双介入治疗原发性肝癌

目的　研究双介入疗法治疗原发性肝癌的临床疗效。　方法　首先行TACE术 ,1～ 3周后在B超或CT引导下行PEIT治疗 ,每周行 (1～ 2 )次 ,连续 (3～ 5 )次。　结果　全组共行TACE 6 1人次 ,PEIT96人次。全组CR 3例 ,PR 12例 ,有效率 (CR PR) 4 8.4 % (15 / 31) ,NC 10例 ,PD 6例。全组 1、2、3、4年生存率分别为 82 .8%、6 1.0 %、4 8.8%、4 0 .7%。　结论　双介入疗法对部分不能手术治疗的原发性肝癌是一种较安全、有效的治疗手段     

超声引导微波联合肝动脉化疗栓塞术治疗大肝癌的疗效评价

目的探讨超声引导微波联合肝动脉化疗栓塞术(transarterial chemoembolization,TACE)治疗大肝癌的疗效.方法 35例大肝癌采用超声引导微波联合TACE介入治疗(微波联合TACE组),并选择同期40例大肝癌采用单纯微波治疗(单纯微波治疗组)和31例采用单纯TACE治疗(单纯TACE治疗组)作为对照. 结果微波联合TACE治疗后30例AFP降至正常,3例明显下降;超声检查:80.0%(28/35)肿块缩小 ,20.0%(7/35)无变化, 肿块中心回声增强 , 周边呈低回声, 境界清晰, 其中可见钙化回声, 肿瘤内血流消失或减少.12例超声引导下活检,病理组织学结果显示: 肿瘤完全坏死9例,不完全坏死3例.30例CT检查, 76.7%(23/30)肿块缩小.微波联合TACE组缓解率(CR PR)88.6%(31/35),1、2、3、5年生存率分别为88.6%(31/35)、71.4%(25/35)、60.0%(21/35)、42.9%(15/35),均高于单纯微波组及单纯TACE组.无严重并发症发生. 结论超声引导微波联合TACE介入治疗大肝癌安全、有效、实用, 比单纯微波或TACE治疗效果好,为不能手术切除或其它治疗效果不佳的大肝癌提供了一种可行和有效的治疗方法.     

亚砷酸联合FOLFOX4方案化疗在转移性肝癌中的疗效分析

目的通过研究亚砷酸和FOLFOX4方案联合应用与单用FOLFOX4方案在转移性肝癌治疗中疗效的比较,以评估亚砷酸在转移性肝癌中的临床应用价值,并监测其不良反应,评估其临床应用的安全性,为临床用药奠定基础。方法选取我院2006年7月至2007年12月期间晚期胃肠道肿瘤伴肝转移的患者共26例,随机分成2组,分别采用亚砷酸联合FOLFOX4方案(治疗组)以及单用FOLFOX4方案进行治疗(对照组),观察并比较其疗效。结果26例患者均完成至少2个周期的联合治疗。随访6～24个月(中位随访时间12.5个月),治疗组平均生存时间242d,中位生存时间281d;对照组平均生存时间227d,中位生存时间246d,2组比较差异无统计学意义(P0.05)。疼痛:治疗组完全缓解(CR)2例,部分缓解(PR)5例,稳定(SD)2例,客观有效(CR+PR+SD)为9例;对照组CR1例,PR3例,SD2例,客观有效(CR+PR+SD)为6例,2组客观有效情况比较差异无统计学意义(P0.05)。客观疗效:2组中均无CR病例,其中治疗组PR5例,无效(NC)6例,进展(PD)2例,客观有效(CR+PR)为5例,受益(CR+PR+NC)为11例;对照组PR2例,NC4例,PD7例,客观有效(CR+PR)为2例,受益(CR+PR+NC)为6例。2组客观有效情况比较差异无统计学意义(P0.05),但治疗组受益情况优于对照组,差异有统计学意义(P0.05)。不良反应主要表现为胃肠道反应和骨髓抑制,2组比较差异无统计学意义(P0.05),未见砷中毒反应。结论亚砷酸联合FOLFOX4方案治疗可以取得较好的疗效,亚砷酸不会增加常规化疗的毒副反应。     

