放射治疗83例宫颈癌预后的相关因素

目的 :探讨放射治疗宫颈癌预后的相关因素 ,着重从肿瘤大小、疗程、局部控制情况等方面分析其与生存率的关系。方法 :83例Ⅰ、Ⅱ、Ⅲ期的宫颈癌于 1993年 4月～ 2 0 0 1年 4月在本科行首次放射治疗 ,全部病例均用60 Co远距离治疗机行盆腔外照射加192 Ir高剂量率后装治疗机行腔内照射。外照射 :中平面剂量DT 2 5～ 2 6Gy/13次后中间挡铅加量至DT 4 8～ 5 0Gy。腔内治疗 :A点的剂量DT 5Gy/次 ,DT 35Gy/ 7次。生存率计算采用Kaplan Meier法 ,差异显著性采用Log rank检验。 结果 :①局部控制情况肿瘤消退的 :一年、二年、三年、五年的生存率分别为 95 87%、77 12 %、73 0 9%、73 0 9% ,肿瘤残留的 :一年、二年、三年、五年的生存率分别为 34 2 9%、0 %、0 %、0 % ,差异有显著性意义 (χ2 =111 75 36 ,P <0 0 0 0 1)。②疗程疗程 <5 6天 :一年、二年、三年、五年的生存率分别为 93 88%、82 86 %、80 19%、80 19% ;疗程≥ 5 6天 :一年、二年、三年、五年的生存率分别为 78 95 %、30 5 5 %、2 2 91%、2 2 91%。差异有显著性意义 (χ2 =2 2 4 115 ,P <0 0 0 1)③宫颈肿瘤最大直径 <4cm :一年、二年、三年、五年的生存率分别为 95 12 %、82 86 %、79 6 7%、79 6 7% ;肿瘤最大直     

宫颈癌近距离放射治疗新进展

根治性同步放化疗是ⅡB～ⅣA期宫颈癌患者的主要治疗手段,近距离放射治疗（brachytherapy,BT）是其中重要的部分。近年图像引导的三维近距离放射治疗（image-guided adaptive brachytherapy,IGABT）发展迅速,逐渐引入三维靶区概念、DVH评估等新方式,可有效提高宫颈癌根治性放疗疗效并降低不良反应,但新技术在临床应用中仍存在部分不确定性,且对于如何与精确体外放疗相结合仍需进一步探索。     

影响宫颈癌调强放射治疗相关急性放射性肠炎的临床因素及剂量学参数分析

目的 回顾性分析宫颈癌调强放射治疗(Intensity-modulated radiotherapy, IMRT)中急性放射性肠炎(radiation enteritis, RE)的发生发展与临床因素、剂量-体积参数的关系。方法 收集苏州大学附属第一医院放疗科接受盆腔局部放疗的宫颈癌患者50例,根据不良反应事件评价标准(CTCAE 5.0)统计患者IMRT相关性急性放射性肠炎。用剂量体积直方图评价标准计划下患者的危及器官受照剂量体积。分析小肠V₂₀、小肠V₃₀、小肠V₄₀、结肠V₄₀、直肠V₄₀预测急性RE及严重急性RE的可行性。结果 50例宫颈癌患者IMRT主要放疗相关不良反应包括胃肠道毒性,所有不良反应为1～3级,未出现3级以上不良反应。放疗开始后第2周,腹泻、腹痛、结肠炎、肛门坠胀、便血的发生率分别为28%、22%、8%、20%、6%,第4周时发生率为56%、36%、16%、26%、18%,外照射结束时分别为74%、42%、24%、34%及30%。发生SARE的宫颈癌患者...     

