小细胞肺癌术后辅助化疗的远期结果分析(附65例报告)

分析小细胞肺癌术后辅助化疗的远期结果。方法搜集１９８３年至１９９４年采用手术加术后辅助化疗的小细胞肺癌６５例，其中行脑预防照射２２例。结果在６４例可统计１年以上生存率的病人中，１，３和５年生存率分别为８７．５％、５３．２％和３６．３％，根治性手术加辅助化疗的１，３和５年生存率达９２．５％、５８．５％和４３．８％。Ⅰ与Ⅱ期、Ⅰ与ⅢＡ期的３年生存率相比，差异有显著性（Ｐ＜０．０３）；Ｎ０与Ｎ１期的３年生存率相比，差异有显著性（Ｐ＜０．０２１）；术后２～３与４～６周期化疗相比，１年生存率差异有显著性（Ｐ＜０．００７）。结论对Ⅰ、Ⅱ期和Ｎ０、Ｎ１病人，手术与术后化、放疗综合治疗是最佳选择；而对ⅢＡ或Ｎ２期病变，应首选化疗，先行手术不能改善生存率和生存期     

睾丸精原细胞瘤放疗分析

我们对我院１９７６年６月～１９８８年１２月收治的９６例睾丸精原细胞瘤病例作了回顾性分析。本组病例的３、５、１０年生存率分别为，Ⅰ期９２．４％、９１．０％、８８．８％，Ⅱ期６３．６％、５９０％、５５０％，Ⅲ期３７．５％、１２．５％、０。复发或转移病例经再程治疗，５年生存率为３５．７％。放疗剂量应在２６一３５Ｇｙ，对Ⅱ、Ⅲ期病人可同时加用化疗。高龄组生存率明显高于低龄组。病人死因以肺及纵隔淋巴结转移为主。     

Ⅲ期乳腺癌的新辅助化疗

报告Ⅲ期乳腺癌经新辅助化疗后的治疗结果。从１９８４年１月～１９８９年１月，应用新辅助化疗的方法治疗Ⅲ期乳腺癌３０例．其５年生存率为７３．４％，非新辅助化疗的Ⅲ期乳腺癌患者的５年存活率为４０．０％。临床观察发现术前化疗后原发肿瘤明显变小。光镜下见肿瘤组织明显坏死，炎细胞浸润，肿瘤区域内见血管内皮增生、管壁增厚、透明变性和管腔闭塞．癌巢间胶原纤维增生及纤维化改变。提示：应用新辅助化疗治疗Ⅲ期乳腺癌能够改善病人的预后。     

腹腔隐睾精原细胞瘤的临床特征、分期和治疗探讨

我院１９５８年６月至１９９１年１２月收治６８例腹腔隐睾精原细胞瘤，占睾丸精原细胞瘤的１４％。６０例根据本院提出的分期标准进行分期，Ⅰ期３４例，ⅡＡ期６例，ⅢＢ期１１例，Ⅲ期５例，Ⅳ期４例。８例外院治疗后复发的病人未分期。放射治疗是主要治疗手段，少数合并或单用Ｎ－甲基溶肉瘤素化疗。全组５年、１０年生存率分别为８９．１％和８３．２％。Ⅰ期和ⅡＡ期５年、１０年生存率为１００％，ⅡＢ期分别为９０％和７７．１％，Ⅲ、Ⅳ期为５１．８％和３８．９％。原发灶大小、外侵程度、手术是否切净和预后无关。临床分期是影响预后的重要因素，各分期间生存率有显著差别。Ⅰ期和ⅡＡ期建议作腹主动脉、同侧髂血管淋巴引流区和原发肿瘤床照射，不必全腹照射。Ⅲ、Ⅳ期应以联合化疗为主。     

放疗对局限期和广泛期小细胞肺癌化疗疗效的影响

目的：探讨放疗对局限期和广泛期小细胞肺癌化疗疗效的影响。方法 用寿命表法和Ｌｏｇ－Ｒａｒｋ法分析比较６１例化疗加入疗（化放组）和同期４６例单纯化疗（单化组）小细胞肺癌的生存率。结果：比放组病人１，３，５年生存率分别为７０．５％，２５．４％和１２．９％，而单化组分别为４０．７％，２．６％和２．６％，两组比较有显著差异（Ｐ〈０．０１），在局限期病人中，化放组１－５年生存率明显高于单化组（Ｐ〈０．０２５     

