头颈部侵袭性纤维瘤病放射治疗研究进展

侵袭性纤维瘤病（AF）为良性肿瘤,局部侵袭性强,治疗失败以局部复发为主。手术为头颈部AF的主要治疗手段,配合放疗能明显降低局部复发率。放疗适用于手术切缘阳性,手术后肉眼残留,手术近切缘,局部复发者,手术伤害大或不可手术切除者可行单纯放疗。放疗范围包括全部肿瘤或术床,外放范围依据周围解剖结构实际情况适当调整。放疗剂量为50~56 Gy。     

侵袭性纤维瘤病多学科综合诊疗研究进展CSCD

侵袭性纤维瘤病(aggressive fibromatosis,AF)是一种临床罕见的、起源于软组织的交界性肿瘤,尽管不具备远处转移能力,然而其局部侵袭性强,手术切除后复发率高,使临床治疗存在一定难度。近些年,随着对AF研究的不断深入,其治疗措施与管理模式发生了较大的变化。鉴于AF不可预测的自然病史,目前观察等待是指南推荐的一线治疗方案。此外,目前以手术根治性切除为主联合局部与全身系统性治疗等多学科综合诊疗模式可以在保留患者组织器官功能的同时,最大程度地控制肿瘤,延缓疾病的进展甚至达到根治。本文就AF的临床特征与诊疗进展展开综述。     

侵袭性纤维瘤的靶向治疗进展

侵袭性纤维瘤（aggressive fibromatosis,AF）,又称韧带样型纤维瘤病、韧带样肿瘤（desmoid tumor,DT）、肌肉腱膜纤维瘤病等。AF是一种介于良、恶性之间的肿瘤,虽然无包膜,局部浸润周围组织,可能是多灶性的,并且在术后易复发,但不易发生转移。目前,对于AF的治疗方法主要包括积极监测、手术、放疗、化疗、靶向治疗、内分泌与非甾体类药物治疗等。靶向治疗AF在过去的研究进展较为缓慢,疗效有限,因此通常被应用于其他常规治疗方法失败之后,作为补救治疗手段。但近年来随着靶向治疗基础研究的快速进展,一些新的靶向药物越来越多的用于AF的临床治疗,并且获得了较好的疗效。因此,如何预测这些靶向药物对AF治疗的疗效,其治疗机制又是如何,均是目前靶向治疗AF研究的热点。本文将就AF的靶向治疗新进展进行综述。      

老年侵袭性纤维瘤的临床特征与外科治疗

目的探讨60岁以上老年侵袭性纤维瘤(AF)患者的临床特征、手术疗效及生存预后。方法回顾性分析中国医学科学院北京协和医学院肿瘤医院2008年1月至2019年1月收治的22例老年AF患者的临床病理资料。结果22例患者中男10例,女12例;年龄60～80岁,平均年龄649岁。腹内型AF 6例,肿瘤均位于小肠系膜;腹壁型AF 1例;腹外型AF 15例,其中肿瘤位于胸壁4例,肩背臀部5例,头颈部6例。平均肿瘤直径为55 cm。切缘阳性者4例,分别位于头颈部2例、臀部1例、胸壁1例,其中3例患者术后行化疗／放疗。全组中位随访时间为37个月,共4例患者在我院手术后复发,均为腹外型AF。其中,复治者3例,切缘阳性者2例。中位复发时间为25个月,随访期间1例患者死于肿瘤复发。结论老年AF患者通过根治性手术切除可获得令人满意的治疗效果。初次手术疗效对老年AF患者至关重要,在尽可能保留器官组织功能的前提下确保足够手术切除范围。对于无法达到R0切除的患者,应考虑术后辅助治疗以控制局部复发。     

