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早期乳腺癌术后放疗的临床分析 总被引:1,自引:0,他引:1
目的:探讨早期乳腺癌根治术,仿根治术后的放疗剂量及照射范围.方法:对比分析本院1980年3月~1993年3月收治的T2N1M0期乳腺癌术后放疗者418例(放疗组)与术后未行放疗者180例(手术组).418例中DT≥50Gv者86例,淋巴引流区伴胸壁照射者148例.结果:放疗组中DT≥50Gy者与手术组相比,其中腋淋巴结转移≥4个者的10年生存率分别为66.7%(32/48)与34.5%(10/29),复发率分别为63%(3/48)与34.5%(10/29),P均<0.05.放疗组中淋巴引流区伴胸壁照射者148例与手术组相比,其中腋淋巴结转移≥4枚者的10年生存率分别为62.8%(54/86)与34.5%(10/29),复发率分别为4.7%(4/86)与34.5%(10/29),P均<0.05.结论:对腋窝淋巴结转移≥4枚者,术后提高肿瘤剂量达50Gy以上,可降低锁骨区淋巴结转移与胸壁复发. 相似文献
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32例子宫肉瘤临床分析 总被引:3,自引:0,他引:3
目的 :分析子宫肉瘤的临床资料 ,了解其预后因素 ,寻求治疗的改进方法。方法 :回顾性分析复旦大学上海肿瘤医院 1991~ 2 0 0 1年收治的 32例子宫肉瘤的组织学类型、临床特点、治疗方法及预后因素。结果 :总的 3年及 5年生存率分别为 79 2 %和 6 8 4 % ,总复发率为 4 3 8%。手术分期对 3年及 5年生存率差异有显著性 (P <0 0 5 ) ,对复发有明显影响 (P <0 0 1)。绝经前患者 5年生存率为 85 7% ,绝经后的患者 5年生存率为 5 8 2 % (P <0 0 5 )。不同手术方式与 3年及 5年生存率差异无显著性 (P >0 0 5 ) ,但广泛全子宫双附件 +盆腔淋巴结清扫术与其它手术方式对复发的影响差异有显著性 (P <0 0 5 )。结论 :子宫肉瘤的预后与临床和手术病理分期 ,绝经前后有明显关系。子宫肉瘤的盆腔复发率高 ,盆腔淋巴结清扫术虽不一定能改善其 5年生存率 ,但能减少子宫肉瘤的复发。术后加放疗或化疗不能提高其 5年生存率。采用手术加放疗加化疗的综合治疗 ,其对中位复发时间有明显影响 (P <0 0 1) ,其 5年生存率比手术加放疗或加化疗有所提高 ,但无统计学上显著差异 (P>0 0 5 ) ,尚需积累更多经验 相似文献
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目的 探讨子宫肉瘤术后放疗的价值和预后因素。方法 回顾分析本院1994—2014年收治的经病理确诊的182例子宫肉瘤患者资料。49例术后放疗,133例未术后放疗。放疗采用盆腔野体外照射,处方剂量30~50 Gy分10~25次,5 次/周。采用Kaplan-Meier法计算LRRFS、OS并Logrank法检验差异,Cox法多因素预后分析。结果 全组5年样本量为114例,术后放疗、未放疗的分别为24、90例(分别为2008年10月前收治的例数)。全组5年LRRFS、OS分别为62.1%、56.2%,术后放疗、未放疗的LRRFS分别为78.0%、55.3%(P=0.013),OS分别为64.1%、51.7%(P=0.070)。多因素分析显示病理类型、组织学分级、分期是LRRFS及OS影响因素(P=0.032、0.008、0.000及P=0.046、0.000、0.000),术后放疗是LRRFS的影响因素(P=0.013)。结论 术后放疗显著提高子宫平滑肌肉瘤LRRFS和OS,为子宫平滑肌肉瘤术后个体化放疗提供证据,但仍需进一步探讨。 相似文献
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子宫平滑肌肉瘤(uterine leiomyosarcoma, uLMS)临床罕见。其临床表现缺乏特异性,多数uLMS通常在术中或术后经组织病理得以诊断。由于uLMS恶性程度高、侵袭性强,即便确诊时尚处临床早期,疾病复发转移率及患者死亡率仍然较高,预后不容乐观。现有循证医学数据表明,FIGO分期是其最重要的独立预后因子。因此,在这个讲求精准医学与个体化治疗的时代,应予不同期别uLMS以不同的治疗策略。对于I期uLMS而言,手术仍是首选的治疗方式,但在全子宫切除的同时是否应切除双侧卵巢及是否应行淋巴结清扫仍尚存争议;而其他疗法如化疗、放疗、免疫治疗等亦对I期uLMS作用不一。本文将综述I期uLMS的治疗方式,分析其临床应用现状与最新研究进展,以期为临床诊疗提供参考。 相似文献
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目的:回顾性分析行子宫肌瘤手术意外发现子宫肉瘤的患者的临床病理资料,探讨如何提高此类患者的术前诊断率,并采取何种治疗方式来改善患者的预后。方法:选取2011年12月至2019年10月以诊断为子宫肌瘤在外院行手术治疗,术后病理确诊为子宫肉瘤然后在我院行后续治疗的患者。分析其临床病理资料并随访其预后。结果:共计25例行子宫肌瘤手术意外发现的子宫肉瘤患者,患者平均年龄(43.68±6.66)岁,子宫平滑肌肉瘤15例,子宫内膜间质肉瘤9例,子宫癌肉瘤1例,FIGOI期22例,Ⅱ期3例,行子宫全切除术12例,子宫次全切除术7例,子宫肌瘤切除术6例,开腹手术17例,腔镜手术8例,术后行二次手术者18例,术后单纯化疗者8例,同步放化疗者13例,4例患者未采取术后辅助治疗。随访至2020年2月,平均随访(31.48±16.40)个月,复发11例,死亡5例。平均复发时间(11.4±5.8)个月,中位无进展生存期41个月,中位总体生存期数据尚未观察到。结论:应加强提高子宫肉瘤的术前诊断率,对于意外发现子宫肉瘤的患者应根据患者的病情选择合适的手术及辅助治疗方案以提高患者的生存率。 相似文献
