膀胱容积变化对盆腔肿瘤放疗的影响

宫颈癌是全球妇科肿瘤中发病最高的3种肿瘤之一,2008年的流行病学数据显示,每年新发病例约40万[1].宫颈癌在我国是第2大常见妇科肿瘤,仅次于乳腺癌.手术、放疗、化疗是宫颈癌的常用治疗手段,但多数患者错过早期的手术机会,放疗成为首选的治疗方案.对于局部晚期宫颈癌患者,联合放、化疗可以明显提高盆腔局部控制率和改善总生存[2-3].直肠癌的发病率呈上升趋势,目前位居全球恶性肿瘤的第3位[4],直肠癌治疗失败的重要原因是直肠癌术后局部复发,预防和治疗直肠癌术后局部复发的主要手段是放疗.     

局部晚期鼻咽癌新辅助化疗研究进展

鼻咽癌的治疗手段是以放射治疗为主的综合治疗,随着调强放疗等精确放疗技术和放化综合治疗的广泛应用,初治鼻咽的局部控制率已经提高到90%以上。为了提高局部晚期鼻咽癌的治愈率、降低复发或远处转移,放疗与化疗的结合一直是学者们研究热点。由于同步放化疗已成为局部晚期鼻咽的标准治疗,新辅助化疗是鼻咽癌综合治疗研究的热点,新辅助联合同步放化疗是否获益一直存在争议。同时调强放疗的大量应用,同步化疗的地位受到怀疑,新辅助化疗在调强时代能否替代同步化疗及新辅助化疗后靶区应如何勾画值得进一步研究。因此,本文就新辅助化疗治疗局部晚期鼻咽癌的进展进行综述。     

放疗联合希罗达治疗局部晚期直肠癌近期疗效

目的 观察放疗联合同步口服希罗达治疗局部晚期直肠癌的近期疗效和毒副反应.方法 选择局部晚期无手术指征或拒绝手术直肠癌和直肠癌术后局部复发患者50例,随机分为综合治疗组（23例,接受放疗联合希罗达）和单纯放疗组（27例,仅接受放疗）.结果 综合治疗组总有效率为87.0%,单纯放疗组为66.7%（P＜0.05）.综合治疗组放射性直肠炎发生率为26.1%,手足综合征为21.7%;单纯放疗组放射性直肠炎发生率为11.1%,对症治疗后均好转.结论 放疗联合希罗达治疗局部晚期直肠癌疗效确切、毒副反应较少,值得临床推广应用.     

放疗技术在直肠癌术前治疗中的应用与研究进展

摘 要：放射治疗是局部晚期直肠癌治疗的一个重要组成部分。术前放疗联合化疗有利于降低直肠癌局部复发率,同时又能提高患者的保肛率。近年来,多项研究对如何进一步提高放疗疗效和放疗技术的选择等问题进行了探索。该文除了讨论直肠癌术前放疗的基本作用,同时对术前放疗的技术进行分析,比较其优劣。此外,还对直肠癌术前放疗技术的新理念进行探讨,为临床上对术前放疗方案的选择提供参考。     

直肠癌的辅助治疗

直肠癌的辅助治疗主要包括盆腔放射治疗和５－ＦＵ为基础的化学治疗。放疗可降低局部复发、增加保留肛门括约肌作用的机会,对于局部晚期和不能手术切除的直肠癌,放疗可以提高手术切除率,对不能手术的患者,放化疗是一种很好的姑息治疗手段。不管病变的期别,化疗药物除了细胞毒杀伤作用外,还可以增加放疗的作用。     

直肠癌术前放疗进展

在局部晚期直肠癌治疗中，综合治疗日益受到重视。因术前放疗的降期和保肛作用，有许多学者开展了这方面的研究。与传统的放射治疗方式相比，近年来无论在放疗技术、分割方式还是与化疗新药的联合应用方面都有了进一步的发展。现复习近期有关文献，综述术前放疗在局部晚期直肠癌治疗中的作用。     

外照射联合后装腔内放疗治疗直肠癌术后复发1例

直肠癌术后复发是直肠癌治疗失败的最主要因素,对于直肠癌术后局部区域复发患者,以放疗为主的综合治疗显得尤为重要,无论是手术还是术后放化疗,其目的均为降低复发率,提高患者的生活质量.对于直肠癌术后复发因年龄等因素不能手术的患者来说,外照射联合后装腔内放疗是行之有效的治疗方法.本文报道1例直肠癌术后复发患者通过后装腔内放疗联合外照射治疗取得满意疗效的治疗经过.     

