卢泰祥
从事头颈肿瘤放射治疗的临床和科学研究,在鼻咽癌的放射治疗、头颈肿瘤的适形调强放射治疗及放射性损伤的诊治等方面有突出贡献
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- 姓名:卢泰祥
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学术头衔:
博士生导师
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学科领域:
肿瘤学
- 研究兴趣:从事头颈肿瘤放射治疗的临床和科学研究,在鼻咽癌的放射治疗、头颈肿瘤的适形调强放射治疗及放射性损伤的诊治等方面有突出贡献
卢泰祥,男,广东东莞人,1953年7月出生。主任医师、硕士生导师。现任中山大学肿瘤防治中心副主任,肿瘤医院副院长,放疗科副主任,放射肿瘤学教研室副主任,中国抗癌协会放疗专业委员会副主任委员,广东省抗癌协会放疗专业副主任委员,《中华放射肿瘤学杂志》副总编辑,中华放射肿瘤学会“鼻咽癌专业学组” 副组长,广东省放射肿瘤学会常委,美国Baylor医学院客座教授。1977年毕业于中山医科大学,1977-1985年于中山医学院肿瘤研究所工作,1985年于中山大学肿瘤医院工作至今。主要从事头颈肿瘤放射治疗的临床和科学研究,在鼻咽癌的放射治疗、头颈肿瘤的适形调强放射治疗及放射性损伤的诊治等方面有突出贡献。曾参与了国家科委的七.五和八.五攻关科研课题,承担了广东省鼻咽癌防治的重点实验室建设和临床研究课题、有关改进鼻咽癌放射治疗技术研究的广东省重点攻关项目,以及“鼻咽癌现代放射治疗技术与质量保证”和“鼻咽癌放射治疗靶体积研究新进展”两项国家级继续医学教育项目,建立了本院放疗科鼻咽癌放射治疗的规范。2001年1月在华南地区首次引进了“适形调强放射治疗技术”应用临床,并在我国首次应用这种技术的常规分割方法治疗鼻咽癌,取得了良好效果。共发表论文70余篇,参与编写全国高等学校教材《肿瘤放射治疗学》、《实用鼻咽癌放射治疗学》、《实用鼻咽癌放射治疗学》、《新编常见恶性肿瘤诊治规范》及《鼻咽癌临床与实验研究》等专著。1982年“鼻咽癌组织中EB病毒核抗原和病人血清抗体的检测及其意义”获省高教局三等奖,1997年“鼻咽癌放射治疗的研究”分别获省高教、卫生厅一等奖和省科委三等奖。曾4次分别参加美国和澳大利亚的国际放射肿瘤学学术会议并2次在大会发言,宣读和讨论有关鼻咽癌放射治疗和调强适形放射治疗新技术的论文,获得国内外同行一致好评。
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卢泰祥
Chinese Journal of Cancer, 2004, 23 (2): 230-234,-0001,():
-1年11月30日
目前放射治疗虽仍为鼻咽癌首选治疗手段,且疗效令人满意,但仍有部分患者经积极治疗后难免出现鼻咽和/或颈部淋巴结复发,对这些患者有时诊断和治疗有一定困难。本文对近年来国内外文献进行归纳分析,介绍局部复发鼻咽癌的复发因素、临床特征、现代诊断技术以及现代放射治疗、化疗和手术治疗等挽救治疗的方法。
鼻咽肿瘤, 局部复发, 诊断, 治疗
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卢泰祥, TAI-XIANG LU, M. D., * WEI-YUAN MAI, *, † BIN S. TEH, † CHONG ZHAO, * FEI HAN, * YIN HUANG, * XIAO-WU DENG, PH. D., * LI-XIA LU, * SHAO-MIN HUANG, C. M. D., * ZHI-FAN ZENG, * CHENG-GUANG LIN, R. T. T., * HSIN H. LU, † J. KAM CHIU, † L. STEVEN CARPENTER, M.D., † WALTER H. GRANT III, † SHIAO Y. WOO, † NAN-JI CUI, * AND E. BRIAN BUTLER, M. D.†
PII S0360-3016(01)01678-9,-0001,():
-1年11月30日
To report our initial experience on the feasibility, toxicity, and tumor control using intensity-modulated radiotherapy (IMRT) for retreatment of recurrent nasopharyngeal carcinoma (NPC). Methods and Materials: A total of 49 patients with locoregional recurrent carcinoma in the nasopharynx were treated with IMRT between January 2001 and February 2002 at the Sun Yat-Sen University Cancer Center, Guangzhou, China. The average time to the nasopharyngeal recurrence was 30.2 months after initial conventional RT. The median isocenter dose to the nasopharynx was 70 Gy (range 60.9-78.0) for the initial conventional RT. All patients were restaged at the time of recurrence according to the 1992 Fuzhou, China staging system on NPC. The number of patients