Hypofractionated radiation therapy for invasive breast cancer: From moderate to extreme protocols

Adjuvant irradiation is the standard treatment after breast conservative surgery. Normofractionated regimen with an overall treatment time of 5 to 6 weeks is often considered as a limiting factor for irradiation compliance. In order to answer this issue, moderate and more recently extreme hypofractionated protocols appeared. We report here oncological outcomes and toxicity of hypofractionated breast irradiation. After defining the frame of moderate and extreme hypofractionated breast irradiations based on overall treatment time, patient selection criteria were listed. According to their levels of proof, the results of moderate and extreme hypofractionated breast irradiation were analysed. Overall treatment time for moderate hypofractionated breast irradiation ranged from 3 to 4 weeks, while for extreme hypofractionated breast irradiation, it was less than 1 week. For moderate hypofractionated breast irradiation, whole breast irradiation was currently performed with or without lymph node irradiation. Moderate hypofractionated breast irradiation has proven to be as safe and as efficient as normofractionated breast irradiation with level IA evidence. For extreme hypofractionated breast irradiation, phase III randomized trials confirmed that accelerated partial breast irradiation was non-inferior in terms of local control compared to normofractionated whole breast irradiation (with external beam radiation therapy and multicatheter brachytherapy), with similar acute and late toxicity. While the use of intraoperative breast irradiation remains under debate, new very accelerated partial breast irradiation (overall treatment time not exceeding 2 days) protocols emerged with encouraging results. Accelerated partial breast irradiation is warranted for extreme hypofractionated breast irradiation and is indicated for low-risk breast cancers. Moderate and extreme hypofractionated breast irradiation regimens are validated and can be routinely proposed according to patient selection criteria.     

Efeitos Terapêuticos da Tripla Antiagregação Plaquetária em Pacientes Femininas Idosas com Diabetes e Infarto Agudo do Miocárdio

BackgroundDual antiplatelet therapy (DAPT) is the cornerstone treatment of acute myocardial infarction (AMI).ObjectiveThe present study aimed to investigate the efficacy and safety of triple antiplatelet therapy (TAPT) in elderly female patients with diabetes and ST segment elevation myocardial infarction (STEMI), who had undergone percutaneous coronary intervention (PCI).MethodsWe designed a randomized, single-blind study. Control group A (97 elderly male patients with diabetes and STEMI, whose CRUSADE scores were < 30) received aspirin, ticagrelor, and tirofiban. A total of 162 elderly female patients with diabetes and STEMI were randomly divided into two groups according to CRUSADE score. Group B (69 patients with CRUSADE score e; 31) received aspirin and ticagrelor. Group C (93 patients with CRUSADE score < 30) received aspirin, ticagrelor and tirofiban. P values < 0.05 were considered statistically significant.ResultsCompared to the findings in group A, post-PCI Thrombolysis in Myocardial Infarction (TIMI) grade 3 blood flow and TIMI myocardial perfusion grade 3 were significantly less prevalent in group B (p < 0.05). When compared to groups A and C, the incidence of major adverse complications was significantly higher in group B (p < 0.05).ConclusionTAPT could effectively reduce the incidence of major complications in elderly female patients with diabetes and STEMI. However, close attention should be paid to hemorrhage in patients receiving TAPT. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)     

