介入和分次立体定向适形放射治疗原发性肝癌的疗效观察

目的采用肝动脉化疗栓塞(transcatheter hepaic arterial chemoembolization,TACE)介入治疗与分次立体定向适形放射治疗(fractionated sterotactic confomal radiation therapy,FSCR)的结合治疗晚期原发性肝癌,观察其治疗效果.方法TACE治疗2～3次后,进行分次立体定向适形放射治疗,剂量48～60Gy,照射8～30次.结果采用TACE与分次立体定向适形放射治疗晚期原发性肝癌能够使肿瘤直径显著缩小,由治疗前的89.15±16.34mm缩小至治疗后的43.87±7.3mm,P＜0.05;AFP由治疗前的675.67±147.24μg/ml降低至治疗后的221.91±52.26μg/ml,P＜0.01;患者一年生存率达到77.27%.结论TACE与分次立体定向适形放射治疗晚期原发性肝癌能够明显提高患者的生存期.     

介入和分交众叛亲离体定向适形放射治疗原发性肝癌的疗效观察

目的采用肝动脉化疗栓塞(transcatheter hepaic arterial chemoembolization,TACE)介入治疗与分次立体定向适形放射治疗(fractionated sterotactic confomal radiation therapy,FSCR)的结合治疗晚期原发性肝癌,观察其治疗效果.方法TACE治疗2～3次后,进行分次立体定向适形放射治疗,剂量48～60Gy,照射8～30次.结果采用TACE与分次立体定向适形放射治疗晚期原发性肝癌能够使肿瘤直径显著缩小,由治疗前的89.15±16.34mm缩小至治疗后的43.87±7.3mm,P＜0.05;AFP由治疗前的675.67±147.24μg/ml降低至治疗后的221.91±52.26μg/ml,P＜0.01;患者一年生存率达到77.27%.结论TACE与分次立体定向适形放射治疗晚期原发性肝癌能够明显提高患者的生存期.     

中晚期肝癌患者综合治疗的临床观察

目的探讨介入治疗联合三维适形放射治疗(3DCRT)和调强适形放射治疗(IMRT)综合治疗中晚期肝癌的临床疗效。方法将66例中晚期肝癌患者随机分为观察组(33例)和对照组(33例),对照组患者行肝动脉化疗栓塞(TACE)联合3DCRT治疗,观察组患者行TACE联合IMRT治疗,比较两组患者临床指标的变化、近期疗效和药物不良反应。结果治疗后,观察组患者AFP水平变化优于对照组患者,观察组患者肿瘤大小明显小于对照组患者,差异均有统计学意义(均P<0.05),观察组患者治疗总有效率(93.9%)明显高于对照组患者(75.8%),差异有统计学意义(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论肝动脉化疗栓塞联合调强放射治疗综合治疗中晚期肝癌临床疗效确切,优于肝动脉化疗栓塞联合三维适形放射治疗,具有安全高效和不良反应少等特点,值得进一步推广。     

原发性肝癌介入治疗结合三维适形放射治疗疗效观察

目的　评价肝动脉化疗栓塞 (TACE)结合三维适形放射治疗 (3DCRT)对原发性肝癌(PHC)的疗效。方法　对 94例不能手术切除的原发性肝癌患者 ,采用先TACE后 3DCRT相结合 ,观察疗效及生存率 ,并以Cox回归模型分析预后因素。 94例中单发病灶 82例 ,多结节病灶 12例。TACE1次者 5 9例 ,1次以上者 35例。放射治疗剂量 4 2～ 5 2Gy者 4 2例 ,5 3～ 6 0Gy者 5 2例。结果　治疗后 3个月、1年的肿瘤局部有效率分别为 90 .4 % (85 / 94 )、83.0 % (78/ 94 ) ;其中前者完全缓解 12例 ,部分缓解 73例 ,稳定 6例 ,进展 3例。 1、2、3年生存率分别为 93.6 %、5 3.8%、2 6 .0 % ,中位生存期 2 5 .0个月。多因素分析结果显示Child分级、临床分期及肿瘤数目对放射治疗后患者生存率的影响具有统计学意义。结论　TACE结合 3DCRT是治疗PHC的有效无创治疗手段。     

