肢体恶性黑色素瘤综合治疗进展

皮肤发病率及病死率在全球均有升高趋势,其治疗包括手术、生物、化学、放射以及内分泌治疗。手术是主要治疗手段,切除后部分原发灶的缺损需要修复与重建。高剂量的干拢素（IFN）α-2b是经美国食品与药品监督管理局批准的辅助性生物治疗手段。对于转移性病灶,化疗是主要治疗手段,单药氮烯脒胺治疗仍是标准方案。放射治疗在原发灶、区域淋巴结及转移性病灶的治疗中均有一定意义;而现尚无证据支持内分泌治疗在恶性黑色素瘤治疗中的应用价值。     

原发灶不明颈部转移性鳞癌的诊治

原发灶不明的颈部转移性癌约占头颈部恶性肿瘤的5％,可以分为转移性鳞癌和转移性腺癌,至今仍是临床诊治的一个难题。由于原发灶不明的转移性癌的临床治疗只能以治标为主,治疗效果不佳。所谓原发灶不明,其实是有原发灶,由于病灶较小、部位隐匿或位于黏膜下等原因而不易发现;且肿瘤的生物学行为又较恶劣,较早发生淋巴结转移。临床仔细寻找原发病灶尤为重要,只有找到原发病灶,标本兼治,临床治愈率才能改善。20世纪50年代初,美国纽约纪念医院的Martin教授最早提出：“2周内找不到原发病灶的颈部转移性癌,即诊断为原发灶不明的颈部转移性癌”。随着医学理念的更新,诊疗技术的进步,我们认为用时间概念来作为一个诊断标准不够科学,因此提出：“经临床仔细检查直到治疗开始前仍未发现原发病灶的颈部转移性癌,可以诊断为原发灶不明的转移性癌”。以上概念是否准确大家可以讨论,本文主要讨论原发灶不明的颈部转移性鳞癌。     

乳腺癌内分泌治疗的现状及应用策略

根据国际医学数据服务公司ＩＭＳ统计，内分泌药物在中国肿瘤药物市场所占份额仅为４％，美国为其６倍，欧洲市场高达１１５倍，即使与我国肿瘤发病谱相似的日本及台湾省也约占１２％。这说明我国内分泌治疗与发达国家及地区相比还有很大差距。在我国广大医生及乳腺癌患者心目中，内分泌治疗还只是一个无足轻重的治疗手段，在临床如何合理使用内分泌治疗还存在很多迷茫及困惑。内分泌治疗作为乳腺癌的一种重要治疗手段，有两种用途（图１）：（１）有具体病灶的治疗：如根治性手术前的新辅助治疗，复发转移后的解救治疗。（２）无具体病灶…     

脑神经胶质瘤的术后治疗

恶性星形细胞瘤可扩散至邻近或远离原发灶的脑组织，手术很难将肿瘤组织彻底切除，术后放疗的作用已较明确，化疗及生物调节剂等治疗的疗效尚不能确定。在不明显增加并发症的条件下，适形放疗等提高的局控率的方法与全脑放疗及化疗等可能控制非局部病灶垢有效配合，可能是今后发展的主要方向。     

介入治疗在转移性肿瘤综合治疗中的作用

目的探讨介入治疗在转移性肿瘤综合治疗中的作用。方法对11例转移性肿瘤的转移灶进行介入栓塞化疗，对原发灶采用手术及介入治疗等综合措施。结果11例恶性肿瘤患者生存已超过2年的占72．7％(8／11)，超过3年的占63．6％(7／11)。结论对于能采取介入栓塞治疗的转移灶，进行积极的介入治疗，同时对原发灶采取手术、放化疗及介入治疗等综合治疗措施，可明显延长病人的生存时间，提高生存质量。     

介入治疗在转移性肿瘤综合治疗中的作用

目的　探讨介入治疗在转移性肿瘤综合治疗中的作用。方法　对 11例转移性肿瘤的转移灶进行介入栓塞化疗 ,对原发灶采用手术及介入治疗等综合措施。结果　 11例恶性肿瘤患者生存已超过 2年的占 72 .7% (8/11) ,超过 3年的占 63 .6% (7/11)。结论对于能采取介入栓塞治疗的转移灶 ,进行积极的介入治疗 ,同时对原发灶采取手术、放化疗及介入治疗等综合治疗措施 ,可明显延长病人的生存时间 ,提高生存质量。     

