同步放化疗治疗局部晚期非小细胞肺癌

目的：探讨同步放化疗治疗不能手术的Ⅲ期非小细胞肺癌的疗效及不良反应。方法：分析1998年1月—2007年12月进行同步放化疗的183例不能手术的Ⅲ期非小细胞肺癌患者的临床资料。全组患者均采用常规放疗,每次2Gy,每周5次。在放疗的第1周及第5周各予依托泊苷联合顺铂方案化疗1个周期。结果：179例患者完成了60～70Gy放疗,2例放疗总量52Gy,1例放疗总量54Gy,1例放疗总量56Gy。全组有效率为76.5%,中位疾病进展时间为10.8个月,中位生存期16.3个月,1、2和3年总生存率分别为63.2%、33.2%和21.3%。治疗失败原因为远处转移68例,局部复发18例,局部复发加远处转移19例。不良反应主要为放射性食管炎、放射性肺炎、骨髓抑制,各例均可耐受。结论：同步放化疗治疗局部晚期非小细胞肺癌具有较好的疗效,不良反应可耐受,治疗失败原因主要为远处转移。     

手术加铂类为基础化疗治疗原发性腹膜癌临床分析

目的：回顾性分析手术加铂类为基础化疗治疗原发性腹膜癌的疗效和预后。方法：对1999年1月-2003年12月在本院治疗的11例原发性腹膜癌患者的临床资料进行回顾性分析。结果：全部病例均施行肿瘤细胞减瘤术，术后予以铂类为基础化疗。11例中位生存期为30个月，二年生存率63．6％，三年生存率45．5％。残余瘤小于1cm的2年生存率为77.8％。血浆CA125均增高，经术后化疗，10例降到正常，肿瘤复发时均又升高。结论：对原发性腹膜癌行肿瘤细胞减瘤术加以铂类为基础的化疗可改善预后，延长生存期。     

舒尼替尼治疗晚期肾细胞癌的临床应用

目的评价舒尼替尼治疗晚期肾细胞癌的疗效和安全性。方法晚期肾细胞癌患者19例,男16例,女3例,中位年龄54（35～70）岁,随访时间2008年8月至2010年8月。原发肾脏病灶手术切除17例,穿刺病理证实2例。肾透明细胞癌17例,肾乳头状细胞癌2例。治疗方案：舒尼替尼50mg,每天1次,4/2方案,治疗4周停2周为1个治疗周期;至少每2个周期行影像学检查以确定疗效。结果随访时间3～22个月,可评价疗效18例,1例因患者经济情况停药。11例患者仍在接受舒尼替尼治疗,1例患者因肿瘤进展停药,6例患者因肿瘤进展死亡。中低危患者14例,中位疾病无进展时间（PFS）18个月,尚未测出中位生存时间。高危患者4例,中位PFS6个月,中位生存时间8.5个月。根据实体瘤评价标准（RECIST）进行疗效评价,共16例患者服药超过2个周期,2个周期评价部分缓解（PR）2例（12.5%）;疾病稳定（SD）14例（87.5%）。共10例患者服药超过4个周期,4个周期PR1例（10.0%）;SD6例（60.0%）;疾病进展3例（30.0%）。常见不良反应包括手足皮肤反应、口腔溃疡、高血压、味觉改变、乏力、白细胞降低和血小板下降等,发生的Ⅲ级不良反应为手足反应2例（11.1%）、呕吐1例（5.5%）、白细胞降低1例（5.5%）、血小板降低1例（5.5%）、浮肿1例（5.5%）。通过对症支持及减量,不良反应可以控制并耐受。结论舒尼替尼治疗晚期肾细胞癌的控制率较高,大部分不良反应患者可耐受,部分严重不良反应需要医疗干预。     