with Stage I, II, III and IV disease was 4, 9, 10, and 26, respectively. T1, T2, T3, and T4 disease was found in 4, 9, 11, and 25 patients, respectively. N0, N1, N2, and N3 disease was found in 46, 2, 0, and 1 patient, respectively. Invasion of the nasal cavity, maxillary sinus, ethmoid sinus, sphenoid sinus, and cavernous sinus and erosion of the base of the skull was found in 8, 1, 3, 8, 15, and 20 patients, respectively. The gross tumor volume (GTV) was contoured according to the International Commission on Radiation Units and Measurements (ICRU) Report 62 guidelines. The critical structures were contoured, and the doses to critical structures were constrained according to ICRU 50 guidelines. The GTV in the nasopharynx and positive lymph nodes in the neck received a prescription dose of 68-70 Gy and 60 Gy, respectively. All patients received full-course IMRT. Three patients who had positive lymph nodes were treated with five to six courses of chemotherapy (cisplatin+5-fluorouracil) after IMRT. The treatment plans showed that the percentage of GTV receiving 95% of the prescribed dose (V95-GTV) was 98.5%, and the dose encompassing 95% of GTV (D95-GTV) was 68.1 Gy in the nasopharynx. The mean dose to the GTV was 71.4 Gy. The average doses of the surrounding critical structures were much lower than the tolerable thresholds. At a median follow-up of 9 months (range 3-13), the locoregional control rate was 100%. Three cases (6.1%) of locoregional residual disease were seen at the completion of IMRT, but had achieved a complete response at follow-up. Three patients developed metastases at a distant site: two in the bone and one in the liver and lung at 13 months follow-up. Acute toxicity (skin, mucosa, and xerostomia) was acceptable according to the Radiation Therapy Oncology Group criteria. Tumor necrosis was seen toward the end of IMRT in 14 patients (28.6%). Conclusion: The improvement in tumor target coverage and ignificant sparing of adjacent critical structures allow the feasibility of IMRT as a retreatment option for recurrent NPC after initial conventional RT. This is the first large series using IMRT to reirradiate local recurrent NPC after initial RT failed. The treatment-related toxicity profile was acceptable. The initial tumor response/local control was also very encouraging. In contrast to primary NPC, recurrent NPC reirradiated with high-dose IMRT led to the shedding of tumor necrotic tissue toward the end of RT. More patients and longer term follow-up are warranted to evaluate late toxicity and treatment outcome.
