调强适形放疗联合多西紫杉醇和奈达铂治疗局部晚期食管癌的临床观察

目的观察调强适形放疗联合多西紫杉醇和奈达铂同步化疗治疗局部晚期食管癌的疗效及安全性。方法选取我院收治的经病理证实的局部晚期食管癌患者48例为研究对象,将其随机分为同步放化疗组(CRT组)和单纯放疗组(RT组)各24例。RT组患者采用调强适形放射治疗(IMRT),CRT组患者在RT组治疗基础之上采用多西紫杉醇+奈达铂(DN)进行治疗。治疗后1个月比较两组的近期疗效、生活质量(用KPS标准评价)和毒副反应,并随访评估远期疗效。结果 CRT组的近期总有效率为91.7%,显著高于RT组的62.5%,差异有统计学意义(P<0.05);CRT组的疾病控制率为100.0%,高于RT组的91.7%,但差异无统计学意义(P>0.05);CRT组1年生存率为83.3%,高于RT组的54.2%,差异具有统计学意义(P<0.05)。两组患者生活质量均有所提高,但组间相比无显著差异(P>0.05);两组毒副反应发生率和程度相比无显著差异(P>0.05)。结论调强适形放疗同步化疗治疗局部晚期食管癌的近期疗效及1年生存率优于单纯调强适形放疗,毒副反应可以耐受,值得进一步研究。     

紫杉醇配合后程适形放射治疗食管癌的临床研究

目的观察食管癌单纯后程适形放疗(放疗组)和后程适形放疗加紫杉醇同期化疗(放化疗组)的有效率和不良反应。方法 69例食管鳞癌随机分成放疗组35例,放化疗组34例。放疗组前2/3疗程放疗用常规放疗,后1/3疗程适形放射治疗,总剂量60 Gy(30分次,5 Fx/周)。放化疗组的放疗同放疗组,化疗在放疗第1天开始,4周为1个疗程,共4个疗程。结果中位随访时间32个月,放疗组和放化疗组有效率分别为85.7%和91.2%,1、2、3年生存率分别为56.0%、34.7%、22.4%和78.1%、47.6%、33.3%;2组生存率比较差异有统计学意义(P<0.05),放化疗组Ⅲ+Ⅳ级放射性食管炎为5.9%,放疗组为2.9%(P<0.05)。放化疗组有1例患者在治疗过程中死亡。结论后程适形放疗加紫杉醇同期化疗比单纯后程适形放疗能提高局部晚期食管癌的疗效及1、2、3年生存率,但急性不良反应明显增加,最终结论需大样本的研究结果。     

放化疗联合治疗中晚期宫颈癌64例疗效观察

目的 对比化疗配合放射治疗与单纯放疗治疗宫颈癌疗效,探讨综合治疗中晚期宫颈癌的疗效及安全性。方法 64例Ⅱ~Ⅲ中晚期宫颈癌患者分成两组,放疗同步化疗(A组)34例,在放疗同时给予PF方案化疗2~4周期,化疗第一天开始行放射治疗。单纯放疗组(B组)30例,两组放射治疗均用6MV X射线盆腔大野前后对穿体外照射,DT:45~50Gy;并加¹⁹²IrHDR腔内后装照射,A点DT:20~25Gy。结果 A组和B组近期有效率分别为100%和96.67%,两组的差异无统计学意义(P > 0.05)。A组和B组的3年生存率分别为73.51%和56.67%,差异有统计学意义(P < 0.05)。毒性反应方面,同步放化疗组高于单纯放疗组,尤以造血系统和消化道反应为主,但大部分能耐受。结论 中晚期宫颈癌患者PF方案同步放化疗可提高生存率。     

