原发性输卵管癌的治疗（附21例分析）

本文通过回顾性总结，探讨原发性输卵管癌的治疗问题。本组２１例患者，五年生存率４０％（６／１５）。三年生存率５７．１％（１２／２１）。２１例中１９８６年前治疗５例，术后辅以放射治疗为主，生存时间８月－６４月，平均２８．５月。１９８６年以后治疗１６例，术后主要辅以顺铂等药物的联合化疗，生存时间１１月－８４月，平均４８月（Ｐ〈０．０５）。根据术后残存肿瘤直径〈１ｃｍ和〉１ｃｍ分成两组，两组平均生存时间分     

卵巢癌手术加VPC方案的远期疗效观察

目的探讨细胞减灭术及化疗对卵巢上皮性癌的治疗效果及影响因素。方法回顾分析１９８９年１月至１９９３年１月在我院治疗且经细胞减灭术后的卵巢上皮性癌８６例的临床资料。术后均采用ＶＰＣ方案（长春新碱，顺氯氨铂，环磷酰胺）进行化疗。结果总的３年生存率为７４．４２％，５年生存率为５２．５１％。肉眼无残留病灶、残留病灶≤２ｃｍ及残留病灶＞２ｃｍ的５年生存率分别为８１．０８％，５０％及２１．７４％（Ｐ＜０．０１）。化疗疗程数＜８及≥８的５年生存率分别为２２．２％及６６％（Ｐ＜０．０１）。结论经细胞减灭术后，有无残留灶和术后化疗疗程数均与预后有关     

晚期卵巢上皮癌的综合治疗因素对预后的影响

目的探讨晚期卵巢上皮癌的综合治疗因素对预后的影响。材料与方法回顾性分析１９８３～１９９２年治疗的２２４例晚期卵巢癌的术后残存肿瘤大小、术前化疗、术后顺铂联合化疗疗程、二次剖腹探查结果、复发病人的再次减瘤术及放疗等治疗因素与预后的关系。结果全组３年和５年生存率各为２９％和１５％。Ⅲ期术后残存肿瘤≤２ｃｍ与＞２ｃｍ的３年和５年生存率各为５０％、２０％和３０％、５％，Ｐ值均＜０．０１。术后化疗≥６与＜６疗程的３年和５年生存率分别为５２％、１４％和２５％、８％，Ｐ值均＜０．０１。８９例术前化疗有效和无效对预后无影响（Ｐ＞０．０５），但在有效者中术后残存肿瘤≤２ｃｍ与＞２ｃｍ影响５年生存率，各为２３％与０（Ｐ＜０．０５）。５５例复发病人再次减瘤术后残存肿瘤≤２ｃｍ与＞２ｃｍ的３年和５年生存率各为４３％、４％和３２％、０，Ｐ值均＜０．００１。结论Ⅲ期和术前化疗有效与复发病人术后达理想减瘤术者、顺铂联合化疗≥６疗程可获长期生存益处。     

卵巢癌手术加VPC方案的远期疗效观察

目的 探讨细胞灭术及化疗对卵巢上皮性癌的治疗效果及影响因素，方法 回顾分析１９８９年１月至１９９３年１月在我院治疗且经细胞减灭术后的卵巢上皮性癌８６例的临床资料，术后均要用ＶＰＣ方案（长春新碱，顺氯氨铂，环磷酰胺）进行化疗。结果 总的３年生存率为７４．４２％，５年生丰存率为５２．５１％，肉眼无残留病灶，残留病灶≤２ｃｍ及残留病灶〉２ｃｍ的５年生丰率分别为８１．０８％，５０％及２１．７４％（Ｐ〈０．     

