原发十一重癌一例

患者男,58岁.1998年10月15日行结肠癌、空肠癌切除术,术后病理为左降结肠低分化腺癌(pT3N2M0),小肠中分化腺癌(pT3N1M0).术后行ELFP方案(顺铂+依托泊苷+甲酰四氢叶酸钙+5-氟尿嘧啶)化疗5次,FOM方案(5-氟尿嘧啶+长春新碱+甲环亚硝脲)化疗1次,阿克拉霉素治疗1次,腹腔内化疗2次.     

表没食子儿茶素没食子酸酯对放射性食管炎动物模型的作用研究

目的 研究表没食子儿茶素没食子酸酯（epigallocatechin-3-gallate,EGCG）对放射性食管炎模型新西兰兔的影响。方法 取雄性新西兰兔30只,用随机数表法分为3组,每组10只,分别为空白组、生理盐水组、EGCG组。EGCG组、生理盐水组给予6 MV X射线照射造模,照射结束后分别给予EGCG和生理盐水治疗,每天3次,连续5 d。观察食管组织病理变化并评分,用酶联免疫吸附法测定血清白细胞介素1β（IL-1β）、白细胞介素6（IL-6）、转化生长因子β（TGF-β）及肿瘤坏死因子α（TNF-α）水平,用免疫组织化学检测食管组织67LR的表达,应用Western blot检测67LR水平。结果 给药后,空白组、生理盐水组、EGCG组食管组织病理变化程度评分分别为0、3.90±1.10、2.80±0.92。3组血清IL-1β、IL-6、TGF-β及TNF-α水平的差异随着时间的延长显著增高（F=23.66~236.32,P<0.05）。3组食管组织67LR含量差异有统计学意义（F=585.38,P<0.05）。结论 EGCG能够减轻放射性食管炎的发生及严重程度,其作用可能与67LR表达有关。     

基于小动物精准放疗平台构建Wistar大鼠急性放射性食管炎动物模型

目的 基于小动物精准放疗平台(SARRP)建立Wistar大鼠急性放射性食管炎体内模型。方法 将36只Wistar大鼠按照随机数表法分为对照组、40、60和75 Gy组,每组9只。基于SARRP结合照射前磁共振图像(MRI)勾画大鼠食管靶区并制定计划,每次分别照射0、8、12和15 Gy,连续照射5 d,观察大鼠体重、进食量、食管病理和磁共振图像改变。结果 75 Gy组大鼠在照后第6天体重最先出现明显降低(P<0.05),照后第9天各照射组大鼠食管较对照组增粗(F=14.20,P<0.05)。照后第9天HE染色显示,40 Gy组放射性食管炎形成率为4/5,60 Gy 组食管炎形成率为5/5,且以轻度食管炎为主,75 Gy组食管炎形成率为5/5,其中3/5表现为重度。照后第9天各组大鼠病理损伤评分[M(Q₁, Q₃)]为0、1.0(0.5, 2.5)、1.0(1.0, 2.5)和4.0(1.5, 6.0),75 Gy组与对照组相比,差异有统计学意义(H=12.69,P<0.05)。动态监测颈部MRI图像后发现,照后第9天时各照射组大鼠食管信号增强变宽。结论 本实验基于小动物精准放疗平台结合MRI成功建立大鼠的急性放射性食管炎动物模型,75 Gy是最佳照射剂量,且第9天是最佳观察时间点。     

FDG PET／CT代谢体积对食管癌术后预后的预测价值

目的研究食管癌患者^18F-FDG PET／CTMTV与预后的关系。方法回顾性分析2004年3月至2008年3月行^18F—FDG PET／CT检查的49例Ⅰ—Ⅳa期的食管癌患者,均经病理检查证实,随访资料完整。患者均行食管癌切除术,随访截止至2009年11月,中位随访时间为29（8～57）个月。应用Kaplan—Meier法及Cox比例风险模型分析年龄、性别、肿瘤位置、肿瘤组织分化程度、PET／CT示肿瘤长径、美国肿瘤联合会（AJCC）分期、转移淋巴结个数、原发灶SUVmax及MTV与预后的关系。结果在单因素分析中,仅AJCC分期[χ^2=16．206,危险比（HR）=1．177,P〈0．001）,淋巴结分期（N）（χ^2=9．536,HR=10．833,P=0．002）,浸润深度（T）（χ^2=5．810,FIR=2．397,P=0．016）,淋巴结转移个数（χ^2=11．423,HR=1．567,P=0．001）、MTV（χ^2=3．872,HR=2．433,P=0．049）对预后存在预测作用。对以上变量行多因素分析,仅AJCC分期及MTV是独立的预后因子（r=4．525,HR=1．170,P=0．033;χ^2=4．875,HR=3．071,P=0．027）。Kaplan-Meier生存分析显示术前低MTV组比高MTV组的生存率高（Log—rank检验,χ^2=4．186,P=0．041）。结论MTV与食管癌术后患者的预后密切相关。对于高MTV患者,术后可能需要接受更加积极的治疗。     