侵袭性纤维瘤病的临床诊治

侵袭性纤维瘤病（aggressive fibromatosis,AF）又被称为硬纤维瘤、韧带瘤（desmoid－type fibromatosis,DF）,是一种少见的肌成纤维细胞单克隆增殖性肿瘤［1－4］。 AF 属于交界性肿瘤,好发于育龄期女性,可发生于全身各个部位,常见于四肢、腹壁、腹腔。它以局部侵袭性生长和容易局部复发为主要特点,不发生远处转移［1－4］。其发病机制尚未完全明确,目前认为 Wnt／β－catenin／APC 信号通路的激活在 AF发生发展过程中起重要作用［1－4］。既往手术是治疗AF 的主要手段,其他包括放疗、化疗、内分泌治疗及非甾体类抗炎药（non－steroidal antiinflammatory drugs,NSAIDs）等治疗。随着近年来对AF 研究的逐渐深入,其治疗和管理策略发生了很大变化。本文详细阐述AF 的临床特点、发病机制及治疗策略。     

舒尼替尼治疗肝癌引起病灶大面积坏死1例

肝细胞癌（hepatocellular carcinoma,HCC）是我国最常见的恶性肿瘤之一,目前手术切除仍是获得长期生存最重要的手段,但由于其起病隐匿,发展迅速,60％的患者确诊时已处于晚期,失去手术机会;即使能够手术切除,其复发率仍较高,因此药物治疗占有重要的地位。索拉非尼是唯一被多个国家批准用于治疗晚期不能手术HCC的分子靶向药物。     

奥沙利铂对大肠癌化疗敏感性的实验观察

大肠癌是严重威胁人类健康、发病率呈上升趋势的常见恶性肿瘤之一。目前外科手术仍然是治疗大肠癌的主要手段,但有相当多的患者就诊时已属晚期,失去手术的机会;接受根治术后的患者仍有较高的复发率,因此化疗在大肠癌的治疗中占有十分重要的地位。奥沙利铂(OXA,Eloxatin)作为第三代铂类抗癌药,对中、晚期大肠癌的治疗有较好的效果。我们采用组织块培养-终点染色-计算机图像分析法(TECIA)进行了大肠癌对奥沙利铂等7种化疗药物的体外药物敏感性试验,前瞻性地观察奥沙利铂和其他化疗药物对大肠癌的敏感和耐受情况,为临床进行有效的个体性化…     

乳腺癌内分泌治疗的进展

乳腺癌的治疗包括手术、内分泌治疗、化疗、放疗等。内分泌治疗是一种姑息性的治疗手段,主要适宜晚期患者,其疗法分为去势治疗和药物治疗二大类。近十多年来在乳腺癌内分泌治疗的领域里     

成釉细胞瘤的非手术治疗进展北大核心CSCD

成釉细胞瘤是较为常见的牙源性良性肿瘤, 具有局部浸润生长﹑易复发、转移等特性。目前, 主要治疗方式是扩大性骨切除术, 但术后复发率高, 且易出现面部、功能畸形等诸多并发症。对于无法手术患者, 放疗、化学药物、靶向治疗等治疗可在保留器官下改善预后, 本文复习成釉细胞瘤的非手术治疗现状和进展, 为成釉细胞瘤个体化治疗提供依据。     

Ⅰ、Ⅱ期卵巢交界性肿瘤93例临床分析

目的探讨Ⅰ、Ⅱ期卵巢交界性肿瘤(BOTs)的治疗方法及影响复发和预后的因素。方法回顾性分析93例Ⅰ、Ⅱ期BOTs患者的临床资料。结果Ⅰ期BOTs患者87例(93.5%),Ⅱ期6例(6.5%)。病理类型以浆液性39例(41.9%)和黏液性肿瘤46例(49.5%)为主。所有患者均行手术治疗,38例(40.9%)行保守性手术,55例(59.1%)行根治性手术。93例中24例行术后辅助化疗,Ⅰ期22例,Ⅱ期2例。93例中5例复发,复发率为5.4%,均为Ⅰ期行保守性手术且术后未行化疗的患者,平均复发时间为39.8个月(12~72个月),中位复发时间为36个月,无1例死亡。结论Ⅰ、Ⅱ期BOTs预后良好,手术是其主要的治疗手段,保守性手术治疗虽然会影响复发率,但不影响生存期;对有高危因素患者,术后短期内给予化疗,可减少复发,但不能改变患者预后。     

