术前同步放化疗在局部晚期直肠癌治疗中的价值

目的 探讨术前放化疗联合手术治疗局部晚期直肠癌的临床价值。方法 对22 例术前应用放疗（剂量45Gy/5周）和mFOLFOX 方案（奥沙利铂130mg/m2,dl,静脉滴注;甲酞四氢叶酸钙200mg, dl～d3,静脉滴注;氟尿嘧啶500mg/m2, dl～d3,静脉滴注;每3 周重复,共行2 个周期）进行新辅助治疗的局部晚期直肠癌患者资料进行分析。结果 低位前切除术16 例,保肛率72.7%,腹会阴联合切除6例。肿瘤完全消退3例（13.6 %),肿瘤部分缓解10例（45.5%),治疗有效率为59.1% (13/22。肿瘤分期降低13例,降期率为59.1％。结论 对局部晚期直肠癌采用新辅助治疗可使肿瘤不同程度消退,分期降低,提高保肛率。     

直肠癌的辅助治疗进展

直肠癌的辅助治疗主要包括盆腔放射治疗和５ Ｆ Ｕ 为基础的化学治疗。放疗可降低局部复发、增加保留肛门括约肌作用的机会,对于局部晚期和不能手术切除的直肠癌,放疗可以提高手术切除率,对不能手术的患者,放化疗是一种很好的姑息治疗手段。不管病变的期别,化疗药物除了细胞毒杀伤作用外,还可以增加放疗的作用。     

结直肠癌辅助化疗的研究进展

结直肠癌（colorectal cancer,CRC）是消化道最常见恶性肿瘤,全球每年新发病例850000例,死亡病例500000例,美国CRC占恶性肿瘤发病的第3位和因肿瘤死亡的第2位。我国近年CRC发病明显上升,上海市2005年肿瘤报告CRC位居肿瘤发病和死亡的第4位。CRC根治手术后40％～50％患者最终会出现复发或死于转移性疾病。随着CRC基础与临床研究的深入,特别是新化疗药物的应用,辅助化疗已使CRC患者的预后得到明显改善。     

影响直肠癌预后的分子标志物

直肠癌的预后除了与分期、分化程度、治疗方法等有关外，其内在生物学特征起了重要作用。直肠癌标本中p53、bcl-2,p21,c-myc,k-ras等基因表达以及PCNA标记指数、端粒酶活性、血清中CA19－9含量与预后相关。p53,c-myc,k-ras异常表达和PCNA标记指数高、端粒酶活性高、CA19－9含量高预示肿瘤对放化疗敏感性低，预后不良。p21的表达提示较好的预后。     

晚期直肠癌的化、放疗

近日，在苏格兰爱丁堡召开的欧洲肿瘤学会年会上，Andres Cervantes教授负责指导的一个西班牙研究小组报告了他们为晚期直肠癌患者开发一种新的很有希望的治疗方法，并就该方法如何预防癌瘤复发的试验结果进行了认真的评估，由于直肠癌复发率很     

直肠癌新辅助放化疗

根治性手术结合术后放、化疗一度被作为国际公认的Ⅱ及Ⅲ期直肠癌的标准疗法。近年,新辅助放化疗逐渐得到广泛的关注。大量研究表明,与术后放化疗相比,新辅助放化疗结合根治性手术的多模式联合治疗在降低直肠癌的局部复发率、延长生存时间等方面均显示出更好的效果,特别是在提高保肛率方面具有突出的优势。目前认为,新辅助放化疗适用于局部进展期(T3~4)或有系膜内淋巴结转移的低位直肠癌患者(Ⅱ~Ⅲ期)。随着先进的诊断技术、更优化的放疗模式,以及更多有效的药物及新配伍方案的引入,对直肠癌患者采取个体化的术前新辅助治疗,将使直肠癌的治疗效果得到进一步提高。     

直肠癌根治术后辅助性放射治疗的临床研究

目的比较直肠癌根治术后放射治疗与单纯手术的疗效.方法回顾性分析直肠癌根治术后150例.术后放射治疗92例,剂量范围45～50 Gy;单纯手术58例.组间对比及构成比采用χ2检验.结果全组5年总局部复发率22.0%,术后放疗组和单纯手术组局部复发率分别为16.3%和31.0%,术后放疗显著降低了局部复发率(χ2＝4.498,P＜0.05);但是术后放疗组和单纯手术组远处转移率分别为34.8%和22.4%,无显著性意义(P＞0.05).结论直肠癌根治术后放射治疗可降低局部复发率,但不能降低远处转移率.     