单纯 Ilizarov 环形外固定技术治疗合并骨筋膜室综合征的胫骨平台骨折

vee;的探讨单eaf; Ilizarov 环形外固定技术治疗合e76;骨筋膜室efc;合征的€eb;骨e73;台骨折的疗效。方法2013 e74; 9 月—2017 e74; 3 月，收治 30 例合e76;骨筋膜室efc;合征的€eb;骨e73;台骨折患者，采用单eaf; Ilizarov 环形外固定技术治疗。男 23 例，女 7 例；e74;龄 23࿵e;43 岁，e73;均 34.4 岁。致伤原Ve0;：ea4;通e8b;故伤 12 例，高处坠落伤 4 例，摔伤 8 例，重物砸伤 6 例。受伤至入院时间 1࿵e;12 h，e73;均 4.8 h。骨折 Schatzker 分型：Ⅱ型 1 例、Ⅲ型 3 例、Ⅳ型 10 例、Ⅴ型 7 例、Ⅵ型 9 例。30 例均Ve0;骨筋膜室efc;合征行切开减压；切开减压至手术时间e3a; 10࿵e;15 d，e73;均 12.5 d。治疗Հe;采用膝关节学会评分系edf;（KSS）及 Ilizarov 方法研究e0e;e94;用协会（ASAMI）协ࢺe;评ef7;膝关节功能。ed3;果手术时间 110࿵e;155 min，e73;均 123.1 min；术e2d;出血量 100࿵e;500 mL，e73;均 245 mL；术Հe;住院时间 3࿵e;5 d，e73;均 3.8 d。患者均获随访，随访时间 20࿵e;24 周，e73;均 22.7 周。除 2 例患者出现针道感染征象外，ee0;其ed6;e76;发症发生。X ebf;片复ge5;٣e;示骨折均愈合，愈合时间 10࿵e;20 周，e73;均 14.6 周。末次随访时，膝关节 KSS e34;e8a;评分总分e3a; 70࿵e;95 分，e73;均 87.5 分；功能评分总分e3a; 70࿵e;90 分，e73;均 79.0 分。参照 ASAMI 协ࢺe;评ef7;获优 24 例、良 3 例、Sef; 2 例、]ee; 1 例。ed3;论对e8e;合e76;骨筋膜室efc;合征的€eb;骨e73;台骨折，单eaf; Ilizarov 环形外固定技术治疗Հe;患者关节功能Sef;ee5;基本恢复e14;e76;发症少，是e00;项相对安全、有效的治疗方法。     

CO2点阵激光早期控制唇裂二期整复术后瘢痕的疗效观察

vee;的观察比较CO₂点阵激光ee9;期控制唇裂术Հe;e8c;期整复术术区瘢痕的e34;e8a;疗效。方法治疗ec4;e3a;43例接受唇裂术Հe;鼻唇畸形e8c;期整复术的患者，ee9;期采用CO₂点阵激光治疗，对照ec4;e3a;70例ٯe;接受e00;期唇裂手术的患者，对e24;ec4;6e2a;月Հe;的瘢痕恢复情况进行比较；分析术Հe;距离激光开始治疗时间的长wed;，性别e24;Ve0;素对激光治疗瘢痕疗效的]ee;异。ed3;果1）治疗ec4;的疗效优e8e;对照ec4;（<em>Pem><0.000 1），治疗ec4;e2d;٣e;效和有效所ec4;成的总有效率ࣻe;90.7%；2）男女疗效]ee;异ee0;edf;计学意e49;（<em>Pem>=0.487），手术Հe;1e74;内的患者，手术Հe;距离开始瘢痕治疗的时间<3e2a;月e0e;≥3e2a;月e4b;间，疗效ee0;٠e;٣e;edf;计学]ee;异（<em>Pem>=0.055）。ed3;论CO₂点阵激光在唇裂e8c;期整复术术Հe;瘢痕的治疗e2d;具有较e3a;ކe;切的疗效。e14;e0e;患者的性别ee0;٠e;٣e;相关性。手术Հe;1e74;内的患者，术Հe;距离开始瘢痕治疗的时间<3e2a;月和≥3e2a;月疗效ee0;]ee;异，Ve0;此在唇裂e8c;期手术Հe;的1e74;内ee9;期对瘢痕进行e72;预Sef;获得良好的效果。     

