男性肺癌血中内分泌激素的测定

从１９９１年１０月－１９９３年６月对４５岁以上男性，４４例正常人和８７例肺癌患者血中８种内分泌激素进行测定，肺癌病人治疗前Ｃｏｒｔ、β－ＨＣ、Ｇｌｕｃ和ＰＲＬ明显高于正常人群。８７例肺癌治疗前按不同病理比较，腺癌β－ＨＣＧ明显高于其它病理类型，鳞癌ＰＲＬ高于其它，小细胞未分化Ｇａｓｔ高于其它。４３例肺癌治疗后，ＴＳＨ、ＰＲＬ、Ｃｏｒｔ和Ｇｌｕｅ都明显降低，而ＧＨ则升高，１１例治疗后肿瘤复又增大或远处转移的肺癌患者，再次测定激素水平表明，ＰＲＬ、Ｃｏｒｔ和Ｇｌｕｅ复又升高。这些结果说明部分内分泌激素，可用于男性肺癌的早期诊断或鉴别诊断，有些激素可作为肺癌病理分类的参考。     

乳腺癌内分泌治疗中激素受体问题

雌激素受体(ｅｓｔｒｏｇｅｎｒｅｃｅｐｔｏｒ,ＥＲ)已被作为乳腺癌内分泌治疗和预后评估的一个重要指征。近年来的研究已取得显著进展,特别是有关实际应用中存在的一些问题,许多已有较明确的解释。现就一些有关新认识、新进展做一概要综述。一、雌激素、激素受体与乳腺癌1896年Ｂｅｎｔｓｏｎ发现乳腺细胞的增生及癌变与激素密切相关,并观察到切除卵巢可使进展期乳腺癌消退。1967年Ｊｅｎｓｅｎ发现人类乳腺癌中含有ＥＲ。这一发现把乳腺癌内分泌治疗推向了崭新的阶段,使内分泌治疗变得有的放矢,疗效明显提高。研究证明,有的肿瘤细胞恶变…     

肺癌和异位激素

不是正常产生激素的组织,合成以及分泌的激素称为异位激素.常见于各种恶性肿瘤如肺癌、胃癌、肝癌、乳腺癌等。确定正常和异位激素分泌的标准是:(1)肿瘤组织中的激素浓度比其周围正常组织中高;(2)瘤组织中的激素能作出免疫组化定位;(3)肿瘤切除后激素消失或减少,(4)穿过肿瘤床的动静脉血中存在激素浓度差;(5)离体培养或移植肿瘤组织证明能分泌激素。迄今为至,发现的肺癌异位激素有:ACTH、ADH、PTH、降钙素(CT)、生长激素(STH),促甲状腺激素(TSH)     

胃癌中神经内分泌激素与癌转移关系的探讨

胃癌中神经内分泌激素与癌转移关系的探讨王鲁平１虞积耀２郑集义２田玉旺１吴霞１邓永江胃癌中存在有神经内分泌（Ｎｅｕｒｏｅｎｄｏｃｒｅｎｅ简称ＮＥ）细胞，一些作者认为胃癌中ＮＥ细胞分泌的激素与胃癌的生物学行为有关，本文报道应用组织学，免疫组织化学方法对胃...     

内分泌药物治疗激素依赖性晚期乳腺癌长期获益1例

1 病例介绍患者,女性,59岁,双乳腺癌术后,肝转移,肺转移,淋巴结转移,胸壁转移,左胸腔积液。患者于1997年8月于外院行右乳腺癌改良根治术,术后病理:浸润性导管癌,同侧腋窝淋巴结转移2/9,免疫组化ER(±)、PR( )。术后在外院曾行CMF辅助化疗、白细胞介素治疗。1998年5月左锁上淋巴结转移。1998年5月来我院行法乐通治疗,病情稳定2个月。1998年7月改用甲孕酮治疗,病情稳定10个月。1999年5月右锁骨上淋巴结转移、肺转移。于1999年6月行氨鲁米特治疗,病情稳定5个月。于2000年4月行兰他隆治疗,病情稳定6个月。2000年10月患者左乳行X线检查见一…     

