涎腺腺样囊性癌的放射治疗──附75例分析

１９７５年至１９８７年我院收治腺样囊性癌７５例。腮腺１２例，颌下腺１４例，舌下腺１例和小涎腺４８例。综合治疗５４例（７２％），单纯放疗１６例和单纯手术５例。５年随访率８７．９％，３、５和１０年生存率分别为７７．３％（５８／７５），６５．５％（３８／５８）和４５．２％（１４／３１）。单纯放疗、单纯手术和综合治疗５年生存率分别为３８．５％（５／１３），５０％（２／４）和７５．６％（３１／４１）（Ｐ＜０．０１），Ⅰ～Ⅳ期５年生存率分别为８１．３％（１３／１６）、７０％（１４／２０）、５３．３％（８／１５）和４２．９％（３／７）（Ｐ＜０．０５）。     

气管隆凸、支气管成形肺切除术治疗中心型肺癌94例

目的 分析气管隆凸、支气管成形肺切除术治疗中心型肺癌的近期和远期疗效。方法 自１９８５年４月至１９９９年５月共手术治疗原发性肺癌９０２例,其中气管隆凸、支气管成形肺切除术９４例,即支气管成形术８０例,隆凸切除１４例。结果 术后发生肺不张９例,心律失常２例,吻合口瘘１例,手术死亡率为０。１年生存率为８３．１％（７４／８９）,３年生存率５８．３％（３５／５６）,５年生存率３４．０％（１８／５３）。ⅠＢ     

38例子宫内膜间质肉瘤的诊断和治疗

目的：研究子宫内膜间质肉瘤的诊断和治疗方法。方法：对３８例子宫内膜间质肉瘤进行回顾性分析,其中Ⅰ期１３例,Ⅱ期１４全,Ⅲ期７例,Ⅳ期４例,３８例均经手术治疗。１０例术后补充放疗,１１例补充化疗,７例补充放疗加化疗。结果：本组病例总的３年及５年生存率分别为５４．３％（１９／３５）及４５．５％（１５／３３）,Ⅰ期病例３年及５年生存率分别为７６．９％（１０／１３）及６１．５％（８／１３）,Ⅱ期为５０．０％（７／１４）及４６．２％（６／１３）。结论：子宫内膜间质肉瘤的预后和组织类型、临床分期、治疗方法密切有关,综合运用手术、放疗、化疗及孕激素治疗能减少阴道及盆腔复发,提高生存率。     

直肠癌术后复发及转移的外科治疗

１９８０年￣１９９０年，作者行直肠癌治愈性切除术共１６０例，随访４年￣１４年。术后复发及转移４４例（２７．５％）。再次手术１７例（３８．６％）。其中治愈性切除６例（１３．６％），姑息性切除５例（１１．４％），单纯结肠造瘘６例（１３．６％）。全部再手术患者有６例生存超过５年，５年生存率３５．３％，未经手术治疗者无１例存活超过５年，两者比较差异非常显著（Ｐ〈０．００５）。即使行姑息手术者，２年生存率（     

侵犯胸壁的原发性肺癌的外科治疗

目的 探讨侵犯胸壁的原发性肺癌的外科治疗经验。方法 对３５例侵犯胸壁的原发性肺癌患者,按照肿瘤外侵程度及采取的手术方式不同分组,肺叶及壁层胸膜切除１６例为１组,肺胸块切除１９例为２组,结果 全组无手术死亡。１组３和５年生存率分别为３８．５％和１８．２％,２组３和５年生存率分别为４１．２％和３５．７％。全组Ｎ０患者３、５年生存率分别为６３．２％和４２．９％,Ｎ１－２患者中仅１例生存５年以上。结论手术     

原发性食管小细胞癌

目的 对原发性食管小细胞癌（ＰＥＳＣ０的临床病理学特点及外科治疗问题进行研究。方法 １９９１年４月至１９９９年４月对２４例ＰＥＳＣ进行手术治疗，总结分析病理、临床资料。结果 全组手术切除率９１．７％（２２／２４），手术死亡率４．２％（１／２４），随访２３例术后１、２、３年生存率分别为３８．１％（８／２１），２６．３％（５／１９），１３．３％（２／１５）。结论 ＰＥＳＣ临床具有极高的恶性生物学行为，     

