颈部原发不明转移癌的治疗

目的 探讨颈部原发不明转移癌的合理治疗方式。方法 回顾分析６８例颈部原发不明转移癌患者的临床资料。结果 中上颈低分化转移癌最好的治疗方式是放疗,转移性鳞癌则采用手术后加放疗,转移性腺癌中的乳头状腺癌治疗应采用甲状腺癌联合根治术。其５年生存率分别为５０．０％（２／４）、６６．７（８／１２）、６６．７（８／１２）和８５．７％（１２／１４）。锁骨上区转称癌尤其右侧者应力争手术切除,辅之以化疗。随访中有１５．２％颈部原发不明转移癌患者发现原发病灶。结论 对颈部原发不明转移癌的治疗方式,应根据淋巴结的病理性质、部位、局部和全身情况进行综合考虑。     

原发灶不明的颈部淋巴结转移癌的治疗

目的 探讨原发灶不明的颈部转移癌的治疗方式。方法 分析81例病例资料，采用治疗方法为手术(S)、手术加放疗(S R)、手术加化疗(S C)、单纯放疗(R)、放化疗(R C)。结果 (S)11例，(S R)18例，(S C)5例，(R)19例，(R C)28例。手术包括单侧颈清30例，双侧颈清2例，局部切除2例。放射治疗剂量为40Gv～75Gv。全组5年总生存率为59．26％。中上颈部转移者5年生存率65．7％，其中转移性低分化癌的治疗方式为以放疗为主的综合治疗；转移性鳞癌则以手术为主；转移性腺癌以手术为主，其中的乳头状腺癌采用甲状腺癌联合根治术式，其5年生存率分别为62．5％、71．43％、62．5％。锁骨上区转移癌以化疗及放疗为主，5年生存率为28．57％。转移灶的部位、N分期、综合治疗及放疗范围影响5年生存率。结论 对原发灶不明的颈部转移癌的治疗，应根据淋巴结转移的部位和病理类型决定。     

外阴转移性癌60例临床分析

目的：探讨外阴转移性癌的诊断和治疗。方法：对６０全外阴转移性癌临床资料进行回顾性分析。结果：６０例外阴转移性癌,主要继发于宫颈癌和宫体癌,３年、５年生存率分别为３０．１５％和２０．１０％。综合治疗５年生存率（手术加化疗２４．１０％、放疗加化疗１８．６０％）明显优于单纯化疗（１０．９６％）和单纯放疗（１４．５４％）。转移灶大于２ｃｍ或多伴有原发肿瘤复发／远处转移者生存率较差。结论：外阴转移性癌预后差,综合治疗可提高生存率从而延长生命。     

原发灶不明颈淋巴结转移癌42例临床分析

目的探讨原发灶不明颈淋巴结转移癌的诊断、治疗方法与预后的影响因素。方法回顾分析我院1992年2月～1999年2月收治的42例原发灶不明颈淋巴结转移癌患者的临床资料。结果全组的1、3、5年生存率分别为71．4％(30／42)，45．2％(19／42)，33．3％(14／42．)。随诊中有14．3％(6／42．)的原发灶不明颈淋巴结转移癌患者发现了原发灶。结论影响原发灶不明颈淋巴结转移癌预后的主要因素是组织学类型，N分期，转移癌的部位，原发灶是否找到。对颈部转移性低分化癌、未分化癌或鳞癌应采用放射治疗，位于中上颈者应采用面颈联合野放射治疗，转移性腺癌应以手术治疗为主，晚期颈转移癌应采用化疗、放疗为主的综合治疗。锁骨上区转移癌应以化疗为首选。     

原发灶不明颈部转移性鳞癌的诊治

原发灶不明的颈部转移性癌约占头颈部恶性肿瘤的5％，可以分为转移性鳞癌和转移性腺癌，至今仍是临床诊治的一个难题。由于原发灶不明的转移性癌的临床治疗只能以治标为主，治疗效果不佳。所谓原发灶不明，其实是有原发灶，由于病灶较小、部位隐匿或位于黏膜下等原因而不易发现；且肿瘤的生物学行为又较恶劣，较早发生淋巴结转移。临床仔细寻找原发病灶尤为重要，只有找到原发病灶，标本兼治，临床治愈率才能改善。20世纪50年代初，美国纽约纪念医院的Martin教授最早提出：“2周内找不到原发病灶的颈部转移性癌，即诊断为原发灶不明的颈部转移性癌”。随着医学理念的更新，诊疗技术的进步，我们认为用时间概念来作为一个诊断标准不够科学，因此提出：“经临床仔细检查直到治疗开始前仍未发现原发病灶的颈部转移性癌，可以诊断为原发灶不明的转移性癌”。以上概念是否准确大家可以讨论，本文主要讨论原发灶不明的颈部转移性鳞癌。     

