Preoperative Chemoradiotheraph for Inflammatory Breast Cancer

OBJECTIVE To observe the effect of preoperative chemoradiotherapy for inflammatory breast cancer.METHODS From December 1996 to December 2000, we received and treated 21 patients with inflammatory breast carcinoma with a combinedmodality treatment. The chemotherapy protocol consisted of cyclophosphamide (CTX), pirarubicin (THP-ADM) and 5-fluorouracil (5-FU) or CTX, 5-Fu and methotrexate (MTX). The same infusion scheme was repeated on day 21. After 3～4 cycles the patients were treated with radiotherapy. When the radiation dose reached 40 Gy, the patients who were unable or unwilling to under go an operation received continued radiotherapy. When the radiation dose to the supra clavicular fossa and internal mammary lymph nodes reached 60 Gy and 50 Gy respectively, the radiotherapy was stopped. Chemotherapy was then continued with the original scheme. Patients who had indications for surgery and were willing to under go an operation received no treatment for 2 weeks, after which a total mastectomy was performed. Chemotherapy and radiotherapy was resumed with the original scheme after the operations. When the radiation dose reached 50 Gy, radiotherapy was stopped.RESULTS All patients were followed-up for more than 5 years with a follow-up rate of 100%. The overall 3 and 5-year survival rates of these patients were 42.9%, and 23.8% respectively. For patients in Stage ⅢB the 3 and 5-year survival rates were 50.0% and 27.8% respectively, and for patients in Stage Ⅳ, the 3 and 5-year survival rates were both 0.0%.There was a significant difference between the 2 stage groups (P＜0.05,X2=11.60). For patients who received an operation, the 3 and 5-year survival rates were 80.0% and 33.3% respectively, For patients who were not treated with an operation, the 3 and 5-year survival rates were both0.0%, There was a significant difference between the operated and nonoperated groups (P＜0.05, X2=11.64).CONCLUSION The prognosis of inflammatory breast carcinoma is poor.Before operation, a combined-modality treatment (first chemotherapy,then local therapy, finally chemotherapy and radiotherapy) is the best treatment method.     

肺癌生存5年以上72例分析

[目的]探讨影响肺癌长期生存的因素。方法对1983年1月至1992年12月间收治的经病理证实的存活5年以上的72例肺癌患者进行分析。放疗采用60Co－r线或10MV－X线，大野前后对穿照射Dr40Gy/20次，共4周后缩野加量至总DT52G6y-76Gy（平均61．6Gy，非手术者）或50Gy－70Cy（平均56．1Gy，手术者）。手术均为肺叶（段）切除术。化疗主要方案为（CTX＋5－FU＋VCR、CTX＋ADM＋DDP、CTX＋5－FU＋CBP／E－ADM＋VP-16等。[结果]临床分期、病理类型和是否加用手术治疗对5年生存率的影响，分析显示有统计学差异。I、II、III、IV期5年生存率分别为42．9％、12．9％、5．8％及0；小细胞未分化癌与非小细胞癌的5年生存率分别为3．2％和96％；手术加放疗（加或不加化疗）与放疗（加或不加化疗）的5年生存率分别为对．5％和5．5％。而放疗剂量及是否加化疗对5年生存率的影响未显示有统计学差异。[结论]肺癌应进行早期诊断、早期治疗，尽量采取以手术为主的综合治疗，以提高远期生存率。     

乳腺癌保乳术+化疗后动态调强放疗的临床观察

目的 观察乳腺癌保乳术+化疗后动态调强放疗的疗效和美容效果.方法 117例乳腺癌患者保乳术后先行4～6周期化疗再三维适形(6例)和动态调强放疗(111例).化疗分别采用CAF(环磷酰胺+多柔比星+氟尿嘧啶)、AC(多柔比星+环磷酰胺)、TA(紫杉醇+多柔比星)、NE(长春瑞滨+表阿霉素)、TX(紫杉醇+卡培他滨)方案.放疗采用6 MV-X线全乳腺调强放疗50Gy,瘤床电子线外照射加量10 Gy;其中68例患者锁骨上预防性照射50 Gy,42例肿块位于内侧象限的同时照射内乳淋巴引流区,锁骨上区、内乳区及胸壁均包在一个靶区里.雌、孕激素受体阳性加用内分泌治疗.治疗结束后6～12个月由2位医师评分评价美容效果.结果 随访至2009年9月,随访率为94.0%,随访满3、5年者分别为114、91例.全组3生存率为99.1%,5年生存率为96%,5年无瘤生存率为88%,局部复发率为3.6%,美容效果满意者为100%.放疗中及放疗结束后未出现明显放射性心肺等重要脏器损伤.结论 乳腺保乳术+化疗后胸壁动态调强放疗使靶区得到更均匀照射,有望提高局部控制率和生存率并降低正常组织并发症、肿瘤复发率.     

