中晚期胰腺癌的外科治疗对策

目的：探讨中晚期胰腺癌的外科治疗方法。方法：对1994年8月至2003年8月期间收治的163例中晚期胰腺癌患者的临床资料进行回顾性分析。结果：149例行姑息性手术治疗，其中单纯胆囊空肠吻合术30d内死亡率为14．2％，术后黄疸或胆管炎复发率为61．9％，生存期为7．1个月；肝(胆)总管空肠吻合术死亡率为5．7％，黄疸和胆管炎复发率仅为6．8％，生存期10．3个月，但31．8％的病人术后半年内出现十二指肠梗阻；胆肠吻合加胃空肠吻合术生存期比前两组均高(13．9个月)，术后无出现十二指肠梗阻；7例无水酒精腹主动脉旁注射封闭后6例疼痛明显缓解；14例经PTCD放置胆道支架40d内均退黄，生存期7．5个月。结论：对不能行根治性手术的胰腺癌患者应根据其个体情况选择不同类型的姑息性外科治疗，手术应尽量选择Roux-en-Y式的胆管空肠吻合术，同时应作预防性胃空肠吻合术，胆道内支架可以短期内缓解不能手术患者的胆道梗阻。     

三维适形放疗加希罗达对晚期胰腺癌止痛效果的研究

目的:观察三维适形放疗联合希罗达同步治疗中晚期胰腺癌疼痛的疗效。方法:28例中晚期胰腺癌患者随机分为两组,综合组14例,采用三维适形放疗的同时给予希罗达同步化疗。放疗开始的第1d开始口服希罗达,每日1000mg/m2,bid.连用14d,停药7d,21d为一周期,至少用药2个周期以上。单放组14例,单独应用三维适形放疗。两组病人照射剂量相同(45~56Gy,1.8~2Gy/次,5次/周)。结果:综合组和单放组疼痛缓解率分别为85.7%、42.9%,疼痛改善持续时间分别为137d、102d。两组疼痛缓解率和疼痛改善持续时间有统计学差异(P<0.05)。中位生存期综合组(6.8个月)较单放组(4.7个月)延长(P<0.05)。结论:三维适形放疗联合希罗达可以改善晚期胰腺癌疼痛症状,延长生存期。希罗达可能有放射增敏作用。     

老年性中晚期胰腺癌高强度聚焦超声治疗后的受益反应

目的本研究旨在阐述高强度聚焦超声(HIFU)消融老年性中晚期胰腺癌受益反应(CBR)。方法对不能手术的胰腺癌患者58例分成2组,观察组行HIFU治疗,每周1次,以放射治疗作为对照,分别统计两组CBR、不良反应、生存率等。结果观察组30例共HIFU治疗90次,平均3次/例;对照组28例放射治疗280次,平均10次/例,疼痛程度降低及CBR在观察组分别为66.7%(20/30),76.7%(23/30),对照组为39.3%(11/28),57.1%(16/28)(P<0.05);治疗后CA199浓度下降分别为66.7%(20/30)、35.7%(10/28)(P<0.05);中位生存期观察组7.5个月,对照组为6个月。结论 HIFU治疗老年性中晚期胰腺癌可以提高肿瘤局部控制率,提高生存质量,是晚期胰腺癌较为有效的治疗方法之一。     

三维适形放射疗法联合厄洛替尼对晚期胰腺癌止痛效果的观察

目的 观察三维适形放疗(3D-CRT)联合厄洛替尼治疗中晚期胰腺癌疼痛的效果.方法 30例中晚期胰腺癌患者随机分为两组,综合组15例,采用3D-CRT同时给予盐酸厄洛替尼同步靶向治疗.放疗第1天开始每日口服厄洛替尼150 mg至整个放疗过程.单独放疗组15例,单独应用3D-CRT.两组患者照射剂量相同(45～58 Gy,1.8～2 Gy/次,5次/周).结果 综合组和单独放疗组疼痛缓解率分别为73.33%、40.0%,疼痛改善持续时间分别为(126±24)d、(97±17)d.两组疼痛缓解率和疼痛改善持续时间差异均有统计学意义(P<0.05).中位生存期综合组(6.7个月)较单独放疗组(4.4个月)延长(P<0.05).结论 3D-CRT联合盐酸厄洛替尼片可以改善晚期胰腺癌疼痛症状,延长生存期.盐酸厄洛替尼可能有放射增敏作用.     

