18F-FDG PET-CT联合放疗治疗依从性较差食管癌的临床价值分析

目的 探究¹⁸F-FDG PET-CT联合放疗治疗依从性较差食管癌的临床价值分析。方法 回顾性分析符合标准的96例食管癌患者资料,按照其实际治疗情况分为对照组(常规放疗,n=52)和观察组(¹⁸F-FDG PET-CT联合放疗,n=44)。比较两组患者治疗后临床结果、靶区勾画(GTV、CTV)体积、危及器官(OAR)受量和不良反应情况。结果 观察组缓解率为77.27%,明显高于对照组的57.70%(P=0.003);观察组总体临床治疗效果明显优于对照组(P=0.001)。观察组勾画的GTV、CTV体积均明显小于对照组(P均<0.001)。观察组勾画的靶区OAR(包括肺、心脏、脊髓和气管)受量均明显低于对照组(P均<0.001)。两组均出现急性放射性肺炎、食管炎、骨髓抑制和消化道的不良反应,其不良反应分级无明显差异(P均>0.05)。结论 ¹⁸F-FDG PET-CT联合放疗治疗依从性较差食管癌有助于精准勾画靶区,消除CT分辨率不足,有效保护正常组织,更好帮助进行放射治疗,提高疾病临床治疗效果。     

18F-FDG PET-CT功能影像引导下鼻咽癌同步加速生物调强放疗疗效分析

目的 目前,局部晚期鼻咽癌的治疗效果欠佳,多种不同的放疗技术已应用于鼻咽癌的治疗以提高其疗效.本研究采用18 F-FDG PET-CT功能影像引导同步加速生物调强放疗技术(simultaneous modulated accelerated biological radiation therapy,SMABRT)治疗鼻咽癌,探讨其疗效及安全性.方法 选取2007-06-01-2011-12-05采用GE Discovery ST_8 PET-CT进行模拟定位,显像药物为放射性核素18F标记的FDG,采用视觉分辨法勾画鼻咽肿瘤代谢活性高聚区并定义为GTVnx.pet,中位剂量78 Gy(68.5～81.6 Gy),2.18～2.47 Gy/次,根据CT、MRI或电子鼻咽喉镜所示肿瘤范围勾画大体肿瘤靶区GTVnx,中位剂量74.6 Gy(67～80.4 Gy),2.03～2.44 Gy/次;颈部肿大淋巴结GTVnd中位剂量72 Gy(60～78.5 Gy),1.82～2.38 Gy/次;CTV1剂量60 Gy,1.82 Gy/次;CTV2剂量54～56 Gy,1.64～1.70 Gy/次.结果 中位随访时间56.63个月(1.90～90.97个月).全组4年总生存率(overall survival,OS)、无局部区域复发生存率(local regional recurrence-free survivaal,LRRFS)、无远处转移生存率(distant metastasis-free survival,DMFS)分别为83％、93％和86％.Ⅰ、Ⅱ、Ⅲ和ⅣA期4年OS分别为100％、100％、88％和67％(x2=7.710,P=0.052),LFFRS分别为100％ 、86％ 、92％和97％(x2=1.928,P=0.587),DMFS分别为100％、100％、95％和65％(x2 =14.079,P=0.003).GTVnx.pet低剂量组(≤77 Gy)和高剂量组(＞77 Gy)4年OS、LRRFS和DMFS分别为82％和83％(x 2=0.005,P=0.948)、80％和97％(x2 =5.569,P=0.018)、97％和81％(x2 =3.598,P=0.058).多因素分析显示,LRRFS的独立预后因素为GTVnx.pet照射剂量,DMFS的独立预后因素为总分期,OS的独立预后因素为N分期.全组患者未发生≥3级晚期放射性损伤.结论 采用18 F-FDG PET-CT功能影像引导下SMABRT治疗鼻咽癌,当给予肿瘤代谢活跃区较高的照射剂量时,能提高局部晚期鼻咽癌的局部区域控制率,各分期之间LRRFS无显著差异,不增加正常组织晚反应损伤,肿瘤代谢活跃区的照射剂量为影响LRRFS的唯一因素,总生存及无远处转移生存未见明显改善.     