根治术后盆腔复发直肠癌疗效及预后因素分析

目的 分析直肠癌根治术后盆腔复发规律以及放疗疗效和影响预后的因素.方法 回顾分析2000-2006年直肠癌根治术后盆腔复发接受放疗患者93例,分别为单纯放疗21例、放化疗56例、放疗结合手术和(或)化疗16例.放疗采用60Co或加速器X线,中位剂量59.4Gy,其中90例采用常规分割技术.68例患者放疗后接受了1～8个(中位数3个)疗程化疗,42例行同步放化疗,多为氟尿嘧啶为主的化疗方案.16例患者在放疗后接受了复发灶切除术,其中RO切除7例,姑息性肿块切除9例.结果 全组共132处复发,常见复发部位为直肠周围(31.8%)和骶前区(30.3%),髂外淋巴结和腹股沟淋巴结少见(1.5%和3.0%).总随访率为92%,随访满2、5年者分别为39、4例.有局部症状的84例患者中83%(70例)放疗后症状缓解.全组2、5年局部无进展率分别为49%、22%,2、5年生存率分别为46%、14%.多因素分析结果显示复发后治疗方法是影响直肠癌根治术后复发的局部无进展率的独立预后因素,复发灶最大径、无病间期、放疗后有无远处转移是影响直肠癌根治术后复发患者生存率的独立顶后因素.结论 直肠周围区、骶前区、髂内淋巴结区是直肠癌主要复发部位;放疗可明显改善直肠癌根治术后盆腔复发患者的症状和提高生存质量,放疗联合手术和(或)化疗可提高直肠癌根治术后复发的局部无进展率,复发灶直径＞5 cm、无病间期＜2年、放疗后有远处转移是影响预后的因素.     

Accelerated superfractionated radiotherapy for inflammatory breast carcinoma: complete response predicts outcome and allows for breast conservation

PURPOSE: Chemotherapy and accelerated superfractionated radiotherapy were prospectively applied for inflammatory breast carcinoma with the intent of breast conservation. The efficacy, failure patterns, and patient tolerance utilizing this approach were analyzed. METHODS AND MATERIALS: Between 1983 and 1996, 52 patients with inflammatory breast carcinoma presented to the Medical College of Virginia Hospitals of VCU and the New England Medical Center. Thirty-eight of these patients were jointly evaluated in multidisciplinary breast clinics and managed according to a defined prospectively applied treatment policy. Patients received induction chemotherapy, accelerated superfractionated radiotherapy, selected use of mastectomy, and concluded with additional chemotherapy. The majority were treated with 1.5 Gy twice daily to field arrangements covering the entire breast and regional lymphatics. An additional 18-21 Gy was then delivered to the breast and clinically involved nodal regions. Total dose to clinically involved areas was 63-66 Gy. Following chemoradiotherapy, patients were evaluated with physical examination, mammogram, and fine needle aspiration x 3. Mastectomy was reserved for those patients with evidence of persistent or progressive disease in the involved breast. All patients received additional chemotherapy. RESULTS: Median age was 51 years. Median follow-up was 23.9 months (6-86) months. The breast preservation rate at the time of last follow-up was 74%. The treated breast or chest wall as the first site of failure occurred in only 13%, and the ultimate local control rate with the selected use of mastectomy was 74%. Ten patients underwent mastectomy, 2 of which had pathologically negative specimens despite a clinically palpable residual mass. Response to chemotherapy was predictive of treatment outcome. Of the 15 patients achieving a complete response, 87% remain locoregionally controlled without the use of mastectomy. Five-year overall survival for complete responders was 68%. This is in contrast to the 14% 5-year overall survival observed with incomplete responders. The 5-year actuarial disease-free survival and overall survival for the entire patient cohort was 11% and 33%, respectively. All patients tolerated irradiation with limited acute effects, of which all were managed conservatively. CONCLUSION: Our experience demonstrates that induction chemotherapy, accelerated superfractionated radiotherapy, and the selected use of mastectomy results in excellent locoregional control rates, is well tolerated, and optimizes breast preservation. Based on our present results, we recommend that a patient's response to induction chemotherapy guide the treatment approach used for locoregional disease, such that mastectomy be reserved for incomplete responders and avoided in those achieving a complete response.     

