综合治疗宫颈癌106例临床分析

[目的]对中晚期子宫颈癌综合治疗的疗效进行观察。[方法]106例中晚期子宫颈癌病人，分为两组，一组78例，采用腹壁下动脉插管区域化疗2-3个疗程后，行广泛或次广泛子宫切除，二组28例，在区域化疗的同时加^192铱腔内放射治疗，然后行手术治疗，[结果]一组病人的5年存活率高于国内报道；区域化疗对淋巴结转移有治疗作用；二组病人的疗效明显高于一组。[结论]采用腹壁下动脉插管行区域性化疗结合腔内放疗再行手术治疗中晚期子宫颈癌较好的治疗方法，腹壁下动脉插管化疗具有技术条件低，费用低，方法简单等优点，适于基层医院开展。     

87例Ⅱb期宫颈癌的手术治疗综合放疗和化疗

目的　研究宫颈癌Ⅱｂ 期患者手术治疗综合放疗和化疗的疗效。　方法　１９８９ 年５ 月～１９９４ 年６ 月,①手术综合放疗和化疗治疗组（Ａ 组） ：宫颈癌Ⅱｂ 期患者８７ 例,术前局部放疗或全身化疗或放、化疗结合放疗后手术（ 广泛切除全子宫加盆腔淋巴清扫） ,术后少数病人辅以盆腔照射。②单纯放疗组（Ｂ组） ：同期患者２６８ 例,给予根治性放疗。按不同治疗时间,分两个阶段统计三年、五年生存率。　结果　Ａ 组、Ｂ 组的三年生存率分别为８９５８ ％ 、９０８４％ ,五年生存率分别为８２０５ ％ 、８０９５％ 。Ａ组死于盆腔复发占死亡人数４１６６ ％ ,Ｂ 组为６７５７ ％ 。死于远处转移者两组基本相似。Ａ 组术中及术后并发症基本可以治愈,而Ｂ组放射性直肠炎占２０１５ ％ ,放射性膀胱炎占５２２％ ,直肠及膀胱阴道瘘占２２３％ 。　结论　两组生存率相似,但综合手术治疗可降低盆腔复发,避免病人因根治性放疗所造成的痛苦。为提高病人的生存质量,综合性手术治疗对Ⅱｂ 患者是一种可取的治疗方法。     

术前配合放化疗治疗宫颈癌100例临床分析

目的:观察术前腔内后装配合VBP化疗方案治疗宫颈癌的疗效及毒副反应.方法:1996年～1998年1月住院宫颈癌患者100例,随机分为放化疗组50例(术前腔内放疗配合化疗),对照组50例(术前单纯腔内放疗),分析两组近期有效率、毒副反应及3、5、7年生存率.结果:放化疗组的近期有效率86%,对照组76%,(P＜0.05)有显著性差异.放化疗组3、5、7年生存率分别为98%、94%、86%,对照组为94%、76%、58%.两组比较3年生存率无明显差异(P＞0.05),5、7年生存率有显著差异(P＜0.05).研究组3、5、7年复发率分别为0%、5%、11%,对照组3、5、7年复发率分别为16%、24%、40%.两组比较3、5、7年复发转移率均有显著差异(P＜0.05).结论:宫颈癌术前放疗配合化疗、明显提高有效率及生存率,降低局部复发与转移.     

术前配合放化疗治疗宫颈癌100例临床分析

目的:观察术前腔内后装配合VBP化疗方案治疗宫颈癌的疗效及毒副反应。方法:1996年~1998年1月住院宫颈癌患者100例,随机分为放化疗组50例(术前腔内放疗配合化疗),对照组50例(术前单纯腔内放疗),分析两组近期有效率、毒副反应及3、5、7年生存率。结果:放化疗组的近期有效率86%,对照组76%,(P<0.05)有显著性差异。放化疗组3、5、7年生存率分别为98%、94%、86%,对照组为94%、76%、58%。两组比较3年生存率无明显差异(P>0.05),5、7年生存率有显著差异(P<0.05)。研究组3、5、7年复发率分别为0%、5%、11%,对照组3、5、7年复发率分别为16%、24%、40%。两组比较3、5、7年复发转移率均有显著差异(P<0.05)。结论:宫颈癌术前放疗配合化疗、明显提高有效率及生存率,降低局部复发与转移。     

宫颈癌术前放疗37例报道

目的探讨Ⅰb~Ⅱb期宫颈癌术前放疗的优势及放疗后的手术适应症。方法37例Ⅰb~Ⅱb期宫颈癌接受术前放疗后行广泛性子宫切除加盆腔淋巴结清扫术。结果全组病人均能如期按手术规范完成手术,术中未发生不可控制的大出血,无输尿管、膀胱、直肠等损伤发生。术后常见并发症发生率低。结论Ⅰb~Ⅱb期宫颈癌经术前放疗,降低了手术难度,并使Ⅱb期病人具有手术机会,且不增加术中术后并发症的发生。     

