bcl-2反义寡核苷酸对小细胞肺癌细胞NCI-H69放射敏感性的影响

目的 研究bcl-2反义寡核苷酸对人小细胞肺癌细胞NCI-H69放射敏感性的影响.方法 将NCI-H69细胞培养传代,然后将细胞分为反义寡核苷酸组、正义寡核苷酸组、无义寡核苷酸组和空白对照组,通过脂质体将不同寡核苷酸导入细胞中,用Western-Blot法检测Bcl-2蛋白的表达. 采用直线加速器分别以不同剂量(0、2、4、6、8、10 Gy)X线照射4组细胞.收集照射后的细胞,流式细胞仪检测细胞凋亡率,MTT法测定细胞存活分数.结果 Western-Blot杂交显示反义寡核苷酸组无Bcl-2蛋白表达,相对正义寡核苷酸组、无义寡核苷酸组及空白对照组Bcl-2蛋白表达明显受到抑制(F=7.24～15.31,q=5.03～7.80,P＜0.01).细胞经X线照射后,反义寡核苷酸组细胞凋亡率明显高于空白对照组,差异具有显著性(F=7.24～15.31,q=5.03～7.80,P＜0.01);正义寡核苷酸组和无义寡核苷酸组与空白对照组相比无统计学差异.4组细胞接受辐射后,反义寡核苷酸组在未照射和照射不同剂量后的存活分数均低于空白对照组,差异有统计学意义(F=11.04～45.56,q=5.10～14.75,P＜0.01),而正义寡核苷酸和无义寡核苷酸组与空白对照组比较则无统计学差异.结论 bcl-2反义寡核苷酸能有效封闭bcl-2基因的表达,增强小细胞肺癌细胞NCI-H69对X线的敏感性.     

乳腺癌术后放疗放射性肺损伤的CT诊断

目的:探讨乳腺癌术后放疗放射性肺损伤的CT表现及诊断价值。方法:分析36例乳腺癌术后放疗发生放射性肺损伤患者的CT表现。结果:36例中急性放射性肺炎8例,表现为照射野范围内斑片状、片状密度增高灶或毛玻璃样改变;中间期15例,表现介于急性期与纤维化期之间,可同时见毛玻璃样改变、斑片状实变灶及纤维条索灶;纤维化期13例,表现为照射野范围内的纤维条索灶。结论:CT检查能清晰显示乳腺癌放疗后放射性肺损伤不同时期的特征表现,具有较高的临床价值。     

鼻咽癌放疗效果与p53基因多态关系的临床研究

目的 探讨p53基因的单核苷酸多态与鼻咽癌(NPC)放疗为主的治疗效果的关系.方法 应用PCRRFLP(聚合酶链反应-限制性片断长度多态性)分析方法,对74例以放疗为主治疗的NPC患者,进行p53第72密码子Arg-Pro多态检测,治疗结束后进行效果评价.以非条件Logistic回归模型比较不同基因型与治疗效果的关系.结果 携带Arg/72Pro基因型患者的疗效是携带72Arg/Arg与Pro/Pro基因型患者的2.49倍(95%CI=0.913～6.810,P=0.075);Ⅰ Ⅱ期患者的疗效是Ⅲ Ⅳ期的3.32倍(95%CI=1.028～10.720,P=0.045);男性患者的疗效是女性的2.39倍(95%CI=0.862～6.670,P=0.094);年龄不是影响敏感性的因素(P=0.194);治疗方式的不同,对疗效未见显著影响.结论 与其他两种基因型的携带者相比,携带p53第72密码子Arg/Pro基因型鼻咽癌患者的疗效有可能提高.     

