原发于咽淋巴环的恶性淋巴瘤放射治疗——(附86例临床分析)

原发咽淋巴环(Waldeyer ring)恶性淋巴瘤总五年生存率为37.2％(32/86)。影响五年生存率主要因素是病期Ⅰ期的五年生存率为53.1％(17/32)Ⅱ期为30.6％(15/49)、Ⅰ、Ⅱ期生存率之间有明显差异(P<0.05)。病变部位,病理、放射治疗剂量对疗效的影响关系不大。照射范围:ⅠⅡ期病例照射部位应包括咽淋巴环和全颈,Ⅲ期病例应包括咽淋巴环,全颈和全腹腔放射最常见转移和复发部位为腹块、占转移、复发病例22.7％(5/22),复发和转移出现时间大多数54.6％(12/22)于放疗后一年内出现,最长一例为16年出现。     

影响直肠癌术后生存率的一些因素分析(附210例直肠癌术后远期疗效)

我院自1963年至1977年底止,共收治经手术切除的直肠癌患者386例,除4例手术死亡外,手术死亡率为1.80％(术中或术后一个月内死亡者),其中术后满五年以上者共210例。全部进行了随访,随访率为100％;其中生存在五年以上者共108例,五年生存率为51.43％。手术后满十年者共61例,其中生存满十年以上者为30例,十年生存率为49.18％。若按手术性质而论,则根治术的五年生存率为62.50％,十年生存率为65.21％;而姑息性手术的五年生存率仅16.00％,且无一例能生存至十年者。若按病理分期统计,则DukesA和B_1二组共十例,其五年和十年生存率均为100％(分别为10/10和2/2)(表一、二、十)     

外耳道及中耳恶性肿瘤的放射治疗(附68例临床病例分析)

本文收集我院1964年1月至1978年12月有病理证实的外耳道和中耳恶性肿瘤68例。 外耳道、中耳恶性肿瘤五年生存率为47.1％(32/68)十年生存率为(28％)(11/50)。 本文重点讨论外耳道及中耳恶性肿瘤的治疗方法、疗效和影响放射治疗疗效因素,治疗方式:单纯放射治疗、术后放疗二组五年生存率均为47.1％(16/34)。剂量:单纯放射治疗和术后放疗最适宜剂量似乎以5000—6000rads/4—6周为好,此处还讨论其它影响疗效因素。     

宫颈癌腔内治疗：—高,低剂量率效果的比较

1984年6月至1985年5月,我院收治宫颈癌244例。采用Buchler后装机,后装腔内和体外照射治疗。随访2年以上,2年生存率Ⅰ_B100％,Ⅱ_B81.25％。Ⅲ_B72％。1981年采用常规全镭疗加体外照射治疗193例,2年生存率Ⅰ_B83.3％,Ⅱ_B87.5％,Ⅲ_385.7％。两者相比,高、低剂量率二组各期和总的2年生存率,统计学上无显著差异(P>0.05)。直肠与膀胱放射反应,高剂量率组似比低剂量率组高,但统计学上无差别。所以高剂量率后装治疗可以代替常规镭疗。     

进展期胃癌术后化疗方案选择的远期疗效对比临床观察

我院1975年7月—1985年12月收治130例胃癌术后化疗病人,男107例,女23例。全部病理证实,其中腺癌60例,低分化腺癌25例,印戒细胞癌5例,粘液腺癌22例,未分化癌6例,溃疡恶变2例,Ⅰ期22例,Ⅱ期3(?)例,Ⅲ期3(?)例,Ⅳ期32例。手术后3—4周开始化疗,化疗方案MFV方案49例,MF方案66例,其它方案15例。治疗结果:本组病人随访率为95.3％(124/130),五年生存率为40.8％(53/130),MFV方案五年生存率为30.6％(15/49),MF方案五年生存率为51.5％(34/66),其它方案五年生存率为26.7％(4/5).MF方案其五年生存率同MFV方案及其它方案比较有统计学意义(P<0.01)。MF方案具有给药时间短,毒副作用小,疗效好的优点。     