探讨Ⅰ，Ⅱ期非霍奇金淋巴瘤的综合治疗

目的探讨Ⅰ，Ⅱ期非霍奇金淋巴瘤（ｎｏｎ－Ｈｏｄｇｋｉｎ＇ｓｌｙｍｐｈｏｍａ，ＮＨＬ）综合治疗的有效方法。材料与方法１９８７年１月～１９８９年１２月收治ＮＨＬ１５２例，分别采用单纯放疗、放疗＋化疗、化疗＋放疗＋化疗、化疗＋放疗和单纯化疗治疗。结果Ⅰ期ＮＨＬ分别采用单纯放疗和放、化综合治疗者，其３，５，７年生存率与复发率相近。而Ⅰ期仅有结内受累者，其３，５，７年生存率单纯放疗组分别为１００．０％，１００．０％，８８．９％，放、化综合治疗组分别为８８．２％，８２．４％，５２．９％，单放组生存率较高，而复发率两组相近；Ⅱ期ＮＨＬ，放、化综合治疗组３，５，７年生存率较单纯放疗组稍高，复发率两组相近，其中高度恶性病例，化疗＋放疗＋化疗组３，５，７年生存率分别为７３．３％，７３．３％，６０．０％，较放疗＋化疗、化疗＋放疗组均高，而复发率较低。结论（１）Ⅰ期ＮＨＬ仅有结内受累者可考虑用单纯放疗。（２）Ⅱ期高度恶性ＮＨＬ推荐化疗＋放疗＋化疗方法。     

非小细胞肺癌术后辅助化疗随机研究

目的评价非小细胞肺癌（ＮＳＣＬＣ）根治术后辅助化疗疗效。方法７０例Ⅰ～Ⅲ期ＮＳＣＬＣ患者在根治术后被随机分为两组。一组为辅助化疗组,于手术后３～４周开始接受辅助化疗：环磷酰胺３００ｍｇ／ｍ２;长春新碱１．４ｇ／ｍ２;阿霉素５０ｍｇ／ｍ２,第１天;顺铂２０ｍｇ／ｍ２,第１～５天;环己亚硝脲５０ｍｇ／ｍ２,第１天（ＣＯＡＰＣ方案）。每４～６周重复疗程,共４疗程。此后开始口服喃氟啶２００～３００ｍｇ,每天３次,连用１年或至肿瘤复发止。另一组为单纯手术组。结果辅助化疗组和手术组总的（Ⅰ～Ⅲ期）５年生存率分别为４８．６％和３１．４％,差异无显著性（Ｐ＞０．０５）;Ⅲ期病例的５年生存率分别为４４．０％和２０．８％,差异有显著性（Ｐ＜０．０２５）。Ⅰ～Ⅱ期病例分别为６０．０％和５４．５％（Ｐ＞０．７５）。结论ＮＳＣＬＣ根治术后辅助化疗,其５年生存率有一定提高,其中Ⅲ期病例的５年生存率,辅助化疗组优于单纯手术组。     

术中化疗对乳腺癌复发及预后的影响

从８０～９０年间共收治乳腺癌病人３９４例，全部女性，单纯手术组３、５、１０年生存率７４．４％、６０．７％、３１．３％。８３～８６前后，随机选取乳腺癌患者术中化疗５７例，３、５、１０年生存率：８９．５％、７５．４％、４９．１％。术后化疗６２例３、５、１０年生存率：８８．７％、７５．８％、４８．４％。结果显示：术中术后化疗５、１０年生存率明显高于单纯组（Ｐ＜０．０１）术中化疗５、１０年生存率和术后化疗组无统计学差异。单纯手术组、术中化疗组、术后化疗组五年复发率２４．８％、１２．２％、１７．７％，结果术中化疗组５年复发率低于术后和单纯手术组，差异有显著性（Ｐ＜０．０５）。临床研究证实，术中化疗对Ⅱ、Ⅲ期乳癌患者的预后复发有重要意义。     

Ⅱ,Ⅲ期乳癌根治术后放疗87例临床分析

目的 对８７例乳癌根治术或改良根治术后局部放疗病从进行临床分析。方法 选择１９９１￣１９９４年我院收治的乳癌术后放疗病人,照射部位为患侧锁骨上下区内乳淋以链区、腋窝区、胸壁,照射靶区剂量４５至５５ＧＹ,４－６周,并进行５年随访。结果 Ⅱｂ期５年生存率６５．６％,Ⅲ期５年生存率４８．９％,腋窝淋巴结转移数目１－３个５年生存率７７．８％,４－９个５年生存率４３．３％,大于或等于１０个５年生存率２７．３     

原发性阴道癌临床治疗方法探讨(附40例分析)

目的 探讨中晚期原发性阴道癌临床治疗方法。方法 本组４０例原发性阴道癌,其中１４例采用放疗加顺铂、５－ＦＵ及丝裂霉素三联全身化疗,２６例单行放疗。结果 总５年及１０年生存率分别为５５．７％和４３．２％。Ⅱ期３年及５年生存率为７４．５％和６１．１％,Ⅲ期３年及５年生存率为６４．５％和５３．２％,Ⅱ期３年及５年生存率与Ⅲ期比较Ｐ〈０．０５。Ⅲ期放化疗的完全缓解率及５年生存率分别为７８．６％和６７．１％     

Impact of adjuvant treatment modalities on survival outcomes in curatively resected pancreatic and periampullary adenocarcinoma

Background

We examined the impact of adjuvant modalities on resected pancreatic and periampullary adenocarcinoma (PAC).

