激素受体阳性乳腺癌患者卵巢抑制时机的选择及对预后的影响

摘要：目的  评估绝经前激素受体阳性、腋窝淋巴结阳性（N1）乳腺癌患者辅助化疗同时卵巢抑制治疗,对远期复发、生存的影响。方法  回顾性分析2001年1月-2009年10月该院诊治的激素受体阳性、腋窝淋巴结1～3个转移的167例绝经前乳腺癌患者。根据化疗期间有无接受卵巢抑制治疗,将患者分为A、B两组。A组55例激素受体阳性的乳腺癌患者,该组接受6周期化疗且化疗开始前给予戈舍瑞林缓释植入剂进行药物卵巢去势,化疗结束后接受5年、规范的内分泌治疗。B组112例激素受体阳性乳腺癌患者,该组患者仅接受6周期化疗＋5年内分泌治疗。结果  截止2015年底,中位随访时间58个月,单因素分析显示,A组的5年无病生存期优于B组;A组与B组的总生存期比较差异无统计学意义,但是5年生存期提高10%,具有临床意义。多因素分析显示,有无卵巢去势、脉管浸润结果及组织学分级是影响预后的独立因素。结论  对年龄≤45岁、激素受体阳性及腋窝淋巴结1～3个转移的乳腺癌患者,化疗同时接受卵巢去势治疗可以显著改善治疗疗效。脉管浸润情况及乳腺癌组织学分级是影响激素受体阳性、腋窝淋巴结阳性乳腺癌预后的独立因素。

     

卵巢功能抑制联合芳香化酶抑制剂或他莫昔芬治疗绝经前HR阳性乳腺癌的研究进展

绝经前激素受体（hormone receptor,HR）阳性乳腺癌的辅助内分泌治疗是近年的热点问题。绝经前HR阳性乳腺癌的内分泌治疗包括选择性雌激素受体调节剂（selective estrogen receptor modulator,SERM）,例如他莫昔芬（tamoxifen,TAM）;卵巢功能抑制（ovarian function suppression,OFS）,包括手术、放疗或药物去势;OFS联合TAM;以及芳香化酶抑制剂（aromatase inhibitors,AI）联合OFS。目前建议对复发风险较高的绝经前HR阳性乳腺癌患者使用（AI或TAM）+OFS,但TAM+OFS与AI+OFS之间疗效是否存在差异仍待进一步探索。本文就目前绝经前HR阳性乳腺癌患者的TAM+OFS与AI+OFS之间的疗效及不良反应差异进行综述。     

乳腺癌保乳术后放射治疗的系统评价

目的评价早期乳腺癌保乳术后放射治疗的疗效。方法计算机检索中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库、数字化期刊全文数据库、PubMed、Cochrane Library、SCI及EMBASE数据库．并行手工检索。纳入比较早期乳腺癌保乳术后放疗与根治术的随机对照试验,根据Cochrane系统评价手册4．2．6质量评价标准进行评价,使用RevMan4．2软件进行Meta分析。结果纳入4个研究（1985例）。Meta分析显示．与根治术相比,保乳术后放疗的10年局部复发率差异有统计学意义（比值比1．58,95％可信区间1．01～2．46）,而10年总生存率（比值比1．02,95％可信区间0．84～1．24）及远处转移率（比值比1．02,95％可信区间0．84～1．25）差异无统计学意义。结论与根治术相比,乳腺癌保乳术后放疗虽然10年局部复发率较高,但二者远期疗效相同,由于保乳术保留了乳房,达到了美容效果,提高了患者的生活质量,可作为早期乳腺癌的标准治疗方式。     

