66例食管鳞癌的热放疗近期疗效报告

６６例食管鳞癌的热放疗近期疗效报告解放军海军职工医院（安庆市２４６００３）王程鹏郑满荣沈梅竹李金华食管癌的手术切除率及５年生存率均低，中晚期食管癌主要靠放射治疗，采用传统的外照射加腔内治疗后仍有８０％～９０％的患者出现局部复发和远处转移。我们将６６例...     

调强放疗同步紫杉醇方案化疗治疗食管鳞癌近期疗效观察

目的:观察调强放疗同步紫杉醇+顺铂方案化疗治疗食管鳞癌的近期疗效及治疗相关不良反应。方法:我院2010年6月-2013年7月收治的70例初治食管鳞癌患者,分为放化疗组36例和单放组34例。单放组:放疗剂量为DT （60-66）Gy/（30-32）f;放化疗组:放疗开始给予紫杉醇135mg/m2,第1天,顺铂25mg/m2,第1-3天,21天为一个周期,共两个周期。放疗结束后3个月复查食管钡餐片及CT进行疗效评价。结果:放化疗组共36例食管鳞癌患者,治疗结束后3个月总有效率（response rate,RR)=(CP+PR）为91.7%,其中完全缓解率(complete response,CR)为55.6%、部分缓解率（partial response,PR）为36.1%、无缓解率（non-response,NR）为8.3%,总有效率高于单放组（73.5%）,且差异有统计学意义（P＜0.05）。放化疗组1、2级不良反应发生率高于单放组,有统计学意义（P＜0.05）,而3级以上不良反应及1、2级放射性肺炎两组无差异（P＞0.05）。结论:调强放疗联合紫杉醇+顺铂方案同步化疗治疗食管鳞癌近期疗效好,不良反应患者可耐受。     

食管鳞癌术后辅助治疗现状

食管癌是我国常见的一种恶性肿瘤,其中鳞癌占90%以上。目前手术为可切除食管鳞癌的主要治疗手段,但单纯手术的疗效不尽如人意。目前食管鳞癌术后无标准治疗模式。近年来研究者对术后辅助化疗、术后辅助放疗及术后同步放化疗进行了深入研究,以期能降低肿瘤复发率,改善患者生存。本文就食管鳞癌术后辅助治疗的现状进行了综述。     

食管癌放疗后复发再程调强放疗的临床观察

目的:探讨调强放疗(intensity modulater radiation therapy,IMRT)在食管癌首程放疗后局部复发患者中的应用及临床观察。方法:37例首程放疗后局部复发的食管鳞癌患者,采用调强放疗技术进行二程放疗,处方剂量为（50-60）Gy/［2Gy·（25-30）f］。结果:37例患者中完全缓解（complete response,CR）7例,部分缓解（partial response,PR）20例,有效率（response rate,RR）为73.0%（27/37）。本组患者1、2、3年生存率分别为59.5%、32.4%、21.1%。放射性食管炎、骨髓抑制、胃肠道反应的发生率较高。全部病例随访资料完整。截止2012年12月,25例患者已经死亡,其中死于局部复发11例、远处转移8例、食管气管瘘2例、大出血2例、其他疾病1例、自杀1例。结论:调强放疗对于食管癌首程放疗后局部复发患者是一种较好的有效的治疗方法,能取得较好的局部控制率。     

低剂量紫杉醇同步放疗治疗中晚期食管鳞癌临床观察

目的 观察低剂量紫杉醇同步三维适形放疗(3 D-CRT)治疗中晚期食管鳞癌的疗效.方法全组83例中晚期食管鳞癌均接受低剂量紫杉醇同步3 D-CRT:紫杉醇15 mg/m2,3次/周;3D-CRT总剂量为60 Gy/30次.治疗结束后评价疗效和毒副反应.结果 83例均可评价疗效,其中CR 72例,PR 11例,NR0例...     

