Ⅲ期乳腺癌综合治疗方案初探

本院自１９７６～１９８９年收治Ⅲ期乳癌１７６例，全组５年生存率，局部复发率，远处转移率分别为５０％、１２．５％、２１．５％。单纯手术组（３０例）分别为４３．３％、２６．７％、４０％；术后放疗组（４９例）分别为５１％、８．２％、３６．７％；术后化疗组（３０例）分别为５０％、１６．７％、１０％；术后放、化疗组分别为５２．２４％、７．５％、７．５％。局部复发率单纯手术组最高，术后放疗及放化组最低，二者比较有显著性（Ｐ＜０．０５）；远处转移率单纯手术组最高，术后化疗组及放化组最低，（Ｐ＜０．０５）５年生存率综合治疗组较高，但与手术组比较无显著性差别（Ｐ＞０．０５）。     

Ⅲ期乳腺癌综合治疗方案初探

本院自１９７６～１９８９年收治Ⅲ期乳癌１７６例，全组５年生存率，局部复发率，远处转移率分别为５０％、１２．５％、２１．５％。单纯手术组（３０例）分别为４３．３％、２６．７％、４０％；术后放疗组（４９例）分别为５１％、８．２％、３６．７％；术后化疗组（３０例）分别为５０％、１６．７％、１０％；术后放、化疗组分别为５２．２４％、７．５％、７．５％。局部复发率单纯手术组最高，术后放疗及放化组最低，二者比较有显著性（Ｐ＜０．０５）；远处转移率单纯手术组最高，术后化疗组及放化组最低，（Ｐ＜０．０５）５年生存率综合治疗组较高，但与手术组比较无显著性差别（Ｐ＞０．０５）。     

放射治疗后加化疗治疗中晚期鼻咽癌的临床观察

１９８９年３月至１９９１年１月，作者将经病理诊断且为初治的１６７例Ⅲ、Ⅳ期鼻咽癌病人，随机分为单纯放疗组和综合治疗组（放疗后加ＣＯＢ方案化疗），进行疗效对比。结果：单纯放疗组８８例的５年生存率为３０．７％，综合治疗组７９例为４０．５％；两个治疗组中的Ⅲ期病人，分别为３８．９％和５２．０％（Ｐ＞０．０５）；两组原发灶及颈淋巴结复发率，复发中位时间基本相同；两组Ⅲ期病人的远处转移发生率分别为２４．０％及３３．３％（Ｐ＞０．０５）；出现远处转移的中位时间，综合组比单纯放疗组延迟（Ｐ＜０．０５）；两组患者的主要死亡原因为复发和转移，两组死亡病例的中位生存期，综合组长于单纯放疗组（Ｐ＜０．０５）；远期后遗症的发生率，综合组高于单纯放疗组（Ｐ＜０．０１）。     

睾丸精原细胞瘤预后因素分析

目的：分析睾丸精原细胞瘤综合治疗的几个预后因素。方法：１９８４年～１９９６年间我院放疗科收治２１例睾丸精原细胞瘤,均行患侧睾丸副睾切除加精索高位结扎,术后均采用放疗或化疗。结果：２年生存率Ⅰ期患者为８３．３％（１０／１２）、Ⅱ期患者为１００％（７／７）、Ⅳ期患者为０（０／２）;５年生存率Ⅰ期患者为５８．３％（７／８）、Ⅱ期患者为８５．７％（６／７）,Ⅳ期患者为０（０／１）。结论：Ⅰ期、Ⅱ期睾丸精原细胞瘤应行术后放疗,Ⅱ期应加用２～４周期化疗,综合治疗后可延长生存期。年龄对预后影响不明显,单纯化疗疗效有待进一步证实。     

