嗜酸性淋巴肉芽肿的发病特点与治疗

目的:探讨嗜酸性淋巴肉芽肿的临床病理特点,以提高临床诊治水平.方法:对15例嗜酸性淋巴肉芽肿患者的发病年龄、性别、临床表现、病理及实验室检查、治疗方法等进行回顾性分析.结果:15例嗜酸性淋巴肉芽肿患者中青壮年男性多见(男:女=6.5:1),平均发病年龄为34.5岁;面颈部为好发部位,最多见于腮腺区(33.3%);53.3%的患者伴皮肤瘙痒或色素沉着,66.7%患者外周血嗜酸性细胞增高(EC>0.05×109/L);组织病理表现为肉芽肿背景上大量嗜酸性粒细胞浸润和淋巴组织增生,可有淋巴滤泡及生发中心形成,纤维母细胞及毛细血管增生明显.腺泡及肌肉组织萎缩.临床上嗜酸性淋巴肉芽肿易误诊为慢性淋巴结炎、腮腺肿瘤、神经纤维瘤及颈部转移癌等,误诊率为86.7%.放射治疗可获得满意效果,对病变范围局限的病例可采用手术切除.结论:颌面部无明显压痛的软组织包块伴皮肤瘙痒和色素沉着,外周血嗜酸性细胞增高,应首先考虑嗜酸性淋巴肉芽肿的可能,放射治疗可作为嗜酸性淋巴肉芽肿治疗首选,推荐剂量为30～40Gy.对孤立的、病变范围局限的病例也可采用手术切除,术后需密切随访.     

放射治疗骨嗜酸性肉芽肿27例报告

1970～1985年放射治疗27例骨嗜酸性肉芽肿单独放疗12例,切除或刮除术后放疗15例。男17,女10,1～51岁,平均19.8岁。27例共31个病灶,85.2％发生于头颅骨。除2例用~(60)钴枯及1例用近距离浅层X线治疗外,24例根据病灶大小与部位的不同,选用100～180千X线治疗,每次量100～200rad,每周2～3次,80.6％(25/31)病灶组织量1.200～2,500rad。除2例近期治疗结束外,22例随访6月～15年,病灶均消失,其中顶骨及颞骨病变各1例,分别在放疗后8与9年出现尿崩症。手术刮除加放疗或单独放疗是骨嗜酸性肉芽肿的适宜疗法。     

放射治疗头面部朗罕斯细胞组织细胞增生症9例疗效分析

背景与目的:朗罕斯细胞组织细胞增生症(Langerhans cell histiocytosiS,LCH)是一种罕见的网状内皮组织疾病,常累及头面部.治疗手段尚无统一标准,但认为放射治疗可用于治疗局限性病灶.本研究旨在探讨放射治疗LCH的疗效.方法:对2000年7月-2007年5月期间本院放疗科收治的经病理证实的8例嗜酸性肉芽肿和1例韩-薛-柯病进行临床回顾性分析.结果:嗜酸性肉芽肿5例患者行肿块部分切除和放射治疗,3例活检后单纯放射治疗,韩-薛-柯病1例进行手术、化疗、再程放疗和内分泌治疗,所有病例随访1.5～8年,总有效率为89%.结论:朗罕斯细胞组织细胞增生症采用放射治疗具有良好的治疗效果,但放射剂量尚需进一步研究.     

41例颌面部嗜酸细胞淋巴肉芽肿临床诊治

目的：分析颌面部嗜酸细胞淋巴肉芽肿的临床特点，总结该病的治疗方法.方法：对41例嗜酸细胞淋巴肉芽肿患者的性别、发病年龄、临床表现、病理、实验室检查、治疗方法等方面进行回顾性分析.结果：41例嗜酸细胞淋巴肉芽肿患者中男性多见（男∶女为3.1∶1），平均发病年龄39.9岁，5年以下病程占90.3%，好发于腮腺区（38.2%），放疗及手术切除均可获得满意效果.结论：颌面部局限性肿块，皮肤瘙痒或伴色素沉着，嗜酸细胞增高，首先考虑嗜酸细胞淋巴肉芽肿，以放疗和手术相结合的治疗方法是比较适宜的.     

