中晚期卵巢癌术后顺铂腹腔联合紫杉醇静脉化疗的临床观察

目的:观察顺铂腹腔联合紫杉醇静脉化疗治疗中晚期卵巢癌术后患者的临床疗效和安全性.方法:回顾性分析我院2006-01-2009-12行细胞减灭术Ⅱ～Ⅳ期卵巢癌76例患者,顺铂腹腔联合紫杉醇静脉化疗36例为治疗组,并以同期行顺铂联合紫杉醇静脉化疗患者40例作为对照.比较两组患者无进展生存期(PFS)、生存率和不良反应.结果:治疗组PFS 27个月,对照组PFS 23个月,P＜0.05.治疗组1、2和3年生存率分别为97.22％(35/36)、94.44％(34/36)和88.88％(32/36),对照组1、2和3年生存率分别为95.00％(38/40)、90.00％(36/40)和77.50％(31/40).治化疗组呕吐及肾功能损伤低于对照组,而腹痛高于对照组.结论:顺铂腹腔联合紫杉醇静脉化疗治疗中晚期卵巢癌术后患者可延长患者PFS及生存率,毒副反应轻,值得临床应用.     

肝动脉化疗栓塞联合射频消融治疗中晚期肝癌的临床疗效

目的探讨肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗中晚期肝癌的临床疗效。方法62例具有介入治疗指征的中晚期肝癌患者随机均分为2组,对照组31例单独行TACE治疗,观察组31例行TACE联合RFA治疗。比较观察2组的临床疗效及AFP水平。结果观察组总有效率为87．1％,高于对照组的51．6％（P〈0．05）。观察组术后AFP水平明显低于对照组（P〈0．05）。随访24个月各时期的生存率观察组均明显高于对照组（P〈0．05）。结论TACE联合RFA治疗中晚期肝癌安全、可靠,可提高患者生存率,延长患者生存时间,疗效优于单独应用TACE。     

复方斑蝥胶囊联合三维适形放疗治疗中晚期原发性肝癌临床观察

目的:观察复方斑蝥胶囊与三维适形放疗联合应用对中晚期原发性肝癌的疗效及不良反应.方法:68例中晚期原发性肝癌分为治疗组和对照组,两组放疗方法、剂量相同,治疗组联合应用复方斑蝥胶囊.结果:有效率治疗组79.4%(27/34),对照组58.8%(20/34),P<0.05.治疗后1年、2年生存率治疗组为 73.5%(25/34)和44.1%(15/34),对照组52.9%(18/34)和32.4%(11/34),P<0.05.骨髓抑制发生率治疗组26.5%(9/34),对照组38.2%(13/34),P<0.05.结论:复方斑蝥胶囊与放疗联合应用治疗中晚期原发性肝癌能提高疗效,减轻不良反应.     

单纯放射治疗与放化疗联合治疗中晚期宫颈癌的疗效比较

目的对比单纯放疗与放、化疗联合治疗中晚期宫颈癌的疗效。方法按照随机数字表法将105例中晚期患者随机分为观察组(53例)和对照组(52例),对照组给予放射治疗,观察组给予同步放化疗治疗。结果观察组患者的近期疗效及3年生存率均显著高于对照组(P<0.05),观察组患者胃肠道不良反应发生率及骨髓抑制发生率均显著高于对照组(P<0.05)。结论放疗联合化疗治疗中晚期宫颈癌,疗效确切,可有效提高患者生存质量及生存率,值得临床借鉴。     

DC+CIK联合化疗治疗晚期非小细胞肺癌的临床疗效评价

目的:评价DC+CIK联合常规化疗治疗晚期非小细胞肺癌(NSCLC)的临床疗效.方法:选择70例晚期NSCLC患者进行研究,采用DC+CIK与常规化疗间隔进行的方案(生物治疗联合化疗组),对其进行生存分析;同时,对生物治疗联合化疗组、单纯常规化疗组同期配对NSCLC患者各61例,比较生物治疗联合化疗组与常规化疗对照组患者的生存率.结果:生物治疗联合常规化疗组患者预期1、2、3年生存率分别为59.6%、29.6%、21.8%.生物治疗联合化疗组和单纯常规化疗组比较1年生存率分别为57.2%和37.3%,2年生存率分别为27.0%和10.1%(P＜0.05).结论:临床研究证实了DC+CIK联合常规化疗能够延长晚期NSCLC患者的生存期,提高患者的生存率和生活质量.     

