不同放化疗治疗模式对肺癌患者放射性肺炎发生的影响

目的 比较肺癌放疗患者不同放化疗治疗模式下2级以上放射性肺炎（RP）发生的差异,以及临床治疗特征对RP发生的影响。方法 回顾性分析自2014年1月至2016年1月在我院行放化疗综合治疗的肺癌患者136例,按期随访并复查肺功能、胸部CT,按RTOG急性放射肺炎评价标准对肺损伤分级进行评价,分析临床特征及治疗模式对RP发生的影响。结果 ≥2级RP 36例,发生率为26.5%。临床特征方面,粉尘接触史和病理类型与RP发生有一定相关性（P=0.048, 0.047）,其余指标方面差异均无统计学意义。治疗模式方面,序贯放化疗与同步放化疗比较,在总RP发生、2级和3级RP发生率方面差异均无统计学意义,而≥4级RP发生率两组比较差异有统计学意义（6.7% vs. 0, P=0.05）。不同化疗方案之间比较在≥2级RP发生方面差异无统计学意义。RP严重程度与总化疗周期数及诱导化疗周期数呈显著正相关（P=0.000）。结论 粉尘接触史和病理类型是临床特征方面增加RP发生的独立因素。不同治疗模式对RP的发生有一定的影响,其中与患者化疗周期数密切相关,特别是总化疗周期或诱导化疗周期。     

局限期SCLC超分割比常规分割放化疗疗效及安全性Meta分析

目的 系统评价放化疗治疗局限期SCLC时超分割与常规分割不同放疗模式有效性及安全性差异。方法 计算机检索Pubmed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、万方、中国知网和维普等数据库,查找超分割对比常规分割放化疗治疗局限期SCLC的临床对照研究文献。使用Revman 5.3统计软件对近期疗效、生存资料及不良反应进行Meta分析。结果 纳入8篇临床对照研究文献,共计1 361例患者。Meta分析结果显示,超分割组与常规分割组有着相似的客观缓解率(OR=1.31,95%CI为 0.64~2.69,P=0.46);两组间2、5年OS率相近(RR=1.10,95%CI为 0.98~1.24,P=0.12;RR=1.13,95%CI为 0.75~1.69,P=0.56);超分割组的≥2级放射性食管炎发生率较常规分割组高(RR=1.74,95%CI为 1.39~2.17,P<0.05),但两组间≥2级的放射性肺炎(RR=0.73,95%CI:0.24~2.24,P=0.58)、>3级血液学毒性(RR=1.18,95%CI为 0.99~1.39,P=0.06)发生率相近。结论 在局限期SCLC放化疗中两种放疗分割模式的近期疗效与生存获益相当,但超分割放疗的放射性食管炎发生率较高。超分割放疗并未带来较常规分割放疗更多的优越性。     

从平胃散干预前后水通道蛋白0(AQP0)的定性定量表达研究湿阻中焦证的水液代谢机制

目的观察并分析水通道蛋白0(AQP0)在大鼠消化段(胃贲门、胃体中部、大肠中段、大肠末段)的差异性表达,推测其与消化道生理功能的相关性及平胃散对消化道水液代谢的干预机制。方法通过对三大致湿因素的联合应用(外湿过盛,碍胃困脾;饮食不节,内生湿邪;情志不遂,水湿失布),建立湿困中焦的动物病理模型,采用免疫组织化学技术检测AQP0在消化段的分布及表达情况。结果 AQP0主要在消化道的黏膜层表达,黏膜下层、肌层和外膜处可有疑似表达。空白组与模型组相较而言:AQP0在胃贲门黏膜层表达有增加的趋势。自然恢复3 d后,相较于模型组:AQP0在胃贲门黏膜层,大、小肠中段表达有增加的趋势,胃体中间有降低的趋势。经平胃散干预3 d后,相较于模型组:AQP0在胃贲门和大肠中段黏膜层有增加的趋势,胃体中部和小肠中段黏膜的表达略有降低。且平胃散干预组与自然恢复组比较,AQP0在胃贲门、胃体中部、小肠中段黏膜层的表达有所降低。同时,空白给药组相较于空白组而言:AQP0在消化道各段黏膜层的分布有增加的趋势。结论①AQP0在消化道黏膜层表达,可能与水分吸收,腺体分泌的调控机制相关;②AQP0在胃和肠的表达有差异,内环境pH可能是影响因素之一;③平胃散能促进AQPO的表达,可以通过AQP0维持水液代谢的平衡,这可能是平胃散燥湿健脾、散满和胃在分子水平的机制之一。     

