支气管动脉灌注化疗联合直线加速器放射治疗Ⅲa期非小细胞肺癌

目的　研究支气管动脉灌注化疗联合直线加速器放射治疗Ⅲa期非小细胞肺癌 (NSCLC)的可行性及临床价值。方法　 76例NSCLC患者随机分成A、B 2组 ,A组先行 2次支气管动脉灌注化疗 (BAI) ,第 2次BAI 1～ 2周后再行直线加速器放射治疗 (RT) ;B组单纯行 2次BAI (对照组 )。结果　临床疗效 ,A组 (BAI RT)和B组 (BAI)分别为 89.47%和 60 .5 3% (Ρ <0 .0 1) ;1、3年生存率 ,A、B组分别为 81.5 8%、5 0 .0 0 %和 60 .5 3%、2 1.0 5 % ( 0 .0 1<Ρ <0 .0 5 )。结论　支气管动脉灌注化疗联合直线加速器放射治疗Ⅲa期非小细胞肺癌的临床疗效和患者 1、3年生存率均显著提高     

结直肠癌中雄激素受体及其与临床病理学特征关系的研究

应用放射性配基结合分析法，检测了４０例结直肠癌及部分癌旁正常粘膜组织中的雄激素受体（ＡｎｄｒｏｇｅｎＲｅｃｅｐｔｏｒ，ＡＲ），同时分析了ＡＲ水平与临床病理学变化的关系。证实结直肠癌ＡＲ数目（３３．７±２３．３ｆｍｏｌ／ｍｇ蛋白）明显低于癌旁５ｃｍ以外粘膜（５３．９±３２．４ｆｍｏｌ／ｍｇ蛋白），Ｐ＜０．０１，而其亲和力则无变化；结直肠癌时ＡＲ数目变化与女性、直肠癌、高分化癌及早期癌关系密切。提示ＡＲ与结直肠癌关系密切，本实验为临床上结直肠癌的诊断及内分泌治疗提供了初步资料。     

癌胚抗原及粘液组织化学在胃癌中表达的研究

对60例胃癌进行了粘液组织化学和癌胚抗原免疫组织化学研究。结果表明:胃癌发病率肠型和胃肠混合型占多数。60例胃癌中含大肠型粘液者占50例,而单纯含胃型粘液为极少数。癌胚抗原分布方式,肠型胃癌与胃肠混合型胃癌比较无显著差异性(P>0.05)。癌胚抗原的阳性率,胃肠混合型胃癌高于肠型胃癌,两者之间有非常显著差别(P<0.01)。认为选用能显示硫粘蛋白和氧乙酰基唾液酸粘蛋白的粘液组织化学方法,作为胃癌组织分型和确定胃粘膜肠化性质,对癌前病变诊断有一定价值。     

乳腺囊性增生病癌变过程中部分因素变化的意义

检测乳腺囊性增生病（ＦＣＤ）经不典型增生到癌变部分因素的变化。结果提示：从因明显ＦＣＤ症状活检至癌变为２～１０年；从Ⅱ级以上不典型增生到临床癌变需２～７年；癌变率为３．１％。ＦＣＤ患者存在性激素分泌调控失常，血浆雌激素和催乳素含量增加，导致上皮细胞增生。乳腺一般性增生细胞的ＤＮＡ含量和超微结构与正常乳腺上皮细胞相似；无肿瘤相关抗原及异常基因产物表达。而发生在一般性增生基础上的不典型增生则呈现细胞基因物质ＤＮＡ含量增加，部分为超４Ｃ的多倍体细胞；同时出现细胞膜和细胞核超微结构异常；雌激素受体含量增加，对性激素的依赖性和敏感性增强；部分不典型增生细胞出现胚胎性肿瘤相关抗原和异常基因产物表达。随不典型增生程度加重至乳腺癌，上述诸因素的变化趋势具有明显规律性。提示ＦＣＤ上皮细胞从一般性增生经不典型增生至乳腺癌为细胞生物学连续逐渐变化的过程。部分不典型增生细胞中具有癌倾向的细胞生物学行为异常和表型变化与乳腺癌发生密切相关。细胞核ＤＮＡ含量等异常变化及程度可作为乳腺癌前病变发展程度的客观标志     

超声引导下肿瘤内注射^90钇玻璃微球的肝癌综合治疗

超声引导下对２８例肝癌病人进行了肿瘤内注射＾９０钇玻璃微球（Ｙ－９０ＧＴ ＭＳ）为主的综合性治疗（部分病人配合肿块周边注射无水酒精及门静脉穿刺化疗）。随访２～１６个月（平均７．９个月），病人全健在。肿瘤缩小率为９１％，其中显著缩小达７５％；肿块回声呈致密增强，少数呈混合型或等回声型；肿瘤内及周边血流信号显著减少；原甲胎蛋白升高者１３例，１１例显著下降，其中６例降至正常；病人症状减轻，全身情况改善。     

Exogastric neurilemmoma presenting as acute abdomen: Role of computed tomography in diagnosis

A case of subserosal gastric neurilemmoma is hereby presented. This reported case is unique in its clinical presentation including the appearance of acute abdomen and fever subsequent to unremarkable and uneventful upper gastrointestinal endoscopy. The tendency of neurilemmoma to cause mucosal ulceration with fistula formation probably led to this clinical presentation. The role of computed tomography in establishing diagnosis of exogastric tumor is emphasized.     

