宫颈鳞癌Ⅲ期同步放化疗后巩固化疗疗效分析

[目的]探讨宫颈鳞癌Ⅲ期患者同步放化疗后巩固化疗的疗效和毒副作用.[方法]将2007年1月至2008年6月收治的84例宫颈鳞癌Ⅲ期同步放化疗的患者随机分为试验组（40例）和对照组（44例）,试验组患者在同步化疗后接受2个疗程的巩固化疗.对照组未行巩固化疗.观察比较两组患者的3年生存率和毒副反应.[结果]试验组和对照组相比,3年生存率（86.5%和72.7%）和无进展生存率（82.0%和70.3%）均有所提高,差异有统计学意义（P＜0.05）.试验组Ⅲ～Ⅳ度骨髓抑制发生率为27%.[结论]宫颈鳞癌Ⅲ期同步放化疗后巩固化疗对生存率有益,但骨髓抑制较为严重.     

CYFRA 21-1肿瘤标志物在宫颈鳞癌诊断和放疗疗效评价中的作用

目的探讨CYFRA21-1肿瘤标志物在宫颈鳞癌诊断和放疗疗效评价中的作用。方法采用化学发光法检测68例宫颈鳞癌患者放疗前后血清中CYFRA21-1和常用肿瘤标志物鳞癌细胞相关性抗原SCC-Ag水平。结果治疗前,CYFRA21-1检测阳性率52.9%,并随肿瘤分期而增加;放疗后,血清中CY-FRA21-1检测水平明显下降,除2例放疗存在肿瘤转移的患者外,均达到正常水平;CYFRA21-1检测阳性率与SCC-Ag的相比,后者高于前者(P<0.05),但二者检测水平之间存在显著的相关性(相关系数r=0.65)。结论CYFRA21-1检测对宫颈鳞癌患者,特别是一些SCC-Ag检测结果正常的宫颈鳞癌患者的诊断预后和转归判断及放射治疗效果的评价具有重要价值。     

扩散加权成像预测、监测宫颈癌放化疗效果

目的 探讨扩散加权成像(DWI)在预测、监测宫颈癌放化疗效果中的应用价值.方法 对17例接受放化疗的宫颈癌患者,于治疗前和治疗开始后1个月、2个月分别行常规MR平扫及DWI检查,其中8例患者于治疗开始后15 d加行一次DWI检查.测量治疗前和治疗后不同时间点横轴位T2WI上肿瘤最大径和ADC值,分析各疗效组治疗前和治疗后不同时间点ADC值差异. 结果肿瘤完全消失(CR)组治疗前平均ADC值明显低于肿瘤部分消失(PR)组(P＜0.05);治疗后2个月肿瘤最大径缩小率与治疗前ADC值负相关(r=-0.574,P＜0.05).治疗后1个月肿瘤ADC值变化率与治疗后2个月肿瘤最大径缩小率呈正相关(r=0.572,P＜0.05);治疗后15 d与治疗前比较,平均ADC值升高(P＜0.05),而肿瘤最大径与治疗前相比无明显变化(P＞0.05). 结论 宫颈癌治疗前DWI检查有助于预测放化疗疗效,治疗过程中DWI检查有助于早期监测和动态观察治疗效果.     

宫颈鳞癌患者组织自发性凋亡和辐射诱导凋亡与放疗疗效的关系

目的探讨宫颈鳞癌患者组织细胞自发凋亡和放疗 10 Gy后辐射诱导的凋亡与放疗疗效的关系 , 快速确定宫颈鳞癌的辐射敏感性 , 为肿瘤放射治疗方案的个体化提供理论依据 . 方法采用核酸电泳和 TUNEL方法检测宫颈癌活检组织中细胞凋亡水平 . 结合病人接受根治性放疗后的疗效 , 分析细胞凋亡指数与放疗疗效的关系 . 结果核酸电泳 , 在放疗后的宫颈癌组织出现典型的 DNA梯状带 (DNA ladder). TUNEL标记发现 , 照射前宫颈癌组织存在较低的细胞凋亡指数 , 但与其放疗的疗效具有相关性 ; 放疗 10 Gy后凋亡指数 (AI10)明显增加 (P     

Intratumoral dendritic cells and chemoradiation for the treatment of murine squamous cell carcinoma

