原发性睾丸淋巴瘤及原发性中枢神经系统淋巴瘤研究进展：第19届欧洲血液学会年会报道

原发性睾丸淋巴瘤（PTL）是一类少见的结外淋巴瘤,进展迅速,预后不良.对于早期局限性病变,可联合应用以蒽环类为基础的化疗、利妥昔单抗、鞘内注射甲氨蝶呤后行对侧睾丸放疗等.中枢神经系统复发风险极高,鞘内注射甲氨蝶呤可能是最好的防治方法.原发性中枢神经系统淋巴瘤（PCNSL）是一种侵袭性淋巴瘤,预后较差,对现有非霍奇金淋巴瘤标准治疗方案均不敏感,甲氨蝶呤联合阿糖胞苷是目前的标准诱导方案.抗CD20单克隆抗体虽然脑脊液含量低,但仍有治疗效果.高剂量化疗联合自体造血干细胞移植缓解率高,3年总生存率可达87％.     

原发性中枢神经系统淋巴瘤诊治进展

原发性中枢神经系统淋巴瘤(primarycentralnervoussystemlymphoma,PCNSL)是原发于脑、眼和脊髓的非霍奇金氏淋巴瘤,临床上较罕见,近数十年来发病率逐渐上升。PCNSL多见于老年患者,病理类型、预后因素和治疗方案有别于全身性非霍奇金淋巴瘤(NHL)。PCNSL病理类型以弥漫大B细胞为主,年龄和(performancestatus)PS是最重要的预后因素,预后较全身性NHL差。目前PCNSL尚无标准治疗方法,一般采用化疗和放疗联合的治疗措施。手术仅起到诊断作用。PCNSL对放疗高度敏感,但单纯放疗有效维持时间短。化疗在治疗PCNSL中不可缺少,但CHOP方案对PCNSL无效。大剂量甲氨蝶呤(HD-MTX)是最有效的药物,大剂量阿糖胞苷(HD-AraC)是常用的药物之一。因此,现阶段PCNSL采用含HD-MTX或/和HD-AraC等的联合化疗,同时鞘内注射MTX、AraC和地塞米松(DXM)。放疗疗效差,放疗应在化疗结束后进行。联合化、放疗对60岁以上患者可造成严重的远期神经毒性,对老年患者可选择单纯化疗和延迟放疗的治疗方法。自体造血干细胞支持下超大剂量化疗疗效优于历史对照。新药Temozolomide、Temozolomide联合美罗华、Topotecan、放射免疫治疗药物Y90标记CD20单抗等对PCNSL取得一定效果,值得进一步研究。     

原发性中枢神经系统淋巴瘤的治疗进展

原发性中枢神经系统淋巴瘤（PCNSL）是一种少见疾病,至今尚无标准治疗方案。单纯放疗复发率高,生存期短。放疗宜在化疗结束后进行。化疗联合标准放疗明显降低了复发率,并延长了生存期,但神经毒性发生率高。老年患者易出现神经毒性,不建议放疗,应首选单纯化疗;年轻患者可将放疗作为难治复发时的二线治疗。目前,以大剂量甲氨蝶呤为主的化疗已成为PCNSL的一线治疗,大剂量阿糖胞苷为最常联合的药物。年轻患者可选用包含一些新药如甲基苄肼、替莫唑胺的化疗方案。替莫唑胺为老年患者一种有前途的新药。预防性鞘内化疗的必要性尚未达成共识。自体造血干细胞支持下的大剂量化疗对年轻的初发及复发PCNSL患者均有效。手术通常用于PCNSL诊断。糖皮质激素不宜在取得病理组织前使用。      

原发性中枢神经系统淋巴瘤

原发性中枢神经系统淋巴瘤(PCNSL)是一少见的高度恶性非霍奇金淋巴瘤,其在人免疫缺陷病毒感染人群中的发病率显著高于正常人群.该病病理上为广泛浸润整个脑实质、脊髓及软脑膜等多个部位的弥漫性病变.PCNSL的发病机制不明.大剂量甲氨喋呤为主的联合化疗、放疗结合甲氨喋呤鞘内注射能明显改善其疗效及生存率.     

