Treatment Options for Hodgkin's Disease During Pregnancy

Treatment results of 47 pregnant women with Hodgkin's disease (HD) are analyzed using data reported in the literature since 1960. Twenty-three of the patients were treated with radiation during pregnancy and 17 of the 23 patients (74%) were reported to be long term disease-free survivors. All of these pregnancies resulted in normal deliveries and the babies were evaluated to have no abnormalities at birth. Termination of pregnancy was performed in 12 patients and 10 (83%) of them survived with no evidence of disease after subsequent treatment. In 12 patients, the treatment was initiated only after delivery and 9 (75%) of the 12 patients are disease-free survivors. The characteristics of the patients as well as an analysis of the results according to treatment approach practiced in each trimester of pregnancy are reported. The radiation dose to the fetus is evaluated and the factors affecting the dose are analyzed

Experience with administering chemotherapy for HD during pregnancy is also reviewed. Twenty-six patients were treated during the first trimester. The patients treated with procarbazine, chlorambucil, cyclophosphamide or combination chemotherapy in the first trimester had abortions or malformed babies. When vinblastine was used during the first trimester in 13 patients, and nitrogen mustard in 3 patients, each of the 16 patients were reported to have delivered normal babies. When chemotherapy was used during the second or third trimesters, no abnormalities of the newborns were reported

This review suggests that the cure rate of HD is unlikely to be compromised in pregnancy in spite of the fact that radiation or chemotherapy had to be modified in order to conserve the fetus. The treatment alternatives in each trimester are discussed and the consequences of administering radiation or chemotherapy during pregnancy are reviewed     

非小细胞肺癌的治疗进展

全文综述了近年来非小细胞肺癌手术、化放疗临床治疗上的一些进展，并就可能出现的新的治疗模式作一展望。     

同步放化疗治疗局部晚期食管癌临床观察

目的 探讨同步放化疗治疗局部晚期食管癌的疗效及毒副反应.方法 80例经组织学或细胞学证实的局部晚期食管癌随机分为两组,同步放化疗组40例接受同步放化疗,单纯放疗组40例仅接受放疗,化疗采用DF方案,放疗剂量为60-64 Gy,治疗结束后分别观察疗效及毒副反应.结果 同步放化疗组和单纯放疗组有效率分别为95.0%、82....     

妊娠哺乳期乳腺癌

发生于妊娠哺乳期的乳腺癌较少见 ,约占全部女性乳腺癌发病率的 1%～ 2 % ,目前尚无证据表明妊娠和哺乳与乳腺癌的发病及病程有关系。妊娠前的乳腺检查是很重要的 ,对实质性肿块在乳腺充血前作活组织检查。虽然妊娠哺乳期乳腺癌患者的临床分期较晚 ,但和相同年龄的非孕患者比较 ,生存率没有明显的差异。治疗性流产手术仅在个体中采用 ,因为那些患者需要化疗和放疗 ,且化疗和放疗对发育中的胎儿是有影响的 ,而延迟治疗对母亲来说又是有害的。早期患者乳腺癌治疗 2年后可再次妊娠 ,病情较严重的患者应避免再妊娠     

