Results of radiation therapy in carcinoma of the base of the tongue. The Curie Institute experience with about 166 cases

Between 1960 and 1980, 166 patients with squamous cell carcinoma of the base of the tongue were treated with primary irradiation at the Curie Institute (Paris, France). Distribution according to the TNM system 1978 International Union Against Cancer (UICC) was the following: 22 T1 lesions, 47 T2 lesions, 64 T3 lesions, and 33 T4 lesions. Regional nodes were not palpable in 50 cases, 35 had N1 nodes, 12 had N2 nodes, and 69 had N3 nodes. All patients received external beam radiation. The 2-year, 3-year, and 5-year overall survival rates for all patients were, respectively, 45%, 37%, and 27%. Local control was significantly related to the initial status of the primary, to the tumor regression at the end of the radiation therapy, and to the histologic differentiation. The 2-year local control was 96% for T1 lesions, 57% for T2 lesions, 45% for T3 lesions, and 23% for T4 lesions. Local control was 70% if the tumor regression was complete at the end of the treatment and 27% if the tumor regression was partial. No significant differences were found in primary local control with respect to degree of infiltration, age, and dose of radiation therapy over a dose of 60 Gy in 6 weeks. The 3-year regional control was 86% for N0, 78% for N1, and 60% for N2 and N3. Among the tumor characteristics analyzed, the most useful ones for predicting local control and survival were clinical tumor staging parameters and tumor radiation-induced regression. A new therapeutic approach based on the evaluation of the tumor regression at 50/55 Gy is under discussion.     

Trilateral retinoblastoma: is the location of the intracranial tumor important?

BACKGROUND: Trilateral retinoblastoma refers to bilateral retinoblastoma associated with an intracranial primitive neuroectodermal tumor in the pineal or suprasellar region. The purpose of this study was to review patient and tumor characteristics and treatment outcome in patients with trilateral retinoblastoma and to determine whether there is a difference in presentation or outcome according to the location of the intracranial tumor. METHODS: A MEDLINE search of all English language articles pertaining to trilateral retinoblastoma published between 1977-1997 was performed. A total of 94 different cases were identified and analyzed. RESULTS: The gender was male in 39 patients (41.5%), female in 50 patients (53.2%), and unknown in 5 patients (5.3%). Family history for retinoblastoma was positive in 44 patients (46.8%), negative in 39 patients (41.5%), and unknown in 11 patients (11.7%). The median age at the time of diagnosis of retinoblastoma was 6 months. The median time interval to the development of an intracranial tumor from the time of diagnosis of retinoblastoma was 21 months. In 78 patients (83.0%) the intracranial tumor was in the pineal region and in 16 patients (17.0%) it was in the suprasellar region. The median time interval from the time of diagnosis of retinoblastoma to the development of a pineal region tumor was 24 months whereas the median time interval for the development of a suprasellar region tumor was 1 month. At 6 months after the diagnosis of intraocular tumors, 6 of 61 children with pineal region tumors and 10 of 14 patients with suprasellar region tumors had developed intracranial disease (P = 0.005). Unilateral intraocular retinoblastoma associated with intracranial tumor was more likely to occur in patients with suprasellar region tumors than pineal region tumors (P < 0.015). The median survival after the diagnosis of an intracranial tumor was 6 months regardless of the location of the intracranial tumor. For patients who received no treatment for the intracranial tumor the median survival was 1 month whereas it was 8 months for those who received treatment. Children who were asymptomatic at the time of diagnosis of the intracranial tumor had a better overall survival than those who were symptomatic (P = 0.002). CONCLUSIONS: The prognosis of children who develop trilateral retinoblastoma is dismal with current treatment strategies. Tumors of the suprasellar region present earlier than tumors of the pineal region after the diagnosis of intraocular tumors. Because patients who were asymptomatic at the time of diagnosis of intracranial disease had a better overall survival than those who were symptomatic, screening for intracranial tumors may be a valuable strategy in the management of patients with bilateral and/or hereditary retinoblastoma. [See editorial on pages 3-5, this issue.]     

