64例肺癌脑转移的临床治疗分析

目的通过分析肺癌脑转移的临床特点,探讨其综合治疗的疗效及预后因素。方法收集我科2006年5月至2009年5月的64例肺癌脑转移患者的临床治疗资料,进行回顾性分析。结果发生脑转移的肺癌以腺癌居多,其次为小细胞肺癌。主要为Ⅲ期、Ⅳ期及广泛期患者。3例行姑息性对症治疗,中位生存时间为2个月。手术＋全脑放疗＋化疗组3例,中位生存时间为18个月。全脑放疗＋化疗组46例,中位生存时间为14个月。三维立体定向放疗＋化疗组12例,中位生存时间为16个月。脑干转移者中位生存时间为2个月。结论肺癌脑转移采用以放疗为主,结合化疗的综合治疗是一种比较合理的治疗方法。如有条件手术者,手术后再行放化疗,可有效地改善患者的临床症状及延长患者的生存期。     

以手术为主综合治疗脑单发转移瘤

目的 观察以手术为主综合治疗脑单发转移瘤的临床疗效。方法 采用开颅手术切除肿瘤结合放化疗综合应用。结果 颅内高压症状完全消失、体征明显改善且持续6月者11例,基本消失、仅有轻微头痛感觉者3例,其中2例已经存活3年以上。结论 以手术为主综合治疗脑单发转移瘤有较好的姑息作用,可使大多数患者神经系统症状减轻,神经功能损伤改善．提高患者生活质量．延长生存期．     

以手术为主的综合治疗对食管小细胞癌患者生存期的影响

目的 对我院确诊的17例原发性食管小细胞癌( PESC)的临床特点、治疗方法和预后进行总结,分析以手术为主的综合治疗方法对患者生存期的影响.方法 17例PESC中单纯食管癌根治术2例,单纯放射治疗(放疗)3例,手术+放化疗4例,放疗+化疗7例,单纯化疗1例.化疗采用EP、FP方案,即依托泊苷加顺铂注射液、氟尿嘧啶加顺铂注射液,手术+放化疗者手术后化疗1～2个周期再放疗后再化疗2～3个周期,放疗+化疗者放疗后再化疗3～6个周期.结果 1例广泛期患者单纯化疗后5个月内死亡,5例局限期患者行单纯局部治疗(单纯手术或单纯放疗),1年生存率40.0％(2/5),2年生存率0％.11例局限期患者接受综合治疗(手术+化疗+放疗或化疗+放疗),1年生存率为63.6％( 7/11),2年生存率为54.5％ (6/11),3年生存率为18.1％ (2/11),中位生存期为14个月.综合治疗较单纯治疗生存期有所延长.结论 对PESC患者采用以手术为主的综合治疗方法,有可能延长患者的生存期.     

脑膜转移瘤临床诊断与治疗分析

目的总结本科收治的脑膜转移瘤患者临床资料,分析临床诊断、治疗方法及预后。方法本科2007年12月至2012年12月诊断为脑膜转移瘤20例患者的临床资料进行回顾性分析。结果有明确影像学诊断者13例,脑脊液细胞学检查查到肿瘤细胞7例,20例选择单用或联合全脑放疗、鞘内化疗和全身化疗等治疗,2例行手术分流。确诊后生存期为4周～16个月,中位生存期为7个月。结论脑膜转移瘤病情发展迅速,预后差,诊断主要依靠MRI和脑脊液细胞学检查,治疗方法有全脑放疗、鞘内化疗和全身化疗等,选择合适的综合治疗方法可延长患者生存期。     

肺癌脑转移行单纯放疗与放化疗联合的临床生存状况比较

目的比较单独应用全脑放疗（WBRT）与放化疗联合治疗肺癌脑转移的临床效果。方法56例患者入组,A组即单独接受WBRT,30例;B组接受WBRT后行全身化疗（RT＋CT）,26例;全部病例定期随访直至死亡。结果WBRT组1年生存率18.6%,中位生存期7个月;RT＋CT组1年生存率58.7%,中位生存期18个月。结论肺癌脑转移患者的全脑放疗加全身化疗较单纯全脑放疗有更好的生存状况。     

