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51.
局部晚期食管癌单纯手术治疗预后较差,新辅助放化疗并手术治疗的方案可明显延长食管癌患者的总体生存时间.目前,该治疗方案已成为欧美国家及我国对局部晚期食管癌进行规范化治疗的指南.然而,由于只有经新辅助放化疗后获得病理缓解的患者可从中获益,治疗无反应的患者预后可能比单纯手术更差.因此,预测食管癌新辅助放化疗的疗效,区分优势人群和耐受人群,从而实现个体化的治疗极为重要.分子标记物用于预测食管癌新辅助放化疗的疗效研究前景广阔,有望广泛应用于临床实践,指导局部晚期食管癌个体化治疗方案的决策.  相似文献   
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BackgroundIn rectal cancer, extramural vascular invasion (EMVI) is the presence of tumour cells in blood vessels outside the muscular layer, which is associated with poor prognosis. Regression of EMVI on MRI following neoadjuvant chemoradiotherapy or its persistence may have prognostic implications.MethodsThis retrospective study included 52 patients with rectal cancer who underwent total mesorectal excision following long-course neoadjuvant chemoradiotherapy (CRT). EMVI assessments were done on previous pelvic MRIs obtained before neoadjuvant CRT and eight weeks after the completion of neoadjuvant chemoradiotherapy in initially EMVI positive cases.ResultsPersistently EMVI positive patients had worse overall survival and disease-free survival compared to initially EMVI negative patients and patients who returned to negative (p < 0.001 for both). Multivariate analysis identified persistent EMVI positivity after neoadjuvant treatment (HR, 102.9; p = 0.003) as significant independent predictor of worse overall survival; and persistent EMVI positivity (HR, 17.0; p = 0.002), mesorectal fascia involvement after neoadjuvant treatment (HR, 8.0; p = 0.017), and poor differentiation (HR, 10.3, p = 0.012) as significant independent predictors of worse disease-free survival.ConclusionPersistent EMVI positivity after neoadjuvant therapy appears to be an independent factor for poor overall survival; and persistent EMVI positivity as well as mesorectal fascia involvement on post neoadjuvant therapy MRI and poor differentiation appears to be important predictors of poor disease-free survival in rectal cancer patients.  相似文献   
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侧方淋巴引流是低位直肠癌3个重要的淋巴引流方向之一。沿引流途径清扫淋巴结是直肠癌根治术基本要求,也决定淋巴结清扫范围。但侧方淋巴结是区域淋巴结还是远处淋巴结,一直存在争议。这带来新辅助放化疗和侧方淋巴结清扫、以及新辅助放化疗对侧方淋巴结转移疗效的争议。笔者综合分析国内外研究进展,对直肠癌侧方淋巴结转移规律、影响侧方淋巴结转移复发危险因素以及放化疗前后MRI检查对侧方淋巴结评估等进行深入阐述,并结合临床实践,探讨进展期低位直肠癌新辅助放化疗后侧方淋巴结清扫的选择和意义。  相似文献   
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目的 分析三维适形放疗治疗晚期胰腺癌的疗效及相关预后因素.方法 50例不能手术的晚期胰腺癌病人,采用常规分割的三维适形放疗;其中14例采用姑息性放疗(A组),给予10.8~56 Gy;27例采用单一三维适形放疗(B组),剂量范围为8~60.5 Gy;9例采用同步放化疗的方法(C组),剂量范围为10~64 Gy.同步放化疗中化疗采用吉西他滨(200~600 mg/m~2,1次/周).结果 随访时间为3~35个月,死亡43例,死亡原因主要为肝脏和(或)腹腔内的广泛转移、恶液质、继发感染和出血.存活7例中3例为同步放化疗,3例为单一放疗,1例为姑息治疗.A组存活1人,放疗后局部症状缓解率46%(6/13),平均生存时间5.07个月;其中放疗剂量小于45 Gy的病人有10例,平均存活时间为4.33个月;放疗剂量≥45 Gy者3例,平均存活时间为7.33个月.B组存活3例,治疗后疼痛缓解率为81%(22/27),平均存活6.65个月,其中放疗剂量小于45 Gy的有11例,平均存活时间为4.36个月;放疗剂量≥45 Gy者16例,平均存活时间为8.33个月.C组存活3例,治疗后疼痛缓解率为89%(8/9),放疔后平均存活9.89个月,其中放疗剂量小于45 Gy的有1例,存活时间为3个月;放疗剂量≥45 Gy者8例,平均存活时间为10.73个月.结论 三维适形放疗对晚期胰腺癌有姑息治疗的作用,疗效与治疗方式的选择、放疗剂量、病变累及范围和病人一般状态密切相关.对于部分晚期胰腺癌病人,采用积极同步放化三维适形放疗可获得较长的生存时间.  相似文献   