食管鳞癌再程放疗发生食管瘘高危因素分析

目的再程放疗已经越来越多的应用于首程放疗后复发食管癌患者中,然而食管瘘是其最严重的并发症之一。本研究探索食管鳞癌患者行再程放疗伴或不伴化疗发生食管瘘的高危因素。方法回顾性分析山东省肿瘤医院2014-08-01-2019-04-30收治的71例食管鳞癌复发行再程放疗患者临床和剂量学资料,采用Logistic回归模型进行单因素和多因素分析筛选出发生食管瘘的高危因素。结果纳入研究的71例患者中有17例患者发生食管瘘(23.94%),3例患者在再程放疗过程中发生食管瘘,14例患者再程放疗结束后发生食管瘘;在本研究中食管瘘的类型包括食管气管瘘8例,食管纵隔瘘9例。中位随访时间为12.75(0.33~46.83)个月。单因素分析显示,年龄、性别、T分期、放疗总剂量、超分割放疗、肿瘤最大厚度、溃疡型食管癌和2次放疗时间差与食管瘘发生相关。多因素分析显示,T分期、放疗总剂量和两次放疗时间差为食管瘘发生的高危因素,均P<0.05。结论再程放疗食管癌患者食管瘘发生率显著增加,T4分期、放疗总剂量较高、两次放疗时间间隔较短是发生食管瘘的高危因素,超分割放疗可降低再程放疗食管瘘的发生率。     

胸段食管鳞癌术后复发模式及术后放疗靶区的研究北大核心

目的:研究胸段食管鳞癌术后复发模式,为术后放疗靶区勾画提供参考。方法:回顾分析我院2012年7月至2017年5月收治术后复发的81例胸段食管鳞癌患者的临床资料,参照AJCC第八版食管癌分期,将第1-8M站定义为上中纵隔淋巴结区,8Lo、9、15站定义为下纵隔淋巴结区,16-20站定义为上腹部淋巴结区。标记患者的复发部位,并分析局部复发、区域复发和远处转移的模式。结果:中位复发时间为12个月(2~103个月)。6例(7.4%)患者发生单纯局部复发,64例(79.0%)患者发生区域复发,11例(13.6%)患者发生远处转移。区域淋巴结复发中最高危的复发区域为上中纵隔淋巴引流区,此区域包含了82.8%的复发淋巴结,其次为上腹部淋巴结引流区(13.6%)。11例患者发生上腹部淋巴结复发,其中10(90.9%)例为胸下段,7例(63.6%)患者术后分期≥Ⅲ_(b)期。结论:胸段食管鳞癌术后复发模式以区域淋巴结复发为主,上中纵隔淋巴引流区为最高危复发区域,术后放疗靶区应重点包含。对于术后分期较晚的胸下段食管鳞癌,上腹部淋巴结引流区可能需要涵盖在放疗靶区内。吻合口、瘤床和下纵隔复发风险低,可不必常规涵盖在放疗靶区内。     

食管鳞癌三维适形放疗同步化疗的临床研究

 【摘 要】 目的　观察三维适形放疗（3D-CRT）同步化疗对食管鳞状细胞癌的疗效及不良反应。方法 67例食管鳞状细胞癌患者分为同步放化疗组（观察组）35例、单纯放疗组（对照组）32例,两组均采用3D-CRT,处方剂量2Gy/次,5次/周,总剂量60~66 Gy/30~33次;观察组采用PF方案化疗,28 d为1周期,共2周期,化疗的第1d同步放疗,放疗结束后,再进行2~4周期化疗。结果　观察组、对照组有效率分别为85.7%（30/35）和62.5%（20/32）,1、2、3年生存率分别为82.6%和62.2%、44.4%和69.7%、53.9%和25.0%,中位生存时间分别为33.0和27.0个月,差异有统计学意义（均P＜0.05）。急性不良反应主要为放射性食管炎、骨髓抑制、恶心、呕吐。结论 3D-CRT同步化疗治疗食管鳞状细胞癌可取得较好的疗效,不良反应可耐受,有较高的临床可行性。     

