立体定向放射治疗肺癌脑转移疗效分析

目的探讨不同放射治疗方法对肺癌脑转移的疗效.方法176例由病理学证实的肺癌脑转移患者分为4组:单纯全脑放疗(WBRT)组、全脑放疗加立体定向放射外科(WBRT SRS)组、单纯立体定向放射治疗(SRT)组、全脑放疗加立体定向放射治疗(WBRT SRT)组.SRS治疗单次靶区平均周边剂量8～20Gy,总剂量20～32Gy;SRT治疗单次靶区平均周边剂量2～5Gy,总剂量25～60Gy;WBRT1.8～2Gy/次,总剂量30～40Gy.结果四组的局部控制率分别为47.0%、87.7%、86.5%和78.0%;中位生存期分别为5.0,11.0,11.5和10.0个月;局部无进展生存期分别为3.33,8.33,9.33和7.67个月;颅脑无新病灶生存期分别为4.11,8.57,9.03和6.12个月.在死因分析中,WBRT组死于脑转移的比率为57.6%,较其他三组高.而WBRT SRS组的晚期放射反应的发生率为12.2%,较其他组高.结论肺癌单发脑转移瘤患者的最佳治疗方式是单纯立体定向放射治疗,治疗失败后再行挽救性全脑照射或立体定向放疗.对于多发脑转移,全脑放疗加立体定向放射治疗(WBRT SRT)在提高生存率以及减少并发症方面优于其他治疗方法.     

肺癌脑转移不同放射治疗方法的疗效分析

［目的］探讨不同放射治疗方法对肺癌脑转移的疗效。［方法］１７６例有病理学证实的肺癌脑转移患者分为４组：单纯全脑放疗组(WBRT)、全脑放疗加立体定向放射外科(WBRT＋SRS)，单纯立体定向放射治疗(SRT)，全脑放疗加立体定向放射治疗(WBRT＋SRT)。SRS治疗组，单次靶区平均周边剂量８Gy～２０Gy，总剂量２０Gy～３２Gy；SRT治疗组，单次靶区平均周边剂量２Gy～５Gy，总剂量２５Gy～６０Gy；WBRT组，１．８Gy～２Gy／次，总剂量３０Gy～４０Gy。［结果］４组的局部控制率分别为４７．１％、８７．７％、８６．５％、７８％；中位生存期分别为５．０、１１．０、１１．５、１０．０个月；局部无进展生存期分别为３．３３、８．３３、９．３３、７．６７个月；颅脑无新病灶生存期分别为４．１１、８．５７、９．０３、６．１２个月。单纯全脑放疗组死于脑转移的占５７．６％，较其他３组高。而全脑放疗加立体定向放射外科组的晚期放射反应的发生率为１２．２％，较其它组高。［结论］肺癌单发脑转移瘤患者的最佳治疗方式是单纯立体定向放射治疗。多发脑转移，全脑放疗加立体定向放射治疗(WBRT＋SRT)在提高生存率以及减少并发症方面优于其他治疗方法。     

放射治疗肺癌脑转移临床疗效观察

目的探讨不同放射治疗方法对肺癌脑转移的疗效.方法对65例肺癌脑转移患者进行放射治疗,分为全脑放疗(WBRT)组、三维适形放射治疗(3D-CRT)组和全脑放疗加三维适形放射治疗(WBRT+3D-CRT)组.WBRT组2～3 Gy/次,总剂量30～40 Gy/3～4周;3D-CRT组治疗单次靶区周边剂量3～8 Gy,总剂量40～60 Gy;WBRT+3D-CRT组,WBRT 2～3 Gy/次,总剂量30～40 Gy/3～4周,之后3D-CRT治疗单次靶区周边剂量3～8 Gy,总剂量16～32 Gy.结果三组病例局部控制率分别为42.3%、84.3%和85.0%,中位生存期分别为5,11,12.5个月.在死亡原因中,WBRT组死于脑转移比率为53.8%,较后两组高.结论对于肺癌脑转移,全脑放疗加三维适形放射治疗(WBRT+3D-CRT)组及单纯三维适形放射治疗(3D-CRT)组在肿瘤局部控制率及生存率方面均优于全脑放疗(WBRT)组.     