非根治术或加放疗治疗Ⅰ,Ⅱ期宫颈癌

对全子宫加双侧附件切除或术前后补加放疗的１１８例宫颈癌（临床Ⅰ期７１例、Ⅱ期４７例）的疗效进行总结。结果，单纯手术组（２７例）５及１０年生存率为８机及６３％，补加放疗组（９１例）为７６％及６０％，组间比较Ｐ皆＞０．０５。与本院１７５例宫颈癌根治术相比，５及１０年生存率在Ⅰ期差别有显著性（Ｐ＜０．０１），在Ⅱ期差别无显著性（Ｐ＞０．０５）。放疗在术前或术后对生存无影响（Ｐ＞０．０５）。从本组有限的病例看，建议原位癌早期浸润应按０期癌对待只行全宫切除术，其它Ⅰ期癌应行根治术，Ⅱ期癌可行非根治手术并补加放疗。     

卡铂加放疗联合治疗中晚期食管癌

目的比较卡铂合并放疗与单纯放疗治疗中晚期食管癌的疗效及毒副作用。方法１９９０年８月～１９９２年１０月收治１９２例经病理证实为鳞癌的食管癌病人。病变长度为５－１０ｃｍ,随机配对分为两组,卡铂合并放疗组（卡铂组）与单纯放疗组（单放组）。结果卡铂合并放疗组近期疗效明显优于单纯放疗（Ｐ＜０．０５）。１、３、５年生存率,卡铂组分别为６１．５％、３０．２％、２５．０％;而单放组则为４１．７％（Ｐ＜０．０１）、２０．８％（Ｐ＞０．０５）、１６．７％（Ｐ＞０．０５）。毒副作用为轻度造血功能抑制与放射性食管炎。对症处理后不影响疗程。结论卡铂配合放疗治疗食管癌有协同作用。其毒副作用小,临床应用安全可行。     

61例垂体腺瘤放射治疗

本文总结１９７７年１１月至１９９０年１０月，我科收治垂体腺瘤６１例。单纯放疗１７例，有效率７６．５％，手术加放疗４４例有效率８４．１％。５年以上单纯放疗有效率７５．０％，手术加放疗有效率８５．３％，１０年以上单纯放疗有效率７１．４％，手术加放疗有效率８２．０％，均经统计学处理，Ｐ＞０．０５无显著性差异，与病例少有关。     

X线立体定向放射治疗脑转移瘤疗效分析

目的分析Ｘ线立体定向放射治疗（ＳｔｅｒｅｏｔａｃｔｉｃＲａｄｉｏｔｈｅｒａｐｙ，ＳＲＴ）加全脑放疗降低脑转移瘤局部复发的意义。材料与方法１９９６年５月至１９９７年１０月间对６５例脑转移瘤患者行ＳＲＴ加全脑放疗３０例，单纯ＳＲＴ治疗３５例。全脑放疗３８～４０Ｇｙ／４～４．５周。ＳＲＴ周边剂量１５～３２Ｇｙ。结果ＳＲＴ加全脑放疗组中位复发时间９．５个月，局部复发率３．３％，显著优于单纯ＳＲＴ治疗组的３个月和２８．６％（Ｐ＜０．０５）；ＳＲＴ加全脑放疗组局部控制率９３．６％，中位生存时间１０个月，１年生存率８３．３％和死亡率１６．７％与对照组９２．９％，７个月，７１．４％和２８．６％比较差异无显著意义（Ｐ＞０．０５）。结论ＳＲＴ加全脑放疗治疗脑转移瘤在控制局部复发，延长复发时间方面优于单纯ＳＲＴ治疗     

淋巴母细胞淋巴瘤45例临床疗效分析

目的为探讨淋巴母细胞淋巴瘤的合理治疗方法。材料与方法１９８３年１０月至１９９３年１０月间采用以化疗为主加或不加放疗治疗４５例淋巴母细胞淋巴瘤并总结和分析其临床疗效。结果全组治疗的近期疗效有效率为６１．４％，其中完全缓解（ＣＲ）率为３６．４％。随访３～１０年，３７例死亡，８例仍生存。疗后全组１，３，５，７，１０年生存率分别为４０．０％，２６．７％，１９．４％，１９．４％和０％。化疗和放疗综合治疗组的疗后３，５，１０年生存率分别为３１．５％，２６．１％和１９．４％，优于单化疗组，分别为１９．８％，１２．１％和７．８％（Ｐ＜０．００１）。通过对疗后生存率与近期疗效、临床分期、化疗有效病例是否足量化疗及治疗的不同年代间关系的分析显示，近期疗效达ＣＲ者优于部分缓解（ＰＲ）、稳定（Ｓ）和进展（Ｐ）；早期病变局限（Ⅰ，Ⅱ期）优于晚期（Ⅲ，Ⅳ期）病例；加放疗者优于单纯化疗者；有效病例足量化疗者优于不足量化疗者；近年（１９８８年至１９９３）治疗病例的效果优于早年（１９８３年至１９８７年）所治病例的效果。结论以足量化疗为主，辅以放疗的综合治疗，争取首程治疗达到肿瘤完全缓解是提高淋巴母细胞淋巴瘤疗后生存率的重要途径之一     

