中青年宫颈癌患者拒绝放射治疗原因的调查分析

目的：通过对宫颈癌患者拒绝放射治疗原因的调查分析，采取一系列应对策略，提高治疗效果。方法：对26例官颈癌患者拒绝放射治疗的原因调查，进行多因素相关统计分析，针对原因采取应对策略缓解心理应激。应对策略包括：转变放疗医生的观念、制定科普宣教方案、加强疏导、介绍有关放疗的知识、努力为患者营造一个充满亲情的社会环境，进行因人而异的心理干预。结果：26例拒绝放疗的患者中，23例患者接受了放射治疗，有效率达88.45％。结论：大部分最初拒绝放射治疗的中青年宫颈癌患者，在放疗医生的耐心讲解和科普宣教下能够消除心理障碍，积极配合放射治疗。     

22例拒绝继续放疗食管癌病人的心理护理

放射治疗是治疗中晚期食管癌的重要手段之一，在我院接受放疗的病人中，食管癌占约1／2。一部分病人存在一定的心理障碍，不愿放疗或放疗一段时间后拒绝继续放疗，影响食管癌的治疗效果。我院放疗中心近5年在食管癌放射治疗中发生拒绝继续放疗的患者22例，后经积级的心理疏导，大部分如期完成了治疗，配合临床医生，使病人按计划进行治疗，现将体会报告如下：     

组织间插植与阴道盒近距离放射治疗宫颈癌的疗效对比

目的　探讨组织间插植与阴道盒后装放射治疗宫颈癌的疗效。方法　 80例大体积 ,外生肿瘤直径≥ 4.0cm的宫颈癌应用高剂量率近距离放射治疗 ,以消除局部肿瘤和止血。其中 ,40例菜花型宫颈癌患者接受组织间插植放疗 ,将其分为A、B组。A组 ( 2 0例 ) :术前插植放疗 宫颈癌根治术 ;B组 ( 2 0例 ) :插植放疗 常规放疗。另 40例接受了阴道盒放疗的宫颈癌患者被分为C、D组。C组 ( 18例 ) :阴道盒放疗 宫颈癌根治术 ;D组 ( 2 2例 ) :阴道盒放疗 常规放疗。比较A、C组的消除肿瘤疗效和B、D组的止血效果。结果　A、C组的完全缓解率 (CR )各为 90 %、11% ,2组比较有非常显著性差异 (P <0 .0 1)。B、D组的止血显效率各为 10 0 %、64 %。 2组比较有非常显著性差异 (P <0 .0 1)。结论　组织间插植放射治疗对消除宫颈巨大、外生型肿瘤及局部止血是有效的方法     

43例Ⅱb期宫颈癌术前放疗疗效分析

目的　探讨Ⅱb期宫颈癌经术前放疗的治疗效果。方法　 1993年 1月～ 2 0 0 1年 3月 ,43例Ⅱb期宫颈癌均接受术前放疗 ,放疗剂量DT3 6～ 40Gy ,休息 14d～ 2 0d后行宫颈癌根治术。结果　 3年、5年生存率分别为 77 6%、62 4% ,3年内复发率为 15 3 %。结论　对部分Ⅱb期宫颈癌患者 ,经术前放射治疗后 ,有手术适应症 ,行广泛性全子宫切除术加盆腔淋巴结清扫术 ,可提高生存率 ,同时避免单纯放射治疗引起的并发症     

复发性宫颈癌的放射治疗进展

宫颈癌是女性常见的妇科肿瘤之一,宫颈癌患者治疗后肿瘤出现复发或未获得局部控制是导致患者死亡的主要原因.复发性宫颈癌的治疗一直是临床上一个具有挑战性的难题,无论是常规放疗、立体定向放射治疗、术中放疗,还是放射性粒子组织间近距离治疗,均被证明是可行、有效且安全的,对于部分患者甚至可以达到根治的目的,具体的治疗方式及预后取决于初始治疗方式、病灶复发形式和病变程度等.对于之前接受过放疗的宫颈癌患者,手术是最佳选择,不能进行手术的患者可以接受姑息化疗;而对于之前从未接受过放疗的患者,应对其进行根治性补救放化疗.此外,还应向宫颈癌患者充分说明不同治疗方案的利弊,在制定治疗策略时充分考虑患者的风险偏好.本文就近几年放射治疗复发性宫颈癌的研究进展作一综述.     

