序贯化疗联合脑放射治疗非小细胞肺癌脑转移

背景与目的脑放疗是非小细胞肺癌脑转移的传统治疗,化疗与脑放疗的联合是近年的研究方向。鉴于序贯/维持化疗近年来在晚期非小细胞肺癌显示较好前景,我们对非小细胞肺癌脑转移患者进行序贯化疗联合脑放射的治疗探索。方法对确诊的非小细胞肺癌脑转移患者采用TP-NP-GP三个方案序贯化疗联合同期的脑放射进行治疗。TP方案:TXT175mg/m2d1,DDP20mg/m2d1-5,每3周重复;NP方案:NVB25mg/m2d1、8,DDP20mg/m2d1-5,每3周重复;GP方案:GEM1g/m2d1、8,DDP20mg/m2d1-5,每3周重复。每个化疗方案至少使用2疗程,有效的患者继续原方案至4疗程后行下一个方案的序贯化疗。结果51例患者使用TP-NP-GP方案序贯化疗在外周病灶的有效率分别为41.2%、35.6%及27.8%,联合同期的脑放射治疗在脑转移灶的有效率达到60.8%。中位生存期14.7个月。1年、2年及3年生存率分别为67.8%、20.6%及1.3%。结论第三代新药方案序贯化疗联合脑放射治疗非小细胞肺癌脑转移可以取得较好疗效,总体耐受性良好。     

133例非小细胞肺癌脑转移的综合治疗分析

目的：通过回顾性分析探讨影响非小细胞肺癌脑转移治疗效果的预后因素。方法：对133例非小细胞肺癌脑转移患者进行以全脑射治疗为主结合其他方法的治疗。脑转移症状缓解定义为脑部放射治疗结束后1个月，50％以上的症状和体征消失。将脑转移时原发灶控制与否，脑外转移灶，单发或多发脑转移，化疗周期等因素进行多因素分析。结果：所有患者经放射治疗后脑转移灶症状缓解率达88％，缓解期为1．5－55．0个月，中位缓解期为6个月；全脑放射治疗后CT或MRI显示脑转移灶局部控制率为83％；全组中位生存期为6个月，1、2年生存率分别为24．5％和7．8％，经多因素分析显示生存率与多发脑转移，原发灶未控呈负相关，而与化疗3周期以上呈正相关，结论：影响非小细胞肺癌脑转移的主要因素是脑转移时原发灶控制与否，多发或单发脑转移，化疗周期数，对于单发脑转移，脑转移时原发灶控制以及身体条件能够耐受3周期以上化疗的患者，应采取积极的治疗。     

同步放化疗治疗局限期小细胞肺癌疗效分析

目的探讨局限期小细胞肺癌同步放化疗疗效及相关毒副作用。方法62例局限期小细胞未分化肺癌随机分成两组:序贯放化疗组和同步放化疗联合治疗组。两组患者均以CE和CAP方案交替化疗6周期,放射治疗采用6Mv-X线,总剂量50Gy/ (25f·35d)。序贯组放疗在第3周期化疗后进行,同步组放疗与第1周期化疗同时进行。结果同步放化疗组的近期完全缓解率(CR)较序贯组明显提高,分别为81%,55%,差异有显著意义(P<0.05)。3年生存率同步组和序贯组分别为35%,19%,但无统计学差异。3年远处转移率同步组与序贯组分别为55%,65%。两组毒副作用无明显差异。结论同步放化疗对局限期小细胞未分化肺癌局部控制有较好的作用,3年生存率亦有提高趋势。毒副作用可以接受,远期疗效有待于进一步观察。     

支气管动脉灌注-全身化疗序贯治疗中晚期非小细胞肺癌随机对照研究

背景与目的肺癌临床诊断时多为晚期,中晚期肺癌治疗效果欠佳,本研究对比分析中晚期非小细胞肺癌经支气管动脉灌注化疗、全身静脉化疗、支气管动脉灌注化疗加全身化疗序贯治疗的疗效,以期寻找中晚期非小细胞肺癌更理想的治疗方法。方法中晚期非小细胞肺癌127例,均经病理证实,按自愿及随机原则分为支气管动脉灌注化疗、全身静脉化疗与支气管动脉灌注化疗加全身化疗序贯治疗组。结果肺内原发灶有效率(CR PR)介入治疗组,静脉化疗组,序贯治疗组分别为59.22%、30.23%、69.05%。经统计学分析,原发灶总有效率介入治疗组较静脉化疗组显著提高(P<0.01),序贯治疗组较静脉化疗组显著提高(P<0.01),介入治疗组与序贯治疗组无显著性差异(P>0.05)。肺外转移灶有效率介入治疗组,静脉化疗组,序贯治疗组分别为18.19%、53.85%、60.00%,转移灶有效率介入治疗组显著低于静脉化疗组(P<0.05),序贯治疗组较介入治疗显著提高(P<0.01),静脉化疗组与序贯治疗组无显著性差异(P>0.05)。结论支气管动脉灌注化疗加全身化疗序贯治疗既可有效控制肺内病灶又对远处转移有良好预防和控制的作用,值得进一步推广。     

