与AIDS相关的Kaposi′s肉瘤放射治疗的临床疗效分析

目的总结放疗在艾滋病（AIDS）相关联的流行性卡勃基氏肉瘤（EKS）治疗中的有效性。方法收集和分析H．Mondor医院肿瘤放疗科1987年7月-1997年6月收治的659例AIDS伴有EKS的患者资料。中位随访3．2年。其中,398例患者（60．3％）放疗前曾接受过化疗、干扰素以及抗病毒治疗。病变处放疗采用4MV—X射线,8MeV电子线,或45—100kVX线（视病变情况而定）。根据瘤体大小、部位和范围设野,共对6907部位（野）进行了照射。皮肤病变给予20Gy常规分割照射,休息2周后又给予10Gy补充照射。口腔病变则一般给予总量15．2Gy照射。其它病变如外生殖器、眼部等则给予10Gy-20Gy常规照射。结果可评价患者共629例,放疗总客观有效率92％,临床症状得到不同程度缓解,照射的皮肤对射线耐受好。随访发现病人疗后的复发与生存主要与AIDS本身的进展有关。结论放射治疗是流行性卡勃基氏肉瘤患者有效的治疗方法,能有效杀伤肿瘤并能明显改善生存质量,但应严格掌握放疗方法和剂量,避免放疗后发生严重并发症。     

62例口腔卡勃基氏肉瘤与放射治疗

目的本文旨在介绍放疗在合并ＡＩＤＳ的口腔卡勃基氏肉瘤（ＫＳ）患者治疗中的有效性。材料与方法１９８６年６月至１９９６年１２月，亨利蒙德尔医院肿瘤科对６２例合并有ＡＩＤＳ的口腔ＫＳ患者进行了放射治疗。患者平均年龄３９．２岁（２８～６２岁）；男６１，女１。治疗前共有４４例患者接受过系统的干扰素免疫治疗及化疗等。放疗采用４５ＫＶ及４ＭＶ－Ｘ线，剂量１０～３０．４Ｇｙ不等。其中１５～１５．２Ｇｙ５０人，３０．４Ｇｙ３人，１０～２０Ｇｙ９人。根据肿瘤大小及病变部位设野，其中５３例采用两侧对穿照射野，９例采用体腔管直对照射。结果在接受ＤＴ１５～１５．２Ｇｙ照射的５０例患者中，口腔重度反应８人（１６％），中度反应９人（１８％），轻度反应３３人（６６％）；客观临床缓解率达１００％，其中完全缓解率１７．８％（１１／６２），部分缓解率８２．２％（５１／６２），且临床症状获得了良好的改善。结论ＫＳ对放疗敏感，对口腔ＫＳ放疗是一种有效的姑息治疗手段。ＤＴ１５Ｇｙ足可缓解临床症状并使肿瘤退缩或消退。提倡患者口腔清洁，对患者进行放疗前、中的预防及治疗性的抗真菌治疗很有必要，以改善患者对放疗的耐受性。     

26例新疆Kaposi's肉瘤放射治疗的疗效分析

目的:探讨Kaposi's肉瘤(KS)放射治疗剂量与疗效的关系.方法:26例Kaposi's 肉瘤患者共有66个照射野,按总剂量不同分为三组,＜40Gy组,40Gy~45Gy组,46Gy~52 Gy组.采用加速器X线,电子线或混合射线常规分割照射,每周5次,每次2Gy.结果:本组66个照射野总的客观缓解率(CR+PR)...     

快中子放射治疗软组织肉瘤的疗效分析

目的回顾分析快中子与快中子、光子混合照射治疗软组织肉瘤的疗效及其影响因素.方法 52例患者共79个病灶,其中19例37个病灶采用35 MeV p→Be快中子治疗,33例42个病灶混合照射.单纯中子组剂量4.0～21.0 Gy(中位值11.7 Gy).混合照射组中子剂量3.9～16.0 Gy(中位值8.8 Gy),光子剂量9.0～62.0 Gy(中位值34.0 Gy),总剂量(16.5～69.4 Gy,中位值42.0 Gy).中子分次剂量0.8～1.5 Gy(中位值1.2 Gy),周二、五照射;光子为常规分割. 结果病灶局部控制率为48.7%,在治疗和随访中仅有24.1%的病灶出现进展.非转移性病灶、肿瘤较小以及放射治疗前手术切除是局部控制的有利因素(P< 0.05).混合照射总剂量与局部控制及无进展时间显著正相关(rs=0.453,r=0.288,P值分别为0.001和0.032).混合照射较单纯中子对病灶局部控制的改善接近于有显著性意义(57.1%∶35.5%,χ2=3.60,P=0.058).全组患者的1、3、5年生存率分别为57.3%、20.5%、13.7%,远地转移为主要死因.肿瘤组织学分级较低和接受混合照射的患者生存率较高.全组病灶3+4级近期放射反应发生率为2.7%,远期的为19.0%. 结论快中子治疗软组织肉瘤可以取得较好的局部控制,中子、光子混合照射有可能改善疗效,不能手术或术后残留的G1或G2级肿瘤适用于快中子治疗,放射反应的发生率可以接受.     

