碳离子和质子治疗肝细胞癌的Meta分析CSCD

目的探讨碳离子和质子治疗肝细胞癌(HCC)的有效性和安全性。方法计算机检索PubMed、The Cochrane Library、EMBASE、中国期刊全文数据库、中国生物医学文献数据库、万方数据库,收集碳离子和质子治疗HCC的相关临床研究。由两位评价员独立筛选文献和提取资料,采用STATA 12.0进行Meta分析。结果共纳入7项碳离子和23项质子治疗研究,根据合并结果,碳离子和质子治疗HCC均可获得良好的局控率,且严重不良反应(≥3级)的发生均较少,亚组分析显示接受碳离子和质子治疗的预后较好和预后不良的HCC患者5年OS均有所提高。结论碳离子和质子治疗对预后较好的HCC有可能成为有效的替代治疗选择,对预后不良的HCC患者也显示出较好的疗效。     

含贝伐珠单抗维持治疗晚期结直肠癌患者疗效与安全性的Meta分析

目的 系统评价含贝伐珠单抗不同联合方案治疗晚期结直肠癌的疗效与安全性。方法 计算机检索PubMed、EMbase、Web of Science、Cochrane Library 数据库截至2017年7月31日有关贝伐珠单抗维持治疗晚期结直肠癌的随机对照试验。按纳入排除标准筛选文献、资料提取和评价质量,采用RevMan 5.3 软件进行Meta 分析。 结果 共纳入8项研究,2 644例晚期结直肠癌患者。Meta分析显示,贝伐珠单抗维持治疗组（包括单药和联合化疗）前者无疾病进展生存期（PFS）和总生存期（OS）均优于无治疗组（HR=0.65,95% CI：0.53~0.78,P<0.001;HR=0.83,95% CI：0.71~0.98,P=0.020）,但前者3~4级感觉神经障碍及高血压发生率高于后者（P=0.001,0.008）。贝伐珠单抗维持治疗组与持续治疗组对比,两者的PFS和OS相当（HR=1.05,95% CI：0.56~1.71,P=0.830;HR=1.11,95% CI：0.92~1.35,P=0.270）,而后者3~4级感觉神经障碍、疲乏和手足综合征明显高于前者（P＜0.001,0.020,0.040）。与单药贝伐珠单抗组比较,贝伐珠单抗抗抗联合厄洛替尼组能改善PFS和OS（HR=0.81,95% CI：0.67~0.96,P=0.020;HR=0.81,95% CI：0.67~0.99,P=0.040）,但贝伐珠单联合厄洛替尼组3~4级皮疹发生率明显高于单药贝伐珠单抗组（P<0.001）。结论 贝伐珠单抗单药、联合低毒化疗药物或厄洛替尼,均可改善晚期结直肠癌患者PFS和OS,患者可耐受,贝伐珠单抗维持治疗可作为晚期结直肠癌维持阶段的优选治疗方案。     

直肠癌术后三维适形/调强放疗联合化疗与单纯辅助化疗的疗效比较

目的 比较直肠癌术后三维适形/调强放疗联合化疗与术后单纯化疗的疗效及不良反应。方法 回顾性分析直肠癌根治术患者226例,其中辅助化疗组116例,辅助放化疗组110例。辅助放化疗组采用三维适形放疗88例,调强放疗22例。剂量范围45～54 Gy,中位剂量50 Gy。全组患者化疗周期数为2～8周期,中位4周期。观察患者不良反应,比较三维适形/调强放疗联合化疗与单纯术后化疗两组不同辅助治疗模式对局部复发率、总生存率（OS）及无病生存率（DFS）的影响。结果 术后放化组1、2、3年局部复发率分别为3.8%、10.5%、10.5%,明显低于术后化疗组的15.5%、29.7%、33.2%（P=0.001）,术后放化组与术后化疗组1、2、3年OS分别为94.2%、76%、70.7%和95.6%、68.4%、53.5%,组间差异接近统计学意义（P=0.059）,1、2、3年DFS组间差异无统计学意义（P=0.608）。术后放化组的胃肠道、血液学不良反应发生率分别为78.2%和64.5%,高于术后化疗组的41.4%和30.2%（P=0.000;P=0.000）。亚组分析显示Ⅱ期患者术后放化组和术后化疗组1、2、3年OS、DFS差异均无统计学意义（P=0.810;P=0.067）。Ⅲ期患者术后放化组的1、2、3年OS高于术后化疗组,差异有统计学意义（P=0.047）,DFS与术后化疗组比较差异无统计学意义（P=0.201）。术后放化组中20.9%患者出现放射性肠炎;10%患者出现放射性膀胱炎。无3级以上不良反应发生。结论 直肠癌术后三维适形/调强放疗联合化疗可显著降低局部复发率,提高Ⅲ期直肠癌患者总生存率。放化联合治疗组血液学及胃肠道不良反应高于术后单纯化疗,但患者耐受性较好。盆腔照射采用三维适形或调强放疗技术,在提高局控率的同时可较常规放疗显著降低放射性膀胱炎和放射性肠炎的发生率和发生程度。     

