乳腺癌术后放射治疗照射野的设计

通过肿瘤放疗计划系统对传统放疗照射野进行探讨，认为原腋锁野适当挡铅可减少肺受照射体积，腋下用填充物能使刑量分布均匀，避免剂量热点     

野中野调强放疗在左乳腺癌改良根治术后胸壁放疗的剂量学研究

目的:研究采用野中野调强放疗（FIF-IMRT）进行左乳腺癌改良根治术后胸壁放疗的剂量学特点。方法:回顾性分析 2014年9月至2019年8月以来行左乳腺癌改良根治术后予胸壁及锁骨区放疗的77例患者资料。患者均接受胸壁及锁骨区 行整体化IMRT，胸壁行FIF-IMRT及锁骨区行IMRT这两种治疗方案，采集并比较靶区相关剂量参数、适形度指数、均匀性 指数，肺、心脏及右侧乳腺的剂量体积参数的差异。结果:两种治疗方案均达到放疗计划剂量学要求。两种治疗方案的靶区 均匀性指数和适形度指数、PTV-Dmax、PTV-Dmean、PTV-V105%，左肺V5、V10、V20、V30、Dmean，右肺V30，全肺V30以及心脏Dmean相比 较，均无统计学意义（P>0.05），而PTV-Dmin、PTV-V95%、PTV-V110%、右肺Dmean、V5、V10、V20，全肺Dmean、V5、V20，心脏V5、V30、V40， 右侧乳腺Dmean相比较，均有统计学意义（P<0.05）。结论:乳腺癌根治术后胸壁采取FIF-IMRT结合锁骨区IMRT的治疗方案 在降低正常组织的剂量照射和受照体积方面优势明显。     

一种腰椎手术体表透视定位架的研制与应用

目的 为了准确定位腰椎前后路手术术前手术切口,减少定位时间和X射线透视次数,研制一种用于腰椎手术的体表透视定位架,并评估其应用效果.方法 设计一种定位架.自2018年5月至2020年1月,将北京积水潭医院脊柱外科的采用斜外侧椎间融合术(oblique lumbar interbody fusion,OLIF)方法进行手术的52例患者分为两组,分别使用定位架法和克氏针法进行术前定位,其中定位架组27例,克氏针组25例,对两组患者的定位时间、透视次数和定位准确率进行比较分析.结果 定位架组与克氏针组的定位时间分别为(1.92±0.68)min、(3.87±1.56)min;透视次数分别为(2.53±1.21)次、(4.78±1.57)次;两组的定位时间、透视次数差异有统计学意义(P<0.05).定位准确率分别为97.2％、94.6％,差异无统计学意义(P>0.05).结论 此种透视定位架具有操作方便、定位准确、节省定位时间和透视次数的特点,具有推广应用的价值.     

乳腺癌放疗中两种体位固定方式应用比较

目的:应用千伏级CBCT研究乳腺体架固定与真空垫网膜两种不同固定方式的摆位误差。 方法:选取60例乳腺癌保乳术后调强放疗患者,分为试验组和对照组。试验组采用乳腺体架固定方式,对照组采用体部固定底板+负压真空袋+热塑成型网罩体位固定方式。两组患者放疗前行CBCT扫描并在线匹配,得出左右、上下、前后方向摆位误差,对两组患者摆位误差行独立样本t检验。试验组患者每周扫描一次CBCT,连续扫描4周,对其结果行q检验,验证4次扫描的重复性。 结果:试验组患者左右、上下、前后方向的摆位误差分别为（0.27±3.61）、（0.63±4.19）、（-0.37±5.05） mm,对照组的分别为（0.64±3.25）、（-2.03±4.51）、（2.47±2.67） mm,两组在上述方向比较,t=-0.46、2.55、-2.79,P=0.650、0.014、0.007,Y轴和Z轴有统计学意义。乳腺托架患者X、Y、Z三个轴4次扫描重复性检验结果显示无统计学意义（P>0.05）。结论:在X轴方向,两种固定方式无差别,在Y轴和Z轴方向,采用乳腺体架固定方式优于采用体部固定底板+负压真空袋+热塑成型网罩体位固定方式,而且采用乳腺托架的患者重复性比较稳定。     

