乳腺癌改良根治术后复发高危患者的放疗结果和预后因素分析

目的 总结本院高危乳腺癌患者改良根治术后的治疗结果,探讨放疗的作用和照射野的选择,并对生存预后因素进行分析.方法 回顾性分析381例T_3～T_4期和(或)腋窝淋巴结转移数≥4个的改良根治术后乳腺癌患者临床资料.用Kaplan-Meier法计算生存率,并Logrank法检验.单因素分析临床病理和治疗因素对生存率的影响,多因素分析用Cox回归模型.结果 中位随访时间为48个月.总5年无局部区域复发率为89.7%、总生存率为76.8%.放疗显著提高5年无局部区域复发生存率(93.4%:77.1%,χ~2=19.95,P=0.000)和总生存率(80.9%:62.3%,χ~2=15.47,P=0.001).胸壁和锁骨上区域照射能提高患者的5年无胸壁复发生存率(96.8%:86.2%;χ~2=12.66,P=0.001)和无锁骨上淋巴结复发生存率(97.7%:90.7%,χ~2=9.98,P=0.002),腋窝照射对5年无腋窝复发生存率无影响(98.4%:96.1%,χ~2=0.74,P=0.389).多因素分析显示未放疗(χ~2=14.42,P=0.000)、腋窝淋巴结阳性数≥10个(χ~2=21.60,P=0.000)和T_4期(χ~2=10.79,P=0.001)是总生存率的独立不良预后因素.结论 T_3～T_4期和(或)腋窝淋巴结转移数≥4个乳腺癌患者改良根治术后放疗显著降低局部复发率和提高总生存率,照射部位可选择同侧胸壁和锁骨上淋巴结引流区.     

Postmastectomy hypofractionation radiotherapy in high-risk breast cancer patients: A phase Ⅰ/Ⅱ clinical trial

目的 探讨乳腺癌改良根治术后大分割放疗的近期疗效和副反应.方法 38例高危乳腺癌患者改良根治术后化疗后,同侧胸壁和锁骨上下放疗43.5 Gy分15次3周完成,观察急性放疗反应发生率和肿瘤的局部区域控制率.结果 中位随访13个月,入组38例患者全部生存,无照射野内复发,远处转移率为13%(5例).5例患者出现3级放射性皮炎,均发生在放疗结束后2～3周.3例患者出现2级放射性肺炎.结论 乳腺癌改良根治术后43.5 Gy分15次3周完成的大分割放疗方案的急性副反应可以接受,近期疗效较好.     

中高危老年乳腺癌患者改良根治术后放疗的意义

目的 探讨中高危老年(≥65岁)乳腺癌患者改良根治术后放疗(PMRT)的意义.方法 收集874例改良根治术后中高危乳腺癌患者的临床资料,回顾性分析不同年龄组患者接受PMRT的情况和PMRT的作用,其中T3～T4和(或)N2～N3为高危组,T1～T2N1为中危组.结果 ≥65岁的患者108例,占12.4%.与＜65岁的患者相比,≥65岁的患者中,病理学分级为Ⅲ级、N3、高危和化疗患者所占的比例低,而合并其他疾病和有恶性肿瘤史者所占的比例高.≥65岁的患者中,中危组和高危组患者接受放疗的比例分别为15.3%和52.2%;＜65岁的患者中,中危组和高危组患者接受放疗的比例分别为18.1%和82.7%.≥65岁的患者中,中危组放疗和未放疗者的5年局部区域复发率分别为0和14.2%(P=0.242),5年总生存率分别为100%和75.2%(P=0.159);高危组放疗和未放疗者的5年局部区域复发率分别为0和14.1%(P=0.061),5年总生存率分别为84.6%和77.4%(P=0.597).＜65岁的患者中.中危组放疗和未放疗者的5年局部区域复发率分别为0和9.9%(P=0.035),5年总生存率分别为87.0%和82.1%(P=0.739);高危组放疗和未放疗者的5年局部区域复发率分别为7.2%和26.1%(P=0.000),5年总生存率分别为79.2%和57.7%(P=0.000).结论 不同年龄的中危组患者实施PMRT的比例相仿,但对于高危组患者,接受PMRT的比例随着患者年龄的增长而降低.高危老年乳腺癌患者实施PMRT可能可以降低局部区域复发率,应支持放疗.     

Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

外周T细胞淋巴瘤非特异型58例临床分析

目的对外周T细胞淋巴瘤非特异型的临床特征、治疗和预后进行分析,探讨其治疗策略及预后因素。方法回顾性分析1999年1月至2005年12月我院收治的58例外周T细胞淋巴瘤非特异型患者的临床特征、治疗方法和疗效与预后的关系。结果全组男性46例（79.3%）;中位年龄42岁;Ⅲ/Ⅳ期27例（46.6%）;IPI评分低危37例（63.8%）、低中危7例（12.1%）、高中危12例（20.7%）、高危2例（3.4%）;单纯化疗15例（25.9%）,化放疗联合治疗43例（74.1%）。化疗有效率76.5%,其中初始化疗CR率29.4%;加入放疗后CR率提高至47.1%。全组患者1,3,5年无病生存率和总生存率分别为41.4%、37.9%、22.4%和69.0%、46.6%、31.0%。多因素分析结果显示,近期疗效（P=0.000）和骨髓受侵（P=0.012）是本组病例的独立预后因素。结论化疗加放疗的综合治疗可提高CR率,改善远期生存。     

原发纵隔B细胞淋巴瘤疗效分析

目的 分析原发纵隔B细胞淋巴瘤的治疗疗效和失败原因.方法 搜集14年间收治的病理让实的原发纵隔B细胞淋巴瘤46例,其中Ⅰ期14例,Ⅱ期23例,Ⅲ期3例,ⅣA期6例.21例接受手术治疗,其中开胸探查术19例,纵隔镜活检术2例.37例Ⅰ+Ⅱ期中,8例接受单纯化疗,29例接受化疗+放疗,Ⅲ+Ⅳ期以化疗为主.放疗多采用纵隔加颈部照射野,中位剂量为45.00 Gy(16.95～61.00 Gy).化疗采用CHOP方案27例,三代化疗方案(MACOP-B,ProMACE/CytaBOM,m-BACOD,PmMACE-MOPP)9例,高剂量化疗加自体外周血干细胞移植(HDCT/APBSCT)10例.化疗+美罗华16例.化疗周期多为6～8个.结果 全组患者首程治疗后达完全缓解19例,部分缓解14例,病变进展11例,未评价2例.全组11例死于肿瘤.全组5年总生存率为35%.Ⅰ+Ⅱ期和Ⅲ+Ⅳ期2年总生存率分别为79%和51%,5年总生存率分别为63%和0(X2=4.35,P=0.037),2年无进展生存率分别为63%、11%(x2=17.77,P=0.000).治疗后达完全缓解者5年总生存率为80%,部分缓解者为50%,病变进展者为0(X2=19.58,P=0.003).19例治疗中病变进展或治疗后复发,腹腔淋巴结受侵和远处结外器官受侵最常见.结论 晚期患者生存率低,需要探讨更为有效的全身治疗方案,放疗可改善局部控制率.     