TPF和GP诱导化疗联合同步放化疗治疗局部晚期鼻咽癌的临床疗效分析

目的：本研究旨在比较诱导化疗多西他赛+顺铂+氟尿嘧啶方案（Docetaxel + Cisplatin + Fluorouracil，TPF）和吉西他滨+顺铂方案（Gemcitabine + Cisplatin，GP）治疗局部晚期鼻咽癌的疗效及毒副反应。方法：收集我院2009年6月至2016年12月III～IV期鼻咽癌患者（初诊无远处转移）共149例纳入研究，其中TPF（多西他赛60mg/m2 +顺铂60mg/m2 +氟尿嘧啶600mg/m2 d1-5，三周方案）诱导化疗组73例；GP（吉西他滨1000mg/m2 d1，d8 +顺铂25mg/m2 d1-3，三周方案）诱导化疗组76例。同步化疗方案采用以顺铂（70～80mg/m2）为基础的化疗2～3周期，三周方案。比较两组的生存结果和毒副反应。结果：随访时间截止到2019年8月, 中位随访时间57（13～120）个月。GP组及TPF组5年OS分别为82.8%和90.9%（P = 0.255) ；5年PFS分别为74.8%和85.6%（P = 0.102）；5年LRFS分别为89.7%和89.7% （P = 0.712）；5年DMFS分别为84.4%和91.2%（P = 0.290）。GP组和TPF组3～4级白细胞减少发生率分别为61.8%和75.3% （P = 0.076）；3～4级中性粒细胞减少发生率分别为51.3%和65.7%（P = 0.074）；3～4级血小板减少发生率分别为38.1%和13.7%（P =0.001）；3～4级血红蛋白减少发生率分别为30.2%和11.0%（P = 0.004）；3～4级口腔粘膜炎发生率分别为18.4%和32.9%（P =0.043）。结论：TPF组较GP组更易出现3～4级放射性口腔粘膜炎，而GP组更易出现3～4级血小板减少和血红蛋白减少。TPF诱导化疗方案和GP诱导化疗方案两组疗效无显著差异，期待多中心前瞻性临床研究进一步验证。     

嵌合抗原受体T细胞治疗消化道恶性肿瘤疗效及安全性的Meta分析

目的:系统评价嵌合抗原受体 T 细胞（CAR-T）治疗消化道恶性肿瘤的疾病控制率、严重不良反应发生率及预后情况。方法:计算机检索 PubMed、Embase、The Cochrane Library、CNKI、Wan Fang和 VIP 数据库，搜集利用CAR-T治疗消化道恶性肿瘤的队列研究，检索时限从建库截至2020年03月01日。由2位评价者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用 R 软件和stata12.0软件进行单组率的 Meta 分析。结果:共纳入6项相关研究，共计55例患者。单组率 Meta 分析结果显示，CAR-T 治疗消化道恶性肿瘤的疾病控制率为53%［95%CI（0.38，0.67）］；亚组分析和Meta 回归结果显示，转导方式（P=0.014 8）和给药途径（P=0.014 8）是影响疾病控制率的主要因素。严重不良反应发生率为57%［95%CI（0.23，0.85）］。Kaplan-Meier生存曲线显示患者6个月的无进展生存（progression-free survival，PFS）和总生存（overall survival，OS）率为26.1%和50.0%，1 年的PFS和OS率为 8.7%和16.7%；中位PFS为（4.0±0.16）个月；中位OS为（5.7±2.33）个月。结论:CAR-T 治疗消化道恶性肿瘤具有较好的疗效，转导方式和给药途径是影响疾病控制率的主要因素。虽然CAR-T相关的严重不良反应发生率较高，但均能被积极控制且不会危及生命；CAR-T治疗能明显改善患者预后，更多的临床经验需要进一步研究和积累。     