提高宫颈癌放射治疗疗效的研究进展

宫颈癌是妇科最常见肿瘤之一。因为有天然腔道，使后装治疗成为可能，其后装治疗加体外照射的放疗模式为经典治疗模式，也使放疗5年生存率达70％左右，成为宫颈癌最常用治疗方法。但近30年来放射治疗疗效未见明显提高。随着放疗技术的更新，化学治疗等手段的进步，许多学者曾试图通过改进放疗技术，或与其他手段结合提高疗效，本文就近年的研究报告进行综述。     

宫颈癌的放射治疗进展

宫颈癌是最常见的妇科恶性肿瘤,放射治疗在宫颈癌治疗中占有重要地位[1],约80%的患者把放射治疗作为单独治疗或综合治疗手段之一。腔内近距离治疗结合体外照射是最普遍使用的放射疗法,适合于治疗各个临床期别的子宫颈癌,随着放射治疗设备的不断更新,宫颈癌放疗技术也随之日益革新,下面对宫颈癌放疗的现状及进展加以简述。     

晚期宫颈癌放射治疗进展

晚期宫颈癌首选放射治疗。近年来随着放射治疗技术和放疗设备的发展,宫颈癌的放疗有了较大的进展,同时放、化疗的综合治疗也取得很好的效果。本文就近年来晚期宫颈癌治疗的一些进展进行综述。     

宫颈癌的放射治疗进展

宫颈癌是最常见的妇科恶性肿瘤,放射治疗在宫颈癌治疗中占有重要地位,约80％的患者把放射治疗作为单独治疗或综合治疗手段之一。腔内近距离治疗结合体外照射是最普遍使用的放射疗法,适合于治疗各个临床期别的子宫颈癌,随着放射治疗设备的不断更新,宫颈癌放疗技术也随之日益革新,下面对宫颈癌放疗的现状及进展加以简述。     

晚期宫颈癌放射治疗进展

晚期宫颈癌首选放射治疗.近年来随着放射治疗技术和放疗设备的发展,宫颈癌的放疗有了较大的进展,同时放、化疗的综合治疗也取得很好的效果.本文就近年来晚期宫颈癌治疗的一些进展进行综述.     

宫颈癌放疗敏感性相关因子研究现状

宫颈癌放疗的敏感性与放疗疗效密切相关。目前研究的与宫颈癌放疗敏感性相关因子包括细胞间黏附分子-3、缺氧诱导因子-1α、血管内皮生长因子、Ki67、p53等。寻找能在宫颈癌放疗前预测放射敏感性的指标,对于制定个体化的治疗方案、合理进行综合治疗具有重要意义。     

复发宫颈癌放射治疗的临床分析

目的 探讨复发性宫颈癌的放疗效果。方法 ６９例复发宫颈癌患者给予放射治疗,病人分为二组：放疗邱复发组,放疗剂量与方法视复发时间、部位及范围而定,体外和９或）腔内组织量２０￣７０Ｇｙ;手术后复发组,给予常规盆腔放疗,组织量６５￣８０Ｇｙ。结果６９例患者３年复发率为６０．９％,再放疗后３年生存率为４４．９％,二组中,中央部位（宫颈、阴道、外阴）复发者３年生存率优于其他部位,盆壁复发才疗效差。二年以上     

Factors Associated with Late Diagnosis of Cervical Cancer in Nepal

Background: The majority of cervical cancers, the most prevalent cancer among Nepali women, are diagnosedin advanced stage leading to high mortality in Nepal. The present study explored factors associated with latediagnosis. Materials and Methods: A cross-sectional study was carried out in two specialized cancer hospitalsof Nepal from August 12 to October 12, 2012. Randomly selected 110 cervical cancer patients were interviewedand their medical records were reviewed. Multivariate logistic regression analysis was performed to predictassociations. Results: Mean age of patients was 52.7years (SD=10.6), 66% were illiterate and 77% were ruralinhabitants. Medical shops (33.6%) and private hospitals (31%) were major first contact points of patientswith health care providers (HCP). There was no cervical/per-speculum examination (78.2%) and symptomsmisinterpretation (90%) of patients occurred in initial consultation with HCP. Four in every five cases (80.9%)of cervical cancer had late diagnosis. Literate women (adjusted OR=0.121, CI: 0.030-0.482) and women havingabnormal vaginal bleeding as early symptom (adjusted OR=0.160, CI: 0.035-0.741) were less likely to suffer latediagnosis. Women who shared their symptoms late (adjusted OR=4.272, CI: 1.110-16.440) and did so with peopleother than their husband (adjusted OR=12.701, CI: 1.132-142.55) were more likely for late diagnosis. Conclusions:High level of illiteracy among women and their problematic health seeking behavior for gynecological symptomsare responsible for late diagnosis of cervical cancer in Nepal. In the absence of a routine screening program,prevention interventions should be focused on raising awareness of gynecological symptoms and improvinghealth seeking behavior of women for such symptoms.     

