果 原发性肝癌患者外周血CTC阳性率高于肝脏良性病变患者,差异有统计学意义(P＜0.05);原发性肝癌患者CTC水平与AFP水平、淋巴结转移、肿瘤结节多少有关,与年龄、性别、肿瘤直径、分化程度、肝硬化有无、TNM分期无关;原发性肝癌患者CTC和AFP生存分析显示,原发性肝癌根治术后早期复发转移与CTC和AFP密切相关;CTC较阳性对术后复发转移具有更好的诊断价值,二者联合对复发转移预测价值最高。结论 CTC可以做为一个比传统肿瘤标志物更好的对原发性肝癌术后复发转移进行监测的指标,与肿瘤标志物联合检测预测价值更高。

Objective To detect the expression of peripheral blood circulating tumor cells CTC in patients with primary liver cancer and to explore the dynamic changes of CTC and its predictive effect on postoperative recurrence and metastasis of primary cancer. Methods The number of CTC in peripheral blood was measured in 134 patients with primary liver cancer and 72 patients with benign liver disease, the expression of AFP was detected, and the correlation between CTC and AFP was analyzed. Then 86 patients with primary liver cancer were selected from 134 patients with primary liver cancer who underwent radical hepatectomy. The values of CTC and AFP in evaluating recurrence and metastasis of primary liver cancer before and after operation were analyzed by CTC and AFP, in peripheral blood of these 86 patients. Results The positive rates of CTC in peripheral blood of patients with primary liver cancer were higher than that of patients with benign liver disease(P< 0.05). The levels of CTC in patients with primary liver cancer were related to AFP level, lymph node metastasis and the number of tumor nodules, but not to age, sex, tumor diameter, differentiation degree, liver cirrhosis and TNM stage. The survival analysis of CTC and AFP in patients with primary liver cancer showed that the early recurrence and metastasis of primary liver cancer after radical resection were closely related to the positive rate of CTC and AFP, and the positive rate of CTC was more effective than that of AFP positive in the diagnosis of recurrence and metastasis after operation, and the combination of the two had the highest predictive value for recurrence and metastasis. Conclusion CTC may be used as a better index to monitor postoperative recurrence and metastasis of primary liver cancer than traditional tumor markers. The combined detection prediction value of tumor markers is higher.

目的 探讨原发性肾上腺淋巴瘤的临床表现及诊疗方法。方法 总结我院收治的1例原发性肾上腺淋巴瘤患者的临床表现及诊疗方法,并回顾性分析国内外文献资料。结果 患者在全身麻醉下行右侧肾上腺肿瘤根治术+右叶肝部分切除术+膈肌修补术,取病理活检结果为(右肾上腺区、肝)弥漫性大B细胞淋巴瘤,术后使用R-CHOP方案规律化疗8次,随访1年患者已完全缓解,未见复发征象。结论 原发性肾上腺淋巴瘤是临床少见的恶性程度高的肿瘤,主要以弥漫大B细胞淋巴瘤多见,早期无明显特异性,且缺乏典型临床表现,临床上易误诊,一旦确诊,应及早手术并化疗以减缓疾病进展及减轻患者痛苦。

目的 分析立体定向体部放射治疗(SBRJ)应用于孤立性肺肿瘤的疗效,探讨其临床价值。方法 采用拓能(TOPSLANE)全身X线立体定向放射治疗系统治疗15例孤立性肺肿瘤患者,其中I期非小细胞肺癌患者8例,单个肺转移瘤患者7例。单次剂量为5~8Gy／次,每天1次,每周3次,共8~10次,总剂量50~64Gy,生物有效剂量(BED)75~115Gy。分析治疗的近期疗效、急性放射损伤和局部控制率。结果 3例患者完全缓解(20.0%),10例患者部分缓解(66.7%),2例患者病灶稳定(13.3%),没有疾病进展的患者。15例患者总有效率为86.7%(13/15)。BED<90Gy的患者有效率为33.3%,而BED>90Gy的患者有效率为100%,差异有统计学意义(P＜0.05)。3例患者出现2级急性放射损伤,未见3级以上毒副反应。1年和2年局控率分别为92.3%和81.2%。结论 SBRT治疗孤立性肺肿瘤可获得较好的近期疗效和局部控制率,急性放射损伤较轻。

Objective To analyze the efficacy of stereotactic body radiation therapy(SBRT) onsolitary pulmonary tumor and explore its clinical value. Methods TOPSLANE X-ray stereotactic body radiation therapy system was used for treatment of fifteen patients with solitary pulmonary tumor, including eight patients with stage I non-small cell lung cancer and seven patients with single lung metastasis. Fraction dose of 5 to 8Gy was prescribed once a day, three times a week, totally 8 to 10 times to a total dose of 50 to 64 Gy and biological effective dose(BED) of 75 to 115Gy. Short-term efficacy, acute radiation injury and local control rate were analyzed. Results After treatment, there were three patients with complete response (CR) (20.0%), ten patients with partial response (PR) (66.7%), tow patients with stable disease (SD) (13.3%), and no patients with progressive disease (PD). The total response rate was 86.7% (13/15). The response rate was 33.3% in patients with BED <90 Gy, while it was 100% in patients with BED> 90 Gy, and the difference was statistically significant (P<0.05). Grade 2 acute radiation injuries were observed in three patients, and no toxicity greater than grade 3 was observed. The 1-year and 2-year local control rate was 92.3% and 81.2%, respectively. Conclusion SBRT on solitary pulmonary tumor has good short-term efficacy and local control rate with mild acute radiation injury.