PET-CT图像融合在食管癌精确放疗中的应用

目的探讨PET-CT融合图像勾画靶区的食管癌三维适形放疗计划的优势。方法对16例食管癌病例分别进行CT、PET同机扫描,图像重建后传输至三维治疗计划系统(3D-Treatment planning system,TPS),进行自动图像融合,由同一临床医师分别在CT、PET-CT融合图像上勾画出,同一物理师分别设计优化TPS计划,给予常规处方剂量2.0Gy×30次,每个计划采用5个方向照射野来实现较好的靶区剂量分布,并达到周围正常组织保护的目的。计算各计划的靶区体积并显示剂量体积直方图(dose-volume histogram,DVH),比较2个计划的全肺平均受量(mean lung dose,MLD)、双肺受照超过20Gy的体积占全肺体积的百分比(V20)、气管平均受量、心脏平均受量、脊髓最大受量。结果CT勾画的GTV体积均值为67.10cm3,大于PET-CT融合图像下勾划的GTV均值60.82cm3,包括MLD、全肺V20、气管平均受量、心脏平均受量、脊髓最大受量在内的各项DVH参数的比较显示,均以PET-CT勾画靶区的计划明显优于CT勾画靶区的计划。结论PET-CT图像融合基础上勾画靶区制定放疗计划,可更有效的保护周围正常组织和器官。     

18FDG PET-CT对食管癌临床分期及适形放疗计划设计的影响

准确的TNM分期，包括原发灶浸润深度和长度、淋巴结转移及远处转移，是为食管癌患者制定最佳治疗策略的至关重要因素。对拟行三维适形放疗的食管癌患者，在解剖和功能上准确勾画食管病变范围和受转移淋巴结则是达到精确放疗的必然要求。18↑FDG是临床最常用的PET检查示踪剂，故主要综述18↑FDG PET-CT较以往常规诊断技术对食管癌准确分期及指导放疗靶区确定的价值。[第一段]     

良性肺结节在18F-FDG PET-CT上的摄取特点

目的：分析良性肺结节的18F-FDG PET-CT的摄取特点,提高对良性肺结节的诊断和鉴别诊断能力。方法回顾性分析121例良性肺结节患者的18F-FDG PET-CT表现。98例患者于病灶处行延迟扫描。所有病例均通过组织学、诊断性治疗或随诊证实。结果121例良性肺结节按照其病理类型分为炎性结节（46例）、肉芽肿结节（37例）、错构瘤（15例）和其他类型良性结节（23例）,其SUVmax常规分别为（2.74±2.04）、（3.78±3.07）、（0.88±0.64）和（1.25±1.03）。行常规扫描时没有摄取、轻度摄取增高和明显摄取增高的肺结节分别为21、56和44例。炎性和肉芽肿结节多为轻度或明显摄取增高,错构瘤和其他类型良性结节多为没有摄取或轻度摄取增高（P＜0.01）。98例患者行局部延迟扫描的结果为：摄取升高者有61例、不变或下降者有37例。炎性和肉芽肿结节行延迟扫描后的摄取多升高,而错构瘤延迟扫描后摄取多不变或下降（P＜0.01）。良性肺结节的摄取与大小呈正相关（P＜0.01）。结论炎性和肉芽肿结节在18F-FDG PET-CT上多为轻度或明显摄取增高,需要与肺癌相鉴别。而错构瘤和其他类型良性结节多为没有摄取或轻度摄取增高。对于摄取明显增高（SUVmax≥2.5）的肺结节行延迟显像无鉴别意义。     

18F-FDG PET-CT评价霍奇金淋巴瘤的纵隔残存肿块

目的霍奇金淋巴瘤治疗后常见残存肿块,本研究旨在评价~(18)F-FDG PET-CT诊断肿瘤残存的准确性,并探讨延迟扫描的应用价值。方法回顾性分析了自2006年8月至2011年1月间,50例治疗结束后有纵隔残存肿块[最大径(2.9±2.0)cm]的霍奇金淋巴瘤患者,行PET-CT检查评价治疗疗效。所有患者临床和影像学随访至少1年,证实13例有肿瘤残存,37例无肿瘤残存。结果经过ROC曲线分析,确定SUV_(max)评价肿瘤残存的最佳临界值为2.2。根据此标准,PET-CT诊断肿瘤残存的敏感性为69.2%、特异性为81.1%、准确性为78.0%、阳性预期值为56.2%、阴性预期值为88.2%。其中34例行胸部延迟扫描,以SUV_(max)2.2且延迟后升高10%作为延迟扫描判断肿瘤残存的标准,与常规扫描比较,延迟扫描减少了5例假阳性,增多2例假阴性。两者对肿瘤残存判断的准确性差异无统计学意义(P=0.355)。结论对于霍奇金淋巴瘤治疗后纵隔残存肿块,PET-CT是判断有无肿瘤残存的有效检查方法,延迟扫描可减少假阳性。     

