512例子宫颈癌放射治疗疗效报告(英文)

目的报道512例宫颈癌的治疗结果,寻找提高疗效的途径。方法对512例子宫颈癌的5年生存率和影响预后的因素进行回顾性分析。结果放疗后5年生存率分别为Ⅰ期2/2;Ⅱ期74.5%;Ⅲ期56.5%;Ⅳ期28.6%;总的5年生存率为65.4%,与传统腔内治疗的疗效65.7%基本相同,Ⅱ期宫颈病变>4 cm 其5年生存率为63.9%;宫颈病变≤4 cm 其5年生存率为79.3%(P<0.05),统计学有显著性差异。放疗后放射性直肠炎23例,占4.5%;放射性膀胱炎18例占3.5%。结论子宫颈癌放射治疗的生存率稳定于65%的水平,改进大宫颈型和分化不好的肿瘤治疗,可能有助提高生存率。     

子宫颈腺癌44例临床分析

我院自1987年7月－1994年12月共收治宫颈腺癌44例,占同期宫颈癌治疗总数的5．1％,按FIGO分期：Ⅱ20例（占45．6％）,Ⅲ期24例（占54．4％）,采用单纯放疗21例（47．7％）,综合治疗23例（52．3％）,单纯放疗组总的5年生存率33．3％,其中Ⅱ期5年生存率42．9％,Ⅲ期25％,,综合治疗组总5年生存率61．7％,其中Ⅱ期72．7％,Ⅲ期42．9％,分析表明综合治疗可提高子宫颈腺癌的5年生存率。     

子宫颈腺癌44例临床分析

我院自 1987年 7月～ 1994年 12月共收治宫颈腺癌 44例 ,占同期宫颈癌治疗总数的 5 1% ,按FIGO分期 :Ⅱ期 2 0例 (占 45 6 % ) ,Ⅲ期 2 4例 (占 5 4 4% ) ,采用单纯放疗 2 1例 (4 7 7% ) ,综合治疗 2 3例 (5 2 3 % ) ,单纯放疗组总的 5年生存率 33 3 % ,其中Ⅱ期 5年生存率 42 9% ,Ⅲ期 2 5 % ,综合治疗组总 5年生存率 6 1 7% ,其中Ⅱ期 72 7% ,Ⅲ期 42 9% ,分析表明综合治疗可提高子宫颈腺癌的 5年生存率。     

77例ⅠB2～ⅡA期巨块型宫颈癌术前放疗联合手术疗效分析

目的 分析77例ⅠB2～ⅡA期巨块型宫颈癌患者术前腔内放疗联合手术的疗效.方法 对2001-2007年收治的77例ⅠB2和ⅡA期(局部肿瘤>4 cm)宫颈癌患者先行术前阴道腔内后装放疗[阴道黏膜下0.5 cm(源旁1 cm)剂量20～30 Gy,10～12 Gy/次,1次/周],10～14 d后评价疗效并行广泛性子宫切除+盆腔淋巴结清扫术.分析治疗并发症、术后临床病理学特征、生存及复发情况.结果 术前放疗后宫颈肿块均有不同程度的缩小,完全缓解4例,部分缓解28例.全组仪5例放疗后出现1、2级血液及胃肠道副反应.全组5年生存率为83%,盆腔复发率为12%.结论 术前阴道黏膜下0.5 cm腔内后装放疗20～30 Gy联合手术治疗ⅠB2～ⅡA期巨块型宫颈癌生存率较高且未增加术后并发症率,是该期别肿瘤的一种有效治疗模式.     

高剂量率腔内放疗治疗宫颈癌临床分析

目的 评价高剂量率腔内放疗治疗宫颈癌的疗效及并发症。方法 242例宫颈癌患者,其中Ⅰ期2例,Ⅱ期135例,Ⅲ期102例,Ⅳ期3例;鳞癌225例,腺癌16例,腺鳞癌1例,采用8MVX线或60Co γ线体外放疗及137Cs腔内放疗。结果 Ⅱ期、Ⅲ期患者5年生存率分别为75.60%和50.9％。放射性直肠炎及放射性膀胱炎发生率分别为11.2%和7.9％。结论 高剂量率腔内放疗是治疗宫颈癌的一种可行、有效的方法,疗效较好,并发症轻微,但对高危宫颈癌患者,需强调综合治疗。     

