VEGF-C与肿瘤淋巴管生成和淋巴结转移关系研究进展

淋巴管生成是实体肿瘤发生淋巴结转移的重要步骤,但与肿瘤血管生成相比,目前对淋巴管生成的研究较少。随着研究的不断深入,在肿瘤的动物模型以及人类肿瘤组织和肿瘤周边组织中,均发现了新生淋巴管。目前研究已证实,血管内皮生长因子-C(VEGF-C)在肿瘤的淋巴管生成及淋巴结转移中发挥重要作用,为抗肿瘤淋巴转移治疗提供了有效的靶点,有助于改善患者预后、延长生存期。     

DNA甲基化在非小细胞肺癌诊断和治疗中的应用

DNA甲基化是表观遗传学的重要组成部分,在肿瘤的发生、发展过程中起着重要作用。随着对甲基化研究的不断深入,肿瘤特异性的DNA甲基化标志物可从肿瘤患者血清/血浆、支气管肺泡的灌洗液和痰液中检出,这为进行肿瘤无创性诊断提供了新思路。本文对DNA甲基化在非小细胞肺癌诊断和治疗中的研究进展作一综述,并总结目前甲基化检测方法。     

早期胚胎与肿瘤相关性

发育生物学是研究受精卵直至成熟个体发育全过程的学科。随着对哺乳动物发育认识的不断深入，发现正常的胚胎发育与肿瘤的生物学行为具有相似之处。在胚胎性的环境中肿瘤细胞可以失去恶性表型，而胚胎离开其发育的环境可以产生肿瘤组织。胚胎与肿瘤相互关系的研究将对认识肿瘤及寻找治疗肿瘤的途径提供新的思路。     

c-Myc在肿瘤中的表达及功能

原癌蛋白c-Myc在多种组织和细胞中均有表达,其功能的异常与淋巴瘤、前列腺癌、乳腺癌、胰腺癌等多种肿瘤的发生和预后密切相关.随着对c-Myc在肿瘤中的表达及功能研究的不断深入,通过靶向c-Myc治疗肿瘤取得了较大进展.     

肿瘤干细胞相关研究进展

干细胞具有自我更新和多向分化的特征.随着对干细胞进一步了解及肿瘤基础研究的不断深入,越来越多证据表明肿瘤中极少数细胞具有干细胞特征,肿瘤干细胞概念随之产生,且已从血液肿瘤、乳腺癌及神经系统肿瘤中分离出肿瘤干细胞.这些细胞具有治疗抵抗特性,能够耐受传统的细胞毒化疗和放射治疗.肿瘤生长正是这些具有特殊表型细胞分化增殖的结果.许多学者认为,肿瘤复发、转移以及耐药等均与肿瘤干细胞相关,肿瘤治疗关键应该针对肿瘤干细胞.这一全新的治疗概念给肿瘤治疗带来希望,同时对传统肿瘤治疗模式提出了巨大挑战.肿瘤干细胞的发现、自身特点以及对肿瘤治疗可能影响的研究具有重要意义.     

肿瘤生物治疗开启黑素瘤临床治疗新时代

恶性黑素瘤是一类进展快预后差的恶性肿瘤,对传统放化疗均不敏感,晚期患者5年生存率不足5%。随着单克隆抗体、小分子化合物、过继性免疫细胞和溶瘤病毒等生物治疗技术的研发,肿瘤生物治疗为恶性黑素瘤的临床治疗开启了一个新的时代。2011年到2014年,CTLA-4单抗Ipilimumab,PD-1单抗Pembrolizumab、Nivolumab,BRAF抑制剂Vemurafinib、Dabrafinib和MEK抑制剂Trametinib等相继获得FDA批准用于治疗晚期黑素瘤患者,同时多种自体免疫细胞疗法如TIL、CAR-T,以及溶瘤病毒T-VEC等也都在其各自的临床试验中获得了可靠的疗效证据。肿瘤生物治疗以其独特的治疗优势,打破了恶性黑素瘤临床研究近50年的沉寂。然而,我国恶性黑素瘤的生物治疗临床研究尚处于起步阶段,多种生物治疗技术在中国的推广仍需进一步的临床佐证。但随着研究的不断深入,尤其是细胞免疫学、分子生物学和肿瘤遗传学等学科的发展和融合,越来越多的生物治疗方法将逐渐应用于临床,造福于更多的恶性黑素瘤患者。     