直肠癌的辅助治疗进展

直肠癌的辅助治疗主要包括盆腔放射治疗和５ Ｆ Ｕ 为基础的化学治疗。放疗可降低局部复发、增加保留肛门括约肌作用的机会,对于局部晚期和不能手术切除的直肠癌,放疗可以提高手术切除率,对不能手术的患者,放化疗是一种很好的姑息治疗手段。不管病变的期别,化疗药物除了细胞毒杀伤作用外,还可以增加放疗的作用。     

直肠癌术前放疗进展

在局部晚期直肠癌治疗中,综合治疗日益受到重视.因术前放疗的降期和保肛作用,有许多学者开展了这方面的研究.与传统的放射治疗方式相比,近年来无论在放疗技术、分割方式还是与化疗新药的联合应用方面都有了进一步的发展.现复习近期有关文献,综述术前放疗在局部晚期直肠癌治疗中的作用.     

局部晚期直肠癌的放化疗

外科手术治疗是局部晚期直肠癌最主要的治疗手段,但术后局部复发率一直处于较高水平。直肠癌术前和术后放化疗降低了术后局部复发率,并提高了生存率及生命质量。目前辅助放化疗已成为局部晚期直肠癌的标准治疗。靶向药物、新的化疗药物以及高速发展的放疗技术为局部晚期直肠癌的治疗提供了更多的途径。     

全程新辅助治疗模式用于局部进展期直肠癌治疗的研究进展

大肠癌在全球范围内是一种发病率较高的实体性肿瘤,直肠癌手术难度大、并发症发生率高、局部复发率比较高,尤其是局部进展期直肠癌(locally rectal cancer,LAＲC)治疗效果较差,随着多学科综合治疗理念在直癌中的应用,特别是新辅助放化疗应用于局部进展期直肠癌的治疗,患者的治疗效果得到改善,局部进展期直肠癌领域是目前研究的重点和热点之一,本文对目前最新的2018年美国NCCN直肠癌肿瘤学临床实践指南中局部进展期直肠癌新辅助同步放化疗、新辅助短程放疗、全程新辅助治疗(total neoadjuvant therapy,TNT)的模式进行综述。     

直肠癌的新辅助治疗

局部晚期直肠癌单纯手术后局部复发率高,近年的随机对照Ⅲ期临床研究提示,局部晚期直肠癌的新辅助治疗可明显提高局部控制率,对于治疗后病理完全缓解者还可提高生存率,在欧美国家已成为局部晚期直肠癌的标准治疗.但化疗药物的选择、热疗等的应用等尚需进一步临床研究.     

Current State of Neoadjuvant Radiotherapy for Rectal Cancer

Colorectal cancer is the third most commonly diagnosed cancer, with rectal cancer accounting for 30% of cases. The current standard of care curative treatment for locally advanced rectal cancer is (chemo)radiotherapy followed by surgery and adjuvant chemotherapy. Although neoadjuvant radiotherapy has reduced the risk of local recurrence to less than 10%, the risk of distant metastasis remained high at 30% affecting patient survival. In addition, there is a recognition that there is heterogeneity in tumor biology and treatment response with good responders potentially suitable for treatment de-escalation. Therefore, new treatment sequencing and regimens were investigated. Here, we reviewed the evidence for current neoadjuvant treatment options in patients with locally advanced rectal adenocarcinoma, and highlight the new challenges in this new treatment landscape.     

局部晚期直肠癌术前新辅助治疗

Preoperative radiotherapy combined with chemotherapy and (or) targeted therapy not only reduces the local recurrence of locally advanced rectal cancer and increases the rate of anal preservation and pathologic complete response, but also improves patient compliance. Preoperative neoadjuvant therapy will gradually become the standard treatment for locally advanced rectal cancer.     

