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Objective To evaluate the clinical effects and adverse reaction of raltitrexed combined with radiation for esophageal carcinoma in elderly patients.Methods Sixty patients were randomly divided into two groups by the envelope method, 30 patients in experimental group received raltitrexed combined with radiotherapy and 30 patients in control group received radiotherapy only.Patients in both groups received conventional radiotherapy with a total dose of 56-60 Gy/28-30 F.In experimental group, raltitrexed 2.6 mg/m2 was administered concurrently with the radiotherapy on d1 and d22.Two cycles of concurrent chemotherapy were administered during radiotherapy.The short-term effects, survival times and adverse reactions of the two groups were compared.Results The total effective rates of experimental group and control group were 93.3% and 73.3%, respectively, and there was statistically significant difference between the two groups (χ2=4.320, P=0.038).The median survival times of experimental group and control group was 24.0 months and 12.0 months, respectively, and there was statistically significant difference by Log-rank test (χ2=6.048, P=0.014).The major adverse reactions of grade 3-4 in experimental group and control group were radiation-induced esophagitis (10.0% vs.3.3%;χ2=0.268, P=0.605), leukopenia (13.3% vs.10.0%;χ2=0.000, P=1.000), thrombocytopenia (3.3% vs.0;P=1.000), nausea and vomiting (6.7% vs.0;χ2=0.517, P=0.472), and the differences were not statistically significant.Conclusion Raltitrexed combined with radiotherapy can enhance the short-term effect and prolong the survival time for the elderly esophageal carcinoma patients, and the adverse reactions are mild.It is worthy of further clinical study.
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Objective To discuss the method, safety and clinical value of biliary stenting combined with 125I seed implantation intracavitary irradiation in treating malignant obstructive jaundice. Methods A total of 36 patients with malignant obstructive jaundice were enrolled in this study. PTCD was carried out in all patients, which was followed by biliary stenting combined with 125I seed implantation intracavitary irradiation treatment. The results were analyzed. Results During the interventional management, displacement of the stent and 125I seeds were observed in two cases, and the displaced stent and 125I seeds were replaced to the right position with the help of biliary biopsy forceps. The technical success rate was 100%, and the remission rate of the jaundice was 100%. All the patients were followed up for 1-23 months. No radioactive particles leaking or complications such as radiation enteritis occurred. No in-stent obstruction due to tumor recurrence was observed although slight dilatation of intrahepatic bile duct was detected in 25%of patients, which was resulted from intimal hyperplasia at the stent mesh and/or biliary stone formation. The median survival time was 10.9 months. Conclusion For the treatment of malignant obstructive jaundice, biliary stenting combined with 125I seed implantation intracavitary irradiation is safe, reliable and effective. This technique can prolong stent patency time as well as the patient’s survival time.
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Objective To study investigate the dose accuracy that can be achieved with the method of bulk density assignment.Methods Sixteen cases of nasopharyngeal cancer patients and nineteen cases of esophageal cancer patients who accept radiotherapy in our department were selected.The planning CT images with bulk density assignment to different classes of tissues were applied to calculate the dose distributions,and then the resulting dose volume histograms (DVH) of the tumor and organs of risk were compared with the original treatment plan.The paired t-test was taken for dose comparison between two plans.Results The DVH comparison based on the planning CT and the bulk density assignment CT showed good agreements.With nasopharyngeal cancer patients,differences between the two plans about target and normal tissue were less than 1％.With esophageal cancer patients,the dose differences were less than 2％.Conclusion Preliminary results confirm that the bulk density assignment method can be applied to calculate the dose distributions.
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Objective To investigate the techniques,safety,and efficacy of intraoperative holmium laser lithotripsy under cholangioscopic visualization for refractory intrahepatic stones. Methods A total of 38 patients with refractory hepatolithiasis underwent cholangioscopic holmium laser lithotripsy.The laser setting was: the wavelength of 2.1 ?m,the maximum mean output power of 100 W,the pulse peak power of up to 6 kW,and the laser fiber of 400 ?m in diameter.Results The stones were entirely removed on one session in all the 38 patients.The lithotripsy time was 3~5 min,the times of fragmentation was 3~8,and a total of 65 stones were fragmented.No bile duct injuries or biliary leakage happened.Cholangiography and B-ultrasonography at 2 postoperative months found no residual stones.Follow-up for 6 months found no recurrence.Conclusions Application of holmium laser lithotripsy under cholangioscopic visualization for the management of refractory intrahepatic stones is safe and effective.