70例原发性阴道癌治疗的临床报告

为了探讨原发性阴道癌的预后因素及治疗方法,对１９６３ 年１０ 月至１９９３ 年１ 月间收治的７０ 例阴道癌病例进行回顾性分析。鳞癌５４ 例,腺癌１６ 例,放疗者５７ 例,手术者１３ 例,根据病灶部位不同采取不同治疗方法。各期的５ ａ 生存率为：Ⅰ期６１．１％ （１１／１８） ,Ⅱ期４２ ．３％ （１１／２６）,Ⅲ期２８．６ ％（４／１４）,Ⅳ期１６．７％（２／１２）,Ｐ＜ ０．０５;鳞癌及腺癌的５ ａ 生存率分别为４８．１ ％ 及１２．５％ ,Ｐ＜０ ．０１;不同病理分级的５ ａ 生存率为：Ⅰ级５８ ．３ ％ ,Ⅱ级４４．４ ％ ,Ⅲ级２２．７％ ,Ｐ＞ ０．０５;不同阴道受侵长度的５ ａ 生存率为：１／３ 受侵者５２．５ ％ ,２／３ 受侵者２５．０ ％ ,２／３ 受侵者１６．７ ％ ,Ｐ＜ ０．０１;总的５ ａ 生存率为４０ ．０％ （２８／７０） 。结果表明,临床期别、病理类型、阴道受侵长度与预后相关,病理分级与预后无关;阴道癌治疗首选放疗,早发现,早治疗,合理的放疗剂量分布及适合的剂量是提高生存率的关键。     

腮腺原发性鳞状细胞癌

报道腮腺原发性鳞癌１４例，男性１１例，女性３例，年龄２０～６６岁（平均，５２岁）。Ⅰ期３例，Ⅱ期４例，Ⅲ期７例，均经病理证实，并排除转移性鳞癌和腮腺粘液表皮样癌可能。单纯手术或放疗各２例，手术＋放疗６例，动脉化疗＋放疗＋手术３例，１例仅行动脉化疗。３年、５年生存率分别为３８．５％，１８．２％。初步探讨其临床病理特点。     

子宫颈浸润癌手术方式的选择

［目的］探讨准确选择宫颈癌病人的手术范围。〔方法〕对 ２４２例宫颈癌进行手术治疗,其中 Ｉ类手术 ４例（ Ｉａ１期）,Ⅱ类手术５例（Ｉａ１期）,Ⅲ类手术１０４例（Ｉａ２、Ｉｂ１期及放疗后复发或未控）,Ⅳ类手术１２５例（Ｉｂ２、Ｉｂ３、Ⅱａ、Ⅱｂ期及放疗后复发或未控者）, Ⅴ类及Ⅵ类手术各 ２例,均为复发癌。［结果］Ｉａ及 Ｉｂ１期 ５年生存率为 １００％,Ｉｂ２期 ５年生存率为９３．３３％, Ｉｂ３期为８８．３９％, Ⅱａ、 Ⅱｂ期５年生存率为８７．５０及７７．７８％。放疗后未控及复发癌的５年生存率为６２．３６％。手术主要并发症为泌尿道感染、膀胱功能障碍及输尿管瘘,其发生率随手术范围的扩大而增加。［结论］宫颈癌手术方式的选择,应针对每个病人治疗的需要,采取合适手术,既不盲目扩大,也不能无原则缩小。     

原发性阴道癌33例临床分析

目的本文对我院１９７９年至１９９０年收治的３３例原发性阴道癌进行了临床分析。方法本组发病高峰年龄为４５～６５岁。病变部位以阴道上１／３居多。病理类型中鳞癌占６０．６％。治疗方式包括单纯手术、放疗、化疗以及其中二种方式的综合治疗。结果５年生存率Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为７７．８％、４７．１％、２５．０％、０％。结论临床分期、病变部位及治疗方法的选择均影响预后。     

原发性阴道癌33例临床分析

目的 本文对我院１９７９年至１９９０年收治的３３例原发性阴道癌进行了临床分析。方法 本组发病高峰年龄为４５－６５岁。病变部位以阴道上１／３居多，病理类型巾６０．６％。治疗方式包括单纯手术、放疗、化疗以及其中二种方的综合治疗。结果 ５年生存率Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为７７．８％、４７．１％、２５．０％、０％。结论 临床分期、病变部位及治疗方法的选择均影响预后。     