顺铂为主联合化疗加放疗治疗超长食管癌

目的探讨顺铂为主联合化疗加放疗对病变长度大于８ｃｍ食管癌的疗效。方法１９８８年１月至１９９１年１２月对病变长度大于８ｃｍ,不宜行手术治疗的食管癌病人随机分为二组（各６０例）治疗,一组采用顺铂、平阳霉素、长春新碱联合化疗后根治性放疗（化放组）,一组仅行单纯放射治疗（单放组）,进行对比分析。结果化放组与单放组１,３,５年生存率分别为６１．７％、３０．０％、２０．０％与３６．７％、１０．０％、５．０％,比较均有显著性差异。结论顺铂为主联合化疗后放疗综合治疗是治疗超长食管癌的有效方法。     

化疗和放疗联合治疗晚期子宫颈癌

目的为观实化疗加放疗在治疗晚期子宫颈癌中的作用。材料与方法从１９８９年１月至１９９１年１０月，５０例晚期子宫颈癌患者接受环磷酰胺＋氟尿嘧啶＋顺铂（ＣＦＰ）或环磷酰胺＋丝裂霉素＋顺铂（ＣＭＰ）化疗（顺铂２０ｍｇ，第１～５日给药；环磷酰胺４００～６００ｍｇ．第２，４日；氟尿嘧啶５００ｍｇ，第１，３，５日或丝裂霉素１０ｍｇ，第１日），１～３疗程后放疗。配对抽取单纯放疗患者５０例供疗效对比观察。结果单放组和化放组５年生存率分别为４４．０％和６４．０％，Ｐ＜０．０５，Ⅲ期５年生存率化放组高于单放组（Ｐ＜０．０５）；化放组副作用主要是胃肠反应及骨髓抑制，单放组副反应不明显。结论化疗放疗联合治疗晚期子宫颈癌疗效好且副作用可以耐受。     

大肝癌术后肝血管灌注化疗预防肝癌复发的临床研究

目的：降低肝癌的复发率。方法：术中对根治性切除的大肝癌（直径＞５ｃｍ）行肝动脉或／和门静脉插管皮下埋植化疗药泵，术后间断灌注化疗药物。结果：和对照组相比１、３、５年复发率明显降低（Ｐ＜０．０１），而１、３、５年生存率则明显提高（Ｐ＜０．０１）。结论：术后肝血管灌注化疗可能是降低复发率的有效方法。     

原发三重癌1例

患者女，５０岁。１９９６年１月因反复便血１个月住院。腹部Ｂ超示左下腹部３．０ｃｍ×５．０ｃｍ肿块，纤维结肠镜检，诊断为直肠癌。术前化疗一周期后（用药：亚叶酸钙２００ｍｇ、５－氟脲嘧啶０．５ｇ、顺铂２０ｍｇ连用５天），行直肠癌根治术。术后病理为粘液腺癌...     

111例食管癌锁骨上淋巴结转移放射治疗疗效分析

目的　探讨食管癌锁骨上淋巴结转移放射治疗的价值及影响预后因素。方法　１９８４ 年９ 月至１９９２ 年１２ 月收治食管癌锁骨上淋巴结转移１１１ 例,均采用６０Ｃｏ 外照射,食管ＤＴ６０ ～７０Ｇｙ,锁骨上ＤＴ５０～６６Ｇｙ。结果　治疗后的１、３ 、５ 年生存率分别为４９．６ ％ 、１０．８％ 、６．３ ％ ;病变长度≤５．０ ｃｍ 、５．１ ～８ ｃｍ 、＞ ８ ｃｍ 的５ 年生存率分别为１５％ 、２．５ ％ 、０（ Ｐ＜０．０５） ;疗终Ｘ线表现基本消失与部分消失的５ 年生存率分别为１２．５％ 、１．８％（ Ｐ＜ ０．０５）;锁骨上淋巴结＜３ ｃｍ 和≥３ ｃｍ 的５ 年生存率分别为８．１ ％ 、０ 。结论　食管癌锁骨上淋巴结转移应积极治疗,淋巴结大小、食管病灶长度、疗终Ｘ线表现、放疗剂量是影响预后的主要因素     

