TNM因素对非小细胞肺癌治疗效果的影响

目的 探讨肺部原发肿瘤的大小、淋巴结不同区域的转移及有无远处转移对非小细胞肺癌(NSCLC)综合治疗效果的影响.方法 回顾性分析手术治疗的987例NSCLC患者的临床资料,将其中以手术+化、放疗的574例患者与单纯手术治疗的413例患者进行对比分析.结果 全组患者的1、3、5、10年生存率分别为87.7%、57.5%、54.6%和54.5%.其中综合治疗组的1年生存率高于单纯手术组(P<0.01).在T4患者中,手术+放疗组的5年生存率高于单纯手术组(P<0.05).在N0患者中,手术+化疗组、手术+放疗组与单纯手术组比较,1年生存率差异有统计学意义(均P<0.05);在N1患者中,手术+化疗组、手术+放化疗组与单纯手术组比较,1年生存率差异有统计学意义(P<0.01);在N2患者中,手术+化疗组与单纯手术组比较,1年和3年生存率差异均有统计学意义(均P<0.05).结论 对于NSCLC患者,以手术为主的综合治疗疗效优于单纯手术.对T4患者应加强术后局部放疗,对NO和N1患者应辅以适度化、放疗,对N2患者则应强调辅以足够的化疗.     

下咽鳞癌不同治疗方案的临床分析

目的　探讨不同的治疗方案治疗下咽鳞癌的疗效 ,提出规范化的治疗方案。方法　回顾性分析 4 6 4例下咽鳞癌患者的临床特征和不同治疗方案的治疗结果 ,运用SPSS 10 .0软件包进行统计分析。结果　术前放疗 +手术 2 0 2例 ,手术 +术后放疗 2 2例 ,单纯手术 2 6例 ,根治性放疗失败挽救性手术 4 0例 ,单纯放疗 174例。总的 5年生存率为 34.2 % ,术前放疗 +手术组、手术 +术后放疗组、单纯手术组、根治性放疗失败挽救性手术组及单纯放疗组 5年生存率分别为 4 6 .3%、4 9.2 %、2 2 .8%、4 0 .8%和 18.0 % (P <0 .0 1)。术前放疗 +手术组与单纯手术组比较 ,生存率差异有统计学意义 (P =0 .0 4 6 )。术前放疗 +手术组喉功能保留者 80例 ,占 39.6 % ;手术 +术后放疗和单纯手术组喉功能保留者 8例 ,占 16 .7% ,差异有统计学意义 (P =0 .0 0 3)。单纯放疗组和术前放疗 +手术组死于局部复发分别为 2 7.6 %和 8.9% (P =0 .0 0 8)。结论　下咽鳞癌患者首先应选择术前放疗 +手术或手术 +术后放疗的综合治疗方案 ,术前放疗 +手术能明显提高下咽鳞癌的喉功能保留率。     

同时性结直肠癌肝转移患者治疗策略探讨

背景与目的:肝切除术是治疗同时性结直肠癌肝转移获得长期生存的希望.但如何选择肝切除术的手术时机,存在较大的争议,本研究探讨同时性结直肠癌肝转移的手术治疗策略.方法:选择上海东方肝胆外科医院和上海长海医院1995年1月至2005年12月收治的经手术治疗的83例同时性结直肠癌肝转移患者,其中37例行一期手术,46例行分期手术,比较两组手术并发症、死亡率、术中失血量、住院时间、生存率、中位生存期、无瘤生存期及肝转移癌复发率.结果:一期手术组手术并发症发生率为24.3%,分期手术组为19.6%(P=0.601).两组均没有手术死亡.一期手术组术中平均失血量为462 mL,分期手术组为574mL(P=0-312).一期手术组平均住院时间为19 d,分期手术组为36 d(P=0.001).一期手术组l、3、5年生存率分别为86.5%、54.1%和27.0%,分期手术组分别为89.1%(P-0.713)、52.2%(P=0.865)和23.9%(P=0.746).一期手术组中位生存期为40个月,分期手术组为37个月(丹0.075).一期手术组中位无瘤生存期为12个月,分期手术组为11个月(P=0.532).一期手术组肝转移癌复发率为35.1%,分期手术组为30.4% (P=0.650).结论:同时性结直肠癌肝转移患者有选择的一期手术切除原发病灶及肝转移病灶是合理的.     