Preoperative Chemoradiotheraph for Inflammatory Breast Cancer

OBJECTIVE To observe the effect of preoperative chemoradiotherapy for inflammatory breast cancer.METHODS From December 1996 to December 2000, we received and treated 21 patients with inflammatory breast carcinoma with a combinedmodality treatment. The chemotherapy protocol consisted of cyclophosphamide (CTX), pirarubicin (THP-ADM) and 5-fluorouracil (5-FU) or CTX, 5-Fu and methotrexate (MTX). The same infusion scheme was repeated on day 21. After 3～4 cycles the patients were treated with radiotherapy. When the radiation dose reached 40 Gy, the patients who were unable or unwilling to under go an operation received continued radiotherapy. When the radiation dose to the supra clavicular fossa and internal mammary lymph nodes reached 60 Gy and 50 Gy respectively, the radiotherapy was stopped. Chemotherapy was then continued with the original scheme. Patients who had indications for surgery and were willing to under go an operation received no treatment for 2 weeks, after which a total mastectomy was performed. Chemotherapy and radiotherapy was resumed with the original scheme after the operations. When the radiation dose reached 50 Gy, radiotherapy was stopped.RESULTS All patients were followed-up for more than 5 years with a follow-up rate of 100%. The overall 3 and 5-year survival rates of these patients were 42.9%, and 23.8% respectively. For patients in Stage ⅢB the 3 and 5-year survival rates were 50.0% and 27.8% respectively, and for patients in Stage Ⅳ, the 3 and 5-year survival rates were both 0.0%.There was a significant difference between the 2 stage groups (P＜0.05,X2=11.60). For patients who received an operation, the 3 and 5-year survival rates were 80.0% and 33.3% respectively, For patients who were not treated with an operation, the 3 and 5-year survival rates were both0.0%, There was a significant difference between the operated and nonoperated groups (P＜0.05, X2=11.64).CONCLUSION The prognosis of inflammatory breast carcinoma is poor.Before operation, a combined-modality treatment (first chemotherapy,then local therapy, finally chemotherapy and radiotherapy) is the best treatment method.     

肺癌多学科治疗的动向和趋势

近年来随化疗、放疗效果的提高 ,肺癌的多学科的治疗成为热门研究课题 ,2 0 0 3年ASCO会议主席Dr.Bunn提出几乎所有肿瘤均需多学科治疗。目前新辅助治疗已成为欧美对ⅢaN2 NSCLC的标准治疗 ,认为新辅助化疗有益于Ⅲa期NSCLC ,但尚需更多的多中心随机研究资料证实。术后辅助化疗在以往研究虽较多 ,意见不一致 ,2 0 0 3年ASCO会议中由法国Dr.LeChevalier等报告了 186 7例NSCLC术后辅助化疗的随机研究 ,辅助化疗组与对照组的二年、五年生存率 [70 % ,4 5 %∶6 7% ,4 0 % (P <0 0 3) ]、无进展生存率 [6 1% ,39%∶5 5 % ,34% (P <0 0 5 ) ]均有显著意义 ;上海市肺部肿瘤组在 2 11例手术治疗NSCLC中经COX多因素分析发现术后化疗有较佳的生存率 ,Ⅱ、Ⅲ期的术后生存率也以辅助化疗组为佳 ,以≥ 3周期优于 <3周期。Ⅲa期NSCLC中 pN2 组单手术 ,单放疗的预后差。近年有报告化、放疗或加手术可改善结果 ,为此 ,Dr.Albain等在 2 0 0 3年ASCO年会议中报告了4 2 9例估计可手术切除Ⅲa期NSCLC ,随机分为化放疗和化放疗加手术两组 ,结果以加手术为佳 ,MST为 14月 ,三年无进展生存率、三年生存率均高于非手术组 (2 9%∶19% ,38%∶33% ) ,但加手术组非肺癌死亡较多 ,在会中指出如全世界能开展术后辅助化疗每年可挽救 7     

Evaluating the Impact of the COVID-19 Pandemic on New Cancer Diagnoses and Oncology Care in Manitoba

Individuals with cancer are vulnerable to infection with SARS-CoV-2, the virus causing COVID-19. Physical distancing, the reallocation of health care resources, and the implementation of procedures to reduce the spread of COVID-19 may also have serious consequences for people with cancer. We evaluated the impact of COVID-19 on new cancer diagnoses and oncology care in Manitoba, Canada using an interrupted time series design and data from the Manitoba Cancer Registry and CancerCare Manitoba’s (CCMB) electronic medical record. In April 2020, there was a 23% decrease in new cancer diagnoses, a 21% decrease in pathology reports, and a 43% reduction in surgical resections. There was no difference in new cancer diagnoses by August 2020, surgery by July 2020, and pathology reports by September 2020. From April 2020 to June 2021, there was a 13% decrease in radiotherapy (RT) fractions, an 18% decrease in UCC visits, and a 52% decrease in in-person visits. There was no change in intravenous chemotherapy visits per month, first RT visits, or overall patient visits. The impact of COVID-19 on shifts in the stage at diagnosis and survival will be assessed in future analyses.     

