顺铂和替加氟联合放疗治疗中晚期食管癌疗效观察

目的观察顺铂和替加氟联合放疗治疗食管癌的临床疗效及其毒副反应。方法2003年1月至2006年2月对60例食管癌患者采取顺铂20mg·m-2·d,替加氟750mg·m-2·d,连用5天,序贯放疗60~70Gy/6~7周。结果60例患者中,CR24例,PR18例,SD9例,PD9例,RR(CR+PR)为70·0%,主要毒副作用为骨髓抑制、恶心呕吐。肝肾功损害及口腔炎、静脉炎等较轻。结论顺铂和替加氟联合放疗治疗食管癌疗效好,耐受性好值得推广应用。     

~(131)I治疗Graves’病后发生甲低与TGA,TMA及TRAb的关系

目的 :从甲状腺自身免疫方面探讨1 3 1 I治疗甲亢的效果及甲低发生的因素。方法 :选择1 3 1 I治疗的88例Graves’病甲亢患者随访 3年 ,分为第 1组 (TGA、TMA、TRAb均阳性 )和第二组 (TGA、TMA阴性 ,TRAb阳性 )。采用x2 分析自身抗体水平与甲低发生的关系。结果 :1组甲低发生率为 31 4 % ,2组为 3 8% ,1组明显高于 2组 ,差异有显著性。结论 :TGA、TMA和TRAb水平与确定1 3 1 I剂量及甲低的发生关系密切。认为TGA、TMA水平高的患者应酌情减少1 3 1 I用量     

CT模拟定位三维适形放射治疗食管癌的临床研究

目的探讨CT模拟定位三维适形放射治疗食管癌的疗效。方法1997年4月～2002年7月,经病理证实的食管鳞状细胞癌87例患者，其中男性56例，女性31例，年龄42～75岁，平均年龄62.5岁，随机分为2组，两组患者一般情况、性别、年龄及病变部位构成经统计学检验无统计学意义，一组为采用CT模拟定位进行三维适形放射治疗，另一组为常规模拟定位放射治疗，两组的剂量都为64～66Gy／32.33次／6.4～6.6周。结果采用Kaplan—Meier法计算生存率，并用Log—Rank检验其差异性。治疗计划各指标分析采用kolmogorowSmirnov法行正态分布检验，继而行t检验，以P〈0.05为差异有统计学意义。CT模拟定位三维适形放射治疗组和常规模拟定位放射治疗组1、2、3、4年生存率分别为70.1％、55.6％、40.4％、36.3％和65.4％、50.6％、30.6％、20.9％（p〉0.05）。但是对Ⅰ～Ⅱ期患者，CT模拟定位三维适形放射治疗组和常规模拟定位放射治疗组的生存率分别为81.2％、75.5％、67.3％、61.5％和80.1％、65.7％、54.9％、29.7％（P〈0，05），局部控制率分别为75.6％、71.7％、65.5％、59.0％和65.4％、50.6％、33.3％、25.6％（P〈0.05）。而对于Ⅲ～Ⅳ期的患者，两组之间的生存率和局部控制率差异无统计学意义。结论CT模拟定位三维适形放射治疗的疗效明显好于常规模拟定位放射治疗组。特别对Ⅰ-Ⅱ期早期食管癌患者两组之间差异有统计学意义，而对晚期患者差异无统计学意义。     

Genetic and teratogenic effects of cancer treatments on gametes and embryos

Male and female germ cells vary in their sensitivity to the mutagenic effects of chemotherapy and radiotherapy, depending on their stage of maturation and the agent used. Although sperm DNA damage exists following treatment, no increase in genetic defects or congenital malformations was detected among children conceived to parents who have previously undergone chemotherapy or radiotherapy. The use of assisted reproductive technologies and micromanipulation techniques might increase this risk; hence caution should be exercised. In female cancer patients, miscarriage and congenital malformations are not increased following chemotherapy. However, when IVF and embryo cryopreservation is practised between or shortly after treatment, possible genetic risks to the growing oocytes exist, and hence the babies should be screened. During pregnancy, the potential teratogenic effects of chemotherapy influence the choice and timing of therapy. Termination is usually recommended in the first trimester. Second- and third-trimester exposure does not usually increase the teratogenic risk and cognitive development, but it may increase the risk of poor obstetric outcome and fetal myelosuppression. During the first two weeks after fertilization of the embryo, radiation is lethal but not teratogenic. High doses of radiation during pregnancy induce anomalies, impaired growth and mental retardation, and there may be an increased risk of childhood leukaemia and other tumours in the offspring.     

Radiotherapy and combination chemotherapy with carmustine,vincristine, and procarbazine (BVP) in primary brain tumors

Summary 26 patients with astrocytoma grade 11–111, and 36 with malignant glioma (astrocytoma grade IV or glioblastoma) were submitted three days after surgery to a cycle of combination chemotherapy, including BCNU, VCR, PCZ (BVP). Eighteen days after surgery, patients received 40 Gy (astrocytoma grade 11–111) or 45 Gy (malignant glioma) of megavoltage whole-brain irradiation, with an additional boost to the tumor bed of 20 Gy, delivered in 6 weeks. Vincristine was injected weekly during radiotherapy. At the end of radiotherapy, patients received BVP every 6 weeks for at least 8 cycles or until a recurrence or progressive disease. Performance status of grade 1 or 2 was achieved in 15 (60%) and in 5 (20%), respectively, of patients with astrocytoma grade 11–111 after 6 months, and in 6 ps. (29%) and in 9 ps. (42%) after 12 months of follow-up. Only 2 (5.5%) and 18 (64%) patients with malignant glioma achieved a performance status of grade 1 or 2 after 6 months, and these proportions are 6% and 35%, respectively, after 12 months. After a 5-year follow-up, 59% of patients with astrocytoma are still alive, with a median survival time of 60+ months, whereas only 4% of patients with malignant glioma are alive, with a median of 11.2 months.     