Hyperfractionated accelerated radiotherapy (HART) for inoperable, nonmetastatic non-small cell lung carcinoma of the lung (NSCLC): results of a phase II study for patients ineligible for combination radiochemotherapy

Purpose: To evaluate a hyperfractionated and accelerated radiotherapy (HART) protocol in patients with inoperable non-small cell lung carcinoma (NSCLC) who were ineligible for combination radiochemotherapy studies.

Methods and Materials: From February 1989 through August 1994, 23 patients ineligible for available combined modality protocols in our institution were enrolled and treated with HART, consisting of 63 Gy given in 42 fractions of 1.5 Gy each, twice daily, with a minimum time interval of 6 h between fractions, 5 days a week, over an elapsed time of 4.2 weeks, or 29 days. There was no planned interruption.

Results: The 1-, 2-, and 3-year survival rates were 61%, 39%, and 19%, respectively, with a median survival of 16.8 months. At the time of analysis, 4 patients are alive and 19 have died, 16 from NSCLC and 3 from cardiac disease. Overall response rate was 48%, with 22% of patients achieving a complete response and 26% a partial response. Correlation between acute response rate and survival was poor. First site of relapse was local-regional in 8 patients (35%), distant in 6 patients (26%), and local-regional and distant in 4 (17%) patients. One patient had Grade IV and 2 had Grade III esophagitis. One patient presented with chronic Grade III lung toxicity. There were no treatment-related deaths.

Conclusion: In this group of 23 patients ineligible for radiochemotherapy, this HART regime was quite feasible and was followed by little toxicity. Results in this particularly poor prognosis NSCLC patient category should be compared to series with a similar patient profile; however, median survival is at least similar to that obtained in recent series of combination radiochemotherapy.     

A population-based study of the use and outcome of radical radiotherapy for invasive bladder cancer

Purpose: The objective of this study is to describe the use and outcome of radical radiotherapy for bladder cancer in the province of Ontario, Canada, between 1982 and 1994.

Methods: Electronic records of invasive bladder cancer (ICD code 188) from the Ontario Cancer Registry were linked to surgical records from all Ontario hospitals and radiotherapy (RT) records from all Ontario cancer centers. We identified cases receiving radical RT by selecting RT records containing “bladder” or “pelvis” anatomic region codes and a radical or curative intent code (or dose > 39.5 Gy if intent missing). We identified cases receiving salvage total cystectomy by selecting total cystectomy procedure codes occurring at any time beyond 4 months from the start of radical RT. We used life table methods to compute the following: the time from diagnosis to radical RT, the time from radical RT to salvage cystectomy, overall and cause-specific survival from radical radiotherapy to death, and overall and cause-specific survival from salvage cystectomy to death. We modeled the factors associated with time to death, time to cystectomy conditional on survival, and time to cystectomy or death, whichever came first, using Cox proportional hazards regression.

Results: From the 20,906 new cases of bladder cancer diagnosed in Ontario from 1982 to 1994, we identified 1,372 cases treated by radical radiotherapy (78% male, 22% female; mean age 69.8 years). The median interval to start of radical RT from diagnosis was 13.4 weeks. Ninety-three percent of patients were treated on high-energy linacs, and the most common dose/fractionation scheme was 60 Gy/30 (31% of cases). Five-year survival rates were as follows: bladder cancer cause-specific, 41%; overall, 28%; cystectomy-free, 25%; bladder cancer cause-specific following salvage cystectomy, 36%; overall following salvage cystectomy, 28%. Factors associated with a higher risk of death and a poorer cystectomy-free survival were histology (squamous or nonpapillary transitional cell carcinoma [TCC]) and advanced age.