射波刀治疗局部进展期胰腺癌临床疗效分析

目的 评价射波刀治疗局部进展期胰腺癌的有效性和安全性。方法 回顾分析2006—2014年间接受射波刀治疗的 59例局部进展期胰腺癌患者资料。肿瘤体积为 13.0~125.1 cm³(中位数27.1 cm³)。处方剂量为 35~50 Gy (中位数45 Gy),分割次数为 3~8次(中位数5次)。采用CT为基础的评价有无进展。采用Kaplan-Meier法线计算OS和局部无进展生存LPFS。结果 1、2年样本数分别为26、17例,1、2年OS分别为54%、35%,LPFS分别为91%、70%;中位OS期为12.5个月,LPFS期为10.9个月。1~2级急性和晚期胃肠道反应总发生率为61%,其中 1例为3级晚期胃肠道反应者临床表现为肠道不全梗阻。结论 采用射波刀治疗局部进展期胰腺癌可获得很好疗效且并发症小。     

康复新液防治恶性肿瘤放疗所致放射性食管炎疗效的Meta分析

目的  评价康复新液对恶性肿瘤放疗引起的放射性食管炎的疗效。方法 计算机检索Medline、PubMed、CNKI、WanFang Date、VIP等数据库，搜索康复新液防治恶性肿瘤放疗所致放射性食管炎的临床对照试验，检索期限为建库至2018年12月。根据纳入和排除标准筛选文献，提取资料和质量评价，采用RevMan 5.0软件进行Meta分析。结果 最终纳入6篇文献，合计样本量为482例，其中采用康复新液（试验组）237例，常规健康教育或综合西药疗法（对照组）245例。Meta分析结果显示，试验组和对照组Ⅰ级、Ⅲ级及以上放射性食管炎发生率差异均无统计学意义（RR=1.36，95%CI：0.96~1.95，P=0.09；RR=0.22，95%CI：0.04~1.25，P=0.09）；但试验组Ⅱ级放射性食管炎发生率低于对照组，差异有统计学意义（RR=0.53，95%CI：0.37~0.77，P=0.0006）；试验组放射性食管炎毒性积分亦低于对照组，差异有统计学意义（MD=-0.31， 95%CI：-0.47~-0.16，P<0.0001）。结论 在恶性肿瘤放疗过程中，康复新液可有效降低Ⅱ级放射性食管炎的发生率，但对降低Ⅰ级和Ⅲ级及以上放射性食管损伤无明显优势。     

P-Gemox方案联合调强放疗治疗早期结外NK/T细胞淋巴瘤的临床疗效

目的 探讨P-Gemox方案联合调强放疗治疗早期结外NK/T细胞淋巴瘤（extranodal NK/T-cell lymphoma，ENKTL）的疗效。方法 回顾性分析四川省肿瘤医院2012年3月至2017年10月初治的73例ENKTL患者的临床资料，根据治疗方案分为P-Gemox方案夹心放疗组（n=38）和P-Gemox方案序贯放疗组（n=35），比较两组患者的近期和远期临床疗效。结果 73例ENKTL患者总有效率（ORR）为95.9%，3年无进展生存率（PFS）为73.5%，3年总生存率（OS）为81.9%。P-Gemox方案夹心放疗组ORR为97.4%，3年PFS和OS分别为74.2%和84.1%。P-Gemox方案序贯放疗组ORR为94.3%，3年PFS和OS分别为72.6%和79.2%。两组ORR、PFS和OS差异均无统计学意义（P＞0.05）。控制相关潜在混杂因素后，多因素Cox回归分析显示，P-Gemox方案夹心放疗组与P-Gemox方案序贯放疗组的PFS相当（HR=0.617，95%CI：0.353~1.081，P=0.091），而P-Gemox方案夹心放疗组较P-Gemox方案序贯放疗组OS更好 （HR=0.556，95%CI：0.314~0.982，P=0.043）。两组化疗毒副反应以Ⅰ～Ⅱ级为主，其中P-Gemox方案夹心放疗组较P-Gemox方案序贯放疗组更容易发生Ⅰ～Ⅱ度转氨酶升高（P＜0.05），血液学、胃肠道等毒副反应，发生率差异无统计学意义（P＞0.05）。结论 P-Gemox方案夹心放疗与P-Gemox方案序贯放疗的近期疗效和PFS相当，但P-Gemox方案夹心放疗较P-Gemox方案序贯放疗可提高患者OS。     