107例原发性胆囊癌的外科治疗分析

目的:总结胆囊癌的外科治疗经验.评估其疗效并进一步探讨提高晚期胆囊癌患者术后生存率的方法.方法:回顾性分析1996年1月～2006年12月问经外科治疗的107例胆囊癌患者的临床资料,手术方式和随访结果,分析美国癌症联合委员会(AJCC)分期、外科手术方式等相关因素与预后之间的联系.结果:本组总的手术切除率为82.2%(88/107),其中根治性切除率为57.9%(62/107).根治性手术切除后患者(62例)的中位生存期和1、3、5年生存率(包括累积和无瘤生存率)分别在总体上和在每个不同分期水平上都明显高于经单纯胆囊切除术患者(6例)和姑息性手术患者(39例)组(P＜0.01).MCC分期和手术方式与胆囊癌患者的术后生存率有关(P＜0.01).63例(58.9%)患者术后接受了各种辅助治疗(包括化疗、放疗和中医治疗等),44例(41.1%)未接受辅助治疗.结论:对于原发性胆囊癌患者应充分进行术前评价,并根据临床分期采取积极的外科治疗.可以提高术后患者的生存率.     

根治性手术与姑息性手术对老年胃癌患者的临床疗效及术后创伤的影响

目的 探讨根治性手术与姑息性手术对老年胃癌患者的临床疗效及术后创伤的影响.方法 将89例老年胃癌患者,按照手术方式的不同分为根治性手术组46例与姑息性手术组43例.对2组患者术后创伤程度、术后生存质量恢复情况以及短期术后生存率进行观察与对比.结果 根治性手术组患者术中出血量明显较姑息性手术组患者少,差异有统计学意义(P<0.05).其他指标方面2组差异无统计学意义(P>0.05).根治性手术组患者术后生活质量恢复改善率为50.00%、有效率为80.43%,姑息性手术组生活质量恢复改善率为23.26%、有效率为58.14%,根治性手术组明显高于姑息性手术组,差异有统计学意义(P<0.05).根治性手术患者在6个月、1年及2年时的生存率均远远高于姑息性手术患者,差异具有统计学意义(P<0.05).结论 与姑息性手术相比,根治性手术并不会增加老年胃癌患者的手术创伤,并且对于患者术后生活质量及生存率均有积极意义,因此应当严格遵守根治性手术原则进行手术方案选择.     

脊柱转移瘤外科治疗的临床分析

目的:探讨脊柱转移瘤手术治疗的疗效.方法:回顾性分析1991-06～2005-06收治的59例眷柱转移瘤患者的临床资料,其中手术患者27例,包括脊柱肿瘤全部、部分切除及脊柱重建术.非手术组32例,接受化疗或放疗治疗.结果:手术组术后2周自我疼痛评价,疼痛基本消失16例(59.3%),疼痛减轻9例(33.4%),疼痛未缓解2例(7.3%).无手术中、手术期死亡以及瘫痪等并发症发生,生存期1.43～34个月,中位生存期10个月.未手术组患者疼痛基本消失5例(15.6%),疼痛减轻17例(53.1%),疼痛未缓解10例(31.3%).生存期1.20～20个月.中位生存期6个月.疼痛的缓解率两组比较,差异有统计学意义.x2=4.37,P=0.036.生存率两组比较,差异有统计学意义,x2=6.16,P<0.05.结论:脊柱转移瘤患者应尽早争取手术治疗,减轻神经压迫症状体征,延长生存时间.     