Dendritic cells are potent antigen-presenting cells that have been shown to have significant antitumor effects in vitro and in vivo. However, the therapeutic efficacy of dendritic cells as an immunotherapeutic treatment has been limited by both immunologic tolerance and active immunosuppression in the tumor microenvironment. To address this problem, we examined the ability of concurrent systemic chemotherapy and local, fractionated radiation to augment intratumoral dendritic cell injections in a mouse model of squamous cell carcinoma. Intratumoral injections of dendritic cells alone did not have a significant antitumor effect in mice with squamous cell carcinoma flank tumors, but the addition of chemoradiation resulted in significant tumor regression. Concurrent chemoradiation alone resulted in slower tumor growth, but no complete tumor regressions. The combination of chemoradiation and intratumoral dendritic cell injections resulted in improved survival and complete tumor regression in 30% mice. Mice with complete tumor regression were partially resistant to the repeat challenge with relevant tumor 60 days after treatment. These findings were partially dependent on the presence of CD4 T cells, CD8 T cells, and natural killer cells. Chemoradiation may augment intratumoral dendritic cell injections through increased intratumoral apoptosis and decreased intratumoral regulatory T cells. This work suggests a possible role for the use of intratumoral dendritic cell therapy with more traditional chemoradiation strategies.     

Modified Docetaxel,Cisplatin, and Fluorouracil (mDCF) as a Neoadjuvant Chemotherapy for Non-metastatic Esophageal Cancer (nMEC)

Objective: Perioperative chemotherapy can potentially downstage esophageal cancer, reducing the risk of early systemic dissemination. One recommended neoadjuvant regimen for managing gastroesophageal junction and esophageal cancer is docetaxel, cisplatin, and 5-fluorouracil (DCF). To address the high toxicity profile of DCF, modifications in dosages and treatment intervals have been studied. We integrated a modified DCF regimen (mDCF) into a multimodal treatment approach for non-metastatic esophageal cancer (nMEC). Retrospectively, we sought to describe our community experience of administrating neoadjuvant mDCF to patients with nMEC.Design: Patients diagnosed with nMEC between August 2008 and November 2017 and prescribed mDCF were identified for retrospective review. Outcomes of interest included disease-free survival (DFS), overall survival (OS), and hematologic toxicities. Analyses were performed using SAS 9.4.Results: Thirty patients met inclusion criteria with a median age of 64.9 years; 90% were male. The 2-year and 5-year DFS was 60.8% and 41.7%, respectively, for adenocarcinoma and 71.4% and 71.4% for squamous cell carcinoma (SCC). The 2-year and 5-year OS was 64.9% and 44.5%, respectively, for adenocarcinoma and 71.4% and 71.4% for SCC. Both DFS and OS decreased with increasing disease stage, histology (adenocarcinoma versus squamous), esophageal compared to esophagogastric-junction involvement, and without surgical intervention. Frequent toxicity grades for leukopenia and thrombocytopenia were Grades I and II.Conclusion: Using an mDCF regimen in combination with chemoradiation +/- surgical resection in a community setting appears to have an acceptable toxicity profile as well as DFS and OS outcomes compared to chemotherapeutic regimens reported in other similar studies.     

晚期非小细胞肺癌放化疗疗效观察

目的探讨同步放化疗与序贯化放疗治疗晚期非小细胞肺癌临床疗效及毒副反应。方法60例经病理或细胞学证实为非小细胞肺癌患者,鳞癌31例,腺癌23例,大细胞癌2例,未定型癌4例。经CT或MRI可测值病灶分期Ⅲa15例,Ⅲb30例,Ⅳ15例;年龄在21—86岁;Kamofsky评分／〉70;被随机分为A、B两组。A组30例为：序贯方法,即化疗＋放疗＋化疗;B组30例为：同步化放疗（周一-五放疗,周六化疗）＋化疗。结果近期疗效：PR＋CR：B组明显好于A组,差异有显著性。毒副作用：胃肠反应B组高于A组,骨髓抑制A组高于B组,差异有统计学意义。结论晚期非小细胞肺癌同步化放疗近期疗效明显优于序贯化放疗,而毒副作用没明显增加,更远期疗效尚待进一步观察。     