IMRT, Reirradiation, Recurrent, Nasopharyngeal carcinoma.,
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卢泰祥, 赵充, 韩非, 黄莹, 邓小武, 卢丽霞, 曾智帆, 黄劭敏, 林承光, 崔念基
Chin J Oncol, July 2003, Vol 25, No.4,-0001,():
-1年11月30日
目的评价调强适形放射治疗(IMRT)对复发性鼻咽癌的疗效、放射反应以及对肿瘤的控制。方法49例鼻咽局部复发的鼻咽癌患者(KPS≥80)均采用全程IMRT,其中伴有颈淋巴结转移的3例患者(N12例,N31例) 在IMRT后,给予PDD+52Fu方案5~6个疗程化疗。结果治疗计划结果显示,覆盖鼻咽GTVD95的平均剂量 68.09Gy,GTVV95的平均体积为98.46%,靶区内GTV、CTV1和CTV2 的平均剂量分别为71.40Gy、63.63Gy 59.81Gy。49例患者的中位随访时间为9个月(3~16个月)。局部无进展生存率100%,IMRT结束时有3例(6.1 %) 出现局部残留,14例(28.6%)出现鼻咽腔黏膜坏死。结论IMRT能有利覆盖肿瘤靶区而使邻近敏感器官获得有效分隔,对复发性鼻咽癌的再程放疗不失为一种有效方法。值得注意的是高剂量的鼻咽局部IMRT治疗对于复发性鼻咽癌容易导致鼻咽黏膜坏死,故应适当减少GTV的处方剂量以60~65Gy为宜。
鼻咽肿瘤/, 放射疗法, 调强适形放射治疗, 肿瘤复发, 局部
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卢泰祥, TAI-XIANG LU, M. D., * WEI-YUAN MAI, †‡ BIN S. TEH, ‡ YONG-HONG HU, * HSIN H. LU, ‡ J. KAM CHIU, ‡ L. STEVEN CARPENTER, ‡ SHIAO Y. WOO, ‡ AND E. BRIAN BUTLER, M. D.‡
PII S0360-3016(01)01678-9,-0001,():
-1年11月30日
Purpose: To evaluate the long-term outcome and prognostic factors in patients with skull base erosion from nasopharyngeal carcinoma after initial radiotherapy (RT). Methods and Materials: From January 1985 to December 1986, 100 patients (71 males, 29 females) with a diagnosis of nasopharyngeal carcinoma were found on computed tomography (CT) to have skull base erosion. The mean age was 41 years (range 16-66). Ninety-six patients had World Health Organization type III undifferentiated carcinoma, and 4 had type I. The metastatic workup, including chest radiography, liver ultrasound scanning, and liver function test was negative. All patients underwent external beam RT (EBRT) alone to 66-80 Gy during 6-8 weeks. A daily fraction size of 2 Gy was delivered using 60Co or a linear accelerator. No patient received chemotherapy. All patients were followed at regular intervals after irradiation. he median follow-up was 22.3 months (range 2-174). Survival of the cohort was computed by the Kaplan-Meier method. The potential prognostic factors of survival were examined. Multivariate analyses were performed using the Cox regression model. Results: The 1, 2, 5, and 10-year overall survival rate for the cohort was 79%, 41%, 27%, and 13%, respectively. However, the subgroup of patients with both anterior cranial nerve (I-VIII) and posterior cranial nerve (IX-XII) involvement had a 5-year survival of only 7.7%. A difference in the time course of local recurrence and distant metastasis was observed. Both local recurrence and distant metastasis often occurred within the first 2 years after RT. However, local relapse continued to occur after 5 years. In contrast, no additional distant metastases were found after 5 years. The causes of death included local recurrence (n=59), distant metastasis (n=21), both local recurrence and distant metastasis (n=1), and unrelated causes (n=5). After multivariate analysis, complete recovery of cranial nerve involvement, cranial nerve palsy, and headache after irradiation were found to be independent prognostic factors in this cohort. Conclusions: We present one of the longest follow-ups of patients with nasopharyngeal carcinoma invading the skull base. Our results demonstrate the importance of cranial nerve involvement, recovery of headache, and cranial nerve palsy. These factors should be carefully evaluated from the history, physical examination, and imaging studies. A subgroup of patients with skull base involvement had long-term survival after RT alone. The findings of this study are important as a yardstick against which more aggressive strategies, such as combined radiochemotherapy and altered fractionation RT can be compared.