原发性肝癌DSA表现与TACE疗效的关系分析

目的:探讨原发性肝癌数字减影血管造影(DSA)表现与经肝动脉化疗栓塞(TACE)疗效的关系。方法:选择2012年4月—2014年4月间行DSA造影并进行TACE治疗的原发性肝癌患者61例,根据术中DSA表现,将患者分为富血供组(44例)和中等血供组(17例),术后随访3个月至2年,以m RECIST标准评估肿瘤疗效,分析DSA血供分型与患者疗效及预后的关系。结果:TACE术后2个月,富血供组完全缓解(CR)2例(4.5%),部分缓解(PR)29例(65.9%),疾病稳定(SD)6例(13.6%),疾病进展(PD)7例(8.6%),客观有效率(CR+PR)70.4%,疾病控制率(CR+PR+SD)84.0%;中等血供组CR 0例(0.0%),PR 5例(29.4%),SD 4例(23.5%),PD 8例(47.1%),客观有效率29.4%,疾病控制率52.9%。富血供组、中等血供组中位生存期分别为14与7.9个月,6、12、24个月累计生存率分别为91.0%、68.0%、20.4%与59.1%、23.0%、12.1%,差异均有统计学意义(均P0.05)。结论:原发性肝癌DSA血供分型与TACE治疗效果密切相关,富血供型肝癌TACE治疗效果较好。     

原发性肝癌的放射介入治疗体会

目的观察原发性肝癌采用放射介入治疗的临床疗效。方法选取78例原发性肝癌患者,按照治疗方法不同分为经肝动脉化疗栓塞术(TACE)组36例和TACE+射频消融术(RFA)组42例,比较2组患者的治疗效果。结果 (1)A组CR 7例,PR 12例,总有效率为52.8%;B组CR 14例,PR 18例,总有效率为76.2%。2组患者总有效率比较差异有统计学意义(x2=15.247,P<0.01)。(2)2组患者12、18个月生存率比较差异具有统计学意义(x2=12.417,x2=16.389,P<0.01)。结论采用TACE+RFA联合方法治疗原发性肝癌可达到较理想效果,可显著延长患者生存时间、改善生存质量。     

海藻酸钠微球与碘化油介入栓塞治疗转移性肝癌的临床研究

目的 比较海藻酸钠微球与碘化油化疗栓塞治疗转移性肝癌的临床疗效。方法 回顾性收集分析研究2013年1月至2014年6月的在我院通过两种不同介入模式治疗的转移性肝癌患者43例,随机分为两组:海藻酸钠微球栓塞组及碘化油栓塞组。分别对两组患者治疗前及介入术后4周左右肿瘤大小的改变情况以及栓塞术后并发症发生率,术后生存率进行比较。结果 两组患者术后4周复查CT或MRI显示,海藻酸钠微球组总有效率(CR+PR)为50%,获益率(CR+PR+NC)为90%;碘化油组患者总有效率(CR+PR)为39.1%,获益率(CR+PR+NC)为82.6%;通过术后影像表现,两组患者肿瘤的大小有变化的有19人,其中KMG组10例(50%),对照组9例(39.1%)。两组比较,有统计学意义(P0.05)。随访1年结束后,海藻酸钠微球组患者术后9个月及12个月生存期分别为100%和95%,对照组为100%和91.3%,两组累积生存率差异无统计学意义(P0.05)。结论 海藻酸钠微球组介入术后复查AFP及肿瘤大小的测定,以及治疗后患者生存率均优于单纯碘化油栓塞剂的治疗效果,海藻酸钠微球经肝动脉化疗栓塞是安全、有效的一种介入治疗手段,所以具有良好的应用前景以及重要的临床使用价值。     

CT引导下组织间植入 125 I粒子治疗肺癌的临床应用

目的探讨CT引导下组织间植入125I粒子治疗肺癌的临床价值。方法18例肺癌患者采用CT引导下125I放射性粒子植入。粒子植入之前采用三维治疗计划系统模拟布源,在螺旋CT引导下将125I粒子植入肿瘤组织内。术后2个月复查CT一次,随访6个月。结果全组18例18个病灶共植入粒子812粒,平均每个病灶植入粒子45.1粒。2个月后采用CT评价,完全缓解(CR)7例,部分缓解(PR)10例,无变化(NC)1例,总有效率(CR PR)为94%(17/18)。结论经皮穿刺放射性粒子组织间永久植入治疗中晚期肺癌为一种近期疗效满意、微创、低毒的新方法,值得进一步临床应用,长期观察。     

