宫颈癌患者外周血中CK19 mRNA和HPV16 mRNA基因的检测及其意义

目的：检测宫颈癌患者外周血标本中的组织特异性标志物(CK19 mRNA)与宫颈癌相对特异性标志物(HPV16 mRNA)的表达。方法：采用RT-PCR技术检测了Ⅰb～Ⅱb期宫颈癌患者的外周血标本30例。远处转移宫颈癌患者8例，妇科良性疾病患者16例，健康人9例：结果：30例外周血标本中3例扩增出CK19的特异性条带，检出率为10．0％(3／30)。远处转移患者CK19检出率为8／8，良性病变患者为0／16，健康者为0／9。30例宫颈癌患者中有10例患者术后宫颈癌标本的免疫组化HPV E6和(或)原位杂交为阳性，均未检测到HPV16 mRNA(0／10)；8例远处转移患者的检出率为12．5％(1／8)，妇科良性病变患者和健康者的检出率分别为0／16和0／9。结论：CK19 mRNA作为宫颈癌患者外周血的检测标志物显示了较好的敏感性和特异性。HPV16 mRNA的检出率较低，临床价值有待进一步研究。     

非小细胞肺癌患者外周血 AEG -1 mRNA 的表达及临床意义

目的：探讨非小细胞肺癌患者外周血AEG-1mRNA的表达情况及其临床意义。方法：收集104例新诊断的非小细胞肺癌患者外周血标本,RT—PCR法检测AEG-1mRNA表达水平,分析其与临床病理特征之间的关系。对其中52例接受含铂方案化疗的晚期患者随访12个月,探讨外周血AEG-1mRNA表达水平与化疗反应率及无进展生存期之间的关系。结果：非小细胞肺癌患者外周血高表达AEG-1mRNA,其表达水平与肿瘤分期（P=0．015）、组织分化程度（P=0．048）和远处转移（P=0．007）密切相关。接受含铂方案一线化疗的52例晚期患者中,AEG-1mRNA高表达者较低表达者对含铂方案化疗反应率低（25．0％VS58．3％,P=0．015）,中位无进展生存期短（5．25VS8．25个月,P=0．019）。结论：非小细胞肺癌外周血AEG-1mRNA高表达提示肿瘤分期晚、组织分化差、转移率高。外周血AEG-1mRNA表达有可能成为晚期非小细胞肺癌患者含铂方案-线化疗的疗效预测和预后因子。     

子宫颈癌与HPV感染关系的临床研究

目的分析子宫颈癌组织HPV检测的结果及相关临床资料,探讨HPV与子宫颈癌的临床生物学行为之间关系。方法收集200例有完整临床病历资料的子宫颈癌患者病灶组织,采用HPV分型基因芯片检测系统,进行HPV阳性率及其亚型的检测并对相关资料加以分析。结果HPV检出率94．0％,其中HPV16阳性率65．6％;HPV18阳性率15．5％。HPV阳性率与子宫颈癌临床分期、病理分级无相关性（P=0．25、P=0．75）;HPV阳性率与肿瘤的盆腔淋巴结转移、肿瘤的治疗后复发亦无相关性（P=0．29、P=0．47）;鳞状细胞癌的HPV检出率明显高于腺癌（P〈0．005）。结论子宫颈癌组织中的HPV阳性率很高,主要为16、18型。HPV感染与鳞状上皮恶变的关系更密切;HPV与宫颈癌的临床期别、病理分级、盆腔淋巴结转移、肿瘤的复发无明显相关性。     

检测细胞角蛋白在食管癌外周血和骨髓微转移中的意义

目的：探讨食管癌患者外周血和骨髓中CK18mRNA基因表达及临床意义。方法：采用巢式RT—PCR方法检测50例M0、10例M0的食管癌患者及10例食管良I生病变患者外周血及肋骨骨髓中细胞角蛋白CK18mRNA基因的表达。结果：50例M0食管癌患者外周血、骨髓中CK18mRNA阳性表达率分别为38．0％（19／50）和42．0％（21／50）;10例M,的食管癌患者外周血、骨髓中CK18mRNA阳性表达率分别为90．0％（9／10）、100％（10／10）;食管良性病变患者的外周血和骨髓中K18mRNA阳性表达率均为0％（0／10）,CK18mRNA阳性表达在三组间差异有显著性（P〈0．01）。CK18mRNA在Ⅳ期食管癌患者外周血和骨髓中阳性表达率与III期以前患者相比,有显著性差异（P〈0．05）。CK18mRNA在外周血和骨髓中表达无差异（P〉0．05）,但呈正相关性（r=0．704,P〈0．01）。结论：应用RT—PCR法检测食管癌患者外周血或骨髓中CK18mRNA微转移有助于食管癌的分期和预后的判断。     