放射敏感鼻咽癌个体化放射治疗的可行性研究

目的比较放射敏感性鼻咽癌(NPC)个体化放射治疗与常规放射治疗的长期疗效和毒副作用,以评估降低照射剂量和同期加量照射治疗放射敏感性NPC的可行性。方法选择2005～2006年常规放疗至40Gy/20次经CT和/或MR评估鼻咽原发肿瘤完全消退的64例放射敏感鼻咽癌患者,按照T、N分期随机分为个体化照射(IRT)组和常规剂量照射(CRT)组,IRT采用降低总剂量和对T3期患者同期加量照射,CRT采用常规剂量和常规分割照射,分别予鼻咽原发肿瘤放疗根治剂量60～67.6Gy/30～32次/6～6.5周和66～78Gy/33～35次/6.5～7.5周。结果IRT组的1、2、3年局部控制率分别为96.7%、90.0%、86.7%,CRT组为93.8%、90.6%、87.5%(P>0.05)。IRT组的1、2、3年生存率分别为100%、93.3%、83.3%,CRT组为96.9%、93.8%、84.4%(P>0.05)。急性放射毒性反应主要为咽黏膜炎及唾液腺分泌唾液减少导致口腔干燥,两组差异无统计学意义(P>0.05);晚期的放射损伤IRT组的咽黏膜萎缩、张口受限及放射性中耳炎发生率明显低于CRT组(P<0.05),而放射性脑病及口腔干燥两组发生率相似(P>0.05)。结论放射敏感NPC患者适当降低照射剂量和采用同期加量照射的个体化放射治疗是能够达到与常规剂量照射的根治性放射治疗相当的疗效,而且可一定程度上降低脑、颞颌关节、中耳等重要器官晚期放射损伤的发生率,值得进一步深入研究。     

Fas及FasL在妊娠滋养细胞疾病中的表达及意义

目的 探讨Fas及FasL在妊娠滋养细胞疾病中的表达及意义.方法 应用免疫组化方法分别检测Fas及FasL蛋白在正常滋养细胞(40例)、完全性葡萄胎(36例)、侵蚀性葡萄胎(15例)、绒毛膜癌(11例)中的表达.结果 Fas在正常滋养细胞组、完全性葡萄胎组、侵蚀性葡萄胎组和绒毛膜癌的阳性表达率分别为95.0%、88.9%、46.7%和36.4%.Fas随着妊娠滋养细胞疾病的进展阳性率逐渐降低.正常滋养细胞组分别与侵蚀性葡萄胎组及绒毛膜癌组比较有显著性差异(χ2=14.036,P=0.000;χ2=16.575,P=0.000),完全性葡萄胎组与侵蚀性葡萄胎组和绒毛膜癌组比较有显著性差异(χ2=8.275,P=0.004;χ2=10.202,P=0.001),而正常滋养细胞组与完全性葡萄胎组、侵蚀性葡萄胎与绒毛膜癌组比较无显著性差异(χ2=0.314,P=0.575;χ2=0.015,P=0.902).FasL在正常滋养细胞组、完全性葡萄胎组、侵蚀性葡萄胎组和绒毛膜癌组的阳性表达率分别为17.5%、44.4%、53.3%和81.8%.FasL随着妊娠滋养细胞疾病的进展阳性率逐渐增高.正常滋养细胞组分别与完全性葡萄胎组、侵蚀性葡萄胎组及绒毛膜癌组比较有显著性差异(χ2=6.518,P=0.035;χ2=5.371,P=0.005;χ2=13.724,P=0.000),完全性葡萄胎组与绒毛膜癌组比较有显著性差异(χ2=4.727,P=0.030),完全性葡萄胎组与侵蚀性葡萄胎组、侵蚀性葡萄胎与绒毛膜癌组比较无显著性差异(χ2=0.336,P=0.562;χ2=1.191,P=0.275).Fas与FasL表达在各组之间均呈负相关.结论 Fas的低表达和FasL的高表达降低了妊娠滋养细胞凋亡,可能是妊娠滋养细胞疾病的发病机制之一.Fas和FasL的表达在各组之间均呈负相关提示二者在妊娠滋养细胞疾病进展中可能相互影响,共同作用.     