原发性中枢神经系统淋巴瘤

原发性中枢神经系统淋巴瘤(PCNSL)是一少见的高度恶性非霍奇金淋巴瘤，其在人免疫缺陷病毒感染人群中的发病率显著高于正常人群。该病病理上为广泛浸润整个脑实质、脊髓及软脑膜等多个部位的弥漫性病变。PCNSL的发病机制不明。大剂量甲氨喋呤为主的联合化疗、放疗结合甲氨喋呤鞘内注射能明显改善其疗效及生存率。     

原发性中枢神经系统淋巴瘤的预后因素和治疗进展

原发性中枢神经系统淋巴瘤(PCNSL)是原发于脑和脊髓的非霍奇金氏淋巴瘤(NHL)，临床上较罕见，仅占脑肿瘤的1％和结外NHL的1％-2％。近数十年来发病率逐渐上升。由于部位特殊，现有NHL的预后因素和治疗原则不适用于PCNSL。PCNSL发病率低，目前尚无标准的预后因素和一线标准治疗方案，但随着临床治疗经验的不断积累，在治疗上已取得一定的共识，使PCNSL中位生存期由早年单纯放疗的13-16个月增加到目前综合治疗的30-36个月，疗效有较明显提高。本文着重于评述近年来在免疫功能正常的PCNSL预后因素的确立和临床治疗方面取得的进展。目前PCNSL一般采用化疗和放疗联合的治疗措施，手术仅起到诊断作用。化疗在治疗PCNSL中不可缺少，但CHOP方案对PCNSL几乎无效。大剂量甲氨蝶呤(HD—MTX)是最有效的药物，大剂量阿糖胞苷(HD—Ara—C)是另一个常用的有效药物，鞘内给药有助于预防脑脊髓膜的肿瘤种植。PCNSL对放疗高度敏感，但单纯放疗复发率高，远期疗效差，放疗应在化疗完成后进行，多常用全颅加侵犯野放疗。为降低化放疗的远期神经毒性，有人尝试采用单纯化疔治疗PCNSL，对于获得完全缓解的患者放疗延迟至复发后再进行，远期疗效有待确定。自体造血干细胞移植支持下超大剂量化疗和抗CD20单克隆抗体也试用于治疗PCNSL，取得一定效果。目前全身HD—MTX、化疗后放疗的次序、年龄和PS是PCNSL最重要的预后因素。因此，采用含HD—MTX或／和HD—Ara—C等的联合化疔，同时鞘内注射MTX、Ara—C和地塞米松(DXM)，结合颅脑放疗是现阶段治疗PCNSL最常用的治疗模式。     

原发性中枢神经系统淋巴瘤的影像学特点及治疗

原发性中枢神经系统淋巴瘤是一种比较罕见的结外原发非霍奇金淋巴瘤（NHL）,其细胞来源多为弥漫大B淋巴细胞,淋巴细胞影像学表现为单发或多发的深部脑实质、脑室周围或脑膜等处的病变。其治疗尚无标准方案,目前多采用放化疗结合的综合治疗。化疗采用以大剂量MTX为主的方案,全脑放疗已被公认为治疗PCNSL的有效手段。但最佳的化疗方案组合、MTX最佳剂量及放疗剂量仍无定论。我们收治一例原发性中枢神经系统淋巴瘤,于外院行肿瘤切除术,术后予阿糖胞苷加大剂量MTX化疗6程后残留,现经多学科讨论后认为应予辅助放疗加替莫唑胺维持化疗。现患者已完成放疗,替莫唑胺维持化疗中。本文就此病例的影像特点及治疗进行讨论。     

原发中枢神经系统淋巴瘤治疗进展

 【摘要】　原发性中枢神经系统淋巴瘤（PCNSL）是原发于脑、眼和脊髓的结外淋巴瘤,发病率低,老年患者多见,因其在庇护所内恶性侵袭性生长,使得治疗困难,预后不良。目前PCNSL尚无标准治疗方法,有效的治疗一般采用化疗和放疗联合的措施。手术不能完全切除病灶,仅起到诊断作用。大剂量甲氨蝶呤（HD-MTX）是最有效的药物,大剂量阿糖胞苷是常用的药物之一。PCNSL对放疗高度敏感,但单纯放疗有效维持时间短,对60岁以上患者可导致严重的远期神经毒性,影响预后,故主张延迟放疗。大剂量化疗联合自体干细胞移植通过提高剂量化疗可以克服肿瘤细胞耐药,提高药物生物利用度,替代全脑放疗,减少神经毒性。新药替莫唑胺、利妥昔单抗等对PCNSL取得一定效果,值得进一步研究。     

