内窥镜,Nd：YAG激光对食管癌,贲门癌梗阻的姑息治疗

1988年12月至1989年12月,我们对19例晚期食管癌、贲门癌梗阻或严重狭窄的患者,在内窥镜直视下行Nd:YAG激光治疗。其中食管癌10例,贲门癌9例;鳞状细胞癌10例,腺癌9例。治疗前,7例肿瘤已将管腔梗阻。治疗功率30～50W;每次治疗剂量900～2500J,中位治疗剂量为1500J/次;平均每例治疗3次(范围1～7次);治疗总剂量1500～7250J,中位治疗总剂量4000J。治疗后,患者均能顺利进食半流质食物,缓解期1～7月,中位缓解期为3个月。     

ND：YAG激光^198Au—胶体植入法联合应用治疗肺癌

临床不能手术的晚期中心型肺癌病人，多首选化疗，往往因合并难以控制的肺不张及阻塞性肺炎，延误抗癌治疗，缩短生存期，这已成为关注急切解决的问题，在动物实验的基础上，作者对１８例晚期中心型肺癌，应用ＮＤ：ＹＡＧ激光与胶体＾１９８Ａｕ植入行瘤体内局部照射联合职，近期有效率达１００％，国同尚未见报道，与全身化疗进行疗效对比，差异显著，本文法的优点是“使晚期肺癌的治疗即可显效，迅速改善呼吸功能，控制塞性症，提     

内窥镜下Nd:YAG激光切除鼻腔血管瘤

本组采用Nd：YAG激光经算内窥镜切除鼻腔血管瘤34例。术后随访6～28个月，一次性治愈率为94％。鼻内窥镜下Nd：YAG激光治疗鼻腔血管瘤，诊断部位准确，能彻底消除鼻腔病灶，术后创面不出血，不需填塞，局部反应轻，恢复快，无并发症发生。该术式避免了部分鼻侧切开，能较好地保护了鼻腔生理功能。     

Long-term follow-up results of Nd: YAG laser treatment of premalignant and malignant (Stage I) squamous cell carcinoma of the oral cavity

BACKGROUND AND OBJECTIVES: Only few studies (none from India) have reported the role of Neodymium Yttrium-Aluminum-Garnet (Nd: YAG) laser for treatment of premalignant and stage I (T1N0M0) oral cancer. This study aimed to assess the outcome of Nd: YAG laser in the said lesions after a follow-up of 5 years. Design: Prospective study; Setting: a tertiary care hospital, North India. PATIENTS AND METHODS: Fifty biopsy proven patients of premalignant/malignant (Stage I) lesions oral cavity underwent Nd: YAG laser treatment after prior informed consent from January, 1997 to January, 2000. Patients were followed-up for 5 years. In addition to local recurrence, patient's mucosal response to laser in terms of pain, mastication, salivation, paraesthesias, facial expressions, and speech was also recorded. RESULTS: Twenty-seven patients had leukoplakia, 3 erythroplakia, 6 carcinoma in situ (CIS), and 14 stage I squamous cell carcinoma (SCC) of oral cavity. Four patients required repeat laserization for residual/ recurrent lesion and 15 patients were lost to follow-up. Recurrence free survival (RFS) at 5-years in premalignant and stage I SCC patients was 97.2 and 78.6%, respectively. A minimal persistent edema was observed in 6 (12%) patients at the end of 7th day, rest all tolerated the procedure well. CONCLUSIONS: The present study indicates that Nd: YAG laser is an effective and safe surgical option management of premalignant and malignant lesions of oral cavity.     

Nd:YAG laser therapy of carcinoma lip (stage I squamous cell carcinoma): a retrospective evaluation

Objective

To asses the efficacy of Nd:YAG laser for stage I squamous cell carcinoma of the lip. To the authors’ knowledge this is the first reported study on this subject.

Study design

Retrospective study design involving treatment of 46 patients of either sex of stage I squamous cell carcinoma of lip over a 10-year period in a single tertiary care university teaching hospital with Nd:YAG laser.