同期适形放疗联合化疗治疗中晚期食管癌的临床研究

背景与目的:放化联合治疗是现今治疗中晚期食管癌的标准模式,本研究目的是观察三维适形放疗联合同期化疗治疗中晚期食管癌的不良反应与临床疗效.方法:32例符合入组条件的中晚期食管癌患者接受三维适形放疗及同期化疗.观察患者的治疗完成情况、治疗期间、治疗后的放化疗不良反应及临床疗效.同时进一步研究食管癌同期放化治疗所致放射性肺损伤的相关临床因素.结果:全组患者白细胞减少总发生率为90.62％;急性肝肾损伤总发生率为18.75％.急性放射性食管炎1级16例,2级12例,3级4例,无4级发生.急性放射性肺炎0级6例,1级22例,2级2例,3级2例,无4级发生.治疗结束后完全缓解(CR)8例,部分缓解(PR) 21例,稳定(SD)3例,总有效率(PR+CR)为90.63％(29/32).中位生存期16个月,1、2年生存率为73.5％和60.2％.单因素分析显示肿瘤GTV体积(P=0.000 6)和CT长度(P=0.06)是影响患者生存率的预后因素,肿瘤体积大小是唯一影响放射性肺炎严重程度(P=0.011)的预后因素.结论:LFP方案与放疗同步应用,不良反应较大,但可耐受,远期疗效有一定提高.     

新辅助化疗联合放疗对宫颈癌患者临床疗效及预后的影响

目的 探讨新辅助化疗联合放疗对宫颈癌患者临床疗效及预后的影响.方法 根据治疗方式的不同将85例宫颈癌患者分为单独放疗组(行放疗)37例和联合治疗组(行新辅助化疗联合放疗)48例.比较两组患者治疗后的临床疗效、肿瘤直径及不良反应发生情况.对两组患者均随访2年,比较两组患者的复发率、生存率.结果 治疗后,联合治疗组患者的总有效率高于单独放疗组患者(P﹤0.05).治疗后,联合治疗组患者的肿瘤直径明显短于单独放疗组,差异有统计学意义(P﹤0.01).截至随访结束,单独放疗组患者的复发率高于联合治疗组患者,生存率低于联合治疗组患者(P﹤0.05).单独放疗组患者放射性直肠炎、放射性膀胱炎的发生率均高于联合治疗组患者(P﹤0.05).结论 新辅助化疗联合放疗可有效提高宫颈癌患者的临床疗效,提高生存率,降低复发率,且不良反应可控.     

超选择动脉插管化疗在治疗妇科中晚期恶性肿瘤中的应用

目的:评价选择动脉插管化疗(SIAC)在妇科中晚期恶性肿瘤治疗中的价值。方法:对128例中晚期妇科恶性肿瘤患者采用Seldinger法行超选择动脉插管化疗,主要药物有DDP、MMC、EPIA、ADM、5蛳Fu、DACT、CTX、MTX等。SIAC治疗患者2 ~ 4疗程后手术。结果:128例行SIAC的中晚期恶性肿瘤患者,116例获得再次手术机会,再次手术时术中见大部分肿瘤体积明显缩小,粘连程度明显好转,腹水不同程度消退。完全有效33例,部分有效75例,轻微有效13例,无效7例。经SIAC治疗,患者生存率较以往未行SIAC治疗的患者生存率明显提高,其2 a、5 a生存率分别为57.6 %、24.4 %。结论:超选择动脉插管化疗治疗妇科中晚期恶性肿瘤可使肿瘤缩小甚至消退,提高手术成功率,延长患者生存期。     

125 I粒子植入联合DP方案治疗中晚期肺鳞癌的临床疗效

目的 分析125 I粒子植入联合多西他赛和顺铂(DP)方案对治疗中晚期肺鳞癌的临床疗效.方法 选取84例中晚期肺鳞癌患者为研究对象,随机将患者分为实验组和对照组,每组各42例,实验组患者给予125 I粒子植入联合多西他赛和顺铂(DP)方案治疗,对照组患者给予DP方案化疗,分析比较两组患者的临床疗效及临床不良反应.结果实验组患者的临床治疗有效率为73.81%,明显较高对照组的47.62%(P<0.05);实验组患者的1年生存率(85.71%)及中位无进展生存期[(6.3±1.4)个月]明显高于对照组[54.76%,(3.8±1.1)个月](P<0.05);两组患者临床不良反应主要为白细胞及血小板数目减少、恶心呕吐等症状,但程度均较轻(P>0.05).结论 125I粒子植入联合多西他赛和顺铂( DP)方案治疗中晚期肺鳞癌的临床疗效肯定,患者生存期可得到延长,毒副作用较小,该化疗方案可为临床治疗中晚期肺鳞癌提供参考价值.     