胃癌急性穿孔手术方案的选择及效果

目的探讨胃癌急性穿孔手术方案的选择及效果。方法回顾性分析收治的80例胃癌急性穿孔患者的临床资料,其中姑息性胃切除手术组38例,根治性胃切除手术组42例,比较两组患者的手术效果。结果所有患者均手术成功,且两组患者住院时间和并发症发生率比较,差异无统计学意义(P>0.05)。随访12~36个月,根治性胃切除手术组和姑息性胃切除手术组患者的1年生存率分别为86.8%和85.7%,差异无统计学意义(P>0.05),但根治性胃切除手术组患者的2年生存率为69.0%,明显高于姑息性胃切除手术组的52.6%,根治性胃切除手术组死亡患者的生存时间明显长于姑息性胃切除手术组,差异有统计学意义(P<0.05)。术后6个月,两组患者的生活质量(QOL)评分与术前比较均显著提高,差异有统计学意义(P<0.05)。结论胃癌急性穿孔患者姑息性胃切除和根治性胃切除手术的临床效果满意,可以较好地改善患者的生活质量。如患者机体情况允许,应积极实施根治性胃切除手术,以提高生存时间。     

Ⅲa期非小细胞肺癌术后放疗加化疗的疗效分析

目的:探讨Ⅲa期非小细胞肺癌(NSCLC)患者术后放疗加化疗的临床意义.方法:回顾性分析102例Ⅲa期NSCLC患者术后放疗与单纯手术治疗的生存率及复发情况.其中术后放疗加化疗76例,单纯手术26例.结果:术后放化疗组和单纯手术组5年的生存率分别为32.2%和9.1%,两组比较有显著性差异(P＜0.05).术后放化疗组的5年局控率为73.7%(56/76),明显高于单纯手术组的53.8%(14/26),P＜0.05.术后5年远处转移率放化疗组为50.0%(38/76),单纯手术组为61.5%(16/26),两组比较无显著性差异(P＞0.05).结论:本组资料提示,对Ⅲa期非小细胞肺癌术后患者行放疗加化疗,可以提高生存率,且治疗方式、N分期、血红蛋白为生存率的独立预后因素.     

非小细胞肺癌脑转移不同治疗的疗效分析

目的比较不同治疗方法在非小细胞肺癌脑转移中的作用。方法回顾性分析56例非小细胞肺癌脑转移患者,7例接受开颅手术治疗,13例接受开颅手术 术后放疗,22例接受全脑放疗(WBRT),9例接受立体定向放射治疗(SRT),5例接受全脑放疗 立体定向放疗,全部病例定期随访直至死亡。结果总的1年生存率为39.2%,中位生存期是220天。单纯开颅手术组1年生存率为71.4%,中位生存期517天;开颅手术 术后放疗组1年生存率76.9%,中位生存期533天;全脑放疗组1年生存率4.5%,中位生存期78天;立体定向放疗组1年生存率44.4%,中位生存期187天;全脑放疗 立体定向放疗组1年生存期62.0%,中位生存期509天;年龄大于60岁组1年生存率为26.7%,年龄小于60岁组1年生存率53.8%。结论对于一般情况较好,能耐受手术的单发脑转移患者,开颅手术 术后放疗是一种较好的治疗手段。无开颅手术条件的脑转移患者,选择SRT或SRT联合WBRT较单纯WBRT治疗可能更有效。     