托瑞米芬治疗Luminal型年轻乳腺癌疗效和安全性的回顾性研究

【目的】 探讨托瑞米芬治疗年轻(≤35岁)可手术乳腺癌的疗效及安全性?【方法】 收集2002年1月至2007年10月诊治的绝经前年轻Luminal型乳腺癌的临床病理资料,使用他莫昔芬或托瑞米芬内分泌治疗共247例(分别为181例和66例)?采用Kaplan-Meier法和Log-rank检验分析两组生存情况,COX比率风险回归模型进行多因素分析?【结果】 托瑞米芬组和他莫昔芬组中位年龄分别是33岁和32岁?全组中位随访77.1月,托瑞米芬组和他莫昔芬组的6年无病生存时间为77.0%和79.2%,6年总生存率分别为88.4%和87.4%,两组无病生存时间和总生存时间均无统计学差异(总生存时间, HR = 0.794; P = 0.589; 无病生存时间, HR = 1.132; P = 0.686)?托瑞米芬组和他莫昔芬组的毒性反应无统计学差异?单因素分析显示,肿块大?组织学分级高?分期晚和HER2过表达和患者无病生存时间较短相关;PR阴性患者可能无病生存时间短(P = 0.056);脉管癌栓?淋巴结阳性和分期晚的患者总生存时间较短?多因素分析提示HER2阳性和PR阴性预示年轻Luminal型可手术乳腺癌患者无病生存时间较短;分期较晚是该型患者的总生存时间差的预后因素? 【结论】 托瑞米芬治疗年轻绝经前Luminal型可手术乳腺癌疗效和他莫昔芬相似,安全性好?但仍需要更大规模的研究进一步来证实?     

中西医结合治疗71例乳腺癌术后患者的疗效分析

目的 研究乳腺癌术后中西医结合治疗疗效。方法 对71例乳腺癌术后患者予以化疗、放疗、内分泌治疗，配合中药治疗。结果 全组均存活，57例术后即以中西医结合治疗，复发2例(3．5％)，转移6例(10．5％)，此8例的中位无病生存期5．9年；另14例术后仅以西医治疗，复发、转移后方开始中药治疗，中位无病生存期3．5年。两者有显著性差异(P=0．033)。结论 中医药能预防、延缓乳腺癌术后的复发、转移。     

Effect of progesterone combined with chemotherapy on epithelial ovarian cancer

Objective To identify an effective auxiliary therapy for epithelial ovarian cancer. Methods Progesterone acetate given at 250 mg intramuscularly twice a week for 1 month followed by increased administration to 500 mg intramuscularly every two weeks for 3 years was used in combination with platinum based chemotherapy to treat patients with epithelial ovarian cancer as a first-line therapy. Prognoses of the patients receiving progesterone combined with chemotherapy (progesterone group) and those receiving chemotherapy only (control group) were compared. Results Three-year recurrence and survival conditions of the progesterone and control groups were as follows. Stage Ⅰa:no patient relapsed or died in either group. Stage Ⅰb-Ⅰc:three-year recurrence rates were 14.2% and 37.5%, respectively ( P=0.2845); three-year survival rates were 92.3% and 87.5% (P=0.7221). Stage Ⅱ: 1 patient relapsed and died among the 3 patients in the progesterone group; among the 4 patients in the control group, 1 patient relapsed, none died. Stage Ⅲ: three-year recurrence rates were 30.8% and 64.3%, respectively (P=0.1170); three-year survival rates were 85.7% and 42.9%, respectively (P=0.005). Stage Ⅳ: 4 patients relapsed and 1 patient died among the 7 patients in the progesterone group; both the patients in the control group relapsed and died. Conclusions The results indicated that progesterone combined with platinum based chemotherapy as a first-line therapy may improve the prognosis of advanced epithelial ovarian cancer, but would not change the prognosis of early stage epithelial ovarian cancer.     

Low-dose steroid therapy in cyclosporine-treated renal transplant recipients with well-functioning grafts. The Canadian Multicentre Transplant Study Group.

