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1.
目的 探讨早期结外鼻型NK/T细胞淋巴瘤放化疗综合治疗的疗效及不良反应。方法 回顾性分析本院收治的174例经病理证实的结外鼻型NK/T细胞淋巴瘤患者资料。生存分析及组间比较采用Kaplan-Meier法和Log-rank检验。结果 全组Ⅰ期患者102例,Ⅱ期患者72例。2例患者接受单纯放疗,172例患者接受放化疗综合治疗。全组总有效率为94.2%(164/174),其中完全缓解(CR)患者153例(87.9%)。5年总生存率(OS)为87.3%,5年无进展生存率(PFS)为83.1%,5年局部区域控制率为91.9%。放化疗期间最常见不良反应为骨髓抑制和口腔黏膜炎,≥ 3级骨髓抑制占62.1%,≥ 3级口腔黏膜炎占10.9%。多因素分析结果显示,高龄、B症状及Ann Arbor分期Ⅱ期是OS的独立预后不良因素,而高龄和Ann Arbor分期Ⅱ期是PFS的独立预后不良因素。放疗剂量≥ 50 Gy较低剂量组可显著提高总PFS,两组5年PFS分别为83.5%和76.5%(HR 0.374,95%CI 0.169~0.826,P=0.015)。结论 早期NK/T细胞淋巴瘤经过放化疗综合治疗可达到较好疗效,不良反应可以耐受。  相似文献   

2.
目的 探讨在既往未使用过酪氨酸激酶抑制剂(TKI)的表皮生长因子受体(EGFR)突变的非小细胞肺癌脑转移患者中,脑放疗介入的时间及脑放疗方式的选择。方法 回顾性分析武汉大学中南医院放化疗科2014年1月至2018年9月收治的69例合并脑转移的EGFR突变的非小细胞肺癌(NSCLC)患者,根据脑部放疗介入时间将患者分为两组:早放疗组(45例)即确诊脑转移后先行脑部放疗并接受TKI药物治疗,晚放疗组(24例)即先使用TKI药物至出现脑转移病灶进展后行脑放疗,早放疗组根据脑放疗方式可分为早全脑放射治疗(WBRT)组(20例),早立体定向放射外科(SRS)组(25例),比较患者的总生存(OS)、颅内无进展生存(iPFS)及无进展生存(PFS)。结果 入组69例患者的中位OS为31.2个月,早放疗组与晚放疗组1年和2年OS分别为95%、64%和80%、35%,两组差异有统计学意义(χ2=8.87,P<0.05)。进一步分析显示,早WBRT组、早SRS组及晚放疗组1年和2年OS分别为95%、96%、80%和 42%、88%、35%(χ2=12.01,P<0.05)。早SRS组较晚放疗组有OS获益(HR:0.10,95%CI:0.23~0.46,P=0.003),而早WBRT组较晚放疗组OS未见显著获益(HR:0.54,95%CI:0.21~1.32,P=0.180)。早放疗组与晚放疗组iPFS及PFS比较差异均无统计学意义(P>0.05)。结论 对于既往未接受TKI药物治疗的EGFR突变的NSCLC脑转移患者,尽早脑部放疗介入有助于延长患者生存期,其中使用SRS较使用WBRT获益明显。  相似文献   

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目的 探索术前同步放化疗加新辅助化疗治疗局部进展期直肠癌的疗效及安全性。方法 收集2012年1月-2015年12月贵州省肿瘤医院腹部肿瘤科收治的中低位局部进展期直肠癌患者80例,采用抽签法随机分为:试验组40例,为同步放化疗加化疗组。盆腔放疗DT:45 Gy/25次 ,5周,直肠肿块同步加量至50 Gy/25次,5周,放疗每周第1~5天同步5-FU持续滴注,随后行4周期FOLFOX4方案化疗,治疗结束后行全直肠系膜切除术(TME手术),术后4周再行4周期FOLFOX4方案辅助化疗。对照组40例,为同步放化疗组。盆腔同步放化疗方案同试验组,治疗结束后6~8周行TME手术,术后4周行8周期FOLFOX4方案辅助化疗。比较两组患者病理完全缓解率、降期率、R0切除率、局部复发率、远处转移率、总生存率、不良反应发生率、手术并发症及观察各组治疗完成情况。结果 试验组、对照组病理完全缓解率(pCR率)分别为20.0%、5.0%(χ2=4.114,P<0.05);降期率分别为77.4%、55.6%(P>0.05);R0切除率分别为77.5%和65.0%(P>0.05)。3年局部复发率分别为9.6%及11.5%(P>0.05),3年总生存率、3年远处转移率分别为72.5%和65.5%(P>0.05)、25.0%和37.5%(P>0.05)。两组完成新辅助同步放化疗、根治性切除术及围手术期全身化疗患者共57例,试验组31例,对照组为26例。接受8周期全身化疗完成率试验组与对照组分别为87.1%及61.5%(χ2=4.985,P<0.05)。试验组患者发生1~4级急性反应低于对照组,但差异无统计学意义(P>0.05);两组术中出血发生率、伤口延期愈合发生率及吻合口瘘发生率差异均无统计学意义(P>0.05)。结论 术前同步放化疗联合新辅助化疗治疗局部进展期直肠癌较标准术前同步放化疗能提高近期疗效(pCR率),不良反应发生率更低,但尚需长时间随访观察及扩大病例数进行进一步临床研究。  相似文献   