放化疗同步治疗40例中晚期宫颈癌的近期疗效分析

目的探讨中晚期宫颈癌采用放化疗同步治疗的近期疗效。方法选择我科2009年2月至2012年2月收治的中晚期宫颈癌患者80例,按观察组和对照组各40例划分,对照组采用单纯放疗治疗,观察组采用放化疗同步治疗,回顾性分析两组临床资料。结果治疗结束时观察组总有效率为85%,对照组为72.5%,两组无明显差异(P>0.05)。治疗结束3个月,观察组总有效率为92.5%,对照组为65%,观察组总有效率显著高于对照组(P>0.05)。观察组发生胃肠反应12例,血液毒性10例,对照组分别为7例和5例,有统计学差异(P<0.05),均经处理后好转。两组放射性膀胱炎和放射性肠炎发生率比较无明显差异(P>0.05)。结论中晚期宫颈癌采用放化疗同步治疗可显著提高近期效果,改善患者生存质量。     

凋亡抑制蛋白Survivin在人非小细胞肺癌中的表达及其与COX-2蛋白表达和细胞凋亡的关系

目的探讨Survivin蛋白和COX-2蛋白在人非小细胞肺癌(NSCLC)组织中的表达情况及与细胞凋亡水平的关系,并探讨与预后的关系.方法对75例非小细胞肺癌石蜡组织切片、30例正常肺组织,使用免疫组织化学S-P法检测Survivin和COX-2的表达,用TUNEL法原位测定细胞凋亡水平.结果非小细胞肺癌组织中Survivin和COX-2的阳性率分别为70.6%和68.0%,均显著高于正常肺组织中的阳性率6.7%和10.0%(P均＜0.05).Survivin表达与COX-2表达呈正相关(r=0.78,P＜0.05),Survivin与凋亡指数呈负相关(r=-0.86,P＜0.05),COX-2与凋亡指数呈负相关(r=-0.75,P＜0.05).Survivin阴性组的AI高于Survivin阳性组(z=5.10,P＜0.0001).生存分析显示Survivin阳性组的5年生存率明显低于Survivin阴性组.结论Survivin与COX-2在NSCLC中表达升高,在NSCLC的发生发展中起了重要作用,并与NSCLC的恶性行为相关,Survivin对于监测预后有重要意义.同时Survivin可能成为治疗NSCLC的靶点.     

恶性腹水中COX-2的表达及其临床意义

目的通过检测COX-2在良恶性腹水中的表达情况,并分析其在不同疾病类型间表达的差异,探讨良恶性腹水中COX-2表达的意义。方法收集临床恶性腹水21例(其中卵巢癌7例、结肠癌5例、肝癌6例、胃癌2例、膀胱癌1例)。良性腹水15例(其中肝硬化腹水10例、结核性腹水5例)。应用半定量RT-PCR方法检测良性、恶性腹水中COX-2 mRNA的表达,并对比COX-2 mRNA在不同疾病类型间的阳性检测率。结果 COX-2在良性、恶性腹水中的表达阳性率分别为6.7%(1/15)和42.9%(9/21),2组间差异有统计学意义(P0.05)。COX-2在不同肿瘤类型间表达阳性率的差异无统计学意义(P0.05)。COX-2在肝硬化腹水组(1/10)和结核性腹水组(0/5)表达阳性率间差异无统计学意义(P0.05)。结论 COX-2在恶性腹水中呈过度表达状态,有望成为良性、恶性腹水鉴别的有效指标。     

食管癌Fas、bcl-2蛋白和 DNA含量的流式细胞定量研究

目的探讨Fas和bcl-2蛋白表达和DNA倍体异常在食管癌发生和发展中的作用.方法应用流式细胞术和细胞免疫荧光技术对70例食管鳞癌组织Fas、bcl-2蛋白和DNA含量进行定量检测.结果异倍体36例(51.4%),二倍体34例(48.6%);异倍体肿瘤其DNA指数、增殖指数和S期细胞比率均高于二倍体肿瘤,但差异无显著性(P＞0.05);Fas蛋白阳性表达42例(60.0%) , bcl-2蛋白阳性表达65例(92.9%),Fas蛋白表达与肿瘤病理分级密切相关(γ＝0.584,P＜0.05);异倍体肿瘤和二倍体肿瘤Fas和bcl-2阳性表达率和表达量均差异无显著性(P＞0.05).结论 DNA倍体异常、Fas和bcl-2蛋白的异常表达在食管癌发生和发展中起重要作用.     

