原发性腹膜后脂肪肉瘤的诊断与治疗

目的 探讨原发性腹膜后脂肪肉瘤(primary retroperitoneal liposarcoma,PRPL)诊断与手术治疗情况,分析其影响复发的因素.方法 回顾性分析1995～2010年中山大学附属第一医院收治的23例原发性腹膜后脂肪肉瘤患者的临床病理资料,分析其术后复发情况.结果 PRPL临床表现主要为腹部包块进行性增大、腹胀.所有患者均接受剖腹探查手术治疗.23例患者共进行手术5l例次,首次手术肿瘤肉眼完整切除19例(82.6%),部分切除2例(8.7%),2例仅行术中单纯活检(8.7%),联合脏器切除14例.术后中位复发时间为22.1个月,术后2年复发率达61.9%.患者术后复发与肿瘤大小、联合脏器切除以及手术切缘阳性有关.多次复发者复发间期逐渐缩短.结论 PRPLS首次手术应争取完整切除肿瘤,复发常见,定期复查是诊断术后复发的重要手段,对于复发的病例仍应尽早手术治疗.     

胸腺瘤综合治疗研究进展

胸腺瘤是前纵隔最常见的原发肿瘤,手术切除是其首选治疗方式。胸腺瘤对化疗比较敏感,对于未切除、复发和转移的胸腺瘤,化疗已显示出显著的抗肿瘤活性。术前放疗、化疗或联合使用放化疗,可提高手术切除率,使一些原不可能切除者获得根治或姑息性切除。术后放疗可有效控制肿瘤组织残留,减少术后复发,减缓晚期肿瘤的发展,延长患者的生存期。多种治疗手段综合应用在提高胸腺瘤的疗效中发挥着重要作用。     

胸腺瘤综合治疗研究进展

胸腺瘤是前纵隔最常见的原发肿瘤,手术切除是其首选治疗方式。胸腺瘤对化疗比较敏感,对于未切除、复发和转移的胸腺瘤,化疗已显示出显著的抗肿瘤活性。术前放疗、化疗或联合使用放化疗,可提高手术切除率,使一些原不可能切除者获得根治或姑息性切除。术后放疗可有效控制肿瘤组织残留,减少术后复发,减缓晚期肿瘤的发展,延长患者的生存期。多种治疗手段综合应用在提高胸腺瘤的疗效中发挥着重要作用。     

前路开眶治疗眼眶肿瘤的效果观察

目的 探讨前路开眶治疗眼眶肿瘤的临床疗效.方法 收集接受眶内肿瘤治疗的97例眼眶肿瘤患者的临床资料,分析前路开眶肿瘤切除的治疗效果、术后并发症及患者预后情况.结果 95例眼眶肿瘤患者均完整摘除肿瘤;2例眼眶肿瘤患者的肿瘤与周围组织粘连紧密,为保存视力而行大部分切除术.术中肿瘤位置及粘连情况与影像学检查结果基本一致.术后...     

鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤

目的： 探讨鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤的安全性、临床效果和术式的选择。方法:回顾性分析15例在鼻内镜下行切除手术治疗的侵及眼眶的良性和早期恶性鼻腔鼻窦肿瘤患者的临床资料、手术方法、并发症及治疗预后。结果:全部病例中,11例单纯经鼻内镜下切除肿瘤,4例经鼻腔和鼻外切口双径路手术治疗,其中 1例侵袭性大B细胞淋巴瘤患者术后出现下睑外翻,经治疗后好转;1例鼻腔鼻窦骨瘤患者于鼻内镜下全切骨瘤,术后出现患侧内眦外移;4例良性骨源性病变患者行鼻内镜下病变部分切除术,其余病例均彻底切除肿瘤而无明显并发症,随访6~36月未见复发。结论:鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤有其独特的优势,在鼻内镜下单纯经鼻腔或内镜辅助经鼻腔和鼻外切口双径路手术治疗可以取得比较好的临床预后。     