预防性使用PEG-rhG-CSF在有营养风险的局部晚期非小细胞肺癌化疗后中性粒细胞缺乏中的疗效

目的 探讨预防性使用聚乙二醇重组人粒细胞刺激因子（PEG-rhG-CSF）在有营养风险的局部晚期非小细胞肺癌（NSCLC）患者化疗期间中性粒细胞缺乏中的有效性和安全性。方法 选取有营养风险的局部晚期NSCLC患者337例。随机分为未预防性使用药物组112例（对照组）、预防性使用rhG-CSF治疗组112例（rhG-CSF治疗组）和预防性使用PEG-rhG-CSF治疗组113例（PEG-rhG-CSF治疗组）。观察化疗后中性粒细胞减少症的发生率和持续时间以及外周血中CD4+/CD8+T细胞的比值。结果 对照组、rhGCSF治疗组和PEG-rhG-CSF治疗组中性粒细胞减少症发生率分别为67.97%、41.57%和37.98%（P<0.05）；Ⅲ~Ⅳ度中性粒细胞减少症发生率分别为22.39%、14.25%和11.14%（P<0.05）；中性粒细胞减少性发热发生率分别为3.55%、1.84%和1.21%（P<0.05）；外周血中CD4⁺/CD8⁺T细胞比值分别为1.27±0.44、1.32±0.52和1.49±0.25（P<0.05）。PEG-rhG-CSF治疗组Ⅲ~Ⅳ度中性粒细胞减少症持续时间和中性粒细胞值从最低值到2.0×10⁹/L以上所需时间均低于对照组和rhG-CSF治疗组（P<0.05）。结论 预防性使用PEG-rhG-CSF能降低有营养风险的局部晚期NSCLC化疗期间中性粒细胞减少症的发生率，增强患者免疫功能。     

免疫检查点抑制剂治疗晚期胃癌或食管胃结合部癌的有效性和安全性Meta分析

目的 系统评价免疫检查点抑制剂治疗晚期GC/GEJC患者的疗效及安全性。方法 通过计算机检索CNKI、万方、PubMed、EMBASE、ClinicalTrials、Cochrane Library等数据库收集免疫检查点抑制剂治疗晚期GC/GEJC的临床试验,检索时间从建库至2019年11月,结局指标主要包括客观缓解率、疾病控制率、无进展生存期、总生存期以及安全性;采用率差和风险比为效应量,采用RevMan5.3软件进行Meta分析。结果 共纳入7篇文献1 949例患者。结果显示：晚期GC/GEJC患者≥二线免疫检查点抑制剂治疗比化疗/安慰剂治疗提高了患者12月和18月的总生存率（均P<0.05）,延长了患者的总生存期（P<0.05）。免疫检查点抑制剂治疗引起的任何级别或≥3级不良反应的发生率均低于化疗/安慰剂治疗。结论 免疫检查点抑制剂治疗可改善部分晚期GC/GEJC患者生存终点,且常见不良反应发生率较低。     

