X刀治疗脑胶质瘤的方法及结果分析

本文报告了我院从1995年3月到1996年5月，采用德国BrainScanX刀治疗系统治疗脑胶质瘤病人45例，经过6～12个月的随访，结果表明，总的治疗有效率达到75．56％，半年以上的生存率为77．78％，颅内压增高等严重并发症的发生率为22．22％。作者总结了适应症选择的标准、治疗计划设计优化的原则、疗效判断标准、X刀后病理和影像变化的特声、以及与并发症发生有关因素等方面的经验和体会。     

CT引导125I放射性粒子植入治疗复发性脑胶质瘤的研究

目的：探讨^125I放射粒子植入治疗复发性脑胶质瘤的技术方法、疗效和安全性。方法：33例手术或放疗后复发性脑胶质瘤患者行CT引导下^125I粒子植入术，根据术前计划确定粒子数目、空间分布和粒子针数目。粒子活度为0．4-0．8mCi，间距为0．5～1.0cm，共植入粒子10～35颗，术后即刻行CT扫描并进行质量验证。术后定期复查CT。结果：按照WHO疗效评价标准，1、3和6个月时有效率分别为48．5％、67．7％和80．0％。全组中位生存期16个月，其中1～2级胶质瘤中位生存期26个月，3～4级胶质瘤中位生存期11个月；全组1年生存率为66．7％（22／33），其中1～2级胶质瘤1年生存率为85．0％（17／20），3～4级胶质瘤1年生存率为38．5％（5／13）。并发症包括针道少量出血4例，局部脑坏死5例。未出现与治疗相关的死亡病例。结论：CT引导^125I粒子植入治疗复发性脑胶质瘤具有安全、微创、并发症少和疗效肯定等优点，值得进一步应用。     

肛管癌单纯放疗的治疗结果和预后因素

目的分析肛管癌单纯放疗的治疗结果和预后情况。材料与方法法国蒙贝利埃医学院附属肿瘤医院从１９８７年到１９９２年，用单纯放射治疗３７例肛管癌患者，随访大于６０月。结果局部控制率２年为５８．０％，５年为３０．５％，平均生存时间为８７月，平均无病生存时间为３３月。治疗失败为淋巴结转移２４％，联合局部复发１３．５％，严重并发症５％。并发症及后遗症中，局部疼痛多见占３５．１％，其次为直肠间断性出血１８．９％，肛管坏死２．７％，肛管纤维化伴狭窄２．７％。结论根据临床统计分析预后因素与临床分期、组织学类型、分化程度、年龄等因素有关。     

胆囊癌术后感染性并发症的危险因素分析

目的探讨胆囊癌术后感染性并发症的危险因素。方法回顾性分析本院2000年1月～2005年6月手术治疗的58例胆囊癌患者。分析22个有关病人、肿瘤及手术操作相关的独立因素，因变量为术后感染性并发症。Binary Logistic回归用于分析与因变量相关的独立的危险因素。结果总体术后并发症为32．8％（19／58），58例中14例（24．1％）出现了感染性并发症。单因素分析提示黄疸、低蛋白血症和术中输血与感染性并发症显著相关。多因素Logistic回归分析发现黄疸和术中4单位以上输血对术后感染性并发症具一定影响，但无显著性（OR值和95％c1分别为8．004、7．782和0．886-72．278、0．914～66．283），而体重减轻和低蛋白血症则与术后感染性并发症显著相关（OR值和95％CI分别为9．609、40．257和1．269-72．253、3．901-415．438）。结论体重减轻和低蛋白血症是影响胆囊癌术后感染性并发症的主要独立因素。     

肢端肥大症的放射治疗

报告３６３例肢端肥大症的治疗结果。单纯放疗２０５例，手术加放疗１５８例。以治疗前后血浆生长激素变化为疗效判定标准，单纯放疗和手术加放疗的３、５年完全缓解率分别为２４．１％、４７．０％和２９．７％、５４．８％。疗效与剂量有关。复发率为９．１％，４５Ｇｙ以下发发率高。垂体前叶功能低下是最常见的并发症。放疗后生长激素下降缓慢，仍可对组织和器官起作用。     

