卵巢癌的初始治疗

 卵巢癌的首次治疗直接关系患者预后。早期卵巢癌（EOC）手术效果良好,化疗似无必要。但对高危EOC患者,术后化疗是有意义的。对于晚期患者,理想的细胞减灭术是治疗的基石。术前估计不能达到理想减灭术者,应先行新辅助化疗,然后再手术。卡铂和紫杉醇联合化疗已成为卵巢癌化疗的首选方案。     

卵巢非霍奇金淋巴瘤11例临床分析

目的探讨卵巢非霍奇金淋巴瘤(NHL)的诊断、治疗及预后。方法从1995年10月~2005年8月对11例卵巢NHL进行手术、化疗及放疗。化疗采用CHOP、mBACOD、MACOP及PROMACE-CYtaBOM方案,3例行骨髓移植,接受超大剂量化疗。结果1例术后拒绝化疗,出院后失访;1例骨髓移植,接受超大剂量的化疗后12月无复发;9例随访至死亡。最短生存5月,最长生存26月,中位生存13月。结论卵巢NHL预后差,应采取综合治疗。     

原发性小细胞食管癌的临床特点与治疗：附69例报告

目的探讨原发性小细胞食管癌的临床特点和适当治疗方法。方法利用１９８６年１月至１９９３年１２月,我院收治的经病理证实的初治小细胞食管癌６９例,回顾性分析其临床特点和治疗方法。结果①临床特点：本病占我院同期食管癌的１．８％,平均发病年龄６０岁,男女比１．５６∶１,疗前自然病程平均１．９月,胸中下段占９２．８％,溃疡型、蕈伞型所占比例明显高于非小细胞食管癌。②生存分析：全组总的中位生存期为１２．７月,１、３、５年生存率分别为５５％、１８％、１２％。放疗、化疗、手术、放化、术化、放术各组的中位生存期分别为：８、７、１１．５、１６、１６．５、１１月。术化和放化综合组的生存率均明显优于各单一治疗组（均Ｐ＜０．０５）。术前放疗不提高生存期。③死亡原因：各组病例的死亡原因均以远处转移为主,转移部位主要为肝、骨、肺、脑、锁骨上及腹膜后淋巴结。结论原发性小细胞食管癌的治疗应以放化或术化综合治疗为主。     

Therapeutic implications of molecular imaging with PET in the combined modality treatment of lung cancer

Molecular imaging with PET, and certainly integrated PET-CT, combining functional and anatomical imaging, has many potential advantages over anatomical imaging alone in the combined modality treatment of lung cancer. The aim of the current article is to review the available evidence regarding PET with FDG and other tracers in the combined modality treatment of locally advanced lung cancer. The following topics are addressed: tumor volume definition, outcome prediction and the added value of PET after therapy, and finally its clinical implications and future perspectives.The additional value of FDG-PET in defining the primary tumor volume has been established, mainly in regions with atelectasis or post-treatment effects. Selective nodal irradiation (SNI) of FDG-PET positive nodal stations is the preferred treatment in NSCLC, being safe and leading to decreased normal tissue exposure, providing opportunities for dose escalation. First results in SCLC show similar results. FDG-uptake on the pre-treatment PET scan is of prognostic value. Data on the value of pre-treatment FDG-uptake to predict response to combined modality treatment are conflicting, but the limited data regarding early metabolic response during treatment do show predictive value. The FDG response after radical treatment is of prognostic significance. FDG-PET in the follow-up has potential benefit in NSCLC, while data in SCLC are lacking. Radiotherapy boosting of radioresistant areas identified with FDG-PET is subject of current research.Tracers other than ¹⁸FDG are promising for treatment response assessment and the visualization of intra-tumor heterogeneity, but more research is needed before they can be clinically implemented.     

