伴有齿槽嵴裂的单侧唇裂术后继发鼻畸形的修复

目的探讨伴有齿槽嵴裂的单侧唇裂术后继发鼻畸形的修复方法。方法对34例伴有齿槽嵴裂的单侧唇裂术后继发畸形的患者,在行齿槽嵴植骨的同时,行彻底的鼻整形手术。结果术后随访1~3年,植骨区成活良好,鼻畸形较整形前明显改善,接近正常外形,效果满意。结论在行齿槽嵴植骨的同时,行彻底的鼻整形手术,能够取得满意的效果,并且节省了医疗费用,缩短了治疗时间。     

Impact of Induction Chemotherapy and Preoperative Chemoradiotherapy on Operative Morbidity and Mortality in Patients with Locoregional Adenocarcinoma of the Stomach or Gastroesophageal Junction

Background Significant tumor downstaging has been achieved in patients with localized gastric or gastroesophageal adenocarcinoma by induction chemotherapy and preoperative chemoradiotherapy (CTX–CTXRT). However, the influence of CTX–CTXRT on operative morbidity and mortality has not yet been clarified. The aim of the present study was to document the frequency and nature of morbidity and mortality after surgery combined with CTX–CTXRT, and identify factors predictive of postoperative complications in patients with localized gastric or gastroesophageal adenocarcinoma. Methods A prospectively collected database on 71 consecutive patients who underwent CTX–CTXRT at M.D. Anderson Cancer Center between January 1997 and August 2004 was reviewed. Postoperative morbidity and mortality were investigated, and risk factors for overall complications were identified by multivariate logistic regression analysis. Results Overall morbidity and mortality rates were 38.0% (27 patients) and 2.8% (2 patients), respectively. Age greater than 60 years [relative risk 11.3 (95% confidence interval 2.50–50.6)] and body mass index (BMI) of 26 kg/m² or above [relative risk 4.08 (95% confidence interval 1.08–15.4)] were significant risk factors for overall complications. Conclusions CTX–CTXRT can be performed safely with an acceptable operative morbidity and a low operative mortality rate in patients with gastric or gastroesophageal cancer, with careful consideration of added risk associated with age and obesity.     

Combined large cell neuroendocrine carcinoma

We report a case of combined large cell neuroendocrine carcinoma. A 78-year-old man with vertigo was referred to our hospital where chest X-ray revealed a tumor shadow in the right lung. A transbronchial lung biopsy specimen verified a diagnosis of non-small cell lung carcinoma (cT1N0M0). Right lower lobectomy with mediastinal lymph node dissection (#7,8,9) was performed. A postoperative histological diagnosis was combined large cell neuroendocrine carcinoma of a component of squamous cell carcinoma [pT4 (pm) N2M0]. The patient received concurrent chemoradiotherapy due to upper mediastinal lymph node metastasis 4 months after surgery. The chemoradiotherapy well responded and the patient remains well 9 months after surgery.     

Persistent extramural vascular invasion positivity on magnetic resonance imaging after neoadjuvant chemoradiotherapy predicts poor outcome in rectal cancer

BackgroundIn rectal cancer, extramural vascular invasion (EMVI) is the presence of tumour cells in blood vessels outside the muscular layer, which is associated with poor prognosis. Regression of EMVI on MRI following neoadjuvant chemoradiotherapy or its persistence may have prognostic implications.MethodsThis retrospective study included 52 patients with rectal cancer who underwent total mesorectal excision following long-course neoadjuvant chemoradiotherapy (CRT). EMVI assessments were done on previous pelvic MRIs obtained before neoadjuvant CRT and eight weeks after the completion of neoadjuvant chemoradiotherapy in initially EMVI positive cases.ResultsPersistently EMVI positive patients had worse overall survival and disease-free survival compared to initially EMVI negative patients and patients who returned to negative (p < 0.001 for both). Multivariate analysis identified persistent EMVI positivity after neoadjuvant treatment (HR, 102.9; p = 0.003) as significant independent predictor of worse overall survival; and persistent EMVI positivity (HR, 17.0; p = 0.002), mesorectal fascia involvement after neoadjuvant treatment (HR, 8.0; p = 0.017), and poor differentiation (HR, 10.3, p = 0.012) as significant independent predictors of worse disease-free survival.ConclusionPersistent EMVI positivity after neoadjuvant therapy appears to be an independent factor for poor overall survival; and persistent EMVI positivity as well as mesorectal fascia involvement on post neoadjuvant therapy MRI and poor differentiation appears to be important predictors of poor disease-free survival in rectal cancer patients.     

进展期低位直肠癌新辅助放化疗后侧方淋巴结清扫的选择和意义

侧方淋巴引流是低位直肠癌3个重要的淋巴引流方向之一。沿引流途径清扫淋巴结是直肠癌根治术基本要求,也决定淋巴结清扫范围。但侧方淋巴结是区域淋巴结还是远处淋巴结,一直存在争议。这带来新辅助放化疗和侧方淋巴结清扫、以及新辅助放化疗对侧方淋巴结转移疗效的争议。笔者综合分析国内外研究进展,对直肠癌侧方淋巴结转移规律、影响侧方淋巴结转移复发危险因素以及放化疗前后MRI检查对侧方淋巴结评估等进行深入阐述,并结合临床实践,探讨进展期低位直肠癌新辅助放化疗后侧方淋巴结清扫的选择和意义。     

Strategies in the treatment of diffuse pontine gliomas: the therapeutic role of hyperfractionated radiotherapy and chemotherapy

This article will review the current treatment of pediatric patients with diffuse pontine gliomas (DPG) and discuss three potential avenues of therapeutic research including (i) radiotherapy (RT) in combination with radiation sensitizers, (ii) dose-intensive, induction chemotherapy with hematopoietic support followed in sequence with RT applied as a consolidation therapy, and (iii) the interleafed application of phase-specific chemotherapeutic agents and hyperfractionated external beam radiotherapy (HFEBRT) referred to as chemoradiotherapy.     

