射频治疗在局部晚期非小细胞肺癌综合治疗中的作用

目的:探讨射频治疗在局部晚期非小细胞肺癌综合治疗中的作用.方法:随机将不能切除的Ⅲ期非小细胞肺癌的患者分别纳入综合组和常规组,常规组给予放疗和化疗;综合组在放化疗的基础上加原发灶射频治疗.结果:60例患者进入研究.综合组KPS改善率明显优于常规组(62.07%,21.42%;P=0.02);原发灶局部复发率综合组显著低于常规组(17.2%,42.9%;P=0.017);中位生存期综合组15个月,常规组14个月:1、2年生存率综合组稍高于常规组(78.65%,60.29%;39.84%,27.83%),但两组间比较无统计学意义.结论:射频治疗可有效地降低不可切除的Ⅲ期非小细胞肺癌的局部复发率,改善患者功能状态;但无明显提高不可切除的Ⅲ期非小细胞肺癌1、2年生存率.     

Current status of chemoradiotherapy for locally advanced pancreatic cancer in Japan

Although the results of randomized controlled trials for locally advanced pancreatic cancer conducted between 1969 and 1988 demonstrated a survival advantage for concurrent radiotherapy and bolus 5-fluorouracil (FU) injection, the prognosis of patients with this disease remains very poor. In an attempt to improve patient outcome after chemoradiotherapy, various clinical trials for this disease have been conducted in Japan. These trials were designed to evaluate novel chemotherapy regimens combined with conventional radiotherapy, or intensive radiotherapy in combination with chemotherapy. After gemictabine was shown to yield a better survival outcome than 5-FU in patients with advanced disease, this drug was investigated as a chemotherapeutic agent and/or radiosensitizer for locally advanced pancreatic cancer in a number of trials. S-1, a novel oral fluoropyrimidine derivative that appears promising for the treatment of metastatic disease, is also being intensively evaluated in Japan for the treatment of locally advanced pancreatic cancer. In this review, we summarize recent treatment strategies that are being used in Japan with the goal of establishing a new standard therapy for locally advanced pancreatic cancer.     

Radiofrequency ablation therapy for a pelvic recurrence from rectal cancer after radiotherapy in patient on maintenance hemodialysis-a case report

A 75-year-old man, who was on maintenance hemodialysis, underwent a radiotherapy for locally recurrence of rectal cancer. A pain palliation was achieved and serum tumor markers were reduced. However, after six months, a tumor re- growth was detected and sacral pain was increased. Then, a radiofrequency ablation (RFA) was performed repeatedly as a palliative therapy and pain palliation was achieved. RFA is a safe and effective palliative therapy for patients of poor-risk, such as a terminal stage or hemodialysis patient. Furthermore, it is able to perform repeatedly when the response was not satisfactory. However, a Cool-tip electrode could not to be placed because tumors were hardened by radiotherapy and a repeat of RFA. Then a development of novel Cool-tip electrode may be needed.     

Arterial complication of irreversible electroporation procedure for locally advanced pancreatic cancer

Irreversible electroporation (IRE) is a non-thermal ablation technique used especially in locally advanced pancreatic carcinomas that are considered surgically unresectable. We present the first case of acute superior mesenteric artery (SMA) occlusion secondary to pancreatic IRE procedure that has not been reported before in the literature. A 66-year-old man underwent neoadjuvant chemoradiotherapy for locally advanced pancreatic ductal adenocarcinoma. IRE procedure was applied to the patient during laparotomy under general anesthesia. After finishing the procedure, an acute intestinal ischemia was detected. A conventional vascular angiography was performed and a metallic stent was successfully placed to the SMA and blood flow was maintained. It is important to be careful in such cases of tumor involvement of SMA when evaluating for IRE procedure of pancreatic tumor.     

