非小细胞肺癌的治疗进展

全文综述了近年来非小细胞肺癌手术、化放疗临床治疗上的一些进展，并就可能出现的新的治疗模式作一展望。     

Treatment and prognosis of thymoma: A review of 25 cases

Experience of 25 patients with thymoma is reported. Based on the presence or absence of gross invasion 17 tumors were regarded as benign, 8 as malignant. All patients were operated on. Twenty-two had a complete excision, 2 a palliative excision, and 1 a biopsy only. Five patients received post-operative radiotherapy and 2 patients were given cytotoxic chemotherapy. None of the 17 patients with a benign thymoma had a recurrence or death due to thymoma during the follow-up. The five- and ten-year survival rates for malignant thymoma were 50% and 17%, respectively. Excision is the treatment of choice for all thymomas, since the prognosis for benign tumor is excellent and the malignancy can only be determined at exploration. Post-operative radiotherapy seems to be indicated in malignant thymoma. Myasthenia gravis and histologic features of thymoma have some value in predicting prognosis.     

宫颈癌诊治现状与进展

宫颈癌筛查是早期发现宫颈癌的重要手段,人类乳头状瘤病毒（HPV）和鳞状细胞抗原检测对宫颈癌诊断及病情监测起重要作用。宫颈癌治疗手段的改革与创新,如保留生育功能的宫颈广泛性切除术、保留盆腔神经广泛性子宫切除术、腹腔镜下宫颈癌根治术、新辅助化疗、同步放化疗、调强放疗等,使宫颈癌的治疗效果不断提高。     

Management of glioblastoma: State of the art and future directions

Glioblastoma is the most common malignant primary brain tumor. Overall, the prognosis for patients with this disease is poor, with a median survival of <2 years. There is a slight predominance in males, and incidence increases with age. The standard approach to therapy in the newly diagnosed setting includes surgery followed by concurrent radiotherapy with temozolomide and further adjuvant temozolomide. Tumor-treating fields, delivering low-intensity alternating electric fields, can also be given concurrently with adjuvant temozolomide. At recurrence, there is no standard of care; however, surgery, radiotherapy, and systemic therapy with chemotherapy or bevacizumab are all potential options, depending on the patient's circumstances. Supportive and palliative care remain important considerations throughout the disease course in the multimodality approach to management. The recently revised classification of glioblastoma based on molecular profiling, notably isocitrate dehydrogenase (IDH) mutation status, is a result of enhanced understanding of the underlying pathogenesis of disease. There is a clear need for better therapeutic options, and there have been substantial efforts exploring immunotherapy and precision oncology approaches. In contrast to other solid tumors, however, biological factors, such as the blood-brain barrier and the unique tumor and immune microenvironment, represent significant challenges in the development of novel therapies. Innovative clinical trial designs with biomarker-enrichment strategies are needed to ultimately improve the outcome of patients with glioblastoma.     

同步放化疗治疗局部晚期食管癌临床观察

目的 探讨同步放化疗治疗局部晚期食管癌的疗效及毒副反应.方法 80例经组织学或细胞学证实的局部晚期食管癌随机分为两组,同步放化疗组40例接受同步放化疗,单纯放疗组40例仅接受放疗,化疗采用DF方案,放疗剂量为60-64 Gy,治疗结束后分别观察疗效及毒副反应.结果 同步放化疗组和单纯放疗组有效率分别为95.0%、82....     

The treatment of lung cancer: perspectives and critique

Future improvements in the therapy of lung cancer most probably will result from new treatment approaches that combine all existing modalities. This paper discusses the applications and, in particular, the shortcomings of present knowledge in surgery, radiotherapy, chemotherapy, immunotherapy, and combinations of these modalities as they relate to the growing problem of treatment in lung cancer.     

ERCC1, XRCC1, and GSTP1 Polymorphisms and Treatment Outcomes of Advanced Epithelial Ovarian Cancer Patients Treated with Platinum-based Chemotherapy

Objective: The first line regimen for treating epithelial ovarian cancer (EOC) is platinum-based chemotherapy. Various factors impact its effectiveness including polymorphisms of enzymes in platinum-related metabolism processes.  Methods: We conducted the study to investigate the association between polymorphisms of ERCC1, XRCC1 and GSTP1, which responsible for platinum’s metabolisms in Thai epithelial ovarian cancer patients. Results: Fifty-two patients with advanced epithelial ovarian cancer were enrolled into this study. Genotyping analysis of ERCC1 (C->A, rs3212986), XRCC1 (A->G, rs25487) and GSTP (A->G, rs1695) were performed which variant allele frequencies were found at 35.6%, 28.9% and 10.6%, respectively. Patients with homozygous variant type (A/A) of ERCC1 C8092A had higher rate of platinum-resistance (75% vs 16.7%, p =0.046). In addition, the significant association of GSTP1 polymorphism and grade 2 anemia was found. Patients with A/G genotype of GSTP1 had higher rate of grade 2 anemia (81.8% vs 46.3%, p =0.036). Conclusions: Genetic polymorphisms of ERCC1, and GSTP1 might be useful biomarkers for prediction of clinical benefit and toxicities of platinum-based chemotherapy in Thai epithelial ovarian cancer patients.     