单纯Barrett's食管腺癌108例临床分析

目的分析单纯Barrett’s食管腺癌根治性手术切除后加用放、化疗的临床疗效,探讨影响Barrett’s食管腺癌预后的因素。方法回顾性分析108例Barrett’s食管腺癌患者的临床资料及随访结果。行根治性手术切除者92例,其中术后单纯放疗者76例,术后放疗后加用化疗者16例;姑息性手术治疗者16例,其中有4例患者于术中死亡,另12例患者在术后均采用放疗 化疗。放疗采用60钴或6MV-X线,体外常规分割照射,靶区放射治疗总剂量为55～70 Gy;化疗采用FAM或CMF方案4～6个疗程。结果采用Kaplan-Meier法计算其生存率,本组患者1、3、5年生存率分别为81.5%、51.9%和22.2%,其中根治性手术切除后单纯放疗者5年生存率为15.8%,术后放疗加化疗者为75.0%;有肿瘤外侵者5年生存率为9.1%,无肿瘤外侵者为33.3%;有淋巴结转移者5年生存率为14.3%,无淋巴结转移者为33.3%;姑息性手术治疗术后加放、化疗后5年生存率为0。Log rank检验结果显示,差异均有统计学意义(P<0.05)。结论单纯Barrett’s食管腺癌根治性手术切除后,及时加用放、化疗治疗,有助于疗效的提高。影响预后的主要因素为临床分期、肿瘤外侵、淋巴结转移和根治性手术切除后放、化疗措施的应用。     

鼻腔非霍奇金淋巴瘤的化学治疗及放射治疗

目的 探讨不同治疗方法对鼻腔非霍奇金淋巴瘤(NHL)患者的预后影响。方法 在59例原发于鼻腔NHLIE期患者中,化疗 放疗33例,放疗 化疗8例,单纯化疗10例,单纯放疗8例,化疗方案为CHOP.结果 全组患者的l,3,5年生存率分别为71．2％、42．0％和38．5％,不同治疗方法的生存率差异无显著性(P=0．3943),但生存曲线显示,放化组优于其他组。临床分期显示,Ig局限组患者l,3,5年生存率为84．2c／／,67．7％和62．0%,,Ig超腔组患者为50．0％、14．3％和14．3％,差异有显著性(P=0．0012)。首程化疗≥3个周期24例,首程放疗≥40 Gy16例,CR率分别为25．0v／／,和75．0％,筹异有显著性(P=0．002)。首程化疗2,3～4,5～6个周期的CR率分别为10．5％、25．0％和25．0％,差异无显著性(P=0．48)。并发症发生率及治疗相关死亡率均以化放组为高(39．4％,15．2％),但差异无显著性(P=0．202,P=0．693)。结论 Ⅰ期鼻腔NHL患者首选放疗,以尽早达到局部控制,再根据临床分期及恶性程度或国际预后指数(IPI)酌情给予更有效的化疗方案。     

Management of nonsinonasal neuroendocrine carcinomas of the head and neck

BACKGROUND: Nonsinonasal neuroendocrine carcinomas (NSNEC) of the head and neck are rare and pose a diagnostic and management challenge. The authors undertook a retrospective study to gain insights into the spectrum of clinicopathologic characteristics, patterns of failure, and optimal management of patients with this disease. METHODS: The authors treated 23 adults with pathologically proven, nonmetastatic, primary NSNEC from 1984 to 2001. The majority (13 patients) had laryngeal origin with the following American Joint Committee on Cancer stage distribution: Stage I disease in 1 patient, Stage II disease in 2 patients, Stage III disease in 6 patients, and Stage IV disease in 14 patients. Nine patients underwent definitive surgery with or without postoperative radiation, and 14 patients received definitive radiotherapy. The median definitive radiation dose was 66 grays (Gy) (range, 44-72 Gy) using conventional fractionation. Fourteen patients received chemotherapy, with two to four cycles of induction platinum plus etoposide used most commonly. RESULTS: The median follow-up time for surviving patients was 40 months (range, 15-89 months). The actuarial 2-year and 5-year overall survival (OS) rates were 53% and 33%, respectively; and the disease-free survival (DFS) rates were 41% and 25%, respectively. Both the 2-year OS rate (68% vs. 30%; P = 0.002) and the 2-year DFS rate (55% vs. 17%; P = 0.004) were improved with chemotherapy compared with local therapy alone. Seventy-five percent of patients with measurable disease had complete clinical responses to induction chemotherapy. There was 100% complete clinical response of tumor after radiotherapy. The actuarial 2-year local failure rate was 23%. Chemotherapy did not reduce local failure (P = 0.91). There was no regional failure. The 2-year and 5-year distant metastasis rates were 54% and 71%, respectively. The 2-year rates of metastases without and with chemotherapy were 79% and 39%, respectively (P = 0.006). The 2-year and 5-year rates of intracranial metastases were 25% and 44%, respectively, and the 2-year and 5-year rates of isolated brain metastases were 21% and 41%, respectively. CONCLUSIONS: Based on these results, the authors' treatment strategy for patients with NSNEC is sequential chemotherapy and radiation. They recommend full-dose radiotherapy alone for patients with NSNEC who achieve a complete clinical response to induction chemotherapy. Newer chemotherapeutic regimens or additional adjuvant chemotherapy should be investigated for patients with NSNEC given the high rate of distant failure. Due to the very high rate of brain metastases among patients in the current study, the authors now consider incorporating prophylactic cranial irradiation into primary radiotherapy for individual patients who have complete clinical responses to induction chemotherapy.     