三维适形放射治疗对胰腺癌患者生活质量的影响与预后相关因素分析

目的：探讨三维适形放射治疗（3-dimensional conformal radiation therapy．3DCRT)技术治疗胰腺癌的疗效及生活质量，分析影响预后的因素。方法：3l例胰腺癌患者采用3DCRT技术治疗．观察肿瘤局部控制率及1，2年生存率，采用生活质量评分量表进行日常生活活动、疼痛、食欲、睡眠等13项内容综合评估，并用Cox回归比例风险模型分析预后因素。结果：3，12个月时肿瘤局部控制率分别为58．1％，32．3％，1，2年生存率分别是38．2％，7．6％，中位生存期8．3个月。多因素分析结果显示临床分期、生活质量评分对患者生存率的影响具有统计学意义(P&;lt;0．05)。结论：3DCRT治疗胰腺癌，能明显改善患者的生活质量及提高生存率，临床分期和生活质量评分对胰腺癌患者的预后有重要影响。     

光动力疗法联合化疗对老年人消化道肿瘤疗效及生活质量的影响

目的：观察光动力疗法(photodynamic therapy，PDT)联合化疗对老年人中晚期消化道肿瘤的疗效并比较其对生活质量的影响，探寻老年人中晚期消化道肿瘤的治疗方法。方法：15例选用保守方法治疗的老年中晚期消化道肿瘤，其中食管癌7例，结肠癌4例，直肠癌4例。全部患者进行内镜下PDT联合化疗，其中6例还在PDT前行内镜下肿物切除术。于治疗前及治疗后1，2，3，6，9，12个月复查内镜并进行临床症状评定，并对患者采用世界卫生组织生活质量测定量表简表(WHOQOL-BREF)进行调查，随访生活质量、生存时间，观察毒副作用。结果：15例患者平均随访时间7．5(0．5—16)个月；临床症状缓解率80％(12／15)；半年生存率73％(11／15)，1年生存率40％(6／15)；中位生存期为9个月；内镜下完全应答率27％(4／15)，部分应答率为47％(7／15)。与治疗前比较，患者PDT联合化疗后3个月生理和心理领域的生活质量差异有显著性意义(F=4．307-7．899，P&;lt;0．05)。有1例出现皮肤过敏反应，副反应发生率为7％(1／15)；1例食管癌患者术后1周出现大出血，并发症发生率为7％(1／15)。结论：PDT联合化疗可显著改善老年肿瘤患者的临床症状和生活质量，是治疗老年中晚期消化道肿瘤又一有效手段。     

伽玛刀治疗90例无法手术切除的胰腺癌患者的临床疗效分析

目的探讨伽玛刀立体定向放射治疗对无法手术切除的胰腺癌患者的近期疗效、急性放射性损伤及生存期的影响。方法收集唐都医院放疗科自2004年1月至2012年6月因确诊为胰腺癌但无法手术而接受伽玛刀治疗的患者，其中顺利完成放疗计划者90例。50％剂量曲线覆盖靶体积PTV，剂量为DT 3.0～3.5 Gy，8～10次。放疗后随访。结果放疗后3个月评价，完全缓解22例，部分缓解53例，稳定11例，进展4例。总有效（CR＋PR）率83.3％（75/90）。1、2年总生存率分别为61％、37％，中位生存期为15.5个月。急性放射损伤主要是1～2级的消化道反应和血液系统反应，对症处理后均缓解或消失。结论伽玛刀立体定向治疗可以有效提高无法手术切除的胰腺癌患者的生活质量和生存期。     

