肝切除治疗原发性肝癌自发性破裂

目的 探讨肝切除治疗原发性肝癌自发性破裂(简称肝癌破裂)的作用。方法 分析我院1973年以来采用肝切除术治疗肝癌破裂12例的临床资料。结果 本组男10例，女2例。平均年龄42(22—65)岁。11例为急症肝切除术，1例为2期肝切除，包括肝左外叶切除6例，左内叶切除1例，左半肝切除1例，右肝部分切除2例，肿瘤局部切除2例。本组中Child-Paugh肝功能分级A组的11例中无死亡；B组者1例术后死于肝衰，手术死亡率为8．3％。术后生存的1例均获随访，平均生存时间为16．5个月，1，3，5年生存率分别为72．7，18．2％，9．1％。其中1例已无瘤生存25年9个月。结论 肝切除是治疗肝癌破裂的最好方法，当有可能时应争取施行。肝切除治疗肝癌破裂可能使患者获行长时间生存。     

胆囊腺瘤-腺癌中的DNA含量和基因表达

目的 研究胆囊腺瘤从增殖到恶变中腺上皮细胞的增殖变化和基因表达。方法PCR-RFLP法测定APC、ras基因突变,ABC免疫化学组织染色法测定p53蛋白表达。用TJTY-300全自动图像分析仪测定胆囊上皮细胞核异型性和DNA含量。结果 上皮细胞核异型性和DNA含量在胆囊腺瘤-腺癌过程中逐渐增加。胆囊腺瘤中异倍体比例与腺瘤的大小有明显的关系,直径≥1cm异倍体显著增加(P<0.05)。在胆囊腺瘤-腺癌过程中可检测到APC基因和RAS基因突变。P53蛋白在这一过程中不表达。结论 胆囊腺瘤-腺癌的过程是胆囊癌发生中一条重要的途径。当胆囊腺瘤直径≥1cm时具有明显的癌变潜能。其分子改变机制与胆囊上皮不典型增生-原位癌途径不同。     

肝癌门静脉癌栓多排螺旋CT三维成像

目的 探讨门静脉癌栓多排螺旋CT3D成像的临床意义。方法 收集了57例门静脉3D成像,6例正常,5例肝硬化门脉高压,42例肝癌门静脉癌栓,4例肝门部淋巴结肿大患者,所有病例来源于肝脏常规双期扫描。对比剂按1.5-2ml/kg,对比剂注射流率2.5-3ml/s,门脉期延迟时间60-70s。对肝癌形成的42例门静脉癌栓进行轴位和3D成像观察,并行两组对照。结果 根据癌栓不同部位分为门脉左支(13例)、右支(20例)、主干(9例)3种类型。3D成像与轴位之间对显示门静脉癌栓没有差异性(P>0.05),但3D对显示主干栓塞形成的侧支循环优于轴位。结论 门静脉癌栓多排螺旋CT3D成像可较好地多方位显示癌栓部位及癌栓类型,CT3D成像和轴位结合可更好地对门静脉癌栓作出判断,以进一步指导临床对治疗方案的选择。     

Survivin反义RNA真核表达载体的构建及鉴定

目的 为了特异封闭白血病细胞survivin的表达，抑制其功能，本实验构建了survivin反义核酸载体并导入白血病细胞系中。方法 应用RT—PCR获得survivin的cDNA片段，反向插入pcDNA3质粒载体中；经限制性酶切和测序鉴定所构建的反义核酸是否正确；采用电转染方法将重组体导入HL—60细胞中；RT—PCR技术检测转染细胞survivin表达的变化。结果 经限制性酶切和测序鉴定证明survivin反义核酸已成功构建；RT—PCR产物电泳结果显示，与转染前细胞、空质粒转染细胞相比，转染survivin反义核酸的细胞survivin mRNA水平明显降低。结论 本实验已成功建立了survivin反义核酸真核表达载体，而且在白血病细胞系中发挥了特异封闭作用，为进一步研究survivin反义核酸在白血病治疗中的作用提供了实验基础。     

Incorporating an improved dose-calculation algorithm in conformal radiotherapy of lung cancer: re-evaluation of dose in normal lung tissue.