Methods

Nd:YAG laser ablation of lesions in lip was carried out in all the patients on an OPD basis with prior consent. A regular follow-up was maintained for a period of 5 years. A negative biopsy at the end of one month and one year was considered a treated case. The tabulated data was analysed statistically by “Kaplan Meier” method and “Log Rank” test. Also cosmetic and functional results were assessed by any sign of flow away after filling the oral cavity with water and postoperative integrity of facial nerve in accordance with “House Brackmann” classification.

Results

In this series of 46 patients, 35 patients were disease free at the end of 3 years and this number further declined to 29 at the end of 5 years with 4 deaths and 2 more patients lost to follow-up. The statistical evaluation by Kaplan Meier method gives us an overall 5-year survival rate of 88.14% with a mean survival of 58 months. Further 8 patients required repeat laserization either for residual or recurrence of lesion. Also 2 patients had a lymph node metastasis during the follow-up period. Thus, by applying Kaplan Meier method recurrence-free survival (RFS) and disease-free survival was found to be 85.1% (mean: 55 months) and 73.34% (mean: 57 months respectively. Interestingly on applying Log Rank test it was observed that the site of the lip involvement, i.e. whether upper or lower had no influence on disease-free survival. It was also observed that history of tobacco intake did not influence the disease free survival either (Log Rank Test). Moreover the cosmetic results were excellent and with no significant complication observed.

Conclusion

The results reported here support the use of Nd:YAG laser for treatment of Stage I squamous cell carcinoma of lip in accordance with principles of minimal invasive and morbid surgery.     

A randomised comparative study of 1064 nm Neodymium‐doped yttrium aluminium garnet (Nd:YAG) laser and topical antifungal treatment of onychomycosis

Conventional treatments for onychomycosis include oral and topical antifungal agents. Although Nd:YAG laser has been reported to be effective, controlled studies combined or compared with conventional treatments are needed. To evaluate the efficacy of 1064 nm Nd:YAG laser for onychomycosis and compare outcomes with those of topical antifungal treatment and combination therapy. Patients were randomly divided into three groups: Laser (L); laser with topical antifungal therapy (L + T); and topical antifungal treatment (T). Laser treatment consisted of three or four sessions at 4 week intervals. Outcomes were assessed clinically and mycologically. In 217 nails of 56 patients, 76% in the L group and 71.8% in the L + T group experienced clinical responses, and 15.2% and 22.5%, respectively, were cured at 24 weeks. The clinical and cure rates of both groups were significantly greater than those of the T group. Six patients of the L group developed new infections, as did one patient in the L + T group and two patients in the T group. 1064 nm Nd:YAG laser shows clinically good responses in onychomycosis. Addition of topical antifungal agent did not appear to improve efficacy, but may have protected against new infection.     

Evaluation of Nd:YAG laser device efficacy on onychomycosis: a case series of 30 patients

Until recently, pharmacologic molecules have been the only available treatments for onychomycosis. Laser treatments were introduced for recurrent or resistant cases or in patients in whom oral treatments are contra‐indicated. Some devices were approved by the Food and Drug Administration (FDA). Neodymium yttrium aluminium garnet (Nd:YAG) is used for onychomycosis as a short‐pulse or a long‐pulse system. We aim to evaluate the efficacy of the short‐pulse Nd:YAG in treating onychomycosis, its side effects, cure rates, and 12‐month recurrence rates. Efficacy was evaluated based on a subjective measure of patient satisfaction on a scale from 1 to 10, and an objective measure based on the results of the mycologic cultures. Medical records of 30 patients were reviewed. Ages ranged from 22 to 85, with a mean of 44. Mycologic cure at 12 months was not achieved in 5 patients (16.67%) who had received laser treatment. None of these patients showed any signs of clinical improvement. Twenty patients (66.67%) were completely cured at 12 months, with corroborating negative mycologic cultures. The remaining five patients (16.67%) had discordance between their clinical cure status and their mycologic cultures. Side effects were reported by 7 patients out of 30 (33%): pain within 48 hours of the treatment session, burning sensation in the treated nail bed area. Our primary end point of negative mycologic cultures at 12 months was seen in 24 out of 30 (80%) of our patients. Similar culture cure rates have not been reported before, not even with systemic treatments with oral antifungals. However, few limitations should warrant us (False‐negative results in fungal cultures; time limitation; sample size…). Still, we propose that this alternative should be offered for patients in whom antifungals are contraindicated or for patients previously treated, but not cured by oral antifungals, and in elderly and polymedicated patients.     