局部晚期非小细胞肺癌的综合治疗

综述近年来局部晚期非小细胞肺癌(NSCLC)放射治疗、化学治疗和放化疗综合治疗方面的临床研究进展.介绍放射治疗包括常规分割放疗、超分割放疗和三维适形放疗等的发展,不同化疗方案的疗效分析及对比,推荐较为合理的单纯化疗和放化疗结合的治疗方案及分子靶向药物治疗的进展.同期放化疗与序贯放化疗在局部控制率和生存率上的比较,显示了综合治疗的优势.     

局部进展期胃癌的综合治疗

局部进展期胃癌由于局部区域复发率高,影响治疗的疗效.胃癌根治术后的辅助性放化疗可进一步提高疗效,对于接受D2手术的患者,术后同步放化疗仍可能提高生存率.无论术前放疗还是术前化疗都可以提高局部进展期胃癌的切除率,降低局部复发率,并延长生存期,是目前局部进展期胃癌的研究方向.     

晚期卵巢上皮癌的综合治疗因素对预后的影响

目的探讨晚期卵巢上皮癌的综合治疗因素对预后的影响。材料与方法回顾性分析１９８３～１９９２年治疗的２２４例晚期卵巢癌的术后残存肿瘤大小、术前化疗、术后顺铂联合化疗疗程、二次剖腹探查结果、复发病人的再次减瘤术及放疗等治疗因素与预后的关系。结果全组３年和５年生存率各为２９％和１５％。Ⅲ期术后残存肿瘤≤２ｃｍ与＞２ｃｍ的３年和５年生存率各为５０％、２０％和３０％、５％，Ｐ值均＜０．０１。术后化疗≥６与＜６疗程的３年和５年生存率分别为５２％、１４％和２５％、８％，Ｐ值均＜０．０１。８９例术前化疗有效和无效对预后无影响（Ｐ＞０．０５），但在有效者中术后残存肿瘤≤２ｃｍ与＞２ｃｍ影响５年生存率，各为２３％与０（Ｐ＜０．０５）。５５例复发病人再次减瘤术后残存肿瘤≤２ｃｍ与＞２ｃｍ的３年和５年生存率各为４３％、４％和３２％、０，Ｐ值均＜０．００１。结论Ⅲ期和术前化疗有效与复发病人术后达理想减瘤术者、顺铂联合化疗≥６疗程可获长期生存益处。     

化放疗综合治疗95例局限期小细胞肺癌的疗效分析

目的 回顾性分析９５例局限期小细胞肺癌（ｌｉｍｉｔｅｄ ｓｔａｇｅ ｓｍａｌｌ ｃｅｌｌ ｌｕｎｇ ｃａｎｃｅｒ,ＬＳＣＬＣ０化放疗综合治疗的疗效和影响预后的因素。方法 经病理证实的局限期小细胞肺癌９５例,男８４例,女１１例。中位年龄５８岁（３２～７５岁）。按１９９７年ＵＩＣＣ的ＴＮＭ分期法,Ⅰ期３％（３／９５）,Ⅱ期７％（７／９５）,ⅢＡ期５２％（４９／９５）,ⅢＢ期３８％（３６／９５）。放疗：     

Treatment with curative intent of stage III non-small cell lung cancer patients of 75 years: a prospective population-based study

Background

There is little data on the survival of elderly patients with stage III non-small cell lung cancer (NSCLC).

Methods

Patients with stage III NSCLC in the Netherlands Cancer Registry/Limburg from January 1, 2002 to December 31, 2008 were included.

Findings

One thousand and two patients with stage III were diagnosed, of which 237 were 75 years or older. From 228 patients, co-morbidity scores were available. Only 33/237 patients (14.5%) had no co-morbidities, 195 (85.5%) had one or more important co-morbidities, 60 (26.3%) two or more co-morbidities, 18 (7.9%) three or more co-morbidities and 2 patients (0.9%) suffered from four co-morbidities. Forty-eight percent were treated with curative intent. No significant difference in Charlson co-morbidity, age or gender was found between patients receiving curative or palliative intent treatment. Treatment with curative intent was associated with increased overall survival (OS) compared to palliative treatment: median OS 14.2 months (9.6-18.7) versus 5.2 months (4.3-6.0), 2-year OS 35.5% versus 12.1%, for curative versus palliative treatment.Patients who received only radiotherapy with curative intent had a median OS of 11.1 months (95% confidence interval [95% CI] 6.4-15.8) and a 5-year OS of 20.3%; for sequential chemotherapy and radiotherapy, the median OS was 18.0 months (95% CI 12.2-23.7), with a 5-year OS of 14.9%. Only four patients received concurrent chemo-radiation.

