鼻咽癌调强放疗后腮腺转移的临床分析

摘 要：［目的］ 分析鼻咽癌患者接受根治性调强放射治疗后出现腮腺淋巴结转移的临床特点及可能的危险因素。［方法］ 回顾2008~2011年接受调强放射治疗后出现腮腺淋巴结转移的患者,分析原发肿瘤侵犯的结构及淋巴结分布规律。重新勾画腮腺浅叶,分析复发侧的腮腺及浅叶剂量参数。［结果］ 9例腮腺淋巴结转移患者（中位年龄44岁）均为局部晚期,复发部位主要位于腮腺浅叶（14/16）,初诊至转移的中位时间为25个月。转移同侧的颈淋巴结分布情况为：咽后淋巴结（9/9）、Ⅱ区(9/9)、 Ⅲ区 (4/9)、Ⅳ区(1/9)、Ⅴa区(2/9)、锁骨上区(2/9)。同侧阳性淋巴结77%存在包膜外侵。复发侧腮腺及腮腺浅叶的平均剂量分别为32.2Gy和25Gy。［结论］ 对于颈部多发淋巴结,尤其是咽后及Ⅱ区巨大淋巴结伴包膜外侵的患者,应提高腮腺区域亚临床病灶的警惕。对高危患者腮腺区的保护是调强放疗后腮腺淋巴结转移的诱因。     

初治鼻咽癌患者腮腺淋巴结转移临床特点

[目的]探讨初治鼻咽癌患者腮腺淋巴结转移的临床特点及高危因素。[方法]2008年1-10月．372例病理学证实的初治鼻咽鳞癌患者接受放射治疗，其中234例为调强放射治疗。所有患者在治疗前及治疗近结束时均行MRI扫描。调强放射治疗患者均加做增强定位CT扫描。回顾性分析以上病例影像学资料，分析腮腺淋巴结转移病例临床特点及高危因素。[结果]10例（2．7％）初治鼻咽癌（均为Ⅲ期或Ⅳ期）发生腮腺淋巴结转移。90％发生在鼻咽主要病变一侧。40％为腮腺内多发肿大淋巴结，60％为单发病变：影像学上可分为鼻咽原发病变直接侵犯、邻近淋巴结引流区有巨大转移淋巴结及无腮腺侵犯的孤立性淋巴结转移三类。[结论]Ⅲ～Ⅳ期鼻咽癌、鼻咽原发病变侵及腮腺深叶、邻近淋巴引流区巨大淋巴结转移或包膜外侵犯为鼻咽癌腮腺淋巴结转移的高危因素，应警惕腮腺淋巴结转移可能，不应过分强调患侧腮腺保护。     

鼻咽癌腮腺淋巴结转移危险因素及高危患者腮腺局部调强放疗的探讨

目的 探讨鼻咽癌腮腺淋巴结转移的高危因素,评价高危者腮腺放疗的可行性。方法 收集2011-2017年江苏省肿瘤医院放疗科收治的440例初诊鼻咽癌患者的临床资料,回顾性分析腮腺淋巴结转移相关的影像特点、治疗及预后。全组采用调强放疗技术,全腮腺或部分腮腺照射、选择性PLN照射,X线和(或)电子线补量,剂量45~60 Gy。χ²检验或Fisher's精确概率法检验和单因素分析,Logistic回归模型多因素分析。Kaplan-Meier法生存分析,Logrank检验差异。结果 腮腺区影像学可见淋巴结者共230例。确诊腮腺转移11例(占2.5%,11/440),其中腮腺淋巴结最大径≥5 mm者占81.8%(9/11)。多因素分析显示Ⅱ区淋巴结包膜外侵为其转移的独立危险因素。将腮腺区淋巴结最大径≥5 mm、Ⅱ区淋巴结包膜外侵者筛选为腮腺淋巴结转移高危组,根据腮腺区是否放疗分为放疗组及未放疗组。生存分析发现,在230例患者中,高危组腮腺区放疗者与未放疗者无局部复发生存率不同(P<0.05),总生存、无远处转移生存、无进展生存均相近(P>0.05)。结论 鼻咽癌腮腺淋巴结转移率低,Ⅱ区淋巴结包膜外侵为其独立高危因素。对于腮腺淋巴结最大径≥5 mm,或腮腺区存在影像学可见淋巴结,即使其最大径<5 mm,但若合并Ⅱ区淋巴结包膜外侵,建议行腮腺区放疗。     

