紫杉醇脂质体周疗同步放疗治疗中晚期宫颈癌的疗效及其对患者血清SCCA水平的影响

目的观察紫杉醇脂质体周疗同步放疗治疗中晚期宫颈癌的疗效及其对血清磷状细胞癌抗原(SCCA)水平的影响。方法 73例中晚期宫颈癌患者依据治疗方法不同分为观察组(n=37)和对照组(n=36),观察组采用紫杉醇脂质体周疗同步放疗方案,对照组采用顺铂同步放疗方案,比较观察2组治疗的疗效和血清SCCA水平的变化。结果 2组有效率比较差异无统计学意义(P>0.05);2组治疗中、治疗后的血清SCCA水平均较治疗前降低,差异有统计学意义(P<0.05);观察组治疗中血清SCCA水平低于对照组,差异有统计学意义(P<0.05)。结论紫杉醇脂质体周疗同步放疗治疗中晚期宫颈癌疗效显著,具有较高的应用价值,且能够降低血清SCCA水平。     

中晚期宫颈癌三维适形放疗联合同步化疗的 临床观察

 目的评价三维适形放疗联合同步化疗在治疗中晚期宫颈癌中的临床疗效及不良反应。方法62例中晚期宫颈癌患者,随机分为外照射后三维适形放疗联合同步化疗组（A 组）和外照射结合后装联合同步化疗组（B 组）,盆腔大野照射（36～40）Gy/20次后, A组三维适形照射,总剂量达66～75Gy左右; B组中央铅挡盆腔照射宫旁补量,使外照射B点剂量达45～50Gy;后装治疗补充A点剂量30Gy左右(4～7Gy/次, 1～2次/周)。A、B组均同步GP（吉西他滨+顺铂）方案化疗,3周为一疗程,共2疗程。 结果A组32例,CR 24例,PR 7例,近期有效率96.88%;B组30例, CR 15例,PR 8例, 近期有效率76.67%,A组明显高于B组(P<0.05)。骨髓抑制以及直肠、膀胱晚期放疗损伤发生率A组明显低于B组(P<0.05)。结论外照射后程三维适形放疗联合同步化疗,能提高中晚期宫颈癌的局部控制率,降低远期放疗损伤发生率。     

鸦胆子油乳联合调强放疗及腔内后装治疗宫颈癌的临床观察

目的:观察中药鸦胆子油乳配合调强放疗（IMRT）及192Ir腔内后装治疗宫颈癌的近期有效率及毒副反应。方法:68例宫颈癌患者随机分为2组,对照组34例,全程IMRT配合腔内后装治疗。研究组34例,全程鸦胆子油乳配合IMRT及腔内后装治疗。对照组采用6MV X线调强放疗给予平均剂量54.5Gy,1.8-2.2Gy/次,每周5次,放疗30Gy后开始作腔内后装治疗,后装照射共给5次,每周1次,每次6Gy,治疗当日不进行外照射。研究组在对照组治疗基础上另加用鸦胆子油乳注射液30ml 加入0.9%氯化钠注射液250ml中静脉滴注,每天1 次,连续使用21d。结果:2组近期有效率分别为85.29%和88.24%,无统计学差异（P＞0.05）;研究组治疗后CD3+、CD4+水平较治疗前明显升高（P＜0.05）,对照组CD3+、CD8+水平较治疗前下降（P＜0.05）;两组治疗前CD3+、CD4+、CD8+和CD56+水平比较均无差异（P＞0.05）,研究组治疗后上述各指标均明显高于对照组治疗后水平（P＜0.05）;两组毒副反应比较,研究组急性放射性肠炎及血液学毒性程度均明显低于对照组(P＜0.05)。结论:鸦胆子油乳可通过提高患者机体免疫功能等途径有效避免或降低放疗毒副反应的发生,增强IMRT和腔内后装对宫颈癌患者的放疗疗效。     