放疗合并中药治疗食管鳞癌的远期疗效

目的探讨中药增生平对食管鳞癌放疗的远期疗效。方法1998年6月-1999年12月在食管癌高发现场开展了增生平提高食管癌放疗患者远期生存的前瞻性观察。选择210例食管癌患者,治疗组口服中药增生平,对照组不给予辅助治疗。服药12月以上的病例为有效病例,将死亡率作为终点统计指标。选择临床分组、分期、性别、年龄、Karnosky评分、肿瘤遗传史、吸烟、饮酒、吸烟加饮酒为危险因素,用Cox风险比例模型分析各因素对患者远期生存的影响。结果治疗组Ⅲ期和Ⅳ期患者1、2、3、4、5、6年生存率分别是80.2%、50.2%、42.1%、27.4 %、17.3 %和14.2 %;对照组76.7%、 41.8 %、18.8 %、15.2 %、10.6 %和9.6 %,P=0.039;中位生存期分别是23.5月和18.9月,P=0.027。但临床Ⅰ期和Ⅱ期的远期生存、中位生存期差异均无统计学意义。Cox多因素分析提示临床分组、分期和肿瘤遗传史是影响预后的独立危险因素;其回归系数分别是:0.44、0.32和0.28,P<0.05。全组病例随访93.0 %。结论中药增生平可以提高食管鳞癌Ⅲ期和Ⅳ期远期生存。     

老年食管鳞癌患者单纯放疗和同步放化疗的有效性和安全性比较

目的比较老年食管鳞癌患者(年龄≥65岁)单纯放疗(RT)和同步放化疗(CCRT)的有效性和安全性。方法收集2010年1月至2016年12月于本院首程接受根治性放疗的122例老年食管鳞癌患者,根据治疗情况分为RT组81例和CCRT组41例(替吉奥单药23例、奈达铂单药2例、雷替曲塞联合奈达铂7例和多西他赛联合奈达铂5例),采用实体瘤疗效评价标准RECIST 1.1版评价近期疗效,药物毒性反应标准NCI-CTC 4.0版评价药物毒副反应,急性放射反应评分标准(RTOG/EORTC)评价放疗毒副反应,根据随访数据进行预后分析并采用Cox比例风险回归模型进行多因素分析。结果RT组的总有效率和疾病控制率分别为84.0%和98.8%,与CCRT组92.7%和100.0%的差异无统计学意义(P>0.05)。RT组的中位无进展生存期(PFS)和总生存期(OS)分别为16.1个月和23.8个月,与CCRT组19.7个月和27.1个月的差异无统计学意义(P>0.05)。单因素分析显示影响PFS的因素包括ECOG评分、T分期和放疗剂量,影响OS的因素包括ECOG评分、T分期、N分期、临床分期和放疗剂量,多因素分析显示ECOG评分和放疗剂量是影响PFS的独立预后因素,而ECOG评分和N分期是影响OS的独立预后因素。最常见急性不良反应为放射性食管炎和骨髓抑制(多为1~2级),RT组未发生3~4级不良反应,CCRT组3~4级急性放射性食管炎、放射性肺炎和骨髓抑制的发生率升高至7.3%(3/41)、9.6%(4/41)和7.3%(3/41),差异均有统计学意义(P<0.05)。结论老年食管鳞癌行根治性放疗,放疗剂量提高至60~65 Gy,患者耐受性良好,可延长生存并提高生活质量。是否同步放化疗应综合评估后慎重选择。     