胃癌形成中COX-2的表达及其与细胞凋亡和增殖的关系

目的研究胃癌(GC)形成中环氧合酶-2(COX-2)的表达与其细胞凋亡、增殖的关系,探讨COX-2在GC形成中的可能作用机制。方法采用免疫组化(SABC)法和原位末端标记法(TUNEL)检测15例正常胃黏膜(normalgastricmucosa,NGM)、30例胃粘膜肠上皮化生(IM)、30例异型增生(Dys)和40例GC组织中COX-2、增殖细胞核抗原(PCNA)阳性表达和细胞凋亡情况。结果在NGM→IM→Dys→GC的形成过程中,COX-2的表达呈递增趋势,其阳性表达中GC组(67.5%)和NGM组(13.3%)及GC组和IM组(33.3%)差别均有显著性(P<0.05)。细胞凋亡指数(AI)在GC时最低(2.8±0.6),GC组AI显著低于其他各组(P<0.01)。细胞增殖指数(PI)则呈递增趋势,GC组与各组比较差异有显著性(P<0.01)。在不同程度癌前病变中COX-2的表达差异无显著性(P>0.05)。COX-2在低分化GC中表达显著高于高分化型。COX-2、PI与GC淋巴结转移、血管浸润均密切相关(P<0.05)。从NGM→IM,COX-2与AI呈正相关(r=0.55,P<0.05);从Dys→GC,二者与AI负相关(r=-0.56,P<0.05)。在GC形成整个过程中,COX-2与PI呈正相关(r=0.61,P<0.05)。结论在GC形成过程中,COX-2的表达呈递增趋势;COX-2的表达上调可能是GC形成的早期事件,且其表达水平和PI对评价GC的恶性程度、有无转移和预后有一定参考价值;COX-2在GC形成的不同     

复发性流产患者子宫蜕膜细胞凋亡蛋白Fas、抑制凋亡蛋白Bcl-2表达的相关性研究

目的:探讨子宫蜕膜细胞凋亡蛋白Fas、抑制凋亡蛋白Bcl-2与复发性流产患者的相关性。方法:选择20例复发性流产患者作为研究组,以下称RAS组,同期正常计划外受孕者20例作为对照组。采用免疫组织化学方法测定各组子宫蜕膜细胞Fas、Bcl-2蛋白的表达。根据阳性表达率和表达强度进行量化评分,并进行相关性分析。结果:RAS组Fas的表达为(4.67±0.59)明显高于对照组(1.31±0.66)(P<0.001),而Bcl-2的表达为(1.76±0.51)明显低于对照组(4.89±0.41)(P<0.001),且两者的表达呈明显负相关(r=-0.61,P<0.05)。结论:①子宫蜕膜细胞Bcl-2低表达、Fas高表达与复发性流产患者的发生有关。②Fas与Bcl-2在子宫蜕膜细胞中的表达失衡可能是复发性流产患者发生的原因之一。     

Comparison of chemoradiotherapy with radiotherapy alone in patients with esophageal adenocarcinoma

Despite the wide use of definitive chemoradiotherapy (CRT) for locally advanced esophageal adenocarcinoma, there is little evidence that CRT improves the survival of patients with esophageal adenocarcinoma compared with radiotherapy (RT) alone. Therefore, we retrospectively evaluated the outcome of patients with esophageal adenocarcinoma treated by CRT and RT alone. Patients were treated at the Gunma Prefectural Cancer Center (Ota, Japan) and the Gunma University Hospital (Maebashi, Japan). Patients provided written informed consent before treatment. Patients with distant metastases were excluded. CRT consisting of RT, nedaplatin, and 5-fluorouracil has been performed since 2002 when patients have adequate bone marrow, liver, and renal function. Between November 1993 and April 2006, 8 patients were treated by CRT and 12 were RT alone. The median follow-up period of surviving patients was 19 months. CRT group had a significantly higher complete response rate than those RT alone group (87% vs. 33%, P = 0.05). Of all patients, 2-year overall survival rate was 41% and the median survival time was 18 months. The 2-year overall survival of patients treated by CRT was 58%, significantly better than 24% of those with RT alone (P = 0.02). CRT can improve outcomes of patients with esophageal adenocarcinoma compared with RT alone.     

