同步加量放疗技术在非小细胞肺癌脑转移患者中的应用

目的:评估同步加量放疗技术在非小细胞肺癌（non-small cell lung cancer,NSCLC）脑转移应用中的临床疗效、不良反应、生存时间,探索该技术的可行性。方法:76例NSCLC脑转移患者以不同分割模式分为A组（42例）和B组（34例）。A组患者全脑放疗DT 40Gy/（20f·4周）后局部推量DT 20Gy/（10f·2周）,B组患者全脑放疗DT 36Gy/（20f·4周）全程同步加量适形放疗DT 24Gy/（20f·4周）。比较两组放疗疗效、不良反应、半年、1年总生存率。结果:采用 RECIST 1.1标准,A组放疗有效率为95.2%(40/42),B组有效率为97.1%（33/34）,两组疗效未见统计学差异。A、B两组患者在血液毒性、神经系统受损、消化道反应、脱发等方面均未见明显异常。A组中位生存时间为8.94个月,患者半年、1年生存率为71.4%、35.7%;B组患者中位生存时间为9.47个月,半年、1年生存率为82.4%、38.2%,两组无统计学差异。结论:两种分割模式在临床疗效、不良反应、生存时间方面疗效相当。全脑照射全程同步加量治疗脑转移近期疗效确切,患者耐受性很好,可缩短放疗时间。     

术前同步放化疗在局部晚期直肠癌治疗中的价值

目的 探讨术前放化疗联合手术治疗局部晚期直肠癌的临床价值。方法 对22 例术前应用放疗（剂量45Gy/5周）和mFOLFOX 方案（奥沙利铂130mg/m2,dl,静脉滴注;甲酞四氢叶酸钙200mg, dl～d3,静脉滴注;氟尿嘧啶500mg/m2, dl～d3,静脉滴注;每3 周重复,共行2 个周期）进行新辅助治疗的局部晚期直肠癌患者资料进行分析。结果 低位前切除术16 例,保肛率72.7%,腹会阴联合切除6例。肿瘤完全消退3例（13.6 %),肿瘤部分缓解10例（45.5%),治疗有效率为59.1% (13/22。肿瘤分期降低13例,降期率为59.1％。结论 对局部晚期直肠癌采用新辅助治疗可使肿瘤不同程度消退,分期降低,提高保肛率。     

直肠癌短程放疗研究进展

局部晚期直肠癌的标准治疗方式为术前放疗联合手术治疗,术前放疗包括长程放疗与短程放疗两种方式。两种方式各有利弊,本文就相关文献及指南进行综述,以为直肠癌术前放疗方式的选择提供依据。     

真空垫联合CIVCO俯卧位托架在直肠癌放疗摆位中的应用

目的:改进CIVCO俯卧位托架在直肠癌中应用方法,探究真空垫与CIVCO俯卧位托架联合使用(改进型固定组A)与单独使用CIVCO俯卧位托架(一般型固定组B)摆位误差差异,制定真空垫固定下肢流程与要求。方法:基于CBCT(cone beam CT),采集摆位误差数据,回顾性选取2021年10月至2023年4月行俯卧位直肠癌放射治疗患者。改进型固定组32例,一般型固定组32例;两组中又以BMI(body mass index):24 kg/m²为分界值进行亚组分类(肥胖体态A₁、B₁,普通体态A₂、B₂)。通过统计学方法两独立样本t检验,分别比较两组患者在X(lateral, LAT)、Y(length, LNG)、Z(vertal, VRT)三方向摆位误差均值差异;比较亚组间在X、Y、Z三方向摆位误差均值差异。采用秩和检验比较两组三维空间矢量误差差异;卡方检验展示三维空间矢量误差>0.52 cm占比。采用单因素方差分析探究改进型固定组与放疗摆位时间关系,经事后分析各方向误差...     

