Progress in Diagnosis and Treatment of Small Cell Carcinoma of the Cervix

Small cell carcinoma of the cervix(SCCC)belongs to the neuroendocrine carcinomas,and it is a rare gynecological tumor of high-potential malignancy.It has a poorer prognosis compared to cervical squamous cancer or adenocarcinoma,and the therapeutic regimen of the disease differs.Diagnosis is based on pathomorphological characteristics,i.e.,the small and round cancer cel s(oat cel)which are uniform in shape and size,with the immunohistochemical marker helpful for diagnosis.Combined therapy is first recommended.Postoperative chemotherapy with platinum/etoposide (PE),vincristine/adriamycin/cyclophosphamide(VAC)and taxel/carboplatin (TP)can markedly improve the prognosis of early SCCC patients.     

Evaluation of Intraoperative Radiotherapy for Gastric Carcinoma

OBJECTIVE To study the proper sites and doses of intraoperative radiotherapy (IORT) for gastric carcinoma and the effects of this treatment.METHODS A total of 106 cases of stage Ⅰ- Ⅳ gastric carcinoma who received a D2 or D3 radical resection operation combined with IORT were analyzed. Sixty-seven patients with gastric cancer of the antrum and body received distal gastrectomy. The sites of irradiation were at the celiac artery and hepatoduodenal ligament area. Another 39 patients with carcinoma of the cardia and upper part of the gastric body and whole stomach received proximal gastrectomy or total gastrectomy. The sites of irradiation for this group were the upper margin of the pancreas and the regional paraaorta.The therapeutic effects (including survival and complications) of these 106cases who received a combined operation IORT (IORT group) were compared with 441 cases treated during the same time period by a radical resection operation alone (operation group).RESULTS The radiation dose below 30 Gy was safe. The therapeutic method of the operation combined with IORT did not prolong the survival time of patients with stage Ⅱ and Ⅳ gastric cancer, but the 5-year survival rates of patients with stage Ⅱ and Ⅲ gastric cancers were significantly improved.While the 5-year survival rates of the stage Ⅲ cancer patients receiving D2 resection combined with IORT had marked improvement, for those receiving a D3 radical resection, only the postoperative survival rates at 3 and 4 years of those cases in stages Ⅲ cancers were improved (P＜0.005-0.001). The 5-year survival rate for those patients was raised only 4.7%(P＞0.05).CONCLUSION The 5-year survival rates of patients with stages Ⅱ and Ⅲ gastric carcinoma who received a D2 lymphadenectomy combined with IORT were improved and had no influence on the postoperative complications and mortality.     

Evaluation of the Curative Effect of External Beam Radiotherapy and Brachytherapy for Tongue Carcinoma

OBJECTIVE To evaluate the curative effect of external beam radiothera-py (EBRT) and brachytherapy (BT) for tongue carcinoma. METHODS From 1991 to 2003, 35 patients received EBRT and BT in our department. We analyzed their curative and side effects retrospectively. RESULTS Local control was 80%. The 3-year overall (OS) and disease specific survival (DSS) rates were 75% and 79%. One patient developed metastases. Three patients (9%) developed different late complications. CONCLUSIONS Local regional control, survival, and complications in patients with tongue carcinoma treated by EBRT and BT have been satis-factory.     

Neoadjuvant Therapy for Advanced Rectal Carcinoma in China： Whether Radiochemotherapy Is Superior to Radiotherapy？

Objective  

To verify whether the 30 Gy preoperative radiotherapy regimen is effective to advanced rectal cancer, and whether the preoperative chemoradiation offers an advantage in sphincter preservation and tumor control compared with irradiation alone.     

Surgical Treatment of Carcinoma of Esophagus and Gastric Cardia—A 34—year Investigation

Methods The patients were divided into A,Band C groups:3155 patients (group A)were treated surgically in the first 14 years ,5952 patients (group B)in the next 10 years ,and 3863 patients (group C)in the last 10 years .The early stage lesions (Tis ,Ti)were as-signed as a separate group.The results of these groups were compared. Results The respectability for esophageal and gastric cardiac carcinoma wsa 94.0% and 84.4% respectively ,and the overall respectability .The overall operative mortality was 1.8%,it was 4.4% for group A, 1.6% for group B,and 0.5% for group C.The overall 5-year sur-vival was 31.6%.The 5-year survival for groups A, B,C and the early stage group was 27.0% ,29.1%,32.0% and 92.6%,respect-tively.Among the 3 temporal groups,differences were observed in tems of lesion stage,location and size,surgery with or without com-bined therapy and postoperative complications. Conclusion Best results were achieved in the early cases,with a respectability of 100% and a 5-year survival of 92.6%.The indications for surgical treatment were extended with increased respectability and decreased mortality.Subtotal esophagectomy combined with cervical esophagogastrostomy was advocated as the procedure of first choice for esophageal carcinoma in attempt to diminish the chance of recur-rence,and to achieve better outcomes by using combined therapy for patients with≥stage Ⅲ lesion.     