26例新疆Kaposi’S肉瘤放射治疗的疗效分析

目的：探讨Kaposi’s肉瘤（KS）放射治疗剂量与疗效的关系。方法：26例Kaposi’s肉瘤患者共有66个照射野,按总剂量不同分为三组,〈40Gy组,40Gy-45Gy组,46Gy-52Gy组。采用加速器x线,电子线或混合射线常规分割照射,每周5次,每次2Gy。结果：本组66个照射野总的客观缓解率（CR＋PR）66．7％,其中〈40Gy组为41．7％,40DGy-45Gy组为81．8％,46Gy-52Gy组为80．6％。40Gy～45Gy组与46Gy-52Gy组疗效优于〈40Gy组,差异具有统计学意义（P〈0．05）。放射性皮炎随着剂量的增加而加重,〈40Gy组Ⅲ°～Ⅳ°放射性皮炎发生率8．3％,40Gy～45Gy组为27．3％,46Gy-52Gy组为77．4％,46Gy～52Gy组Ⅲ°～Ⅳ°放射性皮炎发生率明显高于40Gy～45Gy和〈40Gy组（P〈0．001）,但皮损局部消炎处理后基本可痊愈。26例患者5例KS患者死于其他疾病,1例患者死于皮肤及肺部感染,其余20例患者带瘤存活。结论：Kaposi’s肉瘤是一种放射治疗敏感的恶性肿瘤,常规分割照射剂量40Gy-52Gy为宜。     

放射疗法在经典型皮肤卡勃基氏肉瘤治疗中的应用

目的探讨放射疗法在经典型皮肤卡勃基氏肉瘤（Ｋａｐｏｓｉｓｓａｒｃｏｍａ,ＫＳ）这种罕见肿瘤治疗中的有效性。方法１９８６年６月～１９９６年１２月,法国巴黎第十二大学亨利·孟德尔医院肿瘤科共收治经典型皮肤ＫＳ５例。所有病人均接受４５～７０ＫＶＸ线局部放射治疗,共设４８个照射野,剂量均＜３０Ｇｙ。放疗方式为：第１周１０Ｇｙ,２．５Ｇｙ／次×４,休息１０～１５天后再行第２阶段放疗,追加剂量１５～２０Ｇｙ。结果完全缓解率１００％。皮肤对放射的耐受良好,不影响美观。２例出现射野外新病灶,其中１例行放疗而另１例行长春花碱治疗,均完全缓解。结论放射疗法对ＫＳ可以提供有效的局部控制率并保持皮肤的完整美观,剂量２０～３０Ｇｙ足以使经典型皮肤ＫＳ完全缓解。     

Kaposi’s肉瘤的放射治疗

目的：探讨Ｋａｐｏｓｉ肉瘤的发展现律，临床特点及疗效。材料与方法：１９８５－１９９２年间新疆医学院肿瘤医院收治７例。维吾尔族６例，哈萨克族１例。除１例病变起始左股部有腹股沟淋巴结受累外，余６例无淋巴结及内脏受侵。用ｘ线或６０Ｃｏ治疗，射野超过病灶边缘２ｃｍ－３ｃｍ，每日１．８－２．０Ｇｙ，每周５次，总剂量２３－５７ＧＹ。结果：首发于上肢４例，２～６年后向对侧上肢及双下肢远端扩散，进展相对较快。首发于下肢３例，内有２例经８－１１年时沿同侧肢体远端扩散，１例侵及上肢，病程较慢。尽管起病部位不同，是终仍为向心性发展，生存２年以上７／７例，４年以上５／５例，５年以上４／４例。结论：本病病程较长，疗效判断也相应长；对放射线治疗有效，减症剂量１０－２９Ｇｙ，病变消失量２８－５７Ｇｙ。     