原发性阑尾肿瘤临床误诊原因分析

目的 探讨原发性阑尾肿瘤的误诊原因，提高阑尾肿瘤的急诊水平。方法 回顾性分析27例住院手术并经病理确诊为阑尾肿瘤患者的临床资料。结果 27例阑尾肿瘤仅2例术前获确诊。误诊为急性阑尾炎和慢性阑尾炎急性发作16例，误诊为妇科肿瘤3例，肠梗阻4例，消化道出血2例，误诊率92.6％(25/27)。二次手术率为29.6％(8/27)。病理诊断黏液腺癌9例，类癌7例，腺癌3例，印戒细胞癌2例，腺瘤6例(其中2例发生恶变)。术中可疑为肿瘤者行快速冷冻切片，病理检查确诊为恶性者行右半结肠切除术者22例；良性肿瘤和肿瘤直径小于1cm的类癌行阑尾单纯切除术者5例。结论 阑尾肿瘤最易误诊为阑尾炎和慢性阑尾炎急性发作，对急诊患者应重视阑尾肿块的手术中探查及处理；对不能判定性质的肿块，术中应常规做冷冻切片行病理检查，以提高阑尾肿瘤诊断率和疗效。     

The use of computed tomography of the spine to identify patients at high risk for epidural metastases

The usefulness of spinal computed tomography (CT) in predicting the presence of epidural tumor was evaluated in cancer patients undergoing CT myelography for suspected epidural tumor. Two hundred ninety two vertebral levels were evaluated in 30 patients. Spinal CT demonstrated cortical disruption surrounding the epidural space from metastatic cancer in 109 vertebrae. Eighty-five (78%) of these vertebral levels had tumor extension into the adjacent epidural space. The incidence of epidural tumor adjacent to vertebrae which had normal spinal CT or metastatic tumor without cortical disruption was 11%. Eighty-six percent of the epidural tumor adjacent to these vertebrae were a result of craniocaudal tumor extension in the epidural space from adjacent vertebral levels with cortical disruption. Twenty-one of 23 patients (91%) with cortical disruption at more than one vertebral level on spinal CT had epidural tumor. Synchronous noncontiguous epidural lesions were observed in 38% of patients with epidural tumor. Spinal CT is an important diagnostic test in determining which patients are at high risk for epidural tumor. Myelography should be performed in all patients with suspected epidural tumor to accurately define the full extent of tumor.     

Radiotherapy in the treatment of pituitary adenomas

Between 1970 and 1985, 145 patients were treated for pituitary adenomas and 126 patients were available for analysis. Sixty patients were treated with surgery alone (Group I), 54 were treated with surgery and radiation therapy (Group II), and 12 received irradiation only without tissue diagnosis (Group III). Extent of tumor was evaluated by CT scan, PEG, and surgical reports. There were 22 microadenomas in Group I and only 1 microadenoma in Group II. The mean follow-up was 6.4 years, 85% (51/60) of patients in Group I, 93% of patients in Group II, and only 50% of those treated with irradiation alone achieved tumor control. With subsequent salvage treatment, overall tumor control in Group I was 97%. The mean time to recurrence was 3.7 years (Group I), 4.5 years (Group II), and 4 years (Group III). In summary, combined treatment is effective to decrease the chance of local recurrence of pituitary adenomas. Nevertheless, because of successful salvage treatment after surgical failure, overall outcome is similar. Without persistent symptom after surgery or large residual tumor in or near the critical structures, postoperative irradiation can be deferred until tumor regrowth.     