长春瑞滨和顺铂联合同步放疗治疗局部晚期非小细胞肺癌临床研究

目的观察和评价长春瑞滨和顺铂联合同步放疗治疗局部晚期非小细胞肺癌的疗效和不良反应.方法 50例局部晚期非小细胞肺癌患者随机分为同步治疗组和序贯治疗组.同步治疗组累及野常规分割放射治疗:DT 60～64 Gy/30～32次/42～45 d.同步化疗:长春瑞滨25 mg/m2,d1,8,22,29;顺铂25 mg/m2,d1,2,8,9,22,23,29,30.同步放化疗后继续接受辅助化疗.序贯治疗组单纯累及野放疗同前,辅助化疗同前.结果同步治疗组和序贯治疗组的有效率分别为76.0%和36.0%;1,3年总生存率分别为64.0%、36.0%和37.5%、11.1%;1,3年无进展生存率分别为40.0%、16.0%和18.8%、0,差异均有显著性.结论长春瑞滨和顺铂联合同步常规分割放射治疗是局部晚期非小细胞肺癌较为理想的治疗模式.     

VmP方案和全脑放射序贯治疗小细胞肺癌脑转移

背景与目的:单纯化疗或全脑放射治疗(wholebrainradiotherapy,WBRT)姑息性治疗小细胞肺癌(smallcelllungcancer,SCLC)脑转移,生存期均较短,本研究前瞻性观察比较VmP化疗方案与WBRT的不同序贯方法治疗SCLC脑转移患者的疗效、不良反应和生存期。方法:38例SCLC并脑转移初治患者根据使用床位非随机地分为A、B两组,经四格表精确概率法检验两组无显著差异(P>0.05)。A组(VmP-WBRT)采用先化疗2周期后放疗的治疗方法,B组(WBRT-VmP)采用先放疗后化疗2周期的治疗方法。化疗方案VmP:鬼臼噻吩甙(Teniposide,Vm-26)60mg/m2d1～5,顺铂(cisplatin,DDP)25mg/m2d1～3,4周为一治疗周期;WBRT方案:多灶性脑转移患者2周内放疗3Gy×10次;单灶脑转移患者在WBRT后1周内缩野放疗3Gy×5次。序贯治疗完成后继续化疗2～4周期。结果:两组病人治疗后80%以上的患者神经症状改善,两组脑转移癌、肺原发癌有效率和RECIST总客观有效率分别为68.2%和75.0%(P=0.647),77.3%和75.0%(P=0.871),63.6%和56.3%(P=0.646);肿瘤进展时间(timetoprogressions,TTP)分别为6.0个月(95%CI4.4～7.6)和5.0个月(95%CI3.6～6.4)(P=0.383);中位生存期(mediansurvivaltime,MST)分别为12.0个月(95%CI7.9～16.1)和9.0个月(95%CI5.6～12.4)(P=0.049);1年和2年生存率分     

放疗联合长春瑞滨加顺铂同步或序贯化疗治疗Ⅲ期非小细胞肺癌的临床研究

为了比较放射治疗联合长春瑞滨（NVB）加顺铂（DDP）同步与序贯放化疗治疗Ⅲ期非小细胞肺癌（non-small cell lung cancer,NSCLC）的疗效及毒副反应,将55例Ⅲ期NSCLC患者随机分成2组,同步放化疗组（26例）：放疗第1天起即同时开始化疗。序贯放化疗组（29例）：入组后先予化疗2个疗程,再单独予放疗。结果：近期有效率（CR＋PR）同步放化疗组为76.9%（20/26）,序贯放化疗组为51.7%（15/29）,P=0.0456。1、2年生存率同步放化疗组为69.2%（18/26）、42.3%（11/26）,序贯放化疗组为51.7%（15/29）、17.2%（5/29）。2年生存率差异有统计学意义,P=0.041。同步放化疗组白细胞下降与放射性食管炎较序贯放化疗组严重,P〈0.05;但经治疗后,患者大多能耐受。初步研究结果提示,放射治疗联合NVB加DDP同步放化疗治疗Ⅲ期NSCLC的疗效优于序贯放化疗,不良反应增大但可耐受,值得进一步研究。     