肺癌脑转移不同放射治疗方式临床分析

目的:探讨不同放射治疗方法对肺癌脑转移瘤的疗效,并结合文献分析.方法:130例肺癌脑转移患者行放射治疗,分全脑照射组(Whole brain radiotherapy WBRT),立体定向放射治疗外科组(Stereotactic radiosurgery SRS),全脑照射 立体定向放射外科治疗外科组(WBRT SRS).全脑照射1.8Gy-2Gy/次,总剂量30-40/15-20天,立体定向放射治疗外科边缘剂量8Gy-22Gy,单次或分次完成;全脑照射 立体定向放射治疗外科治疗组,先WBRT2Gy-2.2Gy/次,总剂量30Gy-44Cy/3-4周,之后SRS治疗,单次靶区边缘剂量8Gy-12Gy.结果:三组病例局部控制率分别为49.9%,81.6%和85%,中位生存期分别为5个月,11个月及12.3个月.结论:对于肺癌脑转移,SRS及WBRT SRS治疗在局部控制率和生存率上明显优于WBRT.     

分次立体定向放射治疗全脑放疗后肺癌脑转移瘤52例疗效分析

[目的]分析分次立体定向放射治疗全脑放疗后肺癌脑转移瘤的疗效及不良反应.[方法]2007年12月至2010年12月对KPS＞60分的52例全脑放疗后的肺癌脑转移(病灶数目少于4个)患者给予分次立体放射治疗,单次靶区周边剂量为3～5Gy,总剂量为15～25Gy,分3～5次完成,50％等剂量曲线包绕PTV.[结果]截至2011年12月,46例患者死亡.自再次放疗开始算起,全组中位生存期为10.7个月(95％CI为8.5～12.9),1年及2年生存率分别为28.4％和7.2％.全组临床症状缓解率为73.1％,肿瘤局部控制率为90.4％.仅1例患者出现放射性脑坏死.[结论]分次立体定向放射治疗用于全脑放疗后疾病进展的肺癌脑转移患者,可以提高生存质量、延长患者生存期,安全性较好,但需严格掌握适应证.     

X线立体定向放射治疗脑转移瘤的疗效分析

目的观察立体定向放射手术治疗脑转移瘤的疗效。方法X线立体定向放射治疗脑转移瘤患者47例,采用10MV的直线加速器多个非共面弧旋转照射,肿瘤剂量为18～25Gy(平均22.1Gy)。40例患者在术后接受了肿瘤剂量30～40Gy的全脑放疗。结果中位生存期为11个月,1年生存率37.5%,疗后3个月的肿瘤控制率为90.7%,KPS≥70、原发肿瘤已控和无颅外转移患者的预后较好(P<0.05)。结论立体定向放射治疗脑转移瘤是安全和有效的。     

全脑放疗加X线立体定向放射治疗递归分割分析2～3级肺癌脑转移的疗效分析

[目的]探讨肺癌脑转移患者单纯全脑放疗（WBRT）与WBRT＋局部X线立体定向放射治疗（X-SRT）的疗效差异。[方法]回顾性分析72例递归分割分析（RPA）2～3级肺癌脑转移患者资料,其中WBRT组36例,WBRT＋X-SRT组36例。WBRT组放疗剂量DT30～40Gy/10～20f,WBRT＋X-SRT组在WBRT后局部SRT加量DT20～30Gy/2～5f。比较两组生存情况和放射性脑损伤情况。[结果]WBRT组和WBRT＋X-SRT组中位生存期分别为7个月和13个月;1年生存率分别为26.6%和54.4%,2年生存率分别为6.6%和31.4%,有统计学差异（χ2=8.555,P=0.003）。WBRT＋X-SRT组RPA2级和3级患者的中位生存期均为13个月。WBRT＋X-SRT组死于脑内转移者明显少于WBRT组（25.0%vs75.0%,χ2=10.934,P=0.004）。[结论]WBRT＋X-SRT治疗能明显提高肺癌脑转移患者的生存率,同时不增加急慢性放射性脑损伤。RPA分级法在肺癌脑转移中可能需进一步完善。     

三维适形放射治疗肺癌脑转移临床疗效观察

目的：通过观察脑转移三维适形放射治疗的结果，探讨三维适形放射治疗对非小细胞肺癌脑转移的临床意义。方法：1998年5月-2006年2月41例确诊肺癌脑转移患者，其中合并颅外转移18例，非颅外转移23例。所有患者首先经全脑放疗，2—3Gy／次，5次／周，DT30Gy-40Gy，然后行三维适形放射治疗局部加量，90％的等剂量曲线包括靶区，DT4—6Gy／次，总剂量12Gy-24Gy。结果：治疗有效率90．2％（37／41），中位生存期18月，半年生存率79．9％，1年生存率66．7％。结论：全脑放射治疗＋三维适形放射治疗可以提高脑转移的靶区剂量，并提高局部控制率，减少脑部复发的机会，同时颅外转移灶及原发灶的治疗也非常重要。     

