外阴癌76例临床分析

目的 分析外阴癌治疗、预后情况及其淋巴结转移的特征。方法 对随访超过5年并有完整资料的76例外阴癌进行回顾性分析。结果 76例的5年5年生存率64．5％,Ⅰ、Ⅱ、Ⅲ及Ⅳ期5年生存率分别为94．1％（16／17）、67．9％（19／28）、54．5（12／22）、22．2％（2／9）。Ⅲ、Ⅳ期手术加放疗组5年生存率62．5％（10／16）与单纯放疗组25．0％（3／12）比较有显著性差异（P＜0．05）。76例经治疗后有11例未控制,未控率14．5％,复发17例,复发率为26．2％。腹股沟及盆腔淋巴结转移率分别为33．9％（19／56）、28．6％（4／14）。盆腔淋巴结转移者腹股沟淋巴结均有转移。腹股沟淋巴结阴性5年生存率为86．5％、阳性42．1％（P＜0．05）。结论 外阴癌以手术治疗为主,病灶＞1cm者应行根治性外阴切除加双侧腹股沟淋巴清扫术,晚期病例加放疗。单纯放疗预后差。腹股沟淋巴结阴性不必行盆腔淋巴结清扫术。     

不同手术方式联合术后放疗对外阴鳞癌预后的影响

目的对比不同手术方式联合术后放疗对外阴鳞癌的疗效,寻找理想的治疗方法。方法对1980年1月～2005年12月在中山大学肿瘤防治中心经手术治疗并确诊的150例外阴鳞癌进行回顾性分析,生存率计算采用寿命表法,预后比较采用Kaplan-Meier法。多因素预后分析采用Cox回归分析。结果对淋巴结阳性的患者,行外阴广泛切除＋腹股沟淋巴结清扫和（或）盆腔淋巴结清扫术＋放疗、外阴广泛切除＋腹股沟肿大淋巴结切除术＋放疗、外阴广泛切除术＋放疗、外阴广泛切除＋腹股沟淋巴结清扫和（或）盆腔淋巴结清扫术,5年生存率分别为29%、25%、17%、67%（P=0.031）,5年无进展生存率分别为100%、50%、67%、83%（P=0.016）,行外阴广泛切除＋腹股沟淋巴结清扫和（或）盆腔淋巴结清扫术＋放疗者,预后明显好于其余治疗方式患者。对术前检查未发现明显淋巴结肿大的患者,行外阴广泛切除＋腹股沟淋巴结清扫和（或）盆腔淋巴结清扫术,5年生存率（84%vs.46%,P=0.010）和无进展生存率（97%vs.62%,P〈0.001）均明显高于外阴广泛切除术＋放疗患者。结论对中晚期患者,应争取切除原发灶及行腹股沟淋巴结清扫,并术后辅以全量放疗,而对早期外阴癌患者,建议在切除外阴病灶的同时行腹股沟淋巴结清扫术。     

62例阴茎鳞状细胞癌治疗的临床分析

目的:提高阴茎鳞状细胞癌的治疗水平,寻求鳞状细胞癌合理有效的治疗方法。方法:回顾分析62例病理活检证实阴茎鳞状细胞癌治疗的临床资料。结果:除8例拒绝手术治疗外,其余54例均行手术治疗。45例行阴茎部分切除术,9例行阴茎全切加会阴部尿道造口术治疗,腹股沟淋巴结活检术31例,腹股沟淋巴结病理阳性9例,总活检阳性率为29.0%,行腹股沟淋巴结清扫术。5例行阴茎部分切除者3年内复发,再行阴茎全切除并尿道会阴部造口术及髂腹股沟淋巴清扫术。高分化鳞癌43例,中分化鳞癌7例,低分化鳞癌4例;9例术前淋巴结活检有癌转移,腹股沟淋巴结清扫均有转移,盆腔淋巴结转移4例,淋巴结清扫发现转移2例。按照Jackson分期:I期29例;II期13例;III期8例;V期4例。本组62例患者中44例获定期随访2-7年,随访率70.9%。3年、5年生存率分别为90.9%、75%。非手术治疗5年生存率仅为50%。结论:外科手术治疗是目前治疗阴茎鳞状细胞癌的有效方法,淋巴结清扫根据临床分级具体处理,手术联合术后化、放疗是否可减少复发及提高生存率,还需进一步研究。     