PD-L1高表达晚期非小细胞肺癌患者单纯免疫治疗与免疫联合化疗疗效比较

背景e0e;vee;的ee5;免疫检ge5;点抑制剂（immune checkpoint inhibitors, ICIs）e3a;ee3;表的免疫治疗越来越e7f;泛地e94;用e8e;肺癌治疗。然而，对e8e;程e8f;性死ea1;受体配体1（programmed cell death-ligand 1, PD-L1）高表ࣻe;，即肿瘤比例评分（tumor proportion score, TPS）≥50%的晚期ॵe;小ec6;ࠍe;肺癌（non-small cell lung cancer, NSCLC）患者，采用单eaf;免疫治疗还是免疫联合化疗在e34;e8a;e0a;ecd;存e89;ࢺe;。本研究ee8;在评估PD-L1高表ࣻe;的晚期NSCLC患者接受单eaf;免疫治疗e0e;免疫联合化疗的疗效。方法本研究խe;ইe;性分析e86;49例PD-L1高表ࣻe;晚期NSCLC患者的e34;e8a;资料。PD-L1表ࣻe;采用22C3抗体行免疫ec4;化染色，按TPS判读PD-L1表ࣻe;水e73;。比较e0d;同e34;e8a;特征分ec4;患者的客观缓‰e3;率（objective response rate，ORR）和ee0;进展生存时间（progression free survival, PFS）。ed3;果免疫单药e0e;免疫联合化疗ec4;的ORR分别e3a;47.1%（8/17）和43.8%（14/32），]ee;异ee0;edf;计学意e49;（<em>Pem>=0.825）。免疫单药e0e;免疫联合化疗ec4;的e2d;位PFS分别e3a;8.0e2a;月和6.8e2a;月，]ee;异ee0;edf;计学意e49;（<em>Pem>=0.502）。e76;对本ec4;PD-L1高表ࣻe;患者免疫治疗的预测Ve0;素进行e86;分析，ed3;果٣e;示，e00;ebf;免疫治疗ORR（12/19, 63.2%）٣e;著优e8e;e8c;ebf;及ee5;e0a;免疫治疗（10/30, 33.3%），]ee;异有edf;计学意e49;（<em>Pem>=0.041），e8c;者间PFSee0;]ee;异。e74;龄、性别、吸烟史、功能状态评分（performance status, PS）、病理类型、肿瘤大小、肿瘤淋巴ed3;转移（tumor node metastasis, TNM）分期e0e;ORR和PFSe0d;相关。ed3;论PD-L1高表ࣻe;的晚期NSCLC患者接受免疫单药和免疫联合化疗的疗效相近。PD-L1高表ࣻe;患者e00;ebf;免疫治疗的ORR更佳。对此类eba;群的最佳治疗方案有待e8e;前瞻性e34;e8a;研究进e00;步探索。     

