Evaluation of Training Course Effects on Integrated Sexual and Reproductive Health Counseling

Since the International Conference on Population and Development held in Cairo in 1994, and the Fourth World Conference on Women held in Beijing in 1995, the international organizations and public health communities have paid more attention to reproductiv…     

用Lyman NTCP模型分析原发性肝癌三维适形放疗引起的放射性肝病

目的建立原发性肝癌三维大分割适形放疗Lyman NTCP模型的参数和探讨放射性肝病的影响因素。方法109例患者进行大分割三维适形放疗,其中93例患者肝硬化Child-Pugh分级A级,16例为B级。患者每星期治疗3次,每次间隔48h,(4．8±0．5)Gy/次,平均剂量(53．5±5．5)Gy。用最大拟然比方法分别得到Child-A和Child-B患者Lyman模型中的NTCP参数。结果共有17例发生放射性肝病,发生在Child-A组8例,Child-B组9例。多因数分析表明,肝硬化分级程度是与放射性肝病相关的独立因素(P=0．000)。所有患者的NTCP参数为n=1．1,m=0．35,TD_(50) (1)=38．5Gy；Child-A级为n=1．1,m=0．28,TD_(50)(1)=40．5Gy；Child-B级为n=0．7,m=0．43,TD_(50)(1)=23Gy。结论肝硬化分级是预测放射性肝病发生的危险因子。Child-B患者进行适形放疗易引起放射性肝病。     

主动呼吸控制技术(ABC)在肺癌放射治疗中的应用

目的：使用主动呼吸控制技术（aetive brething control,ABC）治疗非小细胞肺癌患者，评价呼吸运动时肺部肿瘤动度的影响及ABC技术的优势和可行性，并评价近期疗效和急性放射反应。方法：选择9例使用ABC技术联合三维造型放疗技术治疗的非小细胞系癌患者进行分析。CT定位扫描时分别采集ABC和自由呼吸（free breath.FB）状态下的图像，评价呼吸运动对肺部肿瘤动度和PTV边界的影响唾弃；并比较两种计划的DVH，放疗剂量为54-60Gy/18-20次。3Gy/次，1次/天，5天/周，定期随访，评价近期疗效及急性放射反应。结果：应用ABC技术后，隔肌的平均位移从FB时的43.5mm（20.0-32.0mm）降低为3.6mm（0.5-72.mm）,胸壁的侧方位移从FB时的3.2mm（2.8-4.0mm）降低为1.2mm（0.5-1.6mm）.PTV边界可以从FB时的1.5mm减少为0.75cm;肺的V20从21.8%降低为15.0%,减少了30.6%.中位随访6个月时,9例患者中有6例CR,3例PR.急性放射副反应都很轻微,仅为I-II.结论：在肺癌的精确放射治疗中,呼吸动度的影响不可忽视.而ABC系统可以有效的降低呼吸运动时治疗的影响,提高放疗的精确性,减少副反应.,但该系统使用较为复杂,延长了治疗的时间,个别患者不能忍受.     

Predictors of long-term survival in patients with gallbladder cancer

The aim of this study was to examine the predictors of long-term survival (>24 months) in patients with gall bladder cancer. A retrospective review of 117 cases of gall bladder cancer resected between 1989 and 2000. The resections included 80 simple cholecystectomies and 37 extended procedures. Patients with survival >24 months (n=44) were compared with those having survival <24 months (n=73) for 17 prognostic factors. Overall median survival was 16 months with a 5-year survival of 27%. T status (P=.000) and adjuvant chemoradiotherapy (P=.001) were independent predictors of long-term survival. Survival advantage was seen in T3N+ve disease (P=.007) with extended procedures. Complete (R0) resection was attained in 30 patients with a 5-year survival advantage of 30% as compared with incomplete (R1) resection (P=.0002). Adjuvant chemoradiotherapy improved survival in simple cholecystectomy group (P=.0008) but no advantage was seen after extended procedures. Stage III (P=.001) and node-positive disease (P=.0005) had significant benefit with adjuvant therapy. Poor differentiation and vascular invasion were associated with poor long-term survival. R0 resection was associated with prolonged survival. Extended procedures improved survival in patients with T3N+ve disease. Addition of chemoradiotherapy made significant improvement in long-term survival in stage III and node-positive lesions and in patients undergoing simple cholecystectomy. R0 resection predicted long-term survival in gall bladder cancer. T3 N+ve disease had better survival after extended procedures. Adjuvant chemoradiotherapy improved survival in stage III and node-positive disease. Poor differentiation and vascular invasion were adverse predictors of survival.     