有关宫颈癌术后淋巴结转移的探讨

宫颈癌根治术的成功与否,术后盆腔淋巴结有无转移是关键所在。这一点已被越来越多的学者所承认。如能在术前对疾病存在的形态学,组织学特征加以分析,明确可能导致淋巴结转移的潜在因素,从而制定切实可行的治疗     

43例Ⅱb期宫颈癌术前放疗疗效分析

目的　探讨Ⅱb期宫颈癌经术前放疗的治疗效果。方法　 1993年 1月～ 2 0 0 1年 3月 ,43例Ⅱb期宫颈癌均接受术前放疗 ,放疗剂量DT3 6～ 40Gy ,休息 14d～ 2 0d后行宫颈癌根治术。结果　 3年、5年生存率分别为 77 6%、62 4% ,3年内复发率为 15 3 %。结论　对部分Ⅱb期宫颈癌患者 ,经术前放射治疗后 ,有手术适应症 ,行广泛性全子宫切除术加盆腔淋巴结清扫术 ,可提高生存率 ,同时避免单纯放射治疗引起的并发症     

放疗联合化疗治疗晚期宫颈癌的临床观察

目的:观察放化疗同步治疗晚期宫颈癌的近期疗效及急性不良反应.方法:初次治疗的Ⅲb期宫颈癌患者60例,随机分为单放组和放化组各30例.放疗采用加速器体外照射+192Ir腔内后装治疗,体外剂量50Gy/25f/5w(36Gy时中央挡铅),腔内照射A点总剂量42Gy/6f.化疗方案,顺铂20-30mg/m2,静脉滴注,第1-4天,5-FU 500mg/m2,d1-5,静脉滴注,共2周期.结果:单放组CR 40.0%,PR 23.3%;放化同步组CR 67.7%,PR 23.3%(P<0.05).两组总有效率单放组63.3%,放化组90.0%(P<0.05).放化疗期间的不良反应,单放组骨髓抑制和胃肠道反应都较轻,而放化同步组较单放组重.结论:放化疗联合应用能提高晚期宫颈癌局部控制率,同时放化疗的不良反应也有增加,但患者均能耐受.     

放疗同时化疗治疗晚期宫颈癌的临床观察

目的观察放化同步治疗晚期宫颈癌的近期疗效及急性毒副反应。方法初次治疗的Ⅲb期宫颈癌患者50例,随机分为单放组和放化组各25例。放疗采用加速器体外照射 192Ir腔内后装治疗,体外剂量50Gy/25f/5w(30Gy时中央挡铅),腔内照射A点总剂量42Gy/6f。化疗方案PDD30mg,d1~d4,静滴,5-FU750mg,d1~d5,静滴,共2周期。结果单放组CR为40.0%,PR为24.0%;放化同步组CR为68.0%,PR为24.0%(P<0.05)。两组总有效率单放组68.0%,放化组92.0%(P<0.05)。放化疗期间的不良反应,单放组骨髓抑制和胃肠道反应都较轻,而放化同步组较单放组重。结论放化疗联合应用能提高晚期宫颈癌局部控制率,同时放化疗的急性反应也有增加,但这些反应是可逆的,而且对骨髓无严重毒性反应,患者均能耐受。     

宫颈癌热放化随机分组治疗

采用随机分组法将120例宫颈癌病人分为单纯放疗组（A）、热放疗组（B）、放化疗组（C）、热放化疗组（D）；治疗结束时评价近期疗效，结果表明：热放化疗组（D）疗效优于单纯放疗组（A）、热放疗组（B）及放化疗组（C），其它三组疗效相似。     

The type of metastasis is a prognostic factor in disseminated cervical cancer

Objective

The objectives of this study were twofold: to verify whether the type of metastasis (lymphatic vs. hematogenous) is a prognostic factor, and to identify molecular markers associated with survival in patients with disseminated cervical cancer.

Methods

Between April 1997 and May 2008, 30 patients with disseminated cervical cancer who had supraclavicular lymph node (N=13) or hematogenous metastases (N=17) were initially treated at our institute. We reviewed medical records to extract clinicopathologic variables. For 17 patients with available pathological specimens, we evaluated the association of immunohistochemical staining for metalloproteinase (MMP)-2, vascular endothelial growth factor (VEGF)-A, and laminin V gamma (LAMC)-2 with survival and clinicopathologic variables via a log-rank test and Cox regression analysis.