Locoregional irradiation for inflammatory breast cancer: effectiveness of dose escalation in decreasing recurrence

Purpose: To evaluate the effect of radiation dose escalation on locoregional control, overall survival, and long-term complication in patients with inflammatory breast cancer.

Patients and Methods: From September 1977 to December 1993, 115 patients with nonmetastatic inflammatory breast cancer were treated with curative intent at The University of Texas M. D. Anderson Cancer Center. The usual sequence of multimodal treatment consisted of induction FAC or FACVP chemotherapy, mastectomy (if the tumor was operable), further chemotherapy, and radiation therapy to the chest wall and draining lymphatics. Sixty-one patients treated from September 1977 to September 1985 received a maximal radiation dose of 60 Gy to the chest wall and 45–50 Gy to the regional lymph nodes, 22 treated once a day at 2 Gy per fraction, and 35 were treated b.i.d. (32 after mastectomy and all chemotherapy was completed, and 2 immediately after mastectomy; one patient had distant metastases discovered during b.i.d. irradiation, and treatment was stopped). Four additional patients received preoperative radiation with standard fractionation. Based on the analysis of the failure patterns of the patients, the dose was increased for the b.i.d. patients in the new series, with 51 Gy delivered to the chest wall and regional nodes, followed by a 15-Gy boost to the chest wall with electrons. From January 1986 to December 1993, 39 patients were treated b.i.d. to this higher dose after mastectomy and all the chemotherapy was completed; and 8 additional patients received preoperative irradiation with b.i.d. fractionation to 51 Gy. During this period, another 7 patients were treated using standard daily doses of 2 Gy per fraction to a total of 60 Gy, either because they had a complete response or minimal residual disease at mastectomy or because their work schedule did not permit the b.i.d. regimen. Comparison was made between the groups for locoregional control, disease-free and overall survival, and complication rates.

Results: The median follow-up time was 5.7 years (range, 1.8–17.6 years). For the entire patient group, the 5- and 10-year local control rates were 73.2% and 67.1%, respectively. The 5- and 10-year disease-free survival rates were 32.0% and 28.8%, respectively, and the overall survival rates for the entire group were 40.5% and 31.3%, respectively. To evaluate the effectiveness of dose escalation, a specific comparison of patients who received b.i.d. radiation after mastectomy and completion of adjuvant chemotherapy was performed. There were 32 patients treated b.i.d. to 60 Gy in the old series versus 39 patients treated b.i.d. to 66 Gy in the new series. There was an significant improvement in the rate of locoregional control for the b.i.d. patients for the old vs. new series, from 57.8% to 84.3% and from 57.8% to 77.0% (p = 0.028) at 5 and 10 years, respectively. Chemotherapy regimens did not change significantly during this time period.

Long-term complications of radiation, such as arm edema more than 3 cm (7 patients), rib fracture (10 patients), severe chest wall fibrosis (4 patients), and symptomatic pneumonitis (5 patients), were comparable in the two groups, indicating that the dose escalation did not result in increased morbidity. Significant differences in the rates of locoregional control (p = 0.03) and overall survival (p = 0.03), and a trend of better disease-free survival (p = 0.06) were also observed that favored the recently treated patients receiving the higher doses of irradiation.

Conclusion: Twice-daily postmastectomy radiation to a total of 66 Gy for patients with inflammatory breast cancer resulted in improved locoregional control, disease free survival, and overall survival, and was well tolerated.     