TPINP和ICTP检测及SPECT和CT显像在乳腺癌骨转移中的应用

目的 比较血清TPINP和ICTP检测及SPECT和CT显像对乳腺癌术后骨转移的诊断价值.方法 选取2012年1月至2014年12月经手术病理确诊的乳腺癌患者252例,进行全身骨显像扫描.SPECT使用低能高分辨准直器,患者取全身前位和后位显像,并结合常规CT扫描进行分析.检测TPINP 和ICTP采用RIA药盒,计算采用log-logit或四参数数据处理模式.结果 乳腺癌术后SPECT骨转移率为19.4%(48/252),48例骨转移患者发现病灶123个;乳腺癌术后CT骨转移率为11.9%(30/252),30例骨转移患者发现病灶53个.SPECT和CT的转移率、病灶数比较差异均有统计学意义(χ2=4.914、P<0.05和χ2=41.386、P<0.01).血清TPINP和ICTP水平在SPECT阳性组明显高于SPECT阴性组,两者比较差异均有统计学意义(t=4.609、P<0.01和t=8.799,P<0.01).结论 99Tcm-MDP全身骨显像与CT显像比较对乳癌术后骨转移有有重要的临床应用价值,具有灵敏度高、早期发现、全身成像不易漏诊的优点.TPINP作为骨形成标志物、ICTP作为骨吸收标志物能在早期出现变化,对乳腺癌术后骨转移有重要的临床应用价值.全身显像与骨转换生化标志物相互补充,乃肿瘤诊断和治疗的趋势.     

血清肿瘤标志物和乳腺钼靶在乳腺癌诊断中的应用价值

目的 探讨乳腺钼靶和血清肿瘤标志物在乳腺癌诊断中的应用价值.方法 回顾性分析2013年1月至2014年10月在我院明确诊断的104例乳腺癌患者的临床资料,按照乳腺肿块大小分别统计乳腺钼靶和血清肿瘤标志物CEA、CA153和CA125检测结果,对两种检查方法阳性符合率进行比较,探讨其在乳腺癌诊断中的意义.结果 乳腺肿瘤直径＜2cm组、2～ 5cm组、＞5cm组,钼靶结果阳性率分别为76.7％,87.5％,94.4％;肿瘤标志物联合诊断阳性率分别为33.3％,62.2％,100％.结论 在乳腺癌诊断中,钼靶诊断是乳腺癌诊断的重要方法,其诊断阳性率明显高于血清肿瘤标志物诊断;血清肿瘤标志物在晚期肿瘤中阳性率明显高于早期肿瘤,其在癌症复发监测、肿瘤疗效评价中的有较高价值.     

Monaco计划系统Multicriterial功能在乳腺癌改良根治术后计划设计中的应用

目的 探讨Monaco计划系统中Multicriterial功能在乳腺癌改良根治术后计划设计中对靶区和危及器官受照剂量的影响。方法 选择乳腺癌根治术后接受放射治疗患者20例，年龄36～80岁，中位年龄59岁；肿瘤单一病灶17例，多个病灶3例；肿瘤直径<2 cm的7例，2～5 cm 13例；TNM分期Ⅱ期8例，Ⅲ期12例。基于Monaco计划系统5.51为每例患者制定两种调强放疗（IMRT）计划，其中一种应用了Monaco计划系统中优化过程中Multicriterial功能（IMRTM），第二种复制第一种计划并在优化过程中去除Multicriterial功能（IMRTNM）重新优化并计算结果。比较两种计划的剂量参数，靶区的适形性指数（CI）、均匀性指数（HI）、平均剂量、最大剂量；肺、心脏、健侧乳腺和脊髓等危及器官的受照剂量差异。结果 两种计划靶区参数均能满足临床需求，IMRTNM计划略优于IMRTM计划，其中在胸壁区（PTV1）和锁骨上区（PTV2）的最大值（Dmax）参数上，IMRTNM计划均优于IMRTM计划，且差异均有统计学意义[（5 573.54±71.58） cGy v...     