Phase II study of radiotherapy combined with gemcitabine for locally advanced pancreatic cancer

Gemcitabine has been reported to be a potent radiosensitiser in human pancreatic cell lines. This study was conducted to evaluate the efficacy and toxicity of radiotherapy combined with gemcitabine for locally advanced pancreatic cancer. In all, 42 patients with pancreatic cancer that was unresectable but confined to the pancreatic region were treated with external-beam radiation (50.4 Gy in 28 fractions over 5.5 weeks) and weekly gemcitabine (250 mg m(-2), 30-min infusion). Maintenance gemcitabine (1000 mg m(-2) weekly x 3 every 4 weeks) was initiated 1 month after the completion of the chemoradiotherapy and continued until disease progression or unacceptable toxicity. Of the 42 patients, 38 (90%) completed the scheduled course of chemoradiotherapy. The major toxicity was leucopenia and anorexia. There was one death attributed to duodenal bleeding and sepsis. The median survival time was 9.5 months and the 1-year survival rate was 28%. The median progression-free survival time was 4.4 months. In 35 patients with documented disease progression at the time of analysis, 34 (97%) showed distant metastasis as the cause of the initial disease progression. The chemoradiotherapy used in this study has a moderate activity against locally advanced pancreatic cancer and an acceptable toxicity profile. Future investigations for treatment with more systemic effects are warranted.     

Concurrent chemoradiotherapy combined with intraoperative radiotherapy for locally advanced pancreatic cancer: a feasibility study

Initial clinical results of concurrent chemoradiotherapy combined with high-dose intraoperative radiotherapy (IOR) for locally advanced pancreatic cancer were analyzed. Between June 1996 and May 1999, 6 patients with locally advanced pancreatic cancer without distant metastasis were treated with preoperative concurrent chemoradiotherapy followed by IOR. Preoperative radiation therapy was given by the dynamic arc conformal technique with a daily fraction of 1.8 Gy to a total dose of 45 Gy in 5 weeks. Cisplatin (5 mg/day for 4 weeks) and 5-fluorouracil (250 mg/day for 5 weeks) were administered continuously during preoperative radiation therapy. IOR as a single dose of 28 or 30 Gy was given to the gross tumor volume using electron beams of 15- to 22-MeV. Concurrent chemoradiotherapy was well tolerated, although all of the patients complained of nausea and fatigue. Two patients developed grade III leukopenia. No other serious acute toxicity was noted. The median survival time of the 6 patients was 17.5 months, which was significantly longer than that of our historical control treated with external radiation therapy with IOR (8 months), although the difference in survival was borderline significant (p=0.068). Concurrent chemoradiotherapy followed by high-dose IOR was well tolerated in patients with locally advanced pancreatic cancer, and the initial clinical results appeared promising.     

Clinical benefit response of concurrent chemoradiotherapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic cancer

Background Pancreatic cancer is a highly virulent disease with a poor prognosis. Although objective tumor response to chemotherapy and/or radiotherapy is low, some patients show an improvement in their symptoms after treatments, without obvious tumor regression. Methods We assessed the clinical benefit of concurrent chemoradiotherapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic cancer. Sixteen patients were enrolled in this study. The clinical benefit response to the chemoradiotherapy was evaluated by 2 indicators, including pain (intensity of pain and consumption of morphine) and performance status. A patient was defined to be a clinical benefit responder if 1 of these 2 variables was positive, and the other variable was positive or stable. Results Seven patients (44%) responded. Six patients (38%) were classified as stable, and 3 (19%) as nonresponders. The survival period in responders was significantly longer than that in nonresponders and stable patients. Conclusion Concurrent external-beam radiation therapy, with protracted 5-fluorouracil infusion, may be a meaningful treatment for locally advanced pancreatic cancer.     

Treatments of pancreatic cancer from the standpoint of medical oncology

The early diagnosis of pancreatic cancer is difficult because of the lack of specific early symptoms,and surgery with curative intent can be performed in only 20% of patients. Chemotherapy for unresectable pancreatic cancer has been advancing ever since gemcitabine (GEM) was confirmed to provide a survival advantage in patients with advanced pancreatic cancer. For more than 20 years, the standard treatment for locally advanced diseases has been chemoradiotherapy using 5-FU, but more effective chemotherapy regimens are required. New standard treatments for locally advanced pancreatic cancer, including GEM chemotherapy and chemoradiotherapy using new agents, should be investigated. Several randomized clinical trials comparing GEM-based chemotherapy and GEM alone for the treatment of unresectable pancreatic cancer have been conducted, but a new standard chemotherapy regimen superior to GEM alone has not established. In Japan, phase II studies of S-1 or a combination of GEM and S-1 have produced promising survival rates, and a large phase III study using GEM and S-1 is necessary to establish the standard chemotherapy. Furthermore, second-line chemotherapy regimens for use after GEM chemotherapy should be investigated to improve the survival of patients with advanced pancreatic cancer.     