OBJECTIVE: Low-dose prednisone given on alternate days as a steroid adjunct to cyclosporine therapy was investigated primarily for its influence on kidney graft and patient survival and, secondarily, on renal function and complications. DESIGN: Multicentre randomized double-blind clinical trial. SETTING: Fourteen Canadian transplant centres. PATIENTS: A total of 523 patients with well-functioning renal transplants (cadaveric grafts or grafts from living related donors) and without active graft rejection reactions who were entered into the trial from 1982 to 1985. INTERVENTION: Patients were randomly assigned 90 days after transplantation to receive either placebo (260 patients) or low-dose prednisone (263 patients). MAIN OUTCOME MEASURES: Graft and patient survival. MAIN RESULTS: After at least 5 years of follow-up 50 patients assigned placebo had lost their graft and 17 had died; the corresponding figures for those assigned prednisone were 38 and 16. After an average interval of 1.4 years 143 patients in the placebo group and 123 patients in the prednisone group had stopped therapy with the test drug or had had their treatment group decoded or both. Patients were withdrawn from the study 2 years after stopping the test therapy. The actuarial 5-year graft survival rates were 73% and 85% in the placebo and prednisone groups respectively (p = 0.03), and the actuarial 5-year patient survival rates were 92% and 94% respectively (p = 0.6). This analysis included 43 and 29 graft losses and 14 and 12 deaths in the placebo and prednisone groups respectively. Weibull parametric modelling of graft survival identified the following variables as risk factors for graft loss: histocompatibility leukocyte antigen B (HLA-B) mismatching (p = 0.007), donor death from cerebrovascular accident (p = 0.01), increased donor age (p = 0.02) and being a male recipient (p = 0.05). When these factors were included in the Cox proportional hazards model, the influence of assigned treatment on graft survival was reduced to p = 0.1. Donor death from cerebrovascular accident (p = 0.002), diabetes mellitus in the recipient (p = 0.02) and increased recipient age (p = 0.05) were risk factors for patient death. Renal function and incidence of complications were similar in the treatment groups. CONCLUSIONS: Continued administration of low-dose prednisone on alternate days is advisable, particularly in patients with cadaveric grafts and those with previously failed transplants.     

戈舍瑞林联合阿那曲唑治疗晚期绝经前乳腺癌的临床观察

目的 观察戈舍瑞林联合阿那曲唑治疗晚期绝经前乳腺癌的疗效和不良反应.方法 我们从2003年5月至2008年5月,采用戈舍瑞林联合阿那曲唑治疗绝经前激素受体阳性的转移性乳腺癌32例,戈舍瑞林3.6mg,皮下注射,每4周1次;阿那曲唑1 mg,口服,1次/日.中位治疗时间为12个月.结果 本组完全缓解(CR)0例(0%),部分缓解(PR)6例(18.8%),稳定(SD)21例(65.6%),进展(PD)5例(15.6%),总有效率(RR=CR+PR)为18.8%,临床获益率(CR+PR+SD>6个月)为68.8%,中位疾病无进展时间(PFS)为12(2-57)个月,1年生存率87.4%,2年生存率为66.9%.无内脏转移患者总生存时间显著长于有内脏转移者(P=0.04).主要毒性反应为潮热和恶心.结论 戈舍瑞林联合阿那曲唑是一种有效且安全地治疗绝经前转移性乳腺癌的方案.     

颅内生殖细胞瘤综合治疗的初步效果

①目的 探讨颅内生殖细胞瘤的综合治疗方法。②方法 回顾分析18例颅内生殖细胞瘤采用单纯全中枢照射、单纯全脑照射及低剂量全脑照射联合化疗3种治疗方法的疗效及并发症。③结果 放化疗联合组与全中枢照射组4年总生存率及无复发生存率比较差异均无显著性（P＝1．000，0．416）；儿童生长延迟及智力发育障碍发生率以放化疗联合组为低（P＝0．0009，0．001）；单纯全脑照射组复发率高于全中枢照射组及放化疗联合组，差异有极显著性（P＝0．003）。④结论 全脑照射联合化疗的综合治疗方法初步效果满意，且并发症低，尤其适用于儿童病人。对于播散性病变或多灶性病变病人不宜给予单纯全脑照射。     

Ⅰ、Ⅱ期乳腺癌保乳根治术加放疗的临床分析

目的比较Ⅰ、Ⅱ期乳腺癌保乳根治术加放疗与改良根治术的临床疗效。方法回顾性分析我院2002年1月～2006年12月实施保乳手术加放疗（保乳组）的106例及改良根治术（对照组）的131例Ⅰ、Ⅱ期乳腺癌患者的临床资料,比较两组的疗效。结果与对照组比较,保乳组术后拔管时间短、并发症发生率低,并且美容效果评价的优良率明显高于对照组：两组的5年生存率及无病生存率相似,差异无统计学意义（P〉0．05）。结论保乳手术加放疗可达到与改良根治术相似的生存率,且手术并发症发生率低,美容效果好,是Ⅰ、Ⅱ期乳腺癌治疗的首选方式。     