血清p185蛋白和CA153对乳腺癌患者的临床应用价值研究

目的检测乳腺癌患者血清p185蛋白表达及肿瘤标志物CA153水平,分析血清p185蛋白与肿瘤标志物CA153的相关性,探讨二者检测在乳腺癌患者中的临床应用价值。方法收集2010年至2012年间在我院住院治疗的乳腺癌55例患者术前、手术后一周血清各一份,应用免疫PCR法检测血清p185蛋白表达,化学发光法检测血清CA153水平。结果乳腺癌患者血清p185蛋白表达和血清CA153水平与临床分期均显著相关(P<0.05),血清p185蛋白表达与淋巴结转移情况无关系(P﹥0.05),血清CA153水平与淋巴结转移情况相关(P<0.05);乳腺癌患者血清p185表达与手术无关(P>0.05),手术前后血清p185蛋白表达无差异,乳腺癌患者血清CA153水平和手术相关(P<0.05),手术前血清CA153水平明显高于术后;乳腺癌患者术前血清CA153水平和p185蛋白表达相关(P<0.05),乳腺癌血清p185蛋白表达阳性患者,血清CA153水平高于阴性患者;乳腺癌患者复发或转移与血清p185蛋白表达及患者术前血清CA153水平相关(P<0.05),血清p185蛋白阳性患者复发或转移率明显高于阴性患者,术前CA153水平高的患者,复发或转移率高。结论乳腺癌患者血清p185蛋白表达与肿瘤标志物CA153水平有相关性,肿瘤标志物CA153可用于术后随访,术前检测乳腺癌患者血清p185蛋白表达与肿瘤标志物CA153水平可用于乳腺癌的预后判断。     

乳腺癌组织中ERα mRNA和PR mRNA检测方法的建立和应用

建立测定雌激素受体α(ERα)mRNA和孕激素受体(PR)mRNA的实时荧光定量RT-PCR,探讨两者在乳腺癌组织及良性乳腺肿瘤组织中的表达水平。分别以pMD18 ERα和pMD18-PR质粒为定量模板,用循环阈值(Ct)定量起始模板,在荧光TaqMan方法的基础上建立了测定ERαmRNA和PR mRNA的实时荧光定量RT-PCR,并分别测定48例乳腺癌组织及28例良性乳腺肿瘤组织中ERαmRNA和PR mRNA的表达水平。ERαmRNA和PR mRNA测定的线性范围为10~3～10~8copy/μg RNA;ERαmRNA和PR mRNA高值和低值的批内和批间变异系数(CV)在5.07%～11.28%之间。ER mRNA在乳腺癌组织中的表达量为6.76×10~5copy/μg RNA(4.17×10~5,9.34×10~5),良性乳腺肿瘤组织中的含量为1.54×10~5 copy/μg RNA(1.02×10~5,2.06×10~5),乳腺癌组织的表达量高于良性组织(P<0.05);PR mRNA在乳腺癌组织中的表达量为1.02×10~6copy/μg RNA(6.81×10~5,1.36×10~6),良性乳腺肿瘤组织中的含量为4.93×10~5 copy/μg RNA(3.21×10~5,6.65×10~5),两者表达无明显差异(P>0.05)。ERαmRNA和PR mRNA在乳腺癌和良性乳腺肿瘤组织中的表达存在相关性。我们建立的测定ERαmRNA和PR mRNA的实时荧光定量RT PCR灵敏、稳定、重复性好,可供临床检测和研究。ERαmRNA和PR mRNA基因表达水平可作为预测治疗效果及判断预后的重要指标。     