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目的 探讨颈胸上段食管癌根治性放化疗时调强放疗靶区范围对生存预后的影响,并结合失败模式,为颈胸上段食管癌放射治疗靶区勾画提供参考标准。方法 回顾性收集2010年至2014年间在本院接受根治性同期放化疗的132例颈胸上段食管癌患者临床资料,其中选择性淋巴引流区照射(ENI)者71例,累及野照射(IFI)者61例。采用Kaplan-Meier法计算局部控制(LC)、无进展生存(PFS)、总生存(OS),并行Log-rank法检验、COX风险模型单因素及多因素预后分析。结果 随访至2017年12月底,中位随访时间59.5(14.2~95.8)个月,随访率为99.2%。ENI组与IFI组1、3、5年LC分别为77.5%、58.8%、48.8%和64.3%、29.1%、26.2%(χ2=9.68,P=0.002),PFS分别为68.6%、37.7%、25.9%和47.5%、17.2%、3.6%(χ2=11.39,P=0.001),OS分别为81.7%、53.9%、31.3%和70.5%、31.9%、16.3%(χ2=7.70,P=0.006)。多因素分析显示T分期、N分期和照射范围是局部控制、无进展生存和总生存的独立性预后影响因素(P<0.05)。ENI组总失败率和局部区域复发率均明显低于IFI组(χ2=13.23、5.24,P<0.05)。ENI组和IFI组≥ 3级的放射性食管炎、肺炎和骨髓抑制差异均无统计学意义(P>0.05)。结论 颈胸上段食管癌患者接受根治性放化疗时,选择性淋巴引流区照射可明显降低局部区域复发和远处转移,进而改善长期生存。  相似文献   
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Purpose. To evaluate the response of advanced squamous cell head and neck carcinoma to a combination of induction chemotherapy and radiotherapy. Methods. We present long-term results of a phase II trial of Induction Chemotherapy with UFT 200 mg/m2 p.o. days 1 to 21, Vinorelbine 25 mg/m2 i.v. days 1 and 8 and Cisplatin 100 mg/m2 i.v. day 1 (UFTVP) each 21 days for 4 courses, followed by Radiotherapy concomitant with UFT 100 mg/m2 p.o. daily and Carboplatin AUC = 0.5 i.v. weekly (RT/UFTJ) in patients (pts) with Non-Resectable Locally Advanced (Stage IV-B) Squamous Cell Head and Neck Carcinoma (IV-B-SCHNC). Primary endpoint was Complete Response to induction UFTVP and secondary endpoints were Disease Free Status Rate after locoregional treatment and long-term Overall Survival. Between 1994 and 1997, 32 pts were included. Results. Complete Response to Induction UFTVP was 59% (95% CI: 48%-70%). Main toxicity of UFTVP was G 3,4 neutropenia (94% of pts; 25% developed febrile neutropenia and 1 of this pts dead). After Induction Chemotherapy with UFTVP, 30 pts received radiotherapy and 25 of them received cocomitant Carboplatin and UFT (RT/UFTJ): main toxicity was mucositis (G3-4: 72%) and one patient died during RT/UFTJ because pneumonia. Twenty-five pts (78%) were alive and disease free at the end of the whole treatment. Actuarial 5 year Overall survival is 32%. Conclusion. Although toxicity is important, this approach has interesting activity and deserves further investigation. In the January issue of Clin Transl Oncol the following article was published with a wrong reference: Fernando Rivera, María E Vega-Villegas, Marta F. López-Brea, Almudena García-Casta?o, Ana de Juan, Francisco Javier Ramos, Antonio Collado, Piedad Galdós, Antonio Rubio, Adolfo del Valle, Julio Rama, Marta Mayorga and Jaime Sanz-Ortiz Long term results of a phase II trial of Induction Chemotherapy with Uracil-Ftegafur (UFT), Vinorelbine and Cisplatin (UFTVP) followed by Radiotherapy concomitant with UFT and Carboplatin (RT/UFTJ) in Non-Resectable Locally Advanced (Stage IV-B) Squamous Cell Head and Neck Carcinoma and Peripheral Blood Stem Cell Support (PBSCS) with Febrile Neutropenia Clin Transl Oncol. 2007 Jan;9:40-47 DOI 10.1007/s12094-007-0008-5 The correct reference should be as follows: Fernando Rivera, María E Vega-Villegas, Marta F. López-Brea, Almudena García-Casta?o, Ana de Juan, Francisco Javier Ramos, Antonio Collado, Piedad Galdós, Antonio Rubio, Adolfo del Valle, Julio Rama, Marta Mayorga and Jaime Sanz-Ortiz Long term results of a phase II trial of Induction Chemotherapy with Uracil-Ftegafur (UFT), Vinorelbine and Cisplatin (UFTVP) followed by Radiotherapy concomitant with UFT and Carboplatin (RT/UFTJ) in Non-Resectable Locally Advanced (Stage IV-B) Squamous Cell Head and Neck Carcinoma Clin Transl Oncol. 2007 Jan;9:40-47The original article can be found online at  相似文献   