RESULTS OF EXTERNAL BEAM RADIOTHERAPY IN 448 PATIENTS WITH CLINICALLY LOCALIZED ADENOCARCINOMA OF THE PROSTATE

The results of external beam radiotherapy for clinically localized adenocarcinorna of the prostate in 448 patients treated in the period 1980–90 were reviewed. The average follow up was 4.9 years. The patients were aged 44–87 years (median 69 years) and all had histopathological evidence of adenocarcinoma by needle biopsy or transurethral resection of prostate. The histopathological grading was: 127 G₁; 154 G₂; 127 G₃; 12 G₄; 28 G_x. Clinical staging according to TNM (American Urological Association) was: 29 T₀ (A2); 4 T₁ (B1); 173 T₂ (B2); 176 T₃ (C1); 63 T₄ (C2); 3 T_x. Routine surgical pelvic lymph node staging was not performed but patients had radiological (computerized tomography scan or lymphogram) nodal staging: 350 N₀; 22 N₁; 12 N₂; 64 N_x. High energy linear accelerator external beam radiotherapy was given by multiple fields to total doses of 50–70 Gy (median 60 Gy). The majority of patients (307, 69%) was treated by a uniform policy under the care of one radiation oncologist (HM). The rates of local and distant failure at 5 years were 10% (s.e. = 2%) and 42% (s.e. = 3%), respectively. The late complication rate at 5 years was 25% (s.e. = 2%), comprising mild 16%, moderate 7% and severe 1.3%. The 5 year overall survival rate was 64% (s.e. = 2%) and the cancer-specific survival rate was 74% (s.e. = 3%). Both histological grade and clinical stage were strongly predictive of overall survival and distant failure. Only histological grade was predictive of local failure. Treatment with external beam radiotherapy for this common cancer resulted in survival and disease control rates that compare favourably with other published radiotherapy series and has been accompanied by acceptably low morbidity.     

Late side-effects with cosmetic relevance following soft X-ray therapy of cutaneous neoplasias

Background Cosmetic changes are to be expected after radiotherapy for skin tumours. Objectives This study aimed to answer the questions: How frequent are cosmetic changes after soft X‐ray therapy? Do treatment parameters, tumour thickness, localization and size of the irradiated field have a major influence? Were patients irritated by the visual appearance of the irradiated field? Methods In total, 2474 examinations of 1149 irradiated fields were performed. Results Hypopigmentation was found in 64.7% of examinations more than 90 days after therapy, teleangiectases in 43.1%, erythema in 24.8%, and hyperpigmentation in 16.8%. The frequency of hypopigmentation, teleangiectases and hyperpigmentation increased with time from X‐ray exposure; more than 4 years after therapy hypopigmentation was diagnosed in 91.8% and teleangiectases in 82.2% of examinations. Total dose, the time–dose–fractionation factor (TDF), field size and dose per fraction were significantly related to the frequency of cosmetic changes. Incidence rates of cosmetic changes differed by less than 15% if different treatment conditions were compared: thicker vs. thinner tumours, larger vs. smaller fields, higher vs. lower total doses, doses per fraction, and TDF. Frequencies of hypopigmentation, teleangiectases, erythema and hyperpigmentation differed by more than 15% between some localizations on the head. Women reported irritation by the visual appearance of the irradiated field in 12.6% of 1116 interviews, and men in 4.4% of 1284 interviews. Conclusions Cosmetic changes after soft X‐ray therapy are relatively frequent. Treatment parameters, tumour thickness and field size have only a minor influence. Few patients, but more women than men, were irritated by the visual appearance of the irradiated field.     

Quality of life and voice following endoscopic resection or radiotherapy for early glottic cancer

Objectives: To assess whether proposed voice and quality of life (QoL) outcome measures were likely to be acceptable to patients previously treated for early glottic cancer by either radiotherapy or endoscopic resection, as well as looking for differences in QoL and voice between treatments. Design: Questionnaire‐based cohort study. Setting: Secondary care, three centres. Participants: All patients treated for T1a or in situ glottic carcinoma between 1997 and 2003. Fifty‐three patients were identified; those who had undergone salvage surgery or radiotherapy were excluded. A proportion refused to participate or could not be contacted and two patients had died of unrelated causes. Thirty‐six patients completed the trial with 18 from each treatment arm. Main outcome measures: Quality of voice as assessed by three questionnaires, Voice Handicap Index (VHI), Vocal Performance Questionnaire (VPQ), Voice Symptom Score (VoiSS) and perceptual analysis of voice by Grade, Roughness, Breathiness, Asthenia and Strained (GRBAS) assessment of vocal recordings. Quality of life as assessed by the Hospital Anxiety and Depression Scale (HADS), University of Washington Quality of Life Questionnaire (UW‐QoL), and the Functional Assessment of Cancer Therapy (FACT) questionnaire. Results: All patients included in the trial were able to complete the questionnaires; however, 19% required assistance of some kind. GRBAS assessment showed no difference between groups for any criteria. All QoL questionnaires gave equivalent good scores. All of the voice questionnaires showed no statistical difference between groups except for the emotional subscale of the VoiSS which showed a significantly better score for the radiotherapy arm (P = 0.04). Conclusion: All outcome measures were applicable and acceptable to the patient group. Overall QoL and voice appears similar despite treatment arm, apart from the emotional subscale of the VoiSS. A randomized controlled trial is required to further assess this question.