目的 探讨容积调强（VMAT）在全脊柱骨多发转移瘤放疗中的运用,观察疗效及安全性。方法 选取 2018年1月—2021年1月本科室收治的50例全脊柱骨多发转移瘤姑息止痛放疗的临床资料,分别对全脊柱靶区设计适形放疗（CRT）和VMAT多中心计划,运用剂量体积直方图及所对应的统计表评估靶区及危及器官剂量覆盖情况,放疗结束后通过1-8周视觉模拟评分法评价近期疗效,每3个月复查全脊柱MRI观察放疗不良反应。结果 采用VMAT技术放疗靶区剂量覆盖度、靶区适形指数和剂量均匀指数均优于CRT技术（P<0.01）,照射野重叠区未见明显剂量热点和冷点。采用VMAT技术危及器官V5 Gy受照体积高于CRT（P<0.01）,除了胃、胰腺和小肠,危及器官V10 Gy受照体积高于CRT（P<0.01或P<0.05）,危及器官V20 Gy受照体积则低于CRT（P<0.01）,除了肾,危及器官V30 Gy受照体积也低于CRT（P<0.01）。采用VMAT技术时危及器官的最大受照量低于CRT（P<0.01或P<0.05）,但除了心脏、胰腺和小肠,VMAT技术的危及器官平均受照量高于CRT（P<0.01或P<0.05）。采用VMAT技术较CRT出束时间增加（P<0.01）,采用CRT时技师摆位时间较VMAT增加（P<0.05）,对于总治疗时间VMAT较CRT增加（P<0.01）。8周后评估疼痛完全缓解16例,部分缓解 22例,轻度缓解8例,无效4例,总有效率为76%。随访日期截至2021年 12月,所有配合随诊的患者3、6、9、12个月全脊柱MRI复查结果显示,VMAT技术照射野内重叠处均未见脊髓及其他组织急慢性损伤情况。结论 VMAT技术对长靶区多中心放疗剂量分布均匀,近期疗效显著,安全性良好。

Objective To investigate the application of volumetric modulated arc therapy（VMAT） in the radiotherapy for multiple bone metastases in the whole spine,and observe of efficacy and evaluation of safety．Methods The clinical data were selected from 50 patients who were treated in our department between January 2018 and January 2021 with palliative analgesic radiotherapy for multiple metastases of the whole spine．Conformal radiotherapy（CRT）and multicenter VMAT plans were respectively applied to target areas of whole spine,and dose volume histogram was used to evaluate the dose coverage of target area and organ at risk（OAR）. After radiotherapy,the short-term efficacy was evaluated by visual analog scale in between 1-8 weeks,and the whole spine MRI was reviewed every 3 months to observe the adverse reactions of radiotherapy．Results The dose coverage,target conformality index and homogeneity index of VMAT treatment were significantly better than those of CRT treatment（P<0.01）,and no obvious dose hotspots and cold spots were observed in the overlapping area of irradiation field. When VMAT treatment was applied,the exposure volume of V5 Gy in OAR was significantly higher when compared with CRT treatment（P<0.01）．Except for stomach,pancreas and small intestine,the exposure volume of V10 Gy in OAR was significantly higher for VMAT treatment when compared with CRT treatment （P<0.01 or P<0.05）．When VMAT treatment was applied,the exposure volume of V20 Gy in OAR was significantly lower when compared with CRT treatment（P<0.01）,and except for kidney,the exposure volume of V30 Gy in OAR was significantly lower when compared with CRT treatment（P<0.01）．When VMAT treatment was applied,the maximum exposure of OAR was significantly lower than that of CRT（P<0.01 or P<0.05）,however,except for the heart,pancreas and small intestine,the average exposure of VMAT treatment to OAR was higher than that of CRT （P<0.01 or P<0.05）．Compared with CRT,VMAT treatment had significantly increased beam-out time（P<0.01）,the therapist setting time of CRT was increased when compared with that of VMAT（P<0.05）,and the total treatment time of VMAT was increased when compared with that of CRT（P<0.01）. In the assessment 8 weeks after the treatments,16 patients had complete pain relief,22 had partial relief,8 had mild relief,and 4 had no effect,which total effective rate was 76%．The follow-up was ended in December 2021．There was no acute or chronic injury to the spinal cord and other tissues in the overlapping areas of the irradiation fields observed for all follow-up patients in the 3rd,6th,9th and 12th month whole-spine MRI re-examination．Conclusions VMAT has uniform dose distribution in multi-center radiotherapy for long target areas,with significant short-term efficacy and safety.