内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的 研究微创下手术切除鼻腔鼻窦内翻性乳头状瘤的治疗效果。方法 对25例鼻腔鼻窦内翻性乳头状瘤的患者施行鼻内窥镜下手术，术中配合使用电动吸切器切除肿瘤，术后随访12～60个月。结果 全部25例均在鼻内窥镜下一次完整切除肿瘤。25例中2例分别于术后12个月和16个月内复发，其余23例在随访期内未见复发。结论 使用鼻内窥镜微创下行鼻腔鼻窦内翻性乳头状瘤切除不仅对病变局限者有效，对病变广泛侵犯后组筛窦和蝶窦者亦有较好疗效。但对瘤体广泛浸及上颌窦或额窦者宜采用联合径路实施手术。     

内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的　研究微创下手术切除鼻腔鼻窦内翻性乳头状瘤的治疗效果。方法　对 2 5例鼻腔鼻窦内翻性乳头状瘤的患者施行鼻内窥镜下手术 ,术中配合使用电动吸切器切除肿瘤 ,术后随访 12～ 60个月。结果　全部 2 5例均在鼻内窥镜下一次完整切除肿瘤 ,2 5例中 2例分别于术后 12个月和 16个月内复发 ,其余 2 3例在随访期内未见复发。结论　使用鼻内窥镜微创下行鼻腔鼻窦内翻性乳头状瘤切除不仅对病变局限者有效 ,对病变广泛侵犯后组筛窦和蝶窦者亦有较好疗效。但对瘤体广泛浸及上颌窦或额窦者宜采用联合径路实施手术。     

眼眶恶性肿瘤综合治疗的疗效和安全性分析（附88例）

目的:评价88例眼眶恶性肿瘤综合治疗的疗效、生存预后和不良反应。方法:本文回顾性分析了88例于2011年01月至2019年06月在我院就诊的眼眶肿瘤患者的临床资料:88例眼眶肿瘤病灶经手术切除或病理活检后,接受放疗或同期放化疗,通过观察随访患者的生存数据及治疗相关不良反应,评价局部控制率和疗效,计算总生存(overall survival,OS)率、局部无进展生存(localregional progression-free survival,LPFS)率和远处无进展生存(distant progression-free survival,DPFS)率。结果:中位随访时间为39.8个月(范围14~111个月),88例患者眼肿瘤的局部控制率为100.0%,完全缓解(complete response,CR)率为83.0%,部分缓解（partial response,PR)率为17.0%。平均OS为93.8个月,5年OS、LPFS和DPFS率分别为80.5%、80.1%和81.8%。辐射相关早晚期不良反应均为1-2级,患者可耐受,较常见的急性不良反应包括眶周红斑或皮炎（98.9%）和眼眶肿胀感（92.0%）。结论:本回顾性分析显示,眼眶恶性肿瘤经手术联合放疗或同期放化疗的综合治疗后有较为满意的生存数据,患者可耐受相关治疗不良反应。     

肺部肿瘤脉冲式低剂量率IMRT临床剂量学研究

对于复发肿瘤,大部分患者已经接受了前期手术切除、化疗和放疗。在初次治疗后,一旦肿瘤发生复发,患者很可能面临不能再次手术、化疗抗拒和放疗过量的风险^[1]。如何对复发肿瘤患者进行治疗,同时减小治疗不良反应,是我们面临的一项挑战。笔者开展了如何利用IMRT技术开展脉冲式低剂量率放疗的可行性研究。     

术后放疗在完整切除的胸腺肿瘤治疗中的价值

胸腺肿瘤是前纵隔最常见的恶性肿瘤，手术切除是胸腺肿瘤的主要治疗方式，但术后是否需要辅助放疗一直存在争议。对于不能完整切除的肿瘤，术后放疗的作用是肯定的。而对于完整切除的胸腺肿瘤，应根据肿瘤分期以及组织学分型决定是否辅以术后放疗。本文对术后放疗在完整切除的胸腺肿瘤治疗中的应用作一综述。     

Actinomycin D synergistically enhances the efficacy of the BH3 mimetic ABT-737 by downregulating Mcl-1 expression