原发性中枢神经系统非霍奇金恶性淋巴瘤手术后的放疗和化疗

目的研究原发性中枢神经系统恶性淋巴瘤手术后化疗、放疗的疗效及其预后的影响。方法上海医科大学肿瘤医院１９８６～１９９６年收治的９例原发性中枢神经系统恶性淋巴瘤。全部病例均经手术后病理证实。全部病例接受放疗，大部分病例同时接受化疗。结果一、二年的生存率分别为８０％和２８６％。生存期≥２０月的５例均接受较强烈的化疗。结论本病的恶性程度高，化疗方案以较强烈的方案为宜，治疗需放疗、化疗相结合。     

弥漫大B细胞淋巴瘤中枢神经系统浸润一例并文献复习

 目的　报告1例弥漫大B细胞淋巴瘤合并中枢神经系统浸润患者病例,提高对该病的诊治水平。方法　介绍该例患者的诊治经过,并进行文献复习。结果　该例患者发生中枢神经系统浸润已8个月余,经过以大剂量甲氨蝶呤为主的方案化疗及鞘内注射治疗,全身CT评估达到完全缓解。结论　对具有中枢神经系统浸润高危因素的非霍奇金淋巴瘤,在有效控制全身淋巴瘤的基础上,有必要早期给予预防性治疗。     

贲门癌患者术前术后化疗的临床研究

目的探讨贲门癌术前术后化疗的疗效.方法贲门癌患者121例随机分为术前术后化疗(A)组,单一手术(B)组.A组患者术前1周连续化疗两次,术后第1、2、8、9天各化疗1次,患者出院后口服替加氟3个月,B组单纯手术治疗.结果 A、B两组1年生存率分别为94.4%和90.6%,3年生存率分别为61.1%和39.1%,5年生存率分别为33.3%和21.9%,10年生存率分别为13.0%和7.8%,A、B两组3年生存率差异有显著性,1,5,10年生存率差异均无显著性.结论术前术后化疗能显著提高贲门癌患者的3年生存率,5,10年生存率也有明显提高,疗效优于单纯手术组.     

高预后评分妊娠滋养细胞肿瘤患者化疗疗效及耐药因素分析

目的虽然低危妊娠滋养细胞肿瘤(low risk gestational trophoblastic neplasms,LRGTN)采用单药化疗方案能获得较高的治愈率,但仍有部分预后评分为5~6分的LRGTN患者发生耐药。本研究探讨联合化疗方案治疗高预后评分LRGTN患者的化疗疗效、耐药因素以及最佳联合方案。方法回顾性分析广西医科大学附属肿瘤医院妇瘤科1998-01-01-2016-12-31收治的84例病历信息完整使用联合化疗方案的低危组妊娠滋养细胞肿瘤病例,按2000年改良预后评分分为5~6和0~4分组,对年龄、是否有肺转移、分期及预后评分等可能影响低危组GTN患者疗效及治愈时间的临床因素进行单因素分析,并分别探讨不同联合化疗的疗效。结果5~6分组LRGTN患者诊断为绒癌(χ^2=4.356,P=0.037)、分期晚(χ^2=9.230,P=0.002)以及发生转移(χ^2=11.850,P=0.001)的比例均高于0~4分组,差异有统计学意义。5~6分组LRGTN患者的完全缓解率、耐药率分别为79.31%(23/29)、20.69%(6/29),0~4分组分别为63.64%(35/55)、16.36%(9/55),2组间的完全缓解率(χ^2=2.183,P=0.140)和耐药率(χ^2=0.242,P=0.623)均差异无统计学意义。在5~6分组GTN病例中,耐药组患者年龄≥40岁占4/6,年龄<40岁占2/3,而所有敏感组患者的年龄均<40岁,2组年龄构成比差异有统计学意义,P=0.037。耐药组的终止妊娠距初次化疗的时间间隔平均(4.67±2.88)个月,敏感组则为(2.61±2.21)个月,差异有统计学意义,P=0.033。采用5-FU+KSM±VCR±Vp-16联合化疗方案治疗,5~6分组LRGTN的耐药率为0,MTX+KSM联合化疗方案耐药率为2/4,差异有统计学意义,P=0.037。5-FU+KSM±VCR±Vp-16联合化疗方案治疗5~6分组的LRGTN治愈率为100%(23/23),MTX+KSM联合化疗方案治愈率为4/6,差异有统计学意义,P=0.037。结论年龄≥40岁、终止妊娠与初次治疗的间隔时间较长是容易导致5~6分LRGTN患者对联合化疗耐药的高危因素。另外,5~6分的LRGTN患者可以首先考虑采用5-FU+KSM±VCR±Vp-16联合化疗方案。     

