局部晚期不可手术食管癌放射治疗研究进展

目的 探讨局部晚期不可手术食管癌患者行根治性同步放化疗的研究进展。方法 以“locally advanced esophageal cancer、radiotherapy”为英文关键词,“局部晚期食管癌、放疗”为中文关键词在PubMed和中国知网数据库进行检索,检索时间为自建库至2022年10月。共检索到英文文献1 668篇,中文文献138篇。纳入标准：(1)局部晚期食管癌的流行病学、放疗技术和剂量、放疗靶区范围、同步化疗方案以及新辅助放化疗;(2)放疗联合免疫检查点抑制剂在局部晚期食管癌治疗中的研究进展。排除标准：(1)综述类文献及个案报道;(2)重复的临床试验;(3)Ⅰ期临床试验。共纳入文献57篇(中文5篇,英文52篇)。结果 局部晚期不可手术食管癌目前的主要治疗方式仍是根治性同步放化疗。放疗技术首选调强放射治疗(IMRT),放疗靶区采用累及野照射(IFI)。放疗剂量的提高和同步化疗方案的改变并未提高患者的治疗疗效。经过诱导放化疗后降期的患者也可能有手术机会,从而获得更好的生存获益。食管癌免疫治疗的相关临床试验正在进行,免疫治疗的添加有可能带来更好的生存获益。结论 局部晚期不可手术...     

尼妥珠单抗在局部晚期食管癌治疗中的应用进展

局部晚期食管癌(local advanced esophageal carcinoma,LAEC)无法通过手术根治,目前首选的治疗方法是根治性同期化放疗,但远期生存率仍不理想。尼妥珠单抗是一种新型人表皮生长因子受体单克隆抗体,细胞实验证实该药与化、放疗具有协同增效作用,近年来对该药与化、放疗联合治疗局部晚期食管癌的研究逐年增加,本文旨在对尼妥珠单抗治疗局部晚期食管癌的最新进展进行综述。     

食管癌根治性放疗剂量研究进展

同步放化疗是不可手术局部晚期食管癌的标准治疗模式,国际推荐根治性放疗剂量为50.0~50.4Gy,但中国食管癌与西方国家在病理类型、生物学行为等方面大有不同,行根治性放疗剂量仍倾向于60Gy。增加放疗剂量能否带来生存获益成为临床亟待解决的问题。有研究认为高剂量放疗可提高局控率、改善生存,但也有研究认为提高剂量未能带来生存获益,且可增加不良反应事件发生率。因此,本文就食管癌根治性放疗剂量对预后的影响进行探讨,并通过放化疗后疗效评估对放疗剂量做出适当调整,以期达个体化放疗。     

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....     

S-1同步低剂量三维适形放疗治疗局部晚期食管癌的临床观察

目的 观察替吉奥(S-1)同步低剂量三维适形放疗治疗局部晚期食管癌的近期疗效及毒副反应.方法 60例局部晚期食管癌患者随机分为试验组和对照组,试验组32例接受S-1同步低剂量三维适形放疗,而对照组28例仅接受单纯三维适形放疗.结果 试验组、对照组有效率分别为 84.4%、78.6%,比较差异无统计学意义(P>0.05); 试验组、对照组放射性食管炎发生率分别为43.8%、64.3%,放射性肺炎发生率分别为15.6 %、39.3 %,比较差异均有统计学意义(P均<0.05).结论 S-1同步低剂量三维适形放疗治疗局部晚期食管癌是一种安全有效的方法.     

紫杉醇联合奈达铂化疗同步适形调强放疗治疗局部晚期食管癌的疗效

目的：探讨紫杉醇联合奈达铂化疗同步适形调强放疗治疗局部晚期食管癌的疗效。方法选取局部晚期食管癌患者60例,分为2组,对照组30例仅给予单纯调强放疗,观察组30例给予紫杉醇联合奈达铂化疗同步适形调强放疗,比较观察2组的疗效和安全性。结果观察组总有效率为96.7％,明显高于对照组的80.0％,差异有统计学意义（P ﹤0.05）。观察组毒副反应以恶心呕吐和Ⅰ、Ⅱ度骨髓抑制为主,对照组以放射性肺炎、放射性食管炎为主。结论局部晚期食管癌采用紫杉醇联合奈达铂化疗同步适形调强放疗治疗,疗效好,安全性高。     

