首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 109 毫秒
1.
目的探讨直肠癌术前放射治疗的疗效及在直肠癌治疗中的价值.方法 1995年6月至1998年6月收治Ⅱ~Ⅲ期直肠癌患者78例,随机分为术前放疗组和单纯手术组,每组39例.采用常规放疗方法,剂量为DT 50 Gy/5周,照射后4~5周行根治性手术.结果术前放疗组术后病理检查肿瘤细胞呈轻度反应者4例,中度反应者15例,重度反应者17例,肿瘤细胞消失者3例;临床分期变化:T期下降17例,占43.6%,N期下降7例,占33.3%.术前放疗组和单纯手术组的淋巴结转移率分别为15.4%和35.9%,差异有显著性(P=0.039);术前放疗组和单纯手术组的术后复发率分别为17.9%和41.0%,差异有显著性(P=0.015);术前放疗组和单纯手术组3,5年生存率分别为76.9%、53.8%和59.0%、35.9%,差异有显著性(P=0.034).术前放疗组的急性放疗反应可耐受,亦未出现由放疗造成的远期并发症.结论术前放疗可降低直肠癌的局部复发率,提高患者的生存率;急性放疗反应可耐受,并不增加手术难度及并发症.  相似文献   

2.
目的:探讨结直肠癌肝转移术前化疗能否提高患者的生存率。方法:计算机文献检索ISI Web ofKnowledge、Pubmed及中国期刊网,检索国内外自1990年1月至2010年12月间公开发表的有关结直肠癌肝转移治疗的文章。Meta分析比较术前化疗组与未接受术前化疗组术后生存率的差异。结果:术前化疗组与未接受术前化疗组相比较,1年生存率(OR=0.44,CI:0.17-1.13,P=0.07)、3年生存率(OR=1.02,CI:0.64-1.62,P=0.93)、5年生存率(OR=0.69,CI:0.42-1.14,P=0.16)均无统计学意义。结论:对于结直肠癌肝转移患者,术前化疗不能提高术后生存率。  相似文献   

3.
术前放疗提高中晚期食管癌生存率随访结果报道   总被引:3,自引:0,他引:3  
目的:研究随机化60Co γ线术前放疗提高食管癌远期生存率的效果.方法:运用生存分析的寿命表法和Kaplan-Meier法对比分析了本院1972~1986年经随机抽签决定的336例术前放疗和1 680例单纯手术患者随访15~30年的资料.结果:发现术前放疗能显著提高中晚期食管癌5、10、15年生存率;术后15年内术前放疗与单纯手术者相比生存曲线位置显著提高(P=0.001);分组分析发现Ⅱa期食管癌术前放疗后分期下降者比分期不变者生存曲线位置显著提高(P<0.04);术前放疗对中段食管癌、根治切除者提高远期生存率效果显著.结论:60Co γ线术前放疗能提高中晚期食管癌的远期生存率,应该在临床上推广应用.  相似文献   

4.
食管癌术后辅助治疗的Meta分析   总被引:1,自引:0,他引:1  
[目的]探讨食管癌术后辅助治疗的价值.[方法]收集1995年至2011年期间发表的关于食管癌术后辅助治疗的随机对照研究文章,利用Stata12.0软件进行Meta分析.[结果]与单纯手术相比,术后辅助化疗患者的3年无进展生存率相对危险度(RR)为1.225 (95%CI:1.012~1.482,P=0.037),差异有统计学意义.而3、5年总生存率的RR值分别为0.899(95%CI:0.797~1.016,P=0.087),1.183(95%CI:0.97~1.442,P=0.098),差异无统计学意义.同样,与单纯手术相比,术后辅助放疗患者的3年总生存率的RR值为0.935 (95%CI:0.879~0.994,P=0.033),差异有统计学意义.而5年总生存率的RR值为0.988(95%CI:0.821~1.188,P=0.897),差异无统计学意义.Begg's与Egger试验检测P值均大于0.05,不存在发表偏倚.[结论]术后辅助化疗能延长食管癌患者术后的3年无进展生存率,术后辅助放疗不利于延长食管癌患者的3年总生存率.  相似文献   