Treatment of oesophageal cancer with preoperative chemoradiotherapy may increase operative mortality

AIMS: This phase II multicentric study evaluates a modified preoperative chemoradiotherapy schedule. METHODS: Patients <75 years with potentially resectable neoplasm were eligible. Treatment included an initial course of CDDP 100 mg/m2 (Day 1) and 5-FU CI 5000 mg/m2 (Days 1-5) followed by 45 Gy (Days 28-63) and 5-FU CI 5000 mg/m2 (Days 28-33), CDDP 75 mg/m2 (Day 56) and 5-FU CI 3750 mg/m2 (Days 56-61). Regional lymph nodes were irradiated. RESULTS: Nineteen patients were studied. Oesophagectomy was performed in 17. Clear margins were achieved in 16 of these. Eight patients showed a pathologic complete response (pCR). One patient died of infection during the preoperative treatment and four died due to acute surgical complications. The study was closed prematurely because of excessive mortality. Median follow-up was 19 months. Local and regional relapse occurred in one and three patients, respectively. Median time and actuarial 3-year of overall survival and progression free rates were 18.6 months and 28%, and 12.7 months and 10.4%, respectively. CONCLUSIONS: This schedule showed a high pCR, resectability and local control rate. Treatment-related mortality limits its clinical applicability, but further investigations are warranted.     

康莱特加同步放化疗治疗局部晚期非小细胞肺癌的临床研究

目的:观察康莱特注射液(KLT)联合同步放化疗对局部晚期非小细胞肺癌的治疗效果。方法:48例局部晚期非小细胞肺癌患者,随机分为两组,综合组25例:采用盖诺 顺铂方案同步放化疗,放疗予常规分割,2Gy/f,总量56～60Gy,同时加用康莱特注射液200ml/d静脉滴入,21天为1个疗程,共2个疗程。对照组23例:采用盖诺 顺铂方案同步放化疗。2疗程后评价疗效,通过KPS评分、体重变化观察生存质量改善情况。结果:两组完全缓解率分别为24.0%(6/25)和13.0%(3/23)(P>0.05);有效率分别为76.0%(19/25)和69.6%(16/23)(P>0.05);综合组3级以上骨髓抑制发生率为40.0%(10/25),而对照组为69.6%(16/23)(P<0.05);综合组3级以上消化道不良反应发生率为8.0%(2/25),对照组为34.8%(8/23)(P<0.05);综合组无3级以上放射性肺炎发生(0/25),而对照组为4.4%(1/23)(P>0.05);综合组3级以上放射性食管炎发生率16.0%(4/25),对照组为43.5%(10/23)(P<0.05);综合组治疗前后KPS评分及体重评分明显高于对照组(P<0.05)。结论:康莱特联合同步放化疗可以减轻放化疗引起的胃肠道反应,减少3级以上骨髓抑制和3级以上放射性食管炎的发生,使患者的生存质量得到改善,并有可能进一步提高局部晚期非小细胞肺癌同步放化疗的疗效。     

不同模式新辅助治疗食管癌的疗效分析

目的 探讨食管癌不同模式新辅助治疗的疗效分析。方法 回顾性分析2015年1月至2022年5月于安阳市肿瘤医院行新辅助治疗的食管鳞癌(ESCC)患者的资料,共纳入542例患者,其中放化疗(NCRT)组137例,化疗(NCT)组241例,免疫加化疗(NICT)组164例;女性198例,男性344例;≤65岁289例,＞65岁253例。首要研究终点包括主要病理缓解(MPR)率、病理完全缓解(pCR) 率,次要研究终点包括总生存(OS)、无进展生存(PFS)和安全性。生存分析采用Kaplan-Meier方法,并采用Log-rank检验进行组间比较。采用Cox比例风险回归模型进行预后因素分析。结果 NCRT组的MPR率和pCR率分别为66.4%(91/137)和35.8%(49/137),NCT组分别为35.3%(85/241)和6.6%(16/241),NICT组分别为63.4%(104/164)和31.1%(51/164)(χ²=1.67, P＜0.001)。NCRT组的1、2、3年的OS分别为89.8%、82.3%、72.3%,NCT组分别为85.9%、71.4%、61.4%,NICT组分别为91.9%、81.5%、77.8%,差异有统计学意义(χ²=9.20,P＜0.01);NCRT组的1、2、3年的PFS分别为81.5%、67.9%、66.6%,NCT组分别75.9%、61.0%、53.5%,NICT组分别为80.1%、65.5%、65.3%,差异有统计学意义(χ²=4.62,P＜0.05)。多因素分析显示,治疗方式、T分期、N分期是OS的独立影响因素(P＜0.05)。3组不良反应及术后并发症差异无统计学意义(P＞0.05)。结论 与NCT对比,NICT与NCRT有更高的pCR、MPR和生存获益,因此新辅助免疫可作为食管癌术前治疗手段之一,但仍需大型的随机对照研究进一步证实。     

影响局部进展期直肠癌新辅助放化疗疗效的临床因素分析

目的:探讨影响局部进展期直肠癌(locally advanced rectal cancer,LARC)患者新辅助放化疗(neoadjuvant chemoradiotherapy,nCRT)的疗效及预后的临床因素。方法:回顾性分析辽宁省肿瘤医院335例接受nCRT后并进行根治性手术的LARC患者的临床资料。通过单因素...