手术治疗外阴恶性肿瘤临床护理分析

目的 :回顾分析外阴恶性肿瘤外科治疗的预后及其影响因素。方法 :回顾分析了山东省肿瘤医院 1971～ 1999年收治的 71例经手术治疗的外阴恶性肿瘤患者临床资料。结果 :中位发病年龄 5 7 9岁 ;Ⅰ期 8例、Ⅱ期 32例、Ⅲ期 2 2例、Ⅳ期 6例、复发者 3例 ;鳞癌 5 2例、恶性黑色素瘤 9例、其他类型 10例 ;行腹股沟淋巴结清除术者 4 5例 ,未清除者 2 6例。外阴区伤口Ⅰ期愈合 5 7例 (80 % ) ,腹股沟区伤口Ⅰ期愈合 32例 (71.1% )。总 5年生存率为 5 0 9% (2 9/ 5 7) ,较早期 (Ⅰ、Ⅱ )患者 5年生存率均高于晚期 ,伤口愈合情况对预后有一定的影响。结论 :①早期发现、早期诊断、早期治疗对外阴癌的治疗预后尤为重要。②手术切除是外阴癌的主要治疗手段 ,手术方式的选择应个体化 ,对病期较早淋巴结转移率小的患者可试行单纯外阴切除 ,术后给予放疗或化疗。③外阴复发癌亦应积极创造再治疗机会 ,如处理得当 ,可挽救或延长患者生命。④加强护理 ,促进伤口愈合 ,及时治疗利于提高生存率     

鼻咽癌原发灶复发再程放疗疗效分析

目的 :了解鼻咽癌原发灶复发再程放疗的治疗价值 ,分析鼻咽癌原发灶复发再程放疗的疗效和影响疗效的因素。方法 :1998年 4月 - 2 0 0 0年 4月 ,收治的 5 4例鼻咽癌放疗后原发灶复发患者 ,所有患者接受外照射放疗 ,放疗剂量为 4 0～ 80Gy ,2 0～ 4 0次 / 4～ 8个周。结果 :总的 3年生存率、局部控制率、远处转移率分别为 5 0 0 %、5 3 7%和 18 5 %。复发间隔时间 2 4个月以上者 ,3年生存率高 ;再程放疗剂量不低于 6 6Gy和T2 期的病例 ,3年生存率和局部控制率高。结论 :鼻咽癌放疗后原发灶复发再放疗仍是有效的治疗手段 ,尤其是对于复发间隔时间 2 4个月以上的早中期病例 ,在治疗上可采用一些非常规治疗方法 ,再程放疗总剂量不应低于 6 6Gy。     

原发性甲状腺鳞状细胞癌42例诊治分析

目的:探讨原发性甲状腺鳞状细胞癌的临床特征和综合治疗效果.方法:回顾性分析我院1964年-2006年收治甲状腺鳞状细胞癌患者42例,22例行原发灶完整切除+患侧侧颈或区域颈淋巴结清扫,其中病理证实有淋巴结转移者18例;13例行原发灶扩大切除;姑息切除术7例,其中2例同时行气管切开.术后行根治性局部放疗37例,剂量为60-75Gy.结果:患者总的半年生存率为52.3%(22/42),1年生存率为28.6%(12/42),2年生存率为19.0%(8/42),中位生存期为10.1个月.结论:甲状腺鳞状细胞癌是罕见的恶性肿瘤,病情发展迅速,预后差.早期发现并进行扩大根治性手术,并辅以足量放疗,能最大限度提高生存率.     

