全中枢神经系统照射治疗脑瘤(附7例报告)

原发于中枢神经系统肿瘤如髓母细胞瘤、幕下室管膜瘤等由于有沿蛛网膜下腔随脑省液循环播散的倾向，在放射治疗中常需要行全中枢神经系统即全脑、全脊髓照射。我院1988年4月至1991年6月共治疗7例，现就治疗技术和疗效报告如下。材料与方法本组男6例，女1例；年龄6～36岁，中位年龄21岁，10岁以下2例。肿瘤类型与部位：髓母细胞瘤5例，其中小脑蚓部2例，小脑半球2例，右侧杨叶1例。室管膜瘤2例，位于第三脑室和右侧脑室1例（室管膜母细胞瘤）和第四脑室1例。肿瘤完整摘除1例，部分切除5例，穿刺活极1例。全部病例放疗前均穿刺抽吸脑脊液细胞…     

髓母细胞瘤的放疗：附17例分析

髓母细胞瘤恶性程度高,术后极易复发,但对射线敏感,我科1962～1984年收治17例髓母细胞瘤术后病例,经全中枢神经系统照射,即:全脑照射DT25～30Gy,后颅凹40～50Gy。全脊髓预防DT30Gy,结果6/17存活5年以上。本瘤常发于小脑蚓部侵犯第四脑室而引起脑脊液循环障碍。为避免在放疗中发生颅压增高,放疗前应先行手术,尽量切除肿瘤。由于瘤细胞易随脑脊液播散,因此应行全中枢神经系统照射。     

髓母细胞瘤的质子放射治疗进展

髓母细胞瘤是中枢神经系统恶性程度很高的神经上皮性肿瘤，绝大多数发生在小脑蚓部，10岁以前小儿多见，是儿童中最常见的实体肿瘤。由于该肿瘤具有生长迅速，手术不易彻底切除并有沿脑脊液播散性种植的倾向，使得该病的治疗比较困难，就诊时约有309／5患儿伴有蛛网膜下腔播散。目前手术、放疗、化疗综合治疗髓母细胞瘤的5年生存率为65％。     

颅内髓母细胞瘤

本文报告34例儿童和成人(年在26岁以下)颅内髓母细胞瘤。其中儿童26例,占同年龄儿童颅内肿瘤的28.3％,占儿童幕下肿瘤的48.1％。临床表现有1.颅内压增高,如头痛(90.6％)、呕吐(84.5％)、视乳头水肿(84.3％)。2.出现小脑体征的占75％。25例脑室造影均能明确诊断病变部位。在治疗上肿瘤全切除者15例(44.1％),大部切除10例(29.4％),部分切除者8例(23.5％)。手术生存29例(85.2％),死亡5例(14.7％)。经随访的12例中,出院后1及6个月死亡各3例,9个月死亡1例。 虽然肿瘤对放疗敏感,但术前不应使用放疗和化疗,用髓母细胞瘤仅74.4％发生在蚓部。我们认为对于这种肿瘤,应全部切除瘤体为宜,并使硬脑膜开放。这样能使减压充分,脑脊液通畅。术后适当加用放疗和化疗可进一步提高远期效果。     

髓母细胞瘤的CT和MRI影像学分析及临床意义

目的：通过对髓母细胞瘤的CT及MRI表现分析,加强对本病的认识,提高术前诊断的准确性并合理选择治疗方案。方法：对31例经手术、病理证实的髓母细胞瘤进行回顾性分析,所有病例均行CT和／或MRI检查。结果：髓母细胞瘤好发于儿童,常见于小脑蚓部;成人髓母细胞瘤少见,多见于小脑半球。CT平扫呈等或稍高密度影,增强扫描多强化明显。MRI扫描T1加权像呈低或等信号,T2加权像呈略高或混杂信号,增强扫描强化明显。结论：髓母细胞瘤有特定的发生部位、年龄及影像学特征性;仔细分析CT和MRI表现,可做出准确的术前诊断并指导制定治疗方案,改善预后。     