腮腺嗜伊红淋巴肉芽肿的放射治疗

嗜伊红淋巴肉芽肿又称“嗜酸性淋收稿日期 :2 0 0 0 -0 4-2 4作者单位 :1.山西省人民医院 ,山西　太原　0 30 0 12 ;2 .山西省肿瘤医院 ,山西　太原　0 30 0 13巴肉芽肿”、“嗜酸性粒细胞增生性淋巴肉芽肿”、“木村氏病”,在我国较少见 ,是以无痛性皮下肿物 ,局部淋巴结肿大为主要表现的良性疾病。其治疗以放射治疗为主。现总结经病理确诊的腮腺区嗜伊红淋巴肉芽肿单纯放射治疗 10例 ,探讨该病临床特点和放射治疗中的作用及预后。1　材料与方法1.1　临床资料　 10例中男性 9例 ,性 1例 ,年龄 18岁～ 45岁 ,中位年龄 32岁。临床表现 :均有…     

放射治疗嗜酸性淋巴肉芽肿16例报告

嗜酸性淋巴肉芽肿是一种少见的慢性瘤样肉芽肿,病因尚不清楚。外周血中嗜酸性粒细胞明显而持续增加为其特点。我院从1981～1985年共收治16例,均经病理证实。在治疗前、后及定期复查中均已进行骨髓穿刺检查,同时行外周血化验做对照,根据骨髓变化情况和局部病灶情况而采用不同的治疗方案。如骨髓正常、病灶局限则行单纯放疗。病     

嗜酸性淋巴肉芽肿

嗜酸性淋巴肉芽肿是一种发生于皮下组织和淋巴结的肉芽肿性疾病。1937年由金显宅首次报导7例“嗜伊红球增多性淋巴母细胞瘤”。1957年金氏再次著文,认为是非肿瘤性疾病,故改称为“嗜伊红细胞增生性淋巴肉芽肿”。1964年林丛根据病理特点,建议命名为“嗜酸性淋巴肉芽肿”。至今国内报告约有225例。     

嗜酸性淋巴肉芽肿放射治疗疗效观察

嗜酸性淋巴肉芽肿是一种较少见的好发于男性青壮年、多累及头颈部的浅层淋巴结、皮下组织等肉芽肿疾患,伴有嗜酸细胞增多或比例增高。可同时或先后累及不同部位,病程较缓慢。此病对放射治疗反应好,~(60)钴r线30Gy,X线2,000～3,000R可获得很好疗效。如局部复发可采用手术治疗。如病人已确诊且治疗过,随诊中发现其他部位出现类似病变,可长期观察。因系良性病变,不必急于放射或手术,侯肿块增长迅速或影响功能时再考虑治疗。     

儿童骨的嗜酸性肉芽肿

目的分析儿童骨的嗜酸性肉芽肿的临床特点和诊治方法。方法1990年～2003年收治11例患者,男8例,女3例,平均年龄3.9岁,单发病灶7例,多发病灶4例;单发胫骨4例,髂骨、颈椎、胸椎各1例。结果8例行病灶刮除植骨,2例行放疗治疗,1例未在我院治疗。8例行手术治疗者均经病检证实为骨嗜酸性肉芽肿。7例在术后2～3个月内愈合,功能完全恢复。1例在术后3个月时发现植骨有部分吸收。结论本病为郎格罕氏细胞增多症,病灶刮除植骨或小剂量放射治疗可减轻疼痛,促进患骨愈合,早日负重。     

嗜酸性淋巴肉芽肿2例报告及文献回顾

嗜酸性淋巴肉芽肿（eosinophilic lymphogranuloma,ELG）是临床上相对少见的一类良性肉芽肿性疾病,因病变好发于头颈部,主要累及皮下组织、淋巴结和大涎腺等组织器官,故患者多就诊于头颈及颌面外科,单发于肢体的病变少见。我科最近收治的2例单发于上肢嗜酸性淋巴肉芽肿,均位于肘关节上方上臂内侧。文献报道发生于肢体的嗜酸性淋巴肉芽肿有多个病例均于该位置发病,     

三维适形放疗配合全脑照射治疗脑转移瘤的疗效观察

Objective: To observe the recently therapeutic effects and toxicity of three-dimensional conformal radiotherapy combined with whole brain irradiation for patients with brain metastasis. Methods: 33 cases were treated by whole brain irradiation at first, the dose of which was 36-40 Gy (18-20 f). Then three-dimensional conformal radiotherapy was added to the focus with a total dose of 20-25 Gy, whose fractionated dose was 2-5 Gy/time, 5 times/week or 3 times/week. Results: Within 1 month after radiotherapy, according to imaging of the brain, the CR of all patients was 45.5%, PR 36.4%, NC 15.1%, and PD 3%. For the 32 cases with neural symptoms before radiation, the CR of the symptoms was 40.6% and PR 59.4%. All patients gained different increases in KPS grade. By the end of the follow-up period, there were 22 deaths with the mean survival time up to 9.3 months. Conclusion: Three-dimensional conformal radiotherapy combined with whole brain irradiation can not only effectively control brain metastases and improve life quality, but also tends to prolong survival time.     