不同治疗方法对前列腺癌合并房颤的影响 及预防策略研究进展

心房颤动(AF)是临床上最常见的心律失常。随着人口老龄化,发病率呈逐年上升趋势。AF风险增加的相关危险因素包括老年、肥胖、糖尿病、高血压和癌症等。研究表明,在所有年龄组中,伴发AF癌症患者的死亡率、住院费用和住院时间均高于非AF患者。前列腺癌(PCa)患者全身炎性反应增加、电解质异常和神经激素变化,导致其AF发生率明显高于其他癌症。前列腺癌手术、化疗和放疗也可能增加AF的风险。本综述系统收集相关文献,了解PCa患者发生AF的机制,确定PCa与AF之间的关系及其对住院预后的影响,为防治PCa患者发生AF提供策略。     

低级别胶质瘤的治疗决策

低级别胶质瘤是常见的颅内肿瘤，虽然常被认为是良性肿瘤，但低级别胶质瘤患者临床预后差异极大．而且世界范围内对于低级别胶质瘤的治疗仍有较大争议。是否所有低级别胶质瘤都需要手术治疗？手术后是否需要辅以放疗？化疗是否必要？化疗能否替代放射治疗？还需要多中心大样本的前瞻性研究获得证据。而深入了解低级别胶质瘤的分子生物学特征，采用适当的技术显示其恶性进展的特征对治疗决策十分有用。     

喉鳞癌治疗后原发灶复发的相关因素分析

背景与目的:分析与喉鳞癌治疗后原发灶复发相关的因素。方法:回顾1990年～1995年于原中山医科大学肿瘤防治中心住院治疗的喉鳞癌病例166例。治疗后随访满6个月以上病理活检证实原发灶出现复发者定为喉癌治疗后复发病例。分析与喉癌治疗后原发灶复发可能相关的因素,包括年龄、病理分化、病变部位、分期、治疗方式、手术术式、切缘、放疗等。结果:本组病例治疗后原发灶复发率为16.3%(27/166)。治疗方式中原发灶行单纯放疗、单纯手术和综合治疗的原发灶复发率分别为50%、8.9%和14.1%,存在显著差异(P<0.05)。原发灶行手术治疗和非手术治疗(包括放疗以及放疗加化疗)的复发率分别为11.3%和44%,存在显著差别(P<0.05)。对比不同治疗方式间T分期显示单纯放疗较单纯手术和综合治疗原发灶的T分期相对较早(P<0.05)。术后切缘阳性和阴性的原发灶复发率分别为34.8%和6.1%,具有显著性差别(P<0.05)。结论:原发灶的处理方式直接影响治疗后原发灶的复发,原发灶手术治疗相对非手术治疗对原发灶的控制较好,喉鳞癌原发灶单纯放疗后复发的机会较大。手术切除的干净程度直接影响对原发灶的控制。     

Laparoscopic Approach in Management of Renal Cell Carcinoma During Pregnancy: State of the Art

Renal cell carcinoma (RCC) is extremely rare in pregnant women. However, this is one of the most reported urologic tumors during pregnancy. The aim of this review was to evaluate RCC during pregnancy in terms of epidemiology, risk factors, diagnosis, natural history of disease, and the safety of laparoscopic approach in the management of this tumor. RCC presentation is frequently made incidentally during an ultrasonography performed for other reasons, such as hydronephrosis owing to non-neoplastic causes. The optimal time for surgery during pregnancy and the consequences of surgery on the maternal and fetal well-being are major considerations. Risks for adverse pregnancy outcomes should be explained, and the patient’s decision about pregnancy termination should be considered. Ultrasound is good in diagnosing renal masses, with a sensitivity comparable to that of computed tomography only for exophytic masses larger than 3 cm. Magnetic resonance imaging is reproducible and a good, though expensive, alternative to computed tomography scans for the evaluation of renal lesions in pregnant women. Radical nephrectomy or nephron-sparing surgery are essential treatments for management of RCC. Laparoscopic surgery has historically been considered dangerous during pregnancy and avoided whenever possible, because of concerns regarding surgery-related risks, such as uterine injury, miscarriage, teratogenesis, preterm birth, and hypercapnia. The laparoscopic treatment during pregnancy is becoming increasingly accepted where feasible with low morbidity. However, the combination of a multidisciplinary approach, multi-specialty communication, and skilled surgeons can give the best possible outcomes for mother and fetus.     