肺癌脑转移不同治疗的疗效分析

肺癌严重危害人民健康 ,晚期肺癌发生远处转移亦很多见 ,其中之一为脑转移。自 1991～ 2 0 0 0年 ,我院收治肺癌脑转移 32例 ,根据不同的方法进行治疗 ,分析其治疗疗效。1　临床资料本组男 2 4例 ,女 8例 ;年龄 4 1～ 6 7岁 ,平均 5 4岁 ,以 5 0～ 6 5岁为主。治疗分单纯肺手术、肺脑联合手术加放化疗、肺手术加放化疗、放化疗、其他治疗五种。病理分型 :腺癌18例 ,大细胞癌 1例 ,小细胞癌 2例 ,鳞癌 8例 ,混合型癌 3例。全组随访 32例 ,随访率 10 0 %。治疗效果 :单纯肺手术2例平均生存时间 16 8ｄ ,肺脑联合手术加放化疗 5例平均生存时间 …     

替尼泊甙联合全脑放疗治疗脑转移癌的临床研究

目的 探讨替尼泊甙联合全脑放疗与单纯全脑放疗治疗脑转移癌的疗效及毒副反应.方法 脑转移癌患者206例,随机分为单纯全脑放疗组(单放组)103例和替尼泊甙化疗+全脑放疗组(综合组)103例.单放组常规全脑放疗36Gy,单发病灶或2～3个病灶位于脑一侧者给予局部缩野加量或半脑加量20Gy,全脑多发者全脑增量10Gy;综合组放疗方法同单放组,于放疗第1天开始静滴替尼泊甙60 mg/m2,每周1次,连续4周.结果 单放组有效率82.5%(85/103),1年生存率39.8%(41/103),中位生存期8.4个月.综合组有效率93.2%(96/103),1年生存率62.1%(64/103),中位生存期12.7个月.2组1年生存期及中位生存期比较差异有统计学意义(P＜0.05).综合组骨髓抑制、消化道反应均高于单放组.结论 替尼泊甙配合全脑放疗治疗脑转移癌疗效好,能延长生存期.     

替莫唑胺配合伽玛刀治疗孤立性脑转移瘤33例

目的 观察替莫唑胺配合伽玛刀治疗孤立性脑转移瘤的疗效和不良反应.方法 33例孤立性脑转移瘤患者予以伽玛刀治疗,剂量曲线40%～70%,平均45.9%;周边剂量15.5～20.5 Gy,平均(18.1±2.8)Gy;中心剂量29～42 Gv,平均(38±5.6)Gy.伽玛刀治疗1 d后使用替莫唑胺单药化学治疗,平均剂量300 mg,每日1次,连用5 d为1个疗程,每4~5周重复1个疗程,共2～3个疗程.治疗期间注意血常规及肝肾功能变化情况,并给予脱水、支持对症治疗.在伽玛刀治疗结束后3个月复查脑MRI,观察肿瘤大小,并统计患者治疗后1年生存情况和中位生存期.结果 33例患者中,27例在治疗期间无颅内、外病灶进展,28例伴有神经症状者均得到缓解.伽玛刀治疗结束后3个月单纯颅内病灶评价,完全缓解(CR)7例,部分缓解(PR)20例,稳定(SD)6例,进展(PD)0例,有效率(CR+PR)为81.82%(27/33).一年生存率为60.61%(20/33),中位生存期13.6个月.不良反应主要是颅内肿瘤周边水肿和替莫唑胺化学治疗反应,多为Ⅰ～Ⅱ度,无Ⅳ度不良反应.结论 替莫唑胺配合伽玛刀治疗孤立性脑转移瘤的疗效好,且不良反应轻.     

无颅外转移的非小细胞肺癌脑转移瘤103例临床分析

目的分析无颅外转移的非小细胞肺癌脑转移瘤患者的手术效果及预后。方法回顾性分析103例无颅外转移的非小细胞肺癌脑转移瘤患者的手术及预后相关资料。结果 103例患者中,男59例,女44例,均接受了脑转移瘤切除术。病理诊断腺癌96例,鳞状细胞癌7例。103例患者的1年和2年生存率分别为81.6%和39.8%。脑转移瘤全切除患者(85例)中位生存期为34个月,长于脑转移瘤部分切除患者(18例)的12个月(P<0.05)。表浅部脑转移瘤患者(75例)中位生存期为34个月,长于深部脑转移瘤患者(28例)的16个月(P<0.05)。单因素和多因素分析均显示,脑转移瘤切除程度和脑转移瘤位置是患者预后的影响因素(P<0.05)。结论非小细胞肺癌脑转移瘤部分切除和深部脑转移瘤的患者预后较差。     