腔内加温合并外照射治疗宫颈癌远期疗效

1984～1987年有124例Ⅱ、Ⅲ期宫颈癌行腔内加温合并外照射治疗,以远期生存率和治疗并发症与本科行传统放疗的116例宫颈癌进行比较。124例中Ⅱ期99例,Ⅲ期23例、残端癌2例。腔内加温用915MHz微波治疗机,本组5年生存率Ⅱ期为65,3％,Ⅲ期为56.5％;行传统放疗的分别为54.2％和33.3％。治疗并发症以放射性肠炎进行对比,本组轻和中度肠炎为19.4％,无瘘及溃疡发生。传统放疗组肠炎发生率为38.8％,且5.2％发生了直肠阴道瘘。     

子宫颈腺癌的治疗及预后

宫颈腺癌的发病率近年呈上升趋势。比较我院２６年来宫颈腺癌在宫颈癌中所占的比例从２．６％到８．３６％，本文收集１９８０－１９９０年间收治的１６３例宫颈腺癌，Ⅰ期１０例、Ⅱ期５４例、Ⅲ期８８例，Ⅳ期２例。１２３例单作放疗，３１例放疗加手术，９例自动中止治疗，１７例失访。按寿命表法累计３、５、１０年生存率５５．７％、５０．４２％、４７．２３％。早期患者无特殊临床症状，易误诊。疗效受临床分期及治疗方法的影响。局部复发为治疗失败的主要原因。对于局部肿瘤大、Ⅱ期以上的病例、桷状宫颈放疗后手术可提高生存率。     

63例宫颈腺癌临床治疗和预后分析

目的:了解影响宫颈腺癌预后的相关因素,探讨宫颈腺癌比较理想的治疗方法.方法:对天津医科大学附属肿瘤医院1980年1月至2000年1月间收治的63例宫颈腺癌进行分析,占同期宫颈癌的4.65%,并随机选取同期治疗的80例宫颈鳞癌作为对照进行比较.患者平均发病年龄53.7岁,绝经后患者占55.6%.主要症状为阴道不规则出血和/或白带增多.其中Ⅰ期17例,Ⅱ期33例,Ⅲ期13例.20例采用单纯放射治疗,43例采用放射治疗与手术相结合的综合治疗.结果:收治的宫颈腺癌占宫颈癌的比例从80年代的3.5%(38/1087)上升至90年代的7.36%(34/462),其5年总的生存率为56.9%(33/63-5),低于同期宫颈鳞癌5年生存率.单纯放疗组5年生存率50%;手术放疗组5年生存率为60.5%,两组间无统计学差异.行根治性手术的Ⅰ、Ⅱ期患者5年生存率为80%,而行全宫切除的同期患者5年生存率仅为39.3%,但二者差异尚无统计学意义.宫颈肿瘤≥4cm和＜4cm者5年生存率分别为34.3%(12/35)和60.7%(17/28)具有明显差异(P＜0.05).Ⅰ、Ⅱ期5年生存率62%(31/50),而Ⅲ期5年生存率为7.7%(1/13),二者差异显著(P＜0.01).结论:宫颈腺癌的发病比例呈上升趋势,宫颈腺癌的预后与临床分期、肿瘤大小、治疗方式关系密切.以根治性手术为主的综合治疗是宫颈腺癌的主要治疗方法.     

非根治术加放疗治疗86例Ⅱb期宫颈癌

目的：探讨非根治性手术加放疗配合治疗Ⅱb期宫颈癌的疗效及并发症。方法：回顾性分析了本科自1989年10月至1995年10月收治的Ⅱb期宫颈癌患86例，经放疗－非根治术－放疗的模式治疗。结果：5年生存率75．6％。近期放疗反应轻微，远期放疗并发症：放射性膀胱炎1例，发生率1．16％。放射性直肠炎5例，发生率5．81％。无膀胱阴道瘘及直肠阻道瘘发生。结论：非根治性手术加放疗治疗Ⅱb期宫颈癌临床上取得了较好的效果和较低的并发症，且手术难度小，便于普及，值得推广使用。     