靶向治疗在局部进展期直肠癌术前同步放化疗中的应用

直肠癌发病率逐年攀升,NCCN推荐T3或淋巴结阳性直肠癌患者的标准治疗方案是术前5-FU联合放疗序贯TME手术。而与术前放疗联合的最佳化疗方案尚不确定[1]。近年来,靶向治疗的疗效令     

晚期直肠癌的化、放疗

近日，在苏格兰爱丁堡召开的欧洲肿瘤学会年会上，Andres Cervantes教授负责指导的一个西班牙研究小组报告了他们为晚期直肠癌患者开发一种新的很有希望的治疗方法，并就该方法如何预防癌瘤复发的试验结果进行了认真的评估，由于直肠癌复发率很     

手术中种植放射碘-125微粒近距离放疗在低位直肠癌综合治疗中的应用

 目的　探讨组织间种植放射碘 12 5 (12 5I)微粒近距离放疗在低位直肠癌综合治疗中的应用。方法　可手术低位直肠癌 82例 ,肿瘤距肛缘在 4～ 6cm者分为盆腔自主神经保留 (PANP)加肛门重建术(ARO)加12 5I微粒种植组 (实验组 :A组 )和Miles手术组 (对照组 :B组 ) ;肿瘤距肛缘 6～ 8cm者分为超低位前切除 (ASP)加PANP加12 5I微粒种植组 (实验组 :C组 )和ASP组 (对照组 :D组 )。随访比较各组间局部复发率、5年生存率、排便功能和性功能障碍等。结果　A与B组及C与D组间局部复发率、控便功能、排尿和性功能障碍发生率、5年生存率差异有统计学意义 (P <0 .0 5 ) ,A、C两组术后局部复发率、排尿功能和性功能障碍发生率分别低于对照组B、D组 (P <0 .0 1)。而术后吻合口瘘、吻合口狭窄和骨盆腔感染的发生率差异无统计学意义。结论　组织间永久性种植12 5I微粒近距离放疗疗效可靠 ,可降低Miles手术的比例 ,有效预防功能保存手术后的局部复发 ,提高 5年生存率和病人的生存质量。     

晚期直肠癌以放疗为主的综合治疗探讨

直肠癌发生率在胃肠道肿瘤中仅次于胃癌,属高发肿瘤,且有逐年上升的趋势,其治疗以手术根治切除为主,但是单纯手术切除的5年生存率始终徘徊在50%左右,其治疗失败的主要原因为局部复发。并且约有5~20%的原发直肠癌患者诊断时已属晚期,失去了手术机会,给予积极的综合治     

奥沙利铂在局部进展期直肠癌术前同步放化疗中的应用进展

目前基于氟尿嘧啶及卡培他滨的术前同步放化疗是局部进展期直肠癌的标准治疗模式,但仍有较高的远处转移率,为进一步提高疗效,探索新的化疗药物越来越受到学界的重视.其中奥沙利铂因其在辅助化疗及姑息治疗中的效果卓越,受到越来越多学者的关注,并因此开展了一系列Ⅰ～Ⅲ期临床研究.绝大多数Ⅰ/Ⅱ期临床研究表明奥沙利铂具有很好的应用前景,不仅达到良好病理完全缓解(pCR)率及肿瘤降期率,且不良反应可耐受.但是,在Ⅲ期临床研究中,STAR-01、ACCORD-12、NSABP-R04、PETACC-6均为阴性结果,仅CAO/ARO/AIO-04是阳性结果,显示奥沙利铂组能够获得显著的总生存期(DFS)获益,故奥沙利铂能否应用于局部进展期直肠癌术前放化疗存在明显的争议.因此根据目前研究结果,在直肠癌术前新辅助放化疗中,仍然不推荐在5-Fu/卡培他滨基础上常规使用奥沙利铂.全文对奥沙利铂在局部进展期直肠癌术前同步放化疗中的应用进行了总结,希望为进一步的临床研究提供依据.     

肿瘤出芽计数在预测T1期结直肠癌淋巴结转移中的应用价值

背景与目的：肿瘤出芽是结直肠癌的不良预后因素。本研究使用10个高倍镜视野计数的方法评价肿瘤出芽,并分析其在预测T1期结直肠癌淋巴结转移中的临床应用价值。方法：通过计数307例T1期结直肠癌10个高倍镜视野下肿瘤出芽个数,参比临床病理特征,建立T₁期结直肠癌淋巴结转移的风险分析公式,并在14例新病例中对该公式进行验证。结果：多因素分析结果显示,肿瘤分化水平、脉管侵犯和肿瘤出芽个数与T₁期结直肠癌淋巴结转移显著相关。统计分析得出的淋巴结转移的风险分析公式为：Z=1.571×(脉管状态：侵犯为1;无侵犯为0)+2.661×(肿瘤分化：高级别为1;低级别为0)+0.024×(肿瘤出芽个数)-3.885,概率=1/1+e^-Z。在14例新病例中得到了验证。结论：通过计数10个高倍镜视野下的肿瘤出芽个数,可以精确地评估淋巴结转移风险,从而协助临床作出合理的决策。     