进展期胃癌术后化疗方案选择的远期疗效对比临床观察

我院1975年7月—1985年12月收治130例胃癌术后化疗病人,男107例,女23例。全部病理证实,其中腺癌60例,低分化腺癌25例,印戒细胞癌5例,粘液腺癌22例,未分化癌6例,溃疡恶变2例,Ⅰ期22例,Ⅱ期3(?)例,Ⅲ期3(?)例,Ⅳ期32例。手术后3—4周开始化疗,化疗方案MFV方案49例,MF方案66例,其它方案15例。治疗结果:本组病人随访率为95.3％(124/130),五年生存率为40.8％(53/130),MFV方案五年生存率为30.6％(15/49),MF方案五年生存率为51.5％(34/66),其它方案五年生存率为26.7％(4/5).MF方案其五年生存率同MFV方案及其它方案比较有统计学意义(P<0.01)。MF方案具有给药时间短,毒副作用小,疗效好的优点。     

下咽及颈段食管癌的外科治疗

下咽及颈段食管癌是头颈部恶性肿瘤当中预后较差的一个部位,以消化管癌为例,从口腔向下到胃按其部位划分,五年生存率逐渐下降。我院从1985年5月～1994年3月治疗下咽及颈段食管癌病人65例,一年生存率87％(53/61),三年生存率45％(13/29),五年生存率25％(4/16),报告如下:     

岛状胸大肌肌皮瓣在头颈部肿瘤术后重建中应用的评价

从1986年5月～1994年2月期间应用岛状胸大肌肌皮瓣重建头颈部较晚期恶性肿瘤切除后组织缺损102例,104次手术(2例游离空肠重建下咽及颈段食管失败,再次应用胸大肌肌皮瓣修复)取得理想效果,一年生存率80.7％(79/98),三年生存率50.8％(32/63),五年生存率34％(14/32)。     

影响胃癌五年生存率因素的探讨

胃癌是最常见的消化道恶性肿瘤之一。据北京肿瘤防治研究所统计,中晚期胃癌切除病例的五年生存率平均为20.8％,日本报道约40％。我院胃镜检查3200人次,检出胃癌132例(4.12％),其中手术切除后5年以上者共31例,对此31例进行随访,至今生存12例。手术后五年生存率为38.7％。早期胃癌3例,五年生存率100％,中晚期胃癌28例,五年以上生存者9例(32.1％)。现分析如下。一般资料     

30岁以内食管贲门癌的外科治疗

本文报告手术治疗的17例30岁以内食管贲门癌患者,其发生率为0.98％(17/1735)。男9例,女8例。手术切除11例,切除率为64.7％(11/17),无手术死亡及并发症,术后恢复顺利。切除癌瘤的11例术后进行随访,1年生存率为66.7％(6/9)、3年生存率为28.6％(2/7),5年生存率为16.7％(1/6)。     

A CLINICAL STUDY ONINTRALUMINAL HYPERTHERMIA COMBINED WITH EXTERNAL IRRADIATION FOR ESOPHAGEAL CARCINOMA

A randomized trial of intracavitary microwavehyperthermia combined with external irradiation (R H)versus radiation (R) alone in the treatment of esophagcalcancer was performed form February 1986 to February1988. In the R group, radiation was given hy 8 MV X-ray with 2 Gy/fraction, 5 fractions per week with a totaldose of 60 Gy/6 weeka. In the R H group, the radiationwas given as R group but with a total dose of 40 Gy/4weeks. lntracavitary 915 Mhz microwave hyperthermiawas given with a nominal temperature of 43.5℃ at themargin of the tumor surface, 45 minutes/session, 1-2sessions/week for 4-8 session. The 1-, 3-, and 5-yearsurvival rates in R H group were 81.2% (48/59 cases),42.4% (25/59) and 23.7%, (14/59), while in the R group59.0% (39/66 cases), 24.2% (16/66) and 16.7% (11/66)respectively. The differences in 1-and 3-year survivalrates were statistically significant (P<0.05) betwecn the 2groups. Using the thermal dose T90 analysis, after thecases with T90<43℃ (insufficient thermal dose) wereeliminated     