Factors Associated with Underscreening for Cervical Cancer among Women in Canada

Background: Cervical cancer is the second most common cancer among women worldwide. Failure toprevent cervical cancer is partly due to non-participation in regular screening. It is important to plan anddevelop screening programs directed towards underscreened women. In order to identify the factors associatedwith underscreening for cervical cancer among women, this study examined Pap test participation and factorsassociated with not having a time-appropriate (within 3 years) Pap test among a representative sample ofwomen in Ontario, Canada using Canadian Community Health Survey (CCHS) data. Materials and Methods:Univariate analyses, cross-tabulations, and logistic regression modeling were conducted using cross-sectionaldata from the 2007-2008 CCHS. Analyses were restricted to 13,549 sexually active women aged 18-69 years oldliving in Ontario, with no history of hysterectomy. Results: Almost 17% of women reported they had not hada time-appropriate Pap test. Not having a time-appropriate Pap test was associated with being 40-69 years old,single, having low education and income, not having a regular doctor, being of Asian (Chinese, South Asian,other Asian) cultural background, less than excellent health, and being a recent immigrant. Conclusions: Resultsindicate that disparities still exist in terms of who is participating in cervical cancer screening. It is crucial todevelop and implement cervical cancer screening programs that not only target the general population, but alsothose who are less likely to obtain a Pap tests.     

宫颈癌与多发癌：附39例报告

1965年至1984年我院住院治疗宫颈癌3850例,宫颈癌与多发癌39例,占1.02％。同时性者10例,异时性者29例,其中发生于宫颈癌治疗后和治疗前各为16例和13例。宫颈癌与多发癌累及部位主要是女性生殖道,乳腺与直肠。对产生宫颈多发癌的可能因素,如放射线,激素,胚胎来源作了扼要讨论。多发癌的预后取决于第二癌所累及的器官,病理类型,期别和治疗。     

ADAM9 Expression in Uterine Cervical Cancer and Its Associated Factors

Background: Cervical cancer is a preventable disease caused by human papillomaviruses. It is the third mostcommon cancer to occur in women of reproductive age. The ADAM9 protein plays a role in basement membranedegradation and tumour metastasis in certain types of tumour. Thus, it has the potential to become a new targetedtherapy. The objective of this study was to investigate ADAM9 expression in cervical cancer and to determine thefactors associated with ADAM9-positive expression. Methods: This cross-sectional study was conducted in HospitalUniversiti Sains Malaysia (HUSM) Kelantan, Malaysia from December 2010 to December 2012. Histological slidesobtained from 95 cervical cancer cases diagnosed and/or treated in HUSM from 2000 to 2010 were analysed. TheADAM9 immunostain was then performed on the paraffin blocks. The statistical data entry and analysis were doneusing SPSS version 18.0. Multiple logistic regression analysis was performed to determine the factors associated withADAM9-positive expression. Result: Of the 95 cervical cancer patients included in the study, 72 (75.8%) patients showedpositive ADAM9 expression. The mean age of the patients was 53.89 (10.83) years old. Squamous cell carcinoma wasthe most common type of cervical cancer (n = 67, 70.5%). Factors that showed a statistically significant associationwith ADAM9-positive expression were tumour size (adjusted odds ratio [adj. OR]: 1.08; 95% confidence interval[CI]: 1.02, 1.13; p = 0.004), distant metastasis (adj. OR: 12.82; 95% CI: 1.91, 86.13; p = 0.009) and the histologicaltype of cervical cancer (i.e. squamous cell carcinoma) (adj. OR: 7.39; 95% CI: 1.42, 38.51; p = 0.017). Conclusion:The ADAM9 immunostain was consistently positive in malignant cells. Thus, ADAM9 expression can be used as aprognostic/therapeutic indicator in aiding clinician decision-making regarding patient treatment (targeted therapy).     