超分割后装治疗中晚期宫颈癌临床初步观察

目的观察192铱超分割后装治疗中晚期宫颈癌的近期疗效及并发症的发生情况,并列超分割后装与传统后装治疗效果及并发症进行比较。方法观察对象为2003年8月至2004年 1月间接受192铱超分割后装治疗的患者,共87例,其中ⅡB期29例,ⅢB期58例,每周治疗4次, 每次A点剂量1．5 Gy,每周累积剂量6 Gy,A点平均总剂量ⅡB期49．7 Gy,ⅢB期52．5 Gy。同时行10-15 MV-X线全盆体外照射,1．6～2 Gy／次,4次／周,外照射20～30 Gy后,中央挡铅4 cm,使盆腔外照射总量达52 Gy,总疗程8～10周。对照组选择2003年1月至2003年6月接受传统192铱后装治疗的患者89例,其中ⅡB期21例,ⅢB期68例,每周5-7 Gy／次,A点总剂量ⅡB期50．1 Gy,ⅢB期53．5 Gy。体外照射方案同超分割治疗。结果87例超分割后装治疗患者失访21例, 有效随访66例中,治疗结束时肿瘤局部控制率95％,1年生存率98％,2年生存率95％,其中ⅡB 期为100％,ⅢB期92％。放射性膀胱炎发生率8％,放射性直肠炎发生率15％。89例传统后装治疗患者失访29例,有效随访60例,1年生存率97％,2年生存率为95％,其中ⅡB期为100％,ⅢB 期93％。放射性膀胱炎发生率9％,放射性直肠炎发生率15％。结论超分割后装加盆腔外照射治疗Ⅱ、Ⅲ期宫颈癌,近期生存率较高,但与传统后装治疗近期疗效比较差异无显著意义,治疗过程中的局部炎性反应较重,不良反应率较高。     

早期舌鳞状细胞癌的疗效分析

目的 分析不同方法治疗Ⅰ、Ⅱ期舌鳞癌的疗效.方法 回顾性分析103例Ⅰ、Ⅱ期舌鳞癌患者,比较单纯手术、单纯放疗和综合治疗(术前或术后放疗)的疗效及其影响因素.结果Ⅰ、Ⅱ期患者的5年生存率分别为82.4%和80.O%(P=0.361),其中单纯手术组、单纯放疗组和综合治疗组的5年生存率分别为90.3%、68.4%和84.0%(P=0.104),局部复发率分别为2.5%、35.7%和5.7%(P＜0.001).隐匿性淋巴结转移率为23.8%,其中Ⅱ区的转移率(19.0%)最高.局部复发、区域复发是影响患者预后的独立因素,单纯手术即能获得满意的局部控制,而低分化鳞癌易出现区域复发.结论 选用单纯手术治疗早期舌癌,如采用择区性颈淋巴清扫术,清扫范围为Ⅰ～Ⅳ区.     

局部放疗对Ⅳ期食管鳞癌患者生存影响的回顾性分析

目的:探讨局部根治剂量及姑息剂量放疗对Ⅳ期食管鳞癌患者生存的影响。方法:回顾性分析2010年1月至2016年7月我院初治的36例Ⅳ期食管鳞癌患者的总体生存时间、1年、2年及3年生存率，同时比较化疗后根治剂量放疗及姑息剂量放疗对生存时间、局部有效率和不良反应的影响。结果:36例Ⅳ期食管鳞癌患者的1年、2年、3年生存率分别为66.7%、36.1%和19.4%，总体中位生存时间为13.5个月。高剂量放疗组和低剂量放疗组的中位生存时间分别是17个月和11个月，1年、2年、3年生存率分别是81%、42.9%、28.6%和46.7%、20%、6.7%，二者的中位生存时间有统计学差异（P=0.024）。高剂量放疗组和低剂量放疗组的放疗有效率分别为71.4%和26.7%，二者之间有统计学差异（P=0.017）。两组间的白细胞减少和血小板减少程度无统计学差异（P>0.05），放射性食管炎及放射性肺炎发生率也无统计学差异（P>0.05）。结论:化疗后给予Ⅳ期食管癌患者局部病灶根治性放疗，有改善患者总体生存的趋势。     

Prognosis and clinicopathological characteristics of Ib-IIb adenocarcinoma of the uterine cervix in patients who have had radical hysterectomy.