原发性尿道癌17例报告

报告原发性尿道癌１７例，其中女性１４例，男性３例，男女之比１：４．６７；女性尿道癌发病年龄３２～７２岁，均龄５６岁；鳞癌、腺癌各７例。男性尿道鳞癌３例，均龄５２岁，其中２例为浸润癌。尿道癌恶性度高，淋巴转移早，治疗主张早期手术切除，结合放疗综合治疗。本组手术切除率５８．２％（１０／１７），女性尿道癌手术切除者８例，２年生存率６２．５％（５／８），５年生存率５０％（４／８），男性尿道癌手术切除者２例，均已无瘤生存达４年以上。     

超声加热和放射综合治疗恶性肿瘤99例

我院１９８６～１９９１年对９９例１２２个部位的晚期体表肿瘤或复发肿瘤用超声加热和放射综合治疗。放疗为Ｄ＿Ｔ１２～５６Ｇｙ，２次／周，３～４Ｇｙ／次，或Ｄ＿Ｔ１８－６７．５Ｇｙ，５次／周，２Ｇｖ／次。加热用１ＭＨｚ，声强０．５～１Ｗ／ｃｍ￣２，热电偶测温精度（０．５℃，放疗前／后６０分钟内进行，加热至４３℃，时间为３０～４５分钟，１～２次／周，平均７次（３～１２次）。近期疗效按部位计，肿块完全消退３２％（３９／１２２），部分消退５２．５％（６４／１２２），无效１５．６％（１９／１２２）。全组１、２和３年生存率分别为２４／８６（２７．９％），８／４１（１９．５％），７／３８（１８Ａ％）。而肿块完全消退组的１、２和３年生存率分别为１２／２５（４８％），６／１５（４０％），５／１３（３８．５％），均高于全组。     

多途径综合治疗原发性巨块型肝癌48例疗效分析

作者对４８例不能一期切除的原发性巨块型肝癌进行多途径的综合治疗。在一期探查术中应用肝动脉结扎、碘化油化疗药物（ＭＤＦ）混合液灌注化疗和液态硅胶（ＴＨ）栓塞术；术后行肝动脉、门静脉分期灌注化疗；化疗间期经皮向癌灶内分点注射无水酒精。综合治疗半年复查结果：ＰＲ６６．７％、ＭＲ２２．９％、ＳＤ１０．４％。复查后依据病情施行Ⅱ期手术切除２３例，占本组病例的４７．９％（２３／４８）。本组病例随访结果：６、８、１０个月、１、３、５年生存率分别为９３．８％、８７．５％、７９．２％、７５．０％、５６．１％、２５．９％。结果显示，多途径综合治疗疗效显著。     

原发性气管肿瘤24例报告

作者报告原发性气管肿瘤２４例，手术治疗２３例，切除１９例，切除率８２．６％，姑息切除及气管造口４例，２４例中恶性肿瘤２１例，良性肿瘤３例。肿瘤位于气管上段８例，中段６例，下段１０例。切除１９例全部临床治愈，术后１、３、５和１０年生存率分别为８２．３％（１４／１７）、７５％（９／１２）、７５％（６／８）和５０％（２／４）。作者认为：气管肿瘤误诊率高，应注意早期诊断，已确诊的气管肿瘤应注意选择手术时机和手术方法。     

Phase II study of cisplatin and 120-hour continuous infusion of 5-fluorouracil in patients with advanced pancreatic adenocarcinoma

