磁共振弥散加权成像对肿瘤调强放疗靶区勾画影响的临床研究

调强放疗靶区确定主要取决于大体肿瘤体积(GTV)的勾画,目前GTV勾画基于CT模拟定位扫描提供的形态学信息来实现。磁共振弥散加权成像(DWI)技术近几年来逐渐被用于肿瘤的早期诊断和临床分期,DWI采用反转恢复回波平面弥散序列,在抑制肌肉、脂肪等组织背景信号的基础上,突出病变区域的弥散加权对比,加之肿瘤组织及肿瘤细胞内水分子活动的狭小空间,使肿瘤组织中水分子弥散受限肿瘤呈高     

雾化吸入粒细胞-巨噬细胞集落刺激因子治疗肺转移癌的临床研究

Objective To evaluate the feasibility of granulocyte macrophage-colony stimulating factor (GM-CSF)delivery to the lung using an aerosol in patients with metastatic lung cancer to the lungs.Methods A Phase I dose escalation study inhaled GM-CSF at three dose levels as twice-a-dayx7 days schedule.Blood counts were checked at the beginning and end of each week of GM-CSF nebulization. If no toxicity was encountered,in-patients rested for 7 days and then were inhaled at the next dose level.Results Six of sevenpatients were all dose escalated from 60 μg/dose twice-a-dayx7 days,to 120μ g/dose twice-a-dayx7 days,then 240μg/dose twice-a-dayx7 days,one of the patients with cerebral hemorrhage was removed from the clinical trials,and no toxicity was seen.Comparison of inhaled GM-CSF of day 0 and day 7 blood leukocyte counts and percentage of neutrophils,it showed no significant difference in analysis of blood count data at the beginning and end of nebulization used paired t tests for each dose level.The other 9 patients received an additional 2-6 months of intermittent aerosol GM-CSF at 240 μg dose level without side effect.Two patients with bilateral lung metastases of lung adenocarcinoma had a progress disease after 2-2.5 months of aerosol GM-CSF.One patient with lung metastasis of SCLC had a progressive disease after 2 months of aerosol GM-CSF,the other 6 patients had stabilization of pulmonary metastases for 2-6 months. Conclusion Aerosol delivery of GM-CSF may achieve effective immunological antitumor action in the metastases tumor to lungs,and this therapy is feasible and possibly effective and worthy of further study.     

胃癌术后不同放疗疗效及对周围组织的影响

目的探讨胃癌术后三维适形放疗(3D2CRT)和调强适形放疗(IMRT)疗效及对周围组织的影响。方法 90例行胃癌根治术患者,采用随机区组法分为A组(45例)和B组(45例),术后分别给予3D2CRT和IMRT。比较两组患者早期症状总有效率、随访生存率、白细胞下降率、中性粒细胞增高率及转氨酶升高率等。结果 A组患者中早期症状完全缓解10例,部分缓解25例,未缓解10例,总有效率为77.78%;B组患者中早期症状完全缓解18例,部分缓解25例,未缓解2例,总有效率为95.56%;B组患者早期症状总有效率显著高于A组,差异具有统计学意义(P<0.05);B组患者随访生存率显著高于A组,差异具有统计学意义(P<0.05);B组患者白细胞下降率、中性粒细胞增高率及转氨酶升高率均显著低于A组,差异具有统计学意义(P<0.05)。结论相较于3D2CRT,IMRT用于胃癌术后患者可有效缓解临床症状,延长生存时间,并有助于降低毒副作用发生风险。     

雾化吸入粒细胞-巨噬细胞集落刺激因子治疗肺转移癌的临床研究

目的研究雾化粒细胞-巨噬细胞集落刺激因子（GM—CSF）作用于原发于肺部肿瘤肺转移癌的药物毒性和治疗的可行性。方法采用GM—CSF三个剂量递增水平的试验设计,每日2次雾化连续7d休息7d的方案。若未观察到药物的毒性反应,休息7d后再进行下一个剂量水平的试验。结果7例患者中的6例完成60、120和240μg3个剂量水平的雾化试验。雾化GM—CSF前后白细胞数和粒细胞百分比数差异无统计学意义。另外9例患者接受240μgGM—CSF的7d雾化方案治疗2～6个月,无一例患者观察到药物的毒性反应。2例肺腺癌双肺转移和1例小细胞肺癌双肺转移,病情进展,其余6例患者病情稳定2～6个月,全部患者未发生药物的不良反应。结论雾化GM—CSF治疗原发性肺癌的肺转移,是一种耐受性较好的生物治疗,也显示出一定的抗肿瘤作用。     

中药“吗啡伴侣”治疗吗啡类药物所致便秘的疗效观察

目的:观察和评价中药"吗啡伴侣"治疗吗啡类药物所致便秘的疗效。方法:符合入选标准的癌痛患者连续服用中药"吗啡伴侣"7天,治疗期间停服其它泻剂及通便药,观察给药后的临床症状。结果:入选42例患者中,临床治愈27例,好转12例,无效3例,总有效率90.5%。中药"吗啡伴侣"对吗啡类药物引起的大便干燥有较好疗效,同时也能缓解因便秘引起的少腹胀急,食少纳呆等症状。结论:中药"吗啡伴侣"能改善吗啡类药物引起的便秘,同时能缓解因便秘引起的少腹胀急,食少纳呆等症状。