高位直肠癌辅助性放疗的问题与争议探讨

局部晚期直肠癌的治疗强调多学科综合治疗,除高质量的直肠全系膜切除术（total mesorectal excision,TME）之外,放化疗的加入也进一步降低了局部复发、延长了总生存,尤其是对于中低位直肠癌。但是,目前对于局部晚期高位直肠癌,放疗的价值仍未明确,国内外各共识指南对高位直肠癌的定义并不完全统一,关于是否放疗的推荐也存在一定差异,目前尚缺乏大型前瞻性随机对照试验,既往的研究结果也存在诸多矛盾之处。同时,盆腔放疗也不可避免的带来一系列不良反应。因此,局部晚期高位直肠癌的治疗应该如何决策,如何基于复发风险进行分层治疗,放疗是否能带来获益,均值得进一步探索。本文旨在针对高位直肠癌辅助放疗的问题与争议进行综述。      

直肠癌多学科综合治疗进展

目的:总结直肠癌多学科综合治疗的最新进展,并对存在的问题和发展前景进行分析.方法:应用计算机检索Medline及cHKD期刊全文数据库检索系统,以"直肠癌/外科手术/化疗/放疗/分析"为关键词,检索2000年1月～2008年12月有关直肠癌多学科综合治疗及其价值方面的文献.精选30篇文献,最后纳入分析26篇.结果:准确的分期是直肠癌多学科综合治疗的关键,新辅助治疗结合根治性手术的模式是降低局部复发率、延长生存时间的有效手段,尤其在提高保肛率方面更具优势.根治性手术结合辅助治疗仍被公认为Ⅱ～Ⅲ期直肠癌的标准治疗模式.把握转移瘤可切除标准和时机结合辅助治疗可延长生存时间.化学新药和靶向药物及新联合治疗方案的引入,可提高直肠癌的疗效.结论:应积极倡导直肠癌规范化多学科综合治疗,与结肠癌相比,直肠癌多学科综合治疗改善总生存率的循证医学证据尚不充分,需深入研究.     

影响直肠癌预后的分子标志物

直肠癌的预后除了与分期、分化程度、治疗方法等有关外，其内在生物学特征起了重要作用。直肠癌标本中p53、bcl-2、p21、c-myc、k-ras等基因表达以及PCNA标记指数、端粒酶活性、血清中CA19-9含量与预后相关。p53、c-myc、kras异常表达和PCNA标记指数高、端粒酶活性高、CA19-9含量高预示肿瘤对放化疗敏感性低，预后不良。p21的表达提示较好的预后。     

门静脉置管皮下植泵化疗预防直肠癌术后肝转移的探讨

探讨门静脉置管皮下植泵化疗对直肠癌根治术后患者肝转移的作用。方法:将69例直肠癌根治术后患者分为观察组35例,以门静脉置管皮下植泵化疗替代全身静脉化疗;对照组34例,采用常规静脉化疗。两组化疗方案均为5-FU+MMC。结果:观察组5年肝转移8例(22.86%),死亡13例,5年生存率62.86%(22/35);对照组5年肝转移16例(47.06%),死亡21例,5年生存率38.24%(13/34);两组5年肝转移发生率和生存率均有显著性差异(P<0.05)。结论:直肠癌根治术后患者,以门静脉置管皮下植泵化疗替代全身静脉化疗可明显降低肿瘤肝转移的发生率,提高其5年生存率。     

直肠癌的辅助治疗

直肠癌辅助治疗观念的提出是基于手术后局部失败率较高。通过术前、术后的放疗或加化疗来提高保肛率、减少复发、提高生存率是近年研究的焦点，对T3期的病人建议采用术前联合治疗、手术加术后以5-Fu为基础的化疗。术前放疗建议按照常规剂量，放疗后4-8周行手术治疗。术后是否行辅助治疗应取决于病理分期，术后辅助治疗方案的选择建议以5-Fu为基础。加用LV、或Capecitabine、或Oxaliplatin、或CPT-11伴随放疗的临床研究正在进行中。     

Outcome of Rectal and Sigmoid Carcinoma Patients Receiving Adjuvant Chemoradiotherapy in Marmara University Hospital

Abstract

Adjuvant chemoradiotherapy is the standard treatment in resected stage II/III rectosigmoid carcinoma. We report a retrospective analysis of 33 patients who received adjuvant chemoradiotherapy. Patients received 5-fluorouracil (375mg/m²/day × 5days) and calcium leucovorin (20mg/m²/day × 5days), q4weeks, two courses before and two courses after radiotherapy. The 5-fluorouracil dose was reduced to 225mg/m²/day given continuously as protracted short-term infusion on the first and last 3 days during radiotherapy. Radiotherapy was started at 7th week and 45-50.4 Gy was given to pelvic region. Median age was 63 years. Median follow- up was 38 months starting from the operation date. Four-year local and distant control rates were 78% and 69%, respectively. Four-year disease-free survival and overall survival were 60% and 62%, respectively. Protracted short-term infusion of 5-fluorouracil during pelvic irradiation is a safe treatment modality. Further studies are needed to improve the local control of high-risk rectal and sigmoid carcinomas.     