Dose escalation study of nedaplatin with 5-fluorouracil in combination with alternating radiotherapy in patients with head and neck cancer

BACKGROUND: This study, with a large number of patients, confirms that after administration of 5-fluorouracil (5FU), a higher dose of nedaplatin (NDP) can be safely administered rather than a single therapy of NDP, as demonstrated in a phase I study. METHODS: The subjects were 52 patients with stage II-IV (M0) head and neck cancer other than nasopharyngeal cancer. Alternating chemoradiotherapy was performed using the following method. Initially, chemotherapy was administered. For chemotherapy, 5FU at 700 mg/m2/24 h was intravenously administered for 5 days (days 1-5), and NDP was administered on day 6. We established three dose groups: level 1, 120 mg/m2; level 2, 140 mg/m2; and level 3, 150 mg/m2 (n = 13 or more per group). RESULTS: The maximum acceptable dose of NDP (150 mg/m2) was confirmed. The 5-year overall survival rates were 77% (95% CI: 66-90%) in all subjects and 75% (95% CI: 61-92%) in the stage III/IV patients. The 5-year progression-free survival rates were 73% (95% CI: 62-87%) in all subjects and 72% (95% CI: 57-89%) in the stage III/IV patients. CONCLUSIONS: After administration of 5FU, a higher dose of NDP can be safely administered. This alternating chemoradiotherapy showed potent antitumor effects. The efficacy of chemotherapy with NDP and 5FU should be compared to that of chemotherapy with CDDP and 5FU.     

Multivariate survival and outcome analysis of 154 patients with gastric cancer at a single Chinese institution

This study was conducted to analyze and elucidate key prognostic factors for gastric cancer (GC), and to understand the current status of GC diagnosis and treatment in Hubei Province, China. Major clinical and pathological information on 154 GC patients was retrospectively collected, including gender, age, tumor site, surgical approach, histological type, TNM stage and chemotherapy cycles. Overall survival (OS) was analyzed in relation to these factors. The median OS was 12.0 months (0.5-69.0 months), and 1-, 2-, 3- and 5-year survival rates were 53.0%, 23.0%, 8.0% and 1.0%, respectively. The median OS by TNM stage was 21.0 months for stages I+II and 11.5 months in stages III+IV (P=0.043), and 1-, 2-, 3- and 5-year survival rates were 72.0% vs 50.0%, 40.0% vs 19.0%, 16.0% vs 6.0% and 0% vs 1.0 %, respectively. The median OS by chemotherapy cycles was 18.0 months in chemotherapy ≥6 cycles group and 11.0 months in chemotherapy <6 cycles group (P=0.009), and 1-, 2-, 3- and 5-year survival rates were 68.0% vs 49.0%, 41.0% vs 18.0%, 12.0% vs 7.0% and 0% vs 1.0%, respectively. Multivariate analysis identified tumor site, surgical approach and chemotherapy cycles as independent predictors for improved survival. Implementation of standardized radical surgery and reasonable adjuvant therapy could improve survival and prognosis of GC patients.     