AIMS: The aim of the present study was to evaluate the outcome of patients with stage lb-IIb cervical adenocarcinoma treated with radical hysterectomy, and to determine the clinicopathological characteristics of those patients. METHODS: A total of 255 patients with cervical carcinoma stage Ib-IIb (57 adenocarcinoma and 198 squamous cell carcinoma) who had undergone radical hysterectomy were included in this study. Patient survival distribution was calculated using the Kaplan-Meier method. RESULTS: The estimated 5-year survival rate for patients with adenocarcinoma was significantly poorer than that for patients with squamous cell carcinoma (77.9% vs 91.7%). The survival rate in stage Ib patients did not differ between two groups (95.8% vs 94.4% respectively). The incidence of lymph node involvement was significantly higher in patients with adenocarcinoma than in those with squamous cell carcinoma (31.6% vs 14.8%). Among patients receiving post-operative radiotherapy, the survival rate for adenocarcinoma (71.1%) was significantly poorer than that for squamous cell carcinoma (90.0%). When patients underwent radical hysterectomy, the survival rate for stage II patients with adenocarcinoma was significantly poorer than that for patients with squamous cell carcinoma. CONCLUSIONS: The higher incidence of lymph node involvement and lower response to post-operative radiotherapy are considered to be factors of poorer prognosis in cervical adenocarcinoma.     

60例上皮源性鼻腔癌的临床疗效分析

目的：评价上皮源性鼻腔癌的临床疗效及影响预后的因素。方法：回顾性分析1995－1992年收治的60例上皮源性鼻腔癌。其中单纯放射治疗34例,手术＋放射治疗26例。生存统计采用Kaplan-Meier法,组间比较采用Log-rank检验,多因素分析采用Cox模型。结果：总5年生存率为55．9％,10年生存率为36．9％。早期患者（I、Ⅱ期）的5,10年生存率分别为79．0％和57．9％,晚期患者（Ⅲ、Ⅳ期）的5,10年生存率则分别为44．1％和26．0％,二者差异有显著性（P＝0.005)。手术＋放射治疗与单纯放疗的生存率差异无显著性（P＝0．33）,鳞癌的生存率明显低于腺癌（P＝0．04）,初诊时颈部有淋巴结转移者的5,10年生存率低于无颈部淋巴结转移者（P＝0.09).结论:治疗方式`颈部淋巴结转移对预后无明显影响,而病理类型`临床分期对预后有显著影响.     

Carcinoma of the intact uterine cervix treated with radiotherapy alone: A french cooperative study: Update and multivariate analysis of prognostics factors

: To determine independent prognostic factors in a group of 1875 patients with invasive carcinoma of the intact uterine cervix treated with radiotherapy alone in a French cooperative study from 1970 to 1993.

: Patients were staged according to the UICC-FIGO and MDAH substaging. The distribution per FIGO stage was Ia-Ib: 25.5%; IIa: 29%; IIIa: 5%; IIIb: 25%, and IV: 3.5%. Ninety-two percent had squamous cell carcinoma. The maximum diameter of the clinically detectable cervical disease was less than 3 cm in 24.5% of Stages I–II and in 10% of Stages III–IV, more than 5 cm in 13.5% of Stages I–II, and in 16% of Stages III–IV. Nodal involvement was shown on lymphangiogram in 16% of Stages I–II and in 32.5% of Stages III–IV.

