老年晚期非小细胞肺癌患者并存疾病及年龄对一线单药化疗耐受性的影响

目的探讨老年晚期非小细胞肺癌患者并存疾病及年龄对一线单药化疗耐受性的影响。方法选取2012年1月至2013年10月在该院肿瘤内科住院治疗的行一线单药化疗的老年晚期非小细胞肺癌患者65例。一线单药化疗方案为吉西他滨或多西他赛,采用Charlason并存疾病指数(CCI)对患者并存疾病进行评价,CCI评分0分患者纳入无并存疾病组,≥1分者纳入并存疾病组。按照NCI-CTC3.0版标准对化疗不良反应进行评估。结果 CCI评分≥1分组患者单药化疗后3或4级血液学毒性、粒细胞缺乏发热、因不良事件中断治疗的发生率明显高于CCI评分0分组(P<0.05);糖尿病和慢性肺病是最常见的并存疾病,其中并存慢性肺病的患者3或4级非血液学毒性发生率明显高于无并存慢性肺病患者(P<0.05);年龄和PS评分不能预测老年晚期非小细胞肺癌患者3级及以上不良反应的发生。结论并存疾病的老年晚期非小细胞肺癌患者化疗后不良反应,尤其是3或4级血液学毒性发生率明显提高,应通过化疗前评价并存疾病提高老年晚期非小细胞肺癌患者对一线单药化疗的耐受性。     

晚期复发转移直肠癌56例同步放化疗的疗效观察

目的观察FOLFOX4联合放疗治疗晚期复发转移直肠癌的疗效与毒性反应。方法对56例无法手术的晚期或复发直肠癌患者进行盆腔放疗,在放疗的第1、5周同时给予FOLFOX4方案化疗,以56例单纯同方案化疗者为对照组。结果单纯化疗组、放化疗组的有效率分别为66.1%、83.9%(P0.05);肛门、会阴疼痛缓解率分别为30.4%、55.4%;粘液血便缓解率分别为17.9%、30.4%;无病生存期分别为10.8个月、12.6个月(P0.05);中位生存期分别为17.2个月、21.8个月(P0.05)。主要毒副反应是消化道反应、神经毒性、骨髓抑制,经对症和支持治疗后患者均能够耐受。结论 FOLFOX4方案化疗与盆腔同步放疗治疗晚期及复发转移直肠癌能较好控制局部复发病灶,控制远处转移,改善局部症状,提高生活质量及生存期。     

宫颈癌术后放疗中安多霖对急性放射性肠炎的预防作用

行盆腔放疗的52例宫颈癌患者,按照有无口服安多霖分为安多霖组25例和对照组27例。比较两组患者的正常组织受量以及肠道的毒性反应。结果显示,安多霖可以明显降低放疗后肠道不良反应,使更大比率患者的肠道反应为0级,并且使患者降低了肠道毒性反应的发生率。     

75岁以上老年急性心肌梗死患者急诊介入术中发生室性心律失常电风暴的危险因素

目的探讨老年急性ST段抬高型心肌梗死(STEMI)患者行急诊PCI术中发生室性心律失常电风暴(VSA)的危险因素。方法收集急性STEMI且行急诊PCI术的老年患者142例,根据VSA发生情况分为VSA组28例,非VSA组114例,另根据治疗时间不同分为干预组80例,未干预组62例。未干预组年龄≥75岁12例,60~75岁50例;干预组年龄≥75岁29例,60~75岁51例。比较各组发生VSA的危险因素。结果未干预组年龄≥75岁患者VSA发生率明显高于60~75岁患者(41.7%vs 32.0%,P0.05)。干预组年龄≥75岁患者VSA发生率明显高于60~75岁患者(13.8%vs 5.9%,P0.05)。干预组年龄≥75岁患者VSA发生率明显低于未干预组年龄≥75岁患者,差异有统计学意义(P0.05)。年龄≥75岁VSA患者心电图J波、QRS波、右冠状动脉、心动过缓、持续低血压以及TIMI 0级比例明显高于非VSA患者(P0.05,P0.01)。多元logisict回归分析显示,心电图J波、心肌肌钙蛋白Ⅰ、TIMI血流分级、持续低血压是年龄≥75岁患者发生VSA的独立危险因素(P0.05,P0.01)。结论提前干预老年急性STEMI患者高危因素,可降低VSA发生率,提高VSA治疗成功率,改善预后。     