乳腺癌与乳腺增生病某些内分泌激素的差异及其临床意义

目的通过比较乳腺癌与乳腺增生病患者内分泌激素变化,对内分泌激素与免疫系统的关系进行初步分析. 方法随机选取绝经前和绝经后的乳腺癌患者各28例、乳腺增生病患者各22例,在治疗前采血样,对垂体激素6项（PRL、GH、TSH、ACTH、FSH、LH）和性类固醇激素3项（E2、P、T）进行检测,采用秩和检验,正态近似法（Wilcoxon法）对结果行统计学分析. 结果绝经前乳腺癌患者FSH 水平高于乳腺增生患者,其它垂体激素（PRL,GH,TSH,ACTH,LH ）和性类固醇激素（E2,T,P）水平无显著性差异（P〉0.05）.绝经后乳腺癌患者ACTH水平高于乳腺增生病患者,其它垂体激素（PRL,GH,TSH,FSH, LH）和性类固醇激素（E2,T, P） 比较含量无显著差异（P〉0.05）.结论绝经前乳腺癌患者血浆中的FSH和绝经后乳腺癌患者ACTH水平高于乳腺增生病患者,说明乳腺癌患者内分泌激素与免疫系统之间正常规律被打破.下丘脑-垂体-肾上腺轴（HPA）短、长反馈失调,使免疫功能受抑制;雌激素诱导癌细胞基因突变,雄激素刺激细胞的敏感性增加,加速乳腺癌的发展.     

16例大细胞神经内分泌肺癌临床分析

目的分析肺大细胞神经内分泌癌(LCNEC)的临床特点以及治疗和生存特征。方法回顾性分析从1999年(2010年中国医学科学院肿瘤医院16例经病理学确诊LCNEC患者的临床相关因素。结果回顾性分析从1999年至2010年中国医学科学院肿瘤医院16例经病理学确诊为LCNEC患者的临床相关因素。结果 16例患者的中位年龄为59岁(42～77岁),男女之比为15:1,所有男性患者均为重度吸烟者。ⅠB期5例、ⅡA期1例、ⅡB期1例、ⅢA期3例、ⅢB期3例、Ⅳ期3例。16例患者中,13例经手术治疗,术后多数接受了辅助化、放疗;3例仅接受非手术治疗,其中2例接受化、放疗,1例Ⅰ期患者拒绝手术,仅接受放射治疗。中位随访时间为13.7个月,患者生存时间从7～39个月。截至2010年底末次随访时,仍然有9例患者存活,只有1名患者生存时间超过5年,所以尚未获得中位生存时间。结论 LCNEC是一种高度恶性内分泌肿瘤,预后不佳。LCNEC发病率很低,故应该对其发病情况、预后以及最佳的治疗策略进行深入探讨。     

小细胞肺癌神经内分泌起源标志物的研究进展

[摘要] 小细胞肺癌（small cell lung cancer,SCLC）具有生长分数高、倍增时间短、侵袭性极高的特点,往往在诊断该病的时候就已发生远处转移,若不对其病情进行及时有效的治疗,患者将在2~3 个月内死亡。如果SCLC能够在局限期得到诊断,那么将有20%～25%的患者在接受联合化疗与放疗后,可以获得一个较长生存期。因此,寻找特异性和敏感性高的血液肿瘤标志物,为SCLC早期诊断提供可靠、简便、安全、耐受性好等依据对治疗SCLC极其重要。本文就近年来SCLC神经内分泌起源标志物嗜铬粒蛋白A、神经特异性烯醇化酶、促胃泌素释放肽、脑型肌酸激酶同工酶BB、神经细胞黏附分子、突触素等的研究进展进行综述。     

肺癌放射治疗的进展

放射治疗是多年来治疗肺癌的有效手段之一,通过足量放射绝大部分病例的肿瘤病灶得以控制,获得满意的近期疗效,有些病例可获得较好的远期疗效。现综述肺癌放射治疗的有关进展。     

Endocrine therapy for male breast cancer: rates of toxicity and adherence

Purpose

Most male breast cancer tumours are hormone receptor–positive; the patients therefore receive endocrine therapy. There is, however, a paucity of published data on toxicities experienced by male breast cancer patients who are prescribed endocrine therapy. In the present study, we examined rates of adherence to and toxicity from endocrine treatments in male breast cancer patients treated at a single institution.