放射治疗时间与中晚期宫颈癌预后关系的研究

目的 研究中晚期宫颈癌单独放疗时总的放疗时间对治疗结果的影响。方法 选择1986～1990年治疗的386例Ⅱb和Ⅲ期宫颈癌患者进行外照射和腔内照射,对这些患者进行综合分析,确定总的放疗时间是否为影响预后的因素。结果 经过综合分析表明,宫颈癌放射治疗中总的治疗时间和输血是影响疗效的两个最具有显著意义的因素。治疗时间超过56 d时,每超过1 d,局部控制率和总生存率大约每天降低1％。结论 总的放射治疗时间是影响中晚期宫颈癌疗效的预后因素。     

插植调强近距离放射治疗复发性宫颈癌的临床研究

为了探计盆腔插植调强近距离放射治疗在复发性宫颈癌中的价值,选择25例盆腔复发性宫颈癌患者行插植后装调强近距离放疗为实验组.同期行常规后裳放疗的25例盆腔复发性宫颈癌患者作为对照组,比较两组间的近期疗效及并发症.实验组CR 20例,PR 5例;对照组CR 10例,PR 7例,SD 4例,PD 4例,两组比较差异有统计学意义,P<0.005.实验组出现5例阴道直肠瘘,1例3级肠炎;对照组出现4例阴道直肠瘘,1例3级肠炎,两组比较差异无统计学意义,P>0.005.初步研究结果提示,盆腔插植调强近距离放射治疗复发性宫颈癌近期疗效满意,优于常规近距离放疗,毒副反应可耐受.     

保留卵巢功能对宫颈癌患者放疗后生活质量的影响

目的探讨保留卵巢功能对宫颈癌患者放射治疗后内分泌及生活质量的影响。方法1995年6月~2001年6月对年龄35岁下,临床Ⅰ、Ⅱ期的宫颈癌患者64例随机分成两组实验组(卵巢移位 放疗)32例,先行手术将卵巢保留并移位至照射区外5cm处,然后行盆腔根治性放疗;对照组(单纯放疗)32例,直接行盆腔根治性放疗。观察两组放疗后性激素水平变化及临床表现,并进行对照分析。结果实验组放疗后血清FSH、LH、E2、T值较放疗前无显著变化(t=0·72,P>0·05),阴道细胞学检查有雌激素影响。B超示卵巢有周期性增大改变,临床表现无怕热、心烦、多汗、肥胖、皮肤粗糙等内分泌失调症状。对照组放疗后FSH、LH值显著增高(t=15·53,P<0·01),E2值都显著降低(t=6·61,P<0·01),阴道细胞学检查无雌激素影响。B超示卵巢无周期性变化,临床表现有怕热、多汗、烦躁、皮肤粗糙等内分泌失调症状。与实验组比较(χ2=32·0,P<0·01),结果证明卵巢移位后能避免卵巢功能丧失。结论保留卵巢功能可以提高年轻宫颈癌患者放射治疗后的生活质量。     