CT引导下组织间植入 125 I粒子治疗肺癌的临床应用

目的 探讨CT引导下组织间植入125I粒子治疗肺癌的临床价值. 方法 18例肺癌患者采用CT引导下125I放射性粒子植入.粒子植入之前采用三维治疗计划系统模拟布源,在螺旋CT引导下将125I粒子植入肿瘤组织内.术后2个月复查CT一次,随访6个月. 结果 全组18例18个病灶共植入粒子812粒,平均每个病灶植入粒子45.1粒.2个月后采用CT评价,完全缓解(CR)7例,部分缓解(PR)10例,无变化(NC)1例,总有效率(CR PR)为94%(17/18). 结论 经皮穿刺放射性粒子组织间永久植入治疗中晚期肺癌为一种近期疗效满意、微创、低毒的新方法,值得进一步临床应用,长期观察.     

经会阴冷冻治疗激素难治性前列腺癌的近期疗效观察

目的 评价超声引导下经会阴冷冻治疗激素难治性前列腺癌的安全性和近期疗效.方法 超声引导下经会阴冷冻治疗激素难治性前列腺癌12例.以PSA、前列腺MRI和全身骨扫描作为评定指标,疗效评价包括完全反应(CR)、部分反应(PR)、病情稳定(SD)和病情恶化(PD).主观反应根据骨痛、排尿异常和血尿等症状的变化评定.分析其即刻和迟发并发症.结果 平均手术时间(105±34)min.均未输血.术后平均住院(6±2)d.随访6～30个月,平均18个月.CR 3例、PR 5例、SD 2例、PD 2例.本组总有效率(CR+PR) 66.7%,PSA无进展生存率 83.3%.主观反应均明显改善.拔除尿管后,控尿满意7例;5例尿失禁3～7 d后,恢复控尿.术后出现尿道坏死组织2例,尿道直肠瘘1例,会阴部不适1例.结论 超声引导下经会阴冷冻治疗激素难治性前列腺癌安全有效,但远期疗效尚需进一步观察后明确.     

放射性粒子组织间种植治疗肿瘤近期疗效

目的　探讨放射性粒子组织间种植治疗肿瘤临床应用的可行性。　方法　 6例腹腔或盆腔肿瘤实施开腹术中超声引导下粒子种植术 ,6例前列腺癌实施经会阴超声引导粒子种植术 ,6例人体浅表肿瘤实施超声引导粒子种植术 ,2例肝癌实施DSA粒子介入治疗术。　结果　随访 2月 ,6例前列腺癌前列腺特异抗原 (PSA) ,由术前 ( 46 95± 2 6 5 8)ng/ml降至( 11 5 1± 11 0 5 )ng/ml(t=3 0 16 ,P =0 0 13)。 14例实体瘤完全缓解率由 2 8 6 % ( 4/ 14) ,部分缓解率为 6 4 3% ( 9/ 14) ,失败 1例。无明显放射相关副作用。　结论　放射性粒子种植治疗肿瘤具有疗效高、创伤小、并发症发病率低等优点。     

Metastasis of cancer to cancer: Report of a case of esophageal carcinoma metastasizing to early gastric cancer

A rare case of esophageal carcinoma metastasizing to early gastric cancer is reported herein. A 66 year old man who had experienced dysphagia for 8 months was preoperatively diagnosed as simultaneously having esophageal and gastric cancers. Thus, a lower esophagectomy and total gastrectomy with paraesophageal and paragastric lymph node dissection were performed. The surgical specimen revealed an ulcerative tumor in the lower esophagus and a slightly depressed lesion with a central elevation similar to that of early type IIc+IIa¹ gastric cancer in the upper part of the stomach. Microscopically, the esophageal tumor was revealed to be well differentiated squamous cell carcinoma while the gastric tumor was found to be early gastric cancer with a metastatic focus of esophageal cancer in the center. Though less than one hundred cases of metastasis of cancer to cancer have previously been reported, metastasis from cancer of one digestive organ to that of another digestive organ is very rare. To our knowledge, this report represents the first case of an esophageal carcinoma metastasizing to a gastric carcinoma.     

