复发性卵巢癌患者放疗联合热疗的临床观察

目的:探讨热疗联合放疗在复发性卵巢癌治疗中的协同增敏作用。方法:68例晚期复发性卵巢癌患者,将其随机分为单纯放疗组(对照组)和热疗联合放疗组(实验组)。两组盆腔三维适形放疗单次剂量为200 c Gy,1次/日,5次/周。实验组在放疗结束后2小时内进行热疗,2次/周,共5周。治疗前及治疗结束后1个月均通过超声及CT检查对两组患者肿瘤体积的变化进行疗效评估,同时观察两组患者治疗后3年的生存情况。结果:近期疗效中发现,实验组11例完全缓解,17例部分缓解,对照组3例完全缓解,15例部分缓解,两组总有效率及完全缓解率差异均有统计学意义(P0.05)。实验组3年总的生存率明显高于对照组,差异有统计学意义(P0.05)。结论:热疗联合放疗可有效的杀灭复发的卵巢恶性肿瘤细胞,可缓解放疗副反应,明显提高患者的生存率。     

放疗联合热疗治疗68例晚期卵巢癌术后复发的放疗联合热疗临床观察

目的:探讨放疗联合热疗治疗晚期卵巢癌术后复发的临床疗效。方法:选择哈医科大学第四临床医院及黑龙江省第二肿瘤医院2010年3月~2013年3月收治的68例卵巢癌术后复发患者(均为术后化疗6-8个疗程盆腔复发),将其随机分为热疗联合放疗组(实验组)和单纯化疗组(对照组)。所有患者均给予化疗6-8个周期以上,实验组在放疗结束后2小时内进行热疗,2次/周,共6-8周。通过影像学检查治疗前后肿瘤体积的变化进行疗效评估,观察两组治疗期间各种不良反应的发生情况及术后3年的生存情况。结果:观察组肿瘤完全缓解率(CR)实验组明显高于对照组(P0.05)。皮肤损伤的发生率显著高于对照组,而白细胞计数下降的发生率明显低于对照组(P0.05)。两组随访1、2年的生存率无明显差异(P0.05),实验组第3年的生存率明显高于对照组(P0.05)。结论:热疗联合放疗可提高晚期卵巢癌术后复发的临床疗效。     

宫颈癌治疗后未控或复发135 例分析

目的：探讨宫颈癌治疗后未控、复发的相关因素。方法：回顾性分析2000年8月至2003年8月山东省肿瘤医院妇瘤科收治的135例治疗后复发或未控的宫颈癌患者的临床病理资料,分析初治时的发病年龄、临床分期、病理类型、肿瘤分化程度、肿瘤生长形态、肿瘤大小以及初治方法和完成情况。结果：发病年龄最小27岁,最大72岁,平均年龄49．9岁,发病年龄≤35y的患者18例（13．1％）;Ⅰ期3例（2．2％）、Ⅱ期52例（38．5％）、Ⅲ期80例60．0％;鳞癌104（75．6％）、腺癌26例（19．3％）、特殊类型7例（5．1％）;高分化14例（10．4％）、中分化88例（53．6％）、低分化33例（24．4％）;糜烂型Ⅱ例（0．7％）、菜花型33例（24．4％）、结节型69例（51．1％）、空洞型27例（20％）、颈管型5例（3．7％）;肿瘤直径≥4cm患者93例（68．9％）;48例患者首选手术治疗,其中外院手术22例、术中有肿瘤残留的10例、术后病理提示具有预后危险因素而未在4周内补充治疗的17例;87例患者放疗为主,其中37例门诊放疗、21例放疗时间超过3个月。结论：宫颈癌治疗后来控、复发的相关因素有临床期别晚、非鳞癌等多种,应争取早期发现、规范治疗采提高疗效。     