卵巢卵黄囊瘤的治疗及预后

背景与目的：探讨卵巢卵黄囊瘤的治疗方法与预后因素。方法：回顾性分析浙江省肿瘤医院1980年1月-2000年1月收治的卵巢卵黄囊瘤52例的临床病例资料。根据治疗方法将患者分为4组：A组（11例）行不保留生育功能手术加术后以铂类为主联合化疗；B组（10例）行不保留生育功能手术加术后以非铂类的联合化疗；C组（23例）行保留生育功能的分期手术加术后以铂类为主的联合化疗；D组（8例）行保留生育功能的分期手术加术后非铂类的联合化疗。对4组患者的生存率及预后因素进行分析。结果：52例患者5年生存率为69．2％。A组、B组、C组和D组的5年生存率分别为81．8％、40．0％、82．6％和50．0％。术后接受铂类为主化疗患者5年生存率为82．4％（28／34），显著高于非铂类化疗患者44．4％（8／18）（P〈0．05）。A组与B组、C组与D组比较，具有显著性差异（P〈0．05）。但A组与C组、B组与D组比较，无显著性差异（P〉0．05）。多因素分析显示，临床期别、术后残留病灶、术后以铂类为主的联合化疗是影响卵巢卵黄囊瘤患者预后的重要因素。结论：进行准确的手术分期和理想的减瘤术，术后辅以铂类为主的联合化疗，是卵巢卵黄囊瘤理想的治疗模式。保留生育功能手术不影响患者的预后。     

Outpatient chemotherapy with infusional 5-fluorouracil in advanced gastrointestinal cancer

These studies were designed to evaluate the efficacy, toxicity, and resulting quality of life (QOL) of outpatient chemotherapy with infusional 5-FU for advanced gastrointestinal cancer. Schedule, sch. A: Treatment consisted of CI 5-FU 200 mg/m2/day, days 1-28, IVB Leucovorin 20 mg/m2 q week. Fifteen patients with advanced gastrointestinal cancer were treated to maintain the efficacy of prior inpatient chemotherapy. Twenty-one patients treated with adjuvant chemotherapy were added to evaluate toxicity and QOL. The mean time to progression (TTP) was 2.6 months. Grade 2 toxicities were seen, including mucositis (23%) and diarrhea (7%). Hand-foot syndrome was seen 60% of patients. The mean QOL score was 89.5 +/- 7.8. Sch.B: Treatment consisted of weekly 24 h infusion of 5-FU 2,600 mg/m2. 5-FU was administered using a Groshong catheter and Baxter infusor LV5 (5 ml/hr). Nine patients with advanced gastrointestinal cancer were treated. Twenty-one patients were treated with adjuvant chemotherapy. The mean TTP was 3.6 month. Grade 2 toxicities were seen, including leucocytopenia (7%), mucositis (3%), diarrhea (10%), and nausea and vomiting (10%). The mean QOL score was 82.6 +/- 10.7. In conclusion, both 5-FU schedules are feasible for outpatient chemotherapy for advanced gastrointestinal cancer.     

单纯Barrett's食管腺癌108例临床分析

目的分析单纯Barrett’s食管腺癌根治性手术切除后加用放、化疗的临床疗效,探讨影响Barrett’s食管腺癌预后的因素。方法回顾性分析108例Barrett’s食管腺癌患者的临床资料及随访结果。行根治性手术切除者92例,其中术后单纯放疗者76例,术后放疗后加用化疗者16例;姑息性手术治疗者16例,其中有4例患者于术中死亡,另12例患者在术后均采用放疗 化疗。放疗采用60钴或6MV-X线,体外常规分割照射,靶区放射治疗总剂量为55～70 Gy;化疗采用FAM或CMF方案4～6个疗程。结果采用Kaplan-Meier法计算其生存率,本组患者1、3、5年生存率分别为81.5%、51.9%和22.2%,其中根治性手术切除后单纯放疗者5年生存率为15.8%,术后放疗加化疗者为75.0%;有肿瘤外侵者5年生存率为9.1%,无肿瘤外侵者为33.3%;有淋巴结转移者5年生存率为14.3%,无淋巴结转移者为33.3%;姑息性手术治疗术后加放、化疗后5年生存率为0。Log rank检验结果显示,差异均有统计学意义(P<0.05)。结论单纯Barrett’s食管腺癌根治性手术切除后,及时加用放、化疗治疗,有助于疗效的提高。影响预后的主要因素为临床分期、肿瘤外侵、淋巴结转移和根治性手术切除后放、化疗措施的应用。     

Adjuvant regional chemotherapy and systemic chemotherapy versus systemic chemotherapy alone in patients with stage II-III colorectal cancer: a multicentre randomised controlled phase III trial