乳腺癌术后辅助治疗疗效分析

 目的　探索乳腺癌根治术后患者病期、淋巴结情况及治疗方法对生存率的影响。方法对比分析我科收治的乳腺癌术后Ⅱ期110例和Ⅲ期90例,采用术后放疗、术后化疗及术后放疗加化疗进行治疗。结果　Ⅱ期和Ⅲ期乳腺癌患者术后放疗、术后化疗+放疗局部复发率均低于术后化疗(P＜0.05);Ⅲ期患者远处转移率术后放疗高于术后化疗或术后放疗+化疗(P＜0.05);Ⅱ期乳腺癌腋窝淋巴结转移数≥4个,生存率下降;Ⅲ期乳腺癌患者随着N的升级,五年生存率逐渐降低。结论　乳腺癌术后放疗可以减少局部复发率;Ⅲ期乳腺癌术后化疗可降低远处转移率;淋巴结转移数影响5年生存率。     

Clinical Analysis of 45 Patients with Thymic Carcinoma

OBJECTIVE To retrospectively evaluate the prognostic factors for advanced thymic carcinoma.METHODS The data from 45 patients with advanced thymic carcinoma were retrospectively analyzed according to Masaoka stage criteria. There were 29 Stage Ⅲ patients and 16 Stage Ⅳ patients (13 Stage IVA patients and 3 Stage IVB patients).According to the World Heath Organization Histological Criteria (2004), 25 cases were identified as low-grade and 20 cases were identified as high-grade. All diagnoses were confirmed by biopsy. Five patients underwent gross total resection, 21patients underwent subtotal resection and 19 patients underwent biopsy alone. Forty-two patients received radiotherapy with a median dose of 60 Gy, and 37 patients underwent conventional radiotherapy, including local irradiation and expanded irradiation.Local irradiation volume covered the primary tumor bed and approximately 1-2 cm2 surrounding the tumor (according to preoperative imaging). Expanded irradiation volume covered the full mediastinal and pericardium areas (with or without prophylactic irradiation in the supraclavicular area). Five cases received stereotactic radiotherapy. Thirty-one patients were also treated with chemotherapeutics, including Cisplatin, VP-16,Endoxan, 5-FU and taxol.RESULTS The median follow-up period was 59 months. The overall 3-year survival rate was 57.8%, and the median survival was 45 months. Univariate statistical analysis showed that the histological subtype and Masaoka stage were prognostic factors.The 3-year survival rate was 61.9% in patients treated with gross total resection and 55.0% in those who underwent biopsy only. The 3-year survival rate was 59.5% in patients treated with conventional radiotherapy and 80% in those treated with stereotactic radiotherapy. The 3-year survival rate was 64.5% in patients treated with simultaneous chemotherapy and 42.9%in patients treated without simultaneous chemotherapy (P >0.05). Chemotherapy in combination with radiation treatment and surgery achieved better outcomes for Stage Ⅳ patients than radiation treatment and surgery without chemotherapy (P < 0.05).CONCLUSION For patients with Stage Ⅲ and Ⅳ thymic carcinoma, complete resection and postoperative radiotherapy or fractionated stereotactic radiotherapy constitute the best treatment solution. Chemotherapy can also be used in combination to improve prognosis. For patients with Stage Ⅳ thymic carcinoma,chemotherapy is necessary.     

Clinical Characteristics and Treatment of Malignant Granuloma

OBJECTIVE To analyse the clinical characteristics of malignant granuloma(MG) and evaluate its treatment.METHODS From March 1985 to May 1998, 101 cases of malignant granuloma were treated with radiation (RT) alone or radiotherapy followed by chemotherapy or chemotherapy followed by radiotherapy. For chemotherapy, a CCNU, COMP (CTX, VCR, MTX, PDN) or CHOP (CTX,ADM, VCR, PDN) regimen was given. Radiation was directed through the anterior field of the nose mainly for nasal and paranasal sinus malignant granuloma, and through the faciocervical field for malignant granuloma of Walderyer's ring or for patients with cervical lymphadenectasis. Total dose was 45-65 Gy over 5-6 weeks.RESULTS The overall 3-year, 5-year and 10-year survival rates were 78.2%, 56.1% and 39.7% respectively. The 5-year survival rate was: RT group 60.3%, RT CHOP or CHOP RT group 64.7% (P ＞0.05), RT CCNU group 40%, and RT COMP group 33.3%. The 5-year survival rates of patients with one involved focus and more than 2 involved foci were 75.6%(34/45) and 39.3% (22/56) (P＜0.001). The 5-year survival rates of patients with or without body symptoms were 39.6% (18/48) and 67.9%(36/53) (P＜0.05). The 5-year survival rate of the 50-60 Gy group and the ＜50Gy group were 60.1% (40/66) and 20% (1/5)(P ＜0.05). The local and regional recurrence rate was 20.8 % (21/101 ).CONCLUSION Radiotherapy alone should be the treatment of choice for patients with one site involvement and without body symptoms. Radiation fields should be large enough to include the potentially involved sites. The recommended dose is 50-60 Gy over 5-6 weeks. It is suggested that patients with more than 2 foci involvement and those with body symptoms should receive the combination therapy.     