38例子宫内膜间质肉瘤的诊断和治疗

目的：研究子宫内膜间质肉瘤的诊断和治疗方法。方法：对３８例子宫内膜间质肉瘤进行回顾性分析,其中Ⅰ期１３例,Ⅱ期１４全,Ⅲ期７例,Ⅳ期４例,３８例均经手术治疗。１０例术后补充放疗,１１例补充化疗,７例补充放疗加化疗。结果：本组病例总的３年及５年生存率分别为５４．３％（１９／３５）及４５．５％（１５／３３）,Ⅰ期病例３年及５年生存率分别为７６．９％（１０／１３）及６１．５％（８／１３）,Ⅱ期为５０．０％（７／１４）及４６．２％（６／１３）。结论：子宫内膜间质肉瘤的预后和组织类型、临床分期、治疗方法密切有关,综合运用手术、放疗、化疗及孕激素治疗能减少阴道及盆腔复发,提高生存率。     

原发性阴道恶性黑色素瘤18例报道

目的探讨原发性阴道恶性黑色素瘤的诊断、治疗特点及影响预后的因素。方法我们对收治的１８例阴道恶性黑色素瘤的临床资料进行了回顾性分析,平均年龄５１岁,主要症状为阴道出血排液和肿物,原发肿瘤多位于阴道前壁的下１／３处;１２例行手术＋放疗／化疗,２例行单纯放疗,１例行单纯化疗,化疗＋放疗３例。结果本组的５年生存率为１１％,３年生存率为３３％,平均生存２６个月,６例存活３年以上者均为Ⅰ、Ⅱ期,其中１例为单纯放疗者肿瘤消退存活４８个月,Ⅲ、Ⅳ期患者无１例存活超过２年,１２例手术病人中有和无淋巴结转移及脉管瘤栓者,平均生存分别为８和４２、１６和４０个月。结论阴道恶性黑色素瘤治疗以手术为主,大单次量少分割放疗可使肿瘤消退或缩小,其预后与分期、淋巴结转移及脉管瘤栓有关。     

腹股沟隐睾精原细胞瘤和阴囊睾丸精原细胞瘤预后的比较

目的分析腹股沟隐睾精原细胞瘤的预后,提出治疗方法。方法我们回顾性分析了１９５８～１９９１年治疗的４３例患者。根据我院精原细胞瘤分期标准,Ⅰ期３３例,Ⅱ期８例,Ⅲ、Ⅳ期各１例。所有患者均经腹股沟隐睾肿瘤切除术,Ⅰ、Ⅱ期以放射治疗为主,Ⅲ及Ⅳ期各１例分别行放疗或化疗。结果全组总的５年、１０年生存率分别为９３．０％和９０．３％,相应无病生存率分别为８８．１％和８５．３％。Ⅰ期５年、１０年总生存率均为１００％,Ⅱ期为７５．０％和６０．０％。２例复发,经放疗治愈。结论本组研究结果表明,腹股沟隐睾精原细胞瘤预后较好,和阴囊睾丸精原细胞瘤相似。建议对Ⅰ期、Ⅱ期早行术后腹主动脉旁和同侧盆腔淋巴结照射。当有腹股沟淋巴结转移或原发肿瘤明显侵及腹股沟周围组织时,再行腹股沟照射。     

高剂量率后装放射治疗原发性阴道癌40例临床分析

目的 分析高剂量率后装治疗原发性阴道癌的疗效。材料与方法 １９８４年１月￣１９９４年４月，共收治原发性阴道癌４０例，全部采用外照射加腔内放疗，外照射采用＾６０Ｃｏ－γ线或直线加速器８ＭＶ－Ｘ线，腔内照射采用Ｂｕｃｈｌｅｒ后装机的中间振荡源。结果 所有病例均随访３年以上，４０例病人Ⅱ、Ⅲ、Ⅳ期的３年生存率分别为７１．４％、５５．６％、０．０％，５年生存率分别为５７．６％、４６．６％、０．０％。轻度放     

38例隐睾精原细胞瘤临床分析

我院１９７５年３月至１９８７年１２月收治隐睾发生的精原细胞瘤３８例，占周期睾丸精原细胞瘤３５．１％，Ⅰ期１８例、ⅡＡ期９例、ⅡＢ期８例、Ⅲ期２例、Ⅳ期１例。其中腹股沟隐睾精原细胞瘤Ⅰ期１０例，占５５．５％，Ⅱ期６例占３３．３％，Ⅲ、Ⅳ期各１例。腹腔隐睾精原细胞瘤Ⅰ期８例占４０％，Ⅱ期１１例占５５％，Ⅲ期１例，放疗为主要治疗手段，当数中晚期合并用Ｎ－甲基溶肉瘤素化疗。５年及１０年生存率分别为８９．５     

International clinical trials: perspectives of clinical research coordinators

There are several different task roles among the co-medicals who are involved in international clinical trials (ICTs). In this review article, several issues related with ICTs from the view point of clinical research coordinators (CRCs) will be discussed. The discussions include interview results from eight CRCs of four institutions who have been involved in ICTs, current status of education for co-medicals in the field of ICTs, and future perspectives of ICTs from the CRC's view point. The following topics are especially focused in the discussion. 1) It is necessary to establish the infra-structure for free discussion among the ICT team so that opinions of co-medicals as the operation managers of the participating institutions can be openly shared and importantly taken into account. 2) It is also important for co-medicals to conduct research studies to clarify the problems in the current ICT support systems. 3) Lastly, the significance of early involvement of CRCs into the ICT protocol development must be emphasized, because the quality of protocols will be better improved by the practical insight of CRCs, and consequently, the accomplishment of the ICT, such as the speed and the data quality, may be accelerated.     