靶向肿瘤微环境精准治疗的策略及研究进展

除了肿瘤细胞本身,疾病进展和患者的最终结局还涉及到肿瘤细胞与细胞外基质、血管系统和免疫细胞等外部环境之间复杂的相互作用。近年来随着研究的不断深入,越来越多的证据表明肿瘤微环境（tumor microenvi-ronment,TME）在肿瘤的恶性进展和治疗耐药中发挥了重要作用。深入了解 TME 的复杂性、多样性及其对肿瘤治疗疗效的影响,对新治疗靶点的发现和针对 TME 进行精准治疗具有重要意义。本文综述了TME中可用于疗效预测和患者预后评价的生物标志物,总结了TME 介导肿瘤耐药性的重要机制和最新研究进展,并强调了通过配向 TME 克服肿瘤耐药和通过精确干预提高治疗效果的治疗策略和研究前景。     

头颈部肿瘤放疗者营养与支持治疗专家共识

放疗是头颈部肿瘤最常用的治疗手段。恶性肿瘤本身代谢异常及治疗过程中伴随的急性和晚期毒性等极易导致患者发生营养不良,其发生率高达44%~88%,其中重度营养不良的发生率为20%~40%。患者一旦发生营养不良,其治疗耐受性和敏感性会降低,治疗并发症会进一步增高,从而延长住院时间增加治疗费用,最终影响患者疗效。因此,营养与支持治疗是头颈肿瘤患者治疗的重要组成部分。为了使这部分患者得到合理、有效的营养与支持治疗,根据我国目前的肿瘤放疗和肿瘤营养治疗现状,参考国内外相关指南,制定适合我国情况的头颈部肿瘤放疗患者营养与支持治疗专家共识非常必要。     

基因工程抗体在肿瘤诊治中的应用

基因工程抗体(GEA)发展十分迅速,利用其特异性的靶向作用,在肿瘤诊断、治疗及预后等方面已初步显示良好效果和广阔应用前景.随着研究的不断深入,基因工程抗体必将发挥更重要的作用.现综述基因工程抗体在肿瘤应用中的最新进展.     

射频消融治疗恶性肿瘤现状

目前,恶性肿瘤的治疗多强调以手术切除为主的多学科综合治疗,而对于一些不能手术切除的肿瘤患者,微创介入疗法是一种较好的肿瘤姑息治疗手段。射频消融(radiofrequency ablation,RFA)是一种针对肿瘤局部的微创介入性疗法,已被证实是一种有效、安全、并发症少、定位准确的治疗恶性实体肿瘤的微创技术。近年来,此项技术已被广泛应用于多种恶性肿瘤,如肝癌、肺癌、乳腺癌等。随着RFA治疗原理研究的不断深入、射频消融技术的不断改进,局部肿瘤治疗的疗效将进一步提高,但仍需要随机化的研究和长期的随访来证实RFA在肿瘤治疗中的重要意义。     

Consensus Patients pour des REcherches en soins de Support : projet CyPRES

In oncology, supportive care should be used along with curative treatment or palliative care in order to improve patients’ health-related quality of life, overall survival, and to better support treatment side effects as well as the disease evolution. Unfortunately, they are not widely used in clinical practice. A direct assessment of the needs perceived as unmet by patients could help to assess the magnitude of expectations to better target treatments as an example. A prospective assessment of the expectations and needs of the patients is thus essential. This would also help to highlight the convergence between the supportive care proposed and used and that expected by patients. The first step to understanding how to optimize the use of resources and to improve the quality of care is to identify patient’s expectations. Moreover, it is now well recognized that patients should play a key role in research and that their active participation in research can increase the relevance of the research. In this context, the CyPRES project aims to: 1) assess through national consensus, patients’ expectations in terms of supportive care in order to help both clinicians and health care services; 2) prioritize patients’ expectations and arrange resources according to the priority needs identified; 3) identify supportive care for which no previous research (evidence-based medicine) has demonstrated their usefulness. A randomized clinical trial will thus be proposed; 4) involve patients in the writing, conduct, and analyses, as well as communications of the randomized clinical trial. Using two questionnaires sequentially administered through a modified DELPHI consensus method with RAND scoring, supportive care considered as priority to patients will be identified.     