中西医结合治疗Leriche综合征78例

目的:总结中西医结合治疗Leriche综合征的方案.方法:回顾性总结Leriche综合征的临床治疗78例,均行人工血管主股或主髂动脉转流手术,术后静脉应用低分子右旋糖酐、复方丹参注射液和维脑路通.结果:手术结束后均能触及股动脉和动脉搏动,手术后7 d,患肢缺血症状均得到改善.手术后3月,患肢缺血症状消失,64例阳痿现象得到改善.彩色超声血管吻合口及人工血管内均未见血栓.结论:人工血管主股动脉转流或主髂动脉转流是治疗Leriche综合征较好的手术方案,围手术期合理应用扩血管、祛聚、活血化瘀药物,同时及时处理伴发疾病是提高临床治愈率和提高远期疗效的关键.     

急性重症胰腺炎的中西医结合非手术治疗

目的:探讨中西医结合非手术治疗急性重症胰腺炎的疗效.方法:同期设治疗组和对照组,两组均给予西医综合治疗,治疗组加用中医中药.结果:治疗组治愈率81.25%,中转手术率4.17%,2～3周后手术处理后遗症率8.33%,病死率6.25%.对照组治愈率40.74%,中转手术率11.11%,2～3周后手术处理后遗症率18.52%,病死率29.63%.均有显著性差异.结论:中西医结合治疗疗效确切,并有降低死亡率、减少并发症、缩短病程等优点.     

Chemotherapy in the treatment of advanced or recurrent olfactory neuroblastoma

Background: Olfactory neuroblastoma is a rare sino‐nasal tumor arising from the olfactory epithelium and is often characterized by local invasion or metastasis. The role of chemotherapy in the treatment of this tumor is unclear. The purpose of this study was to review our institution’s experience of chemotherapy for advanced or recurrent olfactory neuroblastoma. Methods: Twenty‐one patients with histologically proven olfactory neuroblastoma were treated at our institution between 1992 and 2002. Twelve of these patients received chemotherapy in the setting of unresectable or recurrent disease and were retrospectively reviewed for clinical characteristics, treatment outcome or survival. Results: Eight patients of the 12 patients received cisplatin‐based chemotherapy and the remaining four patients received chemotherapy consisting of docetaxel plus irinotecan (three patients) or cyclophosphamide, doxorubicin, and vincristine (1 patient). A partial response was achieved in five patients, with an overall response rate of 42%, although the chemotherapeutic regimens were heterogeneous. Two partial responses were obtained among the three patients who received docetaxel plus irinotecan. The response rate to chemotherapy was 83% in the younger age group (<40 years), as opposed to 0% in the older age group (≥40 years), and the difference between the two groups was statistically significant (P = 0.02). Conclusion: Our study indicated that olfactory neuroblastoma would be sensitive to chemotherapy, especially with young patients. Docetaxel plus irinotecan has the possibility of showing favorable response, and warrants further investigation.     

