影像导航脑肿瘤切除术的Me ta分析

目的：通过 Meta分析评估不同影像导航脑肿瘤切除术和传统手术对比治疗的效果。方法：计算机检索 PubMed、CBM、Cochrane library、Web of Science 数据库至2014年11月15日,以获得有关不同影像导航脑肿瘤切除术的随机对照研究。采用 RevMan 5．3软件分析数据,计算比值比（OR）及95％的可信区间,检验异质性并寻找其来源,应用漏斗图评估发表偏倚。结果：总共纳入10篇随机对照研究（RCT）,共计669例病人,其中影像导航手术者329例,传统手术者340例。Meta分析结果显示：与传统手术相比,影像导航切除脑肿瘤的全切率较高,术后功能障碍发生率减低,差异具有统计学意义（P＜0．05）。在全切率方面,不同影像导航之间无统计学差异（P＞0．05）。但在降低术后功能障碍方面,术中磁共振优于超声,超声优于弥散张量成像（DTI）（P＝0．02）。结论：影像导航脑肿瘤切除术相比传统手术可以提高肿瘤全切率,最大程度保护功能区,降低术后并发症发生率,从而提高患者生活质量。     

miR-145通过靶向HLTF对宫颈癌Me180细胞放射敏感性影响

miR?145在多种肿瘤组织中呈现低表达,对放射敏感性也发挥一定作用[1?2]. HLTF即解螺旋酶样转录因子,作为一种与癌症相关的转录因子,在贲门癌等消化道肿瘤中搞研究较多,HLTF可以增强细胞DNA损伤修复能力,其上调表达与宫颈癌放射耐受有关. 笔者在前人研究基础上就miR?145对宫颈癌Me180细胞的作用进行研究,以探讨其在宫颈癌治疗中的作用机制.     

应用ACNU与Me—CCNU联合化疗治疗进展期胃癌的随机研究

作者比较了亚硝酸脲类药物盐酸嘧啶亚硝脲（ＡＣＮＵ）和甲环亚硝脲（Ｍｅ－ＣＣＮＵ）联合化疗对进展期胃癌的疗效。１０３例进展期胃癌分为Ａ组（Ｍｅ－ＣＣＮＵ，５－Ｆｕ和ＡＤＭ）和Ｂ组（ＡＣＮＵ，５－Ｆｕ和ＡＤＭ）进行随机研究，结果，Ａ组无ＣＲ和ＰＲ者，Ｂ组无ＣＲ，但ＰＲ者８／４６（１７．４％），Ｂ组有效率为１７．４％，Ａ组有疗效为０％，中位生存期Ｂ组为１１２天，Ａ组为１０８天，在疗程中，两组均未发生严重     

实时超声弹性成像对涎腺结节良恶性诊断的Me ta分析

目的：系统评价实时超声弹性成像中的弹性评分法对于区分涎腺结节良恶性的诊断价值。方法：计算机检索PubMed、Embase、High Wire Press、Ovid、中国学术期刊网全文数据库（CNKI）至2016年5月31日,检索语言为英文和中文。选取应用超声弹性评分法区别涎腺结节良恶性的文章。合并敏感度、特异度、诊断比值比（DOR）评价超声弹性评分法区别涎腺结节的诊断准确性。进行综合接受者工作特征曲线（SROC）,计算曲线下面积（AUC）和Q*值来分析超声弹性评分法区别涎腺结节的综合诊断价值。结果：最终纳入11篇研究,包含642名患者,共计691个结节。超声弹性评分法区别涎腺结节的合并敏感度、特异度、诊断比值比分别为：0．77（95％CI：0．68～0．84）,0．74（95％CI：0．65～0．82）,10．12（95％CI：4．67～21．94）。综合SROC曲线下面积为0．82,Q*指数为0．7623。结论：实时超声弹性对于诊断腮腺及颌下腺结节的良恶性方面有一定的诊断价值,它可以作为一个辅助工具与传统超声联合使用,提高腮腺及颌下腺结节诊断的准确度。     

Strahlenexposition der Patienten bei pädiatrischen Herzkatheteruntersuchungen Teil 2: Patientenbezogene Meßergebnisse

Age, entire exposure duration and dose-area products for pa and lat beam as well as the number of angiographies have been recorded for 2114 pediatric cardiac catheterizations within the time period 1982 to 1996. Furthermore the average field dimensions and sizes at the patient entrance surface for pa and lat beams and the frequency distributions for dose-area product rates, the entire dose-area products and the effective doses, calculated by means of age class dependent conversion factors, are given for all patients. The effective doses for new-borns are higher by about a factor 2 (Q₅₀ = 6.5 mSv compared to 3.0 mSv) compared to children of higher age class, despite of the quite smaller body dimensions and thus smaller dose-area product rates. Cancer risks by radiation exposure are significantly higher for new-borns than for elder children for the same effective dose. Although no age specific factor can be given it is possible to derive from literature data, that cardiac catheterizations cause radiation risks, which are larger at least by a factor 2 to 4 with decreasing age, especially for thyroid and breast cancer (the latter more for girls).     