The Impact of Specialized Oncology Nursing on Patient Supportive Care Outcomes

Meeting the supportive care needs of cancer patients remains a challenge to cancer care systems around the world. Despite significant improvements in the organization of medical care of patients with cancer, numerous surveys of cancer populations demonstrate that significant proportions of patients fail to have their supportive care needs met. One possible solution is the introduction of a care coordinator role using oncology nursing to help ensure that patients’ physical, psychological, and social support needs are addressed. Although having face validity, there is little empirical evidence on the effects of nurse-led supportive care coordinator roles on patient reported supportive care outcomes. In this article the authors present the results of a prospective longitudinal cohort study of 113 patients referred to a community-based specialist oncology nursing program. Using validated instruments they found significant improvements in patient-reported outcomes in key supportive care domains: unmet needs, quality of life, and continuity of care, as well as a shift in patterns of health resource utilization from acute care settings to the community over the course of the intervention. The results of this study are important in supporting the design and development of controlled trials to examine provider roles in the coordination of supportive cancer care.     

Inequalities and Barriers to the Use of Supportive Care Among Young Breast Cancer Survivors: a Qualitative Understanding

The development of supportive care for cancer patients has been shown to have a positive impact on both mortality rates and many aspects of life after cancer, particularly in young women. Meanwhile, there are still numerous inequalities in terms of cancer mortalities and quality of life among cancer survivors in France. The processes leading to unequal access to supportive care services, and the impact this has on the post-treatment period, have been poorly documented, however. The goal of this study was to understand the barriers to using supportive care services among young women breast cancer survivors under the age of 50 and to find out how this can contribute to inequalities. Thirty-six young breast cancer survivors, one third of which deemed socially deprived, were interviewed using a qualitative, inductive approach at two comprehensive care centres in France. Our findings primarily show that there are still a number of barriers to accessing supportive care for a large number of patients. The way information about supportive services is delivered is a major cause of inequalities in the use of these services. The guidance provided does not take into account either the patients’ needs or their capacity to integrate the information and anticipate problems. Certain specific post-treatment issues have yet to be addressed. Some systemic barriers could be lifted by changing the way information on supportive care services is currently organised and thereby prevent the survivorship plans now being implemented in cancer care settings from reinforcing health inequalities.     

Experiences in Home Care of Cancer Patients A new approach in cancer nursing

As a result of mutilating operative procedures, aggressive cytotoxic chemotherapy and terminal stage of the disease, tumor patients face frequent visits to the tumor center. They are often hospitalized and thereby excluded from family and home. To enable cancer therapy and supportive care on an ambulatory basis, a team consisting of two physicians, two nurses and one psychologist was settled in our department in November 1986. The purpose of this team was to transfer several oncological treatment modalities from the hospital to the homes of the patients. Apart from organizing the patients' discharge from the hospital and coordinating treatment, the main task of the team has been to follow the patient during the course of the disease and give psycological support. In our experience the possibility of home care has clearly improved the patients' quality of life.     

Challenges and advances in cervix cancer treatment in elder women

With population ageing, cancer treatments in elder patients is becoming a true public health care issue. There is an authentic dilemma between patient’s frailty, residual life expectancy and the toll that take anticancer treatments. Since elder patients are almost always excluded from clinical trials, it is hard to get robust scientific data on the tolerability of oncologic treatments and to set in place recommendations.Cervix cancer is traditionally diagnosed in younger women but it has a 2nd incidence peak between 60 and 70 years old. Cervix cancer in elder patients is a subject to many questions in terms of screening and is a therapeutic challenge.This article reviews literature data on these different aspects, from screening to surgery, from radiotherapy to brachytherapy, from chemotherapy to supportive care, from immunotherapy to geriatric assessment. We tried to show how modern therapeutic innovations may benefit elder patients. Expected benefits in terms of efficacy and toxicity may overcome the long-lasting tendency to undertreatment in elder patients and improve their quality of life after cancer treatment.In 2020, there seems to be less and less reasons justifying that elder women with cervix cancer may not receive the appropriate treatment.     