S-1治疗老年不可切除的晚期结直肠癌的临床观察

目的明确S-1单药对大于70岁的老年不可切除的晚期结直肠癌的疗效与安全性。方法研究纳入的患者需根据WHO(1981)实体瘤疗效评价标准(RECIST)有可测量或可评估的病灶。口服S-1,2次/d,每次剂量为40 mg/m2,每疗程包括4周持续给药治疗,随后2周休息,继而重复下一疗程。结果 78例患者的总治疗缓解率为20.51%,临床获益率为71.79%。3级或3级以上白细胞减少发生率为14%,贫血发生率为29%。其他非血液学毒性反应中,3级或3级以上恶心的发生率为14%,疲劳为23%,厌食为29%。结论 S-1单药治疗对老年不可切除的晚期结直肠癌安全、有效。     

CT图像引导下三维腔内后装治疗宫颈癌的临床疗效

目的探讨老年宫颈癌患者三维适形放疗联合三维后装治疗后胃肠道毒性反应及其相关影响因素。方法 56例局部晚期老年宫颈癌患者,进行盆腔外照射50 Gy/25 f后,进行CT图像引导下192Ir三维腔内后装治疗,观察胃肠道毒性反应率及相关影响因素、总生存率(OS)、无病生存(DFS)、盆腔复发、远处转移情况。结果中位随访时间22.4个月,胃肠道毒性反应16例(28.6%)(1级14例,2级1例,3级1例)。在严格控制剂量体积限制的前提下,多因素分析显示胃肠道毒性反应与FIGO分期及是否同步化疗密切相关,而与年龄、瘤体大小、淋巴结转移及放疗持续时间未显示明显的关联性。56例患者2年OS 87.5%(95%CI 61.7%~96.8%),无病生存率(DFS)78.6(95%CI 49.7%~89.8%)局部复发率(RF)7.1%(95%CI 0%~12.6%),远处转移率(DF)14.3%(95%CI 5.7%~23.4%)。结论联合三维后装患者胃肠道毒性反应明显减少,尤其是3级反应,FIGO分期及是否同步化疗与胃肠道毒性反应的发生率密切相关,具有显著统计学差别。     

老年急性脑梗死后吞咽障碍患者衰弱的风险预测列线图模型构建与验证

目的：探讨老年急性脑梗死后吞咽障碍患者衰弱的的危险因素，并建立风险预测列线图模型。方法：回顾性分析2020年2月～2022年3月本院收治的195例老年急性脑梗死后吞咽障碍患者的临床资料，按2：1的比例将患者随机分为建模组（130例）和验证组（65例），并根据是否衰弱将建模组患者进一步分为衰弱组和非衰弱组。采用多因素Logistic回归分析建模组老年急性脑梗死后吞咽障碍患者衰弱的危险因素，建立风险预测列线图模型。绘制受试者工作特征（ROC）曲线、校准曲线和决策性曲线（DCA）评估列线图模型的预测效能、准确度和临床效益，并使用验证组评估列线图的可行性。结果：195例患者中发生衰弱125例，发生率为64.10%；建模组130例患者中发生衰弱83例，发生率为63.85%；验证组65例患者中发生衰弱42例，发生率为64.62%；衰弱组年龄75岁以上、吞咽障碍病程≥21d、无配肌⒍谰印⒆苑选⒕盟浇喜睢⒑喜⒅ⅰ�3种、服药种类≥3种、肢体运动障碍、抑郁、营养不良、低社会支持水平占比均高于非衰弱组（P＜0.05），膳食指导占比低于非衰弱组（P＜0.05），多因素Logistic回归分析显示上述指标均是老年急性脑梗死后吞咽障碍患者衰弱的影响因素（P＜0.05）；根据上述影响因素构建老年急性脑梗死后吞咽障碍患者衰弱的风险预测列线图模型，ROC曲线分析显示建模组列线图预测模型的曲线下面积（AUC）为0.853（95%CI：0.780~0.909），灵敏度为78.31%，特异度为85.11%；验证组列线图预测模型AUC为为0.844（95%CI：0.732~0.922），灵敏度为76.19%，特异度为82.61%；建模组校准曲线的一致性指数为0.798，提示区分度良好，校准曲线比较接近标准曲线，DCA显示当阈值概率为0~0.9，使用列线图预测老年急性脑梗死后吞咽障碍患者发生衰弱风险的净收益更高，且均在验证组得到证实。结论：年龄75岁以上、吞咽障碍病程、独居、自费、经济水平较差、合并症≥3种、服药种类≥3种、肢体运动障碍、抑郁、营养不良、膳食指导、低社会支持水平均是老年急性脑梗死后吞咽障碍患者衰弱的影响因素，根据上述影响因素构建列线图模型有助于筛选高危患者，指导临床早期干预。     