血清CA15-3和B-AKP检测在乳腺癌术后骨转移显像诊断中的应用

为探讨血清CA15-3和B-AKP在乳腺癌术后骨转移显像诊断中的应用,对92例乳腺癌术后患者的核素骨显像结果、血清CA15-3和B-AKP水平进行回顾性研究。结果显示：①血清CA15-3和B-AKP的值随着骨转移分期的增高而逐步升高,且有显著性差异（P〈0.01）;②血清CA15-3和B-AKP与骨转移灶的数目呈正相关;③血清CA15-3〉25U/mL时,骨转移的阳性率为63.3%,血清CA15-3〈25U/mL时,骨转移的阴性预测值为94.5%;血清B-AKP〉20U/L时,骨转移的阳性率为59.6%,B-AKP〈20U/L时,骨转移的阴性预测值为73.5%;当血清CA15-3〈25U/mL同时B-AKP〈20U/L时,骨转移的阴性预测值为100%。结论：血清CA15-3和B-AKP测定在乳腺癌术后骨显像诊断中具有重要的应用价值。     

Absence of T Cell-Mediated Cytotoxicity in Breast Cancer Patients Against A Breast Cancer-Derived Target Cell

ABSTRACT: Fresh E-rosette positive lymphocytes from normal donors are not cytotoxic for the breast cancer-derived target cell MDA-157, although they do lyse other suspension and monolayer targets. E-rosette positive cells from breast cancer patients in different stages of disease and from patients with benign breast disease also do not lyse MDA-157. This remains true even when an HLA-A or -B locus antigen is shared by effector and target cell. These data therefore provide no evidence for T cell sensitization in breast cancer patients.     

Physical Activity in First-Degree Relatives of Breast Cancer Patients

This study sought to evaluate physical activity in women at moderate risk for breast cancer, the correlates of engaging in regular physical activity, and whether physical activity relates to psychological well-being. The results revealed that 55% of women were regularly active. Logistic regression models indicated that positive affect was associated with increased and negative affect was associated with decreased overall and leisure activity. Older, married, and employed women were more likely to engage in household/occupational activity, whereas women who perceived their risk for breast cancer as high were less likely. More educated women and those with higher perceived risk were more likely to engage in leisure activity, and married women were less likely. These results suggest a need to increase activity levels in women at moderate risk for breast cancer, provide variables upon which interventions can be tailored to promote activity, and point to psychological benefits of activity in this population.     

Tablet,Web-Based,or Paper Questionnaires for Measuring Anxiety in Patients Suspected of Breast Cancer: Patients' Preferences and Quality of Collected Data

Background

Electronic applications are increasingly being used in hospitals for numerous purposes.

Objective

Our aim was to assess differences in the characteristics of patients who choose paper versus electronic questionnaires and to evaluate the data quality of both approaches.

Methods

Between October 2012 and June 2013, 136 patients participated in a study on diagnosis-induced stress and anxiety. Patients were asked to fill out questionnaires at six different moments during the diagnostic phase. They were given the opportunity to fill out the questionnaires on paper or electronically (a combination of tablet and Web-based questionnaires). Demographic characteristics and completeness of returned data were compared between groups.

Results

Nearly two-thirds of patients (88/136, 64.7%) chose to fill out the questionnaires on paper, and just over a third (48/136, 35.3%) preferred the electronic option. Patients choosing electronic questionnaires were significantly younger (mean 47.3 years vs mean 53.5 in the paper group, P=.01) and higher educated (P=.004). There was significantly more missing information (ie, at least one question not answered) in the paper group during the diagnostic day compared to the electronic group (using a tablet) (28/88 vs 1/48, P<.001). However, in the week after the diagnostic day, missing information was significantly higher in the electronic group (Web-based questionnaires) compared to the paper group (41/48 vs 38/88, P<.001).

