临床Ⅳ期舌鳞癌新辅助化疗研究

本文总结我院１９８６年１月～１９９３年１２月住院治疗的临床Ⅳ期舌鳞癌病例４５例，其中完成平阳霉素单药新辅助化疗组病例２０例；１７例病人未行新辅助化疗。平阳霉素总量控制在２５０～３００ｍｇ。休息３周后进行舌癌联合根治术。该方案使部分晚期病例的原发灶有所缩小，从不适合手术到可以进行手术治疗。其１、３、５年生存率分别为６０％，５０％，４０％。两组的死亡都以局部复发为主（５５％：４７．１％）。两组间的局部复发率和５年生存率差异虽无统计学意义（Ｐ＞０．０５），但从临床数字的绝对值看，新辅助化疗组结果尚不理想。这可能与病例数较少有关。同时也提示，单药诱导化疗的方案似不适用于晚期舌鳞癌的病例。我们感到，新辅助化疗的近期疗效不能预示其局部治疗中的中长期疗效，也不宜用于推测病例的生存时间。平阳霉素单药新辅助化疗在降低晚期舌癌局部复发率和提高中长期生存率方面尚无明显的进步。为此，有必要进一步改进和完善舌鳞癌的新辅助化疗方案。     

局部晚期鼻咽癌新辅助化疗联合同步放化疗

鼻咽癌是我国南部地区最常见恶性肿瘤之一,大部分患者被发现时已处于局部晚期.鼻咽癌对放、化疗比较敏感,过去认为同步放化疗方案是鼻咽癌的标准治疗方式;研究显示新辅助化疗联合同步放化疗对局部晚期鼻咽癌患者的治疗效果更佳.然而调强放疗与传统放疗技术相比,在保证原有治疗效果基础上可进一步降低患者的毒副反应.本文比较在传统放疗与调强放疗技术两种情况下,同步放化疗与同步放化疗联合新辅助化疗的两种方案对局部晚期鼻咽癌患者治疗效果做一综述.     

诱导化疗加放射治疗Ⅳ期鼻咽癌的疗效观察

目的评价诱导化疗加放射治疗和单纯放疗治疗Ⅳ(N3M0)期鼻咽癌的临床疗效.方法将经病理证实的34例Ⅳ(N3M0)期鼻咽癌34例随机分为诱导化疗加放疗组(Ⅰ)和单纯放疗组(Ⅱ).Ⅰ组放疗前应用PF方案(DDP+5-FU)化疗2周期,2组放疗方法相同.结果Ⅰ组和Ⅱ组鼻咽部肿瘤完全消退率分别为88.2%和82.4%,颈部转移淋巴结完全消退率分别为94.1%和88.2%,差异无显著性(P＞0.05);Ⅰ组和Ⅱ组3年生存率分别为70.6%和47.1%,差异有显著性(P＜0.05);Ⅰ组和Ⅱ组远处转移率分别为23.5%和41.2%,差异有显著性(P＜0.05).Ⅰ组治疗毒副反应比Ⅱ组重.结论诱导化疗加放射治疗Ⅳ(N3M0)期鼻咽癌,可以提高3年生存率,减少远处转移率,毒副反应比单纯放疗大,但不影响治疗进程.     

鼻咽癌化疗现状及进展

鼻咽癌是我国常见的头颈部肿瘤,90%以上为低分化鳞状细胞癌和未分化癌,所以相对于其他的头颈部肿瘤,鼻咽癌对化疗较敏感,放疗联合化疗已成为局部晚期鼻咽癌标准的治疗模式。化疗方式按照其时间和目的的不同可分为诱导化疗、同步放化疗、辅助化疗和姑息化疗。现就鼻咽癌化疗现状及进展综述如下。     

血红蛋白浓度与鼻咽癌放疗疗效的分析

目的探讨鼻咽癌患者血红蛋白浓度与其放射治疗近期疗效及5年生存率的相关性。方法回顾性分析1991年12月至1992年12月经本院病理确诊并进行系统治疗的鼻咽癌患者314例。全部病人予Co60常规分割根治性放疗,鼻咽病灶放疗剂量65～80/Gy/6～8W,颈部转移淋巴结放疗剂量60～70Gy/6～7W。放疗前及放疗过程中定期检测血红蛋白浓度。结果鼻咽癌患者放疗后的近期效果与其血红蛋白浓度无明显相关性。当血红蛋白浓度在80g～、90g～、100g～、110g～、120g～/L时,患者5年生存率分别为11.1%、36.4%、37.4%、37.9%、60.0%,组间差异有高度统计学意义(P0.001)。结论血红蛋白浓度水平与鼻咽癌患者放疗后的远期疗效明显相关,5年生存率随着血红蛋白浓度的增高而升高。     