磁感应热疗联合放疗对小鼠4T1移植瘤的杀伤作用

目的:探讨磁感应热疗联合放疗在小鼠4T1乳腺癌细胞株皮下移植瘤模型中的治疗作用.方法:小鼠经皮下移植4T1乳腺癌细胞株,建立皮下移植瘤模型,待肿瘤直径达到10mm左右,然后将其分为以下4组进行处理:标准对照组(未做任何特殊处理,C组)、单纯热疗组(48±2℃10min,MIH组)、单纯放疗组(10Gyx2次,R组)、热放联合组(10Gyx1次+48±2℃10min,MIH+R组).观察各治疗组和对照组的肿瘤体积的大小、肿瘤体积抑制率.每组分别在实验处理后24小时处死小鼠应用免疫组化检测肿瘤组织中Bcl-2和Caspase-3的表达情况.结果:热疗后的第1-4周MIH+R组的肿瘤体积抑制率分别为(64.38±17.97)％、(73.90± 9.48)％、(77.43±0.71)％、(73.17±8.58)％;MIH组的分别为(40.66+ 21.46)％、(54.60±10.20)％、(51.22+ 5.05)％、(39.53±5.49)％;R组的肿瘤体积抑制率分别为(51.60±18.93)％、(57.53±9.76)％、(52.34±7.42)％、(35.42±4.14)％.与对照组相比,各治疗组均能抑制肿瘤的生长(P＜0.05).其中以MIH+R组抑瘤作用最显著.与其它组相比,Bcl-2在MIH+R组的表达显著下降,而Caspase-3的表达显著上升,差异具有显著性(P＜0.05).结论:磁感应热疗与放疗均能诱导肿瘤细胞凋亡,有效地抑制小鼠4T1乳腺癌细胞株皮下移植瘤的生长,而磁感应热疗与放疗的联合治疗的抑瘤作用最显著,而且降低了放疗剂量.     

局部刮除肿瘤联合放疗治疗骨巨细胞瘤的临床研究

目的：探讨局部刮除肿瘤联合术中适形固定施源器模型插植放疗和术后外照射治疗骨巨细胞瘤（GCTB）的临床疗效和毒副反应。方法：将2006年2月．2008年2月在湖南省肿瘤医院初次治疗的长骨GCTB患者30例随机分为单纯局部刮除手术组和局部刮除手术联合放疗组,两组患者均行局部肿瘤刮除术,局部刮除手术联合放疗组在此基础上给予术中适形固定施源器模型插植放疗和术后外照射,治疗后比较两组的临床疗效和毒副反应。结果：局部刮除手术联合放疗组1、3、5年均未复发,而单纯局部刮除手术组的1、3、5年复发率分别为9．1％、27．3％、45．5％,3年和5年复发率均显著高于局部刮除手术联合放疗组（P〈0．05）。局部刮除手术联合放疗组中未见严重相关性毒性和死亡,术后两组的关节功能评分比较无明显差剐（P〉0．05）。结论：局部手术刮除病灶结合术中和术后放疗治疗骨巨细胞瘤可显著降低患者的复发率,且不影响关节功能,是一种较为安全的治疗方法。     

CT引导下立体定向射频热凝三叉神经半月节对原发性三叉神经痛的疗效分析

目的：分析CT引导下立体定向射频热凝三叉神经半月节对原发性三叉神经痛的疗效,探讨其临床适用性。方法：选择从2011年5月至2012年12月于我院住院治疗原发性三叉神经痛的58例患者,在三维CT引导下采用通过BrainLAB手术计划系统经前入路卵圆孔穿刺三叉神经半月神经节,术中根据疼痛分布范围射频热凝三叉神经半月节。观察并比较治疗前后的VAS评分,临床疗效,术中和术后不良反应情况。结果：58例患者的穿刺手术均成功,术后1d、3d、6d的VAS评分均较治疗前显著降低（P〈0．01）;1周后58例患者中,有53例患者疼痛完全消失,l例患者偶然出现疼痛,但无需服用药物处理,共显效54例;4例患者疼痛有所减轻或疼痛发作频率降低,但仍需服用药物,或服用药物剂量较治疗前明显减少;疼痛无改善或者非用药不能缓解的持续痛仅1例。总有效例数为57例,总有效率达98．26％。术中发生不良反应6例,在术后均有所缓解。术后发生各种并发症共15例,均未明显影响手术效果。结论：CT引导可以较为准确的进入穿刺部位,使立体定向射频热凝三叉神经半月节手术更加顺利,达到治疗原发性三叉神经痛的理想效果,适合临床长期推广应用。     