The role of cetuximab in the management of head and neck cancers

INTRODUCTION: The standard of care for patients with locally-advanced head and neck cancer is chemoradiation or surgical resection followed by radiation treatment with or without chemotherapy and despite aggressive, multimodality therapies with their associated toxicities, attempts are being made to improve efficacy while reducing toxicity. Cetuximab is a chimeric mAb directed against the EGFR that showed clinical activity in squamous cell carcinoma of head and neck (SCCHN). AREAS COVERED: Cetuximab is beneficial in recurrent and metastatic setting, as well as in the definitive setting. In a landmark study by Bonner et al., cetuximab was found to be effective in prolonging survival in conjunction with radiation treatment in locally-advanced tumors versus radiation therapy alone. The Erbitux in First-Line Treatment of Recurrent or Metastatic Head and Neck Cancer (EXTREME) trial also showed an improvement in conjunction with chemotherapy in recurrent and metastatic tumors. EXPERT OPINION: Cetuximab is an important therapeutic option in SSCHN, and will continue to be used in metastatic and definitive settings. While cetuximab is a valuable tool in the treatment of SCCHN, more studies are needed to maximize the efficacy of this mAb in clinical settings and to identify the subpopulation of patients that truly benefit from its use.     

Unresectable esophageal cancer treated with multiple chemotherapies in combination with chemoradiotherapy: A case report

BACKGROUNDDefinitive chemoradiotherapy (dCRT) using cisplatin plus 5fluorouracil (CF) with radiation is considered the standard treatment for unresectable locally advanced T4 esophageal squamous cell carcinoma (ESCC). Recently, induction chemotherapy has received attention as an effective treatment strategy.CASE SUMMARYWe report a successful case of a 59-year-old female with unresectable locally advanced T4 ESCC treated by two additional courses of chemotherapy with CF after induction chemotherapy with docetaxel, cisplatin and fluorouracil (DCF) followed by dCRT. Initial esophagogastroduodenoscopy (EGD) detected a type 2 advanced lesion located on the middle part of the esophagus, with stenosis. Computed tomography detected the primary tumor with suspected invasion of the left bronchus and 90° of direct contact with the aorta, and upper mediastinal lymph node metastasis. Pathological findings from biopsy revealed squamous cell carcinoma. We initially performed induction chemotherapy using three courses of DCF, but the lesion was still evaluated unresectable after DCF chemotherapy. Therefore, we subsequently performed dCRT treatment (CF and radiation). After dCRT, prominent reduction of the primary tumor was recognized but a residual tumor with ulceration was detected by EGD. Since the patient had some surgical risk, we performed two additional courses of CF and achieved a clinically complete response. After 14 mo from last administration of CF chemotherapy, recurrence has not been detected by computed tomography and EGD, and biopsy from the scar formation has revealed no cancer cells.CONCLUSIONWe report successful case with tumor remnants even after DCF and subsequent dCRT, for whom a complete response was finally achieved with two additional courses of CF chemotherapy. Additional CF chemotherapy could be one radical treatment option for residual ESCC after treatment with induction DCF followed by dCRT to avoid salvage surgery, especially for high-risk patients.     

调强放疗联合同期亚叶酸钙方案对食管鳞癌IGF-1、血管内皮生长因子的影响

目的分析调强放疗联合同期亚叶酸钙（CF）方案对食管鳞癌胰岛素样生长因子1、血管内皮生长因子水平变化及预后的影响。方法选取2015年1月~2018年1月我院肿瘤科收治的110例食管鳞癌患者,随机分为放疗组（采用调强放疗进行治疗）与放化疗组（采用调强放疗联合同期CF方案化疗进行治疗）,55例/组,比较两组患者治疗后近期疗效、血清肿瘤标记物、毒副反应以及生存情况的变化情况。结果放化疗组治疗后近期疗效和放疗组差异无统计学意义(P>0.05);两组治疗后胰岛素样生长因子1、血管内皮生长因子、鳞状细胞癌抗原、癌胚抗原水平明显降低(P < 0.05),放化疗组低于放疗组(P < 0.05);两组毒副反应发生率差异无统计学意义(P>0.05);放化疗组2年、3年生存率明显高于放疗组(P < 0.05),两组中位无进展生存时间、总生存时间差异均有统计学意义(P < 0.05)。结论调强放疗联合同期CF方案化疗治疗食管鳞癌患者近期疗效较好,可降低血清肿瘤标记物水平,不增加毒副反应发生,提高患者生存率,延长患者生存时间。      