保留盆腔自主神经对老年男性直肠癌TME术后性功能和泌尿功能的影响

目的探讨保留盆腔自主神经(PANP)的直肠全系膜切除术(TME)对老年男性直肠癌患者性功能和泌尿功能的影响。方法将36例直肠癌患者随机分为观察组和对照组:观察组行TME+PANP治疗,对照组行常规TME治疗。术后进行半年随访,评价患者性功能和泌尿功能,随访3年观察患者局部复发情况。结果观察组泌尿功能障碍、性功能障碍发生率较观察组低(P<0.05),术后3年两组患者的局部复发率分别为11.1%和16.7%,生存率为74.2%和71.4%,两组间的差异并无统计学意义(P>0.05)。结论保留盆腔自主神经的直肠癌根治术可以较好地保护老年男性患者的性功能和泌尿功能,而患者局部复发率并没有升高。     

氨基末端脑钠肽前体与老年冠心病患者支架置入术后造影剂肾病的相关性

目的探讨血浆氨基末端脑钠肽前体(NT-proBNP)水平与老年冠心病患者行PCI术后造影剂肾病(CIN)的相关性。方法选择行PCI的老年冠心病患者300例,按NT-proBNP水平的四分位分为4组:Q1组75例(NT-proBNP<450ng/L)、Q2组75例(NT-proBNP 450~900ng/L)、Q3组75例(NT-proBNP 901~1800ng/L)、Q4组75例(NT-proBNP>1800ng/L)。PCI手术前后分别测NT-proBNP等。采用ROC曲线及logistic分析NT-proBNP与CIN的关系。结果Q1、Q2、Q3及Q4组发生CIN分别为3例(4.0%)、8例(10.7%)、12例(16.0%)和19例(25.3%),4组CIN发生率比较差异有统计学意义(P=0.000);4组急性心力衰竭发生率比较,差异有统计学意义(1.3%vs 4.0%vs 6.7%vs 14.7%,P=0.000)。NT-proBNP预测CIN的ROC曲线下面积0.701,其界值为1277.5ng/L时,预测CIN的敏感性为73.8%,特异性为62.8%;logistic回归分析示,术前NT-proBNP是CIN的独立危险因素(OR=2.8,95%CI:1.2~6.4,P=0.008)。结论术前血浆NT-proBNP水平与老年冠心病行PCI后CIN密切相关,且是其独立危险因素。     

沙利度胺联合乌苯美司同步放疗对老年局部晚期非小细胞肺癌的效果

目的探讨沙利度胺联合乌苯美司同步放疗在治疗老年局部晚期非小细胞肺癌(NSCLC)中的作用。方法将60例老年局部晚期NSCLC患者随机分成两组,研究组放疗同步沙利度胺联合乌苯美司,在放射治疗开始之日给予沙利度胺口服,第1周100 mg/d,每晚睡前顿服,第2周开始增加至200 mg/d,并以200 mg/d维持,并同时予乌苯美司胶囊,晨空腹口服30 mg/d,沙利度胺和乌苯美司均维持3个月以上;对照组为单纯放射治疗。两组均采用调强适形放射治疗(IMRT),治疗总剂量60 Gy,2 Gy/次,1次/d,5次/w,共6 w。观察两组生活质量、近期疗效、免疫功能及毒副作用。结果研究组生活质量、近期疗效改善均显著高于对照组(χ~2=4.022,4.267,均P0.05);研究组CD3、CD4、自然杀伤(NK)细胞比例均显著高于对照组(χ~2=5.397、3.152、4.528,均P0.05);两组造血系统毒性差异有统计学意义(P0.05);两组急性放射性肺炎、急性放射性食管炎发生率差异无统计学意义(P0.05)。结论沙利度胺联合乌苯美司同步放疗治疗老年局部晚期NSCLC可提高患者生活质量,增强治疗效果及免疫功能,降低血液系统毒性反应,近期疗效良好。     