晚期胃癌治疗进展*

胃癌在全球最常见恶性肿瘤中排名第四位,是恶性肿瘤第二大死因;其发现多在晚期,已经失去了根治性手术机会。晚期胃癌治疗手段主要包括姑息性手术治疗、放疗、化疗、生物免疫治疗、中医药治疗。姑息性手术治疗主要用于减轻患者肿瘤负荷,或减少并发症的发生;放疗在局部晚期胃癌的治疗中具有一定的效用。化疗在晚期胃癌治疗中可发挥主导作用,对有症状的患者有姑息性治疗效果。由FAX 方案到ECF/DCF 方案,再到REAL-2 试验、ML17032、SPIRITS 试验等几项里程碑式的随机性Ⅲ期临床研究结果的公布,关于晚期或转移性胃癌化疗的研究一直是关注的焦点,随着EOX 、XP、S-1/CDDP 、IF 、FOLFOX 、XELOX等化疗方案相继提出,晚期胃癌的临床疗效有了进一步提高,但目前尚未得到优势明显的标准治疗方案。胃癌的生物免疫治疗也逐渐成为研究热点,它是对手术和化、放疗的有益补充,但还不能作为主干性疗法。无论手术、放疗,或是化疗、生物免疫治疗,其在发挥疗效的同时,均具有明显的副作用。因此,采用中药内服外用、针灸推拿、心理干预等多种综合治疗手段,发挥中西医结合在缓解临床症状、对化、放疗减毒与增效、提高患者生存质量、预防肿瘤复发与转移、逆转肿瘤细胞多药耐药、治疗癌性腹水及癌性疼痛等方面的特色与优势,同样具有重要临床价值。     

乳腺癌辅助内分泌治疗的现状和展望

辅助内分泌治疗是乳腺癌综合治疗中的重要组成部分。19 98年英国早期乳腺癌协作组 (EBCTCG)的资料显示[1],乳腺癌术后用三苯氧胺作为辅助内分泌治疗 ,可使乳腺癌术后复发率相对减少 47% ,死亡率相对减少 2 6%。近年来 ,随着第三代芳香化酶抑制剂逐渐地被用于乳腺癌的辅助内分泌治疗 ,乳腺癌辅助内分泌治疗的疗效有望得到进一步的提高。一、新辅助内分泌治疗乳腺癌新辅助内分泌治疗是指对非转移性乳腺癌在应用局部治疗前进行的系统性内分泌治疗。新辅助内分泌治疗和新辅助化疗相似 ,能够使那些对内分泌治疗敏感的乳腺癌达到原发病灶和区域…     

^18F-FDG符合线路SPECT／CT显像寻找肿瘤原发灶35例应用分析

[目的]探讨^18F-氟代脱氧葡萄糖（2-deoxy-2-[F-18]fluoro-D-gluocose,FDG）符合线路SPECT／CT显像在寻找肿瘤原发灶中的价值。[方法]35例原发灶不明的转移瘤患者行^18F-FDG符合线路SPECT／CT显像寻找原发灶。[结果]21例患者符合线路SPECT／CT显像发现可疑原发灶,其中16例被其他影像学检查、活检或手术病理证实,对原发灶的检出率为45．7％（16／35例）,14例未能明确原发灶。^18F-FDG符合线路显像发现其他影像学手段未发现的新病灶13个,8例改变治疗方案。[结论]^18F-FDG符合线路SPECT／CT显像在寻找转移性肿瘤原发灶有较大的临床价值。     

脑转移性肿瘤的局部治疗

脑转移性肿瘤占脑部恶性肿瘤的多数,局部治疗是其主要治疗手段,包括全脑放疗、手术及立体定向照射。不同颅内转移灶数目、不同一般情况、不同颅外病灶控制情况的患者应个体化选择不同局部治疗方式（单用或联合等）。全文就脑转移性肿瘤局部治疗情况作一分析。     

Adjuvant chemo-endocrine therapy for androgen-dependent mammary tumor in mice

Summary About 500 male DS mice grafted with androgen-dependent Shionogi carcinoma 115 (SC115) were used. When the tumor diameter reached about 20 mm (approximately 25 days after transplantation), excision of the tumor and/or castration were carried out. The injection of cyclophosphamide (80 mg/kg body weight × 3 at 7-day intervals) was started from the day after excision.In mice with excised tumor, adjuvant chemo-endocrine therapy was the most effective treatment examined; cumulative 120-day mortalities after transplantation of tumors in non-treated, adjuvant endocrine therapy, adjuvant chemotherapy and adjuvant chemo-endocrine therapy groups were 91%, 29%, 21% and 0%, respectively. Castration induced development of clusters of androgen-independent cancer cells in androgendependent SC115 tumor. In mice without tumor excision, the chemo-endocrine therapy was again the most effective treatment, though 86% of mice died by the 120th day after tumor transplantation. These findings suggest the usefulness of adjuvant chemo-endocrine therapy for achieving complete remission in hormonedependent tumors. Address for reprints: K. Matsumoto, M.D., Dept. of Pathology, Osaka University, Medical School, Kita-ku, Osaka 430, Japan.     

胰腺癌新辅助治疗和辅助治疗

胰腺癌的新辅助治疗和辅助治疗是目前胰腺癌研究的热点问题。新辅助治疗因为缺乏前瞻性随机对照研究,目前除进行临床研究外,仍不能被推荐为标准治疗方法。根据大宗病例的临床试验研究结果,胰腺癌术后化疗可以降低死亡风险,而放疗的作用仍有待进一步研究。     

Updates in adjuvant systemic therapy for melanoma

There has been a rapid increase in adjuvant therapies approved for treatment following surgical resection of stages III/IV melanoma. We review current indications for adjuvant therapy, which currently includes a heterogenous group of stages III and IV patients with melanoma. We describe several pivotal clinical trials of systemic immune therapies, targeted immune therapies, and adjuvant vaccine strategies. Finally, we discuss the evidence for selecting the most appropriate treatment regimen(s) for the individual patient.     