盒式放疗与调强放射治疗对中晚期宫颈癌的临床疗效及不良反应

目的探讨盒式放疗与调强放射治疗(IMRT)对中晚期宫颈癌的临床疗效及不良反应。方法选择68例中晚期宫颈癌患者,根据患者病情及意愿将患者分为盒式放疗组和IMRT组,每组34例。盒式放疗组患者采用盆腔外照射并腔内后装放疗进行根治性放疗,IMRT组患者进行IMRT。比较两组患者的放疗参数、临床疗效及不良反应。结果 IMRT组中计划靶区(PTV)的均匀指数(HI)和适形指数(CI)均优于盒式放疗组(P﹤0.05)。IMRT组中膀胱、小肠和直肠的V30、V40和V50均低于盒式放疗组(P﹤0.05),且随着靶区体积的增加,两组患者膀胱、小肠和直肠的受照剂量均呈下降趋势。盒式放疗组和IMRT组患者均出现了不同程度的急性放射性膀胱炎、急性放射性肠炎及骨髓抑制,其中IMRT组患者的急性放射性膀胱炎和急性放射性肠炎均轻于盒式放疗组(P﹤0.05)。盒式放疗组和IMRT组患者的有效率分别为52.94%(18/34)和67.65%(23/34),差异无统计学意义(P﹥0.05)。盒式放疗组和IMRT组患者的1年和3年生存率、局部复发率和远处转移率比较,差异均无统计学意义(P﹥0.05)。结论与盒式放疗相比,IMRT体现了显著的保护危及器官的优势,且可降低不良反应发生率。     

子宫颈癌调强放射治疗临床分析

目的探讨中晚期宫颈癌患者应用调强放射治疗（IMRT）,在提高靶区剂量与减少正常组织受量方面的价值。方法62例中晚期宫颈癌患者,随机分成IMRT组和普放组。IMRT组30例患者给予全程IMRT和6～7次腔内照射,外照射与内照射同步进行,外照射每周4次,内照射1次/周,IMRT的PTV总处方剂量为50 Gy,2.0 Gy/次;腔内照射5 Gy/次,共30～35 Gy（A点剂量）。同时虚拟设计普通放疗计划,按相同的处方剂量计算,自身比较靶区以及直肠、小肠、膀胱和骨髓等危险器官的受照剂量和体积。普放组32例患者接受普通外照射和腔内照射,外照射24 Gy时开始内照射,腔内照射A点剂量35Gy左右,外照射的剂量和分割方式同IMRT组。比较两组的肿瘤缓解率和1,2年生存率,急慢性放射反应和并发症发生率以及疗程长短。结果IMRT较普放计划的靶区剂量明显提高（P〈0.01）,小肠、直肠、膀胱和骨髓的受照射剂量和体积均明显减少（P〈0.05）;IMRT组肿瘤缓解率较高（P〈0.05）,部分急、慢性放射反应明显减少（P〈0.05）,1,2年生存率比较差异无显著性（P〉0.05）。结论IMRT技术可提高宫颈癌的靶区剂量,并获得理想的剂量分布,邻近危险器官得到很好的保护,从而减少了急慢性放疗反应的发生,但未能提高近期生存率。     

紫杉醇脂质体联合铂类化疗同步放疗治疗宫颈癌患者的临床疗效

目的 探讨紫杉醇脂质体联合铂类化疗同步放疗治疗宫颈癌患者的临床疗效。方法 根据治疗方法的不同将80例宫颈癌患者分为对照组(n=41,紫杉醇联合铂类化疗同步放疗)和观察组(n=39,紫杉醇脂质体联合铂类化疗同步放疗)。比较两组患者的临床疗效、肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCCA)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)]、肝肾功能指标[血肌酐(Scr)、血尿素氮(BUN)、血尿酸(BUA)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)]、免疫功能指标(CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺)及不良反应发生情况。结果 观察组患者的总有效率高于对照组(P﹤0.05)。治疗后,两组患者CEA、SCCA、CA125、CA19-9水平均低于本组治疗前,观察组患者CEA、SCCA、CA125、CA19-9水平均低于对照组,差异均有统计学意义(P﹤0.05)。治疗后,两组患者Scr、BUN、BUA、AST、ALT水平均高于本组治疗前,观...     

宫颈癌患者血清鳞状细胞癌抗原、尿激酶型纤溶酶原激活物受体、CD105、转化生长因子-β水平及临床意义

目的 探讨宫颈癌患者血清鳞状细胞癌抗原(SCCA)、尿激酶型纤溶酶原激活物受体(uPAR)、CD105、转化生长因子-β(TGF-β)水平及临床意义.方法 选取158例宫颈癌患者和50例宫颈上皮内瘤变(CIN)患者,分别作为宫颈癌组和CIN组,检查两组患者的血清SCCA、uPAR、CD105、TGF-β水平,分析血清SCCA、uPAR、CD105、TGF-β水平与宫颈癌患者临床特征的关系.结果 宫颈癌组患者的血清SCCA、uPAR、CD105和TGF-β水平均明显高于CIN组,差异均有统计学意义(P<0.01).TNM分期为Ⅲ～Ⅳ期、有淋巴结转移宫颈癌患者的血清SCCA水平分别高于TNM分期为Ⅰ～Ⅱ期、无淋巴结转移的患者(P<0.05),低分化宫颈癌患者的血清uPAR水平高于中高分化的患者(P<0.05),TNM分期为Ⅲ～Ⅳ期、肿瘤直径≥5 cm、低分化、有淋巴结转移宫颈癌患者的血清CD105水平分别高于TNM分期为Ⅰ～Ⅱ期、肿瘤直径<5 cm、中高分化、无淋巴结转移的患者(P<0.05),有淋巴结转移宫颈癌患者的血清TGF-β水平高于无淋巴结转移的患者(P<0.05).宫颈癌患者的血清SCCA与TGF-β水平呈正相关(r=0.431,P<0.05),血清uPAR与CD105水平呈正相关(r=0.332,P<0.05).治疗1个月后宫颈癌患者的血清SCCA、uPAR、CD105和TGF-β水平均明显低于治疗前(P<0.01).结论 宫颈癌患者的血清SC-CA、uPAR、CD105和TGF-β水平均明显升高,且其表达水平与患者的临床特征具有一定关系,值得进一步研究.     