BACKGROUND: Systemic adjuvant chemotherapy can improve overall survival and reduce the incidence of distant metastases for patients with advanced colon cancer. This study aimed to investigate whether regional chemotherapy (given by intraperitoneal or intraportal methods) combined with systemic chemotherapy was more effective than was systemic chemotherapy alone in terms of survival and recurrence for patients with stage II-III colorectal cancer. The study also compared systemic chemotherapy with fluorouracil and folinic acid with that of fluorouracil and levamisole. METHODS: During surgery, 753 patients with stage II-III colorectal cancer were randomly assigned to systemic chemotherapy alone (379 with fluorouracil and folinic acid, and 374 with fluorouracil and levamisole), and 748 to postoperative regional chemotherapy with fluorouracil followed by systemic chemotherapy with fluorouracil and folinic acid (n=368) or with fluorouracil and levamisole (n=380). Regional chemotherapy was given intraperitoneally (n=415) or intraportally (n=235) according to institution. The primary endpoint was 5-year overall survival. Secondary endpoints were 5-year disease-free survival and toxic effects. Analyses were by intention to treat. FINDINGS: Median follow-up was 6.8 years (range 0.0-10.1). 5-year overall survival was 72.3% (95% CI 69.0-75.6) for patients assigned regional and systemic chemotherapy, compared with 72.0% (68.7-75.3) for those assigned systemic chemotherapy alone (hazard ratio [HR] 0.97 [0.81-1.15], p=0.69). 5-year overall survival for all patients assigned fluorouracil and levamisole was 72.0% (68.7-75.2) compared with 72.3% (69.0-75.6) for all those assigned fluorouracil and folinic acid (HR 0.98 [0.82-1.17], p=0.81). The hazard ratios for 5-year disease-free survival were 0.94 (0.80-1.10) for regional versus non-regional treatment, and 0.92 (0.79-1.08) for all fluorouracil and levamisole versus fluorouracil and folinic acid. Grade 3-4 toxic effects were low in all groups. INTERPRETATION: Fluorouracil-based regional chemotherapy adds no further benefit to that obtained with systemic chemotherapy alone in patients with advanced colorectal cancer.     

放疗联合PF化疗方案治疗儿童鼻咽癌27例疗效分析

[目的]探讨放疗联合PF方案治疗儿童鼻咽癌的放疗剂量及疗效.[方法]27例儿童鼻咽癌患者先给予PF诱导化疗1周期,然后实行放射治疗DT55～60Gy,放疗后再给予PF方案辅助化疗2周期.[结果]有效率(CR PR)100%,CR 5例,PR22例,1、3、5年生存率为100%、74.1%、66.7%.[结论]放疗联合PF化疗方案治疗儿童鼻咽癌可降低放射治疗剂量,毒性低.     

Analysis of the Prognosis for Patients with Stage T3N0-1M0 Nasopharyngeal Carcinoma Treated by Chemotherapy Combined with Radiotherapy

OBJECTIVE To investigate the relationship between the therapeutic modality and prognostic factors for the patients with T3N0-1M0 nasopharyngeal carcinoma. METHODS The clinical data from 127 cases of T3N0-1M0 nasopharyngeal carcinoma patients with initial treatment, during the period from January 4th, 2000 to November 12th, 2001, were retrospectively analyzed. The cases were divided into Group A with simple radiotherapy (90) and Group B with the radiation therapy combined with chemotherapy (37), based on various patients' conditions. In group B, inductive chemotherapy was conducted for 18 cases, inductive chemotherapy plus homochronous chemotherapy for 5 and homochronous chemotherapy for 14. RESULTS The 5-year overall survival (OS) in the groups A and B was 73.4% and 72.3% respectively (P>0.05); the cancer-correlated survival (CCS) in the 2 groups was 76.4% and 72.3% respectively (P>0.05); the disease-free survival (DFS) in group A and B was 65.5% and 71.7% respectively (P<0.05). A multiple analysis showed that the mode of radiation therapy plus chemotherapy was a favorable independent impact factor for DFS. CONCLUSION Chemotherapy plus radiotherapy can improve the DFS of patients with T3N0-1M0 nasopharyngeal carcinoma, but fails to prolong the survival time of the patients. The modality of chemotherapy plus radiotherapy is not the necessary choice in treatment of patients with T3N0-1M0 nasopharyngeal carcinoma.