鼻咽癌350例常规放疗的摆位技术分析

目的:分析鼻咽癌常规放射治疗摆位误差的原因,寻求解决摆位误差的方法。方法:摆完治疗体位放射治疗前,测量治疗室激光定位线与定位时激光线标记的吻合度。结果:在1 750人次的测量中,95%能达到治疗体位的标准,还有5%需要修正,方可进行治疗。结论:为了确保常规放疗的质量保证,定期做好各项设施的调整与校正是很必要的;放疗师的培训也是不可忽视的一项工作。     

肿瘤患者放化疗后真菌感染及耐药分析

目的了解肿瘤患者放化疗后真菌感染情况及对常用抗真菌药物的耐药情况。方法对我院送检的痰液、胸腹水、尿液、粪便、血液等522例患者真菌培养及药敏试验结果进行分析。结果522例患者共检出真菌71株，阳性率为13.6%（11.2%-16.0%），其中以白色念珠菌最为常见，占66.2%。药敏结果表明，本组真菌对所试药物伊曲康唑（ITO）、两性霉素B（AMB）、制霉菌素（NYS）、益康啶（ECO）、酮康啶（KET）、咪康唑（MIC）均有不同程度的耐药，尤其是ECO和KET，耐药率高达21.1%和25.4%，NYS和MIC的耐药率也在10%以上。结论掌握肿瘤患者治疗过程中引起真菌感染的病原菌及耐药情况，可指导临床合理用药。     

局部中晚期宫颈癌同步放化疗临床疗效及预后影响因素分析

目的　探讨局部中晚期宫颈癌单纯放疗与同步放化疗（CCRT）的临床疗效,分析预后的影响因素。方法　选取2008年9月—2013年12月中南大学湘雅二医院肿瘤中心收治的经病理确诊,并接受放化疗的125例局部中晚期宫颈癌患者。根据不同治疗方式分为单纯放疗27例（21.6%）（放疗组）,CCRT 98例（78.4%）（CCRT组）。随访截至2016-03-01,记录其总生存时间。Kaplan-Meier法绘制生存曲线,采用Log-rank进行检验;预后影响因素分析采用多元Cox比例风险回归模型。结果　125例患者1、3、5年生存率分别为89.6%、74.4%、71.2%。放疗组与CCRT组患者1、3、5年生存率比较,差异有统计学意义（P<0.05）。放疗组与CCRT组患者骨髓抑制、胃肠道反应、直肠反应、泌尿生殖道反应、阴道炎症、盆腔积液、放射性肠炎、放射性膀胱炎、下肢静脉栓塞发生率比较,差异无统计学意义（P>0.05）。Log-rank检验显示,国际妇产科联盟（FIGO）临床分期、治疗前血红蛋白水平、完成放疗总时间、不同治疗方案的局部中晚期宫颈癌患者总生存时间比较,差异均有统计学意义（P<0.05）。多元Cox比例风险回归分析结果显示,FIGO临床分期〔HR=0.329,95%CI（0.106,0.770）〕、治疗前血红蛋白水平〔HR=0.937,95%CI（0.925,0.984）〕、完成放疗总时间〔HR=1.081,95%CI（1.022,1.095）〕、治疗方案〔HR=0.203,95%CI（0.072,0.574）〕与局部中晚期宫颈癌患者总生存时间有回归关系（P<0.05）。结论　局部中晚期宫颈癌CCRT临床疗效比单纯放疗有明显的优势。FIGO临床分期、治疗前血红蛋白水平、完成放疗总时间、治疗方案是局部中晚期宫颈癌患者预后的影响因素。     

Risk communication in a patient decision aid for radiotherapy in breast cancer: How to deal with uncertainty?