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目的 探讨大分割放疗(HFR)联合紫杉醇周剂量化疗治疗食管癌术后气管食管沟淋巴结(TGLN)的安全性和疗效。方法 将53例食管癌术后单纯TGLN转移的患者随机抛硬币法分为两组,大分割组25例采用60 Gy/20次放疗,常规分割组28例采用60 Gy/30次放疗,两组患者放疗同时均采用紫杉醇 50 mg周剂量化疗。比较两种不同分割方式对不良反应及预后的影响。结果大分割组和常规分割组患者3~4级放射性食管炎、肺炎发生率分别为44.0%、16.0%和25.0%、7.1%,两组比较差异无统计学意义(P>0.05)。两组近期有效率比较,差异无统计学意义(P>0.05)。淋巴结转移灶直径≤2 cm患者近期有效率高于淋巴结转移灶直径>2 cm的患者(P<0.05)。大分割组和常规分割组中位总生存期(OS)分别为24.2个月(95%CI 16.2~32.1)和11.8个月(95%CI 9.2~14.4),两组比较差异有统计学意义(χ2=5.063,P<0.05)。单因素和多因素分析均显示淋巴结直径和分割方式是影响患者预后的因素(P<0.05)。结论 大分割放疗联合紫杉醇周剂量化疗治疗食管癌术后气管食管沟淋巴结较常规分割提高了患者预后,且治疗并发症未明显增加。  相似文献   

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目的 比较时辰化疗与常规化疗联合调强放疗在局部进展期鼻咽癌患者治疗过程中的不良反应、免疫功能、近期疗效。方法 选取2015年7月至2017年4月在贵州医科大学附属肿瘤医院初治局部进展期鼻咽癌患者159例,采用简单随机分组法,前瞻性将159例初治局部进展期鼻咽癌患者随机分为时辰化疗组与常规化疗组,前者采用时辰化疗模式给药,后者采用常规模式给药,两组均采用调强放射治疗,评价近期疗效及观察不良反应。结果 时辰化疗组与常规化疗组近期疗效完全缓解(CR)、部分缓解(PR)、稳定(SD)、进展(PD)差异无统计学意义(P>0.05),两组有效率(CR+PR)差异无统计学意义(P>0.05);时辰化疗组的白细胞减少(Z=-2.222,P<0.05)、中性粒细胞减少(Z=-1.999,P<0.05)、呕吐(Z=-2.298,P<0.05)、口腔黏膜炎(Z=-3.571,P<0.05)发生率低于常规化疗组,差异有统计学意义;时辰化疗组CD16+56+淋巴细胞计数高于常规化疗组(Z=-2.332,P<0.05)。结论 时辰化疗作为一种新的治疗模式,与调强放疗联合可在不降低临床疗效的同时减轻治疗相关不良反应的发生率及严重程度,减轻免疫抑制,值得临床推广及应用。  相似文献   