198例结直肠癌肝转移患者外科治疗的疗效分析

背景与目的:肝脏是结直肠癌常见的转移部位,35%的患者在确诊时已发生肝转移,肝转移患者的预后较差。尽管手术切除、化疗、射频消融术、介入治疗等手段应用于临床,但治疗效果不同。本研究探讨结直肠癌肝转移外科治疗的临床疗效。方法:对我院5年间经病理检查证实的198例结直肠癌肝转移患者的临床资料进行回顾性分析。根据治疗方法的不同进行分组:根治性切除组46例(23.2%)、姑息性切除组43例(21.7%)、手术探查组或最佳支持治疗组29例(14.6%)、肝动脉置泵化疗组41例(20.7%),全身化疗组39例(19.7%);对其生存期进行比较和统计学分析。结果:根治性切除组中位生存期37.1个月,5年生存率为31.2%;姑息性切除组的中位生存期14.3个月,5年生存率为0;肝动脉置泵化疗组的中位生存期21.3个月,5年生存期为7.5%;全身性化疗和探查组或最佳支持治疗组的中位生存期分别为18.7个月、6.3个月,均无5年生存者。根治性切除组与其他组比较,中位生存期有统计学意义(P<0.01)。结论:根治性切除是提高结直肠癌肝转移患者生存率的重要手段;姑息性切除治疗效果并不优于辅助性治疗,对于不能根治性切除的病例可采用肝动脉置泵化疗。     

High dose, external beam and intraoperative radiotherapy in the treatment of resectable and unresectable pancreatic cancer

Ninety patients with pancreatic cancer were treated by external beam radiotherapy (EBRT) and/or intraoperative radiotherapy (IORT) with or without surgical resection of the tumor, and the results were compared with those of a historical control comprising 112 patients treated by surgery alone. At an early stage of this study, postoperative EBRT (50-60 Gy) or IORT (25-33 Gy) was given alone, but recently the two modalities have been combined. The combination of high doses of EBRT and IORT was well tolerated provided that the gastrointestinal tract was not irradiated during IORT. Although EBRT plus IORT appeared to yield better results than either EBRT or IORT alone, the difference was not significant on multivariate analysis, and patients receiving EBRT, IORT, or EBRT + IORT were grouped together. Patients receiving radiotherapy in addition to macroscopically curative surgery had a slightly longer median survival time (14 months) than those receiving curative surgery alone (10 months), but the 3-year survival rate was similar (21% vs. 19%). In patients who underwent noncurative resection, the median survival time was significantly longer for the irradiated group (12 months) than for the control group (6.5 months). Also, in patients with unresectable lesions but no distant metastases, irradiation prolonged the median survival time significantly (8 vs. 3.5 months). In this group, there was one 5-year survivor, who received EBRT of 55 Gy plus IORT of 30 Gy to his unresectable pancreatic body lesion. Patients with metastases were also treated for palliation of symptoms, but it was found that irradiation prolonged the median survival time even in such cases (4.5 vs. 2.5 months). Based on these results, we plan to use EBRT plus IORT in all pancreatic cancer patients with no metastases.     

Value of external irradiation for locally advanced papillary thyroid cancer

PURPOSE: To look for the possible efficacy of external beam irradiation (EBRT) for locally advanced papillary thyroid cancers. MATERIALS AND METHODS: Between August 1981 and September 1997, 91 patients with locally advanced papillary thyroid cancers (pathologic Stage T4 or N1) were treated with surgical resection. After surgery, 23 patients received postoperative EBRT with or without ablative radioiodine therapy, and 68 patients were treated with ablative radioiodine therapy alone. The distribution of age, gender, and stage was comparable in both groups. RESULTS: The overall survival rates at 7 years were not significantly different statistically between the two groups at 98.1% for the no-EBRT group and 90% for the EBRT group (p = 0.506). The locoregional control rates at 5 years were significantly different (EBRT 95.2% and no EBRT 67.5%; p = 0.0408). Analysis of the prognostic factors, age, gender, stage, and use of radioiodine ablative therapy, indicated these were not significant variables, except for EBRT. CONCLUSIONS: Adjuvant postoperative EBRT did not affect overall survival, but significantly improved locoregional control in patients with locally advanced papillary thyroid cancer (Stage pT4 or lymph node involvement).     