原发性肝癌介入治疗结合三维适形放疗与单纯介入治疗的疗效比较

目的:比较肝动脉化疗栓塞(TACE)结合三维适形放射治疗(3DCRT)与单纯介入肝动脉化疗栓塞(TACE)对原发性肝癌(PHC)的疗效.方法:56例PHC患者分为2个组,A组28例(3DCRT加TACE,先TACE 1次～3次,3DCRT 45Gy～60Gy),B组28例(TACE 2次～3次).介入化疗选用顺铂60mg～100mg、阿霉素40mg、丝裂霉素20mg或5-FU1000mg～1500mg,顺铂60mg～80mg,ADM 40mg(或MMC 10mg～20mg).结果:A组CR+PR27例,总有效率为96%;B组CR+PR 17例,总有效率有60.7%(P＜0.01).癌灶体积与疗效有关,PTV(计划靶体积)≤216cm3者CR 7/8,PTV＞216cm3者CR 1/8(P＜0.01).结论:PHC疗效3DCRT加TACE组优于单纯TACE组.     

原发性肝癌介入治疗加三维适形放射治疗的疗效

目的 探讨肝动脉化疗栓塞（TACE）后采用三维适形放射治疗（3-DCRT）原发性肝癌的疗效。方法 50例肝癌中25例TACE＋3DCRT（综合组）,25例单纯TACE（对照组）。2个组均行TACE 1～3次,3-DCRT 采用6/15MVX线,3Gy/次，1次/天，总剂量45～54Gy。结果综合组近期有效率（CR＋PR）为84.0%,对照组为56.0%（χ^2=4.67,P〈0.05）。其中1、2年生存率综合组和对照组分别为76.0%、56.0%和48.0%、24.0%（χ^2=4.16、5.33,P〈0.05）。结论 TACE＋3DCRT是治疗不宜手术的原发性肝癌的较好方法。     

三维适形放疗联合肝动脉化疗栓塞治疗原发性肝癌的疗效

目的探讨三维适形放疗（3DCRT）联合肝动脉化疗栓塞（TACE）治疗原发性肝癌的疗效、不良反应及生存率。方法对30例原发性肝癌患者先行TACE,将顺铂60～100 mg、丝裂霉素10～20 mg、与40%碘化油20 ml混悬液,注入肝动脉栓塞治疗2～4次。化疗停3～4周后再行3DCRT,采用6MV、X射线治疗,单次剂量1.8～2.0 Gy、每周5次,总剂量45～55 Gy。结果近期有效率为83.3.%,1、2年生存率分别为76.7%、53.3%。结论三维适形放疗联合肝动脉化疗栓塞是非手术治疗原发性肝癌的有效治疗方案。     

立体定向放射结合肝动脉化疗栓塞治疗原发性肝癌疗效观察

目的　探讨立体定向放射(SRT )结合肝动脉化疗栓塞(TACE)治疗原发性肝癌的疗效。方法　对43例未行手术治疗的原发性肝癌患者,放射治疗前均行肝动脉化疗栓塞(TACE )治疗2～4次,SRT采用15MVX射线,肿瘤计划靶体积(PTV )≤12 5cm3 者单次剂量为5～6Gy ,生物等效剂量为DT5 6～60Gy ;PTV >12 5cm3 者单次剂量为4Gy ,生物等效剂量为5 0～5 6Gy ,放射治疗每天1次。结果　12例完全缓解(CR ) ,2 2例部分缓解(PR ) ,4例稳定(NR) ,5例进展(PD ) ,肿瘤总有效(CR +PR)率为79.1% (3 4/4 3 )。1、2、3年生存率分别为74.4% ,5 3 .5 % ,44 .2 % ,治疗前PTV≤12 5cm3 者治疗后的3年生存率(5 5 .2 % )高于PTV >12 5cm3 者(2 1.4% ) (χ2 =4.3 6,P <0 .0 5 )。结论　立体定向放射结合肝动脉化疗栓塞治疗原发性肝癌有较好的疗效。     

原发性中晚期肝癌19例三维适形放疗疗效分析

目的:观察三维适形放射治疗对中晚期原发性肝癌的疗效。方法:回顾分析19例中晚期原发性肝癌行三维适形放射治疗效果,TD38Gy～48Gy/7～12次/2.5～3周。同期30例肝动脉介入 碘油栓塞作为对照。结果:对照组近期疗效有效率70.0%(21/30),观察组78.9%(15/19);对照组与观察组1,2,3年生存率分别为53.3%、26.7%、13.3%,73.7%、42.2%、21.1%。结论:三维适形放射治疗对中晚期原发性肝癌,疗效不亚于动脉介入 碘油栓塞,值得临床推广。     