鼻咽癌N1患者对侧下颈调强靶区优化的临床研究

摘 要：［目的］ 研究鼻咽癌N1患者对侧下颈调强放疗靶区优化的可行性。［方法］ 回顾性研究收治的122例AJCC分期为N1的初治鼻咽癌患者，在多模态影像指导下进行对侧下颈调强放疗靶区的优化。［结果］ 122例患者中有100例对侧下颈未预防照射，22例对侧下颈预防照射。全组随访时间为27～69个月，中位随访时间40个月。3年无疾病生存率、无远处转移率及总生存率分别为90.6%、91.1%、96.5%。全组共有3例出现颈淋巴结复发，均为高剂量区复发。预防照射的22例患者中，15例对侧中下颈有≥5mm但＜10mm的稍大淋巴结，即可疑阳性淋巴结，放疗后这些未达到诊断标准的淋巴结10例缩小，5例无明显变化。［结论］ 鼻咽癌N1患者对侧下颈不进行预防照射是安全的，但对于少数影像显示对侧中下颈存可疑阳性淋巴结时，需要结合多模态影像及重复定位CT的观察结果进行优化。     

鼻咽癌调强放疗后的少见治疗失败方式——腮腺转移

鼻咽癌放疗失败的原因主要为局部、区域复发和远处转移,但目前尚未见失败于腮腺淋巴结转移的文献报道。现报道3例NPC调强放疗后发生腮腺淋巴结转移病例。一、材料与方法1.2001年10月至2006年3月共收治鼻咽癌调强放疗患者147例,中位随访时间15个月(1～58个月)。随访过程中有3例出现腮腺淋巴结转移。3例均为初治患者,病理均为低分化鳞癌,其中男2例,女1例,年龄分别为34、53、54岁。按照福州分期,T2N0M0、T2N2M0、T3N2M0期各1例。其中2例均有颈动脉鞘受侵及双侧咽后淋巴结转移,同时合并有双侧颈部多发性淋巴结转移及同侧上颈部巨大淋巴结转移各1例,另外1例无咽旁及颈部淋巴结转移。放疗均为全程IMRT。     

N0期鼻咽癌颈部可疑阳性淋巴结64Gy放疗疗效观察

[目的]观察N0期鼻咽癌患者颈部可疑阳性淋巴结（最大横断面短径≥0.5cm但〈1cm、包膜完整、无中央坏死）给予放疗剂量64Gy时的疗效,患者的不良反应及预后。[方法]66例N0期鼻咽癌患者,颈部可疑阳性淋巴结予以64Gy的放疗剂量,以MRI检查为标准,评价疗效。[结果]放疗剂量达64Gy时颈部淋巴结转移灶完全缓解62例,有效率达93.9%,放疗前后淋巴结消退情况差异有统计学意义（P〈0.05）。在治疗结束时所有患者均出现Ⅰ级放射性皮炎,并在5年随访过程中无颈部淋巴结复发,无颈部皮下组织纤维化患者。[结论]64Gy的放疗剂量对鼻咽癌颈部可疑阳性淋巴结转移能很好地控制,且不良反应较轻,患者可耐受。     

鼻咽癌调强放疗中再程计划保护腮腺对口干燥症影响的临床研究

摘 要：［目的］ 研究鼻咽癌调强放疗中再程计划改野对减轻腮腺损伤,降低口干燥症发生率的影响。［方法］ 入组117例拟行调强放疗的鼻咽癌患者,分单次计划放疗组（46例）和再程计划放疗组（71例）。对两组靶区受照射剂量和体积、双侧腮腺受照射剂量和体积、4年局部控制率和4年生存率进行比较。［结果］ 两组靶区受照射剂量及体积变化差异无统计学意义（P＞0.05）,但再程计划放疗组双侧腮腺受照射剂量和体积均较单次计划放疗组显著降低（P＜0.05）。再程计划放疗组口干燥症严重程度较单次计划放疗组低（P=0.015）。再程计划放疗组和单次计划放疗组的4年局部控制率分别为94.4%和82.6%（P=0.046）,4年总生存率分别为84.5%和80.4%（P=0.573）。［结论］ 鼻咽癌调强放疗中再程计划改野模式可减轻腮腺损伤,降低口干燥症的发生。     