小儿后颅窝肿瘤临床及MR特点与误诊分析

为了探讨磁共振成像(MR)对儿童后颅窝肿瘤的诊断与鉴别诊断价值及儿童后颅窝肿瘤误诊原因,回顾性分析48例误诊的儿童后颅窝肿瘤的MR和临床资料,其中星形细胞瘤18例、髓母细胞瘤15例、室管膜瘤7例、胚胎发育性神经上皮瘤5例、血管母细胞瘤3例.肿瘤位于小脑蚓部20例.小脑半球14例,脑干9例,第四脑室5例.所有病灶均引起梗阻性脑积水.MR能显示肿瘤的位置、大小、形态及信号特点,定性诊断明显优于CT.初步研究结果提示,儿童后颅窝肿瘤的MR表现具有一定的特征性,对定位和定性诊断具有重要的临床应用价值,患儿不典型的症状与体征以及未及时行头颅MR检查是延误诊断的主要原因.     

儿童髓母细胞瘤的显微手术治疗——附24例报告

背景与目的：髓母细胞瘤是儿童常见的中枢神经系统恶性肿瘤，手术是其治疗的主要手段。本文通过对24例儿童髓母细胞瘤显微外科治疗分析，总结儿童髓母细胞瘤的显微手术经验。方法：收集1999-2007年我院经手术证实的儿童髓母细胞瘤24例，对其临床资料进行回顾性分析。其中男16例，女8例，平均年龄7．5岁，常见症状和体征为高颅压征和共济失调，全部患者均行显微手术治疗，术后辅助放射治疗。19例随访6个月至6年。结果：全组病例中，肿瘤全切21例，大部分切除2例，部分切除1例，手术死亡率4．2％（1／24），未出现严重并发症．患儿生存质量得到提高。结论：掌握显微手术方法和手术中注意事项，有利于提高肿瘤切除程度及减少手术并发症．手术后辅助放疗有利于改善预后。     

髓母细胞瘤的CT和MRI影像学分析及临床意义

目的:通过对髓母细胞瘤的CT 及MRI表现分析,加强对本病的认识,提高术前诊断的准确性并合理选择治疗方案.方法:对31例经手术、病理证实的髓母细胞瘤进行回顾性分析,所有病例均行 CT 和/或 MRI检查.结果:髓母细胞瘤好发于儿童,常见于小脑蚓部;成人髓母细胞瘤少见,多见于小脑半球.CT 平扫呈等或稍高密度影,增强扫描多强化明显.MRI扫描 T1 加权像呈低或等信号,T2 加权像呈略高或混杂信号,增强扫描强化明显.结论:髓母细胞瘤有特定的发生部位、年龄及影像学特征性;仔细分析CT和 MRI表现,可做出准确的术前诊断并指导制定治疗方案,改善预后.     

成人与儿童髓母细胞瘤临床特点的分析

目的探讨成人与儿童髓母细胞瘤的临床特点及预后。方法回顾性分析109例经手术和病理证实的髓母细胞瘤病例,分为成人组和儿童组,对其进行综合治疗并随访。结果成人组和儿童组术后平均生存时间分别为69.6个月、32.3个月,术后3年生存率分别为80.8%(21/26)、42.2%(35/83),术后5年生存率分别为69.2%(18/26)、25.3%(21/83)。结论成人与儿童髓母细胞瘤的好发部位、发生机制以及术后放、化疗耐受程度不同,成人髓母细胞瘤的预后普遍好于儿童髓母细胞瘤。     

儿童第四脑室肿瘤显微外科治疗及手术后并发症的预防

背景与目的:儿童第四脑室肿瘤术后易出现的枕部皮下积液或假性脑膜膨出、切口脑脊液漏、颅内感染等并发症。本文探讨儿童第四脑室肿瘤手术计划的制订,以提高手术疗效。方法:2006年5月以来26例第四脑室肿瘤患儿在切除肿瘤前均行右侧脑室-前额Ommaya囊安置;术中及术后通过Ommaya囊持续外引流;经膜髓帆入路手术切除儿童第四脑室肿瘤。结果:所有患儿在切除肿瘤前均行右侧脑室-前额Ommaya囊安置;术中及术后通过Ommaya囊持续外引流;肿瘤全切23例,次全切除3例,无一例出现缄默症,本手术组无死亡病例。6例颅内感染者得到有效控制,无一例出现脑积水而需要行分流术,未出现一例枕部假性脑膜膨出及切口脑脊液漏等并发症。结论:多数儿童第四脑室肿瘤患者可经膜髓帆入路在不需要切开小脑蚓部的情况下予以肿瘤切除,仅少数患者为了充分显示肿瘤上极而切开小脑下蚓部。术前安置Ommaya囊术后持续外引流,可以有效地预防并发症的发生。     

Soft-tissue tumours of the perineum.