全脑放疗联合立体定向分割放疗治疗脑转移瘤30例

[目的]探讨全脑放疗加立体定向分割放疗治疗脑转移瘤患者的疗效。[方法]30例1～4个脑转移瘤患者接受全脑放疗30~36Gy/（15~30f·3~3.5w）后加立体定向分割放疗25Gy/（5f·1周）（WBRT＋SRT组）。30例1～4个脑转移瘤患者接受单纯全脑放疗30Gy/（10f·2周）（WBRT组）。分析两组患者的1年局控率和1年生存率。[结果]WBRT＋SRT组和WBRT组1年局控率分别为76.3%、23.5%（P〈0.01）,1年生存率分别为46.7%、13.3%（P〈0.05）。两组均未出现严重毒副反应。[结论]全脑放疗加立体定向分割放疗（WBRT＋SRT）治疗脑转移瘤患者安全有效,可提高1～4个脑转移瘤病灶患者的1年局控率和1年生存率。     

非小细胞肺癌62例脑转移行全脑放射治疗联合立体定向放射治疗的疗效及预后因素分析

目的:评估全脑放射治疗联合立体定向放射治疗非小细胞肺癌合并脑转移瘤患者的生存率和肿瘤局部控制率,以及影响生存率的预后因素。方法:回顾性分析62例接受全脑联合立体定向放射治疗的非小细胞肺癌合并1～3个脑转移瘤患者的临床资料,评估生存率,并进行生存相关因素的单因素和多因素分析。结果:62例患者的中位生存期为16个月(95%可信区间为11.27～20.73)。多因素分析结果显示,年龄、病理类型、病灶部位、病灶放射总剂量及全脑放射治疗后接受生物靶向治疗是影响患者生存率的独立预后因素。全组患者的中位肿瘤局部控制时间为20个月(95%可信区间为18.21～22.45),6个月、1年和2年的肿瘤局部控制率分别为96.6%、82.5%和48.9%。全组患者未发现放射治疗相关致死性病例。治疗后1个月,健康相关生活质量评分较治疗前明显改善,差异有统计学意义(P<0.05)。结论:年龄、病理类型、病灶部位、病灶放射总剂量及全脑放射治疗后接受生物靶向治疗是影响患者生存率的独立预后因素。对非小细胞肺癌合并1～3个脑转移瘤的患者,有选择地进行全脑放疗联合立体定向放射治疗是安全而有效的。     

A blueprint for cancer screening and early detection: Advancing screening’s contribution to cancer control

From the mid-20th century, accumulating evidence has supported the introduction of screening for cancers of the cervix, breast, colon and rectum, prostate (via shared decisions), and lung. The opportunity to detect and treat precursor lesions and invasive disease at a more favorable stage has contributed substantially to reduced incidence, morbidity, and mortality. However, as new discoveries portend advancements in technology and risk-based screening, we fail to fulfill the greatest potential of the existing technology, in terms of both full access among the target population and the delivery of state-of-the art care at each crucial step in the cascade of events that characterize successful cancer screening. There also is insufficient commitment to invest in the development of new technologies, incentivize the development of new ideas, and rapidly evaluate promising new technology. In this report, the authors summarize the status of cancer screening and propose a blueprint for the nation to further advance the contribution of screening to cancer control.     

Twinning and the Incidence of Breast and Gynecological Cancers (United States)

Increasing epidemiological and experimental evidence indicates that the carcinogenic pathway in the breast and female reproductive organs is driven, at least in part, by factors associated with reproduction. We conducted a retrospective cohort study, comparing the risk of ovarian, breast, endometrial, and cervical cancers among women who had records of at least one twin pregnancy, compared with women who had given birth to only single children. Subjects were selected from the Utah Population Database, which consists of multiple linked datasets including genealogy, births and deaths and cancer registries. We used Poisson regression to calculate relative risks, adjusted for the number of pregnancies and the age of the mother at the birth of first and last children, with singleton mothers as the reference group in each case. The risks of breast and ovarian cancers did not differ between mothers of twins and mothers of single children. The risk of endometrial cancer was slightly lower in mothers of twins than in mothers of singleton children (RR = 0.90, 95% CI 0.67-1.21). Conversely the risk of cervical cancer was higher among twin mothers (RR = 1.78, 95% CI 0.88-3.52). This latter finding supports previous data suggesting that reproductive hormones act as cofactors in the etiology of cervical cancer.     