鼻咽癌远处转移病例的疗效分析

目的　探讨鼻咽癌远处转移病例的治疗方法及疗效。方法　选择 1988年 3月～ 1997年 5月间的鼻咽癌远处转移病例的 94例 ,其中 2 6例单独行放疗、3 8例行化疗 放疗及 3 0例单独行化疗。生存率统计采用kaplan Meier法 ,行Log rank检验。 结果　全组的 ,1,3 ,5年生存率分别为 3 7.5 %、11.7%及 3 .3 %。其中单独行放疗或化疗组病例的生存率较高 ,且仅单独放疗组有 5年生存率 ( 4 .1% ) ,但 3组的生存率差别不显著。结论　鼻咽癌远处转移病例单独行放疗或化疗的疗效可能较好。     

Adjuvant radiation therapy for pancreatic cancer: a review of the old and the new

Surgery represents the only potential curative treatment option for patients diagnosed with pancreatic adenocarcinoma. Despite aggressive surgical management for patients deemed to be resectable, rates of local recurrence and/or distant metastases remain high, resulting in poor long-term outcomes. In an effort to reduce recurrence rates and improve survival for patients having undergone resection, adjuvant therapies (ATs) including chemotherapy and chemoradiation therapy (CRT) have been explored. While adjuvant chemotherapy has been shown to consistently improve outcomes, the data regarding adjuvant radiation therapy (RT) is mixed. Although the ability of radiation to improve local control has been demonstrated, it has not always led to improved survival outcomes for patients. Early trials are flawed in their utilization of sub-optimal radiation techniques, limiting their generalizability. Recent and ongoing trials incorporate more optimized RT approaches and seek to clarify its role in treatment strategies. At the same time novel radiation techniques such as intensity modulated RT (IMRT) and stereotactic body RT (SBRT) are under active investigation. It is hoped that these efforts will lead to improved disease-related outcomes while reducing toxicity rates.     

Minimally invasive local ablative therapies in combination with radioiodine therapy in benign thyroid disease: preparation,feasibility and efficiency – preliminary results

Abstract

Purpose: Initial studies of combinations of radioiodine therapy (RIT) and local ablative procedures for the treatment of thyroid nodules have shown promising results. The goal of this study was to evaluate the effectiveness of RIT combined with radiofrequency ablation (RFA) in patients with goitres and to determine which ablative procedure is the most suitable for a combined therapy.

Methods: Thirty patients with goitres were divided into two subgroups. A test group of 15 patients received combined therapy (RIT?+?RFA) and a control group of 15 patients received RIT mono therapy. All patients underwent assessments including ultrasound, laboratory evaluation (T3, T4, TSH, TG, TPOAb, TgAbTRAb) and scintigraphic imaging with Tc-99m-Pertechnetate. The 3-month volume reduction was used to evaluate therapy effectiveness.

Results: Combined therapy (subgroup 1) resulted in a significant (p?<?0.05) thyroid volume reduction (22.3?±?54?ml/32.2?±?58.2%) with better performance (p?>?0.05) than the control group (20.2?±?32.2?ml/29.6?±?42.1%). All patients became euthyroid after treatment. No major discomfort or complications occurred. A review of the literature investigating combinations of other local ablative procedures with RIT was performed to determine the most promising combination.

Conclusions: The present study confirms the positive experiences with the combined therapy of RIT and local ablative procedures shown in the current literature and approves this approach for the treatment of goitres with RFA?+?RIT. These findings, when confirmed by further studies, should expand the indication of combined therapy as a minimally invasive alternative to surgery.     

Current status of intensity-modulated radiation therapy (IMRT)

External-beam radiation therapy has been one of the treatment options for prostate cancer. The dose response has been observed for a dose range of 64.8–81 Gy. The problem of external-beam RT for prostate cancer is that as the dose increases, adverse effects also increase. Three-dimensional conformal radiation therapy (3D-CRT) has enabled us to treat patients with up to 72–76 Gy to the prostate, with a relatively acceptable risk of late rectal bleeding. Recently, intensity-modulated radiation therapy (IMRT) has been shown to deliver a higher dose to the target with acceptable low rates of rectal and bladder complications. The most important things to keep in mind when using an IMRT technique are that there is a significant trade-off between coverage of the target, avoidance of adjacent critical structures, and the inhomogeneity of the dose within the target. Lastly, even with IMRT, it should be kept in mind that a “perfect” plan that creates completely homogeneous coverage of the target volume and zero or small dose to the adjacent organs at risk is not always obtained. Participating in many treatment planning sessions and arranging the beams and beam weights create the best approach to the best IMRT plan.     