腔内热疗合并体外放射治疗食管癌的疗效

目的：比较食管腔内微波加温合并体外放射治疗食管癌与单纯放射治疗的疗效。方法：对125例食管癌进行前瞻性分组研究。食管腔内加温合并体外照射（R＋H）组59例,单纯体外照射（RT）组66例,R＋H组外照射DT40Gy,腔内加温1－2次／周,45min／次,要求肿瘤表面温度＞43℃。RT组外照射DT60Gy,2Gy／次,5次／周。结果：近期疗效显著,R H 完全缓解率达46．0％,RT组为24．0％,差异有显著性意义（P＜0．05）。1、5、10年生存率R＋H组分别为81．2％,23．7％和15．2％,RT组分别为59．0％、16．7％和7．5％。将平均T90≥43℃的病例进行统计,R＋H组的5、10年生存率是26．9％和17．3％,分别高出对照组10．2％和9．8％。结论、食管腔内加温合并体外放射治疗可以提高食管癌的局部控制率,近期疗效和远期疗效均高于对照组,局部控制率的高低与加温的次数无明显关系,关键在于每次的加温质量（T90的高低）。     

放射治疗结合热疗治疗宫颈癌的疗效观察

目的:观察放射治疗加热疗治疗宫颈癌的临床效果。方法:将66例经病理确诊的宫颈癌患者随机分为两组:放射治疗 热疗组(热放组)33例和单纯放射治疗组(单放组)33例。两组的放射治疗方法一样:全盆照射 盆腔四野照射 腔内后装放疗。热放组采用了射频深部热疗和微波腔内热疗,热疗每周1次至2次,直至放疗结束。每次热疗均在放疗后30分钟内开始。结果:热放组和单放组的局部控制率(CR)分别为84．8％和 60．6％,有显著性差异(P<0．05)。1年、2年的生存率两组无显著差异(P>0．05),但3年生存率分别为84．8％和 63．6％,有着显著性差异(P<0．05)。结论:放射治疗结合热疗可提高宫颈癌患者的局部控制率和生存率。     

原发性胃肠道非霍奇金淋巴瘤的临床特征及疗效分析

背景与目的:原发性胃肠道淋巴瘤是来源于结外淋巴组织的非霍奇金淋巴瘤(non-Hodgkinslymphoma,NHL),具有独特的临床病理特征。本文报告原发性胃肠道淋巴瘤的临床病理特征及其治疗效果。方法:回顾性分析我院1994年1月至2000年6月收治的经病理检查证实的22例原发性胃肠道淋巴瘤患者的病例资料。结果:本研究所有病例均随访3年以上,随访5年以上13例,3、5年生存率分别为45.5%(10/22)、38.5%(5/13);随着临床分期增高,3、5年生存率降低;低度恶性边缘带粘膜相关淋巴组织淋巴瘤较其它病理类型预后为佳;16例治疗后达到完全缓解者,3、5年生存率分别为62.5%(10/16)、45.5%(5/11),而6例原发灶未控者3年生存率为0,有显著性差异(P<0.05);12例单纯手术治疗者3、5年生存率分别为33.3%(4/12)、10%(1/10),6例手术联合化、放疗者(5例手术后辅助化疗,1例手术后行全腹照射)的3、5年生存率分别为83.3%(5/6)、66.7%(2/3)。结论:原发性胃肠道淋巴瘤应以综合治疗为主,原发灶未控可影响预后。     

The Surgical Treatment and Outcome for Primary Duodenal Adenocarcinoma

Background

To investigate the early diagnosis and outcomes of surgical treatment of primary duodenal adenocarcinoma (PDAC) for curative purpose.

Method

Thirty-two PDAC patients treated surgically between February 1990 and September 2006 were analyzed retrospectively.

Results

All 32 patients underwent laparotomy including 18 (56.3%) pancreaticoduodenectomy (PD), six (18.7%) segmental resection (SR), and eight bypass procedures. And R0 resections were obtained in 22 patients; the other ten procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 78.1% (25/32), 43.8% (14/32), and 18.8% (6/32), respectively; moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (20/20), 70.0% (14/20), and 30.0% (6/20), which were significantly higher than those (41.7%?=?5/12, 0%, and 0%) in patients with palliative operation (P?<?0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (5/18) in pancreaticoduodenectomy patients and 16.7% (1/6) in segmental resection patients, and there was no significant difference between the above two procedures (P?>?0.05).

Conclusion

PD is suggested for tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients especially for tumors of the distal duodenum.     