Analysis of the clinical benefit of intraoperative radiotherapy in patients undergoing macroscopically curative resection for pancreatic cancer

PURPOSE: To determine the survival of pancreatic cancer patients treated with intraoperative radiotherapy (IORT) and/or external beam radiation therapy (EBRT) following macroscopically curative resection. METHODS AND MATERIALS: One hundred and thirty-eight patients with pancreatic cancer who had undergone potentially curative total or regional pancreatectomy between 1980 and 1997 were retrospectively analyzed. Among the 138 patients, 98 had a pathologically negative surgical margin and the remaining 40 patients had a positive surgical margin. The usual EBRT dose was 45-55 Gy with a daily fraction of 1.5-2.0 Gy. The median IORT dose was 25 Gy in a single fraction. RESULTS: The 2-year cause-specific survival rate of patients with pathologically negative surgical margins was 19%, and that of patients with positive margins was 4% (p < 0.005). Although the median survival time (MST) of patients with negative margins treated with IORT and EBRT was significantly longer than that of those treated with operation alone (17 vs. 11 months), no significant difference in survival curves was observed. In patients with positive surgical margins in peripancreatic soft tissue, the difference between the survival curve of patients treated with surgery alone and that of those treated with surgery and radiation therapy was borderline significant (p < 0.10). Patients receiving intraarterial or intraportal infusion chemotherapy had significantly improved survival rates compared with those who did not receive it (p < 0.05). CONCLUSION: Although the MST was longer in patients with negative margins receiving IORT and EBRT than in those receiving no radiation, improved long-term survival by IORT and/or EBRT was not suggested. In patients with positive margins, our results obtained by IORT/EBRT were encouraging. Randomized studies with much higher patient numbers are necessary to define the role of IORT in curatively resected pancreatic cancer.     

Postoperative radiotherapy in carcinoma of the cervix with microscopically positive resection margin

Background Patients with cervical cancer who have positive surgical resection margins after radical hysterectomy are at increased risk for local recurrence. The results of postoperative pelvic radiotherapy for cervix cancer with microscopically positive surgical resection margins were analyzed to evaluate the role of radiotherapy. Methods Between 1979 and 1992, 60 patients with cervix carcinoma were treated with postoperative radiotherapy after radical hysterectomy and pelvic lymphadenectomy because of microscopic positive vaginal (48 patients), or parametrial (12 patients) resection margins. Patients were treated with external beam radiation therapy (EBRT) alone (12 patients), or EBRT plus vaginal ovoid irradiation (VOI) (48 patients). The median follow-up period was 55 months. Results The 5-year actuarial disease-free and overall survival rates for all patients were 75% and 84%, respectively. The overall recurrence rate was 23% (14/60). Among the 48 patients with positive vaginal resection margins, 4 had pelvic recurrence (8%), and 7 had distant metastasis (15%); the recurrence rate was 21% (9/43) in those treated with EBRT and VOI, and 40% (2/5) in the EBRT-only treated group. In the 12 patients with positive parametrial margins, 3 patients (25%) had distant metastases. The most significant prognostic factor was lymph node metastasis. Complications resulting from radiotherapy occurred at a rate of 32% (19/60), and grade III complications occurred in 3 patients (5%). Conclusion Postoperative radiotherapy can produce excellent control rates in patients with microscopically positive resection margins. In patients with positive vaginal margins, whole pelvic EBRT and VOI is recommended.     