放化疗联合治疗局部晚期鼻咽癌的临床观察

  目的  在局部晚期鼻咽癌根治性放疗联合紫杉醇、顺铂化疗中, 分析同步治疗与序贯治疗对治疗疗效的影响。  方法  144例局部晚期鼻咽癌病例进行随机分组, 同步治疗组: 放疗联合TP同步化疗; 序贯治疗组: 一疗程TP诱导化疗+根治性放疗+3疗程TP辅助化疗。放疗采用三维适形技术, 化疗采用紫杉醇联合顺铂方案。放疗及化疗方案联合治疗与同步治疗相同。  结果  全部病例至少随访2年, 同步治疗组与序贯治疗组: 局部控制率分别为81.2%与76.3%;远处转移率分别为9.7%与19.4%;2年无瘤生存率分别为76.4%与66.7%。  结论  研究表明局部晚期鼻咽癌接受同步放化疗, 无瘤生存率提高, 远处转移率降低; 不良反应与序贯治疗相比, 主要是放射性黏膜炎发生率和严重程度增加, 但经对症处理, 患者一般都能耐受。      

食管癌综合治疗新进展

食管癌是中国发病率和死亡率均较高的恶性肿瘤,虽然治疗模式多样但总体5年生存率较低。基于手术、放疗、化疗、免疫治疗和靶向治疗的综合治疗方案是目前食管癌的治疗标准。随着食管癌手术术式的革新、放疗靶区及技术的进步、化疗药物和方案的优化以及靶向、免疫治疗的加入,使食管癌患者在不降低生存质量的前提下,获得了更长的生存时间。本文查阅了近期发表的食管癌治疗相关文献,重点回顾了食管癌放疗、免疫治疗等综合治疗相关研究成果并进行汇总,对食管癌围手术治疗、根治性同步放化疗、老年食管癌患者治疗和晚期食管癌免疫治疗的研究进展进行综述。     

雷替曲塞联合奈达铂同步调强放疗治疗局部晚期食管癌的临床疗效

目的探讨雷替曲塞联合奈达铂同步调强放疗治疗局部晚期食管癌的临床疗效。方法将局部晚期食管癌80例根据治疗方法分为采用雷替曲塞联合奈达铂同步调强放疗组(观察组)38例,采用顺铂联合5-FU同步调强放疗治疗组(对照组)42例,比较2组患者实体瘤的疗效指标,比较2组的不良反应。结果观察组CR为57.9%、PR为39.5%、DCR为97.4%,而对照组CR为47.6%、PR为45.2%、DCR为92.9%。观察组的DCR与对照组相比,差异无统计学意义(χ^2=0.731,P=0.621)。2组患者各项不良反应对比差异均无统计学意义(P>0.05)。结论雷替曲塞联合奈达铂同步调强放疗治疗局部晚期食管癌是有效的及安全的临床治疗方案,其临床应用方便,耐受性良好。     

螺旋断层根治性放疗联合同步化疗治疗局部晚期下咽癌疗效分析

目的:评价螺旋断层根治性放疗联合同步化疗和/或抗 EGFR 单克隆抗体治疗局部晚期下咽癌的疗效及不良反应.方法:回顾性分析螺旋断层根治性放疗联合同步化疗和/或抗EGFR单克隆抗体治疗局部晚期下咽癌患者30例.下咽原发病灶及转移淋巴结根治性放疗计划剂量均为70 Gy/33 F、PTV160 Gy/33 F、PTV254 Gy/33 F.结果:47%患者发生了3~4级急性反应,未发生≥3级的晚期反应.30例患者放疗过程中除2例死于原发部位大出血,其余28例患者中位随访时间为15.5(3~41)个月,1和2年的原发病灶控制率、淋巴结控制率、远处转移控制率和生存率分别为63%和35%、84%和61%、89%和81%、8%和50%.全组患者治疗失败11例,原发病灶进展为最常见的失败原因.结论:螺旋断层放疗联合同步化疗和/或抗EGFR单克隆抗体治疗局部晚期下咽癌患者能很好地耐受,临床疗效较好.     

Candidates for larynx preservation: the next step?

Nonsurgical treatment approaches to enable larynx preservation in patients who would otherwise undergo laryngectomy have evolved over recent years. Randomized trials have demonstrated that concurrent chemotherapy and radiotherapy is more effective than doublet cisplatin and 5-fluorouracil (5-FU) (PF)-based induction chemotherapy and radiotherapy in enabling larynx preservation. However, concurrent chemotherapy and radiotherapy is also associated with more toxicities than induction PF followed by radiotherapy. The triplet induction regimen of docetaxel, cisplatin, and 5-FU (TPF) is more effective than PF and is now considered to be the standard induction chemotherapy regimen for future larynx preservation trials. Manipulating the postinduction treatment regimen may help to improve larynx preservation rates, and possibly survival, and the use of concurrent chemoradiotherapy and radiotherapy plus the epidermal growth factor receptor inhibitor cetuximab has been investigated in this setting. Determining the most effective treatment approach for larynx preservation will involve conducting a trial comparing concurrent chemotherapy and radiotherapy with sequential TPF induction chemotherapy followed by either radiotherapy or cetuximab plus radiotherapy. Collaboration among international groups is required to assess which approach would be most beneficial in terms of larynx function preservation, disease control, and survival.     

