肿瘤热疗的临床应用研究进展

热疗是继手术、放疗、化疗之后一种全新的治疗肿瘤的“绿色疗法”。目前我国有微波热疗、超声聚焦热疗、射频热疗及内生场热疗。叙述了热疗在肿瘤治疗中的应用机制及各种热疗方法在，临床中的应用研究进展。     

Focal Therapy for Prostate Cancer: Possibilities and Limitations

Context

A significant proportion of patients diagnosed with prostate cancer have well-differentiated, low-volume tumors at minimal risk of impacting their quality of life or longevity. The selection of a treatment strategy, among the multitude of options, has enormous implications for individuals and health care systems.

Objective

Our aim was to review the rationale, patient selection criteria, diagnostic imaging, biopsy schemes, and treatment modalities available for the focal therapy of localized prostate cancer. We gave particular emphasis to the conceptual possibilities and limitations.

Evidence acquisition

A National Center for Biotechnology Information PubMed search (www.pubmed.gov) was performed from 1995 to 2009 using medical subject headings “focal therapy” or “ablative” and “prostate cancer.” Additional articles were extracted based on recommendations from an expert panel of authors.

Evidence synthesis

Focal therapy of the prostate in patients with low-risk cancer characteristics is a proposed treatment approach in development that aims to eradicate all known foci of cancer while minimizing damage to adjacent structures necessary for the preservation of urinary, sexual, and bowel function. Conceptually, focal therapy has the potential to minimize treatment-related toxicity without compromising cancer-specific outcome. Limitations include the inability to stage or grade the cancer(s) accurately, suboptimal imaging capabilities, uncertainty regarding the natural history of untreated cancer foci, challenges with posttreatment monitoring, and the lack of quality-of-life data compared with alternative treatment strategies. Early clinical experiences with modest follow-up evaluating a variety of modalities are encouraging but hampered by study design limitations and small sample sizes.

Conclusions

Prostate focal therapy is a promising and emerging treatment strategy for men with a low risk of cancer progression or metastasis. Evaluation in formal prospective clinical trials is essential before this new strategy is accepted in clinical practice. Adequate trials must include appropriate end points, whether absence of cancer on biopsy or reduction in progression of cancer, along with assessments of safety and longitudinal alterations in quality of life.     

Curative in situ ablation of colorectal liver metastases—experimental and clinical implementation

Introduction In situ ablation of colorectal liver metastases is frequently assessed for palliative treatment only. The establishment of clinically relevant lesion size and a lack of long-term survival data were regarded as main limitations to using them with curative intention. In contrast to surgical liver resection, whose oncological findings seem to have remained unchanged over the years, the in situ ablation methods have considerably changed technically and clinically in the last few years. Objective The aim of the paper was to point out experimental and clinical data underlining the impact of in situ ablation for potentially curative treatment of colorectal liver metastases. Discussion On the basis of experimental data, the aim of complete local tumor control (R0 ablation) can only be obtained if additional energy is applied after reaching the tumor-adapted maximal coagulation volume. Analogous to the oncological safety margin in surgical resection, we defined this decisive energy difference as the “energy safety margin” for in situ ablation. The energy safety margin is the energy that must be additionally applied after reaching the plateau in the energy/volume curve to achieve complete tumor coagulation. In addition to that, in situ ablation should be combined with temporary interruption of hepatic perfusion whenever possible to prevent intralesional recurrences. In this way, the thermoprotective mechanism of hepatic perfusion can be effectively eliminated. With restrictions, the survival data after ablation in specialized centers is comparable to surgical resection with concomitantly lower morbidity and mortality. Based on recent findings and with the corresponding expertise in the field of ablation and state-of-the-art equipment, ablation is, thus, an alternative to surgical resection. The combined application of surgical resection and ablation is also a suitable method for increasing the R0 rate and thus helps improve the prognosis of treated patients. In summary, it can be said that in situ ablation is a useful expansion of the therapeutic spectrum of liver metastases and can be applied as an alternative to or in combination with surgical resection.     