The Surgical Treatment and Outcome for Primary Duodenal Adenocarcinoma

Background

The purpose of this study was to investigate the early diagnosis and outcomes of surgical treatment of primary duodenal adenocarcinoma (PDAC) for curative purpose.

Method

Thirty-two PDAC patients treated surgically between February 1990 and September 2006 were analyzed retrospectively.

Results

All 32 patients underwent laparotomy, including 18 patients (56.3%) pancreaticoduodenectomy (PD), six patients (18.7%) segmental resection (SR), and eight patients bypass procedures. R0 resections were obtained in 22 patients; the other 10 procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 86.2% (25/29), 48.3% (14/29), and 20.7% (6/29), respectively, moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (19/19), 73.7% (14/19), and 31.6%(6/19), which were significantly higher than those (50.0%?=?5/10, 0%, and 0%) in patients with palliative operation (P?>?0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (5/18) in pancreaticoduodenectomy patients and 16.7% (1/6) in segmental resection patients, and there was no significant difference between the above two procedures (P?>?0.05).

Conclusion

PD is suggested for tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients, especially for tumors of the distal duodenum.     

Survival and functional outcome of children with hypothalamic/chiasmatic tumors

BACKGROUND: The management of children with hypothalamic (H) and/or chiasmatic (C) tumors remains controversial. We evaluated the impact of clinical and neuroimaging parameters and primary therapy on overall (OS) and progression-free (PFS) survival and on neuroendocrine and neurocognitive outcome in children with H and/or C tumors. METHODS: Records were reviewed for 73 children with H and/or C tumors treated at St. Jude Children's Research Hospital between October 1981 and December 1999. RESULTS: Thirty-six patients received irradiation or chemotherapy immediately postdiagnosis and 37 were observed. The 6-year OS and PFS rates were 86 +/- 5%; and 36 +/- 7%, respectively. The 6-year PFS rates for the irradiation, chemotherapy, and observation groups were 69 +/- 16%, 12 +/- 11%, and 37 +/- 9%, respectively. In multivariate analysis, intracranial NF1 lesions (P = 0.015) and initial irradiation (P = 0.056) led to better PFS rates. There was no difference in OS between those initially treated or observed. Mean serial intelligence quotient (IQ) scores were 86 and 86 at diagnosis and at 6 years later, respectively. Patients younger than 5 years old had a lower mean IQ score at diagnosis (79.1) than older patients (96.3; P = 0.003). Patients who were irradiated at diagnosis had a significantly higher cumulative incidence of endocrinopathy at 3 years (P = 0.008). CONCLUSIONS: Overall survival for children with H and/or C tumors is excellent. Initial treatment with radiation and the presence of intracranial NF1 lesions were positive predictors of PFS. Mean IQ is significantly compromised at diagnosis, but does not change over time or with irradiation. Overall survival is not affected by initial observation. We recommend observation in asymptomatic patients, platinum-based chemotherapy in younger patients, and irradiation in older symptomatic patients.     

无锁骨上淋巴结转移的局限期小细胞肺癌颈部预防照射临床分析

目的:比较颈部预防照射对无锁骨上淋巴结转移的局限期小细胞肺癌预后的影响。方法:回顾性分析1998年2 月至2005年12月间天津医科大学附属肿瘤医院有完整记录的88例局限期小细胞肺癌临床资料，分为颈部预防照射组与无颈部预防照射组。比较两组患者生存率、复发率、远转率、颈部远转率。结果:颈部预防照射组与无颈部预防照射组1 年生存率分别为:82.00% 、84.20%（P=0.785），3 年生存率42.86% 、52.63%（P=0.675），5 年生存率26.67% 、31.42%（P=0.641）；1 年复发率9.09% 、12.50%（P=0.663），3 年复发率39.39% 、32.00%（P=0.562），5 年复发率61.54% 、47.62%（P=0.341）；1 年远转率27.08% 、25.71%（P=0.889），3 年远转率68.18% 、57.14%（P=0.312），5 年远转率75.00% 、70.00%（P=0.642）。 预防照射组与未预防照射组分别有3 例与5例患者2 年内发生颈部淋巴结转移，均伴有其他部位的远处转移灶，该8 例患者均死于别处转移。2 年颈部淋巴结转移率分别为8.33% 与18.52% ，无显著性区别（P=0.230），平均生存期分别为25.67、27.40个月。结论:颈部预防照射未能显著提高患者生存率、降低复发率、远转率，特别是颈部远处转率。颈部预防照射在无锁骨上淋巴结转移的局限期小细胞肺癌治疗中不是必需的放疗靶区。      