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目的:观察老年早期非小细胞肺癌患者三维适形放疗的疗效。方法:2002年到2007年,采用三维适形放疗治疗35例老年早期非小细胞肺癌,放疗剂量66-80Gy,中位剂量70Gy,常规分割,2.0Gy/d,年龄71-89岁,中位年龄76岁,其中12例≥80岁。Ⅰ期患者13例,Ⅱ期22例。结果:治疗有效率23例(65.7%)。3年总生存率为28%,中位生存时间38.9个月;3年肿瘤相关生存率为39%,中位生存时间43.5个月。1例(2.9%)患者死于放疗导致的晚期放射性肺损伤,没有观察到其他严重的放疗毒性发生。结论:采用三维适形放疗技术治疗老年早期非小细胞肺癌是安全有效的。 相似文献
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放射治疗在早期乳腺癌保乳术中的价值 总被引:3,自引:0,他引:3
目的:进一步证实放射治疗在早期乳腺癌保乳术中的重要性。方法:1994年12月~2001年12月本院共收治237例早期乳腺癌。其中83例做保乳手术。154例做改良根治术。保乳术后全部患者接受放疗。放疗的范围根据肿块的大小、部位、腋淋巴结是否受累而定。胸壁切线剂量予8MV—X线5000cGy。肿瘤瘤床加电子线1500cGy。改良根治术后仅3例作放疗。结果:保乳组和改良组局部复发各1人。保乳组区域淋巴结复发1例。改良组无区域淋巴结复发,有肝转移、肺转移各1人。两组各死亡1人。保乳组五年生存率96.49%,改良组98.61%。保乳组双侧乳房外形基本一致,柔软,有弹性。结论:早期乳腺癌保乳术加放射治疗,效果与改良根治术相似,并伴良好美容效果。 相似文献
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目的:观察老年早期非小细胞肺癌患者三维适形放疗的疗效。方法:2002年到2007年,采用三维适形放疗治疗35例老年早期非小细胞肺癌,放疗剂量66-80Gy,中位剂量70Gy,常规分割,2.0Gy/d,年龄71-89岁,中位年龄76岁,其中12例≥80岁。Ⅰ期患者13例,Ⅱ期22例。结果:治疗有效率23例(65.7%)。3年总生存率为28%,中位生存时间38.9个月;3年肿瘤相关生存率为39%,中位生存时间43.5个月。1例(2.9%)患者死于放疗导致的晚期放射性肺损伤,没有观察到其他严重的放疗毒性发生。结论:采用三维适形放疗技术治疗老年早期非小细胞肺癌是安全有效的。 相似文献
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Stereotactic single-dose radiotherapy (radiosurgery) of early stage nonsmall-cell lung cancer (NSCLC) 总被引:2,自引:0,他引:2
BACKGROUND: The clinical results after stereotactic single-dose radiotherapy of nonsmall-cell lung cancer (NSCLC) stages I and II were evaluated. METHODS: Forty-two patients with biopsy-proven NSCLC received stereotactic radiotherapy. Patients were treated in a stereotactic body frame and breathing motion was reduced by abdominal compression. The single doses used ranged between 19 and 30 Gy/isocenter. RESULTS: After a median follow-up period of 15 months (range, 1.5-72 months) the actuarial overall survival rates and disease-free survival rates were 74.5%, 65.4%, 37.4%, and 70.2%, 49.1%, 49.1% at 12, 24, and 36 months after therapy, respectively. The actuarial local tumor control rates were 89.5%, 67.9%, and 67.9% at 12, 24, and 36 months after therapy, respectively. A significant difference (P = .032) in local tumor control was found for patients receiving 26-30 Gy (n = 32) compared with doses of less than 26 Gy (n = 10). The effect of the tumor volume on local tumor control was also evaluated. Although the difference was not statistically significant (P = .078), the subgroup of tumors with a tumor volume of less than 12 cm(3) (n = 10) experienced no tumor recurrence. Thirteen (31%) patients developed metastases during follow-up, whereas isolated regional lymph node recurrence was only