Results

Patients who had only lymphatic metastasis (odds ratio [OR], 5.3; 95% confidence interval [CI], 1.4 to 19.5) or completed initial treatment (OR, 3.2; 95% CI, 1.1 to 9.9) showed better survival than patients who did not, but none of the molecular markers were associated with survival. Out of 13 patients with only lymphatic metastasis, three patients who had received volume-directed radiation with concurrent chemotherapy had a long-term survival of over two years. However, patients with hematogenous metastasis showed extremely poor prognosis.

Conclusion

The type of metastasis and completion of initial treatment were associated with prolonged survival in patients with disseminated cervical cancer, and over 20% of patients with lymphatic metastasis were salvaged with volume-directed radiation with concurrent chemotherapy. None of the molecular markers were associated with survival in patients with disseminated cervical cancer.     

Detection of Apoptosis and Expression of Apoptosis-associated Proteins as Early Predictors of Prognosis after Irradiation Therapy in Stage IIIb Uterine Cervical Cancer

We investigated the proportion of apoptotic cells and the expression of apoptosis-associated proteins after the delivery of the first week of irradiation for stage IIIb uterine cervical cancer. Thirty patients with stage IIIb squamous cell carcinoma of the uterine cervix who received only irradiation therapy were registered in this study. Specimens were obtained before irradiation therapy and at the end of the first week of irradiation. The apoptotic index (AI) of each tissue specimen was calculated by counting the apoptotic cells and expressed as a percentage. Immunohistochemical evaluation for apoptosis-related proteins, p53, Bcl-2, Bax, caspase-1 and caspase-3 was also performed. The AI was 0.8±0.9% (mean±SD) before irradiation and 1.7±1.3% at the end of the first week of irradiation. We observed that the patients who survived more than 5 years had AI levels of 2.1±1.3% at the end of their first week of therapy. This rate was significantly higher than the rate of 1.1±0.8% ( P =0.02) of the patients who died within 5 years. When the cut-off value of the AI was set at 1.7%, the sensitivity, specificity, positive predictive value, and negative predictive value for the prediction of patients' prognosis after irradiation therapy were 73.4%, 72.4%, 82.4%, and 61.5%, respectively. In 17 of the AI-positive cases, expressions of Bax ( P =0.006), caspase-1 ( P =0.045), and caspase-3 ( P =0.013) at the end of the first week were significantly higher than before irradiation. The proportion of apoptotic cells and the expression of apoptosis-associated proteins, Bax, caspase-1, and caspase-3, at the end of the first week of irradiation could be useful predictors of the prognosis in stage IIIb squamous cell carcinoma of the uterine cervix treated by irradiation therapy.     

Cervix Cancer in Tunisia: Clinical and Pathological Study

Introduction: Uterine cervix cancer is the second most commonly diagnosed cancer among women worldwide.Design: In order to review the clinical and pathological features of cervix cancer in the center of Tunisia, aretrospective study was carried out on 410 cancer cases diagnosed in the Pathology Department, Farhet HachedUniversity Hospital, Sousse, Tunisia (1993-2006). Results: The mean age was 52.1 years. Of the 410 patients,90.5% had squamous cell carcinoma and 7.3% had adenocarcinoma. One hundred thirty-eight patients wereidentified as being in early stages (0 and I) (33.6%) and 58.2% in advanced stages (II-IV). Therapy consistedmainly in combination of radiotherapy and surgery in early stages (28.8%), and radiotherapy alone or associatedwith the chemotherapy in advanced stage (29.7%). Surgery was the only treatment in 29.5% of cases. Conclusion:A relatively large proportion of patients presented in stages II to IV, compared to only 36% with early stages,emphasizing the need to reinforce the early detection of this cancer and its precursor lesions in the center ofTunisia.     

