Cytotoxic and anti-proliferative effects of high-energy pulsed ultrasound (HEPUS) on human squamous cell carcinoma cells as compared to connective tissue fibroblasts

The cytotoxic and anti-proliferative effects of high-energy pulsed ultrasound (HEPUS) on human squamous cell carcinoma cells cloned from the hypopharynx (FaDu) and benign connective tissue cells (fibroblasts) were investigated in vitro. Sonication was carried out using an experimental piezoelectric, self-focusing burst-signal transducer. To increase the induction of cavitation, the transducer used was specifically designed to produce multiple oscillations with a high negative pressure amplitude. In both cell lines tested, the application of 100, 800 and 2000 pulses resulted in a high reduction of vital cells. After 2000 pulses, 4.0 ± 1.1% of the fibroblasts but only 2.0 ± 0.4% of the FaDu cells survived HEPUS exposure. A postexposure inhibiting effect of HEPUS for 10 days on the proliferation of surviving cells was noted for the FaDu cells exposed to 2000 pulses, but not as much for the fibroblasts. These findings support the hypothesis that human squamous cell carcinoma cells of the hypopharynx might be more sensitive to HEPUS than fibroblasts and that total tumor cell ablation might be possible in vitro given a sufficient number of HEPUS pulses. Received: 18 November 1997 / Accepted: 21 April 1998     

The therapeutic effect of intratumoral injection of GM-CSF gene-modified allogenic macrophages on tumor-bearing mice

Both the antigen presenting ability and the cytotoxicity of macrophages can be enhanced by GM-CSF gene transfer. In the present study, the therapeutic effect of intratumoral injection with GM-CSF gene-modified allogenic macrophages on tumor-bearing mice observed. The peritoneal macrophages of C57BL/6 mice were transfected with GM-CSF gene mediated by recombinant adenovirus and the subcutaneous CT26 colon adeno-carcinoma-bearing BALB/c mice were treated by intratumoral injection of the above macrophages. The survival time of the tumor-bearing mice were prolonged significantly and some tumor mass disappeared completely. The necroses of the tumor cells and massive infiltration of inflammatory cells were observed 6 days after treatment 30 days after treatment, only the leftover of tumor cells and the inflammatory cells remained. The data indicated that introtumoral injection of GM-CSF gene-modified allogenic macrophages displayed more potent therapeutic effect on the preestablished tumor-bearing mice. Supported by National High Biotechnology Foundation (Z20-01-03). This is one of papers of the special issue on gene therapy research (Chin J Cancer Res Vol. 9 No. 4 December, 1997).     

放、化疗同步与非同步治疗Ⅲ期非小细胞肺癌的对比观察

目的:为比较放、化疗同步治疗与非同步治疗肺癌的临床效果.方法:选择不手术的Ⅲ期非小细胞肺癌(NSCLC)患者81例,随机分为同步治疗组(42例)和非同步组(39例).结果:治疗总有效率同步组66.7%,非同步组61.5%,前者略高于后者,两者比较无显著差异(P>0.05),但达到上述有效率所用的时间前者平均69天,后者为143天,两者比较有非常显著差异(P<0.01).结论:同步组的近期疗效似优于非同步组,且前者治疗周期、住院周期缩短,更有利于患者康复.     

胞嘧啶脱氨酸基因治疗人胰腺癌的实验研究

探讨腺病毒介导的大肠杆菌胞嘧啶脱氨酶基因用于人胰腺癌基因疗法的可行性。方法将含癌胚抗原启动子的重组腺病毒感染人胰腺癌ＳＷ１９９０细胞和Ｃａｐａｎ－２细胞以及人宫颈癌Ｈｅｌａ细胞,用逆转录聚合酶链反应（ＲＴ－ＰＣＲ）和Ｗｅｓｔｅｒｎｂｌｏｔ检测ＣＤ基因在细胞中的表达,以ＭＴＴ法比较细胞对５－氟胞嘧（５－ＦＣ）的敏感性差异。建立胰腺癌裸鼠皮下移植瘤模型,观察ＣＤ基因的原位治疗效应及安全性。结果腺病毒介     