恶性心包积液的内科治疗进展

恶性心包积液是晚期癌症患者常见并发症之一,已严重影响病人的生活质量和生存期,近年来许多临床医师对恶性心包积液的内科治疗做了大量研究,如腔内化疗、生物反应调节剂、博莱霉素、热疗等,其近期疗效均较好,不良反应轻。     

双频双对电极射频热疗比吸收率及温度场模拟

针对双频双对电极射频热疗的比吸收率和瞬态温度分布进行了物理、数学建模和数值模拟计算。该模型能真实反映电磁波在生物组织中的衰减。在非稳态温度场模拟中考虑了血液灌流量随温度变化和肿瘤区低血液灌流的特点。对双频双对电极射频热疗电磁能量分布和温度分布的特点、电极位置和电极功率对有效治疗深度的影响作了细致的分析讨论。     

经瞳孔温热疗法治疗局限性脉络膜血管瘤的疗效观察

目的总结红外光经瞳孔温热疗法(transpupillarythermotherapy,TTT)治疗局限性脉络膜血管瘤的疗效。方法局限性脉络膜血管瘤患者8例8只眼,应用红外半导体激光治疗,波长810nm,功率100mW,光斑直径0.8~3.0mm,曝光时间1min。观察治疗前后视力、浆液性视网膜下积液的变化,彩色多普勒检查瘤体大小,瘤体检眼镜下所见及荧光血管造影中的渗漏情况及并发症等。随访16~40个月。结果经1次或重复的TTT治疗后,全部患眼的浆液性视网膜脱离平复,视力提高,彩色多普勒示瘤体消失。荧光血管造影复查可见瘤体渗漏减轻至消失,眼底检查可见轻微的脉络膜萎缩和视网膜色素上皮色素积聚。结论TTT是治疗伴或不伴有浆液性视网膜脱离的局限性脉络膜血管瘤的一种有效方法。     

Np方案化疗与热疗联合治疗非小细胞肺癌的疗效观察

目的　观察异长春化碱 (NVB) ,顺铂 (DDP)静脉化疗与热疗联合治疗晚期非小细胞肺癌的疗效。方法　 4 0例晚期非小细胞肺癌患者随机分为两组 ,观察组 (2 0例 )应用 NVB2 5 mg/ m2 d1,8,DDP75 mg/ m2 d1静脉化疗联合射频热疗 ,对照组 (2 0例 )仅予常规 NP方案化疗 ,2 8天为一周期 ,至少完成 2周期。结果　观察组 PR9例 ,有效率 4 5 % ,对照组 PR7例 ,有效率 35 % .两组生活质量改善情况 :显著改善 5 5 % ,30 % ;改善 30 % ,15 % ;两组有显著差异 (P<0 .0 5 ) ,毒副反应无差异。主要毒性为骨髓抑制以及胃肠道反应。结论　 NP方案联合热疗治疗晚期非小细胞肺癌是合理 ,方便 ,安全 ,有效的一种可行方案 ,可以作为一线方案推荐临床应用。     

经尿道反馈式微波治疗高危前列腺增生随访2年结果分析

目的 评价高危BPH采用经尿道反馈式微波治疗随访2年的疗效.方法 高危BPH患者62例(含门诊患者2例),均为年龄≥80岁或并发重要器官及系统严重病变或功能损害.治疗前前列腺体积、IPSS、QOL、Qmax分别为(62.03±50.69)ml、23.19±9.33、4.58±1.09、(4.33±3.75) ml/s.62例均在尿道表面麻醉下采用经尿道反馈式微波治疗,分别在治疗后3、12、24个月复查B超测量前列腺体积,复测IPSS、QOL及Qmax. 结果 62例均能耐受治疗,除轻微出血、感染及一过性尿失禁外,无明显外科并发症.治疗后3个月前列腺体积、IPSS评分、QOL评分、Qmax分别为(43.85±33.48)ml、11.63±7.14、2.44±1.36、(11.44±4.20) ml/s,治疗后12个月为(45.10±33.38) ml、12.23±7.33、2.61±1.33、(10.91±4.05) ml/s,治疗后24个月为(45.80±33.46) ml、12.37±7.48、2.66±1.40、(10.82±4.03) ml/s.治疗后各个时间点的各项指标均较治疗前显著改善(P＜0.01). 结论 经尿道反馈式微波治疗高危BPH患者长期安全有效,可用于门诊治疗,治疗后3个月达到最佳疗效.