调强放疗同步化疗治疗宫颈癌血液学毒性相关因素分析

目的 探讨调强放疗同步化疗治疗宫颈癌的过程中出现严重血液学毒性的相关因素。方法 回顾性分析126例调强放疗同步化疗的宫颈癌患者资料,对同步放化疗期间可能与严重血液学毒性相关的因素进行单因素和多因素分析。结果 单因素分析显示严重血液学毒性的发生与治疗前肌酐水平、放疗前是否接受化疗及是否有骨髓抑制、骨盆骨髓平均剂量、V20、V40及V50有关（P<0.05）。多因素分析显示骨盆骨髓平均剂量（OR: 1.004, 95%CI: 1.002~1.007）、V40（<41% vs. ≥41%, OR: 0.040, 95%CI: 0.007~0.235）、V50 （<9% vs. ≥ 9%, OR: 0.040, 95%CI: 0.011~0.152）和治疗前肌酐水平（<65 μmol/L vs.≥65 μmol/L, OR: 0.116, 95%CI: 0.030~0.441）与3~4级血液学毒性相关。结论 治疗前肌酐<65 μmol/L、V40<41%和V50<9%是宫颈癌患者同步放化疗期间3~4级血液学毒性发生率降低的相关因素。骨盆骨髓平均剂量越高,血液学毒性发生率增高。治疗前评估肾功能水平,严格控制骨盆骨髓的放疗照射体积及剂量,能减少宫颈癌患者血液学毒性发生,是顺利完成调强放疗同步化疗的保障。     

p53 与HPV 相关性宫颈癌

 宫颈癌是女性常见的恶性肿瘤，居女性生殖系统恶性肿瘤的第二位，每年都有370000新发病例，而且约190000妇女死于这种疾病。近几年来由于普查和宫颈损伤后治疗的进步，发达国家宫颈癌发病率和死亡率显著下降；发展中国家宫颈癌发病率约占女性恶性肿瘤的20％～309%，仍是威胁女性健康的主要问题之一。因此宫颈癌的病因、发病机制和治疗的研究受到国内外学者的高度重视。     

Factors Associated with Cervical Cancer Screening Amongst Women of Reproductive Age from Yucatan,Mexico

This study aimed to analyse the participation of women of reproductive age in a cancer screening program,and survey reasons for non-screening in a region from Mexico with high cervical cancer mortality. A total of281 obstetric patients from a previous HPV study in a social security hospital during 2008-2009 were included.Reasons for not participating in the screening were directly asked. HPV positive patients were invited toparticipate in an informative workshop, and they filled in a knowledge questionnaire. The women ranged in agefrom 14-47 years; 123 (43.8%) had never participated in screening, of which 97 (78.9%) had their first sexualintercourse 2 to 10 years ago, resulting in 25% HPV positive. Screening history was strongly associated with 2or more gestations (OR= 10.07, p=0.00) and older age (OR=6.69 p=0.00). When 197 women were contacted andinterviewed, reasons referred for non-screening were ignorance, lack of interest or time, recent sexual onset,shame and fear. More than 50% of the workshop participants showed knowledge of HPV, while 38.9% and 25%knew about Pap smear and cervical cancer. A high percentage of women of reproductive age have never had aPap smear. Promoting the screening program in medical facilities seems to be important in this population. Newapproaches to inform vulnerable individuals on the benefits of screening need to be implemented, especially foryoung women.     