AIM: Primary perineal tumours in adults are rare entities that have been infrequently reported (one clinical series of nine patients with sarcoma and isolated case reports). We present our experience of perineal tumours better to characterize and define the natural history of this condition. METHODS: Perineal tumours occurring in adults (>18 years) from January 1990 were identified from the Royal Marsden Hospital's Sarcoma Unit prospective database. RESULTS: Nineteen perineal soft-tissue tumours (12 malignant and seven benign) were evaluated and treated at the Royal Marsden Hospital during this period. Liposarcoma (n=3) and aggressive angiomyxoma (n=4) were the most frequent histological subtypes. Three malignant and four benign tumours were larger than 10 cm. Most tumours were located deep to the deep fascia. Local recurrence in those with sarcoma occurred in one of five patients with negative microscopic margins and in one of two patients who had positive microscopic margins. One patient each with aggressive angiomyxoma and fibromatosis recurred locally. CONCLUSION: Aggressive treatment in the form of wide local excision is associated with fewer local recurrences in adults with primary perineal soft-tissue tumours. The aim of surgical treatment should be to obtain negative resection margins without causing disturbance to urinary or anorectal function.     

The Psychosocial Impact of COVID-19 on Older Adults with Cancer: A Rapid Review

Background: Older adults with cancer are amongst the most vulnerable population to be negatively impacted by COVID-19 due to their likelihood of comorbidities and compromised immune status. Considering the longevity of the pandemic, understanding the subjective perceptions and psychosocial concerns of this population may help ameliorate the psychological aftermath. In this review, we systematically analyze the literature surrounding the psychosocial impact and coping strategies among older adults with cancer within the context of COVID-19. Methods: We conducted a rapid review of literature following PRISMA guidelines between January 2020 to August 2021 using (1) MEDLINE, (2) Embase, (3) CINAHL, and (4) PsychINFO and keyword searches for “cancer” and “COVID-19” focused on adults 65 years or older. Results: Of the 6597 articles screened, 10 met the inclusion criteria. Based on the included articles, the psychosocial impact of COVID-19 was reported under four domains, (1) impact of COVID-19 on quality of life (QoL), (2) concerns related to COVID-19, (3) coping with the impact of COVID-19, and (4) recommendations for future care. Results pertaining to perceived quality of life were inconsistent across the included articles. The most common concerns related to: contracting COVID-19, survivorship transitions, and feelings of isolation. Coping strategies reported by older adults included: spiritual care, lived experience, acceptance, and positive reinterpretation. Conclusions: We found many psychosocial impacts of the pandemic on older adults with cancer. The findings from this review can inform interventions related to shared decision-making and tailored patient care in the future.     

成人噬血细胞性淋巴组织细胞增生症21例临床分析

目的:探讨成人噬血细胞性淋巴组织细胞增生症(HLH)的临床特点。方法:对2005年1月－2015年1月在南京医科大学第二附属医院血液科收治的21例成人HLH患者的临床资料进行回顾性分析。结果:21例患者初治时均表现为高热、肝脾肿大、凝血功能异常、血常规三系或二系受累。病因分析中7例（33.3%）为血液肿瘤相关性;10例（47.6%）为感染,其中3例确诊为发热伴血小板减少综合征（新型布尼亚病毒核酸检测阳性）;1例（4.8%）肿瘤相关性（骨髓活检示转移癌）;3例（14.3%）原因不明。随访中死亡16例,存活3例（最长至今已5年7个月）,2例失访;生存时间为4天～5.7年（中位生存时间183天）。结论:HLH为罕见的致死性疾病,成人更为少见。临床表现复杂,常伴有多脏器受损,病情凶险,进展迅速。预后大多不良。发病机制和治疗手段有待进一步研究。     

Immune-related adverse events in older adults: Data mining of the FDA Adverse Event Reporting System