射频消融联合放化疗治疗局部晚期非小细胞肺癌

 目的　探讨射频消融联合放化疗治疗局部晚期非小细胞肺癌的疗效。方法　 2 0 0 0年 2月至2 0 0 3月 10月采用射频消融联合放化疗治疗局部晚期非小细胞肺癌 4 2例 (综合组 ) ,选择同期条件相同采用常规放化疗局部晚期非小细胞肺癌 38例作对照 (常规组 ) ;比较两组病人的KPS、局部复发率、中位生存期、生存率。结果　综合组和常规组的KPS改善率分别为 2 8.5 7%和 10 .5 2 % ,稳定率分别为4 2 .86 %和 36 .84 %恶化率 2 8.5 7%和 5 2 .6 3% ;综合组KPS评分优于常规组 ( χ2 =6 .32 ,P <0 .0 5 )。原发灶局部复发率综合组显著低于常规组 ( 2 8.5 7%v 5 0 .0 0 % ;χ2 =3.86 ,P <0 .0 5 ) ;中位生存期综合组 16个月 ,常规组 14个月 ;1、2、3年生存率综合组稍高于常规组 6 3.5 3%v 5 3.5 0 % ,31.99%v 2 9.13% ,2 1.33%v 16 .18%。但两组间生存曲线比较无统计学意义 ( χ2 =0 .33,P >0 .0 5 )。结论　射频消融联合放化疗...     

Chemoradiotherapy for pancreatic cancer: current status and perspectives

The poor prognosis of pancreatic cancer is due to both its metastasis-prone and locally resistant nature. To improve therapeutic outcome, a multimodality approach is necessary. Chemoradiotherapy has been regarded as one of the standard treatment options, particularly for locally advanced pancreatic cancer. A number of clinical studies have been undertaken to establish the use of chemoradiotherapy, with or without surgical resection. This review systematically summarizes the current status, controversies, and prospects of postoperative, definitive, and preoperative chemoradiotherapy for pancreatic cancer.     

A case of carcinoma associated with anal fistula resected after preoperative chemoradiotherapy

A 66-year-old man with a 39-year history of anal fistula was admitted to our hospital for anal pain and bleeding. Fistulectomy was carried out for anal fistula. Histological examination of the specimen revealed carcinoma associated with anal fistula. A computed tomography showed that the tumor had invaded the prostate. Therefore, preoperative chemoradiotherapy(S-1 plus radiation 40 Gy/body)for locally advanced cancer was performed. Magnetic resonance imaging showed that the boundary between the tumor and the prostate was unclear, but we performed an abdominoperineal resection and the prostate was fully preserved. Histopathologically, no cancer cell existed on the surgical margin. The histological effect of chemoradiotherapy was judged as grade 2. This case suggested that surgical treatment combined with preoperative chemoradiotherapy may be effective for locally advanced carcinoma associated with anal fistula, in which preservation of adjacent organs is considered to be difficult.     

Chemotherapy followed by chemoradiotherapy in locally advanced pancreatic cancer: A literature review and report of two cases

The optimal treatment of patients with locally advanced pancreatic cancer remains to be elucidated. Chemo-radiotherapy is regarded as the treatment of choice, and studies have examined the sequential schedule of induction chemoradiotherapy followed by chemoradiotherapy, with favourable results. This study investigated the principal clinical trials of chemoradiotherapy treatment in locally advanced pancreatic cancer in 2 patients. The 2 patients received induction chemotherapy with gemcitabine 1000 mg/mq day on days 1 and 8 of a 21-day cycle for two cycles, followed by chemoradiotherapy with concurrent radiosensitizer bi-weekly gemcitabine 50 mg/mq for six weeks. Radiotherapy consisted of an external conformational 3D treatment administered to the pancreatic bed and locoregional nodes, with a total dose of 4500 Gy fractionated in 180 Gy/day, and a boost of 900 Gy to the neoplastic mass. Efficacy was evaluated four weeks after the end of treatment by a computed tomography (CT) scan and by fluorodeoxyglucose positron-emission tomography/CT. The patients underwent further treatment with periodical instrumental evaluation. A disease control rate was observed in the two patients following sequential treatment, enhanced by subsequent treatment. The two patients remained alive 23-24 months following the diagnosis. The sequential treatment schedule therefore was an effective option in our locally advanced pancreatic cancer patients. A phase III trial and further investigation are required to verify this option in clinical practice.     