Many types of cancer cells possess the ability to evade apoptosis, leading to their rapid and uncontrolled proliferation. As major regulators of apoptosis, Bcl-2 proteins serve as emerging targets for novel chemotherapeutic strategies. In this study, we examined the involvement of Bcl-2 proteins in apoptosis induced by the chemotherapeutic agent actinomycin D. A dramatic decrease in anti-apoptotic myeloid leukemia cell differentiation protein (Mcl-1) mRNA and protein expression was detected upon actinomycin D treatment. Further, Mcl-l overexpression caused resistance to cell death upon treatment with actinomycin D, implicating a role for the downregulation of Mcl-1 in actinomycin D-induced apoptosis. We also explored the therapeutic potential of actinomycin D in combination with ABT-737, an experimental agent that inhibits anti-apoptotic Bcl-2 proteins. Actinomycin D sensitized cells to ABT-737 treatment in a Bak- or Bax-dependent manner. Importantly, low concentrations of actinomycin D and ABT-737 were more effective in inducing cell death in transformed cells than their untransformed counterparts. A synergistic effect of actinomycin D and ABT-737 on cell death was observed in several human tumor cell lines. Like actinomycin D treatment, knocking down Mcl-1 expression greatly sensitized tumor cells to ABT-737 and Mcl-1 overexpression abrogated the cytotoxic effect induced by ABT-737 and actinomycin D. These results suggest that the downregulation of Mcl-1 by actinomycin D is likely responsible for the observed synergistic effect between the two drugs. Overall, our studies provide compelling evidence that the combination of actinomycin D and ABT-737 may lead to an effective cancer treatment strategy.Key words: apoptosis, Bcl-2 proteins, Mcl-1, actinomycin D, ABT-737, NSCLC, pancreatic carcinoma     

尼妥珠单抗联合调强放疗及周期化疗治疗局部晚期宫颈癌的临床观察

目的 探讨尼妥珠单抗联合调强放疗及周期化疗在局部晚期宫颈癌的治疗中的临床效果.方法 将80例局部晚期宫颈癌患者分为对照组和观察组.观察组患者43例,行尼妥珠单抗联合调强放疗及周期化疗治疗;对照组患者37例,行调强放疗及周期化疗.比较2组患者的临床有效率、肿瘤体积退缩情况、不良反应发生率以及局部复发和远处转移.结果 在放疗结束后3个月,宫颈癌患者治疗的总有效率观察组和对照组分别为88.4%和70.3%,观察组显著高于对照组(P<0.05);在治疗后2周,观察组患者的肿瘤体积显著小于对照组(P<0.05);在治疗后4周,2组患者肿瘤体积存在显著统计学差异(P<0.05).2组患者在治疗后1年内均有远处转移和局部复发情况发生,其中观察组患者的局部复发和远处转移发生情况显著低于对照组(P<0.05).2组患者不良反应发生情况不存在统计学差异(P>0.05).结论 尼妥珠单抗联合调强放疗及周期化疗能够显著提高局部晚期宫颈癌患者的近期疗效,快速退缩肿瘤体积,降低患者的复发率和远处转移率.     

超声引导下微波消融治疗胃肠神经内分泌肿瘤的应用研究

目的 探讨超声引导下微波消融治疗胃肠内分泌肿瘤的疗效.方法 选取90例胃肠神经内分泌肿瘤,在超声引导下行微波消融治疗,分析其效果,不良反应及并发症,患者的生存情况及影响因素.结果 治疗前超声显示肿瘤内均有血流信号,治疗后血流信号减少或消失(P<0.05);有2例出现发热,5例进针处出现疼痛,对症治疗后消失,不良反应轻微(P<0.05);有40例死亡,50例存活,分化程度、肿瘤数目、肿瘤大小、复发转移均是影响胃肠神经内分泌肿患者生存情况的独立危险因素(P<0.05).结论 在超声引导下微波消融治疗胃肠神经内分泌肿瘤,效果较好,不良反应轻微,患者的生存情况与肿瘤的分化程度、肿瘤的数目、肿瘤大小、复发转移有关.     