: 1) Univariate analysis of Stages I and II: stage, cervical disease diameter, and nodal involvement are significant prognostic factors. Five-year specific survival rate (5ySS) in 83.5% in Stage Ib, 81% in IIa and 71% in IIb. Five-year disease-free survival rate (5yDFS) is 86% in tumors less of 3 cm, 76% in tumors of 3 to 5 cm, and 61.5% in tumor larger than 5 cm. Lymphangiogram strongly influences the 5-year pelvic disease-free survival rate (5yPDFS): respectively, 90% in nonpositive lymphangiogram vs. 65% when positive. A significant drop in specific and disease-free survival is observed (10 and 14%, respectively (p = 0.04) when comparing adenocarcinoma and squamous cell carcinoma. Age is a significant prognostic factor for specific because patients aged less than 30 years old have 91% vs. about 75% for patients over 30 years (p = 0.03). 2) Univariate analysis of Stages III–IV: Stage and positive lymphagiogram are predictive factors for relapse and death. Te MDAH substaging is more reliable to predict the probability of pelvic disease-free survival in Stage III. At 5 years, the FIGO Stages IIIa and IIIb have a rather similar PDFS (65% vs. 59%). Conversely, the difference of survival rates between MDAH Stage IIIA and Stage IIIB is more demonstrative (69% vs. 47.5%). 3) Multivariate analysis (Cox P. H. R. model). Nodal involvement and stage remain significant for all three models in all stages (p < 0.0001). Age above 70 years influences specific survival for Stage I–II (p = 0.01). Tumors larger than 5 cm and adenocarcinoma also appear to be independent prognostic factors for specific and disease-free survival in Stage I–II (p = 0.05 and p = 0.005, respectively).

: The relevance of tumor size (less or greater than 4 cm) is now recognized in the 1995 revised FIGO staging in Stage Ib but unfortunately not in other stages. Tumor size per stage and nodal status should be systematically recorded to allow a better prediction of failure rates and to compare literature reports.     

Ⅲa期非小细胞肺癌术后辅助放射治疗疗效分析

目的　探讨Ⅲa期非小细胞肺癌（NSCLC）术后预防性照射的临床意义。方法　回顾性分析250例 Ⅲa期NSCLC患者术后放射治疗与未放射治疗的生存率及复发情况。其中术后放射治疗115例,未放射治疗135例。肺鳞癌136例,放射治疗70例,未放射治疗66例。肺腺癌75例,肺鳞腺癌及其它类型39例。结果　术后放射治疗5年生存率为24.3%,未予放射治疗5年生存率为14.2%,两组比较有显著差别（P<0.05）。肺鳞癌术后放射治疗5年生存率(26.7%)明显高于未放射治疗者(14.6%)(P<0.05)。结论　能手术切除的Ⅲa期非小细胞肺癌术后应给予预防性照射,以期提高生存期。     

Treatment of squamous cell carcinoma of the uterine cervix with radiation therapy alone: long-term survival, late complications, and incidence of second cancers

The objective of this retrospective study was to determine the survival rate, incidence of late complications, and incidence of second cancers when radiation therapy alone is used for carcinoma of the uterine cervix. Between 1971 and 1995, 1495 patients with squamous cell carcinoma of the uterine cervix (stages I-IV) were treated with radiation therapy alone in our hospital. Radiation therapy consisted of a combination of high-dose-rate intracavitary brachytherapy and external beam radiotherapy. The cumulative 5-year survival rates for stages Ib, II, and III/IVa carcinoma were 93.5, 77.0, and 60.3%, respectively, and the 10-year survival rates were 90.9, 74.5, and 56.1%, respectively. Local control rates for stages Ib, II, and III/IVa carcinoma were 92.0, 79.4 and 64.2%, respectively. Eighty-two (5.5%) patients suffered grade III/IV or V (fatal) complications. A second cancer developed in 13 (0.87%) patients. Second cancers were observed most frequently in the rectum (five cases), colon (three cases), and uterine body (two cases). Long-term follow-up data revealed that our method of radiation therapy alone for locally advanced carcinoma of the uterine cervix is effective, with low incidences of late complications and second cancers.     

Adenocarcinoma of the uterine cervix. Prognosis and patterns of failure in 367 cases