鼻咽未分化癌患者放疗前后血清人细胞角蛋白21-1片段和癌胚抗原水平与预后的关系

Objective The purpose of this study was to evaluate the potential of CYFRA 21-1 (CYFRA) and CEA as a prognostic marker in patients with undifferentiated nasopharyngeal carcinoma ( NPC). Methods From March 2004 to February 2008, 62 patients with newly diagnosed, undifferentiated NPC were treated in our department. Their clinocopathological data were analyzed retrospectively. All patients received intensity-modulated radiotherapy using 6 MV X-rays, and serum CYFRA and CEA before and after radiotherapy were assayed. The association among the long-term follow-up results and age, sex, smoke, TNM stage, chemotherapy, CEA, CYFRA and the changes in any direction of serum CYFRA and CEA were determined. Results Patients with low pre-RT level ( ≤ 2. 49μg/L) of CYFRA had a significantly better overall survival ( OS) than patients with high level ( > 2. 49 μg/L,OR = 8. 555, P = 0.029). N classification and T classification were positively associated with the prediction of progression free survival ( OR = 4. 054, P = 0. 001; OR = 3. 873, P = 0. 001 ). But there was no significant association between the rest predictors (age, sex, CEA, post-RT CYFRA, chemotherapy and a radiation-induced decrease in serum markers) and the survival or recurrence rate by multivariate analysis. Conclusions The results of the present study show that pre-RT serum CYFRA level is a valuable factor for predicting long-term survival in patients with undifferentiated nasopharyngeal carcinoma. More aggressive treatment may be given to those patients with a high serum CYFRA level.     

鼻咽未分化癌患者放疗前后血清人细胞角蛋白21-1片段和癌胚抗原水平与预后的关系

Objective The purpose of this study was to evaluate the potential of CYFRA 21-1 (CYFRA) and CEA as a prognostic marker in patients with undifferentiated nasopharyngeal carcinoma ( NPC). Methods From March 2004 to February 2008, 62 patients with newly diagnosed, undifferentiated NPC were treated in our department. Their clinocopathological data were analyzed retrospectively. All patients received intensity-modulated radiotherapy using 6 MV X-rays, and serum CYFRA and CEA before and after radiotherapy were assayed. The association among the long-term follow-up results and age, sex, smoke, TNM stage, chemotherapy, CEA, CYFRA and the changes in any direction of serum CYFRA and CEA were determined. Results Patients with low pre-RT level ( ≤ 2. 49μg/L) of CYFRA had a significantly better overall survival ( OS) than patients with high level ( > 2. 49 μg/L,OR = 8. 555, P = 0.029). N classification and T classification were positively associated with the prediction of progression free survival ( OR = 4. 054, P = 0. 001; OR = 3. 873, P = 0. 001 ). But there was no significant association between the rest predictors (age, sex, CEA, post-RT CYFRA, chemotherapy and a radiation-induced decrease in serum markers) and the survival or recurrence rate by multivariate analysis. Conclusions The results of the present study show that pre-RT serum CYFRA level is a valuable factor for predicting long-term survival in patients with undifferentiated nasopharyngeal carcinoma. More aggressive treatment may be given to those patients with a high serum CYFRA level.     

结直肠癌肿瘤基因异质性及其临床应用研究

近年随着肿瘤治疗不断发展,针对基因治疗的药物在肿瘤的降期和局部控制中发挥着重大的作用.结直肠癌内部基因的异质性促进了肿瘤的发生发展,关系着靶向药物选择及疗效,其必然成为肿瘤个体化治疗瓶颈的重要突破点.     

表没食子儿茶酸没食子酸酯用于放射损伤防治的研究进展

放射治疗是治疗恶性肿瘤的主要手段之一,在治疗过程中易引起正常组织的损伤,如放射性肺损伤、食管损伤、皮肤损伤及造血、免疫功能异常等。绿茶成分表没食子儿茶酸没食子酸酯（EGCG）是茶多酚的主要成分,具有抗炎、抗氧化、抗凋亡及调节免疫力等功能。近年来大量的动物模型实验证实,EGCG具有防治放射损伤的作用,但EGCG防治放射损伤的临床报道不多。本文将从EGCG的抗放射机制及其在放射性损伤中的应用方面,对近年来EGCG在放射损伤防治方面的研究进展进行综述,以期为EGCG的临床应用提供参考。