早期宫颈鳞癌癌周组织及盆腔淋巴结中podoplanin及高危型HPV的检测及意义

目的：检测早期宫颈鳞癌癌周组织及盆腔淋巴结中podoplanin及HPV16/18抗原的表达,寻求早期宫颈癌淋巴转移的标记物.方法：选取宫颈鳞癌57例,每例取1-3个淋巴结,共选取淋巴结103个,采用免疫组化方法检测podoplanin及HPV16/18的表达.结果：在有淋巴结转移的宫颈鳞癌癌周组织、无淋巴结转移的宫颈鳞癌癌周组织及正常宫颈组织中podoplanin的阳性率分别为76.2％（16/21）,41.7％ （15/36）,27.2％（6/22）.在淋巴转移患者的转移淋巴结,未转移淋巴结,及淋巴无转移患者的淋巴结中HPV16/18的阳性率分别为89.3％ （25/28）,60.0％ （18/30）,42.2％（19/45）,差异有统计学意义（P＜0.05）.二者的检测结果呈正相关.结论：联合检测盆腔淋巴结中HPV16/18和podoplanin抗原,有助于早期发现宫颈癌淋巴结微转移.Podoplanin可以作为检测宫颈癌淋巴转移的特异性标志.     

p63、CD44v6及HPV16/18在子宫颈癌及癌前病变中的表达及意义

  目的　探讨p63、CD44v6及HPV16/18在不同子宫颈组织病变中的表达及临床病理意义。方法　制作包含有60例子宫颈癌,55例子宫颈上皮内瘤变（CIN）,30例健康人子宫颈上皮的组织芯片,采用免疫组织化学及原位杂交方法检测p63、CD44v6及HPV16／18 在145 例子宫颈病变组织中的表达情况。结果　p63、CD44v6及HPV16／18在子宫颈癌中的表达与CIN和对照组比较差别均有统计学意义（P＜0.05）;HPV16／18在CIN组随着级别增高阳性表达率升高（27.3 %,43.8 %,70.6 %）;p63主要在鳞状细胞癌中表达,在腺癌中不表达;p63阳性率与鳞状细胞癌的分级、临床分期有关;CD44v6的阳性率与肿瘤的病理分级和临床分期有关,并且淋巴结转移病例的阳性率明显高于无转移的病例（P＜0.05）。HPV16／18与p63表达程度相关（P＜0.05）,Cp值为0.49。结论　HPV16／18参与子宫颈鳞状细胞癌的发生和发展,p63可能作为癌基因参与了HPV16／18的致瘤过程,并可作为向鳞状上皮分化的恶性肿瘤的标记之一;CD44v6可以作为判断子宫颈癌远处转移指标之一。     

高危型HPV E6/E7 mRNA检测对宫颈高级别病变的预警分流价值

目的:通过比较检测HPV E6/E7 mRNA和HPV DNA两种HPV检测方法对宫颈高级别病变的检出能力,探讨HPV E6/E7 mRNA检测在宫颈癌筛查中的预警分流价值。方法:采集2016年7月至2017年6月就诊于我院接受宫颈癌筛查的1 515例女性宫颈脱落细胞,利用转录介导扩增法检测高危型HPV E6/E7 mRNA（n=505）和PCR+膜杂交法检测HPV DNA（n=1 010）,以组织病理学诊断为金标准,比较两种检测方法对宫颈高级别病变检出率。结果:利用HPV E6/E7 mRNA检测组阴道镜转诊率32.69%（17/52）、HPV DNA检测组阴道镜转诊率10.62%（12/113）,差异有统计学意义（P＝0.001）;HPV E6/E7 mRNA检测组CIN2+的检出率42.42%;HPV DNA组 CIN2+的检出率28.16%,差异有统计学意义（P＝0.034）。结论:与HPV DNA检测方法相比,HPV E6/E7 mRNA检测对CIN2+病变预警分流价值较高。     