5例食管基底细胞样鳞状细胞癌组织化学及免疫组化观察

目的：探讨食管基底细胞样鳞状细胞癌(BSCC)的组织化学、免疫组化特征及在病理诊断中的作用方法：收集5例食管BSCC分别作HE、组织化学及免疫组化染色，同时收集5例典型鳞状细胞癌(SCC)作对照结果：BSCC主要由密集的小细胞组成，排列成实体小叶状及假腺样(筛网状)，并见粉刺样坏死及基底膜样物质沉积(PAS )，4例BSCC均见不同分化程度的鳞状细胞癌成分．1例见局灶性鳞状细胞分化免疫组化基底细胞样成分Ker(AE1／AE3)、Ker14、PCNA、LM及p53均阳性，Ker194例基底细胞样成分及2例伴随鳞癌成分同时阳性：Syn仅1例BSCC阳性；5例SCC Ker(AE1／AE3)均阳性．3例Ker14弱阳性，2例Ker19弱阳性5例BSCC和BCC其S-100、CgA、NSE及SMA均阴性。结论：BSCC是鳞状细胞癌独特的组织学类型，进行组织化学及免疫组化染色有助于BSCC诊断及鉴别诊断。     

食管基底细胞样鳞癌

目的 探讨食管基底细胞样鳞癌（ＢＳＣＣ）的临床病理特点及鉴别诊断。方法 回顾分析１８７６例食管鳞癌手术切除病例的临床资料,其中９例诊断为ＢＳＣＣ,对其临床资料及病理特点进行总结、分析。结果 食管ＢＳＣＣ主要发生于５０岁以上男性的中段食管,占食管鳞癌的０．４８％。平均生存１７．６个月,２年生存率２２．２％,与低分化鳞癌（２年生存率２８．３％）接近。形态学与遥样囊性癌（ＡＣＣ）或小细胞未分化癌（ＳＣＣ     

Immunotherapy in Squamous Cell Cancer of the Esophagus

Treatment of esophageal carcinoma has changed dramatically following several landmark trials, which have proven the benefit of immunotherapy. The selective PD-1 (programmed cell death ligand-1)-inhibitor nivolumab has been shown to improve DFS in the adjuvant therapy setting (CheckMate-577). In the first-line treatment, PD-L1 positive (CPS ≥ 10) squamous cell carcinoma patients (pts) have been shown to have an increased OS following treatment with the PD-1-inhibitor pembrolizumab in combination with chemotherapy (KEYNOTE-590). Nivolumab also improved overall survival in the first line setting either combined with ipilimumab or with chemotherapy (CheckMate 648) compared to chemotherapy alone. In Asian first-line patients, phase III trials investigating camrelizumab (ESCORT 1), toripalimab (JUPITER 06), or sintilimab (ORIENT 15) in addition to chemotherapy also showed significant survival benefits. In the second-line setting, monotherapy with nivolumab (ATTRACTION-03), pembrolizumab (KEYNOTE-181), camrelizumab (ESCORT), and tislelizumab (RATIONALE 302) demonstrated a benefit in OS in comparison to chemotherapy. Here we will review these trials and integrate them into the current treatment algorithm.     

环氧化酶-2在食管癌中表达的初步研究

目的研究环氧化酶-2(cyclooxygenase-2,COX-2)在食管癌中的表达情况,探讨其在食管癌发展中作用。方法应用免疫组织化学方法和Westernblotting方法检测34例食管癌中COX-2的表达情况。结果COX-2约在71%的食管癌中显著表达,其中鳞癌及腺癌的显著表达之间无统计学显著性差异。并且统计学检验表明肿瘤的临床病理特征中,年龄、性别、组织分化程度、临床分期(TNM)以及有无淋巴结转移对食管癌中的COX-2的显著表达无明显影响。结论COX-2在食管癌中的表达显著增高,临床意义尚未明确。     

Differential Relapse Patterns for Non-small Cell Lung Cancer Subtypes Adenocarcinoma and Squamous Cell Carcinoma: Implications for Radiation Oncology