A randomized trial comparing radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy for locally advanced prostate cancer: results at median follow-up of 102 months

BACKGROUND: To investigate the optimal treatment of locally advanced prostate cancer, a prospective randomized trial was conducted to compare radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy. METHODS: One hundred patients with T2b-3N0M0 prostate cancer were enrolled and 95 were evaluated. Of 95 cases, 46 underwent radical prostatectomy with pelvic lymph node dissection and 49 were treated with external beam radiation by linear accelerator with 40-50 Gy to the whole pelvis and 20-Gy boost to the prostatic area. For all patients, endocrine therapy was initiated 8 weeks before surgery or radiotherapy and continued thereafter. The long-term outcome and morbidity were examined. RESULTS: Median follow-up period was 102 months. At 10 years overall survival rates in the surgery group were better than the radiation group (76.2% versus 71.1% for biochemical progression-free rates; P=0.25, 83.5% versus 66.1% for clinical progression-free rates; P=0.14, 85.7% versus 77.1% for cause-specific survival rates; P=0.06, and 67.9% versus 60.9% for overall survival rates; P=0.30), although none of them reached statistical significance. Erectile dysfunction was recognized in almost all patients as a result of continuous endocrine therapy. Incontinence requiring more than one pad per day was observed more frequently in the surgery group than the radiation group (P<0.01). CONCLUSIONS: For the treatment of patients with locally advanced prostate cancer, when combined with endocrine therapy, either radical prostatectomy or external beam radiotherapy demonstrated favorable long-term outcomes. The radiation dose of 60-70 Gy might not be enough for the local treatment of locally advanced prostate cancer.     

Locoregional recurrence of adenocarcinomas of the rectum treated with irradiation combined with or without excision surgery]

PURPOSE: Retrospective study to analyze the results of external beam radiation treatment with or without surgery for loco-regional recurrence of adenocarcinoma of the rectum following previous surgery without pre- or post-operative radiotherapy. PATIENTS AND METHODS: Between March 1973 and November 1991, 211 patients with loco-regional recurrence of rectum cancer were treated with external beam radiation treatment. Radical surgery was the only initial treatment modality. Surgical resection of local recurrence was done in 36 patients and only 17 patients could undergo complete resection. Forty-seven patients underwent radiotherapy (RT) combined with surgery and 164 received external beam radiation treatment alone to a mean total dose of 46 Gy. RESULTS: Among the 151 patients whose recurrence was revealed by pain, 64 (42%) were considered to have a complete symptomatic response after loco-regional treatment with radiosurgery or RT alone. The mean duration of response was 12 months. The 3-year overall survival rate was 16%. Five prognostic factors decreased the overall survival rate in multivariate analysis: high age, sex (male), concomitant distant metastasis, no tumor resection, and low total radiation dose with external beam radiation treatment alone. The 3-year overall survival rate for patients with completely resected recurrences was 39%. CONCLUSION: External beam RT treatment can only be considered a palliative symptomatic treatment. New techniques of early detection of local recurrence and new combined modalities approaches (radiation sensitizers or intra-operative radiotherapy) with surgical resection in some favorable cases should be studied.     

Outcomes in a series of 103 retroperitoneal sarcomas

AIMS: To report the effect on outcome of selection in patients receiving intra-operative electron beam radiation (IOERT) and external beam radiation therapy (EBRT). METHODS: One hundred and three patients treated for primary RS were studied. Median follow-up was 27 months. Clinical presentation, tumor characteristics, and treatment methods were analyzed to determine impact on survival and recurrence and if selection was occurring. RESULTS: Mean age was 55+/-17 years. Mean tumor size was 15+/-6cm and 88 were high-grade. Complete gross tumor resection (CR) occurred in 62 patients and improved survival vs. both debulking (p=0.0005) and biopsy (p<0.0001). The 5- and 10-year survival rates were 62% and 52% for those with CR vs. 29% and 20% after incomplete resection. Among the 62 CR patients, there was selection to receive additional EBRT+/-IOERT in patients with high-grade tumors (p=0.005) and/or microscopically positive margins (p=0.011). In these high-risk patients there was a trend for IOERT to further augment survival vs. EBRT alone and to increase the time to both local and distant recurrences (p=0.036). CONCLUSIONS: Complete gross resection is the primary form of curative treatment for retroperitoneal sarcomas. Selection led to patients with high-risk tumors receiving additional radiation therapy. There appears to be a beneficial effect of IOERT plus EBRT in these high-risk patients after complete tumor resection.     