Conclusions

Younger patients and patients with a higher level of education have a preference towards filling out questionnaires electronically. In the hospital, a tablet is an excellent medium for patients to fill out questionnaires with very little missing information. However, for filling out questionnaires at home, paper questionnaires resulted in a better response than Web-based questionnaires.     

早期乳腺癌保留乳腺手术治疗的临床效果

目的 探究早期乳腺癌保留乳腺手术治疗的临床效果及其不良反应发生情况。方法 选取2014年6月~2018年6月我院收治的50例早期乳腺癌患者作为研究对象,随机分为研究组和对照组,每组25例。对照组患者采用传统的切除乳腺手术方法进行治疗,研究组患者采用保留乳腺手术方法进行治疗。比较两组患者的临床效果、半年存活率及并发症发生率。结果 研究组患者的复发率（12.00%）和转移率（12.00%）均低于对照组的36.00%和32.00%,差异有统计学意义（P＜0.05）,研究组患者的半年存活率为96.00%,高于对照组的76.00%,术后并发症发生率为12.00%,低于对照组的40.00%,差异有统计学意义（P＜0.05）。结论 早期乳腺癌患者采用保留乳腺的手术治疗临床治疗效果优于传统的切除乳腺的手术方法,有助于提高患者半年存活率升高,减少并发症,值得在临床借鉴应用。     

Evidence for Classically Conditioned Fatigue Responses in Patients Receiving Chemotherapy Treatment for Breast Cancer

Fatigue is the most common side effect of chemotherapy for cancer. Not yet explored is the possibility that patients may develop conditioned fatigue responses to clinic cues as a result of the repeated pairing of the clinic environment (conditioned stimulus) with infusions of chemotherapy (unconditioned stimulus) that cause fatigue (unconditioned response). As a first critical test of this possibility, breast cancer patients (N = 82) were studied across their first four cycles of chemotherapy. Consistent with conditioning: (1) fatigue levels in the clinic environment significantly increased with repeated pairings of the clinic environment and chemotherapy administration; (2) fatigue responses in the clinic environment prior to the fourth infusion (CR) were predicted by patients’ previous experiences of post-infusion fatigue (UR) above and beyond effects of concurrent emotional distress. These results provide the first evidence in the literature that fatigue can be conditioned. Additional research is warranted to determine the clinical importance of this source of fatigue in chemotherapy patients.     

Artemin在三阴性乳腺癌中的表达及其临床意义

目的 初步分析和探讨三阴性乳腺癌患者artemin表达情况,及其对疾病预后的价值.方法 选取我院肿瘤科2005年7月至2009年7月收治的149例浸润性乳腺癌患者为研究对象,根据ER、PR和HER-2免疫组化检测结果,将其分成三阴性乳腺癌组和非三阴性乳腺癌组,采用RT-PCR和免疫组织化学方法检测artemin在两组患者肿瘤组织中的表达情况,并分析artemin在不同组织学分级、临床分期和N分期三阴乳腺癌组患者中表达情况.结果 三阴性乳腺癌组免疫组化artemin阳性表达率为79.22％ (61/77),高于非三阴性乳腺癌组患者25.00％ (18/72),差异有统计学意义(x2=5.170,P =0.006);三阴性乳腺癌组artemin mRNA表达量为(3.36±0.04)×103 copies/mL,非三阴性乳腺癌组患者为(2.52±0.06)×103copies/mL,两组差异有统计学意义(x2=3.416,P=0.04);三阴性乳腺癌患者中artemin表达率与组织学分级、临床分期和N分期相关,差异具有统计学意义(P＜0.05),而与就诊年龄、恶性肿瘤家族史、肿瘤长径以及绝经状态无关(P＞0.05).结论 三阴性乳腺癌患者的artemin表达率显著高于非三阴性乳腺癌患者,artemin在三阴性乳腺癌组织中的表达与组织学分级、临床分期和N分期密切相关,临床检测artemin可以对患者疾病的发展和预后判断提供重要的依据.     