老年与非老年直肠黏液腺癌患者对不同放疗策略的受益可能不同：一项基于SEER数据库的回顾性研究

目的探讨老年与非老年直肠黏液腺癌患者对于新辅助放疗、辅助放疗的受益情况,并分析影响直肠黏液腺癌患者预后的因素。 方法应用美国国家癌症研究所的监测、流行病学和结果数据库（SEER）,收集2000~2016年,病理诊断为直肠黏液腺癌的患者共3 997例,根据年龄分为老年组（≥60岁）和非老年组（<60岁）,分析比较两组接受新辅助放疗联合手术、单纯手术和术后辅助放疗患者的预后情况,对两组患者的三种治疗方式分别进行倾向得分匹配,比较不同治疗方法对预后的影响,应用Kaplan-Meier法分别绘制生存曲线,应用Log-rank检验分析各组生存差异,应用COX比例风险模型分析影响直肠黏液腺癌患者预后的因素。 结果三种治疗方案的总生存率,新辅助放疗总生存率最高,其次为术后放疗,最后为单纯手术组,组间比较差异有统计学意义（χ²=13.117,22.541;P<0.05）。但三种治疗方案的肿瘤特异性生存,仅新辅助放疗显著高于术后放疗（χ²=4.023,P=0.045）。对各种治疗方案进行倾向得分匹配后,老年患者新辅助放疗的总体生存率显著高于单纯手术（χ²=4.874,P=0.027）,非老年患者单纯手术的总体生存率（χ²=5.530,P=0.019）和肿瘤特异性生存率（χ²=4.825,P=0.028）均显著高于术后放疗。高龄（≥60岁）、男性、未化疗和高TNM分期是直肠黏液腺癌患者总生存率较差的影响因素,其HR分别为1.689（95% CI=1.524~1.871）、1.110（95% CI=1.007~1.223）和1.549（95% CI=1.338~1.792）,Ⅱ期HR=2.675（95% CI=1.191~6.008）,Ⅲ期HR=3.617（95% CI=1.612~8.115）,Ⅳ期HR=10.835（95% CI=4.797~24.474）;高龄（≥60岁）、未化疗和高TNM分期是直肠黏液腺癌患者肿瘤特异性生存率较差的影响因素,其HR分别为1.297（95% CI=1.156~1.456）,1.344（95% CI=1.129~1.601）,Ⅲ期HR=6.365（95% CI=1.582~25.614）,Ⅳ期HR=20.957（95% CI=5.189~84.637）。 结论老年直肠黏液腺癌患者可能从新辅助放疗中获益,而对于非老年患者,放疗的预后并不优于单纯手术治疗。     

Clinical features,outcomes and treatment-related pneumonitis in elderly patients with esophageal carcinoma

AIM: To investigate the clinical features and prognoses of elderly patients with esophageal carcinoma and to compare the effects of radiotherapy and rates of treatment-related pneumonitis (TRP) between elderly and non-elderly patients.METHODS: A total of 236 patients with esophageal carcinoma who received radiotherapy between 2002 and 2012 were enrolled. The patients were divided into two groups: an elderly group (age ≥ 65 years) and a non-elderly group (age < 65 years). The tumor position and stage, lymph node and distant metastases, and incidence and severity of TRP were compared. Multivariate analysis was applied to identify independent prognostic factors.RESULTS: The median overall survival times after radiotherapy in the elderly and non-elderly groups were 18.5 and 20.5 mo, respectively. Cox regression analysis showed that TRP grade and tumor-node-metastasis (TNM) stage were independent prognostic factors in the elderly group. High-dose radiotherapy (> 60 Gy) was associated with a high incidence of TRP. Tumor TNM staging was significantly different between the two groups in which TRP occurred. Multivariate analysis showed that TNM stage was an independent prognostic factor. Esophageal carcinoma in elderly patients was relatively less malignant compared with that in non-elderly patients.CONCLUSION: An appropriate dose should be used to decrease the incidence of TRP in radiotherapy, and intensity modulated radiation therapy should be selected if possible.     