127例Ⅳ期非小细胞肺癌三维适形放疗疗效分析

目的:探讨三维适形放射治疗(3-dementional conformal radiiation therapy,3-DCRT)对Ⅳ期非小细胞肺癌的疗效及影响预后的因素。方法:对2004年12月-2007年12月由我院放疗科收治的经三维适形放疗的127例Ⅳ期非小细胞肺癌病人进行回顾性分析。其中单纯放疗35例,放疗加化疗92例。原发灶及区域淋巴结的中位照射剂量为64.6Gy,转移灶的中位照射剂量为53.2Gy。评价其疗效、毒副作用、中位生存时间、半年、1年、2年、3年生存率。运用SPSS 17.0统计软件分析Ⅳ期非小细胞肺癌生存的相关因素。结果:全组总半年、1年、2年、3年生存率分别为80%、49%、12%、7%,中位生存时间12个月,有效率82.7%。骨转移有效疼痛缓解率93.18%(CR 15例,PR 26例,NR 3例)。治疗中1例肝转移患者出现Ⅰ级放射性肝炎;1例脑转移患者在治疗之后一个月出现头痛、恶心、呕吐,2例骨转移患者出现III度骨髓抑制。无放射性肺炎发生。COX分析显示生存率与KPS、联合化疗、原发灶放疗、放疗剂量、病理类型、转移器官数目有关;而性别、年龄、伴有合并症及转移灶部位对生存期无明显影响。结论:3-DCRT可延长Ⅳ期非小细胞肺癌患者的生存期,提高生活质量。一般状况佳、原发灶控制、高剂量放疗、联合化疗、腺癌、转移器管数目少是Ⅳ期NSCLC长期生存的主要影响因素。     

局部中晚期非小细胞肺癌同步与序贯放化疗的Meta分析

目的评价局部中晚期非小细胞肺癌同步与序贯放化疗的疗效.方法采用Meta分析方法收集局部中晚期非小细胞肺癌同步与序贯放化疗比较的相关文献进行综合评价.结果局部中晚期非小细胞肺癌同步与序贯放化疗的有效率与1年生存率合并率差95%可信区间分别为0.0855～0.2145和0.0122～0.1522.结论局部中晚期非小细胞肺癌同步放化疗的有效率与1年生存率优于序贯放化疗.     

放疗联合吉非替尼治疗Ⅳ期非小细胞肺癌疗效分析

目的:评价放疗联合吉非替尼治疗非小细胞肺癌的疗效及安全性.方法:26例非小细胞肺癌患者,其中女性20例,男性6例,病理诊断均为腺癌,所有患者均伴有骨或脑单发或多发转移.放疗部位包括肺原发灶及骨或脑转移灶,肺原发灶放疗剂量50-60Gy,脑转移灶接受全脑放疗30-40Gy,部分患者采用适形放疗加量10-20Gy.骨转移灶放疗剂量40-46Gy.放疗期间及结束后服用吉非替尼250mg/qd,直至肿瘤进展.结果:所有患者放疗期间均完成吉非替尼治疗,3例出现腹泻,7例伴发呕吐,12例合并皮疹,7例皮肤干燥.放疗联合吉非替尼治疗期间症状缓解率92%,ECOG评分由放疗前平均3分提高到放疗后2分.原发灶有效率(CR+PR)88.5%(23/26).转移灶有效率(CR+PR)73.1%(19/26).最长随访时间20个月,中位生存时间(MST)9.5个月,疾病进展时间(TTP)6.2个月.1年生存率39.1%(9/23).结论:Ⅳ期非小细胞肺癌放疗联合吉非替尼治疗是有效而安全的,对生存时间的影响需进一步观察.     

The use of distraction and imagery with children during painful procedures

The effectiveness of a paediatric pain management programme was examined using a multiple case study design. This study examined both the children's pain experience during cancer treatment, as well as their parents'anxiety and behavioural stress. Fourteen people were videotaped while receiving lumbar punctures during an 8–12 month period. Baseline data were obtained at the first of three visits prior to the introduction of relaxation, imagery and distraction exercises. Self-ratings of child fear and parent anxiety, videotaped observations of child and parent behaviour and child pain ratings were obtained at all three visits. The children's behavioural responses to the procedure varied considerably, but their fear scores were stable and their reports of pain decreased over time. Parents reported high-trait, low-state anxiety scores that were stable over time. They were observed to be very supportive during the procedures. Implications for further research in this area and recommendations for practice are presented.     