ER和PR及Her-2对改良根治术后腋窝淋巴结阳性乳腺癌放疗疗效的影响

目的 根据ER、PR和Her-2的免疫组化检查结果,把改良根治术后的高危乳腺癌患者分为不同亚组,了解放疗对不同亚组患者的作用.方法 回顾分析437例改良根治术后病理为浸润癌的乳腺癌患者资料,分期为T3-4N1或N2-3期,有ER、PR和Her-2的免疫组化检查结果.408例接受了化疗,352例接受了放疗.ER+或(和)PR+定义为受体阳性(Rec+),ER-和PR-定义和受体阴性(Rec-),Her-2++或+++定义为Her-2阳性(Her-2+).根据结果分为Rec-/Her-2-(69例)、Rec-/Her-2+(62例)、Rec+/Her-2+(89例)和Rec+/Her-2-(217例)组,分别分析4个组在放疗和未放疗下局部区域复发率(LRR)、远处转移率(DM)、无瘤生存率(DFS)和总生存率(OS)的差别.复发率和生存率计算用Kaplan-Meier法,差异检验用Logrank法.结果 中位随访48个月,除外5例放疗不详的患者,资料齐全可分析患者432例.放疗降低了4个组患者的5年LRR,Rec-/Her-2-、Rec-/Her-2+、Rec+/Her-2+和Rec+/Her-2-组放疗和未放疗的5年LRR分别为13.1%和33.3%、9.3%和21.2%、9.7%和47.0%、3.2%和15.4%;对Rec-/Her-2-、Rec-/Her-2+和Rec+/Her-2+患者,放疗降低了5年DM,放疗和未放疗患者的5年DM分别为26.7%和49.2%、27.6%和67.5%、18.4%和100%,并提高5年DFS和OS,三组患者放疗和未放疗的5年DFS分别为66.7%和33.3%、67.7%和33.3%、72.6%和0%,三组患者放疗和未放疗的5年OS分别为73.9%和25.2%、69.8%和41.5%、91.0%和32.8%.结论 不同ER、PR、Her-2状态的改良根治术后高危乳腺癌患者均能从术后放疗中获益.     

美国癌症研究联合会两版临床分期标准对局部晚期胃癌疗后预测价值比较

目的 比较美国癌症研究联合会第6、7版分期对局部晚期胃癌根治术后的预后预测。方法 对2002-2004年在本院接受胃癌根治性手术(R0切除且＞D1淋巴结清扫)、病理诊断为T3-4N0～1M0、TxN2-3 M0期的297例患者分别按两版分期标准进行分期,比较两版分期的N、TNM分期中5年总生存(OS)、无瘤生存(DFS...     

Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

颈段食管癌放疗患者复发模式及生存分析

目的 回顾分析初诊拟行根治性放疗颈段食管癌（CEC）患者的复发模式和生存结果。方法 检索2008年8月至2017年5月初诊拟行根治性放疗的CEC患者,整理相关资料,总结临床特征和复发模式,并行生存分析。结果 97例CEC患者符合条件,均为鳞癌。中位年龄59岁（18~78岁）。病变局限颈段34例,超出颈段63例。气管、甲状腺和主动脉受侵患者分别为69、7、6例。Ⅱ、Ⅲ和Ⅳ期（非区域淋巴结转移）患者分别为11、80、6例。中位大体肿瘤完成放疗剂量66 Gy,46例≥66 Gy,51例<66 Gy。中位随访时间14.90个月,中位无进展生存（PFS）和总生存（OS）时间分别为16.03和23.30个月。1、2、3年PFS分别为56.86%、30.35%和26.34%。1、2、3年OS分别为72.54%、47.94%和40.81%。61例随访中发现治疗失败,其中40、27和18例分别发生局部复发、区域复发和远处转移。单因素分析显示,甲状腺受侵患者与无甲状腺受侵患者比较,PFS和OS差异有统计学意义（χ²=5.773、13.461,P<0.05）;气管受侵患者与无气管受侵患者比较,OS差异有统计学意义（χ²=4.283,P<0.05）。多因素分析显示,主动脉受侵患者、甲状腺受侵患者与无主动脉受侵患者、无甲状腺受侵患者比较,PFS和OS差异有统计学意义（χ²=6.796、4.548、13.421、10.581,P<0.05）;大体肿瘤放疗剂量≥66 Gy与大体肿瘤放疗剂量<66 Gy比较,OS差异有统计学意义（χ²=5.296,P<0.05）。结论 根治性放疗颈段食管癌治疗失败以局部区域复发为主,甲状腺、气管和/或主动脉受侵是预后不良因素,大体肿瘤放疗剂量≥66 Gy可能利于提高OS,但需前瞻大样本数据进一步证实。