外阴癌转移复发分析

目的:总结影响外阴癌预后、转移复发的相关因素,探讨理想的治疗方法。方法:分析本院1970年1月至2000年1月收治的162例外阴癌,比较不同治疗方法、分期以及不同复发时间、部位对5年生存率的影响。结果:162例患者总的5年生存率为60.5%,其中外阴鳞癌5年生存率为68.7%。复发率为34.3%,复发部位单纯外阴占40.0%,腹股沟淋巴结占42.2%,盆腔淋巴结转移占6.7%,远处转移11.1%。结论:外阴癌复发者外阴白斑发病比例高于未复发者(P<0.05),复发部位是影响预后的重要因素,2年内复发者预后差。外科手术是影响外阴局部复发的主要因素。     

根治性放疗后食管癌复发的手术切除和再程放疗的比较

目的 :分析比较食管癌根治性放疗 (DT6 0～ 70 Gy/ 6～ 7周 )后复发的患者经手术切除和再程放疗的疗效。材料与方法 :1984年 1月～ 1990年 1月间将前瞻性随机分组的 78例患者随机分为手术切除组和再程放疗组进行对比治疗。手术切除组 39例 ,再程放疗组 39例 ,放疗剂量 DT4 0～ 6 0 Gy/ 4～ 6周。结果 :手术切除率为 89.7% ,手术切除组术后并发症为 2 5 .7% ,手术死亡率达 11.4 %。 1,3,5年生存率分别为 82 .8%、34.5 %和 2 7.6 % ;再程放疗组 1,3,5年生存率分别为 4 0 .5 %、8.1%和 2 .7% ,两组比较(P<0 .0 1)。结论 :手术切除组的疗效明显好于再程放疗组 ,手术是根治性放疗后复发患者首选的治疗手段。     

巴氏腺腺样囊性癌临床病理分析

目的 探讨巴氏腺腺样囊性癌的临床病理特征和治疗方法.方法 回顾性分析6例巴氏腺腺样囊性癌患者的临床及病理资料.6例患者的中位年龄为40.5岁(30～54岁).主要治疗方式为手术切除,其中单纯外阴肿物剥除术1例,外阴根治性切除术加双侧腹股沟淋巴结清扫或活检术4例,外阴局部扩大切除术加双侧腹股沟淋巴结活检术1例.有2例患者术后补充放疗.6例患者均随访至2009年4月1日,中位随访时间124.5个月(8～241个月).结果 6例巴氏腺腺样囊性癌均经病理确诊,肿瘤细胞呈筛状排列及侵犯神经是其典型的病理特点.术后病理显示,切缘阳性2例,阴性1例,邻近肿瘤1例,不详2例.腹股沟淋巴结阴性5例,不详1例.有4例患者复发,其中3例局部复发,后出现肺转移;1例仅出现肺转移.在复发患者中,死亡1例,生存时间为135个月;另3例患者分别带瘤生存120、30和36个月,总生存时间分别为241、128和103个月.2例无复发患者无瘤生存8个月和121个月.结论 巴氏腺腺样囊性癌生长缓慢,患者长期预后较好,但容易局部复发和肺转移.首选治疗方法为手术切除,对于术后切缘阳性、局部浸润较深或侵犯神经者以及复发无法手术者可行辅助放疗或姑息性放疗.     

原发性甲状腺鳞状细胞癌42例诊治分析

目的：探讨原发性甲状腺鳞状细胞癌的临床特征和综合治疗效果。方法：回顾性分析我院1964年-2006年收治甲状腺鳞状细胞癌患者42例,22例行原发灶完整切除＋患侧侧颈或区域颈淋巴结清扫,其中病理证实有淋巴结转移者18例;13例行原发灶扩大切除;姑息切除术7例,其中2例同时行气管切开。术后行根治性局部放疗37例,剂量为60—75Gy。结果：患者总的半年生存率为52．3％（22／42）,1年生存率为荔．6％（12／42）,2年生存率为19．0％（8／42）,中位生存期为10．1个月。结论：甲状腺鳞状细胞癌是罕见的恶性肿瘤,病情发展迅速,预后差。早期发现并进行扩大根治性手术,并辅以足量放疗,能最大限度提高生存率。     