三维适形放疗治疗32例食管癌γ-刀放疗后复发的近期疗效分析

目的:研究三维适形放疗治疗32例食管癌γ-刀放疗后复发的可行性,观察其近期疗效与安全性.方法:对32例食管癌γ-刀放疗后复发患者实施三维适形放疗,评价急性放疗反应及近期疗效.结果:28例患者顺利完成放疗计划,初次放疗与再次放疗中位间隔时间7月,再次放疗中位剂量57.6Gy,近期完全缓解率9％,部分缓解率69％,稳定9％,进展13％,总治疗总有效率为78％.患者急性放射性食管炎发生率1-2级16％(5/32),3-4级31％(10/32);急性放射性肺炎发生率1-2级16％(5/32),3-4级9％(3/32);骨髓抑制的发生率为47％,1-2级37.5％(12/32),3-4级9.5％(3/32),急性心脏损伤发生率3％,1-2级3％(1/32),3-4级0％(0/32).结论:三维适形放疗治疗γ-刀放疗后复发食管癌的近期疗效较好,患者可耐受,晚期并发症及疗效有待进一步观察.     

川穹嗪对胸部肿瘤患者TGF-beta1水平的影响及放疗性肺损伤的预防作用

目的：探讨川穹嗪注射液对血浆TGF-beta1 水平的影响及对放射性肺损伤的预防作用。方法：随机选取120 例胸部肿瘤放疗患 者分为观察组与对照组,所有研究对象给予三维适形放射治疗,观察组在放疗期间川芎嗪注射液每日静脉滴注1 次;检测两组放 疗前后血浆TGF-beta1含量变化、放射性肺损伤及肺功能情况。结果：放疗后两组血浆TGF-beta1 均上升,观察组在放疗结束时、放疗 结束后3 月、6 月的血浆TGF-beta1 含量明显低于对照组(P<0.05) (19.12± 5.23) vs(26.69± 5.38)ng/mL、(5.62± 3.48)vs(9.64± 7.82) ng/mL、(3.28± 1.81)vs (7.98± 5.16) ng/mL;观察组放射性肺损伤发生率低于对照组(P<0.05);观察组放疗后三月肺功能指标用力肺 活量(FVC)、第1 秒用力呼气容积(FEV)、肺总量(TLC)、CO弥散量(DLCO)出现明显下降的例数显著低于对照组(P<0.05)。结论：川 芎嗪注射液可以降低放疗肺损伤患者的血浆TGF-beta1 含量,降低放射性肺炎与放射性肺纤维化的发生率,改善肺功能,无明显不 良反应、安全性好,可起到较好的预防放疗后放射性肺损伤的作用。     

吐温80 在深部脏器肿瘤热化疗中的应用研究

目的：研究热增敏剂吐温80在深部肿瘤热化疗中的临床应用疗效。方法：采用吐温80合并热化疗综合治疗晚期肿瘤118例,并与同时期未采用吐温80的热化疗组98例进行比较。膀胱癌复发5例,伴腹水、腹膜转移7例。小剂量化疗用5-FU、丝裂霉素、顺铂等行膀胱灌注或腹腔注射,吐温80浓度为0．2％。肿瘤射频热疗机,f：41MHz。平均随访时间36个月。结果：复发性膀胱癌完全缓解率达60％,血尿消失,3例在12～34月随访期间膀胱镜检查未复发;伴腹水者完全缓解率达85．7％（CR6／7）,中位生存期8．5月,腹痛、腹胀、便血等消失。治疗未引起恶心、呕吐等明显的消化道症状,肝、肾和骨髓功能损害。结论：在肿瘤的热化疗中。合用吐温80不仅可以降低化疗药物的剂量,而且降低热疗时的温度,减少毒副作用,改善症状和体征。     