Progress of Environmental and Molecular mutagenesis Research in China

In the past four years,the research of environmental and molecular mutagenesis hasbeing progressed successfully.Here is the brief introduction to some achievements dealtwith the following aspects:     

Surgical Treatment of Perforation with Esophageal Carcinoma

OBJECTIVE: To determine the ideal method of surgical preoperative treatment for perforation with esophageal carcinoma. METHODS 36 cases of. perforation with esophageal carcinoma were treated surgically in this series. Perforations occurre into the right lung in 14 cases, the mediastinum in 17 cases and trachea in 5 cases. Open thoracic surgery was performed in 34 cases, in which the right thoracic approach using a 3-incision method was applied in 16 cases, and operation by stages in, 15 cases. Of the 34 cases, retrosternal substitution of the esophagus with stomach or colon was performed in 26 cases. RESULTS Surgery was successful in 31 cases and operative death occurred in 3 cases. The postoperative follow up study was from 3-72 months. Of these cases 15 were alive at 7-12 months, 2 at 24 months, and 1 at 72 months. The results can be considered satisfactory. CONCLUSION The therapeutic results of surgical treatment of perforation with esophageal carcinoma were markedly superior to that of conventional conservative treatment. The authors suggest that surgical intervention without delay should be undertaken for patients having a perforation with carcinoma of the esophagus. A right thoracic approach with a 3-incision method (retrostemal replacement of esophagus with stomach or colon) or operation by stages is preferable.     

Research Progress on Metastatic Carcinoma of the Spleen

Metastatic carcinoma of the spleen (MCS) is a rare condition which is frequency misdiagnosed. Research progress on the prevalence, clinicopathological features and diagnosis of MCS from the Chinese and English medical literature was reviewed to increase understanding of all aspects related to MCS. It is hoped that a better comprehension of MCS will increase the diagnotic level and the rate of MCS detection.     

Research Progress in the Use of Drugs for Breast Cancer Targeted Therapy

In recent years,many significant advances have been made on molecular target therapy to aim directly at epidermal growth factor receptors and vascular endothelial growth factor in breast cancers.Clinical studies of such agents as trastuzumab,lapatinib,erlotinib and bevacituzumab have been widely conducted.This paper will review the recent research progress related to targeted therapy.     

Three-Dimensional Conformal Radiotherapy for Rectal Cancer and the Changes in Cancer Multi-biomarkers

OBJECTIVE To investigate the clinical efficacy of three-dimensional conformal radiotherapy(3D-CRT)for local y advanced or postoperatively relapsed rectal cancer,and to examine the changes in cancer multi-biomarkers. METHODS Sixty patients with locally advanced or postoperatively relapsed rectal cancer were randomly divided into two groups after 40 Gy external radiation,namely a late-course 3D-CRT group and a conventional radiotherapy group that served as the control.There were 30 patients in each group.For patients in the 3D-CRT group,multi-biomarkers were measured before and after radiotherapy and after relapse. RESULTS Response rates in the 3D-CRT and the control groups were 86.7%(26/30)and 70%(21/30)respectively,without a significant difference (P>0.05).The 1-,2-and 3-year survival rates were 80%,53.3%and 36.7% in the 3D-CRT group;in the control group the rates were 56.7%,40%and 13.3%respectively,with a significant difference(P=0.0213).CEA,CA19-9, CA242 and FER decreased after radiotherapy in the 3D-CRT group,P<0.01, indicating a significant difference.The values after relapse were higher than those without relapse,P<0.01,indicating a significant difference. CONCLUSION Conventional radiotherapy with a 3D-CRT boost gives better therapeutic effect to patients with locally advanced or postoperatively local y relapsed rectal cancer.A multi-biomarker protein chip diagnosis system can be utilized as an effective tool to determine the therapeutic effect and prognosis.     