目的 探讨结直肠癌肝转移瘤的CT 成像特点及规律分析。方法 回顾性分析我院2016 年3 月—2018年3 月的84 例结直肠癌肝转移瘤患者的CT 动态增强图像及临床资料记录并统计其不同血流汇入情况下、不同增强时期的CT 成像结果,根据原发灶部位,将患者分为左半结肠组和右半结肠组,左半结肠组再按照血管重建情况分组。结果 原发灶在左半结肠时,转移瘤的左、右叶分布无差异（P>0.05）,而原发灶在右半结肠时,转移瘤的右叶优势分布多于左叶优势（P<0.001）;左半结肠组内比较,甲组转移瘤的左叶优势分布多于右叶,分布差异有统计学意义（P<0.001）,其左右叶构成比约为4∶1;乙组转移瘤的左、右叶分布差异不具有统计学意义（P>0.05）;丙组转移瘤的右叶优势分布多于左叶优势（P<0.001）;84 例患者中,共发现338 个肝转移灶。平扫中,低密度灶多于高密度灶,最少是等密度灶;动态CT 增强扫描中,环状强化灶多于结节状强化灶,其他不典型强化灶最少,且门脉期时强化灶显示最为清晰。结论 结直肠癌肝转移患者的CT 肝扫描图像特点有一定规律,可以为诊断结直肠癌原发灶及结直肠癌的早期转移提供一定理论依据。

Objective To investigate the characteristics and regularity of CT imaging of colorectal cancer liver metas tases. Methods A retrospective analysis of 84 cases of colorectal cancer liver metastases from March 2016 to March 2018 in our hospital. CT dynamic imaging images and clinical data were recorded and statistically analyzed for different blood flow in flows and different enhancement periods. For the CT imaging results, the patients were divided into the left colon group and the right colon group according to the primary tumor site, and the left colon group was grouped according to the blood vessel reconstruction. Results There was no statistic difference in the distribution of left and right lobe between the primary tumor and the left colon in the left colon （P>0.05） . However, in the right colon, the dominant distribution of the right lobe in the metastatic tumor was more than that in the left lobe. The advantage （P=0.00） in the left colon group, the left leaf dom inant distribution of the metastatic tumor of group A was more than that of the right lobe, and the difference was statistically significant （P=0.00）, and the ratio of left and right lobe was about 4∶1;There was no statistic difference in the distribu tion of left and right leaves between group B metastases （P>0.05） . The right leaf dominant distribution of group C metasta ses was more than that of left lobe （P=0.00） . Among 84 patients, a total of 338 liver metastases were found. In the plain scan, the low-density foci were more than the high-density foci, and at least the iso-density foci;in the dynamic CT-en-hanced scan, the annular intensified foci were more than the nodular intensive foci, and the other atypical intensive foci were the least, and the portal vein period enhanced stove display is the clearest. Conclusion The characteristics of CT liver scan in patients with liver metastases from colorectal cancer do have certain regularity, which may provide a theoretical basis for the diagnosis of primary colorectal cancer and early metastasis of colorectal cancer.

目的 探讨磁共振磁敏感加权成像(SWI)对脑膜、脑转移瘤的诊断价值。方法 随机选取2016年3月—2018年3月我院收治的经临床、病理确诊的50例脑膜、脑转移瘤患者为研究对象,所有患者除常规行T1WI、T2WI扫描及T1WI增强扫描检查外,额外进行SWI检查。观察不同来源脑转移瘤转移部位、肿瘤实质信号在不同成像序列上的特征及对瘤内血管情况和出血状况的判断。结果 脑转移瘤的发生部位多为顶叶(29.75%)和枕叶(20.66%),就血供区域而言,多发生于中动脉(45.45%)和颈内动脉供血区域(38.02%)。不同MRI成像序列中肿瘤信号特征比较,显示均有差异(P<0.001)。其中,肺癌脑转移瘤T1WI呈低信号(62.96%),胃癌T2WI呈现高信号(68.75%),SWI成像序列上多显示为混杂信号。SWI序列成像显示瘤内出血55例(45.45%),显示引流血管16条,瘤内出血及肿瘤血管检出率均明显高于T1WI平扫检查,差异有统计学意义(P<0.05)。结论 不同来源的脑转移瘤MR的表现不同,为逆向推测脑转移瘤来源提供依据,同时SWI是对常规序列的重要补充,尤其是在脑瘤出血和血管检出上有重要作用,值得临床推广使用。