BACKGROUND:: Advanced pancreatic carcinoma (APC) is a rapidly fatal diseaseand an active chemotherapy with palliative effects and impacton patient survival is needed. 5 fluorouracil (5-FU) combinedwith cisplatin (CDDP) has a recognized synergjstic activity,but its activity in APC has never been well established. METHODS:: Forty eligible patients (pts) with measurable APC were treatedin a phase II trial with 5-FU 1000 mg/m²/ day from day 1 today 5 by continuous intravenous infusion and CDDP 100 mg/m²on day 2. Eighty percent of the pts (36/40) had metastatic disease,32.5% (13/40) were previously treated and 65% (26/40) had performancestates of 2 or 3. RESULTS:: Of 38 evaluable pts, one had a complete response and 9 achievedpartial responses; the overall response rate (RR) was 26.5%(95% CI: 12% to 40%). The median duration of responses was 10months (range 4-18). The RR in non-pretreated pts was 32% Apalliative effect was seen in 45% of pts (17/38). The mediansurvival was 7 months and 12 pts (29%) were alive at 1 year.Leukopenia was the most important toxicity; 11 pts (27%) hada grade 4 leukopenia and 3 had neutropenic fever. CONCLUSIONS:: The combination of CDDP and 5-FU in continuous infusion seemsan active and well tolerated treatment in APC and will be comparedto standard therapy in a multicentric randomized trial. pancreatic cancer, chemotherapy, 5-fluorouracilcisplatin combination     

Disease profile and treatment results of anal canal SCC: Experience from AIIMS, New Delhi

Introduction: Anal Canal squamous cell carcinoma (SCC) accounts for nearly 2% of all cancers of the alimentary tract. Over the past few years, the management of anal canal cancer has changed from primary surgery to primary chemo-radiotherapy (CRT). Methods: A total of 83 patients' (pts) records (62 males, 21 females) were retrospectively reviewed. Length of disease was <5 cm in 44 pts and confined to primary in 46 pts. Ten pts have anti-cancer therapy outside. We delivered radiotherapy (RT) alone to 16 pts, chemotherapy (CT) alone to 4 pts, CRT in 51 pts and pre-operative (pre-op) RT in 2 pts. RT dose was up to 30 Gray (Gy) =16; 30-50 Gy=12 and >50 Gy=41 pts. Results: RT compliance was optimal in 64/69, grade (Gr) ≤ 2 toxicity in 56/69 and Gr ≥ 2 in 13/69 pts. Thirteen pts (18.84%) were hospitalized during RT. No response (NR) was found in 4/83, <50% in 18/83, >50-<100% in 39/83 and complete response (CR) in 22/83 pts. Recurrence at primary site was seen in 7 and loco-regional in 2 pts. Salvage therapy was done in all 9 pts (surgery=8 and CT=1). Status at last follow up, alive without disease = 22/83 and with disease = 61/83 pts. Conclusion: This retrospective analysis revealed that the advanced disease was in 47%, the optimal anti-cancer therapy could be delivered to 63.9%. Despite heterogeneity of patient population and management, the overall disease-free survival (DFS) with sphincter-preservation was achieved in 26.5% pts. Key Words: Anal canal, squamous cell carcinoma, chemo-radiotherapy, sphincter preservation, disease free survival.     

A phase II study of irinotecan plus chronomodulated oxaliplatin, 5-fluorouracil and folinic acid in advanced colorectal cancer patients

The combination of irinotecan (CPT-11), oxaliplatin (L-OHP), 5-fluorouracil (5-FU) and folinic acid (FA) is one of the possibilities to overcome chemoresistance in advanced colorectal cancer (ACRC) patients. The aim of this study was to determine the tolerability and activity of CPT-11 plus chronomodulated infusion of L-OHP, 5-FU and FA in ACRC patients. A total of 35 patients (91% pretreated, 77% with CPT-11, 54% with L-OHP, 42% with both) were treated every 3 weeks with CPT-11, 180 mg m(-2) day 1 i.v., plus L-OHP, 20 mg m(-2) day(-1), 5-FU, 700 mg m(-2) day(-1) and FA, 150 mg m(-2) day(-1), all three drugs from day 2 to day 5 by chronomodulated infusion. The patients' (pt) data were as follows: male/female 21/14; median age 58 years (range: 38-70); PS 0: 26 pts (74%), PS 1: 8 pts (23%), PS 2: 1 pt (3%); primary tumour colon/rectum 26/9; involved organs: 1, 14 pts (40%); 2, 17 pts (48%); >or=3: 4 pts (11%); previous chemotherapy lines 1: 12 pts (34%), 2: 10 pts (28%), >or=3: 10 pts (28%). A total of 221 courses (c) were performed; no grade 4 toxicity was observed with only one grade 3 (G3) neutropenia and thrombocytopenia (3%) in one out of 221 courses (<1%). Maximal toxicity (G3) was nausea and diarrhoea in 10 pts (28%), occurring in 14 out of 221 c (6%) and 12 out of 221 c (5%) respectively. Seven patients achieved a partial response (20%, confidence interval (c.i.) 6.8-33.3) and one patient a complete response (2.9%, c.i. 0-8.4), for a total overall response rate of 22.9% (c.i. 9-36.8); 15 out of 35 (42.9%, c.i. 26.5-59.3) had stable disease and 12 out of 35 (34.3%, c.i. 18.6-50) patients underwent a progression. In conclusion, this four-drug regimen is feasible in advanced pretreated ACRC patients with no significant haematological toxicity and acceptable diarrhoea. The activity of this combination is currently studied in EORTC 05011 study.     