单球囊双侧扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的效果分析

目的：探讨单球囊双侧扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折的临床疗效。方法：选取择期在我院接受单球囊双侧扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折的52例老年患者的临床资料,对患者的疼痛评分、椎体高度变化情况、术前和术后的后凸cobb角改善情况、术后复发情况等进行分析。结果：全部患者术后随访2-17个月,疼痛均得到缓解,术前VAS评分为8．6,术后VAS评分为2．5,差异具有统计学意义（P〈0．05）;平均椎体前缘高度恢复（56．5％±34％）,中部恢复（60．5％±35．4％）,后缘恢复（40．7％±32-3％）,矢状面排列改善明显（P〈0．05）;与术前相比,手术后患者侧位X片显示Cobb角平均改善10。（P〈0．05）。术后3例发生椎体前缘骨水泥渗漏,但未引起其他并发症;1例发生肋间神经痛,经保守治疗6个月后症状得到缓解。结论：单球囊zt-N扩张椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折效果明显,值得临床推广。     

复发性妇科恶性肿瘤腹腔镜下病灶切除术^125I粒子植入后血清CA125水平变化及临床意义

目的：研究复发性妇科恶性肿瘤腹腔镜下病灶切除术^125I粒子植入后血清CA125水平变化及临床意义。方法：选取2012年4月-2013年4月来我院就诊的40例复发妇科恶性肿瘤患者,平均分为实验组和对照组,每组各20例。实验组20例行腹腔镜下切除病灶并进行^125I粒子植入治疗,对照组20例仅行腹腔镜切除病灶治疗。监测术后6个月内患者血清CA125的变化情况。结果：术后随访的6个月内,实验组的血清CA125水平明显降低,术后3个月降低至正常水平共有14例（75％）;术后随访的6个月内,对照组血清CA125水平降低后逐步升高,术后3个月降低至正常水平共有3例（15％）,两组比较有统计学意义（P〈0．05）;同时实验组的2a肿瘤生存率为20％,对照组为80％,两组比较有统计学意义（P〈0．05）。结论：复发性妇科恶性肿瘤腹腔镜下病灶切除术125I粒子植入后血清CA125水平显著降低,该法是评估肿瘤治疗疗效的有效方法。     

同步放化疗联合深部热疗治疗中晚期宫颈癌的临床疗效观察

目的观察放化疗联合深部热疗治疗中晚期宫颈癌的临床疗效及不良反应。方法选取本院收治的Ⅱb—Ⅲb期宫颈癌患者70例,分为同步放化疗联合深部热疗组（试验组）和同步放化疗组（对照组）,对照组进行根治性放射治疗,放疗第1天开始行化疗,顺铂40mg静脉滴注1d,化疗6个周期,每周重复。试验组：放化疗方法同对照组,于化疗当天行盆腹腔深部热疗（HG-2000体外高频热疗机）,每次热疗60min,每周1次,共4次。于热疗后1h内行放射治疗。结果两组局部肿瘤消退情况、近期疗效、肿瘤局部控制情况、1年期无瘤生存情况比较,差异有统计（P〈0．05）。两组不良反应比较无统计差异。结论同步放化疗联合深部热疗可以提高患者近期疗效,且无严重的并发症,是中晚期宫颈癌治疗中的一种安全有效的模式,值得进一步研究。     

脑转移瘤局部推量的临床观察

目的：观察脑转移瘤放射治疗局部推量的疗效。方法：回顾性分析63例进行放射治疗脑转移瘤病人,采用6MeV-X线,两侧平行相对野作全脑照射,临床靶体积（CTV）包括肿瘤靶体积（GTV）及周围水肿区,处方剂量为30-40Gy,分割次数为10-20次。其中27例缩野后局部推量20Gy。分析常规处方剂量后进行局部推量与未进行局部推量的两个组别局部区域复发率（LRR）、总生存率（OS）和KPS评分改变的差别。结果：中位随访6个月。局部推量组和未局部推量组的LRR分别为18.5%（5/27）和27.8%（10/36）;局部推量组和未局部推量组的OS分别为85.2%（23/27）和77.8%（28/36）;局部推量组和未局部推量组的KPS〉=70分别为18和19。结论：脑转移瘤常规处方剂量放疗后进行局部推量对脑转移瘤的局部控制率及KPS评分有益。     

INDICATIONS FOR OPERATION IN LARYNGEAL CANCER

Improvements in the surgical treatment of laryngeal cancer by combined laryngectomy and radical neck dissection have given new importance to selection of the mode of treatment for various stages of disease at that site. To cast light on the subject, the cases of 63 patients with cancer of the larynx were reviewed. Twenty-one of them were operated on for recurrence after radiation therapy; and 42 were treated surgically at the outset, 36 of them having combined laryngectomy and radical neck dissection. In almost 80 per cent of the patients the lesion was extrinsic.In the entire series, 51 patients had combined operations, and in 41 of them the cervical lymph nodes were positive for metastasis.Reports in the literature also make note of a very high incidence of cervical node metastasis not only in cases of extrinsic cancer, but also in those in which the lesion is intrinsic.Because of the frequency of cervical node spread, and its occult nature, choice between radiation and surgical operation must be made after candid, critical appraisal of the individual condition in each patient.     

