盆腔肿瘤放疗致放射性肠炎的临床观察

盆腔肿瘤尤其是宫颈癌和直肠癌在放疗过程中常伴有盆腔正常组织不同程度的损伤,其中最常发生的是不同程度的放射性肠炎,而慢性迟发性肠炎往往是增加死亡率的一个重要原因[1].本文对盆腔肿瘤患者放疗后放射性肠炎的发生情况及治疗效果进行临床观察与分析.     

应用六自由度床的直肠癌盆腔放疗患者的不同固定方式比较分析

目的 探讨在使用六自由度床的情况下,接受盆腔放疗的直肠癌患者的固定方式选择.方法 通过对北医三院放射治疗科2015年11月1日至2016年3月25日行盆腔放射治疗的27例直肠癌患者整个疗程中的六自由度床校正摆位误差的分析,比较低温热塑膜和真空垫的固定效果.热塑膜体网入组17例患者(组1),负压真空垫组入组10例患者(组...     

晚期复发转移直肠癌56例同步放化疗的疗效观察

目的观察FOLFOX4联合放疗治疗晚期复发转移直肠癌的疗效与毒性反应。方法对56例无法手术的晚期或复发直肠癌患者进行盆腔放疗,在放疗的第1、5周同时给予FOLFOX4方案化疗,以56例单纯同方案化疗者为对照组。结果单纯化疗组、放化疗组的有效率分别为66.1%、83.9%(P0.05);肛门、会阴疼痛缓解率分别为30.4%、55.4%;粘液血便缓解率分别为17.9%、30.4%;无病生存期分别为10.8个月、12.6个月(P0.05);中位生存期分别为17.2个月、21.8个月(P0.05)。主要毒副反应是消化道反应、神经毒性、骨髓抑制,经对症和支持治疗后患者均能够耐受。结论 FOLFOX4方案化疗与盆腔同步放疗治疗晚期及复发转移直肠癌能较好控制局部复发病灶,控制远处转移,改善局部症状,提高生活质量及生存期。     

结直肠癌远隔转移的治疗策略

世界范围内结直肠癌发病率持续增高,结直肠癌的疗效和预后都有显著改善。然而,结直肠癌的远隔转移仍然是结直肠癌治疗的难点和重点。本文回顾了结直肠癌远隔治疗的历史,总结了结直肠癌肝转移、肺转移、盆腔局部转移和腹膜转移的治疗策略和疗效。     

SATB1在直肠癌新辅助放疗中的作用

目的探讨SATB1在直肠癌新辅助放疗中的作用。 方法选取142例直肠癌患者作为研究对象,其中68例接受术前短程放疗,74例未接受术前放疗。采用组织芯片方法检测直肠癌组织（n=142）和正常黏膜组织（n=107）、术前活检癌组织（n=84）以及转移淋巴结（n=43）中SATB1表达情况,探讨SATB1表达对直肠癌患者预后的影响,并通过生物信息学方法分析SATB1表达与多个放疗相关因子的关系。 结果在未接受术前放疗的患者中,SATB1在正需组织中的表达低于肿瘤组织（χ²=5.396,P=0.032）而肿瘤组织中的表达高于淋巴结转移组织（χ²=6.405,P=0.002）。在接受术前放疗的患者中,SATB1表达与不良的OS（HR,0.516;P=0.039;95% CI：0.274~0.969）和DFS（HR,0.558;P=0.025;95% CI：0.335~0.930）相关。放疗可以降低直肠癌组织中SATB1的表达。在放疗的直肠癌肿瘤组织中SATB1表达与ATM和pRb2/p130表达负相关（χ²=5.427,P=0.032;χ²=4.610, P=0.047）,而与Ki-67和TEM1表达正相关（χ²=4.339,P=0.037;χ²=7.376,P=0.014）。网络和蛋白-蛋白相互作用分析证实了SATB1与这些蛋白的相互联系。 结论放疗能降低SATB1表达,后者可通过参与一些放疗反应相关的信号通路,赋予接受术前放疗的直肠癌患者生存获益。     

