不同放疗靶区对食管癌疗效及安全性的影响

目的:分析不同临床靶区勾画对食管癌同步放化疗疗效及安全性的影响,探讨食管癌三维适形放疗的临床靶区范围。方法:2009年1月至2012年1月收治的60例食管癌患者随机分为非预防组和预防组,均接受同步放化疗。非预防组28例,CTV包括原发灶上下外扩3cm、周围外扩0.8-1.0cm及肿大淋巴结累及区;预防组32例,食管癌原发灶CTV外扩同非预防组,根据原发灶部位不同,给予区域淋巴结引流区的预防照射。结果:非预防组和预防组1、2年的生存率分别为67.9%、57.1%和68.8%、50.0%;1、2年局部控制率分别为71.4%、60.7%和71.9%、59.4%;野内淋巴结复发率分别为7.1%、6.3%。非预防组Ⅲ级以上放射性肺炎、放射性食管炎及骨髓抑制为3.6%、7.1%、14.3%;预防组Ⅲ级以上放射性肺炎、放射性食管炎及骨髓抑制发生率为6.3%、12.5%、15.6%。结论:预防组在提高生存率、局部控制率及降低野内淋巴结复发率方面未表现出明显优势,两组疗效相当(P>0.5)。预防组放射性肺炎、放射性食管炎及骨髓抑制发生率均高于非预防组,但两组比较无统计学意义(P>0.5)。预防组肺V10(%)、肺V20(%)、肺V30(%)三项指标均大于非预防组,两者差异有统计学意义(P<0.05)。     

5-Fluorouracil sensitizes colorectal tumor cells towards double stranded DNA breaks by interfering with homologous recombination repair

Malignant tumors of the rectum are treated by neoadjuvant radiochemotherapy. This involves a combination of 5-fluorouracil (5-FU) and double stranded DNA-break (DSB)-inducing radiotherapy. Here we explored how 5-FU cooperates with DSB-induction to achieve sustainable DNA damage in colorectal cancer (CRC) cells. After DSB induction by neocarzinostatin, phosphorylated histone 2AX (γ-H2AX) rapidly accumulated but then largely vanished within a few hours. In contrast, when CRC cells were pre-treated with 5-FU, gammaH2AX remained for at least 24 hours. GFP-reporter assays revealed that 5-FU decreases the efficiency of homologous recombination (HR) repair. However, 5-FU did not prevent the initial steps of HR repair, such as the accumulation of RPA and Rad51 at nuclear foci. Thus, we propose that 5-FU interferes with the continuation of HR repair, e. g. the synthesis of new DNA strands. Two key mediators of HR, Rad51 and BRCA2, were found upregulated in CRC biopsies as compared to normal mucosa. Inhibition of HR by targeting Rad51 enhanced DNA damage upon DSB-inducing treatment, outlining an alternative way of enhancing therapeutic efficacy. Taken together, our results strongly suggest that interfering with HR represents a key mechanism to enhance the efficacy when treating CRC with DNA-damaging therapy.     

术前放化疗对中低位直肠癌患者手术及术后并发症的影响

目的探讨术前放化疗对中低位直肠癌患者手术及术后并发症的影响。方法回顾性分析2009年1月至2010年12月间第二军医大学长海医院肛肠外科收治的174例T3～T4期中低位进展期直肠癌患者的临床资料,其中接受术前放化疗者加手术治疗者81例（放化疗组）,直接行手术治疗者93例（对照组）。结果术前放化疗组和对照组患者的手术切除率分别为100％（81／81）和94．6％（88／93）,差异无统计学意义（P〉O．05）;保肛率分别为86.4％（70／81）和73．1％（68／93）,差异有统计学意义（P=0．039）。两组手术时间分别为（130±15）min和（125±20）min,术中出血量分别为（100±15）ml和（95±10）ml,差异均无统计学意义（P〉0．05）。两组术后并发症发生率分别为9．9％（8／81）和9．7％（9／93）,差异无统计学意义（P〉0．05）。结论术前放化疗能够显著提高中低位直肠癌患者的保肛率。且并不会增加手术难度和术后并发症的发生率。     

同期康复锻炼在人工全肩胛骨肩关节置换术中的应用研究

目的：探讨肩部恶性肿瘤行人工全肩胛骨肩关节置换术同期康复锻炼的方法与效果。方法：回顾性分析2009-01-2014-04我院骨科收治肩部恶性肿瘤患者12例,采用肩部肿瘤广泛切除术、人工全肩胛骨肩关节置换及功能重建术。术后患肢外展支架固定,手术同期分三阶段行肩关节康复锻炼：被动辅助运动、主动运动、抗阻力肌力增强练习。结果：12例患者在术后3个月,用肩关节Neer评分系统进行疗效评价,得分78～89分,平均83分,总体效果良。并且在术后1周、4周和术后3个月,肩关节的功能评分与术前比较,差异有统计学意义（P〈0.05）。结论：人工全肩胛骨肩关节置换术是治疗肩部恶性肿瘤的有效方法,手术同期康复锻炼能促进肩关节功能的全面恢复。     