AimsCurative-intent (radical) radiotherapy aims to control local disease and cure non-small cell lung cancer (NSCLC). The predominant subtypes of NSCLC are adenocarcinoma and squamous cell carcinoma (SCC). The radiotherapy paradigm offered to patients does not differ according to these two subtypes. Relapse patterns and disease control rates for adenocarcinoma and SCC treated with radical radiotherapy were determined.Materials and methodsA radical radiotherapy database covering the period from 2004 to June 2016 was examined to determine the first sites of relapse and the actuarial local and distant control rates.ResultsIn total, 537 patients with known pathological subtype were treated over the period. In 39 (7%), the site of first relapse was uncertain. Of the remainder, 203 (41%) had adenocarcinoma and 295 (59%) had SCC. At a median follow-up of 16.4 months, 58% had relapsed. There was a difference in relapse patterns (chi-squared test P < 0.0005), with a higher rate of first relapse locally in SCC (42% of all patients versus 24%) and a higher rate of first relapse in the brain for adenocarcinoma (14% versus 3%). The actuarial local control rate was worse for SCC (hazard ratio 0.6, 95% confidence interval 0.5–0.9, P = 0.002). The brain metastasis-free survival was worse for adenocarcinoma (hazard ratio 4.1, 95% confidence interval 2.2–7.5, P < 0.0001).ConclusionThere is a difference in relapse patterns between NSCLC histological subtypes, indicating that these are distinct entities. This may have implications for follow-up policy and strategies to improve disease control.     

手术为主的综合疗法治疗小细胞肺癌

目的：探索以手术为主的综合疗法对小细胞肺癌的适应症，方法及临床效果。方法：回顾性总结分析845例小细胞肺癌治疗的临床资料：其中573例广泛期病变采用化疗或（和）放疗；局限期病变272例：单纯化（放）疗50例：先手术后化疗48例；先化疗后手术再化或（和）放疗174例；比较分析、评价不同方法的疗效。结果：广泛期病变1、2、3年生存率分别为13．0％、6．8％、0；局限期病变：化疗组和手术后化疗组1、3、5年生存率分别为74、2％、31．2％、4-3％和75％、46、6％、31．9％．二组间1年生存率无显著性差异（P〉0．05），3、5年的生存率差异显著（P〈0.05）；而先化疗、后手术、术后化（放）疗组1、3、5、10年生存率分别为88.4％、58．9％、46、5％、11．5％，明显优于前两组（P〈0.05）；术前所用化疗方案与周期对生存时间无明显影响。术式包括肺叶切除、全肺切除、支气管（肺动脉）袖式切除重建，肺叶和全肺切除的5、10年生存率明显优于袖式切除．肺叶切除优于全肺及袖式切除。颅内、肝脏或骨髓转移仍为影响本组小细胞肺癌长期生存的主要原因。结论：小细胞肺癌对化疗、放疗均敏感，广泛期病变无手术适应症，应采用以化（放）疗为主的保守治疗。而局限期小细胞肺癌则应积极选用以手术为主、辅助术前、术后化（放）疗的综合方法，可获得较为满意、甚至长期生存的临床效果.     

食管鳞状细胞癌中PINCH蛋白的表达及意义

 目的探讨PINCH蛋白在食管鳞状细胞癌中的表达及其临床病理意义。方法采用免疫组化ABC法检测10例正常食管粘膜组织和64例食管鳞状细胞癌组织中PINCH蛋白的表达,并分析其临床意义。结果PINCH蛋白在鳞癌组织相关间质中呈异质性表达,其阳性率为56.25%(36/64),明显高于正常食管粘膜组织(0/10)(P<0.05),差异有显著性,而且在肿瘤浸润边缘阳性更明显。PINCH蛋白表达与患者性别、年龄及鳞癌组织学分级无相关性;淋巴结转移组的鳞癌组织中PINCH蛋白阳性表达率为90%(18/20),未转移组鳞癌病例中阳性率为40.91%(18/44),二者相比差异有显著性(P<0.05)。结论PINCH蛋白在食管鳞癌中异常表达,可能利于肿瘤的浸润和转移。提示PINCH蛋白可作一个肿瘤相关间质的标志物来预测肿瘤浸润和淋巴结转移的能力。在肿瘤的预后判断上有重要意义,并可能成为与肿瘤间质相关的抗肿瘤治疗的一个新靶点。     

Significance of Serum Neuron-specific Enolase as a Predictor of Relapse of Small Cell Lung Cancer