三维适形放射治疗局部晚期胰腺癌46例分析

目的：探讨三维适形放射治疗局部晚期胰腺癌的疗效。方法：对46例局部晚期胰腺癌患者采用三维适形放射治疗,单次肿瘤量2 G y,常规分割,总剂量50 G y/5周。结果：治疗后疼痛缓解率为83.5%,肿瘤局控率47.8%,中位生存期8.5个月,1、2、3、5 a生存率分别为23.9%、8.7%、2.2%、0%。结论：三维适形放射治疗是局部晚期胰腺癌的理想的治疗方法。     

高强度聚焦超声为主综合治疗不能手术切除胰腺癌的临床观察

目的观察高强度聚焦超声(HIFU)为主综合治疗不能手术切除胰腺癌患者的临床疗效.方法采用FEP-BY01型超声热疗机治疗,联合化疗及胆总管造口术(伴有黄疸)等方法,对15例不能手术根治切除的胰腺癌患者进行综合治疗及疗效观察.结果(1)15例中,除1例无疼痛外,其余14例伴有疼痛的患者疼痛完全缓解10例(10/14),部分缓解3例,无效1例;(2)生活质量(KPS评分):治疗前(58.57±13.01),治疗后(85.7±4.95)(P＜0.01);(3)生存时间:HIFU治疗后至随访时,患者平均生存9.4个月,略长于传统治疗法(4.8个月),1例治疗后随访至今生存达31个月.结论HIFU为主联合胆总管造口术手术、化疗等综合措施治疗不能手术切除的晚期胰腺癌,可有效缓解患者疼痛,改善生活质量,延长生存期,值得进一步研究.     

持续药泵化疗联合放射治疗大肠癌的临床观察

目的评价持续药泵化疗联合放射治疗大肠癌的疗效与毒副作用。方法经病理证实的中晚期大肠癌80例，随机分为两组：实验组采用持续药泵化疗及放射治疗，对照组采用普通静脉化疗加放射治疗，药物均为国产5-氟脲嘧啶、亚叶酸钙（CF）、奥沙利铂，放射剂量为60-70Gy。结果有效（完全缓解加部分缓解）率：实验组52．5％，对照组45．0％；生存期：实验组有效缓解期6-12月，中位期6．5个月，对照组有效缓解期2-6月，中位期3个月；两组的不良反应主要为腹泻、食欲不振、中性粒细胞减少，在I-Ⅱ度之间，经对症处理后能恢复。结论持续药泵化疗联合放射治疗大肠癌，疗效确切，不良反应小，是大肠癌治疗的有效方法。     

三维适形放疗联合吉西他滨区域性动脉灌注化疗治疗中晚期胰腺癌的疗效观察

目的:评价三维适形放疗联合吉西他滨区域性动脉灌注化疗对中、晚期胰腺癌的治疗效果。方法:将36例经手术病理或临床证实的晚期胰腺癌患者分为观察组、对照组各18例。两组均采用三维适形放疗,观察组加吉西他滨区域性动脉灌注化疗。观察两组疗效、生存率及毒副反应。结果:观察组总有效率,疼痛缓解程度,治疗后6、12个月生存率及中位生存时间均高于对照组(P<0.05)。结论:三维适形放疗联合吉西他滨区域性动脉灌注化疗对中、晚期胰腺癌患者能控制肿瘤生长,缓解疼痛,改善生存质量,且患者耐受良好。     

Intraoperative radiation therapy combined with hyperthermia against pancreatic carcinoma.