食管癌放射治疗联合化疗疗效观察

目的：观察食管癌放射治疗联合DF方案化疗的临床疗效和毒副反应。方法：将符合入组条件的92例食管癌患者随机分为单纯放疗组（46例）和放化组（46例）。单纯放疗组采用6MVX直线加速器常规照射,每次1.8-2Gy,每周5次,照射剂量为60～70Gy。放化组外照射同常规放疗组,放射治疗当日开始采用DF方案化疗：氟尿嘧啶（5-FU）500mg/d,d1-5;顺铂（DDP）20mg/d,d1-5,28天一个疗程,每例至少化疗2疗程后评价疗效,共用2～4疗程。结果：放化组和单放组缓解率分别为82.6%和58.7%（P〈0.05）。结论：放射治疗联合DF方案化疗,疗效优于单纯放疗,毒副反应可以耐受,是治疗食管癌的有效方法。     

Epithelial ovarian cancer: definitive radiotherapy for limited recurrence after complete remission had been achieved with aggressive front-line therapy

The purpose of this study was to assess the efficacy and toxicity of definitive radiotherapy (RT) for the recurrence of epithelial ovarian cancer, which is limited to one or two gross regions, after complete remission had been achieved with aggressive front-line therapy. Twenty-seven patients were treated with definitive RT and were retrospectively analyzed. Their median tumor size was 3.0 cm. Twenty-six (96%) patients received external irradiation at a median total dose of 60 Gy, and a median daily dose of 2 Gy. Only two patients received intracavitary brachytherapy. Twenty (74%) of the 27 patients received systemic chemotherapy for the treatment of a limited recurrent tumor followed by definitive RT. Six (22%) of the patients received concurrent chemotherapy and seven (26%) of the patients also underwent regional hyperthermia during definitive RT. Twenty-two (82%) patients had an objective response (CR: 11, PR: 11). The 2-year overall survival, progression-free survival and local (in-field) control rates after RT were 53%, 39% and 96%, respectively. The toxicities were mild, no Grade 3 or higher toxicity was observed in any of the patients. The tumor size( < 3 cm), period between front-line therapy and RT (≥2 year) and objective tumor response (CR) were significant prognostic factors of the overall survival rate. In conclusion, definitive RT for limited recurrence of epithelial ovarian cancer achieves a better local control rate without severe toxicity, and it may therefore be a potentially effective modality for inducing long-term survival in selected patients.     

同期加量照射个体化治疗放射抗拒鼻咽癌的初步临床疗效分析

目的评估同期加量照射治疗放射抗拒鼻咽癌(NPC)的临床价值。方法选择2005～2007年常规放疗至40Gy/20次经CT和/或MR评估鼻咽原发肿瘤病灶,疗效为无变化(MS)的78例放射抗拒的NPC患者,按照T分期配对分为同期加量照射(SBIRT)组和常规剂量照射(CRT)组,分别采用后程2.3Gy/次和2Gy/次常规分割,照射鼻咽原发肿瘤至总剂量67.6～79.1Gy/32～37次/6.2～7.4周和70～78Gy/35～39次/7～7.8周,T3、T4和/或N2期患者在放疗同期接受顺铂+氟尿嘧啶方案化疗2～3个疗程。结果放疗结束时与放疗结束后3个月SBIRT组和CRT组鼻咽原发肿瘤的完全缓解率和部分缓解率分别为61.5%、25.6%和41.0%、33.3%(P<0.05)。SBIRT组和CRT组的1、2、3年无局部复发生存率分别为94.9%、87.2%、74.4%和92.3%、82.1%、66.7%(P=0.0672);1、2、3年总生存率分别为97.4%、82.1%、69.2%和94.9%、84.6%、71.8%(P=0.0965)。急性放射反应主要为咽黏膜炎及口腔干燥,SBIRT组的3/4度粘膜反应发生率略高为30.8%(12/39),晚期的放射损伤主要为咽黏膜萎缩、张口受限、放射性中耳炎和放射性脑病,无严重致死性毒性反应发生,但两组毒性反应的发生率差异均无统计学意义(P>0.05)。结论放射抗拒NPC患者采用同期加量照射的个体化放射治疗与常规剂量照射的根治性放射治疗相比较整体疗效相当,有提高局部控制率的趋势,而急性和晚期放射损伤发生率基本相似,值得进一步的深入研究。     

