肺癌脑转移75例分析

目的:探讨肺癌脑转移的临床特点及治疗方法.方法:对1996年至2005年收治的75例肺癌脑转移患者的临床特点和治疗方法进行回顾性分析.结果:以神经系统症状和体征为首发者占62%(47/75);单发脑转移占28%(21/75),两处以上占72%(54/75);脑转移灶80%位于幕上,合并其他器官转移37.3%(28/75).27例综合治疗患者生存期均不同程度延长,平均14个月.而其它肺癌脑转移患者平均2.7个月.结论:肺癌脑转移预后不良,治疗原则上应采用以手术为主的综合治疗.     

104例肺癌脑转移临床分析

目的本研究通过分析肺癌脑转移的临床特点, 探讨其综合治疗的疗效及预后因素。方法 回顾分析了2001年3月-2006年7月104例我院肺癌脑转移患者经不同方法治疗后的生存期与生存率。104例患者治疗方式为手术加放疗9例, 单纯放疗51例, 单纯化疗15例, 放疗加化疗26例, 未治疗3例。采用Kaplan-Meier分析及Log-Rank进行预后生存分析。结果 确诊者中以腺癌最多见, 占45%, 依次是小细胞肺癌25%, 鳞癌30%, 脑转移最常见的症状是头痛, 脑实质为最常受累部位。综合治疗后神经系统症状减轻或消失, 可延长生存2-8个月。全组患者中位生存时间7.2个月。单发转移及无颅外转移者生存期明显高于多发转移及伴颅外血行转移者(P＜0.01)。结论 脑转移预后差, 及时发现和合理治疗可减轻神经系统症状, 改善患者的生存质量。目前治疗仍以全脑放疗为主, 化疗的作用还需进一步研究。     

肾上腺转移癌28例临床诊治分析

目的:探讨肾上腺转移癌的临床特点和诊治方法。方法:回顾性分析我院1999年6月至2005年2月收治的28例肾上腺转移癌患者的原发疾病、临床表现、诊治及预后的临床资料。结果:28例肾上腺转移癌患者的原发肿瘤中肺癌12例(42.9%)、肾癌9例(32.1%)、乳腺癌4例(14.3%)、肝癌3例(10.7%)、结肠癌2例(7.1%)、胃癌和甲状腺癌各1例(各占3.4%)。5例临床表现为腰背部压迫感、胀痛,2例乏力、消瘦。手术切除肾上腺转移癌8例,介入动脉灌注化疗及栓塞治疗7例,化疗、放疗共10例,3例放弃治疗。随访22例,随访时间至2007年12月,平均随访时间3年;手术组术后平均生存15.7个月±5.1个月,非手术组平均数生存10.3个月±4.7个月(P(0.05)。结论:肾上腺是恶性肿瘤转移的好发部位之一,肺癌是最常见的原发肿瘤,肾上腺转移癌大多数无典型的临床症状,影像学检查在肾上腺转移癌的临床诊断具有重要作用,外科手术可能延长部分患者的生存期。     

肺癌脑转移42例临床分析

目的探讨肺癌脑转移的临床表现、影像学特点、治疗及预后.方法回顾性分析42例临床诊断明确的肺癌脑转移患者的临床资料.结果肺癌脑转移临床表现多样化,以头痛为首发症状最多见(占80.9%),其它常见症状为恶心、呕吐、肢体障碍等,影像学表现以大脑转移最多(占76.4%),小脑转移只占14.2%;放疗+化疗为主的综合治疗效果较好.结论肺癌脑转移在临床上较常见,应尽早行头颅CT或MRI检查,一旦确诊,即应积极采用手术、化疗及放疗等综合治疗手段,以改善生存质量,延长生存时间.     