Cancer in Pregnancy

Cancer in pregnancy may be increasing in incidence with advancing maternal age and higher rates of obesity. The diagnosis of cancer in pregnancy provokes complex management issues balancing short‐ and long‐term risks for both mother and baby. Every case needs to be individualized, with a multidisciplinary team of midwives, obstetricians, oncologists, surgeons, radiation oncologists, and neonatologists assisting the family to make informed decisions regarding the best treatment course for the mother and baby. The present article reviews the evidence regarding the safety of diagnostic imaging, procedures and treatment modalities for cancer for the pregnant woman and fetus. The efficacy of novel anticancer therapies highlight the need for International Registries to accumulate safety data for these agents in pregnancy as expeditiously as possible.     

Treatment of laryngeal cancer: the permanent challenge

There are many options to treat larynx cancers. Throughout the 20th century, surgical research has provided many partial surgery techniques (either open surgery or endoscopic CO₂ surgery). In parallel, the modification of radiotherapy schedules has notably improved the local control with definitive irradiation. The appearance of active chemotherapy regimens has also modified the concept of treatment for advanced disease, allowing a decrease in the total indications of laryngectomy, although this remains the treatment of choice in some cases. The selection of the most appropriate treatment is based on a multidisciplinary approach. Early diseases may be treated by open surgery, endoscopic laser CO₂ surgery or irradiation. Some advanced diseases may be treated by partial surgery, but the majority are theoretically candidates for radical surgery when resectable. In many instances, but not in all, chemotherapy-based larynx-preserving protocols may avoid performing such mutilating surgery. When inoperable, larynx cancers are better treated by combined chemotherapy and irradiation when the performance status of the patient is compatible with such an intensive regimen.     

Combined Treatment Modality for Anaplastic Oligodendroglioma: A Phase II Study

Purpose: To investigate feasibility, toxicity and antitumor activity of combined surgery, postoperative radiation therapy (RT) and adjuvant chemotherapy (CHT) in adult patients with pure anaplastic oligodendroglioma (PAO) or mixed anaplastic oligoastrocytoma (MAO).Methods: Between January 1988, and June 1993, 23 patients entered into a phase II study. After surgery, post-operative RT was administered with 60Gy in 30 daily fractions in 30 treatment days in 6 weeks. Two weeks after RT, adjuvant modified PCV (mPCV) (Procarbazine, 60mg/m², days 1–14; CCNU, 100mg/m², day 1; and vincristine, 1.4mg/m² (max. 2mg), days 1 and 8) was administered every six weeks up to six cycles or until progression occurred.Results: Median survival time is not attained yet, while 1–5 year survival rates are 100%, 100%, 78%, 61%, and 52%, respectively. Median time to tumor progression is not attained yet, while 1–5 year progression-free survival rates are 100%, 100%, 70%, 52%, and 52%, respectively. On univariate analysis of potential prognostic factors, sex, tumor location (frontal versus other), and histology (pure versus mixed anaplastic oligodendroglioma) were not found to influence survival. Age of <50 years carried improved prognosis as well as Karnofsky performance status (KPS) 90–100 when compared to KPS of 70–80. Patients having tumors 4cm did better than those with tumors >4cm as well as those with total tumor resection when compared to those with subtotal tumor resection or biopsy only. Acute high-grade (3) CHT-related toxicity was mainly hematological with only 3 (13%) patients experiencing acute grade 4 toxicity.Conclusions: Combined treatment modality consisting of surgery, postoperative high-dose RT and mPCV chemotherapy for patients with anaplastic oligodendroglioma was effective with acceptable toxicity. Further studies are needed with more patients and longer follow-up to verify these results in this rare disease.     

Role of Neoadjuvant Chemotherapy in the Management of Advanced Ovarian Cancer

Objective: To analyze efficacy of neoadjuvant chemotherapy for advanced ovarian cancer. Materials andMethods: A total of 107 patients with advanced ovarian cancer undergoing cytoreductive surgery were dividedinto a neoadjuvant chemotherapy group (n=61) and a primary debulking group (n=46) and retrospectivelyanalyzed. Platinum-based adjuvant chemotherapy was applied to both groups after cytoreductive surgery andeoverall and progression-free survival times were calculated. Results: No significant difference was observed induration of hospitalization (20.8±6.1 vs. 20.2±5.4 days, p>0.05). The operation time of neoadjuvant chemotherapygroup was shorter than the initial surgery group (3.1±0.7 vs. 3.4±0.8 h, p<0.05). There were no significantdifferences in median overall survival time between neoadjuvant chemotherapy group and surgery group (42 vs.55 months, p>0.05). Similarly, there was no difference in median progression-free survival between neoadjuvantchemotherapy group and surgery group (16 vs. 17 months, p>0.05). The surgical residual tumor size demonstratedno significant difference between initial surgery and neoadjuvant chemotherapy groups (p>0.05). Multivariateanalysis showed that more than 3 cycles of regimen with neoadjuvant chemotherapy was associated with moreresistance to chemotherapy compared with patients without receiving neoadjuvant chemotherapy (OR: 5.962,95%CI: 1.184-30.030, p<0.05). Conclusions:Neoadjuvant chemotherapy can shorten the operation time. However,it does not improve survival rates of advanced ovarian cancer patients.     