24例Kaposi's肉瘤放疗的远期疗效分析

目的 探讨Kaposi's肉瘤放疗的疗效.方法 采用60Coγ线或直线加速器X线和电子线混合线常规分割照射,180-200 cGy/次,5次/周,总剂量30～62 Gy.单纯放疗2例,22例放疗前后用CHOP方案化疗1～3个周期同时应用生物治疗(LAK、干扰素、免疫核糖核酸和白细胞介素Ⅱ等).结果 24例患者总5、10年生存率分别为79%、54%.放疗剂量30～36 Gy者5例,5、10年生存率分别为60%、20%;放疗剂量40～48 Gy者8例,5、10年生存率分别为75%、50%;放疗剂量50～62 Gy者11例,5、10年生存率分别为91%、73%.三者5、10年生存率无差异可能与分层分析后例数少有关.结论 放疗对Kaposi's肉瘤有较好的远期疗效.     

艾滋病相关肿瘤临床分析总结

目的总结我科收住的13例艾滋病相关肿瘤患者的临床表现及特征。方法对我科自2001年1月-2008年9月共收住入院的13例艾滋病相关肿瘤患者的传播途径、临床表现、实验室检查、治疗结果及转归进行回顾性研究。结果艾滋病期的患者临床表现以多样化为特点。艾滋病由于获得性免疫缺陷病毒对机体免疫系统的破坏,免疫功能出现紊乱,使得机体对自身的免疫监视功能也有不同程度的影响。艾滋病相关肿瘤是艾滋病一个重要的死亡原因,也会是今后艾滋病治疗时所面临的重大挑战。     

血管肉瘤的临床分析

目的 分析血管肉瘤治疗后的生存情况及影响预后的因素。方法 对中国医学科学院中国协和医科大学肿瘤医院收治批病理证实的４１例血管肉瘤进行分析。其中综合治疗（手术＋放射治疗;手术＋化疗;手术＋放射治疗＋化疗）２３例,非综合治疗（手术：放射治疗）１８例,生存率用Ｋａｐｌａｎ－Ｍｅｉｅｒ法计算,用Ｌｏｇｒａｎｋ法进行生存曲线比较,用Ｃｏｘ模型进行多因素回归分析。结果 出现复发或转移的中位时间为１０个月。局部复发１４例,占３８．９％;远地转移１６例,占４４．４％。转移部位依次为淋巴结８例、肺８例、肝脏５例、骨４例、其它４例。全组生存期５个月至２４．５年（中位３０个月）,１、３、５、１０年生存率分别为６７．５％、４６．１％、３４．５％和１４．４％。综合治疗组５年生存率为４２．１％。非综合治疗组为１０．４％（Ｘ＾２＝７．３７,     

Radiation Therapy in AIDS Related Kaposi's Sarcoma

The first case of epidemic Kaposi's Sarcoma requiring radiotherapy in Adelaide is described. A number of points related to the treatment of this condition and particularly the oral mucosa type of lesion are discussed.     

Kaposi's Sarcoma in AIDS: The Role of Radiation Therapy

Radiotherapy can provide good palliation for AIDS patients with symptomatic Kaposi's sarcoma. We have retrospectively reviewed the treatment of 13 lesions in 5 patients. All treated tumours demonstrated significant regression with moderate doses of radiation. Side effects were acceptable and treatment provided good pain relief, functional improvement, and restoration of cosmesis. Our experience confirms that radiotherapy has a meaningful role in the management of AIDS-related Kaposi's sarcoma.     

Radiation therapy in the management of patients with mesothelioma

The results of radiation therapy in the management of 27 patients with malignant mesothelioma were reviewed. Eight patients were treated with a curative intent combining attempted surgical excision of tumor (thoracic in 6 and peritoneal in 2), aggressive radiation therapy, and combination chemotherapy using an adriamycin-containing regimen. One patient achieved a 2-year disease-free interval followed by recurrence of tumor above the thoracic irradiation field. This patient was retreated with localized irradiation and is disease-free after 5 years of initial diagnosis. One patient has persistent abdominal disease at 18 months; the other 6 patients suffered local recurrence within 8-13 months of initiation of treatment. Radiation therapy was used in 19 other patients who received 29 courses for palliation of dyspnea, superior vena cava syndrome, dysphagia, or neurological symptoms of brain metastasis. A palliation index was used to determine the effectiveness of irradiation and revealed that relief of symptoms was complete or substantial in 5 treatment courses, moderately effective in 6 courses and inadequate in 18 treatment courses. Adequate palliation strongly correlated with a dose at or above 4,000 rad in 4 weeks. The management of patients with mesothelioma requires new and innovative approaches to increase the effectiveness of radiation therapy and minimize the significant potential combined toxicity of pulmonary irradiation and adriamycin.     