Radiotherapeutic management of brain metastases from breast cancer

We have reviewed the medical records of 28 breast cancer patients with brain metastases who were treated with radiotherapy at our clinic from 1980 through 1994 (4 patients, postoperatively; 24 patients, radiotherapy alone). Radiotherapy was delivered as whole brain irradiation using lateral opposed 10 MV X-rays. Ten patients received an additional boost to a reduced field. One patient was treated with localized stereotactic irradiation alone. The radiation dose for tumors ranged from 32 Gy to 60 Gy (mean, 49 Gy) in 2 or 3 Gy daily fractionated doses. The brain was the first site of metastatic involvement in only two patients. In the 26 evaluable patients, neurologic functional improvement was achieved in 24 patients (92%) with complete response (CR) in 1 2 patients (46%) and partial response (PR) in 1 2 patients (46%). The survival rates from the initial treatment were 39% at 5 years and 16% at 10 years (median survival time, 50 months), and those after treatment of brain metastases were 29% at one year and 18% at 2 years (median survival time, 6 months). Performance status tended to be associated with survival (p=0.10), and the presence of liver metastasis was the most important risk factor concerning survival (p=0.056). Two patients suffered severe chronic complications. One patient developed severe dementia after whole brain irradiation with a total dose of 45 Gy in 3 Gy daily fractionated dose, and another patient developed widespread brain necrosis after combined radiotherapy with intrathecal local infusion of methotrexate. Radiotherapeutic management is useful for breast cancer patients with brain metastasis, and long-term survival may also be possible even if patients have preexisting extracranial metastases, except for hepatic involvement. Radiation-related complications should therefore be avoided in these patients.     

超级γ刀治疗原发性肝癌的近期疗效观察

目的：观察超级γ刀立体定向放射治疗原发性肝癌的近期疗效。方法：190例患者采用超级γ刀SGS-I型立体定向放射治疗,单次3-7Gy,隔日1次,总照射剂量30-50Gy。结果：治疗结束后3个月复查AFP和CT,完全缓解（CR）15.26%,部分缓解（PR）60.53%,无变化（NC）15.26%,进展（PD）8.95%;CR＋PR为75.79%。结论：超级γ刀治疗原发性肝癌安全有效,可缓解症状,提高患者生活质量。     

Phase II trial of radiotherapy after hyperbaric oxygenation with chemotherapy for high-grade gliomas

We conducted a phase II trial to evaluate the efficacy and toxicity of radiotherapy immediately after hyperbaric oxygenation (HBO) with chemotherapy in adults with high-grade gliomas. Patients with histologically confirmed high-grade gliomas were administered radiotherapy in daily 2 Gy fractions for 5 consecutive days per week up to a total dose of 60 Gy. Each fraction was administered immediately after HBO with the period of time from completion of decompression to irradiation being less than 15 min. Chemotherapy consisted of procarbazine, nimustine (ACNU) and vincristine and was administered during and after radiotherapy. A total of 41 patients (31 patients with glioblastoma and 10 patients with grade 3 gliomas) were enrolled. All 41 patients were able to complete a total radiotherapy dose of 60 Gy immediately after HBO with one course of concurrent chemotherapy. Of 30 assessable patients, 17 (57%) had an objective response including four CR and 13 PR. The median time to progression and the median survival time in glioblastoma patients were 12.3 months and 17.3 months, respectively. On univariate analysis, histologic grade (P=0.0001) and Karnofsky performance status (P=0.036) had a significant impact on survival, and on multivariate analysis, histologic grade alone was a significant prognostic factor for survival (P=0.001). Although grade 4 leukopenia and grade 4 thrombocytopenia occurred in 10 and 7% of all patients, respectively, these were transient with no patients developing neutropenic fever or intracranial haemorrhage. No serious nonhaematological or late toxicities were seen. These results indicated that radiotherapy delivered immediately after HBO with chemotherapy was safe with virtually no late toxicity in patients with high-grade gliomas. Further studies are required to strictly evaluate the effectiveness of radiotherapy after HBO for these tumours.     