Midline Involvement as a Risk Factor for Vulvar Cancer Recurrence

Objective: This observational study was to identify risk factors for vulvar cancer recurrence. Materials andMethods: In the study 107 patients with primary vulvar cancer were analyzed. Surgical treatment consistedof radical excision of the primary tumor in combination with unilateral or bilateral superficial and deepinguinofemoral lymphadenectomy through separate incisions. Patients with deeper tumor invasion >1 mm orwider than 2 cm and/or groin lymphnode metastases were referred for adjuvant radiotherapy. Those with largeprivary vulvar tumors received neoadjuvant radiotherapy of 30Gy followed by surgical treatment and adjuvantradiotherapy. Results: Most of patients had only primary radiotherapy to the vulva and inguinal lymph nodesand only 34.5% of patients were eligible for surgical treatment. In 5 year follow-up period 25.2% (27) patientswere alive without the disease, 15.0% (16) were alive with the disease and 59.8% (64) were dead. 60.7% (65)patients experienced local recurrence and 2.8% (3) patients had distant metastases. Median survival for patientswithout recurrent disease was 38.9±3.2 months and 36.0±2.6 months with no statistically significant difference.Patients with early stage vulvar cancer had longer mean survival rates-for stage I 53.1±3.4 months, 38.4±4.4months for stage II and 33.4±2.6 and 15.6±5.2 months for patients with stage III and stage IV vulvar cancer,respectively. The only signifficant prognostic factor predicting vulvar cancer recurrence was involvement of themidline. Conclusions: Patients having midline involvement of vulvar cancer has lower recurrence risk, probablybecause of receiving more aggressive treatment. There is a tendency for lower vulvar cancer recurrence risk forpatients over 70 years of age and patients who are receiving radiotherapy as an only treatment without surgery,but tendency for higher risk of recurrence in patients with multifocal vulvar cancer.     

20例外阴癌电子束照射

目的　研究采用高能电子束照射治疗外阴癌的疗效。　方法　２０ 例外阴癌中初治组８ 例,局部病灶照射总量为６０ ～６５ Ｇｙ／５～６ 周,腹股沟区照射４０ Ｇｙ／４ ～５ 周。术后复发组７ 例,局部病灶照射总量６０ ～６５ Ｇｙ／５ ～６周。术后肿瘤残留补充放疗组５ 例,局部照射３０ ～４０ Ｇｙ／３ ～４ 周。　结果　照射后肿瘤全部消退占７３３３ ％ （ 不包括术后补充放疗组在内）,皮肤反应较６０Ｃｏ 为轻,三年生存率为６１５％ 。　结论　有手术禁忌证者,较表浅的肿瘤,术后切缘有癌,术后复发者均可采用放疗,如并用以顺铂为主的化疗可提高疗效。     

Impact of inguinal dissection on prognosis of early-stage squamous cell carcinoma of the vulva--a retrospective analysis

BACKGROUND: Inclusion of inguinal lymphadenectomy in the surgical procedure is a potential prognostic factor for squamous cell vulvar carcinoma. PATIENTS AND METHODS: A total of 33 women with early-stage squamous cell vulvar carcinoma were analyzed retrospectively. Before the establishment of FIGO criteria in 1983, 17 patients with stage I and 2 patients with stage II were evaluated clinically without inguinal lymphadenectomy. All patients underwent post-operative radiotherapy with a median dose of 45 Gy to the pelvis (vulva included) and boost dose to the vulva ranging from 10 to 20 Gy. Factors assessed for prognostic value included age, inguinal lymph node dissection, differentiation grade, and total irradiation dose to the vulva and pelvis. RESULTS: The log-rank test and the univariate regression analysis revealed that all above factors except irradiation dose decreased the overall survival. In the multivariate regression analysis, differentiation grade and the absence of inguinal dissection were independent predictors for decreased survival with a relative risk up to 2.6 (95% CI = 1.3, 5.6) and 2.7 (95% CI = 1.31, 5.44), respectively. CONCLUSION: Clinical evaluation of inguinal lymph node involvement is inadequate and node dissection is definitely the only appropriate surgical procedure for vulvar carcinoma.     