伴中危风险因素ⅠB~ⅡA期宫颈鳞癌辅助化疗与同步放化疗预后的前瞻随机对照研究

目的 比较辅助化疗与同步放化疗对伴中危风险因素ⅠB~ⅡA期宫颈鳞癌患者预后的影响，探讨术后辅助化疗的安全有效性。方法 选取广西医科大学附属肿瘤医院190例患者，随机分为两组：单纯化疗组（CT组95例）和同步放化疗组（CCRT组95例），失访10例。生存率计算和生存曲线比较采用Kaplan-Meier生存分析法和Log rank检验，并采用Cox比例风险回归模型进行多因素分析。结果 中位随访36.7月，主要终点可评估的患者共180例。分别有3.30%（CT组）及10.11%（CCRT组）的患者出现了G3/G4级的血液学不良反应（P=0.019）；4.40%（CT组）及17.98%（CCRT组）的患者出现了严重的胃肠道不良反应（P=0.000），22.48%发生放疗相关的反应。两组间的局部复发率（P=0.317）及远处复发率（P=0.224）差异无统计学意义。PFS及OS在两组间亦无显著的统计学差异。结论 伴中危风险因素ⅠB~ⅡA期宫颈鳞癌患者术后化疗与同步放化疗的疗效无显著差别，但不良反应较同步放化疗显著减少。     

Clinical results and risk factors of proton and carbon ion therapy for hepatocellular carcinoma

BACKGROUND:

The objective of this study was to evaluate the clinical outcome of proton and carbon ion therapy for hepatocellular carcinoma (HCC).

METHODS:

In total, 343 consecutive patients with 386 tumors, including 242 patients (with 278 tumors) who received proton therapy and 101 patients (with 108 tumors) who received carbon ion therapy, were treated on 8 different protocols of proton therapy (52.8‐84.0 gray equivalents [GyE] in 4‐38 fractions) and on 4 different protocols of carbon ion therapy (52.8‐76.0 GyE in 4‐20 fractions).

RESULTS:

The 5‐year local control and overall survival rates for all patients were 90.8% and 38.2%, respectively. Regarding proton and carbon ion therapy, the 5‐year local control rates were 90.2% and 93%, respectively, and the 5‐year overall survival rates were 38% and 36.3%, respectively. These rates did not differ significantly between the 2 therapies. Univariate analysis identified tumor size as an independent risk factor for local recurrence in proton therapy, carbon ion therapy, and in all patients. Multivariate analysis identified tumor size as the only independent risk factor for local recurrence in proton therapy and in all patients. Child‐Pugh classification was the only independent risk factor for overall survival in proton therapy, in carbon ion therapy, and in all patients according to both univariate and multivariate analyses. No patients died of treatment‐related toxicities.

CONCLUSIONS:

Proton and carbon ion therapies for HCC were comparable in terms of local control and overall survival rates. These therapies may represent innovative alternatives to conventional local therapies for HCC. Cancer 2011;. © 2011 American Cancer Society.     

尼妥珠单抗联合多西他赛和顺铂一线治疗复发或转移性头颈部鳞癌疗效观察

目的 观察尼妥珠单抗联合多西他赛和顺铂一线治疗复发或转移性头颈部鳞癌的疗效及安全性。方法 回顾性分析28例尼妥珠单抗联合多西他赛+顺铂（观察组）及30例多西他赛+顺铂（对照组）一线治疗复发或转移性头颈部鳞癌患者的临床资料,比较两种方案的客观缓解率（ORR）、疾病控制率（DCR）、无进展生存时间（PFS）及总生存时间（OS）,评估安全性。结果 观察组和对照组ORR分别为42.9%和16.7%,DCR分别为78.6%和53.3%,中位PFS分别为6.2月和4.3月,差异均有统计学意义（P<0.05）;中位OS分别为12.2月和8.5月,差异无统计学意义（P>0.05）;两组患者不良反应差异无统计学意义（P>0.05）。结论 尼妥珠单抗联合化疗较单纯化疗一线治疗复发或转移性头颈部鳞癌可提高患者近期临床疗效,延长患者无进展生存时间,且不增加不良反应的发生。     

Treatment outcome of high-dose image-guided intensity-modulated radiotherapy using intra-prostate fiducial markers for localized prostate cancer at a single institute in Japan