综合治疗卵巢癌远期疗效观察

我院１９８４～１９９４年采取手术加大剂量顺铂腹腔化疗配合静脉化疗治疗卵巢癌３６例,总结报道如下。１　临床资料１．１　一般资料　３６例均经手术病理诊断证实,年龄２８～６３岁。卵巢上皮癌２１例,卵巢皮样囊肿恶变５例。Ｉ期１２例,Ⅱ期１０例,Ⅲ期１４例,Ⅳ期２例。１．２　治疗方法　３６例中２１例行肿瘤细胞减灭术,即高位处理卵巢动静脉,全子宫及附件、大网膜、阑尾切除术,残留灶直径＜２ｃｍ。１５例行肿瘤、附件、大网膜切除术,残留灶＞２ｃｍ,术毕顺铂３０ｍｇ稀释液浸注腹腔。术后肠功能恢复（３～５天）将顺铂１…     

局部晚期鼻咽癌同时放、化疗疗效观察

目的:观察同期放、化疗治疗局部晚期鼻咽癌的近期疗效、生存率、局部控制率、远处转移率和毒副反应。方法:60例局部晚期鼻咽癌为综合治疗组,分别在放疗第1,5周及放疗后1周给予DDP30mg/m21天～3天,5-Fu500mg/m21天～5天化疗共4～5个周期,另配对选取60例单纯放疗者为对照组,两组放疗方法相同。结果:综合组与单放组鼻咽肿瘤完全消退率分别为93%和84.2%(P>0.05),颈部淋巴结完全消退率分别为87.2%和59.8%(P<0.05),3年生存率分别为75.2%和48.3%(P<0.05),3年局控率分别为87.2%和70.3%(P<0.05),3年远处转移率分别为17.2%和38.8%(P<0.05)。综合组白细胞减少症、胃肠道反应和口腔粘膜反应较单放组多且明显(P<0.05),但可接受。结论:同期放、化疗与辅助化疗有助于提高局部控制率和生存率,减少远处转移率。     

Clinical Analysis of 45 Patients with Thymic Carcinoma

OBJECTIVE To retrospectively evaluate the prognostic factors for advanced thymic carcinoma.METHODS The data from 45 patients with advanced thymic carcinoma were retrospectively analyzed according to Masaoka stage criteria. There were 29 Stage Ⅲ patients and 16 Stage Ⅳ patients (13 Stage IVA patients and 3 Stage IVB patients).According to the World Heath Organization Histological Criteria (2004), 25 cases were identified as low-grade and 20 cases were identified as high-grade. All diagnoses were confirmed by biopsy. Five patients underwent gross total resection, 21patients underwent subtotal resection and 19 patients underwent biopsy alone. Forty-two patients received radiotherapy with a median dose of 60 Gy, and 37 patients underwent conventional radiotherapy, including local irradiation and expanded irradiation.Local irradiation volume covered the primary tumor bed and approximately 1-2 cm2 surrounding the tumor (according to preoperative imaging). Expanded irradiation volume covered the full mediastinal and pericardium areas (with or without prophylactic irradiation in the supraclavicular area). Five cases received stereotactic radiotherapy. Thirty-one patients were also treated with chemotherapeutics, including Cisplatin, VP-16,Endoxan, 5-FU and taxol.RESULTS The median follow-up period was 59 months. The overall 3-year survival rate was 57.8%, and the median survival was 45 months. Univariate statistical analysis showed that the histological subtype and Masaoka stage were prognostic factors.The 3-year survival rate was 61.9% in patients treated with gross total resection and 55.0% in those who underwent biopsy only. The 3-year survival rate was 59.5% in patients treated with conventional radiotherapy and 80% in those treated with stereotactic radiotherapy. The 3-year survival rate was 64.5% in patients treated with simultaneous chemotherapy and 42.9%in patients treated without simultaneous chemotherapy (P >0.05). Chemotherapy in combination with radiation treatment and surgery achieved better outcomes for Stage Ⅳ patients than radiation treatment and surgery without chemotherapy (P < 0.05).CONCLUSION For patients with Stage Ⅲ and Ⅳ thymic carcinoma, complete resection and postoperative radiotherapy or fractionated stereotactic radiotherapy constitute the best treatment solution. Chemotherapy can also be used in combination to improve prognosis. For patients with Stage Ⅳ thymic carcinoma,chemotherapy is necessary.     