Qualitätskriterien für Meßsonden zur intraoperativen Lokalisation Tc99m-markierter Lymphknoten

Based on the Sentinel Lymph Node (SLN) concept of malignant melanoma [11] an increasing number of γ-probe guided sentinel lymphadenectomies is performed. Therefore a steadily growing number of commercially available probe systems is presented. Quality control criteria and hints for choosing the appropriate system are defined. Several systems of different manufacturers were tested and their characteristics were determined.     

甲环亚硝脲(Me—CCNu)治疗扩散性恶性肿瘤15例报告(摘要)

我院肿瘤科从1981年7月至1982年12月应用上海医工院供应的甲环亚硝脲综合治疗晚期恶性肿瘤15例,现将治疗情况报告如下: 一般资料本组15例病人,男性8例,女性7例,年龄23—68岁。病种分类:肺癌或转移性肺癌伴胸水6例,乳腺癌术后复发转移3例,肺     

HDCF,5—Fu,Me—CCNU,VCR联合治疗晚期大肠癌38例疗效分析

目的：评价大剂量醛氢叶酸（ＨＤＣＦ）、氟脲嘧啶（５－Ｆｕ）、长春新碱（ＶＣＲ）、甲亚硝脲（Ｍｅ－ＣＣＮＵ）联合治疗晚期大肠癌疗效。方法：经病理证实的晚期大肠癌３８例，其中术后复发的２５例，不能手术的１３例，ＣＦ２００ｍｇ／ｍ＾２静滴２小时第１－４天，５－Ｆｕ５００ｍｇ／ｍ＾２静推第１－４天，ＶＣＲ１．４ｍｇ／ｍ＾２静推第１、８天。上述药物每３周重复；Ｍｅ－ＣＣＮＵ１７５ｍｇ／ｍ＾２和１天口服，第６     

Adjuvant interferon-alpha for melanoma revisited: News?from?old?and?new?studies

Currently the data from 12 randomised phase III trials investigatingthe role of interferon-alpha (IFN-2a) in patients with stageII–III high-risk melanoma are available. The most prominentdifferences between these trials concern the dose of IFN-2a, theduration of IFN-2a administration, and the stage of disease. Some ofthese trials have not yet reached maturity, but despite this thepositive results from some immature trials have attracted considerableattention. When only data from mature trials is considered, one mayconclude that the use of high-dose IFN-2a does prolong disease-freesurvival (DFS) but not overall survival (OS). Combined data fromlow-dose IFN-2a trials does not suggest a benefit in either DFS or OS.A trial with intermediate-dose IFN-2a is still immature. Thereforecurrently the routine use of IFN-2a cannot be recommended outside thescope of clinical trials.     

Scan? Cure? Sure!

Presentation of The Case

A 61-year-old man undergoes a sigmoid colectomy for a T3N1 (two of 18 nodes) adenocarcinoma of the sigmoid colon. He recovers well and receives 6 months of adjuvant FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) uneventfully. At his first follow-up visit, the oncologist recommended every 3 month visits for a physical, liver function tests, and carcinoembryonic antigen (CEA) measurement; every 6 month chest, abdomen, and pelvic computed tomography (CT) scans for 3 years; and aspirin, vitamin D supplementation, and exercise. Is CT scanning appropriate in the follow-up of colon cancer patients? (This case was presented at Massachusetts General Hospital Cancer Center.)

• Oncologist. 2011 Feb; 16(2): 254–256.
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2011 Feb; 16(2): 254–256. doi: 10.1634/theoncologist.2011-0014