Patients and Methods

We conducted a retrospective study of male patients diagnosed with breast cancer at The Ottawa Hospital Cancer Centre during 1981–2003. Data collected included patient age, hormone receptor status, therapy adherence, self-reported toxicities, and type and duration of endocrine therapies.

Results

The review located 59 cases of early-stage and metastatic male breast cancer. Median patient age was 68.0 years. Tamoxifen was given to 38 patients (64.4%), anastrozole to 8 (13.6%), and letrozole to 5 (8.5%). Of patients who received endocrine therapy, 10 (25%) received adjuvant systemic chemotherapy. Toxicity was reported by 19 patients taking tamoxifen (50%), with hot flashes being the most common complaint (18.4%). Decreased libido, weight gain, and malaise were reported by 5 patients (13.2%). Rash and erectile dysfunction were reported by 3 patients (7.9%). Increased liver enzymes, pulmonary embolism, superficial thrombophlebitis, myalgia, depression, visual blurring, and loose stools were each reported in 1 patient (2.6%). Tamoxifen therapy was discontinued secondary to toxicity in 9 patients (23.7%). Of the patients treated with anastrozole, 3 (37.5%) reported toxicity, with 1 report each of decreased libido, leg swelling, and depression (12.5%). Toxicity was reported in 2 patients taking letrozole (40%), with both reporting peripheral edema, and 1 reporting hot flashes. No patient discontinued anastrozole or letrozole because of toxicity.

Conclusions

Few studies specifically report data on adherence to and toxicities from endocrine therapies in male breast cancer patients. The rate of discontinuation at our institution because of toxicity (23.7%) is similar to that reported in the female breast cancer population. Future prospective studies should explore strategies to improve adherence to endocrine therapy in this population.     

The delineation of target volumes for radiotherapy of lung cancer patients

Purpose

Differences in the delineation of the gross target volume (GTV) and planning target volume (PTV) in patients with non-small-cell lung cancer are considerable. The focus of this work is on the analysis of observer-related reasons while controlling for other variables.

Methods

In three consecutive patients, eighteen physicians from fourteen different departments delineated the GTV and PTV in CT-slices using a detailed instruction for target delineation. Differences in the volumes, the delineated anatomic lymph node compartments and differences in every delineated pixel of the contoured volumes in the CT-slices (pixel-by-pixel-analysis) were evaluated for different groups: ten radiation oncologists from ten departments (ROs), four haematologic oncologists and chest physicians from four departments (HOs) and five radiation oncologists from one department (RO1D).

Results

Agreement (overlap ? 70% of the contoured pixels) for the GTV and PTV delineation was found in 16.3% and 23.7% (ROs), 30.4% and 38.6% (HOs) and 32.8% and 35.9% (RO1D), respectively.

Conclusion

A large interobserver variability in the PTV and much more in the GTV delineation were observed in spite of a detailed instruction for delineation. The variability was smallest for group ROID where due to repeated discussions and uniform teaching a better agreement was achieved.     