Carcinoma of the vulva: clinical results of exclusive and adjuvant radiotherapy

BACKGROUND: The aim of this study was to evaluate the historical cohort of 61 patients with carcinoma of the vulva, treated with radiation therapy from 1986 to 1997. PATIENTS AND METHODS: Twenty-seven patients were submitted to radiation therapy alone and 34 received radiotherapy post limited surgery in early stages and post radical vulvectomy in advanced stages. The dose range varied from 59 to 63 Gy in post-operative patients and 65 Gy to 71 Gy in curative patients. RESULTS: Five-year Overall Survival (OS) and Disease-Free Survival (DFS) for patients treated with irradiation alone and for those treated with post-operative radiotherapy were 50.8% and 69.7%, respectively, without significant statistical difference. For OS multivariate analysis showed statistical difference for stage and age variables, and for stage variable in the case of DFS. CONCLUSION: In early stage vulvar cancer patients OS and DFS are good, with high control rate and low incidence of adverse effect. In loco-regionally-advanced patients, especially in those with stage IV or with > 2 positive lymph nodes, the outcomes are poor.     

Preoperative chemoradiation for advanced vulvar cancer: a phase II study of the Gynecologic Oncology Group

Purpose: To determine the feasibility of using preoperative chemoradiotherapy to avert the need for more radical surgery for patients with T₃ primary tumors, or the need for pelvic exenteration for patients with T₄ primary tumors, not amenable to resection by standard radical vulvectomy.Methods and Materials: Seventy-three evaluable patients with clinical Stage III–IV squamous cell vulvar carcinoma were enrolled in this prospective, multi-institutional trial. Treatment consisted of a planned split course of concurrent cisplatin/5-fluorouracil and radiation therapy followed by surgical excision of the residual primary tumor plus bilateral inguinal–femoral lymph node dissection. Radiation therapy was delivered to the primary tumor volume via anterior-posterior–posterior-anterior (AP–PA) fields in 170-cGy fractions to a dose of 4760 cGy. Patients with inoperable groin nodes received chemoradiation to the primary vulvar tumor, inguinal–femoral and lower pelvic lymph nodes.Results: Seven patients did not undergo a post-treatment surgical procedure: deteriorating medical condition (2 patients); other medical condition (1 patient); unresectable residual tumor (2 patients); patient refusal (2 patients). Following chemoradiotherapy, 33/71 (46.5%) patients had no visible vulvar cancer at the time of planned surgery and 38/71 (53.5%) had gross residual cancer at the time of operation. Five of the latter 38 patients had positive resection margins and underwent: further radiation therapy to the vulva (3 patients); wide local excision and vaginectomy necessitating colostomy (1 patient); no further therapy (1 patient). Using this strategy of preoperative, split-course, twice-daily radiation combined with cisplatin plus 5-fluorouracil chemotherapy, only 2/71 (2.8%) had residual unresectable disease. In only three patients was it not possible to preserve urinary and/or gastrointestinal continence. Toxicity was acceptable, with acute cutaneous reactions to chemoradiotherapy and surgical wound complications being the most common adverse effects.Conclusion: Preoperative chemoradiotherapy in advanced squamous cell carcinoma of the vulva is feasible, and may reduce the need for more radical surgery including primary pelvic exenteration.     

Preliminary results of chemoradiation as a primary treatment for vulvar carcinoma

PURPOSE: To assess the role of chemoradiation as a primary treatment for vulvar carcinoma. METHODS AND MATERIALS: Between December 1989 and August 1997, there were 14 patients with the diagnosis of squamous cell carcinoma of the vulva. Two patients were excluded from this study because of advanced stage at presentation. Key information about the remaining 12 patients was extracted from their charts. All patients had biopsy prior to treatment, and were treated with chemoradiation. Radiation was administered to the vulva only. Surgical biopsies from the vulva and inguinal nodal dissection were done 4-6 weeks after radiation treatment. All patients were followed for evaluation of response and clinical detection of recurrence. The period of follow-up ranged from 8 to 125 months. Mean follow-up period was 41 months. RESULTS: All 12 patients showed complete response to the treatment. Only 1 patient (8.3%) developed local recurrence at 3 months posttreatment. Another patient (8.3%) developed nodal recurrence at 30 months posttreatment. Both patients were salvaged by surgical treatment and remained disease free. The actuarial 5-year disease-free survival was 43%. The actuarial 3-year disease-free survival was 84%. The majority of patients developed mild-to-moderate complications due to chemoradiation. These were well tolerated and responded to medical treatment. None of the patients developed late complications to chemoradiation treatment. CONCLUSIONS: Chemoradiation is an effective primary treatment for vulvar carcinoma as shown by these successfully managed cases.     