早期乳腺癌CEA mRNA阳性循环细胞检测及其临床意义

[目的]研究早期乳腺癌外周血中CEAmRNA阳性循环肿瘤细胞的临床意义。[方法]检测50例早期乳腺癌患者、24例乳腺良性疾病患者和20例健康志愿者外周血CEAmRNA阳性细胞。[结果]早期乳腺癌患者外周血CEAmRNA阳性率为14．0％,CEAmRNA阳性率与TNM分期（P=0．004）、肿瘤大小（P=0．027）、血清CEA（P=0．000）水平异常升高显著性相关。CEAmRNA阳性患者中位无瘤生存期为18个月,与阴性患者比较差异有统计学意义（P=0．000）。[结论]CEAmRNA阳性循环肿瘤细胞可能是早期乳腺癌患者监测复发转移的重要指标和独立的预后因素。     

Chemoradiation and adjuvant chemotherapy in cervical cancer.

PURPOSE: Radiotherapy is the standard treatment for locally advanced cervical cancer, but treatment results remain disappointing, particularly for women with bulky central disease. We investigated the role of concurrent chemoradiation and adjuvant chemotherapy in a randomized trial. PATIENTS AND METHODS: Two hundred twenty patients with bulky stage I, II, and III cervical cancer were randomized to receive either standard pelvic radiotherapy or chemoradiation (epirubicin 60 mg/m(2)) followed by adjuvant chemotherapy with epirubicin 90 mg/m(2) administered at 4-week intervals for five additional cycles. RESULTS: Fifty-nine patients have relapsed, with a median follow-up duration of 77 months. Patients who received epirubicin radiation therapy showed a significantly longer disease-free (P =.03) and cumulative survival (P =.04). Patients who received radiation alone had significantly more distant metastasis than those who received chemoradiation (P =.012). There was no difference in long-term local tumor control (P =.99). CONCLUSION: Survival benefit has been demonstrated in patients treated with chemoradiation followed by adjuvant chemotherapy with epirubicin as compared with patients treated with standard pelvic radiotherapy alone.     

KAI1蛋白与人乳头状瘤病毒E6、E7蛋白在子宫颈癌组织中的表达及其意义

目的 探讨高危型人乳头状瘤病毒（HPV）感染和肿瘤转移抑制蛋白KAIl在子宫颈癌形成及进展中的意义.方法 对117例石蜡包埋子宫颈组织[正常对照20例、子宫颈上皮内瘤样病变（CIN）58例、子宫颈癌39例]采用免疫组织化学SP法检测KAI1蛋白、HPV16/18E6、HPV16E7蛋白的表达情况.结果 在正常子宫颈组织、CIN和子宫颈癌组织中,KAII阳性表达率分别为90.0％（18/20）、72.4％（42/58）、25.6％（10/39）,呈下降趋势,差异有统计学意义（P＜0.01）. HPVI6/18E6阳性表达率分别为0（0/20）、31.0％（18/58）、41.0％（16/39）,差异有统计学意义（P＜ 0.01）;HPV16E7阳性表达率分别为0（0/20）、34.5％（20/58）、64.1％（25/39）,差异有统计学意义（P＜0.01）.但KAI1与HPV16/18E6、HPV16E7阳性表达间无相关性（P=0.429）.KAI1蛋白在子宫颈癌中的阳性表达率与细胞分化程度、临床分期、淋巴结转移有关（均P＜ 0.05）,与发病年龄无关（P＞0.05）;HPV感染与子宫颈癌发病年龄、临床分期、细胞分化程度、淋巴结转移均无关（均P＞ 0.05）.结论 KAI1蛋白在子宫颈癌中的表达下调,HPV16/18E6、HPV16E7感染与KAI1蛋白表达无关.     