Between 1965 and 1985, 367 patients received initial treatment for adenocarcinoma of the uterine cervix at the M. D. Anderson Cancer Center (MDACC). Of the 334 patients treated with curative intent, 223 had International Federation of Gynecology and Obstetrics (FIGO) Stage I, 60 had Stage II, and 51 had Stage III/IV disease. The 5-year and 10-year relapse-free survival (RFS) rates for all patients treated for Stage I disease were 73% and 70%, respectively. RFS was strongly correlated with initial bulk of disease (P = 0.002), although locoregional control (LRC) was good in all groups: 91 patients with a normal-sized cervix (tumor less than 3 cm) had a 5-year RFS rate of 88% and an actuarial LRC rate of 94%; 102 patients with lesions 3 to 5.9 cm in diameter had an RFS rate of 64% and an LRC rate of 82%; and 22 patients with bulky lesions greater than 6 cm in diameter had a comparable LRC rate of 81%, but an RFS rate of only 45%. Decreased RFS also was strongly correlated with positive lymphangiogram (LAG) results (P = 0.02) and poorly differentiated lesions (P = 0.0014). When initial primary tumor size was taken into account, there was no significant difference in RFS or LRC between patients treated with radiation (RT) alone or RT plus extrafascial hysterectomy (R + S). The 5-year and 10-year RFS rates of 60 patients who received curative therapy for Stage II disease were 32% and 25%, respectively, with an LRC rate of 62% at 5 years. Patients with bulky Stage II disease did particularly poorly, with a 5-year RFS rate of 15%. Decreased RFS was correlated with positive LAG results and poorly differentiated tumors. Most Stage II patients whose disease relapsed died with distant metastases (73%). Forty-eight patients with Stage III/IV disease treated with curative intent had a 5-year survival rate of 31% and a 5-year pelvic disease control rate of 52%. In summary, patients with small volume Stage IB lesions have excellent LRC and survival with RT alone. RT achieves good LRC of bulkier Stage I lesions, but survival decreases with increasing primary tumor size. R + S holds no apparent advantage over RT alone. Patients with more advanced disease have a high rate of relapse with frequent distant metastasis. In particular, the survival of patients with FIGO Stage II disease is much lower than what we have observed after treatment of comparable stage squamous carcinoma.(ABSTRACT TRUNCATED AT 400 WORDS)     

The review of the treatment of the carcinoma of the uterine cervix in Gifu University Hospital. Primary treated cases from 1972 to 1982

Clinical study was performed to review the treatment of carcinoma of the uterine cervix in 525 cases treated by surgery, radiotherapy, the combination of both, and others at Dept. of Obstetrics and Gynecology, Gifu University Hospital during 10 years from April 1, 1972 through March 31, 1982. 1) Of 525 cases, 80 were classified as stage 0 by the criteria of FIGO, 178 as stage I (39 as Ia, 139 as Ib), 164 as stage II(8 as IIa, 156 as IIb), 98 as stage III and 5 as stage IV. 2) The five year cumulative survival rate was 78.2% for all invasive 445 cases excluding stage 0, 93.8% for stage I, 82.3% for stage II, 45.9% for stage III, and 20.0% for stage IV. 3) The five year cumulative survival rate was 85.1% for stage II cases which were treated by surgery or the combination of surgery and radiotherapy, and 63.8% for stage III. However the five year cumulative survival rate was 60.0% for stage II cases which were treated by radiotherapy only, and 32.0% for stage III. 4) The rate for the cases with adenocarcinoma was 3.8% (17/445) in all invasive carcinoma of the uterine cervix. The five year cumulative rate was 47.1% for the cases with adenocarcinoma, and 79.4% for those with squamous cell carcinoma.     

平阳霉素诱导化疗在T2舌鳞癌治疗中的应用价值

背景与目的：诱导化疗在舌鳞癌治疗中具有重要作用,本研究目的在于探讨单药平阳霉素诱导化疗在T2舌鳞癌治疗中的应用价值。方法：回顾性分析单纯手术及单药平阳霉素诱导化疗加手术分别治疗36例舌鳞癌T2病变患者后,对其生存及复发情况的影响。结果：单纯手术组及诱导化疗加手术组的5年生存率分别为81.46％和57.14％,差异有显著性（P=0.0299）;区域/局部复发率分别为22.2％和33.3％,中位复发时间分别为20和24个月。对Ⅱ、Ⅲ期及Ⅳ期患者,两种治疗措施的5年生存率无显著差异（P=0.0949;P=0.0939）。在Ⅲ及Ⅳ期病变中,单纯手术组和诱导化疗加手术组的区域/局部复发率分别为12.5％和35.7％,中位复发时间分别为12和12.8个月。结论：单药平阳霉素诱导化疗对舌鳞癌T2病变的治疗价值不大。不管是早T2病变还是晚T2病变,它对患者的5年生存率没有明显影响,对局部控制率的影响仍有待进一步观察。