Objective To investigate the diagnostic value of susceptibility-weighted imaging(SWI) in meningiomas and brain metastases. Methods 50 cases of clinically and pathologically confirmed patients with meningioma and brain metastasis admitted to our hospital from March 2016 to March 2018 were randomly selected as the study subjects. All patients received routine T1WI, T2WI scan and T1WI enhanced scan, and additional SWI examination was performed. We observed the characteristics of metastatic sites and tumor parenchymal signals in different imaging sequences of brain metastatic tumors from different sources and to judge the status of intramedullary blood vessels and bleeding. Results The majority of brain metastatic tumors occurred in the parietal lobe (29.75%) and occipital lobe (20.66%). In terms of the blood supply region, the majority occurred in the middle artery (45.45%) and the blood supply region of the lower artery (38.02%). Comparison of tumor signal characteristics in different MRI imaging sequences showed differences, P<0.001. Among them, T1WI of brain metastatic tumor of lung cancer presented significantly low signal (62.96%), T2WI of gastric cancer presented high signal (68.75%), and SWI imaging sequence mostly showed mixed signal.SWI sequence imaging were showed in 55 cases (45.45%) of intracranial hemorrhage and 16 drainage vessels. The detection rate of intracranial hemorrhage and tumor blood vessels was higher than that of T1WI plain scan, with statistically difference (P<0.05). Conclusion MR manifestations of brain metastatic tumors from different sources are different, providing a basis for reverse speculation of the source of brain metastatic tumors. At the same time, SWI is an important supplement to routine sequences, especially in the hemorrhage of brain tumors and the detection of blood vessels, which is worthy of clinical promotion and use.

目的 观察改良INP方案对肺腺癌伴有脑转移患者的临床疗效及毒副作用,并探讨该方案疗效与Ⅲ型β微管蛋白(β-tubulin-Ⅲ)在肺癌组织中表达水平的关系。方法 收集2010年4月—2013年1月广州医科大学附属第一医院胸外科收治的15例肺腺癌伴有脑转移患者的临床资料。所有患者均采用改良INP方案治疗,使用RECIST 1.0标准进行判定。结果 脑转移瘤取得CR 1例(1/15),PR 5例(5/15),SD 4例(4/15),PD 5例 (5/10),该方案对脑转移瘤的总缓解率(overall response rate,ORR)为40%,疾病控制率(disease control rate,DCR)达66.7%,毒副作用轻度可控;Ⅲ型β微管蛋白低表达对该方案的疗效有优于高表达的趋势。结论 肺腺癌伴有脑转移患者采用改良INP方案进行化疗,脑转移瘤临床疾病控制率较高,耐受性良好;肿瘤组织β-tubulin-Ⅲ表达水平可能与该方案的疗效相关。

Objective To investigate the efficacy and toxicity of chemotherapy of modified INP regimen in the treatment of adenocarcinoma with brain metastases. At the same time,to explore the relationship between expression of β-tubulin-Ⅲ in NSCLC biopsies and sensitivity to this modified INP regimen. Methods The clinical data of 15 adenocarcinoma with brain metastases patients who had been admitted to the first affiliated hospital of Guangzhou medical university from April 2010 to January 2013 were retrospectively analyzed. All patients received modified INP regimen.RECIST 1.0 was taken to know the result. Results For brain metastasis of the 15 patients, complete response (CR) and partial response(PR) were 1 and 5 patients, respectively. 4 patients were stable disease (SD) and progression disease(PD) in 5 patients. The overall response rate(ORR) was 40% and the disease control rate(DCR) was 66.7%. The toxicity was mild. Furthermore, we found NSCLC patients with low β-tubulin-Ⅲexpression had better ORR than those with high expression. Conclusion The modified INP regimen is effective and well-tolerable for brain metastases of adenocarcinoma. The β-tubulin-Ⅲ expression may be associated with the efficacy of this regimen.