消化道类癌的诊治现状

类癌起源于胚胎时期的神经嵴,是APUD瘤的一种,较少见。临床上,消化道是类癌最常见的发病部位。本文就消化道类癌的分布、组织学、免疫组化和临床特点,以及相关实验室检查、诊断、治疗和预后作一综述。     

中国消化道癌内镜下诊治现状

早癌检出率和早癌构成比在这里要明确两个概念:早癌的检出率和早癌的构成比。早癌检出率是人群中早癌的发现率。早癌的构成比,也就是我们经常在文献中见到的10%～30%左右的早癌发现率,这不是根本意义上的早癌检出率,要加以区别。消化道早癌检出存在不足食管早癌主要依靠碘染色提高检出率。随着检查设备的普及,其他方法如内镜窄带成像技术     

电穿击化疗法治疗消化道恶性肿瘤的研究现状

电穿击化疗法是电穿击同化疗的组合,目前在治疗消化道恶性肿瘤的动物实验中已取得一定疗效,正逐步过渡至临床验证阶段。本文就其仪器设备、作用原理、化疗药物选用、治疗过程中的几点注意事项及其应用前景作一简要综述。     

电穿击化疗法治疗消化道恶性肿瘤的研究现状

电穿击化疗法是电穿击同化疗的组合，目前在治疗消化道恶性肿瘤的动物实验中已取得一定疗效，正逐步过渡至临床验证阶段。本就其仪器设备、作用原理、化疗药物选用、治疗过程中的几点注意事项及其应用前景作一简要综述。     

消化道类癌临床特征及内镜下诊治现状

类癌是一种少见的特殊类型恶性肿瘤,以消化道最为常见,本文对近年来消化道类癌的临床表现、诊断及内镜下治疗进展作一评述,以利于提高相关知识和临床诊治水平。     

内镜下125碘组织间放射治疗消化道肿瘤的应用研究

低能放射性粒子组织间永久性植入术治疗恶性肿瘤已广泛应用,特别是对前列腺癌能进行有效地控制。但目前尚无经消化内镜进行125碘(125I)粒子植入术治疗消化道癌肿的文献报告。我们研制了经消化内镜活检孔道的植入器,在试用成功后,于2001年11月以后进行了10例消化道癌肿的治疗。     

消化道类癌的诊疗进展

消化道类癌的诊疗进展宫钦爽１于凤沼２陈克田１潘伯荣主题词消化系统肿瘤类癌瘤／诊断类癌瘤／治疗Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｄｉｇｅｓｔｉｖｅｓｙｓｔｅｍｎｅｏｐｌａｓｍｓｃａｒｃｉｎｏｉｄｔｕｍｏｒ／ｄｉａｇｎｏｓｉｓｃａｒｃｉｎｏｉｄｔｕｍｏｒ...     

重视消化道早期癌的诊治

目前我国恶性肿瘤流行趋势呈明显上升,其癌谱变化正处于由发展中国家高发癌谱向发达国家高发癌谱的过渡。1993至1997年中国大城市肿瘤流行病学调查结果显示：消化系统肿瘤发病占总恶性肿瘤发病数的一半以上．其中胃癌、结直肠癌、食管癌分别居肿瘤发病的第1、4、6位,     

Brachytherapy in the elderly

A rapidly and constantly increasing aged population in the western countries poses a wide range of specific problems to oncologists. A different way to face medical issues should be sought for older patients with cancer, looking at the characteristics that are peculiar to the elderly from different points of view. Brachytherapy is an effective form of radiotherapy which, for its specific characteristics, may be a valid alternative to more complex modalities of treatment, thus allowing a better sparing of normal tissues and structures yet achieving a similar tumor control rate. This paper reviews the literature on the subject of cancer treatment in the elderly, focusing on radiotherapy and brachytherapy, to evaluate the current attitude toward this problem in the medical community and to see if it is possible to identify a patient population that will benefit from this technique.     

Restenosis and Brachytherapy

Intracoronary radiation therapy has been developed in an attempt to decrease restenosis after balloon angioplasty and stent implantation. Two parallel technologies, one employing radioactive stents, the other catheter-based radiation (using either beta- or gamma-emitters), have been the subject of both animal and human studies. In vivo intravascular ultrasound imaging studies have helped us to determine the morphologic effect of brachytherapy on the vessel wall. This article is aimed at revising the potential and limitations of this new technique and summarizing the results of the currently reported clinical trials.     