血管内皮生长因子在宫颈鳞癌介入化疗前后的表达比较

【目的】探讨血管内皮生长因子（VEGF）在宫颈鳞癌发生发展中的作用,观察介入化疗前后的VEGF表达并进一步评价术前介入化疗联合根治术治疗宫颈鳞癌的可行性和有效性。【方法】采用免疫组化的方法对20例宫颈鳞癌,30例宫颈上皮内瘤样病变及20例正常宫颈组织进行VEGF检测。【结果】宫颈鳞癌VEGF阳性表达率（70％）明显高于宫颈上皮内瘤样病变（CIN）（20％）及正常宫颈组织（5％）,差异有显著性（P〈0．01）。宫颈鳞癌VEGF表达与肿瘤转秽、临床分期及组织学分级无明显相关性（P〉0．05）。宫颈鳞癌介入化疗前VEGF阳性表达水平以高表达为主,而介入化疗后VEGF阳性表达以低表达为主．差异有显著性（P〈0．05）。本组20例宫颈鳞癌患者均行根治性手术,介入化疗后有效率为95％,手术切除率达100％,术后4例患者有淋巴结转移。阴道残端切缘无癌细胞。20例患者均未发生严重介入化疗和手术相关的并发症。【结论】VEGF在宫颈鳞癌组织中呈高表达,从血管生成方面进一步阐述宫颈鳞癌的发生发展,可作为宫颈鳞癌的一种肿瘤指标。术前介入化疗可缩小肿瘤病灶,减少淋巴结转移,且组织中VEGF在宫颈癌介入化疗前后差异有显著性,故认为介入化疗是宫颈鳞癌有效的具有可行性的辅助治疗手段。     

Detection of human papillomavirus DNA in normal epithelium and in squamous metaplasia of the uterine cervix by the polymerase chain reaction.

The presence of human papillomavirus (HPV) 16 was studied by using the polymerase chain reaction (PCR) directly on sections histologically defined as normal squamous epithelium and metaplastic squamous tissue of the uterine cervix. Ten specimens of normal epithelium were obtained at hysterectomy from women with uterine leiomyoma. Six specimens of squamous metaplasia were adjacent to the areas of dysplastic epithelium in which HPV 16 DNA had been detected previously by PCR. HPV 16 DNA was amplified specifically and detected in two of 10 normal cervical epithelium specimens and in all of 6 squamous metaplasia specimens adjacent to dysplastic lesions. However, HPV DNA could not be detected in the metaplasia by in situ hybridization. These results suggest that metaplastic squamous tissue adjacent to dysplastic lesions harbors fewer copies of HPV DNA than the dysplastic area and the carcinoma and that the HPV copy number per cell may be relevant to the pathogenesis of cervical carcinoma.     

多西他赛联合奥沙利铂并同步放疗治疗局部晚期宫颈鳞癌的疗效观察

[目的]探讨多西他赛联合奥沙利铂并同步放疗治疗局部晚期宫颈鳞癌患者的近期疗效及安全性.[方法]选取2013年7月至2015年1月本院收治的局部晚期宫颈鳞癌患者125例,根据不同治疗方法,将125例患者分为顺铂组(59例)和多西他赛+奥沙利铂组(TP组)(66例),顺铂组给予放疗+顺铂单药同步化疗,TP组给予放疗+多西他赛联合奥沙利铂同步化疗,比较两组近期疗效及不良反应发生率.[结果]TP组的总有效率为93.9％(62/66),明显高于顺铂组81.3％(48/59),其差异具有统计学意义(P＜0.05);TP组胃肠道反应、骨髓抑制、放射性直肠炎和放射性膀胱炎的发生率分别为83.3％、98.5％、95.5％和66.7％,而顺铂组则分别为的91.5％、96.6％、91.5％和54.2％,两组比较差异无统计学意义(P＞0.05).[结论]多西他赛联合奥沙利铂并同步放疗用于局部晚期宫颈鳞癌的治疗安全、有效,值得临床推广应用.     