涎腺腺样囊性癌的放射治疗──附75例分析

１９７５年至１９８７年我院收治腺样囊性癌７５例。腮腺１２例，颌下腺１４例，舌下腺１例和小涎腺４８例。综合治疗５４例（７２％），单纯放疗１６例和单纯手术５例。５年随访率８７．９％，３、５和１０年生存率分别为７７．３％（５８／７５），６５．５％（３８／５８）和４５．２％（１４／３１）。单纯放疗、单纯手术和综合治疗５年生存率分别为３８．５％（５／１３），５０％（２／４）和７５．６％（３１／４１）（Ｐ＜０．０１），Ⅰ～Ⅳ期５年生存率分别为８１．３％（１３／１６）、７０％（１４／２０）、５３．３％（８／１５）和４２．９％（３／７）（Ｐ＜０．０５）。     

Phase I dose escalation study of bortezomib in combination with lenalidomide in patients with myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML)

We conducted a phase I dose escalation study to determine the maximal tolerated dose of bortezomib that could be combined with standard dose lenalidomide in patients with MDS or AML. Treatment consisted of bortezomib (IV) on Days 1, 4, 8, and 11 and lenalidomide 10 mg daily (PO) days 1–21 in 28 day cycles for up to 9 cycles. 23 patients (14 MDS/CMML, 9 AML) were enrolled. The maximally tested dose of bortezomib, 1.3 mg/m², was tolerable in this regimen. Responses were seen in patients with MDS and AML. Further testing of this regimen is planned.     

Cancer in the elderly: the forgotten priority

In 1992, the American Oncology Nursing Society produced a state-of-the-art document, recognizing the fact that cancer is primarily a disease of ageing and addressing the specific needs of elderly cancer patients. As 1993 has been dubbed the 'Year of the Elderly', European oncology nurses should also be establishing a framework to meet the cancer-specific needs of the elderly.     

The use of distraction and imagery with children during painful procedures

The effectiveness of a paediatric pain management programme was examined using a multiple case study design. This study examined both the children's pain experience during cancer treatment, as well as their parents'anxiety and behavioural stress. Fourteen people were videotaped while receiving lumbar punctures during an 8–12 month period. Baseline data were obtained at the first of three visits prior to the introduction of relaxation, imagery and distraction exercises. Self-ratings of child fear and parent anxiety, videotaped observations of child and parent behaviour and child pain ratings were obtained at all three visits. The children's behavioural responses to the procedure varied considerably, but their fear scores were stable and their reports of pain decreased over time. Parents reported high-trait, low-state anxiety scores that were stable over time. They were observed to be very supportive during the procedures. Implications for further research in this area and recommendations for practice are presented.     

Does race influence survival for esophageal cancer patients treated on the radiation and chemotherapy arm of RTOG #85-01?

Purpose: In reported retrospective non-randomized trials of treatment of esophageal carcinoma, blacks have a lower survival from esophageal cancer than whites. None of these studies has accounted for the extent of disease, or the methods and quality of treatment. We reviewed the data that included only patients treated on the chemoradiation arm of the RTOG-8501 esophageal carcinoma trial to see if there were differences in overall survival between black and white patients receiving the same standard of care.

Methods and Materials: One hundred-nineteen patients, 37 blacks and 82 whites were evaluated who met the criteria for receiving chemoradiation of 5000 cGy and four courses of Cisplatin (75 mg/m²) and Fluorouracil (1000 mg/m² for 4 days).