Neoadjuvant chemotherapy in patients with stages II and III breast cancer

Background Neoadjuvant chemotherapy has been used as a primary treatment for locally advanced or inflammatory breast cancer, and recently extended to operable breast cancer. However, only a few studies have published data concerning the outcomes of patients with stages II and III breast cancer after neoadjuvant chemotherapy. Methods This study retrospectively investigated the clinical value of neoadjuvant chemotherapy for patients with stages II and III breast cancer. The patients in Group 1 （n=54） were treated with neoadjuvant chemotherapy, followed by definitive surgery and adjuvant therapy. The patients in Group 2 （n=-43） initially received definitive surgery, followed by adjuvant chemotherapy and other therapies. The operability rates for breast conservation and dermatoplasty were observed in Group 1 after neoadjuvant chemotherapy. After follow-up, the recurrence and overall and disease-free survival rates of the two groups were analyzed. Results Neoadjuvant chemotherapy increased the operability rates for breast conservation from 17.1% to 40.0% in stage II （P=0.034） and 0% to 12.6% in stage III （P=0.016）, and decreased the dermatoplasty rates from 17.1% to 2.8% in stage II （P=0.046） and 28.1% to 8.1% in stage Ill （P=0.026）. After a median follow-up of 46.8 months, there were 11 deaths and 13 recurrences in Group 1, and 15 deaths and 19 recurrences in Group 2. The overall and disease-free survival rates of stage III disease were significantly higher in Group 1 than in Group 2 （68.4% vs 31.2%, P=0.028, and 63.2% vs 25.0%, P=0.024, respectively）. There were no significant differences in the overall and disease-free survival rates of stage II disease for Group 1 compared with Group 2 （85.7% vs 85.2%, P=0.953, and 80.6% vs 74.1%, P=0.400, respectively）. Conclusions Neoadjuvant chemotherapy resulted in increased operability for breast conservation and decreased dermatoplasty. Neoadjuvant chemotherapy exhibited better recurrence control, and overall and disease-free survival rates in stage III disease. However, neoadjuvant chemotherapy did not confer greater survival on stage II disease.     

NUAK2蛋白在Luminal型乳腺癌组织中的表达及意义

目的评估NUAK2蛋白在Luminal型乳腺癌组织中的表达水平和临床意义。方法使用免疫组织化学方法,检测Luminal型乳腺癌患者组织标本中NUAK2蛋白的表达水平,与癌旁组织进行比较,并分析其与患者的临床特征、病理特征及预后的关系。结果NUAK2蛋白在Luminal型乳腺癌组织中的表达水平高于癌旁乳腺组织（P=0.032）;术后因肿瘤复发而死亡的患者,其肿瘤组织中的NUAK2蛋白表达水平也较高（P=0.037）;NUAK2蛋白高表达组患者更容易出现淋巴结转移（P=0.038）,且无复发生存率（P=0.035）和总体生存率（P=0.024）也明显下降;NUAK2蛋白表达水平升高与患者乳腺癌复发明显相关（P=0.011）。结论NUAK2蛋白在Luminal型乳腺癌组织中高表达,其表达水平与淋巴结的转移、肿瘤的复发和患者的预后存在相关性,推测NUAK2可能是乳腺癌的一个癌基因。     

保乳术后放疗治疗早期乳腺癌49例临床疗效

目的:探讨保乳术后根治性放疗治疗早期乳腺癌的临床疗效。方法:对49例早期乳腺癌保乳术后行放疗6～12周,化疗4～6疗程,内分泌治疗5年。观察肿瘤局部复发情况、乳房美容效果和生存率。结果:无一例局部复发,脑转移1例,肺、骨转移1例均病死。对侧乳腺原发癌1例行根治术,3年无瘤生存率为93.88%。乳房美容评价:医生打分满意度佳、良85.71%,患者自评满意度佳、良91.83%,治疗后并发症主要有皮肤急性反应。结论:保乳术后根治性放疗治疗早期乳腺癌可获得满意的疗效和美容效果,但必须严格掌握保乳手术适应证及综合治疗的相关技术。     