放化疗联合治疗食管癌

目的研究放、化疗联合治疗食管癌的临床价值.方法120例食管鳞癌患者,随机分为3个组行前瞻性临床研究.化疗组40例,用5-Fu、DDP、HCPT联合方案化疗;放疗组40例,8MV-X射线常规三野等中心照射,DT60Gy、DT2Gy/次、5次/周;综合组40例联合应用放、化疗方案.结果化疗组、放疗组的1、2、3年生存率分别为52.5%、32.5%、15%;57.5%、42.5%、20%,综合组1、2、3年生存率为75%、65%、42.5%,综合组的2、3年生存率明显高于放疗组,化疗组(P<0.05)且无严重毒副作用.结论食管癌放、化疗联合治疗疗效好,提高了3年生存率,无严重副作用,值得进一步深入研究.     

食管癌放疗配合药物综合治疗的进展

食管癌的综合治疗在提高食管癌患者的远期生存率 ,改善生活质量中的地位变的越来越重要 ,介绍食管癌综合治疗的现状及最新进展     

Induction chemotherapy, surgery, and concomitant chemoradiotherapy for carcinoma of the esophagus: A long-term analysis

Purpose: To define the activity and toxicity of preoperative chemotherapyand postoperative concomitant chemoradiotherapy in patients with carcinomaof the esophagus, and to determine the effect on survival in patientstreated with this approach.Patients and methods: Patients were treated with two 21-day cycles ofinduction chemotherapy with cisplatin 100 mg/m² on day 1,5-fluorouracil (5-FU) 800 mg/m²/day continuous infusion ondays 1–5, and leucovorin 100 mg/m² every four hours ondays 1–5. Surgical resection was performed if feasible (and could alsobe performed prior to chemotherapy). Patients then received radiotherapy (50to 60 Gy) every other week × five to six weeks, concomitantly with5-FU 800 mg/m² continuous infusion daily and hydroxyurea 1 gtwice daily × five days.Results: Forty-six patients were treated. With a minimum follow-up of 58months, the median survival for the entire group was 16 months; the mediansurvivals for patients with squamous carcinoma and adenocarcinoma were 29months and 12 months, respectively. Toxicities of induction chemotherapywere severe neutropenia and mucositis; there was one toxic death. Toxicitiesof concomitant chemoradiotherapy were neutropenia, mucositis andesophagitis. There were five cases of radiation pneumonitis, one fatal.Conclusion: Induction chemotherapy and postoperative concomitantchemoradiotherapy can be added to surgical resection for carcinoma of theesophagus. Combined modality therapy, as reported here, produces long-termsurvival benefit, particularly in patients with squamous carcinoma. However,similar outcome results have been reported with less toxic and shortertreatment regimens as tested in randomized studies.     

不同剂量顺铂和5-氟脲嘧啶联合化疗合并放疗治疗中晚期食管癌临床研究

目的 :评价不同剂量顺铂 5 FU联合放疗治疗中晚期食管癌的疗效及毒副作用。方法 :1993年 2月～ 1994年 9月我科收治中晚期食管鳞癌 83例 ,随机分成大剂量组、小剂量组、单放组。结果 :①近期疗效 :大剂量组 85.7% ,小剂量组 75.0 % ,单放组 37.0 % ;② 1、3、5年生存率 :大剂量组 71.4 %、35 7%、2 1.4 % ;小剂量组 67.9%、39.3%、2 5.0 % ;单放组 4 0 .7%、2 2 .2 %、11.1% ;③毒副反应 (Ⅲ～Ⅳ级 ) :骨髓抑制及胃肠道反应 ,大剂量组 4 6.4 %、39.3% ;小剂量组 10 .7%、3.6%。结论 :①大、小剂量组的近、远期疗效均优于单放组 ,P <0 .0 5;大、小剂量组之间疗效无显著差异 ,P <0 .0 5;②大剂量组的毒副反应明显高于小剂量组 ,P <0 .0 5。因此认为小剂量组治疗中晚期食管癌疗效确切、毒副反应低、治疗连贯 ,值得临床应用     

Postoperative adjuvant radiotherapy and 5-fluorouracil chemotherapy for rectal carcinoma

Postoperative combined modality therapy with radiotherapy and 5-fluorouracil (5FU) chemotherapy is an effective adjuvant approach that reduces locoregional and distant metastatic disease in patients with high-risk rectal carcinoma. However, this approach results in a treatment regimen of at least 6 months’duration. The present prospective study investigates the integration of radiotherapy and 5FU chemotherapy in a protocol designed to minimize toxicity and reduce the overall treatment time. A total of 40 patients with TNM stage II or III disease received postoperative radiotherapy at four fractions per week with weekly 5FU bolus injections delivered on the fifth non-radiotherapy day. Patients also received systemic chemotherapy with leucovorin both before and after pelvic irradiation, with the total treatment duration extending for only 18 weeks. Patients were able to complete radiotherapy in 90% of cases, while the delivery of full-dose chemotherapy was achievable in the vast majority. The incidence of haematologic and gastrointestinal toxicities requiring the cessation of treatment was acceptable. With a median follow-up of 20.9 months among surviving patients, the estimated progression-free and overall survival at 2 years were 71 % and 79%, respectively.     