Prospective multicenter study of combined treatment with chemotherapy and radiotherapy in breast cancer women with the rare clinical scenario of ipsilateral supraclavicular node recurrence without distant metastases

PURPOSE: To evaluate the role of chemotherapy combined with curative radiotherapy in breast cancer patients who presented with recurrent ipsilateral supraclavicular lymph node metastases (ISLM) without "nonregional disease," we designed an observational study performed prospectively. PATIENTS AND METHODS: Forty-four consecutive patients with ISLM from breast cancer as part of recurrent regional disease without distant metastases were included in this study. All patients received chemotherapy with doxorubicin-based schema or paclitaxel for six courses and curative radiotherapy (60 Gy/30 fractions of 2 Gy/5 days a week). An "involved field" radiation was delivered during the interval between the third and fourth chemotherapy course; hormonal therapy was given based on receptor status. RESULTS: The rate of overall clinical response after chemotherapy and radiotherapy was 94.9%. Median time to progression and overall survival were 28 and 40 months, respectively; the 5-year actuarial overall survival and disease-free survival rates were 35% (95% confidence interval, 19-51) and 20% (95% confidence interval, 6-34), respectively. CONCLUSION: A curative course of intravenous chemotherapy and radical irradiation is feasible in patients with ISLM. All patients presenting recurrence in supraclavicular nodes should be treated with definitive locoregional treatments and systemic therapy because the outcomes are better than might be historically assumed.     

胸部放疗在广泛期小细胞肺癌治疗中的价值

目的 探讨胸部放疗在广泛期小细胞肺癌中的应用价值及对患者预后的影响.方法 回顾性分析154例广泛期小细胞肺癌患者的临床资料,化放疗组89例,化疗组65例.放疗采用常规分割1.8～2.0 Gy/次,1次/d,总剂量为40～60 Gy,化疗采用EP方案(顺铂+依托泊甙)、CE方案(卡铂+依托泊甙)或者CAO方案(环磷酰胺+阿霉素+长春新碱).结果 全组中位生存时间为13.7个月,2年和5年生存率分别为27.9%和8.1%,其中化放疗组分别为17.2个月、36.0%和10.1%,化疗组分别为9.3个月、16.9%和4.6%,两组生存率差异有统计学意义(P=0.001).全组中位无进展生存时间为8.0个月,2年和5年无进展生存率分别为13.6%和8.2%,其中化放疗组分别为10.0个月、17.4%和10.5%,化疗组分别为6.2个月、9.8%和4.9%.两组无进展生存率差异有统计学意义(P＜0.001).化放疗组胸内复发率为29.6%(21/89),化疗组胸内复发率为70.0%(42/65),差异有统计学意义(P=0.000).结论 胸部放疗能降低广泛期小细胞肺癌局部失败的发生率,延长患者的总生存时间和无进展生存时间.

Abstract：

Objective To evaluate the effect of thoracic radiation therapy(TRT) on patients with extensive stage small-cell lung cancer(SCLC). Methods One hundred and fifty-four patients with extensive stage SCLC treated in our department between January 2003 and December 2006 were enrolled in this study.Eighty nine patients received chemotherapy and thoracic radiation therapy(ChT/TRT),and 65 patients were treated with chemotherapy alone(ChT without TRT).The chemotherapy was CE(carboplatin and etoposide),PE(cisplatin and etoposide) or CAO(CTX,ADM and VCR) regimens.The total dose of thoracic irradiation was 40-60 Gy with 1.8-2.0 Gy per fraction. Results For the whole group,the median survival time(MST) was 13.7 months,the 2-year and 5-year overall survival rates were 27.9% and 8.1%,respectively.The MST,overall survival rates at 2 years and 5 years in the ChT/TRT group and ChT without TRT group were 17.2 months,36.0%,10.1% and 9.3 months,16.9%,4.6%,respectively(P =0.001).The median progression-free survival(PFS) for all patients was 8.0 months,the 2-year and 5-year PFS were 13.6% and 8.2%,respectively.The median PFS,2-year and 5-year PFS in the ChT/TRT group and ChT without TRT group were 10.0 months,17.4%,10.5% and 6.2 months,9.8%,4.9%,respectively(P ＜0.001).The incidence of intra-thoracic local failure was 29.6% in the ChT/TRT group and 70.0% in the ChT/without TRT group(P = 0.000). Conclusions Chemotherapy plus thoracic radiation therapy can improve the overall survival,progress free survival and reduce local regional failure rate in patients with extensive stage SCLC compared with that by chemotherapy alone.     