Interpretation

In this prospective series treating elderly patients with stage III NSCLC with curative intent was associated with significant 5-year survival rates.     

Feasibility of combined modality therapy for localized high-grade soft tissue sarcomas in adults.

Seventeen consecutive patients with localized, high grade soft tissue sarcomas had resection of their primary tumor, radiation therapy and chemotherapy. The soft tissue sarcoma was primary in 14 patients and regionally recurrent in 3 patients. Chemotherapy consisted of cyclophosphamide 500 Mg/M² day 1, Adriamycin (ADR) 60 mg/M² day 2, and DTIC 400 Mg/M² days 1 and 2, given every 21 days to a maximum ADR dose of 450 mg/M². Cyclophosphamide and DTIC were then given to a total duration of 1 year. Radiation therapy consisted of 4000–5000 rad by megavoltage photons in 5 weeks, and in selected cases, an additional 1500–2000 rad by electron beam boost in the tumor bed delivered over 2 additional weeks. Following surgery, 12 patients were treated sequentially with an interval of chemotherapy, radiation therapy and then the completion of chemotherapy.The added morbidity of this sequential approach is minimal: one patient of 12 had delayed primary healing of her wound, 1 of 10 patients required a break in radiation therapy because of skin erythema. Four patients were treated with intensive pre-chemotherapy radiation therapy because of inadequate surgical margins. The median time on study was 18 months from onset of treatment (range, 8–41 months). Although there have been no local, regional or distant recurrences, the follow-up time is inadequate to assess the therapeutic benefit of this combined modality treatment.     

放疗及放、化疗结合治疗食管癌280例疗效对比分析

目的 探讨放射治疗结合DF方案化疗对食管癌的治疗价值。方法 将280例食管癌患者随机分为2个组进行临床研究，一组140例行放射治疗后配合DF方案化疗(放化组)，另一组140例行单纯放射治疗(单放组)。放射治疗采用^60Coγ射线常规照射，DT60—70Gy；化疗在放疗后1个月内进行，每3周化疗1个周期，共4—6个周期。2组均随访3年。结果 放化组与单放组l、2、3年生存率分别为62．1％、45．0％、34．2％和46．4％、32．1％、17．8％，放化组l、2、3年生存率明显高于单放组(P＜0．05)，且无严重不良反应，2组局部控制率无显著性差异(P＞0．05)，但放化组远处转移率明显低于单放组(P＜0．01)。结论 放射治疗后配合DF方案化疗对食管癌患者疗效较好，值得进一步研究。     

The treatment of inoperable lung cancer by radiotherapy and chemotherapy

The problems of the combined modality treatment of inoperable lung cancer are discussed in this paper. There is a lack of secure data on optimal radiation dose and fractionation schedules when this is the sole treatment. The problem is compounded in the combined modality situation by the possibility of increased toxicity. Whereas there is effective chemotherapy for small cell carcinoma and evidence for improved results in combined modality treatments, the results of such treatments for non-small cell carcinoma are disappointing. Strategies for improving the results are discussed.     

Unexpected toxicity of combined modality therapy for small cell carcinoma of the lung. A Southwest Oncology Group study.