以转移性卵巢癌为首发表现的胃癌25例临床分析

目的探讨胃癌伴卵巢转移（krukenberg瘤）的临床特点、诊断及治疗经验,以减少误诊。方法回顾性分析经手术和病理证实的25例胃癌伴卵巢转移患者的临床资料。结果25例患者年龄27～56岁,平均37．5岁,绝经前21例,占84．0％。首发的主要临床症状为腹胀、腹痛及下腹部包块。病理类型以印戒细胞癌为主,共14例,占56．0％。侵及双侧卵巢者15例,占60．0％。术前误诊为卵巢原发肿瘤者9例,占36．0％。la生存率为51．9％,2a生存率为21．3％。结论胃癌伴卵巢转移常以转移性卵巢癌为首发表现,好发于绝经前中青年妇女,易误诊,预后差;发现卵巢肿瘤的患者,应常规行胃肠道检查以排除转移瘤的可能。     

Prognosis for patients with carcinoma in the middle third of the stomach

In 268 of the 1,115 patients (24.0%) with gastric cancer who underwent a curative resection in our clinics, the tumor was located in the middle third of the stomach. The clinicopathological features and prognosis of these patients were divided into two groups, according to site of the tumor: anterior wall (n = 58) vs. other sites (n = 210). Clinicopathological factors did not differ between the two groups. The survival time for patients with a tumor in the anterior group was shorter than that for patients with a tumor in other areas (P < 0.05). The five-year survival rate was 79.3% for patients with an anterior tumor and 91.9% for those with a tumor at a different site. A multivariate analysis indicated lymph node metastasis, serosal invasion, and anterior wall location to be independent prognostic factors indicative of a poor prognosis when the tumor was located in the middle third of the stomach. For such patients, close follow-up is needed to detect possible recurrences. © 1993 Wiley-Liss, Inc.     

垂体腺瘤术后免疫组化分型与术前激素水平相关性研究

目的:回顾性分析垂体腺瘤手术患者病理免疫组化染色结果与术前相关激素水平的相关性。方法:收集自2011年1月至2016年12月在青岛大学附属医院行手术治疗的垂体腺瘤患者189例,术前行影像学检查、垂体相关激素测定,术后行病理免疫组化染色。采用SPSS 17.0软件进行统计学分析,采用双变量相关分析中的Spearman分析判断两种变量之间的关联性,通过Kappa值判断术前激素水平与病理诊断的一致性。P＜0.05差异有统计学意义。结果:189例垂体腺瘤患者,＞40~60岁组构成比明显高于≤20岁、＞20~40岁、＞60~80岁各组（60.8% vs 1.1%、22.8%、15.3%,均P＜0.05）;大腺瘤明显多于微腺瘤和巨大腺瘤（86.5% vs 4.7%、8.8%,P＜0.05）;PRL瘤血清PRL程度与肿瘤直径呈正相关（r=0.530,P＜0.05）。GH瘤血清GH水平与肿瘤直径呈正相关（r=0.629,P＜0.05）,与年龄呈负相关（r=-0.715,P＜0.05）;垂体PRL瘤、GH瘤血清学诊断与术后免疫组化染色诊断的符合率分别为85.5%、78.9%,Kappa系数分别为0.688、0.465,说明两种诊断的一致性好;以PRL＞100 ng/mL作为PRL瘤的血清学诊断标准时,其与免疫组化染色诊断的符合率和Kappa系数最高,为81.9%和0.517。结论:手术的垂体腺瘤中以大腺瘤为主,好发年龄＞40~60岁。血清PRL、GH水平均与肿瘤直径呈正相关;GH水平与年龄呈负相关。垂体腺瘤临床血清学诊断与病理免疫组化诊断有一致性,以PRL瘤、GH瘤的一致性为最高。PRL＞100 ng/mL可以作为诊断PRL瘤的血清学参考值。     