调强放疗联合NP方案同步与序贯治疗中晚期非小细胞肺癌的疗效观察

Objective： To evaluate the clinical effects of concurrent and sequential therapy for middle and advanced stage non-small cell lung cancer （NSCLC） useing IMRT combined with NP regimen chemotherapy. Methods： Eighty patients with middle and advanced stage NSCLC were randomized into two groups. Forty patients were underwent sequential therapy and other 40 patients were underwent concurrent therapy. IMRT was used in radiotherapy and NP regimen of vinorelbine＋cispatin （NP） was used in chemotherapy. Results： （1） The overall response （CR＋PR） rate was 75% in concurrent group and 45% in sequential group （P〈0.05）; （2） The treatment courses were 84 days and 140 days for concurrent group and sequential group respectively （P〈0.05）; （3） One-year survival rate in concurrent group was 72.4% and 52.3% in sequential group respectively; （4） The toxic effects can be tolerable by all of patients. Conclusion： The concurrent chemo-radiotherapy has better overall response, one-year survival rate and shorter treatment course than the sequential chemo-radiotherapy, so it is a better method for the treatment of middle and advanced stage NSCLC, but the long term survival rate will be studied.     

调强放疗联合NP方案同步与序贯治疗中晚期非小细胞肺癌的疗效观察

目的:比较调强放疗联合NP方案同步与序贯治疗中晚期非小细胞肺癌的临床疗效。方法:选择不能手术的中晚期非小细胞肺癌(NSCLC)患者80例,随机分成同步组和序贯组各40例。放疗采用调强放疗,化疗采用NP方案(盖诺 顺铂)。结果:(1)治疗总有效率比较(CR PR):同步组75·0%,序贯组45·0%,两组比较差异有显著性(P<0·05);(2)两组的总治疗时间比较:同步组平均84天,序贯组平均为140天,两组比较差异有显著性(P<0·05);(3)生存率(Kaplan-Meier法)比较:同步组1年生存率为72·4%,序贯组为52·3%,两组比较差异有显著性(P<0·05);(4)两组病人均能耐受治疗中的不良反应。结论:同步组的近期疗效明显优于序贯组,能提高患者的1年生存率,且能缩短住院周期,减轻患者的经济负担,但远期生存率的比较有待进一步观察。     

小细胞肺癌的治疗进展与现状

肺癌为一种恶性程度较高的肿瘤性疾病,其病死率居各种恶性肿瘤之首,发病率逐年上升,近年随着禁烟教育力度的增强和普及,发病率已出现下降势头。小细胞肺癌(SCLC)是一种以生长迅速、早期转移、高度侵袭性为特点的肺癌类型。小细胞肺癌的肿瘤细胞对化疗和放疗都非常敏感,但几十年来多方案的临床试验并没能找到彻底治愈小细胞肺癌的有效方法,多数患者在一线治疗以后仍会复发或转移。局限期小细胞肺癌的一线治疗包括双药化疗(足量EP方案:依托泊甙 顺铂/卡铂)联合胸腔放射治疗(TRT)。当联合方案达完全缓解(CR)或疗效较好的部分缓解(PR)患者,应后续应用预防性脑照射(PCI),可明显降低未来复发性脑转移的风险。日本和德国的临床研究显示含有伊立替康的IP方案及IC方案(伊立替康 顺铂/卡铂)治疗广泛期小细胞肺癌效果可比标准EP方案。各种强化疗法并不能提高小细胞肺癌患者的生存率。胸腔放疗方案的研究显示局限期小细胞肺癌患者早期同步应用超分割放疗方案配合化疗可以改善预后,可能与放疗越早介入越能有效减少耐药克隆株的发生有关。对于小细胞肺癌复发患者,可依据是敏感复发或是难治复发相应选择再次应用首次化疗方案或用二线单药化疗方案。培美曲塞联合铂类方案已应用于SCLC的一线及二线治疗。PET-CT的应用对小细胞肺癌的精确分期非常重要。真正符合Ⅰ_A期及Ⅰ_B期(TNM分期)的小细胞肺癌患者可考虑手术治疗,术后应行正规化疗。生物靶向治疗小细胞肺癌的若干研究性试验正在进行之中,这些生物制剂及其衍生物有可能会为未来小细胞肺癌的治疗带来一线曙光。     

Increased risk of death due to heart disease after radiotherapy for esophageal cancer

Objective

To evaluate the risk of heart disease related death (HDRD) following radiation therapy (RT) for esophageal cancer (EC).