Maintenance immunotherapy in recurrent or metastatic squamous cell carcinoma of the head and neck

The purpose of this study was to determine the efficacy and safety of a maintenance immunotherapy regimen administered to patients with recurrent/metastatic squamous cell carcinoma of the head and neck (RMHN) who showed clinical benefit from docetaxel, ifosfamide, and cisplatin chemotherapy (DIP). Every 4 weeks, patients with RMHN received 60 mg/m docetaxel on day 1, and 1200 mg/m ifosfamide and 20 mg/m cisplatin on days 1 to 4. Low-dose subcutaneous interleukin-2 and oral 13-cis-retinoic acid were administered as maintenance immunotherapy to patients who showed a clinical benefit (complete or partial response, disease stability). The primary end point was response; secondary end points were progression-free survival, overall survival, toxicity, and evaluations of lymphocytes, natural killer cells, and serum vascular endothelial growth factor (VEGF). After a median follow-up of 22 months, 263 courses of chemotherapy were administered to the 54 patients. The overall response rate was 59%. Forty-two patients (78%) had a clinical benefit and received 185 courses of maintenance immunotherapy. Median progression-free survival and overall survival were 11.1 and 21.8 months, respectively. Statistically significant, progressive increases in lymphocytes and natural killer cells and a decrease in VEGF were observed in patients treated with maintenance immunotherapy. The toxicity was relatively well tolerated and caused no death. Outpatient administration of DIP, followed by low-dose interleukin-2 and 13-cis-retinoic acid, was generally well tolerated and showed promising activity against RMHN. Longitudinal changes in lymphocytes, natural killer cells, and VEGF might be useful biomarkers for response and survival.     

补救性放化疗对宫颈癌术后盆腔复发和未控患者的治疗价值

目的探讨宫颈癌术后盆腔局部复发或未控的患者行同步放化疗的治疗效果。方法选取江苏省苏北人民医院2008年1月至2016年12月宫颈癌术后复发或未控进行补救性放化疗患者32例。从宫颈癌术后到复发的平均间隔时间是27个月。全盆腔体外放疗的剂量临床靶区剂量(CTV)50.0~50.4 Gy,肿瘤靶区(GTV)在CTV基础上局部推量10.0~15.0 Gy。在体外放疗结束后,针对残端复发患者进行阴道模后装放疗,总量15.0~30.0 Gy。32例患者均接受顺铂同步化疗,10例患者在同步放化疗后接受了顺铂联合紫杉醇的巩固化疗。采用Logistic回归模型确定治疗反应的预测因素,采用时序检验方法分析最初的国际妇产科协会(FIGO)分期、盆壁浸润、复发肿瘤大小和缓解状态与生存状态的关系。结果所有患者完成了剂量≥50.0 Gy的放疗。26例(81.2%,26/32)患者得到完全缓解。单因素Logistic回归分析表明,FIGO分期、复发肿瘤的大小及盆壁的浸润是达完全缓解的重要预测因素。5年无进展生存期、局部控制率,无远处转移生存率和总生存率分别是68.7%,78.1%,81.3%,75.0%。单变量时序检验表明,FIGO分期、盆壁浸润和完全缓解状态是影响无进展生存期和总生存率的重要因素。同步放化疗轻中度急性和晚期毒性发生率为4例(12.5%)和1例(3.1%)。维持性化疗的急性毒性发生率为40%(4/10)。结论对于局限于盆腔的复发或未控宫颈癌,积极补救行同步放化疗是可行的,具有良好的治疗效果和可接受的毒性。     

Treatment of small cell carcinoma of the lung with methotrexate, doxorubicin, cyclophosphamide, and lomustine: a community-based study

Forty-four patients with undifferentiated small cell carcinoma of the lung (SCCL) were diagnosed and treated at community hospitals. Patients with limited disease were treated with surgical resection or primary radiation therapy (RT) followed by chemotherapy; those with extensive disease received chemotherapy followed by RT if there was not a complete primary response. The chemotherapy used was a combination of methotrexate, doxorubicin, cyclophosphamide, and lomustine. Median survival for patients with both limited and extensive disease was 12 months, with a six-month survival of 89%. Half of the patients had recurrence in the lung. The toxicity was moderate and tolerable. We conclude that this combination chemotherapy plus radiation therapy carries acceptable toxicity and can be used in a community hospital to achieve response rates and survival of SCCL equivalent to that obtained in large cancer centers.     