Methods

A total of 563 patients who were curatively resected for PAC were retrospectively analyzed between 2003 and 2013.

Results

Of 563 patients, 472 received adjuvant chemotherapy (CT) alone, chemoradiotherapy (CRT) alone, and chemoradiotherapy plus chemotherapy (CRT-CT) were analyzed. Of the 472 patients, 231 were given CRT-CT, 26 were given CRT, and 215 were given CT. The median recurrence-free survival (RFS) and overall survival (OS) were 12 and 19 months, respectively. When CT and CRT-CT groups were compared, there was no significant difference with respect to both RFS and OS, and also there was no difference in RFS and OS among CRT-CT, CT and CRT groups. To further investigate the impact of radiation on subgroups, patients were stratified according to lymph node status and resection margins. In node-positive patients, both RFS and OS were significantly longer in CRT-CT than CT. In contrast, there was no significant difference between groups when patients with node-negative disease or patients with or without positive surgical margins were considered.

Conclusions

Addition of radiation to CT has a survival benefit in patients with node-positive disease following pancreatic resection.     

Simultaneous adjuvant radiotherapy and chemotherapy for stage I and II breast cancer

The purpose of the present paper was to evaluate treatment outcome after conservative breast surgery or mastectomy followed by simultaneous adjuvant radiotherapy and cyclophosphamide, methotrexate and fluorouracil (CMF) therapy. Two hundred and sixty eight (268) patients were treated at two Australian and two New Zealand centres between 1981 and July 1995. One hundred and sixty-nine patients underwent conservation surgery and 99 had mastectomies. Median follow-up was 53 months. Conventionally fractionated radiation was delivered simultaneously during the first two cycles of CMF, avoiding radiation on the Fridays that the intravenous components of CMF were delivered. In conservatively treated patients, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 34.5 ± 5.2%, 25.4 ± 4.5% and 75.5 ± 4.8%, respectively. Crude incidence of local relapse at 4 years was 6.3% and at regional/distant sites was 26.3%. Highest grades of granulocyte toxicity (< 0.5 × 10⁹/L), moist desquamation, radiation pneumonitis and persistent breast oedema were recorded in 10.7, 8.5, 8.9 and 17.2%, respectively. In patients treated by mastectomy, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 59.7 ± 7.3%, 56.7 ± 7.4% and 50.1 ± 7%. The crude incidence of local relapse at 4 years was 5.6% and at regional/distant sites it was 45.7%. The issue of appropriate timing of adjuvant therapies has become particularly important with the increasing acknowledgement of the value of anthracycline-based regimens. For women in lower risk categories (e.g. 1–3 nodes positive or node negative), CMF may offer a potentially better therapy, particularly where breast-conserving surgical techniques have been used. In such cases CMF allows the simultaneous delivery of radiotherapy with the result of optimum local control, without compromise or regional or systemic relapse rates. Further randomized trials that directly address the optimal integration of the two modalities, such as the one carried out in Boston, are clearly necessary.     

Adjuvant chemo-endocrine therapy for androgen-dependent mammary tumor in mice

Summary About 500 male DS mice grafted with androgen-dependent Shionogi carcinoma 115 (SC115) were used. When the tumor diameter reached about 20 mm (approximately 25 days after transplantation), excision of the tumor and/or castration were carried out. The injection of cyclophosphamide (80 mg/kg body weight × 3 at 7-day intervals) was started from the day after excision.In mice with excised tumor, adjuvant chemo-endocrine therapy was the most effective treatment examined; cumulative 120-day mortalities after transplantation of tumors in non-treated, adjuvant endocrine therapy, adjuvant chemotherapy and adjuvant chemo-endocrine therapy groups were 91%, 29%, 21% and 0%, respectively. Castration induced development of clusters of androgen-independent cancer cells in androgendependent SC115 tumor. In mice without tumor excision, the chemo-endocrine therapy was again the most effective treatment, though 86% of mice died by the 120th day after tumor transplantation. These findings suggest the usefulness of adjuvant chemo-endocrine therapy for achieving complete remission in hormonedependent tumors. Address for reprints: K. Matsumoto, M.D., Dept. of Pathology, Osaka University, Medical School, Kita-ku, Osaka 430, Japan.     