TACE联合RFA治疗中晚期原发性肝癌的疗效观察

目的：探讨肝动脉栓塞化疗（TACE）联合多电极射频治疗（RFA）中晚期原发性肝癌的临床疗效。方法：237例单发肿瘤直径5～8cm的中晚期原发性肝癌患者分为单纯RFA组69例和TACE联合RFA组168例,RFA治疗后2周通过超声造影对两组治疗效果进行评估。结果：TACE联合RFA治疗的168例患者中超声造影显示91例（53％）始终无增强,呈边界清楚的低回声,诊断肿瘤完全灭活;77例表现为边缘部分区域的结节状、月牙状或不规则形增强区。而单纯RFA治疗的69例患者中超声造影显示23例（33％）肿瘤完全灭活。结论：TACE联合RFA治疗中晚期原发性肝癌比单纯RFA治疗的疗效更好。     

Oxaliplatin for pretreated patients with advanced or metastatic pancreatic cancer: a multicenter phase II study

A phase II study was designed to evaluate the efficacy and safety of oxaliplatin as second-line treatment in patients with locally advanced or metastatic pancreatic cancer. Eighteen patients with advanced pancreatic cancer previously treated with gemcitabine-based chemotherapy, received oxaliplatin 130 mg/m2 i.v. every 21 days. Patients were treated until tumor progression or unacceptable toxicity. No objective response was observed among the 18 treated patients. Three (16.7%) patients had stable disease for > 2 months. A clinical benefit response was observed in five (27.7%) patients. Toxicity was mild. Oxaliplatin as second-line treatment for patients with unresectable pancreatic cancer is well tolerated and associated with improvement of tumor-related symptoms despite its failure to induce objective responses. LOHP merits further investigation in combination with other drugs as palliative treatment of pretreated patients with advanced pancreatic cancer.     

Combination of percutaneous radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma： observation of clinical effects

Objective： To observe the clinical effect of radiofrequency ablation （RFA） combined with transcatheter arterial chemoembolization （TACE） for advanced hepatocellnlar carcinoma （HCC）. Methods： A total of 92 eases of advanced primary liver cancer underwent TACE and RFA treatment from June 2005 to 2011 at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College. A total of 88 cases with complete clinical treatment and follow-up data were divided into two groups： 43 patients treated with TACE （TACE group） and 45 patients that received TACE combined with RFA treatment （TACE ＋ RFA group）. After clinical data assessment, tumor size and survival status were not significantly different between the groups as determined by stratified analysis. Results： Before and after surgery, spiral CT radiography and color comparison observed ablation conditions. The tumor necrosis rates after treatment （CR ＋ PR） were 67.4% （29/43） and 91.1% （41/45） for the TACE and combined treatment groups, respectively, and the difference was statistically significant （P〈0.05）. The quality of life was significantly improved for patients undergoing TACE ~ RFA compared with the control group. Survival duration was not significantly different in patients undergoing TACE ~ RFA compared with the control group. Conclusions： In this study, the effect of RFA combined with TACE treatment was better than TACE alone in treating advanced HCC.     

直肠癌非手术治疗的新策略

术前同步放化疗联合全直肠系膜切除术是目前局部进展期直肠癌的标准治疗方式。术前同步放化疗可使肿瘤退缩、降期,增加低位直肠癌的保肛率,术后少部分患者可达病理完全缓解。手术相关的前切除综合征引起的功能损害、风险及并发症,使以“器官保留”、“等待观察”为代表的非手术治疗策略逐渐引发研究与探讨,从而为提高和改善患者的生活质量带来了新希望。     