Fourteen patients with pancreatic carcinoma were treated by intraoperative radiation therapy (IORT) combined with hyperthermia (hyperthermia group). Their treatment results were compared with those of fifty five patients treated by IORT without hyperthermia (control group). Most of patients underwent some kind of chemotherapy for the carcinoma and some of them received post-operative irradiation. Although there was no significant difference in pain relief between hyperthermia group and control group, the local tumor control rate of the former group was a little better. The survival rate of all patients was 14.5% at one year, 2.9% at two years, 2.9% at three years and 0% at four years after surgery. The survival rate of the hyperthermia group was 21.4% at one year and 7.1% at two years and that of the control group was 12.7% at one year and 1.8% at two years. The survival of the hyperthermia group was a little better than that of control group, but the difference was not significant. Only 36% of patients of hyperthermia group were successfully heated, and if hyperthermia were given successfully to all patients, their prognoses would be possibly improved.     

A new approach to intraoperative radiation therapy

Intraoperative radiation therapy (IORT) is an adjuvant treatment in which a large single dose of radiation is delivered during a surgical procedure to resected tumor beds or to an unresectable tumor. This article discusses the implementation of an IORT program and highlights the successful collaboration needed between the OR and radiation oncology departments. A better understanding of IORT in the OR setting will contribute to smooth program implementation.     

Lymph node-positive prostate cancer: evaluation of the results of the combination of androgen deprivation therapy and radiation therapy.

OBJECTIVE: To evaluate the outcome of patients with pathologic stage IV prostate cancer treated with androgen ablation plus external-beam radiation therapy. PATIENTS AND METHODS: Sixty consecutive patients treated between August 1986 and February 1995 with androgen ablation plus radiation therapy for stage IV (T1-4 N1 M0) adenocarcinoma of the prostate were selected for outcome analysis in this retrospective study. Bilateral pelvic lymphadenectomy was performed in 56 patients (93%). The 4 remaining patients had pelvic adenopathy on computed tomography, which was confirmed histologically in all patients. The median pretreatment prostate-specific antigen (PSA) level was 28.8 ng/mL (mean, 55 ng/ mL; range, 0.1-428 ng/mL). All patients received radiation therapy to the prostate, and 29 (48%) had pelvic node radiation. Biochemical failure was defined according to the American Society for Therapeutic Radiology and Oncology criteria of 3 successive increases in the PSA level. RESULTS: The median follow-up duration for surviving patients was 101.1 months (range, 20-134 months). Biochemical failure with (in 2 patients) or without (in 10 patients) clinically evident disease relapse was noted in 12 patients (20%). Four additional patients (7%) had clinical relapse without biochemical failure. Local recurrences were observed in 6 patients (10%), and this clinical impression was confirmed by biopsy in 4 patients. Thirteen patients (22%) died of causes related to prostate cancer. The biochemical relapse-free, clinical disease-free, overall, and cause-specific survival rates at 5 years were 82%, 84%, 76%, and 80%, respectively. CONCLUSIONS: This observational case series of patients treated with the combination of external-beam radiation therapy and permanent androgen ablation for pathologic stage IV prostate cancer suggests that the addition of androgen deprivation therapy to radiation therapy may improve disease outcome. In the absence of randomized trial results, these observations may be beneficial in clinical decision making.     

磁共振成像观察宫颈癌放疗后盆部软组织变化

目的分析宫颈癌放疗中与放疗后盆部软组织、器官的异常MR表现.探讨MR成像对显示盆部软组织损伤的临床价值.方法 38例经病理证实的宫颈癌患者在放射治疗前及治疗中和治疗后不同时间段行盆腔MR扫描.在MR图像上观察盆部软组织、器官在放疗前后的大小及信号改变.结果放疗可引起多个组织、器官的异常MR表现.异常MR表现发生率在40%以上的有直肠、直肠筋膜、宫旁组织、盆壁肌肉与皮下脂肪.直肠、膀胱、子宫的异常MR表现在放疗后6个月可消失.结论 MR成像可对盆部软组织的射线损伤进行实时监测,对宫颈癌放射治疗有指导意义.     

Using intraoperative radiation therapy--a case study

The Introduction of a mobile linear accelerator in the OR has made intraoperative radiation therapy (IORT) more plausible. An IORT treatment can deliver a single high dose of radiation to a tumor or tumor bed after surgical resection or surgical exposure of high risk areas. This article details a case study in which IORT was used on a patient with sigmoid carcinoma and the procedure outcomes. AORN J 77 (Feb 2003) 412-417.     