Factors Associated with Delayed Diagnosis of Cervical Cancer in Iran - a Survey in Isfahan City

Background: In the absence of routine screening program for cervical cancer in Iran and high rate of diagnosedcancer in its advanced stage, recognition of sociodemographic factors related to delayed diagnosis of cancer in Irancould be helpful in reducing the burden of disease in our community. The aim of this study was to determine thestage of cervical cancer at diagnosis and factors related to delayed diagnosis of cervical cancer in Isfahan, Iran.Materials and Methods: In this cross sectional study women diagnosed with cervical cancer for the first time byhisto-pathological examination were enrolled. According to the clinical and paraclinical findings and staging ofthe cancer, they were classified into early and delayed diagnosis of cervical cancer. Sociodemographic factorswere compared in the two groups. Results: In this study of 55 women mean age was 48.3±12.0. According to ourclassification 6/55 (10.9%) and 49/55 (89.1%) of them had early and delayed diagnosis of cervical cancer. Delayeddiagnosis of the cancer was significantly higher in patients with lower degree of education, lower socioeconomicstatus, having smoker and addict husband and those who did not have a history of Pap smear test (p<0.05).Conclusions: The results of this study indicated risk factors related to delayed diagnosis of cervical cancer. Theaffected women should be targeted for implementation of specialized educational programmes for improvingknowledge and screening test.     

放射诱导的EGFR核转位阻断可增加人宫颈癌细胞放射敏感度

目的探讨抑制EGFR核转位是否会降低人宫颈癌细胞的放射抵抗。方法 Western blot测定pEGFR-T654多肽、pEGFR-T654对照多肽、西妥昔单抗或吉非替尼预处理后X线照射的人宫颈鳞癌CaSki和腺癌HeLa细胞pEGFR-T654和pDNA-PK-T2609的表达;克隆形成法测定存活分数(SF₂),单击多靶模型拟合剂量-存活曲线,计算放射增敏比(SER)。结果 4 Gy照射后, CaSki和HeLa细胞核EGFR表达呈时间依赖性增加;与对照多肽比较,pEGFR-T654多肽显著降低了CaSki和HeLa细胞核内pEGFR-T654、DNA-PK和pDNA-PK-T2609的表达;与单独放射比较,西妥昔单抗联合放射明显降低了CaSki细胞核EGFR、pEGFR-T654和pDNA-PK-T2609的表达以及克隆形成率和存活分数(SF₂=31.030),增加CaSki细胞的放射敏感度(SER=2.34)。结论放射诱导pEGFR-T654核转位介导pDNA-PK-T2609的活化,西妥昔单抗抑制pEGFR-T654核转运,降低了DN...     

宫颈癌细胞辐射敏感性与IER5基因的关系

摘 要：［目的］ 通过RNA干扰技术致基因沉默和基因过表达的方法研究IER5基因与宫颈癌SiHa细胞系辐射敏感性的相关性,探讨IER5基因不同表达的细胞系对辐射敏感性的差异。［方法］ 构建IER5沉默及过表达的真核表达载体,转染细胞并筛选出稳定表达的细胞系,经Western Blot和Real-time PCR鉴定成功。观察IER5基因不同表达的3种细胞系的形态;对细胞系进行4Gy的辐射后使用CCK-8检测细胞生长曲线;对细胞系进行10Gy的辐射后使用流式细胞仪检测细胞凋亡情况;对细胞系进行4Gy的辐射后使用流式细胞仪检测不同时间点细胞周期的情况。［结果］ IER5基因沉默使SiHa细胞略有增大,照射后的细胞增殖速度加快;而其过表达可使SiHa细胞缩小呈圆形,并且细胞增殖速度有所减慢。IER5沉默导致辐射诱导的SiHa细胞凋亡率降低,过表达可促进辐射诱导的SiHa细胞凋亡,其凋亡在照射后48h最为显著。照射后细胞周期的G2-M期阻滞效应随IER5表达含量的降低而升高,IER5基因沉默促进细胞的增殖分裂。［结论］ IER5基因与宫颈癌SiHa细胞的增殖、凋亡和细胞周期的变化及对辐射的反应有明显相关性,IER5基因可能可提高宫颈癌细胞对放射的敏感性。