Is there a role for a brachytherapy vaginal cuff boost in the adjuvant management of patients with uterine-confined endometrial cancer?

Purpose/Objective: Many patients who have uterine-confined endometrial cancer with prognostic factors predictive of recurrence are treated with adjuvant pelvic radiation. The addition of a brachytherapy vaginal cuff boost is controversial.Materials and Methods: Between 1983 and 1993, 270 patients received adjuvant postoperative pelvic irradiation following hysterectomy for Stage I or II endometrial cancer. Group A includes 173 patients who received external beam irradiation alone (EBRT), while group B includes 97 patients who received EBRT with a vaginal brachytherapy application. The median dose of EBRT was 45 Gy. Vaginal brachytherapy consisted of a low dose rate ovoid or cylinder in 41 patients, a high dose rate cylinder in 54 patients, and a radioactive gold seed implant in two patients. The median follow-up time was 64 months. The two groups were compared in terms of age, histologic grade, favorable versus unfavorable histology, capillary space invasion, depth of myometrial invasion, and pathologic stage.Results: Chi-square analysis revealed that the only difference between the two groups was the presence of more Stage II patients in group B (38% versus 14%). No difference was detected for 5 year pelvic control and disease-free survival rates between groups A and B.Conclusion: There is no suggestion that the addition of a vaginal cuff brachytherapy boost to pelvic radiation is beneficial for pelvic control or disease-free survival for patients with Stage I or II endometrial cancer. Prospective randomized trials designed to study external irradiation alone versus external beam treatment plus vaginal brachytherapy are unlikely to show a positive result. Because EBRT provides excellent pelvic control, protocol development for uterine-confined corpus cancer should focus on identifying patients at risk for recurrence as well as other means of augmenting EBRT (e.g. addition of chemotherapy) in order to improve disease free survival in those subgroups.     

胰腺癌术中放射治疗的价值

目的：回顾总结诸多放射治疗方式对胰腺癌治疗的价值。方法：1986－1999年间收治的无法手术切除的晚期胰腺癌患者68例，伴有严理和中度腹背痛的65例作为研究对象，其中无腹背痛的3例除外，单纯接受术中放射治疗25例，术中放射治疗加体外放射治疗20例，单纯体外放射治疗20例，另外单纯手术治疗胰腺癌30例作对照。结果：（1）单纯术中放射治疗组患者背痛和腹痛的完全缓解率为47％，部分缓解率为34％，总疼痛缓解率为81％，术后2周内见效，中位生存期为5．9个月（从治疗开始计算）。（2）术中放射治疗加体外放射治疗组患者背痛和腹痛的缓解率同单纯疗后4周左右见效，中位生存期是4．5个月。（4）单纯手术治疗组中位生期7个月。结论：术中放射治疗加体外放射治疗能明显延长晚期胰腺癌患者的生存期，而且能明显缓解患者的疼痛，见效快，提高了患者的生活质量。     

Intraoperative electron beam radiation therapy (IOEBRT) for carcinoma of the exocrine pancreas

The abdominal cavities of 50 patients were explored in a specially constructed intraoperative radiotherapy operating amphitheater at the Medical College of Ohio. Twenty-six patients were treated with intraoperative and postoperative precision high dose external beam therapy, 12 with intraoperative irradiation but no external beam therapy, and 12 with palliative surgery alone. All but two patients completed the postoperative external beam radiation therapy as initially prescribed. The median survival time for patients treated with palliative surgery alone was 4 months, and that for patients treated with intraoperative radiotherapy without external beam therapy was 3.5 months. Patients undergoing intraoperative irradiation and external beam radiation therapy had a median survival time of 10.5 months. Four patients died within 30 days of surgery and two patients died of gastrointestinal hemorrhage 5 months posttreatment.