T3、T4喉及喉咽鳞癌的化疗与放疗

目的：用化疗与放疗综合治疗10例晚期喉和喉咽鳞癌，保留器官，替代手术治疗。方法：化疗与放疗按一定程序给予顺铂和5－氟尿嘧啶3个周期，放疗总量至70Gy。结果：原发灶肿块完全消退者（CR）7例，肿块最大直径和最小直径乘积缩小≥50％者（PR）3例，颈部转移淋巴结CR5例，PR3例。2年生存率70％。结论：对晚期喉、喉咽鳞癌，化放疗不仅疗效好，并且保留了器官，提高了患者生存质量。     

动脉灌注化疗在晚期鼻咽癌综合治疗中作为诱导化疗的价值

将经病理确诊的７６例例晚期初治鼻咽癌得于放疗前行诱导性化疗。随机分成两组，分别进行动脉灌注化疗（ＩＡＣＴ）和全身化疗（ＳＣＴ），于放疗后比较两组的疗效，结果ＩＡＣＴ组的化疗完全缓解率及３年生存率分别为３０．０％和８０．０％，而ＳＣＴ组分别为８．３％和５８．３％，两组间差异有显著意义。提示以ＩＡＣＴ行诱导性化疗对此类晚期鼻咽癌疗效更佳。     

联合治疗晚期上颌窦癌121例报告

目的：探讨化疗,放疗与手术联合治疗晚期上颌窦癌的可行性。方法：术前放疗和手术６１例,术前化疗和手术６０例,放疗采和直线加速器和（或）＾６０Ｃｏ,剂量为４０￣６０Ｇｙ。化疗采用ＤＯＰ（顺氯氨铂加长春新碱加平阳霉素）方案。结果：放疗和手术组３年和５年生存率分别为３６．１％和３１．１％,化疗和手术组分别为３５％和３０％。结论;术前化疗加手术是治疗晚期上颌窦癌的可行性方法,且化疗能反复应用,提高手术效果。     

嗅神经母细胞瘤6例诊疗分析

目的：探讨嗅神经母细胞瘤的诊疗方法及预后。方法：回顾性分析6例嗅神经母细胞瘤的临床资料。单纯放疗1例，手术加术后放疗4例，手术加术后放疗、化疗1例。结果：全部患者随访1～10年，1、3、5年生存率分别为100．0％（6／6）、83．3％（5／6）和66．7％（4／6），其中1例已存活8年，无复发。结论：根治性手术加术后放疗为局部控制最佳方案，而化疗对防止远处转移帮助较大。早期的准确诊断和综合治疗是提高本病生存率的关键。     

介入动脉化疗栓塞治疗鼻咽癌的临床研究

目的:探讨介入动脉化疗栓塞治疗鼻咽癌的效果。方法:将87例鼻咽癌随机分成3组。A组:行介入化疗加放疗,26例。B组:放疗加化疗,29例。C组:单纯放疗,32例。结果:随访38～72个月,近期疗效CR分别为A组92.3％,B组72.4％,C组68.8％,A组与B、C组分别比较均有统计学意义(P<0.05);3年生存率分别为A组88.5％,B组69.0％,C组62.5％,A组与B、C组分别比较均有统计学意义(P<0.05)。结论:采用放疗结合介入化疗栓塞对鼻咽癌治疗有协同作用。     

59例晚期声门上型喉鳞状细胞癌治疗和临床疗效分析

目的：比较手术加辅助放疗与单纯手术治疗晚期声门上型喉鳞状细胞癌的疗效。方法：将59例晚期声门上型喉鳞状细胞癌按治疗方法分为手术＋放疗组（33例）和手术组（26例）。手术＋放疗组全喉切除27例,部分切除6例,其中27例行侧颈淋巴结清扫术;手术组全喉切除23例,部分切除3例,其中24例行侧颈淋巴结清扫术。结果：手术＋放疗组和手术组的3年总生存率分别为62．6％和62．6％,5年总生存率分别为43．8％和40．5％,经Log—rank检验两组之间的生存率差异无统计学意义（P〉0．05）。手术＋放疗组5例复发,复发率15．2％;手术组10例复发,复发率38．5％,两组的复发率差异有统计学意义（P〈0．05）。结论：手术加辅助放疗未能提高晚期声门上型喉鳞状细胞癌3、5年总生存率,但明显降低肿瘤复发率。     