18F-FDG PET-CT全身显像肠道高浓聚的临床意义分析

目的：评价PET-CT全身显像肠道摄取18F-FDG的临床意义.方法：本研究回顾性分析我院PET/CT中心2010年7月-2011年6月2387例检查者中肠道出现18F-FDG高代谢灶的227例检查者,通过病理结果及相关影像学检查及临床随访,确定最终结果.结果：227例肠道高浓聚中,局灶性浓聚165例,其中恶性病灶49例,总恶性率为29.70％,分组恶性率分别为体检组为8.51％,肠外原发肿瘤组为13.11％,查找原发病灶组为43.59％,临床怀疑为肠道肿瘤组为68.97％.弥漫性肠道代谢增高者62例,全部为生理性摄取或炎性改变.局灶性病灶中良性与恶性组SUV无统计学差异.结论：18F-FDG PET-CT全身显像对肠道肿瘤检出具有重要的意义,但其良恶性鉴别不能单纯依靠SUV,其病史在诊断中也具有非常重要的作用,最终诊断依靠肠镜活检.     

小柴胡汤合并放疗与单纯放射治疗食管鳞癌66例随机分组研究

对 6 6例中晚期食管鳞癌采用小柴胡汤合并放疗与单纯放疗前瞻性随机分组研究。综合治疗组的Ⅰ、Ⅱ级放射反应率分别为 4 2 .4 %、4 5 .4 % ,显著高于单纯放疗组的Ⅰ、Ⅱ级放射反应率。综合治疗组的 1 ,3年生存率显著高于单纯放疗组的 1 ,3年生存率 (P <0 .0 5 )。显示小柴胡汤合并放疗能提高中晚期食管癌放疗疗效及减轻食管癌放疗所致血象下降的毒性反应。     

18F-FDG PET融合CT对胸中段食管鳞癌区域淋巴结分期的前瞻性研究

目的 探讨正电子发射型电子计算机断层(PET)显像在胸中段食管鳞癌患者术前区域淋巴结临床分期中的应用价值.方法 30例行现代二野淋巴结清扫术的胸中段食管鳞癌患者,术前进行全身18F-氟代脱氧葡萄糖(18F-FDG)PET融合CT显像与CT显像,对区域淋巴结检查结果进行对照研究.结果 现代二野淋巴结清扫术后发现24例患者区域淋巴结阳性(80.00%),转移区域淋巴结总数为61枚.18F-FDG PET融合CT发现食管区域淋巴结转移16例,敏感性、特异性和Youden指数分别为66.67%、100.0%和0.67.CT检出8例.61枚转移区域淋巴结中18F-FDG PET融合CT定性43枚(70.49%),定量分析发现转移区域淋巴结计算标准化摄取值(SUV)为2.9±1.2,均＞2.5;CT检出区域淋巴结转移数24枚(39.34%).18F-FDG PET融合CT在区域淋巴结转移患者与区域淋巴结转移数均明显优于CT,P＜0.05.结论 18F-FDG PET融合CT在诊断胸中段食管鳞癌区域淋巴结转移方面可能优于CT.     

18F-FDGPET-CT用于胰腺癌放疗的研究进展

胰腺恶性肿瘤的治疗是消化系统恶性肿瘤治疗的一个难点,结合各种治疗手段的现状,目前胰腺癌治疗的观念及模式需进一步转变。然而随着现代放射治疗技术图像引导放射治疗（IGRT）等精确放疗技术在胰腺癌治疗中的广泛引用,胰腺癌患者得到了明显生存获益。先进的影像学设备为精确放疗技术提供了重要的基础,本文主要围绕18F-PDG PET-CT 检查在胰腺癌放射治疗中各方面的临床价值进行综述。     