5.
目的 采用偱证医学荟萃分析的方法比较胃癌术后辅助放化疗与辅助化疗间的疗效差异。方法 计算机检索PubMed、EMbase、Cochrane图书馆、万方、维普、CNKI及中国生物医学等数据库,搜集有关胃癌术后辅助放化疗和辅助化疗比较的临床对照研究资料,汇总数据采用RevMan 5.2.5和Stata 12.0软件进行分析。两组间差异采用优势比(OR)及95%可信区间(95% CI)描述。结果 根据纳入和排除标准,最终纳入12个包括1674例患者的临床对照研究资料。荟萃分析结果显示,与胃癌术后辅助化疗相比,辅助放化疗的3、5年生存率更高(OR=2.96,95% CI= 1.75~5.03,P=0.000;OR=1.45,95% CI=1.06~1.99,P=0.020),辅助放化疗的局部复发率更低(OR=0.50,95% CI=0.34~0.72,P=0.000),但远处转移率两组相似(OR=0.79,95% CI=0.58~1.07,P=0.130)。结论 现有研究结果的荟萃分析显示,与胃癌术后辅助化疗相比,胃癌术后辅助放化疗是一种较为安全和有效的治疗方法。  相似文献   

6.
目的探讨局部晚期直肠癌术前小野加速超分割放射治疗的疗效。方法2000年6月至2002年6月收治Ⅱ~Ⅲ期直肠癌患者76例,随机分为术前小野加速超分割放疗组和单纯手术组,每组38例。采用局部小野(local extended fields)加速超分割放疗方法,剂量为DT30 Gy/20f/2周,照射后2~4周行根治性手术。结果术前小野加速超分割放疗组术后病理均有不同程度的放疗反应;临床分期变化:T期下降14例,占36.8%;N期下降7例,占31.8%。术前小野加速超分割放疗组和单纯手术组的术后复发率分别为21.0%和42.1%,差异有显著性(P<0.05);两组的3年生存率分别为71.0%和47.4%,差异有显著性(P<0.05)。术前小野加速超分割放疗组的急性放疗反应可耐受,亦未出现由放疗造成的远期并发症。结论术前小野加速超分割放疗可降低直肠癌的局部复发率,提高患者生存率;急性放疗反应可耐受,并不增加手术难度及并发症。  相似文献   

7.
目的 通过Meta分析评价促炎性饮食和结直肠癌患病风险的关系,为科学饮食提供参考依据。方法 截至2019年7月,系统检索英文数据库PubMed、Embase、Web of Science、Cochrane Library和中文数据库中国知网、万方数据库、维普数据库,筛选出饮食炎症效应与结直肠癌发病风险相关的文献。所纳入文献均采用膳食炎症指数(DII)来评价膳食的炎症效应。采用Revman 5.2软件进行Meta分析,对纳入研究的OR值及95%CI值进行合并,同时根据肿瘤类型和地域进行亚组分析。结果 共纳入文献10篇,参与者964 935例。Meta分析结果显示,最高促炎性饮食的个体与最高抗炎性饮食的个体相比较,结直肠癌的患病风险增加(OR=1.43,95%CI=1.28~1.60)。按肿瘤类型进行亚组分析显示,促炎性饮食的结肠癌患病风险增加(OR=1.37,95%CI=1.20~1.57),直肠癌患病风险亦增加(OR=1.33,95%CI=1.11~1.61)。按地域进行亚组分析显示,促炎性饮食的结直肠癌的患病风险在亚洲(OR=2.17,95%CI=1.77~2.68)、欧洲(OR=1.56,95%CI=1.32~1.85)、北美(OR=1.28,95%CI=1.21 ~1.35)。结论 促炎性饮食可能会增加结直肠癌的患病风险。亚洲地区促炎性饮食与结直肠癌患病风险的相关性可能高于欧洲和北美洲,这一结论需要更多的研究进一步确认。  相似文献   

8.
可切除结直肠癌肝转移患者术后约有75%的复发率.围手术期的氟尿嘧啶、亚叶酸、奥沙利铂(FOLFOX)化疗较单纯手术可以减少合格入组患者和手术患者的疾病进展风险.但术前化疗可导致肝血管改变和脂性肝炎从而增加手术风险.汇总分析显示与单纯手术相比,术后接受氟尿嘧啶和亚叶酸为基础的辅助化疗,有延长无疾病进展生存期的趋势.贝伐单抗无论术前还是术后使用可能均不会增加手术风险.如何合理地选择化疗时机及最佳持续时间等问题尚待解决.  相似文献   