Combination chemotherapy with cyclophosphamide, vincristine, methotrexate and Adriamycin was delivered to 35 patients with small-cell carcinoma of the lung (28 with extenstive and 7 with limited disease), including elective administration of intrathecal methotrexate. Whole-brain irradiation (3000 rad in 10 fractions) was then administered, with concomitant systemic cyclophosphamide and methotrexate for patients with extensive disease. Those with limited disease received concomitant chest irradiation without chemotherapy. Maintenance therapy then involved cyclophosphamide 750 mg/m² day 1, and methotrexate 30 mg/m²days 1 and 8, every 3 weeks. In only 2 patients reinduction was carried out at 24 weeks with the original chemotherapy.Myelosuppression was severe; there were at least 2 drug-related deaths from this cause in the induction period, and 15 febrile episodes with leukopenia. Stomatitis was more frequent and more severe in “maintenance” than in “induction” courses, especially the first maintenance course which was given with concomitant whole-brain irradiation. In addition, 13 episodes of unusual toxicity occurred in close temporal relation to systemic methotrexate administration, usually associated with stomatitis, in patients who were on maintenance therapy. These included 3 episodes of loss of consciousness, 4 of generalized erythroderma, 2 of “flu”-like syndrome, and I each of the following: fatal, bilateral interstitial pneumonia; reversible, eosinophilic pleural effusion; acute myocardial infarction; and renal compromise with hematuria. As a result of this unexpected and protean toxicity, the pilot study was discontinued. However, at this time seven patients (4 with extensive and 3 with limited disease) remain in complete remission.     

Integration of chemotherapy into a combined modality treatment plan for head and neck cancer: a review

This review highlights the most important recent advances in the chemotherapeutic management of patients with squamous cell carcinoma of the head and neck. Prior chemotherapy trials must be interpreted with caution in the absence of information concerning important prognostic variables, such as prior treatment, nutritional and performance status, and the heterogeneity of primary sites. In patients who have recurrent or metastatic disease, metbotrexate, platinum, and bleomycin are three active drugs when used as single agents. There is no evidence that high-dose metbotrexate therapy is superior to more conventional weekly intravenous methotrexate in the treatment of recurrent disease. Platinum is a new agent that has demonstrated activity against hemstogenous as well as regional disease. In the absence of evidence of a dose-response curve for platinum, the lower dosage schedules should be used that can be given with acceptable toxicity on an outpatient basis. Combination chemotherapy has resulted in a high proportion of objective responders and approximately 20% complete remissions to any of several platinum-contaialog regimens. However, the median duration of response remains short and none of the combination drug programs has been established as yet as superior to single agent chemotherapy in a randomized trial. Both single agent and combination chemotherapy programs have been used prior to initial surgery or radiation in patients with advanced inoperable but non-metastatic disease. Despite dramatically higher response rates over these obtained with the same drugs used in recurrent disease, there is as yet no evidence that chemotherapy given in this manner has resulted in improved disease-free or overall survival compared with local treatment alone. Similarly, the use of adjuvant chemotherapy following tumor clearance to eradicate potential micrometastic disease is currently under investigation and cannot be recommended in the absence of a controlled trial. This paper reviews the clinical trials currently in a progress both for patients with recurrent squamous cell carcinoma of the head and neck, as well as those with advanced local or regional disease.     

Platinum based combined modality approach for locally advanced head and neck carcinoma

Radiation therapy delivered soon after cisplatin administration is used for the treatment of advanced head and neck cancer. A radiation dose of 4800 cGy is given in standard fractions, followed by clinical evaluation and either surgical resection or an additional radiation dose of 2000 cGy. The histopathology of the surgical specimens from 21 patients undergoing resection in this protocol is compared with the corresponding clinical evaluation of tumor response. A significant number of both false negative and false positive clinical assessments are revealed by this comparison. In addition, it appears that local control of bulky head and neck cancer is approached by 4800 cGy combined soon after cisplatin. Discussion of the likely bases for this apparently favorable clinical interaction between cisplatin and radiation is presented.     

早期霍奇金淋巴瘤的综合治疗

霍奇金淋巴瘤(HL)已成为一种可以治愈的疾病,目前研究的重点在于不增加疾病死亡率的前提下,降低治疗引起的并发症.最近10～15年,开展了Ⅰ～Ⅱ期HL综合治疗的系列随机研究,比较综合治疗和单纯放疗或单纯化疗的疗效,并研究综合治疗时的最佳化疗方案和化疗周期数、照射靶区大小和照射剂量.综合治疗和单纯放疗或单纯化疗比较,显著改善了早期HL无病生存率10%～15%,但未提高总生存率.预后好:早期HL行单纯放疗或2～4周期ABVD方案化疗加受累野照射;预后不良:早期HL行4～6周期ABVD化疗加受累野照射.     