Metastasis of thyroid cancer to primary lung cancer

We present a case of a 65-year-old woman whose thyroid cancer metastasized to the lesion of primary lung cancer. Ten years after total thyroidectomy for thyroid cancer, chest radiograph by medical checkup demonstrated three nodular lesions in the bilateral lung fields. Segmental resection of the left S6, partial resection of right S4 and left S10 were performed to remove those lesions. Histologically, small nodules in the right S4 and S10 were diagnosed as a metastatic tumor of thyroid and well differentiated adenocarcinoma, respectively. Left S6 lesion 1.5 cm in diameter was also diagnosed as well-differentiated adenocarcinoma (Noguchi type C), however, small metastatic foci of papillary adenocarcinoma was identified within the lesion which revealed to be “cancer in cancer metastasis”. Metastasis of cancer to another primary cancer is a rare event. We discuss interesting phenomenon of cancer in cancer metastasis with a review of the literature.     

Nutrition and pharyngeal cancer: results from a case-control study in Spain

BACKGROUND: Oropharyngeal and hypopharyngeal cancer is increasing all over the world, frequently affecting more and more women and younger individuals and not only the typical 50- to 60-year-old heavy smoker and drinking man. In addition, 5-year overall survival rate remains poor (30% to 40% in most series), despite advances in treatment. Therefore, it is crucial to understand as accurately as possible the risk factors for these malignancies to improve primary prevention. METHODS: We report the results from a case-control study of pharyngeal cancer risk factors conducted in Spain involving 232 consecutive patients who were gender- and age-matched with 232 controls. Data were collected by interviewer-administered personal interview. RESULTS: Our results show that low intake of fruit, fruit juice, uncooked vegetables, dietary fiber-containing foods (legume and cereals), fish, milk, and dairy products is an independent risk factor for pharyngeal cancer and that high consumption of meat and fried foods also increases the risk once data are adjusted for tobacco smoking and alcohol drinking. CONCLUSIONS: Although findings for fruit, juice, and uncooked vegetables are in accordance with those from other authors and can be explained on a biologic basis, the relationship between pharyngeal cancer and dietary excess of saturated fatty acids needs experimental investigation. Findings for milk, dairy products, and fish also warrant more detailed epidemiologic research because of conflicting data reported in the literature and because of the reportedly ambiguous role of retinol in human cancers. No conclusive explanations for the protective effect of dietary fiber-containing foods can be put forward today. Our results are uniquely attributable to oropharyngeal and hypopharyngeal cancers because of the small size of our nasopharyngeal cancer subsample.     

Metachronous Triple Cancers of the Sigmoid Colon, Stomach, and Esophagus: Report of a Case

(Received for publication on Feb. 10, 1999; accepted on Nov. 11, 1999)     

Synchronous or metachronous double cancers of the pancreas and other organs: Report on 12 cases

Pancreatic carcinoma carries a poor prognosis, especially invasive ductal carcinoma of the pancreas. This retrospective study describes the results of the treatment and prognosis for double cancers in which cancer of the pancreas was associated with malignancies in other organs in 12 patients who were diagnosed and treated at Kurume University Hospital. The patients included 4 women and 8 men, with an average age of 67 years. Of the 12 tumors, 7 were metachronous pancreatic cancers which occurred after resections of other organ malignancies. Five patients had synchronous double cancers, one of whom was diagnosed to have gastric cancer on admission. Two other patients of this group were diagnosed to have lung cancer, while the remaining 2 patients suffered from colon cancer. By the time pancreatic cancer was diagnosed, gastrectomies had been performed in 7 patients for either gastric cancer or ulcers. In addition, one patient underwent a hysterectomy for uterine carcinoma and another received a low anterior resection for rectal carcinoma. Four of 5 patients in the synchronous group had nonresectable tumors and a palliative bypass operation was performed in 2 of these patients. Six patients who had metachronous double cancers died because of pancreatic cancer recurrence or metastases. We conclude that the prognosis of double cancers, where cancer of the pancreas is associated with other organ malignancies, primarily depends on the prognosis of the pancreatic carcinoma, and the present study suggests the necessity of long-term follow-up examinations for gastrectomy patients in order to make an early diagnosis of pancreatic cancer. Received: September 24, 1999 / Accepted: March 24, 2000     

Surgery for breast cancer in the elderly--how relevant?