External beam radiotherapy for carcinoma of the prostate

Five hundred nineteen patients with prostate cancer were seen in the Radiation Oncology Division of the State University of New York (SUNY) Health Science Center, Syracuse, New York, between 1969 and 1981. The results for the 239 patients treated with radical intent are reported here. All patients received 60 to 70 Gy to the prostate with megavoltage beam irradiation; 142 with a small field (10 X 10 cm) 360 degrees rotational technique for Stage A, B, or C disease and 69 with a four-field pelvic brick technique (followed by a boost to the prostate) for Stage A through C and D1 disease. Twenty-eight patients were treated postoperatively for residual disease after radical prostatectomy or for recurrent tumor. The minimum follow-up time was 5 years. Actuarial 5-year and 7-year survival rates for Stage A (n = 34), B (n = 100), C (n = 63), and D1 (n = 14) were 91% and 76%, 86% and 75%, 67% and 40%, and 46% and 36%, respectively. The corresponding 5-year and 7-year relapse-free survival rates were 72% and 65%, 77% and 60%, 46% and 28%, and 38% and 25%. The local tumor control rates at 5 years were 91%, 85%, 77%, and 62% for Stage A, B, C, and D1, respectively. In our experience, there was no significant difference in relapse-free survival rates for patients who underwent transurethral resection (TURP) versus those who did not (67% versus 78% for Stage B [P greater than 0.25] and 38% versus 47% for Stage C [P greater than 0.25], respectively). Also there was no significant difference in relapse-free survival rates between large and small field techniques (64% versus 77% for Stage B [P greater than 0.25] and 56% versus 41% for Stage C [P greater than 0.25], respectively). The 5-year and 7-year actuarial survival rates were 90% and 71%, respectively, for the 15 patients with residual tumor and 58% and 33%, respectively, for the 13 patients treated for postprostatectomy recurrence. Severe complications were documented in only nine patients (3.7%) and mild to moderate complications in 53 patients (22%). Larger fields did not cause a higher rate of complications, although small fields were tolerated better than large fields; the significant acute reaction rate was 27% for large field techniques versus 11% for small field techniques (P greater than 0.01). These results confirm that external beam irradiation is an effective treatment for prostate cancer.     

Trimodality therapy of esophagectomy plus neoadjuvant chemoradiotherapy improves the survival of clinical stage II/III esophageal squamous cell carcinoma patients

The prognosis of advanced esophageal cancer patients is poor. Trimodality therapy of surgical resection plus neoadjuvant chemoradiotherapy (CRT) has been developed to improve survival through locoregional control, leading to prevention of micrometastasis. We investigated whether or not neoadjuvant CRT led to survival benefits in TNM stage?II/III esophageal cancer patients. We retrospectively reviewed 62 patients with stage II or III esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant CRT. All patients received esophagectomy 4-7 weeks after CRT consisting of 40?Gy irradiation and chemotherapy (5-FU, 500?mg/m2/day, days 1-5 and cisplatin, 10-20?mg/body, days 1-5). Clinical response and survival rates were analyzed using Kaplan-Meier methods, with p<0.05 considered as significant. The clinical effect rate of CRT for both primary tumors and metastatic nodes was 82.3%. Operative and hospital mortality rates were 1.65 and 6.5%, respectively. The 3-year overall survival (OS) and disease-free survival (DFS) rates were 52.6 and 49.2%, respectively. A significant difference was noted between stages?II and III for both OS and DFS. The 5-year OS rates were 64.2% for stage II, 33.1% for stage III (T4 and non-T4) and 46.9% for stage III (non-T4 only) patients. The depth of tumor invasion (T3 vs. T4), resectability (R0 vs. R1, R2), lymph node metastasis (positive vs. negative), and the effect of CRT were proven to be independent prognostic factors for univariate analysis, with resectability and the effect of CRT for multivariate analysis. These data suggest that CRT in stage II/III (non-T4) ESCC patient contributed to tumor shrinkage, leading to higher resectability and longer survival. Neoadjuvant CRT appears to be a promising option for these patients.