后程加速超分割适形放疗治疗食管癌40例疗效观察

将70例食管癌患者随机分成两组:对照组(30例),放射治疗前程采用前后两野对穿照射,20次后避开脊髓照射;治疗组(40例),放射治疗前程采用常规分割适形放射治疗,后程缩野改用后程加速超分割适形放射治疗.结果 对照组与治疗组肿瘤局部复发率分别为63%和34.8%,远处转移率分别为20.8%和15.2%.对照组与治疗组的有效率分别为56.5%、76.0%(P＞0.05).对照组与治疗组1 a生存率分别为32.6%、67.4%;3 a生存率分别为6.5%、43.5%,治疗组高于对照组组(P均＜0.05).1 a局控率分别为34.8%、71.7%;3 a局控率分别为17.4%、56.5%,治疗组高于对照组组(P均＜0.05).认为后程加速超分割适形放疗组能提高食管癌的3 a局部控制率和3 a生存率,但不良反应两组相当.     

多西他赛、奈达铂化疗联合三维适形调强放疗治疗食管癌术后复发的临床研究

目的探讨食管癌术后复发患者经三维适形调强放疗联合多西他赛+奈达铂化疗治疗后的临床效果。方法选取新疆医科大学附属肿瘤医院2013年2月至2017年2月接收的97例食管癌术后复发患者,根据乱数表法随机分为对照组(48例)和研究组(49例)。对照组患者给予三维适形调强放疗治疗,研究组患者在对照组基础上联合多西他赛+奈达铂化疗。比较两组患者临床疗效、血清肿瘤标志物、生存率、不良反应。结果研究组临床总有效率为69. 39%,明显高于对照组的47. 92%(P 0. 05)。两组治疗后血清细胞角蛋白21-1片段(CYFRA21-1)、鳞状细胞癌抗原(SCC)、癌胚抗原(CEA)水平均降低,且研究组显著低于对照组(P 0. 05)。两组治疗期间不良反应总发生率比较无统计学差异(P 0. 05)。研究组的1年生存率、2年生存率均高于对照组(P 0. 05)。结论食管癌术后复发患者经三维适形调强放疗联合多西他赛+奈达铂同步化疗后,疗效确切,血清肿瘤标志物水平得到显著改善,患者生存率提高,且不增加不良反应发生率。     

鼻咽癌常规放疗与适形调强放疗复发率及疗效比较

随机选择80例鼻咽癌患者，按单纯随机法分为常规放疗组与适形调强放疗组各40例进行放射治疗，治疗后随访10～24个月。结果：①近期疗效：常规放疗组和适形调强放疗组患者肿瘤消退率分别为60％和90％，明显缩小率分别为40％和10％；②早期反应：常规放疗组和适形调强放疗组患者急性黏膜反应和口干发生率分别为100％和80％；③晚期反应：常规放疗组患者有3例出现颞叶坏死，18例出现中耳炎；适形调强放疗组患者无一发生颞叶坏死及中耳炎；④复发率：2a内复发率常规放疗组为21％，适形调强放疗组为8％；两组近期疗效、早期反应、晚期反应、复发率比较差异均有统计学意义（P均〈0．05）。认为鼻咽癌适形调强放疗优于常规放疗。     

后程加速超分割三维适形放射治疗食管癌的临床观察

目的 观察后程加速超分割三维适形放疗(3 DCRT)对食管癌的近远期疗效、不良反应及失败原因.方法 将126例食管鳞癌患者随机分至后程加速超分割三维适形放疗组(后超组)和后程常规分割一维适彤放疗组(对照组).放疗方法 :两组前2/3疗程均为普通模拟机定位常规放疗40Gy,后1/3疗程后超组改为CT模拟定位加速超分割三维适形放疗(1.5Gy/次,24～30Gy,总剂量64～70Gy,36～40次,全疗程38～42 d);对照组常规分割三维适形放疗至上述相当剂量.结果 后超组和对照组5年生存率分别为34%和15%,后超组生存率显著高于对照组(P=0.029).后超组中位复发时间也显著长于对照组(11.0、7.0个月,P<0.01).3、4、5年无瘤生存率分别为36%、34%、32%和19%、16%、15%,后超组无瘤生存率均显著高于对照组(P值均<0.05).后超组和对照组1、2、3、4、5年局部控制率分别为78%、74%、64%、62%、61%和59%、38%、30%、28%、26%.后超组局部控制率均显著高于对照组(P值均<0.05).Cox回归分析显示颈段、胸上段食管癌的疗效明显优于胸中段、胸下段食管癌,蕈伞型优于其他类型(P值均<0.01).结论 常规放疗后进行后程加速超分割三维适形放疗可作为颈段、胸上段和蕈伞型食管癌的首选方法 之一,它可提高局部控制率和远期生存率,且不会明显增加反应.     