Concurrent chemoradiotherapy with cisplatin and fluorouracil for locally advanced hypopharyngeal carcinoma

CONCLUSIONS: The concurrent administration of cisplatin and fluorouracil (CCRT) during radiotherapy after induction chemotherapy had better results than induction chemotherapy followed by radiotherapy alone (CT+RT) for overall survival, laryngeal preservation, and locoregional control in patients with locally advanced hyopharyngeal cancer. OBJECTIVES: To report treatment results comparing CCRT with CT+RT in locally advanced hypopharyngeal cancer. PATIENTS AND METHODS: Sixty-six consecutive patients treated with curative intent were analyzed retrospectively. Thirty-eight patients were treated with induction chemotherapy followed by definitive RT, and 28 patients with induction chemotherapy followed by concurrent chemoradiotherapy. All patients had more than three cycles of continuous infusion of cisplatin and 5-fluorouracil every 3 weeks. The median dose of irradiation was 70 Gy in the CT+RT group and 68.4 Gy in the CCRT group, respectively. RESULTS: The overall 5-year survival rates were 24% for the CT+RT group and 42% for the CCRT group (p=0.031). The 3-year pharyngolaryngectomy-free survival rates were 32% for the CT+RT group and 63% for the CCRT group (p=0.032). The 3-year locoregional control rate for CCRT was significantly better than that for the CT+RT (52% vs 23%, p=0.004). Acute hematologic toxicity appeared in 39% of the CT+RT patients and 75% of the CCRT patients.     

化疗与序贯放化疗治疗鼻型结外NK／T细胞淋巴瘤的疗效比较

目的：探讨化疗与序贯放化疗治疗鼻型结外NK／T细胞淋巴瘤的疗效。方法：57例经病理形态学及免疫组织化学检查确诊的鼻型结外NK／T细胞淋巴瘤患者,随机分为化疗组和放化疗组。化疗组23例患者交替应用CHOP方案、VDLP方案和MEOP方案各2个疗程后进人临床观察;放化疗组34例患者除上述化疗外,均应用直线加速器进行原发部位的三维适形放疗。结果：①治疗结束时,化疗组治疗总有效率为87．0％,放化疗组总有效率为91．2％,2组差异无统计学意义（P〉0．05）;②2组患者随访1年的总有效率分别为73．9％和76．5％,2组仍无明显差异（P〉0．05）;③2组患者随访3年和5年的无病生存率分别为61．3％,47．6％和43．5％,21．4％,差异均有统计学意义（P〈0．05）;④治疗模式与长期生存密切相关;⑤发热、消瘦、盗汗等全身症状、中晚期（Ⅲ、IV期）、国际预后指数、功能状态评分均与预后相关,且均为独立的预后因素。结论：序贯放化疗治疗鼻型结外NK／T细胞淋巴瘤较单纯化疗疗效明显,可以显著改善长期生存率。     

Treatment outcomes for radiotherapy alone are comparable with neoadjuvant chemotherapy followed by radiotherapy in early-stage nasopharyngeal carcinoma

OBJECTIVES: To analyze the impact of neoadjuvant chemotherapy (CT) on the treatment of early-stage nasopharyngeal carcinoma (NPC) as compared with radiotherapy (RT) alone. METHODS: We analyzed retrospectively the outcome of 60 previously untreated and histologically confirmed early-stage NPC patients treated with either RT alone or with neoadjuvant CT followed by RT (CT/RT) at the Seoul National University Hospital between 1986 and 2004. Neoadjuvant CT consisted of three cycles with 5-fluourouracil and cisplatin. RT was given to the nasopharynx and neck nodes. The median dose to the primary site, involved nodes, and elective nodes was 70.2 Gy, 63 Gy, and 45 Gy, respectively. According to the 1997 American Joint Committee on Cancer staging system, 9 patients had stage I or IIA disease, and 22 patients had stage IIB disease in the RT group. For the CT/RT group, 8 patients had stage I or IIA disease, and 21 patients had stage IIB disease. The median follow-up for all patients was 124.5 (range, 5-239) months. RESULTS: The 5-year locoregional failure-free (LRFF), distant metastasis-free (DMF), disease-free survival (DFS), and overall survival (OS) rate was 84%, 93%, 81%, and 84% for the RT group and 77%, 86%, 71%, and 79% for the CT/RT group, respectively. There were no significant differences in LRFF (P = .728), DMF (P = .433), DFS (P = .562), and OS (P = .625) rates between the RT and CT/RT groups. Multivariate analysis revealed that delaying RT for more than 81 days was significantly associated with an increased risk of locoregional failure in the subgroup of patients with stage IIB disease (P = .044). CONCLUSIONS: In our retrospective analysis, the use of neoadjuvant CT showed no additional benefit to treatment with RT alone. Neoadjuvant CT may cause deleterious effect on stage IIB disease by delaying RT.     