Persistent human papillomavirus DNA is associated with local recurrence after radiotherapy of uterine cervical cancer

Human papillomavirus (HPV) DNA is considered as a hallmark of cervical cancer. We investigated whether persistent HPV DNA at the cervix is associated with local recurrence after radiotherapy in patients with locally advanced cervical cancer. A total of 156 patients with HPV-positive cervical cancer (International Federation of Gynecology and Obstetrics stage IB-IVB) treated with radiotherapy between July 2003 and December 2006 were analyzed. HPV DNA was measured prior to radiotherapy and after completion of radiotherapy. The results of HPV DNA test at postradiotherapy 1, 3, 6 and 12 months were analyzed individually for association with local recurrence-free survival (LRFS). In addition, the result of any last follow-up HPV test within 24 months postradiotherapy was defined as the overall status of HPV at 24 months and was also analyzed for association with LRFS. HPV DNA was cleared in 127 patients (81.4%) and persistent in 29 patients (18.6%) by 24 months. In 18 patients with local recurrences, 14 patients (78%) showed positive HPV tests at 1-3 months. Among the various time points analyzed, a positive HPV test at 3 months was the most accurate predictor of local recurrence. Multivariate analysis indicated that overall status of HPV at 24 months, low HPV viral load and histologic grade as being significantly related to poor LRFS. In HPV-positive cervical carcinoma treated primarily with radiotherapy, persistent HPV DNA within 24 months after treatment indicates a high risk of local recurrence. Diagnostic accuracy of HPV test was highest at 3 months.     

Chromosome 6p21.2, 18q21.2 and human papilloma virus (HPV) DNA can predict prognosis of cervical cancer after radiotherapy

Loss of heterozygosity (LOH) is one of the most important mechanisms for inactivation of tumor-suppressor genes. Studies of LOH in patients with cervical carcinoma have reported a high frequency of LOH on 3p21.3, 6p21.2, 17p13.1, and 18q21.2. Our study explored whether p53 status, human papilloma virus (HPV), and LOH on chromosome 3p21.3, 6p21.2, 17p13.1, and 18q21.2 are associated with treatment outcome in 65 patients with cervical cancer after radiotherapy. Tumors and normal DNA were analyzed by polymerase chain reaction (PCR) for genetic losses at 10 polymorphic microsatellite loci. The presence of HPV and its type were analyzed by PCR-based assay using the consensus primers for E6, E7, and L1 region. Mutations of the p53 gene were identified by a single-strand conformation polymorphism analysis. Chromosomes 3p21.3, 6p21.2, 17p13.1, and 18q21.2 were involved in the LOH in 23.1%, 41.5%%, 33.8%, and 23.1% of the tumors in our study, respectively. HPV-positive tumors were found in 73.8% of the patients and p53 mutation in 10.8%. The patients with LOH on chromosome 6p21.2 and 18q21.2 survived significantly shorter compared with those without LOH on chromosome 6p21.2 and 18q21.2 in both the overall survival (P = 0.006 and P = 0.007) and the disease-free survival (P = 0.005 and P = 0.008). The HPV-negative patients survived significantly shorter compared with the HPV-positive patients in both the overall survival (P = 0.01) and the disease-free survival (P = 0.04). According to multivariate analysis, HPV status (P = 0.0004, P = 0.01), LOH on 6p21.2 (P = 0.006, P = 0.02), and LOH on 18q21.2 (in both P = 0.01) is a significant predictor of both overall and disease-free survival time. The results of our study suggest that absence of HPV infection, LOH on 6p21.2, and LOH on 18q21.2 are the most important determinants of outcome of patients with cervical carcinoma after radiotherapy.     