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Richard M. Goldberg

Richard M. Goldberg

University of North Carolina at Chapel HillFind articles by Richard M. GoldbergAuthor information Copyright and License information DisclaimerUniversity of North Carolina at Chapel HillCopyright notice Open in a separate windowRichard M. Goldberg, M.D.Just recently, I reorganized my talking points about management of metastatic colorectal cancer. Now I focus those conversations, whether they occur in a lecture hall or a clinic exam room, around an AJCC (American Joint Committee on Cancer) unsanctioned but pragmatic new staging system, which I will call “UNC.” With multidisciplinary input at the University of North Carolina (also, by coincidence, UNC), we sort patients into those “unlikely (U)” to undergo resection because of the extent of their metastatic disease or their comorbid conditions that make the risk of surgery prohibitive, those who can undergo resection “now (N),” and, those who “could (C)” after a response to medical treatment potentially undergo resection. We formulate management strategies that differ according to those categories. Currently, multidisciplinary teams can realistically offer the possibility of long-term disease-free survival to a subset of patients who fit into the N or C subcategories. How do we segregate patients into those categories? We book them an appointment for a CT scan because they seldom have symptoms or physical findings that reliably tell us how extensive their disease is [1].After patients with stage II or III disease complete their initial therapy, it is common practice to do interval CT scans, CEAs, and colonoscopies aimed at early detection of recurrent disease and new primary tumors. Guidelines issued by the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN), and the Cochrane Collaboration reinforce this practice [2–4]. Are we fooling ourselves and our patients about the value of this approach in terms of lives saved or prolonged and money spent? My fiscally conservative crimson (Harvard''s colors) friend and colleague Dr. Ryan suggests that we are and, from my vantage point on the opposite side of the color wheel (UNC''s team color is sky blue), I disagree. Is there evidence on which to base a CT scan-based surveillance protocol?The natural history of colorectal cancer stands out among solid tumors. Cohen and colleagues studied circulating tumor cells (CTCs) in patients with metastatic disease, proving that with current technology they could readily identify CTCs in a 10-ml aliquot of blood [5]. Yet in many patients, most of these potential seeds never grow and scans detect one or a few metastatic lesions. In patients with pancreatic cancer, resection of metastases is not curative. In many series, resection of limited hepatic and pulmonary metastases in colorectal cancer patients leads to a 30%–60% likelihood of long-term disease-free survival and to a substantial 5-year survival rate, even when surgery and drug therapy prove not to be curative [6]. Unfortunately, a substantial number of patients will subsequently relapse, some rapidly, and we need to discover molecular/genetic profiles that can help predict who among the patients with a single or small number of scan-identified lesions will likely benefit from curative resection and who will not. We hopefully can spare patients the pain and society the expense of fruitless surgeries once those data are available.An expert multidisciplinary committee that included several individuals whose prior published work included recommendations against routine surveillance CT scanning (Loprinzi, Virgo) wrote the most recent 2005 ASCO guidelines that endorse follow-up CT scan screening for patients with stage II and III colorectal cancer [2]. An exhaustive review of the literature available at that time convinced the panel of the value of scans. The review included three meta-analyses, all of which they classified as “highest quality” using the metrics defined by the Oxmann-Guyatt Overview Quality Questionnaire. These three meta-analyses reported a 20%–33% reduction in the risk of death from all causes in the groups of patients who had scans as a routine part of follow-up [4, 7, 8]. Interestingly, this reduction in the odds of death is nearly identical to that reported by Moertel and colleagues for adjuvant therapy of stage III colon cancer [9]. The data on the benefit of adding oxaliplatin to fluorouracil-based therapy provides a lesser incremental benefit [10]. Presumably, Dr. Ryan does offer adjuvant therapy with FOLFOX to his patients with stage III colon cancer after resection. Finally, I am having a hard time with the validity of the cost estimates that Dr. Ryan offers. In summary, I believe the data support CT scan surveillance for patients with stage II or III colorectal cancer and the management of those patients found to have recurrent disease using the “UNC” approach.     

Sekund?res Lymph?dem

Secondary lymphedema is a chronic, distressing condition with excess fluid accumulation in the interstitial spaces caused by obstruction of the lymphatic drainage system. This results in limb swelling leading to malfunctions and impairment of everyday life activities. The therapy of choice is complex physical therapy with manual lymphatic drainage, compression bandings and garments, limb exercises and skin care. In oncology secondary lymphedema occurs basically after operations of the breast, the neck and the pelvis. Radiotherapy can also be a cause of lymphedema or can exacerbate this and complications often increase with progressive lymphedema. Therefore, a comprehensive patient education and training is necessary. Moreover, an optimal communication between physician, physiotherapist and medical store is important. Furthermore, lifelong following of behavior recommendations and a good compliance prevent degradation.     

Prim?re Krebspr?vention

The approach to winning the war against cancer has scientific, political and public health dimensions. In order to reduce cancer mortality in the future primary prevention is a major goal. Primary prevention can be achieved through the reduction of identified risk factors, such as smoking, uncontrolled alcohol consumption, poor nutrition and caloric imbalance, insufficient physical activity, obesity, metabolic syndrome, chronic inflammation, virus and bacterial infections and psychosocial stress. Progress can be made by the use of the new concept of personalized medicine where the genetic and epigenetic make-up of an individual in health and disease is used as a diagnostic and therapeutic fundament for targeted preventive therapy. Ingredients of plants, vegetables and herbs with scientifically proven preventive properties (nutriceuticals), second generation NSAIDs, COX-2 inhibitors, pharmacological chaperone-like molecules, sirtuin and kinase inhibitors can be applied alone or within a cocktail to support primary cancer prevention. The development of prophylactic vaccination strategies against virus and bacteria-induced tumors are promising investments in primary cancer preventions and all efforts are accompanied and complemented by supportive psychooncological care giving.     

Qualit?tssicherung und Qualit?tsindikatoren

Quality assurance in oncology is subject to a rapid process of change. Nowadays, instruments for the permanent observation of care reality have to be introduced. Therefore, quality indicators as quality measures are essential. Quality indicators rely on the acceptance and participation of medical experts and should be used in particular in the context of voluntary benchmarking processes. The costs and terms of indicator-based quality assurance require the development of a systematic quality research in Germany.