Postoperative chemoradiotherapy after surgical resection of gastric adenocarcinoma: can LV5FU2 reduce the toxic effects of the MacDonald regimen?: A report on 23 patients

AIM OF THE STUDY: A North American phase III trial has recently shown that postoperative chemoradiotherapy using the FUFOL Mayo Clinic regimen improves overall survival and relapse-free survival after surgical resection of gastric cancer. However, severe grade 3-4, hematologic and gastrointestinal toxicities were frequent. The aim of this retrospective and multicentric study was to determine the tolerance of a postoperative chemoradiotherapy regimen using LV5FU2 instead of the Mayo Clinic regimen. PATIENTS AND METHODS: Twenty-three patients with resected adenocarcinoma of the stomach or gastroesophageal junction at high risk of recurrence were treated with LV5FU2 chemotherapy and radiotherapy (45 Gy in 25 fractions and 5 weeks) delivered to the tumor bed and regional nodes. Nineteen patients were treated with two to four cycles before radiotherapy, then three cycles during radiotherapy, and finally four cycles after radiotherapy; four patients were only given three cycles during radiotherapy. RESULTS: Of the 23 patients assigned to this protocol, 20 completed treatment (87%). There was only one interruption of treatment because of hematologic or gastrointestinal toxicity. Tolerance of LV5FU2 regimen associated with radiotherapy was excellent: one grade 3 or 4 gastrointestinal toxicity (4.3%), no toxic death, and only one grade 3 neutropenia (4.3%) were reported. CONCLUSION: Radiotherapy combined with LV5FU2 appears to be better tolerated than the Mayo Clinic regimen used in the North American study. These results have to be considered when elaborating future postoperative chemoradiotherapy trials for gastric cancer.     

塞拉利昂弗里敦地区老年埃博拉病毒病患者临床特点研究

目的研究塞拉利昂弗里敦地区老年埃博拉病毒病(Ebola virus disease,EVD)患者的临床特点。方法选取我国解放军援塞医疗队2014年10月—2015年3月收治的老年(60岁)EVD确诊患者21例(老年组)进行回顾性分析,研究其临床特点。选取同期收治的非老年EVD患者235例(非老年组)作为对照。结果老年组病毒载量与非老年组差异无统计学意义。老年组主要临床表现依次为发热、乏力、纳差、腹痛、头痛、咳嗽、关节痛、恶心呕吐、腹泻、肌肉痛、胸痛和结膜炎。老年组腹痛(85.7%)和精神错乱(23.8%)的发生率均高于非老年组[64.3%(P=0.047)和8.9%(P=0.047)],关节痛(61.9%)的发生率低于非老年组(83.0%)(P=0.018)。老年组病死率(33.3%)与非老年组(39.1%)差异无统计学意义,老年组入院后至死亡的平均死亡时间[(3.0±1.4)d]与非老年组[(2.3±1.7)d]差异亦无统计学意义。结论老年EVD患者临床表现及预后与非老年EVD患者类似,但仍具有其自身特点,这对诊断和治疗具有重要的指导意义。     

Long-term prognosis after reperfusion therapy for acute myocardial infarction in elderly patients

Although it has been well demonstrated that TIMI grade 3 flow is associated with improved survival after acute myocardial infarction in non-elderly patients, its implication in elderly patients has not been clarified. To assess this issue, 1,115 patients with acute myocardial infarction who underwent coronary angiography within 24 hours after the onset of chest pain were studied: there were 131 elderly patients (age > or = 75 years) and 984 non-elderly patients (age < 75 years). Follow-up was achieved for 1,092 patients (98%). Elderly patients were associated with more female, Killip class > or = 2, 3 vessel disease and non-smokers. Although modality of reperfusion therapy was not different, final TIMI flow grade was less frequently obtained in elderly patients (53% vs 65%, p = 0.005). Elderly patients were associated with higher in-hospital mortality (25% vs 9%, p < 0.001) and lower 10 years cardiac death free rate (p < 0.001). Cox proportional hazards model showed that final TIMI flow grade 3 was an independent predictor of 10 years cardiac death free in elderly patients (odds ratio (OR) = 0.39, 95% confidence interval (CI) = 0.20-0.74, p = 0.004) as well as non-elderly patients (OR = 0.41, 95% CI = 0.29-0.58, p < 0.001). In conclusion, our data suggest that final TIMI grade 3 flow is an important determinant to improve short- and long-term survival after acute myocardial infarction in elderly patients as well as in non-elderly patients.     