Nasopharyngeal carcinoma, Skull base erosion, Radiotherapy, Prognostic factors, Long-term survival
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卢泰祥, *, 赵充, 朱兰才, 曾祥发, 曾智帆, 张德林
《癌症》2000,19(7):719~720,-0001,():
-1年11月30日
肿瘤, 肺转移瘤, 转移率
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卢泰祥, 卢秦祥, 胡永红, 张思罴, 李家尧
中国肿瘤临床,1997,24(2):115~117,-0001,():
-1年11月30日
鼻咽癌颅底蔓延100例作放疗后疗效回顾分析。其1、3、5年生存率分别为78.79%,41.19%、26.91%,均较鼻咽癌总的生存率低。当A组(I~Ⅶ对)、B组(Ⅸ~xⅡ对)颅神经同时损害时预后极差,5年生存率仅为7.69%。颅底蔓延部位的多寡及蝶窦和筛窦是否同时受侵与预后关系密切。颅底骨与鼻咽为同一照射靶区,疗效最好的照射剂量为70Gy。放疗后有42.42%的颅底骨质完全修复。放疗对头痛的缓解和颅神经的恢复分别为77.38%和57.14%。颅神经损害病程的长短与恢复的程度有关。
鼻咽肿瘤, 放射治疗, 颅底
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卢泰祥, 罗伟, 赵充, 吴少雄, 陈勇, 崔念基, 钱剑扬, 伍建华
《癌症》2000,19(10):930~933,-0001,():
-1年11月30日
目的:探讨鼻咽癌等中心放疗低熔点铅挡块面颈联合野的设野方法。方法:利用鼻咽+上颈部CT/MRI扫描,采用等中心体位固定方法模拟定位并拍摄面颈部X线照片,根据鼻咽病灶侵犯的范围描画照射靶区,制作低熔点铅挡块。结果:(1)常规第一段面颈联合野前上界与眼眶缘的距离15~20nm;前下界与上颌窦底壁的距离5nm;上界平筛窦顶壁;后上界与上1/3斜坡距离5nm;后下界与下1/3斜坡距离10~15nm。第二段面颈分野的后下界向前移5~10nm;下界上移至下颌角水平。口咽受累时,两段均用面颈联合野,但后界前移至颈椎体后缘,其颈后三角区用8~12MeV电子线照射。(2)根据鼻咽癌侵犯的范围相应扩展局部照射野。结论:(1)等中心面颈联合野设野原则可根据鼻咽癌侵犯的范围做个体化放疗设计。(2)通过精确的适形设野,可使照射靶区设计更合理并更有效地遮挡邻近重要器官。
鼻咽肿瘤, 放射疗法, 面颈联合野, CT/, MRI 扫描, 铅挡块遮挡, 放射性损伤
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卢泰祥, 卢泰祥*, 韩非, 赵充, 曾智帆, 卢丽霞, 邓小武, 黄劭敏, 林承光, 崔念基
,-0001,():
-1年11月30日
目的:介绍适形调强放射治疗在头颈肿瘤中临床使用的方法和初步结果。方法:2001年1月至2月我院用适形调强放射治疗头颈肿瘤15例,其中初治鼻咽癌4例,未控或复发鼻咽癌8例,第@6颈椎神经鞘瘤,脑膜瘤,肺癌脑转移瘤各1例。照射靶区和敏感器官按ICRU50号文标准勾划。用孔雀系统的CORVUS做逆向治疗计划设计,用MIMiC作共面旋转照射。照射野每5变换一次,从105°~255°旋转照射。常规外照射+后IMRT6例,全程IMRT9例。全部病例按常规分割照射,200cCY/次,每周5次。常规外照射剂量20~70Gy。IMRT处方剂量:全程IMRT60~76Gy,后程IMRT30~50Gy。结果:尽管全部病例肿瘤体积的目标剂量是20~70Gy,但最后靶区的平均剂量可达到11.42~78.04G。敏感器官照射的平均剂量为,晶体3.26Gy(0.30c.)视神经19.07Gy(0.90c.c),颞颌关节20。55Gy,(5.54c.c),腮腺19.7Gy(13.32c.c),垂体21.98Gy(0.76c.c), 脑干20.6Gy(21.21c.c),脊髓19.14Gy(9.28c.c),结论:孔雀系统对头颈肿瘤的适形调强放疗能较好地适形照射肿瘤体积和有效地保护邻近敏感器官。
Head and neck tumor, Intensity Modulated Radiation Therapy
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