宫颈癌组织IEX-1表达及其与HPV感染相关性研究

目的 即刻早期反应基因(immediate early response gene X-1,IEX-1)是一种凋亡易感基因,在多种人类恶性肿瘤中表达失调,但在宫颈癌组织中的表达相关研究较少,检测宫颈癌组织IEX-1的表达,了解其在宫颈癌发生发展中的作用,分析其与人乳头瘤病毒(human papillomavirus,HPV)感染的关系.方法 收集2011-01-01-2015-10-31郑州大学第一附属医院病理科存档蜡块标本132份,采用免疫组化法检测IEX-1在宫颈癌、宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)及良性宫颈病变组织中的表达情况,分析IEX-1的表达与宫颈癌临床病理关系.采用RT-qPCR法及蛋白质印迹法检测Siha(HPV16+)、HeLa(HPV18+)和C-33a(HPV-)3种宫颈癌细胞株中IEX-1mRNA及蛋白的表达,siRNA法靶向沉默E6后Siha细胞E6、IEX-1的mRNA及蛋白表达,分析与HPV感染的关系.结果 IEX-1在宫颈良性病变、CIN组织和宫颈癌组织中的表达分别为72.4％、58.7％和21.1％,差异有统计学意义,x2=21.345,p=0.001.宫颈癌组织IEX-1的表达与患者年龄、病理类型、HPV感染型别及FIGO分期无关,均P＞0.05.IEX-1的表达与宫颈癌分化程度、淋巴结转移情况及宫旁浸润密切相关,均P＜0.05.C 33a细胞中IEX-1 mRNA表达量为21.652±9.020,明显高于Siha细胞的1(t=7.34,P＜0.001)和HeLa细胞的1.742±0.854(t=6.21,P＜0.001);IEX-1蛋白表达量为18.017±1.351,明显高于Siha细胞的1.519±0.391(t=8.16,P＜0.001)和HeLa细胞的1.957±0.363(t=7.19,P＜0.001).干扰组E6 mRNA水平为0.218±0.106,低于阴性对照组的1.031±0.072(t=9.21,P＜0.001)和空白对照组(t=8.46,P＜0.001);干扰组E6蛋白表达量为0.184±0.274,低于阴性对照组的0.692±0.133(t=8.71,P＜0.001)和空白对照组的0.783±0.097(t=8.06,P＜0.001).干扰组IEX-1 mRNA水平为20.083±0.672,低于阴性对照组的1.193±0.408(t=9.04,P＜0.001)和空白对照组,t=7.56,P＜0.001;干扰组IEX-1蛋白表达量为0.672±0.135,低于阴性对照组的0.137±0.071(t=7.92,P＜＜0.001)和空白对照组的0.081±0.009(t=6.47,P＜0.001).结论 IEX-1在宫颈癌中表达降低,其表达水平与宫颈癌恶性程度呈负相关,可能参与了宫颈癌的发生与发展.IEX-1在宫颈癌细胞中的表达与HPV感染有关,但与感染的HPV型别无关.     

An association between human papillomavirus 16/18 deoxyribonucleic acid in peripheral blood with p16 protein expression in neoplastic cervical lesions

BACKGROUND: Human papillomavirus (HPV) infection plays a crucial role in cervical carcinogenesis. Apart from the detection of p16 protein in cervical tissues, the feasibility of the presence of HPV DNA in peripheral blood being an auxiliary marker of cervical lesions was examined. METHODS: Peripheral blood samples and cervical tissues, from 36 cervical tissues from high-grade squamous intraepithelial lesions (HSIL) and 31 early invasive cervical cancers (EICC), were analyzed for HPV 16/18 DNA and HPV 16/18 E7 mRNA expression, as well as the in situ expressions of p16 and pRb to investigate the in-between associations. RESULTS: The prevalence of HPV 16/18 DNA in patients with EICC was relatively higher than those of HSIL, in both of cervical tissues and peripheral blood. The presence of HPV 16/18 DNA in peripheral blood was positively correlated with that in cervical tissue, as well as with p16 overexpression in cervical tissues together with a significant correlation between E7 mRNA and pRb and p16 protein expressions. DISCUSSION: A positive correlation between the presence of HPV 16 or 18 DNA in peripheral blood and p16 overexpression in tissues of patients with cervical lesions was confirmed. Together with p16 immunostaining in cervical tissues, the detection of high-risk HPV 16 or 18 DNA in peripheral blood may act as an auxiliary biomarker for HPV-associated neoplastic cervical lesions.     