Conservative Treatment of Breast Cancer: Its Evolution

Summary Background. Over recent decades, breast carcinoma surgery has witnessed a considerable evolution. The extent of surgery undertaken has progressively reduced, leading to less disfigurement and a significant improvement in quality of life, thereby offering women considerable motivation to seek early diagnosis. From an oncological perspective, outcome was found to be equally effective, and this key observation provided us with significant impetus to investigate the effects of reducing the radiotherapy field. Patients and methods. We present the achievements made so far in the conservative treatment of breast carcinoma, based on experiences at the European Institute of Oncology in Milan and, prior to 1994, at the Milan Cancer Institute. Results and discussion. Conservative surgery of breast carcinoma, both in the breast and in the axillary nodes, has yielded very good results in terms of overall survival and impact on quality of life. The reduction of the radiation field, conducted in our Institute by means of electron intraoperative radiotherapy (ELIOT), is currently the subject of evaluation via a randomised trial.     

丘脑胶质瘤综合治疗疗效分析

[目的]分析丘脑胶质瘤病例综合治疗的治疗结果。[方法]2009年6月至2011年12川收治病理确诊的匠脑胶质瘤患者3l例,接受手术近全切除10例,部分切除14例,活检术7例？术后调强放射治疗8例,三维适形放射治疗23例;1．8～2．0Gy／次,总剂量48．6～60．0Gv（中位剂量54Gy）。放疗期间同步口服替莫唑胺化疗20例。中位随访35．4个月。[结果]全组患者中位生存时间20．6个月,l、2、3年总生存率分别为74．2％、45．2％和36．2％。多因素分析显示WHO分级低、放疗同步化疗的患者预后较好。[结论]WHO分级和放疗期间同步替莫唑胺化疗是影响丘脑胶质瘤预后的主要因素,手术在丘脑胶质瘤治疗中的地位有待进一步研究。     

Preoperative Chemoradiotheraph for Inflammatory Breast Cancer

OBJECTIVE To observe the effect of preoperative chemoradiotherapy for inflammatory breast cancer.METHODS From December 1996 to December 2000, we received and treated 21 patients with inflammatory breast carcinoma with a combinedmodality treatment. The chemotherapy protocol consisted of cyclophosphamide (CTX), pirarubicin (THP-ADM) and 5-fluorouracil (5-FU) or CTX, 5-Fu and methotrexate (MTX). The same infusion scheme was repeated on day 21. After 3～4 cycles the patients were treated with radiotherapy. When the radiation dose reached 40 Gy, the patients who were unable or unwilling to under go an operation received continued radiotherapy. When the radiation dose to the supra clavicular fossa and internal mammary lymph nodes reached 60 Gy and 50 Gy respectively, the radiotherapy was stopped. Chemotherapy was then continued with the original scheme. Patients who had indications for surgery and were willing to under go an operation received no treatment for 2 weeks, after which a total mastectomy was performed. Chemotherapy and radiotherapy was resumed with the original scheme after the operations. When the radiation dose reached 50 Gy, radiotherapy was stopped.RESULTS All patients were followed-up for more than 5 years with a follow-up rate of 100%. The overall 3 and 5-year survival rates of these patients were 42.9%, and 23.8% respectively. For patients in Stage ⅢB the 3 and 5-year survival rates were 50.0% and 27.8% respectively, and for patients in Stage Ⅳ, the 3 and 5-year survival rates were both 0.0%.There was a significant difference between the 2 stage groups (P＜0.05,X2=11.60). For patients who received an operation, the 3 and 5-year survival rates were 80.0% and 33.3% respectively, For patients who were not treated with an operation, the 3 and 5-year survival rates were both0.0%, There was a significant difference between the operated and nonoperated groups (P＜0.05, X2=11.64).CONCLUSION The prognosis of inflammatory breast carcinoma is poor.Before operation, a combined-modality treatment (first chemotherapy,then local therapy, finally chemotherapy and radiotherapy) is the best treatment method.     

Cancer Stem Cells and Response to Therapy

The cancer stem cell (CSC) model states that cancers are organized in cellular hierarchies, which explains the functional heterogeneity often seen in tumors. Like normal tissue stem cells, CSCs are capable of self-renewal,either by symmetric or asymmetric cell division, and have the exclusive ability to reproduce malignant tumors indefinitely. Current systemic cancer therapies frequently fail to eliminate advanced tumors, which may be dueto their inability to effectively target CSC populations. It has been shown that embryonic pathways such as Wnt, Hedgehog, and Notch control self-renewal and cell fate decisions of stem cells and progenitor cells. These are evolutionary conserved pathways, involved in CSC maintenance. Targeting these pathways may be effective in eradicating CSCs and preventing chemotherapy or radiotherapy resistance.