全脑照射联合三维适形放疗治疗乳腺癌脑转移瘤疗效观察

目的观察全脑照射联合三维适形放疗（3DCRT）治疗乳腺癌脑转移瘤的疗效。方法将乳腺癌脑转移瘤37例分为两组,联合组21例先行全脑照射,局部病灶缩野时针对脑部可见病灶行3DCRT,对照组16例仅针对脑部可见病灶行3DCRT,治疗后每2—3个月行影像学检查。结果对照组局控率59％,1a生存率为43％,联合组局控率75％,1a生存率为41％。两组局控率比较P〈0．05,1a生存率比较P〉0．05。结论全脑照射联合3DCRT可提高局部控制情况,但对生存期的延长无益。     

食管癌根治术后预防性放疗的临床研究

目的探讨食管癌根治术后放射治疗的价值方法 1989-01/1994-06对80例食管癌根治术后行术后预防性放疗,用配对法与同期单纯手术治疗80例食管癌进行对比.结果单纯手术组1,3,5年生存率为76.3%,37.5%,22.5%,术后放疗组1,3,5年生存率为77.5%,56.3%,32.5%(直接法计算生存率),两组差异有显著性意义(P<0.05,卡方检验),无淋巴结转移者术后放疗组1,3,5年生存率较单纯手术组明显提高,有显著差异(P<0.01),淋巴结阳性者1,3,5年生存率两组无统计学意义.结论术后放疗复发率低,无淋巴结转移者术后应放疗,术后放疗组5年生存率高于单纯手术组.     

适形调强放疗联合奥沙利铂、卡培他滨同步化疗治疗晚期食管癌患者效果评价

目的探讨适形调强放疗联合奥沙利铂、卡培他滨同步化疗治疗晚期食管癌患者的临床效果。方法将2012年1月至2013年12月在我院接受治疗的56例晚期食管癌患者按照随机数字表法分为两组,每组28例。对照组患者采用适形调强放疗治疗,研究组患者进行适形调强放疗联合奥沙利铂、卡培他滨同步化疗治疗。比较两组患者的临床治疗效果、远期生存情况、QLQ-OES24评分及不良反应发生情况。结果治疗6周后,研究组患者治疗总有效率(82.1%)显著高于对照组(57.1%),差异有统计学意义(P0.05);研究组患者1、2、3年生存率显著高于对照组(P0.05);两组患者放射性肺炎、放射性食管炎等不良反应及其INM临床分期比较差异均无统计学意义(P0.05);治疗1、2个月后,两组患者QLQ-OES24评分比较差异无统计学意义(P0.05),治疗6个月后研究组患者QLQ-OES24评分显著高于对照组(P0.05)。结论适形调强放疗联合奥沙利铂、卡培他滨同步化疗治疗晚期食管癌患者,可有效提高临床治疗效果,改善患者的生活质量,不增加患者的不良反应,在临床上具有一定的推广应用价值。     

替莫唑胺联合三维适形放疗对恶性脑胶质瘤的疗效评价

目的评价替莫唑胺（TMZ）联合适形放疗对恶性脑胶质瘤（BMG）的疗效及不良反应。方法将2006年10月~2008年10月收治的48例经CT或MR I证实术后病灶残瘤的BMG患者随机分为对照组（适形放疗）和治疗组（TMZ＋适形放疗）,观察并对比疗效。结果治疗组有效率（62.5%）高于对照组（33.3%）（P〈0.05）。治疗组1a生存率为82.5%,对照组为57.0%（P〈0.05）。主要不良反应是Ⅱ~Ⅲ度骨髓抑制、恶心呕吐等。治疗组白细胞减少发生率为66.7%,对照组为37.5%（P〈0.05）,其余严重不良事件发生率差异无统计学意义。结论 TMZ化疗联合适形放疗比单纯适形放疗能更好提高恶性脑胶质瘤患者1 a生存率和更明显地缩小肿瘤体积。     