61例喉癌单纯放射治疗临床分析

目的喉癌单纯放疗效果分析。方法６１例喉癌，以６０Ｃｏ外放射治疗，常规照射。结果五年生存率，声门癌６５％，声门上型癌２４．４％。结论推荐剂量，声门癌Ｔ１Ｔ２６０００ｃＧｙ，Ｔ３６８００ｃＧｙ。声门上型癌Ｔ１Ｔ２６０００～６５００ｃＧｙ，Ｔ３７０００ｃＧｙ。     

原发性肺恶性淋巴瘤的治疗(附10例报告)

目的回顾性分析原发性肺恶性淋巴瘤的治疗效果及其病理学特点与临床的关系。材料与方法上海医科大学肿瘤医院１９７０年～１９９０年收治的１０例原发性肺恶性淋巴瘤。全部病例均经手术切除后病理证实。除１例外，均作术后放疗和化疗。放疗范围包括肿瘤床、纵隔和同侧肺门，剂量２０～４５Ｇｙ。化疗方案均为ＣＯＰ（环磷酰胺、长春新碱、强的松）。结果１例生存１年，３例生存３年，６例生存超过５年。中位生存３年，５年生存率６０％。结论对中度恶性肺淋巴瘤不必作全肺切除，但术后须用放疗和化疗。     

淋巴母细胞淋巴瘤45例临床疗效分析

目的为探讨淋巴母细胞淋巴瘤的合理治疗方法。材料与方法１９８３年１０月至１９９３年１０月间采用以化疗为主加或不加放疗治疗４５例淋巴母细胞淋巴瘤并总结和分析其临床疗效。结果全组治疗的近期疗效有效率为６１．４％，其中完全缓解（ＣＲ）率为３６．４％。随访３～１０年，３７例死亡，８例仍生存。疗后全组１，３，５，７，１０年生存率分别为４０．０％，２６．７％，１９．４％，１９．４％和０％。化疗和放疗综合治疗组的疗后３，５，１０年生存率分别为３１．５％，２６．１％和１９．４％，优于单化疗组，分别为１９．８％，１２．１％和７．８％（Ｐ＜０．００１）。通过对疗后生存率与近期疗效、临床分期、化疗有效病例是否足量化疗及治疗的不同年代间关系的分析显示，近期疗效达ＣＲ者优于部分缓解（ＰＲ）、稳定（Ｓ）和进展（Ｐ）；早期病变局限（Ⅰ，Ⅱ期）优于晚期（Ⅲ，Ⅳ期）病例；加放疗者优于单纯化疗者；有效病例足量化疗者优于不足量化疗者；近年（１９８８年至１９９３）治疗病例的效果优于早年（１９８３年至１９８７年）所治病例的效果。结论以足量化疗为主，辅以放疗的综合治疗，争取首程治疗达到肿瘤完全缓解是提高淋巴母细胞淋巴瘤疗后生存率的重要途径之一     

低剂量粒—巨噬细胞集落刺激因子在肺癌化疗中的应用

３１例肺癌患者大剂量化疗４０例次，采用配对法分成加用低剂量粒－巨噬细胞集落刺激因子（ＧＭ－ＣＳＦ）的治疗组及不加用的对照组（二组均为２０例次）。结果表明，低剂量ＧＭ－ＣＳＦ明显缩短化疗所致白细胞低下的时间：治疗组为１４．５±９．４９天，对照组为１９．４±８．８５天（Ｐ＝０．０２），同时提高白细胞下降最低值：治疗组为３．３５×１０９／Ｌ±１．３７×１０９／Ｌ，对照组为２．９×１０９／Ｌ±１．１８×１０９／Ｌ。低剂量ＧＭ－ＣＳＦ的主要不良反应为发热（８０％）及肌痛、骨痛（１０％）。结果提示：低剂量ＧＭ－ＣＳＦ能支持癌症患者的大剂量化疗及连续化疗     

Daily CT localization for correcting portal errors in the treatment of prostate cancer

Introduction: Improved prostate localization techniques should allow the reduction of margins around the target to facilitate dose escalation in high-risk patients while minimizing the risk of normal tissue morbidity. A daily CT simulation technique is presented to assess setup variations in portal placement and organ motion for the treatment of localized prostate cancer.