Methods

Using the Surveillance, Epidemiology, and End Results (SEER) database, two cohorts of patients with EC were created: (I) patients who received RT with their initial therapy; and (II) those who did not. Heart disease specific survival (HDSS) was analyzed using Kaplan-Meier methods. Cox proportional-hazards regression methods were used for univariate and multivariate analyses.

Results

We identified 40,778 patients with EC. A total of 26,377 patients received RT and 14,401 did not. HDSS analysis revealed increased risk of HDRD in those receiving RT (P<0.05), with an absolute risk of HDRD of 2.8%, 5.3% and 9.4% at 5-, 10- and 20-year, respectively. Log rank test of HDSS revealed the risk of HDRD became significant at 8 months (P<0.05). The following were associated with HDRD: RT, age, race, stage at presentation, time period of diagnosis, and known comorbid condition keeping one from esophagectomy. On multivariate analysis, RT remained predictive of HDRD [hazard ratio (HR) 1.46, P<0.05]. When considering only candidates for definitive therapy, RT remained predictive of HDRD on univariate (HR 1.53, P<0.0001) and multivariate (HR 1.62, P<0.0001) analyses.

Conclusions

The use of RT leads to increased risk of HDRD that is detectable as early as eight months from diagnosis. More research is needed to define optimal dose volume parameters to prevent cardiac death. Consideration should be given to this risk in relation to prognosis and the expected benefits of RT.     

准直器角度对肺癌SBRT-VMAT治疗计划的影响

目的:研究准直器角度对中央型非小细胞肺癌(NSCLC)患者体部立体定向放射治疗(SBRT)容积旋转调强(VMAT)计划剂量学影响。方法:选取10名中央型NSCLC患者进行VMAT计划设计。使用Varian Eclipse系统,6 MV FFF X射线,最大剂量率1400 MU/min。机架角度:CCW 179°~181°、CW 181°~179°,双弧准直器角度互组,0°~90°每间隔10°设置准直器角度,即为(0°,0°)、(10°,350°)、(20°,340°)、(30°,330°)、(40°,320°)、(50°,310°)、(60°,300°)、(70°,290°)、(80°,280°)和(90°,270°)制定十个计划。在处方剂量相同并且处方剂量线包绕相同靶区体积的前提下(归一至80%),比较计划靶区参数:D 95%、V 90%、适形度指数(CI)、梯度指数(GI)、D 2 cm以及机器跳数(MU),危及器官参数:双肺(D 1500 cm³、D 1000 cm³)、心脏(D 15 cm³)、脊髓(D 1.2 cm³、D 0.35 cm³)。用SPSS软件对每个分析指标做Wilcoxon符号秩检验,判断差异是否具有统计学意义。结果:在有统计学意义的基础上,10组计划中,准直器角度为60°时(P<0.05),靶区D 95%剂量最高,准直器角度为50°时(P<0.05),靶区V 90%最高。CI和GI在0°最佳。危及器官双肺(D 1500 cm³、D 1000 cm³)、心脏(D 15 cm³)、脊髓(D 1.2 cm³)受照剂量均在0°最低,脊髓D 0.35 cm³在整个角度范围内不具有统计学差异。此外,所有计划中危及器官受照剂量均远远低于计划规定值,其中双肺(D 1500 cm³)在50°的剂量与最低值仅相差4.1%(P<0.05),心脏(D 15 cm³)在60°的剂量与最低值仅相差3.4%(P<0.05)。结论:改变准直器角度对肺癌SBRT-VMAT计划剂量有明显的影响。选择合适的准直器角度,正常组织受照剂量远远低于计划限量时,靶区体积剂量明显提高,但计划复杂度也略有提升。在临床计划设计过程中,应充分考虑准直器角度的影响,制定更合适的治疗计划。     

子宫动脉栓塞加中药治疗子宫肌瘤疗效分析

目的 :研究子宫动脉栓塞加中药治疗子宫肌瘤的疗效。方法 :40例子宫肌瘤患者 ,采用Seldinger技术 ,穿刺股动脉成功后 ,行双侧子宫动脉超选择插管 ,分别注入 3 5 5～ 70 0 μmPVA颗粒栓塞子宫动脉 ;术后配合中药治疗。分别于术后 3个月、6个月、1年观察疗效。结果 :治疗成功率为 10 0 % ,临床症状逐渐改善、消失。 3个月复查肌瘤平均缩小 3 8 48% ,6个月平均缩小 5 7 40 % ,1年后复查无再增大者。结论 :子宫动脉栓塞加中药治疗子宫肌瘤有很好的临床应用价值