宫颈腺癌363例分析

对中国医学科学院肿瘤医院妇瘤科１９５９年至１９９３年５月收治的宫颈腺癌患者进行了回顾性分析。３６３例初治患者占所有初治宫颈癌的２．５％。患者平均发病年龄５０．５岁，绝经后患者占４６％。主要症状为阴道不规则出血和／或阴道有异常分泌物。Ⅰ～Ⅳ期所占比例分别为：５．２％、４７．５％、４４．６％和６．６％。主要治疗方式为单独放疗。总的５年生存率为５１．８％（寿命表法），宫颈粘液腺癌的５年生存率明显低于其它类型腺癌的５年生存率。复发率为１７．４％，其中肺及锁骨上淋巴结转移较多，复发者１年、２年生存率分别为３５．２％和１９．２％。疾病分期、原发肿瘤大小、组织学类型等是影响预后的主要因素。     

50例宫颈腺癌的临床分析

１９７８年３月至１９８８年３月我院共收治宫颈腺癌患者５０例，Ⅰ期１８例，Ⅱ期３０例，Ⅲ期２例，其５年生存率分别为７７．８％、４６．７％、０。采用放疗与手术为主的综合治疗，单纯放疗５年生存率４８．３％，手术为主的综合治疗５年生存率７０．６％，临床分期，治疗方式，病理分级，有无盆腔淋巴转移均影响其预后。     

食管癌术后放疗交替化疗初步探索

１９９２年１月至１９９３年５月，我科收治３２例食管癌手术后病理证实食管残端癌残留和／或区淋巴结癌转移的病员，采用术后放疗交替化疗方式治疗，其１，２，３年生存率分别为７８．１３％，５６．２５％和１５．６２％，与我科同期采用单纯术后放疗的食管癌病例     

原发灶不明的颈部转移癌49例临床分析

目的:探讨原发灶不明的颈部转移癌的诊断及治疗方法。方法:我院自1980年～1990年共收治原发灶不明的颈部转移癌49例,最终发现原发灶21例(42.9％),以鼻咽、肺最常见。对单纯放疗、放疗加化疗、手术加放疗和/或化疗综合治疗三种方法进行比较。结果:3、5年总生存率分别为55.1％和18.4％。手术加放疗和/或化疗综合治疗优于其他两种方法。结论:随着颈部转移癌部位的下移,其治疗效果越差。     

182例颈部淋巴结转移癌热放综合治疗

自１９９０年～１９９６年，我们利用放疗与加热的综合方法，治疗１８２例颈部淋巴结转移癌，收到较好的效果，现报告如下。方法一般资料：１８２例病人中，男性１１２例，占６１．５％，女性７０例，占３８．５％，男女比为１：０．６。年龄自３２岁～７６岁，平均５４．１岁，以５０岁～６０岁者较多，共１１０例，约占６０％左右。病理分型：低分化鳞癌３７例，占２０．３％，鳞癌７８例，占４２．９％，小细胞未分化癌１２例，占６．６％，低分化腺癌３１例，占１７．０％，腺癌２４例，占１３．２％。原发肿瘤依次为：鼻咽癌、喉癌、肺…     

原发灶不明的颈部淋巴结转移癌的治疗

目的：分析原发灶不明和颈部淋巴结转移癌治疗失败的原因，探讨治疗方法和技术。方法：共收集122例初治治疗的病例，单纯放射治疗（R）62例，单纯手术治疗（S）23例，单纯化疗（C）5例，手术加放射治疗（S＋R）20例，放射治疗加手术（R＋S）12例。手术治疗局部淋巴结切除术 18例，单侧颈淋巴结清扫术34例，双侧颈巴结清扫术3例。放射治疗94例中，全咽部和全颈部照射65例，全颈部照射9例，部分颈部照射20例。结果：全组5年总生存率和无瘤生存率分别为71．9％和36．5％，颈部转移癌未控和复发占45．9％，远地转移率为26．2％，原发灶发现占8．2％。影响颈部治疗失败的主要原因是N分期、综合治疗、全颈照射和肿瘤的放射敏感性。影响远地转移的主要原因是N分期、颈部淋巴结转移部位和原发灶出现。影响原发灶治疗失败的主要原因是颈淋巴结转移部位。结论：早期鳞癌或低分化部、未分化癌局部手术切除或活检术后直接进行放射治疗，晚期颈转移以放射治疗和手术综合治疗为主，可同时加化疗，而腺癌治疗以手术为主。对上中颈部低分化和未分化癌应采用全咽部和全颈部照射，除锁骨上淋巴结转移癌以外，原发灶不明的颈部淋巴结转移癌照射野至少应该包括全颈部。     