Pulmonary Kaposi's Sarcoma in AIDS Patients Treated with Combined Chemotherapy and Recombinant Human Granulocyte Colony-Stimulating Factor

Abstract

Optimal delivery of chemotherapy in AIDS patients with Kaposi's sarcoma (KS) is frequently limited by hematological toxicity, mainly neutropenia. We have conducted an open-label study to investigate the safety and efficacy of recombinant human granulocyte colony-stimulating factor (filgrastim, r-metHuG-CSF) administration in 25 AIDS patients with pulmonary KS treated with Adriamycin, bleomycin, and vincristine (ABV) combination. The patients were assigned to receive r-metHuG-CSF (Neupogen, Dompé, Biotec, 5 mg/kg of body weight per day) injected subcutaneously for 3-5 days before chemotherapy until the absolute neutrophil count was higher than 25 × 10⁹; r-metHuG-CSF was then discontinued 5 days before chemotherapy. Patients were eligible to resume r-metHuG-CSF 3 days after completing the anticancer regimen until normalization of the absolute neutrophil count occurred, for a maximun of 10 days.

The cytotoxic regimen included vincristine 1.4 mg/m², bleomycin 10 mg/m², and doxorubicin 20 mg/m², every 2 weeks. The overall response rate was 58% with a complete response rate of 18%. Median survival was 11 months and median response duration was 6 months. Adverse effects consisted of transient nausea and vomiting in 48% of patients, and moderate headache in 43%. Hematologic toxicities included anemia in 27%, and mild to moderate neutropenia (grade II-III) in 38%. The mean leukocyte and neutrophil nadirs were 1920 and 850 mm³.

The mean duration of neutropenia was 3.2 days. The combination of r-metHuG-CSF and ABV chemotherapy was well tolerated. Administration of r-metHuG-CSF within 5 days before chemotherapy appears to be an acceptable treatment with important clinical implications. We stress that further studies are needed to determine the maximum tolerable doses of combination chemotherapy supported by G-CSF in AIDS-associated KS patients.     

Radiation therapy for Kaposi's sarcoma associated with acquired immunodeficiency syndrome: Tokyo Metropolitan Komagome Hospital experience

Background. Kaposi's sarcoma is frequently found in association with acquired immunodeficiency syndrome (AIDS). We report on radiotherapy for patients with AIDS-related Kaposi's sarcoma at Tokyo Metropolitan Komagome Hospital. Methods. Between April 1991 and May 1997, radiotherapy was given to 11 lesions in eight men with AIDS-related Kaposi's sarcoma to relieve their symptoms. The lesions involved the head and neck region, the legs, and the gastrointestinal tract. Radiotherapy was carried out with 4-MV photon through parallel opposed fields or high energy electrons. Total doses ranged from 20 to 38 Gy, with a median of 30 Gy, delivered in 2- to 3-Gy fractions. Four patients were given other treatments prior to the radiotherapy. Acute reaction was evaluated according to the modified acute radiation morbidity scoring criteria of the Radiation Therapy Oncology Group (RTOG). Results. Radiotherapy had relieved the symptoms in all patients at completion of this therapy. Lesions that involved the hard palate and vocal cords had completely disappeared. The lesions that received radiotherapy were controlled without symptoms until the patients died. Patients who had the head and neck region treated exhibited severe acute mucosal reaction (at a dose of 30 Gy, there was grade 2 morbidity by modified RTOG criteria, in two patients, and grade 3 in three patients) although the radiation therapy was completed for these patients. Conclusion. Radiotherapy promises a favorable outcome for symptom relief in AIDS-related Kaposi's sarcoma. Received: April 24, 2000 / Accepted: August 18, 2000     

Kaposi's Sarcoma in HIV‐infected patients in South Africa: Multicohort study in the antiretroviral therapy era