局部晚期宫颈癌放射治疗对直肠功能影响的研究进展

局部晚期宫颈癌患者接受放疗治疗过程中,放射性直肠炎的发生率较高,该并发症是最常见的放疗毒副反应。近年来,国内外的很多研究证实,局部晚期宫颈癌患者放疗中及放疗后存在的放射性直肠反应,会对患者的生命质量构成影响。影响放射性直肠炎的因素较多,主要为体外照射技术、腔内治疗方式、DICRU点剂量、剂量体积等。本文就目前国内外关于局部晚期宫颈癌放射治疗对直肠功能的影响因素进行综述,为放射性直肠毒副反应的临床处理提供参考方向。     

局部进展期食管鳞癌全新辅助治疗可行方案的探索

新辅助放化疗联合手术为局部进展期食管癌患者的标准治疗方案, 这一治疗方案已得到广泛应用, 其疗效也已得到临床医师的认可。然而, 即使是完成了新辅助放疗和随后的手术治疗, 仍有部分患者在短期内出现局部区域复发和/或远处转移, 其中远处转移成为新辅助放化疗后接受手术患者的主要失败模式, 这从另一方面说明该模式还有进一步改善的必要。借助于直肠癌患者从全新辅助治疗模式中获益的经验, 本文探讨了局部进展期食管癌患者进行全新辅助治疗的可能性及其实施方案。     

The Evolving Field of Neoadjuvant Therapy in Locally-advanced Rectal Cancer: Evidence and Prospects

The standard treatment of locally advanced rectal cancer comprises neoadjuvant chemoradiation followed by total mesorectal excision. This strategy provides low local recurrence rate, however distant recurrence is still an issue and may impact on survival rates. Novel approaches in the neoadjuvant setting have been tested to improve early and late outcomes, as well as to reduce treatment-related toxicity and morbidity. In this review, we discuss the current literature of neoadjuvant treatment in locally advanced rectal cancer, including total neoadjuvant methods, protocols for radiation delivery, chemotherapy regimen and efforts to add novel targeted therapies, selective withdrawal of surgery or radiotherapy, and future perspectives. Moreover, we highlight relevant issues that have emerged with these new treatment possibilities.     

Strahlentherapeutische Aspekte bei der Behandlung des Kolonkarzinoms

Radiotherapy is an integral part of the multimodality treatment for locally advanced rectal cancer. Conversely, for patients with colon cancer there is generally no indication for radiotherapy after R0 resection due to the lower risk of locoregional failure. Randomized trials could not show a benefit of postoperative radiochemotherapy (of the tumor bed or the liver) even in subgroups with an increased risk of recurrence. Preoperative radiochemotherapy can be considered for patients with T4 colon cancer when R0 resection is jeopardized. For liver metastases, stereotactic radiotherapy is an effective non-invasive treatment approach.     

Outcome after the introduction of a multimodality treatment program for locally advanced rectal cancer.

AIM: This prospective study reports the results of a multimodality treatment protocol in patients with locally advanced rectal cancer and assesses outcome after curative vs non-curative surgery and in relation to primary advanced vs locally recurrent cancer. METHODS: Between 1991 and 2002, 122 patients completed the protocol. Fifty-eight had primary advanced and sixty-four had locally recurrent rectal cancer. Median follow up was 82 months (5-143). RESULTS: A potentially curative resection was achieved in 59% of the patients with primary advanced and in 34% of patients with locally recurrent cancer. After curative resection, 53 and 59%, respectively, were free from recurrence during the observation time (median 82 months) and the overall 5-year survival was 34 and 40%. Overall 5-year survival in all patients with primary advanced cancer was 29 and 16% in all patients with locally recurrent rectal cancer. CONCLUSION: Multimodality treatment may cure at least a third of patients with locally advanced rectal cancer provided a radical resection is performed. As the post-operative morbidity is high, an optimised patient selection for neo-adjuvant treatment and surgery is essential. However, palliative surgery may benefit the patient if local control is achieved. Future studies should focus on the problem of distant metastasis.