周剂量紫杉醇同步放疗治疗老年食管癌的临床观察

[摘要]目的观察周剂量紫杉醇同步放疗治疗老年食管癌的近期疗效和安全性。方法86例老年食管癌患者随机分为2组,周剂量紫杉醇同步放疗组（同步组）44例,单纯放疗组（单放组）42例。同步组：紫杉醇75mg·m-2,d1,8,15放疗采用常规分割,照射剂量60～66Gy;单放组：仅接受放疗,方法与同步组相同。结果同步组有效率93．2％,高于单放组的66．7％,比较差异有统计学意义（P〈0．05）。2组主要毒副反应为骨髓抑制、神经毒性、放射性食管炎等,其中同步组Ⅱ-Ⅳ度白细胞减少发生率明显高于单放组（P〈0．05）。结论周剂量紫杉醇同步放疗治疗老年食管癌近期疗效好,毒副反应可耐受。     

选择性动脉插管同步放化疗治疗中晚期鼻咽癌的临床研究

目的:研究选择性动脉插管同步放化疗治疗中晚期鼻咽癌的价值。方法:采用前瞻性随机对照研究,将50例中晚期初治鼻咽癌患者于治疗前用抽签法随机分成两组,25例进行选择性动脉插管同步放化疗(治疗组),25例采用全身静脉化疗联合放疗组(对照组)。两组放疗方法、时间和剂量分割均相同。结果:放疗结束4周评定疗效,治疗组与对照组总缓解率分别为96%(24/25)和68%(17/25),治疗组的凋亡指数和细胞增殖指数数据均高于对照组,两组比较差异有统计学意义,P<0·05。结论:选择性动脉插管同步放化疗治疗中晚期鼻咽癌近期疗效显著,毒副反应轻,是一种安全、有效的治疗方法。     

替吉奥联合同步放疗治疗老年局部晚期鼻咽癌的疗效观察

目的探讨替吉奥联合放疗与单纯放疗治疗老年局部晚期鼻咽癌的疗效和安全性。方法将60例局部晚期鼻咽癌患者（Ⅲ／Ⅳa期）随机分为治疗组（替吉奥＋放疗,30例）和对照组（单纯放疗,30例）,两组患者均接受常规的放射治疗。治疗组从放射治疗的第1天开始,口服替吉奥60mg,每天2次,第1～28天,休息2周。6周为1个疗程,共治疗4周。结果共55例患者可评价客观疗效和毒副反应。治疗组的有效率为81．4％,明显高于对照组的55．6％（P〈0．05）。治疗组的骨髓抑制和胃肠道反应高于对照组（P〈0．05）,治疗组患者放射性皮炎、放射性口腔黏膜炎与对照组比较,差异无统计学意义（P〉0．05）。两组患者的2年无进展生存率分别为88．9％和82．1％,差异无统计学意义（P〉0．05）。结论替吉奥联合常规放疗治疗老年局部晚期鼻咽癌,患者耐受性好,且可提高患者的生存时间,值得进一步研究。     

Attempts to improve organ preservation in patients with squamous cell carcinoma of the head and neck

When surgical resections are performed for patients with locally advanced head and neck cancer, a critical consideration is which organs and functions of patients are sacrificed. In attempts to improve the organ preservation rate in patients with advanced squamous cell carcinoma of the head and neck (SCCHN), chemotherapy has been used either before(neoadjuvant or induction), with (concurrent or concomitant), after (adjuvant) radiotherapy, or as alternating treatment with radiotherapy. A recent systematic review using meta-analysis has revealed that concurrent chemotherapy with radiotherapy shows a significant benefit for the survival rate of patients with SCCHN when compared with radiotherapy alone, and is superior to neoadjuvant chemotherapy. However, no standard concurrent chemoradiotherapy regimen has been defined,although concurrent chemotherapy together with regimens including cisplatin has been considered to be most effective for SCCHN. We combined radiotherapy concurrently with chemotherapy including cisplatin, 5-fluorouracil, methotrexate, and leucovorin in patients with advanced resectable SCC of the hypopharynx to minimize the necessity of radical surgery and preserve the functional larynx. In conclusion, previous reports and our data show that an organ preservation treatment approach using concurrent chemoradiotherapy is feasible.     