Prognosis of patients who develop cervical lymph node recurrence following curative resection for thoracic esophageal cancer

Patients with esophageal cancer often display relapse at cervical nodes after surgery, but their prognosis and a suitable therapy remains unknown. We retrospectively reviewed the records for 35 patients who underwent esophagectomy with lymphadenectomy who then displayed relapse at the cervical lymph nodes alone between 1985 and 2003 in order to observe the prognostic factors for such patients. Median survival time from the date of recurrence for all 35 patients was 12 months with 1-year, 2-year, 3-year and 5-year survival rate of 47.2%, 26.5%, 17.7% and 8.8%, respectively. With regard to the initial treatment against cervical node recurrence, 15 patients were treated by radiotherapy alone, eight by chemoradiotherapy, 11 by surgery and one by chemotherapy alone. Univariate analysis revealed that cervical node dissection at the prior esophagectomy (yes/no, P = 0.0178), time to recurrence (> 9 months or < 9 months, P = 0.0497) and the number of relapsed nodes (solitary/multiple, P = 0.0029) were significant prognostic factors. Among these factors, the number of relapsed nodes (solitary/multiple) was found to be the only significant prognostic factor with an odds ratio of 2.409 and 95% confidence interval of 1.033-5.619 by multivariate analysis. In conclusion, cervical node metastasis is generally considered to be distant organ metastasis. However, if it is a solitary node recurrence, substantial survival can be attained by appropriate loco-regional therapy.     

同期放化疗治疗不能手术的Ⅲ期非小细胞肺癌的生存分析

目的：评估同步放化疗对局部晚期非小细胞肺癌的疗效及毒性。方法：2007年4月至2012年12月在本科接受根治性同期放化疗的局部晚期NSCLC患者,共119例。所有患者治疗前均经组织学或细胞学证实的非小细胞肺癌,包括鳞癌、腺癌、腺鳞癌、大细胞癌及其它非小细胞癌类型;接受根治性同期放化疗,伴或不伴诱导或巩固化疗;放射治疗采用基于CT模拟定位的精确放疗,包括3D-CRT和螺旋断层放疗。分析全组患者的1,3,5年生存率及中位生存期。结果：全组患者的中位生存期26个月,1、3、5年总生存率分别为76％、40％、20％,1、3、5年局部控制率分别为77％、53％、40％,1、3、5年无转移率分别为70％、45％、40％。不良反应包括：WBC毒性3级9.2％,4级4.2％;放射性食管炎2级39.5％,3级7.6％;急性放射性肺损伤2级18.5％,3级5.0％,4级0.8％;晚期放射性肺损伤2级4.2％,3级3.4％,4级1.7％。结论：同步放化疗和精确放疗技术的采用可提高不能手术的Ⅲ期NSCLC的疗效。与本科既往使用二维放疗技术进行的序贯化放疗4年生存率11％相比,疗效有一定的进步。     

伽玛刀联合紫杉醇/卡铂同步加巩固治疗局部晚期非小细胞肺癌临床观察

目的观察体部伽玛刀联合紫杉醇/卡铂同步加巩固治疗局部晚期非小细胞肺癌的临床疗效及毒副反应。方法将62例局部晚期非小细胞肺癌患者随机分为A(30例)、B(32例)两组;均给予伽玛刀同步联合紫杉醇/卡铂方案化疗(紫杉醇45 mg/m2+卡铂AUC=2,第1天,1次/周,共6次);B组在与A组相同治疗后,再给予巩固化疗(紫杉醇175 mg/m2+卡铂AUC=5,第1天,1次/3周,共2周期)。比较临床疗效和毒副反应。结果近期有效率(CR+PR):A组76.67%,B组81.25%;1、2年生存率及中位生存期:A组分别为63.33%、30.00%和14.6个月,B组分别为68.75%、37.50%和16.9个月;两组比较,无统计学差异(P>0.05);毒副反应:B组明显高于A组。结论体部伽玛刀联合紫杉醇/卡铂同步治疗局部晚期非小细胞肺癌安全、有效,而在此基础上加予巩固化疗未能明显提高此类患者的生存率。     

加温合并放化疗治癌作用的实验研究

本研究以荷 S_(37)的 NIH 小鼠为模型,用肿瘤平均直径(MD)为指标,从肿瘤直径倍增时间(MDDT)和荷瘤动物存活时间(AET)为终点,进行了加温合并放射、顺铂(DDP)和平阳霉素(PYM)的实验研究。结果表明:①DDP10mg/kg、PYM 8mg/kg、43℃加温25分钟和4Gy/次放射,对荷 S_(37)的 NIH 小鼠,均有显著疗效,以放射的效果最好;②二联治疗效果较单纯治疗为好,以放射加DDP10mg/kg、PYM 8mg/kg 或43℃加温25分钟的疗效更好;③三联治疗效果比二联的好,比单纯治疗的更好;④四联治疗效果最佳,其 MDDT 和 AET 都是最长的。