化疗-放疗-巩固化疗的序贯治疗模式治疗晚期宫颈癌的疗效分析

目的 探讨化疗-放疗-巩固化疗的序贯治疗模式治疗晚期宫颈癌的疗效.方法 依据术前治疗方法将110例晚期宫颈癌患者分为观察组(n=61)和对照组(n=49),观察组患者术前接受化疗-放疗-巩固化疗的序贯治疗,对照组患者术前接受新辅助化疗.比较两组患者的近期疗效、肿瘤标志物水平、病理特征、不良反应发生情况等.结果 观察组患者临床总有效率为95.08％,高于对照组患者的85.71％(P﹤0.05).治疗后,两组患者癌胚抗原(CEA)、鳞状上皮细胞抗原(SCCA)和糖类抗原125(CA125)均低于本组治疗前(P﹤0.05),且观察组患者CEA、SCCA和CA125水平均明显低于对照组(P﹤0.05).观察组患者的术中出血量、淋巴结转移率、脉管癌栓发生率、直肠炎和胃肠道反应发生率均低于对照组(P﹤0.05).结论 与新辅助化疗相比,化疗-放疗-巩固化疗序贯治疗晚期宫颈癌患者效果显著,可降低肿瘤标志物水平和不良反应发生率.     

调强适形放疗治疗晚期宫颈癌患者的疗效观察

目的:探究调强适形放疗（IMRT）治疗晚期宫颈癌患者的疗效观察。方法:回顾性选取2014年04月至2016年05月我院收治的符合纳排研究标准的79例接受放疗的中晚期宫颈癌患者。根据治疗期选取放疗方式不同，将43例行常规普通放疗的患者纳为常规放疗组，将36例行调强放疗的患者纳为IMRT组。观察两组近期临床疗效、放疗毒性反应及预后复发生存情况。结果:常规放疗组近期临床治疗总有效率（62.79% vs 83.33%）低于IMRT组（P=0.042）。IMRT组急性期血液系统、消化系统、泌尿系统毒性反应总发生率及晚期放射性直肠、放射性膀胱炎总发生率低于常规放疗组（P均<0.05）。Ⅲa-b期IMRT组患者预后3年OS(82.4% vs 47.6%)、DFS(88.2% vs 57.1%)及PFS（70.6% vs 4.8%）显著优于常规放疗组，差异有统计学意义（P＜0.05），Ⅱb及Ⅳa期两组患者差异无显著统计学意义。结论:IMRT可有效提高晚期宫颈癌临床治疗有效率，降低放疗毒性反应，改善患者预后，值得临床推广应用。     

宫颈癌盆腔淋巴结转移调强放射治疗的疗效分析

目的 探讨调强放射治疗(IMRT)对宫颈癌盆腔淋巴结转移患者的临床疗效.方法 回顾性分析94例宫颈癌患者的临床资料,将47例行IMRT方法治疗的患者作为IMRT组,将47例行普通放疗方法治疗的患者作为普通放疗组.分析比较两组患者治疗3个月后的近期疗效、急性不良反应和3年的生存情况.结果 治疗3个月后,IMRT组盆腔淋巴结完全消失和缩小消退的比例均高于普通放疗组(P﹤0.05).IMRT组3年死亡29例,累积生存率为38.3%,普通放疗组3年死亡34例,累积生存率为27.7%,IMRT组和普通放疗组的中位生存时间分别为29(23~35)个月和13(7~20)个月,IMRT组中位生存时间长于普通放疗组(P﹤0.05).IMRT组消化系统和骨髓抑制等急性不良反应均较普通放疗组明显减少,差异有统计学意义(P﹤0.01),且IMRT组均未出现3级不良反应.结论 I MRT不仅可以提高瘤体组织的放射剂量,还可以提高治疗的疗效,减少急性不良反应的发生,延长患者治疗后3年的中位生存时间.     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.