子宫颈癌放射治疗后远处转移63例临床分析

目的　回顾性研究宫颈癌放射治疗后发生远处转移的临床特征。方法　对 1989年 3月～ 1998年 3月我院放射治疗宫颈癌Ⅱ、Ⅲ期患者共 114 6例进行随诊与回顾性分析。结果　发现 63例远处转移病例中 ,骨转移占 2 8.6% ,远处淋巴结转移占 2 7% ,肺转移占 2 3 .8% ,肝或腹腔转移占 11.1% ,其它组织转移占 15 .9% ,同时有两组以上器官转移 4例。 81%转移病例发生于放射治疗后2年内。再次放疗与化疗 ,但预后均差 ,84.1%患者在 2年内死亡。结论　对宫颈癌放疗后的患者应重视定期复查 ,尤其在疗后 2年内更应严密随诊 ,及早发现 ,积极治疗。     

晚期宫颈癌介入加放射治疗近期疗效观察

回顾分析 2 0例宫颈癌介入加放射治疗近期疗效。 2 0例病人全部为宫颈癌Ⅲ期 ,16例为鳞癌 ,4例为腺癌 ,均经一侧股动脉局麻下穿刺 ,在日本岛津 32 0 0型 10 0 0MVX线机透视下应用 5 FU DDP ADM介入治疗。腺癌将ADM改为MMC ,重侧用 2 3,轻侧用 1 3,相同各半。本组 6例介入 2次 ,14例介入 1次 ,结果 2 0例患者症状缓解 85 % ( 17 2 0 ) ,有效率为 80 % ( 16 2 0 ) ,胃肠道反应Ⅰ～Ⅱ级 ,骨髓抑制不明显。结果提示 :单纯放疗时间长、疗效差 ,对隐藏的癌细胞不能杀灭 ,联合治疗可提高疗效 ,减少放疗反应 ,控制已插散癌细胞或减低细胞活力 ,减少肿瘤细胞转移机会。本组患者近期疗效显著 ,为进一步根治性放疗提供有利条件 ,值得推广。     

Coping of cancer patients during and after radiotherapy--a follow-up of 2 years

AIM: We wanted to understand coping strategies specific to different phases up to two years after radiotherapy, to identify patients who are at higher risk of mood disturbances and to characterise the association between coping strategies and psychosocial adaptation. PATIENTS AND METHODS: From 1997 to 2001, 2,169 patients with different diagnoses were screened (27.8% refused to participate). Data of 276 patients from the beginning of radiotherapy (ti1) and 5 follow-up investigations (ti6/2 years) could be analysed. With the FKV (Freiburg Questionnaire Coping with Disease) cancer-specific coping aspects were assessed. The association between coping styles and psychosocial adaptation was evaluated using the Questionnaire on Stress in Cancer Patients (QSC) and the questionnaire on Functional Assessment of Cancer Treatment (FACT-G). RESULTS: 'Active problem-orientated' coping and 'distractions' are the most important coping strategies. Only 'active problem-orientated' and 'depressive' coping showed a significant decrease. We observed higher means on the scales of the FKV in women. Marital status (single, married, divorced/widowed) had a significant influence on active problem-orientated coping and spirituality. Age, children, education, T/M status and curative/ palliative intention of treatment had no influence on coping styles. Breast cancer patients and lymphoma patients demonstrated the highest use of coping strategies after radiotherapy with a significant decrease of 'active problem-orientated coping'. Depressive coping and minimizing importance at ti1 were associated with high psychosocial distress and low quality of life (QoL) at ti6. CONCLUSION: The correlation of coping mechanisms at the beginning of radiotherapy with low QoL and high psychosocial stress at 2 years could help to identify patients at risk for low psychosocial adaptation. Psycho-oncologically trained teams of physicians would best correspond to this profile of needs and would contribute significantly to an ameliorated adaptation of patients to cancer which could lead to higher life satisfaction.     