食管癌贲门癌切除术后器械吻合口早期隐性瘘的诊治分析(附1例典型病例分析)

目的:探讨食管癌贲门癌切除术后器械吻合口早期隐性瘘的预防及诊治要点。方法:回顾分析西安交通大学第一附属医院2006年9月至2007年8月应用管状消化道吻合器对226例食管癌贲门癌切除后行胸内、腹腔内机械吻合,总结器械吻合口早期隐性瘘的诊治体会。结果:器械吻合口早期隐性瘘的发生与多种因素相关。结论:熟练掌握吻合性能和吻合技术是预防器械吻合口早期隐性瘘的关键。早期发现、早期治疗是处理的关键。     

中国与美国恶性肿瘤的现状比较及差异分析

恶性肿瘤是当今世界最主要的死亡原因之一,但不同国家的不同肿瘤在性别、年龄、地区分布的发病率和死亡率有着显著差异。中美两国作为世界上最大的发展中和发达国家,恶性肿瘤的现状也有所不同,但却存在着许多共性和潜在的相似点。因此,本文目的在于尝试对中美两国最新恶性肿瘤现状相关研究资料进行对比分析探究其中差异,以期为中国在恶性肿瘤的预防、筛查及诊疗方面提供些许借鉴和指导。     

X线立体定向治疗靶点位置精确度分析

目的 :分析影响人头模和实际患者靶点位置精确度的各种因素 ,确定立体定向治疗全过程靶点位置精确度及每一步骤的贡献量。材料与方法 :靶点模拟器设定靶点位置 ,测量靶点计划定位精确度 ;钢珠放置Alderson标准人头模中模似患者治疗 ,测量治疗全过程靶点位置精确度。结果 :CT定位精确度 1 .4± 0 .3mm ,人头模治疗总的精确度为 1 .72± 0 .60mm。结论 :由于有更多的因素影响患者治疗 ,人头模靶点位置精确度是理想情况患者治疗精确度     

Phase I dose escalation study of bortezomib in combination with lenalidomide in patients with myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML)

We conducted a phase I dose escalation study to determine the maximal tolerated dose of bortezomib that could be combined with standard dose lenalidomide in patients with MDS or AML. Treatment consisted of bortezomib (IV) on Days 1, 4, 8, and 11 and lenalidomide 10 mg daily (PO) days 1–21 in 28 day cycles for up to 9 cycles. 23 patients (14 MDS/CMML, 9 AML) were enrolled. The maximally tested dose of bortezomib, 1.3 mg/m², was tolerable in this regimen. Responses were seen in patients with MDS and AML. Further testing of this regimen is planned.     

The importance of thermotolerance for the clinical treatment with hyperthermia

Thermotolerance (i.e. a temporary heat resistance following a prior heat treatment) is a general phenomenon occurring in both normal tissues and tumours. Besides affecting a fractionated heat treatment, thermotolerance may also influence the effect of fractionated combined heat and radiation. The importance of thermotolerance for fractionated clinical hyperthermia is discussed on the basis of a series of in vitro experiments in L1A2 cells and in vivo studies of a C₃H mouse mammary carcinoma.If maximal tumour interaction is wanted, thermotolerance should be avoided, but it would be preferable in normal tissues in order to reduce the amount of damage. Unfortunately, there is a considerable variation in the kinetics and magnitude of thermotolerance between different tissues, and it is currently not possible to predict how thermotolerance will develop in a given tumour or normal tissue. However, both the magnitude and the kinetics appear to depend on the heat damage induced by the priming heat treatment. Thus, in a given tissue, thermotolerance will develop later, but will reach a higher maximum by a larger priming heat treatment. It follows that if a homogeneous temperature cannot be applied to a given tissue, different parts will develop thermotolerance at different kinetic patterns. Therefore, at the time of subsequent heat treament, the tissue may express different heat sensitivities in different areas. With the current knowledge, the best way to overcome the problems of thermotolerance when heat is given alone or sequentially with radiotherapy will be by application of a single or few, but large heat fractions given with an interval that allows thermotolerance to develop and decay before the next hyperthermic treatment is given. With a simultaneous heat and radiation treatment which optimally requires heating in association with all radiation fractions, the fractionation interval should also be long, which is complicated by the fact that such long fractionation intervals may not result in an optimal radiation treatment.     