局部热疗联合同步放化疗治疗Ⅲb期宫颈癌的近期疗效

目的:观察局部热疗联合同步放化疗治疗Ⅲb期宫颈癌的近期临床疗效及不良反应。方法:60例Ⅲb期宫颈癌患者,随机分为局部热疗结合同步放化疗组(治疗组)和同步放化疗组(对照组)。对照组进行根治性放射治疗,放疗第1天开始行化疗,顺铂40mg/m2,静脉滴注,每周1次,化疗6个周期。试验组:放化疗方法同对照组,于化疗当天行盆腔局部热疗,热疗每次60分钟,每周2次,共12次。于热疗后1h内行放射治疗。结果:两组外照射结束时局部肿瘤消退情况、近期疗效比较,差异有统计学意义(P<0．05)。两组不良反应比较,差异无统计学意义(P>0．05)。结论:深部热疗加同步放化疗可以提高患者近期疗效,且无严重的并发症,是Ⅲb期宫颈癌治疗中的一种安全有效的模式。     

射频消融联合放化疗治疗不可切除的局部进展期胰头癌疗效及安全性分析

目的：评估术中冷循环射频消融联合放化疗治疗不可切除的局部进展期胰头癌的疗效和安全性,以及对患者生存质量的影响。方法：对28例不可切除的局部进展期胰头癌患者行术中冷循环射频消融联合放化疗治疗,观察患者手术前后肿瘤标志物 CA19－9水平、影像学变化及术后并发症和生存率。结果：本组患者无手术死亡,术后联合放化疗患者均耐受良好。所有患者 CA19－9水平明显下降,术后30天、90天彩超和CT 在原发病灶未发现肿瘤进展。85．71％（24／28）并发少量胰瘘,分别经引流后愈合,平均引流时间为15天。全组28例随访率为100％,随访时间最长18个月,存活12个月以上23例,最长者已达18个月。其中6个月无进展生存20例,12个月无进展生存13例。结论：开腹下冷循环射频消融联合同期放化疗治疗不可切除的局部进展期胰头癌安全有效,术后患者无进展生存期及生存质量明显提高。     

术前同步放化疗在局部晚期宫颈癌治疗中的应用

目的:分析术前同步放化疗治疗局部晚期宫颈癌的可行性及其疗效。方法:将1995年11月～2008年12月期间,汕头大学医学院附属肿瘤医院收治的259 例宫颈肿瘤最大径>4cm的ⅠB2～ⅡB 期宫颈癌患者分为3 组,其中术前同步放化疗组（A组）64例,术前单纯放疗组（B 组）73例,直接手术组（C 组）122 例,对比A 组和B 组术前放化疗或放疗后宫颈肿块消退情况、不良反应,以及A 组、B 组和C 组3 组术后病理分析宫颈浸润、宫旁浸润、阴道浸润、脉管浸润、淋巴结转移情况及患者生存情况分析。结果:宫颈肿块体积术前同步放化疗组术前放化疗后较术前单纯放疗组术前放疗后明显缩小,差异有统计学意义（P<0.05）;术前同步放化疗组骨髓抑制及胃肠道反应与术前单纯放疗组比较差异无统计学意义（P>0.05）。 术后病理分析显示术前同步放化疗组宫颈浸润明显少于术前单纯放疗组及直接手术组,差异有统计学意义（P<0.05）;脉管浸润术前同步放化疗组明显少于术前单纯放疗组及直接手术组,差异有统计学意义（P<0.05）;但宫旁浸润、阴道残端浸润及盆腔淋巴结转移的发生率各组比较差异无统计学意义（P>0.05）;生存情况分析3 组1、3、5 年生存率无统计学意义（P>0.05）。 结论:局部晚期宫颈癌患者术前行同步放化疗其疗效肯定,且安全可行,值得进一步研究。      

三维适形放疗联合S-1治疗局部晚期胰腺癌临床观察

目的：探讨三维适形放疗联合S-1治疗局部晚期胰腺癌的临床疗效。方法：36例患者随机分为放化疗组与单纯放疗组。放疗组给予5个三维适形放疗野等中心照射,剂量为50Gy／（25f·5w）,放化疗组患者的放疗射野及剂量同放疗组,同时自放疗的第一天起口服S-1,剂量60mg／m2,2次／d,第1至28天,休14天重复,每例患者接受2周期S-1化疗。观察疗效及不良反应。结果：放化疗组有效率高于单放组（66．7％vs44．4％）,放化疗组1年生存率高于单放组（45％vs20％）,不良反应放化疗组稍高于单放组,患者可以耐受。结论：三维适形放疗联合S-1是局部晚期胰腺癌较为理想的方法,疗效优于单纯放疗组。