IntroductionRecent studies reveal that there is no difference in the efficacy of immune checkpoint inhibitors (ICIs) between younger adults and older adults. However, it remains unclear whether age is a risk factor for immune-related adverse events (irAEs).Materials and methodsTo analyze the association between irAEs and age based on data from the Food and Drug Administration Adverse Event Reporting System (FAERS) database between January 2004 and December 2020, we performed a case/noncase study on ICI-related adverse events. Cases were defined as adverse event cases with ICI therapy and irAEs, and noncases were defined as adverse event cases with ICI therapy and without irAEs. One case was matched to a noncase using the sex, reporter, report year, and type of ICI regimen. The reporting odds ratios (RORs) were used to assess the disproportionality of irAEs between older adults (≥65 years) and younger adults (<65 years).ResultsThe study shows that compared with younger adults, the ROR of older adults was 1.12 (95% confidence interval [CI]: 1.08–1.16) and 1.18 (95% CI: 1.14–1.23) before and after matching, respectively. The signal of age-related irAEs was detected in patients treated with ICI monotherapy but not in patients treated with combination therapy. Further analysis revealed a spectrum of age-related toxicities including cardiovascular toxicities, lung toxicities, musculoskeletal toxicities, nervous system toxicities, renal toxicities, and skin toxicities.ConclusionIn this analysis performed based on the FAERS, irAE cases were more likely to be reported in older adults. Our pharmacovigilance study complements the safety data of clinical trials. Further studies are expected to explore the underlying reasons for irAEs in older adults.     

成人股骨颈骨折术后切口部位感染的风险因素分析

目的探讨成人股骨颈骨折术后切口部位感染的危险因素。方法对 2016 年 4 月至 2019 年 1 月因股骨颈骨折入院手术治疗的 400 例患者资料进行分析,其中男 188 例,女 212 例;年龄 65~88 岁,平均 (78.3±10.6) 岁。按致伤原因分为:跌倒伤 93 例、车祸伤 58 例、外伤 249 例。按照术后是否存切口部位感染,分为感染组 (n=382) 和未感染组 (n=18)。通过单因素和多因素分析确定切口部位感染的相关危险因素。结果单因素分析结果显示,多发损伤、肥胖 (BMI ≥ 28)、风湿病、服用激素及贫血史均是切口部位感染的危险因素 (P<0.05),而其它变量均与切口部位感染的发生不相关。多因素分析结果显示 BMI ≥ 28、糖尿病、服用激素、贫血及术前血红蛋白水平均是切口部位感染的独立危险因素 (P<0.05)。Hosmer-Lemeshow 检验结果显示多因素回归模型的拟合优度可 (χ^2=9.645,P=0.213)。结论糖尿病、BMI ≥ 28、皮质类固醇激素及贫血均是股骨颈骨折患者术后切口部位感染的独立危险因素。     

Use of geriatric assessment in cancer clinical trials: A systematic review

BackgroundOlder adults are underrepresented in cancer clinical trials despite accounting for most of the disease burden. Geriatric assessment (GA) could be used in clinical trials of cancer drugs for older adults to improve the clinical evidence for cancer drug use among older adults.ObjectiveTo examine patterns of use of GA in cancer clinical trials.MethodsWe undertook a systematic review of the studies reporting use of GA in a clinical trial setting for all cancer types and published between January 2010 and January 2020. Characteristics of GA use were extracted for each study, along with study phase, cancer type, and participant age (PROSPERO: CRD42020170584).ResultsWe identified 320 studies and 63 studies met the final inclusion criteria. Among 74 purposes of GA use, the most common was to examine the association between impairments in GA domains and clinical outcomes (28/74, 38%). Among 258 GA domains assessed across 63 studies, physical status (59/258, 23%) and comorbidities (50/258, 19%) were most often evaluated. There was significant heterogeneity in the instruments used to assess physical function (n = 16) and mood disorders (n = 7). Most studies were phase 2 (32/63, 51%).ConclusionsGA is most often used in clinical trial settings to examine associations between GA-identified deficits and clinical outcomes. Significant heterogeneity exists in the GA instruments used across trials. Comprehensive and consistent incorporation of GA into future cancer clinical trial designs could help collect more older adult-specific clinical information and adjust trial eligibility criteria to increase representation by older adults.     