长期生存复发转移性乳腺癌患者的临床病理特征和预后因素分析

目的分析复发转移后生存5年以上乳腺癌患者的临床病理特征和预后因素。方法1996年1月至2002年12月就诊、确诊时为Ⅰ-Ⅲ期、在之后的治疗随访过程中出现复发转移,且复发转移后生存期长于5年的乳腺癌患者72例,分析其临床病理特征、预后因素及治疗情况。结果全组患者复发转移时中位年龄46岁,原发肿瘤≤5cm者80.5%;腋窝淋巴结转移0～3个者69.5%;受体阳性者74.5%;以软组织转移为主者69.4%;中位无病生存期为31个月。一线治疗后完全缓解率为42.5%,中位完全缓解持续时间达26个月。COX多因素分析显示,腋窝淋巴结转移数目是总生存期（P=0.03）和复发转移后生存期（P=0.04）的独立预后因素。结论复发转移后长期生存的乳腺癌患者通常具有更多有利的临床病理指标并且在复发转移后接受了合理的综合治疗。腋窝淋巴结转移数目是独立的预后因素,有长期预测总生存和复发转移后生存期的价值。     

Efficacy of postoperative antiviral combined transcatheter arterial chemoembolization therapy in prevention of hepatitis B-related hepatocellular carcinoma recurrence

Background  Recurrence of hepatitis B-related hepatocellular carcinoma (HCC) after curative resection is the leading factor influencing the prognosis of the disease. Therefore, further improvement of long-term survival may depend on the prevention and treatment of the recurrent tumor. The aim of this research was to investigate the role of antiviral therapy and postoperative transcatheter arterial chemoembolization (TACE) in the prevention and treatment of hepatitis B-related HCC recurrence.

Methods  One hundred and twenty patients who underwent curative resection of hepatitis B-related HCC between January 2005 and June 2008 at our hospital were enrolled. Patients were divided into four groups according to the post-operative adjuvant therapy they received, i.e., control, antiviral therapy group, TACE group, and combined group. The disease-free survival (DFS) and the 12-, 24-, 36-month cumulative recurrence rates were studied.

Results  There was no significant difference between isolated postoperative antiviral therapy group and control in terms of disease-free survival (P=0.283), while it was significantly higher in the TACE group compared to control (P=0.019). In all patients, however, viral prophylactic therapy combined with/without TACE brought a favorable result compared to those only with/without TACE (P <0.001). Similarly, no matter combined with or without antiviral treatment, postoperative TACE prolonged DFS (P=0.015). Naturally, a combination of viral prophylactic therapy on the baseline TACE significantly benefited patients’ postoperative DFS (P=0.047) and vice verse (P=0.002). The 24-month cumulative recurrence rates of combined group were significantly lower than that of isolated control group and antiviral therapy (P <0.001 and P=0.011 respectively). However, 36-month recurrence rate was significantly different in the control group compared to the TACE group and combined group (P=0.040 and 0.002 respectively); same as the antiviral group compared to the combined group (P=0.034).

Conclusions  Post-operative TACE prevents early recurrence while antiviral therapy prevents late recurrence of HCC. Combination of antiviral therapy and TACE are suggested for prevention in HCC patients with high risk of recurrence.