老年直肠癌患者盆腔放疗的急性血液学毒性

目的探究老年直肠癌患者盆腔放疗的急性血液学毒性反应的发生率及其影响因素。 方法回顾分析2006年1月至2014年8月在本院行盆腔放疗的50例75岁及以上直肠癌患者的临床资料。选取同一时期行盆腔放疗的111例75岁以下直肠癌患者作为非老年患者组进行比较。采用卡方检验及Logistic多因素回归模型分析不同临床因素与3~4度血液学毒性发生率的相关性。 结果老年患者组中0度、1~2度、3~4度急性血液学毒性发生率分别为6.0%、78.0%和16.0%,非老年患者组中0度、1~2度、3~4度急性血液学毒性发生率分别为24.3%、68.5%和7.2%。老年患者的3~4血液学毒性反应发生率高于非老年患者（P=0.009）。多因素分析显示体重指数与老年患者的3~4度急性血液学毒性反应发生显著相关（P=0.038）。 结论老年直肠癌患者盆腔放疗的急性血液学毒性反应是可耐受的,高体重指数可能与老年患者盆腔放疗的严重血液学毒性反应相关。     

PET/CT诊断直肠癌术后盆腔复发或转移的价值

回顾性分析56例行PET/CT检查的直肠癌术后患者的组织学及临床影像学资料,判断PET/CT诊断结果的准确性。发现在诊断直肠癌术后盆腔复发或转移患者(35例)中,PET/CT检查的灵敏度为97.14%(34/35),特异度为100.00%(20/20),约登指数为97.14%。认为PET/CT诊断直肠癌术后盆腔复发或转移准确性很高。     

宫颈癌根治术后体外盆腔放疗联合阴道腔内放疗临床观察

目的观察宫颈癌根治术后体外盆腔放疗联合阴道腔内放疗的效果。方法选择已行宫颈癌根治术的宫颈癌患者100例,按术后化疗方案分为观察组及对照组各50例,对照组采用体外盆腔放疗,观察组采用体外盆腔放疗+阴道腔内放疗。观察两组1年无瘤生存率、3年无瘤生存率及放射性肠炎、放射性膀胱炎、阴道残端局部复发、盆腔淋巴结转移、骨转移、肺转移发生情况。结果观察组及对照组1年无瘤生存率分别为78%(39/50)、65.3%(32/50),两组比较,P>0.05;3年无瘤生存率分别为66%(33/50)、44.9%(22/50),两组比较,P<0.05。观察组出现放射性直肠炎6例,放射性膀胱炎3例,阴道残端局部复发7例,盆腔淋巴结转移6例,骨转移2例,肺转移1例;对照组分别为5、3、15、11、3、0例,两组阴道残端局部复发比较,P<0.05。结论宫颈癌根治术后体外盆腔放疗联合阴道腔内放疗的应用效果较好,3年无瘤生存率高,且可有效减少阴道残端局部复发。     

高效液相色谱法测定直肠癌术中肠腔化疗血液和盆腔液及组织5-Fu浓度

目的:测定直肠癌术中肠腔化疗血液、盆腔液和组织5-Fu浓度。方法:20例直肠癌患者术中行肠腔化疗,注药后不同时相采集门静脉血、周围静脉血、盆腔液和癌旁组织,用高效液相色谱法测定5-Fu浓度。结果:门静脉血、盆腔液和组织2min即测得5-Fu,此后,盆腔液和组织浓度降低,门静脉血药浓度上升,60min达到峰浓度,周围静脉血未测得5-Fu。结论:直肠癌术中肠腔化疗可使5-Fu迅速分布于盆腔液、组织和门静脉血,但组织和盆腔液峰浓度低且下降迅速,对预防术后局部复发和腹腔转移作用有限,含5-Fu的门静脉血对抑制肝脏转移有一定意义。     

直肠癌术后早期复发29例回顾性分析

回顾性分析我院29例术后1 a内复发的直肠癌患者的临床资料。术后吻合口复发13例,其中并小肠转移1例,并肝转移1例;会阴部复发3例;骨性骨盆(包括骶前及骶骨、骨盆侧壁)复发8例,并回肠转移1例,并腹腔、盆腔广泛种植转移1例;腹壁切口复发1例;腹腔淋巴结、肝、肺、卵巢转移各1例。认为直肠癌术后早期复发与Dukes分期、原发肿瘤部位、手术切除范围等多种因素密切相关。     