立体定向伽玛刀放射外科治疗肺癌脑转移瘤的疗效分析

目的:探讨伽玛刀治疗肺癌脑转移瘤的临床疗效及不良反应。方法:选择伽玛刀治疗肺癌脑转移瘤患者236 例,根据病变大小和部位选用4-18mm 准直器靶点,肿瘤边缘剂量12-22Gy,平均17Gy,中心剂量32-40Gy,平均35.4Gy,边缘等剂量曲线40%-75％,平均58％。 结果:对全部患者伽玛刀治疗后进行临床随访,视具体情况1-3 个月复查影像,随访时限不少于半年;6个月、12个月患者生存率,腺癌患者分别为69.1％（56/81）、38.3％（31/81）,鳞癌患者为60.0％（45/75）、20.0％（15/75）,小细胞癌患者则为62.7％（37/59）、27.1％（16/59）;伽玛刀治疗后1-3个月随访KPS评分,提高128 例（54.2％）,不变81 例（34.3％）,下降27例（11.4％）。腺癌、鳞癌、小细胞癌、鳞腺混合癌脑转移瘤局部控制有效率分别为87.7％（71/81）、93.3％（70/75）、100％（59/59）、85.7％（18/21）。无1例患者出现严重脑水肿而终止放疗,无1例患者出现严重骨髓功能抑制。 结论:伽玛刀治疗肺癌脑转移瘤具有疗效好、安全的优势,能有效提高脑转移瘤患者生活质量,延长生存期。     

408例恶性肿瘤骨转移临床特征分析

  目的  随着抗肿瘤治疗方法的不断进步, 延长了晚期肿瘤患者的生存期, 出现骨转移及骨相关事件的发生率也随之增加, 本文旨在总结分析转移性骨肿瘤的临床特点, 以期进一步提高早期诊断和治疗水平。  方法  回顾性分析2004年5月至2011年4月本院收治转移性骨肿瘤408例, 总结其病史、原发肿瘤来源、好发部位及转移时间等临床特点。  结果  408例转移性骨肿瘤中, 发病年龄最早的是乳腺癌(57.68岁), 最晚是前列腺癌(72.33岁); 原发肿瘤来源依次为肺癌55.88%(228/408)、乳腺癌8.58%(35/408)、食管癌4.66%(19/408)、肾癌4.41%(18/408)、来源不明4.41%(18/408)、肝癌2.94%(12/408)等; 脊柱受累占74.02%(302/408), 肋骨61.27%(250/408), 骨盆38.24%(156/408), 股骨23.53%(96/408), 胸骨15.44%(63/408);平均转移时间为11.41个月, 最短和最长的分别为胰腺癌(3.0个月)和乳腺癌(55.46个月); 276例骨转移患者在初诊时既已发现骨转移; 228例肺癌骨转移中, 腺癌占39.91%(91/228), 鳞癌占24.56%(56/228), 小细胞癌占5.26%(12/228), 腺鳞癌占3.07%(7/228), 大细胞癌占0.88%(2/228), 病理类型不明为26.32%(60/228);全组中位生存期为18.45个月, 6、12和24个月生存率分别为61.27%、27.70%和10.29%。  结论  转移性骨肿瘤好发于41岁以上患者; 肺癌、乳腺癌、食管癌、肾癌最常发生骨转移, 骨转移常见部位依次为脊柱、肋骨、骨盆、股骨、胸骨, 脊柱中胸椎最常见; 男性骨转移以肺癌、肾癌及肝癌为主, 女性以肺癌、乳腺癌癌和食管癌为主; 肺癌骨转移中腺癌最多见; 积极综合治疗, 可改善骨转移患者症状。      

非小细胞肺癌伴单发脑转移瘤的外科治疗

目的 探讨非小细胞肺癌伴单发脑转移瘤的外科治疗及预后.方法 回顾我院1991年1月至2002年1月收治的56例非小细胞肺癌伴单发脑转移瘤患者临床资料,脑转移瘤伽马刀治疗后均行肺癌根治术,术后常规化疗和全脑放疗,并评估疗效.结果 本组患者均无严重手术并发症,1年生存率为73.5%(36/49),3年34.7%(17/49),5年16.3%(8/49),中位生存期20.5个月.结论 非小细胞肺癌伴单发脑转移瘤外科治疗可以延长患者的生存期和提高治疗效果.     