伽马刀或三维适形调强放疗联合经皮肝动脉插管化疗栓塞治疗原发性肝癌的疗效观察

目的探讨γ刀或三维适形调强放疗联合经皮肝动脉插管化疗栓塞(TACE)治疗原发性肝癌的近期疗效和不良反应。方法对2008年4月至2010年9月间69例原发性肝癌患者进行随机分组治疗。69例患者随机分为A、B两组,A组35例患者接受深圳一体医疗科技有限公司生产的月亮神γ刀设计放疗联合TACE治疗,B组34例患者接受瑞典医柯达公司生产的医用电子直线加速器设计三维适形调强放疗联合TACE治疗。两组患者治疗结束后2个月复查肝脏增强CT,根据病灶大小评估疗效。所有患者均先行肝动脉化疗栓塞1次,4周后重复1次,休息2周后再根据分组情况分别行γ刀治疗或三维适形调强放疗。γ刀及三维适形调强放疗具体方法为:在各自的立体定向放疗定位系统下以5mm层厚行CT增强扫描靶区,对所获图像在TPS上进行三维重建,勾画靶区,GTV为影像学上所见肿瘤靶区,PTV在GTV基础上均外扩1cm,修饰解剖学边界。γ刀为50%等剂量曲线包绕病灶,照射剂量为每次3Gy,每周5次,共15次。三维适形调强放疗为90%等剂量曲线包绕肿瘤边缘,照射剂量为每次2.5Gy,每周5次,共28次。结果 A组患者完全缓解(CR)2例(5.7%),部分缓解(PR)20例(57.1%),稳定(SD)8例(22.9%),进展(PD)5例(14.3%),总有效率(RR)为62.9%。B组患者CR 0例(0),PR 19例(55.9%),SD 8例(23.5%),PD 7例(20.6%),RR为55.9%。A组患者6个月、1年生存率分别为82.3%和60.7%,B组患者6个月、1年生存率分别为79.6%和58.1%。两组患者主要不良反应均为骨髓抑制、消化道反应和轻度肝功能损伤,无与治疗相关死亡患者。结论γ刀联合TACE和三维适形调强放疗联合TACE均为治疗原发性肝癌安全、有效的方法。γ刀联合TACE治疗对患者骨髓抑制作用影响更小。     

洛铂联合多西他赛行肿瘤细胞减灭术加腹腔热灌注化疗治疗腹膜癌的临床观察

目的 分析洛铂联合多西他赛行肿瘤细胞减灭术（cytoreductive surgery, CRS）加腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy, HIPEC）治疗腹膜癌（peritoneal carcinoma, PC）的围手术期安全性及疗效。 方法 PC患者行CRS+HIPEC治疗,药物为洛铂50 mg/m2、多西他赛60 mg/m²,加入12 000 ml 0.9%氯化钠溶液加热至（43±0.5）℃持续灌注60 min。记录术后6天体温和心率变化、围手术期不良事件、血常规及血生化指标、术后患者恢复情况及生存结果。结果 90例PC患者行95次CRS+HIPEC,手术时间180~450 min (中位数485 min）;术后6天最高体温、心率分别为36.4℃~38.6℃（中位数37.5℃）、76~124 bpm（中位数100 bpm）,严重不良事件16例,包括围手术期死亡2例。中位生存期20.8月（95%CI: 13.1~25.8月）,1、3、5年生存率分别为75.6%、45.6%、43.3%。 结论 洛铂联合多西他赛进行CRS+HIPEC治疗PC安全性可接受,有助于延长患者生存期。     

Endoscopic Endonasal Dacryocystorhinostomy: Best Surgical Management for DCR

EEDCR is a highly rewarding Endoscopic procedure for management of dacryocystitis when epiphora does not respond to medications or repeated syringing of nasolacrimal duct. It is a simple, less time consuming, safe but skilful, highly satisfying surgery both for the patients as well as the surgeons. There is very big advantage of EEDCR, it is close 100% successful procedure, even if there is recurrence of epiphora it is again correctable fully with no residual affects. EEDCR is far more superior to External DCR/Laser DCR and there are definite reasons for it. A total number of 578 cases have been operated by me from April 1, 2005 to March 31, 2011, only very few reoccurrences were there and they were corrected easily so much so that it can be said that it is a close 100% successful procedure and best surgical management of DACRYOCYSTITIS up to date. The successful outcome was defined as symptomatic relief from epiphora and dacryocystitis and a patent nasolacrimal duct upon syringing at the end of procedure and on follow up of patient.     