食管癌治疗后纵隔转移灶后程加速超分割三维适形放疗协同化疗的疗效观察

将106例食管癌纵隔转移患者随机分为两组,对照组采用三维适形放射治疗(3-DCRT),治疗组采用3-DCRT协同化疗.结果治疗3个月后,治疗组总有效率明显优于对照组(P＜0.05),1、2 a生存率高于对照组(P＜0.05),两组不良反应无统计学差异.提示3-DCRT协同化疗可明显提高食管癌患者的近期疗效和生存率,且其毒副作用不增加,患者可耐受其急性放射反应.     

Ⅲ期食管癌综合治疗69例分析

将已确诊Ⅲ期食管癌鳞癌患者患者69例随机分为综合治疗组和单纯手术组。综合治疗组35例采用术前放疗化疗＋手术治疗＋术后化疗。单纯手术组34例采用食管癌根治术＋淋巴结三野清扫术。发现综合治疗组根治性手术切除率、1a生存率、无病生存率高于单纯手术组（P〈0．05）,单纯手术组开胸探查率高于综合治疗组（P〈0．05）。认为Ⅲ期食管癌综合治疗可以提高根治性手术切除率,改善近期预后及无病生存率,术后化疗对于预防肿瘤复发有一定作用。     

Mediastinal and hilar lymph node of cancer unknown origin: 3 case reports]

We encountered three rare cases of cancer of unknown origin affecting the mediastinal and hilar lymph nodes. Patient 1 was a 63 year-old man. Chest X-ray and CT films revealed an enlarged right hilar lymph node. A right mediastinal and hilar lymphadenectomy was performed. The histological diagnosis was metastatic squamous cell carcinoma (SCC). SCC of the right upper lobe appeared 34 months after the operation, requiring a right pneumonectomy. Patient 1 was alive 43 months after his first operation. Patient 2 was a 73 year-old man in whom left mediastinal and hilar lymph node swelling had been detected. A mediastinoscopy and lymph node biopsy were performed. The histological findings resulted in a diagnosis of metastatic small cell carcinoma. Chemotherapy was initiated, and the patient was alive 5 months after the biopsy procedure, Patient 3 was a 57 year-old man in whom right mediastinal and hilar lymph node swelling had been disclosed by chest CT scans. We performed a medianosternotomy and mediastinal and right hilar lymphadenectomy. Histologically, the diagnosis was metastatic adenocarcinoma. After the operation, radiation therapy was performed on the patient's mediastinum. Patient 3 was alive 5 months after the initial operation. The patients were given diagnoses of T0N1 or T0N2 lung cancer.     

Insignificance of prophylactic upper mediastinal lymph node dissection by sternotomy for papillary thyroid carcinoma

Papillary thyroid carcinoma (PTC) is characterized by extensive lymph node metastases. A considerably high frequency of lymph node metastases in the upper mediastinal compartment (UMC) has been reported. However, the significance of prophylactic upper mediastinal lymph node dissection (UMLND) by sternotomy as an appropriate therapeutic option has not yet been clarified. Thirty-three patients who underwent prophylactic UMLND by sternotomy for PTC at our institution between 1980 and 1987 (group A) were analyzed. One hundred and fifty-one consecutive patients with PTC who underwent curative total thyroidectomy, bilateral modified radical neck dissection, and UMLND by collar incision as initial treatment between 1990 and 1999 (group B) were analyzed as controls. The patterns of lymph node metastases in the cervical compartment of these two groups were comparable; distribution of lymph node metastases in UMC was considerably less frequent than in other compartments. Clinical relapse in UMC was not observed in both groups. No significant difference in disease specific survival or relapse free survival between group A and B was observed. The lack of clinical relapse in UMC in group B indicates that most of the lymph node metastases in this compartment could be resected by the conventional collar incision or most microscopic lymphatic metastases could remain dormant as with lateral microscopic node metastases. Thus, upper mediastinal lymph node metastases requiring sternotomy to resect in curable patients with PTC could be less frequent. Prophylactic UMLND by sternotomy for PTC is discouraged from a clinical view point.     