厄洛替尼联合全脑放射治疗非小细胞肺癌多发脑转移的初步观察

背景与目的:非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的多发脑转移预后极差。全脑放射治疗(whole brain radiotherapy,WBRT)是标准治疗方法。大多数临床研究结果显示化疗对肺癌多发脑转移的疗效不佳。厄洛替尼(Erlotinib,TARCEVA)是表皮生长因子受体的酪氨酸激酶抑制剂,用于NSCLC的治疗,本研究目的在于探讨WBRT同期联合厄洛替尼治疗NSCLC患者多发脑转移的疗效与耐受性。方法:12例NSCLC患者伴有多发脑转移接受WBRT(40Gy/20次/4周)并同期口服厄洛替尼150mg,每日1次,共计28天。治疗结束后和每3个月一次进行临床疗效评价直至疾病进展。结果:总有效率100%,其中完全缓解率66.7%,部分缓解率33.3%。中位总生存时间10个月,中位疾病进展时间8个月。临床症状缓解率100%。3例(25%)出现1级皮疹,1例(8.3%)发生轻度腹泻。结论:厄洛替尼同期联合WBRT治疗NSCLC多发脑转移有良好的近期治疗效果和耐受性。     

肺癌合并眼部转移:单中心回顾性研究并文献综述

背景与目的 眼部转移(ocular metastasis)是肺癌少见转移之一,影响患者生活质量.本研究旨在探讨肺癌合并眼转移患者的临床特征及预后.方法 回顾性分析肺癌合并眼部转移9例患者的临床资料,回顾近10年文献报道共42例患者的临床特点.结果 9例患者的中位年龄为51岁(范围:41岁-61岁),其中7例诊断为非小细胞肺癌(包括腺癌6例);1例为小细胞肺癌;1例病理不详.眼转移部位方面,脉络膜8例,虹膜1例.文献回顾中,小细胞肺癌占21.4%(n=9),腺癌占47.6%(n=20),脉络膜是最常见的眼转移部位(66.7%,n=28).肺癌合并眼转移患者,系统化疗的疾病控制率仅为28%,联合眼部局部治疗可有效控制眼部症状.结论 肺癌合并眼部转移以肺腺癌多见,脉络膜转移是肺癌眼部转移的最常见转移部位.眼部局部治疗可控制局部症状,但系统性化疗疗效差.     

三维适形放疗对肺癌脑转移的疗效及预后因素分析

目的 探讨三维适形放射治疗对肺癌脑转移的治疗效果及影响预后的因素.方法 对46例肺癌脑转移患者先给予全颅放疗30 Gy,再局部三维适形放疗9～18 Gy.分割方法均为3 Gy/次,5次/周.与头部同期行肺部放射治疗22例,和(或)后期给予全身化疗26例.结果 疗后1～3个月有38例(69个病灶)复查头部CT、MRI,颅内转移瘤有效率为79.7%(55/69);全组神经系统症状改善率91.3 %(42/46);中位随访13个月,随访率100%,中位生存期11个月,1,2年生存率分别为46.2%(18/39)和13.3%(2/15).单因素分析显示,Karnofsky评分、颅内转移瘤放疗剂量、有无颅外转移、体重变化、是否采用综合治疗对生存期有影响.结论 肺癌脑转移三维适形放疗疗效满意,放疗并发症少;Karnofsky评分、颅内转移瘤放疗剂量、有无颅外转移、体重变化、是否采用综合治疗是影响生存期的预后因素.     

肺癌脑膜转移11例临床分析

目的:探讨肺癌合并脑膜转移的临床表现、诊断、治疗和预后。方法:回顾分析11例肺癌脑膜转移患者的临床资料。结果:11例腺癌患者均有头痛、呕吐等神经系统症状,影像学表现为脑膜强化、脑室扩张及脑转移。9例患者颅内压升高,11例患者脑脊液均发现肿瘤细胞。9例患者接受了综合治疗,包括全身化疗、靶向治疗、鞘内化疗、脑室腹腔分流术、全脑放疗。中位生存期3个月。结论:脑膜转移是晚期肺癌并发症之一,根据临床表现、影像学及脑脊液检查可明确诊断。给予鞘内化疗、靶向治疗等综合治疗可减轻症状、延长生存。     