     

早期乳腺癌保乳术后大分割放疗的研究

目的探讨早期乳腺癌保乳术后大分割放疗的疗效、美容效果及不良反应。方法选择2006-2009年陕西省人民医院收治的早期乳腺癌保乳手术后患者69例,其中36例行大分割放疗（大分割组）,两野切线全乳照射DT42.56 Gy,共16次,后续瘤床X线或电子线推量DT7.98 Gy,共3次,总疗程25-27 d;33例行常规分割放疗（常规组）,两野切线全乳照射DT50 Gy,共25次,后续瘤床X线或电子线推量DT10 Gy,共5次,总疗程40-42 d。应用SPSS 16.0软件行Kaplan-Meier法计算局部复发率和生存率,Log-rank法检验差异。χ2检验比较两组资料一般情况、美容效果及不良反应。以P〈0.05为差异有统计学意义。结果中位随访时间为61个月,随访率为100%。两组5年生存率均为100%。大分割组和常规组局部复发率分别为0.0%、3.0%（χ^2=0.28,P=0.600）。大分割组和常规组1级皮肤反应发生率分别为55.6%与51.5%（χ^2=0.11,P=0.737）,1级皮肤及皮下组织晚期反应发生率分别为13.9%与9.1%（χ^2=0.06,P=0.806）,1级白细胞减少发生率分别为8.3%与12.1%（χ^2=0.02,P=0.903）。大分割组和常规组1、3、5年美容效果优良率分别为85.7%与84.8%（χ^2=0.01,P=0.920）;88.2%与87.1%（χ^2=0.02,P=0.889）;87.1%与88.0%（χ^2=0.01,P=0.919）。结论保乳术后大分割放疗的疗效与常规分割相似,美容效果相当且未加重皮肤反应。     

早期乳腺癌复发、转移危险因素分析

目的 分析早期乳腺癌复发转移的危险因素,为早期乳腺癌个体化治疗提供依据.方法 分析广东省中山市人民医院2002～2008年收治的650例早期乳腺癌患者的临床、病理及免疫组化资料,随访观察患者的复发、转移情况.Kaplan-Meier法计算患者无瘤生存率,Log-rank检验对可能影响患者预后的相关因素进行分析,COX模型进行多因素分析.结果 3、5年无瘤生存率分别为96.7％ 、91.7％.单因素统计分析发现,肿瘤分期、大小,淋巴结转移,病理类型,CerbB-2,Ki-67可显著影响乳腺癌转移、复发情况（P＜0.05）;术后联合化疗、放疗或内分泌治疗均可降低复发转移率（P＜ 0.05）;COX分析显示,肿瘤分期（RR=2.39,95％CI=1.14～4.71）,肿瘤大小（RR=3.92,95％CI=1.05～5.53）,淋巴结转移（RR=2.23,95％CI=1.21～3.92）,病理类型（RR=1.14,95％CI=1.01～5.78）,CerbB-2阳性（RR=1.49,95％CI=1.13～7.76）,Ki-67（RR=1.69,95％CI=1.04～6.77）,化疗（RR=1.59,95％CI=1.21～4.47）,放疗（RR=1.74,95％CI=1.11～6.23）,内分泌治疗（RR=1.95,95％CI=1.18～6.42）是影响患者5年无瘤生存率的因素（P＜0.05）.结论 肿瘤分期晚、肿块大、存在淋巴结转移、病理类型为浸润性、CerbB-2及Ki-67阳性是早期乳腺癌发生复发转移的危险因素;而术后联合化疗、放疗及内分泌治疗均可显著降低患者复发、转移率.对于存在上述危险因素的患者,应根据实际情况选择合适的个体化治疗方案,降低复发转移率.     

复发转移性三阴乳腺癌患者进展后生存特征分析

目的 分析复发转移性三阴乳腺癌(metastatic recurrent triple-negative breast cancer, mrTNBC)的生存特征并寻找独立影响患者生存的预后因素。方法 收集四川大学华西医院收治、经病理组织学证实、在治疗过程中或治疗完成后发生首次复发转移的三阴乳腺癌(triple-negative breast cancer, TNBC)患者的临床病理资料。进展后生存情况采用Kaplan-Meier方法进行分析,单因素预后分析采用log-rank检验,多因素预后分析采用Cox比例风险模型。结果 本研究共纳入142例患者,中位随访时间41.9月(5.1～189.5月),进展后中位生存时间22.0月。单因素分析结果显示:肿瘤直径大小、淋巴结状态、肿瘤TNM分期、无疾病间隔期(disease-free interval, DFI)、复发转移部位的个数、是否脑转移、是否肝转移和进展后治疗模式是进展后生存时间的影响因素。多因素分析结果提示,发生多部位进展( P=0.004)、DFI≤12月( P=0.010)、发生脑转移( P=0.037)和单模式治疗(single-modal therapy, SMT, P<0.001)是影响mrTNBC患者预后的独立危险因素。在局部复发的患者中,多模式治疗(multi-modal therapy, MMT）比SMT预后更好(进展后3年生存率,53.0% vs. 11.4%, P=0.024),远处转移的患者也有相同的趋势(进展后3年生存率,58.1% vs. 29.3%, P=0.003)。结论 发生多部位进展、DFI短、发生脑转移均为影响mrTNBC患者生存的危险因素,MMT为其保护因素。     