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沙利度胺联合放化疗治疗食管癌随机对照研究   总被引:2,自引:2,他引:0       下载免费PDF全文
目的 评价沙利度胺联合放化疗治疗食管癌的安全性及疗效。方法 对102例食管鳞癌患者进行放化疗。放疗前1周内、放疗第2~3周、放疗结束后1周测定患者血清血管内皮生长因子(VEGF)水平。放疗中较放疗前血清VEGF水平不降低的患者随机抛硬币法分为沙利度胺组和对照组;另将血清VEGF下降患者设为阴性对照(VEGF降低组)。沙利度胺组放化疗过程中给予沙利度胺治疗,对照组和VEGF降低组行常规放化疗。结果 95例患者完成治疗且随访资料齐全,其中沙利度胺组24例,对照组24例,VEGF降低组47例。沙利度胺不良反应主要表现为不同程度嗜睡。全组1、3年生存率分别为68.4%、22.3%,1、3年无进展生存率分别为56.8%、19.5%,1、3年局部控制率分别为83.6%、51.6%;中位生存期和中位无进展生存期分别为18.2和15.8个月。对照组、沙利度胺组、VEGF降低组患者生存曲线、无进展生存曲线比较,差异均无统计学意义(P>0.05)。局部晚期患者(Ⅱ、Ⅲ期)亚组分析显示,对照组、沙利度胺组、VEGF降低组患者3年生存率和3年无进展生存率分别为0、31.3%、20.0%和0、31.3%、16.7%,沙利度胺组均高于对照组,差异均有统计学意义(P均<0.05)。放疗后与放疗中血清VEGF水平比较,沙利度胺组和对照组降低、稳定、升高的病例数分别为13、11、0例和4、15、5例,差异有统计学意义(P<0.05)。沙利度胺组放疗后血清VEGF降低与稳定的患者1年生存率、1年无进展生存率分别为92.3%、84.6%和45.5%、27.3%,3年生存率、3年无进展生存率和3年局部控制率分别为55.6%、55.6%、100%和0.0%、0.0%、0.0%,VEGF降低的患者均高于VEGF稳定的患者,差异有统计学意义(P均<0.05)。多因素分析显示,与Ⅰ期患者相比,Ⅲ期患者死亡风险明显上升,差异有统计学意义(RR=4.868,P<0.05);放疗后有病灶残留的患者死亡风险明显增加,差异有统计学意义(RR=1.731,P<0.05)。结论 沙利度胺可能改善放疗中血清VEGF水平不降低的局部晚期食管癌患者预后,其治疗不良反应可耐受。  相似文献   

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目的 探讨老年胃癌患者放疗的安全性。方法 回顾性分析2009年3月-2014年12月63例≥70岁)、接受放疗及放化疗的胃癌患者,均经病理确诊。男性48例,女性15例,中位年龄74(70~85)岁,分期Ⅰb~Ⅳ期,中位放疗剂量50(16~60)Gy,中位放疗时间36(11~73)d,同期联合以氟尿嘧啶类为基础的化疗或不联合。观察患者治疗完成情况、不良反应、症状控制、近期疗效及1、2年生存率。比较同期放化疗组和单纯放疗组的生存和治疗耐受情况。结果 63例患者中,81.0%(51/63)的患者按计划完成放疗。19.0%(12/63)的患者出现3、4级不良反应,其中血液毒性占9.5%(6/63),胃肠道反应发生率9.5%(6/63)。56例近期疗效可评价,其中7.1%(4/56)完全缓解(CR),39.3%(22/56)部分缓解(PR),39.3%(22/56)疾病稳定(SD)。中位随访时间13.75个月(1.5~69个月),中位生存时间17个月(95%CI6.9~21.1),1、2年总生存(OS)率分别为55.0%(95%CI 48.6% ~61.4%)及36.2%(95%CI29.2% ~43.2%)。同期放化疗组和单纯放疗组的中位生存时间分别为20.5和12个月,差异无统计学意义(P>0.05)。两组严重不良反应发生情况的差异亦无统计学意义(P>0.05)。结论 多数老年胃癌患者能耐受放疗和放化疗,不良反应在允许范围内,并且有一定的疗效。  相似文献   

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目的 探讨采用质子碳离子笔形束扫描技术治疗复发性颅底及颈椎脊索瘤和软骨肉瘤患者的不良反应和近期疗效。方法 收集2014年6月30日至2018年7月30日收治的45例复发性颅底及颈椎肿瘤患者,其中脊索瘤39例,软骨肉瘤6例,中位肿瘤体积57 cm3(6.6~231.7 cm3)。术后复发患者31例,术后放疗后复发14例。行单纯质子治疗1例,质子加碳离子放疗21例,单纯碳离子治疗23例。结果 所有患者均顺利完成治疗。患者中位随访时间29个月(8~57个月),2年总生存率、局部控制率及无进展生存率分别为82.7%、85.3%及73.8%。除1例3级急性口腔黏膜炎外,未见其他3~4级急性或晚期不良反应。粒子射线放疗作为再程放疗的患者与第1次放疗的患者,其总生存率分别为50.3%和96.2%(χ2=16.969,P<0.05)。结论 质子重离子治疗复发性颅底及颈椎脊索瘤软骨肉瘤取得了较好的短期疗效,长期疗效及不良反应仍需要进一步随访。  相似文献   