T-status and an oral fluoropyrimidine,S-1, adjuvant chemotherapy are prognostic factors in reduced-RADPLAT for resectable hypopharyngeal cancer

Conclusion: Reduced-RADPLAT for HPC achieved comparative survival and locoregional control rates with lower toxicities compared with concurrent chemoradiotherapies including original RADPLAT. S-1 adjuvant chemotherapy showed a survival benefit. Objectives: To evaluate the efficacy and toxicities of targeted intra-arterial (IA) infusion of cisplatin with concurrent radiotherapy with a reduced dose (reduced-RADPLAT) for resectable hypopharyngeal cancer (HPC). Methods: Between 1999–2012, 50 patients with stage II–IVA HPC primarily treated by reduced-RADPLAT were analyzed. They were treated by 2–5 courses of IA cisplatin infusion (100?mg per body) with simultaneous systemic infusion of sodium thiosulfate concurrent with conventional radiotherapy (66–70?Gy). After 2003, S-1, an oral fluoropyrimidine, adjuvant chemotherapy was administered to all eligible patients. Results: During a median follow-up of 48.6 months, the estimated 3- and 5-year overall survival (OS), progression-free survival (PFS), locoregional control, and laryngoesophageal dysfunction-free survival (LEDFS) rates were 76.0% and 62.0%, 58.0% and 50.0%, 66.0% and 62.0%, and 56.0% and 54.0%, respectively. Grade 3 toxicities were observed in 30.0%. No patient had grade 4 or higher toxicities. No patient required tube feeding or tracheotomy at 3 months after treatment. T4-lesions and S-1 administration were significant factors predicting poor and good OS, PFS, and LEDFS, respectively.     

成人嗅神经母细胞瘤20例综合治疗结果分析

目的 回顾性分析与比较20例经综合治疗的嗅神经母细胞瘤患者的生存差异,探讨最佳治疗策略.方法 1998年1月至2005年1月中山大学肿瘤防治中心采用综合疗法治疗了≥14岁的嗅神经母细胞瘤患者20例,6例为Kadish B期,14例为Kadish C期.12例采用诱导化疗联合放疗,8例为手术联合放疗.以Kaplan-Meier法统计患者的生存率和无瘤生存率,采用Log-rank法比较两种治疗方法 的生存率差异,Fisher精确概率法检验其组间均衡性.结果 自治疗开始之日随访至2008年3月31日,20例综合治疗患者3年生存率50.0%.诱导化疗联合放疗组12例的3年生存率和3年无瘤生存率分别为25.0%和16.7%;手术联合放疗组8例的3年生存率和3年无瘤生存率分别为87.5%和75.0%.手术联合放疗组的生存率和无瘤生存率均优于诱导化疗联合放疗组(X2值分别为6.81和7.33,P值分别为0.0091和0.0068).结论 对于中晚期成人嗅神经母细胞瘤,手术联合放疗的疗效可能优于诱导化疗联合放疗,积极手术联合放疗及化疗的综合治疗策略有望进一步改善其生存率.     

鼻咽癌放化疗局部失败的相关因素分析

目的：探讨鼻咽癌放化疗后局部失败（残留或复发）的相关影响因素。方法：对308例鼻咽部原发癌患者的临床病理资料进行回顾分析。选择性别、年龄、T分级、N分级、原发癌病理类型、有无颈淋巴结转移、颈转移淋巴结大小、颈淋巴结转移侧数、颈淋巴结转移累及区域、放疗方法、有无同步化疗等临床病理因素,用x^2检验和Logistic回归进行单因素和多因素分析,并用Kaplan-Meier法对残留和复发患者进行生存分析。结果：在308例头颈部原发鳞状细胞癌患者中,93例（30．2％）发生原发灶和颈部的残留或复发。单因素分析显示,T分级（P〈0.01）、N分级（P〈0.01）、有无颈淋巴结转移（P〈0.05）、颈转移淋巴结大小（P〈0.05）、颈淋巴结转移侧数（P〈0.01）与残留或复发有关。多因素分析结果表明,仅T分级与残留或复发明显相关。用Kaplan-Meier法进行生存分析显示71例残留或复发患者再次治疗的1年、3年、5年生存率分别为77．2％、40．4％、22．4％。结论：原发癌T分级是鼻咽癌治疗局部失败的决定性因素。而有无颈淋巴结转移、原发癌N分级、颈淋巴结转移侧数、颈淋巴结大小是影响因素和T分级的协同因素,但不是导致残留和复发的的初始和根本因素。鼻咽癌侵犯骨时易导致治疗失败。治疗失败者经再次治疗可以提高生存率。     