青年胃癌136例临床病理特点及预后观察

目的：分析青年胃癌患者的临床病理特征,探讨影响预后的因素。方法：回顾性分析2000年5月—2005年1月间行胃癌手术治疗的年龄≤45岁的青年患者136例的临床资料。结果：青年人胃癌临床表现以腹上区疼痛不适最常见,占72.1%,男女之比为1∶1.66,肿瘤部位以胃窦部常见,肿瘤分期Ⅲ～Ⅳ期120例,占88.2%;患者原发灶穿透浆膜（T3-4）114例,占全组的83.8%;Borrmann分型以浸润型（Ⅲ型＋Ⅳ型）为主,共110例,占80.9%;全组平均生存期为28.81个月,全组1,3,5年生存率分别为57.3%,25.7%和20.5%。结论：青年胃癌以女性和弥漫型癌所占比例较高,临床分期晚,根治性手术切除率低。TNM分期、手术性质及术后辅助化疗是评价其预后的重要参考因素。     

Small cell carcinoma of the lung: results of combination chemotherapy and radiation therapy

A retrospective study of 244 patients treated for small cell carcinoma of the lung from Jan 1, 1971 to Dec 31, 1976 revealed that 34% of patients, with local-regional disease who received radiation alone survived one year (median survival, seven months), and 53% with local-regional disease survived one year (median survival, 12 months) when treated with combination chemotherapy and radiation. The one-year survival for patients presenting with metastatic disease was 14.5% (median survival, five months) when treated with radiation alone and 50% (median survival, 11 months) when treated with combination chemotherapy and radiation. Although combination chemotherapy and radiation will prlong the disease-free interval in patients with small cell carcinoma of the lung, more than 90% will develop evidence of progressive disease within two years.     

Endoscopic submucosal dissection for residual/local recurrence of early gastric cancer after endoscopic mucosal resection

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection (EMR) is a widely accepted treatment for early gastric cancer; however, incomplete resection with residual local disease and recurrences continues to be a difficult problem. The aim of this study was to evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for residual/local recurrent early gastric cancer lesions after EMR. PATIENTS AND METHODS: The en bloc resection rate, histologically complete resection rate, complications, and local recurrence were assessed in 15 patients who underwent ESD for residual/local recurrent early gastric cancer lesions after EMR. RESULTS: The nonlifting sign after injection of a glycerin solution was positive due to scar formation in all cases. En bloc resection was attempted in all cases, with a complete resection rate of 93.3 % (14 of 15). The lesion was completely resected with histologically adequate margins in the 14 patients who received complete en bloc resection. The average operation time was 85.4 +/- 52.9 min, and the mean follow-up period for all patients was 18.1 +/- 7.4 months. Major bleeding during the procedure in one case was the only complication (one of 15, 6.7 %). None of the patients experienced recurrence of early gastric cancer after ESD. CONCLUSIONS: ESD appears to be a safe and effective treatment for residual/local recurrent early gastric cancer lesions after EMR, and it is useful for histological confirmation of successful treatment.     

肾细胞癌根治术后脑转移的治疗：8例报告并文献回顾

目的分析肾细胞癌根治性切除术后脑转移的临床特点、治疗方式及预后，探讨局部切除的作用及预后影响因素。 方法回顾性分析2005年3月至2019年5月北京大学第一医院神经外科收治的肾细胞癌脑转移患者的临床资料。对患者进行随访，并绘制生存曲线。 结果8例肾细胞癌脑转移患者，男性5例，女性3例，年龄42~70岁，中位年龄63岁。脑转移发生距肾癌根治时间7~103个月，中位时间41个月。8例患者共行9次手术，切除10个颅内转移灶。随访时间为38~204个月，中位随访时间为95个月。8例患者中死亡3例，生存5例。脑转移手术后总生存时间为6~86个月，中位生存时间23个月。 结论肾癌脑转移患者的预后较差，手术局部切除结合放疗能够达到满意的局部控制，并延长患者生存期。     