同步放化疗联合香菇多糖治疗非小细胞肺癌脑转移的临床研究

目的观察同步放化疗联合香菇多糖治疗非小细胞肺癌脑转移的临床疗效及毒副反应。方法将112例肺癌脑转移患者随机分为治疗组和对照组各56例。对照组：脑转移灶≤3个者,全脑放疗40Gy后缩野放疗至总量60Gy;脑转移灶﹥3个者,全脑放疗至总量40Gy。治疗组：放疗方法与对照组相同,放疗同时予TP方案化疗并静脉滴注香菇多糖治疗,28d为一周期。结果治疗组和对照组总有效率分别为88.7%和83.3%（P〉0.05）。中位生存期分别为11.8个月和5.6个月,1年生存率分别为41.5%和18.5%,差异有统计学意义（P〈0.05）。治疗组骨髓抑制和胃肠道反应高于对照组,差异有统计学意义（P〈0.05）。结论同步放化疗联合香菇多糖治疗非小细胞肺癌脑转移可以延长生存时间。     

非小细胞肺癌脑膜转移12例临床分析

目的通过对12例非小细胞肺癌脑膜转移病例的分析,探讨该病的诊断及治疗。方法12例经临床、影像学或脑脊液(CSF)细胞学检查证实的非小细胞肺癌脑膜转移患者,3例全脑放疗,8例全脑放疗加全身化疗,1例放弃治疗。结果3例单纯放疗者中1例PR,2例SD,中位生存4.2个月;8例全脑放疗加全身化疗者中4例PR,3例SD,1例PD,中位生存6.1个月;1例放弃治疗者存活1个月。结论MRI结合CSF细胞学检查有助于该病诊断,放疗加化疗疗效优于单纯放疗。     

CNS complications of breast cancer: current and emerging treatment options

In general, the development of CNS metastases of breast cancer depends on several prognostic factors, including younger age and a negative hormone receptor status. Also, the presence of a breast cancer 1, early onset (BRCA1) germline mutation and expression of the human epidermal growth factor receptor 2 (Her2/neu) proto-oncogene seem to contribute to an increased rate of development of CNS metastases.The choice of appropriate therapy for brain metastases also depends on prognostic factors, including the age of the patient, the Karnofsky performance score, the number of brain metastases and the presence of systemic disease. Surgery followed by whole brain radiation therapy (WBRT) is generally restricted to ambulant patients with a single brain metastasis without active extracranial disease. In patients who have two to four metastases, stereotactic focal radiotherapy (i.e. radiosurgery) with or without WBRT is usually indicated. In the remainder of patients, WBRT alone provides adequate palliation. Although breast carcinoma is sensitive to chemotherapy, the role of chemotherapy in the treatment of brain metastases is still unclear. Objective responses after cyclophosphamide-based therapies were reported in studies performed in the 1980s. Subgroup analysis of data from a randomised study indicates that survival may improve if WBRT is combined with the radiosensitiser efaproxiral. Interestingly, the Her2/neu antibody trastuzumab, which does not cross the blood-brain barrier, produces systemic responses and enhanced survival, without a clear effect on brain metastases.Breast cancer constitutes the most common solid primary tumour leading to leptomeningeal disease. Clinical symptoms such as cranial nerve dysfunction or a cauda equina syndrome can be treated with local radiotherapy. A randomised study in patients with leptomeningeal disease secondary to breast cancer has revealed that intrathecal chemotherapy is associated with substantially more adverse effects than non-intrathecal treatment, without a clear benefit in terms of response or survival.Intramedullary metastasis is rare but often presents with a rapidly progressive myelopathy. Local radiotherapy may preserve neurological function.Epidural spinal cord metastasis occurs in approximately 4% of patients and can lead to paraplegia. A randomised study has shown that surgical intervention together with local radiotherapy is superior to local radiotherapy alone.     