The incidence of Kaposi's Sarcoma (KS) is high in South Africa but the impact of antiretroviral therapy (ART) is not well defined. We examined incidence and survival of KS in HIV‐infected patients enrolled in South African ART programs. We analyzed data of three ART programs: Khayelitsha township and Tygerberg Hospital programs in Cape Town and Themba Lethu program in Johannesburg. We included patients aged >16 years. ART was defined as a regimen of at least three drugs. We estimated incidence rates of KS for patients on ART and not on ART. We calculated Cox models adjusted for age, sex and time‐updated CD4 cell counts and HIV‐1 RNA. A total of 18,254 patients (median age 34.5 years, 64% female, median CD4 cell count at enrolment 105 cells/μL) were included. During 37,488 person‐years follow‐up 162 patients developed KS. The incidence was 1,682/100,000 person‐years (95% confidence interval [CI] 1,406–2,011) among patients not receiving ART and 138/100,000 person‐years (95% CI 102–187) among patients on ART. The adjusted hazard ratio comparing time on ART with time not on ART was 0.19 (95% CI 0.13–0.28). Low CD4 cell counts (time‐updated) and male sex were also associated with KS. Estimated survival of KS patients at one year was 72.2% (95% CI 64.9–80.2) and higher in men than in women. The incidence of KS is substantially lower on ART than not on ART. Timely initiation of ART is essential to prevent KS and KS‐associated morbidity and mortality in South Africa and other regions in Africa with a high burden of HIV.     

Interferon-alpha, zidovudine, and granulocyte-macrophage colony-stimulating factor: a phase I AIDS Clinical Trials Group study in patients with Kaposi's sarcoma associated with AIDS.

PURPOSE: To increase the hematologic tolerance of interferon-alpha (IFN alpha) and zidovudine combination therapy by the addition of granulocyte-macrophage colony-stimulating factor (GM-CSF), and to evaluate the safety, tolerance, and potential efficacy of the combination in patients with Kaposi's sarcoma and AIDS. PATIENTS AND METHODS: Seventeen patients with Kaposi's sarcoma associated with AIDS received zidovudine 200 mg orally every 4 hours and GM-CSF 5 micrograms/kg/d subcutaneously. Successive cohorts received IFN-alpha 2b at a daily subcutaneous dose of 5, 10, or 20 million units. The dose of GM-CSF was titrated to maintain the neutrophil count between 1 and 5 x 10(9) cells/L. Doses of all three drugs were reduced, as required, for nonhematologic toxicities. RESULTS: GM-CSF induced leukocytosis in all patients. On average, a dose of 1.25 micrograms/kg/d was sufficient to maintain the neutrophil count within the desired range. The combination of 20 million units of IFN-alpha with zidovudine and GM-CSF induced dose-limiting toxicity in four of six patients. The major side effects were constitutional symptoms, which included malaise, anorexia, fatigue, fever, and were dose-limiting in three patients. Severe anemia and/or thrombocytopenia developed in three patients. Seven patients (41%; 95% confidence interval [CI], 18% to 64%) showed objective tumor regression that persisted for a median of 51 weeks. A rapid decrease in free-serum p24 antigen levels was observed in seven patients who had measurable levels at baseline; the mean time required to isolate human immunodeficiency virus (HIV-1) from peripheral-blood cells was increased by 7 days. The number and percentage of CD4-positive lymphocytes showed no significant change. CONCLUSIONS: GM-CSF prevents neutropenia induced by the IFN-alpha and zidovudine combination and induced no adverse effects on immune function or HIV activity. However, nonhematologic toxicity precluded a major increase in the maximum-tolerated doses of IFN-alpha and zidovudine.     

Radiation therapy in the management of rectal cancer

For many years, rectal carcinoma has been treated by surgery alone. However, survival rates have not improved historically and local recurrence remains a problem. Adjuvant radiation therapy does have a role in this disease. While the optimal scheduling and dose are not determined yet, it can certainly prevent local recurrence and potentially increase survival. There are advantages to delivering radiation therapy preoperatively and postoperatively and the combination of low-dose preoperative radiation therapy and postoperative radiation therapy in selected patients ("sandwich" therapy) appears promising. The use of chemotherapy in combination with radiation therapy may further improve survival rates. Care must be taken in patients treated with rectal carcinoma to minimize the normal tissue irradiated to decrease complications and deliver tumoricidal doses to the areas at risk. Techniques are available to both the surgeon and the radiation oncologist to minimize the amount of small bowel irradiated. Radiation therapy also has a role in the treatment of very early rectal cancers as part of a sphincter-saving procedure and in the treatment of advanced or recurrent rectal cancers. In the latter, intraoperative radiation therapy plays an important role in controlling recurrent or residual rectal cancer.