老年食管癌贲门癌的手术疗效180例分析评价

 我科于1986年至1995年间收治的食管癌、贲门癌病人1337例，其中65岁以上的高龄食管癌、贲门癌180例。手术切除156例，转流1例，探查23例，总手术切除率约86．67%，手术后20天内死亡1例，手术死亡率计0．56%，术后发生吻合口瘘3例占1．92%（3／156），术后肺、心血管并发症19例，远期的吻合口狭窄13例占8．28%，术后三年生存率约65．56%，五年生存率为33．89%。     

Intensive chemotherapy with hematopoietic cell transplantation after ESHAP therapy for relapsed or refractory non-Hodgkin's lymphoma. Results of a single-centre study of 65 patients.

This study was designed to assess the results of protracted courses of ESHAP (etoposide, cytarabine, cisplatin, methylprednisolone) therapy followed by intensive chemotherapy and hematopoietic cell transplantation (IC+HCT) for relapsed or refractory non-Hodgkin's lymphoma (NHL). Treatment consisted of 3 cycles of ESHAP; responsive patients (pts) then received 3 more cycles, and IC+HCT was used for pts in maintained partial (PR) or complete (CR) remission after the sixth ESHAP. Sixty-five pts entered the study. At enrollment, 27 pts had bone marrow (BM) and/or central nervous system (CNS) lymphomatous infiltration. Disease status was primary refractory lymphoma in 41 pts (63 %), and relapse in 24 pts (37 %). Results showed that two pts were not evaluable for the therapeutic response because of early treatment-related death. Thirty-nine (62 %) pts entered PR or CR after 3 cycles of ESHAP. Eleven pts subsequently had disease progression. Twenty-eight pts were in persistent CR or PR after 6 cycles of ESHAP. Refractory pts did not show a different response rate to relapsing pts (chi2= 1.73). Five pts were excluded from IC+HCT because of an inadequate graft or treatment-related toxicity. Twenty-three (35 %) pts completed the procedure. Five pts (22 %) relapsed after IC+HCT. The overall survival rate of the 39 responsive pts is 45 % at 60 months, with a median survival time of 30 months. Median survival among the 35 pts in whom second-line chemotherapy failed is 7.1 months, with a 4-year survival rate of 3 %. Despite the poor prognostic features of this group, 45% of pts responding to the first 3 cycles of chemotherapy are in prolonged remission, suggesting that rather than to transplant after just 2 cycles of salvage therapy, pursuing second-line chemotherapy may better discriminate between patients more likely to benefit from a subsequent transplant.     