鼻及咽部树突细胞肿瘤4例临床分析并文献复习

目的：探讨树突细胞肿瘤的临床表现、病理特点、治疗和预后。方法：4例鼻及咽部树突细胞肿瘤患者中，滤泡状树突细胞肉瘤（FDCS）2例，朗格汉斯组织细胞增多症（LCH）1例，朗格汉斯细胞肉瘤（LCS）1例。2例FDCS中有1例行综合治疗（手术加放化疗），1例仅行放化疗；1例LCH及1例LCS患儿均行手术治疗。结果：2例FDCS患者，l例术后行4个疗程CHOP方案及同步放疗（50Gy）后达完全缓解，1例仅行放化疗者随访7个月仍带瘤生存；1例LCH患儿随访2年余，肿瘤无复发及转移；1例LCS患儿，术后未行放化疗，随访10个月后死亡。结论：树突细胞肿瘤罕见，临床易误诊，确诊需病理组织形态、免疫组织化学及电镜相结合，FDCS、LCH及LCS具有独特的病理表现、免疫表型、诊治及预后。     

原发性鼻黏膜及口腔黏膜恶性黑色素瘤患者的预后因素分析

目的:总结手术治疗的原发性鼻黏膜及口腔黏膜恶性黑色素瘤患者的临床特点及生存状况,探讨影响其预后的主要因素。方法:回顾性分析1980-01-2005-01期间66例原发性鼻黏膜及口腔黏膜的恶性黑色素瘤患者的临床资料,复习病历并进行随访。生存分析采用Kaplan-Meier法,多因素分析采用Cox模型。结果:66例患者中,37例行术后辅助治疗,包括化疗12例,生物治疗8例,化疗加生物治疗5例,放疗8例,放疗加化疗4例。15例(22.7%)首次治疗后6个月内原发灶复发或伴淋巴结转移或远处转移。10例(15.2%)出现远处转移。平均生存时间为77.9个月,中位生存时间为33.7个月,3年和5年累积生存率分别为41.4%和31.1%。多因素分析显示:肿瘤最长径、有无淋巴结转移、首次治疗效果是影响预后的独立因素。结论:原发性鼻黏膜及口腔黏膜的恶性黑色素瘤预后较差,生存率较低,局部复发率较高,且容易出现淋巴结转移及远处转移。影响预后的独立因素是肿瘤大小、有无淋巴结转移和首次治疗效果。关于术后辅助治疗的作用仍需进一步研究。     

Survival and failure outcomes in locally advanced esthesioneuroblastoma: a single centre experience of 15 patients

Esthesioneuroblastoma (ENB) constitutes 3 % of all malignant intranasal tumors. As the tumor is very rare, the number of patients of ENB treated in individual departments is small. We present our institute’s experience in combined modality management of 15 successive patients of ENB treated from 2006 to 2010. Clinical characteristics and treatment modality in form of surgery, radiotherapy and chemotherapy were noted. Kadish stage C was the most common stage (12 patients) followed by stage B (3 patients). Fourteen patients underwent primary surgery, of which nine had total excision and five had subtotal excision. One patient was treated with combination of chemotherapy (CT) and radiotherapy (RT). Median RT dose delivered was 54 Gy. Twelve patients received CT with cisplatin and etoposide. Overall, eight patients had complete response, five had partial response, while one had static disease and progressive disease each. Two patients had distant metastases. Four-year loco-regional control (LRC) was 25 % and 4-year overall survival (OS) was 45 %. Most common presentation in our series was locally advanced tumors. Most of these patients require adjuvant RT, which helps in significant LRC. Systemic CT benefits in inoperable, advanced and high risk tumors. Risk-adapted and multimodality approach is the need of hour to achieve good control rates while minimizing treatment related toxicity.