Conclusion: This population-based study confirms previous institutional studies and clinical trials and shows that radical RT has a curative role in the management of invasive bladder cancer and allows about one-quarter of patients receiving radiotherapy to survive 5 years while retaining the bladder. Salvage cystectomy following RT provides a chance of cure at the time of bladder relapse.     

Treatment of stages i and ii cancer of the cervix: Analysis of 5 year survival and recurrence rates

Eight hundred and thirty five patients with a diagnosis of Stages I or II carcinoma of the cervix were treated at Instituto Portugues de Oncologia de Francisco Gentil, in Lisbon, from 2 January 1965 to 30 June 1971. The purpose of this study was to calculate the 5 year survival rates and to analyze the treatment failures according to the modality of treatment applied. Two series of Stages Ib and IIa patients were available; one group was treated with radiotherapy, and the other with radical hysterectomy and pelvic lymphadenectomy after previous intracavitary radiumtherapy. No statistically significant difference was found in the 5 year survival of both groups. Most Stage IIb patients were treated with radiotherapy.When residual tumor was found in the uterus of patients who underwent radical surgery after intracavitary radiumtherapy it did not influence survival. On the other hand, the presence of metastatic pelvic lymph nodes after intracavitary radium treatment was related to a lowered survival rate. The number of severe injuries was higher in patients who were treated surgically. Recurrences developed within 5 years after completion of treatment in 10.8% of Stage Ib patients, 21.5% of Stage IIa patients, and 34.5% of Stage IIb patients. Ninety per cent of these recurrences appeared within 3 years after therapy.     

顺氯氨铂联合化疗加放疗治疗晚期非小细胞肺癌的疗效评价

目的　对晚期非小细胞肺癌应用顺氯氨铂联合化疗合并放疗的疗效进行评价。方法　顺氯氨铂联合化疗加放疗58例为实验组,单纯放疗29例为对照组,观察并比较其疗效。结果　实验组CR、CR+PR和PD分别为55.2%(32/58)、65.5%(38/58)和8.6%(5/58),对照组分别为24.1%(7/29)、31.0%(9/29)和44.8%(13/29),两组比较均有非常显著差异(P<0.01)。实验组1、2和3年生存率均显著优于对照组(P<0.01)。结论　顺氯氨铂联合化疗加放疗有助于提高晚期非小细胞肺癌的疗效和生存率,值得在临床上推广。     

~(153)Sm-EDTMP治疗骨转移癌的临床观察

目的　评价１５３Ｓｍ － 乙二胺四亚甲基膦酸（ＥＤＴＭＰ） 治疗骨转移癌的临床价值。方法　４５ 例临床上确诊为恶性肿瘤伴多发性骨转移患者,其中男１６ 例,女２９ 例,年龄３１ ～７６ 岁,均有显著骨痛。采用两次给药法静脉注射１５３Ｓｍ － ＥＤＴＭＰ。结果　治疗后骨痛完全缓解者２０ 例（４４．４ ％ ） ,骨痛部分缓解者２２ 例（４８．９ ％ ） ,无效者３ 例（６．７ ％ ）,止痛总有效率为９３．３％ 。转移灶缩小或消失总有效率为２６．７ ％ 。结论　１５３Ｓｍ － ＥＤＴＭＰ治疗骨转移癌有一定的临床价值。     

顺铂为主联合化疗加放疗治疗超长食管癌

目的探讨顺铂为主联合化疗加放疗对病变长度大于８ｃｍ食管癌的疗效。方法１９８８年１月至１９９１年１２月对病变长度大于８ｃｍ,不宜行手术治疗的食管癌病人随机分为二组（各６０例）治疗,一组采用顺铂、平阳霉素、长春新碱联合化疗后根治性放疗（化放组）,一组仅行单纯放射治疗（单放组）,进行对比分析。结果化放组与单放组１,３,５年生存率分别为６１．７％、３０．０％、２０．０％与３６．７％、１０．０％、５．０％,比较均有显著性差异。结论顺铂为主联合化疗后放疗综合治疗是治疗超长食管癌的有效方法。