食管鳞状细胞癌p53基因杂合性缺失和基因突变的相关研究

 目的 检测食管鳞状细胞癌（ESCC）中p53基因杂合性缺失（LOH），p53基因突变及蛋白表达的情况，分析其与临床病理和预后的相关性。方法 采用聚合酶链反应-单链构象多态性分析（PCR-SSCP）和免疫组织化学方法（SP）检测56例ESCC中p53基因LOH和p53基因蛋白的表达情况。结果 56例ESCC组织中p53蛋白阳性表达率为60.7 %（34／56），它与患者的年龄、性别和家族史无关（P＞0.05），有或无淋巴结转移的阳性率分别为81.0 %（17／21），48.6 %（17／35）；生存率低于3年组和高于3年组的p53阳性表达率为73.9 %（17／23），46.4 %（13／28），差异有统计学意义。p53基因LOH率为80.5 %（33／41），与患者的年龄、性别、家族史和有无淋巴结转移无关，与3年生存率有相关性（P＜0.05）。p53基因总突变率为76.8 %（43／56），突变位于17号染色体第4外显子者5例，第5外显子者23例，第6外显子者1例，第7外显子者4例，第8外显子者7例，有3例在内含子。p53基因突变／过度表达率为46.4 %（26／56），两种方法检测的符合率为55.4 %（31／56）。结论 p53基因在ESCC的发生、发展中可能发挥重要作用，伴有p53基因LOH／p53蛋白过度表达的3年生存率明显降低。p53蛋白阳性表达的ESCC更易发生淋巴结转移，可作为判断食管癌预后的参考指标之一。     

Expression of P53 and bcl-2 proteins in T-cell lymphoblastic lymphoma: prognostic implications

In patients (pts) with non-Hodgkin's lymphoma (NHL) under 25 years, treatment with MCP-842 protocol, a short duration intense protocol, yields worse survival in pts with lymphoblastic lymphoma (LL) compared to other high grade lymphomas. In order to identify both favourable and unfavourable subgroups in pts with T-cell LL (T-LL) with respect to relapse free survival following treatment with MCP-842 protocol, we analysed the expression of p53 and bcl-2 proteins in 22 pts with T-LL treated at the Tata Memorial Hospital, Mumbai by immunohistochemistry. p53 protein overexpression was noted in 59% cases and bcl-2 overexpression was noted in 29.4% cases. p53 expression correlated with a higher rate of relapse (p = 0.03; RR 7.9). The 5-year relapse free survival (RFS) was better in p53 negative patients compared to positive patients (70 vs 38%) (log-rank sigma = 0.04). In conclusion, in this study, overexpression of p53 protein was common in patients with T-LL. T-LL pts negative for p53 are likely to benefit from the short intense protocol--MCL-842. Bcl-2 protein overexpression was not a prognostic factor in these patients.     

P-VEBEC: A new 8-weekly schedule with or without rG-CSF for elderly patients with aggressive non-Hodgkin's lymphoma (NHL)

BACKGROUND: Chemotherapy regimens devised for elderly patients with intermediate-highgrade NHL are a matter of discussion. The aim is to reduce generaltoxicity without loosing an antilymphoma effect. The most importantlimiting factor of chemotherapy is myelotoxicity; for this reasonthe use of growth factor may be useful in these patients. PATIENTS AND METHODS: From November '91 to November '92, 67 pts older than 65 yearswith intermediate-arid high-grade advanced-stage NHL were treatedwith the P-VEBEC regimen, an original scheme with epirubicin50 mg/m², cyclophosphamide 350 mg/m² and etoposide 100 mg/m²on weeks 1, 3, 5, 7; vinblastine 5 mg/m² and bleomycin 5 mg/m²on weeks 2, 4, 6, 8, prednisone 50 mg/m²/day p. os in the first2 weeks and thereafter every other day. Twenty-eight pts receivedr-GSF 5 (µg/kg/day throughout the treatment starting onday 2 of every week for 4 consecutive days. Their median agewas 71 years (65–80), 31 pts were male and 36 female,histology according W.F. was D 6; E 17; F 16; G 19; H 9. Twenty-fivepercent of pts had B symptoms, 35% had bulky disease, 41% LDHlevel > normal, 44% stage IV and 26% had B.M. involvement. RESULTS: CR. was achieved by 66% of pts. Adverse prognostic factors forCR were E histology, stage IV, bone marrow infiltration andLDH above normal. Severe toxicity was never recorded, no toxic death was observed.With a median follow-up of 24 months OS, DFS and EFS were 55%,52%, and 33%, respectively. EFS was influenced by stage, BMinvolvement and level of LDH. The relative dose intensity (RDI) was calculated by the methodof Hryniuk and Bush. Patients who received rG-CSF had a significantlyhigher median RDI (94% vs 79%) and lower myelotoxicity (neutrophilnadir <500 18% vs 56%). The rate of CR was influenced byRDI >80% (89% vs 56%). EFS was also better in pts who received a RDI higher than 80%(50% vs 18% p = 0.05). CONCLUSION: P-VEBEC is a feasible cycle in elderly patients; the use ofrG-CSF improves RDI. In patients with adverse prognostic factors(BM involvement, poor performance status) a RDI >0.80 couldplay a role in improving the outcome. lymphoma, elderly patients, rG-CSF     

Neck dissection following radiochemotherapy of advanced head and neck cancer--for selected cases only?