非典型结节病21例临床分析

目的　提高对非典型结节病的认识。方法　回顾性分析了２１ 例非典型结节病的临床资料,所有病例均经病理检查证实。结果　不典型结节病影像学可表现为：（１）肺内病变：有孤立结节影,肺不张,单侧、双侧肺实变,双肺栗粒样结节。（２） 单纯纵隔淋巴结病变：有纵隔肿物,纵隔淋巴结肿大和单侧肺门淋巴结肿大,纵隔单纯淋巴结肿大。（３） 胸膜病变：有液、气胸,胸膜增厚。（４） 肺门病变：有单侧肺门淋巴结肿大和纵隔淋巴结肿大,双侧肺门淋巴结非对称性肿大, 单侧肺门淋巴结肿大钙化。结论　不典型结节病临床表现多种多样,影像学检查难以满足诊断需要。只有对结节病有足够认识,辅以其他检查,其诊断并不困难。     

非黄型结节病21例临床分析

目的 提高对非典型结节病的认识,方法 回顾性分析了２１例非典型结节病的临床资料,所有病例以病理检查证实。结果 不典型结节病影像学可表现为：１）肺内病变;有孤立结节影,肺不张,单侧,双侧肺实变,双肺栗粒样结节。（２）单纯纵隔淋巴结变;有纵隔肿物,纵隔淋巴结肿大和单侧肺门淋巴结肿大,纵隔单纯淋巴结肿大。（３）胸膜病变;有液,气胸,胸膜增厚。（４）肺门病变：有单侧肺门淋巴 肿大和纵隔淋巴 肿大,双侧肺门     

The efferent cardiac lymphatic pathways in the macaque monkey.

In ten postmortem hearts of the Macaque monkey (M. mulatta), the coronary lymphatics were visualized using an India ink suspension in 2% gelatin. The left coronary lymphatic initially passed to the dorsal surface of the aortic arch. In five hearts, this lymphatic went directly to the cardiac lymph node, whereas in the others, it first ascended to the left superior tracheobronchial node and then interconnected with the cardiac lymph node. The right coronary lymphatic usually passed in front of the ascending aorta and common arterial (brachiocephalic) trunk and entered the cardiac lymph node. In two hearts, however, the right coronary lymphatic first ascended to an anterior transverse mediastinal node and from here lymphatics joined the cardiac lymph node. Those lymphatics that passed cephalad from the cardiac lymph node to the right anterior mediastinal nodes and the right paratracheal nodes ultimately emptied into the right venous angle. Those lymphatics that passed cephalad from the cardiac lymph node to the anterior transverse mediastinal nodes ultimately emptied into the left venous angle. In five other Macaque monkeys (M. mulatta and M. fascicularis) after marker injection (T1824 blue dye and micropulverized barium sulfate) into the living heart or pericardium, lymphatic drainage beyond the base of the heart could not be demonstrated. Whereas postmortem morphologic studies suggest that the monkey coronary lymphatic system is amenable to obstruction by removal of the cardiac lymph node and interruption of its adjacent lymphatic connections, effective methods for visualizing the mediastinal lymphatic collecting system in the living monkey must be developed before experimental cardiac lymphatic ablation can be accomplished in this species.     

Testicular cancer with enlarged mediastinal lymph nodes: a diagnostic pitfall.

A patient with embryonal cell carcinoma restricted to the left testicle, without retroperitoneal but with mediastinal lymph node enlargement and highly elevated serum alpha-fetoprotein levels, is presented (T1N4M0). Because stage III of the disease was presumed, he received chemotherapy, which was unfortunately complicated by a bleomycin-induced pneumonitis. At re-evaluation after chemotherapeutic treatment, it appeared that the tumor marker level had decreased exponentially after the operation and that the mediastinal lymph node enlargement was due not to metastatic disease but to sarcoidosis. The necessity of calculating the half-life of tumor markers after operation and histological examination of the mediastinal lymph nodes prior to chemotherapy in such cases, is discussed.     

Ultrasonographic evaluation of neck and supraclavicular lymph nodes metastasized from lung cancer.