甲状腺乳头状癌颈部的处理

目的 探讨甲状腺乳头状癌颈部处理的最佳方案。方法 总结１９６５年１月～１９８７年１月４２４例甲状腺乳头状癌的临床资料,根治原发灶的同时,对颈部淋巴结阳性（Ｎ＋）患者进行颈清扫术,对颈部淋巴结阴性（Ｎ０）患者进行观察,待出现颈淋巴结转移后再行治疗性颈清扫术。所有患者均随访１０年以上。结果 ２５８例颈部Ｎ＋患者的５,１０年生存率分别为８４．３％和８０．４％,而１６６例Ｎ０患者的５,１０年生存率分别为９     

Intensity-modulated radiotherapy for cervical lymph node metastases from unknown primary cancer

PURPOSE: To compare the effectiveness of intensity-modulated radiotherapy (IMRT) and conventional (two-dimensional) radiotherapy in the treatment of cervical lymph node metastases from unknown primary cancer (UPC). METHODS AND MATERIALS: Between February 2003 and September 2006, 23 patients with UPC of squamous cell carcinoma were treated with IMRT. Extended putative mucosal and bilateral nodal sites were irradiated to a median dose of 66 Gy. In 19 patients, IMRT was performed after lymph node dissection, and in 4 patients primary radiotherapy was given. The conventional radiotherapy group (historical control group) comprised 18 patients treated to a median dose of 66 Gy between August 1994 and October 2003. RESULTS: Twenty patients completed treatment. As compared with conventional radiotherapy, the incidence of Grade 3 acute dysphagia was significantly lower in the IMRT group (4.5% vs. 50%, p = 0.003). By 6 months, Grade 3 xerostomia was detected in 11.8% patients in the IMRT group vs. 53.4% in the historical control group (p = 0.03). No Grade 3 dysphagia or skin fibrosis was observed after IMRT but these were noted after conventional radiotherapy (26.7%, p = 0.01) and 26.7%, p = 0.03) respectively). With median follow-up of living patients of 17 months, there was no emergence of primary cancer. One patient had persistent nodal disease and another had nodal relapse at 5 months. Distant metastases were detected in 4 patients. The 2-year overall survival and distant disease-free probability after IMRT did not differ significantly from those for conventional radiotherapy (74.8% vs. 61.1% and 76.3% vs. 68.4%, respectively). CONCLUSIONS: Use of IMRT for UPC resulted in lower toxicity than conventional radiotherapy, and was similar in efficacy.     

外阴癌临床治疗309例报告

目的　分析外阴癌不同治疗方法的结果 ,并探讨其复发转移的特征。方法　采用回顾性研究的方法 ,对 30 9例外阴癌的临床治疗结果进行分析。结果　 30 9例患者总的 5年生存率为6 7.9% ,Ⅰ、Ⅱ、Ⅲ及Ⅳ期的 5年生存率分别为 86 .9%、82 .5 %、5 9.2 %和 43.6 %。总的治疗失败率为49 .8% (其中 2年内失败者占 6 9.5 % ) ;复发部位依复发时间不同而异 ,83.6 %的腹股沟、盆腔及远处转移发生在治疗后 2年内 ,外阴局部复发占 2年后治疗失败的 81.1%。外阴癌复发转移与年龄无关。Ⅰ期癌各种治疗方法的生存率及治疗失败率差异无显著性。Ⅱ期癌外阴根治性切除 腹股沟清扫术生存率较高 (P <0 .0 5 ) ;腹股沟淋巴结阳性者 ,手术治疗的失败率显著低于放疗 (P <0 .0 5 ) ;腹股沟淋巴结阴性者 ,两种治疗方式差异无显著性 ;腹股沟预防照射剂量Dm达 6 0Gy者 ,失败率显著低于剂量Dm <6 0Gy者 (P <0 .0 5 )。结论　早期外阴癌应施行外阴根治性切除 ,加施预防性淋巴清扫或腹股沟足量放疗 ;对中晚期患者 ,争取切除原发灶及行腹股沟淋巴清扫 ,并辅以术前、术后放疗。     

Cervical lymph node metastases of squamous cell carcinoma from an unknown primary: outcomes and patterns of failure

Context: Management of cervical lymph nodes metastases of squamous cell carcinoma (SCC) from primary of unknown origin (PUO) is contentious and there is insignificant data from India on this subject. Aims: To present experience of management of these patients treated with curative intent at a single institution. Settings and Design: Retrospective study of patients treated between 1989-1994 in a tertiary referral cancer centre. Materials and Methods: Eighty-nine patients were evaluated in the study period and their survival compared with patients with common sites of primary in the head and neck with comparable node stage. Statistical analysis used: Kaplan-Meier method. Results: The clinical stage of the neck nodes at presentation was N1 in 11%, N2a in 28.5%, N2b in 22.5%, N3 in 35% and Nx in 3.4% patients. All patients underwent surgery and 70 patients received more than 40Gy postoperative radiotherapy. Twenty-nine (32.6%) patients had relapse of which 19 (21%) were in the neck. Postoperative radiotherapy did not influence the neck relapse (p=0.72). Primary was detected in 13 patients (14.6%) on subsequent follow up. The overall five and eight-years survival was 55% and 51% respectively. The overall five-year survival was better compared to patients with known primary with comparable node stage. Conclusions: Patients with cervical lymph nodes metastases of SCC from PUO have reasonable survival and low rate of development of subsequent primary when treated with surgery and radiotherapy. The overall survival is comparable to that of patients with known primary and hence an attempt at cure should always be made.     