化放疗、放疗和化疗治疗肺癌脑转移的疗效评价

目的评价化放疗、放疗和化疗治疗肺癌脑转移的疗效。方法化疗加放疗32例,放疗19例,化疗11例。结果化放疗组、放疗组和化疗组的中位生存期分别为6．9月、5．8月、3．6月;1年生存率分别为28．1％、21．1％、0％。化放疗组的疗效虽稍优于放疗组,但在统计学上差异无显著性（P＞0．05）。而化放疗组及放疗组明显好于化疗组（P＜0．05）。结论化放疗及放疗特别是化放疗是治疗肺癌脑转移的有效治疗方案。     

外科手术在治疗病变局限期小细胞肺癌中的地位

近年对外科手术在治疗局限期小细胞肺癌中的地位有了重新的认识。现有资料认为采用综合治疗力争根治性切除是使患者长期存活的重要治疗模式。化、放疗仍是小细胞肺癌的主要治疗手段 ,手术应掌握适应证。总的策略是在术前诱导化疗的基础上手术 ,辅以必须的术后化疗。手术能够完全切除的 ,术后应进行预防性颅脑照射。对于术中发现肺门和纵隔淋巴结转移的 ,建议术后纵隔放疗     

宫颈癌诊治现状与进展

宫颈癌筛查是早期发现宫颈癌的重要手段,人类乳头状瘤病毒（HPV）和鳞状细胞抗原检测对宫颈癌诊断及病情监测起重要作用。宫颈癌治疗手段的改革与创新,如保留生育功能的宫颈广泛性切除术、保留盆腔神经广泛性子宫切除术、腹腔镜下宫颈癌根治术、新辅助化疗、同步放化疗、调强放疗等,使宫颈癌的治疗效果不断提高。     

直肠癌外科治疗进展

结直肠癌发病率和死亡率仍呈上升趋势,2002年全球结直肠癌新发病例102．3万,死亡52.9万,分别比2000年增加8．3％和7．5％。其发病率和死亡率分别居所有癌症的第三位和第四位。中国亦不例外,结直肠癌死亡率2005年比1991年增加70．7％,年均增加4．71％。因此,迄今许多国家仍然把结直肠癌作为重点肿瘤进行研究。本文着重介绍直肠癌近年来的治疗进展。外科方面保肛手术日益受到重视,所占比例越来越高,这主要是手术技术提高、全直肠系膜切除术（TME）推广、吻合器的应用,但更重要的是越来越多学者接受远端安全切缘为1—2cm的意见。TME事实上已作为直肠癌手术的”金标准”。因为TME技术原则使局部复发率由35％-45％下降到3％-11％。微创手术也是近年颇受重视的新技术。腹腔镜下结肠癌切除较为成熟,但仍需注意选择适应征。直肠癌扩大根治术使腹膜返折以下进展期直肠癌的术后5年生存率提高到68％。但要进一步提高直肠癌手术效果还要多学科综合治疗,特别是术前放化疗显示出良好的势头。但是还有许多具体问题,有待进一步开展多中心临床试验加以解决。     

Report from the Western Canadian Gastrointestinal Consensus Cancer Conference—Management of Total Neoadjuvant Therapy in Rectal Cancer

An educational session related to the Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held virtually on 14 October 2020. The WCGCCC is an interactive multidisciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba), who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists, radiologists, and allied health care professionals participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of total neoadjuvant therapy in rectal cancer.     

胰腺癌新辅助与辅助放疗进展

新辅助和辅助放疗在胰腺癌中的作用还不明确.对于可切除的胰腺癌首选手术,新辅助放疗只是手术存在困难时的补充;对于交界可切除及局部晚期的胰腺癌,基于化疗基础上联合放疗的新辅助治疗方案,可提高R0切除率并提高局控率;由于现有的临床试验的结果不一致,胰腺癌术后辅助放疗存在争议,但对于非R0切除及pN1的患者,建议在辅助化疗的基...     