512例子宫颈癌放射治疗疗效报告

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。     

放疗前后宫颈癌细胞凋亡及Fas、p53及bcl-2的表达

目的:探讨Fas、p53及bcl-2放疗前后的变化及与细胞凋亡的关系。方法:采用免疫组织化学SP法和脱氧核糖核酸转移酶介导的缺口末端标记(TUNEL)技术,分别检测40例宫颈鳞癌患者放疗前后同一位点凋亡阳性率及Fas、p53和bcl-2的表达。结果:放疗前后凋亡阳性率有显著性差异(P<0.01);放疗后Fas与p53表达明显升高(P<0.01),而bcl-2表达明显降低(P<0.01);放疗后p53与Fas及bcl-2表达有相关性(P<0.05)。结论:Fas、p53及bcl-2对放射线诱导的宫颈癌细胞凋亡均具有重要调控作用。p53可能通过上调Fas在宫颈癌中的表达参与了放疗诱导的细胞凋亡过程。     

Estimation of an optimal radiotherapy utilization rate for gynecologic carcinoma: part I--malignancies of the cervix, ovary, vagina and vulva

BACKGROUND: Radiotherapy usage rates exhibit wide variations both within and between countries. Current estimates of the proportion of cancer patients who should optimally receive radiotherapy are based either on expert opinion or on the measurement of actual usage rates rather than on the best available scientific evidence. METHODS: With the goal of developing an evidence-based benchmark for radiotherapy use in the treatment of malignancies of the cervix, vagina, vulva, and ovary (endometrial malignancies are covered in a separate article), the authors reviewed international evidence-based treatment guidelines. Optimal radiotherapy usage trees were constructed, and proportions of patients with clinical indications for radiotherapy were obtained from epidemiologic data. These ideal usage rates were compared with actual radiotherapy utilization rates recorded in Australia and elsewhere. RESULTS: According to the best available evidence, radiotherapy is indicated at least once for 58% of patients with cervical carcinoma, 4% of patients with ovarian carcinoma, 100% of patients with vaginal carcinoma, and 34% of patients with vulvar carcinoma. A review of the limited data available suggests that actual radiotherapy usage rates for patients with gynecologic malignancies are comparable to optimal usage rates. CONCLUSIONS: Actual practice appears to approximate the authors' model of optimal radiotherapy use. This finding reflects the high level of agreement among treatment guidelines as well as the existence of high-quality evidence related to the management of gynecologic malignancies, and it may also be indicative of the fact that a large proportion of patients are treated in specialist units. The management of gynecologic malignancies may serve as a good example in the development of management strategies for other types of cancer.     

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。     

Possible Role of Glutathione in Predicting Radiotherapy Response of Cervix Cancer

Purpose: To see if changes in tumor/blood glutathione (GSH) levels after one fraction of radiotherapy can be correlated with the treatment response in patients with carcinoma of the uterine cervix.Methods and Materials: The study was done on 45 patients with squamous cell carcinoma of the uterine cervix, FIGO Stages IIB (17 patients) and IIIB (28 patients). Stage IIB patients received 35 Gy of cobalt-60 external radiotherapy (RT) in 16 fractions over 4 weeks with a concurrent high-dose-rate intracavitary dose of 8.5 Gy to point A once a week. Stage IIIB patients were given 45 Gy of RT in 20 fractions over 5 weeks, followed by two doses of intracavitary therapy once a week. Blood and tumor samples were collected before and after one dose of RT and GSH was estimated. Tumor response was assessed clinically at 1 month after treatment.Results: Glutathione levels in both blood and tumor showed a significant decrease after one fraction of RT, but the degree of decrease varied among patients. There was a good correlation between the extent of GSH decrease and the tumor response. All patients who had complete response (CR) (seven Stage IIB and eight Stage IIIB) showed ≥70% decrease in both tumor and blood GSH, while those who had <50% regression (NR) (five Stage IIB and 13 Stage IIIB) showed <50% decrease in GSH. The partial responders recorded an intermediate level (50–70%) of depletion in blood and tumor GSH.Conclusions: The results indicate that the changes in tumor/blood GSH levels after one fraction of RT could serve as an index of tumor response to therapy and may help in identifying radioresistant tumors, at least in the case of cervix carcinoma.     