宫颈癌化疗灌注栓塞治疗39例临床疗效观察

39例晚期子宫颈癌患者均采用经子宫动脉选择性化疗药物灌注和栓塞，25例治疗后Ⅱ期手术。介入、手术者1年及3年生存率分别为100％和88．0％(22／25)；单纯介入治疗者1年及3年生存率分别为100％和74．2％(23／31)。无并发症发生。     

142例恶性黑色素瘤的分期治疗

目的探讨恶性黑色素瘤分期治疗的意义。方法收集1961—1999年住院治疗的恶性黑色素瘤142例，按照1997年TNM分期标准，Ⅰ期20例（14．1％）、Ⅱ期36N（25．3％）、Ⅲ期64例（45．1％）、Ⅳ期22例（15．5％）；Ⅰ期手术治疗、Ⅱ期手术＋放疗、Ⅲ期化疗＋手术或放疗、Ⅳ期以化疗为主要综合治疗。结果Ⅰ期5年生存率高达97％，Ⅱ期5年生存率47％～74％，Ⅲ期5年生存率13％～41％，Ⅳ期3年生存率0～10％。结论分期治疗恶性黑色素瘤有助于提高患者的5年生存率及降低医疗费用。     

肾功能衰竭行替代治疗的肿瘤患者化疗疗效和不良反应

目的分析合并肾功能衰竭并需要行替代治疗的恶性肿瘤患者临床特点、化疗疗效和对患者生存的影响。方法选取合并肾功能衰竭并需要行替代治疗的恶性肿瘤患者，分析其所采用的化疗方案、药物的剂量强度、有效率和对患者生存的影响及其不良反应。结果共22例肾功能衰竭合并替代治疗患者进行化疗，其中骨髓瘤患者10例，非骨髓瘤患者12例。骨髓瘤合并肾功能衰竭行替代治疗患者化疗平均剂量强度为标准剂量的91±19．12％，化疗有效率为87．5％，6个月、1年、2年和3年生存率分别达到80％、60％、不低于25％和不低于12．5％。3例患者肾功能好转。非骨髓瘤患者化疗平均剂量强度为标准剂量的82．55±17．73％，行辅助化疗患者6个月、1年和2年无病生存率分别为83．33％，不低于60％和不低于40％。晚期患者化疗有效率为80％，6个月、1年、2年和3年生存率分别为83．33％、不低于80％，不低于40％和不低于20％。常见的不良反应：Ⅲ-Ⅳ度骨髓抑制发生率为18．18％，感染率发生率为31．82％。结论合并肾功能衰竭并需要行替代治疗的恶性肿瘤患者可以进行化疗并获得一定的长期生存，医师需要根据药物的代谢特点和患者个体化需求进行剂量调整并监测不良反应。     

贲门癌全胃切除腹部与胸部不同切口治疗结果对比观察

作者报告收治贲门癌（含高位胃癌）行全胃切除术38例，其中行左下胸第8～10肋床切口手术22例，经上腹切口手术16例。两组治疗情况进行比较，从手术切口、手术并发症、病理检查结果及随访存活情况进行对比分析讨论，发现以左下胸切口组为优。胸切口组与腹切口组并发症发生率分别为9．0％与25．0％。5年生存率分别为23．8％与16．7％。故此认为：较晚期的贲门及近侧胃癌还是选用左下胸切口为妥。     

高龄肺癌患者的手术治疗

[目的]探讨高龄肺癌患者的外科治疗。[方法]对1993～1998年行外科手术的68例高龄肺癌患者进行回顾性分析。[结果]68例中64例手术切除肿瘤(94．1％)，术后并发症22例．术后l、3、5年生存率分别为76．5％、48．6％、30．4％。[结论]高龄肺癌患者术后并发症的处理、术式选择、TNM分期对手术预后影响显著。     

A Phase II NCCTG study of irinotecan and docetaxel in previously treated patients with non-small cell lung cancer