Methods and Materials: Six patients who consented to this study underwent supine position CT simulation with an alpha cradle cast, intravenous contrast, and urethrogram. Patients received 46 Gy to the initial Planning Treatment Volume (PTV₁) in a four-field conformal technique that included the prostate, seminal vesicles, and lymph nodes as the Gross Tumor Volume (GTV₁). The prostate or prostate and seminal vesicles (GTV₂) then received 56 Gy to PTV₂. All doses were delivered in 2-Gy fractions.

After 5 weeks of treatment (50 Gy), a second CT simulation was performed. The alpha cradle was secured to a specially designed rigid sliding board. The prostate was contoured and a new isocenter was generated with appropriate surface markers. Prostate-only treatment portals for the final conedown (GTV₃) were created with a 0.25-cm margin from the GTV to PTV. On each subsequent treatment day, the patient was placed in his cast on the sliding board for a repeat CT simulation. The daily isocenter was recalculated in the anterior/posterior (A/P) and lateral dimension and compared to the 50-Gy CT simulation isocenter. Couch and surface marker shifts were calculated to produce portal alignment. To maintain proper positioning, the patients were transferred to a stretcher while on the sliding board in the cast and transported to the treatment room where they were then transferred to the treatment couch. The patients were then treated to the corrected isocenter. Portal films and electronic portal images were obtained for each field.

Results: Utilizing CT–CT image registration (fusion) of the daily and 50-Gy baseline CT scans, the isocenter changes were quantified to reflect the contribution of positional (surface marker shifts) error and absolute prostate motion relative to the bony pelvis. The maximum daily A/P shift was 7.3 mm. Motion was less than 5 mm in the remaining patients and the overall mean magnitude change was 2.9 mm. The overall variability was quantified by a pooled standard deviation of 1.7 mm. The maximum lateral shifts were less than 3 mm for all patients. With careful attention to patient positioning, maximal portal placement error was reduced to 3 mm.

Conclusion: In our experience, prostate motion after 50 Gy was significantly less than previously reported. This may reflect early physiologic changes due to radiation, which restrict prostate motion. This observation is being tested in a separate study. Intrapatient and overall population variance was minimal. With daily isocenter correction of setup and organ motion errors by CT imaging, PTV margins can be significantly reduced or eliminated. We believe this will facilitate further dose escalation in high-risk patients with minimal risk of increased morbidity. This technique may also be beneficial in low-risk patients by sparing more normal surrounding tissue.     

Radiation therapy in the management of desmoid tumors

Purpose: To evaluate the outcome of patients with extra-mesenteric desmoid tumors treated with radiation therapy, with or without surgery.

Methods and Materials: The outcome for 75 patients receiving radiation for desmoid tumor with or without complete gross resection between 1965 and 1994 was retrospectively reviewed utilizing univariate and multivariate statistical methods.

Results: With a median follow-up of 7.5 years, the overall freedom from relapse was 78% and 75% at 5 and 10 years, respectively. Of the total, 23 patients received radiation for gross disease because it was not resectable. Of these 23 patients, 7 sustained local recurrence, yielding a 31% actuarial relapse rate at 5 years. Radiation dose was the only significant determinant of disease control in this group. A dose of 50 Gy was associated with a 60% relapse rate, whereas higher doses yielded a 23% relapse rate (p < 0.05). The other 52 patients received radiation in conjunction with gross total resection of tumor. The 5- and 10-year relapse rates were 18% and 23%, respectively. No factor correlated significantly with disease outcome. There was no evidence that radiation doses exceeding 50 Gy improved outcome. Positive resection margins were not significantly deleterious in this group of irradiated patients. For all 75 patients, there was no evidence that radiation margins exceeding 5 cm beyond the tumor or surgical field improved local-regional control. Ultimately, 72 of the 75 patients were rendered disease-free, but 3 required extensive surgery (amputation, hemipelvectomy) to achieve this status. Significant radiation complications were seen in 13 patients. Radiation dose correlated with the incidence of complications. Doses of 56 Gy or less produced a 5% 15-year complication rate, compared to a 30% incidence with higher doses (p < 0.05).

Conclusions: Radiation is an effective modality for desmoid tumors, either alone or as an adjuvant to resection. For patients with negative resection margins, postoperative radiation is not recommended. Patients with positive margins should almost always receive 50 Gy of postoperative radiation. Unresectable tumors should be irradiated to a dose of approximately 56 Gy, with a 75% expectation of local control.