Fast neutron radiotherapy for locally advanced prostate cancer: results of an RTOG randomized study

Between June 1977 and April 1983, the Radiation Therapy Oncology Group (RTOG) sponsored a Phase III randomized study investigating fast neutron radiation therapy in the treatment of patients with locally advanced (Stage C and D1) adenocarcinoma of the prostate gland. Patients were randomized to receive either conventional photon radiation therapy or fast neutron irradiation used in a mixed-beam treatment schedule (neutron/photon). A total of 91 analyzable patients were entered in the study; 78 of them were treated without major protocol deviations. The two treatment groups were balanced in regard to all major prognostic variables. Actuarial curves for "overall" survival, "determinantal" survival and local/regional control are presented both for the entire group of 91 patients and the 78 patients treated within protocol guidelines. The overall local/regional tumor recurrence rate is 7% for the mixed-beam treated group of patients and is 22% for the photon (X ray) treated group of patients. The difference is statistically significant at the p = 0.05 level. For the entire group of 91 evaluable patients, the 5-year "overall" survival rate is 62% for the mixed-beam-treated group and 35% for the photon-treated group. This difference is also statistically significant (p less than 0.05). However, this statistical significance is lost when the smaller number of patients treated strictly within protocol guidelines is considered. The significance is regained (p less than 0.02) when one looks at "determinantal" survival, which uses active cancer at time of death as the failure endpoint. This study demonstrates that a regional treatment modality, in this case mixed-beam irradiation, can influence both local/regional tumor control and survival in patients with locally-advanced adenocarcinoma of the prostate gland.     

Radio-chemo-immunotherapy (CCNU plus Levamisole) for treatment of metastatic brain tumors

Summary Thirty-one patients with metastatic brain tumors were treated with Radiotherapy (RT) and CCNU or with RT, CCNU and Levamisole (LMS) in a randomized clinical trial. Twenty-seven were evaluable. All patients were submitted to whole brain radiation (50 ± 5 Gy) and CCNU (130 mg/ m² p. o. every 8 weeks). 15 also received Levamisole (2.5 mg/ kg p.o. daily for 3 weeks in the first month, for 2 weeks in the second, and then once a week monthly until progression). Primary tumor was predominantly lung cancer (22/27) and brain lesions were generally multiple (24/27). The overall response rate was 35% in the RT plus CCNU treated group and 38% in the RT plus CCNU plus LMS treated group. The median survival time was similar and not statistically different in both groups (7 versus 6 months). No important side effects were observed either in the RT + CCNU or in the RT + CCNU + LMS treated groups. The absence of combined depression of T-cell levels and responsiveness of lymphocytes to mitogens suggests that thymus dependent immunity could be improved by LMS administration. However, such improvement had no impact on duration of survival in patients with metastatic brain tumors.     

HFRT和CFRT模式对乳腺癌患者外周血淋巴细胞的影响

目的 探讨不同放疗分割模式即大分割放疗（hypofractionated radiotherapy, HFRT)和常规分割放疗（conventional fractionation radiotherapy, CFRT)对乳腺癌患者外周血淋巴细胞的影响。方法 回顾性分析2019年11月至2021年8月在徐州市中心医院接受保乳术后放射治疗的40例早期乳腺癌患者。随机分为观察组（HFRT,n = 20）与对照组（CFRT,n = 20）,比较2组患者放疗前及放疗中的外周血淋巴细胞计数(peripheral lymphocyte count,PLC)变化。结果 大分割组和常规分割组患者的基线PLC无统计学差异（1.53 ± 0.54 vs 1.64 ± 0.56;P > 0.05）。2组的PLC在放疗过程中稳定下降,大分割组淋巴细胞减少发生率低于常规分割组（32.5% vs 50.0%),但差异无统计学意义（P > 0.05）;大分割组的最低点PLC高于常规分割组（0.91 ± 0.28 vs 0.55 ± 0.22;P < 0.001）。大分割组治疗期间的最低PLC与基线阶段的比值明显高于常规分割组（0.64 ± 0.24 vs 0.38 ± 0.21,P < 0.05）。结论 与常规分割放疗方案相比,乳腺癌患者接受大分割放疗发生放射诱导淋巴细胞减少的风险更低。     

Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status

Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.     

食道癌根治术后放射治疗的观察研究

目的：评估食道癌根治术后放射治疗的价值。方法：取我院1985－1992年进行根治术后放射治疗24例食管癌病人作术后放疗组,按该组病人的分期,分层随机抽取同期食管癌单纯根治术病人24例作对照组,DT50－60Gy/5-7周,生存分析用Kaplan-Meier方法计算,并以Log-rank作显著性检验。结果：单纯手术组1,3,5年生存率分别为87．5％（21／24）,66．7％（16／24）,34．8％（8／23）,术后放疗组95．8％（23／24）,78．3％（18／23）,54．5（12／22）,（P＞0．05）,单纯手术组血行转移16．7％（4／24）,术后放疗组为12．5％（3／24）,两组相比较,无显著差异（P＞0．05）,局部（瘤床以及局部淋巴引流区）复发率单纯手术组为58．3％（14／24）,术后放疗组25．0％（6／24）,后者明显比前者低度（P＝0．02）,结论：食道癌根治术后放疗可以减少局部复发。