直肠癌新辅助放疗研究进展

在过去的近40年里，直肠癌的治疗方案逐渐标准化。大多数早期直肠癌患者仅通过手术即可得到充分的治疗。然而，相当比例的直肠癌患者处于局部进展期，此类患者需要行新辅助治疗。直肠癌的新辅助放射治疗已被证明能有效地降低患者术前肿瘤分期、改善患者生存以及降低直肠癌局部复发率等，随之而来的是患者放疗后出现的不同程度的放疗不良反应，但随着放射治疗规范化、放射治疗技术及设备的改进，放疗不良反应严重程度在逐渐降低。本文就新辅助放疗中的放疗方案的选择、放射治疗技术、放疗不良反应、放疗后的手术时间以及放疗后的观察与等待等问题的最新研究进展进行了系统性的综述，从而为临床直肠癌新辅助治疗提供有力依据。     

吉西他滨膀胱灌注预防高危非肌层浸润性膀胱癌术后复发的疗效观察

目的观察吉西他滨膀胱灌注预防高危非肌层性浸润膀胱癌术后复发的疗效。方法90例高危非肌层浸润性膀胱癌经尿道膀胱肿瘤电切(TURBt)术后患者随机分为两组,每组45例,分别采用吉西他滨(治疗组)和吡柔比星(对照组)膀胱灌注。术后定期行膀胱镜检查,观察两组患者肿瘤复发情况及不良反应。结果治疗组患者随访期间有7例复发,总复发率为15.5%;对照组患者随访期间有16例复发,总复发率为35.5%,两组差异有统计学意义(P<0.05)。治疗组发生不良反应10例,对照组发生不良反应9例,主要为尿频、尿急、尿痛和血尿等,对症治疗后缓解,两组患者均未发生严重不良反应。结论 TURBt术后膀胱灌注吉西他滨预防高危非肌层浸润性膀胱癌术后复发的疗效确切,患者耐受性好,是较理想的膀胱灌注化疗药。     

口服水飞蓟宾胶囊联合吡柔比星膀胱灌注对非肌层浸润性膀胱癌患者术后复发的影响

目的:观察口服水飞蓟宾胶囊联合吡柔比星膀胱灌注对非肌层浸润性膀胱癌患者术后复发的影响。方法:将非肌层浸润性膀胱癌患者124例患者随机分为对照组62例和观察组62例,对照组给予吡柔比星膀胱灌注,观察组给予口服水飞蓟宾胶囊联合吡柔比星膀胱灌注。单因素分析性别、年龄、血尿、吸烟、肿瘤数目、肿瘤大小、肿瘤病理分级、肿瘤分期、水飞蓟宾联合吡柔比星对膀胱肿瘤复发的影响。将单因素分析可能影响肿瘤复发的因素纳入多因素Cox回归分析独立影响肿瘤复发的因素。结果:单因素分析结果提示肿瘤数目、肿瘤大小、肿瘤病理分级、肿瘤分期、水飞蓟宾联合吡柔比星可能是影响膀胱肿瘤复发的因素（P＜0.05）;多因素Cox回归分析显示肿瘤多发、T1是非肌层浸润性膀胱癌的独立危险因素（P＜0.05）,水飞蓟宾联合吡柔比星是非肌层浸润性膀胱癌的独立保护因素（P＜0.01）。结论:口服水飞蓟宾胶囊联合吡柔比星膀胱灌注对非肌层浸润性膀胱癌TUR-BT术后复发的预防效果较好,可减少患者术后早期复发率,且不增加不良反应,较为安全,值得临床推广应用。     

33例膀胱内灌注吡柔比星预防浅表性膀胱癌术后复发疗效观察

目的评价吡柔比星(THP)膀胱内灌注预防浅表性膀胱癌术后复发的近期疗效和不良反应。方法对33例浅表性膀胱癌患者行经尿道膀胱肿瘤电切术(TURBT),术后2周THP30mg膀胱灌注,每周1次,共8次;以后每月1次,共10个月,随访期间内行膀胱镜检查。结果30例可评价疗效,无肿瘤复发28例,复发2例,复发率为6.7%;发生不良反应者12例(40.0%),均为不同程度膀胱刺激症状。结论THP膀胱内灌注预防浅表性膀胱癌术后复发近期疗效满意,不良反应小,耐受性良好。     

Definitive irradiation in multidisciplinary management of localized Ewing sarcoma family of tumors in pediatric patients: outcome and prognostic factors