Line-1 Hypomethylation in Multistage Carcinogenesis of the Uterine Cervix

Objective: To evaluate characteristics of global hypomethylation in evolution of cervical cancer. Materialsand Methods: Eight cases of squamous cell carcinoma (SCC) and seven cases of carcinoma in situ (CIS) werestudied. Each of the SCC samples contained CIS, and all SCC and CIS samples contained normal ectocervicalepithelium. Microdissection was performed to separate normal epithelium, CIS and SCC prior to DNA extraction.Hypomethylation levels of long interspersed nuclear elements (LINE-1 or L1) were measured with a combinedbisulfite restriction analysis (COBRA) PCR (polymerase chain reaction) protocol. The percentage of L1hypomethylation for SCC, CIS and normal epithelium was compared. Results: In the SCC cohort, the L1hypomethylation level showed progressive increase comparing normal epithelium (59.4 ± 8.86%) to CIS (64.37± 7.32%) and SCC (66.3 ± 7.26%) (repeated measurement ANOVA, P = 0.005). A significantly greater L1hypomethylation level was found in CIS (62.06 ± 3.44 %) compared to normal epithelium (60.03 ± 3.69 %)(paired t-Test, P = 0.03). No significant difference in L1 hypomethylation level was noted between CIS of the twosample groups (unpaired t-Test, P = 0.2). Conclusions: In our study, there was a significant correlation betweenthe degree of hypomethylation and progression from normal ectocervical mucosa to CIS and invasive cancer.Laboratory assessment of biopsies for this molecular event may have clinical significance.     

肝细胞生长因子及C-Met的表达与宫颈癌浸润和转移的关系

目的：研究肝细胞生长因子（HGF）及其受体C—Met在宫颈癌组织中的表达．探讨二者与宫颈癌浸润和转移的关系。方法：采用RT—PCR检测36例宫颈癌组织手术标本及31例正常宫颈组织标本中HGF mRNA和C—Met mRNA的表达，并进行相对定量研究。结果：宫颈癌组织中C—Met的阳性表达率显著高于正常宫颈组织：宫颈癌组织中，淋巴结转移组C—Met的表达水平高于未转移组；临床分期Ⅱ期组的表达水平高于IB期组；中、低分化组的表达水平高于高分化组。结论：宫颈癌组织中存在C—Met的高表达．肿瘤细胞丰富的C—Met受体可能是通过与旁分泌途径获得的HGF结合而在宫颈癌浸润和转移的过程中发挥重要作用。     

子宫颈癌综合治疗后腹主动脉旁合并或不合并锁骨上淋巴结转移的临床分析

 【摘要】　目的　分析子宫颈癌综合治疗后出现腹主动脉旁合并或不合并锁骨上淋巴结转移的临床特征、治疗和预后。方法　对20例出现腹主动脉旁合并或不合并锁骨上淋巴结转移的子宫颈癌患者的临床资料进行回顾性分析。结果　20例患者初诊时均行以下一项或二项检查：磁共振成像（MRI）、计算机层析成像（CT）、单光子发射型计算机断层显像（SPECT）,未发现远处淋巴结转移。在手术、放化疗等综合治疗后,于观察期2年内,最短2个月开始出现转移,其中1例黏液腺癌为治疗中进展,开始治疗到死亡时间为6个月。15例为单纯腹主动脉旁淋巴结转移,其中4例为腹主动脉旁淋巴结放疗后3～6个月又出现左锁骨上淋巴结转移。4例为腹主动脉旁及左锁骨上淋巴结同时发现转移。20例病例中,复发放弃治疗的7例均在2年内死亡,中位生存时间为7.50个月;复发有治疗的13例,中位生存时间18.98个月,两者差异有统计学意义（χ2＝7.23,P＜0.01）。结论　子宫颈癌综合治疗后出现腹主动脉旁合并或不合并锁骨上淋巴结转移患者经再治疗可明显延长生存期,有积极治疗意义。     

肝癌多学科联合治疗对疗效的影响

肝癌是我国常见的恶性肿瘤之一,治疗效果欠佳。目前治疗方案仍是以手术为主的综合治疗,多学科联合治疗是近年来肝癌治疗的主要模式。随着越来越多的新技术、新方法应用于临床,肝癌患者的预后得到了明显改善。本文就如何根据肝癌患者的不同情况及不同肝癌类型,选择最优的个体化联合治疗方案以提高疗效作一阐述。     

子宫颈癌的高剂量率后装腔内治疗

我院自1983年1月到1986年12月应用天津Ⅰ型高剂量率~(60)钴遥控后装腔内治疗机照射和体外照射治疗子宫颈癌216例。Ⅱ期病人腔内治疗35～40Gy,宫旁外照射常规分割45Gy;Ⅲ期病人先全盆照射30Gy,然后腔内25Gy,再给宫旁外照射25～30Gy。Ⅰ期大菜花型直径大于5cm时,增加阴道插管治疗,使A点最终增加剂量5～15Gy。Ⅱ期病人1983年治疗患者5年存活率为73.9％,1984年3年存活率为73.3％;Ⅲ期病人1983年5年存活率为58.3％,1984年者3年存活率为65.3％。1983年者5年随访放射反应,便血为16.6％,血尿为4.2％,比手工镭疗及后装镭疗要少。我们认为采用A点剂量率在0.5Gy/分,每周2次,每次A点剂量在5Gy为宜,井注意个别化治疗。