Values of mutations of K-ras oncogene at codon 12 in detection of pancreatic cancer：15-year experience

AIM: To summarize progress in the study of K-ras gene studies in pancreatic cancer and its potential clinical significance in screening test for early detection of pancreatic cancer, and to differentiate pancreatic cancer from chronic pancreatitis in recent decade. METHODS: Literature search (MEDLINE 1986-2003) was performed using the key words K-ras gene, pancreatic cancer, chronic pancreatitis, and diagnosis. Two kind of opposite points of view on the significance of K-ras gene in detection early pancreatic cancer and differentiation pancreatic cancer from chronic pancreatitis were investigated. The presence of a K-ras gene mutation at codon 12 has been seen in 75-100% of pancreatic cancers, and is not rare in patients with chronic pancreatitis, and represents an increased risk of developing pancreatic cancer. However, the significance of the detection of this mutation in specimens obtained by needle aspiration from pure pancreatic juice and from stools for its utilization for the detection of early pancreatic cancer, and differentiation pancreatic cancer from chronic pancreatitis remains controversial. CONCLUSION: The value of K-ras gene mutation for the detection of early pancreatic cancer and differentiation pancreatic cancer from chronic pancreatitis remains uncertain in clinical practice. Nevertheless, K-ras mutation screening may increase the sensitivity of FNA and ERP cytology and may be useful in identifying pancreatitis patients at high risk for developing cancer, and as a adjunct with cytology to differentiate pancreatic cancer from chronic pancreatitis.     

SELDI-TOF-MS在筛选肝癌高发家系与无癌家系血清蛋白差异中的应用

目的：比较肝癌高发家系患者和无癌家系患者血清蛋白质谱图,探寻两者间的血清蛋白差异。方法用表面增强激光解吸电离-飞行时间质谱技术（ SELDI-TOF-MS）及CM10蛋白芯片对25例肝癌高发家系患者和25例无癌家系患者血清样本进行分析,将获得的血清蛋白质指纹图谱,用计算机软件进行比较分析,建立高发家系患者和无癌家系患者的比较筛选模型。结果肝癌高发家系组与无癌家系组共有15个蛋白质差异有统计学意义。筛选出4个蛋白峰建立诊断模型的灵敏度为96.0％（24/25）,特异度为88.0％（22/25）,准确率为92.0％（46/50）。结论肝癌高发家系患者组和无癌家系患者组的血清存在一定的差异蛋白, SELDI技术在特异性蛋白生物标志分子的筛选等方面具有较好的临床应用前景。     

Circulating microRNAs as stable blood-based markers for cancer detection

Improved approaches for the detection of common epithelial malignancies are urgently needed to reduce the worldwide morbidity and mortality caused by cancer. MicroRNAs (miRNAs) are small ( approximately 22 nt) regulatory RNAs that are frequently dysregulated in cancer and have shown promise as tissue-based markers for cancer classification and prognostication. We show here that miRNAs are present in human plasma in a remarkably stable form that is protected from endogenous RNase activity. miRNAs originating from human prostate cancer xenografts enter the circulation, are readily measured in plasma, and can robustly distinguish xenografted mice from controls. This concept extends to cancer in humans, where serum levels of miR-141 (a miRNA expressed in prostate cancer) can distinguish patients with prostate cancer from healthy controls. Our results establish the measurement of tumor-derived miRNAs in serum or plasma as an important approach for the blood-based detection of human cancer.     