鼻咽癌’92分期临床验证

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Globalization of clinical trials

Based on reviews of the Japanese clinical trial situation in lung cancer, gastric cancer, prostate cancer and breast cancer, it was clear that much progress has been made in short time. There are considerable differences between Japan and the West and also differences between clinical areas in Japan. For regulatory purposes bridging studies have become increasingly important. Use of identical protocols are required for effective bridging. Participations in global phase III trials is the best way of achieving registration in Japan. For successful global trials in Japan it is important to include Japanese investigators in the preparation of the protocol and to recognise the challenges facing such a project. Clinical practice in diagnosis and treatment have many differences, thus it is recommended to have clear and detailed information in the protocol. Hard end points like survival are important since they are not biased by cultural differences. There are clear difficulties with HE or QOL outcomes. The emergence of focus on evidence based medicine is also happening in Japan and will help to harmonize documentation across the world. For large adjuvant or prevention cancer global trials are essential. To facilitate global studies further development of infrastructure is necessary in Japan. Use of electronic data capture web based communication etc. will help overcome communication difficulties. Other improvements that will make Japanese participation in global trials easier and better include establishment of clinical trial centre at each hospital, introduction of trial coordinators or study nurses and an improved collaboration with company staff. A critical issue that also need addressing is agreement of centre target recruitment. We need to introduce a new flexible system in Japan if participation in global trial is to be optimised. If we can address these issues Japanese investigators and collaborative groups should be able to initiate and lead global trials in the future.     

Review of clinical radioimmunotherapy

Radioimmunotherapy involves a form of biologically targeted radiopharmaceutical treatment in which a radioactive isotope (typically a short-range, high-energy beta-emitter) is chemically bound to a target-specific monoclonal antibody or fragment. Thus, these radioimmunoconjugates combine the exquisite targeting specificity of the humoral immune system with the known cancer-killing power of high-energy radiotherapy. To date, two radioimmunotherapy agents have been fully approved for commercial use: 90Yttrium ibritumomab tiuxetan and (131)Iodine tositumomab. Both compounds target the CD20 surface molecule found on normal and malignant B cells, and both are medically indicated for the treatment of indolent B-cell lymphoma and related conditions. Clinical results are excellent (20-40% complete response rates and 60-80% overall response rates) and toxicity is typically quite mild. Current research is now attempting to both explore the biology of these compounds and to expand the spectrum of CD20+ diseases that could be treated using either or both of these active agents. Concurrently, work is in progress to achieve the same excellent clinical results using antibodies specific for other, more common epithelial tumors. This work is at an earlier stage than the lymphoma work, partly due to the high innate radiosensitivity of the lymphoid system. Thus, various enhancement methodologies are being explored to increase clinical response rates for these solid tumors, and a number of solid tumor RIT agents are now in early-stage clinical trials. The most likely pattern of use for this field in the next 5 years will probably involve combination or sequential regimens incorporating both radioimmunotherapy and more conventional chemotherapy or external radiotherapy.     

The impact of clinical practice guidelines and clinical trials on treatment decisions

With increasing numbers of clinical practice guidelines (CPGs) becoming available to guide physicians, it is important to understand how guidelines are developed. Of importance, is evaluation of the scientific evidence on which guidelines are based, indeed whether the guideline is evidence based or based on expert opinion alone. This report will review in general, guideline development. The impact of CPGs, including expected outcomes, as well as potential harms is discussed. Clinical trials, meta analyses and CPGs relevant to the treatment of lung cancer are reviewed.     

SEOM clinical guidelines for using molecular markers in clinical practice

Nowadays, treatment selection for most types of cancers is based on anatomical, histological and clinical criteria, which are defined by the selection criteria used in registration phase III trials. However, different cancers present distinct molecular features, so the current approach results in a lack of specificity of cancer therapy, which is associated with decreased efficacy and unnecessary toxicities and costs. Molecular diagnostics has proved able to predict the efficacy of selected targeted therapies. This allows the selection of specific treatments for different types of cancer, increasing their efficiency. Even though the number of treatments for solid tumours that can be selected based on molecular diagnostic tools is limited, much effort is being put into the identification of new biomarkers. This guideline reviews molecular diagnostic biomarkers that allow selection of specific therapies that have obtained regulatory approval as treatment of solid tumours.