经动脉灌注健择治疗中晚期胰腺癌临床疗效初步观察

目的 回顾性分析经动脉灌注健择（盐酸吉西他滨）治疗中晚期胰腺癌临床疗效。方法 １３例中晚期胰腺癌患者接受动脉灌注健择治疗。治疗后观察肿瘤改善情况及临床受益反应（ＣＢＲ）。结果 ＰＲ１例（７．７％）,ＮＣ３例（２３％）,ＳＤ３例（２３％）,６例无法评价。Ｋａｐｌａｎ－Ｍｅｉｅｒ法计算６个月累积生存率为４６．８８％,频数分布法计算中位生存期为５．５个月,中位进展期为２．６９个月。临床受益率为３０．７６％与文献相比Ｐ〈０．００１）。结论 无论对于初治或化疗无效的病人,动脉灌注健择均显示出良好的临床受益反应;并能有效延长病人的生存时间。     

胰十二指肠切除联合^125I粒子治疗胰头癌疗效观察

目的探讨胰十二指肠切除联合^125I粒子治疗胰头癌的效果。方法51例行胰十二指肠切除（pancreaticoduodenectomy,PD）的胰腺癌患者,其中20例行标准胰十二指肠切除术（标准PD组）,31例行标准PD术联合腹膜后^125I离子植入治疗（联合PD组）,比较2组手术情况、组织病理情况及并发症发生率,采用Kaplan-Meier方法分析2组生存率。结果2组手术时间、术后住院时间、脉管癌栓、神经浸润发生率、分化程度及并发症发生率差异均无统计学意义（P〉0．05）;标准PD组中位生存期（14个月）与术后1、2、3a生存率（66．7％、30．8％、17．1％）明显低于联合PD组（29个月、82．7％、55．4％、28．1％）（P〈0．05）。结论标准胰十二指肠切除联合^125I粒子治疗胰头癌可提高患者生存率。     

Small cell carcinoma of the lung: results of combination chemotherapy and radiation therapy

A retrospective study of 244 patients treated for small cell carcinoma of the lung from Jan 1, 1971 to Dec 31, 1976 revealed that 34% of patients, with local-regional disease who received radiation alone survived one year (median survival, seven months), and 53% with local-regional disease survived one year (median survival, 12 months) when treated with combination chemotherapy and radiation. The one-year survival for patients presenting with metastatic disease was 14.5% (median survival, five months) when treated with radiation alone and 50% (median survival, 11 months) when treated with combination chemotherapy and radiation. Although combination chemotherapy and radiation will prlong the disease-free interval in patients with small cell carcinoma of the lung, more than 90% will develop evidence of progressive disease within two years.     

Intraoperative delivery of cell-killing boost radiation – a review of current and future methods

Techniques for intraoperative radiation therapy (IORT), the applications of tumor bed radiation immediately after surgery or utilising intracavitary access, have evolved in recent years. They are designed to substitute or complement conventional external beam radiation therapy in selected patients. IORT has become an excellent treatment option because of good long-term therapy outcomes. The combination of IORT with external beam radiation therapy has the potential to improve local control. The purpose of this paper is to present IORT techniques using gamma and electronic sources, as well as more conventional nuclide-based approaches and to evaluate their effectiveness. Common techniques for radiation of tumor cavities are listed and compared. Radionuclide IORT methods are represented by balloon and hybrid multi-catheter devices in combination with appropriate afterloaders. Electron beam therapy dedicated for use as intraoperative radiation system is reviewed and miniature x-ray sources in electronic radiation therapy are presented. These systems could further simplify IORT, because they are easy to use and require no shielding due to their relatively low photon energies. In combination with additional imaging techniques (MRI, US, CT and NucMed) the application of these miniature x-ray sources or catheter-based nuclide therapies could be the future of IORT.