肺灌注显像检查预测肺癌放射性肺损伤的价值

目的探讨肺癌患者肺灌注显像的特点及其放射治疗过程中的变化,观察其与放射性肺损伤发生的关系。方法31例接受根治性放疗的肺癌患者接受了肺灌注显像检查,其中8例仅在放疗前接受了此项检查。以照射前后计算区域的肺灌注平均计数值占相应全肺平均计数值的百分比,比较照射前后肺灌注的变化。放射性肺损伤的评价按美国肿瘤放射治疗组（RTOG）急性放射性肺炎标准评定。结果31例患者中,中央型22例,周围型9例。病理类型：鳞癌12例,腺癌1例,小细胞肺癌15例,未分型3例。Ⅰ、Ⅱ期8例,Ⅲa期9例,Ⅲb期14例。行适形放疗26例,常规放疗5例;照射剂量32—72Gy,中位剂量58Gy。6例发生2级或3级放射性肺炎,无放射性肺炎死亡病例。全部患者治疗前均有不同程度的灌注受损,中央型肺癌患者灌注受损范围≥2级者占68．2％（15／99）,而周围型仅占22．2％（2／9,P=0．04）。受损范围为1级和2级以上者,分别有40．0％（6／15）和37．5％（6／16）的患者发生2级以上放射性肺损伤。在两次行肺灌注检查的23例中,肺灌注受损有所改善者占70．0％（16／23）,其中2级以上放射性肺炎发生率为31．3％（5／16）;在肺灌注受损加重者中,2级以上放射性肺炎发生率为42．9％（3／7）。结论灌注受损是肺癌患者的常见表现,中央型肺癌灌注受损较重,放射治疗后多数病例肺灌注受损有所改善;放疗前和放疗中,肺灌注受损范围的变化和放射性肺损伤的发生无明显相关性。     

绝经前激素受体阳性乳腺癌内分泌治疗现状

内分泌治疗是激素受体阳性乳腺癌患者术后辅助治疗的重要手段之一。在内分泌治疗的背景下,接受5年他莫昔芬治疗一直是绝经前患者的标准治疗方案。近年来,这一标准受到挑战。许多大型随机临床试验结果为绝经前患者辅助内分泌治疗提出了新的选择。本文拟将绝经前激素受体阳性乳腺癌患者的内分泌治疗现状做一综述。     

肺癌与食管癌螺旋断层放疗致放射性肺炎的临床观察

目的 探讨螺旋断层放疗（HT）治疗肺癌与食管癌致放射性肺炎的发生情况及与双肺剂量体积（DVH）和临床病理特征的关系。方法 回顾性分析HT 治疗的19例肺癌和14食管癌患者的临床资料。全组患者中13例仅行HT治疗,20例联合化疗。放疗剂量：小细胞肺癌54～61.8Gy／27～28次,非小细胞肺癌54～66Gy／25～31次,食管癌60～66Gy／28～30次。结果 全组33例患者中,发生0级放射性肺炎8例（24.2％）,1级15例（45.4％）,2级1例（3.0％）,3级5例（15.2％）,5级4例（12.1％）。DVH参数分析显示,发生≥2级放射性肺炎与V30～V45有关,与V5～V25、双肺平均剂量（MLD）、计划靶区（PTV）无关。临床病理特征中,发生≥2级放射性肺炎与ECOG评分有关,与病种、性别、年龄、吸烟、慢性阻塞性肺病和化疗情况无关。结论 HT治疗肺癌与食管癌未明显增加放射性肺炎的发生率,一般状态差、分期晚的患者应严格限制DVH。     

Once-a-week irradiation for locally advanced lung cancer

Twenty-eight patients with very advanced lung cancer were treated with 500 rad once weekly to a total dose of 6000 rad (2050 ret). Twenty-one of the 28 patients (75%) achieved at least a partial local response. There were 9 patients (32%) who achieved a complete response and 12 patients (43%) who achieved a partial response. The responses were 9/11 for squamous cell carcinoma, 5/10 for adenocarcinoma, 5/5 for large cell carcinoma, and 2/2 for small cell carcinoma patients. Treatment was very well tolerated and in fact, no acute radiation related complications were observed during the 10-12 week treatment duration. Radiation induced fibrosis of various degrees has occurred but it has been mostly asymptomatic and similar to what is normally seen using conventional continuous schedules. In this group of very advanced lung cancer patients, failures have mostly resulted from metastatic progression; only one patient progressed locally in the irradiated field without evidence of metastatic disease. A preliminary analysis indicates that this treatment yields results that are similar to those achieved with conventional fractionation regimens and should be explored further.     