Sustained complete response in lung metastasis of breast cancer by goserelin--report of two cases

We report two patients with lung metastasis of breast cancer who had durable complete responses (CR) with goserelin. The first patient was a 48-year-old woman diagnosed with left breast cancer (T1N0M0, Stage I) at the age of 40, for which she underwent mastectomy. The tumor was estrogen receptor (ER) and progesterone receptor (PgR) positive. She received tamoxifen for 2 years as adjuvant therapy. After 8 years and 7 months, a lung metastasis was found by chest X-p, and treatment with goserelin was started. After 11 months of this treatment a CR was achieved, and the response lasted 3 years and 5 months. The second patient was a 38-year-old woman with a diagnosis of lung metastasis. She underwent right mastectomy at the age of 29 for breast cancer (T2N1M0, Stage IIB), and the tumor was ER and PgR positive. She received tamoxifen and doxifluridine for 2 years as adjuvant therapy. Eight years and 6 months after the mastectomy, a lung metastasis was found by chest X-p, and goserelin treatment was started. After 8 months of this treatment, chest X-p and CT revealed a complete regression of the lung metastasis, and response lasted 1 years and 7 months. Serum estradiol levels were suppressed below 10 pg/ml during the treatment in both patients. These results indicate the usefulness of LH-RH agonist in the treatment of recurrent breast cancer.     

多西紫杉醇联合卡铂或卡培他滨一线治疗乳腺癌肺转移的疗效对比

目的:回顾性对比分析多西紫杉醇分别联合卡铂或卡培他滨一线治疗乳腺癌肺转移的临床效果。方法:收集我院2014年1月至2017年6月间符合乳腺癌切除术后、经蒽环类和／或紫杉类辅助化疗后出现肺转移患者的临床资料，共筛选出65例。其中25例行多西紫杉醇联合卡铂(A组)作为一线解救治疗，40例行多西紫杉醇联合卡培他滨(B组)作为一线解救治疗。每2个疗程后进行效果评价，比较两类不同解救治疗方案对乳腺癌肺转移患者的近期疗效及远期预后。结果:65例乳腺癌肺转移患者中，A组和B组客观有效率（ORR）分别为68.0%和42.5%，差异有统计学意义（P=0.045）。A组和B组平均化疗周期(5.0 vs 4.8)、疾病控制率（DCR）(88.0% vs 82.5%)、中位PFS(13.3 vs 12.2个月)、中位OS(51.4 vs 51.0个月)、肺转移后2年PFS(28.0% vs 24.8%)、5年OS(76.0% vs 43.4%)比较差异均无统计学意义(P=0.577、P=0.377、P=0.978、P=0.989、P=0.955、P=0.672)。两组均出现血液学毒性以及恶心、呕吐、腹泻、手足综合征等不良反应，A组患者中白细胞减少、手足综合征的发生率明显低于B组，差异有统计学意义(P=0.049、P<0.001)。结论:乳腺癌肺转移的预后较差，采用多西紫杉醇联合卡铂化疗方案一线解救治疗乳腺癌肺转移的患者近期疗效较好，不良反应小，是值得推荐的一线化疗方案。但从患者的远期预后来看，两组化疗方案并没有明显改善乳腺癌肺转移患者的预后。     

A patient with recurrent rectal cancer in whom pulmonary metastasis disappeared by FOLFOX 4 therapy

We performed FOLFOX 4 therapy in a patient with lung metastasis (a 62-year-old woman) after surgery for rectal cancer and observed both normalization of tumor markers and disappearance of the metastasis. Low anterior resection was performed for progressive rectal cancer, and treatment with UFT and folinate was started one month after surgery. However, tumor markers increased after 2 months of treatment and CT scans showed metastases to both lungs. FOLFOX 4 therapy was started, and tumor markers became normal after four courses, while the lung metastases disappeared after 10 courses. The dosage of FOLFOX 4 was reduced after three courses due to neutropenia and diarrhea. This treatment appeared to be effective for the inhibition of lung metastasis associated with colorectal cancer.     