Brain metastases in metastatic non-small cell lung cancer responding to single-agent gefitinib: a case report

Brain metastases are a frequent finding in patients with non-small cell lung cancer (NSCLC). The present case reports the clinical course of a patient who was treated with gefitinib alone for progressive brain metastases after whole-brain irradiation treatment (WBRT). A 50-year-old women with primary stage IV NSCLC (bone metastases) developed brain metastases after 3 cycles of chemotherapy consisting of paclitaxel and carboplatin (CBDA). After completion of the WBRT, magnetic resonance imaging (MRI) indicated further progression. Two cycles of temozolomide and topotecan were applied; this was ineffective in preventing central nervous system progression. For symptomatic brain metastatic disease the patient received gefitinib as single-agent treatment. Within a few weeks of treatment there was an obvious clinical improvement. Follow-up of the brain 2 months after the start of treatment showed a decrease in both the size and number of brain metastases. Additional manifestations in the lungs and the skeletal system were re-assessed as stable disease during the treatment with gefitinib. Within 4 months of treatment there were no side-effects such as skin rash or any other systemic toxicity. Gefitinib may therefore have a role in the treatment of brain metastases from NSCLC.     

单纯放疗与宫颈植入性化疗协同放疗治疗老年宫颈癌的临床疗效对比分析

目的对比分析单纯放疗及应用植入性氟尿嘧啶同步放化治疗老年宫颈癌初治患者的疗效和并发症。方法选择2006年11月至2007年5月在吉林省肿瘤医院收治的初治宫颈癌患者共58例,临床分期为Ⅰb-Ⅲb期,按治疗方法不同分为单纯放疗组（共30例,给予X线远距离治疗机体外照射及192Ir腔内后装治疗）和同步放化疗组（共28例,给予宫颈植入氟尿嘧啶缓释剂500-800mg,同时给予X线远距离治疗机体外照射及192Ir腔内后装治疗）,对两组患者的疗效及并发症发生情况进行对比分析。结果单纯放疗组与同步放化疗组有效率分别为92%、86%,两组比较,差异有统计学意义（P〈0.05）两组患者近期并发症均以骨髓抑制为主,其中Ⅲ级以上骨髓抑发生率分别为3%、0%,两组比较,差异无统计学意义（P〉0.05）。结论宫颈植入性化疗协同放疗在不增加患者毒副反应的同时可明显改善老年宫颈癌患者的预后。     

Nephroblastoma in infants, 1969-75: variations in treatment and survival

In a series of 79 infants aged under 1 year with nephroblastoma diagnosed during 1969-75 all the patients underwent nephrectomy, 33 (42%) received a course of radiotherapy, and 49 (62%) received chemotherapy. The overall three-year survival rate for patients who survived at least one week after diagnosis was 65%. The corresponding rate for infants with stage I tumours was 76%. The survival rate in children with early-stage tumours was significantly higher in those who were treated by nephrectomy and chemotherapy alone compared with those who also received radiotherapy. In a large proportion of cases nephrectomy and chemotherapy together constituted sufficient treatment for the cure of infants with nephroblastoma, and in some instances nephrectomy alone proved adequate. There was no general tendency for children under 1 year old to be unable to withstand chemotherapy.     

Targeting angiogenesis for treatment of NSCLC brain metastases

Lung cancer is the leading cause of cancer-related mortality worldwide, and non-small cell lung cancer (NSCLC) accounts for about 85% of all new lung cancer diagnosis. The majority of people with NSCLC are unsuitable for surgery since most patients have metastatic disease at diagnosis. About 60% of brain metastases arise from lung cancer. Therapeutic approaches to brain metastases include surgery, whole brain radiotherapy (WBRT), stereotactic radiosurgery, chemotherapy and new biologic agents. Angiogenesis is essential for the development and progression of cancer, and vascular endothelial growth factor (VEGF) is a critical mediator of tumour angiogenesis. One of the targeted approaches most widely studied in the treatment of NSCLC is the inhibition of angiogenesis. Bevacizumab, an anti-VEGF recombinant humanized monoclonal antibody, is the first targeted agent which, when combined with chemotherapy, has shown superior efficacy versus chemotherapy alone as first-line treatment of advanced non-squamous NSCLC patients. Patients with central nervous system (CNS) metastases have initially been excluded from bevacizumab trials for the risk of cerebral haemorrhage as a result of the treatment. Nevertheless, the available data suggest an equal risk of intracranial bleeding in patients with CNS metastases treated with or without bevacizumab therapy. Several other anti-angiogenetic drugs are being investigated in the treatment of advanced NSCLC patients, but results of their activity specifically in CNS metastases are still lacking. This review will focus on the potential role of bevacizumab and other anti-angiogenetic agents in the treatment of brain metastases from NSCLC.     