鼻咽癌调强放疗临床靶区中ⅡB区的优化对腮腺剂量的影响研究

[目的]评估优化鼻咽癌调强放疗临床靶区中ⅡB区后对腮腺剂量的影响,为鼻咽癌调强放疗靶区的优化提供依据。[方法]81例鼻咽癌调强放疗患者,以Kaplan-Meier法进行生存分析。对治疗计划保存完整的76例病例测算腮腺的放疗剂量参数,评估优化ⅡB区后对腮腺剂量的影响,并比较不同临床期别、T分期和N分期间腮腺放疗剂量参数。[结果]缩减临床靶区中C1横突或C2椎体以上水平ⅡB区可显著降低同侧腮腺的平均剂量及体积百分剂量V26（P〈0.05）;将该区处方剂量降为50Gy亦可显著降低同侧腮腺的平均剂量及V26（P〈0.05）。Ⅳ期和T4期患者的腮腺平均剂量与V26显著高于相应的其它各期别,而N0期患者的腮腺平均剂量与V26则显著低于淋巴结阳性者。[结论]对早期患者尤其是N0患者可以更合理地设计靶区,优化临床靶区中C1横突或C2椎体以上水平ⅡB区,更好地保护腮腺。     

初治鼻咽癌IMRT和常规放疗的急性不良反应的临床分析

目的观察初治鼻咽癌调强放疗和常规放疗的急性不良反应,比较两组的差异。方法将60例初治鼻咽癌患者分为常规放疗组(33例)和调强放疗组(27例),观察放疗中患者的急性皮肤反应,口干,口咽黏膜炎,急性腮腺肿胀等急性不良反应。结果调强放疗组患者的急性皮肤反应,口干和急性腮腺水肿等急性不良反应明显低于常规放疗组,对口腔黏膜炎调强放疗并无优势。结论采用调强放射治疗可以减轻患者的皮肤反应,口干,急性腮腺水肿等早期不良反应。     

鼻咽癌腮腺淋巴结转移临床分析

目的:探讨鼻咽癌腮腺淋巴结转移的发生概率和表现形式,研究其可能的转移机制及其预后的影响.方法:收集2007年7月至2009年7月江西省肿瘤医院初治鼻咽癌患者MRI诊断考虑有腮腺淋巴结转移者,分析其表现形式,可能的转移机制及预后.结果:2年期间1004例初治鼻咽癌患者中15例腮腺区结节考虑有淋巴结转移,按拟定诊断标准14例确诊为腮腺淋巴结转移,1例排除,发生率1.4%.转移淋巴结大部分(82%)为浅叶淋巴结.发生腮腺淋巴结转移者绝大部分(93%)为中晚期病例,N3患者占43%,64%患者有颈部淋巴结包膜外侵,7例患者有Ⅱa及Ⅱb区淋巴结包膜外侵融合.79%的患者有咽旁间隙不同程度侵犯,36%患者放化疗前进行过颈部干预.中位随访10.5个月后,14例患者6例1年内发生远处转移,其中2例已死亡.结论:鼻咽癌腮腺淋巴结转移率为1.4%.其发生可能与颈部淋巴结＞6cm伴包膜外侵;Ⅱa、Ⅱb区淋巴结融合;咽旁间隙肿瘤占据紧邻腮腺以及既往曾行颈部干预等有关.腮腺淋巴结转移是鼻咽癌预后不良的因素.     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Sarcopenia is associated with survival in patients with urothelial carcinoma treated with systemic chemotherapy

International Journal of Clinical Oncology - Sarcopenia impacts perioperative outcomes and prognosis in various carcinomas. We aimed to investigate whether sarcopenia at the time of chemotherapy...     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

超声心动图诊断26例心脏黏液瘤

应用经胸二维超声心动图（2DE）、彩色血流显像（CDFI）及频谱多普勒显像（Doppler）诊断26例心脏黏液瘤（27个瘤体），对团块的位置、数目、大小、形状、瘤蒂附着点和活动度、心腔内及瓣膜口血流等进行探查及分析．认为心脏超声检查是心脏黏液瘤的首选检查方法，具有实时、经济、简便易行等优点。