PURPOSE: To address the value of neck dissection (ND) in patients with advanced head and neck cancer following primary radiochemotherapy and to specifically analyse its impact on locoregional tumour control, survival and toxicity. PATIENTS AND METHODS: Between 1987 and 1997 (9,335), a total of 142 patients (pts) were treated by primary radiochemotherapy (RCT) according to prospective protocols. There were 64 pts with involvement of the hypopharynx, 57 pts with oropharyngeal and 21 with oral cavity carcinoma. UICC (1997) stages included: 16 pts in stage III, 113 pts in stage IV A, 13 pts in stage IV B. All pts received platin-based RCT up to a median total dose of 70 Gy (range, 60-72 Gy). Six weeks after RCT, pts with complete response of the primary tumour (N=97) were offered a uni- or bilateral ND depending on the initially diagnosed nodal disease as part of a strict institutional policy. Fifty-six pts consented to ND and 41 refused. These two groups were analysed in terms of characteristics, local and regional tumour control, survival and long-term side effects. Median follow-up was 37 months (range, 22-124 months). RESULTS: Among the 56 pts receiving ND, a total of 13 (23%) was found to have residual tumour in the neck specimen. The rates of positive histology according to clinical N category after RCT were: yN0 (2/22[9%]), yN1 (2/10[20%]), yN2a-b (2/10[20%), yN2c-3 (7/14[54%]). Five-year overall survival and disease-specific survival rates for pts with ND were 44 and 55%, for pts without ND 42 and 47%, respectively (P=0.9). No difference was seen for long-term local and regional control between the two patient groups. Comparing the group of patients with and without ND, a trend towards higher subjective morbidity of grade 3 and 4 (LENT-SOMA), i.e. pain recording (24% vs. 17%), dysphagia (48% vs. 35%) and hoarseness (20% vs. 9%) was evident in patients with ND. CONCLUSION: No clear evidence for routine clinical use of ND after RCT in advanced head and neck tumours can be derived from these data. ND may be contemplated in selected cases with multiple residual nodes only.     

Phase II trial of primary radiation therapy and concurrent chemotherapy for patients with locally advanced pancreatic cancer

OBJECTIVES: Primary chemoradiotherapy for locally advanced pancreatic cancer (LAPC) may improve local control, curative resection rate and long-term survival. We performed a phase II study to evaluate toxicity and activity of primary radiation therapy and concurrent chemotherapy with gemcitabine (GEM) twice weekly in patients (pts) with LAPC. METHODS: From 6/1999 to 6/2003, 23 LAPC pts received GEM 100 mg/m2 twice weekly in the first 15 pts and 50 mg/m2 in the last 8 pts, concurrently with radiotherapy (1.8 Gy/day for a total dose of 45 Gy). RESULTS: The treatment was completed in 19/23 pts. Toxicities: G3-4 hematological toxicity occurred in 35 and 4% respectively; G3 nausea and vomiting and gastrointestinal toxicity in 30%. Clinical benefit was found in 10/18 pts (55%). Overall response: partial response rate 4/18 (22%); stable disease 13/18 (72%); progressive disease 1/18 (6%). Six pts underwent pancreaticoduodenectomy with extended lymphadenectomy (5/6 pts pT3, 1/6 pts microscopic cancer foci, 1/6 N+, 5/6 negative retroperitoneal margin). MEDIAN SURVIVAL: 14 months for the entire group, 12 months for unresected pts, 20 months for resected pts. CONCLUSIONS: The treatment with GEM twice weekly at 50 mg/m2 associated with radiotherapy (45 Gy) is feasible and permits to obtain clinical benefit in a good percentage of pts. Objective response, median survival, and local and systemic control are similar to other studies and need further improvement.