甲状腺髓样癌32例临床分析

本文报告甲状腺髓样癌32例。其发病率占同期甲状腺癌的6.67％,32例患者的初发症状均为甲状腺肿块及其它一些症状。多数患者术前无法明确诊断,主要依赖病理诊断。17例行甲状腺叶切除 古典式颈清术,12例行甲状腺叶切除 改良颈清术,3例仅行腺叶切除术。本组5年生存率为90％,复发率为12.5％。腺叶切除 改良颈清术为较理想的术式,外科治疗的关键是原发病灶的彻底切除。     

An enzymatic method for the consistent production of monodispersed viable cell suspensions from human solid tumors

An enzymatic method is described for disaggregation of viable tumor cells from human solid tumors. The enzymatic cocktail consists of 0.1% collagenase, 0.01% hyaluronidase, and 0.002% deoxyribonuclease. After mechanical mincing of the tumor tissue, tumor specimens are dissociated by incubation in the enzymatic cocktail for 12-18 hours at room temperature. In 17 cases of sarcoma, the mean yield was 5 X 10(6) viable cells per gram tumor tissue. Yield was 1 X 10(7) viable cells per gram tumor tissue in 23 cases of gastrointestinal carcinoma. The viabilities of tumor cell suspensions ranged from 50 to 98%, except for low viabilities in four specimens that were grossly composed almost entirely of necrotic tissue. The dissociation procedure is simple and the viable cell yield is sufficient for applications in studies of human cancer immunobiology.     

Brachytherapy with Ir as treatment of carcinoma of the tarsal structure of the eyelid

PURPOSE: Some eyelid tumors present a great challenge for surgical therapy because of the cosmetic and functional impairment. Interstitial radiation with (192)Ir is an optimal alternative treatment modality. The aim of this study was to evaluate the local tumor control and cosmetic results in patients with eyelid tumors treated by interstitial (192)Ir wires. METHODS AND MATERIALS: Twenty-four previously untreated carcinomas involving the eyelid tarsal structure in 23 patients were treated with (192)Ir wire implantation. The tumor location was in the lower eyelid in 22 cases and in the upper eyelid in 2. The mean tumor size was 1.33 cm. Of the 24 tumors, 79.2% were basal cell carcinoma, 16.7% were squamous cell carcinoma, and 4.2% were adenocarcinoma. The total radiation dose was 4000 cGy, delivered to 2-mm depth (mean dose rate, 73 cGy/h). RESULTS: The mean follow-up was 43 months. Local control was obtained in 22 (91.6%) of 24 tumors. Good functional results were achieved in all patients. CONCLUSION: (192)Ir interstitial brachytherapy in a braided silk filament appears to be an excellent method to treat carcinomas involving the eyelid tarsal structure for tumor control and functional and cosmetic results.     

Epithelial carcinoma of the ovary

A total of 176 patients with untreated epithelial cancer of the ovary received postoperative irradiation at the Alice Crocker Lloyd Radiation Therapy Center of the University of Michigan from 1955 to 1973. Irradiation was delivered to the pelvis alone or to the pelvis and part of the abdomen, depending on the extent of the disease and the location of the residual tumor. No patient received whole abdominal irradiation. Post-irradiation chemotherapy was administered to patients with advanced disease. Twenty-six patients with Stage III disease were treated according to a protocol consisting of pre- and post-irradiation administration of chlorambucil. The overall 5-year actuarial survival rate was 42%. The 5-year survival rates for patients with Stage I through IV disease were 77%, 31%, 23%, and 0% respectively. Patients whose tumor was grossly removed at the initial surgery did better (63 % 5-year survival rate) than patients whose tumor was only partially removed (26% 5-year survival rate). The pathologic grade of the tumor was a major factor determining the prognosis. The 5-year survival rates were 76 % for patients with well-differentiated carcinomas, 33% for those with moderately differentiated carcinomas, and 14% for those with poorly differentiated carcinomas. Thirty-four (20%) of the patients were found to have at least a second primary tumor either at the time of the initial surgery or some other time. Autopsy results for 25 patients in this series are presented.     