A retrospective evaluation of the effects of deuterium depleted water consumption on 4 patients with brain metastases from lung cancer

Hypotheses. Because of the number of sufferers and high mortality rate, the standard care and new therapeutic options in the treatment of brain metastasis from lung cancer are the subject of intense research. A new concept based on the different chemical and physical behavior of protium and deuterium affecting cell signaling and tumor growth has been introduced in the treatment of cancer patients. The aim of this study was to investigate the impact of deuterium depleted water (DDW) consumption in addition to conventional forms of therapy on the survival of lung cancer patients with brain metastasis. STUDY DESIGN: A series of 4 case histories was retrospectively evaluated. The patients were diagnosed with brain metastasis deriving from a primary lung tumor and started consuming DDW at the time of or after the diagnosis of the brain metastasis, which was inoperable or the surgical intervention did not result in complete regression. The primary objective was survival. METHODS: The daily water intake of the patients was replaced with DDW, which complemented the conventional forms of treatment. Patients were consuming DDW for at least 3 months. The treatment was continued with DDW of 10 to 15 to 20 ppm lower deuterium (D) content every 1 to 2 months and thus a gradual decrease was maintained in the D-concentration in the patient's body. RESULTS: DDW consumption integrated into conventional treatments resulted in a survival time of 26.6, 54.6, 21.9, and 33.4 months in the 4 patients, respectively. The brain metastasis of 2 patients showed complete response (CR), whereas partial response (PR) was detected in 1 patient, and the tumor growth was halted (no change or NC) in 1 case. The primary tumor of 2 patients indicated CR, and the lung tumor in 2 patients showed PR. CONCLUSIONS: DDW was administered as an oral anticancer agent in addition to conventional therapy, and noticeably prolonged the survival time of all 4 lung cancer patients with brain metastasis. We suggest that DDW treatment, when integrated into other forms of cancer treatment, might provide a new therapeutic option.     

Surgical management of cerebral metastases from non-small cell lung cancer

AIMS AND BACKGROUND: The objective of the study was to assess the efficacy of surgical resection of solitary brain metastasis in patients with non-small-cell lung cancer. METHODS AND STUDY DESIGN: We report a retrospective analysis of 32 patients with single brain metastasis surgically excised at our hospital. All but one patient underwent postoperative whole brain radiation therapy. RESULTS: The median survival of patients was 12.5 months postoperatively (mean, 17 months), and the overall 1-year survival was 53%. Thirteen patients had recurrence of brain metastasis: 6 of 13 underwent reoperation for the recurrent lesion, and 1 of the 6 patients had a third craniotomy. Baseline characteristics, which significantly influenced survival, included age less than 60 years, tumor histology (ie, adenocarcinoma), and treatment of the primary lung cancer. The analysis did not yield any significant differences between treatment modalities. CONCLUSIONS: Our findings correspond well with those reported in the literature and suggest that surgical resection of single brain metastasis in patients with non-small cell lung cancer can improve survival over conservative management. Furthermore, surgical treatment of the primary tumor and the single brain metastasis, combined or not with radiotherapy and chemotherapy, represents an approach that merits further investigation with more patients and a prospective longitudinal design.     

肺癌肾上腺转移30例分析

目的 探讨肺癌肾上腺转移的综合治疗效果。方法 回顾性分析1995年2月-2001年4月间收治的30例肺癌肾上腺转移患者资料，其中小细胞肺癌14例，非小细胞肺癌16例，患者均采用化疗和（或）放疗，18例化疗 放疗综合治疗，12例单纯化疗。结果 全组患者中位生存期8个月，12例单纯化疗者中部分缓解3例，有效率为25.0%；18例化疗 放疗综合治疗者中完全缓解1例，部分缓解7例，有效率为44.4%，有疼痛症状者放疗后疼痛明显缓解。结论 肺癌肾上腺转移的化疗 放疗的综合治疗比单一化疗效果更好。     