Preoperative chemoradiation in adenocarcinoma of the pancreas. A single centre experience advocating a new treatment strategy

Aims

To evaluate a single centre's experience with pancreatic carcinoma focused on preoperative chemoradiation therapy (CRT) for treatment of locally advanced pancreatic carcinoma. The aim of the present analysis was to evaluate the median overall survival time (OS) after preoperative CRT and to compare it with OS after primary resection of pancreatic carcinoma. In conclusion a new treatment strategy was developed using multimodality treatment for pancreatic carcinoma deemed to be resectable by CT-scan.

Patients and methods

Between 1995 and 2003, 302 patients with ductal adenocarcinoma of the pancreatic head and body were recorded prospectively and OS was analysed with regard to therapy.

Results

Fifty-eight patients were resected without any pretreatment and had an OS of 21 months. Twenty-one patients with initially unresectable tumours underwent CRT followed by resection and had an OS of 54 months, which was not significantly different from primary resection (p = 0.315). Lymph node metastasis was significantly reduced after CRT (p = 0.0029). OS for patients whose tumours could not be resected was 3–10 months, depending on tumour stage and consecutive therapy.

Conclusion

CRT pretreatment was effective in locally advanced pancreatic carcinoma and resulted in resection of tumours otherwise staged as non-resectable. This experience led to a randomized trial for patients who by CT are staged to have resectable cancer of the pancreatic head with the intent to increase curative resectability and survival by neoadjuvant CRT (ISRCTN78805636/NCT00335543).     

放疗合并化疗治疗晚期宫颈癌的疗效观察

对60例晚期宫颈癌患者分别采用常规根治量放疗加VPB方案化疗（治疗组）和单行根治量放疗（对照组）、结果表明：治疗组患者的宫颈局部肿瘤缩小和消失时间校对照组明显缩短,宫颈局部肿瘤缩小50％所需放射剂量亦校对照组减少;治疗组未出现严重毒性反应,患者对治疗耐受性良好。     

Combined-modality treatment for advanced oral tongue squamous cell carcinoma

PURPOSE: The aim of this study was to investigate prognostic factors in advanced-stage oral tongue cancer treated with postoperative adjuvant therapy and to identify indications for adjuvant concomitant chemoradiotherapy (CCRT). METHODS AND MATERIALS: We retrospectively reviewed the records of 201 patients with advanced squamous cell carcinoma of the oral tongue managed between January 1995 and November 2002. All had undergone wide excision and neck dissection plus adjuvant radiotherapy or CCRT. Based on postoperative staging, 123 (61.2%) patients had Stage IV and 78 (38.8%) had Stage III disease. All patients were followed for at least 18 months after completion of radiotherapy or until death. The median follow-up was 40.4 months for surviving patients. The median dose of radiotherapy was 64.8 Gy (range, 58.8-72.8 Gy). Cisplatin-based regimens were used for chemotherapy. RESULTS: The 3-year overall survival (OS) and recurrence-free survival (RFS) rates were 48% and 50.8%, respectively. Stage, multiple nodal metastases, differentiation, and extracapsular spread (ECS) significantly affected disease-specific survival on univariate analysis. On multivariate analysis, multiple nodal metastases, differentiation, ECS, and CCRT were independent prognostic factors. If ECS was present, only CCRT significantly improved survival (3-year RFS with ECS and with CCRT = 48.2% vs. without CCRT = 15%, p = 0.038). In the presence of other poor prognostic factors, results of the two treatment strategies did not significantly differ. CONCLUSIONS: Based on this study, ECS appears to be an absolute indication for adjuvant CCRT. CCRT can not be shown to be statistically better than radiotherapy alone in this retrospective series when ECS is not present.