不同年龄成年人急性白血病形态学、免疫学及细胞遗传学分型比较

Objective To investigate the characters of morphology,immunology and cytogenetics of adult acute leukemia (AL) in different ages. Methods 172 cases of newly diagnosed adult AL were divided into two groups:the non-aged group (age＜60 years) and the aged group ( age≥60 years). Morphology,immunology and cytogenetics between the two groups were compared. Results The incidence of M3 in aged AL was significantly lower than that in non-aged AL[6.0 %(3/50) vs 18.9 %(23/122),P ＜0.05]. The incidence of hypo-or extremely hypo-cellular AL in aged AL was significantly higher than that in non-aged AL[14.0 %(7/50) vs 4.1 %(5/122),P ＜0.05],but the incidence of hyper-or extremely hyper-cellular was significantly lower than that in non-aged AL[52.0 %(26/50) vs 73.8 %(90/122),P ＜0.05]. Among aged acute myeloid leukemia (AML),the incidence of lymphoid antigen positive AML (Ly+AML) was significantly higher than that in non-aged AML[63.4 %(26/41) vs 41.3 %(38/92),P ＜0.05]. The incidence of adverse karyotypes in aged AML was significantly higher than that in non-aged AML[33.3 %(11/33) vs 14.1 %(10/71),P ＜0.05].Conclusion Age is an important prognostic factor in AL. Generally,aged AL has poorer prognosis than nonaged AL.     

不同年龄成年人急性白血病形态学、免疫学及细胞遗传学分型比较

Objective To investigate the characters of morphology,immunology and cytogenetics of adult acute leukemia (AL) in different ages. Methods 172 cases of newly diagnosed adult AL were divided into two groups:the non-aged group (age＜60 years) and the aged group ( age≥60 years). Morphology,immunology and cytogenetics between the two groups were compared. Results The incidence of M3 in aged AL was significantly lower than that in non-aged AL[6.0 %(3/50) vs 18.9 %(23/122),P ＜0.05]. The incidence of hypo-or extremely hypo-cellular AL in aged AL was significantly higher than that in non-aged AL[14.0 %(7/50) vs 4.1 %(5/122),P ＜0.05],but the incidence of hyper-or extremely hyper-cellular was significantly lower than that in non-aged AL[52.0 %(26/50) vs 73.8 %(90/122),P ＜0.05]. Among aged acute myeloid leukemia (AML),the incidence of lymphoid antigen positive AML (Ly+AML) was significantly higher than that in non-aged AML[63.4 %(26/41) vs 41.3 %(38/92),P ＜0.05]. The incidence of adverse karyotypes in aged AML was significantly higher than that in non-aged AML[33.3 %(11/33) vs 14.1 %(10/71),P ＜0.05].Conclusion Age is an important prognostic factor in AL. Generally,aged AL has poorer prognosis than nonaged AL.     

Current status of the infrastructure and characteristics of radiation oncology in Korea

BACKGROUND: An analysis of radiotherapy infrastructure in Korea was performed in 2006 to collect data on treatment devices, the work force and new patients for future development plans. METHODS: The survey included radiotherapy centers, their major equipment and personnel. The centers were categorized into four levels: level 0 (stand-alone teletherapy units); level 1 (teletherapy, brachytherapy, treatment planning system, and at least the part-time service of a medical physicist); level 2 (level 1 plus individual customized radiotherapy block and full-time medical physicist); and level 3 [level 2 plus intensity-modulated radiation therapy (IMRT), intra-operative radiation therapy or stereotactic radiotherapy]. RESULTS: A total of 61 facilities delivered radiation therapy with 104 megavoltage devices, which included 96 linear accelerators, two cobalt 60 units, three Tomotherapy, two CyberKnife units and one proton accelerator. There were 28,789 new radiotherapy patients in 2004. Personnel included 132 radiation oncologists, 50 radiation oncology residents, 64 physicists, 130 nurses and 369 radiation therapy technologists. Thirty-two percent (20 facilities) used a CT-simulator, 66% (40) used a PET or PET-CT scanner, and 35% (22) had the capacity to implement IMRT. Centers were also divided into four levels: 41% were included in level 3, 31% in level 2, 25% in level 1 and 3% in level 0. CONCLUSIONS: There is a shortage of human resources. The distribution of megavoltage units per million inhabitants over the country was inadequate; geographic disparities were noted. Furthermore, the necessity of quality assurance for recent high-technology radiation therapy is increasing.