外放射结合腔内照射治疗气管癌和支气管肺癌的疗效观察

目的 探讨气管癌、支气管肺癌腔内放射治疗的价值。方法 4例原发气管癌和22例原发支气管肺癌及14例(18处病变)支气管肺癌术后复发者，外放射采用6MV X射线，剂量为DT30～77Gy(平均52Gy)；腔内照射采用低剂量率^192Ir小线源(1．48BGq)，支气管黏膜参考点剂量为4～6Gy／次，总剂量10～53Gy(中位值28Gy)。结果 37例肿瘤完全消退(CR)，2例部分消退(PR)，1例轻微变化(MR)，3、5年局部控制率分别为75％和65％。23例生存时间≥3年，3年生存率为57．5％。并发症较少见。结论 外放射结合腔内照射治疗对于早期支气管肺癌、局限性气管癌和支气管肺癌术后复发者是有效的治疗手段．长期生存是可能的。     

非小细胞肺癌三维适形放射治疗临床研究

 目的 比较三维适形放射治疗（3DCRT）和立体定向放射治疗（SRT）圆形准直器系统治疗非小细胞肺癌（ NSCLC）的临床疗效。方法 64例NSCLC患者随机分为治疗组（3DCRT组）和对照组（SRT组），均常规放射治疗40 Gy后，再分别应用3DCRT和SRT加量照射，两组均为4～5 Gy／次，6～7次，隔日1次，每周3次，总量28～35 Gy，2～3周完成。结果 3DCRT组和SRT组有效率分别为87.9 ％和64.5 ％，差异有统计学意义；3DCRT组和SRT组1、2、3年生存率分别为74.6 ％、51.5％、36.2 ％和71.2 ％、48.9 ％、26.5 ％。中位生存时间分别为23和18个月，差异均无统计学意义；3DCRT组和SRT组正常组织并发症发生率（NTCP）分别为27.3 ％和48.4 ％，差异有统计学意义。结论 3DCRT可有效提高NSCLC患者肿瘤局部控制率和生存质量。     

A preliminary report of intraoperative radiotherapy (IORT) in limited-stage breast cancers that are conservatively treated

Local recurrences after breast conserving surgery occur mostly in the quadrant harbouring the primary carcinoma. The main objective of postoperative radiotherapy should be the sterilisation of residual cancer cells in the operative area, while irradiation of the whole breast may be avoided. We have developed a new technique of intra-operative radiotherapy (IORT) of a breast quadrant after the removal of the primary carcinoma. A mobile linear accelerator (linac) with a robotic arm is utilised delivering electron beams able to produce energies from 3 to 9 MeV. Through a perspex applicator, the radiation is delivered directly to the mammary gland and to spare the skin from the radiation, the skin margins are stretched out of the radiation field. To protect the thoracic wall, an aluminium-lead disc is placed between the gland and the pectoralis muscle. Different dose levels were tested from 10 to 21 Gy without important side-effects. We estimated that a single fraction of 21 Gy is equivalent to 60 Gy delivered in 30 fractions at 2 Gy/fraction. Seventeen patients received a dose of IORT of 10 to 15 Gy as an anticipated boost to external radiotherapy, while 86 patients received a dose of 17–19–21 Gy intra-operatively as their whole treatment. The follow-up time of the 101 patients varied from 1 to 17 months (mean follow-up time was 8 months). The IORT treatment was very well accepted by all of our patients, either due to the rapidity of the radiation course in cases where IORT was given as the whole treatment or to the shortening of the subsequent external radiotherapy in cases where IORT was given as an anticipated boost. We believe that single dose IORT after breast resection for small mammary carcinomas may be an excellent alternative to the traditional postoperative radiotherapy. However, a longer follow-up is needed for a better evaluation of the possible late side-effects.     

与AIDS相关的Kaposi′s肉瘤放射治疗的临床疗效分析

目的总结放疗在艾滋病（AIDS）相关联的流行性卡勃基氏肉瘤（EKS）治疗中的有效性。方法收集和分析H．Mondor医院肿瘤放疗科1987年7月-1997年6月收治的659例AIDS伴有EKS的患者资料。中位随访3．2年。其中,398例患者（60．3％）放疗前曾接受过化疗、干扰素以及抗病毒治疗。病变处放疗采用4MV—X射线,8MeV电子线,或45—100kVX线（视病变情况而定）。根据瘤体大小、部位和范围设野,共对6907部位（野）进行了照射。皮肤病变给予20Gy常规分割照射,休息2周后又给予10Gy补充照射。口腔病变则一般给予总量15．2Gy照射。其它病变如外生殖器、眼部等则给予10Gy-20Gy常规照射。结果可评价患者共629例,放疗总客观有效率92％,临床症状得到不同程度缓解,照射的皮肤对射线耐受好。随访发现病人疗后的复发与生存主要与AIDS本身的进展有关。结论放射治疗是流行性卡勃基氏肉瘤患者有效的治疗方法,能有效杀伤肿瘤并能明显改善生存质量,但应严格掌握放疗方法和剂量,避免放疗后发生严重并发症。     