9.
目的探讨术前放疗对可手术切除直肠癌患者手术与预后的影响.方法 189例直肠癌患者随机分为实验组(术前放疗 手术)及对照组(单纯手术),实验组术前辅助加速超分割放疗,前瞻性分析其疗效.结果实验组和对照组吻合口漏发生率分别为4.5%及2.5% (P>0.05);实验组与对照组局部复发率分别为15.7%和28.1%(P<0.05).实验组和对照组无瘤生存率、总5年生存率分别为78.4%、86.3%和48.3%、62.5%,差异有显著性(P=0.01及P=0.0072).结论术前放疗没有明显增加手术难度和术后并发症,并有助于改善直肠癌患者的预后.  相似文献   

10.
术前放疗加手术与单纯手术治疗喉癌疗效比较的系统评价   总被引:1,自引:0,他引:1  
目的:比较术前放疗加手术与单纯手术治疗喉癌的疗效,为喉癌治疗方式的选择提供可靠的循证依据.方法:采用系统评价的方法,检索Cochrane中心临床对照试验注册数据库、Medline (OVID)、Embase、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)以及中文科技期刊全文数据库(VIP),截至2009-11-30,以喉癌患者为研究对象,高质量随机对照研究术前放疗加手术与单纯手术的疗效.结果:共纳入6个随机对照试验,研究对象1 127例.术前放疗加手术与单纯手术相比并未提高喉癌患者的3和5年生存率,RR分别为0.94(95%CI为0.72~1.23)和1.09(95%CI为0.87~1.37).术前放疗加手术与单纯手术相比治疗声门上型、声门型以及Ⅱ和Ⅲ期喉癌5年生存率,差异均无统计学意义,RR分别为1.02(95%CI为0.79~1.31)、1.01(95%CI为0.61~1.68)、1.10(95%CI为0.65~1.85)和0.85(95%CI为0.37~1.93).纳入研究均未比较2种治疗后的生存质量.结论:本系统评价纳入研究有限,且无比较2种治疗后生存质量的研究,尚不能得出在喉癌的治疗中术前放疗加手术优于单纯手术治疗疗效的结论.需开展更多高质量研究,对术前放疗加手术与单纯手术治疗喉癌的全面疗效评估提供更可靠的证据.  相似文献   

11.
目的以Meta分析评价针对新辅助治疗后达临床完全缓解的直肠癌患者行根治性手术、局部切除以及非手术临床观察的效果,为临床决策提供临床依据。方法以"rectal cancer"、"rectal adenocarcinoma"、"rectal neoplasms"、"neoadjuvant therapy"、"preoperative therapy"、"radiochemotherapy"、"radiotherapy"、"clinical complete response"、"complete pathological response"为主题词,在PubMed上收集有关直肠癌临床完全缓解患者进行根治性手术、局部切除和非手术治疗临床观察的公开发表的英文文献。纳入局部切除与根治性手术预后情况对比文献5篇,非手术临床观察与局部切除对比文献5篇。经两名研究者独立提取相关数据资料后进行Meta分析,用定性方法比较各预后指标在非手术组与根治性手术组、局切组与根治性手术组间的差异。利用漏斗图法评价发表偏倚。结果定性分析结果显示,与根治性手术组相比,非手术治疗临床观察组局部复发RR为5.33,95%CI为1.64~17.36,总复发RR为2.37,95%CI为1.15~4.85,差异有统计学意义;但远处转移率(RR=0.87,95%CI:0.16~41.11)及3~5年总生存率(RR=0.89,95%CI:0.66~1.21)则无统计学差异。与根治性手术组相比,局部切除组局部复发率(RR=1.25,95%CI:0.64~2.44)、远处转移率(RR=0.55,95%CI:0.27~1.10)及总复发率(RR=0.77,95%CI:0.49~1.22)均无统计学差异,且5年总生存率局部切除组界值性高于根治性手术组(P0.05)。结论直肠癌新辅助治疗后达临床完全缓解患者行非手术观察的局部复发率、总复发率高于根治性手术,但远处转移、长期生存与根治性手术相比无显著差异。局部切除术的局部复发率、远处转移率与根治性手术相比无显著差异,行局部切除者术长期生存甚至优于根治性手术。  相似文献   

12.
刘秀兰  孙晓革 《癌症进展》2011,9(6):730-733
目的 探讨术前同步放化疗治疗局部晚期低位直肠癌的安全性和有效性.方法 对临床分期属T3/T4低位直肠癌患者分为A组和B组.A组28例患者,给予术前放疗,同步口服卡培他滨.B组26例患者直接给予手术.结果 A组和B组根治术率分别为82.1%和50.0% (P <0.01),保肛率分别为64.3%和26.9% (P<0.0...  相似文献   