77例直肠癌伴肝转移患者的预后因素分析

目的 探讨影响直肠癌伴肝转移患者预后的相关因素.方法 回顾性分析77例直肠癌伴肝转移患者的临床病理资料,以Kaplan-Meier法分析患者的总生存率,以Log rank检验和Cox模型对影响患者生存的临床病理因素进行单因素和多因素分析.结果 全组患者的中位生存时间为12个月,1、2、3和5年生存率分别为47.7%、28.0%、13.1%和1.5%.单因素分析结果显示,原发肿瘤的分化程度越低、肠壁浸润程度越深、有淋巴结转移、肝转移灶分布于双叶、肝转移灶数目＞1个、肝转移灶的最大直径＞5 cm、有肝外受侵或转移、确诊时癌胚抗原(CEA)≥5 ng/ml以及未行根治性手术者的预后较差(均P＜0.05).多因素分析结果显示,原发肿瘤的分化程度(P=0.007)、肠壁浸润深度(P=0.027)、肝转移灶的最大直径(P=0.003)以及确诊时的CEA水平(P=0.000)为影响直肠癌伴肝转移患者预后的独立因素.结论 对于直肠癌伴肝转移的患者,原发肿瘤的分化程度越高、肠壁浸润越浅、肝转移灶的最大直径越小以及确诊时CEA水平越低,患者的预后越好.     

Surgeon's awareness of the synchronous liver metastases during colorectal cancer resection may affect outcome

Aim

There is conflicting evidence about the importance of synchronous metastases upon tumor outcome. The aim of this study is to identify the effect of finding synchronous colorectal liver metastases on the performance of the surgeon whilst operating on primary colorectal cancer.

Methods

Patients with completed colorectal cancer data who underwent liver resection for colorectal metastases between 1993 and 2001 were included. Two hundred seventy patients were categorised according to the site of the primary tumour (colon or rectum) and knowledge of the presence of liver metastases by the colorectal surgeon (SA = surgeon aware, n = 112, SNA = surgeon not aware, n = 158). The number of retrieved lymph nodes and colorectal resection margin involvement were used as surgical performance indicators. Survival and local recurrence rate were monitored.

Results

The SA group had a higher rate of colorectal circumferential resection margin involvement, the local and intra-abdominal recurrence rate was also significantly higher in this group (p < 0.001).

Conclusions

Awareness of the presence of liver metastases by the operating surgeon is an independent predictor of intra abdominal extra hepatic recurrence of colorectal cancer following potentially curative hepatic resection. This is related to an increased rate of primary colorectal resection margin involvement.     

Upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer with synchronous liver metastases

BackgroundThe optimal treatment of locally advanced rectal cancer with synchronous liver metastases remains controversial. In this study, we aimed to evaluate the safety, efficacy, and oncologic outcomes of upfront chemotherapy and short-course radiotherapy with delayed surgery in patients with locally advanced rectal cancer and synchronous liver metastases.MethodsForty-four patients who underwent upfront chemotherapy and short-course radiotherapy with delayed surgery for locally advanced rectal cancer (cT3/4, <2.0 mm from the mesorectal fascia) with synchronous liver metastases between January 2010 and June 2017 were reviewed retrospectively. Primary and metastatic liver lesions were resected with curative intent. Upfront chemotherapy and short-course radiotherapy were administered. Thereafter, restaging, surgery only, or additional chemotherapy followed by surgery was performed.ResultsAt the time of initial diagnosis, 20 patients had <3 liver metastases; 24 patients had ≥3 liver metastases. Twenty-three patients had hemi-liver metastases; 21 patients had bilobar liver metastases. R0 resection of rectal lesions was achieved in 43 patients. Synchronous R0 resection of liver metastases was achieved in 41 patients. Postoperative complications (Clavien–Dindo Grade ≥ III) were noted in 5 patients. Grade 3/4 adverse events were observed in 26 patients. All adverse events were managed effectively with medication and supportive care. The 3-year overall survival and progression-free survival rates were 65.3% and 26.9%, respectively.ConclusionUpfront chemotherapy and short-course radiotherapy with delayed surgery appear to be safe and effective in patients with locally advanced rectal cancer and synchronous liver metastases without substantially increasing treatment induced morbidity.     