Clinicopathological Characteristics of Male Breast Cancer

Purpose

To investigate clinicopathological characteristics and outcomes of male breast cancer (MBC).

Patients and Methods

We retrospectively analyzed the data of 20 MBC patients in comparison with female ductal carcinoma treated at Yonsei University Severance Hospital from July 1985 to May 2007. Clinicopathological features, treatment patterns, and survival were investigated.

Results

MBC consists of 0.38% of all breast cancers. The median age was 56 years. The median symptom duration was 10 months. The median tumor size was 1.7 cm, 27.8% showed node metastasis, and 71.4% were estrogen receptor positive. All 20 cancers were arisen from ductal cells. No lobular carcinoma was found. The incidence of stages 0, I, II, and III in patients were 2, 10, 4, and 3, respectively. All patients underwent mastectomy. One with invasive cancer did not receive axillary node dissection and stage was not exactly evaluated. Adjuvant treatments were determined by pathologic parameters and stage. Clinicopathological parameters and survival rates of MBC were comparable to those of female ductal carcinoma.

Conclusion

The onset age of MBC was 10 years older and symptom duration was longer than in female patients. No difference in outcomes between MBC and female ductal carcinoma suggests that the biology of MBC is not different from that of females. Therefore, education, an appropriate system for early detection, and adequate treatment are necessary for improving outcomes.     

Open Communication as an Effective Stress Management Method for Breast Cancer Patients

Abstract

The social and emotional adaptation of 51 breast cancer patients was assessed four times during the first year after mastectomy according to Weissman and Paykel's Social Adaptation Scale (SAS)¹ and judges' ratings. Openness of communication was measured by eight indices during the first two interviews. It was predicted that they would correlate positively with successful adaptation as measured at the third and fourth interviews. Most patients were aware of their diagnosis, and their communication about their plight was found to be multifaceted. Successful copers sought information; less successful copers avoided it. However, where emotions and not facts were the issue, palliative measures such as avoidance of speaking about the threat and refusal to accept its further implications were connected with better adjustment. The findings indicate that palliation is a prerequisite to good instrumental adjustment when the emotional reactions are intense and countermeasures are limited. More research is needed for assessing communication with specific others and change over time.     

乳腺癌与良性病患者人格、情绪适应和心境比较

目的 探讨乳腺癌患者的人格倾向以及确诊前的情绪适应和心境特点。方法 确诊前以艾森克人格问卷（EPQ）、癌症病人情绪适应问卷（MAC），简明心境问卷（BPOMS）测查乳腺病就诊者的人格、情绪适应以及心境状况，将其中42名乳腺癌患者与60名乳腺良性疾病患者比较。结果 乳腺癌患者的外向人格分数明显高于乳腺良性痰病患者（P〈0．01）；乳腺癌患者的宿命情绪适应分数明显高于乳腺良性痰病患者（P〈0．01）。结论 乳腺癌患者具有外向人格特点，确诊前具有高宿命情绪适应特点。     

乳腺癌患者生命质量测定量表(FACT-B)中文版的修订

目的：修订乳腺癌生命质量测定量表FACT-B的中文版，并对其进行考评。方法：通过量表的释译、回译及文化调适，制定中国版的FACT-B，并通过165例乳腺癌患者进行的测定对量表进行考评。结果：躯体状况、社会／家庭、情感状况、功能状况、附加的关注5个领域以及总量表的重测信度分别为0．82、0．85、0.85、0．85、0．86、0．89；5个领域内部一致性信度的。值分别为0．84、0．84、0．79、0.83、0．61;该量表在人院治疗2-4周后能够反映出生命质量的变化。结论：FACT-B中文版具有较好的信度、效度及反应度，可用于中国乳腺癌患者的生命质量测定。