乳腺癌保乳术后不同放疗方式的疗效及不良反应

目的:回顾性分析早期乳腺癌保乳术后不同放疗方式对局部正常器官的影响,观察不同放疗方式与生存率的关系。方法:收集我院1998-2010年保乳术后接受不同放疗方式治疗的乳腺癌患者121例,其中37例接受常规二维放疗,80例接受三维放射治疗,放疗采用6MV-X线全乳腺放疗50Gy,瘤床电子线外照射加量10Gy或同步加量至60Gy,4例未接受放疗,雌、孕激素受体阳性的患者加用内分泌治疗。治疗结束后每三个月复查至2年,每半年复查至5年,以后每年复查,放射性不良反应按照RTOG评价标准进行评价。结果:全组3年生存率为97.0％,5年生存率为95.0％,5年无瘤生存率为95.0％,局部复发率为0％。二维放疗放射性肺损伤的发生率明显高于三维放疗（P=0.010）。左侧乳腺癌放射性心脏损伤发生率稍高于右侧,但无明显统计学差异（P=0.210）,二维放疗放射性心脏损伤的发生率明显高于三维放疗（P=0.007）。二维放疗引起II°及III°急性放射性皮肤损伤发生率明显高于三维放疗（P=0.003）。美容效果与放射性皮肤反应相关,发生II°及以上皮肤反应的乳腺外观美容效果差于I°及以下皮肤反应的美容效果（P=0.030）。保乳术后接受局部放疗的患者3年生存率为98.0%,5年生存率为98.0%,T1与Ｔ2患者1、3、5年生存率分别为100%与97%、100%与94%、100%与94%,差异具有统计学意义（P=0.014）。结论:保乳术后行局部放疗明显延长生存时间,三维放疗与二维放疗相比5年生存优势未体现,但在保护肺、心脏、皮肤及美容效果方面明显好于二维放疗。     

乳腺癌保乳术后同步加量IMRT前瞻性研究

目的 前瞻性评估乳腺癌保乳术后瘤床同步加量IMRT的疗效和不良反应。     

Alternating radiotherapy and chemotherapy in non-metastatic inflammatory breast cancer

Ninety-nine patients presenting with non-metastatic inflammatory breast cancer were treated with an alternating protocol of radiotherapy and chemotherapy. The alternating schedule consisted of 8 courses of combined chemotherapy, including doxorubicin, vincristine, cyclophosphamide, methotrexate and 5-Fluorouracil, and 3 series of loco-regional radiotherapy delivering a total dose of 65 to 75 Gy to the breast tumor, 65 Gy to the axilla, and 50 Gy to the supraclavicular and internal mammary chain lymph nodes. Radiotherapy was started after the third course of chemotherapy. A 1-week gap was respected between each course of chemotherapy and each series of radiotherapy. Seventy-five percent of patients were in complete remission at the end of this induction treatment. The 3-year local control was 72% and the 3-year overall survival rate was 70%. An isolated local recurrence was observed in only 4% of patients. Approximately one-half of patients developed distant metastases. These results show that alternating radiotherapy and chemotherapy schedules deserve further investigation in locally advanced breast cancer.     