Comparison of Presentation and Clinical Outcome between Children and Young Adults with Differentiated Thyroid Cancer

Background: The aim of the present study was to evaluate the presentation, clinical course and outcome between children and young adults with differentiated thyroid cancer (DTC) treated in our hospital. Materials and Methods: The medical records of 145 patients with DTC who underwent surgery followed by radioiodineand thyroid hormone (TSH) suppression were retrospectively reviewed. The follow up was between January 2006 and June 2012. These patients consisted of 38 children (age≤18y) and 107 young adult patients (age≤30y). The clinical characteristics and outcome were analyzed and compared, and the progression-free survival (PFS) was evaluated using the Kaplan-Meier method. Results: At initial diagnosis, a greater degree of extra thyroidal extension was found in children than adults patients (p<0.001). However, there was no significant difference between the two groups with regard to the tumor size and the presence of lymph node or distant metastasis (p=0.172, p=0.050 and p=0.068, respectively). The extent of surgery and the cumulative or mean dose of radioiodinewere similar in both groups. During the follow up, the overall survival rate was 100% for both groups, and the PFS rate was similar in children and in young adults group (log rank test, χ2=0.126, p=0.723). Conclusions: In comparison to the young adult patients, DTC in children presents with more aggressive behavior, but outcomes are similar between the two groups after the intensive management of surgery followed by radioiodine and TSH suppression therapy.     

Distinct features of colorectal cancer in children and adolescents

BACKGROUND:

Colorectal cancer is exceedingly rare in children and adolescents. Reports from small series indicate that poor prognostic factors are more common in children than in adults, resulting in worse outcome for the pediatric population.

METHODS:

The Surveillance, Epidemiology, and End Results database was searched for records of children/adolescents with colorectal cancer, and the features and outcomes were compared with those of adults.

RESULTS:

From January 1973 through December 2005, only 159 children/adolescents (ages 4‐20 years) were reported with a diagnosis of colorectal cancer. The most common sites of involvement were the rectum (27%) and the transverse colon (26%). Adenocarcinoma was the most common histiotype in both adults and pediatric patients; however, children/adolescents had more unfavorable histiotypes (ie, mucinous adenocarcinoma [22%] and signet ring cell carcinoma [18%]) when compared with adults (10% and 1%, respectively; P < .001). Poorly differentiated and undifferentiated tumors (grades III and IV, respectively) and distant stage were more common in children/adolescents (P < .001). The 5‐year relative survival estimates in children/adolescents and adults were 40% ± 4.2% and 60% ± 0.10%, respectively, confirming a worse outcome in the pediatric age group (P < .001).

CONCLUSIONS:

Children/adolescents represent a minority of patients with colorectal cancer and have high‐risk features and worse outcome than adults. The small number of patients in this age group was an impediment to the development of meaningful clinical trials. Thus, the principles of management for adult colorectal cancer should be used in the treatment of children and adolescents. Cancer 2010. © 2009 American Cancer Society.     

Care provided by older adults in active cancer treatment to a spouse: A scoping review

ObjectivesOlder adults with cancer may be spousal caregivers for partners with one or more chronic conditions, and there has not been an overview of the needs of this population. Therefore, we conducted a scoping review to assess what is known about the type and amount of spousal care provided by older adults (≥65 years) with any type of cancer, in the active treatment phase.Materials and methodsA search strategy was designed with a Health Sciences Librarian and performed using the following electronic databases from inception to January 2021: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo. Two independent reviewers screened all abstracts and full-text studies for inclusion.ResultsSearches were run February 26, 2020, and re-run January 8, 2021. A total of 8887 titles and abstracts were screened and 32 selected for full text review, but only two case reports were included in this review. The two case reports discussed the experience of an older adult with cancer, in active treatment, as the caregiver to a spouse. However, the type and amount of care provided by the caregiver to the spouse was not specified in either report. In both reports, caregivers declined cancer therapy to focus on the needs of the care recipients.ConclusionOnly two case reports were identified that examined the experiences of older adults with cancer acting as caregivers to a spouse. It is important for future studies to address this gap to better understand the needs of this population and develop future supportive interventions.