重组人白介素-2治疗恶性胸腔积液的疗效分析

目的通过重组人白介素-2治疗恶性胸腔积液的效果分析,为临床工作参考.方法我院36例恶性胸腔积液患者,采用重组人白介素-2（200万单位）配合50ml生理盐水,抽胸水后注入,每周2次,连续2周.判断指标总有效率（CR＋PR）,生活质量状况及毒副反应.结果本组36例患者总有效率为86.1%,生活质量状况提高55.6%,有5例发热（13.9%）, 6例胸痛（16.7%）,经对症处理后缓解,均未见血常规和肝肾功能异常.结论重组白细胞介素-2对恶性胸腔积液治疗有一定的疗效,并无严重毒副反应,要提高疗效还得从联合用药和给药途径上加以探讨.     

46例首诊伴远处转移鼻咽癌的预后分析

Objective To retrospectively analyze the therapeutic results of patients with initially di-agnosed metastatic nasopharyngeal carcinoma (NPC). Methods From January 1995 to December 1998, 46 NPC patients with distant metastases were treated in Fujian provincial cancer hospital. Among these pa-tients, 43 were single site metastasis and 3 were multiple sites metastases;The site of metastasis were 19 pa-tients in the liver, 11 in the bone, 7 in the lung, 1 in the brain, 6 in mediastinal nodes and 6 in axillary lymph nodes. All patients received standard radiotherapy to the primary site and cervical node region with a median dose of 72 Gy. Forty-one patients (89%) received 1-5 cycles chemotherapy (cisplatin and 5-flu-orouracil), and 23 (50%) received palliative irradiation to the metastatic site. Results The median surviv-al time was 20 months. The 1-, 2-, 3-year and 5-year overall survival rates were 66%, 47%, 30% and 19%, respectively. Irradiation to the metastatic sites and KPS were the significant prognostic factors. Pa-tients with palliative irradiation to the metastatic site had longer survival than those without (39 months vs. 13 months, X2=8.63, P=0.012). Patients with good performance status (KPS≥80) had better outcomes thanthose with poor performance status (26 months vs. 12 months, X2= 3.95, P=0.035) . Conclusions Active therapy may prolong the survival of patients with initially diagnosed metastatic NPC, especially for those who have good performance status. Under systematic chemotherapy, radiotherapy to the primary site and supportive care, the palliative irradiation to the metastatic site may also yield a good result.     

46例首诊伴远处转移鼻咽癌的预后分析

Objective To retrospectively analyze the therapeutic results of patients with initially di-agnosed metastatic nasopharyngeal carcinoma (NPC). Methods From January 1995 to December 1998, 46 NPC patients with distant metastases were treated in Fujian provincial cancer hospital. Among these pa-tients, 43 were single site metastasis and 3 were multiple sites metastases;The site of metastasis were 19 pa-tients in the liver, 11 in the bone, 7 in the lung, 1 in the brain, 6 in mediastinal nodes and 6 in axillary lymph nodes. All patients received standard radiotherapy to the primary site and cervical node region with a median dose of 72 Gy. Forty-one patients (89%) received 1-5 cycles chemotherapy (cisplatin and 5-flu-orouracil), and 23 (50%) received palliative irradiation to the metastatic site. Results The median surviv-al time was 20 months. The 1-, 2-, 3-year and 5-year overall survival rates were 66%, 47%, 30% and 19%, respectively. Irradiation to the metastatic sites and KPS were the significant prognostic factors. Pa-tients with palliative irradiation to the metastatic site had longer survival than those without (39 months vs. 13 months, X2=8.63, P=0.012). Patients with good performance status (KPS≥80) had better outcomes thanthose with poor performance status (26 months vs. 12 months, X2= 3.95, P=0.035) . Conclusions Active therapy may prolong the survival of patients with initially diagnosed metastatic NPC, especially for those who have good performance status. Under systematic chemotherapy, radiotherapy to the primary site and supportive care, the palliative irradiation to the metastatic site may also yield a good result.     

自杀基因联合放射对食管癌细胞株的实验研究

目的自杀基因具有能将无细胞毒性的前体药物转化为有细胞毒性作用的药物而使细胞死亡,通过观察大肠杆菌胞嘧啶脱氨酶/氟胞嘧啶(CD/5-FC)自杀基因系统对食管癌EC109细胞杀伤效应及与放射联合应用对食管癌肿瘤细胞协同杀伤效应。方法采用PCR方法从大肠杆菌基因组DNA中扩增出CD基因;构建重组真核载体pcDNA3.1-CD;用脂质体转染法转染EC109细胞;观察CD/5-FC体系对EC109细胞的杀伤效应和旁观者效应及对放射的增敏效应。结果RT-PCR分析结果表明CD基因已转入EC109细胞并表达。离体实验证实5-FC对转CD基因后的食管癌细胞株有明显的细胞毒作用,含5%的转基因食管癌细胞加入5-FC后的细胞存活比率为41.8%±14.2%,低于对照组的94.6%±4.3%结果(t=3.14,P<0.05);加入10%的转基因细胞的存活比率为37.8%±4.4%,低于对照组的95.6%±5.4%结果(t=9.75,P<0.01)。CD/5-FC体系对肿瘤细胞放射增敏效果明显,加前药5-FC及放射组细胞存活曲线低于单纯加前药5-FC对照组或单纯放射对照组,重复测量数据方差分析结果显示F=11.50,P<0.01;治疗组分别与5-FC对照组及单纯放射对照组相比F值分别为4.11、10.53,P值分别<0.05、0.01。结论CD/5-FC体系的旁观者效应和放射增敏效果明显。     