参麦注射液对阿霉素所致大鼠心肌损伤保护作用的实验研究

目的　观察参麦注射液 (SMI)对阿霉素 (ADM )诱导大鼠心肌损伤的保护作用和抗氧化作用。方法　选用ADM诱导大鼠心肌损伤模型。SD大鼠 60只 ,随机分为 3个组 ,每组 2 0只 ,分别为正常组、治疗组、对照组。正常组 :实验第 1～ 9天注射生理盐水 ,每天 3ml/kg ,1次 /天。治疗组 :实验第 1～ 9天注射参麦注射液 ,每天 3ml/kg ,1次 /天 ,第 4天注射阿霉素 ,隔天 1次 ,连用 3次 ,用生理盐水配置成 1mg/ml,每次 3mg/kg。对照组实验 1～ 9天注射生理盐水 ,每天 3ml/kg ,1次 /天。第 4天注射阿霉素 ,以后隔天 1次 ,连用 3次 ,用生理盐水配置成 1mg/ml,每次 3mg/kg。到期测定血丙二醛 (MDA )含量和超氧化物歧化酶(SOD )活性 ,并进行心肌病理检查。结果　对照组MDA水平明显高于治疗组 ,对照组SOD水平则显著低于治疗组 ,即加用SMI可提高SOD活性 ,降低MDA含量。SMI能明显减轻大鼠心肌损伤 ,对照组与治疗组比较 ,治疗组心肌损伤明显减轻 ,治疗组与正常组比较无显著性差异。参麦注射液有抗氧化作用 ,与对照组比较 ,血SOD水平升高 ,MDA水平降低 ,心肌病理计分下降。结论参麦注射液有抗氧化作用和对阿霉素所引起的心脏毒性具有保护作用 ,为临床寻找有效的阿霉素所致心肌损伤保护药物提供良好的客观依据 ,值得临床推广应用     

Denosumab in patients with cancer and skeletal metastases: A systematic review and meta-analysis

Background

We conducted a systematic review of the literature to determine the efficacy and safety of denosumab in reducing skeletal-related events (SRE) in patients with bone metastases.

Methods

A literature search using MEDLINE, EMBASE, Web of Science and The Cochrane Collaboration Library identified relevant controlled clinical trials up-to-March 14, 2012. Two independent reviewers assessed studies for inclusion, according to predetermined criteria, and extracted relevant data. The primary outcomes of interest were SRE, time to first on-study SRE, and overall survival. Secondary outcomes included pain, quality of life, bone turnover markers (BTM), and adverse events.

Results

Six controlled trials including 6142 patients were analyzed. Compared to zoledronic acid, denosumab had lower incidence of SRE with a risk ratio (RR) of 0.84 (95% confidence intervals (CI) 0.80–0.88), delayed the onset of first on-study SRE (RR 0.83; 95% CI 0.75–0.90) and time to worsening of pain (RR 0.84; 95% CI 0.77–0.91). No difference was observed in overall survival with pooled hazard ratio of 0.98 (95% CI 0.90–1.0). For total adverse events, denosumab was similar to zoledronic acid (RR 0.97; 95% CI 0.89–1.0). No significant differences were observed in the frequency of osteonecrosis of the jaw (RR 1.4; 95% CI 0.92–2.1). Patients on denosumab had a greater risk of developing hypocalcemia (RR 1.9; 95% CI 1.6–2.3).

Conclusions

Denosumab was more effective than zoledronic acid in reducing the incidence of SRE, and delayed the time to SRE. No differences were found between denosumab and zoledronic acid in reducing overall mortality, or in the frequency of overall adverse events.     

体内诱导艾氏腹水瘤细胞的耐药性研究

肿瘤细胞耐药性的存在是临床化疗失败的主要原因之一。本实验在小鼠体内用阿霉素（ADR）诱导艾氏腹水瘤细胞（EHR）的耐药性，探讨细胞产生耐药性的机理。HPLC法测定细胞内药物浓度．结果表明耐药细胞─—EHR/ADR细胞内ADR积聚低于EHR细胞，而对ADR外排快于EHR细胞；异博定（VER）增加EHR／ADR细胞对ADR的摄取并阻滞其外排．而对EHR影响不大，揭示EHR／ADR细胞具有MDR特性。     

Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis

The aim of this study was to determine the efficacy of palliative oxygen for relief of dyspnoea in cancer patients. MEDLINE and EMBASE were searched for randomised controlled trials, comparing oxygen and medical air in cancer patients not qualifying for home oxygen therapy. Abstracts were reviewed and studies were selected using Cochrane methodology. The included studies provided oxygen at rest or during a 6-min walk. The primary outcome was dyspnoea. Standardised mean differences (SMDs) were used to combine scores. Five studies were identified; one was excluded from meta-analysis due to data presentation. Individual patient data were obtained from the authors of the three of the four remaining studies (one each from England, Australia, and the United States). A total of 134 patients were included in the meta-analysis. Oxygen failed to improve dyspnoea in mildly- or non-hypoxaemic cancer patients (SMD=-0.09, 95% confidence interval -0.22 to 0.04; P=0.16). Results were stable to a sensitivity analysis, excluding studies requiring the use of imputed quantities. In this small meta-analysis, oxygen did not provide symptomatic benefit for cancer patients with refractory dyspnoea, who would not normally qualify for home oxygen therapy. Further study of the use of oxygen in this population is warranted given its widespread use.     

邻近腋窝的上皮样血管内皮瘤1例报道

We described a case of a 71-year-old woman with an epithelioid hemangioendothelioma (EHE) in her left axilla,a rare location which hasn't been reported yet. The patient suffered from numbness, pain and decreased muscle strength of her left upper extremity. Sonography revealed a hypoechoic mass surrounded the axillary artery and brachial artery. No obvious capsule was demonstrated. CT showed a soft-tissue mass with some calcifications and peripheral ring-like en-hancement. The MRI indicated a mass with mainly intermediate signal intensity on Tl-weighted imagine and intermediate signal intensity on T2-weighted imagine. The diagnosis was confirmed by histopathologic examination after surgery. There are some correlations of these imaging features with its histopathologic characters.     

GF方案与TP方案一线治疗晚期非小细胞肺癌的临床对照研究

Objective  

The aim of the study was to evaluate the efficacies of initial gemcitabine plus cisplatin (GP) and paclitaxel plus cisplatin (TP) 1st-line chemotherapies for advanced non-small cell lung cancer (NSCLC) and observe their side effects.     

鼻咽癌患者放射性骨坏死引起的正电子显像假阳性结果1例及文献复习

目的:探讨鼻咽癌(NPC)患者放射性骨坏死(osteoradionecrosis,ORN)引起正电子假阳性结果的原因及避免因此引发诊断错误的方法。方法:回顾性分析1例放疗后的鼻咽癌患者,行鼻咽部MRI及正电子显像后,再行组织病理学检查,对三种结果进行分析、比较。结果:MRI及正电子显像均诊断患者颅底区域肿瘤复发,组织病理学结果则显示鼻咽部病灶为放射性骨坏死。因此正电子扫描结果为假阳性结果。结论:鼻咽癌患者放疗后所致的放射性骨坏死容易引起正电子显像假阳性结果并可能引发不必要的治疗,因此NPC患者的正电子图像,对于可能的局限性肿瘤复发诊断,应该非常慎重。     

Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence

Background: Neuropathy is a common adverse effect of bortezomib. Isolated central nervous system (CNS) relapse in MM remains exceedingly rare and carries a dismal prognosis. We present an unusual case of bortezomib related neuropathy masking a CNS relapse of MM. Case presentation: A 57-year-old female was diagnosed with standard-risk MM with clinical and cytogenetic features not typically associated with CNS involvement. She was treated with 4 cycles of bortezomib/cyclophosphamide/dexamethasone (VCD) and achieved a VGPR, after which she underwent an autologous stem cell transplant (ASCT) followed by bortezomib maintenance. Six months after ASCT she developed symptoms suggestive of peripheral neuropathy which was attributed to bortezomib. However the symptoms persisted despite discontinuation of bortezomib. Imaging and cerebrospinal fluid analysis subsequently confirmed a CNS relapse. Discussion: CNS involvement in MM (CNS-MM) is uncommon and is considered an aggressive disease. Recently published literature has reported biomarkers with prognostic potential. However, isolated CNS relapse is even less common; an event which carries a very poor prognosis. Given the heterogeneous neurologic manifestations associated with MM, clinical suspicion may be masked by confounding factors such as bortezomib-based therapy. The disease may further remain incognito if the patient does not exhibit any of the high risk features and biomarkers associated with CNS involvement. Conclusion: In the era of proteasome inhibitor (PtdIns)/immunomodulator (IMID)-based therapy for MM which carries neurologic adverse effects, it is prudent to consider CNS relapse early. This case further highlights the need for more robust biomarkers to predict CNS relapse and use of newer novel agents which demonstrate potential for CNS penetration.