乳腺癌内科治疗的现状及展望

本文对近年来可手术乳腺癌辅助治疗以及晚期转移性乳腺癌的内科治疗进展进行了回顾,认为规范化、个体化和靶向治疗是乳腺癌的治疗方向.     

子宫肉瘤术后辅助治疗102例临床观察

[目的]探讨子宫肉瘤术后辅助治疗的疗效.[方法]回顾性分析102例子宫肉瘤,其中单纯手术25例,术后放疗23例,术后化疗32例,术后放化疗22例.[结果]5年生存率单纯手术组为32.0%,术后放疗组34.7%,术后化疗组31.2%,术后放化疗组36.4%;盆腔复发和远处转移率单纯手术组分别为48%和36%,术后放疗组为34%和30.4%,术后化疗组为40.6%和28.1%,术后放化疗组为31.8%和27.3%.总5年生存率为33.3%.[结论]子宫肉瘤术后辅助放疗可减少盆腔复发,辅以化疗可延缓和降低远处转移,两者均可提高无瘤生存率,但不能提高总的生存率.     

乳腺癌术后系统性辅助治疗的现状和进展

辅助治疗是可手术乳腺癌综合治疗的重要组成部分，了解乳腺癌辅助治疗的进展，选择合理的辅助治疗方案，对提高乳腺癌患者术后的长期生存率有重要的意义。     

淋巴结阴性乳腺癌患者辅助治疗的研究进展

淋巴结阴性乳腺癌患者中有20%～30%经手术治疗后复发和转移.本文综述了如何选择需要内分泌治疗和/或化疗的淋巴结阴性乳腺癌患者,以及如何选择正确的治疗模式.     

Preoperative and adjuvant therapies for upper gastrointestinal cancers

Survival of esophageal, gastrointestinal junction and gastric cancers is poor given that they frequently present with locally advanced or metastatic disease. The incidence of gastrointestinal junction adenocarcinoma is increasing whereas that of squamous cell carcinoma of the esophagus is decreasing. The accuracy of staging has improved with newer diagnostic techniques, including positron emission tomography, endoscopic ultrasound and laparoscopy, and this should be integrated in prospective Phase III clinical trials evaluating neoadjuvant and adjuvant therapies for some esophageal and all gastric carcinomas. For esophageal cancer (except for one trial by Walsh and colleagues), four randomized Phase III trials comparing preoperative chemoradiation followed by surgery versus surgery alone have not shown a survival benefit. Neither have the trials, where preoperative chemoradiation followed by surgery, is compared with definitive chemoradiation. Nevertheless, it is commonly practiced in the USA and has become a preferred combined modality approach. Postoperative chemoradiation is favored in the USA for good performance status patients with resected, high-risk gastric or gastroesophageal junction carcinoma (more than Stage IA). The UK–MAGIC trial results, showing survival benefit with perioperative chemotherapy in operable gastric and lower esophageal cancers, probably has an impact on the treatment practice of these cancers in Europe and Asia. Promising results from trials involving preoperative chemoradiation followed by surgery in gastric cancer (pathologic complete response of 20–30%) need to be further evaluated in a Phase III setting and compared with postoperative chemoradiation. Active ongoing research will help us clarify the role of preoperative and adjuvant therapies in esophageal and gastric cancers. The role of molecular profiling is evolving and will help us differentiate the responders from the nonresponders.     

子宫内膜癌的诊断和治疗

Approximately 6000 endometrial cancer death occurs annually worldwide, predominantly noticed in postmenopausal women. The current diagnostic and therapeutic research trials for endometrial carcinoma are giving new clues to select best postoperative adjuvant treatment especially in high risk disease. Transvaginal ultrasound and hysteroscopy endometrial biopsies are tending to replace the dilation and curettage in establishing a diagnosis. The standard primary treatment of endometrial carcinoma is surgery but to select best adjuvant therapy, the risk of disease recurrence is determined by certain pathological factors and also by surgical stage. The most commonly used adjuvant therapy is radiation therapy but satisfactory results have not been noticed in high-risk endometrial carcinoma. On the basis of review of current research guidelines it is indicated that hormonal or chemotherapeutic agents must be added with radiation therapy to improve prognosis and efficacy in endometrial carcinoma after surgery.     

局部晚期食管癌的围手术期治疗策略

我国是食管癌的高发地区之一,目前手术仍是局部晚期食管癌治疗的主要手段。为降低手术患者复发、转移的几率,延长其生存期,寻求最佳的治疗方法,已有多个临床研究对围手术期联合化、放疗的综合治疗方法进行了探索。本文对近年来针对围手术期治疗的主要临床研究做一综述。