Local Excision for Rectal Carcinoma

Local excision is an alternative approach to radical proctectomy for rectal cancer, but from an oncologic standpoint, it is a compromise, and its role remains controversial. Careful patient selection is essential because local excision is generally considered only for early rectal cancer with no evidence of nodal metastasis, parameters that can be predicted by clinical examination, and various radiologic modalities with variable accuracy. In this review, we present the literature evaluating the oncologic adequacy of local excision, including transanal endoscopic microsurgery and the results of salvage surgery after local excision. An overview of local excision in the context of perioperative adjuvant therapies is included. Finally, we suggest a treatment algorithm for local excision in rectal cancer.     

Carcinoma Microsatellite Instability Status as a Predictor of Benefit from Fluorouracil-Based Adjuvant Chemotherapy for Stage II Rectal Cancer

Purpose: Rectal cancers with high microsatellite-instable have clinical and pathological features thatdifferentiate them from microsatellite-stable or low- frequency carcinomas, which was studied rarely in stageII rectal cancer, promoting the present investigation of the usefulness of microsatellite-instability status asa predictor of the benefit of adjuvant chemotherapy with fluorouracil in stage II rectal cancer. Patients andMethods: Data of 460 patients who underwent primary anterior resection with a double stapling technique forrectal carcinoma at a single institution from 2008 to 2012 were retrospectively collected. All patients experienceda total mesorectal excision (TME) operation. Survival analysis were analyzed using the Cox regression method.Results: Five-year rate of disease-free survival (DFS) was noted in 390 (84.8%) of 460 patients with stage II rectalcancer. Of 460 tissue specimens, 97 (21.1%) exhibited high-frequency microsatellite instability. Median age ofthe patients was 65 (50-71) and 185 (40.2%) were male. After univariate and multivariate analysis, microsatelliteinstability (p= 0.001), female sex (p< 0.05) and fluorouracil-based adjuvant chemotherapy (p< 0.001), the 3 factorswere attributed to a favorable survival status independently. Among 201 patients who did not receive adjuvantchemotherapy, those cancers displaying high-frequency microsatellite instability had a better 5-year rate of DFSthan tumors exhibiting microsatellite stability or low-frequency instability (HR, 13.61 [95% CI, 1.88 to 99.28];p= 0.010), while in 259 patients who received adjuvant chemotherapy, there was no DFS difference betweenthe two groups (p= 0.145). Furthermore, patients exhibiting microsatellite stability or low-frequency instabilitywho received adjuvant chemotherapy had a better 5-year rate of DFS than patients did not (HR, 5.16 [95% CI,2.90 to 9.18]; p< 0.001), while patients exhibiting high-frequency microsatellite instability were not connectedwith increased DFS (p= 0.696). It was implied that female patients had better survival than male. Conclusion:Survival status after anterior resection of rectal carcinoma is related to the microsatellite instability status,adjuvant chemotherapy and gender. Fluorouracil-based adjuvant chemotherapy benefits patients of stage IIrectal cancer with microsatellite-stable or low microsatellite-instable, but not those with high microsatelliteinstable.Additionally, free of adjuvant chemotherapy, carcinomas with high microsatellite-instable have a better5-year rate of DFS than those with microsatellite-stable or low microsatellite-instable, and female patients havea better survival as well.     

超选择直肠动脉化疗栓塞术治疗直肠癌的疗效评价

目的 :观察超选择直肠动脉化疗 (栓塞 )术治疗直肠癌的疗效、安全性等情况。方法 :选择直肠 (结肠 )癌患者4 6例 ,采用超选择动脉化疗术 (化疗组 ) 2 7例 ,超选择动脉化疗栓塞术 (栓塞组 ) 19例。选择肠系膜下动脉和双髂内动脉进行动脉造影 ,对最优势供血动脉应用明胶海绵微粒行动脉化疗栓塞。化疗方案选择 :氟苷 +羟基喜树碱 +草酸铂或氟苷 +开普拓。介入治疗前予以相应的预处理。结果 :化疗组CR 1例 ,PR 13例 ,SD 8例 ,PD 5例 ,治疗有效率 5 1 85 % ;栓塞组CR 4例 ,PR 11例 ,SD 3例 ,PD 1例 ,有效率 78 95 %。两组疗效差异显著 (χ2 =2 4 5 ,P <0 0 5 )。两组副反应均不明显。结论 :超选择直肠动脉化疗栓塞术治疗直肠癌是安全、可行的 ,副反应较小 ,值得临床推广使用     

Adjuvant Therapy for Renal Cell Carcinoma

In the past few years, several targeted therapies have been approved by the U.S. Food and Drug Administration for the treatment of advanced renal cell carcinoma. This has led to an improvement in the progression-free survival and quality of life for these patients. Nevertheless, the use of these and other therapies in the adjuvant setting has failed to demonstrate a clear benefit. Immune therapies and hormonal or targeted therapies have been studied in this indication, and there are clinical trials currently enrolling patients with high risk of relapse. This article reviews the available data and the ongoing trials exploring the role of adjuvant therapy for kidney cancer.