Risk factors for colorectal cancer following breast cancer

Objective. To investigate risk factors for colorectal cancer following breast cancer. Methods. In this nested case-control study, all women (n=14,900) with a first primary breast cancer (1978–1992) were identified from the western Washington population-based Surveillance, Epidemiology, and End Results Cancer Registry. Cases (n=160) developed a second primary colorectal cancer before 1995, at least 6 months after the first cancer diagnosis. Controls (n=310, matched to the cases on calendar year, age and breast cancer stage) were randomly selected from those who did not develop a second primary cancer and who survived to the case's colorectal cancer diagnosis date. Characteristics of the cases and controls at initial diagnosis were compared using conditional logistic regression. Results. The incidence of colorectal cancer was associated with a family history of breast cancer (v.s. no family history, matched odds ratio (mOR)=2.1, 95% confidence interval (CI): 1.1–4.1), high body mass index (30 kg/m² v.s. <30 kg/m², mOR=2.2, CI: 1.2–3.9), and lobular breast cancer histology (v.s. ductal, mOR=2.0, CI: 0.9–4.4). Risk was unrelated to menopausal status, prior hormone replacement therapy and estrogen/progesterone receptor status of the breast tumors. Conclusions. The risk of developing a second primary colorectal cancer may be elevated among certain subsets of breast cancer patients.     

Neoplasms in skin and subcutis over the breast, simulating breast neoplasms: case reports and literature review

Twenty cases of neoplasms in skin and subcutaneous tissue over the breast were reviewed. There were 17 women, from 15 to 70 years of age, and three men, from 25 to 66 years of age. Among the benign skin neoplasms, superficial leiomyoma, granular cell tumor, and eccrine acrospiroma were misdiagnosed clinically as primary breast carcinoma. Among the malignant neoplasms in subcutaneous tissue, there were three metastatic malignant melanomas, one metastatic epidermoid bronchogenic carcinoma, and two malignant lymphomas. It is interesting that four of these six patients had no prior history of malignant lesion, the subcutaneous nodule presenting as the first manifestation of an occult primary. It is concluded that histological diagnosis of such tumors may lead to avoidance of unnecessary radical surgery.     

结直肠神经内分泌肿瘤的研究进展

结直肠神经内分泌肿瘤来源于结直肠神经内分泌细胞,发病率较低,但近年有上升趋势.WHO病理学将结直肠神经内分泌肿瘤分为神经内分泌瘤、神经内分泌癌、混合型腺-神经内分泌癌和增生性及肿瘤前病变.结直肠神经内分泌肿瘤细胞具有激素合成及分泌功能,但不一定都出现相应的临床症状.不同分类、分期的结直肠神经内分泌肿瘤的诊断及治疗方法也...     

Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening

Each year, the American Cancer Society publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates from the National Health Interview Survey, and select issues related to cancer screening. In this 2018 update, we also summarize the new American Cancer Society colorectal cancer screening guideline and include a clarification in the language of the 2013 lung cancer screening guideline. CA Cancer J Clin 2018;68:297–316 . © 2018 American Cancer Society .     

从高发现场视角看食管癌和贲门癌的临床研究趋势

我院流行病室开展食管癌和贲门癌高发现场研究已历30余年,所取得的最显著成绩主要有以下4个方面：（1）对食管癌癌前病变（即鳞状上皮不典型增生）及其逐级发展和演变规律的确认,以及对各级不典型增生诊断及处理的经验;（2）对食管癌早诊早治方法的探索,以及实践所得的优异效果;（3）食管鳞状细胞癌易发部位的发现及其对食管癌早期诊断的贡献;（4）胃贲门癌高发位点的发现及其对贲门癌早诊早治的贡献。在此基础上,结合我们长期在高发现场的实际工作经验,展望今后食管癌和贲门癌临床研究的趋势。     

Metastatic Breast Cancer Presenting as a Subconjunctival Mass

Breast cancer is the most common primary source of orbital metastasis. Metastasis occurs through hematogenous spread and predominantly involves the choroid. We present a case of a metastatic subconjunctival mass associated with primary breast cancer. To our knowledge, this is the first reported case of its kind. A 41-year-old woman presented with complaints of conjunctival injection and a foreign body sensation in the left eye. She had a history of breast cancer and had been treated 2 years previously with modified radical mastectomy followed by adjuvant radiotherapy and chemotherapy. Slit-lamp examination showed a cystic mass under the temporal bulbar conjunctiva, associated with dilated overlying conjunctival vessels. An excisional biopsy revealed a poorly differentiated adenocarcinoma. Positron emission tomography examination for systemic malignancy revealed multiple systemic metastasis. Metastatic disease should be considered in the differential diagnosis of subconjunctival lesions, and ophthalmic manifestations can play an important role in the detection of metastatic spread of a known primary breast cancer.