The significance of ultrasonography in the evaluation of metastasized neck and supraclavicular lymph nodes from lung cancer was analyzed. By ultrasonography, the lymph nodes could be visualized clearly as low-echogenic round areas, and the size could be precisely measured in three dimensions. It was also possible to diagnose whether or not the lymph node adhered to the surrounding tissues and to determine the relationship and the connection of supraclavicular lymph node and upper mediastinal lymph node. The therapeutic effect related to the size of the lymph node was evaluable by ultrasonography. Therefore, the ultrasonographic approach to the neck and supraclavicular lymph nodes metastasized from lung cancer is considered to be useful for clinical use.     

Prognosis of patients with adenocarcinoma of the lung and mediastinal lymph node metastases undergoing pulmonary resection

Of 57 patients who were operated on for adenocarcinoma of the lung during the period 1966-1970, 18 with mediastinal lymph node metastases successfully underwent potentially curative pulmonary resection combined with complete mediastinal lymph node dissection. The 5-year survival rate was nil. In light of this poor outlook, we do not recommend surgery as the primary treatment of choice in patients with adenocarcinoma of the lung and known mediastinal lymph node metastases.     

A case of small liver cancer presenting as a huge mediastinal mass]

A 61-year-old male was admitted because of hemoptysis. He had a 9 year history of liver cirrhosis associated with HB viral chronic hepatitis. Physical examination revealed no abnormalities. Laboratory investigations revealed positive HBs antigen with normal alpha-fetoprotein. Chest X-ray film showed large mediastinal lymph nodes and an endobronchial polypoid mass in the distal end of the right main bronchus. The right main PA was narrowed due to compression by the mediastinal mass. Bronchoscopic examination revealed a polypoid mass in the right main bronchus. The biopsy specimen was histologically diagnosed as undifferentiated large cell carcinoma. The patient developed respiratory failure, and died 3 weeks after admission. Autopsy revealed a small liver cancer of 1.3 cm diameter within the cirrhotic liver, associated with a small abdominal lymph node metastasis and large mediastinal lymph node swellings. Thromboembolism in the bilateral main pulmonary arteries was concluded to be the cause of death. The mediastinal mass which directly invaded into the right main bronchus had a close histological similarity with the liver cancer, showing undifferentiated carcinoma cells with bizarre nuclei and abundant cytoplasm. An immunohistological study revealed cells positive for alpha-fetoprotein in the mediastinal lymph nodes. The patient was diagnosed as having small liver cancer with mediastinal lymph node metastases. A survey of the literature revealed only a few cases of advanced hepatoma associated with prominent mediastinal metastases. This is the first reported case of small liver cancer presenting with large mediastinal lymph node metastases.     

Recurrence after endoscopic mucosal resection of esophageal squamous cell carcinoma invading the muscularis mucosae or upper submucosa

Background: Endoscopic mucosal resection (EMR) is recommended for cases of squamous cell carcinoma of the esophagus in which the tumor is confined to the lamina propria mucosa. However, EMR is often performed in patients whose tumors invade the muscularis mucosae (m3) or upper submucosa (sm1) to minimize surgical invasion, despite the increased risk of lymph node metastasis. We evaluated patients who were found to have distant or lymph node metastasis after EMR for such lesions. Methods: Thirty‐four consecutive patients with esophageal carcinoma invading m3 or sm1 who underwent EMR during the period from June 1992 through March 2001 (extended EMR group) were studied. Results: Five of these patients were found to have distant or lymph node metastasis on follow up. Patient 1 died of lung metastasis 34 months after EMR. Patient 2 underwent chemotherapy because of an abnormally high value of squamous cell carcinoma (SCC) antigen. Patient 3 died of upper mediastinal lymph node metastasis 62 months after EMR. Patient 4 underwent total gastrectomy because of gastric wall metastasis 41 months after EMR and underwent chemoradiotherapy because of upper mediastinal lymph node metastasis 87 months after EMR. Patient 5 was found to have cardiac lymph node metastasis by follow‐up endoscopic ultrasonography examination 42 months after EMR and underwent curative lymph node dissection. Conclusion: It is unlikely that patient 1 and patient 2, both with probable distant metastasis, received inadequate treatment. Surgery with lymph node dissection usually cannot prevent distant metastasis. The patients with lymph node recurrence (patient 3 and patient 4) should have been followed up more carefully. We believe that patients with early lymph node metastasis, such as patient 5 in this study, should undergo curative surgical resection. Patients undergoing extended EMR should be carefully followed up for a long period to enable early detection and treatment of lymph node metastasis.