Chemoradiotherapy for Squamous Cell Cancer of the Anal Canal: A Systematic Review

Squamous cell cancer of the anal canal is a rare tumour for which there remains uncertainty regarding optimal therapy. A systematic review was conducted to summarise the evidence examining concurrent chemotherapy and radiotherapy or different chemotherapy regimens in combination with radiotherapy. MEDLINE, EMBASE and conference proceedings were searched for relevant randomised controlled trials. Outcomes of interest were colostomy rate, local failure, overall survival, disease-free survival, adverse effects and quality of life. Six randomised controlled trials were identified. Two trials reported lower colostomy and local failure rates for concurrent 5-fluorouracil (5-FU) plus mitomycin C (MMC) and radiotherapy compared with radiotherapy alone. The omission of MMC from this regimen resulted in higher colostomy and local failure rates and lower disease-free survival. Induction chemotherapy followed by concurrent 5-FU plus cisplatin and radiotherapy resulted in a higher colostomy rate than concurrent 5-FU plus MMC and radiotherapy. Haematological toxicity rates were lower in patients who received radiotherapy with 5-FU alone or 5-FU plus cisplatin compared with 5-FU plus MMC. No benefit was seen for the addition of induction or maintenance chemotherapy to concurrent chemoradiotherapy. The available evidence continues to support the use of radiotherapy with concurrent 5-FU and MMC as standard treatment for cancer of the anal canal to decrease colostomy and local failure rates.     

Localized small-cell lung cancer: which type of thoracic radiotherapy and which time schedule

The effect of scheduling combined radio-chemotherapy was studied in randomised trials for limited-disease small-cell lung cancer. The available trials with constant overall treatment time of combination therapy were separated into three classes: (1) same radiotherapy scheme, given early vs. late, (2) split-course radiotherapy, given alternately with chemotherapy, vs. continuous-course radiotherapy given concurrently, (3) radiotherapy, given with altered fractionation and the same concurrent chemotherapy. There was a trend towards a better survival in the group in which early radiotherapy was given concurrently with chemotherapy. A shorter treatment radiotherapy cycle, using hyperfractionated accelerated irradiation during concurrent radio-chemotherapy, was more effective than conventional fractionation, whereas alternating radio-chemotherapy schedules were as effective as concurrent schedules, leaving overall treatment time of radio chemotherapy constant. The data show that scheduling of radiotherapy and chemotherapy is important in the treatment of a fast proliferating tumour such as SCLC. Prolonged overall treatment with sequential radiotherapy and chemotherapy should be avoided. And there is every indication that an early onset of radiotherapy, concurrently applied to chemotherapy, is superior to a late onset [odds ratio of death within 2 years: odds ratio = 0.77 (0.60-0.99)]. There is a need to increase the effectiveness of radiotherapy over conventionally fractionated radiotherapy to 45 Gy, and this can be accomplished by using hyperfractionated accelerated radiotherapy.     

同步放化疗治疗复发性宫颈癌的疗效及安全性

目的探讨同步放化疗与单纯放疗治疗复发性宫颈癌的疗效及安全性。方法将260例复发性宫颈癌患者依据治疗方式不同分为同步放化疗组(150例)和单纯放疗组(110例),单纯放疗组予以放疗,同步放化疗组在单纯放疗组的治疗基础上予以同步化疗。比较两组患者临床疗效、血清肿瘤标志物[鳞状细胞癌相关抗原(SCC-Ag)、癌胚抗原(CEA)、糖类抗原72-4(CA72-4)]水平、不良反应及生存情况。结果同步放化疗组患者治疗有效率为90.00%(135/150),明显高于单纯放疗组的71.82%(79/110),差异有统计学意义(P﹤0.01)。治疗前,两组患者SCC-Ag、CEA及CA72-4水平比较,差异均无统计学意义(P﹥0.05);治疗后,两组患者SCC-Ag、CEA及CA72-4水平均降低(P﹤0.05),且同步放化疗组患者SCC-Ag、CEA及CA72-4水平均明显低于单纯放疗组(P﹤0.01)。两组患者3~4级不良反应总发生率比较,差异无统计学意义(P﹥0.05)。同步放化疗组患者3年生存率及5年生存率均明显高于单纯放疗组,差异均有统计学意义(P﹤0.01)。结论同步放化疗相较于单纯放疗治疗复发性宫颈癌具有更加显著的疗效,可降低血清肿瘤标志物水平,提高生存率,且不会明显增加不良反应。     

放疗联合卡培他滨同期治疗术后直肠癌疗效分析

目的探讨放疗联合卡培他滨同期治疗术后直肠癌的疗效和毒性。方法直肠癌术后患者67例,术后3～4周后先行改良的FOLFOX4方案化疗4次后行盆腔放疗,其中36例行单纯放疗,31例行同期放化疗。同期放化疗者从放疗的第1天开始给予卡培他滨825 mg/m2,2次/天,用至放疗结束。所有患者放疗结束后再用先前的化疗方案化疗4次。结果 67例患者中有66例完成了放疗。中位随访时间为26个月,有7例患者死亡,其中同期放化疗者中4例死亡,单纯放疗者中3例死亡。同期放化疗者中有1例盆腔复发,1例肝转移。单纯放疗者中有1例盆腔复发,2例肝转移和1例肺转移。结论直肠癌术后同期放化疗较单纯放疗有降低远处转移的趋势。