Efficacy of Yanshu injection (a compound Chinese traditional medicine) combined with concurrent radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma

Objective To evaluate the efficacy and toxicity of Yanshu injection (a compound Chinese traditional medicine from Sophora flauescens Ait) combined with concomitant radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma. Methods Sixty patients with stage Ⅲ nasopharyngeal carcinoma were randomized into Yanshu group and control group (n =30, each). Patients in the Yanshu group received Yanshu injection in addition to intensity modulated radiation therapy ( IMRT) and concomitant chemotherapy, and those in the control group were treated with IMRT and concurrent chemotherapy. Results The 1-year, 2-year, 3-year and 4-year overall survival rates were 100%, 93.3%, 86.7% , 80. 0% for Yanshu group, and 96. 7% , 90. 0% , 83. 3% , 76. 7% for the control group, respectively, with no significant difference between the two groups ( P = 0.565). The 1 -year, 2-year, 3-year and 4-year progression-free survival rates were 96.7% , 90. 0% , 83. 3% , 70. 0% for Yanshu group, and 90.0% , 86.7% , 76. 7% , 66. 7% for control group, respectively, with no significant difference (P = 0.554). However, the reaction of mucosa of oral cavity, myelosuppression and thrombocytopenia in the Yanshu group were significantly lower than that in the control group (P < 0. 05). The quality of life of the patients in the Yanshu group was significantly higher than that in the control group ( P < 0. 05 ). Conclusions Yanshu injection combined with radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma show a good efficacy and can reduce the side effects of radiochemotherapy of nasopharygeal carcinoma, and improve the quality of life of the patients.     

~(99m)Tc-MIBI心肌灌注断层显像监测蒽环类药物的心脏毒性

目的 :探讨99mTc-MIBI心肌灌注断层显像在蒽环类药物心脏毒性监测中的价值。方法 :2 3例接受蒽环类药物治疗的患者 ,在治疗前进行心电图、心肌酶学检查、核素心室造影测左室射血分数 (LVEF)和99mTc MIBI心肌灌注断层显像并计算相对定量值。并于每一周期治疗后重复上述检查。结果 :蒽环类药物治疗一周期后 ,2 3例患者心肌相对定量值明显下降 (P <0 .0 1)。其中 11例吡喃阿霉素、6例表阿霉素和 6例米托蒽醌治疗的患者 ,心肌相对定量值明显下降 (P <0 .0 5 ) ,心电图和心肌酶学无明显变化 (P >0 .0 5 )。蒽环类药物治疗多周期后的 10例患者心肌相对定量值较治疗前下降 (P <0 .0 5 )。 9例患者的心肌相对定量值 (最大累积剂量为 2 0 0mg/m2 )与一周期后无明显差别 (P >0 .0 5 )。10例患者治疗前及多周期治疗后LVEF均 >6 0 %,且化疗前后无明显差别 (P >0 .0 5 )。结论 :99mTC MIBI心肌灌注断层显像能监测蒽环类药物所致的心肌损害 ,且较左室射血分数敏感 ,比心电图和心肌酶学检查优越 ,有利于指导蒽环类药物的临床应用。     

鼻咽癌放疗对甲状腺功能的影响

目的研究鼻咽癌一、二程放疗对甲状腺功能的影响.方法对该院2000年9月～2003年6月共97例鼻咽癌患者进行前瞻性研究,分放疗前、一程放疗后、二程放疗后(复发再治)三组,采用放疗法测定血清游离三碘甲状腺原氨酸(FT3)、游离四碘原氨酸(FT4)及高敏促甲状腺激素(hTSH)水平.结果一、二程放疗后血清FT3、FT4值较放疗前水平降低,hTSH值无明显差异;二程放疗后血清FT3、FT4、hTSH值与一程放疗后比较无明显差异.追踪3～24个月,一程放疗后有2例发生甲状腺功能减退(甲减),发生率6.45%(2/31).二程放疗后3例发生甲减,发生率为10%(3/30).一、二程放疗后总甲减发生率为8.2%(5/61).结论鼻咽癌放疗对甲状腺功能有损伤,一、二程放疗对甲状腺功能损伤无程度上的差别.     