PURPOSE: To assess the effect of radiation dose on local tumor control of the Ewing sarcoma family of tumors in 79 patients with localized disease treated at a single institution. METHODS AND MATERIALS: Thirty-seven patients received vincristine, actinomycin D, cyclophosphamide, and doxorubicin, and 42 received vincristine, actinomycin D, and cyclophosphamide, with alternating cycles of ifosfamide and etoposide; all underwent definitive radiotherapy (median dose, 37.5 Gy) with either low-dose (<40 Gy) or standard dose (> or =40 Gy) radiation delivered according to the protocol. We calculated the cumulative incidence of local treatment failure, disease recurrence, and overall survival and analyzed the effect of known prognostic factors and radiation dose. RESULTS: The cumulative incidence of local treatment failure at 10 years was 30.4% and that of disease recurrence was 40%. The overall survival rate was 64.5%. Patient age > or =14 years and tumor size > or =8 cm were adverse prognostic factors for local treatment failure; patient age > or =14 years was also associated with worse survival. Although the radiation dose alone did not predict for local treatment failure, the cumulative incidence of local failure at 10 years was 19% when tumors <8 cm were treated with <40 Gy, and no patient treated with standard doses (> or =40 Gy) developed local recurrence (p = 0.084). CONCLUSION: Tumor size and patient age predict for local tumor control in patients with Ewing sarcoma family of tumors treated with systemic therapy and definitive radiotherapy. Patients treated with reduced-dose radiotherapy experienced unacceptably high rates of local recurrence.     

表柔比星联合紫衫醇治疗三阴性乳腺癌的临床观察

目的 探讨表柔比星联合紫衫醇治疗三阴性乳腺癌的临床效果.方法 85例三阴性乳腺癌患者分为对照组(39例)和观察组(46例),对照组以环磷酰胺联合表阿霉素化疗,观察组患者进行表柔比星联合紫杉醇的新辅助化疗法,治疗结束后对两组有效率、治疗前后肿瘤直径大小、叉头框蛋白A1(FOXAl)和乳腺癌易感基因(BRCAl)蛋白表达水平以及术后不良反应发生情况进行统计.结果 治疗后,对照组和观察组的总有效率分别为64.1%和84.9%,观察组有效率显著高于对照组(P<0.05);在治疗后,两肿瘤直径大小、癌细胞中FOXAl和BRCAI蛋白水平较治疗前均显著下降(P<0.05),且观察组显著低于对照组(P<0.05);观察组和治疗组治疗后不良反应发生率分别为13.0%和17.9%,经比较,无显著性差异(P>0.05).结论 表柔比星联合紫杉醇对三阴性乳腺癌的临床治疗效果显著,且对于肿瘤的缩小,FOXAl、BRCAl水平降低等有显著的效果.     

Study protocol of the SACURA trial: a randomized phase III trial of efficacy and safety of UFT as adjuvant chemotherapy for stage II colon cancer

ABSTRACT: BACKGROUND: Adjuvant chemotherapy for stage III colon cancer is internationally accepted as standard treatment with established efficacy, but the usefulness of adjuvant chemotherapy for stage II colon cancer remains controversial. The major Western guidelines recommend adjuvant chemotherapy for "high-risk stage II" cancer, but this is not clearly defined and the efficacy has not been confirmed. METHODS: SACURA trial is a multicenter randomized phase III study which aims to evaluate the superiority of 1-year adjuvant treatment with UFT to observation without any adjuvant treatment after surgery for stage II colon cancer in a large population, and to identify "high-risk factors of recurrence/death" in stage II colon cancer and predictors of efficacy and adverse events of the chemotherapy. Patients aged between 20 and 80 years with curatively resected stage II colon cancer are randomly assigned to a observation group or UFT adjuvant therapy group (UFT at 500-600 mg/day as tegafur in 2 divided doses after meals for 5 days, followed by 2-day rest. This 1-week treatment cycle is repeated for 1 year). The patients are followed up for 5 years until recurrence or death. Treatment delivery and adverse events are entered into a web-based case report form system every 3 months. The target sample size is 2,000 patients. The primary endpoint is disease-free survival, and the secondary endpoints are overall survival, recurrence-free survival, and incidence and severity of adverse events. In an additional translational study, the mRNA expression of 5-FU-related enzymes, microsatellite instability and chromosomal instability, and histopathological factors including tumor budding are assessed to evaluate correlation with recurrences, survivals and adverse events. DISCUSSION: A total of 2,024 patients were enrolled from October 2006 to July 2010. The results of this study will provide important information that help to improve the therapeutic strategy for stage II colon cancer.