喉癌单纯放疗失败后行喉部分切除术的预后研究

目的探讨喉癌经单纯放疗后原发灶复发的患者行喉部分切除术治疗的临床疗效和预后影响因素。方法回顾性分析根治性喉癌放疗后原发灶复发的20例喉癌患者行喉部分切除术后的临床资料。结果20例患者的3年总生存率为60.0%;其中15例切缘阴性患者3年总生存率为66.7%;5例切缘阳性患者3年总生存率为40.0%;在15例切缘阴性患者中3例(20.0%)复发,其中2例患者出现口咽部肿瘤,1例患者同时出现肿瘤原位复发和淋巴结转移,患者平均无复发生存率为12个月(5~16个月),2年无瘤生存率为66.7%;术后患者均能发音,并恢复吞咽功能,正常进食,平均拔胃管时间13d(6~50d);除3例局部复发未能拔管,1例因放射性喉水肿拔管困难外,余16例均顺利拔管,拔管率80.0%,平均拔管时间为16d(13~124d)。经过筛选的10例患者,术后UW-QOL生活质量评估显示患者的疼痛、活动能力、娱乐、工作、咀嚼、吞咽、说话交流等方面均有所改善;多因素分析得出原发瘤位置是生活质量的主要影响因素。结论早期喉癌单纯放疗后原发灶复发患者行喉部分切除术可以获得较好的疗效。     

儿童霍奇金淋巴瘤HL-98方案临床报告

目的 获得在规范治疗下我国霍奇金淋巴瘤(HL)患儿的远期预后资料.方法 根据国外发达国家报告设计诊断与治疗方案,根据个体分期、肿瘤大小、有无全身症状分为低、中和高危3组(R1,R2,R3),不同组别治疗强度不同,分别接受4、6、9个疗程短程化疗.根据对治疗的不同反应确定在化疗结束时是否给予15～20 Gy的受累野放疗.对1998年至2008年12月明确诊断的连续病例进行分析.采用Kaplan-Meier法计算全组生存率.结果 研究期间共纳入26例患儿.中位年龄94.5(30～179)个月.男20例,女6例.Ⅰ期3例,Ⅱ期4例,Ⅲ期9例,Ⅳ期10例.26例中24例有原发或转移性颈部淋巴结病变,12例存在纵隔病变,11例有脾脏多发性浸润,5例有B症状.进入R14例,R212例,R3 10例.25例完成所有治疗计划,1例Ⅱ期患儿未行最后1个疗程.,26例患儿中有8例在完成化疗计划时因增强CT提示有残留病灶可能而接受受累野放疗,7例总剂量为20～26 Gy,1例91个月患儿接受36 Gy.随访至2009年6月,26例患儿中有21例(80.76%)持续完全缓解(CCR)中.中位随访时间为31(10～120)个月.5例复发(Ⅲ期1例,Ⅳ期4例).其中1例Ⅲ期患儿颈部原发部位复发、4例Ⅳ期患儿分别为全身、腹腔、胸腔和肝脏复发,平均复发时间为8(5～12)个月.Ⅰ期与Ⅱ期共7例患儿均在CCR中,CCR率为100%;Ⅲ期9例患儿中1例复发,CCR率为89%;Ⅳ期10例患儿中4例复发,CCR率为60%.预计5年总生存率为85.9%,5年无事件生存率为73.7%.有B症状者共5例,其中Ⅲ期1例,Ⅳ期4例,4例Ⅳ期患儿中3例复发.结论 该方案预计5年无事件生存率73.7%,提示方案有合理性;Ⅰ、Ⅱ期患儿无放疗者预后仍良好.     

显微手术后间质化疗联合增敏放疗治疗恶性脑胶质瘤

目的：探讨显微外科手术后间质化疗联合增敏放疗治疗脑胶质瘤的临床疗效。方法：对45例恶性脑胶质瘤患者行开颅显微手术全切除，术中于瘤腔内安置化疗囊，并行化疗药物体外敏感性及放疗增敏作用检测，术后第2，4，8，12周和6个月分别行经皮穿刺注入敏感化疗药物联合增敏放疗。随访6～36个月，并与以前随访的40例接受肉眼下全切后常规放化疗的脑胶质瘤结果相比较。结果：45例患者均获随访，生存期明显延长，6个月内复发4例(8．8％)，死亡3例(6．6％)；1年内复发9例(20．0％)，死亡7例(15．6％)；2年内复发19例(42．2％)，死亡15例(33．3％)；3年内复发25例(55．6％)，死亡22例(48．9％)。未发现明显的不良反应，生存质量得到明显改善。结论：显微外科手术力争全切除，术后敏感药物间质化疗联合增敏放疗，是一种可供选择的治疗人脑恶性胶质瘤安全有效的方法。     