Reassessment of radiation therapy for the management of lung cancer in patients with chronic pulmonary disease

Surgery has remained the mainstay of definitive treatment for lung cancer. Radiation therapy has been advocated when the location of the lung cancer precludes resection or the severity or the cardiopulmonary impairment indicates that the patient cannot withstand the proposed resection. Extended field irradiation has been shown to improve tumor control and survival. However, in patients with chronic pulmonary disease, extended field irradiation may exacerbate pulmonary insufficiency and compromise survival. Between 1975 and 1980, 29 patients with lung cancer and chronic pulmonary disease were treated by involved field irradiation (IFR). This was compared to the experience of 41 patients who had been treated prior to 1975 by extended field irradiation (EFR). The frequency of subjective response and tumor control were comparable in each group. One patient treated by IFR developed a marginal recurrence. Radiation pneumonitis was observed in $\text{7}\text{14}$ (17%) EFR patients versus $\text{2}\text{29}$ (7%) IFR. Treatment related death occurred in $\text{2}\text{41}$ (5%) EFR versus $\text{1}\text{29}$ (3.3%) [FR. One year disease free survival was $\text{8}\text{41}$ (19%) EFR values $\text{12}\text{29}$ (41 % ) IFR. Two of 14 (14 %) [FR patients at risk five years are alive without evidence of disease.     

Results of A trial with topotecan dose escalation and concurrent thoracic radiation therapy for locally advanced, inoperable nonsmall cell lung cancer

: To conduct a dose escalation clinical study with topotecan and concurrent standard dose thoracic irradiation to assess its feasibility and toxicity in the treatment of patients with locally advanced, inoperable nonsmall cell lung cancer (NSCLCA).

: Between April 1993 and August 1994, 12 patients with inoperable, loco-regionally advanced NSCLCA were entered in a prospective dose escalation trial and assigned to receive concurrent thoracic radiotherapy and topotecan. Patients received thoracic irradiation to a total tumor dose of 60 Gy in 30 fractions. Initial fields were to encompass the gross disease plus the mediastinum. Topotecan was delivered by bolus injection days 1 through 5, and days 22 through 26, beginning on the same day as the radiation therapy. The initial dose level was 0.5 mg/m². Two additional dose levels of 0.75 mg/m² and 1.0 mg/m² were tested.

: Six patients were accessioned to the 0.5 mg/m² dose level, three patients to the 0.75 mg/m² dose level, and three patients to the 1.0 mg/m² dose level. At the 0.5 mg/m² dose level, zero of six patients had ≥Grade 4 hematologic toxicity. One of the six had Grade 3 esophagitis. At the 0.75 mg/m² dose level, two of three patients had ≥Grade 3 nonhematologic toxicity including anorexia, fatigue, nausea, vomiting, and weakness; zero patients experienced ≥Grade 4 hematologic toxicity. At the 1.0 mg/m² dose level one of three patients had ≥Grade 3 esophagitis, and two of three patients experienced Grade 4 neutropenia. With a follow-up of 12 to 24 months, two patients are alive and free of disease, three patients are alive with disease (two with distant metastasis, one with local disease and distant metastasis), and the remaining seven patients are dead of disease.

: The combination of topotecan and thoracic radiotherapy for nonsmall lung cancer, in the manner given by this protocol, could be safely given at a dose level of only 0.5 mg/m² days 1 to 5 and 22 to 26 with 60 Gy of external beam radiotherapy. Higher doses of topotecan were associated with high hematologic and gastrointestinal toxicity. Distant metastasis was the primary pattern of failure.     

Endocrine therapy of metastatic breast cancer

Breast cancer growth and dissemination is regulated by estrogen and different growth factor receptor signalling pathways. The increasing knowledge of the biology of breast cancer regarding the interaction of these signalling pathways provides a tool to understand endocrine therapies response and resistance mechanisms. In patients with slowly progressive disease, no visceral involvement, and minimal symptoms, endocrine therapy could be the strategy of choice, even if the tumor has low estrogen receptor expression. Ovarian suppression and tamoxifen are recommended for premenopausal patients whether aromatase inhibitors are the option for postmenopausal ones. Chemotherapy still remains as the right alternative for hormone unresponsive or resistant patients. This is a review focused on the different strategies and combinations of endocrine therapies for metastatic breast cancer patients considering the potential strategies clinically tested to overcome resistance and the different treatments of choice available for each scenario of disseminated disease.