BACKGROUND AND PURPOSE: The low density of lung tissue causes a reduced attenuation of photons and an increased range of secondary electrons, which is inaccurately predicted by the algorithms incorporated in some commonly available treatment planning systems (TPSs). This study evaluates the differences in dose in normal lung tissue computed using a simple and a more correct algorithm. We also studied the consequences of these differences on the dose-effect relations for radiation-induced lung injury. MATERIALS AND METHODS: The treatment plans of 68 lung cancer patients initially produced in a TPS using a calculation model that incorporates the equivalent-path length (EPL) inhomogeneity-correction algorithm, were recalculated in a TPS with the convolution-superposition (CS) algorithm. The higher accuracy of the CS algorithm is well-established. Dose distributions in lung were compared using isodoses, dose-volume histograms (DVHs), the mean lung dose (MLD) and the percentage of lung receiving >20 Gy (V20). Published dose-effect relations for local perfusion changes and radiation pneumonitis were re-evaluated. RESULTS: Evaluation of isodoses showed a consistent overestimation of the dose at the lung/tumor boundary by the EPL algorithm of about 10%. This overprediction of dose was also reflected in a consistent shift of the EPL DVHs for the lungs towards higher doses. The MLD, as determined by the EPL and CS algorithm, differed on average by 17+/-4.5% (+/-1SD). For V20, the average difference was 12+/-5.7% (+/-1SD). For both parameters, a strong correlation was found between the EPL and CS algorithms yielding a straightforward conversion procedure. Re-evaluation of the dose-effect relations showed that lung complications occur at a 12-14% lower dose. The values of the TD(50) parameter for local perfusion reduction and radiation pneumonitis changed from 60.5 and 34.1 Gy to 51.1 and 29.2 Gy, respectively. CONCLUSIONS: A simple tissue inhomogeneity-correction algorithm like the EPL overestimates the dose to normal lung tissue. Dosimetric parameters for lung injury (e.g. MLD, V20) computed using both algorithms are strongly correlated making an easy conversion feasible. Dose-effect relations should be refitted when more accurate dose data is available.     

Psychosocial Support for Women with Advanced Breast Cancer

Women with advanced breast cancer frequently experience psychologic distress as a result of their illness and its treatment. This distress may be manifest as depression, anxiety, symptoms of the stress-response syndrome, difficulty coping and social isolation. Six randomized trials of psychosocial interventions have been conducted in metastatic breast cancer. Five of these evaluated group psychosocial support – supportive-expressive therapy in three studies, cognitive-behavioral in one, and a combination of cognitive-behavioral and supportive therapy in another. All of these studies identified psychological benefits, notably improvement in mood, pain control and coping, although benefits were small in one study that provided the control group with a home cognitive-behavioral study program. One study identified an unexpected survival benefit associated with a group intervention – three subsequent studies have failed to replicate this result. Survival results of one additional ongoing study are pending.Studies in early breast cancer, and in patients with a spectrum of other cancers, have demonstrated benefits of individual psychological interventions, educational interventions and relaxation/self-hypnosis/imagery interventions, however, these have not been adequately evaluated in metastatic breast cancer.Based on these results, it is recommended that psychosocial support be offered to women with advanced breast cancer. Current research does not provide sufficient information to determine the optimal type of intervention to be used, or the optimal timing and duration of such interventions. Furthermore, it is not clear which patients benefit the most from psychosocial intervention and whether there are some patients who do not require psychosocial intervention. Research to address these issues is recommended.     

First results of a phase I/II dose escalation trial in non-small cell lung cancer using three-dimensional conformal radiotherapy.

PURPOSE: To evaluate the feasibility of dose escalation in non-small cell lung cancer (NSCLC) using three-dimensional conformal radiation therapy. PATIENTS AND METHODS: The main eligibility criteria of the trial were: pathologically proven inoperable NSCLC, ECOG performance status or=grade 3 (SWOG), grade 3 early and grade 2 late esophageal toxicity or any other (RTOG) grade 3 or 4 complications). RESULTS: Fifty-five patients were included. Tumor stage was I/II in 47%, IIIA in 33% and IIIB in 20%. The majority of the patients received a dose of 74.3 Gy (n=17) or 81.0 Gy (n=23). Radiation pneumonitis occurred in seven patients: four patients developed a grade 2, two patients grade 3 and one patient a grade 4. Esophageal toxicity was mild. In 50 patients tumor response at 3 months follow-up was evaluable. In six patients a complete response was recorded, in 38 a partial response, five patients had stable disease and one patient experienced progressive disease. Only one patient developed an isolated failure in an uninvolved nodal area. So far the radiation dose was safely escalated to 87.8 Gy in group 1 (lowest rMLD), 81.0 Gy in groups 2 and 3 and 74.3 Gy in group 4. CONCLUSION: Three-dimensional conformal radiotherapy enables significant dose escalation in NSCLC. The maximum tolerable dose has not yet been reached in any risk group.