Medulloblastoma--prognostic factors and outcome of treatment: review of the Mayo Clinic experience

From March 1965 through December 1984, 58 patients (35 male and 23 female patients; median age, 17 years) with posterior fossa (PF) medulloblastoma underwent surgical treatment and postoperative radiation therapy at our institution. Radiation fields were the craniospinal axis in 39 patients, PF plus spinal axis in 12, PF in 6, and whole brain in 1. Median radiation doses were 43 Gy (22 to 60 Gy) to the PF and 34 Gy (6.2 to 50 Gy) to the spinal axis. Overall 5- and 10-year survivals were 50% and 33%, respectively; 5- and 10-year relapse-free survivals were 46% and 32%. Treatment failed in 34 patients (59%): in 18 who had irradiation to the craniospinal axis (13 had received 50 Gy or less to the PF) and in 16 who had a radiation field of less than the craniospinal axis. A statistically significant (P less than 0.05) improvement in 10-year survival was associated with the following prognostic variables: PF dose of 50 Gy or more, whole-brain irradiation, and spinal axis irradiation. In comparison with subtotal resection, total resection was correlated with better 10-year relapse-free survival but not overall survival. All five patients with initial treatment failure only in the spine had received a radiation dose of 30 Gy or less to the spinal axis. The 2-year survival after relapse was 46% with salvage chemotherapy or irradiation in 23 patients and 0% in the 11 patients who received no further treatment (P less than 0.01).     

局部晚期头颈部鳞状细胞癌术后同期放化疗的疗效分析

目的观察局部进展期头颈部鳞状细胞癌术后放疗,同期多西他赛联合顺铂方案化疗的疗效,探讨提高术后放疗疗效的方法。方法回顾性分析2008年3月至2011年12月行术后同期放化疗的79例头颈部鳞状细胞癌患者治疗资料,原发灶位于口咽、喉或喉咽,术后有以下高危因素:淋巴结包膜外侵犯;手术切缘阳性;病理学为T4或N2、N3。根据复发风险处方照射剂量,同期多西他赛联合顺铂方案化疗,3周1次。用Kaplan-Meier法分析生存获益及无进展生存率,RTOG毒性标准评价放疗引起的急性与晚期毒性反应,NCI化疗毒性标准评价化疗毒性反应。结果中位随访38个月,全组共9例发生局部区域复发。2年局部区域控制率92%,2年无进展生存率75%,2年总体生存率87%。Ⅲ度或以上治疗相关毒性反应:粒细胞缺乏(59%),黏膜损伤(47%),口干(6%),肌纤维化(10%),吞咽困难(8%)及皮肤损伤(13%),9例患者发生咽瘘,无治疗相关死亡。结论局部进展期头颈部鳞状细胞癌术后放疗,同期多西他赛联合顺铂方案化疗是安全、有效的治疗手段。     

胃癌急性穿孔的诊断与外科治疗

目的：探讨胃癌急性穿孔的诊断和外科治疗。方法：对我院1998年－1999年间45例胃癌急性穿孔患者的临床资料进行回顾性分析。结果：胃癌穿孔多见于高龄，均为进展期溃疡型癌，病理多为低分化或未分化腺癌（37／45例，82．2％），全组45例行单纯穿孔修补20例，姑息性胃癌切除10例，胃癌根治切除15例，3种术式术后并发症发生率分别为30％、10％、13％；术后平均生存时间分别为6．1个月、16个月、26个月，全组2例死亡均为单纯穿孔修补病例。死亡原因为脏器功能衰竭和局部再穿孔。结论：胃癌穿孔常表现为年龄偏大，全身情况差，溃疡及穿孔直径大，邻近器官转移或侵润等，术中应提高对本病的认识和警惕性，应积极手术治疗，尽可能行姑息性或根治性胃癌切除术。     