时辰化疗联合放疗治疗晚期贲门癌

目的:探讨时辰化疗联合放疗治疗晚期贲门癌的疗效。方法:晚期贲门癌患者85例,随机分为单放组和综合组,综合组40例,时辰化疗采用顺铂(DDP)联合5氟尿嘧啶(5-FU)静脉输入,DDP20mg/m2,10时至22时给药,5-FU600mg/m2,22时至翌日10时给药,疗程5天,间隔16天重复。时辰化疗同时予以放射治疗,靶区剂量(DT)60Gy~65Gy,6~7周照射;单放组45例,常规放疗DT70Gy/7周,观察患者治疗的效果及影像改善情况,随访6~24个月。结果:综合组和单放组梗阻症状改善率分别为90%(36/40)及66%(33/45),两组差异有统计学意义(P<0.05);X线好转率分别为85%(34/40)及68%(31/45)(P>0.05);综合组和单放组患者1、2年生存率分别为75%(30/40)和53.3%(24/45)(P<0.05),40%(16/40)和28.9%(13/37)(P>0.05)。结论:时辰化疗联合放疗是一种治疗晚期贲门癌的有效方法。     

贝伐珠单抗注射液联合替莫唑胺同步放疗治疗脑转移的疗效及安全性

目的:探讨贝伐珠单抗注射液联合替莫唑胺同步放疗治疗脑转移的疗效及安全性。方法:于2016年01月至2018年06月,将我院救治的60例脑转移患者纳入研究,按照随机数字表法将患者随机分为两组,30例每组。对照组实施替莫唑胺同步放疗,观察组实施贝伐珠单抗注射液联合替莫唑胺同步放疗,比较两组患者的临床总有效率、癌因性疼痛评分、癌因性疲乏评分、生存质量评分、不良反应发生率、远期存活率。结果:观察组患者临床总有效率为70.00%,高于对照组的43.33%（P<0.05）。治疗后3个月、6个月,观察组患者癌因性疼痛评分、癌因性疲乏评分均低于对照组（P<0.05）,观察组患者生存质量评分高于对照组（P<0.05）。观察组患者恶心呕吐、骨髓抑制、贫血、脱发、白细胞减少、血小板减少等不良反应发生率与对照组比较,差异均无统计学意义（P>0.05）。随访2年,观察组患者1年存活率、2年存活率均高于对照组（P<0.05）。结论:在替莫唑胺同步放疗基础上应用贝伐珠单抗注射液,可提高脑转移患者的近期疗效,有效控制病情,减轻癌因性疼痛和疲乏症状,有利于提高患者生存质量和远期存活率,且不良反应未增加,安全性良好。     

B3 型胸腺瘤术后放射治疗的临床价值探讨

目的:探讨B 3 型胸腺瘤术后放射治疗的临床价值和长期生存的预后因素。方法:收集1995年10月至2008年10月在同济大学附属上海市肺科医院接受胸腺肿瘤切除术并病理诊断明确的159 例B 3 型胸腺瘤患者病历资料。按Masaoka临床分期,Ⅰ期12例,Ⅱ期33例,Ⅲ期62例,Ⅳ期52例。其中38例患者伴有重症肌无力。根治术后常规放射治疗的中位剂量50Gy。不同时期共有58例接受化疗。Kaplan-Meier 法计算总生存率、无进展生存率。Cox 回归比例风险模型用于预后多因素分析。结果:中位随访时间为52（8～125）个月,全组5 年总生存率为81.6% ,5 年无进展生存率为76.2% 。5 年局部控制率为82.6% ,复发率为32.6% ,转移率为9.3% 。结论:B 3 型胸腺瘤治疗主要失败原因是局部复发和远处转移,肺和胸膜是胸腺瘤转移复发的主要部位。术后放疗可提高晚期胸脉瘤患者的局部控制率和总生存率。Masaoka分期、手术切缘和放疗是与 5 年无进展生存率相关的独立预后因素。      