Purpose: This Phase II study was undertaken to define the efficacy and toxicity of the combination of docetaxel and irinotecan for the second-line treatment of non-small cell lung cancer (NSCLC). Patients and Methods: Forty-six patients with measurable NSCLC who had relapsed after an initial response to chemotherapy or who had failed to respond to initial chemotherapy, received 130 mg/m² of irinotecan IV over 90 minutes and 50 mg/m² docetaxel IV over 60 minutes on Day 1 q3 weeks for 6 cycles. Dexamethasone and diphenhydramine pretreatment were given. Response to treatment was evaluated by response evaluation criteria in solid tumors RECIST criteria, and toxicity was graded according to the National Cancer Institute Common Toxicity Criteria (NCI CTC) version 2.0. Results: The most common severe (NCI CTC Grade 3+) adverse events were neutropenia (67 percent), diarrhea (28 percent), fatigue (20 percent), nausea (17 percent), infection (15 percent), vomiting (13 percent), leucopenia (13 percent), abdominal pain (11 percent), and dyspnea (11 percent). Grade 5 toxic events were seen in 2 patients. One of these 2 cases was a possibly-treatment related event (intestinal fistula). The median number of treatment cycles received was 3. Twelve patients (26 percent) received all 6 cycles of treatment. Five patients (11 percent) had a confirmed response (complete response (CR), partial response (PR), or regression). Median follow-up for the five surviving patients is 26.5 months (range: 25.1-28.4). Forty-two patients have reported progressive disease and 41 patients have died. Median time-to-progression (TTP) and survival are 2.6 months and 7.5 months, respectively. Conclusion: This second-line treatment regimen of irinotecan and docetaxel in NSCLC patients has shown activity, but can not be recommended over single-agent regimens because of significant toxicity.     

CT引导下肺部病变穿刺活检的临床应用价值及并发症的预防

 目的探讨CT引导下肺部病变穿刺活检的临床应用价值及并发症的预防。方法对80例患者96个病灶在CT引导下做了108次穿刺。结果细胞学阳性率93.7%(75/80);组织学阳性率95%(76/80)。恶性肿瘤准确率93.8%(62/65);良性病变准确率80%(12/15);并发症气胸7.5%(6/80),咳血2.5%(2/80)。结论CT引导下肺部病变穿刺活检安全、准确、高效。严格、娴熟、规范的操作可减少并发症的发生。     

Clinical Application of Recombinant Human Endostatin in Postoperative Early Complementary Therapy on Patients with Non-small Cell Lung Cancer in Chinese Mainland

Objective: To explore the clinical application of recombinant human endostatin (Endostar) in the treatmentof patients with non-small cell lung cancer (NSCLC) in Chinese mainland. Materials and Methods: A total of75 patients diagnosed as NSCLC were randomly divided into control group (37 cases) and treatment group(38 cases). Control group was treated with postoperative complementary chemotherapy containing two-agentplatinum protocol on postoperative d21, 3 weeks as a cycle, for totally 4~6 cycles. On this basis, treatment groupwas added with Endostar 7.5 mg/m2 on postoperative d8~9, 3~4 h/time, qd, 14 weeks as a cycle, for totally 4cycles. The interval between every two cycles was 7 d. The 5-year progression-free survival (PFS), 5-year survivaltime and complications in both groups were observed. Results: Compared with control group, the average PFSincreased evidently in treatment group by 9.8 months (41.6 months vs. 31.8 months), and there was significantdifference (P<0.05). And the median PFS was 42.5 months in treatment group, obviously longer than that incontrol group (33.7 months) by 8.8 months (P<0.05). Additionally, the 5-year overall survival rate (OS), averagesurvival time and median survival time (MST) were 47.4%, 50.1 months and 59.3 months in treatment group,significantly higher than the 29.7%, 42.1 months and 43.5 months in control group (P<0.05). Only 1 patientshowed poor healing of surgical wound in treatment group, but no surgery-associated complication was foundin control group. Moreover, the postoperative complementary therapy-connected complication rates were63.2% (24/38) and 59.5% (22/37) in treatment group and control group respectively, but there was no significantdifference (P>0.05). Conclusions: The application of Endostar combined with sensitive platinum-containedchemotherapeutic agents in the postoperative complementary chemotherapy can be widely used in clinic becauseit can significantly prolong the long-term survival time of patients with NSCLC.     