Background and aimPatient decision aids for oncological treatment options, provide information on the effect on recurrence rates and/or survival benefit, and on side-effects and/or burden of different treatment options. However, often uncertainty exists around the probability estimates for recurrence/survival and side-effects which is too relevant to be ignored. Evidence is lacking on the best way to communicate these uncertainties. The aim of this study is to develop a method to incorporate uncertainties in a patient decision aid for breast cancer patients to support their decision on radiotherapy.MethodsFirstly, qualitative interviews were held with patients and health care professionals. Secondly, in the development phase, thinking aloud sessions were organized with four patients and 12 health care professionals, individual and group-wise.ResultsConsensus was reached on a pictograph illustrating the whole range of uncertainty for local recurrence risks, in combination with textual explanation that a more exact personalized risk would be given by their own physician. The pictograph consisted of 100 female icons in a 10 x 10 array. Icons with a stepwise gradient color indicated the uncertainty margin. The prevalence and severity of possible side-effects were explained using verbal labels.ConclusionsWe developed a novel way of visualizing uncertainties in recurrence rates in a patient decision aid. The effect of this way of communicating risk uncertainty is currently being tested in the BRASA study (NCT03375801).     

Local Failure and Survival After Definitive Radiotherapy for Aggressive Prostate Cancer: An Individual Patient-level Meta-analysis of Six Randomized Trials

BackgroundThe importance of local failure (LF) after treatment of high-grade prostate cancer (PCa) with definitive radiotherapy (RT) remains unknown.ObjectiveTo evaluate the clinical implications of LF after definitive RT.Design, setting, and participantsIndividual patient data meta-analysis of 992 patients (593 Gleason grade group [GG] 4 and 399 GG 5) enrolled in six randomized clinical trials.Outcome measurements and statistical analysisMultivariable Cox proportional hazard models were developed to evaluate the relationship between overall survival (OS), PCa-specific survival (PCSS), and distant metastasis (DM)-free survival (DMFS) and LF as a time-dependent covariate. Markov proportional hazard models were developed to evaluate the impact of specific transitions between disease states on these endpoints.Results and limitationsMedian follow-up was 6.4 yr overall and 7.2 yr for surviving patients. LF was significantly associated with OS (hazard ratio [HR] 1.70 [95% confidence interval {CI} 1.37–2.10]), PCSS (3.10 [95% CI 2.33–4.12]), and DMFS (HR 1.92 [95% CI 1.54–2.39]), p < 0.001 for all). Patients who had not transitioned to the LF state had a significantly lower hazard of transitioning to a PCa-specific death state than those who transitioned to the LF state (HR 0.13 [95% CI 0.04–0.41], p < 0.001). Additionally, patients who transitioned to the LF state had a greater hazard of DM or death (HR 2.46 [95% CI 1.22–4.93], p = 0.01) than those who did not.ConclusionsLF is an independent prognosticator of OS, PCSS, and DMFS in high-grade localized PCa and a subset of DM events that are anteceded by LF events. LF events warrant consideration for intervention, potentially suggesting a rationale for upfront treatment intensification. However, whether these findings apply to all men or just those without significant comorbidity remains to be determined.Patient summaryMen who experience a local recurrence of high-grade prostate cancer after receiving upfront radiation therapy are at significantly increased risks of developing metastases and dying of prostate cancer.     

Ten-year Mortality,Disease Progression,and Treatment-related Side Effects in Men with Localised Prostate Cancer from the ProtecT Randomised Controlled Trial According to Treatment Received

BackgroundThe ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer (PCa) randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy.ObjectiveTo determine report outcomes according to treatment received in men in randomised and treatment choice cohorts.Design, setting, and participantsThis study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy.InterventionTwo cohorts included 1643 men who agreed to be randomised; 997 declined randomisation and chose treatment.Outcome measurements and statistical analysisHealth-related quality of life impacts on urinary, bowel, and sexual function were assessed using patient-reported outcome measures. Analysis was carried out based on treatment received for each cohort and on pooled estimates using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores.Results and limitationsAccording to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and outdating of the interventions being evaluated during the lengthy follow-up required in trials of screen-detected PCa.ConclusionsAnalyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group.Patient summaryMore than 90 out of every 100 men with localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are much better after active monitoring, but the risks of spreading of prostate cancer are more common.