人乳头状瘤病毒感染及人白细胞抗原-DQB1等位基因多态性与南疆维吾尔族女性宫颈癌的关系

目的 探讨人类乳头状瘤病毒(HPV)感染及人类白细胞抗原(HLA)-DQB1等位基因多态性与南疆维吾尔族女性官颈癌的关系.方法 采用导流杂交基因芯片技术,检测190例南疆维吾尔族女性宫颈癌组织和190例正常维吾尔族女性宫颈组织21种HPV亚型的感染情况.采用聚合酶链反应序列特异性寡核苷酸探针(PCR-SSO)检测其5个HLA-DQB1等位基因的基因频率.结果 (1)在对照组中,HPV感染17例,感染率为8.9%.190例宫颈癌中,HPV感染133例,感染率为70.0%,高于对照组(P<0.05).其中HPV16的感染率最高,为64.7%,也明显高于对照组(3.7%,P<0.05).其他亚型的感染率均远低于HPV16,依次为HPV18(2.6%)、HPV68(2.1%)、HPV45(1.6%)、HPV58(1.6%)、HPV39(1.6%)、HPV31(1.1%)、HPV56(1.1%)及HPV59(0.5%),中国汉族人常见类型HPV53和低危型HPV6的感染率均为0.5%.(2)宫颈癌组和对照组的HLA-DQBI*03基因分布差异有统计学意义(P=0.014),携带HLA-DQB1*03基因者罹患宫颈癌的风险降低31.7%(OR=0.683),其他等位基因与维吾尔族女性宫颈癌的发生无关.(3)携带HLA-DQB1*06基因的宫颈癌患者HPV和HPV16的感染率高于非HLA-DQB1*06携带者(P值分别为0.046和0.025),携带HLA-DQB1*06等位基因的维吾尔族女性更容易被HPV和HPV16感染(OR分别为1.808和1.879).其他等位基因与HPV及HPV16感染无关.结论 南疆维吾尔族女性宫颈癌患者的HPV感染率高于非宫颈癌女性,均以HPV16感染为主.HLA-DQB1*03可能为南疆维吾尔族女性罹患宫颈癌的保护基因.HLA-DQB1*06为HPV和HPV16感染的易感基因.     

Vaccination of healthy volunteers with human papillomavirus type 16 L2E7E6 fusion protein induces serum antibody that neutralizes across papillomavirus species

Oncogenic human papillomavirus (HPV) infection is a necessary cause of cervical cancer. Therefore, vaccination to prevent or eliminate HPV infection could reduce the incidence of cervical cancer. A fusion protein comprising HPV16 L2, E6, and E7 is a candidate combination preventive and therapeutic HPV vaccine. The L1- and L2-specific and neutralizing serum antibody titers and peripheral blood mononucleocyte antigen-specific proliferative responses generated by vaccination thrice at monthly intervals with HPV16 L2E7E6 were compared in two studies: a phase I randomized double-blind placebo controlled dose escalation trial in 40 healthy volunteers and a phase II trial of HPV16 L2E7E6 at the maximum dose in 29 women with high-grade anogenital intraepithelial neoplasia (AGIN). Vaccination of healthy volunteers induced L2-specific serum antibodies that were detected 1 month after the final vaccination (P(binomial) < 0.001). There was a significant trend to seroconversion for HPV16 and HPV18 neutralizing antibodies with increasing vaccine dose (P = 0.006 and P = 0.03, respectively). Seroconversion for HPV18 neutralizing antibodies showed a significant positive trend with increasing dose (P = 0.03) and was associated with seroconversion for HPV16 neutralizing antibodies (P(exact) = 0.04). The antigen-specific proliferative response of vaccinated healthy volunteers also showed a significant trend with increasing vaccine dose (P = 0.04). However, AGIN patients responded less effectively to vaccination than healthy patients for induction of HPV16 L2-specific antibody (P < 0.001) and proliferative responses (P < 0.001). Vaccination of healthy volunteers thrice with 533-mug HPV16 L2E7E6 at monthly intervals induced L2-specific serum antibodies that neutralized across papillomavirus species. Responses in AGIN patients were infrequent.     

41例局部晚期不可手术胰腺癌三维适形或调强放疗的临床分析

目的 分析局部晚期胰腺癌以放疗为主的治疗结果.方法 搜集2007年12月前近8年初治局部晚期胰腺癌临床资料,共1例,均为2002AJCC分期Ⅲ期.采用三维适形或调强放疗,单纯放疗11例,同步放化疗30例.结果 全组中位生存时间和1年总生存率分别为9.2个月和23%.疗前KPS评分≥80、无区域淋巴结转移和放疗后达完全缓解或部分缓解者提示可获得更好生存期,其中位生存时间分别为11.1个月:5.8个月(χ2=7.50,P=0.006)、10.8个月:6.5个月(χ2=5.67,P=0.017)和19.5个月:9.1个月(χ2=7.28,P=0.007).同步化疗的加入较单纯放疗有提高生存的趋势(χ2=3.25,P=0.072).放疗末总临床获益者18例,主要为腹痛缓解17例(41%).无4级血液学毒性及3级非血液学毒性发生.结论 三维适形或调强放疗局部晚期胰腺癌副反应低,可提高临床获益.疗前KPS较高、无区域淋巴结转移和疗后达完全缓解或部分缓解者可望获得较好疗效,加同步化疗有提高生存率趋势.