Erlotinib resistance is altered after gemcitabine chemotherapy for recurrent non-small-cell lung cancer

We report the case of a male Mongolian lifelong non-smoker with recurrent non-small-cell lung cancer (NSCLC) who developed resistance to the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor erlotinib after initially responding to this agent but then subsequently had another response to a second course of erlotinib treatment after intervening gemcitabine chemotherapy. Sixteen months after the patient received chemoradiotherapy with gemcitabine/cisplatin plus radiotherapy, his recurrent mediastinal metastases were found to have progressed. Treatment with erlotinib was followed by an initial, partial response but evidence of progression was again observed 6 months later. The patient was then treated with gemcitabine chemotherapy, which resulted in a reduction in tumour volume. One month later, progression of mediastinal metastases was again observed and the patient received a second course of erlotinib. Another partial response occurred and the patient's disease remained stable at the 9-month follow-up visit (and with no reported symptom progression at an 11-month telephone follow-up). Genetic examination of tumour tissue collected at the time of the original diagnosis and during the second course of erlotinib therapy revealed activating exon 19 mutation in the EGFR gene. This case suggests that resistance to erlotinib may change following chemotherapy and that repeat erlotinib therapy may be worth considering after chemotherapy in NSCLC patients who initially respond positively to erlotinib treatment but subsequently experience recurrence of disease.     

唑来膦酸联合放疗治疗骨转移临床分析

目的 探讨唑来膦酸联合放疗治疗骨转移临床疗效、不良反应.方法 收集2009年3月至2010年2月安阳市肿瘤医院放疗科收治的148例恶性肿瘤骨转移病例进行回顾性分析.综合组:放射治疗+唑来膦酸注射液治疗80例;单放组:单纯行姑息性放射治疗68例.两组放疗均采用6 mV-X线大分割体外照射,3 GY/次,5次/周,总DT30 GY;综合组药物治疗为唑来膦酸注射液4 mg+0.9%NaCl 100 ml静脉滴注,15 min输完.结果 综合组和单放组的疼痛缓解率分别是 92.5%,91.2%,比较差异无统计学意义(P>0.05);两组不良反应发生比较无明显差异;骨转移灶再钙化有效率分别是68.8%,41.2%比较差异有统计学意义(P<0.05);疼痛缓解期:综合组6～20个月,单放组3～12个月.结论 唑来膦酸联合放疗治疗骨转移疗效明显,骨质修复、疼痛缓解期及患者生活质量均优于单纯放射治疗,并未见明显不良反应,是目前恶性肿瘤骨转移的常规治疗手段.     

The importance of surgery as the first step in multimodality treatment of small cell bronchial carcinoma. The ISC Lung Cancer Study Group

For patients with small cell lung cancer (SCLC) in their early stages (TNM I, II), surgery for cure was used to eliminate the primary tumour and its regional lymph-nodes followed by intermittent chemotherapy and radiotherapy within the first six postoperative months. After the pathohistological examination of the operation-specimen a two-arm-randomization was performed: standard chemotherapy (1000 mg/m2 cyclophosphamide, 50 mg/m2 doxorubicin, 1.4 mg/m2 vincristine) compared with sequential chemotherapy using three different drug-combinations (A: 1500 mg/m2 cyclophosphamide, 100 mg/m2 lomustine, 15 mg/m2 methotrexate; B: 1000 mg/m2 cyclophosphamide, 40 mg/m2 doxorubicin, 1 mg/m2 vincristine; C: 5 x 1.6 g/m2 ifosfamide plus mesna, 5 x 120 mg/m2 etopside). Thereafter disease-free patients only received prophylactic cranial irradiation (PCI: administering 3600 TD Gy/18 fractions) according to the protocols of the International Society of Chemotherapy Studies I and II. Preliminary evaluations in March 1990 of 170 patients from 24 cooperating departments for thoracic surgery showed that the projected life-table four-year-survival rate of 63 patients with SCLC at pTNM-stage I was 61%, of 54 patients at pTNM-stage II was 35%, of 13 patients at stage pT3, 4 NO, 1 MO was 59% and of 40 patients at stage pT N2 MO was 35%. The indication for surgery is emphasized for pTNM-stages I + II. For N2-lesions surgery would not be recommended in general, but the survival rate seems to indicate that this treatment was not detrimental, being rather more favourable compared with chemotherapy or radiotherapy alone. The continuation and enlargement of these studies seem not only justified, but emphatically indicated.(ABSTRACT TRUNCATED AT 250 WORDS)