Studies suggest that elderly women receive less aggressive treatment, experience higher disease progression and mortality from breast cancer. We report on an experience of 256 consecutive cases of symptomatic breast cancer in a population of over 75 years of age. 142/256 patients underwent surgical intervention in the form of breast conserving surgery or mastectomy, 114/256 did not. Mean follow up was 6.4 years. Our results show a statistically significant association between surgery and survival (p = 0.05, CI 0.00046-0.19641) and a strong statistically significant association between surgery and disease progression/recurrence (p = 0.001, CI 0.08713-0.03145). Women treated conservatively are significantly less fit hence suffering high cancer unrelated mortality; as a consequence they suffer higher disease related progression and mortality. In our study surgical treatment with adjuvant endocrine and/or radiotherapy was associated with a statistically significant advantage in terms of disease related mortality and local disease control.     

“Clinical significance of multifocal and multicentric breast cancers and choice of surgical treatment: a retrospective study on a series of 1158 cases”

Background

The biological and clinical significance of multifocal and multicentric (MF/MC) breast cancers and the choice of appropriate surgical treatment for these tumors are still debated.

Methods

1158 women operated on for a stage I-III breast cancer were included in this retrospective study; clinical and pathological data were obtained from the institutional database of the Department of Oncology of the University of Siena, Italy. The impact of MF/MC breast cancers on patterns of recurrence and breast cancer specific survival (BCSS) was investigated in relation to the type of surgical treatment.

Results

MF and MC cancers were present in 131 cases (11.3%) and 60 cases (5.2%) respectively and were more frequently treated with mastectomy (55 MF and 60 MC cancers, 81.2%) than with breast conserving surgery (36 MF cancers, 18.9%; p < 0.001). MF and MC breast cancers were associated with a worse prognosis with a BCSS of 154 months compared to 204 months of unicentric cancers (p < 0.001). In multivariate analysis, MF/MC cancers were independent prognostic factors for BCSS together with higher number of metastatic axillary nodes, absence of estrogen receptors and high proliferative activity. MF and MC cancers were related to a significantly shorter BCSS in patients submitted to mastectomy as well as those submitted to breast conserving surgery. Relapse at any site was higher in the subgroup of MF and MC cancers but the incidence of loco-regional and distant recurrences did not differ between patients treated with mastectomy or breast conserving surgery.

Conclusions

Our results indicate that MF/MC cancers have a negative impact on prognosis and are related to higher loregional and distant relapse independently from the type of surgery performed. Adjuvant therapies did not modify the poorer outcome, but in patients receiving adjuvant anthacyclines, the differences with unicentric tumors were reduced. Our data support the hypothesis that MF/MC tumors may have a worse biological behavior and that the presence of multiple foci should be considered in planning adjuvant treatments.     

Avances en uro-oncología «OncoForum»: lo mejor de 2013

ObjectiveTo present the new findings in oncologic urology with impact on clinical practice which were displayed at 2013 major annual meetings (EAU, ESTRO, AUA, ASCO and ASTRO).MethodsThe abstracts on prostate kidney, bladder and upper tract urothelial cancer with the highest scores by the OncoForum committee, presented in 1013 Congresses are included in this paper.Resultsthe following messages were considered as important by the OncoUrology Forum committee. In renal tumors T1a, comorbidities should be evaluated by its impact on overall and specific cancer survival, especially in men over 65. In metastatic renal tumors, the benefit of Everolimus vs. Sunitinib has not been demonstrated. Patients with non-muscle invasive bladder cancer of high risk, with three or more risk factors, should be considered for radical cystectomy. The ERSPC study’ data demonstrate the benefit of the systematic screening in prostate cancer. In metastatic disease, the results of the Ra-223 and enzalutamide studies show benefit in pain control and overall survival in metastatic disease.ConclusionsLocalized renal and non-muscle invasive bladder of high-risk tumors, should be assessed according to comorbidities or oncologic risk factors, to determinate the adequate treatment options. New data from metastatic prostate cancer clinical trials have shown promising results in the control of the disease