Evidence for a synchronous operative approach in the treatment of colorectal cancer with hepatic metastases: A case matched study

Background

Traditionally, a staged operative approach has been used for patients with synchronous colorectal cancer and liver metastases in the U.K. With improved outcomes from hepatic resection the role of a synchronous operative approach needs re-evaluated.

Methods

32 consecutive patients with colorectal cancer and hepatic metastases that underwent a synchronous operative approach were individually case matched (according to: age; sex; ASA grade; type of hepatic and colonic resection) with patients that had undergone a staged approach. The following variables were analysed: operative blood loss; in hospital morbidity and mortality; duration of hospital stay; disease free and overall survival.

Results

Operative blood losses were: synchronous group, median 475 mL (range 150–850 mL) vs median 425 mL (range 50–1700 mL), (p > 0.050). There were no significant differences in morbidity: (34% synchronous group vs 59%, p = 0.690) with no recorded mortality. Synchronous group had a shorter hospital stay (median 12 days [range 8–21] vs 20 [range 7–51], p = 0.008). There were no statistical differences between synchronous and staged patients for disease free and overall survival: 10 months (95% CI 5.8–13.7) versus 14 (95% CI 12.2–16.3; p = 0.487) and 21% versus 24% at 5 years (p = 0.838).

Conclusion

This present study provides supporting evidence for synchronous operative procedures in patients with colorectal liver metastases.     

Simultaneous approach for patients with synchronous colon and rectal liver metastases: Impact of site of primary on postoperative and oncological outcomes

Background and aimsWe aimed to investigate the impact of the site of the primary on postoperative and oncological outcomes in patients undergone simultaneous approach for colon (CC) and rectal cancer (RC) with synchronous liver metastases (SCRLM).Patients and methodsOf the 220 patients with SCRLM operated on between Mar 2006 and Dec 2017, 169 patients (76.8%) were treated by a simultaneous approach and were included in the study. Two groups were considered according to the location of primary tumor RC-Group (n = 47) and CC-group (n = 122).ResultsMultiple liver metastases were observed in 70.2% in RC-Group and 77.0% in CC-Group (p = 0.233), whilst median Tumor Burden Score (TBS) was 4.7 in RC-Group and 5.4 CC-Group (p = 0.276). Severe morbidity (p = 0.315) and mortality at 90 days (p = 0.520) were comparable between RC-Group and CC-Group. The 5-year overall survival (OS) rate was similar comparing RC-Group and CC-Group (48.2% vs. 45.3%; p = 0.709), but it was significantly different when considering left-CC, right-CC and RC separately (54.5% vs. 35.2% vs. 48.2%; p = 0.041). Primary tumor location (right-CC, p = 0.001; RC, p = 0.002), microscopic residual (R1) disease at the primary (p < 0.001), TBS ≥6 (p = 0.012), bilobar metastases (p = 0.004), and chemotherapy strategy (preoperative ChT, p = 0.253; postoperative ChT, p = 0.012; and perioperative ChT, p < 0.001) resulted to be independent prognostic factors at multivariable analysis.ConclusionIn patients with SCRLM, simultaneous resection of the primary tumor and liver metastases seems feasible and safe and allows satisfactory oncological outcomes both in CC and RC. Right-CC shows a worse prognosis when compared to left-CC and RC.     

局部进展期直肠癌术前新辅助治疗疗效分析

目的 观察术前同期放化疗或术前单纯放疗在T3、T4期或影像学淋巴结阳性直肠癌患者治疗中的疗效和安全性.方法 回顾分析2000 -2009年收治的141例局部进展期或影像学淋巴结阳性的直肠癌患者资料,其中术前同期放化疗97例,术前单纯放疗44例.放疗采用二维或三维技术,化疗采用4种方案.结果 随访率为91.5％,随访满3、5年者分别为106、68例.降期率达59.0％ (82/139),保肛手术率达65.5％ (91/139).3、5年总生存率分别为85.8％、65.7％,局部复发率分别为9.2％、14.1％,转移率分别为33.8％、45.8％.术前同期放化疗患者中位无瘤生存期优于术前单纯放疗(51:31个月,x2=12.88,P=0.000).肿瘤降期患者在远处转移时间上迟于未降期患者(60:29个月,x2=14.65,P=0.000).急性不良反应多为1、2级,伤口愈合延迟及吻合口瘘发生率低.结论 术前同期放化疗或术前单纯放疗能明显降低肿瘤分期、提高手术保肛率,不良反应小且绝大多数患者可耐受.     