Tolerability and safety of nintedanib in elderly patients with idiopathic pulmonary fibrosis

BackgroundIn the phase III trial of nintedanib, only 10.8% of participants were aged ≥75 years. Here, we aimed to evaluate the tolerability and safety of nintedanib in elderly patients with idiopathic pulmonary fibrosis (IPF).MethodsIn total, 71 consecutive patients with (1) IPF, (2) age ≥75 years, and (3) newly prescribed nintedanib from September 2015 to April 2018 (elderly group) were retrospectively reviewed. Patient characteristics, treatment status, and adverse events (AEs) were compared between the elderly group and 126 patients with IPF, aged <75 years, with newly prescribed nintedanib during the same period (non-elderly group).ResultsIn the elderly group, 32 patients (46.4%) discontinued nintedanib within 6 months. Body size was significantly smaller, the incidence rates of anorexia and nausea were significantly higher, and early termination within 6 months were more common in the elderly than in the non-elderly group. In elderly patients, a univariate logistic regression analysis showed that body mass index (BMI) and percentage forced vital capacity (FVC) were risk factors for early termination (p = 0.02 and 0.03, respectively). A low initial nintedanib dose did not reduce the incidence of AEs and early termination rate in the elderly group.ConclusionsIn elderly patients with IPF, the incidence of early nintedanib termination was higher, and anorexia and nausea were common AEs compared with those in non-elderly IPF patients. Treatment was frequently discontinued in elderly patients with low BMI and FVC, and chest physicians should be aware that nintedanib therapy may result in early termination in these patients.     

老年人反流性食管炎1119例分析

目的 探讨老年人反流性食管炎（RE）的临床和内镜特点。方法 将2067例RE分为老年组（1119例）和非老年组（948例），并对其临床和内镜资料进行对比分析。结果 老年组和非老年组RE检出率分别为8．9％和4．3％（P〈0．01）；呕血或／和黑便的发生率分别为14．6％和6．9％（P〈0．05）；其他临床表现两组相似。老年组内镜下分级为Ⅰ级62．4％、Ⅱ级24．7％、Ⅲ级11．6％和Ⅳ级1．3％，非老年组分别为74．5％、21．1％、4．1％和0．3％，两组构成趋势一致，但老年组Ⅲ级＋Ⅳ级所占的比率显著高于非老年组，分别为13．0％和4．4％（P〈0．01）；老年组伴发食管裂孔疝和残胃者分别为32．4％和9．8％，非老年组分别为11．9％和4．2％（均为P〈0．05）；老年组合并的Barrett食管伴异型增生者占33．8％（24／71）、癌变者占4．2％（3／71），非老年组分别为11．8％（9／76）和0％（均为P〈0．05）。结论 RE是老年人常见病，检出率是非老年人的2倍；老年人RE伴发食管裂孔疝和残胃者较多，内镜下病变较重，伴出血者较多；老年人RE合并的Barrett食管更易发生异型增生和癌变。     