食管癌综合治疗进展

食管癌的综合治疗，临床试验有术前（新辅助）化疗，术前同时联合化放疗，或对局部区域病变单用化放疗，以及对有高复发危险的患者行术后（辅助）化疗；食管癌的综合治疗在提高食管癌患者的远期生存率，改善生活质量中的地位变得越来越重要。全文介绍食管癌综合治疗的现状及最新进展。     

溃疡型食管癌单纯放疗与综合治疗的临床观察

目的　了解溃疡型食管癌单纯放疗和综合治疗的区别。方法　对本院 1994.1～ 1998.12资料完整的 32例溃疡型食管癌 (单纯放疗组 18例 ,综合治疗组 14例 )进行回顾性分析。结果　两组的近期疗效 (CR PR)分别为 88.9%和 85 .7% ,P>0 .0 5。综合治疗组的消化道反应和白细胞减少多于且重于单纯放疗组 ,P<0 .0 5 ;平均治疗时间为 78天 ,长于单纯放疗组 (6 5天 ) ,P<0 .0 5。结论　单纯放疗组较综合治疗组有治疗反应轻 ,患者易于耐受 ,治疗时间短 ,经济负担轻等优点     

肺大细胞神经内分泌癌综合治疗进展

大细胞肺癌在肺癌中并不常见,但其恶性程度高,侵袭性高,生存较差。目前虽然被定义为非小细胞肺癌,但其生物学特性、临床特性以及预后因素都与小细胞肺癌相似,目前治疗模式尚有争议。本文就大细胞肺癌目前的综合治疗状况研究进展做一综述。     

食管癌后程加速超分割放疗加卡莫氟增敏的临床研究

目的:比较后程加速超分割放疗加口服卡莫氟、后程加速超分割放疗及常规放射治疗食管癌的近期疗效,以及卡莫氟的增敏作用。方法:对90例食管鳞癌患者采用信封法随机分成3组。常规分割(CF)组31例,2·0Gy/次、5次/周,总剂量60~68Gy;后程加速超分割(LCAF)组29例,先常规照射至40Gy后改为2次/d、1·3Gy/次,间隔6h,总剂量62~69Gy;后程加速超分割合并口服卡莫氟(LCAF C)组30例,照射方法与LCAF组相同,放疗开始同步口服卡莫氟200mg/次、3次/d,至放疗结束。结果:CF、LCAF和LCAF C组的近期疗效分别为74·2%(23/31)、86·2%(25/29)和96·7%(29/30);局部控制率分别为54·8%(17/31)、79·3%(23/29)和90·0%(27/30);1年生存率分别为51·6%、75·9%和86·7%。LCAF C组优于LCAF组,χ2=7·92,P=0·024;LCAF组优于CF组,χ2=6·27,P=0·038。急性毒副反应LCAF C组略高于LCAF组,两者均高于CF组,但三者之间差异无统计学意义,χ2=0·78,P=0·093。3组死于远处转移的比率差异无统计学意义。结论:卡莫氟对食管癌放疗有增敏作用,同后程加速超分割放疗结合应用能提高食管癌的局部控制率和生存率。     

放化疗同时治疗食管癌

目的　探讨放化疗同时治疗食管癌的价值。方法　将 6 8例食管癌患者随机分为 2组 ,一组 35例放疗同时合并 5 Fu、PDD方案化疗 (放化组 )。另一组 33例单纯放疗 (单放组 )。放疗采用 6MV或 15MV X线照射 ,中平面DT 5 5～6 5GY ;化疗共 4个周期 ,与放疗同时进行 2个周期 ,放疗结束后 2个周期。结果　随访 3年 ,放化组和单放组近期疗效CR分别为 80 %和 5 1.5 %(P <0 .0 5 )、1、2、3年生存率分别为 74.3%、5 1.4%、34.3%和 48.5 %、30 .3%、2 1.2 %。放化组生存率明显高于单放组 (P <0 .0 5 )。但骨髓抑制及胃肠道反应放化组高于单放组 (P <0 .0 5 )。结论　放化疗同时对食管癌治疗有协同作用 ,值得临床进一步探讨。