65～75岁胸段食管鳞癌患者根治术后放疗的临床观察

目的回顾性分析65~75岁老年胸段食管鳞癌患者接受根治性切除术后放疗的疗效和安全性。方法收集2004年5月至2018年5月接受根治性手术联合术后放疗的68例老年食管鳞癌患者的临床资料,术后4~6周开始放疗,靶区包括术后瘤床和高危淋巴引流区,总剂量为50~54Gy,其中19例患者接受术后同步放化疗。采用Kaplan-Meier法计算总生存时间(OS)、无病生存时间(DFS)、无局部区域复发生存时间(LRFS)以及无远处转移生存时间(DMFS),影响OS的多因素分析采用Cox比例风险回归模型。结果随访截止于2018年5月15日,随访率为98.5%,中位随访27.7个月。全组1、3、5年生存率分别为87.9%、65.2%和50.4%,中位OS为61.2个月;中位DFS为48.8个月,1、3、5年无病生存率分别为85.1%、55.8%和37.2%;中位LRFS为54.4个月,1、3、5年无局部区域复发生存率分别为81.6%、60.4%和47.8%;中位DMFS为60.5个月,1、3、5年无远处转移生存率分别为84.8%、62.4%和50.2%。单因素分析显示,T分期、淋巴结转移、淋巴结转移数量和TNM分期与OS有关(P<0.05);多因素分析显示,TNM分期(HR=3.626, 95%CI:1.610~8.167,P=0.002)是影响OS的独立因素。全组常见不良反应为放射性肺炎、骨髓抑制、黏膜反应、疲劳、出血和吻合口狭窄,以1~2级为主,3级不良反应10例。全组死亡40例,肿瘤原因死亡22例,非肿瘤原因死亡15例,另外3例死因不详。结论可耐受手术的老年(65~75岁)胸段食管鳞癌患者进行术后放疗可延长OS,不良反应可耐受,TNM分期是影响OS的独立因素。     

Signatures within esophageal microbiota with progression of esophageal squamous cell carcinoma

ObjectiveEsophageal squamous cell carcinoma (ESCC) is one of the dominant malignances worldwide, but currently there is less focus on the microbiota with ESCC and its precancerous lesions.MethodsPaired esophageal biopsy and swab specimens were obtained from 236 participants in Linzhou, China. Data from 16S ribosomal RNA gene sequencing were processed using quantitative insights into microbial ecology (QIIME2) and R Studio to evaluate differences. The Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used to compare diversity and characteristic genera by specimens and participant groups. Ordinal logistic regression model was used to build microbiol prediction model.ResultsMicrobial diversity was similar between biopsy and swab specimens, including operational taxonomic unit (OTU) numbers and Shannon index. There were variations and similarities of esophageal microbiota among different pathological characteristics of ESCC. Top 10 relative abundance genera in all groups include Streptococcus, Prevotella, Veillonella, Actinobacillus, Haemophilus, Neisseria, Alloprevotella, Rothia, Gemella and Porphyromonas. Genus Streptococcus, Haemophilus, Neisseria and Porphyromonas showed significantly difference in disease groups when compared to normal control, whereas Streptococcus showed an increasing tendency with the progression of ESCC and others showed a decreasing tendency. About models based on all combinations of characteristic genera, only taken Streptococcus and Neisseria into model, the prediction performance was the ideal one, of which the area under the curve (AUC) was 0.738. ConclusionsEsophageal biopsy and swab specimens could yield similar microbial characterization. The combination of Streptococcus and Neisseria has the potential to predict the progression of ESCC, which is needed to confirm by large-scale, prospective cohort studies.     

食管鳞癌肿瘤微环境相关研究进展

食管鳞癌是我国食管癌的主要类型，危害严重。近年来，许多研究发现，其发生、发展与所在的肿瘤微环境密切相关。食管鳞癌细胞所在的肿瘤微环境可通过调控免疫微环境、释放细胞因子、改变血管生成等多种途径促进食管鳞癌细胞生长、侵袭和转移，并造成免疫逃逸。本综述从白介素-6（interleukin-6，IL-6）、程序性死亡［蛋白］-1（programmed death-1，PD-1）/程序性死亡［蛋白］配体-1（programmed death ligand-1，PD-L1）、转化生长因子-β（transforming growth factor-β，TGF-β）、乏氧诱导因子-1（hypoxia inducible factor-1，HIF-1）及血管内皮细胞生长因子（vascular endothelial growth factor，VEGF）等影响食管鳞癌肿瘤微环境的重要通路方面，阐述肿瘤微环境与食管鳞癌预后的关系及相关机制，并介绍相关靶向治疗的研究进展，旨在为食管鳞癌的防治研究提供参考。     

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。     

Results of radiotherapy for primary subglottic squamous cell carcinoma

: To retrospectively evaluate the outcome after radical radiotherapy (RT) and surgical salvage and assess the risk of late toxicity for patients with primary subglottic squamous cell carcinoma treated at our center.

: Between 1971 and 1996, 43 patients with primary squamous cell carcinoma of the subglottis (35 men, 8 women) were treated with radical RT. All received megavoltage irradiation, most commonly to a dose of 50–52 Gy in 20 fractions during 4 weeks (39 patients). The median follow-up was 4.2 years.

: Local control was achieved with RT alone in 24 (56%) of the 43 patients: 7 of 11 with T1, 8 of 12 with T2, 4 of 8 with T3, and 5 of 12 with T4. The 5-year actuarial local relapse-free rate was 52%. Subsequent local control was achieved in 11 of the 13 patients with failed RT and attempted surgical salvage, for an ultimate local control rate of 81.4% (35 of 43). The 5-year overall and cause-specific actuarial survival rate was 50.3% and 66.9%, respectively. No patients developed Grade 3 or 4 late radiation morbidity.