胃癌组织中Cox-2表达及其与临床病理特征、P53、PCNA的关系

目的研究Cox-2基因在胃癌组织中的表达,并评价Cox-2表达与临床病理参数、P53、PCNA表达的关系。方法本研究采用免疫组织化学方法检测28例胃癌组织中Cox-2、P53及PCNA的表达。结果胃癌患者中Cox-2、P53及PCNA的阳性表达率分别为78.6%、85.7%和92.9%。Cox-2表达与胃癌的淋巴结转移(P=0.045)、浸润深度(P=0.007)及生存时间(P=0.043)相关,但与患者年龄、性别、肿块部位、肿块大小、TNM分期、组织学类型及分化程度无关(P>0.05)。另外,胃癌组织中Cox-2异常表达与PCNA表达在统计学上呈高度相关(P=0.006),但与P53表达无关(P>0.05)。结论Cox-2在胃癌的转移浸润中可能起重要作用,可作为判断预后的恶性指标之一。胃癌组织中Cox-2与PCNA表达的高度相关为Cox-2具有促细胞增殖的作用进一步提供了证据。Cox-2和P53基因可能分别通过各自不同的途径参与胃癌的发生发展。     

Radio- and chemotherapy variably affect the general immunocompetence of lung cancer patients.

OBJECTIVE: The evaluation of the effects of radiotherapy and chemotherapy on the immune status of lung cancer patients. EXPERIMENTAL DESIGN: Prospective nonrandomized study. SETTING: Hospitalized care. PATIENTS: 121 patients with unresectable non-small-cell lung cancer (Stage IIIb or IV), who were planned for radiotherapy (n = 81) or chemotherapy (n = 40). MEASURES: The relative and absolute numbers of blood T lymphocytes and monocytes, as well as the mitogen-induced proliferative response of the former, and phagocyting capacity of the latter cell subpopulation, were determined in patients before starting any therapy. In radiotherapy (RT)-treated group, the immune parameters were evaluated after 45 Gy and 60 Gy had been given. In chemotherapy (ChT)-treated group, the same parameters were determined three weeks after the 2nd and 4th cycle of ChT. RESULTS: The number and proliferative response of T lymphocytes were significantly (p < 0.001) lower, while the number and phagocyting capacity of monocytes were significantly (p < 0.001) higher in all patients before therapy, in comparison to the controls. After RT, the T cell number and proliferative response were significantly (p < 0.001) decreased, while the number of monocytes and their phagocyting capacity remained unchanged, when compared to the pretreatment values. Unlike RT, chemotherapy did not change any investigated parameter, except for the phagocyting activity of monocytes, which was significantly (p < 0.02) decreased, in comparison to the pretreatment value, after four cycles of ChT only. CONCLUSIONS: Two cancer treatment modalities--radio- and chemotherapy--variably affect the immune status of lung cancer patients. The initial great disturbances of general immunity parameters are further aggravated by radiotherapy. Unlike RT, chemotherapy exerts no suppression at all; on the contrary, it tends to normalize some of the parameters of cellular immunity of lung cancer patients.     

Ⅰ_B期及Ⅱ_A期宫颈癌术前介入化疗与术前放疗的疗效观察

目的:比较ⅠB及ⅡA期宫颈癌术前介入化疗或放疗联合根治手术的疗效,探讨该期宫颈癌患者适宜的治疗方法。方法:选择温州医学院附属第二医院妇产科1998年5月～2003年5月收治的ⅠB和ⅡA期宫颈癌患者138例,所有患者肿瘤均>2cm。按FIGO分期,ⅠB1期24例,ⅠB2期48,ⅡA期66例;按肿瘤大小分为非巨块型(肿瘤直径2～4cm)53例,巨块型(肿瘤直径≥4cm)85例;术前介入化疗74例(化疗组),术前腔内放疗64例(放疗组)。对两组的近期疗效、术后病理组织学变化及中远期疗效进行比较。结果:非巨块型病例化疗组有效率为89.3%,稍高于放疗组88.0%,两组间差异无统计学意义(P>0.05)。巨块型病例化疗组有效率为84.8%,高于放疗组71.8%(P<0.05)。术后病理组织学比较,化疗组淋巴结转移率21.6%,深肌层浸润率21.6%,均低于放疗组的32.8%和34.4%(均P<0.05)。两组宫旁、阴道切缘浸润率及脉管癌栓比较差异无统计学意义(P>0.05)。非巨块型病例化疗组2年复发率为8.8%,5年生存率为83.2%,分别与放疗组10.1%及79.5%比较差异均无统计学意义(P>0.05);巨块型病例化疗组2年复发率为22.5%,5年生存率为81.4%,分别与放疗组31.9%及68.6%比较,均有统计学意义(P<0.05)。结论:巨块型ⅠB和ⅡA期宫颈癌术前应用介入化疗较术前放疗为佳;非巨块型病例术前介入化疗与术前放疗疗效相似。     