Intracranial metastases: behavioral patterns related to primary site and results of treatment by whole brain irradiation

Three hundred and fifty cases of tumors that metastasized to the brain and treated by radiotherapy were reviewed. The majority of patients had either lung (46 % I or breast (42 % ) primaries. Eighty percent of the patients had other sites of metastatic involvement. Seventy-five percent of the patients improved after cranial irradiation. The median survival was less than 6 months, regardless of the primary disease or the dose employed. No subgroup could be identified that might benefit from a more aggressive treatment regimen. Radiation treatment in the range of 2,000 rad in one week or 3,000 rad in two weeks is recommended for palliation of metastatic cancer to the brain.     

A study of surgical management of chronic suppurative otitis media with cholesteatoma and its outcome

Objective

Aim of this study is evaluation of course of improvement of surgically treated cases of chronic suppurative otitis media (CSOM) with cholesteatoma; it includes hearing status, condition of mastoid cavity, study of different, natural and surgical condition and recurrence of disease within the study period.

Design

It is a prospective study.

Settings

This study was conducted in a premiere government hospital in Kolkata between May 2007 to April 2008.

Patients

Total 40 patients between age group of 6–70 years were included in the present study which includes 19 males and 21 females.

Intervention

Surgical interventions were done in all the cases. Different types of mastoidectomy with or without tympanoplasty was done according to extent of disease process.

Outcome

Audiometrically documentable hearing improvement occurred in 35% cases (p = 14), in rest of the ears hearing status remained unaltered. At the end of 6 months follow up 92.5% (p = 14) in rest (p = 37) operated ears become completely dry. Five percent cases (p = 2) presented with facial paralysis; among them one patient improved completely and another patient improved from grade V to grade III facial paralysis. No patient developed any post operative intracranial complications and recurrence of cholesteatema not found in 6 months follow up. Meatal stenosis developed in 5% cases (p = 2) at the end of 6 months.

Conclusion

Surgery is mainstay of treatment in CSOM with cholesteatoma. Eradication of disease, prevention of complication, maintenance and restoration of hearing, and giving the patient a non-discharging ear are main aim of treatment.     

Docetaxel and epirubicin as first-line treatment for patients with metastatic breast cancer: a Minnie Pearl Cancer Research Network Phase II trial

BACKGROUND: Taxanes and anthracyclines are the two most active classes of cytotoxic agents in the treatment of patients with metastatic breast cancer. Epirubicin, a doxorubicin analog, has shown modest toxicity advantages when compared to the parent compound. In this Phase II trial, we evaluated the activity and toxicity of a docetaxel/epirubicin combination. METHODS: Thirty patients with previously untreated metastatic breast cancer were treated with docetaxel 60 mg/m2 one-hour IV infusion and epirubicin 90 mg/m2 IV bolus; both drugs were repeated at 21-day intervals. Patients were evaluated for response after 2 courses of treatment; responding and stable patients continued treatment for a total of 6 courses. RESULTS: Fifteen patients (50 percent) had objective response to treatment; an additional 20 percent of patients had stable disease of more then 6 months duration. The median and 2-year progression-free survivals were 12 months and 34 percent, respectively. Median and 2-year overall survivals were 18 months and 42 percent, respectively. Myelosuppression was the most common Grade 3/4 toxicity, and 2 patients in this trial (6 percent) had treatment-related mortality associated with severe sepsis. CONCLUSION: The results of this Phase II trial confirm previous observations regarding the efficacy and toxicity profile of the docetaxel/epirubicin combination. This combination has activity similar to other taxane/anthracycline combinations used in the first-line treatment of metastatic breast cancer.     