Pediatric aggressive fibromatosis: a retrospective analysis of 13 patients and review of literature

BACKGROUND: Aggressive fibromatosis (AF) is a soft tissue tumor and is rare in childhood, with high potential for local invasiveness and recurrence. General recommendations for the clinical management of pediatric patients with AF remain undetermined. METHODS: The authors retrospectively analyzed 13 children with AF who were diagnosed from 1987 until 2004 in the Erasmus MC-Sophia Children's Hospital, and a review of the pediatric literature was conducted. RESULTS: Two patients received preoperative chemotherapy with combined vincristine, actinomycin-D, and cyclophosphamide (VAC). All 13 patients underwent surgery. Three of six patients who underwent incomplete resection received adjuvant treatment, two patients received radiotherapy, and one patient received chemotherapy (VAC). The median follow-up was 3.9 years (range, 0.6-14.0 years). Three patients developed recurrent AF, including two recurrences after patients underwent incomplete resection without adjuvant treatment. Secondary resection was performed, which was incomplete in one patient who subsequently received chemotherapy (VAC). At the time of the current report, all 13 patients were in complete remission. Ten pediatric AF studies, including the current study, with a total of 187 patients were reviewed. Incomplete resection was the most important determinant for disease recurrence; in the authors' opinion, the role of adjuvant therapy needs to be studied further. CONCLUSIONS: Primary surgery with negative surgical margins was found to be the most successful primary treatment modality for children with AF. Positive margins after surgery indicated a high risk for disease recurrence. Multicenter, prospective (randomized) trials will be necessary to clarify the role of adjuvant treatment for patients with pediatric AF.     

肺癌肉瘤（附18例临床分析）

目的：通过１８例肺癌肉瘤诊治，提高对罕见疾病癌肉瘤诊断，治疗及预后的认识，方法：回顾性分析１８例肺癌肉瘤的临床表现，病理类型，Ｘ线特征及３例患和抑癌基因Ｐ５３和Ｐ１６的表达，并对其，治疗及随访情况进行分析。结果：肺癌肉瘤临床特征及Ｘ线表现与原发性肺癌相似，但淋巴道转移较少，其ｐ５３和ｐ１６基因表达均未见异常突变，平均随访７年，其１年存活率为７２．２％（１３／１８），３年生存率为６１．２％（１１／１８），５年生存率为４６．７％（７／１５），结论：肺癌肉瘤预后与非小细胞肺癌相似，手术仍是首选治疗方式。     

胸腺瘤非手术治疗的研究进展

对于不能手术的胸腺瘤患者常采用放疗、化疗、免疫治疗及靶向治疗等非手术治疗或综合治疗。对于局部晚期胸腺瘤,首选手术治疗,术后辅助放化疗;不能手术的患者可先行诱导治疗,再予以手术治疗和术后辅助放化疗。目前,胸腺瘤尚无统一的治疗标准,临床还处于研究探索阶段。本研究就胸腺瘤非手术治疗的预后进行综述,以期为临床治疗提供参考。     

Altered fractionation

For improving radiotherapy treatment results, altered fractionation (AF) is one of the most important biological factors to modify the conventional fractionation schedule. AF is classified into two categories. One is decreasing in dose-per-fraction and increasing in total dose, so-called hyperfractionation (HF), which expands the difference in radio-sensitivity between tumor and normal tissue. On the other hand, shortening of overall treatment time, so-called accelerated hyperfractionation (AHF), prevents accelerated repopulation of tumor cells during radiotherapy. AF is rarely recognized as a standard therapy despite many reports about its efficacy against various cancers, totally. This is often used for head and neck cancer. However, the problem is that they usually improve local-control, but do not always improve survival. Although AHF is recognized as one of a standard treatment for small cell lung cancer, it is still objectionable and disputable. Besides these, efficacy of AF against non-small cell lung cancer, bladder cancer and malignant glioma, has been reported. However, AF is not considered as a standard treatment. Accompanied with spread out of stereotactic irradiation, dose-fractionation-time relationship becomes to be more important subject, especially hypofractionation, to clarify the new aspect of AF.