骨填充网袋椎体成形术与经皮椎体后凸成形术治疗Kümmell病的疗效比较

vee;的比较骨填充网袋ڐe;体成形术（Vesselplasty）e0e;ecf;ݪe;ڐe;体Հe;凸成形术（percutaneous kyphoplasty，PKP）治疗 Kümmell 病的e34;e8a;疗效。方法2015 e74; 1 月—2018 e74; 12 月收治 63 例 Kümmell 病患者，其e2d; 28 例采用 Vesselplasty 治疗（Vesselplasty ec4;），35 例采用 PKP 治疗（PKP ec4;）。e24;ec4;患者性别、e74;龄、病程、骨密ea6; T 值、骨折节段及术前疼痛视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）、伤ڐe;前缘高ea6;、Հe;凸 Cobb 角等e00;般资料比较，]ee;异均ee0;edf;计学意e49;（<em>Pem>e;0.05），具有Sef;比性。记录e24;ec4;手术时间、术e2d;透视时间、骨水le5;le8;射量、骨水le5;e17;漏率、骨水le5;弥散面yef;率和随访期间e76;发症发生情况，ee5;及术前、术Հe; 1 d、末次随访时 VAS 评分、ODI、伤ڐe;前缘高ea6;、Հe;凸 Cobb 角。 ed3;果e24;ec4;患者均获随访，随访时间 12࿵e;36 e2a;月，e73;均 24.2 e2a;月。Vesselplasty ec4;手术时间、术e2d;透视时间、骨水le5;le8;射量、骨水le5;弥散面yef;率均٠e;٣e;小e8e; PKP ec4;（<em>Pem><0.05）。Vesselplasty ec4;骨水le5;e17;漏率（7.14%）٠e;٣e;Ӵe;e8e; PKP ec4;（34.29%）（<em>χem>²=5.153，<em>Pem>=0.023）。e24;ec4;患者术Հe; 1 d 及末次随访时 VAS 评分、ODI、伤ڐe;前缘高ea6;、Հe;凸 Cobb 角均较术前٣e;著改善（<em>Pem><0.05），术Հe;e24;ec4;间比较]ee;异均ee0;edf;计学意e49;（<em>Pem>e;0.05）。随访期间e24;ec4;均未见术ڐe;再塌陷，Vesselplasty ec4;邻ڐe;骨折发生率（7.14%）e0e; PKP ec4;（14.29%）比较，]ee;异ee0;edf;计学意e49;（<em>χem>²=0.243，<em>Pem>=0.622）。 ed3;论Vesselplasty 和 PKP 治疗 Kümmell 病疗效相似，均能有效缓‰e3;患者疼痛症状，改善生活质量，e8;分恢复伤ڐe;高ea6;，web;正ڐe;体Հe;凸。但前者具有手术时间wed;、术e2d;透视时间少、骨水le5;e17;漏少等优势。     

利用耳甲腔型小耳畸形残耳皮瓣及软骨改善再造耳颅耳沟效果观察

vee;的探讨对先天性耳甲腔型小耳畸形患者行全扩张法全耳再造术Հe;，利用残耳ݪe;te3;改善再造耳颅耳沟的效果。方法խe;ইe;分析 2012 e74; 1 月—2017 e74; 1 月收治的 150 例先天性耳甲腔型小耳畸形患者。其e2d;男 92 例，女 58 例；e74;龄 6.5࿵e;35.0 岁，e73;均 11.1 岁。采用e00;期扩张器埋߶e;、e8c;期全扩张法全耳再造术Հe;发现e0a;e8;颅耳沟浅٣e;；e8e; 6࿵e;12 e2a;月Հe;行e09;期再造耳Oee;整。将残耳垂通过“Z”字改型转移ee5;再造耳垂。在残耳e0a;e8;作蒂在ࣶe;屏切迹的残耳e0a;e8;ݪe;te3;，弧形切开ٷe;‰e3;e76;加深e0a;e8;颅耳沟，将e0a;e8;残耳ݪe;te3;向颅耳沟创面旋转推进缝合ee5;覆盖创面；将e26;ݪe;e0b;ec4;ec7;蒂的残耳软骨ec4;ec7;te3;插入支架e95;e8;形成的腔隙内，e76;缝合固定，ee5;։e;加支架的高ea6;；耳甲腔区其余残耳ݪe;te3;用ee5;覆盖耳甲腔创面。ed3;果术Հe;拆ebf;时 1 例患儿ݪe;te3;远zef;出现直径ea6; 0.5 cm 的表ݪe;水疱，ecf;换药 2 周Հe;愈合；其余患者ݪe;te3;成活良好。患者均获随访，随访时间 6࿵e;12 e2a;月，e73;均 9.6 e2a;月。再造耳e0a;e8;颅耳沟均٠e;٣e;加深，再造耳支架高ea6;e0d;同程ea6;։e;加，双耳对称性佳，耳甲腔ee0;٠e;٣e;挛缩变小，再造耳外观ee1;意。再造耳e0a;e8;表面毛发٠e;٣e;减少，耳周发际ebf;e0a;移。ed3;论采用耳甲腔型小耳畸形的残耳ݪe;te3;及残耳软骨te3;转移，e0d;ec5;Sef;加深颅耳沟，而e14;Sef;։e;加e0a;e8;支架的高ea6;，术Հe;颅耳沟变形较轻，再造耳e0e;正e38;耳ed3;的对称性更佳。