ABSTRACT: BACKGROUND: Several studies have confirmed the advantages of delivering high doses of external beam radiotherapy to achieve optimal tumor-control outcomes in patients with localized prostate cancer. We evaluated the medium-term treatment outcome after high-dose, image-guided intensity-modulated radiotherapy (IMRT) using intra-prostate fiducial markers for clinically localized prostate cancer. METHODS: In total, 141 patients with localized prostate cancer treated with image-guided IMRT (76Gy in 13 patients and 80Gy in 128 patients) between 2003 and 2008 were enrolled in this study. The patients were classified according to the National Comprehensive Cancer Networkdefined risk groups. Thirty-six intermediate-risk patients and 105 high-risk patients were included. Androgen-deprivation therapy was performed in 124 patients (88%) for a median of 11months (range: 2-88 months). Prostate-specific antigen (PSA) relapse was defined according to the Phoenix-definition (i.e., an absolute nadir plus 2 ng/ml dated at the call). The 5-year actuarial PSA relapse-free survival, the 5-year distant metastasis-free survival, the 5- year cause-specific survival (CSS), the 5-year overall survival (OS) outcomes and the acute and late toxicities were analyzed. The toxicity data were scored according to the Common Terminology Criteria for Adverse Events, version 4.0. The median follow-up was 60 months. RESULTS: The 5-year PSA relapse-free survival rates were 100% for the intermediate-risk patients and 82.2% for the high-risk patients; the 5-year actuarial distant metastasis-free survival rates were 100% and 95% for the intermediate- and high-risk patients, respectively; the 5-year CSS rates were 100% for both patient subsets; and the 5-year OS rates were 100% and 91.7% for the intermediate- and high-risk patients, respectively. The Gleason score (<8 vs. [greater than or equal to]8) was significant for the 5-year PSA relapse-free survival on multivariate analysis (p=0.044). There was no grade 3 or 4 acute toxicity. The incidence of grade 2 acute gastrointestinal (GI) and genitourinary (GU) toxicities were 1.4% and 8.5%, respectively. The 5-year actuarial likelihood of late grade 2-3 GI and GU toxicities were 6% and 6.3%, respectively. No grade 4 GI or GU late toxicity was observed. CONCLUSIONS: These medium-term results demonstrate a good tolerance of high-dose image-guided IMRT. However, further follow-up is needed to confirm the long-term treatment outcomes.     

大分割放疗联合EP方案化疗治疗局限期小细胞肺癌的临床疗效及安全性

Objective To investigate the efficacy and safety of hypofractionated thoracic radiotherapy combined with EP chemotherapy in the treatment of limited-stage small-cell lung cancer (LS-SCLC). Methods A total of 117 patients with LS-SCLC were enrolled and randomly divided into test group (n=59) and control group (n=58). Patients in the experiment group were given hypofractionated thoracic radiotherapy combined with EP chemotherapy, while patients in the control group were given hyperfractionation radiotherapy combined with EP chemotherapy. Objective response rate (ORR), 2-year overall survival (OS), 2-year progression free survival (PFS), and immune cell level were used to evaluate clinical efficacy. We compared the incidence of side effects between the two groups. Results After the treatment, the ORR of patients in the test group was higher than that in the control group (P>0.05). The mean OS and PFS of patients in the test group were significantly longer than those in the control group (P<0.05). The levels of CD3+, CD4+, CD4+/CD8+, and NK cells in the test group were significantly higher, whereas the levels of CD8+ were significantly lower than those in the control group (P<0.05). The incidence of radiation pneumonitis, radiation esophagitis, and severe dermatitis in the test group was significantly lower than that in the control group (P<0.05). Conclusion Hypofractionated radiotherapy combined with EP chemotherapy for treatment of LS-SCLC can effectively improve the anticancer efficacy and patient survival, reduce the damage to the body’s immune function, and alleviate adverse reaction of radiotherapy. © 2023, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.     