三维适形放射治疗局部晚期和术后复发性直肠癌

目的：探讨局部晚期和术后复发性直肠癌三维适形放射治疗（three dimensional conformal radiation therapy,3D-CRT）的临床疗效。方法：60例局部晚期和术后复发性直肠癌均在外照射40Gy后随机分为后程适形放疗组（适形组）30例,常规放疗组（对照组）30例。结果：适形组及对照组有效率分别为86.7%和70.0%,2组差异无统计学意义（P〉0.05）;适形组及对照组1、2、3年生存率分别为80.0%、53.3%、36.7%和56.7%、40.0%、13.3%,P=0.02;1、2、3年局部控制率分别为86.7%、80.0%、50.0%和73.3%、53.3%、30.0%,2组差异均有统计学意义（P=0.0438）;在副反应方面2组差异无统计学意义（P〉0.05）。结论：局部晚期和术后复发性直肠癌常规外照射加三维适形放疗有较好疗效。     

Socioeconomic inequalities in the use of radiotherapy for rectal cancer: A nationwide study

Preoperative radiotherapy (PRT) in rectal cancer reduces the risk of local recurrence by at least half but the influence of the socioeconomic status of patients on the use of PRT is little investigated in Europe.

Methods

Individually attained data on civil status, education and income were linked to the Swedish Rectal Cancer Registry 1995-2005 (n = 16,713) and analysed by logistic regression.

Results

Forty-six percentage of the patients received PRT and the crude rate varied with age, gender, civil status, education and income as well as with sublocalisation, stage, type of hospital and health care region. In a multivariate analysis, all civil status groups had PRT to a lesser extent compared with married patients; odds ratio (OR) for unmarried patients was 0.67 (95% confidence interval (CI) 0.59-0.76). Patients with secondary and university education had PRT to the same extent as those with compulsory school (OR 1.04 (0.94-1.15) and 0.92 (0.81-1.06)). The use of PRT was associated with income; OR for patients with income Q1 versus Q4 was 0.76 (0.67-0.86). The inequalities by civil status and income remained unchanged also in groups with a relatively stronger indication for adjuvant radiotherapy, i.e. younger patients and in low rectal cancer.

Conclusion

Unmarried and low-income patients are at increased risk for not receiving PRT in rectal cancer. Comorbidity may explain some differences but increased awareness of the role of non-medical variables for the use of PRT is warranted.     

Epidermal growth factor receptor is a predictor of tumor response in locally advanced rectal cancer patients treated with preoperative radiotherapy

Epidermal growth factor receptor (EGFR) expression is observed in 50%–70% of colorectal carcinomas and is associated with poor prognosis. The aim of this study was to determine the EGFR expression rate in locally advanced rectal cancer and to analyze whether EGFR expression predicts tumor response to preoperative radiotherapy.

Between December 1997 and October 2000, 45 patients were included. Treatment consisted of preoperative pelvic radiotherapy and, in 21 patients, 2 courses of 5-fluorouracil leucovorin. Surgical resection was performed 4–8 weeks later. Immunohistochemistry for EGFR was determined at the preradiation diagnostic biopsy and in the resected specimens. Immunostaining was performed using EGFR monoclonal antibody (Biogenex, MU 207-UC). Immunohistochemical staining was evaluated according to extension and intensity. We defined positive staining (EGFR+) as extension of 5% or more.

Preoperative treatment resulted in pathologic complete remission in 7 patients (15%), downstaging in 13 patients (29%), and no response in 25 patients (56%). EGFR+ was observed in 29 of 45 tumors (64%) and was associated with neither clinical tumor stage nor clinical nodal stage. The overall response rate was 34% in EGFR+ patients vs. 62% in those who were EGFR− (p = 0.07). Only 1 of the 7 pathologic complete remission patients was EGFR+ (p = 0.003).

EGFR is expressed in a significant number of locally advanced rectal tumors. EGFR expression is an indicator for poor response to preoperative radiotherapy in advanced rectal carcinoma.