33例颅内生殖细胞瘤远期疗效分析

本文对33例颅内生殖细胞瘤几种治疗方法的远期疗效进行探讨。结果表明，肿瘤全消23例，部分消除10例；5年生存率为91.7％；第一组中3例智力障碍、2例头痛、1例身材矮小；第二组无智力障碍及头痛，1例身材矮小；第三组1例智力障碍、1例头痛、无身材矮小。认为伽玛刀立体定向治疗联合全脑放疗可减少远期颅内并发症的发生，脊髓预防性放疗是否作为颅内生殖细胞瘤常规治疗有待进一步探讨。     

颅内生殖细胞瘤肺转移一例

1临床资料患者,男,15岁,因头痛、头晕伴呕吐1月余,于2001年11月15日入本院神经外科。头部MRI报告:松果体区占位性病变。入院后,于2001年11月19日拟“松果体区占位性病变待查?”,在全麻下行“脑室腹腔分流术”;11月28日行γ-刀治疗:松果体区肿瘤中心剂量31.11Gy,周边剂量14Gy。患者于2001年12月1日出院,出院后仍有头痛。患者于2002年1月3日第2次入本院神经外科,1月7日在全麻下行“脑室镜下三脑室造瘘术”。患者于2002年9月20日第3次入本院神经外科,复查头部MRI报告:松果体区肿瘤较2001年12月31日病灶增大;胸片报告正常。于2002年9月25日…     

紫杉醇脂质体诱导加同期放化疗与序贯放化疗治疗局部晚期非小细胞肺癌的随机对照研究

背景与目的序贯放化疗及同期放化疗在局部晚期肺癌治疗中得以广泛研究,而诱导加同期放化疗的研究尚少。紫杉醇脂质体副作用少,可使诱导加同期放化疗更顺利地实施。本文旨在比较紫杉醇脂质体加顺铂(TP方案)诱导加同期放化疗和序贯放化疗治疗局部晚期非小细胞肺癌(non-small celllung cancer,NSCLC)的疗效及毒副作用。方法我院60例局部晚期NSCLC患者随机分为诱导加同期放化疗组(A组)和序贯放化疗组(B组)。A组:诱导化疗2个-3个周期后行同期放化疗,放疗的第1天及第22天予TP方案化疗(紫杉醇脂质体135mg/m2-175mg/m2,d1;顺铂70mg/m2-80mg/m2,d2),期间持续放疗。B组:化疗方案同前,化疗4个-6个周期后,行放疗。两组放疗方式均为三维适形放疗,总剂量为56Gy-70Gy。观察和比较两组的疗效和毒副作用。结果 A组、B组总有效率分别为80.3%和60%,组间有统计学差异(P=0.042);1年生存率分别为71.4%和53.2%,组间无统计学差异(P=0.18);骨髓抑制发生率分别为90%和73.3%,组间无统计学差异(P=0.09);放射性食管炎发生率分别为50%和36.7%,组间无统计学差异(P=0.147);肺纤维化发生率分别为30%和20%,组间无统计学差异(P=0.276)。结论在晚期NSCLC的局部治疗中,TP方案诱导加同期放化疗较序贯放化疗的近期疗效好,但毒副反应无明显区别。     

颅内血管母细胞瘤的临床研究

目的 探讨颅内血管母细胞瘤（HB）的临床特点及次全切除术后的综合疗效。方法 采用回顾性分析方法，对经手术完全切除的38例（手术组）及手术切除有残灶、术后辅以放疗的25例（综合治疗组）颅内血管母细胞瘤进行临床分析和疗效总结。主要临床症状为颅内压增高（35例）、小脑机能障碍（20例）及颅神经损害（8例）。52例病灶位于小脑，肿瘤病理组织学特点由毛细血管网和间质细胞构成。结果 综合治疗组5例复发，4例死于复发，22例非脑干区术后残留肿瘤照射剂量50～55Gy；其5、10和15年生存率分别为100％、92％和89％。手术组6例复发，3例死于复发；其5、10、15年生存率分别为97％、85％、79％。结论 颅内血管母细胞瘤好发于成人小脑部位，术后有残留者辅以放疗可能会减少复发。     

Efficacy of Yanshu injection (a compound Chinese traditional medicine) combined with concurrent radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma

Objective To evaluate the efficacy and toxicity of Yanshu injection (a compound Chinese traditional medicine from Sophora flauescens Ait) combined with concomitant radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma. Methods Sixty patients with stage Ⅲ nasopharyngeal carcinoma were randomized into Yanshu group and control group (n =30, each). Patients in the Yanshu group received Yanshu injection in addition to intensity modulated radiation therapy ( IMRT) and concomitant chemotherapy, and those in the control group were treated with IMRT and concurrent chemotherapy. Results The 1-year, 2-year, 3-year and 4-year overall survival rates were 100%, 93.3%, 86.7% , 80. 0% for Yanshu group, and 96. 7% , 90. 0% , 83. 3% , 76. 7% for the control group, respectively, with no significant difference between the two groups ( P = 0.565). The 1 -year, 2-year, 3-year and 4-year progression-free survival rates were 96.7% , 90. 0% , 83. 3% , 70. 0% for Yanshu group, and 90.0% , 86.7% , 76. 7% , 66. 7% for control group, respectively, with no significant difference (P = 0.554). However, the reaction of mucosa of oral cavity, myelosuppression and thrombocytopenia in the Yanshu group were significantly lower than that in the control group (P < 0. 05). The quality of life of the patients in the Yanshu group was significantly higher than that in the control group ( P < 0. 05 ). Conclusions Yanshu injection combined with radiochemotherapy in patients with stage Ⅲ nasopharyngeal carcinoma show a good efficacy and can reduce the side effects of radiochemotherapy of nasopharygeal carcinoma, and improve the quality of life of the patients.     

30例脑胶质瘤的术后调强适形放射治疗

目的探讨术后脑胶质瘤调强适形放疗的临床疗效。方法30例脑胶质瘤予术后调强适形放疗,以90%~95%等剂量线包绕计划靶体积（PTV）。肿瘤靶体积（GTV）照射(58~70) Gy/(28~33)f,临床靶体积（CTV）照射(56~66) Gy/(28~33)f ,PTV照射(50.4~60) Gy/(28~33)f,1次/天,5f/w。结果完全缓解率（CR）23.3%（7/30）,部分缓解率（PR）66.7%（20/30）,稳定率为10%（3/30）。1、2、3年总生存率分别为93.3%、76.7%、60%。Ⅰ~Ⅱ级1、2、3年生存率分别为100%、94.1%、76.5%;Ⅲ~Ⅳ级1、2、3年生存率分别为84.6%、53.8%、38.5%。Ⅰ~Ⅱ级组与Ⅲ~Ⅳ级组相比差异有统计学意义（P=0.0153）。患者对治疗的耐受性良好,不良反应主要为颅高压症状,放射性脑水肿。结论脑胶质瘤术后调强适形放疗疗效好,无严重不良反应。     

西乐葆对鼻咽癌CNE-1细胞增殖和凋亡的影响

目的 探讨鼻咽癌CNE-1细胞中环氧化酶-2(cyclooxygenase-2,COX-2)的表达及其选择性抑制剂通过抑制CNE-1细胞增殖和诱导其凋亡从而起抗肿瘤作用.方法 细胞免疫化学法检测COX-2在鼻咽癌CNE-1细胞中的表达,对鼻咽癌CNE-1细胞以不同的西乐葆浓度0、1.25、2.50和5.00μM设A、B、C、D4个实验组药物干预,再分别行四唑盐(MTT)比色试验、克隆形成实验、流式细胞仪计数检测细胞的增殖能力、克隆形成能力及早、晚期凋亡4项指标.结果 COX-2在CNE-1细胞内高表达;MTT法测得A组OD值与C、D组之间差异有显著性,A组与B组之间差异无显著性(P>0.05),B、C、D组两两比较差异有显著性,提示1.25μM西乐葆对CNE-1细胞增殖无影响,2.50～5.00μM西乐葆明显抑制CNE-1细胞增殖,且抑制作用随西乐葆剂量增加而增强,克隆形成及早、晚期凋亡率A组与B、C、D组比较差异均有显著性(各P<0.05),B组与C组差异无显著性(P>0.05),B组与D组之间差异有显著性(P<0.05);C、D组之间的差异无显著性(p>0.05).提示西乐葆对CNE-1细胞的克隆形成能力有抑制作用,对CNE-1细胞早、晚期凋亡有明显的诱导作用,其作用与西乐葆浓度存在相关性,5.00μM较1.25μM西乐葆对CNE-1细胞增殖抑制和诱导凋亡作用明显增强,而在1.25μM与2.50μM间、2.50μM与5.00μM间比较,其对CNE-1细胞增殖抑制和诱导凋亡作用差异无显著性.结论 ①CNE-1鼻咽癌细胞为COX-2阳性表达细胞.②西乐葆对CNE-1细胞的增殖、克隆形成能力具有抑制作用,并能诱导早、晚期凋亡,从而对CNE-1细胞存在抗肿瘤作用.③西乐葆对CNE-1细胞的抗肿瘤作用与西乐葆浓度存在剂量相关性.