The value of cytoreductive second-look surgery in advanced epithelial ovarian carcinoma

40 patients with advanced epithelial ovarian carcinoma were investigated to evaluate the influence of further cytoreduction during second-look surgery on survival after termination of first-line polychemotherapy containing cisplatinum. Radical tumorectomy with no macroscopic residual tumor mass was achieved in 27.5% of cases; in 52.5% the residual tumour mass was less than 2 cm and in 20% it was more than 2 cm in diameter after cytoreductive second-look surgery. Median survival time after second-look within these three groups of patients was 15.2 months, 16.9 months and 15.3 months, respectively (Mantel test, p = 0.74). In contrast to the situation at the diagnostic operation, further cytoreduction during second-look surgery has no positive influence on survival. We therefore abandoned this operation in clinically tumour-positive patients.     

电子胃镜活检病理诊断伴幽门螺杆菌感染的胃黏膜上皮内瘤变的分析

目的 评价电子胃镜活检病理诊断伴幽门螺杆菌感染的胃黏膜上皮内瘤变价值.方法 99例电子胃镜活检诊断胃黏膜上皮内瘤变,均有外科手术病理对照,分析影响电子胃镜活检准确性的因素.结果 诊断为胃浸润癌的病例术前电子胃镜活检病理诊断为LGIN与HGIN的比例分别为7.4％（7/94）及68.1％（64/94）,两者有显著差异（P＜0.05）.相符组与不相符组比较,内镜分型Ⅱ型、肿瘤大小＞2 cm、肿瘤高中分化,是诊断准确性降低的因素.轻-中度胃炎,符合率为37.0％（20/54）,重度胃炎,符合率为17.8％（8/45）,两者有显著差异（P＜0.05）.结论 电子胃镜病理活检可以发现绝大部分的胃部病变患者.一次活检不能排除胃癌的可能.电子胃镜活检病理诊断为高级别GIN时,大多数情况下有更重病变的可能,内镜分型Ⅱ型、肿瘤大小＞2 cm、肿瘤高中分化,胃炎越重,胃镜活检与随访及外科手术病理符合率越低,密切随访及外科手术治疗可以弥补电子胃镜活检病理诊断的不足,最大限度地提高 胃部疾病诊断准确性.     

经动脉灌注健择治疗中晚期胰腺癌临床疗效初步观察

目的 回顾性分析经动脉灌注健择（盐酸吉西他滨）治疗中晚期胰腺癌临床疗效。方法 １３例中晚期胰腺癌患者接受动脉灌注健择治疗。治疗后观察肿瘤改善情况及临床受益反应（ＣＢＲ）。结果 ＰＲ１例（７．７％）,ＮＣ３例（２３％）,ＳＤ３例（２３％）,６例无法评价。Ｋａｐｌａｎ－Ｍｅｉｅｒ法计算６个月累积生存率为４６．８８％,频数分布法计算中位生存期为５．５个月,中位进展期为２．６９个月。临床受益率为３０．７６％与文献相比Ｐ〈０．００１）。结论 无论对于初治或化疗无效的病人,动脉灌注健择均显示出良好的临床受益反应;并能有效延长病人的生存时间。     

Combination chemotherapy and radiation therapy of undifferentiated small cell bronchogenic carcinoma

We reviewed 76 cases of small cell bronchogenic carcinoma seen at the University of South Florida Medical Center. One third of the 55 patients who have subsequently died did so within one month of diagnosis. Thirty-five patients were treated with cyclophosphamide, adriamycin, vincristine, and radiation therapy including prophylactic cranial irradiation. Of these 35 patients, 40% demonstrated a complete remission for a total objective response rate of 63%. The projected median survival of patients referred for study is 14 months. Improved survival was found in patients less than 60 years of age, with limited disease, who responded to treatment and in whom there were no violations of protocol. Patients treated with combination therapy appear to survive longer than untreated patients and those treated with radiation therapy alone. Toxicity was tolerable and there were no deaths related to treatment. Small cell bronchogenic carcinoma is a rapidly progressive systemic disease responsive to multimodality therapy with long-term survival in some patients.     