: These data support the use of primary RT in the treatment of patients with primary squamous cell carcinoma of the subglottis as an appropriate treatment approach providing an option for laryngeal conservation.     

Human papillomavirus tumor infection in esophageal squamous cell carcinoma

The association between human papillomavirus (HPV) and esophageal squamous cell carcinoma (ESCC) has been recognized for over three decades. Recently, multiple meta-analyses have drawn upon existing literature to assess the strength of the HPV-ESCC linkage. Here, we review these analyses and attempt to provide a clinically-relevant overview of HPV infection in ESCC. HPV-ESCC detection rates are highly variable across studies. Geographic location likely accounts for a majority of the variation in HPV prevalence, with high-incidence regions including Asia reporting significantly higher HPV-ESCC infection rates compared with low-incidence regions such as Europe, North America, and Oceania. Based on our examination of existing data, the current literature does not support the notion that HPV is a prominent carcinogen in ESCC. We conclude that there is no basis to change the current clinical approach to ESCC patients with respect to tumor HPV status.     

A case of esophageal squamous cell carcinoma metastatic to the breast

Metastasis to the breast from extramammary malignancies is rare. There are especially few reports of metastasis from esophageal cancer. We report the pathological and autopsy findings of a 44-year-old man with advanced esophageal cancer and a left breast tumor. Squamous cell carcinoma invading the mammary glands was demonstrated histologically. Immunostains for ER, PgR, and ErbB-2 were negative. At autopsy, metastatic lesions were found in lung, liver, diaphragm, peritoneum, spine, and mediastinal lymph nodes, with no evidence of metastasis to the skin. While metastatic breast tumors are rarely the initial sign of malignancy, it is important to distinguish a metastasis from primary breast cancer to avoid unnecessary conflicting treatments.     

EXPRESSION OF ANNEXIN Ⅰ IN TUMORIGENESIS OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Objective: To detect the expression of annexin I in esophageal squamous cell carcinoma and precursor lesions, and evaluate its effect on the tumorigenesis. Methods: The immunohistochemistry S-P method was used to determine the expression of annexin I in 135 cases of esophageal squamous cell carcinoma, in which precursor lesions were found in some cases, and in the corresponding normal controls. Results: Of 135 cases, 35 (25.9%) were strongly positive, 60 (44.4%) were weakly positive and 40 (29.6%) negative, while in the corresponding normal controls, 129 (95.6%) were strongly positive, 6 (6.4%) weakly positive. The expression of annexin I was decreased in esophageal squamous cell carcinoma (P<0.0001), and the degree and rate of the decrease did not show correlation with age, gender, differentiation, and lymph node metastasis (P<0.05). The expression of annexin I was also decreased in the lesions of dysplasia and carcinomain situ, with 2 (4.3%) strongly positive, 17 (37.0%) weakly positive and 27(58.7%) negative (P<0.0001). Conclusion: Annexin I may be useful in early detection of esophageal squamous cell carcinoma and in evaluation of predisposition for the risk of cancerization of precursor lesions. Foundation item: This work was supported by the National Natural Science Foundation of China (No.30271460). Biography: LU Ning (1955-), associate professor, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical Sciences, majors in pathology of cancer. E-mail: ninglv@hotmail.com     

肿瘤标志物在食管鳞状细胞癌中的应用

对细胞角蛋白19片断（CYFRA21—1）、鳞状细胞癌抗原（SCC）等常规食管鳞状细胞癌（简称鳞癌）肿瘤标志物应用状况,肿瘤标志物在食管鳞癌早期诊断、预测化放疗敏感性、监测术后复发和转移、判断预后方面的研究进展作一介绍。虽然食管鳞癌肿瘤标志物的研究和报道较多,但是尚无令人满意的肿瘤标志物。蛋白质组学技术已开始用于食管鳞癌肿瘤标志物的寻找,随着分子生物学技术的进步,有望寻找到理想的肿瘤标志物,为食管鳞癌的诊断治疗提供便捷途径。     

食管癌放射治疗模拟定位

 在食管癌的放射治疗中，精确定位是提高食管癌放疗局部控制率的关键，CT模拟定位是食管癌放射治疗中提高肿瘤剂量，减少并发症，提高肿瘤控制率得很好的方法，PET／CT融合更多地显示有治疗意义的征象，对放射治疗的准确定位有很大价值。