结直肠癌辅助治疗现状

在过去的20年结直肠癌辅助治疗有很大改进。辅助性放化疗已成为结直肠癌综合治疗的重要组成部分。本文综述了结直肠癌术后辅助化疗、术前、术后辅助放疗、免疫治疗、局部门静脉灌注化疗的现状。     

直肠癌新辅助化放疗

近年来的前瞻性研究已证实新辅助化放疗即术前化放疗可以明显提高直肠癌患者的局部控制率和保肛率,但直肠癌新辅助化放疗的理论基础、适应证、治疗方案、治疗时间等尚未明确.     

Role of chemotherapy and targeted therapy in early-stage non-small cell lung cancer

Introduction: Adjuvant platinum based chemotherapy is accepted as standard of care in stage II and III non-small cell lung cancer (NSCLC) patients and is often considered in patients with stage IB disease who have tumors ≥ 4 cm. The survival advantage is modest with approximately 5% at 5 years.

Areas covered: This review article presents relevant data regarding chemotherapy use in the perioperative setting for early stage NSCLC. A literature search was performed utilizing PubMed as well as clinical trial.gov. Randomized phase III studies in this setting including adjuvant and neoadjuvant use of chemotherapy as well as ongoing trials on targeted therapy and immunotherapy are also discussed.

Expert commentary: With increasing utilization of screening computed tomography scans, it is possible that the percentage of early stage NSCLC patients will increase in the coming years. Benefits of adjuvant chemotherapy in early stage NSCLC patients remain modest. There is a need to better define patients most likely to derive survival benefit from adjuvant therapy and spare patients who do not need adjuvant chemotherapy due to the toxicity of such therapy. Trials for adjuvant targeted therapy, including adjuvant EGFR-TKI trials and trials of immunotherapy drugs are ongoing and will define the role of these agents as adjuvant therapy.     

Prognostic factors affecting the outcome of early cervical cancer treated with radical hysterectomy and post-operative adjuvant therapy

The purpose of this study is to investigate the clinical and histological features that may affect the survival of the patients and to evaluate the impact of post-operative adjuvant therapy on the outcomes of patients with stage IB and IIA carcinoma of the cervix. From August 1998 to January 2005, 140 patients with International Federation of Gynecology and Obstetrics stage IB and IIA cervical cancer were treated with radical hysterectomy and post-operative pelvic radiation therapy with or without chemotherapy. The median age was 55 years (range, 29-86 years). Seventy-six patients had stage IB and 64 patients had stage IIA disease. Tumour size was <4 cm in 96 patients and > or = 4 cm in 44 patients. One hundred and eleven patients had histology of squamous cell carcinoma, 12 patients has adenocarcinoma and 17 patients had other histologic types. Depth of stromal invasion was <2/3 in 20 patients and > or = 2/3 in 120 patients. Twenty-three patients had parametrial invasion and 117 patients had no parametrial invasion. Thirteen patients had lymphovascular space invasion and 127 had no lymphovascular space invasion. Nine patients had positive surgical margin and 131 patients had negative margin. Twenty-seven patients had pelvic lymph node metastasis and 113 patients had no pelvic lymph node metastasis. Seventy-five patients received concurrent chemoradiotherapy and 65 patients received radiotherapy alone. The 5-year overall survival (OAS) and disease-free survival were 83% and 72% respectively. In the log rank test, tumour size (P = 0.0235), pararmetrial invasion (P = 0.0121), pelvic lymph node metastasis (P < 0.0001) and adjuvant chemotherapy + radiotherapy (P = 0.0119) were significant prognostic factors for OAS, favouring tumour size <4 cm, absence of parametrial invasion and pelvic lymph node metastasis, and those who received adjuvant chemoradiotherapy. The patients who received radiation with concomitant chemotherapy had a 5-year OAS rate of 90% versus those who received radiotherapy alone, with a rate of 76%. For patients with high-risk early stage cervical cancer who underwent a radical hysterectomy and pelvic lymphadenectomy, adjuvant chemoradiotherapy resulted in better survival than radiotherapy alone. The addition of weekly cisplatin to radiotherapy is recommended. The treatment-related morbidity is tolerable.     

局部晚期食管癌的新辅助治疗

新辅助治疗是指在成功的术后辅助治疗经验基础上提出的术前辅助治疗,其目的 在于增加手术切除肿瘤的可能性并提高患者的生存率,包括新辅助化疗、新辅助放疗和新辅助放化疗.新辅助放化疗在促进切除率和提高生存率上可能成为局部晚期食管癌新辅助治疗的首选方案.