CT模拟与三维计划对减低鼻咽癌放疗并发症的价值

目的了解引起鼻咽癌放射治疗并发症的影响因素,通过观察CT模拟及三维计划与X线模拟二维计划比较分析对鼻咽癌放射并发症的影响.方法临床观察从1995年～2005收治的并且能够随诊到的161例鼻咽癌病人放疗后出现的并发症.临床从张口受限、急性皮肤反应、颈部组织纤维化、口干症以及鼻腔粘连等并发症来观察结果.结果颈部组织纤维化中、重度,三维计划分别为8/108(7.4%)和1/108(0.9%);二维计划分别为8/53(15.1%)和4/53(7.5%).口干症中、重度三维计划分别为10/108(9.3%)和3/108(2.8%);二维计划分别为17/53(32.1%)和9/53(17.0%).急性皮肤反应中、重度三维计划分别为18/108(16.7%)和8/108(7.4%);二维计划分别为19/53(35.8%)和11/53(20.8%).张口受限三维计划为7/108(6.5%);二维计划为12/53(22.6%).鼻腔粘连三维计划为12/108(11.1%),二维计划为13/53(24.5%).结论CT模拟与三维计划可明显降低放疗并发症的发生.     

Symptomatic osteoradionecrosis of pelvic bones in patients with gynecological malignancies—result of a long-term follow-up

The aim of this study was to assess the incidence and risk factors of pelvic fractures as a result of radiation therapy in women with gynecological cancer. We retrospectively reviewed 3530 female patients treated at our institute between 1980 and 1998 with megavoltage radiation with or without brachytherapy for cancer in the pelvic area. Eligible were patients with vulvar, vaginal, cervical, endometrial, and fallopian tube cancer. Median follow-up was 88 months (range 0-240). Emphasis was put on treatment-related and patient-related risk factors. Of the eligible 3155 patients, 15 developed symptomatic bone fracture caused by osteoradionecrosis, which makes an overall incidence of 0.44% The diagnosis was based on anamnesis, clinical course, and X-ray or computed tomography images. Median time of onset was 44 months (range 6-197). All patients had pain as the first symptom. The only independent predictive factor for developing osteoradionecrosis seemed to be preexistent osteoporosis. Other risk factors that are related to osteoporosis include higher age, postmenopausal status, or steroid treatment. We did not find any significant treatment-related predictive factor for pelvic osteoradionecrosis. Patients with osteoporosis are probably at the highest risk for developing osteoradionecrotic fractures after pelvic radiotherapy. More studies are needed to find out other endogenous predictive factors.     

Vaginal stenosis in patients treated with radiotherapy for carcinoma of the cervix

The aim of our study was to determine the incidence, timing, and severity of vaginal stenosis in patients with carcinoma of the cervix who had received pelvic and/or vaginal radiotherapy as part of their treatment. We also sought to determine if there were any predisposing factors for the development of stenosis. A retrospective chart review was undertaken for all the patients diagnosed with carcinoma of the cervix between January 1, 1990, and December 31, 2000 and treated with pelvic and/or vaginal radiation at Westmead Hospital. Since January 1, 1990, data regarding vaginal stenosis has been prospectively recorded on all the patients. Data collected included patient demographics, stage of disease, treatments administered, and incidence, timing, and severity of vaginal stenosis. One hundred and eighty-eight patients were treated. Mean age was 58.6 years. Thirteen percent of patients had stage IB disease, 45% had stage II disease, 39.5% had stage III disease, and 1.5% had stage IV disease. One hundred and seventy-nine patients returned for follow-up, and data regarding vaginal toxicity were available in 98%. Twenty-seven percent had grade 1 toxicity (partial stenosis or shortening but not complete occlusion), and 11% had grade 2 (complete occlusion). Stenosis of any grade was noted at a mean of 9.6 months and median of 7.5 months (range, 26 days-5.6 years) from completion of treatment. The only prognostic factor associated with increased risk of stenosis was age greater than 50 years (odds ratio 2.26). Vaginal stenosis is a common complication of pelvic and vaginal radiotherapy, occurring in 38% of patients. Stenosis occurs most often in the first year after treatment. Patients over the age of 50 are most at risk.