Significance of residual tumor at the esophageal stump after resection for carcinoma

Residual tumor at the esophageal stump was found in 103, or 14.3%, of a series of 719 resected esophageal specimens for carcinoma. The residual tumor pathologically presented as basal epithelial-cell carcinomatous change in 16 (15.5%), carcinoma in situ in 26 (25.5%), invasive carcinoma in 51 (49.5%), and cancerous emboli in 6 (5.8%) cases. A follow-up study of the 719 patients showed that the long-term survival rate of those with residual tumor was significantly lower than that of those without. Factors of occurrence besides inadequate resection were analyzed, and indications of surgical treatment were recommended. The presence of residual tumor is not an important factor in the development of anastomotic leakage.     

Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: Results and prognostic factors governing treatment success

The aim of the study was to evaluate the effectiveness of transarterial chemoembolization (TACE) with four chemotherapeutic protocols in terms of local tumor control and survival of patients with unresectable cholangiocarcinoma (CCC) and to identify the prognostic factors governing treatment success. In the single-centre study, 115 patients (mean ages = 60.4 years) with unresectable CCC were repeatedly treated with TACE. In total, 819 chemoembolization sessions were performed in 4 week intervals with a mean of 7.1 (range, 3-30) sessions per patient. The chemotherapeutic used was Mitomycin C only in 20.9% of patients, Gemcitabine only in 7%, Mitomycin C with Gemcitabine in 47% and combination of Gemcitabine, Mitomycin C and Cisplatin in 25.1%. Local tumor response was evaluated by MRI according to RECIST. Survival data were calculated according to the Kaplan-Meier method. Prognostic factors for patient's survival were evaluated using log-rank-test. The local tumor controls were: partial response 8.7%, stable disease 57.4% and progressive disease 33.9% of patients. The median and mean survival times from the start of TACE were 13 and 20.8 months. Survival rate from the start of TACE was 52% after 1-year, 29% after 2-years and 10% after 3-years. Initial tumor response, high tumor vascularity and Child-Pugh class A were statistically significant factors for patient's survival. No statistically significant difference between patients treated with different chemotherapy protocols was noted. In conclusion, TACE is a palliative and safe treatment option for patients with unresectable CCC. Child Pugh class B, tumor hypovascularity and initially progressive disease were poor prognostic factors for patient survival.     

Lack of effect of tumor size on the prognosis of carcinoma of the uterine cervix Stage IB and IIA treated with preoperative irradiation and surgery.

PURPOSE: The purpose of this analysis was to evaluate the prognostic significance of cervical tumor size in patients with Stages Ib and IIa carcinoma of the cervix treated with preoperative irradiation and radical or conservative hysterectomy. METHODS AND MATERIALS: This study is a retrospective analysis of 177 patients. One hundred forty-one patients had Stage Ib and 36 patients had Stage IIa carcinoma of the cervix. All patients were treated with preoperative irradiation and surgery. Radiation therapy consisted of external pelvic irradiation and intracavitary brachytherapy; total doses ranged from 30 to 60 Gy to the pelvic sidewall and 60 to 70 Gy to point A. Surgery consisting of radical hysterectomy and lymph node dissection or a conservative hysterectomy and lymph node dissection was performed 4 to 6 weeks after completion of irradiation. RESULTS: The 5-year progression-free survivals were 80% for Stage Ib and 63% for Stage IIa (p = 0.03). The 5-year cumulative pelvic failure rates for Stage Ib were 16% for tumors <3 cm and 9% for tumors >3 cm (p = 0.90). The 5-year cumulative pelvic failure rates for Stage IIa were 22% for tumors <3 cm and 22% for tumors >3 cm (p = 0.75). The corresponding cumulative distant metastasis failure rates at 5 years for Stage Ib were 21% for tumors <3 cm and 21% for tumors >3 cm (p = 0.60). For patients with Stage IIa disease, the 5-year cumulative distant metastasis rates were 33% for tumors <3 cm and 36% for tumors >3 cm (p = 0.70). A multivariate analysis was performed to evaluate prognostic factors for the endpoint of progression-free survival. The variables that were analyzed were patient age, tumor histology, tumor size, clinical stage, point A and pelvic lymph node irradiation dose, and cervical tumor status and pelvic lymph node status at the time of hysterectomy. The variables that were found to be of independent significance for progression-free survival by multivariate analysis were pelvic lymph node irradiation dose (p <0.001), pelvic lymph node status at the time of hysterectomy (p = 0.01), and clinical stage (p = 0.02). Cervical tumor size at the time of diagnosis and the presence of tumor cells in the cervix in the hysterectomy specimen was not an independent prognostic factor by multivariate analysis. The overall severe complication rate was 11% for all patients. CONCLUSIONS: For this population of patients treated with preoperative irradiation and surgery, pelvic lymph node status at the time of hysterectomy and the preoperative irradiation dose to the pelvic lymph nodes are independent predictors of progression-free survival and the development of distant metastasis. The pretreatment cervical tumor size is of less importance for predicting progression-free survival and the development of distant metastasis but clinical stage is an important prognostic variable. These results are in contrast with those of surgery or irradiation alone, in which primary tumor size is a critical prognostic factor for all outcome parameters.     