两种联合放化疗方案治疗Ⅱ～Ⅳ期宫颈癌比较研究

目的：探讨紫杉醇脂质体与铂类单药化疗联合盆腔三维适形放疗治疗Ⅱ～Ⅳ期宫颈癌临床疗效和安全性差异。方法研究对象选取四川省自贡市第三人民医院妇产科2006年4月至2014年8月收治的Ⅱ～Ⅳ期宫颈癌患者共98例,采用随机抽样方法分为A组（49例）和B组（49例）,分别在盆腔三维适形放疗基础上同期采用铂类和紫杉醇脂质体治疗;比较两组患者临床近期疗效,随访生存率,治疗前后KPS评分及药物毒副作用发生率等。结果两组患者临床近期疗效比较差异无统计学意义（χ2＝0．45,P＞0．05）,两组患者随访1年生存率和无进展生存率比较差异均无统计学意义（χ2值分别为0．54、1．33,均P＞0．05）。两组患者治疗前KPS评分无显著性差异（t＝1．33,P＞0．05）,治疗后KPS评分均显著增加（t值分别为3．65、4．17,均P＜0．05）,而B组患者治疗后KPS评分显著高于A组（t＝2．78,P＜0．05）。 B组患者白细胞减少、血小板减少、恶心呕吐、腹泻及食欲减退发生率均显著低于A组,差异有统计学意义（χ2值分别为5．86、8．61、13．20、4．22、5．15,均P＜0．05）,而两组患者肝功能损伤发生率比较差异无统计学意义（χ2＝0．38,P＞0．05）。结论两种单药化疗联合盆腔三维适形放疗治疗Ⅱ～Ⅳ期宫颈癌临床疗效及生存率接近;但相较于铂类单药化疗,紫杉醇脂质体单药化疗联合盆腔三维适形放疗治疗Ⅱ～Ⅳ期宫颈癌可有效提高生活质量,降低不良反应发生风险。     

Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma

The aim of this study was to analyze the risk factors and prognosis for patients with esophageal perforation occurring during or after radiotherapy for esophageal carcinoma. We retrospectively analyzed 322 patients with esophageal carcinoma. These patients received radiotherapy for unresectable esophageal tumors, residual tumors after operation, or local recurrence. Of these, 12 had radiotherapy to the esophagus before being admitted, 68 patients had concurrent chemoradiotherapy (CRT), and 18 patients had esophageal perforation after RT (5.8%). Covered self-expandable metallic stents were placed in 11 patients. Two patients continued RT after stenting and control of infection; one of these suffered a new perforation, and the other had a massive hemorrhage. The median overall survival was 2 months (0–3 months) compared with 17 months in the non-perforation group. In univariate analysis, the Karnofsky performance status (KPS) being ≤70, age younger than 60, T4 stage, a second course of radiotherapy to the esophagus, extracapsular lymph nodes (LN) involving the esophagus, a total dose >100 Gy (biologically effective dose₋₁₀), and CRT were risk factors for perforation. In multivariate analysis, age younger than 60, extracapsular LN involving the esophagus, T4 stage, and a second course of radiotherapy to the esophagus were risk factors. In conclusion, patients with T4 stage, extracapsular LN involving the esophagus, and those receiving a second course of RT should be given particular care to avoid perforation. The prognosis after perforation was poor.