老年患者的大胰癌外科治疗

目的 探讨老年患者胰腺癌接受胰十二指肠切除术,以期明确手术成功的相关因素。方法 本研究包括74例大胰癌患者。35例年龄大于70岁,30例为标准胰十二指肠切除术和5例为区域性胰十二指肠切除术,其中15例按“三步法”予以切除。这组患者的结果与另外39例非老年患者作比较。结果 老年患者的30天手术死亡率与并发症率分别为5.9％和26.4％;而在非老年患者中分别为5.2％和18.4％。危险因素、并发症率和死亡率差别有统计学意义。老年患者和非老年患者的5年生存率分别为11.7％和15.7％,无显著性差异。结论 本研究表明老年患者可安全接受根治性胰十二指肠切除术,而长期效果与非老年患者相似。减黄可改善肝、肾功能,增加患者对手术的耐受。术前介入化疗可在肿瘤与门静脉间产生“炎性水帘”,从而减少门静脉切除率。     

进展期胃癌的术前新辅助治疗进展

自美国INT0116试验结果发表以后,胃癌术后辅助治疗已经成为局部晚期胃癌的标准治疗方法,但对胃癌术前新辅助治疗的价值,目前还未能达成共识.现临床有大量研究显示:通过术前新辅助治疗,不仅可以提高患者的R0切除率,还可以减少复发转移,提高患者生存期,该文就目前国内外关于进展期胃癌术前新辅助治疗的进展进行综述.     

肺癌脑转移的放射治疗

目的　分析放射治疗肺癌转移的疗效及与化疗比较。材料与方法　 1980年 1月至 1996年 12月 ,对肺癌脑转移 12 6例进行回顾性研究。化疗采用CCNU ,BCNU ,CTX ,MTX ,DDP ,VP -16。放疗采用60 Co或 6MV X直线加速器 ,全脑DT30～ 40Gy ,并局部追加DT10～ 2 0Gy ,局部放疗DT35～ 5 5Gy。结果　全组 1、2年生存率分别为 16 7% (2 1/12 6 )、3 2 (4/12 6 ) ,中位生存时间为 7 9个月。单纯放疗组 1年生存率为 5 4% (3/86 ) ,中位生存时间为 7 0个月。放疗加化疗综合组 1、2年生存率分别为 2 5 7% (18/70 )、5 7% (4/70 ) ,中位生存时间为 8 6个月。结论　肺癌脑转移化疗加放疗综合治疗为主要治疗手段能提高疗效     

Pregnancy after treatment of secondary acute promyelocytic leukemia following Hodgkin's disease: a case report

The authors report a case of therapy-related acute promyelocytic leukemia (t-APL), with typical cytogenetic translocation t(15;17), which appeared following chemotherapy (ABVD), and radiotherapy for Hodgkin's disease (IIB). After treatment with all-trans retinoic acid (Vesanoid(R) 45 mg/m2 daily) complete remission of t-APL was achieved. Then only one course of chemotherapy '3+7' (doxorubicin 45 mg/m2 1-3 d, cytosar 200 mg/m2 1-7d) was applied and the patient interrupted further treatment in July 1994. Four years later she had a normal pregnancy and delivered a healthy female infant in December 1998.     

局限期小细胞食管癌2种化疗方案的对比分析

目的：对比分析依托泊苷联合顺铂（EP）与伊立替康联合顺铂（IP）2种化疗方案治疗局限期小细胞食管癌的疗效及预后。方法回顾性分析53例局限期小细胞食管癌患者的临床资料,53例均未出现远处转移,均采用放化疗联合治疗的模式,其中化疗方案的选择为 EP 方案28例,IP 方案25例。采用χ2检验分析2种方案的疾病控制率,Kaplan-Meier 法及 log rank 检验分析其生存时间。结果 EP 组的疾病控制率为78.6%,IP 组的疾病控制率为52.0%,差异有统计学意义（P <0.05）。EP 组中位生存期为9.5个月,IP组为8.0个月,差异有统计学意义（P <0.05）。结论 EP 方案联合放疗治疗局限期小细胞食管癌的近远期疗效均优于 IP 方案联合放疗。