乳腺实性乳头状癌的临床病理研究

背景与目的：实性乳头状癌(solid papillary carcinoma,SPC)是乳腺癌的少见类型,不足乳腺癌的1%。作为乳腺乳头状癌的特殊亚型,SPC表现为实体结节状或膨胀性生长。本研究探讨乳腺SPC的临床病理特征、免疫表型特点及预后。方法：收集32例SPC的患者资料,进行病理组织学观察,免疫组织化学染色(EnVision法)检测ER、PR、C-erbB-2、p63、Calponin、CK5/6、Ki-67、Syn和CgA。结果：32例均为女性,平均年龄67.3岁,主要表现为乳头血性溢液和乳腺肿块。大体观察肿瘤呈结节状,灰褐色或灰白色,质地偏中或软。镜下肿瘤呈实体状或乳头状,实性区内见纤细的纤维血管轴心。肿瘤细胞呈卵圆形、多角形、梭形或印戒样,细胞质丰富嗜酸性,细胞核轻度或中度异型。免疫组化结果显示,所有患者肿瘤细胞ER和PR均强阳性(++～+++),C-erbB-2均无表达,实性结节内肿瘤细胞均不表达CK5/6、p63和Calponin。Syn和CgA阳性表达率分别为68.8%和78.2%。Ki-67平均阳性指数为7.5%(2%～20%)。27例获得随访资料,随访时间6～84个月,25例患者无瘤生存。1例患者术后复发,再次手术后生存至今,1例患者因发生转移而死亡。结论：乳腺SPC好发于老年女性,具有独特的组织学形态和免疫表型。SPC具有较为惰性的生物学行为,即使伴有浸润切除后也不易复发和转移,预后较好。     

血浆EBV DNA监测鼻咽癌治疗疗效意义

目的 探讨血浆EBV DNA监测鼻咽癌治疗疗效的临床意义。方法 回顾分析2016-2017年间本院初诊的799例鼻咽癌根治性调强放疗患者的临床资料。分析疗前血浆EBV DNA与临床分期、肿瘤进展的相关性,比较放疗结束及随访中EBV DNA与肿瘤进展的关系。结果 疗前DNA表达水平与临床分期、肿瘤进展呈正相关(P<0.001)。放疗结束后6~8周,19例(2.3%)血浆EBV DNA持续阳性者预后最差,14例发生了肿瘤进展。9例放疗结束后6~8周转为EBV DNA阴性,3例肿瘤进展。而放疗结束EBV DNA阴性患者肿瘤进展率仅8.3%(64/772),3个组无肿瘤进展生存率不同(P<0.05)。随访中持续性血浆EBV DNA阳性,诊断肿瘤进展的敏感性、特异性、准确性分别为77.6%、100%、98.1%。结论 鼻咽癌患者疗前EBV DNA表达水平与肿瘤负荷和肿瘤进展相关,放疗结束6~8周EBV DNA持续阳性者预后极差,应给予合适的辅助治疗。随访中持续性血浆EBV DNA阳性诊断肿瘤进展的正确性高,是鼻咽癌根治性治疗后可靠的疗效监测指标。     

Resection of the primary liver cancer of the hepatic hilus.