Rectal Complications After Prostate Brachytherapy

PURPOSE Prostate brachytherapy is gaining wide popularity as an alternative to resection for the treatment of locally advanced prostate cancer. Rectal-urethral fistula after prostate brachytherapy is a rare but serious complication, and its incidence, presentation, risk factors, and clinical management have not been well described.METHODS From January 1997 to October 2002, seven patients with rectal-urethral fistulas were referred to two institutions (Brigham and Womens Hospital and West Roxbury Veterans Administration Hospital) of a major teaching referral center. Clinical presentation, risk factors, prostate staging, and clinical management were examined in a retrospective fashion.RESULTS Seven rectal-urethral fistulas developed from roughly 700 (1 percent) patients treated with prostate brachytherapy for prostate cancer. The average patient age was 67.7 years, preimplant prostate-specific antigen was 7.1, and Gleason score was 3+3. Symptoms occurred at a mean of 27.3 months after prostate brachytherapy was started and included anorectal pain (57 percent), clear mucous discharge (57 percent), diarrhea (43 percent), and rectal ulceration (43 percent). Coronary artery disease was a common comorbidity (71 percent). Previous transurethral resection of prostate (28 percent) and pelvic irradiation or external beam radiation therapy (14 percent) were not associated with increased risk of rectal-urethral fistula. All patients underwent a diverting colostomy (86 percent) or ileostomy (14 percent), and four patients went on to have definitive therapy. Definitive resection was performed between 5 and 43 months after diverting ostomy and was chosen on the basis of comorbid disease, quality of life, and degree of operation. Two patients required a second diversion after definitive resection because of anorectal pain and a colocutaneous fistula. Postoperative complications included myocardial infarction (14 percent), blood transfusion (14 percent), and bowel perforation (14 percent). Patients became symptom-free nine months after surgery. Six patients are alive and well today; one died from an unrelated cause.CONCLUSIONS Rectal-urethral fistula after prostate brachytherapy is a rare but devastating complication. Patients should be followed for at least three years after prostate brachytherapy because symptoms can develop late in the course. Although diversion of fecal stream does not heal the fistula, all patients diagnosed with rectal-urethral fistula should first undergo diverting ostomy to alleviate symptoms. Then, one should consider definitive resection and ostomy closure.Read at the meeting of The American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003.     

Biomedical Radioactive Glasses for Brachytherapy

The fight against cancer is an old challenge for mankind. Apart from surgery and chemotherapy, which are the most common treatments, use of radiation represents a promising, less invasive strategy that can be performed both from the outside or inside the body. The latter approach, also known as brachytherapy, relies on the use of implantable beta-emitting seeds or microspheres for killing cancer cells. A set of radioactive glasses have been developed for this purpose but their clinical use is still mainly limited to liver cancer. This review paper provides a picture of the biomedical glasses developed and experimented for brachytherapy so far, focusing the discussion on the production methods and current limitations of the available options to their diffusion in clinical practice. Highly-durable neutron-activatable glasses in the yttria-alumina-silica oxide system are typically preferred in order to avoid the potentially-dangerous release of radioisotopes, while the compositional design of degradable glass systems suitable for use in radiotherapy still remains a challenge and would deserve further investigation in the near future.     

Brachytherapy: Update and results

Prostate cancer is the most common noncutaneous malignancy and the second most common cause of cancer mortality in American men. Treatment options for these patients include radical prostatectomy, external beam radiation therapy, hormonal therapy, and prostate brachytherapy. Patients with clinically and radiographically localized disease, especially young patients with few comorbid illnesses, are good candidates for prostate brachytherapy. Prostate brachytherapy has gained widespread acceptance throughout the past two decades and data from several large series of patients are now available. This article describes current techniques, treatment issues, and clinical results of permanent seed implants.     

Brachytherapy in prostate cancer: the use of QuickLink? system within the real-time technique. A new technique is presented

INTRODUCTION. Brachytherapy with real-time technique allows the ultrasound transperineal implant of needles and the release of I125 seeds in the prostate, with intraoperative dosimetry carried out by a special software. After performing this seed-releasing technique on 160 patients, we present 15 cases treated with strand seeds using the QuickLink?system. MATERIALS AND METHODS. Inclusion criteria: CaP clinical stage T1-T2, PSA ≤10 ng/ml, prostate volume ≤ 50g, Gleason score ≤3+3=6, Q maximum >13-15 ml/sec., and I-PSS score <10. METHODICAL. In ultrasound-guided transrectal technique the needles are inserted near the prostatic capsule. A 5mm section plan is performed; the computer allows identifying the contours of prostate, rectum, urethra, and the position of needles to be inserted. The total activity is defined, as well as the number and location of the sources to be included; isodoses are calculated, the correct position of seeds and spacers is printed. The strand seeds are prepared on the basis of this scheme, using the QuickLink? system, and placed into the prostate tissue. RESULTS. The QuickLink? system allows reducing the operative time (110 min, range 95-125). The pelvic CT assessing the post-planning has shown a more regular distribution of seeds. The cut-off of D90≥140 Gy was reached in all patients, with doses at urethra and rectum within the prescribed limits. CONCLUSIONS. The brachytherapy real-time with strand seeds QuickLink? combines the flexibility of planning intraoperative real-time with a faster process, and less tendency for the relocation of the seeds.