35例肺癌脑膜转移的临床观察

目的 探讨肺癌并脑膜转移的临床诊断、治疗及预后。方法 收集35例脑膜转移患者的临床资料进行回顾性分析,并对影响预后的因素进行分析。结果 35例患者中24例接受了包括全身化疗、局部放疗、靶向治疗及鞘内化疗等抗肿瘤治疗,其余11例仅接受了侧脑室引流、甘露醇降颅压等对症支持治疗;两者的中位生存期分别为6.9个月和2.8个月,差异有统计学意义（P=0.005）。7例接受靶向治疗患者的中位生存期为10.0个月,17例接受放、化疗患者的中位生存期为5.1个月,差异有统计学意义（P=0.038）。Cox多因素回归分析显示,抗肿瘤治疗是影响预后的独立因素（HR=0.377,95％CI：0.152～0.936,P=0.035）。结论 脑膜转移是晚期肺癌的严重并发症之一,预后较差,抗肿瘤治疗有助于延长生存期。     

Nonsmall cell lung cancer presenting with synchronous solitary brain metastasis

BACKGROUND: Solitary brain metastases occur in about 50% of patients with brain metastases from nonsmall cell lung cancer (NSCLC). The standard of care is surgical resection of solitary brain metastases, or stereotactic radiosurgery (SRS) plus whole brain radiation therapy (WBRT). However, the optimal treatment for the primary site of newly diagnosed NSCLC with a solitary brain metastasis is not well defined. The goal was to distinguish which patients might benefit from aggressive treatment of their lung primary in patients whose solitary brain metastasis was treated with surgery or SRS. METHODS: The cases of 84 newly diagnosed NSCLC patients presenting with a solitary brain metastasis and treated from December 1993 through June 2004 were retrospectively reviewed at The University of Texas M. D. Anderson Cancer Center. All patients had undergone either craniotomy (n = 53) or SRS (n = 31) for management of the solitary brain metastasis. Forty-four patients received treatment of their primary lung cancer using thoracic radiation therapy (median dose 45 Gy; n = 8), chemotherapy (n = 23), or both (n = 13). RESULTS: The median Karnofsky performance status score was 80 (range, 60-100). Excluding the presence of the brain metastasis, 12 patients had AJCC Stage I primary cancer, 27 had Stage II disease, and 45 had Stage III disease. The median follow-up was 9.7 months (range, 1-86 months). The 1-, 2-, 3-, and 5-year overall survival rates from time of lung cancer diagnosis were 49.8%, 16.3%, 12.7%, and 7.6%, respectively. The median survival times for patients by thoracic stage (I, II, and III) were 25.6, 9.5, and 9.9 months, respectively (P = .006). CONCLUSIONS: By applying American Joint Committee on Cancer staging to only the primary site, the thoracic Stage I patients in our study with solitary brain metastases had a more favorable outcome than would be expected and was comparable to Stage I NSCLC without brain metastases. Aggressive treatment to the lung may be justified for newly diagnosed thoracic Stage I NSCLC patients with a solitary brain metastasis, but not for locally advanced NSCLC patients with a solitary brain metastasis.     

Effective chemo-endocrine combination therapy for obstructive-jaundice caused by multiple liver metastasis of recurrent breast cancer--a case report]

A 68-year-old woman complained of obstructive jaundice 9 years after a radical mastectomy. CT scan demonstrated multiple metastasis of the liver and two coin lesions of the right lung. The biliary tract was completely obstructed at the portal fissure. Multiple liver and lung metastasis of breast cancer were diagnosed because of high CA 15/3 serum levels and normal gastrointestinal study. Following unsuccessful treatment with tamoxifen (TAM), we used toremifene (TORE) and 5'-deoxy-5-fluorouridine (5'-DFUR) followed by percutaneous transhepatic cholangiodrainage (PTCD). The biliary tract was reopening and jaundice disappeared with improvement of the general condition. Then endocrine therapy with medroxy progesterone acetate and UFT and chemotherapy with CAF (Cyclophosphamide, Adriamycin, 5-FU) were begun. A partial response (PR) was obtained with the disappearance of liver metastasis and two coin lesions of the lung 5 months after the first treatment. The effect of chemo-endocrine combination therapy continued for 5 months. Survival time from recurrence was 13 months. In our case, PR was obtained by using chemo-endocrine combination therapy, although a poor prognosis has been reported in patients with obstructive jaundice caused by multiple liver metastasis of recurrent breast cancer.