Radiotherapy of pancreatic carcinoma

During the 10-year period between 1974 and 1984, we treated 34 pancreatic carcinomas by radiotherapy as follows: Eight by intraoperative radiotherapy (IOR), five by external radiotherapy (ERT), and 21 by IOR in combination with ERT. The mean survival time of the eight patients treated by IOR was 5.6 months, and that of the 21 receiving the combination therapy 7.2 months. Although it is not statistically significant, patients treated by the combined regimen survived longer than those treated by IOR alone.     

Malignant meningiomas: a retrospective study of 22 cases

Malignant (anaplastic) meningioma constitutes a rare subset of meningioma. The aim of the study was to study clinical features and management of malignant meningiomas. Twenty-two patients with malignant meningiomas were surgically treated in our department between January 1986 and January 2005 in Qilu hospital, and we reviewed each patient's clinical records, radiological findings, operative reports, and pathological examinations. Simpson grade I resection was achieved in 16 cases and grade II resection in 6 cases. Postoperative radiotherapy was performed in all patients. No death occurred during the perioperative period in this series. The follow-up period ranged from six months to ten years. Overall 5-year survival and recurrence-free survival estimates were 36.4 and 27.3%, respectively. 16 patients with Simpson Grade I resection had longer median survival times than 6 patients with Simpson Grade II resection (70 months compared with 10 months, p = 0.0001). Only tumor location (p = 0.016) and Simpson grade of surgical resection (p = 0.002) had an impact on outcome according to a Cox regression analysis. Surgical resection and adjuvant radiotherapy are the main treatments for malignant meningiomas, and the degree of tumor removal is the leading factor determining postoperative recurrence and survival.     

全脑联合三维适形放射治疗30例单病灶脑转移癌的疗效分析

背景与目的:全脑放疗是治疗脑转移癌的主要治疗手段。本文总结全脑联合三维适形放射治疗单病灶脑转移癌的疗效。方法:30例恶性肿瘤单病灶脑转移癌,全脑放疗DT39～45Gy后,以三维适形放疗追加转移病灶DT10～16Gy,常规分割1次/d,5次/w,总剂量DT55Gy。结果:6例CR,21例PR,3例NC,6个月、1年和2年生存率分别为73.3%(22/30)、40%(12/30)、13.3%(4/30),平均生存时间11.9个月。结论:全脑联合三维适形放射治疗单病灶脑转移癌,可以缓解颅脑神经症状,改善生活质量,延长生存期。     

Ewing's sarcoma--report of 18 cases

Eighteen cases of Ewing's sarcoma are presented. The mean age was 13 years. The male to female ratio was 2:1. Tumor occurred frequently in the long bones, especially the femur. The average course was 7 months. The main symptoms were pain, moderate fever, tumor mass with tenderness and leucocytosis. Diagnosis was established according to the clinical, radiological and pathological findings. In this series, the major treatment was radiotherapy alone or radiotherapy combined with chemotherapy. The mean survival time was 16 months with 2- and 5-year survival rate of 31% and 20%, respectively. Misdiagnosis and failure or interruption of the combined treatment were the main factors for poor prognosis.     

35岁以下青年食管贲门癌181例诊治分析

１９８１年１月至１９９２年１２月间，我们共治疗食管贲门癌３４６７例，其中３５岁以下青年食管贲门癌１８１例，占同期手术病例的５．２４％（１８１／３４６７）。手术切除率９０％，并发症发生率６．８％（１１／１８１），手术死亡率１．１％（２／１８１）。术后１、３、５、１０年生存率分别为９８．５％、３９．６％、２７．５％、１２．３％，综合治疗远期生存率，３、５、１０年为４２．３％、３０．６％、１３．１％。本文提示：提高远期生存率的关键在于早期确诊，尽早治疗及术后放疗、化疗的配合。