257例Ⅱa期直肠癌根治术后不同治疗方法的疗效比较

【目的】分析比较Ⅱa期直肠癌不同治疗方法的临床疗效。【方法】257例患者全部行直肠癌根治术。单纯手术78例;术后行化疗66例,采用5-Fu／LF、DDP＋5-Fu／LF或L-OHP＋5-Fu／LF方案、化疗2周期以上;术后放疗54例,照射剂量45～50Gy／5～5．5周;术后放化疗59例,术后放疗在化疗2周期后进行。【结果】各组1、3、5年生存率及远处转移率均无明显差别（P〉0．05）,但术后放疗组与术后放化疗组的局部复发率下降（P〈0．05）。各组治疗不良反应均可耐受。【结论】Ⅱa期直肠癌术后放疗及术后放化疗能降低局部复发率,但对患者生存率无明显影响。     

Noninvasive ventilation in patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease who refused endotracheal intubation

OBJECTIVE: To determine the long-term outcome of noninvasive ventilation in chronic obstructive pulmonary disease patients who refused intubation for acute hypercapnic respiratory failure. DESIGN: Prospective, observational study. SETTING: Noninvasive ventilation unit in an acute regional hospital in Hong Kong. METHODS: The study recruited 37 chronic obstructive pulmonary disease patients who had the do-not-intubate code and developed acute hypercapnic respiratory failure. They were offered noninvasive ventilation, and their long-term outcomes were followed. Survival and event-free survival (an event is death or recurrent acute hypercapnic respiratory failure) were analyzed by survival analysis. Their disease profile and outcome were compared with another 43 chronic obstructive pulmonary disease patients without the do-not-intubate codes, who had acute hypercapnic respiratory failure and received noninvasive ventilation during the study period (usual care group). RESULTS: Patients in the do-not-intubate group were significantly older (p =.029), had worse dyspnea score (p <.001), worse Katz Activities of Daily Living score (p <.001), worse comorbidity score (p =.024), worse Acute Physiology and Chronic Health Evaluation II score (p =.032), lower hemoglobin (p =.001), and longer stay in the hospital during the past year (p =.001) than patients who received usual care. In the do-not-intubate group, the median survival was 179 days, and 1-yr actuarial survival was 29.7%; in the usual care group, the median survival was not reached during follow-up, and 1-yr actuarial survival was 65.1% (p <.0001). In the do-not-intubate group, the median event-free survival was 102 days, and 1-yr event-free survival was 16.2%; in the usual care group, median event-free survival was 292 days, and 1-yr event-free survival was 46.5% (p =.0004). CONCLUSIONS: A 1-yr survival of about 30% was recorded in chronic obstructive pulmonary disease patients with the do-not-intubate code who developed acute hypercapnic respiratory failure requiring noninvasive ventilation. The majority of survivors developed another life-threatening event in the following year. Information generated from this study is important to physicians and chronic obstructive pulmonary disease patients when they are considering using noninvasive ventilation as a last resort.     

Adjuvant PSK immunotherapy in patients with carcinoma of the nasopharynx

A controlled study using adjuvant PSK immunotherapy in patients with nasopharyngeal carcinoma was initiated with the aim of improving survival by enhancing the host immune system against tumour cells. A total of 38 patients were randomly selected, all of whom had previously received radiotherapy with or without chemotherapy. Eight patients in the PSK immunotherapy group (n = 21) developed local recurrence, three of whom later died due to distant metastasis. In the control group (n = 17) three patients developed local recurrence while six patients developed distant metastasis. All of these six patients later died due to disease progression. It seems that PSK exerts its antitumour effect systemically; the risk of distant metastasis occurring is decreased, but it is apparently ineffective in improving local disease control. The estimated median survival time of the PSK-treated group compared with the control was significantly increased (35 months versus 25 months, P = 0.043). The 5-year survival rate was also significantly better in the PSK immunotherapy group (28% versus 15%, P = 0.043). It is concluded that PSK deserves careful consideration as an important immunotherapeutic agent in the management of nasopharyngeal carcinoma.