13.
Radiotherapy and concurrent radiochemotherapy for rectal cancer   总被引:3,自引:0,他引:3  
Rödel C  Sauer R 《Surgical oncology》2004,13(2-3):93-101
Adjuvant radiotherapy with or without chemotherapy has been used widely in an attempt to improve outcome in rectal cancer. For locally advanced disease, postoperative radiochemotherapy significantly improved both local control and overall survival when compared with surgery alone or surgery plus irradiation. This prompted a National Cancer Institute Consensus Conference in the United States in 1990 to recommend postoperative radiochemotherapy for patients with TNM stage II and III rectal cancer as standard treatment. In Europe, several randomized studies tested preoperative radiotherapy in comparison to surgery alone and showed lower local failure rates. A recent meta-analysis concluded that the combination of preoperative radiotherapy and surgery, as compared with surgery alone, significantly improves local control and overall survival. These results are, however, challenged by more recent reports of extraordinarily low local failure rates following improved surgical techniques, including total mesorectal excision. Evidently, the current monolithic approaches to either apply the same schedule of postoperative radiochemotherapy to all patients with stage II/III rectal cancer or to give preoperative intensive short-course radiation according to the Swedish concept for all patients with resectable rectal cancer irrespective of tumor stage and treatment goal (e.g. sphincter preservation), need to be questioned.  相似文献   

14.
BACKGROUND: The benefit of external radiotherapy for gastric carcinoma has been extensively studied, but data on survival are still equivocal. OBJECTIVE: To assess the effectiveness of surgery combined with preoperative radiotherapy or postoperative chemoradiotherapy in the reduction of all-cause mortality in patients with resectable gastric carcinoma. METHODS: Computerised bibliographic searches of MEDLINE and CANCERLIT (1970-2006) were supplemented with hand searches of reference lists. STUDY SELECTION: Studies were included if they were randomised controlled trials (RCTs) comparing mortality of surgery combined with preoperative radiotherapy or postoperative chemoradiotherapy to surgery alone, and if they included patients with histologically-proven gastric adenocarcinoma without metastases. Nine eligible RCTs, 4 of preoperative radiotherapy (832 patients) and 5 of postoperative chemoradiotherapy (869 patients), were identified and included in the meta-analysis. DATA EXTRACTION: Data on study populations, interventions, and outcomes were extracted from each RCT according to the intention to treat method by three independent observers and combined using the DerSimonian and Laird method. RESULTS: Surgery combined with preoperative radiotherapy compared to surgery alone significantly reduced the 3-year (OR 0.57; 95% CI 0.43-0.76: p=0.0001) and 5-year (OR 0.62; 95% CI 0.46-0.84; p=0.002) mortality rate. A significant reduction of the 5-year (OR 0.45; 95% CI 0.32-0.64; p<0.00001) mortality rate was observed when surgery followed by chemoradiotherapy was compared to surgery alone. CONCLUSIONS: In patients with resectable gastric carcinoma, adjuvant radiotherapy significantly reduces 3-year and 5-year all-cause mortality, but the magnitude of the benefit is relatively small. Available evidence is inadequate to determine whether postoperative chemoradiotherapy is superior to preoperative radiotherapy.  相似文献   

15.
Chemoradiotherapy (CRT) followed by surgery is the recommended approach in the last years for stage II and III rectal cancer with the intention to decrease the risk of local recurrence. However, fewer patients benefit from this strategy in terms of overall survival and long-term adverse outcomes because T3 rectal cancer has a broad range of prognosis, as shown by recent publications. Many patients with cT3 rectal cancer have a substantial risk of overtreatment with long-term toxicity related to radiotherapy that could be avoided in a subset group of cT3 tumors with good prognosis. These findings raised the question of whether all cT3 rectal cancer should receive preoperative radiotherapy and if a selected cT3 subgroup could be treated by surgery alone. This review addresses the rationale of selecting good prognosis cT3 rectal cancer for surgery alone and analyzes the data to support this recommendation.  相似文献   

16.
目的 观察可切除低位直肠癌术前同步放疗化疗临床疗效及安全性.方法 23例可切除低位直肠癌患者,术前予4野盆腔照射,放疗总剂量为46Gy.200cGy/f,5f/W,并于放疗第1、4周同步亚叶酸钙200 mg,静脉输注d1~d5,氟脲嘧啶500 mg/m<'2>/d,持续静脉输注d1~d5化疗,完成放化疗后,4周手术,术...  相似文献   