Chitosan-DTPA-Gd舌间质磁共振淋巴造影显示兔颈淋巴的研究

目的：探讨磁共振间质淋巴造影剂Chitosan-DTPA-Gd经舌黏膜下注射后,显示颈淋巴的应用价值。方法：选取健康成年纯种新西兰大白兔12只,麻醉并仰卧位固定磁共振平扫,再于每只兔双侧舌缘中后交界处粘膜下各注射0.1 mL造影剂,注射部位按摩30秒,按摩后5、10、15、20、25、30、35、40 min行三维增强磁共振淋巴造影成像,测量增强前后不同时间颈部淋巴结的信号强度（SI）,计算相对应的信号强化率（E%）,采用SPSS软件进行数据的统计学分析。结果：Chitosan-DTPA-Gd于兔双侧舌缘粘膜下注射后很快吸收进入颈部淋巴引流区,淋巴结及淋巴管明显、均匀的强化,血管无显影。颈部淋巴结于注射后15 min信号强度达到峰值,并可保持一段时间,25 min后信号强化率开始明显降低,40分钟后淋巴系统显影与周围组织无差别。结论：间质磁共振淋巴造影剂Chitosan-DTPA-Gd用量小,强化效应明显,能够有效的显示颈部淋巴结形态及淋巴管走形。     

3D radiation therapy or intensity-modulated radiotherapy for recurrent and metastatic cervical cancer: the Shanghai Cancer Hospital experience

We evaluate the outcomes of irradiation by using three-dimensional radiation therapy (3D-RT) or intensity-modulated radiotherapy (IMRT) for recurrent and metastatic cervical cancer. Between 2007 and 2010, 50 patients with recurrent and metastatic cervical cancer were treated using 3D-RT or IMRT. The median time interval between the initial treatment and the start of irradiation was 12 (6-51) months. Salvage surgery was performed before irradiation in 5 patients, and 38 patients received concurrent chemotherapy. Sixteen patients underwent 3D-RT, and 34 patients received IMRT. Median follow-up for all the patients was 18.3 months. Three-year overall survival and locoregional control were 56.1% and 59.7%, respectively. Three-year progression-free survival and disease-free survival were 65.3% and 64.3%, respectively. Nine patients developed grade 3 leukopenia. Grade 5 acute toxicity was not observed in any of the patients; however, 2 patients developed Grade 3 late toxicity. 3D-RT or IMRT is effective for the treatment of recurrent and metastatic cervical cancer, with the 3-year overall survival of 56.1%, and its complications are acceptable. Long-term follow-up and further studies are needed to confirm the role of 3D-RT or IMRT in the multimodality management of the disease.     

Prevention of recurrence and prolonged survival in primary central nervous system lymphoma (PCNSL) patients treated with adjuvant high-dose methylprednisolone

Five patients at risk for primary central nervous system lymphoma (PCNSL) recurrence were treated with high-dose methylprednisolone, (HDMP) to prevent ‘trafficking’ of malignant lymphocytes into the central nervous system (CNS). HDMP was chosen because of its ability to stabilize the ‘blood brain barrier (BBB)’. Three men with newly diagnosed PCNSL, ages 62, 76 and 78 y, whose survival was projected to be 6.6 months, began treatment after achieving complete response (CR) to initial radiation therapy alone and survived 27, 37 and 59 months after treatment. In none was death from recurrent disease in CNS but one patient did die of systemic non-Hodgkin’s lymphoma (NHL) five years after PCNSL diagnosis. A 20 y old man was treated with HDMP after successful combined modality therapy and is alive 75+months after initial diagnosis without evidence of disease recurrence. A 34 y old man relapsed after combined modality initial treatment and failed to respond to HDMP when treatment was begun after unsuccessful salvage therapy; he died of disease 12 months after initial diagnosis. There were no treatment complications. The promising results in this pilot study from the basis for a North Central Cancer Treatment Group (NCCTG) 96-73-51, a Phase 2 clinical trial of brain radiotherapy and HDMP for PCNSL patients 70 y of age and older, a group of patients at high risk for toxicity from intensive combined modality therapy.     