双侧腹股沟淋巴结转移对淋巴结阳性阴茎癌预后评估的价值

目的探讨双侧腹股沟淋巴结转移在淋巴结阳性阴茎癌预后评估中的价值。方法回顾性分析60例淋巴结转移阳性阴茎鳞状细胞癌患者资料。所有患者均接受区域淋巴结清扫手术。Kaplan-Meier法绘制无复发生存曲线并通过Log—rank检验加以分析,COX回归模型进行多因素生存分析。结果60例患者中18例有双侧腹股沟淋巴结转移,其3年无复发生存率（26．7％）显著低于单侧腹股沟淋巴结转移患者（65．3％）,差异有统计学意义（x^2=10．6,P=0．001）。经多因素生存分析,阳性淋巴结数目和双侧腹股沟淋巴结转移均是独立的生存预后因素（均P〈0．05）。生存曲线比较显示双侧腹股沟淋巴结转移且阳性淋巴结数〉2个的患者预后差。结论在考虑了淋巴结阳性阴茎癌阳性淋巴结数目的影响后,双侧腹股沟淋巴结转移仍是其重要预后指标。     

Chemoradiation as primary or adjuvant treatment for locally advanced carcinoma of the vulva

Purpose: To determine the impact of primary or adjuvant chemotherapy and radiation (CRT) on the survival rates of patients with locally advanced vulvar carcinoma.

Methods and Materials: Between 1973 and 1998, 54 patients with vulvar cancer were treated with radiation therapy, among which 20 received CRT, while 34 patients received radiation therapy (RT) alone. Of the 20 patients, 14 were treated for primary or recurrent disease (pCRT), and 6 after radical vulvectomy for high-risk disease (aCRT). Of the 34 patients, 12 were treated primarily (pRT) and 22 received adjuvant treatment (aRT). Chemotherapy consisted of 2 courses of 5-fluorouracil (5-FU) and mitomycin C administered during RT. Six patients received cisplatin in place of mitomycin C. In CRT groups, radiation was administered to the vulva, pelvic, and inguinal lymph nodes to a median dose of 45 Gy with additional 6–17 Gy to gross disease. In RT groups, the median dose to the microscopic diseases was 45 Gy. Nine patients received external beam boost and 16 patients received supplementary brachytherapy in the forms of ²²⁶Ra or ²⁴¹Am plaques to sites of macroscopic disease.

Results: Overall survival was superior in the patients treated with pCRT versus pRT with statistical significance (p = 0.04). There was also a statistically significant improvement in disease-specific (p = 0.03) and relapse-free survival (p = 0.01) favoring pCRT. No statistically significant trends of improved survival rates favoring aCRT over aRT were observed.

Conclusion: Concurrent radiation therapy and chemotherapy decreases local relapse rate, improves disease-specific and overall survival over RT alone as primary treatment for locally advanced vulvar cancer.     

Management of vulvar cancer]

In the treatment of vulvar malignancy surgery, chemotherapy, irradiation therapy and so on can be used. Actually, it was rarely performed only by a single method. For treatment by the stage of cancer progression, the superficial cancer was treated by wide local resection for the patients except old women who were done simple vulvectomy. For the invasive cancer, stage 1 or 2, the pre-operative bleomycin (BLM) was administered to reduce the tumor mass, thereafter, radical vulvectomy with inguinal lymph node resection was performed. If inguinal lymph nodes metastasis was found, area of resection was extended to pelvic lymph nodes. Recently, micro-invasive carcinoma was defined that the foci was below 2 cm and interstitial invasion below 1 mm. In this condition, it was needless to remove the lymph nodes. For the stage of 3 or 4 which was inoperable, chemotherapy (mainly BLM) combined with irradiation therapy was done. In the cases of good general condition, it was chosen by super-radical vulvectomy.