Merkel cell cancer of the skin.

Merkel cell carcinoma (MCC) is a rare malignant cutaneous tumor of the elderly with rapidly growing skin nodules found predominantly on sun-exposed areas of the body. The vast majority of patients present with localized disease, while up to 30% have regional lymph node metastases. Despite local excision and the incidence of local recurrence, regional lymph node metastases and distant metastases is high and usually occurs within 2 years of primary diagnosis. The optimal treatment for patients with MCC remains unclear. The best outcome is achieved with multidisciplinary management including surgical excision of primary tumor with adequate margins and post-operative radiotherapy (RT) to control local and regional disease. Patients with regional nodal metastases should be treated with lymph node dissection plus RT. Adjuvant chemotherapy (CT) should be considered as part of the initial management. In case of metastatic disease CT based on regimens used for small-cell lung cancer is the standard treatment of care.     

Diagnosis and treatment of isolated neck metastases of adenocarcinomas.

AIMS: Cervical metastases of adenocarcinoma or undifferentiated large cell carcinoma (ULCC) (non-squamous cell carcinoma) of unknown primary origin are rare and often accompanied by distant metastases at multiple sites in the body. Nevertheless, in the past decades, several patients have presented in our clinic with isolated neck metastases of this type of malignancy. The aim of our study is to evaluate the clinical behaviour of these cases and to define the role of surgery and radiotherapy. METHODS: Over the past 24 years, we selected 15 out of 270 patients (6%) with isolated cervical lymph node metastases of adenocarcinoma (six) or ULCC (nine) of unknown primary origin. Diagnosis was made either by histology or by fine needle aspiration cytology. Treatment consisted of (selective) neck dissection and/or radiotherapy. RESULTS: The clinical presentation of isolated cervical metastases of adenocarcinoma compared with ULCC is equivalent, with an overall median survival time of 25 months (confidence interval 21--29 months). Combined therapy was correlated with an increased and persistent regional control and was associated with longer duration of survival. CONCLUSIONS: Patients with isolated cervical neck node metastases of adenocarcinoma or ULCC of unknown primary origin are rare and the diagnostic process to identify this subgroup requires a systemic work-up. In selected cases treatment should concentrate on (selective) neck dissection combined with radiotherapy to achieve a prolonged survival. Copyright Harcourt Publishers Limited.     

Patterns of treatment failure following radiotherapy with combination chemotherapy for patients with high-risk stage IIB cervical carcinoma

Background To evaluate the patterns of treatment failure in patients with stage IIB cervical carcinoma with high-risk factors following radiotherapy given concurrently with combination chemotherapy.Methods A retrospective analysis of 349 patients with stage IIB cervical carcinoma with high-risk factors (lesion size 4cm, lymph node metastasis, high-risk cell type) treated by radiotherapy and cisplatin-based chemotherapy was performed. Sites of treatment failure were categorized as pelvic, pelvic plus distant metastases, and distant metastases alone. Pelvic failure included local and pelvic nodal failures.Results Of the 349 patients, treatment failure occurred in 79 patients (22.6%). Forty-six (13.2%) had persistent disease and 33 (9.5%) had recurrent disease. Among these 79 patients, overall pelvic failure was observed in 67%, of whom 72% had local failure; 19%, pelvic nodal failure; and 9%, local with pelvic nodal failure. Incidences of distant metastases alone and pelvic with distant metastases were 24% and 9%. In the 26 patients with distant metastases either alone or combined with pelvic failure, the most frequent metastatic region was the paraaortic lymph node (50%). The distant metastasis rate was 6.5% (19/289) in the pelvic tumor control group and 11.6% (7/60) in the pelvic failure group. Pelvic failure was the most frequent failure in the group with tumor size of 4cm or more, whereas, for the positive-lymph-node group, distant metastasis was most frequent and metastases to paraaortic lymph nodes were common. The incidences of pelvic failure alone and distant metastases were similar in the high-risk cell-type group, and the distant metastasis regions were mostly paraaortic lymph nodes.Conclusion Although systemic chemotherapy was administered concurrently with radiotherapy, the incidence of pelvic failure was highest, followed by paraaortic lymph node metastases, in patients with stage IIB cervical carcinoma with high-risk factors, following radiotherapy with combination chemotherapy.