17.
目的评估术前口服卡培他滨(希罗达)与放疗联合治疗局部进展期低位直肠癌的远期疗效及安全性。方法对局部进展期(T3/T4)低位直肠腺癌(距肛缘≤9Ccm)患者51例,术前给予口服卡培他滨(希罗达)并联合放疗。放疗结束后休息3—4周,按TME原则进行手术。结果3例患者临床完全消退(cCR),占5.88%,未行手术;其余48例患者均行根治性切除术(R0),实际保肛率90.20%(46/51),10例术后病理检查未见肿瘤细胞,为病理消退(pCR),总消退率为25.49%(13/51)。肿瘤降期41例,占80.39%。5年无病生存率为70.59%,总生存率为80.39%。放化疗过程中出现3、4级不良反应5例,无疾病进展、手术死亡者。结论术前口服卡培他滨联合放疗治疗局部进展期低位直肠癌是有效安全的。  相似文献   

18.
Purpose is to give an overview of treatment possibilities of rectal cancer over time, but also of the real management of rectal cancer especially in relation to age. From literature search representative randomised studies on patients with resectable rectal cancer, comparing only surgery, post- and preoperative radiotherapy with or without chemotherapy, are reviewed. We also reviewed the literature regarding radiotherapy for rectal cancer described in population-based studies. The overview of the trials showed that preoperative radiotherapy improves local control in relation to no or postoperative radiotherapy. Adding chemotherapy did not significantly improve survival. No relations were seen between age and complications. All population-based studies showed that increasing age is associated with less (neo)adjuvant treatment. To avoid local recurrence, the best possible treatment, being preoperative RT, should be given to all patients with resectable rectal cancer, irrespective of age.  相似文献   

19.
目的 探讨子宫颈癌术后调强放疗(IMRT)与三维适形放疗(3DCRT)的临床疗效及安全性。方法 选取我院2012年9月至2013年3月60例宫颈癌术后患者,均制定IMRT和3DCRT两种放疗计划,随机分为IMRT组和3DCRT组进行放疗, IMRT组行5野6MV X射线放疗, 3DCRT组行4野6MV-X射线盒式照射,处方剂量均为95%计划靶区体积(PTV)为45 Gy/25 f/5 W。评价PTV和危及器官(OAR)的剂量分布特点;随访两组OAR的急慢性放射性损伤,计算两组3年生存率。结果IMRT组PTV的适形度指数(CI)、均匀性指数(HI)分别为0.80±0.03、1.10±0.01,3DCRT组分别为0.58±0.19、1.09±0.01,差异有统计学意义(P<0.05);IMRT组膀胱前壁的V10、V20、V30、V40和V45均低于3DCRT组,差异有统计学意义(P<0.05);IMRT组直肠后壁的V20、V30、V40和V45均低于3DCRT组,差异有统计学意义(P<0.05);IMRT组直肠和膀胱的急性和慢性放射性损伤发生率低于3DCRT组,差异有统计学意义(P<0.05)。IMRT组3年生存率为83.3%,3DCRT组为80.0%,差异无统计学意义(P>0.05)。结论 在PTV的CI、HI及保护OAR如膀胱前壁、直肠后壁上,IMRT优于3DCRT。  相似文献   

20.
Aims: Controversy continues regarding the treatment of patients with resectable rectal cancer, particularly in regard to the effects of adjuvant therapies on long‐term survival. The benefits of adjuvant chemotherapy alone in patients with stage III rectal cancer after curative resection remain unclear. The aim of this study was to compare the overall survival of patients who had received adjuvant chemotherapy after resection of a stage III rectal cancer (111 patients) with the survival of a historical control group who had surgery alone before chemotherapy was introduced (129 patients). Methods: Treatment and outcomes data were drawn from a prospective hospital registry of consecutive patients who had a resection for stage III rectal cancer. Results: The estimated Kaplan–Meier overall 5‐year survival rate in patients who received chemotherapy (68.7%, 95% CI 58.3–77.1%, log‐rank P < 0.001) was improved compared with the historical controls (40.5%, 95% CI 31.4–49.5%, log–rank P < 0.001 ). No systematic differences between the treated and control group were found. Conclusion: This study has shown improved survival after adjuvant chemotherapy in patients with stage III rectal cancer as compared with historical controls treated by surgery alone. Hence, there could be subsets of patients whom when treated with surgery in a specialized surgical unit, may benefit from chemotherapy and spared the toxicities of adjuvant radiotherapy. This should be explored further in a cooperative trial group setting.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号