Colorectal cancer in hereditary breast cancer kindreds

PURPOSE: This study compared characteristics of colorectal cancer between families with dominant breast cancer inheritance and the general population. The cumulative incidence of colorectal cancer was also studied in genetically determined breast cancer syndrome subjects with BRCA1 and BRCA2 mutations and compared with the general population. METHODS: Subjects included 42 patients with colorectal cancer from 32 clinically determined hereditary breast cancer kindreds based on the autosomal dominant inheritance of breast cancers and early age of onset. The general population colorectal cancer cohort was composed of 755 patients from a tumor registry. Lifetime risk of colorectal cancer was determined in 164 BRCA1 and 88 BRCA2 gene mutation carriers and compared with the general population. Mean age of colorectal cancer onset, anatomic site distribution, histologic stage at presentation, and five year stage-stratified survival rates were compared between clinically determined hereditary breast cancer family members and the general population. RESULTS: The lifetime risk of colorectal cancer in male BRCA1 and BRCA2 mutation carriers was 5.6 percent, which was not different from 6 percent in males from the general population. Likewise, the lifetime colorectal cancer risk in female BRCA1 and BRCA2 mutation carriers was 3.2 percent, which was not different from 5.9 percent in females from the general population. Mean age of onset ± standard error for patients with colorectal cancer was 60±2 years for hereditary breast cancer kindreds compared with 67±0.4 years for the general population (P=0.0004). Colorectal cancer site distribution did not vary between hereditary breast cancer and the general population. Overall colorectal cancer stage distribution was significantly different, with more Stage I and fewer Stage IV cancers in subjects with hereditary breast cancer compared with the general population (P=0.01). Overall five year stage-stratified colorectal cancer survival rate ± standard error was 66±8 percent for hereditary breast cancer kindreds and 46±2 percent for the general population (P=0.023). CONCLUSION: Lifetime cumulative colorectal cancer incidence in subjects with BRCA1 and BRCA2 gene mutations was not different from the general population. However, significant differences in colorectal cancer were noted between hereditary breast cancer family members and the general population. Hereditary breast cancer-associated colorectal cancer had an earlier age of onset, lower tumor stage, and better survival rate than the general population. Except for age of onset, colorectal cancer in hereditary breast cancer kindreds exhibited more favorable characteristics than colorectal cancer in the general population.Read at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998.     

Thyroid cancer: a lethal endocrine neoplasm

This conference focuses on the controversies about managing thyroid cancer, emphasizing the possibility that the treatment of patients with potentially fatal thyroid cancer may be improved. Although the mortality rate from thyroid cancer is low, it is the highest among cancers affecting the endocrine glands (excluding the ovary). Exposure to radiation during childhood in the 1930s and 1940s increased the incidence of but not the mortality from thyroid cancer, because these tumors are mainly papillary cancers developing in young adults. These rates may change as the exposed cohort ages. Risk factors that increase mortality include older patient age and the growth characteristics of the tumor at diagnosis, the presence of distant metastases, and cell type (for example, the tall-cell variants of papillary cancer, follicular cancer [to be distinguished from the more benign follicular variant of papillary cancer], medullary cancer, and anaplastic cancer). Local metastases in lymph nodes do not seem to increase the risk for death from papillary cancer, but they do increase the risk for death from follicular and medullary cancer. In the latter, mortality is decreased by the early detection and treatment of patients with the familial multiple endocrine neoplasia syndrome 2a. There are excellent tumor markers for differentiated cancer of the parafollicular and of the follicular cells (serum calcitonin and serum thyroglobulin levels, respectively). Measuring the calcitonin level allows early diagnosis of familial medullary cancer, whereas measuring the thyroglobulin level, although useful only after total thyroidectomy, allows early recognition of recurrence or metastases of papillary or follicular cancer. Initial surgery, protocols for follow-up, and the use of radioiodine for the ablation of any residual thyroid and the treatment of metastatic cancer are discussed. Because these tumors resist currently available chemotherapy regimens, possible ways to increase the effectiveness of radioiodine therapy are considered as are new approaches to treatment.     

Primary Gastric Carcinoma with the Bull's eye Sign in a Case of Breast Cancer — Immunohistochemical Differentiation from Metastatic Cancer—

Abstract: A 53-year-old female, who had undergone a mastectomy for breast cancer 4 years previously, was found to have gastric cancer. Judging from the Bull's eye sign of the upper GI series and endoscopy, it appeared to be a metastatic gastric cancer. Histopathological findings of biopsy specimens revealed adenocarcinoma and metastases from the breast cancer were not negligible. However, the surgically resected specimen had different immunohistochemical staining for CEA, Alcian blue, 115D8, and C-erb B2 from the breast cancer. The tumor was finally diagnosed as a primary gastric carcinoma. This case shows that immunohistochemical studies are useful for differentiation between metastatic and primary gastric cancer     

Risk of intestinal cancer in inflammatory bowel disease: a population-based study from olmsted county, Minnesota