三维放疗联合顺铂同期化疗局部晚期宫颈癌疗效分析

目的 分析CT图像为基础三维适形放疗联合顺铂同期化疗对晚期宫颈癌患者疗效及副反应情况.方法 回顾分析2007-2008年本科收治的181例Ⅱa～Ⅳa期宫颈癌患者资料,其中年龄32～82岁(中位数50岁).放疗采用以CT图像为基础的三维适形放疗和三维192Ir后装照射技术,同期联合顺铂单药每周化疗方案.结果 随访中位数34个月,随访率为92.2%.全组患者3年总生存率为73.4%、无瘤生存率为70.4%、盆腔控制率为91.3%.肿瘤直径≥4 cm和＜4 cm者总生存率分别为66.9%和86.4%(χ2=6.29,P=0.012).RTOG分级急性胃肠道副反应1、2级发生率分别为40.0%、45.0%,泌尿系副反应l、2级发生率分别为19.9%、4.4%.RTOG分级晚期下消化道副反应3+4级发生率为4.9%.结论 以CT图像为基础三维适形放疗和三维192Ir后装照射技术联合顺铂同期化疗对局部晚期宫颈癌患者疗效较好,并对降低晚期严重副反应的发生有益.

Abstract：

Objective To analyze the therapeutic efficacy and treatment related toxicities for patients with locally advanced cervical cancer treated with three-dimensional conformal radiotherapy (3DCRT) combined with concurrent chemotherapy. Methods From January 2007 to February 2008, 181 patients with stage ⅡA-ⅣA cervical cancer were retrospectively analyzed. All patients were treated with CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent weekly cisplatin-based chemotherapy. The median age was 50 years (range, 32 to 82 years). The overall survival ( OS), disease-free survival (DFS) and local control (LC) rates were calcalated by Kaplan-Meier method and the difference was compared using Log-rank test. The treatment related toxicities were evaluated according to Radiotherapy Oncology Group (RTOG) criteria. Results With a median follow-up time of 34 months and following rate of 92. 2%, the 3-year OS, DFS and LC rates were 73.4%, 70. 4% and 91.3%,respectively. The 3-year OS rate was 66. 9% for patients with tumor diameter ≥4 cm and 86. 4% for those with tumor diameter ＜4 cm( χ2 =6. 29 ,P =0. 012). The incidences of grade 1 and grade 2 acute toxicities of the lower gastrointestinal tract and the genitourinary system were 40. 0% ,45.0% and 19. 9% ,4. 4%,retrospectively. There were no grade 3 or more acute toxicities. The incidence of grades 3 or 4 late toxicities of the lower gastrointestinal tract was 4. 9%. Conclusions CT-based three-dimensional external beam and 192Ir intracavity radiotherapy combined with concurrent chemotherapy can achieve good therapeutic effects for locally advanced cervical cancer. The acute and late toxicities are significantly reduced compared with historic controls as a result of incorporation of 3DCRT technique.     

外周血NLR、PLR对胃肠胰神经内分泌肿瘤的诊断价值

目的 探讨外周血中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）在胃肠胰神经内分泌肿瘤患者（GEP-NENs）中的诊断价值。方法 应用血细胞分析仪检测经病理确诊为GEP-NENs的95例患者外周血细胞参数，分别计算NLR和PLR，并以97例慢性胃炎及106例健康体检者为对照进行分析。利用受试者工作特征曲线（ROC）分析NLR、PLR检测的诊断价值，并找出其界值。分析NLR及PLR与GEP-NENs患者临床病理相关性。结果 （1）GEP-NENs组NLR（2.51±1.32）及PLR（148.26±72.99）显著高于慢性胃炎组及健康对照组（P<0.01）。（2）ROC曲线结果显示：NLR诊断GEP-NENs的曲线下面积为0.674，界值为2.24，敏感度为48%，特异性为86%；PLR诊断GEP-NENs的曲线下面积为0.671，界值为156.85，敏感度为41%，特异性为89%。（3）Spearman相关性分析显示，NLR及PLR与GEP-NENs的病理分级无明显相关性（P>0.05）。依据NLR及PLR诊断GEP-NENs的界值，将GEP-NENs患者分为高值组及低值组，卡方检验显示NLR及PLR值与肿瘤临床病理参数无相关性（P>0.05）。结论 外周血NLR和PLR值在GEP-NENs患者中明显升高，但诊断GEPNENs准确性及阳性率低，且与病情严重程度及疾病进展无明显相关性。     

Long term tolerance of high dose three-dimensional conformal radiotherapy in patients with localized prostate carcinoma.