Lung Cancer Survival with Current Therapies and New Targeted Treatments: A Comprehensive Update from the Srinagarind Hospital-Based Cancer Registry from (2013 to 2017)

Background: Lung cancer (LC) is a common malignancy and leading cause of cancer death worldwide and in Thailand. An update on LC survival factors after diagnosis at Srinagarind Hospital is needed. Methods: We conducted a retrospective cohort study, and the data were sourced from the Srinagarind Hospital-Based Cancer Registry. All LC cases were diagnosed between January 1, 2013, and December 31, 2017, and followed up until November 30, 2019. Cases of LC (ICD-O-3) numbered 2,149, but only those with coding C34.0-C34.9 were included. The survival rate was estimated using Kaplan-Meier, while the Log-rank test was used to estimate survival. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard regression models. Results: The 2,149 patients had a total follow-up of 269.6 person-years. Overall, 1,867 patients died during the study, for a corresponding case-fatality mortality rate of 86.0 per 100 person-years. The respective 1-, 3-, and 5-year survival rate was 31.2 % (95% CI; 29.21 to 33.15%), 12.9 % (95%CI: 11.49 to 14.45), and 10.2% (95%CI: 8.74 to 11.70). After patient diagnosis, the median survival time was 0.46 years (5.51 months) (95% CI: 0.42 to 0.50). Targeted therapy was associated with longer survival than non-targeted therapy (p-value < 0.001). After adjusting for sex, TNM stage, and histologic type, multivariable analysis of the entire cohort identified chemotherapy as an independent predictor of improved survival (adjusted HR= 0.48; 95% CI: 0.42 to 0.55; P < 0.001), and that sex, TNM stage, and histologic type were associated with survival. Conclusion: The study confirmed that sex, stage of disease, histology, and chemotherapy are associated with survival of LC. Primary prevention and screening for early detection improve survival. Further investigations into factors affecting survival of LC in Northeast Thailand should focus on targeted therapy.     

Full Compliance of Adjuvant Endocrine Therapy Is Associated with Higher Disease-Free Survival in Hormone Receptor-Positive and HER2-Negative Chinese Breast Cancer Patients with First Tumor Recurrence

Purpose: To characterize the compliance status of adjuvant endocrine therapy (aET) and its relationship with disease-free survival (DFS) in hormone receptor-positive (HR+) and HER2-negative (HER2−) in Chinese breast cancer (BC) patients with first tumor recurrence. Methods: All women with primary unilateral stage I – III HR+HER2− BC and first tumor recurrence in 2008 - 2018 at our institution were identified. Full (vs. none/partial) compliance of aET was classified from records. Multivariate Cox regression estimated the hazard ratio (HR), its 95% confidence interval (CI), and p value. DFS. Covariates included age, T stage, N stage, pathology, tumor grade, LVI, chemotherapy, radiotherapy.      Results: A total 258 patients had average age 47.4 years at BC diagnosis and median DFS 31.7 months. Patients with ipsilateral (contralateral) region and organ recurrence were 47.7% (19.8%) and 71.9%. Compared to the patients with none/partial compliance of aET, the full compliance patients (54.3% ) had a higher DFS (median 35.0 vs. 25.2 months, p=0.009). Multivariate analysis showed that the full compliance of aET was associated with a lower HR 0.614 (95%CI 0.467 – 0.807, p<0.001) on recurrence. Early discontinuation (67.5%, 56/83) due to the drug side effects was the top reason for partial compliance of aET. Conclusions: Full compliance of aET was quite low in Chinese HR+HER2− BC patients. However, it was associated with a 38.6% lower risk of first tumor recurrence. To search for effective tools to improve the compliance of aET in this population should be stressed.