BACKGROUND & AIMS: The risk for colorectal cancer in Crohn's disease and ulcerative colitis patients from the United States currently is unknown. We estimated the risk for small-bowel and colorectal cancer in a population-based cohort of 692 inflammatory bowel disease patients from Olmsted County, Minnesota, from 1940 to 2001. METHODS: The Rochester Epidemiology Project was used to identify cohort patients with colorectal and small-bowel cancer. The cumulative probability of cancer and standardized incidence ratios (SIR) were estimated using expected rates from Surveillance, Epidemiology, and End Results, white patients from Iowa, from 1973 to 2000, and Olmsted County, from 1980 to 1999. RESULTS: Colorectal cancer was observed in 6 ulcerative colitis patients vs 5.38 expected (SIR, 1.1; 95% confidence interval [CI], 0.4-2.4), but 4 of these occurred among those with extensive colitis or pancolitis (SIR, 2.4; 95% CI, 0.6-6.0). Six Crohn's disease patients (vs 3.2 expected) developed colorectal cancer (SIR, 1.9; 95% CI, 0.7-4.1). Three Crohn's disease patients developed small-bowel cancer vs 0.07 expected (SIR, 40.6; 95% CI, 8.4-118). CONCLUSIONS: The risk for colorectal cancer was not increased among ulcerative colitis patients overall, but appeared to be increased among those with extensive colitis. The colorectal cancer risk was increased slightly among Crohn's disease patients, who also had a 40-fold excess risk for small-bowel cancer.     

支气管灌洗液抑癌基因过甲基化对肺癌诊断价值的研究

目的探讨支气管灌洗液抑癌基因过甲基化对肺癌诊断的应用价值。方法选取北京市结核病胸部肿瘤研究所收治怀疑肺癌患者78例,包括肺癌51例和良性病变患者27例,从支气管灌洗液上清和细胞提取DNA,对上清游离DNA进行定量分析,并采用NMSP完成对支气管灌洗液上清和细胞的过甲基化分析,所选择的靶基因包括p16,MGMT以及RASSF1A基因。将NMSP结果与临床诊断比较,计算敏感性和特异性。结果中心型肺癌、周围型肺癌和肺部良性病变支气管灌洗液上清游离DNA含量没有显著差异。支气管灌洗液细胞抑癌基因过甲基化诊断中心型肺癌的敏感性和特异性分别为85.2%和81.5%,诊断周围型肺癌的敏感性和特异性分别为54.2%和81.5%。支气管灌洗液上清和细胞抑癌基因过甲基化诊断中心型肺癌的敏感性和特异性为88.9%和70.4%,诊断周围型肺癌的敏感性和特异性为75.0%和70.4%。结论支气管灌洗液抑癌基因的过甲基化可为肺癌诊断提供帮助。     

Analysis of microsatellite instability in stool DNA of patients with colorectal cancer using denaturing high performance liquid chromatography

INTRODUCTION Colorectal cancer, one of major causes of tumor-induced death in the Western population, becomes prevalent in Korea. The mortality rate from colorectal cancer has increased rapidly from 3.9 per 100 000 individuals in 1983 to 11.4 in 2003 in K…     

GASTRIC CANCER RETROSPECTIVELY INVESTIGATED FOR 9 YEARS AND 6 MONTHS: A CASE OF LINITIS PLASTICA

This report presents a rare case of a patient with gastric cancer whose clinical course with the development of tumor from early cancer type IIc to advanced cancer of linitis plastica was observed for 9.5 years. The cancer remained in early stage for 3 years and 8 months after the patient’s first endoscopy. At 5 years and 10 months after initial endoscopy, the lesion progressed to advanced cancer, and after 6 years and 7 months sclerotic changes in the gastric wall were detected at the lesion site. After 9 years, advanced gastric cancer of linitis plastica was present throughout the stomach. The initial stage of linitis plastica is considered to be early gastric cancer type IIc with histologically undifferentiated cancer cells. It is widely accepted that a period of 6–8 years is required for this type of cancer to develop from carcinogenesis to completion of lesions. The present case is valuable in that development from early gastric cancer type IIc to linitis plastica during approximately 10 years of follow up was clinically observed, and will contribute to knowledge of the natural history of gastric cancer.