BACKGROUND: The current study was undertaken to evaluate the incidence and predictors of late toxicity in patients with localized prostate carcinoma treated with high dose three-dimensional conformal radiotherapy (3D-CRT). METHODS: A total of 743 patients with prostate carcinoma classified as T1c-T3 were treated with 3D-CRT that targeted the prostate and seminal vesicles. A minimum tumor dose of 64.8 gray (Gy) was given to 96 patients (13%), 70.2 Gy to 266 patients (365), 75.6 Gy to 320 patients (43%), and 81.0 Gy to 61 patients (8%). The median follow-up time was 42 months (range, 18-109 months). Late toxicity was graded according to the Radiation Therapy Oncology Group morbidity scoring scale. RESULTS: Late gastrointestinal (GI) and urinary (GU) toxicities were absent or minimal (Grade 0 or 1) in 90% of patients. The 5-year actuarial likelihood of the development of Grade 2 and 3 late GI toxicities was 11% and 0.75%, respectively. A multivariate analysis identified doses > or =75.6 Gy (P<0.001), history of diabetes mellitus (P = 0.01), and the presence of acute GI symptoms during treatment (P = 0.02) as independent predictors of Grade > or =2 late GI toxicity. The 5-year actuarial likelihood of the development of Grade 2 and 3 late GU toxicities was 10% and 3%, respectively. Doses > or =75.6 Gy (P = 0.008) and acute GU symptoms (P<0.001) were independent predictors of Grade > or =2 late GU toxicity. Among 544 patients who were potent before treatment (73% of all patients), 211 (39%) became impotent after 3D-CRT. The 5-year actuarial risk of potency loss was 60%. Doses > or =75.6 Gy (P<0.001) and the use of neoadjuvant androgen deprivation (P = 0.01) were independent predictors of posttreatment erectile dysfunction. CONCLUSIONS: The incidence of severe late complications after high dose 3D-CRT was minimal. Radiation doses > or =75.6 Gy and the presence of acute treatment-related symptoms during 3D-CRT correlated with a higher incidence of Grade > or =2 late GI and GU toxicities. In addition to higher doses, the use of androgen deprivation therapy increased the likelihood of permanent impotence in these patients. Intensity-modulated radiotherapy, which makes it possible to enhance the conformality of the dose distribution, has recently been implemented in an attempt to reduce the incidence of moderate grade toxicities in patients receiving high dose 3D-CRT.     

Treatment of anal carcinoma in immune-compromised patients

Background

Immune-compromised populations show an increased incidence of anogenital tract neoplasms. This study was undertaken to evaluate local control (LC), overall survival (OS) and toxicity in immune-compromised patients with anal carcinoma treated with radiotherapy with or without chemotherapy.

Methods

We identified 25 patients with anal carcinoma and human immunodeficiency virus (HIV) infection or history of solid-organ transplant on chronic medical immune-suppression. Median age and follow-up were 44 years and 26 months respectively. AJCC T-stages were Tis (4%), T1 (8%), T2 (58%) and T3 (29%). N-stages were N0 (79%), N1 (4%), N2 (13%) and N3 (4%). One patient had meta-static disease at diagnosis. Seventy-five percent received concurrent chemoradiotherapy. Median radiation dose to the primary tumour was 50 Gy.

Results

One-, 3- and 5-year LC without salvage therapy was 87%, 87% and 70% respectively. One-, 3- and 5-year actuarial OS was 96%, 73% and 61% respectively. One-, 3- and 5-year OS was 100% for treatment time (TT) <50 days and 57%, 38% and 0% for TT ≥50 days (p=0.0009). All patients had acute grade 2–3 skin toxicity. Acute grade 3–4 gastrointestinal (GI), genitourinary (GU) and haematological toxicity occurred in 8%, 0% and 38%. Late grade 3–4 skin, GI and GU toxicity occurred in 8%, 4% and 0%.

Conclusions

Most HIV-positive and organ transplant patients receiving radiotherapy with or without chemotherapy experience acute toxicity but few have chronic complications. T-stage and CD4 level in HIV-positive patients predict for LC. T-stage and TT predict for OS.