Clinical Application of Transcatheter ArterialChemoembolization Combined with Synchronous C-armCone-Beam CT Guided Radiofrequency Ablation in treatmentof Large Hepatocellular Carcinoma

Objective: This work aimed to evaluate the safety and clinical efficacy of transcatheter arterialchemoembolization (TACE) combined with c-arm cone-beam CT guided synchronous radiofrequency ablation(RFA) in treatment of large hepatocellular carcinoma (HCC). Methods: 21 patients with large HCC were studiedfrom January 2010 to March 2012. TACE combined with synchronous C-arm cone-beam CT guided RFA wereperformed on a total of 25 lesions. Conventional imaging examination (CEUS, enhanced CT or MRI) and AFPdetection were regularly conducted to evaluate the technical success rate of combined treatment, complications,treatment response, time without disease recurrence and survival rate. Results: The technical success rate ofcombined treatment was 100%, without any significant complication. After 1 month, there were 19 cases withcomplete response and 2 cases with partial response, with an complete response rate of 90.4% (19/21) and aclinical effective rate of 100% (21/21). The complete response rates of single nodular lesions (100%, 17/17) wassignificantly higher than that of multiple nodular lesions (50%, 2/4) (P < 0. 05). During 2 to 28 months of followup,in 19 cases with complete response, the average time without disease recurrence was 10.8 ± 6 months. Thetotal survival rates of 6, 12 and 18 months in 21 patients were 100%, respectively. Conclusion: TACE combinedwith synchronous C-arm CT guided RFA is safe and effective for treatment of large HCC. The treatment efficacyfor single nodular lesion is better than that for multiple nodular lesions.     

Long-term survival in metastatic melanoma patients treated with sequential biochemotherapy: report of a Phase II study

The overall survival for patients with metastatic melanoma is very poor, with a median survival of 8.5 months. In this Phase II trial, we assessed the efficacy, safety, and tolerability of a sequential biochemotherapy schedule, using dacarbazine as antiblastic agent and immunomodulant doses of interleukin-2 and interferon-alfa. Thirty-one eligible patients with metastatic melanoma received dacarbazine IV as antiblastic therapy and interluekin-2, plus interferon-alfa SC as sequential immunotherapy, for 6 months. Responding and nonprogressing patients were subsequently maintained on immunotherapy treatment for further 6 months. Twenty-nine patients had an adequate trial, and were assessable for both response and toxicities, with a median follow-up of 49 months. The overall response rate was 52 percent (3 CR and 12 PR), SD was 8 (27 percent) and PD were achieved in 6 patients (21 percent). The median survival duration of responders was 28 months, significantly longer (p < 0.001) than the 16 months of nonresponders. Therapy was well tolerated and produced a significant improvement in progressive-free survival. Further studies, thus, are recommended for larger groups of patients not only to confirm these results, but also to apply this biochemotherapy regimen as adjuvant postsurgical treatment in early stages of malignant melanoma.     

皮下脂膜炎样T细胞淋巴瘤的诊断及文献复习

目的 :观察皮下脂膜炎样T细胞淋巴瘤 (SPTCL)的临床表现并分析SPTCL的病理组织学形态、诊断及鉴别诊断。方法 :报道 3例发生在四肢、躯干的多发性病灶的病例 ,从临床病理组织学及免疫组化、临床表现等方面进行了观察。结合文献 ,探讨SPTCL的发病学、临床表现、实验室检查、治疗及转归。结果 :SPTCL主要表现四肢、躯干皮肤水疱、皮下结节、多发溃疡。 2例合并噬血细胞综合征 ,临床进展迅速 ,于发病后 4个月及 8个月内死亡。组织病变均呈脂膜炎样改变 ,瘤细胞主要浸润皮肤真皮及皮下组织 ,瘤组织可见明显大片状坏死 ,肿瘤细胞浸润血管壁并见血管壁的凝固性坏死。免疫组化肿瘤细胞LCA、CD4 5R0阳性 ,证实瘤细胞为T细胞型。结论 :SPTCL是一种特殊类型的皮肤原发性恶性肿瘤 ,具有特殊生物学行为 ,预后差