Results: Blacks had squamous histology only, with 86% of blacks having weight loss of 10 lbs. or more compared to 56% of whites (p = 0.001). In addition, blacks had larger tumors and more difficulty eating (p = 0.010). Overall, there was no difference in the Kaplan-Meier median survival estimate by race (p = 0.2757). Only when we limited the analysis to the “squamous histology” subgroup, stratified according to age >70 vs. <70 years (p = 0.0002), and nodal status (p = 0.0177) in a Cox regression model analysis, did race appear to be a significant factor (p = 0.0012). However, using the entire database, the age effect was found to be a “bimodal” effect, wherein the “youngest” (< age 60 years) and “oldest” patients (age > 70 years) did poorly. Because of the dramatic differences in the age and histology distributions between blacks and whites, this issue could not be resolved in the subset of squamous only who received chemoradiation.

Conclusions: The increasing incidence of adenocarcinoma among white patients without a corresponding increase of this histology in blacks reflects a difference in diet and or lifestyle compared to blacks that deserves additional study. When treated aggressively with chemoradiation, race did not appear to be a statistically significant factor for overall survival.     

X线立体定向治疗靶点位置精确度分析

目的 :分析影响人头模和实际患者靶点位置精确度的各种因素 ,确定立体定向治疗全过程靶点位置精确度及每一步骤的贡献量。材料与方法 :靶点模拟器设定靶点位置 ,测量靶点计划定位精确度 ;钢珠放置Alderson标准人头模中模似患者治疗 ,测量治疗全过程靶点位置精确度。结果 :CT定位精确度 1 .4± 0 .3mm ,人头模治疗总的精确度为 1 .72± 0 .60mm。结论 :由于有更多的因素影响患者治疗 ,人头模靶点位置精确度是理想情况患者治疗精确度     

中国与美国恶性肿瘤的现状比较及差异分析

恶性肿瘤是当今世界最主要的死亡原因之一,但不同国家的不同肿瘤在性别、年龄、地区分布的发病率和死亡率有着显著差异。中美两国作为世界上最大的发展中和发达国家,恶性肿瘤的现状也有所不同,但却存在着许多共性和潜在的相似点。因此,本文目的在于尝试对中美两国最新恶性肿瘤现状相关研究资料进行对比分析探究其中差异,以期为中国在恶性肿瘤的预防、筛查及诊疗方面提供些许借鉴和指导。     

VEGFR‐2 expression in carcinoid cancer cells and its role in tumor growth and metastasis

Carcinoid tumors are slow growing and highly vascular neuroendocrine neoplasms that are increasing in incidence. Previously, we showed that carcinoid tumors express vascular endothelial growth factor receptor 2 (VEGFR‐2) in the epithelial compartment of carcinoid tumor sections; yet, its role is not completely understood. The purpose of our study was to: (i) assess the expression of VEGFR‐2 in the novel human carcinoid cell line BON, (ii) to determine the role of PI3K/Akt signaling on VEGFR‐2 expression and (iii) to assess the effect of VEGFR‐2 on BON cell invasion, migration and proliferation. We found that, although VEGFR‐2 is expressed in BON cells, reduction in VEGFR‐2 expression actually enhanced proliferation, invasion, and migration of the BON cell line. Also, expression of VEGFR‐2 was inversely related to PI3K signaling. Carcinoid liver metastases in mice demonstrated decreased VEGFR‐2 expression. Furthermore, the expression of a truncated, soluble form of VEGFR‐2 (sVEGFR‐2), a protein demonstrated to inhibit cell growth, was detected in BON cells. The presence of VEGFR‐2 in the epithelial component of carcinoid tumors and in the BON cell line suggests an alternate role for VEGFR‐2, in addition to its well‐defined role in angiogenesis. The expression of sVEGFR‐2 may explain the inverse relationship between VEGFR‐2 expression and PI3K/Akt signaling and the inhibitory effect VEGFR‐2 has on BON cell proliferation, migration and invasion.