宫颈腺样囊性癌临床病理特征及免疫组织化学表型

  目的  探讨宫颈腺样囊性癌(adenoid cystic carcinoma, ACC)临床病理及免疫组化特征。  方法  收集北京协和医院2003年1月至2013年12月病理数据库及会诊数据库中诊断为宫颈腺样囊性癌病例共4例; 并采用免疫组化方法对石蜡组织标本进行检测, 总结其临床病理特征、治疗及预后。  结果  4例宫颈腺样囊性癌患者平均年龄61.5岁, 多为绝经后妇女(3/4), 就诊主要症状为阴道流血(3/4), 肿瘤类型多为外生性肿物(3/4)。病理学特征方面, 3例患者表现为宫颈腺样囊性癌合并侵袭性鳞癌, 1例为宫颈腺样囊性癌单一组分; 腺样囊性癌的主要生长方式为筛状; 免疫组织化学表达方式支持其导管腺上皮及肌上皮两种组成成分:CK7在导管腺上皮中阳性表达, P63、SMA在肌上皮中阳性表达; 腺样囊性癌特征性标志物C-MYB在所有病例中均强阳性表达。3例患者完全切除子宫, 1例患者行宫颈锥切, 临床分期均为Ⅰ期; 术后均行放射治疗, 2例患者同时行化学治疗; 4例患者平均随访时间为21.25个月, 均为无病生存状态。  结论  宫颈腺样囊性癌是一种罕见的特殊类型腺癌, 常合并其他类型的宫颈肿瘤, 免疫组化表型与其他部位的腺样囊性癌相同, 但预后相对较差, 术后可辅以放疗及化疗, 早期发现并治疗可以提高患者生存率。     

Prevalence of human papillomavirus type 18 DNA in adenocarcinoma and adenosquamous carcinoma of the uterine cervix occurring in Japan

To identify whether the incidence of human papillomavirus (HPV) type 18 DNA in adenocarcinoma and adenosquamous carcinoma is attributable to the histological types or geographical differences, the presence of HPV-16 and HPV-18 DNA in carcinoma of the uterine cervix from Japan were studied by in situ hybridization using tritium labeled HPV DNA probes. HPV-18 DNA was detected in 5 of 11 cases (45%) of adenocarcinoma, one case of adenocarcinoma in situ and 2 of 3 cases of adenosquamous carcinoma. In contrast, HPV-16 DNA was detected in 2 of 11 cases (18%) of adenocarcinoma, and 3 of 7 cases (43%) of squamous cell carcinoma. Compared with our previous results (Tase et al. 1988), the present results imply that the prevalence of HPV-18 DNA in carcinoma of the uterine cervix is attributable rather to the histological differences than to the geographical differences.     

膀胱部分切除术联合放化疗治疗肌层浸润性膀胱癌的研究

目的总结我院采用膀胱部分切除术联合放化疗治疗肌层浸润性膀胱癌的经验。方法回顾性分析27例接受膀胱部分切除联合放化疗的肌层浸润性膀胱癌患者的临床资料。男20例、女7例,中位年龄51岁。96%（26/27）的患者肿瘤位于膀胱侧壁、前壁或顶部,81%（22/27）的患者肿瘤单发,肿瘤平均直径2.3cm,手术切缘1.3～2.0cm。病理分期为T2期14例、T3期11例、T4期2例,病理分级为G12例、G210例、G315例。尿路上皮癌25例、鳞癌1例、腺癌1例。膀胱部分切除术中用羟基喜树碱浸泡膀胱及切口,6例行新辅助治疗,其中同步放化疗2例、髂动脉导管化疗4例,辅助化疗19例、辅助放疗2例,27例患者均接受膀胱灌注化疗。结果 27例患者外科切缘均为阴性,无切口种植。6例新辅助治疗的患者总反应率为66.7%。本组25例患者获得随访,中位随访期为80个月,7例局部复发,其中4例行挽救性全膀胱切除术,11例死亡,7例无瘤生存,患者5年生存率为56%。结论选择合适的肌层浸润性膀胱癌患者,采取膀胱部分切除联合放化疗可取得较为满意的疗效。