保乳术后放疗加后装插植治疗与加电子线放疗远期疗效观察

目的：观察早期乳腺癌保乳手术后常规全乳放疗加后装插植治疗与加电子线补量照射的长期疗效及美容效果．方法回顾性分析1995年1月至2003年12月在昆明医科大学第三附属医院就诊的早期乳腺癌患者,要求肿块最大直径≤3 cm,显微镜下手术切缘阴性,腋窝淋巴结清扫为阴性,病理类型为浸润性导管癌．选取有随访资料的53例;其中23例术后使用6MV-X线切线野常规分割全乳房照射46-50 Gy/23-25次,局部瘤床区用高剂量率后装插植补量8-10 Gy/1-2次,30例对照组电子线加量照射10 Gy/5次．治疗后2 a内每3个月,第3-5年每6个月,之后每年随访1次观察治疗和美容效果．结果全组病例随访217个月（平均165个月）,插植组2例分别在治疗后62个月和158个月死于远处转移,美容效果优良率均超过78%．无局部复发,局控率100%．3、5、10、15 a生存率分别为100%、100%、95.7%、88.3%;电子线组3例分别在治疗后45个月、97个月、87个月死于远处转移,美容效果优良率均超过80%．有1例局部复发,局控率97.0%;3、5、10、15 a生存率分别为100%、96.7%、93.6%、82.3%个月,2组局部复发率、生存率和美容效果比较没有差别（P〈0.05）．结论早期乳腺癌保乳术后6MV-X线切线照射加瘤床后装插植治疗与电子线野局部加量比较,疗效及美容效果相当、生存质量高,治疗时间短.     

放化同步治疗宫颈癌术后脉管癌栓阳性患者的疗效及不良反应观察

目的：观察放化同步治疗宫颈癌术后脉管癌栓阳性患者的近期疗效及不良反应。方法选择宫颈癌术后脉管癌栓阳性患者共118例。按治疗方案的不同分为两组：放化同步治疗组57例,给予术后辅助同步放化疗,同步化疗方案为DDP周疗,于盆腔外照射治疗期间给予,术后病理提示手术切缘阳性、淋巴结阳性和/或宫旁组织阳性的患者予追加192 Ir后装腔内放疗;单纯放疗组61例,放疗方案与放化同步组相同。随访、评估和比较分析,两组患者的3年无病生存率、3年总生存率、1年、2年及3年盆腔复发率及治疗相关不良反应。结果宫颈癌根治术后脉管癌栓阳性的患者,术后放化同步治疗较单纯放疗降低了1年盆腔复发率（放化同步治疗8．77％,单纯放疗22．95％,P＜0．05）及2年盆腔复发率（放化同步治疗12．28％,单纯放疗27．87％,P＜0．05）,3年盆腔复发率放化同步治疗组与单纯放疗组比较,差异无显著性意义（P＞0．05）,两组3年无病生存率、3年总生存率相似。放化同步组的早期不良反应较单纯放疗组增加,主要体现在骨髓抑制和胃肠道反应,均在可耐受范围内,经积极对症支持处理未影响后续治疗。晚期不良反应两组患者无差别。结论放化同步治疗降低了宫颈癌根治术后脉管癌栓阳性患者近期局部复发率,3年的无进展生存率及总生存率未见明显改善。放化同步治疗的早期不良反应稍有增加。