Primary liver cancer (PLC) of the hepatic hilus was designated as a tumor situated at the main branch of the portal vein or pedicle of the hepatic veins in contact with the intrahepatic vena cava. That is, the main tumor located at segment I, IV, V, or VIII and concentrating on the central part of the liver was called "the central type of PLC," which differed from a tumor located at segment II, III, VI, or VII; the latter was called "the peripheral type of PLC." Surgical treatment of the PLC has been significantly improved in the past two decades, but the resection of the central type of PLC is difficult and hazardous. This institution admitted 903 PLC from January 1970 to April 1988, of which 118 cases were the central type; 65 cases were resected successfully, a resectability of 55.1%. One patient died from sepsis within 1 month of operation (mortality 1.53%). The modes of operation for the different segments are described, and suggestions for improvements are presented. The survival rates were compared with a similar number of patients with the peripheral type of tumor in the same period and treated by the same surgeons. The results show noticeable differences. The one-year, three-year, and five-year survival rates after resection were 70.9%, 43.2%, and 39.2% in the central type of PLC; they were 98.3%, 85.0%, and 76.4% in the peripheral type of PLC (P less than 0.001). Further discussion of improvements in surgical techniques and mental awareness are suggested.     

同种异体骨移植修复四肢骨肿瘤切除后大段骨缺损

目的分析大段同种异体骨移植在四肢骨肿瘤瘤段切除后大段骨缺损中的疗效。方法对35例四肢骨肿瘤,按Enneking分期原则确定切除范围,进行瘤段广泛切除,大段异体骨移植修复骨缺损,并辅以坚强内固定,高恶性骨肿瘤则进行术前、后化疗。结果随访7～65个月,治疗满意率为75%,主要并发症是感染、不愈合、骨折、局部复发、肺转移死亡,其发生率为30%,保肢率为77%。结论大段同种异体骨移植是治疗四肢骨肿瘤瘤段切除后骨缺损的一种有效可行的方法。     

血浆EBV DNA监测鼻咽癌治疗疗效意义

目的 探讨血浆EBV DNA监测鼻咽癌治疗疗效的临床意义。方法 回顾分析2016-2017年间本院初诊的799例鼻咽癌根治性调强放疗患者的临床资料。分析疗前血浆EBV DNA与临床分期、肿瘤进展的相关性,比较放疗结束及随访中EBV DNA与肿瘤进展的关系。结果 疗前DNA表达水平与临床分期、肿瘤进展呈正相关(P<0.001)。放疗结束后6~8周,19例(2.3%)血浆EBV DNA持续阳性者预后最差,14例发生了肿瘤进展。9例放疗结束后6~8周转为EBV DNA阴性,3例肿瘤进展。而放疗结束EBV DNA阴性患者肿瘤进展率仅8.3%(64/772),3个组无肿瘤进展生存率不同(P<0.05)。随访中持续性血浆EBV DNA阳性,诊断肿瘤进展的敏感性、特异性、准确性分别为77.6%、100%、98.1%。结论 鼻咽癌患者疗前EBV DNA表达水平与肿瘤负荷和肿瘤进展相关,放疗结束6~8周EBV DNA持续阳性者预后极差,应给予合适的辅助治疗。随访中持续性血浆EBV DNA阳性诊断肿瘤进展的正确性高,是鼻咽癌根治性治疗后可靠的疗效监测指标。