Radiotherapy in the management of cutaneous epidemic Kaposi's sarcoma

Between June 1986 and December 1988, we treated 149 patients who had AIDS-related epidemic Kaposi's sarcoma with cutaneous irradiation. According to Mitsayasu's staging, 34 patients (23%) had Stage I disease, 82 (55%) Stage II, 0 Stage III, and 33 (22%) Stage IV. Fifty-eight patients (39%) had previously presented with one or more opportunistic infections. Ninety-four patients (63%) had received previous treatment of their Kaposi's sarcoma: 85 (57%) with interferon and 43 (29%) with vinblastine. Among the 149 patients, we treated 88 (59%) with extended cutaneous irradiation using 4- and/or 8-MeV electron beam energy and 61 patients (41%) with localized irradiation using 45-kVp x-ray energy. The total prescribed dose was 30 Gy: 20 Gy in 2 weeks (2.5 Gy/fraction, 4 times/week), followed by 2 weeks of no irradiation, and then 10 Gy in one week by the same dose schedule. Twenty patients (13%) with edema of the lower limbs were treated using 4-Mv photon therapy with bolus. Of the 131 evaluable patients, 63% achieved a complete remission (CR) and 30% a partial remission (PR) after a mean period of 1.5 months (range: 0.5-3 months). The clinical disease stage, anatomic site, and irradiation technique did not significantly influence the remission rates, although we noticed a higher CR rate when localized irradiation was used (71% vs 55.5% for localized and extended irradiation, respectively; p = 0.08). The overall tolerance was acceptable. Complications were severe epidermitis with skin ulcerations (8% of patients), exudative epidermitis (26%), dry epidermitis (60%), and varying degrees of erythema (6%). Of the 87 patients whose AIDS remained relatively clinically stable during the observation period, recurrences occurred in 56 (64%) after an average of 5.5 months (range: 1.5-12 months). We conclude that radiotherapy is useful and can be recommended as a palliative treatment to relieve pain and physical discomfort or to achieve cosmetic improvements for patients with epidemic Kaposi's sarcoma. We also conclude that radiotherapy is most beneficial in the early stages of disease, when localized treatment is practical.     

Results of radiotherapeutic management of primary carcinoma of the vagina

Forty-five previously untreated patients with primary carcinoma of the vagina were treated with curative radiotherapy from 1965 through 1985. All patients were staged according to the FIGO system. One patient was classified as Stage 0, 15 as Stage I, 22 as Stage II, 6 as Stage III, and 1 as Stage IV. Treatment consisted of intracavitary irradiation alone in Stage 0 patients. Stage I patients received intracavitary/interstitial irradiation alone or in combination with external irradiation and an implant when feasible. When treated with an implant only, the total tumor dose delivered was between 65-70 Gy. External irradiation consisted of delivering a dose of 45-50 Gy over a period of 4 1/2-5 weeks to the whole pelvis to treat the regional lymph nodes. An additional dose of 20-25 Gy was delivered to the site of original involvement using an implant when feasible. If not technically feasible, as in advanced stages, the patient was treated with additional external irradiation to a total dose of 65-70 Gy by a shrinking field technique. All patients except one were followed either until death or for a minimum of 2 years. The actuarial 5-year survival rates were 100% for Stage 0, 78% for Stage I, and 71% for Stage II patients. None of the patients with Stage III or IV disease survived. Of the patients who recurred, all but two did so within 16 months after diagnosis. Pelvic recurrence as the first site of recurrence occurred in 86% of the patients who recurred. Distant recurrence as a component occurred in 20% of all failures. Complications as a consequence of therapy occurred in 18% of the patients. Vaginal necrosis that healed with conservative treatment was seen in four patients and the other four patients had rectal complications of varying severity. Thus, curative radiotherapy is an effective method of treatment, with acceptable morbidity, in patients with early stage primary carcinoma of the vagina.