老年与非老年溃疡性结肠炎患者直肠肛门运动及直肠感觉功能对比分析

目的 探讨老年溃疡性结肠炎(UC)患者肛门直肠运动及直肠感觉变化特点.方法 采用瑞典CTD-SYNECTICS公司生产的PC-Polygraf HR高分辨多道胃肠功能消化道检测仪,对35例非老年UC及19例老年UC患者肛门直肠动力和直肠感觉功能进行检测,并与20例非老年健康人和28例老年健康人进行比较.结果 (1)肛门静息压、括约肌压力、肛门括约肌最大缩窄压,老年UC组与相应对照组比较差异均无统计学意义(t值分别为1.311、1.298、1.401,P＞0.05);增加腹压时,老年UC组肛门括约肌净增压为(2.8±1.1)kPa,低于相应对照组的(3.8±1.2)kPa,差异有统计学意义(t=2.238,P＜0.05).(2)直肠对容量刺激的最低敏感量、最大耐受性和顺应性,老年UC组为(85±30)ml、(180±69)ml和(26.5±8.8)ml/kPa,低于老年对照组的(95±31)ml、(205±78)ml和(32.9±12.9)ml/kPa,差异均有统计学意义(t值分别为3.121、3.135、3.146,P＜0.01).(3)直肠对容量刺激的最低敏感量、最大耐受性、顺应性,老年UC组均高于非老年UC组(t值分别为2.246、2.239、2.240,P＜0.05);直肠最低敏感量、最大耐受性老年对照组高于非老年对照组(t值分别为2.238,2.301,P＜0.05).结论 UC患者存在肛门直肠运动异常,肛门自控能力减弱;UC患者直肠对容量刺激存在高敏感、低耐受、低顺应性现象.健康老年人直肠对容量刺激的感受阈较高,老年UC患者对容量扩张刺激敏感性比非老年UC患者弱.     

Adjuvant radiotherapy on older and oldest elderly rectal cancer patients

The purpose of this study was to evaluate the impact of radiotherapy in terms of feasibility and activity in the patients aged > or = 75 with advanced rectal cancer. From January 2002 to December 2006, 41 consecutive patients (27 men and 14 women) aged > or = 75 received radiotherapy for local advanced rectal cancer, 9 in a pre-operative and 22 in a post-operative setting. Sixteen patients received concomitant chemotherapy. Variables considered were age, co-morbidities, evaluated according to the adult co-morbidity evaluation index (ACE-27), surgery versus no surgery, and timing of radiotherapy. The median age was 80.5 years (range 75-90). A total of 19.5% of the patients had no co-morbidity, 48.8% mild, 17.1% moderate, and 14.6% had severe co-morbidities. Thirty-nine subjects (95.1%) were submitted to surgery. All patients but one completed the planned radiation schedule. At a median follow-up of 23.1 months, the 2- and 4-year overall survival rates were 71.8% and 61.6%, respectively. There was a better survival for patients with no or mild co-morbidities (p=0.002) and a good performance status (p=0.003). The cancer-free survival at 2 and 4 years was 78.9% and 26.4%, respectively. No difference in acute and late toxicity rates was found between patients with different ACE-27 indexes. We conclude that compliance with radiotherapy is good and rate of toxicity is acceptable in elderly patients. Patients with no or mild co-morbidities have a significantly better survival. Increasing severity of co-morbidity may sufficiently shorten remaining life expectancy to cancel gains with adjuvant radiotherapy. Further prospective trials are needed to confirm these results.     

Stereotactic body radiotherapy using CyberKnife for locally advanced unresectable and metastatic pancreatic cancer

AIM: To evaluate the efficacy and toxicity of stereotactic body radiotherapy using CyberKnife for locally advanced unresectable and metastatic pancreatic cancer.METHODS: From June 2010 to May 2014, 25 patients with locally advanced unresectable and metastatic pancreatic cancer underwent stereotactic body radiotherapy. Nine patients presented with unresectable locally advanced disease and 16 had metastatic disease. Primary end-points of this study were overall survival, relief of abdominal pain, and toxicity.RESULTS: Fourteen patients were treated with a total dose of 30-36 Gy in three fractions and the remainder with 40-48 Gy in four fractions. Median follow-up was 11 mo (range: 2-25 mo). The median survival duration calculated from the time of stereotactic body radiotherapy for the entire group, the locally advanced group, and the metastatic group was 9.0 mo, 13.5 mo, and 8.5 mo, respectively. Overall survival was 37% and 18% at one and two years, respectively. Abdominal pain relief was achieved within 2 wk of completing radiotherapy in the patients who received successful palliation (13 of 20 patients had significant pain). Five patients (20%) had grade 1 nausea, and one (4%) had grade 2 nausea. No acute grade 3+ toxicity was seen.CONCLUSION: Stereotactic body radiotherapy using the CyberKnife system is a promising, noninvasive, palliative treatment with acceptable toxicity for locally advanced unresectable and metastatic pancreatic cancer.