消糜栓联合波姆仪治疗宫颈糜烂的疗效观察

目的探讨消糜栓联合波姆光治疗宫颈糜烂的疗效。方法90例病例随机分为单纯波姆光照射组（对照组）和波姆光联合消糜栓治疗组（治疗组）,每组各45例。对照组单纯用波姆光照射。治疗组术前每晚阴道置消糜栓1枚,共用7d,月经干净3～7d后用波姆光治疗,再用药14d结果对照组阴道内分泌物异常持续天数为24.5d,显著长于治疗组的15.5d（P〈0.01）,且前者伴有明显的腥臭味。术后1个疗程内对照组1次治愈39例（86.7%）,治疗组治愈45例（100%）,治疗组明显优于对照组（P〈0.05）。结论采用波姆光联合消糜栓治疗宫颈糜烂效果显著,能明显地改善单纯波姆光照射治疗后阴道分泌物异常,缩短持续时间,提高治愈率。     

Analysis of the efficacy,safety and survival factors of stereotactic body radiation therapy in patients with recurrence of pancreatic cancer

Objective: This study aims to evaluate the efficacy and safety of stereotactic body radiation therapy (SBRT) using Cyber Knife (CK) in the treatment of patients with recurrent pancreatic cancer after surgery, and analyze its survival-related factors. Methods: The primary endpoint was freedom from local progression (FFLP) and local control (LC) rate after CK. The secondary endpoints were overall survival (OS), progression-free survival (PFS), symptom relief and toxicities. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off values of inflammatory composite indicators NLR, PLR, SII and PNI. The prognostic factors that affected these patients were analyzed by univariate and multivariate analysis, respectively. Results: A total of 27 patients were enrolled. Median local recurrence disease free interval（DFI）was 11.3 (1.3-30.6) months, LC was 81.5% and 37.0% at 6 and 12 months, respectively. Median PFS was 7.1 (1.3-27.1) months. Median OS was 11.3 (1.3-30.6) months. Symptom alleviation was observed in 16 of 17 patients (94.1%) within 2 weeks after CK. Subsequent chemotherapy, CA199≥50% decrease after CK were independent prognostic factors for OS (all P <0.05). Conclusion: SBRT is a safe and effective treatment approach for recurrent pancreatic adenocarcinoma. Encouraging local control rate, low toxicity, and effective symptom relief suggests the vital role of CK in the treatment of these patients. This clinical application needs to be further studied in the combination of CK and multimodal therapy.     

Clinical management of patients with invasive cervical cancer following a negative Pap smear

Among 535 patients with invasive cervical carcinoma seen between January 1975 and June 1986, 26 were found to have developed the disease within six months (65 percent), 35 within 12 months (88 percent), 37 within 13 months (93 percent), and three developed the disease within 17 months after a negative Pap smear. Eighty-eight percent of these 40 patients were under age 40 at diagnosis. Rapidly progressive cancers are highly resistant to radiation therapy. Seven stage IB patients treated only with radiation died within nine to 29 months after initial therapy. By contrast, 15 patients treated by radical hysterectomy and four by radical hysterectomy and post-surgical radiation were alive with no evidence of disease from six to 109 months after surgery (median, 30 months). Six of nine patients with stage II to IV disease treated with radiation have died; the remaining three are alive. One patient is well 14 months after therapy, but two others have developed metastases seven and 12 months after treatment. Surprisingly, 37 of 40 patients had symptoms of pain, bleeding, and discharge at the initial diagnosis, but their physicians had a false sense of security because of a recent negative Pap smear. Early biopsy diagnosis and radical hysterectomy with bilateral pelvic lymphadenectomy is the most effective management for this cancer.