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目的 研究老年营养风险指数(GNRI)与接受根治性放疗或放化疗的老年食管癌患者预后间的关系。方法 回顾性分析河北医科大学第四医院2007年1月至2013年12月197例接受根治性放疗或放化疗且年龄≥75岁的食管鳞癌患者的临床资料,计算患者放疗前后老年营养风险指数(GNRI)、体质量指数(BMI)并进行分组。Kaplan-Meier法对生存时间行单因素预后分析,Cox回归模型行多因素预后分析。结果 放疗前GNRI评分正常组139例,异常组58例,两组5年生存率及无进展生存率分别为11.08%、9.82%和8.73%、6.18%(P>0.05)。放疗后GNRI评分正常组68例,异常组129例,5年生存率及无进展生存率分别为17.04%、7.42%和16.17%、3.65%(χ2=12.316、14.617,P<0.05)。单因素分析显示,T分期、N分期、TNM分期、大体肿瘤体积(GTV)、放疗前中性粒细胞与淋巴细胞比值(NLR)及放疗后BMI、放疗后血红蛋白水平、放疗后GNRI与总生存时间(OS)相关(χ2=6.569~22.434,P<0.05);T分期、GTV、放疗前NLR及放疗后的BMI、放疗后血红蛋白水平、放疗后GNRI与无进展生存时间(PFS)相关(χ2=4.579~18.990,P<0.05)。多因素分析显示,T分期、N分期、放疗前NLR、放疗后血红蛋白水平、放疗后GNRI为患者OS的独立影响因素(P<0.05)。放疗前NLR、放疗后血红蛋白水平、放疗后GNRI为患者PFS的独立影响因素(P<0.05)。多因素分析显示,T分期、放疗后的血红蛋白水平、GNRI均为影响患者近期疗效的独立相关因素(χ2=4.716、13.083、4.519,P<0.05)。结论 营养指标GNRI可作为老年食管鳞癌患者的有效预后指标。临床工作中对GNRI评分风险较高的老年患者可积极行营养干预以改善患者预后。  相似文献   

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目的 比较紫杉醇联合氟尿嘧啶(TF)与顺铂联合氟尿嘧啶(PF)两种同期放化疗方案治疗局部晚期食管鳞癌的疗效与安全性。方法 共纳入江南大学附属医院自2014年7月至2016年6月所收治的103例食管癌患者,采用随机数表法将入组的患者按1:1比例随机分为研究组(TF)或对照组(PF),TF组52例,PF组51例。研究的主要终点为生存率(OS),次要终点为局部控制率(LPFS)、无进展生存率(PFS)和不良反应。结果 经过2年随访,TF组及PF组1年OS分别为76.9%及74.5%(P>0.05),2年OS分别为和59.6%及56.9%,差异无统计学意义(P>0.05)。TF组及PF组1年LPFS分别为71.2%及66.7%(P>0.05);2年LPFS分别为61.5%及58.8%(P>0.05);1年PFS分别为63.5%及62.7%(P>0.05),2年PFS分别为51.9%及39.2%,差异无统计学意义(P>0.05)。不良反应方面,TF组与PF组3~4级白细胞减低分别为36.5%及17.6%(χ2=4.642,P<0.05),3~4级急性放射性肺炎发生率分别为15.4%及3.9%(χ2=3.859,P<0.05),PF组3~4级恶心呕吐反应率17.6%,高于TF组的1.9%,差异有统计学意义(χ2=7.262,P<0.05)。结论 两组同期放化疗方案治疗局部晚期食管鳞癌的OS、PFS、LPFS无差异,但不良反应不同。TF组在血液学毒性、放射性肺炎等发生率上要高于PF组,而PF组更应关注消化系统不良反应的发生。  相似文献   

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The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.  相似文献   

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Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.  相似文献   

15.
Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).  相似文献   

16.
KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief,intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.,≥90%of VO2 peak).  相似文献   

17.
Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.  相似文献   

18.
In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex® ESI 16 (European Standard Investigator 16) and the PowerPlex® ESI 17 Systems. The PowerPlex® ESI 16 System combines the 11 loci compatible with the UK National DNA Database®, contained within the AmpFlSTR® SGM Plus® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR® SGM Plus® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex® ESI 17 System amplifies the same loci as the PowerPlex® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR® SGM Plus® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.  相似文献   

19.
The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.  相似文献   

20.
Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula (BSF). Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types (A and B) of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 (87.5%) of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. (J Intervent Radiol, 2007, 16: 253-257)  相似文献   

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