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Little is known about chemoradiotherapy (CRT) in elderly patients with a locally advanced oesophageal cancer (OC). The aim of our study was to evaluate the tolerance and the outcome of elderly patients older than 70 years treated with CRT for a non-metastatic OC. Chemoradiotherapy was based on radiotherapy combined with a cisplatin-based chemotherapy. Clinical complete response (CCR) to CRT was evaluated on upper digestive endoscopy and computed tomography scan 6–8 weeks after CRT completion. One hundred and nine consecutive patients were included. A CCR was observed in 63 patients (57.8%) and 2-year survival was 35.5%. Adverse events ⩾grade 3 were observed in 26 (23.8%) patients. Chemotherapy dose reduction, chemotherapy delays more than 1 week, and treatment discontinuation were observed in 33 (30.3%), 45 (41.3%), and 17 patients (15.6%), respectively. Comorbidity index according to Charlson score was significantly associated with treatment tolerance. In multivariate analysis, a CCR to CRT (P<0.01), a dose of radiotherapy ⩾80% (P=0.02), and a Charlson score ⩽2 (P=0.046) were identified as independent prognostic factors of overall survival. These results suggest that CRT could be considered as an effective treatment without major toxicity in elderly patients with OC.  相似文献   
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60.
Background A phase II one-arm study was performed to evaluate the efficacy and safety of concurrent chemoradiotherapy with the use of uneven fractionation in glioblastoma patients. Methods A total of 19 glioblastoma patients underwent concurrent chemoradiotherapy with the use of uneven fractionation. Vincristine (VCR) and 3-[(4-amino-2-methyl-5-pyrimidinyl)methyl]-1-(2-chloroethyl)-1-nitrosourea hydrochloride (ACNU) were administered on day 1 and day 2, respectively. Irradiation at a dose of 3 Gy was administered on days 3 and 4, and at a dose of 1.5 Gy from day 5 on. The treatment was repeated at 10 day intervals. The total radiation dose was 57 Gy. Results All 19 patients received full dose irradiation. However, 8 patients required treatment interruption, and 2 patients required decreases in drug dosages due to the effects of acute toxicity such as, myelosuppression, liver function disorder and skin toxicity. The treatment responses were recorded as CR in 5, PR in 1, and NC in 10 patients. The remaining three patients received total removal of the enhancing area on CT or MRI. The 1 year and 2 year survival rates were 73% and 23%, respectively. The median survival times of this study and the historical controls were 16 months and 15 months, respectively. Conclusion The concurrent chemoradiotherapy failed to prolong the survival of glioblastoma patients.  相似文献   
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