非小细胞肺癌脑转移放射治疗进展

脑转移癌是一种常见的肿瘤神经系统并发症,约20%~40%的颅外恶性肿瘤在病程中发生脑转移[1]。常见的原发肿瘤为肺癌、乳腺癌、恶性黑色素瘤、肾癌等,其中肺癌脑转移率高达50%,以非小细胞肺癌(non-small cell lung cancer,NSCLC)最常见[2]。随着MRI等诊断技术的提高,脑转移患者的检出率也呈现上升趋势。肺癌脑转移患者预后较     

三维适形放射治疗肺癌脑转移临床疗效观察

目的：通过观察脑转移三维适形放射治疗的结果，探讨三维适形放射治疗对非小细胞肺癌脑转移的临床意义。方法：1998年5月-2006年2月41例确诊肺癌脑转移患者，其中合并颅外转移18例，非颅外转移23例。所有患者首先经全脑放疗，2—3Gy／次，5次／周，DT30Gy-40Gy，然后行三维适形放射治疗局部加量，90％的等剂量曲线包括靶区，DT4—6Gy／次，总剂量12Gy-24Gy。结果：治疗有效率90．2％（37／41），中位生存期18月，半年生存率79．9％，1年生存率66．7％。结论：全脑放射治疗＋三维适形放射治疗可以提高脑转移的靶区剂量，并提高局部控制率，减少脑部复发的机会，同时颅外转移灶及原发灶的治疗也非常重要。     

胸段食管癌淋巴结转移规律与放疗意义探讨

目的 了解胸段食管癌淋巴结转移规律，探讨胸段食管癌放疗临床靶区的设计。方法 对首程治疗行颈、胸、腹3个野根治术的胸段食管鳞癌患者621例，标记各部位清扫的淋巴结分别送检，进行临床病理资料分析，了解淋巴结转移规律，为食管癌放疗临床靶区的设计提供理论依据。结果 胸上、中、下段食管癌颈部淋巴结转移率分别为42．9％、27．9％和7．9％，上纵隔的分别为31．2％、24．0％和10．1％，中纵隔的分别为14．3％、29．7％和33．7％，下纵隔的分别为1．3％、4．0％和19．1％，腹部的分别为11．7％、25．1％和55．1％。胸部各段食管癌淋巴结转移部位比较差异有统计学意义（P〈0．05）。病变长度愈长、肿瘤分化越低、肿瘤浸润越深食管癌淋巴结转移率也愈高（P〈0．05）。结论 胸上段食管癌淋巴结转移以颈段食管旁、锁骨上、上中纵隔转移多见，胸中段食管癌淋巴结转移具有明显的上下双向转移和跳跃性转移特点，胸下段食管癌淋巴结转移以腹部、中下纵隔转移多见。建议胸上段食管癌临床靶区的范围上界包括颈段食管旁及锁骨上、下界包括隆突下的淋巴结引流区，胸下段食管癌临床靶区的范围上界至隆突水平、下界包括胃左血管旁的淋巴结引流区，胸中段食管癌临床靶区的范围应根据具体情况设定。     

胃癌术后放射治疗的进展

胃癌的发病率和死亡率在世界范围内位居第二,在美国,2006年估计有大约36830例新发上消化道肿瘤患者,约25200例死亡[1]。我国是胃癌高发区之一,除局部地区近年略有下降外,整体未见明显下降趋势,胃癌的死亡率仍占全部肿瘤死亡率的1/5以上[2]。目前手术仍是治疗胃癌最有效、治愈率     

放射诱导鼻咽癌细胞凋亡的研究现状

鼻咽癌（NPC）是我国高发的恶性肿瘤之一，放射治疗是其主要的治疗手段。目前研究表明，放射与细胞凋亡存在密切关系，放射可诱导肿瘤细胞发生凋亡，并加速细胞凋亡过程而使更多的肿瘤细胞死亡，从而使肿瘤发生消退。探讨和研究射线与NPC细胞凋亡的关系，对了解放射诱导NPC细胞死亡的分子机制、放疗技术的改进和放射防护等具有重要的现实意义。     

I型胶原吡啶交联终肽诊断肿瘤骨转移的价值

目的 探讨I型胶原吡啶交联终肽(ICTP)诊断肿瘤骨转移的临床价值. 方法 采用EIA法分析262例恶性肿瘤患者(其中178例为骨转移)及30例健康体检者(对照组)的ICTP水平. 结果 肿瘤骨转移患者ICTP水平较肿瘤非骨转移及对照组显著升高(P＜0.05);ICTP诊断肿瘤骨转移的敏感性为71.35%(127/178),特异性为91.23%(104/114),准确性为79.10%(231/292);各种嗜骨性肿瘤中,敏感性分别为:前列腺癌96.00%,肺癌86.05%,胃癌83.33%,乳腺癌55.10%,鼻咽癌45.16%. 结论 ICTP对肿瘤骨转移有一定的敏感性和特异性;对治疗后癌症患者的随访及预后判断有帮助.