The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO)

The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire ‘cancer journey’. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today's and tomorrow's professional cancer care.     

单周方案紫杉醇单药治疗在晚期胃癌应用的进展

晚期胃癌给予化疗加支持治疗，患者的生存率和生活质量都较单独给予支持治疗高。目前，在晚期胃癌治疗中，紫杉醇类的药物是最有前途的细胞毒药物之一。紫杉醇的单药使用，特别是低剂量每周的单药治疗，显示出了令人振奋的作用，且毒副反应较低，起效快，迅速缓解症状，对于一些老年、生存状况差、不适于进行联合化疗，甚至失去常规化疗指征的晚期胃癌患者，不失为一种可供选择的治疗方法。本文着重介绍小剂量每周紫杉醇单药治疗晚期胃癌的一些临床报道。     

The impact of specialized oncology nursing on patient supportive care outcomes

Meeting the supportive care needs of cancer patients remains a challenge to cancer care systems around the world. Despite significant improvements in the organization of medical care of patients with cancer, numerous surveys of cancer populations demonstrate that significant proportions of patients fail to have their supportive care needs met. One possible solution is the introduction of a care coordinator role using oncology nursing to help ensure that patients' physical, psychological, and social support needs are addressed. Although having face validity, there is little empirical evidence on the effects of nurse-led supportive care coordinator roles on patient reported supportive care outcomes. In this article the authors present the results of a prospective longitudinal cohort study of 113 patients referred to a community-based specialist oncology nursing program. Using validated instruments they found significant improvements in patient-reported outcomes in key supportive care domains: unmet needs, quality of life, and continuity of care, as well as a shift in patterns of health resource utilization from acute care settings to the community over the course of the intervention. The results of this study are important in supporting the design and development of controlled trials to examine provider roles in the coordination of supportive cancer care.     

肺癌的最佳支持治疗

肺癌是一个有高流失率和高症状负荷的常见恶性肿瘤,其最佳治疗不仅是疾病本身的治疗,还有对症处理和确定额外所需要的支持治疗。针对晚期肺癌患者给予以缓解症状、改善生活质量为目标的支持治疗尤为重要,不仅能缓解晚期肺癌患者的痛苦,而且还避免了因过度治疗所致的痛苦,同时还能合理利用有限的医疗资源。本文着眼于肺癌患者4个主要症状（呼吸困难、咳嗽和咳血、厌食和消瘦、乏力）及精神心理困扰和实际需求的综合治疗进行讨论。     

Supportive Care in Older Adults with Cancer: Across the Continuum

Supportive care is an essential component of anticancer treatment regardless of age or treatment intent. As the number of older adults with cancer increases, and supportive care strategies enable more patients to undergo treatment, greater numbers of older patients will become cancer survivors. These patients may have lingering adverse effects from treatment and will need continued supportive care interventions. Older adults with cancer benefit from geriatric assessment (GA)-guided supportive care interventions. This can occur at any stage across the cancer treatment continuum. As a GA commonly uncovers issues potentially unrelated to anticancer treatment, it could be argued that the assessment is essentially a supportive care strategy. Key aspects of a GA include identification of comorbidities, assessing for polypharmacy, screening for cognitive impairment and delirium, assessing functional status, and screening for psychosocial issues. Treatment-related issues of particular importance in older adults include recognition of increased bone marrow toxicity, management of nausea and vomiting, identification of anemia, and prevention of neurotoxicity. The role of physical therapy and cancer rehabilitation as a supportive care strategy in older adults is important regardless of treatment stage or intent.