Results of radiation therapy for unresected soft-tissue sarcomas

PURPOSE: Definitive radiotherapy is uncommonly used in the management of soft-tissue sarcoma (STS). The purpose of the study was to evaluate the results of radiotherapy for unresected STSs treated in a single institution. METHODS AND MATERIALS: Between 1970 and 2001, 112 patients with STSs underwent radiotherapy for gross disease. Locations of the tumor were 43% in the extremities, 26% retroperitoneal, 24% in the head and neck, and 7% in the truncal wall. Histologic grades were 11% G1 and 89% G2 to G3. Median size of tumor at radiotherapy was 8 cm (range, 1-30 cm). Median radiation dose was 64 Gy (range, 25-87.5 Gy). Twenty percent of patients received chemotherapy. Local control (LC), disease-free survival (DFS), and overall survival (OS) rates were evaluated in univariate (log-rank) and then multivariate (Cox model) analysis to determine prognostic factors for STS. RESULTS: Median follow-up for patients is 139 months (range, 30-365 months). The 5-year actuarial LC, DFS, and OS were 45%, 24%, and 35%, respectively. Tumor size at radiotherapy and radiation dose influenced LC, DFS, and OS in univariate analysis. LC at 5 years was 51%, 45%, and 9% for tumors less than 5 cm, 5 to 10 cm, and greater than 10 cm, respectively. Patients who received doses of less than 63 Gy had 5-year LC, DFS, and OS rates of 22%, 10%, and 14%, respectively, compared with 5-year LC, DFS, and OS rates of 60%, 36%, and 52%, respectively, for patients who received doses of 63 Gy or more. AJCC stage was related to the OS and DFS without statistically significant influence on LC. Use of chemotherapy, histologic grade, age, and location did not influence results. In multivariate analysis, LC was related to total dose (p = 0.02), T size at radiotherapy (p = 0.003), and AJCC stage (p = 0.04); DFS was related to total dose (p = 0.007), T size at radiotherapy (p = 0.01), and AJCC stage (p < 0.0001); and OS was related to AJCC stage (p = 0.0001) and total dose (p = 0.002), but not to T size, at radiotherapy. Major radiotherapy complications were noted in 14% of patients; 27% of patients who received doses of 68 Gy or more had these complications compared with 8% of patients treated with doses of less than 68 Gy. CONCLUSIONS: Definitive radiotherapy for STS should be considered in clinical situations where no acceptable surgical option is available. Higher radiation doses yield superior tumor control and survival. A rise in complications occurs in patients who receive doses of 68 Gy or more, which provides a therapeutic window for benefit in these patients.     

69例脑胶质瘤术后三维适形放射治疗临床分析

背景与目的:胶质瘤是成人最常见的颅内肿瘤,其治疗首选以手术为主的综合治疗方案,术后辅助放射治疗是提高疗效的关键。本文旨在探讨脑胶质瘤术后辅助三维适形放射治疗的疗效及其预后因素。方法:69例脑胶质瘤术后的患者,均接受三维适形放射治疗,低级别胶质瘤95%PTV1中位剂量为49.8Gy,95%PTV2中位剂量为56Gy;高级别胶质瘤95%PTV1中位剂量为49.95Gy,95%PTV2中位剂量为60Gy。其中15例患者同步口服替莫唑胺,40例患者口服司莫司汀。结果:全组患者失访3例,死亡32例。1、3、5年生存率分别为68.1%,47.8%和41.8%,中位生存时间17个月。WHOⅠ级、Ⅱ级、Ⅲ级和Ⅳ级患者的3年生存率分别为100%、78.7%、45.0%和25.7%,肿瘤血供较为丰富和血供一般的患者的3年生存率分别为16.3%和81.2%,肉眼全切组和肿瘤残留组的3年生存率分别为64.1%和32.4%。结论:病理分级和肿瘤血供显著影响胶质瘤患者生存,肉眼全切肿瘤有助于提高疗效。     

Ⅳ期肺鳞癌三维放疗对生存的影响

目的 回顾性分析Ⅳ期肺鳞癌原发肿瘤三维放疗对生存的影响。方法 病例源自2项前瞻Ⅱ期临床研究,101例鳞癌中完成研究方案88例,原发肿瘤为化疗同期三维放疗。主要观察终点为OS和PFS。Kaplan-Meier计算生存率并Logrank检验和单因素分析,Cox模型多因素分析。结果 88例鳞癌患者1、2、3、5年OS和MST分别为42.2%、13.6%、8.7%、3.1%和10个月,≥63 Gy和<63 Gy的1、2、3、5年OS及MST分别为45.7%和39.6%、25.7%和4.5%、17.1%和2.8%、7.1%和0%及11月和10个月(P=0.007);中位PFS分别为9个月和7个月(P=0.032)。4周期化疗同期原发肿瘤剂量≥63 Gy的1、2、3、5年OS和PFS分别为51.9%、29.6%、18.5%、9.9%和9个月,OS和PFS较其他模式显著延长(P=0.001、0.012);多因素分析原发肿瘤剂量≥63 Gy对OS有影响接近统计学意义(P=0.080)。结论 Ⅳ期肺鳞癌原发肿瘤三维放疗可能延长生存,随放化疗强度提高OS和PFS逐渐延长,原发肿瘤≥63 Gy可能影响OS。