Risk of cervical cancer among wives of men with carcinoma of the penis

The relationship between carcinomas of the penis and cervix uteri was analyzed in married couples. The final series comprised 239 patients with squamous cell carcinoma of the penis and their 224 wives. Two wives were found to have squamous cell carcinoma of the cervix uteri. The expected number of cervical cancers within the group of wives was 1.88, the relative risk thus being 1.05 (95% confidence interval 0.13-3.8). The incidence of condylomas has increased during the recent decades, while that of carcinomas of the penis and uterine cervix has decreased. The results of this study did not support the hypothesis that wives of men with penile cancer incur an increased risk of carcinoma of the cervix uteri. Although there is much evidence from a large number of studies that human papilloma virus (HPV) has a role in the aetiology of cervical cancer, our study suggests that HPV associated with genital malignancies has a low infectivity or that these cancers have multifactorial aetiology.     

The impact of an informational self-management intervention on the association between control and illness uncertainty before and psychological distress after radiotherapy

Many studies have reported that cancer patients who show difficulties maintaining perceptions of control report more psychological distress than patients who are higher in control. Besides perceptions of control, feelings of illness uncertainty have also been regarded as a predictor of psychological distress. Given these strong relationships between perceptions of low control and high illness uncertainty and psychological distress, the present study examined whether an informational self-management intervention (booklet) could moderate this relationship. The booklet contained general and specific information about cancer and cancer treatment, information about possible coping strategies, and social comparison information, which consisted of short stories of other patients. Prior to radiotherapy, 209 patients with cancer completed baseline measures, including control and illness uncertainty. After completing radiotherapy, patients were randomly allocated to receive either a booklet (experimental group; N=103) or no booklet (control group; N=106). Three months after the intervention, aspects of psychological distress were assessed, including tension, anger, depression, fatigue and vigour. The results supported our hypotheses and suggested that a self-management intervention is relevant in reducing the relationship between control and illness uncertainty before radiotherapy and psychological distress after radiotherapy. This seems important, especially for high-risk patients who perceive little control and much illness uncertainty.     

Role of endoscopic studies and cytogenetic indices in diagnosis of preclinical variants of cervix neoplasms

The results of colpocervicoscopic examination of more than 15,000 females suggested cervical carcinoma in 345 cases, which was confirmed histologically in 319 patients. A detailed morphological and cytogenetic investigation carried out in 36 patients with preclinical form of TIaNXMO invasive carcinoma of cervix uteri established a relationship of mitotic activity, pathological mitosis count and fraction of cells with X-chromatin, on the one hand, and the depth of tumor invasion, on the other. The stages of complex examination of patients with pathology of cervix uteri are discussed.     

Treatment of carcinoma of the uterine cervix by remotely controlled afterloading intracavitary radiotherapy with high-dose rate: A comparative study with a low-dose rate system

From September, 1974 through December, 1979, a total of 249 patients with carcinoma of the cervix uteri Stage IIb and III were randomly allocated to either remotely controlled high-dose-rate intracavitary radiotherapy or manual afterloading low-dose-rate therapy, with radiotherapy of 20 Gy in 2 weeks to Point A to whole pelvis and 40 Gy in 4 weeks to the parametria. The dose to Point A by intracavitary radiotherapy was 40–60 Gy with one or two fractions in the low-dose-rate group and 30 Gy for the high-dose-rate group by 3 fractions with a once a week schedule. The purpose of this paper is to compare the results between the groups and to clarify the problems in the high-dose-rate group clinically. The local control rate was higher in the high-dose-rate group; however, the complication rate was also higher in this group than in the low-dose-rate group. The dose schedule and the place of rectal dose measurement is discussed. The overall cumulative survival rate was nearly the same in both groups (55 % at 5 years), although some difference was noted in each stage. The most common cause of death was distant metastasis outside the pelvis and the second most common was intercurrent disease in Stage IIb and local failure in Stage III.