We conducted a prospective study to evaluate the significanceof serum neuron-specific enolase (NSE) as a predictor of relapseof small cell lung cancer (SCLC). Patients entered into thestudy were drawn from those who had shown a complete or partialresponse to first-line chemotherapy with a concurrent declinein the NSE level to less than 10 ng/ml. When the serum NSE levelincreased to more than 15 ng/ml, the patient was restaged onthe basis of clinical, radiological, and bronchoscopic examinations.During the period from August 1988 to December 1990, 57 patientswith SCLC were enrolled and followed up until May 1992; Of thesepatients, 45 had clinical relapses, and 14 (31%) of them showeda clear elevation of the serum NSE level prior to the clinicalrecognition of relapse. Although one false-positive case wasnoted, this involved only a transient elevation of the NSE level.In patients who showed increased NSE levels, the relapses occurredin more difficult to detect silent sites such as the adrenalgland, liver, and deep lymph nodes. In addition, the percentageof patients demonstrating high NSE levels who were able to benefitfrom salvage chemotherapy was higher than for those who didnot (P<0.05). Our results indicate that serial NSE measurementsare useful for the early prediction of SCLC relapse and shouldhelp to facilitate early administration of salvage chemotherapyfor affected patients.(P<0.05)     

改良Ivor-Lewis手术对胸中段食管鳞癌治疗效果的评价

目的:评价改良Ivor-Lewis手术对胸中段食管鳞癌的治疗效果。方法:对1997年1月～2001年1月间,改良Ivor-Lewis手术治疗的241例胸中段食管鳞癌患者回顾研究。应用Kaplan-Meier法计算生存率;Cox回归分析判定预后的危险因素。结果:围手术期内40例(16.6%)患者有并发症发生,死亡6例(2.5%)。整体5年生存率为31%。Ⅰ、ⅡA、ⅡB和Ⅲ期患者的5年生存率分别为72%、40%、16%和13%(P<0.001)。手术后辅助放疗的T3和N1患者肿瘤局部复发率为23.3%,未完成放疗者的局部复发率为41.3%(P<0.05)。Cox回归分析显示,N1(HR=2.074,P<0.01)和T3(HR=3.493,P<0.01)是独立的预后危险因素。结论:改良Ivor-Lewis手术无严重的手术后并发症。手术后辅助放疗可降低N1和T3患者的肿瘤局部复发率。患者的预后取决于T及N分期。该手术可以治愈多数T1N0M0和T2N0M0胸中段食管鳞癌患者,但是对于T3和N1患者,单纯手术的远期疗效欠佳。     

Peritumoral Retraction Clefting Correlates with Advanced Stage Squamous Cell Carcinoma of the Esophagus

The present study was designated to analyze correlation between the presence and extent of peritumoral retraction clefting and various clinicopathologic features in esophageal squamous cell carcinoma (ESCC), and to possibly establish the significance of this phenomenon in ESCC. Fifty-four consecutive patients with advanced ESCC were included in the study. The presence of peritumoral retraction clefting was classified on the basis of the proportion of tumor nests exhibiting this phenomenon. Tumors with clefts that affected up to 25% of tumor nests were classified as group I; with clefts that affected >25% to 50% of tumor nests as group II; with clefts that affected >50% to 75% of tumor nests as group III; and tumors with clefts that affected more than 75% of tumor nests were classified as group IV. Statistical analysis showed a correlation between presence and extent of peritumoral clefting and lymph node metastasis. T3 tumors and tumors with lymph node metastasis had significantly more pronounced peritumoral clefting compared with T2 tumors and tumors without lymph node metastasis. The presence of peritumoral clefting was not associated with the number of affected lymph nodes. There was no correlation between the presence and extent of peritumoral clefting with patient age and sex, and tumor location, diameter and grade. The association of peritumoral retraction clefting in ESCC with local invasiveness and lymph node metastasis indicated that peritumoral clefting could be a simple and useful morphological feature of tumor aggressiveness and may contribute to the pathological and clinical assessment of patients with ESCC.