encountered in 2 patients. No clinically significant treatment-associated side effects were documented. CONCLUSIONS: Stereotactic single-dose radiotherapy is a safe and effective treatment option for patients with early stage NSCLC not suitable for surgery. Especially for small tumor volumes it seems to be equally effective as hypofractionated radiotherapy, while minimizing the overall treatment time. 相似文献
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宫颈癌是全球范围内严重威胁人类身体健康的疾病,也是中国最常见的妇科恶性肿瘤之一。在尚未开展宫颈涂片普查的国家和地区,患者就诊时肿瘤通常已发展至大肿块ⅠB/Ⅱ期或局部晚期宫颈癌。宫颈癌最常应用的分期系统是FIGO分期系统。尽管分期为早期,但大肿块ⅠB/Ⅱ期宫颈癌的预后与局部晚期患者类似,且单纯子宫切除术无法治愈这类患者。外放射后继以腔内近距离放射联合同期DDP为主的化疗可有效提高局部晚期宫颈癌的总生存率。本文将就目前支持联合治疗大肿块ⅠB/Ⅱ期或局部晚期宫颈癌的临床试验结果进行全面评估。 相似文献
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体部立体定向放射治疗(stereotactic body radiotherapy,SBRT)成为医学上不能手术的早期非小细胞肺癌(non-small cell lung cancer,NSCLC)的标准治疗方式。近十年的临床证据表明SBRT替代手术治疗效果可观。由于毒副作用小,SBRT同样适用于肺功能差、患有某些严重并发症的老年患者。最近针对可手术早期NSCLC患者的对比研究中发现SBRT可能同样适用于这一群体,但这些可观的结果仍需要长期随访的前瞻性实验的验证。本文就SBRT治疗早期非小细胞肺癌的临床进展做一综述。 相似文献
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Biewenga P van der Velden J Mol BW Stalpers LJ Schilthuis MS van der Steeg JW Burger MP Buist MR 《Cancer》2011,117(4):768-776
BACKGROUND:
In the management of early stage cervical cancer, knowledge about the prognosis is critical. Although many factors have an impact on survival, their relative importance remains controversial. This study aims to develop a prognostic model for survival in early stage cervical cancer patients and to reconsider grounds for adjuvant treatment.METHODS:
A multivariate Cox regression model was used to identify the prognostic weight of clinical and histological factors for disease‐specific survival (DSS) in 710 consecutive patients who had surgery for early stage cervical cancer (FIGO [International Federation of Gynecology and Obstetrics] stage IA2‐IIA). Prognostic scores were derived by converting the regression coefficients for each prognostic marker and used in a score chart. The discriminative capacity was expressed as the area under the curve (AUC) of the receiver operating characteristic.RESULTS:
The 5‐year DSS was 92%. Tumor diameter, histological type, lymph node metastasis, depth of stromal invasion, lymph vascular space invasion, and parametrial extension were independently associated with DSS and were included in a Cox regression model. This prognostic model, corrected for the 9% overfit shown by internal validation, showed a fair discriminative capacity (AUC, 0.73). The derived score chart predicting 5‐year DSS showed a good discriminative capacity (AUC, 0.85).CONCLUSIONS:
In patients with early stage cervical cancer, DSS can be predicted with a statistical model. Models, such as that presented here, should be used in clinical trials on the effects of adjuvant treatments in high‐risk early cervical cancer patients, both to stratify and to include patients. Cancer 2011. © 2010 American Cancer Society. 相似文献18.
V Pavone U Ricardi S Luminari P Gobbi M Federico L Baldini E Iannitto G Ucci L Marcheselli L Orsucci E Angelucci M Liberati P Gavarotti A Levis 《Annals of oncology》2008,19(4):763-768
BACKGROUND: In 1997, the Intergruppo Italiano Linfomi started a randomized trial to evaluate, in unfavorable stage IA and IIA Hodgkin's lymphoma (HL) patients, the efficacy and toxicity of the low toxic epirubicin, vinblastine and etoposide (EVE) regimen followed by involved field radiotherapy in comparison to the gold standard doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) regimen followed by the same radiotherapy program. PATIENTS AND METHODS: Patients should be younger than 65 years with unfavorable stage IA and IIA HL (i.e. stage IA or IIA with bulky disease and/or subdiaphragmatic disease, erythrocyte sedimentation rate higher than 40, extranodal (E) involvement, hilar involvement and more than three involved lymph node areas). RESULTS: Ninety-two patients were allocated to the ABVD arm and 89 to the EVE arm. Complete remission (CR) rates at the end of treatment program [chemotherapy (CT) + RT] were 93% and 92% for ABVD and EVE arms, respectively (P = NS). The 5-year relapse-free survival (RFS) rate was 95% for ABVD and 78% for EVE (P < 0.05). As a consequence of the different relapse rate, the 5-year failure-free survival (FFS) rate was significantly better for ABVD (90%) than for EVE (73%) arm (P < 0.05). No differences in terms of overall survival (OS) were observed for the two study arms. CONCLUSIONS: In unfavorable stage IA and IIA HL patients, no differences were observed between ABVD and EVE arms in terms of CR rate and OS. EVE CT, however, was significantly worse than ABVD in terms of RFS and FFS and cannot be recommended as initial treatment for HL. 相似文献
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Ⅱ和Ⅲ期直肠癌根治术后放射治疗的疗效观察 总被引:5,自引:1,他引:5
目的 比较直肠癌根治术后放射治疗与单纯手术的疗效。方法 回顾性分析可手术切除、无远地转移的Ⅱ、Ⅲ期直肠癌243例。手术加术后放射治疗192例,剂量范围32~62Gy,中位剂量50Gy;单纯手术51例。生存分析采用Kaplan-Meier法及Logrank法检验。结果 全组5年总生存率和无瘤生存率分别为60.3%和58.3%。术后放射治疗组和单纯手术组5年总生存率分别为59.4%和64.7%,其相应无瘤生存率分别为57.0%和66.4%,其生存率差异均无显著性意义(P=0.601,P=0.424)。但术后放射治疗使局部复发率明显降低,其与单纯手术组的5年累积复发率分别为15.8%和26.8%(P=0.043)。结论 Ⅱ、Ⅲ期直肠癌术后放射治疗可提高局部控制率,不能延长生存期。 相似文献